In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
Chinese medicine （CM） is the most typical conventional therapy compared with any other traditional or alternative medicine systems. The active components of CMs are either primary or secondary metabolites generated ...Chinese medicine （CM） is the most typical conventional therapy compared with any other traditional or alternative medicine systems. The active components of CMs are either primary or secondary metabolites generated by metabolic and biosynthetic enzymes in plants, protecting the plants from environmental stress. The characteristics of these metabolites are diverse, complicated and unique. In this paper, current approaches for quality assessment were extensively reviewed, a new concept of quality marker （Q-marker） was then proposed for CM quality assessment. Additionally, definition of the Q-marker, as well as the relevant methods, were discussed, on the basis of the biosynthetic pathways of secondary metabolites and source of biological active components. Study design of Q-marker is complex system for quality assessment and production process control of CM products with transitivity and traceability. Therefore, the system with characteristics of transmission and traceability is expected to be established for regulation of quality. Upon the concept which the transitivity and traceability in the quality assessment and production process control covered the entire process, such as raw materials, decoction slices, processing, extraction and production can be further enhanced. The transitivity and traceability will inevitably require close attention to ＂who, what, where, when, and why＂ details at each stage of Q-markers of CM production form raw materials to patent product. The establishing quality standards are enablers of many and various transitivity and traceability solutions, not a solution in them. It means that the transitivity and traceability system is readily link between products and across borders in quality. According to the thinking mode and methods of investigation on quality assessment of CM product, we focus on the entire process, in terms of safety and effectiveness and quality control. The standard preparation of CM or CM decoction is not only the basis for study of Q-marker, but also the展开更多
AIM:To compare intensity-modulated radiotherapy (IMRT) with conformal radiotherapy (CRT) by investigating the dose profiles of primary tumors,electively treated regions,and the doses to organs at risk. METHODS:CRT and...AIM:To compare intensity-modulated radiotherapy (IMRT) with conformal radiotherapy (CRT) by investigating the dose profiles of primary tumors,electively treated regions,and the doses to organs at risk. METHODS:CRT and IMRT plans were designed for five patients with upper esophageal carcinoma.For each patient, target volumes for primary lesions (67.2 Gy) and electively treated regions (50.4 Gy) were predefined.An experienced planner manually designed one CRT plan.Four IMRT plans were generated with the same dose-volume constraints,but with different beam arrangements.Indices including dose distributions,dose volume histograms (DVHs) and conformity index were compared. RESULTS:The plans with three intensity-modulated beams were discarded because the doses to spinal cord were lager than the tolerable dose 45Gy,and the dose on areas near the skin was up to 50Gy.When the number of intensity beams increased to five,IMRT plans were better than CRT plans in terms of the dose conformity and homogeneity of targets and the dose to OARs.The dose distributions changed little when the beam number increased from five to seven and nine. CONCLUSION:IMRT is superior to CRT for the treatment of upper esophageal carcinoma with simultaneous integrated boost (SIB).Five equispaced coplanar intensity-modulated beams can produce desirable dose distributions.The primary tumor can get higher equivalent dose by SIB technique. The SIB-IMRT technique shortens the total treatment time, and is an easier,more efficient,and perhaps a less error- prone way in delivering IMRT.展开更多
AIM: To analyze the correlation between cytokineinduced killer (CIK) cells adoptive immunotherapy and cancer-related death in gastric cancer patients. METHODS: One hundred and fifty-six gastric cancer patients after o...AIM: To analyze the correlation between cytokineinduced killer (CIK) cells adoptive immunotherapy and cancer-related death in gastric cancer patients. METHODS: One hundred and fifty-six gastric cancer patients after operation at the Third Affiliated Hospital of Soochow University were enrolled in this study. Their clinical data including demographic characteristics, operation time, tumor size, pathological type and staging, tumor metastasis, outcome of chemotherapy or CIK cells adoptive immunotherapy, survival time or time of death were collected with a standard structured questionnaire. Kaplan-Meier method was used to estimate the median survival time, and the 2- and 5- year survival rates. Hazard risk (HR) and 95% confidence interval (95% CI) of CIK cells adoptive immunotherapy for gastric cancer were calculated using the two-stage time-dependent covariates Cox model. RESULTS: The survival time of gastric cancer patients was longer after CIK cells adoptive immunotherapy than after chemotherapy (χ 2 = 10.907, P = 0.001). The median survival time of gastric cancer patients was also longer after CIK cells adoptive immunotherapy than after chemotherapy (49 mo vs 27 mo, P < 0.05). The 2- and 5-year survival rates of gastric cancer patients were significantly higher after CIK cells adoptive immunotherapy than after chemotherapy (73.5% vs 52.6%, 40.4% vs 23.9%, P < 0.05). A significant difference was observed in the survival curve for patients who received CIK cells adoptive immunotherapy (0, 1-10, 11-25, and over 25 frequencies) (χ 2 = 14.534, P = 0.002). The frequencies of CIK cells adoptive immunotherapy were significantly related with the decreasing risk of death in gastric cancer patients after adjustment for sex and age of the patients, tumor stage and relapse (HR = 0.54, 95% CI: 0.36-0.80) when the first stage Cox model was used to define the subjects who remained alive beyond 36 mo as survivors. However, no correlation was observed between the frequencies of death in CIK cells adoptive immunotherapy and the 展开更多
Background： Atopic dermatitis （AD） is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several ...Background： Atopic dermatitis （AD） is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczemaJAD and to propose Chinese diagnostic criteria for adult/adolescent AD. Methods： A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients （12 years and over） with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and-investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software. Results： A total of 2662 valid questionnaires were collected （1369 male and 1293 female）. Of all 2662 patients, 2062 （77.5%） patients had the disease after 12 years old, while only 600 （22.5%） patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine （80.4%） patients had the disease for more than 6 months. One thousand one hundred and forty-four （43.0%） patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight （58.2%） patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients. Conclusion： Late-onset of eczema or AD is common. Th展开更多
AIM: To investigate the mechanism underlying intestinalbarrier function damage after severe trauma and thetherapeutic effect of glutamine.METHODS: Burned patients, and animal models of severstrauma replicated by hemor...AIM: To investigate the mechanism underlying intestinalbarrier function damage after severe trauma and thetherapeutic effect of glutamine.METHODS: Burned patients, and animal models of severstrauma replicated by hemorrhagic shock combined withendotoxin infusion and burn injury, were included in a serialexperiment. Effects of oral glutamine on intestinal barrierfunction were observed in scalded rets. Parametersmeasured in these experiments were as follows: plasmalevels of diamine oxidase (DAO), tumor necrosis factor(TNFα), endotoxin (LPS), and lactate as well as D-lactateby biochemical methods, lactose/mannitol (L/M) ratio inurine by SP-3400, and pathological examination of intestinalmucosa under light microscopy.RESULTS: Plasma DAO activity was significantly increasedafter injury. There was a negative correlation betweenplasma DAO and intestinal mucosal DAO or pHi ( r= -0.93,plasma 0.80 ± 0.93,2.83 ± 1.71, 1.14 ± 0.64,2.36 ± 2.06 and2.49± 1.67 vs intestinal 0.52± 0.12,0.34 ± 0.03,0.45 ± 0.18,0.37± 0.26 and 0.41 ± 0.07; r = - 0.533, plasma 0.87 ± 0.75,1.89± 1.13, 1.21 ± 0.23,3.03 ± 2.61 and 4.70 ± 1.22 Vs pHi7.03± 0.05,7.05 ± 0.06,7.14 ± 0.096,7.20 ± 0.08 and 7.05 ±0.07; P ＜ 0.01-0.05). Positive correlations were foundbetween DAO activity and plasma TNFα, LPS, lactate, L/Mand D-lactate ( r = 0.817, 0.842, 0.872, and 0.951; plasmaDAO 0.87 ± 0.75,1.89 ± 1.13, 1.21 ± 0.23,3.03 ± 2.61 and 4.70± 1.22 vs TNF 0.08 ± 0.02,0.03 ± 0.25,0.17 ± 0.09,0.34 ± 0.15and 0.33 ± 0.18; vs LPS 0.14 ± 0.03,0.16 ± 0.04,0.21 ± 0.02,0.18± 0.16 and 0.37 ± 0.10; vs lactate 9.03 ± 2.19, 18.30 ±2.56,9.81 ± 2.83,12.01 ± 6.83, 12.01 ± 6.84 and 43.61 ± 11.27;vs L/M 0.03 ± 0.01,0.41 ± 0.27,0.62 ± 0.20, 1.70 ± 0.60; r =0.774, plasma DAO 1.25 ± 0.41,2.17 ± 0.71,2.29 ± 0.87, 1.23± 0.55 and 1.11 ± 0.47 vs D-lactate 8.37 ± 2.48, 18.25 ± 6.18,13.96 ± 4.94, 8.93 ± 3.00 and 12.39 ± 4.94; all P ＜ 0.01),repestively. Damage of intestinal mucosa was found bypathological examination. Intestinal barri展开更多
Background:A patient’s infectivity is determined by the presence of the virus in different body fluids,secretions,and excreta.The persistence and clearance of viral RNA from different specimens of patients with 2019 ...Background:A patient’s infectivity is determined by the presence of the virus in different body fluids,secretions,and excreta.The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease(COVID-19)remain unclear.This study analyzed the clearance time and factors influencing 2019 novel coronavirus(2019-nCoV)RNA in different samples from patients with COVID-19,providing further evidence to improve the management of patients during convalescence.Methods:The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20,2020 to February 10,2020 were collected retrospectively.The reverse transcription polymerase chain reaction(RT-PCR)results for patients’oropharyngeal swab,stool,urine,and serum samples were collected and analyzed.Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive(minimum 24 h sampling interval)negative RT-PCR results for viral RNA from oropharyngeal swabs.The effects of cluster of differentiation 4(CD4)+T lymphocytes,inflammatory indicators,and glucocorticoid treatment on viral nucleic acid clearance were analyzed.Results:In the 292 confirmed cases,66 patients recovered after treatment and were included in our study.In total,28(42.4%)women and 38 men(57.6%)with a median age of 44.0(34.0-62.0)years were analyzed.After in-hospital treatment,patients’inflammatory indicators decreased with improved clinical condition.The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5(6.0-11.0)days.By February 10,2020,11 convalescent patients(16.7%)still tested positive for viral RNA from stool specimens and the other 55 patients’stool specimens were negative for 2019-nCoV following a median duration of 11.0(9.0-16.0)days after symptom onset.Among these 55 patients,43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs,with 展开更多
Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in ...Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in China.Among the confirmed cases,1527 were severe cases,171 had recovered and been discharged at home,and 213 died.And among these cases,a total of 28 children aged from 1 month to 17 years have been reported in China.For standardizing prevention and management of 2019-nCoV infections in children,we called up an experts' committee to formulate this experts' consensus statement.This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections.The present consensus statement summarizes current strategies on diagnosis,treatment,and prevention of 2019-nCoV infection in children.展开更多
AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori pos...AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.展开更多
AIM: To investigate the effects and molecular mechanisms of berberine on improving insulin resistance induced by free fatty acids (FFAs) in 3T3-L1 adipocytes. METHODS: The model of insulin resistance in 3T3-L1 adipocy...AIM: To investigate the effects and molecular mechanisms of berberine on improving insulin resistance induced by free fatty acids (FFAs) in 3T3-L1 adipocytes. METHODS: The model of insulin resistance in 3T3-L1 adipocytes was established by adding palmic acid (0.5 mmol/L) to the culture medium. Berberine treatment was performed at the same time. Glucose uptake rate was determined by the 2-deoxy-[3H]-D-glucose method. The levels of IkB kinase beta (IKKβ) Ser181 phosphorylation, insulin receptor substrate-1(IRS-1) Ser307 phosphorylation, expression of IKKβ, IRS-1, nuclear transcription factor kappaB p65 (NF-κB p65), phosphatidylinositol-3-kinase p85 (PI-3K p85) and glucose transporter 4 (GLUT4) proteins were detected by Western blotting. The distribution of NF-κB p65 proteins inside the adipocytes was observed through confocal laser scanning microscopy (CLSM). RESULTS: After the intervention of palmic acid for 24 h, the insulin-stimulated glucose transport in 3T3-L1 adipocytes was inhibited by 67%. Meanwhile, the expression of IRS-1 and PI-3K p85 protein was reduced, while the levels of IKKβ Ser181 and IRS-1 Ser307 phosphorylation, and nuclear translocation of NF-κB p65 protein were increased. However, the above indexes, which indicated the existence of insulin resistance, were reversed by berberine although the expression of GLUT4, IKKβ and total NF-κB p65 protein were not changed during this study. CONCLUSION: Insulin resistance induced by FFAs in 3T3-L1 adipocytes can be improved by berberine. Berberine reversed free-fatty-acid-induced insulin resistance in 3T3-L1 adipocytes through targeting IKKβ.展开更多
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
基金National Natural Science Fundantion of China(No.81430096)
文摘Chinese medicine （CM） is the most typical conventional therapy compared with any other traditional or alternative medicine systems. The active components of CMs are either primary or secondary metabolites generated by metabolic and biosynthetic enzymes in plants, protecting the plants from environmental stress. The characteristics of these metabolites are diverse, complicated and unique. In this paper, current approaches for quality assessment were extensively reviewed, a new concept of quality marker （Q-marker） was then proposed for CM quality assessment. Additionally, definition of the Q-marker, as well as the relevant methods, were discussed, on the basis of the biosynthetic pathways of secondary metabolites and source of biological active components. Study design of Q-marker is complex system for quality assessment and production process control of CM products with transitivity and traceability. Therefore, the system with characteristics of transmission and traceability is expected to be established for regulation of quality. Upon the concept which the transitivity and traceability in the quality assessment and production process control covered the entire process, such as raw materials, decoction slices, processing, extraction and production can be further enhanced. The transitivity and traceability will inevitably require close attention to ＂who, what, where, when, and why＂ details at each stage of Q-markers of CM production form raw materials to patent product. The establishing quality standards are enablers of many and various transitivity and traceability solutions, not a solution in them. It means that the transitivity and traceability system is readily link between products and across borders in quality. According to the thinking mode and methods of investigation on quality assessment of CM product, we focus on the entire process, in terms of safety and effectiveness and quality control. The standard preparation of CM or CM decoction is not only the basis for study of Q-marker, but also the
文摘AIM:To compare intensity-modulated radiotherapy (IMRT) with conformal radiotherapy (CRT) by investigating the dose profiles of primary tumors,electively treated regions,and the doses to organs at risk. METHODS:CRT and IMRT plans were designed for five patients with upper esophageal carcinoma.For each patient, target volumes for primary lesions (67.2 Gy) and electively treated regions (50.4 Gy) were predefined.An experienced planner manually designed one CRT plan.Four IMRT plans were generated with the same dose-volume constraints,but with different beam arrangements.Indices including dose distributions,dose volume histograms (DVHs) and conformity index were compared. RESULTS:The plans with three intensity-modulated beams were discarded because the doses to spinal cord were lager than the tolerable dose 45Gy,and the dose on areas near the skin was up to 50Gy.When the number of intensity beams increased to five,IMRT plans were better than CRT plans in terms of the dose conformity and homogeneity of targets and the dose to OARs.The dose distributions changed little when the beam number increased from five to seven and nine. CONCLUSION:IMRT is superior to CRT for the treatment of upper esophageal carcinoma with simultaneous integrated boost (SIB).Five equispaced coplanar intensity-modulated beams can produce desirable dose distributions.The primary tumor can get higher equivalent dose by SIB technique. The SIB-IMRT technique shortens the total treatment time, and is an easier,more efficient,and perhaps a less error- prone way in delivering IMRT.
基金Supported by The National Natural Science Foundation of China, No. 30872176, 30950022 and 30972703grants of Jiangsu Province and Soochow University Medical Development Foundation, No. EE126765
文摘AIM: To analyze the correlation between cytokineinduced killer (CIK) cells adoptive immunotherapy and cancer-related death in gastric cancer patients. METHODS: One hundred and fifty-six gastric cancer patients after operation at the Third Affiliated Hospital of Soochow University were enrolled in this study. Their clinical data including demographic characteristics, operation time, tumor size, pathological type and staging, tumor metastasis, outcome of chemotherapy or CIK cells adoptive immunotherapy, survival time or time of death were collected with a standard structured questionnaire. Kaplan-Meier method was used to estimate the median survival time, and the 2- and 5- year survival rates. Hazard risk (HR) and 95% confidence interval (95% CI) of CIK cells adoptive immunotherapy for gastric cancer were calculated using the two-stage time-dependent covariates Cox model. RESULTS: The survival time of gastric cancer patients was longer after CIK cells adoptive immunotherapy than after chemotherapy (χ 2 = 10.907, P = 0.001). The median survival time of gastric cancer patients was also longer after CIK cells adoptive immunotherapy than after chemotherapy (49 mo vs 27 mo, P < 0.05). The 2- and 5-year survival rates of gastric cancer patients were significantly higher after CIK cells adoptive immunotherapy than after chemotherapy (73.5% vs 52.6%, 40.4% vs 23.9%, P < 0.05). A significant difference was observed in the survival curve for patients who received CIK cells adoptive immunotherapy (0, 1-10, 11-25, and over 25 frequencies) (χ 2 = 14.534, P = 0.002). The frequencies of CIK cells adoptive immunotherapy were significantly related with the decreasing risk of death in gastric cancer patients after adjustment for sex and age of the patients, tumor stage and relapse (HR = 0.54, 95% CI: 0.36-0.80) when the first stage Cox model was used to define the subjects who remained alive beyond 36 mo as survivors. However, no correlation was observed between the frequencies of death in CIK cells adoptive immunotherapy and the
文摘Background： Atopic dermatitis （AD） is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczemaJAD and to propose Chinese diagnostic criteria for adult/adolescent AD. Methods： A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients （12 years and over） with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and-investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software. Results： A total of 2662 valid questionnaires were collected （1369 male and 1293 female）. Of all 2662 patients, 2062 （77.5%） patients had the disease after 12 years old, while only 600 （22.5%） patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine （80.4%） patients had the disease for more than 6 months. One thousand one hundred and forty-four （43.0%） patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight （58.2%） patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients. Conclusion： Late-onset of eczema or AD is common. Th
基金the Key Project of the"Tenth Five-Year Plan"of the Chinese PLA(01L081)
文摘AIM: To investigate the mechanism underlying intestinalbarrier function damage after severe trauma and thetherapeutic effect of glutamine.METHODS: Burned patients, and animal models of severstrauma replicated by hemorrhagic shock combined withendotoxin infusion and burn injury, were included in a serialexperiment. Effects of oral glutamine on intestinal barrierfunction were observed in scalded rets. Parametersmeasured in these experiments were as follows: plasmalevels of diamine oxidase (DAO), tumor necrosis factor(TNFα), endotoxin (LPS), and lactate as well as D-lactateby biochemical methods, lactose/mannitol (L/M) ratio inurine by SP-3400, and pathological examination of intestinalmucosa under light microscopy.RESULTS: Plasma DAO activity was significantly increasedafter injury. There was a negative correlation betweenplasma DAO and intestinal mucosal DAO or pHi ( r= -0.93,plasma 0.80 ± 0.93,2.83 ± 1.71, 1.14 ± 0.64,2.36 ± 2.06 and2.49± 1.67 vs intestinal 0.52± 0.12,0.34 ± 0.03,0.45 ± 0.18,0.37± 0.26 and 0.41 ± 0.07; r = - 0.533, plasma 0.87 ± 0.75,1.89± 1.13, 1.21 ± 0.23,3.03 ± 2.61 and 4.70 ± 1.22 Vs pHi7.03± 0.05,7.05 ± 0.06,7.14 ± 0.096,7.20 ± 0.08 and 7.05 ±0.07; P ＜ 0.01-0.05). Positive correlations were foundbetween DAO activity and plasma TNFα, LPS, lactate, L/Mand D-lactate ( r = 0.817, 0.842, 0.872, and 0.951; plasmaDAO 0.87 ± 0.75,1.89 ± 1.13, 1.21 ± 0.23,3.03 ± 2.61 and 4.70± 1.22 vs TNF 0.08 ± 0.02,0.03 ± 0.25,0.17 ± 0.09,0.34 ± 0.15and 0.33 ± 0.18; vs LPS 0.14 ± 0.03,0.16 ± 0.04,0.21 ± 0.02,0.18± 0.16 and 0.37 ± 0.10; vs lactate 9.03 ± 2.19, 18.30 ±2.56,9.81 ± 2.83,12.01 ± 6.83, 12.01 ± 6.84 and 43.61 ± 11.27;vs L/M 0.03 ± 0.01,0.41 ± 0.27,0.62 ± 0.20, 1.70 ± 0.60; r =0.774, plasma DAO 1.25 ± 0.41,2.17 ± 0.71,2.29 ± 0.87, 1.23± 0.55 and 1.11 ± 0.47 vs D-lactate 8.37 ± 2.48, 18.25 ± 6.18,13.96 ± 4.94, 8.93 ± 3.00 and 12.39 ± 4.94; all P ＜ 0.01),repestively. Damage of intestinal mucosa was found bypathological examination. Intestinal barri
基金The work was supported by grants from the First-class university and first-class discipline building project of the Fudan University(No.IDF162005)the Scientific research for special subjects on 2019 novel coronavirus(No.2019-nCoV)the Shanghai Public Health Clinical Center(No.2020YJKY01)。
文摘Background:A patient’s infectivity is determined by the presence of the virus in different body fluids,secretions,and excreta.The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease(COVID-19)remain unclear.This study analyzed the clearance time and factors influencing 2019 novel coronavirus(2019-nCoV)RNA in different samples from patients with COVID-19,providing further evidence to improve the management of patients during convalescence.Methods:The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20,2020 to February 10,2020 were collected retrospectively.The reverse transcription polymerase chain reaction(RT-PCR)results for patients’oropharyngeal swab,stool,urine,and serum samples were collected and analyzed.Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive(minimum 24 h sampling interval)negative RT-PCR results for viral RNA from oropharyngeal swabs.The effects of cluster of differentiation 4(CD4)+T lymphocytes,inflammatory indicators,and glucocorticoid treatment on viral nucleic acid clearance were analyzed.Results:In the 292 confirmed cases,66 patients recovered after treatment and were included in our study.In total,28(42.4%)women and 38 men(57.6%)with a median age of 44.0(34.0-62.0)years were analyzed.After in-hospital treatment,patients’inflammatory indicators decreased with improved clinical condition.The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5(6.0-11.0)days.By February 10,2020,11 convalescent patients(16.7%)still tested positive for viral RNA from stool specimens and the other 55 patients’stool specimens were negative for 2019-nCoV following a median duration of 11.0(9.0-16.0)days after symptom onset.Among these 55 patients,43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs,with
文摘Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in China.Among the confirmed cases,1527 were severe cases,171 had recovered and been discharged at home,and 213 died.And among these cases,a total of 28 children aged from 1 month to 17 years have been reported in China.For standardizing prevention and management of 2019-nCoV infections in children,we called up an experts' committee to formulate this experts' consensus statement.This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections.The present consensus statement summarizes current strategies on diagnosis,treatment,and prevention of 2019-nCoV infection in children.
基金Supported by A grant from the China National Science and Technology Major Project, No. 2012ZX09303-011-002
文摘AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.
基金The National Natural Science Foundation of China, No. 30371816
文摘AIM: To investigate the effects and molecular mechanisms of berberine on improving insulin resistance induced by free fatty acids (FFAs) in 3T3-L1 adipocytes. METHODS: The model of insulin resistance in 3T3-L1 adipocytes was established by adding palmic acid (0.5 mmol/L) to the culture medium. Berberine treatment was performed at the same time. Glucose uptake rate was determined by the 2-deoxy-[3H]-D-glucose method. The levels of IkB kinase beta (IKKβ) Ser181 phosphorylation, insulin receptor substrate-1(IRS-1) Ser307 phosphorylation, expression of IKKβ, IRS-1, nuclear transcription factor kappaB p65 (NF-κB p65), phosphatidylinositol-3-kinase p85 (PI-3K p85) and glucose transporter 4 (GLUT4) proteins were detected by Western blotting. The distribution of NF-κB p65 proteins inside the adipocytes was observed through confocal laser scanning microscopy (CLSM). RESULTS: After the intervention of palmic acid for 24 h, the insulin-stimulated glucose transport in 3T3-L1 adipocytes was inhibited by 67%. Meanwhile, the expression of IRS-1 and PI-3K p85 protein was reduced, while the levels of IKKβ Ser181 and IRS-1 Ser307 phosphorylation, and nuclear translocation of NF-κB p65 protein were increased. However, the above indexes, which indicated the existence of insulin resistance, were reversed by berberine although the expression of GLUT4, IKKβ and total NF-κB p65 protein were not changed during this study. CONCLUSION: Insulin resistance induced by FFAs in 3T3-L1 adipocytes can be improved by berberine. Berberine reversed free-fatty-acid-induced insulin resistance in 3T3-L1 adipocytes through targeting IKKβ.
