Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of ...Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.展开更多
The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent cause...The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used i展开更多
Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed...Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.展开更多
Rheumatoid arthritis （RA） is a chronic systemic autoimmune disease chiefly affecting synovial membranes of multiple joints. The clinical manifestations are highly variable. Besides joint affection, extra-articular m...Rheumatoid arthritis （RA） is a chronic systemic autoimmune disease chiefly affecting synovial membranes of multiple joints. The clinical manifestations are highly variable. Besides joint affection, extra-articular manifestations always occur in RA patients, such as lung, blood vessel, heart, endocrine glands, hematological system, and nervous system affections. In addition to Western medicine therapy, Chinese medicine also plays a significant role in the treatment of RA with good efficacy and less adverse reactions. This paper summarizes the effects of Xinfeng Capsule （新风胶囊）, a Chinese medicine, and the mechanisms of its action in ameliorating the extra-articular manifestations based on a series of clinical and experimental researches.展开更多
BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis ...BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't signi? cant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients.METHODS: A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale(GCS), agitation were analyzed in this study.RESULTS: In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had signi? cantly higher prevalence in hemorrhagic stroke patients(P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients(P<0.001).CONCLUSION: Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.展开更多
Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Rece...Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Recently,emerging evidence has suggested that UC presents complications in esophageal,stomachic,and duodenal mucosal injuries.However,UC-related UGI tract manifestations are varied and frequently silenced or concealed.Moreover,the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific.Therefore,UGI involvement may be ignored by many clinicians.In addition,no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy.Furthermore,specific treatment recommendations may be needed for patients with UC-associated UGI lesions.Herein,we review the esophageal,gastric,and duodenal mucosal lesions of the UC-associated UGI tract,as well as the potential pathogenesis and therapy.展开更多
Objective： To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease （CHD） according to the acute cardiovascular events （ACEs） in one-year follo...Objective： To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease （CHD） according to the acute cardiovascular events （ACEs） in one-year follow-up which based on the pathogenesis hypothesis of ＂blood-stasis and toxin causing catastrophe＂. Methods： Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2：1 according to the gender, age （± 2.5 years）, diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared. Results： Fifteen cases manifested with bluish tongue （including bluish-grounding or bluish purple tongue）, among which 11 cases （37.9%） in the ACEs group and four cases （7.4%） in the non-ACEs group, and there was significant difference （P〈0.002）. Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group （48.1 vs. 10.3%, P=0.001）. The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group （66.7% vs. 41.4%, P=0.026）. The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group （41.4% vs. 20.4%, P=0.041）. Odd ratio （OR） analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one- year follow-up （OR： 11.67, 95%CI： 3.34-40.81, P〈0.001; OR： 2.76, 95%CI： 1.02-7.44, P〈0.05; OR： 3.12, 95%, CI： 0.89-10.92, P=0.066）. Conclusions： The bluish tongue （including bluish-grounding or bluish purple tongue） 展开更多
Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that often involve organs other than those of the gastrointestinal tract. Immune-related extraintestinal manifestations (EIMs) are usu...Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that often involve organs other than those of the gastrointestinal tract. Immune-related extraintestinal manifestations (EIMs) are usually related to disease activity, but sometimes may take an independent course. Globally, about one third of patients develop these systemic manifestations. Phenotypic classification shows that certain subsets of patients are more susceptible to developing EIMs, which frequently occur simultaneously in the same patient overlapping joints, skin, mouth, and eyes. The clinical spectrum of these manifestations varies from mild transitory to very severe lesions, sometimes more incapacitating than the intestinal disease itself. The great majority of these EIMs accompany the activity of intestinal disease and patients run a higher risk of a severe clinical course. For most of the inflammatory EIMs, the primary therapeutic target remains the bowel. Early aggressive therapy can minimize severe complications and maintenance treatment has the potential to prevent some devastating consequences.展开更多
Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifest...Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifestations for both Crohn’s disease and ulcerative colitis(UC),and typically do not correlate with intestinal activity.Primary sclerosing cholangitis(PSC)is the most common hepatobiliary manifestation of IBD,and is more prevalent in UC.Approximately 5%of patients with UC develop PSC,with the prevalence reaching up to 90%.Cholangiocarcinoma and colon cancer risks are increased in these patients.Less common disorders include autoimmune hepatitis/PSC overlap syndrome,IgG4-associated cholangiopathy,primary biliary cirrhosis,hepatic amyloidosis,granulomatous hepatitis,cholelithiasis,portal vein thrombosis,liver abscess,and non-alcoholic fatty liver disease.Hepatitis B reactivation during immunosuppressive therapy is a major concern,with screening and vaccination being recommended in serologically negative cases for patients with IBD.Reactivation prophylaxis with entecavir or tenofovir for 6to 12 mo after the end of immunosuppressive therapy is mandatory in patients showing as hepatitis B surface antigen(HBsAg)positive,independently from viral load.HBsAg negative and anti-HBc positive patients,with or without anti-HBs,should be closely monitored,measuring alanine aminotransferase and hepatitis B virus DNA within 12 mo after the end of therapy,and should be treated if the viral load increases.On the other hand,immunosuppressive therapy does not seem to promote reactivation of hepatitis C,and hepatitis C antiviral treatment does not influence IBD natural history either.Most of the drugs used for IBD treatment may induce hepatotoxicity,although the incidence of serious adverse events is low.Abnormalities in liver biochemical tests associated with aminosalicylates are uncommon and are usually not clinically relevant.Methotrexaterelated hepatotoxicity has been described in 14%of patients with IBD,in a dose-depend展开更多
OBJECTIVE:Electroacupuncture effect on neurological behavior and the expression of tyrosine kinase Janus kinase 2(JAK 2) of ischemic cortex in rats with the focal cerebral ischemia were investigated in this study.METH...OBJECTIVE:Electroacupuncture effect on neurological behavior and the expression of tyrosine kinase Janus kinase 2(JAK 2) of ischemic cortex in rats with the focal cerebral ischemia were investigated in this study.METHODS:The model of focal cerebral ischemia was established by the heat-coagulation induced the occlusion of the middle cerebral artery.The electro-acupuncture was applied on Baihui(GV 20) and Dazhui(GV 14),and AG490 was applied by intracerebroventricular infusion.The expressions of JAK2 mRNA and phospharylatedJAK2(p-JAK2) in the ischemic cortex were observed by in situ hybridization and western blotting.RESULTS:The expressions of JAK2 mRNA and p-JAK2 were rarely found in sham surgery group.In model group,the expression of JAK2 mRNA and JAK2 phosphorylation had increased.After 1 day of cerebral ischemia,the expression had reached its peak.After cerebral ischemia,the expressions of JAK2 mRNA and p-JAK2 were consistent with the neurological deficit score.Electroacupuncture treatment and AG490 intervention were able to improve the neurological deficit score after cerebral ischemia,and down-regulate the expressions of JAK2 mRNAand JAK2 phosphorylation.CONCLUSION:After cerebral ischemia,the excessive expressions of JAK2 and the JAK2 phosphorylation would be one of mechanisms by which the brain injury got worse.The therapy of electro-acupuncture could reduce the expression of JAK2,and inhibit JAK2 phosphorylated activation,so as to block the abnormal activation of signal transduction pathway which was induced by JAK2.展开更多
Scrub typhus is a zoonosis caused by the pathogen Orientia tsutsugamushi(O.tsvtsugamushi). The disease has significant prevalence in eastern and Southeast Asia.Usually presenting as an acute febrile illness,the diagno...Scrub typhus is a zoonosis caused by the pathogen Orientia tsutsugamushi(O.tsvtsugamushi). The disease has significant prevalence in eastern and Southeast Asia.Usually presenting as an acute febrile illness,the diagnosis is often missed because of similarities with oilier tropical febrile infections.Many unusual manifestations are present,and these are described in this review,together with an outline of current knowledge of pathophysiology.Awareness of these unusual clinical manifestations will help the clinician to arrive at an early diagnosis,resulting in early administration of appropriate antibiotics.Prognostic indicators for severe disease have not yet been clearly established.展开更多
Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patien...Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patients with TS. The aim of this study is to summarize thecharateristic cutaneous features and common extracutaneous involvement of TS, which are helpful tothe early detection of visceral involvement. The analyzed clinical data from 78 patients with TSincluded those from detailed history, physical and dermatological examination, cranial computedtomography ( CT) and magnetic resonance imaging ( MRI) , abdominal ultrasonography, chestroentgenography, hand and foot X-ray and ophthalmologic examination. The skin, brain and kidney wereinvolved frequently in TS patients. Hypomelanotic macules were the most common and earliestcutaneous lesions. Their number was more than 3 in 81. 5% of'the patients. They were followed byfacial angiofibromas and Shangreen' s patch in a decreasing frequency. Forehead plaque, facialangiofibromas and Shagreen's patch appeared in patients at mean age of 2. 6, 6. 0 and 8. 1 yearsrespectively. Cranial CT showed a high positive rate in TS patients . Cutaneous features of TS arehelpful in the early diagnosis of the disease. Hypomelanotic macules are especially important forpatients with epilepsy or babies whose number of hypomelanotic malues is more than 3. Cranial CT isof great value in the diagnosis of TS. The involvement of visceral organs such as the brain andkidney should be examined in TS patients.展开更多
AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.
AIM To investigate whether immune mediated diseases(IMD) are more frequent in patients with inflammatory bowel disease(IBD).METHODS In this population based registry study,a total of 47325 patients with IBD were alive...AIM To investigate whether immune mediated diseases(IMD) are more frequent in patients with inflammatory bowel disease(IBD).METHODS In this population based registry study,a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16,2013. Controls were randomly selected from the Danish Civil Registration System(CRS) and matched for sex,age,and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis(UC),Crohn's disease(CD) and Both the latter referring to those registered with both diagnoses. Subsequently,odds-ratios(OR) and 95%CI were obtained separately for each group and their respective controls. The use of Bonferoni post-test correction adjusted the significance level to P < 0.00125. P-values were estimated using Fisher's exact test.RESULTS There were significantly more women than men in the registry,and a greater percentage of comorbidity in the IBD groups(P < 0.05). Twenty different IMDs were all significantly more frequent in the IBD group. Sixteen were associated with UC versus twelve with CD. In both UC and CD ORs were significantly increased(P < 0.00125) for primary sclerosing cholangitis(PSC),celiac disease,type 1 diabetes(T1D),sarcoidosis,asthma,iridocyclitis,psoriasis,pyoderma gangrenosum,rheumatoid arthritis,and ankylosing spondylitis. Restricted to UC(P < 0.00125) were autoimmune hepatitis,primary biliary cholangitis,Grave's disease,polymyalgia rheumatica,temporal arteritis,and atrophic gastritis. Restricted to CD(P < 0.00125) were psoriatic arthritis and episcleritis. Restricted to women with UC(P < 0.00125) were atrophic gastritis,rheumatoid arthritis,temporal arteritis,and polymyalgia rheumatica. Restricted to women with CD were episcleritis,rheumatoid arthritis,and psoriatic arthritis. The only disease restricted to men(P < 0.00125) was sarcoidosis. CONCLUSION Immune mediated diseases were significantly more frequent in patients with IBD. 展开更多
文摘Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.
文摘The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used i
文摘Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.
文摘Rheumatoid arthritis （RA） is a chronic systemic autoimmune disease chiefly affecting synovial membranes of multiple joints. The clinical manifestations are highly variable. Besides joint affection, extra-articular manifestations always occur in RA patients, such as lung, blood vessel, heart, endocrine glands, hematological system, and nervous system affections. In addition to Western medicine therapy, Chinese medicine also plays a significant role in the treatment of RA with good efficacy and less adverse reactions. This paper summarizes the effects of Xinfeng Capsule （新风胶囊）, a Chinese medicine, and the mechanisms of its action in ameliorating the extra-articular manifestations based on a series of clinical and experimental researches.
文摘BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't signi? cant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients.METHODS: A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale(GCS), agitation were analyzed in this study.RESULTS: In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had signi? cantly higher prevalence in hemorrhagic stroke patients(P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients(P<0.001).CONCLUSION: Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.
文摘Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Recently,emerging evidence has suggested that UC presents complications in esophageal,stomachic,and duodenal mucosal injuries.However,UC-related UGI tract manifestations are varied and frequently silenced or concealed.Moreover,the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific.Therefore,UGI involvement may be ignored by many clinicians.In addition,no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy.Furthermore,specific treatment recommendations may be needed for patients with UC-associated UGI lesions.Herein,we review the esophageal,gastric,and duodenal mucosal lesions of the UC-associated UGI tract,as well as the potential pathogenesis and therapy.
基金Supported by National Major Project for Fundamental Research and Development(No.2006CB504803)National Natural Science Foundation of China(No.30973702)+1 种基金Beijing Project of Science and Technology Plan(No.D08050703020801)Major Discipline Project of China-Japan Friendship Hospital
文摘Objective： To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease （CHD） according to the acute cardiovascular events （ACEs） in one-year follow-up which based on the pathogenesis hypothesis of ＂blood-stasis and toxin causing catastrophe＂. Methods： Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2：1 according to the gender, age （± 2.5 years）, diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared. Results： Fifteen cases manifested with bluish tongue （including bluish-grounding or bluish purple tongue）, among which 11 cases （37.9%） in the ACEs group and four cases （7.4%） in the non-ACEs group, and there was significant difference （P〈0.002）. Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group （48.1 vs. 10.3%, P=0.001）. The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group （66.7% vs. 41.4%, P=0.026）. The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group （41.4% vs. 20.4%, P=0.041）. Odd ratio （OR） analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one- year follow-up （OR： 11.67, 95%CI： 3.34-40.81, P〈0.001; OR： 2.76, 95%CI： 1.02-7.44, P〈0.05; OR： 3.12, 95%, CI： 0.89-10.92, P=0.066）. Conclusions： The bluish tongue （including bluish-grounding or bluish purple tongue）
文摘Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that often involve organs other than those of the gastrointestinal tract. Immune-related extraintestinal manifestations (EIMs) are usually related to disease activity, but sometimes may take an independent course. Globally, about one third of patients develop these systemic manifestations. Phenotypic classification shows that certain subsets of patients are more susceptible to developing EIMs, which frequently occur simultaneously in the same patient overlapping joints, skin, mouth, and eyes. The clinical spectrum of these manifestations varies from mild transitory to very severe lesions, sometimes more incapacitating than the intestinal disease itself. The great majority of these EIMs accompany the activity of intestinal disease and patients run a higher risk of a severe clinical course. For most of the inflammatory EIMs, the primary therapeutic target remains the bowel. Early aggressive therapy can minimize severe complications and maintenance treatment has the potential to prevent some devastating consequences.
文摘Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifestations for both Crohn’s disease and ulcerative colitis(UC),and typically do not correlate with intestinal activity.Primary sclerosing cholangitis(PSC)is the most common hepatobiliary manifestation of IBD,and is more prevalent in UC.Approximately 5%of patients with UC develop PSC,with the prevalence reaching up to 90%.Cholangiocarcinoma and colon cancer risks are increased in these patients.Less common disorders include autoimmune hepatitis/PSC overlap syndrome,IgG4-associated cholangiopathy,primary biliary cirrhosis,hepatic amyloidosis,granulomatous hepatitis,cholelithiasis,portal vein thrombosis,liver abscess,and non-alcoholic fatty liver disease.Hepatitis B reactivation during immunosuppressive therapy is a major concern,with screening and vaccination being recommended in serologically negative cases for patients with IBD.Reactivation prophylaxis with entecavir or tenofovir for 6to 12 mo after the end of immunosuppressive therapy is mandatory in patients showing as hepatitis B surface antigen(HBsAg)positive,independently from viral load.HBsAg negative and anti-HBc positive patients,with or without anti-HBs,should be closely monitored,measuring alanine aminotransferase and hepatitis B virus DNA within 12 mo after the end of therapy,and should be treated if the viral load increases.On the other hand,immunosuppressive therapy does not seem to promote reactivation of hepatitis C,and hepatitis C antiviral treatment does not influence IBD natural history either.Most of the drugs used for IBD treatment may induce hepatotoxicity,although the incidence of serious adverse events is low.Abnormalities in liver biochemical tests associated with aminosalicylates are uncommon and are usually not clinically relevant.Methotrexaterelated hepatotoxicity has been described in 14%of patients with IBD,in a dose-depend
基金Supported by the Funds of National Basic Research Program of China(973 program,No.2010CB530500)National Natural Science Foundation of China(No.30973788)+1 种基金Guangdong province science and technology projects (No.2010B031500016)Guangdong Natural Science Foundation(No.9351040701000001)
文摘OBJECTIVE:Electroacupuncture effect on neurological behavior and the expression of tyrosine kinase Janus kinase 2(JAK 2) of ischemic cortex in rats with the focal cerebral ischemia were investigated in this study.METHODS:The model of focal cerebral ischemia was established by the heat-coagulation induced the occlusion of the middle cerebral artery.The electro-acupuncture was applied on Baihui(GV 20) and Dazhui(GV 14),and AG490 was applied by intracerebroventricular infusion.The expressions of JAK2 mRNA and phospharylatedJAK2(p-JAK2) in the ischemic cortex were observed by in situ hybridization and western blotting.RESULTS:The expressions of JAK2 mRNA and p-JAK2 were rarely found in sham surgery group.In model group,the expression of JAK2 mRNA and JAK2 phosphorylation had increased.After 1 day of cerebral ischemia,the expression had reached its peak.After cerebral ischemia,the expressions of JAK2 mRNA and p-JAK2 were consistent with the neurological deficit score.Electroacupuncture treatment and AG490 intervention were able to improve the neurological deficit score after cerebral ischemia,and down-regulate the expressions of JAK2 mRNAand JAK2 phosphorylation.CONCLUSION:After cerebral ischemia,the excessive expressions of JAK2 and the JAK2 phosphorylation would be one of mechanisms by which the brain injury got worse.The therapy of electro-acupuncture could reduce the expression of JAK2,and inhibit JAK2 phosphorylated activation,so as to block the abnormal activation of signal transduction pathway which was induced by JAK2.
文摘Scrub typhus is a zoonosis caused by the pathogen Orientia tsutsugamushi(O.tsvtsugamushi). The disease has significant prevalence in eastern and Southeast Asia.Usually presenting as an acute febrile illness,the diagnosis is often missed because of similarities with oilier tropical febrile infections.Many unusual manifestations are present,and these are described in this review,together with an outline of current knowledge of pathophysiology.Awareness of these unusual clinical manifestations will help the clinician to arrive at an early diagnosis,resulting in early administration of appropriate antibiotics.Prognostic indicators for severe disease have not yet been clearly established.
文摘Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patients with TS. The aim of this study is to summarize thecharateristic cutaneous features and common extracutaneous involvement of TS, which are helpful tothe early detection of visceral involvement. The analyzed clinical data from 78 patients with TSincluded those from detailed history, physical and dermatological examination, cranial computedtomography ( CT) and magnetic resonance imaging ( MRI) , abdominal ultrasonography, chestroentgenography, hand and foot X-ray and ophthalmologic examination. The skin, brain and kidney wereinvolved frequently in TS patients. Hypomelanotic macules were the most common and earliestcutaneous lesions. Their number was more than 3 in 81. 5% of'the patients. They were followed byfacial angiofibromas and Shangreen' s patch in a decreasing frequency. Forehead plaque, facialangiofibromas and Shagreen's patch appeared in patients at mean age of 2. 6, 6. 0 and 8. 1 yearsrespectively. Cranial CT showed a high positive rate in TS patients . Cutaneous features of TS arehelpful in the early diagnosis of the disease. Hypomelanotic macules are especially important forpatients with epilepsy or babies whose number of hypomelanotic malues is more than 3. Cranial CT isof great value in the diagnosis of TS. The involvement of visceral organs such as the brain andkidney should be examined in TS patients.
文摘AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.
文摘AIM To investigate whether immune mediated diseases(IMD) are more frequent in patients with inflammatory bowel disease(IBD).METHODS In this population based registry study,a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16,2013. Controls were randomly selected from the Danish Civil Registration System(CRS) and matched for sex,age,and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis(UC),Crohn's disease(CD) and Both the latter referring to those registered with both diagnoses. Subsequently,odds-ratios(OR) and 95%CI were obtained separately for each group and their respective controls. The use of Bonferoni post-test correction adjusted the significance level to P < 0.00125. P-values were estimated using Fisher's exact test.RESULTS There were significantly more women than men in the registry,and a greater percentage of comorbidity in the IBD groups(P < 0.05). Twenty different IMDs were all significantly more frequent in the IBD group. Sixteen were associated with UC versus twelve with CD. In both UC and CD ORs were significantly increased(P < 0.00125) for primary sclerosing cholangitis(PSC),celiac disease,type 1 diabetes(T1D),sarcoidosis,asthma,iridocyclitis,psoriasis,pyoderma gangrenosum,rheumatoid arthritis,and ankylosing spondylitis. Restricted to UC(P < 0.00125) were autoimmune hepatitis,primary biliary cholangitis,Grave's disease,polymyalgia rheumatica,temporal arteritis,and atrophic gastritis. Restricted to CD(P < 0.00125) were psoriatic arthritis and episcleritis. Restricted to women with UC(P < 0.00125) were atrophic gastritis,rheumatoid arthritis,temporal arteritis,and polymyalgia rheumatica. Restricted to women with CD were episcleritis,rheumatoid arthritis,and psoriatic arthritis. The only disease restricted to men(P < 0.00125) was sarcoidosis. CONCLUSION Immune mediated diseases were significantly more frequent in patients with IBD.
