Background&Aims: We used a multistate modeling approach to assess the effect of ursodeoxycholic acid (UDCA) therapy on the natural course of primary biliary cirrhosis (PBC), which remains controversial. Methods: O...Background&Aims: We used a multistate modeling approach to assess the effect of ursodeoxycholic acid (UDCA) therapy on the natural course of primary biliary cirrhosis (PBC), which remains controversial. Methods: Our population included 2 62 patients with PBC who had received 13-15 mg/kg UDCA daily for a mean of 8 ye ars (range, 1-22 years). Data were analyzed using a multistate Markov model, wi th histologic stage progression,death, and orthotopic liver transplantation (OLT ) as main end points. Survival without OLT was comparedwith that predicted by th e updated Mayo model and with the expected survival in the control population. R esults: Forty-five patients developed cirrhosis, 20 underwent OLT, and 16 died by the censor date. Ten deaths were due to liver disease. The overall survival r ates were 92%at 10 years and 82%at 20 years. Survival rates without OLT were 8 4%and 66%at 10 and 20 years,respectively, which were slightly lower than the s urvival rate of an age-and sex-matched control population (relative risk [RR], 1.4; P =. 1) but better than the spontaneous survival rate as predicted by the u pdated Mayo model (RR,. 5; P <. 01). The survival rate of patients in stage 1 an d 2 was similar to that in the control population (RR,. 8; P =. 5), whereas the probability of death or OLT remained significantly increased in treated patients in late histologic stages (RR, 2.2; P <. 05). Conclusions:Treatment with UDCA a lone normalizes the survival rate of patients with PBC when given at early stage s. However, there is a continued need f- or new therapeutic options in patients with advanced disease.展开更多
Nonalcoholic fatty liver disease (NAPLD) is consistently associated with features of the metabolic syndrome, a condition carrying a high risk of cardiovascular events. We measured the vasodilatory response of the brac...Nonalcoholic fatty liver disease (NAPLD) is consistently associated with features of the metabolic syndrome, a condition carrying a high risk of cardiovascular events. We measured the vasodilatory response of the brachial artery in response to ischemia (a test of endothelial function) (FMV) as well as cardiovascular risk profile in 52 NAPLD cases and 28 age-and sex-matched controls. The 10-year risk of coronary events was calculated according to the Framingham equation and the scores derived from the PROCAM study and NCEP-ATP III proposals. FMV was 6.33% ± 5.93% in NAFLD versus 12.22% ± 5.05% in controls (P < .0001), and higher in pure fatty liver (9.93% ) compared with nonalcoholic steatohepatitis (4.94% ) (P = .010). No differences were observed in flow-independent vasodilation (response to sublingual nitroglycerin). Percent FMV was negatively associated with insulin resistance (homeostasis model assessment) in the whole population (r = - 0.243; P = .030). In logistic regression analysis, NAFLD was associated with a percent FMV in the lower fertile (OR, 6.7; 95% CI, 1.26- 36.1), after adjustment for age, sex, body mass index, and insulin resistance. Among NAFLD patients, low FMV was associated with nonalcoholic steatohepatitis (adjusted OR, 6.8; 95% CI, 1.2- 40.2). The 10-year probability of cardiovascular events was moderately increased in NAFLD, and particularly in nonalcoholic steatohepatitis. In conclusion, our study provides evidence of endothelial dysfunction and increased risk of cardiovascular events in NAFLD. The risk of advanced liver disease is well recognized in NAFLD patients, but the large majority of cases might experience cardiovascular disease in the long term, indirectly limiting the burden of liver failure.展开更多
Objective. Liver cholestatic enzymes and/or bilirubin occasionally occur in acute stroke and are usually, but not always, ascribed to comorbid conditions. We investigated the frequency and possible etiology of this ph...Objective. Liver cholestatic enzymes and/or bilirubin occasionally occur in acute stroke and are usually, but not always, ascribed to comorbid conditions. We investigated the frequency and possible etiology of this phenomenon. Material and methods. Prospective evaluation of post- admission biochemical cholestasis of all patients hospitalized with acute stroke was conducted during a 21- month period. Results. Of 169 consecutive patients, 18 (10.7% ) developed cholestasis. In 7 of the patients (4.1% ; 4 M, 3 F, median age 70 years, range 57- 82 years) no apparent cause of cholestasis could be found, and they were further evaluated (Group A). These patients were compared with 21 randomly selected stroke patients without cholestasis, matched for age and gender, and who acted as controls (Group B). Group A patients were in a deeper coma than the controls (Glasgow Coma Scale 3.4 ± 0.8 versus 1.9 ± 0.7, p < 0.001), associated with severe autonomic and hypothalamic involvement, while no such manifestations were present in Group B (p < 0.001). Cholestasis started on the 3rd- 6th day and lasted up to the 11th- 25th day, with maximum median levels of γ - GT and serum alkaline phosphatase (SAP) of up to 4.38 (range 2.33- 8.25) and 1.49 (range 0.63- 2.56) times the upper limit of normal, respectively. Serum alanine aminotransferase (ALAT), total and direct bilirubin increased in Group A but not in Group B. The common bile duct was significantly wider in Group A than in Group B (7.7 ± 0.5 versus 4.7 ± 0.6 mm, p < 0.001) and within Group A during and after cholestasis (7.7 ± 0.5 versus 4.7 ± 0.5 mm, p < 0.001). Conclusions. Transient cholestasis may occur in 4.1% of patients following acute stroke. Cholestasis is associated with deeper coma, autonomic and hypothalamic involvement and common bile duct dilatation without obstruction, possibly related to inordinate hypertonia of the sphincter of Oddi.展开更多
Background & Aims: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia...Background & Aims: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1- year follow- up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. Methods: Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. Results: Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8% ); the prevalence of IBS was also similar (2.9% vs 2.3% ). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7- 9.8) and for IBS was 7.8 (95% confidence interval, 3.1- 19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. Conclusions: Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow- up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.展开更多
Background: While elevation of antidiuretic horm one(ADH )(arginine vasopressin)levels in the serum has beenreported in severe atopic derm atitis (A D ),the cause is asyetunexplained.On the other hand,transepiderm alw...Background: While elevation of antidiuretic horm one(ADH )(arginine vasopressin)levels in the serum has beenreported in severe atopic derm atitis (A D ),the cause is asyetunexplained.On the other hand,transepiderm alwaterloss (TEW L)is known to increase in the dam aged skin dueto AD .O bjectives:A s A D H increases as a result of de-hydration of the body,this study exam ined whether thehigh A DH levelin severe A D is a reaction to the increasedwater loss through the entire body skin surface area.M ethods:Forty-eight patients of different ages and withvarious degrees of A D along with six age-and sex-m atchedcontrolpersons were the study subjects.Using a quick re-sponsive evaporim eter, an average total body TEW L(A TEW L)value was obtained for each subject.Laboratorytests including AD H ,serum lactate dehydrogenase (LD H )and peripheral blood eosinophil count (EOS)were alsoperform ed.Clinical severity grading was m ade globally.The relevancy ofthis grading was em pirically dem onstratedby its statistically significant relation to LDH and EO Swhich are com m only known as appropriate gauges for A Dseverity.Results:ATEW L was observed to be significantlygreater in patients with A D of at least m oderate severitythan in norm alcontrols,and ADH was significantly greaterin patients with severe and very severe A D.Both A TEW Land AD H showed a significant relation to AD severity.Finally,a significant correlation was found between A DHand ATEW L.Conclusions:It is possible that elevatedA DH is atleastin parta reaction to increased ATEW L.展开更多
The cause of psoriatic erythroderma (PE) is still unknown. Elevation of serum IgE has been reported in erythroderma, and as serum hyper-IgE is Th2 cell dominated it is of interest to investigate the serum IgE level in...The cause of psoriatic erythroderma (PE) is still unknown. Elevation of serum IgE has been reported in erythroderma, and as serum hyper-IgE is Th2 cell dominated it is of interest to investigate the serum IgE level in PE. In this study, the level of immunoglobulins in the sera of PE patients was analysed by a retrospective case-control study using psoriasis vulgaris (PV)patients as controls. The PE and PV patients were matched in a 1: 3 pattern: the first three age and sex matched PV inpatients were selected. All of the subjects were nonatopic and without allergic history. The serum IgE level was found to be elevated in 81.3% of the PE group, which is much higher than that (6.3% ) of the controls (odds ratio, 65.0; 95% CI, 11.7-361.2; P < 0.001; χ 2 test). The mean level of serum IgE was much higher in the PE group (272.38 ± 207.63 IU/mL vs. 53.20 ± .86.05 IU/mL, P < 0.001, Student’ s t-test). No differences were found for other immunoglobulins. These results suggest that in PE the Th1/Th2 cell imbalance may be switched from Th1 dominant to Th2 dominant. The exact role of serum IgE in PE should be investigated further.展开更多
Purpose: To compare thirst, drinking behaviour, and en-dothelin-1 (ET-1) pl asma levels between vasospastic and non-vasospastic subjects. Methods: We compa red 67 subjects with a primary vasospastic syndrome with 64 a...Purpose: To compare thirst, drinking behaviour, and en-dothelin-1 (ET-1) pl asma levels between vasospastic and non-vasospastic subjects. Methods: We compa red 67 subjects with a primary vasospastic syndrome with 64 age-and sex-matche d non-vasospastic control subjects. A detailed medical history was recorded, in cluding a questionnaire containing queries about thirst and drinking behaviour, history of migraine or unspecific headache, history of episodes of low blood pre ssure, and smoking habits. Body mass index (BMI) was calculated and blood sample s were drawn for ET-1 measurements. Results: Subjects with a vasospastic syndro me reported a reduced desire to drink and a lower estimated quantity of daily fl uid intake, more often forgot to drink, more often had both migraine and unspeci fic headache, more often had episodes of low blood pressure, and had an increase d plasma level of ET-1. These features differed statistically significantly bet ween the two groups. There was also a non-significant trend among vasospastic s ubjects to smoke less and to have a smaller BMI. Conclusion: A reduced desire to drink is found frequently among vasospastic subjects.展开更多
Oculomotor studies provide a novel strategy for evaluating the functional inte grity of multiple brain systems and cognitive processes in autism. The current s tudy compared pursuit eye movements of 60 highfunctioni...Oculomotor studies provide a novel strategy for evaluating the functional inte grity of multiple brain systems and cognitive processes in autism. The current s tudy compared pursuit eye movements of 60 highfunctioning individuals with aut ism and 94 intelligence quotient, age and gender matched healthy individuals usi ng ramp and oscillating target tasks. Individuals with autism had normal pursuit latency, but reduced closedloop pursuit gain when tracking both oscillating a nd ramp targets. This closedloop deficit was similar for leftward and rightwar d pursuit, but the difference between individuals with autism and their agemat ched peers was more apparent after midadolescence, suggesting reduced maturati onal achievement of the pursuit system in autism. Individuals with autism also h ad lower openloop pursuit gain (initial 100 ms of pursuit) and less accurate i nitial catchup saccades during a foveofugal stepramp task, but these deficit s were only seen when targets moved into the right visual field. Pursuit perform ance in both openand closedloop phases was correlated with manual praxis in individuals with autism. Bilateral disturbances in the ability to use internally generated extraretinal signals for closedloop pursuit implicate frontostriata l or cerebellar circuitry. The hemifield specific deficit in openloop pursuit demonstrates a lateralized disturbance in the left extrastriate areas that extra ct visual motion information, or in the transfer of visual motion information to the sensorimotor areas that transform visual information into appropriate oculo motor commands.展开更多
Financial support was provided, in part, by the Manitoba Medical Services Foundation. Magnetic resonance imaging (MRI) and functional MRI studies involving n- back spatial working memory (WM) tasks were conducted in a...Financial support was provided, in part, by the Manitoba Medical Services Foundation. Magnetic resonance imaging (MRI) and functional MRI studies involving n- back spatial working memory (WM) tasks were conducted in adults and children with Fetal Alcohol Spectrum Disorders (FASD), and in age- and sex- matched controls. FMRI experiments demonstrated consistent activations in regions of the brain associated with working memory. Children with FASD displayed greater inferior- middle frontal lobe activity, while greater superior frontal and parietal lobe activity was observed in controls. Control children also showed an overall increase in frontal lobe activity with increasing task difficulty, while children with FASD showed decreased activity. FASD adults demonstrated less functional brain activity overall, but greater inferior- middle frontal lobe activity during the simpler tasks, relative to controls. Control adults demonstrated greater inferior frontal activity with increasing task difficulty, while this pattern was not consistently observed in FASD adults. All four groups showed increasing activity with increases in task difficulty in the parietal and frontal regions at more superior slice levels. The results suggest impairment in spatial working memory in those with FASD that does not improve with age, and that fMRI may be useful in evaluation of brain function in these individuals.展开更多
Aim: To determine the anatomical site and extent of electrophysiological dysfu nction in patients with ethambutol associated visual loss. Methods: A comparativ e case series. Four patients with ethambutol associated v...Aim: To determine the anatomical site and extent of electrophysiological dysfu nction in patients with ethambutol associated visual loss. Methods: A comparativ e case series. Four patients with ethambutol associated visual loss underwent mu ltifocal electroretinography (mERG). Two patients had advanced visual loss while two had early signs of toxicity. The N1-P1, N1, P1 amplitudes, N1, and P1 late ncies were compared to 10 age and sex matched controls. Results: mERG abnormalit ies were detected in the ethambutol treated patients. The N1 amplitude was signi ficantly lower in the ethambutol treated patients than in the control group. Con clusion: Ethambutol is possibly toxic to the retina, and not only the optic nerv e. The multifocal ERG may be of value to diagnose and monitor patients taking et hambutol.展开更多
Purpose: The purpose was to evaluate the diurnal variation (DV) of intraocular pressure (IOP) in patients with exfoliation syndrome (XS), to measure retinal nerve fiber layer (RNFL)-thickness by using scanning laser p...Purpose: The purpose was to evaluate the diurnal variation (DV) of intraocular pressure (IOP) in patients with exfoliation syndrome (XS), to measure retinal nerve fiber layer (RNFL)-thickness by using scanning laser polarimetry, and to compare these measurements with those of normal subjects. Methods: Forty-five subjects with XS and 40 healthy, age/sex matched subjects were recruited into the study. A detailed ophthalmologic examination was performed. IOP measurements were obtained at 08:00 am, 12:00 pm, 03:00 pm, and 06:00 pm. The XS group was further divided into DV ≥ 5 mmHg and DV<5 mmHg groups and also according to the existence of IOP fluctuation. The IOP measurements and RNFL thickness measurements were compared between the groups. Results: The mean IOP value was found to be highest in the morning both in the XS and control groups. IOP showed a gradual decrease from 8.00 am to 6.00 pm in the control group, whereas a second peak at 03:00 pm was observed in the XS group. There was a fluctuation in 53.3% of the XS group, while none of the healthy subjects showed fluctuation. Superior and inferior ratios were statistically lower in XS patients than those in control subjects (p<0.05). Moreover, in patients with XS showing a DV ≥ 5 mmHg and/or a fluctuation, the superior ratio, inferior ratio, the number, superior average and superior integral were significantly different (all p values<0.05) from those of control subjects. Conclusions: As the XS patients with high diurnal IOP variation and fluctuating pattern of IOP had lower RNFL thickness measurements, it is crucial to follow up these patients by performing scanning laser polarimetry in order to discover any possible glaucomatous damage at an earlier stage than with the use of conventional visual field analysis.展开更多
文摘Background&Aims: We used a multistate modeling approach to assess the effect of ursodeoxycholic acid (UDCA) therapy on the natural course of primary biliary cirrhosis (PBC), which remains controversial. Methods: Our population included 2 62 patients with PBC who had received 13-15 mg/kg UDCA daily for a mean of 8 ye ars (range, 1-22 years). Data were analyzed using a multistate Markov model, wi th histologic stage progression,death, and orthotopic liver transplantation (OLT ) as main end points. Survival without OLT was comparedwith that predicted by th e updated Mayo model and with the expected survival in the control population. R esults: Forty-five patients developed cirrhosis, 20 underwent OLT, and 16 died by the censor date. Ten deaths were due to liver disease. The overall survival r ates were 92%at 10 years and 82%at 20 years. Survival rates without OLT were 8 4%and 66%at 10 and 20 years,respectively, which were slightly lower than the s urvival rate of an age-and sex-matched control population (relative risk [RR], 1.4; P =. 1) but better than the spontaneous survival rate as predicted by the u pdated Mayo model (RR,. 5; P <. 01). The survival rate of patients in stage 1 an d 2 was similar to that in the control population (RR,. 8; P =. 5), whereas the probability of death or OLT remained significantly increased in treated patients in late histologic stages (RR, 2.2; P <. 05). Conclusions:Treatment with UDCA a lone normalizes the survival rate of patients with PBC when given at early stage s. However, there is a continued need f- or new therapeutic options in patients with advanced disease.
文摘Nonalcoholic fatty liver disease (NAPLD) is consistently associated with features of the metabolic syndrome, a condition carrying a high risk of cardiovascular events. We measured the vasodilatory response of the brachial artery in response to ischemia (a test of endothelial function) (FMV) as well as cardiovascular risk profile in 52 NAPLD cases and 28 age-and sex-matched controls. The 10-year risk of coronary events was calculated according to the Framingham equation and the scores derived from the PROCAM study and NCEP-ATP III proposals. FMV was 6.33% ± 5.93% in NAFLD versus 12.22% ± 5.05% in controls (P < .0001), and higher in pure fatty liver (9.93% ) compared with nonalcoholic steatohepatitis (4.94% ) (P = .010). No differences were observed in flow-independent vasodilation (response to sublingual nitroglycerin). Percent FMV was negatively associated with insulin resistance (homeostasis model assessment) in the whole population (r = - 0.243; P = .030). In logistic regression analysis, NAFLD was associated with a percent FMV in the lower fertile (OR, 6.7; 95% CI, 1.26- 36.1), after adjustment for age, sex, body mass index, and insulin resistance. Among NAFLD patients, low FMV was associated with nonalcoholic steatohepatitis (adjusted OR, 6.8; 95% CI, 1.2- 40.2). The 10-year probability of cardiovascular events was moderately increased in NAFLD, and particularly in nonalcoholic steatohepatitis. In conclusion, our study provides evidence of endothelial dysfunction and increased risk of cardiovascular events in NAFLD. The risk of advanced liver disease is well recognized in NAFLD patients, but the large majority of cases might experience cardiovascular disease in the long term, indirectly limiting the burden of liver failure.
文摘Objective. Liver cholestatic enzymes and/or bilirubin occasionally occur in acute stroke and are usually, but not always, ascribed to comorbid conditions. We investigated the frequency and possible etiology of this phenomenon. Material and methods. Prospective evaluation of post- admission biochemical cholestasis of all patients hospitalized with acute stroke was conducted during a 21- month period. Results. Of 169 consecutive patients, 18 (10.7% ) developed cholestasis. In 7 of the patients (4.1% ; 4 M, 3 F, median age 70 years, range 57- 82 years) no apparent cause of cholestasis could be found, and they were further evaluated (Group A). These patients were compared with 21 randomly selected stroke patients without cholestasis, matched for age and gender, and who acted as controls (Group B). Group A patients were in a deeper coma than the controls (Glasgow Coma Scale 3.4 ± 0.8 versus 1.9 ± 0.7, p < 0.001), associated with severe autonomic and hypothalamic involvement, while no such manifestations were present in Group B (p < 0.001). Cholestasis started on the 3rd- 6th day and lasted up to the 11th- 25th day, with maximum median levels of γ - GT and serum alkaline phosphatase (SAP) of up to 4.38 (range 2.33- 8.25) and 1.49 (range 0.63- 2.56) times the upper limit of normal, respectively. Serum alanine aminotransferase (ALAT), total and direct bilirubin increased in Group A but not in Group B. The common bile duct was significantly wider in Group A than in Group B (7.7 ± 0.5 versus 4.7 ± 0.6 mm, p < 0.001) and within Group A during and after cholestasis (7.7 ± 0.5 versus 4.7 ± 0.5 mm, p < 0.001). Conclusions. Transient cholestasis may occur in 4.1% of patients following acute stroke. Cholestasis is associated with deeper coma, autonomic and hypothalamic involvement and common bile duct dilatation without obstruction, possibly related to inordinate hypertonia of the sphincter of Oddi.
文摘Background & Aims: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1- year follow- up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. Methods: Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. Results: Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8% ); the prevalence of IBS was also similar (2.9% vs 2.3% ). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7- 9.8) and for IBS was 7.8 (95% confidence interval, 3.1- 19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. Conclusions: Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow- up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.
文摘Background: While elevation of antidiuretic horm one(ADH )(arginine vasopressin)levels in the serum has beenreported in severe atopic derm atitis (A D ),the cause is asyetunexplained.On the other hand,transepiderm alwaterloss (TEW L)is known to increase in the dam aged skin dueto AD .O bjectives:A s A D H increases as a result of de-hydration of the body,this study exam ined whether thehigh A DH levelin severe A D is a reaction to the increasedwater loss through the entire body skin surface area.M ethods:Forty-eight patients of different ages and withvarious degrees of A D along with six age-and sex-m atchedcontrolpersons were the study subjects.Using a quick re-sponsive evaporim eter, an average total body TEW L(A TEW L)value was obtained for each subject.Laboratorytests including AD H ,serum lactate dehydrogenase (LD H )and peripheral blood eosinophil count (EOS)were alsoperform ed.Clinical severity grading was m ade globally.The relevancy ofthis grading was em pirically dem onstratedby its statistically significant relation to LDH and EO Swhich are com m only known as appropriate gauges for A Dseverity.Results:ATEW L was observed to be significantlygreater in patients with A D of at least m oderate severitythan in norm alcontrols,and ADH was significantly greaterin patients with severe and very severe A D.Both A TEW Land AD H showed a significant relation to AD severity.Finally,a significant correlation was found between A DHand ATEW L.Conclusions:It is possible that elevatedA DH is atleastin parta reaction to increased ATEW L.
文摘The cause of psoriatic erythroderma (PE) is still unknown. Elevation of serum IgE has been reported in erythroderma, and as serum hyper-IgE is Th2 cell dominated it is of interest to investigate the serum IgE level in PE. In this study, the level of immunoglobulins in the sera of PE patients was analysed by a retrospective case-control study using psoriasis vulgaris (PV)patients as controls. The PE and PV patients were matched in a 1: 3 pattern: the first three age and sex matched PV inpatients were selected. All of the subjects were nonatopic and without allergic history. The serum IgE level was found to be elevated in 81.3% of the PE group, which is much higher than that (6.3% ) of the controls (odds ratio, 65.0; 95% CI, 11.7-361.2; P < 0.001; χ 2 test). The mean level of serum IgE was much higher in the PE group (272.38 ± 207.63 IU/mL vs. 53.20 ± .86.05 IU/mL, P < 0.001, Student’ s t-test). No differences were found for other immunoglobulins. These results suggest that in PE the Th1/Th2 cell imbalance may be switched from Th1 dominant to Th2 dominant. The exact role of serum IgE in PE should be investigated further.
文摘Purpose: To compare thirst, drinking behaviour, and en-dothelin-1 (ET-1) pl asma levels between vasospastic and non-vasospastic subjects. Methods: We compa red 67 subjects with a primary vasospastic syndrome with 64 age-and sex-matche d non-vasospastic control subjects. A detailed medical history was recorded, in cluding a questionnaire containing queries about thirst and drinking behaviour, history of migraine or unspecific headache, history of episodes of low blood pre ssure, and smoking habits. Body mass index (BMI) was calculated and blood sample s were drawn for ET-1 measurements. Results: Subjects with a vasospastic syndro me reported a reduced desire to drink and a lower estimated quantity of daily fl uid intake, more often forgot to drink, more often had both migraine and unspeci fic headache, more often had episodes of low blood pressure, and had an increase d plasma level of ET-1. These features differed statistically significantly bet ween the two groups. There was also a non-significant trend among vasospastic s ubjects to smoke less and to have a smaller BMI. Conclusion: A reduced desire to drink is found frequently among vasospastic subjects.
文摘Oculomotor studies provide a novel strategy for evaluating the functional inte grity of multiple brain systems and cognitive processes in autism. The current s tudy compared pursuit eye movements of 60 highfunctioning individuals with aut ism and 94 intelligence quotient, age and gender matched healthy individuals usi ng ramp and oscillating target tasks. Individuals with autism had normal pursuit latency, but reduced closedloop pursuit gain when tracking both oscillating a nd ramp targets. This closedloop deficit was similar for leftward and rightwar d pursuit, but the difference between individuals with autism and their agemat ched peers was more apparent after midadolescence, suggesting reduced maturati onal achievement of the pursuit system in autism. Individuals with autism also h ad lower openloop pursuit gain (initial 100 ms of pursuit) and less accurate i nitial catchup saccades during a foveofugal stepramp task, but these deficit s were only seen when targets moved into the right visual field. Pursuit perform ance in both openand closedloop phases was correlated with manual praxis in individuals with autism. Bilateral disturbances in the ability to use internally generated extraretinal signals for closedloop pursuit implicate frontostriata l or cerebellar circuitry. The hemifield specific deficit in openloop pursuit demonstrates a lateralized disturbance in the left extrastriate areas that extra ct visual motion information, or in the transfer of visual motion information to the sensorimotor areas that transform visual information into appropriate oculo motor commands.
文摘Financial support was provided, in part, by the Manitoba Medical Services Foundation. Magnetic resonance imaging (MRI) and functional MRI studies involving n- back spatial working memory (WM) tasks were conducted in adults and children with Fetal Alcohol Spectrum Disorders (FASD), and in age- and sex- matched controls. FMRI experiments demonstrated consistent activations in regions of the brain associated with working memory. Children with FASD displayed greater inferior- middle frontal lobe activity, while greater superior frontal and parietal lobe activity was observed in controls. Control children also showed an overall increase in frontal lobe activity with increasing task difficulty, while children with FASD showed decreased activity. FASD adults demonstrated less functional brain activity overall, but greater inferior- middle frontal lobe activity during the simpler tasks, relative to controls. Control adults demonstrated greater inferior frontal activity with increasing task difficulty, while this pattern was not consistently observed in FASD adults. All four groups showed increasing activity with increases in task difficulty in the parietal and frontal regions at more superior slice levels. The results suggest impairment in spatial working memory in those with FASD that does not improve with age, and that fMRI may be useful in evaluation of brain function in these individuals.
文摘Aim: To determine the anatomical site and extent of electrophysiological dysfu nction in patients with ethambutol associated visual loss. Methods: A comparativ e case series. Four patients with ethambutol associated visual loss underwent mu ltifocal electroretinography (mERG). Two patients had advanced visual loss while two had early signs of toxicity. The N1-P1, N1, P1 amplitudes, N1, and P1 late ncies were compared to 10 age and sex matched controls. Results: mERG abnormalit ies were detected in the ethambutol treated patients. The N1 amplitude was signi ficantly lower in the ethambutol treated patients than in the control group. Con clusion: Ethambutol is possibly toxic to the retina, and not only the optic nerv e. The multifocal ERG may be of value to diagnose and monitor patients taking et hambutol.
文摘Purpose: The purpose was to evaluate the diurnal variation (DV) of intraocular pressure (IOP) in patients with exfoliation syndrome (XS), to measure retinal nerve fiber layer (RNFL)-thickness by using scanning laser polarimetry, and to compare these measurements with those of normal subjects. Methods: Forty-five subjects with XS and 40 healthy, age/sex matched subjects were recruited into the study. A detailed ophthalmologic examination was performed. IOP measurements were obtained at 08:00 am, 12:00 pm, 03:00 pm, and 06:00 pm. The XS group was further divided into DV ≥ 5 mmHg and DV<5 mmHg groups and also according to the existence of IOP fluctuation. The IOP measurements and RNFL thickness measurements were compared between the groups. Results: The mean IOP value was found to be highest in the morning both in the XS and control groups. IOP showed a gradual decrease from 8.00 am to 6.00 pm in the control group, whereas a second peak at 03:00 pm was observed in the XS group. There was a fluctuation in 53.3% of the XS group, while none of the healthy subjects showed fluctuation. Superior and inferior ratios were statistically lower in XS patients than those in control subjects (p<0.05). Moreover, in patients with XS showing a DV ≥ 5 mmHg and/or a fluctuation, the superior ratio, inferior ratio, the number, superior average and superior integral were significantly different (all p values<0.05) from those of control subjects. Conclusions: As the XS patients with high diurnal IOP variation and fluctuating pattern of IOP had lower RNFL thickness measurements, it is crucial to follow up these patients by performing scanning laser polarimetry in order to discover any possible glaucomatous damage at an earlier stage than with the use of conventional visual field analysis.
