The Effect of Costimulatory Factors in the Pathogenesis of Chronic Idiopathic Thrombocytopenic Purpura

To investigate the effect of costimulatory factors in the pathogenesis of chronic idiopathic thrombocytopenic purpura(CITP), we examined the expression of CD80 on platelets and megakaryocytes in patients with CITP and the controls by FACS. By using CD80 monoclonal antibody (McAb) to inhibit interaction among cells which is mediated by costimulatory factors, we observed the effect of CD80 McAb on the growth and maturation of megakaryocytic progenitors of patients with CITP in vitro . The results showed the expression of CD80 on platelets and megakaryocytes in CITP group was significantly higher than that in controls ( P <0.01). There was a significantly positive correlation between the expression of CD80 on platelets and serum PAIgG in CITP (r=0.86, P <0.05). The mean of various clone numbers (CFU MK, BFU MK and mCFU MK) in CITP were all lower than those in controls ( P <0.05). In megakaryocytes co cultured with CD80 McAb, there was an increasing tendency of the number of CFU MK and big CFU MK (the number of megakaryocyte with GPⅢ a positive was more than 20) and mediate CFU MK (the number of megakaryocyte with GPⅢ a positive was 11-20). When the concentration of CD80 McAb was 10 μg/L, there was a significant difference in the number of megakaryocytic colony formation (CFU MK, BFU MK and mCFU MK) between the group with CD80 McAb and that without it ( P <0.05).These showed the abnormality of costimulatory factors had important effect in the pathogenesis of CITP.

Association between Helicobacter Pylori Infection and Chronic Idiopathic Neutropenia

Summary： The possible association between Helicobacter pylori （H. pylori） infection and chronic idiopathic neutropenia （ClN） was investigated. A total of 78 subjects with CIN were recruited in this case-control study. As a control group, 40 subjects without ClN were selected for comparison with the case group. All participants were evaluated for the prevalence of H. pylori infection by 14C-urea breath test. The corrected splenic index （CSI） was calculated, and serum IL-6, IL-8, IL-10 and HsCRP levels were measured. The differences in CSI, serum IL-6, IL-8, IL-10 and HsCRP levels were compared between CIN patients and controls, as well as between subjects with and without H. pylori infection. The positive rate ofH. pylori was 87.18% in ClN group and 52.50% in control group, showing a significant difference （Fisher＇s exact, P=0.000）. CSI values, and serum IL-6 and HsCRP levels in H. pylori positive-CIN patients were significantly higher than those in negative subjects （Mann-whitney U-test, P=-0.016, P=0.001 and P=0.000 respectively）, while IL-10 level declined sig- nificantly in H, pylori negative-CIN patients （Mann-whimey U-test, P=0.000）. In control group, se- rum IL-6 and HsCRP levels in H. pylori positive individuals were also increased significantly （Mann-whitney U-test, P=0.000）, while IL-10 level declined （Mann-whimey U-test, P=0.018）. Mul- tivariate regression analysis revealed that H. pylori infection and IL-10 were significant risk factors for CIN with odds ratio （OR）： 3.09, 95.0% CI： 1.22-6.93; P=0.019, and OR： 0.17, 95.0% CI： 0.05-0.94; P=0.021, respectively. This prospective study confirmed the existence of an association between H. pylori infection and CIN, suggesting the screening for H. pylori infection and eradicating bacterium in positive cases seem appropriate and beneficial for those patients with CIN diagnosis.

Inhibition of ileal bile acid transporter:An emerging therapeutic strategy for chronic idiopathic constipation

Chronic idiopathic constipation is a common disorder of the gastrointestinal tract that encompasses a wide profile of symptoms. Current treatment options for chronic idiopathic constipation are of limited value; therefore, a novel strategy is necessary with an increased effectiveness and safety. Recently, the inhibition of the ileal bile acid transporter has become a promising target for constipation-associated diseases. Enhanced delivery of bile acids into the colon achieves an accelerated colonic transit, increased stool frequency, and relief of constipationrelated symptoms. This article provides insight into the mechanism of action of ileal bile acid transporter inhibitors and discusses their potential clinical use for pharmacotherapy of constipation in chronic idiopathic constipation.

Evaluation of chronic idiopathic tinnitus and its psychosocial triggers

BACKGROUND The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.AIM To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.METHODS Participants were 230 adults(males=70;females=160;mean age=38.6±3.3).They underwent audiograms,speech discrimination and masking testing,and neuropsychiatric evaluation.Measures used for assessment included tinnitus handicap inventory,depression anxiety stress scale 21(DASS-21),perceived stress scale(PSS),and insomnia severity index(ISI).RESULTS Patients had mean duration of tinnitus of 11.5±2.5 mo.They had intact hearing perception at 250-8000 Hz and 95(41.3%)had aggravation of tinnitus loudness by masking noise.Decompensated tinnitus was reported in 77%(n=177).The majority had clinically significant insomnia(81.3%),somatic symptoms(75%)other than tinnitus and perceived moderate(46.1%)and high(44.3%)stress to tinnitus.The severe/extremely severe symptoms of depression,anxiety and stress were reported in 17.4%,35.7%and 44.3%,respectively.Patients with decompensated type had significantly higher scores for ISI(P=0.001)and DASS-21(depression=0.02,anxiety=0.01,stress=0.001)compared to those with compensated tinnitus.Psychiatric interviewing showed that 35.7%had non-specific anxiety disorder,17.4%had major depression,and 19.6%fulfilled the criteria of somatization disorder.Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus[odd ratios(OR)=0.832,95%CI:0.640-1.158;P=0.001]and PSS(OR=0.835,95%CI:0.540-1.125;P=0.001)scores.CONCLUSION To the best of our knowledge,this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset,severity and persistence.Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities.Therefore,multidisciplinary consultation(psychologists,psychiatrists,and neurologists)is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

Long-term liver allograft fibrosis:A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection

Liver transplantation(LT)is a life-saving surgical procedure and the current standard of care for most patients with end stage liver disease.With improvements in organ preservation techniques,perioperative care,and immunosuppression,there is better patient and graft survival following LT,and assessment of the liver allograft in long-term survivors is becoming increasingly important.Recurrent or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in adults.However,no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients,as they have been transplanted for non-recurrent liver diseases.Serial surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological changes.Pathological findings are frequently present in liver biopsies obtained after a year post LT.The significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry parameters.This narrative review summaries the factors predisposing to long-term liver allograft fibrosis,highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.

A Rare Case of Chronic Recurrent Multifocal Osteomyelitis with Undifferentiated Juvenile Idiopathic Arthritis, Uveitis, and Psoriasis

We report here a 17-year-old boy with a complicated presentation of undifferentiated juvenile idiopathic arthritis, vision-threatening uveitis and chronic recurrent multifocal osteomyelitis (CRMO) in the pelvis. His severe iritis needed subtenon injections and only responded to infliximab after failing multiple biologics. Unfortunately he later developed infliximab-associated psoriasis. A combination of infliximab and ustekinumab induced remission of his arthritis, osteomyelitis, uveitis and psoriasis without experiencing severe infections.

Cost of Treatment of Chronic Spontaneous Urticaria in Turkey

Chronic Spontaneous Urticaria (CSU) is a chronic disease with significant negative impact on quality of life of patients. The direct and indirect costs of the disease can be substantial both for the health care system and society. The aim of this research is to estimate the cost of mild, moderate and severe CSU in Turkey and to forecast the cost of the disease from the payer (Social Security Institution—SSI) perspective. Expert opinions with Delphi technique were used in order to determine the cost items and their frequency. A questionnaire was designed to outline resources used in the out-patient, inpatient and emergency care episodes and was answered by dermatologists followed by a consensus meeting. Unit costs were calculated from the price list of the SSI. The annual total cost of treating the disease to the SSI was estimated as 262,111,978TL (94,417,870€) comprising 0.06% of the total healthcare budget in 2013. Since there is limited information about the cost of CSU in Turkey, the methodology and results of this study are unique and very important.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Signifcant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been esta-blished. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pul-monary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

耳蜗神经交替声束治疗联合基于互联网的认知行为治疗对慢性特发性耳鸣的疗效研究

目的评估运用耳蜗神经交替声束治疗(CeAABT)联合基于互联网的认知行为疗法(iCBT)对慢性特发性耳鸣的有效性。方法选取诊断为慢性特发性耳鸣的患者112例随机分为2组,iCBT(56例)采取iCBT治疗,CeAABT联合iCBT组(56例)在iCBT的基础上给予CeAABT,连续治疗12周,观察2组治疗前后耳鸣残疾量表(THI)、视觉模拟量表(VAS)和耳鸣响度评分的变化情况。结果治疗后,2组患者的THI、VAS、耳鸣响度评分都出现了明显的降低,与同组治疗前比较差异均有统计学意义(P均<0.05),且CeAABT联合iCBT组THI评分(35.34±7.51)分、VAS评分(3.38±1.34)分、耳鸣响度评分(34.53±5.77)分比iCBT组[(40.13±10.95)(3.91±1.38)(39.39±6.92)分]更低,2组比较差异均有统计学意义(P均<0.05)。结论CeAABT联合iCBT可以有效地降低患者的耳鸣响度和由耳鸣带来的负面情绪,能提高慢性耳鸣患者的生活质量,是一种简便安全的耳鸣治疗方法,值得进一步研究和推广。

低浓度利多卡因联合甲钴胺星状神经节阻滞治疗慢性特发性耳鸣临床价值研究

目的:探讨1%利多卡因联合甲钴胺星状神经节阻滞治疗慢性特发性耳鸣的临床价值。方法:选取我院就诊的慢性特发性耳鸣患者80例,根据随机数字表法将患者分为观察组和对照组,各40例。对照组口服长春胺缓释胶囊和甲钴胺片,观察组在对照组基础上给予1%利多卡因4 ml+甲钴胺1 ml双侧交替星状神经节阻滞。比较两组治疗前后耳鸣心理声学特征及THI评分。比较两组患者耳鸣治疗效果。观察并记录观察组患者星状神经节阻滞后不良反应。结果:观察组与对照组治疗后1个月耳鸣响度、耳鸣主频率及THI评分较治疗前降低(均P<0.05)。与对照组比较,观察组治疗后1个月耳鸣响度及耳鸣主频率降低(均P<0.05)。治疗后1个月,观察组显效率和总有效率高于对照组(均P<0.05)。观察组所有患者星状神经节阻滞成功,未发生气胸、局部血肿、局麻药物中毒及声嘶等不良反应,阻滞成功后Horner综合征均自行缓解。结论:低浓度利多卡因联合甲钴胺行星状神经节阻滞治疗慢性特发性耳鸣可降低患者耳鸣响度及耳鸣主频率,减轻耳鸣严重程度,疗效显著且安全性较好。

地氯雷他定与氯雷他定治疗慢性特发性荨麻疹的临床效果分析

目的:探讨地氯雷他定与氯雷他定治疗慢性特发性荨麻疹的临床效果。方法:选取2021年1月—2023年12月临沂市中医医院收治的慢性特发性荨麻疹患者104例作为研究对象,采用随机数字表法分为观察组与对照组,各52例。对照组接受氯雷他定治疗,观察组接受地氯雷他定治疗。比较两组治疗效果、不良反应发生情况、满意度、起效时间。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.028);两组不良反应总发生率比较,差异无统计学意义(P>0.05);观察组总满意度高于对照组,差异有统计学意义(P=0.008);两组治疗起效时间比较,差异无统计学意义(P>0.05)。结论:地氯雷他定治疗慢性特发性荨麻疹效果优于氯雷他定,患者满意度更高,且未增加不良反应发生风险,未延长治疗起效时间。

耳周穴位注射联合认知行为疗法对老年慢性特发性耳鸣的疗效及影响因素分析

目的探讨耳周穴位注射联合认知行为疗法治疗老年慢性特发性耳鸣的疗效及影响因素分析。方法将2021年10月—2022年9月在上海中医药大学附属龙华医院耳鼻喉科就诊的128例老年慢性特发性耳鸣患者采用随机数字法将其分为观察组和对照组各64例。对照组进行耳周穴位注射治疗,观察组在对照组基础上联合进行认知行为疗法治疗,治疗4周,并于治疗前、治疗结束时、治疗结束后1个月时进行耳鸣严重程度评估量表、匹兹堡睡眠质量指数量表、汉密顿焦虑量表评分,比较治疗前与治疗结束时、治疗结束1个月后的改善情况,观察组和对照组的差异,分析观察组的疗效的影响因素分析。结果耳周穴位注射联合认知行为疗法治疗老年慢性特发性耳鸣总有效率达到37.5%,与本组治疗前相比,在治疗结束时和治疗结束1个月后在耳鸣严重程度、PSQI、HAMA评分方面差异均有统计学意义(P<0.01),与对照组比较差异也有统计学意义(P<0.05)。年龄是耳周穴位注射联合认知行为疗法治疗老年慢性特发性耳鸣疗效的影响因素之一。结论耳周穴位注射联合认知行为疗法能有效治疗老年慢性特发性耳鸣,但是高龄患者疗效有限。

脂质组学在慢性肺部疾病生物标志物发现中的应用

慢性肺部疾病(CLD)通常包括慢性阻塞性肺疾病、哮喘、特发性肺纤维化等。研究表明,CLD与脂质代谢紊乱密切相关,因此脂质作为CLD的生物标志物,对于疾病的诊断、预防及治疗过程中的监控可能有着重要价值。本文从脂质组学技术方法、脂质组学临床样本选择、CLD生物标志物发现和CLD不同中医证侯区分4个方面讨论脂质组学在CLD生物标记物研究中的应用。

高压氧联合鼓室内灌注地塞米松对慢性特发性耳鸣患者疾病严重程度、睡眠质量的影响

目的探究慢性特发性耳鸣患者采用高压氧联合鼓室灌注地塞米松的临床疗效。方法选取2022年7月—2023年7月永康市第一人民医院收治的80例慢性特发性耳鸣患者为研究对象,依据随机数表法分组(对照组:鼓室灌注地塞米松;观察组:高压氧+鼓室灌注地塞米松),分析两组血液流变学、匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)评分、耳鸣分级量化评分。结果治疗后,观察组血液流变学、PSQI评分低于对照组,差异有统计学意义(P均<0.05);观察组治疗后耳鸣分级量化评分为(7.49±1.37)分较对照组的(10.58±1.46)分低,差异有统计学意义(t=9.761,P<0.05)。结论对慢性特发性耳鸣患者治疗时,高压氧联合鼓室灌注地塞米松可缓解耳鸣,提高睡眠质量。

地洛他定治疗慢性特发性荨麻疹的疗效及安全性研究

目的 观察地洛他定治疗慢性特发性荨麻疹的疗效和安全性 ,并与氯雷他定进行比较。方法 采用多中心、随机双盲、平行对照法。结果 完成治疗者共 15 8例 ,其中地洛他定组 79例。治疗后 ,患者主、客观症状观察项目平均积分于服药第 14、2 8天均有下降 ,但两组比较均无统计学意义 (P >0 .0 5 )。治疗结束时 ,地洛他定组痊愈 60例(75 .95 % ) ,总有效率 89.87% (71/79) ;氯雷他定组痊愈 5 4例 (68.3 5 % ) ,总有效率为 87.3 4% (69/79)。两组比较差异无显著性 (χ2 =0 .3 ,P >0 .0 5 )。

依巴斯汀治疗慢性特发性荨麻疹的临床试验研究

目的:评估国产依巴斯汀治疗慢性特发性荨麻疹的临床疗效和安全性。方法:采用随机、双盲、平行对照的方法对依巴斯汀治疗慢性荨麻疹进行Ⅱ期临床试验,并与西替利嗪进行对照。结果:共观察患者136例,依巴斯汀组69例,西替利嗪组67例,依巴斯汀组的有效率和显效率分别为91.3%和63.8%,而西替利嗪组分别为87.9%和65.2%,两组间比较差异均无显著性(P>0.05)。依巴斯汀组症状积分下降指数为0.79±0.26,而西替利嗪组为0.76±0.29,两组间比较差异无显著性(P>0.05)。两种药物的不良反应主要为轻至中度困倦和口干。结论:依巴斯汀治疗慢性特发性荨麻疹安全有效,其疗效及不良反应与西替利嗪相似。

重组人血小板生成素治疗慢性难治性特发性血小板减少性紫癜的临床研究

目的 评价国产重组人血小板生成素 (rhTPO)治疗慢性难治性特发性血小板减少性紫癜 (ITP)的疗效及不良反应。方法 采用开放试验。 30例慢性难治性ITP患者皮下注射rhTPO 1 0mg/kg ,疗程 14d或给药至血小板计数比给药前增高≥ 5 0× 10 9/L。动态观察全血细胞计数 ,定期复查尿常规、大便常规、肝肾功能、心电图、血小板形态及凝血功能检查。结果 用药前血小板平均值为 (19 0± 13 1)× 10 9/L ,用药后最高值为 (16 0 8± 115 6 )× 10 9/L ,二者比较差异有显著性意义 (P <0 0 1) ,升高达最高值的时间为 (17 8± 6 5 )d。rhTPO治疗前后WBC、血红蛋白、肝功能、肾功能、心电图、血小板聚集功能及凝血功能 (PT、APTT、纤维蛋白原 )均无显著性差异 (均P >0 0 5 )。仅 1例出现头痛、血压升高 ,但停药后可自行消失 ,未见其它不良反应。结论 国产rhTPO治疗慢性难治性ITP具有良好的疗效 ,不良反应轻微 ,具有良好的临床应用前景。

雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹疗效观察

目的观察雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹的临床疗效和安全性。方法共入选180例患者,将其随机分成两组,每组各90例,治疗组予雷公藤多甙片10mg口服,3次/d,地氯雷他定5mg口服,1次/d,均连用28天;对照组仅予地氯雷他定5mg口服,1次/d,连用28天。结果治疗第7天时治疗组有效率为69.77%,对照组为54.02%;第14天时治疗组有效率82.56%,对照组59.77%;第28天时治疗组有效率93.02%,对照组67.82%。两组患者在治疗第7,14和28天时有效率比较,差异均有统计学意义(P均<0.05)。患者主观生活质量评估在治疗14天后DLQI和睡眠情况改善明显好于对照组,28天后DLQI、睡眠情况和日常活动评分也明显好于对照组(P均<0.05)。不良反应:治疗组发生率为8.14%,对照组为6.90%,两组差异无统计学意义。停药6周后进行随访和复诊,试验组复发率低于对照组,差异有统计学意义(P<0.05)。结论雷公藤多甙片联合地氯雷他定治疗慢性特发性荨麻疹的临床疗效比单纯应用地氯雷他定治疗的疗效好,停药后复发率低。

枸地氯雷他定片治疗慢性特发性荨麻疹有效性与临床安全性分析

目的评价枸地氯雷他定片治疗慢性特发性荨麻疹的疗效与安全性。方法采用多中心、开放、非比较性临床试验的研究方法,共有1 235例受试者进入研究,符合方案分析集(PPAS)1 210例,全分析集(FAS)1 213例,安全性分析集(SAS)1 235例,受试者均给予枸地氯雷他定片8.8mg口服,1次/d,疗程两周。观察记录受试者用药前、治疗期间、治疗结束后的症状、体征情况及不良反应,分别在治疗第1周和第2周结束时计算疗效指数,对其有效率和安全性给予评价。结果枸地氯雷他定片治疗慢性特发性荨麻疹用药后1周、2周的治愈率分别为23.08%和56.94%,有效率分别为42.10%和87.86%。对瘙痒、风团数量及大小等症状有明显改善作用;治疗过程中出现口干、嗜睡、困倦、乏力、头晕、头痛、心动过速等51例不良反应,发生率4.13%。结论枸地氯雷他定片治疗慢性特发性荨麻疹有较好的临床疗效,且安全性优良。