血清sST2、LTBP-2联合检测对心力衰竭的预后价值

目的 探究血清可溶性ST2(sST2)、潜伏转化生长因子β结合蛋白2(LTBP-2)联合检测对心力衰竭(HF)的预后价值。方法 选取2020年2月至2021年2月我院收治的HF患者108例即为HF组,同期选择在我院体检健康的志愿者108例为对照组,采用酶联免疫吸附测定(ELISA)法检测血清sST2和LTBP-2的表达水平;Pearson法分析sST2和LTBP-2的相关性;多因素Logistic回归分析影响HF患者预后的影响因素;绘制受试者工作特征(ROC)曲线分析sST2和LTBP-2表达水平预测HF患者预后的价值。结果 与对照组相比,HF组总胆固醇(TC)、三酰甘油(TG)、左室舒张末期内径(LVEDD)水平显著升高,左心室射血分数(LVEF)水平显著降低(P<0.05)。与对照组相比,HF组血清中sST2、LTBP-2表达水平均显著升高(P<0.05)。III级和IV级患者血清sST2、LTBP-2的表达水平与II级相比显著升高,IV级的sST2、LTBP-2表达水平与III级相比显著升高(P<0.05)。相关性分析显示,HF患者血清中sST2、LTBP-2表...     

血清肌钙蛋白I和缺血修饰白蛋白在急性冠状动脉综合征早期诊断及预后评估中的价值

目的 探讨血清肌钙蛋白I(TnI)和缺血修饰白蛋白(IMA)在急性冠状动脉综合征(ACS)早期诊断及预后评估中的价值,为临床的诊断治疗及预后提供更准确的实验室依据,以便及时进行临床干预.方法 收集543例ACS患者发病3小时内的血清样本,其中不稳定心绞痛(UA)180例、非ST段抬高心肌梗死(NSTEMI) 100例、ST段抬高心肌梗死(STEMI) 173例,以同期400例体检健康者作为对照组.全自动生化仪检测IMA、血糖(GLU)、血脂(TG、CHO、HDL、LDL),全自动化学发光仪检测TnI.各组间TnI、IMA比较采用非参数Mann-Whitney U检验,利用受试者工作特征(ROC)曲线分析抗TnI及IMA对ACS的早期诊断价值,采用二分类Logistic回归分析对ACS的预后因素进行评估.结果 UA组、NSTEMI组及STEMI组IMA水平分别为79.30 (77.50～ 86.00)、81.40(78.25～89.70)、83.46(80.01～90.04),均显著高于对照组[71.28(66.44 ～75.55)],而NSTEMI组和STEMI组TnI水平[0.65(0.173 ～3.523)、0.74(0.29～22.51)]也显著高于对照组[0.03(0.018～0.6)],TnI、IMA及联合诊断的ROC曲线下面积(AUC)分别为0.842、0.868、0.904.ACS患者30天内发生主要心脏不良事件(MACEs)的几率为16.70％ (88/527),发生MACEs组的血清TnI及IMA水平[0.41(0.11～16.43),89.10(84.20～93.89)]均高于未发生MACEs组[0.11(0.05 ～1.78),81.80(77.70～85.60)],多因素Logistic回归分析显示血清IMA水平是30天内MACEs发生的独立危险因素.结论 血清TnI、IMA均可作为ACS早期诊断的生物学标志,两者联合检测具有高敏感度和特异度,具有更强的诊断价值,血清IMA是ACS近期预后不良的独立危险因素,还可对ACS患者近期预后进行评估.     

IMA、H-FABP、cTnI联合检测对非ST段抬高性急性冠状动脉综合征患者早期诊断价值研究

目的 研究缺血修饰白蛋白(IMA)、心肌脂肪酸结合蛋白(H-FABP)与心肌肌钙蛋白Ⅰ(cTnI)联合检测对非ST段抬高性急性冠状动脉综合征(NSTE ACS)患者心肌缺血早期诊断的价值.方法 收集急诊胸痛患者135例,其中NSTE ACS 80例、非心源性胸痛(NCCP) 55例,均于胸痛3小时内入院检测血清IMA、H-FABP、cTnI,比较组间差异;整理住院患者病例资料,统计发生主要心脏不良事件(MACE)患者入院时IMA、H-FABP、cTnI结果差异.结果 NSTE ACS组入院时IMA、H-FABP、cTnI均高于NCCP组(P＜0.01);诊断NSTE ACS早期心肌缺血的灵敏度IMA(86％)高于H-FABP(68％)和cTnI(79％),IMA、H-FABP、cTnI平行试验灵敏度可达到90％,并具有更高阴性预测价值(85％);发生MACE的患者入院时IMA、H-FABP、cTnI结果明显高于非MACE患者(P＜0.05).结论 IMA是较cTnI和H-FABP更敏感的急性心肌缺血早期诊断指标,IMA、H-FABP、cTnI联检可以提高NSTE ACS早期心肌缺血诊断与排除诊断效率,并对预后具有一定评估价值.     

冠心病患者PCI术后血清IL-33、sST2、LP-PLA2水平及其与预后的关系

目的 分析冠心病(CHD)患者经皮冠状动脉介入术(PCI)术后血清白介素-33(IL-33)、可溶性生长刺激表达基因蛋白2(sST2)、脂蛋白相关磷脂酶A2(LP-PLA2)水平及其与预后的关系.方法 选取2017年1月至2020年1月我院收治的128例行PCI治疗的CHD患者为研究对象,作为观察组,根据冠状造影结果 分为单支病变组(n=48)、双支病变组(n=55)及多支病变组(n=25),并选取同期入院后未行PCI术治疗的CHD患者60例作为对照组,并随访术后6个月不良心血管事件(MACE)发生情况,根据MACE分为MACE组(n=25)和非MACE(n=103),检测血清IL-33、sST2、LP-PLA2水平,采用ROC曲线分析其水平对预后的评估价值.结果 观察组血清IL-33、sST2、LP-PLA2水平高于对照组(P<0.05);多支病变组血清IL-33、sST2、LP-PLA2水平高于单支病变组和双支病变组,双支病变组血清IL-33、sST2、LP-PLA2水平高于单支病变组(P<0.05);MACE组血清IL-33、sST2、LP-PLA2水平高于非MACE组(P<0.05);Logistic回归分析显示,血清IL-33、sST2、LP-PLA2水平是影响CHD患者PCI术后发生MACE的危险因素(P<0.05);ROC曲线分析显示,血清IL-33、sST2、LP-PLA2水平联合预测CHD预后的灵敏度及特异性均高于单独预测(P<0.05).结论 CHD患者PCI术后血清IL-33、sST2、LP-PLA2水平升高,可预测冠脉病变程度和预后,值得临床推广.     

急性ST段抬高型心肌梗死患者血清LDH1、MYO水平与短期预后的相关性分析

目的 探究急性ST段抬高心肌梗死(STEMI)患者入院时血清LDH1、肌红蛋白(MYO)水平,并分析血清LDH1、MYO与STEMI患者短期预后的关系.方法 选取2019年3月至2020年3月本院收治的STEMI患者90例为研究对象(急性心肌梗死组),根据STEMI患者随访90天结果,分为预后良好组70例,和预后不良组20例;同期选择本院健康体检者90例为对照组.采用酶联免疫吸附(ELISA)法检测STEMI患者入院时和对照组体检时血清中LDH1水平,采用微粒子酶免疫分析法检测STEMI患者入院时和对照组体检时血清MYO水平;ROC曲线分析LDH1、MYO及二者联合检测对STEMI患者预后不良诊断价值.结果 与对照组相比,急性心肌梗死组血清LDH1、MYO水平较高(P<0.05);与预后良好组相比,预后不良组血清LDH1、MYO水平较高(P<0.05);LDH1、MYO对STEMI患者不良预后诊断的AUC分别为0.870、0.825,二者联合对STEMI患者不同预后诊断的AUC为0.902,灵敏度为98.60％,特异性为75.00％.结论 入院时血清LDH1、MYO水平升高与STEMI不良预后发生密切相关,对评估STEMI不良预后发生具有一定的应用价值.     

肺鳞癌患者手术前后血清VEGF-C、IL-6及MMP-2水平变化及其临床意义

目的探讨肺鳞癌(SCC)患者手术前后血清血管内皮生长因子C(VEGF-C)、白介素-6(IL-6)及基质金属蛋白酶-2(MMP-2)水平变化及其临床意义。方法将我院接诊的94例SCC患者纳入SCC组,均行手术治疗,80例同期健康体检者纳为对照组,比较两组及SCC患者手术前后血清VEGF-C、IL-6、MMP-2水平的变化,并分析其与淋巴结转移的关系。结果 SCC组血清VEGF-C、IL-6及MMP-2水平均明显高于对照组(P<0.05);SCC淋巴结转移组血清VEGF-C、IL-6及MMP-2水平明显高于SCC非淋巴结转移组(P<0.05);VEGF-C、IL-6及MMP-2的ROC曲线下面积(AUC)分别为0.793、0.729、0.670,其中VEGF-C的AUC最大;三者联合检测的灵敏度、特异性(AUC 0.861)高于VEGF-C(AUC 0.793),即三者联合检测淋巴结转移的诊断效能高于单一检测;SCC患者术前、术后7d及术后30d的血清VEGF-C、IL-6、MMP-2水平呈下降趋势(P<0.05)。结论 VEGF-C、IL-6及MMP-2三者联合检测可提高对SCC患者淋巴结转移的诊断价值,动态监测SCC患者血清VEGF-C、IL-6及MMP-2水平有助于预后判断和指导术后治疗。     

血清淀粉样蛋白A1、脂蛋白结合指数预测急性冠脉综合征患者病情严重程度及预后的价值

目的 探讨血清淀粉样蛋白A1(SAA1)、脂蛋白结合指数(LCI)对急性冠脉综合征(ACS)患者病情严重程度及预后的评估价值.方法 选取2016年12月至2019年1月我科收治的130例ACS患者作为研究对象(观察组),同时,另选我院体检健康志愿者80例(对照组).比较各组受试者血清SAA1、LCI水平.根据患者出院后6个月是否发生不良心血管事件(MACE)分为预后良好组和预后不良组.采用COX比例风险模型分析影响ACS患者预后的危险因素,采用受试者工作特征曲线(ROC)分析SAA1、LCI对ACS患者短期预后的评估价值.结果 观察组血清SAA1、LCI水平高于对照组,差异有统计学意义(P＜0.05).ACS重度组血清SAA1、LCI水平高于中度组、轻度组,中度组血清SAA1、LCI水平高于轻度组,差异有统计学意义(P＜0.05).预后不良组患者血清SAA1、LCI水平高于预后良好组患者,差异有统计学意义(P＜0.05).COX多因素回归分析结果显示,Genisis评分、SAA1、LCI是影响ACS患者预后的独立危险因素(P＜0.05).ROC曲线显示,SAA1、LCI预测ACS患者短期预后的曲线下面积分别为0.821、0.840.结论 ACS患者血清SAA1、LCI水平明显升高,与患者病情严重程度及短期预后密切相关,且对ACS患者预后评估有一定预测价值.     

妊娠相关性蛋白A、超敏C反应蛋白及D-二聚体用于早期诊断急性冠脉综合征

目的:分析血浆妊娠相关性蛋白A(PAPP-A)、超敏C反应蛋白(hs-CRP)及D-二聚体(D-D)水平变化及对急性冠脉综合征(ACS)的早期诊断价值。方法:选择本院急诊内科及心血管内科收治的56例ACS患者为ACS组,同期另选50例健康体检者作为对照组,分别检测ACS组胸痛发生2h内和对照组静脉血血浆PAPP-A、hs-CRP及D-D浓度,并比较组间差异,同时绘制受试者工作特征(ROC)曲线,评价以上各项指标对ACS患者的诊断效能。结果:ACS组血浆PAPP-A、hs-CRP及D-D水平明显高于对照组(P0.01)。血浆PAPP-A、hs-CRP及D-D诊断ACS的ROC曲线下面积(AUC)分别为0.910、0.871和0.845,三者联合检测ACS的AUC为0.955,大于单独检测。PAPP-A诊断ACS的敏感度为82.10%,特异度为98.00%。hs-CRP诊断ACS的敏感度为91.10%,特异度为74.00%。D-D诊断ACS的敏感度为75.00%,特异度为86.00%。结论:血浆PAPP-A、hs-CRP及D-D水平与ACS发病相关,可作为ACS早期诊断指标,联合检测可提高对ACS的诊断效能。     

血清Melatonin、 NOX4水平在动脉瘤性蛛网膜下腔出血患者预后评估中的应用

目的 探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者血清褪黑素(Melatonin)、烟酰胺腺嘌呤二核苷酸磷酸氧化酶4(NOX4)水平及其与患者预后的相关性.方法 选取在我科接受治疗的aSAH患者120例(观察组).另选取我院体检健康者80例(对照组).采用酶联免疫吸附法检测血清Melatonin、NOX4水平.出院6个月后,采用GOS评分评估患者预后情况并将其分为预后不良组(n=42)和预后良好组(n=78),比较2组患者临床资料及血清Melatonin、NOX4水平.采用多因素Logistic回归分析影响aSAH患者预后不良的危险因素.结果 观察组血清Melatonin、NOX4水平高于对照组,差异有统计学意义(P＜0.05).aSAH患者治疗后血清Melatonin、NOX4水平低于治疗前,差异有统计学意义(P＜0.05).预后不良组血清Melatonin、NOX4水平高于预后良好组,差异有统计学意义(P＜0.05).ROC曲线显示,血清Melatonin、NOX4及二者联合检测预测aSAH患者不良预后的AUC分别为0.793、0.834和0.900.多因素Logistic回归分析显示,Hunt-Hess分级Ⅲ～Ⅴ级、改良Fisher分级Ⅲ～Ⅳ级、并发迟发性脑缺血及血清Melatonin、NOX4升高是aSAH患者预后不良的独立危险因素(P＜0.05).结论 血清Melatonin、NOX4水平升高与aSAH患者预后不良密切相关,可作为评估aSAH患者临床预后的生物学指标.     

心型脂肪酸结合蛋白对急性冠脉综合征患者的诊断价值及预后评估的研究

目的探讨心型脂肪酸结合蛋白（H-FABP）对急性冠脉综合征（ACS）患者诊断及预后评估的价值。方法选择急性心肌梗死（AMI）患者108例;不稳定性心绞痛（UA）患者90例;稳定性心绞痛（SA）患者84例;健康对照组60例。患者各组分别在入院时和入院8h后检测血清H-FABP、cTnI和CK-MB水平。结果入院时,AMI组和UA组H-FABP水平高于SA组和对照组（P〈0.05）,AMI组CK-MB水平高于其他三组（P〈0.05）,H-FABP对AMI和UA的诊断阳性率明显高于cTnI和CK-MB（P〈0.05）;入院8h后,H-FABP水平下降,cTnI和CK-MB水平上升,AMI组H-FABP水平高于其他三组（P〈0.05）,AMI组和UA组cTnI和CK-MB水平明显高于SA组和对照组（P〈0.05）,H-FABP对AMI的诊断阳性率与cTnI和CKMB相比差异无统计学意义（P〉0.05）,而对UA的诊断阳性率低于cTnI和CK-MB（P〈0.05）。发生心脏意外事件的ACS患者H-FABP水平明显高于未发生心脏意外事件的ACS患者（P〈0.01）。结论 H-FABP对ACS患者的早期诊断具有较高的准确性;当发病超过8h后,应联合其他心肌酶学指标共同诊断。临床可结合H-FABP水平对ACS患者预后进行评估。     

宫颈分泌物HPV16,18型的FQ-PCR检测对育龄夫妇生殖健康的意义

目的探讨人乳头瘤病毒（HPV）16,18亚型在河北省衡水市育龄妇女中的流行情况以及感染妇女的男性性伴侣的感染率。方法采用荧光定量PCR（FQ-PCR）技术对367名育龄妇女进行了HPV16,18检测。观察HPV16,18感染的年龄分布特点。随后,30名HPV16,18阳性妇女和30名阴性妇女的男性性伴侣被邀请进行了HPV16,18检测。结果本地区HPV16,18现患率为10.4%（38/367）。感染妇女其男性伴侣感染率为13.3%（4/30）,与对照组非感染妇女的男性伴侣的感染率0（0/30）相比,有显著性差异（P=0.019,单侧检验）。结论367例育龄妇女分泌物HPV16,18检测阳性率为10.4%,男性性伴侣的感染率为13.3%。     

音乐治疗团体干预在改善养老院老年人身心健康中的作用

目的:探讨音乐治疗团体干预对养老院老年人身心健康的干预效果以及性别、年龄、文化程度对干预效果的影响。方法:在河北衡水市选取两所养老院199名60岁及以上老年人,一所养老院的参与者为干预组(97人),接受音乐治疗团体干预,另一所养老院的参与者为对照组(102人),接受常规身心保健宣教。采用《老年人身心健康问卷》进行前测,并在干预结束2个月后进行追踪后测。结果:干预组与对照组的身心健康量表总分的后测与前测成绩差值有显著差异,分量表结果显示两组被试主要在身心状态、情绪状态、社会适应和人际关系上有显著差异,且性别能够显著预测干预效果。结论:音乐治疗团体干预对提升老年人身心健康有显著的作用,女性比男性改善效果更明显。     

河北省手足口病病例的病原构成及EV71病毒基因特征分析

目的了解河北省不同地区、不同严重程度手足口病病例的病原构成情况及EV71病毒的基因特征。方法采集河北省不同地区的HFMD患者粪便、疱疹液、咽拭子标本进行核酸检测和病毒分离,同时结合所收集的HFMD患病例的居住地、疾病严重程度信息加以分析。选取18株EV71阳性分离株进行VP1编码区基因扩增和核苷酸序列测定和分析,与其它38株各基因型和基因亚型的EV71代表株构建系统发生树。结果2009年河北省HFMD临床诊断病例的EV阳性率为65．13％,其中以EV71为主,占阳性病例的58．0％（752／1296）。秦皇岛、邯郸、保定、邢台地区手足口病例以EV71感染为主,而衡水、沧州等地区则以CA16为主。轻型病例中EV71阳性率为37．74％,重症病例中EV71阳性率为80．64％,死亡病例检测13例,均为EV71阳性。18株EV71分离株的VP114核苷酸同源性为94．9％～99．8％,与C4亚型代表株的VP1区核苷酸同源性最高,为91．9％～99．6％。进化树结果显示,河北省EV71分离株与c4亚型代表株处于同一分支,并在C4a进化分支的不同簇中。结论2009年引起河北省手足口病流行的病原体主要为EV71和CA16。秦皇岛、邯郸、保定、邢台地区手足口病例以EV7I感染为主,而衡水、廊坊、沧州等地区则以CA16为主。EV71是重症病例的主要致病病原体。河北省EV71分离株为c4亚型C4a进化分支。     

河南省林州地区儿童肠道寄生虫感染情况调查

目的为了解林州地区儿童肠道寄生虫的感染情况,尤其是机会性致病原虫和人兽共患寄生虫的流行情况。方法2007年10月至2008年5月,对林州地区8个乡镇进行了调查。采用卢戈氏碘液染色法、饱和蔗糖溶液漂浮法、改良抗酸染色法和分子生物学方法对林州地区23个调查点的1949名15岁以下儿童进行了检测。结果寄生虫总感染率为1.33%（26/1949）,共查出6种肠道寄生虫,其中原虫和蠕虫均为3种,感染率分别为0.72%和0.62%。男女寄生虫感染率分别为1.27%（14/1103）和1.42%（12/846）,差异无统计学意义（P〉0.05）。姚村镇、城郊乡、茶店乡、临淇镇、五龙镇、东姚镇、横水镇和采桑镇儿童感染率分别为1.76%、1.42%、0.83%、2.71%、0.00%、0.74%、1.45%、0.75%和1.33%,各个乡镇之间感染率差异无统计学意义（P〉0.05）。首次摸清了林州地区儿童隐孢子虫感染的流行状况,感染率为0.15%。对分离到的1例等孢球虫进行了分子鉴定,序列分析结果显示与雀类的一种球虫Atoxoplasma sp.（AY331571）最为接近,同源性达99.4%,表明可能为鸟类粪便污染所致。结论 林州地区儿童肠道寄生虫感染率较低,但仍应进一步开展健康教育,普及卫生知识,提高自我保健意识和自我保健能力。预防寄生虫病的发生和流行。     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.     

PTEN与信号转导及肿瘤

ＴＥＮ[1] (ｐｈｏｓｐｈａｔａｓｅａｎｄｔｅｎｓｉｎｈｏｍｏｌｏｇｙｄｅｌｅｔｅｄｏｎｃｈｒｏｍｏｓｏｍｅｔｅｎ)又名ＭＭＡＣ1 [2 ] (ｍｕｔａｔｅｄｉｎｍｕｔｉｐｌｙａｄａｎｃｅｄｃａｎｃｅｒ 1 )和ＴＥＰ1 [3 ] (ＴＧＦ -βｒｅｇｕｌａｔｅｄａｎｄｅｐｉｔｈｅｌｉａｌｃｅｌｌ -ｒｉｃｈｅｄｐｈｏｓｐｈａｔａｓｅ 1 ) (以下均称为ＰＴＥＮ) ,是 1 997年由 3个研究小组先后发现的一个具有双特异磷酸酶活性的抑癌基因。ＰＴＥＮ基因异常广泛存在于人类多种恶性肿瘤 ,如恶性神经胶质瘤、前列腺癌、子宫内膜癌、黑色素瘤等…     

Beta-endorphin and drug-induced reward and reinforcement

Although drugs of abuse have different acute mechanisms of action, their brain pathways of reward exhibit common functional effects upon both acute and chronic administration. Long known for its analgesic effect, the opioid beta-endorphin is now shown to induce euphoria, and to have rewarding and reinforcing properties. In this review, we will summarize the present neurobiological and behavioral evidences that support involvement of beta-endorphin in drug-induced reward and reinforcement. Currently, evidence supports a prominent role for beta-endorphin in the reward pathways of cocaine and alcohol. The existing information indicating the importance of beta-endorphin neurotransmission in mediating the reward pathways of nicotine and THC, is thus far circumstantial. The studies described herein employed diverse techniques, such as biochemical measurements of beta-endorphin in various brain sites and plasma, and behavioral measurements, conducted following elimination (via administration of anti-beta-endorphin antibodies or using mutant mice) or augmentation (by intracerebral administration) of beta-endorphin. We suggest that the reward pathways for different addictive drugs converge to a common pathway in which beta-endorphin is a modulating element. beta-Endorphin is involved also with distress. However, reviewing the data collected so far implies a discrete role, beyond that of a stress response, for beta-endorphin in mediating the substance of abuse reward pathway. This may occur via interacting with the mesolimbic dopaminergic system and also by its interesting effects on learning and memory. The functional meaning of beta-endorphin in the process of drug-seeking behavior is discussed.     

Postinfectious immunodeficiency and autoimmunity: pathogenic and clinical values and implications

Autoimmunity is still a mystery of clinical immunology and medicine as a whole. The etiology and pathogenesis of autoimmune disorders remain unclear and, thus, are assessed as a balance between hereditary predisposition, triggering factors and the appearance of autoantibodies and/or self-reactive T cells. Among the immunological armamentarium, molecular mimicry, based on self-reactive T- and B-cell activation by cross-reactive epitopes of infectious agents, is of special value. Hypotheses regarding the possible involvement of molecular mimicry in the development of postinfectious autoimmunity are currently very intriguing. They provide new approaches for identifying etiological agents that are associated with postinfectious autoimmunity, paired microbial- and tissue-linked epitopes targeted for autoimmune reaction determination, postinfectious autoimmunity pathogenesis recognition and specific prevention, and therapy for autoimmune disorder development.     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

Tobacco and alcohol and the risk of head and neck cancer

Summary We carried out two case-control studies on the relative risk of head and neck cancer in association with tobacco and alcohol consumption. The first study carried out at the ENT Department of the University hospitals of Heidelberg and Giessen (FRG) comprised 200 male patients with squamous cell cancer of the head and neck and 800 control subjects matched for sex, age, and residential area (1:4 matching design). Of the tumour patients, 4.5% had never smoked, in contrast to 29.5% of the control group. The average tobacco and alcohol consumption of the patients was approximately twice as high as in the control subjects. The highest alcohol and tobacco consumption was observed in patients suffering from oropharyngeal cancer. Tobacco and alcohol increased the risk of head and neck cancer in a dose-dependent fashion and acted as independent risk factors. In heavy smokers (> 60 pack-years) a relative risk of 23.4 (alcohol adjusted) was calculated. Combined alcohol and tobacco consumption showed a synergistic effect. The risk ratio increased more in a multiplicative than in an additive manner. Oral and laryngeal cancer were associated with the highest tobacco-associated risk values. The highest ethanol-associated risk values were associated with oropharyngeal and laryngeal cancer. The second study was carried out at the ENT Department of the University of Heidelberg on 164 males with squamous cell carcinoma of the larynx and 656 control subjects matched for sex, age and residential area (1:4 matching design). Of the cases, 4.2% had never smoked, compared with 28.5% of the control subjects. The risk of laryngeal cancer by tobacco consumption was dose dependent, reaching a maximum value of 9.1 (adjusted for alcohol) for a consumption of more than 50 tobacco-years (TY). The relative risk of laryngeal cancer associated with alcohol intake was also dose dependent, reaching a value of 9.0 (adjusted for tobacco) for a mean daily consumption of more than 75 g alcohol. An analysis of subsite specific risks showed that heavy smokers (> 50 TY) carried a nearly ten times higher risk of supraglottic cancer than of glottic cancer. The risk of supraglottic cancer from alcohol consumption was also higher than that of glottic cancer.