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Analysis of First Symptoms and Emergency Diagnosis of Aortic Dissection

目的　認識主動脈夾層患者的急診癥狀，減少漏診與誤診。 方法　對2006年1月－2012年7月21例急性主動脈夾層患者的首發癥狀、輔助檢查、臨床診斷進行回顧性分析，總結誤診的原因。 結果　首發癥狀為劇烈胸痛和（或）腹痛15例（71.4%），胸悶、呼吸困難4例（19.0%），胸痛伴肢體偏癱1例（4.8%），無痛性暈厥1例（4.8%）。15例行心電圖檢查，10例（66.7%）異常；17例行急診胸部X線片檢查，7例（41.2%）異常；9例行急診增強螺旋CT檢察，均發現真假兩腔（100.0%）；10例行急診超聲心動圖檢查，8例（80.0%）見假腔形成；15例行心肌梗死3項（肌酸激酶同工酶、肌紅蛋白、肌鈣蛋白I）檢查，4例（26.7%）異常；12例行D-二聚體檢查，3例（25.0%）異常。15例急診擬診主動脈夾層，6例誤診為其他疾病。 結論　主動脈夾層臨床表現復雜，提高認識及必要的輔助檢查有助于早期診斷。

Research progress of anti-inflammatory cytokines in sepsis

Sepsis is a worldwide problem. Although there are many related researchs and animal experiments about sepsis, the mortality of sepsis is still high. In the early stage of sepsis, after the pathogenic bacteria invade the body, the immune response produced by the body promotes the synthesis and secretion of a series of cytokines. Among them, there are proinflammatory cytokines that promote inflammatory response and anti-inflammatory cytokines that inhibit inflammatory response. These cytokines interact with each other and maintain a dynamic balance in complex cell grid. This is to restore the steady state of the body after resisting and eliminating the invaders.Anti-inflammatory cytokines play an important role in it. They act on specific immune cells or immune regulatory receptors. Anti-inflammatory cytokines limit persistent or excessive inflammatory responses after killing invaders, and reduce or block pro-inflammatory cytokine activities. These anti-inflammatory cytokines also can heal body to restore the normal immune physiological level of the organism. This article will review the related research of anti-inflammatory cytokines in sepsis.

馬尿泡中毒致意識障礙一例

The clinical significance of plasma interleukin-17 in patients with acute respiratory distress syndrome

ObjectiveTo investigate the clinical signification of plasma interleukin-17 (IL-17) 1evel in patients with acute respiratory distress syndrome (ARDS).MethodsForty-five adult ARDS patients and 22 healthy controls were enrolled in this study. The plasma cytokine levels of IL-17, IL-6 and IL-10 were measured by enzyme linked immunosorbent assay. Meanwhile, the baseline data of demographic and clinical tests including oxygenation index, procalcitonin and brain natriuretic peprtide were collected, the acute physiological and chronic health Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score were recorded. The main outcome was defined as hospital mortality within 28-day follow-up.ResultsThe plasma concentration of IL-17, IL-6 were higher in the ARDS patients (P<0.05) compared with the controls and the mean levels of IL-17, IL-6 and the APACHEⅡ score and the SOFA score in the non-survivors was higher than those in the survivors (P<0.05). In particular, there was a significant correlation between the plasma levels of IL-17 and IL-6 (P<0.05). Logistic regression and COX multivariate survival analysis suggested that age and SOFA score may be prognostic factors for ARDS.ConclusionsThe plasma concentration of IL-17 is significantly increased in ARDS patients, and its expression is linearly related to the proinflammatory factor IL-6. Both are important inflammatory markers in the acute phase of ARDS and may be important disease severity and prognostic indicators in addition to age and SOFA score.