人巨细胞病毒感染对非特异性下腰痛患者内皮功能的影响

目的探讨内皮功能异常与人巨细胞病毒(HCMV)感染致非特异性下腰痛(NLBP)的关系,及其在NLBP发病中的作用。方法NLBP组50例,对照组36例,检测尿沉渣HCMV-DNA和包涵体,外周血HCMV-IgM、IgG和内皮素水平。结果NLBP组尿HCMV-DNA和包涵体,血HCMV-IgM、IgG阳性率高于正常对照组(P<0·05)。NLBP组内皮素水平增高(P<0·05)。结论NLBP常伴有HCMV感染及内皮功能异常。     

儿童特发性血小板减少性紫癜与人类巨细胞病毒感染

目的为探讨特发性血小板减少性紫癜（ITP）与人类巨细胞病毒（HCMV）感染之间的关系，采用非抗凝血清用ELISA方法检测CMV—IgM及清洁晨尿用聚合酶链反应（PCR）方法测定HCMV—DNA含量。结果显示36例ITP患者中，HCMV—DNA阳性者17例，阳性率47．2％，儿童保健门诊正常体检儿童对照组28例，HCMV—DNA阳性者4例，阳性率14．3％，P〈0．01，差异有显著性。ITP患者CMV—IgM阳性者8例，阳性率22．2％，儿童保健门诊正常体检儿童对照组中CMV—IgM阳性者0例。P（0．01，差异有显著性。结论HCMV感染与ITP密切相关。     

首发精神分裂症患者弓形虫感染情况及其对精神症状的影响

背景：弓形虫感染被认为至少与部分精神分裂症的发生有关，不少临床和实验性研究支持该假说。目的：调查首发精神分裂症患者及其母亲弓形虫抗体阳性率，比较弓形虫抗体阳性与阴性患者在临床表现上的区别。设计：采用成组病例对照观察。单位：武汉大学人民医院精神卫生中心。对象：选择2000-01／2004-12武汉大学人民医院精神科住院600例精神分裂症患者为精神分裂症组，患者家属同意参加此调查。选择同期本院参加健康体检的、无任何躯体疾病和精神障碍的正常人200人为正常对照组。选择本院内外科住院的、精神健康的躯体疾病患者200例为疾病对照组。收集252份精神分裂症患者母亲的血样本。方法：①采用酶联免疫法检测血清样本中弓形虫IgG，IgM抗体的水平。②在患者人院两三天后作30～40min的半结构式晤谈，结合患者家属和管床医师提供的有关资料，记录患者的精神障碍家族史、病程、受教育程度、发病年龄、母亲年龄、居住地区。③精神症状评定采用阳性与阴性症状量表，该量表包括阳性症状量表7项（分别为妄想、概念紊乱，幻觉行为、兴奋、夸大、多疑／被害、敌对性），阴性症状量表7项[分别为情感迟钝、情绪退缩、（情感）交流障碍、被动／淡漠社交退缩、抽象思维困难、交谈缺乏自发性和流畅性、刻板思维]和一般精神病理量表16项（分别为关注身体健康、焦虑、自罪感、紧张、装相和作态、抑郁、动作迟缓、不合作、不寻常思维内容、定向障碍、注意障碍、判断和自知力缺乏、意志障碍、冲动控制障碍、先占观念、主动回避社交），共30项，及3个补充项目（分别为愤怒、延迟满足困难、情感不稳）评定攻击危险性（7项评分：1为无．7为极重度）。④计量资料差异比较采用两样本独立t检验；计数资料差异比较采用X^2检验。主要观察指标：①正常对照组、疾病对照组、精神分裂症组及其母亲弓形虫抗体阳性率比较。②弓形虫抗体阳性组和阴性组患者年龄、教育程度、病程、发病年龄和母亲年龄比较。③弓形虫抗体阳性组患者和阴性组患者精神障碍家族史阳性率、居住地区比例．母亲弓形虫抗体阳性率比较。④弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表评分结果。结果：精神分裂症组600例，正常对照组200人，疾病对照组200例，精神分裂症患者母亲252例，其中抗体阴性组患者母亲206例，阳性组患者母亲46例，均进入结果分析。①正常对照组、疾病对照组、精神分裂症组和精神分裂症患者母亲间IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异明显（P〈0．01）。②进一步X^2检验表明，正常对照组和疾病对照组IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异不明显。③精神分裂症患者母亲IgG抗体阳性率明显高于精神分裂症组和正常对照组＋疾病对照组（P〈0．05，0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．01）。④精神分裂症患者母亲IgM抗体阳性率明显高于精神分裂症组和正常对照组＋疾病对照组（P〈0．05，0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．05）。⑤分裂症患者母亲IgG抗体或IgM抗体阳性率明显高于精神分裂症组（P〈0．01）和正常对照组十疾病对照组（P〈0．01），精神分裂症组明显高于正常对照组＋疾病对照组（P〈0．01）。⑥根据患者弓形虫抗体是否阳性分组，IgG抗体或IgM抗体中任一个为阳性则为阳性组n=99），IgG和IgM抗体均为阴性则为阴性组（n=501）。弓形虫抗体阴性组和阳性组患者年龄、受教育情况、发病时间、病程、母亲年龄相近。⑦弓形虫抗体阴性组患者有精神障碍家族史的比例显著高于弓形虫抗体阳性组患者（P〈0．01）；弓形虫抗体阳性组患者的母亲IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率均高于阴性组患者（P〈0．05～0．01）；弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表、阳性症状量表、阴性症状量表、一般精神病理量表总分差异不明显。⑧弓形虫抗体阳性组阳性与阴性症状量表分量表患者兴奋、敌对、装相和作态、意志障碍、冲动控制障碍、愤怒、延迟满足困难得分明显高于弓形虫抗体阴性组（P〈0．01）；而多疑得分低于弓形虫抗体阴性组（P〈0．01）。结论：①弓形虫感染是精神分裂症的重要候选病因。②弓形虫感染与精神分裂症患者年龄、受教育情况、发病时间、病程、母亲年龄关系不大。③未感染弓形虫的精神分裂症患者有精神障碍家族史的更多，感染弓形虫的精神分裂症患者母亲感染弓形虫情况更多见。④弓形虫感染阳性的精神分裂症患者临床表现倾向于兴奋、激越和行为紊乱，对于紊乱性兴奋的精神病患者应注意其是否存在弓形虫感染。     

呼吸道合胞病毒感染大鼠肺干扰素调节因子1表达与Th1／Th2失衡的相关性研究

目的探讨呼吸道合胞病毒（RSV）感染时干扰素调节因子1（IRF-1）对辅助性T淋巴细胞（Th1／Th2）类细胞因子分泌的调控作用。方法随机将16只SD大鼠分为对照组、RSV感染组（RSV滴鼻法建立RSV感染模型）,每组8只。在第8周测定气道反应性;取肺组织苏木素伊红（HE）染色观察病理改变;通过免疫组织化学染色和蛋白质印迹（western—blot）法检测IRF-1在肺组织中的表达;酶联免疫吸附试验（ELISA）检测肺组织匀浆白细胞介素4（IL-4）和干扰素Ⅱ型（IFN-7）水平。结果RSV感染组大鼠肺部病理学切片呈现典型的过敏性炎症表现,而且RSV感染组气道阻力增高程度明显高于对照组大鼠。免疫组织化学染色RSV感染组灰度值较对照组灰度值20838±9931 vs 14514±6553,较对照组显著减低（P〈0．01）。蛋白质印迹法检测肺组织中IRF-1的表达RSV感染组积分光密度值也较对照组积分光密度值0．428±0．02 vs 0．756±0．04显著减低（P〈0．01）。RSV感染组IL-4蛋白水平较对照组明显增强（P〈0．01）,而IFN-γ蛋白水平明显减低（P〈0．01）。肺IBF-1水平与IFN-γ水平呈正相关（P〈0．01）,与IL-4水平呈负相关（P〈0．01）,与IFN-／IL-4比值呈正相关（P〈0．01）。结论RSV感染可以下调IRF-1在肺组织中表达,并可能与Th1／Th2的免疫失衡有关。     

病毒性肝炎患者血脂水平观察

目的：了解病毒性肝炎患者的血脂水平。方法：将90例患者分两组，38例血清抗-HCV抗体阳性患者为HCV感染组，52例血清HBsAg阳性携带者为HBV感染组。结果：（1）HBV感染组和HCV感染组的血清总胆固醇水平[分别为（3．91±3．75）mmol／L；（3．54±3．94）mmol／L]均比正常对照组低，存在显著差异（P〈O．05）；甘油三酯水平[分别为（1．25±0．35）mmol／L；（1．44±0．4）mmol／L]均比正常对照组高，且存在显著差异（P〈O．05）。（2）HCV感染组的总胆固醇比HBV感染组的低（P〈O．05），比甘油三脂的水平要高（P〈O．05）。（3）HDL-CH、LDL-CH浓度两组间无显著差异（P〉0．05），与正常对照组也无显著差异（P〉0．05）。结论：病毒性肝炎患者依其感染病毒的不同而血脂水平有差异。     

肺癌与幽门螺杆菌感染相关性研究

目的探讨肺癌与幽门螺杆菌（Hp）感染的关系。方法用酶联免疫吸附试验（ELISA）检测方法，对50例肺癌患者和50例非肿瘤患者进行血清幽门螺杆菌血清学抗体（Hp-IgG）和幽门螺杆菌细胞毒素相关蛋白抗体（Hp-CagA-IgG）检测。结果①肺癌组Hp-IgG阳性率92．0％，平均抗体水平250．714U／ml。显著高于对照组的阳性率44．0％（P〈0．01）和平均抗体水平77．674U／ml（P〈0．01）。②肺癌组Hp-CagA-IgG阳性率88．0％，显著高于对照组的阳性率20．0％（P〈0．01）。③鳞癌Hp-IgG平均水平（322．10U／ml），明显高于腺癌和小细胞癌（163．92U／ml、196．66U／ml）（P〈0．05）。结论肺癌与Hp感染密切相关，鳞癌平均Hp-IgG水平明显高于腺癌和小细胞癌。     

老年脑梗死患者肺炎衣原体感染与血脂关系的研究

目的探讨老年脑梗死患者肺炎衣原体（Cpn）感染与血脂的关系。方法采用微量免疫荧光法检测老年脑梗死组88例及对照组80例外周血CpnIgG抗体，同时测定血脂。结果脑梗死组及对照组血清CpnIgG抗体阳性率分别为79．5％及47．8％，差异有统计学意义（P〈0．01），脑梗死组血脂总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白A（apoA）显著高于对照组（P〈0．01），而高密度脂蛋白胆固醇（HDL—C）脑梗死组显著低于对照组（P〈0．01）；Cpn感染者特异性抗体IgG滴度与血中TG、LDL—C及apoA有明显相关性（r分别为0．47、0．65和0．43），而与HDL—C成负相关（r=-0．81）（P〈0．01）。结论Cpn感染可能是老年患者脑梗死的一个重要发病机制之一，Cpn可能通过影响脂质代谢在脑梗死的发生、发展中起作用。     

疼痛教育项目提高癌症患者疼痛治疗效果的有效性评价

目的：确定疼痛教育项目对减轻患者对疼痛治疗的顾虑、提高遵医行为，从而提高疼痛缓解程度及对疼痛治疗的满意程度的有效性。方法：对112例癌症疼痛患者开展疼痛教育，对比干预前后患者对疼痛治疗的顾虑和遵医行为的变化，对比干预前后患者的疼痛缓解程度及对疼痛治疗的满意度的变化。结果：与疼痛教育前比较，教育后患者对疼痛治疗的总体顾虑水平明显减低（P〈0．01）；能够完全遵医嘱用止痛药的患者比例明显增加（P〈0．01）；疼痛中度及明显缓解的患者比例增加（P〈0．01）；患者对疼痛治疗的满意度明显提高（P〈0．01）。结论：在规范化治疗的前提下，开展疼痛教育项目，可明显减轻患者对疼痛治疗的顾虑，提高其治疗依从性，从而保证疼痛治疗的顺利进行，对临床癌症疼痛控制起积极的促进作用。     

可溶性CD14和HCMV感染与冠心病病情变化关系

目的探讨可溶性CD14（sCD14）和人巨细胞病毒（HCMV）感染与冠心病（CHD）病情变化的关系。方法应用ELISA法测定120例CHD病人血清sCD14和HCMV—IgG的浓度,其中急性心肌梗死（AMI）、不稳定型心绞痛（UAP）和稳定型心绞痛（SAP）病人各40例,并与40例健康体检者（对照组）进行比较。结果AMI、UAP与SAP组SCD14和HCMV—IgG的浓度均显著高于对照组,差异有显著意义（F=132．94、49．07,q=9．70～27．58,P〈0．01）。AMI、UAP与SAP病人sCD14和HCMV-IgG比较,差异有显著性,且以AMI病人增高最明显（q=2．92～17．88,P〈0．05、0．01）。结论血清sCD14浓度升高和HCMV感染程度可能与冠状动脉病变程度有关,对冠状动脉病变程度有预测价值。     

肥大细胞及其脱颗粒在幽门螺杆菌相关性胃炎中的作用

目的：探讨肥大细胞（MC）在幽门螺杆菌（Hp）相关性胃炎中的作用。方法：选择200例慢性胃炎患者，取胃窦黏膜进行HE染色及Hp检查，计算黏膜及黏膜下的完整和脱颗粒MC数。结果：Hp阳性组黏膜内MC脱颗粒者多于Hp阴性组（P〈0．01）；MC计数在活动性炎症组高于非活动性炎症组（P〈0．01）。结论：MC可能在Hp相关性胃炎的发生中起着重要作用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.