一种简易的气管灌洗新方法

目的探讨一种简易的气管灌洗新方法的效果。方法 10只健康成年比格犬随机分为两组,新方法组利用无菌胶带将一次性吸痰管固定于气管插管导管的套囊上端,吸痰管另一端连接注射器组合成简单的灌洗装置,对实验犬常规经口气管插管并对球囊充气固定,调高实验台并保持头高脚低且与水平成45°的体位,利用注射器经过吸痰管注入生理盐水至气管腔内,通过反复抽吸灌洗液或左右翻身以充分灌洗气管壁后,回抽灌洗液。对照组利用支气管镜经口进入犬气管腔内并固定,用无菌注射器经过支气管镜操作管道注入生理盐水至气管腔后,立即通过负压吸引回收灌洗液。灌洗后测量外周血氧饱和度以及进行喉部和双肺听诊,并比较两种灌洗方法的灌洗液回收率、操作时间以及术后并发症等情况。结果新方法组灌洗回收率[(91.00±0.24)%]明显高于对照组[(10.20±0.27)%](t=-70.69,P<0.01);新方法操作时间[(62.20±7.48)s/次]少于对照组[(165.46±7.83)s/次](t=-20.68,P<0.01)。新方法组灌洗后未出现喉部痰鸣音、双肺啰音等术后并发症,外周血氧饱和度无明显降低,灌洗前后SpO2分别为(97.52±1.33)%和(97.46±1.12)%(t=0.31,P>0.05);而对照组灌洗后均可闻喉部痰鸣音及双肺啰音,外周血氧饱和度降低,灌洗前后SpO2分别为(96.67±1.63)%和(94.27±1.75)%(t=3.88,P<0.01)。结论经气管插管行气管灌洗的方法操作简便、高效、安全可靠,可为气管疾病的诊治以及相关的实验研究提供一种气管内灌洗的新手段。     

血清和支气管肺泡灌洗液胃泌素前体释放肽片断31-98水平与小细胞肺癌不同病理分期的关系及其临床意义

目的 探讨血清和支气管肺泡灌洗液胃泌素前体释放肽片断31-98(ProGRP)水平与小细胞肺癌(SCLC)不同TNM分期的关系及其临床意义.方法 将明确痛理组织学分型的96例SCLC患者分为3组:Ⅰ～Ⅱ期SCLC(Ⅰ～Ⅱ期)组30例,Ⅲ期SCLC(Ⅲ期)组31例,Ⅳ期SCLC(Ⅳ期)组35例,并以90例确诊的肺部良性病变患者做为对照组.采用酶联免疫吸附实验对所有患者进行血清和支气管肺泡灌洗液ProGRP检测,同时以神经元特异性烯醇化酶(NSE)做对比研究,比较血清和支气管肺泡灌洗液ProGRP水平与SCLC不同TNM分期的关系.结果 Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组和对照组血清、支气管肺泡灌洗液ProGRP水平分别为(295.33±118.56)μs/mol与(516.67±208.45)μg/mol、(421.13±196.66)μg/mol与(1170.55±414.65)μg/mol、(758.76±326.19)μg/mol与(1739.12±696.08)μg/mol和(29.68±16.32)μg/mol与(49.23±22.50)μg/mol(P均＜0.01);各组血清、支气管肺泡灌洗液NSE水平分别为(10.36±6.76)mg/mol与(16.66±11.62)mg/mol、(24.19±10.88)mg/mol与(45.47±20.74)mg/mol、(35.76±17.30)mg/mol与(65.18±29.87)mg/mol和(9.70±5.28)mg/mol与(9.70±5.28)mg/mol(P均＜0.01).血清和支气管肺泡灌洗液ProGRP和NSE水平,Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组明显高于对照组(P均＜0.01).各组血清ProGRP检测阳性率分别为60.00%、70.97%、82.86%、6.67%(P均＜0.01),支气管肺泡灌洗液ProGRP检测阳性率分别为63.33%、74.19%、85.71%、4.44%(P均＜0.01);血清NSE检测阳性率分别为23.33%、67.74%、80.00%、22.22%(P均＜0.01),支气管肺泡灌洗液NSE检测阳性率分别为26.67%、70.97%、82.86%、26.67%(P均＜0.01);Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期组支气管肺泡灌洗液ProGRP和NSE检测阳性率均高于血清检测,且均随其分期级别提升而增高;但Ⅲ期组和Ⅳ期组比较差异无统计学意义(P＞0.05).结论 血清和支气管肺泡灌洗液ProGRP及NSE检测对SCLC的诊断与TNM分期均有较大的临床价值;对不同TNM分期SCLC的诊断,支气管肺泡灌洗液ProGRP和NSE检测优于血清检测;对SCLC的早期诊断血清和支气管肺泡灌洗液ProGRP检测优于NSE.     

血清及肺泡灌洗液半乳甘露聚糖检测对非粒细胞缺乏患者侵袭性曲霉菌感染的诊断价值

目的评价血清及肺泡灌洗液(BALF)曲霉菌半乳甘露聚糖(GM)试验对非粒细胞缺乏(中性粒细胞绝对数0.5×109/L,简称非粒缺)患者侵袭性曲霉菌病(IA)的诊断价值。方法应用酶联免疫吸附法对四川大学华西医院临床怀疑IA的206例非粒缺患者定量检测血清及肺泡灌洗液半乳甘露聚糖水平,将检测结果和临床特征进行分析。参照欧洲癌症研究和治疗组织/侵袭性真菌感染协作组和美国真菌病研究组标准、美国抗感染学会指南,将临床病例分为确诊、临床诊断、拟诊和非IA组;并分析其灵敏度、特异度、阳性预测值、阴性预测值。结果临床高危IA非粒缺患者206例,其中GM试验阳性93例,灵敏度89%,特异度83%,阳性预测值86%,阴性预测值91%,约登指数为0.72,诊断符合率78%;各组肺泡灌洗液GM水平均高于血清GM水平,肺泡灌洗液GM阳性率亦高于血清GM阳性率;确诊组+临床诊断组绘制ROC曲线,曲线下面积为0.82。结论 GM对IA的非粒缺患者的早期诊断同样具有临床意义。     

支气管肺泡灌洗液对免疫功能正常肺曲霉病患者的早期诊断价值

目的探讨支气管肺泡灌洗液(BALF)对免疫功能正常患者肺曲霉病的早期诊断价值,并了解支气管肺泡灌洗术操作方法对半乳甘露聚糖(GM)试验的影响,初步探讨建立统一的检测肺泡灌洗液GM试验的支气管肺泡灌洗术及取样操作方法与流程。方法对2016年1月-2017年2月因肺部感染在该院呼吸内科诊治的患者84例,进行BALF收集。按照收集灌洗液顺序前后收集2管送检GM实验,根据结果病例组及对照组内均分为GM1及GM2亚组。根据诊断标准及分级制度,将患者分为病例组22例(包括确诊2例、临床诊断7例、拟诊13例)以及对照组62例。统计并分析病例组和对照组的GM试验结果。结果 GM1与GM2组检测的GM-I值有明显差异,且GM1的I值平均秩较高(Z=-3.98,P=0.000)。BALF-GM1界限值0.60,诊断效率最高。敏感度86.36%,特异度93.55%,阳性预测值82.61%,阴性预测值95.08%。BALFGM1的曲线下面积(0.941)明显高于BALF-GM2(0.798)。结论支气管肺泡灌洗术中收集BALF的操作顺序对BALF-GM试验I值大小存在影响,送检第1管肺泡灌洗液BALF-GM试验对肺曲霉病诊断具有更高的应用价值。     

G试验对艾滋病患者合并真菌感染的诊断价值

目的探讨G试验在艾滋病合并真菌感染中的诊断价值,为临床治疗提供依据。方法回顾性研究2017年1月至2017年12月在赣州市第五人民医院住院疑似合并真菌感染的HIV患者31例,分别进行灌洗液真菌培养、血G试验和灌洗液G试验检查。结果真菌培养、血G试验、灌洗液G试验的阳性率分别为48.4%、67.7%,和74.2%。经统计学分析,血G实验阳性率高于真菌培养阳性率,差异无统计学意义(P=0.123),灌洗液G试验阳性率高于真菌培养阳性率,差异有统计学意义(P=0.037)。两种G试验方法相比较,灌洗液G试验的阳性率高于血G试验,差异无统计学意义(P=0.576)。结论G试验检查的阳性率高于真菌培养,可以用于早期诊断艾滋病合并真菌感染。     

支气管肺泡灌洗液(1,3)-β-D葡聚糖检测对重症监护病房患者侵袭性肺部真菌感染的诊断价值

目的 探讨支气管肺泡灌洗液(BALF)检测(1,3)-β-D葡聚糖(G试验)在重症监护病房(ICU)患者侵袭性肺部真菌感染(IPFI)早期诊断及疗效判断的价值.方法 入选2010年2月至2011年8月贵阳医学院附属医院内科ICU中怀疑IPFI患者.每周2次送检BALF、血清,行G试验及BALF真菌培养和镜检,记录培养、镜检及G试验阳性率及阳性时间、G试验的结果.按IPFI诊断标准回顾性分为确诊、临床诊断、拟诊及非IPFI感染对照组.G试验检测采用鲎试剂法;G试验阳性定义为连续2次不同时间点检测值≥20 ng/L.对BALFG试验阳性的患者给予氟康唑或伊曲康唑抢先抗真菌治疗,并于治疗7d、14d行BALF及血清C试验.结果 共98例患者纳入本研究,IPFI确诊10例,BALFG试验阳性率90.0％;临床诊断29例,BALFG试验阳性率82.8％;拟诊32例,BALF G试验阳性率71.9％;非IPFI 27例,BALF G试验阳性率7.4％.针对确诊及临床诊断者,BALFG试验阳性率84.6％(33/39),血清G试验阳性率59.0％( 23/39),BALF曲霉菌培养阳性率41.0％( 16/39),BALF镜检阳性率38.5％(15/39);BALF G试验敏感性84.6％ (33/39)、特异性92.6％ (25/27)、阳性预测值94.3％(33/35)、阴性预测值80.7％(25/31),血清G试验敏感性58.9％ (23/39)、特异性88.9％ (24/27)、阳性预测值88.5％ (23/26)、阴性预测值60.0％ (24/40),二者敏感性比较差异有统计学意义(P＜0.05).BALF G试验阳性时间早于真菌培养2～8d,平均(5.35±2.26)d.56例BALF G试验阳性患者有40例完成2周抗真菌抢先治疗,31例有效,9例无效死亡,病死率为22.5％.治疗有效组BALF、血清G试验结果(ng/L)呈下降趋势(BALF:245.13±43.84、174.00±13.01、28.52±7.38,血清:93.26±18.75、72.15±12.90、37.37±10.45,均P＜0.05),治疗无效组G试验结果呈上升趋势(BALF:267.58±54.63、309.71±82.47、486.72±98.21,血清:101.58±12.75、98.07±27.45、112.07±19.21,均P＜0.05);且两组间治疗7d、14 d BALF G试验与血清G试验结果比较差异均有统计学意义(均P＜0.05).结论 BALF G试验可用于IPFI的早期诊断,且动态监测其变化对临床疗效的评价具有重要意义.     

早期气管切开对重型颅脑损伤患者肺部感染及HMGB-1、esRAGE水平的影响

目的探讨早期气管切开对重型颅脑损伤患者肺部感染及血清高迁移率族蛋白-1(HMGB-1)、内源性分泌型晚期糖基化终产物受体(esRAGE)水平的影响。方法将80例重度颅脑损伤患者随机分成早期组和对照组,两组患者均接受同样的基础治疗方案,早期组患者在入院后24h内进行气管切开。对照组患者在入院后24h后进行气管切开。比较两组患者肺部感染的发生率,比较已发生肺部感染患者的感染控制率、病死率、感染控制时间及气管切开前及手术3d后血清HMGB-1、esRAGE水平。结果早期组患者肺部感染发病率(62.5%)低于对照组患者(85.0%),差异有统计学意义(χ2=5.230,P0.05);早期组中肺部感染患者的感染控制时间(8.04±1.97)d明显快于对照组患者(13.65±2.71)d,差异有统计学意义(t=-8.782,P0.01);早期组肺部感染患者的感染控制率(88.0%)明显高于对照组患者(58.8%),差异有统计学意义(χ2=5.979,P0.05);早期组肺部感染患者的病死率(16.0%)明显低于对照组患者(47.1%),差异有统计学意义(χ2=6.202,P0.05);早期组患者的血清HMGB-1水平(65.08±6.29)mmol/L均显著低于对照组患者(71.54±5.80)mmol/L,差异有统计学意义(t=-4.077,P0.01);早期组患者的血清esRAGE水平(61.51±3.78)mmol/L均显著低于对照组患者(65.62±4.56)mmol/L,差异有统计学意义(t=-3.673,P0.01)。结论在患者入院后24h内进行气管切开能够明显控制患者肺部感染的发生率,同时能够提高肺部感染的控制率,减少肺部感染患者的病死率,显著降低血清HMGB-1、esRAGE水平。     

肺泡灌洗液基因甲基化联合癌胚抗原、气道径向超声对肺癌的诊断价值

目的探讨肺泡灌洗液(BALF)中矮小同源盒基因2(SHOX2)和RAS相关区域家族1A(RASSF1A)基因甲基化联合癌胚抗原(CEA)、气道径向超声在肺癌诊断的价值。方法选取2019年7月至2020年6月于佛山市第二人民医院就诊经胸部CT提示肺结节或占位患者114例,根据病理诊断确认肺癌62例(肺癌组),肺良性病变52例(对照组)。在气道径向超声定位后收集患者BALF样本、外周静脉血,对BALF样本进行细胞学检查及实时荧光PCR法检测SHOX2和RASSF1A基因甲基化阳性率,对外周静脉血血清CEA水平进行检测。结果肺癌组SHOX2、RASSF1A基因任一甲基化阳性40例(64.52%),阴性22例,对照组任一甲基化阳性2例(3.85%),阴性50例,差异有统计学意义(P<0.05);肿瘤直径与肺泡灌洗液甲基化阳性率呈负相关(P<0.05);23例肺癌患者肺泡灌洗液CEA水平异常20例(86.96%),CEA联合任一甲基化阳性22例(95.65%);17例对照组CEA小于5 ng/ml的12例(70.59%),CEA联合基因甲基化双阴性的11例(64.71%);49例肺癌患者气道径向超声可探及明显回音图像,其中任一基因甲基化阳性34例(71.4%),无探及回音图像有13例,其中基因甲基化阴性8例(38.4%),差异有统计学意义(P<0.05)。结论肺癌组患者经气道径向超声定位后获取的肺泡灌洗液甲基化阳性率更高。肺泡灌洗液SHOX2和RASSF1A基因甲基化联合癌胚抗原、气道径向超声有助于肺癌的早期诊断。     

早期气管镜灌洗治疗重度颅脑损伤后肺部病变

目的:探讨早期气管镜灌洗治疗重度颅脑损伤后肺部病变的临床价值.方法:102例重度颅脑损伤患者分为实验组48例和对照组54例.实验纽伤后早期加行气管镜灌洗,其他治疗措施与对照组基本相同.结果:早期行气管灌洗后,患者SpO2明显升高;实验组肺部感染发生率(46%),较对照组(79%)明显降低,差异有显著性;实验组肺部病变持续平均时间(4±2.5)d,对照组(12 ±3.6)d,差异有显著性.结论:早期支气管肺泡灌洗能有效防治重型颅脑损伤后并发肺部病变.并缩短肺部感染治愈时间.有较高的临床应用价值.     

血清抗微生物抗体检测在诊断炎症性肠病中的价值

目的探讨血清抗微生物抗体检测在诊断炎症性肠病(IBD)中的临床价值。方法选择2016年1月—2017年12月山东省平邑县人民医院收治的60例IBD患者作为观察对象(IBD组),其中包括26例克罗恩病(CD)患者(CD组)和34例溃疡性结肠炎(UC)患者(UC组);另外选择同期进行健康体检的30例正常人群作为健康体检组。对所有受试者均进行血清4项抗微生物抗体检测,对比分析检测结果。结果与健康体检组比较,IBD组患者的血清抗酿酒酵母抗体(ASCA)阳性率明显升高(61.7%比33.3%;χ~2=6.435,P=0.011),荧光假单胞菌相关序列I2抗体(anti-I2)、大肠埃希菌外膜孔道蛋白C抗体(anti-OmpC)阳性率明显降低(anti-I2:30.0%比53.3%,anti-OmpC:5.0%比43.3%;χ~2=4.632,P=0.031;χ~2=20.106,P=0.000)。在IBD患者中,CD组的ASCA阳性率较健康体检组明显升高(69.2%比33.3%;χ~2=7.180,P=0.007),CD组和UC组的anti-OmpC阳性率较健康体检组均明显降低(11.5%、0%比43.3%;χ~2=6.900,P=0.009;χ~2=18.048 9,P=0.000)。各组细菌鞭毛蛋白抗体(anti-CBirl)比较差异均无统计学意义(均P0.05)。CD组和UC组ASCA、anti-I2、anti-OmpC、anti-CBirl检测敏感度较低(CD组:69.2%、38.5%、11.5%、26.9%,UC组:55.9%、23.5%、0%、11.8%),特异度较高(CD组:64.7%、100.0%、100.0%、100.0%,UC组:84.6%、100.0%、100.0%、100.0%)。结论血清抗微生物抗体检测可辅助IBD患者的临床诊断,具有良好的应用价值。     

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.