口服Cocktail A乳酸菌制剂对人肠道乳酸菌群影响的研究

目的评价口服Cocktail A乳酸菌制剂后人肠道乳酸菌群的变化。方法用需氧和厌氧定量培养方法分离并鉴定烧伤病房中30例腹泻患者给予Cocktail A乳酸菌制剂治疗前后肠道中的细菌,并以正常健康体检者的粪便培养鉴定结果作为对照。同时对未鉴定出的细菌用16S rRNA基因进行鉴定。结果腹泻患者肠道中的菌群与健康体检者肠道中的菌群相比,乳酸菌的数量和种类少,而口服乳酸菌制剂治疗后肠道中的植物乳杆菌、明串珠球菌、戊糖片球菌、副酪蛋白乳杆菌大量增加。结论口服Cocktail A乳酸菌制剂能调节肠道的菌群失调。     

严重烧伤伴腹泻患者口服双歧杆菌制剂的疗效观察及护理

目的：观察双歧杆菌制剂治疗严重烧伤病人腹泻的作用。方法：选取烧伤后腹泻病人26例，从腹泻当天开始喂服双歧杆菌活菌制剂，于喂服前及喂服后第3天及第6天采集粪便做粪便菌群分析。另选10名健康成年人粪便标本为对照组。结果：严重烧伤后粪便菌群总菌量较正常显下降，肠杆菌轻度下降，双歧杆菌下降近1000倍，酵母样真菌显升高，说明肠道菌群发生紊乱。用双歧杆菌制剂治疗6d后腹泻均停止，肠道菌群趋向正常，与对照组和治疗前比较均存在显性差异（P＜0．05或P＜0．01）。结论：口服双歧杆菌制剂能调整肠道菌群紊乱，起到治疗腹泻的作用。注意饭后给药，低温（4℃）存放药物。     

双歧杆菌四联活菌辅助治疗对高尿酸血症的临床分析

目的 研究高尿酸血症（HUA）患者肠道菌群变化,观察双歧杆菌四联活菌制剂干预对HUA治疗效果及肠道菌群影响。方法 将100例高尿酸血症患者随机分为实验组A组和标准组B组各50例,另选择同期健康体检者50例作为对照组C组。 A、B组患者均予非布司他治疗,B组加服双歧杆菌四联活菌片,疗程为2周。测定各组治疗前后的血尿酸及粪便结果。结果 治疗前,A、B组粪便中双歧杆菌、乳酸杆菌及粪肠球菌含量明显低于正常对照组,而大肠杆菌含量明显增多（P<0.05）。治疗后A、B患者血尿酸水平明显下降,其中A组明显低于B组（P<0.05）,A组患者粪便内细菌分解尿酸量较治疗前明显升高,且与B组具有统计学意义（P<0.05）,A组粪便中双歧杆菌、乳酸杆菌及粪肠球菌含量较治疗前明显增多,且与B组存在明显统计学意义（P<0.05）。 结论 HUA治疗过程中添加双歧杆菌活菌制剂辅助治疗可明显降低血尿酸,可能与肠道细菌尿酸处理能力增强有关。     

乳酸菌对高脂血症小鼠血脂和肠道菌的影响

目的:研究功能乳酸菌制剂的降血脂作用及对肠道菌的影响。方法:建立小白鼠高脂血症动物模型;模型小鼠30只,随机分为:生理盐水组、复合乳酸菌组和辛伐他汀组,每组10只。采取灌胃处理,分别灌服生理盐水、复合乳酸菌制剂(等比例混合的植物乳杆菌、嗜酸乳杆菌和干酪乳杆菌)和降血脂药物辛伐他汀。结果:与生理盐水比较,乳酸菌和辛伐他汀药物处理显著降低了小鼠血清胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白胆固醇(HDL-C)含量(P0.05);乳酸菌处理和药物处理间TC、TG和HDL-C无显著差异。与降血脂药物相比,乳酸菌处理显著增加小鼠粪便乳酸菌数量(P0.05),降低了大肠杆菌(P0.05)和肠球菌数量(P0.01)。结论:乳酸菌制剂具有降低血脂、增加肠道有益菌数量、降低肠道有害菌数量的作用。     

乳酸菌与肿瘤防治

双歧杆菌乳杆菌是人和动物肠道中占绝对优势的生理性细菌这些细菌都能发酵糖类，并产生大量到，因此称之为 到菌。双歧杆菌等乳酸菌与机体共同构成一个整体，对维护肠道微生态平衡和健康具有重要意义。     

肠易激综合征患者肠道菌群分析及应用益生菌疗效观察

目的了解益生菌治疗肠易激综合征的疗效及治疗前后患者肠道菌群变化。方法选取符合罗马Ⅲ标准的IBS患者26例及年龄、性别相匹配的对照组25人,采用细菌培养法对肠道五种常见菌群进行定量检测,肠易激综合征(IBS)患者给予益生菌治疗,比较治疗前后患者粪便中五种常见菌群数量的变化,同时根据患者治疗前后肠道症状评分评价疗效。结果与健康对照组相比,IBS患者粪便中肠杆菌明显增加(P<0.05);双歧杆菌及乳杆菌差异数量均少于正常人群(P<0.01,P<0.05);B/E值显著低于健康对照组(P<0.01);而肠球菌和拟杆菌差异无统计学意义;治疗后粪便中双歧杆菌及乳杆菌含量均高于治疗前(P<0.01,P<0.05);B/E值增加(B/E>1)但较治疗前差异无统计学意义;肠杆菌、肠球菌、拟杆菌治疗前后差异无统计学意义。服用益生菌制剂4周后,26例IBS患者中16例有效,10例无效,有效率为62%;症状总积分显著降低(P<0.01)。结论 IBS患者存在肠道菌群异常,肠道定植抗力减弱;益生菌制剂能够增加IBS患者肠道有益菌数量,改善肠道症状。     

异基因造血干细胞移植过程中患者艰难梭菌感染与肠道微生态失调关系的临床研究

本研究探讨异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation,allo-HSCT）过程中患者艰难梭菌相关性腹泻（clostridium difficile associated diarrhea,CDAD）与肠道微生态的关系,了解肠道微生态失衡的临床特征,寻找有效防治措施,保护肠道菌群,减少细菌易位及感染的发生。对44例allo-HSCT后腹泻患者采用艰难梭菌毒素A＆B检测试剂盒进行毒素检测,采用厌氧培养方法进行艰难梭菌的分离、鉴定。对患者粪便标本进行肠道微生态研究;采用光冈复合式法对目的菌群（双歧杆菌、乳酸杆菌、类杆菌、消化链球菌、产气荚膜梭菌、肠杆菌、肠球菌、酵母菌）进行定性定量分析。结果表明：44例腹泻患者中共检测出12例艰难梭菌阳性,阳性率为27.27%;CDAD的发生与使用抗生素或化疗药物有关;CDAD患者的肠道微生态发生了明显变化,表现为乳酸杆菌、双歧杆菌、类杆菌、肠杆菌等细菌数量明显下降;对CDAD用万古霉素、甲硝唑等药物并配合给予益生菌治疗效果好,但有一定复发率（16.67%）。结论：allo-HSCT并发CDAD与肠道微生态的改变有关,应用敏感抗生素治疗的同时应积极扶植肠道菌群,这样的治疗有利于改善病情和减少复发。     

婴幼儿病毒性腹泻肠道微生态变化特点分析

目的 分析婴幼儿病毒性腹泻与肠道微生态变化的关系.方法 300例病毒性腹泻婴幼儿(腹泻组),随机分为微生态制剂治疗组(微生态制剂组)和常规收敛剂治疗组(收敛剂组);50例健康婴幼儿作为对照组;采集粪便标本进行细菌涂片革兰染色检查.结果 腹泻组婴幼儿粪便中细菌分布与对照组差异有统计学意义(P<0.05);微生态制剂组患儿腹泻持续天数少于收敛剂组(P<0.05).结论 病毒性腹泻婴幼儿肠道菌群以革兰阳性球菌为主,存在菌群失调,应用微生态制剂可缩短治疗周期.     

NEC患儿肠道菌群的优势菌属及益生菌制剂疗效分析

目的探讨新生儿坏死性小肠结肠炎(NEC)患儿肠道菌群的优势菌属及益生菌制剂的疗效。方法选取2018年2月至2020年2月于该院治疗的30例NEC患儿作为观察组,同时选取于该院体检的健康儿童30例作为对照组。比较观察组和对照组儿童肠道菌群的丰富度并分析两组儿童肠道菌群的优势菌属。采用随机数字表法,将观察组患儿分为A组及B组;A组患儿采用酪酸梭菌二联活菌散剂联合奥曲肽治疗,B组患儿仅采用奥曲肽治疗;两组患儿均治疗1周,比较两组患儿的治疗效果以及肠道菌群的差异。结果观察组肠道菌群丰富度显著低于对照组(P0.05),两组儿童的肠道细菌优势菌属条带相似度接近100%。观察组患儿双歧杆菌及大肠埃希菌呈下降趋势。经1周治疗,A组治疗总有效率显著高于B组(P0.05);治疗后,A、B两组患儿的粪便乳酸杆菌、双歧杆菌、肠球菌、真杆菌菌落数均有所升高(P0.05),且A组患儿乳酸杆菌、双歧杆菌、肠球菌、真杆菌菌落数明显高于B组。结论 NEC患儿肠道菌群中的双歧杆菌以及大肠埃希菌呈下降趋势,可通过采用益生菌制剂进行辅助治疗。     

儿童抗幽门螺旋杆菌感染治疗对肠道菌群影响的研究

目的探讨抗幽门螺旋杆菌 (helicobacter pylori,Hp)感染治疗对患儿肠道菌群的影响,为预防抗生素所致肠道不良反应提供实验依据。方法收集2013年12月～2014年7月在陕西省人民医院消化内科、儿科共60例患儿,对Hp阳性患儿使用克拉霉素片、阿莫西林／克拉维酸钾片和奥美拉唑肠溶胶囊抗Hp菌治疗10天后,留取新鲜粪便标本进行肠道菌群分析。分别称取患儿治疗前后的新鲜粪便1.0 g,进行肠道菌群培养,鉴定肠道菌群的菌种,将其数量和检出率等观察指标进行统计学分析。结果肠杆菌、肠球菌、双歧杆菌、类杆菌和乳杆菌在抗Hp感染治疗前后患儿肠道的检出率均为100%。治疗后双歧杆菌、乳杆菌数量下降,差异有统计学意义(t=44.745～49.19,P<0.01),其余肠杆菌、肠球菌、类杆菌、产气荚膜梭菌和酵母菌五类菌种治疗前后的数量差异无统计学意义(P>0.05)。治疗后患儿肠道微生物定植抗力值(B/E值)0.69±0.33,较治疗前1.18±0.44降低(t=7.715,P<0.05)。结论抗Hp感染治疗易引起患儿双歧杆菌和乳杆菌菌群紊乱,患儿肠道定植抗力降低。故抗菌药物治疗Hp感染时须注意及时补充以双歧杆菌和乳杆菌为主要成分的益生菌制剂。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."