Effect on cellular recruitment and the innate immune response by combining saponin,monophosphoryl lipid-A and Incomplete Freund’s Adjuvant with Leishmania (Viannia) braziliensis antigens for a vaccine formulation

The poor immunogenicity displayed by some antigens has encouraged the development of strategies to improve the immune response and safety of vaccine candidates, resulting in an intense search for substances that potentiate vaccine response. Adjuvants have these properties helping vaccine candidates to induce a strong, durable, and fast immune response. In this study, we evaluated the specific immune response of adjuvants alone, Saponin (SAP), Incomplete Freund’s Adjuvant (IFA) and Monophosphoryl lipid-A SE (MPL-SE®) and in combination with total antigen of L. braziliensis (LB): LBSAP, LBIFA and LBMPL. The specific immune response induced by these compositions demonstrated that they were powerfully immunogenic, increasing cellular infiltration in the skin. Draining lymph nodes cultures showed that LBIFA and LBMPL have higher ability to increase the capacity of APCs to present antigens, with increased frequency of CD11c⁺CD86⁺ cells. SAP, MPL, LBSAP, LBIFA and LBMPL could activate lymphocytes increasing expression of CD69 and CD25. LBSAP group was an excellent inducer of pro-inflammatory cytokines at 24 h. At 48 h, higher cytokines production was observed in IFA, LBIFA, MPL and LBMPL groups. Our data demonstrate that LBSAP and LBMPL are potential formulations to be tested in other experimental models. Also, the data obtained could expand the knowledge about immune response after sensitization and also contribute to the development of safe, immunogenic and effective vaccines.     

Early tibial loosening of the cemented ATTUNE knee arthroplasty – Just a question of design?

BackgroundTotal knee arthroplasty is a very successful standard treatment for severe osteoarthritis. Nevertheless, the literature reports tibial debonding between implant and bone cement as well as radiolucent lines related to the tibial components of different knee systems. Regardless of cementing techniques and the influences during surgery, we examined the design of a newly developed knee system and its predecessors (Attune, Attune S+, P.F.C. Sigma, P.F.C. Sigma RP/M.B.T., all DePuy).MethodsWe investigated the dimensions of the tibial components and the fit between them and their bone bed after instrumentation in a foam material.ResultsOur results showed considerable differences for the used knee prostheses as well as their tibial instrumentation options with a corresponding risk for incomplete seating.ConclusionThe orthopedic surgeons need to be aware of these design features and the resulting increased seating resistance especially in hard and sclerotic bone.Article focusComparison of the tibial instruments and the different design options of the Attune knee system and its predecessor knee prostheses.Key messagesThe Attune implant showed incomplete seating because of too much press fit and an uneven bone quality or sclerosis can result in tilting of the tibial component.Strengths and limitationsThis is the first study investigating the Attune knee and its predecessor in terms of implant seating and press fit. The foam material is a limitation.     

不完全性脊髓损伤患者的个体化分阶段护理

目的 :探讨个体化分阶段护理模式对不完全性脊髓损伤(ISCI)患者的护理效果,为临床护理工作提供参考。方法:将我院2015年2月~2016年4月收治的60例ISCI患者随机分为对照组与观察组。对照组中女性10例,男性20例;年龄19~57岁,平均42.16±4.27岁;ASIA分级B级9例、C级10例、D级11例,脊髓损伤发生于颈段5例,胸段10例,腰段15例。观察组中女性8例,男性22例,年龄21~55岁,平均45.23±6.72岁;ASIA分级B级10例、C级8例、D级12例,脊髓损伤发生于颈段6例,胸段9例,腰段15例。两组在性别、年龄、脊髓损伤节段及ASIA分级等情况无统计学差异。观察组予个体化分阶段护理,包括对个性化分阶段的心理康复、功能锻炼与呼吸道、肠道、泌尿系管理,对照组住院期间给予常规护理。治疗前及治疗后(90d时)依次采用Zung氏抑郁自评量表(SDS)、康复效果评定表(ISNCSCI-2013)、改良Barthel指数量表分别对两组患者的心理健康状态(SDS评分)、运动和感觉功能及日常生活能力进行评估,并比较两组患者治疗过程中并发症的发生率。结果:观察组SDS评分治疗前61.51±2.3分,治疗后40.11±2.1分;对照组治疗前62.22±2.9分,治疗后50.50±3.1分。观察组运动功能评分治疗前47.8±10.2分,治疗后68.4±13.2分;对照组治疗前47.4±11.3分,治疗后60.1±13.5分。观察组感觉功能评分治疗前87.2±14.5分,治疗后102.5±19.3分;对照组治疗前88.3±14.7分,治疗后94.1±18.3分。观察组日常生活能力评分治疗前55.4±8.7分,治疗后78.1±9.5分;对照组治疗前55.2±9.2分,治疗后69.6±11.4分。观察组在心理健康状态、运动和感觉功能恢复情况及日常生活能力优于对照组(P0.05)。观察组的肺部感染(6.67%)、泌尿系感染(3.33%)、便秘并发症发生率(10%)低于对照组(分别为13.33%、16.67%及23.33%)(P0.05)。结论 :个体化分阶段护理模式对于不完全性脊髓损伤患者心理健康、功能康复及其减少并发症具有优势,值得应用推广。     

星状神经阻滞疗法联合传统针刺治疗动眼神经麻痹的临床疗效

目的探讨星状神经阻滞疗法联合传统针刺与星状神经阻滞疗法治疗动眼神经麻痹的临床疗效。方法选取2020年1—11月本院针灸科门诊及住院部、眼科门诊及住院部的60例动眼神经麻痹患者,随机分为观察组与对照组,每组各30例。对照组采用星状神经阻滞疗法,观察组在对照组基础上加用传统针刺方法,比较两组治疗后眼裂大小、眼球运动、复视评分、斜视角度、瞳孔大小、光反射指标及总有效率。结果观察组总有效率为93.3%(28/30),高于对照组的66.7%(20/30,P0.05);治疗后两组眼裂大小、眼球运动、复视评分、斜视角度、瞳孔大小、光反射均优于治疗前(P0.01)。且治疗后观察组与对照组比较,差异无统计学意义(P0.05)。结论星状神经阻滞疗法联合传统针刺能促进动眼神经麻痹的恢复,疗效优于单一星状神经阻滞疗法。     

生长抑素治疗不全性肠梗阻的临床效果研究

目的：研究生长抑素治疗不全性肠梗阻的临床效果。方法病例资料来源于整群选取该院2014年1月—2015年1月就诊的83例不全性肠梗阻患者。随机将患者分为常规组和生长抑素组。常规组常规给予抗感染、胃肠减压、禁食、纠正水电解质紊乱、酸碱失衡,并给予营养支持;生长抑素组在常规组基础上增加生长抑素治疗。比较：①临床总有效率;②急诊手术率;③患者肛门恢复排气时间、胃肠减压量的差异。结果①生长抑素组总有效率为95.24%,对比常规组临床总有效率75.61%更高,P﹤0.05;②两组肛门恢复排气时间比较,常规组为(2.39±0.77)d生长抑素组为(1.51±0.21)d,生长抑素组对比常规组肛门恢复排气时间更短,两组胃肠减压量比较,常规组为(517.39±132.57) mL/d生长抑素组为(215.51±72.61) mL/d,生长抑素组对比常规组更低,差异有统计学意义,P﹤0.05。结论生长抑素治疗不全性肠梗阻的临床效果确切,可有效改善临床症状,减少胃肠减压量,促进患者肛门排气,降低急诊手术率,改善患者预后,值得推广。     

中医内科为主治疗不完全性肠梗阻20例分析

目的：选择我所门诊不完全性肠梗阻20人,都为外院确诊转入我所门诊留观治疗人员,对其治疗方法探讨。方法：采用追踪,收集我所门诊不完全肠梗阻患者20例。采用中医内科治疗为主,部分病例辅助西医治疗。采用SPSSl2．0统计软件进行分析。结果：研究20名病例中,其中20名为不完全性肠梗阻。中医内科辅助西医治疗15名,其中痊愈为13例,痊愈率为86．7％,有效为2例,无效0例。单独中医内科治疗为5名,痊愈为4名,痊愈率80％,有效为1名。两种方式治疗无差异。结论：中医内科为主治疗肠梗阻有着较好的效果,但与单独中医内科治疗在效果方面没有差异。     

神经节苷脂对不完全性脑缺血后大脑皮层NOS阳性神经元表达的影响

目的 :探讨神经节苷脂 (GM1 )对不完全性脑缺血及再灌注不同时间后大脑皮层一氧化氮合酶 (NOS)的影响。方法 :用双侧颈总动脉夹闭加放血的方法制成大鼠不完性脑缺血及再灌注模型 ,以还原尼克酰胺腺嘌呤二核苷酸脱氢酶 (NADPH -d)组织化学方法观察缺血及再灌注后大脑皮层NOS阳性神经细胞变化及GM1 对其的影响。结果 :大脑皮层在缺血 3 0min时NOS阳性细胞数最高 ( 12 .83± 4.49) ,再灌注 2h、12h、2 4h、3d后逐渐下降 ,5天时恢复正常水平。而GM1 能防止脑缺血及再灌注后NOS阳性神经细胞变化。结论 :GM1 对大鼠不完全性脑缺血及再灌注不同时间后大脑皮层NOS的表达有抑制作用     

Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Objective

To expand access to postabortion care (PAC) services in Senegal by introducing misoprostol as a first-line treatment at the community level.

Methods

The present prospective study enrolled 481 women seeking treatment for incomplete abortion at 11 community health posts in Senegal between September 2011 and August 2012. Participants were given 400 μg of sublingual misoprostol and asked to return to the clinic 1 week later to confirm clinical status. At study completion, all women were asked to respond to a series of questions regarding their experience with this method. All care was provided by nurse midwives.

Results

All but three of the study women (99.4%; 474/477) had successful complete abortion after taking misoprostol. Almost all women were satisfied or very satisfied with the treatment (99.6%; 469/471), would select the method again if needed (98.9%; 465/470), and would recommend the method to a friend (99.8%; 468/469).

Conclusion

The results provide further evidence that 400 μg of misoprostol is highly effective for first-line treatment of incomplete abortion. Furthermore, this regimen can be fully provided by nurse midwives, and can be easily and successfully introduced in community health settings where other methods of PAC may not previously have been available. Clinicaltrials.gov: NCT01939457     

Residual SYNTAX score can predict short- and long-term outcomes in patients with STEMI

ObjectivesThe prognostic value of residual SYNTAX score (rSS) has been observed in different patient groups. However, its prognostic value has not been compared in patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsA total of 208 patients meeting the eligibility criteria were included in the study. Complete revascularisation (CR) was defined as rSS = 0 and incomplete revascularisation (IR) was defined as rSS ≥ 1.ResultsAmong the sample, 78 patients (33.3%) were included in the CR group and 130 patients (67.7%) in the IR group. One patient (1.3%) in the CR group and 8 patients (6.2%) in the IR group died by day 30 (P < 0.01). The incidence of stent thrombosis, recurrent myocardial infarction (MI) and target lesion revascularisation (TLR) was similar between the two groups. During follow-up (mean 28.8 ± 7.1 months), 2 patients (2.6%) from the CR group and 10 (7.7%) patients from the IR group died (P > 0.05). The incidence of recurrent MI (18.5% vs. 7.7%; P < 0.01) and major adverse cardiovascular events (MACE) (24.6% vs. 7.7%; P < 0.01) were significantly higher in the IR group.ConclusionrSS, which is an indirect marker of incomplete revascularisation, was independently correlated with recurrent MI and MACE after STEMI.     

小儿典型川崎病与不完全性川崎病的临床特征分析

目的 探讨小儿典型川崎病与不完全性川崎病的临床特征。方法 研究选取2012年1月~2017年1月宜宾市第二人民医院接收的76例小儿川崎病患儿为观察对象,按照入院顺序分为两组,每组38例,A组为典型川崎病患儿,B组为不完全性川崎病患儿,比较两组患儿的临床症状,实验室检查指标特征。结果 两组患儿的发热、指端脱屑、肛周脱屑等症状发生率比较,差异无统计学意义（P＞0.05）,两组患儿的血钠、Hb、ALB、ESR、ALT、PLT计数对比,差异无统计学意义（P＞0.05）,A、B组皮疹（71.1%vs28.9%）、手足水肿（78.95%vs39.47%）、卡巴红肿（13.16%vs34.21%）、球结膜充血（92.10%vs34.21%）、口腔黏膜充血（86.84%vs52.63%）、颈部淋巴结肿大发生率（73.68%vs50.00%）比较,差异有统计学意义（P＜0.05）。A组发热持续时间（9.4±0.3）d,高于B组（7.9±0.4）d;A、B两组的CRP、WBC指标则分别为[（34.3±21.4）mg/L vs（51.7±33.6）mg/L]和[（14.8±6.4）×109/L vs（19.6±5.7）×109/L],差异有统计学意义（P＜0.05）。结论 相比于典型川崎病患儿,不完全性川崎病患儿发生皮疹、卡巴红肿、手足水肿、口腔黏膜充血等症状的几率更低,且其发热症状持续时间更短,CRP水平与WBC计数更高。