Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis

Severe infections are emerging as major risk factors for death among children with juvenile idiopathic arthritis (JIA). In particular, children with refractory JIA treated with long-term, multiple, and often combined immunosuppressive and antiinflammatory agents, including the new biological disease-modifying antirheumatic drugs (DMARDs), are at increased risk for severe infections and death. We investigated 4 persons with JIA who died during 1994–2013, three of overwhelming central venous catheter–related bacterial sepsis caused by coagulase-negative Staphylococus or α-hemolytic Streptococcus infection and 1 of disseminated adenovirus and Epstein-Barr virus infection). All 4 had active JIA refractory to long-term therapy with multiple and combined conventional and biological DMARDs. Two died while receiving high-dose systemic corticosteroids, methotrexate, and after recent exposure to anti–tumor necrosis factor-α biological DMARDs, and 2 during hematopoietic stem cell transplantation procedure. Reporting all cases of severe infections and especially deaths in these children is of paramount importance for accurate surveillance.     

Emplacing India's “medicities”

Plans for ‘medicities’, announced in the Indian press from 2007 onwards, were to provide large scale ‘one-stop-shops’ of super-speciality medical services supplemented by diagnostics, education, research facilities, and other aspects of healthcare and lifestyle consumption. Placing this phenomenon within the recent domestic and global political economy of health, we then draw on recent research literatures on place and health to offer an analysis of the narration of these new healthcare places given in promotional texts from press media, official documents and marketing materials. We consider the implications of such analytic undertakings for the understanding of the evolving landscapes of contemporary health care in middle-income countries, and end with some reflections on the tensions now appearing in the medicity model.     

Structure and agency in long-distance truck drivers’ lived experiences of condom use for HIV prevention

Condom promotion has emerged as a mainstay of targeted HIV prevention interventions in India, with its emphasis on individual behaviour change and personal responsibility. However, such approaches often do not account for marginalised populations’ structural vulnerability to HIV, arising from social, economic and political factors in the lived environment. In this paper, I use a critical health communication framework to analyse how structure and agency interact in influencing condom use among long-distance truck drivers in India. Drawing on an abductive discourse analysis of condom-use discourses among truckers and peer educators in two Indian cities, findings reveal that while truckers understand the biomedical logic of condoms as barriers, they also express anxiety about condom breakage and experience structural barriers to condom use. The paper concludes by calling for greater attention to structural vulnerabilities in future HIV prevention efforts with truck drivers.     

猕猴眼屈光生物学参数的检测

目的：观察人工繁育猕猴眼球的屈光生物学参数,为眼动物实验提供可靠的参考数据。方法采用电脑验光仪、IOL-Master、角膜超声测厚仪,对47只猕猴93眼的屈光度数、角膜曲率半径、眼轴长度、中央角膜厚度等屈光生物学参数进行测量。结果各年龄组猕猴眼中央角膜厚度比较无统计学差异（P>0.05）;眼轴长度在2.5岁以前随年龄的增长不断变长,2.5岁以后眼轴长度可能不再变化;0.5岁组角膜曲率半径最小,随年龄增长有变长趋势,1.5岁以后趋于稳定;等效球镜屈光度数越小,轴率比就越大,2.5岁~4.5岁期间轴率比维持在一个较稳定的范围。结论与人类相比,人工繁育猕猴眼中央角膜厚度更薄,眼轴长度更短,角膜曲率半径也更小,角膜曲率半径和眼轴长度的变化规律和人类接近,可作为理想的动物眼实验模型。     

Development and optimization of boswellic acid-loaded proniosomal gel

Context: Boswellic acids (BAs) are isolated from oleo gum of Boswellia serrata and are mainly used as potential anti-inflammatory, hypolipidemic, immunomodulatory, and antitumor agents. Pharmacokinetic investigations of BAs uncover its poor bioavailability through digestive system thus creates a need for improved therapeutic responses which can possibly be achieved by developing formulations through novel delivery system.

Objective: Present study was conducted to design topical BA-loaded proniosomal gel for the management of inflammatory disorders with enhanced bioavailability.

Materials and methods: Nonionic surfactant vesicles were prepared using the coacervation phase separation method. A central composite design was employed to statistically optimize formulation variables using Design-Expert software. Three independent variables were evaluated: amount of surfactant (X₁), amount of soya lecithin (X₂), and amount of cholesterol (X₃). The encapsulation efficiency percentage (Y₁) and particle size (Y₂) were selected as dependent variables.

Results and discussion: The optimum formulation (F10) displayed spherical bi-layered vesicles under transmission electron microscopy with optimum particle size of 707.9?nm and high entrapment efficiency as 98.52%. In vitro skin permeation study demonstrated the most sustained release of 84.83?±?0.153?mg/cm² in 24?h. Anti-inflammatory activity of the gel showed a significant (p < 0.001) higher percentage inhibition as compared to the marketed gel at the same dose.

Conclusion: The present study exhibited that BA-loaded proniosomal gel was better in terms of absorption, bioavailability, and release kinetics.     

普拉洛芬联合氯替泼诺治疗白内障患者术后炎症的疗效观察

目的观察普拉洛芬联合氯替泼诺治疗白内障患者术后炎症的临床疗效。方法选取2013年9月—2015年5月延安大学附属医院收治的白内障手术患者156例,随机分为对照组和治疗组,每组各78例。对照组在术后采用氯替泼诺混悬滴眼液治疗,治疗组在对照组的基础上采用普拉洛芬滴眼液治疗,给药方式均为术后一周内2滴/次,6次/d,一周后减为2滴/次,4次/d。两组均连续给药两周。比较术后第3、7、15、30天两组患者的炎症评分、眼压、黄斑中心凹视网膜厚度(CMT)以及不良反应情况。结果术后第3、7、15天,两组的炎症评分均高于术前,同组治疗前后差异均有统计学意义(P0.05);治疗组术后第3、7、15、30天的炎症评分均显著低于同期对照组,两组比较差异具有统计学意义(P0.05)。术后第7、15天,对照组的眼压均高于术前,同组治疗前后差异均有统计学意义(P0.05);治疗组术后第7、15天的眼压均显著低于同期对照组,两组比较差异具有统计学意义(P0.05)。术后第7、15、30天,两组的CMT均显著高于术前,同组治疗前后差异均有统计学意义(P0.05);治疗组术后第7、15、30天的CMT均显著低于同期对照组,两组比较差异具有统计学意义(P0.05)。治疗组和对照组的不良反应发生率分别为24.36%、44.87%,两组比较差异具有统计学意义(P0.05)。结论普拉洛芬联合氯替泼诺对白内障术后抗炎效果显著,且可以降低眼压的升高,改善黄斑中心凹视网膜厚度,安全性高,具有一定的临床推广应用价值。     

头孢他啶致中枢神经系统不良反应1例病例分析

目的:探讨头孢他啶在口腔手术术后抗感染不良反应发生的原因、机理和处置办法。方法:对1例口腔疾患患者术后输注头孢他啶后发生中枢神经系统不良反应进行分析。结果:头孢他啶不良反应发生后需及时处理,首先停药后给予对症治疗,临床药师对医师及患者进行药物不良反应的指导、教育可以起到举足轻重的作用。结论:头孢他啶致中枢神经系统不良反应较少发生,临床药师在进行临床查房过程中需注意观察,及时发现头孢他啶及其他药物不良反应发生并积极采取对症治疗。     

原发性中枢神经系统淋巴瘤16例临床分析及文献回顾

目的 探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的临床特点及诊治措施.方法 总结我院1993年7月至2005年9月收治的16例免疫正常的PCNSL患者的临床资料.结果 16例PCNSL,男11例,女5例,中位年龄52岁.就诊时主要临床表现为颅内压增高、偏瘫和癫痫,肿瘤多位于幕上的额顶颞叶.11例行手术,4例行立体定向活检,均给予放化疗,2000年1月以前的10例患者行VM-26 BCNU化疗,2000年1月以后的6例患者均给予大剂量甲氨蝶呤化疗.2000年以前的10例患者已全部死于肿瘤复发,中位生存期为16个月.2000年以后的6例患者已有3例死亡,中为生存期为29个月.结论 原发性中枢神经系统淋巴瘤是一种恶性肿瘤,无特殊临床表现和影像学特征.颅内压增高为主要表现,大剂量甲氨蝶呤化疗联合放疗治疗PCNSL有效.     

Clonidine antinociceptive activity: Effects of drugs influencing central monoaminergic and cholinergic mechanisms in the rat

Summary Clonidine is able to increase the threshold for vocalisation during stimulation and the threshold for vocalisation after withdrawal of stimulus (vocalisation afterdischarge). These effects of clonidine were investigated after treatment of rats with drugs influencing central monoaminergic and cholinergic mechanisms.Chlorpromazine, atropine and p-chlorophenyl-alanine increased the activity of clonidine at both thresholds while phenoxybenzamine and reserpine pretreatment increased the activity at the threshold for vocalisation only.Yohimbine decreased clonidine activity at both thresholds while 5-HTP and -methyl-p-tyrosine decreased the effects at the threshold for vocalisation afterdischarge. Naloxone did not change the activity of clonidine at either pain response studied.It is concluded from the present findings that influence from several neuronal systems modulate the antinociceptive action of clonidine.The inhibition of the medullary nociceptive response after clonidine might be connected to a decreased activity of noradrenergic neurons. Endogenous noradrenaline seems to be of minor importance in mediating this effect. It is moreover shown that decreased cholinergic receptor activity enhances clonidine antinociceptive action on both medullary and diencephalic-rhinencephalic pain responses. The possible involvement of serotonin in these functional responses after clonidine is also discussed.Data from this investigation was presented at the International Narcotic Research Club Conference, Airlie, Va. 1975.     

褐云玛瑙螺中枢内支配大触角肌肉神经元的分布

实验用荧光素Ｂｂ逆行追踪方法，研究了褐云玛瑙螺支配大触角肌肉活动的神经元在中枢的分布，结果表明，Ｂｂ标记神经元大多分布于同侧脑节，少量分布于侧脑节，同侧口球节，足节和侧节，Ｂｂ标记神经元大多为中小型神经元，个别属于大型神经元。