医院信息系统:过去,现在,未来

长期以来,信息曾被视为一个不可避免的弊病,它存在着,但有时又使人不便得到,随着信息量的增大,信息就愈加难以组织。直到最近几年,信息才被视为一种资源,一种与医院或商业中的物资及资金同样重要的资源。用最简单的话来讲,健康护理人员应当利用所有的有用信息为其提供护理工作的行动方针,从而为病人提供最大的康复机会;数据处理专家应当使信息在健康护理人员需要时容易利用。这些就要依赖工程技术的进步来实现。     

BAFF, APRIL, TWE-PRIL: who's who?

BAFF and APRIL are two members of the TNF superfamily that have co-stimulatory activity on B cells and contribute to autoimmunity. While BAFF is processed at the cell surface, APRIL is processed inside the cell by a furin-convertase and is able to perform its function only as a soluble factor. However, APRIL can be expressed as a cell surface fusion protein with TWEAK called TWE-PRIL. BAFF can also exist as a soluble molecule and can be detected in human serum. Whether the biological functions controlled by membrane-bound BAFF differ from those triggered by soluble BAFF is unclear. In addition to this complexity, DeltaBAFF, an alternative splice isoform of BAFF shows different properties. BAFF can also, in autoimmune disease form heterotrimers with APRIL but the control and function of these heterotrimers remain unclear. In order to understand the function of these molecules we need to elucidate the complexity of the various forms of these members of the TNF family.     

Transfusion de plaquettes : produits,indications, dose,seuil, efficacité

The quality of platelet concentrates had been greatly improved since the implementation of processing techniques based on the use of the buffy-coat in the years 1980. More recently, in the last 10 years, it is in the domain of safety that the greatest advances have been done, by the introduction of platelet additive solutions, on one hand, and by the progressive availability of pathogen reduction techniques, on the other hand. These developments in quality and safety of platelet components are important, as they lead to the conclusion that nowadays, apheresis platelet concentrates and pooled random donor platelet concentrates can be considered as equivalent, the only specific indication of the former being the care of HLA or HPA allo-immunized patients. This review covers the physiological basis of prophylactic and curative platelet transfusions, and the means to evaluate their efficacy. The main investigations that are necessary to perform in the event of an inefficient prophylactic transfusion are also mentioned. Platelet transfusion is an essential part of the transfusion support in case of central thrombocytopenia, and more indications in other medical and surgical situations are well defined. The vast majority of clinical situations in which platelet transfusions are indicated have been defined in the national guidelines published in 2003 by the AFSSAPS French authority, and are still fully valid today. Therefore, only some specific domains for which recent published data are questioning our present practices are discussed, such as the use of platelet concentrates in massive transfusion. Finally, three critical factors for establishing a coherent platelet transfusion strategy are developed: the transfusion trigger for prophylactic platelet transfusion, the platelet dose, and the impact of ABO compatibility between the product and the recipient.     

基因污染:无孔不入,防不胜防

用于动植物转基因的运载体DNA中含有一段作标志用的特殊基因棗抗菌素抗性基因。这种基因的危险性一直未被充分认识。芬兰的研究人员发现，基因工程食物中存在的抗菌素抗性基因能转移到人体肠道中的细菌内。虽然还没有人报道，这种食物在人体内能使肠道菌特别是致病菌对抗菌素产     

Cancer vaccines: dream,reality, or nightmare?

Introduction. Over the past 30 years, a multidisciplinary approach com-bining surgery, chemotherapy, and radiation has led to a dramatic improvement in survival for patients affected by malignant diseases. Cellular therapies, such as stem cell transplantation, have also made a significant contribution. Nonetheless, many patients are still resistant to standard therapies, which also have high and often unacceptable acute and chronic organ toxicity, with an increased risk for secondary malignancies. Therefore new strategies are needed to improve overall survival and decrease treatment-asso-ciated morbidity. Immunotherapy represents one of the most appealing of these approaches, and active immunization in particular has proved to be amongst the most important of these new cellular strategies because of its ability to stimulate the immune system to actively recognize and kill the malignant cells. Identification of antigens expressed on tumor cells (Table 1), together with a better understanding of the molecular and cellular mechanisms involved in the immune response against cancer, have given investigators tools to manipulate the immune system to induce an efficient immune response in the tumor-bearing host [1-5]. The present review describes the approaches used in cancer vaccination that are intended not only to optimize antitu-mor immunity, but also to overcome tumor immune escape. Examples of how these approaches are being applied clinically are also given. Received: 9 September 2002 / Accepted: 23 September 2002 Correspondence to M. K. Brenner     

Interfering antiviral immunity: application, subversion, hope?

RNA interference (RNAi), initially recognized as a natural antiviral mechanism in plants, has rapidly emerged as an invaluable tool to suppress gene expression in a sequence-specific manner in all organisms, including mammals. Its potential to inhibit the replication of a variety of viruses has been demonstrated in vitro and in vivo in mouse and monkey models. These results have generated profound interest in the use of this technology as a potential treatment strategy for viral infections for which vaccines and drugs are unavailable or inadequate. In this review, we discuss the progress made within the past 2-3 years towards harnessing the potential of RNAi for clinical application in viral infections and the hurdles that have yet to be overcome.     

Bioartificial liver systems: why, what, whither?

Acute liver disease is a life-threatening condition for which liver transplantation is the only recognized effective therapy. While etiology varies considerably, the clinical course of acute liver failure is common among the etiologies: encephalopathy progressing toward coma and multiple organ failure. Detoxification processes, such as molecular adsorbent recirculating system (MARS) and Prometheus, have had limited success in altering blood chemistries positively in clinical evaluations, but have not been shown to be clinically effective with regard to patient survival or other clinical outcomes in any Phase III prospective, randomized trial. Bioartificial liver systems, which use liver cells (hepatocytes) to provide metabolic support as well as detoxification, have shown promising results in early clinical evaluations, but again have not demonstrated clinical significance in any Phase III prospective, randomized trial. Cell transplantation therapy has had limited success but is not practicable for wide use owing to a lack of cells (whole-organ transplantation has priority). New approaches in regenerative medicine for treatment of liver disease need to be directed toward providing a functional cell source, expandable in large quantities, for use in various applications. To this end, a novel bioreactor design is described that closely mimics the native liver cell environment and is easily scaled from microscopic (<1 ml cells) to clinical ( approximately 600 ml cells) size, while maintaining the same local cell environment throughout the bioreactor. The bioreactor is used for study of primary liver cell isolates, liver-derived cell lines and stem/progenitor cells.     

Thick ascending limb: the Na+:K+:2Cl− co-transporter, NKCC2, and the calcium-sensing receptor, CaSR

The thick ascending limb of Henle’s loop is a nephron segment that is vital to the formation of dilute and concentrated urine. This ability is accomplished by a consortium of functionally coupled proteins consisting of the apical Na⁺:K⁺:2Cl⁻ co-transporter, the K⁺ channel, and basolateral Cl⁻ channel that mediate electroneutral salt absorption. In thick ascending limbs, salt absorption is importantly regulated by the calcium-sensing receptor. Genetic or pharmacological disruption impairing the function of any of these proteins results in Bartter syndrome. The thick ascending limb is also an important site of Ca²⁺ and Mg²⁺ absorption. Calcium-sensing receptor activation inhibits cellular Ca²⁺ absorption induced by parathyroid hormone, as well as passive paracellular Ca²⁺ transport. The present review discusses these functions and their genetic and molecular regulation.

Familial ring (18) mosaicism in a 23-year-old young adult with 46,XY,r(18) (::p11→q21::)/46,XY karyotype, intellectual disability, motor retardation and single maxillary incisor and in his phenotypically normal mother, karyotype 47,XX,+r(18)(::p11→q21::)/46,XX

We report on a 23-year-old man with craniofacial findings of the holoprosencephaly spectrum disorder (microcephaly, hypotelorism, depressed nasal bridge, single median maxillary central incisor), fusion of C2-C3 vertebrae, intellectual disability, and severe sleep apnea. Chromosome analysis of blood lymphocytes showed 75% ring (18) cells and 25% normal cells, karyotype mos 46,XY,r(18)(::p11→q21::)[75]/46,XY[25]. His mother was phenotypically normal except for a double ureter and bifid renal pelvis as in his son. She had a supernumerary ring (18) in 10% of blood lymphocytes, karyotype mos 47,XX,+r(18)(::p11→q21::)[10]/46,XX[90]. Familial ring (18) is a rare cytogenetic abnormality. This is the first report of a mother with a supernumerary ring (18) and a son with ring (18) mosaicism. Interestingly, the son showed a true mosaicism (mixoploidy) of ring (18) and normal cells. The mother's 46,XX cells could be easily explained by mitotic instability and ring loss during cell division. However, the coexistence of ring (18) and normal cells in the son is unusual. Possibly, during early postzygotic divisions of a 47,XY,+r(18) zygote, two (possibly subsequent) genetic events could have occurred, one when one normal chromosome 18 was lost (resulting in a cell line with ring 18), and one when the ring 18 was lost (resulting in a cell line without ring, "escape to normal"). Alternatively, the zygote of the son could have been 46,XY,r(18), and postzygotic loss of the ring 18 could have resulted in monosomy 18 cells followed by duplication of chromosome 18 in these cells (a rare mechanism for cell survival previously described as "compensatory" isodisomy).     

Bimanual Fitts’ tasks: Kelso,Southard, and Goodman, 1979 revisited

The experiment was designed to replicate and extend to an integrated feedback condition the pattern of movement time results found by Kelso et al. (J Exp Psychol Hum Percept Perform 5:229–238, 1979a, Science 204:1029–1031, 1979b) where the simultaneous movement of one hand to a low ID target and the other to a higher ID target indicated “a tight coordinate coupling between the hands” (p. 229). In the present experiment, a control group was provided feedback that depicted the independent movement of the two limbs under low and higher indexes of difficulty (ID). A Lissajous group was provided integrated feedback in the form of a Lissajous plot. The results indicated a pattern of results for the control and Lissajous groups similar to that found by Kelso et al. for one and two-limb movements to the same difficulty targets. The control group also replicated the finding for two-limb movements to mixed ID tasks. However, the Lissajous group simultaneously produced disparate movement in the mixed target conditions. The results are consistent with recent findings indicating that when provided salient integrated feedback participants can effectively produce disparate movements of the two limbs.     

Sense,antisense, nonsense: where's the right way?

The application of small nucleic acids is slowly moving from chemistry and molecular biology laboratories into the clinic. However, the development of a new family of therapeutics is always difficult. Research must be performed to produce chemically compatible compounds in vivo and pharmacological investigations are necessary to precisely define the in vivo mechanisms of action of these potentially new drugs. The 2nd International Conference on Antisense Nucleic Acids: Biology, Pharmacology, Therapy held in Garmisch-Partenkirchen addressed these questions.     

共心力:概念,测量,影响因素与作用

共心力由母亲敏感性的概念发展而来,它反映了照顾者自发关注和准确理解儿童心理状态的能力。目前,研究者主要通过对照顾者的访谈以及对自由玩耍情境中亲子互动的观察来评价共心力。共心力受到照顾者依恋经历、认知能力、情绪健康状况、家庭和社会因素的影响,并在儿童的社会情感、认知和语言发展中起着重要作用。本文从共心力的概念、测量方法、影响因素及作用等方面介绍了相关研究进展。未来研究应完善共心力的测量方法,并探索共心力的发展历程、它在亲密关系中的作用及其在跨文化研究中的应用。     

Stress, social support, and cortisol: inverse associations?

An association between stress and health has been hypothesized. However, the association pathways are unclear. In this article, the authors examined the associations between stress, social support, and cortisol and the mediating effect of several psychosocial variables. Adult men and women (n = 146) completed psychosocial surveys and provided saliva samples for cortisol assessments, quarterly, for 1 year Cross-sectional analysis results showed an inverse relationship between basal cortisol and stress (Model 1: coefficient = -.068, SE = .024, p = .006). After controlling for stress, the authors also found an inverse relationship between basal cortisol and social support among individuals with high social support (upper tertile compared with 1st and 2nd tertiles) (Model 2: coefficient = -.440, SE = .155, p = .005). Longitudinal models showed similar findings for both associations. These findings do not support the general hypothesis of a negative effect of chronic intermittent stress on health through Hypothalamic Pituitary Adrenal (HPA) axis activation, but do support a positive effect of social support on the HPA axis. Both findings deserve further investigation.     

Mesh词表主题词扩展:移植,异位Transplantation,HeterotopicCSCD

In medicine a heterologous transplant means＂between species＂or＂from one species to another＂.In cell biology and protein biochemistry,     

Immune response to Salmonella: location, location, location?

Successful immunity against Salmonella infections is dependent on the generation of CD4(+) T helper cells and to a lesser extent on antibody production and CD8(+) T cells. The cells within the lymphatic tissue of the gut are likely to be central for the orchestration of a proper and rapid response. The anatomical restriction of the pathogen may also determine the distribution of effector cells. In this issue of Immunity, McSorley et al. address both of these processes using identifiable CD4 T cells that are specific for Salmonella typhimurium. Such cells localize to the Peyer's patches of the small intestine when the bacteria are delivered orally.     

Präparateverwechslungen: Ursachen, Auswirkung, Prävention

Zusammenfassung Die steigende Zahl von Gewebeentnahmen zur Diagnosesicherung hat in den letzten Jahren zu einer Vervielfachung des Probenaufkommens in Instituten für Pathologie geführt. Es wurden Kriterien und Ma?nahmen zur Qualit?tssicherung der histologischen Diagnostik entwickelt. Entsprechende Vorschriften zur Organisation der Gewebeentnahme bis zur -aufarbeitung existieren (bislang) nicht. Der Verdacht auf Gewebeverwechslungen wird sicherlich h?ufiger ge?u?ert als tats?chlich Verwechslungen auftreten. Wichtig ist, an die prinzipielle M?glichkeit einer Vertauschung zu denken, diese Bedenken dem einsendenden Arzt mitzuteilen und m?gliche Quellen für Vertauschungen weitestgehend zu beseitigen. Die zivil- und strafrechtlichen Konsequenzen einer Vertauschung, nachfolgender „falscher” Diagnosestellung und daran anknüpfender Therapiema?nahmen bilden nur den rechtlichen Hintergrund für m?glicherweise dramatische Folgen bei den betroffenen Patienten selbst. Wichtige Verwechslungsursachen und m?gliche pr?ventive Ma?nahmen werden dargestellt.