Genetic diagnosis of H. pylori strains

Helicobacter pylori strains are divided into two broad families, type I and type II, based on whether or not they possess the cag pathogenicity island (cagPAI). It has been suggested that cagPAI is inherited by horizontal transfer from an unknown microorganism, and the genes of cag are thought to be encoded by a putative type IV secretory system. In addition, CagA may be delivered from attached H. pylori into the host crytoplasm by this system and is tyrosine phosphorylated in gastric epithelial cells. The phosphorylated CagA may play a crucial role in promoting the inflammatory responses of gastric mucosa. These findings suggest that type I H. pylori is a pathogenic H. pylori.     

Helicobacter pylori resistance to rifabutin in the last 7 years

A low rate of resistance (0.24%) to rifabutin was noted in Helicobacter pylori strains isolated from 414 Japanese patients. The only rifabutin-resistant strain detected showed a point mutation in the rpoB gene and was isolated from a patient with a history of rifampin treatment for pulmonary tuberculosis.     

H. pylori infection and the development of gastric cancer in Japan

In Japan, where the incidence of gastric cancer is the highest in the world due to its different health care insurance system from Europe and the US, early-stage gastric cancer is more often discovered by endoscopy. This paper describe the relationship between H. pylori infection and development of gastric cancer in Japan. Our study shows that, during the 8 year follow-up, gastric cancer developed in 36 of the 1,246 H. pylori-infected patients(2.9%), but in none of the 280 uninfected patients. In terms of the development status of gastric cancer over time, our study estimated the risk of gastric cancer in H. pylori-positive patients to be about 5% at ten years. Epidemiologically, just as cancer of the liver is closely associated with hepatitis C viral infection, a majority of gastric cancers are known to develop from the persistent inflammation of the gastric mucosa caused by H. pylori infection. It is therefore considered rare for clinical gastric cancer to develop in uninfected patients--rigorously diagnosed after taking into account the possibility of false negative results occurring in various test methods--or, in other words, in gastric mucosa having no persistent inflammation.     

我国护理教育10年研究热点回顾与分析

以“护理教育”作为检索关键词,运用文献计量学方法统计1999年-2008年收录到中国知网（CNKI）的文献,以文献的被引频次排序;分析排在前100位的文章,通过轻索有709篇文献被其他论文引用,引用频次高达3987次,我国护理教育10年研究热点包含护理教育评估及改革、学生素质教育、教学方法、临床教学、国内外护理教育比较、课程设置、学生心理行为及教学手段。     

我国护理教育10年研究热点回顾与分析

以"护理教育"作为检索     

The development of use of oral morphine within the last 10 years in Japan

Japan's national cancer relief programme was initiated with a field-test of the WHO guidelines for cancer pain management in 1982. It revealed in an excellent result that 87% of 156 cancer patients could be completely relieved of their persistent pain, but this result were ignored by most Japanese health professionals, because of their lack of interest in cancer pain relief. The WHO guidelines were published in 1986 and made quite an impact on those health professionals in Japan. In 1987, a special research team appointed by the Ministry of Health and Welfare of Japan (MOHW) initiated discussion on the philosophy of palliative care in Japan. According to the recommendations made by this research team, the MOHW established a new policy on palliative care, edited manuals on palliative care for terminally ill cancer patients which included guidelines on cancer pain management, and revised narcotics control measures by 1992 in order to much improve the accessibility of opioid analgesics to cancer patients who need them for effective pain relief. The annual consumption of morphine for medical purposes was only 65 kg in 1986 in Japan, but it rose to 973 kg in 1999. Currently, morphine is mostly given by mouth and two-thirds of morphine preparations consumed are MS Contin Tablets. However, the current morphine consumption per capita in Japan is still less than one-sixth of the consumption in the United States.In order to achieve further improvement, educational effort should be much emphasized. In the 1990s, approximately 70% of medical and nursing schools in Japan have initiated their educational curriculum for cancer pain relief and palliative care. There have been government-sponsored, medical, nursing and pharmaceutical societies-sponsored seminar courses on appropriate morphine use in cancer pain management, palliative care and opioid availability, all of which have increasingly strengthened postgraduate education.     

Characteristics and trends in macrolide resistance among Helicobacter pylori strains isolated in Bulgaria over four years.

Macrolide resistance trends were examined among Helicobacter pylori strains from 154 patients between 1994 and 1998. Applicabilities of screening agar method (SAM) and modified disk diffusion method (MDDM) were evaluated. Overall primary resistance rates to erythromycin and clarithromycin were 14.8% and 8.7%, respectively. No association was found with age, sex, and diseases. Clarithromycin-resistance rate reached 12.5% in the last 2 years. Secondary resistance to erythromycin occurred more often (in 62.5%) than to clarithromycin (in 42.9%). Therapy with spiramycin or erythromycin in four cases induced no clarithromycin resistance. These data show a considerable prevalence of H. pylori resistance to macrolides, which exhibited a tendency to increase and was often associated with metronidazole resistance. By comparing the MDDM with SAM, an overall agreement was obtained in 81 (94.2%) of 86 results. MDDM and SAM are reliable techniques for testing H. pylori susceptibility to macrolides.     

The development of cancer pain management and palliative care over the last 5 years in Japan

After the release of the World Health Organization guidelines in 1986, palliative care units (PCUs) were authorized to offer effective cancer pain management under the Japanese National Health Insurance in 1990. Although the number of PCUs increased to more than 100 during this decade, they could only cover 5% of all terminal-stage cancer patients in Japan. Due to the resistance to opioids together with the delay in establishing oncology practice, palliative care including cancer pain management was offered only to terminal cancer patients in PCUs, and cancer pain management did not improve sufficiently in general practice during the 1990s. To change the situation, the concept of hospital-based palliative care teams (HPCTs) were introduced into general hospitals and covered by the National Health Insurance in 2002. The HPCT mainly acts as a consultation team to help primary physicians or nurses who care for cancer patients in a general hospital. After the initiation of HPCTs, the role of palliative care in Japan is gradually changing because the HPCTs have been required to cover not only the terminal phase, but also overall cancer care. In addition to the spread of HPCTs, the types and formulations of opioids available and education on cancer pain management has also improved during the last 5 years. To further improve cancer pain management and palliative care in Japan, a triangle system should be established to offer seamless care in all healthcare settings based on the coordination among PCUs, general hospitals with HPCTs, and home-based care. This is referred to as a “palliative care program”.     

幽门螺杆菌粪便抗原检测法在幽门螺杆菌根除后患者中的效果

目的：探讨幽门螺杆菌（Hp）粪便抗原检测（HpSA）在Hp根除后患者中的效果,为Hp感染患者后期复查提供依据。方法选取该院2011年12月至2013年12月进行Hp根治后的170例患者进行研究,所有患者均进行14C尿素呼气试验检测HpSA,观察HpSA检测Hp的灵敏度和准确率,为Hp感染的检测提供依据。结果与14C尿素呼气试验金标准检测比较,患者治疗1周后,HpSA试验检测灵敏度为78．08％,诊断正确率为68．24％;患者治疗2周后HpSA试验检测灵敏度为74．12％,诊断正确率为54．71％;患者治疗3周后,HpSA试验检测灵敏度为46．38％,诊断正确率为47．65％。结论HpSA检测方法的诊断准确率高、灵敏度高、特异度高、适用于Hp的诊断,尤其适用于儿童、老年患者的筛查及无法开展13C或14C‐尿素呼气试验的贫困地区,且检测值不受患者是否进行治疗的影响。