卵巢癌患者外周血调节性T细胞与TGF-β、IL-10检测及其临床意义

目的探讨卵巢癌患者手术前后及化疗前后外周血CD4~+CD25~+调节性T细胞(Treg)比例,与TGF-β1、TGF-β2、IL-10含量变化的意义。方法收集30例卵巢癌患者手术前后及化疗后的外周静脉血。采用流式细胞术检测外周血Treg比例;用ELISA法检测血清中细胞因子TGF-β1、TGF-β2、IL-10的含量,并以同期30例健康体检者为对照组。结果与健康对照组比较,卵巢癌患者CD4~+CD25~+CD127LOW占CD4~+T淋巴细胞的比率、CD4~+CD25~+Foxp3~+占CD4~+T淋巴细胞比率及TGF-β1、IL-10含量明显增高、TGF-β2明显降低,差异有统计学意义(P0.01),手术后及化疗后外周血CD4~+CD25~+CD127LOW占CD4~+T淋巴细胞的比率分别为[(1.610±0.465)%],[(1.182±0.195)%],[(1.033±0.210)%];CD4~+CD25~+Foxp3~+占CD4~+T淋巴细胞比率分别为[(2.305±0.77)%],[(1.573±0.45)%],[(0.986±0.37)%];细胞因子TGF-β1含量分别为(425.1±239.8)pg/ml,(287.5±239.8)pg/ml,(196.7±192.5)pg/ml;TGF-β2含量分别为(47.76±25.36)pg/ml,(32.22±17.81)pg/ml,(19.59±13.15)pg/ml;IL-10含量分别为(42.13±61.22)pg/ml,(17.34±11.21)pg/ml,(9.67±4.05)pg/ml,手术后及化疗后卵巢癌患者CD4~+CD25~+CD127LOW占CD4~+T淋巴细胞的比率、CD4~+CD25~+Foxp3~+占CD4~+T淋巴细胞比率及TGF-β1、TGF-β2、IL-10的含量较术前明显减低(P0.01)。结论卵巢癌患者手术后及化疗后外周血CD4~+CD25~+CD127LOW占CD4~+T淋巴细胞的比率、CD4~+CD25~+Foxp3~+占CD4~+T淋巴细胞比率及血清中细胞因子TGF-β1、TGF-β2、IL-10水平明显降低,动态监测它们的水平变化可作为评估卵巢癌患者免疫功能的可靠指标,对其辅助诊断及疗效观察的评价具有重要临床意义。     

卵巢子宫内膜异位症女性AMH与免疫水平的研究

目的探究子宫内膜异位症(EMT)女性抗苗勒管激素(AMH)水平与免疫水平。方法选择2015年12月至2017年6月该院收治的EMT患者49例作为观察组,其中Ⅰ~Ⅱ期20例,Ⅲ~Ⅳ期29例,对照组为同期住院因输卵管因素不孕行腹腔镜手术患者48例。采用酶联免疫吸附试验(ELISA)法检测2组患者血清AMH水平,利用流式细胞仪检测外周血免疫调节细胞Th17、Treg占CD4~+ T细胞比例;ELISA法检测血清及腹腔液的白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。结果观察组AMH水平低于对照组,且随年龄增长,AMH呈下降趋势;观察组患者Th17所占CD4~+ T细胞比例水平明显高于对照组[(2.18±0.67)%],且Ⅲ~Ⅳ期患者[(6.74±2.32)%]高于Ⅰ~Ⅱ期[(4.61±0.79)%]、Treg所占CD4~+ T细胞比例低于对照组[(6.28±1.25)%],且Ⅲ~Ⅳ期患者[(3.09±1.13)%]低于Ⅰ~Ⅱ期[(5.64±1.02)%],观察组Th17/Treg高于对照组(P0.05);血清及腹腔液炎性因子IL-6、TNF-α高于对照组(P0.05)。结论 EMT患者体内AMH水平随年龄增长逐渐下降,免疫调节细胞Th17及Treg存在紊乱现象。     

免疫性血小板减少症患者外周血中滤泡辅助性T细胞和IL-21的水平及临床意义

目的探讨滤泡辅助性T细胞(Tfh细胞)和IL-21在免疫性血小板减少症(ITP)中的作用。方法采集15例ITP患者及20例健康对照者外周血,用流式细胞术检测外周血单个核细胞(PBMC)中CXCR5+CD4+Tfh细胞的百分率,ELISA法检测血清IL-21水平;用实时荧光定量PCR检测PBMC中IL-21 mRNA的表达。结果 ITP组PBMC中CXCR5+CD4+Tfh细胞比例(17.55±1.015)%显著高于健康人对照组(10.19±0.343)%,差异有统计学意义(t=7.657,P0.01);ITP组血清中IL-21水平(100.7±3.71)pg/mL显著高于健康人对照组(64.6±0.81)pg/mL,差异有统计学意义(t=10.84,P0.01),且两者之间存在明显相关性(r=0.689 3,P0.01)。ITP患者IL-21 mRNA的相对表达量4.319±0.767明显高于健康人对照组1.125±0.052,差异有统计学意义(t=4.813,P0.01)。结论 ITP患者外周血Tfh细胞比例、IL-21水平及IL-21 mRNA表达均增高,可能在ITP的发病机制中发挥重要作用。     

骨髓中CD4+CD25highFoxp3+调节性T细胞与儿童急性B淋巴细胞白血病的相关性研究

目的通过检测急性B淋巴细胞白血病(B-ALL)患儿骨髓中叉状头/翅膀状螺旋转录因子(Foxp3)mRNA的表达及CD4+细胞中调节性T细胞(Treg)比例,探讨Treg与儿童B-ALL发生及预后的关系。方法用实时定量聚合酶链反应(PCR)检测10名正常儿童、35例初发B-ALL患儿及68例临床缓解患儿骨髓中Foxp3mRNA水平;用流式细胞术检测上述骨髓标本中CD4+CD25highFoxp3+Treg的比例;利用酶联免疫吸附试验(ELISA)检测骨髓中细胞因子白细胞介素10(IL-10)的表达情况。结果骨髓中Foxp3 mRNA表达水平在B-ALL初发患儿组是对照组的4.44倍,微小残留病(MRD)阳性组是阴性组的2.39倍;B-ALL初发患儿骨髓中Treg占CD4+T淋巴细胞的比例[中位数(M)=12.77%]较对照组(M=8.09%)增高,差异具有统计学意义(P<0.01);MRD阳性组Treg比例(M=14.74%)与MRD持续阴性组(M=11.30%)比较,差异具有统计学意义(P<0.05)。治疗后MRD阳性组骨髓中IL-10水平[(24.69±11.73)pg/mL]显著高于MRD持续阴性组[(9.19±5.82)pg/mL,P<0.05]。结论 B-ALL初发和MRD阳性患儿骨髓中Foxp3 mRNA水平和Treg比例显著增高,且骨髓中IL-10水平与Treg的比例变化趋势相一致。Treg可作为评价B-ALL患儿预后和复发的指标,Treg可能是通过分泌抑制性细胞因子IL-10而发挥其抑制作用。     

外周血T淋巴细胞亚群和细胞因子在儿童肺炎支原体肺炎诊断中的意义

目的探讨外周血T淋巴细胞亚群(CD4~+、CD8~+T细胞)及细胞因子[白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子(TNF)-α]在儿童肺炎支原体肺炎(MPP)诊断中的意义。方法采用流式细胞仪和酶联免疫吸附试验(ELISA)分别检测153例MPP患儿(疾病组)和122例健康儿童(对照组)外周血CD4~+、CD8~+T细胞比例,IL-6、IL-8、IL-10和TNF-α水平,并对疾病组治疗前、治疗后及疾病组并发胸腔积液伴肺纤维化(纤维化组)与不伴有肺纤维化(非纤维化组)数据进行统计分析。结果疾病组治疗前外周血IL-6、IL-8、IL-10和TNF-ɑ水平及CD8~+T细胞比例均显著高于治疗后和对照组,CD4~+T细胞比例和CD4~+/CD8~+均低于治疗后和对照组,差异有统计学意义(P0.05)。疾病组治疗后外周血IL-6、IL-8、IL-10水平高于对照组,CD4~+、CD8~+T细胞比例低于对照组,差异有统计学意义(P0.05)。纤维化组外周血IL-6、IL-8、IL-10水平和CD8~+T细胞比例高于非纤维化组,CD4~+T细胞比例和CD4~+/CD8~+低于非纤维化组,差异有统计学意义(P0.05)。受试者工作特征曲线表明,IL-6和IL-8辅助诊断肺纤维化的敏感性和特异性较高,敏感性分别为100.0%和92.6%,特异性分别为95.6%和93.0%。结论联合检测外周血CD4~+、CD8~+、CD4~+/CD8~+比例及细胞因子IL-6、IL-8、IL-10和TNF-α水平有助于全面了解MPP患儿治疗前、后免疫功能的变化。外周血IL-6和IL-8最有助于MPP患儿肺纤维化的辅助诊断。     

间充质干细胞调控趋化因子配体2对系统性红斑狼疮作用的机制探讨

目的:探讨趋化因子配体2[chemokine(C-C motif)ligand 2,CCL2]在间充质干细胞(mesenchymal stem cells,MSCs)移植治疗系统性红斑狼疮(systemic lupus erythematosus,SLE)中的作用。方法:采用酶联免疫吸附试验检测SLE患者及正常对照者的血清、尿液及骨髓MSCs培养上清中的CCL2及白细胞介素(interleukin,IL)-17的表达水平,并采用流式细胞术检测外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)中Th17-CD4+IL-17+的百分率及其表面CCR2的表达。将18只雌性MRL/lpr SLE小鼠随机分为SLE小鼠组(n=6)(未治疗组)、脐带MSCs移植联合CCL2中和抗体治疗SLE小鼠组(n=6)及脐带MSCs移植联合同型对照IgG2B治疗SLE小鼠组(n=6),另选6只同周龄雌性C57BL/6小鼠作为健康阴性对照组。采用酶联免疫吸附试验检测各组血清CCL2及IL-17的水平,流式细胞术检测各组PBMCs中CD4+CCR2+IL-17+细胞百分率。结果:SLE患者血清[(839.0±160.5)pg/mL]、尿液[(881.8±162.7)pg/mL]及骨髓MSCs培养上清[(22 935±2 304)pg/mL]的CCL2含量均显著高于正常对照者[(433.0±31.0)pg/mL、(222.7±52.8)pg/mL、(8 394±5 125)pg/mL];SLE患者PBMCs中CD4+CCR2+IL-17+细胞百分率较正常对照者显著升高(P<0.01)。脐带MSCs移植联合CCL2中和抗体治疗SLE小鼠组血清CCL2浓度显著低于未治疗组,PBMCs中CD4+T细胞亚群IL-17、CCR2表达较未治疗组显著降低。结论:MSCs移植治疗SLE的效果可能通过抑制CCL2表达,进而下调患者Th17细胞水平来实现。     

Graves病患者CD3~+CD56~+自然杀伤T细胞及其分泌的细胞因子表达研究

目的探讨CD3~+CD56~+自然杀伤T细胞(natural killer T cell,NKT)及其分泌的白细胞介素(interleukin,IL)-2、IL-6、IL-10、IL-12、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)等细胞因子和血清游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、促甲状腺激素(thyroid stimulating hormone,TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)和促甲状腺素受体抗体(thyrotrophin receptor antibody,TRAb)水平在Graves病患者体内表达情况。方法 Graves病患者30例为观察组,同期体检健康者30例为对照组,检测2组外周血CD3~+CD56~+NKT占淋巴细胞比率、CD3~+CD56~+NKT分泌的细胞因子IL-2、IL-6、IL-10、IL-12、TNF-α水平及血清FT_3、FT_4、TSH、TPOAb、TGAb、TRAb水平。结果观察组CD3~+CD56~+NKT占淋巴细胞总数比率[(1.37±0.43)%]低于对照组[(2.47±0.39)%](P0.05);观察组血清FT_3[(23.76±5.51)pmol/L]、FT_4[(88.29±31.35)pmol/L]、TSH[(1.68±1.01)mu/L]、TPOAb[(293.58±141.32)u/mL]、TGAb[(380.58±215.31)u/mL]、TRAb抗体[(10.75±8.23)u/mL]水平均高于对照组[FT_3(4.79±0.59)pmol/L、FT_4(17.84±3.15)pmol/L、TSH(0.08±0.01)u/L、TPOAb(20.06±4.85)u/mL、TGAb(31.48±22.68)u/mL、TRAb抗体(1.21±0.23)u/mL](P0.05);观察组血清IL-6[(2.51±0.31)μg/L]、IL-10[(43.79±21.54)ng/L]、IL-12[(1 306.14±514.39)ng/L]、TNF-α[(4.38±0.66)ng/L]水平均高于对照组[(1.01±0.20)μg/L、(27.68±5.41)ng/L、(584.34±214.57)ng/L、(2.41±0.81)ng/L](P0.05);观察组IL-2表达水平[(1.26±0.43)ng/L]低于对照组[(4.81±0.71)ng/L](P0.05)。结论 Graves病患者存在免疫功能紊乱情况及免疫调节细胞失衡,通过CD3~+CD56~+NKT减少及其分泌的细胞因子调节Th1/Th2分化,参与Graves病的发病过程。     

复发性口腔溃疡患者外周血调节性T细胞和白细胞介素2水平的表达

目的研究复发性口腔溃疡(RAU)患者溃疡期外周血调节性T细胞和白细胞介素2(IL-2)的水平变化。方法收集RAU患者溃疡期和健康人外周血,采用流式细胞术分析其CD4+ CD25+ Foxp3+ T细胞比例的变化,ELISA检测IL-2的水平。结果 RAU患者外周血中调节性T细胞[(3.29±0.86)%vs.(5.67±0.99)%]和IL-2的水平[(31.12±4.71)pg/mlvs.(36.11±4.99)pg/ml]低于正常对照组(P<0.05)。结论调节性T细胞和IL-2在RAU患者外周血中表达下降,提示在RAU免疫发病机制中两者起到了重要作用。     

急性肝衰竭患儿细胞免疫及肠黏膜屏障功能临床研究

目的探讨急性肝衰竭患儿细胞免疫及肠黏膜屏障的功能变化。方法急性肝衰竭患儿30例为肝衰竭组,体检健康儿童30例为对照组,检测2组细胞免疫、调节性T细胞、血浆内毒素、二胺氧化酶水平变化。结果肝衰竭组患儿CD4~+细胞比率[(21.6±8.7)%]、CD4~+/CD8~+比值(1.33±0.42)、CD4~+CD25~+FOXP3~+调节性T细胞比率[(4.22±1.33)%]较对照组[(59.7±9.2)%、3.75±0.53、(8.35±2.89)%]明显减少(P0.01),CD8~+细胞比率[(29.8±5.4)%]、血浆内毒素[(21.71±4.47)EU/mL]、二胺氧化酶[(18.91±4.03)u/L]水平较对照组[(23.1±4.4)%、(3.10±1.73)EU/mL、(3.59±1.99)u/L]明显增高(P0.05)。结论急性肝衰竭患儿存在细胞免疫紊乱,参与肝衰竭的发生、发展,并加重肠道黏膜屏障功能受损。     

Th9、Th17、CD4~+CD25~+FoxP3~+调节性T细胞在慢性淋巴细胞白血病患者外周血中的变化

目的探讨慢性淋巴细胞白血病患者外周血中Th9、Thl7和CD4~+CD25~+FoxP3~+调节性T细胞及相关细胞因子的表达水平及意义。方法采用流式细胞仪检测36例CLL患者和45例健康对照组外周血Th9、Th17和Treg细胞的表达率,采用酶联免疫吸附方法(ELISA)检测外周血中细胞因子IL-9、IL-17、TGF-β的表达水平。结果 1)CLL组患者外周血Th9、Th17细胞比例及细胞因子IL-9、IL-17浓度均明显高于健康对照组[(1.29±0.35)%vs(0.74±0.23)%,P0.05;(2.15±0.46)%vs(1.08±0.37)%,P0.05;(24.25±7.05)%vs(16.35±5.42)%,P0.05;(11.47±3.99)%vs(7.36±2.85%),P0.05]。CD4~+CD25~+FoxP3~+细胞比例及细胞因子TGF-β浓度明显低于对照组[(4.76±0.89)%vs(7.26±1.95)%,P0.05;(3.82±1.39)%vs(6.82±2.01)%,P0.05]。2)相关性分析:患者Th9、Th17细胞比例及IL-9、IL-17浓度与淋巴细胞计数负相关(γ_s=-0.374,P=0.034;γ_s=-0.382,P=0.032;γ_s=-0.445,P=0.011;γ_s=-0.413,P=0.024);患者Treg细胞比例及TGF-β浓度与淋巴细胞计数正相关(γ_s=0.416,P=0.023;γ_s=0.403,P=0.028)。结论慢性淋巴细胞白血病患者Th9、Th17与CD4~+CD25~+FoxP3~+调节性T细胞比例失衡,血清IL-9、IL-17和TGF-β水平变化,这些原因可能参与慢性淋巴细胞白血病的免疫发病过程。     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。