维持性血液透析患者血清FGF23和Klotho水平及其与左心室肥厚的关系

目的检测维持性血液透析(maintenance hemodialysis,MHD)患者血清成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)和Klotho蛋白水平,探讨它们与左心室肥厚之间的关系。方法选取首都医科大学附属复兴医院病情稳定的MHD患者46例。采用酶联免疫吸附技术测定血清FGF23和Klotho蛋白水平。其他指标有血清全段甲状旁腺激素(i PTH)、血钙、血磷、白蛋白、B型脑钠肽、血红蛋白、肾功能等,并进行超声心动检测,根据Devereux公式计算左室质量指数(LVMI)。结果1 MHD患者血清FGF23水平为(1829.29±1947.05)ng/L,明显高于正常人水平(10.48±8.93)ng/L,差异有统计学意义(P0.01)。,MHD患者血清Klotho水平为(283.26±219.06)ng/L,明显低于同年龄正常人血清Klotho水平(1125.50±126.96)ng/L,差异有统计学意义(P0.01)。2Pearson相关分析显示,MHD患者Log Klotho与Log FGF23呈负相关(r=-0.929,P0.01)。Log Klotho和Log FGF23与超声心动图检测的各项指标无相关关系。3 MHD患者左心室肥厚的发生率为61%,LVMI与收缩压、B型脑钠肽呈正相关(P0.01)。多元逐步回归分析显示,B型脑钠肽是影响左心室肥厚的独立危险因素。结论 1 MHD患者血清FGF23水平明显升高,血清Klotho水平明显降低。2MHD患者左心室肥厚的发生率高,B型脑钠肽是影响左心室肥厚的独立危险因素,未发现血清FGF23和Klotho水平与左心室肥厚有相关关系。     

慢性肾脏病患者血清Klotho蛋白、成纤维细胞生长因子-23水平与疾病严重程度的相关性分析

目的探讨Klotho蛋白及成纤维细胞生长因子(FGF)-23在慢性肾脏病(CKD)发生、发展中的作用。方法选取2014年3月至2016年3月该院收治的160例CKD患者纳入CKD组,同时将160例健康体检者纳入对照组,对2组研究对象基本临床资料、血生化指标、血清Klotho蛋白及FGF-23水平进行对比分析。结果CKD组患者血红蛋白(Hb)、血清清蛋白(ALB)、血钙(Ca)、肾小球滤过率(GFR)、Klotho蛋白水平均低于对照组,血肌酐(Cr)、血清尿素(Urea)、血磷(P)、FGF-23水平均高于对照组(P0.05)。随着CKD患者分期的进展,Hb、GFR、Klotho蛋白水平逐渐降低,Cr、Urea、P、FGF-23水平逐渐升高(P0.05)。相关性分析发现,CKD患者血清FGF-23水平与Hb、GFR、Klotho蛋白水平呈负相关(r=-0.584、0.692、-0.724),与Cr、P、Urea呈正相关(r=0.814、0.703、0.527);血清Klotho蛋白水平与Hb、GFR水平呈正相关(r=0.612、0.685),与Cr、P、Urea、FGF-23呈负相关(r=-0.720、-0.690、-0.519、0.724)。结论高水平FGF-23及低水平Klotho蛋白不仅与CKD患者钙磷代谢紊乱有关,也与CKD患者的预后有关,可能成为CKD患者的早期生物标志物及病情的预测指标。     

血清FGF-23、Klotho蛋白与维持性血液透析患者心脏瓣膜钙化的相关性

【】 目的 探讨血清FGF-23、Klotho蛋白水平与维持性血液透析(Maintenance hemodialysis,MHD)患者心脏瓣膜钙化(Cardiac valve calcification,CVC)的相关性。方法 选取2022年1月至2023年1月期间复旦大学附属金山医院血液净化中心MHD患者共169例,采用心脏超声检查患者CVC情况。结果 169例MHD患者中CVC者共111例,罹患率为65.68%。与非CVC组相比,CVC组FGF23、β2微球蛋白、BNP水平、年龄显著高,Klotho、透前肌酐、血红蛋白、血浆白蛋白水平显著低。Pearson/Spearman相关系数分析提示FGF23、年龄、β2微球蛋白、BNP与CVC呈显著正相关,Klotho、透前肌酐、血红蛋白、Alb与CVC呈显著负相关,非条件二元Logistic回归分析显示FGF23、Klotho、年龄、β2微球蛋白是MHD患者CVC的独立危险因素。结论 MHD 患者易发生CVC,血清FGF23蛋白水平与CVC呈显著正相关,Klotho蛋白水平与CVC呈显著负相关,FGF23、Klotho、年龄、β2微球蛋白是MHD患者CVC的独立危险因素。     

运动管理联合帕立骨化醇上调血清Klotho蛋白并改善继发性甲状旁腺功能亢进症CSCD

目的探讨运动管理联合帕立骨化醇对维持性血液透析(maintenance hemodialysis,MHD患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床疗效及其对成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)-Klotho轴的影响。方法40例MHD患者随机等分为帕立骨化醇组(用药组)和运动联合帕立骨化醇组(联合组)。比较2组治疗前(0周)、治疗12周及24周血清钙(Ca)、磷(P)、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)、FGF23及Klotho水平。结果干预随着时间的推移,联合组较用药组P、iPTH水平下降(F=4.614、4.144;P=0.038、0.049),联和组Klotho蛋白升高(F=27.744;P=0.007),2组Ca、ALP、FGF23比较差异无统计学意义(F=0.004、0.379、0.115;P=0.070、0.542、0.501)。2组在干预前(0周)、干预12周、24周不同时间点上,血清P、iPTH、ALP水平有统计学差异(F=31.395、60.159、38.469,P均<0.001)且具有下降的趋势,血清Ca(F=21.368,P<0.001)、Klotho蛋白(F=5.268;P<0.001)在不同时间点上也具有统计学差异且具有升高的趋势;P、Ca、iPTH、ALP、Klotho蛋白组别与时间之间存在交互效应(F=6.013、0.208、5.321、4.618、5.813;P=0.008、0.013、0.013、0.028、0.013)。FGF23组别与时间之间无交互效应(F=2.637,P=0.645)。结论运动联合帕立骨化醇提高Klotho水平,降低P、iPTH水平进而控制SHPT进展。     

终末期肾病患者成纤维细胞生长因子23-Klotho调节轴与血管内皮功能的关系

目的探讨终末期肾病(end stage renal disease,ESRD)患者成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)-Klotho调节轴与血管内皮功能表达因子一氧化氮(nitric oxide,NO)、内皮素1(endothelin-1,ET-1)的关系。方法收集确诊为ESRD并规律行血液透析、腹膜透析治疗患者50例,同时选取正常对照组30例,利用酶联免疫吸附法检测各组血清Klotho蛋白、FGF23以及血管内皮功能表达因子NO、ET-1的表达水平,比较组间差异,并行相关性分析。结果血液透析组、腹膜透析组血清Klotho蛋白浓度分别为(59.1±21.1)U/L、(66.0±27.9)U/L,较正常对照组(107.6±17.2)U/L明显降低,差异有统计学意义(P0.01);血液透析组的FGF23、NO、ET-1的表达分别为(1 025.8±963.4)ng/L、(114.4±20.9)μmol/L、(107.5±16.9)ng/L;腹膜透析组FGF23、NO、ET-1的表达分别为(987.6±834.2)ng/L、(123.5±19.7)μmol/L、(96.5±19.1)ng/L,较正常对照组(26.6±14.4)ng/L、(38.7±17.8)μmol/L、(40.7±19.0)ng/L明显增高,差异有统计学意义(P0.01);ESRD患者血清Klotho蛋白与FGF23、ET-1呈负相关,与NO无相关性;FGF23与ET-1呈正相关,与NO无相关性。结论 ESRD患者存在血清FGF23、Klotho蛋白浓度的改变,且与血管内皮功能损伤有关。     

血清同型半胱氨酸、成纤维细胞生长因子23、klotho蛋白与血液透析患者心血管功能关系研究

目的探讨血清同型半胱氨酸(Hcy)、成纤维细胞生长因子23(FGF-23)、klotho蛋白与血液透析患者心血管疾病的关系。方法选取2014年6月-2015年5月在本院进行维持性血液透析患者共85例为研究组,同时选择进行体检的85名健康人为对照组。研究组又分为心血管功能差组(n=29)与心血管功能正常组(n=56)。所有研究对象检测采血检测空腹血糖(FPG)、血红蛋白(Hb)、白蛋白(ALB)、肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、FGF-23、Hcy和klotho蛋白水平,并比较分析。结果研究组血清ALB、Hb、HDL和Klotho蛋白含量的水平低于对照组,Cr、BUN、UA、FGF23和Hcy水平高于对照组,差异均有显著性(P0.05),两组的FPG、TC、TG和LDL的含量无显著差异(P0.05)。心血管功能差组的FGF23、Hcy含量显著高于心血管功能正常组,Klotho蛋白显著低于心血管功能正常组。结论 Hcy、FGF 23和klotho蛋白与维持性血液透析患者心血管病变有着密切的联系。     

维持性血液透析患者无症状性颈动脉硬化及其相关因素的分析

目的探讨尿毒症维持性血液透析(MHD)患者无症状性颈动脉硬化及其相关危险因素.方法选择北京友谊医院透析中心42例MHD患者(男19例,女23例)和41例健康对照者(男20例,女21例)为对照组.检测血红蛋白(Hb)、红细胞压积(Hct)、血尿素氮(BUN)、血肌酐(SCr)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、极低密度脂蛋白(VLDL)、血清白蛋白(ALB)、血钙(Ca)、血磷(P)、血糖(GLU)、C反应蛋白(CRP)、甲状旁腺素(iPTH)、血沉(ESR)、血压、Kt/V等指标.用彩色多谱勒超声测量双侧颈动脉中层厚度(CIMT)及斑块结构.结果HD患者和对照组CIMT分别是(0.67±0.13)mm和(0.43±0.05)mm,患者的CIMT较对照组明显增厚(P＜0.001),HD患者和对照组斑块发生率分别是48%和13%,HD患者斑块的出现率明显高于对照组(P＜0.001).CIMT和斑块发生率与下列因素相关:分别是年龄(r=0.39,P＜0.001),Hct(r=-0.32,P＜0.05),血浆CRP(r=0.52,P＜0.001),ESR(r=0.46,P＜0.01),ALB(r=-0.37,P＜0.05).结论尿毒症HD患者颈动脉硬化发生率明显高于正常人;除传统的危险因素外,我们认为尿毒症内环境紊乱也是加速动脉粥样硬化过程的重要因素.     

碳酸镧对非糖尿病维持性血液透析患者血管钙化的影响

目的探讨长期应用碳酸镧对非糖尿病维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化的影响及可能的机制。方法 60例非糖尿病MHD患者随机分为碳酸镧组(LC组)和碳酸钙组(CC组)各30例,治疗12个月。以多层螺旋CT评价冠状动脉钙化积分(coronary artery calcification score,CACS),比较两组患者治疗前后CACS、磷酸盐代谢、内皮素(endothelin,ET)、成纤维细胞生长因子(fibroblast growth factors,FGF-23)、基质Gla蛋白(matrix gla protein,MGP)、微炎症、血脂及营养状态相关指标变化。应用SPSS 17.0软件包进行统计学分析。结果与基线时相比,LC组12个月时血磷、血钙、FGF23、MGP均显著下降,ET显著升高(P0.05),而CC组血磷、MGP显著下降,血钙、ET显著升高(P0.05),FGF23无明显变化。12个月时两组相比,LC组血磷、血钙、FGF23明显低于CC组,MGP明显高于CC组(P0.05)而两组血压、BMI、ALB、hs CRP、Hb、i PTH、ET和血脂均无显著变化。Pearson相关分析显示两组患者CACS变化与血磷变化(r=-0.720,P=0.000)、FGF23变化(r=-0.480,P=0.000)显著负相关、与MGP变化显著正相关(r=0.600,P=0.000);而与血钙变化、内皮素变化、年龄、透析龄无明显相关(P0.05)。多元线性回归显示血磷变化、FGF23变化是CACS变化的独立影响因素。结论与碳酸钙相比,碳酸镧能延缓非糖尿病MHD患者血管钙化的进展,可能与碳酸镧能有效控制血磷、使FGF23降低及影响血清MGP水平有关。     

血液透析患者颈动脉内中膜厚度与血清高敏C反应蛋白、成纤维细胞生长因子23和klotho蛋白的相关性研究

目的 了解维持性血液透析（maintenance hemodialysis,MHD）患者颈动脉粥样硬化情况,分析该人群颈动脉内中膜厚度（carotid intima-media thickness,CIMT）与血清高敏C反应蛋白（HsCRP）、成纤维细胞生长因子23（fibroblast growth factor 23,FGF23）及Klotho蛋白水平之间的相关性.方法 选取2012年1月至6月期间在卫生部北京医院血液净化中心MHD患者共88例,根据颈动脉彩色多普勒超声检查结果分为CIMT增厚组和CIMT正常组.对CIMT增厚可能的危险因素进行分析,采用非条件Logistic回归分析进行CIMT影响因素的多因素分析.结果 88例MHD患者中CIMT增厚者共53例（60.2％）,CIMT正常者共35例（39.8％）,2组CIMT中位数分别为1.5mm和1.0mm,有统计学意义（P=0.000）.其中CIMT增厚组粥样硬化斑块发生率明显高于CIMT正常组（92.5％比65.7％,P=0.001）.CIMT增厚组平均年龄为66.64±10.61岁,CIMT正常组平均年龄为58.63±11.78岁,有统计学意义（t=3.320,P=0.001）;CIMT增厚组糖尿病患病率为37.7％,CIMT正常组糖尿病患病率为17.1％,有统计学意义（x2=4.294,P=0.038）;CIMT增厚组与正常组FGF23中位数分别为127.82 ng/L和86.74 ng/L有统计学意义（Z=-3.713,P=0.000）;2组HsCRP中位数分别为5.34mg/L和2.19mg/L,有统计学意义（Z=-3.547,P=0.000）.CIMT增厚组与正常组Klotho蛋白中位数分别为42.48 U/L和41.21U/L,2组无统计学意义（Z=-0.085,P=0.932）.非条件Logistic回归分析显示年龄、FGF23和HsCRP是CIMT增厚的独立危险因素.结论 MHD患者伴CIMT增厚者易形成动脉粥样硬化斑块.血清HsCRP、FGF23和年龄是MHD患者CIMT增厚的独立危险因素.     

维持性血液透析患者成纤维细胞生长因子23与心血管病变的临床研究

目的分析维持性血液透析(MHD)患者血清成纤维细胞生长因子23(FGF-23)与心血管病变的关系,探讨FGF-23对心血管疾病的影响机制。方法选取本院MHD患者50例,应用夹心酶联免疫吸附法(ELISA法)检测FGF-23,同时行血液生化指标、彩色多普勒超声心动图、颈部血管超声检查。结果 MHD患者血清FGF-23水平较健康对照组显著升高(P0.01)。相关性分析显示,MHD患者血清FGF-23与血清肌酐、磷、全段甲状旁腺激(iPTH)呈正相关(P0.01),与1,25-二羟维生素D3[1,25-(OH)2VitD]呈负相关(P0.01),与血清钙无关(P0.05)。心血管病变组血清FGF-23显著高于非心血管病变组(P0.01)。逐步多元回归分析显示FGF-23是颈总动脉内-中膜厚度(β=0.189,P0.01)的独立危险因素。结论 MHD患者FGF-23水平明显升高,提示其是重要的磷调节因子。FGF23与MHD患者心血管病变的发生发展密切相关。     

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。