淋巴细胞亚群功能状态的影响

目的：探讨黄芪注射液对银屑病患者辅助性T淋巴细胞（Th细胞）亚群功能状态的影响。方法：对20例银屑病患者的外周血淋巴细胞体外分别经植物血凝素（PHA）和PHA＋黄芪诱导：即病例对照组和病例黄芪组,同时对10例健康志愿者外周血淋巴细胞体外经PHA诱导（即正常对照组）,各组培养48h,用ELISA法检测培养上清液中Th类细胞因子IFN-γ和IL-4含量。结果：病例对照组IFN-γ水平高于正常对照组（P〈0.05）,而IL-4水平低于正常对照组（P〈0．05）。病例黄芪组IFN-γ水平低于病例对照组（P〈0．05）,而IL-4水平高于病例对照组（P〈0．05）。结论：黄芪注射液可显著下调银屑病患者Th1亚群优势状态。促进向Th2亚群转换,改善患者Th1／Th2失衡状态,对银屑病的治疗具有重要意义。     

白细胞介素12对小鼠T淋巴细胞亚群分化的影响

目的观察白细胞介素12（IL-12）对小鼠T淋巴细胞亚群分化的影响。方法以RPMI-1640培养基培养小鼠脾淋巴细胞，实验组中加入10pg／ml和5pg／ml重组mIL-12，对照组不加，72h后以ELISA检测各组培养上清中IFN—γ和IL-4含量；流式细胞仪检测各组淋巴细胞中CD4T、CD8T细胞亚群变化。结果与对照组相比实验组脾淋巴细胞中T细胞总数、CD4T细胞比例及CD4T／CD8T比值显著增大，上清中Th1型细胞因子（IFN-γ）含量显著增加，而Th2型细胞因子（IL-4）含量则相应减少。结论IL-12可以诱导CD4T淋巴细胞亚群的分化增殖，调节Th细胞亚群平衡，使免疫应答向Th1漂移。     

体外循环中T淋巴细胞IL-4 IFN-γmRNA的表达变化及意义

目的研究体外循环（CPB）中T淋巴细胞IL-4、IFN—γmRNA的表达变化及意义。方法随机抽取年龄6-12岁先心病惠儿30例，分别于术前24h、CPB开始20min、CPB结束前、术后6h、术后24h抽取静脉血，分离T淋巴细胞．提取RNA，RT—PCR测定IL-4、IFN-γmRNA表达。结果CPB开始20min，T淋巴细胞IL-4mRNA表达明显升高，在CPB结束前达到峰值，术后24h逐渐恢复至术前水平；IFN-γmRNA表达在CPB开始20min下调，CPB结束前达到谷底，术后24h逐渐恢复至术前水平。结论CPB引起T淋巴细胞IL-4．mRNA表达上调、IFN-γmRNA下调，说明CPB可导致Th1／Th2失衡，在CPB创伤、炎性反应中可能起重要作用。     

流式微珠阵列法检测IFN-γ诱导的Jurkat细胞Th1/Th2细胞因子表达

本研究旨在探讨流式微珠阵列法检测Th1／Th2细胞因子表达及IFN-1应用于T淋巴细胞白血病治疗的临床价值。以不同浓度IFN-γ诱导培养Jurkat细胞48小时，用流式微珠阵列法检测培养上清液中IL-2、IL-6、TNF-α和IFN-γ表达，并采用流式细胞术检测膜上IL-2受体（CD25）的表达。结果表明：IFN-γ诱导Jurkat细胞IL-2和TNF-α的表达呈浓度依赖性升高，未检测到IL-6表达，CD25表达明显升高。结论：Jurkat细胞能被IFN-γ诱导高表达Th1细胞因子和CD25，流式微珠阵列法能准确客观地反映Th1／Th2细胞因子表达的动态变化。     

哮喘患者单个核细胞Th1／Th2和IFN-γ及IL-4 mRNA表达

目的探讨外周血单个核细胞Th1／Th2在哮喘发病中的作用和IFN-γ及IL-4 mRNA表达的情况。方法分别用流式细胞仪及RT-PCR方法检测97例哮喘患者及20例健康人外周血单个核细胞（PBMCs）Th1／Th2水平和IFN-γ及IL-4 mRNA表达。结果哮喘组外周血Th1细胞百分比低于对照组（P〈0．01），而Th2百分比高于对照组（P〈0.01）；哮喘组PBMCS IFN-γ的mRNA表达水平与对照组差异无统计学意义（P〉0．05），而IL-4 mRNA的表达显著高于对照组（P〈0．01）。结论哮喘患者体内存在Th1／Th2的失衡，并提示哮喘属于Th2优势疾病。     

川芎嗪治疗支气管哮喘急性发作的临床疗效及对Th1／Th2细胞因子的影响

目的探讨川芎嗪注射液配合常规疗法治疗支气管哮喘急性发作的疗效及其对哮喘患者外周血Th1／Th2细胞因子的影响。方法将80例支气管哮喘急性发作期患者随机分为常规治疗组和联用川芎嗪治疗组,联用川芎嗪治疗组在常规治疗的基础上联用川芎嗪注射液治疗。观察两组临床疗效并检测治疗前、后外周血IL-4、IL-5和IFN-γ水平的变化。结果联用川芎嗪治疗组IL-4、IL-5水平较治疗前明显下降,IFN-γ水平明显上升（均P〈0．01）。常规治疗组治疗前后IL-4、IL-5和IFN-γ水平差异无显著性。联用川芎嗪治疗组临床有效率明显高于常规治疗组（P〈0．05）。结论在常规疗法的基础上联用川芎嗪注射液治疗支气管哮喘急性发作能明显提高临床疗效,其作用可能是通过增强,Th1介导的细胞免疫抑制Th2介导的体液免疫,纠正Th1／Th2细胞因子平衡。     

IL-23单独或联合IL-2诱导人外周血单个核细胞对K562细胞杀伤效应的实验研究

本研究旨在探讨IL-23单独或联合IL-2诱导的人外周血单个核细胞（PBMNC）对白血病细胞的杀伤效应及作用机制.IL-23（50 ng/ml）单独或联合IL-2（100 U/ml）体外诱导正常人PBMNC 72 h,并与白血病细胞株K562共同培养.采用CCK-8法测定不同时间诱导后的PBMNC对K562细胞的杀伤效应;采用ELISA方法检测杀伤活性最大时细胞培养液中IFN-γ的水平;应用RQ-PCR法检测诱导后PBMNC的穿孔素、颗粒酶B的表达水平.结果表明,IL-23单独或联合IL-2作用后的PBMNC均对K562细胞有杀伤活性,随着时间延长,杀伤率明显增加,各个时间点比较,有显著性差异（P＜0.05）;各细胞因子组培养液中分泌IFN-γ水平均显著高于空白对照组（P＜0.05）,其中以IL-23联合IL-2组诱导PBMNC表达IFN-γ的水平最高,与其它两组比较,差异显著（P＜0.05）.各细胞因子组PBMNC的穿孔素、颗粒酶B mRNA的表达量均较对照组明显增加（P＜0.05）,且IL-23联合IL-2组的穿孔素、颗粒酶B mRNA表达量显著高于其他组（P＜0.05）.结论：IL-23能促进PBMNC对K562细胞的杀伤活性,与IL-2联合具有协同增强作用,并呈时间依赖性.IL-23作用于PBMNC后IFN-γ、穿孔素、颗粒酶B的表达均明显增加,且与IL-2具有协同作用.推测IL-23可能通过诱导PBMNC表达IFN-γ、穿孔素、颗粒酶B发挥抗白血病细胞作用.     

重组鼠白细胞介素-12腺病毒载体对哮喘小鼠模型IL-4、IFN-γ表达的影响

目的探讨重组鼠白细胞介素-12(IL-12)基因的腺病毒载体(AdCMVIL-12)对小鼠支气管哮喘模型IL-4、IFN-γ表达的影响。方法雌性BALB/c小鼠50只,按数字随机表法分为5组,每组10只:哮喘模型组、AdCMVIL-12组、AdCMVLacZ组、激素治疗组和正常对照组。并于第20天分别鼻内吸入50μL生理盐水和5×108 PFU AdC-MVIL-12。第28天收集各组小鼠的支气管肺泡灌洗液(BALF),检测IL-4、IFN-γ的变化,RT-PCR方法检测各组肺组织中IL-4、IFN-γmRNA的表达水平。结果哮喘模型组与对照组、AdCMVIL-12组相比较,BALF中的IL-4表达水平明显升高,而IFN-γ在AdCMVIL-12组中的表达水平显著上升。RT-PCR结果显示,哮喘模型组小鼠肺组织IL-4mRNA的表达与AdCMVIL-12组、激素治疗组及正常对照组相比较明显升高;而IFN-γmRNA的表达水平明显下降。结论 AdCMVIL-12对哮喘小鼠的气道及肺组织内的IL-4表达有明显的抑制作用,其机制可能与AdCMVIL-12阻断IL-4的表达,调节Th1/Th2类细胞因子的平衡有关。     

体外与非体外循环手术T淋巴细胞白细胞介素-4γ-干扰素mRNA表达的比较研究

目的比较体外与非体外循环手术中T淋巴细胞IL-4、IFN-γmRNA的表达及意义。方法随机抽取年龄3～12岁先心病、先天性动脉导管未闭患儿各20例，分为体外与非体外循环手术组，体外循环（CPB）手术组于术前24h、CPB结束前、术后4h、术后24h抽取静脉血，非CPB手术组于术前24h、手术结束前、术后4h、术后24h抽取静脉血。分离T淋巴细胞，提取RNA，RT—PER测定IL-4、IFN-γmRNA表达。结果CPB手术组：T淋巴细胞m-4mRNA表达在CPB结束前明显升高，术后24h逐渐恢复至术前水平；IFN-γmRNA表达在CPB结束前明显下调，术后24h逐渐恢复至术前水平。非CPB手术组：IFN-γ、IL-4mRNA表达变化无统计学意义。结论与非CPB手术比较，CPB引起T淋巴细胞IL-4mRNA表达上调、IFN—YmRNA表达下调，说明CPB可导致Th1／Th2平衡变化，在CPB创伤、炎性反应中可能起重要作用。     

先兆子痫和正常孕妇外周血辅助性T细胞及其细胞因子的变化

目的 探讨先兆子痫、正常妊娠女性Th细胞亚群功能变化和外周血Th1、Th2细胞百分率与外周血单个核细胞（PBMC）培养上清液中IFN-γ、IL-4浓度的相关性。方法 应用流式细胞仪检测外周血Th1、Th2细胞百分率，ELISA法测定PBMC体外培养上清液中细胞因子IFN-γ和IL-4浓度。结果 与正常对照组相比，先兆子痫患者Th1细胞百分率、Th1/ Th2比值明显升高，差异非常显著；正常妊娠组Th1细胞百分率、Th1/ Th2比值明显下降，差异非常显著。与正常妊娠组相比，先兆子痫患者Th1细胞百分率、Th1/ Th2比值明显升高，差异非常显著。外周血Th1细胞百分率与PBMC培养上清液中IFN-γ浓度、Th2细胞百分率与PBMC培养上清液中IL-4浓度、Th1/Th2与PBMC培养上清液中IFN-γ／IL-4的比值均呈显著性正相关。结论 先兆子痫患者Th1细胞亚群功能增强，Th1/Th2细胞亚群功能失衡，导致病理妊娠。正常妊娠女性Th1细胞亚群功能明显减弱，对妊娠具有保护作用。流式细胞仪检测外周血Th1、Th2细胞百分率和ELISA法测定PBMC体外培养上清液中细胞因子IFN-γ和IL-4浓度具有良好的相关性。     

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。