结直肠癌患者血清miR-92a-3p表达水平及其临床意义

目的分析miR-92a-3p在体检健康者、结直肠腺瘤息肉患者以及结直肠癌(CRC)患者手术前后血清中的相对表达水平,探讨其在CRC临床诊断中的应用价值。方法用Trizol法分别对30例体检健康者、25例结直肠腺瘤息肉患者和40例CRC患者术前及术后的血清进行总RNA提取,用实时荧光定量PCR检测miR-92a-3p的相对表达水平,分析其在各组中的表达差异及其与CRC临床病理参数的关系,以受试者工作曲线确定血清miR-92a-3p的CRC诊断效能。结果 CRC术前组血清miR-92a-3p的表达水平高于结直肠腺瘤息肉组(Z=4.75,P0.01)、CRC术后组(Z=4.28,P0.01)和健康人对照组(Z=8.00,P0.01);健康人对照组血清miR-92a-3p的表达水平低于CRC术后组(Z=4.08,P0.01)和结直肠腺瘤息肉组(Z=2.70,P=0.01);结直肠腺瘤息肉组和CRC术后组的血清miR-92a-3p的表达水平差异无统计学意义(Z=0.99,P=0.32);血清miR-92a-3p鉴别CRC的ROC曲线下面积(AUCROC)为0.899(95%CI:0.840~0.959),当cut off值为2.75时,敏感性和特异性均为80%;血清miR-92a-3p的高低与CRC的浸润深度(Z=2.14,P=0.03)、淋巴结转移(Z=2.86,P=0.04)、TNM分期(Z=2.93,P0.01)等临床病理参数关系密切。结论血清miR-92a-3p可能为临床上CRC的筛查、病情监测等方面提供实验室依据。     

乙型肝炎病毒相关慢加急性肝衰竭患者血清miR-328-3p 表达水平及其与疾病严重程度及预后的相关性研究

目的 探究微小核糖核酸（microRNA,miR）-328-3p表达水平与乙型肝炎病毒相关慢加急性肝衰竭（hepatitis B virus-related acute-on-chronic liver failure,HBV-ACLF）严重程度及预后的关系。方法 选取 2018年 12月～2021年 12月陕西省人民医院收治的 HBV-ACLF患者 120例（HBV-ACLF组）、慢性乙型肝炎（chronic hepatitis B,CHB）患者 120例（CHB组）,另选取同期健康体检者 120例为健康组。比较三组一般资料及血清 miR-328-3p表达水平,比较不同分期 HBV-ACLF患者血清 miR-328-3p表达水平;分析 HBV-ACLF患者血清 miR-328-3p表达水平与终末期肝病模型（model for end-stage liver disease,MELD）评分的相关性;比较不同预后 HBV-ACLF患者基线资料及血清 miR-328-3p表达水平;评估血清 miR-328-3p和 MELD评分对 HBV-ACLF患者预后的预测价值; COX回归分析 HBV-ACLF患者预后的影响因素。结果 健康组、 CHB组和 HBV-ACLF组血清 miR-328-3p（1.03±0.34,1.85±0.62和 2.76±0.92）表达水平比较,差异有统计学意义（F=200.241,P＜ 0.05）;早期、中期、晚期组 HBV-ACLF患者血清 miR-328-3p（2.30±0.58,2.88±0.72和 3.63±0.91）表达水平逐渐升高,差异有统计学意义（F=28.023,P＜ 0.05）;HBV-ACLF患者血清 miR-328-3p表达水平与 MELD评分、血清天门冬氨酸氨基转移酶（aspartate aminotranferase,AST）、总胆红素（total serum bilirubin,TBIL）和丙氨酸氨基转移酶（alanine aminotransferase,ALT）呈正相关（r=0.598,0.418,0.375,0.339,均 P＜ 0.05）;死亡组 HBV-ACLF患者 MELD评分（28.62±5.72）和血清 miR-328-3p（3.34±0.67）表达水平均高于生存组（21.14±4.23,2.32±0.46）,差异有统计学意义（t=8.237,9.878,均 P＜ 0.05）;血清 miR-328-3p和 MELD评分预测 HBV-ACLF患者预后的曲线下面积（area under curve,AUC）分别为 0.861（95%CI:0.791～0.932）,0.853（95%CI: 0.781～0.925）,且二者联合预测 HBV-ACLF患者预后的 AUC为 0.945（95%CI:0.902～0.989）,高于 miR-328-3p和 MELD评分单独预测（Z=1.991,2.137,均 P＜ 0.05）,且其敏感度和特异度分别为 96.2%,86.8%;回归分析显示, MELD评分 [OR(95%CI)=2.532(1.635～3.920)]和 miR-328-3p[OR(95%CI)=2.928(1.836～4.668)]均是 HBV-ACLF患者死亡的危险因素（均 P＜ 0.05）。结论 HBV-ACLF患者血清 miR-328-3p表达水平较高,与 HBV-ACLF疾病严重程度和预后显著相关,且血清 miR-328-3p与 MELD评分联合能较为有效地预测 HBV-ACLF患者预后,有一定临床参考价值。     

乙型肝炎肝硬化患者血清miR-25-3p 和IBSP 表达及临床意义

目的 研究乙型肝炎肝硬化患者血清微小核糖核酸（miRNA,miR）-25-3p 和整合素结合唾液蛋白(integrinbinding sialoprotein,IBSP) 表达及临床意义。方法 选取2018 年5 月～ 2019 年5 月南通市第六人民医院诊治的乙型肝炎肝硬化患者120 例为肝硬化组,并将其分为肝硬化失代偿并发腹腔积液组（47 例）和非肝硬化失代偿并发腹腔积液组（73例）,以同期诊治的慢性乙型肝炎患者80 例为肝炎组,健康体检者60 例为对照组。应用酶联免疫吸附法检测各组血清IBSP 表达,荧光定量PCR 检测各组血清miR-25-3p 的表达。比较肝硬化组不同临床特征患者血清miR-25-3p 和IBSP 水平差异。Pearson 线性相关分析血清miR-25-3p 和IBSP 与肝功能评分的相关性。多因素Logistic 回归分析影响肝硬化失代偿并发腹腔积液的危险因素。受试者工作曲线（ROC）分析miR-25-3p 和IBSP 及联合检测对肝硬化失代偿并发腹腔积液的诊断价值。结果 肝硬化组、肝炎组及对照组血清miR-25-3p 水平分别为5.22±0.41,1.16±0.34 和0.92±0.32,IBSP 蛋白水平分别为9.34±1.28ng/ml, 3.15±0.37ng/ml 和1.02±0.30ng/ml。肝硬化组血清miR-25-3p 和IBSP 蛋白明显高于肝炎组（t=73.327, 42.067）及对照组（t=4.238, 34.486）,差异均有统计学意义（均P ＜ 0.05）。肝硬化组患者血清miR-25-3p 和IBSP 蛋白表达水平与肝纤维化、消化道出血及腹腔积液有关（t=10.194 ～ 34.744, 均P ＜ 0.05）。肝硬化组患者血清miR-25-3p 和IBSP 蛋白表达与清蛋白-胆红素评分（albumin-bilirubin, ALBI）、终末期肝病模型评分（modelfor end-stage liver disease, MELD）、肝硬化Child -Pugh 评分均呈明显正相关（r=0.457 ～ 0.584,均P ＜ 0.05）。多因素Logistic 回归分析结果血清miR-25-3p 升高（OR:1.202,95%CI:1.059 ～ 1.642）,IBSP 升高（OR:1.229, 95%CI:1.081 ～ 1.719）是肝硬化失代偿并发腹腔积液的独立危险因素。ROC 曲线显示,miR-25-3p 和IBSP 联合诊断肝硬化失代偿及并发腹腔积液的曲线下面积（AUC）大于miR-25-3p 和IBSP 单独诊断(Z=3.727,4.163,均P=0.000)。结论 乙型肝炎肝硬化患者血清中miR-25-3p 和IBSP 蛋白水平升高,二者联合检测对乙型肝炎肝硬化失代偿并发腹腔积液具有较高诊断价值。     

乳腺癌患者血清脂质运载蛋白-2和基质金属蛋白酶-9的表达及临床意义

目的：探讨血清脂质运载蛋白-2（LCN-2）和基质金属蛋白酶-9（MMP-9）在乳腺癌中的表达及临床意义。方法应用酶联免疫吸附法（ELISA）检测96例乳腺癌患者血清 LCN-2和 MMP-9的表达水平,并与42例乳腺良性病变患者和27例健康对照者比较,分析其与肿瘤大小、TNM 分期、分化程度、淋巴结转移以及 ER,PR表达的关系。结果乳腺癌患者血清 LCN-2表达量为89.76±28.38 ng／ml,明显高于乳腺良性病变组的56.44±21.15 ng／ml和健康对照组的44.32±16.84 ng／ml,差异均具有统计学意义（P＜0.05）,而乳腺良性病变组与健康对照组无明显差异（P＞0.05）。乳腺癌患者血清 MMP-9的表达量为96.34±23.26ng／ml,明显高于乳腺良性病变组的28.16±11.57 ng／ml和健康对照组的23.54±13.61 ng／ml,差异均具有统计学意义（P＜0.05）,而乳腺良性病变组与健康对照组无明显差异（P＞0.05）;相关分析显示,乳腺癌患者血清 LCN-2和 MMP-9水平之间呈正相关（r＝0.5135,P＜0.05）。乳腺癌患者血清 LCN-2和 MMP-9的表达水平与肿瘤大小、淋巴结转移情况、ER和PR表达、TNM分期明显相关（P＜0.05）;但与肿瘤分化程度无明显相关性（P＞0.05）。结论 LCN-2和 MMP-9可能在乳腺癌的发生、发展中起着重要作用,两者联合检测对于乳腺癌的辅助诊断、疗效监测及预后判断具有一定的临床意义。     

miR-574-5p在乳腺癌患者血清中的水平及与临床病理特征的关系

目的探讨微小RNA-574-5p(miR-574-5p)在乳腺癌患者血清中的水平及与临床病理特征的关系。方法选取2014年12月至2015年9月期间60例乳腺癌患者和60例乳腺纤维腺瘤患者作为研究对象,选择于同期在本院健康检查的60例健康女性作为健康对照组。采用实时荧光定量PCR(qPCR)检测入组对象血清miR-574-5p水平。结果经RT-PCR检测,乳腺癌组血清miR-574-5p水平为55.26±6.71,纤维瘤组血清miR-574-5p水平为14.21±4.11,健康对照组血清miR-574-5p水平为3.39±1.02,乳腺癌组miR-574-5p水平高于纤维腺瘤组和健康对照组,差异有统计学意义(F=68.17,P0.05),纤维腺瘤组miR-574-5p水平高于健康对照组,差异有统计学意义(t=21.08,P0.05)。随着患者病理分期的增加、肿瘤体积的增加、分化程度的降低,乳腺癌组血清miR-574-5p水平呈升高趋势,伴淋巴结转移的乳腺癌患者,血清miR-574-5p水平高于未出现淋巴结转移的乳腺癌患者(P0.05)。手术后,乳腺癌患者血清miR-574-5p水平(46.19±6.15)明显低于治疗前(54.91±6.62),差异有统计学意义(t=16.72,P0.05)。结论乳腺癌血清miR-574-5p水平高于良性乳腺病变及健康人群。血清miR-574-5p水平与乳腺癌的临床病理特征及预后密切相关。乳腺癌根治术可以抑制miR-574-5p的表达,改善患者病情。     

动态检测乳腺癌患者手术前后血清IL-6、VEGF-A表达的临床意义

目的 对乳腺癌患者手术前后动态检测血清中白细胞介素-6（IL-6）、血管内皮生长因子-A（VEGF-A）,探讨IL-6、VEGF-A表达与乳腺癌预后的相关性。方法 作者将60例乳腺癌患者及57例乳腺良性病患者分为两组：观察组（60例乳腺癌患者）;对照组（67例乳腺良性病患者）。作者分别手术前、后均采用双抗体夹心法（ELISA法）检测两组病人血清IL-6、VEGF-A的表达。结果 ①观察组、对照组术前血清IL-6、VEGF-A水平表达具有差异性（P〈0.01）;术前、后观察组本组血清IL-6、VEGF-A水平表达呈显著差异（P〈0.01）。结论 通过对两组血清IL-6、VEGF-A表达的动态变化,观察组IL-6、VEGF-A表达的动态变化,显示乳腺癌患者手术前后不同的IL-6、VEGF-A表达与其预后呈正相关性改变。     

老年急性 ST 段抬高型心肌梗死患者血浆 miR-499-5p 表达水平对并发急性心力衰竭的预测价值

目的　探讨老年急性 ST 段抬高型心肌梗死（STEMI）患者血浆微小核糖核酸 -499-5p（miR-499-5p）水平对并发急性心力衰竭（AHF）的预测价值。方法　连续性收集 2019 年 1 月 ~12 月就诊于西安市第五医院的 135 例老年急性STEMI 患者纳入病例组,并根据发病 48h 内是否发生急性心力衰竭（AHF）将病例组分为 AHF 亚组和非 AHF 亚组。另随机选择同期在该院行健康体检的志愿者 50 例为对照组。采用实时荧光定量 PCR（RT-qPCR）法检测血浆 miR-499-5p 的相对表达水平。结果　病例组血浆 miR-499-5p 相对表达水平显著高于对照组（Z=10.434,P ＜ 0.001）。AHF 亚组血浆 miR-499-5p 相对表达水平显著高于非 AHF 亚组（Z=5.817,P ＜ 0.001）。病例组患者血浆 miR-499-5p 相对表达水平与 cTnI,CK-MB,BNP 和 Killip 分级均呈正相关关系（r=0.339,0.243,0.477,0.581,均 P ＜ 0.01）。多因素分析结果显示老年急性 STEMI 患者血浆 miR-499-5p 表达升高是并发 AHF 的独立危险因素（OR=3.192,P=0.011）。血浆miR-499-5p 预测 AHF 的 AUC 为 0.797（0.725,0.869）。结论　老年急性 STEMI 患者血浆 miR-499-5p 表达水平显著升高,可能是并发 AHF 的独立危险因素。     

荧光定量PCR检测血清微小RNA-21方法的建立及对乳腺癌诊断的初步应用

目的 建立一种SYBR Green Ⅰ荧光定量PCR检测血清miR-21方法,并初步探讨其对乳腺癌诊断的应用价值.方法 用Trizol试剂提取血清总RNA.用茎环引物将miR-16(作为miR-21内参基因)与miR-21分别逆转录成相应cDNA.再用SYBR Green Ⅰ荧光定量RT-PCR对cDNA进行扩增、检测.然后,通过信噪比(signal to noise ratio,SNR)分析试验的准确性;通过熔解曲线评价试验的特异性;通过标准曲线的R2评估试验的精确性;通过批内和批间差异计算试验的稳定性.另外,用自建方法检测33例乳腺癌患者、18例乳腺良性疾病和49名健康人群血清miR-21和miR-16水平,并根据乳腺癌组与健康对照组中miR-21相对表达量确定临界值,以评价其对乳腺癌诊断的敏感度、特异度.结果 通过PCR退火与延伸在温度和时间上的优化,本试验所建立方法SNR≥99.36％;熔解曲线为单峰;标准曲线R3=0.994 8;批内CV＜ 1.5％,批间CV＜ 4％.以miR-16为内参,用自建SYBR Green Ⅰ荧光定量PCR检测乳腺癌组、良性疾病组与健康对照组血清miR-21的相对表达量分别为20.83±18.18、20.86±10.11和9.33±4.44,经Kruskal Wallis检验,3组间表达量差异有统计学意义(x2=16.92,P＜0.001),且健康对照组与乳腺癌组、健康对照组与良性疾病组间的差异均有统计学意义(Z值分别为-2.58、-4.42,P均≤0.01),而乳腺癌组与良性疾病组血清miR-21表达量差异无统计学意义(Z=-0.51,P=0.608).以miR-21相对表达量18.32为临界值,其对乳腺癌诊断的敏感度为51.5％(17/33),特异度为93.9％(46/49).结论 建立了一种较敏感、特异、稳定的SYBRGreen Ⅰ荧光定量PCR检测血清miR-21方法,该方法对乳腺癌的诊断可能有一定价值.     

血浆miR-127-3p对原发性乳腺癌患者的检测效果

目的探讨血浆miR-127-3p在原发性乳腺癌患者检测中的应用效果。方法选取2012年6月至2015年8月在该院接受治疗的乳腺癌患者125例组成观察组、良性乳腺肿瘤患者97例组成对照组、健康体检者82例组成健康组,收集以上患者的血浆标本。运用实时荧光定量反转录PCR法对患者血浆中的miR-127-3p表达进行统计,并对乳腺癌患者血浆miR-127-3p水平与癌胚抗原(CEA)、血清癌抗原153(CA153)表达进行相关性分析。Mann-Whitney检验分析血浆miR-127-3p的表达与乳腺癌患者临床病理特征的关系。结果乳腺癌患者血浆中miR-127-3p的相对表达量15.376(6.103~17.254)显著高于乳腺良性肿瘤患者3.213(2.015~5.108)和健康对照者2.410(1.185~4.369),差异具有统计学意义(P0.05)。而对照组患者与健康体检者之间,差异无统计学意义(P0.05)。miR-127-3p表达水平与CA153表达水平呈正相关(r=0.680,P0.05),与CEA无明显相关性(r=0.246,P=0.061)。乳腺癌患者血浆miR-127-3p的表达水平与不同病理特征组间的差异无统计学意义(P0.05)。结论血浆miR-127-3p在乳腺癌患者检测中的高表达可作为一个诊断乳腺癌的重要指标。     

动态检测CA-153、VEGF-A探讨乳腺癌预后的相关性研究

目的通过对乳腺癌患者手术前后动态检测其血清CA-153、VEGF-A,探讨CA-153、VEGF-A表达与乳腺癌预后的相关性。方法作者将127例乳腺良、恶疾病患者分为两组：观察组（60例乳腺癌患者）;对照组（67例乳腺良性疾病患者）。手术前、后均采用ELISA分别检测患者血清CA-153、VEGF-A水平。结果①观察组与对照组患者术前检测血清中CA-153、VEGF-A,表达已具有差异性变化（P〈0.01）;②观察组手术前、后乳腺癌患者血清CA-153、VEGF-A水平表达呈差异性改变（P〈0.01）。③观察组手术后与对照组血清CA-153表达（P〉0.05）;VEGF-A表达（P〈0.05）。结论通过对两组血清CA-153、VEGF-A表达的差异,乳腺癌患者手术前后不同的CA-153、VEGF-A表达与其预后呈正相关性改变。     

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。