慢性肾功能不全血液透析和不宁腿综合征患者的睡眠质量分析

目的:调查老年和老年前期不宁腿综合征与血液透析患者的睡眠质量,并分析影响其睡眠质量的因素。方法:以2003-07中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院因慢性肾功能不全进行血液透析的患者123例及广州市社区居民59人为观察对象。按年龄分为老年前期(50～59岁)70例,老年期(≥60岁)112例。每组又分3小组,分别为透析伴不宁腿综合征组(简称不宁腿综合征组),透析不伴不宁腿综合征组(简称透析组),社区人群组。采用自行设计的一般情况调查表调查性别,年龄,职业,患病病程等。不宁腿综合征的诊断采用国际不宁腿综合征研究小组制定的不宁腿诊断标准量表。睡眠质量评定采用匹茨堡睡眠质量指数量表,由23个项目7个因子构成,各因子累计得分系匹茨堡睡眠质量指数量表总分。将总分以4分,8分为界限将睡眠分为好,中,差3个级别进行分析。结果:纳入的123例透析患者及社区老年人59人,全部进入结果分析。①透析患者中不宁腿综合征者的患病率为25.2%(31/123);其中老年前期组为31%(16/52);老年组为21%(15/71);差异无显著性(χ2=1.48,P>0.05)。②不宁腿综合征组匹茨堡睡眠质量指数量表的主观睡眠质量、睡眠潜伏期、催眠药物与日间功能障碍项目分及总分均比透析组、社区人群高(P<0.05);透析组的睡眠潜伏期与催眠药物项目得分及总分比社区人群高(P<0.05)。②不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分比透析组得分高(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分比社区人群组高(P<0.05)。③老年前期不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分高于透析组(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分高于社区人群组(P<0.05)。④老年期不宁腿综合征组的睡眠潜伏期、用睡眠药物、白天功能紊乱和总分高于社区人群组,透析组也高于社区人群组,差异有显著性(P<0.05)。⑤老年前期组与老年期组不宁腿综合征患者之间仅在睡眠持续性上差异有显著(P<0.05),老年前期组与老年期组非不宁腿综合征患者仅在日间功能障碍上差异有显著性(P<0.05)。结论:透析伴不宁腿综合征对老年前期和老年期患者的睡眠质量有明显影响,透析不伴不宁腿综合征对老年前期患者的睡眠质量无影响。在肾脏血液透析的患者中,年龄因素与睡眠质量关系不明显。     

不安腿综合征对血液透析患者生活质量及睡眠质量影响的研究

目的了解北京大学第一医院肾内科血液透析中心不安腿综合征(RLS)的患病率,对其严重程度进行量化评分,并初步探讨RLS的影响因素及其严重程度对睡眠质量和生活质量的影响。方法以我院108例因慢性肾功能不全进行维持性血液透析治疗的患者为研究对象。不安腿综合征的诊断采用国际不安腿综合征研究小组制定的不安腿诊断标准量表。以匹兹堡睡眠质量指数(PSQI)和简明健康状况调查表(SF-36量表)分别进行生活质量和睡眠质量评估。记录患者的透析方案、生化指标及治疗用药等资料,探讨RLS的影响因素。随机抽取一组不伴RLS患者为对照组,进一步评估RLS对睡眠质量和生活质量的影响。结果①我院血液透析中心RLS患者共14例,男性7例,女性7例,其患病率为13%。②RLS患者与不伴RLS患者在年龄、性别、透析龄、每周透析时间,尿素清除率,透析前血肌酐、尿素氮、血红蛋白、红细胞压积、铁蛋白、转铁蛋白饱和度、钙、磷、钙磷乘积、全段甲状旁腺激素(iPTH)等生化指标,以及是否使用铁剂、钙离子拮抗剂等治疗方面均未发现差异。③RLS组PSQI为(10.86±5.48),不伴RLS组PSQI为(4.93±4.73),两者间差异具有显著性(P=0.005)。但RLS严重程度仅与主观睡眠质量具有相关性(P<0.05),与SF-36分值呈负相关(r=-0.661,P=0.01)。结论我中心维持性血液透析患者中RLS患病率为13%。RLS患者的睡眠较差,主要表现在主观睡眠质量、睡眠时间、习惯睡眠效应、日间功能等方面。同时维持性血液透析RLS患者的RLS严重程度影响到患病者的生活质量。     

慢性肾功能不全血液透析和不宁腿综合征患者的睡眠质量分析

目的：调查老年和老年前期不宁腿综合征与血液透析患者的睡眠质量，并分析影响其睡眠质量的因素。 方法：以2003—07中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院因慢性肾功能不全进行血液透析的患者123例及广州市社区居民59人为观察对象。按年龄分为老年前期（50-59岁）70例，老年期（≥60岁）112例。每组又分3小组，分别为透析伴不宁腿综合征组（简称不宁腿综合征组），透析不伴不宁腿综合征组（简称透析组），社区人群组。采用自行设计的一般情况调查表调查性别，年龄，职业，患病病程等。不宁腿综合征的诊断采用国际不宁腿综合征研究小组制定的不宁腿诊断标准量表。睡眠质量评定采用匹茨堡睡眠质量指数量表，由23个项目7个因子构成，各因子累计得分系匹茨堡睡眠质量指数量表总分。将总分以4分，8分为界限将睡眠分为好，中，差3个级别进行分析。结果：纳入的123例透析患者及社区老年人59人，全部进入结果分析。①透析患者中不宁腿综合征者的患病率为25．2％（31／123）；其中老年前期组为31％（16／52）；老年组为21％（15／71）；差异无显著性（，=1．48，P〉0．05）。②不宁腿综合征组匹茨堡睡眠质量指数量表的主观睡眠质量、睡眠潜伏期、催眠药物与日间功能障碍项目分及总分均比透析组、社区人群高（P〈0．05）；透析组的睡眠潜伏期与催眠药物项目得分及总分比社区人群高（P〈0．05）。（2）不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分比透析组得分高（P〈0．05）；而睡眠潜伏期、用睡眠药物、睡眠总分比社区人群组高（P〈0．05）。③老年前期不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分高于透析组（P〈0．05）；而睡眠潜伏期、用睡眠药物、睡眠总分高于社区人群组（P〈0．05）。（少老年期不宁腿综合征组的睡眠潜伏期、用睡眠药物、白天功能紊乱和总分高于社区人群组，透析组也高于社区人群组，差异有显著性（P〈0．05）。⑤老年前期组与老年期组不宁腿综合征患者之间仅在睡眠持续性上差异有显著（P〈0．05），老年前期组与老年期组非不宁腿综合征患者仅在日间功能障碍上差异有显著性（P〈0．05）。 结论：透析伴不宁腿综合征对老年前期和老年期患者的睡眠质量有明显影响，透析不伴不宁腿综合征对老年前期患者的睡眠质量无影响。在肾脏血液透析的患者中，年龄因素与睡眠质量关系不明显。     

血液透析患者不宁腿综合征对睡眠质量的影响

目的:调查分析慢性肾功能不全血液透析患者不宁腿综合征症状对其睡眠质量影响。方法:选择2003-07-24/2003-07-30在中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院进行血液透析的患者171例为观察对象。①睡眠质量评定采用匹茨堡睡眠质量指数量表。可划分为主观睡眠质量,睡眠潜伏期,睡眠持续性,习惯睡眠效率,睡眠紊乱,用睡眠药物和白天功能紊乱7个因子,各因子累计得分系总分。将总分以4分,8分为界限将睡眠分为好,中,差3个级别进行分析。②采用不宁腿综合征患者病情严重程度评定量表了解其严重程度。由10个项目构成,各项累计得分系总分。原量表将总分以10分,20分,30分为界限将严重程度分为轻微,中度,严重,非常严重进行分析。③采用自行设计的一般情况调查表,包括性别,年龄,职业,患病病程,每周透析次数,文化程度,家庭环境,家庭平均收入,身体健康情况,有无其他躯体疾病,有无服用药物,一级亲属睡眠问题等。运用统一问卷和统一指导语解释,让患者自己填写。个别不能填写的,患者回答后由调查人员填写。结果:在171例血液透析患者中有43例符合诊断不宁腿综合征症状标准,发生率为25.2%,其中男28例,女15例。不宁腿综合征组的匹茨堡睡眠质量指数量表总分高于非不宁腿综合征组,差异有显著性[(10.07±4.49),(7.03±3.94),t=3.881,P<0.001]。不宁腿综合征组主观睡眠质量、睡眠潜伏期、用睡眠药物、总分、睡眠紊乱、日间功能障碍因子分均高于非不宁腿综合征组(P<0.05),而两组睡眠持续性,习惯睡眠效率因子分差异无显著性。不宁腿综合征组睡眠质量较差。性别及不宁腿综合征各等级严重程度对肾脏透析不宁腿综合征睡眠质量无影响。不宁腿综合征严重程度总分与睡眠质量匹茨堡睡眠质量指数量表总分相关(相关系数为0.508,P=0.001)。二者存在回归关系(b=0.508,t=3.585,P=0.001)。结论:慢性肾功能不全血液透析伴不宁腿综合征症状的患者睡眠质量明显较差。不宁腿综合征严重程度总分与睡眠质量严重程度相关。     

长时程透析对血液透析患者睡眠质量的影响

目的 调查长时间血液透析对血液透析患者睡眠质量的影响. 方法 通过问卷调查和收集临床资料相结合的方法,选取首都医科大学附属北京友谊医院血液净化中心40例维持性血液透析患者进行研究,应用AIS量表、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表爱泼沃斯嗜睡、(Epworth Sleepiness Scale,ESS)量表调查患者的睡眠质量,根据睡眠质量情况将患者配对分组为普通透析组(Hemodialysis HD)20人和长程透析组)6个月的临床试验.结果 LSHD组患者Kt/V明显高于HD组患者,P值＜0.05,2组患者在PSQI量表、ESS量表评分差异存在显著性,LSHD组患者睡眠质量明显高于HD组,P值＜0.05. 结论 维持性血液透析的患者多存在睡眠质量下降的问题,增加透析剂量可以改善睡眠质量.     

失眠障碍患者主客观评价参数的相关性研究

目的:探索主客观方法评价的失眠障碍患者睡眠参数间的相关性。方法:慢性失眠患者61例,其中慢性失眠障碍(CID)31例、抑郁共病性失眠(ICD)30例。患者完成汉密尔顿抑郁17项量表(HAMD17)、匹兹堡睡眠质量指数(PSQI)和阿森斯失眠量表(AIS)评估和整夜多导睡眠图(PSG)监测。结果:CID患者仅PSQI睡眠障碍因子分低于ICD患者(Ps0.05),PSG N3%高于ICD组(P0.05),其余主客观睡眠参数均无显著性差异(Ps0.05);全部患者的偏相关分析(控制年龄、性别、教育年限、体重指数、HAMD17总分)的显示PSQI和AIS 2个量表的总分和各因子分彼此间相关性较好,但就与PSG睡眠参数的相关性而言,PSQI的相关项目更多(Ps0.05)。结论:PSQI和AIS量表彼此间有良好的一致性,但PSQI与PSG睡眠参数的相关性可能更好。     

铁蛋白和血红蛋白与原发性不宁腿综合征的关系

目的 探讨血红蛋白和铁蛋白水平与原发性不宁腿综合征(RLS)发病之间的关系.方法 对35例原发性不宁腿综合征患者(RLS组)及对照组20例失眠患者的血红蛋白及铁蛋白水平进行检测并行统计学比较.结果 RLS组患者血清铁蛋白水平为(89.77±48.52)μg/L,对照组为(123.36±35.06)μg/L,RLS组较对照组血清铁蛋白水平低,差异有统计学意义(t=-2.713,P<0.01),而血红蛋白水平RLS组为(142.77±11.79)g/L,对照组为(139.05±12.33)g/L,2组相比差异无统计学意义(t=1.108,P>0.05).结论 血清铁蛋白的降低可能是原发性不宁腿综合征的危险因素之一,而血红蛋白水平可能与原发性不宁腿综合征无关.     

血液透析患者不宁腿综合征对睡眠质量的影响

目的：调查分析慢性肾功能不全血液透析患者不宁腿综合征症状对其睡眠质量影响。 方法：选择2003—07—24／2003—07—30在中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院进行血液透析的患者171例为观察对象。①睡眠质量评定采用匹茨堡睡眠质量指数量表。可划分为主观睡眠质量，睡眠潜伏期，睡眠持续性，习惯睡眠效率。睡眠紊乱，用睡眠药物和白天功能紊乱7个因子。各因子累计得分系总分。将总分以4分，8分为界限将睡眠分为好，中。差3个级别进行分析。②采用不宁腿综合征患者病情严重程度评定量表了解其严重程度。由10个项目构成，各项累计得分系总分。原量表将总分以10分，20分，30分为界限将严重程度分为轻微，中度，严重。非常严重进行分析。③采用自行设计的一般情况调查表，包括性别，年龄，职业，患病病程，每周透析次数。文化程度，家庭环境，家庭平均收入。身体健康情况，有无其他躯体疾病，有无服用药物，一级亲属睡眠问题等。运用统一问卷和统一指导语解释，让患者自己填写。个别不能填写的，患者回答后由调查人员填写。 结果：在171例血液透析患者中有43例符合诊断不宁腿综合征症状标准，发生率为25.2％，其中男28例，女15例。不宁腿综合征组的匹茨堡睡眠质量指数量表总分高于非不宁腿综合征组，差异有显著性[（10．07&;#177;4．49）。（7．03&;#177;3．94），t=3．881，P〈0．001]。不宁腿综台征组主观睡眠质量、睡眠潜伏期、用睡眠药物、总分、睡眠紊乱、日间功能障碍因子分均高于非不宁腿综合征组（P〈0．05），而两组睡眠持续性，习惯睡眠效率因子分差异无显著性。不宁腿综合征组睡眠质量较差。性别及不宁腿综合征各等级严重程度对肾脏透析不宁腿综合征睡眠质量无影响。不宁腿综合征严重程度总分与睡眠质量匹茨堡睡眠质量指数量表总分相关（相关系数为0．508，P=-0．001）。二者存在回归关系（b=0．508，t=3．585，P=0．001）． 结论：慢性肾功能不全血液透析伴不宁腿综合征症状的患者睡眠质量明显较差。不宁腿综合征严重程度总分与睡眠质量严重程度相关。     

维持性透析患者的睡眠情况调查

目的调查维持性血液透析患者的睡眠质量和可能的影响因素。方法通过问卷调查和收集临床资料相结合的方法,选取首都医科大学北京朝阳医院血液净化中心134例维持性血液透析患者进行研究。应用匹兹堡睡眠质量指数(Pittsburghsleepqualityindex,PSQI)量表调查患者的睡眠质量,并根据PSQI总分值(PSQI≤5和PSQI>5)将患者分为“睡眠质量较好”与“睡眠质量较差”2组。结果83例(62%)患者睡眠质量较差。2组患者之间,在年龄、血红蛋白、血清白蛋白、是否吸烟方面差异存在显著性,而在性别、透析龄、血压、超率量、Kt/V值、iPTH方面差异没有显著性。结论维持性血液透析的患者多存在睡眠质量下降的问题。睡眠质量可能与年龄、吸烟、血红蛋白和白蛋白水平有一定关系。     

盐酸苯海索与阿普唑仑治疗血液透析患者合并不宁腿综合征的对照研究

目的探讨血液透析患者合并不宁腿综合征的有效治疗方案。方法将合并不宁腿综合征的血液透析24例患者，分别给予盐酸苯海索与阿普唑仑两种治疗，观察两组治疗前后国际RLS评估量表评分的变化以及对睡眠改善等指标。结果血液透析患者中RLS患病率达到19．2％，盐酸苯海索组在减轻症状（7．2±2．5vs16．8±7．3），减少睡眠／醒时腿动较佳乐定组更为有效（83．3％vs25％，100％vs21．4％），改善睡眠障碍两者差异不大，应用两种药物前后电解质和肾功能变化不大。结论盐酸苯海索能有效减轻血液透析患者合并不宁腿综合征的症状，明显优于阿普唑仑。     

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。