CD64和降钙素原在小儿细菌性腹泻早期诊断中的价值探讨

目的检测腹泻患儿外周血中性粒细胞CD64指数和降钙素原(PCT)水平,探讨其在儿童腹泻鉴别诊断中的意义。方法选取2012年7月至2014年5月该院收治的180例腹泻患儿为研究对象,并将其分为细菌性腹泻组(60例),病毒性腹泻组(60例),非感染性腹泻组(60例)。检测3组患儿外周血中性粒细胞CD64指数和PCT表达水平,并分析两者对小儿腹泻的诊断价值。结果细菌性腹泻组患儿外周血CD64指数和PCT水平均高于病毒性腹泻组和非感染性腹泻组;且细菌性腹泻组CD64和PCT检测阳性率也高于其他两组,差异均有统计学意义(P0.05)。CD64指数对细菌性腹泻诊断的特异度和阳性预测值均高于PCT,差异均有统计学意义(P0.05)。相关性分析显示,细菌性腹泻患儿外周血中性粒细胞CD64指数和PCT水平呈正相关(r=0.865,P0.05)。结论细菌性腹泻患儿外周血中性粒细胞CD64指数和PCT水平均有明显升高,CD64和PCT检测对儿童细菌性腹泻的早期诊断具有重要的参考价值。     

川崎病患儿中性粒细胞明胶酶相关载脂蛋白及基质金属蛋白酶-9改变的临床意义

目的:观察中性粒细胞明胶酶相关载脂蛋白(NGAL)、基质金属蛋白酶-9(MMP-9)在川崎病(kawasaki disease,KD)患儿单个核细胞中的表达,并检测血清中两者的水平,探讨两者在KD中的作用。方法:KD患儿46例,其中20例发生冠状动脉扩张(CAL组),26例无冠状动脉扩张(NCAL组)。另以20例年龄相似的健康儿童作为对照组(NC组)。分别用ELISA法测定急性和恢复期血清NGAL、MMP-9水平。RT-PCR及Westernblot检测急性期外周血单个核细胞NGAL、MMP-9mRNA及蛋白质的表达水平。结果:与NC组相比,NCAL组和CAL组急性期NGAL、MMP-9均明显升高,CAL组恢复期MMP-9显著升高。CAL组恢复期MMP-9水平较NCAL组恢复期升高,与急性期相比差异无显著性。NCAL组和CAL组NGAL、MMP-9mRNA和蛋白质的表达较NC组增加。与NCAL组比较,CAL组NGALmRNA和蛋白质的表达差异无统计学意义,而MMP-9mRNA和蛋白质的表达水平升高。结论:NGAL、MMP-9在急性期升高,参与急性期KD的发病。NGAL对诊断有无冠脉损伤无临床意义。MMP-9可能是反映冠状动脉异常的预测标志,对评价KD预后有一定临床应用价值。     

中性粒细胞CD64和降钙素原检测在新生儿黄疸治疗前后的变化及临床价值

目的探讨中性粒细胞CD64与降钙素原(PCT)在新生儿感染性黄疸治疗前后中的变化及临床价值。方法选取我院2015年10月-2017年5月住院治疗的新生儿感染性黄疸共92例作为新生儿黄疸组,根据感染程度分为轻度组(35例)、中度组(32例)及重度组(25例),选取同期的35例健康新生儿作为健康对照组。比较各组患儿中性粒细胞CD64、PCT、总胆红素(TBIL)、直接胆红素(DBIL)水平并对结果进行相关性分析。结果新生儿黄疸组患儿治疗前中性粒细胞CD64、PCT、总胆红素、直接胆红素水平显著高于健康对照组,差异有统计学意义(P0.01),并且各组间中性粒细胞CD64、PCT、总胆红素、直接胆红素水平差异显著,重度组患儿最高,其次是中度组和轻度组,差异有统计学意义(P0.05)。新生儿黄疸组患儿治疗后中性粒细胞CD64、PCT、总胆红素、直接胆红素水平明显下降,与治疗前比较差异有统计学意义(P0.05)。Penson相关性分析表明中性粒细胞CD64和PCT和血清总胆红素、直接胆红素之间均呈正相关(P0.05)。结论新生儿感染性黄疸治疗前后血清PCT、中性粒细胞CD64变化显著,并且与患儿病情程度显著相关,其检测对新生儿感染性黄疸病情监测、预后及治疗具有重要的临床价值。     

外周血中性粒细胞CD_(64)与C反应蛋白诊断烧伤感染的临床价值

目的探讨外周血中性粒细胞CD_(64)与C反应蛋白(CRP)诊断烧伤感染的临床价值。方法将2015年12月—2016年6月榆林市第二医院烧伤整形手足外科收治的烧伤120例根据入院时病情分为烧伤脓毒症组、烧伤局部感染组和烧伤不伴感染组各40例,检测比较各组治疗前外周血中性粒细胞CD_(64)和CRP水平,并比较烧伤脓毒症组治疗前和治疗1周后外周血中性粒细胞CD_(64)与CRP水平,并应用受试者工作特征(receiver operating characteristic,ROC)曲线分析灵敏度及特异度。结果 3组治疗前外周血中性粒细胞CD_(64)和CRP水平总体比较差异均有统计学意义(P0.05)。治疗前烧伤脓毒症组外周血中性粒细胞CD_(64)和CRP水平明显高于烧伤局部感染组及烧伤不伴感染组,烧伤局部感染组外周血中性粒细胞CD_(64)和CRP水平明显高于烧伤不伴感染组,差异均有统计学意义(P0.05)。烧伤脓毒症组治疗1周后外周血中性粒细胞CD_(64)及CRP水平较治疗前明显下降,差异均有统计学意义(P0.05)。ROC曲线下面积比较:Y(0.943)CRP(0.910)中性粒细胞CD_(64)(0.926),灵敏度与特异度新变量Y优于外周血中性粒细胞CD_(64)和CRP。结论临床可通过外周血中性粒细胞CD_(64)和CRP水平检测来确定烧伤患者感染程度,外周血中性粒细胞CD_(64)和CRP水平可以为烧伤感染严重程度诊断及治疗结果评价提供参考。     

哮喘与感染患儿外周血中性粒细胞CD64指数、B淋巴细胞、BTLA的表达差异及临床意义研究

目的研究哮喘与细菌感染患儿外周血中性粒细胞CD64指数、B淋巴细胞、B和T淋巴细胞衰减因子(BTLA)的表达差异及其作用机制。方法选取皖南医学院弋矶山医院儿科2015年6月至2017年1月收住入院的49例患儿,其中3~6岁哮喘患儿26例(哮喘组),同期一般细菌感染患儿为23例(感染组)。两组受试对象在性别、年龄及体质量上差异均无统计学意义(P0.05)。住院后24h内收集两组清晨空腹外周静脉血,应用流式细胞术检测外周血中性粒细胞CD64指数和B淋巴细胞水平及其BTLA表达水平,散射比浊法测定血清IgE水平,免疫透射比浊法测定血清CRP水平。结果哮喘组外周血中性粒细胞CD64水平高于感染组(P0.05)。哮喘组B淋巴细胞百分比高于感染组(P0.05);哮喘组B淋巴细胞表面BTLA表达较感染组减少(P0.01);哮喘组B淋巴细胞百分比与其表达BTLA成正相关(r=0.569 8,P0.01)。哮喘组外周血清CRP水平较感染组低(P0.05)。哮喘组外周血清IgE水平较感染组显著升高(P0.01)。结论感染是哮喘的诱发因素之一,CD64、CRP的早期检测可指导哮喘患儿抗菌药物的应用。BTLA在哮喘患儿B淋巴细胞表达下调,参与免疫应答的调控。     

PCT联合CD64指数在肝硬化合并自发性细菌性腹膜炎患者抗感染治疗效果中预测作用

目的研究降钙素原(PCT)联合CD64平均荧光强度指数(CD64指数)在肝硬化合并自发性细菌性腹膜炎(SBP)患者抗感染治疗效果中的预测作用。方法选择2010年5月至2014年5月接受诊治的失代偿期的肝硬化腹水患者112例实施研究。依据患者临床表现及实验室检测结果将患者划分为非SBP组24例(阴性对照组)和疑似SBP组70例,以及SBP确诊组18例。将疑似SBP组70例患者进一步划分亚组,分别是伴腹痛组30例,无腹痛组40例。外周血的中性粒细胞百分比上升组36例,外周血的中性粒细胞百分比未上升组34例。SBP确诊组及疑似SBP组共88例经抗感染治疗后划分亚组,分别是治疗有效组59例和治疗无效组29例。对比各组实验室指标情况、疑似SBP组不同亚组的实验室指标情况、SBP确诊组及疑似SBP组经抗感染治疗后不同效果亚组的实验室指标情况,分析PCT联合CD64指数对患者治疗效果的预测作用。结果 SBP确诊组、疑似SBP组及阳性对照组的腹水CD64指数及外周血PCT水平均分别显著高于阴性对照组,同时,SBP确诊组的腹水CD64指数及外周血PCT水平均分别显著高于疑似SBP组,差异均有统计学意义(均P0.05)。疑似SBP组下的伴腹痛组与无腹痛组在腹水CD64指数、WBC计数以及外周血WBC和PCT指标水平上对比,差异无显著性。但外周血的中性粒细胞百分比上升组的腹水CD64指数及外周血PCT水平均分别显著高于外周血的中性粒细胞百分比未上升组,差异均有统计学意义(均P0.05)。治疗有效组的腹水CD64指数及外周血PCT水平均分别显著低于治疗无效组,差异均有统计学意义(均P0.05)。PCT联合CD64指数对患者治疗效果进行预测的灵敏度和准确性均高于两指标单独应用,特异度亦较好。结论 PCT联合CD64指数对肝硬化合并SBP患者的抗感染疗效具有较好的预测作用,值得在临床上推广应用。     

川崎病患儿血清血管生长因子及内皮抑素的变化及与冠状动脉扩张的关系研究

目的观察川崎病(KD)患儿血清血管生长因子(VEGF)及内皮抑素(ES)的变化,探讨其在KD发病机制中的作用及与冠状动脉扩张的相关性。方法以30例健康儿童为对照组,将32例初发KD患儿根据心脏彩超结果分为冠状动脉病变组(CAL组)12例,无冠状动脉病变组(NCAL组)20例,采用酶联免疫法检测两组患儿血清VEGF及ES的水平,运用超声心动图检测冠状动脉扩张程度,分析血清VEGF、ES水平及VEGF/ES变化及其与冠状动脉扩张程度的相关性。结果两组患儿急性期和恢复期血清VEGF、ES水平及VEGF/ES均高于对照组,差异均有统计学意义(P0.05);CAL组急性期和恢复期血清VEGF及ES水平明均显高于NCAL组,差异均有统计学意义(P0.05),且患儿血清VEGF、ES水平及VEGF/ES与冠状动脉扩张程度均呈显著正相关(P0.01)。结论 VEGF及ES可能参与KD患儿急性期血管炎的发病机制,并且对于评估KD冠状动脉损伤具有良好的临床价值。     

结核病感染期间中性粒细胞CD64、TLR2和 TLR4表达变化及其对免疫反应的影响

目的探究结核病感染期间中性粒细胞CD64、TLR2和TLR4表达变化分析其对免疫反应造成的影响。方法筛取2016年10月至2018年3月来该院呼吸内科就诊的患者,按患者是否患有结核病分为对照组(n=38)和观察组(n=36),分别检测感染结核分枝杆菌前后其外周血中中性粒细胞和Toll样受体(TLRs)的表达水平,检测中性粒细胞吞噬作用变化。结果两组感染后CD64表达水平均明显高于感染前且观察组均高于对照组,差异有统计学意义(P0.05);对照组感染后CD32表达水平明显提升,差异有统计学意义(P0.05);对照组感染前TLRs表达水平均明显低于观察组,差异有统计学意义(P0.05),感染后两组TLRs表达量均明显下降,差异有统计学意义(P0.05);两组感染前后中性粒细胞吞噬作用百分比均明显变化,差异有统计学意义(P0.05),感染前对照组吞噬作用百分比明显高于观察组,差异有统计学意义(P0.05)。结论结核病感染期间,患者外周血中性粒细胞CD64、TLR2和TLR4表达水平均明显升高,且中性粒细胞吞噬功能下降明显。     

血液细菌感染患者中性粒细胞CD64指数、CRP及WBC水平变化

目的探讨中性粒细胞CD64指数、C-反应蛋白(CRP)、白细胞(WBC)及中性粒细胞和淋巴细胞绝对值比值(N/L)在血液细菌感染患者中的水平变化及临床意义。方法采用流式细胞术检测105例血液细菌培养阳性患者(阳性组)、66例血液细菌培养阴性患者(阴性组)及50例健康体检人员(正常组)外周血中性粒细胞CD64指数、免疫比浊法测定血清CRP水平及血液分析仪检测WBC数及N/L比值。结果与正常组比较,阳性组和阴性组中性粒细胞CD64指数、CRP、WBC水平及N/L比值明显升高,差异均具有统计学意义(均P0.01)。阳性组中性粒细胞CD64指数、CRP水平及N/L比值明显高于阴性组,差异均具有统计学意义(P0.01,P0.05)。与G-菌组比较,G+菌组中性粒细胞CD64指数、N/L比值明显降低,差异均具有统计学意义(均P0.05)。阳性组患者中性粒细胞CD64指数与CRP呈轻度正相关(rs=0.377,P0.05)。结论中性粒细胞CD64指数、CRP及N/L比值均为较好的血液细菌感染指标;中性粒细胞CD64指数和N/L比值可能有助于G+菌与G-菌的鉴别。     

中性粒细胞CD64在新生儿败血症中的应用

目的 检测新生儿败血症外周血中性粒细胞表面CD64的表达水平,探讨其对新生儿败血症的诊断价值.方法 将67例新生儿败血症和27例无感染症状的新生儿进行外周血中性粒细胞CD64、血清C反应蛋白(CRP)和白细胞(WBC)计数检测.结果 败血症组外周血中性粒细胞CD64为62.3%±9.3%,非感染组为7.2%±2.3%,两组比较差异有统计学意义(P<0.01).CRP在败血症组与非感染组之间差异也有统计学意义(P<0.05),而两组之间的WBC则差异无统计学意义(P>0.05).ROC曲线分析显示.CD64曲线下面积为0.92,CRP曲线下面积为0.73,而WBC曲线下面积仅为0.56.结论 新生儿败血症外周血中性粒细胞表面CD64的表达及血清CRP水平均显著增加,可作为早期诊断新生儿败血症的实验室指标,且中性粒细胞表面CD64表达较血清CRP有更高的敏感性和特异性.     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001