Dyspareunia. Tracing the cause

Difficult or painful sexual intercourse is a sensitive topic for most women. The causes range from inflammation of the vulva and interstitial cystitis to marital discord. To exclude an organic disorder, a detailed pelvic examination with good lighting and magnification is in order. Dr DeWitt describes the technique for meticulous examination and discusses the diagnoses that need to be considered.     

Tracing transgene expression in cancer gene therapy: a requirement for rational progress in the field.

This review summarizes the status of gene therapy in medicine and the role of molecular imaging in its development. In gene therapy, genetic material is introduced into cells in order to generate a specific biological effect. Natural (viruses) or artificial molecular constructs, named gene therapy vectors, are used to achieve efficient cell transduction. This new form of therapy can be used for treating a broad variety of conditions including hereditary diseases, infections, degenerative disorders and cancer. Monitoring transgene expression using noninvasive imaging techniques is a necessary complement for the development of clinical gene therapy. Recent developments in magnetic resonance imaging afford the possibility of detecting gene transfer in vivo, but the most promising results have been obtained with positron emission tomography (PET). PET allows imaging gene therapy products by administration of a labeled substrate when the transgene codes for an enzyme or by administration of a labeled ligand when the transgene codes for a receptor. In the latter strategy, a membrane molecule (somatostatin or dopamine receptors) is used to detect the selective trapping of its radiolabeled ligand in the transduced cells. One of the approaches for the genetic treatment of cancer consists in transferring the "suicide genes" into tumor cells, the most common being the thymidine kinase (tk) of herpes viruses. Different nucleoside analogs can be labeled for its use as PET reporter probes in order to visualize tk expression. The results of pre-clinical studies are extremely encouraging. Reliable methods for the in vivo tracing of transgene expression in humans have to be developed in order for the field of gene therapy to mature. PET has emerged as a powerful tool to assist in achieving this goal.     

Tracing the molecular pathogenesis of antiphospholipid syndrome

Fetal loss induced by antiphospholipid antibodies (aPLs) in mice is a complement-driven inflammatory condition. Engagement of the complement receptor C5aR on neutrophils induces expression of the principal initiator of the blood clotting mechanism, tissue factor (TF), and blocking this downstream event of complement activation prevents antibody-induced fetal loss. In this issue of the JCI, the study by Redecha et al. clarifies that in mice, the contribution of TF to this pathogenic mechanism is independent of its role in coagulation and thrombosis, but involves inflammatory signaling through the receptor PAR2 (see the related article beginning on page 3453). The study not only sheds light on a critical effector mechanism of aPL-induced fetal loss, but also suggests that treatment with statins, which decrease TF and PAR2 expression, may hold promise as a therapeutic approach to antiphospholipid syndrome-associated pregnancy complications.     

Tracing the route to path analysis in neuroimaging

This article provides a personal perspective of the adoption of path analysis (structural equation modeling) to neuroimaging. The paper covers the motivation stemming from the need to merge functional measures with neuroanatomy and early innovations in its application. The use of path analysis as a means to test directional hypotheses about networks is presented along with the development of the complementary method, partial least squares. A method is useful when it provides insights that were previously inaccessible, and reflecting this, the paper concludes with a synopsis of the theoretical developments that arose for the routine use of methods like path analysis.     

Tracing the Evolution of Competence in Haemophilus influenzae

Natural competence is the genetically encoded ability of some bacteria to take up DNA from the environment. Although most of the incoming DNA is degraded, occasionally intact homologous fragments can recombine with the chromosome, displacing one resident strand. This potential to use DNA as a source of both nutrients and genetic novelty has important implications for the ecology and evolution of competent bacteria. However, it is not known how frequently competence changes during evolution, or whether non-competent strains can persist for long periods of time. We have previously studied competence in H. influenzae and found that both the amount of DNA taken up and the amount recombined varies extensively between different strains. In addition, several strains are unable to become competent, suggesting that competence has been lost at least once. To investigate how many times competence has increased or decreased during the divergence of these strains, we inferred the evolutionary relationships of strains using the largest datasets currently available. However, despite the use of three datasets and multiple inference methods, few nodes were resolved with high support, perhaps due to extensive mixing by recombination. Tracing the evolution of competence in those clades that were well supported identified changes in DNA uptake and/or transformation in most strains. The recency of these events suggests that competence has changed frequently during evolution but the poor support of basal relationships precludes the determination of whether non-competent strains can persist for long periods of time. In some strains, changes in transformation have occurred that cannot be due to changes in DNA uptake, suggesting that selection can act on transformation independent of DNA uptake.     

Tracing the development of critical thinking in baccalaureate nursing students

A repeated measures design was used to trace 83 baccalaureate students' critical thinking (CT) ability as they progressed in a nursing program. CT was assessed with the Watson-Glaser Critical Thinking Appraisal at four strategic junctures in the curriculum; program entry, mid junior year, beginning of senior year, and program exit. Sixty students (Group One) had been in the program when the study began and were not pretested. Group Two (N = 23) was tested at all four junctures. The sample was racially and culturally diverse, predominantly female, and a majority had prior college. Over time, scores tended not to improve, and they were below published norms. Findings are discussed from the perspectives of what constitutes CT in nursing and its measurement, the cultural context of its assessment, and the nature of nursing education and its influence on CT.     

Tracing our roots: the beginnings of a profession.

OBJECTIVE: To examine the role of the American Society of Clinical Pathology and the Board of Registry in shaping the field of clinical laboratory science during its formative years. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: The Board of Registry played a significant role in the early development of clinical laboratory science. The Board established standards of competence for entry-level practitioners and a mechanism for assessing competence and developed an accreditation process for educational programs.     

Tracing of noradrenergic projections using manganese-enhanced MRI

We examined the applicability of manganese-enhanced MRI (MEMRI) to the in vivo tracing of diffuse neuromodulatory projections by means of simultaneous iontophoretic injections of an extremely low, non-toxic concentration of MnCl₂ (10 mM) and fluorescent dextran in the locus coeruleus (LC) in the rat. We validated the use of the iontophoretic injection by reproducing previously reported results from pressure injections of MnCl₂ in primary somatosensory cortex. Twenty four hours after injection in LC, Mn^2 + labeling was detected in major cortical and subcortical targets of LC projections including predominantly ipsilateral primary motor and somatosensory cortices, hippocampus and amygdala. Although the injections were in most cases centered in the core of LC, the pattern of Mn^2 + labeling greatly varied across rats. In addition, despite a certain degree of overlap of the labeling obtained with both MEMRI and classical tracing, MEMRI tracing consistently failed to reliably label not only several minor but also major targets of LC, notably the thalamus. The lack of Mn^2 + labeling in thalamus possibly reflected a weaker functional connectivity within coeruleothalamic projections that could not be predicted by anatomical tracing. Inversely, a number of brain regions, particularly contralateral motor cortex, that were not or only sparsely labeled with fluorescent dextran were strongly labeled by Mn^2 +. This discrepancy could be partly due to both the activity-dependent and transsynaptic nature of Mn^2 + transport. The overall labeling produced using MEMRI with iontophoretic injections in LC indicates that the Mn^2 + imaging of highly diffuse projections is in principle feasible. However, the labeling pattern of each individual case needs to be carefully interpreted particularly before submitting data for group analysis or in the case of longitudinal examination of discrete changes in functional connectivity under various physiological or behavioral conditions.     

护理不良事件管理的追踪检查分析及对策

目的探讨护理不良事件追踪检查的方法及实施干预效果。方法对2013年发生的267例不良事件进行追踪检查,对管理过程中存在的环节质量问题进行分析,根据问题提出改进措施。结果护理环节质量问题及不良事件发生率呈现下降趋势。结论对护理不良事件管理进行追踪检查,实施改进措施后可以提高护理质量。     

质粒图谱分析追踪医院感染的不动杆菌来源

目的：追踪医院感染不动杆菌的来源。方法 应用生物分型,耐药谱分型和质粒图谱分析对９株医院的感染不动杆菌进行分析。结果 生物分型不能区分它们之间的不同;质粒图谱分析分出５种四谱,来自新生儿科的７株菌中有６株菌分属其中的２种图谱;耐药谱分型和质粒图谱分析的结果有所不同,但它们之间具有较高的相羞生。结论 新生儿科的呼吸机管道和氧化湿化瓶是院内感染不动杆菌的贮菌源。     

鲍曼不动杆菌医院感染溯源研究

摘要 目的追溯医院感染鲍曼不动杆菌的来源,进行医院感染源头控制。方法 通过分离鉴定和分子分型技术,对江苏某医院ICU分离到的不动杆菌属进行溯源研究。结果 从该医院ICU各种送检标本中分离出64株不动杆菌属,鉴定确认其中34株为鲍曼不动杆菌,分别来自感染患者5株、物体表面27株、医护人员手1株和空气标本1株。分离自患者痰液的菌株分型与其周边物体表面和医护人员手分离菌株一致。患者标本分离的5株鲍曼不动杆菌全部为多重耐药菌株。结论 本研究通过分型溯源方式发现医院感染病原菌很多与其周围环境分离菌株具有同源性,说明有效控制环境污染有助于医院感染的防控。     

重症监护病房中耐甲氧西林金葡菌的流行

目的调查耐甲氧西林金黄色葡萄球菌（ＭＲＳＡ）在重症监护病房（ＩＣＵ）的流行情况。方法将临床分离２８株ＭＲＳＡ包埋于琼脂块中，原位溶解细菌，ＳｍａⅠ消化染色体ＤＮＡ，经脉冲场凝胶电泳（ＰＦＧＥ）分离，比较染色体限制性内切酶图谱，确定菌株的亲缘关系。结果２８株ＭＲＳＡ的ＰＦＧＥ图谱有Ｋ、Ｍ、Ｌ、Ｎ４型，以Ｋ型为主（１８株）。ＩＣＵ本次流行期间的ＭＲＳＡ分离株均为Ｋ１亚型（１４株），与前次流行株Ａ１亚型完全不同。采集２０位ＩＣＵ医护人员鼻拭子，分离到２株ＭＲＳＡ，阳性率１０％，其ＰＦＧＥ图谱与流行株一致。结论ＭＲＳＡ在ＩＣＵ流行情况十分严重，及时采取有效措施控制这种流行及播散是至关重要的     

Tracing best PEEP by applying PEEP as a RAMP

Objective: The aim of this study was to show the feasibility of a slow, continuously increasing level of positive end-expiratory pressure (PEEP) (ramp manoeuvre) in selecting best PEEP and to evaluate whether best PEEP, as definded by maximal oxygen transport, coincides with best systemic arterial oxygenation or best compliance. Design: In 11 anaesthetized piglets, PEEP was increased between 0 cmH₂O (zero end-expiratory pressure; ZEEP) and 15 cmH₂O (PEEP₁₅) with a constant rate of 0.67 cmH₂O · min⁻¹. This ramp manoeuvre was performed both under normal conditions and after induction of an experimental lung oedema. During the ramp manoeuvre, haemodynamic and pulmonary variables were monitored almost continuously. Results: During the rise in PEEP, cardiac output declined in a non-linear way. In the series with normal conditions, best PEEP was always found at ZEEP. In the series with experimental lung oedema, best PEEP, as defined by maximum oxygen transport, was found at PEEP_1–6, as defined by maximal compliance, at PEEP_7.5 and by maximal arterial oxygen tension (PaO₂) at PEEP_10–14. Conclusions: Best PEEP according to oxygen transport is lower than best PEEP according to compliance and PaO₂; the use of PEEP as a ramp might prevent unnecessarily high levels of PEEP. Received: 16 June 1997 Accepted: 24 April 1998     

Interdisciplinary Team Huddles for Fetal Heart Rate Tracing Review

To address an increase in unexpected poor outcomes in term neonates, our team developed a goal of high reliability and improved fetal safety in the culture of the Labor and Delivery nursing department. We implemented interdisciplinary reviews of fetal heart rate, along with a Category II fetal heart rate management algorithm and a fetal heart rate assessment rapid response alert to call for unscheduled reviews when needed. Enhanced communication between nurses and other clinicians supported an interdisciplinary approach to fetal safety, and we observed an improvement in health outcomes for term neonates. We share our experience with the intention of making our methods available to any labor and delivery unit team committed to safe, high-quality care and service excellence.