危重病全身炎症反应综合征患者血清降钙素原的动态变化及其意义

目的探讨血清降钙素原(PCT)在全身炎症反应综合征(SIRS)和多器官功能障碍综合征(MODS)发生发展中的意义及其与SIRS/MODS严重程度的相关性.方法选择重症监护室(ICU)危重病患者66例,在入院第1、3、5天分别测定其外周血PCT、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α).结果血清PCT、IL-6及TNF-α在SIRS组、MODS组及死亡组均较非SIRS组、非MODS组及非死亡组明显升高,且SIRS组、MODS组及死亡组PCT、IL-6及TNF-α始终维持在较高水平.组内比较,第1、3、5天血清PCT和IL-6有逐步升高趋势,提示PCT和IL-6与MODS和死亡组比TNF-α更具有密切的相关关系.结论血清PCT是一个新的较为敏感的反映SIRS/MODS严重程度的指标,并能指导临床早期诊断和早期治疗.     

通里攻下法对严重创伤导致肠源性内毒素血症的影响

目的:观察通里攻下法对多器官功能障碍综合征(MODS)或全身炎症反应综合征(SIRS)模型动物内毒素血症的影响.方法:40只纯种新西兰大白兔随机分为实验组和对照组,每组20只.用Wiggers方法制成失血性休克模型,观察并记录MODS或SIRS的发生率.实验组家兔每日经口灌服大承气颗粒剂1.25 g,连续3 d.所有动物于休克前及休克后1、3、7 d取血测定血清内毒素水平.结果:40只兔中29只(72.5%)发生MODS.治疗后对照组内毒素水平呈升高趋势,而实验组呈下降趋势,实验组内毒素在治疗后7 d显著低于对照组(P<0.01).结论:使用大承气颗粒能够控制严重创伤所致MODS或SIRS模型动物内毒素血症.     

提高对创伤感染及其并发症的认识

严重创伤、感染、休克、外科大手术等应激状态常常会对机体造成强烈刺激,并引起一系列并发症,如全身炎症反应综合征(SIRS)、脓毒症(sep-sis)、多器官功能障碍综合征(MODS)等,是现代危重病急救医学关注的重大热点问题之一.由于临床上缺乏特异性治疗手段,目前严重感染病死率仍然很高.因此,深入探讨创伤感染的发生规律与病理生理机制,寻求新的有效防治途径,对于创伤感染及其并发症的早期识别、诊断和干预,从而降低患者的病死率及提高生活质量具有重要意义.     

血清PCT、IL-6水平及SIRS对严重多发伤脓毒血症早期诊断临床研究

目的:探讨降钙素原(PCT)、白介素6(IL-6)及全身炎性反应综合征(SIRS)在早期诊断严重多发伤患者脓毒血症的临床应用价值。方法:记录50例严重多发伤患者伤后SIRS病情变化,检测伤后(d0)及伤后第1天早晨血清PCT、IL-6及CRP水平,并进行比较分析。结果:36例患者发生全身炎性反应综合征而无全身感染(SIRS组),14例患者在并发脓毒血症(Sepsis组);血清PCT及IL-6在Sepsis组伤后第1天就有明显升高(P<0.05),但是CRP相近;血清PCT及IL-6水平结合SIRS表现诊断多发伤后脓毒血症特异性和敏感性更高。结论:严重多发伤后第1天血清PCT和IL-6水平变化可以作为脓毒血症的早期指标,为早期诊断及治疗提供基础。     

中医药防治多器官功能障碍综合征回顾与展望

多器官功能障碍综合征 (MODS)是创伤及感染后最严重的并发症。近年来 ,西医学对 MODS发生机制的认识已有了长足进步 ,阐明了全身炎症反应综合征 (SIRS)、代偿性抗炎反应综合征 (CARS)与 MODS的关系 ,认为 MODS是过度 SIRS或过度 CARS所致 ,而多器官功能衰竭 (MOF)只是 MODS的终末阶段。其中速发型 MODS是创伤、休克、感染、炎症等打击引起的缺血再灌注损伤和过度的 SIRS直接损伤的结果 ,发病与否与损伤的严重程度以及机体易感性有关。迟发型 MODS主要是过度的抗炎反应导致机体免疫功能障碍引起的间接损伤 ,与继发感染…     

严重创伤患者高迁移率族蛋白-1的变化

目的研究多发伤患者血清高迁移率族蛋白-1(HMG-1)的变化，并探讨其与创伤严重度及多器官功能障碍综合征(MODS)的关系。方法测定33例多发伤患者伤后第1、3和7d血清HMG-1水平，同时评定其创伤严重度评分(ISS)、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、全身炎症反应综合征(SIRS)评分。结果伤后1d内，多发伤患者血清HMG-1显著高于对照组，HMG-1水平与APACHEⅡ评分值呈正相关(r=0．495，P=0．016)，发生脏器功能不全组HMG-1、APACHEⅡ值均明显高于脏器功能正常组SIRS评分在两组间差异不显著(P=0．105)。结论创伤可引起HMG-1的升高，且与创伤严重度相关；检测HMG-1变化有助于预警MODS的发生。     

EICU中患者严重多发伤后全身炎性反应综合征和多器官功能障碍综合征的临床研究

目的：探讨EICU中患者严重多发伤后全身炎性反应综合征（SIRS）的特点、不同程度SIRS与多器官功能障碍综合征（MODS）的关系以及对进展为MODS的防治。方法：根据SIRS的诊断标准及参照APACHE评分系统、创伤严重程度、全身感染等指标确定SIRS的严重程度,明确SIRS向MODS发展的渐进过程及分析不同程度SIRS与MODS的关系。结果：EICU中患者严重多发伤364例中轻、中、重度SIRS分别为163例、120例和81例。其中,中、重度SIRS患者MODS的发生率明显增加（P〈0．05）;受累器官中,呼吸功能障碍最多见,患病率达27．7％;随着受累器官增多,病死率显著增加（P〈0．05）。结论：EICU中患者严重多发伤后SIRS患者由于二次打击因素的存在,MODS发生率明显升高。SIRS的程度与MODS的发病和预后密切相关。高度重视SIRS向MODS演变过程中的高危因素,削弱或阻断二次打击,早期支持保护重要脏器功能是防治MODS、降低病死率最有力的措施。     

创伤后血清NO浓度变化与TNF-α水平之间的相关性及其在创伤后MODS发病中的意义

目的　探讨严重创伤患者血清NO浓度变化与TNF -α水平之间的相关性及其与创伤后MODS发生、发展的关系。方法　分别采用目前常用的硝酸还原酶法和双抗体夹心ABC -ELISA法动态检测 83例严重创伤患者血清NO和TNF-α含量 ,分析各组间血清NO浓度变化和TNF -α水平之间的相关性关系。结果　①严重创伤患者不论是否发生MODS ,其血清NO和TNF -α含量于伤后第 1天即明显升高 ,而且在MODS组升高幅度较大 ,持续时间较长 ,在死亡患者升高幅度更大且一直保持在峰值水平 ;②严重创伤患者各组、各时间段血清NO浓度变化与血清TNF -α水平 (ng/L)之间呈正相关关系 (γ =0 .97～ 0 .6 6 ,P <0 .0 1) ,但正常对照组血清NO含量与TNF -α含量之间无相关关系 (γ=0 .0 3,P>0 .0 5 )。结论　①血清NO与TNF -α含量高低与创伤后MODS的发生及其严重程度直接相关 ;②创伤后血清NO含量变化与TNF -α水平之间呈明显的正相关关系 ;③严重创伤诱发血清TNF -α过度表达 ,进而导致iNOS异常诱生并持续大量合成NO可能是创伤后MODS的重要发病机制之一。     

胸部创伤患者早期SIRS评分及血清中C反应蛋白含量与创伤后感染的关系

目的:研究胸部创伤患者早期的全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)评分及血清C反应蛋白(C reactive protein,CRP)含量与创伤后感染的关系.方法:选取复旦大学附属上海市第五人民医院胸外科2009年7月-2012年6月收治的以胸部创伤为主的患者406例,入院时均进行SIRS评分,检测伤后24 h血清CRP含量.分析SIRS评分和血清CRP含量与创伤后感染的关系.结果:SIRS评分3～4分患者创伤后感染发生率高于SIRS评分0～1分及2分患者.logistic回归显示,SIRS评分3～4分是胸部创伤患者发生创伤后感染的独立预测因素.感染组伤后24 h血清CRP含量显著高于非感染组.结论:入院后SIRS评分是预测胸部创伤患者发生创伤后感染的有效指标.创伤后24 h血清CRP含量的升高幅度对预测患者后期是否发生感染有一定参考价值.     

降钙素原、ISS评分和SOFA评分在外科创伤患者预后评估中的比较

目的:比较降钙素原(PCT)、ISS评分和SOFA评分对外科创伤患者的预后评估.方法:对首次入急诊抢救和重症监护病房的机械性创伤患者采集血标本,采用免疫发光法检测血浆PCT水平,同时对患者进行ISS评分和SOFA评分.用此三种方法预测患者的病死率.结果:ISS评分和SOFA评分均随着患者病情加重(即各评分的分值升高)而病死率升高,同时血浆PCT水平随着病情加重而升高(P=0.03).ISS评分、SOFA评分和PCT水平的ROC曲线下面积依次为0.691(0.062)、0.711(0.069)、0.692(0.072).结论:PCT、ISS评分和SOFA评分都能对外科创伤患者的预后进行较为准确的评估,PCT更具有较好的客观性和敏感度.     

Cellular uptake and efflux of azithromycin, erythromycin, clarithromycin, telithromycin, and cethromycin

Macrolide antibiotics have an outstanding ability to concentrate within host cells, particularly phagocytes. In the study described in this paper five different macrolide antibiotics were compared regarding the uptake and release kinetics in human peripheral blood polymorphonuclear neutrophils (PMNs) and three different cell lines, two phagocytic cell lines (RAW 264.7 and THP-1) and an epithelial cell line (MDCK). Based on the results obtained, the substances tested could be clustered into different groups. Azithromycin constituted the first group, characterized by rapid and nonsaturable uptake into phagocytic cells and a high degree of retention in the preloaded cells. The second group included erythromycin and clarithromycin. These two substances do not exhibit cell specificity; consequently, they are taken up to a similar extent and are released by all cell types studied. Ketolides constituted the last group. Their uptake was saturable in cells of monocytic lineage as well as in nondifferentiated cells of myeloid lineage, and they were rapidly released from all the cell lines studied. However, in PMNs, ketolide uptake was not saturable; and unlike telithromycin, cethromycin rapidly egressed from the loaded cells.     

Comparative Activities of Clinafloxacin, Grepafloxacin, Levofloxacin, Moxifloxacin, Ofloxacin, Sparfloxacin, and Trovafloxacin and Nonquinolones Linozelid, Quinupristin-Dalfopristin, Gentamicin, and Vancomycin against Clinical Isolates of Ciprofloxacin-Resistant and -Susceptible Staphylococcus aureus Strains

The activities of eight fluoroquinolones and linezolid, quinupristin-dalfopristin (Synercid), gentamicin, and vancomycin were tested against 96 ciprofloxacin-susceptible and 205 ciprofloxacin-resistant Staphylococcus aureus strains. Overall, clinafloxacin, followed by moxifloxacin and trovafloxacin, was the most active quinolone tested. For all isolates, linezolid and quinupristin-dalfopristin showed activities that were at least comparable to vancomycin, with no cross-resistance to any other test compound.     

Attributional,life-event,and affective predictors of onset of depression,anxiety, and negative attributional style

This investigation examined (1) the extent to which negative attributional style and life events predict the development of depression and anxiety, and (2) the extent to which measures of life events, depression, and anxiety predict the development of negative attributional style. Sets of questionnaires, including the Attributional Style Questionnaire (ASQ), the Multiple Affect Adjective Check List (MAACL), the Beck Depression Inventory (BDI), the Stimulus-Response Inventory of General Trait Anxiousness (SR-GTA), and the Life Experiences Survey (LES), were administered to 80 undergraduate students on two occasions separated by a 1-month interval, between midterm and final examination periods of an academic semester. Results of hierarchical multiple regression analyses indicated that (1) composite negative attributional style predicted the onset of anxiety, measured by the MAACL anxiety scale, and (2) depression, measured by the MAACL depression scale, and low amounts of desirable life events each predicted the onset of composite negative attributional style.This research was partially supported by the Temple University Research Incentive Fund to the second author. We thank Edward Gracely for his assistance in the data-analytic process.     

Worry, Procrastination, and Perfectionism: Differentiating Amount of Worry, Pathological Worry, Anxiety, and Depression

This study investigates features that differentiate worry from somatic anxiety and depression. Theoretical models of the worry process suggest that worry is closely related to procrastination. In addition, research on worry and elevated evidence requirements proposes a relationship between worry and perfectionism. Perfectionism, however, is multidimensional in nature. Moreover, previous research has linked procrastination and perfectionism mainly to anxiety and depression. Therefore, the relationship among worry, procrastination, and dimensions of perfectionism was investigated in a sample of 180 students, controlling for anxiety and depression. Results show that worry had substantial correlations with procrastination and perfectionism, particularly with perfectionist concern over mistakes and doubts. Moreover, worry was related to parental criticism and expectations, but unrelated to excessively high personal standards. Instead, high-worriers reported to lower standards under stress. Partial correlations indicated that these correlations were specific for amount of worry, thus differentiating amount of worry, pathological worry, anxiety, and depression.     

Absorption, distribution, metabolic fate, and elimination of pefloxacin mesylate in mice, rats, dogs, monkeys, and humans

Pefloxacin mesylate is well absorbed by the oral route. The antimicrobial activity in dog, cynomolgus monkey, and human plasma was essentially due to unchanged drug which respectively accounted for 64, 94, and 84% of the total activity (ratios derived from relative area under the curve [AUC] values). Half-lives ranged from 1.9 h in mice to 8.6 h in humans. Protein binding was weak, about 20% in plasma. Except in brain, concentrations in most of the organs and tissues tested in rats and dogs were higher than the plasma levels. Microbiological activity in urine was mainly due to pefloxacin and norfloxacin, the N-desmethyl metabolite. The norfloxacin/pefloxacin ratios were 0 in mice, ca. 1 in rats and dogs, 1.6 in cynomolgus monkeys, and 2.3 in humans. The principal urinary compounds were unchanged drug in mice, pefloxacin glucuronide and pefloxacin N-oxide in rats and dogs, norfloxacin and pefloxacin in monkeys, and pefloxacin N-oxide and norfloxacin in humans. The urinary recovery of identified metabolites was 29.5% of the dose in mice, 37.8% in rats, 36.3% in dogs, 26.5% in monkeys, and 58.9% in humans. Biliary excretion occurred and was extensive in rats and dogs, mainly as a glucuronide conjugate of the drug. In rat and human bile, the main active compound was unchanged pefloxacin.     

Cancers of the prostate, penis, and testicles: epidemiology, prevention, and treatment

Cancer is a disease that most people fear. Nurses are required to provide information on how to avoid cancer, and, once the diagnosis is made, how to cope with it. Prevention and early detection of the cancers described in this article are in the very early stages of knowledge development, but general health promotion guidance can be offered on how to avoid most cancers (ie, no tobacco use, a high-fiber and low fat diet, exercise, and maintaining a normal weight). Nurses also can advise patients to be screened for colorectal cancer at the appropriate ages and time intervals and to be aware as new developments occur in the scientific base for screenings in the areas of prostate, penile, and testicular cancer. Finally, coping with these forms of cancer often requires the patient to make major lifestyle and psychological changes, especially if surgery in the genital area occurs. Decreased libido, incontinence, and impotence are major complications that can occur with these illnesses. The male cancers described vary tremendously in their prevalence, incidence, mortality, treatment, and survival rates. Within this group, there are remarkably positive outcomes and outcomes much in need of improvement. Penile and testicular cancers are the bright spots in this picture; both are uncommon, and both are eminently treatable. Prostate cancer, on the other hand, is quite common, difficult to screen, difficult to treat without major sexual problems, and yet receives relatively little funding from the NIH. Although as many men die from prostate cancer as women die from breast cancer, NIH funds breast cancer research at much higher levels than prostate cancer. According to the latest data available at the NIH Web site, during the 1990s, the amount of NIH funding varied from four times more for breast cancer (1993) to 2.9 times more in 1999. For fiscal year 2002, NIH is providing $522 million in funding for breast cancer and $278 million for prostate cancer. Private foundation funds for prostate cancer are much smaller than those available for breast cancer. Both types of cancer are extremely important to address, and both should receive adequate research attention. Nurses can advocate for more funding for prostate cancer, from basic science approaches to behavioral science strategies.     

Effect of 5-fluorouracil, mitoxantrone, methotrexate, and vincristine on the antibacterial activity of ceftriaxone, ceftazidime, cefotiam, piperacillin, and netilmicin

Using the checkerboard agar dilution technique, antibacterial activity and in vitro interactions of 4 antineoplastic agents and 5 antimicrobial drugs were examined against 56 strains of 7 bacterial species. 5-fluorouracil was found to inhibit all strains of Staphylococcus aureus and of Staphylococcus epidermidis at a concentration of 0.8 micrograms/ml or less. 84% of all gram-negative strains were inhibited synergistically when 5-fluorouracil was combined with beta-lactam antibiotics. Methotrexate and cefotiam were antagonistic in 42% of all combinations, especially when tested against Escherichia coli and Klebsiella pneumoniae.