布鲁氏菌病实验室诊断研究进展

布鲁氏菌病（Brucellosis）是由布鲁氏菌（Brucella）引起的一种重要人兽共患病。根据致病性和宿主特异性,将布鲁氏菌分为6个种19个生物型,即羊种布鲁氏菌（B．meltensis）、牛种布鲁氏菌（B．abortus）、猪种布鲁氏菌（B．suis）、绵羊附睾种布鲁氏菌（B．ovis）、犬种布鲁氏菌（B．canis）和沙林鼠种布鲁氏菌（B．neotomae）。另外,     

布鲁氏菌耐药性与耐药机制研究进展

布鲁氏菌病是由布鲁氏菌引起的人兽共患病。近年来,我国布鲁氏菌病发病率逐年攀升,给公共卫生、畜牧业和社会经济发展带来重大损失。以多西环素联合利福平或链霉素为首选的抗生素治疗方案,在布鲁氏菌病的治疗中发挥关键作用,但随之布鲁氏菌出现耐药,给临床治疗带来挑战。本文就2013-2022年发表的牛羊源布鲁氏菌(主要是羊种、牛种布鲁氏菌)及人源布鲁氏菌(主要是羊种布鲁氏菌)耐药研究进展,包括耐药种类、耐药率及可能的耐药机制作一综述,为布鲁氏菌病的临床治疗和布鲁氏菌的耐药机制研究提供参考。     

布鲁氏菌毒力基因的研究状况

随着马耳他布鲁氏菌、猪布鲁氏菌和流产布鲁氏菌的全基因组被破译,发现这三种布鲁氏菌的染色体序列、组成和结构非常相似。染色体的序列测定和阐明为布鲁氏菌蛋白质的研究和分析铺平了道路,与以前通过分析染色体来推测布鲁氏菌的毒力比较,这对后基因组时代完全弄清楚不同布鲁氏菌种生物学特征的研究提供了可能性。而对基因结构和功能的大量研究,很多与致病性和毒力有关的基因发现,将为弄清楚布鲁氏菌的致病机制打下坚实的基础,     

AMOS-PCR对布鲁氏菌种型鉴定的应用

目的评价AMOS-PCR方法鉴定布鲁氏菌种型的特异性和实用性。方法用已建立的AMOS-PCR方法在国内检测标准菌株和对国内分离的布鲁氏菌地方株种型进行检测。结果羊种布鲁氏菌、牛种布鲁氏菌1,2,4、猪种布鲁氏菌1型和绵羊附睾布鲁氏菌有特异条带。结论AMOS-PCR是一种快速、简便、特异的鉴定布鲁氏菌的方法之一。     

布鲁氏菌噬菌体基因组学研究进展北大核心CSCD

布鲁氏菌噬菌体用于鉴定和鉴别布鲁氏菌种属,其种类、遗传特性以及基因组功能对布鲁氏菌鉴别分型具有重要作用,因此布鲁氏菌噬菌体的研究备受关注。基于当前的研究进展,本文对布鲁氏菌噬菌体的基本特征、基因组功能、基因组比对以及最新应用技术的相关研究进行综述,在了解布鲁氏菌噬菌体基因多样性和复杂性的基础上,进一步认识噬菌体与宿主的相互作用机制。     

甘肃省人群布鲁氏菌病防治知识及行为与健康教育现状调查分析

目的了解甘肃省人群布鲁氏菌病防治知识知晓现状,为今后布鲁氏菌病防控提供科学依据。方法选取不同类型地区的普通、高危、医务人群为调查对象,进行布鲁氏菌病防治知识问卷调查,并进行相关统计学分析。结果普通人群对布鲁氏菌病概念、布鲁氏菌病症状、传播途径、如何正确食用乳肉制品、布鲁氏菌病危害平均知晓率分别为9.17%、7.59%、7.70%、32.40%和1.82%;高危人群对布鲁氏菌病传染源、危害、牲畜检疫和免疫淘汰、防护平均知晓率分别为15.66%、16.43%、9.97%和8.32%;医务人员对布鲁氏菌病症状、布鲁氏菌病治疗原则平均知晓率分别为30.20%和32.67%。结论甘肃省人群布鲁氏菌病防治知识知晓率普遍偏低,防病知识相对缺乏,尤其是高危人群普遍缺乏个人防护知识,加强布鲁氏菌病防治知识健康教育,探讨有效干预方式是当务之急。     

MALDI-TOF-MS鉴定布鲁氏菌方法建立和评价

目的 为了快速、准确、便捷的检测和鉴定布鲁氏菌,本研究拟建立鉴定布鲁氏菌属的MALDI-TOF-MS方法,利用现场分离菌株对该方法进行特异性和敏感性评价。方法 收集布鲁氏菌标准菌株和地方流行株,应用MALDI-TOF-MS采集图谱,获取独特的蛋白质指纹图谱,汇总成标准图谱,建立布鲁氏菌鉴定数据库。并用39株布鲁氏菌菌株,对建立的数据库进行验证。结果 经数据库鉴定,39株布鲁氏菌菌株与数据库中布鲁氏菌的匹配分数全部大于2.300,均报告为布鲁氏菌,表明鉴定结果的可信度很高。 聚类分型结果表明,在蛋白质水平,MALDI-TOF-MS将测试的布鲁氏菌分成3大类。结论 MALDI-TOF-MS对布鲁氏菌进行鉴定,具有快速、准确、灵敏等优点,可以实现对布鲁氏菌属的准确鉴定,对布鲁氏菌病的临床诊断具有较高的使用价值。     

广西家畜布鲁氏菌病的监测分析

目的 对广西家畜布鲁氏菌病进行监测。方法 采用虎红平板凝集和试管凝集试验对2009-2011年广西14个市的16 143份家畜血清进行布鲁氏菌抗体监测;同时对1 070份家畜脾、胎衣、流产胎儿等样本以及10份布鲁氏菌试管凝集试验抗体阳性家畜的子宫或睾丸进行布鲁氏菌分离和鉴定。结果 2009年有1头种公猪,2010年有1头牛和8头山羊被检出为布鲁氏菌抗体阳性;经生化特性和PCR鉴定有1株从布鲁氏菌试管凝集试验抗体阳性羊内脏分离到的细菌被鉴定为羊种布鲁氏菌。对分离的羊种布鲁氏菌毒力基因VirB8的克隆测序结果显示,VirB8基因在布鲁氏菌种型间高度保守。结论 虽然广西家畜布鲁氏菌防治仍然达到稳定控制标准,但是需加强家畜引种和动物流通检疫工作,防止因引种和动物流通而将布鲁氏菌引入广西。     

用PCR法对布鲁氏菌进行筛查及分型鉴定的研究

目的寻找一种快速检测布鲁菌病的方法,并且用这种方法鉴别布鲁氏菌的种和部分型。方法根据布鲁氏菌编码312 kDa布鲁氏菌蛋白的基因（BSCP31）和IS711插入序列及相邻单染色体DNA种的不同,设计引物,建立AMOS-PCR方法,用于诊断布鲁氏菌病,并鉴定种。结果布鲁氏菌蛋白的基因（BSCP31）为引物可以扩增出牛、羊、猪型布鲁氏菌,用IS711插入序列及相邻单染色体设计的引物可以区别不同型别的布鲁氏菌,最低可检测到1 pg的布鲁氏菌DNA。结论AMOS-PCR方法是一种快速、简便、准确的布鲁氏菌病诊断方法,并能鉴定布鲁氏菌的种。     

布鲁氏菌S2菌壳的安全性和免疫学特性研究

目的利用小鼠模型对布鲁氏菌菌壳、布鲁氏菌S2活菌和福尔马林灭活菌的安全性和免疫学特性进行比较研究。方法利用猪布鲁氏菌S2株和重组裂解质粒制备出布鲁氏菌菌壳,将布鲁氏菌菌壳、布鲁氏菌S2活菌和福尔马林灭活菌通过腹腔注射免疫小鼠,进行安全性比较分析。监测免疫后小鼠的血清抗体水平、脾脏T淋巴细胞分型,并进行免疫攻毒实验。结果与布鲁氏菌弱毒疫苗菌株S2比较,布鲁氏菌菌壳具有更好的安全性,免疫小鼠后能产生与弱毒菌株相似的血清抗体水平、脾CD3+和CD4+T淋巴细胞反应,并具有与之相当的免疫保护作用。结论布鲁氏菌菌壳具有良好的安全性,能刺激机体产生体液免疫和细胞免疫反应,可作为预防布鲁氏菌病的新型候选疫苗。     

"Pain elsewhere" and the impact of knee pain in older people

OBJECTIVE: To investigate how often knee pain is accompanied by pain elsewhere and to determine whether the presence of "pain elsewhere" than the knee influences either knee-related disability or the impact of knee pain on health and psychological status. METHODS: A survey was mailed to 8,995 individuals (age > or =50 years) registered with 3 general practices in North Staffordshire in the UK. Patients recorded pain on a manikin and completed the Short-Form 36 health survey, the Hospital Anxiety and Depression Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Responders were categorized as having no pain, knee pain with or without pain elsewhere, or other pain (no knee pain, but pain elsewhere). Those with knee pain or other pain were subdivided by the extent of pain elsewhere. RESULTS: The adjusted survey response rate was 70%. Fifty-seven percent of responders with knee pain had pain in at least 2 other joint areas. Pain elsewhere was associated with lower physical function and with anxiety and depression both in the knee-pain group and in the other-pain group (associations were stronger in the knee-pain group). Knee pain and disability were less severe in those with knee pain alone than in those with knee pain and pain elsewhere, even after adjusting for age, sex, obesity, laterality of pain, and depression. CONCLUSION: Most people with knee pain have multiple joint site pain. The importance of this to clinicians and researchers is that the severity of knee pain and related disability is worse in the presence of pain elsewhere. This finding has implications for the management and treatment of older people with knee pain.     

Role of pain in placebo analgesia.

The hypothesis that perceived pain intensity can influence placebo analgesia was tested. One hundred and seven subjects rated their pain from from 0 to 10 on a visual analog scale after a standard wisdom tooth extraction. The expected course of such postoperative pain in the absence of therapy or placebo is a steady increase; this was confirmed by blind administration of the placebo. When placebos were given intravenously in view of the patients, some (placebo nonresponders) reported that their pain increased, whereas others (placebo responders) reported that their pain either decreased or remained the same over the next 60 min. A placebo response was more likely to occur if the pain rating 5 min prior to placebo administration (initial pain) was greater than 2.6. Furthermore, placebo responders with initial pain above this 2.6 level reported significantly greater mean analgesia than those with lower initial pain. Indeed, responders with initial pain less than 2.6 reported no change in pain during the 60 min after administration of a placebo. When their initial pain level was greater than 2.6, they reported a steady decline in pain over this period. However, above the 2.6 level there was no obvious relationship between the magnitude of the placebo analgesia and the initial pain.     

A survey of pain prevalence at Albert-Chenevier Hospital. Comparison of patient, caregivers and physician assessments

The purpose of this study is to estimate the prevalence of pain in hospitalized patients and to compare pain assessments performed by patients, caregivers and physicians. This cross-sectional study was based on evaluating pain with three questionnaires. Two structured questionnaires explored the patient's and physician's points of view about hospital pain management. Caregivers used the validated Doloplus-2 scale. The three assessments were considered consistent when all three indicated the presence or absence of pain. All inpatients (447) were included. The prevalence of pain was 57% when assessment was performed by caregivers and 53% when it was performed by physicians. Among patients included in the prevalence study, 366 could express themselves and agreed to answer the self-assessment questionnaire (82%): 66% of these patients reported pain. Patients and physicians often reported leg pain. Assessment of pain produced a higher level of pain intensity when performed by patients than when by physicians. Furthermore, 88% of patients reporting pain received pain relief treatment: nevertheless patients felt that their pain was satisfactorily managed in only half of their locations, and they had a less positive appreciation of their level of pain management than physicians did. Our study showed that many psychiatric patients declared they suffered pain. Full consistency between the three assessments was noted for half the cases. One out of ten patients experiencing pain was not identified.     

Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder

Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty‐two treatment‐seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high‐density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity‐related health risks among individuals with BED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Pain and satisfaction with pain control in hospitalized medical patients: no such thing as low risk

BACKGROUND: Pain is common in many populations of hospitalized patients. It is unknown if any populations of hospitalized patients are at low risk for pain. We studied the prevalence of pain and satisfaction with pain control in a general medicine inpatient service to determine if this population was at low risk for pain. METHODS: We performed a prospective cohort study of 5584 hospitalized patients. Pain and pain control were assessed in a follow-up telephone survey. Predictors of pain were determined through administrative databases and patient survey. RESULTS: Of the study patients, 59% had pain (28% reported severe, 19% moderate, and 12% mild pain). Among patients with common diagnoses, those with sickle cell crisis were the most likely and those with syncope were the least likely to report significant pain (90% and 34%, respectively). Patient characteristics significantly associated with increased pain included DRG (diagnosis related group) weight (odds ratio [OR], 1.19), Charlson Index score (OR, 1.03), age older than 65 years (OR, 0.65), female sex (OR, 1.17), and education level higher than high school (OR, 1.31). Pain was reported by 28% of patients without high-risk characteristics for pain; and 82.2% of patients were satisfied, 11.1% somewhat satisfied, and 6.7% dissatisfied with their pain treatment. CONCLUSIONS: Pain was common in the study population and more patients rated their pain as severe than as moderate or mild. Pain was dispersed among diagnoses. Although most patients thought that their pain was adequately controlled, 18% of patients with pain (10% of all patients) reported that their pain was inadequately controlled. Although patient characteristics were associated with pain or dissatisfaction with pain control, they were weak predictors and significant pain was common even in populations at the lowest-risk for pain.     

Parental pain is not associated with pain in the child: a population based study

BACKGROUND: Child pain is associated with adverse psychosocial factors. Some studies have shown an association between children's and parental pain. Children may "learn" pain behaviour from their parents. OBJECTIVES: To examine whether an association exists between parent and child pain, and, if so, whether this relationship persists after adjusting for psychosocial difficulties in the child. METHODS: 1326 schoolchildren took part in a questionnaire based, cross sectional survey. Parents of study participants were sent a postal questionnaire. Occurrence of body pain was ascertained using blank body manikins and, in children, psychosocial factors were assessed using the Strengths and Difficulties Questionnaire. Three child-parent pain relationships were examined: any child pain with any parental pain or with parental widespread pain; and child low back pain with parental low back pain. RESULTS: The risk of child pain associated with parental reporting of pain was minor, and non-significant. Even when both parents reported widespread pain, the relative risk of pain in the child, after adjusting for age and psychosocial difficulties, was 1.2 (95% CI 0.5 to 3.2). CONCLUSIONS: Parental pain is not a risk for child pain. Pain behaviour is not learned. Rather, child pain is probably attributable to individual factors and the social environment.     

Improving the management of pain in hospitalized adults

BACKGROUND: Pain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management. METHODS: This controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing. RESULTS: Units using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores. CONCLUSIONS: A clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics.     

Angina pectoris with pharyngeal pain alone: a case report

Patients with pharyngeal pain are frequently encountered in the department of otorhinolaryngology. The pharyngeal pain is usually caused by an inflammation or a malignant disease. In some cases, anginal pain radiates to the pharynx. However, patients with angina pectoris who suffer from pharyngeal pain without chest pain are believed to be very rare. The patient was a 70-year-old man whose chief complaint was only pharyngeal pain on exertion. The pharyngeal pain was similar to acute pharyngitis with burning pain. Upon cardiac catheterization, no abnormality was found in the right coronary artery or in the circumflex artery, but 99% stenosis was found in the middle portion of the left anterior descending artery. There was no collateral circulation to the left anterior descending artery. Thus, percutaneous coronary intervention was performed, and the pharyngeal pain vanished.     

Reproducible efficacy of tricyclic antidepressant on chronic pain in an elderly patient with osteoporosis

An 81-year-old woman was admitted due to exacerbation of chronic back pain from a vertebral osteoporosis fracture. The lumbar MRI examination revealed compression fracture of Th12 and L1 bones. Initial treatment with roxoprofen, calcitonin, bupurenorfin, and morphine did not achieve pain reduction in the patient. Because her geriatric depression scale score was low, we next tried to treat the pain using an antidepressant. Although the pain was improved by amitriptyline, the side effects of dry mouth and urinary incontinence were occurred. Milnacipran, a serotonin and norepinephrine reuptake inhibitor (SNRI), was then tried for the treatment of the chronic pain instead of amitriptyline, but the pain was increased. Then, she was given amitriptyline again for treatment of the chronic back pain instead of SNRI. The second-time amitriptyline treatment was effective to reduce the pain, with minimal side-effects. Because chronic pain due to osteoporosis is often difficult to treat in elderly patients, the classic antidepressant, amitriptyline, may help pain control by narcotics and anti-inflammatory agents in some elderly patients.     

Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study

OBJECTIVES: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex.
DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
SETTING: Community.
PARTICIPANTS: Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.
MEASUREMENTS: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L.
RESULTS: The mean age±standard deviation was 75.1±7.3 for women and 73.9±6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio=1.96, 95% confidence interval=1.01–3.59) but not in men.
CONCLUSION: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.