儿童系统性红斑狼疮患者外周血淋巴细胞表面CD95的表达及临床意义

目的:探讨儿童系统性红斑狼疮(systemic lupus erythematosus,SLE)外周血淋巴细胞表达CD95的特征及与疾病活动性和其他免疫学指标间的关系。方法:使用流式细胞术检测60例SLE患儿和20例对照外周血T淋巴细胞亚群和B淋巴细胞表面CD95的表达,并分析其与SLE疾病活动性以及实验室检查之间的关系。结果:初发SLE患儿外周血中CD4+T细胞表面CD95的表达显著高于对照组,差异有统计学意义(P0.05);初发SLE患儿外周血中CD19+B细胞表面CD95的表达显著高于健康儿童(P0.05);CD19+CD95+B细胞的比例和SLE疾病活动性呈正相关(r=0.4,P0.05);CD4+CD95+T细胞的比例和SLE疾病活动性呈正相关(r=0.3,P0.05),CD4+CD95+T细胞的比例和外周血抗双链DNA抗体(anti-ds DNA Abs)的水平呈正相关(r=0.2,P0.05);治疗后SLE患儿外周血中CD19+CD95+B细胞和CD4+CD95+T细胞的比例均有显著下降,差异有统计学意义(P0.05)。结论:儿童SLE患者外周血中淋巴细胞表达CD95的水平显著升高,且与SLE的疾病活动性及血清中抗双链DNA抗体相关,可以作为SLE的评价指标。     

系统性红斑狼疮患者的外周血淋巴细胞亚群结果分析

目的研究40例系统性红斑狼疮(SLE)患者不同状态的外周血总T淋巴细胞(CD3+)、T辅助淋巴细胞(CD3+/CD4+),T抑制淋巴细胞(CD3+/CD8+),B淋巴细胞(CD3-/CD19+),NK淋巴细胞(CD3-/CD16+CD56+)的差异并初步探讨其在SLE发病中的意义。方法根据SLE疾病活动积分(SLEDAI)将SLE患者分为活动组(24例)和非活动组(16例),流式细胞仪检测外周血CD3+/CD4+,CD3+/CD8+,CD3-/CD19+,CD3-/CD16+CD56-表达百分率,对其与SLE临床活动度、尿蛋白、补体和抗dsDNA抗体水平的相关性进行研究。结果活动组和非活动组SLE患者外周血总T细胞(CD3+)与健康对照组比较差异无统计学意义(P>0.05);活动组和非活动组SLE患者外周血T细胞(CD3+/CD4+、CD3+/CD8+)、B淋巴细胞(CD3-/CD19+)、NK淋巴细胞(CD3-/CD16+CD56-)表达百分率与健康对照组相比,T、B淋巴细胞表达的分率差异均有统计学意义(P=0.043,P=0.027);NK淋巴细胞(P=0.612)差异无统计学意义;活动组与非活动组的总T细胞,差异无统计学意义,而T辅助淋巴细胞(CD3+/CD4+)、B淋巴细胞(CD3-/CD19+)差异具有统计学意义,提示T辅助淋巴细胞(CD3+/CD4+)、T抑制淋巴细胞(CD3+/CD8+),与SLE活动度相关。T、B、NK细胞与SLE临床表现相关性分析显示,T辅助淋巴细胞(CD3+/CD4+)与SLEDAI,抗dsDNA抗体呈正相关(P=0.096);B细胞与C3呈负相关(P=0.048);NK细胞与SLEDAI和抗dsDNA抗体呈负相关(P=0.096)。结果显示T、B、NK细胞异常与SLE临床表现明显相关。结论 SLE患者的外周血总T细胞(CD3+)、T辅助淋巴细胞(CD3+/CD4+)、T抑制淋巴细胞(CD3+/CD8+)、B淋巴细胞(CD3-/CD19+)、NK淋巴细胞(CD3-/CD16+CD56+)可作为SLE诊断及评价活动性的指标。     

系统性红斑狼疮患者外周血淋巴细胞亚群分析

目的研究系统性红斑狼疮(SLE)患者外周血淋巴细胞亚群的变化。方法应用流式细胞仪检测了65例SLE患者(其中活动期30例,非活动期35例)及32例健康体检者外周血淋巴细胞亚群。结果与健康对照组相比,活动期患者的CD4+、NK细胞(CD16+CD56+)百分率明显降低(P<0.05),CD8+、B(CD19+)细胞百分率明显升高(P<0.05),CD4+/CD8+比值显著降低(P<0.05)。SLE患者活动期与非活动期比较,CD4细胞数低于稳定期,CD8细胞数明显高于稳定期。结论 SLE患者外周血淋巴细胞亚群细胞的变化与疾病的病情变化相关联。     

血清MIF及BCMA表达水平与SLE活动性的相关性研究

摘要：目的：观察SLE患者血清巨噬细胞移动抑制因子(MIF）及B淋巴细胞成熟抗原（BCMA）水平的变化,探讨其与SLE疾病活动性的关系,分析两蛋白质分子间的相关性。 方法：用ELISA测定32例活动期和20例非活动期SLE患者血清MIF、BCMA浓度,并以30例健康人作对照,观察SLE患者血清MIF、BCMA水平的改变,分析MIF、BCMA水平与疾病活动性及相互之间相关性。 结果：SLE患者血清MIF、BCMA水平较对照组显著升高,且与SLE疾病活动指数（SLEDAI）呈显著正相关（r分别为0.76和0.78,P值均<0.01）。SLE患者血清中BCMA浓度与抗dsDNA抗体、抗核抗体浓度显著相关（r分别为0.75和0.64）,MIF浓度与抗dsDNA抗体显著相关（r=0.65）,与抗核抗体浓度无显著相关性（r=0.15）。MIF与BCMA间无相关性。 结论：血清BCMA、MIF水平可作为反映SLE活动性的重要指标之一。T、B淋巴细胞活化均参与SLE发病机制,B淋巴细胞活化程度与SLE活动性有关。     

黄芪对红斑狼疮细胞凋亡和T淋巴细胞亚群的影响

目的:研究黄芪对系统性红斑狼疮(SLE)细胞凋亡和T淋巴细胞亚群的影响,探讨其对SLE的治疗作用。方法:将80例初发SLE患者随机分为常规治疗组和黄芪治疗组(常规治疗的基础上加用黄芪注射液)。观察两组患者治疗前后外周血淋巴细胞上Fas、Bcl-2抗原的表达和T淋巴细胞亚群的变化。结果:两组患者治疗后外周血淋巴细胞上Fas抗原的表达下调(P<0.01),Bcl-2抗原的表达以及CD4+亚群、CD4+/CD8+比值上升(P<0.01);其中,治疗后Fas抗原表达的下调、CD4+亚群及CD4+/CD8+比值的上升在黄芪治疗组更显著(P<0.05)。结论:黄芪在一定程度上增加了激素/免疫抑制剂对细胞凋亡的抑制作用,调节T淋巴细胞亚群比例和功能趋于正常,可以作为提高SLE疗效的重要治疗措施。     

系统性红斑狼疮患者外周血T淋巴细胞亚群及Ag-NORs的变化

目的探讨系统性红斑狼疮(SLE)患者外周血T淋巴细胞亚群及Ag-NORs的变化及意义。方法49例SLE病人及43例健康体检者分别检测外周血T淋巴细胞亚群(CD3 、CD4 、CD8 )及Ag-NORs。结果T淋巴细胞Ag-NORs含量在SLE初发病例升高,经治疗后有一定程度降低(P<0.05);稳定期与正常人相比无显著性差异(P>0.05)。CD3 T细胞SLE各期与对照组相比均无显著差异(P>0.05)。在初发病例及活动期,CD4 T细胞及CD4 /CD8 均降低(P<0.05),CD8 细胞均升高(P<0.05)。在SLE稳定期各亚群正常人相比均无显著性差异(P>0.05)。T淋巴细胞Ag-NORs与T淋巴细胞亚群间无相关性(P>0.05)。结论外周血T淋巴细胞亚群及Ag-NORs分析有助于了解SLE患者免疫功能紊乱的状况。     

血清BLyS和APRIL水平与系统性红斑狼疮关联性研究

目的：探讨系统性红斑狼疮（SLE）患者血清B淋巴细胞刺激因子（BLyS）和增殖诱导配体（APRIL）蛋白水平与疾病活动性的关系。方法：应用酶联免疫吸附试验（ELISA）法检测SLE活动组（13例）和SLE缓解组（10例）患者血清BLyS和APRIL水平,以健康志愿者（23例）作为对照;同时将血清BLyS和APRIL水平与患者的临床检验指标（尿蛋白、抗dsDNA抗体）分组进行分析。结果：SLE患者组血清BLyS水平高于健康对照组,且活动期高于缓解期（P〈0.05）;尿蛋白阳性组血清APRIL水平明显低于尿蛋白阴性组患者（P〈0.05）;抗dsDNA抗体升高组血清BLyS和APRIL均高于抗dsDNA抗体滴度正常组,但均无统计学意义。结论：SLE患者血清BLyS水平增高,且增高与疾病的活动性有关;尿蛋白阳性组血清APRIL水平明显低于尿蛋白阴性组SLE患者,提示BLyS和APRIL可能参与SLE的发病过程。     

系统性红斑狼疮患者树突状细胞CD11c^＋，CD123^＋亚群与疾病活动性的关系

目的 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者外周血树突状细胞CD11c+,CD123+亚群与疾病活动性、肾脏损伤及血清抗ds-DNA抗体产生的关系.方法 选定SLE疾病组51例、疾病对照组30例(类风湿关节炎、舍格伦综合征患者各15例)和正常对照组30例,采用流式细胞术检测上述指标.结果 ①SLE患者外周血树突状细胞CD11c+,CD123+亚群比例均显著低于正常对照组(P<0.01),而疾病对照组与正常对照组之间差异无统计学意义(P>0.05).②疾病活动期SLE患者外周血树突状细胞CD123+亚群比例显著高于稳定期患者(P<0.01),而两者CD11c+亚群比例之间差异无统计学意义(P>0.05).③SLE肾病组外周血树突状细胞CD123+亚群比例显著高于非肾病组患者(P<0.01),两者CD11c+亚群比例之间差异无统计学意义(P>0.05);ds-DNA+组SLE患者外周血树突状细胞CD11c+,CD123+亚群比例均显著低于ds-DNA-组(P<0.05).结论 树突状细胞CD11c+,CD123+亚群的变化可能是SLE发病机制中的关键环节之一.     

雌激素对系统性红斑狼疮外周血T、B细胞BCL-2表达的影响

目的：探讨雌激素对系统性红斑狼疮（SLE）外周血淋巴细胞B细胞凋亡抑制基因(BCL－2）表达的影响。方法：用流式义双标免疫荧光法对29例SLE患者外周血淋巴细胞体外经雌二醇处理后测定BCL－2的表达。结果：雌二醇可使活动期SLE病人T细胞CD3^ ,Cd4^ ,CD8^ 亚群BCL－2蛋白表达增加，而不增加非活动期SLE病人、正常人T细胞BCL－2的表达。CD19^ B细胞BCL－2蛋白表达在各组间无显著差异。结论：雌二醇能上调活动期SLE病人T细胞BCL－2的表达而参与SLE的发生。     

血清BCMA和MIF含量与系统性红斑狼疮疾病活动性的关联度研究

目的探讨血清B淋巴细胞成熟抗原（BCMA）和巨噬细胞游走抑制因子（MIF）含量与系统性红斑狼疮（SLE）疾病活动性的关联度,并分析BCMA与MIF含量之间的相关性。方法 50例SLE患者根据疾病活动指数（SLEDAI）分为活动期组（n=29）和非活动期组（n=21）。应用双抗体夹心酶联免疫吸附法（ELISA）测定50例SLE患者血清BCMA与MIF含量,并与健康对照组31例进行对比,分析SLE患者血清BCMA与MIF含量变化与疾病活动性以及两者之间的相关性。结果与对照组相比,SLE患者血清BCMA与MIF浓度均显著上升,且活动期患者的BCMA与MIF浓度显著高于非活动期患者,差异均显著（P均〈0.01）。SLE患者血清BCMA、MIF浓度与SLEDAI结果呈明显的正相关（r=0.75,0.77,P均〈0.01）。SLE患者的BCMA浓度与ANA及抗dsDNA抗体的浓度呈明显正相关（r=0.74,0.63）;SLE患者的MIF水平与抗dsDNA抗体呈明显正相关（r=0.62）,但和ANA含量不具相关性（r=0.15）。BCMA与MIF两者的浓度之间无相关性（r=0.124,P〉0.05）。结论血清BCMA与MIF含量能够明显反映出SLE疾病的活动性情况。T与B淋巴细胞活化均与SLE发病密切相关。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."