Serogroup B meningococcal disease in the Norwegian armed forces: What can we learn from an inconclusive vaccine protection trial?

Military recruits serving in the armed forces were severelyaffected during the latest serogroup B meningococcal epidemicin Norway. The risk of developing systemic meningococcal disease(SMD) proved highest during the first 12 weeks of service. Adouble-blind, placebo-controlled protection trial with a meningococcalouter membrane vesicle vaccine took place between 1988 and 1991,but the number of proven SMD cases was too low to allow forany conclusions. However, the results of a parallel efficacystudy of the same vaccine among students in secondary school,cross-society examinations for asymptomatic throat carriageof meningococci and recent immunogenicity studies after two-and three-dose vaccination schedules, suggest that a basic immunizationof young teenagers followed by a booster injection at enrolmentwould contribute significantly to preventing SMD in the armedforces.     

Pigmentary changes in rat oral mucosa following antimalarial therapy

Pharmacogenic pigmentation of the oral mucosa has been reported following the use of a number of anti-malarial drugs. The nature and distribution of the pigment is inconclusive in the literature. The aim of the present study was to document pigment deposition within the oral mucosa of DA rats following prolonged chloroquine and pyrimethamine administration. The drugs were given as a combined dosage and separately to different groups via stomach gavage tube. After 12 weekly administrations the palatal mucosa was examined histochemically and ultrastructurally for changes in numbers and size of active melanocytes using the dopa-oxidase technique. The serum was analysed for changes in ACTH and testosterone levels. Morphometric analysis of cells incubated for dopa-oxidase showed a significant increase in the size of dopa positive cells with both drugs but an increase in the number of active melanocytes with chloroquine only. Serum levels of ACTH remained unchanged with both drugs but pyrimethamine caused an elevation in testosterone.     

Urban-rural hospital affiliations: assessing control, fit, and stakeholder issues strategically.

Urban-rural hospital affiliations are an outgrowth of both the external pressures on rural hospitals to survive and the need for urban hospitals to maintain or increase their share of the tertiary referral market. This article discusses the significant role of stakeholders in these affiliations, develops a fourfold typology of urban-rural hospital affiliations based on the notions of organizational control and fit, suggests four generic strategies for forming affiliations, and analyzes four actual cases of affiliation.     

Repair of left ventricular aneurysm. Changes in ventricular mechanics, hemodynamics, and oxygen consumption.

Anteroapical left ventricular aneurysms were produced in 23 sheep by coronary arterial ligation. Plication of the aneurysm does not change stroke volume or cardiac output and does not significantly change left ventricular oxygen consumption from the preoperative value of 5.1 +/- 2.6 ml/100 gm per minute. Plication, however, does increase left ventricular end-systolic elastance from 3.2 +/- 0.9 to 4.4 +/- 1.5 mm Hg/mm (p = 0.005). In nine of these sheep the midsagittal plane of the left ventricle was imaged by means of an array of sonomicrometry crystals before and after plication of the aneurysm. Regional wall stresses at end-systole and end-diastole and changes in diastolic function were calculated for anterior and posterior ventricular walls in the border zone adjacent to the aneurysm and in more basilar myocardium remote from the infarct. Plication significantly reduced end-systolic wall stresses and systolic stress integrals in the posterior border zone and remote myocardium, but it did not significantly change anterior wall systolic stresses or stress integrals. Plication also decreased diastolic stretching of border zone myocardium. Plication of anteroapical left ventricular aneurysm produced a shorter, more spherical ventricle and removed the dyskinetic segments but altered deformation (strain) in both circumferential and longitudinal directions. The changes in ventricular wall geometry and deformation provide an explanation for the increased ventricular end-systolic elastance and unchanged stroke volume observed after aneurysm plication.     

鹿茸多肽的纯化和鉴定(英文)

应用凝胶过虑和离子交换层析等技术,从鹿茸(pilose antler or Cervus nipponTemminck)中分离纯化出一种多肽(peptide of pilose antler,PAP)。经高效液相色谱和N-末端氨基酸分析鉴定为单一多肽,氨基酸组成分析证明,PAP是由68个氨基酸组成,分子是为7200。药理研究证明,PAP对大鼠角叉菜胶性足肿胀具有明显的抑制作用并呈现良好的量—效关系。     

The interleukin-5 messenger RNA expression in a patient with idiopathic hypereosinophilic syndrome

Interleukin-5 has a specific role in various eosinophilic activities. It is the predominant cytokine produces by activated T-lymphocytes isolated from patients with idiopathic hypereosinophilic syndrome. We studied a young patient suffering from idiopathic hypereosinophilic syndrome who presented with Horner's syndrome, peripheral neuropathy and skin ulcers. The IL-5 gene expression by CD4⁺ T-lymphocytes and the peripheral eosinophil count were raised. The skin ulcers continued to deteriorate despite a swift reduction of the IL-5 gene expression and peripheral eosinophil count following systemic corticosteroid treatment. We suggest that peripheral eosinophilia may not be responsible for the damage in skin lesions and more aggressive treatment may be required.     

Revitalizing a documentation system.

The nursing department of a 154-bed acute rehabilitation facility, cognizant of the changing trends in health care and responding to feedback from staff, developed and implemented a comprehensive documentation system. The previous system had been fragmented, inconsistent, and inefficient. The development of the new system focused on the complex needs of the rehabilitation client and the equally complex standards required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and insurance carriers. The final product, which was based on the nursing process and functional health patterns, encompassed the following areas from admission to discharge: providing feedback on clients' functional abilities and progress toward goals, satisfying requirements of the 1990 JCAHO standards, and, finally, using a flow sheet that saves nursing time and increases objectivity. This article describes the system from conceptualization to successful implementation.     

Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

Relapse rate and outcome of ANCA-associated small vessel vasculitis after transplantation.

BACKGROUND: Anti-neutrophil cytoplasm antibody-associated systemic vasculitis (AASV) is a rare disease and frequently leads to end-stage renal disease (ESRD). Potentially fatal disease activity can develop after the onset of ESRD or in transplanted patients despite the immunosuppressive effects of uraemia and rejection prophylaxis, respectively, leading to concern that such patients may have greater morbidity and mortality. METHODS: To assess the outcome of patients with AASV following kidney transplantation, a retrospective analysis was performed of nine patients with AASV at our unit who received renal transplants between 1987 and 2000. The renal survival of the patients was compared with a control population who received kidney transplants over the same period for causes other than AASV and diabetes mellitus. RESULTS: Nine patients with the diagnosis of AASV (five patients with Wegener's granulomatosis and four with microscopic polyangiitis) received eight cadaveric grafts and one live-related graft after a mean of 44 months from the start of dialysis. These patients had a mean age of 49.2 years at time of transplantation and they were followed up for a mean of 62 months post-transplantation. Two patients with Wegener's granulomatosis suffered a vasculitic relapse affecting the upper respiratory tract at 40 and 50 months post-transplantation, corresponding to a relapse rate of 0.04 per patient per year. The renal transplant function of vasculitis patients compared with 18 non-diabetic control patients who were transplanted at the same time was better in the vasculitis patients at some time points (P=0.054 at 6 months). CONCLUSIONS: There is a substantial relapse rate in the AASV population, especially affecting the upper respiratory tract and with increasing duration of follow-up. Nonetheless, renal transplantation is a good option for the treatment of vasculitis patients and their outcome compares favourably with that of other non-diabetic patients following transplantation.     

Effect of heterophil depletion by 5-fluorouracil on infectious bronchitis virus infection in chickens.

An anti-tumour drug, 5-fluorouracil (5 FU) was used to deplete heterophils in 11-day-old white leghorn chickens. The reduction in heterophil numbers was monitored by total and differential white cell counts in the peripheral blood. Three days after injection of 5 FU, when the heterophil numbers were significantly reduced, chickens were infected with the Massachusetts strain of infectious bronchitis virus (IBV). Following infection, although the numbers of birds exhibiting clinical signs (nasal exudate) were significantly higher in the 5 FU treated group, the consistency of the nasal exudate was characteristically thin and watery. No significant differences were seen in the virus titres in trachea, lung and kidney between normal and heteropaenic chickens infected with IBV. However, the epithelial cell damage in the tracheal sections was less in the heterophil-depleted chickens.