Reduction of IL-12 p40 production in activated monocytes after exposure to diesel exhaust particles

BACKGROUND: A reduction of IL-12 production by lung macrophages may partly explain the presumed adjuvant effect of diesel exhaust particles (DEP) in allergy and asthma. IL-12 stimulates T helper type 1 (Th1) lymphocytes, which inhibit Th2 cells via Th1-specific cytokines. The aim of this study was to investigate the influence of DEP on the production of IL-12 p40 in lipopolysaccharide (LPS)-activated monocytes. METHODS: The human monocytic cell line Mono-Mac-6 was stimulated with LPS (200 ng/ml) and grown with DEP (0-200 microg/ml) for 0, 6 or 24 h. IL-12 p40 and the pro-inflammatory cytokine TNF were analysed in the cell supernatants by ELISA and a cell assay, respectively. RESULTS: Levels of IL-12 p40 correlated inversely with the DEP exposure concentrations, whereas TNF increased in parallel to the DEP concentrations. At a DEP concentration of 200 microg/ml, the amount of IL-12 p40 was 35% of that observed without DEP. The corresponding TNF value was 230% of the control. Reduced viability, binding of cytokines to DEP or endotoxin in the DEP samples cannot fully explain the changes in the concentrations of these two cytokines. CONCLUSION: DEP seem to inhibit the production of IL-12 p40 and stimulate that of TNF in activated monocytes. This may partly explain the presumed adjuvant effect of DEP in atopy; by altering the Th1/Th2 balance via down-regulation of IL-12, the Th2 response characteristic of allergy and asthma may be favoured.     

Increased Incidence of Missed Seizures During ECT in the Elderly Male

Monitoring seizure length is an important addition to the clinical practice of ECT. Without monitoring, undetected missed seizures may occur. In a retrospective study of ECT treatments for a sample of 58 patients with a DSM-III diagnosis of major depression, significantly more missed seizures (p < 0.05) occurred in the elderly males.     

Initial Impression of Two New Brief-Pulse Electroconvulsive Therapy Machines

Until last year only two U.S. manufacturers were producing ECT machines for purchase. These machines differed in waveforms: a sine-wave device (Medcraft Corp.) and a brief-pulse bidirectional square-wave machine (MECTA Corp.). Early in 1985 a new brief-pulse bidirectional square-wave machine called the Thymatron was marketed (Somatics Inc.). For the first time this created a choice in brief-pulse equipment available in the U.S. This paper summarizes our initial impressions to this new brief-pulse device and one of MECTA's most recent brief-pulse models (SR-1) in terms of features, safety, practicality, and cost.     

基于信息化的急诊患者早期分级预警方案效果分析

基于早期预警评分系统,构建了急诊患者早期分级预警方案,并借助信息化手段,将方案嵌入急诊护理信息系统中,设置了颜色分级提醒功能,实现了分级预警闭环管理。实施后,急诊患者生命体征监测频次增加,抢救成功率提高,护理不良事件发生率降低。认为基于信息化的急诊患者早期分级预警方案提高了急救质量,保障了患者安全,但需在医护协作、护理人力分配、信息资源整合等方面持续改进。     

实施员工关爱计划保障医务人员职业安全与健康

医务人员的身心健康和执业满意度直接影响医疗服务质量。复旦大学附属华山医院从员工需求切入,建立并实施员工关爱计划:横向包括身心健康、社会支持、个人成长与职业生涯发展等;纵向贯彻危机前、危机中、危机后三级援助体系。实践后,员工满意度、社会支持水平、幸福感有所提升,职业倦怠阳性率有所下降。员工关爱计划在管理理念、方案完善、人才培养等方面还有待进一步改进。     

2019年广东省部分地区感染性腹泻病原学及人轮状病毒分子流行病学特征

目的 对感染性腹泻样本进行检测鉴定,并对轮状病毒A组进行病毒分离,研究2019年广东省部分地区感染性腹泻病原学及轮状病毒分子流行病学特征。方法 2019年1月1日至2020年1月12日,采集广东省广州市、东莞市和江门市临床感染性腹泻患者粪便样本,进行多重RT-PCR扩增和微球杂交技术检测鉴定,并对轮状病毒A组阳性样本进行分离后,采用半巢式PCR试验对阳性细胞培养物进行G/P基因分型。结果 共纳入706例合格病例,病原体总检出率43.06%,病毒检出率18.13%高于细菌检出率8.36%高于寄生虫检出率1.27%。病毒病原谱以轮状病毒A组G9P[8]和诺如病毒GII型感染为主,细菌病原谱以沙门菌和艰难梭菌为主,寄生虫以蓝氏贾第鞭毛虫为首。不同季度、不同年龄组病原谱构成各不相同。轮状病毒A组主要受累群体为≤5岁儿童,主要时间分布于1—4月,基因型呈现多样性,包括G2P[4]、G3P[8]和G9P[8]。结论 2019年广东省部分地区感染性腹泻病毒类病原体高于细菌类高于寄生虫类,轮状病毒A组G9P[8]、诺如GII型、沙门菌和蓝氏贾第鞭毛虫是最主要的病原体,且G9P[8]型A组轮状病毒毒株在轮状病毒感染中占主导趋势。在防控病毒性和细菌性腹泻的同时,应警惕寄生虫所致腹泻并重视混合感染的病原学监测。     

Flattening the quality of life curve? A prospective person-centred study from Norway amid COVID-19

Quality of Life Research - We examined multidimensional, heterogeneous reactions to the COVID-19 pandemic and associated measures to provide further insights into the developmental processes of...     

脑卒中肺部感染危险因素及血清免疫炎性因子的预测价值

目的基于主成分分析(PCA)-决策树模型分析脑卒中肺部感染的危险因素及血清免疫炎性因子的预测价值。方法回顾性分析2014年12月-2019年12月江西省上饶市人民医院确诊的176例脑卒中患者,根据是否发生肺部感染,分为感染组40例和未感染组136例。记录患者临床特征,检测血白细胞(WBC)计数、血清C-反应蛋白(CRP)、降钙素原(PCT)和可溶性白细胞介素-2受体(SIL-2R)水平。采用Logistic回归和卡方自动交叉检验(CHAID)模型分析影响脑卒中后肺部感染的危险因素;受试者工作特征曲线(ROC)分析血WBC、CRP、PCT、SIL-2R预测肺部感染的价值。结果脑卒中肺部感染与患者年龄、卒中类型、是否合并糖尿病、吸烟史、吞咽困难、意识障碍、侵入性操作有关(P<0.05);感染组患者血WBC、CRP、PCT和SIL-2R水平高于未感染组(P<0.05);糖尿病、侵入性操作、CRP和PCT均为影响脑卒中患者肺部感染的独立危险因素(P<0.05);PCA-ROC分析显示,血WBC、CRP、PCT、SIL-2R和联合预测主成分1(PC1)的曲线下面积(AUC)分别为0.670、0.816、0.854、0.686、0.918;PCA-卡方自动交互检测(CHAID)模型分析显示,WBC、CRP、PCT、SIL-2R和PC1预测肺部感染的准确率为77.33%、84.72%、86.90%、79.02%和89.24%。结论血清PCT水平可用于预测脑卒中患者肺部感染的发生,临床可重点关注合并糖尿病、意识障碍和侵入性操作的患者。     

卵巢子宫内膜异位症和卵巢良性肿瘤患者血清CA125和唾液酸测定的临床意义

目的 探讨血清CA125和唾液酸（SA）对卵巢子宫内膜异位症及卵巢良性肿瘤的诊断价值。方法 对30例卵巢巧克力囊肿、30例卵巢良性肿瘤和15例正常妇女采用放免法测定血清CA125值,比色法测定血清SA值。结果 卵巢巧克力囊肿组血清CA125均值明显高于良性肿瘤组及正常对照组（P＜0．01）,而血清SA增值三组间无显著性差异（P＞0．05）。结论 血清CA125测定对巧克力囊肿有辅助诊断价值,且有助于与卵巢良性肿瘤的鉴别。     

The changing face of reoperative parathyroidectomy: a single-centre comparison of 147 parathyroid reoperations

IntroductionReoperative parathyroidectomy for persistent and recurrent primary hyperparathyroidism is dependent on radiology. This study aimed to compare outcomes in reoperative parathyroidectomy at a single centre using a combination of traditional and newer imaging studies.Materials and methodsRetrospective case note review of all reoperative parathyroidectomies for persistent and recurrent primary hyperparathyroidism over five years (June 2014 to June 2019; group A). Imaging modalities used and their positive predictive value, complications and cure rates were compared with a published dataset spanning the preceding nine years (group B).ResultsFrom over 2000 parathyroidectomies, 147 were reoperations (101 in group A and 46 in group B). Age and sex ratios were similar (56 vs 62 years; 77% vs 72% female). Ultrasound use remains high and shows better positive predictive value (76% vs 57 %). 99mTc-sestamibi use has declined (79% vs 91%) but the positive predictive value has improved (74% vs 53%). 4DCT use has almost doubled (61% vs 37%) with better positive predictive value (88% vs 75%). 18F-fluorocholine positron emission tomography-computed tomography and ultrasound-guided fine-needle aspiration for parathyroid hormone are novel modalities only available for group A. Both carried a positive predictive value of 100%. Venous sampling with or without angiography use has decreased (35% vs 39%) but maintains a high positive predictive value (86% vs 91%). Cure rates were similar (96% vs 100%). Group A had 5% permanent hypoparathyroidism, 1% permanent vocal cord palsy and 1% haematoma requiring reoperation. No complications for group B.ConclusionOptimal imaging is key to good cure rates in reoperative parathyroidectomy. High-quality, non-interventional imaging techniques have produced a shift in the preoperative algorithm without compromising outcomes.