Evaluation of the relationship between IL-18 levels in urine and parameters of renal pathological changes in patients with lupus nephritis]

AIM: To evaluate the relationship between IL-18 levels in urine and parameters of renal pathological changes in patients with lupus nephritis (LN). METHODS: IL-18 levels in morning free urine and 24-hour's urine in 19 normal persons and 55 patients with LN were measured by ELISA. The correlation between IL-18 levels and parameters of renal pathological changes, namely activity index (AI) and chronicity index (CI), were analyzed by liner correlation analysis method. RESULTS: IL-18 levels in morning free urine and 24-hour's urine in LN group were elevated significantly compared with control group. In both groups IL-18 levels in morning free urine were (247.1+/-317.5) ng/L and (20.3+/-14.5) ng/L, respectively, P<0.001; those in 24-hour's urine were (192.1+/-170.1) ng/d and (21.0+/-3.8) ng/d, respectively, (P<0.001). There was close positive correlation between IL-18 levels in morning free urine and 24-hour's urine and LN patient's AI (for morning free urine: r=0.602, P<0.001; for 24-hour's urine: r=0.461, P<0.005) but there was no correlation between IL-18 levels in morning urine and 24-hour's urine and CI (P>0.05). Patients with LN were divided into three groups (high, moderate and low) according to AI value. There was distinct difference of IL-18 levels in urine among the three groups: IL-18 levels in morning urine were (69.2+/-82.7) ng/L, (193.5+/-106.1) ng/L and (580.7+/-453.1) ng/L, respectively, (P<0.001); those in 24-hour's urine were (103.5+/-141.4) ng/d, (188.8+/-124.0) ng/d and (333.1+/-183.2) ng/d, respectively. CONCLUSION: It is very simple and convenient to detect IL-18 levels in morning free urine, so it is a good method for evaluating renal pathological activity of LN.     

A tetracycline-regulatable adeno-associated virus vector for double-gene transfer

An increasing demand for polycistronic vectors that express multiple genes simultaneously has arisen in recent years to obtain an efficient gene therapy. Armed with the knowledge that the expression of transgene in mammalian cells often requires tight control, we constructed in this study a tetracycline-regulated double-gene adeno-associated virus (AAV) vector carrying green and red fluorescent protein genes and expressed it in PC12 cells. When detected by fluorescence microscope and fluorescence-activated cell sorting, gene expression was induced by 44-66-fold and could be reversibly controlled by doxycycline. This double-gene AAV vector may be useful for regulated expression of two genes or a marker to monitor transgene expression.     

Development of an inhaled endotoxin challenge protocol for characterizing evoked cell surface phenotype and genomic responses of airway cells in allergic individuals.

BACKGROUND: Environmental exposure to endotoxin is a known cause of exacerbation of asthma. Inhaled endotoxin protocols have been used to evaluate airway cell surface phenotypes associated with antigen presentation and innate immunity in healthy volunteers, but not in allergic volunteers. OBJECTIVES: To establish the safety of challenge with low-dose endotoxin (10,000 endotoxin units) (lipopolysaccharide [LPS]) inhalation in allergic individuals, to measure airway cell surface phenotypes associated with antigen presentation and innate immunity in induced sputum (IS) after LPS challenge, and to conduct gene expression profiling in IS cells to determine which host genetic networks are modified by LPS inhalation. METHODS: Induced sputum was obtained before and 6 hours after LPS inhalation in 10 allergic volunteers (8 with asthma and 2 with rhinitis). Flow cytometry was used to examine cell surface phenotypes on IS cells. Genomic expression was analyzed on a subset of IS samples (n = 10) using microarray and ingenuity pathway analysis. RESULTS: A total of 10,000 endotoxin units of LPS induced significant up-regulation of membrane CD14, CD11b, CD16, HLA-DR, CD86, and Fcepsilon receptor 1 on sputum phagocytes and increased expression of genes that influence antigen-presenting surface molecules (HLA-DR, chemokine ligand 2 or monocyte chemoattractant protein 1, v-rel reticuloendotheliosis viral oncogene homolog, prostaglandin-endoperoxide synthase 2 or cyclooxygenase 2, and transforming growth factor beta), immune activation (CD14, interleukin 1beta, and regulated upon activation, normal T cell expressed and secreted), and inflammation (intracellular adhesion molecule 1 and inhibitory kappaBalpha). Gene profiles for nuclear factor kappaB, interleukin 1, and tumor necrosis factor pathways were also significantly affected. CONCLUSIONS: Low-dose inhaled endotoxin challenge is safe in allergic individuals with mild to moderate disease. It enhances airway cell surface phenotypes and expression of genes associated with antigen presentation, innate immunity, and inflammation. Microarray with ingenuity pathway analysis can be successfully applied to sputum cells to characterize genetic responses to inhaled exacerbants.     

YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis

BackgroundReal-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates.ObjectiveThe purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures.MethodsWe searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique.ResultsIn all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat–related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020).ConclusionsOur findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.     

2018—2020年沈阳市6岁及以下儿童肺炎病例特征及病原菌分析

目的 观察2018—2020年沈阳市6岁及以下儿童肺炎病例特征及病原菌分布情况,为儿童肺炎防治工作提供参考依据。方法 回顾性分析2018年1月至2020年10月沈阳市某医院3 120例6岁及以下儿童肺炎的临床资料,包括患儿的性别、年龄、发病季节、临床症状、住院时间资料、儿童病例呼吸道分泌物细菌培养结果、咽拭子呼吸道病毒抗原检测结果、血清样本肺炎支原体及衣原体抗体检测结果,以及主要病原菌的K-B纸片法药敏试验结果。结果 3 120例患儿中男性1 763例,女性1 357例,以0~3岁患儿比例最高（60.6%）,秋冬季节发病比例高（63.0%）,临床症状主要有咳嗽（96.6%）、发热（95.7%）、呼吸急促（88.6%）、夜寐欠安（86.3%）、食纳差（74.0%）等,住院时间平均（9.3±2.8）d。不同年龄、住院时间的患儿病原菌检出率差异有统计学意义（均P<0.01）,以0~3岁、住院时间>14 d的患儿病原菌检出率最高。所有患儿共检出病原菌2 675株,其中革兰阴性菌1 539株（57.5%）、革兰阳性菌728株（27.2%）、其他408株（15.3%）。革兰阴性菌以肺炎克雷伯菌（412株）、流感嗜血杆菌（365株）为主,革兰阳性菌以金黄色葡萄球菌（296株）、肺炎链球菌（214株）为主。肺炎克雷伯菌对头孢唑啉、头孢呋辛耐药率高,对亚胺培南、美洛培南敏感;流感嗜血杆菌对复方新诺明、氨苄西林耐药率高,对氨曲南、亚胺硫霉素敏感。金黄色葡萄球菌对青霉素、红霉素耐药率高,对万古霉素、替考拉宁敏感;肺炎链球菌对红霉素、阿奇霉素耐药率高,对万古霉素、左氧氟沙星敏感。结论 沈阳市6岁及以下儿童肺炎病例男性、0~3岁、秋冬季节比例高,临床表现多样并且病原菌检出率高,可根据病原菌分布特点及药敏试验结果为儿童病例选择适合的治疗方案。     

某院“一院多区”管理问题分析及对策探析

医院“一院多区”运营存在问题主要集中在学科布局不合理、人力资源配置及管理模式不科学、同质化不够、运营成本过高、绩效分配不平衡等。针对以上问题,结合医院整体发展实际,从科学设置学科、强化人力资源管理、完善管理机构设置、推进一体化管理、加强成本控制等方面入手,取得显著效果。改革后,院区诊疗人数、经济收入等指标均有明显提高（P<0.05）。认为“一院多区”医院要将新老院区作为整体进行科学统筹,确保一体化和同质化,注重学科长远发展,进而形成科学、合理、可持续的“一院多区”管理模式。     

降低腹部 Ⅱ 类切口感染发生率

目的降低腹部Ⅱ类切口感染发生率,确保患者安全。方法选定“降低腹部Ⅱ类切口感染发生率”为主题,开展品管圈活动。结果改善后,腹部Ⅱ类切口感染发生率由14.29%降至5.95%;形成了包括3 L静脉营养专用输液架使用方式等8项标准化作业书。结论品管圈活动开展降低了腹部Ⅱ类切口感染发生率,规范了操作流程,节约了患者费用,提高了圈员解决问题能力,增强了团队凝聚力。     

中孕期胎儿染色体异常高危孕妇羊水细胞胎儿染色体核型及介入性产前诊断指征的大样本分析

目的探讨中孕期胎儿染色体异常(FCA)高危孕妇羊水细胞胎儿染色体核型(FK)及其介入性产前诊断(IPD)指征。方法选择2014—2018年,在四川大学华西第二医院产前诊断中心进行羊膜腔穿刺术羊水细胞FK检测的63581例FCA高危孕妇(孕龄为19~27+6孕周)为研究对象。回顾性分析孕妇不同IPD指征及其胎儿染色体核型异常(FKA)检测结果。本研究遵循的程序符合四川大学华西第二医院伦理委员会所制定的伦理学标准,并通过该伦理委员会批准[审批文号:医学科研2019伦审批第(077)号]。结果①本组63581例中孕期孕妇的FKA检出率为3.13%(1989/63581)。这63581例孕妇的IPD指征分别为高龄(预产期年龄≥35岁)(25648例)、血清学筛查高风险(29009例)、无创产前筛查(NIPT)高风险(333例)、夫妇一方为染色体异常携带者(603例)、超声筛查发现胎儿结构异常及超声软指标异常(2647例)、异常儿生育史(1546例)、于外院进行羊水细胞FK分析结果异常者(7例)、孕妇智力低下及合并智力低下家族史(149例)、孕妇早孕期有害物质接触史(1400例)、其他(2239例),FKA检出率分别为3.26%(836/25648)、2.04%(593/29009)、65.17%(217/333)、34.33%(207/603)、3.51%(93/2647)、1.68%(26/1546)、85.71%(6/7)、4.03%(6/149)、0.14%(2/1400)、0.13%(3/2239)。②351例孕妇的IPD指征为超声筛查发现胎儿结构异常中,IPD指征为胎儿淋巴水囊瘤、皮肤水肿的FKA检出率最高,为26.09%(6/23)。2296例孕妇的IPD指征为胎儿超声软指标异常中,IPD指征为胎儿颈项透明层(NT)值≥2.5 mm的FKA检出率最高,为7.74%(66/853)。结论孕妇高龄、血清学筛查高风险、NIPT高风险、夫妇一方为染色体异常携带者、超声筛查发现胎儿结构异常及超声软指标异常等,均为中孕期孕妇FCA的IPD指征,孕妇IPD指征类型不同,FCA风险不同。羊膜腔穿刺术羊水细胞FK检测,可预测有IPD指征孕妇的妊娠结局,为降低FKA出生率提供参考。     

曲美他嗪对陈旧性心肌梗死后室性心律失常影响的随机配对、交叉研究

目的：研究曲美他嗪（Trimetazidine）对于处于常规治疗中的心肌梗死后的心 律失常的作用。方法：冠心病陈旧心肌梗死病例（OMI）,共29对（58例）;男性27对,女性2对;配对主要条件：性别、年龄、梗死部位、梗死后时间、高血压病史及分级;糖尿病史;采用病例配对、随机进入试验、交叉、单盲的试验设计;结果分析采用方差分析（ANOV／F检验）。结果：综合交叉试验结果,Trimetazidine处理组室性心律失常的发生低于对照组（F＝4．20,P＜0．05）;对于清醒时间段即活动时间段的室性心律失常的分析显示：Trimetazidine也具有显著的抑制作用（F＝5．87,P＜0．05）;对于Lown3级以上室性心律失常的单独分析,也显示出其较明显的抑制作用（F＝7．61,P≈0．01）;对于OMI后LVEF≤40％患者组的室性心律失常,Trimetazidine也表现出明确的抑制作用（F＝5．43,P＜0．05）。结论：对于陈旧性心肌梗死所伴发的室性心律失常,除基础药物的处理外,应用曲美他嗪可对其产生显著地抑制作用,并减少抗心律失常药物的应用;改善缺血心肌的能量代谢可能是此作用的主要基础。     

尿胰蛋白酶原—2测定对急性胰腺炎的早期诊断价值

目的 探讨尿胰蛋白酶原－2测定在急腹症中筛选急性胰腺炎的价值。方法 对346例连续就诊的急腹症病人同时测定尿胰蛋白酶原－2及血、尿淀粉酶。结果 41例急性胰腺炎中有38例尿胰蛋白酶原－2阳性,敏感性为92．7％,305例非胰腺炎的急腹症病人有15例假阳性,特异性为95．1％。5例重症急性胰腺炎中尿胰蛋白酶原－2全部阳性。结论 尿胰蛋白酶原－2是急腹症病人筛选急性胰腺炎快而简便的方法,具有较高的特异性和敏感性。