Evaluation of a Chaplain Residency Program and Its Partnership with an In-Patient Palliative Care Team

In 2009 a Consensus Conference of experts in the field of spiritual care and palliative care recommended the inclusion of Board-certified professional chaplains with at least 1,600 hours of clinical pastoral education as members of palliative care teams. This study evaluates a clinical pastoral education residency program’s effectiveness in preparing persons to provide spiritual care for those with serious illness and in increasing the palliative care team members’ understanding of the chaplain as part of the palliative care team. Results showed chaplain residents felt the program prepared them to provide care for those with serious illness. It also showed that chaplain residents and palliative care team members view spirituality as an integral part of palliative care and see the chaplain as the team member to lead that effort. Suggested program improvements include longer palliative care orientation period, more shadowing with palliative care team members, and improved communication between palliative care and the chaplain residents.     

Detection of bacteriuria and pyuria by URISCREEN a rapid enzymatic screening test.

A multicenter study was performed to evaluate the ability of the URISCREEN (Analytab Products, Plainview, N.Y.), a 2-min catalase tube test, to detect bacteriuria and pyuria. This test was compared with the Chemstrip LN (BioDynamics, Division of Boehringer Mannheim Diagnostics, Indianapolis, Ind.), a 2-min enzyme dipstick test; a semiquantitative plate culture method was used as the reference test for bacteriuria, and the Gram stain or a quantitative chamber count method was used as the reference test for pyuria. Each test was evaluated for its ability to detect probable pathogens at greater than or equal to 10(2) CFU/ml and/or greater than or equal to 1 leukocyte per oil immersion field, as determined by the Gram stain method, or greater than 10 leukocytes per microliter, as determined by the quantitative count method. A total of 1,500 urine specimens were included in this evaluation. There were 298 specimens with greater than or equal 10(2) CFU/ml and 451 specimens with pyuria. Of the 298 specimens with probable pathogens isolated at various colony counts, 219 specimens had colony counts of greater than or equal to 10(5) CFU/ml, 51 specimens had between 10(4) and 10(5) CFU/ml, and 28 specimens had between 10(2) and less than 10(4) CFU/ml. Both the URISCREEN and the Chemstrip LN detected 93% (204 of 219) of the specimens with probable pathogens at greater than or equal to 10(5) CFU/ml. For the specimens with probable pathogens at greater than or equal to 10(2) CFU/ml, the sensitivities of the URISCREEN and the Chemstrip LN were 86% (256 of 298) and 81% (241 of 298), respectively. Of the 451 specimens with pyuria, the URISCREEN detected 88% (398 of 451) and Chemstrip LN detected 78% (350 if 451). There were 204 specimens with both greater than or equal to 10(2) CFU/ml and pyuria; the sensitivities of both methods were 95% (193 of 204) for these specimens. Overall, there were 545 specimens with probable pathogens at greater than or equal to 10(2) CFU/ml and/or pyuria. The URISCREEN detected 85% (461 of 545), and the Chemstrip LN detected 73% (398 of 545). A majority (76%) of the false-negative results obtained with either method were for specimens without leukocytes in the urine. There were 955 specimens with no probable pathogens or leukocytes. Of these, 28% (270 of 955) were found positive by the URISCREEN and 13% (122 of 955) were found positive by the Chemstrip LN. A majority of the false-positive results were probably due, in part, to the detection of enzymes present in both bacterial and somatic cells by each of the test systems. Overall, the URISCREEN is rapid, manual, easy-to-perform enzymatic test that yields findings similar to those yielded by the Chemstrip LN for specimens with both greater than or equal to 10(2) CFU/ml and pyuria or for specimens with greater than or equal to 10(5) CFU/ml and with or without pyuria. However, when the data were analyzed for either probable pathogens at less 10(5) CFU/ml or pyuria, the sensitivity of the URISCREEN was higher (P less than 0.05).     

羊肚菌属群体遗传学和基因组进化的研究进展

羊肚菌Morchella esculenta是子囊菌亚门的一种大型药食两用真菌,具有重要的经济价值和药用价值。然而近年来全球气候变化,导致羊肚菌属物种的栖息地破碎和片段化,加上消费者对羊肚菌美食的喜爱,过渡采挖造成羊肚菌属野生资源急剧减少,因此,急需对羊肚菌属物种资源进行保护。遗传多样性的时空分布是保护生物学的重要内容,遗传多样性关系到一个物种或类群的进化潜力和未来命运。生物基因组和进化的研究能够辅助挖掘物种深层次的优异基因资源,有利于从本质上对物种进行科学保护。从羊肚菌属的遗传多样性、遗传结构和家系关系以及基因组进化等的研究进展进行综述,以期为羊肚菌属资源的科学保护提供重要依据。     

浅谈中西医结合治疗癌性疼痛

癌性疼痛是肿瘤最为常见的临床症状之一,如何有效地控制癌性疼痛,改善癌症病人的生活质量,延长生存期已成为全球关注的焦点。WHO调查认为:进展期癌症和终末期癌症病人约75%～90%以疼痛为主要临床症状,经过治疗90%的癌性疼痛可缓解。单纯运用西医的三阶梯镇痛疗法会导致病人药物成瘾性及较大的毒副作用;而单纯运用中医药疗法止痛效果不甚显著。因此,将中西医疗法结合运用到治疗癌性疼痛上,将成为今后癌症病人综合治疗的重要环节,尤其近年来中医学以其独特的理论体系,辨病辨证相结合,采用中药内服、外用、针灸等方法,对癌性疼痛的治疗研究取得了满意的进展。     

丁香水溶性化学成分的研究

目的：研究丁香水溶性化学成分。方法：利用HP-20大孔吸附树脂、反相硅胶柱色谱、反相制备薄层色谱、制备型反相高效液相色谱进行分离,NMR和MS等方法进行结构鉴定。结果：从丁香干燥花蕾的水提物中分离鉴定了5个化合物,分别为槲皮素-3-O-葡萄糖醛酸苷（1）,槲皮素-3-O-葡萄糖醛酸苷6″-甲酯（2）,槲皮素-3-O-葡萄糖苷（3）,丁香酚-β-芸香糖苷（4）,杨梅酮（5）。结论：化合物1～4为首次从丁香属植物中分离得到。     

川芎嗪诱导大鼠骨髓间质干细胞分化为神经元样细胞的研究

目的用川芎嗪(ligustrazin hydrochloride)在体外定向诱导SD青年鼠骨髓间质干细胞(mesenchymal stem cells，rMSCs)分化为神经元样细胞。方法用低糖DMEM冲洗骨髓腔，收集骨髓细胞悬液，接种在塑料培养瓶中。经体外扩增、纯化，选用第5代后的骨髓间质干细胞进行诱导分化。用10μg／LbFcF预诱导24h，更换成含川芎嗪的无血清培养基DMEM诱导间质干细胞分化为神经元样细胞。用免疫组织化学SABC法鉴定神经丝蛋白(NF—M)、神经元特异性烯醇化酶(NSE)、巢蛋白(nestin)、微管联合蛋白-2(MAP-2)、生长相关蛋白-43(GAP-43)、胶质纤维酸性蛋白(GFAP)的表达。结果第5代间质干细胞形态达到均一，呈梭形。用川芎嗪诱导15min到3h，间质干细胞胞体逐渐增大，并伸出细长突起形似神经元样细胞。免疫组织化学显示NF-M、NSE、nestin、MAP-2和GAP-43表达阳性，而GFAP阴性。对照组上述染色均为阴性。结论川芎嗪可诱导骨髓间质干细胞分化为神经元样细胞。     

Assessment of Clostridium difficile Infections by Quantitative Detection of tcdB Toxin by Use of a Real-Time Cell Analysis System

We explored the use of a real-time cell analysis (RTCA) system for the assessment of Clostridium difficile toxins in human stool specimens by monitoring the dynamic responses of the HS27 cells to tcdB toxins. The C. difficile toxin caused cytotoxic effects on the cells, which resulted in a dose-dependent and time-dependent decrease in cell impedance. The RTCA assay possessed an analytical sensitivity of 0.2 ng/ml for C. difficile toxin B with no cross-reactions with other enterotoxins, nontoxigenic C. difficile, or other Clostridum species. Clinical validation was performed on 300 consecutively collected stool specimens from patients with suspected C. difficile infection (CDI). Each stool specimen was tested in parallel by a real-time PCR assay (PCR), a dual glutamate dehydrogenase and toxin A/B enzyme immunoassay (EIA), and the RTCA assay. In comparison to a reference standard in a combination of the three assays, the RTCA had a specificity of 99.6% and a sensitivity of 87.5% (28 of 32), which was higher than the EIA result (P = 0.005) but lower than the PCR result (P = 0.057). In addition, the RTCA assay allowed for quantification of toxin protein concentration in a given specimen. Among RTCA-positive specimens collected prior to treatment with metronidazole and/or vancomycin, a significant correlation between toxin protein concentrations and clinical CDI severities was observed (R² = 0.732, P = 0.0004). Toxin concentrations after treatment (0.89 ng/ml) were significantly lower than those prior to the treatment (15.68 ng/ml, Wilcoxon P = 0.01). The study demonstrates that the RTCA assay provides a functional tool for the potential assessment of C. difficile infections.Clostridium difficile is recognized as the leading cause of infectious diarrhea that develops in patients after hospitalization and/or in patients receiving antibiotic treatment (3, 12). Moreover, the recently emerged, highly virulent strain BI-NAP1-027 has been associated with increased morbidity and mortality (14, 16). A definitive diagnosis depends on the detection of C. difficile-specific toxin B production in the laboratory, which allows for prompt treatment and isolation procedures to prevent further nosocomial spread of infection (12, 19). There are a number of methods available that have been used for the laboratory diagnosis of C. difficile infection (CDI). The well-accepted standard is cytotoxigenic culture, which is conducted by culturing C. difficile from the stool and then performing a cytotoxin assay on the isolate (21). This standard is labor-intensive, subjective, and time-consuming and therefore is not widely used in the clinical setting. Several enzyme immunoassays (EIAs) detect C. difficile antigens in stool, including glutamate dehydrogenase (GDH), as well as toxins A and B (7, 19, 20, 22-24, 28, 29). PCR-based molecular assays that detect toxin A or B, or both, have shown promising performance (4, 10, 18, 24, 30).Currently, recommended therapies for CDI include oral administration of metronidazole and/or vancomycin for 10 to 14 days (6). However, increased percentages of patients experience infection relapse after completion of treatment (3, 12, 17). The emergence and spread of resistance in C. difficile are complicating treatment and prevention (9). While new antibiotics and therapeutic methods are available, providing a rapid and accurate laboratory tool for monitoring disease severity and therapy efficacy is clinically desirable. The C. difficile toxin assay, which detects cell toxicity caused by toxin B, is a direct determination of whether a functional C. difficile toxin exists in stool. However, this assay is labor- and time-intensive and provides only qualitative results.A real-time cell analysis (RTCA) assay (ACEA Biosciences, San Diego, CA) was developed for monitoring the cell status using electronic impedance technology. Utilizing a dimensionless parameter called the cell index (CI), the RTCA system detects the changes to the cell layers cultured on gold microelectrodes on the glass substrates integrated in the bottom of the microelectronic plates (25). This technology has been applied in a number of cell-based assays, including cytotoxicity, cell adhesion and spreading, functional monitoring of receptor-mediated signaling, and cell invasion and migration (2, 11, 31, 32). In this study, we adapt the system for assessment of C. difficile toxin directly from stool specimens. Analytical and diagnostic sensitivities and specificities of this system for the diagnosis and monitoring of CDI were determined. We also explored the assessment of clinical CDI severities and therapeutic efficacies by using toxin concentrations in stool specimens as determined by the RTCA assay.(This study was presented in part at the 110th American Society for Microbiology Annual Meeting, San Diego, CA, 23 to 27 May 2010.)     

Clonal spread of serogroup W135 meningococcal disease in Turkey

Six cases of Neisseria meningitidis serogroup W135 meningococcal infection have been reported in Turkey since 2003. Seven isolates recovered from four meningococcal meningitis patients and two asymptomatic carriers produced three distinct pulsed-field gel electrophoresis (PFGE) patterns. Multilocus sequence typing and antigen gene sequencing showed that five isolates were indistinguishable from ST-11 (ET-37) serogroup W135 meningococci, which were first isolated in Saudi Arabia and were responsible for the worldwide outbreak among Hajj pilgrims and their contacts in 2000. The remaining two isolates, which had related PFGE patterns, differed from each other at only one of the genetic loci characterized but were not related to the ST-11 clonal complex. None of the six individuals recalled contact with a pilgrim or had traveled on the Hajj. These six individuals exhibited no time or place relationships to each other, except for the two asymptomatic carriers, who were soldiers and served in the same military unit. These data demonstrate that serogroup W135 meningococci with different genotypes, including the Hajj epidemic strain, are endemic in Turkey.