Development of an Enzyme-Linked Immunosorbent Assay Using a Recombinant LigA Fragment Comprising Repeat Domains 4 to 7.5 as an Antigen for Diagnosis of Equine Leptospirosis

Leptospira immunoglobulin (Ig)-like (Lig) proteins are a novel family of surface-associated proteins in which the N-terminal 630 amino acids are conserved. In this study, we truncated the LigA conserved region into 7 fragments comprising the 1st to 3rd (LigACon1-3), 4th to 7.5th (LigACon4-7.5), 4th (LigACon4), 4.5th to 5.5th (LigACon4.5–5.5), 5.5th to 6.5th (LigACon5.5–6.5), 4th to 5th (LigACon4-5), and 6th to 7.5th (LigACon6-7.5) repeat domains. All 7 recombinant Lig proteins were screened using a slot-shaped dot blot assay for the diagnosis of equine leptospirosis. Our results showed that LigACon4-7.5 is the best candidate diagnostic antigen in a slot-shaped dot blot assay. LigACon4-7.5 was further evaluated as an indirect enzyme-linked immunosorbent assay (ELISA) antigen for the detection of Leptospira antibodies in equine sera. This assay was evaluated with equine sera (n = 60) that were microscopic agglutination test (MAT) negative and sera (n = 220) that were MAT positive to the 5 serovars that most commonly cause equine leptospirosis. The indirect ELISA results showed that at a single serum dilution of 1:250, the sensitivity and specificity of ELISA were 80.0% and 87.2%, respectively, compared to those of MAT. In conclusion, an indirect ELISA was developed utilizing a recombinant LigA fragment comprising the 4th to 7.5th repeat domain (LigACon4-7.5) as a diagnostic antigen for equine leptospirosis. This ELISA was found to be sensitive and specific, and it yielded results that concurred with those of the standard MAT.     

腹腔镜下根治性子宫肌瘤剔除术术式特点及临床疗效观察

目的 探讨腹腔镜下根治性子宫肌瘤剔除术术式特点及临床疗效.方法 选取2018年6月至2019年9月本院收治的84例子宫肌瘤患者,根据治疗方法不同分为对照组和实验组,每组42例.对照组接受经腹子宫肌瘤剔除术治疗,实验组接受腹腔镜下根治性子宫肌瘤剔除术治疗.比较两组临床疗效、围术期指标及生活质量.结果 实验组治疗总有效率高于对照组,手术时间短于对照组,术后出血量和复发率均低于对照组,术后心理、生理评分均高于对照组,差异有统计学意义(P<0.05).结论 腹腔镜下根治性子宫肌瘤剔除术具有手术时间短、出血量少和复发率低的特点,疗效显著,可有效提升患者生活质量,对于有保留子宫意愿且具有医学手术指征但无生育要求的多发性子宫肌瘤患者,建议采用腹腔镜下根治性子宫肌瘤剔除术治疗.     

融入“思政元素”的情景教学法在住院医师规范化培训中的应用

目的探讨融入“思政元素”的情景教学法对在肝病科住院医师规范化培训（简称规培）中的应用效果。方法选取进行住院医师规范化培训的学生48人，随机分为两组，试验组采用融入“思政元素”的情景教学法，对照组采用传统教学法，对两组规范化培训学生理论考试、实践技能考核成绩及教学评价满意度进行比较。结果两组学生理论考试成绩无明显差异(P＞0.05）；两组学生临床实践技能得分比较，试验组在接诊患者、临床思维路径分析、医嘱处置、病案书写、医患沟通能力和实践技能总成绩得分均优于对照组(P<0.05)；两组学生教学效果调查问卷比较，试验组在提升学习兴趣、提升自主学习能力、团结协作能力、职业道德素养和总体教学满意度方面得分均明显高于对照组(P<0.05)。结论融入“思政元素”的情景教学法在肝病科住院医师规范化培训中应用，具有良好的效果。     

T1WI_Star_VIBE_FS序列在头颈部放疗MR定位中扫描方法研究

目的 对比分析T1WI_Star_VIBE_FS序列在头颈部肿瘤患者MR定位中不同扫描方式对图像质量、信噪比、对比噪声比等参数的影响,确定优选扫描方式。方法 回顾性分析 78例头颈部MR定位患者,分别采用组织补偿法(A组 23例)、分段扫描拼接法(B组 18例)和二者结合法(C组 37例)进行增强扫描,对比上述3种扫描方式获取的图像质量、颈前部软组织信噪比(SNR)和对比噪声比(CNR)的差异。结果 C组扫描方式可获取较高的图像质量评分;3种扫描方式获取图像的SNR的平均值分别为 214.70±148.78、91.95±59.26、307.61±127.80;CNR的平均值分别为 208.74±148.27、85.79±59.50、301.58±127.48;C组在图像质量评分、SNR和CNR方面均明显优于A、B组(P<0.01)。结论 推荐使用组织补偿和分段拼接扫描相结合方式作为头颈部肿瘤放疗MR定位的优选扫描方式。     

Performance of Older Depressed Patients on Two Cognitive Malingering Tests: False Positive Rates for the Rey 15-item Memorization and Dot Counting Tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.     

Elevated lactoferrin is associated with moderate to severe Clostridium difficile disease, stool toxin, and 027 infection

We evaluated blood and fecal biomarkers as indicators of severity in symptomatic patients with confirmed Clostridium difficile infection (CDI). Recruitment included patients with CDI based on clinical symptoms and supporting laboratory findings. Disease severity was defined by physician’s assessment and blood and fecal biomarkers were measured. Toxigenic culture done using spore enrichment and toxin B detected by tissue culture were done as confirmatory tests. Polymerase chain reaction (PCR) ribotyping was performed on each isolate. There were 98 patients recruited, with 85 (87 %) confirmed cases of toxigenic CDI (21 severe, 57 moderate, and seven mild), of which 68 (80 %) were also stool toxin-positive. Elevated lactoferrin (p?=?0.01), increased white blood cell (WBC) count (p?=?0.08), and low serum albumin (p?=?0.03) were all associated with the more severe cases of CDI. Ribotype 027 infection accounted for 71 % of severe cases (p?<?0.01) and patients with stool toxin had significantly higher lactoferrin levels and WBC counts (p?<?0.05). Our findings show that elevated fecal lactoferrin, along with increased WBC count and low serum albumin, were associated with more severe CDI. In addition, patients infected with ribotype 027 and those with stool toxin had significantly higher fecal lactoferrin and WBC counts.     

恒速滴注法在高龄卧床管饲患者中的应用效果

目的探讨恒速滴注法在高龄卧床管饲患者中的应用效果。方法2010年5月至2011年8月，方便性抽样选择在解放军总医院住院治疗的携带鼻胃管或鼻肠管行胃肠营养的老年患者60例，按入院先后分为观察组和对照组各30例，观察组采用恒速滴注法管饲肠内营养乳剂，对照组采用常规管饲方法即分次推注法，观察并比较两组患者堵管、腹胀、腹泻、反流、误吸等并发症的发生率。结果观察组患者发生堵管、反流及误吸的例数均少于对照组，差异均有统计学意义（均P〈0．05）；发生腹胀与腹泻的例数与对照组比较，差异无统计学意义（均P〉0．05）。结论恒速滴注法肠内营养可有效满足高龄长期卧床患者的营养需求，预防和减少并发症的发生，推荐在临床广泛应用。