The perceptions of nurse teachers regarding the preparation for their role in Project 2000 programmes.

This paper discusses the findings related to the perceptions of nurse teachers regarding the preparation for their role in Project 2000 programmes. Data were collected by utilising three rounds of a Delphi survey with a panel of experts made up of Grade 2 nurse teachers. The panel of 201 respondents was obtained from 25 of the 28 colleges of nursing and midwifery that had implemented Project 2000 between September 1989 and April 1991. The profile of the respondents revealed that 68% work in general nurse courses, 18% in mental health, 8% in mental handicap and 6% in child care. Over half of the respondents hold a degree related to health care and over a quarter are studying for one. The findings suggest that the nurse teachers working in Project 2000 programmes consider their teacher preparation course an important means of preparation for the activities within their role. Degree and diploma courses are also considered important along with additional professional qualifying courses and subject related courses. What did not appear evident was any preparation for the many specific activities they carry out apart from teaching. Experience came out strongly as an important means of preparation for all the activities. Staff development programmes were said by 52% of respondents to be organised within their colleges and perceived by many as an important means of preparation.     

The roles of turbulence and vasa vasorum in the aetiology of varicose veins

Noradrenaline can dilate a canine lateral saphenous vein which at the time is constricted by noradrenaline. It does so when it is released from the vasa vasorum network of the constricted vein. By filling a limited section of the network of a normal, tonically constricted vein with endogenous noradrenaline it is possible to dilate the vein locally, in effect creating an acute experimental varicosity. These findings have led to the proposal that human varicosities are an active response of the vein to endogenous noradrenaline released from sections of its vasa vasorum network. The noradrenaline involved is part of the circulating overflow derived from normal adrenergic nerve activity. A bout of turbulence in the vein lumen is proposed as the trigger which causes a reflux of hypoxic blood and the endogenous noradrenaline in it from the vein lumen to the vasa. The size and shape of the varix reflects the mosaic pattern of a vein's vasa vasorum network. The site of the varicosity is determined by the location in the vein lumen of the bout of turbulent non-laminar flow.     

Is circulating noradrenaline the cause of varicose veins?

When noradrenaline, either endogenous or exogenous, is released from the venae venarum of a dog's lateral saphenous vein which is constricted by noradrenaline, it dilates the vein. By limiting the release of the drug to just a section of the vein's venae venarum network it is possible to dilate the normal vein segmentally, that is, cause varicosities. This has led to the suggestion that pathological varicosities begin as localised physiological dilator responses of the vein wall to circulating endogenous noradrenaline, released from the vein's venae venarum. Under ambulatory conditions small quantities of noradrenaline probably flow almost continually from the lumen of the vein to different parts of its venae venarum network and serve to adjust constrictor tone downwards. When there is turbulence in the vein lumen the volume of reflux becomes excessive and causes so much adjustment that constrictor tone is abolished. The vein, in effect, then exhibits a frank dilator effect, visible as a varicosity, localised to the level in the vein at which the turbulence occurs. If a high volume of hypoxic blood reflux continues for a critical period then the wall of the varicosity suffers secondary degenerative structural changes which make the varicosity permanent.     

实施现代结核病控制策略对传染性肺结核患者发现与治疗效果的影响

目的：分析实施DOTS策略对传染性肺结核病例发现与治疗效果的影响。方法：通过对1995—2000年分批实施的卫生部加强与促进结核病控制项目、WHO西太区结核病控制项目及福建省结核病控制项目资料进行分析。结果涂阳病例新登记率由1995年的6．3／10万提高到2000年的19．0／10万，涂片阳性占活动性病例比例由21．5％提高到37．4％，新发涂阳病例治愈率由80．7％提高到89．2％，病例丢失率由7．3％下降到2．7％，治疗失败率由6．9％下降到1．4％。流动人口传染性肺结核病例治愈率仅59．7％。结论：实施DOTS策略，重视流动人口结核病治疗管理，提高涂阳病例发现率、治愈率，减少病例丢失和治疗失败，有效控制结核病。     

Epithelial cells bearing class II molecules stimulate allogeneic human colonic intraepithelial lymphocytes.

HLA-DR+ gut epithelial cells may present antigen to intraepithelial lymphocytes (IEL). This study aimed to isolate an IEL population from the human colon to activate CD3 + IEL by a human colonic epithelial cell line (HT-29), bearing different concentrations of class II antigen (HLA-DR). IEL were isolated by a mechanical method from six patients with ulcerative colitis (UC) and from 14 control patients. IEL were cocultured with HT-29 which had been induced to express class II molecules by gamma-interferon (IFN-gamma) in a dose dependent manner. The phenotype and the subsequent expression of activation markers by the IEL were determined to two colour flow cytometry. The IEL population had a CD4/CD8 ratio similar to that seen in tissue sections. In the mixed cell culture, the degree of IEL activation showed a positive correlation with the degree of HLA-DR expression by the HT29 cells and the IEL secreted a IFN-gamma like factor that in turn stimulated the HT-29. Thus, depending on their expression of HLA molecules, colonic epithelial cells are able to activate CD3+CD8+IEL.     

Epidemiology,Co-Infections,and Outcomes of Viral Pneumonia in Adults: An Observational Cohort Study

Advanced technologies using polymerase-chain reaction have allowed for increased recognition of viral respiratory infections including pneumonia. Co-infections have been described for several respiratory viruses, especially with influenza. Outcomes of viral pneumonia, including cases with co-infections, have not been well described.This was observational cohort study conducted to describe hospitalized patients with viral pneumonia including co-infections, clinical outcomes, and predictors of mortality. Patients admitted from March 2013 to November 2014 with a positive respiratory virus panel (RVP) and radiographic findings of pneumonia within 48 h of the index RVP were included. Co-respiratory infection (CRI) was defined as any organism identification from a respiratory specimen within 3 days of the index RVP. Predictors of in-hospital mortality on univariate analysis were evaluated in a multivariate model.Of 284 patients with viral pneumonia, a majority (51.8%) were immunocompromised. A total of 84 patients (29.6%) were found to have a CRI with 48 (57.6%) having a bacterial CRI. Viral CRI with HSV, CMV, or both occurred in 28 patients (33.3%). Fungal (16.7%) and other CRIs (7.1%) were less common. Many patients required mechanical ventilation (54%) and vasopressor support (36%). Overall in-hospital mortality was high (23.2%) and readmissions were common with several patients re-hospitalized within 30 (21.1%) and 90 days (36.7%) of discharge. Predictors of in-hospital mortality on multivariate regression included severity of illness factors, stem-cell transplant, and identification of multiple respiratory viruses. In conclusion, hospital mortality is high among adult patients with viral pneumonia and patients with multiple respiratory viruses identified may be at a higher risk.     

A proposal for applying molecular markers as an aid to identifying potential cases of imported tuberculosis in immigrants

In recent years, the percentage of tuberculosis (TB) cases in immigrants in Spain has increased markedly. In this context, discrimination between cases with potentially imported TB and cases likely to have acquired it by recent transmission after arrival is a basic issue. In this study, we evaluated molecular markers to obtain information on the geographic origin of Mycobacterium tuberculosis (MTB) strains and to determine whether they could help to identify imported TB cases. We analyzed the pks15/1 gene, spoligotype, and MIRU locus 24 in 168 MTB isolates from immigrants of 32 nationalities and from a selection of autochthonous cases. In non-Asian immigrants we could not detect major differences with the autochthonous cases. For the Asian cases, we found some specific features for these markers. pks15/1 was intact in 69% of the Asian patients, but this gene had a 7-bp deletion in all non-Asian and Spanish (non-Beijing) cases. The spoligotype-defined lineages EAI and CAS, and the allele with two repetitions in MIRU locus 24 was found exclusively among Asian immigrants. The analysis of certain bacterial molecular markers could help to discriminate between potentially imported TB cases and those more probably acquired in the host country.     

Increased Internal Carotid Artery Peak Systolic Velocity Is Associated with Presence of Significant Atherosclerotic Plaque Instability Independent of Degree of ICA Stenosis

The aim of our work was to study the relationship between Doppler ultrasound velocity measurements and the presence of histologic features of plaque instability in carotid atherosclerosis, in particular, intraplaque hemorrhage (IPH). Consecutive patients undergoing carotid endarterectomy in a one-year period were included. All patients were examined by duplex ultrasonography and carotid angiography. Endarterectomy specimens were examined histologically for features of plaque instability. The quantity of IPH was measured by digital image analysis. The associations between Peak Systolic Velocity (PSV), end-diastolic velocity (EDV), degree of ICA stenosis, shape and length of the lesion and the features of plaque instability and quantity of IPH were assessed. Seventy-four patients (20 asymptomatic, 54 symptomatic) were included. PSV was independently associated with the presence of significant IPH [p < 0.001, OR = 1.04 (95% CI = 1.01–1.06)], as was the degree of angiographic ICA stenosis [p < 0.05, OR = 0.98 (95% CI = 0.92–1.6)]. Neither EDV nor the shape of the lesion was associated with IPH (p = 0.26 and p = 0.38, respectively). A close correlation was observed between PSV and the quantity of IPH (r² = 0.68, p < 0.0001). A significant association was observed between PSV and the presence of plaque ulceration (p < 0.05); however, this was not found to be independent of the quantity of IPH and the degree of ICA stenosis [p = 0.17, OR = 1.28 (95% CI = 0.6–2.44)]. PSV at the site of ICA stenosis appears to be associated with the quantity of intraplaque hemorrhage, independent of the angiographic degree of ICA stenosis. We propose that the role of Doppler velocity measurements extends beyond measurement of the degree of ICA stenosis. Increased ICA peak systolic velocity by itself may be an indicator of atherosclerotic plaque instability.