儿童医院围手术期预防性应用抗菌药物合理应用分析

OBJECTIVE To investigate the preventive use of antibacterials in surgery.METHODS 170 operation histories which are the select date operations of top seven of type I and II incisions in 2007 were reviewed retrospectively and analyzed statistically by quest     

住院医师规范化培训的区域实践与建议——以山西省为例

为了解山西省临床医学专业学位研究生“四证合一”规培的实施现状,并分析其影响因素,本研究自行设计调查问卷,对山西省2015 级临床专业学位研究生规培的基本情况、成效、师资、存在问题及建议等方面进行了调查分析。问卷Cronbach’s α 信度系数为0.89,结构性效能分析显示KMO 检验值为0.93,Bartlett 球形检验值P ＜ 0.01,方差累计贡献率为64%。结果显示,70.63% 的研究生选择“出于未来就业考虑”作为参加规培的原因;46.39% 的研究生认为参加规培以来“有较大压力”;34.97% 的人认为有“较多”的临床实践机会。研究表明,当前山西省“四证合一”规培体系已较为完善,但依然存在诸多薄弱环节,如规培轮转安排及培养模式等问题急待改进,希望本文能为完善今后规培制度提供借鉴和参考。     

HIV reservoir: antiviral immune responses and immune interventions for curing HIV infection

Antiretroviral therapy against human immunodeficiency virus (HIV) is effective in controlling viral replication but cannot completely eliminate HIV due to the persistence of the HIV reservoir. Innate and adaptive immune responses have been proposed to contribute to preventing HIV acquisition, controlling HIV replication and eliminating HIV-infected cells. However, the immune responses naturally induced in HIV-infected individuals rarely eradicate HIV infection, which may be caused by immune escape, an inadequate magnitude and breadth of immune responses, and immune exhaustion. Optimizing these immune responses may solve the problems of epitope escape and insufficient sustained memory responses. Moreover, immune interventions aimed at improving host immune response can reduce HIV reservoirs, which have become one focus in the development of innovative strategies to eliminate HIV reservoirs. In this review, we focus on the immune response against HIV and how antiviral immune responses affect HIV reservoirs. We also discuss the development of innovative strategies aiming to eliminate HIV reservoirs and promoting functional cure of HIV infection.     

免疫调节剂对致痫大鼠脑内神经元及小胶质细胞内谷氨酸和蛋白激酶C免疫反应的影响

为了探讨免疫调节作用对癫痫发病的影响与相关机制,应用免疫细胞化学技术研究免疫调节剂干预戊四氮(pentyle-netetrazol,PTZ)致痫时,大鼠脑内及培养的小胶质细胞内谷氨酸(Glu)和蛋白激酶C(PKC)的表达变化。结果显示:在体实验中大鼠大脑皮质及海马,Glu和PKC在生理盐水对照组(NS组)、戊四氮组(PTZ组)、左旋咪唑+戊四氮组(LMS+PTZ组)、地塞米松+戊四氮组(DEX+PTZ组)均有不同的表达,且二种物质变化趋势基本一致。其中PTZ组较NS组表达增强,LMS+PTZ组进一步增强,DEX+PTZ组较PTZ组和LMS+PTZ组明显减弱。离体实验中,PTZ作用小胶质细胞2h即可引起Glu和PKC表达增多,6h达峰值,12h表达有所减弱,且PTZ组Glu和PKC表达较NS组明显增多,免疫增强剂(levamisole,LMS)可进一步增强Glu和PKC的表达;免疫抑制剂(dexamethasone,DEX)则下调其表达。以上结果提示免疫调节剂可能通过作用于神经元和小胶质细胞内Glu和PKC的表达而共同影响癫痫的发病机制和发病状态。     

慢性阻塞性肺疾病急性加重期的抗菌治疗

<正>关于慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重的诊断标准尚缺乏统一的认识,通常认为是在疾病过程中,患者短期内出现咳嗽、咳痰、气短和(或)喘息加重,痰量增多,呈脓性或黏脓性,可伴发热等炎症明显加重的表现。     

Addition of glomerular lesion severity improves the value of anemia status for the prediction of renal outcomes in Chinese patients with type 2 diabetes

We aimed to determine the utility of biopsy data and anemia for the prediction of renal outcomes in Chinese patients with type 2 diabetes. In total, 441 Chinese patients with type 2 diabetes and biopsy-confirmed diabetic nephropathy (DN) were enrolled in a retrospective study. Their renal pathology was assessed using the Renal Pathology Society system. Cox proportional hazards models were used to estimate hazard ratios (HRs) for end-stage renal disease (ESRD), and immunofluorescence staining was used to assess the expression of hypoxia-inducible factor (HIF)-α in patients’ kidneys. We found that glomerular pathology classification was an independent pathological predictor of low hemoglobin concentration, according to linear and logistic regression analyses. Each 1 g/dL decrease in baseline hemoglobin concentration was associated with a 42% higher risk of an adverse renal outcome, after adjustment for clinical and pathologic covariates. In patients with severe glomerular lesions, the risk of progression to ESRD was significantly higher if mild or moderate/severe anemia was present, but in patients with mild glomerular lesions, the risk was only significantly higher in those with moderate or severe anemia than in the absence of anemia. Harrell’s C Concordance was improved, but the Akaike information criterion was worsened by adding the glomerular pathology classification to the use of anemia status and clinical data. Immunofluorescence staining revealed that renal HIF-1α and HIF-2α expression was significantly higher in classes II–IV than class I. Thus, the addition of glomerular pathology classification increases the value of anemia status for the prediction of the progression to ESRD.