手足口病儿童血浆γ干扰素诱导蛋白10的表达水平及临床意义

目的:探讨γ干扰素诱导蛋白10(interferon-γ inducible protein-10,IP-10)在手足口病(hand-foot-mouth disease,HFMD)儿童血浆中的表达水平及临床意义?方法:选取HFMD患儿74例,根据是否伴有神经系统症状将患儿分为重症组和普通感染组;另选取30例体检儿童作为健康对照组?采用流式液相多重蛋白定量检测技术检测血浆中IP-10的表达量,同时检测分析淋巴细胞亚群比例?免疫球蛋白和血常规相关指标?比较各指标在健康对照组?HFMD普通感染组及重症组中的差异;分析IP-10与皮疹出现天数及淋巴细胞各亚群比例之间的相关性?结果:HFMD普通感染组及重症组患儿白细胞计数均增高,但和健康对照组相比无统计学差异?HFMD普通感染组及重症组患儿IP-10蛋白表达均显著增加(P < 0.001),重症组IP-10蛋白表达略低于普通感染组,差异无统计学意义(P > 0.05)?HFMD普通感染组及重症组患儿T细胞比例显著降低(P < 0.001),其中CD4+ T 淋巴细胞与CD8+ T 淋巴细胞亦显著降低(P < 0.05)?相反,B淋巴细胞比例显著增加(P < 0.001)?HFMD普通感染组?重症组与健康对照组相比,IgA降低,IgG增加,但无统计学差异(P > 0.05)?HFMD普通感染组患儿IP-10蛋白表达量与皮疹天数呈负相关(P < 0.05),而重症组虽IP-10蛋白表达量与皮疹天数呈负相关,但无统计学意义?HFMD重症组IP-10蛋白表达量与T淋巴细胞比例呈正相关,其中与CD4+ T 淋巴细胞的正相关有统计学意义(P < 0.01)?结论:HFMD患儿T淋巴细胞比例降低,B淋巴细胞比例增加,IP-10蛋白表达显著增加,与皮疹天数呈负相关?     

鼻胆管引流术后的导管相关性感染分析

目的了解在经内镜下逆行胰胆管造影术(ERCP)后行鼻胆管引流术(ENBD)的导管感染情况,研究鼻胆管导管感染危险因素及预防策略。方法回顾性分析2011年8月至2014年8月我院收治的218例行ERCP术后放置鼻胆管患者的导管感染率、相应的感染源及感染途径、感染细菌培养结果。结果 ERCP手术放置鼻胆管导管感染率为7.3%,感染源有胃肠道、导管堵塞及胆管自身因素;感染细菌培养结果主要为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肠球菌及金黄色葡萄球菌、鲍曼不动杆菌。结论逆行胰胆管造影术后鼻胆管引流术后发生鼻胆管导管感染的概率低(7.3%),感染途径主要为胆肠逆行感染及经血、细菌感染以革兰阴性菌为主。     

MSCs 2种分离培养方法及其培养液中的 VEGF、SDF-1α浓度比较

目的：通过2种分离培养方法所得骨髓间充质干细胞（MSCs）的生长特征和微环境中细胞因子的比较,提供一种可以快速、安全、高效地为临床和实验提供大量优质MSCs的方法。方法提取C57BL／c小鼠的骨髓,分别作密度梯度离心法和全骨髓贴壁培养分离法分离培养MSCs ,通过流式细胞仪检测细胞表面CD29＋、CD31－、CD34－、CD45－表达水平,并比较各自所得细胞的生长曲线;ELISA检测培养液中的血管内皮生长因子（VEGF）、SDF‐1α浓度并比较二者的差异。结果与密度梯度离心法比较,全骨髓贴壁分离法所得原代细胞有较快的生长速度,较短的生长周期;培养液中VEGF和SDF‐1α浓度也稍高于密度梯度离心法。结论全骨髓贴壁培养法可以快速、方便、有效地为临床和实验提供大量MSCs ,所得细胞的培养环境优于密度梯度离心法,减少了对细胞功能的损害。     

传统村落文化知识产权保护的现状及模式

以湖南省永州市传统村落为研究对象,通过实地走访调查,详细了解永州市传统村落文化的知识产权保护现状及存在的问题及其原因,探讨了传统村落文化知识产权的保护模式。     

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N?=?470) and triage nurses (N?=?189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents’ profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture.

• Key Points

• Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that:

• ??healthcare providers in Dutch GP cooperatives perceive patient safety culture positively;

• ??triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals – on several patient safety culture factors; and

• ??within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

     

After neoadjuvant chemotherapy platelet/lymphocyte ratios negatively correlate with prognosis in gastric cancer patients

Introduction

Circulating predictors prognostic factors of neoadjuvant chemotherapy, which identify the patients who are potential possibly to benefit from it are limited at present. In this research, we aimed to compare the prognostic significance of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with locally advance gastric carcinoma who were treated with neoadjuvant chemotherapy (NAC) followed by D2 gastrectomy.

Materials and methods

From 2007 to 2015, 91 patients with locally advanced gastric cancer treated with NAC followed by D2 gastrectomy included in this retrospective cohort study. The correlation of clinical data, including tumor regression, response evaluation, tumor location, pathological type, systemic therapy, tumor size (cm), neural invasion, lymphatic‐vascular invasion, ypTNM stage, and survival prognosis were analyzed.

Results

Platelet/lymphocyte ratio and neutrophil/lymphocyte ratio in gastric cancer patients were higher than in matched normal volunteers. PLR levels higher after neoadjuvant chemotherapy are associated with worse OS. Multivariate Cox proportional analysis showed that pre‐neoadjuvant chemotherapy PLR was an independent prognostic factor.

Conclusions

Pre‐neoadjuvant chemotherapy PLR may be a feasible biomarker for survival prognosis in patients with locally advanced gastric cancer. PLR and NLR were reduced after neoadjuvant chemotherapy. After neoadjuvant chemotherapy, PLR level was negatively correlated with survival prognosis.

     

养阴润肺汤治疗肺阴亏虚型肺结核临床研究

目的：观察养阴润肺汤治疗肺阴亏虚型肺结核的临床疗效。方法：108例肺阴亏虚型肺结核患者随机分为联合组54例和西医组54例。西医组采用常规肺结核化疗方案,联合组在西医组治疗基础上加用自拟养阴润肺汤,两组患者共治疗12个疗程。比较两组患者治疗后痰菌阴转率,并对比两组患者治疗前后 T 淋巴细胞值和血清细胞因子水平。结果：治疗1个月后、3个月后、6个月后联合组和西医组痰菌阴转率比较,差异无统计学意义（P ＞0．05）。治疗后两组患者 CD4＋细胞、CD4＋／CD8＋显著升高,CD8＋显著降低（P ＜0．05）;其中联合组 CD4＋细胞、CD4＋／CD8＋显著高于西医组,CD8＋显著低于对西医组,组间比较,差异均有统计学意义（P ＜0．05）。治疗后两组白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α均显著降低（P ＜0．05）;联合组各细胞因子水平显著低于西医组,两组间比较,差异均有统计学意义（P ＜0．05）。结论：养阴润肺汤治疗肺阴亏虚型肺结核的临床疗效较好。     

In vitro exposure of DE‐71, a penta‐PBDE mixture,on immune endpoints in bottlenose dolphins (Tursiops truncatus) and B6C3F1 mice

Polybrominated diphenyl ethers (PBDEs) are an emerging contaminant of concern with low level exposures demonstrating toxicity in laboratory animals and wildlife, although immunotoxicity studies have been limited. Bottlenose dolphin peripheral blood leukocytes (PBLs) and mouse splenocytes were exposed to environmentally relevant DE‐71 (a penta‐PBDE mixture) concentrations (0–50 µg ml^?1) in vitro. Natural killer (NK) cell activity and lymphocyte (B and T cell) proliferation were evaluated using the parallelogram approach for risk assessment. This study aimed to substantiate results from field studies with dolphins, assess the sensitivities between the mouse model and dolphins, and to evaluate risk using the parallelogram approach. In mouse cells, NK cell activity increased at in vitro doses 0.05, 0.5 and 25 µg DE‐71 ml^?1, whereas proliferation was not modulated. In dolphin cells, NK cell activity and lymphocyte proliferation was not altered after in vitro exposure. In vitro exposure of dolphin PBLs to DE‐71 showed similar results to correlative field studies; NK cell activity in mice was more sensitive to in vitro exposure than dolphins, and the parallelogram approach showed correlation with all three endpoints to predict risk in bottlenose dolphins. Copyright © 2014 John Wiley & Sons, Ltd.     

医院核心价值观不可或缺

针对2012年度中国最佳医院前50名医院网站有6家无"核心价值观"理念,本文从医院哲学入手,简析核心价值观在医院文化理念体系中的位置,医院核心价值观的内容、提炼与表达。