Hypersensitivity pneumonitis in rabbits. Modulation of pulmonary inflammation by long-term aerosol challenge with antigen

Immunized rabbits that were aerosol challenged for 2 to 3 wk with pigeon dropping extract, an etiologic agent of hypersensitivity pneumonitis, developed chronic pulmonary inflammation associated with cell-mediated immunity in bronchoalveolar cells. However, prolonged aerosol challenge for 12 wk resulted in the diminution of pulmonary inflammation (modulation) and the loss of demonstrable cell-mediated immunity. This was probably not due to loss of sensitized lymphocytes that mediated pulmonary inflammation. Furthermore, rabbits undergoing modulation when they were challenged with an unrelated antigen were refractory to the development of pulmonary inflammation for at least 9 wk. After this refractory period, animals reimmunized and aerosol challenged with pigeon dropping extract displayed an anamnestic response and produced pulmonary lesions that were strikingly similar to the histopathology of human hypersensitivity pneumonitis.     

Human T cell responses to peptides of the Mycobacterium leprae 45-kD serine-rich antigen

In order to identify T cell epitopes within the Mycobacterium leprae 45-kD serine-rich antigen, we analysed responses to overlapping 17-mer peptides encompassing the whole antigen in non-exposed UK controls, Pakistani leprosy patients and tuberculosis patients in both the United Kingdom and Pakistan. This antigen has been described as M. leprae-specific, although it has a hypothetical homologue in M. tuberculosis. Human peripheral blood mononuclear cells were stimulated with peptide for 5 days and IFN-gamma measured in supernatants by ELISA. Some peptides were recognized more frequently by T cells from tuberculoid leprosy patients than those from UK controls, suggesting that such T cell epitopes might have diagnostic potential, while other peptides induced greater responses among UK control subjects. Short-term cell lines confirmed that these assays detected specific T cell recognition of these peptides. However, many tuberculosis patients also recognized these potentially specific peptides suggesting that there could be a true homologue present in M. tuberculosis.     

Impact of Type of Intervention on Youth Reoffending: Are Gender and Risk Level Involved?

The objective of this study was to analyse the impact of the type of intervention on youth reoffending. Moreover, the possible influence that the offender's gender and level of risk could have on this relationship was also explored. Juvenile offenders from four different types of educational interventions participated in the study (N = 210): victim–offender mediation (VOM) as a diversion procedure, and case closure, reprimand, and community service as dispositions. Aged between 14-18 years, they were assessed by means of the Youth Level of Service/Case Management Inventory (YLS/CMI). Recidivism rates were evaluated as the number of new records in a follow-up period of 24 months. Results of this study showed that type of intervention (diversion versus dispositions) had no apparent effect on youth recidivism. Furthermore, an important aspect to consider in youth assessment was the different impact that risk level had on boys’ and girls’ recidivism.     

CMI在评估学科绩效建设中的模式研究与实践

目的：为提高医疗绩效评价水平、提升医院的内涵质量和医疗服务效率,上海市肺科医院利用CMI工具在学科绩效建设模式方面进行了探索性的研究与实践。方法：以上海市肺科医院2012年7月-2013年6月胸外科住院患者数据为基础,建立基于临床路径与DRGs大数据支持下的以CMI为核心的学科绩效评价模式。结果：2013年7月-2014年6月该院胸外科平均CMI值由上年同期的基准值1.00升高至1.06（增加6%）,单病种均次费用下降,所有医疗组的校正平均住院天数均降低。结论：以CMI为核心的学科绩效评价模式,能够在保证医疗内涵质量的前提下,实现提高疑难危重患者收治率、缩短平均住院日和控制费用的目标。     

El Cuadro de Mando Integral como instrumento para la evaluación y el seguimiento de la estrategia en las organizaciones sanitarias

Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations.     

Summary of knowledge gaps related to quality and efficacy of current influenza vaccines

Influenza viruses are a public health threat, as they are pathogenic, highly transmissible and prone to genetic changes. For decades vaccination strategies have been based on trivalent inactivated vaccines, which are regulated by specific guidelines. The progress in scientific knowledge and the lessons learned from the A(H1N1)2009 pandemic have highlighted further the need to improve current guidelines, including the immunogenicity criteria set by the CHMP in 1997, and to promote the discussion on the shortcomings encountered, e.g. the evaluation of vaccine efficacy in the paediatric and elderly populations, the measurement of the naivety of a population, the impact of prior immunity on subsequent vaccinations, and the technical issues with the serological assays for detection of immunity and immunogenicity.     

Association of an insertion/deletion polymorphism in IL1A 3′-UTR with risk for cervical carcinoma in Chinese Han Women

Emerging evidence has demonstrated that polymorphisms of interleukin-1 (IL-1) may be involved in human tumorigenesis by regulating the production of this cytokine. Previous studies have investigated the association between two genetic variants (rs3783553 and rs17561) of IL1A and many diseases. The present study was conducted to evaluate whether these two variants are associated with cervical carcinoma (CC). These two polymorphisms were genotyped in 319 CC patients and 424 healthy controls by polymerase chain reaction polyacrylamide gel electrophoresis (PCR-PAGE) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Significantly reduced CC risk was observed to be associated with the insertion allele of rs3783553 (P = 0.014, OR = 0.71, 95% CI = 0.57–0.88). Stratification analysis based on different certain clinical features showed that patients with the heterozygous genotype were associated with a reduced predisposition advancing to clinical stage II-III or developing non-squamous cell carcinoma. Furthermore, patients with the insertion homozygous genotype were also associated with a reduced risk to have a poor tumor differentiation. No significant association was observed between rs17561 and CC. The present study provided evidence that the rs3783553 in IL1A 3′-UTR is inversely associated with CC risk, suggesting an important role IL-1α may play in cervical carcinogenesis.     

成年医学生心身健康与疲劳相关研究

目的探讨成年医学生的心身状况、疲劳及其相关性。方法用CMI量表和FAI量表进行调查问卷,自编程序输入,用SPSS10郾0软件分析。结果成年医学生男学生康奈尔医学指数总分莛35分,占总体6郾40%,M—R莛15分,占总体6郾02%。女学生康奈尔医学指数总分≥40分,占总体12郾27%,M—R≥20分,占总体7郾30%。男女之间疲劳因子3有统计学意义穴P<0.005雪。康奈尔医学指数总分与疲劳总分、疲劳因子1、疲劳因子2、疲劳因子3呈正相关。经多重线性回归分析,康奈尔医学指数总分与4个疲劳因子有直线关系。M—R与疲劳总分、疲劳因子1、疲劳因子2、疲劳因子3呈正相关。经多重线性回归分析,M—R与4个疲劳因子有直线关系。年龄与康奈尔医学指数总分、躯体健康、不适应、既往健康、消化系统、心血管系统、生殖泌尿系统呈负相关。结论在成年医学生中,女性比男性更易出现心身障碍,对女性给予更多的关注;疲劳与心身健康、精神症状的相关性提示心身健康状况对疲劳有影响;疲劳也可导致心身障碍。积极采取有效的干预措施,减少心身疾病的发生。     

Effect of Morphine on the Neuropathogenesis of SIVmac Infection in Indian Rhesus Macaques

Morphine is known to prevent the development of cell-mediated immune (CMI) responses and enhance expression of the CCR5 receptor in monocyte macrophages. We undertook a study to determine the effect of morphine on the neuropathogenesis and immunopathogenesis of simian immunodeficiency virus (SIV) infection in Indian Rhesus Macaques. Hypothetically, the effect of morphine would be to prevent the development of CMI responses to SIV and to enhance the infection in macrophages. Sixteen Rhesus Macaques were divided into three experimental groups: M (morphine only, n = 5), VM (morphine + SIV, n = 6), and V (SIV only, n = 5). Animals in groups M and VM were given 2.5 mg/kg of morphine sulfate, four times daily, for up to 59 weeks. Groups VM and V were inoculated with SIVmacR71/17E 26 weeks after the beginning of morphine administration. Morphine prevented the development of enzyme-linked immunosorbent spot-forming cell CMI responses in contrast to virus control animals, all of which developed CMI. Whereas morphine treatment had no effect on viremia, cerebrospinal fluid viral titers or survival over the time course of the study, the drug was associated with a tendency for greater build-up of virus in the brains of infected animals. Histopathological changes in the brains of animals that developed disease were of a demyelinating type in the VM animals compared to an encephalitic type in the V animals. This difference may have been associated with the immunosuppressive effect of the drug in inhibiting CMI responses.     

Ajustement de la posologie de la vancomycine administrée en perfusion continue chez des patients de réanimation

Introduction

As the susceptibility of staphylococcal strains to glycopeptides rises, it is becoming necessary to increase vancomycin dosages.

Objective

To evaluate an administration protocol for vancomycin using continuous infusion with a loading dose of 30 mg/kg followed by 30 mg/kg per 24 h in intensive care patients presenting creatinine clearance (CLc) greater than 50.

Results

A total of 22 patients were included in the study. Serum vancomycin concentrations after 24 h (C24h) ranged from 25 to 30 mg/l in seven of 14 patients with CLc less than 120 ml/min (50 %), compared with three patients (21 %) with C24h greater than 35 mg/l and four patients (29 %) with C24h less than 25 mg/l. However, C24h was less than 20 mg/l for the eight patients with CLc greater or equal to 120 ml/min. Bacteriological data was available for eight of the 14 patients with CLc less than 120 ml/min, and in these eight patients, the C24h/MIC was greater or equal to 8; seven of these patients had an AUC/MIC greater or equal to 350.

Conclusion

Assay of serum vancomycin concentrations after 24 h of treatment is necessary to enable rapid adjustment of vancomycin concentration in order to improve therapeutic efficacy or avoid nephrotoxicity.