系统性红斑狼疮患者中检测ANCA临床意义的研究

目的探讨抗中性粒细胞胞浆抗体（ANcA）在系统性红斑狼疮（SLE）患者中检测的临床意义。方法通过间接免疫荧光法和免疫印迹法分别检测了25例健康对照组和106例SLE患者血清中的ANCA、抗核抗体（ANA）、抗双链DNA抗体、抗-SmDI抗体。结果对照组测定均为阴性。SLE患者中ANCA阳性率为47．2％（50／106）,且均为环细胞核着色的核周型（pANCA）;在ANCA阳性组及ANCA阴性组中：ANA及抗-SmDl抗体阳性率分别为100％（50／50）、91．1％（51／56）：829／0（41／50）、67．9％（38／56）,P均〉0．05;抗ds—DNA抗体阳性率分别为94％（47／50）、50％（Z8／56）,P〈0．01。在活动性sLE（52例）和非活动性sLE（54例）中ANCA阳性率分别为84．6％（44／52）;11．1％（6／54）,P〈O．01。结论ANCA在sLE患者中检测与ANA及抗-SmD1抗体没有相关性,与抗ds—DNA抗体正相关,活动期SLE患者中ANCA阳性率明显高于非活动期的患者。     

抗心磷脂抗体在中青年脑梗死中的意义

目的　研究抗心磷脂抗体与中青年缺血性脑血管疾病关系。方法　以酶联免疫吸附法 (ELISA)对 76例脑梗死病人 (<5 0岁 39例 ,≥ 5 0岁 37例 ) ,2 5例非缺血性脑血管疾病病人及 15例正常人的血清抗心磷脂抗体 (ACL抗体 )进行测定。结果　 <5 0岁的脑梗死病人ACL抗体阳性率为 35 9% ,≥ 5 0岁的脑梗死病人ACL抗体阳性率 16 2 % ,对照组ACL抗体阳性率 7 5 %。 <5 0岁脑梗死病人的ACL抗体阳性率高于≥ 5 0岁的脑梗死病人及对照组 (P <0 0 5 )。≥ 5 0岁脑梗死病人ACL抗体阳性率与对照组无显著差异。说明临床上无任何自身免疫疾病中青年脑梗死病人与ACL抗体更密切相关。结论　ACL抗体是中青年脑血管疾病的重要危险因素 ,对中青年脑梗死病人应积极检测ACL抗体 ,提示除常规脑梗死治疗外 ,加入免疫抑制剂、血浆置换治疗有一定的积极意义。ACL抗体的检测为中青年脑血管病的一级预防提供可靠依据     

系统性红斑狼疮患者血清γ干扰素诱导的蛋白10表达水平与疾病活动的关系

目的　探讨血清γ干扰素诱导的蛋白 10 (IP 10 )水平 ,与红斑狼疮 (SLE)疾病活动的关系及其在SLE肾损伤中的可能作用。方法　收集了 112例SLE患者及 4 0名正常健康人和 30例类风湿性关节炎 (RA)患者血清。应用ELISA测定血清IP 10水平。结果　SLE活动组血清IP 10水平 (5 0 8 7± 2 5 2 4 ) μg/L较非活动组 (32 2 2± 95 9) μg/L和对照组 (12 4 9± 4 1 3) μg/L明显升高 (P<0 0 0 1)。活动性狼疮肾炎 (LN)组IP 10水平 (5 5 0 9± 2 0 6 1) μg/L与活动性无肾损伤组 (35 4 8±10 5 3) μg/L及对照组比较其差异均具有统计学意义 (P <0 0 0 1)。特别是Ⅲ型和Ⅳ型LN患者血清IP 10水平 (6 2 9 85± 16 4 ) μg/L升高最为显著 ,与Ⅱ型和Ⅴ型LN(30 2 9± 2 0 7 1) μg/L相比其差异具有统计学意义 (P <0 0 1)。另外 ,血清IP 10水平随着SLE疾病活动水平明显升高 ,与总的SLEDAI评分密切相关 (r=0 6 312 ,P <0 0 0 1) ,与SLEDAI肾评分亦密切相关 (r =0 6 880 ,P <0 0 0 1)。结论　以上结果表明IP 10可能在SLE肾损伤中起着十分重要的作用 ,血清IP 10水平与SLE疾病活动密切相关 ,可作为SLE疾病活动、尤其是监测狼疮肾损伤的重要指标。     

血栓调节蛋白在弥散性血管内凝血中的意义

目的　检测弥散性血管内凝血 (DIC)患者血浆中的血栓调节蛋白 (TM)水平 ,探讨它对DIC的诊断和预后判断的意义。方法　在患者入院后第 1、2、3、5、7天 ,通过ELISA方法检测 1 2例DIC患者和 1 8例非DIC患者的血浆TM水平。结果　DIC患者的血浆TM水平 (77 83± 1 1 46ng/mL)明显高于非DIC患者 (56 56± 1 6 31ng/mL)且P <0 0 0 1。预后不良者 (1 4例 )与预后良好者 (1 6例 )相比 ,血浆TM水平显著升高 (P <0 0 0 1 )。结论　DIC早期即发生血浆血栓调节蛋白 (TM)水平升高 ,表明患者存在血管内皮细胞损伤。检测血浆TM水平对DIC的诊断和预后判断具有一定的意义     

自身抗体联合检测对糖尿病肾病诊断的应用价值

目的探讨联合检测抗心磷脂抗体(ACLA)、抗中性粒细胞胞浆抗体(ANCA)、抗肾小球基底膜(GBM)抗体及C反应蛋白(CRP)、胱抑素C(Cys C)、微量白蛋白(mAlb)在糖尿病肾病诊断中的应用价值,为糖尿病肾病的临床诊断和治疗提供依据。方法收集56例糖尿病肾病(DN)患者血清标本作为糖尿病肾病组、40例健康人血清作为对照组。采用ELISA法检测标本血清中ACLA,采用IIF法检测ANCA和抗GBM抗体,采用免疫比浊法测定CRP、Cys C和mAlb。结果进行统计学分析。结果糖尿病肾病组血清中ACLA和ANCA的阳性率较对照组显著增高(P0.01),抗GBM抗体的阳性率也较对照组明显增高(P0.05);DN组CRP、Cys C和U-mAlb的水平较非DN组均明显增高,两组有显著性差异(P0.01);联合检测ACLA、ANCA和抗GBM抗体的阳性率较单独检测明显升高(P0.05或P0.01)。结论联合检测血清中ACLA、ANCA和抗GBM抗体可提高糖尿病肾病诊断的阳性率,对糖尿病肾病的诊断具有重要应用价值。     

抗中性粒细胞胞浆抗体在系统性红斑狼疮伴有血管炎病变中的临床意义

目的探讨抗中性粒细胞胞浆抗体(ANCA)在系统性红斑狼疮(SLE)伴有血管炎病变中的临床意义。方法收集138例SLE住院病例的临床和实验室资料,间接免疫荧光(IIF)方法检测患者血清AN-CA,ANCA阳性者加做髓过氧物酶(MPO)、蛋白酶3(PR3)的酶联免疫检测(ELISA)。对患者进行SLEDAI评分评判疾病活动性,比较间接免疫荧光法检测ANCA阳性组与阴性组血管炎病变发生比率及疾病活动度有无差异。结果①间接免疫荧光法检测ANCA在SLE中的阳性率是15.2%,其中核周型ANCA阳性14.5%,胞浆型ANCA阳性0.7%;②SLE患者皮肤血管炎病变(包括面部红斑、结节红斑、雷诺现象、网状青斑、紫癜)发生率78.3%,肺间质病变(包括肺间质纤维化及出血性肺泡炎)发生率6.5%,肾脏病变(血尿及蛋白尿)发生率64.5%,ANCA阳性及ANCA阴性组SLE患者血管炎表现,包括皮肤血管炎(P=0.442)、肺间质病变(P=1.000)、肾脏病变(P=0.471)差异无统计学意义。③对所有SLE患者进行SLEDAI评分,ANCA阳性组及ANCA阴性组SLE活动性差异无统计学意义(P=0.879)。结论采用间接免疫荧光法检测ANCA的结果与SLE血管炎表现及病情活动无明显相关性。     

白细胞介素-18与系统性红斑狼疮活动性关系探讨

目的进一步证实系统性红斑狼疮(SLE)患者血清中IL-18的水平与SLE活动性的关系。方法采用酶联免疫吸附试验(ELISA)检测了38例SLE患者在活动期和治疗后稳定期及30例对照血清中IL-18的水平,观察IL-18与SLE疾病活动指数标准(SLEDAI)及其它疾病活动指标[血沉(ESR),抗双链-DNA(ds-DNA)抗体,补体C3和C4及总补体CH50]的相关性。结果(1)活动期和治疗后稳定期SLE患者血清中IL-18水平[分别为(754.2±314.8)pg/ml,(311.5±256.7)pg/ml]显著高于健康对照组[(108.4±12.6)pg/ml];活动期SLE患者血清中IL-18水平显著高于稳定期患者(P<0.05)。(2)在活动期SLE患者,血清中IL-18水平分别与抗ds-DNA抗体滴度和SLEDAI评分呈现显著的正相关(均P<0.05)。与ESR,C3,C4和CH50等其它实验室指标无显著相关性(均P>0.05)。而活动期SLEDAI评分分别与C3、CH50和抗ds-DNA抗体滴度呈显著的相关性(均P<0.05)。(3)活动期和治疗后稳定期SLE患者血清中IL-18水平变化结果与SLEDAI评分变化结果呈现显著相关性(r=0.46,P<0.05)。结论IL-18水平在SLE中升高,与SLE活动性呈现显著正相关,检测IL-18可以作为诊断SLE活动性的有效的指标之一。     

间接ELISA检测抗中性粒细胞胞浆总抗体及其临床意义

目的　建立检测抗中性粒细胞胞浆抗体 (ANCA)的间接酶联免疫吸附试验 (ELISA) ,观察韦格纳氏 /多血管炎、系统性红斑狼疮 (SLE)、肾炎和溃疡性结肠炎患者中ACNA的存在状况。方法　用建立的ELISA法检测 10 0例韦格纳氏 /多血管炎、SLE、肾炎或溃疡性结肠炎患者血清中的ANCA ,同时以特异性MPO ANCA及PR3 ANCA为对照。结果　阳性参考血清批内变异系数 (CV)和批间CV分别为 0 .0 6 1%和 0 .10 2 %。用抗原吸收后吸光度 (A)降低明显。总ANCA在韦格纳氏 /多血管炎患者中的阳性率为 4 3.8% ,高于SLE、肾炎和溃疡性结肠炎患者 (分别为 15 .2 %、2 3.1%和 2 5 % ) ,而 5 2份正常人血清均为阴性。用特异性MPO ANCA及PR3 ANCA与ELISA检测总ANCA结果比较差异无显著性 (P >0 .0 5 )。结论　ANCA可作为韦格纳氏 /多血管炎的血清学标志 ,ELISA检测总ANCA可克服间接免疫荧光法的不足 ,灵敏度高 ,适于大样本的ANCA检测。     

抗中性粒细胞胞浆抗体的间接免疫荧光法检测

目的 建立简便、准确的抗中性粒细胞胞浆抗体检测方法。方法 用2％冰醋酸破坏红细胞提取白细胞制得白细胞抗原片，以1：40稀释的抗人IgG荧光抗体进行染色，检测80例SLE患者及40例正常对照组血清的抗中性粒细胞胞浆抗体，并与德国欧蒙公司提供的ANCA试剂盒进行对比试验。结果 80例SLE患者血清中检出13例P－ANCA阳性，阳性率16．2％，与进口试剂结果相一致。结论 ①研制的ANCA间接免疫荧光检测方法结果可靠、操作简便；②ANCA的检测对系统性红斑狼疮伴发小血管炎的诊断有一定的价值。     

复发性流产患者联合检测三种血清自身抗体及临床意义

目的:探讨血清抗心磷脂抗体(anticardiolipin antibody,ACL)、抗β2-糖蛋白Ⅰ抗体(anti-beta2-glycoproteinI antibody,抗β2-GPI抗体)和狼疮抗凝物(lupus anticoagulant antibody,LAC)联合检测对复发性流产(reeurrent spontaneous abortion,RSA)的预测意义.方法:选取85例RSA患者为实验组,50例正常经产妇作为对照组,检测两组血清ACL、抗β2-GP1抗体和LAC水平.结果:RSA组ACL阳性率为27.06％(23/85),而对照组为8％(4/50),差异有统计学意义(P＜0.01);抗β2-GPI抗体阳性率为21.18％(18/85),而对照组2％(1/50),差异有统计学意义(P＜ 0.01);LAC阳性率为21.18％(18/85),而对照组为6％(3/50),差异有统计学意义(P＜0.05).在确诊的40例抗磷脂抗体综合症患者中,ACL或抗β2-GPI抗体阳性率为95.00％(38/40),和ACL或LAC阳性组比较,差异有统计学意义(P＜0.01);和抗β2-GPI抗体或LAC阳性组比较,差异有统计学意义(P＜0.05).结论:(1) ACL、抗β2-GPI抗体和LAC均与RSA有关.(2)ACL和抗β2-GPI抗体联合检测可以提高RSA患者抗磷脂抗体综合症检出率,对于临床诊断和指导治疗有重要意义.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."