血栓性微血管病患者肾动脉阻力指数与肾功能的相关性研究

目的 探讨血栓性微血管病(TMA)患者肾动脉阻力指数(RRI)与肾功能的相关性,为患者急性肾损伤(AKI)可预见性的诊断、处理提供依据.方法 选取北京协和医院急诊科2014年8月至2015年3月收治的46例TMA患者为研究对象,于入院当日测量患者右肾小叶间动脉的RRI并记录血清肌酐(SCR)及肾小球滤过率(GFR)数值,按照2012年“改善全球肾脏病预后组织”(KDIGO)指南中A KI的诊断标准将患者分为AKI组和非AKI组,比较组间差异,分析RRI对AKI的诊断意义及RRI与SCR、GFR的相关性.所有患者在肾损伤最重时再次测量RRI(RRI*),记录此时的SCR(SCRmax)与GFR(GFRmin),计算△RRI(RRI*-RRI)、△SCR(SCRmax-SCR)、△GFR(GFR-GFRmin),并将治疗期间达到A KI诊断标准的36患者进一步分为KDIGO-1期、KDIGO-2期及KDIGO-3期3个组,比较RRI*组间差异,分析△RRI与△SCR、△GFR的相关性.结果 入院时以RRI ＞0.7来诊断AKI,敏感度为92.3％,特异度为80.1％.患者入院及肾损伤最严重时的RRI与同时期的SCR显著正相关(r1=0.709,P＜0.01;r2=0.675,P＜0.01),与GFR显著负相关(r1=-0.728,P＜0.01;r2=-0.709,P＜0.01).3组AKI患者RRI*差异有统计学意义(F=37.979,P=0.001),但△RRI比较差异无统计学意义(F=0.634,P=0.537);Spearman相关分析结果表明3组A KI患者的△RRI与ASCR、△GFR之间无相关性(均P＞0.05).结论 监测TMA患者的RRI有助于A KI的诊断并能评价肾损伤程度,但不能准确反映肾损伤的变化趋势.     

血清胆碱酯酶对脓毒症相关急性肾损伤患者的预测价值

目的评估血清胆碱酯酶（SCHE）对脓毒症相关急性肾损伤（SAKI）患者的预测价值。 方法回顾性分析2018年1月至2020年12月首都医科大学附属北京友谊医院ICU收治的382例诊断为脓毒症患者的临床资料,根据是否发展为急性肾损伤将其分为SAKI组和非SAKI组。比较2组患者基线资料及临床指标,并进行多因素回归分析,绘制受试者工作特征曲线（ROC）来评价SCHE对SAKI的预测价值。 结果本研究382例脓毒症患者中,195例患者出现SAKI,SAKI的发生率为51.05%。SAKI患者中SCHE水平明显低于非SAKI患者,差异有统计学意义［4.27（2.75,6.54）KU/L vs 7.70（4.58,10.41）KU/L,P＜0.01］。SAKI不同亚组中,AKI 1期、2期、3期患者的SCHE水平分别为5.08（2.64,6.32）、4.69（2.75,6.67）、3.17（2.54,6.34）KU/L,不同亚组与非AKI患者［7.70（4.58,10.41）KU/L］组间比较,差异有统计学意义［克鲁斯卡尔-沃利斯H（K）=53.870,自由度=3,P=0.000］。SCHE为SAKI发生的独立保护因素（95%CI：0.753~0.856,P=0.000）。SCHE预测SAKI发生的AUC为0.716,95%CI为0.664~0.768（P＜0.01）。截断值为6.70 KU/L时,SCHE预测SAKI发生的敏感度为77.9%,特异度为62.0%。 结论SCHE可作为SAKI发生的预测指标,但其机制需要进一步研究。     

KDIGO标准APACHEⅡ与SOFA评分对脓毒症急性肾损伤患者的预后评估

目的 探讨急性肾损伤国际指南(KDIGO)制定的急性肾损伤(AKI)诊断分期标准、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评分对脓毒症AKI患者的预后评估价值.方法 前瞻收集2012-03-01 ～2013-03-01期间在我院ICU接受治疗的脓毒症患者的临床资料,采用KDIGO标准对脓毒症患者进行AKI诊断和分期；根据患者入ICU第1个24h内的生理指标最差值进行APACHEⅡ和SOFA评分,并用受试者工作特征(ROC)曲线评估3项系统对预后评估的准确性.以Logistic多元回归分析对预后的影响.结果 共280例脓毒症患者,占同期ICU住院患者的41.7％ (280/670),总体院内死亡率为29.8％.脓毒症肾损伤168例,占脓毒症患者的60％,其中1期76例,死亡率22.4％；2期48例,死亡率37.5％；3期44例,死亡率72.7％.脓毒症肾损伤患者的APACHEⅡ及SOFA评分均高于非AKI患者(P＜0.05).Logistic多元回归分析显示,APACHEⅡ评分＞22分(OR =4.50),KDIGO分期1、2、3期(OR值分别为2.31、7.44、45.00)是脓毒症并AKI患者院内死亡的独立预测指标.结论 KDIGO诊断标准与APACHEⅡ、SOFA评分对脓毒症肾损伤患者整体预后都有较好的预测价值.     

生物学标志物在脓毒症肾损伤中的诊断价值

目的 评价血清半胱氨酸蛋白酶抑制蛋白C(cystatin C,Cys C),血清中性粒细胞胶原酶相关脂质运载蛋白(sNGAL)、尿肾损伤因子-1(uKIM-1)、尿白细胞介素-18(uIL-18)对脓毒症急性肾损伤的诊断作用.方法 2012年8月至2013年3月入住天津医院ICU时间≥24 h的62例成年脓毒症患者,根据RIFLE标准将患者分为急性肾损伤组和非急性肾损伤组,其中急性肾损伤组患者39例,非急性肾损伤组患者23例.测定入组患者即刻的Cys C、sNGAL、uIL-18、uKIM-1,比较上述生物标志物的组间差异,评价生物标志物在脓毒症急性肾损伤的诊断作用.结果 急性肾损伤组CysC (2.27±0.93) μg/L、sNGAL (275.04±79.37) μg/L、uKIM-1 (2.52±1.06) μg/L显著高于非急性肾损伤组CysC (1.19±0.77) μg/L、sNGAL(137.51±99.33) μg/L、uKIM-1 (1.27±0.62) μg/L,P＜0.05,而急性肾损伤在uIL-18 (374.87 ±70.23) ng/L与非急性肾损伤组uIL-18(354.09±66.42) ng/L,差异无统计学意义(P＞0.05).经过计算CysC、sNGAL、uKIM-1诊断急性肾损伤曲线下面积分别为o.84 (90％ CI:0.74 ～0.95)、0.90 (90％ CI:0.79～1.00)、0.87 (90％CI:0.78～0.96).结论 CysC、sNGAL、uKIM-1可能成为脓毒症急性肾损伤的生物学标志物.     

下腔静脉扩张指数在脓毒症休克性急性肾损伤中的作用

目的 探讨下腔静脉扩张指数在脓毒症休克性急性肾损伤(AKI)中的作用.方法 回顾性研究2013年10月至2015年2月新疆医科大学第一附属医院EICU收治的确诊为脓毒症休克且已于液体复苏开始即刻及其后24 h时应用床旁超声测量了下腔静脉吸气及呼气时管径的成年患者62例,按照自液体复苏后24 h时下腔静脉扩张指数(dIVC),dIVC≥9％组为H组,dIVC＜ 9％组为L组,收集液体复苏即刻及其后24 h时的血肌酐(Scr)值、血流动力学监测指标、APACHEⅡ评分、血清乳酸(Lac)水平并统计AKI发生率、EICU内病死率及其确诊后28 d病死率,观察dIVC对EICU内脓毒症休克性急性肾损伤的发生率及对其预后所产生的影响.结果 所有患者中共有41例发生AKI,其中L组和H组分别为26例、15例,L组AKI发生率高于H组,其差异具有统计学意义(x2=5.047,P＜0.05);所有患者中有23例在EICU内发生死亡,其中L组为16例(48.5％),H组为7例(24.1％),L组明显高于H组(x2 =3.921,P＜0.05);两组患者确诊28d后共死亡29例,L组和H组分别死亡18例(54.5％)、11例(37.9％),L组患者病死率虽高于H组,但差异无统计学意义(x2=1.711,P＞0.05).确诊28 d后死亡的患者中,发生AKI患者23例,而未发生AKI患者有6例,两组间差异有统计学意义(x2=4.226,P＜0.05).结论 脓毒症休克性AKI可加重脓毒症休克患者的不良预后,而过低的dIVC可增加脓毒症休克性AKI的发生风险,进而加重其不良预后.所以,在脓毒症休克患者的液体复苏过程中应注意避免追求过低的dIVC,以免加重其不良预后.     

HIV感染者围手术期脓毒症相关危险因素分析

目的 分析HIV感染者围手术期脓毒症的相关危险因素.方法 回顾性分析2008年10月至2011年9月在上海市公共卫生临床中心外科进行手术治疗的251例HIV感染患者临床资料,其中男228例,女23例.将患者分为脓毒症组和无脓毒症组两组,比较分析两组年龄、手术前后CD4、CD8、CD4/CD8、白细胞、血红蛋白、血小板、白蛋白等指标.根据手术前CD4+T淋巴细胞计数分为0～99 cells/μl (A)、100～199cells/μl(B)、200～349 cells/μl(C)、≥350 cells/μl(D)四组,比较各组围手术期脓毒症发生率,x2分割法对各组进行两两比较.进一步将HIV感染者分为年龄＜60岁组与≥60岁组两组,比较两组脓毒症发生率有无差异.结果 脓毒症组与无脓毒症组术前CD4、术后CD4、术后血红蛋白有统计学差异.术前CD4+T淋巴细胞计数无脓毒症组(290.00±194.603)显著高于脓毒症组(174.39±206.411)(P＜0.05).CD4+T淋巴细胞水平与脓毒症发生率呈显著负相关关系(r=-0.319,P =0.000).A、B、C、D四组围手术期脓毒症发生率分别为75.5％、50.9％、28.3％和19.0％,差异有统计学意义(x2 =41.609,P ＜0.05).A组与C组、A组与D组、B组与C组、B组与D组比较差异有统计学意义.HIV感染者年龄＜60岁组与≥60岁组脓毒症发生率无统计学差异.结论 CD4+T淋巴细胞计数＜200 cells/μl为HIV感染者围手术期脓毒症的高危因素,CD4+T淋巴细胞计数可作为HIV感染者围手术期脓毒症的独立预测因素.     

肾损伤分子-1对于脓毒症急性肾损伤的早期诊断作用

目的 检测肾损伤分子-1 (kidney injury molecule-1,KIM-1)可对脓毒症急性肾损伤(acute kidnoy injury,AKI)患者具有早期诊断作用.方法 选取自2007-10～2008-10在首都医科大学附属北京朝阳医院急诊抢救室收治脓毒症患者176例,分别检测KIM-1,血、尿β2-微球蛋白(beta 2-microglobulin,β2-MG),尿微量白蛋白浓度,根据是否出现急性肾损伤分组,研究KIM-1浓度升高早期诊断急性肾损伤的价值.结果 随访28 d,51例患者出现AKI,AKI发病率29%;AKI组KIM-1,血、尿β2-MG浓度均高于非AKI组(P<0.05);KIM-1与血β2-MG,尿β2-MG呈正相关(r=0.61,P<0.01;r=0.445,P<0.01),KIM-1﹥19.83 pg/mL是预测AKI的独立危险因素,(OR 1.416,95%CI 1.155～1.737).ROC曲线下面积:KIM-1是0.879,界值为19.83 pg/mL(灵敏度82.0%,特异度84.5%).结论 KIM-1在尿中早期出现,具有较高的敏感性及特异性,可以早期诊断脓毒症相关急性肾损伤.     

白血病患者cyclin E2、CDK2的表达与复发的关系

目的 探讨急性白血病患者细胞周期蛋白E2 (cyclin E2)和细胞周期蛋白依赖性激酶2(CDK2)的表达情况及预后意义.方法 急性白血病(AL)患者70例,包括新近诊断急性白血病患者41例、复发患者10例和完全缓解期患者19例.14例健康人为正常对照.应用半定量反转录-聚合酶链反应(RT-PCR)方法检测骨髓或外周血单个核细胞cyclin E2和CDK2 mRNA表达水平.结果 Cyclin E2和CDK2 mRNA在初治的AL患者阳性表达明显高于正常对照组(70.7％ vs 0％,P＜0.05),cyclin E2在完全缓解组中阳性率低于初治组(47.4％ vs 70.7％,P＜0.05),初治组CDK2阳性率高于正常对照组(78.0％ vs 28.6％,P＜0.05).cyclin E2 mRNA阳性表达患者完全缓解率低于阴性表达者(48.3％ vs 91.7％,x2 =5.016,P＜0.05).结论 Cyclin E2和CDK2可望成为急性白血病早期预后指标和复发判断指标.     

脓毒症相关急性肾损伤患者外周血调节性T细胞水平与肾功能恢复的关系

目的:观察脓毒症相关急性肾损伤患者外周血调节性T细胞的变化,明确其与肾功能恢复的关系。方法:选择符合脓毒症相关急性肾损伤诊断标准的患者为研究对象,排除预期7d内转出或死亡的患者。在入ICU时、病程7d、14d(D1、D7、D14)留取外周血标本,应用流式细胞仪检测CD4+CD25+Foxp3+调节性T细胞(Treg)水平,随访观察时间为28d,主要观察指标为肾功能水平是否恢复。结果:根据SSC指南及KDIGO指南提出的脓毒症相关急性肾损伤(AKI)的诊断标准,南京鼓楼医院ICU在2017-01—2017-08期间共入选患者28例。发生急性肾损伤1期、2期、3期患者分别为7例、7例和14例。随访至28d时,16例患者肾功能恢复至正常,12例患者肾功能未恢复。肾功能恢复组的患者在入院时的APACHE II评分较未恢复组低,两组分别是(19.8±4.9)分和(24.9±5.0)分(P0.05)。入院时两组的CD4+CD25+Foxp3+调节性T细胞水平差异无统计学意义(3.43±1.88vs.3.20±2.04,P0.05),但肾功能恢复组的患者Treg细胞水平随病程逐渐上升,未恢复组的患者Treg细胞水平呈逐渐下降趋势,其中,肾功能恢复者在第14天的Treg水平远远高于肾功能未恢复者(3.89±1.56vs.1.76±0.45,P0.05)。且肾功能恢复组的患者第14天Treg细胞水平较基线的上升率为1.32±0.70,而未恢复组的患者仅为基线水平的0.59±0.31(P0.05)。此外,将急性肾损伤的程度与Treg细胞的水平做进一步统计分析,发现急性肾损伤1期、2期及3期的3组患者在入院时及第7天、第14天的Treg细胞水平均差异无统计学意义(P0.05)。结论:脓毒症相关急性肾损伤患者存在Treg细胞的异常,Treg细胞的水平与急性肾损伤的程度无相关性。急性肾损伤患者外周血Treg细胞水平逐渐升高,预示着肾功能的恢复。D7、D14时Treg细胞水平的快速上升可能成为脓毒症相关急性肾损伤患者肾功能恢复的预测指标。     

重症患儿粪弹性蛋白酶-1的变化及其临床意义

目的 通过测定重症患儿粪弹性蛋白酶-1 (FE-1),探讨FE-1与胰酶、脓毒症及疾病严重程度之间的关系.方法 分析2013年7月至2014年3月湖南省儿童医院PICU收治的402例重症患儿,入住PICU 24 h内留取成形大便标本,根据FE-1质量分数分组:＞200μg/g为胰腺外分泌功能正常组(A组,n =300),(100～200)μg/g为轻中度胰腺外分泌功能不全组(B组,n =52),＜100 μg/g为重度胰腺外分泌功能不全组(C组,n=50).分析各组与胰酶变化、脓毒症及其严重程度,及其与休克、器官功能障碍个数、PCIS评分、SOFA评分、APACHEⅡ评分之间的关系.计数资料采用x2检验.计量资料非正态分布或方差不齐,以中位数和四分位数[M(P25,P75)]表示,行非参数检验,有统计学意义时行多个样本两两比较的秩和检验.相关性采用Spearman相关分析.结果 (1)A、B两组间血脂肪酶升高差异有统计学意义(P＜0.O1).(2)非脓毒症患儿288例,脓毒症114例,两组FE-1水平差异具有统计学意义(P＜0.05).脓毒症患儿分为一般脓毒症组、严重脓毒症组、脓毒性休克组,与非脓毒症组四组间FE-1差异具有统计学意义(P＜0.01). (3)A、B、C三组患儿在脓毒症与非脓毒症所占比例分别为65.79％vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,B、C组在脓毒症中所占比例高于非脓毒症且逐渐升高.(4) FE-1质量分数的总体趋势随脓毒症严重程度而降低,非脓毒症组与一般脓毒症组,严重脓毒症组与脓毒性休克组两两比较差异无统计学意义(P＞0.05),其余组两两比较差异均具有统计学意义(P＜0.01).(5)三组间休克、器官功能障碍个数、MODS≥3个、PCIS评分、SOFA评分、APS评分比较差异均有统计学意义(P＜0.05).随着FE-1质量分数降低,器官功能障碍个数、SOFA评分、APS评分呈升高趋势(rst=-0.194,P=0.000;rs2=-0.348,P=0.000;rs3=-0.176,P=0.000),PCIS评分呈下降趋势(rs4=0.185,P=0.000).结论 胰腺外分泌功能受损与脓毒症存在相关性,这种胰腺功能障碍在轻症脓毒症患者可能并不显著,但随脓毒症严重程度加重或病情严重程度加重其发生率逐渐升高.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。