An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.     

浅谈临床教师的角色素养及道德要求

探讨了临床教师的角色特征;认为临床教师的角色要求与现实状况之间存在反差;据此就其原因进行了分析。提出要强化临床教师的角色意识;在教学实践中自觉加强对其角色素养的自我锻炼和培养。     

营养不良老年人非药物干预临床实践指南

老年人是营养不良的高发人群,营养不良与众多不良临床结局密切相关,严重影响老年人的身体健康和生活质量,给家庭和社会造成沉重负担。因此,采取有效措施改善老年人的营养不良至关重要,非药物干预是改善营养状况的重要措施。然而,国内尚无专门针对营养不良老年人的非药物干预临床实践指南,因此,中国老年护理联盟、国家老年医学中心和国家老年疾病临床医学研究中心的营养专家,通过对老年人营养不良最新的国内外文献的全面检索与分析,采用推荐意见评估、制订及评价(GRADE)分级体系制订了本指南,针对营养不良老年人非药物干预提出9条推荐意见,以期能够改善老年人营养不良状况,提高生活质量。本指南侧重于可经口进食的营养不良老年人,聚焦于肠内营养,肠外营养不在本指南讨论范围内。     

Deposition of amyloid β protein in non-Alzheimer dementias: evidence for a neuronal origin of parenchymal deposits of β protein in neurodegenerative disease

Summary In two elderly patients with frontal lobe dementia and in two others with progressive aphasia an inverse relationship between the severity of protein deposition and the principal pathology of these disorders was noted. Deposition of protein occurred only in areas of cortex where functional (viable) neurones were still present and was absent where neuronal decimation had taken place. Such findings suggest that the presence of functional neurones is necessary for protein deposition to occur and, therefore, that neurones may be the source of the amyloid protein that is deposited within brain parenchyma not only in these disorders but also in other conditions, particularly Alzheimer's disease.Supported by a grant from the North Western Regional Health Authority (DJ) and a B.Sc Intercalated Studentship from the MRC (PWS)     

In-vitro maturation of human germinal vesicle stage oocytes: role of cumulus cells and epidermal growth factor in the culture medium

In-vitro maturation (IVM) of oocytes is a promising technique to reduce the costs and avert the side-effects of gonadotrophin stimulation for in-vitro fertilization (IVF). The pregnancy rates from oocytes matured in vitro are much lower than those of in-vivo stimulation cycles indicating that optimization of IVM remains a challenge. Therefore, we investigated the effect of supplementation of the medium with gonadotrophins, oestradiol and epidermal growth factor (EGF) and the effect of retaining or removing the cumulus cells on nuclear and cytoplasmic maturation of immature oocytes. Human germinal vesicle (GV) oocytes obtained after gonadotrophin stimulation for intracytoplasmic sperm injection (ICSI) were cultured in a complex defined medium either supplemented with gonadotrophins, oestradiol and physiological concentrations of EGF (2 ng/ml) or gonadotrophins and oestradiol alone. The cumulus cells were either removed or kept intact. In GV stage oocytes cultured without cumulus (group I) significantly more oocytes reached the metaphase II (MII) stage at 30 h in media supplemented with EGF (64.3 versus 33.9%, P < 0.003). For oocytes cultured with intact cumulus (group II), more oocytes reached MII at 30 h than in group I, but there was no difference in medium with or without EGF supplementation (81.8 and 79.8% respectively). Cytoplasmic maturation of MII oocytes was judged from their capability to activate and fertilize after ICSI. In group I, the rates of activation and normal fertilization were similar. However, in group II, significantly more oocytes underwent normal fertilization in the EGF-supplemented than the unsupplemented group (71.7 versus 45.6%, P < 0.05). The cleavage rates of the fertilized oocytes were similar in the sibling oocyte subgroups cultured with or without EGF supplementation, but the overall cleavage rates were higher in cumulus-intact compared to cumulus-denuded oocytes (88.9 versus 47.8%, P < 0.001). Thus, supplementation of the maturation medium with EGF and maintenance of the cumulus during culture improve the nuclear and cytoplasmic maturation of human oocytes in vitro.      

中学生学业能力倾向测验的初步编制

目的：编制一个适用于中学生的学业能力倾向测验。方法：采用理论与工作分析相结合的编制策略而成的中学生学业能力倾向测验包括A、B两个复本，均由三个分量表含七个分测验组成，分别测量语文．数理及图形等能力。研究样本由河北省石家庄市1424名中学生组成，并对其中468人分别进行信效度检验。结果：①各分测验原始分基本随年级升高而增长；②各分测验难度在0．46～0．54。鉴别指数在0.38～0．52；③各分量表及总分的重测相关系数在0．68～0．92，α系数在0．64～0．89．G系数在0．64～0．92；④探索性因素分析表明各分测验对基本能力因子均有中度以上的负荷，抽取的三个因子解释了总方差的72．18％(A式)和73．53％(B式)；⑤测验分数与长一鞍团体智力测验、与教师评价均呈显著正相关。测验分数在不同年级之间存在显著差异。学习成绩的回归分析可见，测验分数与考试成绩显著正相关，语文及数理分量表进入考试总成绩的回归方程。结论：中学生学业能力倾向测验的条目质量及信效度符合心理测量学的基本要求。     

The effects of co-culture with human fibroblasts on human embryo development in vitro and implantation

In a human in-vitro fertilization (IVF) programme, the effect of co- culture of embryos with human fibroblasts was evaluated with respect to pregnancy rate and embryo development. Patients were included in the study after giving informed written consent. The IVF treatments were randomly assigned by stratification of both age (<36 versus > or =36 years) and previous IVF attempts (yes versus no). After fertilization was established, the zygotes were transferred to a 4-well dish with or without fibroblasts and cultured for 2 days. On the third day after ovum pick-up (OPU), cell number and quality [5 (good) to 1 (poor)] of the embryos were scored and a maximum of three embryos was transferred. Supernumerary embryos of good quality were cryopreserved. The design of this study was a group sequential trial with the objective of detecting differences between pregnancy rates following IVF with conventional incubation or incubation in co-culture with fibroblasts. This design included one evaluation at half-way data collection. In the study, 148 patients had an OPU, of whom 77 were allocated to the co-culture group. There was no statistically significant difference in pregnancy rate, cell number and embryo quality between the two groups. The ongoing pregnancy rate per embryo transfer was 27% in co-culture and 30% in the conventional culture group. The implantation rates per transferred embryo were 17 and 18% respectively. Using a multivariate logistic regression model for the probability of ongoing pregnancies, the odds ratio of co-culture, adjusted for age and previous IVF attempts, was not statistically significant. In conclusion, co-culture with human fibroblasts does not contribute to an improvement of embryo quality nor to a higher pregnancy rate after IVF in an unselected group of patients.      

白松片对慢性应激抑郁模型大鼠行为学及血浆CORT、ACTH的影响

目的：观察白松片对慢性应激抑郁大鼠模型行为学和血浆CORT、ACTH含量的影响。方法：SD雄性大鼠28只随机分为空白对照组、模型对照组、氟西汀对照组及白松片试验组，选用慢性轻度不可预见性应激加孤养造模，观察各组大鼠敞箱实验和液体消耗等行为学指标变化，采用放射免疫方法检测大鼠血浆皮质醇(CORT)和促肾上腺皮质激素(ACTH)含量。结果：慢性应激抑郁大鼠体重增加缓慢，敞箱实验中的水平运动、垂直运动得分、清洁动作次数显著减少，中央格停留时间显著延长；糖水消耗明显下降，纯水消耗显著增多，而且其血浆皮质醇和促肾上腺皮质激素含量增加。氟西汀和白松片均显著改善慢性应激抑郁大鼠模型的行为学和神经内分泌变化。结论：慢性轻度不可预见性应激可使大鼠行为及神经内分泌发生异常改变，引起抑郁状态，白松片对此具有一定拮抗作用。