BACKGROUND & AIMS: :A retrospective study of male breast cancer was undertaken at Ouagadougou University Teaching Hospital over a 3 year period (1993-1996). Authors report 5 cases representing 4.16% of all breast cancers. The patients' mean age was 61 years. The average duration of signs and symptoms before the diagnosis was 13 months. Clinically all the 5 cases presented advanced cancers (4 T4N2M0, 1 T4N2M1 according to UICC TNM System) with size ranging from 5.5, to 11.5 cm. Histology found: 2 medullary infiltrating carcinoma, 1 canalar infiltrating carcinoma, 1 colloid mucous carcinoma and 1 lobular infiltrating carcinoma. All patients had mastectomy associated with axillary clearance in 4 cases. Radiotherapy, chemotherapy and hormonotherapy were not associated because unavailable in Burkina Faso. Three patients died: the first, 10 days after surgical treatment and the 2 others respectively after 14 and 17 months. We have lost sight 1 patients. The last one is still alive. Authors find that to get better prognosis, it is important to improve medical and technical means, to increase information and to promote early detection.

背景与目标： ：在瓦加杜古大学教学医院进行了为期3年（1993年至1996年）的男性乳腺癌回顾性研究。作者报告了5例病例，占所有乳腺癌的4.16％。患者的平均年龄为61岁。诊断前平均体征和症状持续时间为13个月。临床上，所有5例患者均出现晚期癌（根据UICC TNM System，4例T4N2M0、1例T4N2M1），大小在5.5至11.5厘米之间。组织学发现：2个髓样浸润癌，1个管状浸润癌，1个胶体粘​​液癌和1个小叶浸润癌。所有患者均进行了伴有腋窝清除术的乳房切除术4例。放疗，化学疗法和激素疗法没有联系，因为布基纳法索无法使用。 3例患者死亡：第一例，手术治疗10天后死亡，另外2例分别在14个月和17个月后死亡。我们失去了视力1名患者。最后一个还活着。作者发现，要获得更好的预后，重要的是改善医学和技术手段，增加信息并促进早期发现。

BACKGROUND & AIMS: STUDY OBJECTIVE:To examine the prevalence, symptomatology, risk factors, and other infections associated with urogenital chlamydial infection in pregnant teenagers. DESIGN:Retrospective case-control study by medical record review. SETTING:Prenatal care clinic for adolescents at University of Tennessee Medical Center, Knoxville, Tennessee. PARTICIPANTS:Pregnant adolescents younger than 19 years of age who were diagnosed with chlamydial infection on the first prenatal visit from 1988 to 1994 were studied. Pregnant adolescents of similar age and socioeconomic background who came in the same day for the first prenatal visit, but were not infected, made up the control group. INTERVENTION:Routine prenatal questionnaires regarding personal and medical histories, and routine prenatal screening, including pelvic examination with Papanicolaou (PAP) smear and laboratory investigations for common genital infections and sexual transmitted disease (STDs), were obtained. MAIN OUTCOME MEASURES:Analyzed the prevalence of chlamydial infection and compared the infected group to the control group with regard to race, behavioral factors, symptoms, prenatal screening results, other concurrent genital infections, and histories of STDs. RESULTS:Of a total population of 596 pregnant teenagers, 67 (11.24%) were infected with Chlamydia trachomatis. In multivariate analysis, black race (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.74-9.23; p = 0.001) and greater gestational age at first prenatal visit (OR = 1.11; 95% CI = 1.04-1.18; p = 0.001) were independently associated with chlamydial infection. Age, marital status, number of pregnancies, smoking, alcohol abuse, drug abuse, age at first intercourse, and multiple sex partners were not associated with the infection. Likewise, the symptom of vaginal discharge (a complaint of > 70% in each group), other genital co-infections (found > 50% in each group, mainly candidiasis and bacterial vaginosis), abnormal PAP smears (found > 60% in each group) and histories of STDs or previous chlamydial infection were not significantly different between case and control groups. Human papillomavirus infection, trichomonal infection, and dysplasia or atypia were found more often in patients infected with chlamydia, but were not statistically significant. CONCLUSION:Pregnant adolescents in east Tennessee were at risk for chlamydial infection as well as for other genital infections and abnormal PAP smears. Routine prenatal chlamydial screening is warranted because of a lack of specific symptoms.

背景与目标： 目的：研究孕妇青少年泌尿生殖道衣原体感染的患病率，症状，危险因素和其他感染情况。
设计：回顾性病例对照研究，病历审查。
地点：田纳西州诺克斯维尔市田纳西大学医学中心的青少年产前保健诊所。
研究对象：1988年至1994年第一次产前检查时被诊断患有衣原体感染的19岁以下的青少年。年龄相同，社会经济背景相似的怀孕青少年在同一天进行第一次产前检查，但未感染，组成了对照组。
干预措施：获得有关个人和医学史的常规产前问卷，以及常规的产前筛查，包括用帕潘尼古拉（PAP）涂片进行盆腔检查以及常见生殖器感染和性传播疾病（STD）的实验室检查。
主要观察指标：分析衣原体感染的发生率，并比较种族，行为因素，症状，产前筛查结果，其他并发生殖器感染和性病史，比较感染者与对照组。
结果：在596名怀孕的青少年总数中，有67名（11.24％）感染了沙眼衣原体。在多变量分析中，黑人种族（赔率[OR] = 4.01； 95％置信区间[CI] = 1.74-9.23； p = 0.001）和第一次产前检查时的胎龄较高（OR = 1.11； 95％CI = 1.04- 1.18； p = 0.001）与衣原体感染独立相关。年龄，婚姻状况，怀孕次数，吸烟，酗酒，药物滥用，初次性交年龄和多性伴侣均与感染无关。同样，白带的症状（每组的投诉> 70％），其他生殖器合并感染（每组的发现> 50％，主要是念珠菌病和细菌性阴道病），PAP涂片异常（每发的发现> 60％）病例组和对照组之间的性病史或以前的衣原体感染史无显着差异。感染衣原体的患者更常发现人乳头瘤病毒感染，滴虫感染和异型增生或异型性，但无统计学意义。
结论：田纳西州东部的怀孕青少年有衣原体感染以及其他生殖器感染和PAP涂片异常的危险。由于缺乏特定症状，需要常规的产前衣原体筛查。

BACKGROUND & AIMS: :Descriptions of primary HIV-1 infection have so far been based on Caucasians living in industrialized nations. Due to studies of leptospirosis in the predominantly black population of Barbados, serum was available for patients admitted with acute febrile illnesses to the Queen Elizabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that predated or coincided with their first HIV-1-positive test. Serological testing confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keeping with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established. :A retrospective review was conducted of the medical records of 510 HIV-1-positive adult patients who had attended the Queen Elizabeth Hospital (QEH) to determine whether any had been admitted for an illness compatible with a diagnosis of primary HIV-1 infection. A serum bank, created from patients who had been admitted with acute febrile illnesses and investigated for leptospirosis, provided serological evidence for primary HIV-1 infection in 10 patients. Serological testing of the serum samples confirmed primary HIV-1 infection in nine patients and was suggestive in the tenth. The clinical features of the 10 patients fit the earlier descriptions of primary HIV-1 infection, but differed from the leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. These findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.

背景与目标： ：到目前为止，主要针对HIV-1感染的描述都是基于生活在工业化国家中的高加索人。由于对巴巴多斯主要是黑人人群的钩端螺旋体病进行了研究，因此伊丽莎白女王医院（QEH）接受了急性发热性疾病的患者可获得血清。通过搜索510例已知HIV-1感染的成年患者的病历，我们确定了10例在首次发热HIV-1阳性测试之前或与其同时发生的急性发热疾病患者入院时就储存了血清的患者。血清学检查证实了9例原发性HIV-1感染，并提示第10例患者。这10例患者的临床特征与原发性HIV-1感染的先前描述相符，但与QEH所见的钩端螺旋体病病例有所不同。一名患者在血清转化疾病中死亡，另一名患者在血清转化后3个月死亡。研究结果表明，严重的原发性HIV-1感染可能是相对罕见的事件，该病可能被误诊，只有在AIDS流行之前，病例才可能发生。
：回顾性分析了510例曾在伊丽莎白女王医院（QEH）住院的HIV-1阳性成年患者的病历，以确定是否有人因与原发性HIV-1感染诊断相符的疾病而入院。由被接纳患有急性发热性疾病的患者创建的血清库，并研究了钩端螺旋体病，为10例患者的原发性HIV-1感染提供了血清学证据。血清样本的血清学检测证实了9名患者的原发性HIV-1感染，而第十名患者则具有启发性。这10例患者的临床特征符合原发性HIV-1感染的早期描述，但与QEH所见的钩端螺旋体病病例有所不同。一名患者在血清转化疾病中死亡，另一名患者在血清转化后3个月死亡。这些发现表明，严重的原发性HIV-1感染可能是相对罕见的事件，可能会误诊该病，并且直到艾滋病流行才可能发生。

BACKGROUND & AIMS: :Zalcitabine is a dideoxynucleoside antiretroviral agent that is phosphorylated to the active metabolite 2',3'-dideoxycytidine 5'-triphosphate (ddCTP) within both uninfected and HIV-infected cells. At therapeutic concentrations, ddCTP inhibits HIV replication by inhibiting the enzyme reverse transcriptase and terminating elongation of the proviral DNA chain. The results of 3 large pivotal trials comparing zidovudine monotherapy with combination therapy have now clearly established that zalcitabine plus zidovudine combination with an improvement in viral load and CD4+ cell count compared with zidovudine monotherapy. More recently, clinical end-point and surrogate marker data have established the efficacy of zalcitabine in combination with the protease inhibitor saquinavir in zidovudine-experienced patients. Other studies have demonstrated the utility of zalcitabine in combination with ritonavir and the nucleoside analogue lamivudine. Importantly, early use of zalcitabine in the treatment sequence does not appear to limit the therapeutic efficacy of subsequent therapy with other nucleoside analogues such as lamivudine. Peripheral neuropathy is the most frequent dose-limiting adverse effect associated with zalcitabine therapy and is generally reversible on discontinuation of treatment. Stomatitis and mouth ulcers may occur frequently with zalcitabine therapy but tend to resolve with continuing treatment. Haematological toxicity, which is a common adverse effect associated with zidovudine, is reported infrequently with zalcitabine. Overall, combination therapy with zalcitabine plus zidovudine or saquinavir has been shown to have a tolerability profile comparable to that of either agent alone, although treatment with zidovudine plus zalcitabine was associated with a significant increase in the incidence of haematological toxicity compared with zidovudine monotherapy in one study. Therefore, current data suggest that zalcitabine is a useful antiretroviral agent for inclusion as a component of initial double combination therapy with zidovudine or as part of triple combination therapy including zidovudine plus a protease inhibitor in the management of patients with HIV infection.

背景与目标： 扎西他滨是一种双脱氧核苷抗逆转录病毒药，在未感染和感染HIV的细胞中均被磷酸化为活性代谢物2'，3'-二脱氧胞苷5'-三磷酸（ddCTP）。在治疗浓度下，ddCTP通过抑制酶逆转录酶并终止原病毒DNA链的延伸来抑制HIV复制。齐多夫定单一疗法与联合疗法比较的3个大型关键试验的结果现已清楚地确定，与齐多夫定单一疗法相比，齐西他滨加齐多夫定联合疗法可改善病毒载量和CD4细胞计数。最近，临床终点和替代标记数据已经确定了扎西他滨与蛋白酶抑制剂沙奎那韦联合在齐多夫定患者中的疗效。其他研究表明扎西他滨与利托那韦和核苷类似物拉米夫定联合使用。重要的是，在治疗顺序中早期使用扎西他滨似乎没有限制后续用其他核苷类似物如拉米夫定进行治疗的疗效。周围神经病变是与扎西他滨治疗相关的最常见的剂量限制性不良反应，通常在停药后可逆。扎西他滨治疗可能会经常发生口腔炎和口腔溃疡，但继续治疗后往往会缓解。扎西他滨很少报道血液毒性，这是与齐多夫定有关的常见不良反应。总的来说，与齐多夫定单一疗法相比，齐多夫定+齐多夫定或沙奎那韦联合治疗的耐受性与单独使用任一种药物相当，尽管与齐多夫定单一疗法相比，齐多夫定+齐西他滨治疗的血液学毒性发生率显着增加。学习。因此，目前的数据表明，扎西他滨是一种有用的抗逆转录病毒药物，可作为包含齐多夫定的初始双重联合疗法的组成部分或包含齐多夫定加蛋白酶抑制剂在内的三重联合疗法的一部分用于治疗HIV感染患者。

BACKGROUND & AIMS: :Methicillin/oxacillin (Oxa) resistance in Staphylococcus aureus is primarily mediated by the acquired penicillin-binding protein (PBP2a) encoded by mecA. PBP2a acts together with native PBP2 to mediate oxacillin resistance by contributing complementary transpeptidase and transglycosylase activities, respectively. The VraS/VraR two-component regulatory system is inducible by cell-wall antimicrobials (beta-lactams, glycopeptides) and controls transcriptional induction of many cell-wall genes including pbp2 and itself. We investigated the role of VraS/VraR in the phenotypic expression of oxacillin resistance by inactivating vraS in community-acquired MRSA clinical isolates that lack functional genes encoding the mecA regulatory sequences mecI and mecR1. Inactivation of vraS abrogated oxacillin resistance, and complementation with the vraS operon restored the resistance phenotype. mecA transcription increased in the vraS mutants; however, PBP2a abundance was similar to that of the wild type. Although pbp2 transcription decreased in the vraS mutants, overexpression of the pbp2 operon did not restore resistance. These data demonstrate that although expressions of mecA and pbp2 are required for oxacillin resistance, they are not sufficient. Therefore, the vraS/vraR regulatory system plays a crucial role in allowing MRSA to respond to beta-lactams by regulation of a gene target other than the known effectors of methicillin resistance.

背景与目标： 金黄色葡萄球菌对甲氧西林/奥沙西林（Oxa）的耐药性主要由mecA编码的获得性青霉素结合蛋白（PBP2a）介导。 PBP2a与天然PBP2共同发挥作用，通过分别贡献互补的转肽酶和转糖基酶活性来介导奥沙西林抗性。 VraS / VraR两组分调节系统可通过细胞壁抗微生物剂（β-内酰胺，糖肽）诱导，并控制包括pbp2及其本身在内的许多细胞壁基因的转录诱导。我们通过灭活社区获得的MRSA临床分离株中的vraS而失活，研究了VraS / VraR在奥沙西林耐药性表型表达中的作用，该分离株缺乏编码mecA调控序列mecI和mecR1的功能基因。 vraS的失活消除了奥沙西林的耐药性，与vraS操纵子的互补恢复了耐药性表型。在vraS突变体中，mecA转录增加；但是，PBP2a的丰度与野生型相似。尽管在vraS突变体中pbp2转录降低，但是pbp2操纵子的过表达不能恢复抗性。这些数据表明，尽管抗mecA和pbp2的表达是奥沙西林耐药性所必需的，但它们还不够。因此，vraS / vraR调节系统在允许MRSA通过调节除已知的甲氧西林抗性效应子以外的基因靶标而对β-内酰胺作出响应中起着至关重要的作用。

BACKGROUND & AIMS: :A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

背景与目标： ：在癌症医院的医疗重症监护室连续12个月进行了前瞻性抗菌药物阳性培养。在528例入院病例中，总共记录了144例感染和163种病原体。肺，尿，耳鼻喉（耳，鼻和喉）感染和菌血症的记录最频繁。葡萄球菌，链球菌，大肠杆菌，克雷伯菌和假单胞菌是最常见的病原体。革兰氏阳性菌株主要在单微生物菌血症期间观察到（48.9％）。分别在58％和92％的分离菌株中发现了耐甲氧西林的金黄色葡萄球菌（MRSA）和表皮葡萄球菌（MRSE）。没有发现特定的爆发。有必要进行进一步的前瞻性研究，以评估抗生素使用对我们ICU中耐药菌株选择的影响。

BACKGROUND & AIMS: :Human immunodeficiency virus (HIV) binds to cells via an interaction between CD4 and the virus envelope glycoprotein, gp120. Previous studies have localized the high affinity binding site for gp120 to the first domain of CD4, and monoclonal antibodies (mAbs) reactive with this region compete with gp120 binding and thereby block virus infectivity and syncytium formation. Despite a detailed understanding of the binding of gp120 to CD4, little is known of subsequent events leading to membrane fusion and virus entry. We describe two new mAbs reactive with the third domain of CD4 that inhibit steps subsequent to virus binding critical for HIV infectivity and cell fusion. Binding of recombinant gp120 or virus to CD4 is not inhibited by these antibodies, whereas infection and syncytium formation by a number of HIV isolates are blocked. These findings demonstrate that in addition to virus binding, CD4 may have an active role in membrane fusion.

背景与目标： 人类免疫缺陷病毒（HIV）通过CD4和病毒包膜糖蛋白gp120之间的相互作用与细胞结合。先前的研究已经将gp120的高亲和力结合位点定位在CD4的第一个域，并且与该区域反应的单克隆抗体（mAb）与gp120结合竞争，从而阻断了病毒的感染性和合胞体的形成。尽管对gp120与CD4的结合有详细的了解，但对导致膜融合和病毒进入的后续事件知之甚少。我们描述了与CD4的第三个域具有反应性的两个新的单克隆抗体，可抑制继病毒结合后对HIV感染性和细胞融合至关重要的步骤。重组gp120或病毒与CD4的结合不受这些抗体的抑制，而许多HIV分离株的感染和合胞体形成却被阻止。这些发现表明，除病毒结合外，CD4可能在膜融合中发挥积极作用。

BACKGROUND & AIMS: :Gliomas are highly lethal neoplasms that cannot be cured by currently available therapies. Temozolomide is a recently introduced alkylating agent that has yielded a significant benefit in the treatment of high-grade gliomas. However, either de novo or acquired chemoresistance occurs frequently and has been attributed to increased levels of O6-methylguanine-DNA methyltransferase or to the loss of mismatch repair capacity. However, very few gliomas overexpress O6-methylguanine-DNA methyltransferase or are mismatch repair-deficient, suggesting that other mechanisms may be involved in the resistance to temozolomide. The purpose of the present study was to generate temozolomide-resistant variants from a human glioma cell line (SNB-19) and to use large-scale genomic and transcriptional analyses to study the molecular basis of acquired temozolomide resistance. Two independently obtained temozolomide-resistant variants exhibited no cross-resistance to other alkylating agents [1,3-bis(2-chloroethyl)-1-nitrosourea and carboplatin] and shared genetic alterations, such as loss of a 2p region and loss of amplification of chromosome 4 and 16q regions. The karyotypic alterations were compatible with clonal selection of preexistent resistant cells in the parental SNB-19 cell line. Microarray analysis showed that 78 out of 17,000 genes were differentially expressed between parental cells and both temozolomide-resistant variants. None are implicated in known resistance mechanisms, such as DNA repair, whereas interestingly, several genes involved in differentiation were down-regulated. The data suggest that the acquisition of resistance to temozolomide in this model resulted from the selection of less differentiated preexistent resistant cells in the parental tumor.

背景与目标： ：胶质瘤是高度致死性的肿瘤，目前尚无法治愈。替莫唑胺是最近引入的烷基化剂，已在治疗高级神经胶质瘤中产生了显着的益处。然而，从头或获得性化学抗性经常发生，并且归因于O6-甲基鸟嘌呤-DNA甲基转移酶水平的增加或失配修复能力的丧失。但是，极少的神经胶质瘤过表达O6-甲基鸟嘌呤-DNA甲基转移酶或错配修复缺陷，提示其他机制可能与对替莫唑胺的抗性有关。本研究的目的是从人类神经胶质瘤细胞系（SNB-19）产生抗替莫唑胺的变体，并使用大规模的基因组和转录分析来研究获得的替莫唑胺抗性的分子基础。两个独立获得的替莫唑胺抗性变体对其他烷基化剂[1,3-双（2-氯乙基）-1-亚硝基脲和卡铂]无交叉抗性，并且共有遗传变异，例如2p区域丢失和扩增丢失染色体4和16q区域。核型改变与亲本SNB-19细胞系中先前存在的抗性细胞的克隆选择相容。基因芯片分析显示，在17,000个基因中，有78个在亲代细胞和两种替莫唑胺耐药变体之间差异表达。没有人参与已知的抗性机制，例如DNA修复，而有趣的是，参与分化的几个基因被下调。数据表明，在该模型中获得对替莫唑胺的抗药性是由于在亲本肿瘤中选择了分化程度较低的抗药性细胞而引起的。

BACKGROUND & AIMS: Environmental pollution has become a major concern for the future of life on our planet; medical care, especially in hospitals, contributes significantly to this pollution. The increasing usage of highly-developed medical devices, drugs and disposable products are a drain on natural resources as well as financial ones. In this situation, it is a major task for hospital epidemiologists to maintain high standards of hygiene while reducing environmental pollution, reducing consumption of limited natural resources, and minimizing costs. The reduction of hospital waste, the control of polluting and toxic emissions, the avoidance of unnecessary disinfection procedures and disposables, the implementation of energy and water saving technologies are practicable measures in hospital ecology. To realize a sustainable development within hospitals, it is necessary that the need to maintain a balance between effective infection control and a good ecological environment is recognized and supported by health-care workers and the hospital management.

背景与目标： 环境污染已经成为我们星球上未来生活的主要关注点；医疗服务，尤其是医院的医疗服务，是造成这种污染的重要原因。高度发达的医疗设备，药物和一次性产品的使用日益增加，这既浪费了自然资源，也浪费了金融资源。在这种情况下，医院流行病学家的主要任务是保持较高的卫生标准，同时减少环境污染，减少有限自然资源的消耗并最大程度地降低成本。减少医院浪费，控制污染和有毒物质排放，避免不必要的消毒程序和一次性用品，实施节能节水技术是医院生态学中的切实可行的措施。为了实现医院内部的可持续发展，必须在卫生保健工作者和医院管理人员的认识和支持下，在有效的感染控制和良好的生态环境之间保持平衡。

BACKGROUND & AIMS: :IL-7 signals are crucial for the survival of naive and memory T cells, and the IL-7R is expressed on the surface of these cells. Following viral infection, the IL-7R is expressed on only a subset of effector CD8 T cells, and has been demonstrated to be important for the survival of these memory precursors. IL-7 message levels remain relatively constant during the T cell response to lymphocytic choriomeningitis virus, but a short-lived burst of GM-CSF is observed soon after infection. Retroviral expression of a chimeric GM-CSF/IL-7R, in which binding of GM-CSF by T cells leads to IL-7 signaling, allows for the delivery of an IL-7 signal in all effector T cells expressing the receptor. In mice infected with lymphocytic choriomeningitis virus, CD8 and CD4 T cells transduced with this chimeric receptor underwent an enhanced proliferative response compared with untransduced populations in the same host. Similarly, TCR transgenic CD8 cells expressing the chimeric receptor produced higher effector numbers during the peak of the T cell response to infection. Surprisingly, the enhanced proliferation did not lead to higher memory numbers, as the subsequent contraction phase was more pronounced in the transduced cell populations. These findings demonstrate that artificial IL-7 signaling during an infection leads to significantly increased Ag-specific effector T cell numbers, but does not result in increased numbers of memory progeny. The extent of contraction may be dictated by intrinsic factors related to the number of prior cell divisions.

背景与目标： ：IL-7信号对于幼稚和记忆T细胞的存活至关重要，而IL-7R在这些细胞的表面表达。病毒感染后，IL-7R仅在效应CD8 T细胞的一部分上表达，并已证明对这些记忆前体的存活很重要。在对淋巴细胞性脉络膜脑膜炎病毒的T细胞应答过程中，IL-7信息水平保持相对恒定，但是感染后不久就观察到了短暂的GM-CSF爆发。嵌合GM-CSF / IL-7R的逆转录病毒表达（其中T细胞与GM-CSF的结合导致IL-7信号传导）允许在表达该受体的所有效应T细胞中传递IL-7信号。在感染了淋巴细胞性脉络膜脑膜炎病毒的小鼠中，用该嵌合受体转导的CD8和CD4 T细胞与同一宿主中未转导的种群相比，具有增强的增殖反应。同样，表达嵌合受体的TCR转基因CD8细胞在感染的T细胞反应高峰期间产生更高的效应子数量。出人意料的是，增强的增殖并未导致更高的记忆数，因为随后的收缩期在转导的细胞群中更为明显。这些发现表明，感染期间的人工IL-7信号转导会导致Ag特异性效应T细胞数量显着增加，但不会导致记忆后代数量增加。收缩的程度可以由与先前细胞分裂数有关的内在因素决定。

BACKGROUND & AIMS: :Thirty-three consecutive liver-transplant recipients were prospectively studied over a 37-mo period for evidence of cytomegalovirus infection. Sixteen (48%) episodes of cytomegalovirus infection were identified; 9 were primary infections and 7 were recurrent infections. Beginning with patient 8, gamma-globulin prophylaxis was routinely administered to most patients. Twelve potential risk factors for cytomegalovirus infection were evaluated and included pretransplant cytomegalovirus serological status of donor and recipient; recipient's age, sex, race, and liver disease; number and type of blood products transfused; type and intensity of immunosuppression; and occurrence of rejection. The Cox proportional hazards model identified positive donor cytomegalovirus serology as the single most important risk factor for subsequent development of cytomegalovirus infection, regardless of recipient cytomegalovirus serological status. In addition, use of gamma-globulin prophylaxis seemed to be protective against the occurrence of disseminated cytomegalovirus disease.

背景与目标： ：在37个月内对33例连续肝移植接受者进行了前瞻性研究，以发现巨细胞病毒感染的迹象。鉴定出十六例（48％）巨细胞病毒感染； 9例是原发性感染，7例是复发性感染。从患者8开始，常规对大多数患者进行了γ-球蛋白的预防。对巨细胞病毒感染的十二种潜在危险因素进行了评估，包括供体和受体移植前巨细胞病毒的血清学状况。接受者的年龄，性别，种族和肝脏疾病；输血产品的数量和类型；免疫抑制的类型和强度；和拒绝的发生。 Cox比例风险模型将阳性供体巨细胞病毒血清学确定为随后发展成巨细胞病毒感染的唯一最重要的危险因素，而与受体巨细胞病毒血清学状况无关。另外，使用γ-球蛋白预防似乎可以预防弥漫性巨细胞病毒病的发生。

BACKGROUND & AIMS: :Two cases of iatrogenic acquired Brown's syndrome are presented, and other causes of this disorder and its treatment are discussed. Care should be taken not to cause damage when operating in the region of the trochlea.

背景与目标： ：介绍了两例医源性获得性布朗综合征，并讨论了该病的其他原因及其治疗方法。在滑车区域操作时，应注意不要造成损坏。

BACKGROUND & AIMS: BACKGROUND:Granulocyte apheresis is a safe and effective method for granulocyte collection. We present a five year experience (2006-2010) of the Blood Center, Faculty Hospital Ostrava, Czech Republic. Donor granulocyte transfusion is one treatment option for haemato-oncology patients with severe neutropenia complicated by bacterial/fungal infections unresponsive to standard antibiotic/antifungal treatment. In this study, we describe the experiences of the Blood Centre at the Faculty Hospital in Ostrava of granulocyte apheresis. METHODS AND RESULTS:A total of 149 granulocyte units were collected for 33 patients from the Department of Haemato-oncology, University Hospital Olomouc, over a 5-year period (2006-2010). Information on donor selection, laboratory screening, mobilization regimen and granulocyte yield was obtained and analyzed. All mandatory screening tests for infection markers, AB0 and Rh and abnormal erythrocyte antibodies were performed. The cytomegalovirus status of the donors was not investigated. Steroids were the only mobilization regimen used, and were generally well accepted. The mean granulocyte yield was 12.6×10(9)/per transfusion unit (range 5.4-30.3). All granulocyte concentrates were irradiated and transfused according to AB0 Rh compatibility within 24 h after collection. CONCLUSION:Based on our experience, granulocytapheresis is a safe and effective method for obtaining granulocytes but the yield can be significantly influenced by other variables. From the recipients' perspective, the use of donor granulocytes supports an effective therapeutic modality.

背景与目标： 背景：粒细胞单采是一种安全有效的收集粒细胞的方法。我们介绍了捷克共和国俄斯特拉发学院医院血液中心的五年经验（2006-2010）。供体粒细胞输注是严重中性粒细胞减少症并发细菌/真菌感染而对标准抗生素/抗真菌治疗无反应的血液肿瘤患者的一种治疗选择。在这项研究中，我们描述了粒细胞单采的俄斯特拉发大学医院血液中心的经验。
方法与结果：在5年期间（2006-2010年），从Olomouc大学医院血液肿瘤科收集了149粒粒细胞单位，用于33例患者。获得并分析了有关供体选择，实验室筛查，动员方案和粒细胞产量的信息。进行了所有感染标志物，AB0和Rh和异常红细胞抗体的强制性筛查测试。没有研究捐赠者的巨细胞病毒状况。类固醇是唯一使用的动员方案，并且普遍被接受。平均粒细胞产量为12.6×10（9）/每输血单位（范围5.4-30.3）。收集后24小时内，按照AB0 Rh相容性对所有粒细胞浓缩物进行辐照和输血。
结论：根据我们的经验，粒细胞穿刺术是一种安全有效的获取粒细胞的方法，但产量会受到其他变量的显着影响。从接受者的角度来看，使用供体粒细胞支持有效的治疗方式。

BACKGROUND & AIMS: GENERAL PURPOSE:To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs). TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant should be better able to:1. Identify the purpose and methods used for this study.2. Compare costs and effectiveness related to preventative strategies for PIs. ABSTRACT:BACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective. OBJECTIVE:The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments. DATA SOURCES:Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic ReviewsSELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered. DATA EXTRACTION:Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed. DATA SYNTHESIS:The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered. CONCLUSIONS:Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors' review revealed a need for additional high-quality studies that adhere to commonly used standards of both currently utilized and emerging ways to prevent hospital-acquired PIs.

背景与目标： 一般目的：提供文献综述中有关压力伤害预防策略（PIs）的经济评估的信息。
目标听众：此继续教育活动面向医师，医师助理，护士从业人员以及对皮肤和伤口护理感兴趣的护士。
学习目标/结果：参加此教育活动后，参与者应能够：1。确定本研究的目的和方法2。比较与预防PI有关的成本和有效性。
摘要：背景：压力伤害（PI）是全球急诊医院普遍且资源密集的挑战。尽管许多预防策略都有可能降低医院获得的PI的成本，但尚不清楚哪种方法最有效。
目的：作者对预防策略的经济评估文献进行了叙述性回顾，以调查当前发现并确定经济评估中的重要因素。
数据来源：Ovid，MEDLINE，NHS经济评估数据库和Cochrane系统评价数据库选择标准：考虑了潜在相关的原始研究文章和系统评价。
数据摘录：选择标准包括英语撰写的文章，提供有关急性护理中PI预防策略的成本或经济评估的数据，并于2004年1月至2015年9月之间发表。如何处理《综合卫生经济评估报告标准》清单中的项目。
数据综合：这些搜索确定了192篇参考文献。选择了33篇原创文章进行全文审查。这些文章中有19个提供了对干预措施，研究方法和所考虑结果的清晰描述。
结论：现有文献的局限性阻止了关于预防PI的各种方法的相对经济价值的确切结论。作者的评论表明，有必要进行更多高质量的研究，这些研究既要遵循目前使用的标准，又要采用新的方法来预防医院获得的PI。

BACKGROUND & AIMS: :We describe a case of faecal microbiota transplantation (FMT) used for severe binary toxin-positive Clostridium difficile infection in an intensive care setting. The patient was admitted to the ICU of a tertiary hospital and failed traditional maximal pharmacological management. Adjunctive therapy with FMT given through gastroscopy resulted in resolution of the C. difficile-related symptoms. Although there is a growing experience with FMT for recurrent C. difficile infection, published evidence in severe disease is very limited. In a landscape of increasingly severe C. difficile infection, adjunctive FMT may be considered a useful early treatment option.

背景与目标： ：我们描述了在重症监护室中用于严重二重毒素阳性艰难梭菌感染的粪便微生物菌群移植（FMT）的情况。该患者入院于一家三级医院的ICU，传统的最大药物治疗失败。通过胃镜进行FMT的辅助治疗可解决艰难梭菌相关症状。尽管对于复发性艰难梭菌感染，FMT有越来越多的经验，但有关严重疾病的公开证据非常有限。在艰难梭菌感染日益严重的情况下，辅助性FMT可能被认为是一种有用的早期治疗选择。