RESUMO
The in-hospital triage is the first step to every emergency department visit, and it is considered the main tool for matching medical and nursing resources to an exploding demand for care. In the current organization of care, triage is done by a triage nurse who can in certain situations request medical advice. However, given the increase in the number of visits to the emergency room, the heterogeneity of the demand of care and the perception of patients as to their needs, the role of a medical-nursing tandem is taking shape.
Le triage, première étape de la consultation d'un patient aux urgences, est devenu depuis plusieurs années l'outil principal de mise en adéquation des ressources médicosoignantes à une demande en soins qui explose. Dans son organisation actuelle, ce tri est effectué par une infirmière d'accueil et d'orientation qui, dans certaines situations, sollicite un avis médical. Cependant, devant l'augmentation du nombre de consultations aux urgences, l'hétérogénéité des motifs de recours aux urgences et la perception des patients quant à leurs besoins, le rôle de plus en plus important d'un tandem médico-infirmier se dessine.
Assuntos
Serviço Hospitalar de Emergência , Triagem , Hospitais , HumanosRESUMO
We discuss here three recent applications of high technology in pulmonary medicine. GeneXpert has considerably improved the diagnosis of active tuberculosis. However, the test has also its limits so that clinical assessment, radiology, and sputum microscopy remain fundamental. Treatment of severe emphysema by lung volume reduction is no longer confined to surgical approach, but is now possible by bronchoscopy. Implantation of Nitinol coils in the most diseased parts of the emphysematous lung is a promising technique. Finally, several clinical trials on bronchial thermoplasty have been reported for intractable asthma. The recent publication of the long term effects of this technique is the occasion to update on this matter.
Assuntos
Técnicas de Diagnóstico Molecular , Pneumonectomia/instrumentação , Pneumologia/tendências , Tuberculose Pulmonar/diagnóstico , Broncoscopia/instrumentação , Broncoscopia/métodos , Cauterização/instrumentação , Cauterização/métodos , Humanos , Pneumonectomia/métodos , Pneumologia/métodos , Tuberculose Pulmonar/genéticaRESUMO
Dendritic cells are excellent targets for antigen-specific immune intervention. Here we attempted to introduce a CD8 T cell-dependent epitope into dendritic cells for presentation on major histocompatibility complex class I and induction of immunity. Murine bone-marrow-derived dendritic cells were subjected to electroporation with mRNA transcribed in vitro from a plasmid encoding lymphocytic choriomeningitis virus glycoprotein or enhanced green fluorescent protein under the control of a T7 promotor. The transfection efficiency of dendritic cells was 22 to 40%. Maturation was not inhibited by the electroporation. Dendritic cells electroporated with the appropriate antigen induced cell number-dependent in vitro proliferation in CD8 T cells expressing a transgenic receptor recognizing the 33 to 41 sequence of lymphocytic choriomeningitis virus glycoprotein in association with H-2Kb/Db, indicating correct synthesis, processing, and presentation of the epitope. Naive C57BL/6 mice vaccinated with electroporated dendritic cells and challenged with lymphocytic choriomeningitis virus were protected. Vaccination induced epitope-specific T cells as assessed by tetramer staining in blood and spleen. These results indicate that targeting dendritic cells with antigen-encoding mRNA can induce antigen-specific CD8 T cell responses as well as protective anti-viral immunity in vivo. Targeting dendritic cells with antigen-encoding mRNA may find wider application for immune intervention in disorders such as autoimmunity and cancer.