The impact of the updated EORTC/MSG criteria on the classification of hematological patients with suspected invasive pulmonary aspergillosis

ObjectivesOur aim was to evaluate the effect of the updated European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group 2019 definitions for invasive pulmonary aspergillosis (IPA) on patient classification and the related all-cause 12-week mortality.MethodsIn this retrospective cohort study from our tertiary care centre, we reclassified patients with haematological malignancy who underwent bronchoalveolar lavage between 2014 and 2019 for suspected IPA using the novel EORTC 2019 criteria. We performed receiver operating characteristic curve analysis to define the optimal cut-off for positive PCR and galactomannan and present survival analyses and their possible association with these diagnostic criteria through post hoc comparisons with log rank and Cox regression.ResultsFrom 323 episodes of suspected IPA in 282 patients, 73 were reclassified: 31 (42.5%) from possible to probable IPA, 5 (6.8%) from EORTC criteria not met to probable IPA, and 37 (50.7%) from EORTC criteria not met to possible IPA. Probable IPA increased therefore 11.1% (64/323, 19.8% to 100/323, 30.9%), mostly due to positive PCR (31/36, 86.1%). There was no difference in mortality between newly defined possible and probable IPA (log rank p = 0.950). Mortality was higher in probable cases with lower cycle thresholds (Ct values) versus higher Ct values (p = 0.004). Receiver operating characteristic curve analysis showed an optimal Ct value cut-off of 36.8 with a sensitivity of 75% (95% CI 64.9%–85.1%) and a specificity of 61.7% (95% CI 53.5–69.9) for 12-week mortality.DiscussionThe new EORTC criteria led to 11.1% more probable IPA diagnoses, mostly due to Aspergillus PCR. Restricting positive PCR to below a certain threshold might improve the discrimination of the new EORTC IPA categories for mortality.     

某设备所致脉冲X射线辐射场测量与防护评价

目的 了解某设备实验条件下不同位置脉冲X射线电离辐射水平，提出适当的防护建议。方法 采用热释光测量方法，分别在设备舱周围不同方向不同距离布放热释光剂量计，累积一定数量脉冲辐射后进行测量；采用电离室型X、γ剂量率仪（FJ-347A）实时测量工作状态下不同距离处电离辐射剂量率水平。依据《电离辐射防护与辐射源安全基本标准》（GB18871—2002）规定的职业照射人员和公众个人剂量限值提出不同工作位辐射防护建议。结果 热释光剂量计累计接收3 000个脉冲辐射，设备舱外壁0.01～8.98 mGy，顶部0.01～15.67 mGy，距外壁1～12 m之间0.01～2.18 mGy，工作位0 mGy。工作状态下，X射线剂量率仪测得距设备舱外侧壁1～20 m之间空气比释动能率范围0.26～16 mGy/h。结论 热释光剂量计、电离室型剂量率仪测量结果基本一致，说明两种方法均可用于脉冲X射线测量；工作状态下设备舱外近距离处辐射剂量率较高，可通过采取防护措施或者限制人员工作量以满足辐射防护要求。     

Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco

ObjectiveTo propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease.Material and methodsRetrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3 weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee.Results50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59 years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P < .05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P < .05, for all measurements).ConclusionIPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.     

Role of pulsed electromagnetic fields after joint replacements

Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients' satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient's functional recovery.     

贵阳地区儿童重症社区获得性肺炎肺泡灌洗液病原及药敏分析

目的分析贵阳地区儿童重症社区获得性肺炎支气管肺泡灌洗液（BALF）病原学分布及耐药特点。方法收集989例重症社区获得性肺炎患儿临床资料，将支气管肺泡灌液采用支气管镜取出进行细菌培养、病毒以及肺炎支原体(MP)检测。结果（1）989例重症社区获得性肺炎患儿病原检出阳性716例，阳性率72.40%，细菌、病毒、支原体检出率分别33.27% （329例）、22.45%（222例）、31.45%（311例）。（2）细菌感染中的肺炎链球菌、金黄色葡萄球菌为最为常见的革兰阳性菌株(G+)；而肺炎克雷伯菌、大肠埃希菌为最为常见的革兰阴性菌株(G-)。培养菌株对青霉素类、红霉素、第1、2、3代头孢类抗生素有较高的耐药性，对头孢吡肟、拉氧头孢、哌拉西林、左氧氟沙星有较高的敏感性，对亚胺培南、万古霉素、利奈唑烷均无耐药发生。（3）病毒感染检出222例，其中呼吸道合胞病毒131例，腺病毒检测49例，流感病毒6例（A型2例，B型4例），副流感病毒36例（1型3例、2型4例、3型29例），病毒检出率以0～12月龄组最高，RSV、ADV感染主要集中在冬春季节。（4）肺炎支原体检出阳性率31.45%（311例），肺炎支原体检出率以3～5岁组最高。结论贵阳地区重症肺炎中肺炎克雷伯杆菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌为重要的细菌病原。重要病毒为腺病毒和呼吸道病毒为主，1～12月龄组的病毒感染检出率比较高。     

Inactivated influenza vaccine formulated with single-stranded RNA-based adjuvant confers mucosal immunity and cross-protection against influenza virus infection

Influenza vaccination is considered the most valuable means to prevent and control seasonal influenza infections, which causes various clinical symptoms, ranging from mild cough and fever to even death. Among various influenza vaccine types, the inactivated subunit type is known to provide improved safety with reduced reactogenicity. However, there are some drawbacks associated with inactivated subunit type vaccines, with the main ones being its low immunogenicity and the induction of Th2-biased immune responses. In this study, we investigated the role of a single-stranded RNA (ssRNA) derived from the intergenic region in the internal ribosome entry site of the Cricket paralysis virus as an adjuvant rather than the universal vaccine for a seasonal inactivated subunit influenza vaccine. The ssRNA adjuvant stimulated not only well-balanced cellular (indicated by IgG2a, IFN-γ, IL-2, and TNF-α) and humoral (indicated by IgG1 and IL-4) immune responses but also a mucosal immune response (indicated by IgA), a key protector against respiratory virus infections. It also increases the HI titer, the surrogate marker of influenza vaccine efficacy. Furthermore, ssRNA adjuvant confers cross-protective immune responses against heterologous influenza virus infection while promoting enhanced viral clearance. Moreover, ssRNA adjuvant increases the number of memory CD4⁺ and CD8⁺ T cells, which can be expected to induce long-term immune responses. Therefore, this ssRNA-adjuvanted seasonal inactivated subunit influenza vaccine might be the best influenza vaccine generating robust humoral and cellular immune responses and conferring cross-protective and long-term immunity.     

Improvement of oral colonic lavage with supplemental simethicone

We have noted that colons of patients prepared for colonoscopy with Golytely, a nonabsorbable electrolyte lavage solution, frequently contain foam which may obscure small mucosal lesions. Therefore, a randomized, blinded controlled trial was performed to determine the prevalence of Golytely-induced foam and the effect of supplemental simethicone in decreasing the prevalence of foam. Foam was present in 32% of colons prepared with Golytely alone but in none of the colons prepared with Golytely supplemented with simethicone. In addition, only 5% of colons prepared with supplemental simethicone had residual stool noted at the time of colonoscopy, a significant improvement over the 39% prevalence of residual stool in colons prepared with Golytely alone. Addition of simethicone to Golytely lavage decreases the prevalence of colonic foam and residual stool.     

强脉冲光治疗浅表(皮肤)血管瘤临床观察

目的：观察强脉冲光（IPL）治疗浅表（皮肤）血管瘤的疗效。方法：选择60例浅表（皮肤）血管瘤患者,随机分为治疗组和对照组,治疗组用535nm、580nm强脉冲光治疗皮损,每三周治疗一次,三次为一个疗程;对照组采用波长为532nm的Q开关Nd：YAG激光治疗,每两周治疗一次,三次为一个疗程。观察两组皮损的治愈率、并发症等情况,并行统计学处理。结果：治疗组皮损三次治愈率明显高于对照组（P〈0.01）,患处瘢痕形成及炎症性色素沉着发生率均低于对照组。结论：强脉冲光（IPLTM）治疗浅表（皮肤）血管瘤效果满意。     

Arthroscopic irrigation - a cautionary tale

A fit 38-year-old female patient developed absent foot pulses following a routine arthroscopic partial medial meniscectomy. Irrigation fluid, which was delivered using an arthroscopic flushing set, had extravasated through a ruptured Baker's cyst into the popliteal fossa causing vascular compression and spasm. The pulses gradually returned to normal following the procedure. Knee arthroscopy is a common procedure and a Baker's cyst is a common sequel to degenerative disease. With the increasing popularity of pressurised fluid irrigation systems, this previously unreported complication is both relevant and important.     

犬烟雾吸入性损伤早期肺洗出液灌注大鼠肺所致损伤的研究

目的　研究犬烟雾吸入性损伤早期肺洗出液的生物学活性。　方法　获取犬急性烟雾吸入性损伤早期肺洗出液及正常犬肺洗出液。将Wistar大鼠随机分为A(2 8只 )、B(2 9只 )、C(37只 )组 ,每组各取 7只不作处理作为正常对照 ,其余大鼠肺部作如下处理 :A组注入等渗盐水 ,B组注入正常犬肺洗出液 ,C组注入致伤犬肺洗出液。处死各组中正常对照大鼠 ,并于灌注后 4、12、2 4h处死灌注大鼠 ,观察各组大鼠处死前的存活情况、处死后双肺大体变化及组织病理学改变。检测肺组织匀浆中 6 酮 前列腺素F1α/血栓素B2 (PGF1α/TXB2 )、肿瘤坏死因子α(TNF α)、髓过氧化物酶 (MPO)含量及肺毛细血管通透性。　结果　A、B组大鼠处死前均存活 ,C组大鼠非处死死亡 9只。犬吸入性损伤早期肺洗出液可引起大鼠肺产生类似于烟雾吸入性损伤样的病理变化。A、B组大鼠灌注后肺组织PGF1α/TXB2 均有升高倾向 ;C组大鼠灌注后PGF1α/TXB2 逐渐降低 (P <0.0 1),A、B组灌注后肺组织TNF α、MPO含量均无明显变化 (P >0.0 5 ),C组灌注后 4h肺组织TNF α、MPO含量显著增加 ,分别为 (1.0 2± 0 .0 4 )ng/ml、(1.0 1± 0.0 9)U/g肺组织湿重 ,随后下降 (P <0.0 5～ 0.0 1)。肺灌注后4hC组大鼠肺组织毛细血管通透性高于A、B组 (P <0.0 1)。结论　犬