磁共振特征诊断中枢神经细胞瘤

目的 探讨6种特征性MRI征象对中枢神经细胞瘤的诊断价值。方法 回顾性分析30例中枢神经细胞瘤及68例其他侧脑室肿瘤患者术前MRI,以5分法对6种MRI征象,包括扇贝征、宽基底征、皂泡征、周围泡泡征、液-液平面征及宝石征进行评分。绘制ROC曲线,评估各征象的诊断价值。结果 扇贝征曲线下面积（AUC）最大（0.82）,大于其他5个征象（P均<0.05）;宽基底征、皂泡征及周围泡泡征次之（AUC为0.73~0.75）,大于液-液平面征及宝石征（P均<0.05）。扇贝征特异度最高（84.56%）,其次为液-液平面征（77.94%）、宝石征（74.26%）及周围泡泡征（70.34%）。皂泡征敏感度最高（83.89%）,其次为宽基底征（76.11%）和周围泡泡征（75.00%）。结论 6种特征性MRI征象中,扇贝征对诊断中枢神经细胞瘤价值最高。     

Intestinal permeability in spondyloarthritis and rheumatoid arthritis: A systematic review of the literature

ObjectivesTo describe the current methods usable to assess intestinal permeability in spondyloarthritis (SpA) and rheumatoid arthritis (RA), to analyze the available data on intestinal permeability in SpA and RA patients and the effects of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) on intestinal permeability.MethodsA systematic review was conducted. Medline, Embase, and Cochrane Library databases were searched. Studies published in the last 40 years (January 1980–September 2020) with patients with SpA and/or RA assessing the intestinal permeability were selected.ResultsA total of 2916 articles were collected, after discarding 1125 duplicate articles, we analyzed the titles and abstracts of 1791 studies. There were 459 articles that met the inclusion criteria and whose text was read. A total of 23 studies were included in the final analysis. Sample sizes ranged from 6 to 206 participants. In patients with spondyloarthritis, a large majority of studies reported an increase in intestinal permeability regardless of the method used. No increase in intestinal permeability was found in RA patients compared to healthy subject in half of the studies. NSAID treatment does not appear to influence intestinal permeability in SpA and seems to increase the intestinal permeability in RA patients as much as in healthy subjects.ConclusionThe results of our review suggest the existence of increased intestinal permeability in SpA patients even in the absence of NSAIDs use and regardless of the method assessing the intestinal permeability. Studies in RA patients are more controversial.     

Glycated haemoglobin predicts progression to diabetes mellitus in Pima Indians with impaired glucose tolerance

Summary Glycated haemoglobin could offer several practical advantages over the OGTT for assessing glucose metabolism. Initial cross-sectional studies (1983–1985) on 381 subjects (mostly Pima Indians) described the relationship between HbA_1c (a specific glycated Hb) and the OGTT. We performed follow-up OGTTs and HbA_1c measurements on 257 of these same subjects 1.6–6.1 years later. Subjects were again grouped according to both the result of the OGTT (normal, IGT or diabetes, by WHO criteria) and HbA_1c result (normal or elevated based on mean ± 1.96 SD of normal). Of 66 subjects with IGT at baseline, 47 (71%) had normal HbA_1c and 19 (29%) had elevated HbA_1c. Twentysix (39%) of these subjects had diabetes at follow-up. Of these subjects with IGT, a significantly greater percentage of subjects with elevated HbA_1c at baseline (68%) showed worsening to diabetes than those with a normal HbA_1c (28%); (chi-square=7.8, df=1, p<0.01). Thus, in subjects with IGT, glycated Hb may be a useful predictor of progression to diabetes.Abbreviations OGTT Oral glucose tolerance test - WHO World Health Organisation - IGT impaired glucose tolerance     

Natural antibodies to oxidation‐specific epitopes: innate immune response and venous thromboembolic disease

Essentials

• Natural antibodies to oxidation‐specific epitopes have antithrombotic properties.
• We evaluated the relation between natural IgM and IgG antibodies and the venous thrombosis risk.
• Risk of recurrent thrombosis was higher in patients with low natural IgM antibody levels.
• The protective effect of high IgM levels suggests a role of innate immune response in thrombosis.

Summary

Background and objectives

Natural antibodies to oxidation‐specific epitopes protect from atherothrombotic events. Whether mechanisms of innate immunity are relevant in the pathogenesis of venous thromboembolism (VTE) is unknown.

Patients/Methods

We measured plasma levels of immunoglobulin M (IgM) antibodies to oxidized low‐density lipoproteins (OxLDL) and phosphocholine (PC) by enzyme linked immune assay in 663 patients with unprovoked VTE, who were prospectively followed after discontinuation of anticoagulation for a median of 8.8 years. The study endpoint was recurrent VTE.

Results

IgM antibody levels to OxLDL and PC were higher in patients without compared to those with recurrent VTE (n = 174, 26.2%). For each doubling of OxLDL‐IgM or PC‐IgM the hazard ratio (HR) of recurrence was 0.88 (95% confidence interval [CI], 0.77–1.01) and 0.82 (95% CI, 0.71–0.94), respectively. After 5 years the probability of recurrence in patients with PC‐IgM levels in the highest tertile (> 19.6 RLU/100 ms) was 13.0% (95% CI, 8.1–17.6%), compared with 21.1% (95% CI, 14.9–26.9%) in the middle tertile and 20.6% (95% CI, 14.7–26.0%) in the lowest tertile. The corresponding HR was 0.56 (0.39–0.82) for PC‐IgM levels in the highest compared with the lowest tertile. Neither immunoglobulin G IgG antibody levels to OxLDL nor those to PC were associated with risk of VTE.

Conclusion

Levels of natural IgM antibodies to oxidation‐specific epitopes are inversely related to the risk of VTE.     

Poliovirus immunity in newly resettled adult refugees in Idaho,United States of America

BackgroundIn the United States, vaccines have eliminated wild poliovirus (WPV) infection, though resettling refugees may lack immunity and importation of WPV remains a concern.MethodsA cross-sectional survey was performed to determine the prevalence of poliovirus immunity in adult refugees resettling in Boise, Idaho, U.S.A.; immunity was evaluated using two definitions: serotypes 1, 2 and 3 positive, or serotypes 1 and 3 positive.ResultsThis survey evaluated 795 adult refugees between August 2010 and November 2012. Poliovirus immunity in adults >18 years was 55.3% for serotypes 1, 2 and 3 combined, and 60% for serotypes 1 and 3 only.ConclusionThis study demonstrated a WPV immunity rate of <60% in a recently resettled adult refugee population in the United States, reinforcing the need to ensure poliovirus immunity in all newly arrived adult refugees, either by expanding pre-departure immunization or by screening for immunity at resettlement and vaccinating when indicated.     

Home-based record prevalence among children aged 12–23 months from 180 demographic and health surveys

BackgroundThere is currently a re-focus at the global level on the importance of the home-based record within vaccination service delivery as an important information resource but there are few reports of ever and current home-based record prevalence across countries.MethodsWe considered all Demographic and Health Surveys (starting with DHS round 3) conducted between 1993 and 2013 for which a final dataset was available in the public domain at the time of the analysis. Ever and current prevalence of home-based records for recording vaccination was estimated for children aged 12–23 months at the time of the survey through a secondary analysis of data from 180 Demographic and Health Surveys conducted in 67 countries derived from questions asked of women aged 15–49 years for their children on home-based record availability and retention. Ever home-based record prevalence is the proportion of children aged 12–23 months who have ever received a home-based record. Current home-based record prevalence is the proportion of children aged 12–23 months for whom a home-based record was available for viewing by the surveyor at the time of the survey.ResultsEstimated ever home-based record prevalence was ≥90% in 116 surveys from 52 countries and was <70% in 15 surveys from 7 countries. Estimated current home-based record prevalence was ≥80% in 31 surveys from 23 countries and was <50% in 51 surveys from 24 countries. Current home-based record prevalence was <80% as of the most recent survey during 2010–2013 for five (Bangladesh, Ethiopia, Nigeria, Indonesia and Pakistan) of the ten countries with the largest birth cohorts globally. Among 34 countries that conducted three or more DHS, we observed improvements in both ever and current home-based record prevalence of >10% points in six countries. Current home-based record prevalence increased >10% points in six countries where the ever prevalence was maintained at ≥90% across the period of observation. And, no meaningful change was observed in estimated ever and current home-based record prevalence in 11 countries, five of which maintained ever prevalence ≥90% across the period of observation. High home-based record loss rates were observed in many countries.ConclusionsThe results here show that despite improvements in the availability, utilization and retention of home-based records for recording vaccination history in some countries, opportunities remain to change the mind-set in many national immunization programmes around the importance of the home-based record, particularly in countries with large birth cohorts. Immunization programmes are encouraged to monitor ever and current home-based record prevalence. Nationally representative household surveys collecting information on immunization coverage should include ever and current home-based record prevalence in the standard survey reports and tables to better enable programme managers to identify problems and target corrective action.     

Safety,tolerability, and immunogenicity of 15-valent pneumococcal conjugate vaccine in healthy adults

BackgroundPneumococcal disease remains an important health priority despite successful implementation of pneumococcal conjugate vaccines (PCVs) in infant immunization programs, mainly due to the emergence of diseases caused by serotypes not included in licensed PCVs. A 15-valent pneumococcal conjugate vaccine (PCV-15) containing the 7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) included in licensed PCV-7 available at study initiation plus 8 additional serotypes (1, 3, 5, 6A, 7F, 19A, 22F, 33F) was developed and evaluated in healthy adults 18–45 years of age.MethodsSixty subjects received one dose of PCV-15 or PCV-7. Injection-site and systemic adverse events (AEs) were collected for 14-days postvaccination and serious AEs were collected for 30-days postvaccination. Safety laboratory tests (hematology, chemistry, and urinalysis) were evaluated prior to vaccination and 14-days postvaccination. Serotype-specific IgG and opsonophagocytic killing activity (OPA) responses to 15 serotypes included in PCV-15 were measured immediately prior to vaccination and 30-days postvaccination.ResultsAE incidences were comparable between vaccine groups although numerically higher frequencies of erythema (33.3% versus 13.3%), swelling (50.0% versus 23.3%), and myalgia (63.3% versus 36.7%) were reported among PCV-15 versus PCV-7 recipients. Majority of AEs, irrespective of vaccine received, were transient and of mild-to-moderate intensity. No clinically significant differences were observed when comparing AE duration and severity. No laboratory abnormalities, vaccine-related SAEs or discontinuations from the study due to AEs were reported. IgG concentrations for the shared serotypes substantially increased postvaccination at comparable levels between recipients of PCV-15 and PCV-7. Substantial increases in antibody (IgG and OPA) responses to 8 serotypes unique to PCV-15 were observed in PCV-15 recipients. Slight increases to 2 serotypes unique to PCV-15, serotypes 6A and 19A, were also noted in PCV-7 recipients.ConclusionPCV-15 displays an acceptable safety profile and induces IgG and OPA responses to all serotypes included in the vaccine.     

Who provides GP after-hours care?

Understanding the demographic and financial factors likely to influence the supply side of after-hours GP care is crucial in meeting the increasing demand for these services. This study answers two questions: which GPs are more likely to provide after-hours GP care, and of those who do, which are more likely to take a heavier load. Data from the first wave of the Medicine in Australia: Balancing Employment and Life (MABEL) survey is used, with logistic regression applied to address the decision to undertake after-hours work and linear regression to address the question of the quantum of work. The results show that female, older, and urban GPs are less likely to work outside of normal hours. GPs who are employees are less likely to participate in after-hours work than GPs who are principals or partners of a practice. On the other hand, principals and partners, are likely work more hours in the after-hours period than employee GPs if they do participate in this work. Similarly, those GPs in solo practice who work after-hours also tend to take a heavier after-hours workload than the GPs who are not in solo practice. The role of GP wages and family income does not seem to be compelling. These conclusions are likely to relate to the ways doctors behave independent of the health system.     

A three‐dimensional point process model for the spatial distribution of disease occurrence in relation to an exposure source

We study methods for how to include the spatial distribution of tumours when investigating the relation between brain tumours and the exposure from radio frequency electromagnetic fields caused by mobile phone use. Our suggested point process model is adapted from studies investigating spatial aggregation of a disease around a source of potential hazard in environmental epidemiology, where now the source is the preferred ear of each phone user. In this context, the spatial distribution is a distribution over a sample of patients rather than over multiple disease cases within one geographical area. We show how the distance relation between tumour and phone can be modelled nonparametrically and, with various parametric functions, how covariates can be included in the model and how to test for the effect of distance. To illustrate the models, we apply them to a subset of the data from the Interphone Study, a large multinational case‐control study on the association between brain tumours and mobile phone use. Copyright © 2015 John Wiley & Sons, Ltd.