Enfermedad fúngica invasora: ¿Diagnóstico micológico convencional o molecular?

Diagnosis of invasive mycoses is a difficult challenge due to the limitations and low sensitivity of traditional microbiology methods which lead to diagnostic and therapeutic delays. The aim of this review is to summarise the state of the art of the molecular diagnosis of invasive fungal disease and to clarify its current role in the clinical practice. Conventional microbiological methods could be complemented with molecular methods in the rapid and definitive identification of fungal isolates. Biomarkers (β-glucan, galactomannan) are very useful in immunocompromised patients and have been included as probable invasive mycoses by the EORTC/MSG. Nucleic acid detection is currently used as a complementary tool for diagnosis. However, PCR can be very useful in mould invasive mycoses. Finally, the combined detection using biomarkers can improve the diagnosis. However, their applicability in the microbiology laboratory is not so easy and further studies are required for the appropriate evaluation of its clinical usefulness.     

红细胞膜免疫磁珠检测成分血中抗A/抗B的研究

目的比较应用红细胞膜免疫磁珠法及传统方法进行成分血中抗A/抗B效价检测之间的相关性。建立应用红细胞膜免疫磁珠检测血浆标本中高效价抗体的方法。方法采用新鲜细胞试管法、微柱凝胶法及红细胞膜免疫磁珠法进行血浆样本抗体效价检测。将试管法检测效价≥128的样本10倍、15倍、20倍稀释后,用红细胞膜免疫磁珠检测,测定其凝集强度。结果微柱凝胶法最敏感,其次为试管法,红细胞膜免疫磁珠法低于试管法1个滴度。将试管法检测效价≥128的待检样本15倍稀释后,用红细胞膜免疫磁珠检测,其凝集强度≥2+。结论红细胞膜免疫磁珠可做为标准红细胞抗原应用于抗体效价检测,将样本进行15倍稀释,若凝集强度≥2+,则可视其带有高效价抗体。     

The Activity of β-Hexosaminidase (uHex) and γ-Glutamyl-Transferase (uGGT) in Urine as Non-Invasive Markers of Chronic Alcohol Abuse: I. Alcohol-Dependent Subjects

It has been demonstrated that in alcohol-dependent men the uHex test is one of the most powerful discriminating tools, while uGGT has a discriminating power similar to that of sHex but worse than that of uHex, sGGT and s%CDT. Receiver Operating Characteristic (ROC) areas under the curves (AUC) for uHex, uGGT, s%CDT, sHex and sGGT were 0.92, 0.79, 0.88, 0.79 and 0.92, respectively. Due to their good parameters, low cost, ease of use and noninvasive character the uHex and uGGT tests are useful tools for the detection of chronic alcohol abuse.     

White matter hyperintensities mediate the impact of amyloid ß on future freezing of gait in Parkinson's disease

BackgroundFreezing of gait (FOG) is a common symptom in Parkinson's Disease (PD) patients. Previous studies have reported relationships between FOG, substantia nigra (SN) degeneration, dopamine transporter (DAT) concentration, as well as amyloid β deposition. However, there is a paucity of research on the concurrent impact of white matter damage.ObjectivesTo assess the inter-relationships between these different co-morbidities, their impact on future FOG and whether they act independently of each other.MethodsWe used baseline MRI and longitudinal gait data from 423 de novo PD patients from the Parkinson's Progression Markers Initiative (PPMI). We used deformation based morphometry (DBM) from T1-weighted MRI to measure SN atrophy, and segmentation of white matter hyperintensities (WMH) as a measure of WM pathological load. Putamen and caudate DAT levels from SPECT as well as cerebrospinal fluid (CSF) amyloid β were obtained directly from the PPMI. Following correlation analyses, we investigated whether WMH burden mediates the impact of amyloid β on future FOG.ResultsSN DBM, WMH load, putamen and caudate DAT activity and CSF amyloid β levels were significantly different between PD patients with and without future FOG (p < 0.008). Mediation analysis demonstrated an effect of CSF amyloid β levels on future FOG via WMH load, independent of SN atrophy and striatal DAT activity levels.ConclusionsAmyloid β might impact future FOG in PD patients through an increase in WMH burden, in a pathway independent of Lewy body pathology.     

妇幼保健医院门诊实施艾滋病PITC策略效果

目的了解在妇幼保健医院实施医务人员提供艾滋病检测咨询（PITC）策略的可行性，探讨艾滋病检测率的影响因素，为在艾滋病防治工作中推广实施PITC策略提供参考。方法2010年6月-2011年8月，选择广州市番禺区妇幼保健医院作为临床医疗机构试点，共选择3个门诊量较大的门诊科室作为试点，收集试点工作报表和访谈结果等资料进行分析。结果项日周期内，共计为57309人提供PITC服务，其中19809人（34．57％）接受艾滋病检测，婚检科、产科和妇科的艾滋病检测人数分别为9817人（100．00％）、6157人（35．63％）和3569人（12.37％）。产科艾滋病检测率高于妇科，差异有统计学意义（X^23514．72，P〈0．01）。在接受检测的19809人中，确认HIV阳性者3人（0．15％。1。产科和妇科调查对象拒绝艾滋病检测的主要原因均为认为自身没有感染艾滋病的可能性，分别占41．00％和59．00％。产科和妇科检测率与前15个月相比，差异均有统计学意义（P〈0．01）。结论在妇幼保健医院实施PITC策略具有可行性，政策支持、检测费用等对PITC的开展有重要影响。     

同步应用促红细胞生成素提高晚期胃癌化疗疗效及依从性的临床研究

目的观察促红细胞生成素（EPO）与胃癌患者化疗疗效及依从性的相关性。方法将40例局部晚期胃癌并轻度贫血患者均分为2组，每组20例，治疗组化疗同时给予EPO，开始剂量为150U／kg，每周3次，持续观察3周期化疗。对照组单纯化疗。结果整个治疗过程中，治疗组血红蛋白（Hb）、红细胞（RBC）、网织红细胞（Ref）、红细胞压积（HCrI）水平高于对照组，治疗组近期疗效明显高于对照组（P〈0．05）。结论EPO能明显改善胃癌贫血患者的血液学指标，提高化疗近期疗效及化疗依从性。     

盐酸昂丹思琼的两种不同剂型的临床应用研究

目的观察盐酸昂丹司琼口腔崩解片与注射液两种剂型的临床应用情况。方法选取拟行TACE治疗的肝癌患者38例,按随机原则分为A组和B组,各19例。A组在TACE围手术期使用盐酸昂丹司琼口腔崩解片,B组在TACE围手术期使用盐酸昂丹司琼注射液。观察两组术后恶心、呕吐的发生率及输液量的差异。结果 A组的恶心、呕吐的发生率及输液量均显著低于B组。结论盐酸昂丹司琼的两种剂型均可有效地预防和治疗肝癌TACE后的恶心、呕吐,口腔崩解片较注射液更有效、更安全、更便捷。     

知柏地黄丸治疗糖调节受损患者的临床研究

目的观察知柏地黄丸对糖调节受损(IGR)患者的临床疗效及对胰岛素抵抗、胰岛β细胞功能的影响。方法 176例IGR患者,随机分为治疗组与对照组,观察结束共脱落及剔除病例19例,纳入统计病例157例,治疗组77例,对照组80例,两组均给予教育及生活方式干预,治疗组在其基础上给予知柏地黄丸口服,治疗12个月后,观察两组体重指数(BMI)、HOMA胰岛素分泌指数(HOMA-β)、早期胰岛素分泌指数(EISI)及HOMA胰岛素抵抗指数(HOMA-IR)的改变。结果两组患者的BMI及HOMA-IR较治疗前均有下降,HOMA-β明显升高,差异有统计学意义(P0.05,P0.01);与对照组比较,治疗组治疗后HOMA-IR下降,EISI及HOMA-β升高,差异有统计学意义(P0.05,P0.01)。结论知柏地黄丸能减轻胰岛素抵抗,改善胰岛β细胞功能,延缓或预防IGR患者向2型糖尿病(T2DM)发展。