Is influenza-like illness a useful concept and an appropriate test of influenza vaccine effectiveness?

Purpose

To assess the utility of “influenza-like illness” (ILI) and whether it appropriately tests influenza vaccine effectiveness.

Principal results

The WHO and CDC definitions of “influenza-like illness” are similar. However many studies use other definitions, some not specifying a temperature and requiring specific respiratory and/or systemic symptoms, making many samples non-comparable. Most ILI studies find less than 25% of cases are RT-PCR-positive, those which test for other viruses and bacteria usually find multiple other pathogens, and most identify no pathogen in about 50% of cases. ILI symptom and symptom combinations do not have high sensitivity or specificity in identifying PCR-positive influenza cases. Rapid influenza diagnostic tests are increasingly used to screen ILI cases and they have low sensitivity and high specificity when compared to RT-PCR in identifying influenza.

Main conclusions

The working diagnosis of ILI presumes influenza may be involved until proven otherwise. Health care workers would benefit by renaming the WHO and CDC ILI symptoms and signs as “acute respiratory illness” and also using the WHO acute severe respiratory illness definition if the illness is severe and meets this criterion. This renaming would shift attention to identify the viral and bacterial pathogens in cases and epidemics, identify new pathogens, implement vaccination plans appropriate to the identified pathogens, and estimate workload during the viral season. Randomised controlled trials testing the effectiveness of influenza vaccine require all participants to be assessed by a gold standard (RT-PCR). ILI has no role in measuring influenza vaccine effectiveness. ILI is well established in the literature and in the operational definition of many surveillance databases and its imprecise definition may be inhibiting progress in research and treatment. The current ILI definition could with benefit be renamed “acute respiratory illness,” with additional definitions for “severe acute respiratory illness” (SARI) with RT-PCR testing for pathogens to facilitate prevention and treatment.     

蒙特利尔认知评估中文计算机软件的临床应用

目的 编制蒙特利尔认知评估量表（MoCA）中文计算机软件并观察其临床应用效果。方法 根据MoCA的操作和记分思想将其转换为中文计算机操作系统,软件生成后以69例轻度认知功能受损患者（MCI组）及80名健康体检者（对照组）为对象进行测试。结果 共有144例（96．64％）患者顺利完成软件版MoCA测试,两组MoCA评分除命名条目外（t=0．56,P=0．571）其余各条目得分及总分差异均有统计学意义（t=3．19～22．10,P〈0．01）。以26分为截断值,软件版MoCA诊断MCI的灵敏度为92．54％,特异度为89．61％,Youden指数为0．82。结论 本次研究生成的MoCA中文应用软件可用于临床筛查MCI,其较纸质版量表的优势值得探讨。     

An Examination of the Frequency of Invalid Forgetting on the Test of Memory Malingering

The Test of Memory Malingering (TOMM) is the most used performance validity test in neuropsychology, but does not measure response consistency, which is central in the measurement of credible presentation. Gunner, Miele, Lynch, and McCaffrey (2012 Gunner, J. H., Miele, A. S., Lynch, J. K., & McCaffrey, R. J. (2012). The Albany Consistency Index for the Test of Memory Malingering. Archives of Clinical Neuropsychology, 27(1), 1–9. doi:10.1093/arclin/acr089.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed the Albany Consistency Index (ACI) to address this need. The ACI consistency measurement, however, may penalize examinees, resulting in suboptimal accuracy. The Invalid Forgetting Frequency Index (IFFI), created for the present study, utilizes an algorithm to identify and differentiate learning and inconsistent response patterns across TOMM trials. The purpose of this study was to assess the diagnostic accuracy of the ACI and IFFI against a reference test (Malingered Neurocognitive Dysfunction criteria), and to compare both to the standard TOMM indexes. This retrospective case-control study used 59 forensic cases from an outpatient clinic in Southern Kansas. Results indicated that sensitivity, negative predictive value, and overall accuracy of the IFFI were superior to both the TOMM indexes and ACI. Logistic regression odds ratios were similar for TOMM Trial 2, Retention, and IFFI (1.25, 1.24, 1.25, respectively), with the ACI somewhat lower (1.18). The IFFI had the highest rate of group membership predictions (79.7%). Implications and limitations of the present study are discussed.     

新型肿瘤标志物:Mu-GlcNAc

作者发现了一个新的肿瘤标志物MA153,其化学结构为Mu-GlcNAc（粘蛋白1-N-乙酰氨基葡萄糖）,它可与单克隆抗体Ma695和相关Aptamer（适配体MA153-A）形成Ma695-Mu-GlcNAc-MA153-A式的夹心反应。临床血清学检测表明,Mu-GlcNAc存在于癌症患者血中,以1U/mL为正常界值,Mu-GlcNAc的肿瘤特异度达95%,癌症检出的灵敏度对乳腺癌、胰腺癌、肝癌、肺癌、食管癌、口腔癌、结肠癌、胆管癌、卵巢癌、宫颈癌、子宫癌,分别为80%、74%、68%、70%、75%、50%、60%、55%、70%、64%、60%。本研究资料显示,Mu-GlcNAc是一个新的良好广谱肿瘤标志物。     

一对高亲和力抗人肌钙蛋白Ⅰ单克隆抗体的制备及鉴定

目的 获取抗人肌钙蛋白Ⅰ（cTnI）的单克隆抗体（McAb）.方法 以人cTnI作为抗原,免疫Balb/c小鼠,通过杂交瘤技术制备了抗人cTnI高亲和力、高特异性单克隆抗体.随后采用间接ELISA法测定抗血清效价,用protein G亲和纯化法纯化抗体,抗原竞争ELISA法鉴定抗体亲和力,SDS-PAGE法鉴定纯度,Western blotting鉴定抗cTnI单克隆抗体的特异性,竞争ELISA法分析抗原结合位点.结果 筛选出9株稳定分泌抗cTnI的单抗杂交瘤细胞株,其中A3、A9两株免疫球蛋白亚类均为IgG2a,分泌的抗体纯度高,与CK-MB、cTnT无交叉反应,效价均为：1：1024000,亲和力分别为4.21×10^8mol/L、1.07×10^8mol/L,抗原结合位点不同.结论 成功制备出了一对高亲和力、高特异性抗人cTnI单克隆抗体.     

Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study

IntroductionIn the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma.MethodsWe conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable.ResultsHigher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively.ConclusionsOur findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.     

Region of Interest Sensitivity Ratio in Analyzing Sensitivity Distributions of Electrocardiographic Measurements

Modern devices such as wearable and implantable systems provide new methods for bioelectric measurement while creating new needs to assess the efficacy of the measurements. A modeling related analysis method, called the region of interest sensitivity ratio (ROISR), has been developed and applied hitherto in analyzing EEG measurements. ROISR describes how well the sensitivity of a measurement is concentrated within the region of interest (ROI). The objectives of the present study were to demonstrate and evaluate the applicability of this method in analyzing the specificity of ECG leads and to compare the results with those previously published. Here the specificities of the 117 leads of a Dalhousie body surface ECG mapping system to different segments of the left ventricular myocardium and the whole right ventricular free wall were analyzed. The ROISR method was also validated with epicardial dipole simulations. The results are consistent with those from previous clinical studies, and the ROISR method is thus applicable in future studies where, e.g., sensitivity distributions of implantable ECG measurements are analyzed.     

酿酒酵母中的D-(-)-扁桃酸脱氢酶

酿酒酵母BY1．1b对苯乙酮酸不对称还原成D-（-）-扁桃酸的反应具有高度的催化还原活性和光学选择性。采用超声波细胞破碎、硫酸铵沉淀、DEAE-Sepharose FF离子交换层析及Sephacryl S-200分子筛层析等步骤，从酵母BY1．1b中分离纯化得到D-（-）-扁桃酸脱氢酶。该酶的相对分子质量约60000。该酶的生物合成模式为非细胞生长偶联型和非底物诱导型。该酶与酵母醇脱氢酶、马肝醇脱氢酶、乳酸脱氢酶及丙酮酸脱氢酶的底物特异性具有显著差别，是一种新型的脱氢酶。     

Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorder: a receiver operating characteristic analysis

We report on the use of the Penn State Worry Questionnaire (PSWQ) to identify individuals with generalized anxiety disorder (GAD). Fifty individuals with primary or secondary GAD and 114 individuals with social anxiety disorder (without GAD) completed the PSWQ. In receiver operating characteristic analyses, a score of 65 simultaneously optimized sensitivity and specificity in discriminating individuals with GAD from individuals with social anxiety disorder. Results support the use of the PSWQ in screening individuals likely to meet criteria for GAD who present for treatment at an anxiety disorders specialty clinic.     

5种沙门菌分离培养基的应用和比较

目的：比较目前使用的5种沙门菌分离培养基的检测效果。方法：使用CAS、WS、SS、HE、XLD平板测试实验室保存沙门菌和非沙门菌落的敏感性、特异性；分别使用CAS、WS、SS和CAS、HE、XLD对2517份从业人员肛拭和303份食品样品进行沙门菌的现场分离检测。结果：5种沙门菌分离培养基表现测试菌落的敏感性、特异性分别为CAS(100％、96．62％)、WS(57．14％、93．24％)、SS(61．90％、93．92％)、HE(47．62％、93．24％)、XLD(85．71％、92．57％)；CAS、WS和ss在肛拭样品中沙门菌检出率分别为1．07％(27／2，517)、0．35％(6／1717)、0％(0／800)；CAS、HE、XLD在食品样品中的检出率分别为25．08％(76／303)、12．54％(38／303)、24．75％(75／303)。结论：CAS、XLD平板在测试菌株敏感性和分离过程中对疑似菌落的鉴别筛选准确性明显优于WS、SS、和HE平板。建议将CAS、XLD平板作为常规检测沙门菌的首选培养基应用。