International multi-centre evaluation of a dipstick assay for human leptospirosis

A dipstick assay for the detection of Leptospira-specific immunoglobulin M (IgM) antibodies in human sera was evaluated in 27 laboratories in 23 countries. 873 serum samples from 711 patients including 329 laboratory-confirmed leptospirosis case patients, 239 noncase patients and 69 patients with viral infections causing heamorrhagic fever were tested. Relative to the results of the reference leptospirosis test, the sensitivity of the dipstick assay was 84.5% for serum samples collected during the first 10 days of the disease and 92.1% for serum samples collected 10-30 days after the onset of disease. The specificity was 87.5% and 94.4%, respectively. Similar to viral haemorrhagic fevers, leptospirosis may cause bleeding. A small number of serum samples from patients with haemorrhagic viral infections gave a weak (1 +) stain. All other samples were negative. In conclusion, the dipstick assay is sensitive and specific and reacts well with serum samples from patients infected with a range of leptospiral strains. It is also easy to use and does not require special equipment or refrigeration. Therefore the assay is ideal for use in developing countries and rural settings.     

应用DIFA等三项试验联合筛选孕妇弓形虫感染的研究

用DIFA初筛检测197例武汉地区非选择性孕妇，其弓形虫抗体阳性率为8．12％（16／197）；阳性者用IFT—IgG复查，阳性符合率为93．75％，即阳性率为7.61％（15／197），15例阳性者的滴度分别为1：164例，1:649例，≥1：10242例；DIFA阳性者还用Toxo－IgG／IgA／IgM－ISAGA检测，有2例IgA和IgM均为阳性。其中1例IgA1：64（＋）、IgM1：16384（＋）为急性弓形虫感染件发葡萄胎。DIFA是一种敏感性高、特异性强、操作简便适用于孕妇弓形虫感染初筛的好方法，为达到优生优育监测弓形虫感染的目的，而采用DIFA、IFT－IgG、Toxo－IgG／IgA／IgM联合测试是较好的方案。     

Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients

Objective

Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations.

Methods

Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis.

Results

Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p = 0.0004), and more likely to use medical jargon (p = 0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects.

Conclusions

While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication.

Practice implications

Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.     

Diagnosis of Parasitic Zoonoses by Immunoenzymatic Assays—Analysis of Cross‐Reactivity Among the Excretory/Secretory Antigens of Fasciola hepatica,Toxocara canis,and Ascaris suum

Several parasitic infections such fasciolosis, toxocariosis or ascariosis are important zoonoses. During the infection with Fasciola hepatica, Toxocara canis and Ascaris suum, an important intraorganic phase in their hosts takes place, releasing antigens responsible for a humoral immune response, which enables the diagnosis of that parasitosis. A study to identify the existence of cross‐reactivity among the excretory/secretory antigens of F. hepatica, T. canis and A. suum was developed. One group of Sprague–Dawley rats was infected with 20 metacercariae of F. hepatica and another group remained uninfected as control. By means of an Indirect‐ELISA, the rat humoral immune response (IgG and IgM) against the excretory/secretory antigens of F. hepatica was analysed and measured for cross reactivity with T. canis and A. suum. IgM cross‐reaction was mainly observed in the first 10 weeks post‐infection. IgG cross‐reaction was observed throughout the study, and was maximal at the 2–3 weeks and 3–6 weeks post‐infection, which corresponds to the intraorganic migratory phase of these parasites. The western‐blot showed that the rat IgG recognised three proteins of 190, 160 and 33 kDa in the antigens from F. hepatica, T. canis and A. suum. The existence of cross‐reactivity among these antigens seems to demonstrate also the presence of structural similarities, such as tegumental proteins. These results should be consider when immunoassay probes are used in the diagnosis of parasitic infections.     

六例神经型布鲁菌病患者临床特点分析

目的探讨神经型布鲁菌病的临床特点,以提高对该病的诊治能力。方法对运城市中心医院感染科自2014年1月至2019年12月收治的6例确诊为神经型布鲁菌病的患者,收集并分析其流行病学史、临床表现、辅助检查结果、治疗经过、预后等临床资料。结果6例患者均为男性,2例患者有明确的流行病学史,1例患者合并睾丸炎,1例患者伴脑血管病变相关影像学异常;3例患者脑脊液培养出马耳他布鲁菌,1例患者血培养出马耳他布鲁菌;2例患者脑脊液虎红平板凝集试验阳性,脑脊液二代测序结果为布鲁菌属核酸序列;予抗生素治疗后6例患者均预后良好。结论神经型布鲁菌病的临床表现多样,脑脊液培养、脑脊液布鲁菌凝集试验、脑脊液二代测序等多种方法联合应用可以提高神经型布鲁菌病的诊断率。     

Diagnosis of prolactinoma in two male‐to‐female transsexual subjects following high‐dose cross‐sex hormone therapy

Male‐to‐female transsexual persons use oestrogens + antiandrogens to adapt their physical bodies to the female sex. Doses are usually somewhat higher than those used by hypogonadal women receiving oestrogen replacement. Particularly in cases of self‐adminstration of cross‐sex hormones, doses may be very high. Oestrogens are powerful stimulators of synthesis and release of prolactin and serum prolactin levels are usually somewhat increased following oestrogen treatment. Prolactinomas have been reported in male‐to‐female transsexual persons, both after use of high and conventional doses of oestrogens but remain rare events. We report two new cases of prolactinomas in male‐to‐female transsexual persons, one in a 41‐year‐old subject who had used nonsupervised high‐dose oestrogen treatment since the age of 23 years and another one in a 42 year old who had initiated oestrogen treatment at the age of 17 years. Their serum prolactin levels were strongly increased, and the diagnosis of a pituitary tumour was confirmed by imaging techniques. Both cases responded well to treatment with cabergoline treatment whereupon serum prolactin normalised. Our two cases are added to the three cases of prolactinomas in the literature in persons who had used supraphysiological doses of oestrogens.     

非特异性梅毒螺旋体抗体对HIV明胶颗粒凝集试验的影响

目的 探讨梅毒血清中非特异性梅毒螺旋体抗体对艾滋病病毒(HIV)明胶颗粒凝集试验的影响.方法 采用回顾性调查的方法,用快速血浆反应素环状卡片试验(RPR)、HIV明胶颗粒凝集试验(HIV1/2-PA)、梅毒螺旋体明胶颗粒凝集试验(TPPA)以及Abbot HIV胶体硒快速试验(Determine HIV-1/2),同时检测性病门诊保存的96份梅毒血清及96份健康对照者血清.结果 96份梅毒血清中有32份HIV1/2-PA结果被干扰而无法判读(致敏颗粒和非致敏颗粒同时凝集),其他64份血清HIV1/2-PA结果为阴性.将96份梅毒血清按滴度分成11组,观察到随着RPR滴度的升高,HIV1/2-PA结果出现干扰现象的频率也升高.RPR滴度＞1:8的标本出现此现象的比例与≤1:8的标本相比,两者差异有统计学意义(χ2=74.73,P＜0.005).对9例出现HIV1/-PA结果干扰的梅毒患者进行随访,在苄星青霉素规范治疗后6个月,用HIV1/2-PA测试其血清,原结果中的干扰现象消失.比较这9例患者治疗前后RPR和TPPA滴度的变化发现,RPR的滴度均下降至≤1:8,而TPPA的滴度则有4例升高,有4例未变化.5份RPR阳性、滴度均＜1:8.TPPA阴性标本,在HIV1/2-PA试验中未出现结果被干扰现象.结论 高滴度(＞1:8)的非特异性梅毒螺旋体抗体,是HIV1/2-PA出现致敏颗粒和非致敏颗粒同时凝集这一干扰现象的主要原因.     

Improved sectioned images and surface models of the whole dog body

The objective of this research was to produce high-quality sectioned images of a whole dog which can be used to create sectional anatomy atlases and three-dimensional (3D) models. A year old female beagle was sacrificed by potassium chloride injection and frozen. The frozen dog was then serially ground using a cryomacrotome. Sectioned surfaces were photographed using a digital camera to create 3555 sectioned images of whole dog body (intervals, 0.2 mm; pixel size, 0.1 mm; 48 bit color). In a sectioned image, structures of dimension greater than 0.1 mm could be identified in detail. Photoshop was used to make segmented images of 16 structures. Sectioned and segmented images were stored in browsing software to allow easy access. Segmented images were reconstructed to make surface models of 16 structures using Mimics software and stored in portable document format (PDF) using Adobe 3D Reviewer software. In this research, state-of-art sectioned images and surface models were produced for the dog. The authors hope that the sectioned images produced will become a useful source of software for basic and clinical veterinary medicine, and therefore, are distributing the sectioned images and surface models through browsing software and PDF file available free of charge.     

Topical rather than intradermal application of the TLR7 ligand imiquimod leads to human dermal dendritic cell maturation and CD8+ T‐cell cross‐priming

Toll‐like receptor (TLR) ligands are attractive candidate adjuvants for therapeutic cancer vaccines, since TLR signaling stimulates and tunes both humoral and cellular immune responses induced by dendritic cells (DCs). Given that human skin contains a dense network of DCs, which are easily accessible via (intra‐)dermal delivery of vaccines, skin is actively explored as an antitumor vaccination site. Here we used a human skin explant model to explore the potential of TLR ligands as adjuvants for DC activation in their complex microenvironment. We show that topical application of Aldara skin cream, 5% of which comprises the TLR7 agonist imiquimod, significantly enhanced DC migration as compared with that resulting from intradermal injection of the TLR7/8 ligand R848 or the soluble form of imiquimod. Moreover, Aldara‐treated DCs showed highest levels of the costimulatory molecules CD86, CD83, CD40, and CD70. Topical Aldara induced the highest production of pro‐inflammatory cytokines in skin biopsies. When combined with intradermal peptide vaccination, Aldara‐stimulated DCs showed enhanced cross‐presentation of the melanoma antigen MART‐1, which resulted in increased priming and activation of MART‐1‐specific CD8⁺ T cells. These results point to advantageous effects of combining the topical application of Aldara with antitumor peptide vaccination.     

B‐cell modulation of dendritic‐cell function: Signals from the far side

An appropriate immune response against a specific pathogen requires finely orchestrated interactions between the various cell populations within the immune system. At the same time, immunological tolerance to self must be maintained. DCs play an essential role in achieving these dual requisites. They coordinate adaptive immunity by integrating signals directly emanating from both infectious agents and cells of the immune system. Many such signals, especially those from innate cells and T cells, have been extensively characterized. In contrast, little is known about how B cells modulate function of DCs. B cells produce a variety of cytokines, including IL‐10 and IL‐6, which are known to influence DC function. In addition, Igs constitute the major secretory products of terminally differentiated B cells (plasma cells). DCs express various types of receptors for binding Ig, such as Fc receptors and C‐type lectin receptors. In accordance, Igs can regulate DC function depending on the receptors engaged. Here, we review the emerging immunomodulatory role of cytokines and Ig secreted by B cells. We discuss the evidence for how these B‐cell‐derived factors may shape the adaptive immune response by directly acting on DCs.