Reevaluation of the Premier Clostridium difficile toxin A and B immunoassay with comparison to glutamate dehydrogenase common antigen testing evaluating Bartels cytotoxin and Prodesse ProGastro Cd polymerase chain reaction as confirmatory procedures

Enzyme immunoassays are currently the most common tests used in the clinical laboratory for the detection of Clostridium difficile toxins; however, significant problems with their performance have recently been described. We prospectively reevaluated the Meridian Premier C. difficile toxin A/B assay with direct comparison to a 2-step algorithm that screened for C. difficile common antigen and compared cytotoxin and real-time polymerase chain reaction (PCR) as confirmatory procedures. The Premier assay lacked sufficient sensitivity, missing 25% of true-positive samples. PCR was the most sensitive method and the only procedure that allowed same day testing and reporting.     

Molecular characterization of toxin A-negative,toxin B-positive variant strains of Clostridium difficile isolated in Korea

A⁻B⁺Clostridium difficile strains are prevalent in Korea. We performed pulsed-field gel electrophoresis (PFGE), polymerase chain reaction ribotyping, and toxinotyping in 82 A⁻B⁺ clinical isolates in Korea. PFGE showed highest discriminatory capability among the 3 methods. By PFGE, persistence of a clone was found, suggesting this clone has adapted to the hospital environment.     

A型肉毒毒素对脑损伤后下肢痉挛的影响

目的 探讨A型肉毒毒素(botulinum toxin A,BTXa)能否有效、安全地治疗下肢肌痉挛,改善步行能力及步行速度.方法 27例中风、脑外伤患者,选择下肢肌肉局部注射国产BTXa.每个患者每次选择3～5块肌肉,每块肌肉总的注射剂量为50～100 IU,患者每次接受的注射总量≤400 IU.所有患者同时接受步态训练等康复治疗.注射前、注射后2周、4周按改良式Ashworth量表(modified ashworth scale, MAS)评定肌张力,足印分析法(footprint analysis) 测量并记录步行时的时间距离参数的变化,研究各肌群肌张力变化与步态参数的关系.结果 整体比较,注射后2周(股直肌除外)、4周各肌群肌张力降低,与注射前相比差异有显著性意义(P<0.05),步态时间距离参数值(T-D值)除步角外,各参数均有不同程度改善(P<0.001或<0.05).注射前与注射后4周比较,步长、步宽、步速差异均有显著性意义(P<0.05).注射后2周与4周比较,步长、步速有改善(P<0.05),而步宽、步角变化不大.Spearman相关分析表明各肌群肌张力降低与步长具有较好的相关性(r=0.650～-0.875).结论 下肢肌肉局部注射BTXa结合步态训练,可以明显改善中风、脑外伤的痉挛步态,表明局部的化学去神经方法结合康复训练,可以更好地改善特定的功能.     

用PCR方法检测粪便难辨梭状芽胞杆菌

目的：采用PCR方法检测粪便难辨梭状芽胞杆菌。方法：北京协和医院的36例应用抗生素后腹泻的病人粪便标本,采用PCR方法对难辨梭状芽胞杆菌（以下简称C．D）的毒素B基因和毒素A基因进行扩增,同时进行厌氧细菌培养。结果：PCR法毒素B基因的阳性率为46．7％（16／36）,毒素A基因为36．1％（13／36）;用厌氧菌培养的阳性率为19．2％（7／36）。PCR检测C．D毒素基因方法与厌氧培养法的一致性为100％。结论：用PCR方法检测C．D比厌氧培养法检出率明显增高（P＜0．05）,与厌氧菌培养法的一致性高。     

104例痉挛性斜颈临床特点及A型肉毒毒素疗效分析

目的:分析104例痉挛性斜颈的临床特点、A型肉毒毒素的临床疗效及其与临床特点相关性。方法:回顾分析我院2012年1月至2019年12月住院的符合痉挛性斜颈诊断标准的患者104例,统计患者临床特点;分析A型肉毒毒素疗效在不同性别、年龄、体质指数、教育年限、病程、临床分型、注射次数、注射总量、平均每次注射剂量、注射方式各方面的差异性及治疗后不良反应的发生情况。结果:痉挛性斜颈患者男:女=1:1.36,年龄以40~50岁为主,且以40~50岁发病较多,病程(56.84±82.19)个月,发病到确诊间隔时间(22.75±57.44)个月,疾病早期易误诊为颈椎病;易合并精神情绪类疾病;其病因与劳累、情绪异常、饮酒和相关部位的外伤等有关,69.23%的患者在日常生活中起病,64.42%患者情绪激动、劳累或者行走时症状明显;A型肉毒毒素治疗有效率97.22%,A型肉毒毒素疗效与年龄、性别、体质指数、教育年限、病程、临床分型、注射次数、注射总量、平均每次注射剂量之间均无统计学差异(P>0.05);不良反应发生率10.58%。结论:痉挛性斜颈女性多于男性,年龄多在40~50岁;痉挛性斜颈的临床诊断较困难,病程长,发病多与劳累、情绪等因素有关,早期应防止误诊。A型肉毒毒素治疗痉挛性斜颈有效率较高且不良反应较少,多次注射未见疗效明显降低,但是否有其他影响因素不能肯定。     

Identification of BmKAPi, a novel type of scorpion venom peptide with peculiar disulfide bridge pattern from Buthus martensii Karsch

A novel cDNA sequence encoding a new type of scorpion venom peptide (BmKAPi) was first isolated from the venom gland of Buthus martensiiKarsch by cDNA library screening combined with 5′-race. The encoded precursor of BmKAPi consisted of 89 amino acid residues including a signal peptide of 24 residues, a putative mature peptide of 64 residues (BmKAPi) and an extra basic residue at the C-terminus which might be removed in the post-translational processing. BmKAPi is stabilized by five disulfide bridges, whereas all other disulfide-bridged scorpion toxins described are cross-linked by three or four disulfide bridges. It suggested the three-dimensinal scaffold of BmKAPi might be different from other scorpion toxins. The amino acid sequence of BmKAPi showed no homology with other scorpion venom peptides, but shared a little similarity with some anticoagulant peptides and proteinase inhibitors isolated from hookworm, honeybee or European frog, respectively. RT-PCR analysis showed that BmKAPi mRNA could be induced by venom extraction suggesting BmKAPi might be a component of scorpion venom. These results suggest that BmKAPi is a new type of scorpion venom peptide different from other described scorpion toxins in structural and functional aspects.     

Identification of BmKAPi, a novel type of scorpion venom peptide with peculiar disulfide bridge pattern from Buthus martensii Karsch.

A novel cDNA sequence encoding a new type of scorpion venom peptide (BmKAPi) was first isolated from the venom gland of Buthus martensiiKarsch by cDNA library screening combined with 5′-race. The encoded precursor of BmKAPi consisted of 89 amino acid residues including a signal peptide of 24 residues, a putative mature peptide of 64 residues (BmKAPi) and an extra basic residue at the C-terminus which might be removed in the post-translational processing. BmKAPi is stabilized by five disulfide bridges, whereas all other disulfide-bridged scorpion toxins described are cross-linked by three or four disulfide bridges. It suggested the three-dimensinal scaffold of BmKAPi might be different from other scorpion toxins. The amino acid sequence of BmKAPi showed no homology with other scorpion venom peptides, but shared a little similarity with some anticoagulant peptides and proteinase inhibitors isolated from hookworm, honeybee or European frog, respectively. RT-PCR analysis showed that BmKAPi mRNA could be induced by venom extraction suggesting BmKAPi might be a component of scorpion venom. These results suggest that BmKAPi is a new type of scorpion venom peptide different from other described scorpion toxins in structural and functional aspects.     

A型肉毒毒素注射治疗慢性紧张型头痛的临床对照研究

目的 对A型肉毒毒素注射治疗慢性紧张型头痛的疗效及安全性进行临床观察和研究.方法 纳入慢性紧张型头痛病人共50例,分为A型肉毒毒素注射治疗组和传统药物治疗对照组,每组各25例,对两组疗效进行比较研究,并对A型肉毒毒素注射治疗的安全性进行观察.结果 肉毒毒素注射治疗组较传统药物治疗对照组在治疗后1、2及3个月各项指标(头痛发作天数、发作时头痛严重程度、头痛发作持续时间、需临时口服止痛药的天数)的改善均更加显著(P<0.05).肉毒毒素注射治疗组约72%的病例感颈部乏力,约在1周~1月内消失,无其他明显不良反应.结论 A型肉毒毒素注射治疗慢性紧张型头痛方法简便、起效快、效果显著、副反应小、药效维持时间长.