The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales

Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58–96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.     

上海市闸北区居民急性胃肠炎发病现状及就医情况分析

目的了解城区急性胃肠炎发病现状及其就医情况。方法采用入户问卷方式,自2010年7月开始至2011年6月开展为期12个月的社区人群调查工作,询问调查对象过去4周的急性胃肠炎发病及就医情况。结果本次调查共回收问卷3600份,男女性别比为1.01:1;居民年腹泻发生率为7.97%,发病时间集中在6～10月份;主要发病人群为离退休人员;40.00%的居民回忆有可疑水产品饮食史;85.71%的居民发生急性胃肠炎后不去就诊。结论现有监测数据不足以反映急性胃肠炎实际患病现状,完善相关监测及调查工作将显得极其重要与必要。     

北京市2014－2018年诺如病毒急性胃肠炎暴发的影响因素分析

目的 分析2014－2018年北京市诺如病毒急性胃肠炎暴发的影响因素。方法 收集2014年4月至2018年3月北京市诺如病毒急性胃肠炎聚集性事件及暴发资料,应用非条件logistic回归模型分析诺如病毒急性胃肠炎暴发的影响因素。结果 北京市共报告由诺如病毒感染引起的急性胃肠炎事件765起,85.88%（657/765）为聚集性事件,14.12%（108/765）为暴发。在暴发中,70.37%（76/108）发生在2017年;84.26%（91/108）发生在冬、春季节;88.89%（96/108）发生在托幼机构及中小学;主要传播途径为人传人（81.48%,88/108）;93.52%（101/108）为GⅡ组诺如病毒感染引起。多因素logistic回归分析结果显示,在近郊区及远郊区发生的事件,出现暴发的风险分别是城区的1.84倍（95% CI：1.13～3.02）及3.78倍（95% CI：1.62～8.82）;在小学、中学及其他机构发生的事件,出现暴发的风险分别是幼儿园的6.26倍（95% CI：3.53～11.10）、14.98倍（95% CI：6.23～36.01）及8.71倍（95% CI：3.07～24.71）;就诊率低于全部事件就诊率中位数的,发生暴发的风险是就诊率高的2.29倍（95% CI：1.42～3.68）;传播途径为食源性的事件,发生暴发的风险为人传人传播的14.55倍（95% CI：3.15～67.07）。结论 加强郊区、中小学及其他机构诺如病毒暴发疫情的防控力度,急性胃肠炎患者积极就医,做好食源性疫情的防控及厨工的健康管理,有助于减少诺如病毒急性胃肠炎的暴发。     

Novel eosinophilic neuronal cytoplasmic inclusions in the external cuneate nucleus of humans

We report the occurrence of neuronal cytoplasmic inclusions (NCIs) in the external cuneate nucleus of humans. The NCIs appeared as accumulations of eosinophilic rod‐like structures in the neuronal somata in 20 (9.5%) of 211 consecutive autopsy cases. Histochemically, the NCIs were stained bright red with Gomori trichrome, Azan‐Mallory and methyl green‐pyronin, indicating that they contain protein and RNA. Immunohistochemically, the NCIs were positive for stress granule marker proteins, including Hu‐antigen R, eukaryotic translation initiation factor 3 and poly(A)‐binding protein 1, but negative for ubiquitin‐ and autophagy‐related proteins. Ultrastructurally, the NCIs were composed of randomly oriented arrays of parallel fibrillar crystalline material with a well‐defined substructure consisting of longitudinal striations, and were often associated with ribosome‐like granules. These NCIs are morphologically, immunohistochemically and topographically distinct from any other inclusions previously described. Their incidence was found to increase with age. A high incidence was also observed in individuals with noninfectious inflammatory disease. These findings suggest that eosinophilic NCIs in the external cuneate nucleus are novel inclusions and might be formed under stress conditions.     

Morphological characteristics of eosinophilic neuronal death after transient unilateral forebrain ischemia in Mongolian gerbils

Various types of eosinophilic neurons (ENs) are found in the post‐ischemic brain. The aim of the present study was to elucidate the temporal and spatial profile of ENs, the expression of TUNEL staining and ultrastructural characteristics in the core and peripheral regions of the cortex post‐ischemia. Unilateral forebrain ischemia was induced in Mongolian gerbils by transient common carotid artery occlusions, and the brains from 3 h to 2 weeks post‐ischemia were prepared for morphometric, electron microscopy (EM) and TUNEL staining of the ENs. Light microscopy showed that ENs with minimally abnormal nuclei and swollen cell bodies appeared at 3 h in the ischemic core and at 12 h in the periphery. Thereafter, ENs with pyknosis and irregular atrophic cytoplasm peaked at 12 h, pyknosis with scant cytoplasm peaked at 4 days, and TUNEL‐positive staining was observed in the ischemic core. In the ischemic periphery, ENs had slightly atrophic cytoplasm and sequentially developed pyknosis, karyorrhexis and karyolysis over 1 week. These cells were also positive for TUNEL. In EM, severe organelle dilation and vacuolization preceded chromatin fragmentation in the ischemic core, while chromatin fragmentation and homogenization were the vital characteristics in the ischemic periphery. There might be two region‐dependent pathways for EN changes in the post‐ischemic brain: pyknosis with cytoplasmic shrinkage in the core and nuclear disintegration with slightly atrophic cytoplasm in the periphery. These pathways were comparable to necrosis and proceeded from non‐classical apoptosis to necrosis, respectively.     

嗜酸性粒细胞增生性淋巴肉芽肿的免疫研究进展

嗜酸性粒细胞增生性淋巴肉芽肿也称木村病(KD),伴有嗜酸性粒细胞和血清免疫球蛋白(Ig)E升高.低亲和力IgE受体表达于B细胞、T细胞、嗜酸性粒细胞表面,调节各种免疫应答.在KD初发和复发患者中,IgG4均增高,被看作非主要致病性抗体.滤泡树突细胞分泌的趋化因子、黏附分子和营养因子可调控B细胞免疫应答并作用于局部微环境.嗜酸性粒细胞分泌的嗜酸性粒细胞阳离子蛋白在KD发病过程中起着重要的作用.肥大细胞可促进嗜酸性粒细胞的浸润并诱导B细胞合成IgE.KD患者血清补体C5a高反应性可以调节补体活化后介导的细胞免疫应答.白细胞介素(IL)-4可诱导IgE合成,IL-5、粒细胞-巨噬细胞集落刺激因子和IL-3可促使嗜酸性粒细胞局灶浸润.嗜酸性粒细胞趋化因子与调节正常T细胞表达和分泌因子一起参与嗜酸性粒细胞在炎症处的聚集.Th细胞又分为Th1和Th2细胞,Th1细胞参与细胞免疫反应,Th2细胞参与体液免疫及变态反应性免疫反应.嗜酸性粒细胞增多及IgE升高,可能系Th2细胞在KD发病机制中起着重要的作用.     

Serum IgG4 as a biomarker reflecting pathophysiology and post-operative recurrence in chronic rhinosinusitis

BackgroundType 2 chronic rhinosinusitis (CRS), especially eosinophilic CRS (ECRS), is an intractable upper airway inflammatory disease. Establishment of serum biomarkers reflecting the pathophysiology of CRS is desirable in a clinical setting. As IgG4 production is regulated by type 2 cytokines, we sought to determine whether serum IgG4 levels can be used as a biomarker for CRS.MethodsAssociation between the serum IgG4 levels and clinicopathological factors was analyzed in 336 CRS patients. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of serum IgG4 levels that can be used to predict the post-operative recurrence.ResultsSerum IgG4 levels were significantly higher in patients with moderate to severe ECRS versus those with non to mild ECRS. The levels were also significantly higher in asthmatic patients and patients exhibiting recurrence after surgery compared to controls. ROC analysis determined that the best cut-off value for the serum IgG4 level to predict the post-operative recurrence was 95 mg/dL. The corresponding sensitivity and specificity were 39.7% and 80.5%, respectively. When we combined the two cut-off values for the serum IgG4 and periostin, patients with high serum levels of either IgG4 or periostin exhibited a high post-operative recurrence (OR: 3.95) as compared to patients having low serum levels of both IgG4 and periostin.ConclusionsThe present results demonstrate that the serum IgG4 level is associated with disease severity and post-operative course in CRS. In particular, the combination of serum IgG4 and periostin could be a novel biomarker that predicts post-operative recurrence.     

Validation of the Short-Form Esophageal Hypervigilance and Anxiety Scale

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Co-circulation of classic and novel astrovirus strains in patients with acute gastroenteritis in Germany

Objectives

In order to analyze the molecular epidemiology of human astroviruses (HAstV) in Germany, a retrospective long-term study was performed to characterize circulating human astrovirus in patients with acute gastroenteritis in Germany.