Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets.MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS).ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria.ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.     

Treatment of thalassaemia: a review of the new approaches on transfusion safety and the novel therapeutics

Lifetime red cell concentrate (RCC) transfusions still account for significant iron overload‐related morbidity and mortality despite chelation therapy in thalassaemia. The cumulative risk of transfusion‐transmitted infections is substantial for thalassaemia patients. Pathogen reduction technologies for RCC may imply a proactive approach against new/re‐emerging pathogens and may be an ultimate safeguard for transfusion safety in the developing countries. Red cell alloimmunization may become a significant clinical challenge in thalassaemia. The availability of high‐throughput molecular blood group antigen typing in the donors may allow perfect match transfusion, beyond ABO‐D and CEK antigen‐matched transfusions. Allogeneic stem cell transplantation (A‐SCT) is the only available curative therapy in thalassaemia, but carries a substantial risk of serious adverse events and mortality. Gene addition therapy for correction of the α‐globin chain imbalance overcomes the problems of donor availability and immunological complications of A‐SCT. Gene editing by either gene disruption or correction emerged as a potential alternative to gene addition therapy in beta‐thalassaemia. A new era of novel therapeutics targeting α/β imbalance, ineffective erythropoiesis or iron dysregulation is unfolding in thalassaemia management, and a number of those now have agents in preclinical and clinical development. Hydroxyurea (HU) may improve globin chain imbalance and be beneficial for reducing or omitting transfusion requirement. Ruxolitinib has allowed steady decrease in spleen volume that may serve for avoiding splenectomy in beta‐thalassaemia. Luspatercept may restore normal erythroid differentiation and improve anaemia. Hepcidin mimetics or TMPRSS6 inhibitors may modulate ineffective erythropoiesis by iron restriction and improve anaemia and organ iron loading.     

A guide to oral vaccination: Highlighting electrospraying as a promising manufacturing technique toward a successful oral vaccine development

Most vaccines approved by regulatory bodies are administered via intramuscular or subcutaneous injections and have shortcomings, such as the risk of needle-associated blood infections, pain and swelling at the injection site. Orally administered vaccines are of interest, as they elicit both systemic and mucosal immunities, in which mucosal immunity would neutralize the mucosa invading pathogen before the onset of an infection. Hence, oral vaccination can eliminate the injection associated adverse effects and enhance the person's compliance. Conventional approaches to manufacturing oral vaccines, such as coacervation, spray drying, and membrane emulsification, tend to alter the structural proteins in vaccines that result from high temperature, organic and toxic solvents during production. Electrohydrodynamic processes, specifically electrospraying, could solve these challenges, as it also modulates antigen release and has a high loading efficiency. This review will highlight the mucosal immunity and biological basis of the gastrointestinal immune system, different oral vaccine delivery approaches, and the application of electrospraying in vaccines development.     

Predicting the initial spread of novel Asian origin influenza A viruses in the continental USA by wild waterfowl

Using data on waterfowl band recoveries, we identified spatially explicit hotspots of concentrated waterfowl movement to predict occurrence and spatial spread of a novel influenza A virus (clade 2.3.4.4) introduced from Asia by waterfowl from an initial outbreak in North America in November 2014. In response to the outbreak, the hotspots of waterfowl movement were used to help guide sampling for clade 2.3.4.4 viruses in waterfowl as an early warning for the US poultry industry during the outbreak . After surveillance sampling of waterfowl, we tested whether there was greater detection of clade 2.3.4.4 viruses inside hotspots. We found that hotspots defined using kernel density estimates of waterfowl band recoveries worked well in predicting areas with higher prevalence of the viruses in waterfowl. This approach exemplifies the value of ecological knowledge in predicting risk to agricultural security.     

“透法”在外感热病中的运用

外感之邪从口鼻、皮毛侵袭人体,肺卫首先受邪。在外感病初期,肺卫失宣是病机的关键,治疗应重在宣通肺卫。外感风寒邪气,寒邪直接损伤卫阳,郁遏肺气,治当辛温解表。外感风热邪气,阳邪郁遏气机,损伤津液,易化燥化火,甚则内陷生变,治当辛凉解表。湿热邪气从口鼻、皮毛而入,初起即表现为卫气同病,治当宣化表里湿热。燥气为病,易伤肺脏、耗津液,与热相合则易化热化火,而成温燥,治宜辛凉甘润。外感热病初起,六淫邪气侵袭肺卫,气机郁滞,进而津停成饮、成痰;气有余便是火,郁滞之气化燥化火,甚则动血。治疗总则为宣通气机,此即"透法"之运用。故在外感热病初起的治疗中,贵在把握气机状态,让肺卫之气宣畅,正气宣布,则邪气潜消。     

贵阳地区儿童重症社区获得性肺炎肺泡灌洗液病原及药敏分析

目的分析贵阳地区儿童重症社区获得性肺炎支气管肺泡灌洗液（BALF）病原学分布及耐药特点。方法收集989例重症社区获得性肺炎患儿临床资料，将支气管肺泡灌液采用支气管镜取出进行细菌培养、病毒以及肺炎支原体(MP)检测。结果（1）989例重症社区获得性肺炎患儿病原检出阳性716例，阳性率72.40%，细菌、病毒、支原体检出率分别33.27% （329例）、22.45%（222例）、31.45%（311例）。（2）细菌感染中的肺炎链球菌、金黄色葡萄球菌为最为常见的革兰阳性菌株(G+)；而肺炎克雷伯菌、大肠埃希菌为最为常见的革兰阴性菌株(G-)。培养菌株对青霉素类、红霉素、第1、2、3代头孢类抗生素有较高的耐药性，对头孢吡肟、拉氧头孢、哌拉西林、左氧氟沙星有较高的敏感性，对亚胺培南、万古霉素、利奈唑烷均无耐药发生。（3）病毒感染检出222例，其中呼吸道合胞病毒131例，腺病毒检测49例，流感病毒6例（A型2例，B型4例），副流感病毒36例（1型3例、2型4例、3型29例），病毒检出率以0～12月龄组最高，RSV、ADV感染主要集中在冬春季节。（4）肺炎支原体检出阳性率31.45%（311例），肺炎支原体检出率以3～5岁组最高。结论贵阳地区重症肺炎中肺炎克雷伯杆菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌为重要的细菌病原。重要病毒为腺病毒和呼吸道病毒为主，1～12月龄组的病毒感染检出率比较高。     

1870株致病菌感染概况及敏感性情况

目的了解临床标本中主要致病菌分布及敏感性分析，指导抗生素的选择及合理治疗方法对我院1994～1996年临床分离的1870株细菌的分布及敏感性、耐药性进行分析，1996年与1994年的结果进行比较，并将1995年的结果与北京地区5家教学医院同年的结果进行比较。结果分离菌株主要分布于呼吸道、消化道、泌尿道、血液及骨髓。G＋菌占10.5％，G-菌占89.5％，占明显优势。沙门氏菌对头孢唑啉和哌拉西林的耐药性明显降低（P＜0.01），大肠埃希氏菌对氨苄西林和氟嗪酸的耐药性明显增高（P＜0.01），其余菌株无明显差异。抗生素敏感性覆盖率最高的是复达欣，其次为丁胺卡那，最低者氨苄西林。大肠埃希氏菌、假单胞菌对哌拉西林的耐药率，克雷伯杆菌属对西力欣的耐药率，肠肝菌属对哌拉西林的耐药率均高于北京地区。结论本组资料显示不断监测和分析菌丛的变化及对不同抗生素耐药性出现的频率和耐药谱至关重要。     

肺螨类生境研究

本文叙述了肺螨类的孳生环境及其不同生境里肺螨的种群分布,并对分离出的28种螨的生境和肺螨病患者的工作环境进行了对比分析,认为螨在肺螨病患者工作环境中的分布和肺螨的生境基本上相符合,因此证实了患者的病原体是直接来源于工作环境。     

肝脏移植术后肺部感染病原体调查及危险因素分析

目的　总结肝移植术后肺部感染的病原体分布特点并探讨其危险因素。方法　对我院1999年 11月至 2 0 0 3年 6月间的 130例肝脏移植进行前瞻性调查 ,统计其发病率、病死率 ,描述其时间分布、病原学分布 ,利用非条件Logistic回归方程筛选术后肺部感染危险因素。结果　肝移植术后肺部感染发病率为 32 .31% ,病死率为 35 .71%。 78.5 7%的肺部感染发生在术后第一周。革兰氏阴性菌是最常见肺部感染病原体且多高度耐药。肝移植术后肺部感染危险因素包括 :术后使用呼吸机≥ 2d、长时间手术、纤支镜检查或治疗、术前大量腹水、术后气管切开、术后肾功能异常、术后肺水肿、术后长时间留置胃管、术中长时间低血压。结论　肝移植术后肺部感染多发生在移植术后早期 ,具有高发病率、病死率高的特点。病原体多为具耐药性的革兰氏阴性菌。围手术期多方面因素均可能成为肺部感染的诱因 ,其防治工作必须贯穿整个围手术期     

病原生物学多媒体网络互动教学实验室的建设与展望

介绍了病原生物学多媒体网络互动教学实验室的建设和应具备的功能 ,论述了多媒体互动网络的建成对病原生物学实验教学环境和实验教学效果的积极促进作用 ,并对实验室以后的发展方向进行了展望