An observational study of antibody responses to a primary or subsequent pertussis booster vaccination in Australian healthcare workers

Adult pertussis vaccination is increasingly recommended to control pertussis in the community. However, there is little data on the duration and kinetics of immunity to pertussis boosters in adults. We compared IgG responses to vaccination with a tetanus, low-dose diphtheria, low-dose acellular pertussis (Tdap) booster at 1 week, 1 month and 1 year post-vaccination in whole-cell (wP)-primed Australian paediatric healthcare workers who had received an adult Tdap booster 5–12 years previously, to those who received their first Tdap booster.Tdap vaccination was well tolerated in both groups. Previously boosted adults had significantly higher pre-vaccination IgG concentrations for all vaccine-antigens, and more were seropositive for pertussis toxin (PT)-specific IgG (≥ 5 IU/mL) (69.5%; 95% confidence interval (CI) 59.5–79.5) than adults in the naïve group (45.2%; 95% CI 32.8-57.5). Tdap vaccination significantly increased IgG responses 1 month post-vaccination in both groups. This increase was more rapid in previously boosted than in naïve adults, with geometric mean fold-increases in PT-IgG at 1 week post vaccination of 3.6 (95% CI 2.9–4.3) and 2.6 (95% CI 2.2–3.2), respectively. Antibody waning between 1 month and 1 year post-vaccination was similar between groups for IgG specific to PT and filamentous haemagglutinin (FHA), but was faster for IgG against pertactin (PRN) in the naïve group (GMC ratio 0.36; 95% CI 0.31–0.42) than the previously boosted group (GMC ratio 0.45; 95% CI 0.39–0.50). At baseline, all but one adult had protective IgG titres against tetanus toxin (TT) (≥ 0.1 IU/mL), and 75.6% in the previously boosted and 61.3% in the naïve group had protective IgG titres against diphtheria toxoid (DT) of ≥ 0.1 IU/mL.This study shows that pertussis immune memory is maintained up to 12 years after Tdap vaccination in wP-primed Australian adults. There was no evidence that pertussis immune responses waned faster after a booster dose. These findings support current recommendations of repeating Tdap booster vaccination in paediatric healthcare workers at least every 10 years. Clinical trials registry: ACTRN12615001262594.     

海洋青铜小单孢菌FIM 02-523全基因组测序及分析

青铜小单孢菌(Micromonospora chalcea, M. chalcea)FIM 02-523能够合成对乏氧肿瘤细胞、艰难梭菌等具有活性的环脂肽类化合物rakicidins。利用Illumina HiSeq高通量测序平台,本研究首次对M. chalcea FIM 02-523进行全基因组测序,得到总长约6.74Mb的序列信息。分析表明基因组GC含量为72.89%,包含了6167个蛋白编码序列。利用AntiSMASH预测基因组中存在19个生物合成基因簇。结合PKS/NRPS生物合成特征和rakicidins化学结构特点,定位到了rakicidins的生物合成基因簇,并初步推测其生物合成途径。研究为M. chalcea FIM 02-523的功能基因组学研究和代谢调控提供了理论基础。     

早期康复对脑卒中患者功能活动能力的影响

采用FIM量表对68例急性脑卒中患者功能活动能力进行临床对照研究。两组患者在病后3月时的功能活动能力均有不同程度的改善，但康复组优于对照组（P＜0．001），在恢复独立功能活动者中，康复组16例（47．06％），对照组4例（11．76％）。研究结果表明，早期康复干预有助于脑卒中患者独立功能活动能力的恢复；患者在病后1月内，FIM评定为72．25±20．96分考，经早期康复治疗有可能达到功能活动独立。     

肌电生物反馈联合康复训练对脊髓损伤患者运动功能及功能独立性的影响

目的:观察肌电生物反馈疗法联合康复训练对脊髓损伤(SCI)患者运动功能障碍的康复疗效。方法:60例胸腰段不完全性脊髓损伤患者随机分为观察组和对照组,每组30例。2组均进行常规康复治疗,观察组加用双下肢肌电生物反馈治疗。治疗前及治疗后8周、12周进行下肢肌肉最大收缩时表面肌电(sEMG)信号采集、运动功能评定及功能独立性(FIM)评定,比较临床疗效。结果:治疗8周后,2组患者股四头肌、胫前肌最大收缩时的sEMG信号均较治疗前明显提高(P0.05),治疗后12周继续提高(P0.01);观察组sEMG信号增幅高于对照组(P0.05)。治疗8周后,2组患者ASIA运动功能评分及FIM评分亦较治疗前提高(P0.05),组间比较差异无统计学意义;治疗12周后,2组ASIA运动功能及FIM评分较治疗8周后提高更明显(P0.01),观察组更高于对照组(P0.05)。结论:肌电生物反馈疗法联合康复训练对胸腰段不完全性脊髓损伤患者运动功能有促进作用,能明显提高患者的股四头肌、胫前肌表面肌电信号及肌力,并能提高功能独立水平,减少并发症。     

The work of rehabilitation

Purpose. To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation.

Method. A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000 - 2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores.

Results. Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM.

Conclusions. The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.     

Increasing FIM2/3 antigen-content improves efficacy of Bordetella pertussis vaccines in mice in vivo without altering vaccine-induced human reactogenicity biomarkers in vitro

Current acellular-pertussis (aP) vaccines appear inadequate for long-term pertussis control because of short-lived efficacy and the increasing prevalence of pertactin-negative isolates which may negatively impact vaccine efficacy. In this study, we added fimbriae (FIM)2 and FIM3 protein to licensed 2-, 3- or 5-component aP vaccines (Pentavac®, Boostrix®, Adacel®, respectively) to assess whether an aP vaccine with enhanced FIM content demonstrates enhanced efficacy. Vaccine-induced protection was assessed in an intranasal mouse challenge model. In addition, potential reactogenicity was measured by biomarkers in a human whole blood assay (WBA) in vitro and benchmarked the responses against licensed whole cell pertussis (wP) and aP vaccines including Easyfive®, Pentavac® and Pentacel®. The results show that commercial vaccines demonstrated reduced efficacy against pertactin-negative versus pertactin-positive strains. However, addition of higher amounts of FIM2/3 to aP vaccines reduced lung colonization and increased vaccine efficacy against a pertactin-negative strain in a dose-dependent manner. Improvements in efficacy were similar for FIM2 and FIM3-expressing strains. Increasing the amount of FIM2/3 proteins in aP formulations did not alter vaccine-induced biomarkers of potential reactogenicity including prostaglandin E₂, cytokines and chemokines in human newborn cord and adult peripheral blood tested in vitro. These results suggest that increasing the quantity of FIM proteins in current pertussis vaccine formulations may further enhance vaccine efficacy against B. pertussis infection without increasing the reactogenicity of the vaccine.     

颅脑外伤患者高压氧介入时间对FIM评分的影响

目的：观察颅脑外伤患者高压氧介入时间对功能独立性评定（FIM）评分的影响,为探讨综合康复治疗最佳介入时机提供临床依据。方法选择中重型颅脑外伤患者130例,根据受伤时间分为对照组25例,综合康复1组（TBI〈15d）与综合康复2组（15d≤TBI≤30d）各40例,综合康复3组（TBI〉30d）25例,均给予药物治疗和康复措施,综合康复各组在前述的基础上行高压氧治疗共40次,以治疗前和治疗第30天、60天的FIM评分进行疗效评价。结果资料完整、实际纳入组TBI患者共123例,各组临床资料有可比性。各组内TBI患者在治疗第30天、60天的FIM评分差异有统计学意义（P〈0.05）。各组间TBI患者第1天FIM评分差异无统计学意义（P〈0.05）,对照组与综合康复1、2组在第30天、60天差异有统计学意义（P〈0.05）。结论三组TBI患者2个月内FIM评分改善呈匀速好转趋势,30d内的高压氧综合康复1、2组对认知与运动功能改善作用明显优于对照组,优于综合康复3组患者。     

康复训练对慢性精神分裂症患者社会功能的影响

目的探讨院内分类康复训练对慢性精神分裂症患者社会功能康复的影响。方法将120例慢性精神分裂症患者随机分为训练组与对照组各60例;训练组根据功能独立性评定量表评分分为轻度组（≥80分）30例,重度组（〈80分）30例;两组均维持原用抗精神病药物治疗和一般日常管理,训练组在此基础上根据轻、重度分类进行系统康复训练,观察24周。于训练前及训练第4周、12周、24周末采用功能独立性评定量表、阴性症状量表进行评定分析。结果对照组训练前后功能独立性评定量表、阴性症状量表评分均无显著变化（P〉0．05）;训练组训练后各时段功能独立性评定量表评分均呈持续性升高,而阴性症状量表评分均呈持续性下降。轻度组各时段功能独立性评定量表评分均显著高于重度组及对照组（P〈0．05或0．01）;重度组训练前及训练4周末均显著低于对照组（P〈0．05或0．01）,而训练24周末显著高于对照组（P〈0．01）。轻度组训练前及训练后各时段阴性症状量表评分均显著低重度组及对照组（P〈0．01）;重度组训练前显著高于对照组（P〈0．05）,而训练第12周、24周末显著低于对照组（P〈0．01）。结论在药物治疗基础上,联合院内分类康复训练,能显著缓解患者的阴性症状,改善社会功能,提高功能独立性。     

Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-CompassTM

Background

Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic “Rehab-Compass,” a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

高压氧不同时间窗治疗对颅脑损伤患者认知功能的影响

目的研究高压氧治疗颅脑损伤患者在不同时间的临床治疗效果。方法选取2013-01—2016-01我院确诊为颅脑损伤的患者300例,随机分为3组进行研究,Ⅰ组83例为1周内行高压氧治疗的患者;Ⅱ组95例为入院1~4周行高压氧治疗的患者;Ⅲ组122例为4周以上行高压氧治疗的患者。记录3组治疗前与治疗后NCSE评分,采用FIM对3组患者行独立功能评价,比较治疗前后的总有效率。结果经我院高压氧治疗后3组患者认知功能及独立功能均明显有效于治疗前(P0.05),Ⅰ组的认知功能优于Ⅱ组和Ⅲ组(P0.05),但Ⅱ组和Ⅲ组无差异性(P0.05);FIM评价治疗后3组患者恢复效果明显高于治疗前(P0.05);Ⅱ组、Ⅲ组患者FIM数据明显低于Ⅰ组,差异具有统计学意义(P0.05),Ⅱ组、Ⅲ组间无显著差异(P0.05),Ⅰ组治疗总有效率显示高于其他2组,差异具有统计学意义(P0.05)。结论早期接受高压氧治疗可明显缓解或治愈颅脑损伤,最大程度提升认知功能,促使患者早日恢复自主生活能力,值得推广应用。