Vaccination rates and adherence in pneumococcal conjugate vaccination in mature born infants before and after vaccination schedule change – A claims database analysis

BackgroundIn August 2015, the German Standing Committee on Vaccination (STIKO) changed the pneumococcal conjugate vaccination (PCV) schedule for mature infants from a 3+1 scheme to a 2+1 scheme. It was expected that a reduction of doses would be associated with a higher acceptance of the vaccination. Aim of this study was to assess vaccination rates and adherence for PCV after the change of recommendation based on real-world data.MethodsA retrospective claims data analysis using the InGef Research Database was conducted. The study population consisted of all mature infants born in 2013 (last birth cohort completely under 3+1 recommendation) or 2016 (first birth cohort completely under 2+1 recommendation) with an individual follow-up of 24 months. Hexavalent combination vaccination (HEXA) with a consistent 3+1 recommendation was analyzed as reference.ResultsAfter follow-up of 24 months, 90.9% (91.2%) of the 2016 (2013) cohort received at least one dose of PCV. At the same age, 67.7% of the 2013 cohort received a booster dose according to the 3+1 schedule and 75.6% of the 2016 cohort received a booster dose presumably either according to the 2+1 (71.7%) or 3+1 (3.9%) schedule. Of those receiving the booster dose, only 46.3% (2016) and 45.1% (2013) received the booster dose on time as recommended. The HEXA vaccination rate increased from 88.9% (2013) to 91.6% (2016) with a full series completion in 69.1% (2013) vs 72.9% (2016). The proportion of infants receiving the booster vaccination on time rose to 50.0% in 2016 (47.8% in 2013).ConclusionsAlthough the rate for the PCV booster dose slightly increased, nearly a quarter of the infants born in 2016 did not receive a booster dose at all. Furthermore, vaccinations were still frequently delayed, and the rate of unvaccinated infants remained constant.     

Imaging benign gynaecological conditions

Radiology plays an essential role in the management of benign gynaecological conditions and includes: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities, their recommended roles in the imaging and imaging findings of common female pelvic pathology.     

Homemade Glove Retrieval Bag in Laparoscopic Complete Excision of Benign Ovarian Teratoma with Ovarian Tissue Preservation in Children: A Case Series

Study ObjectiveTo present our experience of laparoscopic resection of pediatric benign ovarian teratomas with gonadal preservation, using a homemade glove retrieval bag.Design, Setting, Participants, Interventions, and Main Outcome MeasuresReview of all girls with benign ovarian teratomas who were managed with laparoscopic ovarian-sparing surgery (OSS) at our hospital between January 2013 and December 2018.ResultsEleven patients were included for analysis with a mean age of 6.1 years. Ten patients received elective surgery, whereas 1 patient received emergency surgery because of ovarian torsion. Main indication for OSS was the existence of a dissection plane between tumor margins and healthy ovarian tissue. Postoperative outcome and follow-up were uneventful with a median follow-up of 30.1 months (range; 12-60 months).ConclusionLaparoscopic OSS can be safely performed for these tumors. Laparoscopic magnification with energy devices are excellent tools in such procedures. The homemade glove bag can be used to retrieve the tumor effectively in countries with limited resources.     

超声诊断小儿骶尾部畸胎瘤的价值

〔摘 要〕 目的：探讨超声在小儿骶尾部畸胎瘤（SCT）诊断中的应用价值。方法：回顾性选取 2015 年 1 月至 2020 年 9 月 期间于福建省妇幼保健院进行超声检查且病理证实的 SCT 患儿 27 例，分析其临床特征与超声特点。结果：26 例（96 %） 患儿年龄小于 1 岁，27 例 SCT 中成熟性畸胎瘤 25 例，未成熟性畸胎瘤 2 例。25 例成熟性畸胎瘤囊性为主 16 例（64 %）， 囊实混合性 7 例（28 %），实性为主 2 例（8 %）；Altman 分型 Ⅰ 型 19 例，Ⅱ 型 3 例，Ⅲ 型 2 例，Ⅳ 型 1 例，术前超声提 示 SCT 20 例，5 例未做定性诊断。2 例未成熟性畸胎瘤均为囊实混合性（100 %）；Altman 分型均为 Ⅰ 型，术前超声均提 示 SCT。27 例患儿术后随访 6 个月至 76 个月，除 2 例成熟性畸胎瘤术后原位恶性复发卵黄囊瘤，余患儿未见异常。结论： SCT 多见于 1 岁以下婴幼儿，超声能对大部分 SCT 做出初步诊断及分类。     

单中心卵巢畸胎瘤患者中合并抗N-甲基-D-天冬氨酸受体脑炎的比例调查及临床特征分析

目的 探究卵巢畸胎瘤患者中发生抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的比例,并将合并抗NMDAR脑炎的卵巢畸胎瘤患者与未合并抗NMDAR脑炎的卵巢畸胎瘤患者的临床特征进行总结对比。方法 收集卵巢畸胎瘤患者的临床资料,将其分为合并抗NMDAR脑炎组与未合并抗NMDAR脑炎组,对其临床特征进行对比分析。结果 共收集到168例卵巢畸胎瘤患者,其中14例（8.3%）合并抗NMDAR脑炎;合并抗NMDAR脑炎的卵巢畸胎瘤患者年龄低于未合并抗NMDAR脑炎的卵巢畸胎瘤患者[（23.8±5.5）岁 vs. （29.8±9.1）岁,P = 0.016]。合并抗NMDAR脑炎的卵巢畸胎瘤患者肿瘤标志物以癌抗原125及血清铁蛋白升高为主,而未合并抗NMDAR脑炎的卵巢畸胎瘤患者肿瘤标志物以糖类抗原199升高为主。合并抗NMDAR脑炎与未合并抗NMDAR脑炎的卵巢畸胎瘤患者的肿瘤组织均可含有神经组织。结论 卵巢畸胎瘤患者中发生抗NDMAR脑炎的比例不低,对于无明显症状的卵巢畸胎瘤患者,可考虑积极行手术治疗,以降低发生抗NMDAR脑炎的风险。     

Immune checkpoints and the regulation of tolerogenicity in dendritic cells: Implications for autoimmunity and immunotherapy

The immune system is responsible for defending the host from a large variety of potential pathogens, while simultaneously avoiding immune reactivity towards self-components. Self-tolerance has to be tightly maintained throughout several central and peripheral processes; immune checkpoints are imperative for regulating the immunity/tolerance balance. Dendritic cells (DCs) are specialized cells that capture antigens, and either activate or inhibit antigen-specific T cells. Therefore, they play a key role at inducing and maintaining immune tolerance. DCs that suppress the immune response have been called tolerogenic dendritic cells (tolDCs). Given their potential as a therapy to prevent transplant rejection and autoimmune damage, several strategies are under development to generate tolDCs, in order to avoid activation and expansion of self-reactive T cells. In this article, we summarize the current knowledge relative to the main features of tolDCs, their mechanisms of action and their therapeutic use for autoimmune diseases. Based on the literature reviewed, autologous antigen-specific tolDCs might constitute a promising strategy to suppress autoreactive T cells and reduce detrimental inflammatory processes.     

Primary study in maturity status of native arteriovenous fistula on the wrist

Object To investigate the maturity status of the cephalic vein when the native arteriovenous fistula matures and set up indicators of a matured native arteriovenous fistula. Methods The diameter, flow rate and wall thickness of the cephalic vein were prospectively measured by Doppler ultrasound after the native fistula was created. Mature judgment was done by skilled nurses depending on their experience before the fistula was punctured. The ultrasound data was marked as proposed mature at the same time. After three times dialysis, if blood flow was fluent and complications such as prolonged bleeding time and hematoma were absent, fistula mature was confirmed. Results Thirty-one patients were admitted to the study, then fistula were matured. The average age of those patients was (52.93±3.21) years old. Thirteen patients were female. Twenty two fistula located on the left arm. Thirteen of the patients were diabetic nephropathy. The average diameter of cephalic vein was increased from (3.10±0.11) mm before surgery to (4.74±0.16) mm when the fistula was matured, though it was still smaller than 6 mm which K/DOQI guideline had recommended (P＜0.05). The average mature period was (57.10±3.21) days. The matured fistula had an average high flow rate of (569.76±48.34) ml/min and wall thickness of (0.95±0.04) mm. The one-side 95% credibility interval of the diameter, flow rate and wall thickness of cephalic vein was 4.44 mm, 486.37 ml/min and 0.67 mm, respectively. Conclusions The diameter of cephalic vein in a matured native arteriovenous fistula in our study was significantly smaller than 6 mm which K/DOQI guideline had recommended. The indicators of native arteriovenous fistula mature in our country may different from abroad.     

Paraneoplastic neurological disorders in children with benign ovarian tumors

Aim: Paraneoplastic neurological diseases (PND) are rare, but potentially treatable disorders. Paraneoplastic encephalitis is rapidly emerging as an important but likely under-recognized condition in children. The aim of this study was to assess the prevalence and spectrum of PND in children with benign ovary tumor and the long-term outcome. Patients and methods: We retrospectively reviewed the charts of all female patients below 18 years of age diagnosed with a benign ovarian tumor proven by pathology between January 1993 and December 2010. All the clinical symptoms developed within 5 years of tumor diagnosis and the related investigations were recorded. Results: There were total 133 children and adolescents with benign ovarian tumors, mostly mature teratoma. Six patients (4.5%) had neuropsychiatric manifestations and all but one were beyond age 10 years. The most common neuropsychiatric presentations were depression or low mood (84%), headache (50%), mutism (50%), hypoventilation (50%), seizures (30%), hallucination (30%), vomiting and hypersalivation (30%). Three patients (2.2%) had serious PND including acute disseminated encephalomyelitis in 1 and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in 2. Although all of three improved after tumor removal, one without immunotherapy had neurological sequelae and prolonged ICU stay. Conclusion: The prevalence of PND in benign ovary tumor is not so uncommon in children. It is important to survey ovary tumors in female adolescents with subacute presentation of multiple-level involvement of neuraxis where no clear alternate diagnosis is possible. Treatment of serious PND associated with ovary tumors should include immunotherapy in addition to tumor removal.