结核病患者外周血γ干扰素释放试验假阴性的相关因素分析

目的 分析影响结核病患者外周血γ干扰素释放试验(interferon-gamma release assay,IGRA)检测假阴性的影响因素。方法 回顾性分析2018年1月至2020年3月解放军总医院第八医学中心结核四科收治的资料完整、外周血IGRA检测阴性和阳性的结核病患者,分别作为IGRA假阴性组(38例)和IGRA阳性组(119例),收集其一般情况、病史特点、血清生化指标和外周血淋巴细胞亚群,采用单因素和多因素logistic回归分析导致IGRA检测结果假阴性的影响因素。结果 IGRA假阴性组淋巴细胞计数、T细胞计数、CD4⁺T细胞计数、CD8⁺T细胞计数、NKT细胞计数M(Q₁,Q₃)分别为1.15(0.77,1.58)×10⁹个/L、867.50(508.75,1135.50)个/μl、493.00(256.00,673.75)个/μl、254.50(170.25,429.25)个/μl、38.50(16.50,88.25)个/μl,均明显低于IGRA阳性组[分别为1.46(0.99,1.88)×10⁹个/L、1013.00(667.00,1394.00)个/μl、590.00(386.00,850.00)个/μl、335.00(232.00,561.00)个/μl、57.00(30.00,121.00)个/μl,差异均有统计学意义(Z值分别为-2.512、-2.143、-2.092、-2.303、-2.338,P值分别为0.012、0.032、0.036、0.021、0.019)。logistic回归分析结果显示,NKT细胞计数低于正常值(<40个/μl)的患者,IGRA检测出现假阴性的风险是NKT细胞计数正常者的2.440倍(95%CI:1.159~5.134)。结论 NKT细胞计数的减少可能导致外周血IGRA出现假阴性。     

以肺间质疾病为主要表现的免疫缺陷病六例分析

目的探讨以肺间质疾病为主要表现的免疫缺陷病的临床特征,提高对免疫缺陷引起的肺间质疾病的认识。方法回顾性分析2014年1月至2016年12月收治在深圳市儿童医院的6例以肺间质疾病为主要表现就诊且最终诊断为免疫缺陷病患儿(男5例、女1例)病例资料,分析免疫缺陷相关的肺间质疾病的临床特点和诊断线索。结果6例患儿年龄3月龄~5岁9月龄,均表现为咳嗽、气促;3例急性肺部感染和呼吸衰竭;2例慢性缺氧;1例杵状指和趾;3例皮疹;5例营养不良。6例胸部CT均表现为双肺弥漫性磨玻璃密度影,其中2例有囊状影,1例"铺路石征"。5例确诊免疫缺陷前均怀疑肺表面活性物质功能障碍并进行基因检测,结果阴性。通过人类免疫缺陷病毒抗体、免疫功能检查和(或)基因检测,最终诊断1例获得性免疫缺陷综合征、2例高IgM综合征、1例高IgE综合征、1例湿疹-血小板减少伴免疫缺陷综合征、1例STAT3基因功能获得性变异。回顾分析所有病例均有提示免疫缺陷的临床线索。结论免疫缺陷引起的肺间质疾病主要表现为咳嗽、气促或慢性缺氧,合并感染可引起呼吸衰竭,影像主要表现为弥漫性磨玻璃密度影。仔细询问病史和免疫筛查可发现诊断免疫缺陷的线索。肺间质疾病的病因诊断程序中应重视免疫缺陷病的筛查,否则可能导致漏诊或不必要的检查。     

Immunologic non-inferiority and safety of the investigational pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) 4-dose vial presentation compared to the licensed PHiD-CV 1-dose vial presentation in infants: A phase III randomized study

BackgroundTo support vaccination programs in developing countries, a 4-dose vial presentation of pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) was developed. This study assessed immunologic non-inferiority and safety of the investigational PHiD-CV 4-dose versus licensed 1-dose vial presentation in infants.MethodsIn this phase III, mono-center, observer-blind study in Bangladesh, 6–10-week-old infants were randomized 1:1 to receive PHiD-CV primary vaccination (at ages 6, 10, 18 weeks) and a booster dose (at age 9 months) with a 4-dose vial (with preservative, 4DV group) or 1-dose vial (preservative-free, 1DV group). DTPw-HBV/Hib was (co)-administered per study protocol and polio, measles and rubella vaccines as part of the national immunization program. Non-inferiority of PHiD-CV 4-dose versus 1-dose vial for each vaccine pneumococcal serotype (VT) and vaccine-related serotype 19A in terms of antibody geometric mean concentration (GMC) was assessed (criterion: upper limit of 2-sided 95% confidence interval of antibody GMC ratios [1DV/4DV] <2-fold). Immune responses were measured. Solicited, unsolicited and serious adverse events (AEs) were evaluated.ResultsOf 320 infants (160 per group) vaccinated during the primary vaccination phase, 297 received a booster. Non-inferiority was demonstrated for each VT and 19A. One month post-primary vaccination, for most VT, ≥97.9% of infants in each group had antibody concentrations ≥0.2 μg/mL; for 19A ≥ 80.1% reached this threshold. Pneumococcal antibody responses and opsonophagocytic activity for each VT and 19A were within similar ranges between groups after primary and booster vaccination, as were anti-protein D responses. Booster immune responses were observed in both groups. Reported AEs were within similar ranges for both presentations.ConclusionImmunologic non-inferiority of PHiD-CV 4-dose vial (with preservative) versus PHiD-CV 1-dose vial (preservative-free) was demonstrated. Immune responses and reactogenicity following primary/booster vaccination were within similar ranges for both presentations. PHiD-CV 4-dose vial would help improve access and coverage in resource-limited countries.Clinical Trial Registry: NCT02447432.     

Relationship between functional disc position and mandibular displacement in adolescent females: posteroanterior cephalograms and magnetic resonance imaging retrospective study

The purpose of this study was to investigate the relationship between the disc positions of temporomandibular joints (TMJ), the vertical and lateral mandibular displacement (VMD and LMD, respectively) and age in female adolescents with signs and symptoms of the temporomandibular disorders (TMD). The VMD and LMD were assessed, using posteroanterior (PA) cephalograms. The disc positions were assessed by magnetic resonance imaging (MRI) and categorized as follows: normal disc position, functional disc displacement and functional disc dislocation. Excluding patients with osteoarthritis, the total number of subjects was 54 female adolescents who were grouped into three: the bilateral normal disc position group, the unilateral or bilateral functional disc displacement group, and the unilateral or bilateral functional disc dislocation group. We compared the extent of VMD and LMD between the three groups, and investigated their correlation with age. Results indicate that functional disc displacement and dislocation are related to mandibular displacement, and VMD did not correlate with age but LMD did correlate with age. This study suggests that the onset of disc displacement is related to the mandibular displacement and disturbs normal growth of the mandible three-dimensionally.     

Temporomandibular joint internal derangement: detection with 12.5 MHz ultrasonography

The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) internal derangement (ID). In 48 consecutive patients with TMJ disorders 192 TMJ positions were investigated by US to analyse the functional disc-condyle relationship (DCR). In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 0.58 and 0.75, and a specificity of 0.92 and 0.84 for disc displacement with and without reduction, the data revealed US to be marginal in detecting the presence, but sensitive in detecting the absence of the respective types of a TMJ ID. In addition, with a positive predictive value of 0.83 and 0.71, and a negative predictive value of 0.81 and 0.87 for disc displacement with and without reduction, the results indicate that US may be insufficient in establishing a correct diagnosis for the presence or absence of the respective types of TMJ ID. Regarding the diagnosis of absence or presence of TMJ ID, the results demonstrate high-resolution (HR)-US to be sensitive in detecting the absence, and reliable in predicting the presence of TMJ ID. In view of the fact that the 12.5 MHz US technique proved to be a reliable diagnostic aid for the detection of normal, and the prediction of abnormal DCR, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.     

颞下颌关节骨关节炎与关节内紊乱关系的研究

目的 :探讨颞颌关节骨关节炎 (TMJOA)与颞颌关节内紊乱 (TMJID)的关系。方法 :利用MRI金标准 ,对 44例颞颌关节紊乱病患者 88侧关节完成开闭口T1加权成像 ,观察盘突关系和骨改变。结果 :88个关节中40 .9% ( 3 6/88)表现为TMJID ,13 .6% ( 12 /88)表现为TMJOA ,骨改变的分布情况 :正常盘突关系 (NDCR)关节中 2个 ,破坏和骨赘各 1个 ;可复性关节盘前移位 (ADDR)关节中 3个全部表现为骨破坏 ;不可复性关节盘前移位 (AD DWR)关节中 7个 ,表现为髁状突变平 3个 ;表现为破坏、骨赘、硬化和短小各 1个 ,统计学分析发现TMJOA与TMJID具有显著相关性。结论 :TMJOA的发生与关节结构紊乱显著相关。由于TMJOA可独立于TMJID之外而单独存在 ,目前将TMJOA看作是与TMJID密切相关的另一类疾病较为合适。     

颞下颌关节渗出液与内紊乱的关系

目的探讨渗出液与颞下颌关节内紊乱(TMJID)的关系,揭示渗出液的成因。方法用磁共振成像技术,对44例单侧关节疼痛、颞下颌关节紊乱病患者88侧关节完成开闭口T1、闭口T2加权成像,观察TMJID与关节腔渗出液的发生率。结果33个关节腔存在渗出液,占37.5%,其中21个(63.6%)表现为TMJID:9个(27.3%)为可复性关节盘前移位(ADDR),12个(36.3%)为不可复性关节盘前移位(ADDWR);而55个无渗出液的关节中,15个(27.3%)表现为TMJID,其中8个(14.5%)为ADDR,7个(12.8%)为ADDWR。经统计学分析,TMJID的发生在有渗出液关节与无渗出液关节差异具有统计学意义(P<0.05);去除少量渗出液的关节后,进一步分析发现两者差异仍有统计学意义(P<0.05)。结论渗出液可能反映了盘突关系异常所致的关节内炎症反应的存在。     

TMJ symptoms reduce chewing amplitude and velocity,and increase variability

Objective: The null hypothesis was that mandibular amplitude, velocity, and variability during gum chewing are not altered in subjects with temporomandibular joint (TMJ) internal derangements (ID).

Methods: Thirty symptomatic subjects with confirmed ID consented to chew gum on their left and right sides while being tracked by an incisor-point jaw tracker. A gender and age matched control group (p > 0.67) volunteered to be likewise recorded. Student’s t-test compared the ID group’s mean values to the control group.

Results: The control group opened wider (p < 0.05) and chewed faster (p < 0.05) than the ID group. The mean cycle time of the ID group (0.929 s) was longer than the control group (0.751 s; p < 0.05) and more variable (p < 0.05).

Discussion: The ID group exhibited reduced amplitude and velocity but increased variability during chewing. The null hypothesis was rejected. Further study of adaptation to ID by patients should be pursued.     

Open mandibular condylotomy (osteotomy) with precision scaphoid staple osteosynthesis and meniscopexy. A description of the operation

The technical minutiae of the operation of open mandibular condylotomy and precision scaphoid staple osteosynthesis with meniscoplasty or meniscopexy is described and illustrated. The operation is regarded as an evolution of closed condylotomy described by Ward in 1961 and is indicated for those cases of severe and persistent temporomandibular joint pain and crepitus unresponsive to skilled conservative treatment over a reasonable time. The success of the procedure is probably the sequel of a partial denervation of the joint capsule associated with arthrotomy, the interruption of venous hypertension, the relocation of the mandibular condyle and enlargement of the joint space. The operation is also applicable to cases of active (and inactive) mandibular condylar hyperplasia wherein a condylar neck ostectomy and staple is used to ablate an active growth centre or correct a lesser degree of mandibular asymmetry.     

微波对红细胞免疫功能的影响

体外实验证明，微波输出功率８０Ｗ，辐射时间２分钟，对红细胞免疫功能有明显的促进作用．２０例正常人静脉血微波辐射后ＲＢＣ－ＣＲ＿１花环率显著提高（Ｐ＜０．０１），ＲＢＣ－ＩＣ花环率则无变化（Ｐ＞０．０５）．肿瘤、风湿性心脏病、冠心病及肺疾病患者静脉血共８０例，微波辐射后ＲＢＣ－ＣＲ＿１及ＲＢＣ－ＩＣ花环率均明显提高．实验提示，微波的这种生物学效应为非热效应，临床上应根据不同个体选择不同的微波输出功率和辐射时间，才能充分发挥微波的生物学效应，提高患者的红细胞免疫功能．