1H nuclear magnetic resonance-based metabolic profiling of cerebrospinal fluid to identify metabolic features and markers for tuberculosis meningitis

BackgroundTuberculosis meningitis (TBM) is the most severe form of tuberculosis, and currently lacks efficient diagnostic approaches. Metabolomics has the potential to differentiate patients with TBM from those with other forms of meningitis and meningitis-negative individuals. However, no systemic metabolomics research has compared the cerebrospinal fluid (CSF) of these patients.Methods¹H nuclear magnetic resonance (NMR) was used for CSF metabolic profiling. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OPLS-DA) were used to screen for important variables. The Human Metabolome Database was used to identify metabolites, and MetaboAnalyst 4.0 was used for pathway analysis and over-representation analysis.ResultsOPLS-DA modeling could distinguish TBM from other forms of meningitis, and several significantly changed metabolites were identified. Additionally, 23, 6, and 21 metabolites were able to differentiate TBM from viral meningitis, bacterial meningitis, and meningitis-negative groups, respectively. Pathway analysis indicated that these metabolites were mainly involved in carbohydrate and amino acid metabolism, and over-representation analysis indicated that some of these pathways were over-represented.ConclusionsThe metabolites identified have the potential to serve as biomarkers for TBM diagnosis, and carbohydrate and amino acid metabolism are perturbed in the CSF of patents with TBM. Metabolomics is a valuable approach for screening TBM biomarkers. With further investigation, the metabolites identified in this study could aid in TBM diagnosis.     

海芋散在复治肺结核中的作用初探

目的探讨经炮制海芋散在复治肺结核中的作用。方法把102例多治病人随机分成两组。采用WHO推荐的复治方案3H3R3Z3E3／6H3R3E3为对照组（51例），将用复治方案3H3R3Z3E3／6H3R3E3，加口服经炮制海芋散作为治疗组（51例），对病例的症状体征、病灶吸收情况、空洞吸收和闭合情况、痰菌阴转情况及不良反应发生的情况进行观察研究。结果症状体征改变情况治疗组总有效率为96．0％，对照组为66．7％（P〈0．01）；病灶吸收情况治疗组为96．1％，对照组为64．7％，治疗组明显高于对照组（P〈0．01）：空洞吸收或闭合治疗组为98．0％，对照组为68．6％，治疗组明显高于对照组（P〈0．01）；痰菌阴转情况治疗组为94．1％。对照组为70．5％，治疗组明显高于对照组（P〈0．05）；不良反应发生情况治疗组为25．1％，对照组为52．2％．治疗组显著低于对照组（P〈0．01）。结论加服用经炮制海芋散联合抗痨化疗组合药物治疗复治肺结核的疗效优于单纯用抗痨化疗组合药的化疗方案，且可减轻抗痨化学药物的不良反应，作用肯定，值得在临床中进一步探讨研究。     

2011—2020年重庆市结核病防治经费投入与效益产出分析

目的 评估重庆市2011—2020年结核病防治经费投入产生的社会效益。方法 收集《传染病监测系统》中2011—2020年重庆市登记涂阳肺结核患者（初治涂阳和复治涂阳）治疗转归情况和肺结核患者劳动人口比例,历年各级政府结核病防治经费投入,历年全市人均国内生产总值（gross domestic product,GDP）等数据,采用常用卫生经济学方法评估10年间结核病防治经费投入的社会效果、社会效用和社会效益。结果 2011—2020年,全市共投入结核病防治经费约3.60亿元,成功治疗涂阳肺结核患者60 924例,避免45.69万名健康人受传染,挽救43.41万个伤残调整生命年（disability adjusted life year,DALY）,为社会节约医疗费用3.26亿元,挽回社会经济损失约176.25亿。保持目前的设施设备和人员条件不变,每投入787.70元即可避免1名健康人被传染,每投入829.16元即可挽救1个DALY,每额外投入1元即可产生49.87元的经济效益。结论 10年间重庆市结核病防治经费投入产生了较大的卫生经济效益,建议各级政府继续加大结核病防治经费投入。     

Examining the temporality of vitamin E acetate in illicit THC-containing e-cigarette,or vaping,products from a public health and law enforcement response to EVALI — Utah, 2018-2020

BackgroundIn the summer of 2019, e-cigarette, or vaping, product use-associated lung injury (EVALI) was detected in the United States. Multiple agencies reported illicit tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products containing vitamin E acetate (VEA) as a substance of concern.MethodsAs an expansion of the Utah Department of Health's response to EVALI, the Utah Public Health Laboratory and the Utah Department of Public Safety screened 170 products from 96 seizures between October 2018 and January 2020. Using Pearson's correlation coefficient, we analyzed the temporal correlation of national, and Utah specific case counts, and the percentage of seizures indicating VEA by month.ResultsThe findings indicate strong and significant correlations between seizures indicating VEA and both the national (r = 0.70, p = 0.002) and Utah specific (r = 0.78, p < 0.001) case counts.ConclusionThese findings underscore that VEA should not be added to e-cigarettes, or vaping, products and the importance of collaboration with law enforcement when responding to outbreaks associated with illicit substances.     

Discitis and sacroiliitis diagnosed 15 years after iatrogenic Mycobacterium xenopi inoculation

A patient was diagnosed with discitis and sacroiliitis due to Mycobacterium xenopi. He had a history of percutaneous nucleotomy performed 15 years earlier (in 1992) at the Clinique du Sport, Paris, France, during an outbreak of nosocomial M. xenopi infection at that institution. In 1997, magnetic resonance imaging performed as part of the routine follow-up program for patients who had surgery at the Clinique du Sport during the outbreak was not interpreted as indicating discitis; this assessment was confirmed by our review of the images. Bone and joint infections due to atypical mycobacteria are rare and can develop very slowly. To our knowledge, this is the first reported case of M. xenopi discitis with secondary extension to the sacroiliac joint in an immunocompetent patient.