广西1例儿童危重型甲型H5N6禽流感脑炎救治成功报告

目的总结南宁市第四人民医院确诊且救治成功1例儿童危重型甲型H5N6禽流感相关性脑炎病例临床特征以及诊疗经验。方法回顾性分析2021年11月24日南宁市第四人民医院收治的1例儿童危重型甲型H5N6禽流感脑炎病例的临床资料及治疗经过。结果本案例患儿,男性,3岁11月,因“发热9 d,意识障碍2 d”入院,病初以发热、咳嗽为表现,病后第2天出现呕吐,第3天出现乏力、嗜睡,第5天出现抽搐、意识障碍。经脑脊液、痰液、咽式子病原学检测出甲型流感病毒H5N6,确诊为儿童危重型甲型H5N6禽流感脑炎,积极快速有效抗病毒、抗感染、脱水治疗、镇静、抗癫痫等治疗,治疗后第9天,患儿神志转清,27 d后病情好转,转外院继续行康复治疗,分别于出院后2周、1月随访,患儿恢复良好。结论临床工作中,如早期与普通呼吸道疾病症状类似,同时合并神经系统受累症状,病情进展迅速,需警惕排查流感。禽流感发病前不一定有明确禽类接触史,禽流感病毒可能存在其他宿主,有待相关研究证实。人感染H5N6禽流感重症率高,死亡率高,病情进展迅速,发病人群主要为成人,儿童病例极少,多数病例以重症肺炎为主,以神经系统受累表现少见;早发现、早诊断禽流感,同时应用有效可行的综合治疗有望控制病情和改善预后。     

流动人口艾滋病防治知识和感染率调查

[目的]为了解流动人口对于艾滋病防治知识的掌握程度及感染率,便于制定对流动人口艾滋病预防的干预措施。[方法]随机调查某市工厂、餐饮及KTV等娱乐场所的流动人口1000名。年龄17～40岁,中位年龄32.5岁。采用自行设计调查表,调查形式采用匿名现场填写。同时给予被调查者抽血检测人类免疫缺陷病毒(HIV)感染情况。[结果]教育程度在高中以上者与在高中以下者对艾滋病传播途径和艾滋病预防知识的了解差异性显著,经χ2检验,差异有统计学意义(P﹤0.01)。收入在1500元以上者与在1500元以下者对艾滋病传播途径和艾滋病预防知识的了解差异性显著,经χ2检验,差异有统计学意义(P﹤0.01)。常接触媒体宣传者与不常接触媒体宣传者对艾滋病传播途径和艾滋病预防知识的了解差异性显著,经χ2检验,差异有统计学意义(P﹤0.01)。对艾滋病传播途径和艾滋病预防知识了解者与不了解者,感染率差异性显著,经χ2检验,差异有统计学意义(P﹤0.01)。[结论]对于流动的人群,应该加大艾滋病防治知识的宣传力度,宣传的形式也应该多样化,内容要利于理解。     

循环肿瘤细胞早期筛查肝细胞癌的研究进展

本文总结了肝癌主要血清指标的局限性,循环肿瘤细胞的发现、常用检测方法及其筛查恶性肿瘤的价值,尤其是近年来循环肿瘤细胞在肝细胞癌早期诊断、预后评价远处转移和复发等方面的研究进展,使其成为目前有较大临床意义的新指标.     

广西HIV/AIDS患者合并巨细胞病毒感染特征与影响因素分析

目的调查HIV/AIDS患者巨细胞病毒(CMV)感染情况,比较不同标本(血液、尿液)在HIV合并CMV感染早期筛查的应用价值,分析HIV合并CMV感染的影响因素。方法收集2018年1月—2020年12月南宁市第四人民医院诊治的848例HIV/AIDS患者的性别、年龄、CD4^(^(+))T细胞计数、抗逆转录病毒治疗(ART)等资料信息,采用荧光PCR(FQ-PCR)检测血液/尿液CMV-DNA载量。采用卡方检验、Fisher确切概率法分析感染的差异,以二项Logistic回归分析HIV合并CMV感染的危险因素。结果848例HIV/AIDS患者中,有205例(24.17%)CMV-DNA阳性。尿液CMV-DNA检出率20.03%(142/709)高于血液CMV-DNA检出率12.04%(102/847)。多因素二项Logistic回归分析显示男性合并CMV感染的危险是女性2.30倍(95%CI:1.43~3.71),年龄30~<50岁和≥50岁合并CMV感染危险是年龄<30岁的2.43和2.32倍(95%CI分别为:1.20~4.91,1.15~4.65)、CD4^(+)T<50个/μL合并CMV感染的危险是CD4^(+)T≥100个/μL的3.88倍(95%CI:2.50~6.03),ART治疗患者合并CMV感染的危险比非ART治疗下降89%(OR=0.11,95%CI:0.05~0.24)。结论尿液在CMV感染的早期筛查比血液准确度更高,应重视CD4^(+)T计数较低、中年以上男性,加强其CMV感染的早期筛查和抗病毒治疗。     

Proxalutamide in metastatic castration-resistant prostate cancer: Primary analysis of a multicenter,randomized, open-label,phase 2 trial

We aim to assess the safety and efficacy of proxalutamide, a novel androgen receptor antagonist, for men with metastatic castration-resistant prostate cancer (mCRPC) in a multicenter, randomized, open-label, phase 2 trial. In our study, the enrolled mCRPC patients were randomized to 100, 200 and 300 mg dose groups at 1:1:1. The primary efficacy endpoint was prostate-specific antigen (PSA) response rate. The secondary endpoints included objective response rate (ORR), disease control rate (DCR) and time to PSA and radiographic progression. Safety and pharmacokinetics were also assessed. Finally, there were 108 patients from 17 centers being enrolled. By week 16, there were 13 (35.1%), 12 (36.4%) and 15 (42.9%) patients with confirmed 50% or greater PSA decline in 100 mg (n = 37), 200 mg (n = 33) and 300 mg (n = 35) groups, respectively. Among the 19 patients with target lesions at study entry, three (15.8%) had a partial response and 12 (63.2%) had stable disease. The ORRs of 20.0%, 22.2%, 0% and DCRs of 80.0%, 88.9%, 60.0% were, respectively, achieved in 100, 200 and 300 mg groups. By the maximum follow-up time of 24 weeks, there were 42.6% and 10.2% of cases experiencing PSA progression and radiographic progression, respectively. Overall, adverse events (AEs) were experienced by 94.4% of patients, most of which were mild or moderate. There were 28 patients experiencing ≥grade 3 AEs. The most common AEs were fatigue (17.6%), anemia (14.8%), elevated AST (14.8%) and ALT (13.0%), decreased appetite (13.0%). These findings preliminarily showed the promising antitumor activity of proxalutamide in patients with mCRPC with a manageable safety profile. The proxalutamide dose of 200 mg daily is recommended for future phase 3 trial (Clinical trial registration no. CTR20170177).     

MSCT纹理影像对原发性直肠癌患者淋巴结转移的预测效果

目的探讨多层螺旋电子计算机断层扫描(MSCT)纹理分析对原发性直肠癌患者淋巴结转移的预测效果。方法回顾性分析2015年5月至2019年5月间收治的60例原发性直肠癌患者临床资料,所有病例均经手术病理确诊。患者术前均进行MSCT检查,评估MSCT诊断淋巴结转移的效能,比较有无淋巴结转移者的纹理分析参数分析,绘制ROC曲线评估纹理分析参数的诊断效能。结果MSCT诊断N0、N1、N2分期准确率分别为83.33%、70.00%、83.33%,总准确率为68.33%(41/60);直肠癌无淋巴结转移者短径、峰度、熵均低于直肠癌有淋巴结转移者(P<0.05),有无淋巴结转移者方差、峰度和逆差矩对比差异无统计学意义(P>0.05);短径、峰度和熵值诊断淋巴结转移ROC曲线下面积分别为0.969、0.674和0.863(P<0.05)。结论MSCT纹理影像诊断淋巴结转移效能较高,其中短径、峰度、熵是有较多参考意义的参数。     

HAART患者失访相关影响因素Logistic回归分析

目的 探讨艾滋病抗病毒治疗患者失访发生的相关影响因素,为HIV/AIDS患者管理提供依据。方法 收集2005年6月-2018年12月在南宁市第四人民医院进行抗病毒治疗的艾滋病抗病毒治疗患者为研究对象,使用Excel的RAND随机函数生成的随机数字由小到大进行排序,选取排序前200例的HAART失访的患者为观察组,对照组为在治疗的艾滋病患者中随机选取的200例。采用Logistic回归分析方法分析患者性别、年龄、基线CD4⁺T淋巴细胞计数、传播途径、基线疾病分期、目前疾病分期、最近1次CD4⁺T淋巴细胞计数、领药、婚姻状况、子女人数、地区、药物不良反应等12项因素与失访的关系。结果 观察组接受HAART 12个月内失访85例,占总失访人数的42.5%,24个月内失访123例,占总失访人数的61.5%。将12个因素进行多因素logistic回归分析,最终进入回归模型的因素为传播途径、最近1次CD4⁺T淋巴细胞、药物不良反应,其调整的OR值及OR95%CI分别为6.26(2.99~13.10)、8.68(4.32~17.45)、10.52(2.77~40.00)。结论 HIV/AIDS患者HAART 失访大部分发生在开始治疗的2年内,对出现HAART有不良反应的患者进行及时处理或更换治疗方案,强化对注射吸毒、治疗后CD4⁺T淋巴细胞提升不理想HIV/AIDS感染者的个体指导和警示教育,增强患者治疗信心,减少失访的发生。     

Artesunate alleviates intracerebral haemorrhage secondary injury by inducing ferroptosis in M1-polarized microglia and suppressing inflammation through AMPK/mTORC1/GPX4 pathway

Intracerebral haemorrhage (ICH) is a catastrophic subtype of stroke with severe morbidity and mortality. However, little progress has been made in the subsequent secondary injury. Artesunate, a water-soluble semi-synthetic derivative of artemisinin, exhibits remarkable pharmacological effects on anti-neuroinflammation. However, the effects of artesunate on ICH remain unknown. In the present study, haemoglobin (Hb) treatment in BV2 cell and collagenase type IV intracerebroventricular injection in Sprague–Dawley rats were used to establish in vitro and in vivo ICH models, respectively. For in vivo, the neurological scores, haematoma volume, brain oedema, inflammatory factors and iron deposition were evaluated. Besides, lipopolysaccharide (LPS) was used in in vitro to polarize BV2 cell to M1 phenotype. Cell viability, cellular reactive oxygen species (ROS), Fe²⁺ concentration, and lipid peroxidation levels, ferroptosis-associated proteins and mRNA, morphological of mitochondria were measured in vitro. Additionally, the AMP-activated protein kinase (AMPK)/mammalian/mechanistic target of rapamycin (mTOR) pathway were measured by western blot and immunofluorescence staining. The present in vivo results indicated that artesunate significantly ameliorated neurological deficits, haematoma volume and brain oedema in ICH rats. Besides, artesunate suppressed the M1-microglia relative inflammatory factors and up-regulated iron deposition. For in vitro, artesunate significantly selectively decreased the viability of LPS-stimulated BV2 cell. Furthermore, ROS and lipid peroxidation levels were up-regulated. And the glutathione peroxidase 4 (GPX4) were silenced via the AMPK/mTORC1 axis. Our finding supports that artesunate ameliorates the ICH secondary injury both in vitro and in vivo by inducing ferroptosis in microglia and further inhibiting inflammation mainly through the AMPK/mTORC1/GPX4 pathway. This finding may provide a novel target for ICH treatment.     

艾滋病合并马红球菌感染1例并文献复习

马红球菌是人类感染性疾病谱中一个较为罕见的病原体,但在获得性免疫缺陷综合症患者中已成为一种机会性致病性病原体。通常表现为亚急性肺炎,多数为空洞性肺炎,有时甚至是细菌性肺炎。虽然在自然界分布广,但是从临床和微生物学的方面来诊断马红球菌感染仍然具有挑战性,目前还没有建立标准的治疗方案。此次报道分析一例艾滋病合并马红球菌性肺炎及败血症患者的详细情况。患者为29岁男性,以咳嗽、咳痰、发热为主要临床表现,肺脏组织镜下见灶状坏死,中性粒细胞和浆细胞浸润,无明显的干酪样坏死。痰液、骨髓、肺脓肿均培养出马红球菌。我们描述马红球菌的临床特点,强调早期诊断及联合抗生素治疗的重要性,为持续进行抗逆转录病毒治疗做好准备。