Secondary cases of invasive disease caused by spread of Haemophilus influenzae type b

Three 6-year-old girls were admitted to hospital within a period of 9 days because of invasive disease caused by Haemophilus influenzae type b (Hib). Two days after the index case contracted bacterial meningitis, her twin sister developed septicemia. Nine days after onset of illness in the index case, a day-care contact developed a febrile illness. The antibiograms of the bacterial strains isolated from cerebrospinal fluid or blood in the first two cases were identical; in the third case, blood cultures were negative but Hib antigen could be detected in serum and in urine. These cases illustrate the contagiousness of Hib disease. All household contacts of a case should be informed about the risk and their protection with rifampicin considered.     

Meningitis due to beta-lactamase producing, chloramphenicol-resistant Haemophilus influenzae type b, in South Africa

A case of meningitis and septicaemia due to Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol is reported. After initial failure of chloramphenicol therapy, the patient responded to cefotaxime alone. To our knowledge, this represents the first such reported case in South Africa.     

Current status and future prospects for new therapies for pulmonary tuberculosis

PURPOSE OF REVIEW: Nowadays tuberculosis is becoming a worldwide problem, and according to the World Health Organization, which declared tuberculosis a global health emergency in 1993, each year 8 million people worldwide develop the active disease and almost 3 million die. RECENT FINDINGS: Due to this problem there is an urgent need for new strategies and drugs to fight against this disease. In this context, this review describes promising new classes of compounds against tuberculosis that are under study, as well as promising drugs that may soon be introduced onto the market. Another subject reported in this review is inhaled therapy, an important route under study for delivering antitubercular drugs directly to the lungs. SUMMARY: The implications of new drugs and inhaled therapy in tuberculosis treatment are fewer toxic side-effects, improved pharmacokinetics properties, extensive and potent activity against Gram-positive and Gram-negative bacteria, including resistant strains, and a reduction in the total treatment time.     

消化内镜手术机器人发展现状及展望

随着消化内镜微创治疗技术的迅速发展, 内镜黏膜下剥离术已成为胃肠道早期癌的标准治疗方式, 但由于操作难度大、学习曲线长、术中出血及穿孔风险相对较高, 限制了其在世界范围内的推广。目前出现的多种牵引技术仍存在不同程度的不足, 为此, 消化内镜手术机器人应运而生。根据内镜搭载平台的可获得性, 消化内镜手术机器人分为专用型内镜机器人和普通内镜整合型机器人。在内镜黏膜下剥离术中, 已有多项研究显示出消化内镜手术机器人较普通内镜的优势。本文就目前常见的消化内镜手术机器人的结构特点及临床操作性能进行介绍, 以期为消化内镜手术机器人的发展及临床应用提供参考。     

Current status and future prospects of chemotherapy for advanced hepatocellular carcinoma

Sorafenib is the only drug that demonstrates a survival benefit for advanced hepatocellular carcinoma (HCC). However, the therapeutic effect of sorafenib is limited, so development of a more effective treatment method and second-line treatments is needed. Since the advent of sorafenib, clinical studies have been conducted with a variety of drugs and treatment methods, mainly with molecular targeted therapy, but almost all trials have ended in failure. The reasons for the difficulty in the development of a novel drug or treatment method include the diversity of mechanisms in the carcinogenesis and development of HCC, as well as the presence of background liver diseases such as chronic hepatitis and cirrhosis. Trials with immune-checkpoint inhibitors, which have an entirely different anti-tumor mechanism from that of molecular targeted drugs or cytotoxic drugs, have recently begun. Based on the results to date, clinical trials are now being conducted with enriched target subjects. In the future, providing more individualized treatment approaches for patients with advanced HCC will be essential.     

Positron-emission tomography for hepatocellular carcinoma:Current status and future prospects

Hepatocellular carcinoma(HCC) is one of the leading causes of cancer mortality worldwide. Various imaging modalities provide important information about HCC for its clinical management. Since positron-emission tomography(PET) or PET-computed tomography was introduced to the oncologic setting, it has played crucial roles in detecting, distinguishing, accurately staging, and evaluating local, residual, and recurrent HCC. PET imaging visualizes tissue metabolic information that is closely associated with treatment. Dynamic PET imaging and dual-tracer have emerged as complementary techniques that aid in various aspects of HCC diagnosis. The advent of new radiotracers and the development of immuno-PET and PET-magnetic resonance imaging have improved the ability to detect lesions and have made great progress in treatment surveillance. The current PET diagnostic capabilities for HCC and the supplementary techniques are reviewed herein.     

Gallstone dissolution therapy. Current status and future prospects

Findings by several groups of investigators have provided a reliable data base that supports a nonoperative approach toward the management of so-called silent gallstones. Considerable progress has been made in the medical dissolution treatment of selected patients with cholesterol gallstones. Ursodeoxycholic acid, and, more recently, a combination of ursodeoxycholic and chenodeoxycholic acids have been shown to be both effective and safe in dissolving gallstones that are predominantly composed of cholesterol. A drawback of the bile acid dissolution therapy lies in a significant recurrence rate after treatment is discontinued. Currently, several new methods of gallstone treatment are under study, which involve either the injection of a cholelitholytic solution, such as methyl tert-butyl ether, into the gallbladder or the use of mechanical means, such as excorporeally induced shock waves, to disintegrate gallstones. These treatments, however, are effective only if the stones are composed mainly of cholesterol without significant admixtures of calcium salts, pigment, or mucus. Most of the treatment failures are probably related to the presence of calcifications that are not visible on conventional radiographs. Future improvements of gallstone dissolution therapy can be expected from the following possible developments: improvement in ability to predict gallstone composition; dissolution of calcium salt-, pigment-, and mucus-containing stones; early treatment, before calcifications occur; combination of chemical and mechanical methods of treatment; stimulation of gallbladder contraction; prevention of stone recurrence after dissolution; and synthesis of new cholelitholytic agents.     

丙型肝炎疫苗研究现状与方向

丙型肝炎(丙肝)病毒(hepatitis C virus,HCV)主要经血液传播,是急性和慢性肝炎、肝硬化、肝癌的重要致病因子。目前全球HCV感染者约有1.7亿,每年新增感染者达300万～400万,我国HCV感染者近4 000万。HCV感染的慢性率高达70%以上,至今尚无有确切保护作用的疫苗问世,迫切需要发展有效的疫苗预防、控制HCV的感染和传播。     

Current challenges and future prospects in oral anticoagulant therapy

The choice for oral anticoagulant (OAC) therapy was previously limited to the vitamin K antagonists (VKAs). The advent of the direct oral anticoagulants (DOACs) brought with it the expectation that oral anticoagulation would become simpler (with the elimination of routine monitoring and introduction of a fixed‐dose anticoagulant), and that the use of VKAs would be slowly phased out. Although DOACs have made anticoagulation more convenient and accessible, we are now faced with what can be described as a tyranny of choice, together with many unanswered questions relating to DOAC use. These include optimal DOAC selection and dosing, use in complex ‘real‐world’ patients, the role for monitoring and issues surrounding adherence. Warfarin remains the anticoagulant of choice in certain scenarios (e.g. metallic heart valves). The future holds much excitement: clinical studies are underway to expand the indications for DOACs and experience continues to grow outside the trials setting.