Aspergillus galactomannan detection in exhaled breath condensate compared to bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in immunocompromised patients

ObjectivesExhaled breath condensate (EBC) is a noninvasive means of sampling the airways that has shown significant promise in the diagnosis of many disorders. There have been no reports of its usefulness in the detection of galactomannan (GM), a component of the cell wall of Aspergillus. The suitability of EBC for the detection of GM for the diagnosis of invasive aspergillosis (IA) using the Platelia Aspergillus enzyme-linked immunosorbent assay was investigated.MethodsProspective, cross-sectional study of lung transplant recipient and haemotologic malignancy patients at a university centre. EBC samples were compared to concomitant bronchoalveolar lavage (BAL) samples among lung transplant recipients and healthy controls. EBC was collected over 10 minutes using a refrigerated condenser according to the European Respiratory Society/American Thoracic Society recommendations, with the BAL performed immediately thereafter.ResultsA total of 476 EBC specimens with 444 matched BAL specimens collected from lung transplant recipients (n = 197) or haemotologic malignancy patients (n = 133) were examined. Both diluted and untreated EBC optical density (OD) values (0.0830, interquartile range (IQR) 0.0680–0.1040; and 0.1130, IQR 0.0940–0.1383), respectively, from all patients regardless of clinical syndrome were significantly higher than OD values in healthy control EBCs (0.0508, IQR 0.0597–0.0652; p < 0.0001). However, the OD index values did not correlate with the diagnosis of IA (44 samples were associated with IA). Furthermore, no significant correlation was found between EBC GM and the matched BAL specimen.ConclusionsGM is detectable in EBC; however, no correlation between OD index values and IA was noted in lung transplant recipients.     

Impact of revised EORTC/MSGERC 2020 criteria on diagnosis and prognosis of invasive pulmonary aspergillosis in patients with hematological malignancies undergoing bronchoscopy

IntroductionThe first consensus definitions for invasive fungal diseases (IFD) were published in 2002. Advances in diagnostic tests and a clear need for improvement in certain areas led to a revision of these definitions in 2008. However, growing data on Aspergillus galactomannan (GM) thresholds and the introduction of new polymerase chain reaction-based diagnostic tests resulted in a further update by EORTC and Mycoses Study Group Education and Research Consortium (MSGERC) in 2020. Compared to the 2008 version, the 2020 EORTC/MSGERC criteria have stricter definitions, especially regarding GM levels, which should lead to improved specificity. Thus, our study aimed to evaluate diagnostic changes, based on GM levels, resulting from these new definitions and ascertain the impact of the new classification on mortality rates.MethodPatients hospitalized in a single tertiary care center with hematologic malignancies and undergoing bronchoscopy for suspected IPA between April 2004 and December 2019 were included in this retrospective study.ResultsThe study population consisted of 327 patients with 31 patients (nine patients with proven IPA and 22 patients with no IPA) excluded from the study. 194 patients were classified as probable IPA cases according to 2008 EORTC/MSG criteria. However, 53 (27.3%) of these patients were re-classified as possible IPA according to 2020 EORTC/MSGERC criteria, due to novel galactomannan cut-off levels. Compared to re-classified possible IPA patients, those remaining in the probable IPA category experienced a higher incidence of septic shock (34.0% vs 16.9%, p=0.02), and required more non-invasive (12.0% vs 0.0%, p=0.004) and invasive (44.6 vs 24.5%, p=0.01) mechanical ventilation. There was a higher in-hospital mortality rate in probable IPA patients than in the re-classified possible IPA group (42.5% vs 22.6%, p=0.01). Patients reassigned to possible IPA had similar underlying diseases, radiological features and prognosis to patients already classified as possible IPA. Independent risk factors for mortality were classification as probable IPA according to 2020 EORTC/MSGERC criteria, lack of remission from hematologic malignancy, and number of nodules in Thorax CT.ConclusionThe use of 2020 EORTC/MSGERC criteria resulted in a 27.3% significant reduction in probable IPA diagnoses and created a more homogeneous category of patients with respect to treatment response, prognosis and mortality. Therefore, 2020 EORTC/MSGERC criteria afford more reliable mortality prediction than 2008 EORTC/MSG criteria.     

侵袭性肺曲霉病小鼠肺组织差异表达蛋白的初步分析

目的初步分析侵袭性肺曲霉病(IPA)小鼠肺组织蛋白质的表达变化。方法运用双向电泳(2-DE)技术对正常组、正常感染组和IPA组小鼠肺组织总蛋白质进行分离,获得蛋白质表达谱;应用基质辅助激光解吸电离串联飞行时间质谱(MALDI-TOF/TOF)结合生物信息学进行蛋白质鉴定。结果初步鉴定出4个蛋白质点分别为过氧化物还原酶(peroxiredoxin-6,Prx6)、黄素还原酶(flavin reductase,FR)、Rho因子鸟苷酸解离抑制蛋白2(rho GDP-dissociation inhibitor 2,RhoGDI2)、肌球蛋白轻链2(myosin regulatory light chain 2,MLC2),它们与氧化还原平衡、信号转导通路、细胞骨架等功能有关。结论鉴定的差异表达蛋白可能与IPA的发病机制有关。     

Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature

Background: Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013. Case outline: The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People’s Hospital of Tongji University and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from patient. A 56-year-old man presenting with productive cough for several weeks and unremitting high fever for a week was hospitalized with an initial clinical diagnosis of pneumonia, for which antibiotics were prescribed but did not work. Seeing that the condition progressed both clinically and radiographically, bronchoscopy, bronchoalveolar lavage and lung biopsy were performed, and the diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-existence was made. Initially, the patient responded to steroid pulse therapy and voriconazole treatment, and his condition was partially improved. However, the patient’s condition deteriorated progressively 5 months after the disease onset and the patient died during the third admission due to respiratory failure and the adverse reactions of coriaceous hormone therapy. Conclusion: The diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-occurrence depends on clinical, radiological and histological presentations. Similarities with other disease processes could lead to a delayed diagnosis or misdiagnosis. The present case suggests that clinicians should be alert to this disease in their clinical practices.     

SRY基因在性发育异常诊断中的应用

目的为SRY在临床分子诊断中的应用提供参考,并对性发育异常机制进行探讨。方法通过对32例性发育异常患者和男性不育症患者进行SRY基因的检查分析,应用聚合酶链式反应（PCR）对性发育异常患者和男性不育症患者进行SRY检测。结果检出成功率为93.75%（30/32）,异常率为28.13%（9/32）,其中女性SRY扩增阳性率为9.38%（3/32）,男性SRY扩增阴性率为18.75%（6/32）。结论SRY基因是性别分化的关键基因,SRY基因的缺失或突变是造成性发育异常的主要原因,研究也表明人类的性别决定和分化还有其他相关基因的参与。对性发育异常患者进行SRY基因检测,有利于了解该类患者的遗传学病因,为其诊断和治疗提供科学依据。     

定量聚合酶链反应检测肝病患者血清中乙型肝炎病毒 …

目的 了解肝病患者血清乙型肝炎病毒（ＨＢＶ）ＤＮＡ的含量，以便观察临床抗病毒治疗效果及血清ＨＢＶ ＤＮＡ水平与病情及预后的关系。方法 应用荧光素标记的半巢式引物在扩增中能量转移的定量聚合酶 链反应（ＱＰＣＲ），对６３例肝功能异常的肝病患者血清进行ＨＢＶ ＤＮＡ含量测定，并与普通ＰＣＲ及酶联免疫吸附试验（ＥＬＩＳＡ）进行比较。结果 ＱＰＣＲ阳性率为８２。５４％，普通ＰＣＲ法为７１．４３％，ＥＬＩＳＡ     

中国湖北地区人群白细胞介素-6基因-174G/C多态性分布特点

目的 :探讨湖北地区汉族人群白细胞介素 6基因启动子 -174位点多态性分布特点 ,比较其在不同种族间分布的差异。方法 :采用聚合酶链反应及限制性片断长度多态性方法 ,检测中国湖北地区人群白细胞介素 6基因启动子 -174位点多态性 ,并结合文献进行不同种族间的比较分析。结果 :中国湖北地区人群白细胞介素 6基因启动子-174位点各基因型频率GG型 98% ,GC型 2 % ,CC型 0 %。等位基因频率G为 99% ,C为 1%。与欧美国家人群相比 ,该位点多态性存在显著差异 (P <0 .0 1)。结论 :白细胞介素 6基因启动子 -174位点多态性有明显的种族差异。     

性反转综合征患者SRY、SOX9基因检测

目的探讨性反转综合征发生与性别分化相关基因SRY、SOX9之间的关系。方法分析了4例XX男性性反转及1例XY女性性反转患者临床表现、染色体核型，并采用聚合酶链反应（PCR）对SRY、SOX9基因进行了检测。结果5例性反转中，3例XX男性性反转及1例XY女性性反转患者SRY阳性，1例XX男性性反转患者SRY阴性。5例患者均检测到SOX9基因。结论SRY易位是导致性反转发生的重要原因之一，某些性反转的发生可能与SOX9基因异常有关，SOX9的计量效应关系有待研究。     

慢性乙肝患者HBV核心基因一组单核苷酸多态性与血清HBV DNA水平的相关性研究

目的 研究慢性乙肝患者HBV核心基因的单核苷酸多态性(SNP)与血清HBV DNA水平的相关关系.方法 采用PCR-RFLP和限制性内切酶Tsp509I榆测HBV核心基因的SNP,采用双脱氧终止法对核心基因进行序列测定,实时荧光PCR技术用于HBVDNA水平的定量检测.结果 慢性乙肝人群中发现5种典型的PCR-RFLP图谱,分别是RFLP-C、RFLP-D、RFLP-E、RFLP-G和RFLP-C/G,各种RFLP图谱的分布频率依次为61.5%、2.6%、9.6%、16.7%和9.6%.A165T、A336C、A336T、T337C和T385C等5种SNP与RFLP图谱的变化有关,但是只有SNP A336C和A336T会导致HBcAg第83位的Glu被Asp所替代.RFLP-C组患者的血清HBV DNA水平显著高于RFLP-G组(P=0.02)和RFLP-C/G组(P=0 006),而且RFLP-C/G组患者血清ALT的阳性率显著低于RFLP-C、RFLP-E和RFLP-G组;当HBeAg阳性时,RFLP-C组患者的血清HBV DNA水平显著高于RFLP-G组(P=0.015)和RFLP-C/G组(P=0.008).结论 本研究中使用的PCR-RFLP能够用于检测核心基因的SNP,RFLP-C组患者的血清HBV DNA水平显著高于RFLP-G组和RFLP-C/G组,可能与Glu83 Asp突变有关.

Abstract：

Objective To investigate the relation between a set of single nucleotide polymorphisms (SNP) in core gene of HBV in chronic hepatitis B patients and HBV DNA levels. Methods PCR restriction fragment length polymorphism(PCR-RFLP) assay and restriction enzyme Tsp509I were adopted to determine HBV SNP in HBV core gene. Nucleotide sequences of core gene were determined using the dideoxy chain termination method. HBV DNA levels were quantitated with real-time PCR. Results Five typical RFLP patterns, RFLP-C, RFLP-D, RFLP-E, RFLP-G and RFLP-C/G mixture were found and the distribution of HBV RFLP patterns was as follows: C, 61. 5% ; D, 2. 6% ; E, 9.6%; G, 16.7%; C/G mixture, 9.6%. Five SNPs, A165T, A336C, A336T, T337C and T385C, were found to be associated with RFLP patterns change and only SNP A336C or A336T caused the substitution of Glu-83 with Asp in HBcAg. The serum HBV DNA levels in RFLP-C group were higher than that in RFLP-G (P =0. 02) and RFLP-C/G group(P = 0. 006) , respectively, furthermore, the positive rate of serum ALT in RFLP-C/G group was lower than that in RFLP-C, RFLP-E and RFLP-G group, respectively. Under the condition of HBeAg-positive, the serum HBV DNA levels in RFLP-C group were higher than that in RFLP-G (P = 0. 015) and RFLP-C/G group(P =0.008) , respectively. Conclusion PCR-RFLP used in this study can be adopted to determine HBV SNPs, not genotypes in Chinese patients with chronic hepatitis B. The serum HBV DNA level in RFLP-C group higher than that in RFLP-G or RFLP-C/G group maybe associated with amino acid mutation, Glu83 Asp.     

高致病性禽流感病毒H5N1安徽株A/Anhui/1/2005感染人肺癌上皮细胞(A549)的差异表达分析

目的 筛选人细胞中与高致病性禽流感病毒致病相关的基因,探讨高致病性禽流感病毒的致病机理.方法 分别用高致病性禽流感病毒安徽株和普通人流感病毒H1N1株分别感染人肺癌上皮细胞,通过人类全基因表达谱芯片技术对不同时段感染细胞进行差异表达分析,筛选出与高致病性禽流感病毒感染相关的候选基因,以实时定量荧光PCR法验证差异表达基因.结果 获得了不同致病性流感病毒感染细胞后的差异表达谱,验证了细胞凋亡通路、mTOR通路中以及与免疫相关的16个基因的差异表达.结论 H5N1感染后与普通人流感病毒H1N1相比具有促进细胞凋亡的趋势.     

疏血通对慢性肺心病急性加重患者红细胞膜黏弹特性的影响

探讨疏血通对慢性肺心病急性加重期患者红细胞膜黏弹特性的影响。采用微管吸吮技术,定量测定了慢性肺源性心脏病患者体外使用疏血通前后红细胞膜的黏弹特性的变化情况。结果表明:一定浓度疏血通可降低红细胞膜的弹性模量、黏性系数。这为临床上在肺心病的综合治疗中包括改善红细胞变形性的药物或措施提供了实验依据。     

The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease

Dyspnea is the cardinal symptom of chronic obstructive pulmonary disease (COPD). Affective states can profoundly impact upon the perception of dyspnea, but little is known about this relationship in patients with COPD. We, therefore, examined the impact of viewing positive versus negative affective picture series on perceived dyspnea during two cycle ergometer exercise tests (CEET) in 30 patients with COPD. Whereas cardiopulmonary measures indicated comparable exercise intensity during both CEETs, parallel viewing of negative affective pictures resulted in increased dyspnea ratings compared to positive affective pictures. Regression analyses showed that only during positive picture viewing increases in the affective unpleasantness of dyspnea, but not in the sensory intensity of dyspnea, during CEETs were predictive of greater dyspnea during everyday activities and reduced health-related quality of life. The results suggest that negative affective states increase perceived dyspnea in patients with COPD and underline the importance of targeting the affect-dyspnea-relationship in this patient group.     

多发性肌炎/皮肌炎患者外周血单个核细胞中糖皮质激素受体α、βmRNA表达与糖皮质激素疗效相关性的研究

目的探讨多发性肌炎/皮肌炎（PM/DM）患者外周血单个核细胞（PBMC）中糖皮质激素受体（GR）正常表位α和突变体表位β mRNA表达与PM/DM患者对糖皮质激素（GC）疗效的相关性。方法采用逆转录-聚合酶链反应（RT-PCR）方法对18例GC治疗敏感、10例GC治疗抵抗的PM/DM患者PBMC中GRα、β mRNA的表达水平进行了检测,同时采用放射免疫分析法测定血清中的皮质醇含量,并与20例正常对照进行比较。结果血清皮质醇含量在GC治疗敏感和抵抗的PM/DM患者及正常对照间差异均无统计学意义（均P〉0.05）。GC治疗敏感和抵抗的PM/DM患者PBMC中GRα mRNA的表达水平均显著低于正常对照（均P〈0.01）,且GC治疗抵抗的PM/DM患者显著低于GC治疗敏感的PM/DM患者（P〈0.05）。GC治疗敏感和抵抗的PM/DM患者PBMC中GRβ mRNA的表达均显著高于正常对照（均P〈0.05）,但在GC治疗敏感和抵抗的PM/DM患者间则差异无统计学意义（P〉0.05）。结论GRα mRNA表达水平降低可能与PM/DM患者对GC治疗抵抗相关,GRβ mRNA表达水平在PM/DM患者的GC治疗抵抗中无显著作用。     

Instillation of Amphotericin B by bronchoscopy combined with systemic voriconazole in advanced non-small cell lung cancer patients with chronic cavitary pulmonary aspergillosis: A case series and literature review

Although the treatment of aspergillosis has been studied for years, the optimal nonsurgical treatment of chronic cavitary pulmonary aspergillosis (CCPA) remains unsatisfactory, especially in lung cancer. We report two advanced non-small cell lung cancer (NSCLC) patients who recovered from CCPA following instillation of Amphotericin B (AmB) by bronchoscopy combined with systemic voriconazole. The first patient was diagnosed with lung adenocarcinoma after right upper lobe resection and was treated with anaplastic lymphoma kinase-targeted therapy. Chest computed tomography (CT) revealed a right pulmonary cavity containing solid materials. The second patient was diagnosed with squamous cell carcinoma and received immunotherapy following surgery, chemotherapy, and radiotherapy. Chest CT tomography revealed a mass in the right lung cavity. Both patients' cultures and next-generation sequencing of their bronchoalveolar lavage (BAL) samples revealed presence of Aspergillus fumigatus. In addition, the galactomannan test of both patients BAL samples was positive. Systemic voriconazole was prescribed based on in vitro susceptibility testing. The chest images and clinical symptoms of both patients did not improve after one month of voriconazole therapy within the therapeutic blood concentration. Considering the low local concentrations of antifungals against CCPA, AmB instillation by bronchoscopy combined with systemic voriconazole was utilized. The chest CT images and clinical symptoms of both patients markedly improved in the following third month. Instillation of AmB combined with systemic voriconazole may be a promising treatment option for NSCLC patients with CCPA who fail voriconazole monotherapy.     

The potential impact of CD4+ T cell activation and enhanced Th1/Th2 cytokine ratio on HIV-1 secretion in the lungs of individuals with advanced AIDS and active pulmonary infection

Bronchoalveolar lavage fluid (BALF) provides a source of mucosal CD4(+) T cells. We investigated the physiological properties of T lymphocytes from BALF and blood and their role on the dynamic of HIV-1 replication among AIDS patients with active lung infections. Pulmonary CD4(+) T cells consist mainly of effector memory cells (CD45RO(+) and CCR7(-)) with increased expression of activation markers (HLA-DR(+) and CD69(+)) when compared to the blood counterpart. We observed a high frequency of BALF cells capable of secreting HIV-1-Ags suggesting that the local lung environment may support favorable conditions for CD4(+) T lymphocytes harboring HIV-1 DNA to initiate the viral cycle. Nevertheless, the high number of IFN-γ-producing cells and the predominance of Th1 immune response in the lung could limit the secretion of HIV-1 RNA. In conclusion, the capacity of activated CD4(+) T cells to produce HIV-1 is driven by both the level and quality of cellular activation in the lung.