Comparison of Nucleic Acid Amplification Assays with BD Affirm VPIII for Diagnosis of Vaginitis in Symptomatic Women

A commercially available, nonamplified, nucleic acid probe-based test system (BD Affirm VPIII) was compared with nucleic acid amplification (NAA)-based assays for determining the etiology of vaginitis in a cohort of 323 symptomatic women. First, a semiquantitative, multiplexed PCR assay (BV-PCR) and the Affirm VPIII Gardnerellavaginalis test were compared with a unified bacterial-vaginosis (BV) reference standard incorporating both Nugent Gram stain scores and Amsel clinical criteria. In the evaluable population of 305 patients, BV-PCR was 96.9% (191/197) sensitive and 92.6% specific (100/108) for BV, while Affirm VPIII was 90.1% sensitive (179/197) and 67.6% specific (73/108). Second, a multiplexed PCR assay detecting Candida albicans and Candida glabrata (CAN-PCR) was compared with the Affirm VPIII Candida test using a reference standard for vulvovaginal candidiasis (VVC) of yeast culture plus exclusion of alternate vaginitis etiologies. In the population evaluated (n = 102), CAN-PCR was 97.7% sensitive (42/43) and 93.2% specific (55/59) and Affirm VP III was 58.1% sensitive (25/43) and 100% specific (59/59) for VVC. Finally, the results of a commercial NAA test (GenProbe Aptima Trichomonas vaginalis assay; ATV) for T. vaginalis were compared with the Affirm VPIII Trichomonas vaginalis test. In the absence of an independent reference standard for trichomonal vaginitis (TV), a positive result in either assay was deemed to represent true infection. In the evaluable cohort of 388 patients, the sensitivity of ATV was 98.1% (53/54) versus 46.3% (25/54) for Affirm VPIII. The diagnostic accuracy of the combined NAA-based test construct was approximately 20 to 25% higher than that of the Affirm VPIII when modeled in populations with various prevalences of infectious vaginitis.     

Comparison of ESwab and Wound Fiber Swab Specimen Collection Devices for Use with Xpert SA Nasal Complete Assay

Paired nasal swab specimens were collected from patients who were undergoing routine methicillin-resistant Staphylococcus aureus (MRSA) screening prior to elective cardiac or orthopedic procedures. Each patient was swabbed using a traditional wound fiber liquid Stuart swab and an ESwab device, a flocked swab with a modified liquid Amies microbiology transport medium. The two specimens were tested using the Cepheid Xpert SA Nasal Complete assay. Results demonstrated a 95.5% agreement between the ESwab and the FDA-cleared wound fiber swab collection device.     

子母式集尿袋声光报警技术的设计

设计一套适合子母式集尿袋临床使用的报警装置,可自动识别集尿袋内尿液是否达到要求高度并报警,提高临床自动化水平。根据非接触式检测和光电转换方法,采用红外对管将测量尿液高度转化为测量电压值,由电压变化判断尿液是否达到报警高度,达到要求就进行报警,否则不报警。最后通过数值估算和电子仿真验证设计方案可行性,实物验证临床可行性。通过实际实验,当集尿袋内的尿液达到报警高度时,光敏二极管的输出电压变小,蜂鸣器报警,结果表明可以满足要求。根据此方法设计的子母式集尿袋声光报警装置有效可行,能够满足临床使用,可减少护士工作量,为集尿袋的临床使用提供更多选择。     

Microneedle-Based Device for the One-Step Painless Collection of Capillary Blood Samples

正The advancement of point-of-care diagnostics and the decentralization of healthcare have created a need for the simple, safe, standardized and painless collection of blood specimens. Here, The design and implementation of a capillary blood-collection device is more convenient and less painful than a finger-     

Use of a Dry-Plasma Collection Device to Overcome Problems with Storage and Transportation of Blood Samples for Epidemiology Studies in Developing Countries

Studies are difficult in areas lacking modern facilities due to the inability to reliably collect, store, and ship samples. Thus, we sought to evaluate the use of a dry plasma collection device for seroepidemiology studies. Plasma was obtained by fingerstick using a commercial dry plasma collection device (Chemcard Plasma Collection Device) and serum (venipuncture) from individuals in Kazakhstan. Plasma samples were air dried for 15 min and then stored desiccated in foil zip-lock pouches at 4 to 6°C and subsequently shipped to the United States by air at ambient temperature. Serum samples remained frozen at −20°C until assayed. Helicobacter pylori status was determined by enzyme-linked immunosorbent assay (HM-CAP EIA) for the dry plasma and the serum samples. The results were concordant in 250 of the 289 cases (86.5%). In 25 cases (8.6%), the dry plasma samples gave indeterminate results and could not be retested because only one sample was collected. Five serum samples were positive, and the corresponding dry plasma samples were negative; one serum sample was negative, and the corresponding plasma sample was positive. The relative sensitivity and specificity of the Chemcard samples to serum were 97.6 and 97.9%, respectively, excluding those with indeterminate results. Repeated freeze-thawing had no adverse effect on the accuracy of the test. We found the dry plasma collection device to provide an accurate and practical alternative to serum when venipuncture may be difficult or inconvenient and sample storage and handling present difficulties, especially for seroepidemiologic studies in rural areas or developing countries and where freeze-thawing may be unavoidable.     

Evaluation of the Alfred 60/AST Device as a Screening Test for Urinary Tract Infections

The performance of the Alfred 60/AST device, an automated bacterial culture device which uses laser nephelometry to detect and quantify bacterial growth, was evaluated. The instrument is effective at screening negative samples and is more reliable at detecting bacteria than yeasts. Microscopy can be used to reduce the false-negative numbers.     

Comparison of the Copan ESwab system with two Amies agar swab transport systems for maintenance of microorganism viability

Swab transport systems are used for a variety of specimen types and must maintain organism viability throughout the transport process. The Copan ESwab is a new nylon-flocked swab designed to optimize specimen collection and to minimize entrapment of the specimen. We used the quantitative elution method with recommended strains, as described in CLSI document M40-A, to evaluate the ESwab for maintenance of viability of aerobic and anaerobic microorganisms for 0, 6, 24, and 48 h during room temperature and refrigerated temperature storage. The Becton Dickinson CultureSwab MaxV swab and the Remel BactiSwab were used as comparators. The ESwab met CLSI acceptance criteria for all aerobic isolates stored at both temperatures and for all anaerobic isolates stored at refrigerated temperature. The ESwab also met CLSI criteria for four of five anaerobic strains at room temperature. Prevotella melaninogenica was not recovered after 24 or 48 h of room temperature storage with any of the three swab transport systems tested. Overall, the ESwab was equivalent to the Becton Dickinson CultureSwab MaxV swab in organism recovery but recovered more isolates than Remel BactiSwab.     

Microbial stimulation as an aetiologic factor in atopic disease

Epidemiologic evidence from various sources suggests that exposure to microbial stimuli during early childhood can influence the induction and expression of atopic diseases, particularly in the respiratory tract. Moreover, these effects may have long-lasting consequences in relation to expression of the atopic phenotype in adulthood. This review discusses key aspects of this evidence in relation to the underlying mechanisms which regulate T-helper (Th)-cell function; in particular, the generation of Th-memory cells responsive to inhalant allergens.     

Use of the placenta as an artificial lung

Oxygen transfer across a single cotyledon of the human placenta was assessed by using three different perfusates in the maternal circuit: 1) M-199 culture medium, 2) human adult red blood cells (RBCs), and 3) perflubron. These maternal circuit perfusates were oxygenated with a membrane oxygenator. RBCs were perfused on the fetal side of the circuit and samples were taken preplacenta and postplacenta for each maternal perfusate. PO2 and PCO2 were measured and O2 transfer was calculated for each maternal perfusate. O2 transfer per single cotyledon (mean +/- SE) was 0.18 +/- 0.04, 0.20 +/- 0.03, and 0.15 +/- 0.05 ccO2/min when using: 1) M-199, 2) RBCs, and 3) perflubron, respectively. O2 transfer per kilogram of placental tissue was 13.08 +/- 2.78, 14.57 +/- 2.05, and 10.43 +/- 3.79 ccO2/kg per minute when using: 1) M-199, 2) RBCs, and 3) perflubron, respectively. When extrapolated to the individual weights of the entire placenta, the O2 transfer was 9.15 +/- 1.95, 10.20 +/- 1.43, and 7.30 +/- 2.65 when using: 1) M-199, 2) RBCs, and 3) perflubron, respectively. We conclude from these data that O2 transfer can be accomplished during placental perfusion. Larger studies are required to differentiate efficacy among the three maternal circuit perfusates.     

Collection and Preservation of Cord Blood for Personal Use

Unrelated-donor umbilical cord blood (CB) is a useful alternative hematopoietic stem cell source for patients without suitably matched and readily available related or unrelated stem cell donors. Expectant parents today may have the option of either donating the CB to a public CB bank or keeping and storing the CB in a private bank for potential use in the future. The alternatives are often referred to as public banking and private banking. On behalf of the American Society of Blood and Marrow Transplantation (ASBMT), we have reviewed the currently available data and opinions and offer the following recommendations:

• 1.Public donation of CB is encouraged where possible.
• 2.The probability of using one's own CB is very small—difficult to quantify but probably as low as 0.04% (1:2500) to 0.0005% (1:200,000) in the first 20 years of life—and therefore, storage of CB for personal use is not recommended.
• 3.Family member banking (collecting and storing CB for a family member) is recommended when there is a sibling with a disease that may be treated successfully with allogeneic transplant. Family member banking on behalf of a parent with a disease that may be treated successfully with allogeneic transplant is only recommended when there are shared HLA-antigens between the parents.

The committee acknowledges the expanding potential of indications for CB in the future, and suggests review of these recommendations at regular intervals.     

Use of Stable Sensitized Cells in an Improved Indirect Microhemagglutination Test for Malaria

Aldehyde-fixed cells sensitized with Plasmodium knowlesi and P. falciparum antigens were tested with sera from P. vivax and P. falciparum infections. Titers were improved by use of a mixture of cells sensitized with the two antigens.     

Use of Liposomes as an Immunopotentiating Delivery System: in Perspective of Vaccine Development

Liposomes have been widely used to deliver antigens to the antigen-presenting cells (APCs) and also to modify their immunological behaviour in model animals. We recently demonstrated the potential of yeast lipid liposomes to undergo membrane-membrane fusion with cytoplasmic membrane of the target cells. Interestingly, studies in the present report revealed that antigen encapsulated in yeast lipid liposomes could be successfully delivered simultaneously into the cytosolic as well as endosomal processing pathways of APCs, leading to the generation of both CD4+ T helper and CD8+ cytotoxic T cells. In contrast, encapsulation of same antigen in egg phosphatidyl-choline (PC) liposomes, just like its free form, has inefficient access to the cytosolic pathway of major histocompatibility complex (MHC) I dependent antigen presentation and failed to generate antigen specific CD8+ cytotoxic T-cell response. However, both egg PC as well as yeast lipid liposomes have elicited strong antigen specific antibody responses in immunized animals. These results imply usage of liposome encapsulated antigen as potential candidate vaccine capable of eliciting both cell mediated as well as humoral immune responses.     

The Use of the Zickel Device for a Malunited Subtrochanteric Femur Fracture

Surgical treatment of adult subtrochanteric femur fractures by internal fixation, using the Jewett nail, has been associated with a high degree of major complications. Jewett nail failures in these fractures can produce functionally disabling varus deformities. The Zickel device is an effective means of providing internal fixation following subtrochanteric osteotomy. A case is presented in which the Zickel device was effectively used.     

Optimized Use of the MALDI BioTyper System and the FilmArray BCID Panel for Direct Identification of Microbial Pathogens from Positive Blood Cultures

Despite the current reliance on blood cultures (BCs), the diagnosis of bloodstream infections (BSIs) can be sped up using new technologies performed directly on positive BC bottles. Two methods (the MALDI BioTyper system and FilmArray blood culture identification [BCID] panel) are potentially applicable. In this study, we performed a large-scale clinical evaluation (1,585 microorganisms from 1,394 BSI episodes) on the combined use of the MALDI BioTyper and FilmArray BCID panel compared to a reference (culture-based) method. As a result, the causative organisms of 97.7% (1,362/1,394) of the BSIs were correctly identified by our MALDI BioTyper and FilmArray BCID-based algorithm. Specifically, 65 (5.3%) out of 1,223 monomicrobial BCs that provided incorrect or invalid identifications with the MALDI BioTyper were accurately detected by the FilmArray BCID panel; additionally, 153 (89.5%) out of 171 polymicrobial BCs achieved complete identification with the FilmArray BCID panel. Conversely, full use of the MALDI BioTyper would have resulted in the identification of only 1 causative organism in 97/171 (56.7%) of the polymicrobial cultures. By applying our diagnostic algorithm, the median time to identification was shortened (19.5 h versus 41.7 h with the reference method; P < 0.001), and the minimized use of the FilmArray BCID panel led to a significant cost savings. Twenty-six out of 31 microorganisms that could not be identified were species/genera not designed to be detected with the FilmArray BCID panel, indicating that subculture was not dispensable for a few of our BSI episodes. In summary, the fast and effective testing of BC bottles is realistically adoptable in the clinical microbiology laboratory workflow, although the usefulness of this testing for the management of BSIs remains to be established.