Inhibition of Mycobacterial Growth In Vitro following Primary but Not Secondary Vaccination with Mycobacterium bovis BCG

Despite the widespread use of the Mycobacterium bovis BCG vaccine, there are more than 9 million new cases of tuberculosis (TB) every year, and there is an urgent need for better TB vaccines. TB vaccine candidates are selected for evaluation based in part on the detection of an antigen-specific gamma interferon (IFN-γ) response. The measurement of mycobacterial growth in blood specimens obtained from subjects immunized with investigational TB vaccines may be a better in vitro correlate of in vivo vaccine efficacy. We performed a clinical study with 30 United Kingdom adults who were followed for 6 months to evaluate the abilities of both a whole-blood- and a novel peripheral blood mononuclear cell (PBMC)-based mycobacterial growth inhibition assay to measure a response to primary vaccination and revaccination with BCG. Using cryopreserved PBMCs, we observed a significant improvement in mycobacterial growth inhibition following primary vaccination but no improvement in growth inhibition following revaccination with BCG (P < 0.05). Mycobacterial growth inhibition following primary BCG vaccination was not correlated with purified protein derivative (PPD) antigen-specific IFN-γ enzyme-linked immunospot (ELISPOT) responses. We demonstrate that a mycobacterial growth inhibition assay can detect improved capacity to control growth following primary immunization, but not revaccination, with BCG. This is the first study to demonstrate that an in vitro growth inhibition assay can identify a difference in vaccine responses by comparing both primary and secondary BCG vaccinations, suggesting that in vitro growth inhibition assays may serve as better surrogates of clinical efficacy than the assays currently used for the assessment of candidate TB vaccines.     

腓肠肌外侧头纤维化钙化与膝及小腿后外侧疼痛

目的：探讨腓肠肌外侧头纤维化、钙化引起膝后及小腿后外侧疼痛的临床特点及治疗方法。方法：收集腓肠肌外侧头纤维化、钙化导致膝及小腿后外侧疼痛病例25例（28侧）,其中侧位X线片于股骨外侧髁后部可见明显的小豆骨22侧,仅见小钙化点6侧;均行钙化或纤维化组织包块切除,腓总神经探查松解术。结果：全部病例随访6-24个月,平均12个。术后静态及动态一过性足下垂及小腿下段与足背麻木症状消失,膝关节后外侧疼痛消失或明显缓解。结论：腓肠肌外侧头纤维化钙化是膝后外疼痛的重要原因,大多伴有腓总神经受损症状,目前对其认识欠缺,误诊率高,手术切除纤维化钙化包块、选择松解受累的腓总神经效果确切。     

Estimated low risk of rupture of small-sized unruptured intracranial aneurysms (UIAs) in relation to intracranial aneurysms in patients with subarachnoid haemorrhage

Objective

International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms <10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting.

Methods

We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (H&H), modified Rankin Scale (mRS) and Fisher classification.

Results

Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were >10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %) <10 mm (mean size, 6.2 mm). In total, 112 were categorised as berry-like configured aneurysms (n?=?113 <10 mm, n?=?3 >10 mm), 18 as multi-lobar (n?=?16 <10 mm, n?=?2 >10 mm) and 5 as fusiform (n?=?4 <10 mm, n?=?1, >10 mm).

Conclusion

Since the results of our study showed that the majority of the aneurysms are <10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs.     

Retrospective review of rectal cancer surgery in northern Alberta

Introduction

Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved.

Methods

We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region.

Results

We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage.

Conclusion

Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.     

氟对大鼠甲状腺过氧化物酶mRNA表达的影响

目的 观察长期氟过量对大鼠甲状腺过氧化物酶(TPO)活性、TPO mRNA表达的影响,并探讨其可能的机制.方法 选用雄性SD大鼠40只,按体质量分为对照组、低氟组、中氟组、高氟组,每组10只,分别饮用含氟化钠0.40(普通自来水)、15.00、30.00和60.00 mg/L的自来水,均食用普通粮食配制的饲料.喂养180 d后处死.测定血清FT3和FT4;采用改良愈创木酚法测定甲状腺TPO活性;半定量RT-PCR方法检测甲状腺TPO mRNA表达水平.结果 低、中、高氟组血清FL3水平[(3.62±0.47)、(3.57±0.55)和(3.30±0.68)pmol/L]与对照组[(3.64±0.45)pmol/L]相比虽呈下降趋势,但差异无统计学意义(P＞0.05);高氟组血清FT4水平[(8.64±1.72)pmol/L]低于对照组、低、中氟组[(13.08±1.69)、(12.68±1.32)、(12.05±1.43)pmol/L,P均＜0.05].对照组、低氟组、中氟组、高氟组甲状腺细胞TPO活性[(1.572±0.064)、(1.414±0.086)、(1.322±0.049)、0.960±0.083)U/L]随着氟浓度的升高而明显降低,任意两组组间比较差异均有统计学意义(P均＜ 0.05),TPO活性与氟浓度呈显著负相关(r=-0.955,P＜0.05).半定量RT-PCR结果显示:对照组、低氟组、中氟组、高氟组甲状腺TPO mRNA表达水平(0.936±0.160、0.368±0.095、0.115±0.018、0.016±0.008)随着氟浓度升高而明显降低,任意两组组间比较差异均有统计学意义(P均＜0.05).结论 长期摄入过量氟抑制甲状腺TPO活性和TPO的表达,影响甲状腺激素合成.     

血管成形术后血管外膜改变与血管重塑的相关性研究

目的:探讨大鼠胸主动脉血管成形术后血管外膜激活与血管重塑的相关性。方法:用6F人冠状动脉快速交换球囊损伤大鼠胸主动脉,术后2周和6周取材,行血管形态学定量分析,并行增殖细胞核抗原(PCNA)免疫组织化学染色,观察PCNA在血管外膜上的表达。结果:血管成形术组血管外膜细胞数量、血管外膜细胞增殖指数,外膜面积、厚度均较对照组显著增大(P<0.05),血管外弹力板围绕面积、内弹力板围绕面积和管腔面积较对照组显著减小(P<0.05),血管呈收缩性重塑。结论:血管成形术后,血管外膜被牵拉激活,导致外膜细胞分裂、增殖,以及血管收缩性重塑,参与再狭窄的发生。     

ST段抬高型急性下壁心肌梗死并心力衰竭患者的冠状动脉病变特征

目的:探讨ST段抬高型急性下壁心肌梗死(AIMI)并心力衰竭(HF)患者的冠状动脉病变特点及临床特征。方法:对108例行急诊冠状动脉介入治疗的ST段抬高型AIMI患者的临床资料进行分析,根据心功能分为2组,HF组32例,无HF组76例,比较2组临床特征及冠脉病变特点。结果:HF组年龄偏大(P<0.05),血清肌酐水平、恶性心律失常、心源性休克需要主动脉内球囊反搏比例(均P<0.01),三度房室传导阻滞发生率显著高于非HF组(P<0.05);罪犯血管为右冠状动脉,合并前降支血管病变,HF组显著高于非HF组(P<0.05和P<0.01)。结论:ST段抬高型AIMI罪犯血管为右冠状动脉,同时合并有前降支血管病变时,易发生心力衰竭。     

肺癌合并肝硬化患者术后胸腔闭式引流观察和护理特点

目的通过对我科近4年中18例肺癌合并肝硬化患者术后胸腔闭式引流进行观察,探讨此类患者的护理特点。方法 18例患者术后3d每天均有500ml以上引流胸腔积液,有10例(A组)在术后3d仍有800ml胸腔积液,给予自体血胸膜固定术,8例(B组)仍予常规支持对症治疗,比较两组术后恢复时间和住院费用。结果 A组平均住院时间为26d,平均住院费用为4.1万元;B组平均住院时间为19d,平均住院费用为3.2万元,差异均有统计学意义(P<0.05)。结论肺癌合并肝硬化患者术后需加强观察胸腔积液的变化,及时的自体血胸膜固定术并加强指导翻身护理,可在临床上加快此类患者的康复,同时减少住院费用。