Adverse reactions in blood donors with a history of seizures or epilepsy

BACKGROUND: Individuals with epilepsy or seizure disorders are restricted from donating blood because of concern that they are prone to adverse donor reactions such as syncope and convulsions. A study evaluating whether that concern is warranted is reported. STUDY DESIGN AND METHODS: During a 2-year period beginning in 1987, blood donors in Maryland with a history of seizures were actively recruited by the American Red Cross. Adverse donor reactions were classified as "slight", indicating dizziness and nausea without loss of consciousness; "moderate," denoting syncope; and "severe," indicating convulsive syncope. RESULTS: There were 329,143 satisfactory blood donations; 613 individuals reporting a history of seizures donated blood a total of 723 times. Among donors with seizures, 186 (35.7%) were taking antiepileptic medication, and 61 (8.4%) had had one or more seizures in the preceding year. Individuals with seizures had a low incidence of adverse reactions (3.34%). Although this incidence was slightly higher than that in the entire population (2.24%), the difference was not significant. In particular, the risk of syncope with or without convulsive activity was low for people with seizures (0.21%) and not significantly greater than that in other donors (0.28%). CONCLUSION: Individuals with seizures or epilepsy are not at greater risk for adverse reactions after blood donation, and major restrictions on their participation as blood donors are not warranted.     

Seroconversion to human immunodeficiency virus (HIV) in hemophiliacs. Relation to lymphadenopathy

The authors studied the natural history of human immunodeficiency virus (HIV) exposure in 187 hemophiliacs followed for an average of 45 months. Overall, 55 percent developed antibody specific for HIV and 21 percent developed persistent generalized lymphadenopathy. Most patients seroconverted sometime between early 1982 and the end of 1984. Four patients developed acquired immune deficiency syndrome (AIDS) and four seropositive patients developed idiopathic thrombocytopenia (ITP). One of the four patients who developed AIDS and three of the four with ITP had preexisting lymphadenopathy. None of the 10 patients with lymphadenopathy or the 20 asymptomatic patients was seropositive for human T-lymphotropic virus, type I. Although seropositivity and lymphadenopathy have been found in many of the authors' patients, few have developed clinical disease that can be related to HIV infection.     

Clinicopathology of childhood-onset renal systemic lupus erythematosus

AIMS: To determine the clinicolaboratory renal manifestations; glomerular, extra-glomerular histopathologic lesions; renal tubular dysfunction (RTD) frequency and outcome of a short-term renal follow up in Nigerian children with systemic lupus erythematosus (SLE). METHODS: A non-randomized prospective study of consecutive cases of childhood-onset SLE with nephropathy was conducted. Baseline/follow-up clinicolaboratory data were collected. Each patient was followed up for 12 months. RESULTS: Seven of the 11 children studied were girls. The median age at diagnosis was 11.0 years. Median diagnosis time interval (1.9 years) and median time of renal disease onset (1.0 year) were similar. Hypertension, nephrotic syndrome and acute renal failure (ARF) occurred in 45.5%, 54.5% and 63.7% of the patients, respectively. The glomerular lesions were non-proliferative lupus nephritis (LN) in 9.0% (class II LN); focal (class III LN) and diffuse (class IV LN) proliferative LN (PLN) in 27.0% and 64.0%, respectively. Tubulointerstitial nephritis (TIN, 91.0%) and RTD (64.0%) were common. ARF (P = 0.033) and RTD (P = 0.015) were significantly associated with severe TIN. Complete renal remission rate at end-point was 71.4%. Relapse and renal survival rates were 14.3% and 86.0%, respectively. RTD was persistent in 43.0%. CONCLUSION: Renal function disorders, diffuse PLN and extra-glomerular lesions were frequent. Significant association of ARF and RTD with severe TIN in this series suggests the need for early renal tubular function (RTF) assessment in our SLE patients. Deranged RTF may be marker of severe TIN in SLE warranting early confirmatory renal biopsy and aggressive interventional treatment.     

16S rDNA测序技术在婴儿肠道微生态研究中的应用

目的探讨16SrDNA测序技术在新生儿、婴儿肠道微生态研究中的应用。方法于生后3天、1月、6月、1岁时收集2例健康婴儿粪便标本共8份,提取细菌总DNA,以Illumina Hiseq 2000为测序平台,采用新一代高通量16SrDNA宏基因组测序技术对V6可变区测序,并进行生物信息分析(物种分类和丰度分析;多样性分析)。结果 8份样品共产生原始测序数据为1 027.47 Mbp,Unique tags序列数量均值为58630,OTU数量63~209;优势菌门为Proteobacteria和Firmicutes;在科水平,1%的物种1个月之内2~4种,6月后达7~10种;1号婴儿一直以Enterobacteriaceae占优势,2号婴儿优势菌群包括Enterobacteriaceae、Lachnospiraceae、Streptococcaceae和Bacteroidaceae;4个时间点的npShannon和Simpson指数分别为1.17、1.29、2.16、2.51和0.43、0.40、0.26、0.14。结论 16SrDNA测序技术能满足新生儿、婴儿肠道微生态研究需求;新生儿、婴儿粪便中含丰富细菌基因组;细菌物种丰度及分类存在个体差异;从出生到1岁,婴儿肠道菌群结构趋向复杂和多样。     

急性阑尾炎多层螺旋CT扫描征象与血清炎性标志物的相关性研究

目的探讨急性阑尾炎多层螺旋CT征象与血清炎性标志物的关系。方法收集2012年1月至2013年12月于同济大学附属杨浦医院经手术病理证实的具有完整临床及影像资料的急性阑尾炎患者66例,对所有患者的急性阑尾病变程度行CT分级,分析其与患者白细胞(WBC)计数、中性粒细胞百分比(NEUT%)及血清C反应蛋白(CRP)水平的相关性。结果急性阑尾炎CT分级与患者WBC计数与CRP水平呈正相关(P0.05),穿孔性阑尾炎患者NEUT%及CRP水平明显高于其他患者。CRP水平与阑尾直径、阑尾积液、回盲部变化、阑尾周围炎性条纹、小肠积液呈正相关(P0.05),WBC计数与回盲部变化及阑尾周围炎性条纹呈正相关(P0.05)。结论WBC计数及CRP水平与急性阑尾炎CT分级有关,CRP对急性阑尾炎的诊断及其严重程度的判断更有优势;CRP、NEUT%是穿孔性阑尾炎的重要预测因子,WBC可以更好地发现早期阑尾周围的炎性反应,综合分析CT表现与血清炎性标志物能更准确地诊断急性阑尾炎。     

移动差值控制图评估临床实验室肌钙蛋白不确定度

目的运用控制图评估肌钙蛋白I(cTnI)测量不确定度。方法采用日本东曹AIA-1800全自动荧光磁微粒酶免分析仪测定cTnI控制品,1次/天,共30d;用Anderson-Darling法检验数据的正态分布性和独立性;建立单值-移动差值及指数加权移动平均值控制图及评估不确定度。结果 Anderson-Darling检验cTnI质控数据为正态分布性且具有独立性,结果测量不确定为(0.218±0.016)μg/L,(k=2)。结论移动极差控制图法可用来评估cTnI结果不确定度,本研究为临床实验室评价不确定度提供了新的思路。     

肺炎支原体肺炎患儿肺泡灌洗液病菌量与临床特征相关性研究

目的研究肺炎支原体(MP)肺炎患儿肺泡灌洗液(BALF)中MP-DNA基因拷贝数和患儿病情严重程度的关系。方法选取河北省儿童医院2012年10月至2013年12月收治的82例MP肺炎患儿作为研究对象,行支气管镜下支气管肺泡灌洗(BAL),采用荧光实时定量聚合酶链反应(FQ-PCR)对肺泡灌洗液中MP-DNA定量检测,并根据检测结果的基因拷贝数分为低菌量组(MP-DNA的拷贝数103/mL的患儿),中等菌量组(MP-DNA的拷贝数为103~106/mL的患儿)和高菌量组(MP-DNA的拷贝数106/mL的患儿)。比较不同菌量组患儿的临床症状、实验室检查结果和影像学结果。结果高菌量组患儿总病程长,高热患儿和热程大于或等于7d的患儿数量均多于中、低菌量组,使用大环内酯类药物后退热时间也较其他两组更长,差异均具有统计学意义(P=0.027、P=0.025、P=0.029、P=0.003)。实验室检查中高菌量组C反应蛋白值升高明显,高于中低菌量组,差异有统计学意义(P=0.005)。影像学检查中高菌量组大片肺实变、肺不张者较、低菌量组多(P=0.002)。低菌量组未见双侧胸腔积液或大量胸腔积液患儿,中高菌量组此症状患儿较多,差异有统计学意义(P=0.033)。结论 MP肺炎患儿BALF病菌量和临床表现密切相关,高菌量组患儿病情更为严重。可能与患儿体内的肺炎支原体不易清除和存在较强的免疫反应有关,临床需延长抗菌药物治疗时间以及加强免疫治疗。     

多房棘球绦虫重组BCG-EmⅡ/3疫苗诱导小鼠脾细胞因子变化的研究

目的 探讨多房棘球绦虫(Em)重组BCG-EmⅡ/3疫苗免疫和Em原头节攻击后小鼠脾细胞因子的变化.方法 将Balb/c小鼠按体质量随机分为3组:疫苗皮下注射组、疫苗鼻腔内接种组、对照组.免疫后8周用Em原头节进行攻击感染,感染后18周杀鼠取脾,分离脾细胞,分别用原液、Em抗原(EmAg)、刀豆蛋白A(ConA)或植物血凝素(PHA)培养,酶联免疫吸附(ELISA)法检测脾细胞培养上清液中白细胞介素2(IL-2)、γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-β)、白细胞介素4(IL-4)水平.结果 疫苗皮下注射组原液培养条件下IL-2、IFN-γ、TNF-α和IL-4水平分别为(34.6±2.7)、(34.5±2.8)、(265.0±0.0)、(9.8±2.6)ng/L,与对照组[(25.0±1.9)、(30.0±0.0)、(10.0±0.0)、(12.5±2.7)ng/L]比较差异均有统计学意义(P＜0.01或＜0.05);疫苗鼻腔内接种组原液培养条件下上述4种指标分别为(32.5±2.2)、(33.6±2.7)、(130.0±0.0)、(10.4±2.7)ng/L.与对照组比较差异均有统计学意义(P＜0.01或＜0.05);疫苗皮下注射组原液培养条件下TNF-α水平明显高于疫苗鼻腔内接种组(P＜0.01).EmAg、ConA(或PHA)刺激培养条件下,上述4种指标明显高于相同组别的原液培养(P＜0.01),且ConA(或PHA)刺激培养条件下,上述4种指标明显高于相同组别的EmAg刺激培养条件(P＜0.01).结论 多房棘球绦虫重组BCG-EmⅡ/3疫苗诱导小鼠产生辅助T淋巴细胞(Th)1型免疫反应,从而对抗Em原头节攻击感染.     

p38丝裂原活化蛋白激酶信号途径在鼠破骨细胞生成和骨吸收中的作用

目的研究p38丝裂原活化蛋白激酶(p38MAPK)信号途径在甲状旁腺素相关肽(PTHrP)诱导的破骨细胞生成和骨吸收中的作用。方法取小鼠骨髓细胞,在PTHrP(45ng/ml)的刺激下,在不同试验组中分别入0.1、1.0及10μmol/L的p38MAPK抑制剂Fr167653,继续培养6d。抗酒石酸染色,进行破骨细胞计数。在小鼠颅骨部位注射PTHrP建立骨吸收和高钙血症动物模型。每日给予p38MAPK抑制剂Fr16765330mg/kg,每日2次,X线片观察骨吸收面积,组织学检查计算单位面积内破骨细胞数目,采集血样观察全血内游离钙水平。结果PTHrP刺激下,大量破骨细胞生成(118.9±28.3)个/孔;加入0.1μmol/LFr167653可以部分抑制破骨细胞的生成(79.6±28.0)个/孔,加入10μmol/LFr167653几乎全抑制了破骨细胞生成(7.4±0.4)个/孔,每日给予Fr16765330mg/kg,每日2次,可以明显抑制骨吸收,表现为X线片上骨吸收面积减少,单位面积内破骨细胞数目减少,但是并不能有效地抑制高钙血症。结论抑制p38MAPK信号途径可以抑制破骨细胞的分化和局部骨吸收。