Immunogenicity of COVID-19 Vaccination in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: The Efficacy of a Mix-and-Match Strategy

BackgroundThe objective of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19) vaccination in patients with end-stage renal disease (ESRD) on hemodialysis.MethodsESRD patients at the hemodialysis center of a tertiary-care university-affiliated hospital and healthy employees at the clinical laboratory center were prospectively recruited between March and June 2021. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody analysis, blood samples were collected serially on days 0, 14, 28, and 56 after the first vaccine dose, and on days 7 and 50 after the second dose. Antibodies against the SARS-CoV-2 spike protein were quantified, and SARS-CoV-2 neutralizing antibodies were measured in the serum and plasma.ResultsThirty-one ESRD patients and 55 healthy employees were regularly monitored. Twenty-five (80.6%) ESRD patients on hemodialysis received a mix-and-match strategy with ChAdOx1-BNT162b2 (AZ–Pf group) and six (19.4%) received two doses of ChAdOx1 (AZ–AZ group). ESRD patients on hemodialysis showed lower binding antibody titers and neutralizing antibody activities compared to healthy participants following the first vaccination with ChAdOx1. After the second dose, AZ-Pf group had higher immunogenicity than healthy people on days 7 and 50. The binding antibody titer and neutralizing antibody activities on days 7 and 50 were significantly higher in the AZ–Pf group than in the AZ–AZ group.ConclusionESRD patients on hemodialysis receiving the mix-and-match strategy (ChAdOx1–BNT162b2) have COVID-19 vaccine immunogenicity comparable to healthy individuals receiving two doses of ChAdOx1.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT04871945","term_id":"NCT04871945"}}NCT04871945     

临床拟诊机化性肺炎31例诊疗的回顾性分析

目的 探讨临床拟诊机化性肺炎的诊断与治疗.方法 回顾性分析31例临床拟诊为机化性肺炎患者的临床资料、影像资料和治疗方法.结果 31例经抗生素治疗无效的患者,通过支气管镜肺活检病理或经皮肺穿刺病理除外结核、真菌、化脓性炎、肺癌而拟诊机化性肺炎24例,无病理检查结果而经激素治疗有效拟诊7例.21例患者具有典型机化性肺炎CT表现,所有病例均经短期（6～14d）激素治疗后影像学结果明显改善.随访6～25个月,复发6例,均发生在激素减量过快或停药患者中.结论 临床上经抗生素治疗无效、结合临床影像学特点、病理检查除外其他疾病是拟诊机化性肺炎的重要指标;对于无病理检查患者短期激素治疗有效有助于诊断.过早激素减量容易导致复发.     

Artificial Neural Network Modelling of the Effect of Vanadium Addition on the Tensile Properties and Microstructure of High-Strength Tempcore Rebars

In high-strength rebar, the various microstructures obtained by the Tempcore process and the addition of V have a complex effect on the strength improvement of rebar. This study investigated the mechanism of strengthening of high-strength Tempcore rebars upon the addition of vanadium through artificial neural network (ANN) modelling. Various V contents (0.005, 0.072 and 0.14 wt.%) were investigated, and a large amount of bainite and V(C, N) were precipitated in the core of the Tempcore rebar in the high-V specimens. In addition, as the V content increased, the number of these fine precipitates (10–30 nm) increased. The precipitation strengthening proposed by the Ashby–Orowan model is a major contributing factor to the yield-strength increase (35 MPa) of the Tempcore rebar containing 0.140 wt.% V. The ANN model was developed to predict the yield and tensile strengths of Tempcore rebar after the addition of various amounts of V and self-tempering at various temperatures, and it showed high reproducibility compared to the experimental values (R-square was 93% and the average relative error was 2.6%). ANN modelling revealed that the yield strength of the Tempcore rebar increased more significantly with increasing V content (0.01–0.2 wt.%.) at relatively high self-tempering temperatures (≥530 °C). These results provide guidelines for selecting the optimal V content and process conditions for manufacturing high-strength Tempcore rebars.     

pH and Redox-Dual Sensitive Chitosan Nanoparticles Having Methyl Ester and Disulfide Linkages for Drug Targeting against Cholangiocarcinoma Cells

The aim of this study is to prepare pH- and redox-sensitive nanoparticles for doxorubicin (DOX) delivery against DOX-resistant HuCC-T1 human cholangiocarcinoma (CCA) cells. For this purpose, L-histidine methyl ester (HIS) was attached to chitosan oligosaccharide (COS) via dithiodipropionic acid (abbreviated as ChitoHISss). DOX-incorporated nanoparticles of ChitoHISss conjugates were fabricated by a dialysis procedure. DOX-resistant HuCC-T1 cells were prepared by repetitive exposure of HuCC-T1 cells to DOX. ChitoHISss nanoparticles showed spherical morphology with a small diameter of less than 200 nm. The acid pH and glutathione (GSH) addition induced changes in the size distribution pattern of ChitoHISss nanoparticles from a narrow/monomodal distribution pattern to a wide/multimodal pattern and increased the fluorescence intensity of the nanoparticle solution. These results indicate that a physicochemical transition of nanoparticles can occur in an acidic pH or redox state. The more acidic the pH or the higher the GSH concentration the higher the drug release rate was, indicating that an acidic environment or higher redox states accelerated drug release from ChitoHISss nanoparticles. Whereas free DOX showed decreased anticancer activity at DOX-resistant HuCC-T1 cells, DOX-incorporated ChitoHISss nanoparticles showed dose-dependent anticancer activity. Intracellular delivery of DOX-incorporated ChitoHISss nanoparticles was relatively increased at an acidic pH and in the presence of GSH, indicating that DOX-incorporated ChitoHISss nanoparticles have superior acidic pH- and redox-sensitive behavior. In an in vivo tumor xenograft model, DOX-incorporated ChitoHISss nanoparticles were specifically delivered to tumor tissues and then efficiently inhibited tumor growth. We suggest that ChitoHISss nanoparticles are a promising candidate for treatment of CCA.     

2005-2007年医院感染大肠埃希菌产ESBLs、AmpC酶及耐药性分析

非产ESBLs间差异有统计学意义;医院感染大肠埃希菌对碳青酶烯类药物以外的15种抗菌药物出现不同程度的耐药,比较敏感的抗菌药物尚有哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及阿米卡星.结论 医院感染大肠埃希菌ESBLs携带率高,可同时携带AmpC酶及其他耐药基因,造成多药耐药;需加强对抗菌药物应用的规范化管理,提高临床医师合理使用抗菌药物的意识.     

2009-2013年无锡地区医疗机构中华核心期刊论文发表情况排名分析

按照文献检索的方法,通过万方数据知识服务平台搜集相关文献,提取符合标准的相关基本信息,按照年度变化、医疗机构、期刊分布、作者情况等进行统计分析,从而了解无锡地区医疗机构2009-2013年间在中华系列核心期刊上发表论文数量动态变化,为医院科研管理部门提供决策参考。     

Acute Tubular Necrosis Associated with Angiotensin Receptor-neprilysin Inhibitor

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), significantly reduces mortality and morbidity in patients with chronic heart failure with a reduced ejection fraction (HFrEF). However, a considerable number of patients treated with sacubitril/valsartan experience hypotension, oliguria, progressive azotemia, and renal failure as adverse events. These issues have been linked to significant gaps in the usage and dosing of guideline-directed medical therapy with ARNI in patients with HFrEF. We herein report a relevant case of pathologically proven acute tubular necrosis after the first dose of sacubitril/valsartan, highlighting the importance of optimizing the medical therapy in an outpatient with HFrEF.     

Experimental-Numerical Study on the Flexural Ultimate Capacity of Prestressed Concrete Box Girders Subjected to Collision

Precise evaluation for flexural ultimate capacity of bridges which are subjected to the collision of over-height trucks is essential for making decisions on corresponding maintenance, strengthening or replacement. When the span of a cross-line continuous bridge with a double-box girder was hit by an overly high vehicle, the concrete floor of one girder was severely damaged, and part of the prestressed strands and reinforcements in the girder were broken. After the double-box girder was removed and separated into two single box girders, the ultimate flexural capacity of both box girders was studied by destructive tests, and a comparison was made between the damaged and undamaged girders. Moreover, finite element analysis was conducted to simulate the failure process. The results show that the flexural bearing capacity of the damaged box girder decreased by 33%, but it was still 1.07 times greater than the design bearing capacity, which basically meets the design requirements. Also, the damaged box girder showed a desirable serviceable limit state for three-axle vehicles and five-axle vehicles, but showed an undesirable serviceable limit state for six-axle vehicles. This study shows that repairing or strengthening the damaged span may be better than demolishing and rebuilding the whole superstructure bridge.     

Gastric Cancer Risk Was Associated with Dietary Factors Irritating the Stomach Wall: A Case–Control Study in Korea

The incidence of gastric cancer is high in Korea, and dietary factors are important risk factors for gastric cancer. This study examined whether gastric cancer risk was related to dietary factors that directly irritate the stomach wall. This case–control study consisted of 308 matched pairs of gastric cancer cases and controls recruited from 2002 to 2006 at two hospitals in Korea. Dietary assessments were completed using a food frequency questionnaire and a dietary habit questionnaire. Gastric cancer risk was increased for high meal frequency of >3 vs. low meal frequency of ≤3 times per day, overeating vs. not overeating, and preferred vs. not preferred spicy or salty foods. Furthermore, participants with dietary factors of high meal frequency, overeating, and preference for spicy or salty foods elevated the risk of gastric cancer compared to those with low meal frequency, not overeating, and not preferring spicy or salty foods, simultaneously. In conclusion, gastric cancer risk was significantly increased in people with dietary factors that irritate the stomach wall, such as high meal frequency, overeating, and preference for spicy or salty foods.