Comparison of Parascreen Pan/Pf, Paracheck Pf and light microscopy for detection of malaria among febrile patients, Northwest Ethiopia

Two malaria rapid diagnostic tests (RDT), Parascreen Pan/Pf^® and Paracheck Pf^®, were tested in rural health centres in Ethiopia against independent expert microscopy (the gold standard). Participants (n =1997) presented with presumptive malaria to ten health centers in Amhara Regional State during the 2007 peak malaria season (October to December). By microscopy, 475 (23.8%) suspected malaria cases were positive, of which 57.7% were P. falciparum; 24.6% P. vivax and 17.7% mixed infections. Parascreen and Paracheck were positive for 442 (22.1%) and 277 (13.9%) febrile patients, respectively. For Parascreen, P. falciparum sensitivity was 79.6%, specificity 97.4%, positive predictive value (PPV) 86.9%, and negative predictive value (NPV) 95.6%. For Parascreen, P. vivax sensitivity was 74.4%, specificity 98.6%, PPV 76.3% and NPV 98.4%. For Paracheck, P. falciparum sensitivity was 73.7%, specificity 99.2%, PPV 95.3%, NPV 94.5%. Sensitivity was significantly higher for both tests (P < 0.05) when parasite density was >100/μl of blood; in these cases Parascreen was 90.7% and 91.5% sensitive for P. falciparum and P. vivax, respectively, while Paracheck was 87.9% sensitive for P. falciparum. Parascreen thus performed adequately for both P. falciparum and P. vivax compared to expert microscopy and is more useful than Paracheck where microscopy is unavailable.     

Human immunodeficiency virus type-1 group M quasispecies evolution: diversity and divergence in patients co-infected with active tuberculosis

The evolution of intra-host human immunodeficiency virus type 1 (HIV-1) quasispecies prior and after treating active tuberculosis (TB) with chemotherapy in HIV-1/TB patients was assessed. Two time points HIV-1 quasispecies were evaluated by comparing HIV-1-infected patients with active tuberculosis (HIV-1/TB) and HIV-1-infected patients without tuberculosis (HIV-1/non-TB). Plasma samples were obtained from the Frankfurt HIV cohort, and HIV-1 RNA was isolated. C2V5 env was amplified by PCR and molecular cloning was performed. Eight to twenty-five clones were sequenced from each patient. Various phylogenetic analyses were performed. We found a significant increase in diversity and divergence in HIV-1/TB compared to the HIV-1/non-TB. For HIV-1/TB, the average rate of evolution of C2V5 env was higher than previous reports (2.4 × 10⁻⁴ substitution/site/day). Two groups of HIV-1/TB were observed based on the rate of HIV-1 evolution and coreceptor usage: A fast evolving R5-tropic dominating group and a relatively slowly evolving X4 group. The results demonstrated that active TB has an impact on HIV-1 viral diversity and divergence over time. The influence of active TB on longitudinal evolution of HIV-1 may be predominant for R5 viruses.     

全肺灌洗治疗婴儿肺泡蛋白沉积症一例并文献复习

目的探讨婴儿全肺灌洗治疗肺泡蛋白沉积症的安全性、可行性及操作要点。方法报道2018年11月上海交通大学医学院附属上海儿童医学中心重症医学科收治的1例肺泡蛋白沉积导致呼吸衰竭的患儿的临床表现、基因检查及全肺灌洗治疗方法;并以"whole lung lavage""pediatric""pulmonary alveolar proteinosis""全肺灌洗""儿童""肺泡蛋白沉积"为检索词,检索PubMed、Springer Link、中国知网、维普、万方数据库建库至2019年4月相关文献并进行总结。结果患儿男,3月龄,因"咳嗽、气促伴口唇青紫1周"入院。查体示肝脾肿大。血常规示轻度贫血(血红蛋白96 g/L),白细胞、血小板及C反应蛋白正常。白蛋白偏低(31 g/L),天冬氨酸转氨酶轻度升高(115 U/L);乳酸脱氢酶显著升高(>6600 U/L),铁蛋白显著升高(>4500μg/L),血氨轻度升高(165μmol/L)。胸部CT显示两肺透光度减低,斑片状高密度影及磨玻璃样影。基因检查显示SLC7A7基因存在突变(c.625+1G>A)。支气管肺泡灌洗液过碘酸希夫反应(PAS染色)阳性。患儿诊断为重症肺炎、呼吸衰竭、赖氨酸尿性蛋白耐受不良、肺泡蛋白沉积症。行左右肺全肺灌洗治疗后患儿顺利撤机,脱离吸氧并出院。文献检索共11篇,中文0篇、英文11篇,纳入21例患者,进行全肺灌洗后呼吸功能好转者占76%(16/21)。结论全肺灌洗可有效改善婴儿肺泡蛋白沉积导致的呼吸衰竭,改善患儿呼吸功能;且操作具有可行性及安全性。     

A case report of intracardiac bone cement embolization after posterior decompression and cement-enhanced pedicle screw fixation for osteoporosis and lumbar degeneration

Rationale:Bone cement leakage is a common complication of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) surgery and has also been reported in posterior decompression and cement-enhanced pedicle screw fixation. When bone cement leaks through the venous system, it will have serious consequences and even endanger the life of the patient, especially when the bone cement causes intracardiac embolism.Patient concerns:A 70-year-old woman developed chest tightness and decreased blood oxygen saturation following posterior decompression and cement-enhanced pedicle screw fixation.Diagnosis:After the patient was given symptomatic treatment, the symptoms were not relieved, the high-sensitivity troponin I level continued to rise, the electrocardiogram results were abnormal, and chest computed tomography (CT) revealed multiple flaky and strip-shaped dense shadows in the heart.Intervention:The patient underwent removal of foreign bodies from the heart under cardiopulmonary bypass and tricuspid valvuloplasty, removal of intracardiac bone cement, and repair of the tricuspid valve and chordae.Outcome:The patient recovered well postoperatively and was discharged from the hospital after 3 weeks. There were no intracardiac foreign bodies observed on chest CT after the operation.Lessons:For patients with cardiopulmonary discomfort after posterior decompression and bone cement-enhanced pedicle screw fixation, in view of the limitations of radiographic examination, we recommend performing chest CT examination to confirm the diagnosis. For patients with intravascular foreign body embolism, multidisciplinary team joint treatment saves lives.     

小儿心源性休克的临床分析

目的分析小儿心源性休克(CS)的临床特点和预后。方法2002年1月至2005年12月本院PICU收治的非心脏病近期手术所致CS患儿19例。回顾分析临床表现、心电图、胸片、超声心动图特点及与预后的关系。结果小儿CS临床表现以呼吸道、消化道症状为主,缺乏特异性。病死率68.4%,其中61.5%死于入院24h内,平均死亡时间为入院后31.5h。死亡的原发病为心肌炎(58例),先心病(56例),心肌病(22)和感染性心内膜炎(11)。直接死亡原因分别是心脏泵功能衰竭、心律失常各4例,心脏泵功能衰竭与心律失常共同作用5例。超声心动图的血流动力学参数LVEF、SVI、LVEDVI、LVESVI、CI在生存者和死亡者之间差异无显著性(P>0.05)。并发DIC及心跳呼吸骤停的病死率分别是100%及75%。肝、肾功能异常,代谢性酸中毒的严重度与病死率无关。结论小儿CS病死率高,尤其在CS早期,并发DIC及心跳呼吸骤停者预后更差。致死的主要原因是心肌炎、心肌病、先心病等原发病导致心脏泵功能衰竭或和心律失常。超声心动图对原发病的诊断起十分重要的作用,应早期常规检查,但其血流动力学变化不能作为判断预后的指标。传统治疗方法效果不佳,在国内应尽快采用VAD、BiVAD、ECMO等技术救治暴发性心肌炎所致CS,以挽救患儿生命。     

Design of new bioinspired GO-COOH decorated alginate/gelatin hybrid scaffolds with nanofibrous architecture: structural,mechanical and biological investigations

The current research study deals with the design and investigation of novel bioinspired and biocompatible GO-COOH decorated hybrid polymeric scaffolds with nanofibrous architecture as biomaterials with highly appropriate features for functional restoration of damaged tissue. Gelatin and alginate, two biobased-polymers with excellent biocompatibility, high microenvironment biomimicry and ability for proper guidance of cell development in combination with carboxylated graphene oxide (GO-COOH), embody the matrix of electrospun hybrid scaffolds. The underlying principle is based on various types of interactions that can take place between the functionalities of the system''s entities (proved by DLS) and their synergy in improving the structural integrity, mechanical tailorability and biological performances of the new nanofibrous GO-COOH decorated hybrid scaffolds. The nanofibrous structure along with the presence of GO-COOH are established by SEM. The new covalent bonds formed between various functionalities of the protein-polysaccharide-GO-COOH system are proved by FTIR and XPS. The physico-chemical state of GO-COOH lattices within the hybrid structures is investigated by Raman spectrometry. The interpenetrated network of bicomponent structures determines a 10-fold increase of Young''s modulus as compared to monocomponent counterparts while the dispersion of GO-COOH significantly increases the elasticity of materials. The biological results (MTT and LDH assays) indicate a good cytocompatibility of crosslinked bicomponent AGS scaffolds; the metabolic cellular activity is substantially improved following the GO-COOH addition, suggesting that GO-COOH can support the cell adhesion, growth and proliferation.

The study deals with the design and investigation of bioinspired and biocompatible GO-COOH decorated hybrid polymeric scaffolds with nanofibrous architecture as biomaterials with appropriate features for functional restoration of damaged tissue.     

儿童呼吸道腺病毒感染临床特征和流行情况分析

目的探讨儿童呼吸道腺病毒感染的临床特征及流行病学情况,为本地区腺病毒感染的诊断、监测及防治提供依据。方法选取2016年11月至2017年11月在上海儿童医学中心住院的呼吸道感染病例样本775例,通过FilmArray检测84例为腺病毒感染。结果775例病例中检出84例腺病毒感染,阳性率10.8%。腺病毒感染全年散发,流行高峰为冬春夏季,尤其是冬季检出率20.8%,1月份检出率最高32.2%。发病年龄以6个月~2岁为主(占47.7%)。常见临床表现为发热(91.7%)、咳嗽(96.4%)、喘息(48.8%)、气促(14.2%)。15例(17.9%)伴有基础疾病,其中伴先天性心脏病最多(9例,10.7%)。混合感染53例(63.1%),合并人鼻病毒/肠病毒比例最高(21例,25.0%)。诊断上呼吸道感染5例,支气管炎3例,肺炎76例,其中轻症肺炎55例,重症肺炎21例。平均住院时间为8.3 d。混合感染组住院天数、喘息例数、重症病例数明显高于单一感染组(P<0.05)。重症组住院天数、喘息症状、肺外症状、存在基础疾病、混合感染明显高于轻症组,差异有统计学意义(P<0.05)。结论腺病毒感染好发于6个月~2岁儿童,冬春夏季高发,1月份为感染高峰。临床表现以高热、咳嗽、喘息为主。有基础疾病、喘息症状、肺外症状、混合感染的患儿更易进展为重症。FilmArray检测系统可以快速、准确检测病原,为临床医师早期诊断、监测及防治提供依据。     

Dangers on the road: A longitudinal examination of passenger‐initiated violence against bus drivers

This study examined the impact of workplace violence against 109 bus drivers over a 1‐year span. Workplace violence is related to both psychological and work‐related consequences. Our findings showed that bus drivers experienced a wide range of violence at work and the psychological consequences were devastating: Half of the participants met the diagnostic criteria for acute stress disorder within the first month following the index event. Majority of them experienced at least moderate levels of post‐traumatic stress disorder (PTSD) problems over the 1‐year span. About 9.3% of participants showed a delayed onset of PTSD 6 months after. Furthermore, counter‐supportive behaviours and reexposure to violence played important roles in the maintenance of PTSD symptoms over time. Even though PTSD symptoms per se did not relate to bus driver's confidence in coping with aggressive passengers, the immediate post‐traumatic reaction—symptoms of acute stress disorder—showed a significant long‐term negative effect on bus drivers' confidence in dealing with aggressive passengers 12 months after. This study provided empirical evidence of the changing nature of PTSD symptoms over time among bus drivers.