Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

IntroductionAmong high tuberculosis (TB) and HIV burden countries in Asia, tuberculosis preventive therapy (TPT) in people living with HIV (PLWH) has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Therefore, we determined the incidence of active TB and mortality among 9179 adult PLWH who attended and received ART from 15 tertiary care hospitals across Thailand.MethodsA retrospective study was conducted in 2018 using follow‐up data from 1999 to 2018. The primary endpoint was incident TB disease after ART initiation. Factors associated with TB incidence were analysed using competing risk regression. The Kaplan–Meier method was used to estimate mortality after ART initiation.ResultsDuring a median of 5.1 years of ART (IQR 2.2–9.5 years), 442 (4.8%) PLWH developed TB (TB/HIV), giving an overall incidence of 750 (95% CI 683–823) per 100,000 persons‐year of follow up (PYFU). In multivariate analysis, lower CD4 at ART initiation (≤100 cells/mm³, adjusted sub‐distribution hazard ratio [aSHR]: 2.08, 95% CI, 1.47–2.92; 101–200 cells/mm³, aSHR: 2.21, 95% CI, 1.54–3.16; 201–350 cells/mm³, aSHR: 1.59, 95% CI, 1.11–2.28 vs. >350 cells/mm³), male sex (aSHR: 1.40, 95% CI, 1.11–1.78), lower body weight (<50 kg, aSHR: 1.52, 95% CI, 1.17–1.95) and prior TB event (aSHR: 3.50, 95% CI, 2.72–4.52) were associated with TB incidence. PLWH with HIV RNA ≥50 copies/ml had 5–9 times higher risk of active TB disease higher than those with HIV RNA <50 copies/ml at the same CD4 level. The risk for developing TB was remarkably high during the initial period of ART (175,511 per 100,000 PYFU at<3 months) and was comparable to the general population after 10 years of ART (151 per 100,000 PYFU). TB/HIV had higher mortality (10% vs. 5%) and poorer HIV treatment outcomes: HIV RNA <50 copies/ml (63.8% vs. 82.8%), CD4 cells count (317 vs. 508 cells/mm³) at the most recent visit.ConclusionsIn this high TB burden country, TB incidence was remarkably high during the first few years after ART initiation and thereafter decreased significantly. Rapid ART initiation and appropriate TPT can be potential key interventions to tackle the TB epidemic and reduce mortality among PLWH in TB/HIV high burden settings.     

Cloning and characterization of Fc alpha Rb, a novel Fc alpha receptor (CD89) isoform expressed in eosinophils and neutrophils

The Fc receptor for IgA (Fc alpha R, CD89) is a transmembrane glycoprotein found on monocytes, macrophages, neutrophils, and eosinophils. Here we describe the characterization of a novel isoform of the Fc alpha R cloned from a human eosinophil cDNA library. This clone, Fc alpha Rb, lacks the exon encoding the transmembrane/intracellular region of wild type Fc alpha R, which is replaced by 23 new amino acids. Expression of Fc alpha Rb mRNA could be detected in eosinophils and neutrophils. IIA1.6 murine pro-B cells transfected with Fc alpha Rb cDNA secrete high levels of the protein, but also a substantial amount of Fc alpha Rb is expressed at the cell membrane. Membrane-bound Fc alpha Rb binds IgA-coated beads equally well as wild type Fc alpha R. Surface expression is not affected by phosphatidyl inositol phospholipase C, indicating that glycosyl phosphatidyl inositol-linkage of Fc alpha Rb is not likely. In IIA1.6 cells expressing Fc alpha Rb and FcR gamma, which is necessary for signal transduction by wild type Fc alpha R, no tyrosine phosphorylation or Ca(2+)-mobilization could be observed after receptor cross-linking. These results indicate that Fc alpha Rb is likely to have a different function than wild-type Fc alpha R receptor.     

归口管理对缩短新发涂阳肺结核诊断延迟的影响

目的　了解实施肺结核病人归口管理对涂阳肺结核病人诊断延迟的影响。方法 调查1993和 2001年肺结核病人归口管理检查和病人的卡片、病志等有关资料，分析归口管理前后诊断延迟情况。结果 归口转诊率由 48.5%，提高到 89.0%，归口到位率由 29.0%提高到 72.4%，确诊延迟率由 29.4%降到 10.6%，平均延迟天数由 22.2d降到 7.7d，就诊延迟率分别为 63.4%、68.8%和平均延迟天数分别为 48.9d、50.3d，延迟病人时间分布中 20周有一个高峰。结论 归口管理对缩短确诊延迟有明显影响，对就诊延迟无影响，加大结防宣传力度，提高群体对结防意识是缩短就诊延迟的关键。     

A four phase development model for integrated care services in the Netherlands

Background  

Multidisciplinary and interorganizational arrangements for the delivery of coherent integrated care are being developed in a large number of countries. Although there are many integrated care programs worldwide, the process of developing these programs and interorganizational collaboration is described in the literature only to a limited extent. The purpose of this study is to explore how local integrated care services are developed in the Netherlands, and to conceptualize and operationalize a development model of integrated care.     

Phospholipid and glycolipid composition of acidocalcisomes of Trypanosoma cruzi

Highly purified acidocalcisomes from Trypanosoma cruzi epimastigotes were obtained by differential centrifugation and iodixanol gradient ultracentrifugation. Lipid analysis of acidocalcisomes revealed the presence of low amounts of 3beta-hydroxysterols and predominance of phospholipids. Alkylacyl phosphatidylinositol (16:0/18:2), diacyl phosphatidylinositol (18:0/18:2), diacyl phosphatidylcholine (16:0/18:2; 16:1/18:2; 16:2/18:2; 18:1/18:2 and 18:2/18:2), and diacyl phosphatidylethanolamine (16:0/18:2 and 16:1/18:2) were the only phospholipids characterized by electrospray ionization-mass spectrometry (ESI-MS). Incubation of epimastigotes with [(3)H]-mannose and isolation of acidocalcisomes allowed the detection of a glycoinositolphospholipid (GIPL) in these organelles. The sugar content of the acidocalcisomal GIPL was similar to that of the GIPL present in a microsomal fraction but the amount of galactofuranose and inositol with respect to the other monosaccharides was lower, suggesting a different chemical structure. Taken together, these results indicate that acidocalcisomes of T. cruzi have a distinct lipid and carbohydrate composition.     

人工髋关节材料改进及固定技术探索

目的:回顾人工髋关节从设计应用、改进历史,展望未来发展趋势,从材料学及临床应用方面阐述提高人工髋关节性能的重要性,为提高人工髋关节置换质量提供依据。方法:应用计算机检索Medline 1994-01/2006-12关于人工髋关节的文章。检索词“Artificial HipJoint”并限定文章的语言种类为English。同时利用计算机检索中国期刊全文数据库1994-01/2006-12的相关文章,限定文章语言种类为中文,检索词“人工髋关节”。结果:人工髋关节从设计应用、改进、再应用已经经历了100余年历史,目前已成为一种效果非常肯定的治疗手段。虽然假体材料及临床技术渐趋成熟,但对材料改进及技术探索从未停止,近年,国外生物陶瓷材料被广泛研制、已应用于临床,硬质耐磨的钴铬钼合金关节假体在临床试用。人们仍在寻找更加理想的人工关节材料。结论:低磨损型人工髋关节是提高治疗质量的重要因素,临床技术的改进依赖于材料改进,需要多方向不断探索。     

内蒙古自治区"卫生部加强与促进结核病控制项目"实施情况分析

目的　分析项目实施 8年的情况。方法 根据项目实施细则建立规范的报告系统而获得信息。结果 项目占全区总县数的 31.7% ,人口覆盖率为 4 3.4 %。 8年共发现涂阳肺结核病人132 6 0例。涂阳病人治愈率 93.7% ,其中初治治愈率 94 .7% ,复治 88.3%。结论 卫生部项目实施 8年 ,对自治区结核病控制工作起到了促进作用。     

河南省肺结核流行趋势及病例发现方法分析

目的 以河南省第四次全国结核病流行病学抽样调查（流调）数据为依据，揭示河南省结核病疫情现状及变化趋势，并就病例发现方法进行分析。方法 应用痰检和X线、PPD等检查手段，从46个流调点的抽样人群中筛选活动性肺结核患。结果 活动性肺结核患病率497／10万，涂阳肺结核患病率132／10万，菌阳肺结核患病率为159／10万。与1990年流调结果相比，10年间涂阳患病率下降6.15%，年平均递降率仅为0.63%，下降极为缓慢。增加1次痰涂片检查，可提高6.6%的病例发现率。结论 河南省结核病疫情仍很严重，病例发现工作有待加强，加强肺结核可疑症状查痰有助于提高传染性肺结核患的发现率。