Rare detection of hepatitis B and hepatitis C virus genomes by polymerase chain reaction in seronegative donors with elevated alanine aminotransferase

BACKGROUND: Since screening for antibody to hepatitis C virus (HCV) was introduced in 1990, posttransfusion hepatitis has been reduced to nearly background levels. This has led to reconsideration of the value of testing donated blood for elevated alanine aminotransferase (ALT). The contribution of ALT testing in detecting seronegative infection was evaluated by the performance of polymerase chain reaction (PCR) for hepatitis B virus (HBV) or HCV in plasma from ALT-elevated blood units. STUDY DESIGN AND METHODS: Testing was performed on 375 units of plasma, derived from an equivalent of 47,500 blood donations, with a highly sensitive hemi-nested PCR procedure. Using a triplet of primers directed at the conserved regions of HBV DNA and 5'-noncoding regions of HCV RNA, the hemi-nested PCR assay can reliably amplify 10 viral molecules to levels detectable in ethidium bromide-stained agarose gels. Pools of plasma from groups of four donors were screened with hemi-nested PCR. For any reactive pools, the plasma from individual donors was retested twice on different aliquots. RESULTS: Two of 375 units, both with midrange ALT elevation, were repeatedly reactive in hemi-nested PCR (one each for HBV DNA and HCV RNA). However, samples from the two suspect donors tested 9 and 5 months later revealed no seroconversion, elevated ALT, or viral genomes in hemi-nested PCR. CONCLUSION: The lack of confirmed HBV or HCV infection in this study representing an estimated 47,500 voluntary blood donations suggests that routine ALT testing for further prevention of posttransfusion hepatitis after exclusion of HBV- and/or HCV-seropositive blood may be superfluous.     

中国人胚胎肝组织来源纤溶酶原kringle5基因的克隆与序列分析

目的：分离、克隆和测定中国人纤溶酶原Kringle5功能区基因，为进一步研究其功能奠定基础。方法：实验于2002—06／2003-05在广州医学院金域医学检验中心完成。①实验材料：国人胚肝组织取自广州医学院第一附属医院的流产胚胎（取得家属同意，并经广州医学院第一附属医院伦理委员会批准）。pET21a（＋）载体购自Novagen公司，大肠杆菌BL21（DE3）为医学检验中心保存。引物均由上海生工合成。②实验方法：从国人胚肝组织中提取mRNA，用反转录-聚合酶链反应方法将人纤溶酶原Kringle5的cDNA扩增出来，克隆到pET21a（＋）载体中测序。（D实验评估：采用紫外分光光度仪和琼脂糖凝胶电泳分析胚肝组织总RNA的抽提结果；经琼脂糖凝胶电泳鉴定Kringle5的反转录-聚合酶链反应扩增结果；pET-Kringle5重组质粒的酶切鉴定；序列测定。结果：①胚肝组织提取总RNA结果：提取的总RNA经紫外分光光度仪测得A260nm/A80nm〉1．8，A60nm，A270nm〉1.2，表明无蛋白残留；电泳结果显示提取的总RNA有明显的28S、18S两条带，说明RNA基本完整。②Kringle5的反转录-聚合酶链反应扩增结果：人Kringle5 cDNA片段长为240bp，加上引物设计的2个酶切位点，总长度为258bp，聚合酶链反应产物长度与该长度一致，符合预期结果。③）pET-Kringle5重组质粒的构建和酶切鉴定结果：用引物所带的限制性内切酶BamH Ⅰ、NdeⅠ双酶切，结果有250bp左右条带出现。④序列测定结果：证实国人纤溶酶原Kringle5功能区基因被成功克隆，序列分析证实为该基因，未发现有基因突变或多态性现象，但第153位核苷酸与文献比较存在碱基替代现象，其组成的密码子由于遗传的简并性，所编码的氨基酸相同，并未造成氨基酸组成的改变。结论：中国人纤溶酶原Kringle5功能区cDNA基因编码序列与国外文献报道的相应序列可能存在碱基替代现象。     

意大利的耐多药结核病管理

地点：SMIRA（意大利抗结核药品耐药性研究）网络,包括意大利全国46个主要临床单位和22个实验室.目的：确定1995年1月至1999年12月登记的耐多药结核病人（MDR-TB）的特点、对WHO指南的依从性以及治疗结果.设计：根据WHO的建议,先作耐药水平测试,然后进行观察性研究.结果分为治疗方案适当和治疗方案不合理（少于三种有效药物）.根据治疗的合理程度分析治疗结果.用单变量和多变量分析法分析危险因素和治疗结果预报因素（显著性水平P＜0.0结果：共诊断127个耐多药病人.总的治疗成功率低（39%）.70%的病人至少使用过3种有效药物.治疗成功的预报因素有,新治MDR-TB病人（OR=3.45;95%CI：1.22-9.87;P＜0.05）和治疗≥12个月（OR=5.03;95%CI：1.65-15.31;P＜0.05）.在新治MDR-TB病人中,移民和艾滋病病毒感染是主要的危险因素.结论：应该给所有新诊断MDR-TB病人提供现有的最好治疗,避免使用不适宜的治疗方案.MDR-TB病人应该被转诊到专业机构诊治.     

Systemic inflammation after inspiratory loading in chronic obstructive pulmonary disease

Objective

Patients with chronic obstructive pulmonary disease (COPD) present systemic inflammation. Strenuous resistive breathing induces systemic inflammation in healthy subjects. We hypothesized that the increased respiratory load that characterizes COPD can contribute to systemic inflammation in these patients.

Patients and methods

To test this hypothesis, we compared leukocyte numbers and levels of circulating cytokines (tumor necrosis factor alpha [TNFα], interleukin-1β [IL-1β], IL-6, IL-8, and IL-10), before and 1 hour after maximal incremental inspiratory loading in 13 patients with stable COPD (forced expiratory volume in one second [FEV₁] 29 ± 2.5% ref) and in 8 healthy sedentary subjects (FEV₁ 98 ± 5% ref).

Results

We found that: (1) at baseline, patients with COPD showed higher leukocyte counts and IL-8 levels than controls (p < 0.01); and, (2) one hour after maximal inspiratory loading these values were unchanged, except for IL-10, which increased in controls (p < 0.05) but not in patients with COPD.

Conclusions

This study confirms the presence of systemic inflammation in COPD, shows that maximal inspiratory loading does not increase the levels of pro-inflammatory cytokines (IL-1β, IL-8) in COPD patients or controls, but suggests that the former may be unable to mount an appropriate systemic anti-inflammatory response to exercise.     

Trichomonas vaginalis in HIV/AIDS subjects in Nigeria

ObjectiveTo determine the prevalence of Trichomonas vaginalis (T. vaginalis) in HIV/AIDS patients attending two different hospitals in southeast Nigeria.MethodsWe collected 970 urine samples from HIV/AIDS patients attending two different hospitals in southeast Nigeria. Samples were processed by microscopy and cultural methods.ResultsOut of the 970 screened, 355 (36.60%) were positive for T. vaginalis. Subjects with the least CD4⁺ count in the range of 40-140 cells/mL had the highest number of positive samples (180, 50.70%), while those in the range of 480-580 cells/mL had the least value (2, 0.56%). Those in the rural areas had a higher number of positive samples (155, 38.75%) than their urban counterparts (200, 35.09%) with respect to the total number examined in each group but this was not statistically significant (P>0.05). Out of the 355 positive cases, the university undergraduate students’ group had the highest percentage incidence of 53.00% followed by the low-income group with 47.08%.ConclusionsIt can be concluded that the occurrence of T. vaginalis increases with decrease in the CD4⁺ counts in HIV/AIDS patients in Nigeria. Since T. vaginalis may be an important cofactor in promoting the spread of HIV and, in some circumstances, may have a major impact on the epidemic dynamics of HIV, there is a need to take measures to check the spread of this parasitic infection.     

中老年人糖化血红蛋白水平与颈动脉内膜-中层厚度的相关性研究:广州生物库心血管疾病亚队列

目的 探讨相对健康的中老年人血中糖化血红蛋白(HbAlc)含量对颈动脉硬化的影响.方法 从广州生物库队列中单纯随机抽样收集1863名年龄≥50岁的广州市居民的个人资料,问卷调查其病史、体格检查及测定血清空腹血糖、血脂、HbA1c的含量并应用彩色多普勒超声测量颈总动脉内膜-中层厚度(intima media thickness,IMT).在调整相关混染因素后,应用协方差分析进行连续变量分析.结果 (1)在调整年龄、性别和空腹血糖等因素后,平均颈总动脉IMT随HbA1c含量升高呈明显增加趋势(P=0.005).线性回归模型显示,在调整年龄、性别、吸烟状态、腰围、收缩压和舒张压、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和空腹血糖等潜在危险因素后,结果仍然显示HbA1c水平与平均颈总动脉IMT有明显的线性相关(回归系数为0.014,P=0.03);(2)经过调整多种潜在混杂因素后,与HbA1c理想组(HbA1c<6.5%)比较,良好组(HbA1c为6.5%～7.5%)和差组(HbA1c>7.5%)发生颈动脉硬化的比值比(95%置信区间)分别为1.62(1.10,2.38)和1.76(0.86,3.63),趋势检验(P=0.01).结论 相对健康的中老年人HbA1c含量升高是颈动脉硬化的独立危险因素之一,提示降低HbA1c水平对阻止或延缓颈动脉硬化的发生与发展有重要意义.     

Treatment of metastatic glucagonoma to the liver: case report and literature review

Glucagonoma, a rare neuroendocrine pancreatic tumour, is frequently malignant and often accompanied by hepatic metastases. Our aim was to consider the different treatments of metastatic glucagonoma to the liver and their results. A case of glucagonoma with metachronous, small, multiple and bilobar liver metastases is reported. Combined treatment with octreotide and hepatic arterial chemoembolization was applied with good results in terms of symptom relief, plasma glucagon levels and regression of hepatic metastases. Survival rates were also improved. Based on our experience, glucagonoma with metachronous, multiple, diffuse and bilobar hepatic metastases should be treated with octreotide plus hepatic arterial chemoembolization with improved outcome and prognosis.