老年急腹症患者全身炎症反应综合征和多器官功能不全综合 …

目的 分析全身性炎症反应综合征（ＳＩＲＳ）向多脏器功能不全综合征（ＭＯＤＳ）的发展过程,探索ＭＯＤＳ的防治策略。方法 回顾性分析２８０例老年急腹症患者的ＳＩＲＳ和ＭＯＤＳ的临床资料。结果 老年急腹症患者入院时,ＳＩＲＳ的发生率４１．４％,其中ＭＯＤＳ发生率１２．９％,病死率１０．３％;经治疗（包括手术和保守治疗）４８小时后,仍伴有ＳＩＲＳ的患者３９例中,１５例发展为ＭＯＤＳ。２８０例老年急腹症患者     

肝硬变肝功能衰竭患者行肝移植时术前准备的重要性

目的 探讨肝功能衰竭患者行同种原位肝移植（OLT）时术前准备的原则和方案。方法 回顾性比较分析7例因肝硬变肝功能衰竭行OLT和3例因非硬变性肝病行OLT术前凝血功能、一般状况、内环境状况、术中出血量与术后过程的关系。结果 7例肝硬变患者血小板计数均下降，凝血功能差，而例因非硬变性肝病者血小板下降不明显；7例肝硬变患者术前均进行了利尿和保肝支持治疗，而例因非硬变性肝病者除2例进行了保肝支持、输少量全血和人白蛋白外，未输注凝血因子和血浆，也未进行利尿治疗。术中7例肝硬变患者平均出血8455ml，除补充相应量的血以外，还平均输注人白蛋白88.5g和血浆957.1ml，但术比血白蛋白仅26.1g/L，术后48h内内环境紊乱较明显，术后1个月内5例发生真菌感染，3例发生腹腔内出血，而3例非硬变直病患者平均出血2660ml，术中仅输少人白蛋白，术毕血白蛋白30.7g/L，内环境紊乱不明显，术后1月内无感染和腹腔内出血发生。结论 肝硬变肝功能衰竭患者行肝移植术前完全纠正凝血功能障碍、低蛋白血症、贫血和内环境紊乱是保证手术和术后顺利的重要因素。     

弓形钢针内固定在火器伤掌骨缺损早期治疗中的应用

应用“弓”形钢针治疗早期火器伤所致的掌骨缺损18例,共40根掌骨。克服了由于掌骨缺损带来的继发畸形,为后期植骨创造了条件。介绍了“弓”形钢针的制作和临床应用的要点。认为手术成功的关键在于清创彻底,术后良好的引流和创面有血供良好的软组织覆盖。     

Immunogenicity of the pentavalent DTwP-HB-Hib vaccine (Shan-5) used in the Thai Expanded Program on Immunization compared to the hexavalent DTaP-HB-Hib-IPV and DTwP-HB-Hib (Quinvaxem) vaccines administered to infants at 2, 4, 6 months of age

BackgroundThe pentavalent DTwP-HB-Hib (Shan-5) vaccine was first introduced into the Thailand Expanded Program on Immunization (EPI) in 2019. The Shan-5 vaccine is administered to infants at 2, 4, and 6 months of age, after initial vaccination with monovalent hepatitis B (HepB) and Bacillus Calmette-Guérin (BCG) vaccines at birth. This study compared the immunogenicity of the HepB, diphtheria, tetanus, and Bordetella pertussis antigens incorporated in the EPI Shan-5 vaccine versus the optional pentavalent (DTwP-HB-Hib) Quinvaxem and hexavalent (DTaP-HB-Hib-IPV) Infanrix-hexa vaccine.MethodsThree-dose Shan-5-vaccinated children were prospectively enrolled at the Regional Health Promotion Centre 5, Ratchaburi province, Thailand, between May 2020 and May 2021. Blood sampling was performed at months 7 and 18. The levels of HepB surface antibody (anti-HBs), anti-diphtheria toxoid (DT) IgG, anti-tetanus toxoid (TT) IgG, and anti-pertussis toxin (PT) IgG were evaluated using commercially available enzyme-linked immunoassays.ResultsAnti-HBs levels of ≥10 mIU/mL were achieved in 100 %, 99.2 %, and 99.2 % of infants in the Shan-5 EPI group, hexavalent group and Quinvaxem group one month after four dose immunization (at 0, 2, 4, 6 months of age), respectively. The geometric mean concentrations of the EPI Shan-5 and hexavalent groups were comparable but were higher than those of the Quinvaxem group. At one month after primary vaccination (month 7), infants in the Shan-5 EPI group had significantly higher levels of anti-DT IgG, anti-TT IgG, and anti-PT IgG than infants in the hexavalent and Quinvaxem groups.ConclusionsThe immunogenicity of the HepB surface antigen in the EPI Shan-5 vaccine was similar to that achieved by the hexavalent vaccine, but was higher than that achieved by the Quinvaxem vaccine. The Shan-5 vaccine is highly immunogenic and generates robust antibody responses after primary immunization.     

Cardiac events following JYNNEOS vaccination for prevention of Mpox

The incidence of cardiac adverse events following JYNNEOS vaccination for prevention of mpox is unknown, however the Advisory Committee on Immunization Practices states that people with underlying cardiac risk factors should be counseled about the theoretical risk for myopericarditis following vaccination. We conducted a retrospective cohort study of 2,126 patients who were vaccinated with at least 1 dose of JYNNEOS vaccine and searched the Kaiser Permanente Northwest databases, including the electronic health record, to evaluate for cardiac adverse events of special interest (AESI). After physician adjudication, there were 10 confirmed cardiac AESI for an incidence of 3.1 per 1000 doses (exact 95% CI, 1.5 to 5.7), however none of these events could be directly attributed to vaccination. This retrospective cohort study of JYNNEOS vaccination for prevention of mpox identified 10 cardiac events that all had alternative explanations; and no hospitalizations or serious adverse outcomes were attributed to vaccination.     

Immunogenicity and immune persistence in 4-year-old children completing four doses of Sabin strain or wild strain inactivated poliovirus vaccine: A phase IV,open-labeled,parallel-controlled observational study

BackgroundSabin strain inactivated poliovirus vaccine (hereinafter as “sIPV”) has been marketed globally in recent years, and more data on its immune persistence are needed.MethodsThis is a phase IV, open-labeled, parallel-controlled observational study based on phase III clinical trial as required by the China National Medical Products Administration (NMPA). At least 450 subjects aged four years (48–54 months) who received four doses at 2, 3, 4 and 18 months of age of sIPV or wild strain poliovirus vaccine (wIPV) in phase III clinical trial enrolled at a 2:1 ratio and collected blood samples for neutralizing antibody testing.ResultsA total of 500 subjects of four years old (334 in the sIPV group and 166 in wIPV group) were finally enrolled. The seropositivity rates (≥1:8) of neutralizing antibodies against serotype I-III were all 100.00% in all participants, and the geometric mean titers (GMT) were 1117.33 vs. 337.77 against serotype I, 632.72 vs. 267.34 against serotype Ⅱ, 1665.98 vs. 923.02 against serotype III in the sIPV group and wIPV group respectively at 4 years old. The seropositivity rates and GMTs of neutralizing antibodies in the test group were non-inferior to that of the control group against all three serotypes at different time points (P < 0.0001). The antibody GMT experienced a 10-fold, 8-fold, and 7-fold decline for serotypes I, Ⅱ, and III in the sIPV group, and a 13-fold, 7-fold, and 7-fold decline in the wIPV group from one month after booster vaccination to 4 years old.ConclusionsThe neutralizing antibody level is much higher than the seroprotection cutoff (≥1:8) among children of 4 years old who completed the four-dose vaccination of either sIPV or wIPV. Therefore, another booster vaccination is not recommended at 4 years old. Longer immune persistence observation is still ongoing.Registration: ClinicalTrials.gov Identifier: NCT04989231.     

Spatial distribution and determinants of childhood vaccination refusal in the United States

Parental refusal and delay of childhood vaccination has increased in recent years in the United States. This phenomenon challenges maintenance of herd immunity and increases the risk of outbreaks of vaccine-preventable diseases. We examine US county-level vaccine refusal for patients under five years of age collected during the period 2012–2015 from an administrative healthcare dataset. We model these data with a Bayesian zero-inflated negative binomial regression model to capture social and political processes that are associated with vaccine refusal, as well as factors that affect our measurement of vaccine refusal. Our work highlights fine-scale socio-demographic characteristics associated with vaccine refusal nationally, finds that spatial clustering in refusal can be explained by such factors, and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.     

BBIBP-CorV vaccination accelerates anti-viral antibody responses in heterologous Omicron infection: A retrospective observation study in Shanghai

ObjectivesTo investigate how BBIBP-CorV vaccination affecting antibody responses upon heterologous Omicron infection.Methods440 Omicron-infected patients were recruited in this study. Antibodies targeting SARS-CoV-2 spike protein receptor binding domain (RBD) and nucleoprotein of both wild-type (WT) and Omicron were detected by ELISA. The clinical relevance was further analyzed.ResultsBBIBP-CorV vaccinated patients exhibited higher anti-RBD IgG levels targeting both WT and Omicron than non-vaccinated patients at different stages. By using a 3-day moving average analysis, we found that BBIBP-CorV vaccinated patients exhibited the increases in both anti-WT and Omicron RBD IgG from the onset and reached the plateau at Day 8 whereas those in non-vaccinated patients remained low during the disease. Significant increase in anti-WT RBD IgA was observed only in vaccinated patients. anti-Omicron RBD IgA levels remained low in both vaccinated and non-vaccinated patients. Clinically, severe COVID-19 only occurred in non-vaccinated group. anti-RBD IgG and IgA targeting both WT and Omicron were negatively correlated with virus load, hospitalization days and virus elimination in vaccinated patients.ConclusionsBBIBP-CorV vaccination effectively reduces the severity of Omicron infected patients. The existence of humoral memory responses established through BBIBP-CorV vaccination facilitates to induce rapid recall antibody responses when encountering SARS-CoV-2 variant infection.