Immunogenicity and safety of a mixed vaccination schedule with one dose of nonavalent and one dose of bivalent HPV vaccine versus two doses of nonavalent vaccine – A randomized clinical trial

BackgroundLimited data is available on the use of different HPV vaccines in the same subjects. We evaluated the immunogenicity and safety of a mixed vaccination schedule with one dose of nonavalent (9vHPV) and one dose of bivalent vaccine (2vHPV) administered in different order versus two doses of 9vHPV vaccine.Methods371 girls and boys aged 9–10 years were randomized (1:1) to receive (I) two doses of 9vHPV or (II) a mixed schedule of 2vHPV + 9vHPV or 9vHPV + 2vHPV with a 6 month interval. Antibodies to HPV were tested by ELISA in blood samples collected one or six months post-first dose and one month post-second dose.ResultsPost-first dose of 9vHPV 99.4–100% of subjects were seropositive to 9 HPV types included in the vaccine. GMTs varied from 5.0 to 73.6 IU(AU)/ml depending on HPV type. Post-first dose of 2vHPV all subjects were seropositive to HPV16 and 18 (GMTs 16.7 and 11.7 IU/ml, respectively) and 50.0–76.7% were seropositive to 7 types not included in 2vHPV (GMTs varied from 0.3 to 17.5 AU/ml depending on type). Post-second dose all subjects, regardless of the study group, were seropositive to 9 HPV types included in 9vHPV. Anti-HPV16 and 18 GMTs were higher in subjects with the mixed schedule and for the other 7 HPV types higher in subjects who received two doses of 9vHPV vaccine. A higher proportion of subjects who received 2vHPV reported local or systemic adverse events than those who received 9vHPV as the first dose. Post-second dose there were no differences in reported adverse events between the two vaccines.ConclusionsThe results show the mixed HPV vaccination schedules used in this study are immunogenic and have an acceptable safety profile. Although the seroprotective threshold of antibodies remains unknown the 100% seropositivity to all 9 HPV types included in 9vHPV and the increase of GMTs observed in all study groups post-second dose administration are reassuring and suggest protection might be achieved regardless of the schedule used.Clinical Trials Registration: Clinicaltrials.gov NCT02567955.     

深部胸骨切口感染的研究进展

深部胸骨后感染(DSWI)是接受胸骨正中切口术后患者可怕的、灾难性的一种并发症。流行病学资料显示,近5年来DSWI的发生率为0.6%².0%,而其住院病死率或者30 d病死率却高达10.25%2.0%,而其住院病死率或者30 d病死率却高达10.25%²5.8%。围术期预防措施在降低DSWI发生率方面至关重要。真空辅助闭合装置治疗是一种优于其他传统方法有效的过渡治疗方案。胸廓重建术在治疗DSWI中起着决定性作用。多学科协作能够降低DSWI的发生率,在DSWI防治过程中值得提倡。     

肌萎缩侧索硬化患者血清肌酶水平的临床研究

目的 探讨肌萎缩侧索硬化(ALS)患者血清肌酸激酶(CK)的水平,及其与年龄、性别、病情分级、起病方式、病程之间的关系.方法 回顾性分析40例确诊ALS并行血CK检查患者的临床资料,根据性别、年龄、起病部位、病情分级、病程进行分组,统计各组间CK水平的差异.结果 本组患者CK为25～562 U/L,平均88 U/L.15例CK轻度增高.男女性别间CK水平差异无统计学意义(P=0.12),中青年组(＜60岁)和老年组(≥60岁)CK水平差异无统计学意义(P=0.85),临床分级轻度、中度、重度、危重组间CK水平差异无统计学意义(P=0.58),病程较短组(＜1年)和较长组(≥1年)CK水平差异无统计学意义(P=0.11)；球部起病组CK水平明显低于肢体起病组[(109.54±23.40)U/Lvs.(206.13±29.56)U/L,P=0.02].结论 CK增高在ALS患者中并不少见,肢体起病者CK水平更高,CK水平与年龄、性别、病程、病情分级不相关.     

Trends of the internal phthalate exposure of young adults in Germany—Follow-up of a retrospective human biomonitoring study

The exposure of the general population to phthalates is of increasing public health concern. Variations in the internal exposure of the population are likely, because the amounts, distribution and application characters of the phthalate use change over time. Estimating the chronological sequences of the phthalate exposure, we performed a retrospective human biomonitoring study by investigating the metabolites of the five most prominent phthalates in urine. Therefore, 24 h-urine samples from the German Environmental Specimen Bank (ESB) collected from 240 subjects (predominantly students, age range 19–29 years, 120 females, 120 males) in the years 2002, 2004, 2006 and 2008 (60 individuals each), were analysed for the concentrations of mono-n-butyl phthalate (MnBP) as metabolite of di-n-butyl phthalate (DnBP), mono-iso-butyl phthalate (MiBP) as metabolite of di-iso-butyl phthalate (DiBP), mono-benzyl phthalate (MBzP) as metabolite of butylbenzyl phthalate (BBzP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (5oxo-MEHP), mono-(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP) and mono-(2-carboxymethyl hexyl) phthalate (2cx-MMHxP) as metabolites of di(2-ethylhexyl) phthalate (DEHP), monohydroxylated (OH-MiNP), monooxidated (oxo-MiNP) and monocarboxylated (cx-MiNP) mono-iso-nonylphthalates as metabolites of di-iso-nonyl phthalates (DiNP). Based on the urinary metabolite excretion, together with results of a previous study, which covered the years 1988–2003, we investigated the chronological sequences of the phthalate exposure over two decades. In more than 98% of the urine samples metabolites of all five phthalates were detectable indicating a ubiquitous exposure of people living in Germany to all five phthalates throughout the period investigated. The medians in samples from the different years investigated are 65.4 (2002), 38.5 (2004), 29.3 (2006) and 19.6 μg/l (2008) for MnBP, 31.4 (2002), 25.4 (2004), 31.8 (2006) and 25.5 μg/l (2008) for MiBP, 7.8 (2002), 6.3 (2004), 3.6 (2006) and 3.8 μg/l (2008) for MBzP, 7.0 (2002), 5.6 (2004), 4.1 (2006) and 3.3 μg/l (2008) for MEHP, 19.6 (2002), 16.2 (2004), 13.2 (2006) and 9.6 μg/l (2008) for 5OH-MEHP, 13.9 (2002), 11.8 (2004), 8.3 (2006) and 6.4 μg/l (2008) for 5oxo-MEHP, 18.7 (2002), 16.5 (2004), 13.8 (2006) and 10.2 μg/l (2008) for 5cx-MEPP, 7.2 (2002), 6.5 (2004), 5.1 (2006) and 4.6 μg/l (2008) for 2cx-MMHxP, 3.3 (2002), 2.8 (2004), 3.5 (2006) and 3.6 μg/l (2008) for OH-MiNP, 2.1 (2002), 2.1 (2004), 2.2 (2006) and 2.3 μg/l (2008) for oxo-MiNP and 4.1 (2002), 3.2 (2004), 4.1 (2006) and 3.6 μg/l (2008) for cx-MiNP. The investigation of the time series 1988–2008 indicates a decrease of the internal exposure to DnBP by the factor of 7–8 and to DEHP and BzBP by the factor of 2–3. In contrast, an increase of the internal exposure by the factor of 4 was observed for DiNP over the study period. The exposure to DiBP was found to be stable. In summary, we found decreases of the internal human exposure for legally restricted phthalates whereas the exposure to their substitutes increased. Future investigations should verify these trends. This is of increasing importance since the European Commission decided to require ban or authorization from 1.1.2015 for DEHP, DnBP, DiBP and BzBP according to REACh Annex XIV.     

结核性肛周脓肿延误诊断临床分析(附5例报告)

2015年12月至2017年12月,航空总医院普外科收治的320例肛周脓肿患者中5例患者术后30d内切口未愈合,最终诊断为结核性肛周脓肿;其中3例并发肺结核,给予2R-H-E-Z/4R-H-E抗结核药物化疗方案治疗后,切口均愈合,平均愈合时间(25.5±3.6)d,无复发。分析延误诊断原因主要为:结核性肛周脓肿临床较少见,临床表现缺乏特异性,医务人员对此病的认识不足,未对患者病史进行详细分析,未进行脓液抗酸杆菌检查及肛周病变组织病理学检查。对于肛周脓肿的患者,应仔细询问患者病史,常规进行脓液分泌物抗酸杆菌检查、组织病理学检查。确诊为结核性肛周脓肿后应给予规范抗结核药物化疗方案治疗6个月至1年。     

血清同型半胱氨酸水平与急性脑梗死严重程度及中国缺血性卒中亚型分型的关系

目的探讨急性脑梗死患者血清同型半胱氨酸与急性脑梗死严重程度及中国缺血性卒中亚型分型之间的关系。方法应用酶联免疫吸附法检测423例急性脑梗死患者血清同型半胱氨酸水平,按中国缺血性卒中亚型分型、神经功能缺失程度(NIHSS评分)进行分组,将各亚组之间以及与179例健康对照者进行比较。结果急性脑梗死组血清同型半胱氨酸水平显著高于对照组(18.07±10.23μmol/L比7.40±3.48μmol/L,t=16.86,P<0.001);轻、中、重型患者同型半胱氨酸水平分别为16.76±6.37、20.41±6.01、24.48±6.29μmol/L,组间差异有统计学意义(P<0.05);不同病因和发病机制患者血清同型半胱氨酸水平差异无统计学意义(P>0.05)。结论血清同型半胱氨酸水平在脑梗死急性期升高,与脑梗死发生密切相关,可作为判断急性脑梗死病情严重程度的检测指标,但在不同病因和发病机制患者血清同型半胱氨酸水平无显著差异。     

不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.     

阿托伐他汀对不稳定型心绞痛病人血管内皮功能及血小板活化的影响

目的探讨阿托伐他汀对不稳定型心绞痛病人血管内皮功能及血小板活化的影响。方法 68例不稳定型心绞痛病人随机分成常规组(34例)和阿托伐他汀组(34例)。所有病人分别于入院时及用药4周后取血,行血清一氧化氮(NO)、血浆内皮素-1(ET-1)及血小板胞质内α-颗粒膜糖蛋白(CD62p)测定。另选本院同期健康体检者30名作为对照组,要求采血前两周内未服用任何药物。结果不稳定型心绞痛病人血NO水平显著低于对照组(P<0.01),ET-1、CD62p水平明显高于对照组(P<0.01)。治疗4周后两组病人血清NO水平显著升高,血浆ET-1、血小板CD62水平明显降低(P<0.01),且治疗后两组之间有统计学意义(P<0.01),但治疗4周后两组患者血NO水平仍低于对照组(P<0.01),ET-1、CD62p水平仍高于对照组(P<0.01)。结论阿托伐他汀有改善不稳定型心绞痛病人内皮功能,抑制血小板活性作用,阿托伐他汀10mg/d治疗4周后不稳定型心绞痛病人仍然存在内皮功能障碍及血小板活化的问题。     

心脏活动平板运动试验参数对冠心病的诊断价值

目的 总结平板运动试验对冠心病的诊断价值.方法 2006年1月至2011年3月在我院住院接受心脏活动平板运动试验（TET）及冠状动脉造影（CAG）检查的患者445例,回顾性总结分析其平板运动试验中不同参数变化对冠心病的诊断价值.结果 ①进行平板运动试验的445例患者中,TET阳性200例,其中CAG阳性150例、CAG阴性50例;TET阴性245例,其中CAG阴性206例、CAG阳性39例.TET检出冠心病的敏感性为79.36%（150/189）,特异性为80.47%（206/256）,预测准确性为80.00%（356/445）.②CAG阳性组（189例）与CAG 阴性组（256例）比较,CAG阳性组的总运动时间、峰值心率、ST段下移出现时间明显小于CAG阴性组（P＜0.05）,其ST段下移幅度及持续时间显著大于CAG阴性组（P＜0.05）.③CAG阳性的189例中,单支病变87例、多支病变102例,多支病变组总运动时间、峰值心率、ST段下移出现时间明显小于单支病变组（P＜0.05）,ST段下移幅度及持续时间显著大于单支病变组（P＜0.05）.④在平板运动试验阳性组中,性别在冠心病的诊断价值中差异有统计学意义,男性对冠心病的诊断率明显高于女性（P＜0.05）;在平板运动试验阴性组中,性别在冠心病的诊断率方面差异无统计学意义（P＞0.05）.⑤平板运动试验Bruce方案级别与冠心病也有明显的相关性：1级的阳性预测值、阴性预测值和准确率均较其他级高,分别为85.71%、94.44%和88.33%.随着级别的递增,到4级时,其阴性预测值达100%,准确率也为100%.结论 平板运动试验是一项诊断冠心病较理想的非创伤性的检查方法,综合多项参数分析可初步估测其病变程度.