Cytomegalovirus-induced pathology in human temporal bones with congenital and acquired infection

ObjectivePublications on histopathology of human temporal bones with cytomegalovirus (CMV) infection are limited. We aim to determine histopathology of the inner ears and the middle ears in human temporal bones with congenital and acquired CMV infections.MethodsTemporal bones from 2 infants with congenital and 2 adults with acquired CMV infection were evaluated by light microscopy.ResultsTwo infants with congenital CMV infection showed striking pathological changes in the inner ear. There was a hypervascularization of the stria vascularis in the cochlea of the first infant, but no obvious loss of outer and inner hair cells was seen in the organ of Corti. However, cytomegalic cells and a loss of outer hair cells were found in the cochlea of the second infant. The vestibular organs of both infants showed cytomegalic cells, mostly located on dark cells. There was a loss of type I and type II hair cells in the macula of the saccule and utricle. Loss of hair cells and degeneration of nerve fibers was also seen in the semicircular canals. Both infants with congenital infection showed abundant inflammatory cells and fibrous structures in the middle ear cavity. No evidence of cytomegalic cells and hair cell loss was found in the cochlea or vestibular labyrinth in acquired CMV infection.ConclusionsIn two infants with congenital CMV infection, the cochlea, vestibule, and middle ear were highly affected. Temporal bones of adult donors with acquired viral infection showed histological findings similar to donors of the same age without ear disease.     

Association Between Antihypertensive Use and Hospitalized Pneumonia in Patients With Stroke: A Korean Nationwide Population-Based Cohort Study

BackgroundWe aimed to examine the association between antihypertensive use and the incidence of hospitalized pneumonia in patients with a history of stroke.MethodsIn this case-crossover study, we obtained data from the Korean National Health Insurance Service–National Sample Cohort database. We included the data of patients with history of stroke who were admitted with a disease code of pneumonia. We analyzed the patients’ exposure to antihypertensives in the 30 (single case period), 90–120, and 150–180 days (2 control periods) before the onset of pneumonia using conditional logistic regression analysis. Additionally, sensitivity analysis and subgroup analysis according to diabetes status, age, and documented disability were performed.ResultsAngiotensin II receptor blocker (ARB) use was associated with a reduced risk of hospitalized pneumonia (adjusted odds ratio [OR] [95% confidence interval; 95% CI]: 0.718 [0.576–0.894]). However, the use of angiotensin converting enzyme inhibitors and other antihypertensives were not associated with a change in hospitalized pneumonia incidence (adjusted OR [95% CI]: 0.902, [0.603–1.350] and 0.788 [0609–1.018], respectively). Subgroup analysis revealed that ARB use was associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke who were older than 65 years, but not in younger (≤ 65 years) group (adjusted OR [95% CI]: 0.687 [0.536–0.880]).ConclusionARB use is associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke, especially in older adults.     

Molecular typing and in vitro resistance of Cryptococcus neoformans clinical isolates obtained in Germany between 2011 and 2017

Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients’ samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.     

拓扑替康对鼻咽癌放射增敏的体内实验

目的 研究拓扑替康(topotecan,TPT)对鼻咽癌裸鼠移植瘤的放射增敏作用.方法 ①首先行拓扑替康对裸鼠最大耐受剂量以及拓扑替康和放疗(radiotherapy,RT)有效率的研究;②放射增敏实验方案:53只移植瘤裸鼠随机分为5组,RT 20 Gy组,RT40 Gy组,TPT 12.5 mg/kg组,TPT 12.5 mg/kg RT20 Gy组,生理盐水对照组并给予相应处理,评价有效率(完全缓解 部分缓解)和再生长延缓时间(regrowth delay time,TGD),并绘制生长曲线,计算增敏比,抑瘤率等.结果 RT20 Gy TPT 12.5 mg/kg组与RT20 Gy组和TPT12.5 mg组比较差异有统计学意义;RT20 Gy TPT 12.5 mg/kg组RT40 Gy组比较差异没有统计学意义;增敏比=1.34.结论 本研究证明了TPT对鼻咽癌裸鼠移植瘤放射治疗有明显的增敏效果.     

芬太尼预防鼻咽部手术七氟醚全麻术后躁动

目的 探讨芬太尼对鼻咽部手术七氟醚全麻术后躁动的预防作用.方法 鼻咽部手术69例,美国麻醉医师协会(the American Society of Anesthesiologists,ASA)Ⅰ、Ⅱ级,随机分为3组,每组23例.均采用静吸复合全麻,七氟醚吸入诱导维持,麻醉用药相同.术毕停麻醉前10分钟分别静脉注射芬太尼1 μg/kg(稀释1倍,Ⅰ组)、2 μg/kg(Ⅱ组)或生理盐水体积等同于Ⅱ组(Ⅲ组,对照组).观察各组术后躁动发生率、清醒情况、拔管时间及恶心和呕吐发生率.结果 与对照组比较,Ⅰ、Ⅱ组拔管后躁动发生明显减少(P＜0.05),Ⅱ组的拔管时间和苏醒时间长于对照组(P＜0.05),恶心和呕吐发生率大于Ⅲ组(P＜0.05).结论 静脉注射1 μg/kg芬太尼可以减少鼻咽部手术七氟醚全麻术后躁动的发生,且不明显延长拔管苏醒时间,不增加术后恶心和呕吐发生率.     

莫沙必利联合阿嗪米特治疗胆汁反流性胃炎的临床疗效

【目的】探讨阿嗪米特联合胃肠动力药物莫沙必利对胆汁反流性胃炎患者的治疗效果。【方法】选择本院于2011年12月至2013年12月接诊的120例胆汁反流性胃炎患者的临床病例资料,将所有接诊患者按随机数字表分为对照组60例患者,采用碳酸铝镁联合莫沙必利治疗,观察组60例患者,采用阿嗪米特联合莫沙必利治疗,比较两组患者的治疗效果。【结果】治疗后,观察组患者的总有效率为86．67％,明显高于对照组患者66．67％,组间差异具有统计学意义（P＜0．05）;观察组患者的症状评分均较对照组患者治疗前明显改善,组间差异均具有明显统计学意义（P＜0．05）;观察组患者的胆汁反流次数和最长反流时间等均明显低于对照组患者,组间差异具有明显统计学意义（P＜0．05）。【结论】阿嗪米特与胃肠动力药物莫沙必利联合应用,可通过协同治疗作用,不但促进胆汁规律性地分泌,而且增加胃肠运动,促进食物消化能力,改善患者的临床不适症状,有利于患者病情改善和生活质量的提高,值得临床推广应用。