新型冠状病毒肺炎疫情防控期间开展肺功能检查的专家共识

新型冠状病毒肺炎(COVID-19)主要通过呼吸道飞沫传播及密切接触传播,也可能会通过气溶胶传播。肺功能检查可增加医务人员和受检者发生COVID-19传播的风险,必须严格执行有效的预防和控制措施以防止院内感染。为了指导肺功能检查室医务人员做好防控工作,本文结合肺功能检查的特点,总结了当前疫情下肺功能检查在医务人员管理、检查流程管理和检查环境物品管理3个方面的要求及注意事项。文中强调在疫情流行期间,必须严格掌握肺功能检查的适应证,强烈建议COVID-19确诊病例或疑似病例在传染期内暂缓检查,其他病患如非病情急需也暂缓检查;肺功能室医务人员应严格执行标准分级防护措施;受试者应在单独区域进行隔离检查;检查时必须使用一次性呼吸过滤器;并重视肺功能检查环境和设备的清洁消毒。     

Occult Hepatitis C Virus Infection in Patients With Autoimmune Hepatitis

Background:

Occult hepatitis C virus infection (OCI) is recognized by finding hepatitis C virus (HCV) RNA in hepatocytes without detectable anti-HCV antibodies and viral RNA in plasma. Autoimmune hepatitis (AIH) is a chronic and generally progressive disease without exactly-identified etiology.

Objectives:

This study aimed to determine the prevalence of OCI among patients with AIH and to evaluate the tests used to rule out HCV infection in diagnosing AIH.

Patients and Methods:

Between July 2012 to February 2013, 35 Iranian patients with AIH who attended Tehran Hepatitis Center were investigated. For identifying OCI, detection of HCV RNA in both ultracentrifuged serum samples and peripheral blood mononuclear cells (PBMCs) was used. Data analysis was performed using SPSS.

Results:

Six males and 29 females with mean disease duration of 77.1 ± 39.5 month and mean age of 43.62 ± 12.67 years were investigated. All cases were negative for anti-HCV antibody and we could not find any HCV RNA in ultracentrifuged serum samples and PBMCs.

Conclusions:

With our laboratory diagnostic method, it seems that there are no cases of OCI in patients with AIH. However, we recommend further studies with more samples and more precise laboratory method.     

Persistent Hepatitis E Virus Genotype 4 Infection in a Child With Acute Lymphoblastic Leukemia

Introduction:

In general, the hepatitis E virus (HEV) causes acute, self-limiting hepatitis. Prolonged and chronic infections caused by HEV genotype 3 have been found in some immunosuppressed patients in developed countries.

Case Presentation:

Here we report a Chinese boy with acute lymphoblastic leukemia, who developed hepatitis E during a period of intensive chemotherapy. Twenty months after the initial infection, HEV viremia was reappeared in the patient, with detectable anti-HEV IgM and IgG and modestly elevated serum transaminases. Sequence analysis of the viral RNAs revealed the reactivation of the HEV genotype 4d strain, indicating viral persistence in the patient.

Conclusions:

To our knowledge, this is the first chronic case confirmed by the prolonged presence of HEV RNA in china. It is also the first reported persistent hepatitis E infection caused by HEV genotype 4.     

Effects of the Chemokine Receptor 5 (CCR5)-Delta32 Mutation on Hepatitis C Virus-Specific Immune Responses and Liver Tissue Pathology in HCV Infected Patients

Background:

The specific antiviral T cells provide CC chemokine receptor 5 (CCR5) for the immune response during the hepatitis C virus (HCV) infection. Heterogenous and/or homozygous 32 base pair deletion in CCR5 gene (CCR5Δ32 bpdel) leads to reduced protein expression.

Objectives:

In the current case control study, we aimed to compare the histopathological findings of liver to the CCR5Δ32 bpdel mutation profiles, expression and some other clinical findings in patients with chronic HCV infection.

Materials and Methods:

Multiple Strip Assay reverse hybridisation and Real Time PCR techniques were used to determine the germline CCR5 mutations and immunohistochemical technique was used to evaluate the gene expression in targer tissue biopsies.

Results:

Target CCR5 WT/WT, WT/Δ32, and Δ32/Δ32 genotypes were observed in 91.4%, 8.6% and 0.0% for HCV positive patients and 98.3%, 1.7% and 0.0% for control group respectively. The histologic activity index (HAI) was significantly lower (4.0 ± 1.0) in the mutated group than the non-mutated group (5.7 ± 1.0). Decreased fibrosis levels were detected in HCV positive mutated group.

Conclusions:

Results showed that CCR5 polymorphism was more frequent in HCV positive patients than in healthy population in Turkish population. Current results also showed that mutated CCR5 signalling pathway due to CCR5-Delta32 may potentially result in subtle reduction of HCV specifity to the drug responses due to the positive impact on liver inflammation, fibrosis levels and liver destruction in HCV infection.     

河北省承德地区不孕不育症患者弓形虫感染调查

目的 了解承德地区不孕症患者弓形虫感染情况及影响因素. 方法 采用酶联免疫吸附试验（enzyme linked immunosorbent assay,ELISA）对2012年3月至2014年2月在承德市中医院妇产科进行不孕问诊咨询的不孕症患者进行弓形虫抗体检测,同时对不孕患者中的阳性病例进行感染史追溯,用SPSS 13.0软件进行数据统计分析. 结果 1 474例（737对）不孕症患者弓形虫抗体阳性118例,阳性率8.01％;正常对照组349对（698例）,阳性19例,阳性率2.72％,两组差异有统计学意义（x2=22.37,P＜0.01）.不孕症患者中男性阳性74例,阳性率10.04％,女性阳性44例,阳性率5.97％,对照组男性阳性11例,阳性率为3.15％,女性阳性8例,阳性率为2.29％,2组男女比较差异均有统计学意义（P＜0.01）.不孕组118例阳性病例中,35人家庭有养猫养犬历史,占29.66％;54人经常在外就餐,占45.76％; 31人喜吃火锅或烧烤,占26.27％.而在不孕组1 356例阴性病例中仅有97人有养猫养犬历史,占7.15％;132人经常在外就餐,占9.73％;109人喜吃火锅或烧烤,占8.04％. 结论 承德地区不孕症患者弓形虫感染率较高.     

Successful control of vancomycin-resistant Enterococcus faecium nosocomial outbreak in a teaching hospital in China

In 2008, a vancomycin-resistant enterococci outbreak occurred across 2 intensive care units in our hospital. This outbreak prompted us to implement intensified control measures. We describe the molecular epidemiology of the outbreak, as well as the intervention strategies that resulted in successful control of the outbreak.     

Outbreak or coincidental cases of tuberculosis? Genotyping provides the clue

We illustrate how genotyping of mycobacterial strains contributed to the discovery of an undetected outbreak of tuberculosis in a hospital ward, ruling out misleading assumptions of transmission chains. Genotyping should be taken into account in routine tests for the control of tuberculosis.     

A novel method of surgical site infection surveillance after cardiac surgery by active participation of stake holders

We describe a comprehensive surveillance system involving infection control practitioners, surgeons, administrative staff, and patients aimed at improving the postdischarge surveillance of surgical site infections. The system was able to detect 22 infections out of 538 procedures, 95% of which were detected during the postdischarge period.