108例小儿轮状病毒肠炎合并肝脏损害临床分析

目的:探讨轮状病毒肠炎合并肝脏损害的临床特征。方法:对485例轮状病毒肠炎患儿作肝功能及肝脏B超检查,并对其中108例合并肝脏损害者的临床特征进行分析。结果:(1)108例患儿中,单纯丙氨酸转移酶(ALT)升高者30例,占27.8%;单纯天冬氨酸转移酶(AST)升高者18例,占16.7%;单纯Υ-谷氨酰转肽酶(Υ-G T)升高者10例,占9.3%;ALT和AST同时升高者24例,占22.3%;ALT、AST和Υ-G T同时升高者12例,占11.1%;转氨酶升高伴胆红素(TB IL或DB IL)升高者3例,占2.7%;转氨酶升高伴白蛋白(ALB)降低者3例,占2.7%;肝功能异常伴肝脏肿大者8例,占7.4%。ALT升高总例数为66例,占61.1%;AST升高总例数为54例,占50%;Υ-G T升高总例数为22例,占20.4%。(2)经病毒唑及能量合剂等治疗后,2周内ALT恢复正常者60例,占全部AST升高病例的90.9%;AST恢复正常者51例,占全部AST升高病例的94.4%;Υ-G T恢复正常者21例,占全部Υ-G T升高病例的95.5%;合并TB IL或DB IL升高及ALB降低、肝脏肿大者,全部于2周内恢复正常。结论:轮状病毒肠炎可同时合并肝脏损害,其中以ALT及AST升高者最多见,经一般抗病毒及护肝等治疗后预后良好,绝大多数患儿在2周内肝功能及肝脏大小可恢复正常。     

重庆北部地区婴幼儿轮状病毒感染的流行病学特征研究

目的:了解重庆市北部地区婴幼儿A组轮状病毒感染的流行病学特征。方法:分析2000～2004年门诊和住院6岁以下腹泻患儿1311例的粪便A组轮状病毒抗原检测资料。实验采用酶联免疫吸附法(ELISA)检测粪便中A组轮状病毒抗原。结果:1311例腹泻患儿中,检出A组轮状病毒抗原阳性566份,阳性率43.2%,发病季节为每年的11月至次年2月为检出高峰,患儿年龄以2岁以下的婴儿为主。结论:A组轮状病毒是本地区婴幼儿腹泻的主要病原之一,以1～24月龄儿童为主;流行季节明显,以秋末至春初为高峰期。     

不同地区婴幼儿轮状病毒感染性腹泻的流行病学研究

目的 分析比较不同地区婴幼儿轮状病毒(RV)感染性腹泻的流行病学特征。方法 于2001年9月至2003年9月在江苏省苏州市和安徽省马鞍山市各选择一所医院建立临床监测哨点,以临床就诊的<5岁腹泻患儿为研究对象,用酶联免疫吸附试验检测RV抗原,同时采用逆转录聚合酶链反应对RV毒株进行血清型与基因型的鉴定。结果 (1)两地区RV感染均呈现明显的秋冬季节性,但季节高峰有所不同,高峰季节的感染率可达50％～80％;(2)两地区腹泻患儿RV感染率差异具有统计学意义,住院腹泻患儿的平均感染率分别为47.28％和30.38％,门诊腹泻患儿平均感染率分别为28.39％和14.77％;(3)两地区RV的感染率均表现出年龄分布的不同,以6～35月龄组较高,无性别差异;(4)苏州市的两个流行高峰均以G3型为主,其次是G1型;马鞍山市第一个流行高峰以G1型为主,第二个高峰则以G3型为主;两地区流行株的G/P组合型与国内外有所不同。结论 婴幼儿RV腹泻在地区、时间以及病毒流行株分布等方面各有不同,提示RV感染的监测工作对其疫苗的研制和应用具有重要的指导作用。     

Development of a bivalent conjugate vaccine candidate against rotaviral diarrhea and tuberculosis using polysaccharide from Mycobacterium tuberculosis conjugated to ΔVP8* protein from rotavirus

Conjugation of carbohydrate antigens with a carrier protein is a clinically proven strategy to overcome the poor immunogenicity of bacterial polysaccharide. In addition to its primary role, which is to help generate a T cell-mediate long-lasting immune response directed against the carbohydrate antigen, the carrier protein in a glycoconjugate vaccine can also play an important role as a protective antigen. Among carrier proteins currently used in licensed conjugate vaccines, non-typeable Haemophilus influenzae protein D has been used as an antigenically active carrier protein. Our previous studies also indicate that some carrier proteins provide B cell epitopes, along with T cell helper epitopes.Herein we investigated the dual role of truncated rotavirus spike protein ΔVP8* as a carrier and a protective antigen. Capsular polysaccharide lipoarabinomannan (LAM), purified from Mycobacterium tuberculosis (M.tb), was chemically conjugated with ΔVP8*. Mouse immunization experiments showed that the resultant conjugates elicited strong and specific immune responses against the polysaccharide antigen, and the responses were comparable to those induced by Diphtheria toxoid (DT)-based conjugates. The conjugate vaccine induced enhanced antibody titers and functional antibodies against ΔVP8* when compared to immunization with the unconjugated ΔVP8*. Thus, these results indicate that ΔVP8* can be a relevant carrier protein for glycoconjugate vaccine and the glycoconjugates consisting of ΔVP8* with LAM are effective bivalent vaccine candidates against rotavirus and tuberculosis.     

Gastrointestinal radiation injury:Symptoms,risk factors and mechanisms

Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer.Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality.Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy,which significantly reduces their quality of life as well as adding an extra burden to the cost of health care.The accurate diagnosis and treatment of intestinal radiation injury often represents a clinical challenge to practicing physicians in both gastroenterology and oncology.Despite the growing recognition of the problem and some advances in understanding the cellular and molecular mechanisms of radiation injury,relatively little is known about the pathophysiology of gastrointestinal radiation injury or any possible susceptibility factors that could aggravate its severity.The aims of this review are to examine the various clinical manifestations of post-radiation gastrointestinal symptoms,to discuss possible patient and treatment factors implicated in normal gastrointestinal tissue radiosensitivity and to outline different mechanisms of intestinal tissue injury.     

Infliximab induces remission in cryptogenic multifocal ulcerous stenosing enteritis:First case

We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn’s disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin’s valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.     

A chicken intestinal ligated loop model to study the virulence of Clostridium perfringens isolates recovered from antibiotic-free chicken flocks

Necrotic enteritis (NE) is a major problem in antibiotic-free (ABF) chicken flocks and specific strains of Clostridium perfringens are known to induce NE. The objective of this study was to develop a chicken intestinal ligated loop model in order to compare the virulence of various C. perfringens strains recovered from consecutive ABF flocks with and without NE. Intestinal loops were surgically prepared in 10 anaesthetized specific-pathogen-free chickens and alternately inoculated with C. perfringens isolates or brain heart infusion (BHI) media. Histological lesion scoring was performed for each loop. All strains from NE-affected flocks induced histological lesions compatible with NE whereas inoculation of loops with a commensal C. perfringens strain or BHI did not. Among inoculated strains, CP0994 (netB-positive and cpb2-positive) and CP-2003-1256 (netB-positive) demonstrated mean histological lesion scores significantly higher (P?netB-negative and cpb2-positive) induced intestinal lesions without significantly higher scores. In loops where villi were colonized by Gram-positive rods, significantly higher (P?C. perfringens is a critical step in the pathogenesis of NE. Finally, we demonstrated the importance of controlling virulent C. perfringens strains in ABF chicken flocks as a highly virulent strain can be present in consecutive flocks with NE and possibly affect multiple flocks.     

Safety and immunogenicity of a parenterally administered rotavirus VP8 subunit vaccine in healthy adults

BackgroundThe P2-VP8 subunit vaccine for the prevention of rotavirus gastroenteritis is comprised of a truncated VP8 subunit protein from the rotavirus Wa strain (G1[P8]) fused to the tetanus toxin P2 epitope, and adsorbed on aluminum hydroxide for intramuscular administration.MethodsThree groups of 16 adults were randomized to receive three injections of P2-VP8 (12) or placebo (4) at doses of 10, 30 or 60 μg of vaccine. IgG and IgA antibodies to P2-VP8 were assessed by ELISA in serum and lymphocyte supernatant (ALS). Serum samples were tested for neutralizing antibodies to homologous and heterologous strains of rotavirus.ResultsThe vaccine was well-tolerated. All vaccine recipients demonstrated significant IgA responses and all but one demonstrated IgG responses; in the 60 μg cohort, geometric mean titers (GMTs) rose 70- and 80-fold for IgA and IgG, respectively. Homologous neutralizing antibody responses were observed in about half of participants in all three dose cohorts; in the 60 μg cohort, GMTs against Wa rose from 128 to 992. Neutralizing antibody responses were robust to P[8] strains, moderate to P[4] strains and negligible to P[6] strains. ALS IgA responses were dose dependent.ConclusionsThe P2-VP8 subunit vaccine was well tolerated and evoked promising immune responses.Clinical trials registrationNCT01764256     

A rare G1P[6] super-short human rotavirus strain carrying an H2 genotype on the genetic background of a porcine rotavirus

Rotavirus strains with a rearranged 11th genome segment may show super-short RNA electropherotypes. Examples from human strains were limited to seven strains, 69M, 57M, B37, Mc345, AU19, B4106 and BE2001, which have a variety of G and P genotypes. AU19 is a rare G1P[6] human rotavirus strain detected in a Japanese infant with severe acute gastroenteritis. This study was undertaken to better understand the origin of AU19 by determining the genotype constellation of AU19. Upon nearly-full genome sequencing, AU19 had a G1-P[6]-I5-R1-C1-M1-A8-N1-T1-E1-H2 genotype constellation. Possession of I5 and A8 genotypes is indicative of its porcine rotavirus origin, whereas possession of H2 genotype is indicative of its DS-1 like human rotavirus origin. At the phylogenetic lineage level for the genome segments that share the genotype between porcine and human rotaviruses, the VP1-4, VP7, NSP3-4 genes were most closely related to those of porcine rotaviruses, but the origin of the NSP2 gene was inconclusive. As to the NSP5 gene, the lineage containing AU19 and the other three super-short human strains, 69M, 57M and B37, carrying the H2 genotype (H2b) clustered with the lineage to which DS-1- like short strains belonged (H2a) albeit with an insignificant bootstrap support. Taken all these observations together, AU19 was likely to emerge as a consequence of interspecies transmission of a porcine rotavirus to a child coupled with the acquisition of a rare H2b genotype by genetic reassortment probably from a co-circulating human strain. The addition of the AU19 NSP5 sequence to much homogeneous H2b genotypes shared by previous super-short rotavirus strains made the genetic diversity of H2b genotypes as diverse as that of the H2a genotype, lending support to the hypothesis that super-short strains carrying H2b genotype have long been circulating unnoticed in the human population.     

护理对轮状病毒性肠炎患儿预后的影响

目的为了进一步研究和探讨有效改善轮状病毒性肠炎患儿预后的相关临床护理干预措施和方法 ,从而为轮状病毒性肠炎患儿的护理实践提供参考和依据。方法入选该次研究的病例均为2010年12月—2013年12月期间该院收治的轮状病毒性肠炎患儿,全部患儿共计156例,随机对患儿进行分组,分成了护理干预组和常规护理组,每组患儿78例。分别实施护理干预措施和常规护理措施,对实施不同的临床护理措施的两组患者的家长关于护理工作的满意程度和提供护理干预措施之后患者的大便情况分别进行观察和比较。结果 1对临床护理总满意度组间作比较,护理干预组明显比常规护理组的高,而且组间数据的比较差异有统计学意义（χ2=13.650 0,P=0.000 2）;2大便平均次数组间比较,得到的结果是护理干预组明显低于常规护理组,而且组间数据的比较差异有统计学意义（t=51.390 7,P=0.000 0）。结论针对患有轮状病毒性肠炎的患儿在临床实施护理实践的过程中,若采用该院所提出的临床护理干预措施的临床,则效果显著,可以显著的改善患儿预后并提高临床护理满意度水平,是临床针对轮状病毒性肠炎患儿实施护理的理想选择。