Differentiation of primary cytomegalovirus infection from reactivation using the urea denaturation test for measuring antibody avidity

Cytomegalovirus (CMV) is probably the most common agent of prenatal infection of the newborn, and one of 20 congenitally infected newborns shows serious symptoms. It was therefore considered important to be able to differentiate primary CMV from reactivation in pregnant females. A urea denaturation test was used to distinguish primary from secondary rubella infection in which the urea is included in the wash step of the standard IgG ELISA. This resulted in the removal of low-avidity antibodies, which are the antibodies produced early in infection. A group of CMV IgM-negative and -positive sera were tested, and all but one showed moderate to high avidity, with an avidity index reading of more than 30%. Among a group of babies 3-12 months of age, who were CMV IgM positive, 55% (16 of 29) showed low-avidity CMV antibodies. A small group of renal transplant patients and patients with clinically and laboratory-confirmed CMV gave more or less predicted avidity index results. It appears that, with the method used at this laboratory, the urea denaturation test can be applied to CMV to determine primary infection or reactivation in the majority of cases.     

Quality validation of platelets obtained from the Haemonetics and Trima Accel automated blood-collection systems

BackgroundPlatelet transfusion is required to treat haemo-oncology or trauma patients. Platelet apheresis (PA) performed with apheresis equipment has increased rapidly in recent years. Leucocyte-reduced platelet apheresis (LRPA) can reduce the risk of platelet refractoriness and febrile nonhemolytic transfusion reactions (FNHTRs) for transfusion. Accordingly, this study aimed to investigate and compare the platelet metabolic and functional responses between PA performed with Haemonetics and LRPA performed with Trima Accel cell separator.MethodsThe qualities of platelets collected through PA and LRPA were evaluated in terms of visual appearance, morphology, platelet-aggregation changes, metabolic activities, and bacterium-screening test during 5-day storage. Statistical analyses included two-sample t-test and generalised estimating equation(GEE) method.ResultsDuring 5-day storage in LRPA, residual leucocytes were all <1.0×10⁶, and the parameters of platelet function were as follows: platelet aggregated to agonists such as adenosine 5′-diphosphate (ADP) and collagen, and the extent of shape change and pO₂ showed no statistically significant difference between PA and LRPA. The hypotonic shock reaction (HSR) on days 0, 1, and 3 were significantly higher in LRPA than in PA (71.78±6.92 vs. 64.10±7.42; P=0.002; 71.53±8.98 vs. 62.96±9.84; P=0.007; 68.05±7.28 vs. 57.76±6.80; P<0.0001, respectively). Values of mean platelet volume (MPV) were statistically larger in PA than in LRPA on days 0, 1, and 3. On day 5, the swirling score was higher in LRPA than in PA. The mean lactate levels had no statistically significant difference between PA and LRPA. Moreover, no growth was observed through bacterium-screening test conducted on 40 samples.ConclusionComparison of LRPA and PA products collected from the Trima Accel and Haemonetics automated blood-collection systems, respectively, revealed that both products possessed good platelet qualities even though additional processes are needed to reduce leucocytes. Furthermore, investigating the outcomes of other apheresis instruments with focus on the safety of donors, products, and recipients is necessary.     

The Binding of Different Lectins on Peripheral Blood Mononuclear Cells from Patients with Chronic Inflammatory and Malignant Diseases

Peripheral blood mononuclear cells from patients with multiple myeloma, gastrointestinal tumors, and inflammatory bowel disease were analyzed for binding of various lectins. The results demonstrated that in most of the patients with multiple myeloma a significantly increased percentage of cells positive for Lotus tetragonolobus agglutinin (LTA), peanut agglutinin (PNA), soybean agglutinin (SBA), and wheat germ agglutinin (WGA), and a decreased number of Agaricus bisporus agglutinin (ABA) positive cells were present as compared to a normal control group. This could not be shown in malignant or inflammatory disorders of the gastrointestinal tract where only some patients exhibited an increased PNA and LTA binding, respectively. Patients with the systemic malignant disease differed from patients with solid localized tumors by a significantly altered number of ABA, LTA and SBA-positive peripheral blood mononuclear cells. Double fluorescence studies using monoclonal antibodies and lectins revealed that most of the cells expressing receptors for ABA had also receptors for OKT3, whereas most of the cells with receptors for LTA, PNA SBA, and WGA were found to be positive for OKM.     

丹参和黄芪治疗气虚血瘀型心力衰竭的作用

本文报道91例气虚血瘀型心力衰竭(心衰)病人选用丹参和黄芪治疗作用。16例作气囊漂浮导管监测,发现黄芪明显增加心排出量、每搏量及心脏指数,而丹参无此作用,提示黄芪有正性肌力作用;30例给黄芪加党参,治疗后心功能分级及某些异常的血液流变学指标均有改善;44例先丹参,继之丹参加黄芪,治疗后心功能分级有明显改善,且能改善异常的血液流变学指标,明显抑制血小板聚集功能。提示丹参具有活血化瘀改善血液流变学及抑制血小板的聚集性,黄芪有补气强心改善心功能的作用。     

人体测量指标预测肥胖儿童非酒精性脂肪肝的研究

目的 研究人体测量指标对儿童肥胖伴非酒精性脂肪肝的预测作用,探讨不同指标筛查非酒精性脂肪肝的切点值。方法 选取自2018年6月—2019年12月在西安交通大学第二附属医院小儿内分泌门诊就诊的94例肥胖儿童为研究对象,进一步分为肥胖伴非酒精性脂肪肝组与肥胖不伴非酒精性脂肪肝组,52例正常儿童为对照组。测量身高(H)、体重(W)、腰围(WC)、臀围(HC)和血甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);行肝脏B超的检查。计算体质指数(BMI)、腰臀比(WHR)、腰高比(WHtR)、腹部体积指数(AVI)、脂质蓄积指数(LAP)和内脏脂肪指数(VAI)等指标。通过绘制人体测量指标的受试者工作特征曲线(ROC曲线)评估人体测量指标与肥胖儿童非酒精性脂肪肝的相关性,并比较各项人体测量指标的曲线下面积(AUC)确定切点值。结果 肥胖组BMI、WC、WHR、WHtR、AVI、LAP、VAI及TG均高于对照组(t=23.090、21.068、12.547、22.855、17.578、8.159、5.394、6.183,P＜0.001)。肥胖伴非酒精性脂肪肝组BMI、WC、AVI、LAP、VAI均高于肥胖不伴非酒精性脂肪肝组(t=2.180、2.389、2.362、3.643、2.839,P＜0.05)。人体测量指标的ROC曲线下面积按从大到小的顺序依次为 LAP、VAI、 WC、 AVI、 BMI。对肥胖伴非酒精性脂肪肝的联合诊断指标进行筛查效能分析结果显示,LAP+AVI 曲线下面积为0.706(95%CI:0.595~0.817,P＜0.001);AVI+VAI 曲线下面积为0.685(95%CI:0.570~0.800,P＜0.01);BMI+WC 曲线下面积为0.652(95%CI:0.537~0.768,P＜0.05)。联合指标的ROC曲线下面积从大到小为LAP+AVI、AVI+VAI、BMI+WC。结论 LAP联合AVI对儿童肥胖伴非酒精性脂肪肝具有较好的筛查作用。     

Relational continuity of care in community pharmacy: A systematic review

Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle–Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.     

太原市8~11岁儿童体成分与血清尿酸的相关性分析

目的 分析8~11岁儿童体成分和尿酸的含量以及不同年龄、性别、体重指数(BMI)之间的差异,分析血尿酸与体成分各指标的相关性。方法 以2020年4—12月在太原市妇幼保健院营养科体检的306例8~11岁儿童为研究对象,检测身高、体重及体成分各项指标,并检测血清尿酸的水平,分析该年龄段儿童体成分特征及其与尿酸的相关性。结果 男童和女童体成分各指标相比,男童的BMI显著高于女童,差异具有统计学意义(t=2.253,P<0.05),其余各指标差异均无统计学意义(P>0.05);BMI和体脂百分比(PBF)在女童中判断肥胖的一致性较高(Kappa值=0.642),而在男童中的一致性较低(Kappa值=0.438);男童中9岁年龄组一致性最高(Kappa值=0.669),女童中11岁年龄组一致性最高(Kappa值=0.761);Person相关性分析显示,尿酸与体成分各指标均呈正相关,男童中,BMI与血尿酸的相关性最大(r=0.579,P<0.001);女童中,BMI(r=0.706,P<0.001)、体脂肪含量(r=0.705,P<0.001)与血尿酸的相关性最大,多重线性回归分析显示,BMI对8~11岁儿童血清尿酸影响最大(P<0.05)。结论 太原市8~11岁儿童身体状况与全国水平较为接近;体成分PBF与BMI筛查8~11岁儿童肥胖率具有较高的一致性;体成分各指标与血清尿酸水平均有相关性,对于BMI较高的儿童,应注意预防早期高尿酸血症。     

中药治疗糖尿病肾脏疾病随机对照试验结局指标的现状分析

目的 分析中药治疗糖尿病肾脏疾病（DKD）随机对照试验中结局指标的使用情况和其他试验设计要素,为中药治疗DKD临床试验的设计及核心指标集的构建提供依据。方法 计算机检索知网、万方、维普、中国生物医学等7个医学数据库及2个临床试验注册中心（clinicaltrials.gov、chinadrugtrials.org.cn）近5年收录的中药治疗DKD随机对照试验,运用Cochrance手册对纳入的文献进行偏倚风险评估,对结局指标及其他试验设计要素进行统计与分析。结果 共纳入97项随机对照试验（RCTs）,包含5项试验注册方案,研究发现,97项研究总体偏倚风险较高;DKD Ⅲ期（36项,41.38%）和气阴两虚兼血瘀证（16次,26.23%）为应用最多的DKD分期及中医证型;92项RCTs的疗程最多96周,最少2周,其中52项（56.52%）研究疗程为12周;92项RCTs及5项注册试验共采用152种结局指标,使用1 040次,共分为8大类,实验室检查（血液）、实验室检查（尿液）、临床疗效、中医证候积分、生活质量量表、生命体征、其他指标及其他事件,应用频率较高的依次是血肌酐（68次,70.10%）、临床有效率（55次,56.70%）、空腹血糖（51次,52.58%）、尿素氮（48次,49.48%）、总胆固醇（47次,48.45%）、24 h尿蛋白定量（43次,44.33%）等;56项RCTs及2项注册试验共采用安全性指标53种,频数227次,使用频率较高的依次是,不良反应（49次,84.48%）、肝功能（28次,48.28%）、血常规（24次,41.38%）、心电图（17次,29.31%）、尿常规（14次,24.14%）;10项RCTs及5项注册试验报告了主要结局指标;54项RCTs报告了临床有效率指标。结论 目前中药治疗DKD的RCTs结局指标设计尚不规范,未来应积极构建突显出中医药特色的核心结局指标集,提升临床研究的质量,提高试验结果的应用价值。     

Visceral adiposity index is positively associated with blood pressure: A systematic review

PurposeThis systematic review aimed to investigate the association between VAI and blood pressure.MethodsThe study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases.ResultsThis review included 32 articles, with 60,482 individuals – children to elderly people between 7 and 102 years old – of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design.ConclusionIndividuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965).