呼出气冷凝液检测在呼吸系统疾病中的研究进展*

呼出气冷凝液(exhaled breath condensate, EBC)的检测具有安全无创、简单易操作、便捷可重复等优点,是一种前景广大的检测呼吸道内衬液成分的新型技术。近年来EBC研究取得了许多新的发展,积累了丰富的经验,尤其在呼吸系统疾病中的应用明显增多。本文主要就EBC检测方法及其在呼吸系统疾病应用中的最新研究进展进行总结。     

Diagnosing pancreatic cancer in general practice: a cross-sectional study on associations between suspicion of cancer,urgent referral and time to diagnosis

ObjectiveThis study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP’s suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval.DesignCross-sectional study combining register and survey data.PatientsPatients with incident pancreatic cancer recorded in the Danish National Patient Register (n = 303).Main outcome measuresThe patient’s first point of symptoms presentation, GP’s cancer suspicion, CPP referral and diagnostic interval.ResultsGeneral practice was the first point of contact for 85.5% of the population. At the first consultation, cancer was suspected in 32.7% and 22.9% were referred to a CPP. The GPs were more likely to suspect cancer or serious illness in patients aged >70 years (prevalence rate ratio (PRR) 1.34, 95% CI 1.09–1.66) and among patients with high comorbidity (PRR 1.23, 95% CI 1.04–1.47). A CPP referral was less likely among patients with low education. The median diagnostic interval was 39 days (interquartile range: 15–72). When the GP initially did not suspect cancer, the likelihood of longer diagnostic interval increased.ConclusionThe majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice.

Key points

• Patients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage.
• The majority of patients with pancreatic cancer began their diagnostic process in general practice.
• General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients.
• The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis.

     

山牛蒡超临界二氧化碳萃取物GC-MS技术分析

[目的]对长白山产山牛蒡超临界萃取物的化学成分进行分析.[方法]采用超临界二氧化碳萃取技术对山牛蒡地上部分进行萃取,采用GC-MS技术对其化学成分进行分析,计算相应含量.[结果]超临界萃取物为灰绿色油状物,得率为1.57%;从山牛蒡超临界二氧化碳萃取物中可鉴定出22种化合物.[结论]山牛蒡超临界二氧化碳萃取物的主要化学成分为羽扇醇、乙酸羽扇-20(29)-烯-3-醇酯、四十四烷、齐墩果-12-烯-3-酮、5-烯-3-豆甾醇及羽扇-20(29)-烯-3-酮等.     

2013 — 2014年昆明市游泳池水的致病菌污染研究

  目的  了解辽宁省游泳场所池水卫生状况,特别是微生物指标情况,为加强游泳场所卫生管理和水质监测提供参考。  方法  2014 — 2018年连续5年对全省游泳场所水质按照国家标准检验方法进行检测,分别检测其细菌总数、大肠菌群、尿素、浊度、余氯、pH,根据国家标准判定其合格情况并加以分析。  结果  2014 — 2018年分别检测207、249、287、306、326户游泳场所水质,5年水质总合格率分别为72.95 %、75.50 %、87.80 %、80.72 %、84.97 %,均值为81.09 %。细菌总数、大肠菌群、尿素、浊度、余氯、pH合格率均值分别为93.09 %、97.09 %、96.22 %、99.85 %、89.81 %、98.69 %。全省14个市泳池水质总体合格率为68.87 %～94.55 %,不同地区游泳池水细菌总数、大肠菌群、尿素、浊度、余氯和pH合格率差异无统计学意义。细菌总数合格率分别与余氯、pH合格率显著相关,大肠菌群合格率与尿素、浊度、余氯、pH合格率显著相关。  结论  全省游泳场所水质单项指标合格率较高,微生物致病风险较低。水质总合格率在正常可控水平且逐年上升。不同地区间各指标合格率差异不显著,微生物指标与理化指标之间存在关联。     

2010年中国艾滋病疫情网络直报现状与分析

  目的  了解2014 — 2018年江苏省南京市新报告HIV阳性男男性行为（MSM）人群婚姻的相关因素及配偶HIV检测情况。  方法  从国家艾滋病综合防治信息系统中筛选出南京市2014 — 2018年新报告的达到法定结婚年龄（≥ 22岁）、通过同性性传播HIV阳性的MSM人群,用SPSS 20.0软件分析其婚姻状况和配偶检测情况。  结果  共2 197例HIV阳性MSM人群纳入分析,其中“有婚姻”组人数为795例,占36.2 %,无婚姻组为1 402人,占63.8 %。logistic回归分析显示30～39岁（aOR = 10.411,95 % CI = 7.700～14.077）、40～49岁（aOR = 41.079,95 % CI = 27.995～60.277）和 ≥ 50岁（aOR = 72.873,95 % CI = 45.405～116.958）有婚姻比例明显高于20～29岁年龄组;学历为高中/中专（aOR = 1.945,95 % CI = 1.426～2.653）和初中及以下（aOR = 2.756,95 % CI = 1.957～3881）有婚姻比例大于大专及以上学历组;职业为工人/农民/渔民（aOR = 1.585,95 % CI = 1.039～2.417）有婚姻比例最高;现住址为外地（aOR = 1.448,95 % CI = 1.099～1.907）的有婚姻的比例明显高于本地;和失访的病例相比,能随访（aOR = 5.963,95 % CI = 1,641～21.664）的病例有婚姻比例较高。有婚姻组的配偶HIV阳性检出率为12.8 %（37/290）。  结论  南京市HIV阳性MSM人群有婚姻比例随着年龄增长不断增加,尽早发现病例,尽快进行配偶告知和检测有利于减少HIV的婚内传播。     

2020年肾移植临床国际前沿热点及新进展荟萃

在浩瀚的肾移植相关文献中, 本文汲取和盘点2020年肾移植临床国际前沿热点和难点, 移植新技术、新方法、新视野及新进展荟萃, 主要内容包括排斥反应, 免疫抑制优化应用与调控, 移植感染, 移植后恶性肿瘤, 无创检测与生物标志物, 供者器官保存、修复及利用, 肾移植术后肾病复发, 多因素影响移植肾长期存活, 计算机与人工智能等。加强对肾移植领域文献的阅读与思考, 站在更高的起点开拓视野, 结合中国肾移植临床实践, 以推动肾移植获得更好的长期效果。     

Real time Detection of Significant Blood Pressure Events in Ambulant Subjects

A typical twenty-four hour continuous ambulatory blood pressure (BP) record demonstrates many marked, apparently spontaneous blood pressure spikes. Awareness of such BP fluctuations may help determine their causative mechanisms and lead to improved applications of conscious learned control of BP (Biofeedback). A microprocessor device has been constructed to monitor direct arterial blood pressure in real time and to compile a profile history of the BP and heart rate (HR). When the BP level exceeds a threshold based on the BP history, an audio signal prompts the subject, who is then able to record the current physical and emotional status. Alternatively, a combination of the parameters (SBP, DBP, HR) may be used to determine the threshold criteria. A decision table determines whether each parameter should lie above, below or within the threshold region. Triggering will occur only if a predefined relationship has occurred. The device will aid in the detection and interpretation of significant BP events occurring during a 24 hour recording as well as in the application and assessment of biofeedback control of blood pressure.     

A Comparison of Acoustic Cavitation Detection Thresholds Measured with Piezo-electric and Fiber-optic Hydrophone Sensors

A Fabry-Perot interferometer fiber-optic hydrophone (FOH) was investigated for use as an acoustic cavitation detector and compared with a piezo-ceramic passive cavitation detector (PCD). Both detectors were used to measure negative pressure thresholds for broadband emissions in 3% agar and ex vivo bovine liver simultaneously. FOH-detected half- and fourth-harmonic emissions were also studied. Three thresholds were defined and investigated: (i) onset of cavitation; (ii) 100% probability of cavitation; and (iii) a time-integrated threshold where broadband signals integrated over a 3-s exposure duration, averaged over 5–10 repeat exposures, become statistically significantly greater than noise. The statistical sensitiviy of FOH broadband detection was low compared with that of the PCD (0.43/0.31 in agar/liver). FOH-detected fourth-harmonic data agreed best with PCD broadband (sensitivity: 0.95/0.94, specificity: 0.89/0.76 in agar/liver). The FOH has potential as a cavitation detector, particularly in applications where space is limited or during magnetic resonance-guided studies.     

Validation of the EntericBio Panel II® multiplex polymerase chain reaction system for detection of Campylobacter spp., Salmonella spp., Shigella spp., and verotoxigenic E. coli for use in a clinical diagnostic setting

A total of 717 faeces samples were tested prospectively using the EntericBio Panel II® detection system (Serosep, Limerick, Ireland), in parallel with routine laboratory testing, which combines the EntericBio® system with retrospective culture of each specimen where a target is detected. Discrepancy analysis was conducted using molecular methods. The EntericBio Panel II® assay produced 585 negative and 132 positive results, namely, Campylobacter spp. (n = 66); SLT 1 and/or SLT 2 (n = 64); Salmonella spp. (n = 5); and Shigella spp. (n = 0). Three samples were positive for more than 1 target. Of these results, 4 Campylobacter spp. detections and 4 SLT 1/ SLT 2 detections remained unconfirmed, and the system failed to detect 2 Campylobacter spp. targets detected by routine laboratory detection. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were calculated to be 98.4%, 98.7%, 93.9%, 99.7%, and 98.6%, respectively.     

Detection of expanded-spectrum β-lactamases in Gram-negative bacteria in the 21st century

Emerging β-lactamase-producing-bacteria (ESBL, AmpC and carbapenemases) have become a serious problem in our community due to their startling spread worldwide and their ability to cause infections which are difficult to treat. Diagnosis of these β-lactamases is of clinical and epidemiological interest. Over the past 10 years, several methods have been developed aiming to rapidly detect these emerging enzymes, thus preventing their rapid spread. In this review, we describe the range of screening and detection methods (phenotypic, molecular and other) for detecting these β-lactamases but also whole genome sequencing as a tool for detecting the genes encoding these enzymes.