Increased Bronchial Hypersensitivity after Early and Late Bronchial Reactions Provoked by Allergen Inhalation

The non-specific bronchial reactivity following bronchial allergen challenge was studied in 40 patients with allergic bronchial asthma, particularly in subjects without definite late reactions 6 h after the provocations (reduction in peak expiratory flow or forced expiratory volume in 1 s of less than 15% of the control value at this time). Among a group of 21 patients submitted to bronchial provocation tests, 13 carried out maximal exercise tests 6 and 1 week after the allergen challenge. In another group of 19 patients, the bronchial hyperreactivity to methacholine was assessed before and 6 h and 1 week after challenge. Two patients with a dual response (early & late) reacted with bronchial obstruction to the exercise. Exercise tests performed after 1 week did not provoke asthma in any patient. In the methacholine group a marked increase in responsiveness to methacholine 6 h after the provocation was observed in those patients with a dual response who were tested and in those with equivocal late reactions and even in three patients with an isolated immediate reaction. The increases responsiveness was still present in many patients 1 week after challenge. The airway caliber did not influence the degree of responsiveness to methacholine. Nor did the degree of responsiveness have any influence on the patterns of reactions observed after allergen exposure. It was concluded that in some individuals exposure to the relevant allergen predisposes them to exercise-inducible bronchial obstruction. Further, it was confirmed that non-specific bronchial reactivity can be increased not only in patients with late responses - both definite and equivocal--but also in some patients with immediate reactions alone.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bee moth (Galleria mellonella) allergic reactions are caused by several thermolabile antigens

BACKGROUND: Exposure and contact with bee moth (Galleria mellonella) larvae (Gm) can cause an allergic reaction both in anglers and breeders. We described the case of an amateur fisherman who experienced an allergic reaction using Gm but not using heat-treated Gm (h-Gm) (mummies). The aim of this study was to demonstrate by immunoblotting and radioallergosorbent test (RAST)-inhibition experiments the loss of allergenic epitopes in h-Gm extracts. METHODS: Galleria mellonella larvae and h-Gm were homogenized and extracted at 10% (w/v) in 0.5 M phosphate-buffered saline, pH 7.4 containing 0.5% NaN(3) for 16 h at 4 degrees C. Gm and h-Gm extracts were electrophoresed in a 10% polyacrylamide precast Nupage Bis-Tris gel at 180 mA for 1 h and the resolved proteins stained with 0.1% Coomassie brilliant blue and the molecular weight calculated. For the immunoblotting detection of allergenic components the resolved extracts were transferred onto a nitrocellulose membrane and incubated with the patient's serum. Bound specific-IgE was detected by peroxidase-conjugated anti-human IgE. RAST inhibition experiments were performed according to the Ceska method. RESULTS: The protein profile of Gm and h-Gm extracts resulted markedly different in number, intensity and the position of bands, indicating that heat-treatment modifies the chemical-physical characteristics of the protein contents. The Gm extract showed a strong-coloured band at 73 kDa and more than 20 components ranging from 12 to 133 kDa; h-Gm showed two main band at 77 and 38 kDa and about 15 faint bands between 20 and 133 kDa apparently without any correspondence to the bands present in the Gm extract. Immunoblotting with the patient's serum demonstrated several bands of reactivity with the Gm extract ranging from 20 to 100 kDa and no recognizable bands, but only a diffuse smear with h-Gm. When used in a RAST inhibition experiment the h-Gm extract demonstrated an inability to compete with the Gm one for the binding to patient's IgE serum. CONCLUSIONS: The h-Gm seems to lose the allergenic epitopes and has two advantages for anglers: to avoid new possible sensitizations as well as allergic symptoms in sensitized people, without interfering with their skills and satisfaction in their fishing performance.     

Untangling the relationship between early adversity,placement breakdowns,and obesity in a secure adolescent developmental disorder service: A cross-sectional study

BackgroundObesity is a growing global health concern, and those with a developmental disorder are at particular risk. Elevated levels of childhood trauma, placement breakdowns and obesity have been documented in the developmental disorder population, yet their relative associations remain unclear.ObjectiveA previous study (Morris et al., 2020) highlighted a high prevalence of adverse childhood experiences (ACEs) and obesity in adolescents with developmental disorders residing in a secure inpatient setting. The current cross-sectional study sought to further explore the prevalence of placement breakdowns and its relationship with Body Mass Index (BMI) in this sample.MethodsSecondary analysis was conducted on existing data for 34 adolescents, aged 10–17 years at admission, held in a secure mental health hospital developmental disorder service in the United Kingdom (UK) under the Mental Health Act.ResultsAlmost half of participants had experienced a placement breakdown (47.1%), the majority of whom typically experienced multiple breakdowns (M = 3.94, SD = 2.14). Placement breakdowns significantly predicted BMI and had a predictive effect that was independent to and above that of ACEs.ConclusionsPlacement breakdowns significantly contribute to risk for obesity, above that explained by early adversity. Those who have experienced placement breakdowns have a greater risk for obesity, irrespective of their level of exposure to ACEs. A history of previous placement breakdowns may act as a red flag for obesity.     

我国医疗质量安全不良事件分类的思考

患者安全问题已经成为世界各国医疗质量管理关注的焦点,从国家层面对医疗质量安全不良事件进行统一定义和分类具有重要意义。通过总结世界卫生组织、美国、英国以及我国目前不良事件分类及严重程度分级情况,结合我国相关上报数据,分析存在问题,建议国家及各级卫生行政部门发挥引导推动作用,医疗机构利用现有国家医疗质量安全相关平台,参考借鉴相关分类,开展同质化医疗质量安全管理工作。     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。     

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

PurposeThe main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.MethodsData were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.ResultsFamily communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%–42% lower prevalence of suicidal behaviors for middle school youth and a 27%–39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.ConclusionsThe findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.     

基于预防接种异常反应补偿的山东省卡介苗淋巴结炎经济负担测算

目的了解山东省卡介苗(BCG)淋巴结炎经济负担情况。方法以2011年5月至2019年12月山东省304例申请省级补偿的BCG淋巴结炎病例为对象,收集患者基本情况、预防接种相关情况、门诊(住院)病历和收费票据等相关资料,对其直接经济负担(包括直接医疗费用和直接非医疗费用)、间接经济负担和总经济负担进行测算,比较不同特征病例经济负担的差异。结果304例BCG淋巴结炎患者月龄的M(Q1,Q3)为3(2,4)月,其中男性239例(78.6%),淋巴结破溃71例(23.4%),手术227例(74.7%)。单纯门诊、单纯住院和门诊后住院病例分别占25.7%(78例)、7.2%(22例)和67.1%(204例)。贴现后单例直接、间接和总经济负担的M(Q1,Q3)分别为9910(5713,16074)、2081(1547,3122)和12262(7694,18571)元。直接医疗费用占直接经济负担的89.4%,直接经济负担占总经济负担的84.9%,80.0%病例的总经济负担仅占其补偿金额的20.0%左右,只有2.3%的病例总经济负担占补偿金额的60.0%以上。单纯住院和门诊后住院病例的直接、间接和总经济负担高于单纯门诊病例,手术病例的直接、间接和总经济负担高于非手术病例,淋巴结未破溃病例的直接和总经济负担高于破溃病例(均P<0.05)。结论山东省BCG淋巴结炎病例经济负担受诊疗方式的影响,且以直接医疗费用为主。