Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica

ObjectiveTo explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection.MethodsA retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA.ResultsA total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P = .004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P = .008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P = .016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P = .024).ConclusionsContinuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD.     

2019年度FFRCT研究进展

FFRCT自2013年提出后经过多年的发展现已在冠心病(CAD)诊疗中显示出重要的价值。随着CT技术及计算机算法的进步,FFRCT的诊断性能不断提高,临床适用人群也不再局限于稳定性冠心病病人。就2019年FFRCT的主要研究进展予以综述,包括如何提高成功率、探索最佳阈值以及最新临床应用。     

金黄色葡萄球菌侵袭性感染分离株细胞毒素与侵袭毒素基因研究

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Early impact of sequential introduction of 7-valent and 13-valent pneumococcal conjugate vaccine on IPD in Israeli children <5 years: An active prospective nationwide surveillance

BackgroundThe 7-valent pneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7.AimTo report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years.MethodsAn ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included.ResultsOverall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7 + 6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR] = 0.05; 95% CI = 0.03–0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR = 0.30; 0.21–0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR = 2.43; 1.73–3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2–4 years old, respectively).ConclusionsAfter initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.     

多节段髂股动脉闭塞症的微创治疗：附40 例报告

目的：探讨采用髂动脉支架植入术+股动脉内膜剥脱术+补片成形术治疗多节段髂股动脉硬化闭塞症的临床疗效。 方法：选择2010年3月—2013年3月收治的40例多节段髂股动脉硬化闭塞症患者,均采用髂动脉支架植入术+股动脉内膜剥脱术+补片成形术治疗。 结果：所有患者均手术成功,术后37例（92.5%）患者临床症状明显改善。术后间歇性跛行距离和静息下踝肱指数均明显高于术前（均P<0.05）。40例患者术后随访12~45个月,一期通畅率为70.0%（28/40）、辅助一期通畅率为82.5%（33/40）、二期通畅率为92.5%（37/40）。统计分析显示,Fontaine II级患者的一期通畅率明显高于III、IV级的患者（P=0.039,0.015）,未发现术后一期通畅率的独立影响因素。 结论：微创手术治疗多节段髂股动脉硬化闭塞症临床疗效显著,且应在临床症状出现的早期进行治疗,以获得更佳的一期通畅率。     

Economic evaluation of meningococcal serogroup B childhood vaccination in Ontario,Canada

Objective

Invasive Neisseria meningitidis serogroup B (MenB) disease is a low incidence but severe infection (mean annual incidence 0.19/100,000/year, case fatality 11%, major long-term sequelae 10%) in Ontario, Canada. This study assesses the cost-effectiveness of a novel MenB vaccine from the Ontario healthcare payer perspective.

Methods

A Markov cohort model of invasive MenB disease based on high quality local data and data from the literature was developed. A 4-dose vaccination schedule, 97% coverage, 90% effectiveness, 66% strain coverage, 10-year duration of protection, and vaccine cost of C$75/dose were assumed. A hypothetical Ontario birth cohort (n = 150,000) was simulated to estimate expected lifetime health outcomes, quality-adjusted life years (QALYs), and costs, discounted at 5%.

Results

A MenB infant vaccination program is expected to prevent 4.6 invasive MenB disease cases over the lifetime of an Ontario birth cohort, equivalent to 10 QALYs gained. The estimated program cost of C$46.6 million per cohort (including C$318,383 for treatment of vaccine-associated adverse events) were not offset by healthcare cost savings of C$150,522 from preventing MenB cases, resulting in an incremental cost of C$4.76 million per QALY gained. Sensitivity analyses showed the findings to be robust.

Conclusions

An infant MenB vaccination program significantly exceeds commonly used cost-effectiveness thresholds and thus is unlikely to be considered economically attractive in Ontario and comparable jurisdictions.     

胎盘粘连植入组织和人胎盘滋养层细胞中VCAM-1的表达及其与侵入性胎盘疾病的相关性

目的探讨胎盘粘连植入组织和人胎盘滋养层细胞中血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)的表达及其与侵入性胎盘疾病的相关性。方法采用酶联免疫吸附试验检测2017年9月至2018年9月期间我院收治的20例产妇静脉血中可溶性VCAM-1(sVCAM-1)的表达水平,根据sVCAM-1的平均值将另外随机选取的200例产妇分为高表达组和低表达组,计算两组侵入性胎盘发生率。采用免疫组化染色、实时定量PCR和Western blot检测40例侵入性胎盘组织和40例正常胎盘组织中的VCAM-1、TNF-α、NF-κB p65和IκBα表达。应用20 ng/mL的TNF-α处理人胎盘滋养层HTR8/SVneo细胞系后检测细胞中VCAM-1、TNF-α、NF-κB p65和IκBα的表达。结果20例健康产妇静脉血中的VCAM-1平均水平为36.32±3.25 ng/mL。高表达组的侵入性胎盘发生率(6.98%)显著高于低表达组(0.64%)(χ^2=0.922,P=0.009)。实时定量RT-PCR和Western blot结果表明,与对照组相比,侵入性胎盘组VCAM-1的mRNA和蛋白表达水平显著升高。免疫染色显示VCAM-1蛋白主要在滋养细胞的细胞质和膜中表达,侵入性胎盘组的VCAM-1阳性率(72.50%)显著高于对照组(17.50%)(Z=-5.063,P<0.001)。与对照组相比,侵入性胎盘组的TNF-α和NF-κB p65表达水平显著升高,而IκBα表达水平显著降低(P<0.05)。与未用TNF-α处理(0 ng/mL)的HTR8/SVneo细胞相比,应用20 ng/mL浓度的TNF-α处理细胞1周后,细胞中的NF-κB p65和VCAM-1表达水平显著升高,而IκBα表达水平显著降低(P<0.05)。结论VCAM-1在侵入性胎盘产妇血液和胎盘组织中均为高表达模式。VCAM-1的活化至少部分依赖于TNF-α、NF-κB信号通路的激活,从而诱导其在滋养细胞中高表达并引起过度侵袭,导致侵入性胎盘的发生。     

(1,3)-β-D葡聚糖、半乳甘露聚糖联合降钙素原检测对侵袭性真菌感染的诊断价值

目的 探讨血清中(1,3)-β-D葡聚糖[ (1,3) β-D-glucan,G]和半乳甘露聚糖(galactomannan,GM)联合降钙素原(procalcitonin,PCT)检测对患者侵袭性真菌感染(invasive fungal infections,IFI)的临床诊断价值。方法 选取徐州市中心医院2017年1月至2018年6月收治的具有高危IFI因素的住院患者447例,根据血培养结果分成实验室诊断组和非实验室诊断组。分别采用定量检测、比色法及电化学发光法对血清中G、GM和PCT的含量进行检测,评价三者联合检测对IFI的早期诊断价值。结果 447例患者中实验室诊断组51例,非实验室诊断组396例。51例患者中G试验阳性39例,GM试验阳性14例,PCT阳性41例。G试验、GM试验、PCT检测的敏感性为76.47%、27.45%和80.39%;特异性为76.77%、87.12%和66.67%;阳性预测值为29.77%、21.54%和23.70%;阴性预测值为96.20%、90.31%和96.35%;阳性似然比为3.29、2.13和2.41;阴性似然比为0.31、0.83和0.29;Youden指数为0.53、0.15、0.47。三者联合检测的敏感性为94.12%、特异性为62.88%、阳性预测值为24.62%,阴性预测值为98.81%,阳性似然比为2.54,阴性似然比为0.09,Youden指数为0.57。三者联合检测的敏感性均高于G试验、GM试验、PCT单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为6.331、47.545、4.320和5.299,P值均<0.05)。三者联合检测的特异性均低于G试验、GM试验单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为18.127、62.061和16.754,P值均<0.05),但与PCT单独检测相比差异无统计学意义(χ2=1.245,P>0.05)。结论 G、GM以及PCT三者联合检测可显著提高IFI检出的敏感性,并且对IFI的诊断排除有很大的价值,从而降低假阳性率和假阴性率,为IFI的早期诊断提供一定的依据。