Characterization of circulating monocytes expressing HLA-DR or CD71 and related soluble factors for 2 weeks after severe, non-thermal injury

BACKGROUND: Severe injury is associated with changes in monocytes that may contribute to poor outcomes. Longitudinal characterization of monocyte response patterns after trauma may provide added insight into these immunological alterations. METHODS: Venous blood obtained seven times during post-injury days 1 through 13 from 61 patients with an injury severity score >20 was assessed by flow cytometry for monocytes (CD14+) expressing HLA-DR or CD71 (transferrin receptor) and for circulating levels of interleukin (IL) 1alpha, IL-1beta, IL-6, soluble CD14 (sCD14), tumor necrosis factor-alpha (TNF-alpha), prostaglandin E(2) (PGE(2)), thromboxane B(2) (TXB(2)), and endotoxin. Urine neopterin was measured by high-pressure liquid chromatography, expressed as a neopterin-creatinine ratio. RESULTS: Trauma patients had leucocytosis days 1 through 13, monocytosis days 5 through 13, reduced proportions of CD14+HLA-DR+ cells days 2 through 5, and elevated proportions of CD14+CD71+ cells days 1 through 13. Neopterin was elevated all days, peaking on day 10. sCD14 was elevated days 2 through 13, and there were sporadic elevations of IL-1alpha, IL-1beta, IL-6, TNF-alpha, PGE(2), TXB(2), and endotoxin. Sepsis syndrome patients (n = 6) had larger and more prolonged reductions in CD14+HLA-DR+ cells and higher neopterin values, in comparison with uneventful patient outcomes. CONCLUSIONS: Altered proportions of monocytes expressing HLA-DR and CD71 and elevated sCD14 and urine neopterin levels, for up to 2 weeks after severe injury, underscores an extended period of profound immunological effects. Additional studies to more fully assess temporal monocyte response patterns after severe injury, including activation, may be warranted.     

Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004-2005

OBJECTIVE: WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. METHODS: In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). FINDINGS: In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). CONCLUSION: In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness.     

Safety and immunogenicity of an HIV subtype B and E prime-boost vaccine combination in HIV-negative Thai adults

ALVAC-HIV (vCP1521) and AIDSVAX B/E were evaluated in a phase 1/2 trial of human immunodeficiency virus (HIV)-negative Thai adults. Of 133 volunteers enrolled, 122 completed the trial. There were no serious vaccine-related adverse events, nor were there intercurrent HIV infections. Lymphoproliferative responses to glycoprotein 120 E were induced in 63% of the volunteers, and HIV-specific CD8 cytotoxic T lymphocyte responses were induced in 24%. Antibody responses increased in frequency and magnitude in association with the dose level of AIDSVAX B/E. Binding and neutralizing antibodies to the MN strain were induced in 100% and 98%, respectively, of the volunteers receiving 600 microg of AIDSVAX B/E, and such antibodies to E strains were induced in 96% and 71%, respectively, of these volunteers. This vaccine combination was well tolerated and was immunogenic, meeting milestones for advancement to phase 3 evaluation.     

云南西盟佤族居民患疟求医的现状、费用支付能力和障碍

目的　评价佤族患疟求医的现状、费用支付能力和障碍。　方法　对社区居民进行问卷调查和参与式行动评估 ,对关键人员进行半结构深度访谈。　结果　自己治疗是村民治疗疟疾的第一行动 ,只有自己治疗无效后才到卫生机构求医 ;5 1% (95 %CI :2 6～ 8 9% )问卷调查回答者从不求医 ,8 8% (95 %CI :5 4～ 13 3 % )仅靠自己治疗 ;3 7 4% (95 % :3 0 9～ 44 3 % )付不起疟疾治疗费 ;村民提出的疟疾治疗费为平均RHB 64 15± 7 0 6(范围 :0～ 5 0 0 )元 ,88 5 % (95 %CI :82 4～ 93 0 % )的人认为不能超过RHBl0 0元。　结论　佤族中的患疟求医行为不当 ,障碍为经济 ,地理 ,知识和技术上的不可及性 ;疟疾病例的家庭管理是改善疟疾治疗现状的方法之一。     

与目标人群一起开发制作疟疾防治IEC材料

目的开发目标人群喜爱的疟疾防治信息-教育-交流(IEC)材料和指南.方法 采用各类参与式方法,在不同材料制作的各个阶段中让目标人群充分参与.结果开发制作了一套由针对一级目标人群的互动式录像片和两张海报、针对学生的故事画册、教师用"手拉手"活动手册、基层卫生人员实用图表、沟通技巧和上述5种材料使用指南组成的IEC材料.结论通过目标人群的充分参与,开发了一套目标人群喜闻乐见的疟疾防治IEC材料和指南.     

采用社区参与式制作疟疾健康教育互动式录像片(In English)

目的制作一部通俗易懂和适应佤族文化特点的互动式翘首健康教育录像片。方法直接从目标人群中悼念背景材料及故事素材，邀请社区代表参与创作故事提纲，预测试脚本，充当演员和观测试录像片。结果制作出了六节传递六则疟疾信息的录像片。结论目标人群的参与可确保所制作的IEC村落通俗易懂和文化习俗上易于接受，在西盟制作的这一录像片不仅被认为适用千佤族，而且也适用于其它民族，现已经被从中文翻译成了佤、哈尼和傣等少数民族语言。     

边远贫困山区少数民族疟疾诊治干预效果分析

目的 探讨改进边远贫困山区少数民族疟疾诊断和治疗可及性策略.方法 免费提供疟疾诊断和治疗;培训当地本民族的村疟防员制作发热病人血片,为疟疾病人送药并监督服药,开展以入户为主的面对面健康教育.结果 村卫生人员与居民比从干预前的1:1 116.75改变为干预后的1:248.17;发热开始24 h内求医病人比例,使用公共卫生机构发热病人比例和对疟防服务满意村民比例分别从基线的23.03%(95%CI=18.81～27.71).56.94%(95%CI=52.55～61.25)和82.65%(95%CI=81.23～86.31)提高到干预后评估调查的86.95%(95%CI=68.47～96.57),91.30%(95%CI=74.13-98.51)和96.81%(95%CI=93.08～98.82).结论 改进当地经济、地理、信息和文化方面疟疾诊治可及性,与其他措施一起有效地降低了当地疟疾的发病和流行程度.