头孢噻肟在恶性血液病合并感染患者体内杀菌效价及临床疗效比较

目的 对比观察头孢噻肟（ＣＴＸ）与其他两种抗菌药物治疗方案对３０例血液病合并感染患者杀 菌活性（ＳＢＡ）及临床疗效。方法ＳＢＡ采用微量稀释法测定，临床疗效根据临床治疗登记表按三 级标准判定。结果与结论 头孢噻肟的临床反应最佳，杀菌作用时间维持较长，但对绿脓假单胞 菌和阴沟肠杆菌杀菌作用较差；呱拉西林（ＰＩＰ）与阿米卡星（ＡＮ）方案的抗菌谱广，但ＰＩＰ杀菌 作用时间较短，可考虑缩短给药间期，而ＡＮ可按一日一次给全日量的方案，以提高疗效减少不 良反应；头孢哌酮（ＣＰＺ）可主要用于绿脓假单胞菌感染，也可用于其它细菌的混合感染，但给药 间隔时间以一日三次为宜。     

2006～2010年湖北省流行性脑脊髓膜炎病原学和血清学监测分析

目的分析湖北省2006～2010年流行性脑脊髓膜炎(流脑)病原学和血清学监测结果,掌握湖北省流脑的变迁规律。方法对2006～2010年分离的脑膜炎奈瑟菌(Nm)菌株进行生化鉴定、血清学分型和药物敏感性检测,并采用多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)方法进行分子分型;对所有的脑脊液和血液标本进行Nm种属特异性荧光PCR检测;对健康人群血清,运用血清杀菌试验(SBA)进行C群杀菌力抗体水平测定。结果 2007年湖北省Nm以B群为主,2008～2010年以来C群为优势菌群;对青霉素等6种抗生素均敏感,但对环丙沙星、米诺环素、萘啶酸、复方新诺明4种抗生素出现多重耐药;分子分型结果显示,湖北省B群Nm菌株具有高度的遗传多样性,未发现明显优势的克隆群,C群优势病原株为ST-4821型。RT-PCR检测(988份脑脊液)确诊29例流脑病例,其中C群22例,A群2例、B群5例。C群杀菌力总保护率(抗体滴度≥1︰8)为38.10%。结论湖北省流脑菌株发生了从B群散发到C群流行的变迁,人群对C群Nm的免疫力不足。     

Prevalence of chronic hepatitis B virus infection before and after implementation of a hepatitis B vaccination program among children in Nepal

Background

In Nepal, an estimated 2–4% of the population has chronic hepatitis B virus (HBV) infection. To combat this problem, from 2002 to 2004, a national three dose hepatitis B vaccination program was implemented to decrease infection rates among children. The program does not currently include a birth dose to prevent perinatal HBV transmission. In 2012, to assess the impact of the program, we conducted a serosurvey among children born before and after vaccine introduction.

Methods

In 2012, a cross-sectional nationally representative stratified cluster survey was conducted to estimate hepatitis B surface antigen (HBsAg) prevalence among children born from 2006 to 2007 (post-vaccine cohort) and among children born from 2000 to 2002 (pre-vaccine cohort). Demographic data, as well as written and oral vaccination history were collected. All children were tested for HBsAg; mothers of HBsAg positive children were also tested. Furthermore, we evaluated the field sensitivity and specificity of the SD Bioline HBsAg rapid diagnostic test by comparing results with an enzyme immunoassay.

Results

Among 2181 post-vaccination cohort children with vaccination data by either card or recall, 86% (95% confidence interval [CI] 77–95%) received ≥3 hepatitis B vaccine doses. Of 1200 children born in the pre-vaccination cohort, 0.28% (95% CI 0.09–0.85%) were positive for HBsAg; of 2187 children born in the post-vaccination cohort, 0.13% (95% CI 0.04–0.39%) were positive for HBsAg (p = 0.39). Of the six children who tested positive for HBsAg, two had mothers who were positive for HBsAg. Finally, we found the SD Bioline HBsAg rapid diagnostic test to have a sensitivity of 100% and a specificity of 100%.

Conclusions

This is the first nationally representative hepatitis B serosurvey conducted in Nepal. Overall, a low burden of chronic HBV infection was found in children born in both the pre and post-vaccination cohorts. Current vaccination strategies should be continued.     

长沙市20家医院自体输血开展情况调查报告

目的了解长沙市各级医疗机构自体输血开展情况,促进本地区自体输血在临床中规范、安全地应用。方法通过现场走访,填写调查问卷表,对长沙市用血量前20家医疗机构2012-2017年自体输血的开展情况及制约因素等进行调研。结果 2012-2017年长沙地区用血量前20家医院平均自体输血开展率为31.7%,某部级、省级、市级医院2012-2017年平均自体输血率分别为:12.07%、2.27%、13.32%。自体输血类型以术中输血的回收式为主。结论长沙地区较大型的三甲医院已逐步开展自体输血并取得一定成效。自体输血是临床输血的重要组成部分,大力推广和实施自体输血仍任重而道远。     

头孢哌酮钠舒巴坦钠不同给药频次用于慢性阻塞性肺疾病急性加重期患者的疗效及病原菌清除率比较

目的:比较头孢哌酮钠舒巴坦钠不同给药频次用于慢性阻塞性肺疾病急性加重期患者的疗效及对病原菌清除率的影响,为临床慢性阻塞性肺疾病患者合理应用抗菌药物提供指导.方法:选取2018年1月至2019年1月邢台医学高等专科学校第二附属医院收治的慢性阻塞性肺疾病急性加重期患者120例,以随机数字表分为研究组(n=60)和对照组(n...     

Systematic assessment and evaluation of sliding interleaved ky (SLINKY) acquisition for 3D MRA

In comparison with the conventional three-dimensional multiple overlapped thin slab acquisition (MOTSA) for magnetic resonance angiography (MRA), we have developed a novel sliding interleaved k_y (SLINKY) acquisition technique, which can eliminate the slab boundary artifact (SBA) or venetian blind artifact without any a priori knowledge of blood flow. This work addresses the systematic assessment and evaluation of the SLINKY technique and verifies the advantages of SLINKY in the following several aspects: (a) scan time efficiency; (b) signal-to-noise ratio (SNR), and signal-difference-to-noise ratio (SDNR); (c) sensitivity to flow velocity range; (d) sensitivity to flow direction; (e) signal loss in slow/reversal flow regions; and (f) reconstruction efficiency and feasibility. Both phantom and in vivo experiments verify the clinical significance of the technique. The new MRA images acquired with this imaging technique in 31 volunteer/patient examinations show highly reliable mapping of vascular morphology without the SBA and reduction of signal voids in complex/slow flow regions.     

Structural characterisation, stability and antibody recognition of chimeric NHBA-GNA1030: an investigational vaccine component against Neisseria meningitidis

A new generation multi-component vaccine, principally directed against serogroup B Neisseria meningitidis (4CMenB), has recently been developed. One of its components, identified through reverse vaccinology, is the neisserial heparin-binding antigen (NHBA) which is included in the formulation as a novel NHBA-GNA1030 fusion protein (NHBA-FP). We describe here the biophysical characteristics of this vaccine antigen to understand better its structural properties in solution and concurrent immunogenicity prior to formulation. By deliberately stressing the protein to lose its immune responses, we were able to study the protein's structural changes at the molecular level. The unmodified NHBA-FP was found to be mainly monomeric with mass of 67kDa and secondary structure dominated by β-sheets and turns (57% average). The antigen was very stable in storage buffer. It could be forced to unfold in a low-salt buffer resulting in the exposure of one of its two tryptophan residues at 50°C. Long-term stress studies (10-15 days at 37°C) showed modification in the chromatographic and electrophoretic profiles with progressive degradation and aggregation. Since there was little change in secondary structure (as monitored by circular dichroism and tryptophan fluorescence spectroscopy), the loss of functional immunogenicity of the thermal stressed protein could be mainly attributed to the observed fragmentation and aggregation. We therefore conclude that the maintenance of the intact, non-fragmented state of the NHBA-FP is important to preserve its functional immunogenicity. This may thus be utilised as an assay for the control testing of the protein.     

Study of the effects of cardiovascular drugs in heart cell cultures

Compounds that produce myocardial pathology in vivo can be separated into two main classes—those that are directly toxic to the myocardium and those that are considered to act by way of an indirect vascular or neurologically based mechanism. An in vitro model of myocardium without nervous or systemic influences can be used to differentiate between direct myocardial cytotoxic effects and indirect cardiac pathology arising in vivo from exaggerated vascular or neural pharmacological effects of a number of drugs. In this study direct-acting cardiotoxic compounds are distinguished from those causing cardiac pathology by indirect mechanisms by their different pattern of effects in chick embryonic myocardial myocyte reaggregates (MMRs) cultures. The toxicity of the direct-acting cardiotoxic drugs allylamine (positive control, 50 μ ) and doxorubicin were compared with digoxin and isoprenaline, which show both direct and indirect mechanisms in vivo, and the indirectly acting hydralazine and pinacidil. Changes in spontaneous beating activity (SBA), leakage of lactate dehydrogenase (LDH) and cell morphology by light and transmission electron microscopy were used to assess toxicity. The MMRs were cultured for up to 24 hr in a series of concentrations of the five compounds in the range 0.1 to 10,000 μ . Allylamine, doxorubicin, digoxin and, to a lesser extent, isoprenaline were highly toxic to the MMRs, as shown by alterations in SBA, LDH leakage and cellular morphology. In contrast, hydralazine showed a very mild degree of toxicity at the highest concentrations in the absence of LDH leakage; treatment with pinacidil did not show any evidence of morphological degeneration but did cause a dose-related inhibition of SBA. These results are consistent with the view that doxorubicin and digoxin are directly toxic to myocardial cells and also suggests that this is an important mechanism in vivo for isoprenaline. The absence of a significant degree of toxicity with hydralazine and pinacidil is consistent with an indirect toxic mechanism.     

Preclinical safety and immunogenicity evaluation of a nonavalent PorA native outer membrane vesicle vaccine against serogroup B meningococcal disease

Background

An improved nonavalent PorA native outer membrane vesicle vaccine was developed with intrinsic adjuvating activity due to presence of less-toxic (lpxL1) LPS. In the present study, the safety and immunogenicity of this next-generation NonaMen vaccine were evaluated following repeated vaccination in rabbits and mice.

Methods

A repeated–dose toxicology study was performed in rabbits. Immunogenicity of next-generation NonaMen was evaluated by determining the serum bactericidal antibody (SBA) titers against meningococcal serogroup B strains containing several PorA subtypes. Release of the pro-inflammatory cytokine, interleukin-6 (IL-6), by the human monocytic cell line (MM6) was measured to estimate pyrogenic activity.

Results

No toxicologically relevant findings were noted in vaccinated rabbits receiving plain next-generation NonaMen. In agreement, next-generation NonaMen induced reduced amounts of the pro-inflammatory cytokine, IL-6, released by human monocyte cell line. In both rabbits and mice, next-generation NonaMen induced high SBA titers against all tested MenB strains regardless of whether or not aluminium phosphate adjuvant is used.

Conclusions

The data suggest that next-generation NonaMen is a safe vaccine with the potential to develop a broadly protective immune response and encourage the start of the first clinical studies.