Lower incidence of hospital-treated infections in infants under 3 months of age vaccinated with BCG

BackgroundLive vaccines potentially have non-specific effects that protect against other infections than those the vaccines are targeted against. The national vaccination program (NVP) in Finland was changed on September 1st, 2006: before BCG vaccine was given to all newborn babies and afterwards to babies in risk groups only. We used this natural experiment to study the non-specific effects of BCG in the frame of NVP using before-after design.MethodsWe compared the incidence of several outcomes obtained from Finnish health registers between children born between July 1st, 2004, and June 30th, 2006 (BCG-eligible) and an age- and season-matched reference cohort born between July 1st, 2007, and June 30th, 2009 (BCG-non-eligible) using Poisson regression. These cohorts were restricted to full-term children whose parents were born in Finland. Follow-up began at birth and lasted 3 months, which is the scheduled age for DTaP-IPV-Hib vaccination, and from 4 months until first birthday. The outcomes included all infections, pneumonia and injuries as a negative control outcome.ResultsThe incidence rate ratio (IRR) of the BCG-eligible cohort (N = 93,658) compared to BCG-non-eligible cohort (N = 94,712) for hospital-diagnosed infections was 0.89 (95 %Cl 0.86–0.93) for the 3-month follow-up. The decrease was mainly caused by respiratory infections. In 4–12 months follow-up the BCG-eligible had slightly more infections than BCG-non-eligible children (IRR 1.03, 1.01–1.06).ConclusionsBCG vaccination was associated with a lower incidence of all hospital-diagnosed infections during the first three months of life. The difference cannot be attributed to lung tuberculosis, since only few paediatric cases occurred in Finland during 2000s. The disappearance of non-specific effect after administration of an inactivated vaccine is compatible with previous studies.     

Clinical manifestations and radiological features by chest computed tomographic findings of a novel coronavirus disease-19 pneumonia among 92 patients in Japan

IntroductionThe novel coronavirus disease (COVID-19) could cause a severe acute respiratory infectious disease, showing a high mortality rate of 12–45% among cases who required intensive care unit admission. COVID-19 pneumoniaPatients and methodsFor the purpose of identifying clinical manifestations and radiological findings of COVID-19 pneumonia, we reviewed all cases of COVID-19 pneumonia which were published by the homepage of the Japanese Association for Infectious Diseases from Feb 5 2020 until April 30 2020, including our cases. All patients were diagnosed based on positive results of the novel coronavirus-real-time RT-PCR with chest computed tomography (CT) findings.ResultsA total of 92 patients were enrolled in this study. The median age was 66 years (range 16–92 years). For all, 50 (54%) were males. The most common underlying disease was hypertension in 32 (36%). Any comorbidity was seen in 60 (67%). The mortality rate was 4 (6%). In terms of clinical symptoms on an initial visit, fever and cough were confirmed in 66 (72%) and 37 (40%). Forty-three (47%) had no respiratory symptoms. As for radiological findings by chest CT scan, ground-glass opacities (GGO)s, peripheral distribution, bilateral lung involvements were seen in 88 (96%), 76 (83%) and 78 (85%), respectively.ConclusionIt is difficult to diagnose as COVID-19 pneumonia due to poor respiratory symptoms. Chest CT findings typically show GGO, peripheral and bilateral shadows. Patients should have chest CT performed if suspected for early diagnosis and therapeutic intervention, resulting in a favorable outcome and prevention of secondary nosocomial transmitted infection.     

基于文本挖掘和生物医学数据库的新型冠状病毒肺炎药物发现

目的 基于文本挖掘技术和生物医学数据库对新型冠状病毒肺炎（COVID-19）相关文献进行数据挖掘分析，探究COVID-19及其主要症状发热、咳嗽、呼吸障碍相关基因靶点，筛选潜在有效的化学药和中药。方法 使用GenCLiP 3网站获取COVID-19和其主要症状咳嗽、发热、呼吸障碍共4个关键词的共有靶点，在METASCAPE数据库中对其进行基因本体（GO）和通路富集分析，再利用String数据库和Cytoscape软件构建共有靶点的蛋白质相互作用网络，筛选获得核心基因，运用DGIdb数据库、SymMap数据库针对核心基因进行中西医治疗药物预测。结果 获得COVID-19及其主要症状共有基因靶点28个，其中有IL2、IL1B、CCL2等核心基因16个，使用DGIdb数据库筛选获得与16个关键靶点相互作用的化学药包括沙利度胺、来氟米特、环孢素等28种，中药包括虎杖、黄芪、芦荟等70味。结论 COVID-19及其主要症状的病理机制可能和CD4、KNG1、VEGFA等28个共有基因相关，可能通过介导TNF、IL-17等信号通路参与COVID-19病理过程。潜在有效药物可能通过作用相关靶点通路起到治疗COVID-19的作用。     

2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan,China

We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. The reported cases highlight non-specific clinical presentations of 2019 novel coronavirus disease (COVID-19) as well as the importance of rapid laboratory-based diagnosis.     

Retrospective study of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in Reunion

ObjectivePanton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia, although associated with a high case fatality. This infection mainly affects young individuals, without any history, and is most often preceded by flu-like symptoms.MethodWe focused on patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion (Indian Ocean) admitted to the emergency department. We performed a retrospective study based on data collected from laboratory registers and medical files of patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion between December 2014 and December 2017.ResultsA total of 16 patients were recruited for this study, with a median age of 40.5 years. More than half of patients had previously been admitted to the emergency department for acute respiratory distress syndrome or severe sepsis. Fourteen patients were admitted to the intensive care unit and six patients died (five premature deaths).ConclusionPhysicians should be aware of this infection during the flu season and quickly adapt the specific antibiotic treatment, including a drug inhibiting toxin production. As methicillin-resistant Staphylococcus aureus is very rarely observed in Reunion, physicians can still adapt the empirical treatment, without glycopeptides.     

真菌性、细菌性和病毒性肺炎的若干凝血指标变化分析

探讨真菌性、细菌性和病毒性肺炎的若干凝血指标差异性研究。方法 回顾性分析2017 年7 月～2019 年11 月本院肺炎患者128 例与同期门诊健康体检者50 例，分析患者血浆纤维蛋白原（FIB）、凝血酶原时间（PT）和活化部分凝血酶时间（APTT）的水平。结果 三类肺炎组与对照组在FIB、PT 和APTT 水平比较，差异均有统计学意义（P＜0.01）；FIB、PT 水平与病原感染呈正相关，APTT 与病原感染呈负相关。结论FIB、PT、APTT 可以间接提示肺炎感染病原体类型，具有临床意义。     

自拟温润方治疗风寒袭肺型急性咳嗽病的临床观察

目的 观察自拟温润方治疗风寒袭肺型急性咳嗽病的临床疗效。方法 64例风寒袭肺型急性咳嗽病患者,随机分为对照组(31例)和治疗组(33例)。对照组患者给予复方甘草口服溶液治疗,治疗组患者给予温润方治疗。比较两组患者治疗前和治疗3、6 d后的中医症状评分以及临床疗效。结果 治疗3、6 d后,两组患者咳嗽、咯痰、恶风、咽痒、鼻塞、流涕、鼻干、口干咽燥症状评分均低于治疗前,差异均具有统计学意义(P<0.05)。治疗组患者治疗3 d后咳嗽、咽痒、鼻干、口干咽燥症状评分分别为(2.18±0.98)、(1.15±0.81)、(0.60±0.61)、(0.81±0.71)分,均低于对照组的(3.04±1.62)、(1.68±0.96)、(0.96±0.67)、(1.37±0.86)分,差异均具有统计学意义(P<0.05);治疗组患者治疗6 d后咳嗽、咽痒、鼻干、口干咽燥症状评分分别为(0.54±0.51)、(0.42±0.48)、(0.40±0.46)、(0.47±0.51)分,均低于对照组的(1.12±0.76)、(1.11±0.98)、(0.88±0.98)、(1.01±0.92)分,差异均具有统计学意义(P<0.05)。两组患者治疗3、6 d后咯痰、恶风、鼻塞、流涕症状评分比较,差异无统计学意义(P>0.05)。治疗3 d后,治疗组治疗总有效率90.9%高于对照组的71.0%,差异具有统计学意义(P<0.05)。治疗6 d后,治疗组患者治疗总有效率93.9%与对照组的90.3%比较,差异无统计学意义(P>0.05)。结论 在风寒袭肺型急性咳嗽病治疗中,温润方在缓解咳嗽以及部分次症方面明显优于复方甘草口服溶液,起效更快。     

肝移植术后巨细胞病毒性肺炎的临床特点和治疗方法

目的 探讨肝移植术后巨细胞病毒（CMV）性肺炎的临床特点和治疗方法。方法 回顾性分析2003年10月至2005年6月间施行肝移植的451例患者的临床资料，对肝移植术后CMV性肺炎的临床特点和治疗方法进行总结。结果 在451例患者中，发生CMV性肺炎7例，感染率为1．66％。CMV性肺炎的症状明显早于体征，7例患者均无明显诱因出现高热，约1周后逐渐出现干咳、气促、呼吸困难等；血氧饱和度降低，血气分析提示低氧血症；CMV pp65抗原检测均为阳性。CMV性肺炎患者采用更昔洛韦联合膦甲酸钠抗病毒治疗，同时采取停用免疫抑制剂、加用较大剂量的丙种球蛋白和适量的胸腺肽等的个体化免疫调节方案以及广谱抗生素等综合治疗方法，6例治愈，治愈率为85．7％。结论 CMV性肺炎的早期临床表现虽然缺乏特异性，但仍有规律可循，CMV pp65抗原检测法具有特异性和敏感性高的特点。采取联合抗病毒和个体化免疫调节等综合措施治疗CMV性肺炎效果确切。     

Obstinate cough as a sole presenting symptom of non-metastatic renal cell carcinoma

Renal cell carcinoma (RCC) causes many kinds of symptoms such as hypercalcemia, hypertension, polycythemia and fever. Here we describe a rare case of RCC presenting with a persistent cough. After radical nephrectomy, the obstinate cough disappeared. When the tumor recurred locally, the cough also recurred. Furthermore, the cough disappeared completely again after the removal of the recurrent tumor. Although all the clinical findings suggested that the RCC caused the cough, we could not identify a specific humoral substance responsible for the cough.