新型肺炎链球菌疫苗研究进展

肺炎链球菌(Streptococcus pneumoniae)是引发人类肺炎、中耳炎、脑膜炎的主要病原体。为了预防肺炎链球菌感染,人类已研制出了多种相关的疫苗。目前,常用23价肺炎球菌多糖疫苗(23-valent pneumococcal polysaccharide vaccine,PPV23)预防成人和2岁以上儿童肺炎链球菌的感染,用7价、10价、13价肺炎球菌结合疫苗来预防婴幼儿肺炎链球菌的感染。虽然荚膜多糖类疫苗能预防其所包含的肺炎链球菌血清型的感染,但非疫苗血清型的菌株还是可以在鼻咽部定植,并引起感染,而且结合疫苗研制工艺复杂、价格昂贵,在发展中国家使用还不普及。鉴于上述原因许多疫苗公司开始研发具有保护力强、价格低廉的新型疫苗。近年来,肺炎链球菌全细胞疫苗和肺炎链球菌纯化蛋白疫苗由于其血清非依赖性和较低的生产成本已成为人们关注的焦点。现对肺炎链球菌新型疫苗的研制及临床应用作一概述。     

母婴接种肺炎球菌多糖疫苗

<正>幼龄预防肺炎球菌感染有其必要性,可通过母亲接种疫苗或者婴儿尽可能早接种疫苗来实现。在一项开放对照的研究中,给孕妇接种23价肺炎链球菌多糖疫苗(PPV)、B型流感嗜血杆菌结合疫苗和破伤风类毒素,或者单独接种破伤风类毒素。     

PCV13在未接种或既往接种PPV23的重度慢性肾病成年患者中的免疫原性和安全性

<正>慢性肾脏疾病(CKD)患者感染肺炎球菌的风险很高,因此建议接种23价肺炎球菌多糖疫苗(PPV23)。尽管研究已表明13价肺炎球菌结合疫苗(PCV13)在某些免疫缺陷成人中的免疫原性比PPV23更高,但既往PPV23免疫的患者接种PCV13可能会降低后者的免疫原性。此研究纳入74例无PPV23接种史和58例既往PPV23免疫1年以上的重度慢性肾病(4-5期)患者,评估其接种PCV13后的免疫原性和安全性。免疫前、免疫后4周和1年后,定量检测7种肺炎球菌血清型(3、6B、9V、14、19A、19F、23F)的特异性IgG、IgM和IgA。结果显示,在既往PPV23免疫的患者中,大多数血清特异性IgG和IgM以及血清3型特异性IgA的基线浓度高于无PPV23接种史的患者。     

系统管理对重度支气管哮喘患者预后的影响

目的:探讨通过系统管理,对长期改善重度支气管哮喘患者预后的影响.方法:选择2006年4月至2007年3月在我科进行系统管理的住院支气管哮喘患者45例,采用问卷调查方式统计系统管理前1年中患者的急性发作次数,对日常工作、生活的影响天数,住院次数,肺功能,治疗费用等指标,与开展系统管理后1年时上述指标前后自身对照.结果:进行系统管理后较系统管理前1年中,患者平均急性发作次数减少90.3%,时日常工作、生活影响平均天数减少76.4%,住院次数平均下降70%,平均治疗费用减少47.5%.平均肺功能FEV1增加17.6%.结论:通过对支气管哮喘患者开展系统管理,可以使患者生活质量,肺功能长期明显改善,治疗费用大幅度下降.     

应用无创通气治疗56例COPD患者呼吸衰竭的临床分析

目的探讨无创通气在慢性阻塞性肺疾病（COPD）呼吸衰竭的应用价值。方法将急性加重期COPD患者56例分为无创通气组26例和有创通气组30例,观察患者上机前、上机后30min、上机后2天的血气变化,机械通气天数,住院天数。费用及并发感染等指标。结果有创通气组上机30min后PaO2升高、PaCO2下降、pH的恢复幅度明显快于无创通气组（P〈0．01）.但2天后两组PaO2、PaCO2、pH差异无显著性（P〉0．05）。无创通气组机械通气天数、住院天数、费用以及院内感染的发病率明显低于有创通气组（P〈0．01）。无创通气组明显嗜睡者12例．占27．3％,其中10例经无创通气治疗后清醒,无需有创通气。结论无创通气治疗急性加重期COPD患者呼吸衰竭是一种方便有效的方法。     

定西市2013年疑似预防接种异常反应监测分析

目的分析定西市2013年疑似预防接种异常反应(AEFI)的发生特征,评价AEFI监测系统运转情况、预防接种服务质量和疫苗的安全性。方法采集辖区内疑似预防接种异常反应信息管理系统报告的2013年AEFI数据,进行描述性流行病学分析。结果 2013年全市报告发生AEFI 2 091例,报告发生率为236.75/10万剂次;其中一般反应2 080例,异常反应6例,心因性反应5例。全年每月均有AEFI报告,10、11月份报告例数最多。1岁内儿童报告比例最大;AEFI多发生在接种后0~1 d内,发生后多于2 d内就诊。23价肺炎疫苗、白破疫苗和百白破疫苗报告发生率居前三位;一、二类疫苗报告发生率有统计学差异。结论定西市AEFI监测系统敏感性较高,AEFI报告发生率远低于世界卫生组织的估计值。全年未报告疫苗质量事故、接种事故和偶合症病例。免疫规划接种实施是规范、安全的。     

家庭应用无创机械通气对COPD患者肺功能及医疗费用的影响

目的:在COPD急性发作期无创机械通气治疗已经被临床医生重视并广泛应用于临床治疗.但对于家庭应用无创机械通气治疗缓解期的患者是否获益,目前尚无明确结论.本试验旨在探讨家庭应用无创机械通气对COPD患者生活质量、运动耐量、肺功能及医疗费用的影响.方法:随机观察103例慢性阻塞性肺疾病急性发作合并 Ⅱ型呼吸衰竭患者,于医院应用无创辅助通气治疗缓解后出院.其中39例继续应用无创机械通气治疗(治疗组),其余64停止无创机械通气治疗(对照组),观察6个月,比较家庭应用无创机械通气治疗后生活质量、运动耐量、肺功能变化、血气分析、心率、呼吸频率及急性发作的间隔期、医疗费用状况.结果:治疗组较对照组生活质量、运动耐量明显改善(P＜0.05),肺功能下降明显减慢(P＜0.05),平均医疗费用明显减少(P＜0.05).结论:家庭应用无创机械通气能够延缓COPD患者肺功能下降速度,减少医疗费用近万元,延长急性加重间隔时间6个月以上,减少住院次数,提高生存质量.     

预防接种,不应动摇

正预防接种毫无疑问是最具成本效益的公共卫生措施.预防接种在世界各地的推广已使上亿人免于传染病的痛苦,并拯救了上百万人的生命.新中国成立后,得益于预防接种的有力推动,我国在20世纪60年代初消灭了牛痘.自1978年起我国开始实施计划免疫,对全部儿童免费接种可预防6种疾病的4种疫苗,2007年进一步将可预防15种传染病的疫苗纳     

2013—2018年上海市闵行区老年人接种23价肺炎球菌多糖疫苗的异常反应监测

目的评估2013年9月15日—2018年8月31日期间,上海市闵行区≥60岁老年人群接种1剂23价肺炎球菌多糖疫苗后的安全性。方法采用主动监测和被动监测,对接种过1剂23价肺炎球菌多糖疫苗的≥60岁老年人群进行疑似预防接种异常反应(adverse events following immunization,AEFI)监测。结果主动监测的AEFI报告发生率为167.64/10万,未见罕见严重AEFI;被动监测AEFI报告发生率为41.86/10万,主要为一般反应(36.84/10万),以局部红肿和发热为主。54.00%的AEFI发生在疫苗接种后24 h内,且一般反应持续时间均未超过3 d。AEFI报告发生率为2.50/10万,为血管水肿和淋巴结肿大。经统计学分析,主动监测和被动监测的AEFI报告发生率,差异无统计学意义(χ2=4.337、P>0.05)。结论 23价肺炎球菌多糖疫苗具有良好的安全性,可以在老年人群中大规模接种。     

微生态制剂防治婴幼儿肺炎继发腹泻的卫生经济学评价

目的 评价预防性应用微生态制剂(培菲康)防治婴幼儿肺炎继发腹泻的疗效及成本效益.方法 2008年1月到2010年9月住院治疗的婴幼儿肺炎966例为研究对象,对患儿的临床特征、微生态制剂(培菲康)预防性应用情况、是否出现继发腹泻及住院治疗费用的关系进行分析.结果 干预组594例,对照组372例,两组住院治疗期间继发腹泻的发病率分别为18.69％、39.78％,两组比较,x2 =51.889,P ＜0.01,RR=0.470;干预组99例发生继发腹泻后继续原有微生态制剂治疗,对照组134例因继发腹泻才开始应用同类微生态制剂治疗,两组腹泻治疗总有效率分别86.87％、74.63％,差异无统计学意义(x2=5.299,P=O.021).干预组、对照组每例(次)患儿住院总费用分别为(2775.0±1724.2)元和(3130.7±1899.8)元,预防性应用微生态制剂(培菲康)次均节省直接医疗费用支出355.6元,差异有统计学意义(t =2.998,P=0.003);预防性应用微生态制剂(培菲康)的效益成本比为13.02.结论 预防性应用微生态制剂(培菲康)不仅能降低肺炎继发腹泻的发病率,缩短住院病程,提高腹泻治疗总有效率,同时,明显降低患儿的次均医疗费用,效益成本比高.     

Scurvy in capybaras bred in captivity in Argentine

In order to determine if the absence of vitamin C in the diet of capybaras (Hydrochoerus hydrochaeris) causes scurvy, a group of seven young individuals were fed food pellets without ascorbic acid, while another group of eight individuals received the same food with 1 g of ascorbic acid per animal per day. Animals in the first group developed signs of scurvy-like gingivitis, breaking of the incisors and death of one animal. Clinical signs appeared between 25 and 104 days from the beginning of the trial in all individuals. Growth rates of individuals deprived of vitamin C was considerably less than those observed in the control group. Deficiency of ascorbic acid had a severe effect on reproduction of another population of captive capybaras. We found that the decrease in ascorbic acid content in the diet affected pregnancy, especially during the first stages. The results obtained suggest that it is necessary to supply a suitable quantity of vitamin C in the diet of this species in captivity.     

Changes in lactate dehydrogenase activity in chicken tissues in hyperthyreosis in ontogenesis

The lactate dehydrogenase activity in reactions of lactate oxidation and synthesis was studied in subfractions of the chicken brain, heart and liver at the embryonal, early postembryonal and adult stages of development after thyroxine administration. It has been shown that during embryogenesis thyroxine predominantly enhanced the rate of lactate oxidation in the mitochondrial tissues. A marked increase in the lactate synthesis was found in cytoplasm of the adult chicken tissues. Specificity of enzyme activity alterations was detected in the chicken brain during ontogenesis after thyroxine administration.     

Role for dopamine in malonate-induced damage in vivo in striatum and in vitro in mesencephalic cultures

Defects in mitochondrial energy metabolism have been implicated in the pathology of several neurodegenerative disorders. In addition, the reactive metabolites generated from the metabolism and oxidation of the neurotransmitter dopamine (DA) are thought to contribute to the damage to neurons of the basal ganglia. We have previously demonstrated that infusions of the metabolic inhibitor malonate into the striata of mice or rats produce degeneration of DA nerve terminals. In the present studies, we demonstrate that an intrastriatal infusion of malonate induces a substantial increase in DA efflux in awake, behaving mice as measured by in vivo microdialysis. Furthermore, pretreatment of mice with tetrabenazine (TBZ) or the TBZ analogue Ro 4-1284 (Ro-4), compounds that reversibly inhibit the vesicular storage of DA, attenuates the malonate-induced DA efflux as well as the damage to DA nerve terminals. Consistent with these findings, the damage to both DA and GABA neurons in mesencephalic cultures by malonate exposure was attenuated by pretreatment with TBZ or Ro-4. Treatment with these compounds did not affect the formation of free radicals or the inhibition of oxidative phosphorylation resulting from malonate exposure alone. Our data suggest that DA plays an important role in the neurotoxicity produced by malonate. These findings provide direct evidence that inhibition of succinate dehydrogenase causes an increase in extracellular DA levels and indicate that bioenergetic defects may contribute to the pathogenesis of chronic neurodegenerative diseases through a mechanism involving DA.     

SSTR5 ablation in islet results in alterations in glucose homeostasis in mice

Somatostatin (SST) peptide is a potent inhibitor of insulin secretion and its effect is mediated via somatostatin receptor 5 (SSTR5) in the endocrine pancreas. To investigate the consequences of gene ablation of SSTR5 in the mouse pancreas, we have generated a mouse model in which the SSTR5 gene was specifically knocked down in the pancreatic beta cells (betaSSTR5Kd) using the Cre-lox system. Immunohistochemistry analysis showed that SSTR5 gene expression was absent in beta cells at three months of age. At the time of gene ablation, betaSSTR5Kd mice demonstrated glucose intolerance with lack of insulin response and significantly reduced serum insulin levels. Insulin tolerance test demonstrated a significant increase of insulin clearance in vivo at the same age. In vitro studies demonstrated an absence of response to SST-28 stimulation in the betaSSTR5Kd mouse islet, which was associated with a significantly reduced SST expression level in betaSSTR5Kd mice pancreata. In addition, betaSSTR5Kd mice had significantly reduced serum glucose levels and increased serum insulin levels at 12 months of age. Glucose tolerance test at an older age also indicated a persistently higher insulin level in betaSSTR5Kd mice. Further studies of betaSSTR5Kd mice had revealed elevated serum C-peptide levels at both 3 and 12 months of age, suggesting that these mice are capable of producing and releasing insulin to the periphery. These results support the hypothesis that SSTR5 plays a pivotal role in the regulation of insulin secretion in the mouse pancreas.     

我国葫芦科植物离体培养研究进展

葫芦科植物包括多种瓜类蔬菜,对其进行离体培养研究具有重要的理论和实践意义。综述了国内在葫芦科植物器官培养、体细胞胚胎发生、花药培养、原生质体培养和体细胞杂交及离体遗传转化等方面取得的研究进展,并对葫芦科植物离体培养、遗传转化与育种的前景作了展望。