电子阴道镜在诊断妊娠期阴道出血的价值

探讨应用电子阴道镜在寻找妊娠期阴道出血原因方面的价值。方法:对我院2004年5月-2006年11月64例非产科原因孕期阴道流血的孕妇,进行电子阴道镜检查及颈管分泌物培养和镜下定位活检。结果:阴道镜下发现宫颈赘生物12例,其中2例坏死,10例明显充血水肿;宫颈炎伴活动性出血2例,宫颈炎无活动性出血18例;正常宫颈16例;宫颈上皮内瘤样病变图象15例;宫颈分泌物培养阳性23例。结论:妊娠期不规则阴道出血原因复杂,阴道镜检查能较快排除与查明宫颈及阴道病变所导致的出血。     

北京市2010年手足口病死亡病例流行病学及临床特征分析

目的：通过描述2010年北京市手足口病死亡病例的流行病学特点和临床特点,分析手足口病重症病例发生死亡的危险因素,为防制手足口病,减少手足口病的死亡提供科学依据。方法：采用现况描述及病例对照研究的方法,对2010年北京市手足口病死亡病例的特点进行分析。结果：2010年北京市共报告18例手足口病死亡病例,88．9％分布在5．8月份;死亡病例的男女比例为3．5：1;年龄均小于4岁;流动人口聚集区的死亡病例较多;散居儿童及外地户籍儿童比例高,分别为83．3％和94．4％。死亡病例均出现出疹、发热及神经精神系统症状,整体精神状况,呼吸功能指标以及循环系统受累明显。与重症痊愈病例相比,感染EV71型病毒是发生死亡的危险因素（x2=4．774,P=0．029）。结论：手足口病死亡病例分布与重症病例分布基本一致。应对流动人口聚集地区的4岁以下婴幼儿重症病例进行重点防控。     

The Curious Case of “Case Report” of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool,an Online Archive,or a Format in Need of Retooling

Case reports describe the unusual occurrence and complications of diseases, diagnostic challenges, and notable therapeutic successes. Some journals have discontinued the case reports, while new case report journals have appeared in recent years. During the eightieth anniversary of Mycopathologia, it is fitting to examine the relevance of the case report since the journal continues to traverse the boundaries of basic and clinical sciences. A random sample of recent case reports and other articles were selected from Mycopathologia. Springer Nature individual article download statistics, and Google Scholar and Scopus citations numbers were compared to assess the reader access and bibliometric impact of case reports. Our analysis indicated that the case report format continues to be a vital element of publication in a cross-disciplinary journal such as Mycopathologia. Medical and veterinary case reports covering fungal pathogens are widely read as evident from their download numbers. The download numbers have a positive correlation with the completeness of the report, the topics and geographic origin of reports have a neutral influence, and the recency leads to lower downloads. There is no discernible trend between the download numbers and the citations of case reports as measured by Google Scholar and Scopus. A specially designed checklist for Mycopathologia case reports and new format MycopathologiaIMAGES are being introduced to improve the quality and relevance of case reports further.     

“Because Somebody Cared about Me. That's How It Changed Things”: Homeless,Chronically Ill Patients’ Perspectives on Case Management

Background

Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants’ perspectives on case management interventions.

Methods

This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program.

Results

Four recurrent themes emerged: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management.

Conclusions

Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.     

Risk Factors for Inadequate TB Case Finding in Rural Western Kenya: A Comparison of Actively and Passively Identified TB Patients

Background

The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.

Objective and methods

We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses.

Findings

HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI) 2.0–5.9), but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR) HIV 1.8, 95% CI 0.85–3.7). Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60–0.97 per 10 years increase), and women (aOR 0.27, 95%CI 0.10–0.73). Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23–0.79). Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively.

Conclusion

HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women and the elderly are needed to improve TB case detection in Kenya.     

多切面法联合彩色多普勒超声在胎儿先天性心脏病诊断中的应用

目的:探讨多切面法联合彩色多普勒超声在胎儿先天性心脏病(congenital heart diseases,CHD)诊断中的应用价值。方法:采用多切面法联合彩色多普勒超声对2015年5月~2016年7月300例胎儿进行CHD筛查,并与随访的产后超声或尸解结果作对照。结果:300例胎儿经产前超声联合多切面法检出CHD胎儿20例,检出率为6.7%,经产后超声或尸解确诊14例:三尖瓣下移畸形1例,室间隔完整型完全性大动脉转位1例,完全性房室间隔缺损1例,室间隔完整型肺动脉瓣闭锁1例,双流入型单心室1例,共同动脉干Ⅰ型2例,单纯室间隔缺损2例,法洛氏四联症2例,主动脉弓缩窄1例,肺动脉瓣轻度狭窄1例,二尖瓣闭锁并共同动脉干1例;误诊为单纯室间隔缺损1例,误诊为法洛氏四联症1例,病例流失4例。产前超声联合多切面法对有、无高危因素的检出率分别为3.79%、13.48%,比较有统计学意义(P0.05)。产前超声联合多切面法诊断CHD的灵敏度为100%、特异度为99.66%、阳性预测值为80.00%、阴性预测值为100%。结论:多切面法联合彩色多普勒超声在胎儿CHD诊断中具有较高的应用价值。     

Shear Viscosity of Model Mixtures by Nonequilibrium Molecular Dynamics. IV. Effect of Molecular Shape

Abstract

We present new results for thermodynamic properties and viscosities of pure dumbbell fluids, spherical/dumbbell mixtures, and dumbbell/dumbbell mixtures. It is evident that the interaction between dumbbell molecules is less attractive than that between spherical molecules which leads to lower viscosities. The shear viscosities and the LJ energies of both spherical Ar/dumbbell Kr (case B) and dumbbell Ar/dumbbell Kr (case C) are described quite well by the liquid mixture expression. The ideality in case C is much better than in case B which is consistent with the idea that dumbbell/dumbbell mixtures are likely to be more ideal than spherical/dumbbell mixtures. But the mixture pressures of the spherical/dumbbell mixture (case B) are described accurately by the ideal liquid mixture expression while those of the dumbbell/dumbbell mixture (case C) are not, which is not consistent with the better ideality of case C in the shear viscosity and the LJ energy than case B.     

Wildervanck syndrome with hypoplastic frontal sinus: A rare case presentation

We report a case of Wildervanck syndrome exhibiting Klippel–Feil anomaly, Duane''s retraction syndrome and congenital deafness. Since the first case was reported in 1952, there have been more reports describing this triad either complete or incomplete. Our case has a complete triad of the syndrome along with frontal sinus hypoplasia. Our case is unique as the triad was associated with frontal sinus hypoplasia, which is very rare association.     

Contribution of BRCA1 and BRCA2 mutations to breast and ovarian cancer in Pakistan

The population of Pakistan has been reported to have the highest rate of breast cancer of any Asian population (excluding Jews in Israel) and one of the highest rates of ovarian cancer worldwide. To explore the contribution that genetic factors make to these high rates, we have conducted a case-control study of 341 case subjects with breast cancer, 120 case subjects with ovarian cancer, and 200 female control subjects from two major cities of Pakistan (Karachi and Lahore). The prevalence of BRCA1 or BRCA2 mutations among case subjects with breast cancer was 6.7% (95% confidence interval [CI] 4.1%-9.4%), and that among case subjects with ovarian cancer was 15.8% (95% CI 9.2%-22.4%). Mutations of the BRCA1 gene accounted for 84% of the mutations among case subjects with ovarian cancer and 65% of mutations among case subjects with breast cancer. The majority of detected mutations are unique to Pakistan. Five BRCA1 mutations (2080insA, 3889delAG, 4184del4, 4284delAG, and IVS14-1A-->G) and one BRCA2 mutation (3337C-->T) were found in multiple case subjects and represent candidate founder mutations. The penetrance of deleterious mutations in BRCA1 and BRCA2 is comparable to that of Western populations. The cumulative risk of cancer to age 85 years in female first-degree relatives of BRCA1-mutation-positive case subjects was 48% and was 37% for first-degree relatives of the BRCA2-mutation-positive case subjects. A higher proportion of case subjects with breast cancer than of control subjects were the progeny of first-cousin marriages (odds ratio [OR] 2.1; 95% CI 1.4-3.3; P=.001). The effects of consanguinity were significant for case subjects with early-onset breast cancer (age <40 years) (OR=2.7; 95% CI 1.5-4.9; P=.0008) and case subjects with ovarian cancer (OR=2.4; 95% CI 1.4-4.2; P=.002). These results suggest that recessively inherited genes may contribute to breast and ovarian cancer risk in Pakistan.     

Larval case and water balance in Tinea pellionella

In a very dry environment (0% r.h.) the case plays an important role in the physiology of the Tinea pellionella larva. Absence of the case leads to a reduction of oxygen consumption and a great loss of body water. At 0% r.h. the rate of water loss from a larva without its case, is twice that from a larva remaining within its case.In a very humid environment (r.h. higher than 95%) the case absorbs a very large quantity of water and becomes very heavy, but it does not interfere with larval physiology. With or without their cases the weight of the larvae stays stable, and their oxygen consumption does not change.When the humidity changes abruptly, the case acts as a buffer and assists in the regulation of the water balance of the larva. If the humidity decreases the case slows the rate of body water loss; if the humidity increases, it very quickly builds up a reserve of atmospheric water around the larva's body.     

Chimpanzee Down syndrome: a case study of trisomy 22 in a captive chimpanzee

We report a case of chimpanzee trisomy 22 in a captive-born female. Because chromosome 22 in great apes is homologous to human chromosome 21, the present case is analogous to human trisomy 21, also called Down syndrome. The chimpanzee in the present case experienced retarded growth; infantile cataract and vision problems, including nystagmus, strabismus, and keratoconus; congenital atrial septal defect; and hypodontia. All of these symptoms are common in human Down syndrome. This case was the second reported case of trisomy 22 in the chimpanzee. The chimpanzee in our case became blind by 7 years old, making social life with other chimpanzees difficult, but opportunities to interact with other conspecific individuals have been offered routinely. We believe that providing her with the best care over the course of her life will be essential.     

Serological and genetic analysis of ABO ambiguous blood group samples

The accuracy of regular serum methods to detect ABO blood groups can be negatively affected by some factors, such as irregular antibodies, autoantibodies or effects of diseases leading to false or weak agglutination. This study aimed to accurately identify ambiguous ABO blood groups by serological and gene detection methods. The samples were collected in the First Affiliated Hospital of Nanjing Medical University from December 2018 to December 2019. ABO genotyping was performed by polymerase chain reaction-sequence specific primer (PCR-SSP) method in 20 samples, and ABO exons 6 and 7 or FUT1 and FUT2 genes were sequenced in 5 samples. The genes detected in the 21 specimens included 4 cases of A/B, 2 cases of A205/O01, 3 cases of A/O01, 3 cases of A/O02, 1 case of O01/O01, 1 case of O01/O02, 1 case of B/O01, 1 case of B/O02, 1 case of Bel/O01, 1 case of Cisab01/O01, 1 case of rare B/O04, 1 case of Bombay-like Bmh, 1 case of new gene showing c.261del G of exon 6, c.579 T>C of exon 7 and B new/O01. This study suggests that ABO blood group genotyping technology combined with serological typing can be used for accurately typing ambiguous blood groups.     

Convergent evolution of morphology and habitat use in the explosive Hawaiian fancy case caterpillar radiation

Species occurring in unconnected, but similar habitats and under similar selection pressures often display strikingly comparable morphology, behaviour and life history. On island archipelagos where colonizations and extinctions are common, it is often difficult to separate whether similar traits are a result of in situ diversification or independent colonization without a phylogeny. Here, we use one of Hawaii's most ecologically diverse and explosive endemic species radiations, the Hawaiian fancy case caterpillar genus Hyposmocoma, to test whether in situ diversification resulted in convergence. Specifically, we examine whether similar species utilizing similar microhabitats independently developed largely congruent larval case phenotypes in lineages that are in comparable, but isolated environments. Larvae of these moths are found on all Hawaiian Islands and are characterized by an extraordinary array of ecomorphs and larval case morphology. We focus on the ‘purse cases’, a group that is largely specialized for living within rotting wood. Purse cases were considered a monophyletic group, because morphological, behavioural and ecological traits appeared to be shared among all members. We constructed a phylogeny based on nuclear and mitochondrial DNA sequences from 38 Hyposmocoma species, including all 14 purse case species and 24 of non‐purse case congeners. Divergence time estimation suggests that purse case lineages evolved independently within dead wood and developed nearly identical case morphology twice: once on the distant Northwest Hawaiian Islands between 15.5 and 9 Ma and once on the younger main Hawaiian Islands around 3.0 Ma. Multiple ecomorphs are usually found on each island, and the ancestral ecomorph of Hyposmocoma appears to have lived on tree bark. Unlike most endemic Hawaiian radiations that follow a clear stepwise progression of colonization, purse case Hyposmocoma do not follow a pattern of colonization from older to younger island. We postulate that the diversity of microhabitats and selection from parasitism/predation from endemic predators may have shaped case architecture in this extraordinary endemic radiation of Hawaiian insects.     

The influence of larval case design on vulnerability of Limnephilus frijole (Trichoptera) to predation

• 1 We examined the potential selective pressures exerted by different types of predators on morphological prey defences using the case-building larvae of the limnephilid caddisfly, Limnephilus frijole. The predators were a predaceous minnow, Gila pandora, and an aeschnid dragonfly naiad, Oplonaeschna armata.
• 2 The influence of larval case design on vulnerability to predators was evaluated in a series of laboratory experiments. Larval L. frijole were collected from a stream without fish or dragonflies. In the laboratory, larvae still occupying their field-built cases were exposed to the two predators, with which L. frijole co-occurs in other streams. Following 24 h exposure of caddisfly larvae to a specific predator, the pre-trial case length, case strength, case width, and case composition of victims and survivors were compared.
• 3 Principal components analysis (PCA) indicated substantial independent variation for all four case parameters in the study population. The cases of larvae surviving exposure to either dragonfly naiads or fish were significantly stronger and wider than cases of victims of predation. Cases of survivors were also longer and had a greater mineral fraction than those of victims, but differences were either marginally significant or not significant.
• 4 These results demonstrate that specific aspects of case design affect the vulnerability of caddisfly larvae. In addition, predaceous fish and predaceous invertebrates, using different predation techniques, may exert similar selective pressures on these defenses. Case aspects influencing vulnerability in these experiments are broadly consistent with natural variation in case design associated with predator-rich and predator-free habitats for related caddisfly species.

     

Fatal Pulmonary Mucormycosis due to <Emphasis Type="Italic">Rhizopus homothallicus</Emphasis>

We report here a case of cavitary pneumonia due to Rhizopus homothallicus in a diabetic patient. This is the first proven case of R. homothallicus infection in Western countries and the third case described worldwide. The organism was isolated from lung biopsy and identified after amplification and sequencing of the internal transcribed spacer region.     

Quality of Inpatient Pediatric Case Management for Four Leading Causes of Child Mortality at Six Government-Run Ugandan Hospitals

BackgroundA better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.MethodsAll children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.ResultsA total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.ConclusionsAppropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality improvement initiatives should target deficiencies in care unique to each health facility, and interventions should focus on the simultaneous management of multiple diagnoses.     

Increased Case Notification through Active Case Finding of Tuberculosis among Household and Neighbourhood Contacts in Cambodia

Background

Globally, there has been growing evidence that suggests the effectiveness of active case finding (ACF) for tuberculosis (TB) in high-risk populations. However, the evidence is still insufficient as to whether ACF increases case notification beyond what is reported in the routine passive case finding (PCF). In Cambodia, National TB Control Programme has conducted nationwide ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts alongside routine PCF. This study aims to investigate the impact of ACF on case notifications during and after the intervention period.

Methods

Using a quasi-experimental cluster randomized design with intervention and control arms, we compared TB case notification during the one-year intervention period with historical baseline cases and trend-adjusted expected cases, and estimated additional cases notified during the intervention period (separately for Year 1 and Year 2 implementation). The proportion of change in case notification was compared between intervention and control districts for Year 1. The quarterly case notification data from all intervention districts were consolidated, aligning different implementation quarters, and separately analysed to explore the additionality. The effect of the intervention on the subsequent case notification during the post-intervention period was also assessed.

Results

In Year 1, as compared to expected cases, 1467 cases of all forms (18.5%) and 330 bacteriologically-confirmed cases (9.6%) were additionally notified in intervention districts, whereas case notification in control districts decreased by 2.4% and 2.3%, respectively. In Year 2, 2737 cases of all forms (44.3%) and 793 bacteriologically-confirmed cases (38%) were additionally notified as compared to expected cases. The proportions of increase in case notifications from baseline cases and expected cases to intervention period cases were consistently higher in intervention group than in control group. The consolidated quarterly data showed sharp rises in all forms and bacteriologically-confirmed cases notified during the intervention quarter, with 64.6% and 68.4% increases (compared to baseline cases), and 46% and 52.9% increases (compared to expected cases), respectively. A cumulative reduction of case notification for five quarters after ACF reached more than -200% of additional cases.

Conclusions

The Cambodia’s ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts resulted in the substantial increase in case notification during the intervention period and reduced subsequent case notification during the post-intervention period. The applicability of retrospective contact investigation in other high-burden settings should be explored.     

The evolution of migration in a seasonal environment

Despite the fact that migration occurs in a wide variety of taxa worldwide, little is known about the conditions under which migration is expected to evolve from an ancestral resident population. We develop a model that focuses on ecological factors affecting the evolution of migration in a seasonal environment within a genetically explicit framework. We model the evolution of migration for two common types of migration: ‘shared breeding’ where migrants share a breeding ground with residents and migrate to a separate non-breeding area, versus ‘shared non-breeding’, where migrants share a non-breeding ground with residents and migrate to a separate breeding area. Ecologically, migration is more easily established in the shared-breeding case versus the shared-non-breeding case. Genetically, the additive effect of a migratory allele affects its establishment more in the shared-non-breeding case versus the shared-breeding case, whereas the dominance effect of the allele affects its establishment more in the shared-breeding case versus the shared-non-breeding case. Generally, migratory alleles can invade even when residents are competitively superior to migrants during the shared season. Partial migration occurs when the population is polymorphic for migratory and non-migratory alleles, and is dependent upon which season is shared and the additive and dominance behaviour of the migratory allele.     

Exclusion probabilities of 22 bovine microsatellite markers in fluorescent multiplexes for semiautomated parentage testing

Six multiplexes developed for semiautomated fluorescence genotyping were evaluated for parentage testing. These multiplexes contained primer pairs for the amplification of 22 microsatellites on 17 bovine autosomes. Exclusion probabilities were determined from genotypes of 1022 Holstein cattle and 311 beef cattle belonging to five breeds. Two cases were considered: case 1, genotypes are known for an alleged parent and an offspring but genotypes of a confirmed parent are unknown; and case 2, genotypes are known for an alleged parent, a confirmed parent and an offspring. If the alleged parent is not the true parent, then the 22 markers will exclude the alleged parent with a probability of >0·9986 for case 1 and with a probability of >0·99999 for case 2. On the basis of these exclusion probabilities, the probability that an alleged parent will be falsely included as a parent is in the range of 1/716 to 1/2845 for case 1 and 1/1·2 million to 1/159753 for case 2. In addition to these results, a rapid and efficient non-organic method for extraction of DNA from semen is described.