2012年广州市越秀区疑似麻疹风疹病例血清学检测结果分析

目的:对2012年广州市越秀区疑似麻疹风疹的血清学结果进行整理分析,以了解麻疹风疹病例的流行特点。方法:选取2012年1月-2012年12月的166例疑似麻疹风疹患者的血清作为研究对象,统计血清中IgM阳性抗体的检出情况,以及各年龄段、月份IgM抗体阳性的例数及构成比。结果:麻疹风疹疑似病例中有36.1%的患者检测出IgM抗体阳性,其中麻疹IgM阳性以0-1岁婴幼儿的检出率较高,可达44.4%。从月份来看,12月、8月和5月是麻疹的好发时期。风疹IgM阳性以20岁以上中老年患者检出率最高,为75.0%,7月、4月和5月是风疹的易感季节。结论:疑似麻疹风疹病例有较高的IgM抗体阳性检出率,0-1岁婴幼儿和20岁以上中老年人是麻疹风疹的易感人群,4-5、7-8和12月是发病的高峰时期,临床应注意加强防范。     

The Role of Rubella in the Etiology of Supravalvular Aortic Stenosis

The possibility of an etiological relationship between rubella embryopathy and sporadic forms of supravalvular aortic stenosis is considered. A case is presented of a patient with rubella embryopathy and supravalvular aortic stenosis associated with pulmonary valvular and peripheral pulmonary artery stenosis, bicuspid aortic valve, aortic valve stenosis and subendothelial myocardial fibrosis. A review of the literature revealed many clinical and pathological features common to both syndromes. The hypothesis that rubella virus produced germ-cell mutation and subsequent persistence of rubella in the zygote produced further fetal damage is presented to explain these observations.     

Measles Virus Antibody in Cerebrospinal Fluids from Patients with Multiple Sclerosis

A strong measles-specific gel precipitation reaction was found in the cerebrospinal fluid (C.S.F.) of two patients with multiple sclerosis (M.S.) (total of 15 tested). The serum and C.S.F. specimens from these two patients were tested for measles antibody by six assay methods. The results were compared with those obtained from serum and C.S.F. specimens of a patient with subacute sclerosing panencephalitis (S.S.P.E.). The gel precipitation line produced by the C.S.F. from the M.S. patients was identical with one of the three lines produced by the C.S.F. from the S.S.P.E. patient. The main antigenic component responsible for measles antibody appearing in the C.S.F. of the S.S.P.E. patient and the M.S. patients was also electrophoretically similar, and the corresponding antibody was associated with IgG. The serum/C.S.F. antibody titre ratios with the various assay methods used suggest that the C.S.F. antibodies are mainly to other than envelope components of measles virus. No complement-fixing antibody against 27 other viruses or Mycoplasma pneumoniae was found in the C.S.F. of the two M.S. patients.     

Lower Transplacental Antibody Transport for Measles,Mumps, Rubella and Varicella Zoster in Very Preterm Infants

Background

Maternal antibodies, transported over the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. In term infants, this protection does not last until the first recommended measles-mumps-rubella vaccination at 14 months in the Netherlands, while these viruses still circulate. The aim of the study was to investigate the antibody concentration against measles, mumps, rubella and varicella (MMRV) in mothers and preterm infants or healthy term infants at birth.

Methods

Antibody concentrations specific for MMRV were measured in cord blood samples from preterm (gestational age <32 weeks and/or birth weight <1500 g) and term infants, and matched maternal serum samples, using a fluorescent bead-based multiplex immune-assay.

Results

Due to lower placental transfer ratios of antibodies against MMRV in 96 preterm infants (range 0.75–0.87) compared to 42 term infants (range 1.39–1.65), the preterm infants showed 1.7–2.5 times lower geometric mean concentrations at birth compared to term infants. Maternal antibody concentration is the most important determinant of infant antibody concentration against MMRV.

Conclusions

Preterm infants benefit to a lesser extent from maternal antibodies against measles, mumps, rubella and varicella than term infants, posing them even earlier at risk for infectious diseases caused by these still circulating viruses.     

Procalcitonin Predicts Real-Time PCR Results in Blood Samples from Patients with Suspected Sepsis

Background

Early diagnosis and rapid bacterial identification are of primary importance for outcome of septic patients. SeptiFast® (SF) real-time PCR assay is of potential utility in the etiological diagnosis of sepsis, but it cannot replace blood culture (BC) for routine use in clinical laboratory. Procalcitonin (PCT) is a marker of sepsis and can predict bacteremia in septic patients. The aim of the present study was to investigate whether PCT serum levels could predict SF results, and could help screening febrile patients in which a SF assay can improve the etiological diagnosis of sepsis.

Methods

From 1009 febrile patients with suspected sepsis, 1009 samples for BC, SF real-time PCR, and PCT determination were obtained simultaneously, and results were compared and statistically analysed. Receiver operating characteristic (ROC) curves were generated to determine the area under the curve and to identify which cut-off of PCT value produced the best sensitivity to detect SF results.

Results

Mean PCT values of sera drawn simultaneously with samples SF positive (35.42±61.03 ng/ml) or BC positive (23.14±51.56 ng/ml) for a pathogen were statistically higher than those drawn simultaneously with SF negative (0.84±1.67 ng/ml) or BC negative (2.79±16.64 ng/ml) samples (p<0.0001). For SF, ROC analysis showed an area under the curve of 0.927 (95% confidence interval: 0.899–0.955, p<0.0001). The PCT cut-off value of 0.37 ng/ml showed a negative predictive value of 99%, reducing the number of SF assays of 53.9%, still identifying the 96.4% of the pathogens.

Conclusion

PCT can be used in febrile patients with suspected sepsis to predict SF positive or negative results. A cut-off value of 0.37 ng/ml can be considered for optimal sensitivity, so that, in the routine laboratory activity, SF assay should not be used for diagnosis of sepsis in an unselected patient population with a PCT value <0.37 ng/ml.     

Predictors of Bacteraemia in Patients with Suspected Community-Acquired Pneumonia

Introduction

The diagnostic yield of blood cultures is limited in patients with community-acquired pneumonia (CAP). Yet, positive blood culture results provide important information for antibiotic treatment and for monitoring epidemiologic trends. We investigated the potential of clinical predictors to improve the cost-benefit ratio of obtaining blood cultures.

Methods

Data from two prospective cohort studies of adults with suspected CAP, admitted to non-ICU wards, were combined. Two models were created, one using readily available parameters and one additionally including laboratory parameters.

Results

3,786 patients were included (2,626 (69%) with X-ray confirmed CAP). Blood cultures were obtained from 2,977 (79%) patients (and from 2,107 (80%) with X-ray confirmed CAP). 266 (8.9%) of the patients with a blood culture had bacteraemia. Clinical predictors of bacteraemia were absence of pre-admission antibiotic treatment, pleuritic pain, gastro-intestinal symptoms, tachycardia, tachypnea, hypotension and absence of hypoxia. After including laboratory results in the model, younger age, C-reactive protein, leukocytosis or leukopenia, low thrombocyte count, low sodium level, elevated urea and elevated arterial pH were added, while gastro-intestinal symptoms and hypotension were no longer significant. The area under the receiver operating characteristics curve was 0.66 (95% confidence interval 0.63–0.70) for the first model and 0.76 (95% confidence interval 0.73–0.79) for the second model.

Conclusion

In conclusion, in patients hospitalized with CAP, bacteraemia was moderately predictable using clinical parameters only. We recommend against the use of a risk prediction model for the decision to obtain blood cultures.     

IgG Antibodies against Measles,Rubella, and Varicella Zoster Virus Predict Conversion to Multiple Sclerosis in Clinically Isolated Syndrome

Background

Multiple sclerosis (MS) is characterized by a polyspecific B-cell response to neurotropic viruses such as measles, rubella and varicella zoster, with the corresponding antibodies measurable in CSF as the so-called “MRZ reaction” (MRZR). We aimed to evaluate the relevance of MRZR to predict conversion of patients with clinically isolated syndrome (CIS) to MS, and to compare it to oligoclonal bands (OCB) and MRI.

Methodology/Principal Findings

MRZR was determined in a prospective study over 2 years including 40 patients that remained CIS over follow-up (CIS-CIS) and 49 patients that developed MS (CIS-RRMS) using ELISA. Using logistic regression, a score (MRZS) balancing the predictive value of the antibody indices included in MRZR was defined (9 points measles, 8 points rubella, 1 point varicella zoster, cutpoint: sum of scores greater 10).MRZR and MRZS were significantly more frequent in CIS-RRMS as compared to CIS-CIS (p = 0.04 and p = 0.02). MRZS showed the best positive predictive value (PPV) of all parameters investigated (79%, 95%-CI: 54–94%), which could be further increased by combination with MRI (91%, 95%-CI: 59–99%).

Conclusions/Significance

Our data indicate the relevance of MRZR to predict conversion to MS. It furthermore shows the importance of weighting the different antibody indices included in MRZR and suggest that patients with positive MRZR are candidates for an early begin of immunomodulatory therapy.     

Strontium fallout from Chernobyl and perinatal mortality in Ukraine and Belarus

Perinatal mortality rates in the regions of Ukraine and Belarus surrounding the Chernobyl site increased in 1987, the year following the Chernobyl accident. The same year, increases of perinatal mortality were also observed in Germany and Poland, and the effect can be associated with the caesium burden in pregnant women. After 1989, there is an unexpected second rise of perinatal mortality in Belarus and Ukraine. This increase is shown to correlate with the strontium content in pregnant women. The findings parallel an increase of perinatal mortality in Germany following the atmospheric bomb tests in the 1950's and 1960's. While the effect from caesium is essentially limited to 1987, the effect from strontium persists until the end of the study period in 1998. The cumulative effect from strontium around Chernobyl outweighs the effect from caesium by at least a factor of 10. This is contrary to the assertion that the caesium content in the Chernobyl fallout was more than 10-times greater than the strontium content. Thus, the dose factor presently used seems to severely underestimate the effect of strontium on perinatal mortality.     

Molecular Analysis of Anaplasma phagocytophilum Isolated from Patients with Febrile Diseases of Unknown Etiology in China

Although anaplasmosis cases have been nationally identified in China, no human isolates of A. phagocytophilum have been obtained, which limits the analysis of any molecular and genetic contributions to patients'' severe clinical manifestations and the study of the bacteria''s pathogeneses in China. Given this situation, a joint project was conducted in 2009–2010. A total of 421 febrile cases of unknown etiology were collected and the patients'' blood samples were collected for laboratory diagnoses including serologic diagnosis based on the four-fold rise in the anti- A. phagocytophilum IgG titer by indirect micro-immunofluorescence assay (IFA), positive PCR assay and confirmation of A. phagocytophilum DNA and positive culture of A. phagocytophilum and confirmed by amplification and sequencing of the 16S rRNA and ank A genes of the A. phagocytophilum isolates. A total of 570 ticks were collected from the patients'' domestic animals (456) and from wild fields (114) for culturing and amplifying and sequencing the 16S rRNA gene of A. phagocytophilum. Phylogenetic analyses were performed on the 16S rRNA and ank A gene sequences of the isolates and the ticks tested in the study. A total of 46 (10.9%) confirmed and 16 (3.8%) probable cases were diagnosed and severe clinical features and higher mortality rates were observed in these Chinese patients. Five isolates were obtained and the 16S rRNA genes of the 5 isolates were conserved but variety for ank A genes. Two human isolates and 1 tick isolate from Shandong Peninsula, where all patients exhibited severe clinical manifestations, were grouped as one clan based on the phylogenetic analyses, while 2 other human isolates were clustered in a second clan. 43.5% of H. longicornis were infected with A. phagocytophilum.The present study is the first to obtain clinical isolates of A. phagocytophilum in China. The diversity of the ank A genes of Chinese isolates will help us to further discern the relationship between the variations in the ank A genes and the severity of the disease''s clinical manifestations in China.     

老年良性前列腺增生夜尿病因特点及相关因素分析

目的:探索老年良性前列腺增生夜尿病因特点及相关因素。方法:选取49~84岁年龄段并已明确诊断为前列腺增生(BPH)的男性患者及没有进行过治疗或服用药物者120例。所有患者按照IPSS评分中夜尿频率从0~5分为6组,记录和测量研究对象的各项指标,包括国际前列腺症状评分(IPSS)、生活质量(QOL)、剩余尿量(PVR)、最大尿流率(Qmax)、前列腺体积(TPV)和排尿量(V)。结果:夜尿频率为0~1次者共38例(31.7%),平均QOL评分为2.43;夜尿频率为2~3次者共50例(41.7%),平均QOL评分为3.87;夜尿频率为4次以上者共32例(26.7%),平均QOL评分为5.23。不同组的夜尿频率BPH患者间的QOL评分具有显著性差异(P0.05);多因素Logistic回归分析表明,BPH患者的年龄和PVR是夜尿频率增高的危险因素(P0.05),而TPV和Qmax与夜尿频率的关系无统计学意义(P0.05)。结论:夜尿频率的增多明显影响老年人的生活质量,并且随着老年人的年龄、残余尿量的增加,夜尿频率出现增加的趋势;但前列腺的体积和最大尿流率与夜尿频率无关。     

43例术后疑似急性肺栓塞分析

目的:探讨影响术后急性肺栓塞(Acute Pulmonary Embolism,APE)的发生和预后的相关因素,以提高对术后肺栓塞的认识和诊疗水平。方法:收集2009.01-2014.12期间南方医院术后疑似急性肺栓塞患者的临床资料,总结其临床特征,分析其诱发因素、临床表现、治疗和预后,探讨其发病的高危因素。结果:共收集术后疑似肺栓塞43例,平均年龄56.09±14.08岁(17~80岁),明确诊断为肺栓塞15例(34.9%),共死亡20例(死亡率46.5%)。其临床表现和体征均具有非特异性,呼吸困难、心悸和晕厥是主要的临床表现。不仅可以发生于下肢、胸腹部(包括妇产科)、颅内等大手术后,也可能发生在介入栓塞术后。相关危险因素很多,包括性别、年龄、恶性肿瘤、全身麻醉、手术时间长等。具有高危因素的患者并具有可疑肺栓塞的临床表现时,结合D-二聚体、动脉血气分析、心电图、胸部X线、超声心动图、下肢彩超可检查协助APE的诊断,而胸部增强CT作为检查手段有利于明确诊断。结论:肺栓塞是手术后致命的并发症之一,早期诊断、早期治疗,能降低术后肺栓塞患者的死亡率。     

Clinical and Molecular Characterization of Brazilian Patients Suspected to Have Lynch Syndrome

Lynch syndrome (LS) accounts for 3–5% of all colorectal cancers (CRC) and is inherited in an autosomal dominant fashion. This syndrome is characterized by early CRC onset, high incidence of tumors in the ascending colon, excess of synchronous/metachronous tumors and extra-colonic tumors. Nowadays, LS is regarded of patients who carry deleterious germline mutations in one of the five mismatch repair genes (MMR), mostly in MLH1 and MSH2, but also in MSH6, PMS1 and PMS2. To comprehensively characterize 116 Brazilian patients suspected for LS, we assessed the frequency of germline mutations in the three minor genes MSH6, PMS1 and PMS2 in 82 patients negative for point mutations in MLH1 and MSH2. We also assessed large genomic rearrangements by MLPA for detecting copy number variations (CNVs) in MLH1, MSH2 and MSH6 generating a broad characterization of MMR genes. The complete analysis of the five MMR genes revealed 45 carriers of pathogenic mutations, including 25 in MSH2, 15 in MLH1, four in MSH6 and one in PMS2. Eleven novel pathogenic mutations (6 in MSH2, 4 in MSH6 and one in PMS2), and 11 variants of unknown significance (VUS) were found. Mutations in the MLH1 and MSH2 genes represented 89% of all mutations (40/45), whereas the three MMR genes (MSH6, PMS1 and PMS2) accounted for 11% (5/45). We also investigated the MLH1 p.Leu676Pro VUS located in the PMS2 interaction domain and our results revealed that this variant displayed no defective function in terms of cellular location and heterodimer interaction. Additionally, we assessed the tumor phenotype of a subset of patients and also the frequency of CRC and extra-colonic tumors in 2,365 individuals of the 116 families, generating the first comprehensive portrait of the genetic and clinical aspects of patients suspected of LS in a Brazilian cohort.     

Pheochromocytoma in Patients Suspected of Harboring Adrenal Meta stasis: Management and Clinical Predictors

ObjectiveTo study clinical management of patients with suspected adrenal metastasis and to assess whether there are clinical predictors of pheochromocytoma in this patient population.MethodsIn this retrospective cross-sectional study, we reviewed medical records of patients who had adrenalectomy for adrenal lesions or had adrenal biopsy performed between January 1997 and July 2007 in a large academic hospital. Patients who harbored adrenal masses that were suspected of being metastases were identified on clinical findings. Pathologic diagnosis, demographic data, clinical history, imaging studies, and laboratory test results were reviewed and compared among patients whose adrenal mass was determined to be metastasis, adenoma, or pheochromocytoma.ResultsOne-hundred sixty-three patients had adrenalectomy or had adrenal biopsy during the study period. Thirty patients (18%) had adrenal masses that were suspected of being metastases. Of the adrenal masses, 18 (60%) were metastases, 8 (27%) were benign adenomas, and 4 (13%) were pheochromocytomas. Eleven patients (37%) had biochemical testing for pheochromocytoma. Adrenal biopsy was performed without biochemical testing for pheochromocytoma in 9 patients (30%), including 2 subsequently found to have this tumor. Adrenalectomy was performed in 10 patients (33%) without biochemical testing for pheochromocytoma. Clinical parameters were similar among patients with metastasis, adenoma, or pheochromocytoma. There were no clinical predictors to suggest pheochromocytoma.ConclusionsPheochromocytoma occurs frequently in patients suspected of harboring adrenal metastasis, but this tumor is often not considered in clinical practice. The size and imaging characteristics of the adrenal mass and history of known metastasis may help clinicians in decision-making. Biochemical testing for pheochromocytoma should ideally be performed in all patients suspected of having adrenal metastasis. (Endocr Pract. 2008;14:967-972)     

Molecular taxonomic identification of Schistosomatidae from Naroch Lake and Polonevichi Lake in Belarus

In Belarus, Naroch Lake is the only area with a high incidence of the human cercarial dermatitis (HCD). However, very little is known about the taxonomy of avian schistosomes, the causative agents of the disease, which are found in Naroch Lake and other lakes in Belarus. In this study, we used a molecular approach to investigate the systematic position and biodiversity of avian schistosomes from Naroch Lake and Polonevichi Lake. Based on the sequence analysis of the ITS genomic region, we were able to detect four different species of bird schistosomes in Naroch Lake (Trichobilharzia szidati, Trichobilharzia franki, Bilharziella polonica and a novel Trichobilharzia species) and two species in Polonevichi Lake (T. szidati and B. polonica). The data were used to reveal the phylogenetic position of HCD causative cercariae found in Belarusian water reservoirs and to establish their relationships within the group of avian schistosomes. We discuss the possibility of identifying species of Trichobilharzia using the fragment length polymorphism analysis of the ITS region. Possible epidemiological causes of HCD incidence in Belarus are also discussed.