CagA and VacA are immunoblot markers of past Helicobacter pylori infection in atrophic body gastritis

BACKGROUND AND AIM: Atrophic body gastritis (ABG) may be induced by H. pylori infection. It is difficult to diagnose H. pylori infection in this condition, since during progression of body atrophy the bacterium disappears. In 30% of patients with ABG no sign of H. pylori infection is detectable. We aimed to investigate whether patients with ABG, classified as H. pylori-negative by conventional methods (ELISA serology and Giemsa stain histology), have been previously exposed to the infection. METHODS: Case series consisted of 138 outpatients with ABG, of whom 31 are H. pylori negative (histology and ELISA serology), and 107 are H. pylori related (histology and ELISA serology positive: active infection, n = 29; only serology positive: past infection, n = 78). Thirty control subjects who were H. pylori negative at histology and ELISA serology were investigated. Immunoblotting of sera against H. pylori whole-cell protein lysate was performed. RESULTS: None of the control sera recognized CagA, VacA, heat-shock protein B, and urease B, yielding a specificity of 100%. All H. pylori-negative patients with ABG showed immunoblotting seroreactivity, including in each case either CagA or VacA. The concomitant seroreactivity against CagA and VacA was highly prevalent in the H. pylori-negative patients with ABG, comparable to those with active infection (77.4% vs. 86.2%) and with past infection (vs. 61.5%). CONCLUSIONS: Immunoblotting against CagA and VacA is able to prove past exposure to H. pylori infection in all patients with ABG defined as H. pylori-negative by conventional methods, suggesting a hidden role of H. pylori infection in gastric atrophy also in these patients.     

宫颈上皮内病变与HPV相关

目的了解辽宁省妇女生殖道人乳头瘤病毒（Human Papillomavirus,HPV）感染情况,研究辽宁省妇女宫颈上皮内病变与HPV感染的相关性。方法回顾性分析600例行核酸分子快速导流杂交基因芯片技术（Hybri Max）检测的患者,该600例患者均行薄层液基细胞学技术（Liguid-based cytologic teset,LCT）检查,有127例患者行病理活检,结合3种方法研究HPV感染与宫颈病变的相关性。结果导流杂交HPV-DNA检测结果与LCT结果相结合,600例患者中,感染HPV的阳性率分别为正常32%（92/288）,Asc-us42%（87/208）,LSIL53%（40/75）,HSIL86%（19/22）,癌100%（7/7）。导流杂交HPV-DNA检测结果与病理活检结果相结合,感染HPV的阳性率分别为：正常或慢性炎症36.17%（17/47）,CINⅠ66.67%（36/54）,CINⅡ-Ⅲ84.21%（16/19）,癌100%（7/7）,HPV感染阳性率随宫颈病变程度加重而明显升高。细胞学与组织学病理诊断符合率分别为LSIL72%（54/75）,HSIL86.36%（19/22）,SCC100%（7/7）。不同年龄阶段妇女感染HPV的阳性率依次为20-29岁46.76%（65/139）,30-39岁43.41%（79/182）,40-9岁40.48%（71/174）,50-59岁38.16%（29/76）,60-69岁37.50%（6/16）,70岁76.92%（10/13）。600例患者HPV感染总阳性率为40.83%（245/600）,在HPV21种亚型中,有19种亚型均被检测出,感染率最高的是HPV16 35.51%（87/245）,其它常见型别依次为HPV58,HPV6,HPV53,HPV18,HPV31,HPV52和cp8304。此外还发现高危型HPV16的感染率：正常或慢性炎症35.29%（6/17）CINⅠ33.33%（12/36）,CINⅡ-Ⅲ56.25%（9/16）,癌85.71%（6/7）,其感染率阳性率在各种程度的宫颈病变中占很大比重,也随宫颈病变的严重程度而增高,进一步论证了HPV16的高危性。结论辽宁省妇女HPV感染的主要亚型是HPV16,HPV58及HPV6.无论是与细胞学检测结果相结合还是与病理活检结果相结合,HPV感染阳性率均随宫颈病变程度的加重而增高。提示宫颈病变的防治重点应放在预防及治疗HPV感染。     

The place and role of serologic methods in detecting Helicobacter pylori infection

The aim of the study was to determine the place and role of serologic methods in detecting Helicobacter pylori (H. pylori) infection, on the basis of estimated enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT) sensitivity and specificity. A total of 549 patients were included in the study. ELISA and CFT as serologic methods were compared with invasive methods (rapid urease test--CLO test, culture, histology). The sensitivity of serologic methods was above 90%, and their specificity was around 80%. Study results confirmed the value, reliability and usefulness of serologic methods in the detection of H. pylori infection.     

风险预判与主动干预在综合ICU患者多重耐药菌医院感染防控中的关键作用研究

目的:阐述风险预判与主动干预的综合防控措施对综合重症监护病房(GICU)患者多重耐药菌(MDRO)医院感染的防控效果。方法:对2018年1月~2019年12月入住GICU病房(分为A、B两个病区)>48 h的737例患者进行回顾性调查,其中A病区监测患者286例,MDRO防控参照院感科常规制度要求;B病区监测患者451例,MDRO防控采用入GICU时预判患者感染风险,再根据感染风险及患者自身状况对患者采取鼻腔去定植或肠道去定植的综合防控策略。用卡方检验比较两病区患者的感染结果与MDRO感染菌种分布情况,以验证不同防控策略的效果。结果:本研究共监测GICU住院患者737例,研究期间共发生MDRO医院感染85例。其中A病区监测患者286例,MDRO医院感染66例,感染率为23.1%;B病区监测患者451例,MDRO医院感染19例,感染率为4.2%,低于A病区(P<0.001)。单菌种感染结果显示,两病区感染菌种分布存在差异,CR-AB、CR-PA和MASR的感染率都为B病区低于A病区,两病区患者的共患病类型无差异。说明B病区MDRO防控效果优于A病区。结论:感染风险预判与主动干预的综合防控策略,有利于降低GICU患者MDRO医院感染发病率。     

碳青霉烯耐药肠杆菌科细菌主动筛查研究进展

耐碳青霉烯类抗菌药物的肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)的感染已成为威胁全球人类健康的严重问题。预防CRE感染已迫在眉睫。人体肠道是绝大多数细菌的储存库,而导致院内感染主要的危险因素之一是肠道中定植的耐药菌。CRE定植一般先于或同步于CRE感染,对入院48 h内患者进行CRE主动筛查并对阳性结果的患者采取主动干预措施是预防CRE感染与传播的有效途径。该文就CRE传播与流行、需要筛查的人群、主要的筛查样本及主要的筛查方法等作一综述。     

幽门螺杆菌相关性胃炎与胃癌胃大部切除术后患者胃体黏膜上皮不典型增生

目的研究幽门螺杆菌(Hp)感染及胃癌胃大部切除与胃体黏膜上皮不典型增生(GED)的关系。方法采用组织病理学的方法测定了20例慢性萎缩性胃炎和20例胃癌胃大部切除术后患者胃体GED情况。Hp的测定采用1min快速尿素酶法14C呼气试验法。结果(1)20例胃大部切除术后患者中,12例存在轻度～中度胃体GED,占60%;20例慢性胃炎中,7例存在轻度胃体GED,占35%。2组之间差异有显著性(P<005)。(2)在10例Hp相关性慢性胃炎中,6例存在轻度胃体GED,占60%;在10例慢性胃炎无Hp感染中,只有1例存在轻度胃体GED,占10%;2组之间差异有显著性(P<005)。(3)在10例胃大部切除术后合并Hp感染的患者中,8例存在轻度～中度胃体GED,占80%;在10例胃大部切除术后未合并Hp感染的患者中,4例存在轻度的胃体GED,占40%,2组之间差异有显著性(P<005)。结论胃大部切除术后和Hp感染患者,胃体GED发生率增加,发生恶变的发生率更高。     

重型肝炎患者肝移植术后真菌感染临床分析

目的分析重型肝炎肝移植受体术后真菌感染情况,进一步探讨其易感因素和防治措施。方法回顾性分析我院器官移植中心2003年3月至2006年2月间89例重型肝炎肝移植患者的临床资料并进行讨论。结果89例重型肝炎肝移植患者中21例出现术后真菌感染,感染率为23.6%,较其他病种肝移植更高,其中12例为白念珠菌(57.1%),6例为光滑念珠菌(28.6%),1例为近平滑念珠菌,1例为克柔念珠菌,1例为热带念珠菌。真菌感染多发生在术后1周内,感染部位以呼吸系统为主。结论重型肝炎肝移植患者术后真菌感染以念珠菌属的早期呼吸道感染为主。术前肝性脑病与术后发生真菌感染之间存在相关关系。而一般的白念珠菌感染不会显著地影响重型肝炎肝移植患者的预后。预防性使用抗真菌药物在重型肝炎肝移植术后真菌感染的治疗中具有重要意义。     

The comparative characteristics of the indices of lymphocyte and neutrophil functional activity in patients with HIV infection and chronic viral hepatitis B]

In 34 patients with human immunodeficiency virus (HIV) infection at the asymptomatic stage and 29 patients with chronic viral hepatitis B at the period of exacerbation (of these 14 patients had chronic persistent hepatitis and 15 patients had chronic active hepatitis) the complex study of the functional activity of lymphocytes and neutrophils was carried out by cytochemical methods with the simultaneous determination of the content of immunoregulating lymphocyte subpopulations. In patients with chronic active hepatitis a decrease in the percentage and the absolute number of helper T-lymphocytes and the ratio of CD4/8 in comparison with those in patients with HIV infection were revealed. At the same time patients with HIV infection exhibited more pronounced decrease in the activity of all lymphocytic enzymes under study (neutrophil esterase, acidic phosphatase and succinate dehydrogenase in lymphocytes), as well as in the activity of myeloperoxidase and the content of cation proteins and glycogen in neutrophils in comparison with patients having chronic active hepatitis.     

Laboratory diagnosis of Epstein-Barr virus infection

Laboratory confirmation of EBV infection requires proper methods and schema of investigation adequate to aim of diagnostic procedure. In paper the results of routine diagnostic tests of EBV infection performed in Department of Virology NIH in 2005-2006 years was included and also, evaluation of usefulness of different laboratory methods was done. Based on results of ELISA tests 10,7% routine investigated subjects was classified as primary EBV infection, 20,1% was seronegative, 7,4% was classified as reactivation of latent infection and serological markers in 45,6% subjects pointed past EBV infection. Positive result of PCR method was obtain in 11,2% samples subjected of routine laboratory investigation. Comparison of specific and non-specific serological methods results (ELISA versus tests of heterophile antibodies) showed the high percentage of false negative results in children tested by non-specific tests. PCR results in serum samples from patients with primary infection (confirmed by serological tests) were positive in 15% cases only. Based on analyzed results it could be stated that reliable confirmation of infectious mononucleosis, as primary EBV infection, is detection of specific IgM antibodies and in case of heterophile antibodies tests the possibility of false negative results, mainly in children, must be taken into account. The most proper samples for PCR method are whole blood, sections of tissue or cells from swabs.     

Guided transtracheal distal pulmonary brushing-washing: diagnosing acute pneumonia in high-risk patients.

Transtracheal brushing-washing of distal pulmonary lesions was performed in 20 patients. Specimens were obtained by brushing and washing through a catheter placed in the pulmonary lesion with the aid of a guide. In nine patients pathogenic organisms were isolated. In the other 11 patients infectious studies of the specimens were negative, five of the patients (true-negatives) showing no infection and six (false-negatives) showing infection. Serious complications were uncommon, but one patient, who had diffuse intravascular coagulation, died. This procedure seems to represent an advance over transtracheal aspiration and is an effective alternative to such invasive methods are transthoracic lung aspiration and pulmonary biopsy.     

休斯敦共识会议:关于美国幽门螺杆菌感染的检测

虽然,美国已有关于幽门螺杆菌(Helicobacter pylori,H.pylori)检测和治疗的指南,但对患者进行治疗前后H.pylori检测的建议通常没有得到遵循。来自美国不同地区研究成人和儿童H.pylori感染处理的11名专家参加了"休斯敦共识会议",并在会议中讨论诊断H.pylori感染的关键因素:确定目标人群进行H.pylori检测;抗生素药物敏感性对检测和治疗的影响;确认H.pylori感染和确认根除治疗结果的合适方法。专家被分为多组,采用改良的Delphi小组讨论法来评定需行H.pylori检测的目标人群,抗生素药物敏感性检测方法和治疗方法、根除治疗后的结果确认及相关检测方法。证据质量和建议强度均采用GRADE系统进行评估。各工作小组的结果将提交给所有小组成员进行最后的共识表决。在专家共识会议之后,这些结论将提交给一个独立的胃肠病学专家小组进行验证,并对会议中提出的29项声明进行认同程度评估。最后的建议是基于现有最佳证据提出,并提供带参考文献的共识声明,以便在全美各地的医疗保健体系中实施。     

Single-serum diagnosis of recent rubella infection with the use of hemagglutination inhibition test and enzyme-linked immunosorbent assays

Single-serum diagnosis of recent rubella infection was attempted with the use of hemagglutination inhibition (HI) test and two commercially available enzyme-linked immunosorbent assays (ELISAs). The period during which IgM antibody was detectable by IgM capture ELISA was 4 to 30 days after the onset of rash. Rubella IgG ELISA values relative to HI titer were lower in the sera from the patients with recent infection than in the sera from the subjects with remote infection. IgM ELISA and the combined use of IgG ELISA and HI test are two useful methods of single-serum diagnosis of recent rubella infection.     

个体化美罗培南治疗铜绿假单胞菌感染老年患者的临床经验

目的:探讨个体化美罗培南对感染铜绿假单胞菌老年患者的有效性及安全性。方法:110例经细菌培养已证实铜绿假单胞菌感染的老年肺部感染患者,随机分成两组,美罗培南常规剂量组和公式定量法剂量组(个体化组),分析两组美罗培南的疗效及安全性。结果:个体化剂量组的美罗培南平均用药0.8 g/12 h较常规剂量组的1.0 g/12 h低。个体化剂量组的有效率为78.2%高于常规剂量组的63.6%,但两组差异无显著性(P>0.05)。轻度不良反应的发生率个体化剂量组高(P<0.05),两组未发生肝功能异常病例,常规剂量美罗培南对肾功能有一定影响,而个体化用药能减轻美罗培南对肾功能的影响。结论:美罗培南个体化给药治疗铜绿假单胞菌感染的老年肺部感染患者可以在保证疗效的前提下提高安全性,减少对肾功能的影响。     

Nosocomial Infections and Obesity in Surgical Patients

Objective: There is an increased morbidity and mortality associated with surgery in the obese patient. This study was conducted to determine risk factors and compare the nosocomial infection rate in obese and nonobese surgical patients. Research Methods and Procedures: A total of 395 surgical patients were evaluated. BMI was calculated for each patient. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and high‐density lipoprotein‐cholesterol levels were measured. The diagnosis of infection was made according to the Centers for Disease Control and Prevention criteria. Univariate and two‐step multivariate logistic regression methods were used for determination of nosocomial infection risk factors. Results: There were 117 nosocomial infections identified in 96 of 395 surgically operated patients. A significant increase in the total number of nosocomial infections was determined in obese patients compared with the normal‐weight patients (p < 0.05). High‐density lipoprotein‐cholesterol below the 10th percentile increased risk of surgical site infection. Discussion: Our results suggest that obesity is an important risk factor for postoperative nosocomial infection.     

Diagnosis of CMV infections in patients diagnosed with acute leukemia

The purpose of this paper was to estimate the best method of CMV diagnosis in leukemic patients. Materials from 9 patients (serum, heparinized blood and urine) were investigated by serological methods (ELISA and Western blot), for the presence of specific antigens and virus capable of replication, and also by genetic methods (hybridization and PCR). It seems, that the best method for CMV diagnosis in leukemic patients is hybridization performed in quantitation variant, and that DNA CMV level of approximately 20 pg/ml of blood was not linked to symptomatic infection.     

Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment

Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.     

Evaluation of the usefulness of various PCR method variations and nucleic acid hybridization for CMV infection in immunosuppressed patients

In diagnosis of CMV infection various laboratory methods are used. The methods based on detection of viral nucleic acids have been introduced routinely in many laboratories. The aim of this study was to compare nucleic acid hybridisation method and various variants of PCR methods with respect to their ability to detect CMV DNA. The studied material comprised 60 blood samples from 19 patients including 13 renal transplant recipients and 6 with acute leukaemia. The samples were subjected to hybridisation (Murex Hybrid Capture System CMV DNA) and PCR carried out in 3 variants: with one pair of primers (single PCR), nested PCR and Digene SHARP System with detection of PCR product using a genetic probe in ELISA system. The sensitivity of the variants ranged from 10(0) particles of viral DNA in nested PCR to 10(2) in single PCR. The producer claimed the sensitivity of the hybridisation test to be 3 x 10(5) and it seems to be sufficient for detection of CMV infection. The obtained results show that sensitivity of hybridisation was comparable to that of single PCR and the possibility of obtaining quantitative results makes it superior, on efficacy of antiviral therapy, especially in monitoring CMV infection in immunossuppressed patients and in following the efficacy of antiviral treatment.     

Post-transfusion malaria in thalassaemia patients

A total of 125 beta-thalassaemia patients receiving repeated blood transfusions were screened by Giemsa stain, Acridine-orange stain and antigen detection for evidence of malaria infection on each visit. A total of 8 (6.4%) of the patients developed post-transfusion malaria (PMT) as confirmed by tracing the infected blood donors. A high incidence of PTM in thalassaemia patients appears to be due to the use of fresh blood and the high frequency of blood transfusions required by these patients. Antigen detection using monoclonal antibody was found to be more sensitive for diagnosis of PTM and for screening suspected donors than the conventional blood smear examination methods and is therefore recommended for routine blood donor screening to rule out malaria infection.     

Etiological diagnosis of suppurative bacterial meningitis today

As the result of laboratory examination of 2165 patients with virulent bacterial meningitides, including cases of meningococcal infection, the etiological diagnosis was confirmed in 1407 patients (65.0%), the number of cases confirmed by the laboratory examination being significantly greater among adults than among children: 67.5 +/- 1.37% and 63.1 +/- 1.53%, respectively, (t = 2.1). Meningococcal infection was confirmed in 1111 (70.6%) out of 1572 patients under examination. Of the patients with purulent meningitides, pneumococcal etiology was determined in 27.4%, type b of Haemophilus influenzae in 13.5%, other infective agents in 10.0%. The comparison of the results obtained in the examination, carried out by different methods, of 946 children and 770 adults with meningococcal infection revealed a considerable difference in the number of positive results yielded by the bacteriological method and countercurrent immunoelectrophoresis (CIE). Among adults meningococci were isolated twice as frequently (41.1 +/- 2.5% - 19.4 +/- 1.6%), and the results yielded by CIE were predominantly positive (55.1 +/- 2.5% and 40.1 +/- 2.5%). CIE and the immunoenzyme assay were shown to have advantages in the diagnosis of the disease. Under the conditions of intensive antibiotic therapy the methods based on the detection of specific antigens in body fluids can greatly assist in diagnosis.     

腹部大手术术后深部真菌感染的临床与真菌学分析

目的探讨腹部大手术术后深部真菌感染的危险因素及诊治措施。方法回顾性分析2006年1月～2009年6月期间我科腹部大手术术后合并深部真菌感染48例患者的临床和真菌学资料。结果 48例真菌感染患者共分离出56株菌株,其中白念珠菌占41.1%,是最主要的致病菌株。患者基础疾病和术后长期、多种广谱抗生素联合使用是深部真菌感染的重要因素。结论深部真菌感染是腹部大手术术后的重要并发症,白念珠菌仍然是主要病原菌。对术后患者深部真菌感染应采取积极预防、及时发现和有效治疗。