加强传染病学领域中高通量检测技术的应用研究

近年来,全球传染病流行十分严重,如何在第一时间对病原体作出诊断与分析已成为各国学者研究的重点,以生物芯片为代表的高通量诊断技术得到了飞速发展。高通量检测技术及其相关的生物信息学,已被广泛应用于各种病原体的快速诊断、型别鉴定和变异分析及耐药检测等多个方面。

2009—2011年徐州市传染病自动预警信息响应工作评价

目的了解徐州市传染病自动预警信息响应状况,发现并改进影响响应工作质量的因素。方法利用Excel 2007对2009—2011年信号核实卡进行统计分析,评价指标为响应及时性、完整性、准确性。结果徐州市2009—2011年共收到预警信息3 594条,响应率100%,及时响应率97.08%,完整率65.50%,初步判断为疑似事件16条,经流行病学调查,全部判定为阳性信息,并报告了突发公共卫生事件及相关信息。结论徐州市传染病自动预警信息响应工作逐步完善,响应及时率和完整率需要进一步提高。

某医院传染病收治与潜在医院感染的状况调查

目的:了解基层医院传染病患者收治情况。方法:回顾性调查2005-01/2008-01某基层医院传染科专科收治与转科情况。结果:在1 991例患者中,295例为转科患者,转科率为14.82%。结论:许多科室均存在误收传染病患者现象。因此,门(急)诊医生必须对传染病的收治给予足够重视,以避免因传染病误诊误收而诱发的医院感染发生。

General Characteristics of HIV/AIDS Patients in Ditan Hospital

Objective: To elucidate general characteristics of HIV/AIDS patients seeking care at Ditan Hospital in an attempt to guide early diagnosis in routine medical care. Materials and methods: A retrospective analysis of 185 HIV/AIDS cases from January 1990 to June 2002 was completed using SPSS statistical analysis. Results: Male to female ratio was 1.8 :1. Subjects ranged in age from 1 year old to 64 years old. 16 cases were younger than 20 years old with the median age among the younger subset at 7.7 years. 169 cases were older than 20 years old with a median age of 36 years old. 29% of the subjects were peasants. The remaining 71%, were of other unspecified occupations. 90.8% of individuals were of Han descent while 3.7% of individuals were of a minority heritage. 50.3% of subjects were married; 23.8% have never married; 8.1% were divorced; and the remaining 17.8% were of unknown marital status. Of those represented in this study, 36.8% came from the Henan province; 17.8% were from Beijing; 8.6% were from Shanxi; 31.4% from the other 20 provinces of China; and 5.4% from outside of China. Mode of transmission: 40.0% (74/185) contracted HIV through unprotected sexual contact; 29.2% (54/185) through receiving blood or plasma transfusions; 21.1%(39/185) through donating plasma; 7 cases were intravenous drug users; 7 cases were vertically transmitted. Mode of transmission was unknown in 4 cases. Clinical categories: An included 45 cases; B included 85 cases: C consisted of 76 cases. 12 cases were deceased. Initial presentation: 39 cases presented with fever ,cough and diarrhea. 37 cases had fever and cough only. 38 cases presented with chronic diarrhea. 16 cases were discovered incidentally at time of operation. 8 cases presented with fungal infection of the oral cavity or in esophagus. The common HIV associated symptoms and opportunistic infections were: weight loss and diarrhea, respiratory diseases, der-matologic diseases, anemia , neutropenia. Diseases of other organ systems were less common. Common misdiagnoses included pneumonia, the common cold, and enteritis. Conclusion: The majority of cases were of middle age (between 30-40 years old) and had contracted HIV/ AIDS sexually.Receiving contaminated blood or plasma via a transfusion accounted for the second most common mode of transmission. Donating plasma was the third most likely mode of transmission. Initial presenting symptoms were various and complicated. Even though the majority of HIV/AIDS cases present to the general hospital, many doctors working at the general hospital are still unable to recognize the symptoms of HIV/AIDS. Thus, it is imperative to identify general characteristics of the HIV/AIDS population in order to diagnose the disease at an earlier stage and halt further transmission.

Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes

This review aims to outline the most up-to-date knowledge of pancreatic adenocarcinoma risk, diagnostics, treatment and outcomes, while identifying gaps that aim to stimulate further research in this understudied malignancy. Pancreatic adenocarcinoma is a lethal condition with a rising incidence, predicted to become the second leading cause of cancer death in some regions. It often presents at an advanced stage, which contributes to poor five-year survival rates of 2%-9%, ranking firmly last amongst all cancer sites in terms of prognostic outcomes for patients. Better understanding of the risk factors and symptoms associated with this disease is essential to inform both health professionals and the general population of potential preventive and/or early detection measures. The identification of high-risk patients who could benefit from screening to detect pre-malignant conditions such as pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms is urgently required, however an acceptable screening test has yet to be identified. The management of pancreatic adenocarcinoma is evolving, with the introduction of new surgical techniques and medical therapies such as laparoscopic techniques and neo-adjuvant chemoradiotherapy, however this has only led to modest improvements in outcomes. The identification of novel biomarkers is desirable to move towards a precision medicine era, where pancreatic cancer therapy can be tailored to the individual patient, while unnecessary treatments that have negative consequences on quality of life could be prevented for others. Research efforts must also focus on the development of new agents and delivery systems. Overall, considerable progress is required to reduce the burden associated with pancreatic cancer. Recent, renewed efforts to fund large consortia and research into pancreatic adenocarcinoma are welcomed, but further streams will be necessary to facilitate the momentum needed to bring breakthroughs seen for other cancer sites.

From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world

Hepatocellular carcinoma(HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as hepatitis B virus or chronic hepatitis C virus, nonalcoholic fatty liver disease, consumption of aflatoxins and tobacco smocking. Clinical presentation varies widely; patients can be asymptomatic while symptomatology extends from right upper abdominal quadrant paint and weight loss to obstructive jaundice and lethargy. Imaging is the first key and one of the most important aspects at all stages of diagnosis, therapy and follow-up of patients with HCC. The Barcelona Clinic Liver Cancer Staging System remains the most widely classification system used for HCC management guidelines. Up until now, HCC remains a challenge to early diagnose, and treat effectively; treating management is focused on hepatic resection, orthotopic liver transplantation, ablative therapies, chemoembolization and systemic therapies with cytotocix drugs, and targeted agents. This review article describes the current evidence on epidemiology, symptomatology, diagnosis and treatment of hepatocellular carcinoma.

Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease

Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases(IBD).The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis.Arthritis associated with IBD belongs to the category of spondyloarthropathies.Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease.Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients.Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately.Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations.The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.

First attempt to produce experimental Campylobacter concisus infection in mice

AIM： TO infect mice with atypical Campylobacter concisus （C. concisus） for the first time. METHODS： Three separate experiments were conducted in order to screen the ability of five clinical C. concisus isolates of intestinal origin and the ATCC 33237 type strain of oral origin to colonize and produce infection in immunocompetent BALB/cA mice. The majority of the BALB/cA mice were treated with cyclophosphamide prior to C. concisus inoculation to suppress immune functions. Inoculation of C. conc/sus was performed by the gastric route. RESULTS： C. concisus was isolated from the liver, ileum and jejunum of cyclophosphamide-treated mice in the first experiment. No C. concisus strains were isolated in the two subsequent experiments. Mice infected with C. concisus showed a significant loss of body weight from day two through to day five of infection but this decreased at the end of the first week. Histopathological examination did not consistently find signs of inflammation in the gut, but occasionally microabscesses were found in the liver of infected animals. CONCLUSION： Transient colonization with C. concisus was observed in mice with loss of body weight. Future studies should concentrate on the first few days after inoculation and in other strains of mice.

Utility of Pooled HIV RNA RT-PCR Assay in Diagnosing Acute HIV Infections

The P24 antigen test, HIV RNA PCR test, HIV isolation/culture and fourth-generation HIV uniform Ag/Ab assay are being utilized in diagnosing acute HIV infection in different labs. Many factors limit the use of screening for acute HIV in high-risk populations, in blood donors and during voluntary HIV testing, including, cost, technique, sensitivity and specificity. In this review we explore a new NAAT method which involves HIV RNA RT-PCR on pooled samples. This technique is able to screen for acute infections in a large testing volume and may be used as a screening method in high-risk populations and blood donors.

Enteropathic spondyloarthropathy:A common genetic background with inflammatory bowel disease?

The association between spondyloarthropathy and in flammatory bowel disease(IBD) is largely established, although prevalence is variable because of different population selection and diagnostic methodologies.Most studies indicate that as many as 10%15% of cases of IBD are complicated by ankylosing spondylitis(AS) or other forms of spondylarthritis(SpA).Of note, ileal inflammation resembling IBD has been reported in up to two thirds of cases of SpA, and it has been suggested that the presence of ileitis is associated with the chronic ity of articular complications.Although this observation is of interest to unravel the pathophysiology of the disease, systematic screening of patients with SpA by ileocolonos copy is not indicated in the absence of gut symptoms, as only a small proportion of patients with subclinical gut inflammation will develop overt IBD over time.The existence of familial clustering of both IBD and AS, the coexistence of both conditions in a patient, the evidence of an increased risk ratio among f irstand seconddegree relatives of affected AS or IBD patients and f inally, the increased crossrisk ratios between AS and IBD, strongly suggest a shared genetic background.So far, however, IL23R is the only identified susceptibility gene shared by both IBD and AS.Although functional studies are still needed to better understand its pathogenic role, great ef fort is being spent therapeutically targeting this pathway that may prove effective for both disorders.

血清铁蛋白、降钙素原和C反应蛋白在感染性疾病诊断中的临床意义

目的评价血清铁蛋白(SF)、降钙素原(PCT)和C反应蛋白(CRP)对感染性疾病的诊断价值。方法回顾分析2012年至2017年明确诊断为感染性疾病患者190例,其中细菌感染130例(细菌感染组),病毒感染60例(病毒感染组)。对细菌和病毒感染组SF、CRP、PCT测定值进行统计分析。结果 190例感染性疾病病例中,细菌感染组(68.4%)PCT、CRP、SF水平均高于病毒感染组(31.6%),差异有统计学意义。细菌感染组ROC曲线分析:CRP、PCT、SF曲线下面积(AUC)分别为0.797、0.803、0.883。结论在感染性疾病患者中,SF、CRP、PCT对鉴别细菌和病毒感染有价值。

EB病毒抗体联合检测在小儿感染性疾病诊断中的应用

目的探讨EB病毒抗体联合检测在小儿感染性疾病诊断中的临床应用。方法 采用化学发光法定量检测患儿血清中的EB病毒VCA-IgM、VCA-IgG、EBNA-IgG含量，阳性标本加做EBV-DNA检测。结果 326例疑似EB病毒感染患者，抗体检测阳性率为81.90%（267/326）；单个抗体VCA-IgM、VCA-IgG、EBNA-IgG阳性率分别为24.85%、77.30%、53.99%。267例抗体阳性患儿中，原发感染81例，疾病累及全身多个系统。抗体联合检测出现5种组合类型，抗体检测与EBV-DNA检测结果差异无统计学意义（P〉0.05）。结论 多种抗体联合检测可提高EB病毒检出阳性率，动态反映病毒感染水平，为临床医生对EB病毒的诊断、治疗提供依据。

细菌感染的血清标志物在感染性疾病中的应用

目的比较细菌感染标志物PCT(血清降钙素原)与CRP(C反应蛋白)在感染性疾病中的应用价值。方法将120例患者分为感染和非感染组各60例,感染组中37例为全身感染23例为局部感染。两者和正常对照组分别抽血检测PCT和CRP进行比较。结果感染组的PCT和CRP高于非感染组和对照组(P<0.01);全身感染组的PCT和CRP高于局部感染组(P<0.01)。全身感染组的PCT和CRP阳性率,比较(P<0.05)。结论 PCT和CRP的检测对感染性疾病均有重要的临床意义,但PCT对全身细菌感染疾病的诊断和鉴别更具有实用价值。

儿童感染性疾病测定α-羟丁酸脱氢酶的临床价值

目的探讨α-羟丁酸脱氢酶在儿童感染性疾病测定的临床价值,并与心肌酶谱其他各项目指标作相关分析。方法对患有感染性疾病住院患儿随机抽样1 753例,检测血清心肌酶谱-磷酸肌酸激酶(CK)及同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)的活性,比较各项检测指标的相关系数。结果四种心肌酶都存在正相关,差异有统计学意义(P<0.01)。HBDH与LDH相关系数r=0.975(P<0.01),高度正相关。结论调查显示,由于LDH与α-HBDH高度正相关,建议感染性疾病患儿取消α-HBDH检测,以其他更敏感的指标代替。