支气管肺泡灌洗液的半乳甘露聚糖检测对血液系统疾病患者侵袭性肺曲霉病的诊断价值

侵袭性肺曲霉病（IPA）的快速诊断仍然存在挑战,作者等使用酶免疫方法检测支气管肺泡灌洗液（BALF）中半乳甘露聚糖（GM）,以便该试验直接用于靶器官标本的检测。对99例高危血液系统疾病患者（其中58例患者为确诊或拟诊侵袭性肺曲霉病）使用酶免疫方法检测BALF中GM含量并分析其结果。     

侵袭性肺曲霉菌病检测方法进展

烟曲霉是导致侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)的主要致病菌。免疫功能低下的患者更容易发生这种病变,且病死率很高。早期、准确的诊断和治疗对于患者的预后至关重要。目前用于检测这种真菌感染的诊断方法是常规真菌学检查(直接显微镜检查,组织学检查和培养)、影像学、非培养基检测半乳甘露聚糖和(1,3)-β-D-葡聚糖和细胞外糖蛋白以及基于PCR的分子检测等。上述方法的灵敏度和特异性较低,有待开发新的诊断工具和方法,以提高高危患者侵袭性肺曲霉病的快速诊断。     

侵袭性肺曲霉病并发皮肤、肋骨损害一例并文献复习

正曲霉菌广泛分布于大自然中,可机会性感染免疫受损人群,但侵袭性曲霉病(invasive aspergillosis,IA)的临床表现不一,早期明确诊断十分困难,诊治不及时易导致曲霉菌进一步播散感染,严重危害人类健康。现将浙江大学医学院附属第四医院1例侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)并发皮肤、肋骨损害患者的诊治经过汇报如下。     

血清G试验、GM试验对非粒细胞缺乏侵袭性肺曲霉病的诊断价值

目的 研究血清1,3-β-D葡聚糖检测(G试验)、半乳甘露聚糖检测(GM试验)对非粒细胞缺乏侵袭性肺曲霉病(IPA)的诊断价值.方法 选取2019年6月至2020年7月该院收治的非粒细胞缺乏IPA患者53例(IPA组)作为研究对象.另选取同期该院收治的非粒细胞缺乏细菌性感染患者51例作为非IPA组.对所有患者进行血清G试验与GM试验检测,对试验结果进行比较,并绘制受试者工作特征曲线(ROC曲线)分析血清G试验、GM试验对非粒细胞缺乏IPA的诊断效能.结果 IPA组GM试验结果比非IPA组高,差异有统计学意义(P<0.05);IPA组G试验结果比非IPA组高,差异有统计学意义(P<0.05).血清GM试验和G试验联合诊断非粒细胞缺乏IPA的ROC曲线下面积为0.663.随着GM试验、G试验临界值增高,GM试验、G试验诊断非粒细胞缺乏IPA的灵敏度降低,特异度升高.结论 血清GM试验和G试验联合检测对非粒细胞缺乏IPA患者早期诊断具有一定价值,动态监测血清GM试验结果对其疗效有着重要的临床意义.     

侵袭性肺曲霉病30例临床分析

侵袭性肺曲霉病（invasive pulmonary aspergillosis,IPA）是一种病死率很高的深部真菌感染,早期诊断的困难和初期治疗的延误是该病预后差的主要原因.近年来,由于脏器移植患者的增加、艾滋病发病率的迅速增长和广谱抗生素、免疫抑制剂及激素的大量应用,侵袭性肺曲霉病的发病率有增加的趋势.现就我院2002～2004年确诊的30例侵袭性肺曲霉病临床资料进行了回顾性分析,报告如下.     

侵袭性肺曲霉菌病诊断方法的研究进展

侵袭性曲霉菌病(invasive aspergillosis,IA)是免疫功能低下患者最常见的侵袭性真菌感染,致死率高。由于曲霉菌孢子飘浮于空气中而易被吸入,IA中以侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)最常见。然而,由于临床表现不典型,诊断金标准即病理学依据获得困难,IPA的诊断仍具挑战性,尤其是在疾病早期阶段。因此,寻找简便、快速、准确性高的诊断方法具有重要意义。本文就目前IPA的诊断进展作一综述。     

伊曲康唑治疗侵袭性肺曲霉菌的临床观察及护理

侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)是一种病死率很高的深部真菌感染[1,2],早期诊断的困难和初期治疗的延误是该病预后差的主要原因.     

曲霉IgG抗体检测在血液病/恶性肿瘤患者侵袭性肺曲霉病中的诊断价值

目的 评价曲霉IgG抗体检测在血液病/恶性肿瘤患者侵袭性肺曲霉病(IPA)的诊断价值,为血液病/恶性肿瘤患者IPA的诊断提供新的检测方案.方法 回顾性研究.收集中国医学科学院血液病医院检验科2018年1月至2021年9月临床诊断IPA患者24例作为疾病组,临床排除IPA患者35例作为对照组.用ELISA法检测血清曲霉半...     

重症监护室侵袭性支气管肺曲霉病高危因素研究进展

<正>侵袭性支气管肺曲霉病(invasive bronchialpulmonary asperaillosis,IBPA)临床表现主要有曲霉性气管支气管炎(aspergillus tracheobronchitis,ATB)和侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA),两者的易感因素基本相同[1]。其中IPA为霉菌病中病死率最高的类型,其患病率呈上升趋势,目前     

血清半乳甘露聚糖检测在诊断儿童侵袭性肺曲霉感染中的价值

目的评价血清半乳甘露聚糖(GM)试验对儿童侵袭性肺曲霉病(IPA)的诊断价值。方法用双抗体夹心ELISA法测定77例临床高度怀疑IPA患儿的血清GM浓度,以吸光度指数(AI)值绘制ROC曲线,评价其对儿童IPA的诊断价值。结果收集77例患儿标本89份,ROC曲线分析,以AI 1.0为阳性界定值时,诊断儿童IPA的敏感性为79.4%,特异性为83.7%;ROC曲线下面积(AUCROC)为0.841(95%CI:0.747～0.936)。结论血清GM抗原检测对儿童IPA有一定的诊断价值。     

Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoietic stem cell transplantation

Hepatic veno-occlusive disease (VOD), increasingly referred to as sinusoidal obstruction syndrome, is a well-recognized complication of hematopoietic stem cell transplantation and contributes to considerable morbidity and mortality. In the Western Hemisphere, VOD, classified as a conditioning-related toxicity, is most commonly caused by stem cell transplantation. VOD has been described after all types of stem cell transplantation, irrespective of the stem cell source, type of conditioning therapy, or underlying disease. Recognition of this disease in the posttransplantation setting remains a challenge in the absence of specific diagnostic features because many other more common conditions can mimic it. Limited therapeutic or preventive strategies are currently available for the management of VOD. In this review, we provide a comprehensive account of the pathophysiology of this disease as we understand it today, risk factors for its development, and the current state of knowledge regarding preventive and therapeutic options.     

Challenges and options in the management of viral infections after stem cell transplantation

During the period of profound combined immunodeficiency after bone marrow or peripheral blood stem cell transplantation (SCT), patients are at increased risk for serious viral disease. Recent advances in rapid diagnostic methods and the introduction of potent antiviral compounds have made it possible to establish efficient management strategies for several herpesviruses. Acyclovir, valaciclovir, and famciclovir are widely used for the treatment of herpes simplex virus or varicella zoster virus disease. Intravenous ganciclovir, foscarnet, and cidofovir are available for prevention or therapy of cytomegalovirus disease, and oral valganciclovir could become a valuable alternative to intravenous treatment if shown to be effective and safe after SCT. Preliminary data on pleconaril for therapy of picornaviral disease are promising. Future investigations may help to clarify the role of the neuraminidase inhibitors zanamivir and oseltamivir in the management of influenza in SCT recipients. The emergence of viruses resistant to antiviral drugs is of concern, and alternative treatment strategies need to be defined.     

进展性非酒精性脂肪性肝病无创性诊断的临床研究进展

非酒精性脂肪性肝病(NAFLD)目前已是世界第一大慢性肝脏疾病,为全球终末期肝病、肝细胞癌和肝移植的主要原因。NAFLD的病理变化是从单纯性肝脂肪病变进展为非酒精性脂肪性肝炎(NASH),最终可进展至中晚期肝纤维化,因此准确诊断和鉴别NASH和纤维化对NAFLD的治疗和管理是十分必要的。近年来,肝活组织检查的局限性促使无创诊断技术迅速发展。本文就进展性NAFLD(NASH及纤维化)的无创性诊断方法展开论述,明确各种新的无创性诊断手段的特点,旨在进一步优化NAFLD的临床管理,推动本领域科学研究进展。     

Management and prevention of cytomegalovirus infection after renal transplantation.

We reviewed the epidemiologic characteristics, diagnosis, clinical features, and management of cytomegalovirus (CMV) infection after renal transplantation. CMV, the major viral pathogen after renal transplantation, increases patient morbidity and mortality. The spectrum of CMV infection ranges from latent infection to asymptomatic viral shedding to life-threatening multisystem disease. The two major risk factors for the development of CMV infection in renal transplant recipients are (1) preexisting CMV antibody seropositivity of either the organ donor or the recipient and (2) host immunosuppression. Blood cultures (but not urine cultures) positive for CMV predict the progression of asymptomatic infection to CMV disease, characterized by fever, malaise, myalgia, leukopenia, abnormal transaminase levels, and often involvement of the lung and gut. New genomic methods of viral detection now offer diagnostic advantages, including methods of detecting only actively replicating CMV. No evidence shows that CMV directly causes allograft rejection or glomerulonephritis, but patients with tissue-invasive CMV disease have higher rates of allograft loss and mortality than do those without the disease. Therapy for established CMV disease includes decreasing the immunosuppressive therapy and administering the antiviral agent ganciclovir sodium. Proven prophylactic strategies include limitation of exposure to the virus from CMV seropositive blood or organ donors, administration of CMV-specific immune globulin, and use of high-dose acyclovir therapy. Preemptive therapy with ganciclovir is a promising alternative to prophylaxis for patients at highest risk for progression to symptomatic CMV disease, such as those with CMV viremia and seropositive recipients receiving antilymphocyte therapy.     

Uni- and bilateral lung transplantation: patient evaluation and selection. Vienna Lung Transplant Group]

Lung transplantation has been available as a therapeutic option for patients with end-stage lung disease for only a short period of time. Since this procedure is now being successfully performed with increasing frequency in various transplantation centers, we must now begin to consider transplantation as a therapeutic options in patients with lung diseases unresponsive to medical therapy. Physicians are required to know principles involved for determination of suitable candidates and operative procedures of choice. We report here our experiences of preoperative assessment of patients undergoing lung transplantation. Patient selection, indications, contraindications, choice of operation, appropriate timing for transplantation and preoperative rehabilitation methods are discussed. It is concluded that appropriate recipient selection remains an important determinant for the success of this treatment modality.     

Primary and metastatic liver cancer

OBJECTIVES: To review liver physiology, the disease process, diagnostic tests, and current treatment options for primary and metastatic liver cancer. DATA SOURCES: Research studies, review articles, and textbooks relating to liver cancer. CONCLUSIONS: Surgical resection offers the best available treatment modality, but only a small percentage of patients are eligible. However, combined treatment of radiation therapy and chemotherapy (systemic and intra-arterial), as well as chemoembolization, cryosurgery, and transplantation, offers hope of palliation, conversion of unresectable to resectable disease, and prolonged survival. IMPLICATIONS FOR NURSING PRACTICE: Understanding and knowledge of the disease process and treatment modalities for primary and metastatic liver cancer will assist the oncology nurse in educating patients and families during their diagnostic and treatment phases.     

Calcific aortic valve disease: imaging studies and therapeutic interventions.

Echocardiography is the predominant imaging method used for patients with aortic valve disease because of its excellent diagnostic accuracy, high reproducibility and noninvasive nature. Cardiac catheterization is typically reserved for patients in whom the diagnosis remains unclear, those requiring coronary angiography prior to valve replacement, and in the setting of complex valve disease. Cardiac computed tomography (CT) has recently been applied as a research tool to quantify the amount of aortic valve calcium (AVC), which has served as a clinical end point in several medical therapy trials. Medical therapy for aortic valve disease remains an active area of clinical research. Multiple retrospective studies have shown a benefit for 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors or statins) in reducing disease progression. However, two recently completed prospective, randomized trials yielded conflicting results. The data for using angiotensin converting enzyme (ACE) inhibitors are in the preliminary stages. This review will focus on imaging methods that are available for patients with aortic valve disease and summarize the recent trials that have evaluated medical therapy aimed to reduce progression of aortic valve disease.     

Treatment of multiple myeloma: An emphasis on new developments

Not all patients who fulfill the minimal criteria for diagnosis of multiple myeloma should be treated. If doubt exists about beginning therapy, one should wait and re‐evaluate the patient in 2 or 3 months. There is no evidence that early treatment of multiple myeloma is advantageous. All patients should be considered possible candidates for an autologous stem cell transplantation. If they are deemed to be eligible, they should be treated for 3 to 4 months with therapy that does not damage the hematopoietic stem cells. Currently, most physicians use thalidomide plus dexamethasone or dexamethasone alone for induction. Vincristine, doxorubicin (Adriamycin), and dexamethasone (VAD) have been used in the past. Autologous stem cell transplantation prolongs disease‐free survival and overall survival. The treatment‐related mortality rate is 1% to 2%. Melphalan, 200?mg/m², is the most widely used preparative regimen. Although allogeneic transplantation is attractive, the mortality rate (about 20%) is too high to recommend conventional allogeneic transplantation. Non‐myeloablative transplantation is currently under investigation. If the patient is not a candidate for autologous stem cell transplantation, therapy with melphalan and prednisone is a good choice. Patients with relapsed or refractory disease may be treated with dexamethasone, thalidomide and dexamethasone, bortezomib (Velcade, PS‐341), or lenalidomide (Revlimid, not yet approved by the Food and Drug Administration).     

Wound therapy with autologous bone marrow stem cells in diabetic patients with ischaemia-induced tissue ulcers affecting the lower limbs

Previous studies suggest that autologous transplantation of bone marrow mononuclear cells is safe and effective in inducing therapeutic angiogenesis in patients with peripheral arterial occlusive disease (PAOD). Here we discuss a multidisciplinary approach to treating PAOD with a focus on the use of angiological diagnostic tools. We conclude that our autologous stem cell therapy is working in this patient and it is a potential new therapeutic option for diabetic patients with chronic foot ulcers induced by critical limb ischaemia.     

Tumour cell purging for autologous bone marrow transplantation

Interest in autologous bone marrow transplantation as treatment for haematological disease has increased considerably in the past 10 years. Remission bone marrow can be collected, stored until the patient has received myeloablative therapy, then re-infused. A disadvantage of this form of treatment is the possibility of re-infusion of residual malignant cells. The methods currently available for removal of neoplastic cells from autologous marrow prior to transplantation are reviewed.