宏基因二代测序技术对非结核分枝杆菌感染病原学诊断的价值

目的:探讨宏基因二代测序(metagenomic next-generation sequencing,mNGS)技术对非结核分枝杆菌(non-tuberculosis mycobacteria,NTM)感染病原学诊断的价值。方法:回顾性选取2018年9月至2019年12月复旦大学附属中山医院感染病科收治的疑似NTM感染患者183例,共计样本388例,比较常规微生物培养法和mNGS技术对NTM病原体的检出率差异及不同样本类型的亚组分析。结果:常规微生物培养法和mNGS总体检测阳性率差异无统计学意义(21.9%vs 24.7%)。痰液样本培养法的阳性率明显高于mNGS(56.6%vs 22.9%,P0.000 1),而组织样本却低于mNGS(7.8%vs 27.8%,P0.000 1)。另外,mNGS对患者抗菌药物调整频率低于培养法(20.3%vs 40.2%,P0.05)。结论:mNGS对NTM灵敏度较低,需重点改进以促进此技术更好地应用于临床。     

宏基因二代测序技术对肝脓肿病原学诊断的价值

目的:探讨宏基因二代测序(metagenomics next-generation sequencing,mNGS)技术对肝脓肿病原学诊断的价值。方法:前瞻性纳入2020年2月至2021年4月复旦大学附属中山医院急诊科收治的35例肝脓肿患者,采用常规微生物培养法和mNGS技术分别检测血液和脓肿引流液样本。并将患者按是否出现休克分为两组,采用SPSS 25.0进行统计学分析,对比分析两组患者之间的差异。结果:mNGS技术在血液样本和引流液样本中总体检测阳性率显著高于常规培养法(血液：67.6% vs. 15.2%, P<0.05;引流液：100% vs. 55.2%, P<0.05)。35例肝脓肿病例中71.4%检出致病病原体为肺炎克雷伯菌。休克组患者脓肿引流液样本中mNGS检测出的致病病原体序列数显著高于非休克组( P<0.05)。 结论:mNGS能够快速准确的检测出肝脓肿的致病病原体,为临床精准治疗提供重要的病原学依据。     

宏基因二代测序技术对脊柱感染病原学诊断的价值

目的:探讨宏基因二代测序(metagenomic next-generation sequencing,mNGS)技术对脊柱感染病原学诊断的价值。方法:回顾性分析2018年1月至2019年12月复旦大学附属中山医院收治的24例疑似脊柱感染患者的病例资料,采用常规微生物培养法和mNGS技术检测脊柱组织标本。结果:mNGS总体检测阳性率高于常规培养法(62.5%vs 35.0%),mNGS平均耗时36～48 h,明显短于常规培养法的平均天数21.8 d。脊柱感染主要检出病原体为结核分枝杆菌、金黄色葡萄球菌、大肠埃希菌。结论:mNGS能够快速检测脊柱感染病原体,为临床早期精准治疗提供重要的病原学依据。     

宏基因组二代测序在重症肺炎患者病原学中的应用

目的 探究重症肺炎患者肺泡灌洗液（BALF）宏基因组二代测序（mNGS）与传统培养病原学诊断的差异以及mNGS结果对抗生素方案调整的影响。方法 回顾性分析2019年8月至2021年4月于贵州医科大学附属医院重症医学科住院期间，同时送检BALF传统培养和mNGS的重症肺炎患者。比较两种病原学检测结果的差异，分析mNGS与传统培养诊断的阳性率、一致性及抗生素方案的调整。结果研究期间共纳入患者75例，其中mNGS的阳性率为97.3%，传统培养阳性率为41.3%;mNGS细菌的检出率为94.7%，传统培养细菌检出率为38.7%;mNGS真菌检出次数最多的为耶氏肺孢子菌24.0%。mNGS对于罕见菌、不典型菌、真菌以及病毒的阳性率远高于传统培养。两组病原学检测结果一致性差（Kappa=0.038,P=0.229）,mNGS较传统培养检出更多种类的微生物。基于mNGS检测结果，临床医生对于69%的患者进行抗生素方案的调整。结论 mNGS在重症肺炎患者病原学诊断中敏感性高，对于免疫抑制重症肺炎患者尤为适用。同时，mNGS可以指导临床医师调整抗生素策略。     

痰消化集菌法用于结核分枝杆菌检测的可行性研究

目的探讨痰消化集菌法进行痰标本结核分枝杆菌检测的临床价值。方法收集2012年3—10月门诊和住院疑似肺结核225例的痰标本,分别采用直接涂片法和消化集菌法检测结核分枝杆菌并比较。结果 225例痰标本采用消化集菌法检测结核分枝杆菌阳性率为38.67%,直接涂片法25.78%,消化集菌法检出阳性率高于直接涂片法(P0.05)。镜下检出痰液标本结核分枝杆菌不同数量时的阳性率消化集菌法明显高于直接涂片法,尤以结核分枝杆菌在(++++)时最明显,此时消化集菌法阳性率35.63%,直接涂片法12.07%,组间比较差异有统计学意义(P0.05)。结论痰消化集菌法用于痰标本结核分枝杆菌检测具有操作简便、检出阳性率高及实验室安全等优点。     

3种检测方法在HIV合并结核分枝杆菌感染诊断中的对比研究

目的对比3种检测方法在HIV合并结核分枝杆菌感染中的诊断价值,以期找到最优的检测方法或检测方法组合。方法收集2013年1月至2015年12月确诊为HIV合并结核分枝杆菌感染患者的各类标本115份。每例患者均用相同类型的标本进行直接涂片抗酸染色镜检、罗氏培养和实时荧光定性PCR法检测。结果以任意1种标本检出阳性计算阳性率,115例HIV合并结核分枝杆菌感染患者的标本直接涂片抗酸染色法与罗氏培养法检测的阳性率比较,差异有统计学意义(χ~2=19.865,P=0.001);直接涂片抗酸染色法与实时荧光定性PCR法检测的阳性率比较,差异有统计学意义(χ~2=0.028,P=0.001);罗氏培养法与实时荧光定性PCR法检测的阳性率比较,差异无统计学意义(χ~2=21.261,P=0.868)。应用罗氏培养法来检测脓液、粪便和尿液,其检出率都达到了100.0%。实时荧光定性PCR法检测脑脊液、胸腔积液及腹水等含菌量较少的标本,检出率达到100.0%。罗氏培养法与实时荧光定性PCR法在检测痰液标本时检出率也较高(80.0%)。而从标本类型上来看,脓液标本3种方法均全部检出结核分枝杆菌,粪便和尿液标本用培养的方法检测结核分枝杆菌阳性率均为100.0%。支气管肺泡灌洗液的检出率也较高,均大于70.0%。结论实时荧光定性PCR在检测低排菌量标本如脑脊液、胸腔积液及腹水时具有明显优势;脓液标本3种方法均全部检出结核分枝杆菌,粪便和尿液标本用培养的方法均能100.0%检测出结核分枝杆菌。     

添加复苏促进因子的液-固相培养技术在结核分枝杆菌培养中的应用研究

摘要:目的通过 与常用的结核病病原学实验室诊断技术进行比较,评价液-固相培养技术在结核分枝杆菌培养中的应用价值,为临床诊断提供参考依据。方法选取无锡市第五人 民医院2020年7-12月收治的肺结核患者176 例。用浓缩集茵抗 酸涂片、MGIT 960全自动液体培养和液-固相培养分别对入组患者痰液样本进行检测,并统计分析阳性率、阳性时间差异。结果液-固相培 养的阳性率为58.0% ,相对MGIT 960液体培养(56.3%),差异无统计学意义。液-固相培养和MGIT 960液体 培养平均阳性时间分别为8.0( 6.0,10.0) d和10.0(7.0,15.0) d,差异有统计学意义(Z=-3.223 ,P<0.001)。按MGIT 960液体培养阳性时间,分为1~10d、11~20d、21~35 d 3个组别,在11~20 d组内,液-固相培养阳性时间10.0( 7.3,13.5)d相较于 MGIT 960液体培养14.0( 12.0,16.0)d,差异有统计学意义(Z=-4.582,P<0.0001);在21~35 d组内,液-固相培养相较于MGIT 960液体培养差异有统计学意义( Z=-2.805, P=0.005)。此外,液-固相培养技术还可以初步鉴别非结核分枝杆菌,5例 非结核分枝杆菌经基因芯片确认为胞内分枝杆菌3例和鸟分枝杆菌2例。结论液-固 相培养检测结核分枝杆菌阳性率高,且培养时间短,可作为结核分枝杆菌培养的优选方法。     

mNGS技术在儿童重症肺炎病原学诊断中的价值

目的探讨宏基因组二代测序(mNGS)技术在儿童重症肺炎病原学诊断中的价值。方法选取2017年12月至2020年6月武汉儿童医院收治住院治疗的219例社区获得性重症肺炎患儿临床资料,比较肺泡灌洗液mNGS检测与传统实验室病原检测对诊断儿童重症肺炎的诊断价值。结果 219例送检标本中mNGS共检出阳性病例190例(86.76%);而传统实验室病原共检出阳性病例173例(78.99%),两种检测方法比较,差异有统计学意义(P<0.05)。mNGS和传统实验室病原病原总检出率在各年龄段之间比较,差异有统计学意义(Χ²=76.488 7,P<0.05)。mNGS与传统实验室病原学检测均阳性患者163例,mNGS与传统实验室病原学检测均阴性患者22例,mNGS阳性而传统实验室病原学检测阴性患者27例,mNGS阴性而传统实验室病原学检测阳性患者7例。mNGS和传统实验室病原诊断儿童重症肺炎病原学灵敏度、特异度比较,差异有统计学意义(P<0.05)。结论二代测序技术较传统实验室病原检测可快速检测重症肺炎患儿病原学诊断,指导临床早期合理用药。     

宏基因组二代测序技术在慢性肺曲霉病诊断中的价值

目的：评估宏基因组二代测序技术在慢性肺曲霉病诊断中的价值。方法：回顾性收集2017年9月至2019年9月在复旦大学附属中山医院感染病科住院的疑似慢性肺曲霉病患者,并同步采集标本进行传统培养、血清烟曲霉特异性抗体IgG检测及mNGS检测,分析mNGS在慢性肺曲霉病诊断中的价值。 结果：共有78例疑似慢性肺曲霉病的患者纳入分析,根据诊断标准,最终诊断CPA 35例,non-CPA 43例。送检的的78例样本中,痰标本55例、支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)标本17例、肺组织标本6例。与最终诊断相比,mNGS诊断CPA的敏感度和特异度分别为65.7%和86.0%,烟曲霉特异性抗体IgG的敏感度和特异度分别为48.6%和90.7%,传统培养的敏感度和特异度分别为28.6%和93.0%,其中mNGS的敏感度显著高于传统培养方法(P=0.001)。对于临床诊断的CPA患者,mNGS检测的阳性率为50.0%。mNGS、烟曲霉特异性抗体IgG和传统培养方法的ROC曲线下面积(Area Under Curve, AUC)分别为0.759、0.696和0.608。在所有最终诊断为CPA的35例患者的样本中,痰标本、BALF标本和肺组织标本的mNGS阳性率分别为56.5%(13/23)、77.8%(7/9)和100%(3/3),但三组之间的差异无统计学意义。结论：在CPA的诊断中,mNGS的敏感度显著高于传统培养方法,在传统诊断方法无法确诊的患者中,mNGS仍有较高的阳性率,同时在检测时间上具有明显优势。     

显色固液双相培养基快速检测结核分枝杆菌的临床应用评价

目的探讨固液双相培养基快速检测结核分枝杆菌的临床价值。方法对350例患者的痰标本分别进行涂片抗酸染色、改良罗氏培养法、固液双相培养法、Bactec 960培养法检测。结果 350例痰标本涂片抗酸染色法阳性率为14.8%,改良罗氏培养法为24.0%,固液双相法为35.7%,Bactec 960培养法为40.3%,改良罗氏培养法与涂片抗酸染色法比较,差异有统计学意义(P0.01),固液双相培养法与改良罗氏培养法比较,差异有统计学意义(P0.01),固液双相培养法与Bactec 960培养法比较,差异无统计学意义(P0.05)。改良罗氏培养法平均报告阳性时间为21.5d,固液双相培养法液相平均为13.2d,固相为16.4d,Bactec 960培养法平均为11.8d。结论固液双相培养法操作简便,阳性率高,时间短,适合基层医院快速检测结核分枝杆菌。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."