To analyze the mother-to-child transmission (MTCT) of hepatitis B virus (HBV) infection in pregnant and postpartum women, and explore the MTCT rate and its influencing factors in the real-world where strict preventive interventions measures are implemented.

A cohort study was conducted on 10 250 mothers of HBV-exposed children in Beijing from January 1st, 2021 to December 31st, 2023. Socioeconomic data, HBV serological markers, HBV viral load and MTCT prevention interventions were analyzed, respectively. The relationship between year, maternal age and positivity of hepatitis B virus surface antigen (HBsAg) were analyzed by Poisson regression analysis. Data of HBsAg-positive mothers and HBV-exposed children were sourced from the National Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Information System. Post-vaccination serological testing (PVST) results and MTCT rates were described for 8 412 (82.07%) HBV-exposed children who completed follow-up serological testing after full vaccination. Mothers and children were grouped based on the HBV DNA load of infected mothers: pregnant women with high viral load group (1 780 cases) and pregnant women with low viral load group (8 470 cases), children with high-exposure group (1 664 cases) and children with low-exposure group (6 748 cases). The differences of basic information, fetal outcomes and prevention of MTCT interventions between two groups of pregnant women were analyzed by Chi-square test and Mann-Whitney test; the differences of MTCT rates under different socioeconomic, infection status and prevention of MTCT interventions were compared by Chi-square test.

From 2021 to 2023, there were a total of 403 368 deliveries in Beijing, including 10 093 HBsAg-positive delivery women (10 250 live born children were delivery women), the HBsAg positivity rate was 2.50% (95%CI: 2.45%-2.55%), with a downtrend that the younger of pregnant woman was, the lower the positive rate of HBsAg (RR = 0.93, P < 0.001). Timely vaccination rate of hepatitis B vaccine (99.94% vs. 99.76%) and timely injection rate of hepatitis B immunoglobulin (HBIG) (99.89% vs. 99.88%) of pregnant women in high viral load group and low viral load group were both higher than 99.50%, but without significant difference (χ² = 2.33, P = 0.127; χ² = 0.00,P = 0.950). The vaccination time of hepatitis B vaccine were 0.48 (0.26, 0.60) h and 0.53 (0.30, 1.15) h, respectively (Z = 12.83, P < 0.001); the injection time of HBIG in children with high exposure group and low exposure group were 0.41 (0.25, 0.51) h and 0.50 (0.28, 1.07) h, respectively (Z = 14.85, P < 0.001), both with significant differences. The antiviral treatment rate of pregnant women in high viral load group was 96.35% (1 715/1 780), significantly higher than that of the low viral load group (14.06%, 1 191/8 470) (χ² = 4 902.99, P < 0.001); the proportion of pregnant women in high viral load group delivered in specialized hospitals (89.94%, 1 601/1 780) was significantly higher than that of the low exposure group (34.90%, 2 956/8 470) (χ² = 1 805.80, P < 0.001), with significant difference. Total of 6 cases of MTCT were identified, the MTCT rate of HBV was 0.07% (95%CI: 0.02%-0.16%). Among different delivery ages, educational levels, types of delivery institutions and delivery methods, the MTCT rates of HBV were without significant difference (all P > 0.05). The MTCT rate of HBV in HBeAg positive pregnant women was higher than that of HBeAg negative pregnant women (0.28% vs. 0.00%: χ² = 17.15, P < 0.001), and the MTCT rate of HBV in high viral load pregnant women was higher than that of low viral load pregnant women (0.36% vs. 0.00%:χ² = 24.35, P < 0.001), both with significant differences.

Timely administration of HBIG and vaccination for all HBV-exposed children, combined with antiviral treatment starting in late pregnancy for mothers with high MTCT risk, could reduce the MTCT rate of HBV to an extremely low level.

本视频主要介绍发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome，SFTS）的流行病学特征、发病机制、临床特征、诊疗以及预防等相关内容。

SFTS是我国于2009年发现的大别班达病毒（Dabie bandavirus，DBV）感染引起的一种新发病毒性传染病，多由蜱虫叮咬传播，主要分布于山区和丘陵地带，全年均可发病，多发于春、夏季。临床主要表现为发热、白细胞降低、血小板减少、多脏器损伤。SFTS报告病例数逐年升高，且病死率可高达20%。

一、　流行病学特征及发病机制

1. 流行病学特征：（1）传染源：感染的动物是主要传染源，患者也可作为传染源。（2）传播途径：SFTSV主要经带毒长角血蜱等媒介生物叮咬传播，还可在无防护情况下通过接触感染动物或患者的血液、分泌物、排泄物及其污染物造成感染。（3）各类人群普遍易感。

2. 发病机制与病理改变：SFTSV直接作用于人体多种细胞引起组织、器官损伤。SFTSV感染机体后导致免疫功能失调，严重者可诱发细胞因子风暴、内皮损伤，患者可因出血或多脏器功能衰竭死亡。SFTS病理损伤广泛，主要表现为心肌细胞结构素乱伴空泡变性，肺泡出血及间质纤维增生，肝脏汇管区增大、肝窦充血、嗜酸性变，脏明显充血、局灶性出血及缺血性损伤，肾小管弥漫性扩张伴肾小管上皮细胞肿大，桥脑局灶性神经元细胞变性，骨髓造血功能减低，可见巨噬细胞增多。

二、临床表现以及分型

潜伏期可能为1～2周，在人-人传播病例中，潜伏期多为6～9 d。初期（发热期）、极期（多器官功能损害期）和恢复期3期可有重叠，临床分型分为轻型、中型、重型和危重型。

三、诊疗与预防

1. 诊断：根据患者流行病学史、临床表现以及实验室检查等综合分析。

2. 治疗：本病尚无特异性治疗方法，主要是对症支持治疗和针对并发症的治疗。

3. 预防控制：在山区、丘陵及林地等流行区域从事生产、生活或旅游的人群应做好个人防护，防止蜱虫叮咬。在救治、护理过程中，医务人员、陪护人员应做好个人防护，接触患者血液、分泌物和排泄物时佩戴外科口罩及一次性乳胶手套，进行气道操作时佩戴医用防护口罩、护目镜或防护面屏对患者的血液、分泌物、排泄物及其污染物，应按照《医疗机构消毒技术规范》及时做好清洁和消毒。患者转出、离院或死亡后进行终末消毒。

To investigate the effect of continuity care intervention based on the knowledge, attitude and practice (KAP) theory on the clinical outcomes of patients with high-risk human papillomavirus (HR-HPV) persistent infection complicated with cervical intraepithelial neoplasia grade Ⅰ (CIN Ⅰ) undergoing aminolevulinic acid photodynamic therapy (ALA-PDT).

Total of 120 patients with HR-HPV persistent infection and CIN Ⅰ diagnosed at the Dermatovenereology Outpatient Department of Beijing Ditan Hospital, Capital Medical University, from July 1st 2022 to June 30th 2023 were selected by convenience sampling method. Patients were randomly divided into control group (60 cases) and observation group (60 cases) by random number table method. Both groups received ALA-PDT treatment. Patients in control group received routine care, while observation group underwent additional continuity care intervention based on KAP theory. Indexes of generalized self-efficacy scale (GSES scores) and short form health survey (SF-36 scores) were compared between the two groups at baseline, after 6 times of ALA-PDT, 3-month and 6-month after ALA-PDT by independent samples t-test. HPV genotyping results and colposcopy reexamine findings were evaluated at 3 months and 6 months after ALA-PDT by Chi-square test.

GSES and SF-36 scores between control group and observation group before treatment were not significantly different (t = 0.852, P = 0.398; t = 0.012,P = 0.991). After 6 times of ALA-PDT, 3-month and 6-month after ALA-PDT, the GSES scores of patients in observation group were (25.63 ± 4.34), (30.09 ± 4.34) and (34.21 ± 4.56), significantly higher than those of the control group [(22.23 ± 4.05), (25.78 ± 4.57) and (29.56 ± 5.13)], with significant differences (t = 3.137, 3.746, 3.711; P = 0.003, < 0.001, < 0.001); while the SF-36 scores of patients in observation group were (72.73 ± 3.58), (80.25 ± 4.20) and (89.34 ± 4.65), significantly higher than those of the control group [(64.59 ± 3.47), (72.78 ± 3.96) and (78.79 ± 4.11)], with significant differences (t = 8.547, 7.088, 9.311; all P < 0.001). At 3 and 6 months after ALA-PDT, the HPV-negative conversion rates of patients in observation group were 73.3% (44/60) and 70.4% (42/60), respectively, significantly higher than those of the control group [65% (39/60) and 61.7% (37/60)], with significant differences (χ² = 15.98, 13.76; both P < 0.001). At 6 months after ALA-PDT, the rate of lesion reversal in observation group was 80.0% (48/60), significantly higher than that of control group [68.3% (41/60)], with significant difference (χ² = 16.89, P < 0.001).

Continuity care intervention based on the KAP theory can significantly improve the self-efficacy and life quality of patients with HR-HPV persistent infection complicated with CIN Ⅰ, and optimize the clinical outcome of patients.

To investigate the distribution characteristics and drug resistance of pathogenic bacteria in patients with chronic refractory wounds, and to guide the formulation of personalized antimicrobial treatment plans and promote rational use of antibacterial drug in clinical practice.

A retrospective study was conducted on the clinical data of 124 patients with chronic refractory wounds admitted to the Dermatology Outpatient Department, Dermatology Inpatient Unit and Vascular Surgery Inpatient Unit of the First Affiliated Hospital of Tsinghua University from January 2020 to January 2025. Wound secretions or necrotic tissues were collected by sterile swabs and sent to laboratory for bacterial culture. Species identification was performed by VITEK MS microbial identification system (bioMérieux, France) with VITEK-2 identification cards. In vitro antimicrobial susceptibility testing employed matching VITEK-2 susceptibility cards and the Kirby-Bauer disk diffusion method (Oxoid, UK). All experimental procedures and result interpretations were adhered to guidelines established by the Clinical and Laboratory Standards Institute (CLSI). The independent risk factors for positive pathogen culture in wound were analyzed by binary Logistic regression.

Total of 92 strains of pathogenic bacteria were isolated, with the isolation rate of 74.2%; Gram-positive cocci primarily included Staphylococcus aureus (27 strains, 29.3%) and coagulase-negative Staphylococci (23 strains, 25%); Gram-negative bacilli mainly comprised Pseudomonas aeruginosa (9 strains, 9.8%), Escherichia coli (4 strains, 4.3%) and Proteus mirabilis (4 strains, 4.3%). The top three etiological factors for chronic refractory wounds were lower extremity arterial vascular ulcers (43 cases, 34.7%), infectious ulcers (38 cases, 30.6%) and postoperative poor wound healing (15 cases, 12.1%). The detection rate of Staphylococcus aureus was significantly higher in patients with infectious ulcer group compared with patients of lower extremity arterial disease (χ²=6.618, P=0.014). Wound pathogen detection rates were significantly elevated in patients ≥ 60 years old compared with those < 60 years old (χ²=5.236, P=0.022). Logistic regression analysis showed that diabetes mellitus was an independent risk factor for positive wound pathogen culture (OR=2.620, 95%CI: 1.013-6.777, P=0.047). The detection rate of wound pathogen was significantly higher in patients with diabetes compared with patients without diabetes (χ²=7.079, P=0.008), the positive detection rate of other Gram-negative bacilli was also significantly higher in patients with diabetic (χ²=3.932, P=0.047). In patients with type 2 diabetes mellitus duration ≥ 15 years, detection rates of other Gram-negative bacilli were significantly higher than those with duration < 15 years (χ²=5.013, P=0.025), all with significant differences. The detection rate of Staphylococcus aureus in head and neck region was significantly higher than that in trunk (χ²=8.531, P=0.003) and limbs (χ²=11.738, P=0.001). Methicillin-resistant Staphylococcus aureus accounted for 5 strains (5.4%) and methicillin-resistant coagulase-negative Staphylococci accounted for 15 strains (16.3%), all were sensitive to vancomycin, tigecycline and linezolid. Pseudomonas aeruginosa (9 strains, 9.8%) demonstrated universal susceptibility to cefepime, meropenem, amikacin, levofloxacin, ciprofloxacin and colistin, while 1 strain (11.1%) exhibited resistance to imipenem. Among Escherichia coli isolates (4 strains, 4.3%), resistance was observed in 1 strain (25%) to amikacin, levofloxacin and sulfamethoxazole/trimethoprim, respectively. Proteus mirabilis (4 strains, 4.3%) showed resistance to tigecycline in 3 strains (75%) and 2 strains (50%) to cefuroxime and sulfamethoxazole/trimethoprim, respectively.

Infection is closely associated with the development of chronic refractory wounds, with diabetic and elderly patients being particularly high-risk populations. Wound bacteria exhibit diverse species and characteristic clinical distribution patterns. Rational individualized selection of antimicrobial agents can effectively control infection, promote wound healing, and prevent or delay the emergence and spread of antibiotic-resistant bacteria.

To evaluate and compare the experimental parameters and resultant differences of two magnetic bead-based nucleic acid extraction reagents in pathogen-targeted next-generation sequencing (ptNGS) for the detection of bronchoalveolar lavage fluid (BF) and peripheral blood (PB) samples, and to identify the more effective nucleic acid extraction reagent and assess its applicability in ptNGS detection, in order to offer guidance for the selection of appropriate nucleic acid extraction reagents tailored to various sample types.

Two representative magnetic bead-based nucleic acid extraction kits, designated as KitA and KitB were employed to conduct ptNGS detection on 12 BF samples and 8 PB samples, all of which had established culture or real-time fluorescence quantitative PCR (qPCR) results. An equal volume was utilized for each sample. The methodology encompassed several key stages, including nucleic acid extraction, library construction, sequencing and subsequent result analysis. The experimental parameters, including total nucleic acid extraction mass, absorbance (A) _260/280, library concentration and sample sequencing data quality index Q30; and pathogen detection copy numbers between KitA and KitB during the detection process of samples (BF and PB) were systematically compared by Wilcoxon signed-rank tests, and the magnetic bead extraction reagent which was more suitable for ptNGS detection of BF and PB samples were clarified. The suitability of the extraction kit was further evaluated by the accuracy, precision, detection limit and conventional anti-interference ability of ptNGS detection.

The total amount of nucleic acid extracted in BF by KitA was significantly higher than that of KitB (W=-66, P=0.001), but without significant difference in PB (W=19, P=0.063). However, the absorbance A_260/280 of KitB nucleic acid in BF and PB samples were significantly better than those of KitA (BF: W=54, P=0.014; PB: W=21, P=0.031). But the library concentration and fragment size of the libraries constructed by KitA and KitB nucleic acid were not significantly different; sequencing data quality metrics including Q30 scores, primer dimer percentage and percentage of Real aligne were not significantly different between the two extraction methods (all P > 0.05). The number and species of KitA and KitB detected in the pathogen were consistent. The pathogen copy number detected by KitA in BF was significantly higher than that of KitB (W=-301, P < 0.001), however, there was no statistically significant difference in pathogen copy number in PB between the two extraction methods (W=-3, P=0.844). Further, a more suitable nucleic acid extraction kit KitA was selected to evaluate its suitability for ptNGS detection in BF and PB. The positive concordance rate of ptNGS detected by KitA was 97.14%, the missed detection rate was 2.86%, and the overall concordance rate was 95%. Both intra-batch and inter-batch precision exhibited coefficients of variation below 10%. The limit of detection (LOD) was established at 100 copies/ml for bacterial and fungal targets, and 1 000 copies/ml for viral targets. Notably, non-target nucleic acids (including human-derived DNA/RNA) in the samples did not interfere with the qualitative results of ptNGS analysis.

For ptNGS detection in BF samples, Kit A demonstrated overall superior performance compared with Kit B across all evaluated parameters. In PB samples, both kits were consistent in overall experimental parameters, including total nucleic acid yield, library concentration and sequencing data quality indicators Q30. KitA meets the requirements of clinical testing in terms of accuracy, precision, detection limit and routine anti-interference capability in the performance evaluation of ptNGS detection

本视频主要介绍基孔肯雅热概述、临床表现、流行病学和病原学特征、发病机制、实验室检测、诊断与鉴别诊断和治疗与预防。

一、基孔肯雅热概述和临床特征

基孔肯雅热是由基孔肯雅病毒（Chikungunyavirus，CHIKV）引起、经媒介伊蚊叮咬吸血传播的一种急性传染病，临床特征为发热、皮疹、肌肉和关节疼痛（突然"发烧"、皮肤"报警"和关节"罢工"），潜伏期为1～12 d，通常为3～7 d，部分患者会伴有持续6个月甚至更长的慢性多发性关节炎，对人类健康危害较大。

二、流行病学特征

传染源为基孔肯雅热患者、隐性感染者、携带病毒的非人灵长类动物，主要通过携带CHIKV的伊蚊叮咬传播，人群普遍易感，感染病毒后可获得持久免疫力。传播媒介为白纹伊蚊和埃及伊蚊，患者在发病当天至7 d具有传染性。基孔肯雅热的地理分布与媒介伊蚊的地理分布相关。发病季节与当地媒介伊蚊季节消长有关。

三、病原学特征

CHIKV属于披膜病毒科甲病毒属成员，为直径约65 nm的单链RNA病毒，病毒颗粒星球形，病毒基因组长度约11～12 kb。CHIKV主要编码3个结构蛋白和4个非结构蛋白。56 ℃ 30 min、70%酒精、次氨酸钠、脂溶剂、酸性环境（pH< 6）可灭活。－70 ℃条件下长期存活，4 ℃条件下仅维持数天。

四、发病机制和相关免疫病理学

CHIKV感染通过受感染蚊虫叮咬传播，引发皮肤感染阶段。病毒在感染皮肤驻留细胞后开始初始复制阶段，之后进入外周器官感染阶段。CHIKV感染会引发炎症反应。病毒随血液播散后出现病毒血症，从而触发促炎性免疫介质的产生，导致急性病症，部分患者会发展为慢性疾病。

五、实验室检测

病原学检测包括核酸检测、病毒培养、抗原检测和基因组测序，血清学检测常用于恢复期患者诊断。

六、诊断与鉴别诊断

病例诊断分类：可分为基孔肯雅热疑似病例、临床诊断病例和确诊病例，参见《基孔肯雅热诊断》（WS/T590--2018）。需要与登革热鉴别。

七、治疗与预防

基孔肯雅热国内目前尚无特异性抗病毒治疗，以对症及支持治疗为主；症状治疗主要包括休息、补液，以及使用镇痛药和解热药。国内尚无特效药及相关疫苗，防蚊是唯一盾牌。

To analyze the status and risk factors of nosocomial infection in patients with malignant tumors during chemotherapy, and to construct a nomogram model for predicting the risk of infection.

Total of 402 patients with malignant tumors who were hospitalized for chemotherapy in Suzhou Ninth Hospital Affiliated to Soochow University from January 2024 to October 2024 were selected. The patients showed no signs of infection upon admission. The patients were divided into infection group (47 cases) and non-infection group (355 cases) according to whether nosocomial infection occurred during hospitalization. The clinical data of the two groups were compared. The risk factors of nosocomial infection in cancer patients undergoing chemotherapy were analyzed by multivariate Logistic regression analysis, and nomogram model was constructed to predict the risk of infection. The predictive efficacy of Logistic regression model and nomogram model were analyzed by receiver operating characteristic (ROC) curve. The two models were compared by Delong test. The stability and clinical value of the dominant model were evaluated by K-fold cross-validation and decision curve.

The hospital infection rate for the first hospitalization chemotherapy of 402 patients with malignant tumors was 11.69% (47/402), the main infection site was respiratory system (27 cases, 57.45%). Among the 47 infected specimens, 30 strains (51.72%) of Gram-negative bacteria, 24 strains (41.38%) of Gram-positive bacteria, and 4 strains (6.90%) of fungi were isolated and cultured. The ages of patients in the infection group and the non-infection group [(63.96 ± 6.85) years old vs. (60.22 ± 5.94) years old: t=3.982, P < 0.001], complicated with diabetes [17 (36.17%) vs. 69 (19.44%): χ²=6.911, P=0.009], neutrophil count before chemotherapy [(2.39 ± 0.47) vs. (2.59 ± 0.54) × 10⁹/L]: t=2.038, P=0.042), neutrophil count to lymphocyte count ratio (NLR) before chemotherapy [(1.07 ± 0.26) vs. (0.79 ± 0.24): t=7.442, P < 0.001], nutritional risks before chemotherapy [15 (31.91%) vs. 62 (17.46%): χ²=5.597, P=0.018)] and invasive operations [39 (82.98%) vs. 225 (63.38%): χ²=7.072, P=0.008] were all with significant differences. Multivariate Logistic regression analysis showed that age (OR=2.775, 95%CI: 1.415-5.447, P=0.003), complicated with diabetes (OR=2.106, 95%CI: 1.157-3.834, P=0.015), NLR before chemotherapy (OR=3.557, 95%CI: 1.763-7.178, P < 0.001), nutritional risk before chemotherapy (OR=1.679, 95%CI: 1.059-2.662, P=0.028), invasive procedures (OR=2.391, 95%CI: 1.224-4.673, P=0.011) were risk factors for nosocomial infection of tumor patients undergoing chemotherapy in hospital. ROC curve analysis and Delong test showed that the area under the curve (AUC) of nomogram in predicting the risk of nosocomial infection in patients with tumor chemotherapy was significantly higher than that of Logistic regression model (0.884 vs. 0.798: Z=4.137, P=0.018). The 10-fold cross-validation of the nomogram model for 100 times showed that the model had good stability. The decision curve showed that the net benefit curve of the model is located above the two extreme curves of all measures and no measure, indicating that the model had clinical practical value in this range.

The risk of nosocomial infection in cancer patients undergoing chemotherapy is high. This study based on factors such as age, whether diabetes was present, NLR before chemotherapy, whether there was nutritional risk before chemotherapy and whether invasive procedures were performed, constructed a nomogram model which has a good predictive ability for the risk of hospital-acquired infections in cancer patients undergoing inpatient chemotherapy, can be used as risk assessment tool for medical staff to identify patients with nosocomial infection.

To identify the risk factors that lead to maternal and infant adverse outcomes of bloodstream infection.

Total of 314 pregnant women with bloodstream infection were selected from the Department of Obstetrics, Obstetrics and Gynecology Hospital of Tongji University·Shanghai First Maternity·Infant Hospital From January 1st 2021 to January 31st 2024 as the study subjects (bloodstream infection group), during the same period, 300 pregnant women who had no bloodstream infection of the whole pregnancy period and had undergone prenatal examination were selected as control group, the clinical data of two groups of pregnant women were collected for retrospective analysis. According to the pregnancy outcome, 314 pregnant women with bloodstream infection were divided into normal outcome group (240 cases) and adverse outcome group (74 cases). The general information, clinical symptoms and indicators of bloodstream infection and pathogen isolation of patients in normal outcome group and adverse outcome group were analyzed by univariate analysis. The indicators with statistically significant differences were further analyzed by Logistic multivariate binary regression analysis to explore the risk factors affecting maternal adverse outcomes of bloodstream infection.

The incidence of adverse pregnancy outcomes of cases in bloodstream infection group was 23.57% (74/314), significantly higher than that of the control group (8.00%, 24/300), with significant difference (χ²= 27.717, P < 0.001). Between pregnant women in normal outcome group and adverse outcome group, age [(36.56 ± 4.56) years old vs. (29.45 ± 5.02) years old: t = 10.877, P < 0.001], pre-pregnancy body mass index (BMI) [(25.09 ± 2.21) vs. (22.64 ± 1.31): t = 12.245, P < 0.001], the highest body temperature distribution (χ² = 30.250, P < 0.001), occurrence of septic shock (χ² = 40.968,P < 0.001), level distribution of WBC (χ² = 65.677,P < 0.001), CRP (χ² = 13.977,P < 0.001) and PCT (χ²= 17.452, P < 0.001), and the number of original bacterial species (χ² = 29.216,P < 0.001) were all with significant differences. There was no significant difference in educational background, residence, working conditions, pregnancy and childbirth history, number of fetuses in this pregnancy, time of infection, source of infection, course of infection and pathogen type between the two groups (all P > 0.05). The results of multivariate Logistic regression analysis showed that the occurrence of septic shock (OR = 3.695, 95%CI: 1.627-5.462,P = 0.037), the number of infectious bacteria (OR = 18.746, 95%CI: 10.630-27.651, P = 0.049) and PCT level (OR = 33.683, 95%CI: 21.533-40.029,P = 0.011) were all risk factors for adverse maternal and infant outcomes in pregnant women with bloodstream infection.

Infectious shock, abnormal increase of PCT level and mixed pathogen infection are important indicators to evaluate maternal adverse outcomes of bloodstream infection.

布鲁菌病是由布鲁菌属细菌侵入机体，引起人兽共患的变态反应传染性疾病。本视频主要介绍布鲁菌病的临床表现、诊断、鉴别诊断以及治疗相关内容。

一、临床表现

1. 潜伏期7～21 d，平均14 d，少数患者可达数月至1年以上。

2. 临床表现复杂、分型困难，临床一般分为急性期、亚急性期、慢性期活动型及慢性期相对稳定型。各期症状：急性期以发热、多汗、关节痛等为主要表现，慢性期病程超6个月，可累及多系统，并出现多种并发症，且存在再次感染可能。

二、诊断与鉴别诊断

目前临床诊断标准为WS269-2019《布鲁氏菌病诊断标准》，职业病诊断按GBZ227-2017《职业性传染病诊断标准》。另外，需结合患者的职业史、临床症状体征及实验室检查（如血清学检测和病原培养等），分为疑似、临床诊断、确诊及隐性感染病例。鉴别诊断方面，急性期需与风湿热、伤寒等长期发热性疾病区分，慢性期应与慢性骨关节病、神经官能症鉴别。

三、治疗

1. 治疗原则：早期、联合、足量、足疗程，必要时延长疗程，预防并发症，防止复发和慢性化。

2. 治疗目标：①近期疗效治愈：体温恢复正常，其他临床症状、体征消失，体力和劳动能力恢复；原有布鲁菌培养阳性者两次细菌培养转阴；各脏器功能指标正常。②远期疗效治愈：达到近期疗效治愈目标后维持1年以上无复发。

3. 急性期、亚急性期、慢性期急性发作治疗包括一般治疗、抗菌治疗以及皮质激素的应用；慢性期治疗包括菌苗脱敏疗法、抗菌治疗以及手术治疗等。

四、预后

1. 布鲁菌病发病的急性期及早发现，且采取正规方法进行治疗，大部分布鲁菌病患者可痊愈且终身不复发。患者大多预后良好，大多在3～6个月内康复，仅10%～15%患者病程超过6个月、未经抗菌药物治疗前病死率为2%～3%，采用抗菌治疗后患者中少有死亡病例。

2. 慢性布鲁菌病很难治愈，可导致多组织器官侵害，严重时影响患者的生殖能力，故危害较大。

To improve the understanding of Actinotignum schaalii and expand clinical diagnosis and treatment approaches for infections caused by this bacteria.

The clinical data of a patient with complicated urinary tract infection caused by Actinotignum schaalii and admitted to Jiading Campus of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in July 29th 2024 was analyzed, retrospectively. Relevant domestic and foreign literatures were searched to explore the characteristics, clinical diagnosis and treatment of this bacteria.

The patient, a female, 66 years old, was hospitalized for treatment due to urinary retention and repeated difficulty in urinating. Actinotignum schaalii was isolated from the clear mid-stream urine. CT urography showed bilateral renal pelvis and bilateral upper ureter dilation with hydrops, and bladder enlargement with multiple cords and diverticula, which may be caused by chronic cystitis. Transurethral resection of bladder tumor (TURBT) + transurethral resection of bladder neck (TURBN) were performed, and 1.5 g/time of Cefuroxime was intravenously infused twice a day. After three days’ anti-infection treatment, the patient improved and was discharged.

Actinotignum schaalii has atypical morphology and high culture requirements. Laboratory staff should pay attention to avoid missed detection. For urinary tract infections caused by this bacteria, β-lactam antibiotics such as Cephalosporins are recommended. Surgical patients should be alert to the occurrence of postoperative translocation infection.

To investigate the predictive efficacy and effect of bacterial DNA level in ascites on prognosis of bacterial peritoneal inflammation (SBP) of cirrhosis patients with ascites after removing cell-free DNA.

A single-center prospective cohort design was adopted, and a total of 230 patients with ascites due to liver cirrhosis who were hospitalized in Beijing YouAn Hospital, Capital Medical University from September 2021 to December 2022 were enrolled. Ascitic fluid samples were collected at admission and pretreated with Benzonase to remove free DNA. Bacterial DNA levels were then quantitatively measured using droplet digital PCR (ddPCR). Based on the ascitic bacterial DNA load at admission, patients were divided into high bacterial DNA load group [log (bacterial DNA) ≥ 2, 38 cases] and low bacterial DNA load group [log (bacterial DNA) < 2, 192 cases]. Independent risk factors for SBP within 30-days after hospitalized were analyzed by Logistic regression analysis, while the impact of bacterial DNA load on 90-days and 360-days of hospitalized survival were assessed by Cox regression and ROC curve analysis.

The incidence of SBP in high bacterial DNA load group was 44.7% (17/38), significantly higher than that of low bacterial DNA load group (6.25%, 12/192), with significant difference (χ² = 42.81, P < 0.001). Multivariate Logistic regression analysis indicated that elevated bacterial DNA load in ascites [log (bacterial DNA) ≥ 2] (OR = 3.040, 95%CI: 1.605-5.756, P = 0.001), upper gastrointestinal bleeding (OR = 6.061, 95%CI: 2.315-15.625, P < 0.001), and chronic kidney disease (OR = 12.195, 95%CI: 4.504-32.258, P < 0.001) were all independent risk factors for the occurrence of SBP within 30 days in patients with cirrhotic ascites. A predictive model incorporating the MELD score, log (bacterial DNA) and neutrophil count was constructed to assess the risk of 90-days mortality. ROC curve analysis showed that the predictive performance of the combined model (AUC = 0.823) was superior to that of the MELD score alone (AUC = 0.754), with significant difference (Z = 2.823, P = 0.005). The 90-days and 360-days survival rates in high bacterial DNA load group (71.1% and 57.9%) were significantly lower than those of low bacterial DNA load group (84.4% and 79.2%), with significant differences (χ² = 2.99, P = 0.038;χ² = 6.68, P = 0.002).

Ascitic bacterial DNA levels after removal of free DNA have significant predictive value for the occurrence of SBP in patients with cirrhotic ascites. High bacterial DNA load in ascites is associated with lower survival rates of 90-days and 360-days after hospitalized, suggesting that bacterial translocation may play an important role in prognostic evaluation of liver cirrhosis.

To explore the influencing factors of postoperative recurrence of chronic suppurative otitis media (CSOM), and to construct the relevant prediction model of postoperative recurrence based on procalcitonin (PCT), soluble interleukin-2 receptor (sIL-2R) and clinical characteristics.

The clinical data of 400 patients with CSOM who were treated by surgery and reached the cure standard in Chengdu Seventh People’s Hospital from June 2018 to June 2023 were collected, retrospectively. After following-up for one year, the patients were divided into recurrence group (31 cases) and non-recurrence group (369 cases) according to whether they had recurrence. The influencing factors of postoperative recurrence of CSOM were analyzed by univariate analysis and multivariate Logistic regression analysis models, and a risk prediction model for postoperative recurrence of CSOM based on PCT, sIL-2R and clinical characteristics was established, and the predictive efficacy of the risk prediction model was analyzed by receiver operating characteristic (ROC) curve.

Age (χ²=3.955, P=0.047), impatency of eustachian tube (χ²=3.955, P=0.047), repeated upper respiratory tract infection (χ²=5.679, P=0.017), fasting blood glucose (t=4.741, P < 0.001), postoperative PCT level (t=3.488, P=0.001) and sIL-2R level (t = 2.864, P=0.004) between patients in recurrence group and non-recurrence group were all significantly different. The results of the binary Logistic regression model showed that impatency of eustachian tube (OR=2.492, 95%CI: 1.062-5.852, P=0.036), recurrent upper respiratory tract infection (OR=3.830, 95%CI: 1.668-8.791, P=0.002), fasting blood glucose (OR=2.843, 95%CI: 1.643-4.919, P < 0.001), postoperative PCT level (OR=155.371, 95%CI: 3.650-6 613.023, P=0.008) and sIL-2R level (OR=1.007, 95%CI: 1.001-1.014, P=0.029) were all independent risk factors for CSOM recurrence after surgery. According to the results of Logistic regression analysis, the prediction model equation was obtained: G=Log (P)=0.923 × impatency of eustachian tube + 1.299 × repeated upper respiratory tract infection + 1.093 × fasting blood glucose + 5.367 × postoperative PCT + 0.007 × sIL-2R-14.803. ROC curve analysis of the predictive model showed that AUC of this predictive model was 0.819 (95%CI: 0.737-0.902), suggesting a good predictive value for postoperative recurrence of CSOM.

Eustachian tube obstruction, repeated upper respiratory tract infection, fasting blood glucose, postoperative PCT level and sIL-2R level are all risk factors for recurrence after CSOM surgery. The predictive model constructed based on these factors has certain predictive value.

To investigate the impact of vitamin D deficiency on the risk of osteoporosis in middle-aged and elderly individuals after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Total of 388 middle-aged and elderly patients aged ≥ 55 years old previously infected with SARS-CoV-2 in the surrounding communities of Beijing Ditan Hospital, Capital Medical University from December 1st 2019 to August 31st 2024 were selected, who were divided into 25-OH-VD ≥ 20 ng/ml group (182 cases) and 25-OH-VD < 20 ng/ml group (206 cases) according to 25-OH-VD sufficiency or deficiency. The general data, bone and vertebral bone structure, and SARS-CoV-2 infection related indicators of the two groups were compared, respectively. The factors affecting osteoporosis in middle-aged and elderly people aged 55 years old and over after SARS-CoV-2 infection were analyzed by Logistic regression analysis.

Gender of patients between 25-OH-VD ≥ 20 ng/ml and 25-OH-VD < 20 ng/ml group was significantly different (χ² = 29.85, P < 0.001). Patients in 25-OH-VD < 20 ng/ml group had significantly lower levels of red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), white blood cells (WBC), eosinophil count (EO#), mean corpuscular hemoglobin concentration (MCHC), prealbumin (PAB), creatinine (CREA) and uric acid (URCA) compared with those of 25-OH-VD ≥ 20 ng/ml group (all P < 0.05); but phosphate ions (PHOS), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bile acids (TBA), parathyroid hormone (PTH), triiodothyronine (T3) and tetraiodothyronine (T4) were significantly higher than those of 25-OH-VD ≥ 20 ng/ml group (all P < 0.05). T values of the left hip, right hip and lumbar spine of patients in 25-OH-VD < 20 ng/ml group were significantly lower than those of 25-OH-VD ≥ 20 ng/ml group, with significant differences (Z =－4.45, P < 0.001; Z =－4.84, P < 0.001; Z =－3.03, P = 0.002). The incidence of fractures, thoracic hyperplasia, osteoporosis and FRAX^@ predicted 10-year osteoporosis of patients in 25-OH-VD < 20 ng/ml group were significantly higher than those of 25-OH-VD ≥ 20 ng/ml group, but the rate of thoracic degeneration was significantly lower than that of 25-OH-VD ≥ 20 ng/ml group, with significant differences (all P < 0.05). The number of typical symptoms of corona virus disease 2019 (COVID-19) of patients in 25-OH-VD < 20 ng/ml group was significantly higher than that of 25-OH-VD ≥ 20 ng/ml group, with significant difference (χ² = 9.89, P = 0.007). Multivariate Logistic regression analysis showed that patient gender (OR = 3.13, 95%CI: 1.17-8.37, P = 0.023), number of typical symptoms of COVID-19 (4-9: OR = 1.72, 95%CI: 1.01-2.96, P = 0.049; ≥ 10: OR = 5.90, 95%CI: 2.98-11.69, P < 0.001), ALP (OR = 1.02, 95%CI: 1.01-1.03, P < 0.001), CREA (OR = 0.97, 95%CI: 0.95-0.99,P = 0.041), CD3⁺ T% (OR = 0.96, 95%CI: 0.93-0.99, P = 0.044) and 25-OH-VD (OR = 0.96, 95%CI: 0.93-0.99,P = 0.048) were all independent influencing factors for osteoporosis.

After SARS-CoV-2 infection, middle-aged and elderly people with vitamin D deficiency are more likely to develop osteoporosis. Attention should be paid to middle-aged and elderly women, nutritional status, immune indicators and 25-OH-VD in the prevention and control of osteoporosis.

To investigate the risk factors for significant liver damage (SLD) in patients with chronic hepatitis B (CHB) during the immune-tolerant phase (IT-CHB) and establish a diagnostic model to guide clinical decisions on initiating antiviral therapy.

A retrospective analysis was conducted on the clinical data (including age, gender, examination and test results, etc.) of IT-CHB patients who were hospitalized and undergoing liver biopsy at the Fifth Medical Center of the PLA General Hospital from August 2018 to June 2022. Patients were stratified into SLD group [≥ G2 (inflammation) or S2 (fibrosis) according to Scheuer classification] and non-SLD group. Influencing factors were identified and diagnostic models were established by univariate and multivariate Logistic regression analysis, and the diagnostic performance was evaluated by receiver operating characteristic (ROC) curve and mosaic plots.

Among the 478 enrolled IT-CHB patients, the age was (32.9 ± 10.1) years old, with 62.1% males (297 cases), 21.1% cases (101/478) showed SLD (SLD group), 377 cases (78.9%) showed no SLD (non-SLD group). The results of the multivariate Logistic regression analysis showed that age (OR = 1.07, 95%CI: 1.04-1.11, P < 0.001), aspartate aminotransferase (AST) (OR = 1.09, 95%CI: 1.05-1.14, P < 0.001), platelet (PLT) (OR = 0.99, 95%CI: 0.98-0.99, P < 0.001), hepatitis B virus (HBV) DNA (OR = 0.51, 95%CI: 0.29-0.91, P = 0.017) and liver stiffness measurement (LSM) (OR = 2.25, 95%CI: 1.81-2.78, P < 0.001) were all independent influencing factors for SLD. The diagnostic model (IT-CHB-5) integrating these factors achieved an AUC of 0.89 (optimal cut-off: 23.8), with the sensitivity of 77.3%, the specificity of 89.2%, and the accuracy of 95.4% for SLD detection.

A substantial proportion of IT-CHB patients present SLD. The non-invasive IT-CHB-5 model provides an objective tool to timely initiation of antiviral therapy for IT-CHB patients who refuse liver biopsy.

According to the National Cancer Center’s 2024 National Cancer Report, liver cancer remains the second leading cause of cancer death in our country. A large number of studies have found that microbes are widely present in various types of cancer tissues such as colorectal cancer, pancreatic cancer and breast cancer. Their composition is different from that of normal tissues. In addition, some studies have found that intratumoral microbiome has an important effect on the occurrence, development of tumors. The immune microenvironment, metabolic pathways and epigenetic modification might be the main mechanisms. In this paper, the ways that the intratumoral microbiome of liver cancer affected tumour occurrence and development, and the role in clinical treatment and prevention were reviewed.