2020年 · 第100卷第26期

Antibiotic tests have been widely used for the diagnosis of bacterionegative pulmonary tuberculosis for over 30 years, especially in low-resource countries. It is estimated that at least 26.5 million courses of antibiotics are prescribed each year as a result of this practice, which may increase antibiotic exposure and the occurrence of resistance. To assess the diagnostic efficacy of antibiotic tests, the researchers conducted a systematic review and meta-analysis of the relevant literature. By searching the Medline, Embase, and Global Health databases for literature as of March 15, 2019 on the diagnostic efficacy of antibiotic tests in adult patients with suspected tuberculosis, the risk of bias was assessed using the QUADAS-2 tool, and the pooled sensitivity and specificity of antibiotic tests were estimated using a bivariate random effects model, usingI²Statistics were analyzed for heterogeneity. Eight final studies were included in the meta-analysis, with a total of 2 786 patients from 7 countries in Africa, South America, and Asia. The results showed that the combined sensitivity of antibiotic test in the diagnosis of pulmonary tuberculosis was 67% (95%CI: 42-85), with a specificity of 73% (95%CI：58~85）。 The study showed that antibiotic tests were less efficacious in the diagnosis of tuberculosis, with estimates of sensitivity and specificity well below the internationally recommended diagnostic criteria. Given the dire situation of antibiotic resistance, current policies and practices regarding this trial seem inappropriate and its use should be limited and further studies undertaken.

Between 1973 and 2011, male sperm density in western countries dropped rapidly by more than 50%, and there is currently no effective treatment to slow down its decline. More and more clinical studies and animal experiments have shown that obesity and metabolic syndrome mediated by high-fat diet can reshape intestinal flora, and then affect physiological functions such as energy metabolism, intestinal mucosal barrier, host immunity, and prevention of pathogens. In order to understand whether high-fat diet affects male reproduction through intestinal flora, the intestinal flora of mice fed on normal diet was transplanted into 6 mice fed on normal diet (group 1), and the intestinal flora of mice fed on high-fat diet was transplanted into another 6 mice fed on normal diet (group 2). After 15 weeks, it was detected that the sperm production, sperm motility, the number of spermatogonial stem cells in seminiferous tubules and spermatocytes in group 2 mice were significantly decreased, and the blood endotoxin increased nearly 2 times, but the above indexes of group 1 mice did not change significantly. Further exploration of the mechanism found that the disordered intestinal flora transplantation triggered the infiltration of intestinal T lymphocytes and macrophages and the significant increase of epididymal pro-inflammatory factors. In order to explore which microorganisms have this effect on the reproductive system, this study used 16S-rDNA sequencing to find that the bacterial flora in the two groups of mice appeared intragroup clustering at the genus level, that is, the abundance of Bacteroides and Progenitor in Group 2 mice increased significantly, so it is speculated that the increased abundance of Bacteroides and Progenitor is the cause of endotoxemia. RNA sequencing of spermatogenesis-related genes in mice testis showed that the expression of genes involved in sperm cell meiosis and regulating testicular mitochondrial function was significantly reduced in mice testis in group 2 compared with group 1. At the same time, the study also collected blood and fecal samples from 12 healthy men and 48 oligoasthenospermia men aged 22 to 45 years for analysis, and found that it was consistent with the results of animal experiments: the abundance of Bacteroides and Probacterium in human specimens was negatively correlated with sperm motility (r=-0.28，P=0.029), circulating endotoxin levels were positively correlated with Bacteroides abundance (r=0.30，P=0.021), which indicates that the unbalanced intestinal flora may be directly involved in the occurrence and development of male infertility diseases.

The honeymoon period of type 1 diabetes mellitus (T1D), also known as the partial remission period (PR), is mainly manifested by a transient recovery of self-islet function and a reduction in exogenous insulin requirement, accompanied by downregulation of autoimmune response. PR is a short "clinical cure stage", and inducing and prolonging PR is the common research goal of domestic and foreign scholars. Programmed cell death protein-1 (PD-1) and its ligand PD-L1 are important immunosuppressive molecules. Monoclonal antibodies to PD-1 and PD-L1 are widely used in the field of oncology and are closely related to the pathogenesis of T1D. However, its expression changes in the PR phase of T1D patients are completely unknown. In order to investigate the correlation between the expression levels of PD-1 and PD-L1 in peripheral blood T lymphocytes of T1D patients and PR, 98 T1D patients and 49 healthy controls who were regularly visited by the outpatient clinic of Xiangya Second Hospital were included in this study. The onset age of T1D patients was 12.9 (1.9-65.7) years and the course of diabetes was 4.2 (0-23.7) months. According to PR status, T1D patients were divided into 4 groups: no PR (n =39), before PR (n =15), in PR (n =30) and after PR (n =14). PR was defined as C-peptide ≥300 pmol/L or insulin-corrected glycosylated hemoglobin (IDAA1c) ≤9. Twenty-nine newly diagnosed patients who had not yet entered PR were followed up for 1 year. Detection of CD4 in peripheral blood mononuclear cells (PBMC) by flow cytometry⁺/CD8⁺Dynamic changes of PD-1/PD-L1 expression on T cells, regulatory T cells (Treg) and IL-35⁺Frequency changes in Treg cells. The results showed that the expression level of PD-1 in peripheral T cells of T1D patients was significantly lower than that of healthy controls. PD-1 and PD-L1 proteins in circulating CD4⁺/CD8⁺The expression on T cells showed dynamic changes around PR: the expression level of PD-1/PD-L1 was the lowest before PR, and the expression of PD-1/PD-L1 returned to close to the level of normal healthy control after entering PR, but decreased again after PR. However, this expression pattern of PD-1/PD-L1 is not present in patients who do not develop PR. In addition, CD8⁺PD-1⁺T cell frequency was positively correlated with PR duration. Circulating Treg and IL-35⁺There was no significant correlation between Treg cell frequency and PR. It can be seen that the occurrence of PR is related to CD4⁺/CD8⁺PD-1⁺/PD-L1⁺It suggests that PD-1/PD-L1 protein may be a potential biological target to induce or prolong PR in T1D patients, which provides a new idea for the prevention and treatment of T1D.