Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years.</p><p><b>METHODS</b>The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985.</p><p><b>RESULTS</b>Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital.</p><p><b>CONCLUSIONS</b>During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.</p>

A prospective longitudinal study evaluating a T-cell-based assay for latent tuberculosis infection in health-care workers in a general hospital in Beijing / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The health-care workers (HCWs) are at high risk of acquiring infection with Mycobacterium tuberculosis. The objectives of this study were to compare the performance of the T-SPOT.TB and tuberculin skin test (TST) for latent tuberculosis infection (LTBI), evaluate diagnostic concordance and risk factors for LTBI, and observe the progression to active tuberculosis (TB) disease among HCWs in a general hospital in Beijing.</p><p><b>METHODS</b>The prospective cohort study enrolled HCWs in a tertiary general hospital in Beijing, China, to evaluate LTBI with T-SPOT.TB and TST. The subjects were evaluated every 12 months during the 60-month follow-up.</p><p><b>RESULTS</b>Of 101 participating HCWs, 96 and 101 had valid TST and T-SPOT.TB results, respectively. Twenty-nine (28.7%, 95% confidence interval (CI), 19.9% - 37.5%) were defined as positive by T-SPOT.TB and 53 (55.2%, 95%CI, 45.2% - 64.9%) were defined as positive by TST (using a ≥ 10 mm cutoff). An agreement between the two tests was poor (57.3%, κ = 0.18, 95%CI, 0.01% - 0.52%). In multivariate analysis, direct exposure to sputum smear-positive TB patients was a significant risk factor for a positive T-SPOT.TB (OR 5.76; 95%CI 1.38 - 24.00). Pooled frequency of antigen-specific IFN-γ secreting T-cells for subjects who reported direct contact with sputum smear-positive TB patients was significantly higher than that for participants without direct contact (P = 0.045). One of 20 participants with positive result of T-SPOT.TB and TST developed active TB at 24-month follow-up.</p><p><b>CONCLUSION</b>T-SPOT.TB is a more accurate, targeted method of diagnosing LTBI than TST.</p>

Blood collection procedures influence contamination rates in blood culture: a prospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Blood culture contamination is a significant adverse event. The aim of this project was to evaluate the efficacy of a strict blood collection procedure in reducing the blood culture contamination rate.</p><p><b>METHODS</b>A prospectively controlled study was performed in two different medical areas in Peking Union Medical College Hospital (PUMCH) for 16 months (from May 2006 to September 2007). In test group, a strict blood collection procedure was carried out by trained nurses with the veinpuncture sites were scrupulously disinfected with 2.5% tincture of iodine plus 70% alcohol. In control group, commonly used procedure in PUMCH was performed with 0.45% chlorhexidine acetate plus 0.2% iodine. Blood culture positive results for 4 target organisms (Coagulase-negative staphylococci, Propionibacterium acnes, Corynebacterium species and Bacillus species) were further assessed by physicians from infectious department to determine whether a sample was true positive (pathogen) or false positive (contamination).</p><p><b>RESULTS</b>Total 9321 blood culture collections were analyzed. The blood culture contamination rate in test group was significantly lower than that in control group (5/3177 (0.16%) vs. 77/6144 (1.25%); χ(2) = 13.382, P < 0.001). The most common contaminant was Coagulase-negative staphylococcus (76.83%). The average cultural time during which contaminated samples became positive was longer than that for true pathogen samples (42.0 hours vs. 13.9 hours, P = 0.041).</p><p><b>CONCLUSION</b>Using a strict blood collection procedure can significantly reduce blood culture contamination rate.</p>

Clinicopathological analysis of nine cases of small cell carcinoma of the uterine cervix / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic characteristics, therapy and prognostic factors of small cell carcinoma of the uterine cervix (SCCC).</p><p><b>METHODS</b>Nine patients with SCCC underwent radical hysterectomy at the Cancer Hospital of CAMS between 2000 to 2009. Clinical and pathological data were analyzed, and the related literature was reviewed.</p><p><b>RESULTS</b>The average age of 9 patients was 41 years old. Irregular vaginal bleeding and postcoital spotting were the most common symptoms. According to FIGO staging criteria, six patients were stage Ib1 disease, 2 stage Ib2 and 1 stage IVb. All tumors were composed of small-sized cells with scant cytoplasm, darkly stained round to oval nuclei, finely dispersed chromatin and absence of nucleoli. High mitotic activity and lymphovascular invasion were also common findings. Immunohistochemical staining showed at least three neuroendocrine markers (NSE, CgA, Syn and CD56) were positive in each case. All patients received postoperative chemotherapy, with or without radiotherapy. Seven patients remained alive 6 to 104 months and one died 14 months postoperatively.</p><p><b>CONCLUSION</b>SCCC is a highly malignant tumor with aggressive behavior. Correct diagnosis of SCCC depends on the combination of light microscopic and immunohistochemical analysis. It is necessary to use multimodality treatment for SCCC, especially the chemotherapy. However, the prognosis is dismal.</p>

Longitudinal observation of an interferon gamma-released assay (T-SPOT.TB) for Mycobacterium tuberculosis infection in AIDS patients on highly active antiretroviral therapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>T-SPOT.TB is a novel test for tuberculosis infection with higher sensitivity and specificity than the traditional tuberculin skin test (TST). However, there are no longitudinal data in the literature evaluating T-SPOT.TB for Mycobacterium tuberculosis in patients with acquired immune deficiency syndrome (AIDS) on highly active antiretroviral therapy (HAART). The objective of this study was to assess the value of T-SPOT.TB longitudinally in AIDS patients on HAART without prophylaxis for tuberculosis.</p><p><b>METHODS</b>A prospective observational study was conducted in 50 AIDS patients on HAART. None of the subjects had evidence of active tuberculosis. T-SPOT.TB, a T-cell-based interferon gamma released assay, was performed at the onset of the study and repeated 24 months thereafter. Subjects were evaluated every 6 months during the 36-month follow-up.</p><p><b>RESULTS</b>Twenty-one (42%) AIDS patients on HAART tested positive by T-SPOT.TB (95%CI 28.3% - 55.7%). The pooled spot-forming cells of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) peptides were 68/million peripheral blood mononuclear cell (PBMC) (interquartile range 44 - 220). The average number of CD4 cells in subjects was (305 +/- 152) cells/microl, and there was no significant difference in T-SPOT.TB response rates between subjects with CD4 cell counts < 200 cells/microl (7/15 (46.7%), 95%CI 21.5% - 71.9%) and those with CD4 cell counts >/= 200 cells/microl (14/35 (40.0%), 95%CI 23.8% - 56.2%, P = 0.662). In the 32 subjects who completed the 24-month follow-up, 10 underwent T-SPOT.TB reversion, one had T-SPOT.TB conversion, six remained positive and 15 remained negative. None of them advanced to active tuberculosis during the 36-month follow-up.</p><p><b>CONCLUSION</b>The inactive status of tuberculosis infection may be maintained for a long period in AIDS patients on HAART.</p>

Clinical characteristics of 143 Chinese HIV/AIDS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in China.</p><p><b>METHODS</b>Totally 143 HIV/AIDS patients who were first diagnosed in Peking Union Medical College Hospital form January 1988 to April 2006 were enrolled in this study. Clinical characteristics were retrospectively analyzed.</p><p><b>RESULTS</b>Among 143 HIV/ AIDS patients, 57 patients had no clinical symptoms and were confirmed by routine examinations; 86 patients had clinical symptoms, including fever (n = 50), weight loss (n = 18), and discomforts involving respiratory system (n = 34), gastrointestinal system (n = 16), and derma and mucosa (n = 17). Opportunistic infections (OIs) such as pneumocystis jiroveci pneumonia (PCP) (n = 27), oropharyngeal candidiasis (n = 16), tuberculosis (n = 15) , and cytomegalovirus (CMV) infection (n = 9) were also observed in patients whose CD4 + T cell counts were less than 200/mm3. Most CMV infection and cryptococcal meningitis occurred in patients whose CD4 + T cell counts were less than 100/mm3. CD4 + T cell count was negatively correlated with plasma viral load (r = -0.420, P = 0.001).</p><p><b>CONCLUSIONS</b>Fever, dyspnea, and weight loss are the most common symptoms in the patients of this study. The respiratory system, gastrointestinal system, derma and mucosa are the most commonly affected areas by OIs, and PCP is the most common OI. The occurrence of OIs corelates with CD4 + T cell count.</p>

Dynamics of T lymphocyte subsets in SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study dynamics of T lymphocyte subsets in severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>Sequential anti-coagulated blood samples were collected from 46 cases of SARS patients during the 1st week, the 2nd week, the 3rd-5th week and the 8th-12th week after the infection. T lymphocyte subsets including CD3+CD4+ cells, CD3+CD8+ cells, naive CD4+ cells (CD4+CD45RA+CD62L+) and activated CD8+ cells (CD8+CD38+) were detected by 3-color flow cytometry. Fifty-six normal healthy blood donors were also detected as normal controls.</p><p><b>RESULTS</b>Compared with the results of normal controls, both of the percentages of CD4+ cells and CD8+ cells of SARS patients were in normal levels during the 1st week, but the cell counts decreased significantly to (306 +/- 140)/mm3 and (270 +/- 143)/mm3, respectively. The cell count of naive CD4+ subset also remarkably decreased to (96 +/- 49)/mm3, and the percentage of CD8+CD38+ subset was higher than that of normal controls [(59.3 +/- 12.6)% vs (44.9 +/- 12.5)%]. During the 3rd-5th week, the CD8+ cell count and the percentage of CD8+CD38+ subset reached normal values, which were (581 +/- 356)/mm3 and (40.1 +/- 17.6)%, respectively. During the 8th-12th week, the cell counts of CD4+ cell [(578 +/- 193)/mm3] and naive CD4+ subset [(176 +/- 64)/mm3] were still less than those of normal controls, while compared with those of the 1st week, the increments were remarkable.</p><p><b>CONCLUSIONS</b>T lymphocytes of SARS patients decreased dramatically but could be obviously resumed in a short time. It will take more than 8-12 weeks for CD4+ cell and naive CD4+ subset to reach to normal levels.</p>