Epidemiological characteristics of pulmonary tuberculosis in the elderly people in Wuhan in 2016-2020 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of pulmonary tuberculosis in the elderly people in Wuhan during 2016-2020, and to provide a basis for formulating effective prevention and control strategies and measures. Methods Using the National Tuberculosis Information Management System, a descriptive statistical analysis was performed on the medical records of elderly (≥60 years old) pulmonary tuberculosis patients registered in Wuhan from 2016 to 2020. Results A total of 9 427 elderly pulmonary tuberculosis patients were registered in Wuhan during 2016-2020, accounting for 32.07% of the total number of registrations in the whole population. The reported incidence rate of tuberculosis in the elderly was significantly higher than that in the total population, and the reported incidence rates in both the elderly and the general population showed declining trends (whole population χ2trend=216.97, P2trend=153.57, P<0.05). The time distribution showed that more cases occurred from April to November (70.90%). The top three districts with the largest number of registered cases were far urban areas, namely Huangpi District (13.81%), Xinzhou District (11.55%), and Jiangxia District (9.82%). The ratio of male to female with pulmonary tuberculosis in elderly patients was 2.85:1. Among the elderly pulmonary tuberculosis, the most registered cases were in the age group of 60 ~ years old, followed by 65 ~ years old. The proportion of smear-positive in elderly patients with pulmonary tuberculosis retreatment was 16.83%. Conclusion From 2016 to 2020, the epidemic situation of elderly pulmonary tuberculosis showed a downward trend in Wuhan. However, the elderly population with tuberculosis registrations still accounted for a relatively high proportion of the total population. According to the epidemiological characteristics of pulmonary tuberculosis among the elderly, the city should carry out tuberculosis prevention and control work in a timely, appropriate and focused manner.

Regulation of kidney on potassium balance and its clinical significance / 生理学报

Virtually all of the dietary potassium intake is absorbed in the intestine, over 90% of which is excreted by the kidneys regarded as the most important organ of potassium excretion in the body. The renal excretion of potassium results primarily from the secretion of potassium by the principal cells in the aldosterone-sensitive distal nephron (ASDN), which is coupled to the reabsorption of Na+ by the epithelial Na+ channel (ENaC) located at the apical membrane of principal cells. When Na+ is transferred from the lumen into the cell by ENaC, the negativity in the lumen is relatively increased. K+ efflux, H+ efflux, and Cl- influx are the 3 pathways that respond to Na+ influx, that is, all these 3 pathways are coupled to Na+ influx. In general, Na+ influx is equal to the sum of K+ efflux, H+ efflux, and Cl- influx. Therefore, any alteration in Na+ influx, H+ efflux, or Cl- influx can affect K+ efflux, thereby affecting the renal K+ excretion. Firstly, Na+ influx is affected by the expression level of ENaC, which is mainly regulated by the aldosterone-mineralocorticoid receptor (MR) pathway. ENaC gain-of-function mutations (Liddle syndrome, also known as pseudohyperaldosteronism), MR gain-of-function mutations (Geller syndrome), increased aldosterone levels (primary/secondary hyperaldosteronism), and increased cortisol (Cushing syndrome) or deoxycorticosterone (hypercortisolism) which also activate MR, can lead to up-regulation of ENaC expression, and increased Na+ reabsorption, K+ excretion, as well as H+ excretion, clinically manifested as hypertension, hypokalemia and alkalosis. Conversely, ENaC inactivating mutations (pseudohypoaldosteronism type 1b), MR inactivating mutations (pseudohypoaldosteronism type 1a), or decreased aldosterone levels (hypoaldosteronism) can cause decreased reabsorption of Na+ and decreased excretion of both K+ and H+, clinically manifested as hypotension, hyperkalemia, and acidosis. The ENaC inhibitors amiloride and Triamterene can cause manifestations resembling pseudohypoaldosteronism type 1b; MR antagonist spironolactone causes manifestations similar to pseudohypoaldosteronism type 1a. Secondly, Na+ influx is regulated by the distal delivery of water and sodium. Therefore, when loss-of-function mutations in Na+-K+-2Cl- cotransporter (NKCC) expressed in the thick ascending limb of the loop and in Na+-Cl- cotransporter (NCC) expressed in the distal convoluted tubule (Bartter syndrome and Gitelman syndrome, respectively) occur, the distal delivery of water and sodium increases, followed by an increase in the reabsorption of Na+ by ENaC at the collecting duct, as well as increased excretion of K+ and H+, clinically manifested as hypokalemia and alkalosis. Loop diuretics acting as NKCC inhibitors and thiazide diuretics acting as NCC inhibitors can cause manifestations resembling Bartter syndrome and Gitelman syndrome, respectively. Conversely, when the distal delivery of water and sodium is reduced (e.g., Gordon syndrome, also known as pseudohypoaldosteronism type 2), it is manifested as hypertension, hyperkalemia, and acidosis. Finally, when the distal delivery of non-chloride anions increases (e.g., proximal renal tubular acidosis and congenital chloride-losing diarrhea), the influx of Cl- in the collecting duct decreases; or when the excretion of hydrogen ions by collecting duct intercalated cells is impaired (e.g., distal renal tubular acidosis), the efflux of H+ decreases. Both above conditions can lead to increased K+ secretion and hypokalemia. In this review, we focus on the regulatory mechanisms of renal potassium excretion and the corresponding diseases arising from dysregulation.

PLA2R1 and HLA-DQA1 gene variations in idiopathic membranous nephropathy in South China

INTRODUCTION@#Associations of variations in PLA2R1 and HLA-DQA1 genes with susceptibility to idiopathic membranous nephropathy (IMN) have been well documented. Association with spontaneous remission, however, is poorly defined in the Chinese Han population.@*METHODS@#A Chinese cohort of 117 IMN patients and 138 healthy controls were recruited between July 2009 and November 2019. Case-control studies for single-nucleotide polymorphisms (SNPs) within HLA-DQA1 (rs2187668) and PLA2R1 (rs35771982, rs4664308, rs3749117, rs3749119) genes were performed. The contributions of these polymorphisms to predict susceptibility, titre of autoantibodies against the M-type phospholipase A2 receptor (anti-PLA2R1), glomerular PLA2R1 expression, and spontaneous remission were analysed.@*RESULTS@#We found that variations in PLA2R1 (SNPs rs35771982, rs4664308, rs3749117) were strongly associated with IMN susceptibility, while SNP (rs2187668) within HLA-DQA1 did not increase the risk of IMN. All SNPs in PLA2R1 and HLA-DQA1 were not statistically associated with anti-PLA2R1 titre, glomerular PLA2R1 expression and spontaneous remission after Bonferroni correction (@*CONCLUSION@#This study confirms that variations in PLA2R1 (SNPs rs35771982, rs4664308, rs3749117) are risk factors for IMN. We found excellent association of serum albumin level, anti-PLA2R1 titre and glomerular PLA2R1 positivity with non-spontaneous remission in IMN.

Application of three artemisinin derivatives in neuropathic pain: evaluating co-curation of nociceptive and emotional syndromes in spinal cord ligation mice / 中国中药杂志

In this study, on aspects of the nociceptive, anxiety and depressive syndromes in neuropathic pain (NP), the effects of dihydroartemisinine (DHA), artesunate (ART) and artemether (ARTN) (40 mg·kg⁻¹) were analyzed in the spinal cord ligation (SNL) mice. Clinical equivalent dose of the first-line drug for NP, pregabalin (PGB, 25 mg·kg⁻¹) and amitriptyline (ARP, 20 mg·kg⁻¹), were used as positive controls. General, from day 7 to 14, significant remissions of the nociceptive, anxiety and depressive behaviors were achieved by DHA, ART and ARTN separately. Moreover, on day 14, on aspects of the nociceptive behaviors, analyzed 1.5 h after the gavage administration, no significant difference between the shamed mice and mice administrated with DHA, ART and ARTN was detected; analyzed 3 h after the gavage, significant decreases of pain thresholds in ARTN, but not in DHA nor ART group, were detected as compared with thresholds measured 1.5 h; analyzed 24 h after gavage, pain thresholds in DHA, ART and ARTN were still higher than PGB, in spite of the significant decreases as compared to Sham group. On aspects of the anxiety and depressive behaviors, no significant difference was detected between the shamed mice and mice administrated with DHA nor ART. However, differences still remained between the shamed ones and ones administrated with ARTN. Preliminarily, the effects of DHA, ART and ARTN were consolidated in SNL mice. On aspects of the duration of analgesic effects and the control of negative emotion, ART and ARTN were proven more favorable than ARTN.

Renal Phospholipase A2 Receptor and the Clinical Features of Idiopathic Membranous Nephropathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>According to the renal phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (iMN) could be categorized into PLA2R-associated and non-PLA2R-associated iMN. This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN.</p><p><b>METHODS</b>A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study. Renal PLA2R expression was examined by immunofluorescence. Among these patients, 186 (80.5%) with complete baseline clinical data were used for further study. Urinary protein excretion, serum albumin, and creatinine were analyzed. For those patients with follow-up longer than 1 year, the relationship between PLA2R and response to immunosuppressants were analyzed. The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis. Categorical variables were described as frequencies or percentages, and the data were analyzed with Pearson's Chi-square test or Fisher's exact test.</p><p><b>RESULTS</b>Of the 231 iMN patients, 189 showed renal detectable PLA2R expression (81.8%). The baseline serum creatinine, serum albumin, and urine protein excretion were not significantly different between PLA2R-associated (n = 145) and non-PLA2R-associated iMN patients (n = 41). However, about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests, significantly more common than PLA2R-associated iMN (31.7% vs. 8.3%, P = 0.000). The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN (P = 0.004). The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants (complete remission [CR] 42.9%; partial remission [PR] 14.3%) compared with PLA2R-associated iMN (CR 3.2%; PR 48.4%, P = 0.004) at the 3rd month.</p><p><b>CONCLUSIONS</b>There were no significant differences in serum creatinine, albumin, and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN, while the non-PLA2R-associated iMN patients showed more abnormal serological tests. The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with PLA2R-associated iMN.</p>

Comparison of Biological Characteristics and Immunosuppressive Activity between Human Amniotic Mesenchymal Stem Cells and Human Bone Marrow Mesenchymal Stem Cells / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To compare the biological characteristics and immunosuppressive activity between human amniotic mesenchymal stem cells (hAMSC) and human bone marrow mesenchymal stem cells (hBMMSC).</p><p><b>METHODS</b>MSC from human amnion and bone marrow were isolated using enzymatic digestion and Ficoll-Hypaque density gradients, respectively. Their biological characteristics were compared by morphology, cell growth curves, cell cycle profile analysis, immunophenotype and immunofluorescence assay. Their immunosuppressive activities were studied on total activated T-cells with phytohemagglutinin (PHA-PBMSC). An in vitro co-culture was performed to compared the lymphocyte proliferation and the supernatant level of IFN-γ were measured by CCK-8 method and ELISA, respectively.</p><p><b>RESULTS</b>Both hAMSC and hBMMSC demonstrated fibroblast-like morphology. The hAMSC were able to be amplified for at least 15 passages, while the hBMMSC only for 6-7 passages. There was no significant difference in the proportion of G2/M phase cells of the 2 cells types (P>0.05). By FACS analysis for immunophenotype, both MSC were shown to be positive for CD105, CD90, CD73 and negative for CD34, CD45, CD11b, CD19, HLA-DR, but hAMSC were positive for Oct-3/4, which was in contrast to hBMMSC. Both of them expressed vimentin. Both the cells exhibited a inhibitory role on the lymphocyte proliferation induced by PHA in co-culture conditions, that was increased with the increase MSC proportion and both the suppressing effecs were enhanced. The supernatant IFN-γ levels of hAMSC co-cultured with lymphocyte at a ratio of 1:1 after 72 hours were measured by ELISA, and the level of IFN-γ was significantly lower than that in the same co-culture system of hBMMSC. In contrast to the IFN-γ in the PHA-stimulated group, the IFN-γ level in both co-culture groups was significantly lower.</p><p><b>CONCLUSION</b>MSC from amnion displayed a higher proliferative capacity and stem cell properties, compared with hBMMSC. Both MSC can inhibit lymphocyte proliferation and suppress IFN-γ secretion induced by PHA in vitro.</p>

Rituximab-induced interstitial pneumonitis: report of two cases and literature review / 南方医科大学学报

We report two cases of rituximab (RTX)-induced interstitial pneumonia in two lymphoma patients receiving RTX treatment. Interstitial pneumonia was successfully managed in these two cases after a one-week-long intervention with corresponding treatments without affecting further treatment of the primary disease. RTX-induced interstitial pneumonia is characterized by a latent onset with an unclear pathological mechanism and absence of typical symptoms. High-resolution CT scan can provide valuable evidence for early diagnosis of RTX-induced interstitial pneumonia, which might be attributed partially to an increased susceptibility to P. jirovecii and fungal infection due to prolonged RTX treatment.

Effect of simulated microgravity on erythroid differentiation of K562 cells and the mechanism / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of simulated microgravity on erythroid differentiation of K562 cells and explore the possible mechanism.</p><p><b>METHODS</b>The fourth generation rotating cell culture system was used to generate the simulated microgravity environment. Benzidine staining was used to evaluate the cell inhibition rate, and real-time quantitative PCR (qRT-PCR) was used to detect GATA-1, GATA-2, Ets-1, F-actin, β-Tubulin and vimentin mRNA expressions. The changes of cytoskeleton were observed by fluorescence microscopy, and Western blotting was employed to assay F-actin, β-tubulin and vimentin protein expression levels.</p><p><b>RESULTS</b>Benzidine staining showed that simulated microgravity inhibited erythroid differentiation of K562 cells. K562 cells treated with Hemin presented with increased mRNA expression of GATA-1 and reduced GATA-2 and Ets-1 mRNA expressions. Simulated microgravity treatment of the cells resulted in down-regulated GATA-1, F-actin, β-tubulin and vimentin mRNA expressions and up-regulated mRNA expressions of GATA-2 and Ets-1, and reduced F-actin, β-tubulin and vimentin protein expressions. Exposure to simulated microgravity caused decreased fluorescence intensities of cytoskeletal filament F-actin, β-tubulin and vimentin in the cells.</p><p><b>CONCLUSION</b>Simulated microgravity inhibits erythroid differentiation of K562 cells possibly by causing cytoskeleton damages to result in down-regulation of GATA-1 and up-regulation of GATA-2 and Ets-1 expressions.</p>

Changes and clinical significance of serum 25-hydroxy-vitamin D levels in rheumatoid arthritis / 中华风湿病学杂志

Objective To determine the serum level of 25-hydroxyvitamin D[25(OH)D] in rheumatoid arthritis (RA) patients and to assess the association of 25(OH)D with clinical presentations.Methods Serum 25(OH)D levels were detected by enzyme-linked immunosorbent assay (ELISA) in 130 cases with RA and 80 healthy controls.The detailed clinical data of the RA patients were recorded and bone mineral density (BMD) were measured by dual-energy X-ray absor-ptiometry (DXA).Sharp score of both hands were measured for evaluating the effects of 25(OH)D on bone erosion.T-test and one-way ANOVA test were used for data analysis,and x2 test was used to compare the differences between groups.Pearson's test was adsopted for correlation analysis.Muhi-variate analysis and Logistic analysis were carried out for risk factors identification.Results ① The serum levels of 25 (OH)D were markedly lower in the RA group than the control group [(17±6) ng/ml vs (23±6) ng/ml,t=-6.624,P＜0.01],while cases of 25(OH)D insufficiency/deficiency in the RA group were more than the control group (98.5％ vs 81.5％,x2=26.291,P＜0.01); ② Negative correlation was detected between 25(OH) D levels and the following:duration of morning stiffness,tender joint count (TJC),swollen joint count (SJC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),health assessment questionnaire (HAQ) of the patients with RA (r=-0370,-0.307,-0.243,-0.369,-0.175,-0.381,both P＜0.05),respectively; ③ 25 (OH)D levels were signific-antly lower in group with moderate and severe disease activity than in group with stable or low disease activity (both P＜0.05); Insufficiency/deficiency of 25 (OH)D was the risk factor for disease activity by multiple regression analysis (b=-0.46,P=0.029); ④ No statistically significant association was detected between 25(OH)D and degree of bone erosion in RA (P＞0.05); ⑤ BMD was classified into three groups:normal,osteopenia and osteoporosis,and significant differences of serum 25(OH)D levels were found by compared with each group (P＜0.01).Normal serum 25 (OH)D level was a protective factor for RA-induced osteoporosis by Logistic rcgression analysis (OR=0.898,95％CI 0.830-0.972,P=0.008).Conclusion Significantly low 25 (OH)D level could be found in patients with RA.Negative correlation is detected between 25 (OH)D level and disease activity and osteoporosis respectively in patients with RA.Insufficiency/deficiency of 25 (OH)D is the risk factor for disease activity and RA-induced osteoporosis.

Study on family and economic burden caused by chronic Schistosomiasis japonica / 中华流行病学杂志

Objective To evaluate the family and economic burden of chronic Schistosomiasis japonica. Methods Relevant information on 226 chronic schistosomiasis patients from four surveillance sites in Yangxin county was collected. A questionnaire survey was conducted on 219 of them who agreed to corporate. Family burden was estimated with standard Family Burden Scale of Disease (FBS). Direct economic burden was calculated by questionnaire survey. Human capital method combined with Years Lived with Disability (YLDs) was adopted to evaluate the indirect economic burden. Results The positive rates on the dimensions of family economic burden and family entertainment were 54.8 percent and 47.0 percent respectively. The remaining dimensions were lower than 40.0 percent. Results of the questionnaire survey among 219 chronic Schistosomiasis patients showed that the total economic burden was 353 480.59 Chinese Yuan, which was 1614.07 Yuan per person. The direct and indirect economic burden were 61 679 and 291 801.59 Yuan respectively. The average direct and indirect economic burden when counted on money losses, were 281.64 and 1332.43 Yuan per person, respectively. Conclusion The family burden caused by chronic Schistosomiasis japonica was serious, economically in particular. With regard to the income level of local residents, the economic burden of chronic Schistosomiasis was heavy to every household with indirect economic burden accounted for major proportion, suggesting close attention to be paid.

Study on the reliability, validity and sensitivity of a Family Burden Scale used for evaluation on schistosomiasis / 中华流行病学杂志

Objective To evaluate the reliability, validity and sensitivity of a Family Burden Scale (FBS) of disease used on schistosomiasis. Methods 224 schistosomiasis patients were investigated, using the FBS. Reliability was estimated by Cronbach's α coefficient and split-half reliability. Validity was tested by factor analysis. Sensitivity was evaluated by comparison of patients with different income levels. Results The Cronbach's α coefficient was 0.874 and split-half reliability was 0.939 for FBS, respectively. Most values of Cronbach's α and split-half reliability for each component of scale were above 0.70. Construct validity was appraised by factor analysis, and 6 factors were identified. These factors could explain 66.76 % of the total variance. Patients with different income levels showed significant difference in terms of family burden for schistosomiasis (P<0.001 ). Conclusion This FBS appeared to have satisfactory reliability, validity and sensitivity and could be used in evaluating family burden of schistosomiasis patients.

Study on the factors influencing the quality of life among patients with malignant lymphoma / 中华流行病学杂志

<p><b>OBJECTIVE</b>To measure and assess the quality of life (QOL) and to explore the influencing factors on patients with malignant lymphoma.</p><p><b>METHODS</b>QOL of 110 patients with malignant lymphoma were marked using EORTC QLQ-C30 short form, and multiple linear regression models were used to study the main factors influencing the QOL of patients with malignant lymphoma on five functional scales (physical, role, cognitive, emotional, and social) and the total scores.</p><p><b>RESULTS</b>The influencing factors of quality of life on patients with malignant lymphoma appeared to be: history of relapse, refraining from smoking, older age, educational level, space for living, exercises, medical care system, and available health care programs. Relapse (beta = 5.997, P= 0.020) and refraining from smoking (beta = -6.526, P= 0.006) were associated with total QOL scores, educational level (beta = -2.144, P= 0.057), History of relapse (beta = 5.857, P = 0.003) was associated with total functional scales while exercises (beta= -0.771, P = 0.097) and refraining from smoking (beta= -4.106, P = 0.005) were with physical scales, refraining from smoking (beta = -4.644,P = 0.008) and older age (beta = 0.989, P= 0.029) were with role scales, relapse (beta = 14.035, P= 0.001) and older age (beta = 2.230, P= 0.023) were with cognitive scales, relapse (beta = 8.500, P= 0.031) and living space (beta = - 3.054, P= 0.0901) were with emotional scales and medical care system and available health care programs (beta = -6.577, P= 0.018) were with social scales respectively.</p><p><b>CONCLUSION</b>Factors as prevention of relapse, correct cognition on malignant lymphoma, reasonable exercise, refrain from bad habits, improving medical care system could all increase the functions of malignant lymphoma patient, and to improve their quality of life.</p>

Study on the relations between serum insulin-like growth factor-1, insulin-like growth factor binding protein-3 and colorectal cancer: a meta-analysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between circulating levels of insulin-like growth factor-1 (IGF-1), IGF-binding protein-3 (IGFBP-3) and colorectal cancer.</p><p><b>METHODS</b>A meta-analysis of 6 epidemiological studies on insulin-like growth factors and risk of colorectal cancer were performed.</p><p><b>RESULTS</b>The pooled odds ratio (OR) of IGF-1 and IGFBP-3 were 1.56 (95% CI: 1.14-2.13) and 0.78 (95% CI: 0.43-1.44) respectively. According to the results from different measurements (enzyme-linked immunoabsorbent assay and immunoradiometric assay), the pooled OR were 1.92 and 1.23 for IGF-1, 0.46 and 1.44 for IGFBP-3 respectively.</p><p><b>CONCLUSION</b>High serum levels of IGF-1 were independent risk factors of colorectal cancer but the OR of IGFBP-3 was not statistically significant. The heterogeneity between studies on IGFBP-3 and colorectal cancer was caused by different measurements used, but there was still a need to conduct simultaneous large size study under 2 different measurements for further conclusion.</p>