A single-center study on the distribution and antibiotic resistance of pathogens causing bloodstream infection in patients with hematological malignancies / 中华血液学杂志

Objective: To study the incidence of bloodstream infections, pathogen distribution, and antibiotic resistance profile in patients with hematological malignancies. Methods: From January 2018 to December 2021, we retrospectively analyzed the clinical characteristics, pathogen distribution, and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology, Nanfang Hospital, Southern Medical University. Results: A total of 582 incidences of bloodstream infections occurred in 22,717 inpatients. From 2018 to 2021, the incidence rates of bloodstream infections were 2.79%, 2.99%, 2.79%, and 2.02%, respectively. Five hundred ninety-nine types of bacteria were recovered from blood cultures, with 487 (81.3%) gram-negative bacteria, such as Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. Eighty-one (13.5%) were gram-positive bacteria, primarily Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecium, whereas the remaining 31 (5.2%) were fungi. Enterobacteriaceae resistance to carbapenems, piperacillin/tazobactam, cefoperazone sodium/sulbactam, and tigecycline were 11.0%, 15.3%, 15.4%, and 3.3%, with a descending trend year on year. Non-fermenters tolerated piperacillin/tazobactam, cefoperazone sodium/sulbactam, and quinolones at 29.6%, 13.3%, and 21.7%, respectively. However, only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics. Conclusions: Bloodstream pathogens in hematological malignancies were broadly dispersed, most of which were gram-negative bacteria. Antibiotic resistance rates vary greatly between species. Our research serves as a valuable resource for the selection of empirical antibiotics.

Research advances in the interspecies transmission of hepatitis E virus / 临床肝胆病杂志

‍Hepatitis E virus （HEV） is a pathogen for viral hepatitis and can be transmitted across species via animals. The incidence rate of hepatitis E caused by HEV infection ranks first among acute viral hepatitis worldwide， and now it has become a major public health issue that threatens human health. In recent years， more and more species have been identified as the natural hosts of HEV， and there are more routes for the interspecies transmission of HEV， which greatly inhibits the prevention and control of this virus. Therefore， this article reviews and discusses the advances in the interspecies transmission of HEV， so as to provide a reference for the prevention and control of HEV.

Mammary myofibroblastoma: a clinicopathological analysis of fifteen cases / 中华病理学杂志

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of breast myofibroblastoma. Methods: The clinicopathological data and prognostic information of 15 patients with breast myofibroblastoma diagnosed at the Department of Pathology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from 2014 to 2022 were collected. Their clinical characteristics, histological subtypes, immunophenotypes and molecular characteristics were analyzed. Results: There were 12 female and 3 male patients, ranging in age from 18 to 78 years, with a median and average age of 52 years. There were 6 cases in the left breast and 9 cases in the right breast, including 12 cases in outer upper quadrant, 2 cases in inner upper quadrant and 1 case in outer lower quadrant. Most of the cases showed a well-defined nodule grossly, including pushing growth under the microscope in 13 cases, being completely separated from the surrounding breast tissue in 1 case, and infiltrating growth in 1 case. Among them, 12 cases were classic subtype and composed of occasional spindle cells with varying intervals of collagen fiber bundles; eight cases had a small amount of fat; one case had focal cartilage differentiation; one case was epithelioid subtype, in which epithelioid tumor cells were scattered in single filing or small clusters; one case was schwannoma-like subtype, and the tumor cells were arranged in a significant palisade shape, resembling schwannoma, and one case was invasive leiomyoma-like subtype, in which the tumor cells had eosinophilic cytoplasm and were arranged in bundles, and infiltrating into the surrounding mammary lobules like leiomyoma. Immunohistochemical studies showed that the tumor cells expressed desmin (14/15) and CD34 (14/15), as well as ER (15/15) and PR (15/15). Three cases with histologic subtypes of epithelioid subtype, schwannoma-like subtype and infiltrating leiomyoma-like subtype showed RB1 negative immunohistochemistry. Then FISH was performed to detect RB1/13q14 gene deletion, and identified RB1 gene deletion in all three cases. Fifteen cases were followed up for 2-100 months, and no recurrence was noted. Conclusions: Myofibroblastoma is a rare benign mesenchymal tumor of the breast. In addition to the classic type, there are many histological variants, among which the epithelioid subtype is easily confused with invasive lobular carcinoma. The schwannoma-like subtype is similar to schwannoma, while the invasive subtype is easily misdiagnosed as fibromatosis-like or spindle cell metaplastic carcinoma. Therefore, it is important to recognize the various histological subtypes and clinicopathological features of the tumor for making correct pathological diagnosis and rational clinical treatment.

Clinicopathological characteristics of natural killer cell enteropathy: report of two cases and review of literature / 中华病理学杂志

Objective: To study the clinicopathological and genetic features of natural killer (NK)-cell enteropathy for better understanding of this rare disease and prevention of its misdiagnosis. Methods: Two cases of NK-cell enteropathy were diagnosed in the First Affiliated Hospital of Zhengzhou University, China from October 2017 to February 2021. The clinical characteristics, morphology, immunohistochemistry, Epstein-Barr virus-encoded RNA (EBER) in situ hybridization and T cell receptor gene rearrangement were analyzed. The patients were followed up by a telephone interview. Results: The patients were both male, aged 40 and 28 years, respectively. Both patients were admitted to the hospital for an annual checkup without obvious gastrointestinal symptoms. The endoscopy showed that the gastric body of case 1 had a mucosal bulge, small area of congestion and erosion, while the rectum of case 2 had congestion and erosion. Microscopically, the lesions of the 2 cases were relatively limited. Many lymphoid cells infiltrated within the lamina propria of the mucosa and into the muscularis mucosa in case 2. In case 1, the glands were reduced in the lesion, and the glandular cavity was slightly compressed and deformed. There was no infiltration or destruction of the glands in either case. Lymphoid cells were atypical, with medium-to-large cell sizes. Their cytoplasm was medium-to-slightly abundant and appeared eosinophilic or translucent. In case 2, characteristic eosinophilic granules were seen in the cytoplasm of a few cells. The nuclei in both cases were round, oval and irregular, with fine chromatin, inconspicuous nucleoli, and no mitotic figures were noted. Necrosis was seen in case 1 while both cases had no central growth or destruction of blood vessels. Immunophenotyping showed that CD56, granzyme B and TIA-1 were positive in both cases, part of the cells was CD3-positive, and some cells were weakly CD4-positive in case 2. The CD5, CD8, CD30, ALK and B-lineage markers (CD20, CD79α) were all negative. The Ki-67 proliferation index was about 60% and 30%, respectively. Both cases were EBER negative. TCR gene rearrangement was polyclonal. Follow-up showed that none of the 2 patients had any special treatments and stayed well. Conclusions: NK-cell enteropathy is rare, with biological behaviors similar to benign tumors, and occasional recurrence. Its histology and immunophenotype are easily confused with NK/T cell-derived lymphomas. Combination of its unique endoscopic features, EBER negativity, polyclonal TCR gene rearrangement and good prognosis can confirm the diagnosis and avoid misdiagnosis and overtreatment.

Prognostic significance of IKZF1 gene deletions in patients with B-cell acute lymphoblastic leukemia / 中华血液学杂志

Objective: This study aimed to investigate the prognostic significance of IKZF1 gene deletion in patients with acute B lymphoblastic leukemia (B-ALL) . Methods: The clinical data of 142 patients with B-ALL diagnosed in Nanfang Hospital between March 2016 and September 2019 were analyzed. Results: IKZF1 deletion was found in 36.0% of the 142 patients with B-ALL, whereas exon 4-7 deletion was found in 44.0% . White blood cell counts were higher in patients with the IKZF1 deletion (52.0% and 28.3% , P=0.005) ; these patients also experienced worse effects of mid-term induction therapy (40.0% and 70.7% , P<0.001) and had a higher proportion of Philadelphia chromosome-positive (52.0% and 21.7% , respectively, P<0.001) . Univariate analysis revealed that the 3-year overall survival rate (OS) and event-free survival rate (EFS) in the IKZF1 deletion group were significantly lower than the IKZF1 wild-type group [ (37.1±7.3) % vs (54.7±5.4) % , (51.8±7.9) % vs (73.9±4.7) % ; P=0.025, 0.013, respectively]. Multivariable analysis showed that harboring IKZF1 deletion was an adverse factor of EFS and OS (HR=1.744, 2.036; P=0.022, 0.020, respectively) . Furthermore, the IKZF1 deletion/chemotherapy group had significantly lower 3-year OS, EFS, and disease-free survival rates than other subgroups. In the IKZF1 deletion cohort, allo-hematopoietic stem cell transplantation (HSCT) significantly improved OS and EFS compared to non-allo-HSCT[ (67.9±10.4) % vs (31.9±11.0) % , (46.6±10.5) % vs (26.7±9.7) % ; P=0.005, 0.026, respectively]. Conclusion: Pediatric-inspired chemotherapy was unable to completely reverse the negative effect of IKZF1 deletion on prognosis. Pediatric-inspired regimen therapy combined with allo-HSCT, in contrast, significantly improved the overall prognosis of IKZF1 deletion B-ALL.

Expression and Significance of BLIMP-1 in Regulatory T Cells of Children with Aplastic Anemia / 中国实验血液学杂志

OBJECTIVE@#To study the expression of B lymphocyte-induced mature protein-1 (BLIMP-1) in regulatory T cells (Tregs) of children with aplastic anemia (AA), and analyze its correlation with the number of Tregs and the levels of inhibitory cytokines interleukin (IL)-10 and transforming growth factor (TGF)-β in plasma.@*METHODS@#The peripheral blood samples of 10 newly diagnosed AA children and 10 healthy children were collected for experiment. qPCR was used to detect FOXP3 and PRDM1 mRNA expression levels. Flow cytometry was used to detect the proportion of Tregs, the expression of BLIMP-1 in Tregs, and the levels of cytokines such as IL-2, IL-17A, IL-6, interferon (IFN)-γ, IL-10 and TGF-β in plasma. Pearson correlation model was used to evaluate the relationship between the expression of BLIMP-1 in Treg and the number of Tregs, as well as the levels of IL-10 and TGF-β in plasma.@*RESULTS@#Compared with control group, the proportion of Tregs in peripheral blood of AA children was decreased significantly (P<0.001); The plasma levels of proinflammatory cytokines IL-2, IL-6 and IFN-γ in AA children were increased significantly (P=0.033, P=0.031, P=0.006), and IL-17A also was increased but the difference was not statistically significant (P=0.052), while anti-inflammatory cytokines IL-10 and TGF-β were significantly reduced (P=0.048, P=0.002). The relative expressions level of FOXP3 and PRDM1 mRNA in AA children were significantly lower than those in control group (P=0.037, P=0.016). The expression of BLIMP-1 protein in Tregs of AA children was significantly lower than that in control group (P<0.001). The expression level of BLIMP-1 protein in Tregs was positively correlated with the percentage of Tregs in lymphocytes (r=0.671, P=0.001), and was also positively correlated with the levels of IL-10 and TGF-β in plasma (r=0.500, P=0.029; r=0.486, P=0.030).@*CONCLUSION@#The expression of BLIMP-1 in Tregs of AA children is impaired, and the low expression of BLIMP-1 is related to the decrease of the number in Tregs and IL-10 and TGF-β expressions.

Clinical Characteristics and Prognosis of Elderly Patients with Medium and High risk Myelodysplastic Syndrome / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinical characteristics and prognosis of patients with medium and high risk myelodysplastic syndrome (MDS).@*METHODS@#97 MDS patients above the age of 60 treated in Nanfang Hospital, Southern Medical University from February 2011 to August 2020 were enrolled. The clinical characteristics and prognosis of the MDS patients with medium risk, high risk or very high risk based on IPSS-R category were retrospectively analyzed. According to the difference of treatment regimes, the patients were divided into the transplantation group, chemotherapy group and other treatment group, and the efficacy among the patients in the 3 groups were analyzed.@*RESULTS@#MDS with excess blast (MDS-EB) in the elderly patients with medium and high risk MDS were the most common, 47.4% of the patients with abnormal chromosome karyotypes, and 23.7% with complex karyotypes (≥3). 97.3% of the patients showed at least one gene mutation, and TP53 mutations were detected in nearly 20% of the patients with medium and high risk. Multivariate analysis showed that IPSS-R category and treatment regimes were the factors affecting the prognosis of elderly patients with medium and high risk MDS. The median overall survival (OS) time of the patients in the 3 groups showed significant difference (P=0.012), and the median OS of the patients in the transplantation group was significantly longer than that in the chemotherapy group and other group (P=0.003,P=0.014,respectively), while there was no significant difference in median OS between chemotherapy group and other treatment group (P=0.685).@*CONCLUSION@#Elderly MDS patients with medium and high risk can benefit from allogeneic hematopoietic stem cell transplantation, which will prolong their OS.

Clinical and Experimental Research Progress of Wulingsan in Treatment of Renal Diseases： A Review / 中国实验方剂学杂志

Wulingsan， a classic prescription first recorded in the Treatise on Cold Damage （Shang Han Lun） by ZHANG Zhong-jing for patients with water retention syndrome due to the disturbance of Qi transformation in bladder， has often been modified by ancient and modern doctors for the treatment of renal diseases. It produced satisfactory outcomes without inducing adverse reactions. The databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， and PubMed were searched for articles concerning the clinical application and pharmacological mechanism of Wulingsan in the treatment of renal diseases published by domestic and foreign scholars in recent years. The summary of the included articles revealed that Wulingsan has been widely employed for the treatment of renal edema， diabetic nephropathy， acute and chronic glomerulonephritis， nephrotic syndrome， renal insufficiency， abnormal urination， etc.， and the resulting outcomes were satisfactory. Wulingsan alone or in combination with western medicine yielded better clinical outcomes than the western medicine alone. In the exploration of its pharmacological mechanism， there existed some individual reports by Korean scholars， while Chinese scholars tended to work as a team. After years of research， each team has found that Wulingsan was superior to Wulingsan decoction in excreting water， which might be related to the absence of massive low-polarity and volatile components in the decoction that were responsible for regulating the expression of aquaporins （AQP） in kidney of saline-loaded rats. Wulingsan regulates the endocrine state of rats with kidney yang deficiency， inhibits the reabsorption of water， increases the activity of Na+-K+-ATPase， and reduces the expression of AQP 1， AQP 2， AQP 3， and AQP 4. Besides， it bi-directionally regulates the human water metabolism， which is achieved via the dual-directional regulation of purinergic P2X3 receptor expression on bladder detrusor. The efficacy of Wulingsan in treating chronic renal failure is attributed to its protection against the damaged renal tissue，structure and fanction. Hence， this paper summarized the research progress of Wulingsan in the treatment of renal diseases in recent years， aiming to provide a reference for the clinical and basic exploration of Wulingsan against renal diseases in the future.

Relationships Between Expression level of MicroRNA-146a, STAT1 Protein and Clinical Characteristics in Children with Acute Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the relationships between expression levels of serum microRNA-146a, STAT1 protein and clinical characteristics in children with acute lymphoblastic leukemia (ALL).@*METHODS@#A total of 102 children diagnosed as ALL in our hospital from June 2014 to June 2016 were enrolled, and were compared by into groups according to clinical characteristics including sex, age, lymphocyte type, disease risk, chemotherapy stage and gene mutation. Fifty healthy children were chosen as control group. The relative expression of microRNA-146a and STAT1 gene was detected by real-time RT-PCR and the relative level of STAT1 protein was detected by Western blot. The difference of microRNA-146a and STAT1 protein levels between clinical factors and laboratory indexs were compared. Followed-up for 3 years, The difference of overall survival (OS) rates between ALL children with different microRNA-146a and STAT1 protein were compared.@*RESULTS@#The levels of microRNA-146a, STAT1 mRNA and protein in ALL children were significantly higher than those in control group (P＜0.05), but there were no significantly differences in sex, age and lymphocyte type grouping in ALL children (P＞0.05). There were significantly differences in different disease risk, chemotherapy stage and gene mutation groups in ALL children (P＜0.05). Followed-up for 3 years, the OS rate of ALL children with high microRNA-146a and STAT1 protein levels were better than those with low microRNA-146a and STAT1 protein levels (P＜0.05).@*CONCLUSION@#The up-regulation of microRNA-146a and STAT1 protein may be involved in occurrence and development of ALL, which closely relates to clinical characteristics in ALL children, such as disease risk, chemotherapy stage and gene mutation.

Surveillance of antibody level of influenza among physical examination population of Shenzhen City from 2014 to 2018 / 上海预防医学

Objective To provide the basis for influenza epidemic prevention and control by monitoring the antibody level of influenza among the general population in Dapeng New District of Shenzhen City. Methods A total of 1 350 serum samples of people were collected ten times from 2014 to 2018, and the antibody level was tested by hemagglutination-inhibition test. Results During 2014-2018 years, only the positive rate of antibody to H3N2 was above 60%.The positive rates of H1N1, H3N2, BV and BY were 50.0%, 85.6%, 35.4% and 45.6%, respectively, and the geometric mean titers (GMT) of antibody were 8.2, 81.5, 3.9 and 6.4, respectively.Influenza antibody titers of 1 : 160 and 1 : 320 were mainly distributed in influenza H3N2.The antibody level of BV and BY in age group 0~4 years was 29.0% and 30.4% separately. Conclusion It is imperative to enhance the surveillance of antibody level of influenza among general population in Dapeng New District, to investigate the epidemic development trend of influenza constantly, and to prevent and control the outbreak of influenza epidemics.

Risk Analysis of Catheter-related Bloodstream Infection and Thrombosis in Patients with Blood Diseases Undergoing Peripheral Introvascular Central Catheter (PICC) / 中国实验血液学杂志

OBJECTIVE@#To evaluate the effects of peripheral introvascular central catheters (PICC) on the catheter-associated bloodstream infections (CRBSI) and the formations of catheter-related bloodstream infections.@*METHODS@#Total of 483 patients with hematologic malignancies admitted in our hospital from January 2013 to December 2016 were enrolled in this study, and 612 PICC catheterization were conducted. The median time of catheterization was 101 d (48 ∼ 184 d) . The incidence rates of CRBSI and CRTC were observed, and the CRBSI and CRTC associated variables were also analyzed.@*RESULTS@#There were 47 cases of CRBSI (7.7%), and the incidence was 0.59‰ PICC days, and there were 16 cases of CRTC (2.6%), with the incidence of 0.20‰ PICC days. Meanwhile, no other related serious complications found. The Cox regression analysis of CRBSI and CRTC-associated variables showed that the acute leukemia was significantly related with a higher incidence of CRBSI as compared with the other type of disease, however, which was not significantly related with the CRTC.@*CONCLUSION@#Compared with the traditional CVAD catheterization, the PICC is more safe and effective for the patients with malignant tumors, thus which may become a alternative method for CVAD.

Epidemiological characteristics of mumps in Hefei City from 2011 to 2016 / 中华疾病控制杂志

Objective To analyze the epidemiological characteristics of mumps in Hefei City from 2011 to 2016, in order to provide a basis for effective prevention of mumps. Methods The data of mumps in Hefei City from 2011 to 2016 was analyzed by descriptive epidemiology. Results There were a total of 9 678 cases of mumps in Hefei City from 2011 to 2016. The average annual incidence was 22.7/100 000, with the highest in 2013 being 40.56/100 000. Mumps had obvious seasonality with high incidence in spring. Mumps cases increased in winter but the peak was not distinct. The group with the largest number of cases was mainly students, accounting for 64.5% of the total number of cases, followed by childcare and residentially-scattered children. The average annual morbidity of nine counties existed differences( 2=256.845，P<0.001). Conclusions There was a high incidence of mumps in Hefei City from 2011 to 2016. More effective measures should be taken to prevent the incidence of mumps and reduce the spread of mumps virus.

Efficacy Observation of Addition and Subtraction Therapy of Xuanshen Ganju Tang Combined with Sanniutang to Post-infection Cough with Lung Injury Caused by Dryness and Heat / 中国实验方剂学杂志

Objective: To observe the clinical efficacy of addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang to post infection cough (PIC) with lung injury caused by dryness and heat, and investigate its effects on allergic inflammation and neurogenic inflammatory mediators.Method: One hundred and eighty eligible patients with PIC were randomly divided into control group (58 cases) and observation group (122 cases) according to the visiting sequence. Patients in control group got compound methoxyphenamine capsules, 2 capsules/time and tid. Patients in observation group got addition and subtraction therapy of Xuanshen Ganju Tang,combined with Sanniutang, 1 dose/day. The treatment course was 7 days in both groups. Symptom scores for cough (day and night), visual analogue scale of coughing (VAS) and scores for lung injury caused by dryness and heat injury were graded. Time to relieve a cough, time to relieve symptoms, time to vanish cough, and cough recurrence were recorded. Life quality was evaluated by cough-specific quality of life questionnaire (CQLQ), and the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8 and substance P in sputum neurogenic inflammatory mediators (SP), neuropeptide A (NKA) and calcitonin gene related peptide (CGRP) were detected.Result: Ridit analysis showed that the clinical efficacy in observation group was better than that in control group (PPPPα, IL-1β, IL-6, IL-8, SP, NKA and CGRP in observation group were all lower than those in control group (PConclusion: Addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang can control systems of cough, shorten coughing course, reduce recurrence rate, improve patients' life of quality, and can inhibit allergic inflammation and neurogenic inflammatory mediators in the treatment of PIC with symptom of lung injury caused by dryness and heat, with a better clinical efficacy than pure compound methoxyphenamine capsules.

Computational investigation of Artemisia pollen deposition in realistic nasal cavities of residents in northwest China / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the deposition rate of Artemisia pollen in different nasal cavity regions and its influence factors in residents of northwest China.@*Methods@#Thirty healthy adults from northwest China were enrolled. The computational fluid dynamics (CFD) and discrete phase model (DPM) were used for numerical simulation of nasal structures. The pollen deposition fraction in each anatomical part was counted and the effects of pollen density and breathing rate on deposition were analyzed. SPSS 19.0 software was used for statistical analysis.@*Results@#The hottest deposition parts of Artemisia pollen were nasal septum (30.70%±12.27%), vestibule (27.45%±8.21%), middle turbinate area (13.59%±8.98%) and nasopharynx (7.14%±5.90%). When the inspiratory flow rate increased to 30 L/min, the deposition rates of pollen in nasal vestibule and nasal septum were significantly higher than that at the rate of 15 L/min (43.20%±11.14% vs 27.45%±8.21%, 51.48%±9.77% vs 30.70%±12.27%, t value was -8.126,-5.264, respectively, all P<0.05), which indicated that with the increase of the inspiratory flow rate, the deposition hotspot moved forward. Compared with the wet Artemisia pollen, the deposition rate of the dry pollen in nasal vestibule and nasal septum decreased significantly (16.55%±4.33% vs 27.45%±8.21%, 7.09%±3.69% vs 30.70%±12.27%, t value was 8.669, 9.173, respectively, all P<0.05). The escape rate at outlet increased from 17.00%±9.57% to 43.48%±13.43% (t=-9.282, P<0.05).@*Conclusions@#The deposition of Artemisia pollen in nasal cavity is highly concentrated. The inhalation velocity and the dry-wet degree of pollen are the main determinants of the deposition site.

Efficacy comparison of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer / 肿瘤研究与临床

Objective To compare the efficacy of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer (NSCLC) and its effect on the immunity of patients. Methods A total of 82 patients with NSCLC at the First Affiliated Hospital of Hainan Medical College from June 2014 to May 2018 were retrospectively analyzed. According to the different treatment methods, the patients were divided into erlotinib group (150 mg/d, oral administration, 2 hours after the meal) and pemetrexed group (500 mg/m2, intravenous drip, 21-day each cycle). There were 41 cases in each group. The clinical effects of the two groups were analyzed. Flow cytometry was used to detect the immune index. Results The objective effective rate in pemetrexed group was lower than that in erlotinib group [34.2％ (14/41) vs. 39.0％ (16/41), χ 2 = 0.210, P =0.647). There was no significant difference in T lymphocyte subsets between the two groups before and after treatment (both P > 0.05). The values of CD3+ T cells, CD4+ T cells, CD4+ / CD8+ in both groups after the treatment were decreased compared with the values before the treatment; CD8 + T cells was increased after the treatment compared with the value before the treatment (all P < 0.05). Quality of life questionnaire-C30 (QLQ-C30) score in erlotinib group was higher than that in pemetrexed group [(75.1±13.5) vs. (68.9±12.9), t = 2.158, P = 0.017]. Myelosuppression and gastrointestinal reactions were the main adverse events in pemetrexed group; rashes and diarrhoea were the main adverse reactions in erlotinib group. Grade Ⅰ-Ⅱ side effects occurred in both groups. There were statistical differences in the incidence of myelosuppression, gastrointestinal reactions, rashes and diarrhoea of both groups (all P < 0.05). Conclusions The efficacy oferlotinib and pemetrexed in treatment of advanced NSCLC is similar, and both of them could regulate the immune response. Erlotinib has a significant advantage in improving the quality of life.

Extrahepatic damage characteristics and clinical manifestations of hepatitis E / 中华实验和临床病毒学杂志

Hepatitis E virus (HEV) is a pathogen of viral hepatitis that is considered to severely harm human health. HEV infection usually causes self-limited diseases. Chronic hepatitis E was reported in organ transplant recipients. HEV was considered as a hepatotropic virus, but multiple organs involvement causing various clinical symptoms was reported recently. The involved organs and the clinical manifestations of HEV infection are summarized in this review, which will benefit understanding the pathogenesis of HEV infection, and improving the clinical diagnosis.

Comprehensive Optimization of Rehabilitation Measures of Traditional Chinese Medicine to Elderly Patients with COPD at Stable Period / 中国实验方剂学杂志

Objective:To discuss the clinical efficacy of comprehensive optimization of rehabilitation measures of traditional Chinese medicine(TCM) on elderly patients with COPD at stable period, in order to study its effect on immune function and inflammatory factors. Method:One hundred and forty-four patients were randomly divided into control group and observation group by random number table. Patients in control group got ipratropium bromide, 40-80 μg/time, 2-4 times/days, salmeterol roticasone powder, 1 suction/time, 2 times/days, as well as comprehensive western medical treatment measures of healthcare education, oxygen therapy and respiratory muscle exercise. In addition to the basic therapy of ipratropium bromide and salmeterol roticasone powder, patients in observation group was added with syndrome differentiation therapy of TCM, foot bath with TCM and respiratory function exercise with TCM. The course of treatment was 6 months, and 6-month follow-up were recorded. Comprehensive assessment of COPD was recorded. Before and after treatment, respiratory questionnaire (mMRC), self-assessment test for patients with chronic obstructive pulmonary disease (CAT), forced expiratory volume in the first second (FEV1), FEV1%, St George's respiratory questionnaire (SGRQ), 6-minute walking distance (6 MWD) were scored. And levels of CD3+, CD4+, CD8+, CD4+/CD8+, interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and hypersensitive C-reactive protein (hs-CRP) were detected. Result:Comprehensive assessment of COPD in the two groups were better than those before treatment (PZ=2.066, Pα were lower than those in control group (P+ was lower than that in control group (P1 and FEV1% were higher than those in control group (P+, CD4+, CD4+/CD8+ and 6-minute walking distance were more than those in control group (PConclusion:Comprehensive optimization of rehabilitation measures in TCM can inhibit inflammatory factors, improve immune function, alleviate clinical symptoms, improve lung function, improve exercise endurance and quality of life of patients, and promote the lung rehabilitation.

Efficacy and safety observation of apatinib in treatment of advanced gastric cancer / 肿瘤研究与临床

Objective@#To investigate the effect and safety of apatinib in the treatment of advanced gastric cancer.@*Methods@#A total of 60 patients with advanced gastric cancer at the first Affiliated Hospital of Hainan Medical College from April 2015 to October 2018 were retrospectively analyzed, and all patients were divided into two groups according to the treatment method, each group of 30 cases. The control group was treated with conventional treatment, and the observation group was given the treatment of apatinib on the basis of the control group, and then the clinical curative effect and adverse reactions were compared between the two groups.@*Results@#There were 2 cases (6.67%) of complete remission in the observation group, 14 cases (46.67%) of partial remission, 10 cases (33.33%) of stability and 4 cases (13.33%) of disease progression, and the total effective rate was 53.33% (16/30). The control group had no complete remission, 8 cases (26.67%) of partial remission, 11 cases (36.67%) of stability and 11 cases (36.67%) of disease progression, and the total effective rate was 26.67% (8/30). The difference of total effective rate between the two groups was statistically significant (χ 2 = 4.444, P = 0.035). There was no significant difference in the level of tumor marker carcinoembryonic antigen (CEA), carbohydrate antigen (CA)199, CA125, cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) between the two groups before and after treatment (all P > 0.05). The incidence of hand-foot syndrome and hypertension in the observation group was higher than that in the control group [73.33% (22/30) vs. 43.33% (13/30), H = 5.554, P = 0.018; 76.67% (23/30) vs. 46.67% (14/30), H = 5.711, P = 0.017]. The incidence of proteinuria, bone marrow suppression and the cardiac adverse reactions in the observation group was higher than that in the control group [63.33% (19/30) vs. 33.33% (10/30), H = 3.300, P = 0.069; 60.00%(18/30) vs. 36.67% (11/30), H = 5.455, P = 0.071; 53.33% (16/30) vs. 30.00% (9/30), H = 3.360, P = 0.067].@*Conclusion@#Apatinib is effective in the treatment of advanced gastric cancer, but the occurrence of hand-foot syndrome and hypertension should be paid close attention during the treatment.

Composition and Drug Resistance of Pathogenic Isolates from CSF Culture of Pediatric Patients in Guangzhou / 现代检验医学杂志

Objective To explore the composition and drug resistance characteristics of pathogenic isolates from cerebrospinal fluid (CSF) cultures to facilitate empirical therapy of pediatric patients with meningitis in Guangzhou district.Methods During 2011 Jan 1st to 2015 Dec 31st,cerebrospinal fluids were collected from pediatric patients with suspected meningitis for regular culture,identification and drug susceptibility test of pathogenic isolates according to the national clinical laborato ry standard operation procedure,followed by analysis of their composition and drug resistance characteristics.Results There were 132 pathogenic isolates from CSF cultures,including Gram-positive strains (39.40％,52/132),Gram-negative strains (757.58％,6/132),fungi (3.03 ％,4/132),respectively.The main isolates were Escherichia coli (E.coli) (23.48％,31/132),Streptococcus pneumonia (S.pneumonia) (22.73％,30/132),Staphylococcus aureus (S.aureus) (12.12％,16/132)and Streptococcus agalactiae (S.agalactiae) (9.85％,13/132),respectively.E.coli had no resistance to piperacillin/tazobactam,furantoin,cefepime,amikacin,tobramycin,imipenem,ertapenem and meropenem.3.22 ％ resistance rate to cefotetan,9.38％ to ceftazidime,12.90 ％ to aztreonam,approximately 30 ％ to ampicillin/sulbactam,ofloxacin,ciprofloxacin,ceftriaxone,gentamycin,cefazolin,over 60 ％ to both sulfamethoxazole and ampicillin,31.25 ％ strains were ESBL positive.S.pneumonia had no re sis tance to ertapenem,5.88 ％ resistance rate to telithromycin,14.71％ to chloromycetin,17.76 ％ to ceftriaxone,23.53 ％ to amoxicillin,32.30 ％ to meropenem,35.29 ％ to cefotaxime,over 70 ％ to tetracycline,erythromycin,penicillin,and sulfamethoxazole.S.a ureus had no resistance to rifampicin,tigecycline,quinuprin/dupletin,linezolid and vancomycin,6.25％ resistance to ciprofloxacin,6.25％ to gentamicin,12.50％ to sulfamethoxazole,18.75％ resistance to clindamycin,31.25 ％ to tetracycline,62.50 ％ to erythromycin,over 90 ％ to cephalosporins and nearly 100 ％ to penicillin,the rate of MRSA strain was 56.25 ％.S.agalactiae had no resistance to penicillin,23.08 ％ resistance rate to ofloxacin,7.69 ％ to ciprofloxacin,over 60％ to tetracycline,erythromycin and clindamycin.Conclusion The main pathogenic isolates from CSF cultures were E.coli,S.pneumonia,S.aureus,S.agalactiae,different species of isolates have different drug resistance characteristics.This will provide instructions for the prevention,pathogenic diagnosis and treatment of meningitis in pediatric patients.

Sorafenib combined with chemotherapy and donor lymphocyte infusion as salvage therapy in patients with FLT3-positive acute myeloid leukemia relapse after allogeneic hematopoietic stem cell transplantation / 中华内科杂志

To explore the efficacy of sorafenib combined with chemotherapy and donor lymphocyte infusion (DLI) in patients with FLT3-positive acute myeloid leukemia (AML) relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Of the 14 patients relapsed after allo-HSCT,9 achieved complete remission after salvage therapy of sorafenib combined with chemotherapy and DLI,6 with complete molecular remission,2 with partial remission,and 3 with no response.With a median follow up of 220 (range,30-1 782) days after post-transplantation relapse,7 patients were still alive and 7 died.Salvage therapy of sorafenib combined with chemotherapy and DLI shows a decent therapeutic effect for FLT3-positive AML relapsed after allo-HSCT.