Epidemiological study of pathogens in hospitalized children with lower respiratory tract infection in a single center of Shanghai from 2015 to 2019 / 中华传染病杂志

Objective:To analyze common respiratory pathogens epidemiology in hospitalized children with lower respiratory tract infection (LRTI) in a single center in Shanghai, and to provide the basic data support for clinical diagnosis and treatment of children with LRTI in Shanghai.Methods:Children with LRTI in Children′s Hospital of Fudan University were enrolled from January 1, 2015 to December 31, 2019, and respiratory samples were collected and tested by direct immunofluorescence assay and real time polymerase chain reaction. The epidemiological characteristics of different respiratory pathogens were analyzed. Chi-square test was used for statistical analysis.Results:A total of 18 716 children were included, the total detection rate of respiratory pathogens was 36.96% (6 918/18 716), and the most frequent detected pathogen was Mycoplasma pneumoniae (MP) (15.31%(2 866/18 716)), followed by respiratory syncytial virus (RSV) (10.40%(1 946/18 716)) and parainfluenza virus Ⅲ (PIV-Ⅲ) (4.65%(871/18 716)). The detection rate of pathogens in female was significantly higher than that in male (38.48%(2 936/7 630) vs 35.92%(3 982/11 086), χ2=12.72, P<0.001). RSV and influenza virus A (Flu-A) infections peaked in winter. The detection rates of influenza virus B (Flu-B) and human metapneumovirus (MPV) were higher in winter and spring. PIV-Ⅲ infection peaked in spring and summer. The peak of PIV-Ⅱ infection occurred in summer and autumn. The infections of adenovirus (ADV), MP, Chlamydia trachomatis (CT) and PIV-Ⅰ were prevalent throughout the year without significant seasonality. The detection rate of RSV declined with age, while the detection rate of MP increased with age. The co-infection rate was 1.65%(309/18 716), and the predominant co-infection type was MP and RSV (0.37%(70/18 716)). Conclusions:A variety of pathogens lead to children′s LRTI in Shanghai from 2015 to 2019, with the common infection of MP, RSV and PIV-Ⅲ. Different pathogens showed different epidemiological characteristics in age and season distributions.

Study on the inpatient care use since China′s new healthcare reform / 中华医院管理杂志

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.

Clinicopathological characteristics of renal amyloid leukocyte chemotactic factor 2 amyloidosis / 中华肾脏病杂志

Objective:To investigate the clinicopathological characteristics of renal leukocyte chemotactic factor 2 amyloidosis (ALECT2).Methods:The patients with renal ALECT2 diagnosed by renal biopsy in Peking University First Hospital, Shanxi Medical University Second Hospital and Shanxi Bethune Hospital from January 2001 to October 2021 were retrospectively enrolled. According to whether the patients had concurrent glomerular diseases, they were classified into two groups: isolated ALECT2 group and ALECT2 with concurrent renal diseases group. Clinicopathological data of the two groups were compared. Light microscopy, immunofluorescence and immunoelectron microscopy were applied to investigate pathological characteristics of renal tissues. Mass spectrometry was used to analyze the composition of renal amyloid deposits. Gene sequencing was employed to detect the leukocyte chemotactic factor 2 ( LECT2) gene sequence in peripheral blood of the patients. Results:Sixteen patients with ALECT2 were enrolled in this study and nine of them had concurrent renal diseases. The age of 16 patients was (65.00±8.45) years old. The sex ratio of males to females was 7 to 9. Most of patients were Han ethnicity (15/16). Eight patients came from Shanxi province. Fifteen patients presented with varying degree of proteinuria [2.16(1.07, 4.72) g/24 h]; 5 patients had nephrotic syndrome; 11 patients had renal insufficiency; 12 patients had microscopic hematuria. Part of patients also had hypertension (12/16) and diabetics (6/16). Compared with isolated ALECT2, the ALECT2 group with concurrent renal diseases had a higher proportion of nephrotic syndrome (5/9 vs 0/7, P=0.034). Renal biopsy results showed that all patients (16/16) had amyloid deposits in the interstitium of renal cortex with varying degree of inflammatory cell infiltration and fibrosis, and glomeruli (12/16) and arterioles (14/16) were involved by amyloid deposits. The amyloid deposits were strongly congophilic and immunohistochemistry for LECT2 was positive. By semi-quantitative analysis, the proportions of glomerular and overall amyloid loads in ALECT2 with concurrent renal diseases group were lower than those in isolated ALECT2 group (both P<0.05). Electron microscopy revealed randomly oriented and non-branching fibrils with a diameter of 8-12 nm. The LECT2 peptides were detected by mass spectrometry in renal amyloid deposits of 8 patients, and homozygous G allele of LECT2 was found in 7 patients by gene sequencing. Complete follow-up data of 13 patients showed that 2 patients died, 1 patient developed end-stage renal disease at the time of renal biopsy, and most of the rest patients had stable renal function (8/10). Conclusions:Patients with renal ALECT2 mainly present with proteinuria, along with a high incidence of renal insufficiency, microscopic hematuria, and concurrent renal diseases. The pathologic feature is the preferential deposition of amyloid in renal cortical interstitium.

Herbal Textual Research on Menthae Haplocalycis Herba in Famous Classical Formulas / 中国实验方剂学杂志

In this paper， the name， origin， producing area and other aspects of Menthae Haplocalycis Herba in the famous classical formulas were carried out by consulting herbal literature， medical books， prescription books in the past dynasties and related modern documents. Through the textual research， it can be seen that the name of Bohe was used as the correct name in the mainstream of the past dynasties， and there were still multiple synonyms， most of which originated from the false transmission of dialectal accent， producing area and efficacy. There are many varieties recorded in the literature of the past dynasties such as Bohe， Longnao Bohe， Hubohe and Shibohe. According to the textual research， Bohe， Longnao Bohe and Yebohe are consistent with Mentha haplocalyx， whcih is the mainstream variety. Longnao Bohe is named for its form of producing area， Shibohe is Mosla chinensis， Daye Bohe is Agastache rugosa， and Nanbohe is M. crispata. Menthae Haplocalycis Herba has been widely planted since Tang dynasty. It was mainly grown in Jiangsu， Zhejiang， Jiangxi and Sichuan in Ming and Qing dynasties， and Jiangsu is the genuine production area. Its quality is best if it has dry body， no roots， many leaves， green color and strong smell. In ancient times， the stems and leaves of Menthae Haplocalycis Herba were often picked and dried in summer and autumn， which is basically the same as the records of modern times when the stems and leaves are luxuriant in summer and autumn， or when the flowers bloom to three rounds， they are picked in sunny days and cut in different times， and then dried in the sun or in the shade， and the raw products was often used as medicine in ancient and modern times. Before the Song dynasty， Menthae Haplocalycis Herba was recorded as pungent and warm. Until the Song dynasty， it was written as “extremely cool” in Lyuchanyan Bencao. It may have been thought in the early stage that it was similar to several warm herbs， such as Perilla frutescens， Stachys japonica， Elsholtzia ciliata and M. chinensis in appearance， all of which have the function of Xinsan， so it was recorded as warm. Since the Qing dynasty， Menthae Haplocalycis Herba has been recorded as cool property in the mainstream materia medica， Menthae Haplocalycis Herba recorded as pungent and cool in the 2020 edition of Chinese Pharmacopoeia， and its effect is to dissipate wind heat， clear the head， relieve the pharynx and so on， the records of efficacy in ancient and modern times are basically the same. Based on the research results， it is suggested that raw products of M. haplocalyx should be selected when developing the famous classical formulas containing Menthae Haplocalycis Herba.

Current status and future considerations on laboratory diagnosis of viral central nervous system infections in children / 中华检验医学杂志

Viral central nervous system infection (VCNSI), with high disability and mortality rates, is a serious threat for the health of children. Given the low pathogen load in cerebrospinal fluid and limitations of conventional virus detection technology, the early pathogenic diagnosis methods are less than ideal. With the development of multiplex polymerase chain reaction (PCR), digital PCR, point-of-care testing detection of nucleic acid, and metagenome high-throughput sequencing, the clinical use of viral diagnostic technologies has become more prevalent. In this comment, the current status and future directions of laboratory diagnosis of VCNSI in children are discussed.

Application value of Manchester Pain Management Model of patients undergoing rotator cuff repair surgery / 中国实用护理杂志

Objective:To investigate the effects of Manchester Pain Management Model (MPMM) on postoperative pain and joint function for patients undergoing rotator cuff repair surgery.Methods:A total of 66 patients undergoing rotator cuff repair surgery from February 2017 to October 2020 in the First People′s Hospital of Hefei were divided into experimental group and control group by random digits table method, with 33 cases in each group. The control group received routine nursing; based on the routine care, the experimental group implemented MPMM-based intervention. The degree of pain and shoulder function of the two groups were assessed by Visual Analogue Scale (VAS) and Constant-Murley Scale (CMS).Results:During the study period, 1 case in the experimental group was lost, 32 cases in the final experimental group and 33 cases in the control group. There was no significant difference in the score of VAS and CMS before surgery between the two groups ( P>0.05). At 1 day, 3 days, 3 weeks and 6 weeks after surgery, VAS scores in the experimental group were 5.47 ± 1.72, 4.63 ± 1.16, 3.25 ± 0.78, 1.81 ± 0.52, lower than those scores in the control group 6.42 ± 1.03, 5.45 ± 1.54, 4.30 ± 0.64, 2.39 ± 0.47, the differences were statistically significant ( t values were 2.36-3.11, all P<0.05). At 3, 6, 12 weeks after surgery, CMS scores in the experimental group were 57.09 ± 4.32, 67.75 ± 4.60, 81.94 ± 4.18, higher than those scores in the control group 52.27 ± 5.39, 64.24 ± 3.76, 78.91 ± 4.36, the differences were statistically significant ( t=3.97, 3.37, 2.89, all P<0.01). Conclusions:MPMM can effectively alleviate the postoperative pain and promote the recovery of joint function in patients undergoing rotator cuff repair surgery.

Course of disease and related epidemiological parameters of COVID-19: a prospective study based on contact tracing cohort / 中华预防医学杂志

Objective: To analyze the course of disease and epidemiological parameters of COVID-19 and provide evidence for making prevention and control strategies. Methods: To display the distribution of course of disease of the infectors who had close contacts with COVID-19 cases from January 1 to March 15, 2020 in Guangdong Provincial, the models of Lognormal, Weibull and gamma distribution were applied. A descriptive analysis was conducted on the basic characteristics and epidemiological parameters of course of disease. Results: In total, 515 of 11 580 close contacts were infected, with an attack rate about 4.4%, including 449 confirmed cases and 66 asymptomatic cases. Lognormal distribution was fitting best for latent period, incubation period, pre-symptomatic infection period of confirmed cases and infection period of asymptomatic cases; Gamma distribution was fitting best for infectious period and clinical symptom period of confirmed cases; Weibull distribution was fitting best for latent period of asymptomatic cases. The latent period, incubation period, pre-symptomatic infection period, infectious period and clinical symptoms period of confirmed cases were 4.50 (95%CI:3.86-5.13) days, 5.12 (95%CI:4.63-5.62) days, 0.87 (95%CI:0.67-1.07) days, 11.89 (95%CI:9.81-13.98) days and 22.00 (95%CI:21.24-22.77) days, respectively. The latent period and infectious period of asymptomatic cases were 8.88 (95%CI:6.89-10.86) days and 6.18 (95%CI:1.89-10.47) days, respectively. Conclusion: The estimated course of COVID-19 and related epidemiological parameters are similar to the existing data.

Epidemiology of classic human astrovirus among infants and young children with acute diarrhea in a hospital outpatient in Shanghai, 2012-2016 / 中华传染病杂志

Objective:To investigate the epidemiological characteristics of classic human astrovirus (HAstV) among children under five years old with acute diarrhea, and to understand the role of HAstV in children acute diarrhea.Methods:A total of 1 010 fecal specimens were collected in 1 010 outpatients under five years old with acute diarrhea admitted to Children′s Hospital of Fudan University, Shanghai from January 2012 to December 2016. Reverse transcription polymerase chain reaction (PCR) or PCR was used for screening classic HAstV, group A rotavirus, norovirus and adenovirus. Genotypes of classic HAstV were determined by nucleotide sequencing and phylogenetic tree analysis.Results:The overall positive rate of classic HAstV was 2.7%(27/1 010). The detection rates of classic HAstV from 2012 to 2016 were 6.9%(10/144), 3.5%(5/144), 2.1%(3/144), 1.5%(4/265) and 1.6%(5/313), respectively. Almost 96.3%(26/27) of children infected with HAstV were 0 to 36 months of age. The prevalence of classic HAstV infections displayed a typical autumn/winter seasonality except in 2016. All the positive classic HAstV strains were genotyped as HAstV-1 with two lineages of HAstV-1a and HAstV-1b. Among them, the lineage of HAstV-1a was the predominant subtype (63.0%, 17/27). There were 77.8%(21/27) of the children with acute diarrhea only infected with classic HAstV, whereas for the remaining cases a variety of other enteric viruses were detected (three cases co-infected with HAstV and group A rotavirus, two cases co-infected with HAstV and adenovirus, and one case co-infected with HAstV, group A rotavirus and adenovirus).Conclusions:Children infected with HAstV are mainly less than 36 months of age. Although the genotype of classic HAstV detected in this study is single, but the lineages are in a state of dynamic change. Long-time and continuous monitor for the epidemiology of classic HAstV is needed to avoid outbreak of diarrhea in children.

Clinical analysis of 82 cases of brucellosis with first symptom of joint pain / 中华地方病学杂志

Objective:To understand the characteristics and diagnosis and treatment of brucellosis with joint pain as the first clinical manifestation, and summarize the clinical classification of brucellosis complicated with joint pain, so as to provide reference for clinical diagnosis and treatment.Methods:Cases of brucellosis with first symptom of joint pain diagnosed in the 940th Hospital of PLA Joint Logistic Support Force from January 2015 to January 2020 were selected. The main clinical features, laboratory examination, diagnosis and treatment were analyzed.Results:A total of 82 patients with joint pain of the first symptom were selected, including 61 males and 21 females. Joint pain was the main complaint of the patients, 63.4% (52/82) of the patients visited spine surgery department, 17.1% (14/82) visited minimally invasive orthopedics department, 12.2% (10/82) visited rheumatic immunology department, and 7.3% (6/82) visited traditional Chinese medicine department. Brucellosis patients with cervical lesions accounted for 22.0% (18/82), combined with lumbar lesions accounted for 51.2% (42/82). The patients with elevated C-reactive protein accounted for 68.3% (56/82), abnormal liver function accounted for 52.4% (43/82), anti "O" positive accounted for 3.7% (3/82), abnormal autoantibodies accounted for 6.1% (5/82), and human leukocyte antigen-B27 (HLA-B27) positive accounted for 12.2% (10/82). Four patients with HLA-B27 positive had sacroiliac arthritis. All patients were cured after standard and full course therapy.Conclusion:Joint pain may be the first symptom of brucellosis, and the lumbar spine and cervical spine are the most vulnerable parts.

Quality analysis of Citri Trifoliatae Fructus in different harvest time by HPLC combined with electronic eye technology / 中国中药杂志

As a local variety of medicinal material, Citri Trifoliatae Fructus is widely used in many places, whereas its harvest time remains unclear. Therefore, studying its harvest time can make more reasonable use of this medicinal material. In this study, we determined the flavonoids content and compared the color of Citri Trifoliatae Fructus harvested in different time, aiming to guide the harvest of this medicinal material. The fresh fruits of Citrus trifoliata were collected from Xinxiang city, Henan province, graded according to the diameter range, and then dried. The contents of isonaringin, naringen, and poncirin in Citri Trifoliatae Fructus were determined by HPLC, and the color values of the samples were detected by electronic eye. The correlation analysis of the obtained data was carried out to explore the relationships of color and diameter with quality. The results showed that the contents of isonaringin, naringen, and poncirin varied significantly in different harvest time, within the ranges of 0.21-1.20, 2.21-11.59, and 3.73-23.16 mg·g~(-1), respectively. With the delay of harvest time, Citri Trifoliatae Fructus showed the color changing from green to yellow, gradually increased diameter, and gradually decreased contents of isonaringin, naringen, and poncirin. The contents of isonaringin, naringen, and poncirin were negatively correlated with the degree of red and green(a~*) and positively correlated with the degree of yellow and blue(b~*). The contents of naringen and poncirin had significantly negative correlations with the diameter. This study indicates that the quality of Citri Trifoliatae Fructus can be judged by its diameter and skin color, which provides a theoretical basis for the rational harvest of this medicinal material.

Herbal textual research on Rubi Fructus / 中国中药杂志

Rubi Fructus is a commonly used traditional Chinese medicine. The origin of Rubi Fructus is the dried fruit of Rubus chingii, a plant of the family Rosaceae, according to the 2015 edition of Chinese pharmacopoeia. There are some differences in the plant origin of Rubi Fructus in ancient herbal literature, to trace back its sources, we conducted a textual research on its origin, producing areas, quality evaluation, processing and concocting, properties, tastes and efficacy etc. based on the records of ancient herbal literatures and combined with plant morphology and related investigation. RESULTS:: showed that the variety of Rubi Fructus was more complex among ancient herbal literature, including R. coreanus, R. hirsutus, R. corchorifolius, R. foliolosus and other mixed varieties. Most scholars believe that the R. chingii has not been recorded in ancient herbal literature, while R. chingii was recorded as early as the Ming Dynasty in Compendium of materia medica through our textual research. Ancient Chinese herbs recorded that Rubi Fructus was mostly produced in Hubei, Shandong, Shanxi and Jiangsu provinces, while R. chingii mainly produced in Anhui, Jiangsu, Zhejiang, Jiangxi, Fujian and other provinces nowadays. Also, it was recorded that Rubi Fructus harvested in wheat field during May were the best. Besides, R. chingii with big, full, grain integrate, firm, yellow and green color, sour taste and impurity free possess the best quality in the contemporary. The ancient records of processing and concocting, properties, tastes and efficacy were basically the same as modern ones.These results provide the basis for the correct utilization and further development of Rubi Fructus.

Clinical features of elderly patients with acute pancreatitis aged ≥80 years / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of elderly patients with acute pancreatitis (AP) aged ≥80 years. MethodsA retrospective analysis was performed for 3642 patients with pancreatitis who were admitted to Department of Gastroenterology in The Affiliated Hospital of Southwest Medical University from January 2013 to December 2019, and according to age, they were divided into young group (aged ＜65 years) with 2955 patients, middle-aged group (aged 65-79 years) with 558 patients, and elderly group (aged ≥80 years) with 129 patients. Related clinical data were collected and analyzed, including sex, age, etiology, predisposing factors, past medical history, disease severity, complication, and clinical outcome. The independent samples one-way ANOVA-test was used for comparison of normally distributed continuous data between groups and the least significant difference t-test was used for comparison within each group; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables. ResultsIn the young group, there were 1721 male patients and 1234 female patients; in the middle-aged group, there were 214 male patients and 334 female patients; in the elderly group, there were 48 male patients and 81 female patients; the middle-aged group and the elderly group had a significantly higher proportion of female patients than the young group (62.8% vs 61.6% vs 41.8%, P＜0.05). High-fat diet was the main predisposing factor for all three groups, and compared with the young group, the elderly group had a significantly lower proportion of patients with AP induced by alcohol or high-fat diet+alcohol (P＜0.05). The elderly group had a significantly higher proportion of patients with the etiology of biliary diseases than the middle-aged group and the young group (798% vs 69.2% vs 41.4%, χ2=204.127, P＜0.05), as well as a significantly lower proportion of patients with the etiology of hyperlipidemia, alcohol, or biliary diseases+hyperlipidemia (all P＜0.05). Among the 129 patients in the elderly group, 83 (64.3%) had mild AP, 23 (17.8%) had moderate-severe AP, and 23 (17.8%) had severe AP; there was a significant difference in the constituent ratio of disease severity between the elderly group and the middle-aged/young groups (H=1972.5, P＜005). The elderly group and the middle-aged group had a significantly lower proportion of patients with recurrence than the young group (both P＜0.05). There were no significant differences in local complications between the three groups (all P＞0.05), and as for systemic complications, compared with the young group, the elderly group had a significantly higher proportion of patients with pneumonia (3.9% vs 2.2%, P＜0.05), acute kidney injury (AKI) (6.2% vs 2.5%, P＜0.05), or multiple organ dysfunction syndrome (MODS) (7.8% vs 4.0%, P＜0.05). Compared with the middle-aged group and the young group, the elderly group had a significantly lower proportion of cured patients (67.4% vs 76.3% vs 820%, P＜0.05) and a significantly higher proportion of patients with improvement (23.3% vs 147%/12.7%, P＜0.05). The elderly group and the middle-aged group had a significantly higher proportion of patients withdrawn from treatment than the young group (8.5%/5.9% vs 3.4%, P＜0.05). There was 1 death in the elderly group (0.8%), 9 deaths in the middle-aged group (1.6%), and 16 deaths in the young group (0.5%), and there was no significant difference between the three groups (P＞0.05). There were no significant differences in length of hospital stay and hospital costs between the three groups (P＞0.05). ConclusionAP patients aged ≥80 years are mainly female and are often caused by biliary factors, and they are likely to develop the complications such as pneumonia, AKI, and MODS.

Textual Research on Visci Herba / 中国实验方剂学杂志

Visci Herba， a commonly used Chinese medicinal， was often mistaken as Taxilli Herba in ancient Chinese materia medica. The two Chinese medicinals have often been confused even in present clinical practice， and their origins are difficult to be identified. Hence， it is necessary to carry out systematic and in-depth textual research. This paper explored the origin， producing area， quality evaluation， harvesting and processing， property， flavor， and efficacy of Visci Herba based on ancient Chinese materia medica of the past dynasties and modern plant morphology， so as to provide evidence for the development and utilization of Visci Herba. The findings demonstrated that Visci Herba was mostly recorded as Taxilli Herba until the name of Visci Herba appeared in the Tang Dynasty. The records of the two Chinese medicinals could be traced back to the Song Dynasty. Visci Herba and Taxilli Herba were officially listed as two different Chinese medicinals in the 1977 edition Chinese Pharmacopoeia for the first time， where the origin of Visci Herba was determined to be Viscum coloratum（Komar.）Nakai. According to the ancient Chinese materia medica， V. coloratum was mainly distributed in Lingbao， Henan province and Xuzhou， Jiangsu province and now it mostly grows in Northeast China and North China. In ancient times， Visci Herba with deep yellow cross-section and sticky fruit juice on the tree was preferred， which was often harvested on 3， March in spring， dried in the shade， grinded together with the roots， branches， stems， and leaves using the copper file， and preserved away from fire. By contrast， it is now usually harvested from winter to the next spring and then cut into sections for drying after the removal of thick stems， or dried after being steamed. As described in ancient Chinese materia medica， Visci Herba， bitter and sweet in flavor， neutral in property， possessed the effects of dispelling rheumatism， tonifying kidney， strengthening sinews and bones， benefiting blood vessels， and preventing abortion， basically consistent with its modern functions of dispelling rheumatism， tonifying liver and kidney， strengthening sinews and bones， and preventing abortion.

Evaluation of the performance of systems for whole blood C-reactive protein detection: a multi-center study / 中华检验医学杂志

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.

A case of cutaneous collagenous vasculopathy / 中华皮肤科杂志

A 22-year-old female patient presented with skin flushing in the bilateral legs for 4 years, which gradually spread throughout the whole lower limbs and forearms 6 months ago. Skin examination showed diffuse flushing and dilated capillaries in the lower limbs and both forearms, and the flushing faded after a press. Histopathological examination of the skin lesion on the leg showed hyperkeratosis in a basket-like shape, increased pigmentation in the basal layer, infiltration of the superficial dermis with scattered lymphocytes, with no obvious red blood cell overflow; periodic acid-Schiff staining showed thickened and homogeneous deposits around the blood vessels; immunohistochemical staining showed thickened blood vessel walls and positive staining for type Ⅳ collagen. Diagnosis: cutaneous collagenous vasculopathy.

Efficacy and Safety of Peroral Endoscopic Myotomy in Achalasia Patients with Failed Previous Intervention: A Systematic Review and Meta-analysis

Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected.The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.

Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission / 临床肝胆病杂志

ObjectiveTo investigate the value of neutrophil-lymphocyte ratio (NLR) combined with apolipoprotein A-I (ApoA-I) level in predicting the severity of acute pancreatitis (AP). MethodsA retrospective analysis was performed for 460 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2015 to December 2019, among whom 250 had mild acute pancreatitis (MAP), 166 had moderate-severe acute pancreatitis, and 44 had severe acute pancreatitis (SAP). Related clinical data were collected, including basic information, laboratory markers (neutrophil count, lymphocyte count, serum triglyceride, serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, and apolipoprotein B), and scores (Ranson, BISAP, and MCTSI). A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups; a logistic regression analysis was performed for the variables with statistical significance in univariate analysis; a Spearman correlation analysis was performed to investigate the correlation between data. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of indices, and MedCalc software was used to investigate whether there was a significant difference in diagnostic efficiency. ResultsThere were significant differences in NLR and ApoA-I level between the groups with different severities of AP (χ2= 64.124, F=40.277, P＜0.001). On admission, NLR was positively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=0.370, 0.129, 0.260, and 0.122, all P＜0.05), and ApoA-I level was negatively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=-0.358, -0.220, -0.297, and -0.251, all P＜0.05). NLR was an independent risk factor for non-MAP (odds ratio ［OR］=1.104, 95% confidence interval ［CI］: 1.070-1.140, P＜0.001), while ApoA-I was an independent protective factor against non-MAP (OR=0.138, 95% CI: 0.070-0.264, P＜0.001); NLR was an independent risk factor for SAP (OR=1.163, 95% CI: 1.107-1.222, P＜0.001), while ApoA-I was an independent protective factor against SAP (OR=0013, 95% CI: 0.003-0.056, P＜0.001). NLR had an area under the ROC curve (AUC) of 0.700 (95% CI: 0.656-0.742, P＜0.001) in predicting non-MAP; ApoA-I had an AUC of 0.684 (95% CI: 0.640-0.726, P＜0.001) in predicting non-MAP; NLR combined with ApoA-I had an AUC of 0.748 (95%CI: 0.706-0.787, P＜0.001) in predicting non-MAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting non-MAP (Z=3.439 and 2.462, both P＜0.05). NLR had an AUC of 0.752 (95% CI: 0.710-0.791, P＜0.001) in predicting SAP; ApoA-I had an AUC of 0.797 (95% CI: 0.757-0.833, P＜0.001) in predicting SAP; NLR combined with ApoA-I had an AUC of 0.857 (95% CI: 0.822-0.888, P＜0.001) in predicting SAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting SAP (Z=3.171 and 2.630, both P＜0.05). ConclusionNLR combined with ApoA-I can be used as a good indicator for predicting the severity of AP in the early stage after admission.

Influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer / 中华消化外科杂志

Objective:To investigate the influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 104 patients with pancreatic head cancer who underwent radical resection in Fudan University Shanghai Cancer Center from May 2014 to May 2015 were collected. There were 62 males and 42 females, aged (61±10)years. Patients underwent carative pancreaticoduodenectomy. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer. Follow-up was conducted using telephone interview to detect recurrence of patients up to postoperative 1 year. Measurement data with normal distribution were represented as Mean±SD. Count data were described as absolutes numbers, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was analyzed using the Logistic regression model. Results:(1) Surgical situations: 104 patients underwent curative pancreaticoduodenec-tomy successfully. The volume of intraoperative blood loss was (474±280)mL and the number of lymph node dissection was 21±10. (2) Follow-up: 104 patients received postoperative follow-up, 44 of whom had early recurrence. Of the 44 patients with early recurrence, 42 cases had intraperitoneal recurrence including 23 cases with liver metastasis, 7 cases with metastasis in surgical site, 7 cases with retroperitoneal lymph node metastasis, 5 cases with omentum metastasis, 2 cases had extraperitoneal recurrence including 1 case with pleural metastasis and 1 case with pulmonary metastasis. (3) Influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer: results of univariate analysis showed levels of preoperative CA19-9, levels of postoperative CA19-9, the number of lymph node dissection were related factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer ( χ2=5.833, 9.276, 4.261, P<0.05). Results of multivariate analysis showed that postoperative CA19-9 >37 U/mL was an independent risk factor for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer ( odd ratio=3.599,95% confidence interval as 1.551-8.347, P<0.05). Conclusion:Postoperative CA19-9>37 U/mL is an independent risk factor for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer.

Strengthening medical ethics education in clinical practice of internal medicine / 上海预防医学

With rapid society development and the constant changes in people's thinking， the medical ethics issue has become more prominent. Medical interns are often facing ethical problems in clinical practice. Due to the lack of understanding of the experience in medical ethics， they often handle the problems poorly， which leads to intensified disputes between doctors and patients. The paper discusses some ethical problems that often appear in the clinical practice of internal medicine， and suggests several methods to improve the medical ethics education of interns in the clinical process.

Nerve sheath tumor of extremities: analysis of split-fat sign and entering and exiting nerve sign / 中华放射学杂志

Objective@#To explore the relationship between split-fat sign and entering and exiting nerve sign on MRI in nerve sheath tumors (NSTs) of extremities.@*Methods@#The MRI data of 141 patients with benign soft tissue NSTs of extremities confirmed by operation and pathology from January 2014 to July 2018 in the Second Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The patients were divided into intramuscular and intermuscular groups according to the location of the tumors. The split-fat sign and entering and exiting nerve sign in the two groups were compared using χ2 test.@*Results@#There were 152 NSTs in 141 patients, including 41 intramuscular NSTs and 111 intermuscular NSTs. There were 48 split-fat sign and 14 entering and exiting nerve sign in intramuscular NSTs, while 9 split-fat sign and 190 entering and exiting nerve sign in intermuscular NSTs. Statistical analysis showed that there were statistically significant differences in split-fat sign (χ2=55.545, P<0.001) and entering and exiting nerve sign (χ2=26.969, P<0.001) between the two groups.@*Conclusion@#The split-fat sign mostly appeared in intramuscular NSTs, and the entering and exiting nerve sign mostly appeared in intermuscular NSTs.