The Brain Structure Volume Estimation Based on Synthetic MRI in Pediatric Acute Lymphoblastic Leukemia / 中山大学学报(医学科学版)

ObjectiveCentral nervous system （CNS） infiltration commonly occurs in children with acute lymphoblastic leukemia （ALL）. Early subclinical CNS infiltration in pediatric ALL is hard to detect with conventional methods. This study aimed to investigate the changes of brain structure volume parameters based on Synthetic MRI （SyMRI） in pediatric ALL without clinically diagnosed CNS infiltration. MethodsThirty-six ALL and twenty-nine typically developing （TD） children were prospectively collected and all underwent SyMRI. The Synthetic MR software was used to obtain brain volumetric parameters including total white matter volume （WMV）， gray matter volume （GMV）， cerebrospinal fluid （CSF） volume， etc. and their within-group differences were assessed by analysis of covariance. The Spearman correlation analysis was used to examine the correlation between biological characteristics and statistically significant brain volume parameters. ResultsALL children showed increased CSF volume （PFDR-corrected = 0.009） and decreased GMV （PFDR-corrected = 0.027） when compared to TD children. We also found a moderately negative association between GMV/intracranial volume and risk classification in pediatric ALL （rs = -0.380， P = 0.022）. ConclusionsPediatric ALL without clinically diagnosed CNS infiltration presented with accumulation of CSF and reduction of gray matter. The brain volumetric changes in subclinical CNS infiltration of pediatric ALL provides a new attempt for exploring the underlying mechanism and early detection of CNS infiltration in pediatric ALL.

Systemic thinking on family health promotion / 中华行为医学与脑科学杂志

In the systemic perspective, family is a system capable of self-organization, which possesses enough resources and ability to solve its own problems. To promote family health, the systemic therapists are required to consider each family member’s opinions and construction to certain problems, and assist them to discover and activate their own resources as well. Promoting family health also requires members to actively develop a sharing pattern within the family, exert the positive role of family rules, develop an authoritative parenting style so as to promote the mental health of children. Family members should ensure the clear and open boundaries between different subsystems, and maintain the stability of subsystem of the husband and wife especially. Furthermore, family members in different subsystems should make reasonable trade-offs and choices corresponding to different situations in order to both minimize conflicts and maintain the satisfying function of the family system. A healthy and ideal intimate relationship is interpreted from the systemic perspective of " evolvable, changeable, associative" on the core of " intimacy, passion and commitment" . The relationship will enhance partners' personal growth, in which the partners can not only examine its dynamic variations together but also deepen the understanding and acceptance of each other under the circumstances of bilateral original families and living environments. In addition, a healthy conjugal relationship has higher requirements such as " kinship" , commitment to two families of the couple and the children, and balancing the benefits between core family and original family.

The characteristics of non-alcoholic fatty liver disease and its associated factors in patients with rheumatoid arthritis / 中华预防医学杂志

Objective: To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. Methods: This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. Results: The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% vs. 1.0%), central obesity (47.3% vs. 16.8%), hypertension (45.2% vs. 29.8%) and type 2 diabetes mellitus (24.7% vs. 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L vs. (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L vs. (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L vs. (2.97±0.78) mmol/L, all P<0.05]. Multivariate logistic regression analysis showed that BMI (OR=1.314) and triglyceride (OR=1.809) were the independent factors positively associated with NAFLD in RA patients. Conclusion: NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.

Expert Consensus on Sepsis Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

To give full play to the therapeutic advantages of traditional Chinese medicine （TCM） in sepsis， clarify the entry point of integrated TCM and western medicine， further standardize the clinical treatment of TCM， develop a recognized and integrated treatment protocol of TCM and western medicine， and improve the clinical efficacy on sepsis，the Chinese Association of Chinese Medicine organized TCM and western medicine experts specialized in sepsis treatment to conduct in-depth discussions on the advantages of TCM and integrated TCM and western medicine in the treatment of sepsis based on the TCM etiology and pathogenesis of sepsis， a representative acute and critical disease. They emphasized the pathogenesis characteristics of asthenia of healthy Qi and sthenia of pathogenic factors and summarized the roles of Chinese medicine in correcting the imbalance of inflammatory response， improving blood coagulation dysfunction， and relieving organ damage. Furthermore， they proposed the treatment protocol with integrated TCM and western medicine， which is expected to provide references for actual clinical treatment and scientific research.

ZHANG Wei-hua's experience in clinical treatment of somatalgia with "point-zone-strip stimulation technique" of acupuncture / 中国针灸

The clinical experience in treatment of somatalgia with "point-zone-strip stimulation technique" of acupuncture of professor ZHANG Wei-hua was summarized. Professor ZHANG integrates the theories of the cutaneous region of meridian, biaoben, "taking tender point as acupoint" and local holography as a whole in treatment of somatalgia. The "point-stimulation technique" of acupuncture (subcutaneous needling technique) is adopted for the painful site less than 3 cm in diameter, the "zone-stimulation technique" (surrounding needling technique) is for the site larger than 3 cm in diameter and the "strip-stimulation technique" (cubit-tibia needling technique) is for various acute and chronic somatalgia. These three needling techniques are applicable singly or in combination in clinical practice.

Effect and Mechanism of Fuzheng Touxie Prescription on Immune Homeostasis of Drug-resistant Pseudomonas aeruginosa Lung Infection Rats / 中国实验方剂学杂志

Objective:To investigate the effect and mechanism of Fuzheng Touxie prescription （FZTX） on the immune homeostasis of drug-resistant <italic>Pseudomonas aeruginosa</italic> lung infection in rats at different time points. Method:A total of 168 rats were divided into a blank group （<italic>n</italic>=8），a model group （<italic>n</italic>=40），a Touxie （TX） group （<italic>n</italic>=40），an early Fuzheng （FZ） group （<italic>n</italic>=40）， and a delayed FZ group （<italic>n</italic>=40）. The blank group was given distilled water by gavage， the model group was given distilled water by gavage after infection，the TX group was given clear heat and penetrate evil drug free decoction granules（3.5 g·kg^-1） by gavage after infection， the early FZ group was given Fuzheng Touxie whole formula free decoction granules（10.75 g·kg^-1） by gavage after infection， the delayed FZ group was given clear heat and penetrate evil drug free decoction granules by gavage after infection， on the third day plus Fuzheng drug free decoction granules［（3.5+10.75） g·kg^-1］ by gavage， the three treatment groups were gavaged twice a day， 2 mL each time .Each drug treatment group was divided into five groups according to five time points （3 h，1 d，3 d，5 d， and 7 d）， with eight rats in each group. The levels of tumor necrosis factor-<italic>α</italic>（TNF-<italic>α</italic>），high mobility group protein 1（HMGB1），interleukin-10（IL-10）， and tumor necrosis factor -<italic>α</italic>-induced protein-8-like2 （TIPE2） were measured by enzyme-linked immunosorbent assay （ELISA）， and HMGB1 protein expression level by Western blot. Result:At 3 h，the TNF-<italic>α</italic> content in the drug treatment groups was higher than that in the blank group and the model group （<italic>P</italic><0.05）. At 3 d，the TNF-<italic>α</italic> content in the early FZ group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05） and the TX group （<italic>P</italic><0.05）. At 1 d，the HMGB1 content in the TX group and the delayed FZ group was higher than that in the model group （<italic>P</italic><0.05）. At 5 d，the HMGB1 content was lower in the delayed FZ group than in the model group （<italic>P</italic><0.05）. At 7 d，HMGB1 protein expression in the model group was higher than that in the blank group （<italic>P</italic><0.05） and the early FZ group （<italic>P</italic><0.05）. At 3 d，the IL-10 content was significantly higher in both the early FZ group and the delayed FZ group than that in the model group （<italic>P</italic><0.05）. At 5 d，the IL-10 content was higher in the early FZ group than that in the TX group （<italic>P</italic><0.05）. At 7 d，the IL-10 content in the early FZ group and the delayed FZ group was lower than that in the TX group （<italic>P</italic><0.05）. At 5 d，the TIPE2 content in the early FZ group was lower than that in the model group （<italic>P</italic><0.05）. At 7 d，the TIPE2 content in the TX group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05）. Conclusion:FZTX or modified prescription can promote the inflammatory response to eliminate pathogenic bacteria in the early stage and suppress the inflammatory response in the late stage to avoid the inflammatory cascade effect and lung tissue damage，indicating that Fuzheng drugs have an important role in maintaining the immune homeostasis of the body after infection.

Exploration and practice of benefit evaluation for medical equipments based on objectives and key results / 中华医院管理杂志

The study aims to improve the level of fine management of medical equipments, give full play to the functions and roles for better patient service, and explore methods for evaluating the benefits of medical equipment that can take into account and reflect the needs of multiple parties. Based on objectives and key results(OKR) methods and concepts, a benefit evaluation system was developed with the goal of giving full play to the functions and roles of medical equipments, with corresponding evaluation indexes and supervision and evaluation mechanisms formulated as well. This index system could take into account the needs and concerns of hospitals, the departments in use, the management authorities and patients at large, while contributing to process supervision and continuous improvement. In the OKR practice of large medical equipments(CT, MR) from 2018 to 2019, they had performed significantly better in inspections, inspection positive coincident rates, clinical service capabilities, maintenance assurance levels, patient satisfaction, scientific research and academics among others. The use of a medical equipment benefit evaluation system based on OKR concepts and methods can provide effective evaluation indicators for the operation and management of medical equipments. In addition, the system can maintain internal improvement momentum leveraging process supervision and continuous improvement methods, in order to assure the elevation of fine management level of medical equipments of modern hospitals, thus offering better medical services for patients at large.

Transcriptomic profile of human erythroleukemia cells in response to Sargassum fusiforme polysaccharide and its structure analysis / 中国天然药物

Sargassum fusiforme (S. fusiforme) has been used as an ingredient in Chinese herbal medicine for thousands of years. However, there are a limited number of studies concerning its therapeutic mechanism. High performance gel permeation chromatography (HPGPC) analysis showed that the average molecular weight of the S. fusiforme polysaccharide, SFPS 191212, is 43 kDa. SFPS 191212 is composed of mannose, rhamnose, galactose, xylose, glucose, and fucose (at a molar ratio: 2.1 : 2.9 : 1.8 : 15.5 : 4.6 : 62.5) with α- and β-configurations. The present research evaluated the anti-tumor potential of the S. fusiforme polysaccharide in human erythroleukemia (HEL) cells in vitro. To explore the SFPS 191212's apoptosis mechanism in HEL cells, transcriptome analysis was performed on HEL cells that were incubated with SFPS 191212. The inhibitory effect of SFPS 191212 on HEL cell growth was also analyzed. It was found that SFPS 191212 inhibited HEL cell proliferation, reduced cell viability in a concentration-dependent manner, and induced an insignificant toxic effect on normal human embryonic lung (MRC-5) cells. Compared with the control group, transcriptome analysis identified a total of 598 differentially expressed genes (DEGs), including 243 up-regulated genes and 355 down-regulated genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on all DEGs, and 900 GO terms and 52 pathways were found to be significantly enriched. Finally, 23 DEGs were randomly selected and confirmed by quantitative real-time polymerase chain reaction (qRT-PCR). Moreover, SFPS 191212 down-regulated the PI3K/Akt signal transduction pathway. Our results provide a framework for understanding the effect of SFPS 191212 on cancer cells and can serve as a resource for delineating the anti-tumor mechanisms of S. fusiforme.

Genetic analysis of 46,XY disorders of sex development in children caused by a new NR5A1 gene variant / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a child with 46,XY disorders of sex development (DSD) and explore its genotype-phenotype correlation.@*METHODS@#The child was subjected to whole exome sequencing (WES), and exons 1 to 7 of NR5A1 were subjected to multiplex ligation-dependent probe amplification (MLPA) analysis.@*RESULTS@#The patient presented with rudimentary vulva of a female with Tanner stage 1. B-mode ultrasonography has detected ovary and uterus. The child was found to have a chromosome karyotype of 46,XY. WES revealed that the patient has harbored heterozygous deletion of exon 5 of the NR5A1 gene, which was a novel pathogenic variant inherited from the mother. No abnormality was found in the father.@*CONCLUSION@#The main symptoms of 46,XY DSD children are insufficient external genitalia masculinization, for which variants of the NR5A1 gene are an important cause. WES has improved the detection rate of genetic variants and provided a solid basis for genetic counseling of the affected families.

Utility of cross-sectional area of erector spinae muscle combined with serum GDF-15 for the diagnosis and prognosis assessment of ICU-acquired weakness in mechanically ventilated patients / 中华急诊医学杂志

Objective:To identify the clinical correlations between the cross-sectional area loss of the erector spinae muscle (ESMcsa Loss) and serum growth differentiation factor-15 (GDF-15) in mechanically ventilatied patients in ICU. In addition, to investigate their diagnostic value for ICU-acquired weakness (ICU-AW) and their predictive value for 60-day survival in mechanically ventilated patients.Methods:Ninety-two patients with acute respiratory failure, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from June 2018 to November 2019. The serum GDF-15 level was detected by ELISA, the total cross-sectional area of the right and left erector spinae muscles was calculated by CT images, and the patient's muscle strength was assessed using the British Medical Research Council (MRC) muscle strength score on day 1 and day 7. The patients were divided into the ICU-AW group and the non-ICU-AW group according to the MRC-score on the 7th day of ICU admission. The correlations between plasma GDF-15 level, ESMcsa loss, and MRC score on day 7 were investigated. The receiver operating characteristic (ROC) curve was used to calculate the predictive value of serum GDF-15, ESMcsa loss, and ESMcsa loss ratio on day 7 of mechanically ventilated patients in the diagnosis of ICU acquired muscle weakness. Moreover, the predictive value of GDF-15 and ESMcsa loss ratio on the 90-day survival status of the patients was assessed using survival curves.Results:Ninety-two patients were enrolled. According to whether the MRC-score on the 7th day was less than 48, 49 cases were included in the ICU-AW group and 43 cases in the non-ICU-AW group. The mechanical ventilation time, length of ICU stay and length of hospital stay in the ICU-AW group were higher than those in the non-ICU-AW group, and there were no significant differences in other baseline indicators. There were no significant differences in serum GDF-15, ESMcsa and MRC-score between the two groups on day 1. The GDF-15 level in the ICU-AW group was significantly higher than that in the non-ICU-AW group while ESMcsa and MRC-score were significantly lower than those in the non-ICU-AW group on day 7 [GDF-15 (pg/mL): 2529.53±625.67 vs. 1614.21±567.18; ESMcsa (cm 2): 23.76±6.85 vs. 29.15±6.5; MRC-1score: 41.10±3.35 vs. 51.23±2.84; all P <0.001]. ESMcsa loss and ESMcsa loss ratio were significantly positively correlated with serum GDF-15 levels on day 7 ( r = 0.2355 and 0.3192, respectively). ESMcsa loss and ESMcsa loss ratio were significantly negatively correlated with MRC-score ( r = -0.3072 and -0.3527, respectively). The ROC curve analysis showed that plasma GDF-15 level, ESMcsa loss, and ESMcsa loss ratio on day 7 had predictive value for ICU-AW diagnosis in mechanically ventilated patients [Areas under the ROC curve (AUC) were 0.904, 0.835, and 0.889, all P <0.001]. The 60-day survival curve demonstrated that the survival rate was 60.0% in the high GDF-15 group, while was 77.8% in the low GDF-15 group; and was 60.0% in the high ESMcsa loss ratio group, while was 80.0% in the low ESMcsa loss ratio group (all P<0.05). Conclusions:There was a significant correlation between the cross-sectional area loss of the erector spinae muscle and the increase of serum GDF-15 level after 7 days of mechanical ventilation in ICU, suggesting the acute muscle wasting and skeletal muscle hypofunction, which has certain diagnostic value for ICU-AW, and can predict the 60-day survival status of mechanically ventilated patients in ICU.

Exploration of the molecular mechanism of Lishi-Kuijie decoction in the treatment of ulcerative colitis based on network pharmacology / 药学学报

We used network pharmacology and molecular docking to investigate the molecular mechanism of Lishi-Kuijie decoction (KJF) in the treatment of ulcerative colitis (UC). Chemical components and targets related to the 13 herbs of Chinese Materia Medical in KJF were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). The UC-related targets were identified through OMIM, DisGeNet and GeneCards databases. Using Cytoscape 3.7.2 software a drug-compound-disease-target network was established. The target interaction network and core target for KJF against UC was built and selected based on the String database and topological parameters. Using the R package clusterprofile in Bioconductor, the intersection genes and the disease-drug intersection targets were transformed to Entrez gene ID, followed by gene ontology biological process enrichment analysis and KEGG pathway annotation analysis. The KJF compound-UC target network contained 149 compounds, 108 corresponding targets and 12 core targets (including signal transducer and activator of transcription 3, interleukin 6, tumor necrosis factor, c-x-c motif chemokine ligand 8, interleukin 2, etc.). We identified 2 371 GO terms and 155 pathways (mainly involving IBD, PI3K-ATK, NF-kappa B, TNF, Toll-like receptor signaling pathway) as determined by enrichment analysis. Molecular docking, used with the key molecular factors and the core targets, revealed stable binding for IL2, TNF-α, MAPK1 and RELA. These results suggest the possible molecular mechanism of KJF in treatment of UC and lay the foundation for further characterization of the components and their mechanisms.

Effect of Sargassum fusiforme polysaccharide on apoptosis and its possible mechanism in human erythroleukemia cells / 中国天然药物

This study aimed to investigate the effects of Sargassum fusiforme polysaccharide (SFPS I, II, and III) on the apoptosis and regulation of human erythroleukemia (HEL) cells. The effect of different doses of SFPS on HEL cell growth was detected using the Cell Counting Kit-8 method, and apoptosis was detected by Hoechst staining. Cell cycle distribution and apoptosis were detected using flow cytometry. Expression of the cell cycle gene, p53, antiapoptotic genes, Bcl-xL and Bcl-2, and pro-apoptotic genes, Bax, Bad, and Caspase-3, as well as the expression of the corresponding proteins, were detected using real-time quantitative polymerase chain reaction (qPCR) and Western blot. The results showed that SFPS II and III decreased HEL cell viability and induced HEL cell apoptosis. Different concentrations of SFPS (I, II, and III) were detected that induced much less toxic effect in normal human embryonic lung (MRC-5) cells, and SFPS I increased cell proliferation, indicating its favorable selectivity towards cancer cells. The mechanism by which SFPS induced apoptosis was also found to be related to the induction of cell cycle arrest in the G/G phase and the increased expression of apoptosis-related genes and proteins. We concluded that SFPS induces HEL cell apoptosis, possibly via activation of the Caspase pathway, providing the theoretical basis for the development of SFPS-based anti-tumor drug products.

Epilepsy in Southeast Asia, how much have we closed the management gap in past two decades?

@#The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review aimed to update the understanding of epilepsy management in this region over the past 23 years. There has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per 1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas, and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However, HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is questionable. Stigma and its psychosocial consequences are still a major concern despite enormous efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries. The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many SEA countries, related to cost, cultural perception and lack of facilities. More resources should also be channelled in training adequate number of epileptologists who can spearhead epilepsy care around the region, as well as public education and research in epilepsy. In conclusion, there is an increase in epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.

Knowledge, Attitude and Practice (KAP) Regarding Non-Surgical Intervention Among Osteoarthritis Patients: A Review

@#Treatment effectiveness depends on the knowledge, attitude, and practice (KAP) of osteoarthritis (OA) patients towards their assigned treatment. This study aimed to explore the KAP towards non-surgical intervention among OA patients. A methodological framework proposed by Arksey and O’Malley (2005) was implemented. An electronic database search of English-language academic articles was conducted using PubMed and ScienceDirect databases encompassing 1998 to 2018 period of time, resulting in a total of 26 studies. OA patients were knowledgeable about the disease and exercise management. However, they were lack of knowledge on drug therapy and complementary strategies. The attitude towards non-surgical interventions was ambivalence. Lastly, the practice section mainly focused on patients’ compliance and behaviour towards different conservative managements, namely physiotherapy, medications, and complementary and alternative medicines (CAMs) which influenced by both knowledge level and attitudes. In conclusion, a higher knowledge level and positive attitude will result in good practice.

An unexpected electrocardiogram sign of subacute left ventricular free wall rupture: Its early awareness may be lifesaving / 世界急诊医学杂志（英文）

@#BACKGROUND: Post-infarct left ventricular free wall rupture (LVFWR) is not always an immediately catastrophic complication. The rupture can be subacute, allowing time for diagnosis and intervention. Accordingly, early recognition of the entity may be lifesaving. METHODS: We present an electrocardiogram (ECG) change pattern in two cases, which was erroneously attributed to ischemia. Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain. They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment. Unfortunately, they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation. The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads. RESULTS: The two cases were regrettably received a misjudgement of reinfarction at first, and one of the patients even was administrated with tirofi ban. Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography. CONCLUSION: New ST-segment elevation (STE) in infarct-associated leads, coupled with recurrence of chest pain and new-onset hypotension, may constitute the premonitory signs of a subacute LVFWR.

Comparisons of clinical characteristics and prognosis between patients with primary and secondary thyroid lymphoma / 中华血液学杂志

Objective@#To compare clinical characteristics and prognosis between patients with primary (PTL) and secondary thyroid lymphoma (STL) .@*Methods@#A retrospective analysis was performed on 46 patients with thyroid lymphoma (PTL 19, STL 27) from January 2002 to October 2018.@*Results@#①PTL group included 4 males and 15 females, with a median age of 57 years. The STL group included 10 males and 17 females, with a median age of 61 years. Diffuse large B-cell lymphoma (DLBCL) was the main pathological subtype in both PTL and STL groups, with 14 cases (73.7%) and 20 cases (74.1%) respectively. In terms of clinical manifestations, goiter was the most common symptom in PTL patients 100.0% (19/19) , while 29.6% (8/27) STL had goiter (P<0.001) . The incidences of increased thyroglobulin antibody (TRAb) /thyroid peroxidase antibody (TPO) were 81.3% (13/16) in PTL group and 43.8% (7/16) in STL group (P=0.028) respectively. Concerning the clinical features of patients, only two PTL patients (10.5%) with advanced Ann Arbor stage (Ⅲ/Ⅳ) , while 21 (77.8%) STL experienced advanced Ann Arbor stage (P<0.001) . Elevated serum β2-MG were appeared in 1 (7.1%) PTL and 9 (47.4%) STL patients (P=0.013) , and advanced IPI score (3-5) was more common in STL than PTL (59.3% vs 5.3%, P<0.001) . ②Among the 17 PTL patients who received treatments, 15 (88.2%) achieved remission; as for STL patients received treatments, 23/25 (92.0%) were in remission. The 5-year overall survival (OS) rates of PTL (n=17) and STL groups (n=25) were (87.4±8.4) % and (70.0±13.1) % (P=0.433) respectively. ③The 5-year OS rate in 41 patients with B-cell thyroid lymphoma was (81.1±7.5) %. Univariate analysis showed that IPI score of 3-5 (P=0.040) and high level of serum IL-8 (P=0.022) were significantly associated with poor outcome.@*Conclusion@#DLBCL was the most common subtype in both PTL and STL, and goiter was the major symptom in PTL. IPI score of 3-5 and high level of serum IL-8 were unfavorable prognostic factors for patients with B-cell thyroid lymphoma.

Discussion on primary closed-loop management mode of chronic diseases in Ningxia / 中华医院管理杂志

The pre-during-post hospital closed-loop management of chronic diseases is an efficient way to upgrade the current chronic disease management level. The authors described the feasibility, what to build and imperative problems in implementing such a closed-loop management in primary level in Ningxia. The introduction focused on the construction of a chronic disease management path for multiple diseases, the implementation of a closed-loop management model for chronic diseases based on the " three in one model(specialist-family physician-health manager)" , the promotion of primary physician training and standardization management level, as well as the establishment of a community-centered three-level prevention and treatment system for chronic diseases. These efforts aim at promotion of chronic disease management outcomes, elevation of patients′ health and quality of life, and minimization of people′s economic burden.

Characteristics of Uric Acid Excretion in Gout Patients with Obesity / 中山大学学报(医学科学版)

@#【Objective】To explore clinical manifestations and features of renal uric acid excretion in gout patients with obesity.【Methods】Totally 228 primary gout patients were enrolled and divided into three groups according to body mass index（BMI）. Clinical and fasting blood biochemical analysis data were collected. Indices of renal uric acid excretion were calculated according to 24 h urinary uric acid and urinary creatinine.【Results】The obese group（n = 44）was younger than overweight group（n = 88）and non-overweight group（n = 96）［43（32，57）years vs 55（45，65）years，58（45，67）years］，with earlier onset age［37（26，48）years vs 48（38，59）years］，higher serum uric acid［594（522，697）μmol/L vs 511（372，653）μmol/L］and had more hypercholesterolemia（56.8% vs 31.3%）and low density lipoproteinemia（59.1% vs 47.9%）compared with non-overweight group. The ratio of hypertriglyceridemia（43.5% and 37.5% vs 17.7%）and metabolic syndrome（50.0% and 36.4% vs 12.5%）in the overweight and obese group were both higher than non- overweight group. Fraction excretion of uric acid（FEUA）in obese group［5.5（3.6，7.4）% vs 7.0（5.2，9.8）%］was lower than non-overweight group，and the glomerular filtration load of uric acid［5.3（4.2，7.5）mg·min- 1 ·1.73 m- 2 vs 3.5（2.2，5.2）mg·min-1·1.73 m-2］in obese group was higher than that in non-overweight group（All P < 0.0167）. Multivariate regression analysis showed that overweight or obesity were negatively correlated with FEUA（All P < 0.05）.【Conclusion】High uric acid load of serum and glomerular filtration in gout patients with obesity may be due to the relative insufficiency of renal uric acid excretion.

Correlation analysis between mechanical power and lung ultrasound score and their evaluation of prognosis in patients with acute respiratory distress syndrome / 中华危重病急救医学

Objective To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluationⅡ (APACHEⅡ), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. Results At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHEⅡ was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. Conclusions There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.

Clinical Application of Loop-mediated Isothermal Amplification in Detection of Mycoplasma Pneumoniae / 中国医学科学院学报

Objective To explore the clinical value of one-step visualization loop-mediated isothermal amplification(LAMP)in the detection of Mycoplasma pneumoniae(Mp). Methods One-step visualized LAMP,polymerase chain reaction(PCR),and enzyme-linked immunosorbent assay(ELISA)were used to simultaneously detect 108 clinical Mp specimens in children,which included 73 cases of Mp infection diagnosed by PCR and 35 cases of other chronic/acute respiratory tract infections.On the first day of admission,one-step visualization LAMP,PCR(fluorimetric method),and ELISA were used to test the throat swab and serum sample obtained from the same patient,and the Kappa value was calculated.The consistence between LAMP and PCR and that between LAMP and ELISA were compared.On the fifth day of admission,40 patients were resampled and the findings of these three tests on the first day and on the fifth day were compared. Results One-step visualization LAMP had a sensitivity of 100% and a specificity of 94.3%,whereas ELISA had a sensitivity of 65.8% and a specificity of 82.9%.The ratio of Kappa camparing one-step visualization LAMP and PCR was 0.956 and the ratio of Kappa camparing one-step visualization LAMP and ELISA was 0.38.The number of positive specimens detected by LAMP was higher than that by ELISA on the first day. Conclusions One-step visualization LAMP has excellent sensitivity and specificity in detecting early acute Mp infection.It has high consistency with PCR and can be applied to detect Mp.