Clinical features of critically ill pregnant and parturient women infected with chronic hepatitis B virus： An analysis of 41 cases / 临床肝胆病杂志

ObjectiveTo investigate the clinical features and outcomes of critically ill pregnant and parturient women with chronic hepatitis B virus （HBV） infection， and to provide clinical experience for the rescue of critically ill pregnant and parturient women and the prevention and treatment of the severe exacerbation of liver disease. MethodsA total of 41 pregnant and parturient women with chronic HBV infection who were admitted to Department of Critical Care Medicine， Nanjing Second Hospital， from March 2013 to March 2023 were enrolled in this study， and their clinical data were collected through the electronic medical record system of hospital to summarize the main causes of transfer to the intensive care unit （ICU）， the causes of death， and treatment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 41 patients， 13 （31.71%） did not receive regular antenatal examination and 8 （19.51%） with a high viral load （HBV DNA ≥2×105 IU/mL） did not receive antiviral therapy. Cesarean section was the main mode of delivery in 32 patients （78.05%）； 23 patients （56.10%） had premature delivery， and 5 patients died （12.20%）. The top three causes of transfer to the ICU were liver failure， postpartum hemorrhage， and hypertensive disorders of pregnancy. Liver failure mainly occurred in late pregnancy， with hepatic encephalopathy as the most common complication （28.57%） and intrahepatic cholestasis of pregnancy as the most common comorbidity （21.43%）； among the 14 patients with liver failure， 6 （42.86%） received regular antenatal examination， and 13 （92.86%） did not receive antiviral therapy before admission. The mean length of ICU stay was 3.31±1.65 days for the patients with postpartum hemorrhage， among whom the patients with severe liver disease had coagulation disorders before delivery， which were difficult to correct after 48 hours of treatment. ConclusionPregnant and parturient women with chronic HBV infection tend to have complex conditions and a relatively high mortality rate. For pregnant and parturient women with chronic HBV infection， assessment of liver status， regular antenatal examination， and timely antiviral therapy are of vital importance to reduce severe exacerbation and mortality rate.

Clinical features of patients with drug-induced liver injury in Shaanxi Province from 2009 to 2019 / 临床肝胆病杂志

Objective To investigate the clinical features of patients with drug-induced liver injury (DILI). Methods A retrospective analysis was performed for the clinical data of 1 376 patients with DILI who were admitted to 20 hospitals in Shaanxi Province, China, from 2009 to 2019 and were diagnosed with RUCAM scale as the diagnostic criteria, and these patients were analyzed in terms of sex, age, underlying diseases, suspected drugs causing DILI, clinical manifestations, laboratory examination, treatment process, and prognosis. The t -test and Wilcoxon test were used for comparison of continuous data between two groups, the chi-square test was used for comparison of categorical data between groups, and the Kruskal-Wallis H rank sum test was used for comparison of ordered polytomous data between groups. Results Among the 1 376 patients, there were 577(41.93%) male patients and 799 (58.07%) female patients, with a male/female ratio of 0.72:1. As for different age groups, the 40-60 years group had a higher incidence rate and accounted for 44.77%, and there was a significant difference in sex distribution between different age groups ( χ 2 =20.784, P =0.008). As for the three clinical types, there was no significant difference in incidence rate between men and women ( χ 2 =1.409, P =0.494), and there was a significant difference in the distribution of clinical types between different age groups ( χ 2 =47.025, P 0.05). Conclusion There is a high incidence rate of DILI in women and middle-aged and elderly people, and traditional Chinese medicine is the leading cause of DILI. Patients with different clinical types tend to have different prognoses, with a good overall prognosis.

Clinical characteristics and prognosis of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis / 第二军医大学学报

Objective: To analyze the clinical characteristics and prognosis of patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV). Methods: Clinical data (general information, clinical manifestation, and laboratory indexes) of 168 patients newly diagnosed as AAV between Jul. 2008 and Dec. 2016 were retrospectively analyzed. Patients were followed up for a median period of 12 months (range, 1-96 months). End-point event was death. Results: There were 152 cases of microscopic polyangiitis (MPA), 14 cases of granulomatous polyangiitis (GPA) and 2 cases of eosinophilic granulomatosis with polyangiitis (EGPA). MPO-ANCA was positive in 145 (86.3%) patients and PR3-ANCA was positive in 20 (11.9%) patients. Forty-nine patients died, 91 patients survived, and 28 patients lost their visits. Interstitial lung disease and renal involvement were more common in MPA patients as compared with GPA patients (50.7% [77/152] vs 14.3% [2/14], 78.9% [120/152] vs 50.0% [7/14], all P<0.05). Estimated glomerular filtration rate (eGFR) in MPA patients was significantly lower than that in GPA patients (14.23 [7.27, 71.49] mL/[min · 1.73 m2] vs 104.08 [16.61, 135.72] mL/[min · 1.73 m2], P<0.05). Compared with PR3-ANCA positive patients, MPO-ANCA positive patients was more elder ([64.01 ± 10.62] years vs [50.50±16.88] years), had more renal involvement (77.9% [113/145] vs 50.0% [10/20]) and lower eGFR (19.00 [9.40, 42.85] mL/[min · 1.73 m2] vs 149.40 [86.75, 249.45] mL/[min · 1.73 m2], all P<0.05). Compared with the survivals, the dead patients were older ([67.45±10.61] years vs [61.98 ± 12.52] years), had higher incidence of interstitial lung disease (59.2% [29/49] vs 41.8% [38/91]), higher Birmingham vasculitis activity score (BVAS) (18.53 ± 8.02 vs 13.68 ± 5.98), lower eGFR (8.58 [5.73, 22.07] mL/[min · 1.73 m2] vs 45.15 [11.54, 120.79] mL/[min · 1.73 m2], lower blood sodium concentration (137.00 [134.00, 140.00] mmol/L vs 139.00 [136.00, 141.00] mmol/L), lower albumin level ([28.41 ± 5.24] g/L vs [31.92 ± 5.91] g/L), and higher serum D-dimer level (2.84 [1.20, 6.28] mg/L vs 2.24 [0.80, 3.69] mg/L) (all P<0.05). Multivariate Cox proportional regression analysis showed that age, eGFR, serum albumin level and BVAS were independent influence factors of death (hazard ratio =1.058, 0.987, 0.932, and 1.086, all P<0.05). Conclusion: The clinical manifestations of AAV are mostly pulmonary and renal involvement. Age, eGFR, serum albumin level and BVAS are independent risk factors of death in AAV patients. Interstitial lung disease, high level of D-dimer and hyponatremia may be associated with prognosis of AAV.

Effect of Fuyanshu Capsules combined with antibiotics on inflammatory factors in patients with pelvic inflammatory disease / 中国中药杂志

To investigate the effect of Fuyanshu Capsules combined with Western medicine antibiotics on symptoms and inflammatory factors IL-10 and IL-1β in patients with pelvic inflammatory disease and its possible mechanism. Totally 112 patients with pelvic inflammatory disease of damp-heat stagnation treated since April 2017 to April 2018 were randomly divided into treatment group( group A,57 cases) and control group( group B,55 cases). The treatment group was given Fuyanshu Capsules for 56 d,and levofloxacin hydrochloride tablets and metronidazole tablets for 14 d. The control group was given Fuyanshu Capsules as its analogue. The curative rate,effective rate and inefficiency,serum IL-10 and IL-1β levels were compared between the two groups. The curative effect was evaluated with McCormack score and traditional Chinese medicine( TCM) syndrome score. The recurrence rate and chronic pelvic pain were followed up after one menstrual cycle. It was found that the curative rate and effective rate of group A were higher than those of group B after treatment. After 28 d of treatment,there was a difference in the effective rate of TCM syndrome score between group A and group B( 62. 71% vs 8. 47%,P < 0. 01). After 56 d of treatment,serum IL-10 increased,while IL-1β decreased in group A,which was significantly different from that in group B( P<0. 01). The recurrence rate of PID and chronic pelvic pain in group A were significantly lower than those in group B( P<0. 01). The results showed that Fuyanshu Capsules combined with levofloxacin and metronidazole could alleviate the clinical symptoms and signs of chronic pelvic inflammation of damp-heat stagnation type,reduce the recurrence rate of pelvic inflammation,relieve pelvic pain,and alleviate the inflammation status of patients by regulating the expression of IL-10 and IL-1β in peripheral serum.

Comparative analysis of the clinical characteristics of elderly onset rheumatoid arthritis and elderly onset rheumatoid arthritis with osteoarthritis / 中华风湿病学杂志

Objective@#To compare the clinical features, ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA).@*Methods@#Eighty-eight patients with rheumatoid arthritis were divided into two groups: group EORA (n=36) and group EORA+OA (n=52). The onset age of all patients was 60 years or older. General conditions, joint involvement distribution, ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed. The χ2 test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data.@*Results@#There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P>0.05). The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old], and the difference was statistically significant (t=-3.465, P=0.001). Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA. Joint involvement in the two groups was mainly found in shoulder, wrist, Metacarpophalangeal joint (MCP)2, MCP3, proximal inter-phalangeal joint (PIP)2, PIP3, PIP4, and knee joint (34.7%-86.5%). The percentage of MCP2[36.5%(38/104), 70.8%(51/72); χ2=20.02, P<0.01], MCP3[33.7%(35/104), 59.7%(43/72); χ2=11.72, P=0.001], MCP4[4.8%(5/104), 22.2%(16/72); χ2=12.28, P<0.01], PIP2[69.2%(72/104), 83.3%(60/72); χ2=4.51, P=0.034] and PIP3[53.8%(56/104), 70.8%(51/72); χ2=5.15, P=0.023] in the EORA+OA group was lower while the percentage of MCP1, DIP 2, DIP3, DIP4 and knee joints were higher than that in the EORA group (P<0.05). In group EORA+OA, the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm] were significantly thicker than those in group EORA [(3.2±0.9) mm; (6.3±0.8) mm, t=-5.82, P<0.01; t=-7.22, P<0.01]; The proportion (70.0%) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9%; 52.3%), the difference between the two groups was statistically significant (χ2=4.64, P=0.031; χ2=4.43, P=0.035). There was no significant difference in DAS28-3 scores between the two groups before patients received treatment. After 2 weeks and 12 weeks of glucocorticoid treatment, DAS28-3 scores in group EORA [3.62(2.88, 4.03); 2.35(2.26, 2.62) points] were significantly lower than group EORA+OA [5.01(4.68, 5.26); 3.38(2.28, 3.83) points] (Z=-7.766, P<0.01; Z=-3.461, P<0.01).@*Conclusion@#Compared with patients of EORA alone, patients of EORA with OA have more obvious joint symptoms, MCP1, DIP and knee joint are susceptible to the co-involvement among them, longer duration of disease, and were prone to synovial hyperplasia and pannus flow formation. The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.

Comparative analysis of the clinical characteristics of elderly onset rheumatoid arthritis and elderly onset rheumatoid arthritis with osteoarthritis / 中华风湿病学杂志

Objective To compare the clinical features,ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA).Methods Eighty-eight patients with rheumatoid arthritis were divided into two groups:group EORA (n=36)and group EORA+OA (n=52).The onset age of all patients was 60 years or older.General conditions,joint involvement distribution,ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed.The x2 test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data.Results There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P＞0.05).The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old],and the difference was statistically significant (t=-3.465,P=0.001).Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA.Joint involvement in the two groups was mainly found in shoulder,wrist,Metacarpophalangeal joint (MCP)2,MCP3,proximal interphalangeal joint (PIP)2,PIP3,PIP4,and knee joint (34.7％-86.5％).The percentage of MCP2 [36.5％(38/104),70.8％ (51/72);x2 =20.02,P ＜0.01],MCP3 [33.7％ (35/100),59.7％ (43/72);x2 =11.72,P =0.001],MCP4 [4.8％ (5/100),22.2％ (16/72);x2 =12.28,P＜0.01],PIP2 [69.2％ (72/104),83.3％ (60/72);x2 =4.51,P=0.034]and PIP3 [53.8％(56/100),70.8％(51/72);x2=5.15,P=0.023] in the EORA+OA group was lower while the percentage of MCP1,DIP 2,DIP3,DIP4 and knee joints were higher than that in the EORA group (P＜0.05).In group EORA+OA,the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm]were significantly thicker than those in group EORA [(3.2±0.9) mm;(6.3±0.8) mm,t=-5.82,P＜0.01;t=-7.22,P＜0.01];The proportion (70.0％) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9％;52.3％),the difference between the two groups was statistically significant (x2=4.64,P=0.031;x2=4.43,P=0.035).There was no significant difference in DAS28-3 scores between the two groups before patients received treatment.After 2 weeks and 12 weeks of glucocorticoid treatment,DAS28-3 scores in group EORA [3.62 (2.88,4.03);2.35 (2.26,2.62) points] were significantly lower than group EORA+OA [5.01(4.68,5.26);3.38(2.28,3.83) points](Z=-7.766,P＜0.01;Z=-3.461,P＜0.01).Conclusion Compared with patients of EORA alone,patients of EORA with OA have more obvious joint symptoms,MCP1,DIP and knee joint are susceptible to the coinvolvement among them,longer duration of disease,and were prone to synovial hyperplasia and pannus flow formation.The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.

Clinical Characteristics, Pathogenic Distribution, Treatment and Prognosis of 300 Patients With Infective Endocarditis Hospitalized in Fuwai Hospital / 中国循环杂志

Objectives: To analyze the clinical features, pathogenic distribution, treatment and prognosis of patients with infective endocarditis (IE) hospitalized in Fuwai Hospital during the latest 4 years, and to improve the diagnosis and treatment of this disease. Methods: This retrospective study included a cohort of 300 IE patients hospitalized in Fuwai Hospital from 2013 to 2016. Predisposing cardiac disease,pathogenic distribution and clinical outcomes were analyzed.Clinical and epidemiological features of patients treated with medications or surgery were compared. Results: There were 228 male and 72 female patients in this cohort; the mean age was (40.0±15.7) years old. Among the IE patients, 35.3% patients had congenital heart diseases, 22.3% had non-rheumatic valve diseases, and 10.3% had history of PCI or heart surgery. Only 4.3% patients suffered from rheumatic heart diseases. Cardiac murmur (93.3%) and fever (84.3%) were the most common clinical presentations. Congestive heart failure was the most common complication (75.3%), followed by systemic and pulmonary embolism (16.7%). Incidence of positive blood culture was 52.4%.Streptococcus (76.3%) were the most common causative organisms, followed by Staphylococcus (11.0%). 91.3% IE was detected by echocardiography. In-hospital mortality rate was 3.0%. Subgroup analysis showed that the cure rate of surgical treatment group was significantly higher than that of the medical treatment group (96.6% vs 48.6%, P<0.001). Conclusion: Congenital heart disease is the main underlying disease related to IE.Streptococcus is still the primary pathogen of IE. Due to the 1ower positive rate of blood culture, echocardiography serves as the most important diagnostic tool for infective endocarditis.Early, effective and regular antibiotic therapy is still the cornerstone of the treatment of IE. Cardiac surgery treatment can reduce the mortality rate of IE.

Comparison between "five needles therapy" and conventional acupuncture for individual symptoms and signs of asthma of latent cold phlegm-fluid in the lung / 中国针灸

<p><b>OBJECTIVE</b>To observe the effect difference between acupuncture of "five needles therapy" and conventional acupuncture for asthma of latent cold phlegm-fluid in the lung.</p><p><b>METHODS</b>Two hundred and ten cases were randomly assigned into an observation group and a control group, 105 cases in each one. Finally 7 cases were dropped out in the observation group; 6 cases in the control group. Feishu (BL 13), Dazhui (GV 14), Fengmen (BL 12) were used in the observation group; conventional acupuncture was used in the control group, and the main acupoints were Feishu (BL 13), Zhongfu (LU 1), Tiantu (CV 22), Danzhong (CV 17), Kongzui (LU 6), Dingchuan (EX-B 1), Fenglong (ST 40), Fengmen (BL 12), Taiyuan (LU 9). The needles were retained for 30 min each time, once a day for continuous 12 days. The scores of the individual symptoms and signs were observed before treatment and on the 3rd, 6th, 9th, 12th days, including pant, cough, cough up phlegm, fullness and oppression in the chest and diaphragm, wheezing rale and shortness of breath. The clinical effects were compared between the two groups.</p><p><b>RESULTS</b>The scores of six individual symptoms and signs on the 3rd, 6th, 9th, and 12th days in the two groups were lower than those before treatment (all<0.05), except the score of wheezing rale in the control group on the 3rd day (>0.05). The scores of pant, wheezing rale, cough on the 3rd, 6th, 9th, and 12th days in the observation group were lower than those in the control group (all<0.05), except the score of wheezing rale score on the 3rd day (>0.05). There were no significant difference between the two groups about the scores of cough up phlegm, fullness and oppression in the chest and diaphragm and shortness of breath on the 3rd, 6th, 9th, and 12th days (all>0.05), except the score of fullness and oppression in the chest and diaphragm in the observation group was lower than that in the control group on the 12th day (<0.05). 46 cases were clinical cured, 39 cases were markedly effective, 10 cases were effective and 3 cases were ineffective in the observation group with the total effective rate of 96.9%. 23 cases were clinical cured, 43 cases were markedly effective, 24 cases were effective and 9 cases were ineffective in the control group with the total effective rate of 90.9%. The difference was statistical (<0.05).</p><p><b>CONCLUSION</b>"Five needles therapy" has significant therapeutic effect for asthma of latent cold phlegm-fluid in the lung, which is better than conventional acupuncture.</p>

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

PURPOSE: To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms. MATERIALS AND METHODS: We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores. RESULTS: From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01). CONCLUSION: One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS.

Classification of symptoms and signs in clinical term system of traditional Chinese medicine / 中华医学图书情报杂志

After the concept of symptoms in traditional Chinese medicine was defined, the classification of symp-toms in traditional Chinese medicine and the characteristics of clinical diagnosis and treatment in traditional Chinese medicine were described .It was suggested that the symptoms in traditional Chinese medicine should be classified into 3 kinds, namely symptoms and signs according to the 4 diagnostic methods, symptoms and signs according to the diagnostic devices, symptoms and signs according to the physical constitutions of patients in order to lay a foun-dation for improving the classification in clinical term system of traditional Chinese medicine.

Clinical analysis of atypical pulmonary embolism / 重庆医学

Objective To analyze the common reasons for misdiagnosis of atypical pulmonary embolism (APE) ,and to im‐prove the identification of APE .Methods The risk factors ,clinical manifestations ,laboratory examinations and radiographic data of 120 cases of APE diagnosed from January 2006 to December 2013 in the department of cardiovascular medicine and respiratory medicine of Xinqiao Hospital and the Affiliated Hospital of Luzhou Medical College were studied retrospectively .Results Among those 120 cases of APE ,39 cases were misdiagnosed on admission (32 .5% ) .8 cases were misdiagnosed as acute coronary syn‐drome ,7 cases as stable angina pectoris ,7 cases as chronic cor pulmonale ,5 cases as pneumonia ,3 cases as pleural effusion ,3 cases as tuberculosis ,3 cases as asthma ,1 case as atrial septal defect ,1 case as acute heart failure ,and 1 case as cardiogenic syncope .Con‐clusion APE is easy to be misdiagnosed for its non‐specific clinical manifestation .Pulmonary enhanced CT or CTPA should be car‐ried out in time for those highly suspected patients ,in order to reduce the misdiagnosis of APE .

Ondansetron versus Amitriptyline in the Treatment of Peripheral Neuropathy: A Randomized Double Blind Prospective Clinical Study.

Background and Objective: Clinical trials have shown the potential use of 5-HT3 receptor antagonists like Ondansetron, Tropisetron and Zacopride in a number of disorders of gastrointestinal tract and the central nervous system such as cancer chemotherapy induced vomiting, anxiety, depression, schizophrenia and migraine. Various experimental and clinical studies also point the usefulness of Ondansetron in neuropathic pain. Therefore, the present study was conducted to find out whether Ondansetron could be used as an alternative to a standard drug, Amitriptyline in the treatment of peripheral neuropathy. Methodology: A randomized double blind prospective clinical study was conducted on Original Research Article British Journal of Medicine & Medical Research, 4(26): 4444-4454, 2014 4445 thirty six patients of peripheral neuropathy divided into two groups of equal number of patients. Group 1 received Ondansetron 8 mg per day while Group 2 received Amitriptyline 25 mg per day. Patients were being evaluated on the basis of improvements (decrease) in LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), VAS (Visual Analogue Scale) and NCV (Nerve Conduction Velocity) for six weeks. Student’s ttest and/or repeated measure ANOVA followed by Bonferoni correlation was used to compare sets of paired observations. The Friedman test followed by multiple comparisons was used to compare the data which was not normally distributed. Results: LANSS and VAS scores showed significant improvements in the 1st and 2nd visit in both the groups. NCV showed improvement in Ondansetron group with less number of adverse effects compared to that of Amitriptyline. NCV in Amitriptyline group demonstrated significant increase in one of the parameters, F-waves, indicating a worsening in left tibial nerve (p=0.036), whereas no such change was found in the group treated with Ondansetron. Conclusion: Ondansetron has beneficial role in peripheral neuropathy by improving its sensory component as it significantly decreased LANSS and VAS scores. Our results also demonstrated that Ondansetron was at least as efficacious as Amitriptyline in the treatment of peripheral neuropathy with lesser adverse effects.

Clinical analysis of symptoms and signs of herpangina children developing into hand-foot-mouse disease / 中国综合临床

Objective To analyze the relationships and differences of the clin(HFMD) ical signs and the possibility of children with herpangina developing into HFMD by observing the clinical signs.Methods Eighty children diagnosed herpangina clinically firstly were divided into Group A,B and C.Group A included 42 cases with only herpangina,and Group B including 28 cases who were herpangina developing into mild HFMD and Group C including 10 cases with serve HFMD.The clinical signs of the three groups,including blood routine test and lymphocyte count,neutrophil count,and monitor the degree of fever,blood pressure,heart rate,respiratory and digestive system,nervous system symptoms were recorded.Results In Group A,B and C,white blood cell number,lymphocyte number,neutrophil number were no significant difference(P ＞ 0.05).However,fever degree,thermal history,heart rate,respiratory rate,systolic pressure,diastolic pressure were significant differences (F =5.03,3.62,4.83,3.65,6.72,3.74 ; P ＜ 0.05).Meanwhile The sigh of loss of appetite,vomiting,diarrhea,gastrointestinal symptoms and easily frightened,limb jitter,sleepiness were statistically significant(x2 =6.10,5.75,4.86,3.58,3.42,4.35;P ＜0.05).Conclusion The herpangina children with symptoms and signs such as higher fever and higher blood pressure,simultaneously with diarrhea,vomiting,hyperarousal and amyostasia,have the more chance to develop HFMD.

The expression features of hydrolase genes related to the sec retion of thyroid hormone of H22 hepatoma mice with different symptoms in early stage / 国际中医中药杂志

Objective To study the expression features of hydrolase genes related to the secretion of thyroid hormone of H22 hepatoma mice with different symptoms in early stage. Methods Firstly, The quantitative diagnosis and syndrome differentiation methods were used in H22 tumor-bearing mice in early stage, the expression profile of Tg and related hydrolase genes in poisonous pathogenic factors syndrome group (PPFS) and qi-deficiency syndromes (QDS) were got, and the major differential expression were selected. Secondly, the experiment was repeated and ELISA were used to detect T3 and T4 in serum, RT-PCR were applied to detect gene transcription level of genes including Tg, Ctsb, Ctsd, Ctsl, Napsa and Tpp1. Results ① Based on gene chip, the expression of Tg, Ctsb, Ctsd, Ctsl, Napsa and Tpp1were decreased in the first batch of experiment, the exactly ratio was Tg(0.77 in PPFS;0.84 in QDS), Ctsb(0.83 in PPFS, 0.91 in QDS), Ctsd(0.79 in PPFS;no notable change in QDS), Ctsl(no notable change in PPFS; 0.65 in QDS), Napsa(0.78 in PPFS; no notable change in QDS), and Tpp1 (0.75 in PPFS; no notable change in QDS), respectively. ② T3 and T4 downregulated in PPFS (the T3 value was 1.519±0.162ng/ml, T4 value was 2.194±0.305mg/dl) and in QDS (the T4 value is 4.366±0.727μg/dl) in early stage (P<0.01), especially in PPFS, which was in accordance with the change of Tg in both batches. ③the same trend happened in the validation of Tg(0.22 in PPFS;0.38 in QDS), Ctsb(0.31 in PPFS;0.55 in QDS), Ctsd(0.36 in PPFS;0.78 in QDS) and Napsa(0.24 in PPFS;0.59 in QDS) ,while ctsl(1.24 in PPFS;2.11 in QDS) and Tpp1 (2.85 in PPFS;0.85 in QDS)werethe opposite;even this, the total trend of the expression in QDS was still higher than that in PPFS. Conclusion All the results showed that the thyroid function of H22 hepatoma mice was inhibited in early stage especially in PPFS.

Pulmonary artery hypertension of adult onset of Still's disease: 3 cases report with literature review / 中华风湿病学杂志

Objective To improve the rheumatologists'understanding of pulmonary artery hypertension (PAH) of adult onset Still's disease (AOSD).Methods Three cases of (AOSD) with (PAH) were reported and the related literatures were reviewed.Results All patients were female.The average age was 29 years old.As the cases showed,the clinical manifestations of AOSD were all before the appearance of PAH symptoms and the interval could be 5 months to 9 years.From the ultrasonic cardiogram estimation,the PASP of these patients was (80±21) mm Hg (1 mm Hg=0.133 kPa) on average.The common characteristics included the severity of AOSD,recurrence after high dose of corticosteroid and various immunosuppressive agents aggressively.In addition,PAH was developed rapidly,and we found that patients were die 1 year later after disease onset.Studies showed that all of their death were related to circulation failure caused by right heart failure combined with obstructive shock.And infection was considered as an important predisposing factor of the obstructive shock.Conclusion From the findings above,we can conclude that ASOD complicated with PAH is rare,and it always develops rapidly.Furthermore,the state of disease is very serious and at the same time,the prognosis remains poor.Rheumatologists should aware this rare condition.

Clinical features of patients with painless acute pancreatitis / 中华胰腺病杂志

ObjectiveTo investigate the clinical features of patients with painless acute pancreatitis ( AP),and to improve the diagnosis accuracy of painless AP.MethodsThe clinical data of 12 patients with painless AP were retrospectively collected from January 2007 to January 2011.Results The mean age of patients with painless AP was 52 years old.Seven (58.3％) patients complained of abdominal distension and discomfort,4 (33.3％) patients complained of nausea and vomiting,abdominal tenderness occurred in 7(58.3％ ) patients.Serum levels of lipase and amylase was increased in 11 (91.7％) and 8 (66.7％)patients,respectively.The diagnostic accuracy of abdominal ultrasound and CT for AP was 58.3％ and 91.7％,respectively.Five (41.7％) patients were diagnosed to have AP upon admission,and 4 patients were misdiagnosed to have non-digestive diseases.There were 7 severe AP patients among the 12 painless AP patients,and the percentage was significantly higher than that in AP patients with pain (65/327,x2 =7.30,P ＜ 0.05).Painless AP patients needed longer hospital stay when compared with that of AP patients with pain [ ( 20.4 ± 9.1 ) d vs.( 12.9 ± 6.2) d,t =2.296,P ＜ 0.05 ) ].ConclusionsThe misdiagnosis rate of painless AP is high and patients with painless AP are in critical situation,and early measurement of serum levels of lipase and amylase,as well as CT scan is important for correct diagnosis.

Endovascular recanalization therapy of basilar artery occlusion based on clinical-diffusion mismatch / 中国脑血管病杂志

Objective: To investigate the feasibility of performing endovascular recanalization therapy (ERT) in patients with acute basilar artery occlusion (BAO) of broadened time window (≥24 hours) based on clinical-diffusion mismatch (CDM). Methods: A total of 11 CDM patients whose Glasgow Coma Scale (GCS) score <8 at admission were recruited and the diffusion-weighted imaging (DWI) did not find their brainstem reticular formation and bilateral damage to hypothalamus. Intra-arterial thrombolysis (IAT) with rt-PA alone or in combination with IAT, percutaneous transluminal angioplasty (PTA) and stenting were used. At the same time, the degree of recanalization was evaluated according to the thrombolysis in myocardial infarction (TIMI) criteria and the complications were observed. The modified Rankin scale (mRS) was used to assess after 3 months. Results: Circled digit oneThe mean onset time and duration of coma of the 11 patients were 42 hours (range 25 to 73 hours) and 11 hours (range 2 to 24 hours), respectively. The mean GCS score at admission was 6 (range 3 to 7) and that was 14 (range 3 to 15) at discharge. Circled digit twoNine patients performed ERT successfully (n = 2, TIMI grade 2, n = 7, TIMI grade 3) and 2 failed (TIMI 0). There were no complications such as bleeding. The patients regained consciousness within 9 to 27 hours. Circled digit threeThe patients were followed up after 3 months, 7 had good outcome (mRS, 0 to 2) and 2 had poor outcome (mRS, 3). ERT failed in 2 patients and they died at day 5 and day 21 after the procedures. Conclusion: The patients with broadened time window on CDM who performed ERT may have a higher recanalization rate and relatively good clinical outcome. The patients with collateral circulation has good outcome.

Clinical features of different pathologic type of intraductal papillary mucinous tumors of the pancreas / 中华胰腺病杂志

Objective To summarize the clinical features of intraductal papillary mucinous tumors (IPMT) of the pancreas to improve the diagnosis and treatment of IPMT.Methods The clinical features,imaging features and clinicopatholagic characteristics of 49 IPMT patients,who underwent operations in our department from March 1996 to September 2008,were retrospectively analyzed.The clinical features of benign,borderline and malignant IPMT were compared.Results Among the 49 patients,there were 27 males and 22 females;the average age was 58±11 years.There were 18 benign cases,9 borderline cases and 22 malignant ones.The difference in sex ratio,age of disease onset,smoking and drinking habit,history of pancreatitis and diabetes,presence of abdominal pain,radiation pain,abdominal bloating and weight loss symptoms,serum levels of CEA,AST,ALT,tumor location and type were not significantly different between the 3 groups.However,there were significant difference in term of jaundice,serum carbohydrate antigen 19-9(CA19-9)and alkaline phosphatase (AKP) levels,size of tumor,diameter of main pancreatic duct,presence of septum in cystic tumor,mural modules in the tumor.Among the malignant IPMT patients,one patient died 5 years after operation,one patient had malignancy recurrence;among the benign and borderline IPMT patients,1 patient had malignancy recurrence and 1 patient died due to other disease.Conclusions Different types of IPMT had different clinical features and comprehensive judgment were needed to differentiate.

Clinical characteristics of rheumatoid arthritis with interstitial pulmonary fibrosis / 北京大学学报(医学版)

Objective:To analyze the clinical characteristics of interstitial pulmonary fibrosis (IPF) in patients with Rheumatoid arthritis (RA). Methods: We retrospectively analyzed 198 RA patients with or without IPF. Characteristics of RA-IPF in clinical and lab data were analyzed. Age, duration of disease,clinical and laboratory parameters, history of smoking and medicine were compared between the patients with and without IPF. Results: (1) Among the 198 RA patients, 15.2% (30/198) were found with IPF. 100% RA-IPF patients had HRCT findings. However, 63.3% (19/30) had positive findings in chest X-ray, and only 46. 7% ( 14/30) had the complaints of cough and short breath. Velcro rales were found in 50.0% (15/30) patients with IPF and no acropachy occurred. Only one patient suffered from hypoxemia. IPF presented after the joint symptoms in most patients. (2 ) RA-IPF patients were older than those without IPF [(65.50±9.71) vs (55.22±12.98) years, P＜0.01]; Higher positivity of anti-keratin antibodies ( AKA) were found in RA-IPF compared to patients without IPF (61. 5% vs 35.9% , P =0.014). Furthermore, the levels of anti-cyclic citrullinated peptide (CCP) antibody were significantly higher in RA-IPF [(4.38±2.08) vs (3.20±2. 12) , P =0.01]. No differentiation of duration of disease, history of smoking and medicine, IgM rheumatoid factor, IgG rheumatoid factor, anti-nuclear antibody, anti-SSA antibody and levels of immunoglobins and complements were found between the two groups of RA patients with and without IPF. Conclusion: The clinical symptoms of IPF in RA patients are mild and more common in older patients. AKA and anti-CCP antibody might be important antibodies associated with RA-IPF.

Clinical features of primary Sjǒgren's syndrome involved in the extra-gland organs as initial manifestations / 中华全科医师杂志

Objective To investigate clinical characteristic of primary Sjogren's syndrome(pSS) with initial manifestations in the extra-gland organs. Methods Clinical data, including symptoms, laboratory parameters and complications of 85 pSS patients with initial manifestations of extra-gland organs hospitalized at the People's Hospital of Peking University during 2003 to 2006 were collected and analyzed retrospectively, as compared to those of pSS with xerophthalmia or xerostomia as initial ones. Results Mean time interval from onset to diagnosis in these patients with initial manifestations involved in the extra-gland organs was 94.5 months, higher than that in those with xerophthalmia or xerostomia as initial ones. Arthritis was manifested initially in 38 of the 85 patients (44.7 percent), peripheral leukopenia in 16 (18.8 percent), thrombocytopenia in nine (10.6 percent) and abnormal liver function in 13 (15.3 percent), respectively. Percentage of serum positive autoantibedies was higher in the patients with initial manifestation of the extra-gland organs than that in those with xerophthalmia or xerostomia as initial ones. Conclusions Initial manifestation of primary Sjogren's syndrome varies, and some patients can be initially involved in their extra-gland organs, with more proportion of arthritis than of other symptoms, and xerophthalmia or xerestomia could appear in them during the course of disease. And, xerophthalmia or xerostomia would not appear even as pSS was diagnosed in some other pSS patients. More attention should be paid to these clinical characteristics mentioned above in practice to avoid misdiagnosis.