Clinical features and outcome of Takayasu arteritis associated pulmonary hypertension / 中华急诊医学杂志

Objective To investigate the clinical features, diagnosis, treatment and outcome of patients with Takayasu arteritis associated pulmonary hypertension (TA-PH). Methods Patients diagnosed as TA-PH in Shanghai Pulmonary hospital from 2008 to 2017 were retrospectively reviewed and followed up. Baseline characteristics including hemodynamics were collected. Data were summarized as mean ± standard deviation or frequency (％). Survival analyses were performed using the Kaplan-Meier method. Results Thirteen TA-PH patients (10 female, aged 39±11 years old) were included. The duration from symptoms onset to diagnosis was 2 months to 50 years, and ten patients were diagnosed TA and PH at the same time. Shortness of breath was the most common clinical manifestation (12 cases), followed by chest pain and tightness (8 cases) and palpitation (6 cases). All patients had a moderated WHO functional class and 8 patients were in active phase. Vessel wall thickening, lumen narrowing, occlusion and/or dilation were found in CT pulmonary angiography and angiography. Mean pulmonary arterial pressure (48.0±14.0) mmHg and pulmonary vascular resistant (7.59±4.21) Wood U were increased. All patients received PH-specific therapies, and patients at active status took glucocorticoid. Stentimplantation in pulmonary artery was performed in 4 patients. Three patients died during the follow-up. Conclusions Patients with TA are at risk of PH, and PH can be the first manifestation of TA, which suggest that PH should be screened regularly in patients with TA and shortness of breath. The prognosis of TA-PH is poor. PH-specific therapies and vascular reconstruction therapy may be effective, but need further investigation.

Clinical character and genetic mutation of 64 patients with Gitelman syndrome / 基础医学与临床

Objective To study the clinical and genetic profile of the patients with Gitelman syndrome ( GS ) . Methods We retrospectively analyzed the gene mutation and clinical character of 64 GS patients diagnosed in Pe-king Union Medical College Hospital from 2012 to 2016 .Results The age at diagnosis of these 64 patients ( 39 male,25 female) were (35±14) years.At admission, the serum potassium level of the patients was (2.86± 0.44) mmol/L, serum magnesium level was ( 0.62 ±0.14 ) mmol/L, 24-hour urine potassium was ( 82.27 ± 39.73)mmol/day, 24-hour urine calcium was (0.94±0.83)mmol/day and their average blood pressure was 110/69 mmHg.The gene mutation were divided into four groups including homozygous mutation ( n=5) , compound het-erozygous mutation(n=40), multiple mutations (n=9) and single heterozygous mutation (n=10) group.The compound heterozygous group had higher serum potassium concentration ( P<0.05 ) and the homozygous group had a relatively higher serum magnesium concentration but without significance .A total of 74 distinctly different mutation alleles were identified , of which 24 were new mutation alleles .p.Asp486Asn was a hotspot in our series which was found in 16 patients ( 25.0%) .Conclusions There exists great heterogeneity of gene mutation and clini-cal character in Gitelman syndrome .Patients with compound heterozygous have a relatively milder clinical character.p.Asp486Asn mutation is a hotspot in Chinese patients .

Analysis of clinical character and infection of 24 children with Takayasu′s arteritis / 中华实验和临床病毒学杂志

Objective@#To analyze the clinical characteristics and infection of children with Takayasu′s arteritis(TA) for improving the awareness of the disease.@*Methods@#A retrospective study was performed on the 24 children with TA in our hospital.@*Results@#The average onset age was 9.3±3.2 years old, the ratio of male to female was 1∶3. The most common TA type was thoracic abdominal aortic type (54.2%) in clinical classification. The initial symptoms included high blood pressure, dizziness/headache, fever and fatigue, etc.Six cases (25%) had tuberculosis infection, including 1 case of tuberculosis. There are 3 patients (8.3%) with elevated O levels, 2 patients (8.3%) with EB virus infection and 1 patient (4.2%) with small viral B19 infection.@*Conclusions@#The onset of TA in children is complicated. It is important to take examinations carefully for early diagnosis, avoiding delay treatment and bad prognosis.

Clinical characteristics of 92 misdiagnosis cases of tracheobronchial tuberculosis and the clinic value of endoscope / 天津医药

Objective To investigate the reasons of tracheobronchial tuberculosis misdiagnosis and its clinical charac?teristics as well as the diagnostic value of bronchoscope. Methods Clinical data of 92 cases of misdiagnosis of tracheobron?chial tuberculosis by electronic bronchoscopy in our department from January 2006 to January 2012 were analyzed retrospec?tively. Bronchoscopy, endoscopic biopsy, brushing, lavage and radiological images were all compared. Results Clinical symptoms and laboratory tests showed no specificity in diagnostic value;Chest X-ray was not typical. Bronchial stenosis was seen in 45 cases(48.9%)and bronchial obstruction was seen in 6 cases(6.5%)as shown in chest CT while no abnormality in the bronchus was seen in 41 cases(44.6%). Bronchoscopy revealed 28 cases (30.4%) of inflammatory infiltration, 14 cas?es (15.2%) of necrotizing ulceration, 35 cases (38.0%) of granulation hyperplasia and 15 cases (16.3%) of Scar stricture. En?doscopic biopsy confirmed 56 cases (60.9%), while bronchoscopic brushing and examination of acid-fast bacillus approved 32 cases (34.8%). Then, bronchoscopic lavage of acid-fast bacillus verified 39 cases (42.4%). Lastly, tuberculosis bacterium culture ascertained 75 cases (81.5%). Conclusion Bronchoscopy of local lesion with brush, lavage and biopsy is the most sensitive and specific diagnostic method to diagnose tracheobronchial tuberculosis. It has great clinical value in preventing tracheobronchial tuberculosis misdiagnosis.

Analysis of clinical characteristic and drug therapy in elderly chronic heart failure patients / 中国药学杂志

OBJECTIVE: To investigate the clinical characters and the situation of oral drug therapy in elderly chronic heart failure patients. METHODS: The survey was conducted among 68 chronic heart failure patients who were hospitalized between October 2013 and October 2014 in Peking university people's hospital. Data were collected and statistically analyzed concerning the clinical characters and the oral drug therapy between the elderly and non-elderly groups. RESULTS: Worsening of heart function was more significantly in the elderly chronic heart failure group than the non-elderly group. There was a tendency of multiorgan statement represented by hepatic and renal function to decrease with age. Both the level of serum and the percentage of those proper for beta blocker arrived to the minimal target dose were lower in the elderly group than in the matched group. Combined treatment of different drug was more common in the elderly group. CONCLUSION: The physiological functions of elderly patients decreased and the patients often had many concomitant disease. It is very important to pay more attention to drug selections, drug interactions and adverse reactions to optimize the treatment plan to improve the quality of life and the prognosis of these elderly chronic heart failure patients according their clinical characters.

Occurrence and intervention of hysteria in left-behind children in Chongqing rural area / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics and the interventional effects of hysteria in leftbehind children in Chongqing rural area for early detection,early treatment and prevention of the disease.Methods One hundred and three left-behind children aged from 7 to 17 years were diagnosed as hysteria from Jun.2008 to Jun.2011.Their general information,clinical presentations were analyzed retrospectively.After comprehensive intervention,they were assessed the clinical efficacy in accordance with Brief Psychiatric Rating Scale,and some of them were tested by Eysenck Personality Questionnaire (EPQ) and Symptom Checklist (SCL-90).Results There were many clinical forms of hysteria in 103 left-behind children.Physical dysfunction accounted for 72 cases(69.90％),whose symptoms were mainly paralysis and convulsive seizure,which was significantly higher than mental disorder(5 cases,4.9％).The mixed episode of physical dysfunction and mental disorder accounted for 26 cases (25.40％).Seventy-eight cases (75.73 ％) were cured,19 cases (18.45％) improved significantly,and 6 cases (5.83％) improved respectively after intervention of 3 to 12 days.Emotional instability accounted for 12 cases(63.16％) in personality factors with EPQ test in 19 cases.Their factors of somatization,interpersonal relationship,depression,anxiety,and hostility with SCL-90 significantly decreased(all P ＜0.05) after intervention of 7 to 12 days.Conclusions The main forms of hysteria in leftbehind children in Chongqing rural area are physical dysfunction and mixed episode,which are paralysis and convulsive seizure.Emotional instability is common in personality factors for them.It can be achieved good results of hysteria in left-behind children to pay attention to the emotional exchange between the children and their parents,early detect,early treat and active prevent the disease.

Psychologic Characteristics in Caregivers of Children with Attention Deficit Hyperactivity Disorder

PURPOSE: ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder with three characteristics, such as impulsivity, inattention, and hyperactivity symptoms. This is a common disease that the prevalence reaches 4-7% of all children. There are a variety of hypothesis in the pathogenic mechanisms and etiology. Parental psychopathology influences directly and indirectly on the occurrence of ADHD in children. The aim of this study was to evaluate the clinical and psychological characteristics of caregiver of child with ADHD using the MMPI (Minnesota Multiphasic Personality Inventory)-2. METHODS: The subjects consisted of 35 caregivers of patients with ADHD and 34 caregivers of children without neuropsychiatric disorders who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2009 to June 2011. We diagnosed ADHD according to DSM(Diagnostic and Statistical Manual of Mental Disorder)-IV criteria. We compared the psychologic characteristics between ADHD group and control group using T score of MMPI-2. RESULTS: MMPI T scores of caregivers of children with ADHD were significantly higher on the depression(D), psychasthenia(Pt), schizophrenia(Sc), social introversion (Si) scales than control group and most of scales were significantly higher in restructured clinical (RC) scale and personality psychopathology five (PSY-5) scales. CONCLUSION: The results suggested that psychopathology of caregivers might induce ADHD in the children. On the contrary, ADHD symptom of children might be associated with occurrence of psychopathology in the cargiver. In order to proper treatment of ADHD patient, we need to psychologic evaluation in the caregivers of patients with ADHD.

Clinical characteristics and prognostic analysis of primary testicular lymphoma / 中华泌尿外科杂志

Objective To discuss the clinical features and prognostic factors of primary testicular lymphoma (PTL). Methods A retrospective review was performed based on the clinical records of 33 PTL cases treated at Tianjin Medical University Cancer Hospital from June 1977 to May 2009.Drawing survival curves by Kaplan-Meier method, using Log-rank test to the univariate analysis, and multivariate analysis by COX regression model to evaluate independent prognostic factors. Results The median age of patients was 62 years at presentation(range 33-81 years). Painless testicular swelling was the initial symptom. The majority of histological subtype was B cell lymphoma, 48% of which was diffuse large B-cell non-Hodgkin's lymphoma. By postoperative chemotherapy and/or radiotherapy, 23 patients achieved complete remission and 7 achieved partial remission, with a median follow-up of 23 months (4-231 months). The 5 years and 10 years of overall survival was 39.1% and 19.5%. The effect of patients who received chemotherapy≥4 cycles and B cell lymphoma patients combination with Rituximab were better. In multivariate analysis, Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival. Conclusions Primary non-Hodgkin lymphoma should be treated with multi-modality strategies. Treatment with doxorubicin-based chemotherapy after orchiectomy should be recommended. Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival in PTL.

Diagnosis and treatment of 81 patients with primary gastrointestinal lymphoma / 中南大学学报(医学版)

Objective To analyze the status quo of the diagnosis and treatments of primary gastro-intestinal lymphoma (PGIL) in order to improve it. Methods Eighty-one patients with PGIL were ana-lyzed retrospectively including clinical manifestations, endoscopic features, pathological features, HP in-fection, treatment, and prognosis. Results The age of patients with gastric lymphoma was (52.84±15.33) years. The age of patients with intestinal lymphoma was (42.09±15.28) years. Common symp-toms included abdominal pain (76.5%), gastrointestinal bleeding (55.6%), anemia (54.3%), abdominal mass (25.9%), hypoproteinemia (40.7%), bowel obstruction (11.1%), abdominal dis-tension, vomiting, and other non-specific gastrointestinal symptoms (32.1%), weight loss (33.3%); fever (8.6%), diarrhea (7.4%), digestive tract perforation (1.2%), constipation (1.2%), and dysphagia (1.2%). Endoscopic appearances were as follows: tumor type (67.7%), ulcer type (27.7%), and diffuse type (4.6%). Clinical diagnosis rate and endoscopic biopsy confirmation rate were 30.9% and 73.8%. MALT lymphoma accounted for 61.7% of the patients. HP detection rate was 39.5 % and positive rate was 37.5 %. A total of 69 patients received surgeries: 3 had preoperative chem-otherapy, and 34 had postoperative chemotherapy. Twelve patients had non-surgical treatment, 6 patients of whom had simple chemotherapy and HP eradication therapy, and the other 6 gave up during the treat-ment. There was no significant difference in the survival rate of Stage Ⅰ～Ⅱ patients in the surgery alone group, surgery plus chemotherapy group, and chemotherapy and HP eradication therapy group (P>0.05). The survival rate of Stage IIIⅢ～Ⅳ patients in the surgery alone group was lower than that in the other 2 groups (P<0.05). The 5-year, 3-year, and 1-year survival rate was 55.87%, 70.96%, and 96.39%, respectively. Conclusion There are no specific clinical and endoscopic features in PGIL, so the misdiagnosis rate is high. Multi-site biopsy or repeated biopsies and immunohistochemical methods can be used to raise the pathological diagnosis rate. Chemotherapy and HP eradication are recommended.

Clinical Characteristics of Paroxysmal Kinesigenic Choreoathetosis:Diagnosis,Treatment and Prognosis / 华中科技大学学报（医学）（英德文版）

The clinical characters,diagnosis and differential diagnosis of paroxysmal kinesigenic choreoathetosis (PKC),and efficacy of the anti-epileptic drugs (AEDs) were investigated.Thirty-one patients with PKC were collected,and the clinical characters and change of EEG were analyzed.The average age of the first attack was 16.8 years old and the pinnacle was 10 to 20 years old.There were definite causes for every attack and the sudden movement was the most common one (92%).Time for the whole attack was always less than 1 rain.The attack presented with muscle tension disturbance (83.9%),movement like dancing (16.1%),abnormal movement of mouth and face and other symp-toms (16.2%).The attack tended to be very frequent and 71% patients were beyond once per day.The EEG examination and image scan of primary PKC were normal in most patients.Low dosage of AEDs could control the attack of 50%-77.3% patients.It was concluded that PKC was a common disease of movement disorder.The therapy by AEDs was very effective.PKC should be differentiated from epilepsy and the relationship between PKC and epilepsy needs further research.

A comparasion of clinical and financial aspects of laparoscopic versus open cholecystectomy / 临床外科杂志

Objective To evaluate the safety,clinical and financial aspects of laparoscopic cholecystectomy(LC).Methods 278 cases undergone LC and 234 cases undergone open cholecystectomy(OC)were compared in retrospective study.Results LC was as safe as OC.In favour of LC,significant differences were observed regarding the time of severe pain,hospitalization and recovery.The total occurences of postoperative complications were low in all the patients undergone LC or OC,and its significantly lower in patients undergone LC than that in those undergone OC.Furthermore,the total charges for LC were significantly lower than that for OC.Conclusions LC is as safe as OC and has clan obvious advantage over OC in clinical,social and financial aspects.