Clinical Characteristics and Diagnostic Methods of Pulmonary Mucormycosis / 中山大学学报(医学科学版)

ObjectiveTo summarize the clinical features and prognosis of pulmonary mucormycosis （PM） in southern China， and to explore the diagnostic value of metagenomic next generation sequencing （mNGS） in PM. MethodsThe clinical manifestations， diagnosis， treatment and prognosis of patients diagnosed with PM in The First Affiliated Hospital of Sun Yat-sen University from January 1， 2019 to January 31， 2022 who had undergone mNGS detection in lung tissue or alveolar lavage fluid were collected retrospectively. A total of 14 patients with PM were included， including 4 patients with confirmed diagnosis and 10 patients with clinical diagnosis. ResultsAll patients had underlying medical conditions， with hematological malignancies and diabetes being the most common. The most common symptoms were fever （n = 10）， cough （n = 9） and shortness of breath （n = 9）. Consolidation was the most common sign of chest CT， followed by mass， mostly with cavity. On laboratory tests， decreased CD4+T lymphocytes， elevated CD8+T lymphocytes， and decreased CD4+/CD8+ ratio， and presentation with pleural effusion indicate poor prognosis. The positive rate of mNGS diagnosis was 78.5%， which was significantly higher than that of histopathology （50%）， fungus rapid fluorescence staining （61.5%） and fungal culture （23.1%） of bronchoalveolar lavage fluid. ConclusionsPulmonary mucormycosis is more likely to occur in patients with underlying diseases or who are immunocompromised. The clinical manifestations lack specificity. The low CD4/CD8 ratio and presentation of pleural effusion on CT imaging indicate poor prognosis of patients. mNGS is a rapid， convenient and sensitive method for the diagnosis of PM， which has advantages in the diagnosis of pulmonary mucormycosis.

Study on the Stakeholders of Drug Supply Support Reform in Sanming City / 中国医院管理

Government departments,pharmaceutical enterprises,health providers and patients were the four main stakeholders who involved in drug supply support reform in Sanming City.The paper centered on stakeholders' role and basic appeal,their influence on the reform or the influence of reform on them and the probable problems of reform,to make the motivation and resistance of the reform clearly and provide evidence for the sustainability and reproducibility of the reform.

Laryngo-tracheobronchial amyloidosis: a case report and review of literature / 中国医学科学杂志(英文版)

AMYLOIDOSIS is a benign process which can have systemic involvement. Though larynx is the common site of localized amyloidosis in the head and neck region,1 it was seldom reported with heterochronous implication of bilateral ventricles. Here we report a case of laryngeal amyloidosis heterochronously localized at bilateral ventricles with tracheobronchial involvement. Combined with our experience we reviewed the literature, and discuss the pertinent managements of this condition.

Relationship between bacterial biofilms and chronic rhinosinusitis by scanning electron microscopic study / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the presence and the morphological features of bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis (CRS) compared with control patients without CRS by scanning electron microscopy (SEM), and to evaluate the role of biofilm on the pathogenesis of CRS.</p><p><b>METHODS</b>Fifteen patients with CRS undergoing endoscopic sinus surgery and 11 control patients with fracture of nasal bone were enrolled in this study. Clinical information was recorded from each patient. All patients underwent a thorough otolaryngological examination, preoperative paranasal sinus computerized tomography (CT) scanning which were evaluated according to the Lund-Mckay CT scoring system. All the samples including uncinate process, ethmoid mucosa from CRS group and uncinate process, ethmoid bulla from control group were prepared using standard methods for SEM. The presence of bacterial biofilms on the samples of two groups was observed by SEM. Statistical analysis was performed using SPSS 13.0. Continuous data was analyzed by Student t test and dichotomous data was analyzed by chi² or Fisher exact test. P was considered to be significant at a level of 0.05.</p><p><b>RESULTS</b>Nine (60.0%) of the 15 patients were found to have evidence of biofilms. In control group, only 1 (9.1%) of 11 patients had biofilm. The difference was statistical significant (chi² = 6.949, P < 0.01). All controls except one had healthy appearing cilia and goblet cells without biofilms. All the 16 CRS patients showed aberrant findings of the mucosal surface with variation in degrees of severity from disarrayed cilia to complete absence of cilia and goblet cells. Among them the typical morphologic feature such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in 9 cases. Five samples including one case from control showed cilia aggregation. The preoperative CT scores of the CRS patients with biofilms (n = 9) were significantly higher than those without biofilms (n = 6, t = 2.14, P < 0.05).</p><p><b>CONCLUSIONS</b>The typical morphologic feature of BF such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in sinus mucosa of patients with CRS by the SEM. The positive rate of bacterial biofilms in CRS group was significantly higher compared to control group, which indicated bacterial biofilms might play an important role in the pathogenesis of CRS. Besides the typical bacterial biofilm features, cilia aggregation was found in five cases of CRS patients. We consider cilia aggregation can be regarded as one morphologic feature of bacterial biofilm in nasal mucosa, which needs further study. The presence of bacterial biofilms in CRS patients is associated with paranasal CT scores, which indicates that bacterial biofilm is correlated with the severity of CRS.</p>

Clinical significance of angiopoietin-2 expression in oral squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of angiopoietin-2 (Ang-2) and its clinical significance in oral squamous cell carcinoma.</p><p><b>METHODS</b>The expression of Ang-2 mRNA was measured by real-time RT-PCR, and the expression of Ang-2 protein in tissue samples was detected by immunohistochemical staining.</p><p><b>RESULTS</b>The mean dCt value of Ang-2 mRNA expression in the cancer tissue was 6.86 +/- 1.37, significantly lower than that in the paired adjacent non-cancerous tissue (7.95 +/- 2.08, P < 0.05), indicating a significantly higher expression of Ang-2 mRNA in the cancerous tissue than that in the adjacent non-cancerous tissue. The distribution of Ang-2 protein was found not only in the vascular endothelial cells but also in tumor cells. Semi-quantitative analysis revealed that the expression of Ang-2 protein in tumor specimens (53.6%) was significantly higher than that (24.0%) in the paired adjacent non-cancerous tissue (P < 0.05), the result was well consistent with that measured by RT-PCR. The dCt value of Ang-2 mRNA expression was 6.48 +/- 1.16 in the patients with metastasis in lymph nodes versus 7.16 +/- 1.49 in those without, with a non-significant difference between the two groups (P > 0.05). As regards the clinical stages, no significant difference was found between the expressions of Ang-2 mRNA in stage I + II (7.11 +/- 1.63) and stage III + IV cases (6.49 +/- 1.10, P > 0.05).</p><p><b>CONCLUSION</b>Angiopoietin-2 protein is expressed not only in vascular endothelial cells, but also in tumor cells, suggesting that angiopoietin-2 may take part in angiogenesis in oral squamous cell carcinoma. However, our results that high expression of angiopoietin-2 mRNA is not correlated with lymph node metastasis and clinical stages, needs to be further verified in a large scale study.</p>

Transnasal endoscopic repair of acquired posterior choanal stenosis and atresia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are congenital and acquired choanal atresias and many approaches have been used for their repair. We assessed the clinical effect of power instrument, endoscopic repair of acquired choanal stenosis and atresia.</p><p><b>METHODS</b>Nineteen patients, aged from 32 to 61 years, with acquired choanal stenosis and atresia (from trauma in 5 cases and from radiotherapy after nasopharyngeal carcinoma in 14; 6 bilateral and 13 unilateral cases), underwent transnasal endoscopic repair of choanal stenosis and atresia. No patient had stenting. Antibiotic and local glucocorticoid were administered postoperatively.</p><p><b>RESULTS</b>Eighteen patients remained free of symptoms for 12 - 40 months after the surgery, and the diameter of the neochoana was more than 1 cm after the procedure. One patient required revision surgery and recovered completely with no restenosis at 12 months after the second surgery. There were no postoperative complications. Histology of the resected tissue revealed respiratory epithelial-lined stromal tissue with chronic inflammation, edema and fibrosis, but no tumor cells.</p><p><b>CONCLUSIONS</b>Transnasal endoscopic approach is a useful procedure for the repair of acquired choanal stenosis and atresia: it is highly successful, safe and effective with swift recovery and short time of hospitalization. It is very important in postoperative care to remove any granulation or polyps at the site of the neochoana at that time.</p>