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Objective:To explore the rapid evaluation of the early pathogen of severe Chlamydophila psittaci pneumonia by bedside diagnostic bronchoscopy, so as to start effective anti-infection treatment before the results of macrogenome next generation sequencing (mNGS) test. Methods:The clinical data of three patients with severe Chlamydophila psittaci pneumonia who were successfully treated in the First Affiliated Hospital of Xinjiang Medical University, the First People's Hospital of Aksu District, and the First Division Hospital of Xinjiang Production and Construction Corps from October 2020 to June 2021 were retrospectively analyzed, including the rapid assessment of early pathogens by bedside diagnostic bronchoscopy and the use of antibiotics to start anti-infection treatment. These patients were successfully treated. Results:The three patients were male, aged 63, 45 and 58 years old, respectively. Before the onset of the penumonia, they had a clear medical history of bird exposure. The clinical manifestations mainly included fever, dry cough, shortness of breath and dyspnea. One case had abdominal pain and lethargy. The results of laboratory examination indicated that the peripheral blood white blood cell count (WBC) of two patients were high [(10.2-11.9)×10 9/L], the percentage of neutrophils increased (85.2%-94.6%) and the percentage of lymphocytes decreased (3.2%-7.7%) in all 3 patients after admission to hospital and entering into intensive care unit (ICU). The procalcitonin (PCT) of 3 patients increased after admission, and still increased when entering ICU (0.3-4.8 ng/L), so did C-reactive protein (CRP, 58.0-162.0 mg/L) and erythrocyte sedimentation rate (ESR, 36.0-90.0 mm/1 h). After admission, serum alanine transaminase (ALT) increased in 2 cases (136.7 U/L, 220.5 U/L), so did aspartate transaminase (AST) in 2 cases (249.6 U/L, 164.2 U/L). ALT (162.2-267.9 U/L) and AST (189.8-223.2 U/L) increased in 3 patients when they entered ICU. The level of serum creatinine (SCr) of 3 patients were normal after admission and entering ICU. The chest computed tomography (CT) findings of 3 patients were acute interstitial pneumonia, bronchopneumonia and lung consolidation, of which 2 cases were accompanied by a small amount of pleural effusion, and 1 case was accompanied by more regular small air sacs. Multiple lung lobes were involved, but mainly one lung lobe. The oxygenation index (PaO 2/FiO 2) of the 3 patients admitting to ICU were 100.0, 57.5 and 105.4 mmHg (1 mmHg ≈ 0.133 kPa), respectively, which met with the diagnostic criteria of moderate and severe acute respiratory distress syndrome (ARDS). All three patients received endotracheal intubation and mechanical ventilation. Under the bedside bronchoscope, the bronchial mucosa of 3 patients were obviously congested and edematous, without purulent secretion, and there was 1 case with mucosal hemorrhage. Three patients underwent bedside diagnostic bronchoscopy, and the evaluation result of the pathogen was that it might be atypical pathogen infection, so they were given moxifloxacin, cisromet and doxycycline intravenously, respectively, and combined with carbapenem antibiotics intravenously. After 3 days, the detection results of mNGS in bronchoalveolar lavage fluid (BALF) showed that only Chlamydia psittaci was infected. At this time, the condition was significantly improved, and PaO 2/FiO 2 was significantly increased. Therefore, the antibiotic treatment scheme remained unchanged, and mNGS only served to verify the initial diagnosis. Two patients were extubated on the 7th and 12th day of admission to the ICU, respectively, while one patient was extubated on the 16th day of admission to the ICU due to nosocomial infection. All 3 patients were transferred to the respiratory ward after the condition was stable. Conclusion:The bedside diagnostic bronchoscopy based on clinical characteristics is conducive to not only the rapid assessment of the early pathogens of severe Chlamydia psittaci pneumonia, but also effective anti-infection treatment before the returning of mNGS test results, which can make up for the lag and uncertainty of the mNGS test results.
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Objective@#Based on the MSM college students in Tianjin, this study aims to explore the demographic and behavioral characteristics of MSM with different sexual partners, and to provide evidence and information for intervention in combination with social networks.@*Methods@#According to the source and access of seeking sexual partners, 546 MSM of Tianjin college students aged 18-24 in 2018 Jan. and 2019 Dec. were divided into internet-based MSM (396) and traditional MSM (150). Chi-square test and rank-sum test were used to compare the demographic information, sexual behavior characteristics, HIV prevention and testing awareness, and psychoactive substance use of the two MSMs, and Logistic regression was used to explore factors affecting college students use of the Internet for sexual partners.@*Results@#Internet-based MSM has advantages in receiving HIV testing and safety consulting services, AIDS knowledge level, and peer education in the past year (P<0.05). The psychoactive substance use of the survey population reached more than 40%, and the awareness rates of pre-exposure prophylaxis and post-exposure prophylaxis were 32.98% and 55.32%, respectively. After multivariate Logistic regression analysis, MSM students who had received condom distribution, AIDS counseling and peer education (OR=2.16, 1.98, P<0.01) were more inclined to use the Internet for sexual partners.@*Conclusion@#Relevant departments can use the Internet to intervene in the prevention and control of MSM in colleges and universities in terms of AIDS-related knowledge, HIV testing, and mental substances.
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Objective To compare the clinical value of cardiac magnetic resonance (CMR)and echocardiography in diagnosis of hypertrophic cardiomyopathy (HCM).Methods 3 6 patients with HCM diagnosed clinically underwent CMR examination,and then compared with the results of echocardiography.Results 36 cases of HCM were all detected by CMR,including 15 cases of ventricular-septal HCM,5 cases of diffuse HCM,4 cases of midventricular HCM,2 cases of anterior-wall HCM and 10 cases of apical HCM.In addition,12 cases were performed enhanced-CMR scanning,and myocardial ischemia was showed in 4 cases and myocardial fibrosis in 5 cases.1 3 cases of ventricular-septal HCM,5 cases of diffuse HCM,3 cases of midventricular HCM and 1 cases of anterior-wall HCM were detected by echocardiography respectively(22/26).There was no significant difference between echocardiography and CMR(26/26)(P＞0.05).However, only 3 cases of apical HCM were detected by echocardiography (3/10)definitlely,and there was statistically significant difference between echocardiography and CMR(10/10)(P＜0.05).Additionally,on CMR theleft ventricular ejection fraction(EF)in all patients [(58.24±3.24)%] was significantly lower than the results of echocardiography [(71.20±6.24)%]and the left ventricular mass (LVM)[(126.54±36.42)g/m2 ]was higher than echocardiography [(84.54±36.42)g/m2 ],and the mean EF and LVM value had a significant difference between echocardiography and CMR (P＜0.05).Conclusion CMR imaging is superior to echocardiography in the diagnosis of HCM and evaluation of cardiac function,especially in the apical HCM.In addition,myocardial perfusion and delayed-enhanced imaging can effectively assess myocardial perfusion and viability in HCM.
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Objective: To determine whether microtubule-associated protein 2 (MAP2) and microtubule-associated protein 1B (MAP1B) could be prognostic biomarkers for patients with pancreatic neuroendocrine tumors (PNETs). Methods:With immunohisto-chemical staining, the expressions of MAP2 and MAP1B were examined in 193 and 120 primary tumors and peritumoral tissues, re-spectively. Then, the relationship between the expression of each protein and clinicopathological characteristics, including prognosis was analyzed. Results:MAP2 and MAP1B were expressed in 88 of 193 (45.6%) and 77 of 120 (64.2%) tumors, respectively. The expres-sion of MAP2 was significantly associated with the favorable overall survival of patients with PNETs (P=0.012). Moreover, MAP2 expres-sion was associated with the improved overall survival in a subset of patients with stageⅡand stageⅢtumors (P=0.017). The MAP1B expression did not correlate with other clinicopathological features and prognosis. Conclusion:MAP2 could be a novel, independent prognostcbiomarker for PNETs.
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Gastrointestinal neuroendocrine tumors are a group of highly heterogeneous tumors. Their incidences have increased in the Western countries as well as in Asia for years. In recent years, predominant progression has been made in the basic and translational studies on gastrointestinal neuroendocrine tumors. Gastric neuroendocrine neoplasmas are classified as four types: type I( occurs on the basis of autoimmune atrophic gastritis, type II( clinically manifests as multiple endocrine tumor type I( and Zollinger-Ellison syndrome, type III( is sporadic neuroendocrine neoplasmas, and type IIII( is neuroendocrine carcinoma. According to the location of primary tumor, intestinal neuroendocrine neoplasmas are classified as small intestine neuroendocrine neoplasmas and colorectal neuroendocrine neoplasmas. The latest finding shows that familial type I( gastric neuroendocrine neoplasmas exists homozygous missense mutation (c.2107C>T) of ATP4A gene. A number of researches focus on small intestine neuroendocrine neoplasmas recently. The chromosome instability, whole genome low methylation and abnormal expression of microRNA can be found in small intestine neuroendocrine neoplasmas. Part of them presents heterozygous mutations and loss of heterozygosity of CDKN1B gene. A recent study showed the heterozygous mutations of IPMK gene (c.990-993del) in familial small intestinal neuroendocrine neoplasmas. PROX1 and Annexin A1 may be involved in the malignant progression of rectal neuroendocrine neoplasmas via the Wnt pathway. The molecular mechanism of gastrointestinal neuroendocrine carcinoma is significantly different from gastrointestinal neuroendocrine tumors. The expression of mTOR, thymidylate synthase and PD-L1 protein, and gene mutation of BRAF V600E and KRAS have been exclusively found in gastrointestinal neuroendocrine carcinoma. The expression of thymidylate synthase, p27, p16, Gα15, PROX1 and Annexin A1 in gastrointestinal neuroendocrine neoplasmas is associated with the prognosis of these patients. Neurokinin A is a specific peripheral blood tumor biomarker for the prognosis and response to the treatment of patients with small intestinal neuroendocrine neoplasmas. INSL5 can be used as a unique biomarker for rectal neuroendocrine neoplasmas.