Clinical characteristics and prognosis of bacterial liver abscess in patients with diabetes mellitus / 中华传染病杂志

Objective:To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without diabetes mellitus (DM), to provide a reference for clinical diagnosis and treatment.Methods:Patients with bacterial liver abscesses hospitalized in Tongren Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to August 2021 were enrolled, and their clinical data were collected. The patients were divided into diabetic and non-diabetic groups for comparison according to whether they had comorbid DM. Statistical analysis was performed by chi-square test or Fisher′s exact test, and multivariate logistic regression analysis.Results:A total of 131 patients with bacterial liver abscesses were included, including 47 cases in the diabetic group and 84 cases in the non-diabetic group. The percentages of platelet count <100×10 9/L, C-reactive protein>10 mg/L, and total bilirubin>17.5 μmol/L were lower in the diabetic group than that in the non-diabetic group, and the differences were all statistically significant ( χ2=3.90, 6.44 and 5.56, respectively, all P<0.05). The percentage of multiple abscesses in the diabetic group was 10.6%(5/47), which was lower than 29.8%(25/84) in the non-diabetic group, and the difference was statistically significant ( χ2=6.24, P=0.012). The positive rate of pus culture for Klebsiella pneumoniae was 64.9%(24/37) in the diabetic group, which was higher than 41.5%(27/65) in the non-diabetic group, with a statistically significant difference ( χ2=5.13, P=0.023). The incidences of pleural effusion and abscesses at other sites in the diabetic group were 29.8%(14/47) and 10.6%(5/47), respectively, which were both higher than 14.3%(12/84) and 1.2%(1/84) in the non-diabetic group, respectively, and the differences were statistically significant ( χ2=4.55, Fisher′s exact test, both P<0.05). The proportion of hospital stays>21 d was 34.0%(16/47) in the diabetic group, which was higher than 16.7%(14/84) in the non-diabetic group, with a statistically significant difference ( χ2=5.15, P=0.023). DM (odds ratio ( OR)=2.654, 95% confidence interval ( CI) 1.020 to 6.907, P=0.046) and abscess maximum diameter>10 cm ( OR=11.045, 95% CI 4.493 to 27.154, P<0.001) were significant risk factors for hospital stay>21 d. Conclusions:Bacterial liver abscesses combined with DM are more common with single abscess, a higher rate of Klebsiella pneumoniae infection, and more likely to develop pleural effusions and abscesses at other sites. Liver abscesses>10 cm in maximum diameter and comorbid DM would prolong hospital stay.

Research progress on health literacy of cancer caregivers / 中国实用护理杂志

This paper was reviewed the research status of health literacy of cancer caregivers, including an overview of health literacy, assessment tools for health literacy of cancer caregivers, factors affecting health literacy of cancer caregivers and measures to improve health literacy of cancer caregivers. To provide theoretical basis for the localized development of health literacy assessment tools for cancer caregivers and further research.

Role of glutathione transferase in nonalcoholic fatty liver disease: An analysis based on gene expression profile / 临床肝胆病杂志

Objective To investigate the role of glutathione transferase in nonalcoholic fatty liver disease (NAFLD) induced by high-fat diet using the RNA-Seq technique in combination with gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of differentially expressed genes. Methods A total of 14 male C57BL/6J mice were divided into control group with 6 mice and model group with 8 mice by random sampling. The mice in the control group were fed with normal diet, and those in the model group were fed with high-fat diet for 7 consecutive weeks to establish a model of NAFLD. Kits were used to measure the activities of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the level of triglyceride (TG), and HE staining and oil red staining were used to observe liver pathology and deposition of lipid droplets. Liver tissue RNA was extracted for RNA-Seq, and genes with a fold change of ≥2.0 and a P value of 0.05). Compared with the control group, the model group had a significantly higher serum level of TG (2.02±0.50 mmol/L vs 1.00±0.29 mmol/L, t =-4.45, P =0.001). HE staining showed diffuse steatosis and ballooning degeneration in the model group, and oil red staining showed that the model group had a significant increase in orange-red lipid droplets in the cytoplasm of hepatocytes and a significantly higher grade of hepatocyte steatosis than the control group (1.88±0.64 vs 1.00±0.00, t =-3.86, P =0.006). RNA-seq results showed a total of 1367 differentially expressed genes between the two groups, among which there were 608 upregulated genes and 759 downregulated genes, and there were 17 differentially expressed GST genes between the two groups. The top 10 GST genes in terms of fold change were validated, and compared with the control group, the model group had downregulated expression of GSTa2, GSTa3, GSTa4, GSTm1, GSTm2, GSTm3, GSTm4, GSTp1, and GSTo1 and upregulated expression of GSTk1. The results of qRT-PCR were consistent with the results of sequencing. Conclusion GST affects lipid metabolism by participating in various biological processes such as steroid metabolism, fatty acid metabolism, and cholesterol metabolism and is closely associated with the pathogenesis of NAFLD.

Clinical features of drug-induced liver injury due to / 临床肝胆病杂志

Objective To investigate the clinical features of drug-induced liver injury (DILI) due to Tripterygium wilfordii preparation and concomitant medications in patients with rheumatoid arthritis (RA). Methods A retrospective analysis was performed for the clinical data of 112 RA patients with DILI caused by Tripterygium wilfordii preparations and concomitant medications who were treated in Honghu Hospital of Traditional Chinese Medicine from January 2014 to December 2019, and demographic data and the clinical features of DILI were observed to explore the influence of concomitant medications and underlying diseases on DILI. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups and further comparison between two groups. Results All 112 patients had a mean age of 48.13±14.38 years, and there were 81 female patients (72.32%). The most common underlying disease was nonalcoholic fatty liver disease (NAFLD) in 8 patients (7.14%), and as for concomitant medications, 70 patients (62.50%) were treated with Tripterygium wilfordii preparation combined with non-steroid anti-inflammatory drug (NSAID) or disease-modifying anti-rheumatic drug (DMARD). The main clinical manifestation was joint pain in 110 patients (98.21%). Among the 112 patients, 102 (91.07%) had abnormal results of liver biochemical examinations; 66 patients (58.93%) had an RUCAM score of 6-8 points, and 110 patients (98.21%) had mild (grade 1) liver injury. After liver-protecting treatment (for less than 6 months in all patients), all patients had an improvement in liver function without aggravation or death. The Tripterygium wilfordii preparation+glucocorticoid+NSAID/DMARD group with 22 patients had significant increases in the serum levels of alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) compared with the Tripterygium wilfordii preparation+NSAID/DMARD group with 70 patients ( P < 0.05). The 8 patients with NAFLD had a significantly greater increase in serum alanine aminotransferase compared with the 90 patients without underlying diseases ( P < 0.05). Conclusion RA patients may develop DILI due to Tripterygium wilfordii preparation and concomitant medications, which is commonly observed in middle-aged women. Joint pain is the main clinical manifestation, and patients tend to have mild liver injury and good prognosis without marked chronicity. More severe liver injury is observed in patients with combined medication of glucocorticoids and NSAID/DMARD or those with the underlying disease of NAFLD.

Application effect of color Doppler ultrasound in diagnosis of lower extremity vascular disease in elderly patients with type 2 diabetes / 中国基层医药

Objective:To study the clinical value of color Doppler ultrasound in diagnosis of lower extremity vascular disease in elderly patients with type 2 diabetes.Methods:From May 2017 to February 2018, 40 elderly patients with type 2 diabetic lower extremity vascular disease diagnosed and treated in the Special Inspection Department of the Seventh People's Hospital of Shaoxing were selected as the observation group, and 40 healthy medical examinees in the same period were selected as control group.The results of Doppler ultrasound examinations of the two groups were compared.Results:The detection rates of atherosclerotic plaque, occlusion and stenosis in the observation group were higher than those in the control group(all P<0.05). The inner diameter of the posterior tibial artery, inner diameter of the dorsal foot artery in the observation group were (1.85±0.11)mm and (1.70±0.15)mm, respectively, which were smaller than those in the control group [(2.22±0.13)mm, (1.94±0.15)mm] ( t=13.741, 7.155, all P<0.05). The intima-media thickness of the tibial posterior artery and dorsal plantar artery in the observation group were (0.56±0.24)mm, (0.36±0.11)mm, respectively, which were thicker than those in the control group [(0.36±0.13)mm, (0.22±0.17)mm] ( t=55.337, 4.373, all P<0.05). There were no statistically significant differences in the inner diameter of the femoral artery and popliteal artery(all P>0.05). The thickness of the intima-media layer of the observation group was thicker than that of the control group(all P<0.05). The resistance index of the femoral artery, popliteal artery, posterior tibial artery and dorsal plantar artery of the observation group[(0.84±0.15), (0.88±0.11), (0.93±0.17), (1.01±0.22)] were larger than those of the control group[(0.65±0.10), (0.65±0.10), (0.70±0.13), (0.74±0.15)]( t=6.666, 9.785, 5.300, 6.413, all P<0.05). The detection rates of lower extremity artery stenosis(27.50%) and occlusion (10.0%) in the observation group were higher than those in the control group(7.50% and 0.00%), the differences were statistically significant(χ 2=5.54, 4.21, all P<0.05). Conclusion:Color Doppler ultrasonography in the diagnosis of lower extremity vascular lesions in elderly patients with type 2 diabetes can identify the lesions and has significant diagnostic value, which is worthy of application and promotion.

Research progress of regulatory B cells in autoimmune skin diseases / 中国基层医药

Regulatory B cells is a subgroup of B cells,they mainly secrete interleukin-10,produce factors, such as transforming growth factor-β and they exert a negative regulatory role in immune tolerance to inhibit the inflammatory response.This paper mainly summarizes the research progress of regulatory B cells＇phenotypes,classifi-cations and function of related molecules in autoimmune skin diseases,such as systemic lupus erythematosus,systemic sclerosis,psoriasis and pemphigus.Last but not least,we will discuss the prospect and significance of regulatory B cells targeted therapies.

Performance evaluation of the chemiluminescence immunoassay for mycoplasma pneumonia antibody detecting / 中华检验医学杂志

Objective Assessing the detection performance of testing mycoplasma pneumonia(MP) type-specific antibodies by Chemiluminescence immunoassay(CLIA), in order to evaluate the feasibility of screening MP infection by CLIA.Methods Total of 280 cases of respiratory disease patients,20 examples infected mycoplasma pneumonia and 20 cases health volunteers as the control group were enrolled in this study from August 2016 to October 2017 in the Nanfang Hospital,Southern Medical University,testing MP antibodies by CLIA,Enzyme linked immunosorbent assay(ELISA)and Passive agglutination method(PA) respectively.According to the performance evaluation scheme, we evaluate the performance indexs of detecting MP antibodies by CLIA, including lower limit of detection, intra-batch precision, inter-batch precision,linearity range,clinical coincidence rate and consistency compared with ELISA and PA,and the results were analyzed by EXCEL and SPSS version 22.0.Results MP-IgG CLIA reagent:Limit of blank, Limit of detection and Limit of quantitation were 1.9 AU/ml,4.5 AU/ml and 5.1 AU/ml respectively;Coefficient Variation(CV)of intra-batch precision in high and low concentration levels were 2.98% and 2.45%respectively; CV of inter-batch precision in high and low concentration levels were 6.44% and 6.83% respectively;both the Linear range and Clinical report range are from 2.0 AU/ml to 253.0 AU/ml;the linear regression equation R 2≥0.990 0,0.85≤b≤1.15.MP-IgM CLIA reagent: CV of intra-batch precision in high and low concentration levels were 2.55% and 2.86% respectively; CV of inter-batch precision in high and low concentration levels were 4.82% and 5.46% respectively.The total clinical coincidence rate of MP-IgG and MP-IgM detected by CLIA were 90.0%and 97.5%respectively.The kappa values of MP-IgG and MP-IgM detected by CLIA and ELISA were 0.763(P=0.000)and 0.804(P=0.023)respectively, with Consistent percentage of 88.9% and 91.4% respectively.The kappa value of CLIA and PA was 0.541(P=0.063)with a consistent percentage of 79.6%.Conclusions The results of study show that detecting MP type-specific antibodies by CLIA meet the prescribed performance indexes. Detecting MP type-specific antibodies by CLIA,which is precise, speedy and automated, could be applied to clinical and replace ELISA and PA, becoming the prior choice in clinical for MP infection screening.

The association of genetic polymorphisms of N-acetyltransferase 2 gene with hepatotoxicity and efficacy in Chinese Han patients with tuberculosis / 中华传染病杂志

Objective To investigate the association of the polymorphism of the N-acetyltransferase 2 (NAT2 )gene with isoniazid-induced hepatotoxicity and anti-tuberculous treatment efficacy in Chinese Han patients with tuberculosis(TB).Methods A total of 108 TB patients who received initial anti-TB treatment were followed up prospectively.A polymerase chain reaction direct sequencing approach was used to detect genetic polymorphisms of the NAT2 gene.Associations between NAT2 genotype and isoniazid-induced hepatitis/early treatment were analyzed.Chi-square test was used for statistical analysis. Results Among the 108 TB patients, intermediate-acetylators (IA ) was the most frequent NAT2 genotype with the proportion of 54.63%(59/108).The proportion of rapid-acetylators(RA)was 33.33%(36/108),slow-acetylators (SA)was 10.19%(11/108)and super-rapid acetylators was 1 .85 % (2/108). Among the 20 patients who developed drug-induced hepatitis,2 were RA,5 were SA and 13 were IA. Regarding NAT2 genotype,RA patients had a lower incidence of hepatotoxicity (OR =0.176,95 %CI :0.038-0.809,P =0.014)and SA patients were more likely to developed drug-induced hepatic injury (OR=4.556,95 %CI :1 .231 -16.854,P =0.044 ).Statistical analysis revealed that the frequency of variant diplotypes,NAT2*4/*6A (OR=7.741 ,95 %CI :2.653-22.586,P <0.01 )and NAT2 *6A/*6A (OR=15 .353,95 %CI :1 .506 -156.552,P =0.020)were significantly increased in TB patients with hepatotoxicity.NAT2 *4/*4 was less likely to developed hepatic injury (OR =0.176,95 %CI :0.038-0.809,P =0.014).Among the 58 culture-positive patients,12(31 .03%)were persistent culture positive after 2 months standard therapy.Early treatment failure was observed with significantly higher incidence rate in RA than other genotypes (OR = 7.200, 95 % CI :1 .794-28.900, P = 0.008). Conclusions In Chinese Han TB patients,IA is the most frequent NAT2 genotype.The SA status of NAT2 is a risk factor of isoniazid-induced hepatotoxicity.The diplotype of NAT2 *6A has clearly high risk of isoniazid-induced hepatotoxicity.In contrast,NAT2 * 4/* 4 is protective diplotype.RA is associated with early treatment failure in culture-positive patients.

Evaluation of sphingosine kinase 1 expression and its clinical significance in breast invasive ductal carcinoma / 中国免疫学杂志

Objective:To investigate the expression of sphingosine kinase 1 (SphK1) and its clinical significance in breast invasive ductal carcinoma ( BIDC).Methods: We detected SphK1 expression in 58 samples of surgically resected paired BIDC and normal tumor-adjacent tissues samples by using immunohistochemistry.The correlation between SphK 1 expression and clinicopathologic features was analyzed.Results: The positive expression rate of SphK 1 in BIDC tissues was 69.0% ( 40/58 ) , while its positive expression rate in normal tumor-adjacent was 17.2% (10/58),the difference was statistical significance (χ2=31.636,P=0.000). Clinicopathological evaluation suggested that SphK 1 positive expression was associated with ER negative (χ2=4.392,P=0.036),PR negative (χ2=7.920 , P=0.005 ) , lymph node metastasis (χ2 =5.033 , P=0.025 ) and tumor stage (χ2 =7.117 , P=0.008 ) . Conclusion:The high-expression of SphK1 is correlated with the poor clinicopathological features in BIDC ,suggesting SphK1 may play a key role in development and progression of BIDC.