Three years follow-up report of two diffuse connective tissue disease cases caused by SARS-CoV-2 infection / 中国热带医学

@#Abstract: To report on two patients with Coronavirus Disease 2019 (COVID-19) combined with diffuse connective tissue disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection followed for nearly 3 years, in order to understand the long-term effects on the patients' immune system. Both patients were male, aged 81-82 years, and were hospitalized with fever on January 29, 2020 and February 10, 2020, respectively. Both were diagnosed with COVID-19 after positive SARS-CoV-2 polymerase chain reaction (PCR) tests. After receiving anti-infection treatment, cough suppressants, ex‐pectorants, and symptomatic supportive treatment, their body temperature returned to normal and two consecutive PCR tests were negative for SARS-CoV-2, and they were discharged from hospital. However, due to recurring fevers and varying degrees of rheumatic disease-related symptoms, both patients were readmitted to the hospital, indicating the presence of positive auto‐ antibodies and organ involvement. One patient recovered from COVID-19 with recurrent fever, joint pain, muscle aches and subcutaneous nodules, and was subsequently diagnosed with undifferentiated connective tissue disease. The other patient developed recurrent fever, mouth ulcers and rash after recovery from COVID-19 and was subsequently diagnosed with anti neutro phil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The patient was treated with glucocorticoids and immunosuppres sive drugs and the symptoms resolved rapidly and subsequent laboratory and imaging examinations showed stable condition. However, due to self-termination of medication, their symptoms quickly relapsed, and further treatment with glucocorticoids and immunosuppressive agents resulted in sustained stability of their condition. The erythrocyte sedimentation rate and hyper‐sensitive C-reactive protein remained within normal limits, and lung CT scans showed stable lesions with partial absorption.SARS-CoV-2 infection may have long-term effects on patients' immune systems, leading to abnormal immune responses and diffuse connective tissue disease. This suggests that regular follow-up observation of immune system-related diseases may be necessary for elderly patients with COVID-19.

Characteristics and management of children with Clostridioides difficile infection at a tertiary pediatric hospital in China

ABSTRACT Background: Clostridiodes difficile infection (CDI) is one of the most common causes of antibiotic-associated diarrhea in children. Conventional antibiotics and emerging fecal micro-biota transplantation (FMT) are used to treat CDI. Methods: Children with CDI admitted to the Shanghai Children's Hospital, from September 2014 to September 2020, were retrospectively included to this observational study. Pediatric patients were assigned as initial CDI and recurrent CDI (RCDI), and symptoms, comorbid-ities, imaging findings, laboratory tests, and treatments were systematically recorded and analyzed. Results: Of 109 pediatric patients with CDI, 58 were boys (53.2%), and the median age was 5 years (range, 2-9 years). The main clinical symptoms of CDI children were diarrhea (109/109, 100%), hematochezia (55/109, 50.46%), abdominal pain (40/109, 36.70%); fever, pseudomembrane, vomit, and bloating were observed in 39 (35.78%), 33 (30.28%), and 24 (22.02%) patients, respectively. For the primary therapy with conventional antibiotics, 68 patients received metronidazole, and 41 patients received vancomycin. RCDI occurred in 48.53% (33/68) of those initially treated with metronidazole compared with 46.33% (19/41) of those initially treated with vancomycin (p=0.825). The total resolution rate of FMT for RCDI children was significantly higher than with vancomycin treatment (28/29, 96.55% vs 11/23, 47.83%, p < 0.001). There were no serious adverse events (SAEs) reported after two months of FMT. Conclusions: The major manifestations of children with CDI were diarrhea, hematochezia, and abdominal pain. The cure rate of FMT for pediatric RCDI is superior to vancomycin treatment.

Polygonum hydropiper extract attenuates ethanol-induced gastric damage through antioxidant and anti-inflammatory pathways

The present study was conducted to investigate the underlying mechanisms and effective components of Polygonum hydropiper in ethanol-induced acute gastric mucosal lesions. The ethanol extract was purified on an AB-8 macroporous resin column and eluted with 60% ethanol and was then injected into the HPLC system for quantitative analysis. Sprague-Dawley rats were orally pretreated with P. hydropiper extract (PHLE; 50, 100, and 200 mg/kg) for 5 days and then absolute ethanol was administered to induce gastric mucosal damage. One hour after ethanol ingestion, the rats were euthanized and stomach samples were collected for biochemical analysis. Antioxidant enzymes and anti-inflammatory cytokines were quantified. Western blotting was used to detect the expression levels of proteins. Cell proliferation was assayed by CCK-8 assays. The proportion of total flavonoids in the final extract of P. hydropiper was 50.05%, which contained three major bioactive flavonoid constituents, including rutin, quercitrin, and quercetin. PHLE significantly increased cell viability and effectively protected human gastric epithelial cells-1 against alcohol-induced damage in vitro. PHLE pretreatment attenuated gastric mucosal injuries in a dose-dependent manner in rats, and increased the activity of superoxide dismutase, glutathione peroxidase, and glutathione, and decreased the levels of malondialdehyde in gastric tissue. Pretreatment with PHLE also reduced the generation of the pro-inflammatory cytokines tumor necrosis factor-α and interleukin-1β in gastric tissue by downregulating the expression of nuclear factor-kappa B. PHLE exerted protective effects against gastric injury through antioxidant and anti-inflammatory pathways. Flavonoids might be the main effective components of P. hydropiper against gastric mucosal injury.

Dietary exposure of lead in primary, middle and high school students in Pudong new area of Shanghai / 中国学校卫生

Objective@#To obtain the dietary exposure of lead in primary, middle and high school students, and to provide basic foundation for food safety risk assessment and management for children and adolecsents.@*Methods@#Weighing method, 3-days hour dietary survey, combining with the food frequency questionnaire, was applied to obtain basic dietary data in 616 primary, middle and high school students selected through multi-stage randdom sampling method from Pudong new area of shanghai. Data on lead concentrations were derived from the food safety risk monitoring system, which included 1 145 samples.@*Results@#Lead was detected in 568 of 1 145 samples (49.61%) from 10 categories of foods. The exceeding standard rate was 3.58% (41 samples exceeded). The average content of lead was (0.12±0.25) mg/kg, fungi and algae, beans and the aquatic products were found to be the primary food sources of lead exposure. The average dietary lead exposure in primary, middle and high school students was 9.94 μg/kg per week, accounted for 39.76% of PTWI. The lead exposure level at the 97.5th percentile which accounted for 118.24% of PTWI was 29.56 μg/kg. Vegetables, beans and cereal foods were the mainly source of dietary lead exposure, with average dietary lead exposure 2.57, 2.44 and 1.43 μg/kg peer week, accounted for 10.26%, 9.76% and 5.74% of PTWI, respectively.@*Conclusion@#Lead is present in some foods available in local markets in Pudong New Area, Shanghai. Low level of dietary exposure to lead is found in primary, middle and high school students, however, it depends on dietary pattern. Continued efforts are needed to reduce the dietary exposure of lead in school students.

Comparison of clinical application of iRoot SP, GuttaFlow 2 and AH Plus root canal sealer / 口腔疾病防治

Objective@# The short-term clinical effects of two kinds of normal temperature flow root sealers (the calcium silicate-based sealer iRoot SP and the siloxane-based sealer GuttaFlow2) combined with single point filling technology and a frequently-used sealing agent (AH Plus) combined with continuous wave hot tooth filling technology were evaluated. @*Methods @#A total of 279 teeth (656 root canals) were randomly divided into three groups: the iRoot SP group, GuttaFlow2 group and AH plus group. We recorded the filling time of each root canal, collected a digital dental film to evaluate the filling effect of each root canal, and conducted a follow-up visit one week and one month after the operation to record the incidence of pain. We used SPSS 18.0 to analyze the above data. @*Results @# There was no significant difference in the root canal filling effect among the three groups (P > 0.05). There was no significant difference in the filling time between the iRoot SP group and the GuttaFlow2 group (P > 0.05), but the filling time was significantly shorter in the AH Plus group (P < 0.05). There was no significant difference in the postoperative pain between the iRoot SP group and the GuttaFlow2 group (P > 0.05), and the incidence of pain in the iRoot SP group and the GuttaFlow2 group was lower than that in the AH Plus group (P < 0.05).@*Conclusions @# GuttaFlow2 and iRoot SP combined with single point filling technology can save filling time and obtain good clinical effects compared with frequently-used hot tooth filling technology and the incidence of postoperative pain was low.

Application of positron emission tomography in the clinical evaluation and treatment of hypothalamic-pituitary diseases / 中国医学科学院学报

Positron emission tomography (PET) and PET/CT are playing increasingly important roles in the clinical evaluation and treatment of tumors. As neuroendocrine tissues, the hypothalamus and pituitary gland have their unique features, and PET can be valuable in evaluating hypothalamic-pituitary diseases lesions. This article reviews the application of PET in the clinical evaluation and treatment of hypothalamic-pituitary diseases.

Clinical features and prognosis of IgA nephropathy with glomerular crescents / 南方医科大学学报

<p><b>OBJECTIVE</b>To understand the clinical features and prognosis of IgA nephropathy (IgAN) patients with glomerular crescents.</p><p><b>METHODS</b>The clinical data collected at the time of renal biopsy and the follow-up data of 89 IgAN patients with glomerular crescents were analyzed with 412 IgAN patients without crescents serving as the control group. Follow-up study was conducted in 78 patients with crescents and 198 without it, and the renal survival rate was estimated using Kaplan-Meier survival analysis.</p><p><b>RESULTS</b>The incidence of glomerular crescents was 17.8% in IgAN patients. Clinically, 39 patients with crescents experienced rapidly progressive glomerulonephritis, resulting in a significantly higher rate of this manifestation than that in patients without crescent. Patients with crescents also had more grave pathological changes in the glomerulus and renal tubule interstitium than the control patients. Patients were followed up for an average of 40.3-/+29.6 months in crescent group and 45.1-/+26.9 months in the control group, and the 1-, 3-, 5-year renal survival rate was 95.24%, 80.95%, 61.9% in the former and 100%, 91.67%, 79.17% in the latter, respectively.</p><p><b>CONCLUSION</b>IgAN patients with crescents have severer clinical and pathological manifestations and poorer prognosis than those without crescents.</p>

Osteopontin gene polymorphism in association with systemic lupus erythematosus in Chinese patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Osteopontin (OPN) is one kind of cytokine which can play a number of roles in promoting activation of T lymphocyte, regulating balance between Th1 and Th2, participating in cell-induced immunologic response and stimulating B lymphocyte to express multi-clone antibodies. Some researches have showed that OPN may be involved in the pathogenesis of systemic lupus erythematosus (SLE). The aim of this study was to investigate possible association of a single nucleotide polymorphism (SNP) at position 9250 in exon 7 of the OPN gene (OPN gene 9250) with SLE in Chinese patients.</p><p><b>METHODS</b>Totally 158 patients (18 males and 140 females) fulfilled the revised criteria for SLE by the American College of Rheumatology in 1982 and 180 healthy volunteer controls (34 males and 146 females), all from the south of China, consented to participate in the study. OPN gene 9250 polymorphism was detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).</p><p><b>RESULTS</b>The frequency of TT genotype of the OPN gene 9250 was significantly lower (52.5% vs 70%, P < 0.05) and the frequency of TC genotype of the OPN gene 9250 was significantly higher (43.7% vs 29.4%, P < 0.05) in SLE patients than in controls. There were significant differences in OPN gene 9250 allele and phenotype frequencies between the SLE patients and controls (P < 0.05). When the SLE patients and controls were separated into men and women, significant differences of frequencies were noted in TT genotype, TC genotype and allele of the OPN gene 9250 in women (P < 0.05) but not in men (P > 0.05).</p><p><b>CONCLUSIONS</b>OPN gene 9250 polymorphism appears to be associated with susceptibility to SLE in Chinese Han ethnic population.</p>

Clinical and pathological characteristics of patients with glomerular hematuria as the major manifestation / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical and pathological characteristics between patients with and without glomerular hematuria.</p><p><b>METHODS</b>Totally 310 patients with isolated microscopic hematuria and 24-hour urinary protein <0.5 g were enrolled in this study, who were free of renal calculi, infections, or tumors. These patients were divided into glomerular hematuria group and non-glomerular hematuria group according examination by phase-contrast microscope, and their clinicopathological data were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 209 patients identified to have glomerular hematuria, 46.41% had IgA nephropathy, 22.49% had small glomerular lesions, and 14.35% had non-IgA mesangioproliferative glomerulonephritis. In the patients with non-glomerular hematuria, 65.34% had IgA nephropathy, 21.78% had non-IgA mesangioproliferative glomerulonephritis, and 8.91% had small glomerular lesions. No significant differences were found in the patients' gender, age, course of disease or hypertension between the two groups (P>0.05), but renal insufficiency was more common in patients with glomerular hematuria.</p><p><b>CONCLUSION</b>IgA nephropathy is still the most frequent pathological finding in patients with hematuria, and even in non-glomerular hematuria patients severe renal pathological changes can be common.</p>

Overexpression of a recombinant gamma-glutamyltranspeptidase from Escherichia coli Novablue.

A truncated Escherichia coli Novablue gamma-glutamyltranspeptidase (EcGGT) gene, lacking the first 48-bp coding sequence for part of the signal sequence, was amplified by polymerase chain reaction (PCR) and cloned into expression vector pQE-30 to generate pQE-EcGGT. The maximum production of His6-tagged enzyme by E. coli M15 (pQE-EcGGT) was achieved with 0.1 mM IPTG induction for 12 h at 20 degrees C. The overexpressed enzyme was purified to homogeneity by nickel-chelate chromatography to a specific transpeptidase activity of 4.25 U/mg protein and a final yield of 83%. The molecular masses of the subunits of the purified enzyme were determined to be 41 and 21 kDa respectively by SDS-PAGE, indicating the precursor EcGGT still undergoes the post-translational processing even in the truncation of signal sequence. His6-tagged EcGGT migrated relative to the molecular mass of approximately 120 kDa and its heterodimeric structure was confirmed by a native-PAGE gel.