Improving access to quality of care for drug-resistant tuberculosis patients: a qualitative study on patient-centered support system / 中华医院管理杂志

Objective:To analyze the role of patient support system in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment adherence and outcome, and provide evidence for deepening the patient-centered support system.Methods:Based on the stakeholder analysis, definite stakeholders (administrators from the Department of Medical Insurance, and those from the provincial CDC), expectant stakeholders (administrators from regional CDC, health workers from primary CDCs, medical workers from designated MDR/RR-TB hospitals and MDR/RR-TB patients), and latent stakeholders (MDR/RR-TB patient families and their neighbors or colleagues) were selected using a purposive sampling. These stakeholders were subject to a semi-structured interview on patient support. The inclusion of participants ceased after reaching code or thematic saturation and meaning saturation, while thematic framework analysis was applied in interview data.Results:The 25 interviewees included could be categorized into three groups of stakeholders, i. e., 4 definite stakeholders, 19 expectant stakeholders and 2 latent stakeholders. Three themes summarized in this regard were definite stakeholders providing policy support to advance these patients′ access to standardized diagnosis and treatment services; diagnosis and treatment and management support of expectant stakeholders of these patients to encourage their compliance to treatment and enable their access to high quality medical care; and support from latent stakeholders as a critical guarantee for the patients to welcome a desirable treatment outcome. Psychological support provided under MDR/RR-TB basic care program in some provinces contributed positively to raising patients′ compliance. Economic support, treatment support from family menmbers ccould help the patients to welcome desirable outcomes.Conclusions:MDR/RR-TB patient-centered support system operating in the Yangtze River delta provide the patients with MDR/RR-TB diagnostic and treatment services of some accessibility. Given the progress, there are still shortcomings for the respective stakeholders to enhance their attention and collaboration to improve the access and equity to medical service.

Clinical effect of an additional maintenance dose of caffeine before ventilator weaning in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of an additional maintenance dose (5 mg/kg) of caffeine citrate injection at 1 hour before ventilator weaning in improving the success rate of ventilator weaning in preterm infants (gestational age ≤32 weeks) with respiratory distress syndrome (RDS) on mechanical ventilation.@*METHODS@#A total of 338 preterm infants with RDS (gestational age of ≤32 weeks) who were admitted to the Neonatal Intensive Care Unit of Xiamen Maternal and Child Health Hospital from January 2017 to December 2019 and treated with mechanical ventilation were enrolled. They were randomly divided into an observation group and a routine group, with 169 infants in each group. Both groups received early routine treatment with caffeine. The infants in the observation group received an additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning. The two groups were compared in terms of reintubation rate and number of apnea episodes within 48 hours after ventilator weaning, changes in blood gas parameters, blood glucose, heart rate, and mean blood pressure at 2 hours after ventilator weaning, and incidence rates of major complications during hospitalization.@*RESULTS@#Compared with the routine group, the observation group had significantly lower reintubation rate (@*CONCLUSIONS@#An additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning is safe and effective in improving the success rate of ventilator weaning in preterm infants with RDS and thus holds promise for clinical application.

SeqSQC: A Bioconductor Package for Evaluating the Sample Quality of Next-generation Sequencing Data / 基因组蛋白质组与生物信息学报·英文版

As next-generation sequencing (NGS) technology has become widely used to identify genetic causal variants for various diseases and traits, a number of packages for checking NGS data quality have sprung up in public domains. In addition to the quality of sequencing data, sample quality issues, such as gender mismatch, abnormal inbreeding coefficient, cryptic relatedness, and population outliers, can also have fundamental impact on downstream analysis. However, there is a lack of tools specialized in identifying problematic samples from NGS data, often due to the limitation of sample size and variant counts. We developed SeqSQC, a Bioconductor package, to automate and accelerate sample cleaning in NGS data of any scale. SeqSQC is designed for efficient data storage and access, and equipped with interactive plots for intuitive data visualization to expedite the identification of problematic samples. SeqSQC is available at http://bioconductor.org/packages/SeqSQC.

Zuogui pill regulates DKK1 in the prevention and treatment of glucocorticoid-induced osteoporosis / 中国组织工程研究

BACKGROUND: Chinese medicine is effective for preventing and treating glucocorticoid-induced osteoporosis, however, the underlying mechanism remains unclear. DKK1, an inhibitor of Wnt/β-catenin signaling pathway, can be up-regulated by glucocorticoid. Thereafter, DKK1 is an important target in the prevention and treatment of osteoporosis. OBJECTIVE: To explore the regulatory effect of Zuogui pill on DKK1 in the prevention and treatment of glucocorticoid-induced osteoporosis. METHODS: Eighteen three-month-old female Sprague-Dawley rats were randomly divided into three groups: control group, model group and Zuogui pill group. Rats in the model and Zuogui pill groups received the subcutaneous injection of dexamethasone to establish the model of glucocorticoid-induced osteoporosis. The Zuogui pill group rats were administrated Zuogui pill extracts, and the control rats were given the same volume of normal saline. At 1 month after modeling, the lumbar vertebrae were removed to test the bone mass and microstructures by micro-CT scanning. The biomechanical properties were detected by compression test. The mRNA expression levels of DKK1, Runx2 and CTSK were determined by Qpcr. The serum alkaline phosphatase activity was tested. RESULTS AND CONCLUSION: Compared with the control group, in the model group, the volumetric bone mineral density, trabecular bone volume fraction, trabecular number, and trabecular thickness were significantly decreased (P ＜ 0.05), the trabecular separation and structure model index were significantly increased (P ＜ 0.05). The serum alkaline phosphatase activity was on a decline. The mRNA expression level of DKK1 showed a significant up-regulation (P ＜ 0.05). The mRNA expression level of Runx2 showed a down-regulated trend while mRNA expression level of CTSK showed an up-regulated trend. Compared with the model group, the Zuogui pill group showed significantly enhanced volumetric bone mineral density, trabecular bone volume fraction, and trabecular number (P ＜ 0.05); the structure model index was significantly decreased (P ＜ 0.05); the trabecular separation was reduced; the serum alkaline phosphatase activity was enhanced; the mRNA expression level of DKK1 showed a significant down-regulation (P ＜ 0.05); the mRNA expression level of Runx2 showed an up-regulated trend while mRNA expression level of CTSK showed a down-regulated trend. The vertebral compressive strength in the Zuogui pill group was significantly higher than that in the model group (P＜0.05). In summary, Zuogui pill prevents and treats glucocorticoid-induced osteoporosis possibly through the down-regulation of mRNA expression of DKK1.

Comparison of biomechanical properties by different posterior fixation methods with or without crosslink for fixing thoracolumbar fractures / 医用生物力学

Objective To compare the biomechanical differences in 3 posterior fixation methods with or without crosslink for treatment of thoracolumbar fractures, so as to find the optimal posterior fixation methods. Methods On the basis of the validated finite element model of T12-L2 segments to simulate L1 vertebra burst fracture, the superior 1/2 cortical bone of T12 segment was removed and the superior 1/2 cancellous bone was assigned with the material damage property of cancellous bone. Then 6 thoracolumbar fracture models by intermediate unilateral pedicle screw fixation without or with crosslink (Model A1, A2), traditional short-segment pedicle screw fixation without or with crosslink (Model B1, B2), intermediate bilateral pedicle screw fixation without or with crosslink (Model C1,C2) were established, respectively. The range of motion (ROM) as well as the maximum Von Mises stress of the pedicle screw and rod for 6 models under various physiological loading conditions were compared. Results The ROM under flexion-extension and lateral bending in Model A and Model C was obviously smaller than that of Model B. Under flexion-extension, no significant difference was found in ROM between Model A and Model C; under lateral bending, the ROM of Model C was smaller than that of Model A. The stress was concentrated in the root of upper screw and the rob located between upper screw and intermediate screw; the maximum stress of upper screw in Model C was smaller than that in Model A and Model B. The crosslink could increase the stability of all fixation groups under axial rotation stress condition, and decrease the maximum stress on upper screw and rod under axial rotation stress condition, but no significant difference was found under flexion-extension and lateral bending. Conclusions Additional pedicle screws at the level of fracture vertebra can achieve the better biochemical stability. The additional crosslink not only increases the torsional rigidity, but also decreases the maximum torsional stress of the screw and rod, which is a better choice as the treatment of thoracolumbar fractures.

Diagnostic value of enzyme-linked immunospot assay using CFP10/ESAT6 fusion protein as antigen in spinal tuberculosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a method of detecting spinal tuberculosis (TB) infection by enzyme-linked immunospot (ELlSPOT) assay and evaluate the value of CFP10/ESAT6 fusion protein for diagnosis of spinal TB.</p><p><b>METHODS</b>Suspected spinal TB patients were prospectively recruited in two hospitals (First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; Nanfang Hospital, Southern Medical University) from May 2012 to December 2013. Data on clinical characteristics of the patients and conventional laboratory results were collected. Compare and analyze the positive detection rate in spinal TB diagnosis by different methods including ELISPOT detection and conventional detection methods.</p><p><b>RESULTS</b>47 patients with spinal TB had available biopsy or surgical specimens for histopathological examination and 41 specimens had pathological features consistent with a diagnosis of TB infection. Among the spinal TB patients and non-TB disease patients,the overall sensitivity, specificity, positive predictive value, and negative predictive value of the ELISPOT assay in spinal TB diagnosis were 82.7%,87.2%,89.6%, and 79.1%,respectively; the 4 indexes of the PPD skin test were 61.5%, 46.2%, 60.4%, and 47.4%, respectively;those of the antibody detection were 55.8%, 61.5%, 65.9%, and 51.1%. The positive rate of ELISPOT was significantly higher than those of PPD skin test and antibody detection test (82.7% vs. 61.5%, Χ² =5.786, P=0.016; 82.7% vs. 55.8%, Χ² =8.847, P=0.003), but not significantly different from the positive rate of pathological examination (82.7% vs. 87.2%, Χ² =0.396, P=0.529). Moderate agreement was found between pathological examination and the ELISPOT assay (87.2%, Κ=0.498, P=0.001).</p><p><b>CONCLUSION</b>With high sensitivity and specificity, the ELISPOT assay using CFP10/ESAT6 fusion protein as antigen is an effective technique for auxiliary diagnosis of spinal TB.</p>

Clinical effect of combination therapy with high-frequency oscillation ventilation, pulmonary surfactant and inhaled nitric oxide in the treatment of neonatal hypoxemic respiratory failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of combination therapy with high-frequency oscillation ventilation (HFOV), pulmonary surfactant (PS) and inhaled nitric oxide (iNO) in the treatment of neonatal hypoxemic respiratory failure (HRF).</p><p><b>METHODS</b>A total of 116 neonates with HRF were studied, and they were randomly divided into two groups: triple therapy (n=58) and dual therapy (n=58). The triple therapy group received HFOV, PS, and iNO, while the dual therapy group received HFOV and iNO. Blood gas values, PaO2/FiO2 (P/F), oxygenation index (OI), and pulmonary arterial pressure (PA) were determined before treatment and after 24 and 48 hours of treatment. Among the neonates with different P/F ratios and OI values and with or without persistent pulmonary hypertension of the newborn (PPHN), the treatment outcomes of two groups were compared.</p><p><b>RESULTS</b>The durations of mechanical ventilation and iNO therapy in the triple therapy group were significantly shorter than in the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the triple therapy group had significantly improve PaO2 and PaCO2 compared with the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the neonates with PPHN in the triple therapy group had significantly decreased PA compared with the dual therapy group (P<0.01). In the cases with a P/F ratio of ≤50, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the P/F ratios of the neonates who died were significantly lower than those of survivors (P<0.01). In the cases with an OI of ≥40, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the OI values of the neonates who died were significantly higher than those of survivors (P<0.01). In neonates with PPHN, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). The triple therapy group had a significantly shorter length of hospital stay (P<0.01) and a significantly higher cure rate (P<0.05) compared with the dual therapy group. There were no significant differences in complications between the two groups (P>0.05). No severe side effect was found during the treatment in either group.</p><p><b>CONCLUSIONS</b>Triple therapy with HFOV, PS and iNO is a more effective treatment for neonatal HRF compared with the dual therapy with HFOV and iNO. The triple therapy can significantly improve oxygenation and survival rate, providing a new treatment for the neonates with HRF, especially the critical cases who suffer severe lung disease with PPHN and have a P/F ratio of ≤50 or an OI of ≥40.</p>

Potential use of the herbicide quizalofop-p-ethyl for eicosapentaenoic acid overproduction by the diatom Nitzschia laevis / 生物工程学报

The diatom Nitzschia laevis is a good alternative source of eicosapentaenoic acid (EPA). Besides strategies for high cell density culture, EPA productivity may be further improved by herbicides. The effect of the herbicide quizalofop-p-ethyl on the growth and EPA production was studied in this paper. As the solvent of the herbicide, DMSO was proved to inhibit the growth and EPA production of N. laevis. The concentration of DMSO in the medium should not exceed 0.2%. Quizalofop-p-ethyl could cause morphology damage to the N. laevis cells. With the increasing concentration of quizalofop-p-ethyl from 0 mmol/L to 0.4 mmol/L, the dry cell weight production decreased, while at the same time, the lipid content of the dry cell mass increased. When treated with 0.1 mmol/L quizalofop-p-ethyl, the EPA content increased from 3.00% to 3.58% (of dry cell weight, DW), and the proportion of EPA (20:5) in total fatty acids (TFA) increased from 25.15% to 32.88% . These results indicated that the herbicide quizalofop-p-ethyl could stimulate the accumulation of EPA; therefore it might be useful for selecting algae colonies that overproduce EPA.

Value of multi-slice helical CT in the diagnosis and differential diagnosis of thyroid lesions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the value of multi-slice helical CT in the differentiation of benign from malignant thyroid lesions.</p><p><b>METHODS</b>The multi-slice helical CT images of 72 patients with 82 thyroid lesions were prospectively studied. The CT features including the margin, density of the lesion and cervical lymph node enlargement were evaluated double-blindly. All the image findings were compared with the pathological results, and analyzed statistically using the Chi-square test.</p><p><b>RESULTS</b>Of 42 benign lesions, 38 (90.5 % ) showed well-defined margin, 13 (30. 9% ) contained low density nodular areas, 3 (7. 1% ) showed granular calcifications, and 2 (4. 8% ) had cervical lymph node enlargement. Of 40 thyroid carcinomas, 37 lesions(92.5% ) had irregular border, no lesion contained low density nodular areas, 14 (35. 0%) showed granular calcifications, and 31 (77. 5% ) had enlarged cervical lymph nodes. Nineteen lesions (55. 9% ) from 34 thyroid carcinoma patients who had undergone contrast enhanced CT scan showed complex density, while only 2(6. 3% ) of 32 benign lesions showed such findings on contrast enhancement. There were statistically significant differences between benign and malignant lesion in margin, low density nodular area, granular calcification, cervical lymph node enlargement and complex density( P <0.01).</p><p><b>CONCLUSION</b>The findings of well-defined margin and low density nodular area in CT image may suggest benign thyroid lesions, whereas the presence of irregular border, granular calcifications and cervical lymph node enlargement as well as complex density may indicate thyroid malignancy.</p>

Pathologic changes of the cardiac conduction system in 12 patients with abnormal ECG / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between abnormal ECG and pathologic changes in the cardiac conduction system (CCS).</p><p><b>METHOD</b>Pathological changes of the CCS in 12 cases with abnormal ECG out of 16 pre-death ECG were observed.</p><p><b>RESULTS</b>(1) Among 7 cases of sudden cardiac death, ECG monitoring recorded bradyarrhythmia in 6 cases, tachyarrhythmia 6 cases, bradycardia-tachycardia syndrome 2 cases, conduction block 6 cases, atrial premature beats 6 cases, ventricular premature beats 6 cases, and ST-T changes 4 cases. (2) The histopathological findings in the CCS were noted in all cases. Of these 12 cases, three had signs of fatty infiltration, and/or fibrous 4 cases, three of amyloidosis, one of chronic inflammatory changes, two of acute inflammatory changes, two of developmental anomalies, two of hemorrhages and one of LAD stenosis. (3) Acute inflammation changes in the CCS corresponded to tachyarrhythmia and multiple ventricular premature beats, whereas chronic inflammation and degenerative changes in the CCS were often related to bradyarrhythmia, bradycardia-tachycardia syndrome and conduction block. (4) The CCS changes alone could lead to ST-T changes in ECG.</p><p><b>CONCLUSION</b>The pathological changes in the CCS are related to ECG changes, and attributed to the pathological bases of arrhythmia.</p>

Traumatic cerebral infarction: a histopathological study of 17 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To assess the morphologic changes in traumatic cerebral infarction and to discuss its mechanism.</p><p><b>METHODS</b>Specimens from seventeen cases of cerebral infarction were selected from 81 patients with severe brain injury, and subject to routine gross and histological examinations.</p><p><b>RESULTS</b>(1) The cerebral infarction in all cases was hemorrhagic in nature with a wedged or irregular shape upon gross inspection. The lesions were found in occipital gyrus (8 cases), occipital lobes (3 cases), basal nuclei (3 cases), cingulate gyrus (2 cases), and lateral occipitotemporal gyrus (1 case). Histologically, the lesions were located at the junction between the cortex and medulla, showing congestion, edema, hemorrhage, necrotic nerve tissue and blood vessels. In severe cases, the lesion extended into the entire cortex and subarachnoid spaces. (2) Swelling of the brain and cerebral hernia were found in all cases, 8 of which demonstrated that the posterior cerebral artery was compressed and stenotic within the space between the crus cerebri and uncus.</p><p><b>CONCLUSION</b>Brain tissue necrosis in traumatic cerebral infarction is the result of brain swelling and cerebral hernia formation, following congestion, bleeding and ischemia due to vasculature compression.</p>

Morphological changes of tissues after extensive soft tissue injury / 法医学杂志

OBJECTIVE@#To study the pathological morphological changes for diagnosing the cause of death of extensive soft tissue injury or crush syndrome.@*METHODS@#The tissues were stained by HE and IHC.@*RESULTS@#(1) The Mb positive rate was 60%, 75%, 95% respectively. (2) Both the HSP70 positive rate of hearts and brains were 90%.@*CONCLUSION@#(1) The animal model of broad soft tissue injury was established. (2) Accumulated the pathological morphological data for diagnosing the cause of death of extensive soft tissue injury or crush syndrome.

Diagnosis of non-typical myocarditis by applying immunohistochemical method of CD68 / 法医学杂志

OBJECTIVE@#To make a distinction between myocarditis and the reaction to some pathological state of myocardium.@*METHODS@#Myocardium of 26 cases with sudden cardiac death were stained and LM light microscopies with immunohistochemical method 10 cases with normal myocardium were contrasted.@*RESULTS@#A great deal of stained positive monocyte of immunohistochemistry emerged in the parasetions of myocarditis patients with various farms and stacking(> 15).@*CONCLUSION@#The stain of immunohistochemistry can be used as one of the indications for diagnosing non-typical myocarditis.