[Munchausen syndrome in a child].

A six-and-a-half-year-old girl with white secretions in her eyes for 2 weeks was treated in the Ophthalmology Department of the First Affiliated Hospital of Xi'an Jiaotong University after ineffective treatment in several hospitals. The patient refused to communicate with the doctor and receive detailed examination. Only conjunctival congestion was found in both eyes. According to the photos and specimens of white secretions from both eyes provided by the parents of the patient, the diagnosis was conjunctivitis and conjunctival foreign bodies. With the doctor's reminding, the parents did close observation and good communication. The child finally admitted that she had put tissue fragments into her eyes in order to attract the parents' attention. Munchausen syndrome was diagnosed by a psychiatrist. After symptomatic treatment and improvement of family environment, the patient's condition improved. (Chin J Ophthalmol, 2021, 57: 621-623).

[An analysis on newly reported HIV/AIDS cases in medical institutions in Tianjin, 2005-2017].

Objective: To analyze the characteristics of newly reported HIV/AIDS cases in medical institutions in Tianjin from 2005 to 2017 and provide evidence for the improvement of AIDS prevention and treatment in medical institutions. Methods: The data of the newly reported cases of HIV/AIDS in medical institutions in Tianjin from 2005 to 2017 were analyzed. Meanwhile a retrospective survey was conducted on the source department of medical institutions and the main disease for treatment of HIV/AIDS cases. Results: A total of 3 035 HIV/AIDS cases were reported in medical institutions in Tianjin from 2005 to 2017 with an annual increase of 24.8%, among these cases, 49.2% (1 343/2 728) were reported from inpatients and 50.8% (1 385/2 728) were reported from outpatients. There was an increasing trend in the HIV positive detection rate in STD outpatients from 2011 to 2017 (χ(2)=18.469, P=0.005). The counts of the first CD(4)(+) T cell counts (CD(4)) (χ(2)=17.189, P=0.000) among the cases from inpatients and outpatients and the proportions of deaths in the year when the cases were found differed (χ(2)=61.198, P=0.000), the differences were significant. And the statistically significant differences in the counts of the first CD(4) (χ(2)=16.751, P=0.000) and the proportions of deaths in the year when the cases were found (χ(2)=18.926, P=0.000) existed among the cases in grade Ⅲ hospitals and in grade Ⅱ hospitals; meanwhile the differences in the counts of the first CD(4) (χ(2)=37.620, P=0.000) and the proportions of deaths in the year when the cases was found ( χ(2)=95.489, P=0.000) among the cases from different departments were significant. Conclusion: The timeliness of HIV/AIDS case reporting by outpatient departments was better in medical institutions in Tianjin, and the case reporting in grade Ⅱ hospitals were more timely than in grade Ⅲ hospitals; so it is suggested to provide active HIV test in key departments of medical institutions for the better HIV/AIDS prevention and control in Tianjin.

[Survival analysis on HIV/AIDS patients who began receiving antiretroviral therapy from 2005 to 2015 in Tianjin].

Objective: To study the survival time and influencing factors of HIV/AIDS cases who began receiving antiretroviral therapy (ART) from 2005 to 2015 in Tianjin. Methods: Data related to HIV/AIDS cases that receiving ART between 2005 and 2015 in Tianjin, were collected from the Chinese HIV/AIDS Basic Information Management System. A retrospective cohort study was conducted to analyze data of collection. Life table was used to calculate the survival proportion and Cox proportion hazard regression model was used to analyze the factors associated to the time of survival. Results: A total of 2 057 HIV/AIDS cases were involved, including 51 died from AIDS related disease, ending up with the survival rates of 1, 3, 5 and 10 years as 98.4%, 97.8%, 97.4% and 95.8%, respectively. Results from the multivariate Cox proportion hazard regression model showed that when comparing with the cases aged<30 years, aHR (95%CI) of the cases aged 30-39 years, 40-49 years, 50 years or above appeared as 4.506 (1.226-9.059), 5.944 (1.479-13.892) and 15.958 (5.309-27.206) respectively. When comparing with the cases having no loss of follow-up during ART process, the aHR of the cases having lost of follow-up during ART was 5.645 (95%CI: 3.124-10.200). When comparing with the cases diagnosed by other institutions, the aHR of the cases diagnosed by hospitals was 3.823 (95%CI: 1.423-10.274). When compared with the cases had no hepatitis B or hepatitis C before ART, aHR of the cases with hepatitis B or C prior to ART was 2.580 (95%CI:1.210-5.502). Compared with the cases receiving ART at Ⅰ/Ⅱ clinical stages, the aHR of the cases at Ⅲ/Ⅳ clinical stages was 3.947 (95%CI: 2.167-7.188). Compared with the cases with junior high school education or below, the aHR of the cases with high school education or above was 0.440 (95%CI: 0.238-0.810). Compared with the cases diagnosed before operation, aHR of the cases from special investigation and from counseling and testing (VCT) were 0.111 (0.027-0.456) and 0.182 (0.049-0.674) respectively. Conclusions: The survival rate of HIV/AIDS cases that received ART was high in Tianjin. Risk factors related to the survival of cases would include: old age when started receiving ART, loss of follow-up during ART, diagnosed by hospitals, co-infected with hepatitis B or hepatitis C and receiving ART at Ⅲ/Ⅳ clinical stages. Meanwhile, protective factors related to the survival of cases would include: having high school or above education, diagnosis was made through other special programs or from VCT services.

Clinicoradiological features associated with epidermal growth factor receptor exon 19 and 21 mutation in lung adenocarcinoma.

AIM: To retrospectively identify clinicopathological and radiological characteristics that could be independent predictors of epidermal growth factor receptor (EGFR) exon 19 and 21 mutation in surgically resected lung adenocarcinomas in a cohort of Asian patients. MATERIALS AND METHODS: Demographics, histopathology data, and preoperative chest computed tomography (CT) images were evaluated retrospectively in 471 surgically resected lung adenocarcinomas. A total of 24 CT descriptors were assessed. Univariate analyses and multivariate logistic regression analyses were performed to identify independent predicted factors of harbouring EGFR mutations. RESULTS: EGFR mutations were existed in 252 (53.5%) of 471 patients, and associated with 11 clinicoradiological features. For the model with both clinical and radiological features, the independent predictors of harbouring EGFR mutation were small maximum diameter (≤3.9 cm), non-smokers, micropapillary pattern, pleural retraction, vascular convergence, and absence of solid pattern. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.784. Multivariable logistic regression analysis indicated that non-smokers, vascular convergence, and absence of solid pattern were important independent predictors of EGFR exon 19 mutation, while non-smokers and vascular convergence were independent predictors of EGFR exon 21 mutation. The AUCs were 0.807 and 0.794, respectively. A lepidic growth pattern appeared more frequently in exon 21 mutant tumours than in exon 19 mutant group (p<0.001). CONCLUSION: CT imaging features of lung adenocarcinomas in combination with clinical variables could be used to prognosticate EGFR mutation status. The separate analysis of EGFR exon 19 or 21 mutation could further improve diagnostic performance.

Determination of salbutamol in human plasma and urine by high-performance liquid chromatography with a coulometric electrode array system.

A method is developed to determine salbutamol in human plasma and urine using high-performance liquid chromatography (HPLC) with a coulometric electrode array system, based on the electrochemical behavior of salbutamol at graphite electrode. The mobile phase component A is 30 mM sodium dihydroxy phosphate-30 mM triethylamine and is adjusted to pH 6.0 with 20% phosphate acid. The mobile phase component B is methanol. The optimized mobile phase composition was A and B in the proportion of 90:10 (v/v). Paracetamol is selected as the external standard. The human plasma and urine samples are pretreated using solid-phase extraction cartridges (Sep-Pak Silica), and the eluting solution is monitored by the coulometric electrode array system. The electrode potentials are set at 300, 400, 550, and 650 mV, respectively. Calibration curves show good linearity, and the recovery of salbutamol proves to be constant and unaffected by the concentration of the drug. This method, developed using HPLC-electrochemical detection, is reproducible and sensitive enough for the determination of salbutamol in human plasma and urine.