[A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China].

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.

[The multiple regression analysis of related factors in chronic rhinosinusitis postoperative recurrence].

Objective: To study the relative factors of endoscopic surgical effect in chronic rhinosinusitis. Method:The study included 179 chronic rhinosinusitis patients in our hospital who had a nasal endoscopic surgery from January 2013 to June 2014, and evaluate the treatment effect one year after the surgery，the patients were divided into two groups :recurrent and non-recurrent. Collecting clinical data and using uni-variate and multivariate analysis to find out the risk factors of recurrence, then the regression equation was established. Result:There are 29 cases of recurrence and 150 cases of non-recurrent in the total 179 chronic rhinosinusitis patients with a nasal endoscopic surgery.Uni-variate analysis showed that smoking，nasal polyps, allergic rhinitis,bronchial asthma,deviation of nasal septum, gastro-esophageal reflux disease,scores of VAS,maxillary sinus integral ,anterior ethmoid sinus integral,posterior ethmoid sinus integral,sphenoid sinus integral,frontal sinus integral,ostiomeatal complex integral,total sinus integral were statistically significant between chronic rhinosinusitis recurrent group and non-recurrent group(P <0.05). Multivariate analysis showed that smoking,nasal polyps, allergic rhinitis, bronchial asthma, deviation of nasal septum,scores of VAS,anterior ethmoid sinus integral,sphenoid sinus integral, ostiomeatal complex integral, total sinus integral were statistically significant between chronic rhinosinusitis recurrent group and non-recurrent group(P <0.05). Among those factors, smoking,nasal polyps, allergic rhinitis ,scores of VAS ,anterior ethmoid sinus integral,sphenoid sinus integral are the strongest in difference. Conclusion:The effect of chronic rhinosinusitis endoscopic surgery is not only related to clinical typing ,but also closely related to smoking,nasal polyps , allergic rhinitis and their severity.

[The clinical application of tinnitus handicap index(THI-12) Chinese version].

Objective:The original prospective of this study is to explore a convenient tinnitus severity assessment tool, using Chinese version of THI-12.Method:We surveyed 229 outpatients on their first hospital visits with primary tinnitus as chief complaint. Both the Chinese version THI-12 and the standard THI-25 were administrated. Their tinnitus grading and administration time were compared. The correlation between the two scores was evaluated. A reliability and factor analysis of the Chinese version of THI-12 was also performed.Result:Two hundred and fifteen of the 229 questionnaires were valid with a 93.9% response rate. The average administration time was(18.9±21.0) min for the standard THI-25 and(8.96±4.70)min for the Chinese version THI-12, which was significantly different. Pearson's correlation coefficient between the two total scores was r=0.833(P <0.01), which indicates a strong positive correlation.The tinnitus grading was not statistically significant(Z=-0.307，P >0.05).Cronbach's coefficient of THI-12 was α=0.765, suggesting good reliability and internal consistency. Factor analysis found three entries with characteristic values greater than 1. These three common factors explained 51.77% of the overall variance, suggesting that the 12 entries can be grouped into three dimensions(emotionality, sociality, concentration). Entry"Because of your tinnitus is it difficult for you to concentrate? "had the highest common value(0.78), suggesting that this entry would contribute the most should all entries be divided into three dimensions.Conclusion:The Chinese version THI-12 is time-efficient, has good reliability and internal structural validity, and provides good assessment of tinnitus severity.It can be widely applied in clinical practice.