Current Issue

2018 Vol.3 No.4 Published:30 November 2018

Academician column

The main strategy for prevention of gastric cancer: Eradication of Helicobacter pylori Barry J Marshall, Alfred Chin-Yen Tay 2018, 3 (4):  193-197.  Abstract ( 106)    PDF (682KB) ( 643 )

Forum of Specialist

Cholera: an old plague that should not be forgotten WU Shi-pin 2018, 3 (4):  198-201.  Abstract ( 434)    PDF (864KB) ( 1005 )    Cholera is a severe infectious disease, which has caused seven world-wide pandemics in history, resulting in millions of deaths. Because the breaks out of pandemics rapidly and easily transcends national boundaries to cause a worldwide pandemic, it is stipulated by the International Health Regulations and Law of the People's Republic of China on Frontier Health Quarantine Inspection as one of the international quarantine infectious diseases and also one of the class A infectious diseases under compulsory management in China. Recently, Cholera has been raging in many parts of the world and causing great harm to human health. In this paper, the recent epidemic situation of cholera in the world was described in detail, and the influencing factors and preventive measures of cholera epidemic were put forward. It is of great practical significance to review the history of cholera and analyze the epidemic factors.

Original Articles

Analysis of the effect of the treatment of lymph node fistula bronchial tuberculosis by bronchoscope YE Tao-sheng, ZHANG Pei-ze, ZENG Xuan, LI Min, HE Jun-mei, TANG Yi-min, ZHANG Jiao-hong 2018, 3 (4):  202-205.  Abstract ( 203)    PDF (838KB) ( 663 )    Objective To study the effects and advantages of the treatment of lymph node fistula type bronchial tuberculosis by bronchoscopy. Methods A total of 64 patients with lymph node fistula bronchial tuberculosis who received treatment in our hospital from March 2017 to March 2018 were selected. The control group was treated with conventional chemotherapy for tuberculosis, and the experimental group was treated with bronchoscopy. Sputum conversion, lesion absorption, clinical effect and adverse reactions were compared between the two groups. Results After 1 month (59.38%), 2 months (81.25%) and 3 months (93.75%), the proportion of sputum bacteria becoming to negative in the experimental group was significantly higher than that in the control group (25.00%, 34.38%, 46.88%, P<0.05). There was no significant differences (P>0.05) in the proportion of lesion absorption (21.88%, 18.75%) between the 2 groups at 1 month after treatment (65.63%) and 3 months after treatment (96.88%). The rate of lesion absorption in the experimental group was significantly higher than that in the control group (27.13%, 34.38%, P<0.05).The total effective rate of clinical treatment of lymph node fistula bronchial tuberculosis in the experimental group was significantly higher than that of the reference group, with significant difference (93.75%, 59.38%, P<0.05). There was no significant difference in the incidence of adverse reactions (12.50%, 15.63%) after treatment of lymph node fistula bronchial tuberculosis between the 2 groups (P<0.05). Conclusion The treatment with lymph node fistula type bronchial tuberculosis can effectively improve the clinical effect of chemotherapy, improve the sputum negative rate of the patients, and promote the full absorption of the lesions of the patients. In addition, this treatment has fewer adverse reactions and higher safety, which should be promoted clinically.

Clinical and CT features of multi-drug resistant Klebsiella pneumoniae pulmonary infection MAO Yi-chuan, ZHU Jing-fen, LI Yong-gang 2018, 3 (4):  206-209.  Abstract ( 310)    PDF (1639KB) ( 925 )    Objective To investigate the CT imaging and clinical features of multidrug-resistant Klebsiella pneumonia. Methods The clinical data and CT films of 18 patients who were diagnosed as multidrug-resistant Klebsiella pneumonia were retrospectively analyzed. Results Multidrug-resistant Klebsiella pneumonia is common in the elderly with longer length of hospitalizations, mechanical ventilation, surgical intervention, lower immune functions and underlying diseases. Of the 18 cases reviewed,16 cases, 12 cases and 15 cases had pleural effusion, consolidation and bronchial wall thickening, respectively. 10 cases showed ground-glass attenuation, 9 cases showed scattered pulmonary nodules, interlobular septal thickening could be seen in 6 cases and intralobular reticular opacity could be seen in 5 cases. Multiple imaging manifestations can coexist in patients and the lesions are randomly distributed. Conclusion The CT imaging and clinical features of multidrug-resistant Klebsiella pneumoniae pulmonary infection demonstrate certain characteristics. The diagnosis needs to be combined with clinical signs and CT features. The importance of imaging examination is to determine the extent of the lesions and is useful for follow-up diagnosis during treatment.

Imaging differentiation of solitary tuberculosis and peripheral lung cancer HUANG Zao-sheng, LUO Zhe-huang, XU Xin-hua, QIAN Lu-yao 2018, 3 (4):  210-213.  Abstract ( 203)    PDF (1305KB) ( 1176 )    Objective To study the differential imaging diagnosis of solitary tuberculosis and peripheral lung cancer.Methods CT images of 15 cases of tuberculosis and 24 cases of peripheral lung cancer confirmed by surgical pathology and clinical analysis were retrospectively analyzed. Among the 15 tuberculosis,7 cases had chest CT plain scans, 8 cases had chest CT plain scans and enhanced scans, and 3 cases were examined by 18F-FDG PET/CT. Among the 24 lung cancer cases, 4 cases had chest CT plain scans 20 cases had chest CT plain scans and enhanced scans and 2 cases were examined by 18F-FDG PET/CT. The CT and PET/CT signs were comprehensively analyzed. Results The probabilities of calcification and smooth edges among tuberculosis patients (7/15, 4/15) were higher than peripheral lung cancer patients (1/24, 0/24)(P<0.05、P<0.05). The probabilities of lobulation signs, speculation signs and enhancement>20HU among tuberculosis patients (4/15, 5/15, 2/15) were lower than peripheral lung cancer patients (18/24, 17/24, 17/24) (P<0.05、P<0.05、P=0.001).There were no significant differences in lesion diameters, cavities,and pleural indentation or thickening between tuberculosis patietns and peripheral lung cancer patients (P>0.05). The SUVmax of tuberculosis was lower than that of peripheral lung cancer, however, the differences were not significant. Conclusion CT signs of tuberculosis and peripheral lung cancer are characteristic, and some of them overlap. Reasonable combination of PET/CT is of great value for the diagnosis of tuberculosis and peripheral lung cancer.

Clinical value of Artificial Intelligence in detecting and analyzing lesions in patients with pulmonary tuberculosis YAN Ming-yan, Chen Gen-ming, LAI Chao, CHEN Zhi-hong, ZHU Jun-lan, LI Jiao, DONG Shu-wen, CHENG Guan-xun 2018, 3 (4):  214-217.  Abstract ( 495)    PDF (1021KB) ( 635 )    Objective To compare the detection abilities of pulmonary nodule detection and analysis system and radiologists in the diagnosis of pulmonary tuberculosis lesions. To explore the contribution of artificial intelligence to the detection of lesions in tuberculosis patients. Methods A retrospective study was conducted to analyze the computed tomography images of tuberculosis patients from December 2016 to March 2018 in Peking University Shenzhen hospital. Firstly, CT images were retrospectively analyzed by two methods and divided into two groups, A and B. Group A was analyzed by σ-Discover/Lung pulmonary nodule detection and analysis system 1.0. Group B was analyzed by two chest radiologists. The abilities of lesions detection in tuberculosis patients in groups A and B were compared. Secondly, after reading by two experienced chest radiologists, patients with malignant pulmonary nodules or masses were excluded, and σ-Discover/Lung pulmonary nodule detection and analysis system was used to analyze the probabilities of malignant lesions (more than 50% as a high malignant criterion). Results A total of 32 patients with pulmonary tuberculosis were enrolled in the study, with a total of 413 lesions. A total of 380 lesions were detected in group A, including 10 misdetections and 43 missed examinations. A total of 407 lesions were detected in group B and with no false detections and 6 missing lesions. The detection rate of lesions in group A was 89.83%, the rate of false detection was 2.63%, and the rate of missing diagnosis was 10.17%. The detection rate of lesions in group B was 98.55%, the rate of false detection was 0%, and the rate of missing diagnosis was 1.42%. The pulmonary nodule detection and analysis system judged that the total malignant probability of 217 lesions was greater than 50%, and 57.1% of benign lung lesions were analyzed for high malignant probability. Conclusion sThe pulmonary nodule detection and analysis system has a good ability to detect the lesions of pulmonary tuberculosis patients, but the detection ability is not as good as radiologists. The rate of missing diagnosis is high, and the current accuracy of diagnosis of benign lesions of tuberculosis patients is low.

Joinpoint regression analysis on trend of sexually transmitted diseases in Longgang district, Shenzhen CHANG Shu-xia, WEN Yi-qiong, LI Wei-xiong, CAI Yu-mao 2018, 3 (4):  218-220.  Abstract ( 562)    PDF (837KB) ( 707 )    Objective To understand the epidemic trends of sexually transmitted diseases(STDs) in Longgang District of Shenzhen, and provide scientific reference for control and prevention policy by the government. Methods The trends of STDs from 2008 to 2017 in Longgang district and annual percent changes were analyzed by joinpoint regression program．Results The incidence of STDs in Longgang district decreased with an APC of 15.0% from 2008 to 2010 and reached the lowest point in 2010. The incidence of STDs in Longgang district increased with an APC of 10.0% from 2010 to 2013 and then declined with an APC of 1.0% from 2013 to 2017 but either is significant. From 2008 to 2017, the APC of gonorrhea was 3.0%, syphilis was 5.6%, condyloma acuminatum was -3.6%, genital herpes was -12.2%, and chlamydia trachomatis was 1.3%. The proportion of chlamydia trachomatis was the highest, others were syphilis, gonorrhea, condyloma acuminate and genital herpes in Longgang district from 2008 to 2017. The proportion of STDs cases aged between 20 and 29 years was the highest and then followed by 30-39 years group. The proportion of STDs cases aged more than 50 years increased year by year. Conclusion STDs incidence was stable in Longgang district. Control and prevention strategy targeted STDs should be developed and implemented according to own characteristics.

Analysis of etiology of unexplained fever cases reported in Chinese literature in the past 10 years ZHAI Pan-pan, LU Jian 2018, 3 (4):  221-224.  Abstract ( 232)    PDF (839KB) ( 1195 )    Objective To explore the causes of fever of unknown origin（fever of unknown origin,FUO）in various regions in recent 10 years and provide reference for clinical diagnosis and treatment of FUO. Methods Retrospectively reviewed the clinical data of 2444 cases of fever in China in the past 10 years. Results Out of 2444 cases, 2195 cases had been diagnosed with a confirmed diagnosis rate of 89.9%. Of the 2195 cases diagnosed, 1,300 cases were infectious diseases, accounting for 53.2%, and 895 cases were non-infectious diseases, accounting for 46.8%. Conclusion The etiology of patients with fever is unclear. Most patients with fever should be diagnosed by reviwing careful medical history, physical examination and laboratory analysis. The main cause of the fever of unknown originis infectious diseases, followed by connective tissue diseases and tumors. For fever patients, apart from routine examination,etiology, imaging, and pathology should be repeated in time for the early diagnosis of the disease.

Case Report

2 cases of lymph node tuberculosis similar to lymphoma on PET/CT LUO Zhe-huang, LUO Xiao-yan, JIN Ai-fang, Liao Feng-xiang 2018, 3 (4):  225-227.  Abstract ( 573)    PDF (1248KB) ( 1613 )

Review

2018 WHO Tuberculosis Report: Key data analysis for global and China YU Wei-ye, TAN Wei-guo, LUO Yi-ting, LU Pu-xuan 2018, 3 (4):  228-233.  Abstract ( 285)    PDF (1085KB) ( 1251 )    Worldwide, TB is one of the top 10 causes of death. In 2017, TB caused an estimated 1.3 million deaths among HIV-negative people and there were an additional 300 000 deaths among HIV-positive people. Globally, the best estimate is that 10.0 million people developed TB disease in 2017. Drug-resistant TB continues to be a public health crisis. Worldwide in 2017, 558 000 people developed TB that was resistant to rifampicin (RR-TB) and 82% had multidrug-resistant TB(MDR-TB).India, China and the Russian Federation accounted for almost half of the world’s cases of MDR/RR-TB. Although the disease burden caused by TB is falling globally in all WHO regions, in most countries, it is not fast enough to reach the first (2020) milestones of the End TB Strategy. Diagnosis and successful treatment of people with TB averts millions of deaths each year (an estimated 54 million over the period 2000-2017), but there are still large and persistent gaps in detection and treatment. The latest treatment outcome data for new casess show a global treatment success rate of 82% in 2016. The End TB Strategy targets set for 2035 cannot be met without intensified research and development.

New advance in diabetes and tuberculosis: interrelation, diagnosis and treatment YANG Song, YAN Xiao-feng 2018, 3 (4):  234-238.  Abstract ( 477)    PDF (843KB) ( 1287 )    The growing epidemic of diabetes mellitus (DM) is set to become one of the major global health challenges. The rising DM epidemic could contribute to an increase in TB burden. DM also has a major effect on TB treatment outcomes; in particular, it is associated with delayed sputum culture conversion, increased risk of treatment failure, and increased risk of TB relapse and mortality. The tuberculosis epidemic is still serious and is still prevalent globally. One of the important reasons may be the rise of diabetes patients, and the prevalence of DM may affect WHO's “End TB strategy”, especially the prevention and treatment situation of patients with tuberculosis and diabetes.. With the accumulation of recent evidence supporting the TB-DM association, there is a need for an updated understanding of the magnitude of the TB-DM association. This understanding is critical for the implementation of comprehensive TB - DM control programs. The WHO's proposal to end tuberculosis by 2035 reminds us that the prevention and treatment of tuberculosis and diabetes must not be relaxed, otherwise the “End TB”is just a slogan. This paper reviews the recent progress on the relationship between tuberculosis and diabetes and its diagnosis and treatment. A new bi-directional screening and early diagnosis and treatment strategy for the prevention and control of global TB-DM was put forward. These included strengthening the monitoring of tuberculosis in patients with diabetes, of diabetes in patients with tuberculosis, anti-tuberculosis treatment in patients with DM and hypoglycemic therapy and its management in TB patients with. The treatment were determined respectively according to the DM and TB guidelines or international standards. In the end,an effective and integrated strategy of prevention and control for twin-epidemic of DM-TB by early detection, early reporting, early diagnosis, early treatment and early isolation might be explored and implemented.

Clinical and imaging manifestations of AIDS complicated with intracerebral parasitic infection YUAN Hong 2018, 3 (4):  239-243.  Abstract ( 191)    PDF (1594KB) ( 1232 )    HIV is a neurotoxic virus. HIV-infected T lymphocytes can enter the central nervous system through the blood-brain barrier and target oligodendrocytes and damage its support of the myelin sheath. This reaction will cause serious multi-stage demyelinating lesions, such as HIV encephalitis caused by AIDS dementia syndrome and the development of multi-focal white matter encephalopathy. After HIV infection, the human immune system has been severely damaged which will trigger opportunistic infections, resulting in healthy people who were not sensitive to some pathogenic microorganisms and parasites become highly susceptible. Such as AIDS combined with toxoplasmosis encephalopathy, it normally causes recessive infection. Among the AIDS patients with low immune function , toxoplasmosis directly caused the central nervous system damage and due to the delayed diagnosis and treatment, the fatality rate is high. The MRI features of AIDS complicated with toxoplasmosis mainly include: ①The most of pathogenic sites are the frontal lobe, basal ganglia, thalamus and brainstem, while ventricular and ventricular tubular membranes are rarely invaded. ② The morphology of intracranial lesions is mainly circular or nodular. ③The MRI signal of lesion is mainly T1WI low signal. If there is a high signal in the lesion T1WI, there is a possibility of a small amount of bleeding in the lesion; T2WI is mostly high signal, and the enhanced form of developed lesion is mainly manifested as annular reinforcement, petal-like and nodule enhancement. As a result, the "target sign" after the enhancement of magnetic resonance T1WI signal has certain diagnostic significance..