Current Issue

2019 Vol.4 No.1 Published:30 March 2019

Guidelines and Consensus

Chinese expert consensus on prevention and treatment of Zika virus disease (2019) ZHANG Fu-chun, HE Jian-feng, LI Xing-wang, QIN Cheng-feng, LI De-xin, YAO Hang-ping, NI Da-xin, WANG Jian, LI Ping, WANG Gui-qiang, GAO Fu, LU Hong-zhou 2019, 4 (1):  1-7.  Abstract ( 189)    PDF (895KB) ( 771 )    To standardize the diagnosis, treatment and prevention of Zika virus disease, the experts of the Society of Tropical Medicine and Parasitology, and Society of Infectious Diseases of Chinese Medical Association have reached this a Chinese expert consensus on prevention and treatment of Zika virus disease (2019) based on previous systemic reports on Zika. The consensus includes 9 aspects：epidemiology, etiology, pathogenesis, clinical manifestations, laboratory examinations, diagnosis, differential diagnosis, treatment, prevention and control. The publication of this consensus is of great significance to improve the diagnosis, treatment and prevention of Zika virus disease in China.

Forum of Specialist

Living tissue intravoxel incoherent motion (IVIM) diffusion MR analysis without b=0 image: an example for liver fibrosis evaluation WANG Yi-xiang 2019, 4 (1):  8-14.  Abstract ( 204)    PDF (1212KB) ( 778 )    With the reported intravoxel incoherent motion (IVIM) analyses, the diffusion image signal decay is computed starting from b=0 s/mm2 image and then increasingly higher b-values using a biexponential decay model. In many organs such as the liver, the relationship between b-value and diffusion signal is composed of two parts: ① low b-values are associated with quick signal decay caused by fast moving water associated with blood perfusion; ② high b-values are associated with slow signal decay caused by pure water diffusion. These associations are represented by three parameters associated with a bi-exponential model, i.e. Dslow (D), Dfast (D* ), PF (f). PF is the fraction of the pseudo-diffusion linked to microcirculation, Dslow is the true diffusion coefficient representing the pure molecular diffusion, and Dfast is the perfusion-related diffusion. Although the theory of IVIM is very appealing, the practical application in the liver is difficult due to the difficulties in curve fitting and instability of results. Due to its relatively high blood supply, the liver is a very suitable organ for IVIM study. However, the liver is in the meantime particularly affected by physiological motions such as respiration and heart beating; meanwhile, the left liver is also affected by susceptibility artefact due to contents in the stomach. Recently we published two small cohort studies. Study-1 had 16 healthy volunteers and 33 viral hepatitis-b liver fibrosis patients among them 15 patients had stage-1 liver fibrosis. Study-2 had 26 healthy volunteers and 12 viral hepatitis-b liver fibrosis patients among them 4 patients had stage-1 liver fibrosis. All patients and healthy volunteers can be separated by IVIM analysis. Interestingly, study-2 had four patients with biopsy showing no or minimal fibrosis, and these four subjects’ IVIM measurements resembled healthy volunteers. While our current data acquisition and analysis still remain not optimal, we believe we were able to achieve these good results by the following measures: ①IVIM analysis without b=0 data; ②Carefully select b value distribution and the threshold b-value; ③ Discard poor image quality files; ④ Incorporating all IVIM parameters for consideration. We expect that with further improvement in data acquisition and post-processing, IVIM technique will have high sensitivity and specificity for early liver fibrosis evaluation.

Original Articles

The application of diffusion tensor imaging in AIDS patients with brain opportunistic infection: a comparative study of tuberculosis and toxoplasmosis MA Jing-xu, YANG Yu-xin, LIU Ying, HAO Lu, CHU Xiang-le, WANG Hong 2019, 4 (1):  15-19.  Abstract ( 136)    PDF (1489KB) ( 740 )    Objective To study the clinical diagnostic values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in brain AIDS-associated infection patients.Methods 32 subjects who had been confirmed with AIDS (17brain tuberculosis, 15 toxoplasmosis) were recruited to perfprm routine MRI, T1WI-CE and DTI sequences. Then lesions' morphological characteristics were observed, ADC and FA values of the lesions solid area, edematous area and the contralateral normal area were measured and results were statistically annlyzed. The diagnosis efficiency of the two values were analyzed by ROC curve.Result sSignificant differences of ADC and FA values were observed among the three regions between subjects with brain tuberculosis and subjects with toxoplasmosis (P<0.05). Compared with the contralateral normal areas, ADC and FA values of the solid area and edematous area in two groups had statistical significance (P<0.05). Both the FA values of solid and edematous area of the lesions in two groups and ADC values of solid and edematous area of tuberculosis had significant differences. FA values of the solid area in two groups had statistical significance(t=-5.637,P<0.01). ROC curve showed the AUC of ADC value was larger than that of FA value(0.721vs.0.919,respectively, P<0.05).Conclusion DTI is valuable for making diagnosis and differential diagnosis of AIDS patients with brain tuberculosis or toxoplasmosis, also providing the rational use of drug for clinical doctors' reference.

Analysis of clinical characteristics of AIDS complicated with bacterial pneumonia DOU Yan-yun, HUANG Kui, LAN ke, XIE Lu-man 2019, 4 (1):  20-23.  Abstract ( 146)    PDF (959KB) ( 758 )    Objective To explore the HIV/AIDS associated with bacterial pneumonia's clinical characteristics, etiological characteristics and chest CT imaging data,and provide guidance for clinical diagnosis and treatment.Methods The clinical data and chest CT imaging data of 105 cases of AIDS complicated with bacterial pneumonia diagnosed in Guangxi Longtan Hospital from 2014 to 2015 were retrospectively analyzed. All cases met the diagnostic criteria for community-acquired pneumonia,and other pulmonary diseases were excluded.Result sIn 83 patients, CD4+T was less than 50/μL（P<0.05）. Procalcitonin was elevated in 95% of patients, while leukocyte and neutrophil ratios were normal or low in 87% of patients. A total of 236 pathogenic bacteria were isolated from the sputum or alveolar lavage (BALF) specimens of 105 patients. Pathogenic bacteria samples were common in klebsiella pneumoniae, pseudomonas aeruginosa, escherichia coli and staphylococcus aureus. 61% of patients were infected with multiple bacterial species, and most of them were drug-resistant strains. There were 11 cases of two bacterial infections, 41 cases of mixed three bacterial infections, and 12 cases of patients with more than three bacterial infections. Early chest CT only showed thickening and disorder of texture, followed by focal or large infiltrating shadows. When the lesion was severe, it showed lobar pulmonary consolidation or diffuse grid-like pattern in both lungs. There was no statistically significant difference in etiology, lung lesion site distribution and chest CT images (P>0.05).Conclusion Bacterial pneumonia was associated with immune function in AIDS patients, and patients with CD4+T was less than 50/μL were easily associated with bacterial pneumonia, which was not significantly associated with host age. PCT examination can assist AIDS patients in the diagnosis of bacterial pneumonia. The pathogenic bacteria of AIDS complicated with bacterial pneumonia are mainly g-bacillus and staphylococcus, and a variety of pathogenic bacteria are mixed for infection, among which the majority are durg-resistant strains. There was no significant correlation between etiology and clinical manifestations, pulmonary lesion site distribution and chest CT imaging. Dynamic observation of pulmonary lesions on chest CT was helpful for diagnosis.

Investigation into drug-resistant mutations in the treatment of chronic hepatitis B with nucleos(t)ide analogues CHEN Hong-tao, HE Gui-rong, YANG Zhi, MAI Run-zhang, WU Shi-pin 2019, 4 (1):  24-27.  Abstract ( 191)    PDF (1001KB) ( 727 )    Objective To clarify the characteristics of HBV resistance mutant induced by treatment of chronic hepatitis B with nucleos(t)ide analogues (NAs).Methods HBV DNA genotyping and drug resistance mutant detection were performed in 211 patients with chronic hepatitis B (CHB) treated with NAs and 195 NA-naïve patients with CHB via DNA chip technology which combines routine PCR and DNA reverse spot hybridization, and the characteristics of NAs resistance mutation was analyzed.Result sAmong the 406 samples, 61% were genotype B, 31% were genotype C, and the mutation rate of genotype C(65%) was significantly higher than that of genotype B(46%) (P<0.001). rtM204I was the most common resistance mutation site (43%). rtM204V, rtL180M, rtM250V, rtA181T/V, rtN236T and rtM250L were often accompanied by other resistance sites. RtT184S/A/I/L, rtS202G, rtM/V207I existed only in the multi-site resistance pattern.The genotype C was more prone to mutation in the shared pathway, and the mutation of the resistance pathways had no correlation with the patients’ HBeAg status.Conclusion The HBV genotypes in Shenzhen are mainly genotype B. Genotype C has a higher incidence of resistance mutation than genotype B, and is more likely to mutate in the shared pathway.

Correlation between MRI imaging findings and clinical outcomes of 162 cases with intracranial tuberculosis WANG Zhao-qing, WANG Yu-xiang, TANG Yi-min, TAN Jie, ZHANG Pei-ze, DENG Guo-fang 2019, 4 (1):  28-32.  Abstract ( 141)    PDF (1590KB) ( 699 )    Objective To analyze the correlation between MRI imaging findings and clinical outcomes in patients with intracranial tuberculosis.Methods 162 cases of intracranial tuberculosis diagnosed in the Third People's Hospital of Shenzhen from August 2011 to December 2016 were reviewed. Their MRI findings and clinical outcomes were analyzed retrospectively.Result The imaging findings and clinical outcomes were as below: 67 cases of meningeal tuberculosis, the clinical cure rate was 83.6% (56/67); 52 cases of brain parenchymal tuberculosis, the clinical cure rate was 71.2% (37/52); 43 cases of mixed intracranial tuberculosis, the clinical cure rate was 65.1%. (28/43), the difference between the three groups was not statistically significant (χ2=5.231, P=0.073). The imaging findings of complication were as below: 17 cases of cerebral infarction, the clinical cure rate was 58.8% (10/17); 18 cases of hydrocephalus, clinical cure rate was 50.0% (9/18); 4 cases of cerebral infarction and hydrocephalus, clinical cure rate was 75.0 %(3/4). The difference between the three groups was not statistically significant (χ2=0.888, P=0.726). There were 123 cases of imaging without complications, the clinical cure rate was 80.5% (99/123) and 39 cases had complications, the clinical cure rate was 56.4% (22/39). The difference between the two groups was statistically significant (χ2=9.081), P=0.003).Conclusion The imaging complications of intracranial tuberculosis were significantly correlated with clinical cure rate, this finding may provide a certain reference value for the evaluation of clinical outcomes.

Clinical value of interferon-γ release assays in diagnosis of early pelvic tuberculosis CAI Qiu-e, WANG Miao, WAN Jian-yu, ZHANG Ming-xia, LIU Yu-juan 2019, 4 (1):  33-35.  Abstract ( 130)    PDF (872KB) ( 741 )    Objective To explore the significance and application value of interferon-γ release assays(IGRA) in the diagnosis of early pelvic tuberculosis.Methods 46 cases of pelvic tuberculosis patients diagnosed in the Third People’s Hospital of Shenzhen from June 2014 to June 2017 were selected as experimental group and randomly 30 cases of non-tuberculous pelvic were selected as control group. The pelvic effusion which was extracted by laparoscopic surgery or abdominal puncture and the peripheral blood of all patients were detected by using tuberculous specific IFN-γ ELISPOT detection techniques(IGRA combining high-throughput antibody chip technology) to evaluate the specificity and sensitivity of the techniques.Result sThe positive diagnosis rate of pelvic effusion in the experimental group was 97.8%(45/46), 87.0%(40/46) in peripheral blood, and the positive diagnosis rate of pelvic effusion was significantly higher than that of peripheral blood specimens (P<0.01). The positive rate of diagnosis in patients with pelvic tuberculosis was 97.8%(45/46) and 10.0%(3/30) in patients of control group. The diagnostic sensitivity and specificity of tuberculous specific IFN-γ ELISPOT test were more than 85%.Conclusion The tuberculous specific IFN-γ ELISPOT detection technique with highly specific and sensitive to early pelvic tuberculosis can specifically distinguish pelvic tuberculosis from non-tuberculous pelvic inflammation, which is worth clinical promotion.

The analysis of negative conversion rates and cure rates of smear-positive pulmonary tuberculosis patients in different age groups from a street in Shenzhen city YANG Pi-jian, LIAO Hui-ling, CHEN Jun, RUAN Li-ping 2019, 4 (1):  36-38.  Abstract ( 138)    PDF (915KB) ( 735 )    Objective To explore the negative conversion rates and cure rates of smear-positive pulmonary tuberculosis patients with initial treatment or re-treatment of directly observed therapy from different age groups, in order to provide evidence for the formulation and adjustment of directly observed therapy of smear-positive pulmonary tuberculosis patients under initial treatment or re-treatment. MethodDirectly observed therapy according to Guidelines for the Implementation of China's Tuberculosis Control Program (2008) was applied to 318 initially treated patients and 48 retreated patients with smear-positive sputum from a street of Shenzhen city during 2012 to 2016 and results of sputum smear were analyzed.Result sThe negative conversion rates and cure rates at the end of Month 2, 5 and 6 of initially treated patients were the highest with the age of fewer than 19 years, lower with the age of between 20 and 39 years and the lowest with the age of more than 40 years. The negative conversion rates and cure rates at the end of Month 2, 5 and 8 of re-treated patients were the highest with the age of more than 60 years, lower with the age of between 20 and 39 years and the lowest with the age of between 40 and 59 years.Conclusion In the smear-positive patients who received directly observed therapy, the highest cure rates were achieved in initially treated patients with the age of fewer than 19 years and in re-treated patients with the age of between 20 and 39 years. Both the initially treated and the re-treated patients with the age of more than 40 years were suffered to lower cure rates.

Analysis on the effect of community-based TB grading diagnosis and treatment and comprehensive prevention service mode YE Hai-ming, CHEN Wen-si, ZHANG Ju-fang, LIAO Yu-fang, CHEN Jie, XU Jie, ZHANG Sheng-nan 2019, 4 (1):  39-41.  Abstract ( 141)    PDF (873KB) ( 774 )    Objective Summarize the results of the pilot project regarding the implementation of the TB hierarchical medical systems and comprehensive prevention service model in the Futian District Community Health Service Center in 2017. Method196 people with suspected tuberculosis who were referred to Futian Chronic Diseases Control Hospital from the Community Health Service Center in 2016-2017 for the purpose of evaluating the referral of suspected tuberculosis were selected; 873 tuberculosis patients managed by the Community Health Service Center from 2016 to 2017 were selected as subjects to evaluate the patient's standardized treatment management.Result sIn 2017, the community health service center referred 188 suspected tuberculosis patients, and 185 people took the initiative to follow. The referral rate was 98.4%, which was higher than the rate of referral of suspected tuberculosis patients in the general hospitals in the same period. The difference was statistically significant (χ2= 88.9, P<0.05); The Community Health Service Center managed 504 patients with tuberculosis. All patients underwent the first household survey with a management rate of 100%. Patients were regularly followed up according to the requirements of basic public health service regulations, and 493 people were standardized and managed. The rate reached 97.8%; The Community Health Service Center conducted a follow-up supervision of 187 smear-positive patients during the isolation period.Conclusion In 2017, the Futian District Community Health Service Center implemented a pilot program for hierarchical medical operations and comprehensive prevention of tuberculosis,effectively improved the rate of referral of suspected tuberculosis patients which enhanced management of tuberculosis patients, It has played a great role in protecting susceptible populations, overall, the hierarchical medical system has achieved good results and it is worth continuing implementation.

Review

Classification and imaging manifestations of drug-resistant pulmonary tuberculosis YU Wei-ye, TAN Wei-guo, LU Pu-xuan 2019, 4 (1):  42-47.  Abstract ( 175)    PDF (1162KB) ( 1058 )    Drug-resistant tuberculosis, a TB caused by Mycobacterium tuberculosis, is a major respiratory infection that currently threatens human health. Globally, WHO reported 160,684 cases of MDR/RR-TB in 2017, with 139,114 cases receiving treatment. About 47% of drug-resistant TB patients come from India (24%), China (13%) and Russia (10%). At the same time, about 230,000 MDR/RR-TB patients died. In order to effectively standardize the prevention, diagnosis and treatment of drug-resistant tuberculosis, it has been divided into two categories, new drug-resistant TB and previously treated drug-resistant TB, according to the laboratory bacteriology and the cause of drug resistance. While based on the degree of drug resistance, the categories could also be single-drug resistance, multidrug resistance, poly-drug resistance, extensively drug resistance and rifampicin resistance. In this paper, the imaging manifestations of rifampicin resistance, multidrug resistance and XDR-TB were described with representative images of CT and X-rays. Three kinds of drug-resistant pulmonary tuberculosis have some imaging characteristics, mainly manifested as multiple thick wall voids in the lungs, different sizes of the nodule shadow, patchy real changes, fiber stripe shadow, lymph node enlargement and pleural effusion. The lesions involved a wide range areas and long extended time which can cause damaged lungs. Keeping track of the incidence, fatality rate and clinical classification as well as understanding the imaging features of the main types of drug-resistant pulmonary tuberculosis is helpful to guide the clinical diagnosis, treatment and evaluation of curative effect, and to reduce the incidence and fatality rate.

Progress in tuberculosis detection using biosensing technology GAO Xiang, YE Tao-sheng, YANG Qian-ting, ZHANG Ming-xia 2019, 4 (1):  48-51.  Abstract ( 152)    PDF (900KB) ( 850 )    Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium infection which is a serious threat to human life and health.Early diagnosis and effective treatment is significant for Tuberculosis control. Due to the emerging of XDR-TB (Extensively drug Resistant-TB) and MDR-TB(Multidrug Resistant-TB),some shortcomings of traditional TB diagnosis techniques, such as delay and complexity have emerged.Biosensor is a kind of analytical detection device which is composed of the bioactive material immobilized as the sensor and the appropriate transducer.In general, the samples do not need pretreatment, and the separation and detection of the tested components are carried out synchronously, which can be analyzed automatically and in living organisms. Biosensor technology has great potential in MTB detection and clinical diagnosis.This paper briefly reviews the current TB detection technology and summarizes the application and research progress of biosensing technology in TB.

Factors associated with relapse after discontinuation of long-term nucleos(t)ide analogue therapy in patients with chronic hepatitis B DING Xia, LIAO Gui-chan, XIA Mu-ye, PENG Jie 2019, 4 (1):  52-57.  Abstract ( 158)    PDF (957KB) ( 866 )    Nucleos(t)ide-analogues(NAs) is widely applied to the antiviral therapy of hepatitis B virus (HBV)clinically.However, few patients treated with NAs could reach HBsAg clearance, considering the ideal end-point of treatment. Over the past decades, researchers have increasingly focused on optimal stopping strategies, mainly in which indicators could effectively predict clinical outcomes and during which optimal time point to perform. The report summarizes the crucial factors causing the relapse after the NAs treatment is stopped based on virology and host immunology：①Serum HBsAg, HBcrAg, and HBV RNA play crucial roles in determining end-point of NAs’antiviral therapy.②Immunological factors including levels of cytokines, natural immune responses and adaptive immune responses. In addition, NK cell and HBV-specific T cell are closely associated with host immune response.③The interaction between virological and immunological factors induce the clinical outcomes.

Education Fields（Video）

Image manifestations of Influenza and the key points of the latest National Diagnostic and Therapeutic schemes LU Pu-xuan, LUO Yi-ting, ZHENG Qiu-ting 2019, 4 (1):  58-64.  Abstract ( 121)    In the past 100 years, there have been six outbreaks and epidemics of influenza. Sibamia flu is one of the ten most terrible infectious diseases in history, causing tens of thousands of patients to die. To this end, China has developed a revised version of the 2018 Influenza diagnosis and treatment Plan based on the 2009 / 2011 / 2018 Influenza Diagnostic Plan. Within one year, two diagnosis and treatment plans were formally introduced, which shows that the National Health and Health Commission attaches great importance to the prevention and treatment of influenza in China, and has revised and released the plan in a scientific manner. The etiology, epidemiology, diagnosis basis, treatment principles and treatment methods of influenza are described in this paper. To guide the effective prevention and control of influenza in China accurately, it has feasibility and practicability. The clinical diagnosis and treatment of influenza pneumonia, especially the severe and critical cases, are difficult. CT examination and diagnosis are valuable in the diagnosis and evaluation of the curative effect of influenza pneumonia. Influenza pneumonia had some characteristics, such as: ① glass opacity and pulmonary density shadow, ② multiple lobar lung segments, severe lower lung fields, ③ pleural effusion and / or pericardial effusion, and pericardial effusion. Children with influenza pneumonia should also pay attention to influenza associated encephalopathy and acute necrotizing encephalitis. Imaging features and imaging classification can be helpful for clinical diagnosis, treatment and evaluation of curative Useful help.