Current Issue

2019 Vol.4 No.4 Published:30 December 2019

Guidelines and Consensus

Research course and value of artemisinin WANG Ji-gang, ZHU Yong-ping, XU Cheng-chao, YANG Jing, QIU Chen, LIAO Fu-long, JIANG Ting-liang, TU Youyou 2019, 4 (4):  193-195.  Abstract ( 433)    PDF (925KB) ( 1064 )    Malaria has always been a devastating and life-threatening global infectious disease.Artemisinin-based combination therapies are the most effective treatment for malaria in the world, used in almost all endemic regions, and has successfully saved millions of lives. The discovery of artemisinin is the product of close combination of traditional Chinese medicine and modern science and technology. It is the effort and wisdom of a large number of Chinese scientists that eventually deliver artemisinin as a gift of traditional Chinese medicine to the world.

Clinical diagnosis and prevention strategies of important mycosis LIAO Wan-qing, CHEN Min 2019, 4 (4):  196-199.  Abstract ( 189)    PDF (897KB) ( 820 )    Parallel with bacteria and viruses, fungi are one of the three major pathogenic microorganisms in humans, which primarily infect immune-suppressed hosts. Since the founding of New China, great progress has been made in China's medical technology. A large number of internationally-level achievements have also been achieved in the prevention and clinical diagnosis and treatment of fungal diseases in China, which significantly improved the health of Chinese people. But we should be soberly aware that the improvement of medical level also brings a large number of long-term survival hosts in China, such as HIV-infected patients, patients after tumor radiotherapy and chemotherapy, etc. Moreover, high-virulence, multidrug-resistant pathogenic fungal isolates such as Candida auris (“super fungi”)- infections that caused by global exchanges and climate change have also been reported in many cities in China. Therefore, the future of prevention and treatment of important fungal diseases in China is still a long way to go. There is an urgent need to strengthen the collaboration between clinical disciplines and basic disciplines such as medical mycology and epidemiology and related companies. Particularly the epidemiology, pathogenesis, transformation of mycosis, and cooperation in production, education and research should be strengthen, striving to build a key technical system for the prevention, diagnosis and treatment of important fungal diseases at an early stage, and providing the world with clinical diagnostic criteria for mycosis with Chinese characteristics, which will significantly contribute to the prevention and treatment of important fungal diseases in China.

Strategies of prevention and control for Ebola virus under the frame of "One Beld and One Road" LU Hong-zhou, YUAN Wei 2019, 4 (4):  200-203.  Abstract ( 394)    PDF (927KB) ( 848 )    Ebola virus disease is thought to be a great threat to international public health security due to its high mortality. Under the frame of “One Belt and One Road”initiation, we have established a series of response mechanism to ensure the safety of public health at home and abroad. With the increasing exploitation of new medicaments and vaccines, the epidemic of ebola virus is bound to end.

Prevention of mother-to-child transmission of syphilis: technical measures and effectiveness WU Xiao-bing, FENG Tie-jian, YU Wei-ye1 2019, 4 (4):  204-208.  Abstract ( 644)    PDF (924KB) ( 1006 )    China is working with the world in the great action to eliminate the congenital syphilis. By strengthening syphilis serological screening among pregnant women, standardizing the diagnosis and treatment of syphilis, and promoting sexual partner intervention, congenital syphilis and associated adverse pregnancy outcomes can be effectively prevented. Taking Shenzhen’s syphilis prevention mother-to-child-transmission (MTCT) program as an example, through the establishment of an integrated medical prevention and control model and the implementation of intervention measures among pregnant women, neonatal and sexual partners, the incidence of congenital syphilis was effectively reduced from 109.31/100 000 live births in 2002 to 3.94/100 000 live births in 2016. The program had produced great economic and social benefits, and had established a typical example for preventing MTCT of syphilis in China. This study hopes the strategy for syphilis MTCT prevention can be further improved and the technical measures can be widely implemented at both national and provincial levels, so as to achieve the goal for the elimination of congenital syphilis in China.

Original Articles

CT manifestations of cervical non Hodgkin lymphoma in AIDS SONG Shu-lin, ZENG Zi-san, ZHANG Shi-qian, MO Yi-mei, LU Yi-bo, HUANG Ya-hui 2019, 4 (4):  209-211.  Abstract ( 309)    PDF (1329KB) ( 869 )    Objective To investigate CT findings of cervical Non-Hodgkin’s lymphoma (NHL) in AIDS patients. Methods To collect 10 cases of NHL in the cervical of AIDS patients in Nanning Fourth People's Hospital from January 2014 to June 2017 as observation group, and 20 cases of NHL in the cervical of non-AIDS patients in the First Affiliated Hospital of Guangxi Medical University were collected as control group. Results The maximum diameter of lymph nodes in AIDS patients with cervical NHL (6.88 ±3.19 )cm was larger than that of non AIDS patients with cervical NHL (4.33 ±2.33 )cm, and the difference was statistically significant (t = 2.495, P = 0.019). The difference of lymph node density and boundary between the two groups was statistically significant (Fisher exact test, P = 0.019, 0.045). Lymph node fusion (Fisher exact test, P = 1.000) and enhanced scan enhancement (χ²= 1.069, P = 0.586) were not statistically significant. Conclusion The diameter of lymph nodes of AIDS combined with cervical NHL was usually larger (6.88 ±3.19 )cm and more necrotic, and usually AIDS patients have poor prognosis.

Imaging diagnosis and differential diagnosis of the hepatic tuberculosis HE Zhan-ping, CHEN Jing, XU Hai-xia, LU Hong 2019, 4 (4):  212-216.  Abstract ( 277)    PDF (2584KB) ( 1204 )    Objective To investigate the diagnostic value of CT plain scan + dynamic enhancement for hepatic tuberculosis. Methods The imaging findings of 15 cases of hepatic tuberculosis confirmed by surgery or puncture pathology were retrospectively analyzed. There were 10 males and 5 females with CT scan and dynamic enhanced scan of the upper abdomen. Results In 4 cases, there were single nodules in the liver parenchyma; 9 cases showed multiple nodules in the liver; 2 cases were located under the liver capsule. The enhanced scan showed mild inhomogeneous enhancement of the arterial phase in 2 cases, and the degree of enhancement in the portal vein and lag phase was reduced. The type of enhancement was “fast-forward and rapid-out”; 2 cases were mildly intensified in the arterial phase, and the portal vein and delayed phase were associated with the liver. The essence was basically similar, the type of enhancement was “slow-in and slow-out”; 4 cases showed ring-shaped enhancement; 5 cases showed “syncope” in the arterial phase; 1 case showed no obvious enhancement in arterial phase, and the portal vein and delayed phase showed lesions. There are mild enhancement and no obvious enhancement in 3 lesions. Calcification in 4 lesions. Conclusion CT plain scan and enhanced examination have high diagnostic value for hepatic tuberculosis. According to the different enhancement features of lesions, the pathological features of lesions can be judged.

Clinical observation and adverse reactions analysis of linezolid in the treatment of severe multi-drug resistant pulmonary tuberculosis JI Le-cai, YU Wei-ye, TAN Wei-guo, LV De-liang, LV Jian-wen 2019, 4 (4):  217-219.  Abstract ( 354)    PDF (859KB) ( 840 )    Objective To investigate the role of linezolid in the treatment of severe multidrug-resistant tuberculosis, especially the pre-XDR-TB and XDR-TB. Methods 9 patients with pre-XDR-TB and 3 patients with XDR-TB were collected from the tuberculosis clinic of Shenzhen Center for Chronic Disease Control from July 1, 2015 to June 30, 2017. The demographic characteristics and disease characteristics were summarized. After consultation with specialists in the departments, the individualized treatment plan containing linezolid was formulated. During the treatment, the treatment plan was adjusted according to the Results of drug sensitivity and adverse reactions, and the clinical efficacy and drugs adverse reactions were observed. Results 10 were cured and 2 failed. The success rate of treatment was 83.3% (10/12). 8 of the 12 patients had adverse reactions, including 3 cases of optic nerve injury. The visual acuity was restored after discontinuation of linezolid. One case had mild anemia and 3 cases had leukopenia, which returned to normal after symptomatic treatment. There were 7 cases of liver function damage, of which 5 cases needed to stop medication for a short time and change the treatment plan, and then completed the treatment smoothly. Conclusion Linezolid is effective in the treatment of severe MDR-TB, with controlled side effects and it is worth promotion.

Study on depression and related factors in HIV/AIDS patients with MSM QI Hui, WANG Min, YOU Xia, PENG Shuang 2019, 4 (4):  220-222.  Abstract ( 266)    PDF (861KB) ( 746 )    Objective To investigate the occurrence and influencing factors of depression in HIV/AIDS patients with men who have sex with men（MSM), and to provide a theoretical basis for promoting their physical and mental health. Methods A cross-sectional survey of 598 MSM transmitted HIV/AIDS patients in Changsha City was conducted using the ZUNG self-rating depression scale and Psychological Diagnosis CT. The influencing factors of depression were analyzed by logistic regression. Results The detection rate of depression symptoms was 43.8%, and that of depression was 27.8%.The multi-factor regression analysis showed that divorced or widowed (OR=4.54, 95%CI:2.03~10.14),

Clinical analysis of 25 cases of AIDS complicated with Penicillium marneffei pneumonia HUANG Wei, LI Yong, QIN San-fang, HUANG Kui, LAN Ke, TANG Ji-fu, CEN Yu-lan, TANG Xiu-wen 2019, 4 (4):  223-226.  Abstract ( 197)    PDF (1092KB) ( 1163 )    Objective To investigate the clinical manifestations, chest imaging features, diagnosis and treatment of AIDS combined with Penicillium marneffei pneumonia. MethodWe retrospectively analyzed the clinical data of 25 patients diagnosed with AIDS combined with Penicillium marneffei pneumonia. ResultAmong the 25 patients, 20 were male and 5 were female, aged 28-64 years old, with an average age of (44±11) years old. The duration of disease ranged from 1 to 12 weeks, with a median duration of 4 weeks. Clinical manifestations of fever, cough, sputum, weight loss, shortness of breath, night sweats, abdominal pain, diarrhea, liver, spleen and lymph nodes, umbilical concave rash. CD4+T lymphocytes <50 /μl were present in 92% of patients with abnormal blood system. The chest imaging features are diverse, including patch, nodules, ground glass, cavity, mass, millimeter, mediastinum hilar lymph node enlargement, pleural effusion, pericardial effusion, etc. 84% of the patients also had other pulmonary infections. Twenty-two patients received amphotericin B and itraconazole for antifungal treatment, and 23 received anti-hiv treatment.Finally, 21 patients got better, 2 were discharged automatically, and 2 died. Conclusion The clinical and chest imaging manifestations of AIDS complicated with marneffei basilar pneumonia are complex and diverse.

Embolization treatment of severe hemoptysis in patients with pulmonary tuberculosis LIAO Feng-xiang, LUO Zhe-huang, JIN Ai-fang, QI Wan-ling 2019, 4 (4):  227-230.  Abstract ( 312)    PDF (1373KB) ( 868 )    Objective To describe the finding of angiography and assess the efficacy of artery emblization(AE) in pulmonary tuberculosis patients with severe hemoptysis. Methods A retrospective review of angiographies and artery embolizations from 27 pulmonary tuberculosis patients (PBP)severe hemoptysis(SH) was performed, the efficacy of artery embolizations and follow-up Results in 1 year was compared with that of sugery of PBPs with SH. Results In PBPs with SH, angiograpy shows tortuosity, dilation, angiogenesis of bleeding artery, and Fistula formation between branches of systemic circulation bleeding artery and pulmonary artery or vein. 9 PBPs with SH have systemic circulation and pulmonary artery fistula(SPF). 23 PBPs with SH were effective hemostasis. 3 cases recurred in 1 year. Compared with surgery, the efficacy and hemoptysis recurrence in AE patients have no significant difference, but hospital stay and cost have significant difference. Conclusions PF is common in PBP with SH. AE is an effective treatment to use first.

Reactive nodular fibrous pseudotumor of abdominal cavity: a case report and review of literature GAO Xiao-ning, BIAN Jie, LUO Jia-wen 2019, 4 (4):  231-234.  Abstract ( 364)    PDF (1399KB) ( 986 )    Objective To analyze the imaging features of Reactive nodular fibrous pseudotumor (RNFP), to improve the understanding and preoperative diagnosis of the disease, and to prevent clinical over-medication. Methods A number of databases such as MEDLINE, EMBASE, Web of Science, China Knowledge Network, and Wanfang Medical Network were searched to obtain cases of abdominal reactive nodular fibroids, and the corresponding clinical, imaging, and pathological features were summarized. Results 11 patients (35.5%) had a clear history of surgery, and 10 patients (32.3%) mentioned a more obvious history of abdominal disease.17 cases were single (54.8%) and 10 cases were multiple (32.3%).The most common lesions were the colon and appendix (10 cases), followed by the mesentery and small intestine, especially the terminal ileum (9 cases), omentum (5 cases), peritoneal wall (4 cases), hepatic sac, stomach wall and pancreatic circumference. Some RNFP can infiltrate the stomach and intestinal wall and ulcer or intestinal fistula formation (9 cases), some cases of lesions invade the pancreas and tail, spleen and left adrenal gland (1 case).The imaging manifestations of the disease and the pathological features of the disease, that is, the tumors appear as a disorderly arrangement of stellate or fusiform cells, with clear boundaries, with mucoid degeneration or hyaline degeneration, showing that keloid-like coarse collagen fibers are closely related. Conclusion RNFP is considered to be a rare abdominal fibrotic inflammatory lesion caused by abdominal, pelvic surgery or inflammatory stimuli. Because there is no specific imaging manifestation, it is easy to be confused with ovarian-derived diseases. Pathology and immunohistochemistry are diagnoses, gold standard. Surgery is the first choice of treatment.

Review

Imaging manifestations of pneumocystis jiroveci pneumonia QIU Jin-ming, WU Ren-hua 2019, 4 (4):  235-239.  Abstract ( 674)    PDF (870KB) ( 1019 )    Pneumocystis jiroveci pneumonia (PJP), previously named pneumocystis carinii pneumonia, one of the fungoid and opportunistic infections in lungs, is commonly found in dysfunction of immunity, including Acquired Immunodeficiency Syndrome (AIDS), organ transplantation, long-term treatment with immunosuppressant or corticosteroids, malignant tumor and suffering from chemotherapy, and so on. PJP has a characteristic that there is a discrepancy with a mild sign and a serious symptom of low-grade fever, nonproductive cough, and progressive dyspnea. If necessary diagnosis and treatment could not be implemented on time, its mortality rate would be increasingly high, with a sharp development. The typical image of PJP is bilateral, diffused, and symmetrical ground-glass opacity around the hilus pulmonis. The image of PJP can be divided into five types, including ground-glass opacities dominated, lung cysts dominated, consolidation dominated, interstitial lesions dominated, and mixed lesions pattern. If a patient with AIDS appears spontaneous pneumothorax, the most possible cause is the infection of pneumocystis. The early identification and diagnosis with typical image for PJP, and the following specific treatment, play an important role in prognosis of patients.

Research progress of acute encephalitis in MRI GONG Xiao-ming, LU Zhi-yan 2019, 4 (4):  240-243.  Abstract ( 532)    PDF (865KB) ( 973 )    Acute encephalitis is an infectious disease caused by viruses, bacteria, fungi or other microorganisms, which will mainly cause by central nervous system damage. This disease can be life-threatening. If active and effective treatment measures can be taken earlier, the cure rate will be improved. In clinical practice, patients with typical acute encephalitis can be diagnosed by neurological symptoms and signs of infection, while suspected patients are often difficult to be diagnosed. Imaging examination is crucial for the diagnosis of acute encephalitisby various pathogens, especially after the lumbar puncture. Immediate MRI examination of the brain is the first choice for the diagnosis of acute encephalitis [1]. Brain MRI can prompt diagnosis and sometimes even can discover pathogens. It can not only assess the extent of brain damage, but also exclude some major differential diagnoses, such as cerebrovascular lesions or tumors[2]. At present, there are few reviews about MRI manifestations of encephalitis caused by various pathogens in China. This article briefly reviews the pathogenesis of some viruses and bacterial encephalitis and the MRI manifestations of encephalitis caused by different pathogens, in order to facilitate early accurate diagnosis and guide clinical practice timely and effectively.

Spectrum and changes offever of unknown origin LV Kun-lai, XIN Xiao-juan 2019, 4 (4):  244-246.  Abstract ( 347)    PDF (857KB) ( 1060 )    Fever is a common clinical manifestation of many diseases and is one of the common reasons for patients to see a doctor. However, the diagnosis of the cause of fever in many patients is very difficult, sometimes even unable to find the exact cause. Fever is also known as fever of unkown origin (FUO), It was defined FUO as body temperatureabove 38.3°C on three or more occasions and a duration of illness of at least three weeks, in which no diagnosis was made after one week of hospital admission or physical examination and routine laboratory examination. The concept of fever to be investigated provides an important clinical idea for the diagnosis and treatment of patients with unexplained fever. In recent years, with the progress of medical technology and the change of epidemiology, the spectrum of febrile diseases has changed correspondingly. This article aims to discuss and summarize the composition of fever, distribution and change trend of disease spectrum, and provide a reference for clinical diagnosis.

Progress of new MRI techniques in diagnosis of liver fibrosis ZHANG Hao, ZOU Li-qiu 2019, 4 (4):  247-251.  Abstract ( 532)    PDF (872KB) ( 828 )    Liver fibrosis is an injured and healing reaction of various chronic liver diseases. Early diagnosis and treatment plays an important role in the halt of the progression.Accurate liver fibrosis staging is helpful for formulation plan of treatment, evaluation of prognosis and prevention and treatment of complications. Recently, there are new perspectives for diagnosis and treatment from multiple new non-invasive magnetic resonance imaging(MRI) techniques. This paper aims to review the recent progress of new MRI techniques for staging liver fibrosis.

Education Fields

Characteristic CT images of pulmonary tuberculosis in children under three years of age FANG Wei-jun, SONG Min, HAN Yuan-yuan, LI Hui-ru, ZHANG Hui, REN Hui-li, LIU Wen 2019, 4 (4):  252-256.  Abstract ( 337)    PDF (2420KB) ( 1141 )    Mycobacterium tuberculosis in children with pulmonary tuberculosis under three years of age, of which immune organs are not mature, most likly spreads among blood circulation pathway, even lead to disabiling or lethal tuberculous meningitis. So it is essential that pulmonary tuberculosis of these children are diagnosed accurately and early. But these factors, including vague chief complicated with sympotoms or atypical sympotoms, collection of qualified sample and low reactivity caused by immature immune function, have made serious trouble for clinical diagnosis and treatment. Therefore CT imaging diagnosis for pulmonary tuberculosisin childre nunder three years of age is extremely important because CT imagines have high density resolution and image clarity.Based on achievements so far and our practical experience, characteristics of chest CT imagines of pulmonary tuberculosisin children under three years of age may be summarized as following: ①nodular, inflammatory, mass, interstitial and other forms shadows scattered in four or more lobes, especially at the lower. ②enlarged hilar and mediastinal Lymph node of moderately dense shadow among over 90% of cases and calcified lesion among over 50% cases, mainly located at the upper right tracheal (2R), lower right tracheal (4R), aortic arch (5 area), subcarinal (7 area), lower mediastinum (8 area) and right hilar (10R). ③ axillary lymph node enlargement more common on the left side. ④ miliary lesions or miliary nodules due to acute, subacute or chronic dissemination in about 10% of cases. more than 25% presented intracranial tuberculosis in head MR. ⑤emphysema next to the lesion and tracheobronchial lesion more than one quarter or about 6% respectively. These characteristics of chest CT images are very useful to help diagnosis of tuberculosis in children under three years of age.