Current Issue

2022 Vol.7 No.4 Published:30 November 2022

Everything for the People's Health -- Our Decade

The changes of Chinese guidelines for diagnosis and treatment of HIV/AIDS reflect the progress in prevention and treatment of HIV/AIDS in China Shen Yinzhong, Li Taisheng 2022, 7 (4):  1-5.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.001 Abstract ( 253)    PDF (875KB) ( 441 )    Guidelines for diagnosis and treatment of HIV/AIDS are of great significance for guiding prevention and treatment of HIV infection. Chinese guidelines for diagnosis and treatment of HIV/AIDS were released from the first edition in 2006 to the fifth edition in 2021, which reflects the continuous progress of China's HIV/AIDS prevention and research. The changes in the guidelines reflect the changes in the concept of HIV/AIDS prevention and control, and promote the development of HIV/AIDS prevention and treatment in China. Through the joint efforts of governments at all levels and the whole society, the HIV/AIDS epidemic in China has generally been kept under control at a low epidemic level; the public's awareness of HIV/AIDS prevention and control has been significantly improved, the transmission of blood transfusion has been basically blocked, and the transmission of HIV from mother to child and injecting drug abuse has dropped to the lowest level in history; the coverage and success rate of antiretroviral treatment for HIV-infected people exceeded 90%, and the quality of life of HIV/AIDS patients continued to improve. The changes of the guidelines reflect the combination of "prevention" and "treatment" in HIV/AIDS prevention and control, strengthen the whole process management concept of HIV infection, emphasize the joint application of multiple measures to improve the effect of HIV infection prevention, advocate the early initiation of antiviral treatment and the optimization of antiviral treatment programs, emphasize standardized follow-up, and pay attention to the screening and treatment of HIV related diseases and associated diseases. The guidelines for diagnosis and treatment will continue to be updated and revised with the progress of HIV/AIDS prevention and research, and continue to play an important role in China's HIV/AIDS prevention and treatment work.

Original Articles

Characteristics and clinical significance of T lymphocyte subsets in peripheral blood during immune tolerance period of chronic HBV infection Xu Qinglang, Huang Jiansheng, Fu Jiwei, Zhu Ying, Yuan Songsong, Wu Xiaoping 2022, 7 (4):  6-11.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.002 Abstract ( 468)    PDF (912KB) ( 417 )    Objective To study the characteristics of peripheral blood T lymphocyte subsets in patients with chronic HBV infection during immune tolerance period, and to evaluate their role in immune tolerance status, the significance of antiviral timing during immune tolerance period, and the role in HBV infection. Method A total of 79 patients (immune tolerance group), 152 non immune tolerance patients (non immune tolerance group) and 44 healthy volunteers (healthy control group) in the immune tolerance period of chronic HBV infection hospitalized in the Infection Department of the First Affiliated Hospital of Nanchang University from December 2018 to December 2020. Basic data and clinical indicators were collected, and the diagnostic efficacy of T lymphocyte subsets in evaluating immune status was observed. At the same time, 55 patients with chronic HBV infection in immune tolerance stage were followed up to observe the diagnostic efficacy of T lymphocyte subsets for breaking immune tolerance and the difference of T lymphocyte subsets in peripheral blood of patients with and without breaking immune tolerance Result ①The absolute values of CD3+, CD4+, CD8+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes in immune tolerance group and non-immune tolerance group after HBV infection were significantly lower than those in healthy group (P<0.05). The absolute values of CD3+ and CD4+T lymphocytes, the proportion of CD4+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes in immune tolerance group were lower than those in non-immune tolerance group, and the differences were statistically significant (P<0.05). ②The area under the curve of the absolute value of CD4+T lymphocytes, the proportion of CD4+T lymphocytes and the ratio of CD4+/CD8T lymphocytes in evaluating immune status were 0.774, 0.827 and 0.721, respectively. ③The area under the curve of the number of CD3+, CD4+, CD8+T lymphocytes and the ratio of CD4+/CD8+T lymphocytes for breaking immune tolerance were 0.831, 0.892, 0.802, 0.837, respectively. Conclusion ①The decline of cellular immune function and immune disorder are common after HBV infection. ②The absolute number and proportion of CD4+ cells and CD4+/CD8+T ratio have a good effect on the evaluation of immune status in patients with HBV infection. The number of CD3+, CD4+, CD8+T cells and CD4+/CD8+T ratio have a certain reference value for predicting the breaking of immune tolerance status in patients with immune tolerance. Clinically, peripheral blood T lymphocytes can be dynamically detected to assist in evaluating the immune status of patients and the possibility of breaking immune tolerance, so as to understand the immune status of patients and start antiviral therapy in time.

Analysis of drug resistance and comorbidity in 6765 patients with culture positive pulmonary tuberculosis Li Tongxia, Chu Yan, Lin Mei, Li Jing, Wang Bingrui, Ma Guangren 2022, 7 (4):  12-15.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.003 Abstract ( 277)    PDF (876KB) ( 455 )    Objective To investigate the drug resistance and comorbidity of pulmonary tuberculosis patients in Qingdao, and provide scientific basis for the prevention and control of tuberculosis and the management of drug-resistant tuberculosis. Method A retrospective study was conducted on the relevant with pulmonary tuberculosis diagnosed clinically in or out of the Qingdao Thoracic Hospital from September 2016 to March 2021. The sputum smear and culture of the patients with sputum or alveolar lavage fluid were positive. At the same time, the laboratory drug sensitivity test was carried out. According to the test results, 6765 patients with pulmonary tuberculosis diagnosed were divided into multi drug/rifampicin resistant group and drug sensitive pulmonary tuberculosis as the control group. The Charlson comorbidity index (CCI) of the two groups was calculated, The drug resistance related factors and comorbidity of the two groups were analyzed. Result Which 346 cases were multidrug/rifampicin resistant and 6419 cases were drug sensitive pulmonary tuberculosis. Drug resistance of pulmonary tuberculosis patients and classification of tuberculosis treatment history(χ2=47.165, P<0.001), age(χ2=62.531, P<0.001), region（χ2=12.671, P<0.001） and high comorbidity(χ2=20.983,P<0.001); MDR/rifampicin resistant patients in rural areas are more likely to be complicated with high comorbidities.The incidence of diabetes from high to low was diabetes, hypertension, pulmonary heart disease, mental illness, malignant tumors and HIV infection. Multidrug resistant/rifampicin resistant combinations were higher than those of non resistant groups in diabetes(χ2=20.142,P<0.001）, mental disorders(χ2=6.266, P=0.012), malignant tumors(χ2=6.266, P=0.012) and HIV infection(χ2=4.335, P=0.037). Conclusion The high risk factors of MDR/rifampicin resistant pulmonary tuberculosis are retreatment, rural areas, aging and high comorbidity. The proportion of high comorbidity in MDR/rifampicin resistant pulmonary tuberculosis patients is higher than that in the control group. We should strengthen the intervention of high comorbidity patients, so as to improve the cure rate of MDR patients.

Study on the prevalence of human T-cell lymphotropic virus among blood donors in Guangdong Zhong Huishan, Shan Zhengang, Liao Qiao, Xu Ru, Huang Jieting, Wang Min, Rong Xia 2022, 7 (4):  16-19.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.004 Abstract ( 451)    PDF (933KB) ( 662 )    Objective Investigate the prevalence of human T-cell lymphotropic virus (HTLV) among blood donors in Guangdong province, so as to improve blood safety and provide support for health authorities to formulate blood screening policies. Method Enzyme linked immunosorbent assay (ELISA) was used to conduct preliminary screening on blood donors in the whole province from January 2018 to October 2021. Those who failed to pass the test were recorded as positive in preliminary screening and further confirmed by Western blotting (WB). A positive result of confirmation test was considered to be HTLV positive. According to the results of the confirmatory test, the prevalence of HTLV in Guangdong province and each city was figured out, then regional and interannual variations in prevalence rate were analyzed. Result A total of 4 702 539 blood donors were screened in Guangdong province in four years. Therein, 1427 blood donors were found to be positive in ELISA but only 74 blood donors were confirmed positive for HTLV, with a prevalence rate of 0.0016% (74/4 702 539). The prevalence of HTLV in eastern Guangdong is higher than that in northern Guangdong, western Guangdong and the Pearl River Delta (χ2=5.567, P=0.02; χ2=13.502, P<0.001; χ2=32.612, P<0.001). Shanwei in eastern Guangdong had the highest prevalence rate of HTLV in the province (7/56 691, 0.0123%).The prevalence rates of HTLV in the four years were 0.0018% in 2018, 0.0012% in 2019, 0.0016% in 2020 and 0.0018% in 2021, respectively. The difference was not statistically significant (χ2=1.965, P=0.58). Conclusion Guangdong is a low epidemic area of HTLV. In order to improve the quality of blood products, it is suggested to carry out HTLV screening in areas with high prevalence. As for other regions, flexible strategies can be adopted according to the local economic development.

Analysis of short-term prognostic value of multiple models in predicting HBV-ACLF complicated with IPA Liang Jiayuan, Wu Xiaoping, Yang Lixia, Cai Tianpan, Wang Liang, Cheng Qiqi, Sun Jun, Liu Liping, Gan Xia, Ruan Ninghang, Ge Shanfei 2022, 7 (4):  20-24.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.005 Abstract ( 491)    PDF (899KB) ( 450 )    Objective MELD score, MELD-Na score, CLIF-C OF score, and CLIF-C ACLF score were used to predict the short-term mortality risk in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) complicated with invasive pulmonary aspergillosis（IPA）, to explore and compare the predictive value of various scoring systems for the short-term fatality rate in patients with HBV-ACLF incorporates the IPA. Method Collect the clinical data of HBV-ACLF patients who admitted to the Infection Department of the First Affiliated Hospital of Nanchang University from January 2019 to December 2021. The MELD score, MELD-Na score, CLIF-C OF score and CLIF-C ACLF score were calculated respectively, and the receiver operating characteristic curve (ROC curve) was applied to compare the diagnostic value of the above scoring system. Comparisons between two groups meeting the normal distribution were performed by the t-test, Comparisons between two groups who did not fit the normal distribution were performed using the Mann-Whitney U test. Result Among the 110 patients, 36 patients (32.7%) died after 28 days of treatment.The area under the ROC curve (AUC) of the MELD score, MELD-Na score, CLIF-C OF score and CLIF-C ACLF score was 0.77,0.74,0.93 and 0.89, respectively. The AUC of CLIF-C OF score was the largest, and there was no significant difference with CLIF-C ACLF score (P>0.05).There were significant differences in AUC between CLIF-C OF score, CLIF-C ACLF score, MELD score and MELD-Na score (P<0.05). Conclusion The CLIF-C OF score and CLIF-C ACLF score can effectively predict the 28-day risk of death in patients with ACLF incorporates the IPA.

Role of protein induced by vitamin K absence/antagonist-Ⅱ and alpha-fetoprotein-L3 ratio combination in the diagnosis of HBV-related HCC with negative AFP Chen Yuanyuan, Cheng Wenbing, Chen Chuantie, Zhu Zhibin, Huang Deliang, Chen Yanping, Chen Jun 2022, 7 (4):  25-28.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.006 Abstract ( 360)    PDF (946KB) ( 554 )    Objective To explore the diagnosis value of serum protein induced by vitamin K absence/antagonist-Ⅱ and alpha-fetoprotein-L3 ratio in HBV-related hepatocellular carcinoma(HCC) patients with negative AFP. Method 86 cases with HCC and 69 cases with benign liver disease and 56 cases with control group were enrolled in Shenzhen Third People's Hospital from January 2018 to October 2021. Serum PIVKA-Ⅱ and AFP-L3% were measured and statistically analyzed. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of PIVKA-Ⅱ and AFP-L3% alone and in combination for AFP negative HBV-related HCC. Result Serum PIVKA-Ⅱ and AFP-L3% were significantly different among the three groups (P<0.05). PIVKA-Ⅱ and AFP-L3% in HCC group were higher than those in benign liver disease group and control group (P<0.05); Serum PIVKA-Ⅱ had a sensitivity of 54.7% and a specificity of 91.2% in the diagnosis of HBV-related HCC with negative AFP, while AFP-L3% had a sensitivity of 60.5% and a specificity of 84.0%. The combination between PIVKA-Ⅱ and AFP-L3% have a higher sensitivity(74.7%). Conclusion PIVKA-Ⅱ and AFP-L3% are both having diagnosis value in AFP negative HBV-related HCC. Combined detection between AFP-L3% and DCP can improve the diagnostic efficiency in AFP negative HBV-associated HCC, and provide theoretical basis for the early diagnosis of AFP negative HBV-associated HCC.

Visualization analysis on research status and trends of severe fever with thrombocytopenia syndrome in recent 10 years based on CNKI Xu Kuanqin, Shi Hui, Qiu Yanqin, Hou Yuting 2022, 7 (4):  29-32.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.007 Abstract ( 339)    PDF (1012KB) ( 621 )    Objective The researches on severe fever with thrombocytopenia syndrome (SFTS) is systematically reviewed in recent 10 years, in order to grasp the research status and reveal the research hotspots and frontiers in this filed. Method The literature related to SFTS was retrieved from CNKI. After format conversion, the CiteSpace software was used to draw the knowledge map of the authors, institutions and keywords in the literature on SFTS. Result Totally 350 articles were included. A total of 162 authors were included in the author cooperative knowledge map, among them Li Shibo published the most papers and formed the largest collaborative group represented by him. A total of 17 institutions were included in the institution cooperative knowledge map, but there was no cooperation among institutions. A total of 78 keywords were included in the keyword co-occurrence clustering knowledge map, forming 7 clusters. In recent 5 years, the burst words are as follows: nursing, traditional Chinese medicine and prognosis. Conclusion In recent 10 years, the research filed of SFTS in China has developed rapidly, but the cross-institutional and cross-regional cooperation needs to be strengthened. Etiological characteristics, laboratory indicators, epidemiological characteristics and clinical characteristics are the research hotspots in this filed, and nursing, TCM diagnosis and treatment and prognosis are the research frontiers in this filed.

The value of AFP combined with AFP-L3, GPC3 and MMP2 detection in the diagnosis of hepatocellular carcinoma Pang Wenxiao, Li Jike, Chen Tingyu, Zhao Yong, Wei Guo 2022, 7 (4):  33-36.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.008 Abstract ( 257)    PDF (895KB) ( 385 )    Objective The purpose of detecting the expression of serum AFP,AFP-L3, GPC3 and MMP2 was to study the diagnostic value of the combined detection of four indicators in HCC．Method 60 HCC patients,60 case of liver cirrhosis patients,60 cases of chronic viral hepatitis B ( HBV) patients and 60 healthy controls were selected from Outpatients in Public Health Clinical Center of Chengdu from December 2019 to December 2020.The serum AFP,AFP-L3 and GPC3,MMP2 detected with chemiluminescence and enzyme-linked immunosorbent double antibody sandwich method, respectively. Analyzed the differences of serum marker in each group, and the diagnostic efficiency of combined detection was calculated. Result The levels of serum AFP,AFP-L3,GPC3,and MMP2 in HCC patients were significantly higher than those of other non-HCC groups,and the differences were statistical significance(M =122.3 μg/L, 88.33 μg/L, 53.45 pg/ml, 701.3 μg/L;H =125.8, 167.5, 209.4, 210.4; P< 0.05). The diagnostic accuracy of the combined detection of four indicators was 89.3%, the sensitivity and specificity were 84.87% and 84.59%, respectively, and the area under the curve was 0.905, which was higher than that of single detection, there are significant difference in those three groups(P< 0.05). Conclusion The combined detection of serum AFP, AFP-L3, GPC3 and MMP2 are the risk factors of HCC ppatients, which is helpful to the early diagnosis and treatment of cancer in high-risk patients with hepatocellular carcinoma, and improve survival time of patients and the survival rate.

Analysis of the correlation between dysglycemic dyslipidemia and pulmonary tuberculosis combined with type 2 diabetes Gui Jing, Yang Hui, Fu Yu, Liu Ta 2022, 7 (4):  37-41.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.009 Abstract ( 282)    PDF (907KB) ( 385 )    Objective To address the correlation between dysglycemic dyslipidemia and pulmonary TB combined with T2DM (pulmonary TB-T2DM) was investigated to provide new ideas for reducing the prevalence of pulmonary TB. Method A total of 330 cases, including 270 cases in the experimental group—90 patients of pulmonary TB(PTB group)、90 patients of T2DM(T2DM group) and 90 patients of pulmonary TB-T2DM(TB-T2DM group), and 60 cases of healthy subjects from outpatient physical examination in the control group, were collected from September 2020 to August 2021 in Shenzhen Center for Chronic Disease Control. After the whole blood and serum specimens were collected from the experimental and control group, the anticoagulated whole blood was tested by high performance liquid chromatography (HPLC) to determine the percentage of hemoglobin A1c (HbA1c), and serum fasting blood glucose (FBG), total cholesterol (CHOL), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) levels were measured by enzyme colorimetric method. To analyze the prediction of the level of glycemic lipid control on the prevalence of pulmonary TB. Result The T2DM group has the highest average age (57.34 ± 9.52 ), the proportion of people with poorly controlled HbA1c and FBG in both T2DM and pulmonary TB-T2DM groups was significantly higher than that in the healthy control and pulmonary TB groups (all P<0.05); pulmonary TB, T2DM and pulmonary TB-T2DM groups all had significantly higher proportions of elevated CHOL and LDL-C than controls (all P<0.05), while T2DM and pulmonary TB-T2DM groups had significantly higher proportions of elevated TG than healthy control and pulmonary TB groups (all P<0.05). Binary logistic regression shows that elevated TG（OR=2.43,95% CI：1.117~5.289,P<0.05）was independent risk factors for the prevalence of pulmonary TB. Conclusion Elevated TG is possible independent risk factor for pulmonary TB disease; Lifestyle guidance and interventions aimed to contain abnormal fluctuations in lipid profiles are recommended for middle-aged and elderly populations.

Epidemiological investigation of a tuberculosis outbreak in a middle school in Shenzhen Li Minlu, Liao Jinsheng, Liu Jingyuan, Qiu Yonghong, Zheng Tiehong 2022, 7 (4):  42-46.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.010 Abstract ( 497)    PDF (878KB) ( 483 )    Objective To analyze the epidemiological characteristics and investigation and disposal process of a tuberculosis epidemic in a middle school in Shenzhen during the COVID-19 epidemic, and provide reference experience for further standardizing the disposal of tuberculosis epidemics in schools. Method Field epidemiological methods were used to investigate and deal with the epidemic, and the epidemiological relevance of the epidemic was judged according to the time axis of the onset of cases, population distribution and gene sequencing results. All data were collected and sorted to analyze the causes of tuberculosis cluster in the school. Result From September 2020 to June 2021, a total of 8 cases of pulmonary tuberculosis were found, including 6 cases of laboratory diagnosis and 2 cases of clinical diagnosis. 7 cases were G senior students, with a student attack rate of 2.81%, and 1 case was a H senior student, with a student attack rate of 0.40%. There was a statistically significant difference in the attack rate between the two different grades (χ2=4.671, P<0.05). There were 2 females and 6 males. 2 cases (25.0%) were found in medical treatment due to symptoms, and 6 cases (75.0%) were found in close contact screening. In this outbreak, the latent infection rate of Mycobacterium tuberculosis among faculty and staff was 5.00% (4/80); the latent infection rate of Mycobacterium tuberculosis among students was 3.14% (36/1147), of which 12.5% (32/256) of the class with pulmonary tuberculosis cases were found, the class with no cases found was 0.48% (4/841), and the difference was statistically significant (χ2=89.403, P<0.001). Whole genome sequence analysis showed that case 1, case 3, case 4, case 5, and case 6 belonged to the same transmission chain;the strain of case 2 was a unique strain, and there was no transmission relationship with other positive patients. Conclusion Schools should implement tuberculosis health examination for students, and close contacts, especially those with latent Mycobacterium tuberculosis infection, are the focus groups of tuberculosis cluster epidemic in schools. During the period of COVID-19 epidemic prevention and control, all screening will be completed in schools, and joint prevention and control by all departments can effectively contain the tuberculosis epidemic in schools.

Correlation between Gd-EOB-DTPA enhanced MRI and histologic grade of hepatocellular carcinoma in hepatitis B Du Yanni, Lyu Zhibin, Xing Yuxue, Guan Chunshuang, Zhang Zixin, Xie Ruming, Chen Budong 2022, 7 (4):  47-52.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.011 Abstract ( 281)    PDF (1780KB) ( 357 )    Objective A retrospective analysis was performed to analyze the the correlation between quantitative indicators by gadoxetic acid disodium enhanced MRI and the differentiation degree of hepatocellular carcinoma. Method A total of 38 patients who pathologically confirmed for HCC in hepatitis B which were divided into high(10 patients), medium(21 patients) and low(7 patients) groups at our institution between June 2020 and June 2021 were retrospectively analyzed. Gadoxetic acid enhanced MRI was performed in all patients before surgery. The SNR of liver parenchyma, LLC, CER and SIR of HCC were calculated. The comparisons of these quantitative data among different grades were performed. Result Among 38 patients, 7 were poorly differentiated, 21 were moderately differentiated and 10 were well differentiated. The SNR of hepatic parenchymal in plain scan and arterial phase (AP) were lower than those in portal venous phase (PVP) and hepatobiliary phase (HP) (P<0.05). The LLC value of well differentiated HCC was higher than moderately differentiated HCC in plain scan and HP; the CER value of well differentiated HCC was lower than moderately and poorly differentiated HCC in AP; The value of SIR of well differentiated HCC was higher than moderately and poorly differentiated HCC in plain scan, and well differentiated was higher than moderately differentiated in HP; all the differences were statistically significant (P<0.05). Conclusion The quantitative index LLC, CER and SI ratios of Gd-EOB-DTPA-enhanced MRI were correlated with the histological differentiation of hepatocellular carcinoma, which could provided value for the evaluation of hepatocellular carcinoma with different degrees.

Comparison of T cell spot test and sputum smear in the diagnosis of pulmonary tuberculosis in adults of different ages Fu Xiong, Fu Linlin, Fu Qiuye, Wu Weizhen 2022, 7 (4):  53-56.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.012 Abstract ( 378)    PDF (875KB) ( 498 )    Objective To analyze the clinical significance of T-SPOT test (T-SPOT.TB) and sputum smear examination in the diagnosis of pulmonary tuberculosis in adults of different ages. Method The data of 650 patients with suspected pulmonary tuberculosis treated in our hospital from March 2018 to December 2019 were retrospectively analyzed. The participants were divided into young group (18-44 years old) 296 cases, middle-aged group (45-59 years old) 144 cases and elderly group (≥60 years old)210 cases according to the age of the World Health Organization. All patients were examined with T-SPOT.TB and sputum smear, The positive rates of the two methods in different age groups were compared.The diagnostic value of a antigen and B antigen in patients with pulmonary tuberculosis at different ages was judged by the working characteristic curve of subjects. To analyze the diagnostic efficacy of T-SPOT.TB in adult tuberculosis of different ages. Result ① In different age groups, the positive rate of T-SPOT.TB was significantly higher than that of sputum smear method, and the difference was statistically significant (P<0.05). ② There was significant difference between the sensitivity and accuracy of T-SPOT.TB detection in different age groups (P<0.05); The diagnostic sensitivity of T-SPOT.TB for young group, middle-aged group and old group were 92.72%, 79.81% and 64.52% respectively, and the difference was statistically significant (P<0.0166); The diagnostic accuracy of T-SPOT.TB in the elderly group was 67.14%, which was lower than 86.15% in the youth group and 75.69% in the middle-aged group, respectively. There was significant difference between the groups (P<0.0166). Conclusion The diagnostic sensitivity and accuracy of T-SPOT.TB detection method in young and middle-aged patients are higher than that in elderly patients, and the diagnostic efficiency of tuberculosis in elderly patients is low. It should be combined with other diagnostic methods to avoid misdiagnosis and missed diagnosis.

Dual-center clinical evaluation of sputum smear automatic microscopy system for detecting tuberculosis Zhao Doudou, He Huishan, Xia Li, Zheng Qiuting, Qian Lingjun, Hong Kunlei, Lure Fleming Yuan-ming, Tao Lili, Guo Lin 2022, 7 (4):  57-60.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.013 Abstract ( 297)    PDF (874KB) ( 478 )    Objective To evaluate the mycobacterium tuberculosis detection performance of ASSMS and compare it with that of the traditional manual way. Method 474 and 451 sputum specimens were retrospectively collected from Eighth Affiliated Hospital of Xinjiang Medical University (Center Ⅰ) and Shenzhen Chronic Disease Control Center Shenzhen (Center Ⅱ), respectively, and mycobacterium tuberculosis tests were separately conducted by doctors and ASSMS after specimens were made into sputum smears. Results were finally compared and analyzed. Result The detection rate of ASSMS was higher than manual detection on two datasets of 925 cases (Center Ⅰ: P<0.05,Center Ⅱ: P>0.05). The results of center Ⅰshowed that the accuracy, sensitivity and specificity of manual and automatic detection were 91.8% vs 90.5%, 74.4% vs 86.7% and 97.7% vs 91.8%, and the ASSMS finally identified 31 sputum samples (25.8%)that was missed by doctors. While the results from center Ⅱ showed that the accuracy, sensitivity and specificity of manual and automatic detection were 90.7% vs 85.8%, 52.3% vs 68.2% and 94.8% vs 87.7%, and the ASSMS identified 21 sputum samples (47.7%) doctors missed. Conclusion Automatic detection may be functioned as an effective assistant to help doctors reduce missed diagnosis rate of tuberculosis.

A retrospective analysis of CT features of primary varicella pneumonia in 31 adults Wang Sudan, Zhang Yanyan, Wang Wei, Li Hongjun 2022, 7 (4):  61-64.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.014 Abstract ( 306)    PDF (1261KB) ( 557 )    Objective To summarize the chest CT characteristics of primary varicella pneumonia (PVP) in adult, and to improve the medical staff's understanding of this disease. Methods Chest CT images of 31 adult patients cared at Beijing You'an Hospital, Capital Medical University between January 2013 and March 2021 with varicella pneumonia were retrospectively analyzed and collected, and the imaging features of PVP were summarized. Results All the chest CT images of 31 patients with varicella pneumonia presented pulmonary nodules with halo sign, with diameters of 2-12mm. There was no trend in the distribution of pulmonary nodules in each lobe of the lungs, which were more common near the pleura of both lungs. And nodules with halo sign were typical manifestations. The lungs of 10 patients showed patchy ground glass density, and consolidation was observed in 2 patients with a slightly more serious condition. Conclusion The CT manifestations of adult PVP are mainly ground glass opacity nodules with halo sign.

Prevalence of neurosyphilis among syphilis serofast patients: a Meta-analysis Wu Xiaobing, Mao Yajun, Liu Xin, Guan Yang, Zheng Jinfen 2022, 7 (4):  65-69.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.015 Abstract ( 322)    PDF (1225KB) ( 669 )    Objective To estimate the prevalence of neurosyphilis among syphilis serofast patients and analyze its associated factors using a meta-analysis approach. Method Key words with syphilis serofast and neurosyphilis were searched in the Chinese National Knowledge Infrastructure (CNKI), Wan Fang Database and PubMed. Literatures with clear definitions of syphilis serofast and neurosyphilis, and reporting the numbers of both serofast patients and neurosyphilis patients were collected. Statistical analysis was performed in the R software. Result A total of 769 literatures were retrieved, and 23 literatures were finally included. The included literatures involved 2103 syphilis serofast patients, among whom 420 were neurosyphilis patients. The prevalence of neurosyphilis among serofast patients was 18% (95% CI: 13% to 25%) in the random-effects model. The prevalence rates varied with serofast patients' age (χ2=104.82, P<0.001) and the follow-up time to define serofast (χ2=139.44, P<0.001). The positive rates of neurosyphilis testing also varied with detection methods of cerebrospinal fluid (χ2=137.86, P<0.001). Conclusion Syphilis serofast patients have high prevalence of neurosyphilis. It is necessary to conduct more researches on the relationships between syphilis serofast and neurosyphilis, and thus provide more scientific data for the formulation of syphilis prevention and control policies.

Hemophagocytic syndrome in patients with AIDS：a report of three cases and literature review Liu Xia, Cai Lin 2022, 7 (4):  70-73.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.016 Abstract ( 287)    PDF (903KB) ( 426 )    Objective This paper describes the clinical features of three cases with hemophagocytic syndrome in AIDS patients and compares them with literature data. This is to deepen the understanding of the disease. Method A retrospective analysis was conducted to collect the basic information, clinical manifestations, laboratory tests and outcome characteristics of 3 patients diagnosed with AIDS and hemophagocytic syndrome in Public and Health Clinical Center of Chengdu from March 2020 to December 2021, and to review the literature. Result The 3 cases included 2 males and 1 female. The average age was 38. All patients were diagnosed with AIDS. Fever, splenic and multiple lymph node enlargement, methemoglobinemia, and blood system damage were the common clinical characteristics of 3 patients. Laboratory examination showed that sCD25 was significantly increased, NK cell activity was decreased, hemophagy of the bone marrow smear was observed, and EBV-DNA was detected in the blood. 3 cases were complicated with opportunistic infection, which failed to respond to anti-infective therapy. The disease progressed rapidly and all cases were died. Conclusion The case of AIDS complicated with HPS is rare, and infection is the common cause. Because variable clinical symptoms are easily confused with other diseases,low correct diagnosis rate of HPS is found among these patients. The control of HPS is as important as ART.But this disease progresses rapidly, resulting in high mortality. Doctors should be alert to the occurrence of HPS among these patients.

Case Report

Adult Gaucher disease with chronic viral hepatitis B, liver cirrhosis and primary liver cancer：a case report Huang Zhihua, Zhou Meiyun, Lei Feng 2022, 7 (4):  74-77.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.017 Abstract ( 367)    PDF (1361KB) ( 411 )    A male patient of 59 year old presented with recurrent abdominal distension for more than 10 years. Physical examination: clear mind, slight yellowing of skin and mucous membrane, no touch under the liver costal, spleen subcostal reached about 20cm, positive mobile turbidity, skin pigmentation of both lower limbs. Laboratory examination: WBC 1.75×109/L, RBC 2.92×1012/L, HGB 97.00g/L, PLT 22.00×109/L; AFP increased from 2.2μg/L to 82.25μg/L in recent 9 months, and AFP-L3 3.0μg/L. Hepatitis B surface antigen and hepatitis B e antigen were positive. CT and MRI of abdomen showed chronic hepatitis B cirrhosis, splenomegaly, ascites, primary liver cancer and multiple splenic aneurysms. Gene detection: GBA gene detected suspected pathogenic variation of chromosome position 1q22, Exonll, cDNA level: c.1448T>A, protein level: P (Leu483Gln), which is consistent with the gene detection of his sister (confirmed GD patient). The patient was diagnosed as adult Gaucher disease.

Imaging features of blood stream infection and brain abscess caused by Streptococcus constellation and related literature review Hu Fengling, Li Yanyan, Wang Junda 2022, 7 (4):  78-81.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.018 Abstract ( 340)    PDF (1530KB) ( 722 )    As an opportunistic pathogen, Streptococcus constellation can cause septic infection in various tissues and organs of human body, currently, there are few reports in the literature, and the imaging characteristics and treatment options are not well understood. Through clinical CT and MRI imaging manifestations, combined with blood culture and cerebrospinal fluid bacterial culture detection, it can play the purpose of early diagnosis, and provide important value for follow-up treatment and prognosis. A case of cerebral abscess and bloodstream infection caused by Streptococcus constellation in Chongqing Hospital of Traditional Chinese Medicine was analyzed retrospectively, inoder to explore the imaging characteristics of bloodstream infections and brain abscesses caused by Streptococcus constellation and analyze the literature in order to improve the understanding of the imaging characteristics of brain abscesses caused by Streptococcus constellation infections.

Pulmonary metastasis of thyroid carcinoma misdiagnosed as hematogenous disseminated pulmonary tuberculosis in children: report of 3 cases Wang Xiaoxia, Liang Ruiyun, Zhong Peng 2022, 7 (4):  82-85.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.019 Abstract ( 384)    PDF (1482KB) ( 360 )    Pediatric thyroid cancer is a malignant tumor of endocrine system. The early clinical symptoms are not typical, and parents are easy to ignore it. When the obvious symptoms or signs appear, the course of disease is often delayed for a long time, and lung shadow is found at this time, which is easy to be misdiagnosed as tuberculosis. Three cases of thyroid cancer reported in this study were misdiagnosed as hematogenous disseminated tuberculosis due to diffuse or multiple nodules in both lungs on chest imaging, and were recommended to be hospitalized in The Pediatrics Department of Guangzhou Chest Hospital. The disease course of the three cases all lasted more than half a year, and they had no history of tuberculosis (TB) exposure. After hospitalization, T-SPOT.TB for tuberculosis, and CT examination showed high possibility of pulmonary metastasis. The 3 cases were not diagnosed as disseminated pulmonary tuberculosis through comprehensive analysis. They were transferred to another hospital for diagnosis and treatment, we learned through telephone follow-up that they were both diagnosed with thyroid cancer and lung metastases.In recent years, the incidence of thyroid cancer in children in China has increased significantly. It is not easy to be detected in early stage and is prone to cervical lymph node metastasis and distant metastasis. Distant metastasis is one of the risk factors for poor prognosis. When pulmonary metastasis occurs, it is easy to misdiagnose as hematogenous disseminated pulmonary tuberculosis, thus delaying diagnosis and treatment, and losing the best treatment opportunity. Therefore, the differential diagnosis of pulmonary metastasis and hematogenous disseminated pulmonary tuberculosis should be emphasized in clinical work.

Review

Application of extractive electrospray ionization mass spectrometry in epidemiology Zhai Xingying, Long Zi, Zhang Xinglei, Zhu Tenggao, Liu Kun, Xu Jiaquan 2022, 7 (4):  86-90.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.020 Abstract ( 328)    PDF (954KB) ( 451 )    Extractive electrospray ionization mass spectrometry (EESI-MS) combines the advantages of electrospray ionization and liquid-liquid extraction. EESI-MS can be used for real-time mass spectrometry analysis of complex samples, featuring the characteristics of strong tolerance of biomatrices, good stability, high sensitivity, and wide applicability. It has become an effective mass spectrometry method for in vivo analysis, in-situ analysis, and long-distance analysis. For liquidand gas, EESI-MS can be directly carried out to obtain analytical data. For actual samples such as colloids, heterogeneous mixtures and living plant surface, EESI-MS technology can adopt neutral gas desorption sampling, which can realize mild mass spectrometry analysis without chemical pollution, biological stress, and obvious damage, and has no obvious interference to the physiological or pathological state of animals and plants. More importantly, the improved internal extraction electrospray ionization (iEESI) MS technology can directly and quantitatively achieve trace amounts of trace substances in tissue samples without pretreatment of homogenate and extraction. Therefore, EESI-MS technology has the characteristics of powerful function and wide application. In recent years, EESI-MS has been widely used in epidemiology, which includes the analysis of infectious diseases and chronic diseases, the detection of harmful substances affecting human health in the fields of environment, labor and food. EESI-MS has special advantages in the molecular diagnosis of infectious diseases and chronic diseases. Due to the limitation of length and theme, this paper mainly reviews the application of EESI-MS technology in epidemiology to promote the exchange and development of related fields.

Research progress in traditional Chinese medicine treatment of menstrual disorder caused by antiretroviral therapy for AIDS Liu Fengyun, Li Weixin, Ou Jian, Wen Lemin 2022, 7 (4):  91-94.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.021 Abstract ( 315)    PDF (874KB) ( 753 )    Antiretroviral therapy (ART) is currently the most effective treatment for aacquired immunodeficiency syndrome（AIDS）. Clinical studies have shown that the ART treatment causes menstrual disorder for some female patients. Compared with ordinary menstrual disorder syndrome, the menstrual disorder with ART treatment has its own syndrome characteristics: often accompanied by fatigue, decline of immunity, susceptibility to wind chill, internal obstruction of dampness and turbidity, phlegm and blood stasis, HIV lingering to deficiency, etc. According to theory of traditional Chinese medicine (TCM), the menstrual disorder in ART treatment are mainly caused by deficiency of liver and kidney, loss of vitality, and accumulation of evil poisons. The treatment on this menstrual disorder should focus on invigorating the kidney and filling essence, reinforcing the vital essence and strengthening the body, expel evil spirits, righteousness and exorcism. TCM treatment of menstrual disorder has the advantages of a long history, significant curative effect, rich experience, fewer side effects, etc. The authors analyzed the recent studies on the TCM treatment of menstrual disorder after ART and found that there were few clinical studies on the intervention of TCM in the treatment of menstrual disorder after ART. The most research works were carried out from the perspective of menstrual disorder caused by other diseases, but not from the perspective of menstrual disorder caused by AIDS.

New progress in the application of ultrasonic AI in viral hepatitis-related complications Zeng Weimei, Dong Changfeng 2022, 7 (4):  95-98.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.022 Abstract ( 299)    PDF (872KB) ( 354 )    China has a high incidence of viral hepatitis, viral hepatitis can occur many complications, endanger the physical and mental health of patients, seriously threaten the lives of patients, early diagnosis of viral hepatitis-related complications is of great significance to guide clinical treatment.Artificial intelligence is becoming more and more popular in the field of medicine, and the research and application of ultrasonic artificial intelligence in the field of liver diseases is also deepening day by day. Ultrasonic artificial intelligence is a research hotspot in recent years to analyze the characteristics of clinical data and imaging data of a large number of patients with viral hepatitis and to establish various algorithm models to provide a new method of rapid diagnosis for clinic. This article reviews the new progress in the application of ultrasonic artificial intelligence in viral hepatitis-related complications.

Education Fields

Clinical imaging diagnosis and differential diagnosis of AIDS complicated with bacterial pneumonia Lu Yibo, Pan Shirong, Li Chunhua, Lu Puxuan, Lyu Shengxiu 2022, 7 (4):  99-104.  DOI: 10.19871/j.cnki.xfcrbzz.2022.04.023 Abstract ( 217)    PDF (1233KB) ( 581 )    About 50% of HIV /AIDS patients have pulmonary complications, including infectious and non-infectious diseases. At present, there are many studies on AIDS-associated pneumocystis jirovecii pneumonia and pulmonary tuberculosis. Consequently characteristic imaging manifestations can help diagnose them. AIDS-associated bacterial pneumonia can occur at any stage of AIDS. Pathogenic bacteria include Klebsiella, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii and so on. The imaging features of AIDS-related bacterial pneumonia were invasive lesions of varying sizes in one segment, one lobe or multiple lobes of the lung, with diffuse or focal reticular shadows, nodular shadows, patchy consolidation shadows, but rarely occasional cavity shadows or pleural effusion. AIDS-associated bacterial pneumonia should be distinguished from AIDS-associated pneumocystis jirovecii pneumonia and pulmonary tuberculosis. Clinical diagnosis can be made based on the patient's medical history and clinical imaging characteristics and determined by sputum, bronchoalveolar lavage fluid smear, culture and percutaneous lung biopsy.