Current Issue

2023 Vol.8 No.1 Published:28 February 2023

Forum of Specialist

A brief discussion on the practical necessity of adjusting the prevention and control strategy of COVID-19 in China Feng Siyang, Lu Jianhua, Liao Yuxue, Zhang Zhen, Guo Yansheng, Lyv Qiuying, Kong Dongfeng, Chen Zhigao, Zou Xuan, Feng Tiejian, Liao Yi 2023, 8 (1):  1-7.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.001 Abstract ( 285)    PDF (974KB) ( 411 )    The pandemic of SARS-CoV-2 lasts for three yeas since the outbreak, and has become the most significant public health emergency of the 20th century. This paper reviews trends in the global pandemic over the past three years, systematically analyzes the epidemiological properties, pathogenic characteristics, clinical features, and effectiveness of various interventions over time. Our study focuses on comprehensive factors to be considered for adjusting prevention and control strategies under the new situation, including pathogen and transmission characteristics, immune barriers, disease burden and hazards, therapeutic progress. We aim to make recommendations for the prevention and control of SARS-CoV-2 infections in terms of resource preparation, establishment of surveillance system, vaccination of key populations, health promotion, and we believe this experience will provide useful reference for the emergency response and comprehensive prevention and control of new infectious diseases in the future.

Original Articles

Study on the changes of antibodies and nucleic acid clearance in patients with COVID-19 during the recovery period in the treatment of COVID-19 Lin Guoyue, Duan Li, Qin Ying, Li Yuanda, Sun Xianli, Zhang Jianfeng, Zhang Chi, Zhao Doudou, Qu Xiaojuan, Yang Zhenping, Sa Yuling, Cao Lili, Guan Wenlong, Wang Quan, Lin Zhiqiang, Xu Jun 2023, 8 (1):  8-13.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.002 Abstract ( 312)    PDF (915KB) ( 246 )    Objective To explore the production of antibodies IgM and IgG in the body of patients with COVID-19 after treatment with convalescent plasma of convalescent patients with novel coronavirus, and the regularity of viral nucleic acid negative change and clinical treatment effect, so as to provide basis for specific antibody treatment of COVID-19. Method 75 cases of COVID-19 hospitalized patients were treated with plasma from convalescent patients of COVID-19 as the blood transfusion group, and 200 cases were not treated with blood transfusion as the non blood transfusion group. The contents of antibody IgM and IgG, nucleic acid gene ORF1ab and N in the two groups were detected regularly, and analyzed statistically. Result ① The levels of antibody IgM and IgG (47.89±64.63, 68.70±69.14) in the blood transfusion group after plasma transfusion were significantly higher than those before blood transfusion (4.55±11.02, 4.46±13.99, respectively) (P<0.05); The levels of IgM and IgG in the blood transfusion group at discharge (47.89±64.63, 68.70±69.14) were significantly higher than those in the non blood transfusion group (17.33±16.26, 43.41±35.61) (P<0.05); The levels of IgM and IgG (45.63±54.19, 63.69±85.75, 28.80±35.54; 55.15± 59.09, 99.6±79.49, 57.21±52.50) in patients with rapidly developing type, severe type and critical type after blood transfusion were higher than those before blood transfusion (3.78±9.85, 3.88± 10.07, 7.49±14.22; 2.98±12.23, 6.05±18.24, 5.88±10.07) (P<0.05), In addition, the contents of rapidly developing IgM (45.63±54.19) and severe IgM (63.69±85.75) were significantly higher than those of critically ill patients (28.80±35.54) (P<0.05). ② The clearance rate of ORF1ab and N gene in COVID-19 patients in blood transfusion group (61.33%) was significantly higher than that in non blood transfusion group (26.50%) in the same period (P<0.005). ③ The hospitalization days [(24.00±8.68)d,(28.00±11.46)d] of rapidly developing and severe patients in the blood transfusion group were significantly shorter than those in the non blood transfusion group [(31.00±6.33)d, (39.00±8.69)d] (P<0.05). Conclusion The application of COVID-19 convalescent frozen plasma in the treatment of COVID-19 patients can significantly increase the content of antibody IgM and IgG, enhance immune function, speed up virus clearance and nucleic acid negative rate in severe and critical patients.

Detection and analysis of immune cells in bronchoalveolar lavage fluid of child patients with pulmonary tuberculosis Li Jinpei, Ye Taosheng, Xu Yuxiang, Zeng Xuan, Liu Zhichao, Yang Qianting 2023, 8 (1):  14-18.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.003 Abstract ( 242)    PDF (1006KB) ( 267 )    Objective To investigate the changes of lymphocyte immune function of pulmonary alveolar lavage fluid (BALF) in patients with pulmonary tuberculosis by flow cytometry. Method 19 pediatric tuberculosis patients were enrolled, according to sputum smear results, they were divided into bacteria positive group (11 cases) and bacteria negative group (8 cases). 21 adult tuberculosis patients were selected as the control group. Flow cytometry was used to detect the changes in the proportion of lymphocytes, CD4+T cells, CD8+T cells, monocytes and B lymphocytes in Balf of the two groups, and the differences were compared. Result The proportion of immune cells in Balf of children with tuberculosis was as follow: The proportion of T lymphocytes was (54.57±5.28)%, CD4+T cells (66.14±4.08)%, CD8+T cells (33.80±4.07)% and B cells (13.54±2.53)% pediatric tuberculosis patients. The proportion of T lymphocytes was (53.30±4.76)%, CD4+T cells (65.45±3.49)%, CD8+T cells (34.55±3.49)% and B cells (14.70±2.83)% in adult pulmonary tuberculosis patients. There was no statistical significance between the two groups (P>0.05). There was no difference in the ratio of CD4+/CD8+T cells between two groups (P>0.05). The monocytes of children tuberculosis patients (16.00±3.20)% were significantly higher than those of adult tuberculosis patients (9.25±1.17), and the difference was statistically significant (P<0.05). The proportion of CD4+T lymphocyte was (65.64±5.41)%, CD8+T lymphocyte （34.36±5.41）% and monocyte (19.15±5.18)% in the Balf of the positive of bacteriology subgroup of pediatric tuberculosis patients. The proportion of CD4+T lymphocyte was (66.84±6.65)% , CD8+T lymphocyte (33.03±6.58)% and monocyte (11.75±1.75)% in the negative of bacteriology subgroup of pediatric tuberculosis patients. There was no statistical significance (P>0.05). However, The proportion of T lymphocyte was (45.06±6.38)% and B cells (9.30±2.60)% in positive of bacteriology subgroup were significantly lower than those in the negative group [(67.64±6.93)% and (21.48±4.17)%], respectively, and the difference was statistically significant (P<0.05). Conclusion Monocytes from pediatric patients with pulmonary tuberculosis were higher than those in adult pulmonary tuberculosis patients;The proportion of B lymphocytes in pediatric TB patients with sputum smear bacteria positive was significantly lower than in sputum smear bacteria negative patients. It suggests that the immune function of active children with tuberculosis has decreased, which provides some theoretical basis for understanding the pathogenesis of pulmonary tuberculosis and for clinical immunotherapy.

The role of macrophage MAC387 in the inflammation and fibrosis of hepatic alveolar echinococcosis of human cases Zhang Jingyi, Tian Fengming, Jiang Tao, Qi Xinwei, Li Jiajun, Min Hongyue, Madinaimu•Aibibula, Zhou Xuan, Liu Yumei, Ma Xiumin 2023, 8 (1):  19-25.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.004 Abstract ( 252)    PDF (2260KB) ( 382 )    Objective To investigate the correlation of MAC387 with liver inflammation and fibrosis in patients infected with hepatic alveolar echinococcosis (AE). Method Liver tissues were collected from 32 hepatic AE patients with surgical removal. Each of the liver tissues was divided into two section groups, close to AE lesion (CLT) and distal from AE lesion(DLT). Hematoxylin-eosin (H&E) and Sirius red staining were employed to assess the pathological inflammatory changes and collagen deposition in these patients' livers, respectively determined by the inflammatory grading scores and fibrotic staging scores (GS scores). Immunohistochemistry was used to detect the expressions of MAC387 in the two section groups. The patients were divided into two groups, MAC387 high-level group and MAC387 low-level group. The correlation of MAC387 with major biochemical parameters associated with liver functions and their changes before and after operation were analyzed. RT-qPCR was employed to measure the mRNA expression of MAC387 in the two liver section groups. Result Compared to the DLT, the level of MAC387 was significantly increased in CLT sections(P<0.0001). Additionally, patients with higher inflammatory grading scores and fibrotic staging scores had more MAC387-positive cells in the liver than patients with lower scores (P<0.001). In the MAC387 high-level group, MAC387 had a positively correlation with ALT and AST (ALT：r=0.523, P=0.013;AST：r=0.503, P=0.017), and there was no significant correlation with GGT, ALP and Alb（P>0.05). In the MAC387 low-level group, there was no correlation between MAC387 and ALT, AST, GGT, ALP, Alb. After 9 days of operation, GGT in MAC387 low-level group was significantly higher than MAC387 high-level group（P<0.05）. RT-qPCR showed that MAC387 expression was higher in the CLT section group than it in the DLT(P<0.05). Conclusion MAC387 is highly expressed in CLT in the patients with hepatic AE, and the infiltration of MAC387 positive cells have higher score of inflammation grade and fibrosis stage, suggesting that MAC387 may play a role in aggravating liver inflammation and fibrosis in AE patients.

Clinical, imaging and bronchoscopy findings of 57 cases of diabetes mellitus complicated with tracheobronchial tuberculosis Wu Zhisong, Ma Nanlan, Zeng Yi, Zhang Cheng, Wang Wenlian 2023, 8 (1):  26-30.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.005 Abstract ( 227)    PDF (1422KB) ( 224 )    Objective To explore the clinical, imaging and electronic bronchoscopy manifestations of diabetes mellitus complicated with tracheobronchial tuberculosis, so as to provide clues for the early diagnosis of diabetic TBTB. Method From January 2020 to December 2021, 824 patients with diabetes and first-treat pulmonary tuberculosis were hospitalized in Nanjing Second Hospital, among which 57 were diagnosed with TBTB after electronic bronchoscopy. Demographic characteristics, clinical symptoms, glycosylated hemoglobin, chest CT scan, TBTB pathological typing and etiological examination results were analyzed. Result Among the patients with diabetes and first-treated pulmonary tuberculosis hospitalized during the same period, the detection rate of TBTB was 6.92% (57/824). The average age of the 57 diabetic patients with TBTB was (57.5±14.6) years old, more men than women (2.8:1), and the age of onset in men was lower than that of women [(54.9±14.5)years vs (64.7±12.3)years], and there was a statistically significant difference in age between genders(P<0.05). Cough (46 cases, 80.7%) was the main symptom of diabetic patients with TBTB, and the average glycated hemoglobin level was (9.18±2.03)%. All patients showed direct or indirect signs of TBTB in chest CT images. The direct signs were mainly wall thickening (18 cases, 31.6%) and lumen stenosis (20 cases, 35.1%), and the indirect signs were mainly multiple nodular shadows (40 cases, 70.2%) and cavity shadows (27 cases, 47.4%).The main lesions of diabetes mellitus complicated with TBTB were the left upper bronchus (22 cases, 38.6%), right upper bronchus (23 cases, 40.4%) and right lower bronchus (18 cases, 31.6%), and 28 cases had ≥2 lobe segmental bronchial invasion sites, accounted for 49.1%. The pathological type was mainly type Ⅳ (40 cases, 70.2%) and mixed type (38 cases, 66.7%). Sputum tuberculosis was positive in 26 cases, lavage fluid tuberculosis was positive in 45 cases. The positive rate of lavage fluid was significantly higher than that of sputum (78.9%: 45.6%). Conclusion For diabetic patients with poor blood glucose control, repeated cough and direct or indirect signs of TBTB on chest CT, bronchoscopy should be performed early, and the diagnosis should be confirmed by combined etiological and pathological examination.

Effects of metabolic syndrome and its components on serum HBsAg levels in patients with chronic hepatitis B Wang Hongxia, Wang Yan, Duan Ruixian, Zhang Jianwei, Ren Yuan 2023, 8 (1):  31-34.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.006 Abstract ( 189)    PDF (885KB) ( 251 )    Objective To explore the effects of metabolic syndrome and its components on serum HBsAg levels in patients with chronic hepatitis B, so as to provide ideas for the subsequent clinical cure of chronic hepatitis B patients with metabolic syndrome. Method A retrospective analysis of 415 patients with chronic hepatitis B who were admitted to Shanxi Bethune Hospital from May 2019 to September 2020. They were divided into chronic hepatitis B group and chronic hepatitis B combined with metabolic syndrome group according to whether they were complicated with metabolic syndrome. The general data, biochemical parameters, virological parameters, and liver transient elasticity were collected. Non-parametric rank sum test, chi-square test and multiple linear regression were used to analyze the effects of metabolic syndrome and its components on serum HBsAg levels in patients with chronic hepatitis B. Result A total of 415 patients were included in this study, including 247 patients (59.50%) in CHB group and 168 patients (40.50%) in CHB combined with MetS group. The results of multiple linear regression showed that blood glucose and triglyceride had statistically significant effects on serum HBsAg level (t=-3.25, P=0.001; t=2.25, P=0.025), while blood pressure and waist circumference had no statistically significant effects on serum HBsAg level. Conclusion Blood glucose negatively predicted serum HBsAg level in CHB patients, triglyceride positively predicted serum HBsAg level in CHB patients, but blood pressure and waist circumference did not affect the level of HBsAg.

Analysis of chest CT of AIDS patients with Talaromyces marneffei infection Li Yipan, Song Lu, Shi Yanbin, Zeng Yingting, Lu Zhiyan 2023, 8 (1):  35-38.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.007 Abstract ( 364)    PDF (1640KB) ( 240 )    Objective To explore the features of chest computed tomography(CT) in AIDS patients with Talaromyces marneffei(TM) opportunistic infection in order to improve the understanding and diagnosis of the disease. Method A retrospective analysis was carried out on 32 patients who were diagnosed with human immunodeficiency virus (HIV) and Talaromyces marneffei infection by etiology during their hospitalization in Zhong Nan Hospital of Wuhan University from January, 2013 to August, 2020. After the relevant clinical and imaging data being collected, the chest CT sign of the 32 patients were observed. Result Fifteen patients (46.9%) had patchy ground-glass opacity or consolidation, of which 3 patients showed patchy consolidations with scattered and symmetrical distribution ,lesions that were centered on the hilar and spread outwards, 17 patients (53.1%) had nodules ,one case with a cavity,3 patients (9.4%) with nodular bump.3 patients (9.4%) with miliary pulmonary nodules in the lung field, 8 patients (25.0%) had pleural effusions, and 3 patients (9.4%) with pleural thickening. 20 patients (62.5%) had mediastinal lymph node enlargement, and the maximum short diameter range was 13.6-20.4mm. Seven patients (21.9%) had a significant increase in mediastinal lymph nodes, and some of them gathered into clusters. Conclusion The chest CT signs of AIDS patients with Talaromyces marneffei infection are diverse. The patchy consolidation with scattered and symmetrical distribution, which lesions were centered on the hilar and spread outwards, and miliary pulmonary nodules are two characteristic signs. Meanwhile, paying attention to the law of mediastinal lymph node enlargement lesions can also provide important differential diagnostic value for the disease.

The analysis of mycobacterial infection and drug resistance among children in Sichuan Xu Yuanhong, Wu Zhangjun, Luo Mei, Zhu Ma, Wang Dongmei, Zeng Peibin 2023, 8 (1):  39-43.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.008 Abstract ( 307)    PDF (961KB) ( 235 )    Objective Understand the situation of mycobacterial infection and drug resistance in children in Sichuan, provide data support for the prevention and management of tuberculosis in children in the region, and provide help for clinical treatment. Method From January 2019 to March 2021,various specimens of children younger than 15 years old admitted to the tuberculosis area and tuberculosis clinic of Chengdu Public Health Clinical Medical Center were isolated and cultured for mycobacteria, and the positive strains were cultured for silver micropores Plate method (48 holes) rapid drug susceptibility test, Microplate method drug susceptibility test includes strain identification (TCH, PNB) and streptomycin (SM), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), rifapentin (RFT), levofloxacin (LFX), amikacin (AMK), capreomycin (CPM), prothionamide (PTO), lectra pasiniazid (PI), moxifloxacin (MFX), P-Amino Water Susceptibility results of 16 drugs including salicylic acid (PAS), clarithromycin (CLR), rifabutin (RFB), kanamycin (KAN), and clofazimine (CFZ). The distribution, drug resistance and epidemiological characteristics of mycobacterial culture-positive children were retrospectively analyzed. Result Among the 200 strains of mycobacteria in children, 194 strains (97.00%) of Mycobacterium tuberculosis (MTB) were found, and 6 strains (3.00%) of nontuberculous mycobacteria (NTM). The results of MTB drug susceptibility showed that 43 of the 194 MTB strains were resistant to at least one anti-tuberculosis drug, with a total resistance rate of 22.16%; 10 strains were resistant to INH and RFP (MDR) at the same time, with a multidrug resistance rate of 5.15%, no extensively drug-resistant (XDR) strains were found. Mono-resistance was mainly mono-resistance to INH, and multi-resistance was mainly RFP+RFB+RFT and INH+PI. The resistance rankings were INH (12.37%), RFP (9.79%), RFT (9.79%), RFB (7.22%), PI (5.67%), SM (4.12%), PAS (2.58), CPM (2.06) main. There were significant differences in ethnicity (Han nationality), age (7-11 years old and 12-14 years old), and residence (Tibetan area) between the sensitive group and the resistant group (P<0.05). Conclusion The INH drug resistance rate of pediatric tuberculosis patients in Sichuan is the highest, and children in Tibetan areas in Sichuan are more likely to develop drug-resistant tuberculosis. This study provides a theoretical basis for the prevention and treatment of pediatric tuberculosis in Sichuan.

Analysis of indications for antiviral therapy in chronic HBV patients with persistent normal level of alanine aminotransferase Li Yandong, Fan Rongshan 2023, 8 (1):  44-47.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.009 Abstract ( 312)    PDF (1532KB) ( 184 )    Objective To investigate the feature of liver pathology in chronic HBV patients with normal level of alanine aminotransferase (ALT),to analyze the risk factors of liver inflammation and fibrosis ,to determine the exact timing of antiviral treatment. Method The clinical data of 150 patients with chronic HBV infection with normal level of serum ALT in Shenzhen Hospital of Integrated Traditional And Western Medicine from September 2020 to January 2022 were retrospectively collected and the liver pathological results of all subjects were statistically analyzed. Univariate analysis and multivariate regression were used to analyze the risk factors for significant liver inflammation (G≥2) or fibrosis (S≥2). Result The pathological examination of liver tissue reveal G≥2 or S≥2 in 93 cases (62.00%). Univariate analysis showed that ALT>25U/L, glutamyl transpeptidase (GGT)>20U/L, prealbumin (PA)≤230g/L, platelet(PLT) count ≤160×109/L, partial activated prothrombin time (APTT) >28s were the possible risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT (P<0.05); Multivariate analysis of binary logistic regression showed that ALT>25U/L, PLT count≤160×109/L and APTT>28s were independent risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT. Conclusion ALT level, PLT level and APTT level can be used as the basis for judging the severity of liver pathology and receiving antiviral therapy in chronic HBV infected patients with normal level of ALT.

Correlation between 1,25-dihydroxyvitamin D3 level and neonatal respiratory tract infection Zhang Hui, Han Shuxia, Zhang Jin 2023, 8 (1):  48-51.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.010 Abstract ( 233)    PDF (884KB) ( 238 )    Objective To investigate the correlation between 1,25-(OH)2-D3 levels and neonatal respiratory tract infections, and to provide a basis for the prevention and treatment of neonatal respiratory tract infections. Method 120 neonates diagnosed with acute respiratory tract infection in the neonatal intensive care unit of Department of Obstetrics, Beijing Shijitan Hospital, Capital Medical University were selected as the respiratory tract infection group, 116 healthy neonates were selected as the control group in the same term, and the serum level of 1,25-(OH)2-D3 in each group was measured at the same time.They were divided into four groups according to the 1,25-(OH)2-D3 test level, 1,25-(OH)2-D3 >250nmol/L excessive, 1,25-(OH)2-D3 75-250nmol/L appropriate, 1,25-(OH)2-D3 50-74nmol/L deficient, and 1,25-(OH)2-D3 <50nmol/L deficient. Study data were analyzed using the IBM SPSS Statistics 24.0 statistical software. Result The level of 1,25-(OH)2-D3 in the respiratory tract infection group was significantly lower than that in the healthy control group [P<0.001, (85.85±18.07)nmol/L vs (119.34±26.12)nmol/L]. The proportion of 1,25-(OH)2-D3 deficiency in the respiratory tract infection group was significantly higher than that in the healthy control group (P<0.001). Compared with the proportion of 1,25-(OH)2-D3 deficiency, the difference was not statistically significant (P>0.05); the level of 1,25-(OH)2-D3 in the severe respiratory tract infection group was lower than that in the mild respiratory tract infection, and the difference was statistically significant Significance (P<0.05). Conclusion The level of 1,25-(OH)2-D3 in neonates with respiratory tract infection is significantly lower than that in normal healthy neonates. The lack or insufficiency of 1,25-(OH)2-D3 may lead to respiratory tract infection in neonates, vitamin D can be appropriately supplemented to prevent respiratory tract infection in the early stage.

Analysis on characteristics of tuberculosis in patients with chronic kidney disease Ren Tantan, Zhan SenLin, Zhang Peize, Tang Quanzhen, Xu Zhengfu, Wang Lingwei, Fu Liang, Deng Guofang 2023, 8 (1):  52-55.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.011 Abstract ( 340)    PDF (884KB) ( 234 )    Objective To retrospectively analyze the incidence and prognosis of tuberculosis in patients with chronic kidney disease（CKD）, and to investigate the characteristics of tuberculosis in patients with CKD. Method Patients who received CKD treatment and dialysis treatment for more than 3 months in the nephrology department and blood purification center of four hospitals in Shenzhen from January 2013 to December 2017 were divided into 2 groups, ESRD group（end-stage renal disease,ESRD): glomerular filtration rate <15ml/(min·1.73m2); no-ESRD group（non-end-stage renal disease,no-ESRD): glomerular filtration rate ≥15ml/(min·1.73m2), and all patients meet the diagnostic criteria for CKD. The incidence, clinical features and prognosis of tuberculosis in these patients were retrospectively analyzed. Result There were 1169 and 3026 patients in the ESRD group and no-ESRD group respectively. Fifty-seven patients (4.9%) with active pulmonary tuberculosis were diagnosed in the ESRD group,of which 36 patients (63.2%) with pulmonary tuberculosis, 14 patients (24.6%) with extrapulmonary tuberculosis, 7 patients (12.3%) with pulmonary tuberculosis complicated extrapulmonary tuberculosis. The all-cause mortality rate was 8.8% (5/57) in the ESRD group. Sixty-nine patients (2.3%) with active tuberculosis were diagnosed in the no-ESRD group, of which 47 patients (68.1%) with pulmonary tuberculosis, 16 patients (23.2%) with extrapulmonary tuberculosis, and 6 patients (8.7%) with pulmonary tuberculosis complicated extrapulmonary tuberculosis.The all-cause mortality rate was 2.9% (2/69) in the no-ESRD group. Comparing the two groups of ESRD and no-ESRD, the incidence and etiology distribution are statistically significant (χ2=19.502、10.076,P=0.000、0.018); But there was no statistical difference between the two groups in immunological detection, tuberculosis type, and clinical prognosis (χ2=0.222、0.530、3.971,P=0.974、0.767、0.137). Conclusion The incidence of tuberculosis in patients with CKD is high, especially in ESRD patients. There is an urgent need screening tuberculosis for timely diagnosis and treatment in patients with CKD.

Investigation on the epidemiology and related risk factors of Helicobacter pylori infection among adults in Bazhong, Sichuan Jiang Hua, Qin Qin, Chen Li 2023, 8 (1):  56-59.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.012 Abstract ( 210)    PDF (882KB) ( 199 )    Objective To understand the epidemiological characteristics of adult Helicobacter pylori (Hp) infection in Bazhong area, identify risk factors, and formulate targeted disease prevention strategies. Method From January 2017 to January 2020, 1998 local adults who underwent Hp infection detection in Bazhong area were investigated. The Hp infection rate in the past 4 years was counted, and the Logistic regression equation was used to analyze the influencing factors of Hp infection. Result The total detection rate of the 1198 population tested for Hp infection was 10.18% (122/1198); logistic regression model analysis, male (OR=2.834), 41-65 years old (OR=2.843), smoking (OR=3.454), alcohol consumption (OR=3.389), meal gathering ≥1 time/week (OR=2.831), fasting blood glucose (FBG)≥4.75mmol/L (OR=3.424) and density lipoprotein cholesterol (HDL-C)≤1.39mmol/L (OR=3.486) were risk factors for Hp infection in Bazhong. Conclusion The prevalence of Hp infection in adults in Bazhong was 10.18%. Men, age 41-65 years, history of smoking, history of alcohol consumption, gathering for meals ≥1 time/week, fasting blood glucose (FBG)≥4.75mmol/L and HDL-C≤1.39mmol/L were risk factors for Hp infection.

Study on the correlation between electrocardiogram QTc interval and score of Child-Pugh in 100 patients with HBV-infected cirrhosis Liao Tingshu, Li Zhao, Qiu Ting, Chen Ruihua 2023, 8 (1):  60-65.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.013 Abstract ( 225)    PDF (894KB) ( 231 )    Objective To study the correlation between electrocardiogram (ECG) correction of QT (QTc) interval and score of Child-Pugh in 100 patients with hepatitis B virus (HBV) infected cirrhosis, and to provide reference and basis for its application in the diagnosis of cardiomyopathy in patients with HBV infected cirrhosis. Method A total of 100 patients with HBV infected cirrhosis admitted to Hezhou People's Hospital from January 2020 to December 2021 were selected as the cirrhosis group, and 97 healthy subjects who underwent physical examination in the same period of Hezhou People's Hospital were selected as the healthy control group. All of them underwent ECG examination. According to Child-Pugh, 100 HBV-infected cirrhosis patients were divided into the group A (28 cases), the group B (40 cases) and the group C (32 cases). The general data of healthy physical examination subjects and HBV-infected cirrhosis patients with different score of Child-Pugh were collected, and the ECG QTc interval indexes of healthy physical examination subjects and HBV-infected cirrhosis patients with different score of Child-Pugh were compared. Spearman test was used to analyze the correlation between QTc interval index detected by ECG and score of Child-Pugh and laboratory index in patients with HBV-infected cirrhosis. Result The serum levels of total bilirubin (TBil), albumin (ALB), globulin (GLB) and heart rate in the healthy control group, the group A, the group B and the group C showed a gradually increasing trend, the prothrombin time (PT) showed a gradually lengthening trend, and the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) showed a trend of first increasing, then decreasing and then increasing. Albumin/globulin (A/G) was firstly decreased and then increased, while levels of serum fasting blood glucose (FBG), 2h postmeal blood glucose (2h BG), creatine kinase (CK) and high-sensitive troponin T (hs-TnT) in the groups A, B and C showed a gradual increasing trend. The serum levels of FBG, 2h BG, CK and hs-TnT in the healthy control group were higher than those in the group B and C, and the differences were statistically significant (P<0.05). The QTc, QT interval dispersion (QTd) and corrected QT interval dispersion (QTcd) in the cirrhosis group were significantly higher than those in the healthy control group (P<0.05), and the abnormal rate of QTc in the cirrhosis group (56.00%) was significantly higher than that in the healthy control group (9.28%, P<0.05). QTc, QTd and QTcd in the groups A, B and C showed a trend of gradual extension, and the difference between groups was statistically significant (P<0.05), while the abnormal rate of QTc (21.43%, 50.00%, 93.75%) showed a trend of gradual increase, and the difference between groups was statistically significant (P<0.05). The abnormal rates of QTc, QTd, QTcd and QTc were significantly positively correlated with score of Child-Pugh in HBV-infected patients with cirrhosis (r=0.673, 0.588, 0.498, 0.529, P<0.05). Conclusion HBV-infected patients with cirrhosis had prolonged QTc, QTd and QTcd. With the increase of patient score of Child-Pugh, QTc, QTd and QTcd are prolonged, and the abnormal rate of QTc increases. The abnormal rates of QTc, QTd, QTcd and QTc were significantly positively correlated with score of Child-Pugh in HBV-infected patients with cirrhosis.

Investigation on medical expenses of rifampicin-resistant pulmonary tuberculosis patients in Foshan Zhong Qianhong, Zhao Zhimeng, Du Fangfang, Cheng Shiming, Zhou Jie, Huang Fei, Ye Yinong, Zhang Xilin, Zhong Qiu 2023, 8 (1):  66-70.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.014 Abstract ( 568)    PDF (886KB) ( 233 )    Objective To understand the medical seeking behavior and medical expenses of rifampicin-resistant pulmonary tuberculosis patients with different types of medical insurance before and after diagnosis, so as to provide reference for policy-making. Method A quantitative questionnaire survey was conducted among rifampicin resistant pulmonary tuberculosis patients registered in the tuberculosis information management system in Foshan from 2018 to 2019 with the treatment outcome of "cured" and "completed " to understand the medical seeking behavior and medical expenses before and after diagnosis. Result A total of 56 patients were included in the survey. 39 patients (69.6%), 14 patients(25.0%) and 3 patients (5.4%) were found through symptomatic visits, annual physical examination, and close contact screening respectively. Among 11 employee medical insurance patients, 4 cases (36.4%) were found through the annual physical examination, which was higher than that of other medical insurance patients. 49 patients (87.5%) had been hospitalized, with an average hospital stay of 27 days. 47 patients (83.9%) adopted self-managed medication during outpatient treatment. The average cost of the included patients from first visit to completion of treatment was 29 804 yuan, and the average reimbursement was 7816 yuan (26.2%). Employee medical insurance patients have the highest reimbursement ratio before diagnosis and inpatient and outpatient after diagnosis. Conclusion There are differences in medical seeking behavior, treatment management and direct medical expenses among pulmonary tuberculosis patients with different types of medical insurance. We should further strengthen efforts to detect drug-resistant patients as soon as possible, take measures to enhance patient's medication management, and improve the health security level and reduce patient’s economic burden.

Case Report

A case of Tuberculous constrictive pericarditis —evaluation with multi-parameter cardiac magnetic resonance Kang Bin, Gao Yueqin, Xiong Wei, Zheng Haiyan, Jiang Min, Liu Sufang, Li Huiling, Zhang Na, Hou Keke 2023, 8 (1):  71-73.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.015 Abstract ( 273)    PDF (1236KB) ( 208 )    Constrictive pericarditis is caused by acute or chronic pericarditis in delayed healing and the tuberculosis(TB) is the main pathogenic bacteria. Pericardial thickening adhesions, fibrosis, with or without calcification are the most common imaging performance. Clinically, it is not difficult to make diagnosis through medical history and imaging. The main points of diagnosis are tuberculosis history, tuberculous serous effusion, tuberculous experimental examination, pericardium constriction, pericardium thickening and adhesion to constricted fibrous bands. Especially the imaging presentation with pericardial thickening or calcification is typical sign of diagnosis of the disease. The clinical and imaging feature in this case are not obviously that the pericardium did not show the typical signs of adhesion and calcification. Therefore, early diagnosis of constrictive pericarditis is extremely challenging. The combination of multimodality cardiac magnetic resonance examination can not only clarify the pericardium condition and cardiac changes, but also make a comprehensive quantitative assessment of cardiac structure, function and movement abnormalities caused by constrictive pericarditis, so as to provide more imaging evidence for early diagnosis of the disease and further to reduce misdiagnosis rate.

Review

Research progress on virulence factors and antibiotic resistance genes of Vibrio vulnificus based on genomics Xu Shiqin, Shi Xiaolu, Lu Huiqun, Ji Liyin, Qiu Shuxiang 2023, 8 (1):  74-81.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.016 Abstract ( 325)    PDF (935KB) ( 539 )    Vibrio vulnificus is a fatal opportunistic pathogen with the highest mortality among foodborn diseases. It causes infection mainly through consumption of undercooked seafood and contact of broken skin with seawater. Symptoms that occur include gastroenteritis, wound infection, and deterioration of the disease leading to sepsis, which is extremely lethal. With the rapid development of genomics sequencing technology, 285 strains of Vibrio vulnificus genome sketch sequences and 24 strains of completed sequences have been published in the National Center of Biotechnology Information(NCBI) database. The advance on genomics research of Vibrio vulnificus not only facilitates the study of typing precisely, evolutionary relationships and pathogenesis, but also facilitates the prediction of virulence factors and antibiotic resistance genes, which play an important role in rapid detection, epidemiological investigation and prevention after food poisoning caused by Vibrio vulnificus. However, there are few studies on the analysis of drug resistance in Vibrio vulnificus. In this review, we provide an overview of important virulence factors, antibiotic resistance, resistance mechanisms and resistance genes from the genomics of Vibrio vunnificus.

The research progress of MRI diagnosis of Brucella spondylitis Zhou Yanni, Zhao Jianhua 2023, 8 (1):  82-86.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.017 Abstract ( 336)    PDF (889KB) ( 372 )    Brucella spondylitis is caused by brucella infection, with the highest incidence of the lumbar spine. Patients were initially diagnosed as BS with increased C-reactive protein and erythrocyte sedimentation rate, tiger Red plate agglutination test (RBPT) plate agglutination test and plate agglutination test (PAT) positive.The clinical symptoms of BS are mostly pain in the low back and lumbosacrum, low fever in the afternoon, and multiple osteoarthralgia. If not diagnosed and treated in time, it will cause serious injury to the spine and cause huge economic losses.MR is rapid, accurate and reproducible, has high sensitivity for soft tissue lesions, and is the preferred imaging method for BS detection.Besides,conventional MR sequence combined with special sequences,such as DTI, IVIM and DCE-MRI, can play an important role in the early diagnosis of BS, evaluation of disease progression, determination of treatment effect and prognosis of BS, contribute to the differential diagnosis of spinal diseases, and provide effective reference for the clinical diagnosis and treatment of BS patients.

Guidelines and Consensus

The global tuberculosis report 2022: key data analysis for China and the global world Song Min, LU Puxuan, Fang Weijun, Han Yuanyuan, Liang Ruiyun 2023, 8 (1):  87-92.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.018 Abstract ( 598)    PDF (1237KB) ( 948 )    Tuberculosis is the second largest killer of infectious diseases after coronavirus disease 2019(COVID-19), and it also is the 13th largest cause of death in the world. The global tuberculosis(TB) report 2022 shows that, an estimated 10.6 million people worldwide will be infected with tuberculosis in 2021, of which 6 million will be men, 3.4 million women and 1.2 million children. HIV-positive people accounted for 6.7 percent of the total. The reported number of people newly diagnosed with TB had recovered from 5.8 million in 2020 to 6.4 million in 2021, but there were still about 4.2 million people who had not been diagnosed or reported. The incidence rate of tuberculosis had risen with an increased number of TB deaths. In 2021, the estimated number of deaths caused by TB was more than double the number caused by HIV/AIDS. 450 000 patients have been newly diagnosed with rifampicin-resistant tuberculosis (RR-TB) in 2021, which number was significantly higher than that in 2020. However, the treatment coverage and treatment success rate for drug-resistant tuberculosis(DR-TB) was still low. The report suggests that the impact of the COVID-19 epidemic on global tuberculosis prevention and control still continued. The report calls on multiple departments to redouble their efforts to increase funding for basic tuberculosis services and research, to reduce and reverse the negative impact of COVID-19 on tuberculosis prevention and control services, so as to achieve the goal of ending tuberculosis and save lives.

Expert consensus on clinical management of severe/critical Omicron subvariant infection in adults in Shenzhen Shenzhen Third People's Hospital, National Clinical Research Center for Infectious Diseases, Shenzhen Infectious Disease Quality Control Center 2023, 8 (1):  93-101.  DOI: 10.19871/j.cnki.xfcrbzz.2023.01.019 Abstract ( 198)    PDF (962KB) ( 86 )    The global pandemic has changed with the emergence of omicron strains and the prevalence of multiple variants on their evolutionary branches. Infection in China is currently dominated by BA.5 and its sub-lineage variants BA.5.2 and BF.7. Infection may lead to severe/critical situation, and even to death in high-risk groups. Based on the epidemiological and clinical research data of COVID-19 infection both in and outside China, as well as evidence-based medical information, this consensus focuses on the clinical characteristics of severe or critical COVID-19 adults with Omicron subvariant infection, related indicators of disease progression, imaging characteristics, antiviral treatment, respiratory support, anticoagulation and blood purification treatment, Traditional Chinese medicine (TCM) treatment, standards for ICU discharge, etc., summarizes 10 recommendations. In particular, new insights into the selection and duration of antiretroviral therapy have been provided.