Current Issue

2023 Vol.8 No.2 Published:30 April 2023

Original Articles

Study on the characteristics of gut microbiota in diabetes with metabolic associated fatty liver disease Liu Xing, Wang Xiaomei, Gu Ye, Guan Xin, Zhang Zhen, Li Xinyue, Li Meiyuxi, Li Lizhu, Wang Yan 2023, 8 (2):  1-7.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.001 Abstract ( 246)    PDF (2637KB) ( 560 )    Objective To explore the correlation between the occurrence and development of metabolic associated fatty liver disease (MAFLD) in diabetes and fat metabolism related genes and gut microbiota, and to provides a new idea for the prevention and treatment of diabetes combined with MAFLD. Method 21 Mice were randomly divided into diabetes group(6 cases) and diabetes with MAFLD group(15 cases). The mice in the diabetes group and the mice in the diabetes combined with MAFLD group were fed with high sugar and high fat diet for 35 days and 63 days respectively, then the levels of blood glucose, blood lipids, liver function, insulin, liver lipoprotein lipase (LPl), fatty acid synthase (Fasn) and intestinal flora in the two groups were detected, and the changes of liver HE staining and intestinal tight junction protein in diabetes with MAFLD group were observed. Fifteen diabetes patients hospitalized in the Sixth People's Hospital of Shenyang from November 2021 to June 2022 were divided into diabetes group (7 cases) and diabetes with MAFLD group (8 cases). Whole genome shotgun sequencing was used to detect the gut microbiota in feces samples of patients. Result Compared with the diabetes group, the levels of blood lipid, liver function and insulin in diabetes with MAFLD group were lower, while the levels of blood glucose, liver LPl and Fasn were higher. The HDL-C, LPl and Fasn had significant difference between the two groups (P<0.05). The changes in liver HE staining and intestinal tight junction protein were observed between 4 weeks before and 2 weeks after successful modeling in both groups of mice, with the progress of MAFLD, liver cells first appeared lipid accumulation, then developed into ballooning degeneration, and the expression levels of intestinal tight junction protein presented a gradual downward trend. Compared with the diabetes group, the Ruminococcus abundance in diabetes with MAFLD group was higher in both mice and patients, the difference was statistically significant (P<0.05). Compared with non obesity patients, the abundance of Ruminococcus, Blautia and Collinsella in obesity patients were increased, while the abundance of Bifidobacteria was decreased, the differences between the two groups were statistically significant(P<0.05). Conclusion In the development of diabetes combined with MAFLD, lipid deposition in the liver occurs before the changes of intestinal tight junction protein. Ruminococcus and high expression of LPl and Fasn in the liver may play an important role in the occurrence of MAFLD. Ruminococcus, Blautia and Collinsella may related to obesity, while Bifidobacterium has a protective effect on obesity.

Interleukin-35 expression in peripheral blood and its correlation with viral load and transaminase in patients with chronic hepatitis B based on the natural course of HBV infection Dong Xu, Liu Yayun, Zhu Tong, Xu Aijing, Xue Jianya, Liang Xuesong 2023, 8 (2):  8-12.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.002 Abstract ( 248)    PDF (1574KB) ( 528 )    Objective To investigate the expression of interleukin-35 (IL-35) in the natural course of chronic HBV infection and its correlation with viral load and liver biochemical parameters, and to evaluate its role in the management of chronic HBV infection so as to provide evidence for dynamic monitoring of the course of disease and reducing severity. Method 83 patients with chronic HBV infection were selected from the Department of Infectious Diseases of Shanghai Changhai Hospital from January 2015 to November 2020, including immune tolerance group (n=22), immune clearance group (n=29) and severe hepatitis group (n=32) according to the natural course of chronic HBV infection. 20 healthy people were chosen as control. The expression level of IL-35 in peripheral blood was detected by ELISA (enzyme linked immunosorbent assay), HBV DNA and transaminase were also detected meanwhile. Statistical analysis was performed using the Mann-Whitney U test between two groups, Kruskal-Wallis H test between multiple groups and correlation analysis. Result The IL-35 levels of chronic HBV infection and healthy people were 51.75 (9.9,96.5)pg/ml and 7.33 (3.35,8.76) pg/ml respectively, the difference was statistically significant (Z=-5.69, P<0.01). The natural course of chronic HBV infection was higher than that in healthy controls, and IL-35 expression was highest in severe hepatitis group [121.46 (68.98,213.44) pg/ml]. There was no significant correlation between IL-35 and HBV DNA (r=0.385, 0.392, -0.168, P>0.05). There was positive correlation between IL-35 and ALT in patients with severe hepatitis (ρ=0.543, P=0.045), and a good positive correlation between IL-35 and ALT or AST in patients with chronic HBV infection (ALT: r=0.684, P=0.001; AST: r=0.618, P=0.001). For each unit increase in serum IL-35, the likelihood of progression to severe hepatitis increased by 7.2%. The ROC curve of serum IL-35 level showed AUC was 0.9491 (95%CI: 0.9078-0.9905, P<0.01), cut off <50.95 pg/ml. Conclusion ①IL-35 is highly expressed in peripheral blood in the course of HBV chronic infection and is positively correlated with the degree of liver inflammation; ②IL-35 has important application value in clinical evaluation of hepatitis B patients. Dynamic monitoring of IL-35 level in peripheral blood can assist in evaluating patients’ immune status, and early antiviral treatment can reduce the incidence of severe hepatitis.

Effects of integrated traditional Chinese and Western medicine on intestinal microecology of liver failure Li Jike, Luo Mei, Chen Zhu, Li Shoujuan, Mao Chuangjie, Gao Feng, Duan Meng, Ye Qing, Wang Yuelian, Pang Wenxiao 2023, 8 (2):  13-17.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.003 Abstract ( 327)    PDF (1052KB) ( 372 )    Objective To observe the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of liver failure and its influence on the abundance and diversity of intestinal microbiota. Method In a randomized controlled clinical study, 77 patients with liver failure who were hospitalized at Chengdu Public Health Clinical Medical Center from June 2019 to December 2020 were randomly divided into experimental group (39 cases) and control group(38 cases), 20 healthy control groups were also established. The experimental group was treated with integrated Traditional Chinese and Western medicine, and the control group was treated with western medicine. The course of treatment was 4 weeks.The changes of intestinal flora abundance and diversity before and after treatment were observed in the two groups. Result Compared with healthy control group, the abundance of bacteria in patients with liver failure was significantly different（P<0.05）. Firmicutes decreased and proteobacteria increased at phylum level, and Klebsiella, Streptococcus and Eschia increased at phylum level.β-diversity analysis showed that there was a difference in intestinal microbiota diversity before and after treatment in experimental groups（P<0.05）. The LEfSe analysis showed that after treatment, the relative abundance of beneficial bacteria such as lactobacillus increased, while the relative abundance of opportunistic pathogens such as Klebsiella and Escherichia decreased in the experimental group. Conclusion Patients with liver failure have intestinal microecology disorder, which is manifested by the increase of conditional pathogenic bacteria and the decrease of beneficial bacteria. After treatment with integrated Traditional Chinese and Western medicine, the relative abundance of beneficial bacteria such as lactobacillus can be increased, the relative abundance of conditional pathogenic bacteria can be reduced, and the intestinal micro-ecology can be improved.

Effect of FloTrac-Vigileo system on anesthesia management of pneumonectomy for tuberculous destroyed lung Yu Juan, Xu Fenlan 2023, 8 (2):  18-22.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.004 Abstract ( 253)    PDF (858KB) ( 452 )    Objective Discuss with FloTrac - Vigileo system monitoring hemodynamic goal-directed fluid therapy in patients with tuberculous damaged lung pneumonectomy and the effect of postoperative complications. Method From January 2020 to December 2021, patients with tuberculous destroyed lung (TDL) who did not respond to medical treatment and had received total pneumonectomy in our hospital were randomly stratified. Group S was randomly selected from 19 surgical patients who were treated with FloTrac - Vigileo and group C was randomly selected from 20 patients who were not treated with FloTrac - Vigileo. A total of 39 patients were selected. Hemodynamic parameters of 2 groups were recorded when patients entered the operating room (T0), after endotracheal intubation (T1), at the beginning of surgery (T2), after pulmonary artery occlusion (T3) and at the end of surgery (T4). The amount of fluid used during operation, operation time, operation blood loss, use of vasoactive drugs and use of diuretics after operation were analyzed. Postoperative complications were observed. Result There were no statistically significant differences in the general situation, operation time and amount of surgical bleeding between the two groups (P>0.05); There were no significant differences in intraoperative mean arterial pressure (MAP) and heart rate (HR) between 2 groups (P>0.05). In terms of liquid use between the two groups, the total amount of infusion in group S was significantly lower than that in group C, with an increase in colloidal amount and a decrease in crystal amount (P<0.05), while there was no significant difference in the amount of transfusion (P>0.05). 3. The number of intraoperative vasoactive drugs used in group S was lower than that in group C, and the number of post-operative diuretics used in group S was lower than that in group C, with statistical differences (P<0.05). 4. Postoperative complications were observed, postoperative complications were reduced in group S, especially pulmonary edema, and the incidence of hypotension was significantly reduced, with statistical differences (P<0.05). Conclusion Using FloTrac - Vigileo to monitor hemodynamics and conduct target-directed fluid therapy can guide more reasonable and effective intraoperative fluid therapy and precise drug use in total lung resection for TDL patients, which has important reference significance for reducing the incidence of serious postoperative complications and speeding up postoperative recovery.

MRI features of AIDS complicated with progressive multifocal leukoencephalopathy Ren Meiji, Li Li, Zhao Jing, Qi Shi, Li Hongjun 2023, 8 (2):  23-27.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.005 Abstract ( 292)    PDF (1351KB) ( 439 )    Objective To improve diagnosis level based on MRI features of progressive multifocal leukoencephalopathy (PML) in AIDS patients. Method Retrospective analysis of 27 AIDS patients with PML confirmed by pathology or clinical diagnosis in Beijing You'an Hospital, Capital Medical University from May 2015 to March 2022. We analyzed MRI features of PML in AIDS patients to explore the characteristic features. Result All of 27 patients of PML in AIDS patients in our study were male with average age of (38 ± 9) years. All of 27 patients of PML in AIDS patients in our study equipped multiple lesions in subcortical. 26 (96.3%) lesions of PML in AIDS patients were asymmetrically distributed, and 1 (3.7%) involved cerebral cortex. There were 23 (85.19%) cases of supratentorial lesions, 14 (51.85%) cases of infratentorial lesions, and 10 (37.04%) cases of supratentorial and infratentorial lesions. Among patients with supratentorial lesions, many brain areas were involved, including 18 (66.67%) in the parietal lobe, 17 (62.96%) in the frontal lobe, 12 (44.44%) in the temporal lobe, 6 (22.22%) in the occipital lobe, 3 (11.11%) cases in splenium of corpus callosum. The cases with supratentorial lesions were multilobed. Regarding patients with infratentorial lesions, 8 (29.63%) cases were involved in the cerebellum, 4 cases (14.81%) in the pons, 3 cases (11.11%) in the medulla oblongata, 2 (7.41%) cases in the pontine arm. All patients equipped multiple lesions [27 cases (100%)] which were asymmetrically located in subcortical [26 cases (96.3%)]. 18 cases (66.67%) showed “Milky way sign” on T2WI. 17 cases (62.96%) showed high signal at the edge of the lesion on DWI. 27 cases were no space occupying effect, and brain atrophy in 2 cases (7.41%). 19 cases had MRI enhancement scan, only 1 case (5.26%) was enhanced, showing punctate and linear enhancement. Conclusion PML in AIDS patients mainly presented multiple and asymmetric demyelinating lesions under the bilateral frontal parietal occipital cortex. “Milky way sign” on T2WI was a characteristic feature of PML in AIDS patients. The distribution range of lesions was inconsistent with the distribution area of cerebral vessels. The edge of lesions on DWI can show high signal. But there was not obvious diffusion limitation, and space occupying effect of lesions, and enhanced signal in enhancement phases. MRI examination combines with the clinical history, physical sign and laboratory examination of patients, it can obviously improve the diagnostic accuracy.

Expression of pyroptosis related factors in peripheral blood mononuclear cell of patients with severe chronic hepatitis B and its relationship with prognosis Wang Lianshan, Ma Xuemei, Zheng Chengfang 2023, 8 (2):  28-33.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.006 Abstract ( 255)    PDF (982KB) ( 421 )    Objective To investigate the expression levels of interleukin-18 (IL-18), interleukin-1β (IL-1β), nod-like receptor protein 3 (NLRP3), cysteinyl aspartate specific proteinase (Caspase)-1 in the supernatant of peripheral blood mononuclear cells (PBMC) of patients with severe chronic hepatitis B (CHB), and analyze their relationship with the prognosis of patients. Method A total of 251 CHB patients admitted in Hainan West Central Hospital from January 2019 to January 2021 were gathered as the research group. According to the severity of patients, they were divided into mild CHB group (93 cases), moderate CHB group (80 cases), and severe CHB group (78 cases). According to whether severe CHB patients died after 6 months of treatment, the patients were divided into a death group (11 cases) and a survival group (67 cases). In addition, 265 healthy people who came to our hospital for physical examination during the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA method) was used to detect the expression levels of IL-18, IL-1β, NLRP3 and Caspase-1 in the supernatant of PBMC culture; Kaplan-Meier method was used to analyze the relationship between the levels of IL-18, IL-1β, NLRP3, Caspase-1 and the prognosis of patients with severe CHB; multivariate Logistic regression was used to analyze the factors influencing the prognosis of patients with severe CHB. Result The levels of IL-18, IL-1β, NLRP3 and Caspase-1 [(65.86±21.32) pg/ml, (68.06±22.44) pg/ml, (241.57±104.07) pg/ml, (179.01±81.46) pg/ml] in the PBMC culture supernatant of the study group were higher than those in the control group [(32.11±8.95) pg/ml, (25.49±7.06) pg/ml, (87.61±23.70) pg/ml, (10.33±3.29) pg/ml], with statistically significant differences (all P<0.05); the levels of IL-18, IL-1β, NLRP3 and Caspase-1 in the PBMC culture supernatant of patients in mild CHB group, moderate CHB group and severe CHB group increased in turn [IL-18: (50.66±12.80) pg/ml, (70.29±19.03) pg/ml, (79.43±20.56) pg/ml, IL-1β: (51.23±13.17) pg/ml, (72.91±18.64) pg/ml, (83.15±21.78) pg/ml, NLRP3: (136.13±34.95) pg/ml, (289.61±73.08) pg/ml, (318.01±80.50) pg/ml, Caspase-1: (100.26±27.03) pg/ml, (201.30±54.15) pg/ml, (250.04±67.42) pg/ml], with statistically significant differences (all P<0.05); the levels of IL-18, IL-1β, NLRP3 and Caspase-1 [(104.40±10.36) pg/ml, (110.32±11.57) pg/ml, (367.03±32.25) pg/ml, (292.34±36.28) pg/ml] in the PBMC culture supernatant of the death group were significantly higher than those of the survival group [(75.33±19.82) pg/ml, (78.69±21.39) pg/ml, (309.96±71.19) pg/ml, (241.10±61.44) pg/ml], with statistically significant differences (all P<0.05); Kaplan-Meier results showed that the survival rate (75.6%, 73.7%, 75.6%, 76.9%) of patients with severe CHB in the high expression group of IL-18, IL-1β, NLRP3, and Caspase-1 were lower than that in the low expression group (97.3%, 97.5%, 97.3%, 94.9%) (all P<0.05); model for end-stage liver disease (MELD) score, international normalized ratio (INR) and IL-18, IL-1β, NLRP3, Caspase-1 levels were independent risk factors affecting the prognosis of patients with severe CHB (OR=1.821, 1.693, 2.866, 3.514, 2.007, 2.354, all P<0.05). Conclusion The elevated levels of IL-18, IL-1β, NLRP3, and Caspase-1 in the PBMC culture supernatant of patients with severe CHB are related to the poor prognosis of patients, and can be used as auxiliary indicators for prognostic evaluation of patients with severe CHB.

Analysis of serum neutralizing antibodies in patients with COVID-19 and its clinical significance Xu Yi, Xu Heng, Guo Yun, Huang Ying, Gao Peng, Hu Qian, Gao Huixia 2023, 8 (2):  34-38.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.007 Abstract ( 239)    PDF (1120KB) ( 480 )    Objective To analyze the levels of neutralizing antibody in the serum of patients infected with SARS-CoV-2,and to evaluate the severity and prognosis. Method In this study, 172 COVID-19 patients who underwent isolation treatment at Shijiazhuang Fifth Hospital from February 2020 to March 2021 were selected, serum samples were collected from COVID-19 patients, including patients with early(1-7d), intermediate(8-14d), late(15-21d), and recovery(22-41d) stages of infection. The levels of SARS-CoV-2 neutralizing antibody were detected by magnetic particle-based chemiluminescence immunoassay. Result The positive rates of neutralizing antibody increased gradually with disease progression, peaking at 90% in the late stage of infection.The levels of SARS-CoV-2 neutralizing antibody were positively corrected with the length of infection(R=0.35, P<0.001). In early stage,the positive rates of neutralizing antibody were significantly higher in the asymptomatic infected persons than in the symptomatic patients (P<0.05), and the positive rates and levels of neutralizing antibody were significantly higher in patients <60 years old than in patients ≥60 years old.In the late and recovery stages, the positive rates and levels of neutralizing antibody increased gradually with disease progression (P<0.001),and were not correlated with age. Conclusion The positive rates and levels of SARS-CoV-2 neutralizing antibody in serum were related with the severity of COVID-19 patients, and maybe an indicator for evaluating the prognosis.

MRI features of primary central nervous system lymphoma in patients with different immune statuses Shi Yanbin, Zeng Yingting, Li Yipan, Song Lu, Lu Zhiyan 2023, 8 (2):  39-44.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.008 Abstract ( 244)    PDF (1546KB) ( 640 )    Objective This study aims to investigate the MRI features of primary central nervous system lymphoma (PCNSL) in patients with different immune statuses, in order to enhance the understandings of PCNSL and offer clinical guidance for the diagnosis of PCNSL. Method A retrospective analysis was conducted on cases of primary central nervous system lymphoma confirmed by pathology at Zhongnan Hospital of Wuhan University. The sample included 16 males and 14 females, with an average age of (60.1±11.6) years. Additionally, 5 AIDS patients were included in the study. The misdiagnosis rate was 33.3%. The aim of the study was to analyze the imaging findings of PCNSL. Result A total of 30 patients with PCNSL were included in the study, all pathologically classified as diffuse large B-cell lymphoma. Of these patients, 20 cases (66.6%) presented as solitary lesions and 10 cases (33.3%) as multiple lesions, with 26 cases (86.7%) located in the supratentorial area and 4 cases (13.3%) in the infratentorial area. The lesions were found to be round in shape in 13 cases (43.3%), irregular in 11 cases (36.7%), and lobulated in 6 cases (20.0%). Peripheral edema was observed in 29 cases. On T1WI, the lesions showed slightly hypo-signal in 25 cases (83.3%), while on T2WI, the signal intensity was and slightly hyper-signal in 23 cases (76.7%). 14 cases (46.7%) exhibited homogeneous enhancement, 10 cases (33.3%) showed nonhomogeneous enhancement, and 6 cases (20.0%) showed circular enhancement. In addition, 20 cases (66.6%) exhibited special features. Conclusion The lesions of PCNSL in immunocompetent patients are mostly round in shape and typically exhibit a well-defined, markedly homogeneous enhancement with special features. In contrast, the lesions of PCNSL in immunocompromised patients are often lobulated and irregular in shape, and show ring enhancement with lower ADC values compared to those in immunocompetent patients.

Clinical characteristics of 287 cases of HIV/AIDS with sputum-negative and sputum-positive pulmonary tuberculosis Yang Honghong, Zeng Qin, Wu Yushan, Liu Qian, Li Mingjun, Liu Min, Su Shifang 2023, 8 (2):  45-48.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.009 Abstract ( 241)    PDF (834KB) ( 411 )    Objective To analyze the clinical characteristics of HIV/AIDS patients with sputum-negative and sputum-positive pulmonary tuberculosis. Method The clinical data of 99 patients with sputum-negative pulmonary tuberculosis and 188 HIV/AIDS patients with sputum-positive pulmonary tuberculosis were collected and retrospectively analyzed. Result The incidence rates of delay in first seeking care and delay in diagnosis were 68.1% and 88.8% in the sputum-positive group, respectively, which were higher than those of in the sputum-negative group (48.5% and 83.8%); the difference in delay in first seeking care was significant (P<0.05). The delay in diagnosis (health system delay) in the sputum-negative group was greater than that in the sputum-positive group, but the difference was not statistically significant (P>0.05). The sputum-positive group had significantly greater rates of cough and weight loss than the sputum-negative group (P<0.05). In the positive-group, patients with more than 3 lung fields involved accounted for 53.7%, a significantly higher proportion than that in the sputum-negative group (40.4%)(P<0.05). The incidence rates of hypochromica and hypoproteinemia were 72.9% and 85.1% in the sputum-positive group; these rates were higher than those in the sputum-negative group (65.6% and 74.7%). The incidence rates of extrapulmonary tuberculosis and tuberculous meningitis in the sputum-negative group (67.7% and 26.3%) were significantly higher than those in the sputum-positive group (51.1% and 11.2%) (P<0.05). Conclusion There were diagnostic delays in both the sputum-positive group and the sputum-negative group. The sputum examination of tuberculosis should be improved in HIV/AIDS patients when chest imaging or blood indicators are abnormal, especially in patients with malnutrition and hypoproteinemia. The incidence rates of extrapulmonary tuberculosis and tuberculous meningitis were high in HIV/AIDS patients in the sputum-negative group. Screening for extrapulmonary tuberculosis in HIV/AIDS patients should be improved.

Clinical imaging manifestations and diagnostic analysis of seven cases of anthrax Sun Yan, Fu Xuwen, Wu Jingu, Dong Huimin, Cun Xinhua, Li Xiang 2023, 8 (2):  49-52.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.010 Abstract ( 253)    PDF (2717KB) ( 415 )    Objective To exploring the imaging manifestations and clinical course of patients with cutaneous anthrax,and to improve the understanding of anthrax. Method Retrospective analysis and summary of the epidemiological history, clinical manifestations, laboratory tests, imaging and treatment of seven patients with cutaneous anthrax admitted to the Third People's Hospital of Kunming from October 2015 to July 2020. Result In the three outbreaks, a total of 14 people were exposed to diseased cattle or sheep, of whom 7 developed the cutaneous anthrax. The patients were 6 males and 1 female, 4 Hui and 3 Han, aged 35-60 years, with a median age of 46 years; the onset was mostly within 7 days after exposure; the lesions first appeared on the hands and forearms, with 6 cases showing papules, 1 case with fluid and pus flowing on the basis of the original hand wound, and in turn with clear herpes, swelling of the surrounding tissues with scab formation, and 1 patient with osteofascial compartment syndrome. Five patients (71.4%) had elevated total peripheral blood leukocyte and neutrophil counts,and six patients (85.7%) had elevated C-reactive protein; two patients (28.6%) had positive Gram-positive bacterial culture of wound secretions; six patients underwent chest CT, all of which showed multiple lymph node enlargement and perilymph node inflammation in the affected axilla, and patients with complicated osteofascial compartment syndrome underwent CT of the upper limbs, which showed soft tissue swelling of the affected limbs. Seven patients were treated with local wet compresses of potassium permanganate and penicillin-based anti-infective therapy, and those with osteofascial compartment syndrome underwent vacuum sealing drainage,all patients were cured. Conclusion Patients with cutaneous anthrax have a clear history of contact with diseased animals and typical skin manifestations; imaging CT examination shows enlarged axillary lymph nodes and perilymph node inflammation; laboratory tests show elevated white blood cell count, neutrophils, and C-reactive protein; early local treatment and full application of antibiotics are the primary treatment.

Efficacy of pegylated interferon α monotherapy in inactive chronic hepatitis B virus carriers Luo Jie, Du Zhan, Dou Xiaowen, Li Jian, Chen Mingfa, Li Manni, Yin Yanyao 2023, 8 (2):  53-57.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.011 Abstract ( 279)    PDF (955KB) ( 463 )    Objective To evaluate the the HBsAg loss and serological conversion rate of pegylated interferon alpha (Peg-IFN-α) treatment in inactive hepatitis B surface antigen carrier(IHC). Method 58 IHC patients, who admitted to the department of liver disease in Luohu People's Hospital from January 2019 to December 2021, were divided into treatment group (35 cases) and control group (23 cases) according to the patient's willings. Treatment groups were subcutaneously administered with Peg-IFN-α-2a or Peg-IFN-α-2b for 180μg/week for 48 weeks. The control group was not given any antiviral treatment. HBsAg clearance and serological conversion rate were compared between the two groups, Logistic regression was used to analyze the factors affecting HBsAg loss in Peg-IFN-α treatment with IHC. Result The mean baseline HBsAg levels were 172.99U/ml and 106.22U/ml in the treatment and control groups, respectively. For 48 weeks of treatment, loss of HBsAg was obtained in 40% (14/35) of IHC in the treatment group, HBsAg seroconversion in 14.3% (5/35) of IHC, and HBsAg loss and serological conversion were not observed in the control group. The HBsAg loss and HBsAg seroconversion rates were significantly higher than those in the control group (P<0.05).Baseline HBsAg levels and the magnitude of HBsAg decrease at 12 weeks and 24 weeks were independent factors affecting the occurrence of HBsAg clearance in Peg-IFN-αtreated IHC. No serious adverse events occurred during treatment. Conclusion Peg-IFN-α improves the HBsAg loss and serological conversion rate of IHC and the treatment is safe and effective.

A study on the effect of hemodialysis on the blood concentration of rifampicin Su Chunxiong, Wei Lijuan, Zhou Jia, Huang Aixian, Deng Wenhai, Qin Hongfa, Qin Guoqing, Xu Qiuna, Zou Jun 2023, 8 (2):  58-62.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.012 Abstract ( 316)    PDF (856KB) ( 563 )    Objective By analyzing the characteristics of rifampicin concentration in hemodialysis patients, to understand whether hemodialysis treatment affects rifampicin concentration, and to provide a basis for the scientific anti-tuberculosis treatment plan for patients receiving long-term hemodialysis. Method Analyzed 149 patients hospitalized with pulmonary tuberculosis in the Fourth People's Hospital of Nanning City from July 2021 to July 2022, and divided the patients into hemodialysis group (43 cases) and non-hemodialysis group (106 cases). By using high performance liquid chromatography analysis to measure the changes of rifampicin blood concentration on post rifampin treatment on days 8 at 2 hours, 4 hours and 6hours. Result There was no statistically significant difference in the blood concentration of rifampicin between hemodialysis group and non-hemodialysis group (P>0.05). Higher rifampicin blood levels accompanied by a sever hepatic dysfunction and exacerbate liver injury after anti-tuberculosis treatmen (P<0.05). The ratio of delayed blood concentration and oral patients is overrepresented in the haemodialysis group. Conclusion There was no significant effect of haemodialysis on the blood concentration of rifampicin, and no top-up dose was needed; the ratio of rifampicin blood level in the haemodialysis group was higher than that in the non-haemodialysis group, which was considered to be affected by the orally. Individualized anti-tuberculosis treatment basing on the blood concentration of rifampicin at 2h, 4h and 6h after the use of drugs can ensure the therapeutic effects.

Risk factors analysis of blood infection in patients with acute bacterial skin and skin structure infection Yuan Ling, Wang Jiping, Li Qiang, Zhou Li, Xiao Min, Fang Qin 2023, 8 (2):  63-67.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.013 Abstract ( 231)    PDF (846KB) ( 605 )    Objective To study the demographic factors and clinical characteristics of blood infection (BSI) in patients with acute bacterial skin and skin structure infection (ABSSSI), and to analyze which factors are the risk factors of BSI. Method Patients with ABSSSI who visited the People's Hospital of Jianyang City between January 2017 and January 2021 were selected. The case group was patients who developed bloodstream infection (BSI) within 48h after admission, and the control group was ABSSSI patients without bloodstream infection (BSI). A retrospective case-control study was performed on both groups. Independent predictors of bloodstream infection (BSI) in ABSSSI patients were sought by multifactorial logistic regression analysis. Result Three hundred ninety-two patients were included in the study,including 196 cases in the case group and 196 cases in the control group. Independent predictors of BSI in ABSSSI patients were male (OR=1.85, 95%CI=1.11~3.66), acute renal failure (OR=2.08, 95%CI=1.18~3.66), history of the previous hospitalization (OR=2.41, 95%CI=1.24~4.93), Rural residents (aOR=2.18, 95%CI=1.38~3.4), leukocytosis (OR=2.24, 95%CI=1.41~3.55), abnormal body temperature (aOR=2.86, 95%CI=1.66~4.93). Conclusion Among demographic factors, male, previous hospitalization history, rural residents and clinical characteristics of acute renal failure, leukocytosis and abnormal body temperature are highly correlated with secondary BSI in patients with ABSSSI, which are the main high-risk factors of BSI. The results of this study can provide early warning for the early treatment of ABSSSI patients with BSI and can improve the prognosis of patients.

Case Report

Pertussis clustered in 2 families (cases report) Chen Yiran, Deng Jikui 2023, 8 (2):  68-70.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.014 Abstract ( 306)    PDF (825KB) ( 396 )    Case 1, a 4-month-old girl, was admitted to hospital because of cough for half a month, while Case 2, a 1-month-old girl, was hospitalized with an 8-day cough. Both 2 infants were diagnosed with pertussis by polymerase chain reaction (PCR) detection of Bordetella pertussis nucleic acid in nasopharyngeal swabs. The parents of Case 1 and the parents and elder brother of Case 2 were all diagnosed as pertussis by either IgG antibody levels against pertussis toxin (PT-IgG) or nucleic acid detection. Infants who have not been fully vaccinated with diphtheria, tetanus and pertussis combined vaccine are the main population of pertussis, but older children and adults often become the major infectious reservoir due to atypical symptoms. The key transmission route of pertussis in family clusters is from adults (mainly parents) to infants. Recent infection with Bordetella pertussis can be indicated by measuring a 2- to 4-fold increase of PT-IgG in the convalescent and acute phases or a single PT-IgG detection increase of more than 80 to 100 IU/ml. However, the serological test results are not reliable for children who have received pertussis vaccine within 1 year, while a comprehensive analysis of data from multiple laboratory tests is required.

Management of lymphatic leakage after peripherally inserted central catheter in a patient with AIDS complicated with malignant lymphoma Yu Qing, Liu Min, Huo Qin, Bai Yan, Tan Jiarong, Qi Weiwei 2023, 8 (2):  71-73.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.015 Abstract ( 284)    PDF (827KB) ( 722 )    AIDS associated lymphoma (ARL)is the most common malignant tumor in AIDS patients. Chemotherapy is the most effective treatment for ARL. Peripherally inserted central catheter(PICC) can effectively avoid the stimulation of chemotherapy drugs to the vein.However, a series of complications may occur during catheter indwelling. The incidence of catheter-related lymphatic leakage was less,Difficult to identify clinically. If not found and treated early, it may lead to unplanned extubation or catheter-related bloodstream infection and other serious consequences.This paper reports the identification and treatment of a case of catheter-related lymphatic leakage: through the patient's symptoms, signs, local examination of the catheter, combined with secretion microbial culture and ultrasonic exploration, the common factors such as local infection, catheter damage, fibrin sheath formation and so on were quickly eliminated, and finally it was determined as lymphatic leakage; The puncture point is covered with alginate dressing and gauze, and then according to the anatomical structure of the lymphatic vessels running along the basilic vein, the gauze is wrapped into a cylinder to compress the part, so that the stress point is concentrated, and then the adhesive elastic bandage is used to compress and wrap, and the local seepage can be quickly relieved through the above treatment. The catheter was retained for 4 months and the whole chemotherapy was completed. This case provides reference for clinical diagnosis, treatment and nursing.

Review

Progress in drug treatment of tuberculosis complicated diabetes Xu Xinyue, Zhao Xiaolong 2023, 8 (2):  74-77.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.016 Abstract ( 272)    PDF (831KB) ( 528 )    Lifestyle changes have brought about a pandemic of diabetes. As an ancient disease, tuberculosis also has an increasing trend. The trend of co morbidity of tuberculosis and diabetes is increasingly obvious. Tuberculosis and diabetes interact with each other, promote each other, aggravate the condition of infected persons and make their clinical diagnosis and treatment complicated. This review focuses on the main points of medical nutrition therapy for tuberculosis complicated diabetes, the special features of anti-tuberculosis therapy for diabetic patients, the types of antidiabetic drugs for patients with tuberculosis complicated diabetes and their relationship with anti-tuberculosis therapy, as a way to improve the effectiveness of drug therapy for tuberculosis complicated diabetes.

Research progress in component analysis of exhaled breath Li Chengmu, Wu Xiaoping 2023, 8 (2):  78-81.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.017 Abstract ( 275)    PDF (835KB) ( 675 )    The detection of compounds in human exhaled breath provides new methods for determining human physiological state, diagnosing disease or assessing environmental exposure. Advances in metabolomics research have enabled new tools to probe the state of human respiratory metabolism. Despite some significant challenges in sampling and analysis, exhaled breath remains an ideal medium for metabolomics applications, mostly due to its noninvasiveness, convenience, and nearly limitless availability. Several breath-based assays for endogenous or exogenous gas-phase compounds have been established and used in practice and/or clinical settings. This review provides an overview of breath analysis concepts and unique test methods and their applications. We discuss their physiological production in humans and the development and implementation of related tests separately for the respiratory biomarkers targeted in each test. The article concludes with an outlook on the direction of future respiratory research.

Research progress on gut microbiota dysbiosis in patients with pulmonary tuberculosis Yang Shuqi, Li Feng 2023, 8 (2):  82-85.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.018 Abstract ( 274)    PDF (831KB) ( 603 )    Trillions of microorganisms are planted in the human intestine, and gut microbiota can protect the host from disease through derived metabolites. During the thousands of years of struggle between human and Mycobacterium tuberculosis, pulmonary tuberculosis has been confirmed to cause the host's gut microbiota dysbiosis, affect resistance to the colonization of gut microbiota, and make pulmonary tuberculosis more difficult to cure. This article summarized the latest research progress of the pulmonary microbiome, the impact of gut microbiome on the pulmonary microbiome, and the gut microbiota dysbiosis in patients with pulmonary tuberculosis.

Progress in imaging research of brucellosis Yin Songtao, Li Junlin, Zhang Xiaoqin, Ding Haitao, Wang Zhanguo 2023, 8 (2):  86-90.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.019 Abstract ( 258)    PDF (416KB) ( 699 )    Brucellosis is one of the most common zoonotic diseases in the world and is widespread worldwide. It was originally discovered on the Mediterranean island of Malta and was named "Malta fever".Later, in order to commemorate the British doctor Bruce who first isolated the Brucella pathogen, it was renamed Brucellosis. Brucella can invade all systems of the human body. The clinical manifestations are often non-specific. The most common manifestations are fever, sweating, muscle pain, lymphadenopathy or hepatosplenomegaly. Therefore, imaging examination is very important for the timely diagnosis and treatment of the disease. B-ultrasound, X-ray, CT, MRI and PET radionuclide imaging have corresponding effects. B ultrasound is the basic means of inspection, the heart, pericardium infection, hepatosplenomegaly, body surface lymph nodes and Brucella orchitis has a certain diagnostic value. X-ray is simple and suitable for primary screening. It can observe the chest lesions of Brucella and the changes of bone and joint in the later stage, but the sensitivity is poor due to overlapping images. CT found that the high sensitivity of the lesion, the systemic infection of brucellosis have important diagnostic significance for the nervous system, joints and spine of the early lesions show poor. PET radionuclide imaging can accurately show the lesion site. MRI with multi-sequence, multi-modality and good soft tissue resolution is considered the "gold standard" of brucellosis imaging diagnosis.

Guidelines and Consensus

Interpretation of Expert consensus on imaging diagnosis of acquired immune deficiency syndrome associated pneumocystis jirovecii pneumonia Qu Jing, Liu Jinxin 2023, 8 (2):  91-95.  DOI: 10.19871/j.cnki.xfcrbzz.2023.02.020 Abstract ( 349)    PDF (856KB) ( 719 )    Pneumocystis jirovecii pneumonia is a worldwide opportunistic infection disease. Imaging technology had proven to be very useful in early detecting, evaluating and surveillance on chemotherapy. For promoting the diagnosis and treatment of acquired immunodeficiency syndrome associated pneumocystis jirovecii pneumonia in our country can be worked correctly and effectively, safely and widely, the expert group use the guide of evidence-based medicine and the requirements of standard methodology to formulate Expert consensus on imaging diagnosis of acquired immunodeficiency syndrome associated pneumocystis jirovecii pneumonia. The interpretation of this expert consensus combines relevant studies,and includes the disease etiology, epidemiology, clinical manifestation, laboratory examination, clinical diagnosis and differential diagnosis. We hope that it can improve clinicians' understanding of the disease.