Current Issue

2023 Vol.8 No.4 Published:31 August 2023

Special Topic on Prevention of Monkeypox

Epidemiological and clinical characteristics of monkeypox in Shenzhen Chen Chuming, Wu Weibo, Peng Ling, Cao Mengli, Feng Shiyan, Li Jianming, Yang Liuqing, Lin Yuanlong, Yi Yunlan, Wu Zhanhui, Wang Fuxiang, Lu Hongzhou 2023, 8 (4):  1-5.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.001 Abstract ( 188)    PDF (1388KB) ( 269 )    Objective This study aims to clarify the epidemiological and clinical characteristics of monkeypox in Shenzhen. Method Retrospective analysis of the clinical characteristics, blood analysis results, ultrasound examination, and other data of 49 monkeypox patients hospitalized at Shenzhen Third People's Hospital from June 9 to July 18, 2023. Collect epidemiological information and summarize demographic characteristics, clinical manifestations, laboratory examination results, complications, treatment, and prognosis data. Result All of these patients were monkeypox virus-positive (49/49, 100%) by PCR test, and all the patients were men (49/49, 100%). The patients were relatively young, with a median age of 29 (21～48) years, and an average age of 30. 45 out of 49 patients were male sexual contacts (91.84%), and two were bisexual (4.08%). The average time of hospitalization was 6.55 days, and the average incubation period was 8.64 days. Among these patients, 30 were with HIV infection（61.2%), 17 were with syphilis (34.69%), 1 was with lymphoma (2.04%) and 4 were perianal abscess (8.16%). 90% (27/30) of monkeypox patients with HIV infection received anti-retroviral therapy (ART). All patients presented with skin rash, which mainly affected the anus and genitals (38/49, 77.55%), trunk and limbs (34/49, 69.39%), face (19/49, 38.79%), soles and palms (2/49, 4.08%). Most patients had lymphadenopathy in the groin (43/49, 87.76%), neck (36/49, 73.5%), armpit (26/49, 53.06%), and supraclavicular fossa (5/49, 10.2%). The proportion of fever and rash in anal genital in non-HIV infected cases is significantly higher than that in HIV-infected cases (P＜0.05). Conclusion Our study showed that transmission of monkeypox in Shenzhen was found mainly in the MSM population. Monkeypox is generally mild in this study. Cases without HIV-infected have a higher proportion of fever and rash in anal and genital.

4 cases of monkeypox and literature review Zhao Rui, Liu Hongyan, Li Dan, Li Xinghai, Xiao Tingyue, Liang Xuan 2023, 8 (4):  6-9.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.002 Abstract ( 139)    PDF (2553KB) ( 306 )    Objective To understand the etiological characteristics, transmission route, clinical manifestations, detection and diagnosis methods of monkeypox, and provide the basis for the prevention and control of monkeypox. Method The epidemiological history, clinical manifestations and laboratory examination of 4 monkeypox patients admitted to Shenyang Sixth People's Hospital were analyzed, and the relevant case data reported at home and abroad were reviewed. Result All the 4 cases were men who have sex with men（MSM） population, and no monkeypox patients had been in close contact in the past 21 days. The main symptoms after the onset were rashes on genitals, perianal, face, and trunk, which were maculopapular in the early stage and gradually evolved into water herpes and pustular rash until scabs. Monkeypox virus nucleic acid test was positive in skin lesions, blood samples and throat swabs of 4 cases, and case 1 was found to be Ⅱb B.1.3 (West African clades) by gene sequencing. After treatment, all the 4 cases were discharged after meeting the discharge standard. Conclusion Monkeypox is still a newly emerging infectious disease in China, which can be diagnosed according to exposure history, clinical manifestations and nucleic acid test results. The rash recognition of monkeypox patients by clinicians should be improved, especially monkeypox nucleic acid testing in patients with rash in MSM population.

A brief discussion on the safety factors in managing infectious biospecimen conservation-take the monkeypox as an example Yang Sen, Shen Yan, Xia Chengshuang, Chen Yaokai, Chen Yemiao 2023, 8 (4):  10-14.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.003 Abstract ( 79)    PDF (1282KB) ( 168 )    Mpox is a zoonotic infectious disease caused by mpox virus (MPXV). Mpox virus is a double-stranded DNA virus of the genus orthopoxvirus that can be spread by infectious people, infected animals, and contaminated objects. For the first time since May 2022, mpox virus has spread widely in multiple regions outside of Central and West Africa. The World Health Organization declared mpox as an "internationally concerning public health emergency" in July 2022. However, on May 11, 2023, they announced that the mpox outbreak no longer constitutes an "internationally concerning ongoing public health emergency." This indicates that there has been great progress globally in controlling the mpox outbreak. As of June 12, 2023, a total of 87 979 cases have been reported worldwide. The first imported mpox case in mainland China was admitted to the Chongqing Public Health Medical Center in September, 2022, and the remaining samples from the clinical diagnosis and treatment were preserved in the biobank of the center. Four cases of the mpox virus infection have been reported from Beijing and Guangzhou in June 2023, respectively. Currently, the mpox outbreak in our country is in the sporadic transmission phase. Based on the main characteristics of mpox virus, this paper takes the whole-process management of mpox samples stored in biobank as an example, briefly analyzes the safety factors for managing infectious biospecimen from the aspects of the protection of operators, the protection of the surrounding environment and the guarantee of the quality of stored samples, so as to provide reference for future preservation of mpox and related infectious samples.

Original Articles

Expression levels of serum cytokines in patients with COPD combined with active tuberculosis and their correlation with the disease He Qingjun, Yao Wenyan, Xiao Dan, Li Hongbing, Wu Shuimiao 2023, 8 (4):  15-19.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.004 Abstract ( 93)    PDF (2321KB) ( 104 )    Objective To analyze the correlation between FEV1 level and serum cytokine levels in patients with chronic obstructive pulmonary disease (COPD) complicated with active tuberculosis infection, and to provide theoretical evidence for clinical intervention. Method Patients with COPD combined with active tuberculosis infection admitted to the department of respiratory and critical care medicine of the fourth people's hospital of Shaanxi province from January 2019 to April 2022 were included in the study, and patients with COPD control group, tuberculosis control group and conventional control group were included in the same period. General data such as age, gender and lung function of the four groups were compared. The expression levels of natural killer cells (NK), T lymphocyte subsets and cytokines in peripheral blood of patients were compared and analyzed, and the correlation between lung function and T lymphocyte subsets and cytokine expression levels was analyzed. Result There were statistically significant differences in age, smoking history, lung function, NK expression rate, CD4+T lymphocyte level, CD8+T lymphocyte level and CD4+/CD8+ ratio among 4 groups of patients (all P<0.05), the levels of SIL2R, IL-6, IFN-γ and TNF-α were significantly higher in COPD patients with tuberculosis than in COPD patients (P<0.05); The levels of FEV1 were negatively correlated with the levels of Sil2R, TNF-α and IL-6 (r=-0.476,-0.487,-0.596; P<0.05). Conclusion The levels of SIL-2R, IL-6, IFN-γ and TNF-α in COPD patients with active tuberculosis infection were significantly increased, and the increased levels of SIL-2R, TNF-α and IL-6 were significantly correlated with the deterioration of FEV1.

Correlation analysis between intestinal microbiota and serum PPARγ and MMP-9 protein levels in children with Mycoplasma pneumoniae pneumonia and its diagnostic value Guo Jianming, Zuo Yiyu, Zhao Aibao 2023, 8 (4):  20-24.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.005 Abstract ( 87)    PDF (997KB) ( 79 )    Objective To investigate the correlation between the levels of peroxisome proliferator activated receptor (PPARγ) and matrix metalloproteinase-9 (MMP-9) and the intestinal flora of children with mycoplasma pneumoniae pneumonia (MPP) and its diagnostic value. Method A total of 100 children with MPP admitted to Hejian Children's Hospital from January 2021 to January 2023 were collected as the study subjects, according to the course of the disease, they were grouped into an acute phase group (48 cases) and a recovery phase group (52 cases), and 50 healthy children who underwent routine physical examinations in our hospital during the same period were included as the control group, the number of intestinal flora (Escherichia coli, bifidobacteria, Bacteroides, Enterococcus, Lactobacillus) and serum PPARγ, MMP-9 levels were compared among the three groups. Pearson method analysis were applied to analyze the correlation between serum PPARγ, MMP-9 levels and Escherichia coli, bifidobacteria, Bacteroides, Enterococcus, Lactobacillus. Logistic regression was used to analyze the influencing factors of MPP in acute stage and recovery stage. ROC curve was used to analyze the diagnostic value of serum PPARγ, MMP-9 and Lactobacillus levels for acute MPP. Result The numbers of Escherichia coli and Enterococcus and the level of serum MMP-9 in the acute phase group and the recovery phase group were higher than those in the control group, and the acute phase group were higher than that in the recovery phase group (P<0.05); the numbers of Bifidobacterium, Bacteroides, Lactobacillus, and serum PPARγ level in the acute phase group and recovery phase group were lower than those in the control group, and the acute phase group were lower than the recovery phase group (P<0.05). Pearson analysis showed that the numbers of Escherichia coli and Enterococcus were negatively correlated with the serum PPARγ level (P<0.05), there was a positive correlation between the numbers of Bifidobacterium, Bacteroides, and Lactobacillus and the serum PPARγ level (P<0.05); the numbers of Escherichia coli and Enterococcus were positively correlated with the level of serum MMP-9 (P<0.05), there was a negative correlation between the number of Bifidobacterium, Bacteroides, and Lactobacillus and serum MMP-9 level (P<0.05). Logistic regression analysis showed that PPARγ was a protective factor for the development of MPP in acute and recovery stages (P<0.05), MMP-9 was a risk factor for the development of MPP in acute and recovery stages (P<0.05), and Lactobacillus was a protective factor for the development of MPP in acute stage (P<0.05).The AUC of serum PPARγ, MMP-9, Lactobacillus and their combination in the diagnosis of acute MPP were 0.797, 0.761, 0.839 and 0.905, respectively. The sensitivity and specificity of combined diagnosis were 93.24% and 76.34%, respectively. The combination of the three was better than that of serum PPARγ, MMP-9 and Lactobacillus alone (Z Combination of the three-PPARγ=2.604, P<0.001; Z Combination of the three-MMP-9=3.310, P=0.007; Z Combination of the three-Lactobacillus=2.810, P=0.008). Conclusion Serum PPARγ level of MPP children increases with the decreases of Escherichia coli and Enterococcus and the increases of Bifidobacterium, Bacteroides and Lactobacillus, the serum MMP-9 level increases with the increasse of Escherichia coli and Enterococcus and the decreases of bifidobacteria, Bacteroides and Lactobacillus.Serum PPARγ, MMP-9 and Lactobacillus have certain diagnostic value for acute MPP, and the combination of the three has higher efficacy.

Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode Zhong Xiangpeng, Liu Yong, Liu Qian, Liu Weiting, Liu Minqiang, He Renliang, WuQiang 2023, 8 (4):  25-29.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.006 Abstract ( 78)    PDF (935KB) ( 167 )    Objective To explore the therapeutic value of GDFT in reducing pulmonary edema after pleurodectomy in tuberculosis patients. Method From January 2021 to May 2022, 60 patients who plan to undergo pleural exfoliation surgery with tuberculosis were enrlled as the research subjects, and they were randomly divided into the group S and the group C equally. Group S accepted the goal-directed fluid therapy, and the transfusion speed was adjusted according to the Stroke volume variation(SVV). Group C accepted the traditional liquid treatment, which according to the mean arterial pressure(MAP), central venous pressure, urinary production and other parameters. Radiographic assessment of lung edema (rale scoring) was used to evaluate the patients' pulmonary disease before operation, on the first day after operation, and on the third day after operation. Mean arterial pressure (MAP), heart rate (HR),pulse oxygen saturation(SPO2) and peak airway pressure (PEAK)were recorded at five moment（T1, 5minutes before anesthesia; T2, 5minutes after tracheal intubation; T3, Beginning of the surgery; T4, Surgery was started for 1 hour; T5, the end of surgery）, the occurrence of postoperative complications also were recorded; The postoperative recovery quality score (The QoR-15) was performed on patients 1 day before surgery, the first postoperative day, and the third postoperative day to evaluate their postoperative recovery. Result Compared with group C, the rale score in group S was lower on the first postoperative day (P<0.05), and there was no significant difference in rale scores between the two groups on the third postoperative day; There was no statistically significant difference in intraoperative vital signs between the two groups; The infusion volume in group S was lower than group C (P<0.01); There was no significant difference in extubation time, postoperative hospital stay, urinary production and QoR-15 score. Conclusion GDFT can mitigate postoperative acute pulmonary edema and maintain stable circulation while reducing the infusion volume in TB patients.

Analysis of successful treatment factors and establishment of predictive models for multidrug-resistant tuberculosis patients Wu Xueqing, Cheng Yao, Yang Ming, Yuan Ping, Li Jiao, Sun Qiuping 2023, 8 (4):  30-35.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.007 Abstract ( 90)    PDF (2199KB) ( 93 )    Objective To analyze the factors related to treatment success in patients with MDR-TB, and establish a nomogram model to predict the probability of treatment success. Method 263 MDR-TB patients admitted to the tuberculosis Department of Chengdu Public Health Clinical Medical Center from November 2019 to May 2022 were retrospectively analyzed. The patients were divided into model group (184 cases) and verification group (79 cases) by 7:3. According to the efficacy results, the model group was divided into successful treatment group and adverse outcome group, and the clinical parameters, CT examination results and laboratory indicators of the two groups were compared. After the potential factors were screened by LASSO regression method, multivariate Logistic regression analysis was performed, and a nomogram model was established and verified according to the results of multiple factors. Result Among the 184 patients in the model group, 103 (55.98%) cases were successfully treated, and 81 (44.02%) cases had adverse outcomes. The results of ascending Logistic regression analysis on the basis of LASSO regression showed that age, history of second-line anti-TB drug use, sputum turning negative after 6 months of treatment, lesion scope, multiple cavity, erythrocyte sedimentation rate and urinary protein were independent factors influencing the treatment success of MDR-TB patients. The AUC for successful treatment of MDR-TB patients was 0.894 (95%CI: 0.847-0.941). The AUC of the verification group was 0.865 (95%CI: 0.810-0.919). The prediction curves of the model group and the verification group were basically fitted with the standard curves. When this column chart model predicts that the probability threshold of treatment success for MDR-TB patients is 0.10-0.95, the net benefit rate for patients is greater than 0. Conclusion The success of treatment of MDR-TB patients is affected by age, history of second-line anti-TB drugs, sputum turning negative after 6 months of treatment and other factors. The nomogram model has high accuracy and differentiation in predicting the success of treatment of MDR-TB patients.

Epidemiological investigation and infection route analysis of two psittacosis outbreaks in Shenzhen Liu Wei, Wan Jia, Chen Yixiong, Duan Lina, Xu Zhongliang, Huang Yucheng, Gao Shitong, Zhang Zhen, Kong Dongfeng 2023, 8 (4):  36-40.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.008 Abstract ( 102)    PDF (1253KB) ( 101 )    Objective To analyze the epidemiological characteristics and influencing factors of two psittacosis outbreaks in Shenzhen, and to provide scientific basis for formulating prevention and control measures. Method The data of two outbreaks of psittacosis in Shenzhen were collected by field epidemiological method, and the incidence and epidemiological characteristics were analyzed by descriptive epidemiological method. Result There were two outbreaks of human infection with chlamydia psittaci in Baoan District and Futian District of Shenzhen in 2023, with a total of two cases and no death. The two cases were all home-raised parrots, with symptoms such as fever and limb muscle soreness, the exposure time was 15 days and 33 days, respectively. The investigation of co-exposed persons showed that no infection occurred in the occupational population of pet shop birds (0/13), and there were two cases of fever and muscle soreness in the non-occupational population such as family members or friends, but sampling was refused. The positive rate of chlamydia psittaci in external environment was 58.0% (29/50). Conclusion Chlamydia psittaci infection is an occasional infection. Long-term unprotected close contact is the main mode of infection, and no human-to-human transmission has been found. In order to prevent and control psittacosis, it is suggested to strengthen the environmental and related population health monitoring.

Study on the prevention of hypoxemia during painless bronchoscopy in patients with bronchial tuberculosis by modified chest compression Yang Xiaorui, Xuan Peng, Li Jinpei, Zhang Liang, Liu Yong, Liu Minqiang, He Renliang 2023, 8 (4):  41-44.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.009 Abstract ( 105)    PDF (901KB) ( 76 )    Objective To observe the clinical effect of modified chest compression in preventing hypoxemia in patients with bronchial tuberculosis during painless bronchoscopy. Method Select 200 patients with bronchial tuberculosis (EBTB) who underwent bronchoscopy diagnosis and treatment at Shenzhen Third People's Hospital from May to October 2022, patients were randomly assigned into two groups: control group (group C) and test group (group T), 100 cases per group. The anesthesia method is intravenous injection with midazolam and remifentanil, inserting bronchoscopy after patient's consciousness disappears. During the surgery, jaw thrust (in group C) or chest compressions (in group T) was performed if apnea occurred over 10 seconds. If the state continues to deteriorate and plus oxygen saturation (SpO2) runs to be lower than 90% for more than 60 seconds, the staff will suspend operation and perform mask ventilation. The heart rate (HR), mean arterial pressure (MAP), SpO2, anesthetic dosage, recovery time, hypoxemia and times of interruption were recorded at the following time points: before anesthesia (T0), bronchoscope going through glottis (T1), end of operation (T2), leaving room (T3). Result Compared with T0, both groups had an increase in MAP, a faster increase in HR, and a decrease in SpO2 during surgery. After surgery, they gradually recovered to the basic level, but there was no statistically significant difference in MAP and HR between the two groups at different time points (P>0.05). Compared with group C, SpO2 in group T was maintained at a high level at T1 and T2 (P<0.05), and the incidence of hypoxemia and interruption in group T was significantly decreased (P<0.05). There was no significant difference in the incidence of apnea, lowest value of SpO2, and other adverse reactions between the two groups (P>0.05). There were no chest pain, rib fracture, pneumothorax and other adverse reactions related with chest compression in group T. Conclusion Modified chest compression is a safe and feasible technique during painless bronchoscopy in patients with bronchial tuberculosis, which can effectively prevent hypoxemia and reduce the interruptions of operation.

Correlation between Zonulin, sRAGE and intestinal flora in patients with severe pneumonia Xu Henggui, Zhao Qinggui 2023, 8 (4):  45-49.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.010 Abstract ( 92)    PDF (903KB) ( 81 )    Objective To investigate the expression levels of serum Zonulin and soluble advanced glycation end product receptor (sRAGE) in patients with severe pneumonia and their correlation with intestinal flora. Method 80 patients with severe pneumonia admitted and diagnosed in Taizhou Jiangyan Hospital of Traditional Chinese Medicine from January 2019 to June 2022 were selected as the study group, in addition, 82 patients with common pneumonia were selected as the control group. General data of patients were collected; the serum levels of Zonulin and sRAGE were detected by ELISA; real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the number of intestinal flora; Pearson method was used to analyze the correlation between the levels of Zonulin, sRAGE and intestinal flora in patients with severe pneumonia.Divide patients into poor prognosis group(26 cases) and good prognosis group(54 cases) based on their survival within 28 days after discharge. Result The levels of Zonulin and sRAGE in the study group were obviously higher than those in the control group (t=14.293、12.033, P<0.05); The numbers of bifidobacterium, lactobacillus and rumen coccus in the study group were lower than those in the control group (t=9.139, 7.838, 5.130, P<0.05), and the numbers of enterococcus, Escherichia coli and staphylococcus in the study group were higher than those in the control group (t=3.397, 4.807, 3.960, P<0.05).; the levels of serum Zonulin and sRAGE were negatively correlated with the numbers of bifidobacteria, lactobacilli and rumen cocci (P<0.05), and positively correlated with the numbers of enterococci, staphylococci and Escherichia coli (P<0.05); Serum Zonulin and sRAGE levels in the poor prognosis group were significantly higher than those in the good prognosis group (t=6.910, 4.358, P<0.05). The number of bifidobacterium, lactobacillus and rumen cocci in the poor prognosis group was lower than that in the good prognosis group (t=4.368, 2.167, 3.197, P<0.05), and the number of enterococcus, staphylococcus and Escherichia coli in the poor prognosis group was higher than that in the good prognosis group (t=2.704, 3.489, 3.995, P<0.05). Conclusion The levels of serum Zonulin and sRAGE in patients with severe pneumonia are elevated, and there is a certain correlation between their levels and intestinal flora in patients with severe pneumonia.

Analysis of virology response of obipari combined with dasepvir in the treatment of genotype 1b chronic hepatitis C Cai Xiaojuan, Wang Meihua, Mao Liping, Xue Hong, Miao Youhan, Yao Chao, Zhu Xiaohong 2023, 8 (4):  50-53.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.011 Abstract ( 82)    PDF (878KB) ( 86 )    Objective To explore the effect and Virology response of the combination of obipari and dasepvir in the treatment of chronic hepatitis C patients with genotype 1b, so as to provide reference for the selection of clinical treatment plans for chronic hepatitis C patients with genotype 1b. Method 136 patients with genotype 1b chronic hepatitis C in Nantong Third Hospital Affiliated to Nantong University from January 2019 to January 2022 were selected as the study subjects. Patients were treated with ombitasvir (ombitasvir/paritaprevir/ritonavir) 25/150/100mg once daily combined with dasubuvir 250 mg twice daily. All patients received a 12 week treatment regimen and were followed up for 24 weeks after the end of treatment. The virological response of the patients was evaluated at week 4, the end of treatment, 12 weeks and 24 weeks after the end of treatment, and the adverse reactions of the patients during the follow-up period were recorded. Result A total of 136 patients were enrolled, 75 were male (55.15%) and 61 were female (44.85%). Among them, 127 (93.38%) were newly diagnosed patients, 5 (3.68%) were treated with ombitasvir or dasubuvir, and 4 (2.94%) were treated with interferon. There were 10 patients (7.35%) with liver cirrhosis. All patients were followed up to 24 weeks after the end of treatment, and no death or loss of contact occurred. The virological response rate of patients was 100% (136/136) at the 4th week of treatment and 100% (136/136) at the end of treatment. The virological response rate was 100% (136/136) at 12 weeks after the end of treatment and 100% (136/136) at 24 weeks after the end of treatment. A total of 108 adverse events were reported, all of which were mild. No adverse events or deaths led to discontinuation of the study drug. Common adverse events and laboratory abnormalities that occurred were considered to be unrelated to the study drug, and no patients discontinued the study drug prematurely. Conclusion Ombitasvir combined with dasabuvir in the treatment of genotype 1b chronic hepatitis C has a virological response rate of 100% and high safety.

Significance of multi-slice spiral CT and 18F-FDG PET/CT in differentiating isolated pulmonary cavity from the cancerous cavity Peng Xuehua, Chen Yanzi, Jiang Hong, Jin Aifang, Luo Zhehuang 2023, 8 (4):  54-59.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.012 Abstract ( 86)    PDF (2468KB) ( 110 )    Objective The multi-slice spiral CT signs and PET/CT semi-quantitative analysis of the isolated tuberculosis cavity and cancerous cavity were compared to explore the differential value of the two cavities. Method 38 patients with single tuberculosis cavity and 28 patients with a lung cancer cavity confirmed by pathology and clinical records from January 2020 to September 2022 in People's Hospital of Longhua Shenzhen were retrospectively analyzed. MSCT scan was performed on all patients, the clinical basic data and CT imaging findings were compared. At the same time, the clinical data of isolated tuberculosis cavitary and lung cancer cavitary patients who were pathologically confirmed by 18F-FDG PET/CT examination in Jiangxi People's Hospital were collected, and the metabolic characteristics were compared. Result The main onset age of tuberculosis cavity was (36.32±14.68) years, and the main manifestations were thick wall and uniform thickness, with satellite foci around the lesion. The main onset age of cancerous cavity was (63.75±12.92) years. A carcinomatous cavern was mostly characterized by thick wall (thicker than the tuberculosis cavity), uneven inner margins, internal partitions, and wall nodules. Lobed、burr and ground glass density metastasis were seen. The proportions of intra-spacer, inner wall disjointed, wall nodule, bronchial signs were seen around the cavernous focus. The morphology was mainly type IV, and some signs of interruption, thick-walled cavity, lobed sign,stubble burr sign, ground glass density sign,andmetastasis sign in lung cancer cavity were higher than those in single tuberculosis cavity (P<0.05), while the proportions of the satellite foci, long thin burr sign,and wall calcification were lower than those in single tuberculosis cavity (P<0.05). There was no significant difference in gender、cavity site、cavity mean diameter 、vascular cluster sign and pleural depression sign between the two groups (P>0.05). The SUVmax value of lung cancer cavity group was (11.41±6.55), and that of the pulmonary tuberculosis cavity group was (5.96±3.55), with significant difference between the two groups (P=0.038). The SUVmax value of squamous cell carcinoma (13.66±7.20) >adenocarcinoma (10.28±5.60), the difference was not statistically significant (P=0.293). Conclusion There are some imaging and metabolic differences between the tuberculosis cavity and the cancerous cavity, multi-slice spiral CT combined with 18F-FDG PET/CT can accurately distinguish the tuberculosis cavity from the lung cancer cavity, which is worthy of clinical promotion and application.

Diagnostic value of tuberculin skin test, interferon gamma release assay and nucleic acid test in tuberculosis Wu Duochi, Liang Aiqun, Wu Yeying, Yun Fei 2023, 8 (4):  60-63.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.013 Abstract ( 97)    PDF (877KB) ( 86 )    Objective To investigate the value and difference of three diagnostic technologies, tuberculin skin test (TST), interferon gamma release assay assay (TB-IGRA) and nucleic acid test technology (NAT) in detection of tuberculosis. Method A total of 206 suspected tuberculosis patients admitted to the hospital from January 2021 to December 2021 were selected. Among them, 106 patients diagnosed with tuberculosis were divided into research group (17 new patients and 89 patients have been treated 1-2 months), and 100 patients with other pulmonary diseases were divided into control group. Two groups of patients were given TST, TB-IGRA and NAT detection, and the clinical value of these three detection methods was analyzed. Result The positive rates of the three detection methods in the research group were significantly higher than those in the control group (P<0.05); Compared with TST, the positive rates of TB-IGRA and NAT tests in the research group were higher, while the positive rates of TB-IGRA and NAT tests in the control group were lower, with a statistically significant difference (P<0.05); There was no statistically significant difference in TB-IGRA and NAT detection between new patients and patients with 1-2 month treatment (P>0.05); The coincidence rate, sensitivity, specificity of TB-IGRA and NAT detection were higher than those of TST detection, and the difference was statistically significant (P<0.05). Conclusion TB-IGRA and NAT have high diagnostic coincidence rates for tuberculosis, and both have high sensitivity and specificity.

Analysis of the risk factors of reproductive tract infections of pregnant women in the third trimester of pregnancy and their correlation with preterm delivery Wang Rui, Li Wenhua, Tang Liwen 2023, 8 (4):  64-68.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.014 Abstract ( 90)    PDF (1385KB) ( 133 )    Objective Explore the relevant influencing factors of reproductive tract infections in late pregnancy women, and the relationship between reproductive tract infections and premature birth. Method 123 late pregnancy women who were treated at the Department of Obstetrics, Nanhai District People's Hospital in Foshan City from February 2018 to January 2020 were selected. They were divided into an infection group (n=49) and a control group (n=74) based on whether they had reproductive tract infections. The clinical data of the two groups of patients were compared, and Logistic regression analysis was used to analyze the independent risk factors of reproductive tract infections in late pregnancy women. 123 pregnant women were divided into preterm delivery group (n=35) and non preterm delivery group (n=88) based on whether they were born prematurely. The general information of the two groups of pregnant women was compared, and Logistic regression analysis was used to analyze the independent risk factors for preterm delivery in late pregnancy pregnant women. Build a prediction model based on independent factors and validate the model. Result Diabetes in pregnancy, low education level, poor health habits, abortion history, delivery history, infection history were independent risk factors of reproductive tract infection in late pregnancy (P<0.05). By comparing the conditions of preterm infants of different gestational ages at birth and after birth, we can see that the smaller the gestational age and the lower the birth weight, the higher the incidence rate and death rate of asphyxia, hyaline membrane disease, and intraventricular hemorrhage above Ul degree (P<0.05). Pregnancy diabetes, abortion history and reproductive tract infection were independent risk factors for preterm delivery in late pregnancy (P<0.05). Construct a prediction model for premature delivery in late pregnancy. The C-index calculation result of the prediction model is 0.863 (95% CI: 0.825-0.884), and the ROC curve AUC is 0.868 (95% CI: 0.822-0.963), which has good discrimination and accuracy. Conclusion Diabetes during pregnancy, low education level, poor health habits, abortion history, delivery history, infection history are the risk factors of reproductive tract infection in late pregnancy. Enhance maternal safety awareness, timely cleaning of the reproductive tract and regular relevant examinations, reduce unnecessary abortion and cesarean section, effectively reduce the risk of reproductive tract infection and the rate of preterm birth.

Guidelines and Consensus

Expert consensus on establishing an enhanced integrated surveillance system for key infectious diseases based on the "one health" Cheng Yanpeng, Zhang Zhen, Shu Yuelong, Ren Lili, Kang Min, Kong Dongfeng, Shi Xiaolu, Lyu Qiuying, Chen Zhigao, Li Yinghui, Zhang Renli, Lu Puxuan, Lu Yan, Liu Tingting, Chen Nixuan, Xiong Huawei, Du Chen, Yuan Jun, Wang Liang, Liu Rongqi, Chen Weihong, Li Xueyun, Lin Qihui, Li Gang, Zhang Xindong, Yuan Jianhui, Wang Tieqiang, Guo Yongchao, Lu Jianhua, Zou Xuan, Feng Tiejian 2023, 8 (4):  69-79.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.015 Abstract ( 369)    PDF (3118KB) ( 322 )    China has continuously improved the monitoring of key infectious diseases. After the SARS epidemic in 2003, we have established a comprehensive reporting network system for infectious diseases and public health emergencies. With the constant development of molecular biology, bioinformatics, artificial intelligence, and other identification and analysis technologies, along with the increasing demands for early warning thresholds, information, and techniques, strengthening early monitoring and warning capabilities has become a top priority for enhancing the public health system. A total of 31 experts, based on the "One Health" concept and through analysis of the current situation, have suggested the fourth-generation comprehensive surveillance system targeting key infectious diseases (39 notifiable diseases and emerging infectious diseases). This surveillance system aims to systematically monitor the epidemiology and pathogenics of major disease hosts such as humans, animals, and vectors, along with the associated environmental pathogens. By integrating factors influencing epidemic spread and risk assessment elements, the surveillance system aims to detect, predict, and provide early warnings for the occurrence, development, variation, and spread of new and key infectious diseases. Moreover, we are attempting to build an organizational management system for comprehensive infectious disease monitoring based on the fourth-generation surveillance system, along with a data-integrated monitoring and early warning platform and an intensive pathogen detection technology system. This series of considerations, based on systematic and comprehensive monitoring across multiple sectors, dimensions, factors, and pathogens, is supported by data integration and connectivity. It provides an opportunity for collaboration in various fields and relies on interdisciplinary application to enhance the comprehensive monitoring, prediction, and early warning capabilities for the next generation of infectious diseases surveillance. This serves as a reference for infectious disease prevention and control and related organizations.

Case Report

Three cases of human immunodeficiency virus infection combined with cutaneous squamous cell carcinoma Yu Yuanyuan, Yang Tinghui, Chen Wuyan, Liu Yang, Li Xiang 2023, 8 (4):  80-84.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.016 Abstract ( 89)    PDF (3546KB) ( 81 )    Cutaneous squamous cell carcinoma (cSCC) is a malignant neoplasm originating from the epidermis or accessory organ keratin-forming cells.It mainly starts with skin nodules, gradually increases in size, and in the later stage, ulcers may appear in the center, often with bleeding or covered with purulent secretions on the surface.Infection with human immunodeficiency virus impairs cell-mediated immune function, increases the risk of cSCC and makes tumors more invasive, leading to poor prognosis.This paper reports the clinical manifestations, physical characteristics and imaging of three patients with HIV infection combined with cSCC.All three patients developed from skin nodules, and the skin lesions progressed rapidly. Among them, one case had near bone destruction and was amputated after clear diagnosis, one case had lymph node metastasis and pulmonary metastasis, which was clearly diagnosed dead a few months later, one case violated the anal canal after rapid progression and was inoperable, and three patients had a poor prognosis.HIV infected patients with skin lesions and ulcers need to be alerted to the possibility of cSCC, and pathological examination should be performed as soon as possible to clarify the diagnosis and provide timely treatment.

Review

Research progress of diabetes mellitus with latent tuberculosis infection Liu Guizhen, Han Tingting, Chen Qiuqi, Deng Guofang 2023, 8 (4):  85-89.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.017 Abstract ( 122)    PDF (885KB) ( 190 )    Diabetes and tuberculosis are two chronic diseases that pose serious risks to human health, and there is a complex interaction between them. Diabetes not only increases the risk of tuberculosis infection, but also aggravates the severity of tuberculosis and the difficulty of treatment. The comorbidity of diabetes and tuberculosis is increasing worldwide and represents a major public health challenge. Although epidemiologic data on latent tuberculosis infection with diabetes are scarce, evidence suggests that the prevalence of latent tuberculosis infection is twice as high with diabetes as in those without diabetes. To effectively control this dual epidemic, timely screening, diagnosis and preventive treatment of patients with diabetes and latent tuberculosis infection are needed. This article reviews recent advances in the epidemiologic characteristics, interactions, diagnostic methods, and prevention strategies of latent tuberculosis infection with diabetes to provide reference and enlightenment for clinical practice and public health intervention.

New advances in medical imaging diagnosis of AIDS complicated with intracranial tuberculosis Xu Chengzhi, Nong Hengrong 2023, 8 (4):  90-94.  DOI: 10.19871/j.cnki.xfcrbzz.2023.04.018 Abstract ( 93)    PDF (1400KB) ( 137 )    The number of tuberculosis patients in China has increased year by year, AIDS patients with low immunity are more likely to be complicated with tuberculosis, which can worsen their condition and increase the likelihood of mortality. In recent years, there has been a rise in cases of intracranial tuberculosis among HIV patients. These cases are typically diagnosed using immunological tests and imaging techniques. Among them, imaging diagnosis is the first choice for diagnosis of AIDS complicated with intracranial tuberculosis. Through early diagnosis and timely treatment, HIV infection and its complications can be improved. AIDS complicated with intracranial tuberculosis includes, tuberculoma of the brain, and tuberculous brain abscess. Imaging results for HIV intracranial TB are closely linked to the patient's CD4+ T lymphocyte count.When the infected patient has a CD4+ T lymphocyte count below 100 cells/μl, the intracranial TB lesions are predominantly subcortical parenchymal lesions; each type of intracranial tuberculosis has characteristic imaging presentations at different stages. Complications of AIDS complicated with intracranial tuberculosis usually include hydrocephalus, vasculitis, and cerebral infarction. When the CD4+ T lymphocyte count in infected patients is above 100 cells/μl, there is no clear distinction between the presentation of intracranial TB and that caused by simple infection. The aim of this article is to review the advances in diagnostic imaging of intracranial tuberculosis infection in AIDS and to improve the diagnosis of this disease.