Current Issue

2017 Vol.2 No.2 Published:30 May 2017

Forum of Specialist

The progress of epidemiology and diagnosis of Yellow Fever LING Yun, LU Hong-zhou 2017, 2 (2):  65-67.  Abstract ( 149)    PDF (837KB) ( 633 )    After the outbreak of yellow fever was reported in Angola 2016 (March), imported cases were firstly reported in Beijing, Shanghai and Fujian. Yellow fever remains as an important threat in sub-Saharan Africa and South America. The estimative of incidence may be low as the incompleted reported system in Africa. The diagnosis of yellow fever depends on the epidemiology, clinical manifestation, and virological tests. It is important to control yellow fever spreading by improving epidemiology monitors, virologic detection, and increasing supplies of vaccine in cooperation with regions and countries.

Original Articles

Study of virtual touch tissue quantification and aspartate aminotransferase to platelet ratio for hepatic fibrosis in patients with Chronic Hepatitis B combined with nonalcoholic fatty liver LI Yu-dan, DONG Chang-feng, LIU Ying-xia, LI Han-ying, CHEN-Xin, LUO Yong-fang, HUANG Wei-qiang, LU Pu-xuan 2017, 2 (2):  68-71.  Abstract ( 283)    PDF (1535KB) ( 528 )    Objective To compare the diagnostic value of virtual touch tissue quantification (VTQ) and aspartate aminotransferase to platelet ratio index(APRI) for noninvasive assessment of hepatic fibrosis in patients with Chronic Hepatitis B combined with non-alcoholic fatty liver (NAFL). Methods One hundred and sixteen patients with HBV infection were recruited from May 2012 to May 2015 in our hospital.They were divided into the hepatic fibrosis group and hepatic fibrosis combined with NAFL group according to the pathological results, and all subjects were examined by VTQ and APRI systems.In addition, sex,age,and etc were also included as covariates. 39 healthy volunteers were selected as the control group, who accepted the same examinations. Results For the three groups results,there were statistical differences（P<0.05）in sex,age,BMI,thickness of soft tissue,oblique diameter of right lobe of liver(ODRL),thickness of spleen and APRI.The statistical difference of VTQ were significant (P<0.05)among these three groups by one-way analysis of variance(ANOVA), but there was no statistical difference in VTQ between the control group and the hepatic fibrosis combined with NAFL group（P>0.05） by covariance analysis correction.The difference of VTQ value and APRI between different pathological stages of hepatic fibrosis was statistically significant（P<0.001）, with the correlation coefficients of 0.721 and 0.618 respectively. Conclusions Compared with APRI ,VTQ is more accurate to evaluate hepatic fibrosis in patients without NAFL. VTQ provides better correlation with the pathological results, but when hepatic fibrosis combined with NAFL, VTQ can't truly reflect the presence of hepatic fibrosis.APRI is a better indicator in this situation.

The relationship between clinical parameters and liver histology in 611 patients with CHB LAN Yun-cui, LIU Xi, DING-Li, ZHOU Yao-yong, XIA Jin-yu 2017, 2 (2):  72-75.  Abstract ( 115)    PDF (868KB) ( 479 )    Objective To study the relationship between clinical parameters and liver histology in patients with chronic hepatitis B(CHB).Methods The clinical parameters and the results of liver pathology of 611 patients with CHB who underwent liver biopsy were analyzed retrospectively.Statistical analysis was performed by using t test,ANOVA analysis,Chi square analysis,etc. Results There was significant correlation of ALT,AST,APRI index and liver inflammation among the 611 patients with CHB(P<0.05).The higher ALT,AST,APRI index,the more severe degree of liver inflammation,which was not affected by the state of HBeAg or the level of HBV-DNA;In HBeAg positive group or HBV-DNA≥20,000IU/ml group,the G3~4 ratio of patients older than age 35 was above 50%(P<0.05).The higher AST, APRI index, the more severe degree of liver fibrosis.In patients older than age 35,the proportion of S3~4 reached 76.5%(P<0.05). Conclusion In a sense,ALT,AST,APRI index and age can predict the liver histological features,keeping some patients from liver puncture.If HBeAg was positive or HBV-DNA was higher than 20000IU/ml,when patients older than age 35,the Intrahepatic histopathological changes have been more obvious,it is recommended to start antiviral therapy in time.

The influence of HIV infection on the balance of peripheral gut-homing Tc1/Treg and Tc17/Treg PENG Qiao-li, CHEN Lin, TANG Xian, JIANG Qiang, XIAO Jin-feng, HE Yun, WANG Hui 2017, 2 (2):  76-80.  Abstract ( 108)    PDF (1124KB) ( 585 )    Objective To investigate the influence of HIV infection on the balance of peripheral gut-homing CD8+T cell Tc1/Treg and Tc17/Treg. Methods 62 asymptomatic HIV infected patients as well as 41 healthy volunteers were recruited in this study. The patients were divided into two groups, which were the untreated and the treated group. The whole blood surface and intracellular cytokine staining were detected by BD FACSCanto, after that, the expression of gut-homing CD8+T cell subpopulation Tc1, Tc17 and Treg were analyzed by FACSDiva software and compared the differences of Tc1/Treg and Tc17/Treg ratio among different groups and the correlation with CD4 count and viral load. Results The ratio of peripheral gut homing Tc1/Treg increased significantly after HIV infection (24.68+16.12 vs 11.57±4.75,P<0.001), ART treatment can bring the ratio to the nearly normal level（15.43+13.90 vs 11.57±4.75,P=0.617）. Meanwhile, the ratio of peripheral gut homing Tc17/Treg showed a significant decrease（0.61±2.44 vs 1.02±0.95,P<0.001）. ART can not restore this ratio to normal (0.57±0.78 vs 0.61±2.44, P<0.001),which was still much lower than healthy control（0.57±0.78 vs 1.02±0.95,P<0.001）.The correlation analysis showed that the ratio of peripheral gut-homing Tc1/Treg was negatively correlated with viral load（r=-0.633,P<0.001）, but no relationship with CD4 count was found. Different to Tc1/Treg, the ratio of gut-homing Tc17/Treg were negatively correlated with viral load （r=-0.387,P=0.034）and positively with CD4 count（r=0.404,P=0.027）. Conclusion The peripheral gut-homing T cell functional subpopulation Tc1, Tc17 and Treg break homeostasis in vivo after HIV infection, which is correlated with disease progression. Antiretroviral therapy can not reconstitute this imbalances completely.

Analysis of the correlation between 2-5AS activity and Stat1/Stat2 levels in PBMC of patients suffered with chronic HCV SU Dong-na, WU Shi-pin 2017, 2 (2):  81-84.  Abstract ( 101)    PDF (1114KB) ( 507 )    Objective To investigate the correlation between 2’, 5’-Oligoadenylate synthetase （2-5AS） activity and Stat1/Stat2 levels in peripheral blood mononuclear cells （PBMC）of patients suffered fromchronic hepatitis C virus （HCV）. Methods PBMC from 60 HCV patients were extracted and examined Then PBMC in each sample was optionally divided into two groups, which were the control group and the experimental group. PBMCs in experimental group were cultured in vitro for 24 hours at the presence of 1000 IU/ml of interferon alpha （IFN-α）, while PBMCs in control group were cultured without IFN-α. 24 hours later, the activity of 2-5AS and levels of Stat1/Stat2 were assessed. The correlations between basal 2-5AS activity and changes of 2-5AS, Stat1 and Stat2 were evaluated. Results Compared with control group, activity of 2-5AS in experimental group was significantly elevated（P<0.05）. And in experimental group, similar to the elevation of 2-5AS activity, Stat1/Stat2 levels were also significantly up-regulated（P<0.05）. Conclusions Basal 2-5AS activity was negatively correlated with the changes of Stat1 after IFN-α stimulation（P<0.05）, while there was no obvious correlation between basal 2-5AS and Stat2 level after IFN-α stimulation（P>0.05）.

The role of diagnostic indexes in tuberculous meningitis patients HUO Yong-jun, ZHAN Yun-fei, LIU Guo-li, YANG Xiao-guang, Hou Dai-lun 2017, 2 (2):  85-88.  Abstract ( 311)    PDF (1061KB) ( 580 )    Objective To investigate the role of partial diagnostic indexes in TBM patients. Method TBM patients(group TBM, n=40), non-TBM patients(group NTBM, n=40, 20 viral meningitis patients and 20 cryptococcal meningitis patients) were enrolled in the study. The blood T-SPOT.TB, CSFADA and CSFTBAb were examined and the clinical data were collected. The data were analyzed by the software EmpowerStats 2.14.9, P<0.05 was considered to be statistical significant. Results The sensitivity, specifity, positive predictive values(PPV) and negative predictive values(NPV) of blood T-SPOT.TB, CSFADA and CSFTBAb were respectively 0.600, 0.950, 0.923, 0.704;0.500, 0.950, 0.909, 0.655 and 0.200, 0.975, 0.889, 0.549. The sensitivity of blood T-SPOT.TB and CSF ADA was higher than the CSFTBAb(P<0.001). The specifity, PPV and NPV of the blood T-SPOT.TB, CSFADA and CSFTBAb had no statistical difference(P>0.05). The positive rates of CSF mycobacterium tuberculosis PCR and cultivation(5.0%, 2/40; 2.5%, 1/40) showed no statistical significance(χ2=0.000, P=1.000). The cranial magnetic resonance showed meningeal enhancement occupied 62.5%(25/40), meningeal non-enhancement occupied 37.5% (15/40), hydrocephalus occupied 15.0%(6/40) and tuberculomas occupied 17.5%(7/40). Conclusions Blood T-SPOT.TB and CSFADA have higher diagnostic significance than CSFTBAb in the diagnosis of TBM. The cranial image is important in the diagnosis, therapy and prognosis of tuberculous meningitis.

Influence of propofol and ketamine on postoperative T lymphocyte subtype and tubercle bacillus replication in tuberculosis mice LIU Min-qiang, HAN Ya-kun, YU De-hui, MA Ming-fei, SHI Hao-wen, HE Ren-liang 2017, 2 (2):  89-92.  Abstract ( 107)    PDF (1207KB) ( 593 )    Objective To compare the influence of propofol and ketamine on postoperative T lymphocyte subtype and tubercle bacillus replication in tuberculosis mice. Methods 36 mice were enrolled in this study, and were randomly divided into propofol group (group P), ketamine group (group K), and control group (group C) with 12 cases each. Tuberculosis model was established in all mice 6 weeks before the test. Blood samples were taken from the tail vein at 30 minutes before operation, 1 day after the operation and 3 days post-operation, CD3+T lymphocyte, CD4+T lymphocyte, CD4+/CD8+T lymphocyte ratio, and interferon gamma (IFN-γ) expression were calculated with flow cytometer. Lung slices and tubercle bacillus culture were observed at 3 weeks and 6 weeks after surgery with 6 mice in each group. Results Compared with group C, CD3+T lymphocyte, CD4+T lymphocyte, CD4+/CD8+T lymphocyte ratio, and IFN-γ expression in group P and group K decreased apparently after surgery, and tuberculosis bacterium count was higher (P<0.05). Compared with group K, CD3+T lymphocyte, CD4+T lymphocyte levels were higher but IFN-γ lower 3 days postoperative in group P (P <0.05), but there was no difference about postoperative tubercle bacillus replication in these two groups. Conclusion Both propofol and ketamine could inhibit postoperative T lymphocyte's function in tuberculosis mice, and tuberculosis bacterium number increase. However, the influence on T lymphocyte subtypes were not synchronously, meaning further researches are needed.

The study of the expression of CXCL9 detected by ELISA in patients with tuberculosis and its application in clinic XIE Shu-zhi, SHENG Xing, CHEN Qi, ZHANG Ming-xia, DENG Guo-fang, YANG Qian-ting, DENG Qun-yi 2017, 2 (2):  93-95.  Abstract ( 129)    PDF (903KB) ( 524 )    Objective To detect the expression of CXCL9 in plasma from different groups of people by ELISA and to evaluate its potential in tuberculosis diagnosis. Method CXCL9 were detected by ELISA in the plasma from 16 cases of tuberculosis and 20 healthy controls, 20 cases of LTBI as well as 16 cases of TB. And ROC curve were drawn to evaluate the efficiency of CXCL9 in diagnosis of tuberculosis. Result The expression of CXCL9 in the plasma of those with tuberculosis was significantly higher than those are healthy controls of LTBI (P<0.001). The level of CXCL9 decreased significantly after anti- tuberculosis treatment. When CXCL9 was used to distinguish from tuberculosis to HC and tuberculosis, the value of AUC was 0.9125, with a sensitivity of 75% and a specificity of 90%. When CXCL9 was used to distinguish TB from LTBI, the value of AUC was 0.8188, with a sensitivity of 75% and a specificity of 80%. Conclusion The expression of CXCL9 in TB was high. It could be used as a biomarker in diagnosis of tuberculosis.

Characteristics and follow-up value of MRI in cerebral sparganosis YANG Chen, CHENG Bing-xue, HE Yu-lin, ZHOU Li 2017, 2 (2):  96-99.  Abstract ( 133)    PDF (1269KB) ( 589 )    Objective To explore MRI characteristics and follow-up value of cerebral sparganosis. Methods The clinical and MRI imaging data of 16 patients with cerebral sparganosis proved by ELISA in our hospital were retrospectively analyzed. Results The patients consisted of 11 males and 5 females, with an average age of 27 year-old (10-54 year-old). 14 patients have ingested uncooked frogs,while 12 patients have drank cyclops polluted water. All 16 patients with cerebral sparganosis received MRI scans before clinically verified and in the follow-up respectively. The results showed that 28 lesions were found in 16 patients while there were 6 patients with solitary lesions and 10 patients with multiple and asymmetrical lesion. The locations of these lesions were as following: 24 lesions in cerebral hemisphere, 2 lesions in cerebellar hemisphere and 2 lesions in brain stem. The lesions were slight hypointense on T1WI, hyperintense on T2WI and FLAIR, surrounded by edema but without remarkable occupied effect. Enhanced MRI showed characteristic patterns such as peripheral ring,tortuous beaded, serpiginous tubular shape,or multiple enhancements tangled as "string-kont shape". Among those 9 patients who received follow-up MRI scan, morphological and location changes of lesions emerged in 3 patients, while new additional lesions occurred in 2 patients and the lesion vanished in 1 patient. Conclusions MRI characteristic enhancements and the follow-up could provide additional information to the diagnosis of cerebral sparganosis. To diagnose the cerebral sparganosis, MRI enhancement scans, follow-up scans and clinical histories should be referred to.

Imaging analysis of five patients with hepatic tuberculosis with literature review WANG Xin, JIANG Cheng-cheng, LI Yong-gang 2017, 2 (2):  100-103.  Abstract ( 311)    PDF (1605KB) ( 828 )    Objective To analyze the clinical and imaging features of hepatic tuberculosis, and to review the common modalities and the main imaging findings of the disease. Methods To further understand the diversity of the image performance, CT and MRI findings of five patients with pathological confirmed hepatic tuberculosis were retrospectively analyzed combined with the literature reviews. Results There were 3 types of hepatic tuberculosis: ① Hepatic serous type(n=1), which showed multiple nodular lesions with low density and no enhancement;② Liver parenchymal type(n=3): including miliary subtype (n=1), which showed diffuse liver enlargement, low density and heterogeneous enhancement of liver parenchyma. Nodular subtype(n=1), one with nodular calcification on CT scan. Cystic subtype(n=1) showed cyst-like low density with ring-shaped calcifications;③ Tuberculous cholangitis(n=1), presented with biliary ducts dilatation and enhanced. Conclusions The clinical and imaging manifestations of liver tuberculosis are diverse and can be easily misdiagnosed. The remaining 3 types of hepatic tuberculosis of CT and MRI features showed some characteristics, especially with calcifications, which could help us make the diagnosis of hepatic tuberculosis.