Volume 100 ·  Issue 11 ·  2020

Nucleic acid detection is an important means to confirm the diagnosis of novel coronavirus pneumonia, but at present, it is clinically reflected that there is a high proportion of false negative nucleic acid detection. This article will clarify the concept of false negative nucleic acid test and analyze the causes of false negative nucleic acid test. On the basis of nucleic acid detection, supplementing the combined dynamic multiple detections of novel coronavirus-specific IgM/IgG antibodies can significantly reduce the false negatives at the clinical level where there are clinical symptoms and imaging evidence of viral pneumonia, but nucleic acids are tested negative multiple times or always, which is of great significance for the final diagnosis and accuracy evaluation of clinically diagnosed cases.

The National Health and Wellness Commission (hereinafter referred to as the Health and Wellness Commission) issued the guidelines for the diagnosis and treatment of novel coronavirus pneumonia (the fifth edition of the trial). With the continuous awareness and understanding of the disease, the guidelines for the diagnosis and treatment have also been revised. The release of the diagnosis and treatment guidelines (hereinafter referred to as the guidelines) guides us to understand, treat and prevent diseases. Then, what content is updated in the fifth edition of the guidelines issued by the National Health Commission compared with the fourth edition of the guidelines? This article interprets it.

novel coronavirus pneumonia (NCP) is a new type of respiratory infectious disease. Since December 2019, NCP patients have been discovered one after another in Wuhan, Hubei Province, China. With the spread of the epidemic, such cases have also been discovered in other parts of China and abroad. In the practice of first-line clinicians, nearly 20% of NCP patients have coagulation dysfunction, and almost all severe and critical patients have coagulation dysfunction^[1,2]。 Acute inflammatory response caused by severe infection or sepsis can affect the coagulation and fibrinolysis system through various ways, including the decrease of circulating protein C and antithrombin-Ⅲ levels, the upregulation of plasminogen activator inhibitor-1 levels and other factors, which eventually lead to the activation of coagulation cascade and the inhibition of fibrinolysis process, thus promoting thrombosis. In some NCP patients, the disease suddenly deteriorates, the D-dimer is significantly increased, and even sudden death occurs during the progression of the disease. In this regard, special attention should be paid to whether pulmonary thromboembolism (PTE) occurs after deep vein thrombosis (DVT) is shed. It is suggested that in the process of prevention, control and treatment of NCP, attention should be paid to the assessment of the risk of venous thromboembolism (VTE), and effective prevention should be implemented for high-risk patients. Those with sudden clinical manifestations such as oxygenation deterioration, respiratory distress and blood pressure drop should be more alert to the occurrence of PTE and give corresponding treatment in time.

The novel coronavirus pneumonia (NCP), which broke out in China in December 2019, has been included in the national "Class B" infectious disease, and the prevention and control measures of "Class A" infectious disease have been adopted. The treatment medical expert group of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology formulated this document based on the experience of frontline clinical diagnosis and treatment in Wuhan and with reference to relevant domestic and foreign diagnosis and treatment opinions for quick reference in clinical diagnosis and treatment.

To compare diagnostic consistency for chronic insomnia (CI) and obstructive sleep apnea (OSA) between cardiopulmonary coupling (CPC) and polysomnographm (PSG).

Two hundred and twenty-one patients were enrolled from the Department of Sleep Disorders, Chaohu Hospital affiliated to Anhui Medical University from July 2018 to December 2019, and monitored with overnight CPC and PSG simultaneously. According to clinical representations and PSG results, there were 88 males and 80 females with CI and OSA, including chronic insomnia (CI group, 93 cases), OSA (OSA group, 36 cases) and comorbid OSA with CI (COI group, 39 cases). The consistency of sleep and OSA parameters measured with CPC and PSG were analyzed.

(1)For all patients and CI group, the total sleep time (TST), sleep efficiency (SE) and rapid eye movement (REM) sleep time measured by CPC were significantly higher than those measured with PSG, and the wake time after sleep onset (WASO) was significantly lower than that measured with PSG (the specific median comparisons were as follows 420.0 min vs 395.5 min, 93.7% vs 81.8%, 90.0 min vs 37.5 min, 18.0 min vs 63.0 min in CI group, respectively; 414.0 min vs 392.5 min, 91.9% vs 81.9%, 72.0 min vs 34.8 min, 24.0 min vs 58.4 min in all patients, respectively (all P≤0.001). However, in the OSA patients, the TST, SE, WASO, REM sleep time and NREM sleep time measured using two methods were similar (all P>0.05). (2) According to OSA criteria, the consistency between CPC and PSG was fair (κ=0.255). Only CPC has a certain degree of value for OSA screening when the AHI ≥ 20/h (κ=0.580, sensitivity: 0.85, specificity: 0.82, positive predictive value: 0.59, negative predictive value: 0.95, positive likelihood ratio: 4.72).

CPC technology may overestimate the sleep quality of CI patients, and its consistency is fair compared with that of PSG in the diagnosis of OSA.

To observe the role of cerebrospinal fluid (CSF) TP53 gene mutation in lung cancer associated meningitis.

A retrospective analysis was performed on 35 patients diagnosed with lung cancer associated meningitis at the Second Hospital of Hebei Medical University from December 2015 to December 2018.All patients underwent the next-generation sequencing of CSF, and TP53 gene was found to be mutant or wild type, including 23 patients with TP53 mutant type and 12 patients with TP53 wild type. The clinical characteristics, CSF leukocyte, protein, glucose, chloride, Karnofsky performance (KPS) and overall survival were observed.

Headache, nausea and vomiting were the main clinical manifestations in both groups.There were no significant differences in CSF pressure, leukocyte, biochemical indicators and KPS between the two groups. The average time from diagnosis of lung cancer to diagnosis of lung cancer associated meningitis in the TP53 mutant group was significantly shorter than that in the TP53 wild type group (5.79 months vs 25.5 months).The median survival time of patients in the TP53 mutant group from lung cancer diagnosis to the observation endpoint was 19.77 months, while it was 88.73 months in the TP53 wild type group, and the difference was statistically significant (P=0.043).

Mutation in the tumor suppressor gene TP53 can be detected in the CSF of patients with lung cancer associated meningitis. Patients with such mutation have earlier meningeal metastasis and shorter median survival time.

To explore the feasibility of short-term efficacy prognosis prediction model for HCC patients undergoing transcatheter arterial chemoembolization (TACE) based on MRI-based radiomics technique.

A total of 123 patients with liver cancer who received TACE treatment in Lishui Central Hospital from June 2016 to July 2018 were retrospectively collected, including 90 males and 33 females, with an average age of 24-83 (58±10) years. All the patients were pathologically confirmed as hepatocellular carcinoma and underwent MRI scan before surgery.All patients were followed up 3-4 months after TACE, and further divided into training group (n=85, 42 of which were effective and 43 cases were ineffective) and the validation group (n=38, 19 of which were effective and 19 were ineffective) according to the modified response evaluation criteria in solid tumors (mRECIST). There was no statistical difference in the general information between the two groups of patients, which was comparable. Then, preoperative T₂WI images were used for radiomics analysis, texture parameters were screened based on R language, and short-term efficacy prediction model of TACE for training group and verification group was constructed.

T₂WI image analysis of each patient received 396 different texture parameters, and further used Lasso dimensionality reduction and 10 times cross-validation screening to obtain 5 characteristic texture parameters, specifically stdDeviation, ClusterProminence_angle135_offset4, Correlation_angle135_offset4, Inertia_angle135_offset4, InverseDifferenceMoment_angle45_offset4. According to the above five texture parameters and their corresponding coefficient values, the corresponding radiomics scores (Radscore) were calculated, and the prediction models of the training group and the verification group were further constructed.It was found that the area under the ROC curve of the training group was 0.812 (95%CI: 0.722-0.901), the sensitivity and specificity were 83.7% and 69.0%, respectively. The area under the ROC curve of the validation group was 0.801 (95%CI:0.654-0.947), and the sensitivity and specificity were 89.5% and 63.2%, respectively.

The constructed TACE prediction model in the present study has high prediction accuracy, sensitivity and specificity.The short-term efficacy prognosis prediction model for HCC based on MRI is constructed, stable and reliable.

To observe the safety and efficacy of lenvatinib for the treatment of medium-advanced hepatocellular carcinoma.

A total of 36 patients with medium-advanced hepatocellular carcinoma from the First Medical Center of the Chinese PLA General Hospital were retrospectively analyzed from January 2018 to May 2019. All patients had shown tumor progression after at least 2 sessions of TACE. The patients were consisted of 30 males and 6 females with age range of 35 to 76 (54±10) years. Patients received orally administered lenvatinib at a dose of 12 mg once daily for patients ≥ 60 kg and 8 mg once daily for patients<60 kg. According to modified RECIST criteria the tumor response, disease control rate, overall survival and progression free survival were evaluated once every 6-8 weeks. The adverse events were recorded.

No patient was in complete response, 2 cases (5.7%) in partial response, and 5 cases (14.3%) in stable disease, respectively. Disease control rate was 20.0% (7/35), the overall survival was 11.5 months, and the progression free survival was 5.3 months. The overall incidence of adverse events was 66.7% (24/36). The most frequent adverse events were hypertension, proteinuria, hand-foot skin reaction and abdominal distension.

Lenvatinib can extend the overall survival in a percentage of medium-advanced hepatocellular carcinoma patients who were unresectable and refractory to TACE. Although the incidence of adverse events is high, most of them are mild and reversible.

To evaluate the early diagnostic value of various indicators in the simplified JSTH score criteria for sepsis-associated disseminated intravascular coagulation (DIC).

A retrospective study was conducted. Patients admitted to Intensive Care Unit (ICU) of the Second Affiliated Hospital of Kunming Medical University from January in 2017 to December in 2018 were enrolled. Totally of 365 patients were recruited, with 224 males and 132 females. The simplified JSTH score criteria was used to diagnose DIC. The patients were divided into sepsis with DIC group and sepsis without DIC group according to the diagnostic criteria of sepsis. Platelet (PLT), fibrin degradation products (FDPs), prothrombin time (PT), antithrombin (AT), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores and the simplified JSTH scores were recorded on the first ICU day. Correlation analyses were conducted.Receiver operating characteristic (ROC) curves for diagnosis of DIC with each indicator were drawn to evaluate the diagnostic efficiency and predictive ability of 28-day mortality.

According to the simplified JSTH score, 143 cases of sepsis complicated with DIC were diagnosed. There were significant differences in PLT, FDP, AT, PT, APACHE Ⅱ score, SOFA score, 28-day mortality rate between the two groups (all P<0.01). It was shown by Pearson correlation analysis that the criteria has the best correlation with APACHEⅡ score and SOFA score (r=0.496 and 0.612, both P<0.01). The correlation between PLT and APACHE Ⅱ score or SOFA score was the best (r=-0.440 or-0.568, both P<0.01). It was shown by ROC curve that area under ROC curve (AUC) of PLT was 0.933, and the sensitivity and specificity was 93.0% and 85.0%, respectively. The 28-day mortality was predicted by using the indicators in the criteria. The AUG of AT was 0.813, and both the sensitivity (81.6%) and specificity (73.6%) were the highest.

The simplified JSTH score criteria can be used for early diagnosis of sepsis-associated DIC and it is positively correlated with the severity of the disease. The correlation between PLT and the severity of disease is the best, and early diagnosis efficiency of PLT is the strongest. AT has a good predictive value for 28-day mortality.

To investigate the differences of the radiographic and clinical outcomes after posterior correction surgeries between degenerative scoliosis (DS) patients with type B and type C coronal pattern.

From March 2010 to August 2017, the clinical data of 38 patients (type B: 24; type C: 14) who were treated with posterior correction surgeries for DS were retrospectively reviewed. Radiographic parameters including Cobb angle of main curve, coronal imbalance (CI), lumbar lordosis (LL), global kyphosis (GK) and sagittal vertical axis (SVA) were measured on standing anteroposterior and lateral radiographs of the whole spine before and after surgery. Patient-reported outcomes were evaluated by using the visual analogue scale (VAS), the Oswestry disability index (ODI) and SF-36 questionnaire. The independent t-test was applied to compare the difference for statistical analysis.

There was no significant differences between the two groups in terms of age, gender, follow-up duration, preoperative curve magnitude, severity of CI, sagittal malalignment and surgical strategies (all P>0.05). In patients with type B coronal pattern, the main curve was corrected from 44°±19° before surgery to 19°±7° immediately after surgery (t=8.496, P<0.001) and to 19°±6° at the last follow-up (t=-0.657, P=0.518). In patients with type C coronal pattern, the main curve was corrected from 43°±9° before surgery to 21°±4° immediately after surgery (t=13.537, P<0.001) and to 21°±5° at the last follow-up (t=-0.186, P=0.856). No significant difference of Cobb angle of main curve was found between the two groups either before the operation or immediately post operation (all P>0.05). In addition, significant improvement of CI was observed after surgery in both groups and the correction was maintained well at the last follow-up. However, patients with type C coronal pattern had greater CI than that in those with type B coronal pattern immediately post operation (t=-2.401, P=0.022) and at the last follow-up (t=-2.659, P=0.012). At the last follow-up the scores of SF-36 questionnaire, ODI and VAS showed significant improvement in both groups (all P<0.05).

Posterior correction surgery could provide remarkable radiographic and clinical outcomes in DS patients with type B and type C coronal pattern, and DS patients with type B coronal pattern could achieve a more satisfied coronal balance after surgery.

To analyze the association between postoperative hypoalbuminemia and poor wound healing, and to evaluate whether postoperative supplementation of human serum albumin can improve postoperative wound healing after lumbar internal fixation surgery.

From January 2014 to December 2018, 602 patients who underwent lumbar internal fixation surgery in the Department of Orthopedics, Zhujiang Hostiptal of Southern Medical University were identified. There were 250 males (41.5%) and 352 females (58.5%), with an average age of (60±12) years. All patients′ clinical records were reviewed, including demographics data, comorbidity data, preoperative serum laboratory values, intraoperative factor, postoperative serum laboratory values and wound healing, and the incidence rate of poor wound healing was calculated. The statistical analyses were performed with R software and Empower(R) to analyze the factors related to poor wound healing. Multiple logistic regression models were performed with adjustment for the potential confounders to evaluate the effect of postoperative hypoalbuminemia and supplementation of human serum albumin on the development of poor wound healing.

Poor wound healing occurred in 51(8.47%) patients. After adjusting for the confounding factors, multiple regression analysis showed that there was no correlation between postoperative albumin levels and poor wound healing(OR=1.00, 95%CI: 0.91-1.10, P=1.000). Compared with patients with postoperative normal albumin level, postoperative hypoalbuminemia would increase the risk of poor wound healing by 13% (OR=1.13, 95%CI: 0.47-2.70, P=0.787). There was no correlation between supplementation of human serum albumin and poor wound healing in patients with normal albumin levels or postoperative hypoalbuminemia (P>0.05).

There is no correlation between postoperative hypoalbuminemia and poor wound healing after lumbar internal fixation surgery. Postoperative supplementation of human serum albumin can′t improve wound healing.

To detect gene mutation sassociated with deafness in four Waardenburg syndrome (WS) type Ⅱ patients, and to explore the possible mechanism of molecular genetics.

All patients with WS were identified at the genetic and prenatal diagnosis center of the First Affiliated Hospital of Zhengzhou University from August 2015 to December 2018.Clinical materials and peripheral blood were collected from patients and family members. The genes associated with deafness of the patients were tested by next generation sequencing(NGS). And suspected mutations were verified by Sanger sequencing.

All patients carried heterozygous mutations in SOX10, they were c.355_356insTCAGGCAGCGC, c.1106_1107insTGGGGCCCCCCACACTA, c.511T>C (p.Y171H), c.91_100del. According to the guidelines for genetic variation of the Amercian College of Medical Genetics and Genomics (ACMG), three frameshift mutations were pathogenic mutations, one missense mutation was likely pathogenic mutation.

Application of next generation sequencing technologies make gene diagnosis of Waardenburg syndrome efficiently and accurately.

To explore the feasibility of clinical factors to predict the pathological complete response after neoadjuvant chemoradiotherapy in rectal cancer.

A retrospective analysis was performed on clinical factors of 162 patients with rectal cancer, who underwent neoadjuvant chemoradiotherapy in the General Hospital of People′s Liberation Army from January 2011 to December 2018.According to the postoperative pathological results, the patients were divided into pathological complete response (pCR) group and non-pathological complete response group (non-pCR group) to check the predictive clinical factors for pCR.

Twenty-eight cases achieved pCR after neoadjuvant chemoradiation (17.3%, 28/162). Univariate analysis showed that patients with higher differentiation (P=0.024), tumor occupation of the bowel lumen≤1/2 (P=0.006), earlier clinical T stage (P=0.013), earlier clinical N stage (P=0.009), the time interval between neoadjuvant chemoradiotherapy and surgery>49 days (P=0.006), and maximum tumor diameter≤5 cm (P=0.019) were more likely to obtain pCR, and the differences werestatistically significant. Multivariate analysis showed that tumor occupation of the bowel lumen≤1/2 (P=0.01), maximum tumor diameter≤5 cm (P=0.035), and the interval>49 days (P=0.009) were independent factors in predicting pCR after neoadjuvant therapy.

Tumor occupation of the bowel lumen, maximum tumor diameter, and the time interval between neoadjuvant chemoradiotherapy and surgery can predict the pCR in rectal cancer.

To investigate the accuracy and safety of ultrasound-guided puncture biopsy and enhanced MRI in the diagnosis of alpha-fetoprotein (AFP) negative liver occupying lesions.

Retrospective analysis was conducted on the clinical data of 59 patients with liver occupying lesions who were admitted to the Fifth Medical Center of the PLA General Hospital from February 2015 to November 2017 and received ultrasound-guided coarse needle biopsy with AFP negative. Among them, 35 cases were males and 24 cases were females, the age range was from 25 to 67 years,with an average age of (51±3) years. Serum AFP in all patients were within the normal range. The difference between the pathological results of ultrasound-guided biopsy and the diagnosis of lesions by enhanced MRI was compared, and the diagnostic value of ultrasound-guided biopsy was analyzed. Meanwhile, complications during and after puncture were recorded. SPSS 24.0 software was used for statistical analysis.The measurement data were expressed as ±s and enumeration data were expressed as rate,if the P value was less than 0.05, it indicated that the difference was statistically significant.

There were 32 malignant cases and 27 benign cases based on the final pathological diagnosis. The sensitivity and specificity of ultrasound-guided needle biopsy were 100%, in contrast, the enhanced MRI was 96.9% and 81.5%, respectively, with the former significantly higher than the latter. There were no abdominal bleeding,infections and pneumothoraxduring and after the puncture.

Ultrasound-guided puncture biopsy and enhanced MRI are both safe for the diagnosis of AFP negative liver occupying lesions,but the former is more sensitive than the latter.When the clinical symptoms of the patient are relatively mild and there is uncertainty in the diagnosis due to the lack of specific enhanced imaging, ultrasound-guided puncture is more conducive to identifying the nature of the lesion.

In this study, the occurrence rate and morphological characteristics of the transparent septal cavity (CSP) were compared between schizophrenic patients and healthy subjects during physical examination at the same time, and the brain MRI was examined. Three-dimensional magnetization preparation fast gradient echo (MPRAGE) sequence was used to obtain T₁Structural images were used to detect the anterior-posterior diameter of CSP. It was found that the anterior-posterior diameter of CSP and the number of large CSP cases in schizophrenia were significantly increased, but the number of small CSP cases in the two groups was not significant, which may be caused by the abnormal development of neural circuits in the limbic system of schizophrenia patients, which can be used as the basis of the hypothesis of neurodevelopmental etiology.

A patient with double antibody positive autoimmune encephalitis was diagnosed as autoimmune encephalitis. The clinical manifestations were facial-brachial dystonia, hyponatremia and disturbance of consciousness. The serum anti-LGI1 antibody and anti-NMDAR antibody were positive. The symptoms improved after treatment with glucocorticoid and gamma globulin, and the antibody was negative after re-examination.

Cardiovascular disease is the result of dysregulation of gene regulatory networks in the cardiovascular system, whereas non-coding RNA plays a key regulatory role in its development, physiology, and gene expression in disease pathophysiology. Non-coding RNA expression has cell and organ specificity. In a variety of human tissues and body fluids, especially blood, urine or cerebrospinal fluid, there are non-coding RNAs related to diseases. They are highly stable, easy to obtain and detect, and have high sensitivity and specificity for some diseases, and have the potential to become a biomarker for risk stratification, diagnosis and prognosis of cardiovascular diseases. At present, the FDA has approved lncRNA prostate cancer antigen 3 for routine clinical diagnosis of prostate cancer. In terms of treatment, a variety of drugs targeting miR-21 and miR-34 have entered clinical trials, which improve patient outcomes and are well tolerated. Therefore, non-coding RNA is worth looking forward to in its application to elucidate the pathogenesis of certain cardiovascular diseases, become novel biomarkers and targeted therapeutic drugs, etc.

Currently, there exist multiple maps of skin segments based on studies of severe defects. At the same time, textbooks and literature are still replicating these highly variable and conflicting maps without modification, without mentioning the overlap and variability of derma-segments. In teaching and clinical practice, cutaneous segment mapping helps medical students to understand spinal nerve distribution, clarify neurological or spinal cord lesion segments, evaluate anesthetic segments and effects, but its true clinical value is still controversial. In this paper, the evolution history, variability and clinical value of dermatogram are reviewed.