Volume 100 ·  Issue 23 ·  2020

Since December 2019, cases of novel coronavirus pneumonia (COVID-19) have been reported in various provinces, municipalities and autonomous regions in China and many countries around the world^[1,2,3]。 The disease is more common with mild symptoms, but the mortality rate of elderly and frail patients is high^[4]。 The diagnosis of COVID-19 mainly relies on nucleic acid testing of novel coronavirus (2019-nCoV, hereinafter referred to as novel coronavirus)^[4]。 As an acute respiratory infectious disease, COVID-19 has been included in the Class B infectious disease stipulated in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases, and is managed as a Class A infectious disease^[4]。 On 11 March 2020, the WHO determined that COVID-19 had constituted a global pandemic. At present, the COVID-19 epidemic situation in China has stabilized, but considering asymptomatic infection, recurrence after treatment, and overseas imports, the prevention and control task cannot be neglected^[5,6]。

To explore the value of magnetic resonance imaging (MRI) texture analysis in evaluating renal allograft injury.

A retrospective review was performed on sixty-six patients who underwent allograft renal transplantation (42 males, 24 females; age range, 22-63 years; mean age, (40±10) years) between November 2013 and December 2016. All the patients were divided into three groups according to their eGFR on the day of MRI examination: normal renal allograft function (nRAF) group (n=15), mild to moderate renal allograft injury (mRAI) group (n=18), and severe renal allograft injury (sRAI) group (n=33). All the patients underwent conventional T₂ weighted image (T₂WI), susceptibility weighted imaging (SWI), and blood-oxygen level dependent (BOLD) MRI examination. MRI texture features of renal allograft were extracted. The texture features based on T₂WI, SWI, and BOLD with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05)and also with the highest Z value for Boruta algorithmwere selected. The diagnostic performance of the selected texture features in differentiating the three groups was assessed by receiver operating characteristic (ROC) curve analysis.

T₂WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05) and also with the highest Z value for Boruta algorithm were selected. The AUC for T₂WI_Perc.50%, SWI_Perc.01%, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the mRAI group was 0.785, 0.720, and 0.700. The AUC for T₂WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the sRAI group was 0.687, 0.733, 0.784, and 0.737.The AUC for BOLD_S(4,4) Contrast in differentiating the mRAI group with the sRAI group was 0.667.

MRI texture analysis can provide valuable information for evaluating renal allograft injury.

To investigate the associated factors of different dimensions of fatigue in elderly patients with rheumatoid arthritis (RA).

A cross-sectional analysis was performed in the elderly outpatients with RA (age ≥ 60 years) in the First Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2019. Fatigue was measured by Multidimensional Fatigue Inventory-20 (MFI-20) and 36-item Short Form Health Survey-Vitality (SF-36-VT). Physical fatigue and mental fatigue were subsequently measured by MFI-20 subscales.

A total of 104 patients were included. Male-to-female ratio was 1∶3.3. The average age was (68±6) years. The MFI-20 score and SF-36-VT score were 60±14 and 64±20, respectively. The score of physical fatigue measured by MFI-20 was 14±3, and mental fatigue scored 10±4 (P<0.001). Arthralgia, disease activity, disability, insomnia, depression and anxiety were correlated with fatigue assessed by MFI-20 (correlated coefficient: 0.48-0.62). Multivariable regression analysis showed that arthralgia and depression were associated with physical fatigue (Standardized regression coefficients were 0.44 and 0.38, respectively). Insomnia, depression and anxiety were associated factors of mental fatigue (Standardized regression coefficients were 0.20, 0.32 and 0.24, respectively).

Elderly patients with RA experiencehigh level of fatigue, mainly presenting as physical fatigue. Arthralgia and depression mainly affect physical fatigue, and arthralgia is a critical factor. Insomnia, depression and anxiety are associated with mental fatigue.

To investigate the detection rate, population features and in vitro antifungal drug susceptibility of Candida glabrata in patients with oral candidiasis.

The saliva fungi culture cases and the ratio of Candida glabrata in patients with oral candidiasis were analyzed during 2014—2018. Fungal species were identified by CHROMagar Candida chromogenic medium and API 20C AUX yeast identification kit. Sixty strains with cfu≥200/ml were collected and performed the in vitro antifungal susceptibility tests by using ATB FUNGUS 3 susceptibility kit.

The number of patients with oral candidiasis was 12 401 and the ratio of Candida glabrata was 3.44% (427/12 401) from 2014 to 2018. The positive ratio of infection increased with age increasing.The positive rate of female aged 41 to 50 years old began to increased. Female aged more than 50 years old subgroups demonstrated the tendency towards increased positive rates with increasing age. It was found out through clinical data analyzing that the patients with oral candidiasis were the most and oral lichen planus, Sjögren′s syndrome and xerostomia carrying high quantity ratios of infection. Candida glabrata had highest resistance(8.3%) to the fluconazole, 6.7% of the isolates were of non-WT phenotype to itraconazole and voriconazole, all of the isolates were of WT phenotype to amphotericin B.

The ratio of infection in the patients with oral candidiasis increased with age increasing and the olders are susceptible to infection. Candida glabrata has a certain resistance to azoles and clinically reasonable use of antifungal drugs according to the results of drug susceptibility is very important.

To determine whether 60 Gy is superior to standard 50 Gy for definitive concurrent chemoradiation(CCRT) in esophageal squamous cell carcinoma (ESCC) using modern radiation technology in a phase Ⅲ prospective randomized trial.

From April 2013 to May 2017, 331 patients from 22 hospitals who were pathologically confirmed with stage ⅢA-ⅣA ESCC were randomized to 60 Gy or 50 Gy with random number table. Total of 305 patients were analyzed, including 152 in 60 Gy group and 153 in 50 Gy group. The median age was 63 years, 242(79.3%) males and 63(20.7%) females. The median length of primary tumor was 5.6 cm. The clinical characteristics between two groups were comparable. All patients were delivered 2 Gy per fraction, 5 fractions per week. Concurrent weekly chemotherapy with docetaxel (25 mg/m²) and cisplatin (25 mg/m²) and 2 cycles consolidation chemotherapy with docetaxel (70 mg/m²) and cisplatin (25 mg/m², d1-3) were administrated. The primary endpoint was local/regional progression-free survival (LRPFS). The data were compared with Pearson chi-square test or Fisher′s exact test.

At a median follow-up of 27.3 months, the disease progression rate was 37.5% (57/152), 43.8% (67/153) in the high and standard-dose group, respectively (χ²=1.251, P=0.263). The 1, 2, 3-year LRPFS rate was 75.4%, 56.8%, 52.1% and 74.2%, 58.4%, 50.1%, respectively (HR: 0.95, 95%CI: 0.69-1.31, P=0.761). The 1, 2, 3-year overall survival rate was 84.1%, 64.8%, 54.1% and 85.4%, 62.9%, 54.0%, respectively (HR: 0.98, 95%CI: 0.71-1.38, P=0.927). The 1, 2, 3-year progression-free survival rate was 70.8%, 54.2%, 48.5% and 65.5%, 51.9%, 45.1%, respectively (HR: 0.93, 95%CI: 0.68-1.26, P=0.621). The incidence rates in toxicities between the two groups were similar except for higher rate of severe pneumonitis in high dose group (χ²=11.596, P=0.021).

The efficacy in disease control is similar between 60 Gy and 50 Gy using modern radiation technology concurrent with chemotherapy for ESCC. The 50 Gy should be recommended as the regular radiation dose with CCRT for ESCC.

To analyze clinical characteristics of intracranial vessel involvement in Takayasu′s arteritis (TA).

Retrospectively analyzed 135 hospitalized TA patients′ clinical data in Beijing Anzhen Hospital from November 2012 to November 2018. Based on intracranial artery (IA) complicated or not, TA patients were divided into two groups:32 patients within involvement and 103 patients without involvement. The difference in comparison of imaging types, basic data and laboratory test were analyzed.

The proportion of TA patients with intracranial vascular involvement was 23.7% (32/135) and the most common site was internal carotid artery (intracranial segment) (59.4%, 19/32). The incidences of hypertension and coronary heart disease were significantly higher in TA patients with intracranial vascular involvement compared with the patients without intracranial involvement (46.9% vs 26.2%, 21.9% vs 6.8%, χ ²=4.863, 4.460, all P<0.05). The rate of tocilizumab treatment in the intracranial vascular involved group was higher than that in the group without intracranial vascular involvement (40.6% vs 19.4%, χ ²=5.945, P<0.05). The platelet count in patients with intracranial involvement group was significantly lower than that in patients without intracranial involvement group [(218±55)×10⁹/L vs (272±71)×10⁹/L, t=-3.570, P<0.01], while the hemoglobin [(130±17) vs (121±18) g/L, t=2.363, P<0.05] and triglyceride [1.22(0.75, 1.64) vs 0.92(0.63, 1.21) mmol/L, U=1 017.000, P<0.01] were significantly higher than those without intracranial vascular involvement. Moreover, coronary artery involvement presented more frequently in the intracranial vascular involved group than the group without intracranial vascular involvement (43.8% vs 14.6%, χ ²=12.331, P<0.01). Logistic regression analysis showed that the incidence of intracranial vascular disease in TA patients with coronary artery involvement was 4 times higher than that in patients without coronary artery lesions (OR=3.965, 95%CI:1.584-9.926, P=0.003).

The proportion of intracranial vascular involvement in TA is not rare, TA patients with cardiovascular risk factors should be considered to strengthen imaging examination of intracranial vessels.

To evaluate the effects of functional rehabilitation on rheumatoid arthritis patients after the total knee arthroplasty (TKA).

Two hundred rheumatoid arthritis patients (259 knees) were enrolled in this study at Arthritis Clinic and Research Center, Peking University People′s Hospital from January 2012 to December 2017. All patients received the primary total knee arthroplasty, followed by a systematic functional rehabilitation. The same procedure of rehabilitation was followed, which consisted of patients′ education, resistance training, passive and active range of motion exercise, balance exercise, gait training and daily-activity training. According to the degree of postoperative residual flexion contracture, these patients were divided into three groups: the severe (≥30°), moderate(15°-30°), and mild (≤15°). The outcomes of functional rehabilitation were evaluated among different groups and compared with those before the rehabilitation, which included the active range of motion (AROM), the flexion and extension angle of the knee, pain on the visual analogue scale (VAS). The complications and their impacts on the process of rehabilitation were also studied. Independent t test was applied to compare the data before and after the rehabilitaton.

There were 17 males (20 knees) and 183 females (239 knees) in this group, aged (57±13) years with a disease course of (16±10) years. There were significant improvements after the functional rehabilitation, including the flexion angle, the extension angle, AROM and pain VAS (76°±12° vs 112°±9°, 12.9°±10.2° vs 2.4°±4.6°, 63°±15° vs 110°±10° and 3.7±1.2 vs 2.0±0.4, respectively; t=39.0, 15.1, 41.3, 21.2, all P<0.01). The residual flexion contracture after the surgery in 259 knees were all improved, among which 195 knees (75.3%) reached a complete correction. Compared with the mild flexion contracture, the moderate and severe group had a lower complete correction rate (80.2% vs 45.9%, χ ²=20.15, P<0.05). Total of 141 patients (70.5%) suffered from anemia two days after the surgery. By offering the anti-anemia treatment during the systematic rehabilitation, all cases of anemia were healed. The length of hospital stay was longer in the patients with moderate and severe anemia when compared with that in mild anemia ((13±5) days vs (11±5) days, t=2.2, P=0.028).

The systematic functional rehabilitation is an effective treatment for rheumatoid arthritis patients after TKA, which can not only help release the pain after surgery, but also assist patients to achieve a better function of the knee.

To investigate the difference of serum glutamate (Glu) and gamma- aminobutyric acid (GABA) levels between depressive patients and bipolar disorder patients with depressive episodes.

From May 2018 to March 2019, forty-seven patients with depression (depression group) and 45 patients with bipolar depressive episode (bipolar depression group) were selected from the department of psychiatry, the First Affiliated Hospital of Jinan University, and 41 healthy controls (healthy control group) were simultaneously recruited from the community. The subjects′ depression and anxiety were assessed by 17 items of Hamilton depression scale (HAMD-17) and Hamilton Anxiety Scale (HAMA). The serum levels of Glu, GABA and Glu decarboxylase (GAD) were detected by enzyme-linked immunosorbent assay (ELISA) .

The serum Glu level ( (36±7) mg/L, (37±7) mg/L vs (28±4) mg/L, F=10.97, P<0.01) and Glu/GABA ratio (5.77±0.35, 8.18±0.24 vs 3.35±0.33, F=37.68, P<0.01) in depression and bipolar depression groups were higher than those of healthy control group, while the GABA level ((6.1±0.7) μmol/L,(4.1±0.8) μmol/L vs (8.1±1.2) μmol/L, F=21.61, P<0.01) and GAD ((31±6) U/L, (31±6) U/L vs (35±6) U/L, F=5.61, P<0.01) were lower than those of healthy control group. The level of serum GABA in bipolar depression group was lower than that in depression group. However, Glu/GABA was higher in bipolar depression group than that in depression group (P<0.01). The level of serum GABA in depression group was negatively correlated with HAMD sleep disorder factor (r=-0.46, P=0.01).

Both depression and bipolar depression have abnormal levels of Glu, GABA neurotransmitters and imbalance between Glu and GABA in peripheral blood circulation. Moreover, these abnormalities are more obvious in patients with bipolar depression.

To analyze the cell morphological features of hepatosplenic T-cell lymphoma (HSTCL) gamma-delta (γδ) type, differentiate from acute leukaemia (AL).

This was a retrospective study. The clinical data of four cases of HSTCL γδ type who were treated in Hebei Yanda Ludaopei Hospital from 2009 to 2014 were collected. Their initial morphology diagnoses in other hospitals were all acute leukemia or myelodysplastic syndrome (MDS). Morphological analysis and cytochemical stains to their bone marrow (BM) aspiration and peripheral blood (PB) smears were completed when they had no response to previous chemotherapies, and the morphological reports were compared with results of immunophenotyping, chromosome, and T cell receptor (TCR) gene rearrangement.

The percentages of malignant cells in four patients′ BM aspirations were 7.6%-40.0%, and in two patients′ PB was 9% and 10%, respectively. The morphology of four cases had a very high similarity in Wright′s stain. Predominantly medium-sized cells were seen, with rich cytoplasm and frequently one big conspicuous nucleolus. The malignant cells resembled blasts, especially monoblasts, but with coarse granular chromatin, more compact than that in monoblasts. When comparing to malignant myeloblast and lymphoblasts, HSTCL cells were larger and more irregular in cell shape, with more abundant cytoplasm and prominent nuclear irregularity. The cytochemistric stain played an important role in differential diagnosis. HSTCL malignant cells showed non-specific esterase (NSE) negative or focal punctate activity which couldn′t be inhibited by sodium fluoride. Periodic acid-Schiff (PAS) stain was negative or positive with a form of coarse granules. The myeloperioxdase (MPO) stain was negative.

Malignant cells of HSTCL γδ type have very distinct morphological features of mature lymphocytic neoplasm. The quality of Wright′s stain, being short of complete cytochemical stains, lacking of awareness of this disease, and acute leukemia or MDS like appearance in some cases, result in the possibility of diagnostic error as malignant blast, and probably are main causes of misdiagnosis of HSTCL γδ type.

To investigate the clinical characteristics, treatment and prognosis of optic neuropathy associated with varicella zoster virus (VZV).

Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1, 2014 and March 31, 2019 were retrospectively collected. The clinical manifestations, treatment and prognosis were analyzed.

There were 7 eyes involved in 5 cases, 3 cases (3/5) involved only one eye, and 2 cases (2/5) involved both optic nerves. During the follow-up time, no recurrence was found. Severe visual impairment occurred in 4 eyes (4/7) and non-severe visual impairment in 3 eyes (3/7). Visual acuity improved significantly in 1 eye (1/7), turned better in 2 eyes (2/7), and remained unchanged in 4 eyes (4/7). In acute phase, abnormal signals of optic nerve and/or sheath were observed on MR images. Case 3 received antiviral and hormone therapy on the second day after the onset of the disease, and the visual acuity recovered well; the other 4 cases had poor prognosis.

Head and face VZV infection can cause serious optic neuropathy, leading to severe visual dysfunction, and poor prognosis, but recurrence is rare. Early intravenous administration of antiviral drugs (acyclovir is the best) and hormones are recommended for VZV infection in this area. It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

To explore the relationship between elevation of brachial pulse pressure and coronary heart disease in different genders.

A total of 5 116 inpatients with suspected stable coronary heart disease were consecutively enrolled from December 2011 to June 2017 in the Affiliated Hospital of Chengde Medical College, and divided into coronary heart disease group (n=3 694) and non-coronary heart disease group (n=1 422). The clinical data of all inpatients were collected. A binary logistic regression model of coronary heart disease in different genders were separately established.

The morbidity of hypertension, dyslipidemia, type 2 diabetes, ischemic stroke and elevated pulse pressure were all higher in the coronary heart disease group than those in the non-coronary heart disease group (all P<0.05). The area under curve (AUC) of pulse pressure in the male group was 0.540, with an optimal diagnostic threshold of 50 mmHg. The AUC of pulse pressure in the female group was 0.612, with an optimal diagnostic threshold of 60 mmHg. Besides hypertension, type 2 diabetes, increase of low-density lipoprotein cholesterol, ischemic stroke, smoking, and aging, elevated pulse pressure was also an independent risk factor for coronary heart disease in both male and female groups (allP<0.05). Additionally, the risk of elevated pulse pressure for coronary heart disease was higher in female group than that of male group (odds ratio (OR): 1.741 vs 1.284, P<0.05).

Elevated pulse pressure may be a new risk factor for coronary heart disease, and its risk for coronary heart disease is higher in women than in men.

To investigate the effect of maslinic acid (MA) on isoproterenol (ISO)-induced myocardial fibrosis in mice.

ISO was used to induce myocardial fibrosis in adult male C57BL/6 mice, and MA was administered for two weeks to detect the effects of MA on cardiac function and fibrosis. Molecular changes of fibrosis markers and signaling pathways were detected by RT-PCR and western blotting. Phosphate buffer saline (PBS), PBS+SB203580 (p38 MAPK inhibitor), PBS+MA, ISO, ISO+SB203580, ISO+MA were added to the primary cultured rat fibroblasts. Cells were collected after 48 h for subsequent detection.

In this study, the mouse model of myocardial fibrosis was successfully established. The left ventricular faction shortening (FS) and maximum rate of rise and maximum rate of fall of pressure in left ventricular chamber (±dp/dt) of the ISO+MA group were significantly higher than those of the ISO group ((35.1±1.8)% vs (28.5±2.6)%, (7 256±153) mmHg/s vs (6 402±240) mmHg/s, (7 156±163) mmHg/s vs (6 319±219) mmHg/s, all P<0.05). The levels of interstitial and perivascular collagen deposition in the ISO+MA group were higher than those in the ISO group (P<0.05), the relative mRNA levels of COL-1, COL-3 and TGF-β in the ISO+MA group were significantly lower than those in the ISO group, with the relative expression levels of 1.70±0.24 vs 3.69±0.34, 1.72±0.56 vs 4.84±0.82, 1.52±0.19 vs 2.64±0.29, respectively (allP<0.05). The phosphorylation levels of p38 MAPK, Smad3 and protein expression level of TGF-β1 in ISO+MA group were lower than those in ISO group (relative expression levels were 1.67±0.35 vs 2.61±0.58, 1.68±0.23 vs 2.52±0.19,1.56±0.15 vs 2.48±0.26, respectively, allP<0.05). The results of in vitro cell experiments showed that the mRNA levels of COL-1, COL-3 and TGF-β in the SB203580 and MA groups were significantly lower than those in the ISO group (relative expression levels were 2.25±0.51, 2.16±0.48 vs 5.29±1.21; 1.58±0.34, 1.69±0.29 vs 4.97±1.32; 1.41±0.31, 1.55±0.38 vs 3.53±0.56, respectively, allP<0.05). The phosphorylation levels of p38 MAPK and Smad3 in the SB203580 MA groups was significantly lower than those in the ISO group, and the protein expression level of TGF-β1 was lower than that in the ISO group (1.81±0.18, 1.77±0.16 vs 2.56±0.32; 1.85±0.21, 1.81±0.17 vs 2.48±0.37; 1.84±0.24, 1.72±0.17 vs 2.52±0.29, allP<0.05).

Maslinic acid can inhibit the phosphorylation of p38 MAPK, thereby preventing the canonical TGF-β1/Smads fibrosis signaling pathway to achieve an anti-fibrosis role.