Objective To study the clinical value of cerebrospinal fluid cytology(csfc)and specific stain in tuberculous meningitis(TBM)-purulent meningitis(PM)and cryptococcal meningitis(CM).Methods The csfc data of 179 patients with TBM,PM and CM were retrospectively analyzed.The samples collected from all of these patients were analyzed by csfc May-Grunwald-Giemsa(MGG)staining,aricine blue staining and Indian ink staining. And the cytospin smears from 70 TBM were simultaneously stained by the immunofluorescence(IF)and immunocytological method to demonstrate the presence of mycobacterial antigen.Results ①TBM group showed a mixed-cell response.At the early stage of disease,the proportion of neutrophilic granulocyte reached 80%,and then reduced gradually.Lyumphoidocyte reaction was the most obvious in 1～2 months.The immunofluorescence(IF)and immunocytological method present a sensitivity of 82.9%and 85.7%,respectively.②Neutrophilic granulocyte was the most cell at acute stage of PM,and it descended quickly once treated with effective antibiotics.③The positive rates to detect CM with csfc MGG,aricine and Indian ink staining were 83.3%,81.8%,and 76.5%,respectively.Conclusion Dynamic observation on cerebrospinal fluid cytology is helpful to boost the differential diagnosis of intracranial infection.

ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

OBJECTIVETo discuss the clinicopathological factors for lymph node metastasis (LNM) in early gastric cancer (EGC), including age, gender, location, size, macroscopic type, depth of invasion, histological type, and lymphatic invasion, and the regulation of LNM in EGC.

DATA SOURCESThe data used in this review were mainly from PubMed articles published in English. The search terms were "early gastric cancer" and "lymph node metastasis".

STUDY SELECTIONArticles were selected if they reported the clinicopathological factors and regulation of LNM in EGC.

RESULTSThe prognosis of EGC is better than advanced gastric cancer, with over 90% 5-year survival rate. The main risk factors for LNM in EGC are tumor size, macroscopic type, depth of invasion, histological type, ulceration, and lymphatic invasion.

CONCLUSIONSLNM in EGC is a critical factor for assessment of prognosis and determination of therapeutic strategy. Endoscopic mucosal resection or endoscopic submucosal dissection should be considered when patients have low risk of LNM.

Female ; Humans ; Lymphatic Metastasis ; Male ; Stomach Neoplasms ; complications ; pathology ; surgery

Objective To investigate the clinical applicability and different characteristics of three commonly used diagnostic methods for drug-induced liver injury from the two aspects of liver injury induced by Western medicine and liver injury induced by traditional Chinese medicine. Methods A prospective cohort study was performed for 289 hospitalized patients with acute drug-induced liver injury who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2015 to December 2020 and did not receive integrated traditional Chinese and Western medicine therapy, among whom 187 patients had herb-induced liver injury and 102 had Western medicine-induced liver injury. The 289 patients were diagnosed by the integrated evidence chain (IEC), Roussel Uclaf Causality Assessment Method (RUCAM), and the Structured Expert Opinion Process (SEOP) method, and related data at acute onset were collected, including general information, latency period, detailed medication, and laboratory markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase, alkaline phosphatase, and total bilirubin. A statistical analysis was performed to investigate the consistency between IEC, RUCAM, and SEOP in the diagnosis of Western medicine-induced liver injury and herb-induced liver injury and their own applicability. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data; the chi-square was used for comparison of categorical data. Results The hepatocellular type was the main type of clinical liver injury in both Western medicine-induced liver injury and herb-induced liver injury, accounting for 81.4% and 74.3%, respectively, and laboratory examination showed higher levels of ALT and AST. Western medicine-induced liver injury cases were diagnosed by IEC, RUCAM, and SEOP, with a clinical diagnosis rate of 65.7%, 100%, and 63.7%, respectively, and the constituent ratio of Western medicine-induced liver injury was 23.2%, 35.3%, and 22.5%, respectively. Herb-induced liver injury cases were diagnosed by these three methods, with a clinical diagnosis rate of 47.6%, 100%, and 29.9%, respectively, and the constituent ratio of herb-induced liver injury was 30.8%, 64.7%, and 19.4%, respectively. The consistency test of the three diagnostic methods showed that in the diagnosis of Western medicine-induced liver injury cases, there was good consistency between IEC and SEOP (Kappa=0.785, P < 0.05), while there was poor consistency between RUCAM and IEC (Kappa=0.149, P > 0.05) and between RUCAM and SEOP (Kappa=0.117, P > 0.05); in the diagnosis of herb-induced liver injury cases, there was poor consistency between RUCAM and SEOP (Kappa=0.066, P > 0.05), while there was good consistency between RUCAM and IEC (Kappa=0.026, P < 0.05) and between IEC and SEOP (Kappa=0.437, P < 0.05). Conclusion The IEC method shows good applicability for both Western medicine-induced liver injury and herb-induced liver injury, and there is good consistency between IEC and SEOP in the diagnosis of Western medicine-induced liver injury cases, while there is a relatively low level of consistency between IEC and SEOP in the diagnosis of herb-induced liver injury. There is poor consistency between RUCAM and the other two methods. In the clinical diagnosis of Western medicine-induced liver injury, IEC, RUCAM, and SEOP should be used in combination to accurately judge the causal relationship between drugs and liver injury.