Objective To reduce the misdiagnosis rate of spondyloarthritis (SPA) by reviewing the rare cases misdiagnosed as SpA.Methods Cases misdiaguosed as SpA were collected from our hospital from January 2004 to April 2014.Reported cases among Chinese journals from January 1998 to October,2014 were also collected.According to the Assessment of Spondylo Arthritis international Society (ASAS) axial SpA criteria (2009) and peripheral SpA criteria (2011),the diagnostic accordance rate was studied.Results There were 112 cases within the objective scope,out of which,27 cases (24.1％) were infectious diseases,47 cases (42.0％) were heredity and metabolic diseases,25 cases (22.3％) were hematonosis or tumor,13 cases (11.6％) were osteoarthropathies.Also,only 10 cases (8.9％) out of 112 had the symptoms of inflammatory back pain (IBP),23 cases (20.5％) exhibited fever.Human leukocyte antigen (HLA)-B27 was positive in 20.4％ (21/103) of the cases.Eleven cases out of those 29 cases performed X-ray in the sacroiliac joint and showed blurred articular surface,narrowing of joint space or bone destruction.Four cases were diagnosed based on magnetic resonance imaging (MRI).18/91 (19.8％) cases met the criteria of ASAS axial SpA criteria (2009),2/6(33.3％) cases were in accordance to the ASAS peripheral SpA criteria (2011).Conclusion For patients with atypical back pain,if accompanied with fever,other diseases such as tumor,infection,heredity and metabolic diseases should be considered.The diagnosis should not only based on HLA-B27 for SpA diagnosis.Due to the ambiguity of X-ray in sacroiliac joint,CT or MRI may be recommended to assist the diagnosis.Careful clinical history taken is also with great significance.

Objective T o establish a query table of IB S critical value and identification pow er for the detection system s w ith different num bers of ST R loci under different false judgm ent standards. Methods Sam ples of 267 pairs of full siblings and 360 pairs of unrelated individuals w ere collected and 19 auto-som al ST R loci w ere genotyped by G oldeneyeTM 20A system . T he full siblings w ere determ ined using IB S scoring m ethod according to the 'R egulation for biological full sibling testing'. T he critical values and identification pow er for the detection system s w ith different num bers of ST R loci under different false judgm ent standards w ere calculated by theoretical m ethods. Results A ccording to the form al IB S scoring criteria, the identification pow er of full siblings and unrelated individuals w as 0.7640 and the rate of false judgm ent w as 0. T he results of theoretical calculation w ere consistent w ith that of sam ple observation. T he query table of IB S critical value for identification of full sibling detection system s w ith different num bers of ST R loci w as successfully established. Conclusion T he IB S scoring m ethod defined by the regulation has high detection efficiency and low false judgm ent rate, w hich provides a relatively conservative result. T he query table of IB S critical value for identification of full sibling detection sys-tem s w ith different num bers of ST R loci provides an im portant reference data for the result judgm ent of full sibling testing and ow ns a considerable practical value.

Objective:To summarize the clinical characteristics of neonatal late-onset sepsis (LOS) caused by Leclercia adecarboxylata, and provide evidence for its diagnosis and treatment. Methods:We report a case of Leclercia adecarboxylata induced LOS in a male preterm neonate diagnosed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) at the Affiliated Suzhou Hospital of Nanjing Medical University. Relavant literature was retrieved from Wanfang, VIP, CNKI, and PubMed databases up to April 2021, using terms including "neonate" "sepsis" and " Leclercia adecarboxylata". Results:The patient presented with dyspnea immediately after birth with gestational age of 34 +3 weeks and birth weight of 2 050 g. After admission at 14 min after birth, he was incubated at temperature of 33-35 ℃ and humidity of 50%-60% and received active treatment, consisting of nasal continuous positive airway pressure, tracheal intubation, intratracheal injection of pulmonary surfactant, invasive mechanical ventilation, and anti-infective treatment with piperacillin, cefoperazone/sulbactam, and meropenem. However, the patient developed LOS on day 11 of life and eventually died of disseminated intravascular coagulation and multiple organs failure despite volume expansion, anti-infective therapy, and respiratory support. The blood culture was positive for Gram-negative rod and confirmed as a multi-drug resistant strain of Leclercia adecarboxylata. Two cases of LOS caused by sensitive strain of Leclercia adecarboxylata in premature female infants were retrieved in the literature with atypical symptoms, of whom one was successfully treated and one died after active treatment. Conclusions:Leclercia adecarboxylata infection alone can lead to LOS in preterm infants without typical manifestations. MALDI-TOF MS is helpful for the diagnosis and rational application of antibiotics.

Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Objective To understand the viral spectrum of inpatients with acute respiratory infection in Pudong New Area, and to explore the composition of pathogens in hospitalized children and adults. Methods Samples of acute respiratory infection cases from 10 medical institutions were collected from 2011 to 2020 and tested for human influenza virus, human adenovirus, rhinovirus, human parainfluenza virus, respiratory syncytial virus, human coronavirus, human metapneumovirus and human boca virus. Results A total of 3 145 inpatients were monitored, with a median age of 61 years. The positive rate of any virus was 32.43% (1 020/3 145), and the single virus infection accounted for 85.98% (877/1 020). In single virus infection, the positive rate of human influenza virus was the highest (9.67%, 304/3 145), with influenza A (80.26%, 244/304) as the main virus. The second was rhinovirus (3.97%, 125/3 145). The positive rate of any virus in different age groups was statistically significant (χ²=103.38，P<0.001). The positive rate of respiratory syncytial virus was the highest in the ~5-year-old group, adenovirus was the highest in the 6-14-year-old group, and influenza virus was the highest in the 15-64-year-old group and the 65year-old group. There was a significant difference in the positive rate of any virus in each month (χ²=123.06，P<0.001). The human influenza virus was the dominant virus in winter (December to February) and summer (July to September), and rhinoviruses distributed sporadically in each month. The positive rate of any virus in different departments was significantly different (χ²=90.37，P<0.001). Conclusion The positive rate of virus in hospitalized patients with acute respiratory infection is relatively high in Pudong New Area, Shanghai, with human influenza virus being the main virus. The virus spectrum of hospitalized children and adults is inconsistent. In the future, in-depth research should be strengthened, focusing on the distribution of pathogens in different populations and seasonal prevention and treatment.

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care