Abstract: To report on two patients with Coronavirus Disease 2019 (COVID-19) combined with diffuse connective tissue disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection followed for nearly 3 years, in order to understand the long-term effects on the patients' immune system. Both patients were male, aged 81-82 years, and were hospitalized with fever on January 29, 2020 and February 10, 2020, respectively. Both were diagnosed with COVID-19 after positive SARS-CoV-2 polymerase chain reaction (PCR) tests. After receiving anti-infection treatment, cough suppressants, ex‐pectorants, and symptomatic supportive treatment, their body temperature returned to normal and two consecutive PCR tests were negative for SARS-CoV-2, and they were discharged from hospital. However, due to recurring fevers and varying degrees of rheumatic disease-related symptoms, both patients were readmitted to the hospital, indicating the presence of positive auto‐ antibodies and organ involvement. One patient recovered from COVID-19 with recurrent fever, joint pain, muscle aches and subcutaneous nodules, and was subsequently diagnosed with undifferentiated connective tissue disease. The other patient developed recurrent fever, mouth ulcers and rash after recovery from COVID-19 and was subsequently diagnosed with anti neutro phil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The patient was treated with glucocorticoids and immunosuppres sive drugs and the symptoms resolved rapidly and subsequent laboratory and imaging examinations showed stable condition. However, due to self-termination of medication, their symptoms quickly relapsed, and further treatment with glucocorticoids and immunosuppressive agents resulted in sustained stability of their condition. The erythrocyte sedimentation rate and hyper‐sensitive C-reactive protein remained within normal limits, and lung CT scans showed stable lesions with partial absorption.SARS-CoV-2 infection may have long-term effects on patients' immune systems, leading to abnormal immune responses and diffuse connective tissue disease. This suggests that regular follow-up observation of immune system-related diseases may be necessary for elderly patients with COVID-19.

Humans ; Rib Fractures ; Thoracic Injuries

Objective To explore the nutritional status and determinants among rural stranded children under 7 years of age. Methods The group of stranded children (n=7585) and the children for control (n=7557) were identified by multi-stage stratified cluster sampling. The ascertainment methods mainly included questionnaire, anthropometric measurements and laboratory examination. Results In this study, there were three groups, including the group of stranded children whose single parent left home to look for better job somewhere, the group of stranded children whose parent both left home and the third group serving as control. Prevalent rates on the following items were: stunting -- 14.9%, 17.9% and 16.3%, underweight -- 7.2%, 8.3% and 7.6%, wasting -- 3.1%, 3.4% and 3.3% and anemia -- 18.9%, 20.6%, 18.7% respectively. The prevalent rate of stunting in the group of children with both parents away from home was significantly higher than that those with only one parent did. The prevalence rate of anemia in the group with both parents away from home was significantly higher than that in the control group. Based on multivariate non-conditional logistic regression analysis, the determinants of stunting among the stranded children were: age, with low birth weight, living alone, being the only child in the family, mother's education level, frequency of eating breakfast and snacks every week, motives of caretakers and the relationship between children and the caretakers. The determinants of underweight among those stranded children were: age of child, with low birth weight, the frequency of eating snacks every week, motives of the caretakers and having rickets. Conclusion The nutritional status among rural stranded children was relatively poor, especially in those whose parents were both away from home, which calls for urgent improvement.

Objective To evaluate the efficacy of chemoradiotherapy alone and prognostic factors for locally advanced rectal cancer. Methods The clinical data of 47 patients with locally advanced rectal cancer who were admitted to our hospital and mostly treated with chemoradiotherapy alone from 2003 to 2010 were retrospectively analyzed. Three of the patients received radiotherapy alone. The Kaplan?Meier method was used to estimate overall survival (OS), progression?free survival (PFS), and distant metastasis?free survival ( DMFS ) rates, and the log?rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients, the 3?and 5?year OS rates were 53?2% and 33?2%, respectively, while the 3?and 5?year PFS rates were 37% and 31%, respectively. During the follow?up, 15 patients (32%) had local progression with PFS of 1?60 months (median PFS, 14 months);23 patients (49%) had distant metastasis with DMFS of 2?60 months ( median DMFS, 17 months) . Patients treated with high?dose radiotherapy had significantly lower 3?and 5?year local progression rates than patients treated with medium?dose radiotherapy ( 11% vs. 54%;11%vs. 57%;P=0?004). After chemoradiotherapy, 9 patients (19%) had clinical complete response (cCR), and the 3?and 5?year OS and PFS rates in those patients were all 8/9. The univariate analysis indicated that tumor distance from the anus and cCR were influencing factors for prognosis ( P= 0?026;P= 0?000 ) . However, the multivariate analysis showed that cCR was the only influencing factor for survival ( HR=12?24;95% CI, 1?64 ?91?29;P= 0?015 ) . Conclusions Chemoradiotherpay or radiotherapy alone is effective and safe in the treatment of patients with locally advanced rectal cancer who have to give up surgery or have unresectable tumors. High?dose radiotherapy may improve local control rate. Complete response to chemoradiotherapy predicts satisfactory treatment outcomes.

AIMTo establish an HPLC-fluorescent spectrometric method for the determination of mexiletine hydrochloride in plasma after derivatization with fluram.

METHODSFluram acetone solution was added to the deproteinized plasma with acetone to obtain the derivative of mexiletine. The HPLC method was performed on a column of Allitima C18 (150 mm x 4.6 mm, 5 microns) with the mobile phase of methanol-water-diethylamine-phosphoric acid buffer (2.4 mol.L-1, pH 4.0) (70:28:2), and the detective wavelength were set at Ex 392 nm and Em 480 nm.

RESULTSMexiletine has a liner range over the concentration range from 0.100-6.400 mg.L-1. The lowest detectable concentration of this method was 5 micrograms.L-1 (S/N > or = 4). The intra-day and inter-day RSDs were 1.34%-5.31%, respectively.

CONCLUSIONThis method is simple, selective and can be used for therapeutic drug monitoring (TDM) and pharmacokinetic studies of mexiletine.

Anti-Arrhythmia Agents ; blood ; pharmacokinetics ; Chromatography, High Pressure Liquid ; methods ; Fluorescamine ; chemistry ; Humans ; Mexiletine ; blood ; pharmacokinetics

Objective:To explore clinical application effect of cardiac remote real -time monitoring system.Methods:Cardiac remote real -time monitoring warning instrument(iHolter)was applied in 210 patients.The iHolter gave a-lerts automatically in case of ECG abnormalities for corresponding treatment in time,and it offered corresponding reports on monitoring results.According to age,patients were divided into youth group(<45 years,n=59),mid-dle-aged group(45160 years,n=56)and aged group(≥60 years,n=95).Characteristics of arrhythmias among different age and sex were analyzed.Results:ECG abnormalities were found in 191 cases(90.95%)out of 210 pa-tients,including eight cases with malignant arrhythmias,in which five cases were treated and survived after timely intervention via alerts.Compared with youth group and middle -aged group,there were significant rise in percenta-ges of paroxysmal atrial tachycardia(16.9%,26.8% vs.54.7%)and atrial fibrillation(0%,0% vs.8.4%)in aged group,P< 0.05 or <0.01;abnormal percentages of heart rate variability of middle -aged group and aged group were significantly higher than that of youth group(25.0%,36.8% vs.5.1%,P<0.01 both).Male percent-age of paroxysmal ventricular tachycardia was significantly higher than that of female(81.3% vs.18.8%,P=0.013).Conclusion:Cardiac remote real-time monitoring system can offer timely alerts for cardiovascular events such as arrhythmia and myocardial ischemia etc.,fight for more time for rescuing patients,maximally protect cardi-ac function and improve accuracy of clinical diagnosis.

OBJECTIVETo investigate the characteristics of the hepatic pathological and clinical features of patients with hepatitis B virus (HBV) in immune tolerant stage and find the better measure of diagnosing patients chronic infected by HBV in immune tolerant phase.

METHODS135 patients with HBV chronic infection and persistently normal serum alanine aminotransferase (ALT) levels were involved in this study, whose serum HBeAg and HBV DNA were positive. Statistical analysis included the ages, sex, serum levels of HBVDNA, ALT and histological grade. The grades of inflammation and fibrosis were obtained through hepatic biopsy performed on all the patients.

RESULTSMean age in those patients was 22.61 +/- 8.95 years old. All those patients were divided into two groups according to histological grade: low- histological grade group, G < or = 1 and S < or = 1; and high-histological grade group, G > or = 2, S > or = to 2. Levels of histological grade were low in most of patients (99/135). Patients of low-histological grade had no difference in age, sex and family history of HBsAg carriers. Compared with low-normal ALT (ALT less than 30U/L), those with high-normal ALT (ALT > or = 30U/L) had a greater frequencies of high-histological grade. Compared with high HBVDNA (HBVDNA > or = 10(7) copies/ml), those with low HBVDNA (HBVDNA less than 10(7) copies/ml) had a greater frequencies of high-histological grade.

CONCLUSIONLevels of histological grade were low in most of patients with HBV chronic infection, serum HBeAg and HBVDNA positive, persistently normal serum ALT levels, but some of them were high-histological grade. It showed those patients were not all in immune tolerant stage of chronic HBV infection. Examination of ALT and HBVDNA are helpful to evaluate hepatic pathological damage for them.

Adolescent ; Adult ; Alanine Transaminase ; blood ; Child ; Child, Preschool ; DNA, Viral ; blood ; Female ; Hepatitis B, Chronic ; immunology ; pathology ; virology ; Humans ; Immune Tolerance ; Male ; Middle Aged

OBJECTIVETo study HIV, HBV and HCV infections in intravenous drug users.

METHODS2025 blood samples from intravenous drug users were collected from Sichuan, Hunan, Guangxi and Xinjiang regions, and tested for anti-HIV, anti-HCV, HBsAg using enzyme-linked immuno-sobent assays (ELISAs).

RESULTSThe positive rates of anti-HIV,anti-HCV and HBsAg were14.7%-30.4%, 60.7%-85.5% and 6.6%-22.4% in the intravenous drug users, respectively. The co-infection rates of HIV/HBV, HIV/HCV, HCV/HBV and HIV/HCV/HBV were 0%-0.4%, 11.6%-27.2%, 2.3%-14.3% and 1.6%-4.8% respectively in this population.

CONCLUSIONThe infection rates of HIV, HBV and HCV were higher in the intravenous drug users than that in general populations in the same regions, and HIV/HCV co-infection appeared most frequent in this population.

China ; epidemiology ; HIV Infections ; epidemiology ; Hepatitis B ; epidemiology ; Hepatitis C ; epidemiology ; Humans ; Prevalence ; Substance Abuse, Intravenous

OBJECTIVETo explore the influence of Chinese medicine constitution type on the susceptibility of hypertensive patients to intracerebral haemorrhage.

METHODSPrimary hypertensive patients were studied and divided into the hypertension and the hypertensive intracerebral haemorrhage groups, depending on whether or not the patients had intracerebral haemorrhage. The demographic characteristics, physiological characteristics, living habits, biochemical tests, other chronic diseases, Chinese medicine constitution type, etc. were collected and compared between the two groups. The neurological deficit in the hypertensive intracerebral haemorrhage group was also compared among the different constitution types.

RESULTSA total of 304 patients participated in this investigation, including 213 cases in the hypertension group and 91 cases in the hypertensive intracerebral haemorrhage group. The percentages of dampness-heat and qi-depression types in the intracerebral haemorrhage group were greater than those with the same types in the hypertension group (20.9% vs 6.1%, 22.0% vs 8.0%; P<0.05). The percentages of each constitution type were different between genders in both groups. In addition, there were more male cases (14/20) with qi-depression type and more female cases (7/8) with phlegm-dampness type in the hypertensive intracerebral haemorrhage group than those with the same types (3/17 and 9/34, respectively) in the hypertension group (P<0.05). The cases with phlegm-dampness and qi-depression types had greater levels of blood lipids in the intracerebral haemorrhage group than those with the same types in the hypertension group (P<0.05). Furthermore, the cases with the qi-deficiency type presented with a more severe neurological deficit than those with the other types (P<0.05).

CONCLUSIONSChinese medicine constitution type might have an impact on the susceptibility of hypertensive patients to have an intracerebral haemorrhage. The heat-dampness and qi-depression types might lead to greater susceptibility than the other types. In addition, the patient's gender and blood lipids might also influence the susceptibility along with the constitution type.

Aged ; Body Constitution ; Cerebral Hemorrhage ; etiology ; Disease Susceptibility ; pathology ; Female ; Humans ; Hypertension ; complications ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Nervous System ; pathology

The feasibility of the case-based learning (CBL) of Acupuncture-Moxibustion Techniques is discussed in the aspects of the connotation application, implementation process and effect evaluation of CBL in teaching this course. The result shows that compared with the traditional teaching model, CBL achieves the same effects on the mastery of theoretic knowledge on the techniques of acupuncture, moxibustion and cupping for the undergraduates. Moreover, CBL presentes the obvious advantages on the improvements of the ability of the manipulation selection based on the clinical symptoms and the practical manipulative skills of the students. Hence, CBL is deserved to be promoted as an experimental unit in the professional technique courses of acupuncture-moxibustion.
Acupuncture ; education ; methods ; Acupuncture Therapy ; methods ; Case-Control Studies ; Humans ; Learning ; Moxibustion ; Students ; Teaching