Objective To evaluate the diagnostic value of ultrasound-guided pleural biopsy combined with thoracic biochemical detections in malignant and tuberculous pleural effusions. Methods Sixty-four patients with moderate or large pleural effusions and pleural thickening received the ultrasound-guided diagnostic pleural biopsy. All patients had chest CT enhancement scans to find out the suspicious pleural thickening preoperatively, facilitating the selection of puncture sites by ultrasound. Pleural tissue samples were sent for pathological examinations immediately. After successful achievements of pleural biopsy, ultrasound-guided aspiration or drainage was performed to alleviate symptoms, more importantly, to get pleural effusions for biochemical analysis. Biological results including carcinoembryonic antigen(CEA), CA125, CYFRA21 and lactate dehydrogenase(LDH) in malignant and tuberculous effusions were analyzed by group design t tests. The positive rates of CEA, CA125, CYFRA21, LDH in malignant and tuberculous effusions were compared by chi square tests. Results Pleural tissues in all cases were got by one pleural biopsy procedure. The strategy of pleural biopsy we used in this study had a successful rate reaching 100%(64/64), and 73% (46/64) patients had a definitive diagnosis as malignant or tuberculous effusion. Twenty-seven cases were diagnosed as malignant effusions and thirty-seven cases as tuberculous effusions based on the deifnitive clinical diagnosis. The positive rates of CEA, CA125, CYFRA21, LDH in malignant effusions were 100%(27/27), 100%(27/27), 100%(27/27), 89%(24/27) respectively, and 0%(0/37), 84%(31/37), 78%(29/37), 76%(28/37) respectively in tuberculous effusions. The positive rate of CEA between malignant and tuberculous effusions differed signiifcantly (χ2=64.0, P < 0.01), so did CA125 (χ2=3.1, P < 0.01) and CYFRA21(χ2=4.8, P<0.01). The average levels of CEA, CA125, CYFRA21, LDH in pleural effusion were (727.1±658.8)μg/L, (795.2±1249.6)×103 U/L, (296.2±320.7)μg/L, (1077.9±1058.5) U/L respectively, and (1.7±1.1)μg/L, (336.3±208.6)×103 U/L, (20.7±14.9)μg/L, (309.2±182.7) U/L in tuberculous effusions.There were signiifcant differences in CEA, CYFRA21 and LDH concentrations among malignant and tuberculous effusions (t=45.1, 27.4, 18.8 respectively, all P<0.01). Conclusion Ultrasound-guided pleural biopsy combined with CEA, CYFRA21 and LDH in pleural effusions had an important value in the etiological diagnosis of pleural effusions, while CA125 showed little value in the differential diagnosis.

Objective To compare real-time PCR and gomori-methenamine silver stain in the diagnosis of pneumocystis peumonia (PCP).Methods 2 525 unrepeated specimens from suspected PCP patient admitted in Peaking Union Medical College Hospital were collected in 2014.2 492 samples were detected by gomori-methenamine silver stain,33 samples were detected by real-time PCR,and 429 samples were detected by both methods at the meanwhile.With clinical diagnosis as reference standard,the sensitivity,specificity,positive predictive value and negative predictive value of the two methods were analysised.Results Positive rate of gomori-methenamine silver stain was 1.2 ％ (30/2 492).The first three specimen types were sputum,tracheal intubation suction and bronchoalveolar lavage fluid,the positive rate was 0.70 ％ (13/1 845),4.00％ (10/250) and 2.72％ (7/257) respectively.Positive rate of realtime PCR was 34.20％ (158/462),and the positive rate of sputum and bronchoalveolar lavage fluid was 30.61％ (105/343) and 44.54％ (53/119) respectively.The sensitivity were 13.97％ vs 72.07％,specificity were 100％ vs 94.24％,positive predictive value were 100％ vs 92.14％ and negative predictive value were 55.36％ vs 78.26％ for gomori-methenamine silver stain and real-time PCR respectively.All of which were statistically significant analysed by x2 test for paired data.The x2 value and P alue were x2 =68.625,P＜0.01;x2 =4.296,P＜0.05;x2 =6.380,P＜0.01 and x2 =11.873,P＜0.01.Conclusion The real-time PCR had higher sensitivity,fewer interference factors and more clinical diagnostic value,so clinicians should make more use of real-time PCR to diagnose PCP earlier.

Purpose: The purpose of this study was to investigate the prevalence and risk factors of overactive bladder (OAB) in young adults and to explore the influence of OAB on mental health. Methods: Between October 2019 and January 2020, 14,010 anonymous questionnaires were distributed to freshmen at 2 universities in Henan, China. The students came from all over the country. The questionnaire included general items and information necessary to calculate the overactive bladder symptom score, the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) score, Self-Esteem Scale (SES) score, and Self-Rating Depression Scale (SDS) score. The relationships between the prevalence of OAB and its risk factors were evaluated. Results: The overall prevalence of OAB was 6.0%, with 4.3% of participants characterized as having dry OAB and 1.7% as having wet OAB. The prevalence of mild OAB was 5.5%, and that of moderate OAB was 0.5%; no severe OAB was observed. Higher prevalence rates of OAB were found among women, respondents with constipation, and respondents with primary nocturnal enuresis (PNE) (P <0.05). Compared to healthy controls, the OAB group exhibited a higher mean SDS score (52.12±8.986 vs. 47.71±9.399, P<0.001) and mean PSQI score (5.28±2.486 vs. 4.27±2.431, P<0.001), but a lower mean SES score (27.78±3.599 vs. 29.57±4.109, P<0.001). Conclusions OAB significantly affects the mental health of young adults. Female sex, constipation, and PNE are risk factors for OAB.

OBJECTIVETo study the optimum acupuncture treatment program and the mechanism for treatment of cerebral infarction.

METHODSSixty-three cases were randomly divided into 9 groups. The four factors, times of manipulation, the retaining time of the needle, acupuncture instrument and acupoints,and their corresponding three levels were adopted respectively in treatment of each group. Then nerve function defect score and insulin resistance were observed before and after treatment.

RESULTSThe acupoints, the times of manipulation and the retaining time of the needle have significant effects on nerve function defect and insulin resistance (P < 0.01 or P < 0.05), and the acupuncture instrument has a significant effect on insulin resistance (P < 0.01). The choice of acupoints was the most important factor for acupuncture treatment of cerebral infarction.

CONCLUSIONAcupuncture for regulating The Governor Vessel with twice manipulations and retaining the needle for 60 min is optimum treatment program for cerebral infarction. The good regulating effect of acupuncture on insulin resistance is one of the mechanisms of achieving the therapeutic results.

Acupuncture Points ; Acupuncture Therapy ; Cerebral Infarction ; Humans ; Insulin Resistance ; Needles

AIMTo isolate triterpene saponins of polygalacic acid type from the roots of Platycodon grandiflorum (Jacq.) A. DC and to identify their structures.

METHODSThe compounds were separated by means of extraction, chromatography on silica gel, MPLC and HPLC, and their structures were elucidated on the basis of spectral analyses (FAB-MS, IR, 1H NMR, 13C NMR etc.).

RESULTSThree triterpene saponins were isolated from the roots of Platycodon grandiflorum. They were identified as 3-O-beta-D-laminaribiosyl polygalacic acid (I), 3-O-beta-D-glucopyranosyl polygalacic acid (II), polygalacin D (III), separately.

CONCLUSIONCompound I is a new compound, compounds II, III are known triterpene saponins. The compound I and II were isolated from the plant for the first time, which is also the monodesmoside from the plant for the first time.

Molecular Conformation ; Molecular Structure ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Platycodon ; chemistry ; Saponins ; chemistry ; isolation & purification

OBJECTIVE: To study the clinical effect and safety of tacrolimus (TAC) combined with glucocorticoid (GC) versus mycophenolate mofetil (MMF) combined with GC in the treatment of primary IgA nephropathy (IgAN) in children. METHODS: A retrospective analysis was performed for the clinical data of children with primary IgAN confirmed by renal pathology between January 2012 and December 2017. These children were divided into TAC group and MMF group according to the treatment regimen. Their clinical data before treatment and at 1, 3, and 6 months of treatment were collected, and the remission status of IgAN and adverse reactions were compared between the two groups. RESULTS: A total of 43 children who met the inclusion criteria were enrolled, with 15 children in the TAC group and 28 children in the MMF group. At 1 month of treatment, there was no significant difference in the remission status between the two groups (P>0.05). At 3 and 6 months of treatment, the TAC group had a significantly better remission status than the MMF group (P<0.05). At 1 month of treatment, the TAC group had higher serum albumin levels than the MMF group (P<0.05). Both groups had a significant increase in serum albumin levels at each time point after treatment (P<0.0083) and a significant increase in the glomerular filtration rate (GFR) at 3 and 6 months of treatment (P<0.0083). There was no significant difference in the overall incidence rate of adverse reactions between the two groups (P>0.05), but fungal infection was observed in one child from the TAC group. CONCLUSIONS TAC combined with GC can effectively reduce urinary protein in children with primary IgAN, and it has a better short-term clinical effect than MMF combined with GC, with good safety.
Child ; Drug Therapy, Combination ; Glomerulonephritis, IGA ; drug therapy ; Glucocorticoids ; therapeutic use ; Humans ; Immunosuppressive Agents ; Mycophenolic Acid ; Retrospective Studies ; Tacrolimus ; therapeutic use

OBJECTIVETo explore the clinical features, laboratory findings and treatment of infant leukemia.

METHODSA retrospective analysis of the clinical data was performed of the cases with the diagnosis of infant acute leukemia from August 1993 to October 2014 in our hospital.

RESULTSA total of 144 cases of infant leukemia were diagnosed in the defined period, including 83 cases of acute lymphoblastic leukemia, 55 myeloid leukemia, 1 hybrid acute leukaemia and 5 with incompatible cytological and immunophenotyping findings. The patients at the age of 9 to 12 months accounted for the largest proportion (38.2%), and 87.5% of the patients had hepatosplenomegaly; Six patients below 6 months old had skin infiltration. In about 1/3 of the patients, the white blood cells count was no greater than 100 × 10⁹ /L. Ninety-five patients had chromosome examinations, which identified chromosome abnormalities in 67 patients, including 18 positive for t(4;11)or t(9;11)or t(11;19), and younger patients were more likely to have chromosome abnormalities. Thirty-seven patients underwent MLL gene detection and 11 of them had positive results; the positive patients had higher rate of chromosome 11 abnormalities than the negative patients. Most of the patients gave up treatments after diagnosis and only 6 patients older than 6 months completed regular chemotherapeutic treatments and were now in complete remission.

CONCLUSIONInfant leukemia is a rare type of leukemia with different clinical features from other types of leukemia. The patients often present with hepatosplenomegaly, high white blood cell counts, MLL gene fusion, and chromosome 11 abnormalities. The prognosis of infant leukemia is not favorable, and the current treatment still relies on chemotherapy.

Acute Disease ; Chromosome Aberrations ; Chromosome Disorders ; Chromosomes, Human, Pair 11 ; Humans ; Immunophenotyping ; Infant ; Leukemia, Myeloid ; pathology ; Leukocyte Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; pathology ; Prognosis ; Retrospective Studies

In 2007, an outbreak of acute hemorrhagic conjunctivitis (AHC) occurred in Beijing. In order to identify the etiology of this outbreak, 57 eye conjunctival swabs were collected from 57 outpatient patients, and detected for adenovirus, human enterovirus 70 (HEV70) and Coxsackievirus A24 variant (CVA24v) genes by using RT-PCR or PCR methods. The results showed that 38 were positive for CVA24v, the positive rate was 66.7%, but none was positive for HEV70 and adenovirus, showing that this outbreak was caused by CVA24v. 9 viral isolates were obtained from 57 clinical specimens by using viral isolation method, and all were identified as CVA24v by molecular typing method. All 9 CVA24v isolates were performed by VP1 sequencing, the results showed that except for strain 0744/BJ/CHN/2007, the variability at nucleotide acid level and amino acid level among other 8 CVA24v were relatively low, and the homologies were more than 99.6% and 100.0%, respectively; the homologies of nucleotide acid and amino acid between strain 0744/BJ/CHN/2007 and other 8 CVA24v were 96.8%-97.2% and 99.7%, respectively. Phylogenetic analysis of 9 CVA24v revealed that they represented the Clade 4 and Clade 5 in Group I, showed that this outbreak was caused by at least 2 viral transmission chains. Comparing to 3C region of CVA24v frequently used before, VP1 region was considered as the most rigorous target for molecular epidemiology study of CVA24v. To enhance the research of sero-epidemiology and molecular epidemiology of CVA24v and to know the genetic characterizations and molecular evolution of CVA24v are most important to prevent and control the outbreaks of AHC in China.
China ; epidemiology ; Conjunctivitis, Acute Hemorrhagic ; epidemiology ; virology ; Disease Outbreaks ; Enterovirus C, Human ; classification ; genetics ; isolation & purification ; Humans ; Molecular Epidemiology ; Molecular Sequence Data ; Phylogeny ; Viral Proteins ; genetics

OBJECTIVETo investigate the significance of serum cholesterol and fibrinogen (Fib) in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome.

METHODSSixty-three children with primary nephrotic syndrome were divided into two groups according to their pathological types: minimal change glomerulopathy (MCG) (n=39) and focal segmental glomerulosclerosis (FSGS) groups (n=24). Serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and Fib and 24-hour urinary protein excretion were retrospectively analyzed.

RESULTSSerum levels of TC, non-HDL-C, and LDL-C were significantly higher in the FSGS group than in the MCG group (P<0.05), but there were no significant differences in HDL-C, Fib and 24-hour urinary protein excretion between the two groups (P>0.05). According to the results of logistic regression analysis, high levels of LDL-C, non-HDL-C and TC were risk factors for FSGS (P<0.05). In patients whose proteinuria did not disappear after taking enough glucocorticoid for 4 weeks, the level of non-HDL-C was significantly higher in the FSGS group than in the MCG group (P<0.05); there were no significant differences in TC, LDL-C, HDL-C, and Fib between the MCG and FSGS groups (P>0.05).

CONCLUSIONSSerum cholesterol, especially non-LDL-C, is of great significance in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome. There is no sufficient evidence to support serum Fib as a marker for predicting glomerulosclerosis in these children.

Child ; Child, Preschool ; Cholesterol ; blood ; Female ; Fibrinogen ; analysis ; Glomerulosclerosis, Focal Segmental ; etiology ; Humans ; Logistic Models ; Male ; Nephrosis, Lipoid ; etiology ; Nephrotic Syndrome ; blood ; complications ; Retrospective Studies ; Risk

OBJECTIVETo determine the effect of national free highly active antiretroviral treatment (HAART) on reduction of mortality and relevant risk factors among adult Acquired immunodeficiency syndrome (AIDS) patients.

METHODSA retrospective cohort study was conducted and all AIDS patients diagnosed before Aug. 30th, 2008 in Zhumadian, Henan province, and Fuyang, Anhui province were enrolled in this study, where HAART initiated in early time. The data and information were collected such as AIDS progress, diagnosis, treatment, death and et al.

RESULTSAmong 10,394 AIDS patients, the mean age was (41.7 +/- 9.3) year-old, 50.3% (5233/10,394) were male, 85.0% (8808/10,394) were married, 95.1% (9880/10,394) were farmers, and 81.2% (8438/10,394) were former plasma donors (FPDs). The coverage of HAART increased from 5.2% in 2002 to 66.5% in 2008. Conversely, the overall mortality declined from 35.4/100 person-years in 2002 to 5.9/100 person-years in 2008. In a multivariate Cox proportional hazards analysis, the greatest risk factor for mortality was non-HAART, with a hazard ratio (HR) 4.3 (95%CI: 4.0 - 4.7). Among treated patients, compared with higher CD(4)(+) T cell counts (> 200 cells/microl), those initiating therapy with lower CD(4)(+) T cell counts, were at greater risk to death (< 50 cells/microl, HR = 7.9; 50 - 199 cells/microl, HR = 2.8). Number of opportunistic infections (OIs) was risk to mortality (HR = 2.1). In addition, other risk factors included male, age (>or= 50 years old), and other infection way except FPDs (HR were 1.4, 1.6 and 1.8).

CONCLUSIONThe national free treatment program has significantly reduced the AIDS mortality rate among HIV-infected FPDs through the use of generic antiretroviral drugs in rural clinical settings. The effective reduction of AIDS mortality could be realized through increased coverage of therapy.

Acquired Immunodeficiency Syndrome ; drug therapy ; economics ; mortality ; Adult ; Anti-HIV Agents ; economics ; therapeutic use ; Antiretroviral Therapy, Highly Active ; economics ; utilization ; China ; Cohort Studies ; Female ; Humans ; Inpatients ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate