Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups:control group,treatmentⅠand treatmentⅡgroups(each,16 cases). All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules(one capsule 0.3 g)each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume(LVEDV),the left ventricular end-systolic volume(LVESV),the left ventricular ejection fraction(LVEF)and the plasma B type brain natriuretic peptide (BNP),etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram(ECG),aspartate transaminase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),serum creatinine(SCr),blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week:81.2%(13/16),81.2%(13/16)vs. 43.8%(7/16);after 2 months:87.5%(14/16),93.7%(15/16)vs. 50.0%(8/16), all P<0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV (mL):142.4±33.0 vs. 174.8±52.5,LVESV(mL):111.6±23.7 vs. 132.4±29.0,LVEF:0.421±0.037 vs. 0.390±0.045,BNP(μg/L):1.944±0.751 vs. 3.038±1.905,all P<0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients' life quality.

Objective The type 1 autoimmune pancreatitis is gradually being recognized, but the type 2 AIP is still very rare in Asia.This paper summarizes the clinical characters of type-2 AIP patients in Peking Union Medical College Hospital.Methods From January 2001 to December 2016,all type 2 AIP hospitalized patients who met the ICDC were included in the study.The clinical data, laboratory results and imaging features of all patients were recorded, verified and follow-up.Results Six patients with type 2 AIP were included in the study.The ratio of men and women was 2/1, with an average age of 38.4 years.67.7% (4/6) patients have UC.37.7% (2/6) of patients were asymptomatic.Three patients were diagnosed by pathology.50% (3/6) of patients showed mass of pancreas, and 50% (3/6) of patients showed pancreatic enlargement.Conclusions The clinical manifestations of the type 2 AIP patients in Peking Union Medical College Hospital are the same as those in foreign countries.

Objective To investigate the clinical value of a new-generation cartridge Xpert MTB/RIF Ultra assay on detection of Mycobacterium tuberculosis(MTB)and rifampin(RIF)resistance.Methods A total of 111 patients from He'nan Provincial Chest Hospital with suspected tuberculosis(TB)and retreated TB were enrolled into this study from March to December 2016,including 33 cases of tuberculosis detection group(CDG)and 78 cases of drug resistant high-risk group(DRG).The sputum samples of patients were collected.The sensitivity and specificity of Xpert MTB/RIF Ultra,sputum smear,solid Lowenstein-Jensen(L-J)culture and mycobacterial growth indicator tube(MGIT)culture for MTB were evaluated.RIF resistance was performed by Xpert MTB/RIF Ultra,traditional phenotypic drug sensitivity test and Xpert MTB/RIF assay.Measurement data were compared using t-test,and categorical data were compared using chi-squared test.Results Using clinical diagnosis result as the standard,in the CDG,the sensitivity of Xpert MTB/RIF Ultra for MTB detection(75.8%)was not significantly different from those of sputum smear(66.7%),L-J culture(63.6%),MGIT culture(75.6%)and Xpert MTB/RIF(66.7%)(x2=0.67,1.15,0.00 and 0.67,respectively,all P>0.05).In the DRG,the sensitivity of Xpert MTB/RIF Ultra(94.9%)was better than those of L-J culture(55.1%)and MGIT culture(80.8%)with statistical significance(x2=32.8 and7.25,respectively,both P <0.05).The sensitivity of Xpert MTB/RIF Ultra was not significantly different from sputum smear(84.6%)and Xpert MTB/RIF(91.0%)(x2=3.41 and 0.39,respectively,both P>0.05).Xpert MTB/RIF Ultra took the shortest time to obtain the final results,which was(1.76±0.18)h and significantly shorter than smear test([5.04±0.49]h),L-J culture([31.67±0.56]h),MGIT culture([22.36±9.68]h),Xpert MTB/RIF([2.00±0.30]h)(t=16.90,31.98,24.38 and 7.05,respectively,all P <0.01).Using culture result as the standard,the sensitivity for MTB detection of Xpert MTB/RIF and Xpert MTB/RIF Ultra were 93.2% and 98.9%,and the specificity of Xpert MTB/RIF and Xpert MTB/RIF Ultra were both 100%.The sensitivity for MTB detection of Xpert MTB/RIF Ultra(52.2%)was significantly better than that of Xpert MTB/RIF(21.7%)in 23 smear-negative pulmonary TB patients with statistical significance(x2=4.98,P=0.025).Using traditional drug susceptibility test as the standard,the sensitivities for RIF resistance detection of Xpert MTB/RIF and Xpert MTB/RIF Ultra in culture-positive TB patients were 90.9% and 93.2%,respectively,and the specificities were 89.5% and 92.9%,respectively.Conclusions Xpert MTB/RIF Ultra has a higher MTB detection rate than Xpert MTB/RIF in smear-negative pulmonary TB patients.In drug-resistant pulmonary TB patient,MTB/RIF Ultra has high sensitivity,and it takes shorter time to detect MTB and RIF resistance.Thus,Xpert MTB/RIF Ultra has a good application prospect in clinical work.

Objective:To establish a new molecular typing method for Treponema pallidum (TP) based on TP0136 protein sequence heterogeneity. Methods:The amino acid sequences of TP0136 open reading frame (ORF) of 9 strains of Treponema pallidum ssp. Pallidum (TPA) , 3 strains of Treponema pallidum ssp. Pertenue (TPE) , 1 unclassified simian strain of Treponema Fribourg-Blanc (FB) and 1 strain of Treponema pallidum ssp. Endemicum (TEN) were searched from Genbank, and multiple sequence comparisons were performed to obtain the molecular typing results of TP0136 protein. The TP0136 protein-based molecular typing method was used to classify 23 TPA clinical isolates, which were collected from Dermatology Hospital of Southern Medical University from January 2015 to December 2018, and the typing results were compared with those by the traditional typing method based on the tp0548/Arp/Tpr genes. Results:TP0136 protein was highly heterogeneous in different TP strains. According to the amino acid sequence of TP0136, TPE, FB and TEN strains were divided into 4 subtypes of Ⅰ- Ⅳ, TPA strains were divided into 6 subtypes of Ⅴ-Ⅹ, and TPA clinical strains were classified into 4 subtypes of Ⅶ, Ⅸ, Ⅹ, Ⅺ. Through the traditional typing method described above, 23 TPA clinical strains could be divided into 5 types (13D/d, 14D/f, 14D/g, 15D/f, 16A/e) . By using the TP0136 protein-based typing method combined with traditional typing method, the above clinical strains could be further subdivided into 10 types, and the 14D/f type could be further divided into 3 subtypes by using the TP0136 protein-based typing method.Conclusion:The TP0136 protein-based molecular typing method can be used to distinguish TP species, which is helpful for further improvement of traditional TPA molecular typing.