Objective To summarize studies about palliative care (PC) in mainland China and to provide a guidance for propagandizing the concept of palliative care and to carry out related investigations.Methods Key words of Shu Huan Yi Xue,Gu Xi Zhi Liao,An Ning Liao Hu,Ling Zhong Guan Huai,Shu Huan Yi Liao,together with conception,acceptance were used in CBM.And palliative care AND China AND(acceptance OR acknowledgement OR concept OR conception) were used in PubMed.Above searches were for articles,without any other limitations such as publishing date,author,journal,type or language.Eligible articles investigating acceptance of palliative care in mainland China were screened out with artificial work.Descriptive analysis was adopted as a statistic method.Results A total of 35 articles related with palliative care were picked out.Most of the investigation methods were questionnaire.The palliative care-accepting degrees were 25.3 ％ to 86.6％ in overall,25.3％ ～70.8％ in the elderly,30.8％ ～ 56.2％ in advanced stage of cancers,61.7％ ～ 68.4％ in families of patients,and 56.6％～95.8％ in health care workers.In the subgroup analysis,the acceptance showed no difference between genders.But age,followed by careers,degrees of medical education and religions and nationalities were all effective factors for the acceptance of palliative care,which was mostly agreed in all the articles.Conclusions People in mainland China are insufficient very much in the perception of palliative care idea.More publicity and education are needed to popularize the palliative care idea.More studies with better design and more rigorous protocol are needed to have a better understanding of the acceptance of palliative care.

Objective:To explore efficacy of the rehabilitative strategy in hospitalized schizophrenics.Method:Sixty-four schizophrenic patients were randomly divided into the intervention group and the control group.Both groups received the anti-psychotics therapy, but the teamwork education,medication management skills training module, symptom management skills training module were only given to the intervention group for ten weeks. And a one-year follow-up was carried out after their discharge from hospital. All subjects were evaluated with the Positive and Negative Syndrome Scale (PANSS), Nurses` Observation Scale for Inpatient Evaluation-30 (NOSIE-30), Insight and the Attitude to Treatment Scale, Social Disability Screening Schedule (SDSS), Morning Side Scale. We also recorded the relapse rate, reemployment rate, and re-hospitalization rate. Result:The clinical outcome of the intervention group was significantly superior to the control group on overall improvement according to PANSS (31.17?3.13 vs 52.34?13.02,7.34?1.08 vs 12.36?4.28,7.76?2.13 vs 13.26?4.50,16.13?1.82 vs 32.17?9.82 ),increase of active factor score of NOSIE-30 (-18.3?3.2 vs 14.4?6.7),and the reduction of inactive factor score of NOSIE-30(9.4?6.2 vs -22.3?7.4).The relapse rate(9.4% vs 54.8%),re-hospitalization rate(3.2% vs 42%),reemployment rate(37.5% vs 9.6%)were also better in the intervention group.Conclusion:The effect of rehabilitative strategy for schizophrenic patients not only improves the symptom, but also their social function.

Objective To better understand the clinical characteristics and predisposing factors in non-pregnant patients with Listeria monocytogenes (Listeria) sepsis.Methods Clinical data were collected at Peking Union Medical College Hospital between January 2002 and December 2014.A case with non-pregnant Listeria sepsis is defined as a non-pregnant person with clinically compatible illness and from whom Listeria was isolated from his/her blood culture.We define an underlying condition if a patient has been diagnosed of and/or has been treated for a concurrent baseline disease within 1 month prior to the onset of Listeria sepsis.Results A total of 35 patients were enrolled.The age of all patients was (49.1 ± 17.0) years.The male to female ratio was 2∶ 3.Most patients were combined with at least 1 underlying condition (33,94.3％),including 42.9％ patients with an autoimmune disease,34.3％ with malignancies.The majority (91.4％) represented an acute onset (＜ 1 week) with median time of 3 days.Clinical manifestations included fever (34/35,97.1％),central nervous system (CNS) symptoms (17/35,48.6％),gastrointestinal tract symptoms (13/35,37.1％).Fourteen patients had undergone lumber puncture and cerebral spinal fluid (CSF) tests,which revealed abnormalities comparable of Listeria meningitis.Listeria was isolated from CSF in 11 of 14 patients (78.6％).There were 34 patients receiving empiric antibiotics including 54.3％ cephalosporins which are resistant to Listeria.Twenty five (71.4％) patients were switched to the target antimicrobials according to positive blood culture.Of the 35 patients with Listeria sepsis,21 (60.0％) recovered or were cured,however the rest (40.0％) had dismal outcome.Six patients died in hospital,8 critical patients were discharged and died after transferring to local hospitals.Conclusions Listeria sepsis is commonly associated with non-pregnant patients with compromised immune function.Clinical presentations include acute fever,CNS symptoms and gastrointestinal symptoms etc.Empiric antibiotics covering Listeria should be considered when sepsis is suspected among susceptible hosts.

Objective:To analyze the clinical characteristics of patients with eosinophilic granulo-matosis with polyangiitis (EGPA) and improve the understanding of the disease.Methods:EGPA patients who fulfilled the 1990 American College of Rheumatology (ACR) classification criteria were recruited from Sun Yat-sen Memorial Hospital Sun Yat-sen University between December 2003 and April 2020. Their demographic characteristics, clinical manifestations, laboratory and auxiliary examinations were analyzed retrospectively. Mann-whitney U test and χ2 test were used for statistical analysis. Results:Among 52 EGPA patients, 34 (65.4%) were males and the median age at disease onset was 47(38-55) years. The median time from disease onset to diagnosis was 30(4-96) months. The most common initial symptoms were respiratory (61.5%) and nose/paranasal sinus (21.2%) involvement. The most common department for the first visit was respiratory medicine (53.8%), followed by rheumatology (11.5%). 44.2% EGPA patients were diagnosed by rheumatologists. The most common clinical manifestations were asthma (88.5%), nose/paranasal sinusitis (84.6%), pulmonary (76.9%) and nervous system (61.5%) in volvement. Eight(15.4%) patients were positive for antineutrophil cytoplasmic antibodies (ANCA). Patients with positive ANCA had lower incidence of asthma, but higher incidence of general symptoms especially arthralgia and renal involvement, elevated eosinophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Birmingham vasculitis activity score and vasculitis damage index than patients with negative ANCA (all P<0.05). 21.2%-34.6% EGPA patients had poor prognostic factors. Conclusion:Early diagnosis of EGPA is important. EGPA patients with positive ANCA may be more severe than patients with negative ANCA. The management should be a multi-disciplinary collaboration between rheumatologists and pulmonologists.

Objective To analyze the genomic sequences of Cryptococcus neoformans var grubii strains of two genotypes with different virulence and to screen out the virulence-associated genes. Methods A clinical strain (IFM56800) with the strongest virulence and an environmental strain (IFM56731) with the weakest virulence were screened out for whole genome sequencing analysis. The results of sequencing analy-sis were comprehensively analyzed by using the method of comparative genomics. Genetic variations were ex-tensively screened by using the strategies of non-synonymous single nucleotide polymorphisms ( nsSNPs), nonsense SNPs and the insertions or deletions ( InDels) causing frameshift mutations. The filtered genes were sequenced in 20 experimental strains. The whole RNAs were extracted and then the full-length cDNAs were sequenced by using the rapid amplification of 5′ and 3′ cDNA ends (RACE) method. Results By whole genome sequencing, valid data with high coverage (127 times and 111 times) was obtained in both the environmental strain IFM56731 and the clinical strain IFM56800. The data of InDels and SNPs were statisti-cally analyzed, respectively. Six genes were chosen for further analysis based on the strategies of nonsense SNPs and the InDels causing frameshift mutations. The six genes were amplified and sequenced in all of the experimental strains, three of which were further analyzed with cDNA sequencing. Ultimately, the location and structure of CNAG_01032 gene were determined. The predicted nonsense mutation locus was verified to present in the actual mRNA. Conclusion The strategies of nonsense SNPs and the InDels causing frame-shift mutations showed high-efficiency in screening potential virulence-associated genes. The CNAG_01032 gene was screened out as a novel virulence-associated gene.

Objective To investigate doctor's screening practice for hepatitis B virus (HBV) infection before immunosuppressive therapy for rheumatoid arthritis (RA) patients and clinical management of RA patients with positive surface antigen of HBV (HBsAg).Methods One hundred fifty doctors who treated RA patients in daily clinic were survied with a modified American College of Rheumatology (ACR) questionnaire which was composed of demographic data and 10 multiple-choice questions.Step-forward logistic regression analysis was performed to find out the influencing factors,then receiver operator characteristic curve analysis and area under the curve were performed to confirm the influencing factors.Results One hundred and thirtytwo effective questionnaires were collected.Before immunosuppressive therapy,HBV screening rate in outpatients with RA was significandy lower than that in hospitalized patients (68.7％ vs 94.6％,x2=31.5,P＜0.01).Only 23.7％(31/131) of doctors considered antiviral treatment for all RA patients with positive HBsAg.One hundred and thirteen doctors had clinical experience of antiviral treatment,but only 30.1％(34/113) and 23.9％ (27/113) of these doctors chose entecavir or adefovir as the antiviral drug respectively,59.3％ (67/113) prescribed antiviral drug before or together with immunosuppressive therapy compared with 40.7％(46/113) after HBV reactivation.Only 20.4％(23/113) of doctors would sustain antiviral treatment until the termination of steroid or disease modifying antirheumatic drugs (DMARDs).During immunosuppressive therapy for HBsAg(+) RA patients,11.4％(15/132) and 30.3％(40/132) of doctors reported no regular monitoring of aminotransferase or HBV DNA respectively.Conclusion Our survey shows that HBV screening rate in outpatients with RA is low and low awareness of antiviral treatment for all RA patients with positive HBsAg,and lack of awareness of indication,choosing of antiviral drugs,initiation,monitoring and duration of antiviral treatment during immunosuppressive therapy.Further medical education on the associated information and importance to collaborate with hepatologists should be emphasized.

Objective To observe the efficacy and safety of tocilizumab on patients with refractory rheumatoid arthritis (RA).Methods Eighteen RA patients who were refractory to disease-modifying antirheumatic drugs (DMARDs) or tumor necrosis factor-α (TNF-α) antagonist were treated with tocilizumab were included into this study.Their clinical disease activity indices,Hospital Anxiety and Depression Scale (HADS)and safety were evaluated regularly.Statistical analysis was conducted with Mann-Whitney U test and x2 test.Results According to clinical disease activity index,44％(8/18) of patients reached treatment target 2 weeks after the first infusion of tocilizumab,and 78％ (14/18) reached treatment target after three infusions of tocilizumab.Fifty-six percent (10/18) of patients had anxiety and 22％ (4/18) had depressive symptoms at baseline.After three infusions of tocilizumab,6％(1/18) had anxiety symptoms and 11％(2/18) had depressive symptoms.The adverse effects included upper respiratory tract infection,aminotransferase elevation and neutropenia (3 patients,respectively).Conclusion Tocilizumab can rapidly and significantly improve the disease activity and psychological state with good tolerance and safety,which can be applied to Chinese refractory RA patients who failed with DMARDs or TNF-α antagonist.

Objective To summarize the clinical characteristics and outcome of maternal listeriosis so as to improve the understanding of disease and the level of diagnosis and treatment.Methods Retrospectively,16 cases of maternal listeriosis,who were treated at Peking Union Medical College Hospital between March 2007 and December 2014 were reviewed.Maternal listeriosis is defined when a pregnant woman presents with symptoms as listeriosis,meanwhile Listeria monocytogenes is isolated from sterile tissue or peripheral blood,or from a non-sterile site (uterus swab) or pathological evidence of chorioamnionitis.The neonatal listeriosis is diagnosed as acute listeria sepsis.Results The mean age of these 16 patients was (30.0 ± 3.9) years old.There were 1,8,7 patients with listeriosis diagnosed in the first,second and third trimester of pregnancy,respectively.All had an acute onset of illness (≤2 weeks),the median time from onset to presentation was 2.5 days.Clinical manifestations included fever (93.8％,15/16),leukocytosis (78.6％,11/14),chorioamnionitis (77.8％,7/9),gastrointestinal symptoms (37.5％,6/16) and fetal movement decrease (31.3％,5/16).Listeria monoeytogenes were isolated from blood (6 cases),uterus swab (6 cases),blood plus uterus swab (1 case),and neonates (3 cases).All maternal cases recovered well after the termination of pregnancy,even none of them had received empiric antibiotics sensitive to listeria.A very high proportion of adverse pregnancy outcomes occurred (15/16,93.8％).There were 8 fetal losses.Seven neonates were complicated with listeria sepsis and treated successfully.Conclusions The patients with maternal listeriosis commonly presented with acute fever and an extremely high incidence of adverse pregnancy outcomes,however empiric antibiotics can hardly cover this pathogenic bacterium.So both pregnant women and clinicians should maintain a high level of vigilance against listeriosis and pay more attention to dietetic hygiene.

ObjectivesTo examine the validity of high-frequency Doppler ultrasound in identifying knees synovitis in patients with rheumatoid arthritis(RA).MethodsNinety-five consecutive patients with active RA were examined withhigh-frequency Doppler ultrasound to examine synovitis signals in knees.Synovial tissue samples of 51 patients were obtained by closed needle biopsy from knees after ultrasound examination.Serial synovial tissue sections were stained with H&E and immunohistochemical staining,and the histopathological synovitis scores were evaluated.The relationship among clinical, histopathological and ultrasound synovitis indexes was analyzed by Spearman's rank order correlation test and receiver operating characteristic curve analysis.ResultsAmong 95 RA patients,the median thickness of synovial membrane in ultrasound was 2.8 mm,the median depth of effusion was 2.7 mm; Doppler signals of synovial blood flow were detected in 82％(78/95 ) of patients and the median semiquantitive grading of synovial blood flow was 1.0.The thickness of synovial membrane and synovial blood flow at Doppler ultrasound correlated positively with histological synovitis score,hyperplasia of the lining layer,and inflammatory infiltration in sublining area (the thickness of synovial membrane:r=0.438,0.424,0.368,respectively; synovial blood flow:r=0.357,0.377,0.347,respectively; all P＜0.05).Although there was no significant difference in clinical synovitis indexes between patients with histologically low-grade and high-grade synovitis,the thickness of synovial membrane and synovial blood flow in ultrasound in patients with histologically high-grade synovitis was significantly higher than those with low-grade synovitis(P=0.001,0.036,respectively).When the thickness of synovial membrane in ultrasound was ≥ 3.9 mm,the specificity of diagnosing the high-grade synovitis was 96.7％ and the sensitivity was 61.9％.ConclusionSynovitis signals at high-frequency Doppler ultrasound correlate with histopathological synovitis,and it might be helpful in evaluating the severity of histopathological synovitis.

Objective To investigate the clinical features of internal carotid steal syndrome. Methods The clinical manifestations, CT or MRI, digital subtraction angiography, and blood flow compensation in 6 patients with internal carotid steal syndrome were analyzed. Results Of the 6 patients, 2 had unilateral internal carotid artery stenosis, 4 had severe stenosis (in which 2 were on the left side, 1 was on the right side, and 1 was on both sides). The clinical manifestations of the patients with internal carotid steal syndrome were watershed infarction and transient ischemic attack. Four patients had posterior circulation ischemia and 2 had anterior circulation ischemia. Digital subtraction angiography demonstrated that collateral circulation was established in all the 6 patients. The anterior communicating artery, posterior communicating artery, and pial artery were the common compensatory vessels. Conclusions Internal carotid artery steal syndrome can be presented as anterior or posterior circulation ischemia, and the collateral circulation plays an important role in the compensation.