Objective To understand the etiopathogenesis of pancytopenia (PCP) in Sichuan area and to analyze the statistical difference in the aspects of sex ,season and age .Methods 224 cases of PCP were performed the etiological statistics on sex ,season and age by SPSS11 .0 .Results Among 224 cases of PCP ,46 cases(21% ) were megaloblastic anemia ,followed by 36 cases(16% ) of myelodysplastic syndromes (MDS) and 27 cases(12% ) of aplastic anemia(AA) .224 cases of PCP included 110 males(49 .10% ) and 114 females(50 .90% ) ,there was no statistical difference between sexes (P>0 .05) .In the seasons groups ,most of the patients went to see doctor and were diagnosed in the fourth quarter (32% ) and the first quarter was least (13% ) ,the difference between them had statistical significance(P<0 .05);In the age groups ,the age group of 45- <65 years old was the highest(36 .71% ) and the age group of less than 18 years was lowest(3 .57% ) ,the difference between them had statistical significance(P<0 .05) .Conclu-sion Megaloblastic anemia is the main etiology causing PCP in Sichuan area ,and the next is MDS and AA .The sex has no statisti-cal significance to the patients with PCP ,while the incidence rate in the aspects of season and age has statistical significance .

Objective To explore the value of combined detection of parathyroid hormone(PTH),β2-microglobulin(β2-MG)and high sensitivity C-reactive protein(hs-CRP)in differentiating diagnosis of acute and chronic renal failure. Meth?ods Patients diagnosed with renal failure was divided into acute renal failure patients group (n=64) and chronic renal fail?ure group (n=74) . Other patients with non-renal failure kidney disease (NRF group, n=80) and healthy adult (control group, n=80) were also selected. Levels of PTH,β2-MG, hs-CRP , PTH+β2-MG, PTH+hs-CRP,β2-MG+hs-CRP and PTH+β2-MG+ hs-CRP were compared between these four groups to choose the optimal combination for differential diagnosis. Re?sults Hs-CRP in ARF group was significantly higher than that in control group and CRF group. Levels of PTH andβ2-MG were significantly lower in ARF group than that in CRF groups but not in control group (P < 0.01). hs-CRP andβ2-MG in the ARF group were moderately higher (68.7%) and severely higher (81.2%) while PTH was mild higher (25%) in ARF group than those in control group, On the other hand, hs-CRP andβ2-MG in the ARF group were moderately higher (56.8%) and severely higher (98.6%) while PTH was mild higher (39.2%) in ARF group than those in control group. Combina?tion of hs-CRP withβ2-MG could increase total case rate (TCR) and Youden index (YI) of ARF;while combination of PTH andβ2-MG could improve the TCR and YI of CRF. Conclusion Combined detection of PTH,β2-MG and hs-CRP is use?ful in differential diagnosis of ARF and CRF.

Objective To explore the clinical diagnostic value of parathyroid hormone(PT H)in the diagno-sis of chronic renal failure(CRF).Methods 162 cases of CRF patients who were treated in the Sichuan Pro-vincial People′s Hospital from January 2014 to October 2015 were selected as the CRF group,meanwhile 164 non-CRF(NCRF)patients and 167 persons undergoing healthy physical examination were selected as the NCRF group and the healthy control group respectively.The PTH level was detected in 3 groups.According to the detection results the receiver operating characteristic(ROC)curve was drawn,and the diagnostic value of PTH for CRF was evaluate.Results The PTH level in the CRF group was significantly higher than that in the NCRF group and healthy control group,the difference was statistically significant(P<0.05);when the di-agnostic cut off value of PT H for CRF was 75.00 nmol/L,the area under the ROC curve,sensitivity,specifici-ty,positive likelihood ratio and Youden index were 0.92,80.20%,97.80%,36.45 and 78.00 respectively.Con-clusion PT H has a good diagnostic value to CRF.With the cut off value of PT H for diagnosing CRF as 75.0 nmol/L,it can improve the efficiency of clinical diagnosis.

Objective:To investigate the diagnostic performance of Xpert Mycobacterium tuberculosis/rifampin (Xpert MTB/RIF) assay for pulmonary tuberculosis (TB) in patients with acquired immunodeficiency syndrome (AIDS). Methods:Clinical data of 226 patients with AIDS and suspected pulmonary TB in Shanghai Public Health Clinical Center, Fudan University from July 2017 to November 2019 were retrospectively analyzed. Fluorescence staining microscopy of sputum smear, BACTEC MGIT 960 liquid culture (or Roche solid culture) and Xpert MTB/RIF assay were implemented respectively. The sensitivity and specificity of Xpert MTB/RIF in the diagnosis of Mycobacterium tuberculosis (MTB) infection and rifampin resistance were analyzed. Results:Totally 226 patients of suspected pulmonary TB were enrolled. There were 94(41.6%) patients had positive mycobacterium culture, in which 51 (54.3%) were MTB and 43 (45.7%) were nontuberculous mycobacteria (NTM). Using the positive MTB culture of sputum and mycobacterial protein from BCG of Rm 0.64 in electrophoresis (MPB64) as reference standard, the sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis were 72.6%(95% confidence interval ( CI) 66.7%-78.4%) and 97.1% (95% CI 95.0%-99.3%), respectively. The sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis in patients with positive sputum smear were 76.7%(95% CI 67.7%-85.8%) and 90.0(95% CI 83.6%-96.5%), respectively. The sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis in patients with negative sputum smear were 50.0%(95% CI 41.8%-58.2%)and 99.3%(95% CI 97.9%-100.0%), respectively. With phenotypic resistance as reference standard, the sensitivity and specificity of Xpert MTB/RIF assay for rifampicin resistance were 75.0% and 100.0%, respectively. Conclusion:Among AIDS patients, the performance of Xpert MTB/RIF assay for pulmonary TB diagnosis is pretty good and could differentiate MTB from NTM rapidly, which has good application value.

Objective:To analyze the clinical and epidemiological characteristics and changing trends of acquired immunodeficiency syndrome (AIDS)-associated talaromycosis in Shanghai City.Methods:The clinical data of patients with AIDS-associated talaromycosis hospitalized at Shanghai Public Health Clinical Center, Fudan University from Janauary 1, 2014 to December 31, 2021 were collected. The medical information included age, gender, place of origin, clinical symptoms, imaging manifestations, blood routine test, CD4 + T lymphocyte count. The chi-square test or Fisher exact probability test was used for statistical analysis. Univariate logistic regression was used to analyze the related risk factors for death. Results:From 2014 to 2021, a total of 12 165 AIDS patients were admitted, including 169 (1.4%) AIDS-assiociated talaromycosis patients. The proportions of AIDS-associated talaromycosis in AIDS inpatients from 2014 to 2021 were 1.8%(21/1 149), 1.1%(14/1 307), 1.3%(19/1 446), 0.9%(15/1 610), 1.2%(20/1 626), 1.2%(22/1 778), 1.7%(28/1 624) and 1.8%(30/1 625), respectively, which had not changed much. There was no statistically significant difference in the proportion of AIDS-associated talaromycosis in AIDS inpatients in different years ( χ2=9.50, P=0.218). Among the 169 patients, 157 cases (92.9%) were male, with the age of (37.9±12.2) years, and 35 were from Jiangxi Province, 31 from Shanghai Municipality, 29 from Zhejiang Province, 17 from Anhui Province, 14 from Fujian Province, 11 from Jiangsu Province, eight from Hunan Province, four from Heilongjiang Province, three cases each from Guangxi Zhuang Autonomous Region, Guizhou Province and Henan Province, two cases each from Hubei Province, Shandong Province, Shanxi Province, Yunnan Province and Guangdong Province, and one case from Chongqing Municipality. Patients from non-traditional endemic areas did not find a clear history of living in traditional endemic areas. Of 169 patients, 143(84.6%) cases had fever, 73(43.2%) had respiratory symptoms, and 26(15.4%) had rash during the course of the disease, 147(87.0%) had pulmonary imaging abnormalities, 94(55.6%) were complicated by other pathogens, and 44(26.0%) had hepatosplenomegaly, 137(81.1%) had CD4 + T lymphocyte count <50/μL. Twenty-three patients died, with the total fatality rate of 13.6%. The overall mortality rate showed a downward trend year by year. There was a statistically significant difference in the case fatality rate of AIDS-associated talaromycosis in different years (Fisher exact probability test, P=0.046). The result of univariate logistic regression model showed that patients with platelet count<50×10 9/L had an increased risk of death (odds ratio ( OR)=3.33, 95% confidence interval ( CI) 1.13 to 9.81, P=0.029). Conclusions:The overall change of AIDS-associated talaromycosis inpatients in Shanghai is not significant, while the prevalence rate has increased slightly in recent two years. The case fatality rate is declining year by year. The proportions of patients without a history of living in or traveling to epidemic areas and without rash as the first manifestation are high, and the main clinical manifestation is multi-system damage. Patients with platelet count<50×10 9/L have an increased risk of death.

Objective:To explore the clinical characteristics of acquired immunodeficiency syndrome (AIDS) complicated with nontuberculous mycobacteria (NTM) disease.Methods:The clinical data of 190 patients with AIDS complicated with NTM disease diagnosed by Shanghai Public Health Clinical Center, Fudan University from January 1, 2019 to December 31, 2021 were analyzed retrospectively. NTM diseases were divided into disseminated NTM disease group and non-disseminated NTM disease group. The independent sample t test, Mann Whitney U test and chi-square test were used for statistical analysis. Results:The 190 patients with AIDS complicated with NTM disease included 182 males and eight females. The age was (42±13) years old, and the first hospital stay was 15(6, 26) days. Pneumocystis carinii pneumonia was the most common co-infection in 12.1%(23/190) of patients, 87 cases (45.8%) were disseminated NTM disease. The clinical symptoms of patients were common in fever (55.8%(106/190)), cough (50.0%(95/190)), and expectoration (28.9%(55/190)). The proportions of fatigue (31.0%(27/87) vs 7.8%(8/103)), poor appetite (21.8%(19/87) vs 10.7%(11/103)) in the AIDS patients with disseminated NTM disease group were higher than those in the non-disseminated NTM disease group, and the differences were statistically significant ( χ2=16.99, P<0.001 and χ2=4.42, P=0.036, respectively). There was no significant difference in the proportions of deaths between AIDS patients with disseminated NTM disease and those without disseminated NTM disease (17.2%(15/87) vs 12.6%(13/103), χ2=0.80, P=0.371). The most common NTM species was Mycobacterium avium (67.1%(49/190)), followed by Mycobacterium kansasii (15.1%(11/190)). Hemoglobin ((90.3±23.9) g/L vs (110.1±24.2) g/L), albumin ((29.7±5.5) g/L vs (34.7±5.6) g/L), CD4 + T lymphocyte count (11(5, 30)/μL vs 52(16, 96)/μL) and CD8 + T lymphocyte count ((362±320)/μL vs (496±352)/μL) in the disseminated NTM disease group were lower than those in non-disseminated NTM disease group ( t=-5.63, P<0.001; t=-6.18, P<0.001; Z=-5.90, P<0.001; and t=-2.73, P=0.007, respectively), while procalcitonin (0.24(0.10, 0.77) μg/L vs 0.10 (0.04, 0.51) μg/L) was higher than that in the non-disseminated NTM disease group ( Z=-3.09, P=0.002), with statistical significance. The most common imaging features were lung patch and strip shadow (67.4%(128/190)). Conclusions:The most common type of AIDS patients complicated with NTM disease is disseminated NTM disease, and Mycobacterium avium is the most common NTM species. The clinical manifestations (fatigue, anorexia) and laboratory tests (hemoglobin, albumin, procalcitonin, CD4 + T lymphocyte count, CD8 + T lymphocyte count) of AIDS patients with disseminated NTM disease and non-disseminated NTM disease are different, while the prognosis is not significantly different.

Humans ; COVID-19 ; HIV Infections/drug therapy* ; Risk Factors

Humans ; HIV-1 ; Leukocytes, Mononuclear ; Lymphoma, Non-Hodgkin ; DNA ; HIV Infections

Animals ; Antiviral Agents ; therapeutic use ; Birds ; China ; Humans ; Influenza A Virus, H7N9 Subtype ; pathogenicity ; Influenza in Birds ; transmission ; Influenza, Human ; drug therapy ; epidemiology ; transmission ; Oseltamivir ; therapeutic use

Objective To analyze the clinical characteristics of aspergillus infection and colonization in acquired immune deficiency syndrome (AIDS) patients .Methods A retrospective study was performed in 35 AIDS patients who were admitted to Shanghai Public Health Clinical Center between January 2011 and December 2016 with etiology or histopathological evidence of aspergillus infection and colonization . Results The median age of these patients was 47 years old and 33 patients (94 .3％ ) were male .The median CD4+ T cell count was 24 cells/μL ,and 29 (82 .9％ ) patients had a CD4+ T cell count < 100 cells/μL .Twenty-three patients (65 .7％ ) were diagnosed with aspergillosis ,including 20 pulmonary aspergillosis (brain was involved in 1 case) ,1 renal aspergillosis and 2 intestinal aspergillosis .Twelve patients (34 .3％ ) were diagnosed with respiratory tract colonization . The most frequently cultured aspergillus species was Aspergillus f umigatus (45 .2％ ) .Other infections and underlying risk factors coexisted in 32 patients (91 .4％ ) ,of which pneumocystis jirovecii pneumoni (34 .3％ ) and pulmonary tuberculosis (25 .7％ ) were the most common . The patients with aspergillus colonization showed a significantly higher prevalence of pulmonary tuberculosis (PTB) than those with aspergillosis (58 .3％ vs 10％ ,P=0 .006) .The most common symptoms in pulmonary aspergillosis were cough (100 .0％ ) ,fever(90 .0％ ) ,expectoration (60 .0％ ) ,dyspnea (55 .0％ ) and hemoptysis (10 .0％ ) .The death rate within one year after diagnosis in pulmonary aspergilosis group was significantly higher than colonization group (55％ vs 0％ ,P=0 .000) .Conclusions Pulmonary aspergilosis is the most common disease caused by aspergillus in AIDS patients ,and frequently occurs in those with CD4+ T cell counts <100 cells/μL ,with a high mortality rate .Coinfections with other opportunistic pathogens and combination with other risk factors are common .Clinicians should be alert that aspergillus may colonize in AIDS patients with PTB w hen sputum aspergillus is positive .