Objective: To investigate the occurrence and influencing factors of anemia in lymphoma patients and its effect on treatment. Methods: A total of 501 lymphoma patients, who were hospitalized in four general hospitals in Shanghai from January 2017 to June 2018, were followed up for six months. The clinical data about anemia were collected and statistically analyzed. Results: Among all the enrollment patients, there were 178 patients (35.5%) had anemia. Among 289 patients whom were initially treated for lymphoma, there were 99 patients (34.3%) with anemia. In the following-up time, there were 136 new cases (42.1%) of anemia. The total prevalence of anemia was 62.7%. The univariate analysis indicated that the anemia incidence for initially treated lymphoma patients was significantly related to their age, pathological type, bone marrow infiltration, IPI scores and Ann Arbor stage. The response to initially treatment in lymphoma patients with anemia was inferior to those without anemia. The multivariate analysis indicated that IPI scores 3-5 points (P<0.001, OR=4.230, 95%CI 2.339-7.650) and chemotherapy treatment (P<0.001, OR=11.049, 95%CI 5.149-23.711) were the independent influential factors to the emerging anemia incidence. PS score used to evaluate patient physical condition was obviously related to the anemia occurrence. Conclusion Lymphoma patients have a high prevalence and incidence of anemia. The occurrence and severity of anemia are closely related to the efficacy and physical condition of lymphoma patients.

OBJECTIVE: To investigate the use of antibiotics in children with community-acquired pneumonia (CAP) in multiple regions of China, and to provide a reference for CAP standard treatment and rational antibiotic use in children. METHODS: The medical data of 1 383 children with CAP who were hospitalized in the department of pediatrics in 10 grade A tertiary hospitals from 9 cities between April 14, 2014 and January 1, 2016 were reviewed, to analyze the status of antibiotic use in hospitalized children in North China, Northeast China, East China, and South China. RESULTS: The overall rate of antibiotic use in children with CAP was 89.08%, with 88.7% in North China, 95.5% in Northeast China, 83.3% in East China, and 86.6% in South China. The main types of antibiotics used were cephalosporins, macrolides, compound preparations of β-lactam antibiotics, polyphosphoric broad-spectrum antibiotics and other β-lactam antibiotics. The selection of antibiotics was generally rational, but antibiotics were still used in some patients with viral infection alone or a combined use of ≥2 kinds of antibiotics were noted in some patients with infection caused by one kind of pathogen. Irrational antibiotic use was observed in 131 children (10.63%). CONCLUSIONS There are high rates of antibiotic use and irrational use of antibiotics among children with CAP. Standard management of antibiotic use in children with CAP should be strengthened.
Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Hospitalized ; China ; Community-Acquired Infections ; drug therapy ; Humans

OBJECTIVE: To investigate the caries status of the first permanent molars in urban and rural children aged 10-
12 in Chongqing and analyze the related factors in order to provide a theoretical basis for the prevention and treatment of children's caries and targeted suggestions for oral health education. METHODS: A multi-stage, stratified, cluster, and random sampling method was used to extract 5 057 children from 18 schools in three districts and three counties in Chongqing for oral health examination and questionnaire survey from March to May 2018. RESULTS: The total caries rate of the first permanent molar was 39.2%. The decayed-missing-filled tooth was 0.84±1.20. The rate of filling teeth was 3.4%. The rate of pit and fissure sealing was 6.1%. The prevalence of the first permanent molars was significantly different between men and women, between urban and rural areas, between only children and non-only children, and between ethnic minorities and Han nationality (P<0.001). The gap between the pit and fissure sealing was significantly different between urban and rural areas (P<
0.001). Multiple logistic regression analysis showed that many independent factors influence the occurrence of caries, including the frequency of brushing teeth every day, the frequency of eating desserts, the habit of eating dessert/drinking milk before going to bed, whether only-children or not, and parents' education background, among others. CONCLUSIONS The first permanent molars of children aged 10-12 in Chongqing have a high rate of caries but low rates of pit and fissure sealing and dental caries filling. The difference between urban and rural areas is large, children's oral health knowledge is scarce, and children have bad oral hygiene behaviors and eating habits. Children's oral health education must be strengthened, oral health preaching must be implemented in schools, the oral health knowledge of children in school must be improved, and urban-rural differences must be minimized.
Child ; DMF Index ; Dental Caries ; Female ; Humans ; Male ; Oral Health ; Oral Hygiene ; Prevalence ; Students

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.

BACKGROUNDPlasmacytoid dendritic cells (pDCs) and cytokines play an important role in occurrence and recovery of hepatitis B virus (HBV) infection. The aim of this study was to explore the frequency and function of pDC and serum cytokine network profiles in patients with acute or chronic HBV infection.

METHODSThe healthy individuals (HI group), hepatitis B envelope antigen (HBeAg)-positive chronic HBV patients in immune tolerance (IT) phase (IT group), HBeAg-positive chronic HBV patients (CHB group), and acute HBV patients (AHB group) were enrolled in this study. The frequency of cluster of differentiation antigen 86 (CD86) + pDC and the counts of CD86 molecular expressed on surface of pDC were tested by flow cytometer. The quantitative determinations of cytokines, including Fms-like tyrosine kinase 3 ligand (Flt-3L), interferon (IFN)-α2, IFN-γ, interleukin (IL)-17A, IL-6, IL-10, transforming growth factor (TGF)-β1 and TGF-β2, were performed using Luminex multiplex technology.

RESULTSIn this study, there were 13 patients in HI group, 30 in IT group, 50 in CHB group, and 32 in AHB group. Compared with HI group, HBV infected group (including all patients in IT, CHB and AHB groups) had significantly higher counts of CD86 molecular expressed on the surface of pDC (4596.5 ± 896.5 vs. 7097.7 ± 3124.6; P < 0.001). The counts of CD86 molecular expressed on the surface of pDC in CHB group (7739.2 ± 4125.4) was significantly higher than that of IT group (6393.4 ± 1653.6, P = 0.043). Compared with IT group, the profile of cytokines of Flt-3L, IFN-γ, and IL-17A was decreased, IFN-α2 was significantly increased (P = 0.012) in CHB group. The contents of IL-10, TGF-β1, and TGF-β2 in AHB group were significantly increased compared with IT and CHB groups (all P < 0.05).

CONCLUSIONSThis study demonstrated that the function of pDC was unaffected in HBV infection. The enhanced function of pDC and IFN-α2 might involve triggering the immune response from IT to hepatitis active phase in HBV infection. Acute patients mainly presented as down-regulation of the immune response by enhanced IL-10 and TGF-β.

Objective To evaluate the clinical efficacy of single plate,double plates,and intramedullary nail in treating medial cortical comminuted fractures of the medial distal femur.Methods A retrospective case control study was conducted on 63 cases of medial cortical comminuted fractures of the medial distal femur treated from November 2011 through October 2016.According to the type of internal fixation,19 cases of middle and distal shaft fractures were divided into the single plate group (n =11) comprising four males and seven females,aged averagely 57.5 years,and intramedullary nail group (n =8) comprising five males and three females,aged averagely 56.4 years.Forty-four cases of distal femoral fractures were divided into the single plate group (n =14) comprising six males and eight females,aged averagely 57.6 years,intramedullary nail group (n =9) comprising five males and four females,aged averagely 56.6 years,and double plates group (n =21) comprising 14 males and seven females,aged averagely 55.1 years.The rate and period of racture healing,distal femoral valgus resection (DFVR),femoral angle,change of DFVR and femoral angle,and complications were compared within and between groups.Results All the cases were followed up for 6-37 months (mean,13.4 months).Of 19 cases of middle and distal shaft fractures,there were no statistically significant differences in fracture healing rate and period,DFVR after operation and at the last follow-up,and the amount of change of DFVR between the single plate and double plates group (P ＞ 0.05).With respect to postoperative complications of the two groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and mal union (P ＞ 0.05).However,the incidence rate of adverse events in single plate group (46％) was significantly higher than that in intramedullary nail group (0) (P ＜0.05).Of the 44 cases of distal femoral fractures,the pairwise comparisons among three groups showed no statistically significant differences in fracture healing rate,healing period,and the post operative femoral angle (P ＞ 0.05).The femoral angle at the last follow-up in intramcdullary nail group was (80.80 ± 2.93) °,significantly lower than (85.28 ± 5.89) ° in single plate group and (83.55 ± 3.51) ° in double plates group (P ＜ 0.05).Within the intramedullary nail group,no significant difference was found between the femoral angle immediately after operation and at the last follow-up (P ＞ 0.05),but significant difference was detected in both single plate group and double plates group (P ＜ 0.05).The amount of change of the femoral angle in intramedullary nail group [(0.25 ± 1.95) °] was significantly lower than (4.03 ± 3.78) ° in single plate group and (2.60 ± 2.24) ° in double plates group (P ＜ 0.05).With respect to post operative complications in the three groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and malunion (P ＞ 0.05).The malunion rate in single plate group (36％) was significantly higher than that in double plates group (14％).The incidence rate of adverse events in single plate group (50％) was significantly higher than that in double plates group (14％) (P ＜ 0.05).Conclusions Three internal fixations have similar clinical results in fracture healing rate and period.For medial cortical comminuted middle and distal shaft fractures,and distal femoral fractures without involving articular surface,intramedullary nail has better results than locking plate.For medial cortical comminuted distal femoral fractures involving articular surface,double plates fixation might be a better option.

Background: Cytokines play an important role in occurrence and recovery of hepatitis B virus (HBV) infection. The aim of this study was to investigate the changes of cytokines concentration and its correlation to alanine aminotransferase (ALT), HBV deoxyribonucleic acid (HBV-DNA), hepatitis B envelope antigen (HBeAg), and HBV surface antigen (HBsAg) in the development of chronic hepatitis B (CHB). Methods: Thirteen healthy individuals (HI), 30 chronic HBV-infected patients in immune tolerant (IT) phase, and 55 CHB patients were enrolled between August 2015 and May 2017. The peripheral blood samples were collected from all individuals. The levels of interferon (IFN)-α2, interleukin (IL)-10, transforming growth factor (TGF)-β1, HBV-DNA, HBsAg, and HBeAg and liver function were measured. The quantitative determinations of cytokines levels, including IFN-α2, IL-10, and TGF-β1 were performed using Luminex multiplex technology. The correlation of cytokines to ALT, HBV-DNA, HBsAg, and HBeAg was analyzed by linear regression analysis. Results: IFN-α2 levels were similar between HI and IT groups (15.35 [5.70, 67.65] pg/ml vs. 15.24 [4.07, 30.73] pg/ml, Z = -0.610, P = 0.542), while it elevated significantly in CHB group (35.29 [15.94, 70.15] pg/ml vs. 15.24 [4.07, 30.73] pg/ml; Z = -2.522, P = 0.012). Compared with HI group (3.73 [2.98, 11.92] pg/ml), IL-10 concentrations in IT group (5.02 [2.98, 10.11] pg/ml), and CHB group (7.48 [3.10, 18.00] pg/ml) slightly increased (χ = 2.015, P = 0.365), and there was no significant difference between IT and CHB group (Z = -1.419, P = 0.156). The TGF-β1 levels among HI (3.59 ± 0.20 pg/ml), IT (3.62 ± 0.55 pg/ml), and CHB groups (3.64 ± 0.30 pg/ml) were similar (χ = 2.739, P = 0.254). In all chronic HBV-infected patients (including patients in IT and CHB groups), the elevation of IFN-α2 level was significantly associated with ALT level (β= 0.389, t = 2.423, P = 0.018), and was also negatively correlated to HBV-DNA load (β = -0.358, t = -2.308, P = 0.024), HBsAg (β = -0.359, t = -2.288, P = 0.025), and HBeAg contents (β = -0.355, t = -2.258, P = 0.027). However, when both ALT level and cytokines were included as independent variable, HBV-DNA load, HBsAg, and HBeAg contents were only correlated to ALT level (β = -0.459, t = -4.225, P = 0.000; β = -0.616, t = -6.334, P = 0.000; and β = -0.290, t = -2.433, P = 0.018; respectively). Conclusions IFN-α2 elevation was associated with ALT level in patients with chronic HBV infection. However, in CHB patients, only ALT level was correlated to HBV-DNA, HBsAg and HBeAg contents.
Adult ; Alanine Transaminase ; blood ; Antigens, Surface ; Case-Control Studies ; Cytokines ; blood ; DNA, Viral ; Female ; Hepatitis B ; Hepatitis B Surface Antigens ; analysis ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; blood ; immunology ; Humans ; Male ; Young Adult

Objective: To study the factors associated with efficacy of nucleos(t)ide analogues with sequential interferon in HBeAg negative chronic hepatitis B (CHB) patients. Methods: HBeAg negative CHB patients with NA treatment received PEG-IFNα 2a 180 μg subcutaneously once weekly. NA was continually used with PEG-IFN 2a during the first 12 weeks. HBsAg level and HBV DNA load were observed in the sequential pre-treatment (baseline), 12th, 24th, 36th, 48th, 72nd and 96th weeks of sequential therapy in all patients. Results: Of the 26 HBeAg negative CHB patients, 6 (23.1%) achieved HBsAg loss/seroconversion. The comparison between HBsAg loss/ seroconversion group and the group not achieved HBsAg loss/ seroconversion showed that the baseline HBsAg level in HBsAg loss/seroconversion group was 2.210 log₁₀IU/ml, was lower than (t=-4.252, P=0.000) HBsAg-positive patients (3.385 log₁₀IU/ml) in the groupp that not achieved HBsAg loss/seroconversion, the difference was statistically significant in HBsAg decreased at 72^nd, 96^th week in the course of sequential therapy (3.511 vs. 0.723log₁₀IU/ml, 4.291 vs. 0.737 log₁₀IU/ml) (t=6.712, P=0.000, t=13.319; P=0.000, 0.00); the difference was not statistically significant in age, gender and NA therapy time between the two groups; 12 (46.2%) of patients achieved sustained virologic response (SVR), the baseline of HBsAg level was 2.575 log₁₀IU/ml, was less than (t=-4.319, P=0.000) the patients who did not achieve SVR (3.576 log₁₀IU/ml), the difference was statistically significant in HBsAg decrease of each time in the course of sequential therapy between the two groups (0.612 vs. 0.088, 1.192 vs. 0.107, 1.566 vs. 0.167, 1.817 vs. 0.176, 2.424 vs. 0.193, 2.188 vs. 0.014, log₁₀IU/ml) (t=3.109, 4.717, 4.500, 4.544, 5.560, 4.265, P=0.008, 0.010, 0.001, 0.001, 0.000, 0.003), the difference was not statistically significant in gender and NA therapy time, the difference was statistically significant in age (30.8 vs. 39.9 years) ( t=-2.219, P=0.038). Of 9 CHB patients whose baseline HBV DNA were positive, 5 patients (55.6%) had HBV DNA loss after sequential treatment, the patients whose HBV DNA loss with HBsAg decreased at 12^th week in the course of sequential therapy, but there was no influence in the HBsAg decrease/loss after 12^th week, the difference was not statistically significant in age, gender, NA therapy time, HBsAg and HBsAg decrease in the course of sequential therapy between HBV DNA-negative and HBV DNA-positive groups. Conclusions To HBeAg-negative CHB, patients with low baseline HBsAg (2 log10 IU/ml level) and significantly lower HBsAg decrease early were more likely to receive SVR. Among them, prolonged interferon therapy is easier to achieve HBsAg loss/seroconversion.