Objective To investigate the prevalence and symptoms of pertussis in patients with cough,and to predict individual risk based on the combination of symptoms.Methods A total of 1 025 patients with cough or contact with pertussis patients were included.Pertussis was confirmed by nasopharyngeal swab PCR.Patients were divided into the juvenile group(278 cases)and the adult group(747 cases)according to age.The duration of cough from onset to study participation,the visual analogue(VAS)score of cough degree and the number of basic symptoms(paroxysmal cough,vomiting after cough,crowing cough,pauses in breathing after cough and fever)were compared between the two groups.The confirmed patients were further grouped by age,and the different symptoms were compared.70%of the sample was used as the training set.Based on the combination of symptoms(paroxysmal cough,post-cough vomiting,chick-crooning cough and pauses in inspirations after coughing),multivariate Logistic regression was used to establish the prediction model and draw the nomogram.30%of the sample was used as the validation set,and the receiver operating characteristic(ROC)curve was drawn.The differentiation of the area under the curve(AUC)evaluation model was calculated.The calibration degree of the model was evaluated by Hosmer-Lemeshow test,and calibration curve was drawn to evaluate the model.Results By PCR,163 cases(15.9%)were confirmed as pertussis.The juvenile group had a longer duration of cough from onset to study participation than the adult group(P＜0.05).The VAS score of cough severity was higher,and the number of basic symptoms of pertussis was more(P＜0.01).In confirmed cases,the proportion of paroxysmal cough,vomiting after cough,crowing cough and inspiratory pause after cough was higher in the juvenile group than that in the adult group(P＜0.01).In the diagnosed cases,the incidence of paroxysmal cough and post-cough vomiting were higher in the＜1-year-old group compared to the 1-9-year-old group and the≥10-year-old group(P＜0.05).The combination of paroxysmal cough,vomiting after cough,crowing cough and inspiratory pause after cough was selected by Logistic regression analysis to establish a nomogram model.The AUC of this model in the training set was 0.852,and the Hosmer-Lemeshow test χ2=0.208,P=0.901,and in the verification set,the AUC was 0.899,and the Hosmer-Lemeshow test χ2=4.202,P=0.122.The predicted value in the calibration curve was very close to the theoretical value in the training set and the verification set,and the fitting degree was high.Conclusion The infection rate of pertussis is high in patients with cough.The nomogram model based on combined symptoms has a better prediction effect on pertussis differentiation,which can provide reference for the monitoring of pertussis.

Objective To investigate the prevalence and symptoms of pertussis in patients with cough,and to predict individual risk based on the combination of symptoms.Methods A total of 1 025 patients with cough or contact with pertussis patients were included.Pertussis was confirmed by nasopharyngeal swab PCR.Patients were divided into the juvenile group(278 cases)and the adult group(747 cases)according to age.The duration of cough from onset to study participation,the visual analogue(VAS)score of cough degree and the number of basic symptoms(paroxysmal cough,vomiting after cough,crowing cough,pauses in breathing after cough and fever)were compared between the two groups.The confirmed patients were further grouped by age,and the different symptoms were compared.70%of the sample was used as the training set.Based on the combination of symptoms(paroxysmal cough,post-cough vomiting,chick-crooning cough and pauses in inspirations after coughing),multivariate Logistic regression was used to establish the prediction model and draw the nomogram.30%of the sample was used as the validation set,and the receiver operating characteristic(ROC)curve was drawn.The differentiation of the area under the curve(AUC)evaluation model was calculated.The calibration degree of the model was evaluated by Hosmer-Lemeshow test,and calibration curve was drawn to evaluate the model.Results By PCR,163 cases(15.9%)were confirmed as pertussis.The juvenile group had a longer duration of cough from onset to study participation than the adult group(P＜0.05).The VAS score of cough severity was higher,and the number of basic symptoms of pertussis was more(P＜0.01).In confirmed cases,the proportion of paroxysmal cough,vomiting after cough,crowing cough and inspiratory pause after cough was higher in the juvenile group than that in the adult group(P＜0.01).In the diagnosed cases,the incidence of paroxysmal cough and post-cough vomiting were higher in the＜1-year-old group compared to the 1-9-year-old group and the≥10-year-old group(P＜0.05).The combination of paroxysmal cough,vomiting after cough,crowing cough and inspiratory pause after cough was selected by Logistic regression analysis to establish a nomogram model.The AUC of this model in the training set was 0.852,and the Hosmer-Lemeshow test χ2=0.208,P=0.901,and in the verification set,the AUC was 0.899,and the Hosmer-Lemeshow test χ2=4.202,P=0.122.The predicted value in the calibration curve was very close to the theoretical value in the training set and the verification set,and the fitting degree was high.Conclusion The infection rate of pertussis is high in patients with cough.The nomogram model based on combined symptoms has a better prediction effect on pertussis differentiation,which can provide reference for the monitoring of pertussis.

Objective:To evaluate the clinical-application values of whole genome sequencing (WGS) technology to detect the drug resistance feature of second-line injectable drugs (SLIDs) for multidrug-resistant tuberculosis treatment.Methods:The proportional-method drug sensitivity test and the whole gene sequencing technology were used to simultaneously examine the resistance of three SLIDs: kanamycin (Km) and Amikacin(Am) and capreomycin (Cm) in 172 multidrug-resistant tuberculosis (MDR) strains preserved in the strain bank of the Tuberculosis Laboratory of Shenzhen Chronic Disease Prevention and Control Center from 2013 to 2017. The proportional-susceptibility tests were considered as the gold standard to evaluate the sensitivity, specificity and consistency of WGS results. The samples with differences between the two methods were compared with the minimum inhibitory concentration detection method. The McNemar test was used to statistically analyze the detection rates of the two methods, and a P value<0.05 indicated the significant difference between two groups. Results:A total of 172 MDR strains were included in this study. Two mutated genes were identified by the WGS examination: rrs and eis. Among these genes, rrs-A1401G mutation occurred in 58.3% in Am resistant strains, 14/18 in Km resistant strains or 14/14 in Cm resistant strains, respectively. The sensitivity, specificity and consistency of WGS predicted Am were 14/15, 93.6%, and 68.0%, 15/15, 98.1%, and 90.0% in Km, or 14/15, 100%, and 96.0% in Cm. There were 13 strains with inconsistent results by the two methods. One strain was retested by MIC as a drug-resistant strain and other 12 strains were sensitive. There were 11 strains with inconsistent Am test results, and WGS test results showed that 8 strains had rrs-514-A/C mutations, while DST and MIC tests were sensitive. Conclusion:WGS is enough is sensitive and specific for diagnosing SLIDs resistance.

Objective:To investigate the diagnostic value of CT myocardial perfusion combined with serum cystatin C (CysC) and galectin-3 (Gal-3) for coronary heart disease (CHD) and its correlation with coronary artery disease.Methods:The clinical data of 126 patients with CHD (CHD group) and 126 patients with suspected CHD but excluded CHD by coronary angiography (control group) in Shanxi Provincial General Hospital of Armed Police Force from May 2018 to May 2020 were retrospectively analyzed. CT myocardial perfusion myocardial imaging was performed in both groups, and blood perfusion (BF) and mean transit time (MTT) were calculated. The serum Gal-3 was detected by enzyme-linked immunosorbent method, and the serum CysC was detected by immunoturbidimetric method. The changes of indexes in 2 groups and in CHD patients with different degrees of coronary artery stenosis and number of diseased branches were compared. Logistic regression was used to analyze the influencing factors of CHD; Pearson correlation was used to analyze the relationship between BF, MTT, CysC, Gal-3 and the degree of coronary artery stenosis and the number of diseased branches in patients with CHD; the receiver operating characteristic (ROC) curve was drawn, and the effectiveness of each index in diagnosing CHD was analyzed. The area under curve (AUC) was compared by DeLong test, and the combined diagnosis was performed by Logistic binary regression fitting.Results:The BF in CHD group was significantly lower than that in control group: (102.30 ± 9.25) ml/(100 g·min) vs. (119.97 ± 12.08) ml/(100 g·min), the MTT, CysC and Gal-3 were significantly higher than those in control group: (17.23 ± 3.04) s vs. (5.38 ± 1.29) s, (0.98 ± 0.24) mg/L vs. (0.73 ± 0.18) mg/L and (55.27 ± 16.42) ng/L vs. (16.93 ± 5.75) ng/L, and there were statistical differences ( P<0.01). Logistic regression analysis result showed that BF, MTT, CysC and Gal-3 were the influencing factors of CHD ( P<0.01). ROC curve analysis result showed that the AUC of BF, MTT, CysC combined with Gal-3 in the diagnosis of CHD was the largest (0.879), with a specificity of 84.92% and a sensitivity of 80.95%. In patients with CHD, with the aggravation of coronary artery stenosis and the increase of the number of diseased branches, the BF decreased gradually, the MTT, CysC and Gal-3 increased gradually, and there were statistical differences ( P<0.05). Pearson correlation analysis result showed that the BF had negative correlation with the degree of coronary artery stenosis and the number of diseased branches in patients with CHD ( r=-0.592 and -0.573, P<0.01), and the MTT, CysC and Gal-3 had positive correlation with the degree of coronary artery stenosis and the number of diseased branches (MTT: r = 0.695 and 0.674, P<0.01; CysC: r = 0.546 and 0.519, P<0.01; Gal-3: r = 0.628 and 0.609, P<0.01). Conclusions:CT myocardial perfusion imaging indexes (BF and MTT), serum CysC and Gal-3 levels are related to the degree of coronary artery stenosis and the number of diseased branches in patients with CHD. The combined detection of various indicators can improve the diagnostic value and provide a certain basis for clinical diagnosis and treatment and disease monitoring.

Objective To evaluate the antigenicity of two proteins of Mycobacteium tuberculosis (M. tuberculosis), Dnak(Rv0350) and MPT83(Rv2873), in order to provide a scientific basis for immuno-logical diagnosis of tuberculosis and research on vaccines. Methods The two antigen proteins, Dnak (Rv0350) and MPT83(Rv2873), were cloned, expressed and purified using the methods of genetic recom-bination and protein purification technology. Blood samples were collected from subjects including tuberculo-sis patients ( TB) , non-tuberculosis patients with other pulmonary diseases ( non-TB) and healthy volunteers (HV). To analyze the immunological properties of the recombinant Dnak (Rv0350) and MPT83 (Rv2873) proteins, they were used as antigens to detect humoral and cellular immunity in the subjects with enzyme linked immunosorbent assay ( ELISA ) and effector T cell enzyme-linked immunospot assay ( ELISPOT ) . Results The recombinant and purified Dnak (Rv0350) and MPT83 (Rv2873) proteins of M. tuberculosis were successfully obtained and used as antigens in the detection of humoral and cellular immunity in the sub-jects. Specific antibodies ( IgG) in the serum samples of 135 TB, 56 non-TB and 94 HV were tested with ELISA. The results showed that the sensitivity, specificity and accuracy of Dnak ( Rv0350 ) protein were 77. 80％ (105/135), 56. 70％ (85/150) and 66. 67％ (190/285). Similarly, the sensitivity, specificity and accuracy of MPT83 (Rv2873) protein were 76. 30％ (103/135), 43. 30％ (65/150) and 58. 95％(168/285). Cellular immunity was tested with the levels of IFN-γproduced by effector T lymphocytes after stimulating peripheral blood monouclear cells ( PBMC) collected form subjects of 59 TB, 65 non-TB and 64 HV with Dnak (Rv0350) and MPT83 (Rv2873) protein antigens. The results showed that the sensitivity, specificity and accuracy of Dnak (Rv0350) and MPT83 (Rv2873) proteins were 66. 10％ (39/59), 62. 79％ (81/129) and 63. 83％ (120/188), and 47. 46％ (28/59), 79. 84％ (103/129) and 69. 68％(131/188), respectively. Conclusions M. tuberculosis Dnak (Rv0350) and MPT83 (Rv2873) proteins have good antigenicity and could stimulate T cells to produce stronger immune responses. The two proteins used in combination might have promising potential in the research of immunodiagnosis of tuberculosis and the development of new anti-tuberculosis vaccines.

OBJECTIVETo assess the efficacy of Dexamethasone (DM) pericoronal injection for the control of swelling and trismus caused by impacted mandibular third molars extraction.

METHODSCochrane, PUBMED, EMBASE and CBM were searched for eligible studies. Hand-searching included references of the included studies and Chinese dental journals. Risk of bias of the included studies was assessed by two reviewers independently using Cochrane Collaboration's tool, and data extraction was done by them. Meta-analysis was delivered with Revman 5.1.

RESULTSSeven randomized controlled trials, involving 684 participants, were included. Six of them had moderate risk of bias and one had high risk of bias. Meta-analysis showed that DM pericoronal injection could relieve trismus by 6.77 mm (P=0.02) within 1-2 days after the surgery. It could also reduce 51% of the risk of moderate-severe trismus(P<0.000 01) and could significantly control facial swelling (P<0.05). There was no differences between 4 mg and 8 mg DM (P>0.05).

CONCLUSIONPeriodontal injection of 4-5 mg DM could control facial swelling and trismus following impacted mandibular third molar extraction. But more randomized controlled trials are needed.

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.

OBJECTIVETo obtain an evidence-based treatment for an adolescent patient with temporomandibular osteoarthritis.

METHODSThe detailed history of an adolescent patient with temporomandibular osteoarthritis was analysed. Clinical Evidence (to Dec 2010), National Guideline Clearinghouse (2000-Dec 2010), Cochrane Library (Issue 4, 2010), MEDLINE(OVID, 1950-Dec 2010) and China Biology Medicine Database (1978-Dec 2010) were searched to obtain evidence such as clinical guidelines, systematic reviews and randomized controlled trials related to surgery or conservative treatment to temporomandibular osteoarthritis to find a personal treatment strategy for the patient.

RESULTSFive articles were finally included, i.e. 1 clinical guideline, 3 systematic reviews and 1 randomized controlled trials. These evidence showed that: Conservative treatment like intra-articular injection instead of surgery should be adopted for adolescent patient; hyaluronate is the drug with sufficient evidence in supporting its use in treating temporomandibular disorders; inferior temporomandibular joint cavity injection or both upper and lower cavity injection has better effect than that of superior cavity injection only; and there was some evidence to support the use of glucosamine to treat temporomandibular disorders. Considering the situation of the case and the clinical evidence, an individual treatment plan of hyaluronate injection into the upper and lower cavity and glucosamine take orally was established. A long-term follow-up of 6 months showed a good treatment outcome.

CONCLUSIONThrough the evidence-based methods and the use of clinical evidence, an individual treatment plan could be established for each patient with temporomandibular disorders, and this will provide strong supporting to the treatment of temporomandibular disorders. Up to now, it is clear that hyaluronate injection into the upper and lower cavity with glucosamine administration is effective in treating temporomandibular osteoarthritis.

OBJECTIVETo assess the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction.

METHODSTo retrieve randomized controlled trials assessing the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction, bibliographic databases including MEDLINE, Cochrane Controlled Trials Register, EMBASE, OPEN SIGLE and China Biology Medicine Database (CBM) were searched on August 23th 2011. References of the included studies and Chinese dental journals were hand-searched. The risk of bias were used by Cochrane Collaboration's tool and the data were extracted. Meta-analysis was done with Revman 5.1.

RESULTSNine articles met the eligibility criteria and were included, seven randomized controlled trials and 2 quasi-randomized controlled trials. Seven of these studies had unclear risk of bias and 2 had high risk of bias. Drainage could significantly increase 4.44 mm of the post-operative maximal mouth opening (P = 0.003), relief facial swelling (P < 0.05) and reduce post-operative complications (P = 0.008). But no evidence showed that drainage had a positive effects on post-operative pain (P = 0.09).

CONCLUSIONDrainage could probably control the complications following impacted mandibular third molar extraction; but more randomized controlled trials are needed to reinforce the conclusion.

ObjectiveTo study the preoperative evaluation of three-dimensional spiral CTcholangiography(SCTC) in patients with bile duct obstruction.MethodsA retrospective analysis was performed for 60patients with bile duct obstruction from May 2008 to April 2011,who were treated with endoscopic retrograde cholangiopancreatography( ERCP),then SCTC was performed through endoscopic nasobiliary drainage( EN-BD) tube,and the bile duct tree image of SCTC of bile duct obstruction was evaluated.ResultsIn 60 cases of bile duct obstruction who performed three-dimensional SCTC,the left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,cholecyst bile duct was visible in 80％ patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enters into the common bile duct.ConclusionThree-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values in judging the structure of the bile duct tree and the shape of cholecyst bile duct during operation.