Objective:To investigate the diagnostic value of serum Aspergillus fumigatus immunoglobulin G (IgG), bronchoalveolar lavage fluid (BALF) galactomannan antigen test (GM test) and combined detection of the two methods in chronic pulmonary aspergillosis (CPA). Methods:A total of 310 patients with suspected CPA who were hospitalized in Wuhan Pulmonary Hospital from January 2020 to December 2022 were screened. BALF-GM test and serum Aspergillus fumigatus IgG were detected. According to the inclusion and exclusion criteria, 151 confirmed or clinically diagnosed CPA patients were enrolled and 60 non-CPA cases were included as controls. The underlying diseases, clinical symptoms and imaging findings of the two groups were analyzed using case-control study. Statistical comparison was performed by chi-square test. The efficacies of BALF-GM test, serum Aspergillus fumigatus IgG test, and their combined detection for CPA were analyzed by receiver operating characteristic curve. Results:There were 130 confirmed cases and 21 clinically diagnosed cases among 151 patients with CPA, including 106 males (70.2%) with age of (54.6±15.5) years. The age of 60 non-CPA patients was (53.6±17.8) years, including 42 males (70.0%). The proportions of pulmonary tuberculosis, bronchiectasis and chronic obstructive pulmonary disease, and the incidence of hemoptysis in CPA group were 79.47%(120/151), 86.09%(130/151), 26.49%(40/151) and 43.71%(66/151), respectively, which were all higher than those in non-CPA group (10.00%(6/60), 25.00%(15/60), 8.33%(5/60) and 11.67%(7/60), respectively), and the differences were statistically significant ( χ2=86.14, 74.56, 8.44 and 19.48, respectively, all P<0.05). The proportion of interstitial lung disease in non-CPA group was 28.33%(17/60), which was higher than that in CPA group (2.65%, 4/151), and the difference was statistically significant ( χ2=31.61, P<0.001). The common imaging findings of CPA patients were pulmonary cavity (70.86%, 107/151), cavity inclusions (41.72%, 63/151) and lung damage (33.77%, 51/151). The specificity and sensitivity of serum Aspergillus fumigatus IgG for CPA diagnosis were 81.7% and 68.9%, respectively, and the area under the curve (AUC) was 0.753 (95% confidence interval (95% CI) 0.681 to 0.825, P< 0.001). The specificity and sensitivity of BALF-GM test were 76.7% and 67.5%, respectively, and the AUC was 0.724 (95% CI 0.649 to 0.800, P<0.001). The specificity and sensitivity of the two methods in series combined detection were 95.0% and 44.4%, respectively, and those of the two methods in parallel detection were 60.3% and 94.5%, respectively. The AUC of the combined diagnosis of CPA by the two methods was 0.843 (95% CI 0.783 to 0.903, P<0.001). Conclusions:Serum Aspergillus fumigatus IgG combined with BALF-GM test has a good diagnostic efficacy for CPA. The detection of serum Aspergillus fumigatus IgG is non-invasive and highly specific, which is beneficial to the early diagnosis and treatment of CPA.

Objective To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services.Methods A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019.On the basis of the results of literature analysis and the interviews,an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed.Then,consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020.Eventually,the framework of prediagnostic risk assessment system for outpatient dental care was formulated.Results Four themes emerged from the qualitative interviews.Firstly,prediagnostic risks of dental outpatients involved mainly syncope,cardiovascular emergencies,and other emergency medical risks.Secondly,medical risks came from three sources,patients,healthcare professionals,and the environment.Thirdly,medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient.Fourthly,medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient.The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire,which included 3 primary indicators(namely,general information,medical history[including history of allergy],and medication assessment),12 secondary indicators(including patient demographics,patients'status upon admission,oral hygiene habits and special lifestyle habits,sensory disorders,special periods for female patients[ie,menstruation,pregnancy,and breastfeeding],allergy history[history of oral treatment-related allergies],past/present medical history,types of medication,route of medication administration,duration of medication administration,accuracy of medication administration,and adverse drug reactions),and 39 tertiary indicators.The effective recall rate of the expert consultation form was 100%,expert positivity was 100%,and the authority coefficient was 0.83.Kendall's harmony coefficient ranged from 0.808 to 0.839,which was statistically significant(P<0.001).Conclusion The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific,but its applicability still needs further validation in clinical practice.

【Objective】 To explore the intention of voluntary blood donation in students from a middle vocational school in Jinhua and its influencing factors. 【Methods】 A total of 400 students were enrolled from a middle vocational school in Jinhua by convenience sampling, and a self-designed questionnaire was issued to each student to investigate the cognition, intention and attitude of voluntary blood donation. The influencing factors of voluntary blood donation intention were analyzed by Logistic regression. 【Results】 A total of 394 valid questionnaires(98.50%) were collected. For 394 surveyed students, the average score of cognition of voluntary blood donation was (7.27±2.69) points, and the overall rate of intention to voluntary blood donation was 21.32%. Logistic regression analysis equation consisted of family support, better cognition, feeling happy about blood donation and worrying about blood donation, with risk ratios(OR) as 31.78, 188.69, 26.27 and 0.01, respectively(all P<0.05). 【Conclusion】 Students from a middle vocational school showed poor congnition and intention of voluntary blood donation.Family support for voluntary blood donation, better cognition of voluntary blood donation and happiness for blood donation were positive factors, and the fear of blood donation was a negative factor.It is necessary to strengthen the publicity of blood donation among students in middle vocational school to improve their congnition and intention to voluntary blood donation.

Objective:To study the effect of Wuzhi capsules on tacrolimus trough concentration in kidney transplant recipients with different CYP3A5 genotypes.Methods:From June 2015 to October 2019, 162 patients who underwent renal transplantation for the first time were retrospectively analyzed. The patients were divided into two groups, combined and uncombined, according to whether combined with Wuzhi capsules. There were 81 cases in the uncombined group (55 males and 26 females), and 81 in the combined group (62 males and 19 females). There was no significant difference between the two groups( P=0.219). The ages of the uncombined group and the combined group were (39.26±11.91) years old and (37.21±10.88) years old ( P=0.103), the weights were (62.39±11.64) kg and (66.18±13.89)kg ( P=0.298), systolic blood pressure were (147.28±20.24) mmHg and (145.00±16.42) mmHg (1 mmHg=0.133 kPa)( P=0.276), diastolic blood pressure were (92.25±13.87) mmHg and (92.20±12.53) mmHg ( P=0.886), alanine aminotransferase were (12.24±8.59) U/L and (17.06±13.11) U/L ( P=0.015), aspartate aminotransferase were (17.76±9.12) U/L and (16.57±8.37) U/L ( P=0.463), fasting blood glucose were (8.70±3.48) mmol/L and (7.18±2.74)mmol/L ( P=0.006), hemoglobin were (98.96±17.53) g/L and (101.05±18.67) g/L ( P=0.789), creatinine were (665.22±296.55) μmol/L and (797.32±279.32) μmol/L ( P=0.007), estimated glomerular filtration rate were (11.47±14.11) ml/(min·1.73m 2) and (8.85±3.71) ml/(min·1.73m 2) ( P=0.130)in the kidney transplant recipients before surgery. Among the 162 cases in this study, there were 86 cases (53.09%) of CYP3A5*1*3 genotype, 17 cases (10.49%) of CYP3A5*1*1 genotype, 59 cases (36.42%) of CYP3A5*3*3 genotype, and the minimum allele frequency of CYP3A5*1 was 37.04%. In the uncombined group, CYP3A5*1*3 genotype 39 cases (48.15%), CYP3A5*1*1 genotype 5 cases (6.17%), and CYP3A5*3*3 genotype 37 cases (45.68%). In the combined group, CYP3A5*1*3 genotype 47 cases (58.02%), CYP3A5*1*1 genotype 12 cases (14.81%), and CYP3A5*3*3 genotype 22 cases (27.16%), with statistically significant differences in the two groups ( P=0.024). The patients were treated with a triple immunosuppressive regimen (tacrolimus+ mycophenolate mofetil+ glucocorticoid) based on tacrolimus [initial dose: 0.15-0.30 mg/(kg·d)], combination of Wuzhi capsules in the combination group (11.25 mg, twice a day). The trough concentration of tacrolimus was detected by enzyme-linked immunosorbent assay, compare the difference in the trough concentration of tacrolimus between the two groups. The relationship between the effect of Wuzhi capsules and CYP3A5 gene polymorphism was compared, and compare the changes before and after the application of CYP3A5 genotype combined with Wuzhi Capsules. The influencing factors of tacrolimus trough concentration were analyzed by multiple linear regression. Results:In the combined with Wuzhi capsules, the dose corrected trough concentration (C 0/D) of tacrolimus was higher than that in patients without Wuzhi capsules, and the extent of increase was related to genotype. The C 0/D of tacrolimus in patients with CYP3A5*3*3 genotype in the combination and non-combination groups were (12.15±2.95) (ng·ml -1/0.1mg·kg -1·d -1) and (9.99±2.33) (ng·ml -1/0.1mg·kg -1·d -1) ( P=0.004), CYP3A5*1*3 genotype were (11.11±3.20) (ng·ml -1/0.1mg·kg -1·d -1) and (6.86±1.62) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001), and there were significant difference. However, CYP3A5*1*1 genotype were(8.29±2.64) (ng·ml -1/0.1mg·kg -1·d -1) and (6.16±2.87) (ng·ml -1/0.1mg·kg -1·d -1) ( P=0.160), there was no significant difference. The tacrolimus C 0/D of the combined group before and after the Wuzhi capsule were as follows: CYP3A5*3*3 genotype: (7.18±2.33)(ng·ml -1/0.1mg·kg -1·d -1) and (13.33±3.09) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001); CYP3A5*1*3 genotype: (5.14±2.14) (ng·ml -1/0.1mg·kg -1·d -1) and (10.61±3.20) (ng·ml -1/0.1mg·kg -1·d -1) ( P<0.001); CYP3A5*1*1 genotype: (5.17±3.75) (ng·ml -1/0.1mg·kg -1·d -1) and (8.31±2.74) (ng·ml -1/0.1mg·kg -1·d -1)( P=0.002), and the differences were statistically significant. The results of multiple linear regression showed that the combination of Wuzhi capsules (β=0.508, P<0.001) and CYP3A5 genotype(CYP3A5*1*3 and CYP3A5*3*3: β=-0.361, P<0.001; CYP3A5*1*1 and CYP3A5*3*3: β=-0.425, P<0.001)could influence the trough concentration. The sex (β=-0.100, P=0.124) and age (β=-0.003, P=0.967) of renal transplant recipients had no statistical significance to tacrolimus C 0/D. Conclusions:In the renal transplant patients, CYP3A5 genotype and combined use of Wuzhi capsules are the main factors affecting tacrolimus C 0/D. In order to achieve the expected trough concentration as soon as possible, the interaction between CYP3A5 genotypes and drug combination should be considered.

【Objective】 To explore how the awareness and prevention status of COVID-19 epidemic, as well as anxiety affect blood donation behaviors of college students. 【Methods】 From June 7 to 13, 2020, students from two colleges in Jinhua were given self-made questionnaires through Wenjuanxing (a platform providing functions equivalent to Amazon Mechanical Turk), general demographic information, voluntary blood donation, core knowledge and prevention measures of COVID-19, as well as general anxiety were investigated. 466 valid questionnaires were collected, and the influencing factors of voluntary blood donation were analyzed by Logistic regression. 【Results】 College students donated(88.1±19.8)% were more likely to conduct qualified protections against COVID-19 than non-donation students(83.3±19.0)%(P<0.05), and be less anxious (9.68±4.80 vs 10.86±4.74, P<0.05). During COVID-19 outbreak, male donors was 3.732 times females(P<0.05). The donation rate of students with good awareness of COVID-19 protection, getting 60.0% correct or more, was 4.663 times students getting 60.0% below correct (P<0.05), and students with anxiety total score below 10 points was 2.227 times those above 10 points(P<0.05). 【Conclusion】 Gender, awareness of protections against COVID-19, and anxiety level are important factors affecting the blood donation behaviors of college students during COVID-19 epidemic, therefore strengthening psychological counseling and improving protection measures against COVID-19 are conductive to promote blood donation of college students during COVID-19 epidemic.

Objective:To analyze the clinical characteristics of intestinal tuberculosis improving the diagnosis rate of intestinal tuberculosis.Methods:From January 2014 to June 2018, at Wuhan Pulmonary Hospital, the data of clinical symptoms, laboratory examination, imaging, endoscopy, surgery and pathological examination of 205 patients with intestinal tuberculosis were retrospectively analyzed. Descriptive analysis was performed for statistical analysis.Results:Among 205 patients with intestinal tuberculosis, 145 cases were male and 60 cases were female, aged 14 to 85 years old. A total of 189 cases (92.2%) were complicated with lung tuberculosis, of which 151 cases (79.9%) were positive for sputum acid fast staining. A total of 126 cases were tested for feces acid fast staining, of which 83 cases (65.9%) were positive. A total of 60 cases (29.3%) were tested for GeneXpert Mycobacterium tuberculosis/rifampicintablet (GeneXpert MTB/RIP), of which 49 cases (81.7%) were positive. A total of 44 cases of intestinal tuberculosis were diagnosed by biopsy under electronic enteroscopy, and 21 cases were pathologically diagnosed with intestinal tuberculosis after surgical resection. The 21 patients were tested for GeneXpert MTB/RIP, of which 19 cases (90.5%) were positive and 10 cases (47.6%) were positive for tuberculin test. Six patients were clinically diagnosed with intestinal tuberculosis after effective treatment of antituberculosis drugs. Conclusions:Combination of clinical symptoms and laboratory, imaging, endoscopic and pathological examination, as well as the therapeutic effect of diagnostic antituberculosis treatment could make comprehensive diagnosis of intestinal tuberculosis. The GeneXpert MTB/RIP examination is of great value in the diagnosis of intestinal tuberculosis.

Objective:To investigate the effect of BMSC transplantation on the recovery of neurological function in rats with cerebral infarction,and to explore the related mechanism.Methods:90 rats were randomly divided into 3 groups:sham operation group,control group,BMSC transplantation group,30 rats in each group.The control group and BMSC transplantation group established middle cerebral artery occlusion (MCAO) model,the sham operation group only need to separate the cervical tissue of rats,and MCAO model in the MCAO model operation.After 1 days of BMSC transplantation group by intravenous injection of 1 mL 3× 106 BMSC,the control group was injected with the same dose of NS in MCAO after 1 D,3 D,7 d,14 d,21 d,28 d,35 d,42 d,49 D respectively,the neurological function score of rats (mNSS),after 2 months of transplantation BMSC group and control group of brain tissue for immunohistochemical staining,detection of MAP2,TUJ1,Ⅷ factor,the expression of GFAP.Results:In seventh to thirty-fifth days after treatment,BMSC mNSS transplantation group were significantly lower than the control group (P ＜ 0.05).2 months after BMSC transplantation group MAP2,TUJ1,Ⅷ expression level was significantly higher than the control group,while the control group,the expression of GFAP was significantly higher than that of BMSC group (P ＜ 0.01).Conclusion:BMSC transplantation in order to promote the recovery of neurological function in cerebral infarction.

Objective To observe different hypoglycemic treatments on glucagon-like peptide-1 (GLP-1) and its correlation with β cells function in newly diagnosed type 2 diabetes mellitus (T2DM).Methods A total of 76 patients with newly diagnosed T2DM were randomly divided into insulin aspart 30 group and oral drugs group.OGTT test were measured at 0,30,120 min,the serum levels of GLP-1 and corresponding C peptide,and insulin levels were measured,HOMA insulin secretion and insulin resistance index were calculated.Then 30 healthy cases were as the control group,GLP-1 levels were analyzed,and the changes of the index were compared.Results At each time point,blood glucose and glucose area under the curve (AUCg) was significantly decreased (P ＜0.05).Insulin and C-peptide and the AUC (AUCins,AUCc-p) were increased (P ＜ 0.05).HOMA-IR was statistically decreased compared with pre-therapy (P ＜ 0.05),HOMA-IS and △INS30/G30,△ INS120/G120 were significantly increased (P ＜ 0.05).Compared with pre-therapy,GLP-1 levels and AUCglp (area under the curve GLP-1) were significantly increased (P ＜0.05),and reached the peak at 120 min,closed to secretion curve of the control group.Conclusion GLP-1 levels were lower than normal in newly diagnosed T2DM patients,and different hypoglycemic drugs makes GLP-1 levels increase.Insulin,C-peptide and AUCins,AUCc-p,HOMA-IS,HOMA-IR,etc.,suggest that β-cell function is restored and insulin resistance is reduced.

Objective To observe different hypoglycemic treatments on glucagon-like peptide-1 (GLP-1) and its correlation with β cells function in newly diagnosed type 2 diabetes mellitus (T2DM).Methods A total of 76 patients with newly diagnosed T2DM were randomly divided into insulin aspart 30 group and oral drugs group.OGTT test were measured at 0,30,120 min,the serum levels of GLP-1 and corresponding C peptide,and insulin levels were measured,HOMA insulin secretion and insulin resistance index were calculated.Then 30 healthy cases were as the control group,GLP-1 levels were analyzed,and the changes of the index were compared.Results At each time point,blood glucose and glucose area under the curve (AUCg) was significantly decreased (P ＜0.05).Insulin and C-peptide and the AUC (AUCins,AUCc-p) were increased (P ＜ 0.05).HOMA-IR was statistically decreased compared with pre-therapy (P ＜ 0.05),HOMA-IS and △INS30/G30,△ INS120/G120 were significantly increased (P ＜ 0.05).Compared with pre-therapy,GLP-1 levels and AUCglp (area under the curve GLP-1) were significantly increased (P ＜0.05),and reached the peak at 120 min,closed to secretion curve of the control group.Conclusion GLP-1 levels were lower than normal in newly diagnosed T2DM patients,and different hypoglycemic drugs makes GLP-1 levels increase.Insulin,C-peptide and AUCins,AUCc-p,HOMA-IS,HOMA-IR,etc.,suggest that β-cell function is restored and insulin resistance is reduced.

BACKGROUNDEndoscopic submucosal dissection of the esophagogastric junction is the most difficult gastric and esophageal dissection procedure. No reports of endoscopic submucosal dissection for Siewert type II carcinoma of the esophagogastric junction have compared the outcomes of endoscopic submucosal dissection for all three Siewert types of adenocarcinoma. This study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.

METHODSFrom October 2008 to June 2013, 73 patients underwent endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction. The patients were prospectively evaluated regarding the executability of the technique, short-term results of the procedure, en bloc resection rate, curative resection rate, complications and additional treatment after endoscopic submucosal dissection, and follow-up outcomes.

RESULTSSixty-eight of the 73 patients (93.2%) underwent en bloc resection; the mean maximum specimen diameter was 33.7 mm. Fifty-seven of 61 patients (93.4%) who underwent curative resection were successfully followed-up for 1.0 to 56.0 months (average, 24.1 months). Local recurrence developed in one patient with high-grade intraepithelial neoplasm. Twelve patients underwent noncurative resection, including lateral resection margin residues in three, vertical resection margin residues in one, signet ring cell carcinoma or undifferentiated adenocarcinoma in four, lymphatic or vessel invasion in one, vertical residual margin residues combined with signet ring cell carcinoma in one, and undifferentiated adenocarcinoma with lymphatic or vessel invasion in two. In the noncurative resection group, one patient was lost to follow-up, seven underwent additional surgery, and the remaining four were periodically followed up; none had local recurrence or distant metastases. The only complication was delayed bleeding in three patients, which was successfully controlled by conservative treatment or endoscopic therapy.

CONCLUSIONSEndoscopic submucosal dissection is safe and effective for intraepithelial neoplasia of the esophagogastric junction. R0 en bloc resection is possible and can avoid the risk of local recurrence.

Adult ; Aged ; Aged, 80 and over ; Carcinoma in Situ ; surgery ; Dissection ; adverse effects ; methods ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; surgery ; Female ; Gastric Mucosa ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies