BACKGROUND: Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS: In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS: A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Humans ; Retrospective Studies ; Pneumonia/diagnostic imaging* ; Analysis of Variance ; Tomography, X-Ray Computed ; Lymphoma/diagnostic imaging*

Objective: To analyze the changes in tobacco use and exposure in primary school students in Shandong province in 2012 and 2019. Methods: A multi-stage stratified cluster random sampling method was used in the survey. In 2012 and 2019, 5 861 and 4 021 students from 3 different cities of Shandong province were selected as the study population. The questionnaire was filled anonymously by the subjects. χ² test was conducted to compare the difference of groups. Results: In 2012 and 2019, the rate of attempting smoking among pupils under this study in Shandong province were 6.0％and 6.3%, respectively, while the current smoking rate were 1.2％and 2.3%, respectively. The sex ratio of male and female students attempting to smoke was 2.56∶1 in 2012 and 1.31∶1 in 2019. The sex ratio of current smoking rate was 2.43∶1 and 2.00∶1, respectively in 2012 and in 2019. The rate of tobacco exposure in the public places was 50.5％and 41.4%, respectively. The rate of tobacco exposure in family was 49.7% and 46.4%, respectively. Two rates of tobacco exposure decreased, but the reduction in family (3.3%) was far less than that in public places (9.1%). In 2019, the rate of tobacco exposure in family was higher than that in public places. Conclusions: The tobacco exposure rate declined in senior pupils in Shandong province. However, the situation is still grim for the current smoking rate, growth trend of girls tobacco use, and tobacco exposure in family.
Cities ; Environment ; Female ; Humans ; Male ; Prevalence ; Students ; Surveys and Questionnaires ; Tobacco Smoke Pollution ; Tobacco Use/epidemiology*

OBJECTIVE: To investigate the clinical characteristics and treatment of pneumocystis carinii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL), in order to improve the early diagnosis and effective treatment. METHODS: Clinical data of five children with ALL developing PCP in the post-chemotherapy granulocyte deficiency phase were analyzed retrospectively. The clinical manifestations, laboratory tests, imaging findings, treatment methods and effect were summarized. RESULTS: The male-to-female ratio of the five children was 1∶4, and the median age was 5.5 (2.9-8) years old. All patients developed PCP during granulocyte deficiency phase after induction remission chemotherapy. The clinical manifestations were generally non-specific, including high fever, tachypnea, dyspnea, non-severe cough, and rare rales in two lungs (wet rales in two patients). Laboratory tests showed elevated C-reactive protein (CRP), serum procalcitonin (PCT), (1,3)-β-D-glucan (BDG), lactate dehydrogenase (LDH) and inflammatory factors including IL-2R, IL-6 and IL-8. Chest CT showed diffuse bilateral infiltrates with patchy hyperdense shadows. Pneumocystis carinii(PC) was detected in bronchoalveolar lavage fluid (BALF) or induced sputum by high-throughput sequencing in all patients. When PCP was suspected, chemotherapy was discontinued immediately, treatment of trimethoprim-sulfame thoxazole (TMP-SMX) combined with caspofungin against PC was started, and adjunctive methylprednisolone was used. Meanwhile, granulocyte-stimulating factor and gammaglobulin were given as the supportive treatment. All patients were transferred to PICU receiving mechanical ventilation due to respiratory distress during treatment. Four children were cured and one died. CONCLUSION PCP should be highly suspected in ALL children with high fever, dyspnea, increased LDH and BDG, and diffuse patchy hyperdense shadow or solid changes in lung CT. The pathogen detection of respiratory specimens should be improved as soon as possible. TMP/SMZ is the first-line drug against PCP, and the combination of Caspofungin and TMP/SMZ treatment for NH-PCP may have a better efficacy. Patients with moderate and severe NH-PCP may benefit from glucocorticoid.
Caspofungin/therapeutic use* ; Child ; Child, Preschool ; Dyspnea ; Female ; Humans ; Male ; Pneumonia, Pneumocystis/therapy* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy* ; Respiratory Sounds ; Retrospective Studies

ObjectiveTo investigate the current status of psychosocial services in various institutions as well as the mental health status of residents in Northeast Sichuan， so as to provide references for the further construction and implementation of psychosocial services in this area. MethodsA total of 148 institutions in Tongjiang county of Bazhong city， Lizhou district of Guangyuan city and Dazhu county of Dazhou city were surveyed through self-compiled questionnaires covering the construction status of psychosocial service system and the implementation of mental health service in each institution. Meantime， the mental health status and psychological service needs of 21 505 residents in pilot areas of three cities were investigated using the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7） and the self-designed mental health service needs questionnaire. ResultsAmong the 148 institutions in the pilot areas， 81 （54.7%） of which had dedicated mental health service， and 58 （39.2%） were equipped with full-time or part-time mental health service personnel. In 2019， 95 （64.2%） institutions conducted mental health services for employees， and 104 （70.3%） conducted mental health propaganda activities. Of the 75 educational institutions， 67 （89.3%） conducted mental health education for students， and 47 （62.7%） achieved full coverage of the mental health education curriculum among students. The detection rates of depression and anxiety among the residents were 36.8% and 30.8%， respectively， and 83.7% of the residents had the mental health service needs， mainly in the aspects of personal growth， marriage and family， children's education and stress management. ConclusionThe psychosocial services in the pilot areas of the three cities in northeast Sichuan are well conducted， while the guarantee of workplace， funds and personnel remains to further strengthen. Furthermore， residents have prominent emotional problems such as depression and anxiety， and have a high demand for mental health services.

Betacoronavirus ; Consensus ; Coronavirus Infections ; complications ; epidemiology ; prevention & control ; Epidemics ; Humans ; Minimally Invasive Surgical Procedures ; Musculoskeletal Diseases ; complications ; therapy ; Pandemics ; prevention & control ; Pneumonia, Viral ; complications ; epidemiology ; prevention & control

OBJECTIVE: To study the cost-effectiveness of left atrial appendage occlusion(LAAC), rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation, in order to explore the most appropriate economical medication model. METHODS: A total of 156 NVAF patients treated in the First Affiliated Hospital of Dalian Medical University from July2016 to June 2018 were studied; they were divided into group A(LAAC), group B(rivaroxaban)and group C(warfarin)by random digital method.Markov model was used to analyze the drug economy of three methods to prevent stroke in patients with atrial fibrillation within one year, and sensitivity analysis was conducted to verify the stability of the results. RESULTS: The total cost of treatment in group C was significantly lower than that in the other two groups, while in group A it was significantly higher than in the other two groups, with statistical significance(P<0.05). ICER(A vs. B)was 91242.31 yuan/QALY,ICER(B vs. C)was 96706.25 yuan/QALY, and ICER(A vs. C)was 93323.81 yuan/QALY. So the drug economy of group A was better than that of the other two groups, and group B was better than group C. When the sensitive indicators selected changed, there was still a statistical difference in the total cost among the three groups(P<0.05), which indicated that the results of this study were credible. CONCLUSION: Compared with warfarin and rivaroxaban, LAAC may have more pharmacoeco-nomic effects on preventing stroke in patients with atrial fibrillation, but further studies with large sample sizes and longer follow-up cycles are needed.

Objective:To evaluate the effect of Kinesio taping on knee osteoarthritis (KOA). Methods:The Cochrane Library, PubMed, CNKI, Web of Science and PEDro were searched from inception to November, 2018. The randomized controlled trials (RCTs) about the effect of Kinesio taping on knee osteoarthritis were collected. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Meta-analysis was performed using RevMan 5.3. Results:A total of six RCTs were enrolled. There were significant differences in the scores of Visual Analogue Score between the intervention group and the control group (WMD = -1.28, 95%CI -2.36 to -0.20, P = 0.02). There were no significant differences in Western Ontario and McMaster Universities Osteoarthritis Index, range of motion, quadriceps femoris and hamstring muscle strength between the intervention group and the control group (P > 0.05). The other studies only adopted descriptive analysis accordingly. Conclusion:It is still uncertain in the effectiveness of Kinesio taping on knee osteoarthritis.

Background:Clinical outcomes of undifferentiated arthritis (UA) are diverse,and only 40 ％ of patients with UA develop rheumatoid arthritis (RA) after 3 years.Discovering predictive markers at disease onset for further intervention is critical.Therefore,our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.Methods:We performed a prospective,multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals.Clinical and serological parameters were obtained at recruitment.Follow-up was undertaken in all patients every 12 weeks for 2 years.Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.Results:A total of 234 patients were recruited in this study,and 17 (7.3％) patients failed to follow up during the study.Among the 217 patients who completed the study,83 (38.2％) patients went into remission.UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9％ vs.16.8％,x2=8.228,P=0.008),anti-cyclic citrullinated peptide (CCP) antibodypositivity (66.7％ vs.10.7％,x2 =43.897,P ＜ 0.001),and double-positivity rate of RF and anti-CCP antibody (38.1％ vs.4.1％,x2 =32.131,P ＜ 0.001) than those who did not.Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017,95％ confidence interval:5.803-55.938;P ＜ 0.001).Conclusion:As an independent predictor of RA,anti-CCP antibody should be tested at disease onset in all patients with UA.

Objective: To summarize the clinical features and treatment status for elderly in-hospital patients with mitral regurgitation (MR). Methods: A single center retrospective study was conducted in 1 741 patients admitted in our hospital from 2014-05-01 to 2015-04-30 with echocardiography confirmed moderate to severe MR. The patients were divided into 2 groups: Elderly group, n=680(39.06%)patients≥60 years of age and Non-elderly group,n=1 061(60.94%)patients<60 years.Clinical features and treatment status were studied and compared between 2 groups. Results: The mean age in Elderly group was (66.98±5.94) years and the most common type was degenerative MR (41.18%). Compared with Non-elderly group, Elderly group had more patients combining coronary artery disease (37.79% vs 17.43% ), more risk factors of atherosclerosis such as hypertension (45.44% vs 25.17%), diabetes (19.56% vs 8.48%) and hyperglycemia (35.29% vs 19.51%) all P<0.05; Elderly group had the higher EuroSCORE Ⅱ score (5.54±2.42) vs (3.15±1.66), greater left ventricular end diastolic diameter (57.72±12.37) mm vs (57.33±10.19) mm and less patients combining multiple valve disease (35.59% vs 40.81%), less patients received surgical treatment (54.71% vs 63.9%), all P<0.05. The surgery procedures (mitral valve replacement or mitral-plasty) were similar between 2 groups; compared with Non-elderly group, Elderly group had the higher application rate of bio-prosthetic valve (53.88% vs 18.67%), P<0.001. Conclusion: About 40% in-hospital moderate to severe MR patients were the elderly crowd, the most common pathogenesis was degenerative changes which leaded the higher incidences of cardiac complications, worse cardiac function and the higher risk scores for surgical treatment, there were less patients received surgery.

Objectives:To observe the clinical features and factorsrelated to treatment decision for hospitalizedpatients with mitral regurgitation (MR). Methods:A total of 3 450 consecutivepatients with transthoracic echocardiography (TTE) confirmed moderate to severe MR admitted in our hospital from 2014-01-01 to 2015-12-31 were enrolled. Base on therapeutic method, the patients were divided into 2 groups:Surgery group, n=1 845 and Medication group, n=1 605. The baseline data including TTE results were collected, clinical features were compared between 2 groups and factors related to treatment decision were analyzed. Results:Mean age of this patient cohort was (54.8±13.8) years including 26.99% (931/3 450) patients aged ≥65 years. The most common etiology was primary MR, 324 (9.39%) patients were asymptomatic at admission and decreased left ventricular ejection fraction (LVEF) was evidenced in 55.28% (1 907) patients. Total in-hospital mortality was 0.75% (26). Compared with Medication group, the patients in Surgery group were younger ([52.65±12.01] years vs [57.39±15.25] years), prevalence of severe MR (56.69% vs 26.79%) and primary MR (89.49% vs 39.00%), as well as LVEF value ([61.62±9.20] % vs [48.00±17.53] %) were higher (all P＜0.001).Logistic regression analysis indicated that age (OR=0.561, 95% CI 0.503-0.627), MR etiology (OR=3.062, 95% CI 2.565-3.654), MR grade (OR=0.103, 95% CI 0.085-0.126) and LVEF (OR=2.478, 95% CI 2.147-2.860) were the determinants for treatmentdecision making in hospitalized patients with moderate to severe MR. Conclusions:In this patient cohort, there are considerable proportion of aged patients with moderate to severe MR. Primary MRis the major etiology. 46.52% patients received conservative therpay instead of surgery, older age,secondary MR, moderate MR and decreased LVEF are the major reasons for choosing conservative therapy in this patient cohort.