Current Issue

2021 Vol.6 No.4 Published:30 November 2021

The Communist Party of China has been working for the people's health for 100 years

Management of chronic hepatitis B infection in women of childbearing age and measures and effects of prophylaxis and treatment of mother-to-child transmission Han Guorong, Chen Chao, Zhou Guanlun, Jiang Hongxiu 2021, 6 (4):  270-274.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.001 Abstract ( 415)    PDF (886KB) ( 751 )    China is now working with the world to achieve the goal of eliminating viral hepatitis by 2030. Chronic hepatitis B infection is a high pandemic in China. It is vital to eliminate hepatitis B virus infection from the source via blocking mother-to-child transmission (MTCT). The history of blocking hepatitis B MTCT has gone through nearly 30 years. Taking the effects of Department of Obstetrics and Gynecology, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine in preventing hepatitis B MTCT as an example, more than 30 000 chronic HBV infected pregnant women and paired infants have been included in whole-process management and prevention in the past 20 years. Among them, more than 4000 HBV infected pregnant women have been treated with antiviral therapy. From 2010 to 2015, 4820 pregnant women with hepatitis B finished MTCT follow-op while 3607 maternal-infant pairs were in the follow-up between 2016 and 2019 with an overall MTCT rate of 99.7%. Based on evidence-based medical, the management process of HBV infected pregnant women, the standardized blocking of MTCT and long-term follow-up system of infants were first established and improved. The MTCT rate has decreased from 8%-10% in 2010 to 0.3% in 2020 by achieving the process of fertility counseling, preconception screening and evaluation, antiviral therapy, infant immunoprophylax and other measures. The results have been included in domestic and international guidelines for hepatitis B prophylaxis and treatment as vital evidence-based medical evidence and have been awarded the Outstanding Contribution Award of Antiretroviral Pregnancy Registry (APR). The clinical research results have been promoted and applied in nearly 100 hospitals nationwide and more than 5000 doctors have been trained, which established a typical model for preventing hepatitis B MTCT in China. Furthermore, great social and economic benefits were obtained. Further promotion of the overall process nationwide will realize the ultimate goal of eliminating hepatitis B.

Original Articles

Retrospective analysis of functional regional cervical lymph node dissection in the treatment of abscess and ulcerated cervical lymphatic tuberculosis Wang Haijiang, Zheng Shuo, Huang Pilai, Wang Yanfeng, Qiao Kun 2021, 6 (4):  275-279.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.002 Abstract ( 528)    PDF (1017KB) ( 949 )    Objective To investigate the feasibility and safety of functional regional cervical lymph node dissection in the treatment of abscess and ulcerated cervical lymphatic tuberculosis and to improve the therapeutic effect of abscess and ulcer cervical lymph node tuberculosis. Methods From January 2019 to June 2020, 68 patients with abscess and ulcerated cervical lymphatic tuberculosis underwent functional regional cervical lymph node dissection and retrospectively analysed these clinical data. Results In the 68 patients with cervical lymphatic tuberculosis, 50 cases were abscess type and 18 cases were ulceration type. All patients underwent surgical procedure of functional regional cervical lymph node dissection. Postoperative follow-up period ranged from 6 to 18 months, there was 1 case of accessory nerve injury, 2 cases of residual lesion, 2 cases of postoperative recurrence, 12 cases of postoperative wound scar healing or delayed healing, and 25%（17/68） of postoperative adverse complications. The complication rate of abscess type was 12.0%（6/50）, which was significantly lower than 61.1%（11/18） of ulcer type, the difference was statistically significant （χ2=16.77,P<0.05）. The primary healing rate was 82.4%（56/68）, 92.0%（46/50）for abscess type and 55.6%（10/18） for ulcer type, The difference was statistically significant（χ2=12.1,P<0.05）. Conclusion Functional regional cervical lymph node dissection for the treatment of abscess and ulcerated cervical lymphatic tuberculosis, the surgical procedures incision can be sutured in one stage and the healing rate of the incision in one stage is high,abscess type is better than ulcerated type. Patients with early surgery have better outcomes.

Application of MRI in imaging classfication of brain parenchymal tuberculoma Tian Chaoqiao, Yang Ling, Fan Dong, Tang Ronglin, Yang Yaying 2021, 6 (4):  280-284.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.003 Abstract ( 821)    PDF (1065KB) ( 569 )    Objective To explore the clinical significance of MRI in imaging classification of brain parenchymal tuberculoma and provide basis for imaging diagnosis of brain parenchymal tuberculoma. Methods A retrospectively study of 35 patients with brain parenchymal tuberculoma who were clinically diagnosed and treated by Kunming Tuberculosis Hospital from September 2018 to June 2020. According to the enhancement method of brain parenchymal tuberculoma, it was divided into solid enhancement type, ring-shaped central uneven enhancement type, and smooth ring-shaped enhancement type. and calculate the disappearance of different types of lesions after 2, 6, 12 months of anti-tuberculosis treatment,the absorption rates of different types of brain parenchymal tuberculoma were examined by χ2. Results The disappearance rates of three different types of tuberculosis, solid enhancement, annular central uneven enhancement, and smooth annular enhancement after the same period of treatment were statistically significant (χ2= 87.87, 104.02, 24.63, P<0.05). Conclusion According to the enhancement method, the brain parenchymal tuberculoma can be divided into solid enhancement type, ring-shaped central uneven enhancement type and smooth ring enhancement type. It is relatively objective, which can indirectly reflect the pathological characteristics and period of brain parenchymal tuberculoma.

Liver pathological analysis in human immunodeficiency virus or acquired immune deficiency syndrome patients with liver damage Huang Zhizhong, Lyu Jiannan, Qin Jianglong, Li Pinchao, Mou Minhong, Qin Yaqin 2021, 6 (4):  285-288.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.004 Abstract ( 542)    PDF (1131KB) ( 677 )    Objective To investigate the pathological types and features of in HIV/AIDS patients with liver damage, and we try to provide evidence for the diagnosis and treatment of liver diseases in acquired immunodeficiency syndrome. Methods The tissues of liver were obtained from HIV/AIDS patients with liver damage for pathological examination by percutaneous puncture under ultrasonographic guidance. The pathological results were observed by light microscope after Hematoxylin-Eosin, acid-fast, periodic acid-Schiff, and digested-PAS staining. The pathological characteristics and histopathological features of the hepatic tissue were described and analyzed. Results Among the 64 HIV/AIDS patients with liver damage, the viral hepatitis were found in 22 patients (34.4%), the hepatic tumors were found in 23 patients(35.9%), the drug hepatitis were found in 5 patients(7.8%), the opportunistic infectious diseases were found in 7 patients(10.9%) and the nonspecific lesions were found in 7 patients(10.9%).The pathological findings of hepatitis B virus, hepatitis C virus, hepatocellular carcinoma, diffuse large B cell lymphoma, inflammatory myofibroblastoma, mycobacterium tuberculosis infection and talaromyces marneffei infection were 12,10,11,8,3,2 and 2 cases, respectively. Conclusion The main cause of liver damage in HIV/AIDS patients are viral hepatitis, such as hepatitis B virus and hepatitis C virus,the liver tumors are hepatocellular carcinoma and mainly diffuse large B cell lymphoma.Therefore, we need to strengthen the diagnosis and treatment of HIV/AIDS patients with various liver diseases.

Evaluation of IDEAL-IQ imaging in the diagnosis of hepatic fibrosis and early stage of liver cirrhosis associated with hepatitis B virus infection Luo Jieqi, Shen Jing, Guo Ang, Zheng Guangping, Li Haodong, Wang Lifei Yun Yongxing 2021, 6 (4):  289-293.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.005 Abstract ( 432)    PDF (1581KB) ( 830 )    Objective To investigate the application value of MRI IDEAL-IQ imaging technology in the diagnosis of hepatic fibrosis and early cirrhosis of hepatitis B virus and to explore a new and simple imaging method to evaluate hepatic fibrosis and early cirrhosis. Methods A total of 229 patients with hepatitis B and liver fibrosis diagnosed with hepatic puncture and histology from Shenzhen Third People's Hospital from October 2019 to May 2021 were selected and divided into four groups according to the classification and staging criteria of chronic hepatitis: S1 stage (105 cases), S2 stage (51 cases), S3 stage (41 cases), S4 stage (32 cases), the imaging data of four groups of patients (IDAEL-IQ R2* relaxation rate value, ultrasound elastography STE Value) and laboratory examination data (serological examination: hyaluronic acid, procollagen Ⅲ, collagen Ⅳ, laminin). Compare the imaging and laboratory measurement data of the four groups of patients; analyze the correlation between IDAEL-IQ R2* value and ultrasound elastography STE value and serological indicators; use ROC curve to evaluate the diagnostic efficacy of IDAEL-IQ R2* value . Results ①The R2* value of the S4 group was significantly different from the other three groups (S1, S2, S3) (P=0.001, P<0.001, P=0.041), while the S1, S2, and S3 groups There was no statistically significant difference in R2* value between the two groups (P=1.000, P=1.000, P=0.720). ②The R2* value was significantly positively correlated with the ultrasound STE value and hyaluronic acid (r=0.203, P=0.004; r=0.245, P<0.001). ③The area under the ROC curve for the diagnosis of early liver cirrhosis by R2* value is 0.747, the sensitivity and specificity are 0.818 and 0.619, respectively, and the diagnostic cut-off value is 51.05sec-1. Conclusion There were statisticallysignificant difference between the R2* value in the early stage of liver cirrhosis (S4) and the advanced stage of liver fibrosis (S1, S2, S3) in patients with hepatitis B, and can be used as a new technique for the diagnosis of early liver cirrhosis and liver fibrosis in patients with viral hepatitis B.

Application of ultrasound in liver transplantation in patients with HIV infection complicated with hepatitis B cirrhosis Feng Wenxia, Dong Changfeng, Feng Cheng, Jiang Nan, Huang Jia, Zhao Ningbo 2021, 6 (4):  294-297.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.006 Abstract ( 421)    PDF (971KB) ( 649 )    Objective To investigate the feasibility and application value of ultrasound in liver transplantation for patients with HIV infection complicated with viral hepatitis B cirrhosis. Methods The ultrasonographic features of 4 patients with HIV infection complicated with hepatitis B cirrhosis before and after liver transplantation were retrospectively analyzed. Ultrasound examination included hepatic arterial peak systolic velocity (PSV), Systolic acceleration time（SAT）, end-diastolic velocity (EDV), resistance index (RI), portal vein, hepatic venous flow velocity (PVV, HVV) and other hemodynamic indicators, maximum oblique diameter of the right hepatic lobe, perihepatic effusion, pleuroperitoneal effusion and CEUS. Results There were no contraindications for the related vessels and bile ducts in 4 cases diagnosed by preoperative ultrasonography.Early postoperative ultrasound showed no definite signs of rejection.The frequency spectrum of the intrahepatic artery in 1 patient showed small slow wave changes. Contrast-enhanced ultrasonography suggested active abdominal hemorrhage in 2 patients. All the above were confirmed by surgery, pathology or CTA. Conclusion Preoperative and postoperative ultrasound is of certain value in the evaluation of transplanted liver in patients with HIV infection complicated with hepatitis B cirrhosis, especially in the diagnosis of active bleeding by contrast-enhanced ultrasound.

Analysis of cellular immune function in patients with HBV/TP superinfection with different HBeAg status Chen Siyu, Bai Lan, Zhang Jin 2021, 6 (4):  298-301.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.007 Abstract ( 481)    PDF (906KB) ( 674 )    Objective To compare the cellular immune function of patients with hepatitis B virus/Treponema pallidum (HBV/TP) superinfection with different hepatitis B virus e antigen (HBeAg) status, and to further understand the changes of cellular immune function in patients with HBV/TP coinfection. Methods The clinical data of 79 patients with HBV/TP superinfection admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed. All patients were divided into 2 groups according to the different HBeAg status before treatment, 41 HBeAg-positive patients were included in the HBeAg-positive group, and 38 HBeAg-negative patients were included in the HBeAg-negative group. The levels of HBV-DNA, T cell-related cytokines and T lymphocyte subsets in the peripheral blood of the two groups were compared. Results The level of HBV-DNA in the HBeAg-positive group was substantially higher than that in the HBeAg-negative group (P<0.05). The levels of CD3+T, CD4+T, CD4+T/CD8+T and natural killer (NK) cells in the HBeAg-positive group were higher than those in the HBeAg-negative group (P<0.05), and the CD8+T cell level was lower than that in the HBeAg-negative group (P<0.05). The levels of interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-17 (IL-17), transforming growth factor-β (TGF-β) in the HBeAg-positive group were substantially higher than those of the HBeAg-negative group (P<0.05). The levels of interleukin-4 (IL-4) and interleukin-10 (IL-10) in the HBeAg-positive group were not significantly different from those in the HBeAg-negative group (P>0.05). Conclusion HBeAg level affects the immune function of patients with HBV/TP coinfection, which may induce the body to start cellular immunity, improve the level of T lymphocyte subsets and promote the secretion of related cytokines.

Bedaquiline in the treatment of pulmonary drug-resistant tuberculosis: safety and efficacy Yang Liangzi, Ren Tantan, Fu Xiangdong, Liu Zhi, Luo Lan, Zhang Peize 2021, 6 (4):  302-305.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.008 Abstract ( 716)    PDF (881KB) ( 772 )    Objective To evaluate the efficacy and safety of bedaquiline (BDQ)in patients with drug resistant pulmonary tuberculosis (DR-PTB)and to provide guidance for clinical rational and safe drug use. Methods We retrospectively reviewed 44 DR-TB patients (including multi-drug resistant pulmonary tuberculosis, MDR-PTB and extensively-drug-resistant TB (XDR-TB) treated with bedaquiline-containing regimen between January 2020 and August 2020 in the Third People's Hospital of Shenzhen. Results The conversion rate of acid-fast bacilli smear was 97.4%(38/39) and the culture conversion rates was 92.9%(26/28) at 24 weeks. There were 49 adverse events in total, including 18 cases of prolonged QTc interval (36.7%) and 10 cases of liver toxicity (20.4%). Among the 18 QTc prolonged adverse events, 3 were clearly related to bedaquiline, accounting for 6.1% of the total adverse events. Treatment was halted in four patients because of prolonged corrected QTc interval, one of which was associated with a single factor of bedaquiline. Conclusion Bedaquiline-containing regimen was effective and safe for patients with pulmonary DR-TB. But it was still necessary to closely monitor adverse reactions, especially the occurrence of prolonged QTc interval.

A retrospective cohort study of clinical characteristics and treatment regimens of drug-resistant tuberculosis containing isoniazid-resistance Fu Liang, Liao Weiming, Zhang Huihua, Deng Guofang 2021, 6 (4):  306-310.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.009 Abstract ( 577)    PDF (889KB) ( 918 )    Objective To analyze the clinical characteristics and treatment regimens of drug-resistant tuberculosis containingisoniazid-resistance (Hr)DR-TB patients, and provide evidence for clinical practice and further research. Methods We retrospectively enrolled patients with (Hr)DR-TB, including Hr-TB and multidrug-resistant tuberculosis (MDR-TB) during January 2011 to December 2016 in Shenzhen Third People's Hospital, collected the demographic data, history of anti-tuberculosis treatment, phenotypic drug susceptibility testing (pDST) results of Mycobacterium tuberculosis and the changes of pDST, treatment regimens and adjustment strategy, treatment outcomes, and divided these data into new cases and retreated cases for comparative analysis. Results ①There are 37.5% (232/619) of Hr-TB and 62.5% (387/619) of MDR-TB in total, 49.7% and 50.3% in new cases, and 22.8% and 77.2% in retreated cases. Some patients experienced changes in the drug resistance spectrum during anti-tuberculosis treatment or after TB recurrence. 10.8% (67/619) of anti-tuberculosis drugs changed from drug-susceptible to drug-resistant.7.4% (46/619) changed from drug-resistant to drug-susceptible. ②Among 235 cases of Hr-TB, according to the pDST results, 8.5% (20/235) of patients with levofloxacin resistance and 8.9% (21/235) of patients with ethambutol resistance were found. Among the retreated cases, levofloxacin-resistant patients accounted for 20.9% (14/67), which was more than that in new cases (20.9% vs 3.6%, P>0.05). Among those who were sensitive to levofloxacin, 80.5% (167/215) used isoniazid in the initial regimen. Among those resistant to levofloxacin, 70% (14/20) used levofloxacin. After the pDST was reported, most cases (86.4%, 203/235) ignored the results and did not adjust their regimens. In terms of treatment outcome, 71.5% (168/235) were lost to follow-up, and 26.4% (62/235) maintained in the cohort. The treatment success rate of newly cases was higher than that of retreated cases (29.8%, 50/168 vs 16.4%, 11/67, P<0.01). Conclusion The most of (Hr)DR-TB patients were young and middle-aged men, and most of them were combined with rifampicin resistance. The drug resistance spectrum was easy to change during treatment. During the treatment of HR-TB, the treatment was rarely adjusted according to drug sensitivity, and more than 70% of cases were lost to follow-up. Attention should be paid to the standardized diagnosis and treatment of (HR) Dr-TB, especially Hr-TB.

Comparison of chest CT features of two kinds of common slow growing nontuberculous mycobacterial pulmonary diseases Chen Hua, Fang Weijun, Hu Jinxing, Ren Huili, Han Yuanyuan, Liang Ruiyun, Chen Pinru 2021, 6 (4):  311-314.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.010 Abstract ( 518)    PDF (1115KB) ( 834 )    Objective To analyze the chest CT features of two kinds of common slow growing nontuberculous mycobacterial pulmonary diseases and improve the understanding of their imaging signs. Methods 63 patients with pulmonary disease caused by Mycobacterium Kansas (group A) and 60 patients with pulmonary disease caused by Mycobacterium avium cytoplasmic complex (MAC) (group B) in Guangzhou chest hospital from January 2018 to December 2020 were collected. The two groups of patients met the diagnostic criteria for pulmonary disease caused by nontuberculous Mycobacterium. The CT signs of group A and group B were retrospectively analyzed. Results ①The proportion of women, age and the proportion of bronchiectasis in group B were significantly higher than those in group A (all P<0.05). ②Columnar bronchiectasis accounted for 21.74% (10/46) in group A and 48.15% (26/54) in group B; The percentage of cystic bronchiectasis was 43.48% (20/46) in group A and 22.22% (12/54) in group B (P<0.05). ③In group B, 40 cases (74.07%) showed right middle lobe bronchiectasis and 38 cases (70.37%) showed left lingual bronchiectasis; There was significant difference between the two groups (t = 5.881, P= 0.002). ④In group A, consolidation (30.16%), cavity (76.19%), wormhole (18.75%) and thick walled cavity (31.25%) were significantly higher than those in group B; The tree bud sign (65.00%), ground glass shadow (16.67%) and pleural thickening rate (23.33%) in group B were significantly higher than those in group A (P<0.05). Conclusion The CT signs of Kansas lung disease are characterized by columnar bronchiectasis, ground glass patch shadow of both lungs and lung consolidation, while MAC lung disease is characterized by cystic bronchiectasis and micronodule (tree bud sign), involving a wide range of lung lobes and scattered distribution. The CT signs of Kansas lung disease and MAC lung disease have their own characteristics.

Application value of fungal fluorescence staining combined with respiratory tract specimen culture and identification and serum 1, 3-β-D-glucan detection in the diagnosis of invasive pulmonary fungal infections Zou Fang, Liu Zijie, Zhang Hui, Zhong Min 2021, 6 (4):  315-318.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.011 Abstract ( 486)    PDF (930KB) ( 750 )    Objective To evaluate the diagnostic performance of three common laboratory fungal detection methods for invasive pulmonary fungal infections (IPFI),in order to provide a basis for the diagnosis and treatment of IPFI. Methods A retrospective analysis was performed on 301 inpatients with high-risk IPFI who were admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Kunming Medical University from January 2020 to December 2020. Including 83 cases in the observation group and 218 cases in the control group. Fungal fluorescent dye,serum1,3-β-D-glucan, respiratory specimens culture and identification were performed respectively. To evaluate the diagnosis efficacy of the three detection methods for IPFI. Results The detection rates of IPFI were 36.9%（111/301）、9.6%（29/301）、18.6%（56/301）by fungal fluorescence staining, serum 1,3-β-D-glucan and respiratory specimen culture and identification, respectively. The positive rates of the three methods in the observation group were 80.7%（67/83）、15.7%（13/83）、45.8%（38/83）, respectively, which were higher than those in the control group 20.1%（44/218）、7.3%（16/218）、8.3%（18/218）,the differences were statistically significant (P<0.05). The sensitivity、specificity and AUC of fungal fluorescence staining were 80.7%、79.8%、0.803, respectively. serum1,3-β-D glucan levels were 15.7%、92.7%、0.542, respectively. Respiratory specimen culture and identification were 45.8%、91.7%、0.688, respectively. The combined detection of the three indexes were 86.7%、77.5%、0.855, respectively, which was better than any single detection efficiency. Conclusion Fungal fluorescence staining has more advantages in IPFI detection, which is a fast, reliable and sensitive diagnosis method of IPFI, However, the combined detection of the three indicators has more significant application value in diagnosing IPFI, which can improve the diagnosis efficiency and worth of clinical promotion.

Diagnostic reliability of Xpert MTB/RIF with rifampicin resistance detected at very low bacterial level: a retrospective analysis Chen Tao, Wang Yuxiang, Zheng Junfeng, Li Tianpin, Ye Feidi, Ye Taosheng, Deng Guofang, Zhang Peize 2021, 6 (4):  319-322.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.012 Abstract ( 1033)    PDF (983KB) ( 1258 )    Objective To evaluate the reliability of Xpert MTB/RIF assay with rifampicin resistance detected at very low bacterial level on sputum and bronchoalveolar lavage fluid specimens and provide reference for tuberculosis diagnosis. Methods A total of 4476 respiratory specimens detected by Xpert MTB/RIF assay were reviewed. Among them, 95 specimens yielded test results of “MTB detected, very low; Rifampicin resistance detected”. A retrospective analysis of these 95 results was performed to compared the consistency of rifampicin resistance detected by Xpert MTB/RIF and culture-based DST and repeated Xpert MTB/RIF. And the treatment outcome of 9 patients with discordant results was analyzed. Results There were 93 respiratory specimens sent for liquid culture and 65 reported MTB positive and 28 MTB negative. In the 59 culture-based DST, 51 showed rifampicin resistant and 8 rifampicin susceptible. The consistency of Xpert and DST was 86%（51/59）; 28 specimens were sent for a repeated Xpert and 20 turned out MTB positive, of which 16 were found to be rifampicin resistant at the same probe as the first Xpert. 4 showed no rifampicin resistance detection. The consistency of two Xpert tests were 80%（16/20）; 9 patients with discrepant results were successfully cured, 8 with first line medicine and 1 with second line regimen. Conclusion Xpert MTB/RIF shows reliability in detecting rifampicin resistance even ata very low bacterial load, but a repeated Xpert or culture-based DST is recommended for more precise diagnosis.

Research on the function of CT in the differentiation of single nodule or mass type pulmonary tuberculosis and lung cancer Li Huiru, Fang Weijun, Liu Zengwei, Xie Zhi'en 2021, 6 (4):  323-326.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.013 Abstract ( 499)    PDF (1191KB) ( 732 )    Objective To evaluate the value of CT in the differentiation of single nodule or mass type pulmonary tuberculosis and lung cancer, and to provide reference for the differential diagnosis of nodular or mass pulmonary tuberculosis and lung cancer. Methods A total of 60 patients with suspected lung cancer admitted to Guangzhou Chest Hospital from January 2018 to December 2019 were selected as study subjects. CT examination was performed on all patients, postoperative pathological examination was performed, and the disease detection rate and diagnostic value of the two examination methods were compared. Results Among the 60 patients with suspected lung cancer, 38 cases were nodular or mass pulmonary tuberculosis and 22 cases were lung cancer; In patients with nodular or mass pulmonary tuberculosis, 18 cases (47.37%) had lesions located in the posterior segment of the upper lobe tip, 26 cases (68.42%) had diameter less than 3cm, 27 cases (71.05%) had cavity calcification, 30 cases (78.94%) had multipoint necrosis, 26 cases (68.42%) had tortuous bronchiectasis, which was higher than that in 4 cases (18.18%), 7 cases (31.82%), 6 cases (27.27%) and 10 cases (45.45%) of lung cancer 7 cases (31.82%), the difference was statistically significant (P<0.05);Among the patients with lung cancer, 9 cases (40.91%) had blurred edges, 11 cases (45.45%) had lobulation and notch, 7 cases (31.82%) had burr, which was higher than 2 cases (5.26%), 3 cases (7.89%) and 1 case (2.68%) of nodular or mass pulmonary tuberculosis (P<0.05). The detection rate of single nodule or mass type pulmonary tuberculosis granulation by CT examination was 92.11%, and that of lung cancer was 90.91%. Compared with postoperative pathology, the data showed no no significant difference (P>0.05).The sensitivity, specificity and accuracy of CT disease diagnosis were 92.11, 90.91%, 91.67%, missed diagnosis rate 7.89%, and misdiagnosis rate 9.09%. Compared with postoperative pathology examination, there was no significant difference (P>0.05). Conclusion The imaging findings of nodular or mass pulmonary tuberculosis and lung cancer were significantly different.CT has high accuracy and high specificity in differentiating nodular or mass pulmonary tuberculosis and lung cancer. It can replace invasive examination such as needle biopsy to some extent, and provide reference for disease treatment.

Chest CT imaging manifestations of AIDS complicated with Candida infection Zhang Zixin, Lyu Zhibin, Guan Chunshuang, Chen Budong, Xie Ruming 2021, 6 (4):  327-330.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.014 Abstract ( 536)    PDF (1195KB) ( 824 )    Objective To observe and analyze the chest CT imaging characteristics of acquired immune deficiency syndrome(AIDS) combined with Candida infection, improving diagnostic level of AIDS combined with Candida infection. Methods 16 AIDS complicated with pulmonary candida infection diagnosed by fiberoptic bronchoscopy alveolar lavage fluid smear or culture were collected from December 2015 to July 2020 in Beijing Ditan Hospital, Capital Medical University. 13 cases underwent chest CT scan and 3 cases chest CT plain scan and enhanced scan, observe and analysis its CT image characteristics. Results ①The most common CT feature in pulmonary Candida infection with AIDS is patchy, large, or mass-like consolidation with surrounding "halo sign", which is more common under the pleura. ②The solid nodules with clear boundary occurs in pulmonary Candida infection, while the cavities in the nodules are rare. ③There are bronchiole and small blood vessels can be seen inside the mass-like Candida infection. The bronchiole wall is not thick, the lumen is not narrow, and the small blood vessels have no thrombosis or lumen obstruction performance. ④A very small number of patients with confirmed Candida infection have no positive findings in the lungs. Conclusion The most common imaging feature of AIDS complicated with pulmonary Candida infection is subpleural consolidation. Multiple solid nodules with cavities in the lungs are helpful for diagnosis. Study and analyze of the imaging performance of lung Candida albicans can help improve the level of diagnosis with this disease in physicians.

The imaging modalities and characteristics of brucella spondylitis Li Junlin, Wang Lina, Zhang Xiaoqin 2021, 6 (4):  331-335.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.015 Abstract ( 490)    PDF (1014KB) ( 791 )    Objective To analyze the image characteristics of brucella spondylitis, further clarify the value of positive diagnosis and lesions evaluation in different image patterns. Methods Imaging data of 31 cases with brucellar spondylitis (from January 2018 to December 2020) confirmed by laboratory examination were retrospectively reviewed. 24 patients received the lumbar spine X-ray examination, 28 patients CT examination, and 27 patients MRI examination. The lesions of vertebral body, Intervertebral disc, and surrounding tissue of vertebral body, were respectively analyzed by different image patterns. Results 31 patients with brucellar spondylitis were included, 21 males and 10 females, aged 24~77 years with an average age of 48.3 years. In terms of the site, 1 case in the cervical vertebra, followed 2 cases in the thoracic vertebra, and 28 cases in the lumbosacral vertebrae, respectively. In X-ray, 16 cases of lesions of vertebral body (66.7%), and 18 cases of intervertebral space stenosis (75.0%). In CT, 24 cases of lesions of vertebral body (85.7%), 22 cases of lesions of intervertebral disc (78.6%), and 19 cases of lesions of surrounding tissue of vertebral body (67.9%). In MRI, 27 cases of lesions of vertebral body (100%), 24 cases of lesions of intervertebral disc (88.9%), 16 cases of lesions of surrounding tissue of vertebral body (67.9%), and 9 cases of lesions of vertebral canal (33.3%). Conclusion MRI were superior to CT and CT was superior to X-ray in sequence for the positive manifestations of brucella spondylitis. Some specific signs were as follows: osteophytes were perpendicular to the vertebra in CT, and T2WI high signal pattern was consistent with T1WI enhanced pattern of MRI, which was of important significance for the diagnosis of brucella spondylitis.

Epidemiological characteristics analysis of lower respiratory Mycoplasma pneumoniae infection in children Wu Yan, Wei Huiping, Cao Xin, Zhao Hui, Lu Dan, Wang Hui 2021, 6 (4):  336-338.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.016 Abstract ( 365)    PDF (878KB) ( 671 )    Objective To explore the epidemiological characteristics of lower respiratory Mycoplasma pneumoniae (MP) infection in children so as to provide data for the prevention and treatment of MP infection in children. Methods The clinical data of 1134 children with lower respiratory infection (LRI) in Hubei Maternal and Child Health Hospital from January 2017 to December 2019 were collected. Based on retrospective research method, the unified clinical research forms were formulated to read the clinical data of children in detail. The related data were collected and summarized, including gender, age, admission time, clinical symptoms and test results of MP antibody. Results Among the 1134 LRI children from 2017-2019, there were 155 cases (13.67%) with positive MP. The ratios of MP infection in 2017, 2018 and 2019 were 14.40%, 11.17% and 15.49%, respectively. And the difference was not statistically significant (P>0.05). The ratios of MP infection in males and females were 13.11% (78/595) and 14.29% (77/539), and the difference was not statistically significant between the groups (P>0.05). The ratio of MP infection was gradually increased with age. The ratio of MP infection was the lowest in LRI children aged 0-3 years (10.26%), followed by 4-5 years old (15.41%) and 6-14 years old (16.44%). After comparison, ratio of MP infection in LRI children aged 0-3 years was significantly lower than that aged 4-5 years old and 6-14 years old (P<0.05). There was MP infection throughout the year, with the highest ratio of MP infection within October-December (17.21%), followed by January-March (14.01%), April-June (10.67%) and July-September (9.28%). After comparison, ratio of MP infection within October-December was significantly higher than that within April-June and July-September (P<0.05). Conclusion Children aged 4-14 years old are the susceptible population. The main symptoms include cough, fever and wheezing. And the disease is more likely to appear in autumn and winter.

Analysis of the efficacy of Ganning tablets combined with entecavir in the treatment of hepatitis B with elevated alpha-fetoprotein Ma Chenbin, Tian Zhi'ao 2021, 6 (4):  339-342.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.017 Abstract ( 562)    PDF (905KB) ( 497 )    Objective To investigate the efficacy of Ganning tablets combined with entecavir in the treatment of hepatitis B with elevated alpha-fetoprotein, and the effect of alpha fetoprotein (AFP) and liver function. Methods A total of 60 hepatitis B patients with alpha-fetoprotein overexpression who were admitted to the Rugao Hospital of Nantong University from January 2016 to December 2019 were selected as the research objects, and they were randomly divided into a treatment group and a control group with 30 cases each. The control group was treated with entecavir, and the treatment group was treated with Ganning tablets on the basis of the control group. The treatment effects of the two groups were compared, and the alpha-fetoprotein levels of the two groups were detected and compared before and after 12, 24, and 48 weeks after treatment. HBV DNA copy number and liver function level. Results Two groups of patients were treated for 12, 24 and 48 weeks respectively. The normalization rate of alanine aminotransferase (ALT) and alpha-fetoprotein (AFP) in the treatment group was significantly higher than that in the control group (P<0.05); and the two groups After treatment, the HBV DNA copy number and AFP expression level of the patients were significantly decreased compared with before treatment (P<0.05), and the decline in the treatment group was significantly better than that of the control group (P<0.05). After 12, 24 and 48 weeks of treatment, the elasticity index of liver and spleen and portal vein diameter of the two groups were significantly decreased (P<0.05), and the decrease of the treatment group was significantly better than that of the control group (P<0.05). No serious adverse reactions occurred in the two groups of patients during treatment, and there was no significant difference in the incidence of adverse reactions such as mild nausea, insomnia, dizziness, and abdominal discomfort in the two groups (P>0.05). Conclusion Ganning tablets combined with Entecavir has a significant clinical effect in the treatment of hepatitis B with elevated alpha-fetoprotein. It can significantly reduce liver inflammation and fibrosis, improve hepatocyte proliferation and spleen elasticity index, and promote liver function recovery.

Analysis of HIV infection and risk factors among men who have sex with men in Wanzhou, Chongqing Liu Xin, Chen Yonghong, Chen Ruihua, Tian Bing, Zhao chun'e 2021, 6 (4):  343-347.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.018 Abstract ( 338)    PDF (888KB) ( 1211 )    Objective To investigate the HIV infection among men who have sex with men (MSM) in Wanzhou, Chongqing, and analyze its risk factors. Methods From January to December 2020, 349 men with same-sex sexual behavior of oral or anal sex within one year were recruited in Wanzhou, Chongqing were recruited through peer introduction, social organization outreach intervention and referral, QQ group, wechat group and other social platforms. Collect the factors that may affect the HIV infection of MSM population through questionnaire, take blood test for all respondents, and divide the respondents into HIV positive group and HIV negative group according to the HIV infection.The factors collected by the questionnaire were compared between the two groups of survey subjects, and the multi-factor Logistic regression analysis was used to determine the comprehensive impact of each factor on the HIV infection in the MSM population. Results 349 questionnaires were distributed and 342 valid questionnaires were recovered, with a recovery rate of 97.99%. A total of 21 people (6.14%) were diagnosed with HIV infection. Multivariate Logistic regression analysis showed that age（OR=1.436,95%CI=1.015~2.032）, drinking history（OR=1.446,95%CI=1.053~1.987）, drug use history（OR=1.517,95%CI=1.081~2.130 ）, sex role No.0（OR=1.536,95%CCI=1.129~2.089）, occasional condom use or no condom use in recent 6 months（OR=1.505,95%CI=1.075~2.109）, commercial sex history in recent 6 months（OR=1.465,95%CI=1.040~2.065）, sexual history（OR=1.670,95%CI=1.165~2.396）, number of sexual partners >1（OR=1.525,95%CI=1.045~2.226）, and use of booster（OR=1.507,95%CI=1.042~2.178）were risk factors for HIV infection among MSM in Wanzhou, Chongqing (P<0.05). Conclusion The HIV infection rate of MSM population in Wanzhou, Chongqing is high. The HIV infection of this population is mainly affected by age, education level, drinking history and other factors. Targeted intervention can be carried out according to the above factors to reduce the HIV infection rate of MSM population.

Case Report

Mycobacterium chelonii disease misdiagnosed as tuberculosis and leprosy misdiagnosed as non tuberculous mycobacterial disease-case analysis Yue Wuyang, Guo Yan, Li Tongxin, Yang Song, Guo Jianqiong 2021, 6 (4):  348-351.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.019 Abstract ( 542)    PDF (950KB) ( 848 )    Microscopic examination of acid-fast bacilli (AFB) smears is the main diagnostic technique for diagnosing Tuberculosis (TB) in most countries. However, AFB smear positive will cause misdiagnosis if it is used alone. We retrospective analyzed and summarized the treatment process of Mycobacterial disease of tortoise, which has long been misdiagnosed as tuberculosis and leprosy misdiagnosed as non-tuberculous mycobacterial pulmonary disease (NTM-PD), using the two generation sequencing technology combined with other tests simultaneously. What’s more, timely conduct mycobacterium culture and strain identification to diagnose the disease and change treatment process. Provide help for clinical treatment and avoid missed diagnosis, misdiagnosis and mistreatment.

Review

Construction and research of the nucleic acid testing laboratory biosafety intelligent management system Li Wansha, Shao Kunning, Liu Jingzhe 2021, 6 (4):  352-355.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.020 Abstract ( 449)    PDF (992KB) ( 965 )    Confronting the spread of the coronavirus pandemic, it is urgent to enhance the ability of biosafety management for the nucleic acid testing laboratory in China. In this paper, we aim to establish the laboratory biosafety intelligent management system(LBIMS), which can solve the two main tasks in the biosafety management: biosafety monitor and biosafety risk assessment. The structure of LBIMS adopts the model of the intelligent laboratory based on the internet of things, with three layers-- perception layer, transport layer, processing layer. The important content is to research the risk assessment for the laboratory biosafety and to establish the risk assessment model in the LBIMS.

Research progress of the impact of COVID-19 on AIDS patients worldwide Zhan Xiangming, Lu Hongzhou 2021, 6 (4):  356-360.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.021 Abstract ( 590)    PDF (890KB) ( 831 )    The coronavirus disease 2019 is spreading all over the world, triggering a global crisis of medical and health resources, and leading to the reduction or interruption of HIV prevention and treatment services. Studies by many countries and health institutions have pointed out that HIV infection is not directly related to the poor prognosis of COVID-19 but indirectly causes difficulties in obtaining medical resources for HIV positive patients, inadequate antiretroviral treatment, and decline in mental health. As a result, the infection and fatality rate of some HIV positive people in COVID-19 have increased. The reason may be related to the epidemic prevention policies of various countries. This article reviews the impact of COVID-19 on the infection and fatality rate of HIV positive people, the existing problems of HIV positive individuals during the COVID-19 epidemic, and current recommendations and countermeasures. It is expected to provide reference for PLWH in the prevention and treatment of COVID-19.

Research progress on HIV-associated sensory neuropathy Chen Yao, Han Yakun, Wu Qiang, He Renliang 2021, 6 (4):  361-367.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.022 Abstract ( 431)    PDF (900KB) ( 852 )    Sensory neuropathyis a common complication in people living with human immunodeficiency virus. Currently, a great number of patients cannot get effective treatment due to the clinicians have insufficient understanding of the clinical manifestation and mechanism of HIV-associated sensory neuropathy (HIV-SN)and lack of treatment methods. This paper reviews the progress of the risk factors, mechanisms and treatment of HIV-SNin order to improve the diagnosis and treatment of HIV-SN.

Education Fields

The global tuberculosis report 2021: key data analysis for China and the global world Lu Chunrong, Fang Hongxia, Lu Puxuan, Ji Lecai 2021, 6 (4):  368-372.  DOI: 10.19871/j.cnki.xfcrbzz.2021.04.023 Abstract ( 1521)    PDF (991KB) ( 3703 )    The global tuberculosis(TB) report 2021 provides a comprehensive overview of the global situation of TB, the impact of Coronavirus disease 2019(COVID-19) pandemic on TB control, the progress in achieving TB milestones, diagnosis and treatment. The report shows that worldwide, an estimated 9.9 million people fell ill with TB in 2020, equivalent to 127 cases per 100 000 population, but only 5.8 million cases were notified in 2020. That were 4.1 million cases off estimate. Best estimates for 2020 are 1.3 million TB deaths among HIV-negative people and an additional 214 000 among HIV-positive people, with the number of deaths increasing and the incidence of the disease declining slowly. The 2021 Report suggests that our progress towards achieving TB milestones and targets had been hit hard by the COVID-19 pandemic. It will be have a more adverse effect in 2021 and later. It is an urgent need to take action, such as recover the accessibility of basic service of TB, increase the application and popularization of the technology of digital health, increase investment in capital and research for TB services, and try our best to reduced reverse the adverse impact of the COVID-19 pandemic on TB. We strive to realize the beautiful vision of “a world free of TB” as soon as possible!