Current Issue

2018 Vol.3 No.1 Published:28 February 2018

Forum of Specialist

Plagues outbreak in Madagascar, Africa: the importance of plague prevention YAN Xiao-feng, YANG Song 2018, 3 (1):  1-4.  Abstract ( 565)    PDF (535KB) ( 1283 )    Undoubtedly,along with the rapid developments of economy, science and technology in China,plague is preventable and curable and its pandemic like historic catastrophic events can hardly reappear. However, an outbreak of plague occurred recently in Madagascar, Africa. In addition, the globalization of economic,tourism and cultural exchanges is accelerating as well as pet breeding and wild animals preying. Due to these facts, we should raise our awareness about the necessity and urgency of plague prevention in the long-run and the preventive measures must never be relaxed. In this article, the authors briefly introduces the epidemic of plague in Madagascar, Africa and the history and current situation of plague epidemics in the world and China.The authors further proposes strategies for the control and prevention of plague in China,including further understanding about the hazards of plague,strengthening animal entry and exit quarantine,extensively launching patriotic health campaign and Enhancing personal protection. The measures are for implementation of early ditection,early report,early diagnosis, early intervention and early quarantine.

Reflections on influenza epidemic in the USA LI Hang, LU Zhi-yan 2018, 3 (1):  5-7.  Abstract ( 278)    PDF (530KB) ( 788 )    Influenza epidemic in the latest season in the USA is the most serious one in recent 10 years. And in China, the latest influenza epidemic is more serious than those in past 3 years. In this article, the authors briefly introduce the epidemics of influenza in both the USA and China and analyze the main causes of serious epidemic of influenza in the USA. Due to the important role of radiological examinations in the diagnosis and therapeutic efficacy assessment of influenza pneumonia, we also review the imaging demonstrations of type A influenza pneumonia, including the most common ground glass opacity and consolidation opacity and the common findings of lobular septal thickening and pleural effusion as well as cords like opacity after lesion absorption. The latest influenza epidemic indicates that promotion of influenza vaccination is necessary. Meanwhile, medical and health institutions of all levels should exert their own responsibilities and more health education campaigns are needed.

Original Articles

Distribution of enterovirus genotypes in different populations and their pathogenic risk analysis QIU Fang-zhou, SHEN Xin-xin, YAN Teng-fei, ZHOU Shuai-feng, ZHANG Yi, WANG Ji, HE Xiao-zhou, YANG Meng-jie, FENG Zhi-shan, MA Xue-jun 2018, 3 (1):  8-11.  Abstract ( 414)    PDF (565KB) ( 530 )    Objective To analyze the c distribution of enterovirus genotypes in healthy children, children with diarrhea, children with hand foot and mouth disease and children with encephalitis and meningitis and to assess their pathogenic risks. Methods Totally 273 fecal specimens of diarrhea group, 361 fecal specimens of healthy group from Hebei province, 320 fecal specimens from hand-foot-and-mouth disease group and 105 cerebrospinal fluid (CSF) samples of encephalitis meningitis group, 182 fecal specimens of healthy group from Hunan province were examined by real-time nested RT-PCR (RTN RT-PCR) assay in a single closed tube. The positive samples were further sequenced to determine the genotype of the enterovirus for analysis. Results The positive rate in 361 fecal specimens from healthy group of Hebei province was 16.34% (59/361). The 273 fecal specimens of diarrhea group showed a positive rate of 18.68% (51/273). The 320 fecal specimens of hand-foot-and-mouth disease group from Hunan showed a positive rate of 85.31% (273/320). The 105 CSF samples of encephalitis meningitis group had a positive rate of 24% (25/105). And the positive rate of 182 fecal specimens of healthy group was 18.68% (34/182). The positive rates in the 5 groups were statistically significant (χ2=466.4, P<0.0001). Conclusion The distribution of enterovirus in 5 different populations is different. Statistical analysis indicates that RV is a risk factor of diarrhea. EV71 and CVA are highly correlated with hand-foot-and-mouth disease. EV71 is correlated to encephalitis meningitis.

Clinical analysis of 95 adult tuberculous meningitis FENG Jun, YAN Xing-yan, WEN Jiang-xiong, SHI Bai-ru, WU Xiao-ping 2018, 3 (1):  12-14.  Abstract ( 264)    PDF (533KB) ( 816 )    Objective To explore the early clinical features of tuberculous meningitis as well as the laboratory tests and imaging demonstrations so as to improve the diagnosis of the disease. Methods The clinical data of 95 cases who were firstly diagnosed with tuberculous meningitis in our hospital from January 2012 to September 2017 were retrospectively analyzed. Results The presenting symptoms included fever, headache, nausea, vomiting and meningeal irritation. Cerebrospinal fluid examination revealed increased count of nucleated cells with predominating lymphocytes, increased level of protein, decreased levels of sugar and chloride. The peripheral blood T-SPOT was positive in 56% of the cases. Brain imaging commonly demonstrated meningeal enhancement, cerebral infarction, hydrocephalus and tuberculoma. A total of 82 patients showed improved condition after treatment, and the condition of 12 patients deteriorated. Death occurred in 1 case. Conclusion Adult tuberculous meningitis is more common in middle-aged and elderly population. The clinical manifestations and , cerebrospinal fluid changes are non-specific. Etiological examinations show a low detection rate. And early diagnosis and timely treatment play important role in improving the prognosis of the disease.

Pneumocystis jiroveci pneumonia in AIDS: the correlation between SLDH and CT quantitive score of exudative lesion XIE Hao-feng, HUANG Xiang, ZHENG Xiao-lin, ZHONG Qing-yang, ZOU Yu-jian, YIN Si-chun 2018, 3 (1):  15-20.  Abstract ( 255)    PDF (884KB) ( 609 )    Objective To investigate the correlation between absolute value of serum lactic dehydrogenase(SLDH) and CT quantitative score of exudative lesion of Pneumocystis Jiroveci pneumonia(PJP) complicating AIDS and to evaluate the clinical value of the CT quantitative scoring in severity assessment and the outcome prediction. Methods A total of 88 cases suffering from AIDS complicated by PJP were selected from 142 patients and their chest CT scans were retrospectively analyzed. The CT quantitative scores were obtained based on the extent and density of the exudative lesion. Their correlation with the in-sync absolute value of SLDH was statistically analyzed. Furthermore, the 88 cases were divided into non-respiratory failure group(Group A) and respiratory failure group(Group B) based on their outcome. The beween groups difference analysis was conducted in terms of CT quantitative scores and corresponding SLDH. The threshold value was predicted by ROC analysis. Results Significant positive correlations between the extent, density and CT quantitative scores of the exudative lesion and the in-sync SLDH were shown(P<; 0.01), with coefficients of 0.59, 0.68 and 0.79, respectively; Significant differences were shown in terms of each CT quantitative score and in-sync absolute value of SLDH between Group A and B, with data of Group A being significantly lower than those of Group B (P<; 0.05); The CT quantitative scores were proved to be the most accurate predictor for respiratory failure, with a Youden index of 0.81, the area under the curve(AUC) of 0.95 and the prediction threshold of 79.9. Conclusion The CT quantitative scores of exudative lesion of PJP complicating AIDS can provide Objective , accurate and reliable data for early assessment of severity and the outcome prediction, which has significant value in clinical practice.

Magnetic resonance imaging demonstrations of neurosyphilis QIN Zhuan-li, LIANG Xin-ming, FAN Yan-long, PAN Gao-zheng, FU Mao-lin 2018, 3 (1):  21-24.  Abstract ( 343)    PDF (936KB) ( 1109 )    Objective To analyze the clinical manifestations of different types of neurosyphilis and their MRI demonstrations. Method A retrospective analysis of 21 cases of neurosyphilis admitted in Xuchang Municipal Hospital and Nanyang Central Hospital was conducted. Results All the 21 cases of neurosyphilis was demonstrated with abnormalities by MRI. There were 17 cases of brain parenchymal type, 2 cases of meningeal vascular type, and 2 cases of gumma type. The 17 cases of brain parenchymal type were demonstrated with bilateral temporal lobe atrophy, multiple abnormal signals in the temporal lobe, frontal lobe, insular lobe, and occipital lobe. No obvious diffusion restriction was found by diffusion weighted imaging (DWI). The 2 cases of meningeal vascular type were demonstrated with multiple acute infarction with basilar artery stenosis in one case and multiple acute infarction in the other. The 2 cases of gumma type were demonstrated by MRI with intracranial multiple nodular enhancement with adjacent meningeal enhancement. Conclusion The MRI demonstrations of neurosyphilis are diversified. Although no specific MRI demonstrations is found, they can suggest neurosyphilis when similar demonstrations are radiologically found. Therefore, serological tests can be further ordered for early diagnosis and intervention.

MRI demonstrations of meningeal vascular type of neurosyphilis LIU Ren-wei, FANG Jin-zhi, ZHANG Yu-zhong 2018, 3 (1):  25-29.  Abstract ( 782)    PDF (701KB) ( 1134 )    Objective To analyze the MRI imaging demonstrations of meningeal vascular type of syphilis (MVTS) so as to improve the diagnosis of the disease. Methods We retrospectively collected and analyzed MRI data of 6 cases of MVTS. All the cases were definitely diagnosed by cerebrospinal fluid examination and serological test. Results FLAIR sequencing demonstrated MVTS as multiple high signals of small nodular opacity in subarachnoid space or on the surface of the pia mater, accompanied by the adjacent pia mater and gyrus swelling and narrowed sulcus. Meningeal gumma could be accompanied by multiple nodular granuloma of syphilis in the brain, which was demonstrated as corolla-like enhancement. The granuloma of brain syphilis was shown with annular or nodular enhancement; Reexamination by FLAIR sequence revealed enlarged lesions range with high signal in the brain. DWI showed gradually decreased range of slightly high signal. FLAIR and DWI showed the transformation of lesions from cytotoxic brain edema to vasogenic brain edema. Conclusion MRI demonstrations of MVTS are diverse. However, MRI still plays important role in definitive diagnosis of MVTS.

Pan-genotype DAA for treatment of chronic hepatitis C FU Xiao-yi, JIN Xian, XU Xiao-jing, PENG Yan-zhong 2018, 3 (1):  30-33.  Abstract ( 545)    PDF (539KB) ( 702 )    Objective To observe the therapeutic efficacy and side effects of pan-genotype DAA (sofosbuvir+velpatasvir) in the treatment of chronic hepatitis C. Methods After the informed consent was obtained from the patients, 46 cases of chronic hepatitis C that met our recruitment criteria and were inpatients or outpatients in our hospital from 2015 to 2017 were selected as the treatment group. Other 46 cases of chronic hepatitis C receiving interferon therapy were selected as the control group. The treatment group was treated with pan-genotype DAA for 12 weeks,while the control group received short-acting interferon combined with ribavirin. The therapeutic efficacy and side effects were then compared. The comparison of therapeutic efficacy ts was evaluated by Chi-square test. Results At week 12, the HCV-RNA negative rates of the treatment group and the control group were 93.47% and 50%, respectively, with the difference being statistically significant (χ2=115.565, P<0.001). The side effects of the treatment group were less than those of the control group. In the treatment group, the negative rates of HCV-RNA in gene type 1, 2, 3, 6 were 100%, 100%, 77.78%, and 100%, respectively. Conclusion In the treatment of chronic hepatitis C, pan-genotype DAA has a favorable curative effect and less side effects, with the negative conversion rates being 100% except for genotype 3. However, its therapeutic efficacy needs further prove by large scale randomized trial.

Clinical imaging analysis of inactive tuberculosis complicated by pulmonary aspergillosis ZHENG Guang-ping, ZHANG Qian-qian, TAN Wei-guo, DENG Qun-yi, CHEN Pei-fen, SU Dong-na, YU Wei-ye, WU Shi-pin, LU Pu-xuan 2018, 3 (1):  34-36.  Abstract ( 591)    PDF (1013KB) ( 917 )    Objective To investigate the imaging findings of non-active pulmonary tuberculosis complicated by pulmonary fungal infection, and to provide evidence for its early diagnosis. Methods A total of 20 cases were collected based on the recruitment criteria, including 14 males and 6 females. Their clinical imaging data were retrospectively analyzed. Results The history of pulmonary tuberculosis ranged from 9 months to 31 years, with a mean of 10.6 years. The presenting symptoms included cough, expectoration and hemoptysis. As for pulmonary aspergillosis, 13 cases were diagnosed with aspergilloma; 4 cases with chronic necrotizing pulmonary aspergillosis; 2 cases with chronic cavitary aspergillosis and 1 case with chronic fibrosis of pulmonary aspergillosis. The lesions of pulmonary aspergillosis were commonly located at the apicoposterior segment of the upper lobes of both lungs, dorsal segment of the lower lobes of both lungs, which were consistent with that of pulmonary tuberculosis. The imaging demonstrations included singular or multiple heterogenous mass opacity, cavitary opacity, and air crescent opacity. Meanwhile, fibrous cords like opacity of old tuberculosis lesions were demonstrated in the lungs. Conclusion As for inactive pulmonary tuberculosis complicated by pulmonary aspergillosis, 60% of the cases are definitely diagnosed at 4 years after tuberculosis infection. Aspergilloma is the most common pulmonary aspergillosis complicating inactive pulmonary tuberculosis. CT scan demonstrations include heterogenous mass opacity and air crescent opacity at upper lobes of both lungs, occasionally accompanied by fibrous cords like opacity of old tuberculosis lesions.

Detection of KRAS and BRAF gene mutations in primary hepatocellular carcinoma and its clinical significance WU Yu-mei, LUO Zi-yi, HUANG Hua 2018, 3 (1):  37-40.  Abstract ( 670)    PDF (539KB) ( 733 )    Objective To study the expression and clinical significance of KRAS and BRAF mutations in primary hepatocellular carcinoma (HCC), and analyze their relationship with disease development. Methods 126 cases of HCC patients treated in our hospital from January 2016 to May 2017 were enrolled in this study. Among them, 62 cases of patients with primary HCC accompanied by extrahepatic metastasis (the study group), 64 cases of patients with focal liver lesions (the control group). All patients were drawn on the day of admission for treatment of fasting 10ml peripheral blood samples from the blood free DNA, the application of KRAS / NRAS gene mutation detection kit, human BRAF gene V600E mutation detection kit KRAS, BRAF gene mutations, The gene mutation rate, mutation clinical features were analyzed. Results In 126 patients, KRAS mutation was found in 15 cases. The mutation rate of KRAS gene with extrahepatic metastasis was 24.2% (15/62), but the rate of non-extrahepatic metastasis was 0.0% (0/64). The mutation rate of KRAS gene in patients with extrahepatic metastasis was significantly higher than that in patients without extrahepatic metastasis, the difference was statistically significant (P <0.05). It is suggested that there is a significant correlation between KRAS gene mutation and extrahepatic metastasis of hepatocellular carcinoma. No mutation of BRAF gene was detected in 126 cases. Conclusion There was a significant mutation of KRAS gene in patients with hepatocellular carcinoma, and a significant increase of KRAS gene mutation rate in patients with hepatocellular carcinoma and extrahepatic metastasis. No mutation of BRAF gene was detected or the rate of BRAF gene mutation was lower.

Continual irrigation of tuberculosis lesions in patients with spinal tuberculosis complicated by paravertebral abscess YUAN Shan-you, MA Ke, LUO Zi-yi 2018, 3 (1):  41-44.  Abstract ( 363)    PDF (536KB) ( 859 )    Objective To assess the therapeutic efficacy of continual irrigation of tuberculosis lesions in patients with spinal tuberculosis complicated by paravertebral abscess. Methods A total of 60 patients with spinal tuberculosis complicated by paravertebral abscess had been admitted to our hospital from September 2013 to November 2017. All the patients were randomly divided into a study group and a control group. The 30 patients in the study group were treated with continual irrigation of lesions, while the 30 patients in the control group received conventional drainage for treatment. The two groups of patients were compared in terms of mean body temperature within 7 days after the operation, postoperative complications as well as pre- and post-operative erythrocyte sedimentation rate (ESR) . Results The body temperature of the study group decreased gradually within 7 days after the operation, while the body temperature of the control group showed fluctuation within 7 days after the operation. The body temperature of the study group was lower than that of the control group, and the difference was statistically significant (P<0.05). The body temperature showed no significant difference between the two groups at different time points (P>0.05). The pre-operative ESR showed no significant difference between the two groups (P>0.05). At post-operative d 20, the ESR of both groups decreased significantly, compared with that before the operation (P<0.01), while the difference between the two groups showed no statistical significance (P>0.05). The incidence of postoperative complications in the study group was significantly lower than that in the control group (3.33% vs 26.67%, P<0.05). Conclusion Continual irrigation of tuberculosis lesions in patients with spinal tuberculosis complicated by paravertebral abscess can effectively reduce the body temperature of patients within 7 days after operation and the incidence of postoperative complications, which should be promoted for wider clinical application.

New disease report

CT scan demonstrations of the globally first case of human infected avian influenza virus (H7N4) pneumonia JIN Qiu-yan, ZHANG Lu-xi, YANG Lei, XU Li-na, YUN Jia, ZHOU Jian-hua, PAN Feng, XUE Feng, XU Tian-min, WU Jin-ping 2018, 3 (1):  45-48.  Abstract ( 478)    PDF (1228KB) ( 812 )    Objective To investigate the CT scan demonstratons of the globally first case of human infected avian influenza virus (H7N4) pneumonia. Methods The clinical data and CT scan demonstrations of the globally first case of human infected avian influenza virus (H7N4) pneumonia were observed and analyzed．Results The first CT scan demonstrated consolidation opacity in the right lower lung lobe, which rapidly progressed into laminar consolidation opacity and ground glass opacity (GGO) in both lower lung lobes and patchy GGO in both upper and middle lung fields. After treatment, no new lesions were demonstrated. The intrapulmonary patchy GGO was absorbed and the consolidation opacity in both lower lung lobes shrank. Conclusion The main CT scan demonstrations of the globally first case of H7N4 virus pneumonia include consolidation opacity in both lower lungs, multi-lobes and multi-segment GGO in both lungs. After anti-viral treatment by Oseltamivir, the lesions are demonstrated to be absorbed. And CT scan plays important role in observing the dynamic changes of pneumonia lesions and assessing therapeutic efficacy.