Current Issue

2016 Vol.1 No.1 Published:30 November 2016

Forum of Specialist

Current situation and challenge of clinical research on Zika ZHANG Fu-chun, ZHAO Ling-zhai 2016, 1 (1):  1-5.  Abstract ( 274)    PDF (924KB) ( 727 )    Zika is an emerging mosquito-borne acute infectious disease caused by Zika virus (ZIKV) that was first isolated from a rhesus monkey in Uganda in 1947.The first human case of ZIKV infection was confirmed in 1952.In May 2015,the public health authorities of Brazil confirmed the first case of indigenous transmission of ZIKV,and then the number of Zika cases exceeded one million over the next few months companied by a sharp increase of microcephaly in newborns and Guillain-Barre syndrome in adults.Therefore,Zika virus infection had been declared as a public health emergency by the World Health Organization on February 1,2016.The symptoms are similar to flu and include fever,skin rashes,conjunctivitis and so on.Diagnosis of ZIKV infection is relied on recent epidemic history,clinical symptoms and laboratory tests on blood or other body fluids,such as urine or saliva.There is currently no vaccine or drug available.Protection against mosquito bites is a key measure to prevent ZIKV infection.Vaccine is the most effective way to control ZIKV epidemic.

Epidemiological studies of Zika virus disease XIE Xu, CHENG Cong 2016, 1 (1):  6-9.  Abstract ( 288)    PDF (817KB) ( 901 )    Zika virus disease is an acute self-restricted infectious disease caused by Zika virus and propagated by mosquito vectors.Till now,there is no specific vaccine and effective medicine.The data of this paper was collected from the database Medline and Wanfang to summarize the epidemiological characteristics of Zika virus.The useful information about Zika infection in recent 5 years was studied to provide references for diagnosis and prevention.As a matter of fact,there are still lots of problems to be resolved and more attention should be paid to understand comprehensively about the epidemiological characteristics and mechanism of Zika infection.

Research progress of Zika virus WU Chun-li, YANG Fan, ZHANG Ren-li 2016, 1 (1):  10-13.  Abstract ( 270)    PDF (1045KB) ( 610 )    The most serious outbreak of Zika virus in history have been reported in South America from 2015 to 2016.During the epidemic,a significant increase of neonatal microcephaly and Guillain-Barré syndrome patients triggered a global concern.Zika virus belongs to the family Flaviviridae,genus Flavivirus.The epidemic viruses in South America were Asia subtype strains.The primary transmission route of Zika virus is via the Aedes mosquito.However,mounting evidence has shown that sexual transmission of Zika virus is more common than previously assumed.Zika virus disease usually has no symptoms or mild symptoms.But Zika virus in pregnant woman can infect the fetal nervous system,which could result in brain malformation.Nucleic acid detection is the primary method to detect the virus in laboratory.It has been detected in the blood,urine,semen,saliva and other body fluids by the method. There is no vaccine available till now and the current most effective way to prevent Zika virus infection is still prevention of mosquito bites.Pregnant women and couples planning a pregnancy must strengthen the personal protection,to avoid serious consequences of Zika virus infection.

Nervous system injury and neuroimaging finding of Zika virus infection GAO Bo, ZENG Yu 2016, 1 (1):  14-17.  Abstract ( 547)    PDF (1197KB) ( 870 )    Recently,Zika virus disease is prevalent in the global.WHO declared that Zika virus was of global public health importance in 2016.The major threat to human health is that Zika virus infection leads to nervous system injury,including microcephaly and Guillain-Barre syndrome.The neuroimaging finding of the microcephaly with Zika virus infection most commonly include brain calcifications in the junction between cortical and subcortical white matter associated with abnormalities of cortical.Additional findings include diminution of white matter,large ventricles with or without hydrocephalus,cortical malformations,brain calcification,hypoplasia of the cerebellum and the brainstem,cerebellomedullary cistern enlargement and so on;the Guillain-Barre syndrome is mainly contrast enhancement of the nerve.This review describes the nervous system injury and imaging findings of Zika virus infection,in order to improve the imaging understanding and control of this disease.

Original Articles

A descriptive study of the global first case of pneumonia caused by human-infected avian influenza virus H9N2 HOU Wen-zhong, ZHANG Qian-qian, LUO Cai-mei, LU Pu-xuan 2016, 1 (1):  18-22.  Abstract ( 285)    PDF (1476KB) ( 903 )    Objective To discuss the imaging features of pneumonia caused by human-infected avian influenza virus H9N2. Methods A descriptive study was carried out on a case of pneumonia caused by human-infected avian influenza virus H9N2 in Meizhou,Guangdong Province,on June 18,2016. Results The patient was a child with cough, and white phlegm was detected followed by yellow sticky sputum,accompanying with fever. Imaging features included exudative patchy ground glass opacity,and pulmonary fibrosis was visible during the recovery period.The patient was discharged from hospital after antiviral and symptomatic treatments. Conclusion For pneumonia caused by human-infected avian influenza virus H9N2,except for the symptoms of influenza,exudative focus was present in bilateral lung CT images.Clinicians should consider the possibility of viral infection in children who had contact history with poultry and got fever and pulmonary infection.Early diagnosis and antiviral therapy are important to improve the prognosis.

Epidemic investigation and analysis of school tuberculosis in Shenzhen during 2014 LV De-liang, YANG Ying-zhou, TAN Wei-guo, Li Xue-ying, WU Qing-fang, GUAN Hong-yun, CHE Xiao-ling 2016, 1 (1):  23-26.  Abstract ( 234)    PDF (930KB) ( 625 )    Objective To investigate the epidemiology of school tuberculosis in Shenzhen,so as to provide scientific evidence for improving the prevention and control strategy of school tuberculosis. Methods Data of school tuberculosis cases in 2014 was gathered from China Information System for Disease Control and Prevention and Shenzhen weekly monitoring reports for school tuberculosis,which was used for the analysis of epidemiology and morbidity of school tuberculosis in Shenzhen. Results Totally,234 school tuberculosis patients were diagnosed during 2014 and enrolled in this study,including 202 cases of students which accounted for about 86.3%.The positive rate of sputum in students(about 34.7%) was lower than that in the faculty members(about 56.3%),with χ2=5.491 and P=0.019.Detailed data of 5.1%(12/234) patients were not obtainable,and 21.8%(44/202) student patients came from other city.The students were mainly infected during the period of school,and less infected during the winter and summer holidays or during the holidays after the college entrance examination. The faculty members were mainly infected during the latter half of the year,accounting for about 68.8% (22/32).The reported incidences of pulmonary tuberculosis in students and teachers were about 7.7/100 000 and 20.4/100 000,which was much lower than the reported incidence in whole population (about 46.6/100 000). Conclusion Although the epidemic level of tuberculosis in Shenzhen city is low,the prevention and control strategy should be strengthened,especially in surveillance and case reporting.Furthermore,the national coordination mechanism and full-coverage comprehensive strategy on the prevention and control of school tuberculosis should be established to avoid its unexpected outbreaks in schools.

MRI findings of toxoplasmic encephalitis in AIDS patients and its value in prognostic prediction YAN Shuo, LI Jing-jing, XIE Ru-ming 2016, 1 (1):  27-30.  Abstract ( 278)    PDF (964KB) ( 848 )    Objective To evaluate the value of MR in diagnosis of toxoplasmic encephalitis. Methods A retrospective study of 17 AIDS patients with toxoplasmic encephalitis who underwent MRI examination.MR findings of these patients were described.According to the changes of the central nervous system symptoms after treatment,the cases were divided into two groups,including a group with favorable outcomes(n=10) and another group with poor outcomes(n=7). Results ① Multiple-lesion was a common finding for toxoplasmic encephalitis.② Lesions distributed diffusely,could be detected in both supratentorial and subtentorial areas, and could be most commonly found in both the boundary area of cortex and medulla,and the thalamus-basal ganglia area.③ The majority of lesions presented as nodules,with wide edema.④ Lesions were mainly of hypo intensity on T1WI images and hyper intensity on T2WI images.The opposite signal intensity could be detected in certain lesions with hemorrhage.On contrast enhanced images, the lesions showed ring-like enhancement.Target sign can be detected on T2WI, FLAIR and contrast enhanced images.⑤ Oversize and hemorrhage might be signs for poor outcome according to the statistical analysis(χ2=14.405 and 14.912,respectively,P<0.05). Conclusion MR is important in diagnosis of toxoplasmic encephalitis in AIDS patients,and some signs may indicate poor prognosis.

MRI manifestations of meningovascular neurosyphilis ZHU Jing-fen, LI Long-gang 2016, 1 (1):  31-34.  Abstract ( 282)    PDF (983KB) ( 1258 )    Objective To analyze MRI manifestations of meningovascular neurosyphilis,so as to improve its early diagnosis by combination of clinical examinations and laboratory tests. Methods MRI data of 9 patients with meningovascular neurosyphilis were enrolled,with all patients were negative in HIV test.Except for 1 patient who underwent MRI head plain scan,the others were all examined by MRA. Results 7/9 patients were male.The disease started in an acute or subacute way and the main clinical manifestations were paresis,headache,lalopathy,cognitive disorder or any combination of them.The MRI manifestations of meningovascular neurosyphilis included:(1)cerebral atrophy, which could be symmetrical or asymmetrical.(2)cerebral infarction,which could be of multiple locations, and multiple lesions,with varied focal ranges and onset times;(3)cerebrovascular stenosis,which could be of multi-segmental stenosis with bilateral asymmetry,and the proximal part of the arteries was vulnerable to be involved. Conclusion MRA is able to evaluate the cerebral vascular involvement non-invasively.Once a young patient without high risky factors of stroke is manifested as cerebral atrophy,infarction and intracranial vascular stenosis in MRI and MRA,tests of syphilis antibody in serum and cerebrospinal fluid should be carried out as soon as possible,so as to improve the prognosis.

Research of Paeonol affect α-SMA expression in hepatic stellate cells QIU Zhi-hui, ZHANG Fu-ping, ZHANG Jie-yun, LIN Jing-yan, PAN Dong-ming, ZHANG Guo-liang, WANG Wen-fei, ZHANG Ming-xia 2016, 1 (1):  35-37.  Abstract ( 292)    PDF (911KB) ( 761 )    Objective This paper intends to study the effect of paeonol on hepatic stellate cells activation and collagen synthesis,and further indicate the mechanism of inhibiting liver fibrosis,so as to provide new ingredients of the clear Chinese herbal monomer for anti-hepatic fibrosis. Methods In this study,TGF-β was used to stimulate and culture human hepatic stellate cells. Observing the effects of paeonol on hepatic stellate cell phenotype transformation and collagen synthesis to investigate the influencing mechanism of paeonol on anti-fibrosis in vitro.Real time fluorescence quantitative PCR and Western Blotting were utilized to detect the hepatic stellate cellular α-SMA mRNA expression,which can further clarify the effect of paeonol on hepatic stellate cell phenotype conversion in the case of TGF-β stimulation.Hydroxyproline assay method was used to detect the total collagen expression of cell culture supernatant. Results TGF-β stimulation inceased the a-SMA gene expression,and subsequently,adding different concentrations of paeonol decreased the a-SMA gene expression.The a-SMA gene expression had a certain dependency uponpaeonol dose. Hydroxyproline content in the hepatic stellate cell culture supernatant increased significantly in the case of TGF-βstimulation,and significantly decreased after adding different concentrations of paeonol. Conclusion TGF-βstimulation makes a positive effect on a-SMA gene expression,while the adding of paeonol has a negative effect.Paeonol may promote the fibrosis of hepatic stellate cell.Hydroxyproline content in the hepatic stellate cell culture supernatant increased significantly in the case of TGF-β stimulation,indicating an increase of hepatic stellate cells collagen synthesis.

Neuroimaging of HIV-associated cryptococcal meningoencephalitis:comparison of magnetic resonance imaging findings in patients with and without highly active antiretroviral therapy LI Hang, WANG Ming-yue, LU Zhi-yan 2016, 1 (1):  38-41.  Abstract ( 444)    PDF (990KB) ( 661 )    Objectives To analyze the magnetic resonance imaging(MRI) findings of HIV-associated cryptococcal meningoencephalitis and explore the difference between patients with and without highly active antiretroviral therapy(HARRT). Methods The MRI and clinical data of HIV-associated cryptococcal meningoencephalitis in 13 patients were retrospectively analyzed.The enrolled 13 patients were divided into 2 groups.There were 4 patients in the HARRT-group and 9 patients in the non-HARRT-group.Their cranial MRI characterizations and differences were detected and analyzed between the 2 groups. Results In the HARRT-group(n=4),typical focal meningeal enhancement(n=2,50%),parenchymal granuloma (n=2,50%) and parenchymal focal lesions or/and cerebral ischaemia（n=4,100%）were detected.In the non-HARRT-group(n=9),pseudocysts or/and dilated V-R(Virchow-Robin) spaces(n=7,77.78%),parenchymal lesions or/and cerebral ischaemia(n=6,66.67%) and granulomatous lesions(n=1,11.11%) were detected,while no contrast-enhancement focal meningeal lesions were detected. Conclusions The MRI characteristics of patients with HARRT were the typical focal meningeal enhancement and parenchymal granuloma.However,the specific MRI findings of patients without HAART were pseudocysts and dilated V-R spaces that concentrated in the bilateral basal ganglia.

Effects of different viral loads on transmission of mother to child in pregnant women with Hepatitis B virus infection CAI Qiu-e, WANG Miao, CHEN Li-yun, WAN Jian-yu, CHEN Shao-ping 2016, 1 (1):  42-44.  Abstract ( 283)    PDF (913KB) ( 920 )    Objective This study aimed to investigate the effects of reducing the rate of vertical transmission via risk assessment and intervention treatment based on the evaluation of HBV infection management during pregnancy. Methods Analysis was conducted to review 560 HBV-infected pregnant women who attended to our hospital during the period between June 2014 and June 2016.The liver function tests,way of delivery,and neonate vaccination were analyzed to explore the influence of the maternal viral load on the neonates.Detecting the viral load,liver function and HBV markers from the start of birth to delivery to analyze the risk of premature delivery,cesarean section rate and the transmission rate of mother-to-child on which hepatitis B virus in pregnant women with different viral load. Results Statistical analysis showed that the conversion-rate difference between the two groups(high/low viral load group) was not significant,but the high viral load group demonstrated longer liver function recovery, higher rate of employing cesarean section, and higher rate of preterm labor.The HBsAg, HBeAg,and HBV-DNA positive rate of neonates from the high viral load group were statistically significant higher than those of the low viral load group. Conclusions Normalized risk assessment and standardized intervention treatment to HBV-infected pregnant women are necessary for the reduction of vertical transmission rate.

Combination therapy of bilirubin adsorption and plasma exchange in patients with liver failure QIU Zi-hui, LI Qi-biao, CHEN Yu, ZHANG Wen-feng 2016, 1 (1):  45-47.  Abstract ( 271)    PDF (855KB) ( 852 )    Objective To evaluate the efficacy and safety of combination therapy of bilirubin adsorption and plasma exchange (PE) on patients with liver failure,and try to establish a new combination therapy modality. Methods The first group of 35 patients with liver failure were treated with plasma exchange (PE) and plasma bilirubin absorpsion (PBA),and the second group of 35 patients with liver failure were treated with simple plasmapheresis.The levels of TBIL(total bilirubin),AST(alanine aminotransferase) and ALB(albumin) were measured and compared before and after treatment.And plasma dosage and primary side effects(such as fever,rash,skin itching) were also compared between the two groups. Results ①The serum levels of TBIL and DBIL of the patients in both groups after treatment were significantly lower than those before treatment,with significant difference(P<0.05);and the decreased levels of TBIL and DBIL in the combination group were significantly higher than those in the second group(P<0.05).②The ALB levels in the patients of both groups after treatment were significant higher than those before treatment(P<0.05).③Plasma dosages in the combined group were lower than those in the second group(P<0.05).④The incidences of the side effects including fever,rash and anaphylactic shock in the two groups were about 15%,10%,0% and 40%,50%,15% respectively.There was a statistical difference between the incidences of any two of the three side effects(P<0.05). Conclusion The combination therapy of plasma exchange and bilirubin adsorption is effective in the treatment of liver failure,which is significant in reducing TBIL level,DBIL level,plasma dosage, and the incidences of side effects.