The analysis of misdiagnosed rheuma tism cases reported in Chinese journal in 16 years: a retrospective study / 中华风湿病学杂志

Objective To investigate the causes of misdiagnosis related to rheumatism diseasecases.Methods A search was performed in database WanFang to identify the misdiagnosed clinical cases reports which were published in Chinese Journal and a retrospective analysis was conducted.All data were analyzed by chi-square test and Fisher's exact test.Results We screened 705 citations and identified 215 articles on the rheumatic diseases,finally,187 reports and 195 cases in total with definite diagnosis were included,accounting for 25.5％ of the total number of misdiagnosed cases.Primary vasculitis (72 cases),rheumatoid arthritis (25 cases),spondyloarthropathy (17 cases),polymyositis (14 cases),systemic lupus erythematosus (13 cases) and Sj(o)gren's syndrome (SS) (12 cases) were amongst the top misdiagnosed rheumatic diseases.There was no difference between 1998-2006 and 2007-2015 in the overall misdiagnosis cases.Single disease comparison,polymyositis,spondyloarthropathy and IgG4 related disease were increased (P=0.002;P=0.034;P=0.060;respectively),while polymyositis was delayed (P=0.002).Rheumatism misdiagnosed cases reported mainly came from tertiary hospitals and the department of rheumatology.Conclusion Misdiagnosed rheumatism are common in clinic.Strengthen the physicians' continuous education,the validity of clinical thinking mode and rational use of diagnostic criteria are important to make correct diagnosis.

High prevalence of obstructive sleep apnea in Marfan's syndrome / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome, and discuss some proposed potential mechanisms for this relationship.</p><p><b>DATA SOURCES</b>The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013. The search term was "Marfan's syndrome and sleep apnea".</p><p><b>STUDY SELECTION</b>Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome, and coexisting obstructive sleep apnea.</p><p><b>RESULTS</b>A high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome. The potential reasons are craniofacial abnormalities and lax upper airway muscles, which lead to high nasal airway resistance and upper airway collapse. Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms. The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome.</p><p><b>CONCLUSIONS</b>Obstructive sleep apnea is strongly associated with Marfan's syndrome. Craniofacial abnormalities and lax upper airway are the main mechanisms. Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture. Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.</p>

Comparison of symptom and risk assessment methods among patients with chronic obstructive pulmonary disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice.</p><p><b>METHODS</b>A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded.</p><p><b>RESULTS</b>Of the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant.</p><p><b>CONCLUSIONS</b>The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.</p>

The value of procalcitonin in interpretation of infection with systemic use of glucocorticosteroid / 中华检验医学杂志

It is difficult to interpret the infection after glucocorticosteroid treatment because glucocorticosteroid will lead to increased peripheral blood neutrophils.Procalcitonin (PCT) is a major biomarker,which can be used as the basis for early diagnosis of severe bacterial infections.The level of PCT is not inhibited by glucocorticosteroid.PCT can be used to interpret infection as systemic use of glucocorticosteroid

Chinese literature review of etiology distribution of adult patients with fever of unknown origin from 1979 to 2012 / 中华内科杂志

Objective To review the etiology of 10 201 adult patients with fever of unknown origin (FUO) in China from 1979 to 2012,and to compare the reasons between the South and the North of China,and to illustrate the change in different periods.Methods Literatures containing key wordfever of unknown origin were selected in China National Knowledge Infrastructure (CNKI) database from 1979 to 2012.Articles were excluded if patient population were less than 100.Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961.Totally 43 literatures including 10 201 patients were enrolled in this study.The period of the literatures were divided into the early,middle and later period,and the regions were partitioned into the South and the North.Results A total of 42 articles (including 9787 patients) provided the gender information with 5063 men and 4724 women.The etiologies of 10 201 FUO patients included infectious diseases (53.5％),rheumatic diseases (20.1％) and tumor (12.0％).The positive diagnostic rate was 91.8％.Tuberculosis (23.8％) was the most common reason in infectious diseases.Adult Still's disease (7.0％) was the most common cause of FUO among rheumatic diseases.Lymphoma (3.4％) was the most common tumor in FUO patients.Besides,drug-induced fever (1.7％) should also be considered.In the recent 30 years,the proportion of FUO caused by infectious diseases had decreased,rheumatic diseases and other reason had increased (P ＜ 0.05).The proportion of tumor in middle period was significantly higher than that in the early and later period (P ＜ 0.05).The negative diagnostic rate had increased (all P ＜ 0.05).The proportion of infectious diseases in North China was significantly lower than that in the South (P ＜ 0.05).The proportion of other reason was significantly higher in the North (P ＜ 0.05).Conclusion In the recent 30 years,the most common cause of FUO was still infectious diseases,especially tuberculosis.

Underdiagnosis of chronic obstructive pulmonary disease in China: epidemiologic study / 中华健康管理学杂志

Objective To investigate underdiagnosis problem of chronic obstructive pulmonary disease (COPD) in China.Methods Articles published during January 1 st,2000 and December 30th,2011were searched in Wanfang Database and Medline,search words including COPD and epidemiology survey.The papers were then reviewed,and those original contirbutions with sample size ≥ 1000 and strict quality control entered into the final analysis.Results Only 32.90％ (1095/3328) COPD patients had ever been diagnosed to have emphysema,bronchitis or COPD,and only 9.13％ (237/2597) had undergone lung function test.About 65.40％ (2306/3526) COPD patients were presented with at least one of the following symptoms:cough,phlegm and breathlessness.Stage Ⅰ or Ⅱ COPD was found in 74.52％ (1802/2418)patients.Conclusion Underdiagnosis of COPD was quite common in China,and patients with stage Ⅰ or Ⅱ COPD should have deserved early diagosis.

Effect of physician guidance on cigarette cessation in current smokers with chronic obstructive pulmonary disease / 中华健康管理学杂志

Objective To investigate the effect of physician guidance on cigarette cessation in current smokers with chronic obstructive pulmonary disease(COPD).Methods Cigarette cessation education and routine telephone follow-up was provided for 70 COPD patients.Pulmonary function and exhaled carbon monoxide level were detected every 3 months.Results After 6 months' follow-up,28 participants(40.00%) successfully quitted cigarette smoking.Seventeen subjects (24.28%) experienced relapse,with mean cessation time(3.08±0.33) months.Once receiving physician guidance,5 re-attempted to quit cigarette smoking,and 12 reduced tobacco consumption. Sixteen subjects(22.86%) did not quit smoking,although the mean cigarette consumption per day was decreased by 60%.Nine participants (12.86%) showed no change in smoking habit. Conclusion Physician guidance could impreve the rate of cigarette cessation in COPD patients.Intensive intervention may be correlated with successful smoking cessation.

Impact of continuing medical education on chronic obstructive pulmonary disease knowledge of medical doctors practicing at the grassroots / 中华全科医师杂志

ObjectiveTo understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.MethodsKnowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.ConclusionsClinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Single Nucleotide Polymorphisms in the 5'-Upstream Sequence of Chemokine Like Factor and their Association with Asthma / 中国呼吸与危重监护杂志

Objective To detect the single nucleotide polymorphisms (SNPs) in the upstream promoter region of chemokine like factor (CKLF) gene and analyze their possible associations with asthma and asthma-related phenotypes.Methods Direct Sequence of the 1553bp upstream promoter region of CKLF gene was performed in 245 Chinese Han human genomic DNAs (119 asthmatics and 126 controls).The frequencies of alleles, genotypes, and haplotypes were determined and the association of these SNPs with asthmawere further analyzed.Results Fournovel SNPs,SNP88 (T>C),SNPI96 (T>C),SNP568 (C> G) ,and SNP1047 (C > G) were found in the promoter region of CKLF.The frequency of rare allele was 0.168 (SNP88C), 0.168 (SNP196C), 0.352 (SNP568G) and 0.167 (SNP1047G), respectively.Haplotypes,their frequencies and the linkage disequilibrium coefficients between SNPs were constructed.Complete linkage disequilibrium (LDs) were observed between SNP88 and SNP196,SNP88 and SNP1047, as well as SNPI96 and SNP1047 ,respectively (D1 = 1.000,r2 = 1.000).SNP568 was in partial LD with the other three SNPs (r2 = 0.366).No association between asthma and the SNPs was observed.Conclusions Four SNPs in the regulatory region of CKLF in Chinese Han population were firstly identified.Although no significant correlation with asthma was revealed, the SNP and haplotype information is useful for other disease association studies in the future.

Analysis of current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital / 中华全科医师杂志

Objective To investigate current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital. Methods Statistical reports of hospital work, notification forms of tuberculosis (TB) cases on the internet, registration book of laboratory sputum mgcobacteria examinations, statistical reports of X-ray examinations for outpatient department, referral forms for mycobacteria patients, medical records for hospitalized patients at the respiratory ward of the People's Hospital, Peking University during August 2005 to July 2006 were reviewed and analyzed. Results In outpatient pulmonary department, there were 45 055 visitors during the period of August 2005 to July 2006,and 4960 of them (11.0%) had their chest X-ray examined, 1 512 (3.4%) had sputum mycobacteria examined with smear-positive in 24 cases, 189 (0.4%) were referred to specialized TB dispensaries for further diagnosis and 183 with notification forms with a notification rate of 96.8%, and 30 (0.1%) were finally diagnosed as TB after hospitalization with an interval less than 14 days between onset of symptoms and diagnosis in 27 of the 30 (90.0%) and 26 were referred to a specialized TB dispensary (86.7%) for treatment. Conclusions On general, detection, diagnosis and referral of TB in People's Hospital of Peking University are in a good situation.However,more aUenfion should be paid to the following aspects：① quantity and quality of sputum myeobacteria examinations for outpatients should be improved further,②chest radiograph reading by radiologists and clinicians need to be improved,and ③consciousness of early detection for TB need to be enforced in physicians by bronchoscopy and pathological diagnosis,especially in those with complicated and difficultly diagnosed smear-negative TB.

Impact of "three-in-one" asthma education and management model on asthma control in adult patients / 中华内科杂志

Objective To evaluate the impact of the asthma education and management model developed by Peking University People's Hospital on the level of asthma control. Methods Trained respiratory physicians from 6 large teaching hospitals in the urban districts of Beijing conducted a successive questionnaire survey in the form of face-to-face interviews with adult asthma patients attending their respective clinics. The results were used to compare the levels of asthma control between patients who were administered "three-in-one" asthma education and management (education group) and those who were not(control group). Results Among the 100 patients in the education group, 85% showed asthma control test(ACT) values ≥20 points. This was significantly higher than that in the 427 control group patients (37%,χ2 =74.345 ,P <0.01 ). During the past 1 year, the rate of hospitalization due to exacerbation of asthma,number of emergency treatments, and missed working days were significantly lower in the education group than in the control group ( 4%, 18%, 20% vs 23%, 32%, 55%, respectively; χ2 = 19.431,7.515 and 17.853 respectively; and P < 0.01 for all). Conclusion The " three-in-one" asthma education and management model can significantly improve asthma control.

Awareness of Knowledge of COPD by Doctors in District and Community Hospitals / 中国慢性病预防与控制

Objective To discover the knowledge level about the COPD of doctors in District and Community Hospitals. Methods The knowledge level of COPD was investigated with questionnaire in 400 physicians in 10 districts of Beijing in December 2007. Content included: COPD definition, diagnosis, epidemiology, risk factor, COPD common symptoms, exacerbation manifestation, COPD non-pharmacological treatment (pulmonary rehabilitation, smoking quitting, influenza and pneumococcal vaccination), and COPD pharmacological treatment (bronchodilator therapy, antibiotic therapy, inhaled and systemic corticosteroids therapy). Results There were 372 answered copies of questionnaire collected, the total average score was 50.1?20.6 points, pass rate was 42.5%, while was 55.2?20.6 points and 57.6% in 30~year old group and 55.6?14.2 points & 51.9% in 40~year old group, which were higher than those in 20~year old group and ≥50 year old group (P

Effect of Interleukin-17 on neutrophil apoptosis / 北京大学学报(医学版)

Objective: To study the effect of Interleukin(IL)-17 on neutrophil apoptosis and try to explain the possible mechanism involved. Methods: Neutrophils isolated from healthy donors were incubated in enriched RPMI 1640 cell culture medium at 37 ℃ in 5% carbon dioxide. Subgroups were incubated with IL-17, heat-denatured IL-17 (X-IL-17), dexamethasone (DEX), or buffer alone. Apoptosis was assessed by morphologic changes, by detecting DNA strand breaks. Production of proapoptotic protein Bax by neutrophils was evaluated by immunocytochemistry. Results: At the time of neutrophil incubation, neutrophils in the control subsets exhibited morphologic evidence of apoptosis. A steady rise in apoptosis index (AI) was noted, with (1.54?0.08)% for 0 h, (11.48?1.80)% (compared with 0 h, P0.05) for 0 h, (20.47?6.22)% ( compared with control 12 h, P0.05).Neutrophils apoptosis was accompanied by DNA fragmentation. In all groups, the increasing of Bax immunoreactivity was strongly related with more apoptotic neutrophils (r=0.932, P

Correlation of pulmonary functions of COPD patients to those of their first-degree children / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the risk factors correlating to the likelihood for airflow obstruction among first-degree children of chronic obstructive pulmonary disease (COPD) patients and whether familial aggregation of pulmonary function abnormality exists.</p><p><b>METHODS</b>Fifty-nine smokers with COPD and 28 smokers without COPD as control and all their children available were recruited into the study. Their history was recorded and a binary logistic regression analysis was carried out to ascertain the effects of their relationship to a proband with COPD, when other potential risk factors were controlled.</p><p><b>RESULTS</b>Children with COPD probands showed increased risk of FEV1 below the 70% predicted (OR = 1.987) after accounting for the effects of smoking, sex and clinical symptoms. The lower the pulmonary function of the COPD proband, the higher the risk to their children for FEV1 below the 70% predicted.</p><p><b>CONCLUSIONS</b>Our finding demonstrates the presence of a household aggregation inclination of COPD and pulmonary function impairment. Genetic factors might act as the basis of the familial aggregation.</p>

Clinical analysis of 48 cases with pulmonary lymphangioleiomyomatosis:a report of three cases and review of domestic literatures published in the past ten years / 中华全科医师杂志

Objective To improve the understanding and diagnosis of pulmonary lymphangioleiomyomatosis (PLAM) by the comprehensive review of domestic literatures in the past ten years.Methods Three new cases with PLAM were reported and integraed with other 45 cases reported domestically in the past ten years for analysis of their clinical features.Results The newly reported three cases of PLAM were all women at child-bearing age, with initial symptom of dyspnea after activity. Two of them complicated with extra-pulmonary PLAM. All the three cases were free of chylous effusion. Forty-seven of 48 cases with PLAM were pathologically diagnozed, with ages of onset of 5~69 (mean?s of 34?10) years. Their clinical manifestations were mainly respiratory, including dyspnoea (95.8%), haemoptysis (52.1%), pneumothorax (45.8%), chylous effusion (33.3%),cough (31.3%) and chest pain (12.5%). Abnormal manifestations in abdomen, including renal mass, retroperitoneal mass and retroperitoneal lymphadenopathy, were detected in 16 cases. Thirty-nine cases had their high-resolution CT (HRCT) examined and appearance of multiple cysts distributed throughout the bilateral lung fields could be discerned in 38 of them. Obstructive ventilation disturbance could be observed in 23 of 30 cases with the data or conclusions on pulmonary function tests, and mixed ventilation disturbance in seven cases. Respiratory failure was complicated in 17 of 28 cases with the data of arterial blood gas analyses.Conclusions HRCT had confirmative value for diagnosis of PLAM. In practice, HRCT, as well as other routine abdominal and pelvic imaging examinations, should be performed in time for child-bearing-age women with progressive dyspnoea, haemoptysis, or spontaneous pneumothorax, to detect if they complicate with PLAM.

Inhibition of allergic responsiveness in a murine asthma model via IFN-gamma transgene expression / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate adenoviral vector mediated exogenous gene expression in mouse lungs and the effect of mIFN-gamma transgene expression on allergen-induced pulmonary eosinophil infiltration in a murine asthmatic model.</p><p><b>METHODS</b>LacZ marker gene was transduced into CD-1 mouse airway epithelial cells by installation of a replication-deficient adenovirus with LacZ gene (AdCMVLacZ) 5 x 10(9) plaque forming unit (pfu) in the intratrachea or nostril. C57 mice were sensitized intraperitoneally and challenged by aerosol with ovalbumin (OVA) to produce an asthmatic model. AdCMVmIFNgamma 5 x 10(9) pfu was administered via nostril in asthmatic mice 48 h before OVA challenge. Sera, bronchial alveolar lavage (BAL) and lungs were recovered 48 h after OVA challenge.</p><p><b>RESULTS</b>After administration with AdCMVLacZ by intratracheal installation or nose-drop, the lungs revealed a high level of widespread LacZ transduction with X-gal staining, mainly along airways. IFN-gamma via adenoviral vector transduction could be overexpressed both in vitro and in vivo (1624.7 +/- 1321.5 pg/ml in BAL 96 h after AdCMVIFNgamma infection). In AdCMVIFNgamma treated asthmatic models, histological evaluation revealed marked suppression of eosinophil peribronchial and perivascular infiltration; the recoverable percentage of eosinophils in BAL was an average of 9.00% +/- 4.58%, which was a statistically significant decrease versus that of the positive control group (75.13% +/- 6.85%) (P < 0.001). The total cell number in BAL ((145 +/- 55.6) x 10(3) cells/ml) in AdCMVmIFNgamma treated mice also was tremendously reduced compared to the positive control group ((216.6 +/- 71.1) x 10(3) cells/ml).</p><p><b>CONCLUSIONS</b>Adenoviral vector was able to overexpress exogenous gene in murine lungs. IFN-gamma overexpression via adenoviral vector in pulmonary epithelia in vivo can abrogate allergen-induced eosinophilic infiltration in lungs in an asthmatic model, which may suggest a new preventively therapeutic method for cytokine immunogenetic transfer in allergic asthma.</p>

The analysis for the causes of delaying diagnosis of Wegener's granulomatosis-discussing limitations of diagnostic criteria for WG / 中国实用内科杂志

Objective To analyse the cause for delaying diagnosis of WG and improve the diagnosis level.Methods A retrospective study was done on patients who were admitted to the People's Hospital of Peking University and were diagnosed with WG from 1997 to 2007,by searching the computer system of the hospital for patients with WG,who were misdiagnosed and reported in Chinese Journal of Rheumatology and Clinical Misdiagnosis ﹠ Mistherapy from 2003 to 2007.Results WG included multiple systems and organs ivolvement.The lung,kidney and upper airway were the most commonly involved organs,and ear,eye,external salivary gland and oral cavity were also involved.Most initial symptom and clinical manifestation were not typical manifestation of WG trilogy,which led to misdiagnosis and mistreatment.Anti-neurophil cytoplasmic antibody(ANCN)positive rate was high.The most common pathologic features were necrotizing granulomatous inflammation and vasculitis.Conclusion Clinical manifestation of WG is complicated and it injures multiple system or organs.When the symptoms are atypical,it is easy to lead to misdiagnosis,especially in early stage.We suggest running requisite revision for diagnostic criteria of WG,in order to make early diagnosis and treatment of WG.

Effects of islet B cells of rats on the differentiation of T-helper lymphocytes / 中国实用内科杂志

Objective To investigate the effects of islet B cells of rat on the differentiation of T-helper lymphocytes and its potential mechanism.Methods Forty male SD rats were equally divided into five groups.Group-A:render diabetes by injection of streptozotocin (STZ);Group-B:OVA sensitized and then OVA challenged to render asthma;Group-C:render diabetes and then OVA sensitized,and challenged;Group-D:render diabetes,and then insulin subcutaneous injection,OVA sensitized,and challenged;Group-E:nondiabetes,nonsensitized,only OVA challenged.Bronchoalveolar lavage (BAL) was performed in rats from each group 24h after challenged and BAL fluid was used to detect IFN-? and IL-4.Blood glucose was estimated,total and differential leukocyte counts were carried out in blood samples and C-peptide concentration was tested in serum.Results The C-peptide concentration in serum was decreased significantly,while INF-? expression was higher,and IL-4 expression was markedly lower in BAL fluid in both group-A and group-C when compared with that of controls,respectively.Compared with group-C,IL-4 expression was increased and INF-? were significantly lower,respectively in BAL fluid of group-D after insulin subcutaneous injection.Conclusion Islet B cells of rat might modulate the differentiation of T-helper lymphocyte.