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Objective:To evaluate the efficacy and safety of the combination of apatinib and S-1 for treatment of patients with advanced gastric cancer, in order to provide clinical therapy reference for advanced gastric cancer.Methods:Clinical trials were retrieved from China National Knowledge Infrastructure (CNKI) , Chinese Science and Technology Journal Database (CSTJ) , Wanfang Medical Network, VIP Journal Database (VIP) , China Biomedical Literature Database (CBMdisc) , Cochrane Library, PubMed, etc., searched from Jan. 2010 to Oct. 2019. The experimental group were given apatinib combined with S-1, and the control group received S-1 monotherapy. Two sets of RCT in patients with advanced gastric cancer were collected. Researchers first screened literature, data extraction and to assess the risk of bias, then made Meta analysis with RevMan5.3 software, the test level was α=0.05.Results:A total of 12 Meta analysis of randomized RCT were selected from the group, including 561 cases of patients. The results showed that objective response rate (ORR) and disease control rate (DCR) of the experimental group was higher than those of the control group [ (RD=0.16, 95% CI: 0.08-0.23, P<0.0001; RD=0.21,95% CI: 0.14-0.29, P<0.00001) ]; There was no significant difference in nausea and vomiting, hand-foot syndrome, fatigue, diarrhea, thrombocytopenia, neutropenia, leukopenia, neuro-toxicity and mucositis between the two groups. The rate of hypertension, proteinuria, hemoglobin of the experimental group decrease was higher than that of the control group [ (OR=6.21, 95% CI: 1.92-20.13, P=0.002; OR = 10.57,95% CI: 5.06-22.04, P<0.00001; OR=2.84, 95% CI:1.25-6.48, P=0.01) ]; and there was a significant heterogeneity in hypertension among them ( P=0.008, I 2=63) . Conclusion:Compared with S-1 alone, the treatment effect of S-1 combined with targeted drug apatinib can significantly improve ORR and DCR of patients with advanced gastric cancer.
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Objective:To investigate the clinical and pathogenic characteristics of community acquired pyogenic liver abscess (PLA).Methods:The clinical data of 172 patients in First Affiliated Hospital of Soochow University with community acquired PLA from March 2013 to September 2018 were retrospectively collected, including clinical characteristics, distribution of the causative pathogens, treatment regimens and outcomes. Chi-square test was used for statistical analysis.Results:There were 158(91.9%) cases with fever, 69(40.1%) cases with abdominal pain among 172 PLA cases. One hundred and forty-three (83.1%) were solitary, and 141(82.0%) cases localized in right hepatic lobe. One hundred and six (61.6%) cases were PLA of cryptogenic origin. There were 156 cases underwent etiology detection, with the positive etiology detection of 99(63.5%) cases. Ninety-two (92.9%) cases were infected with a single strain, and seven (7.1%) cases were infected with mixed strains. A total of 115 strains of bacteria were isolated. The main strains included 71 (61.7%) Klebsiella pneumoniae (KP), 21 (18.3%) Escherichia coli (EC), among which 17 were extended spectrum β lactamase, and two carbapenem-resistant Enterobacteriaceae. Among the 61 KP-PLA patients, 42(68.9%) cases were diagnosed with diabetes, 16(26.2%) cases with biliary diseases, and one (1.6%) case with malignant tumor. Among the 15 EC-PLA patients, six cases were diagnosed with diabetes, nine cases with biliary diseases, and four cases with malignant tumors. There were statistically significant differences ( χ2=4.307, 4.784 and 8.536, respectively, all P<0.05). After admission, the patients were treated with antibiotics alone or combined with drainage. One-hundred and sixty-seven (97.1%) cases got improved. Conclusions:The clinical manifestations of PLA are atypical, and the dominant pathogens are KP and EC. The risk factors of PLA are diabetes mellitus, biliary diseases and malignant tumors.
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ObjectiveTo investigate the value of interleukin-32 (IL-32) combined with Model for End-Stage Liver Disease (MELD) in predicting the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF). MethodsA total of 92 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Soochow University from January 2015 to December 2018 were enrolled, and according to the follow-up results at 3 months after diagnosis, the patients were divided into survival group with 40 patients and death group with 52 patients. ELISA was used to measure the serum level of IL-32. Clinical data of the patients were collected, including age, sex, underlying diseases, major complications, white blood cell count (WBC), platelet count (PLT), hematocrit (HCT), total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), serum creatinine (SCr), prothrombin time (PT), international normalized ratio (INR), and HBV DNA. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; a Pearson correlation analysis was performed for IL-32 and other variables; a binary logistic regression analysis was performed to investigate the independent risk factors for the prognosis of patients with HBV-ACLF. The receiver operating characteristic(ROC) curve(AUC) was used to evaluate the value of IL-32 combined with MELD score in predicting the prognosis of patients with HBV-ACLF. The normal Z test was used for comparison of AUC. ResultsThere were significant differences between the two groups in HCT, PLT, TBil, SCr, PT, INR, HBV DNA, IL-32, and MELD score (all P＜0.05). IL-32 was positively correlated with TBil (r=0.952, P＜0.001) and MELD score (r=0850, P＜0.001). IL-32 (odds ratio ［OR］=1.137, 95% confidence interval ［CI］: 1040-1243, P=0.005) and MELD score (OR=1.055, 95% CI: 1.001-1.109, P=0.025) were independent risk factors for the death of HBV-ACLF patients. IL-32 combined with MELD score had the highest value in predicting the prognosis of patients with HBV-ACLF (AUC=0.992, 95% CI: 0.981-1000), with a significantly higher AUC than IL-32 (0.992 vs 0.984, Z=2.265, P＜0.05) and MELD score (0.992 vs 0877, Z=3182, P＜0.05). ConclusionBoth IL-32 and MELD score can predict the prognosis of patients with HBV-ACLF, and the combination of these two indicators has a better predictive value.
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Lumbar degenerative disease is one of the most common diseases in orthopaedic clinics, and the chronic low back pain caused by it seriously affects patients' living quality. Currently, intervertebral fusion and rigid fixation are the main surgical methods for lumbar degenerative disease. Although the intervertebral fusion and rigid fixation can achieve a higher fusion rate, due to the stress concentration of adjacent segments, the adjacent segment degeneration may occur and make the patient's satisfaction rate much lower than the imaging fusion rate. Dynamic fixation is a new fixing concept, which can control the abnormal motion of the spine segment while retaining part of the movement of the fixed segment. Moreover, dynamic fixation is also beneficial to reduce the degeneration of adjacent segments and the incidence of breakage of internal fixation. Nowadays, various lumbar transpedicular dynamic fixation systems have appeared on the market. Most of these transpedicular dynamic fixation systems are derived from the design of pedicle screws and rods used in spinal fusion surgery in the 1980 s and 1990 s. The original intention of their design is to stabilize the abnormal segments and reduce the pressure on degenerated intervertebral discs and facet joints, while maintaining the normal movement of relevant segments. By reviewing the biomechanical research, clinical efficacy, existing problems and advantages and disadvantages of common backward lumbar transpedicular dynamic fixation systems, this article intends to provide new ideas for the improvement of the backward lumbar transpedicular dynamic fixation system design, as well as offering surgical treatment strategies for clinicians.
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Objective:To investigate relationships between nasal parasitism by Demodex mites and nasal skin microbiome in patients with rosacea. Methods:From May 2017 to June 2019, 14 patients with rosacea, including 8 with early-stage rosacea and 6 with intermediate-stage rosacea, and 14 human controls with healthy facial skin were collected from Department of Dermatology, Shunde District Center for Prevention and Cure of Chronic Disease of Foshan City. Microbial samples were collected from the nasal alar and nasolabial folds of the subjects. Then, DNA was extracted from the samples, and subjected to metagenomic sequencing and bioinformatics analysis. Relative abundance of strains was estimated by using composition ratios of Demodex mites and microbial reads. Shannon index was calculated to evaluate α diversity of microbiome, and principal component analysis (PCA) was performed to assess β diversity based on relative abundance of microbial species. Enumeration data were compared by using two-independent-sample t test, and relationships between nasal Demodex mites and skin microbiome were analyzed by Pearson correlation analysis. Results:The relative abundance of nasal Demodex mites was significantly higher in the rosacea group (1.647% ± 0.389%) than in the healthy group (0.448% ± 0.089%, t = 2.92, P = 0.007) . The relative abundance of Demodex mites was negatively correlated with the relative abundance of bacteria ( r = -0.95, P < 0.001) , and positively correlated with the relative abundance of fungi ( r = 0.76, P < 0.001) . The Shannon indices of nasal bacterial and fungal communities were significantly higher in the rosacea group (0.91 ± 0.17, 1.261 ± 0.045, respectively) than in the healthy group (0.47 ± 0.12, 0.549 ± 0.071, t = 2.17, 8.48, respectively, both P < 0.05) ; PCA showed that the β diversity of bacterial communities significantly differed between the rosacea group and healthy group ( t = 2.32, P = 0.029) , while no significant difference in the β diversity of fungal communities was observed between the two groups ( t = 0.82, P = 0.461) . In addition, the relative abundance of Demodex mites was significantly higher in the patients with intermediate-stage rosacea than in those with early-stage rosacea ( t = 6.56, P < 0.001) ; there was no significant difference in the Shannon indices of nasal bacterial or fungal communities between the two patient groups (both P > 0.05) ; PCA showed that the β diversities of bacterial and fungal communities significantly differed between the two patient groups (both P < 0.05) . Conclusion:Parasitism of Demodex mites on the nasal skin may affect nasal microbial community structure.
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ObjectiveTo investigate the level of vascular endothelial growth factor (VEGF) in the peripheral blood of patients with liver cirrhosis and portal vein thrombosis (PVT) and its clinical significance in the diagnosis of liver cirrhosis with PVT. MethodsA total of 60 patients with liver cirrhosis and PVT who were followed up or hospitalized in the outpatient service of The First Affiliated Hospital of Soochow University from January 2017 to December 2019 were enrolled as PVT group, and 161 patients with liver cirrhosis and portal hypertension who had no thrombi were enrolled as LC group. Related clinical data were collected, including sex, age, white blood cell count, platelet count, total bilirubin, alanine aminotransferase, albumin, prothrombin time, international normalized ratio, and antithrombin Ⅲ. Double-antibody sandwich ELISA was used to measure the serum level of VEGF. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Pearson correlation test was used for correlation analysis, and a binary logistic regression analysis was used to investigate the risk factors for PVT in patients with liver cirrhosis. ResultsThe comparison of baseline indices showed that there was a significant difference in serum VEGF between the PVT group and the LC group (P＜0.05). The comparison of the patients with Child-Pugh class A, B or C disease showed that there was a significant difference in serum VEGF between the two groups (Z=3.749， 5.469， all P＜0.05). The stepwise logistic regression analysis showed that only serum VEGF (odds ratio=1004, 95% confidence interval: 1.003-1.006, P＜0.001) was an independent risk factor for liver cirrhosis with PVT. ConclusionPatients with liver cirrhosis and PVT tend to have a high level of VEGF in peripheral blood, which provides guidance for clinical diagnosis.
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Objective@#To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks.@*Methods@#Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations.@*Results@#Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29).@*Conclusion@#Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.
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Objective@#To explore the prognostic value of model for end-stage liver disease (MELD) combined with arterial blood lactate (Lac) in admitted patients with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF).@*Methods@#Clinical data of 97 cases with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF) admitted to the First Affiliated Hospital of Suzhou University between March 2016 and March 2018 was retrospectively analyzed. Age, gender, complications, MELD score, lactic acid (Lac), total bilirubin (TBil), creatinine (Cr), serum albumin (Alb), high-sensitivity C-reactive protein (CRP), white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), quantification of HBV DNA and HBsAg, and organ support treatment (artificial liver support system, renal replacement therapy and mechanical ventilation ) were documented after admission. The primary endpoint of treatment was death due to ineffective medical treatment during hospitalization, abandonment of medical treatment due to deterioration of the health condition, and switch to liver transplantation for patients with poor medical treatment. The risk factors for primary endpoint of treatment were analyzed by binary logistic regression. Hosmer-Lemeshow test was used to evaluate the goodness of fit for the scoring system, and the ROC to predict the prognosis of MELD-Lac.@*Results@#Ninety-seven cases with HBV-ACLF were included, 56 cases had good prognosis, and 41 cases had bad prognosis (including two cases with poor medical treatment and liver transplantation). The overall improvement rate was 57.7%. MELD score and Lac value in treated group was significantly lower than non-treated group. Bivariable and multivariable logistic regression analysis showed that the MELD score [odds ratio (OR = 1.806)], and Lac score [odds ratio (OR = 1.820)] was the risk factor for hospitalization and mortality in patients with liver failure (P < 0.05). The area under the ROC curve (AUC) and the 95% confidence interval (95% CI) of prognostic patients with MELD-Lac were significantly better than Lac and MELD scores [0.923 (0.84 to 1.00) vs. 0.804 (0.067 to 0.942) and 0.864 (0.75). 0.977)], P < 0.05. When the MELD-Lac Youden index was set at 0.746, the optimal threshold was 18.36, and the sensitivity and specificity were 91.3% and 83.3%, respectively.@*Conclusion@#MELD-Lac score has a high prognostic value in HBV-ACLF patients.
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Objective@#To evaluate the effect of age and gender on skin microbiome on the face of healthy adults by metagenomic sequencing.@*Methods@#From June 2017 to June 2018, 36 adult volunteers with healthy facial skin were enrolled from the Department of Dermatology, Center for Prevention and Treatment of Chronic Diseases of Shunde, including 16 young volunteers (9 males and 7 females) aged 24-31 (27.1 ± 1.3) years and 20 senior volunteers (10 males and 10 females) aged 61-84 (75.8 ± 2.2) years. Skin microbe samples were obtained from the cheek of volunteers, and DNA was extracted from these samples and subjected to metagenomic sequencing and bioinformatic analysis, so as to evaluate the effect of age and gender factors on microbiota on the healthy facial skin of adults. Statistical analysis was carried out by using two independent-sample t test, Wilcoxon rank sum test and Pearson correlation analysis.@*Results@#The senior group showed significantly higher α diversities of bacterial and fungal communities on the facial skin (Shannon index: 0.98 ± 0.07, 1.11 ± 0.05 respectively) compared with those in the young group (0.72 ± 0.09, 0.81 ± 0.05 respectively; t = 2.201, 3.836, P = 0.035, < 0.001 respectively) . Principal component analysis revealed that age could significantly affect β diversities of bacterial and fungal communities on the facial skin (t = 6.991, 11.591 respectively, both P < 0.001) . There were no significant differences in α diversities of bacterial and fungal communities between males and females (Shannon index: bacteria, 0.83 ± 0.08 vs. 0.92 ± 0.09; fungi, 0.92 ± 0.06 vs. 1.04 ± 0.05; t = 0.801, 1.332 respectively, both P > 0.05) . Gender factor could only affect the β diversity of bacterial communities (t = 2.149, P = 0.020) , but not the β diversity of fungal communities (t = 0.439, P = 0.663) . Moreover, the activity of metabolic pathways in bacterial and fungal communities was significantly lower in the senior group than in the young group (t = 1.995, 2.464, P = 0.020, 0.025, respectively) , while gender factor did not affect the activity of metabolic pathways in bacterial and fungal communities (t = 0.895, 0.483, P = 0.378, 0.631, respectively) . According to the relative abundance of different bacteria and fungi between the senior group and young group, Pearson correlation analysis showed positive or negative correlations between some fungi and bacteria, between some bacteria and bacteria, as well as between some fungi and fungi.@*Conclusion@#Age factor, but not gender, markedly affects α and β diversities of, and activity of metabolic pathways in bacterial and fungal communities on the healthy face of adults.
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Objective@#To analyze the subjective and objective misdiagnostic reasons of brucellosis in Suzhou City.@*Methods@#The clinical data of inpatients with brucellosis from the department of infectious diseases, the First Affiliated Hospital of Soochow University from 2016 to 2018 were collected. The main onset methods, the first consultation department, the diagnosis and treatment process, and the main diagnosis were analyzed. Simultaneously, a questionnaire survey was conducted among doctors from different departments in Suzhou City. To investigate the knowledge and diagnosis of brucellosis by electronic questionnaire, and analyze the results.@*Results@#Totally 24 brucellosis cases were collected. Fever (13 cases, 54.17%), lumbago/arthralgia (6 cases, 25.00%) or both (3 cases, 12.50%) were the main initial symptoms, while a patient with fever, arthralgia and orchitis(1 case, 4.17%) and another with purpura (1 case, 4.17%) were also admitted. The 24 patients were distributed among 10 different departments, in which the department of infectious diseases (6 cases, 25.00%) and orthopedics (5 cases, 20.83%) dominated. Brucellosis was considered in only 2 patients (8.33%) before pathogen results, and the main suspected diagnosis were malignant hematopathy/lymphoma (7 cases, 29.17%), sepsis (5 cases, 20.83%), and tuberculosis (4 cases, 16.67%). Totally 124 questionnaires were collected and analyzed. We divided them into 2 groups: department of infectious diseases (52/124, 41.94%) and other departments (72/124, 58.06%). The proportion of answer "yes" for the question Suzhou is the epidemic area of brucellosis, question whether brucellosis is considered in suspected patients, question whether the epidemiology is collected and question how and where to conduct the serological test was 38.71% (48/124), 32.26% (40/124), 53.23% (66/124) and 29.84% (37/124), respectively. The positive answer in the department of infectious diseases (24/52, 46.15%) was significantly higher than those of others (16/72, 22.22%, χ2=7.913, P < 0.05). The respondents thought the serological test could not be conducted, because of that the non-pasture doctors were not familiar with the test procedure, which was complex (93/124, 75.00%) and the disease was not considered (85/124, 68.55%). And the respondents thought measures helpful to reduce misdiagnosis should include setting up serological test or simplifying the procedure (96/124, 77.42%), massed learning organized by related administrations (95/124, 76.61%) and learning by books, papers and classes (72/124, 58.06%).@*Conclusion@#There is obvious clinical misdiagnosis of brucellosis in Suzhou City, which may be caused by Suzhou doctors not paying enough attention to brucellosis, being unfamiliar with the inspection process and complicated inspection process.
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Objective To evaluate the effect of age and gender on skin micmbiome on the face of healthy adults by metagenomic sequencing.Methods From June 2017 to June 2018,36 adult volunteers with healthy facial skin were enrolled from the Department of Dermatology,Center for Prevention and Treatment of Chronic Diseases of Shunde,including 16 young volunteers (9 males and 7 females) aged 24-31 (27.1 ± 1.3) years and 20 senior volunteers (10 males and 10 females) aged 61-84 (75.8 ± 2.2) years.Skin microbe samples were obtained from the cheek of volunteers,and DNA was extracted from these samples and subjected to metagenomic sequencing and bioinformatic analysis,so as to evaluate the effect of age and gender factors on microbiota on the healthy facial skin of adults.Statistical analysis was carried out by using two independent-sample t test,Wilcoxon rank sum test and Pearson correlation analysis.Results The senior group showed significantly higher α diversities of bacterial and fungal communities on the facial skin (Shannon index:0.98 ± 0.07,1.11 ± 0.05 respectively) compared with those in the young group (0.72 ± 0.09,0.81 ± 0.05 respectively;t =2.201,3.836,P =0.035,＜ 0.001 respectively).Principal component analysis revealed that age could significandy affect 3 diversities of bacterial and fungal communities on the facial skin (t =6.991,11.591 respectively,both P ＜ 0.001).There were no significant differences in α diversities of bacterial and fungal communities between males and females (Shannon index:bacteria,0.83 ± 0.08 vs.0.92 ± 0.09;fungi,0.92 ± 0.06 vs.1.04 ± 0.05;t =0.801,1.332 respectively,both P ＞ 0.05).Gender factor could only affect the 3 diversity of bacterial communities (t =2.149,P =0.020),but not the β diversity of fungal communities (t =0.439,P =0.663).Moreover,the activity of metabolic pathways in bacterial and fungal communities was significantly lower in the senior group than in the young group (t =1.995,2.464,P =0.020,0.025,respectively),while gender factor did not affect the activity of metabolic pathways in bacterial and fungal communities (t =0.895,0.483,P =0.378,0.631,respectively).According to the relative abundance of different bacteria and fungi between the senior group and young group,Pearson correlation analysis showed positive or negative correlations between some fungi and bacteria,between some bacteria and bacteria,as well as between some fungi and fungi.Conclusion Age factor,but not gender,markedly affects α and β diversities of,and activity of metabolic pathways in bacterial and fungal communities on the healthy face of adults.
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Objective To analyze the subjective and objective misdiagnostic reasons of brucellosis in Suzhou City. Methods The clinical data of inpatients with brucellosis from the department of infectious diseases, the First Affiliated Hospital of Soochow University from 2016 to 2018 were collected. The main onset methods, the first consultation department, the diagnosis and treatment process, and the main diagnosis were analyzed. Simultaneously, a questionnaire survey was conducted among doctors from different departments in Suzhou City. To investigate the knowledge and diagnosis of brucellosis by electronic questionnaire, and analyze the results. Results Totally 24 brucellosis cases were collected. Fever (13 cases, 54.17％), lumbago/arthralgia (6 cases, 25.00％) or both (3 cases, 12.50％) were the main initial symptoms, while a patient with fever, arthralgia and orchitis (1 case, 4.17％) and another with purpura (1 case, 4.17％ ) were also admitted. The 24 patients were distributed among 10 different departments, in which the department of infectious diseases (6 cases, 25.00％) and orthopedics (5 cases, 20.83％) dominated. Brucellosis was considered in only 2 patients (8.33％) before pathogen results, and the main suspected diagnosis were malignant hematopathy/lymphoma (7 cases, 29.17％), sepsis (5 cases, 20.83％), and tuberculosis (4 cases, 16.67％). Totally 124 questionnaires were collected and analyzed. We divided them into 2 groups: department of infectious diseases (52 / 124, 41.94％) and other departments (72/124, 58.06％). The proportion of answer "yes" for the question Suzhou is the epidemic area of brucellosis, question whether brucellosis is considered in suspected patients, question whether the epidemiology is collected and question how and where to conduct the serological test was 38.71％ (48/124), 32.26％ (40/124), 53.23％ (66/124) and 29.84％ (37/124), respectively. The positive answer in the department of infectious diseases (24/52, 46.15％) was significantly higher than those of others (16/72, 22.22％,χ2 = 7.913, P < 0.05). The respondents thought the serological test could not be conducted, because of that the non-pasture doctors were not familiar with the test procedure, which was complex (93/124, 75.00％) and the disease was not considered (85/124, 68.55％). And the respondents thought measures helpful to reduce misdiagnosis should include setting up serological test or simplifying the procedure (96/124, 77.42％), massed learning organized by related administrations (95/124, 76.61％) and learning by books, papers and classes (72/124, 58.06％). Conclusion There is obvious clinical misdiagnosis of brucellosis in Suzhou City, which may be caused by Suzhou doctors not paying enough attention to brucellosis, being unfamiliar with the inspection process and complicated inspection process.
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Objective To explore the diagnostic value of MR elastography and diffusion?weighted imaging in patients with liver fibrosis in the context of chronic hepatitis B. Methods Twenty?four patients with chronic hepatitis B, whose course of liver disease was more than 6 months and hepatitis B surface antigen was positive, were prospectively enrolled in the First Affiliated Hospital of Soochow University from July to December 2017. All of the patients underwent abdominal transient elastography (TE), routine MRI, magnetic resonance elastography (MRE) and DWI examination, TE and MRI were performed within one week. TE liver stiffness was measured, the MRE liver stiffness and ADC value were measured on MR imagings. All patients were divided into three groups: mild and non fibrosis (F0 to 1), significant fibrosis(F2 to 3) and cirrhosis (F4), according to the recommended standard of FibroTouch. Correlation between TE liver stiffness, MRE liver stiffness and ADC values were identified by using Spearman correlation test. The difference of the MRE liver stiffness and ADC value among the three groups was tested using independent sample t test. The overall predictive ability of MRE and DWI in assessment of liver fibrosis and cirrhosis was analyzed by constructing ROC curve. Results TE and MRI were successfully performed in all subjects, and the image quality was good. The MRE liver stiffness in mild and non fibrosis, significant fibrosis and cirrhosis was (2.32±0.31),(3.43±1.05),(4.77±0.68) kPa with statistically significant difference(F=61.690, P<0.01). The ADC values in three groups were (1.31 ± 0.14)×10-3, (1.23 ± 0.15)×10-3,(1.22±0.12)×10-3mm2/s without significant difference(F=1.074,P=0.360). The TE liver stiffness in three groups was (5.61±1.05),(9.56±0.57),(17.25±3.55)kPa, respectively, there was significant correlation between the MRE liver stiffness and the TE liver stiffness(t=0.858, P<0.01), but no significant correlation between the TE liver stiffness and the ADC value was found (r=-0.326,P=0.120). The area under ROC of MRE liver stiffness in diagnosing liver fibrosis grade (≥F2 and F4) was 0.96 and 1.00 respectively, while the AUC of ADC value was less than 0.70, which were 0.67 and 0.62 respectively. Conclusion MRE is a non?invasive promising tool for assessing liver fibrosis with chronic hepatitis B, while DWI has limited role.
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Objective To investigate the value of the signal intensity of portal vein at hepatobiliary phase on gadoxetic acid liver enhancement imaging for accessing the liver function. Methods Ninety five subjects who underwent gadoxetic acid enhanced liver MR imaging due to suspicion of liver diseases between January 2015 and June 2016 at the First Hospital of Soochow University were retrospectively analyzed. Patients were classified into 4 groups based on their liver function: cirrhosis patients with Child-Pugh class A(n=50),B(n=19),C(n=6)and control group(n=20).All the patients had underwent the abdominal non-enhanced and gadoxetic acid enhanced MR imaging. The signal intensity (SI) of the portal vein at non-enhanced phase and hepatobiliary phase(delayed 20min)were recorded.The ratio of the portal vein to spleen were calculated.The nonparametric Kruskal-Wallis test was used to compare the differences in the SI of portal vein at non-enhanced and the ratio of portal vein to spleen at hepatobiliary phase among the four groups.Multiple regression analysis was applied to analyze the correlated predicting factors of the ratio of the portal vein to spleen at hepatobiliary phase. Results At non-enhanced phase, the SI ratio of portal vein had no significant difference(P>0.05).The ratio of the portal vein to spleen at hepatobiliary was significantly different (P<0.05). The ratio of the portal vein to spleen at hepatobiliary constantly and significantly decreased as the severity of liver dysfunction increased. The serum levels of albumin and platelet count were independent predictors of the ratio of the portal vein to spleen at hepatobiliary phase(P=0.002 and 0.007).Conclusions The ratio of the portal vein to spleen at hepatobiliary phase on gadoxetic acid enhanced MR imaging indicates the severity of liver dysfunction.It might be used as a tool to assess the liver function.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To evaluate the utility of apparent diffusion coefficient (ADC) values from DWI in identifying intermediate and high grade prostate cancer (patients harboring Gleason 4 and/or 5 components in their radical prostatectomy specimens). Methods We retrospectively analyzed the DWI of 54 patients with biopsy-proven prostate cancer and biopsy Gleason score (GS)≤3+3=6. These patients were divided into two groups, intermediate and high grade prostate cancer (patients harboring Gleason 4 and/or 5 components in their radical prostatectomy specimens) and low-grade prostate cancer (patients not harboring Gleason 4 and/or 5 components in their radical prostatectomy specimens). ROIs were drawn on areas of the most suspicious lesion on T2WI and the ADC values were calculated. The ADC values of the two groups were compared to determine whether there were differences between them with independent-sample t test. Receiver operating characteristic (ROC) curve was used to determine the ability of ADC values in differentiating intermediate/high grade prostate cancer from low-grade prostate cancer. Results Twenty-eight patients had intermediate and high grade prostate cancer while the other twenty-six ones had low-grade prostate cancer. Significant differences were found for the ADC values of these two groups [(0.905±0.162)×10-3mm2/s vs. (1.143±0.165)×10-3mm2/s, t=5.361,P<0.01]. The area under the ROC curve of ADC in differentiating intermediate and high grade prostate cancer from low-grade prostate cancer was 0.861, with sensitivity of 88.5% and specificity of 67.9% at the cut-off of 1.000 × 10-3mm2/s. Conclusion The ADC values of suspicious areas in prostate contribute to identify intermediate/high grade prostate cancer in patients with a GS≤3+3=6 on biopsy.
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Objective To investigate the possible protective effect of adenoviral vector expressing interleukin-1β (IL-1β) small hairpin RNA (shRNA) on spinal cord injury (SCI) and its mechanism in rats.Methods Forty-eight adult male Sprague-Dawley rats were randomly assigned to 4 groups including the Sham, the Vehicle,the Ad-GFP and the Ad-shIL-1β groups.SCI was induced by epidural compression.Motor function of hind limbs was evaluated by Basso-Beattie-Bresnahan (BBB) score, the expressions of green fluorescence in injured spinal cord tissue were observed by fluorescence microscope.Enzyme-linked immunosorbent assay (ELISA) and immunofluorescence were also performed.Results The expressions of green fluorescence in injured spinal cord tissue were observed in the Ad-GFP and Ad-shIL-1β groups one day after SCI.Significant functional improvement was observed in the Ad-shIL-1β group (8.17 ± 1.17, 10.17 ± 0.98 and 11.33 ± 0.82, respectively) compared to the Vehicle (4.00 ± 0.89, 5.67 ± 1.03 and 6.17 ± 1.17, respectively) and Ad-GFP (3.83 ± 0.98, 5.33 ± 1.21 and 5.67 ± 1.03, respectively) groups at 7, 14 and 21 days after SCI (P ＜ 0.05).Rats in the Ad-shIL-1β group had less neuronal loss 21 days after SCI.In addition, IL-1β downregulation significantly decreased IL-1β, tumor necrosis factor-or (TNF-α) and IL-6 levels (138.83 ± 7.96,143.38 ± 10.20 and 120.43 ± 9.79 in Ad-shIL-1β group;169.33 ± 11.45, 172.33 ± 8.26 and 163.00 ± 9.57 in Vehicle group;172.83 ± 10.85,167.48 ± 8.19 and 159.48 ± 10.98 in Ad-GFP group, respectively) one day after SCI (P ＜ 0.05).Conclusion This study demonstrated that the IL-1β downregulation may have potential therapeutic benefits for improving the outcomes after SCI.
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Objective To study the relationship between the polymorphism of interleukin-12B (IL-12B)gene and coronary heart disease.Methods We recruited 256 patients with coronary heart disease admitted to our department as the study group and 256 normal subjects as the control group.The polymorphism of IL-12B gene was detected by polymerase chain reaction and single nucleotide polymorphism.Coronary artery stenosis,visfatin,high sensitive C reactive protein and cardiac function were determined.Results The difference in rs15677380 and rs14050311 allele frequencies between the study group and the control group was significant (χ2 =6.19,7.24,P=0.045,0.021).The G allele of rs15677380 and C allele of rs14050311 were risk factors for coronary heart disease (OR=1.32,1.49).Conclusion IL-12B gene is associated with the occurrence and development of carotid atherosclerosis and participates in the development of coronary heart disease.
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<p><b>OBJECTIVE</b>To investigate the genetic association between cirrhosis and polymorphisms in the genes encoding major histocompatibility complex, class II (HLA)-DR beta 1 (DRB1) and HLA-DP beta 1 (DPB1).</p><p><b>METHODS</b>A population of 168 parent/offspring trios, in which the proband had a diagnosis of hepatitis B virus infection with clinical signs of cirrhosis.The HLA-DRB1 and DPB 1 gene polymorphisms of rs24755213 and rs202176660 were detected by PCR and single nucleotide polymorphism (SNP) genotyping.Correlation analysis and haplotype relative risk analysis were carried out.</p><p><b>RESULTS</b>A/G genotypes were detected in rs24755213 of HLA-DRB1 and C/T genotypes were detected in rs202176660 of DPB1.The rs24755213 allele was associated with cirrhosis (P=0.014), with the G allele identified as a protective factor (Z=-2.33) and the A allele identified as a hazard factor (Z=2.33).The rs202176660 allele was also associated with cirrhosis (P =0.026), with the T allele identified as a protective factor (Z=-2.06) and the C allele identified as a hazard factor (Z=2.06).The haplotypes of G/T and A/C in rs24755213 and rs202176660 respectively were associated with cirrhosis (P =0.037 and 0.002, Z=-2.12 and 2.09 respectively).</p><p><b>CONCLUSION</b>In this group of Chinese patients with hepatitis B virus-related cirrhosis, polymorphisms in the HLA-DRB 1 and DPB1 genes were associated with cimhosis.</p>