Clinical characteristics and prognosis of 44 patients with Nocardia infection / 中华传染病杂志

Objective:To investigate the clinical characteristics and prognosis of the patients with nocardiosis.Methods:From January 2013 to July 2019, 44 patients with nocardiosis in Department of Infectious Diseases, Huashan Hospital, Fudan University in Shanghai were enrolled, and their clinical data were retrospectively analyzed, including baseline characteristics, clinical manifestations, underlying diseases history of glucocorticoid therapy, laboratory data (blood routine examination, procalcitonin, C-reactive protein, lymphocytes subsets, etc.), imaging changes, bacterial strain identification, treatment regimens and outcomes. According to the locations of infection, patients were divided into pulmonary nocardiosis, extrapulmonary single-organ nocardiosis and disseminated nocardiosis. The Mann-Whitney U test was used for comparison between two groups, and the Kruskal-Wallis H test was used for comparison among multiple groups. Results:Among the 44 cases of nocardiosis, 14 cases were pulmonary nocardiosis, 17 cases were extrapulmonary single-organ nocardiosis (including nine cases with central nervous system infection, six cases with skin and soft tissue infection, one case with abdominal abscess and one case with urinary tract infection) and 13 cases were disseminated nocardiosis (including four cases with bloodstream infection, six cases with central nervous system and lung or skin and soft tissue infection, three cases of lung and skin and soft tissue infection). Thirty-four cases had underlying diseases, and 27 cases received glucocorticoid or immunosuppressant treatment. The main symptom of 11 patients in pulmonary nocardiosis group was productive cough, while that of the patients in other two groups was fever. Nocardia species were mainly Nocardia brasiliensis, Nocardia nova and Nocardia farcinicaia. The white blood cell counts and neutrophils proportion were normal or slightly increased in 42 cases, and the platelets were normal or slightly decreased in 41 cases. Erythrocyte sedimentation rate increased in 19 cases, procalcitonin increased in 21 cases, C-reactive protein increased in 34 cases, and ferritin increased in 18 cases. A total of 34 patients were tested for lymphocyte subsets, of which 15 had CD4 + T lymphocytes decreased, 14 had CD8 + T lymphocytes increased, seven had B lymphocytes increased, seven had B lymphocytes decreased, and eight had natural killer cells decreased. The hemoglobin of patients with pulmonary nocardiosis was higher than that of patients with extrapulmonary infection, and the difference was statistically significant ( U=0.095, P=0.025). The imaging manifestations were mainly abscess and inflammatory exudation. Forty cases were cured or improved, one case was still on treatment, and three cases died. Conclusions:The clinical manifestations of nocardiosis involving various organs are non-specific. Standardized treatment could reduce the mortality of nocardiosis.

The Effectiveness of Antiviral Treatments for Patients with HBeAg-Positive Chronic Hepatitis B: A Bayesian Network Analysis.

This network analysis is to determine the most effective treatment in HBeAg-positive patients. PubMed databases were searched for randomized controlled trials. Bayesian network meta-analysis was used to calculate the pairwise hazard ratios, 95% credible intervals, and ranking of surrogate outcomes. 9 studies were identified. The results show that NA add-on PEG IFN might be a better antiviral approach for HBeAg-positive patients in end point of treatment, with a comparable results of nucleoside/nucleotide analogs (NA), PEG IFN, PEG IFN add-on NA, PEG IFN combined NA, and PEG IFN combined placebo in alanine aminotransferase (ALT) normalization and HBV DNA undetectable. Cumulative probabilities of being the most efficacious treatment were NA add-on PEG IFN (30%) for HBeAg loss. The second efficacious (23%) is HBeAg seroconversion. This network analysis shows that NA add-on PEG IFN might be a better antiviral approach for HBeAg-positive patients in end point of treatment. But the long-term efficiency should be further determined.

Etiologies of 224 patients with fever of unknown origin / 中国感染控制杂志

Objective To explore the etiologies of fever of unknown origin(FUO)and methods for confirming di-agnosis in patients at a hospital,and provide reference for clinical diagnosis and treatment of FUO.Methods Pa-tients with FUO admitted to a hospital between January 2008 and July 2014 were performed clinical diagnosis with methods of serology,bacteriology,molecular biology,bone marrow aspiration,tissue biopsy,and diagnostic thera-py,the etiologies and final diagnosis of 224 patients were analyzed retrospectively.Results Of 224 FUO cases,189 (84.38%)eventually got confirmed diagnosis,35 (15.62%)were not confirmed.The percentage of infectious dis-eases,connective tissue diseases,malignant tumor,and other diseases were 50.45%,18.75%,9.82%,and 5.36%respectively.Among infectious diseases,the major pathogens were bacteria,followed by virus.The major connec-tive tissue diseases were systemic lupus erythematosus and polyarteritis nodosa;the main malignant tumor was he-matological tumor,lymphoma was the main form.Among 189 patients with confirmed diagnosis,30.16% and 24.34% were performed pathogenic and pathologic detection respectively,and 20.11% were performed the other (compre-hensive)methods.Conclusion Infectious diseases,connective tissue diseases,and tumor are major etiologies of FUO.

Preliminary study of liver targeting interferon on the immune toxicity of mice / 中国生化药物杂志

Objective To evaluate the immunotoxicity effect of Liver targeting interferon (IFN -CSP) on mice.Methods Mice were randomly divided into five groups:low, middle and high dose of IFN-CSP, solvent control group(saline) and Positive control group (cyclophosphamide).They were injected subcutaneously for 2 weeks.Delayed hypersensitivity test was used to determine the cell immunefunction and plaque forming cell assay was used to determine the humoral immune function.Results There was no significant difference of the the index of immune organ and the ear swelling degree between IFN-CSP groups and control group.There was also no significant difference on hemolytic plaque test between them.Conclusion IFN-CSP has no significant effect on both cellular immunity function and humoral immune function of mice, this results will provides the basis for further safety evaluation.

Serum total bili rubin,prothrombin,HBeAg,and PC mutant--predictors of severe acute exacerbation in patients with chronic hepatitis B / 中国人兽共患病学报

ABSTRACT:In this study ,we elucidated the predictors of progression to liver failure during severe acute exacerbation .We analyzed 69 consecutive patients with severe acute exacerbation of chronic hepatitis B for clinical outcome and factors that influ‐enced the development of liver failure ,including viral genotype ,PC (G1896A) and BCP (A1762T/G1764A) mutants .Thirty‐three (47 .8% ) severe acute exacerbation patients progressed to liver failure .Multivariate analysis identified serum bilirubin (TB>256 μmol/dL ,P=0 .008) and prothrombin activity (PTA<40% ,P<0 .001) as significant determinants of progression to liver failure .HBeAg negativity (P=0 .065) and PC mutant (P=0 .090) were associated with the progression to hepatic de‐compensation .Serum total bilirubin ,prothrombin activities ,HBeAg status and PC mutant were predictors of clinical outcome in patients with severe acute exacerbation of chronic hepatitis B .

Application of problem-based learning combined with extended learning in lemology course / 中华医学教育探索杂志

We applied a new teaching mode,combining problem-based learning (PBL) with extended teaching in clinical internship and case discussion,in order to adapt to the new situation in infectious diseases.The teaching efficacy was evaluated by questionnaire and classroom effect.The results showed that the new mode cultivated the students' self-learning ability and broadened their professional perspective.

Some Reflections on Clinical Teaching Reform in Infectious Diseases / 中华医学教育探索杂志

This paper analyzes the special features of lemology education and the problems in clinical teaching at present,The measures should be taken to improve the clinical teaching quality from the varies of aspects,such as strengthening the construction of teaching staffs and students,applying the modern educational means and teaching samples in clinical teaching,launching active extracurricular activities,developing the evaluation of teaching and improving the teaching quality.