RESUMO
Objective To investigate the clinical characteristics,treatment and prognosis of tuberculosis in patients with autoimmune diseases after tumor necrosis factor-αinhibitors.Methods Clinical data of 33 patients with TB after biologics(tumor necrosis factor-α inhibitors)treated in Guangzhou Chest Hospital from January 2019 to March 2023 were collected,including 25 males and 8 females,with a median age of 32 years.The clinical symptoms,laboratory results,imaging and tracheoscopic features,pathological features,treatment and outcome were analyzed retrospectively.Results The common clinical manifestations were cough(26/33),sputum(23/33)and fever(17/33).The most common cases were pulmonary tuberculosis(32/33),bronchial tuberculosis(15/33),mediastinum and hilar lymph node tuberculosis(11/33).Bilateral lung spread of tuberculosis(21/33),intrapulmonary spread of tuberculosis(bronchus,mediastinal hilar lymph nodes,pleura)(19/33),extrapulmonary tuberculosis(18/33),pulmonary tuberculosis with intrapulmonary or extrapulmonary tuberculosis(26/33).Blood CD4+T lymphocyte test was normal(23/33),and blood IGRA test was positive(27/33).Pulmonary imaging miliary nodules(8/33).The histopathology of the lymph nodes showed atypical granulomatous nodules.The duration of anti-tuberculosis treatment is 8-32 months.1 case of death.Conclusion Patients with autoimmune diseases complicated with tuberculosis after the application of tumor necrosis fact-α inhibitor are more likely to have double lung lesions,which are easy to spread to lung tissues and multiple organs of the body,and have decreased immune function.Most of them need to extend the treatment course,and the prognosis is generally good after comprehensive treatment.
RESUMO
Objective:To investigate the value of visceral fat index (VAI) and lipid accumulation product (LAP) on predicting metabolic associated fatty liver disease (MAFLD) in the population without overweight/obesity.Methods:This study is a cross-sectional study. The physical examination data derived from International Physical Examination and Health Center of the Second Affiliated Hospital of Harbin Medical University from January to December 2021 were collected. According to the inclusion and exclusion criteria, a total of 4 304 subjects without overweight/obesity aged from 18-75 were included in this study. The subjects were divided into two groups with MAFLD or without MAFLD, according to the diagnostic criteria of MAFLD provided by The Asian Pacific Association for the Study of the liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Comparison of the clinical parameters (blood pressure, lipid, glucose) and obesity measurement indexes (BMI, VAI, LAP) between the two groups was analyzed. All subjects were respectively divided into four groups according to BMI, VAI and LAP quartile, which were defined as A, B, C, D. The prevalence of MAFLD in the population without overweight/obesity in quartile area groups of different obesity measurement indexes was calculated. Spearman′s rank correlation was used to evaluate the correlation between BMI, LAP, VAI and MAFLD in the population without overweight/obesity, respectively. Meanwhile, receiver operating characteristics (ROC) curves were used to calculate area under the curve (AUC) and evaluate the accuracy of BMI, VAI and LAP on predicting for MAFLD in the population without overweight/obesity.Results:The prevalence of MAFLD in the population without overweight/obesity was 10.87%. In the population without overweight/obesity, the clinical data blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and fasting plasma glucose (FPG) in the group with MAFLD were significantly higher than those of the group without MAFLD (131/80 vs 113/70 mmHg, 5.29 vs 4.65 mmol/L, 3.21 vs 2.75 mmol/L, 1.87 vs 0.89 mmol/L, 5.60 vs 4.95 mmol/L; P<0.001), but high density lipoprotein cholesterol (HDL-C) of the group with MAFLD was significantly lower than that of the group without MAFLD (1.19 vs 1.49 mmol/L; P<0.001). The obesity measurement indexes (BMI, VAI, LAP) in the group with MAFLD were significantly higher than those of the group without MAFLD (22.10 vs 20.70 kg/m 2, 2.64 vs 1.00, 36.27 vs 12.48; all P<0.001). In the population without overweight/obesity, the prevalence of MAFLD was increased with the increase of BMI, VAI and LAP quartile area, and there was a linear correlation between MAFLD and obesity measurement indexes above. Spearman′s rank correlation analysis showed that correlation coefficient between obesity measurement indexes and MAFLD in the population without overweight/obesity was respectively LAP (0.427)>VAI (0.406)>BMI (0.282). ROC curve analysis showed that in the population without overweight/obesity, LAP had the highest accuracy on predicting MAFLD, with the AUC value of 0.896 (0.886-0.905), the optional cut-off value was 20.75, sensitivity and specificity was 85.9% and 79.0%, respectively. VAI (0.876) took the second place and BMI (0.761) located lastly. Conclusions:Both VAI and LAP have good prediction ability for MAFLD in the population without overweight/obesity. However, compared with VAI, LAP has higher accuracy on predicting MAFLD in the population without overweight/obesity.
RESUMO
Objective:To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods:From August 2013 to December 2020, 25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting. The area of the defects was 0.8 cm× 0.8 cm to 1.6 cm× 1.4 cm. The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm. In order to make the flap transfer to a further distance, the subcutaneous fibre connection of the flap was cut-off during the operation. At the same time, cut off 1 side of subcutaneous pedicle. Finally, the advanced distance of the flap reached 0.5-1.2 cm. After the flap harvested, the medium thickness skin was removed for graft to close the donor site from the wrist striations. After the surgery, follow-up visits were conducted regularly by outpatient clinic, or via telephone or WeChat review or by home visit. Throughout the follow-up, the flap appearance, sensation and recovery of the function of digital joint were observed, together with the patient satisfaction. Results:After the surgery, the postoperative follow-up lasted for 4 months to 8 years. All 25 flaps and skin grafts were survived in first stage wound healing. The flaps and skin grafting areas had excellent texture. The fingerprint had been reconstructed with good appearance. The TPD was 4-9 mm, the functions of digital joint recovered well, and there was no complain about a discomfort at the donor site. According to the evaluation standard of Michigan hand function questionnaire, all 25 patients were very satisfied with the overall appearance and function of the hand. According to Total Angle of Motion (TAM) evaluation standard, finger mobility was excellent in all 25 patients.Conclusion:Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip. The surgery characterises a simple flap cutting, less traumatic damage, long advancing distance of flap and good repair effect.
RESUMO
Objective To explore the correlation between axon guidance factor Semaphorin 5A and clinicopathological features and its role in the invasion and metastasis of gastric cancer.Methods The expression of Semaphorin 5A in gastric cancer tissues of 171 patients with different gender,age,histological type and TNM stage was detected with immunohistochemistry assay.The expression of Semaphorin 5A was determined by Western blotting assay in gastric cancer cell lines SGC7901 and MKN-45 with metastatic ability and gastric cancer cell lines SNU-1 and AGS without metastatic ability.With RNA interfere technique(RNAi),Semaphorin 5A siRNA expression vector was constructed and transfected into gastric cancer cell line SGC7901.The stable gastric cancer cell line down-expressing Semaphorin 5A was established.The effect of Semaphorin 5A gene silencing on the adhesion,migration and invasion of gastric cancer cell was examined by cell adhesion test,wound healing test and transwell chamber assays.Results The expression level of Semaphorin 5A was correlated with the differentiation degree of gastric cancer(x2 =6.32,P =0.01),lymphnode metastasis(x2 =7.68,P=0.01)and distant metastasis of gastric cancer(x2 =13.67,P =0.00),not correlated with age(x2 =0.21,P=0.79),gender(x2=1.79,P=0.15)and the depth of gastric cancer invasion(x2=1.34,P=0.55).The expression of Semaphorin 5A in cell lines SGC7901 and MKN-45 was significantly higher than that of cell lines SNU-1 and AGS(P＜0.01).Semaphorin 5A gene silencing significantly suppressed the adhesion,migration and invasion abilities of gastric cancer cells.Conclusion Semaphorin 5A may play a catalytic role in the invasion and metastasis of gastric cancer through increasing the adhesion,migration and invasion abilities of gastric cancer cell.
RESUMO
Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.
RESUMO
Objective To explore the relationship between behavioral psychological symptoms in Alzheimer' s dementia(AD) patients and region-specific alterations in cerebral blood flow. Methods 60 patients with AD randomly selected from a psychiatric outpatient department and 30 randomly selected healthy elderly community controls were administered the Mini-Mental State Exam (MMSE). All subjects underwent a perfusion CT scan to assess blood perfusion in brain regions of interest. The AD subjects were administered the behavioral patholigy in alzheimer' s disease(BEHAVE-AD) Rating Scale classified as mild, moderate or severe based on the results of the Clinical Dementia Rating scale. Results The most incidence was conduct disorder and the next was delusion.The score was 81.7% and 58.3% in turn. The conduct disorder score was higher in the severe demented group than in the mildly and moderate demented group(P＜0. 05). The delusion score was higher in the moderate demented group than that in the mildly demented group(P＜0.05). The time to peak(TTP)scores in the four groups of subjects were significantly different in the bilateral hippocampal formation, anteroinferior subiculum and entorhinal area. The TTP score was significantly higher in the moderately demented group than that in the mildly demented group and the control group(P＜0. 05 ). Correlation analysis identified a positive correlation between conduct disorder, delusions and TTP in cerebral heteroplasia cortex (P ＜ 0. 05 ), also identified a negative correlation between mood disorder and TTP(P＜0. 05 ). Conclusion The conduct disorder,delusions and mood disorder in AD are associated with the chronicity ischemia of cerebral heteroplasia cortex leading to neural conduction disorders.
RESUMO
OBJECTIVE To investigate the distribution and resistance of pathogenic becteria isolated from inpatients with lower respiratory tract infection in Department of Gerontal Respiratory Medicine during from Aug 2006 to Aug 2007.METHODS All the clinical isolates from sputum were analyzed retrospectively.RESULTS There were 211(79.8%) strains of Gram-negative bacilli,40(15.2%) strains of Gram-positive bacteria and 12(6%) strains of fungi.The most important Gram-negative pathogens were Klebsiella pneumoniae.Pseudomonas aeruginosa,Enterobacter cloacae and Escherichia coli.Strains of Gram-negative bacteria were susceptible to imipenem,cefoperzone/sulbactam and amikacin,strains of Gram-positive pathogens were susceptible to vancomycin,nitrofurantoin,cefazolin and imipenem.CONCLUSIONS Gram-negative bacilli are the major pathogens in lower respiratory tract infection in Department of Gerontal Respiratory Medicine and the dominant is conditional pathogen.Rational use of antibiotics is important for the containment of bacterial resistance.
RESUMO
Objective To evaluate the effectiveness of Moxifloxaein in treatment of multidrug-resistant(MDR)pulmonary tuberculosis.Methods 65 MDR pulmonary Mycobacterium tuberculosis patients were randomized divided into two groups,separately receiving the regimens of contained Moxifloxacin0.4 qd or Levofloxacin 0.6 qd six drugs treatment accompanying with aminoglycosides,prothionamide,pasiniazid,pyrazinamide,ethambutol and clarithromyein from 2003—2005y in Guangzhou chest hospital.The treatment outcomes were evaluated when study executed one and half year later.Results 35 patients in moxifloxacin group had 27 cases cured,and 30 patients in levofloxacin group had 19 cases cured.The success rates were 77.1% versus 63.3%(P=0.222).The time to sputum culture conversion were (1.9?0.7)months and 3.0?1.8 months(P=0.035).Bacillary susceptible to levofloxacin,good adherence,radi- ographic extent less than one lung,and use of moxifloxacin were independent predictors of favorable outcome(odds ratios,7.3 to 21.4).Conclusion Moxifloxacin was found have a better bactericidal activity in vivo and less side effects. Its efficacy was higher than levofloxacin when incorporated into muhidrug regimens used for treatment of MDR tuberculosis.
RESUMO
Abstract Objective:To study GST-? expression in breast cancer and axillary lymphnodes.Methods: The expression of GST-Tr proteinand mRNA was detected by means of immunohistochemistry and RT- PCR. Results: In normal breast tissue, cancer tissue , HE positive lymph-nodes and HE negative lymphnodes , GST-? protein expression rate is 0,60% ,77% ,43%; GST-? mRNA expression rate is 0,88% ,71%and 39% , respectively. Conclusion; GST-?gene whose expression is upregulated as tumor occurs and develops can be used as a tumor biomar-ker; GST-? expression in HE negative lymphnodes suggests the poor prognosis; drug-resistance response is more sensitive in lymphnode than inprimary cancer. The expression of GST-? gene may be regulated by RNA or before RNA transcription.
RESUMO
0.05) ; whereas it was seen in CNE-2Z-H5-9. Anti-PAI-1 antibody did not inhibit the heterogeneous adhesion and invsion of CNE-2Z-H5-9. Conclusions:PAI-1 maybe inhibit the metastasis and invasion of NPC.