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25 August 2022, Volume 21 Issue 04 Previous Issue    Next Issue

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Analysis on the clinicopathological characteristics and follow-up of 32 patients with human immunodeficiency virus infection and chronic kidney diseases SHI Xia, MA Xin, WANG Zhenyan, ZHANG Hui, LIU Shaojun 2022, 21 (04):  437-443.  DOI: 10.16150/j.1671-2870.2022.04.004 Abstract ( 198 )   HTML ( 4 )   PDF (1483KB) ( 110 )   Objective: To analyze the pathological types, clinical characteristics and outcomes of human immunodeficiency virus (HIV)-infected patients with chronic kidney diseases (CKD). Methods: Thirty-two cases of HIV infection combined with CKD who underwent ultrasound guided renal biopsy in Shanghai Public Health Clinical Center from June 2016 to April 2021 were enrolled. Pathological types, clinical conditions and outcomes were all analyzed. Results: Among the 32 patients, there were 28 male and 4 female, with an average age of (43.5±12.3) years. The CD4+T lymphocyte count was (425.9±240.4) cells/μL. Twenty-six patients (81.3%) had been treated with antiretroviral therapy before renal puncture biopsy, and the median treatment time was 24 (1, 72) months. Among the pathological types, membranous nephropathy (8 cases, 25.0%) and IgA nephropathy (6 cases, 18.8%) accounted for the most types, followed by diabetic nephropathy (5 cases, 15.6%). No classical HIV-related nephropathy was found. During the follow-up period of 3 months to 5 years, the remission rate of renal disease reached 84.4% (13 complete remissions, 14 partial remissions), and the unresponsive rate was 9.4% (3 cases, including 1 case of lupus like immune complex mediated proliferative glomerulonephritis, 1 case of diabetes nephropathy, and 1 case of hypertensive nephropathy). The mortality rate was 6.3%(2 cases, all minor lesions). Conclusions: This study shows that the pathological types of HIV infected patients with CKD are various. Membranous nephropathy is predominant pathological type, and followed by IgA nephropathy and diabetes nephropathy, but classical HIV related nephropathy is not common. According to the pathological results of renal biopsy, renal disease related treatment based on antiretroviral therapy can alleviate renal disease or delay the progression of renal disease, but the prognosis of patients with minimal change nephropathy may be poor. Figures and Tables | References | Related Articles | Metrics

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Analysis of 133 dead cases of AIDS patients co-infected with Talaromycosis CHEN Zhimin, LIU Bo, He Haolan, HE Yaozu, FENG Lizhi, LIU Xinhua, ZHANG Jiansheng, CAI Weiping, LI Linghua 2022, 21 (04):  444-449.  DOI: 10.16150/j.1671-2870.2022.04.005 Abstract ( 238 )   HTML ( 4 )   PDF (639KB) ( 63 )   Objective: To investigate the mortality, clinical characteristics and related risk factors of death in the AIDS patient co-infected with Talaromycosis. Methods: A total of 133 AIDS patients co-infected with Talaromycosis who died from 2013 to 2021 in Guangzhou Eighth People′s Hospital of Guangzhou Medical University were enrolled and the information was analyzed retrospectively. The patients admitted in hospital were divided into two groups to compare the clinical data, which were 93 patients receiving antifungal therapy within 14 days after admission(Group A) and 40 patients died after 14 days (Group B). Results: From 2013 to 2021, a total of 18722 AIDS patients were admitted,and 1947 AIDS patients(10.4%) were co-infected with Talaromycosis. It revealed that 133 out of 1947 patients died, and the total mortality was 6.83%. The incidence of septic shock in Group A were significantly higher than those in Group B (93.5% vs 57.5%)(P<0.001). The blood bone marrow culture time, PTA, platelet count (<50×109/L), albumin level (20 g/L vs 25 g/L) and etiological conversion rate in Group A were lower than those in Group B (P<0.05). While the incidence of CMV, TB, PCP, severe pneumonia, and nosocomial infection rate in Group B were higher than those in Group A. Conclusions: The incidence and mortality of AIDS patients co-infected with Talaromycosis is high. The clinical symptoms of patient died early are septic shock, low platelet count and low albumin level, having a higher probability of early death and worse basic status. Most of the pathogens turne negative in the patients die later, while the other opportunistic infections or nosocomial infections could be important causes of death. Figures and Tables | References | Related Articles | Metrics

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Characteristcs of mycobacterial species distribution in acquired immunodeficiency syndrome patients with mycobacterial infection in Shanghai HU Jingjing, LÜ Haiwei, XUN Jingna, SHEN Yinzhong, LIU Li, LU Hongzhou 2022, 21 (04):  450-455.  DOI: 10.16150/j.1671-2870.2022.04.006 Abstract ( 270 )   HTML ( 4 )   PDF (589KB) ( 62 )   Objective: To analyze the distribution of mycobacterium(MB) species in patients with AIDS and with MB. Methods: From January 1, 2012 to December 31, 2021, a total of 9 619 outpatients and inpatients with AIDS and with mycobacterial culture in the Shanghai Public Health Clinical Center were enrolled. The clinical data of those with positive culture of MB were analyzed, and the isolated strains were obtained. The strains were identified using the immunocolloidal gold method of MPB64, a specific secreted protein of tubercle bacilli, or mycobacterial sequencing (16S rDNA) method, and the distribution characteristics of strains in AIDS patients with MB infection were analyzed. Results: A total of 1 478 patients got a positive result of MB culture and among them, 1 367 patients obtained an identified strain species result, including 494 (36.1%) cases of mycobacterium tuberculosis complex (MTBC), 838 (61.3%) cases of non-tuberculous mycobacteria (NTM), and 35 (2.6%) cases of MTBC combined with NTM. The year-by-year composition of NTM (patients with mixed MTBC and NTM infection are not included) from 2012 to 2021 were 55.2%(53/96), 65.5% (78/119), 66.2% (90/136), 55.1% (70/127), 61.6% (93/151), 66.1% (111/168), 58.9% (99/168), 61.8% (94/152), 63.6%(77/121), and 56.6% (73/129). Sputum was the main tissue specimen, accounted for 68.0% (336/494), 78.0% (654/838) and 88.6% (31/35) in patients with MTBC, NTM, mixed MTBC-NTM infection, respectively. One thousand two hundred and seventy-one patients with positive MB culture were admitted to the Department of Infection and Immunology, of which the NTM accounted for 58.5%(743/1 271). Conclusions: From 2012 to 2021, the positive rate of MB culture among AIDS patients in Shanghai is 15.4%(1 478/9 619), of which the composition ratio of NTM are higher than that of MTBC over the years. This suggests that clinicians should pay high attention to the diagnosis and treatment of NTM. Figures and Tables | References | Related Articles | Metrics

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Misdiagnosis by whole exome sequencing in progressive myoclonic ataxia consanguineous families: causes and strategies YANG Hui, LI Yunlu, YANG Kang, LI Shiju, HE Jin 2022, 21 (04):  456-461.  DOI: 10.16150/j.1671-2870.2022.04.007 Abstract ( 234 )   HTML ( 5 )   PDF (1039KB) ( 102 )   Objective: To investigate the causes and strategies of missed diagnosis of progressive myoclonic ataxia (PMA) consanguineous families by whole exome sequencing (WES). Methods: Five PMA consanguineous families with no disease causative variants detected by WES were enrolled, and homozygosity mapping and haplotype analysis for locating disease related region were performed. Further combined with myoclonus and ataxia phenotypes, the possible pathogenic genes were identified. Sanger sequencing was used to verify the candidate mutation and perfomed family co-segregation in five families. Finally, the reasons for missed diagnosis were analyzed by tracing to the SAM and BAM files from WES alignment process. Results: By homozygous regional mapping and reanalysis of WES, 5 families with progressive myoclonic ataxia were identified as sialidosis type I (ST-I) caused by homozygous mutation of NEU1 gene c.544A >G(p.S182G). It was also found that ALT contig in human genome reference sequence could cause multiple pathogenic genes including NEU1 gene to be missed during WES alignment. Conclusions: In clinical diagnosis, autosomal recessive PMA should be paid attention to ST-I which caused by NEU1 gene mutation. For families with hereditary diseases in which WES has not found pathogenic loci, the pathogenic region can be located by combining family genetic mode and genome-wide SNP chip, then the pathogenic genes can be identified by clinical manifestations analysis. Figures and Tables | References | Related Articles | Metrics

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Analysis on incidence of stomach cancer in 2016 and trend of incidence during 2002-2016 in Shanghai BAO Pingping, WU Chunxiao, GU Kai, PANG Yi, WANG Chunfang, SHI Liang, XIANG Yongmei, GONG Yangming, DOU Jianming, WU Mengyin, FU Chen, SHI Yan 2022, 21 (04):  462-469.  DOI: 10.16150/j.1671-2870.2022.04.008 Abstract ( 251 )   HTML ( 5 )   PDF (999KB) ( 64 )   Objective: To investigate the incidence of stomach cancer in 2016 and the trend of incidence during 2002-2016 in Shanghai. Methods: The data on new-diagnosed stomach cancer during 2002-2016 were obtained from population-based cancer registry in Shanghai Municipal Center for Disease Control and Prevention. The incidence of stomach cancer stratified by year of diagnosis, gender, and age-group were analyzed. The number, proportion, crude rate, age-specific rate, age-standardized and annual percentage change were calculated, and the trends of incidence were evaluated. Segi′s World Standard Population in 1960 was used to calculate age-standardized rates of incidence and mortality, and the Joinpoint was used to analyze the trend of incidence of stomach cancer. Results: The new stomach cancer cases in Shanghai were 5 979 in 2016. The crude rate of incidence was 41.29/105 and the age-standardized rate was 15.85/105. The stomach cancer was one the most common cancers and ranked fourth in Shanghai. The age-standardized rate in male (21.19/105) was higher than that in female (10.84/105). The age-standardized rate of stomach cancer decreased during 2002-2016 in both male and female, and the APC was -2.93% (-3.23%, -2.63%) in male and -2.70% (-2.98%, -2.42%) in female, respectively. The morbidity rates of stomach cancer increased with age, which was <10/105 before 45 years, 17.08/105 in male and 13.22/105 in female between 45 and 49 years. After 50 years, the rates increased markedly and reached peak in age group of 80-84 years. While the age-specific incidence rates in all age groups showed decreased trend during 2002 through 2016, especially in the younger age group(<50 years). Conclusions: Population-based incidence data can provide helpful information in prevention of stomach cancer and policy decision. Figures and Tables | References | Related Articles | Metrics

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Effect of Haemophilus influenzae colonizing in lower respiratory tract on immune imbalance through TLR4 signaling pathway in asthmatic mice XU Cheng, XU Xinxin, TIAN Ye, FAN Jiaying, SONG Zhen, YANG Ling 2022, 21 (04):  470-475.  DOI: 10.16150/j.1671-2870.2022.04.009 Abstract ( 227 )   HTML ( 3 )   PDF (829KB) ( 33 )   Objective: To observe the effect of Haemophilus influenzae colonizing in lower respiratory tract on airway inflammation and immune imbalance in asthmatic mice, and to study the signaling pathway. Methods: Thirty-two C57BL/6 wild type (WT) and 32 TLR4 gene knockout (TLR4-/-) mice were used. The C57BL/6 mice were randomly divided into control group (NC), asthma group (AC), inoculation group (NS) and asthma inoculation group (AS), and there were 8 mice in each group. Thirty-two TLR4-/- mice were grouped same as above. Mice in AC and AS group were sensitized and stimulated by ovalbumin (OVA) to make chronice asthma model. The Hemophilus influenzae AGAR bead was infused into the airway to prepare the airway colonization model. The levels of IL-17 and IL-10 in serum were measured by ELISA. Th17, Treg and TLR4+ cells in spleen nonocytes were isolated and detected by flow cytometry, and the association analysis among them was performed. Results: In C57BL/6 wild type mice, compared with AC, NS and NC group, IL-17, IL-17/IL-10, Th17 and TLR4+ cell increased, and IL-10 and Treg decreased significantly in AS group, which indicated Haemophilus influenza colonization worsen airway inflammation and led to immune imbalance. Compared with AS group of C57BL/6, IL-17, IL-17/IL-10, Th17, Th17/Treg, TLR4+ cells were decreased, and IL-10 and Treg increased in AS Group of TLR4-/mice, which implicated Haemophilus influenza colonization in lower airway might play effect through TLR4-/- signaling pathway. Correlation analysis showed that ratio of CD4+T lymphocyte with TLR4 expression was positively correlated with Th17 ratio(r=0.912, 0.723, P<0.05, respectively), while was negatively correlated with ratio of Treg cells (r=0.689, P<0.05), indicating that Haemophilus influenzae colonzing in the lower respiratory tract, may affect the balance of Th17 and Treg to influence the immune balance through TLR4. Conclusions: Haemophilus influenzae colonization in lower respiratory tract may aggravate the immune imbalance of asthmatic mice through signal transduction of TLR4, which led to the progression of asthma. Figures and Tables | References | Related Articles | Metrics

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Pulmonary mixed squamous cell and glandular papilloma clinicopathological characteristics of 2 cases and misdiagnosis analysis of frozen section CHE Wen, LIU Jiangshu, CHEN Xiaoyan, WANG Chaofu, YUAN Fei, WANG Xuan 2022, 21 (04):  476-481.  DOI: 10.16150/j.1671-2870.2022.04.010 Abstract ( 246 )   HTML ( 6 )   PDF (1128KB) ( 98 )   Objective: To discuss the clinicopathologic characteristics of pulmonary mixed squamous cell and glandular papilloma(PMSGP), and to analyze the key points for diagnosis and the causes of misdiagnosis of frozen section. Methods: Two cases of PMSGP diagnosed by pathology at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from 2019 to 2021 were enrolled, and the clinicopathologic and immunohistochemical characteristics and key points of frozen section diagnosis were analyzed based on literature review. Results: Two patients, a 74-year-old female and a 66-year-old male, were found to have pulmonary nodules in physical examination. One patient had chest tightness and pain. All nodules were considered as malignant tumors on imaging and lobectomy was performed. Frozen sections indicated one case was diagnosed as mucinous adenocarcinoma and the other diagnosed as PMSGP, but mucoepidermoid carcinoma could not be ruled out. In the paraffin section, the tumor sizes of 2 cases were 3.0 cm×2.5 cm×2.5 cm and 1.7 cm×1.7 cm×1.6 cm respectively. PMSGP displayed a papillary growth pattern lined by glandular epithelial cells and squamous cells. Inflammatory cells were observed along the papillary axis. Squamous epithelium could be mild to moderately atypical with rare mitosis and no necrosis. Immunohistochemistry examination showed that CK7 and TTF-1 were expressed in glandular epithelial cells, MUC5AC was expressed in mucinous columnar epithelial cells, squamous cells and basal-like cells expressed CK5/6, P63, P40 and Ki-67 was highly expressed only in the basal layer. MAML2 rearrangement was not detected in the 2 cases by FISH. No recurrence or metastasis was observed at 9 and 24 months of follow-up. A literature review of 39 cases showed that due to the morphological crossover with mucoepidermoid carcinoma and mucinous adenocarcinoma, and the atypical nature of the covered squamous epithelium was easily amplified in frozen section diagnosis, the misdiagnosis rate of PMSGP of tumor properties on frozen section is as high as 52.6%. Conclusions: PMSGP is a rare benign tumor of the lung, that has a high rate of misdiagnosis on frozen section. On frozen section, the tumor is well defined and has a papillary structure. The papilla is covered with squamous epithelium and glandular epithelium. Basal cells are arranged in a palisade pattern along the fibrovascular axis, and the cells are stratified without atypia. Mastering these characteristics helps to improve the diagnostic accuracy of frozen section. Figures and Tables | References | Related Articles | Metrics

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Automated synthesis of dopamine transporters imaging probe 18F-FP-CIT based on allin one for Micro PET/CT imaging of rat basal ganglia QU Qian, HAI Wangxi, HU Shengyan, ZHANG Min, CHEN Xiaoyue, ZHOU Yilei, WANG Jin, HU Xiaoping, LI Biao, HU Jiajia 2022, 21 (04):  482-489.  DOI: 10.16150/j.1671-2870.2022.04.011 Abstract ( 354 )   HTML ( 6 )   PDF (1410KB) ( 166 )   Objective: To verify the efficiency and stability of the automated labeling and synthesis of dopamine transporters (DAT) imaging probe, 18F-N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4′-iodophenyl) nortropane (18F-FP-CIT), based on the AllinOne module. Meanwhile, to evaluate the safety and targeted ability of the probe and the imaging effect on the basal ganglia of rats. Methods: A fluorination reaction between nitrogen-[3-(methoxy)propyl]-2β-carbonmethoxy-3β-(4′-iodophenyl) nortropane, the reaction precursor, and the dried fluorine-18 ion (18F) was performed, under the catalysis of TBAOH and Kryptofix 222. The product of the reaction was separated and purified by high performance liquid chromatography (HPLC). All the procedure was established on the AllinOne module under the highest yield conditions to perform automated labeling and synthesis of 18F-FP-CIT. Quality control tests and Micro PET/CT imaging of rat brain with the automatically synthesized product were carried out. Results: The average synthesis time, efficiency after attenuation correction, and radiochemical purity of 20 batches of 18F-FP-CIT made by the AllinOne module was (72.9±8.9) min, 34.8%±5.7%, and 98.4%±2.0%, retrospectively. The results of sterility test, endotoxin test, toxicity test and residual solvent test of acetonitrile were all met the clinical practice standards. Micro PET/CT imaging showed uniform and obvious targeted uptake of 18F-FP-CIT in basal ganglia of normal rats, and the uptake of 18F-FP-CIT in basal ganglia was 2.6 times that in cerebral cortex, 3.7 times that in cerebellum, and 4.1 times that in skull, respectively. Conclusions: The AllinOne module can automatically label and synthesize DAT imaging probe 18F-FP-CIT stably, rapidly, with high-quality, which is expected to provide imaging technical support for the clinical diagnosis and treatment of neurodegenerative changes such as Parkinson′s disease (PD). Figures and Tables | References | Related Articles | Metrics

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Pan-cancer analysis of plasmacytoma variant translocation 1 and MYC gene expression pattern and survival prediction MA Xuefei, WANG Xuefeng, WANG Kankan 2022, 21 (04):  490-496.  DOI: 10.16150/j.1671-2870.2022.04.012 Abstract ( 193 )   HTML ( 7 )   PDF (1374KB) ( 73 )   Objective: To explore the expression levels and survival prediction of plasmacytoma variant translocation 1 (PVT1) and MYC gene in pan-cancer. Methods: The clinic data and RNA-seq data from 31 types of cancer tissues totaling 10 016 cases were retrieved from The Cancer Genome Atlas (TCGA) database, among which 23 types of cancer with adjacent tissues as normal controls. Student t-tests were used to analyze the significant differences of PVT1 or MYC gene expression levels between cancer tissues and corresponding normal controls. Spearman correlation was used to analyze the expression correlation between PVT1 and MYC in 31 types of cancer. The relationship between PVT1 or MYC expression and overall survival of 31 types of cancer patients was depicted by the Kaplan-Meier curve and Cox proportional hazards model. Results: =PVT1 expression was highly expressed in 19 types of cancer(P<0.05) and lowly expressed in 2 types of cancer (P<0.05). MYC expression was significantly upregulated in 7 types of cancer (P<0.05) and downregulated in 6 types of cancer (P<0.05). Expression correlation analysis presented that PVT1 expression was positively correlated with MYC in about 87% (27/31) types of cancer (Rho>0, P<0.01). Finally, survival analysis showed that relatively high expression of PVT1 was significantly associated with shorter overall survival in bladder urothelial carcinoma, breast invasive carcinoma, adrenocortical carcinoma, renal clear cell carcinoma, renal papillary cell carcinoma, lower grade glioma, prostate adenocarcinoma, testicular germ cell tumors and uveal melanoma (log-rank P<0.05). The relatively high expression group of MYC was significantly correlated with shorter overall survival in adrenocortical carcinoma, bladder urothelial carcinoma, cervical squamous cell carcinoma, head and neck squamous cell carcinoma, renal papillary cell carcinoma, ovarian serous cystadenocarcinoma, pancreatic adenocarcinoma and sarcoma (log-rank P<0.05), while was associated with long-time survival in lower grade glioma and rectum adenocarcinoma (log-rank P<0.05). Conclusions: The increased expression of PVT1 in pan-cancer is more prevalent than that of MYC. The positive correlation between PVT1 and MYC indicates a potential regulatory relationship in cancers. Furthermore, the relatively high expression of PVT1 has a poor effect on the overall survival of patients in 9 types of cancer, while the expression level of MYC presents different effects on the overall survival of patients in various cancers. Figures and Tables | References | Related Articles | Metrics

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Primary antiphospholipid syndrome complicated with moyamoya syndrome: a case report and literature review SONG Luoqing, DAI Tingjun 2022, 21 (04):  497-503.  DOI: 10.16150/j.1671-2870.2022.04.013 Abstract ( 175 )   HTML ( 4 )   PDF (886KB) ( 88 )   Objective: To analyze the clinical data of a case of primary antiphospholipid syndrome (PAPS) combined with moyamoya syndrome (MMS), and to explore the clinical characteristics of APS combined with MMS. Methods:The clinical data of a patient with PAPS and MMS were collected and analyzed by searching the relevant literatures. Results: The patient was a 23 year old female with 2 pathological pregnancies. The disease started with cerebral infarction. Cerebrovascular imaging showed severe stenosis or occlusion of bilateral internal carotid arteries with collateral vessels formation, which was consistent with MMS findings. Abdominal CT showed splenomegaly. The symptoms were improved after anticoagulation and immunosuppressive therapy. Through literature review at home and abroad, 7 patients with APS complicated with smoky vascular changes with detailed clinical data were found, all of them were female, with an average age of 26.6 years. Their clinical manifestations were heterogeneous, in which limb weakness was a common symptom, with arteriovenous thrombosis, pathological pregnancy and persistent positive antiphospholipid antibody as the main clinical manifestations. A total of 6 patients were followed up in detail, and the symptoms of the 5 patients were improved after anticoagulation and immunosuppressive therapy. One patient died of cerebral hemorrhage. Conclusions: APS is an autoimmune disease involving multiple systems. The case report of APS with MMS is very rare. The anticoagulant or antiplatelet therapy of APS is contradictory to the risk of bleeding in the collateral vessels of MMS, so dual antiplatelet therapy should be carefully selected. Figures and Tables | References | Related Articles | Metrics

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Ultrasound screening to identify solid pseudopapillary tumours of the pancreas from pancreatic ductal adenocarcinoma GU Xuan, LIU Jun 2022, 21 (04):  504-508.  DOI: 10.16150/j.1671-2870.2022.04.014 Abstract ( 148 )   HTML ( 3 )   PDF (656KB) ( 71 )   Objective: To investigate the ultrasonographic features of solid pseudo papillary tumor of the pancreas (SPTP) and pancreatic ductal adenocarcinoma(PDAC), to initially screen and compare the key points of ultrasonographic diagnosis between the two. Methods: The ultrasound findings of 48 patients with SPTP and 48 patients with PDAC confirmed by surgical pathology in our hospital from August 2009 to March 2018 were retrospectively analyzed. Their ultrasound sonographic features and the key points for differentiation between them were summarized. Results: Using pathological findings as the gold standard, the coincidence rates of the ultrasound diagnosis of SPTP and PDAC was 68.8%(33/48) and 85.4%(41/48), respectively. On ultrasound images, the origin of the mass, internal echogenicity, calcification and internal blood flow were very similar to those of PDAC (P>0.05). However, the rate of clear margins, regular morphology and liquefaction were significantly higher in SPTP than those in PDAC[SPTP, 73.9%(34/46), 73.9%(34/46) and 37.0%(15/42);PDAC, 28.6%(12/42), 35.7%(15/42) and 7.1%（3/42）, whereas the incidence of dilatation of the main pancreatic duct was lower in SPTP than that in PDAC 6.5%(3/46) vs. 35.7%（15/42）, with a statistically significant difference (P<0.01). Among the above ultrasound features, the liquefaction feature was the most significant criterion for identifying SPTP and PDAC. Conclusion: The use of ultrasound screening to identify SPTP and PDAC has the advantages of being non-invasive, convenient and economical. SPTP should be considered first when ultrasound shows a pancreatic mass with liquefaction in a clear margin and regular shape. Figures and Tables | References | Related Articles | Metrics

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Clinical value of serum pepsinogen,gastrin 17 and Helicobacter pylori IgG antibody in primary screening of gastric diseases LI Nana, QI Tao, ZHU Liming 2022, 21 (04):  509-513.  DOI: 10.16150/j.1671-2870.2022.04.015 Abstract ( 241 )   HTML ( 6 )   PDF (506KB) ( 151 )   Objective: To explore the clinical value of serum PGI, PGII, PGI/PGII, G-17 levels and Hp-IgG antibody in the preliminary screening of gastric diseases. Methods: A total of 300 patients who underwent gastroscopy in the Gastroenterology Department of our hospital from July 2018 to July 2020 due to gastric diseases were selected as the research objects. According to gastroscopy and pathological examinations, they were divided into chronic superficial gastritis group,chronic atrophic gastritis group and gastric cancer group. 100 healthy patients from the physical examination center during the same period were selected as the control group. The serum PGI, PGII, PGI/PGII G17 levels and the positive rate of Hp-IgG antibody in each group were compared. Results: Serum PGI/PGII levels in gastric cancer group(10.42±4.63) and atrophic gastritis group (10.54±4.36) were lower than those in control group (12.07±6.80). Serum G-17 levels in gastric cancer group [(13.85±27.68） pmmol/L] and chronic atrophic gastritis group [(9.63±10.82) pmmol/L] were higher than those in control group [(6.02±7.30) pmmol/L]. The serum PGI level in gastric cancer group[(123.53±35.45) μg/L] was lower than that in the control group[(148.24±83.85) μg/L and chronic superficial gastritis group [(141.95±81.11) μg/L]. The differences were statistically significant (P<0.05). The positive rate of Hp-IgG antibody in gastric cancer group (50.75%) and atrophic gastritis group (50.00%) was higher than that of the control group (35.00%), and the difference was statistically significant (P<0.05). Conclusions: Serum PGI, PGII, PGI/PGII, G-17 levels and Hp-IgG antibody detection can be used for the primary screening of gastric diseases, which can identify high-risk groups of gastric cancer and provide a reliable reference for further screening of gastric cancer. Figures and Tables | References | Related Articles | Metrics

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Application of long non-coding RNA ENST00000489676 detection in ultrasonographic evaluation of cervical lymph node metastasis in papillary thyroid carcinoma WANG Wenhan, XIA Shujun, ZHAN Weiwei 2022, 21 (04):  514-519.  DOI: 10.16150/j.1671-2870.2022.04.016 Abstract ( 176 )   HTML ( 2 )   PDF (586KB) ( 54 )   Objective: To analyze the value of lncRNA ENST0000048967 detection in biopsy tissue of papillary thyroid carcinoma (PTC) by ultrasound-guided fine-needle aspiration (US-FNA) for diagnosing cervical lymph node metastasis. Methods: A total of 110 PTC patients with pathologically confirmed cervical lymph node metastasis in Ruijin hospital during June 2020 to December 2020, were enrolled (study group). Another 110 PTC patients without cervical lymph node metastasis were served as the control group. The expression level of ENST00000489676 in FNA biopsy samples from 220 patients were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The correlation of ENST00000489676 expression with lymph node metastasis in PTC patients was explored. ROC curve was used to calculate the cutoff value of ENST00000489676 expression level for diagnosing cervical lymph node metastasis of PTC in puncture specimens. The sensitivity, specificity and accuracy of ultrasonography alone and combined with ENST00000489676 detection in FNA biopsy samples for diagnosis of lymph node metastasis were also calculated respectively. Results: The expression of ENST0000048967 in study group was significantly lower than that in non-lymph node metastasis group(t=-4.198, P<0.001). The statistical results showed that the low expression of ENST000000489676 was positively correlated with PTC lymph node metastasis. The optimal cutoff value of ENST00000489676 for diagnosing cervical lymph node metastasis of PTC in the FNAB specimen was 2.0950 by ROC curve. The sensitivity and accuracy of ultrasonography combined with ENST00000489676 detection for diagnosising lymph node metastasis were higher than those of ultrasonography alone, respectively(sensitivity, 61.11% and 17.27%; specificity, 63.39% and 86.36%; accuracy, 62.27%, and 51.82%). Conclusions: Low expression of ENST00000489676 is significantly correlated with lymph node metastasis of PTC. ENST00000489676 may serve as a molecular marker to assist ultrasonography diagnosis of cervical lymph node metastasis for PTC. Figures and Tables | References | Related Articles | Metrics

Case reports

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Hematogenous disseminated pneumonia secondary to suppurative tonsillitis in adults: a case report and literature review BAO Zhiyao, MENG Wenkai, SHEN Jimin, LI Qingyun 2022, 21 (04):  520-523.  DOI: 10.16150/j.1671-2870.2022.04.017 Abstract ( 225 )   HTML ( 3 )   PDF (854KB) ( 58 )   Streptococcus pyogenes is also called group A streptococcus (GAS), is an uncommon pathogen for community acquired pneumonia(CAP) in adults, which is easily ignored in clinical diagnosis. This paper reports a young man with pneumonia caused by nonstandard treatment of acute suppurative tonsillitis, who accompanied by an increase in antistreptolysin O(ASO) and pathogenic bacteria was identified as GAS. After vancomycin was injected intravenously to control the infection, the ASO antibody titer remained at a high level, so the patient was given intramuscular benzylpenicillin once a month for 5 months. After 6 months of follow-up, the patient had no fever, sore throat or other symptoms, the ASO level decreased to normal, and there was no rheumatic multiple organ injury. In recent years, there are still reports of global GAS infection, and it can cause a series of complications, such as rheumatic heat, rheumatic heart disease, and even death in severe cases. The early diagnosis and treatment of GAS infection is crucial. Figures and Tables | References | Related Articles | Metrics

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Leishmaniasis with secondary hemophagocytic syndrome: a case report XIONG Xinhai, LI Jia, DING Xiaosong, JI Congcong, SHI Hourong, XIANG Minjie 2022, 21 (04):  524-526.  DOI: 10.16150/j.1671-2870.2022.04.018 Abstract ( 203 )   HTML ( 4 )   PDF (474KB) ( 105 )   Leishmaniasis is an infection caused by Leishmania. Different species of Leishmania cause different clinical syndromes. Hemophagocytic syndrome (HPS) is an immune related systemic inflammatory response syndrome mediated by many factors. This paper reported that one male patient with “fever of unknown origin, connective tissue disease” who was not effectively treated and was admitted to the Wuxi District Hospital in Jiangsu Province. After the analysis of clinical manifestations and the inquiry of the working history in the western mountain area, the patient was finally diagnosed as HPS secondary to Leishmaniasis by etiological and genetic examination. The patient was treated with antimony sodium gluconate for Leishmaniasis, according to the 1994 scheme of hemophagocytic syndrome treatment (HLH-94), and was discharged after his condition improved. When HPS secondary to Leishmaniasis, the disease develops rapidly. It is not common, and is easy to miss diagnosis. This paper reports a case of a patient in the eastern plain area, which the doctors should pay more attention to in clinic. Figures and Tables | References | Related Articles | Metrics

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Fabry disease presenting with renal disease as the main manifestation diagnosed by renal biopsy: a case report HAO Xu, WANG Weiming 2022, 21 (04):  527-529.  DOI: 10.16150/j.1671-2870.2022.04.019 Abstract ( 228 )   HTML ( 3 )   PDF (722KB) ( 68 )   Fabry′s disease is an X-linked recessive genetic disease, which is mainly due to the mutation of (galactosidase A, GLA) gene. The decrease or loss of GLA activity eventually leads to the deposition of its metabolic substrate in multiple organs of the body, in which the kidney and heart are the two main affected organs. This paper reports a case of Fabry disease without gene mutation and diagnosed by renal biopsy and derease of GLA activity[26.2 nmol/(mL·h·m)][refer-ence value: >37 nmol/(mL·h·m)], clarifying the role of renal pathology in the diagnosis of the disease. Figures and Tables | References | Related Articles | Metrics

Review articles

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Progress in diagnosis and treatment of human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with tuberculosis CHEN Hong, SHEN Yinzhong 2022, 21 (04):  530-534.  DOI: 10.16150/j.1671-2870.2022.04.020 Abstract ( 307 )   HTML ( 8 )   PDF (524KB) ( 94 )   Tuberculosis is one of the major co-infections that affect the prognosis and quality of life of HIV infection/ AIDS patients. The clinical characteristics of HIV infection/AIDS patients combined with tuberculosis are different from those of patients with tuberculosis alone, and its diagnosis and treatment are more difficult. Etiological diagnosis is the main basis for clinical diagnosis of tuberculosis, and nucleic acid detection methods based on DNA and RNA technology, such as Xpert MTB/RIF and Xpert MTB/RIF Ultra, have been used for early diagnosis for HIV infetion/AIDS patients combined with tuberculosis due to their high sensitivity and specificity. At present, many studies hope to find new diagnostic markers through multi-omics research to help to diagnose tuberculosis earlier and faster in patients. Although there are some biomarkers with potential value in the research of transcriptome and proteome, the practical value needs further research and confirmation. The treatments for patients with co-infection include anti-MTB therapy and antiretroviral therapy (ART). In principle, the treatment of co-infection is the same as that of single pathogen infection. However, due to the complex interactions between the two pathogens and among the therapeutic medicines, the treatment of patients with co-infection is more complex. The complexity of the diagnosis and treatment of co-infection leads to the treatment outcome still needing to be further improved. It is particularly important for us to further study the mechanism and impact of HIV infection/MTB interaction and to explore more optimized and accessible clinical diagnosis methods and treatment regimens in future research. References | Related Articles | Metrics

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Application of metabolomics of different biological samples in study of OSAHS biomarkers ZHOU Sifeng, XU Haishu, FAN Xinsheng 2022, 21 (04):  535-540.  DOI: 10.16150/j.1671-2870.2022.04.021 Abstract ( 280 )   HTML ( 4 )   PDF (684KB) ( 135 )   The obstructive sleep apnea-hypopnea syndrome(OSAHS) is a sleep disorder caused by upper airway stenosis, and the main clinical manifestations were apnea, hypopnea, and arousal. In recent years, the incidence of OSAHS shows increasing trend, while its clinical diagnosis method is still relatively simple, and the early accurate diagnosis cannot be achieved. Metabolomics has played an important role in many disciplines such as medicine, pharmacy, and toxicology as an emerging subject, even if its research develops relatively short time. In this paper, we systematically reviewed the studies and applications of metabolomics on OSAHS biomarkers and found that OSAHS could cause changes in some special metabolites, including amino acids, lipids, acylcarnitines, intestinal flora, phospholipids, aromatic hydrocarbons, saturated hydrocarbons, acetone and isoprene. These metabolites involved in various metabolic pathways and mechanisms such as amino acid metabolism, lipid metabolism, oxidative stress pathway, phospholipid metabolism and endocannabinoids. The differential metabolites existed in a variety of biological samples in patients, including blood, urine, feces, saliva, and tonsil tissue, and some metabolites could be used in the early diagnosis and differential diagnosis of OSAHS and as the reference for further research on the biomarkers and pathogenesis of OSAHS. References | Related Articles | Metrics

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Research progress on the application of machine learning in assisted ultrasound diagnosis of adnexal masses HE Xin, CHEN Hui, FENG Weiwei 2022, 21 (04):  541-546.  DOI: 10.16150/j.1671-2870.2022.04.022 Abstract ( 207 )   HTML ( 3 )   PDF (693KB) ( 161 )   Ovarian cancer is the second most common cause of gynecologic cancer death in women around the world. Around 75% of patients present with stage Ⅲ/Ⅳ disease at diagnosis, with five-year survival rates below 45%. Ovarian cancer is the main adnexal malignant mass. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. In recent years, the field of artificial intelligence is developing rapidly. As a branch of artificial intelligence, machine learning could learn efficiently from complex and large amounts of data, which has infinite potential to differentiate benign and malignant adnexal masses. Logistic regression(LR), artificial neural network (ANN), support vector machine (SVM), deep learning convolution neural networks (DCNN) have been widely applied in this field, and achieved good diagnostic performance. This paper will review the history and progress of machine learning in ultrasound diagnosis of benign and malignant adnexal masses. Figures and Tables | References | Related Articles | Metrics