Table of Content

20 February 2019, Volume 34 Issue 2

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Importance of identification and standardized diagnosis of familial fatal insomnia

Jing Donglai, Kong Yu, Cui Yue, Wang Yuping, Wu Liyong

2019, 34(2):  101-105.  doi:10.3969/j.issn.1004-583X.2019.02.001

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Fatal familial insomnia is a rare and fatal hereditary prion disease. The core clinical manifestations are sleeprelated symptoms, rapidly progressive dementia, autonomic nerve dysfunction and others. For the high fatality rate of this disease, its early diagnosis is particularly important. But, because its symptoms are rare and nonspecific, it is difficult for clinicians to identify FFI in early stage, which cause misdiagnosis rate and missed diagnosis rate. The pathogenesis, pathological changes, clinical features, auxiliary examination features and diagnostic criteria of FFI were described to improve the understanding of FFI among clinicians and  a new diagnostic criteria for Chinese population was put forward.

Progress in diagnosis and treatment of HIV peripheral neuropathy

Sun Liuqing, Cui Fang, Huang Dehui

2019, 34(2):  106-110.  doi:10.3969/j.issn.1004-583X.2019.02.002

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Peripheral neuropathy is the most common neurological disease in HIVinfected people. Distal symmetrical peripheral neuropathy, acute inflammatory demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy and mononeuropathy multiplex are the most common clinical complications, which seriously affect  life quality of patients. This article aims to analyze the pathophysiological changes and pathogenesis of HIV peripheral neuropathy (HIVPN), to understand the clinical manifestations of HIVPN, and to summarize its experience in diagnosis and treatment, so as to guide clinicians to correctly understand, reasonable prevent the disease, and  standardize the diagnosis and treatment.

Progress in diagnosis and treatment of intraspinal tuberculosis

Xiang Feng1,2，Zhang Xu1, Huang Dehui1，Yu Shengyuan1

2019, 34(2):  111-115.  doi:10.3969/j.issn.1004-583X.2019.02.003

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Intraspinal tuberculosis includes spinal cord tuberculosis and meningeal tuberculosis. It has the characteristics of low incidence and high mortality. Due to the lack of specificity in clinical and imaging manifestations, low positive rate of auxiliary examination,  clinical diagnosis and followup treatment are often delayed, thus affecting the prognosis of the disease. This paper focuses on the clinical manifestations,  diagnosis,  treatment and progress of intraspinal tuberculosis infection.

Application of FuglMeyer assessment in mirror therapy of stroke and correlation analysis with functional independence measure

Hu Guojin, Sun Xiuli, Zhang Yifa, Sun Lihuizi, Geng Chao, Zhang Li, Huang Wei, Xiao Yao

2019, 34(2):  116-119.  doi:10.3969/j.issn.1004-583X.2019.02.004

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Objective  To evaluate the role of the upper Fugl Meyer motor function assessment (UFMA) in the mirror therapy of stroke patients and its correlation with the functional independence measure(FIM). Methods  A total of 80 patients with hemiplegia were randomly divided into the mirror therapy group (40 cases) and the routine rehabilitation group (40 cases). Patients in the routine  rehabilitation group were given routine rehabilitation training, mirror treatment group were given the mirror therapy based on routine rehabilitation therapy. The treatment lasted 24 weeks. Before the treatment and after 8, 16, and 24 weeks'  treatment, the UFMA was used to evaluate the motor function with the FIM to assess the daily independent activity ability in order to analyze the patient's motor function and daily life. The improvement degree of the patient's motor function and the daily living activities and the correlation between the two scales were analyzed. Results  After 8, 16 and 24 weeks'  treatment, the scores of UFMA and FIM in two groups were significantly different compared with before treatment (P<0.05). The scores in mirror treatment group were statistically significant than those in routine rehabilitation group (P<0.05). Correlation analysis showed that UFMA score was positively correlated with FIM score.Conclusion  The mirror treatment can improve the upper limb motor function and the activities of daily living in stroke patients with hemiplegia. UFMA and FIM can better reflect the improvement of upper limb motor function and daily living ability of stroke patients after rehabilitation, and the two scores show  positive correlation.

Correlation between serum calcium concentration and prognosis in patients with hypertensive intracerebral hemorrhage

Zhang Zhenzhou, Wu Shengxiang, Zhang Guolong

2019, 34(2):  120-123.  doi:10.3969/j.issn.1004-583X.2019.02.005

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Objective  To investigate the effect of serum calcium concentration on the prognosis of patients with hypertensive intracerebral hemorrhage(HICH). Methods  According to the blood calcium concentration measured at the admission, the patients were divided into three groups,  normal blood calcium group(n=145), hypocalcemia group(n=45) and hypercalcemia group(n=30). At the same time, baseline data and head CT/MRI scans were collected, and followup prognosis was assessed using Grasse Prognosis Scale(GCS). Multivariate logistic regression analysis was used to evaluate the effect of serum calcium concentration at admission on the prognosis of HICH. Results  The hypocalcemia group had a larger amount of hematoma, a lower GCS score,  a higher risk of hematoma breaking into the ventricle and rebleeding, and a higher proportion of patients requiring surgery. The proportion of poor prognosis(71.1%) was significantly higher than that of normal group (35.1%) and hypercalcemia group (33.3%)(P<0.05). Logistic regression analysis showed hypocalcemia is an independent risk factor affecting prognosis of HICH. Conclusion  HICH patients with hypocalcemia at admission are at high risk of critical illness and poor prognosis.

Role of cytokeratin 7 in  pathological diagnosis of liver cirrhosis

Wang Yankun1， Ma Junji2, Zhang Ming2

2019, 34(2):  124-127.  doi:10.3969/j.issn.1004-583X.2019.02.006

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Objective  To explore the role of Cytokeratin 7（CK7 ）in the pathological diagnosis of liver cirrhosis.Methods  A retrospective analysis was performed on the liver pathology of the Department of Pathology, Beijing You'an Hospital, Capital Medical University, from January 2014 to May 2018. This study included 802 cases, 563 males and 239 females, with an average age of (51±11) years. The positive expression ratio of CK7 immunohistochemical staining in liver tissue pathology was analyzed when different diseases were complicated by cirrhosis. Results   The proportion of males with negative expression of CK7 in liver tissue was larger, while the proportion of females with positive expression of CK7 in liver tissue was higher than that of CK7 negative patients. The average age of CK7 immunohistochemical staining in liver cirrhosis liver tissue was larger than that of CK7 positive cases. The positive rate of CK7 immunohistochemical staining in nonviral cirrhosis liver tissue was higher than that in viral cirrhosis group. Compared with chronic hepatitis B cirrhosis and autoimmune hepatitis cirrhosis,  the positive rate of CK7 in liver tissue of patients with PBC cirrhosis was significantly increased. Conclusion  CK7 immunohistochemical staining has a certain guiding value in distinguishing between viral and nonviral cirrhosis. CK7 plays an important role in the identification of PBC and autoimmune hepatitis and hepatitis B cirrhosis.

Effect of nutritional status on clinical outcomes in elderly patients with hepatic cirrhosis

Huang Guangming, Gu Dahui, Hao Yaqin, He Zhijun

2019, 34(2):  128-131.  doi:10.3969/j.issn.1004-583X.2019.02.007

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Objective  To explore the effect of nutritional status on clinical outcomes in elderly patients with hepatic cirrhosis.Methods  A total of 465 patients with liver cirrhosis was collected from November 2012 to July 2018, including 236 elderly patients with hepatic cirrhosis. Nutritional risk screening 2002 (NRS2002) was used to evaluate the nutritional risk of elderly inpatients with liver cirrhosis, and the patients were divided into the survival group and the death group according to the prognosis, logistic regression model analysis was used to evaluate the risk factors influencing the prognosis of patients.Results  The mortality rate of elderly inpatients with hepatic cirrhosis suffering nutritional risk was significantly higher than that of those without nutritional risk (P<0.05). Compared with the survival group, MELD score, NRS2002 score, serum albumin, serum sodium and Child Pugh grading in the death group was significantly different (P<0.05). Multivariate analysis showed that endstage liver disease model (MELD) score, prothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding were independent risk factors for death in elderly hospitalized patients with hepatic cirrhosis suffering nutritional risk. Conclusion  The elderly patients with hepatic cirrhosis have a high incidence of nutritional risk and death during hospitalization. MELD score, aprothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding are independent risk factors for death of elderly patients with hepatic cirrhosis suffering nutritional risk. Therefore, nutritional assessment and treatment in elderly patients with hepatic cirrhosis should be paid attention.

Analysis of current status of treatment for severe communityacquired pneumonia in a thirdgrade class A hospital

Lin Xiaohong1，2, Li Hongru2，3, Chen Yusheng2, 3, Lin Dan2, Chen Shijie2, Xie Jiefeng4

2019, 34(2):  132-135.  doi:10.3969/j.issn.1004-583X.2019.02.008

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Objective  To retrospectively analyze the current status of severe communityacquired pneumonia (SCAP) in Fujian Provincial Hospital.Methods  A total of 88 SCAP patients with communityacquired pneumonia from April 2012 to December 2015 was collected to analyze the current status of drug treatment and respiratory support modes. The treatment of four different etiology groups (including viral, bacterial, combined infection group, and negative group) was compared after the pathogens were detected by highthroughput technology. Results  Among the 88 patients with SCAP, the use of extensive treatment accounted for 4.5%, 18.18%（16/88）  of  which received 1 antibiotic treatment, 42.05% （37/88）  of which received two kinds of antibiotics, 39.78% (35/88) of which received no less than 3 categories. Of all the used antibiotics, βlactams were mostly widely used (87.5%), quinolones were 53.41%, and methicillinresistant Staphylococcus aureus (MRSA) was 37.5%, while the antiviral rate was 26.1%. About 40% of cases used more than 3 kinds of antibiotics in four groups. Patients with combined infection were more likely to use antiMRSA drugs (P<0.05). Noninvasive mechanical ventilation (63.6%) was performed in SCAP patients, 27.3% in simple oxygen therapy, and 9.09% in invasive mechanical ventilation.Conclusion  The antimicrobial treatment of SCAP in our hospital also has different degree of blindness. It is urgent to diagnose early pathogens to guide clinical targeted antimicrobial therapy. The main auxiliary ventilation for severe pneumonia is noninvasive ventilation.

Diagnostic value of serum thymidine kinase 1,  thyroglobulin and thyroid transfer factor1 in benign and malignant thyroid nodules

Tang Chenghui, Li Xueqing

2019, 34(2):  136-139.  doi:10.3969/j.issn.1004-583X.2019.02.009

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Objective  To investigate the clinical value of serum thymidine kinase 1 (STK1),  thyroglobulin (Tg) and thyroid transfer factor 1 (TTF1) in the differential diagnosis of benign and malignant thyroid nodules. Methods  From January 2016 to January 2018, 95 patients with malignant thyroid nodules were  enrolled as malignant nodules group. 45 patients with benign thyroid nodules and 30 healthy subjects were selected in our hospital as benign nodule group and healthy control group. Serum levels of STK1, Tg and TTF1 were detected by enzymelinked immunosorbent assay. The changes of serum STK1, Tg and TTF1 levels in malignant nodules group, benign nodule group and healthy control group, and the relationship between serum STK1, Tg and TTF1 levels and thyroid TNM staging in malignant nodules and the clinical value of serum STK1, Tg and TTF1 levels were observed to identify the clinical value of benign and malignant thyroid nodules.Results  The levels of STK1, Tg and TTF1 in the malignant nodules group were significantly higher than those in the benign nodules group and the healthy control group (P<0.01). The TTF1 level in the benign nodule group was significantly higher than that in the healthy control group (P<0.01), and the levels of STK1 and Tg in the benign nodule group were not significantly different from those in the healthy control group (P>0.05). The levels of serum STK1, Tg and TTF1 in patients with thyroid malignant nodules increased with the increase of tumor stage (P<0.01).Serum STK1 levels in patients with thyroid malignant nodules were positively correlated with Tg (r=0.816, P<0.01) and TTF1 (r=0.753, P<0.01), while Tg levels were positively correlated with TTF1 levels (r=0.687, P<0.01). The combined detection of STK1, Tg and TTF1 was used as the test variable, and the ROC curve was drawn with the occurrence of thyroid malignancy as the state variable. The optimal cutoff value for joint detection in the diagnosis of thyroid malignancy was >0.193, and its sensitivity was 91.6%. The specificity was 92.6%, and the area under the combined detection curve was 0.960, which was significantly better than STK1 (Z=3.031, P<0.01), Tg(Z=4.477, P<0.01) and TTF1 (Z=4.483, P<0.01), and the area under the curve of STK1, Tg and TTF1 was not statistically significant (P>0.05).Conclusion  STK1, Tg and TTF1 are closely related to the malignant degree of malignant thyroid nodules. The combined detection of three markers has high sensitivity and specificity for the differential diagnosis of benign and malignant thyroid nodules.

Association between large volume fluid resuscitation and mortality in severe acute pancreatitis

Zhou Jie, Yang Yaopeng

2019, 34(2):  140-143.  doi:10.3969/j.issn.1004-583X.2019.02.010

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Objective  To explore the association between the large volume fluid resuscitation and hospital mortality risk in severe acute pancreatitis. Methods  Data were collected from hospitalized patients with severe acute pancreatitis from January 1, 2014 to October 31, 2018,including gender, age, height, weight, vital signs at admission, 24hour fluid resuscitation, and treatment outcomes. According to the different amounts of fluid resuscitation, patients were grouped to find the factors influencing the risk of multiple organ failure and death.Results  A total of 231 patients were included in the study, 76 of whom were admitted to the hospital with a 24hour liquid volume of ≥6 000 ml, with an average fluid rehydration volume of (7 628±3 018) ml. There were 155 patients with <6 000 ml, and the average fluid intake was (4 642±2 018) ml. The mortality rates in the two groups were 10.53% and 21.94%, respectively (P<0.05). The proportion of multiple organ failure (respiratory failure, renal failure) was reduced in the highvolume fluid infusion group (P<0.035). The proportion of invasive mechanical ventilation and blood purification was decreased (P<0.05). Conclusion  Large volume fluid resuscitationis associated with decreased mortality and multiple organ failure. Sufficient fluid should be supplied in the early stage in severe pancreatitis.

Clinical analysis of 12 cases of pseudoaneurysm associated with hemodialysis

Feng Zhena, Guo Lana, Dong Chunxiaa, Shi Yanana, Jiao Ronghongb

2019, 34(2):  144-147.  doi:10.3969/j.issn.1004-583X.2019.02.011

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Objective  To analyze the factors related to pseudoaneurysm caused by puncture vascular pathway in hemodialysis patients, and to investigate how to prevent and treat this serious complication in clinic. Methods  Retrospective analysis was appliedto analyze the clinical characteristics and the possiblerisk factors for 12 patients with pseudoaneurysm associated with hemodialysis in our hospital. And to further understand the characteristics and treatment of pseudoaneurysms.Results  Vascular pathway associated pseudoaneurysms in hemodialysis patients may be relevant to the factors, such as direct puncture artery, puncture failure, non-standard usage of arteriovenous fistula, the application of heparin during dialysis, and patients with hypertension arteriosclerosis or diabetes. Surgery was an effective treatment for those diseases. Conclusion  For the patients with hemodialysis, especially patients with hypertensive arteriosclerosis diabetes, the preferred treatment is autogenous arteriovenous fistula, rather than direct puncture artery for vascular access. Pseudoaneurysm should be treated early. To reduce the complications, medical doctors should master the application time and puncture methodwith regular vascular access monitoring and early intervention.

Distribution and drug resistance analysis of 1 113  strains of bloodstream infection

Zhang Pan, Xie Shoujun, Wen Hainan

2019, 34(2):  148-153.  doi:10.3969/j.issn.1004-583X.2019.02.012

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Objective  To investigate the pathogenic bacteria distribution and drug sensitivity of blood stream infection in patients  and provide basis for clinical treatment of blood stream infection. Methods  Strains and clinical data of patients with blood stream infection from June 2015 to April 2018 were collected.Strains identification and susceptibility tests were performed using vitek2 compact. Anaerobic bacteria were detected by concentration gradient method.Results  A total of 1 113 strains of pathogens were isolated from 1 101 patients. 24 patients were treated with mix bacteremia.There were 576 (51.75%) strains of gramnegative bacteria, 510 (45.82%) strains of grampositive bacteria, 27 (2.43%)  strains of fungi and 72 strains of Anaerobic bacteria were isolated. The first seven departments of the distribution of pathogenic bacteria are hematology,  infectious diseases,  geriatrics,  neonatology,  pediatric medicine,  oncology and critical care.The strains of Escherichia coli and Klebsiella pneumoniae have high antibacterial activity against piperacillin/tazobactam,  cefoperazone/sulbactam,  amikacin and tegacycline.The detection rates of MRSA and MRCNS were 27.8% and 82.2% respectively. All Staphylococci were sensitive to vancomycin and linezolid. All enterococci were sensitive to glycopeptides and oxazolidinone antibiotics. Anaerobic bacteria produce an average of 44.4% of the β lactamase. The rate of fragile bacteroides is Highest(87.5%).Conclusion  The characteristics of strains from bloodstream were different. The area should be alert to brucella and methicillin resistant Staphylococcus  infection; Clinical laboratories should not overlook anaerobic and lowtoxic species such as nontuberculosis mycobacteria and nocardia in bloodstream.

Refractory fungal meningitis：report of three cases and literature review

Qi Xuejiaoa, Bu Huia, Zou Yuelia, Yang Jiankaib, Zhao Yinlongb, He Junyinga

2019, 34(2):  154-157.  doi:10.3969/j.issn.1004-583X.2019.02.013

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Objective  To analyze the diagnosis and treatment of refractory fungal meningitis, so as to further improve the diagnosis and treatment of the disease.Methods  Retrospective study was used to analyze the process of diagnosis and treatment of three cases refractory fungal meningitis, and relative literature was reviewed.Results  Case one patient admitted with headache and limb weakness. The patient did  not get well via antitubercular and antiviral treatment. Rare type of fungi was found in CSF through repeated lumbar puncture. The patient improved via antifungal treatment. Case two patient admitted with headache, and cryptococcus was found in CSF. The lung CT showed pulmonary tuberculosis, and the patient recovered via antifungal and antitubercular treatment. Case three patient admitted with headache, and cryptococcus was found in CSF. Because of Intracranial hypertension treated with Ommaya implantation, venous sinus thrombosis treated with anticoagulation combined with antifungal drugs, the patient's clinical symptoms improved.Conclusion  Refractory fungal meningitis is a kind of meningitis with poor prognosis and high mortality. Early diagnosis, active treatment of protopathy and control of intracranial hypertension are the key to improve the prognosis of this disease.

Cerebral aspergillosis in immunocompetent with no signs of infection--a case report and literature review

Zhang Xua, Xiang Fenga, Wang Fulinb, Du Shaojingb, Huang Dehuia, Lang Senyanga

2019, 34(2):  158-162.  doi:10.3969/j.issn.1004-583X.2019.02.014

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Objective To report a case of cerebral aspergillosis in immunocompetent with no signs of infection and corresponding treatment, then review the literature. Methods  One patient of cerebral aspergillus infection in primary angiitis of the central nervous system was diagnosed by pathological biopsy. Results  After the regular anti fungal treatment with voriconazole, the patient's condition and the lesion in the brain were all stable. Conclusion  There are various manifestations of aspergillus infection in the brain. The imaging of immunocompetent patient with no signs of infection and non local dissemination is not specific. It is necessary to improve the acknowledge and vigilance of cerebral aspergillosis contributing to early diagnosis, early treatment and reduce mortality.

Videoassisted thoracoscopic versus robotic--assisted thoracoscopic thymectomy：a systematic review and metaanalysis

Jin Dacheng1, 2, Han Songchen1, 2, Ma Jilong1, 2, Chen Meng1, 2, Wang Bing1, 2, Gou Yunjiu2

2019, 34(2):  163-170.  doi:10.3969/j.issn.1004-583X.2019.02.015

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Objective  To systematically evaluate the safety and effectiveness of roboticassisted thoracoscopic surgery (RATS) and videoassisted thoracoscopic surgery (VATS) for thymectomy. Methods  A computerized search was conducted in PubMed, EMBASE, Cochrane library and CBM database for clinical studies on RATS comparing VATS. RevMan 5.3 was used for metaanalysis. Results  Nine casecontrol studies were included, including 668 patients undergoing thymectomy. Metaanalysis showed that the days of hospitalization in RATS group were less than those in VATS group (MD=-1.42, 95%CI［-2.32; -0.52］, P=0.002).The number of days of postoperative drainage was less than that in VATS group (MD=-0.70，95%CI［-1.26; -0.14］，P=0.01).The operation time was longer in RATS (MD=13.24，95%CI［3.82; 22.66］，P=0.006). The intraoperative blood loss showed no statistical difference between two groups (MD=-19.22，95%CI［-52.66; 14.22］，P=0.26).Transthoracic thoracotomy showed no statistical difference between two groups (OR=0.42, 95%CI［0.07; 2.35］, P=0.32). There was no statistical difference in the incidence of postoperative pneumonia between two groups (OR=0.72，95%CI［0.15; 3.42］，P=0.67).  There was no significant difference in the incidence of myasthenia gravis crisis between two groups (OR=0.61, 95%CI［0.17; 2.15］，P=0.45).  The overall incidence of postoperative complications was not statistically different between two groups (OR=1.4, 95%CI［0.42; 4.69］，P=0.59).Conclusion  The robotassisted thymectomy is safe and effective. There is no difference between two surgical methods: intraoperative blood loss, transthoracic thoracotomy and postoperative pneumonia complications, the incidence of myasthenia gravis crisis after surgery and overall postoperative complication rate.