Journal of Capital Medical University

Coronavirus disease 2019

Jin Ronghua

2020, 41(2): 149-154. doi:10.3969/j.issn.1006-7795.2020.02.001

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2019 novel coronavirus (2019-nCoV) infection represent a significant threat to Chinese public health. In order to help medical doctors to understand this emerging infectious disease well, the review paper presented recent achievements on etiology, epidemiology, pathogenesis, clinical characteristics, treatment plan and prevention strategy of 2019 nCoV infection.

Traditional Chinese medicine characteristics of 46 patients with COVID-19

Li Li, Yang Huasheng, Gou Chunyan, Wang Xiaojun, Luo Xiaolan, Zhang Jiaying, Li Hongyan, Li Tongzeng, Liang Lianchun, Li Xiuhui

2020, 41(2): 155-160. doi:10.3969/j.issn.1006-7795.2020.02.002

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Objective To analyze and understand the traditional Chinese medicine (TCM) characteristics of 46 confirmed cases with COVID-19 in Beijing Youan Hospital, Capital Medical University.Methods Data were collected and analyzed about the history of patients, TCM syndrome characteristics, the diagnosis and treatment process, evolution of the symptoms, and outcomes of the cases. The clinical characteristics of different types of cases were compared with each other. Results Among the 46 patients, 27 cases were epidemic toxin attacking lung syndrome (common type), 13 cases were dampness toxin depression lung syndrome (common type), 6 cases were retention of epidemic toxin in the lung (severe type). All patients received Chinese medicine treatment, 26 cases of which were treated with proprietary Chinese medicine and 20 cases with traditional Chinese medicine decoction. In the early stage (0-3 days), the symptoms were relatively alleviated, yet with the characteristics of red or dark red tongue, yellow greasy tongue coating or white greasy coating. In the advanced stage (4-14 days), more than half of the patients had fever (89.13%), cough and expectoration (71.40%), dry mouth and thirst (68.60%), fatigue (60%), dry throat or sore throat (57.10%), and lack of appetite (54.30%). For the severe patients, the tongue coating was greasy and dry or less. In the recovery stage (>15 d), most of the symptoms were relieved, but with cough and expectoration (72.20%), dry mouth and thirst (66.70%), sweating (50%) remained. Meanwhile tongue coating changed from thick to thin, the degree of greasy coating improved with the color of coating changed from yellow to white, although the changes of tongue manifestation occurred slowly. For cases with common type and severe type, the median course of the disease of were respectively 16.5 d (14-26 d) and 25 d (21-27 d), the average days of hospital stay were (13.24±4.36) d and (19.73±2.33) d, the median time for viral nucleic acid test turning negative was respectively 11.41 d (4-22 d) and 14.5 d (9-24 d), and the median time for pulmonary computed tomography(CT) lesions to start absorption was respectively 10 d (5-19 d), 15.5 d (8-21 d). Conclusion The syndrome with damp and heat are prominent in COVID-19 and the course of the disease is relatively long. The understanding of the characteristics of different TCM syndrome types and the evolution is helpful to guide the syndrome differentiation and treatment with TCM.

Clinical characteristics of 74 hospitalized patients with COVID-19

Zhang Wei, Hou Wei, Li Tongzeng, Li Aixin, Pan Wen, Jin Ronghua, Liang Lianchun, Hu Zhongjie

2020, 41(2): 161-167. doi:10.3969/j.issn.1006-7795.2020.02.003

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Objective To describe the epidemiological and clinical characteristics of 74 patients diagnosed with COVID-19 in our hospital. Methods A retrospective, single-center case series analysis included 74 consecutive hospitalized patients with confirmed COVID-19 at Beijing Youan Hospital, Capital Medical University, from January 21 to February 11, 2020. The final date of follow-up was February 17, 2020. The data of epidemiology, demographics, clinic, laboratory test, radiological examination, treatment, and complications were collected and analyzed.Outcomes of critically ill patients and noncritically ill patients were compared. Results Of 74 patients with COVID-19, the average age was (52.7±19.1) years, the minimum age 1 year old and the maximum age 94 years old. Thirty five were male. According to the severity of the disease at the time of admission, there were 56 cases of common type, 9 cases of severe type and 9 cases of critical severe type.The average time from onset of symptoms to diagnosis was (5.1±2.8) days. There were 39 cases (47.3%) who had lived in the epidemic area of Hubei Province, 48 cases(64.9%) who had clustered onset. The common symptoms included fever 67 (90.5%), dry cough 20 (27%) and dyspnea 17(23.0%). The average time from first symptom to acute respiratory distress syndrome(ARDS) was (9.3±3.8) days, and to Intensive Care Unit(ICU) admission was (10.5±4.7) days. Forty two patients (56.8%) had lymphocytopenia and 35 patients (47.3%) had leukopenia. Twenty seven patients(36.5%) had elevated alanine aminotransferase, 7 patients (9.5%) had elevated creatine kinase;12 patients(16.2%) had elevated myoglobin. Compared with the common patients, the lymphocyte decreased more significantly in the severe and critical severe patients. The chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Among all the 74 patients, 23 (31.1%), 17 (23%), 2 (2.7%) and 6 (8.1%) received low flow oxygen inhalation, high flow oxygen inhalation, non-invasive positive pressure ventilation and invasive positive pressure ventilation, and 1 critically ill patient received extracorporeal membrane oxygenation. Twenty one (28.4%) patients received antiviral therapy, and 16 (21.6%) patients received glucocorticoid therapy. Of the 74 patients, 7 (9.5%) were complicated with acute respiratory distress syndrome (ARDS), 5 (6.8%) with shock, 11 (14.9%) were admitted to ICU, 55 (74.3%) were cured and discharged, and the average hospital stay was (12.3±4.4) days. Conclusion Most of the COVID-19 were clustered, and a few patients progressed rapidly with ARDS. Old age and basic diseases may be the risk factors of poor prognosis.

Early chest CT manifestations of COVID-19

Li Li, Wang Ke, Ren Meiji, Zhao Jing, Li Hongjun

2020, 41(2): 174-177. doi:10.3969/j.issn.1006-7795.2020.02.005

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Objective To analysis the incipient characteristic manifestations of new coronavirus pneumonia (COVID-19) suggested by the chest computed tomography (CT) scan and provide imaging support for early clinical diagnosis. Methods Retrospective analysis of early CT manifestations of 25 cases of COVID-19. Results The early chest CT manifestations of COVID-19 were most commonly ground glass opacity, with thickened blood vessels and dilated bronchioles. The lesions were mostly distributed in the periphery of the lungs or under the pleura. Conclusion The early CT scanning of COVID-19 patients showed characteristic imaging manifestation, which can provide imaging support for early clinical diagnosis.

Expression and role of IL-23 in chronic rhinosinusitis

Wang Min, Li Ying, Wang Xiangdong, Zhang Luo

2020, 41(2): 178-182. doi:10.3969/j.issn.1006-7795.2020.02.006

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Objective To investigate the expression of interleukin-23(IL-23) in chronic rhinosinusitis and the regulation in T helper cell 17(Th-17) response. Methods Fifteen control subjects, 14 patients with chronic rhinosinusitis without nasal polyps(CRSsNP) and 37 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) were recruited. Tissue samples were obtained from the inferior turbinates of control subjects, the ethmoid mucosa of patients with CRSsNP, and the nasal polyps(NP) of patients with CRSwNP, respectively; and the tissue homogenates were prepared. The concentrations of IL-23, myelo-peroxidase(MPO) and IL-17 in tissue homogenates were measured. The number of neutrophils in nasal tissue and the count and percent of neutrophils in peripheral blood were counted. Dispersed nasal polyp cells were prepared from fresh NP tissue and stimulated with IL-23 for 24h in vitro and the concentrations of Th17-related cytokines in the culture supernatants were measured. Results Compared to normal control, no change of IL-23 concentrations in tissue homogenates from CRSsNP and CRSwNP were observed. However, IL-23 concentration in IL-17+CRSwNP was significantly higher than that in the control and IL-17-CRSwNP. IL-23 concentration in tissue homogenates was positively correlated with tissue MPO concentration, but had no correlation with peripheral or tissue neutrophil number. IL-23 simulation promoted the production of IL-17 and IL-1β in dispersed nasal polyp cells, but the production of IL-8 and granulocyte colony stimulating factor(G-CSF) did not change. Conclusion IL-23 may play a role in IL-17+CRSwNP via increasing Th17 response.

Expression and glucocorticoid regulation of MALAT1 in chronic rhinosinusitis with nasal polyps

Wang Ming, Bu Xiangting, Luan Ge, Wang Yang, Wang Chengshuo, Zhang Luo

2020, 41(2): 183-188. doi:10.3969/j.issn.1006-7795.2020.02.007

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Objective To explore the expression of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in different subtypes of chronic rhinosinusitis with nasal polyps (CRSwNP) and its response to glucocorticoid therapy. Methods Real-time PCR was used to detect the expression of MALAT1 in nasal tissues from eosinophilic CRSwNP, non-eosinophilic CRSwNP and healthy control subjects. The correlation between the expression of MALAT1 and Th1/Th2/Th17 cytokines was analyzed. Moreover, the effect of glucocorticoid treatment on MALAT1 expression was measured. Results MALAT1 was significantly down-regulated in both eosinophilic CRSwNP and non-eosinophilic CRSwNP compared to the healthy control. Moreover, the expression of MALAT1 was significantly lower in non-eosinophilic CRSwNP than that of eosinophilic CRSwNP. In contrast, interferon gamma (IFNG) was significantly up-regulated in both eosinophilic CRSwNP and non-eosinophilic CRSwNP compared to the healthy control. The Spearman correlation test showed that the expression of MALAT1 was negatively correlated with the expression of IFNG (r=-0.595,P=0.001). In addition, MALAT1 was significantly up-regulated by glucocorticoid treatment both in patients with eosinophilic CRSwNP and non-eosinophilic CRSwNP (P=0.015, respectively). Conclusion MALAT1 is significantly down-regulated in both eosinophilic CRSwNP and non-eosinophilic CRSwNP compared to the healthy control, and it negatively correlated with the expression of IFNG. Glucocorticoid treatment significantly up-regulate the expression of MALAT1 in CRSwNP.

Effects of different fixatives on immunofluorescence staining in nasal polyp-derived epithelial cells

Li Ying, Jiao Jian, Zhang Luo

2020, 41(2): 189-193. doi:10.3969/j.issn.1006-7795.2020.02.008

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Objective To observe and compare the effects of three different fixatives on immunofluorescence staining in nasal polyp-derived epithelial cells with laser scanning confocal technique in order to choose the optimal fixation method. Methods The nasal polyp-derived epithelial cells were dissociated by enzymatic digestion method and cultured for 7 days, the cells were fixed by 4% paraformaldehyde (PFA), methanol-acetone (50:50), or methanol at room temperature, permeabilized by 1% Triton X-100, blocked with goat serum, and then incubated overnight at 4℃ with primary antibodies. Following the primary incubation, the cells were treated with the secondary antibodies labelled with fluorogenic substrates and counterstained with DAPI nuclear stain and then examined by microscopy using the confocal microscope. Results Methanol-acetone (50:50) and methanol showed a good fixation effect on four labelled proteins; however, 4% PFA showed a poor fixation effect on transmembrane protein 16A (TMEM 16A) and zonular occludens-1(ZO-1). Conclusion Methanol-acetone (50:50) and methanol showed good fixation effect on four labelled proteins and might be an ideal fixatives for cultured nasal epithelial cells.

Analysis for the relationship between interleukin-21 and tissue IgE in recurrent nasal polyps

Du Kun, Zheng Ming, Wang Xiangdong, Zhang Luo

2020, 41(2): 194-199. doi:10.3969/j.issn.1006-7795.2020.02.009

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Objective To investigate the relationship between tissue total IgE and postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) and to further analyze the associated immunological molecules contributing to IgE production. Methods We retrospectively enrolled 73 CRSwNP patients and 24 healthy volunteers as a control group, and compared the clinical characteristics and the levels of tissue IgE, interleukin-4, IL-21 and CD40 ligand of the patients after endoscopic sinus surgery for 3 years. Sequentially, we analyzed the correlation between IgE and these immunological molecules. Results The presence of asthma comorbidity was significantly more frequent in recurrent CRSwNPs than non-recurrent group (30.3% vs 10%). The IgE levels in recurrent group[257.40(143.00-776.05)KU/L] was also significantly higher than that in non-recurrent group[98.89(43.56-255.20)KU/L], while the levels of CD40L, IL-4 and IL-21 showed no differences between the two groups. Among the 73 CRSwNPs (regardless of recurrence or non-recurrence), IL-21 significantly related to CD40L (r=0.440, P<0.001) and IgE(r=0.290,P=0.01). IL-21 significantly related to IgE in the recurrent group while not in non-recurrent group. CD40L and IL-4 showed no relationship with IgE neither in recurrent nor non-recurrent group. Conclusion Increased levels of IgE in nasal polyps related to the recurrence of CRSwNPs. IL-21, not CD40L and IL-4, might contribute to the IgE production in recurrent CRSwNPs.

Experimental study on the regulation of Bushen Yisui formula and its disassembled formulas on related molecules of inhibitory signal pathway of axon regeneration in mice with experimental autoimmune encephalomyelitis

Wang Lei, An Chen, Zhao Hui, Xue Bing, Qi Fang, Li Junling, Jin Liangyun, Zhang Nan, Fan Yongping

2020, 41(2): 200-211. doi:10.3969/j.issn.1006-7795.2020.02.010

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Objectives To observe the regulation of Bushen Yisui formula (BSYSF) and its disassembled formulas, Bushen formula (BSF) and Huatan Huoxue formula (HTHXF) on related inhibition molecules in signal pathway of axon regeneration in mice with experimental autoimmune encephalomyelitis (EAE). Methods Female C57BL/6 mice were randomly divided into normal control (NC), model (MO), prednisone acetate (PA, 6mg/kg), catapol (CA, 40 mg/kg), BSYSF (raw drug 3.02 g/kg), BSF (raw drug 1.44 g/kg) and HTHXF(raw drug 1.57 g/kg), with 16 mice in each group. EAE model in mice was made by immunizing with myelin oligodendrocyte glycoprotein _35-55 (MOG_35-55). The mice in NC and MO groups were given distilled water by means of intragastric administration, the mice in treatment groups were given corresponding drugs once a day for 40 d. The brain and spinal cord of mice were taken on day 25 and 40 of immunization. The gene expression of NogoA, NgR, RhoA and ROCKⅡmRNA were determined by quantitative real time-PCR, the protein expression of the above indexes were detected by the immunohistochemistry and Western blotting technique. Results The mRNA and protein expressions of NogoA, NgR, RhoA and ROCKⅡin the brain and spinal cord in MO mice were increased significantly in EAE mice compared to NC mice (P<0.05, P<0.01, P<0.001). After the treatment of BSYSF and its disassembled formulas BSF和HTHXF, the mRNA and protein expressions of NogoA, NgR, RhoA and ROCKⅡwere reduced to some extent, the above indexes had statistically significant in BSYSF group compared with MO group (P<0.05, P<0.01, P<0.001). Conclusions BSYSF and its disassembled formulas BSF and HTHXF had the regulation on inhibitory factors of axon regeneration NogoA/NgR and its signal pathway RhoA/ROCK in EAE mice, and BSYSF had obvious effect. These findings provide an experimental basis for explaining the mechanism of BSYSF promoting axon regeneration.

Differential α-synuclein oligomerization in plasma of patients with different subtypes of Parkinson's disease and multiple system atrophy

Song Qihan, Li Xuran, Li Xin, Yang Weiwei, Li Wei, Yu Shun

2020, 41(2): 212-216. doi:10.3969/j.issn.1006-7795.2020.02.011

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Objective To study α-synuclein (α-Syn) oligomerization in the plasma of patients with different subtypes of Parkinson's disease (PD) and multiple system atrophy (MSA). Methods The study enrolled 10 healthy controls, 10 tremor dominant PD patients (PD-TD), 10 postural instability/gait difficulty PD patients (PD-PIGD), 10 MSA cerebellar type (MSA-C), and 10 MSA cerebellar and parkinsonism type (MSA-C+P). The blood was collected and the plasma was isolated. Recombinant α-Syn was incubated in the plasma and the amount of α-Syn formed in the plasma was measured using ELISA method and Western blotting. Results Compared with control plasma, PD and MSA plasma significantly increased α-Syn oligomerization. Although the amount of α-Syn oligomer formed in PD plasma was slightly higher than that formed in MSA plasma, the difference was not statistically significant. In addition, α-Syn oligomerization was higher in PD-PIGD than in PD-TD plasma (P<0.05). Moreover, the ability of promoting α-Syn oligomerization was higher for MSA-C than MSA-C+P plasma (P<0.05). Conclusion The plasma of patients with different subtypes of PD and MSA differentially promotes α-Syn oligomerization.

Mechanism of glucagon-like peptide 1 regulating the activity of brown adipose tissue in diabetic db mice by angiopoietin-like protein 4

Yan Cen, Luo Xiaomin, Feng Yingmei

2020, 41(2): 217-224. doi:10.3969/j.issn.1006-7795.2020.02.012

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Objective To explore glucagon-like peptide 1 (GLP-1) whether and how to regulate the function of brown adipose tissue (BAT) though angiopoietin-like protein 4 (ANGPTL4). Methods Mice were randomized and controlled to receive subcutaneous pump intervention for 6 weeks. Before sampling, glucose tolerance test and pet-CT were conducted. Fasting blood, brown fat and liver were taken for cholesterol and triglyceride quantification, FPLC, qPCR, Western blotting, and transcriptometric sequencing, etc. Results GLP-1 analogue exendin-4 (Ex-4) improved abnormal glucose tolerance in diabetic db/db mice and reduced triglyceride levels in peripheral blood and BAT. Ex-4 promoted the expression of UCP-1 in BAT, and pet-CT indicated increased activity; Ex-4 promotes the expression of ANGPTL4 in BAT; the deletion of ANGPTL4 decreased the activity of BAT. Conclusion GLP-1 promoted BAT activity accompanied by increased expression level of ANGPTL4, and the deficiency of ANGPTL4 lowered the activity and function of BAT, which may become a therapeutic target for the regulation of BAT activity.

Evaluation of the inhibitory effect of docetaxel-loaded polymeric micelles on breast cancer metastasis in mice

Wang Aiting, Yan Dan, Qi Xianrong

2020, 41(2): 225-230. doi:10.3969/j.issn.1006-7795.2020.02.013

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Objective To investigate the inhibitory effect of docetaxel-loaded polymeric micelles on breast cancer metastasis in mice. Methods Two kinds of polymer micelles, DSPE-mPEG₂₀₀₀-Micelles (DM) and D-α-tocopheryl polyethylene glycol 1 000 succinate (TPGS₁₀₀₀)/DSPE-mPEG₂₀₀₀-Micelles (TDM), loading with docetaxel (DTX), were prepared by film formation method. The encapsulation, drug loading, size and zeta potential of micelles were evaluated. A mouse lung metastasis model was established by injecting 4T1/Luc cells into the tail vein. The bioluminescence intensity and nodule number of lung tissues after treatment were evaluated. Results The encapsulation rates of prepared polymeric micelles were more than 85% and the drug loading efficiencies were about 3%. The particle sizes were about 20 nm, and the zeta potentials were about -4 mV. The polymeric micelles containing TPGS₁₀₀₀ were characterized with a higher encapsulation rate and drug loading efficiency, and a smaller particle size. Both DM and TDM groups could reduce the bioluminescence intensity of lung tumors and the number of pulmonary nodules in mice with breast cancer lung metastasis model, whilst TDM showed a stronger effect. Conclusion Docetaxel-loaded polymeric micelles containing TPGS₁₀₀₀ exhibited a stronger inhibitory effect on breast cancer metastasis in mice.

Study on clinical demand prediction model of apheresis platelets based on time series analysis

Peng Rongrong, Liu Yunnan, Yang Xiaoli, Yang Dongyan

2020, 41(2): 231-236. doi:10.3969/j.issn.1006-7795.2020.02.014

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Objective To explore the feasibility of autoregressive integrated moving average (ARIMA) model in predicting clinical platelet demand, and to provide basis for scientifically making the plan of blood collection and recruitment. Methods ARIMA model was established for the clinical usage of apheresis platelets monthly from January 2006 to June 2016 in Chongqing Central Blood Stations. The optimal model was used to predict the monthly clinical usage of apheresis platelets from July to December 2016. Results The optimal model for clinical usage of apheresis platelets was ARIMA(0,1,1)(1,0,1)₁₂. The model residual sequence autocorrelation function and partial autocorrelation function were basically within 95% confidence interval, and the Ljung-Box Q statistical results showed that there was no correlation between the residual error (P>0.05), indicating that the residual error sequence was white noise and the model passed the test. The actual values and the predicted values of the model were in the 95% confidence interval. Compared with the actual values of the clinical usage of apheresis platelets during the same period, the trend of curve change was basically the same, which indicates the prediction accuracy was high with a 7.5% mean relative error. Conclusion The optimal model ARIMA(0,1,1)(1,0,1)₁₂ can fit better the trend of clinical usage of apheresis platelets in time series.

Study of symptom and esophageal function in patients with reflux hypersensitivity and non-erosive reflux disease

Li Zhe, Tao Lin, Hou Yanan

2020, 41(2): 237-242. doi:10.3969/j.issn.1006-7795.2020.02.015

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Objective To investigate the symptom and esophageal function in patients with reflux hypersensitivity (RH) and non-erosive reflux disease(NERD). Methods In this study, 60 patients concurrently taking the examinations of upper gastrointestinal endoscope, high-resolution manometry and impedance (HRiM) and multi-channel intraluminal impedance and pH recording (MII/pH) between Nov. 2017 and Mar. 2019 were selected from Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. The patients were separated into RH group and NRED group with 30 cases in each group, according to their symptoms and examinations, to compare the GerdQ Scale Score, esophageal manometry, and pH & impedance pH monitoring between the two groups. Results The scores of negative symptoms (upper abdominal pain, nausea) in RH group were significantly higher than that in NERD group (ie, the incidence of RH group was lower than NERD group), with statistically significant difference(P<0.05).There was no statistical significant difference in the score of GerdQ, positive symptoms(heartburn, reflux), and positive effects(sleep disorders, the usage of OTC drugs) between the two Groups(P>0.05). The residual pressure of lower esophageal sphincter(LES) in RH group was obviously lower than that in NERD group(P<0.05). There was no statistical significant difference in the length of LES, resting pressure of LES, resting pressure of upper esophageal sphincter(UES), average distal contractile integral(DCI), distal contraction delay, percentage of early contraction, percentage of rapid contraction, percentage of large peristalsis interruption, percentage of small peristalsis interruption between the two groups (average P>0.05).The total reflux duration, reflux times; upright position reflux duration, reflux times; supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group(P<0.05). No statistical significant difference was observed between the two groups in the weak acid reflux and non-acid reflux events(P>0.05). Conclusion The symptoms of upper abdominal pain and nausea were obviously less than those in NERD group. The residual pressure of LES in RH group was obviously lower than that in the NERD group; the total reflux duration, reflux times, upright position reflux duration, reflux times, supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group. For patients with typical heartburn symptoms but normal examined with endoscopy and biopsy, high-resolution esophageal manometry and pH & impedance pH monitoring are required to confirm the diagnosis so that the specific treatments are provided to relieve their clinical symptoms.

Study on the relationship between the changes of microbiota and therapeutic effect in patients with reflux esophagitis

Yu Ying, Gao Feng, Zhang Jie

2020, 41(2): 243-248. doi:10.3969/j.issn.1006-7795.2020.02.016

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Objective To study the relationship between the changes of lower esophageal mucosal microbiota and the therapeutic effect in the patients with reflux esophagitis. Methods The patients with reflux esophagitis were recruited and undertook standard proton pump inhibitor (PPI) therapy for 8 weeks. They were divided into mucosal healing group and poor healing group. The high-throughput nucleotide sequencing and bioinformatics analysis techniques were used to analyze the composition of the distal esophageal mucosal microbiota in the reflux esophagitis before and after PPI therapy. Results In the healing group, there were significant differences on the abundances of the lower esophageal mucosa between before and after PPI therapy at the level of genus:Lactobacillaceae, Lactobacillus, Bifidobacterium and Helicobacter [2.7%(1.5%-3.2%) vs 4.8%(3.0%-10.7%), 2.7%(1.5%-3.2%) vs 4.8%(3.0%-10.7%), 0.7%(0.6%-10.7%) vs 1.4%(1.0%-2.2%), 0.08%(0.04%-0.13%) vs 0.12%(0.08%-0.21%)](P=0.001, P=0.001, P=0.042, P=0.049, respectively). The abundances of Bifidobacterium and Helicobacter at the level of genus in the healing group after the PPI therapy were significant increasing than those in the poor healing group[1.4%(1.0%-2.2%) vs 0.7%(0.4%-1.1%), 0.12%(0.08%-0.21%) vs 0.07%(0.03%-0.09%)] (P=0.003, P=0.014). Conclusion The changes in the lower esophageal mucosal microbiota after PPI therapy in patients with reflux esophagitis are related to the therapeutic effect. And in the healing group, the proportion of beneficial bacteria significantly increased.

Application of fluorescence in situ hybridization in prenatal diagnosis

Yang Shufa, Li Jiaqi, Wang Tianduo, Si Yanmei, Liu Xin

2020, 41(2): 249-252. doi:10.3969/j.issn.1006-7795.2020.02.017

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Objective To explore application of fluorescence in situ hybridization(FISH) in fast diagnosing chromosomal aberration of amniotic cells. Methods The pregnant under going amniocentesis in Beijing Gynecology & Obsterics Hospital Capital Medical University from 2013 June to 2016 December were enrolled. Amniotic fluid cells of 1 676 patients were analyzed by FISH and karyotype analysis. Results Indications of 1 676 pregnant included:advanced maternal age(637, 38.1%), high risk of serum screening(699, 41.71%), high risk of cell fetal DNA testing(315, 18.79%), abnormal results of B ultrasound(16, 0.95%). About 240 patients got positive FISH results, including 140 trisomy 21, 44 trisomy 18, 14 trisomy 13, 32 sex chromosomal aneuploidy and 10 mosaics. Among 1 676 patients, 252 patients got positive karyotype type, including 240 above positive FISH results, 1 mosaic of chromosome 22, 6 balanced chromosomal rearrangement, 1 unbalanced chromosomal rearrangement and 4 polymorphism. Conclusion Chromosome 21, chromosome 18, chromosome 13 and sex chromosomal aneuploidy can be quickly diagnosed by FISH. However, karyotype analysis should be adopted in the other suspected chromosomal aberrations.

Comparison of analgesic efficacy between general anesthesia or general anesthesia combined with cervical plexus block administered in thyroid operation

Hou Ruixue, Yin Cheng, Wang Tianlong

2020, 41(2): 253-256. doi:10.3969/j.issn.1006-7795.2020.02.018

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Objective To compare the analgesic efficacy and the incidence of the nausea and vomiting between general anesthesia(GA) and general anesthesia combined with cervical plexus block undergoing thyroid surgery. Methods A total of 80 patients who underwent elective thyroid operations were selected and assigned to four groups:GA fentanyl(group Ⅰa, n=20),GA sufentanil(group Ⅰb; n=20),GA fentanyl+cervical plexus block(group Ⅱa, n=20),GA sufentanil+cervical plexus block(group Ⅱb, n=20). Postoperative visual analogue scale (VAS) score, extubation time, recovery time and the incidence of postoperative nausea and vomiting (PONV) were recorded and compared in four groups. Results VAS scores showed significant difference between 2 and 6 h after operation (P<0.05); with that in Ⅰb and Ⅱb groups significantly lower than that inⅠa and Ⅱa (P<0.05). There was no significant difference between VAS scores in Ⅰa and Ⅱa, Ⅰb and Ⅱb groups (P>0.05). No difference was found in VAS score among four groups at 24 h after operation(P>0.05). There were no significant differences about the time of extubation and recovery (P>0.05). No difference of the incidence on PONV was observed among the four groups at the first 24 h postoperatively.Conclusion There was no significant difference between general anesthesia alone and general anesthesia combined with cervical plexus block. Compared with fentanyl sufentanil, sufentanil as a general anesthesia analgesic component could significantly reduce the VAS score of patients after thyroid surgery.

Clinical presentations and CT features of COVID-19

Li Xiaohu, Qiu Xiaohui, Zhang Jinping, Zeng Xiaosong, Xu Qizhong, Huang Guoquan, He Kewu, Ma Yichuan, Wu Zongshan, Shi Hengfeng, Yuan Yushan, Liu Bin, Yu Yongqiang

2020, 41(2): 257-260. doi:10.3969/j.issn.1006-7795.2020.02.019

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Objective To investigate the thoracic computed tomography(CT) and clinical manifestations of COVID-19. Methods Chest CT and clinical data of confirmed 26 patients COVID-19 were retrospectively analyzed. Results In terms of clinical manifestations, fever and cough were main manifestations with 26 patients (100%) and 21 patients (80.8%) respectively, which could be accompanied by muscle soreness, shortness of breath, diarrhea or vomiting. Laboratory examination showed that 15 patients (57.7%) was normal in white blood cell (WBC),4 patients (15.4%) increased and 7 patients (26.9%) decreased. Lymphocytopenia occurred in 10 patients (38.5%). C-reactive protein(CRP) was elevated in 15 patients (57.7%). In terms of CT features, lesions were found in the lung high resolution computerized tomography(HRCT) of 26 all patients, with unilateral lung distribution in 6 patients (23.1%), mainly subpleural distribution;bilateral lung distribution in 20 patients (76.9%). All lobes and segments of both lungs were involved in 6 patients (23.1%). In focal cases, the involvement of the right lower lobe was the most common with 10 patients (38.5%). One or more of the following signs could be seen in 26 patients with COVID-19:ground -glass opacity(GGO) in 16 patients (61.5%), mainly subpleural distribution;GGO combined with focal consolidation in 6 patients (23.1%); small patchy blur with increased density in 10 patients (38.5%); large patchy consolidation in 7 patients (26.9%); fibrosis, grid shadow in 8 patients (30.8%); bronchovascular bundle thickening and vascular perforator sign were seen in 5 patients (19.2%); air bronchial signs were seen in 4 patients (15.4%); a small amount of pleural effusion was seen in 1 patient (3.8%). Enlargement of mediastinal and hilar lymph nodes was absent. Conclusion Chest CT of COVID-19 shows GGO distributed in multiple sites, periphery, subpleural and lower lobes, which may be accompanied by consolidation. Pleural effusion and enlarged lymph nodes are rare. Chest CT provides an important basis for early prevention and control, early diagnosis and treatment of the disease.

Analyze the etiology of small intestinal bleeding diagnosed by capsule endoscopy

Lin Lin, Wu Jing, Liu Kuiliang, Liu Hong, Wang Canghai

2020, 41(2): 261-266. doi:10.3969/j.issn.1006-7795.2020.02.020

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Objective To analyze the clinical and endoscopic characteristics of the patients with suspected small intestinal bleeding and received a capsule endoscopy (CE) and further to explore the etiology. Methods The consecutive patients with suspected of small intestinal bleeding and receiving a CE for the first time at Beijing Shijitan Hospital, Capital Medical University from January 2010 to September 2018 were enrolled. The basic participant characteristics, CE features, clinical diagnosis and etiology were collected for further analysis. Results A total of 93 patients were enrolled, and CE retention was found in one patient (1.1%). The mean age was (59.7±19.4) years, from 14 to 94 years, and 58 patients (62.4%) were the male. The rate of using non-steroid anti-inflammatory drugs (NSAIDs) and hospitalized patients were 39.8% (37/93) and 93.5% (87/93), respectively. The overt gastrointestinal bleeding group patients had higher rate of hospitalized patients, and lower level of hemoglobin (P<0.05). Small intestinal inflammation (53/93) was the most common lesion, followed by intestinal vascular disease (18/93). The etiology of small intestinal bleeding was indentified in 74.2% (69/93) of patients, including 26 cases of NSAIDs enteropathy, 14 of intestinal telangiectasis, 5 of Crohn's disease, 5 of unidentified ulcers, 5 of intestinal lymphangiectasia, 4 of portal hypertension enteropathy, 4 of parasitic disease, 3 of Meckel's diverticulum, 1 of eosinophilic gastroenteritis, 1 of cryptogenic multifocal ulcerous stenosing enteritis, and 1 of intestinal malignant glomus tumor. The etiology was identified in 75.0% (51/68) and 72.0% (18/25) of patients with overt and obscure gastrointestinal bleeding, respectively (P=0.769).Conclusion CE plays an important role in the diagnosis of small intestinal bleeding. Small intestinal inflammation, especially NSAIDs enteropathy, was the most common etiology of small intestinal bleeding in our hospital.

Study on the correlation between venous blood and arterial blood gas electrolyte hemoglobin concentration

Mei Man, Ren Tianhua

2020, 41(2): 267-271. doi:10.3969/j.issn.1006-7795.2020.02.021

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Objective To study the correlation in the concentrations of sodium(Na⁺),potassium(K⁺),calcium(Ca²⁺), and hemoglobin (HGB)between venous blood and arterial blood gas. Methods The venous blood samples and arterial blood gas samples of the emergency department observation patients were taken at the same time.Venous blood biochemistry panel and routine test were carried out. The concentrations of Na⁺, K⁺, Ca²⁺,HGB in venous blood and arterial blood gas of 60 patients were selected by the method of random number table for statistical analysis. Results The mean values of K⁺ concentrations in arterial blood gas and venous blood were (3.73±0.52)mmol/L and (3.93±0.58)mmol/L, respectively, with P<0.001.The difference is within the clinically permissible error range, and thus the arterial blood gas results were directly used to estimate the venous K⁺ concentration level.The measured Na⁺ concentration of arterial blood gas and venous blood were (136.7±7.0)mmol/L and (136.49±6.6)mmol/L,respectively, with P=0.6.There was no significant difference, and the results of arterial blood gas were directly used to estimate the Na⁺ concentration level in venous blood. The measured values of Ca²⁺ concentration in arterial blood gas and venous blood were (1.12±0.22)mmol/L and (2.02±0.36)mmol/L, with P<0.001. Difference between the two is beyond the maximum clinical error range, however, the correlation coefficient is 0.88, therefore, the venous Ca²⁺ concentration was calculated with linear equation,venous Ca²⁺ concentration (mmol/L)=0.44+1.42×arterial blood Ca²⁺ concentration.The HGB values of arterial blood gas and venous blood were (101.3±26.6)g/L and (98.8±24.6)g/L, respectively, with P=0.17. Difference between the two was not statistically significant, and the arterial blood gas results were directly used to estimate the HGB concentration level in venous blood.Conclusion In emergency management,the concentrations of electrolytes and hemoglobin concentrations in arterial blood gas are reliable for guiding clinical decisions until laboratory results are available.

Retrospective analysis of image-guided sphenopalatine ganglion combined with selective cervical nerve block in the treatment of sphenopalatine neuralgia

Lai Guanghui, Zhang Daqian, Ni Jiaxiang

2020, 41(2): 272-276. doi:10.3969/j.issn.1006-7795.2020.02.022

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Objective To retrospectively analysis the therapeutic effect for viable sphenopalatine neuralgia (SPN) by image-guided (C-arm or CT-guided)sphenopalatine ganglion block combined with selective cervical paravertebral nerve block and cervical joint injection. Methods Totally 22 patients with sphenopalatine neuralgia underwent C-arm guided sphenopalatine ganglion block combined with ultrasound-guided nerve block of cervical 2-5 and cervical joint injection(1-3times,once a week). Numeric rating scales(NRS) was obtained at 24 hours, 1 month,3 months, 6 months,1 year,2 years, and 3 years after nerve block. The telephone follow-up lasted for 3-64 months,with average of (38.86±16.08) months. The therapeutic efficacy was evaluated, and the post-therapy adverse reaction was recorded. Results NRS scores significantly decreased after treatment at 24 hours, 1 month,3 months,6 months 1 year,2 years and 3 years. The effective rate after procedure was 95.45%(21/22),90.9%(20/22),95.24%(20/21),95.24%(20/21),100%(20/20),100%(19/19),100%(17/17)at 24 hours, 1 month, 3 months, 6 months 1 year,2 years and 3 years, respectively. Two (9.09%)patients presented with mild facial hematoma, which were completely relieved after ice compresses applied for 24 hours. No other adverse reaction was found. Conclusion C-arm or CT-guided sphenopalatine ganglion block combined with ultrasound-guided cervical paravertebral nerve block and cervical joint injection for viable SPN could relieve the pain completely, which could last for long time. It is a safe, effective, and stable mini-invasive therapy.

A clinical study and experience on diagnosis and treatment of 24 cases with COVID-19 based on “damp-heat epidemic virus”

Zhang Yong, Xie Yingzhen, Wang Fang, Jin Jiaxin, Han Luyao

2020, 41(2): 277-282. doi:10.3969/j.issn.1006-7795.2020.02.023

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Objective To summarize the clinical efficacy of the self-designed traditional Chinese medicine (TCM) protocol on COVID-19, and analyze the thoughts and methods about diagnosis, treatment and preventing disease from progressing based on "damp-heat epidemic virus". Methods A total of 24 patients with COVID-19 continuously hospitalized in Beijing Huimin Hospital from February 3, 2020 to February 18, 2020 were enrolled. On the basis of routine antiviral and symptomatic treatment, all patients were treated with the self-designed TCM protocol. The treatment lasted 6 to 14 days. The efficacy was evaluated by temperature, symptoms, white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY) and neutrophil lymphocyte ratio (NLR), and the changes of chest computed tomography(CT) manifestations. Results Clinical observation found that the disease is highly contagious, belongs to the damp-heat epidemic virus, invades lung and stomach. The main clinical manifestations are fever, pharyngoxerosis, pharyngalgia, cough, fatigue and muscle pain, anorexia, diarrhea, red tongue and yellow greasy coating. In the 24 patients, there were 15 patients with fever, whose average duration of fever (since the day of having a fever to the last fever day) was (6.23±3.67) days.Symptoms of the respiratory, digestive and nervous system were relieved. Decreased WBC, NE, and LY levels of 23 patients were significantly increased after the treatment (P<0.01). It is worth noting that, NLR of 3 patient among 5 patients older than 50 years with NLR over 3.13 decreased less than 2.90. Among 22 patients admitted to hospital with chest CT diagnosis, 6 patients had significant absorption, 11 had partial absorption, and 3 had no significant change. The improvement rate of the chest CT manifestations was 80.95%. Two patients with chest CT worsen were both over 60 years old, with NLR>3.13, and oxygen saturation(SpO₂) decreased. One of them was transferred. The other was treated with dispelling-dampness, draining-abscess and dissolving-blood-stasis herbal medicines. After treatment, the NLR decreased to 2.90, SpO₂ increased to more than 95%, and most of focus in chest CT were reduced. In this study, one moderate type case developed to severe type accounting for 4.2%. Conclusion It is significantly effective to treat COVID-19 with the self-designed TCM protocol based on "damp-heat epidemic virus". For the middle-aged and elderly population with collateral stasis or underlying diseases, it is suggested to pay attention to the early application of dissolving-blood-stasis and dredging-collateral herbal medicines. For those who had the tendency of damp-heat accumulating virulence and obstructing lung, it is suggested to clear and eliminate phlegm and obstruction, detoxify, dissolving-blood-stasis and dredging-collateral to prevent the disease progression.

Radiological findings of novel coronavirus pneumonia patients with different clinical type

Dong Li, Ma Xi, Lyu Xiaoyan, Yin Xiaoping, Yang Wen, Wang Xiaodong, Bian Weilin

2020, 41(2): 283-289. doi:10.3969/j.issn.1006-7795.2020.02.024

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Objective To investigate the imaging manifestations of COVID-19 with different clinical types.Methods Computed tomography(CT)imaging data of 71 patients diagnosed with COVID-19 were retrospectively analyzed. The clinical characteristics, imaging characteristics, the dominant distribution of lesions and improvement time of patients with common type,severe type and critically severe type were analyzed statistically. Results Among the 71 patients,12 were mild type, 45 common, 14 severe and critically severe. For the clinical manifestations, critically severe and severe patients had symptoms of fatigue,chest tightness and dyspnea(6/14,42.9%;4/14,28.6%),It was more obvious than those common type(2/45,4.4%;0) and mild type (0;0), with a statistically significant difference (P=0.001, 0.002).The C-creative protein level of patients with common type(30/45,66.7%), severe and critically severe type(9/14,64.3%) was higher than that of mild type(2/12,16.7%), with a statistically significant difference (P=0.005).For the CT manifestations:more than three lobes were involved in the lesions:the ratio(13/14,92.9%) in the severe and the critically severe type was higher than that in the common type(26/45,57.8%). For the severe and the critically severe type, the ratio of (12/14,85.7%) the lesions distribution in the peripheral and central lung was higher than the common type(20/45,44.4%). The lesions including consolidation, interlobular septal thickening in the severe and the critically severe type were more serious than those in the common type. These manifestations showed statistically significant differences between the two groups(P values were 0.036, 0.007, 0.004, 0.002).The followed up of 22 patients indicated that the peak of CT manifestations and the improvement of the condition all occurred 10 days later (40.96%,45.5%).Conclusion COVID-19 patients with common type and those with severe and critically severe type have different characteristics in the location of the lesions, the density of the lesion, the degree of consolidation and so on. Most of the patients may improve after 10 days of onset.

Value of multidisciplinary cooperation model in the treatment of COVID-19

Ke Jing, Cao Bin, Jiang Zhifeng, Ding Lin, Liu Zuojun, Zhang Xiwei, Li Xiaohui, Ji Zhili

2020, 41(2): 298-301. doi:10.3969/j.issn.1006-7795.2020.02.027

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More than 70000 people have been infected by the novel coronavirus from Wuhan. It is a great challenge for prevention and treatment of the novel coronavirus pneumonia (COVID-19), due to limited understanding of the COVID-19 and its natural history. Limited data suggested that COVID-19 may cause damage in multiple systems and organs. Moreover, people accompanied with chronic diseases may be more susceptible. This study aimed to explore the clinical value of multidisciplinary cooperation model in the treatment of COVID-19.

Correlation between coagulation and progressive hemorrhagic injury in elderly patients with acute traumatic brain injury

Hu Yue, Song Haozhe, Chen Jiashu, Liang Yuting, Zhao Anqi, Wang Murong, Li Lizhuo

2020, 41(2): 302-306. doi:10.3969/j.issn.1006-7795.2020.02.028

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Traumatic brain injury (TBI) refers to the brain injury caused by external force, As which is the disease with the highest fatality rate and disability rate in the whole body trauma. As one of its serious complications, progressive hemorrhagic injury(PHI) is the main cause of death in patients with craniocerebral trauma,and coagulation dysfunction is one of its main pathophysiological mechanisms. The proportion of elderly patients with craniocerebral trauma gradually increases with the aging of the population. Meanwhile, age is a risk factor for progressive hemorrhagic injury. Elderly patients with craniocerebral trauma are prone to suffering from progressive hemorrhagic injury,with worse state and prognosis than those of non-elderly patients once PHI occurs. Therefore, exploration of the correlation between coagulation indexes and progressive hemorrhagic injury in elderly patients with TBI and the predictive value of each coagulation index to PHI is conducive to clinical reference for early detection and timely diagnosis and treatment. In this paper, we reviewed the research progresses of coagulation disorder and progressive hemorrhagic brain injury after traumatic brain injury in the elderly.

Enhanced recovery after surgery in the anesthesia for total knee arthroplasty

Qi Xinyu, Huang Rui, Zhu Bin, Yao Lan

2020, 41(2): 307-311. doi:10.3969/j.issn.1006-7795.2020.02.029

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The promotion and application of the concept of enhanced recovery surgery in total knee arthroplasty is a hot topic in recent years, and the ultimate goal is to improve the prognosis of patients and reduce medical costs. From the view of perioperative anesthetic management, we summarized the best evidence-based medicine data and focused on the anesthesia progress for total knee arthroplasty under the idea of enhanced recovery after surgery. It may be helpful for clinicians and nurses to improve the existing cognition, practice and decision-making.

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