Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

AIM: To report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data. METHODS: Retrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles. RESULTS: Twelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients. CONCLUSION: For HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.     

Relationship between Ulcerative Colitis and Lung Injuries

Objective To explore the relationship between ulcerative colitis (UC) and lung injuries by assessing their clinical manifestations and characteristics.
Methods From July 2009 to April 2012, 91 UC patients presenting to Longhua Hospital who met the established inclusion and exclusion criteria were enrolled in this retrospective study. According to the scores of disease activity index, the patients were divided into the mild, moderate, and severe groups. Meanwhile, the records of pulmonary symptoms, chest X-ray image, and pulmonary function were reviewed.
Results Sixty-eight (74.7%) patients had at least 1 pulmonary symptom, such as cough (38.5%), shortness of breath (27.5%), and expectoration (17.6%). And 77 (84.6%) had at least 1 ventilation abnormality. Vital capacity value was significantly lower in the severe group than that in the mild group (91.82%±10.38%vs. 98.92%±12.12%, P<0.05).
Conclusions Lung injury is a common extraintestinal complication of UC. According to the theory in Traditional Chinese Medicine that the lung and large intestine are related, both the lungs and large intestine should be treated simultaneously.     

LCT及HR-HPV诊断宫颈病变的临床价值

目的探讨LCT和HR-HPV对宫颈病变的诊断价值。方法对20479例患者行LCT检查,LCT阳性者行HR-HPV检测及电子阴道镜下宫颈活检组织病理检查,以组织病理学结果作为诊断的金标准,比较LCT阳性结果、HR-HPV检测结果与阴道镜下宫颈活检病理结果的符合率。结果1)LCT结果为ASCUS、LSIL、ASCH、HSIL与阴道镜下宫颈活检病理结果的符合率分别为54.55%、62.65%)、88.24%、92.99%。其HR-HPV阳性率分别为71.64%、80.56%、88.24%、92.86%。差异有显著性(P<0.001)。2)HR-HPV阳性组与阴性组比较,高级别宫颈病变的检出率分别为48.14%、17.39%,经卡方检验,P<0.001,差异有显著性。结论高危型人乳头瘤病毒检测对于细胞学诊断为非典型鳞状细胞的患者有重要的分流价值。     

Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

Objective The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. Method The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Results Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Conclusions Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of incomplete fractures of the pars, but the presence of marrow oedema on fat-saturated T2-weighted sequences is a useful means of detecting acute spondylolysis.     

一次力竭性离心运动对大鼠骨骼肌VEGF表达、血管增生和形态学结构的影响

目的:探讨一次力竭性离心运动后大鼠腓肠肌血管内皮细胞生长因子(VEGF)表达的时相变化与运动后肌纤维间毛细血管增生及运动性肌损伤(EIMD)变化之间的关系。方法:雄性Sprague-Dawley大鼠60只,分为10组:安静对照组和运动后即刻、1h、2h、3h、4h、1天、3天、5天、10天组,每组6只。运动方式采用跑台运动,速度16m/min,坡度-16°;运动100min,休息5min,再运动100min。实验后分别测定各组大鼠腓肠肌VEGF蛋白表达水平,并观察其腓肠肌血管增生和形态学结构变化。结果:(1)一次力竭性离心运动后大鼠腓肠肌VEGF蛋白较对照组表达增加,2h达到峰值(P<0.01),3h、4h、1天、3天时保持高表达(P<0.05),5天和10天时基本恢复至基础水平。(2)光镜下一次力竭性离心运动后第1、3天大鼠腓肠肌形态学结构异常最明显,10天时基本恢复正常。(3)光镜下一次力竭性离心运动后3天至10天时可见大鼠腓肠肌肌纤维间血管增生较明显。结论:一次力竭性离心运动后大鼠腓肠肌VEGF蛋白表达增加,5天至10天恢复到基础水平。肌纤维间血管增生滞后于VEGF蛋白表达升高,随着血管明显增生,腓肠肌损伤逐渐恢复。     

单纯性胰腺创伤后大鼠胰腺细胞增殖状况的实验研究

目的：构建大鼠单纯性胰腺创伤模型观察胰腺细胞增殖变化特点并探讨胰腺细胞增殖与组织损伤的关系。方法将60只Wistar大鼠分为2组：撞击组（采用BIM‐Ⅲ生物撞击机构建胰腺创伤大鼠模型,40只）和对照组（假手术组,20只）,每组大鼠于建模后6、24、72 h ,7 d处死,采用分光光度法检测各组大鼠血清淀粉酶（AMS）、脂肪酶（LPS）活性,通过TUNEL染色和流式细胞技术测定胰腺组织细胞死亡并分析细胞周期分布特点,Western blot测定胰腺组织Bcl‐2、Bax蛋白的表达。结果撞击组大鼠LPS活性升高时相点晚于AMS且持续时间较长,TUNEL染色、流式细胞检测、Western blot结果揭示胰腺创伤可诱导胰腺组织细胞凋亡和代偿性增生。胰腺细胞增殖变化特点表明胰腺创伤后的最佳治疗时间是发病24 h内。结论同时检测AMS和L PS有助于判定胰腺的外分泌功能受损情况。     

黄芩苷对脂多糖诱导牙周膜成纤维细胞表达炎症因子的影响

【】目的：探讨黄芩苷对脂多糖促人牙周膜成纤维细胞炎症因子表达的影响。方法：将培养后的人牙周膜成纤维细胞用不同浓度的黄芩苷处理,CCK8实验观察不同浓度黄芩苷对人牙周膜成纤维细胞的细胞毒性。将培养后的人牙周膜成纤维细胞分为空白对照组、LPS组、黄芩苷组和LPS+黄芩苷组。空白对照组仅加入2%胎牛血清的培养液;LPS组加入加入100μg/mLLPS ;黄芩苷组分别加入黄芩苷200、500ng/mL ;LPS+黄芩苷组加入100μg/mL LPS,同时分别加入黄芩苷 200ng/mL 、500ng/mL。24h收集细胞, 检测各组IL-6、IL-8、IL-1βmRNA表达的变化。结果： 500ng/mL浓度以下黄芩苷添加至细胞没有明显的细胞增殖毒性。单独加入黄芩苷200ng/mL和500ng/mL的黄芩苷组和空白对照组比较,IL-6、IL-8、IL-1β均无明显变化(P＞0.05)。 和空白对照组比较,LPS组IL-6、IL-8、IL-1β明显上升,差异有统计学意义 (P<0.05),同时加入LPS和200ng/ml黄芩苷,相比单独加入LPS组,IL-6、IL-8、IL-1β明显下降,差异有统计学意义(P<0.05)。而同时加入LPS和500ng/mL黄芩苷,相比单独加入LPS组,IL-6、IL-8、IL-1β明显上升,差异有统计学意义 (P<0.05) 结论：黄芩苷在低浓度时显示有抑炎作用,而在浓度增加达到500ng/mL时显示有促炎作用。     

呼吸内科不同区域下呼吸道感染耐药菌分布及耐药特征比较分析

目的：探索昆明医科大学第一附属医院呼吸内科不同区域[门诊、病房,呼吸重症监护病房（RIC U ）]下呼吸道感染耐药菌株的分布构成及耐药特征,为临床抗菌药物的合理应用提供依据。方法采用K‐B纸片扩散法和仪器法（VITEK‐TWO）,按照美国临床与实验室标准化研究所（CLSI）2010年版标准判读结果,对昆明医科大学第一附属医院呼吸科门诊、病房、RICU患者送检的痰液、肺泡灌洗液标本通过细菌培养鉴定及药敏试验分离出的480株耐药菌株,用WHONET5．6软件对检测数据进行分析。结果该医院呼吸门诊、病房、RICU下呼吸道感染耐药菌分布构成前4位均以革兰阴性菌为主。肺炎克雷伯菌对多数抗菌药物的耐药率大于30％,对庆大霉素、左氧氟沙星、氨苄青霉素的耐药率大于50％,RIC U与呼吸科门诊和病房相比差异有统计学意义（ P＜0．05）。亚胺培南、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、阿米卡星抗菌活性较强,其耐药率小于20％。大肠埃希菌对11种常用抗菌药物在呼吸科门诊、病房与RICU的耐药率相似。产超广谱β‐内酰胺酶（ESBLs）菌株的多重耐药率明显高于非产ESBLs菌株（P＜0．05）,产ESBLs菌株对亚胺培南耐药率小于10％。铜绿假单胞菌对头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、头孢吡肟、喹诺酮类、氨基糖甙类在呼吸科门诊和病房仍保持较高的抗菌活性,但RIIU的耐药率大于54％（ P＜0．05）。鲍曼不动杆菌对亚胺培南的耐药率在RIC U和病房明显高于呼吸科门诊,分别为70．4％、64．6％和46．2％。RIC U检出的耐甲氧西林金黄色葡萄球菌（MRSA）对利福平耐药率明显高于呼吸科门诊和病房（P＜0．05）。结论呼吸科门诊、病房和RICU的耐药菌分布构成及耐药率均有明显差异,临床医师除了熟悉本地区耐药菌分布及耐药率监测情况外,还应掌握本单位各科室不同区域耐药菌的耐药率情况,才能正确有效合理应用抗菌药物。     

COVID-19患者早期咽拭子病毒载量与临床特征的关联分析

目的:探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者早期咽拭子病毒载量与临床症状及肺部影像学表现的关系。方法:回顾性分析2020年1月24日至2月9日在中南大学湘雅二医院确诊的30例COVID-19患者早期咽拭子病毒核酸载量与临床症状、肺部影像学特征的具体关联。结果:30例COVID-19患者就诊时,4例患者(13.33%)未出现临床症状,23例患者(76.67%)出现发热;20例患者(66.67%)出现COVID-19影像学改变,10例患者(33.33%)影像学无明显异常。COVID-19无症状患者的咽拭子病毒核酸Ct值与有症状患者相比差异无统计学意义;相比于影像学无异常的患者,出现肺炎影像学表现的患者咽拭子病毒核酸Ct值更大(P=0.001),体温更高(P=0.014);通过logistic回归模型校正性别和年龄后,咽拭子病毒核酸Ct值与出现肺炎影像学特征呈独立正相关(OR=1.34,95%CI=1.07～1.66,P=0.009)。结论:早期无临床症状的COVID-19患者与有症状患者的咽拭子病毒载量水平相当;COVID-19患者早...     

中空松质骨拉力螺钉治疗骶髂复合体损伤

目的评价骶髂复合体损伤应用中空松质骨螺钉内固定的疗效.方法对骨盆骨折伴有骶髂复合体损伤的16例,通过影像增强器于骨盆内、外口位下观察、复位,应用中空松质骨加压螺钉行骶髂间的内固定.结果 16例患者经过5～36个月随访,所有患者复位佳,骨折愈合,无明显疼痛,功能恢复良好,无一例神经损伤,临床效果满意.结论中空松质骨加压螺钉治疗骶髂复合体损伤,创伤小、操作简便,只要严格掌握适应证,熟悉局部解剖,认真细致操作,能及时达到骨盆后环的稳定,是治疗骶髂复合体损伤的可靠方法之一.