Objective To compare the performance of MTBDRplus V2 and Xpert MTB/RIF for detecting smear negative pulmonary tuberculosis (PTB).
Methods Clinical PTB suspects were enrolled consecutively in Anhui Chest Hospital and Xi’an Chest Hospital from January to December in 2014. The sputum samples of smear negative PTB suspects were collected and decontaminated. The sediment was used to conduct MTBDRplus V2, Xpert MTB/RIF and drug susceptibility test (DST). All the samples with discrepant drug susceptibility result between molecular methods and phenotypic method were confirmed by DNA sequencing.
Results A total of 1973 cases were enrolled in this study. The detection rates ofMycobacterium tuberculosiscomplex (MTBC) by MTBDRplus V2 and Xpert MTB/RIF were 27.67% and 27.98%, respectively. When setting MGIT culture result as a gold standard, the sensitivity and specificity of MTBDRplus V2 were 86.74% and 93.84%, and the sensitivity and specificity of Xpert MTB/RIF were 86.55% and 93.43%, respectively. For the detection of the resistance to rifampin, the sensitivity and specificity of MTBDRplus V2 were 94.34% and 96.62%, and the sensitivity and specificity of Xpert MTB/RIF were 88.68% and 95.96%, respectively. For the detection of the resistance to isoniazid, the sensitivity and specificity of MTBDRplus V2 were 77.38% and 98.02%, respectively.
Conclusion MTBDRplus V2 and Xpert MTB/RIF can be used to detect MTBC in smear negative samples with satisfactory performance.

胃平滑肌瘤26例分析

胃平滑肌瘤是消化道的一种良性肿瘤，发病率较低，国外报告占住院患者的0.01%，国内为0.019%［1］。因无典型症状，很易误诊。现将我院1997-06～1999-12收治的26例，报告如下。1 临床资料 本组男12例，女14例，年龄30～69岁，平均54岁。左上腹隐痛不适20例，上消化道大出血15例，间断性柏油样大便13例，腹部肿块7例，消瘦贫血4例，急性消化道穿孔1例。X线上消化道钡餐检查诊为胃溃疡14例，胃窦癌8例，胃息肉2例，胃巨皱壁症1例，胃恶性淋巴瘤1例。26例有3例行上腹部CT检查，均发现上腹部实质性占位病变。纤维胃镜检查诊为胃癌11例，胃溃疡10例，胃恶性淋巴瘤2例，胃息肉样腺癌1例，胃平滑肌瘤2例。

多发性骨髓瘤肾损伤诊治专家共识

Renal impairment (RI) is a common complication of multiple myeloma (MM), whichis presented as chronic kidney disease (CKD) or acute kidney injury (AKI).The typical pathologicalfeature is cast nephropathy.Presently international system staging (ISS) is used in evaluating MM.Althoughthe classic Durie-Salmon staging system could be still used in clinical practice , it may miss out some patientswith renal impairment.For evaluations of RI in MM patients with CKD, it′s recommended to assess theestimated glomerular filtration rate (eGFR) by creatinine based formula CKD-epidemiology collaboration(EPI) or modification of diet in renal disease (MDRD) and to stage the renal injuries according to 2013Kidney Disease Improving Global Outcomes (KDIGO) CKD guidelines.For MM patients with AKI, KDIGOAKI guidelines is recommended for evaluation.Renal biopsy is not a routine procedure in all MM patients .It′s necessary for patients presenting with glomerular injuries such as albuminuria >1 g/24 h to eliminateimmunoglobulin associated amyloidosis (AL) and monoclonal immunoglobulin deposition disease (MIDD).The effective treatment of MM can reduce serum light chain concentration and improve renal function .Thebasis of the RI treatment in MM is bortizomib-based regimen, which does not require dosage adjustment inpatients with dialysis or renal insufficiency.Thalidomide and lenalidomide are two major immunomodulatorsin MM treatment.Thalidomide can be used effectively in RI patients without dosage adjustment whilelenalidomide should be used cautiously in patients with mild or moderate RI with dosage adjustment andserum toxicity surveillance. High-dose therapy ( HDT) and autologous peripheral blood stem celltransplantation (APBSCT) can be therapeutical options for RI patients younger than 65 y, and they shouldbe considered more prudently in patients with severe renal insufficiency (GFR <30 ml/min).For patientswho are not suitable for the treatment mentioned above , they can be treated with conventional chemotherapy ,including VAD (vincristine, adriamycin and dexamethasone ), MP (mephalan and prednisolone) and highdosedexamethasone regimen.Adequate hydration (at least 3 litres of fluid intake a day or 2 L· m-2 · d-1 )and correcting reversible causes of RI are key points for the supportive care .Renal replacement therapy(more often hemodialysis) should be started in patients with severe AKI and end stage renal disease(ESRD).High flux or high cut-off membrane are recommended because routine hemodialysis could notremove the serum free light chain (sFLC) effectively.Plasmapheresis (PE) is recommended for patientswith hyperviscosity syndrome or cast nephropathy presented with AKI , which may help to increase thedialysis-independency.

肝硬化肝性脑病诊疗指南

The Chinese Society of Hepatology developed the current guidelines on the management of hepatic encephalopathy (HE) in cirrhosis based on the published evidences and panelists'' consensus. The guidelines provided recommendations for the diagnosis and management of hepatic encephalopathy including minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy (OHE) emphasizing the importance on screening MHE in patients with end-stage liver diseases. The guidelines emphasized that early identification and prompt treatment are essential to improve the prognosis of HE. The principles of treatment mainly consist of eliminating precipitating factors, treating hyperammonemia to improve acute neuropsychiatric abnormalities rapidly, primary and secondary prophylaxis.

中国艾滋病诊疗指南(2018年版)

Acquired immunodeficiency syndrome (AIDS) is an important public health problem in China. In 2005, the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association, which was updated twice in 2011 and 2015. The fourth edition of the guidelines in 2018 is revised on the basis of national clinical practice and the latest research studies. The new research progress in opportunistic infections and human immunodeficency virus(HIV) associated cancers, antiretroviral therapy, HIV post-exposure prophylaxis, and prevention of mother to child transmission were updated in these guidelines. In the 2018 edition, pre-exposure prophylaxis is mentioned for the first time. The strategy of whole course management of HIV infection is put forward in the current version, which needs the participation of multidisciplinary team in prophylaxis, early diagnosis, individualized treatment and humanistic care.

隐球菌性脑膜炎诊治专家共识

Cryptococcal meningitis is a common and refractory central nervous system infection,with high rates of mortality and disability.The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion.Based on the current situation of cryptococcal meningitis in China,the management of cryptococcal meningitis includes 6 aspects:introduction,microorganism identification,clinical manifestations and diagnosis,principles of antifungal therapy,treatment of refractory and recurrent meningitis,treatment of intracranial hypertension.There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis.This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines.The importance of early diagnosis,combined long-term antifungal therapy,control of intracranial hypertension are emphasized.

中国老年2型糖尿病诊疗措施专家共识(2018年版)

According to the national survey data over the past five years,there are about 50.16 million elderly diabetic patients (≥60 years old) in China.With the increase in the total number of the elderly,this number will be expected to increase.Among the elderly patients,most of them are newly diagnosed,and are associated with a number of risk factors for cardiovascular diseases at the time of initial diagnosis.Those who were with young-onset have a long-term clinical course,and often complicated with diabetic chronic complications and potential organ dysfunctions.Most of the elderly diabetic patients in China are with poor glycemic control.The diabetes-related complications have become one of the major reasons for the senile death.It is well accepted that early diagnosis and reasonable treatment could reduce the occurrence of diabetic complications,and the disability and fatal cardiovascular and cerebrovascular events.Thus,it is recommended,in the consensus,to conduct a comprehensive assessment of the glycemic control,metabolic cardiovascular risk factors,diabetes complications,multiple organ functions of the elderly patients,as well as their intelligence and physical fitness.Personalized control targets on blood glucose,pressure,lipids,uric acid and body weight would be established based on the assessment of each patient and consideration of the balance between benefits and risks in order to achieve the goal of early detection,early diagnosis,early treatment and early target reaching.Moreover,it is also recommended,in the consensus,to focus on the basic treatments (diets,exercises,self-monitoring and management),initiate suitable hypoglycemic drugs with complementary mechanisms when needed,and take into consideration of management of multiple cardiovascular risk factors and drug usage together with the caution of mutual interactions of multiple drugs.

中国登革热临床诊断和治疗指南

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease.As a dengue non-endemic country,China has experienced several dengue outbreaks in recent years.However,dengue patients in China displayed distinct clinical characteristics compared to patients in endemic countries.To standardize the diagnosis and treatment of dengue fever,the experts of the Society of Infectious Diseases,Society of Tropical Medicine and Parasitology of Chinese Medical Association,and the Society of Emergency Medicine,China Association of Chinese Medicine have reached this guideline based on guidelines for diagnosis,treatment,prevention and control of dengue (World Health Organization,2009);guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China,2014,Edition 2),health industry standard of the People's Republic of China "diagnosis for dengue fever (WS216-2018)" and systemic reports on dengue.The guideline includes 8 aspects:introduction,terminology,epidemiology and prevention,etiology and pathogenesis,clinical features,diagnosis,treatment and problems to be solved.

2016版美国甲状腺学会《甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南》更新点

The 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis has been officially published in October of 2016,five years after the publication of the previous version.Revised contents in the new guideline are summarized in this review.

“医学难以解释的症状”临床实践中国专家共识

“医学难以解释的症状”（ medically unexplained symptoms， MUS）是临床各学科常遇见的问题之一，常被医生们称为非特异症状、功能性症状、神经官能症等。其中既包括各种功能性疾病，又包括精神障碍中的躯体形式障碍。对临床医生而言，这样一组患者究竟该下什么诊断、进行何种评估、怎样规范干预、如何有效防治、是否应该转诊、如何成功转诊，在理论上缺乏为各临床学科所接受的共识，在实践上缺乏操作性流程和培训。

2018中国类风湿关节炎诊疗指南

To develop a new evidence-based diagnosis,treatment guideline for rheumatoid arthritis (RA) in China.A multidisciplinary guideline development group was established.The grading of recommendations assessment,development and evaluation (GRADE) system was used to rate the quality of evidence and the strength of recommendations.Recommendations were derived from evidence body,the balance of benefits and harmsand patient's values and preferences.The guideline development group developed 10 recommendations for the diagnosis and treatment of RA.The guideline covered the classification criteria,disease activity monitoring and assessing,antirheumatic drugs (DMARDs) and glucocorticoids with treat-to-target approach of RA.This rheumatoid arthritis guideline was intended to serve as a tool for clinicians and patients for best decisions-making in China.

中国多发性骨髓瘤诊治指南(2017年修订)

Multiple myeloma ( MM) is a clonal plasma cell malignancy , mainly in elderly people and still incurable at present .In the ear of novel agents and sensitive laboratory exams , the diagnosis and treatment of MM have been significantly improved .Chinese MM guidelines for the diagnosis and treatment were updated every two years according to the progression of international and domestic research and clinical studies.In this version, we updated the response criteria and new combination regimens in newly diagnosed patients.Monoclonal gammopathy of renal significance ( MGRS) was added as a new part of differential diagnosis, meanwhile, relapsed/refractory MM patients should be treated as long as possible .

Objective: To study the expression and the clinical significance of LEA in colorectal carcinoma. Methods: Immunohistochemistry S-P method to detect the expression of LEA and CEA in 140 colorectal cancer specimens and 100 non-cancerous colorectal specimens. Results: The expression of LEA is relative to tumor differentiation degree and exhibits higher selectivity in well-differentiated adeno-carcinoma (P<0.01). CEA has similar selectivity in well, moderately and poorly differentiated adenocarcinoma (P>0.05). Compared with CEA, the expression of LEA has lower positive rate in non-cancerous tissue (P<0.05). The positive rate of LEA in adenoma is much higher than surrounding non-cancerous mucosa and normal mucosa. In normal mucosa the positive rate of LEA is obviously lower than that of CEA (P<0.05). The expression of LEA and CEA has similar rule except in normal mucosa. In histological diagnosis of colorectal cancer the sensitivity of LEA is 82.9% and the specificity is 48%, while the sensitivity of CEA is 88.6% and the specificity is 35%. Conclusion: The expression of LEA is related to the differentiation degree of colorectal cancer tissue. LEA can be used as an auxiliary index for early diagnosis and a reference for the judgment of the malignancy degree of colorectal carcinoma, thus may be a new tumor marker with applicable clinic value.

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab-lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item);pre-hospital care (one item);evalu-ation and diagnosis (13 items);treatment (23 items); prevention and treatment of major complica-tions (12 items);and rehabilitation (four items). This is the first time that Chinese experts have pub-lished a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the recommenda-tion among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with “1” corre-sponding to neutrality and“5”representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After al of the votes were col ected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom-mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thoracol-umbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treat-ment strategy for acute thoracolumbar spine and spinal cord injury in China.

Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.

Objective　Protein induced by vitamin Kabsence or antagonistⅡ（PIVKAⅡ），also called des－gamma－carboxy prothro mbin（DCP），is a sensitive marker for the diagnosis of hepatocellular carcinoma（HCC）inJapan and the United States since the sensitive kits were available（1998）．PIVKAⅡis not usedin clinicaldiagnosis in China so far．The aimofthis study was to assess the diagnostic value of PIVKAⅡin Chinesepatients with HCC．Methods　Seru mPIVKAⅡandα－fetoprotein（AFP）levels were determined in 60 patients with HCCand 30patients with cirrhosis not carrying HCC．Results　The mean serumconcentration of PIVKAⅡin HCCpatients（784．3±1364．1，x±s）was higherthan thatin cirrhosis patients（16．1±31．7）；this difference was highly significant（P＜0．0001）．When thecutofflevelof 40 mAU／ml was used as the level of discriminating HCCfromcirrhosis，51．7％of patients（31／60）with HCChad PIVKAⅡvalues above this level（sensitivity）．Only 4 patients with cirrhosis hadsuch high PIVKAⅡlevels．Thus，the specificity of this test was 86．7％（26／30）．Total accuracy was62．2％［（31＋26）／（60＋30）］．Seven of 19 small HCCs（36．84％）had PIVKAⅡvalues above the cutofflevel．Concentrations of AFPabove 20 ng／ml were observed in 34 of60 patients with HCC（56．7％）and in11 patients with cirrhosis（36．7％）．Eleven of 26 patients with HCC（46．2％）withoutincreased AFPhadconcentrations of PIVKAⅡgreater than 40 mAU／ml．No significant correlation was found between serumlevels of AFPand PIVKAⅡthat were measured in 60 HCCpatients（rs＝0．101，P＝0．247）．Combiningthe information fromPIVKAⅡand AFPshowed anincrease of approximately 21．6％over AFPand 26．7％over PIVKAⅡalone．For small HCCpatients，combining the information from PIVKAⅡand AFPshowedan increase of approximately 15．8％over AFPalone and 21．1％over PIVKAⅡalone．Conclusion　PIVKAⅡis a useful early diagnostic marker for HCCand may be more sensitive whencombined with AFPin Chinese patients．

Objective To explore prospective diagnostic criteria for preleukemia.Methods A case control study was done comparing the discrepancies on clinical and laboratory features between patients with preleukemia and those with chronic aplastic anemia (CAA) or atypical paroxysmal nocturnal hemoglubinuria (a-PNH).Results There were eight variables of significance: (1) lymphocytoid micromegakaryocytes in the bone marrow; (2) immature granulocytes in the peripheral blood; (3) ≥2.0% myeloblasts in the bone marrow; (4) positive periodic acid schiff (PAS) stained nucleated erythrocytes; (5) myeloid differentiation index ≥1.8; (6) typical colonal karyotypic abnormalities; (7) negative sister chromatid differentiation; (8) cluster/colony ratio of granulocyte-macrophage colony-forming units (CFU-GM)>4.0. The following criteria were assigned: A: to meet variable one and at least two of the other seven variables and B: to meet at least four of the eight variables. All of the patients with preleukemia met either A or B and none of the patients with CAA or a-PNH did. Conclusions Preleukemia is different from CAA or a-PNH. It has its own clinical and laboratory features, which may be useful for its prospective diagnosis.

认识儿童间质性肺疾病及其诊治策略

儿童间质性肺疾病是儿童呼吸系统的重要疾病，包括一大类疾病谱，发病率呈增加趋势，有较高的致死率，且10%的病例为家族性患病。可以为原发性肺部疾病，又可以是全身性系统性疾病的肺部表现，与基因突变和环境因素密切相关。本文就儿童间质性肺疾病的病因、病理、临床特征，诊治新进展作一综述。

腰椎和股骨颈骨质疏松症1087例患病率比较分析

AIM: To discuss the effect of measuring sites to diagnosis of osteoporo-sis. METHODS: 1 087 subjects were measured at both hip and lumbervertebra sites by DEXA. T4 - L4 X-ray were taken and the compressive frac-tttre person were screened. To compare osteoporosis prevalence at differentsite and determine which site was sensitive to diagnosis of ostoopore-sis. RESULTS: BMD in both site was gradually decreasing with age in-creasing. BMD of female was lower than that of male. The prevalence of os-teoporosis at hip was higher than that at lumbar vetebra for men and theprevalence of osteoporosis at lumber was higher than that at hip in wom-en. CONCLUSION: BMD at lumbar vetebra as a indicator to diagnosis ofosteoporosis is better than BMD at hip for women.

透明隔异常CT诊断的临床意义

AIM:Abnormal transparent septum is common in clinical works but little in meaning,so some CT reports are not listed.We collected complete abnormal transparent septum cases to perform comparison analysis between CT diagnosis and clinical data.METHODS:109 abnormal transparent septum diagnosed by CT was compared with symptom of clinics.Axis scanning and no enhanced scanning were used in CT and 2 doctors in charge of sample collection.The 109 cases were excluded with abnormal transparent septum induced by secondary local cerebral atrophy and secondary perforation deformity.RESULTS:There were 15 cases with the fifth ventricle of cerebrum and 22 cases with the fifth and sixth ventricle of cerebrums,10 cases with transparent septum cyst,28 cases with translocation of transparent septum,8 cases with no crack in the forebrain,6 cases with poor development of keratoma and 20 cases of other deformity.CONCLUSION:Abnormal transparent septum cannot be omitted and should be clearly diagnosed by CT.