2016 Vol. 7, No. 1

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Original Contributions
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  Objective  To review the clinical features, treatment effectiveness, and aqueous humor and tear virus load results of the ocular complications in human immunodeficiency virus infection/acquired immuno-deficiency syndrome (HIV/AIDS) patients diagnosed and treated in Department of Ophthalmology in Peking Union Medical College Hospital.  Methods  We retrospectively reviewed the clinical features and treatment effectiveness of ocular complications in 223 HIV/AIDS patients in the period from January 2001 to December 2015, including 157 males and 66 females. The mean age was (39.2±9.7) (8.0-78.0) years. Their HIV exposure, clinical manifestations of ocular complications, diagnostic examinations, and treatment were reviewed.  Results  Ocular manifestations were found in 99 (44.4%, 156 eyes) of the 223 patients, including cytomegalovirus retinitis (CMVR) in 64 eyes (40 patients), HIV retinopathy in 54 eyes (35 patients), HIV and syphilis double infection with fundus disease in 20 eyes (13 patients), immune reconstitution inflammatory syndrome (IRIS) in 16 eyes (10 patients), and chronic dacryoadenitis in 2 eyes (1 patient). Tear secretion was lower in HIV/AIDS patients with CD4+T cell less than 50/mm3 than in normal people (P=0.008). HIV-1 virus was found in the aqueous humor and tears of 16 HIV/AIDS patients responding to highly active antiretroviral therapy (HAART) and with undetectable plasma viral load, with the median viral load being 2291 (519, 6667) copies/ml.  Conclusions  CMVR is the most common opportunistic infection among the ocular complications of late-stage HIV/AIDS patients. Early diagnosis and systematic/topical treatment may save the vision of most patients. Detectable viral load may still be present in aqueous humor and tears even in patients with undetectable viral load in the blood, suggesting that precautions should be taken to prevent transmission of HIV virus.
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  Objective  To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention.  Methods  From July 2012 to July 2013, 645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients, and in-hospital adverse cardiac events (including all-cause death, nonfatal myocardial infarction, new nonfatal ischemic stroke, new nonfatal hemorrhagic stroke, and unplanned vessel revascularization) were recorded. The relationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed.  Results  Among the 645 patients, 68 (10.54%) developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not[41.42 (28.73, 57.07)ng/L vs. 35.66 (22.84, 48.22)ng/L, P=0.009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events (OR 1.018, 95% CI:1.004~1.032, P=0.012).  Conclusion  Plasma level of angiotensin Ⅱ may be correlated with poor in-hospital prognosis of patients who received elective percutaneous coronary intervention, hence it may have important predictive value.
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  Objective  To demonstrate the gross lesion spatial distribution of prostate cancer confirmed by template-guided transperineal prostate biopsy (TTPB).  Methods  This study enrolled 61 consecutive patients diagnosed as prostate cancer with no more than 6 positive regions on TTPB between November 2013 and March 2015 in Peking Union Medical College Hospital. With radical prostatectomy specimens from these patients, we compared the tumor frequencies and characteristics on anterior and posterior zones in gross pathology. The lesion spatial distributions were further compared among apex, middle, and base of prostate.  Results  Of the 61 predominant tumors, the anterior (APCs) and posterior prostate cancers (PPCs) were 32 (52.5%) and 29 (47.5%), with no significant difference (χ2=0.295, P=0.587). There was no difference in positive surgical margin or Gleason score (GS) between APCs and PPCs. The tumor frequencies of apex, middle, and base of prostate were 96.7%, 80.3%, and 29.5%, respectively; the tumor loads per unit volume were 105.17, 130.62, and 69.81 μl/ml, respectively. Compared with the base, the apex had a higher tumor frequency (χ2=31.816, P < 0.001) and tumor load (P=0.028).  Conclusions  The tumor frequencies and pathological characteristics observed in gross pathology of the anterior and posterior zones of whole-mounted radical prostatectomy specimens may be similar in TTPB-confirmed prostate cancer. Compared with the base of prostate, the apex may be associated with a higher tumor frequency and tumor load.
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  Objective  To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors.  Methods  This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score < 10), with 75 patients in each group. The patients completed the illness attribution questionnaire while waiting to see the doctor. After visiting the doctor, each patient and doctor were invited to finish the patient-doctor relationship questionnaire (PDRQ) or difficult doctor-patient relationship questionnaire (DDPRQ) respectively, as well as to report the degree of satisfaction with the clinic visit and the estimated time of this doctor-visiting.  Results  The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P < 0.01) and culture-specific factors (6.5±1.8 vs. 5.6±1.8, P < 0.01). Moreover, the total score of PDRQ in the SOM+ group was significantly lower than that in the SOM- group (37.7±6.7 vs. 39.6±6.4, P=0.011), so did the scores for items "my doctor can help me", "my doctor has enough time for me", and "I am satisfied with the treatment" (P=0.028, 0.038, 0.022). On the other hand, the doctor-reported scores were also higher in the SOM+ group regarding "frustrated by the patient's vague complaints" and "caring for this patient is time-consuming" (P=0.047, 0.021), while lower for the item "I felt at ease when with this patient" (P=0.014). The degrees of satisfaction of both patients and doctors in the SOM+ group were significantly lower than those in the SOM- group (P=0.048, 0.044). The patients reported no significant difference in visit time between the SOM+ group and the SOM- group (P=0.814), but the doctors-reported visit time in the SOM+ group was longer than that in the SOM- group (P=0.030).  Conclusions  Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.
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  Objective  To evaluate the relationship between serum IgG4 levels and CT morphological changes of abdominal organs involved in autoimmune pancreatitis (AIP).  Methods  Serum IgG4 levels, pancreas and other involved abdominal extrapancreatic organs' CT morphological changes of 19 clinically diagnosed AIP patients who had complete related information were retrospectively analyzed. The patients were divided into two groups (recovering and non-recovering) according to the above three aspects. Consistency among serum IgG4 levels, morphological changes of the pancreas and morphological changes of involved abdominal extrapancreatic organs was evaluated by Fisher exact test.  Results  In total, 13/19 patients had consistent trend between serum IgG4 level and pancreatic morphological changes (P=0.169); 15/19 had consistent trend between serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs (P=0.013); 15/19 patients had consistent trend in morphological changes between the pancreas and involved abdominal extrapancreatic organs (P=0.020).  Conclusions  The trend of serum IgG4 level and morphological changes of involved abdominal extrapancreatic organs have a good consistency, so do the morphological changes of the pancreas and involved abdominal extrapancreatic organs, while the trend of serum IgG4 level appears to have a poor consistency with the morphological changes of the pancreas.
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  Objective  To discuss the feasibility of Checkmate 2 as a daily check device in radiotherapy accelerator output check.  Methods  According to the methods proposed in International Atomic Energy Agency(IAEA) Report No. 277, Varian 2300CD accelerator's two photon beams (6 MV and 15 MV) and 5 electronic beams (6, 9, 12, 16, and 20 MeV) were calibrated. Ionization chamber and Checkmate 2 were used to measure the output of the beam at 7 energies delivering 100 MU every day. Maximum permissible error was ±2%. Ambient temperature and air pressure were measured and also detected by Checkmate 2 to calculate the correction factor. A total of 66 continuous measurements were carried out in workdays in 3 months to compare the measurements at different energies and accuracy of temperature and air pressure correction factor every day.  Results  In the measurement results of both Checkmate 2 and ionization chamber, the absolute dose errors were within 2%, and the differences between the two measurement results showed no statistically significant difference (P > 0.05). Measured and Checkmate 2-calculated mean temperature and pressure correction factor were 1.032±0.007 and 1.033±0.007, respectively, with no significant difference(P=0.452). Correlation analysis showed that the two correction factors were positively correlated (r=0.92, P=0.000).  Conclusions  Checkmate 2 could reflect the dose output with short measurement time and simple operation. It may be applied as a very useful device for linear accelerator output morning check.
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