Key determinants of misdiagnosis of tracheobronchial tuberculosis among senile patients in contemporary clinical practice:A retrospective analysis

BACKGROUND Tracheobronchial tuberculosis(TBTB)is a common subtype of pulmonary tuberculosis.Concomitant diseases often obscure the diagnosis of senile TBTB.AIM To characterize senile patients with TBTB and to identify the potential causes of misdiagnosis.METHODS One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively analyzed.Patients were classified as diagnosed group(n=58)and misdiagnosed group(n=62).Clinical manifestations,laboratory results,radiographic data,and endoscopic findings were compared between the two groups.RESULTS Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis(non-TBTB,29/62,46.8%),general pneumonia(9/62,14.5%),chronic obstructive pulmonary disease(8/62,12.9%),and tracheobronchial carcinoma(7/62,11.3%).The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group[median(first quartile,third quartile):6.32(4.94,16.02)mo vs 3.73(2.37,8.52)mo].The misdiagnosed group had lower proportion of patients who underwent bronchoscopy[33.87%(21/62)vs 87.93%(51/58)],chest computed tomography(CT)scan[69.35%(43/62)vs 98.28%(57/58)],and those who showed CT signs of tuberculosis[27.91%(12/62)vs 50%(29/58)]as compared to that in the diagnosed group(P<0.05).There were no significant between-group differences with respect to age,gender,occupation,clinical manifestations,or prevalence of comorbid chronic diseases(P>0.05).CONCLUSION Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of TBTB.Increased implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.

Intervention effect and mechanism of Jisheng Shenqi Decoction plus Panax notoginseng and Bionjia on CCl4-induced hepatic fibrosis rat model

Objective:To investigate the intervention effect and specific mechanism of Jisheng Shenqi Decoction plus Panax notoginseng and Turmeric on carbon tetrachloride(CCl4)-induced liver fibrosis in rats.Methods:SPF SD rats were randomly divided into control group,model group,and Chinese medicine treatment(low,medium and high dose)groups.The model group and Chinese medicine treatment group were given intraperitoneal injection of 40%CCl4 olive oil solution twice a week.A rat model of liver fibrosis was replicated by the method for 8 weeks.After successful modeling,each drug-administered group was gavaged with corresponding drugs,and the control group and model group were gavaged with equal volume of distilled water,once a day,for 4 weeks.After the last intragastric administration,HE staining and Masson staining were used to observe the pathological morphology of liver tissue,and liver function(ALT,AST)was detected;ELISA method was used to determine transforming growth factorβ(TGF-β),angiotensin II(Ang-Ⅱ),chitinase 3-like protein 1(CHI3L1),interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)content;The expression levels of type I,type III collagen(Col-Ⅰ,Col-Ⅲ)and TGF-βmRNA were determined by RT-PCR.Results:①HE and Masson staining showed that a large number of liver cells in the model group were inflamed and necrotic,the collagen fibers in the liver tissue were extensively proliferated,the fibrous septa were interconnected,and the pseudolobules were formed.Compared with the model group,the levels of ALT,AST,TGF-β,Ang-Ⅱ,CHI3L1,IL-1,IL-6 and TNF-αin the traditional Chinese medicine treatment group were decreased,while the levels of Col-Ⅰ,Col-ⅢThe expressions ofⅢand TGF-βmRNA were decreased,and the effect was most obvious in the middle and high dose groups of traditional Chinese medicine(P<0.01).Conclusion:Jisheng Shenqi Decoction combined with Panax notoginseng and Biejia can significantly improve liver fibrosis induced by CCl4 in rats,and its mechanism may be related to the down-regulation of angiotensin-converting enzyme(ACE)-angiotensin II(Ang-II)-angiotensin II receptor 1(AT1R)signaling pathway related gene expression,reducing the level of related cytokines,promoting the degradation of extracellular matrix and so on.

Value and significance of tumor markers as CEA,CA125,SCC-Ag,CA199 and CYFRA21-1 in the diagnosis of cervical cancer

Objective: To investigate the value and significance of serum CEA, CA125, SCC-Ag, CA199 and CYFRA21-1 in the diagnosis of cervical cancer by comparing the detection of five serum markers. Methods: A total of 108 cases were divided into three groups, including 60 cervical cancerpatients and 20 cervical intraepithelial neoplasiain patients treated in our hospital from September 2015 to September 2016 and 28 healthy women. Radioimmunoassay was used to detect and compare the serum levels of CA125, CA199, CYFRA21-1 and ELISA method was used to detect and compare the serum levels of SCC-Ag, CEA. Results: (1) There was no statistically significant difference in the serum CEA, CA125, SCC-Ag, CA199, CYFRA21-1 levels between CIN group and control group. The serums CEA, CA125, SCC-Ag, CA199, CYFRA21-1 levels of cervical cancer patients were significantly higher than the other two groups. The differences were statistically significant. (2)There were statistically significant differences in the serum CEA, CA125, SCC-Ag, CA199, CYFRA21-1 levels between different cervical pathological type groups.The serum CA125, CA199, CEA levels of cervical glandular cancer patients were significantly higher than the other two groups. The differences were statistically significant. The serum SCC-Ag, CYFRA21-1 levels of cervical squamous cancer patients were significantly higher than the other two groups. The differences were statistically significant. Conclusion: The serums CEA, CA125, SCC-Ag, CA199, CYFRA21-1 levels of cervical cancer patients were significantly higher than cervical intraepithelial neoplasiain patients and healthy women. The serum CA125, CA199, CEA levels of cervical glandular cancer patients were significantly higher and the serum SCC-Ag, CYFRA21-1 levels of cervical squamous cancer patients were significantly higher. The five tumor markers can be used in diagnosis of cervical cancer and they are also worthy in distinguishing cervical pathological types.

Adaptive security control of time-varying constraints nonlinear cyber-physical systems with false data injection attacks

In this article,an adaptive security control scheme is presented for cyber-physical systems(CPSs)suffering from false data injection(FDI)attacks and time-varying state constraints.Firstly,an adaptive bound estimation mechanism is introduced in the backstepping control design to mitigate the effect of FDI attacks.Secondly,to solve the unknown sign time-varying statefeedback gains aroused by the FDI attacks,a type of Nussbaum function is employed in the adaptive security control.Then,by constructing a barrier Lyapunov function,it can be ensured that all signals of controlled system are bounded and the time-varying state constraints are not transgressed.Finally,the provided simulation examples demonstrate the effectiveness of the proposed controller.

A bidirectional brain-computer interface for effective epilepsy control

Brain-computer interfaces(BCIs) can provide direct bidirectional communication between the brain and a machine. Recently, the BCI technique has been used in seizure control. Usually, a closed-loop system based on BCI is set up which delivers a therapic electrical stimulus only in response to seizure onsets. In this way, the side effects of neurostimulation can be greatly reduced. In this paper, a new BCI-based responsive stimulation system is proposed. With an efficient morphology-based seizure detector, seizure events can be identified in the early stages which trigger electrical stimulations to be sent to the cortex of the brain. The proposed system was tested on rats with penicillin-induced epileptic seizures. Online experiments show that 83% of the seizures could be detected successfully with a short average time delay of 3.11 s. With the therapy of the BCI-based seizure control system, most seizures were suppressed within 10 s. Compared with the control group, the average seizure duration was reduced by 30.7%. Therefore, the proposed system can control epileptic seizures effectively and has potential in clinical applications.

Tillage force and disturbance characteristics of different geometric-shaped subsoilers via DEM

With the increased use of agricultural machinery in field operations,soil compaction has become increasingly severe,and the plough pan has become deeper.Subsoiling is an excellent way to address this problem.However,it is limited by high energy consumption,which is closely related to tillage force.To investigate the effect of the geometric shape of shanks and tines on tillage force and soil disturbance in loam,a layered soil model in accordance with the actual conditions was established and five different subsoilers were simulated via discrete element modeling.The results indicated that the shank impacted soil disturbance and tine impacted tillage force.The draft force of curved shank and chisel tine was 8%less than that of the straight shank and sweep tine.The straight shank and sweep tine produced a larger furrow profile and a higher furrow width.The subsoiler with curved shank and chisel tine(C-C)exhibited the lowest specific resistance(12.87,17.52,19.46 and 21.18 kN/m^2 in the 30,35,40 and 45 cm tillage depth,respectively)considering the draft force and soil disturbance characteristics.Hence,these results will facilitate in the selection of a suitable subsoiler and design of new subsoilers with lower energy consumption requirements for loam areas worldwide.