Comparison between SARS, MERS and COVID-19 in diagnostic criteria

Since a lot of people get involved by COVID-19 infection and died and lots of them obliged to stay at home and teleworking due to its unknown contagious pneumonia in February and March 2020 in Iran and the world;and this number is growing,it seems necessary to study the diagnostic criteria of this virus,based on the recently published articles,and then compare them with Severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS).Corona viruses are the largest known RNA viruses able to infect humans and birds.These viruses can cause more serious respiratory diseases in elderly,or immunocompromised individuals.In this article,by comparing COVID-19,SARS and MERS viruses,we aim to find similarities and differences between these three which are from the same family and by expressing their diagnostic criteria,help care units to find patients faster and have enough time for treating them.

Comparison of the prevalence of sarcopenia in geriatric patients in Xining based on three different diagnostic criteria

BACKGROUND Sarcopenia is an age-related decline in skeletal muscle mass,which depends on an assessment of muscle strength and muscle mass.The diagnostic definition of sarcopenia varies by region.AIM To determine the optimal diagnostic criteria for sarcopenia in a plateau population.Cut off values for the components of diagnostic algorithms for sarcopenia in plateau populations should consider altitude.METHODS One hundred and fifty subjects aged>60 years attending a tertiary comprehensive hospital in the city of Xining(elevation:2260 m)between October and December 2018 were enrolled.Handgrip strength,muscle mass,and physical performance were measured.Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia(AWGS)2019 criteria,Beijing criteria,and Lasha criteria.RESULTS Across diagnostic criteria,there were significant differences in the prevalence of sarcopenia in the overall population and stratified by gender.The prevalence of sarcopenia measured by the AWGS 2019 or Lasha criteria was significantly higher in female compared to male subjects.In males,the prevalence of sarcopenia measured by the Beijing criteria was significantly higher in subjects who identified as Han compared to Minority.In females,there were no significant differences in the prevalence of sarcopenia by ethnicity according to any criteria.CONCLUSION The Lasha criteria provided a lower prevalence of sarcopenia(males,8.7%;females,22.41%;overall,14%)and were able to differentiate between males and females.The Lasha criteria are likely most appropriate for detection of sarcopenia in this plateau population.We recommend the Lasha criteria for detection of sarcopenia in Xining.

Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus

BACKGROUND Implementation of new diagnostic criteria for gestational diabetes mellitus(GDM)are still a subject of debate,mostly due to concerns regarding the effects on the number of women diagnosed with GDM and the risk profile of the women newly diagnosed.AIM To estimate the impact of the World Health Organization(WHO)2013 criteria compared with the WHO 1999 criteria on the incidence of gestational diabetes mellitus as well as to determine the diagnostic accuracy for detecting adverse pregnancy outcomes.METHODS We retrospectively analyzed a single center Dutch cohort of 3338 women undergoing a 75 g oral glucose tolerance test where the WHO 1999 criteria to diagnose GDM were clinically applied.Women were categorized into four groups:non-GDM by both criteria,GDM by WHO 1999 only(excluded from GDM),GDM by WHO 2013 only(newly diagnosed)and GDM by both criteria.We compared maternal characteristics,pregnancy outcomes and likelihood ratios for adverse pregnancy outcomes.RESULTS Retrospectively applying the WHO 2013 criteria increased the cohort incidence by 13.1%,from 19.3%to 32.4%.Discordant diagnoses occurred in 21.3%;4.1%would no longer be labelled as GDM,and 17.2%were newly diagnosed.Compared to the non-GDM group,women newly diagnosed were older,had higher rates of obesity,higher diastolic blood pressure and higher rates of caesarean deliveries.Their infants were more often delivered preterm,large-for-gestational-age and were at higher risk of a 5 min Apgar score<7.Women excluded from GDM were older and had similar pregnancy outcomes compared to the non-GDM group,except for higher rates of shoulder dystocia(4.3%vs 1.3%,P=0.015).Positive likelihood ratios for adverse outcomes in all groups were generally low,ranging from 0.54 to 2.95.CONCLUSION Applying the WHO 2013 criteria would result in a substantial increase in GDM diagnoses.Newly diagnosed women are at increased risk for pregnancy adverse outcomes.This risk,however,seems to be lower than those identified by the WHO 1999 criteria.This could potentially influence the treatment effect that can be achieved in this group.Evidence on treatment effects in newly diagnosed women is urgently needed.

PRIMARY MALIGNANT LYMPHOMA OF THE LUNG: REPORT OF A CASE AND REFERENCE TO DIAGNOSTIC CRITERIA

Although pulmonary involvement ofmalignant lymphoma is quite common, primarymalignant lymphoma of the lung is rare. Two caseswere reported by Chinese literature in 1985. Thispaper describes a case of primary pulmonarymalignant lymphoma which has been remitted by

Proposal of definition and diagnostic criteria for sarcopenic obesity by ESPEN and EASO

In the last decade,many investigators including us have reported the negative impact of preoperative sarcopenia or low skeletal muscle mass on outcomes after surgery including hepato-biliary-pancreatic(HBP)surgery such as liver transplantation,liver surgery,biliary surgery,and pancreatic surgery(1-5).In addition to low skeletal muscle mass,the abnormality of body compositions,decreased muscle quality and visceral obesity,has been clarified to be also negatively associated with poor outcomes after HBP surgery(2-5).Consequently,it was easily supposed that co-existence of sarcopenia and obesity,called sarcopenic obesity(SO),had more strong negative impact on outcomes.Actually,not a few studies have demonstrated negative clinical impact of SO on outcomes after HBP surgery using various definitions for SO(6-10).We reported that patients with SO,defined by low skeletal muscle mass with high visceral fat to subcutaneous fat ratio evaluated by preoperative computed tomography(CT)image,had significant worse survival than non-sarcopenia patients and patients with sarcopenia only after liver transplantation,hepatic resection,and pancreatic resection(6-9).

Comparing the Diagnostic Criteria of MAFLD and NAFLD in the Chinese Population:A Population-based Prospective Cohort Study

Background and Aims:Metabolic dysfunction-associ-ated fatty liver disease(MAFLD)is a new concept,pro-posed in 2020;however,its applicability in Asia populations has yet to be evaluated.Therefore,we aimed to compare the difference in epidemiological and clinical characteris-tics between MAFLD and non-alcoholic fatty liver disease(NAFLD)among Asian populations.Methods:Based on the Jinchang cohort,30,633 participants were collected.The prevalence and incidence of MAFLD and NAFLD were used to analyze the epidemic characteristics and its overlapping effects.In addition,the corresponding clinical character-istics of the two diagnostic criteria populations were com-pared.Results:The prevalence rates of MAFLD and NAFLD were 21.03%and 18.83%,respectively.After an average 2.28-year follow-up,the incidence densities of MAFLD and NAFLD were 41.58 per 1,000 person-years and 37.69 per 1,000 person-years,respectively.With the increase of baseline age,body mass index(BMI),and waist circumfer-ence(WC)levels,the prevalence and incidence of MAFLD and NAFLD were on the rise(all ptrend<0.05).Among the total patients diagnosed at baseline or follow-up,most pa-tients had both MAFLD and NAFLD,accounting for 78.84%and 82.88%,respectively.Compared with NAFLD,MAFLD patients had greater proportions of males and metabolic diseases(diabetes,dyslipidemia),and had higher BMI,WC,liver enzymes,blood glucose,and lipid levels in the base-line diagnosis patients(p<0.05).Additionally,lean MAFLD patients had higher metabolic disorders than lean NAFLD patients(p<0.05).Conclusions:Compared with NAFLD,the newly proposed definition of MAFLD is more practical and accurate,and it can help identify more fatty liver pa-tients with high-risk diseases.

Diagnostic criteria of latent autoimmune diabetes in adults(LADA):a review and reflection

Diabetes has become a major public health problem in China nowadays.There are almost 97 million diabetic patients nationwide.Latent autoimmune diabetes in adults(LADA)is a subtype of autoimmune diabetes.Although it has been reported for about 20 years,the diagnostic criteria of this disease remain controversial.The discussion mainly focused on serum autoantibodies,period of insulin need and age of diagnosis.Besides,β cell function,metabolic parameters,genetic factors and cell immunity may also contribute to the formulation of the criteria.Here,we aim to review and discuss the diagnostic criteria of latent autoimmune diabetes in adults.

Celiac disease:diagnostic criteria in progress

Until a few years ago,celiac disease(CD)was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa.Currently,CD is regarded as an autoimmune disorder that is common in the general population(affecting 1 in 100 individuals),with possible onset at any age and with many possible presentations.The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal(constipation and recurrent abdominal pain)and extra-intestinal symptoms(anemia,raised transaminases,osteoporosis,recurrent miscarriages,aphthous stomatitis and associated autoimmune disorders),or it could be completely symptomless.Over the last 20 years,the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests,such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies.The routine use of antibody markers has allowed researchers to discover a very high number of‘borderline’cases,characterized by positive serology and mild intestinal lesions or normal small intestine architecture,which can be classified as potential CD.Therefore,it is evident that the‘old celiac disease’with flat mucosa is only a part of the spectrum of CD.It is possible that serology could identify CD in its early stages,before the appearance of severe intestinal damage.In cases with a positive serology but with mild or absent intestinal lesions,the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

NATIONAL FIELD TRIAL OF THE CHINESE CLASSIFICATION AND DIAGNOSTIC CRITERIA OF MENTAL DISORDERS: COMPREHENSIBILITY, ACCEPTABILITY AND APPLICABILITY

The Chinese Neurology and Psychiatry Association conducted a national field trial of its Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2) involov-ing 26 provinces and municipalities, 80 psychiatric institutes, and 224 professionals. The results were as follows: (1)95.2% of researchers considered the comprehensibility of the CCMD-2 diagnstic criteria good. Within the ten major categories, comprehensibility ranged from 85.7% to 100%. (2) Of those surveyed concerning the acceptibility of the CCCMD-2 diagnostic criteria, 85.9% considered them acceptable. In individual classifications, the rate ranged from 74.1% to 95.2%. (3) 1498 cases were tested. The overall applicability rate which indicated the consistency between the CCMD-2 result and the actual clinical diagnoses was found to be 87.6%, (averaging Kappa = 0.82,P<0.01), better than those obtained from non-Chinese systems of diagnosis.

Current trends in acute pancreatitis:Diagnostic and therapeutic challenges

Acute pancreatitis(AP)is an inflammatory disease of the pancreas,which can progress to severe AP,with a high risk of death.It is one of the most complicated and clinically challenging of all disorders affecting the abdomen.The main causes of AP are gallstone migration and alcohol abuse.Other causes are uncommon,controversial and insufficiently explained.The disease is primarily characterized by inappropriate activation of trypsinogen,infiltration of inflammatory cells,and destruction of secretory cells.According to the revised Atlanta classification,severity of the disease is categorized into three levels:Mild,moderately severe and severe,depending upon organ failure and local as well as systemic complications.Various methods have been used for predicting the severity of AP and its outcome,such as clinical evaluation,imaging evaluation and testing of various biochemical markers.However,AP is a very complex disease and despite the fact that there are of several clinical,biochemical and imaging criteria for assessment of severity of AP,it is not an easy task to predict its subsequent course.Therefore,there are existing controversies regarding diagnostic and therapeutic modalities,their effectiveness and complications in the treatment of AP.The main reason being the fact,that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further.In this editorial article,we discuss the efficacy of the existing diagnostic and therapeutic modalities,complications and treatment failure in the management of AP.

Evaluation of the Sensitivity and Specificity of the New Clinical Diagnostic and Classification Criteria for Kashin-Beck Disease,an Endemic Osteoarthritis,in China

This study aimed to evaluate the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease （KBD） using six clinical markers： flexion of the distal part of fingers, deformed fingers, enlarged finger joints, shortened fingers, squat down, and dwarfism. One-third of the total population in Linyou County was sampled by stratified random sampling.

Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Current perspectives on the management of lateral pelvic lymph nodes in rectal cancer

Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases(mLLN)in patients with low rectal cancer.The differing views held by Japanese and Western clinicians on the management of mLLN have been well documented.However,the adequacy of pelvic lymph node dissection(PLND)or neoadjuvant chemoradiation(NACRT)alone in addition to total mesorectal excision(TME)have recently come into question,due to the relatively high incidence of lateral local recurrences following PLND and TME,or NACRT and TME alone.Recently,a more selective approach to PLND has been suggested,involving a combination of neoadjuvant therapy,followed by PLND only to patients in whom the oncological benefit is likely to outweigh the risk of potential adverse events.A number of studies have attempted to retrospectively identify certain nodal characteristics on preoperative imaging,such as nodal size,appearance,and size reduction following neoadjuvant therapy.However,no consensus has been reached regarding the optimal criteria for a selective approach to PLND,partly due to the heterogeneity and retrospective nature of most of these studies.This review aims to provide an overview of recent evidence with regards to the diagnostic challenges,considerations for,and outcomes of the current management strategies for mLLN in rectal cancer patients.

Challenges for clinicians treating autoimmune pancreatitis:Current perspectives

Autoimmune pancreatitis(AIP)is a rare disease clinically characterized by obstructive jaundice,unintentional weight loss,acute pancreatitis,focal pancreatic mass,and diabetes.AIP is classified into two subtypes-type 1 and type 2-according to pathological findings,clinical features,and serology test results,but some cases may be defined as type not otherwise in the absence of pathological findings and inflammatory bowel disease.To address the differences in diagnostic criteria by country,standard diagnostic criteria for AIP were proposed in 2011 by an international consensus of expert opinions.Differential diagnosis of AIP from pancreatic ductal adenocarcinoma is important but remains challenging for clinicians.Fortunately,all subtypes of AIP show dramatic response to steroid treatment.This review discusses the current perspectives on the diagnosis and management of AIP in clinical practice.

混配农药中毒防治研究

首次在我国开展大规模的混配农药中毒流行病学调查,发现接触混配农药是当前发生农药中毒的重要危险因素,为针对性的预防提供了科学依据。毒理学研究证实多数农药混剂呈增毒效应或协同作用,且与其毒代动力学变化有密切关系,为今后开发高效、低毒的混配农药提供了毒理学依据。在国内外首次建立甲基对硫磷单克隆抗体酶联免疫测定法,并成功研制便携式血胆碱酯酶快速测定仪;这些检测接触、效应生物标志物的灵敏、特异、便捷的方法已试用于现场,并具有开发为产品的前景。同时还发现对氧磷酶基因在192位点的单核苷酸多态性,可能是甲基对硫磷免疫毒性作用的易感性生物标志物之一。在总结不同类别农药混配后所致中毒的临床表现特点和规律的基础上,修订现行的农药中毒诊断标准,增添了有机磷单剂及混剂中毒所致“中间期肌无力综合征”的新内容,将提高我国农药中毒的诊治水平。本研究主要成果达国内领先和国际先进水平。

Polycystic ovary syndrome patients with high BMI tend to have functional disorders of androgen excess:a prospective study

Biochemical or clinical changes of hyperandrogenism are important elements of polycystic ovary syndrome （PCOS）. There is currently no consensus on the definition and diagnostic criteria of hyperandrogenism in PCOS. The aim of this study was to investigate the complex symptoms of hyperandrogenic disorders and the correlations between metabolism and hyperandrogenism in patients with PCOS from an outpatient reproductive medicine clinic in China. We conducted a case control study of 125 PCOS patients and 130 controls to evaluate differences in body mass index （BMI）, total testosterone （TT）, modified Ferriman-Gallwey hirsutism score, sex hormone binding globulin （SHBG）, homeostasis model assessment-estimated insulin resistance （HOMA-IR） and free androgen index （FAI） between PCOS patients and controls and subgroups of PCOS. The prevalence of acne and hirsutism did not differ significantly between the hyperandrogenic and non-hyperandrogenic subgroup. Patients with signs of hyper- androgenism had significantly higher BMI （P 〈 0.05）, but differences in TT, SHBG, FAI and waist/hip ratio were insignificant. The odds ratio of overweight was calculated for all PCOS patients. Our results suggest that PCOS patients with high BMI tend to have functional disorders of androgen excess; therefore, BMI may be a strong pre-dictor of hyperandrogenism in PCOS.

Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.

The Gold Coast criteria increases the diagnostic sensitivity for amyotrophic lateral sclerosis in a Chinese population

Objectives:The aim of this study was to assess and compare the diagnostic utility of a new diagnostic criteria for amyotrophic lateral sclerosis(ALS),abbreviated as the‘Gold Coast Criteria’,with the revised El Escorial(rEEC)and Awaji criteria.Methods:Clinical and electrophysiological data of 1185 patients from January 2014 to December 2019 in the Peking Union Medical College Hospital ALS database were reviewed.The sensitivity of the Gold Coast criteria was compared to that of the possible rEEC and Awaji criteria(defined by the proportion of patients categorized as definite,probable,or possible ALS).Results:A final diagnosis of ALS was recorded in 1162 patients.The sensitivity of the Gold Coast criteria(96.6%,95%confidence interval[CI]=95.3%-97.5%)was greater than that of the rEEC(85.1%,95%CI=82.9%-87.1%)and Awaji(85.3%,95%CI=83.2%-87.3%).In addition,the sensitivity of the novel criteria maintained robust across subgroups,and the advantage was more prominent in limb-onset ALS patients and those who completed electromyographic tests.In those who did not achieve any of the rEEC diagnostic categories,the sensitivity of Gold Coast criteria was 84.4%.Conclusions:The current study demonstrated that the Gold Coast criteria exhibited greater diagnostic sensitivity than the rEEC and Awaji criteria in a Chinese ALS population.The application of the Gold Coast criteria should be considered in clinical practice and future therapeutic trials.

Coordinated optimal allocation of water resources and industrial structure in the Beijing-Tianjin-Hebei regions of China

Optimizing the allocation of water resources is critical for promoting the optimization and upgrading of industrial structure and coordinated development in the Beijing-Tianjin-Hebei regions of China.Based on specific regional and water conditions,to strengthen the constraints on water resources,the“three-step”adaptive management approach of“scheme design-scheme diagnosis-scheme optimization”of water resource allocation are adopted to facilitate the coordinated optimal allocation of water resources and industrial structure in the Beijing-Tianjin-Hebei regions.First,from the level of overall industry,a water resource allocation scheme for the regions is designed by applying the master-slave hierarchical mode and a bi-level optimal model to determine the ideal amount of water resource allocation for the regions and respective industries.Second,the diagnostic criteria of spatial balance,structural matching,and coordinated development are constructed to determine the rationality of the water resource allocation scheme.Then a benefit compensation function with water market transactions is developed,to adaptively adjust the water resource allocation scheme.Finally,the optimization and upgrading of industrial structure are promoted to improve water consumption efficiency and the coordinated development of the Beijing-Tianjin-Hebei regions.The study can provide reference for the Beijing-Tianjin-Hebei regions to realize the comprehensive optimal allocation of water resources in the regions and improve the adaptability of water resources and industrial structure optimization.