OBJECTIVE To investigate the distribution and resistance of fungi isolated from hemopathy patients,and to provide the laboratorial data in order to prevent and treat infection caused by fungi more effectively.METHODS Strains were isolated from the upper respiratory tract,lower respiratory tract,genitourinary tract,alimentary tract;and perianal region,perineum,and the soft tissue and skin wounds.Antimicrobial susceptibility of clinical isolates was tested by broth microdilution susceptibility test.RESULTS Candida albicans,Aspergillus,tropicalis,C.krusei,and C.glabrata were the main fungi of total 3104 detected isolates.The resistance rates of C.albicans and C.tropicalis to fluconazole,itraconazole and 5-flucytosine were no more than 1.4%.The MIC50-MIC90 range of C.tropicalis for itraconazole was narrow(0.25-0.5 mg/L),but that was wide for fluconazole(0.25-4.0 mg/L).CONCLUSIONS C.albicans,Aspergillus,C.tropicalis,C.krusei,and C.glabrata are possibly the most common pathogens causing endogenous and exogenous fungi infection.The main infection sites of Aspergillus are the upper respiratory tract and lower respiratory tract,which may be associated possibly with ward's air quality.The MIC50to MIC90 range of C.tropicalis is wider for fluconazole than for itraconazole,which is possibly correlated with overexpression of CtMDR1 in C.tropicalis caused by the widely application of fluconazole in therapy.

Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection.Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair.Thereafter,an additional surgical management was carried out.At length,flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens.Successively,another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection.Results Surgery was carried out under local anesthesia,with operation duration of 170 minutes and intraoperative blood loss of 350 ml.The chest and back pain disappeared after operation.The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia,visceral ischemia,or other complications.Aortic CTA at postoperative one week showed ideal positioning of stent-graft,fluent blood flow of aorta and major visceral artery,and vanishing of false lumen.Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stentgraft in false lumen of aortic dissection.Outback catheter for flap fenestration is characterized by accurate location and high safety.

According 1o the genome sequences of α.β,e,ι toxins of Clostridium perfringens in GenBank,four pairs of primers targeting α,β,ε,ι toxin genes were designed.After the multiplex PCR reaction condition was optimized,the multiplex PCR for identification and toxintyping of C.perfringens strains was developed.The specificity test showed that the expected fragments of C.perfringens reference strains including A.B,C,D,E five toxin types were amplified successfully from genomic DNA of C.perfringens,respectively.However,a band could not be amplified from Clostidrium novyi and Clostridium septicum as negative control groups.The sensitivity test showed that the limit detection of multiplex PCR was 9.0,17.8,12.2,13.8,18.5 pg DNA of A,B,C,D,E five toxin types C.perfringens,respectively.Repetitive testing showed that the established method had a good repeatability.Nine type A strains of and 1 type C strains of C.Perfringens from 21 clinical samples of dead goat were detected by the multiplex PCR developed in this study.This study establishes the multiple PCR method which not only can detect C.perfringens rapidly but also can identify five toxin types of C.perfringens.

[Objective]To investigate the efficacy of a blended instruction model which incorporated preceptorship into the clinical anatomy course at Sun Yat-sen University and improve satisfaction and performance of medical students.[Methods]The study recruited participants including 375 Chinese students aged 20-24 years old,2 anatomy professors,49 surgeons and 7 lab technicians. The students were divided into 10 teams and each team was tutored by 1 anatomy professor,2 surgeons and 1 lab technician. After the course ended,the Course Experience Questionnaire (CEQ) and Student Experience in Education Questionnaire (SEEQ) were used in the survey to measure the quality of teaching and students' overall educational experience. Students' performance scores were collected and analyzed.[Results]The response rates for CEQ and SEEQ were 60.3％ (226/375) and 54.6％ (200/375),respectively. CEQ indicated a moderate level of overall satisfaction with 7.12 out of 10. Subscales like Clear Goals,Good Teaching and Generic Skills showed moderately positive reception of the course,while subscales like Appropriate Workload and Appropriate Assessment revealed students' concerns about heavy workload and difficult exam. There was no statistically significant difference in perceptions between male and female students. The students who are more satisfied with the quality of the course are also more satisfied with the way it is taught (P<0.01). SEEQ further confirmed the universal appeal of the course,with high scores in dimensions like Learning,Enthusiasm and Individual Rapport among the students. Qualitative responses highlighted areas of improvement,such as consistent teaching methods,practical hands-on experience for the students and alignment between what was taught and tested.The students after the preceptorship introduction achieved better academic performance than before.[Conclusions]The blended instruction model incorporating preceptorship enhances the student satisfaction and performance in clinical anatomy course,and also stimulates students' learning enthusiasm and group interaction. We need further improvement in the teaching quality control,syllabus contents and course assessment for teaching of clinical anatomy.

Objective:To study the treatment outcomes of transjugular intrahepatic portal shunt (TIPS) on refractory hepatic sinus obstruction syndrome (HSOS) caused by Gynura segetum.Methods:The clinical data of 15 patients with refractory HSOS caused by Gynura segetum treated at the Department of Vascular Surgery, Henan Provincial People's Hospital from January 2017 to April 2021 were retrospectively analyzed. There were 7 males and 8 females, with ages ranging from 30 to 85 years, mean ± s. d. (61.2±14.1) years. Albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl transferase, and portal vein pressure were compared before and after TIPS. The liver function and renal function of these patients were followed up.Results:When compared with pre-operation, the albumin, alanine aminotransferase, aspartate aminotransferase and other indexes were significantly improved after TIPS (all P<0.05). The portal vein pressure of 15 patients significantly decreased from the preoperative volume of (41.7±3.5) cmH 2O (1 cmH 2O=0.098 kPa) to (28.3±4.4) cmH 2O ( t=10.41, P<0.001). The preoperative liver function was Child-Pugh grade A in 1 patient, grade B in 8 patients, grade C in 6 patients. The postoperative Child-Pugh grading was grade A in 14 patients and grade B in 1 patient. Ascites, gastrointestinal bleeding, abdominal pain, abdominal distention and spontaneous peritonitis all disappeared in these 15 patients. Postoperative hepatic encephalopathy developed in 2 patients and hepatic myelopathy in 1 patient. Conclusion:TIPS for treatment of HSOS caused by Gynura segetum resulted in a rapid recovery of liver function, rapid symptomatic relief, with a low incidence of hepatic encephalopathy/hepatic myelopathy.

AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR), and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS: A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital, Sun Yat-sen University from 2022 to 2023 were included, including 95 first-diagnosed DR patients and 105 patients without DR, and all patients underwent OCTA examination and a collection of demographics and renal function parameters. After a quality check, automated measurements of the foveal avascular zone area, vessel density(VD), and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS: Using random forest and multivariate Logistic regression methods, we developed a diagnostic model for DR based on 12 variables(age, FBG, SBP, DBP, HbA1c, ALT, ALP, urea/Scr, DM duration, HUA, DN, and CMT). Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window, AUC=0.837 vs 0.819, P=0.03). In the study of DN patients, the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD; outer VD; full VD; outer PD; full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model. Meanwhile, compared with the 3 mm×3 mm window, the microvascular parameters in the 6 mm× 6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.

OBJECTIVETo investigate the outcomes of autologous stem cell transplantation (ASCT) for patients with aggressive peripheral T-cell lymphoma (PTCLs) in advanced stage.

METHODSThe clinical data of 25 patients in complete remission (CR) with aggressive PTCLs received ASCT from May 1997 to June 2013 were retrospectively analyzed.

RESULTS① Of the 25 cases, 16 were unspecified PTCL (PTCL-U), 4 with angioimmunoblastic T cell lymphoma (AITL), 3 with anaplastic large cell lymphoma (ALCL) and 2 with hepatosplenic T cell lymphoma (HSTL), with a median age of 30(12-54) years old. Ratio of male to female is 16∶9. The distribution of stages was 8 cases with stage Ⅲ and 17 patients with stage Ⅳ. Nine patients presented with bone marrow involvement. Before ASCT, 18 patients were in CR1 and 7 patients were in CR2. ②Two patients with HSTL in stage ⅣB and IPI score 4/5 in CR1 relapsed and died within 12 months after ASCT. At a median follow-up of 38 (range 14-110) months, the estimated 3-year probability of PFS and OS for the other 23 patients was (63.1 ± 10.5)% and (71.8 ± 9.9)%, respectively. The patients in first CR had a better survival than the patients in second CR. The 3-year probability of PFS were (74.9 ± 11.0)% vs (33.3 ± 19.2)% (P=0.092) and OS were (80.2 ± 10.4)% vs (50.0 ± 20.4)% (P=0.043), respectively. The 3-year probability of PFS and OS were (40.0 ± 17.4)% and (53.3 ± 17.3)% in bone marrow involvement patients and the corresponding figure were (77.9 ± 11.3)% and (84.4 ± 10.2)% in non- bone marrow involvement patients.

CONCLUSIONASCT could improve the survival of aggressive PTCLs. Non CR1 status and bone marrow involvement had negative influence on OS in patients with aggressive PTCLs treated by ASCT. The prognosis was very poor in patients with HSTL and satisfactory regimens should be investigated.

Adolescent ; Adult ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell, Peripheral ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Remission Induction ; Retrospective Studies ; Transplantation, Autologous ; Young Adult

OBJECTIVETo evaluate the results of autologous hematopoietic stem cell transplantation (auto-HSCT) in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph-ALL).

METHODSFrom January 2000 to December 2007, the clinical data of auto-HSCT in adults Ph-ALL with complete remession (CR) 1 according to BDHALL2000/02 protocol were analyzed.

RESULTSA total of 56 patients were enrolled and the probabilities of standard risk, intermediated risk and high-risk group were 41.1%, 33.9%, and 25.0%, respectively. After a median follow-up of 75 months (range 7-177 months), the 5-year overall survival (OS), events free survival (EFS) and relapse free survival (RFS) were (51.8 ± 6.7)%, (51.8 ± 6.7)%, and (60.5 ± 6.9)%, respectively. And the 5-year accumulative relapse rate was (39.1 ± 6.9)%. The 5-year OS of standard risk, intermediate risk, high-risk group were (60.9 ± 10.2)%, (52.6 ± 11.5)%, and (35.7 ± 2.8)%, respectively. The 5-year RFS among three groups were (68.3 ± 9.9)%, (62.5 ± 12.1)%, and (44.9 ± 14.1)%, respectively. The 5-year EFS among three groups were (60.9 ± 10.2)%, (52.6 ± 11.5)%, and (35.7 ± 12.8)%, respectively. The 5-year accumulative relapse rate among three groups were (31.7 ± 9.9)%, (37.5 ± 12.1)%, and (55.1 ± 14.1)%, respectively. There was no statistical significance of any survival rates between standard and intermediate risk groups, just as intermediate and high-risk groups. The OS and EFS in standard risk group were superior to those in high-risk group (P=0.040 and P=0.029, respectively), while there was no statistical significance of RFS and accumulative relapse rate between the two groups. The clinical factors listed below did not influenced the prognosis in the univariate analysis (P>0.05), including more than 5 weeks reaching to CR, WBC count at diagnosis, different immunophenotype (T or B cells), myeloid antigen expression, hyperdiploid chromosome karyotype, complex chromosome abnormality, conditioning regimen with or without TBI, duration between transplantation and diagnosis.

CONCLUSIONPh-ALL adults could achieve a satisfactory CR and better survial according to BDHALL2000/02 protocol followed by auto-HSCT, especially for the standard or intermediate risk group, and no-donors high-risk patients.

Adult ; Autografts ; Disease-Free Survival ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunophenotyping ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Recurrence ; Survival Rate

OBJECTIVETo investigate the treatment outcomes of autologous stem cell transplantation (ASCT) as first-line treatment in patients with high risk lymphoblastic lymphoma (LBL) and compare the effect of different induction regimen on prognosis.

METHODSThirty LBL patients in complete remission received ASCT from 1996 to 2012 in our hospital were retrospectively analyzed.

RESULTS(1)Of the 30 patients, 25 were T-LBL and 5 B-LBL with a median age of 19(7-53) years old. Ratio of male to female is 23:7. Fourteen (46.7%) patients presented with bulky mediastinal masses and 15(50.0%) with bone marrow involvement. The distribution of stages was 2(6.7%), 5(16.7%) and 23 (76.6%)patients with stages II, III, and IV, respectively. The distribution according to age-adjusted international prognostic index (aaIPI) was 5(16.7%) patients in 1 score, 14(46.6%) in 2 scores and 11(36.7%) in 3 scores. (2)At a median follow-up of 32(range, 10-171) months, 17 patients were alive and 13 relapsed and died from LBL after ASCT. The estimated 5-year probability of DFS and OS was (50.4±10.7) % and (53.9 ±10.2)% for all the patients. (3)According to the treatment regimens before ASCT, the patients were divided into NHL-type group (n=12) and ALL-type group (n=18). In NHL-type group, 9 patients relapsed and died, the estimated 5-year probability of DFS and OS was (22.2 ±12.8) % and (33.3 ±13.6) %, respectively. Median DFS and OS time were 24 months and 36 months. In ALL-type group, 4 patients relapsed and died from lymphoma, the estimated 5-year probability of DFS and OS was (77.8 ± 9.8) % and (77.8 ± 9.8) %, respectively. Median DFS and OS time were not reached. For DFS and OS, ALL-type group were better than that of NHL-type group and the difference was significant (P=0.022 and P=0.049).

CONCLUSIONThe results showed that complete remission with intensive first-line ALL-type regimens and followed by ASCT consolidation may significantly improve long-term outcome for high risk LBL patients.

Adolescent ; Adult ; Child ; Disease-Free Survival ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy ; Prognosis ; Retrospective Studies ; Transplantation, Autologous ; Treatment Outcome