10.3969/j.issn.2095-4344.2013.24.024

Radioactive seed implantation in pancreatic cancer is a very effective treatment. Its indications, contraindications and complications have been improved gradually. Radioactive seeds can be implanted precisely under CT or ultrasound-guided. Treatment of seeds can be combined with chemotherapy, radiofrequency ablation and other means to improve the clinical efficacy.

Using immunoenzymatic technique,we have observed the localization ofimmunoglobulins in human palatine tonsils,of patients suffering from chronictonsilitis and hyperplasia.The result as follows:1.Epithelium:The outer surface of tonsil is lined by stratified squamous epithelium,the epithelium rarely shows keratinization and lacks a well-defind and continuousbasement membrane.In the basal layer of epithelium,it is reticular structure andspaces between the cords of epithelium cells are filled with Ig~+ lymphocytes andplasma cells,the reticular structure is particularly pronounced near the crypts.Thisspecial structure is regarded as an expression of active immune function.In thesuperficial layer of epithelium,the predominate cells are Ig~- small lymphocytes,maybe T lymphocytes.2.Follicle:All follicles have germinal centres,especially hyperplastic tonsils.The follicle has polarity,each follicle may be divided into three Zones(a b c),twozones(a b)form the centre of the follicle and the thired(c)is the mass of smalllymphocytes“capping”and enclosing the centre.The upper limits of zone(c)areoften indistinct,from the presence of many lymphocytes in the epithelium.Thedistribution of Ig~+ cells in follicle are different from their three zones.In the centre,IgG cells are most numerous,next most numerous are IgA~+ cells,and considerablyfewer IgM positive cells.In the c zone,only a few Ig~+ cells are seen(IgG IgM).Itis found that the germinal centre may produce more than one type of Ig,it differsfrom the report of Sordat,but quite agrees with Curran's result.However the numbersof cells containing the various types of Ig show a great difference.3.Other lymphoid tissue:The tissue between the follicles are rich in small Tlymphocytes and a few Ig~+ containing cells,this area was called thymic dependentarea.At an older age,this region is always enlarged,but the density of the cellswill decrease,meanwhile much connective tissues are seen in the stroma.

Objective To analyze the morbidity of the old people with hypertension and metabolic syndrome (MS),the characteristics of MS components distribution,and correlation hypertension and MS.Methods 438 old patients over 60 with hypertension were selected randomly from cheek-up crowd in the physical examination center of Affiliated Zhongshan Hospital of Dalian University in 2013.Abdominal girth,height,body mass were measured,and then calculated BMI.The indicators such as FPG,TC,TG,HDL-C,LDL-C were detected and analyzed.Results The total morbidity of MS in the old people with hypertension was 37.7％,39.0％ from male people,36.7％ from female people,and there was no difference between genders(x2 =0.46,P ＞ 0.05).The level of BMI,abdominal girth,FPG,and TG in the old people with MS were higher than the people without MS(t =4.83,8.53,5.08,7.29,all P ＜0.05),and HDL-C was lower than the people without MS(t =-9.67,P ＜ 0.05).The level of FPG in women was higher than that in men apparently(x2 =5.82,P ＜ 0.05),and the level of HDL-C was lower than that in men apparently (x2 =8.73,P ＜ 0.01).The risk factors to MS include BMI,abdominal girth,FPG,TG (OR =2.139,1.106,2.156,2.315,all P ＜0.05),and HDL-C is protective factor to MS(OR =0.039,P ＜0.05).Conclusion Hypertension might increase MS morbidity of old patients.Hypertension related with MS closely.The risk factors include BMI,abdominal girth,FPG,TG,on the other hand HDL-C is protective factor to MS.

Objective To investigate the cutaneous manifestations in patients with ulcerative colitis (UC) and related factors.Methods Patients admitted to Department of Gastroenterology Peking University First Hospital from January 1994 to December 2014 and diagnosed as UC were retrospectively enrolled in this study.Skin disorders were confirmed by the dermatologists.Clinical data were collected and compared between patients with and without cutaneous manifestations.Results Among the total 373 UC patients,there were 34 cases (9.1％) with cutaneous manifestations,including 11 pyoderma gangrenosum,8 erythema nodosum,6 eczema,3 psoriasis,2 pemphigus,1 granulomatous cheilitis,1 ichthyosis,1 acne rosacea,and 1 impetigo.The skin manifestations may occur after the diagnosis,simultaneously or even before the diagnosis of UC,which were 24,7 and 3 patients respectively.The mean age in patients with skin lesions was (47.2 ± 12.1) years,male to female ratio 0.79∶ 1.More patients with skin manifestations had severe activity of UC compared with non-skin group [50.0％ (17/34) vs 25.1％ (85/339),P =0.01].In addition,the proportion of extensive colitis in skin lesion group was significantly higher than that in non-skin group [76.5％ (26/34) vs 54.6％ (185/339),P =0.04].Conclusions The cutaneous manifestations associated with UC are polymorphic,erythema nodosums and pyoderma gangrenosums are the most common skin lesions seen in UC patients.Skin lesions occur concurrently,pre or post the diagnosis of UC.Skin lesions in UC patients suggest more severe disease activity.Clinicians need to pay more attention to this group.

Objective To investigate the molecular mechanisms of cross-resistance to azoles in a clinical isolate of Aspergillus fumigatus. Methods A. fumigatus was isolated from a patient with invasive aspergillosis.Clinical Laboratory Standard Institute M38-A2 broth microdilution method and E-test method were used to determine the minimum inhibitory concentrations (MICs) or minimum effective concentration (MEC) of itraconazole, voriconazole, amphotericin B, posaconazole and caspofungin for the A. fumigatus isolate. DNA was extracted from the isolate and subjected to the amplification of cyp51A gene encoding the target enzyme of azole antifungal agents followed by sequence analysis. Results The broth microdilution test showed that the MEC of caspofungin was 0.5 mg/L, and MICs of itraconazole, voriconazole and amphotericin B were ≥ 16 mg/L,8 mg/L and 1 mg/L, respectively, for this isolate; while E-test assay revealed that the MICs of caspofungin,itraconazole, voriconazole, amphotericin B and posaconazole were 0.047 mg/L, ≥32 mg/L,≥32 mg/L, 12 mg/L and ≥32 mg/L, respectively. Sequence analysis showed an insertion of a 34-bp tandem sequence in the promoter region of the cyp51A gene as well as a T364A point mutation causing the substitution of leucine 98 (L98H). In addition, there were some other mutations in the cyp51A gene of this isolate, such as A137T,G585A, C814A, G836C, T991C and A1350G, which could result in corresponding amino acid substitutions.Conclusions An A. fumigatus strain with cross-resistance to azole antifungal agents is isolated. There is an insertion of a 34-bp tandem sequence into the promoter region as well as a T364A point mutation in the cyp51A gene, which contribute to the cross resistance to azole antifungal agents including itraconazole, voriconazole,and posaconazole. In addition, other mutations causing amino acid substitutions have also been detected in the cyp51 A gene of this isolate.

Two patients were admitted to the hospital for 2-month history of pruritic eruptions on the forehead and 2-week history of pruritie eruptions on the leg, respectively. Both patients had a history of pet contact. Topical application of glucocorticoids did not work well. Dermatological examination revealed a patch measuring 5 cm ×6 cm on the forehead of one patient and a patch measuring 2 cm × 3 cm on the leg of the other patient. Both patches were surrounded by red papules and scaling. Microscopic examination of skin scales revealed hyphae and chain-like spores, and culture of skin scales grew Microsporum gyeum. Both the isolates of Microsporum gyeum were sensitive to ketoconazole, miconazole, bifonazole, terbinafine, and voriconazole. Both patients were healed after treatment with oral terbinafine and topical ciclopirox olamine.

Objective To investigate the in vitro susceptibility of 16 strains of Exophiala dermatitidis to 6 commonly used antifungal agents. Methods The Glinical and Laboratory Standards Institute (CLSI)M27-A2 protocol was carried out to determine the MIGs of terbinafine (TRB), itraconazole (ITC), amphotericin B (AMB), fluconazole (FLC), voriconazole (VRC), and caspofungin (GAS) to 16 strains of E. dermatitidis, and E-test was performed to determine those of VRG, ITC and AMB. Besides, the minimal fungicidal concentrations (MFGs) of the above antifungal agents to the 16 strains of E. dermatitidis were further assessed.The activity of TRB in combination with ITC and VRG against E. dermatitidis was also estimated. Results The MIC ranges of TRB, VRC, ITC, AMB, FLC, and CAS were 0.125 - 0.25 mg/L, 0.25 - 0.5 mg/L, 2.0 mg/L,2.0 mg/L, 16 - 32 mg/L and 16 - 64 mg/L respectively as shown by M27-A2 microdilution assay, while the MIC ranges of VRG, ITG and AMB, as determined by E-test, were 0.032 - 0.094 mg/L, 0.047 - 0.5 mg/L and 0.125 - 3.0 mg/L, respectively. The MFC ranges of TRB, VRC, ITG, AMB and FLG were 0.125 - 0.5 mg/L,0.25 - 0.5 mg/L, 2.0 - 4.0 mg/L, 2.0 - 4.0 mg/L and 16 - 64 mg/L, respectively. No synergism in the acitivity against E. dermatitidis was observed for the combination of TBR with ITC or VRC. Conclusion E. dermatitidis is susceptible to TRB, ITC, AMB, and VRC, but less sensitive to both FLC and GAS.

to common antifungal drugs.

Objective To study dectin-1 mRNA expression in lung of different immune status mice infected with Aspergillusfumigatus, and to explore the influence of immunosuppressive agent on the expression of dectin-1 and its relationship with the progression of disease. Methods Mice were divided into four groups which were normal control, immuncompromised, immuncompromised with A.fumigatus inoculation and immuncompetent with A.fumigatus inoculation groups. We explored the kinetic mRNA expression of dectin-1 in lung of different groups by real-time quantitative PCR. Pulmonary fungal burden assessment was performed to reflect the progressing of disease during the experimental time course. Results On day 3 after inoculation, pulmonary fungal burden of the immuncompromised mice was higher than that of the immuncompetent group. On day 1 and 3, dectin-I mRNA expression in lung of the immuncompromised group was much lower than that of the normal control. On day 3, dectin-1 mRNA expression in lung of the immuncompetent mice infected with A.fumigatus was much higher than that of the immuncompromised with A.fumigatus inoculation and the normal control groups ( P < 0.05 ). Conclusion During the infection, expression of dectin-1 in lung of the immuncompetent group was strikingly increased, which may play an important role on the defence to A.fumigatus invasion. Cyclophosphamide inhibited the expression of dectin-1 in lung of mice which may be one of the mechanisms of the invasive pulmonary aspergillosis development induced by eyclophosphamide.