Objective To investigate the incidence,influencing factors and clinical features of ischemic hepatitis.Methods Changes of serum transaminase and lactate dehydrogenase in patients with shock and respiratory failure were recorded in our hospital.Ischemic hepatitis was identified according to diagnosis guidelines,and its incidence was counted.Clinical data of patients with ischemic hepatitis were recorded.Results There were 53 cases diagnosed as ischemic hepatitis in 317 severe patients,including hemorrhagic shock,heart failure,respiratory failure,et al.The incidence was high in elderly patients aged over 70 years and male.Levels of alanine aminotransferase (ALT),AST and lactic dehydrogenase (LDH) were significantly increased 1-3 days after shock and respiratory failure,then reached to peak value 1-5 days [averaged (3.35±0.89) days] after shock and respiratory failure.Serum ALT was 869-4354 U/L,AST was 773-4833U/L and LDH was 1021-2662 U/L.Total bilirubin level was increased in 16 cases and the total bilirubin was 14-54 μmol/L.AST was declined to a point within 2 times the upper limit of normal range after 9-16 days,averaged (13± 1.6) days.Elevated transaminase level had no correlation with sex,age and pre-existing liver diseases.The time of enzyme changes had no correlation with sex but age and liver diseases.Patients aged ≥ 70 years had later AST peak and the recovery time was longer than younger patients (P＜0.01).Conclusions Ischemic hepatitis occurs mainly in men and elderly people.But advanced age and underlying liver diseases can affect the recovery time of transaminase in patients with ischemic hepatitis.

Objective To research paramagnetic contrast media(PCM)dose,injection speed and imaging time etc in low field MRI.Methods 406 patients with lesions spreading all over the body received Gadolinium-DTPA-enhanced scan by bolus injection with the dose of 0.1～0.15 mmol/kg within 60 seconds,and the effects of contrast-enhanced were observed.Results Among 406 patients lesions,337 cases(83%)were enhanced,9 undiscovered lesions displayed enhancement on the precontrast views,5 cases were discovered new lesions in delaying enhancement scan.Conclusion It is safe to apply the above mentioned dose and injection speed in clinic.The side-effects is small,and the development effect is good.It is especially important for lesions involving the structure of the blood brain barrier(BBB).

Objective To summarize the effect of venous anastomisis from left atrium-common venous anastomisis ( supracardiac anasto-mosis) at the top of left atrium,and to find the best method to treat total anomalous pulmonary venous connection ( TAPVC) . Methods 52 cases,of which 35 male and 17 female with the age of 1 month to 41 years old and the weight of 3. 1~77 kg,hospitalized in West China hos-pital from January 2000 to April 2008,were treated by supracardiac anastomosis. Results One was dead and the other 51 cases were fully recovered and left hospital. After the operation,no anastomotic stenosis or arrhythmia was observed except the dead one. During follow-up peri-od which lasted from 3 months to 12 years,the heart function of 45 cases were normal. Conclusion supracardiac anastomosis can reduce the risk of anastomotic stenosis and arrhythmia,it is a promising method to treat supracardiac type TAPVC .

Objective To investigate the feasibility of using low Kv,low iodine contrast Agent concentration (dual low)CT scan techniques in Coronary CTA (CCTA).Methods Seventy-six patients undergoing CCTA were divided into Group A and Group B , randomly.Group A (38 patients)was the dual-low group,which was scanned with tube voltage of 100 kVp,and injected with iso-osmolarity contrast agent visipaque 270 (270 mg I/mL),with iterative reconstruction technique (ASIR 40%).Group B (38 pa-tients)was scanned with 120 kVp,and low osmolarity contrast agent omnipaque 350 (350 mg I/mL)and FBP reconstruction,The images are assessed double-blindly by two experienced radiologists.Five ROIs were placed onto the ascending root of aorta (AO), left main artery(LM),left anterior descending (LAD),left circumflex artery(LCX),right coronary artery (RCA),and the image qualities are evaluated objectively using CT values,noise,signal noise ratio (SNR),contrast noise ratio (CNR),and compared sta-tistically using Paired t-test.The radiation dosages,such as CTDIvol,DLP and ED were also recorded and compared with Paired t-test.Results CTDIvol,DLP and ED of Group A (dual low)decreased 35.7%,38.6% and 38.6% respectively compared with Group B,the iodine intake decreased 22.9%.While the image qualities of the two groups were not significantly different,all images are good enough for diagnosis,with Group A slightly better than Group B in radiologists’scores.Conclusion Voltage 100 kVp, combined with low contrast agent concentration of 270 mg I/mL can fully satisfy the diagnostics need in CCTA,and significantly lower both the radiation dosage and iodine intake.

Objective To discuss the optical coherence tomography (OCT)characteristics in patients with syphilitic chorioretinitis.Methods This was a retrospective cohort study.58 patients (88 eyes) with syphilitic chorioretinitis were included.The fluorescence fundus angiography (FFA),indocyanine green angiography (ICGA) and OCT examination were performed,and the rapid plasma regain test (RPR) and treponema pallidum particle agglutination test (TPPA) were also made.The treatment response and follow up results were analyzed.Results In this study,87 eyes represented as needle like projections of the retinal pigment epithelium,86 eyes represented as retinal external membrane and myoid,ellipsoid structure was unclear or disappear,68 eyes represented as high reflection points within the vitreous body,16 eyes represented as shallow retinal detachment.After treatment,the needle like projections of the retinal pigment epithelium were fully restored in 79 eyes,retinal external membrane and myoid,ellipsoid structure were partial displayed in 62 eyes,and shallow retinal detachment were fully restored in 16 eyes.Conclusion The manifestations of OCT in patients with syphilitic chorioretinitis include needle like projections of the retinal pigment epithelium,unclear or disappear retinal external membrane and myoid,ellipsoid structure,high reflection points within the vitreous body and shallow retinal detachment.The above manifestations of OCT can be recovered significantly with treatment.

Objective To examine the distribution of bacterial species and antimicrobial susceptibility profile of pathogens in febrile neutropenic patients.Methods A total of 355 bacterial strains were isolated from febrile neutropenic patients in Shanghai General Hospital from January 2005 to December 2012. Antimicrobial susceptibility testing was done by Kirby-Bauer method. The susceptibility testing results were analyzed according to CLSI 2014 breakpoints.Results Gram-negative bacteria accounted for 70.4% of the 355 isolates, while gram-positive organisms accounted for 29.6%. The most common bacterial species werePseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Stenotrophomonas maltophiliaand Staphylococcus haemolyticus. Non-fermentative bacteria accounted for 53.2% of all the gram-negative bacterial isolates. All theEnterococcus and
Staphylococcus isolates were susceptible to linezolid, vancomycin and teicoplanin. All theStaphylococcus strains were resistant to methicillin.P. aeruginosa isolates were relatively more susceptible to cefoperazone-sulbactam, piperacillin-tazobactam and cefepime (>70%) than imipenem (40.8%) and meropenem (59.2%). All theK. pneumoniae isolates were susceptible to imipenem and meropenem and more than 70% of the isolates were susceptible to cefoperazone-sulbactam, amikacin. More than 80% of theA. baumannii isolates were susceptible to carbapenems, cefoperazone-sulbactam, amikacin, ciprolfoxacin and aminoglycosides. All the E. coli isolates were susceptible to carbapenems and more than 70% were susceptible to cefoperazone-sulbactam and ceftazidime. More than 90% of theS. maltophilia strains were sensitive to levolfoxacin, minocycline, cefoperazone-sulbactam and trimethoprim-sulfamethoxazole.Conclusions Our data suggest that gram-negative bacteria, especiallyEnterobacteriaceae and non-fermentative bacteria, are still the primary pathogens in febrile neutropenic patients. Antimicrobial resistant strains are prevalent. Such data of bacterial species and antimicrobial susceptibility proifle of pathogens in febrile neutropenic patients are useful for empirical antimicrobial therapy of such infections.

Objective To analyze the clinical and pathological features of advanced colorectal serrated adenoma(ACSA). Methods The endoscopic and pathological features of 156 cases of ACSA and 121 cases of non-ACSA diagnosed in General Hospital, Tianjin Medical University from January 2010 to March 2016 were retrospectively analyzed and compared.Results ACSA and non-ACSA cases accounted for 56.3%(156/277)and 43.7%(121/277)of all patients with colorectal serrated lesions,respectively. The mean age of ACSA patients was 57.79±13.65 years and 89(57.1%)of these patients were male. There was no significant difference in age and gender between ACSA and non-ACSA patients. A total of 161 ACSA lesions were diagnosed,including 71 sessile serrated adenoma/polyps and 90 traditional serrated adenomas. Among the 161 ACSA lesions,there were 29(18.0%)lesions whose diameter≥10 mm, and 84(52.2%) lesions located in the proximal colon, which were more than non-ACSA(84/161 VS 49/134,P=0.007). ACSA was classified under endoscopy into pedunculated type(20/161),sub-pedunculated type(35/161), sessile type(24/161),flat type(79/161)and laterally spreading tumor(3/161), and the distribution of lesion type was significantly different from non-ACSA(P<0.001). One hundred and sixty(99.4%)ACSA lesions were diagnosed as dysplasia, including 158 low degree dysplasia and 2 high degree dysplasia.Moreover,16 ACSA patients were accompanied with synchronous advanced colorectal neoplasia(sACN), and large serrated polyps(diameter≥10 mm)might have a strong association with sACN(OR=4.35, 95%CI:1.467-12.894, P<0.05). Conclusion ACSA is more common in proximal colon and sub-pedunculated type,sessile type and flat type. ACSA diameter≥10 mm is significantly associated with sACN.

OBJECTIVETo investigate the efficacy of allogeneic peripheral blood stem cell transplantation (PBSCT) in the treatment of severe aplastic anemia (SAA) and severe infection.

METHODSA patient with SAA and pseudomonas aeruginosa septicemia was treated with PBSCT from an HLA-identical sibling with cyclophosphamide (CY) and total body irradiation (TBI) for conditioning. The patient was infused with 20.3 x 10(8)/kg mononuclear cells including 61.0 x 10(6)/kg CD34(+) cells following the conditioning regimen.

RESULTSTwelve days after PBSCT, the absolute neutrophil count (ANC) of 1.0 x 10(9)/L was achieved, with platelet count > 50 x 10(9)/L at twenty days. The donor origin of engraftment was confirmed by polymerase chain reaction (PCR) analysis of short tandem repeats at the end of the first, sixth and twelfth month. The patient's body temperature dropped to normal level when her ANC reached 0.5 x 10(9)/L on day 10, and the bacterial culture of blood sample became negative subsequently. Symptoms and signs of acute or chronic graft versus host disease (GVHD) were not observed in 30 months after PBSCT.

CONCLUSIONSHematopoiesis was reconstituted shortly after PBSCT. The combination of CY and TBI and the infusion of sufficient peripheral blood stem cells may contribute to the successful engraftment. PBSCT may be considered as the first choice when hematopoietic stem cell transplantation is needed for SAA patients complicated with severe infection.

Adult ; Anemia, Aplastic ; immunology ; therapy ; Bacteremia ; complications ; Female ; Humans ; Peripheral Blood Stem Cell Transplantation ; methods ; Prognosis ; Pseudomonas Infections ; complications ; Transplantation, Homologous ; immunology

OBJECTIVETo report on a case of therapy-related acute monocytic leukemia(t-AML) with t(11;17) (q23;q21)/MLL-AF17q after successful treatment for acute promyelocytic leukemia(APL) with t(15;17) (q22;q21)/PML-RARα.

METHODSA MICM method (bone marrow morphology(M), immunophenotype(I), cytogenetics(C), and molecular biology(M)) was used for the diagnosis and classification of the disease at the time of onset and transformation.

RESULTSThe patient was initially identified with typical morphology and immunophenotype of APL. She has carried t(15;17)(q22;q21) and PML-RARα fusion gene but was without t(11;17)(q23;q21) or MLL gene abnormalities. After 13 months of successful treatment, she has transformed to AML with typical morphology and immunophenotype. t(11;17)(q23;q21) and MLL-AF17q fusion gene were detected in her bone marrow sample, while no PLZF-RARα fusion gene was detected by real-time quantitative reverse-transcription PCR(RQ-PCR) and fluorescence in situ hybridization(FISH).

CONCLUSIONt-AML is a serious complication after successful treatment of APL. t(11;17)(q23;q21) is not specific for the diagnosis of variant APL and can also be detected in t-AML. RQ-PCR and FISH are essential for the diagnosis of such patients.

Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 15 ; Chromosomes, Human, Pair 17 ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Leukemia, Monocytic, Acute ; genetics ; Leukemia, Promyelocytic, Acute ; genetics ; Middle Aged ; Neoplasms, Second Primary ; genetics

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged