Epistaxis ; diagnosis ; etiology ; Hemophilia B ; complications ; diagnosis ; Humans ; Male ; Young Adult

Antitussive Agents ; poisoning ; Child, Preschool ; Dextromethorphan ; poisoning ; Humans ; Male

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Objective To understand the risk of heterotopic pregnancy when intrauterine pregnancy and abdominal pain co-exist. Methods and results We report a patient with heterotopic pregnancy in a naturally occurring pregnancy; she also had high risks for secondary infertility. At gestational week 13 she had hemorrhagic shock due to intrauterine pregnancy complicated with rupture of tubal pregnancy; salpingectomy was performed via open operation. The intrauterine pregnancy was uneventful after operation, and a healthy baby was delivered through cesarean section at 37+2 weeks due to placental previa. Conclusion Heterotopic pregnancy usually occurs in women receiving assisted reproductive technology, but it can also happen in natural conception when there are high risk factors. Satisfactory outcome can be obtained in patients with heterotopic pregnancy, rupture of tubal pregnancy, and hemorrhagic shock, if prompt measures and supporting treatment can be given.

Objective To investigate the distribution of acquired carbapenemases in carbapenemresistant strains of Klebsiella pneumoniae, and explore its role in epidemiology of nosocomial infection. Methods From November 2008 to March 2009, twenty clinical isolates of carbapenem-resistant Klebsiella pneumoniae were collected from children hospitalized in Wuhan children's hospital. MICs of antibiotics were tested by DNA of Klebsiella pneumoniae. Modified Hodge test was used to screen strains producing carbapenemases,combined imipenem(IPM)-EDTA , meropenem(MEM)- EDTA and ceftazidime(CAZ) - EDTA double-disk synergy test (DDST) were used to detect metallo-β-lactamase-producing. PCR amplification of the carbapenemase and integrase genes, and sequencing were performed. Plasmid conjugation transfer experiments and Southern hybridization were applied to study the mode of drug resistance transmission. Results Four types of Klebsiella pneumoniae were detected by PFGE, type A consisted of 5 strains, including 3 strains of type Al and 2 strains of type A2), type B (2 strains), type C (12strains) and type D (1 strain). Type A and C were the main drug resistant clones. Eight strains of Klebsiella pneumoniae carried both KPC-2 and IMP-4 genes, 10 strains carried IMP-4 gene, 2 strains carried KPC-2 gene. None of NDM-1 ,GIM, SPM, SIM, OXA-23, and VIM carbapenemase genes was detected in 20 isolates. All of 20 isolates carried lntl which were found to be located on bacterial chromosome by Southern blot. Conclusions KPC-2and IMP-4 genes are the major carbapenemase genes in Klebsiella pneumoniae isolated in Wuhan.Transmission of drug resistance is mainly through vertical transmission of type C resistant clone and horizontal transmission of Intl on bacteria chromosome.

Objective To investigate the changes of interleukin(IL)-2 and interferon(IFN)-γin serum and synovial fluid of patients with joint injure with Kashin-Beck disease(KBD), and study the roles of IL-2 and IFN-γ in KBD joint injure. Methods In accordance with the "Diagnostic Criteria of Kashin-Beck disease"(GB16003-1995),48 cases of KBD patients and 26 healthy people(control group) from KBD endemic area in Long county Shaanxi province were enrolled in the study. KBD patient were 24 males and 24 females, respectively, aged 40 to 65 years (mean age 51 years). Forty-eight serum specimens and 28 synovial fluid specimens of patients(14 males and 14 females,respectively) were collected. Healthy control group were 13 males and 13 females, respectively. Twenty-six serum specimens of healthy controls were collected. Serum and synovial fluid IL-2 and IFN-γ levels were determined by enzyme-linked immunosorbent assay(ELISA). Results In healthy controls and KBD patients, the midian of serum IL-2 were 46.8 ng/L and 55.7 ng/L, respectively, and IFN-γ were 52.3 ng/L and 48.8 ng/L, respectively. The difference was not statistically significant between healthy controls and KBD patients(t = 0.62, 0.70, all P ＞ 0.05).In synovial fluid of KBD patient, the midian of IL-2 and IFN-γwere 48.3 ng/L and 44.1 ng/L, respectively. The difference was not statistically significant between serum and synovial fluid in KBD patients(t = 0.69, 1.72, all P ＞0.05). Conclusion Serum and synovial fluid IL-2 and IFN-γare not significantly increased in KBD patients with articular damage, indicating that IL-2 and IFN-γare not involved in KBD joint injury.

Objective To investigate the molecular epidemiology of CRAB isolated from children in wuhan. Methods Forty non-repetitive strains of CRAB were collected from hospitalized children of emergency department, neonatal medicine, cardiothoracic surgery, bone surgery, respiratory medicine and renal medicine in Wuhan children's hospital during December 2008 and May 2009. MIC values were PFGE; KPC, IMP, GIM, SPM, SIM, OXA-23, VIM genes and integrase gene were amplified by PCR and then sequenced to confirm the genotypes.; Plasmid conjugation experiment was used to study the transfer method of bacterial resistance and southern blot hybridization was used to target the resistance genes. Results Susceptible rates of 40 strains to gentamicin, tobramycin, amikacin, ciprofloxacin, levofloxacin, trimoxazole were 20%, 5%, 93%, 93%, 95%, and 23% respectively. Eleven types of clone were detected by PFGE,including 29 strains of type A clone, 2 strains of type B clone, and 1 strain for each type of C to K clone. Eleven isolates produced both IMP-4 and OXA-23 carbapemase. Twenty-six isolates only possessed OXA-23 carbapemase. Thirty-six strains carried class Ⅰ integron. The results of southern blot hybridization showed that Intl, IMP-4 and OXA-23 type were located on chromosome. Conclusions Type A clone of CRAB is the most common. OXA-23 and IMP-4 type are the major acquired carbapemases, especially the OXA-23 is the most common type. The horizontal transmission of OXA-23 and IMP-4 gene mediated by Int1 and the spread of type A resistant clone is the major way of the spread of carbapenem-resistant Acinetobacter baumannii in the region.

Abscess ; complications ; Adult ; Brain Abscess ; complications ; Female ; Humans ; Meningocele ; complications ; Nasal Cavity ; pathology ; Nose Diseases ; complications

OBJECTIVETo investigate the clinicopathological features and prognosis of patients with the malignant transformation of sinonasal inverted papilloma.

METHODSThirty-two consecutive cases encountered between January 1991 and January 2008 were retrospectively reviewed. Survival rates and prognostic factors were calculated with SPSS 17.0 software using the Kaplan-Meier method and multivariate Cox model survival analysis.

RESULTSThe malignancy accounted for 8.99% of all types of sinonasal inverted papilloma. There were 25 males and 7 females, the median age was 56.5 years. The sites of tumor included 22 cases in nasal cavity and ethmoid sinuses, 10 cases in maxillary sinuses. The tumors included 21 high grade tumors, 8 intermediate grade tumors and 3 low grade tumors. Thirty-two patients were staged as T1(3/32), T2(10/32), T3(16/32), T4(3/32). According to the percentage of the malignant cell in the entire tumor tissue, 5 patients were in grade I, 5 patients were in grade II, 8 patients were in grade III, 14 patients were in grade IV. There were 3 distant metastasis in 32 patients; 19 patients underwent surgery plus postoperative radiotherapy, 10 underwent surgery alone and 3 underwent radiotherapy alone. The 5-year overall survival were 72.5%, and the median overall survival time was 62.2 months. Kaplan-Meier univariate survival analysis indicated that the clinical stages and treatment modalities were prognostic factors, and multivariate Cox model survival analysis confirmed that the clinical stages and treatment modalities were independent factors for overall survival (HR were 4.211 and 0.312, all P < 0.05).

CONCLUSIONSThe morbidity of sinonasal inverted papilloma-associated malignancy is low, the clinical features were not specificity. The clinical stages and treatment modalities may affect the prognosis. Surgery plus postoperative radiotherapy are main treatment means.

Aged ; Carcinoma, Squamous Cell ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Papilloma, Inverted ; pathology ; therapy ; Paranasal Sinus Neoplasms ; pathology ; therapy ; Retrospective Studies ; Survival Rate

Glioblastoma(GBM)is one of the most common primary intracranial tumor that has high de-gree of malignancy ,invasive ability and a fatal prognosis .In recent years ,with the development of modern technol-ogy in biomedical sciences ,the understanding on GBM has developed gradually from pathological diagnosis to mo -lecular classifications ,which is based on the molecular characteristics of genetic signatures .Based on gene expres-sion and DNA methylation patterns , primary glioblastoma is divided into four subtypes , including the classical , neural,proneural and mesenchymal .These molecular classifications are closely relevant to the biological charac-teristics of glioblastoma .This review briefly introduces the molecular classifications of primary glioblastoma , but mainly focuses on the changes of the major genetic EGFR ,PTEN and PI3K,CDKN2A in the classical subtype of GBM,and discusses the treatment strategies for primary glioblastoma .