Objective To investigate the microbiological and epidemiological characteristics of bloodstream infections in Peking University Third Hospital Methods The clinical, microbiological and epidemiological data of bloodstream infections in Peking University Third Hospital from January lst,2005 to December 31st, 2007 were analyzed retrospectively. Differences in proportions were compared using X2 test. Results Six thousand four hundred and eighty-eight blood culture tests for 5 138 episode of bloodstream infections of 3 795 patients were performed. The positive rate was 9.9%. The average incidence rate of nosocomial infection was 40.8 cases per 10 000 hospital admissions. In the 593 pathogens, 483 (81.5%) were pathogens causing nosocomial. The ratio of Gram-positive microbs, Gram-negative ones and fungi (all were Candida spp.) were 38.5%, 54.7%, and 6.8%, respectively. The corresponding ratio of nosocomial pathogens were 42.0%, 49.9% and 8.1%, respectively. The most frequently isolated strain was Escherichia coli (25.3 %). The coagulase negative staphylococcus was the second one (18.8%). The corresponding ratio of Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus spp. , Pseudornonas aeruginosa , Acinetobacter baumannii and anaerobs were 7.1%, 7.4%, 8.3%, 3.2%, 2.2% and 0.7%, respectively. Ten patients (1.7%) had experienced polymicrobial infection. In hospital setting, Streptococcus spp. And Escherichia coli infections were more frequently in non-intensive care unit (ICU) than ICU (X2= 9.240, P= 0.002; X2= 23.609, P,<0.01; respectively). But the infection rate of Candida spp. Was significantly higher in the ICU (X2= 5.498, P= 0.019). The time interval between hospital admission and onset of infection for the most frequently isolated pathogens ranged from 15.1 days (Escherichia coli) to 29.7 days (Acinetobacter baumannii). The degree of resistance to the common antimicrobal agents had no change in the three years. Conclusions The average incidence rate of nosocomial bloodstream infection is 40.8 cases per 10 000 hospital admissions. The main pathogens are the Gram-negative microbs.

Objective To study the mechanism of insulin resistance in obesity, impaired glucose tolerance (IGT) and type 2 diabetes. Methods Insulin sensitivity index (SI), glucose effectiveness (S G) and insulin secretory function of ? islet cells were assessed by the reduced sample number of Bergman's minimal model method with frequently sampled intravenous glucose tolerance test in patients with obesity, IGT and type 2 diabetes as well as in the controls. Body mass index (BMI) and waist hip ratio (WHR) were determined in four groups. Results SI and S G were significantly higher in the controls than those in the IGT and type 2 diabetes patients. The S G in obesity group was nearly the same as that in the controls, but its SI was significantly lower. The area under curve 1 (AUC 1) of insulin in the controls was smaller than that in obesity and IGT (P

Child ; Drug Resistance, Viral ; HIV ; drug effects ; genetics ; HIV Infections ; virology ; Humans

[Summary] A 61-year-old female patient was diagnosed as ACTH independent Cushing′ syndrome, right adrenal adenoma, right facial infection. The situation was well controlled with antibacterial agents, abscess incision drainage and ketoconazole therapy. The patient received partial adrenolectomy of her right adrenal gland 16 months later. This case indicated that anti-adrenal agents could be a reasonable choice when the Cushing′syndrome patients were acompanied with severe infection.

y screen and prevent CAD in these people before diabetes sets in.

Objective To investigate the clinical and genetic characteristics in a male patient with 21hydroxylase deficiency combined with adrenal and testicular tumors.Methods Clinical features and laboratory data were collected from the patient.Testicular biopsy was performed.The CYP21 gene was sequenced for mutations.Results The patient presented left adrenal and testicular enlargements.The laboratory examinations showed that plasma ACTH,androstenedione,testosterone,progesterone,and 17-hydroxyprogesterone were markedly elevated.CT scan revealed that the right adrenal gland being resected and the left adrenal with nodular enlargement.Furthermore,testicular biopsy showed a prominent peritubular fibrosis with increased number of peritubular fibroblasts,tubular hyalinisation,and calcification.Sequencing analysis showed a A>G homozygous mutation at intron 2.Conclusion Patients with untreated 21-hydroxylage deficiency may.have adrenal adenomas and(or)testicular adrenal rest tumor simultaneously.

Objective To assess the diagnosis and treatment of enterovesical fistula.Methods The clinical data of 12 cases (10 men and 2 women;mean age,57 years) of enterovesical fistula were retro- spectively analyzed.Of the 12 cases,7 (58%) had colovesical fistula,3 (25%) had ileovesical fistula,and 2 (17%) had rectovesical fistula.The etiology of fistula was intestinal malignancy in 7 cases,Crohn disease in 3 ,and bladder cancer in 1,and intestinal diverticulitis in 1.The clinical features included fecaluria in 10 cases,recurrent urinary tract infection (UTI) in 6,abdominal pain in 4,and pneumaturia in 3.Five patients (5/9) had a definite diagnosis by CT;3 (3/6),by cystoseopy;2 (2/5),by cystography;and 1 (1/5),by barium enema.Among the 10 patients undergoing surgical intervention,resection of the involved bowl with one-stage anastomosis and partial cystectomy was performed in 4;resection of the bowl with one-stage anasto- mosis and repair of the fistula or single bladder drainage in each of 2;one-stage transverse colostomy and two- stage radical colectomy with partial cystectomy in 1;palliative proximal colostomy in 3;and conservative ther- apy in 2.Results One patient died of septic shock 10 d after admission.Nine patients were followed for 3 months to 16 years (mean,6.5 years).One patient had intestinal fistula recurrence and was cured with re- operation;1 patient with conservative therapy and 1 with palliative surgery died of tumor metastasis;and 1 died of cerebrovascular accident 2 years later without fistula recurrence previously.Five patients undergoing surgery had a better survival with no complication.Conclusions The major cause of enterovesical fistula is intestinal malignancy.Fecaluria and recurrent UTI are the most common symptoms.CT and cystoscopy are the preferred adjunctive examinations.Surgical intervention is the major therapeutic choice.

?Smart phones as a symbol of the mobile Internet appears in college classroom, which is not only a challenge, but also a great opportunities of education information. This paper applied smart phones as the carrier of the Internet into ophthalmology classroom. Smart phones has a lot of features, such as rich teaching resources, diverse learning methods, flexible learning time, collating and recording capabilities and the timely, comprehensive and accurate teaching feedback so on, and could be used in case teaching and interactive teaching. The implementation of smart phones into ophthalmology classroom could inspire the learning enthusiasm of the students, enhance the quality of teaching, eventually improve teaching effects.

Objective To explore the potential mechanism of adrenal androgen excess in patients with polycystic ovary syndrome (PCOS), ACTH stimulation test was conducted and the polymorphisms in the promoter region of CYP21 A2 gene were screened to verify the variations related to the responsiveness to ACTH stimulation. Methods 30 healthy women and 101 PCOS patients, matched for age, were recruited from Ruijin hospital. Blood biochemical examinations were taken and sex hormone profiles obtained at baseline. 17 hydroxyprogesterone( 17OHP)was measured at 0 and 60 min in an ACTH stimulation test. The -710 bp -1 bp of the promoter region of CYP21A2 was sequenced in 87 PCOS patients and 30 control subjects. Results According to the post-stimulation 17 OHP levels obtained from 30 healthy women,PCOS patients were allocated into one group with high responsiveness to ACTH ( HR-PCOS, n = 21) and the other with normal responsiveness to ACTH ( NR-PCOS, n = 80). Compared with NR-PCOS subjects, HR-PCOS patients had higher testosterone( P<0.05), basal and post-stimulation 17OHP (both P<0.01)and dehydroepiandrosterone sulfate levels (P<0.05 or P<0.01) .whereas serum cortisol and androstenedione levels were not significantly different before and after ACTH stimulation test. The genotypes of locus -535 were well correlated with post-stimulation 17OHP levels (r = 0. 20,P = 0. 03) in PCOS patients and the control subjects. The genotype T/T or allele T was significantly more frequent in subjects with a higher fertile of post-stimulation 17OHP (P<0.05 or P<0. 01). The odds ratio(OR)for higher responsiveness to ACTH in women with allele T at -535 was 3. 69 (95% CI 1. 69-8. 06,P = 0. 000 7). Conclusions The PCOS patients with higher responsiveness to ACTH are characterized by severe hyperandrogenemia and adrenal androgenexcess,suggesting that adrenal androgen excess in some PCOS patients may be due to higher responsiveness to ACTH. The polymorphism of -535C>T in the promoter region of CYP21 A2 may play a role in regulating 21 hydroxylase gene expression and further influencing 17OHP responsiveness to ACTH.

This study aims to analyse the value of CODEHOP RT-PCR in the detection of Flavivirus. According to the amino acid sequences of polyproteins of different flaviviruses published in GenBank, a pair of primers was designed using the CODEHOP method. One-step RT-PCR was used to detect Japanese encephalitis virus strain JEV1201, Dengue virus strain JKD001, and yellow fever virus vaccine YV6161. BLAST analysis and phylogenetic analysis were performed after the RT-PCR products of nucleocapsid genes were sequenced. The results showed that this method could amplify Flavivirus specifically, and the size and sequence of the target fragment accorded with the anticipated result. JEV1201 had the highest homology to Japanese encephalitis virus strain YL2009-4/YC2009-3, belonging to the branch of the phylogenetic tree of Japanese encephalitis virus strains. JKD001 had the highest homology to Dengue virus strain DENV-2/ID/1022DN/1975, belonging to the branch of the phylogenetic tree of Dengue virus strains. YV6161 had the highest homology to Yellow fever virus strain 17D, belonging to the branch of the phylogenetic tree of Yellow fever virus strains. In conclusion, the method of CODEHOP RT-PCR can be effectively used to detect, identify, and phylogenetically analyse Flavivirus.
DNA Primers ; genetics ; Flavivirus ; classification ; genetics ; isolation & purification ; Flavivirus Infections ; virology ; Humans ; Molecular Sequence Data ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; Viral Nonstructural Proteins ; genetics