Objective · To observe the vascular structure before autogenous arteriovenous fistula (AVF) construction in patients with end-stage renal disease (ESRD) and analyze the risk factors of the pre-existing venous neointimal hyperplasia. Methods · The 8 vein samples were screened from 20 ESRD patients at their first time of the AVF construction (non-stenosis group), and the other 8 vein samples were screened from 15 ESRD patients at their at least second time of the AVF repair operation (stenosis group). Sections were prepared and stained with hematoxylin & eosin (H-E) or Masson's trichrome for observation. The intimal thickness was measured by the cellSens software, and its correlation with patients' renal function, calcium-phosphorus metabolism, iron metabolism and inflammatory reaction in the non-stenosis group were analyzed. Results · In the non-stenosis group, there were varying degrees of intimal hyperplasia in 5 (62.5%) cases, loss of endothelial cell layer in 3 (37.5%) cases, and vascular wall replacement by collagenous with atrophy or loss of muscle layer in 5 (62.5%) cases. In the stenosis group, almost all vein samples showed general thickening of the wall and 2 (25.0%) totally lost the muscle layer. Avg It of those two groups were statistically significant (P<0.01). In the non-stenosis group, both of average I/M thickness and average I/M area were negatively related to glomerular filtration rate (GFR) (P<0.05) and positively related to serum phosphorus and calcium-phosphorus product (P<0.05). Conclusion · Some apparently normal vein of ESRD patients showed varying degrees of intimal hyperplasia before AVF construction. The intimal hyperplasia had a remarkable correlation with GFR or calcium-phosphorus metabolism. Early intervention of the intimal hyperplasia prior to AVF construction may be a new prevention and control means.

Objective To study carbapenem-resistant genes in a Myroides odoratimimus strain and clinical therapy.Methods A strain of Myroides odoratimimus was isolated from nephrostomy drainage fluid of a patient with urinary tract infection in Xinhua Hospital in May 2013.MicroflexTM MALDI-TOF MS and 16S rDNA sequencing were performed for strain identification.Vitek-2 Compact combined with E-test method was used for antibiotic susceptibility test.Modified Hodge test and imipenem/imipenem-inhibitor (IP/IPI)E-test were performed for drug-resistant phenotype screening.Carbapenemase genes blaMUS-1,blaVIM-1,blaVIM-2,blaIMP-1,blaIMP-2,blaNDM-1,blaOXA-48 and blaGESwere amplified by PCR,and the positive products were sequenced and analyzed.Results The isolated strain was identified as Myroides odoratimimus.The strain was resistant to 17 antibacterial agents,and the minimum inhibitory concentration (MIC) of imipenem was ≥ 16 μg/mL,while it was sensitive to minocycline (MIC =0.38 μg/mL) and intermediate to meropenem (MIC =6 μg/mL).It was negative in modified Hodge test but positive in IP/IPI E-test (IP/IPI≥ 8).blaMUS-1 gene was detected by PCR,and further confirmed by sequencing.Meropenem combined with minocycline was effective for the patient.Conclusion Carbapenem-resistance in this Myroides odoratimimus strain may be related to blaMUS-1 gene,and appropriate therapy for its infection should be based on the result of antibiotic susceptibility test.

Objective To investigate the prevalence and transmission route of Klebsiella pneumoniae carbapenemases ( KPC)-producing Klebsiella pneumoniae in Xinhua Hospital Affiliated to Shanghaijiao Tong University School of Medicine .Methods Carbapenem-resistant Klebsiella pneumoniae isolates from clinical samples were collected from Xinhua Hospital during January 2010 and December 2013.Vitek 2 Compact and disc diffusion method ( Kirby-Bauer method ) were used for identification of the strains and antibiotic susceptibility test . Modified Hodge test was performed for drug-resistant phenotype screening . Carbapenemase gene blaKPC was amplified by PCR, and the positive products were sequenced and analyzed . Enterobacterial repetitive intergenic consensus ( ERIC )-PCR was used to analyze molecular epidemiology of the KPC-producing strains .And clinical information of these isolates was analyzed .Results There were 77 carbapenem-resistant Klebsiella pneumoniae isolates in total , and 71 of them were positive in modified Hodge test.Sixty-nine isolates were identified carrying blaKPC-2 gene.All of the KPC-2-producing isolates were classified as the same genotype by ERIC-PCR. Among 12 patients with KPC-2-producing Klebsiella pneumoniae infection who were first identified in each departments , 7 were transferred from other departments, and 4 were treated in surgery intensive care unit (SICU).Conclusions Most of carbpenem-resistant Klebsiella pneumoniae strains isolated from Xinhua Hospital are KPC-2-producing .The outbreak of carbpenem-resistant Klebsiella pneumoniae infection in the hospital may be associated with the interdepartmental transfer of patients .

Robust and efficient control of therapeutic gene expression is needed for timing and dosing of gene therapy drugs in clinical applications. Ribozyme riboswitch provides a promising building block for ligand-controlled gene-regulatory system, based on its property that exhibits tunable gene regulation, design modularity, and target specificity. Ribozyme riboswitch can be used in various gene delivery vectors. In recent years, there have been breakthroughs in extending ribozyme riboswitch's application from gene-expression control to cellular function and fate control. High throughput screening platforms were established, that allow not only rapid optimization of ribozyme riboswitch in a microbial host, but also straightforward transfer of selected devices exhibiting desired activities to mammalian cell lines in a predictable manner. Mathematical models were employed successfully to explore the performance of ribozyme riboswitch quantitively and its rational design predictably. However, to progress toward gene therapy relevant applications, both precision rational design of regulatory circuits and the biocompatibility of regulatory ligand are still of crucial importance.

OBJECTIVE: To investigate the efficacy of endoscopic nasal cavity expansion surgery on obstructive sleep apnea hypopnea syndrome (OSAHS) and nasal obstruction. METHOD: Clinical data of 48 OSAHS patients with structural abnormality in nasal cavity treated in our department were retrospectively analysed. These patients received endoscopic nasal cavity expansion surgery and were observed for the relief of both subjective and objective symptoms. RESULT: PSG was reexamined 12 months postoperatively. Of all the patients, 29 cases (60.4%) showed complete recovery, 10 cases (20.8%) showed remarkable improvement of the symptoms, 4 cases (8.3%) exhibited curative effect and 5 cases (10.4%) were of no effect, respectively. The symptoms of apnea, hypopnea, LSaO2 and somnolence were significantly improved in all patients,and nasal congestion was obviously relieved. The improvement of snore was not evident. CONCLUSION Endoscopic nasal cavity expansion surgery is effective and safe for the treatment of OSAHS mainly due to nasal obstruction. Operation should be performed to correct structural abnormality in nasal cavity and adjust symmetric distribution of nasal airflow on both sides in order to maintain normal ventilation function. The procedure is applicable to OSAHS patients accompanied by nasal congestion and upper airway resistance syndrome and personalized adjustment is beneficial for better clinical efficacy according to the condition of different patients.
Adult ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasal Cavity ; surgery ; Nasal Obstruction ; complications ; pathology ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; etiology ; surgery ; Treatment Outcome ; Young Adult

Objective To describe the clinical presentations,radiographic findings and histological pathology of bones,diagnosis,treatment options and prognosis for patients with Gorham-Stout syndrome (GSS).Methods Clinical data of 5 GSS patients seen from January 1980 to January 2008 were reviewed.Results(1)There were 2 males and 3 females,aged 15 years to 37 years(mean age was 30.2 years).(2)All of thern had osteolysis,but the site and extent of involved bones were not the same.Three cases had large amount of bloody pieural effusion and two of them had also chylous effusion.All of the 5 cases had no evidence of malignancies.Four cases accepted bone biopsy.Among them,2 cases having local puncture and open biopsy showed typical bone pathologic manifestations.(3)Various forms of treatment including bisphosphonates,calcium supplementation,active vitD3 treatment,local radiation therapy and surgical ligation of thoracic duct were tried.(4)Follow up and clinical outcomes:the two cases,who had only bone osteolysis remained stable.Of the other three cases who had bone osteolysis associated with pleural effusion,one patient needed interrupted effusion drainage with stable bone impairment and the other two cases were out of contact.Conclusions GSS is a rare disorder charactcrized by progressive osteoIysis.The clinical presentations of this disease are variable and depend on the sites of involvement.There were no standard therapy available.Prognosis depends on the site of involvement,extent of the disease and presence of complications.Those who have plueral effusion had poor prognosis.

Objective To explore the imaging features of external iliac artery-related postpartum hemorrhage, and to discuss its interventional therapy measures. Methods The clinical data and imaging findings of one patient with external iliac artery-related postpartum hemorrhage was retrospectively analyzed. The patient received interventional therapy at the intervention department of Shanxi provincial people ’s hospital. The relevant academic papers published in medical literature were reviewed. The common features of this condition were summarized, and the imaging features and the interventional therapy measures were discussed. Results A total of 4 patients, including authors’ case, with external iliac artery- related postpartum hemorrhage were reported in China. Of the 4 case , right external iliac artery-related postpartum hemorrhage was seen in 2 and bilateral external iliac artery-related postpartum hemorrhage was seen in other two. Embolization therapy of three abnormal branches of deep circumflex iliac artery that participated in the uterine blood supply was carried out. Immediately after the embolization the bleeding stopped. Conclusion For the treatment of postpartum hemorrhage, uterine arterial embolization should be followed by abdominal aorta angiography so as to check the external iliac artery. When recurrent bleeding occurs after uterine arterial embolization, the possibility that the abnormal branches of external iliac artery participates in the uterine blood supply should be considered. In performing the embolization of abnormal branches of external iliac artery, the catheter should be inserted to the distal end of the target vessel. Under DSA monitoring the embolic agent should be slowly injected into the targeted artery and the patient should be kept under close observation for blood reflux. Usually, the embolization of abnormal branches of external iliac artery will not cause ischemic symptoms of the pelvis and distal limbs.

Objective To evaluate and compare yeast identification ability between Bruker Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry( MALDI-TOF MS) and Vitek 2 Compact automatic microbial analysis system.Methods Retrospective study.Totally 742 strains of yeast isolated from clinical specimens during March 2013 to March 2014 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were identified by Bruker Microflex MALDI-TOF MS and Vitek 2 Compact automatic microbial analysis system simultaneously.The strains with discordant results were validated by gene sequencing.Results The coincidence rate of 699 Candida identified by Bruker Microflex MALDI-TOF MS or Vitek 2 Compact system was 100.0%(699/699) and 99.6%(696/699) to the species level, respectively and the coincidence rate of 43 yeast-like fungi strains identified was 90.7%(39/43) and 79.1%(34/43) to the species level, respectively.Penicillium marneffei could not be identified by both two instruments, but protein profile of Penicillium marneffei by MALDI-TOF MS was established.Conclusions The coincidence rate of yeast identified by Bruker Microflex MALDI-TOF MS is higher than that of Vitek 2 Compact system.Using Bruker Microflex MALDI-TOF MS to identify yeast especially Candida and yeast-like fungus is fast, simple, low-cost, accurate, and it can be used in routine work of ordinary yeast identification in clinical microbiology laboratory.

Objective To evaluate the efficacy of dual stent placements for the treatment of occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site. Methods The clinical data of 9 patients with occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site were retrospectively analyzed. Stent implantations in the affected subclavian artery and vertebral artery were separately performed; the patients were followed up for 3-12 months after the treatment. The therapeutic efficacy was evaluated with the clinical symptoms and Doppler ultrasonic examination. Results Successful implantation of two stents was accomplished in all 9 patients, with the technical success rate of 100%. After the treatment, the blood flow in both the subclavian and vertebral arteries was unobstructed. Following-up examination showed that the subjective symptoms were obviously improved in all 9 patients, and no serious procedure-related complications occurred. Doppler ultrasound examination showed that no in-stent restenosis or stent displacement was observed. Conclusion For the treatment of occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site, dual stent placement technique is a safe and feasible means with satisfactory effect in improving vertebro-basilar arterial insufficiency.

Objective To evaluate whether the size,number or location of fibroids affect therapeutic efficacy of uterine artery embolization (UAE).Methods 84 patients with symptomatic uterine fibroids who had received uterine fibroid embolization with the use of polyvinyl alcohol(PVA)or gelfoam sponge particles(GSP).According to the lesion's size,number or location,all patients were divided into different groups and following -up as outpatients. Patient's symptomatic improvement and imaging following -up was assessed after UAE.Results A technically suc-cessful embolization was done in all patients.Postoperative 12 -month following -up was performed in 77 cases.No major life -threatening complications were found and the clinical symptoms were improved after UAE.In the different groups,the uterine size and the leiomyoma size after UAE were markedly decreased(t =5.842,P <0.05).Further comparison showed that the mean reduction in fibroids volume after UAE was not significant between the two groups, so was the mean reduction in uterine volume.Solitary leiomyoma group showed no significant difference in volume reduction rate of fibroids and uterine after UAE as compared with multiple leiomyoma group.Changes were not signifi-cantly in Submucosal uterine fibroids,Subserosal uterine fibroids,Intramural uterine fibroids.Conclusion UAE is an effective treatment for uterine fibroids.In this study,the size,number,and location of fibroids did not affect therapeutic efficacy or the complication rate of UAE.