Objective To summarize the types and reasons of misdiagnosis in multiple myeloma (MM),and the approaches of avoiding misdiagnosis by analyzing the misdiagnosis data in MM.Methods 197 references of misdiagnosed MM were retrieved from Wanfang medicine net by using the key words multiple myeloma and misdiagnosis from the year 2000 to 2012,and 62 of them with complete data and statistical certainty from level 2 or higher national hospitals were analyzed and summarized.Results In 62 references,2110 patients were misdiagnosis.There were more than 160 misdiagnosed MM.The shortest time of delay in diagnosis was one week,and the longest was tcn years.The rate of misdiagnosis in MM was 56.44 ％ (1406/2491).The onset age of the youngest was 16 years old and the oldest was 87 years old.A difference of nearly 20 years was found between the maximum and minimum average age of onset.MM was misdiagnosed as 10 kinds of diseases.They were including bone joint disease 32.23 ％ (680/2110),other blood diseases 11.75 ％ (248/2110),infection 14.5 ％ (306/2110),solid tumor 6.35 ％ (134/2110),kidney disease 18.58 ％ (392/2110),digestive system disease 3.13 ％ (66/2110),rheumatism 4.64 ％ (98/2110),heart disease 4.64 ％ (57/2110),nervous system disease 2.99 ％ (63/2110),endocrine disease 0.38 ％ (8/2110).Conclusion MM could occur in all ages except children and may be mistaken for a variety of diseases.It is key to prevent misdiagnosis by strengthening the comprehensive understanding of MM by taking detailed history,careful physical examination,comprehensive laboratory examination,and comprehensive clinical thinking.

OBJECTIVE To evaluate the effect of delayed entry(0-24 h) into BacT/Alert 3D and BACTEC 9120 and the effect of 2 incubation temperatures(22 ℃ vs 35 ℃) on culture positivity.METHODS We utilized the BacT/Alert system with FA bottles and the BACTEC 9120 system with Plus(Aerobic) bottles.Four clinical bacterial species,Staphylococcus aureus,Escherichia coli,Streptococus pneumoniae,Candida albicans,were used as the test strains.and 5 ml of blood were added to each bottle.Each species was inoculated into the bottles 3 times at an inoculum size of 10 CFU/ml,102 CFU/ml and 108 CFU/ml,respectively.The inoculated bottles were cultured using the respective instruments after they were allowed to stand at room temperature(22 ℃)and 35 ℃ for 0,8,16 and 24 h.Time-to-detection and culture positivity were evaluated.RESULTS The delay in transportation of blood culture bottles stored at room temperature(22 ℃) or 35 ℃ had no effect on the recovery rate for BACTEC 3D at less than 24 h preincubation time and for BacT/Alert 9120 at less than 16h preincubation time.The positivity rate decreased significantly for BacT/Alert 9120 for 24 h of delay.Culture positivity of BacT/Alert 3D was higher than BACTEC 9120 for 24 h of delay.CONCLUSIONS The delayed entry for BacT/Alert 3D should be within 24 h,but the delayed entry for BACTEC 9120 should be within 16 h.

Objective To evaluate bone marrow mesenchymal stem cells combined with VEGF gene in the treatment of limb ischemia in rabbits.Methods The right hind limb ischemia model of New Zealand rabbit was established by superficial femoral artery excision and deep femoral artery ligation.Rabbits then were divided randomly into 4 groups: empty plasmid control group(EP group),bone marrow mesenchymal stem cells group(BMSC group),VEGF gene therapy group(VEGF group),combination bone mesenchymal stem cells and VEGF gene therapy group(BV group).There were 8 rabbits in each group.Angiogenesis was detected by arteriography on day 28 after treatment and expression of VEGF was detected by immunohistochemical staining on day 30 after treatment.Results There were no differences of collateral vessel count between the EP group,BMSC group and VEGF group.The collateral vessel count in BV group was higher than that of the other three groups.Immunohistochemistry of VEGF showed that the integrated optical density(IOD)in BMSC and VEGF groups increased significantly compared with the EP group; the IOD in BV group was the highest compared with the other three groups.Conclusions Combination bone marrow mesenchymal stem cells and VEGF gene in the treatment of limb ischemia in rabbits can obtain stable and effective expression of VEGF along with significant improvement of limb ischemia.

OBJECTIVE: We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. MATERIALS AND METHODS: The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and post-treatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. RESULTS: A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in five iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During follow-up (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. CONCLUSION: Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity deep venous thrombosis.
Adult ; Aged ; Angioplasty, Balloon ; *Catheterization, Peripheral ; Combined Modality Therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; *Infusion Pumps ; Infusions, Intravenous ; Leg/*blood supply ; Male ; Middle Aged ; Phlebography ; *Thrombolytic Therapy/methods ; Ultrasonography, Doppler ; Urokinase-Type Plasminogen Activator/*administration & dosage ; Vascular Patency ; Venous Thrombosis/*drug therapy/radiography/ultrasonography

Objective The present study aimed to investigate the molecular characterizations and virulence factors mediating adhesion of S.agalactiae.Methods All the 6 GBS strains from maternity ward, 4 isolated from the blood of neonates and 2 isolated from the vaginal secretions of their mothers, were performed antimicrobial susceptibility tests through disk diffusion method,and analyzed by multilocus sequence typing(MLST)and pulse field gel electrophoresis typing(PFGE)to determine the relationship between the strains and whether it was nosocomial infection or not.The S.agalactiae isolates were subjected to capsular genotyping by PCR.Determinants of adherence factors were also detected by PCR and sequencing,including surface proteins and pilus-like structures.Results The results of antimicrobial susceptibility tests of 7 /13/37/66 are the same,while 142 and 158 are the same but different from the other 4 strains.The MLST results indicate that 7 /13/37/66 are of the same sequence type ST-12,while 142 and 158 are ST-19.PFGE results have further proved that 7/13/37/66 are of the same clone type,and 142 and 158 were another clone type.The strains of 7/13/37/66 are serotype Ib,and contain bac,bca,and alp2/3 genes,while 142 and 158 are serotype III and contain ε gene.All the six strains contain PI-1 and PI-2a genes.Conclusions There are not only vertical but also horizontal transmissions in the 4 cases,which may be a nosocomial infection event.Six strains all contained primary adhesion factor of S.agalactiae: surface proteins and pilus-like structures,which indicates that all the 6 strains has a strong toxicity in adhesion and spread.The hospitals should reinforce the prenatal examination of S.agalactiae and control the nosocomial infection.

Objective To study the clinical significance of serum cystatin C (Cys C) in patients with acute leukemia (AL). Methods A total of 59 newly diagnosed AL patients in Xinghua City People's Hospital from January 2014 to August 2017 were enrolled; meanwhile, 59 healthy individuals who underwent physical examination at Medical Center of Xinghua City People's Hospital were selected as the control group. AU5800 automatic biochemical analyzer from American Beckman Coulter Corporation was applied to detect the levels of serum Cys C, lactate dehydrogenase (LDH) and creatinine (Cr). The receiver operating characteristic (ROC) curve was also drawn. Results The levels of serum Cys C and LDH in AL patients were higher than those in the control group [serum Cys C: (1.36±0.72) mg/L vs. (0.76±0.27) mg/L; LDH: (456±362) U/L vs. (185±29) U/L], and there was a statistical significance (t＝-5.965, P＝0.000; t＝-5.718, P＝0.000). There was no statistical difference in the serum Cr between AL patients and control group [(86±26) μmol/L vs. (82±16) μmol/L] (P＞ 0.05). There was a positive correlation between levels of serum Cys C and LDH in AL patients (rs＝ 0.447, P < 0.05). The ROC area under curve of serum Cys C was 0.823, the standard error was 0.037, and the confidence interval of 95 % was 0.751-0.896. The ROC area under curve of serum LDH was 0.811, the standard error was 0.042, and the confidence interval of 95 % was 0.728-0.894. Conclusion The level of serum Cys C in AL patients is higher than that in the healthy population. The detection of serum Cys C is helpful in the diagnosis of AL and the evaluation of tumor burden, which is consistent with serum LDH.

OBJECTIVE: To analyse the effect of low intensity pulsed ultrasound stimulation (LIPUS) on accelerating the fibrocartilage layer repair of patella-patellar tendon junction. METHODS: A total of 60 mature female New Zealand white rabbits undergoing standard partial patellectomy were divided into 2 groups randomly. The control group was given comfort treatment and the treatment group was given LIPUS treatment starting from day 3 to the end of week 6 postoperatively. The scheduled time points of animal euthanization would be at week 6, week 12 and week 18 postoperatively. The patella-patellar tendon (PPT) complex would be harvested and cut into sections after decalcification for H&E staining, Safranine o/fast green staining. The thickness and gray value of fibrocartilage layer were analyzed by SANO Microscope Partner image analyzer. RESULTS: At week 6, week 12 and week 18 postoperatively, the fibrocartilage layer in the treatment group was significantly thicker than that in the control group (P<0.01), and the gray value of fibrocartilage layer was significantly smaller than that in the control group (P<0.01). CONCLUSION LIPUS helps to accelerate the fibrocartilage layer repair of patella-patellar tendon junction in rabbit models.
Animals ; Female ; Fibrocartilage ; pathology ; physiopathology ; Patella ; surgery ; Patellar Ligament ; injuries ; pathology ; physiopathology ; surgery ; Rabbits ; Tendon Injuries ; therapy ; Ultrasonic Therapy ; methods ; Wound Healing ; physiology

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.