Objective To investigate the transition of uropathogens and drug resistance in patients with type 2 diabetes(T2DM)complicated with urinary tract infection(UTI)in recent 10 years.Methods A total of 392 cases of T2DM with UTI were included in the study.The patients were divided into 2 groups according to time of hospitalization:group A(January 1998 to December 2002)and group B(January 2003 to December 2007).Clinical information,distilbution of uropathogens and antibiotic resistance between the two groups were analyzed.Results The most common pathogens isolated were Escherichia coli(50/152,32.89%),followed by Candida albicans(21/152,13.82%)and Enterococcus faecium(15/152,9.87%).Of the various pathogenic organisms isolated in group B,there were 16 new species not seen in group A.Escherichia coli was found to have higher resistant rates to ciprofloxacin and ceftriaxone in group B than in group A(80.8%vs.42.8%,26.9%vs.0,respectively).Enterococcus faecium was found to be more susceptibility to tetracycline in group B than in group A(0 vs.100.O%).Conclusion Species of uropathogens in T2DM patients ale increased,and the isolates are of high drug resistance,which should be noted in clinic.

Two eases of Hashimoto's encephalopathy (HE) are reported and relative literature is reviewed in this article.Both cases were female,with disturbance of consciousness and dementia as initial symptoms.Marked increase of anti-thyroid antibodies was found in serum of the patients.The symptoms disappeared after steroids and maintenance therapies.A total of 126 cases of HE in Chinese literature were retrieved from 2006 to 2015 through the databases of China National Knowledge Infrastructure and Wanfang Med Online.The male/female radio was 1 ∶ 6 with an average age of 51.3 years.The clinical manifestations included cognitive impairment (44.5％),epilepsy (38.3％),psychiatric disorders (27.3％),stroke-like symptoms (25.8％),disturbance of consciousness (24.2％),and extrapyramidal symptoms (20.3％).Good response to steroids was observed in 77.2％ HE patients.Analysis indicates that HE is an autoimmune disease with the presence of neurological and psychiatric manifestations,elevated titers of anti-thyroid antibodies in serum and well response to steroids,with a good prognosis.

Objective:To approach the clinicopathologic characteristics, treatment modalities, and prognosis of the patients with double primary carcinoma of endometrial carcinoma and colorectal carcinoma and analyze the relationship between this disease and Lynch syndrome. Methods:The clinicopathologic and follow-up data of 34 cases with double primary carcinoma of endometrial carci-noma and colorectal carcinoma treated in Cancer Hospital of Chinese Academy of Medical Sciences were reviewed. Results:The medi-an age of the 34 patients was 51.5 years old (ranging from 39 to 76). Twenty-two of the total cases (22/34, 64.7%) had tumor family his-tory. The pathologic results indicated that 79.4%(27/34) was endometrioid adenocarcinoma. In the 34 cases, 33 were treated by surgical procedure. Of the 33 cases undergoing surgery, 17 patients with endometrial carcinoma and 19 with colorectal carcinoma received fur-ther adjuvant treatment of chemotherapy and/or radiotherapy. The 2-and 5-year survival rates were 84.3%and 63.1%in the 34 cases, respectively. Conclusion:The age of onset is earlier in the patients with double primary carcinoma than in those with sporadic colorec-tal carcinoma. Some cases have cancer family history, and their survival rates are similar to those of the patients with sporadic colorec-tum carcinoma. Diagnosis of some patients with double primary carcinoma may be in line with Lynch syndrome.

Objective To investigate the clinicopathological features,survival,and the impact of postoperative adjuvant radiotherapy on the ovarian function in patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer.Methods One hundred and eighty-six patients who were admitted to our hospital from 2000 to 2011 were retrospectively analyzed.An equal number of patients older than 35 years of age with cervical cancer within the same period were used as stage-marched controls.The Kaplan-Meier method was used to calculate the survival rates,and the log-rank test was used for pairwise comparison and univariate prognostic analyses.The Cox proportional hazards model was used for multivariate prognostic analyses.Results The patients less than or equal to 35 years of age had a significantly higher incidence of non-squamous carcinoma but significantly lower incidence rates of deep stromal invasion and lymph-vascular space invasion (LVSI) compared with the control group (P =0.000;P =0.008;P =0.000).Though young patients had significantly higher 5-year disease-free survival (DFS) and overall survival (OS) rates than the control group (93.7％ vs.84.5％,P=0.005;96.1％ vs.89.5％,P=0.033),age was not an independent prognostic factor (P =0.202;P =0.950).Among patients less than or equal to 35 years of age,lymph node metastasis and LVSI were independent prognostic factors for DFS (P =0.000;P =0.000),while LVSI and initial tumor size were independent prognostic factors for OS (P =0.000;P =0.000).There was no significant difference in the incidence of normal ovarian function between young patients treated with and without adjuvant radiotherapy after ovarian transposition (63％ vs.73％,P =0.422).Conclusions Patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer have a better prognosis than the control group.However,age is not an independent prognostic factor.Postoperative adjuvant radiotherapy will not impair the function of transposed ovaries.

Objective To investigate the clinicopathologic characteristics,therapy and prognostic factors of small cell carcinoma of the cervix.Methods Clinical and pathological data of eight patients were analyzed retrospectively.Results Eight patients all presented with symptoms of abnormal vaginal bleeding or postcoital spotting.One patient had stage Ⅰ b1 disease,2 had stage Ⅰ b2 disease.2 had stage Ⅱ b disease and 3 had stage Ⅲ b disease.Histopathologic findings showed the small tumor cells had scant cytoplasm,round nuclei,absence of nucleoli,and finely dispersed chromatin.Immunohistochemical findings were positive in 7 cases for neuron-specific enolase.Three patients with stage Ⅰ b disease and 1patient with stage Ⅲb disease underwent radical hysterectomy and postoperative chemotherapy.with or without radiotherapy,and the survival period was 64,22,14 and 6 months respectively.Two patients with stage Ⅱ b disease and 2 with stage Ⅲ b disease underwent chemotherapy and radiotherapy,and the survival period was 25,9,10 and 5 months respectively.Conclusions Immunohistochemical analysis using several kinds of neuroendocrine markers is helpful in establishing the correct diagnosis in addition to focusing on characteristic histopathological features.It is necessary to use comprehensive treatment including surgery,chemotherapy and radiotherapy for patients with small cell carcinoma of the cervix.Chemotherapy may play an important role in the treatment.

Objective To investigate the impact of squamous cell carcinoma antigen(SCCAg)in patients with recurrent squamous cell carcinoma of the uterine cervix.Methods Totally 72 patients with recurrent squamous cell carcinoma of the uterine cervix treated at the Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,between 1999 and 2005 were retrospectively analyzed to investigate the impact of SCCAg on diagnosis and prognosis by univariate and multivariate analysis.Results This study included 30 patients with recurrent disease after primary radical surgery and 42 patients with recurrent cervical cancer after radio-chemotherapy.Sixty one patients(85%)had serum SCCAg elevated (≥1.5 pg/L),and 20 of these(28%)had an increase of SCCAg before clinical manifestation of relapse.The median leading time was 3 months(range:1-13 months).Forty five patients had no symptoms with only SCCAg elevation,and 15 patients experienced leg edema and(or)sciatic pain,7 patients suffered from irregular bleeding and 5 patients had symptoms resulting from distant metastasis.Thirty three patients were diagnosed by histology biopsy and (or) cytology,39 patients were diagnosed with SCCAg elevation and clinical and radiological examinations,29 of these patients were diagnosed only by SCCAg elevation and CT or MRI.Fourteen patients recurred limited to the cervix or to the cervix and adjacent tissues(central recurrence),31 cases recurred at pelvis,and 20 patients with distant metastasis and 7 patients suffered from Pelvic recurrence and distant metastasis.Twenty three cases received salvage therapy including surgery for patients recurring after definitive radiotherapy and radiotherapy and or conform radiotherapy for patients after primary radical surgery,46 patients were given palliative chemotherapy and or radiotherapy,and 3 patients refused any treatment.The median and mean survival time were 11 months and 23 months respectively(2-62 months).The 3-year,5-year overall survival rate were 25%and 19%respectively.Univariate analysis showed SCCAg elevation before primary treatment,grade,recurrent site,treatment method,SCCAg≥10pg/L,SCCAg elevation during treatment,and SCCAg not within normal after treatment were correlated with 3-year survival rate.Twenty patients had an increase of SCCAg before clinical manifestation of relapse compared with other patients who did not,and the 3-year survival rate was not significantly different (22% vs 27%). Multivariate analysis revealed that only grade and treatment methods were independent risk factors. Conclusion The impact of the SCCAg in recurrent squamous cell carcinoma of the uterine cervix needs further study.

Objective To investigate the efficacy and prognostic factors in patients with stage Ⅰ b and Ⅱ a cervical carcinoma by radical radiotherapy.Methods Between January 1999 and January 2012,108 patients with stage Ⅰ b and Ⅱ a cervical carcinoma received radical radiotherapy in Cancer Hospital,Chinese Academy of Medical Sciences were included and analyzed retrospectively.Patients of stage Ⅰ b1,Ⅰ b2,Ⅱa1 and Ⅱa2 were 18 (16.7％,18/108),38 (35.2％,38/108),33 (30.6％,33/108) and 19 (17.6％,19/108),respectively.Results The 5-year overall survival rate was 76.2％ and the 5-year disease free survival rate was 75.6％.Totally 25 (23.1％,25/108) patients developed recurrent disease,16 of them (64％,16/25) had local recurrences,6 (24％,6/25) had distant metastases and 3 cases had both local recurrence and distant metastases.Among patients with recurrent disease,23 died and 2 survive with tumor.Totally 24 patients died,23 of them died due to tumor recurrence and the other one died of other reason.The univariate analysis showed that,lymph node metastasis,squamous cell carcinoma antigen (SCC) levels before treatment,SCC levels after treatment 1 month had relation with overall survival time in patients with stage Ⅰ b and Ⅱ a cervical carcinoma (all P ＜ 0.05).The multivariate analysis showed that,lymph node metastasis and SCC levels after treatment 1 month were the independent prognostic factors for overall survival time for the cervical squamous cell carcinoma (OR =2.5,4.4 ; all P ＜ 0.05).Conclusions By means of radical radiotherapy,stage Ⅰ b and Ⅱ a cervical carcinoma patients with lymph node metastasis and SCC levels≥ 1.5 mg/L after treatment one month have poor prognosis.While,stage Ⅰ b and Ⅱ a patients with concurrent chemoradiotherapy after neoadjuvant chemotherapy did not affect the prognosis.The 5-year survival rate with concurrent chemoradiotherapy was higher than that of radiotherapy.

Objective To explore the effect of tumor necrosis factor-alpha(TNF-α) blockade therapy on circulating Th17 cell percentage and serum interleukin (IL)-17 level in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods Twenty-seven RA and 22 AS patients were recruited, of which 14 cases from both diseases received 40 weeks TNF blockade therapy. Twenty-four healthy blood donors were used as controls. The frequencies of circulating Th17 cells were determined by flowcytometry, and serum IL-17 level were measured by enzyme linked immunosorbent assay(ELISA). Results Significantly higher baseline circulating Th17 cells were observed in active RA and AS patients compared with the healthy controls[RA 1.03%(0.66%,1.78%) vs controls 0.50%(0.43%,0.67%), Z=-3.236, P<0.01; AS(1.16±0.09)%vs controls (0.59 ±0.061)% , t =5.226, P <0.01]. Similarly, serum IL-17 level were significantly elevated in patients with both diseases compared with controls[RA(32.3±2.5) pg/ml vs controls(14.3±2.5) pg/ml, t=5.070, P<0.01; AS 28.98(23.84,36.14) pg/ml vs controls 11.84(5.33,22.12) pg/ml, Z=-4.103, P<0.01]. After TNF-α blockade therapy, serum IL-17 was significantly decreased in both diseases groups[RA △(-13.5± 5.0) pg/ml and AS △(-16.0±1.9) pg/ml]. In contrast, no significant differences were found in the frequencies of circulating Th17 cells[RA △(0.104 5±0.212 6)% and AS △(0.002 5±0.183 8)%]. Conclusion Th17 cells and IL-17 have been implicated in the pathogenesis of RA and AS. TNF-α blockade can partially inhibit the function of Th17 cells. However, it is unable to reduce the frequencies of these cells in the circulation after 40 weeks therapy, which may explain the reasons for the relapse.

Objective To explore the change of serum sIL-2R and IL-6 levels in patients with Kawasaki disease (KD) and its role in the pathogenesis. Methods The serum slL-2R and IL-6 were detected by sandwich ELISA. The serum hs-CRP level was measured by DADE BEHRING BN ProSpec. Results The serum levels of sIL-2R and hs-CRP in KD before and after high-dose intravenous gama globulin(IVIg) were significantly higher than in healthy controls (P

Objective To analyse the clinical and pathological characteristics,diagnosis,treatment and prognosis of vulvar Bowen's disease.Methods Clinical data including pathological characteristics,diagnosis,treatment methods and follow-up of 18 cases with vulvar Bowen's disease admitted to Cancer Hospital,Chinese Academy of Medical Sciences during January 1991 to June 2011 were retrospectively analyzed.Results The median age of the 18 patients was 37 years (range:23 to 64 years).Sixteen patients had symptoms of vulvar itching and two patients had no symptom.Five cases were single neoplasm focus and the other 13 cases were multiple focuses.The diagnosis of vulvar Bowen's disease was according to the pathological diagnosis.Its diagnostic characteristic was giant round or ovoid cells with mono nucleolus in the whole layer of epidermis.All the patients received operation,eleven with simple vulvectomy and other seven cases with lumpectomy.The median follow-up time was 123 months (range:5 to 197 months).Relapse was found in two cases.One patient relapsed five months postoperation and received vulvectomy.Another patient relapsed fifteen moths post-operation and received lumpectomy again.And they were follow-up for 192months and 55 months respectively after second operation without relapse.Conclusions The diagnostic characteristic of vulvar Bowen's disease is giant round or ovoid cell with mono nucleolus in the whole layer of epidermis,itsdiagnosis is according to the pathological diagnosis.Operation could get very good curative effect for patients with primary vulvar Bowen's disease and even for the recurrent patients.The prognosis of vulvar Bowen's disease is good.