Objective To summarize the clinical characteristics and evaluate the feasible treatments of primary breast lymphoma (PBL).Methods The clinical data of 34 PBL patients (age 24-79 years) who were treated in our hospital between April 2006 and December 2013 were reviewed.Of these 34 patients, 18 had stage ⅠE PBL and 16 had stage ⅡE PBL.Pathological types included diffuse large B cell lymphoma (29 patients), anaplastic large cell lymphoma (2 patients), marginal zone lymphoma (2 patients), and mantle cell lymphoma (1 patient).Two patients underwent surgery, four patients received chemotherapy alone, five patients received chemoradiotherapy, fourteen patients underwent surgery plus chemotherapy, and nine patients underwent surgery plus chemoradiotherapy.The 5-year overall survival (OS) and progression-free survival (PFS) rates were determined by the Kaplan-Meier estimator.Results During follow-up, 26 patients were alive without lymphoma and 8 patients had died by the end of follow-up (7 died from lymphoma and 1 died from chemotherapy-related hepatic failure).Among the 6 patients who relapsed, 5(83.3%) had recurrence within the first 2 years of treatment.In particular, 1 patient who had bilateral breast involvement developed left breast relapse after bilateral mastectomy and chemotherapy, 2 patients had bone marrow metastasis, 1 patient had lung and mediastinal lymph node metastases, and 2 had skin relapse.The 5-year OS and PFS rates of all patients were 75% and 75%, respectively.Conclusions Since PBL is a rare malignancy, its overall prognosis is fair and the incidence of local relapse is low with chemotherapy alone or in combination with other treatments.However, further studies on the development of more effective treatments will be required for patients who have failed the existing treatments.

Objective To investigate the influence of atorvastatin in methylation and expression level of Bcl-2 in human umbilical endothelial cells(HUVECs)treated with homocysteine(Hcy)and to expound potential mechanism of atorvastatin resisting arteriosclerosis.Methods After HUVECs were treated with 0, 2, 4, 8, 16, and 32 mmol·L-1 Hcy for 48 h,MTT was used to measure the inhibitory rates of HUVECs and the half inhibitory concentration (IC50 ). According to the experimental results, the HUVECs cultured in vitro were divided into control group (0.00 mmol · L-1 Hcy ), Hcy group (9.00 mmol·L-1 Hcy ), and atorvastatin group (9.00 mmol·L-1 Hcy+1×10-3 mmol·L-1 atorvastatin).After treated for 48 h,flow cytometry was used to detect the apoptotic rate of cells, the mRNA expression of Bcl-2 was analyzed by fluorescence quantitative PCR,the protein expression of Bcl-2 was detected by Western blotting method, and the methylation level of Bcl-2 promoter region was determined by nest touch-down PCR combined with methylation specific PCR (MSP ). Results Compared with control group,the apoptotic rate of HUVECs in Hcy group was increased(P<0.01),the mRNA and protein expression levels of Bcl-2 were significantly decreased(P<0.01),and the Bcl-2 promoter region methylation level was also decreased(P<0.01).Compared with Hcy group,the apoptotic rate of HUVECs in atorvastatin group was decreased(P<0.01),the mRNA and protein expression levels of Bcl-2 gene were increased (P<0.05), and the Bcl-2 promoter region methylation level was also increased (P<0.05). Conclusion Atorvastatin can prevent the apoptosis of HUVECs induced by Hcy through regulating Bcl-2 methylation.

Objective Fecal biomarkers have emerged as an important tool for assessing and monitoring disease activity in patients with inflammatory bowel disease ( IBD) .We aimed to investigate the diagnostic value of fecal neopterin and calprotectin in pa-tients with active inflammatory bowel disease and made comparison with that of serum C-reactive protein ( CRP) . Methods A total of 151 consecutive patients with IBD (84 CD and 67 UC) provided 2 gram fecal samples for the measurement of fecal neopterin( FNP) and calprotectin( FCP) concentrations and 2 milliliter blood samples for the serum C-reactive protein measurement before undergoing a colonoscopy.ELISA was applied in the measurement.Clinical disease activities were scored independently according to the Best Crohn′s Disease Activity Index(CDAI) in patients with CD, while the Modi-fied Mayo Scores in patients with UC.Comaprison was made in the relativity of each fecal marker and IBD activity score, the optimum value of diagnosing IBD acitivity as to each fecal marker, as well as sensitivity, specificity, moreover, receiver operating characteristic curve ( ROC) was drawn.50 healthy volunteers who received a normal colonoscopy were also enrolled as the control group and asked to give a 2 gram fresh stool sample. Results The FNP and FCP concentrations in patients with IBD were significantly higher than those in healthy control group(P<0.05).Both FNP and FCP concentrations differed significantly in clinically active IBD when compared with those in patients with inactive disease( P<0.001) .In CD patients, the correlation coefficients of FNP and FCP with CDAI were 0.55 and 0.59, respectively(P<0.001).In UC patients, the correlation coefficients of FNP and FCP with Mayo scores were 0.74 and 0.77, respectively( P<0.001) .The correlation coefficients of serum CRP in CD and UC patients with clinical scores were 0.49 and 0.60, respectively(P<0.001).The area under the ROC curve(AUC) of FNP and FCP for the diagnosis of clinical activity in pa-tients with CD were 0.75 and 0.80, respectively.The AUC of FNP and FCP in UC patients were 0.85 and 0.90, respectively.The AUC of serum CRP in patients with CD and UC were 0.65 and 0.74, respectively.When combined FNP with FCP, the AUC in pa-tients with CD and UC were 0.85 and 0.92, respectively. Conclusion FNP is a novel reliable and non-invasive biomarker to evalu-ate clinical disease activity in patients with IBD as accurate as FCP, It is advisable to combine FNP with FCP to evaluate disease activi-ty in patients with IBD.

Background:Peroral endoscopic myotomy(POEM)is a novel minimally invasive endoscopic technique for treatment of esophageal achalasia(EA). It has been demonstrated to be safe and effective in several short-term clinical studies, however,studies focusing on its mid- and long-term outcome are rare. Aims:To investigate the mid-and-long term efficacy of POEM in EA patients. Methods:A retrospective analysis was performed in 41 EA patients who underwent POEM in the Department of Gastroenterology and Hepatology of Nanjing General Hospital of Nanjing Military Region from Jul. 2012 to Dec. 2013. All these patients were followed up periodically for clinical symptoms(Eckardt score),maximum esophageal diameter and lower esophageal sphincter pressure(LESP),and the intra- and post-operative complications and recurrence were recorded. Results:POEM was successfully completed in all 41 EA patients,the mean operative time was(69. 5 ± 20. 6)min(range 35-125 min),and the mean length of hospital stay was 3. 5 days. Compared with the pre-operative data,the post-operative Eckardt score,maximum esophageal diameter and LESP during follow-up(mean 26. 3 months, range 19-36 months)were significantly decreased(P all < 0. 05). Procedure-related complications were seen in 6 patients (14. 6% );the clinical success rate was 95. 1%(39 / 41)and the recurrence rate was 2. 4%(1 / 41). Conclusions:POEM is safe and effective in mid-and-long term follow-up with low recurrence rate. It might become the first-line therapy for EA,and the long-term efficacy and complications need further follow-up study.

Objective To find out and clone the genes that can influence different willis circle in Meriones unguiculatus, the genomic library has been made.Methods 96 clean Meriones unguiculatus were dissected according to observe the differences of willis circle, and the mixed DNA was extracted from different blood vessels.The genomic library construction has been done by using pCC1FOS vector, following by CopyControl Fosmid Lib manual.The copy numbers, recombined segment size and recombination fraction of the library were measured.Results Genomic library of different Willis circle in Meriones unguiculatus was successfully made.The capacity of the library was 1700 copies.The segment size was 36kb, and the recombination fraction was 93%.Conclusion The library was the good beginning for the following steps which were gene cloning and genescreen.

Objective To analyze and evaluate the drug use on inpa-tients with cerebral infarction ( CI ).Methods By retrospective study method , the analysis of drug use on inpatients with CI , and evaluation of rationality of drug use based on the guidelines and clinical pathway of pa-tients with CI were carried out.Results Drugs or the treatment of CI accounted for 56.49%of all drugs ,and the top three are cerebrovascular medicine , anti-platelet agents and Chinese medicine preparations.Five types of national guidelines recommendations on CI drugs showed disa-greement,for example, insulin and anti-platelet agent etc.The national essential drugs for the treatment of CI in our hospital accounted for 40.27%, and the average cost of medicine was up to 10 000 yuan, accounting for about 50%of the total cost.84%of the medication was in accord with guidelines and clinical pathways.Conclusion The rationa-lity of some drugs for the treatment of CI lacks support from evidence -based medicine.

BACKGROUND AND OBJECTIVEPercutaneous ultrasound-guided thermal ablation is one of the major treatment methods for liver cancer. Tumor location close to the diaphragm or gastrointestinal tract was regarded as the treatment contraindication before due to poor visibility of the tumor or increased risk of thermal injury to the adjacent organs. This study used artificial pleural effusion or ascites to extend the indications of thermal ablation for liver cancer.

METHODSArtificial pleural effusion (20 cases) or ascites (36 cases) was performed in 56 difficult cases of percutaneous thermal ablation for liver tumors. The technical success rates, the rate of approaching the procedure goal, complications, and local treatment response were assessed.

RESULTSThe technical success rates were 95% (19/20) for artificial pleural effusion and 100% (36/36) for artificial ascites, the achieve purpose rates were 100% (19/19) and 91.7% (33/36), the complete ablation rates were 84.2% (16/19) and 93.9% (31/33), respectively. Coughing, transient hematuria, and subcutaneous effusion were observed in 3 patients after the procedure of artificial pleural effusion, and hydrothorax in the right chest occurred in 1 patient during the artificial ascites process.

CONCLUSIONSThermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumors.

Adult ; Aged ; Aged, 80 and over ; Ascites ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; secondary ; surgery ; Catheter Ablation ; adverse effects ; methods ; Colorectal Neoplasms ; pathology ; Cough ; etiology ; Female ; Glucose ; administration & dosage ; Hematuria ; etiology ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Male ; Microwaves ; Middle Aged ; Pleural Effusion ; Ultrasonography, Interventional ; Young Adult

OBJECTIVETo investigate distribution, drug resistance and risk factors of pathogens isolated from septicemic patients in a hospital in the past 6 years.

METHODSMost of the bacterial isolates were identified with BD Phoenix, and a few isolates were identified manually and with K-B method. Candida isolates were identified with color display plates and K-B method. WHONET5.4 software was used for analysis.

RESULTSThe common bacteria isolated form the blood included E. coli, P. aeruginosa, K. pneumoniae, and S. aureu. The gram-negative bacillus from the blood exhibited relatively low resistance to such antibiotics as cefoperazone/sulbactam, imipenem, amikacin, piperacillin/tazobactam, and ceftazidime, and the incidences of E.coli and K. pneumoniae isolates producing extended spectrum beta-lactamase (ESBLs) ranged between 33.3% and 34.9% and between 32.9% and 36.0%, respectively. The gram-positive coccus from blood showed a sensitivity rate of 100.0% to vancomycin and low resistant rates to amikacin and chloramphenicol; the methicillin-resistant rates of S. aureu and coagulase-negative staphylococcus were 26.9%-35.5% and 72.7%-74.3%, respectively. The risk factors of septicemia included hospital stay for over 5 days, venous catheterization, surgeries, puncture, oxygen therapy, urine tract catheterization, and chemotherapy.

CONCLUSIONBlood culture can be of importance in patients with septicemia, and the use of antibiotics should be carefully weighed according to the results of bacterial culture and sensitivity tests of the pathogens isolated from the blood.

Adolescent ; Adult ; Aged ; Candida albicans ; drug effects ; isolation & purification ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; Gram-Negative Bacteria ; drug effects ; isolation & purification ; Humans ; Infant ; Klebsiella pneumoniae ; drug effects ; isolation & purification ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Pseudomonas aeruginosa ; drug effects ; isolation & purification ; Risk Factors ; Sepsis ; microbiology ; Staphylococcus aureus ; drug effects ; isolation & purification ; Young Adult

Objective:To analyze the clinical outcomes of tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate for treatment of segmental bone defect.Methods:A retrospective analysis was conducted by enrolling 11 surgically treated patients with tibial segmental bone defect after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from Jan. 2018 to Jan. 2020. The collected clinical materials and data included gender, age, injury mechanism, smoke or alcohol, comorbidities, intraoperative bleeding loss, bone defect length, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, complications and Paley bone and functional criteria. SPSS 24.0 software was used to analyze the data.Results:Eleven patients were followed up for 8 to 31 months (average 23.2 months). All patients achieved bone healing and the infection was eradicated with no sign of recurrence. The mean length of defect was (8.1±1.6) cm, mean resorption time of calcium sulphate was (6.6±2.6) months, bone transport time was (11.4±2.8) weeks, external fixation time was (4.7±1.2) months, external fixation index was (0.58±0.07) month/cm and full weight bearing time was (6.1±1.4) months. The complication rate was 36.4% including deep vein thrombosis, delayed union of the docking site, pin tract infection and sterile draining of the wound. Paley bone evaluation results were excellent and good in 10 patients (90.9%) and functional results were excellent and good in 11 patients (100%).Conclusion:Tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate is a safe, reliable and successful method for segmental bone defect and eradication of infection which reduces external fixation time and complication rate, allows patients perform weight bearing and return to daily life earlier.