Objective To approach the strategies of prevention and treatment of elderly patients with diabetic foot by analyzing the common pathogens and their drug- resistance.Methods136 isolated strains of drug resistance pathogens from 68 elderly patients with infected diabetic foot were retrospectively studied in our hospital from January 2008 to June 2010.Results Bacterial pathogens and fungal pathogens accounted for 92.6％ and 7.4 ％,respectively.The bacterial pathogens included gram-positive bacteria (58.7％) and gram-negative bacilli (41.3％).Among the gram-positive bacteria,staph were most common.Furthermore,the incidence of methicillin resistant staphylococcus aureus (MRSA) and methicillin resistant coagulase negative staphylococcus (MRCNS) increased year by year.Vancomycin-resistant gram-positive bacteria did not appear.Among the gram-negative bacilli,enterobacteriaceae were the most common pathogens.Patients with mixed infections accounted for 61.8％.Fungous infections were all in the form of mixed infection,increasing with years.Conclusions Pathogenic bacteria and its drug resistance should be timely monitored to control and prevent the diabetic foot in the elderly patients.

Objective To detect the expression of T helper 17 (Th17) cells in the peripheral blood of patient with ankylosing spondylitis (AS),and discuss its role in thc pathogenesis of AS.Methods Twenty AS patients and fifteen healthy controls were enrolled in the study.Th17 (IL-17),Th1 (IFN-γ),Th2 (IL-4)cells and HLA-B27 of their peripheral blood were analyzed by flow cytometry,at the same time,the levels of ESR and CRP were also measured in order to analyze thc relation of Th17 and HLA-B27,ESR as well as the CRP level.The statistical analysis was carried out with single-sample t-test and Speraman's correlation test.Results The level of Th17 cells was significantly higher in the perpipheral blood of AS patients[(2.6±0.8 )%] than those in healthy controls[ (1.1±0.4)% ] (P＜0.01).The level of Th 1 cells was significantly lower in the peripheral blood of AS patients[(3.9±0.8)%] than those in healthy controls[(5.1±1.3)%] (P＜0.01)and the level of Th2 cells was not different in the peripheral blood of AS patients[(4.1±1.6)%] when compared to healthy controls[ (3.1±1.4)% ] (P＞0.05).Th 17 cells was not significantly correlated with the percentage and mean fluorescent intensity of HLA-B27,ESR,CRP(P＞0.05); but there was a tendency that increased expression level of Th17 cells was associated with elevated percentage and mean fluorescent intensity of HLA-B27.Conclusion The level of Th1 cells is decreased,but Th17 is increased in the peripheral blood of AS patients.Th cells are imbalance in AS,patients.The change of Th17 cells may be an important part of the pathogenesis of AS.

Objective To investigate the levels and clinical value of the peripheral blood CD154 and CD4+CD25+FoxP3+ regulatory T cells in patients with ankylosing spondylitis (AS).Methods 20 patients with AS and 20 healthy donors were studied.Flow cytometry was used to analyze the levels of the peripheral blood CD154,CD4+CD25+FoxP3+ regulatory T cells and HLA-B27.And T-test,Spearman correlation analysis were used in statistical analysis.Results The level of the peripheral blood CD154 was significantly higher in AS patients than that in normal controls [(4.38 ± 1.64) ％ vs.(1.92 ± 1.13) ％ (t =5.836,P ＜ 0.05)],and the level of the peripheral blood CD4+CD25+FoxP3+ regulatory T cells was lower in AS patients than that in normal controls [(3.87 ± 1.11) ％ vs.(6.30 ± 1.46) ％ (t =6.254,P ＜ 0.05)].There was negative correlation between the peripheral blood CD154 and CD4+CD25+FoxP3+ regulatory T cells in AS (r =-0.539,P ＜ 0.05).No relationship of the peripheral blood CD154,CD4+CD25+FoxP3+ regulatory T cells with laboratory parameters were found in AS.Conclusion The levels of the peripheral blood CD154 and CD4+CD225+FoxP3+ regulatory T cells in AS are abnormal,and may be involved in the immunological pathogenesis of AS.

Objective To investigate the role and value of interleukin (IL)-17,receptor activator of nuclear factors κB-ligand (RANKL),osteoprotegerin (OPG) in the pathogenesis of AS by detecting the expression of IL-17,RANKL,OPG.Methods IL-17,RANKL,OPG in 44 AS and 15 healthy controls were measured by ELISA.HLA-B27 was measured by flow cytometry.T-test,Spearman's correlation analysis were used for statisical analysis.Results ① Serum IL-17 [(45±12) pg/ml],RANKL [(354±96) pg/ml] levels and RANKL/OPG [(6.5±3.4) pg/ml] ratio were significantly higher in AS patients than those in normal controls (t=11.18,P＜0.05; t=18.66,P＜0.05; t=15.48,P＜0.05),and the serum RANKL levels was higher in AS patients in middle and late period than that in AS patients in early stage (t=47.02,P＜0.05).The serum OPG levels was higher in AS patients in middle and late period than that in AS patients in early stage (t=15.48,P＜0.05).② There were positive linea correletion,respectively,between the serum levels of IL-17 and RANKL (r=0.532,P=O.021),and between serum levels of IL-17 and disease activities of BASDAI (r=0.625,P=0.023),between serum levels of RAN KL and disease activities of BASDAI (r=0.431,P=0.016).Conclusion The surem levels of IL-17 and RANKL are increased in AS patient.

Background and purpose:Positron emission tomography-computed tomography (PET/CT) is playing an increasingly important role in the diagnosis, therapy and follow-up of lymphoma patients. This study aimed to explore clinical and pathological features and bone marrow infiltration status in lymphoma patients with diffused high bone marrow glucose uptake on18F-FDG PET/CT.Methods:It was a retrospective study. Bone marrow infiltration status, pathological and clinical data from 62 cases of pathologically diagnosed lymphoma and diffused high bone marrow glucose uptake were analyzed.Results:Distribution of histopathological subtype in those cases was in accordance with that in previously reported Chinese lymphoma patients. Significant difference was demonstrated in standard uptake value (SUV) between pa-tients with aggressive and indolent histopathological subtypes (8.43vs 5.38,P=0.048), patients with and without B symp-toms (8.30vs 5.72,P=0.033), and patients with and without bone marrow infiltration (8.78vs 6.96,P=0.020). 32 patients were diagnosed as “bone marrow infiltration” by bone marrow biopsy. There was significant difference in histopathologi-cal subtype distribution between patients with and without bone marrow infiltration (P=0.001). In patients with bone marrow infiltration, there were higher proportions of mantle cell lymphoma, nodal marginal zone B cell lymphoma, Burkitt’s lym-phoma and anaplastic large cell lymphoma. In contrast, patients without bone marrow infiltration suffered more from diffuse large B-cell lymphoma, peripheral T cell lymphoma, enteropathic T cell lymphoma and extranodal NK/T-cell lymphoma (nasal type). False positive results in bone marrow glucose uptake may be caused by fever or anemia.Conclusion:Diffused high bone marrow glucose uptake on18F-FDG PET/CT should be evaluated in combination with the uptake values, clinical features and histological subtypes, to minimize the misdiagnosis and to better guide staging and therapy of lymphoma.

Objective:To invest the risk factors associated with delayed hemorrhage after pancreaticoduodenectomy occurred.Methods:A retrospective analysis was performed from January 2012 to June 2015 Shengjing hospital 511 cases of patients who accepted pancreaticoduodenectomy.Results:The incidence of PD postoperative delayed hemorrhage was 8.81％ (45/511).Univariate analysis shows:Preoperative bilirubin levels,pancreatic fistula,biliary fistula,postoperative abdominal infection are all the meaningful related factors(P＜0.05).With the application of multivariate logistic regression analysis,pancreatic fistula (OR=2.158) and abdominal infection (OR=3.051) were independent risk factors for postoperative delayed hemorrhages (P＜0.05).Conclusion:Dealing with the postoperative complications of PD like pancreatic fistula,abdominal infection and others,early detection and rapid diagnosis and correct treatment can effectively reduce the incidence of delayed hemorrhage.

Objective To investigate the difficulty, safety and clinical efficacy of the pterional approach from the side of open A2 plane vs the approach from the side of closed A2 plane for anterosuperior-pointing anterior communicat?ing artery aneurysms (ACoAA). Methods Forty-two patients with anterosuperior-pointing ACoAA treated by microsurgi?cal clipping were divided into two groups of the approach from the side of open A2 plane (n=22) and the approach from the side of closed A2 plane (n=20). Primary objective endpoints were rates of gyrus rectus aspiration, displacement of the ipsilateral A2 and surgical-related complications, clipping results, incidence of cognitive function impairment and Glasgow Outcome Scale (GOS) at 6 months after treatment. Results The incidence of gyrus rectus aspiration and dis?placement of the ipsilateral A2, cognitive impairment at 6 months after treatment and the surgical-related complications was also significant lower in the approach from the side of open A2 plane than in the approach from the side of closed A2 plane [4(18.2%) cases vs. 11(55.0%) cases, χ2=6.185, P<0.05;4(18.2%) cases vs. 10(50.0%) cases, χ2=4.773, P<0.05;1 (4.5%) case vs. 7(35.0%) cases, χ2=4.481 P<0.05]. There were no significant differences in postoperative clipping results and GOS at 6 months after treatment between two approaches (P>0.05). Conclusions The pterional approach from the side of open A2 plane in patients with anterosuperior-pointing ACoAA allows the aneurysmal necks to be secured safely, decreases operation difficulty and prevents surgical-related complications.

Objective To investigate the correlation between serum level of insulin growth factor 1 (IGF-1) and the degree of liver fibrosis in patients with chronic hepatitis C (CHC) complicated to type 2 diabetes mellitus (T2DM). Methods The cases were divided into CHC with T2DM (39 cases), CHC (96 cases), T2DM (60 cases), and healthy control (60 cases) groups. Their human data were collected and the fasting blood glucose, insulin and insulin-like growth factor-1 levels were detected, and the insulin resistance index ( HOMA-IR) wwer calculated. The serum levels of alanine transaminase ( ALT) , aspartate transaminase ( AST) , hepatitis C virus ( HCV) RNA load and HCV genotypes were detected simultaneously in patients with hepatitis C, and liver stiffness were measured ( LSM) by transient elastography ( TE) and aspartate aminotransferase-to-platelet ratio index ( APRI) score was performed. Results ⑴ There was no significant difference between CHC with T2DM group and CHC group in diabetes family history(P>0. 05), but two groups were significantly lower than that of T2DM group (P<0. 05). ⑵The levels of fasting insu-lin (FI) and HOMA-IR in CHC with T2DM group and T2DM group were significantly higher than those in the other two groups (P<0. 05), while the levels of IGF-1 in two groups were significantly lower than those in the CHC group, and were more lower than the control group (P<0. 05). ⑶Compared the serum ALT, AST and HCV RNA load between CHC with T2DM group and CHC group, there had no significant differ-ence (P>0. 05);however, the proportion of 1b genotype, LSM and APRI score of CHC with T2DM group were significantly higher than those in CHC group(P<0. 05). ⑷ The level of serum IGF-1 was negatively correlated with HOMA-IR, LSM and APRI in CHC with T2DM group (r= -0. 71, -0. 75, -0. 69, P<0. 01). Conclusions The degree of hepatic fibrosis and the damage of IGF-1 synthesis in CHC patients with T2DM were significantly higher than those in non T2DM patients, which might be related to the insulin resistance caused by 1b genotype HCV infection.

OBJECTIVETo explore the imaging features, diagnosis and treatment strategies of intracranial lageniform aneurysms.

METHODSThe clinical characteristics and therapeutic outcomes of 6 patients with intracranial lageniform aneurysms were retrospectively analyzed.

RESULTSAll the 6 aneurysms, including 5 anterior communicating artery aneurysms and 1 middle cerebral artery (MCA) aneurysm, were diagnosed by CT, DSA and (or) MRA. Pretreatment CT revealed subarachnoid hemorrhage and intracranial hematoma surrounding the ruptured aneurysm. Three dimensional DSA showed that all the lageniform aneurysms contained two parts, the larger false aneurysm and the smaller true aneurysms. All the 5 Acom aneurysms were coiled and the MCA aneurysm was clipped. Two patients with coiling developed serious brain edema, and acute decompressive craniectomy was performed to 1 of them. Pathological examination of the surgical specimens confirmed that pseudoaneurysm formed the larger part of the lageniform aneurysm. One patient died of brain hernia, and the other 5 patients were discharged with good GOS. All the patients showed stable neurological status during the 3-month follow-up.

CONCLUSIONLageniform aneurysm is a complex aneurysm consisting in larger part of false aneurysm and in smaller part of true aneurysm, and early intervention with individualized surgeries is recommended.

Adult ; Aneurysm, False ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Intracranial Aneurysm ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies

OBJECTIVETo evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).

METHODSThe clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.

RESULTSThe 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.

CONCLUSIONEndovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult