Objective　To study the clinico-pathological features of primary adrenal lymphoma (PAL).　Methods　2 cases of PAL were reviewed and studied.　Results　The age of the 2 patients was 45 and 57.The presenting symptoms were nonspecific.Histologically,the neoplasm was composed of numerous medium-sized cells with round nucleus,usually 1-2 in number and with relatively abundant basophilic cytoplasm.The neoplastic cells showed frequent mitosis.Immunohistochemically,the tumor cells were strongly positive for LCA,L26 and CD74 while negative for UCHL-1,S-100 protein and CK. One case was discharged 3 months after operation because of dyscrasia and the other was lost on follow up.Prognosis of PAL was poor.　Conclusions　PAL is extremely rare with a high grade of malignancy.The diagnosis could be made on histopathological studies and immunohistochemical studies.

Objective To investigate the occupational risk awareness levels of higher vocational nursing students before and after the clinic practice.Methods Five-year higher vocational nursing students were investigated by filling out questionnaires before and after the clinic practice.Results Nursing students' occupational risk awareness improved after the clinic practice.They hoped to acquire knowledge about occupational risk and thought that the school was supposed to offer professional ethics courses and strengthen the occupational risk education.Conclusions The majority of nursing students knew the protective measures of occupational exposure in nursing.But there were also someone who did not know these.Relevant knowledge was in high demand.Therefore,schools and internship units should provide a variety of ways to reduce the risks during the internship of nursing students.

Objective:To investigate the microsurgical anatomy of the far lateral suboccipital approach and to evaluate its application to surgical approach. Methods:Fourteen cadaveric heads(28 sides) were dissected through far lateral suboccipital approach to obtain the anatomical data of this approach.A retrospective analysis of microsurgical treatment in 12 cases of tumors situated at lower clivus and foramen magnum was performed. Results:Transverse process of C_1 and inferior occipital trangle were important anatomical marks in the far lateral occipital approach.Drilling the condyle and jugular tubercle was benefit to expand the surgical space.Total removal of the turmors was achieved in 9 patients,subtotal removal in 3 patients,and without any surgical morbidity. Conclusion:Study on the microsurgical anatomy of the far lateral suboccipital approach was helpful in resecting tumors situated at lower clivus and foramen magnum.

Objective To explore the CT manifestations of pediatric mesenechymal hamartoma of liver (MHL).Methods Clinical data of 15 cases with MHL confirmed by surgery and pathology were retrospectively analyzed.All children were performed with CT scans including plain and enhanced scans,and the imaging features were analyzed.Results All the lesions were solitary,and 9 masses located at the right lobe of liver,4 located at the left lobe,the others located at both right and left lobe.The maximum diameter of lesions was from 5 cm to 30 cm,with an average of (11.52±6.84) cm.Ten cases were cystic and solid mixed,5 cases were solid.After contrast administration,the solid component and the septa of the masses showed enhancement while no enhancement was observed in the cystic component.Two cases had the spot-like calcification.Conclusion MHL has some special characteristics in the CT scan before surgery,which should be differentiated from other cystic and solid tumors of live.Some MHLs can be diagnosed when combined with the clinical information and CT images.

Objective To investigate the mechanism of the different levels of ciprofloxacin resistance in qnrA-containing transconjugants.Methods E. coli J53AzR as the recipient,4 qnrA-containing transconiugants were constructed by conjugation from 4 qnrA-carrying clinical isolates.MICs of the transconjugants were measured by E test.aac(6')-Ib-cr was detected by PCR,and qnrA mRNA expression level was determined by real-time RT-PCR.The promoter sequences of qnrA were amplified by PCR from qnrA-bearing plasmids and cloned into plasmid pKK232-8,then transformed into HB101.All promoter fragments were sequenced.Resuits The MICs of ciprofloxacin against 4 transconjugants demonstrated a 10-fold difference from 0.094 μg/ml to 1.000 μg/m1.Of 4 qnrA-bearing plasmids in E.coli J53,ciprofloxacin MICs of pHS4 and pHS5 were 0.094 μg/ml and 0.125 μg/ml,respectively;pHS3,which contained the aac(6')-Ib-cr gene as well,MIC was 0.25μg/ml;and pHS5,which had a high expression level of qnrA and the aac(6')-Ib-cr gene,MIC was 1.00μg/ml.The relative expression levels of qnrA mRNA in J53 pHS6 was 32.5,much higher than the other 3 transconjugants(from 1.0 to 2.5).The promoter in plasmid pHS6 was 12-fold stronger than that in the other 3 plasmids.Compared with pHS3,there was 7 bp(GTTAGCA)deletion between the transcription initiation site and the start of qnrA in pHS6.Conclusion Co-existence of qnrA and aac(6')-Ib-cr in a single plasmid and high level of qnrA expression can account for the different levels of ciprofloxacin resistance in transconjugants.

The heterogeneity of high-density lipoprotein-cholesterol (HDL-C) in hyperuricemia was analyzed in Uygur,Han,and Kazak ethnic groups in Xinjiang.A total of 2 396 subjects were surveyed.The HDL-C levels were significantly decreased in hyperuricemia group compared with control group in Han and Uygur,while the reverse occurred in Kazak.The serum uric acid (SUA) level in Kazak was the lowest.The SUA was negatively correlated with HDL C in Kazak (P ＜ 0.05).HDL-C was a recognized protective factor for cardiovascular disease.With the lowered SUA level in the Kazak group,HDL-C level was increased.When SUA level was higher than a certain level (such as the SUA-4),there existed a negative impact on cardiovascular disease

Objective To screen fosfomycin-resistant genes in the clinical isolates of Enterococcus faecium Efm-HS0661 and verify their functions. MethodsAntimicrobial susceptibility and conjugation experiments were carried out to determine if the antimicrobial resistance in clinical strain was transferable.By Solexa high-throughput sequencing,the genes conferring fosfomycin resistance were screened. The function of resistance gene was identified by cloning.ResultsThe clinical isolates of Enterococcus faecium Efm-HS0661 were resistant to glycopeptide antibiotics and fosfomycin, and the fosfomycin resistance was found to be transferred by conjugation. Within the 2414 bp nucleotide sequence obtained by high-throughput sequencing, fosB, a plasmid-mediated fosfomycin resistance gene was found. The fosB gene was 420 bp in length, which shared 99. 8％ amino acid identity with other fosB from Staphylococcus spp. The minimal inhibitory concentration (MIC) of DH5α transformant containing fosB gene against fosfomycin was higher than that of DHSa transformant without fosB gene. ConclusionsThe high-throughput sequencing can be used to screen unknown resistance genes in clinical isolates. The plasmidmediated resistance gene fosB can confer fosfomycin resistance in Enterococcus faecium.

Objective To analyze the imaging characteristics of hepatic involvement in Langerhans cell histiocytosis(LCH) in children on MRCP, MRI and CT. Methods Twenty-nine children from three children hospitals in China, who were diagnosed as hepatic involvement by disseminated LCH during Aug 2008 and Jan 2015 were included in this study. Their MRCP (n=16), MRI (n=22), contrast?enhanced CT (n=15) data were retrospectively analyzed. The stenoses and dilatation of the intrahepatic bile ducts, the common hepatic bile duct and its first order branches and the common bile duct were evaluated on the MRCP image. The size and shape of the liver, the imaging characteristics of the periportal lesions in the Glisson sheath and hepatic parenchymal lesions were also evaluated on the cross?sectional images. Results MRCP indicated alternative stenoses/dilatation of the bile duct tree (n=16), stenoses of the common hepatic duct and its first?order branches (n=15), partialindistinctness of the common bile duct (n=2) and multiple cystic lesions along the biliary tree (n=5). On the cross?sectional images, the periportal lesions in the Glisson sheath were observed in 28 children. On MRI, the periportal lesions were shown in all the 22 children with MRI, presented as hypo-signal intensity on T1WI, hyper?signal intensity on T2WI (n=11) or mixed?signal intensity on T1WI and T2WI (n=11); On CT, the periportal lesions were found in 14 of the 15 children with CT, presenting as low density (n=13) and mixed density (n=1). Multiple nodular or cyst?like parenchymal lesions were observed in 21 patients including 18 patients on MRI and 5 patients on enhanced CT. Sixteen patients presented as hypo?intensity on T1WI, hyper?intensity on T2WI and low density on plain CT, and 5 patients with iso? or hypo?intensity on T1WI, hypo?intensity on T2WI,and milder enhancement relative to the adjacent parenchyma on contrast?enhanced CT. Conclusions The imaging characteristics of hepatic involvement by LCH include alternative stenoses and dilatation of the intrahepatic ducts, stenoses of the common hepatic bile duct and its first?order branches on MRCP, the periportal lesions in the Glisson sheath and hepatic parenchymal nodular or cyst?like lesions on cross?sectional images.

BACKGROUND:The risk of lower-extremity deep venous thrombosis was high in patients with the osteoporotic hip fracture. The aged age and hip fracture surgery are major risk factors for thrombosis. No study concerned the critical point in time course to the lower extremity deep venous thrombosis in the osteoporotic hip fracture patients.
OBJECTIVE:To analyze the incidence of the perioperative deep venous thrombosis of lower extremity limb at different time slots in senile osteoporotic intertrochanteric fracture patients repaired by proximal femoral nail antirotation fixation.
METHODS:From June 2012 to January 2016, 220 cases diagnosed as osteoporotic intertrochanteric fracture and performed closed reduction and proximal femoral nail antirotation fixation were selected from the Department of Orthopedics, the Affiliated Hospital of Chengde Medical Col ege in China. Based on administered low-molecular-weight heparins (LMWH) or not after trauma, there were two groups:LMWH group and the non-LMWH group. Vascular Doppler ultrasound was conducted at 1, 3 and 5 days after trauma, more than 5 days after trauma, 2, 5, 7 and 14 days after surgery. The total number of cases and incidence of thrombosis were recorded and compared between the two groups. The number of cases and the incidence of new thrombosis were recorded at different time points in both groups. Frequency distribution table was used to analyze the time of suffering thrombosis after injury and surgery.
RESULTS AND CONCLUSION:(1) Among 220 cases, 18 cases in the LMWH group (n=154) affected thrombosis, with an incidence of 12%, and 15 cases in the non-LMWH group (n=66) experienced deep vein thrombosis, with an incidence of 23%. Significant differences in the incidence of thrombosis were detected between the two groups (P=0.041). (2) Peak time of thrombus was 3 days before injury and 1 day after surgery in both groups. (3) Results suggested that the incidence of deep vein thrombosis was high in proximal femoral nail antirotation fixation for intertrochanteric fracture. The peak time of deep vein thrombosis was 3 days before injury and 1 day after surgery. The prevention of deep vein thrombosis should begin from injury. Prophylactic anticoagulation after injury can dramatical y decrease the incidence of deep vein thrombosis.

Objective To investigate the resistance of clinical isolates from Shanghai Huashan Hospital in 2005.Methods Antimicrobial susceptibility test was carried out by Kirby-Bauer method.Results were analyzed according to CLSI 2005.Results Of the 3 896 clinical isolates,gram negative bacilli and gram positive cocci accounted for 68.1% and 31.9% respectively.About 93.2%(465/499)of S.aureus isolates were identified as methicillin-resistant Staphylococcus,94.9%(260/274)of coagulase negative Staphylococcus(CNS)isolates were methicillin-resistant.No vancomycin-resistant strain was found.The resistance rates of E.faecalis and E.faecium to high level gentamicin(120 ?g)were 67.4% and 82.8% respectively.Two strains of VRE were isolated.Both were VanA type.ESBLs-producing strains accounted for 47.6%(206/433)in E.coli and 69.6%(391/562)in Klebsiella spp(K.pneumoniae and K.oxytoca).Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem,resistance rates being 0-4% except Citrobacter isolates,9.1% of which were resistant.However,39.3% and 59.6% of P.aeruginosa strains were resistant to the above carbapenems,respectively.Conclusions The prevalence of MRSA and MRCNS is very high.ESBLs are prevalent in E.coli and Klebsiella spp.Two glycopeptide-resistant E.faecium isolates are identified firstly in Huashan Hospital.Our data will be useful for rational use of antimicrobial agents in the treatment of bacterial infections.