OBJECTIVE To analyze and summarize the clinical features and distribution of antibiotic susceptibility of Stenotrophomonas maltophilia pneumonia.METHODS We statistically analyzed the clinical data of thirty-one cases of S.maltophilia pneumonia,and determined drug susceptibility of this bacteriaum,using K-B methods.RESULTS Twenty-six out of 31(83.87%) cases were old age patients.All Patients were with underlying diseases,while 17(54.84%)cases had chronic obstructive pulmonary disease history and 15(43.39%) cases were with immunodeficiency.Out-of hospital infection and nosocomial infection were 10(32.26%) cases and 21(67.74%),respectively.The clinical symptoms were mainly cough and expectoration(100.00%),17(54.84%) cases had fever,and 24 cases(77.42%) had dyspnea.Chest X-ray showed different-degree shadow on lungs.Besides compound sulfamethoxazole,ciprofloxacin,minocycline and amikacin were susceptive(71.41-45.00%),the drug susceptibility test showed,that the microbe was resistant to lots of antibiotics(28.57-100.00%).CONCLUSIONS The risk factors of S.maltophilia pneumonia are ageing,underlying diseases and immunodeficiency.Early choosing susceptive antibiotics and drug sensitivity test would improve the prognosis.

Insulin-like factor 3 belongs to the insulin superfamily relaxin subfamily.Insulin-like factor 3 is the main product secretion of leydig cells,and its synthetic process totally relies on the state of leydig cells differentiation.Insulin-like factor 3 plays an important role in testicular descent,and has a great clinical value for evaluating function of leydig cells.Meanwhile,insulin-like factor 3 is deemed to play an important role in germ cell survival and regulation of bone metabolism.

The clinical data and ultrasound findings of 185 patients with thyroid nodules undergoing thyroidectomy from June to December 2015 were retrospectively reviewed.Postoperative pathology confirmed malignant thyroid nodules in 86 cases and benign nodules in 99 cases.The ultrasonographic findings showed that there were significant differences in obscure boundary [51％ (44/86) vs.16％ (16/99)],hypoecho [(95％ (82/86) vs.27％ (27/99)],internal micro-calcification [63％ (54/86) vs.21％ (21/99)] and lymph node enlargement [33％ (28/86) vs.5％ (5/99)] between malignant and benign nodules (all P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of thyroid imaging reporting and data system (TI-RADS) in differentiation of malignant and benign thyroid nodules were 77％ (66/86),86％ (85/99),83％ (66/80),81％ (85/105) and 82％ (151/185),respectively.The positive rates of thyroid globulin antibody(TGAb) and thyroid peroxydase antibody (TPO-Ab) in malignant nodules [6％ (5/79) and 25％ (20/79)] were significantly higher than those in benign nodules [0 (0/94) and 12％ (11/94)] (both P ＜0.05).There was no significant difference in free T3 (FT3),free T4 (FT4) and TSH between the two groups [(4.91-± 0.78) vs.(4.93-± 1.98) pmol/L,(13.57 ±2.22) vs.(13.58 ±2.17)pmol/Land(1.78±1.40) vs.(1.88±2.36)mU/L] (allP＞0.05).The results indicate that TI-RADS grading and thyroid immunity index are valuable for differential diagnosis of thyroid nodules.

European Society of Cardiology guidelines on diagnosis and treatment of heart failure are among the mostly authorized international directing documents,applied widely in clinical practice,epidemiological researches and randomized clinical trials.The guidelines published in 2008 combined chronic and acute hear failure and made significant modifications in the definition,classification,diagnosis,pharmacological and non-pharmacological treatment of heart failure.Simplification of the recommendations and enhancement of the guidelines implication are also point of focusing.This article represents a brief review of the new guidelines,together with comparison with the previous edition and analysis of recommendations based on local clinical practice,to enhance the standardized management of heart failure in China. Abstract:Summ ary:European Soc iety of Card iology gu idelines on d iagnosis and treatm ent of heart failure are among the mostly au-thorized international d irecting docum ents,app lied w idely in c lin ical practice,ep idem iological researches and random ized c lin ical trials.The gu idelines pub lished in 2008 comb ined chron ic and acute hear failure and m ade sign ificant mod ifica-tions in the defin ition,c lassification,d iagnosis,pharm acological and non-pharm acological treatm ent of heart failure.S imp li-fication of the recomm endations and enhancem ent of the gu idelines imp lication are also point of focusing.Th is artic le re-presents a brief review of the new gu idelines,togetherw ith comparison w ith the previous ed ition and analysis of recomm en-dations based on local c lin ical practice,to enhance the standard ized m anagem ent of heart failure in Ch ina.

One hundred and eleven cases of male reproductive diseases including epididymis,testi tis,cyst of epididymis,cryptochidism and varicocele were scanned with 10 MHz bifunctional soft probe.Utilization of high frequency probe may differentiate distinctively testitis from hemorrhage of testis and may easily find the locatipn and structrure of the eryptochidism.The combined use of 2 dimensional ul-trasonography and Doppler technique may be helpful fo detect the extent of varicocele and to evaluatethe postoperative efficacy.High resolution ultrasonography has been an important method for diagnos-ing the scrotal disease and the main indicator to decide whether the surgical or nonsurgical treatment should be undertaken.

Objective To explore the clinical characteristics and prognostic factors in patients with Parkinson's disease (PD) and excessive daytime sleepiness (EDS) and to identify whether EDS could influence the sleep architecture and sleep apnea-related parameters.Methods A total of 130 PD patients were eligible and enrolled in the study.By the Epworth sleepiness scale (ESS),patients were divided into the EDS group (ESS ≥ 10) with 61 patients and the non-EDS group (ESS ＜ 10) with 69 patients.All underwent a video-polysomnography (PSG).Clinical characteristics were mainly evaluated by the unified Parkinson's disease rating scale (UPDRS) and the Hoehn-Yahr(H-Y) stage.while other related scales were applied for evaluating depression,cognitive function,quality of sleep and quality of life.Results A total of 61 patients (46.92％) were diagnosed as EDS (ESS≥ 10).Compared to the non-EDS group,the EDS group had significantly higher score of HAMD,UPDRS Ⅰ and UPDRS Ⅱ,and significantly lower score of MoCA and PDQ (all P ＜ 0.05).Non-conditional logistic regression analysis showed that the scores of HAMD and UPDRS Ⅰ were the main prognostic factors for EDS.Significantly decreased sleep latency (SL) was found in the EDS group by PSG (P =0.008).The score of ESS was showed to be correlated with the scores of HAMD,MoCA,UPDRS Ⅰ,UPDRS Ⅱ,PDQ and SL.Conclusions PD patients with EDS have more severe depression and cognitive dysfunction and worse quality of life.Sleep structure is altered in those patients with decreased sleep latency.Mental status is closely associated with EDS,but not sleep apnea.

Objective To investigate the role of glucocorticoid-induced tumor necrosis factor ligand (GITRL) in regulating the inflammatory reaction of kupffer cells.Methods The kupffer cells and T cells of mice were isolated and divided into 6 groups after being co-cultured:control group,kupffer cells and T cells were cultured in DMEM only; lipopolysaccharide (LPS) group,kupffer cells and T cells were cultured in media with LPS (1 mg/L) ; LPS + GITRL siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with GITRL siRNA ; LPS + control siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control siRNA; LPS + pEGFP-N1 GITRL group,kupffer cells and T cells were cultured in media as the LPS group after transfected with pEGFP-N1 GITRL plasmid; LPS + pEGFP-N1 control group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control plasmid.After 24 hours of treatment,the expressions of GITRL and PDL1 of kupffer cells were detected by immunofluorescence and western blot,respectively.The proliferation and apoptosis of T cells were measured by MTF assay and Annexin V/PI flow cytometry,respectively.The expression of tumor necrosis factor (TNF-α) in the supernatant fluid was measured by ELISA.All data were analyzed using the independent t test and one-way analysis of variance.Results The transfection efficiencies of GITRL siRNA and pEGFP-N1 GITRL were 90％ and 85％,respectively.Compared with normal kupffer cells,the protein expression of GITRL of kupffer cells transfected with GITRL siRNA was significantly decreased,while the protein expression of GITRL of kupffer cells transfected with pEGFP-N1 GITRL was significantly increased (t =41.72,13.10,P ＜ 0.05).There was no significant difference in the protein expressions of GITRL between normal kupffer cells and those in the control groups (F =2.27,P ＞ 0.05).The fluorescence intensity of GITRL in the LPS group was significantly higher than that in the control group (t =49.29,P ＜ 0.05).Compared with LPS group,the activation of GITRL expression by the LPS was significantly suppressed in the LPS + GITRL siRNA group (t =9.84,P ＜ 0.05),while the expression of GITRL in the LPS + pEGFP-N1 GITRL group was significantly increased (t =5.78,P ＜ 0.05).There was no significant difference in the GITRL expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.86,P ＞ 0.05).The expression of PDL1 in the LPS group was significantly lower than that in the control group (t =18.83,P ＜0.05).Compared with LPS group,the expression of PDL1 in the LPS + pEGFP-N1 GITRL group was significantly suppressed (t =11.79,P ＜ 0.05),while the expression of PDL1 in the LPS + GITRL siRNA group was significantly stronger (t =19.08,P ＜ 0.05).There was no significantly difference in the expression of PDL1 in the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =2.22,P ＞ 0.05).The proliferation of T cells was increased and the number of apoptotic T cell was decreased in the LPS group when compared with control group (t =49.43,40.11,P ＜ 0.05).Compared with LPS group,the proliferation and apoptosis of T cells in the LPS + pEGFP-N1 GITRL group had the same trend (t =5.77,12.64,P ＜0.05); while the proliferation of T cells was decreased and the apoptosis of T cells was increased in the LPS + GITRL siRNA group (t =17.00,49.90,P ＜ 0.05).There was no significant difference in the proliferation and apoptosis of T cells among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =1.87,1.35,P ＞ 0.05).The expression of TNF-α was significantly higher in the LPS group than that in the control group (t =125.68,P ＜ 0.05).Compared with the LPS group,the expression of TNF-α was significantly decreased in the LPS + GITRL siRNA group (t =119.65,P ＜ 0.05),while the expression of TNF-α in the LPS + pEGFP-N1 GITRL group was significantly increased (t =147.70,P ＜ 0.05).There was no significant difference in the TNF-α expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.14,P ＞ 0.05).Conclusion Kupffer cells suppress the expression of PDL1 by upregulating GITRL,and thus activate the proliferation of T cells and promote the inflammatory reaction.The immunologic balance may be recovered after the interference of GITRL to restrain the inflammatory reaction.

Humans ; Lung Neoplasms ; blood supply ; pathology ; Lymphatic Vessels ; pathology ; Neovascularization, Pathologic ; metabolism ; Vascular Endothelial Growth Factors ; chemistry ; metabolism ; physiology

Objective To investigate the correlation of diabetes duration and coronary arterial pathological changes by coronary angiography in patients with coronary heart disease and type 2 diabetes mellitus.Methods 206 patients with coronary heart disease admitted into the hospital were divided into 4 groups:no diabetes(n=62),the duration of diabetes ≤5 years(n=41),>5～≤10 years(n=38)and >10～≤20 years(n=45).The interventional therapy history and type 1 diabetes mellitus were excluded.The pathologic changes of coronary artery evaluated by coronary angiography and the results among different groups were analyzed with the diabetes duration.Results There was no significant differences in the pathological changes of coronary artery between the group of no diabetes and the groups of ≤5 years duration and >5～≤10 years duration.However,the group of >10～≤20 years duration showed more serious pathologic changes of coronary artery than other groups including the multi-branch lesion,diffuse lesion and obstruct lesion(P<0.01).Conclusion Following the process of the diabetes,the coronary lesions in patients with type 2 diabetes mellitus tend to be more widespread and severe.