Objective:To describe the clinical characteristics of a possible rare syndrome, the granulomatous mastitis(GM), erythema nodosum and arthritis syndrome (GMENA syndrome), by retrospective analyzing patients with both GM and erythema nodosum, with or without arthritis, and provide clinical evidence for further researchstudy.Methods:This study analyzed the demographic general information, clinical manifestations, laboratory tests results, medications, operations, and the first visits of cases collected from the Affiliated Hospital of Qingdao University between January 2015 and February 2024. All patients were diagnosed with both GM and erythema nodosum, with or without arthritis. The frequency, means and standard deviation were used to perform descriptive analysis.Results:Among the 22 cases, all of the GM were unilateral, and nodular erythema mainly appeared in both lower limbs 17 (77%). Eight (67%) patients had arthritis. Sixteen cases (80%) were reported forwith elevated white blood cells count, and 16 (84%) with elevated C-reactive protein level, 12(86%) patients were with elevated erythrocyte sedimentation rate. Two cases were associated with hyperprolactinemia. In the bacterial tests of the breast abscess, C orynebacterium kroppenstedtii, and one Staphylococcus epidermidis were detected in 1 case respectively. The department of breast surgery was the most frequently first visit (86%) medical service, and 14 cases (64%) visited the department of rheumatology and immunology. Four cases (18%) underwent abscess incision and drainage after ineffective medication and none of them were treated with glucocorticoids. Five cases with glucocorticoids and followed-up by the department of rheumatology and immunology were not operated and four in of them without recurrenc. Conclusion:GMENA syndrome may be a syndrome characterized by high inflammatory activity, cytokine activation, and often involves the breast, skin, and joint. The pathogenesis and treatment of this syndrome need to be investigated further.

Objective:To describe the clinical characteristics of a possible rare syndrome, the granulomatous mastitis(GM), erythema nodosum and arthritis syndrome (GMENA syndrome), by retrospective analyzing patients with both GM and erythema nodosum, with or without arthritis, and provide clinical evidence for further researchstudy.Methods:This study analyzed the demographic general information, clinical manifestations, laboratory tests results, medications, operations, and the first visits of cases collected from the Affiliated Hospital of Qingdao University between January 2015 and February 2024. All patients were diagnosed with both GM and erythema nodosum, with or without arthritis. The frequency, means and standard deviation were used to perform descriptive analysis.Results:Among the 22 cases, all of the GM were unilateral, and nodular erythema mainly appeared in both lower limbs 17 (77%). Eight (67%) patients had arthritis. Sixteen cases (80%) were reported forwith elevated white blood cells count, and 16 (84%) with elevated C-reactive protein level, 12(86%) patients were with elevated erythrocyte sedimentation rate. Two cases were associated with hyperprolactinemia. In the bacterial tests of the breast abscess, C orynebacterium kroppenstedtii, and one Staphylococcus epidermidis were detected in 1 case respectively. The department of breast surgery was the most frequently first visit (86%) medical service, and 14 cases (64%) visited the department of rheumatology and immunology. Four cases (18%) underwent abscess incision and drainage after ineffective medication and none of them were treated with glucocorticoids. Five cases with glucocorticoids and followed-up by the department of rheumatology and immunology were not operated and four in of them without recurrenc. Conclusion:GMENA syndrome may be a syndrome characterized by high inflammatory activity, cytokine activation, and often involves the breast, skin, and joint. The pathogenesis and treatment of this syndrome need to be investigated further.

Objective:To classify and analyze the immunological indicators of patients with unexplained recurrent pregnancy failure, and explore whether the immunological indicators of these patients were related to pregnancy failure.Methods:We retrospectively studied 91 patients who visited the Rheumatology and Immunology Department of the Affiliated Hospital of Qingdao University from January 2022 to June 2022 due to recurrent pregnancy failures, including recurrent spontaneous abortion and recurrent implantation failures (RIF). We adopted case-control study method. Analysis was conducted from two different perspectives: antinuclear antibody (ANA) positivity and natural killer (NK) cell elevation. Among them, there were 34 ANA positive patients and 57 ANA negative patients; 32 patients had normal NK cells and 59 had elevated NK cell. Clinical data, duration of infertility, number of miscarriages, number of biochemical pregnancies, number of recurrent implant failures, and other information from patients were collected. Immunological indicators included ANA, anti-extractable nuclear antigen antibody, antiphospholipid antibodies, peripheral blood lymphocyte subsets, complement, immunoglobulin, rheumatism, etc. Routine laboratory tests included blood routine, urine routine, liver and kidney function, etc. The results were statistically analyzed.Results:There were no statistically significant differences between the ANA-positive and negative groups in terms of the number of spontaneous abortion, the number of post-transplantation abortions, the total number of pregnancy failures, and previous gynecological and chronic diseases (all P>0.05). The number of no-implanting after transplantation in the ANA-positive group was 3.20±2.04, which was significantly higher than that in the ANA-negative group (1.47±0.96, P=0.004). The proportion of CD19 +B cells [(12.96±4.26)%] and CD3 -HLA -DR + activated B/NK cells [(14.58±5.45)%] in the ANA negative group were significantly higher than those in the ANA positive group [(10.23±3.54)%, P=0.007; (11.34±4.11)%, P=0.009]. There were no significant differences in the number of spontaneous abortion, the number of fetal abortion after transplantation and the total number of pregnancy failure between the normal NK cell group and the increased NK cell group (all P>0.05). Conclusion:The number of RIF in ANA positive patients is significantly increased. The relationship between NK cells and pregnancy failure is not clear yet.

Objective:To classify and analyze the immunological indicators of patients with unexplained recurrent pregnancy failure, and explore whether the immunological indicators of these patients were related to pregnancy failure.Methods:We retrospectively studied 91 patients who visited the Rheumatology and Immunology Department of the Affiliated Hospital of Qingdao University from January 2022 to June 2022 due to recurrent pregnancy failures, including recurrent spontaneous abortion and recurrent implantation failures (RIF). We adopted case-control study method. Analysis was conducted from two different perspectives: antinuclear antibody (ANA) positivity and natural killer (NK) cell elevation. Among them, there were 34 ANA positive patients and 57 ANA negative patients; 32 patients had normal NK cells and 59 had elevated NK cell. Clinical data, duration of infertility, number of miscarriages, number of biochemical pregnancies, number of recurrent implant failures, and other information from patients were collected. Immunological indicators included ANA, anti-extractable nuclear antigen antibody, antiphospholipid antibodies, peripheral blood lymphocyte subsets, complement, immunoglobulin, rheumatism, etc. Routine laboratory tests included blood routine, urine routine, liver and kidney function, etc. The results were statistically analyzed.Results:There were no statistically significant differences between the ANA-positive and negative groups in terms of the number of spontaneous abortion, the number of post-transplantation abortions, the total number of pregnancy failures, and previous gynecological and chronic diseases (all P>0.05). The number of no-implanting after transplantation in the ANA-positive group was 3.20±2.04, which was significantly higher than that in the ANA-negative group (1.47±0.96, P=0.004). The proportion of CD19 +B cells [(12.96±4.26)%] and CD3 -HLA -DR + activated B/NK cells [(14.58±5.45)%] in the ANA negative group were significantly higher than those in the ANA positive group [(10.23±3.54)%, P=0.007; (11.34±4.11)%, P=0.009]. There were no significant differences in the number of spontaneous abortion, the number of fetal abortion after transplantation and the total number of pregnancy failure between the normal NK cell group and the increased NK cell group (all P>0.05). Conclusion:The number of RIF in ANA positive patients is significantly increased. The relationship between NK cells and pregnancy failure is not clear yet.

Objective To investigate the role of spo0A gene in growth and sporulation of Clostridium difficile clinical isolates. Methods ClosTron gene knock-out system was used to knock out the spo0A gene of C. difficile strain C25. Bacterial growth curve was plotted by measuring D600 with spectrophotometer in different phases of bacterial growth. Malachite green staining technique was used to count the number of vegetative cells and spores under optical microscope. The sporulation rate was calculated. Results The spo0A mutant and its C25 parental strain showed similar patterns of growth. However, after knock-out of spo0A gene, an asporogenous phenotype was built, while the parental strain could produce spores as usual.Conclusions The spo0A gene plays a key role in sporulation but not growth of C. difficile strain.

Objective To evaluate the feasibility of the combination of amplification refractory mutation system (ARMS) and quantitative real-time polymerase chain reaction (PCR) method in fast detection of clarithromycin resistance of Helicobacter pylori (H.pylori) in gastric mucosa.Methods A total of 150 gastric mucosal specimens with positive H.pylori culture were collected from the H.pylori positive patients who failed in H.pylori eradication from January to August in 2013.The drug resistant gene mutation types of H.pylori in these samples were detected by quantitative real-time PCR based on ARMS.And the accuracy was confirmed by sequencing.The clarithromycin resistance of H.pylori was determined by E-assay.Chi-square test was used for statistical analysis.Results Among 149 gastric mucosal specimens (one specimens without wild type or mutation type had been eliminated),the results of quantitative real-time PCR based on ARMS of two samples were not consistent with the results of sequencing;the consistent rate was 98.7％ (147/149).Among 149 specimens with positive H.pylori culture,104 samples (69.8％) were clarithromycin resistance.In 101 samples the clarithromycin resistance was detected by quantitative real-time PCR based on ARMS;the consistent rate was 97.1％ (101/104).Both E-assay and clarithromycin resistant rate detected by E-assay or quantitative real-time PCR based on ARMS was 69.8％ (104/149) and 67.8％ (101/149),respectively,and the difference was not significant (x2 =0.141,P=0.932).Conclusion The combination of ARMS and quantitative real-time PCR method in fast detection of clarithromycin resistance of H.pylori in gastric mucosa is strongly feasible and highly consistent has high consistent rate with sequencing and E-assay.

Objective To discuss the optical coherence tomography (OCT)characteristics in patients with syphilitic chorioretinitis.Methods This was a retrospective cohort study.58 patients (88 eyes) with syphilitic chorioretinitis were included.The fluorescence fundus angiography (FFA),indocyanine green angiography (ICGA) and OCT examination were performed,and the rapid plasma regain test (RPR) and treponema pallidum particle agglutination test (TPPA) were also made.The treatment response and follow up results were analyzed.Results In this study,87 eyes represented as needle like projections of the retinal pigment epithelium,86 eyes represented as retinal external membrane and myoid,ellipsoid structure was unclear or disappear,68 eyes represented as high reflection points within the vitreous body,16 eyes represented as shallow retinal detachment.After treatment,the needle like projections of the retinal pigment epithelium were fully restored in 79 eyes,retinal external membrane and myoid,ellipsoid structure were partial displayed in 62 eyes,and shallow retinal detachment were fully restored in 16 eyes.Conclusion The manifestations of OCT in patients with syphilitic chorioretinitis include needle like projections of the retinal pigment epithelium,unclear or disappear retinal external membrane and myoid,ellipsoid structure,high reflection points within the vitreous body and shallow retinal detachment.The above manifestations of OCT can be recovered significantly with treatment.

Objective To evaluate the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster?like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well?circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin ? like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features(patterns and refractivity)of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children.

Objective To study the relationship between gestational glucose,lipid metabolism parameters and fetal distress.Methods Retrospectively,82 cases of primipara with fetal distress and 246 cases of primipara without any obstetric complications were analyzed.The latter were treated as control group.All the patients were from the same hospital between January,2014 and January,2016.Factors as fasting plasma-glucose (FPG),triglyceride (TG),total cholesterol (TC),high-density lipoprotein (HDL-C),low-density lipoprotein (LDL-C) parameters during early pregnancy,blood glucose of fasting,1 hour and 2 hours in 75 g oral glucose tolerance test (OGTT),at 24 to 28 weeks of gestation,hemoglobin and blood pressure parameters during ante partum were recorded for all the cases while parameters as glucose and lipid,hemoglobin,blood pressure and cesarean section rate were compared between the 2 groups.Results FPG during early gestation,blood glucose of fasting,1 hour and 2 hours 75 g OGTT during mid gestation,systolic blood pressure and diastolic blood pressure during late gestation in the 'fetal distress' group were significantly higher than that of the control group.Hemoglobin during late gestation in the fetal distress group was lower than that of the control group,with statistically significant difference (P＜0.05).The rate of cesarean section in the fetal distress group was higher than that in the control group (x2=4.489,P=0.034).Conclusions High BMI at pre-pregnancy,high blood glucose during early and mid-gestation,high blood pressure and anemia during late gestation were related to the fetal distress group.Cesarean section rate was high for pregnancy women with fetal distress.

ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.