The skin manifestations of monoclonal(M)-proteinemia are rare and present in patients with monoclonal gammopathy of undetermined significance (MGUS), smoldering plasma cell myeloma (SMM) and multiple myeloma (MM). In this study, we reported 4 cases with M-proteinemia-related rare skin lesions, including pyoderma gangrenosum (PG), erythema elevatum diutinum (EED), cutis laxa (CL) and lichen myxedematosus(LM). These skin lesions are specific, where the potential mechanism was immune-mediated paraneoplastic syndrome rather than direct plasma cell infiltration. Anti-plasma cell treatment was effective in treating skin lesions. The clinical outcome of MM-related skin changes was correlated to tumor control, whereas the prognosis of MGUS or SMM related skin lesions was favorable. Skin involvement in M-proteinemia is extremely rare and less well-known, which greatly impairs quality of life. The diagnosis and treatment of these 4 cases support the need for futher study.

Objective:To explore the real experience of bladder perfusion therapy in patients with recurrence of bladder cancer.Methods:This study used the descriptive phenomenological approach. From May to June 2020, 13 patients with recurrence of bladder cancer who were treated and followed up in a Class Ⅲ Grade A hospital in Jinan were selected as the research object. The interviews and recordings of 13 patients were conducted, and the recordings were transcribed at the same time. The Colaizzi 7-step analysis method was used to analyze, summarize and refine themes.Results:A total of three themes were refined, namely, physical experience, psychological experience, and social experience.Conclusions:Patients with recurrence of bladder cancer face multiple problems. Medical and nursing staff should make effective assessments and interventions on the physical and psychological conditions of patients with recurrence of bladder cancer to improve their physical and psychological health, as well as their quality of life.

OBJECTIVE: To investigate the classification of idiopathic inflammatory myopathies (IIM) based on clinical manifestations and myositis- specific antibodies using cluster analysis. METHODS: We retrospectively analyzed the data of patients with IIM admitted in Nanfang Hospital in 2015-2019. The clinical data of the patients including serum creatine kinase (CK), interstitial lung disease (ILD), cancer, and myositis-specific antibodies were collected for two-step cluster analysis to identify the distinct clusters of patients, whose clinical characteristics were subsequently analysed. RESULTS: A total of 71 patients with IIM were included in this study, including 30 (42.3%) with polymyositis (PM), 20 (28.2%) with classic dermatomyositis (DM), 16 (22.5%) with amyopathic dermatomyositis (CADM), and 5 (7.0%) with immune-mediated necrotizing myopathy (IMNM). Two-step cluster analysis identified 3 distinctive subgroups: Cluster 1 of 15 (51.7%) patients characterized by rash, positive anti-MDA5 antibody and hypoproteinemia ( < 0.05) with normal or slightly elevated CK level, mainly corresponding to CADM; Cluster 2 of 4 (57.1%) patients with significantly elevated CK and positive anti-SRP antibody ( < 0.001) corresponding to IMNM; and Cluster 3 of 17 (48.6%) patients consisting primarily of patients with PM, characterized by positivity for anti- aminoacyl transfer RNA synthetases antibodies (=0.022) corresponding to antisynthetase syndrome (ASS). CONCLUSIONS Patients with IIM can be divided into 3 subgroups based on their clinical and serological characteristics (especially myositis-specific antibodies), and among them ASS may represent an independent IIM subgroup with unique clinical characteristics.
Antibodies ; metabolism ; Humans ; Myositis ; classification ; physiopathology ; Retrospective Studies

OBJECTIVE: To investigate the classification of idiopathic inflammatory myopathies (IIM) based on clinical manifestations and myositis- specific antibodies using cluster analysis. METHODS: We retrospectively analyzed the data of patients with IIM admitted in Nanfang Hospital in 2015-2019. The clinical data of the patients including serum creatine kinase (CK), interstitial lung disease (ILD), cancer, and myositis-specific antibodies were collected for two-step cluster analysis to identify the distinct clusters of patients, whose clinical characteristics were subsequently analysed. RESULTS: A total of 71 patients with IIM were included in this study, including 30 (42.3%) with polymyositis (PM), 20 (28.2%) with classic dermatomyositis (DM), 16 (22.5%) with amyopathic dermatomyositis (CADM), and 5 (7.0%) with immune-mediated necrotizing myopathy (IMNM). Two-step cluster analysis identified 3 distinctive subgroups: Cluster 1 of 15 (51.7%) patients characterized by rash, positive anti-MDA5 antibody and hypoproteinemia ( < 0.05) with normal or slightly elevated CK level, mainly corresponding to CADM; Cluster 2 of 4 (57.1%) patients with significantly elevated CK and positive anti-SRP antibody ( < 0.001) corresponding to IMNM; and Cluster 3 of 17 (48.6%) patients consisting primarily of patients with PM, characterized by positivity for anti- aminoacyl transfer RNA synthetases antibodies (=0.022) corresponding to antisynthetase syndrome (ASS). CONCLUSIONS Patients with IIM can be divided into 3 subgroups based on their clinical and serological characteristics (especially myositis-specific antibodies), and among them ASS may represent an independent IIM subgroup with unique clinical characteristics.
Antibodies ; Autoantibodies ; Dermatomyositis ; Humans ; Lung Diseases, Interstitial ; Myositis ; Retrospective Studies

Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.

Objective To investigate the imaging features of computed tomography (CT) examination of subacute gallbladder perforation.Methods The retrospective cross-sectional study was conducted.The clinical data of 24 patients with subacute gallbladder perforation who were admitted to the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2013 and January 2018 were collected.Patients underwent abdominal plain scan and enhanced scan in the arterial phase and portal venous phase of CT,and received percutaneous cholecystostomy,cholecystectomy,choledocholithotomy,T-tube drainage according to their conditions.Observation indicators and evaluation criteria:(1) CT examination situations."Barrier lake sign" is defined as presence of obvious or occult crevasse in the discontinuous gallbladder wall,with interrupt line seen in the portal venous phase and without crevasse enhancement.There is patchy effusion circled by annular wall around crevasse of gallbladder,shape like barrier lake,appearing as oval,semicircle,circular sector,triangle,etc.Annular wall consists of abscess wall,liver margin or both of them.With smooth inner wall of the abscess and irregular outer wall,abscess wall may be complicated with inflammatory exudation and strip shadow,showing intense enhancement in the venous phase.(2) Treatment and follow-up situations.Follow-up using outpatient examination and telephone interview to detect complications after discharge up to January 2018.Measurement data with skewed distribution were represented as M (range).Results (1) CT examination situations.① Completion status and primary diseases:of 24 patients,2 underwent abdominal plain scan,22 underwent abdominal plain scan combined with enhanced scan in the arterial phase and portal venous phase.The primary disease of all the 24 patients was biliary stone,including 18 located in gallbladder cavity,4 located at gallbladder neck and 2 combined with gallbladder stones and common bile duct stones.The maximum diameter was 2.0 cm (range,0.3-2.5 cm)in the 24 patients.② Crevasse of subacute gallbladder perforation:perforations were detected at the bottom of gallbladder in 11 patients,at body of gallbladder in 7 patients (1 with multiple perforations),at gallbladder neck in 1 patient,at bottom and body of gallbladder in 2 patients,and perforation spot was unable to judge in 3 patients.The maximum diameter of occult crevasses was ＜0.2 cm in 2 patients and maximum diameter of crevasses was 0.5 cm (range,0.2-1.0 cm) in other 22 with defined perforation spot.③ Imaging manifestations of "barrier lake sign":24 patients had manifestation of "barrier lake sign".Annular wall consisted of abscess wall,liver margin or both of them was found in 15,3,6 patients respectively.Gallbladder was partially or totally wrapped by abscess in 21 and 3 patients respectively.④ Gallbladder situation:of 24 patients,23 and 1 had gall bladder volume increased significantly and decreased slightly,with a maximum diameter of 10.0 cm (range,6.0-13.0 cm) and thickness of hydropic gallbladder wall as 0.5 cm (range,0.3-1.3 cm).⑤ Other effusion signs:24 patients had increased fat interval density around gallbladder,partly showing cord-like and line-like changes.(2) Treatment and follow-up situations:of 24 patients,10 underwent laparoscopic cholecystectomy,6 underwent open cholecystectomy,4 underwent cholecystectomy + choledocholithotomy + T-tube drainage,1 was converted to open cholecystectomy + choledocholithotomy + T-tube drainage after laparoscopic exploration,3 underwent cholecystectomy at 2 months after percutaneous cholecystostomy combined with anti-inflammatory treatment.Of 24 patients,22 were followed up for 6-31 months with a median time of 11 months.During the follow-up,2 patients were detected residual stones at fossa for gallbladder and end of the common bile duct,2 were detected cholangitis with stones,1 died of tumor,and other 17 survived well without recurrence of calculus or other complications.Conclusion The "barrier lake sign" is a typical feature of CT examination of subacute gallbladder perforation,which provides timely and accurately differential diagnosis and clinical treatment.

Objective To analyze the typical imaging features of various internal biliary fistulas by multislice spiral CT (MSCT),and the diagnostic value.Methods the data of 56 cases of internal biliary fistula in Wuxi No.2 Affiliated Hospital of Nanjing Medical University from January 2011 to March 2018 were analyzed retrospectively.All cases were examined by MSCT plain scan and enhanced examination.The imaging features of various biliary fistula were analyzed and studied.Results Among 56 cases of biliary fistula,39 cases were gallbladder duodenum fistula,and the diagnostic sensitivity was 87.2％ (34/39).The total coincidence rate was 85.7％ (48/56).21 cases were fistula formation,and 11 cases of narrow neck syndrome.Gallbladder bile duct fistula,liver-gallbladder fistula,bile duct and duodenal fistula of 6 cases were showed.In 4 cases of complex gallbladder fistulas,3 cases showed fistula clearly including 2 cases of fistula and a "clover" sign.In the indirect CT signs of 56 cases of internal biliary fistula,the common imaging features:atrophy of gallbladder or incarceration,stone incarceration of biliary tract,gallbladder or choledochal duct and cavity viscera.Conclusion MSCT scan can not only distinguish the type of biliary fistula and the structure of fistula,but also display the fistula,shape,atrophy of gallbladder,gallbladder and bile duct gas,stone and surrounding conditions,which have important guiding significance for the formulation of the operation scheme.

Objective To establish spastic cerebral palsy model of macaque by partial resection of motor cortex and explore its evaluation method.Methods Four individuals of 3-month-old macaques were divided into healthy control group and operation model group according to random number table.Partial resection of the motor cortex was carried out in operation model group,in which precentral gyrus cortex from above the right lateral cerebral fissure to the inter-hemicerebral fissure,together with the posterior-superior frontal gyrus (about 0.3 to 0.5 cm in front of the anterior median sulcus) cortex were removed with the depth of about 0.5 to 0.6 cm.After the operation,the continuous camera shooting was used to record whether left limb motor dysfunction and abnormal posture existed or not.Muscle tension was assessed by manual examination of muscle tone with reference to the modified Ashworth scale.The quantitative indexes of the two groups were detected by using the gross motor and fine motor assessment scale.9.4T magnetic resonance imaging (MRI) was used to detect the brain imaging changes.Results After operation,the macaque in the operation model group immediately showed left hemiparesis,left upper limb abnormal lifting,left lower limb paralysis,left limb claudication,and eating mainly relied on the right side of the body.After 6 weeks of operation,left limb activity of the operation model group was significantly lower than that of the healthy control group,and the gross motor scores and fine motor scores were significantly lower than those of the healthy control group(Friedman test:χ2=33.939,P<0.05;χ2=37.526,P<0.05).The macaque in the operation model group showed some symptoms that abnormal posture mainly tilted to the left for the rest,sitting in a corner of the monkey cage,left arm was put on the cage to maintain postural balance,and movement was left slightly inclined,which had simulated the typical clinical manifestations of human spastic hemiplegic cerebral palsy.Muscle tension was checked by hand,and the left limb paralysis and muscle tension decreased after operation in the model group,and the left muscle tension increased gradually after 5 weeks,and gradually increased to score 4 points and the score remained 3 after 10 weeks.Brain MRI of 3 weeks postoperatively suggested scar tissue formation after right motor cortex resection,which supported the pathological changes of the hemiplegic cerebral palsy models.Conclusions Through the partial resection of the motor cortex,the model of spastic cerebral palsy was established successfully.The results of behavioral evaluation and MRI showed that the model was consis-tent with spastic hemiplegia.

Objective To investigate antibiotics resistant characteristics and carbapenemases genotype of Acinetobacter baumannii in Intensive Care Unit (ICU),so as to provide theoretical basis for clinical prevention and treatment.Methods Retrospective study was made on 90 non-duplicated clinical isolates of Acinetobacter baumannii,which were collected From January 2013 to January 2014 in three tertiary hospitals of Qingdao.All strains were identified by VITEK2 automated microbiology analyzer;K-B method was used to do drug susceptibility test;polymerase chain reaction (PCR) was used to amplify the OXA-23,OXA-24,OXA-51,OXA-58,KPC-2,VIM,IMP genes,and the positive products of genes were sequenced;the chi-square test was used to compare the difference of the resistance rates.Results The detection rate of multi-drug resistant A.baumannii (MDRAB)and Pan-drug resistant A.baumannii (PDRAB)was 61.11% (55/90) and 17.78% (16/90).In the 32 strains of imipenem-resistant Acinetobacter baumannii,the resistant rates to Cefoperazone/sulbactam,Polymyxin B was lower,while the resistant rates to other drugs tested were more than 85%.The difference of the resistance rates to 9 drugs between imipenem resistant group and Imipenem sensitive group were statistically significant (P≤0.05).PCR result showed: 32 strains detected OXA-51 gene,28 strains detected OXA-23 gene,and 3 strains detected VIM gene,the detection rates of which were 100%,87.50% and 9.38% respectively.All strains were not detected OXA-24,OXA-58,KPC-2 and IMP genes.The sequenced results were absolutely homology with the corresponding genes in genbank.Conclusions The resistance of A.baumannii in ICU is serious in this region,especially imipenem-resistant A.baumannii,which were nearly no-sensitive to most of the drugs commonly used in clinical.The gene existence of carbapenemase and carbapenemase producing is one of the main resistance mechanism of Acinetobacter baumannii to carbapenem antibiotics.OXA-23 was the major genotypes in this region.

Heart Atria ; Humans ; Lung Neoplasms ; Sarcoma ; Skull Neoplasms