Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a tertiary-care hospital in Beijing

Background Bloodstream infections （BSls） remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs （CABs） and nosocomial BSIs （nBSIs） in patients admitted to the surgical wards of a teaching hospital in Beijing, China. Methods This cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared. Results Of the 191 BSIs, 52 （27.2%） and 139 （72.8%）were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation （APACHE） Ⅱand American Society of Anesthesiologists scores, and prevalence of cancer （P 〈0.05）. Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE Ⅱwas independently associated with a risk of mortality （odds ratio =0.97, 95% confidence interval： 0.93-1.02 for APACHE Ⅱ）. Conclusions We found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to hiah APACHE Ⅱ scores.

Prehospital road traffic injuries among the elderly in Beijing, China： data from the Beijing Emergency Medical Center, 2004-2010

Background Road traffic injuries （RTIs） are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing＇s geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries. Methods In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using ;~2 tests and Logistic regression analysis. Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 （P 〈0.001）. The mean age was （72.92＋5.67） years, and 911 （53.40%） of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car （85.64%） and pedestrian victim injuries （79.19%）. Our statistical analysis found three factors for injury severity： abdominal injuries （P 〈0.001）, number of injury sites （P=0.027）, and head injuries （P=0.034）. The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the sevedty of RTIs also decreased. Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

Impact of multidisciplinary team working on the management of colorectal cancer

Background The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline.Colorectal cancer multidisciplinary team （MDT） working model is recommended by UK and other countries,but there is little information on the impact of MDT working on management of colorectal cancer in China.The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.Methods A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery,the pre-MDT cohort include 297 patients,recruited from January 1999 to November 2002,and the MDT cohort had 298 patients enrolled from December 2002 to September 2006.Information recorded included：TNM stage from histological reports,degree of differentiation,the number of examined lymph nodes and CT TNM staging performed or not,and its accuracy,including local and distant recurrence.Results The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group.CT TNM staging was more accurate in the MDT group compared to the pre-MDT group （P=-0.044）.The rate of tumor recurrence in the MDT group was lower than pre-MDT group （log-rank test,P 〈0.001）.Multivariate analysis revealed that age （P=0.001）,management after inception of the MDT （P=0.002）,degree of differentiation （P=0.003）,number of examined lymph nodes （P=0.002）,and TNM stage （P=0.000） were important factors that independently influence overall survival.Conclusions The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients.MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis,evidence-based decision making,and optimal treatment planning.

Intestinal immune barrier integrity in rats with nonalcoholic hepatic steatosis and steatohepatitis

Background Nonalcoholic fatty liver disease （NAFLD） has emerged as the major cause of chronic liver injury.Intestinal barrier plays an important role in the pathogenis of NAFLD.The aim of this article was to assess intestinal immune barrier function during the development of NAFLD.Methods Totally 60 male Sprague-Dawley （SD） rats were divided into 2 groups：normal diet （ND） group and high-fat diet （HFD） group.NAFLD rat model was established in the HFD rat group.Portal blood endotoxin level was assessed by limulus test.The percentage of CD4＋ cells and CD8＋ cells in peripheral blood mononuclear cells （PBMC） and lymphocytes in Peyer＇s patches （PP） were analysed by flow cytometry.Intestinal secretory immunoglobulin A （SIgA） level was evaluated by enzyme-linked immunosorbent assay.Paired Student＇s t test was used for the statistic analysis.Results HFD rats presented with simple steatosis at the 4th and 8th week and progressed to nonalcoholic steatohepatitis at the 12th week.Elevated lipopolysaccharides （LPS） level in HFD rats was observed at the 8th week （（1.54±0.30） times of ND group,P 〈0.01）.CD4/CD8 ratios in PBMC and PP of HFD rats were increased at the 4th week （（1.50±0.47） and （1.63±0.34） times of ND group,P 〈0.05） and decreased at the 8th week （（0.50±0.16） and （0.61±0.26）times of ND group,P 〈0.05）.At the 12th week,CD4/CD8 ratio （（1.47±0.46） times,P 〈0.05） in PP increased to levels observed in the 4th week.Intestinal SIgA expression of HFD rats was remarkably up-regulated at 12th week （（2.70±1.65）times,P 〈0.05）.Conclusion Liver-gut axis in rats with NAFLD may mediate and improve intestinal immune function by increased CD4/CD8 ratio in PP and increased production of SIgA.

Comparison of symptom and risk assessment methods among patients with chronic obstructive pulmonary disease

Background The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease （COPD） guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD （AECOPD）. This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice. Methods A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test （CAT）, Modified British Medical Research Council （mMRC） scale, and results of the lung function tests were recorded. Results Of the 194 patients assessed, 21 had a CAT score 〉10 and an mMRC grade ≤1, 13 had a CAT score 〈10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second （FEV1%） of 〈50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of 〉50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% 〈50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant （P=0.004）. The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant. Conclusions The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease （GOLD） 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.

Three methods assess nutritional status of leukemia patients before hematopoietic stem cell transplantation

Background Some leukemia patients before hematopoietic stem cell transplantation （HSCT） have nutritional risk or undernutrition,which was one of the main reasons that caused series of complications during transplantation.The aim of this study was to find out some appropriate methods to learn about the nutritional status of leukemia patients before HSCT.Methods Nutritional status of patients with leukemia was assessed with three common methods of nutritional assessment （nutritional risk screening 2002 （NRS2002）,mini nutritional assessment （MNA） and subjective global assessment （SGA）） before HSCT.The assessment results of NRS2002 and MNA were compared by paired x2 test.The consistency was analyzed by Kappa test.Results In this study,13 of 50 patients （26.0%） with leukemia had nutritional risk before HSCT assessed by NRS2002,including 7 patients （14.0%） with undernutrition.Of 50 patients assessed by SGA,only 1 case （2.0%） was mild or moderate undernutrition,and the remaining 49 patients （98.0%） were well-nutrition.Assessed by MNA,1 case （2.0%）was undernutrition,11 cases （22.0%） were potential undernutrition,and 38 cases （76.0%） were well-nutrition.Paired x2 test results showed that the difference between NRS2002 and MNA was statistically significant （x2=13.64,P 〈0.05）;Kappa test results showed that they were consistent between NRS2002 and MNA （Kappa=0.62,P〈0.05）.Conclusions It is important to know the nutritional status of patients with leukemia before HSCT,and NRS2002 should be the first choice of nutritional assessment for patients with leukemia.If NRS2002 and MNA used at the same time,the accuracy and comprehensiveness of the assessment can be improved.

Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease： a retrospective study

Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery. Methods The 25 cases that underwent L5-$1 posterior lumbar interbody fusion （PLIF） ＋ L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-$1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading （4 to 6）. The patients were evaluated with visual analogue scale （VAS） and Japanese orthopaedic association （JOA） scores before surgery and in the last follow-up. Modic changes of endplates were recorded. Results The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups （t=-12.1 and 13.5, P 〈0.05）. Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly （Topping-off group： t=-2.30 and -2.24, P 〈0.05; PLIF group： t=--2.76 and -1.83, P 〈0.01）. In the hyperextension and hyperflexion view, Topping-off group＇s range of motion （ROM） and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM （t=--7.82 and -4.90, P 〈0.01） and olisthesis （t=--15.67 and -18.58, P 〈0.01） both significantly increased in extension and flexion. Conclusions Compared with single segment PLIF surgery, Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration, restrict the adjacent segment＇s ROM in extension and prevent excessive olisthesis of adiacent seament in both extension and flexion

Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm：a retrospective study

Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.

Minimally invasive treatment of the KobyGard system for plantar fasciitis： a retrospective study

Background Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis. Methods From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People＇s Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale （VAS）, American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated. Results The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 （P 〈0.001）, respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 （P 〈0.001）, respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome. Conclusion Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.

Ischemic preconditioning produces more powerful anti- inflammatory and cardioprotective effects than limb remote ischemic postconditioning in rats with myocardial ischemia-reperfusion injury

Background Both ischemic preconditioning （IPC） and limb remote ischemic postconditioning （LRIPOC） have been shown to possess significantly different cardioprotective effects against the myocardial ischemia reperfusion injury （IRI）, but no study has compared the anti-inflammatory effects of IPC and LRIPOC during myocardial IRI process. We hypothesized that IPC and LRIPOC would produce different anti-inflammatory effects in an in vivo rat model with myocardial IRI.

Blockade of the OX40/OX40L pathway and induction of PD-L1 synergistically protects mouse islet allografts from rejection

Background OX40/OX40 ligand （OX40/OX40L） and programmed death-1/programmed death ligand-1 （PD-1/PD-L1） co- stimulator/signals play important roles in T cell-induced immune responses. The aim of this study was to investigate the roles of OX40/OX40L and PD-1/PD-L1 costimulatory pathways in mouse islet allograft rejection. Methods Lentiviral vectors containing OX40L siRNA sequences and an adenovirus vector containing the PD-L1 gene were constructed. The streptozotocin-induced model of diabetes was established in C57BL/6 （H-2b） mice. Diabetic C57BL/6 mice were randomly allocated into five groups： group 1, untreated control; group 2, Ad-EGFP treatment; group 3, Ad-PD-L1 treatment; group 4, OX40L-RNAi-LV treatment; group 5, OX40L-RNAi-LV combined with Ad-PD-L1 treatment. Lentiviral vector and the adenovirus vector were injected, singly or combined, into the caudal vein one day before islet transplantation. The islets of DBA/2 （H-2d） mice were transplanted into the renal subcapsular space of the diabetic recipients. Recipient blood glucose and the survival time of the allografts were monitored. Antigen-specific mixed lymphocyte reaction was also evaluated.

Evaluation of whether serum tumor markers in patients with epithelial ovarian carcinoma change following chemotherapy

Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma （EOC） or primary serous peritoneal carcinoma （PSPC）.Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay （ELISA）-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% （7/35） demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma （57.1%,4/7） showed resistance to chemotherapy.In the 37 recurrent patients,51.4% （19/37） had changed serum tumor markers,of whom 57.9% （11/19） presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% （6/17） had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also be monitored during chemotherapy and follow-up.

A live birth of activated one-day-old unfertilized oocyte for a patient who experienced repeatedly near-total fertilization failure after intracytoplasmic sperm injection

Total or near-total fertilization failure after intracytoplasmic sperm injection （ICSl） is a rare event, but it occurs repeatedly because of sperm defects in activating oocyte. The case presents a successful pregnancy and live birth after calcium ionophore A23187 （A23187） activation on one-day-old unfertilized oocytes in a patient whose husband suffered oligoasthenoteratozoospermia, and who had experienced repeated near-total fertilization failure after ICSI. In the second ICSI cycle, only one oocyte was fertilized while nine were unfertilized. Oocyte activation with A23187 were performed on the one-day-old unfertilized oocytes after ICSI and resulted in fertilization and embryo transfer. A clinical pregnancy was achieved and a healthy baby was born. To our knowledge, this is the first reported case of a healthy birth after oocyte activation on the one-day-old unfertilized oocyte. This indicates that ＂rescue oocyte activation＂ on one-day-old unfertilized oocytes after ICSI may be helpful for preventing total or near-total fertilization failure after ICSI.

A new experimental model to study healing process of metaphyseal fracture

Background There are few researches for the healing of metaphyseal fractures; moreover,the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation,which is not in accordance with our current clinical practice.In this study,we established a new model to observe the healing process of metaphyseal fractures.Methods Eighteen New Zealand rabbits were used in the study.The fracture model was created by splitting the medial tibial plateau in rabbits,then reset,and fixed with compression screws.At 1,2,3,4,6,and 8 weeks postoperatively,the tibial specimens were collected; firstly,a general observation and an X-ray examination of the specimens was done,and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer.The sections were stained with Giemsa reagent and examined under light microscopy.Results There was no fracture displacement in the tibial specimens of all time points,except for one showing a collapse.No external callus formation could be observed by X-ray and general examination.After 1 week of the operation,the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively,a large number of woven bones were formed; from the third week onwards,the woven bone began to turn into lamellar bone,and new trabecular structure began to form.In all of the slices,no obvious chondrocytes formed in fracture areas; thus,there was no endochondral ossification.Conclusions This model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing.The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma,good reduction,and firm fixation.

Replication of association study between type 2 diabetes mellitus and IGF2BP2 in Han Chinese population

Background The association between IGF2BP2 and type 2 diabetes mellitus （T2DM） has been repeatedly confirmed among different ethnic populations. However, in several genome-wide association studies （GWAS） from the Chinese Han population, the gene IGF2BP2 has not been replicated. The results of relevant studies for the association between IGF2BP2 and T2DM showed controversy in Chinese Han population. It is necessary to systematically evaluate the contribution of common variants in IGF2BP2 to T2DM in Chinese Han population.

Effect of kappa elastin on melanogenesis in A375 human melanoma cells and its related mechanism

Background Elastin derived peptides can regulate melanocyte precursor development. Ultraviolet irradiation, infrared radiation and heat can increase the synthesis of tropoelastin in human skin epidermis. The aim of this study was to investigate whether the over expressed tropoelastin in epidermis has some role in melanogenesis of melanocytes. Methods A375 human melanoma cells were treated with different concentrations of kappa elastin for 24 hours. A375 human melanoma cells were randomly assigned to control, kappa elastin, and lactose pre-incubated groups. The cell viabilities were detected by the methyl thiazoleterazolium assay. Melanin content and tyrosinase activity in A375 melanoma cells were measured. The expressions of endothelin B receptor （ETBR） mRNA and c-kit mRNA in A375 melanoma cells were measured by quantative reverse transcription polymerase chain reaction. Results Fifty pg/ml of kappa elastin significantly increased the melanin content by 56.64% compared with the control （P 〈0.05）. Kappa elastin increased cellular tyrosinase activity by 46.73% compared with the control at 24 hours （P 〈0.05）. Kappa elastin increased the expressions of ETBR and c-kit mRNA levels by 2.13-fold and 2.47-fold compared with the controls, respectively. When pre-incubating cells with a lactose solution （10 mmol/L）, the inhibition on melanin production was 34.96% compared with the kappa elastin group （P 〈0.05）, tyrosinase activity was inhibited by 29.93% compared with kappa elastin group （P 〈0.05）, and the expressions of ETBR mRNA and c-kit mRNA were decreased by 1.56-fold and 0.82-fold compared with kappa elastin group, respectively. Conclusion Kappa elastin increased the melanogenesis in A375 melanoma cells via the stimulation of tyrosinase activity and the expression of ETBR and c-kit. The over expressed tropoelastin produced by keratinocytes might play a role in melanogenesis of epidermal melanocytes.

Cryoglobulinemia is an independent factor negatively associated with sustained virological response in chronic hepatitis C patients

Background Mixed cryoglobulinemia （MC） is one of the most common and severe symptoms in chronic hepatitis C patients. The aim of this study was to investigate whether mixed cryoglobulinemia is a factor associated with sustained virological response in chronic hepatitis C patients treated with combination therapy of pegylated interferon alpha-2a and ribavirin. Methods This is a single-center study including 57 chronic hepatitis C patients who received combination treatments of pegylated interferon alfa-2a and ribavirin. Serum cryoglobulin was detected by cryoprecipitation prior to treatment. Serum hepatitis C virus （HCV） RNA levels were checked before treatment, during the fourth and 12th week of treatment, and during the 24th week after cessation of treatment. The genotype of HCV was determined at baseline. Logistic regression analysis was used to assess the factors associated with sustained virological response. Results Twenty-five patients were with MC （43.9%）. Twenty-four weeks after cessation of antiviral treatment, sustained virological response achievement in MC~ patients was significantly lower than that in MC- patients （32.0% vs. 75.0%, P=-0.001）. Univariate Logistic regression analysis and multivariate Logistic regression analysis found that only MC （odds ratio： 6.375; 95% Ch 1.998-20.343, P=0.002） was negatively associated with sustained virological response achievement. Conclusion MC is an independent factor negatively associated with sustained virological response in chronic hepatitis C patients treated with pegylated interferon alpha-2a and ribavirin.

Characteristics of peripheral nerve collateral multiplication and its potential use in neural trauma

To the editor： It is well known that outgrovah of collateral sprouts is a natural process during regeneration of theperipheral nervous system. However, current knowledge about this phenomenon was that aberrant growth of axonal sprouts may lead to the fbrmation of persistent neuromas,1.2 From our previous work3-5 verified effectively in clinical environment for nerve repairing and related experiments by small gap sleeve neurorrhaphy, we made a possible inference for peripheral nerve collateral regeneration and functional repairing; the hypothesis of using these collateral sprouts as an auto graft resource to recover the injured nerve.

Tigecycline minimum inhibitory concentration for carbapenem-resistant Acinetobacter baumannii by two methods

To the editor： Carbapenem-resistant Acinetobacter baumannii （CRAB） is one of the most representative multidrug-resistant gram-negative bacteria, and its resistant rate has steadily increased in recent years.1.2 CRAB infections can currently be treated with tigecycline. However, with its rapid promotion and wide application in clinical therapy,

Leprosy presented as cutaneous erythema

To the editor：Leprosy is rarely seen in dermatology clinics,thus it is easily misdiagnosed when presented as erythema.Our first patient presented with sole red plaques on the left ear with numbness,and the second patient presented with generalized ill-demarcated plaques.They were respectively diagnosed as tuberculoid leprosy and borderline leprosy.