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Objective:To investigate the omics mechanism of SARS-related immune injury and predict targeted therapeutic drugs through clinical bioinformatics analysis of the transcriptome data of SARS virus in order to provide reference for clinical treatment of COVID-19.Methods:The transcriptome data of SARA virus were collected from the Gene Expression Oibus (GEO) and used to screen differential genes. Enrichment analysis and protein interaction analysis were performed to investigate the mechanism of immune damage associated with SARS. A platform of epigenetics in precision medicine (EpiMed) was established to predict potential therapeutic drugs.Results:The mechanism of SARS-related immune injury was complex, involving affecting the function of immune cells through signaling pathways such as Toll-like receptors, increasing cytokines in plasma through Th17 signaling pathway and inducing autoimmune responses after autoantibodies were generated by molecules such as IL-6, NF-κB, and TNF. Drugs such as Chuanqiong and Etanercept might have therapeutic effects on SARS-related immune damage.Conclusions:SARS virus could cause abnormal expression of many immune-related molecules and signaling pathways. Drugs such as Chuanqiong and Etanercept might have therapeutic effects on SARS-related immune damage. This study might provide reference for clinical treatment of COVID-19.
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Objective:To analyze the inflammatory mechanism and potential intervention drugs related to angiotensin converting enzyme 2 (ACE2) inhibitory mutations in order to provide reference for the treatment of corona virus disease 2019 (COVID-19).Methods:The data of lung adenocarcinoma with ACE2 mutations were screened from the cancer genome atlas (TCGA) database. The data were analyzed by R program language edgeR package and cluster Profiler package, gene ontology (GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Using String online analysis website for protein-protein interaction (PPI) network analysis, screening out the core genes, and finally using the Epigenomic Precision Medicine Prediction Platform (EpiMed) for multi-group association analysis of key genes, and drug candidates prediction.Results:A total of 1 005 differential genes were obtained, of which 91 were up-regulated and 914 down-regulated. A total of 71 GO were enriched, including 45 items related to biological processes, 16 items related to cell components, and 10 items related to molecular function. A total of 13 KEGG pathways were enriched, mainly in inflammatory pathways, various viral infectious diseases, transcriptional regulation, drug metabolism and protein digestion and absorption pathways. The differentially expressed genes were introduced into String online analysis website for PPI network analysis, a total of 252 proteins were obtained, and 10 core genes were H2A clustered histone 16(HIST1H2AL), H3 clustered histone 2 (HIST1H3B), H3 clustered histone 7 (HIST1H3F), H3 clustered histone 11 (HIST1H3I), H3 clustered histone 3 (HIST1H3C), H2B clustered histone 3 (HIST1H2BB), H2B clustered histone 6 (HIST1H2BI), H4 clustered histone 2 (HIST1H4B), H1-4 linker histone (HIST1H1E), H2A clustered histone 4 (HIST1H2AB). Interferon-α, resveratrol, celecoxib, heartleaf houttuynia herb, weeping forsythia capsule, dexamethasone, Chinese pulsatilla root, tumor necrosis factor-α inhibitors, liquorice root and famciclovir might be drugs for the treatment of ACE2 mutation-related inflammation.Conclusions:Inflammation associated with ACE2 inhibitory mutations is similar to the pathogenesis of COVID-19, which could lead to disease by promoting the activation of inflammatory pathways such as mitogen-activated protein kinase (MAPK), the Janus kinase signal transducer and activator of transcription (JAK/STAT), mammalian target of rapamycin (mTOR). Celecoxib, interferon and resveratrol may have the potential therapeutic effects on COVID-19.
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Objective To investigate the prevalence and transmission mechanisms of plasmid-mediated blaoxa-23 resistance genes in Acinetobacter baumannii.Methods One hundred and one Acinetobacter baumannii were collected from Obstetrics and Gynecology Hospital of Fudan University and Renji Hospital Shanghai Jiaotong University School of Medicine.Antibiotic susceptibility of carbapenems were determined by standard agar dilution method.Molecular typing of Carbapenem-resistant Acinetobacter baumannii (CRAB) was performed by MLST.blaoxa-23、blaoxa-24、blaoxa-51、blaoxa-58、blaIMP-1、blaVIM-1/2 and blaAmp-C were analyzed by PCR.The analysis of blaoxa-23 transposons for carbapenems resistant A.baumannii isolates was also performed by PCR.Plasmid was analyzed by gel electrophoresis.Conjugation experiments were performed to determine the transferability of blaoxa-23.Results The antibiotic susceptibility tests showed the resistant rates to carbapenems were extremely high , and the ones of imipenem and meropenem were 64.4%and 69.3%.Fifty-six (53%) isolates were carbapenems-resistant A.baumannii.Main clone ST208 includes 28 isolates(50%) in CRAB.A total of the CRAB isolates harbored blaoxa-23 and blaoxa-51 (100%), 44 for blaIMP-1(78.6%) and 54 for blaAmp-C(96.4%), while blaoxa-24, blaoxa-58 and blaVIM-1/2 was undetected.Two previously identified transposons ( Tn2006 and Tn2008 ) was found in the isolates.Plasmid gel electrophoresis results showed that the isolates carried 2-4 plasmids and blaoxa-23 were transferable by plasmids.Conclusions There is high carbapenems resistance of A.baumannii infections.ST208 was the most prevalent molecular type.The mainly drug-resistant genes of A.baumannii are blaoxa-23.Based on the findings, blaoxa-23 is plasmid mediated, suggesting that it may transfer by plasmids carrying Tn 2008 transposon, thus induced isolates resistant to carbapenemase.
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Objective The aim of this study was to evaluate the commercial SepsityperTM kit and serum separator tube coupled with matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry for direct identification of microorganisms in a blood culture system.Methods A total of 138 clinical blood samples from clinical laboratory in Renji hospital were tested with two methods respectively from April to June of 2016.Performance of the assays were compared against that of conventional bacterial culture as a reference.Results A total of 138 nonduplicate positive blood culture samples were collected,including 70 (53.03％) gram negative samples,57 (43.18％) gram positive samples,3 fungus samples,2 mixed samples,and 6 false positive samples which were excluded from further analysis.The accuracy rate of SepsityperTM kit and serum separator tube was 91.67％ and 84.09％ in rapid identification of pathogen from blood samples,83.33％ and 61.36％ in correct identification to species level.The accuracy rate of SepsityperTM kit and serum separator tube was 98.57％ and 95.71％ in identifying gram-negative bacteria,87.72％ and 78.59％ in identifying gram-positive bacteria,respectively.The turnaround time for identification of each sample was 40 min by the commercial SepsityperTM kit and 25 min by serum separator tube.Conclusions MALDI SepsityperTM kit has shown slightly higher accuracy rate in identification of pathogen from blood sample than serum separator tube,but the difference is not significant (91.67％ vs.84.09％,P＞0.05).Compared with MALDI SepsityperTM kit,serum separator tube is a rapid,easy,and cost-effective pretreatment method for direct identification of microorganisms from blood cultures using MALDI-TOF mass spectrometry.
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Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.
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Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.
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Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).
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ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.
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Objective To investigate the role of outer membrane protein in clinical isolated car-bapenem resistance Acinetobacter baumannii. Methods Carbapenem resistance and sensitive strains were collected from the same patient. After MIST and REP-PCR analysis, carbapenemases were detected by isoe-lectric focusing. Different expressed membrane proteins were identified by two-dimension electrophoresis and mass spectrometry analysis. We also used efflux pump inhibitor PAβN(Phe-Arg-β-naphthylamide) to con-firm the phenotype. Results Carbapenem resistance and sensitive strains were attributed to the same pat-tern. At positions of P17.6 and P19.0, two β-lactamases were expressed in two investigated strains, no cabapenemases were detected. Six differential expressed membrane proteins were identified, a 34 × 10~3 membrane protein that was confirmed by efflux pump inhibitor PAβN experiment (imiponem MIC decreased from far above 32 μg/ml to 8μ/ml) and OprD and CarO. Conclusion Up-regulation of exported protein accompanied with down-regulation of OprD and CarO other than carbaponemases are responsible for carbap-enem resistance in A. baumannii.
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Objective To evaluate the diagnosis and surgical treatment of adult congenital choledochal cyst(ACCC). Methods Clinical data of 345 ACCC cases from 1974 to 2007 were analyzed retrospectively. Results There were only 110 patients (31.9%) with typical triad (abdominal pain, palpable mass and jaundice). B-ultrasound, CT, ERCP, PTC and MRCP were methods for diagnosis. Cancer arising from choledochal cysts was found in 19 cases who had undergone internal drainage and its incidence of cholangiocarcinoma is much higher than in the general population. All cases underwent surgical treatment, in which total excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was main operation, 337 cases recovered well and 8 (2. 3%) died. C..ondusions Accurate diagnosis of ACCC was difficult depending on clinical symptoms only. B-ultrasound was the choice of atraumatic diagnosis. All patients with an established diagnosis of ACCC should undergo exploratory laparotomy. Total excision of eholedochal cyst and Roux-en-Y hepaticojejunostomy is most effective treatment for ACCC.
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Objective To evaluate the diagnosis and surgical treatment of primary retroperitoneal extraadrenal pheochromocytoma(PREAP). Methods Clinical data of 17 cases with PREAP from 1976 to 2006 were analyzed retrospectively. Results It was not difficult for the diagnosis of PREAP based on the primary symptoms, including paroxysmal hypertension or persistent hypertension. PREAP is usually deep, large and invading on adjacent organs. B-uhrasound was used for preliminary screening. CT and MRI with high soft tissue resolution and multi directional imaging are of great value for correct diagnosis and determination of exact extent of the tumor in diagnosis of PREAP. 24 h urinary VMA output imcreased in 12 cases (92. 3%) and urinary catecholamine level was up to 526. 1 μg- Precise location of PREAP by 123I-MIBG is superior to that by 131I-MIBG. The diagnosis was tentative in 4 cases and definite in 13 cases. Complete tumor resection was achieved in 15 cases, among them 2 cases died on table due to inadequate preparation before surgery in 1970's. In the remaining 2 cases with huge tumors partial resection, silver clips were put in during operation to locate the extent of the tumors for further management after operation. Conclusions Locating and qualitative diagnosis before operation are valuable and once the patients are diagnosed as PREAP, they should receive exploratory laparotomy after an adequate preparation.
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Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple's triad. Accurate preoperative localization rate of B ultrasonography, CT and enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail;while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in 13 cases, resection of pancreatic body and tail plus splenectomy in 6 cases, resection of pancreatic tail in 8 cases, resection of pancreatic tail plus splenectomy in 4 cases, laparoscopic resection of insulinoma in 1 case, piecewise resection of pancreas from left to right (blind resection) in 2 cases, pancreaticoduodenectomy in 1 case. The tumor was benign in 62 cases, and malignant in 2 cases. Pancreatic fistula developed after operation in 3 cases, acute pancreatitis in 4 cases, and in these cases, they healed after non-operative treatment. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 62 cases, 2 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor, 2 malignant tumors cases, recurred and died of hepatic metastasis in 3 years and 4 years after operation. Conclusions Whipple's triad and IRI/G>0.3 are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Resection of insulinoma is the best mode of surgical treatment of insulinoma.
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Objective To explore selective criteria of sphincter preservation operation(SPO) for middle to low third rectal cancer,and analyze clinicopathologic parameters resulting in the selective criteria.Methods Two hundred and seventy-nine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively.One hundred and eighty-seven rectal tumours were located in 5-10 cm from anus,92 rectal tumours in below 5 cm from anus.Among them 127 cases were treated by abdominal-perineal resection(APR),and 152 cases were treated by SPO in which there were 130 Dixon operations,12 Bacon operations,and 10 Parks operations.Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically.Results Gender,age,size,tumor types,site of tumor,degree of differentiation,infiltrated circumference of intestine,and lymph node metastasis,depth of invasion and Dukes stages were not significantly different between APR and SPO groups.SPO performed rate was 54.48% in all.SPO was performed in 48 lower third rectal cancer cases(52.17%,48/92).Regional recurrence rate was 6.81%(19/279).Middle survival time was((65.00?6.87))months and 5-year survival rate was 63.51% in SPO group.Middle survival time was((52.23?5.63)) months and 5-year survival rate was 52.50% in APR group.Chi-Suqare was 18.14 by Log-rank test(P=0.054 1).Conclusion There is no statistically difference in survival rate between APR and SPO groups.
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Objective To investigate the diagnosi s and management of inflammatory abdominal mass after appendectomy. Methods Clinical data of 42 patients wit h inflammatory abdominal mass developing after appendectomy from 1972 to 2004 we re retrospectively analyzed. Results There were two kinds of mass: on abdominal wall (26 cases) and that within the abdominal cavity (16 cases). Diagnosis was established on clinical fi ndings and the barium enema examination. Correct preoperative diagnosis was achi eved in 30 cases, with 12 cases (28.6%) misdiagnosed. Laparotomy was performed in 29 cases. Postoperative pathology revealed inflammatory mass. All the 42 case s recovered from the illness. Conclusions Post-appendectomy abdominal mass is infrequent complication. T he clinical course is most often self-limited. However, laparotomy is indicated in patients when conservative therapy fails or there is a fear of malignancy or tuberculosis.
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Objective To summarize our experience in the diagnosis and treatment of thyroid Hurthle cell neoplasms. Methods Clinical data of thyroid Hurthle cell neoplasm patients admitted from 1972 to 2003 were analyzed retrospectively. Results The main symptoms were thyroid solitary node or mass (37 cases) and multiple nodule (9 cases). 4 cases had cervical lymph node metastasis. With BUS、CT、ECT and FNAC,only 10 cases were diagnosed as HCNs preoperatively, 36 cases were misdiagnosed as nodular benign single or multiple node. Twenty-eight cases were diagnosed by FNAC and quick freezing pathology. Benign HCNs was treated by isolateral thyroidectomy and malignant HCNs by additional contralateral subtotal thyroidectomy. Eighteen cases were diagnosed by postoperative paraffin pathology, and retrival second operation was performed according to the benignity or malignancy of the thyroid lesion. All cases were followed-up for 2 to 10 years and doing well without recurrence. Conclusions We should realize thyroid Hurthle cell neoplasms fully, if HCNs is suspected intraoperatively, quick freezing pathology is helpful. With appropriate therapy, the prognosis is satisfactory.
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Objective To analyse pathogenesis, types, diagnosis and operation methods of adult intussusception. Methods Clinical data of 150 patients with adult intussusception were reviewed retrospectively . Results Symptom included paroxysmal bellyache (90 0%), abdominal mass (64 7%), nausea and vomit (58 0%), hematochezia (20 7%), constipation (10%) and symptom triad of bellyache , mass and hematochezia (15 3%). Tumor, inflammation, Meckel′s diverticulum and mobile cecum were main cause for intussusception. All 150 patients received operation, 147 patients were cured and 3 patients died. Conclusions Most patients of adult intussusception had pathological basis. The result of surgical therapy is good.
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Objective To observe the clinical results of laparoscopic cholecystectomy(LC) combined with endoscopic Oddi sphincterotomy(EST) in treating cholecystolithiasis and choledocholithiasis.Methods The preoperative and postoperative clinical data of 20 cases that received LC & EST combined therapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.Results The success rate was 95.0% ,with all the calculi removed completely;no complications occurred.The average hositpal stay was 7.5 days.Conclusions Combined LC & EST procedure is a safe and effective method to treat patients suffering from cholecystolithiasis and choledocholithiasis.
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Objective To summarize the experience in prevention and treatment of iatrogenic bile duct injury Methods Clinical data of 112 cases with iatrogenic bile duct injury in ten hospitals of Songhua river drainage area from January 1978 to January 2003 were analyzed retrospectively Results The main cause of iatrogenic bile duct injury was wrong identifying the anatomy of the Calot′s triangle before cholecystectomy accounting for 55 4% (62/112) Diagnosis depended on clinical features, celiac puncture and imaging examination Ultrasonography was among the most sensitive diagnostic means (diagnostic rate=97 5%) Six types of injury were identified according to their locations and type Ⅲ damage was most common in clinical practice (92/112) The curative rate in this group was 95 5% (107/112) Eighty seven cases (77 7%) underwent Roux en Y choledochojejunostomy, with cure rate of 94 3%(82/87) Conclusion Iatrogenic bile duct injury prevention lies in identifing the topography of extrahepatic bile ducts Roux en Y choledochojejunostomy is usually the therapy of choice