[Fungal peritoneal dialysis catheter-related exit-site infection combined with tunnel infection: A case report].

Peritoneal dialysis (PD) catheter-related infection (i.e. exit-site infection and tunnel infection) is one of the main causes of PD-related peritonitis. If it cannot be controlled effectively, it could lead to PD technique failure. Therefore, timely and effective diagnosis and treatment and active prevention so as to reduce PD catheter-related infection is an important treatment goal in PD patients. PD catheter exit-site infection (ESI) and tunnel infection can be caused by a variety of microorganisms, mainly bacteria, while fungi are very rare. Few public data can be used to guide treatment of PD catheter-related fungal infection, and there is no related report in China till now. Once fungal peritonitis occurred, the patient can only withdraw from PD treatment. Here, we report a case of fungal PD catheter ESI combined with tunnel infection which was successfully diagnosed and treated in our PD center. A 71-year-old woman came to clinic because of "PD for 5 years, secretions from exit site for 8 days and aggravation for 1 day". The patient suffered from peritonitis, ESI and tunnel infection for many times in the past 5 years, involving a variety of pathogens. Eight days before, she found white viscous discharge from exit site. The subcutaneous cuff completely came out of it and rubbed its skin. The Schaefer exit-site score was 3 points. Due to the suspected ESI 2 months before, the discharge swab for bacterial culture was positive for Pseudomonas aeruginosa, so the exit site swab for bacterial culture was done again, and gentamicin injection was applied topically once a day for empirical treatment. The exit site was evaluated one day before: The subcutaneous tunnel was significantly swollen and slightly tender at 2.5 cm away from the exit site, and with white medium amount of viscous secretions. The exit-site score increased to 4 points. Routine test of dialysis effluent was (-). The bacterial culture of the exit-site discharge was rechecked twice, and Candida parapsilosis was positive for two times, so the diagnosis of fungal PD catheter ESI combined with tunnel infection was clear. Immediately we searched for the causes of ESI and tunnel infection. We found that the patient had a suspicious history of gray toenail on the foot. The toenail smear was positive for fungi and visible hyphae. She washed feet with hands every day, and washed clothes on a low bench every day, which made the exit-site and tunnel squeezed for a long time. Based on the above causes, we gave her comprehensive treatment as follows: For ESI and tunnel fungal infections, fluco-nazole was used systemically according to the drug sensitivity results, and miconazole cream was applied to the exit-site locally. For the subcutaneous cuff that came out completely, daily iodophor disinfection was given locally. At the same time, local antifungal treatment was given to the foot. We followed up closely during treatment, evaluated the exit-site every 2-3 days, and took photos of the exit-site to dynamically observe the effect. After 14 days of treatment, the exit-site score continued to be 0-1, the bacterial culture of the exit-site was negative, the cuff culture was negative, and the tunnel B-ultrasound was normal. The patient had been followed up regularly once a month for 60 months, no ESI and tunnel infection occurred. Fungal PD catheter ESI and tunnel infection are rare complications of PD. When the standard anti-infection treatment is ineffective, the possibility of fungal infection should be considered, so as to avoid prolonged use of antibiotics, aggravating fungal infection, and even progressing to fungal peritonitis, leading to withdrawal from PD. Accurate exit-site evaluation is helpful for timely diagnosis and early treatment of ESI and tunnel infection. The exit-site discharge culture and drug sensitivity test before treatment are helpful to identify the pathogen and adjust subsequent treatment. At the same time, repeated discharge culture is required in order to exclude positive fungal culture results caused by contamination. Once fungal catheter-related infection is diagnosed, we should search for possible causes actively, subsequent targeted and comprehensive treatment plays a decisive role for the prognosis of patients.

[Preliminary study on the expression of MIF in HCC tissues and its relationship with ERK1/2 signaling pathway].

Objective: To investigate the expression of Macrophage migration-inhibitory factors (MIF) in hepatocellular carcinoma (HCC) tissues and its interaction with ERK1/2 signaling pathway, so as to establish a theoretical basis for further studying the molecular mechanism of MIF promoting HCC. Methods: From February 2020 to August 2021, 52 cases of hepatocellular carcinoma (HCC) tissues based on hepatitis B cirrhosis (HBV-LC) and 52 cases of adjacent tissues in Tianjin Medical University Cancer Hospital and 940th Hospital of Joint Logistic Support Force of PLA were collected as the experimental group, including 39 males and 13 females, aged 35-65 years. And 20 cases of normal liver tissue were selected as the control group. Immunohistochemistry was used to detect the expression of MIF, ERK1/2 and p-ERK1/2 proteins in liver tissues of the two groups, and in situ hybridization was used to detect the expression of ERK1/2 nucleic acid in liver tissues of the two groups.HepG2 HCC cells and L-02 normal hepatocytes were co-cultured with different concentrations of rMIF, the expression and phosphorylation levels of ERK1/2 and JNK1 proteins in the two kinds of liver cells were detected by Western-blot, and the expression levels of ERK1/2 nucleic acids in the two kinds of liver cells were detected by RT-PCR. One-way ANOVA was used for measurement data and χ2 test was used for counting data. Results: The expressions of MIF, ERK1/2, p-ERK1/2 and ERK1/2 mRNA were significantly increased in HCC and para-cancer tissues (the expression of MIF in HCC group was 78.8%, and that in adjacent group was 75.0%; ERK1/2 80.8% in HCC group and ERK1/2 71.8% in paracancerous group. The expression of p-ERK1/2 75.0 % in HCC group and 46.2% in paracancerous group were respectively detected. ERK1/2 mRNA was expressed in HCC group 76.9%, ERK1/2 mRNA expression in paracancerous group 78.8%), and the differences were statistically significant compared with normal liver tissues (P<0.05), but there was no significant difference between HCC and para-cancer tissues (P>0.05). The expressions of ERK1/2, p-ERK1/2 and ERK1/2 mRNA in HepG2 HCC cells were significantly increased with the increase of rMIF concentration, and the increase was most obvious when rMIF concentration was 200 ng/ml, and the difference was statistically significant compared with L-02 normal hepatocytes (P<0.05). Conclusion: MIF, ERK1/2 and p-ERK1/2 are highly expressed in HCC tissues and HepG2 HCC cells, suggesting that MIF promotes the occurrence and development of hepatocellular carcinoma through ERK1/2 signaling pathway.

[The prevalence of allergic conjunctivitis based on outpatients in Baotou area].

Objective: To explore the prevalence and influencing factors of allergic conjunctivitis in Baotou area at different times. Methods: A cross-sectional study was conducted in January 2021, 111 patients with allergic conjunctivitis who were admitted to the Department of Ophthalmology, the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology in 2020 were selected as the research subjects. The basic information, allergic conditions, living habits and other information of the patients were obtained by self-made questionnaire. The pollen concentration and allergy related indicators(allergic duration and frequency, eye itching score, eye burn score, eye foreign body sensation score, tears score and the total scores) of 2019 and 2020 were analyzed by paired sample t-test. The pollen concentration of 2019 and 2020 were analyzed by Wilcoxon signed rank test. The allergy related indicators of different genders were analyzed by independent sample t-test. The allergy related indicators of different ages were analyzed by one-way analysis of variance. The relationship between the length of wearing masks and the allergy related indicators were analyzed by Spearman correlation analysis. Results: Among the 111 patients with allergic conjunctivitis, 54 were males and 57 were females, ranging in age from 8 to 69 years old, with a median age of 35 years old and an average age of (36.77±13.18) years old. The average pollen concentration in Baotou in 2019 was (125.35±222.64) grains/1 000 square millimeter, and the average pollen concentration in Baotou in 2020 was (107.38±137.29) grains/1 000 square millimeter. There was no significant difference in pollen concentration between the two years(Z=-0.178, P=0.859). The severity of allergic indicators in all patients in 2020 is significantly lower than in 2019(t values were 4.701,3.587,2.582,3.661,4.444,2.784,2.555,3.886,respectively, with P<0.05). The severity of allergic indicators in male patients is lower than that of female patients (t values were -1.558, -1.257, -3.41, -3.085, -2.335, -2.897, -2.652, -4.124, respectively). The prevalence of allergic conjunctivitis dose not vary significant with age (P values were 0.504, 0.095, 0.499, 0.265, 0.284, 0.655, 0.421, 0.976, respectively). In 2020, the average time that patients wear masks is (6.55±3.28) h/d, and there is a correlation with the difference in allergy duration (r=0.191, P=0.045). Conclusion: The severity of allergic conjunctivitis in Baotou in 2020 was significantly improved compared with that in 2019, which may be related to masks wearing.

[Prevalence and risk factors of hypertension combined with diabetes in middle and elder population in Nan'an district of Chongqing].

Objective: To analyze the prevalence and risk factors of hypertension combined with diabetes in the middle to elder population in the Nan'an district of Chongqing, and to provide evidence for formulating relevant prevention and control strategies. Methods: Middle or elder adults were enrolled by a Stratified multistage cluster sampling method. Questionnaire survey and the related measurements were conducted. The epidemiology of hypertension combined with diabetes was analyzed descriptively, and the risk or protective factors were analyzed by logistic regression method. Results: A total of 24 792 people were surveyed, with 1 547 patients identified as having hypertension combined with diabetes. The overall prevalence rate appeared as 6.2%, of which 6.0% in males and 6.4% in females, respectively. The prevalence of hypertension combined with diabetes in the general population was increasing with age (χ(2)=343.766, P<0.001). Factors as age, education, smoking, marital status, exercise, BMI, triglyceride, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol were related to the prevalence of hypertension and diabetes. High density lipoprotein cholesterol appeared as a protective factor for hypertension combined with diabetes (OR=0.817, 95%CI: 0.715-0.934). Age, education, low density lipoprotein cholesterol and lack of exercise all appeared as risk factors for hypertension combined with diabetes (P<0.05), respectively. Conclusions: The prevalence rate of hypertension combined with diabetes in the middle or elder adults in Nan'an of Chongqing seemed high. Attention should be paid to the health status of people being elderly, overweight or obese, low cultural level, smoking, triglyceride abnormality, total cholesterol abnormality and high low density lipoprotein cholesterol, so as to reduce the risk on hypertension combined with diabetes.

[Cerebral grey matter changes of pre- and post-treatment in first-episode drug-naive adolescents schizophrenia].

Objective: To investigate the gray matter(GM) volume and the change of GM volume after antipsychotic treatment for 8 weeks in first-episode drug-naive adolescents with schizophrenia. Methods: T1-weighted brain MRIs were obtained on a 3T scanner in 35 controls and 35 subjects with adolescents schizophrenia who were admitted to the Second Affiliated Hospital of Xinxiang Medical College from April 2015 to June 2016 and not given antipsychotic medication, the schizophrenia patients received second scan after 8 weeks of antipsychotic treatment. Positive and negative syndrome scale (PANSS) assessments were performed in patients pre- and post-treatment; voxel-based morphometry (VBM) was used to analyze changes of GM volume and the correlation between the baseline GM volume and the PANSS scores was further analyzed. Results: GM volumes in the left frontal gyrus (MIN(x, y, z): -13.5, 36, 46.5), left superior parietal lobule (MIN(x, y, z): -52.5, -42, 52.5), left inferior parietal lobule (MIN(x, y, z): -31.5, -45, 69) and left central anterior (MIN(x, y, z): 9, 21, 61.5) were significantly smaller than those in the normal control group (t=-4.384 0, -4.556 2, -6.430 9, -4.313 9 respectively, P<0.001); after treatment for 8 weeks PANSS scores were significantly lower than those of baseline (P<0.001), however, there was no significant difference in regional GM volume between the pre-and post-treatment (P>0.05) and no significant correlation was found between GM volume and PANSS scores. Conclusion: There are local GM volume reductions in subjects with adolescents schizophrenia and these regions may be independent to mental symptoms of patients.

[Analysis of early response to the antipsychotic treatment and related factors in acute schizophrenia patients].

Objective: The objective was to assess the relationship between early response and later response to antipsychotics, and the relationship between antipsychotics and early response. Methods: Data were retrospectively analyzed from patients with schizophrenia and they were hospitalized in the Second Affiliated Hospital of Xinxiang Medical College from May, 2013 to September, 2015.The patients were divided into theearly response group (PANSS total score improvement ≥20% at week 2) and early nonresponse group.General information, the use of drug and the Positive and Negative Syndrome Scale (PANSS) on before and 2, 4, 6 weeks after treatment were compared between the two groups.The relation between early response and late response and the effect of drug selection on early response were analyzed by correlation analysis and regression analysis. Results: Relative to early nonresponders, early responders were significantly more likely to have lower PANSS scores (total scores on 2, 4, 6 weeks after treatment 66.2±11.8 vs 84.5±10.9, 55.9±13.2 vs 70.9±13.7, 48.9±13.1 vs 60.6±14.9, all P<0.05) and higher PANSS scores improvement at 2, 4, 6 weeks after treatment (total scores improvement on 2, 4, 6 weeks after treatment (37±14)% vs (9±7)%, (56±19)% vs (32±18)%, (68±20)% vs (49±21)%, all P<0.05). The correlation coefficient between PANSS total score improvement at week 2 and at week 4, 6 were 0.730 and 0.541, respectively (all P<0.05). Olanzapine had more PANSS total score improvement than aripiprazole, quetiapine and ziprasidone (2 weeks after treatment (29±19)% vs (19±16)%, (18±15)%, (17±15)%, 4 weeks after treatment (51±21)% vs (37±25)%, (39±18)%, (37±22)%, all P<0.05). The protective factor for early response was olanzapine (P<0.05). Conclusions: Early responders are associated with faster and greater improvement in symptoms, the type of antipsychotic has impacts on early response, early non-responders can benefit from adjustment of treatment.

[Cognitive effectiveness of risperidone and olanzapine in first-episode schizophrenia].

Objective: To study the impairments of cognitive function in first-episode schizophrenia and the potential effectiveness of risperidone and olanzapine monotherapy on first-episode schizophrenia. Methods: A total of 57 first-episode schizophrenia and 30 healthy controls were assessed at baseline, and patients were assessed again after 8-week antipsychotics therapy. Results: The positive and negative symptom scale (PANSS) reductive ratio between the two groups was similar. At baseline, the performance of schizophrenia patients was significant poor than healthy controls in the four domains of cognitive function (P<0.05); after 8-week's antipsychotics therapy, the performance of Trail Making Test (t=3.862, P<0.05) and Verbal Learning (t=-3.073, P<0.05) got significant improvements in patients with risperidone, while in group of patients with olanzapine, the performance of Trail Making Test (t=3.587, P<0.05) and working memory domain (t=-2.891, P<0.05) got significant improvements. Spearman correlation analyses suggested that dosage of risperidone was negatively correlated with the score-reducing rate of the performance of Trail Making Test of patients (r=-0.391, P=0.048). Conclusions: The effects of the two psychotroptic drugs on clinical symptoms and cognitive functions are almost equal. Comprehensive cognitive impairment is found in first-episode schizophrenia, and risperidone and olanzapine could partially improve the performance of cognitive function as well as clinical symptoms. The higher the dosage of risperidone is, the less improvement the patients has in the speed of process domain.

[Endometrial stromal sarcoma: morphologic features and detection of JAZF1-SUZ12 and YWHAE FAM22 fusion genes].

OBJECTIVE: To study the morphologic features, immunophenotype and significance of expression of JAZF1-SUZ12 and YWHAE-FAM22 fusion genes in endometrial stromal sarcoma (ESS). METHODS: Fifty-three cases of ESS were retrieved and the pathologic features were reviewed. Immunohistochemical study for estrogen receptor, progesterone receptor, CD10, cyclin D1, smooth muscle actin, desmin and H-caldesmon were carried out using tissue microarray technology. Reverse transcription-polymerase chain reaction (RT-PCR) was applied for detection of expression of JAZF1-SUZ12 and YWHAE-FAM22 fusion genes in 47 cases of ESS and 12 cases of other spindle cell neoplasia in uterus (including 2 cases of undifferentiated sarcoma, 3 cases of leiomyosarcoma, 3 cases of leiomyoma, 4 cases of adenosarcoma and 2 cases of uterine tumor resembling ovarian sex cord tumor). RESULTS: The 53 cases of ESS studied included 43 cases of low-grade ESS and 10 cases of high-grade ESS. As for low-grade ESS, in addition to the classic morphologic features, smooth muscle differentiation was present in 7 cases (16.3%), sex cord-like differentiation in 2 cases (4.7%), rhabdoid differentiation in 1 case (2.3%), clear cell changes in 1 case (2.3%) and schwannoma-like palisading pattern in 1 case (2.3%). As for high-grade ESS, sex cord-like differentiation (1 case), mucinous microcystic changes (1 case) and focal clear cell changes (1 case) were also observed. The expression rate of estrogen receptor, progesterone receptor, CD10, cyclin D1, smooth muscle actin, desmin and H-caldesmon was 86.0%, 81.4%, 74.4%, 2.3%, 23.3%, 23.3% and 4.7% in low-grade ESS, respectively, and was 1/10, 6/10, 6/10, 7/10, 1/10, 1/10 and 0 in high-grade ESS, respectively. RNA extraction was successful in 47 cases of ESS, including 39 cases of low-grade ESS and 8 cases of high-grade ESS. The positive rate of JAZF1-SUZ12 fusion gene was 30.8% (12/39) in low-grade ESS. The positive rate of YWHAE-FAM22 fusion gene was 12.5% (1/8) in high-grade ESS. The 14 control cases were all negative for JAZF1-SUZ12 and YWHAE-FAM22 fusion genes. CONCLUSIONS: As uncommon pathologic pattern may occur in both low-grade ESS and high-grade ESS, detection of JAZF1-SUZ1 and YWHAE-FAM22 fusion genes by RT-PCR would be helpful in diagnosis and differential diagnosis of ESS, especially for those tumors which lack typical morphologic features.

AQP1 expression alterations affect morphology and water transport in Schwann cells and hypoxia-induced up-regulation of AQP1 occurs in a HIF-1α-dependent manner.

Aquaporin-1 (AQP1) is the principle water channel in the peripheral nervous system (PNS) and is specifically localized to Schwann cells in the PNS. However, the pathophysiological role of AQP1 in peripheral nerves is poorly understood. Here, we utilized RNA interference by lentiviral transduction to specifically down-regulate AQP1 expression and a lentiviral overexpression protocol to up-regulate AQP1 expression, in primary Schwann cell cultures. AQP1 gene silencing resulted in a cell shrinkage phenotype, while AQP1 gene overexpression caused a cell swelling phenotype, as validated by cell volume determinations. Secondly, we utilized an in vitro hypoxia model in Schwann cells to mimic in vivo facial nerve injury. We demonstrated that AQP1 expression was induced within 8h following hypoxia injury in vitro, and that AQP1 knockdown (KD) caused the cells to resist edema following hypoxia. Finally, we investigated the hypoxic regulation of the AQP1 gene, as well as the involvement of Hypoxia-inducible factor-1α (HIF-1α) in AQP1 modulation and we found that KD of HIF-1α decreased hypoxia-dependent induction of endogenous AQP1 expression at both the mRNA and protein levels. Taken together, these results indicate that (1) AQP1 is an important factor responsible for the fast water transport of cultured Schwann cells and is involved in cell plasticity; (2) AQP1 alterations may be a primary factor in hypoxia-induced peripheral nerve edema; (3) HIF-1α participates in the hypoxic induction of the AQP1 gene; (4) AQP1 inhibition might provide a new therapeutic alternative for the treatment of some forms of peripheral nerve edema.

Long-term follow-up of a phase III study comparing radiotherapy with or without weekly oxaliplatin for locoregionally advanced nasopharyngeal carcinoma.

BACKGROUND: Previous results from our trial showed that adding oxaliplatin to radiotherapy (RT) increased survival in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) at 2 years. Here, we present the data of long-term efficacy and late toxic effects. PATIENTS AND METHODS: Between January 2001 and January 2003, 115 Patients with nonkeratinizing/undifferentiated locoregionally advanced NPC were randomly to receive either RT alone (n = 56) or plus concurrent oxaliplatin 70 mg/m(2) weekly for six cycles (n = 59). RESULTS: After a median follow-up of 114 months (range 18-139 months), the 5-year overall survival (OS) and metastasis-free survival (MFS) rates in the concurrent chemoradiotherapy (CCRT) group were significantly higher than those observed in the RT-alone group (OS, 73.2% versus 60.2%, P = 0.028; MFS, 74.7% versus 63.0%, P = 0.027). However, CCRT did not improve locoregional failure-free survival significantly. Subgroup analyses showed that the superiorities of CCRT mainly existed in the T3-4N0-1 stage subgroup (OS: HR = 0.394, P = 0.034). The grade 3/4 late toxic effects were similar in the two groups. CONCLUSION(S): The long-term follow-up data confirms the role of CCRT as a treatment of locoregionally advanced NPC. Oxaliplatin can be considered as an alternative optional therapeutic regimen for these patients due to its high efficiency and low toxic effect.

Treatment results and late complications of 556 patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone.

The aim of this study was to investigate the outcome in 556 patients with locally advanced nasopharyngeal carcinomas treated by radiation therapy alone. We observed 556 patients with stage T3-4 and N0-3 carcinoma who were treated by conventional radiotherapy alone between January and December 1999. The total dose delivered to the nasopharynx was 66-80 Gy over 6.5-8 weeks and to the neck lymph nodes 60-70 Gy over 6-7 weeks. The 5-year actuarial overall survival rate (OS) reached 66.41%. The OS was higher among stage T3 patients than among stage T4 patients (69.12% vs 58.96%, p = 0.0359). Among patients with stage N0, N1, N2 and N3 disease, the OS was 73.98%, 65.96%, 57.58% and 29.39%, respectively (p = 0.0009). Differences in disease-free survival, locoregional control rate and metastasis-free survival rate among each N stage were statistically significant, although this was not true of differences between stage T3 and T4 disease. Multivariate analysis showed that gender, age, T stage and N stage were significant prognostic factors for 5-year overall survival, disease-free survival, locoregional control and metastasis-free survival. We found that N stage is the dominant prognostic indicator for patients with locally advanced nasopharyngeal carcinoma receiving conventional radiation therapy alone, and that T stage was only a secondary correlative factor.

Is the 1997 AJCC staging system for nasopharyngeal carcinoma prognostically useful for Chinese patient populations?

PURPOSE: The 5th edition of the American Joint Committee on Cancer (AJCC) staging manual defines new rules for classifying nasopharyngeal carcinoma (NPC). The study was conducted to assess its effectiveness in predicting the prognosis for Chinese patient populations. METHODS AND MATERIALS: Between June 1993 and June 1994, 621 consecutively admitted patients with nondisseminated NPC were treated with definitive-intent radiation therapy alone. All had computed tomography of the nasopharynx, skull base, and the upper neck. A computer database containing all information for staging was formed on presentation. The extent of disease of each patient was restaged according to the 1997 AJCC system. RESULTS: Of the 621 patients, The 5-year overall survival (OS) rate was 60%. The 1997 AJCC system creates subgroups (Stages I to IV) that are assigned to 38 (6.1%), 270 (43.5%), 157 (25.3%), and 156 (25.1%) patients, respectively. The incidence of parapharyngeal extension was 74.1% (460/621). Of these patients (460) with parapharyngeal extension, 310 (67.4%) patients were classified as T2b disease. The 1997 AJCC system showed highly significant differences between the overall stages for both OS and relapse-free survival (RFS). The 1997 AJCC T classifications showed significant correlation with local failure, and N classification was accurate in predicting FDM. Multivariate analysis showed that paraoropharyngeal involvement was an independently significant prognostic factor for OS, freedom from local recurrence (FLR), and freedom form distant metastasis (FDM). CONCLUSION: The 1997 AJCC staging system for NPC is prognostically useful for Chinese patient populations. We proposed that subdivision of parapharyngeal extension should be included in future revisions of the staging system.

MRI-T2 values in the differentiation of recurrence and fibrosis after radiation of nasopharyngeal carcinoma.

The possibility of T2 values in the differentiation of local recurrence and irradiation fibrosis was studied prospectively in 36 patients with nasopharyngeal carcinoma (NPC) after radiotherapy. All the patients had a soft-tissue mass in the nasopharynx demonstrated by CT. Fourteen patients had tumor recurrence, 20 radiation fibrosis, 1 postradiation edema, and 1 inflammatory change. The control group consisted of 8 patients with untreated NPC. It was found that T2 was longer in patients with tumor than in patients with radiation fibrosis. We conclude that MRI may be used as a noninvasive method for differentiating radiation fibrosis from local recurrent NPC, but the prolonged T2 value of tumor is not specific and may be seen in radiation edema and infection.