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A case of Streptococcus suis sepsis and streptococcal toxic shock syndrome diagnosed by metagenomic next-generation sequencing (mNGS) was presented. A 50-year old male patient visited Zengcheng Branch of Nanfang Hospital on June 25th, 2021. The patient developed fever, dizziness and shock with typical epidemiological history. mNGS revealed Streptococcus suis in blood sample. The diagnosis of Streptococcus suis sepsis and streptococcal toxic shock syndrome were made. Meropenem was given as empirical antibiotics. Antibiotics were adjusted to meropenem and clindamycin while Streptococcus suis was detecting by mNGS and downgraded to piperacillin/tazobactam and clindamycin when symptoms improved. The diagnosis was then confirmed by blood culture. The patient developed dry gangrene and sudden deafness in the later stage and was discharged after treatment. Compared with traditional diagnostic techniques, mNGS has advantages such as timeliness and accuracy, and plays a key role in the field of severe infections and rare pathogen infections. It is suggested that combining mNGS and traditional diagnostic techniques have the advantages for early diagnosis and early treatment.
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Objective@#To investigate the effect of silencing human leukocyte⁃associated antigen⁃G ( HLA⁃G) expression in the chorionic trophoblast cell line JEG⁃3 cells under hypoxic conditions on the biological function of JEG⁃3 cells and through the hypoxia response pathway of endothelial PAS1 region protein 1 (EPAS1)is involved in the molecular mechanism of preeclampsia under high altitude hypoxia. @*Methods@#The expression of HLA⁃G in JEG⁃3 cells was inhibited by transfection of small interfering RNA (siRNA) . The JEG⁃3 cells after transfection were divided into four groups : normoxic control group , hypoxic control group , normoxic inhibition group , and hypoxic inhibition group. CCK⁃8 test and Transwell test were used to detect the proliferation and invasion ability of the cells in four groups ; The effects of four groups of apoptosis and cell cycle were detected by flow cytometry; HLA⁃G and EPAS1 mRNA and protein expression levels were detected by real⁃time fluorescence quantitative PCR ( qPCR) and Western blot.@*Results @#① Compared with the normoxic control group , hypoxic control group , normoxic inhibition group , and hypoxic inhibition group could reduce the proliferation activity and invasion ability of JEG⁃3 cells , and significantly increase the apoptosis rate. The hypoxic control group and hypoxic inhibition group also produced anobvious necrotic cell population ; Under the condition of hypoxia , after reducing the expression of HLA⁃G , the cell necrosis rate was further aggravated ; Whether under normoxia or hypoxia , inhibition of HLA⁃G expression caused the cells to be blocked in the G1 phase. ② Compared with the normoxic control group , hypoxia control group , normoxic inhibition group , and hypoxia inhibition group decreased the expression of HLA⁃G protein , and hypoxia and inhibition of HLA⁃G had a synergistic effect; Hypoxia⁃inducible factors⁃2α ( HIF⁃2α ) , vascular endothelial growth factor(VEGF) and endothelin⁃1(ET⁃1) protein expression could be added , inhibition of HLA⁃G decreased the expression of inducible nitric oxide synthase( NOS2) . @*Conclusion@#In the hypoxic environment , silencing HLA⁃G may affect the biological behavior of trophoblast through the EPAS1 hypoxic response pathway and participate in the occurrence and development of preeclampsia.
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【Objective】 To explore the clinical features and the imaging diagnosis value of tuberous sclerosis. 【Methods】 We retrospectively analyzed the clinical data and imaging findings of 22 patients with tuberous sclerosis clinically diagnosed in our hospital. 【Results】 There were 12 male and 10 female patients, with the mean age of 7.3 years. Among them, 2 patients had a family history; 3 had unclear symptoms and the rest 19 ones except 1 had facial skin rashes for two years, which led to seek for medical help, and the other 18 had epilepsy attack, including 4 with mental retardation. All the 22 patients had characteristic subependymal nodules, including 21 patients with multiple abnormal changes in the bilateral cerebral hemispheres. There were 12 cases with abnormal skin appearance, 2 cases accompanied by facial cortical adenoma, 1 case with right subependymal giant cell astrocytoma, 1 case with bilateral ependymoma, 1 case with Dandy-Wallker malformation, 1 case with right renal duplication, 2 cases with renal hamartoma, 1 case with multiple renal nodules, 1 case with congenital patent ductus arteriosus, 2 cases with cardiac rhabdomyosarcoma, 1 case with multiple hepatic hamartoma, and 2 cases with multiple sclerotin sclerosis changes. 【Conclusion】 The clinical manifestations of tuberous sclerosis are complex and variable, and there are certain imaging characteristics associated with multi-organ involvement. Familiarity with the characteristics and imaging manifestations of lesions in various systems can make the clinical diagnosis more concise and accurate.
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【Objective】 To explore the clinical features of dermatomyositis and diagnostic value of MRI. 【Methods】 The clinical and imaging data of 61 patients with dermatomyositis were analyzed retrospectively. 【Results】 Among the 61 patients， there were 15 males and 46 females with the average age of 45.3 years. The course of disease was 10 days to 12 years. All of them had different degrees of skin lesions， including 57 cases of myasthenia and or myalgia， 4 cases of dysphagia， 2 cases of dyspnea， and 2 cases of drinking water and coughing. There were 18 cases complicated with interstitial lung disease， 1 case complicated with Sjogren’s syndrome， 1 case complicated with arthritis， 1 case complicated with rhabdomyolysis， and 1 case complicated with kidney damage and liver insufficiency. MRI examination performed in 46 patients with dermatomyositis detected 43 cases of abnormal manifestations， 41 cases of muscle inflammatory edema， 37 cases of subcutaneous adipose tissue edema， and 40 cases of myofascitis. 【Conclusion】 The clinical manifestations of dermatomyositis are complex and have certain imaging features. Combined with the laboratory examinations of muscle enzymes and autoantibodies， electromyography， skin and muscle biopsy， they can provide clinical diagnostic evidence. MRI is an important means to diagnose and evaluate the extent and progression of dermatomyositis.
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【Objective】 To screen nucleic acid aptamers that can specifically recognize castration-resistant prostate cancer （CRPC） cells by Cell-SELEX. 【Methods】 For Cell-SELEX selection， CRPC cell lines C4-2 were used as positive control cells， while androgen-dependent prostate cancer cell lines LNCap were used as negative control cells. The 5’end of the upstream primers was labeled with FITC， and the 5’end of the downstream primers was labeled with biotin. Single-stranded DNA （ssDNA） collected from each round of screening was used as template for PCR amplification and purification. The biotin-streptavidin magnetic bead separation was used to isolate PCR product for the next round of screening. The process of Cell-SELEX was analyzed by flow cytometry. ssDNA products of the last round were collected for PCR amplification， purification， cloning and DNA sequencing. The secondary structure of selected DNA aptamers was predicted. Dissociation constants of the two aptamers were calculated. Flow cytometry and confocal microscopy were used to evaluate selective binding of aptamers to CRPC cells and tissues. 【Results】 The binding rate of DNA products to CRPC cells gradually increased with the increase of selection cycles， reaching the highest in the last round. DNA structure prediction analysis showed that the secondary structure of aptamers CRPC-1 and CRPC-2 was mainly stem-loop structure. Flow cytometry analysis and confocal images showed that both CRPC-1 and CRPC-2 could specifically target C4-2 cells. In addition， immunohistofluorescence assay showed that CRPC-1 could specifically target CRPC tissues. 【Conclusion】 Cell-SELEX can be used to screen aptamers that specifically target CRPC cells and tissues， which provides experimental basis for early screening and targeted diagnosis of CRPC. It is of significance for treatment plan adjustment and prognosis improvement of prostate cancer.
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Objective To explore the therapeutic feasibility of uterus transplantation for uterine infertility .Methods Retrospective analysis was performed for the diagnosis ,treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed .The recipient was a 22-year-old woman with a congenital absence of uterus and vagina .Previously she underwent vaginal reconstruction and the donor was her mother . The specific procedures included donor/recipient screening , ethical argumentation ,assisted reproductive technology of obtaining frozen embryos , Vinci robot-assisted uterine procurement ,orthotopic replacement & fixation of retrieved uterus , revascularization;immunoregulation &monitoring of transplanted uterine recipient , assisted reproductive technology after transplantation and gestational management .Results The durations of donor and recipient surgeries were 360 and 530 min respectively .No complications of recipient or donor occurred during the perioperative period .First menstruation occurred at 40 days post-transplantation and regularly thereafter .Pregnancy occurred after embryo transfer at 31 months post-transplantation .No rejection episodes occurred after transplantation or during gestation .Caesarean delivery occurred near gestational week 34 .The boy weighed 2000 grams at birth and the mother remained well . Conclusions In conjunctions with literature review , uterine infertility may be treated by modified uterus transplantation .And a new path is paved for healthy pregnancy of women with uterine infertility .
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Objective@#To explore the therapeutic feasibility of uterus transplantation for uterine infertility.@*Methods@#Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management.@*Results@#The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well.@*Conclusions@#In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.
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Objective@#By analyzing the clinical features of patients with dengue fever in Guangzhou from 2015 to 2018 to furnish the reference evidences for the diagnoses and treatment of dengue fever.@*Methods@#A total of 406 dengue fever patients admitted to Zhujiang hospital during 2015 to 2018 were analyzed for the clinical manifestations and laboratory examination results, retrospectively. ZIKV, CHIKV and the serotypes of DENV were detected in some samples.@*Results@#DENV serotypes were tested in 96 dengue fever patients and 69 cases were positive. Among them, 58 cases (84.1%) were DENV-1, 10 cases (14.5%) were DENV-2, 1 case (1.5%) was DENV-3, DENV-4 was negative and no co-infection with different serotypes of dengue virus was found. Of all the 406 patients, 371 (91.4%) were diagnosed as dengue fever and 35 (8.6%) were severe cases. The most common manifestations included fever, weakness and rash. Significantly higher incidence (P<0.05) of bleeding, coughing, expectoration, vomiting and abdominal pain were found in severe dengue fever. The most common laboratory findings were leucopenia and thrombocytopenia. Significant increase(P<0.05) of total bilirubin, aspartate aminotransferase, serum creatinine, high-sensitivity C-reactive protein and procalcitonin were observed. ZIKV and CHIKV nucleic acids were tested in 380 dengue fever patients and the result were negative for both.@*Conclusions@#The incidence of dengue fever in Guangzhou increased in 2017 and 2018.Most cases of dengue fever were mild and DENV-1 was the dominant serotype.
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Objective@#To evaluate an assay permitting amplification of target 5′-untranslated region (5′-UTR) sequences directly from clinical specimens and distinction among serotypes of enterovirus (EV).@*Methods@#A total of 518 rectal swabs and 148 nasal swabs tested positive by pan-enterovirus real-time PCR were collected. 5′-UTR and the viral protein 1 (VP1) gene fragments were amplified and sequenced separately for serotyping. The inconsistent samples by 5′-UTR and VP1 serotyping were further determined by using the serotype-specific RT-PCR.@*Results@#A total of 553 (83.0%) samples were detected by 5′-UTR serotyping and 318 (47.7%) were detected by VP1 serotyping in all 666 positive specimens, and there was significant difference in the detection rates between two methods in rectal and nasal swabs (P<0.001). For the rectal swabs, the mainly detected serotypes were CoxA6 (217), CoxA16 (88), EVA71 (40), CoxA10 (28) and CoxA4 (27) by 5′-UTR serotyping. Compared with the VP1 serotyping, the sensitivity and specificity of 5′-UTR serotyping were 57.1%-100% and 67.4%-98.1% respectively, with varied consistence with serotypes (kappa value 0.214-0.283). For the nasal swabs, the most frequently detected serotype was EVD68, with the sensitivity of 100%, the specificity of 91.1%, and the poor consistence (kappa value 0.217). CoxA6, CoxA16, EVA71, CoxA10 and EVD68 were further confirmed by serotype-specific RT-PCR. Using VP1 serotyping combined with serotype-specific RT-PCR as a reference method , the effect of performance of 5′-UTR serotyping on diagnosis was increased.@*Conclusions@#The performances of 5′-UTR serotyping in enterovirus vary with serotypes. The application of 5′-UTR serotyping should be considered comprehensively according to the purpose of the study.
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Objective To probe the value of 3.0T MRI in the preoperative assessment of rectal carcinoma.Methods The study recruited 41 patients who were confirmed by biopsy of rectal carcinoma and underwent conventional MRI, high-resolution MRI and diffusion weighted imaging(DWI), the distance from the inferior part of tumor to transitional skin and the percentage of circumferential invasion were measured, the tumor's T staging, N staging,and the status of circumferential resection margin(CRM) and extramural vascular invasion(EMVI) were assessed.MRI findings were compared with endoscope and postoperative pathological results.Results MRI could accurately show the distance from the inferior part of tumor to transitional skin(P>0.05);The mean percentage of circumferential invasion for the tumor with T1-T2 and T3 were 61%,83% respectively (P>0.05);The total accuracy of T,N staging diagnose were 80.5%,75.6% respectively, which had a better consistent with pathological T,N staging(Kappa=0.564,0.634);The total accuracy of CRM and EMVI diagnose were 90.2%,73.2% respectively,which had a better or moderate consistent with pathological diagnose(Kappa=0.765,0.461).Conclusion 3.0T MRI has the unique application in the preoperative assessment of rectal carcinoma, which can provide more comprehensive information for clinic.
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Objective To explore the distribution of pathogens, bacterial drug resistance, clinical features and prognosis of bacterial meningitis (BM) in children.MethodsThe clinical data of children diagnosed with BM during January 2011 to July 2015 were retrospectively analyzed. Children were divided into good outcome group and poor outcome group by the outcome at discharge. The distribution of pathogens, bacterial drug resistance, clinical features, and prognosis were analyzed among different groups.ResultsThere were included 95 children diagnosed with BM,. among whom 69 (72.6%) children had Gram-positive bacterial infections with predominantStreptococcus pneumonia (43 cases, 45.3%) and 26 (27.4%) children had Gram-negative bacterial infections with predominantEscherichia coli (13 cases, 13.7%). More than 50%Streptococcus pneumonia andEscherichia coli were resisted to penicillin. The neurological complications in children with BM included subdural effusions, hydrocephalus, cerebral parenchyma injury, and hearing and visual impairment, et.al. Multivariate logistic regression analysis showed that consciousness, coma, and low level of glucose in cerebrospinal lfuid were the independent risk factors for adverse outcome at discharge.ConclusionStreptococcus pneumonia andEscherichia coli were the predominant pathogens in children with BM with high resistance rate to penicillin. BM children may have varying degrees of neurological sequelae. The unconsciousness and low level of glucose in cerebrospinal lfuid were associated with unfavorable outcomes at discharge.