Progress of research on renal disease in multiple myeloma / 白血病·淋巴瘤

The spectrum of renal lesions that was seen in patients with myeloma include myeloma kidney, or cast nephropathy; light chain (AL) amyloidosis; monoclonal Ig deposition disease(MIDD); and less frequently, cryoglobulinemic glomerulonephritis and proliferative glomerulonephritis.ln native renal biopsy studies of patients with myeloma and renal disease, 40 % to 63 % had east nephropathy, 19 % to 26 % had light-chain deposition disease, 7 % to 30 % had amyioidosis, and 1% had eryoglobulinemie renal disease. The renal pathology of cast nephropathy, MIDD, and amyloidosis was diverse.Extrarenal manifestations of MIDD, as with amyloidosis, were frequent, the incidence of renal insufficiency and ESRD was high.The morbidity and mortality were a significant increase.Patient and renal survival were significantly worse in patients with coexisting nephropathy.Therapy of renal lesions with myeloma was similar to that for multiple myeloma and consisted of chemotherapy alone,and treated renal insufficiency with hemodialysis and peritoneal dialysis, and used of high-dosage chemotherapy followed by ASCT to reduced the level of light-chain production.

Detection of metallo-β-lactamase produced by clinical Chryseobacterium spp.and their genotypes / 中华检验医学杂志

Objective To investigate the antibiotic resistance and the phenotype and genotype of metallo-β-lactamase in clinical isolates Chryseobacterium spp.Methods The MIC of 18 antibiotics in 50 Chryseobacterium spp.isolates was detected by agar dilution method.Phenotype of metallo-β-laetamase was detected by three-disc synergy test and modified three dimension test.Polymerase chain reaction(PCR)detection for metallo-β-lactamase gene was conducted for all isolates,and then the DNA sequence analysis was conducted for the PCR products which are positive for metallo-β-lactamase and identify genotype.conjugation experiment was used to study the transmission of metallo-β-lactamase encoding gene.pIs of β-lactamase was measured by isoelectric focusing assay. Results The antibiotic resistance of 50 clinical isolates of Chryseobacterium spp.against imipenem,Meropenem was 82.0%and 82.0%respectively.However,these isolated had high resistance to gatifloxacin.levofloxacin and rifampin compared with other antibiotics.Phenotype detection showed 33 isolated produced metallo-β-lactamase using three-disc synergy test and modified three dimension test,and the incidence of producing metallo-β-lactamase was 66.0%.Twenty isolateds producing Chryseobacterium indologenes were detected to have metallo-β-laetamase genotype by PCR amplification,among them 9 isolates containing blaIND-1 genotype and 10 isolateds containing blaIND-2 genotype.Strain CI-25 was identified to represent blaIND-LIKE genotype.Fourteen Chryseobacterium meningosepticum were detected to have metallo-β-lactamase genotype by PCR amplification,including 15 blaB and 2 blaGOB. The number of strain producing blaB1,blaB2,blaB3 and blaB11 in Chryseobacterium meningosepticum was 2,5,4 and 4,respectively. Conjugation experiments showed that metallo-β-lactamase encoding gene cannot be transfered. The extracted plasmid of 4 strains did not harbor metallo-β-lactamase gene.Strain C-5 was proved to have blaIND-1 gene,but its phenotype and IEF of metallo-β-lactamase was negative.Conclusions Chryseobacterium spp.had high frequency of multidrug resistance and high incidence for producing metallo-β-lactamase,and thus it was difficult to be treated.The gene of metallo-β-lactamase located on chromosome of Chryseobacterium spp.and cannot be transfered.There was negative or low lever of expression of blaIND-1.

The mechanism of severe acute pancreatitis-associated ascetic fluid production and its influence on body / 国际外科学杂志

Acute pancreatitis is one of the common clinical diseases in emergency.The severe acute pancreatitis-associated ascetic fluid is always found in clinic.Its roles related multiple organ dysfunction(MOD)in acute pancreatitis is being understood.In this article，the possible compositions of the ascites，the mechanism of its formation，and its effect on body are recited，in order to better understand the mechanism，the prevention and the treatment of the acute pancreatitis and its compications related MOD.

Diagnosis and treatment of traumatic diaphragmatic rupture / 中华创伤杂志

Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.

Clinical study of selective multifetal pregnancy reduction in second trimester / 中华妇产科杂志

Objective To investigate the operative indication,timing,method,selective standards of fetieided fetus and the number of reduced fetuses of selective multifetal pregnancy reduction in second trimester,and the pregnancy outcome of multifetal pregnancy by this operation.Methods Trans-abdominal selective multifetal pregnancy reductions in 37 cases of multiple pregnancy (twins 6 cases,triplets 21cases, quadruplets 8 cases,and quintuplets 2 cases) during 12~(+1) -25 weeks were performed under ultrasound guidance.The fetus to be reduced was injected potassium chloride (KC1) intraeardiacally until the fetal heartbeat stopped gradually.Totally 46 fetuses were reduced.Periodic prenatal examination and monitoring of coagulation function were carried out after the procedure.The pregnancy complications and pregnancy outcome of all cases were recorded.Results (1) The successful ratio of reduction was 100% (46/46 fetuses) and the successful pregnancy ratio was 88.9% (24/27).(2) Among all the 37 cases,fifteen deliveried after 36 weeks,seven deliveried in 32-36 weeks,three deliveried in 28-32 weeks,two aborted after feticide,and ten cases were in pregnancy at the time of this study.The mean gestational age of all was (34.9?4.1) weeks,and the delivery ratio after 28 weeks was 92.6% (25/27).(3) The mean birth weight of singletons was (3014?640) g,and of twins was (2557?573) g.The neonates of three triplets all died except for in one case two fetuses were alive.(4) Except in two cases after reducing one fetus of monoamniotie twins,another one died within 24 hours,the remaining fetuses were all alive.(5) Pre- eclampsia occurred in three cases.None of the cases had blood coagulation disturbances.Conclusion (1) Selective muhifetal pregnancy reduction in second trimester can feticide the abnormal fetus objectively or reduce the fetal number effectively.It is a safe procedure to decrease the complications of multifetal pregnancy and increase the birth weight.(2) ff the intention is reducing the fetal number,we choose the fetus who lies in the fundus uteri and reduce the muhifetal pregnancy to twins.(3) It is advised to aviod performing the procedure during vaginal bleeding.We reduce fetus after vaginal bleeding stops for one or more weeks.(4) Selective second-trimester multifetal pregnancy reduction will not result in the disturbance of blood coagulation and the death of remaining fetus.The incidence of pre-eclampsia is decreased after muhifetal pregnancy reduction.