Ineffective communication equals no communication: a case report of splenic hyperfunction combined with pseudothrombocytopenia.

Thrombocytopenia may be caused by diseases of various organ systems, especially the blood system. Certain drugs may also cause thrombocytopenia. In addition, it can result from various causes of pseudo-reduction. Therefore, a correct understanding of the causes of thrombocytopenia and their underlying mechanisms has important significance for clinical diagnosis and treatment. This study aimed to report a case of a 68-year-old woman with left upper abdominal mass and loss of appetite. The auxiliary examination showed splenomegaly and thrombocytopenia. The clinician planned to perform splenectomy. However, the laboratory physician considered that thrombocytopenia might be ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP). After effective communication between laboratory physicians and clinicians, the patient was diagnosed with splenic hyperfunction and pseudothrombocytopenia, and finally saved from undergoing splenectomy. The patient has a good prognosis after oral medication. Thrombocytopenia in this patient is caused by both hypersplenism and EDTA antagonism which is different from a single factor in other reports. The diagnosis of hematological abnormality may be challenging for physicians, especially thrombocytopenia. Therefore, medical staff should possess a rigorous working style and a high sense of responsibility besides maintaining high professional quality. Further, they should actively, timely, and effectively communicate with auxiliary departments to avoid misdiagnosis and missed diagnosis.

Distribution of Carbapenemases and Efflux Pump in Carbapenem-resistance Acinetobacter baumannii.

Acinetobacter baumannii has emerged as an important pathogen related to serious infections and nosocomial outbreaks around the world. In this study, 100 isolates of carbapenem-resistance in Acinetobacter baumannii (CRAB) were collected from clinical specimens. Agar dilution was conducted to determine the minimum inhibitory concentrations (MICs) for 15 kinds of antibiotics. Genes of carbapenemases and efflux pumps were amplified by PCR. The expression difference of pump genes was analyzed by real-time PCR between CRAB and carbapenems-sensitive Acinetobacter baumannii (CSAB). We found that most antibiotics, including aminoglycosides, fluoroquinolones, and cephalosporins showed high MIC values in CRAB. All isolates were sensitive to polymyxin B. Among the CRAB specimens, 54, 32 and 16 isolates were positive for SHV-12, PER-1 and TEM-1, respectively. 86 isolates were positive for OXA-23. 55 and 33 isolates carried adeB and adeJ genes, respectively. The expression level of adeB in CRAB was ten times higher than that in CSAB. We speculate that SHV-12, PER-1, TEM-1, OXA-23 and the AdeABC efflux pump may participate in high-level carbapenems resistance in Acinetobacter baumannii Moreover, adeE may be related to low-level resistance of carbapenems and quinolones in Acinetobacter baumannii.

BUB1 promotes proliferation of liver cancer cells by activating SMAD2 phosphorylation.

Budding uninhibited by benzimidazoles 1 (BUB1) is a mitotic checkpoint serine/threonine kinase that has been reported as an oncogene or tumor suppressor gene in various types of cancer, including breast cancer, pancreatic ductal adenocarcinoma, prostate and gastric cancers. However, its role in liver cancer remains unclear. The present study aimed to explore the biological function of BUB1 in liver cancer. The present study demonstrated that BUB1 mRNA expression levels and the intensity of immunohistochemical staining were significantly increased in liver cancer tissues compared with normal tissues. The role of BUB1 in cell proliferation was also determined. Overexpression of BUB1 significantly promoted cell proliferation, whereas knockdown of BUB1 expression inhibited the proliferation of liver cancer cell lines. In experiments investigating the underlying mechanism, overexpression of BUB1 increased the levels of SMAD2 phosphorylation, whereas knockdown of BUB1 reduced the levels of SMAD2 phosphorylation. Therefore, BUB1 may promote proliferation of liver cancer cells by activating phosphorylation of SMAD2, and BUB1 may serve as a potential target in the diagnosis and/or treatment of liver cancer.

Mutation of CarO participates in drug resistance in imipenem-resistant Acinetobacter baumannii.

OBJECTIVE: Acinetobacter baumannii has become an important problem because of the high drug resistance rate. The aim of this study was to assess the antimicrobial resistance profile and explore the role of membrane porin in imipenem resistance of A baumannii. METHODS: A total of 63 isolates of imipenem-resistant A baumannii (IRAB) and 21 of imipenem-sensitive A baumannii (ISAB) were collected. Susceptibility testing to 16 kinds of antimicrobial agents was conducted by K-B method. PCR technique was used to detect carO and oprD genes, and sequencing was performed to compare the sequence between IRAB and ISAB. Three-dimensional structure model of CarO protein was established. RESULTS: While ISAB isolates presented sensitive to most classes of antibiotics, isolates of IRAB displayed much higher resistance rate except tigecycline (3.2%), cefoperazone/sulbactam (28.6%), and minocycline (30.2%). All 84 isolates were observed carrying both carO and oprD genes. Further sequencing revealed important mutations of carO gene existed in IRAB in comparison with ISAB. Meanwhile, significant differences in three-dimensional structure of carO protein molecule were also found between IRAB and ISAB. CONCLUSIONS: The drug resistance profile of IRAB is increasingly severe in clinical settings. Mutation of CarO was identified as one of the molecular mechanisms involved in imipenem resistance in A baumannii.

Age-related changes in CD4+CD25+FOXP3+ regulatory T cells and their relationship with lung cancer.

OBJECTIVES: CD4+CD25+FOXP3+ regulatory T cells (Treg) inhibit the anti-tumour immune response and reduce the effect of cancer immunotherapy. Although studies have demonstrated that the number and suppressive activity of Treg increase with age, it is not clear whether these changes correlate with a higher incidence of tumours in the elderly. This study was designed to explore the relationship between increase in CD4+CD25+FOXP3+ Treg and the higher risk of lung cancer in the elderly. METHODS: Seventy lung cancer patients and 60 sex- and age-matched controls were recruited. Both groups were divided into three subgroups based on their age (young, middle-aged, or elderly). The proportion of CD4+CD25+FOXP3+ /CD4+ T cells was detected using flow cytometry, and the level of FOXP3 mRNA in the peripheral blood was examined with real-time RT-PCR. RESULTS: The levels of CD4+CD25+FOXP3+/CD4+ T cells and FOXP3 mRNA were significantly higher in lung cancer patients than in healthy controls (t = 7.16, P < 0.01 and t = 3.65, P < 0.01, respectively). Within the healthy groups, the elderly group had larger proportion of CD4+CD25+FOXP3+ Treg (F = 32.54, P < 0.01) and higher FOXP3 mRNA expression (F = 4.76, P < 0.01) than their younger counterparts. Among the six subgroups, the elderly lung cancer patients exhibited the highest levels of both CD4+CD25+FOXP3+ Treg (11.81 ± 2.40%) and FOXP3 mRNA (3.14 ± 1.30). CONCLUSIONS: The accumulation of CD4+CD25+FOXP3+ Treg with age correlates well with the increasing incidence of lung cancer in the elderly.

Study of the correlation of imipenem resistance with efflux pumps AdeABC, AdeIJK, AdeDE and AbeM in clinical isolates of Acinetobacter baumannii.

BACKGROUND: To investigate the role of efflux pumps AdeABC, AdeIJK, AdeDE and AbeM in reduced susceptibility to imipenem in clinical isolates of Acinetobacter baumannii. METHODS: Susceptibility testing was conducted by the agar dilution method. The presence and expression of pump genes were analyzed by conventional PCR and real-time RT-PCR, respectively. RESULTS: Most antibiotics, including carbapenem, aminoglycosides, fluoroquinolones and cephalosporins showed high minimum inhibitory concentration (MIC) values in imipenem-resistant A. baumannii (IRAB). After exposure to the efflux pump inhibitor Phe-Arg-ß-naphthylamide, a 4- to 32-fold reduction of imipenem MICs was observed in 33 (66%) isolates of IRAB, while no significant decrease occurred in imipenem-susceptible A. baumannii (ISAB). The majority of IRAB isolates (>80%) were found to be positive for adeB, adeR, adeS, adeJ and abeM. Positive adeE was discovered in 6 isolates of IRAB and coexisted with adeB. Approximate 4-, 3- and 11-fold increases in adeB, adeJ and abeM expression were observed, respectively, in IRAB compared to those in ISAB. CONCLUSIONS: A variety of efflux pump systems, including AdeABC, AdeIJK and AbeM, seem to play important roles in the resistance to imipenem of A. baumannii. Moreover, this is the first time that adeE has been found to coexist with adeB in a small number of isolates of A. baumannii.