A case of Klinefelter’s syndrome with type 1 diabetes mellitus

Klinefelter’s syndrome (KS) is the most common sex chromosome disease in men. Classical features of the syndrome include a eunuchoidal body habitus, small testes and hypergonadotrophic hypogonadism. There has been an increased risk of diabetes mellitus and autoimmune disease for KS patients. This paper reports a case of KS in association with type 1 diabetes mellitus. The patient was a 21-year-old man, who has been confirmed by absolute insulin deficiency and positive IA-2 autoantibody. The hyperinsulinemic euglycemic clamp test indicated his insulin sensitivity in normal range, and his blood glucose was controlled well by the insulin therapy.

     

Modified arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon

The long head of the biceps tendon （LHBT） pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O＇Brien＇s technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.     

Blastomycosis in China: a case report and literature review

Blastomycosis is a fungal disease that is endemic in parts of North America. It is very rare in China and also commonly misdiagnosed, often as cancer or other infectious diseases. The clinical profile of a case of disseminated blastomycosis with pulmonary changes and skin ulcers was described. He had been misdiagnosed with tuberculosis, after adequate therapy with a lipid formulation of amphotericin B, followed by itraconazole, the lung and skin lesions improved. Then the five cases reported in China and literatures were reviewed. The aim of this report was to improve the knowledge regarding blastomycosis for physicians in China to avoid delaying adequate therapy.

     

A case of Klinefelter's syndrome with refractory asthma,diabetes mellitus and rib fracture

To the editor:We read with a great interest the article by Cai et al.1 They described a good case of Klinefelter's syndrome (KS) with diabetes mellitus (DM).KS is a common abnormality of the sex chromosome,characterized by small testicles,sparse body hair,gynecomastia and hypogonadism in men with two or more X chromosomes.There has been an increased risk of DM,osteoporosis2 and autoimmune disease 3 for KS patients.We report a KS patient accompanying refractory asthma,DM and osteoporosis with a rib fracture. A 43-year-old man was admitted to our hospital for an acute exacerbation of asthma in November 2010.He has suffered from asthma from an age of 3 years,and has been steroid dependent in the past 5 years.Prednisone 20 mg/d alleviated his symptoms and reduced incidences of recurrent attacks.He had a past history of type 2 DM and rib fracture without any trauma.     

Resolution of cystic adventitial disease of the popliteal artery after unsuccessful treatment of percutaneous transluminal angioplasty

Cystic adventitial disease (CAD) is a rare condition characterized by cystic lesions of the non-axial blood vessels adjacent to joints;1 the majority of cysts are in the lower limb,with popliteal artery predominance.Here,we report a case of cystic adventitial disease in a 47-year-old man who was misdiagnosed and performed percutaneous transluminal angioplasty (PTA) in other hospital.He was eventually treated successfully with incision and evacuation of the popliteal cyst and ligation of communicating channels to the knee joint and remains asymptomatic 1 year later.     

Increasing awareness of recognition of chronic obstructive pulmonary disease

The medical community should, by now, be well aware of the importance of chronic obstructive pulmonary disease （COPD）, an increasingly common condition with high morbidity and mortality. In modern terms, COPD has come to signify concurrent chronic bronchitis, asthmatic bronchitis and emphysema. Cigarette smoking has long been recognized as the predominant aetiological agent. Arterial hypoxaemia, a frequent complication of COPD, can lead to pulmonary hypertension and cor pulmonale. COPD affects over 5% of the adult population and is the only major cause of death whose morbidity and mortality are increasing in several countries. In China, it is difficult to quantify how many people are affected with COPD. However, a recent epidemiological survey indicated that COPD prevalence was 8.2% in China. COPD prevalence in men was significantly higher than in women （12.4% cf 5.1%）. The prevalence in rural areas was higher than that in urban areas （8.8% cf 7.8%）. Of patients with COPD, 61.5% were smokers. The report also stated that COPD is the major cause of death in rural areas in China and the fourth leading cause of death in urban areas, rising to the third leading cause of death by 2020. The prevalence of the disease increases with age with highest rates seen in people over the age of 70 years. COPD is the only major cause of mortality with a rising incidence and prevalence worldwide, rendering it an increasingly worrisome.     

Effect of antimicrobial agents on the toll-like receptors and inflammatory cytokines in liver tissue of the alcohol-induced liver disease in rats with Vibrio vulnificus sepsis

Background Septicemia and inflammation-mediated septic shock caused by Vibrio vulnificus （VV） is strongly associated with chronic liver disease. This study examined the effects of antimicrobial therapy on expression of hepatic toll-like receptors and inflammatory cytokines in rats with alcohol-induced liver disease complicated by VV sepsis. Methods Male Sprague-Dawley rats were assigned to the following treatment groups： normal control （N）, alcoholic liver disease control （A）, antimicrobial-treated alcoholic liver disease control （AA）, alcoholic liver disease with VV sepsis （AV）, and antimicrobial-treated alcoholic liver disease with VV sepsis （AVA）. Alcohol-induced liver disease was observed in all groups except N. Expression of mRNAs encoding hepatic toll-like receptors 2 and 4, myeloid differentiation protein-2, tumor necrosis factor-α （TNF-α）, interleukin （IL）-1β, IL-6 and IL-10 was determined by RT-PCR. Results mRNAs encoding toll-like receptors 2 and 4 and myeloid differentiation protein-2 were significantly up-regulated in group AV as compared to control groups at 2-24 hours of sepsis; peak expression occurred at 12 hours. These mRNAs were also up-regulated in group AVA but to lesser degrees than in group AV at comparable time post-infection, mRNAs encoding TNF-α, IL-1β and IL-6 were significantly elevated in group AV as a function of infection. In group AVA as compared to AV, expression of TNF-α and IL-1β mRNAs was lower at 12-24 hours post-infection and expression of IL-6 mRNA was lower at 24 hours post-infection. Compared with control groups, IL-10 mRNA expression in group AV was markedly higher at 12-24 hours of sepsis. Expression of IL-10 mRNA was lower in group AVA as compared to AV at 24 hours of sepsis. Conclusions Antimicrobial therapy reduces expression of toll-like receptors and cytokines in rats with alcohol-induced liver disease complicated by VV sepsis. Monitoring hepatic toll-like receptor and cytokine expression during antibiotic therapy may be valuable for determining the course of VV sepsis in subjects with liver disease.     

Radiofrequency ablation of hepatic paragonimiasis: a case report

HEPATIC paragonimiasis is a rare disease with non-specific manifestation,which is often misdiagnosed in clinical practice.Long-time drug therapy treating this disease would be accompanied by the possible development of side effects.Given the fact that this disease has seldom been reported in the literature,we provide in this article a detailed report of one case with hepatic paragonimiases treated by radiofrequency ablation,which brought favorable outcome,aiming to shed some light on the understanding of this rare condition.     

A MYCOLOGICAL STUDY OF A CASE OF OTOMYCOSIS

Since Schwartze(I) first reported a case of otitis externa as being caused by aspergillus, various kinds of fungus have been found to cause aural disease. Sporothrix was isolated from the external ear by Bahre and Hansen(2) and streptothrix by Martin (3) Cann and Hollis (4) demonstrated the presence of actinomyces in a case of external otitis and Chisolm (5) and Gill (6) found several strains of mucor, aspergillus and penicillium in a series of cases of ear infections. According t。 Hatch(7) and Fort (8) otomycosis is rather common in the tropics, espe- cially in India and southern Florida. On the European continent, re- ports of the disease are infrequently seen, and in China there has not been a single case reported.     

人猪链球菌病的研究现状

人猪链球菌病是由人感染猪链球菌而引起的新发传染病，荚膜2型猪链球菌为主要病原。病猪和带菌猪是人猪链球菌病的主要传染源，夏秋季多发。人猪链球菌病的自然病程可分为潜伏期、前驱期、进展期和恢复期，人猪链球菌病可分为普通型、休克型、脑膜炎型和混合型。抗菌药物治疗有效，休克型的病死率高。     

猪链球菌2型中国强致病株05ZYH33荚膜缺陷菌株的构建

目的 构建猪链球菌2型(Streptococcus suis serotype 2,S.suis 2)中国强致病株05ZYH33荚膜缺陷株.方法 利用同源重组基因敲除方法 获得S. Suis 2强毒株05ZYH33荚膜合成基因cps2B敲除突变株,通过小鼠攻毒实验证实荚膜缺陷株对细菌毒力的影响.结果 PCR和Southern杂交结果均显示cps2B基冈完全被壮观霉素抗性基因替代,表明基因敲除突变体构建成功.电镜结果证实突变体荚膜合成能力缺失,小鼠致病性实验结果显示突变体毒力基本丧失.结论 成功构建05ZYH33荚膜缺陷株,提示菌体荚膜多糖成分对于猪链球菌2型侵袭和致病具有显著作用.     

猪链球菌2型感染的临床特征和治疗效果分析

目的 分析猪链球菌2型感染部分病例的临床特征及治疗效果.方法 回顾分析68例2005年夏季四川省猪链球菌2型感染的临床及病原学确诊的患者资料,从流行病学、临床特征及治疗效果等方面进行总结和分析.结果 猪链球菌2型感染流行于6～8月,传染源主要为猪,易感人群主要为农民,常见的暴露方式为宰杀、洗切病/死猪肉.临床表现为急起畏寒、发热、头昏、头痛、全身不适及疼痛,重者出现休克及昏迷.临床类型主要有单纯败血症型、休克型、脑膜炎型及混合型4型.所分离的猪链球菌2型均对四环素耐药,对其它多种抗菌药物均敏感.本组68例患者治疗后总有效率为76.5%(52/68),病死率为23.5%(16/68).有休克的患者治疗后有效率为42.3%(11/26),病死率为57.7%(15/26).化脓性脑膜炎患者治疗的有效率为97.5%(39/40).结论 猪链球菌2型感染的主要临床表现为化脓性脑膜炎和休克.治疗效果以脑膜炎型为好,休克型及混合型差,病死率高.     

An Australian case of Streptococcus suis toxic shock syndrome associated with occupational exposure to animal carcasses

Streptococcus suis is known to cause sporadic infections in people who have occupational exposure to pigs and pig meat. A large outbreak occurred in China in 2005, where there was 62% mortality among those who developed toxic shock syndrome. Despite S. suis being common in pigs, this is the first published report of a human case of S. suis toxic shock syndrome in Australia.     

2-型猪链球菌保护性抗原RfeA的B细胞表位预测

以2-型猪链球菌(SS2)保护性抗原RfeA推定的氨基酸序列为基础,采用Kyte-Doolittle法分析蛋白的亲水性,Emini法预测蛋白的表面可能性,以及Jameson-Wolf法预测蛋白的抗原指数;辅以Garnier-Robson法、Chou-Fasman法和Karplus-Schulz法对蛋白二级结构中柔性区域...     

2型猪链球菌89K致病岛进化途径分析

目的分析2型猪链球菌89K致病岛的结构特征,探索其进化历程。方法通过BLAST比对,获取89K致病岛的同源序列,构建其同源序列数据库;分析89K致病岛的碱基组成特征,寻找重组热点区域,并对89K进行分区;对各ORF进行功能预测,划分功能模块;对89K致病岛与其同源序列进行系统发育分析及共线性分析,推测其可能的进化历程。结果 89K致病岛可分为4个保守区,4个主要的非保守区及一段Tn916转座子,呈现多个异源序列相嵌合的结构特征。功能分析发现保守区基因主要参与致病岛的横向转移及其在宿主菌基因组中的稳定,保守区的基因呈现出进化上的一致性,且在某些菌株中保守区以连续状态存在。结论保守区在祖先状态时是一个连续整体,不同来源的非保守区经过多次水平转移和重组事件插入到保守区之间,形成了89K致病岛的嵌合结构。     

2005年广东省临床分离猪链球菌的MLST分子分型研究

在2005年四川发生猪链球菌人间感染疫情期间.广东省也加强了监测,并发现了5个散发感染病例.从这5个住院临床病例中,分别分离了5个致病性SS2.通过测定猪链球菌基因组上的7个看家基因dpr、thrA、cpn60、recA、gki、aroA和mutS的部分片段.对这5个猪链球菌进行了多佗点测序分型.通过对上述测序片段进行比对分析发现,5个菌株的dpr、cpn60、recA、gki、aroA和mutS等6个基因片段完全相同;而thrA基凶片段存在两个等位基因型即thrA-c和thrA-h,在该等位基因片段的360位的亮氨酸码子第三位发生了一个中性突变(TTA→TTG).MLST分析结果显示,广东省的临床猪链球菌分离株L-SS002、L-SS003和L-SS005菌株.与四川疫情株相同,属于ST7型;而L-SS004和L-SS006,与香港地区发现的猪链球菌相同,属于ST1克隆;但这5个菌株亲缘关系极近,都属于ST1克隆复合物;这一点与四川省暴发的人间猪链疫情明显不同,后者仅由单一的ST7猪链球菌克隆引起.属于ST7的克隆菌株很可能来源于四川;而其余两个ST1克隆系菌株的来源尚待鉴定.     

PCR技术在附红细胞体感染模型中的应用

大鼠异位心脏移植模型被认为是移植免疫机制研究及药物实验的最常用的动物模型。同其它器官移植比较,它具备手术简单、手术所用时间短及移植物易于观察等优点。作者在Heron等[1]吻合血管的基础上,进行改良,实行大鼠颈部异位心脏移植60次,建立了稳定、可靠的异位心脏移植模型。本文探索该手术操作中的密切配合和围手术期     

海南省首例人感染猪链球菌病流行病学调查

目的 对海南省首例人感染猪链球菌病例进行流行病学调查分析,为制定防控措施提供依据。方法 通过现场访谈,调查病例发病史、感染途径、感染来源;利用VITEK2-compact全自动微生物检验方法,对15份病例血液培养菌,生猪肉、猪鼻拭子、内脏及血液进行检测。结果 病例男性,41岁,泥水工,2017年1月28日发病,临床表现及特征主要为发热、畏寒、气促,腹泻、呼吸不畅,面色潮红、四肢紫绀、全身疼痛、四肢无力等。病情重、进展快、病程短,因多器官功能衰竭（MOF）于2月8日抢救无效死亡。病例发病前屠宰生猪时手指切割受伤。在病例的血液,屠宰生猪肉,以及所屠宰生猪同圈其他生猪的鼻拭子中均培养出猪链球菌。结论 该病例为海南省首例人感染猪链球菌病病例;感染途径为被感染猪链球菌的生猪肉通过伤口感染。建议医疗机构发现休克、败血症病例,应尽快开展血病原菌培养,详细询问猪接触史和尽快控制中毒性休克,可以降低死亡率;防控策略主要是加强病例监测,加大畜牧检疫,从严查处私宰行为,广泛开展健康宣传教育工作,增强人民群众防护意识。     

湖南省首例人感染猪链球菌病的病原分离与鉴定

目的 研究猪链球菌的生物学特征，为病例诊断、治疗以及疫情控制提供科学依据。方法 对患者血液和脑脊液用脑心肉汤增菌，再接种羊血琼脂平板进行分离培养，并对分离的菌株做血清凝集，用API 20 Strep生化条进行生化鉴定，用PCR技术检测猪链球菌菌种基因、荚膜多糖编码基因、溶菌酶释放相关蛋白基因及溶血素基因。结果 从患者的脑脊液和血液中均分离出链球菌，经鉴定均为猪链球菌2型，猪链球菌菌种基因、荚膜多糖编码基因、溶菌酶释放相关蛋白基因及溶血素基因均为阳性。结论 经生物学特征分析，患者为猪链球菌2型的实验室确诊病例。