This study aimed to identify and validate prognostic genes associated with polyamine metabolism-related genes (PMRGs) in hepatocellular carcinoma (HCC), offering potential novel therapeutic targets and strategies. The HCC-related datasets and 19 PMRGs were included in this study. Prognostic genes were screened out through differential expression analysis, univariate and multivariate Cox regression analysis. Subsequently, the construction of the risk model and nomogram, as well as functional enrichment and immune infiltration analysis were carried out. Ultimately, prognostic gene expression was further validated by quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme linked immunosorbent assay (ELISA). SMOX, SRM, and SAT1 were identified as prognostic genes. risk score and stage were investigated as independent prognostic factors to construct nomogram. Moreover, the drug metabolism cytochrome p450 pathway was found had a significantly enriched in different risk groups. After that, 11 immune cells differed significantly across risk groups, with Eosinophi having the highest positive/negative correlation with SAT1/SRM, respectively. Finally, SMOX and SRM were highly expressed in the HCC group, while SAT1 showed the opposite pattern. The three genes linked to PMRGs, were identified as prognostic genes for constructing risk models, which may provide a basis for understanding HCC pathogenesis.

Primary renal lymphoma is a rare renal malignancy, and its occurrence in patients undergoing maintenance haemodialysis is even more uncommon. Herein, we report the case of a 57-year-old woman undergoing maintenance haemodialysis, presenting with gross haematuria. After performing enhanced magnetic resonance imaging, positron emission tomography-computed tomography, and a kidney biopsy, a diffuse large B-cell lymphoma was detected. She was subsequently treated with five cycles of a modified R-CHOP regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, and achieved partial remission, as evidenced by an abdominal computed tomography scan. At the 15-month follow-up, no further enlargement or metastasis of the residual tumour was evident. We emphasize that the clinical manifestations of primary renal lymphoma (PRL) resemble those of renal cell carcinoma, necessitating an imaging and biopsy-based differential diagnosis to avoid misdiagnosis. Although PRL has a highly aggressive phenotype and is associated with high mortality, early diagnosis and appropriate treatment can improve patient outcomes.

The mortality rate of secondary bloodstream infection (BSI) derived from the intestinal colonization of carbapenem-resistant Klebsiella pneumoniae (CRKP) is extremely high. This investigation aimed at clarifying the risk factors and prognosis of BSIs resulting from the initial colonisation of CRKP. In this retrospective, cross-sectional study, we analyzed the clinical data of 167 patients with CRKP colonization who received active screening during hospitalization at Zhejiang Provincial People’s Hospital from January 2019 to December 2021. The cohort consisted of 34 patients with BSI (CRKP BSI group) and 133 patients without BSI (No-BSI CRKP group).Logistic regression was employed to identify risk factors for progression from CRKP intestinal colonization to secondary BSI.Cox proportional hazards regression models were used to analyze independent risk factors for 28-day crude mortality from CRKP BSI. Multivariable analysis revealed that previous use of carbapenems (odds ratio [OR]:4.14, 95

Background: Rheumatoid arthritis (RA) is an autoimmune disease that remains incurable. An increasing number of proteomic genome-wide association studies (GWASs) are emerging, offering immense potential for identifying novel therapeutic targets for diseases. This study aims to identify potential therapeutic targets for RA based on human plasma proteome. Methods: Protein quantitative trait loci were extracted and integrated from eight large-scale proteomic GWASs. Proteome-wide Mendelian randomization (Pro-MR) was performed to prioritize proteins causally associated with RA. Further validation of the reliability and stratification of prioritized proteins was performed using MR meta-analysis, colocalization, and transcriptome-wide summary-data-based MR. Subsequently, prioritized proteins were characterized through protein–protein interaction and enrichment analyses, pleiotropy assessment, genetically engineered mouse models, cell-type-specific expression analysis, and druggability evaluation. Phenotypic expansion analyses were also conducted to explore the effects of the prioritized proteins on phenotypes such as endocrine disorders, cardiovascular diseases, and other immune-related diseases. Results: Pro-MR prioritized 32 unique proteins associated with RA risk. After validation, prioritized proteins were stratified into four reliability tiers. Prioritized proteins showed interactions with established RA drug targets and were enriched in an immune-related functional profile. Four trans-associated proteins exhibited vertical or horizontal pleiotropy with specific genes or proteins. Genetically engineered mouse models for 18 prioritized protein-coding genes displayed abnormal immune phenotypes. Single-cell RNA sequencing data were used to validate the enriched expression of several prioritized proteins in specific synovial cell types. Nine prioritized proteins were identified as targets of existing drugs in clinical trials or were already approved. Further phenome-wide MR and mediation analyses revealed the effects and potential mediating roles of some prioritized proteins on other phenotypes. Conclusions: This study identified 32 plasma proteins as potential therapeutic targets for RA, expanding the prospects for drug discovery and deepening insights into RA pathogenesis.

The aim of this study was to identify the synergistic effect and mechanisms of fosfomycin (FM) combined with colistin (COL) against KPC-producing Klebsiella pneumoniae (KPC-Kp). The bactericidal effects, induced drug resistance and cytotoxicity of FM combined with COL were evaluated by time-kill assays and mutation rate test. Time-kill assays and transcriptomics analysis were used to further clarify the mechanism of FM combined with COL. The bacteria were taken from different points in time-kill assays, reactive oxygen species (ROS), nitric oxide and redox related enzymes were detected. The mechanism of synergistic bactericidal action was analyzed by transcriptome. The bactericidal effect of FM combined with COL was better than that of monotherapy. The mutation frequency of FM alone at low dose (8 mg/L) was higher than that at high dose (64 mg/L). COL induced resistant isolates resulted in FM and COL resistance, while FM alone or combined with COL only resulted in FM resistance. The survival rate of Thp-1 cells in FM combined with COL against K. pneumoniae was higher than that of monotherapy. The intracellular nitric oxide, activities of total superoxide dismutase and catalase were increased along with the increase of FM concentration against KPC-Kp. FM combined with COL induced ROS accumulation and antioxidant capacity increase. Transcriptome analysis showed FM combined with COL could regulate the levels of soxRS and oxidative phosphorylation, in order to clear ROS and repair damage. In addition, FM combined with COL could result in synergetic bactericidal efficacy by inhibiting ribosomal transcription. FM combined with COL mediated synergistic bactericidal effect by regulating ROS accumulation and inhibiting ribosomal protein transcription, resulting in lower resistance and cytotoxicity.

目的 探究碳青霉烯耐药肠杆菌科细菌(CRE)定植转血流感染的危险因素.方法 选取2019年1月-2021年12月浙江省人民医院住院期间因感染高危而行CRE主动筛查阳性的198例患者,根据是否发生血流感染分为血流感染组(37例)和非血流感染组(161例).回顾性分析两组患者的临床资料,并采用多因素logistic回归分析CRE定植转血流感染的危险因素.结果 198例CRE阳性患者中,共检出肺炎克雷伯菌167株(84.34％)、大肠埃希菌15株(7.58％)、奇异变形杆菌8株(4.04％)、产气肠杆菌3株(1.52％)、阴沟肠杆菌5株(2.52％).多因素分析显示:碳青霉烯类抗生素暴露史(0R=3.715,95％CI:1.003～13.761,P＜0.05)、应用糖皮质激素(OR=3.073,95％CI:1.198～7.698,P＜0.05)、中性粒细胞缺乏(OR=9.258,95％CI:2.894～29.614,P＜0.01)是CRE定植转血流感染的独立危险因素.结论 早期识别CRE血流感染的危险因素并对其进行干预,有助于把握抗菌药物治疗时机及优化治疗方案.

Aims The purpose of this study was to perform an assessment of circulating microRNAs (miRNAs) as promising biomarker for hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCV-HCC) through a meta-analysis. Methods A comprehensive literatures search extended up to March 1, 2020 in PubMed, Cochrane library, Embase, Web of Science, Scopus and Ovid databases. The collected data were analyzed by random-effects model, the pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were used to explore the diagnostic performance of circulating miRNAs. Meta-regression and subgroup analysis were further carried out to explore the heterogeneity. Results A total of 16 articles including 3606 HCV-HCC patients and 3387 HCV patients without HCC were collected. The pooled estimates indicated miRNAs could distinguish HCC patients from chronic hepatitis C (CHC) and HCV-associated liver cirrhosis (HCV-LC), with a SEN of 0.83 (95% CI, 0.79-0.87), a SPE of 0.77 (95% CI, 0.71-0.82), a DOR of 17 (95% CI, 12-28), and an AUC of 0.87 (95% CI, 0.84-0.90). The combination of miRNAs and AFP showed a better diagnostic accuracy than each alone. Subgroup analysis demonstrated that diagnostic accuracy of miRNAs was better for plasma types, up-regulated miRNAs, and miRNA clusters. There was no evidence of publication bias in Deeks' funnel plot. Conclusions Circulating miRNAs, especially for miRNA clusters, have a relatively high diagnostic value for HCV-HCC from CHC and HCV-LC.

Introduction: The aim of this study is to investigate the association between loss of muscle mass and prognosis of sepsis. Methods: Six databases, including PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Ovid, were searched by the deadline of August 18, 2020. A meta-analysis was conducted on the collected data by means of a random-effects model. The quality of each included article was assessed according to the Newcastle-Ottawa Scale. Results: Out of 1,819 references, 6 articles and 1 conference abstract were included. Sepsis patients with a loss of muscle mass or sarcopenia had higher mortality (risk ratio [RR]: 1.94, 95% confidence intervals [CI]: 1.59-2.37; I-squared = 18.7%, p < 0.001). The RR of mortality within 30 days (RR: 2.31, 95% CI: 1.78-2.99, p < 0.001) was higher than that of mortality over 30 days. Loss of psoas muscle mass, as evaluated by CT, showed the highest RR of sepsis mortality. In addition, based on data on overall survival retrieved from 4 trials, the pooled hazard ratio (HR) for patients with a loss of muscle mass or sarcopenia was 3.04. Subgroup analysis showed that survival time was the main source of heterogeneity for the overall HR. Furthermore, the scanning areas of muscle mass in survival patients were 0.33 cm(2)/m(2) higher than those measured in deceased patients. Conclusion: A loss of muscle mass, as evaluated by CT scan, was associated with a poor outcome in sepsis.

目的 应用随机森林模型和Logistic回归模型分析新型冠状病毒肺炎(COVID-19)发病的影响因素,为COVID-19防治提供依据.方法 选择2020年1月17日—2月17日浙江省6家医院收治的COVID-19疑似病例为研究对象,通过问卷收集人口学资料、既往基础疾病、流行病学史、临床表现、实验室检测指标和肺部影像学表现等,分别建立随机森林模型和Logistic回归模型分析COVID-19发病的影响因素.结果 共纳入786例COVID-19疑似病例,其中确诊病例336例,占42.75％.随机森林模型分析结果显示,COVID-19发病的影响因素重要性排名前十位依次是白细胞计数正常或减少、胸部影像学表现、淋巴细胞计数减少、聚集性发病、发病前14天内接触来自疫区的发热或呼吸道症状患者、乏力、发病前14天内有疫区旅居史、呼吸困难、鼻塞流涕和肌肉酸痛.多因素Logistic回归模型分析结果显示,发病前14天内有疫区旅居史(OR=8.440,95％CI:4.204～16.944)、发病前14天内接触来自疫区的发热或呼吸道症状患者(OR=2.967,95％CI:1.630～5.402)、聚集性发病(OR=25.164,95％CI:11.833～53.516)、乏力(OR=2.710,95％CI:1.490～4.930)、呼吸困难(OR=5.276,95％CI:2.076～13.410)、肌肉酸痛(OR=14.187,95％CI:1.998～100.730)、白细胞计数正常或减少(OR=1.750,95％CI:1.659～1.852)和胸部影像学表现(OR=6.291,95％CI:4.315～9.171)均与COVID-19存在统计学关联.结论 两种模型的分析结果相似,随机森林模型显示各个因素在COVID-19发病中的重要程度,Logistic回归模型可直观解释不同因素的风险度.

BACKGROUND:The aim of this study was to investigate the mechanism of Listeria monocytogenes (Lm) pathogenicity and resistance. In addition, the effect of existing treatment options against Lm were systematically evaluated. METHODS:Six Lm isolates were collected and antimicrobial susceptibility testing of 15 antibiotics were done. Subsequently, whole genome sequencing and bioinformatics analysis were performed. Biofilm formation was evaluated by crystal violet staining. Furthermore, the effect of meropenem, linezolid, penicillin, vancomycin, and trimethoprim/sulfamethoxazole were determined using the time-kill assay. RESULTS:Four sequence types (STs) were identified (ST1, ST3, ST87, ST451). Multivirulence-locus sequence typing results classified ST87 isolates into cluster. All isolates were resistant to fosfomycin and daptomycin with fosX and mprF. In addition, a total of 80 virulence genes were detected and 72 genes were found in all 6 isolates. Seven genes associated with hemolysin were found in 26530 and 115423. However, due to lack of one genomic island including virulence genes related to flagellar synthesis, isolate 115423 produced less biofilm than 5 other isolates. Although all isolates were susceptible to vancomycin, the in vitro time-kill assay showed that vancomycin monotherapy resulted in less than 2 log10 cerebrospinal fluid (CFU)/mL compared with the initial count. Trimethoprim/sulfamethoxazole at serum or CFU concentrations had bactericidal effect against tested Lm strains at 24 hours. CONCLUSIONS:ST87 clone was a typical prevalent ST in clinical Lm isolates in China. Trimethoprim/sulfamethoxazole might be greater potential therapeutic option against Lm infections.

Early determination of coronavirus disease 2019 (COVID-19) pneumonia from numerous suspected cases is critical for the early isolation and treatment of patients. The purpose of the study was to develop and validate a rapid screening model to predict early COVID-19 pneumonia from suspected cases using a random forest algorithm in China. A total of 914 initially suspected COVID-19 pneumonia in multiple centers were prospectively included. The computer-assisted embedding method was used to screen the variables. The random forest algorithm was adopted to build a rapid screening model based on the training set. The screening model was evaluated by the confusion matrix and receiver operating characteristic (ROC) analysis in the validation. The rapid screening model was set up based on 4 epidemiological features, 3 clinical manifestations, decreased white blood cell count and lymphocytes, and imaging changes on chest X-ray or computed tomography. The area under the ROC curve was 0.956, and the model had a sensitivity of 83.82% and a specificity of 89.57%. The confusion matrix revealed that the prospective screening model had an accuracy of 87.0% for predicting early COVID-19 pneumonia. Here, we developed and validated a rapid screening model that could predict early COVID-19 pneumonia with high sensitivity and specificity. The use of this model to screen for COVID-19 pneumonia have epidemiological and clinical significance.

BACKGROUND Antiviral therapy cannot completely block the progression of hepatitis B to hepatocellular carcinoma (HCC). Furthermore, there are few predictors of early HCC progression and limited strategies to prevent progression in patients with HBV-related cirrhosis who receive nucleos(t)ide analog (NA) therapy. AIM The study aim was to clarify risk factors and the diagnostic value of alpha-fetoprotein (AFP) for HCC progression in NA-treated hepatitis B virus (HBV)-related cirrhosis patients. METHODS In this retrospective cross-sectional study, we analyzed the clinical data of 266 patients with HBV-related cirrhosis who received NA treatment between February 2014 and April 2020 at Zhejiang Provincial People’s Hospital. The patients were divided into two groups, 145 who did not progress to HCC (No-HCC group), and 121 who progressed to HCC during NA treatment (HCC group). The logistic regression analysis was used to analyze the risk factors of HCC progression. The diagnostic value of AFP for HCC was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS Univariate analysis showed that age ≥ 60 years (P = 0.001), hepatitis B and alcoholic etiology (P = 0.007), smoking history (P < 0.001), family history of HBV-related HCC (P = 0.002), lamivudine resistance (P = 0.011), HBV DNA negative (P = 0.023), aspartate aminotransferase > 80 U/L (P = 0.002), gamma-glutamyl transpeptidase > 120 U/L (P = 0.001), alkaline phosphatase > 250 U/L (P = 0.001), fasting blood glucose (FBG) ≥ 6.16 (mmol/L) (P = 0.001) and Child-Pugh class C (P = 0.005) were correlated with HCC progression. In multivariate analysis, age ≥ 60 years [hazard ratio (HR) = 3.089, 95% confidence interval (CI): 1.437-6.631, P = 0.004], smoking history (HR = 4.001, 95%CI: 1.836-8.716, P < 0.01), family history of HBV-related HCC (HR = 6.763, 95%CI: 1.253-36.499, P < 0.05), lamivudine resistance (HR = 2.949, 95%CI: 1.207-7.208, P = 0.018), HBV DNA negative (HR = 0.026, 95%CI: 0.007-0.139, P < 0.01), FBG ≥ 6.16 mmol/L (HR = 7.219, 95%CI: 3.716-14.024, P < 0.01) were independent risk factors of HCC progression. ROC of AFP for diagnosis of HCC was 0.746 (95%CI: 0.674-0.818). A cutoff value of AFP of 9.00 ug/L had a sensitivity of 0.609, and specificity of 0.818 for diagnosing HCC. CONCLUSION Age ≥ 60 years, smoking history, family history of HCC, lamivudine resistance, HBV DNA negative, FBG ≥ 6.16 mmol/L were risk factors of HCC progression. Serum AFP had limited diagnostic value for HCC.

BACKGROUND:Vibrio vulnificus (VV) is a causative agent of foodborne diseases with high mortality. The aim of this study was to investigate the genomic and phenotypic profiles of VV.METHODS:Six VV isolates were collected and conducted whole-genome sequencing. Biofilm formation and anti-complement killing test were performed to evaluate the pathogenicity. Subsequently, 157 publicly available genomes of VV isolates were selected to determine the evolutionary relationship.RESULTS:The resistant genes norM and tet34 were identified in six isolates. A total of 156 virulence genes were identified. However, there is no obvious difference between strains isolated from blood and puncture fluid. The tendency of growth for six isolates decreased with the lapse of time, while the biofilm formation increased. The genes tadC and flp related to Flp pili were found in isolate 25506 and 30896, resulting in more obvious biofilm formation. In addition, the survival rate of 19656 was less than 20% due to lack of one genomic island including virulence genes (impD-H, clpV-1) relevant to type VI secretion system (T6SS). Multi-locus sequence typing (MLST) revealed 95 different STs and 19 novel STs, indicating that the tendency of 163 isolates was sporadic. Further comparative genomics analysis clearly classified 163 isolates into three distinct evolutionary lineages.CONCLUSION:VV infections were sporadic in humans and the environment. Virulence genes impD-H and clpV-1 related to T6SS were associated with pathogenicity phenotype of VV.

BACKGROUND Primary bone lymphoma (PBL) is an uncommon extranodal disease that represents approximately 1%-3% of lymphomas. Anaplastic lymphoma kinase (ALK) positive anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL. The aim of this report is describe the symptoms, diagnosis, and treatment of primary bone ALK-positive ALCL. CASE SUMMARY A 66-year-old man presented to our hospital with neck and shoulder pain and intermittent fever that lasted for 1 mo. After extensive evaluation, positron emission tomography-computed tomography (CT) examination showed multiple osteolytic bone lesions without other sites lesions. CT-guided biopsy of the T10 vertebral body was performed, and the pathology results showed that neoplastic cells were positive for ALK-1, CD30, and CD3. A diagnosis of primary bone ALK positive ALCL was ultimately made. The patient was in partial response after four cycle soft cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, and we planned to repeat the biopsy and radiological examination after completion of the fifth cycle of therapy. CONCLUSION Primary bone ALK positive ALCL is a rare disease and physicians should keep in mind that ALCL can present with isolated osseous involvement without nodal involvement, and lymphoma should be considered in the differential diagnosis of primary bone lesions.

Novel coronavirus pneumonia (NCP) has been widely spread in China and several other countries. Early finding of this pneumonia from huge numbers of suspects gives clinicians a big challenge. The aim of the study was to develop a rapid screening model for early predicting NCP in a Zhejiang population, as well as its utility in other areas. A total of 880 participants who were initially suspected of NCP from January 17 to February 19 were included. Potential predictors were selected via stepwise logistic regression analysis. The model was established based on epidemiological features, clinical manifestations, white blood cell count, and pulmonary imaging changes, with the area under receiver operating characteristic (AUROC) curve of 0.920. At a cut-off value of 1.0, the model could determine NCP with a sensitivity of 85% and a specificity of 82.3%. We further developed a simplified model by combining the geographical regions and rounding the coefficients, with the AUROC of 0.909, as well as a model without epidemiological factors with the AUROC of 0.859. The study demonstrated that the screening model was a helpful and cost-effective tool for early predicting NCP and had great clinical significance given the high activity of NCP.

Enterococcus faecalis is a significant cause of nosocomial infections and is difficult to treat because of intrinsic and acquired resistance to many antibiotics. In addition, the emergence of linezolid-resistant E. faecalis (LZR-Efa) is reducing the choices available for anti-infective therapy. The aim of this study was to examine the in vitro antibacterial effects of fosfomycin (FM), vancomycin (VAN) and daptomycin (DAP), alone and in combination, against LZR-Efa. Five LZR-Efa strains and E. faecalis ATCC 29212 were studied. The antibacterial effects of FM, and of FM, VAN and DAP, were assessed using the time–kill assay. Biofilm formation and elimination were evaluated by crystal violet staining. When used at concentrations greater than 0.5 × MIC, FM did not produce dose-dependent effects against LZR-Efa isolates. The use of DAP (47.1 mg/L) alone, and FM (83 mg/L) combined with DAP (20.6 mg/L), produced a persistent inhibitory effect against both planktonic LZR-Efa isolates and those forming biofilms. In addition, FM and VAN combined with glucose-6-phosphate produced visible eradication effects against biofilms grown for 24 h, while DAP alone or combined with FM resulted in the best eradication activity against biofilms grown for 72 h prior to exposure. The use of FM combined with DAP provided the best potential therapeutic option for treating LZR-Efa infections out of those tested. In addition, the optimum treatment for biofilm elimination depended on the stage of biofilm formation.

Background: Invasive Listeria monocytogenes (Lm) carry a high mortality despite antibiotic treatment. The aim of this study was to investigate the mechanism of pathogenicity and resistance. In addition, the effect of existing treatment options against Lm were systematically evaluated as well. Methods: Three Lm isolates were collected and 15 antibiotics susceptibility tests were done. Subsequently, whole genome sequencing and bioinformatics analysis were performed. Furthermore, the effect of meropenem, linezolid, benzylpenicillin, vancomycin, trimethoprim/sulfamethoxazole were determined using the time-kill assay. Results: Two sequence types (STs) were identified for isolate 23949 (ST87), 26530 (ST3), 34096 (ST87), respectively. All isolates were resistant to fosfomycin and daptomycin. The resistant genes fosX , mprF, norB and vgaALC were identified in all isolates. Furthermore, 80 virulence genes were detected and 72 genes were found in all three isolates. There were 26 virulent genes associated with the structure, biosynthesis, motor switch of flagellum. And other virulent genes were involved in chemotaxis, protease, internalin and metabolism. It is of note that 8 genes ( inlJ , llsB , llsD , llsG , llsH , llsP , llsX , llsY ) were only found in 26530 isolated from cerebrospinal fluid (CSF), 7 of which were associated with haemolysin. Further in vitro time-kill assay found trimethoprim/sulfamethoxazole at serum or CSF concentrations had bactericidal effect (>3.5 log10 CFU/ml) against three tested Lm strains at 24 h. Conclusions: The involved virulence factors were mainly associated with bacterial pathogenicity. Notably, trimethoprim/sulfamethoxazole might be greater potential therapeutic option against Lm bloodstream infection or intracranial infection.

Background: Primary bone lymphoma (PBL) is an uncommon extranodal disease that represents approximately 1-3% of lymphomas. ALK positive anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL. The aim of this report is describe the symptoms, diagnosis and treatment of primary bone ALK-positive ALCL. Case presentation: A 66-year-old man presented with neck and shoulder pain and intermittent fever that lasted for one month to our hospital.After extensive evaluation, positron emission tomography (PET)-CT examination showed multiple osteolytic bone lesions without other sites lesions. CT-guided biopsy of the T10 vertebral body was performed, and the pathology results showed neoplastic cells were positive for ALK-1, CD30 and CD3. A diagnosis of primary bone ALK positive ALCL was ultimately made. The patient received four cycles of CHOP chemotherapy , and we planned to repeat the biopsy and radiological examination after completion of the fifth cycle of therapy. Conclusions: Primary bone ALK positive anaplastic large cell lymphoma is a rare disease and physicians should keep in mind that ALCL can present with isolated osseous involvement without nodal involvement, and lymphoma should be considered in the differential diagnosis of primary bone lesions.

Background Sepsis is can cause serious negative effects among patients with cirrhosis.Finding reliable biomarker in early diagnose and prognosis in septic patients with liver cirrhosis is very important.We assessed value of serumsoluble triggering receptor expressed on myeloid cells-1 ( sTREM-1),D-lactate and Intestinal fatty acid binding protein(I-FABP) in diagnosis and prognosis evaluation in liver cirrhotic patients with sepsis. Methods A prospective observational study of 158 cirrhosis patients was conducted. A total of 158cirrhosis patients were enrolled, 83 of whom were diagnosed with sepsis and 75 patients without sepsis during hospitalization.We evaluated value of early diagnostic and prognosis of cells-1(sTREM-1),D-lactate and I-FABP in cirrhotic patients with sepsis.Receiver operating characteristic curves (ROCs) were used to assess the ability of tested biomarkers to diagnose and prognosis cirrhotic patients with sepsis. Results Our results showed the CRP，PCT，sTREM-1, D-lactate and I-FABP were significantly higher in the sepsis group than in the no-sepsis group.,but only levels of serum sTREM-1 showed increasing trend with the severity of the cirrhotic patients with sepsis. The cutoff value of sTREM-1was 123.62 pg/mL and showed 84.3% sensitivity and 92.0% specificity and high accuracy in the early diagnosis for cirrhotic patients with sepsis.The AUC of sTREM-1 was 0.959(95%CI: 0.934–0. 985) and higher than that of CRP,PCT,D-lactate and I-FABP( P < 0.001, P =0.002, P < 0.001, P < 0.001 respectively).Total 31(37.35%) cirrhotic patients with sepsis cases died during 90-day follow-up.Only sTREM-1 level had significance between survivors and non-survivors(263.99±213.79 vs 672.24±191.44, P =0.031).The AUCs of sTREM-1 for predicting 90-day mortality was 0.904( 95% CI:0.836-.971 ) and higher than that of CRP,PCT,D-lactate ( P =0.001 ,p= 0.003 , P < 0.001 respectively) The AUCs of I-FABP is only 0.482 and had no value of predicting prognosis. Conclusion Serum sTREM-1 is a valuable new biomarker for early diagnosis and prognosis in cirrhosis with sepsis, proving more accurate than CRP,PCT, D - lactate and I - FABP.Serum D-lactate and I-FABP levels can identify early cirrhosis with sepsis, but they is little relationship with the prognosis of patients.

肝硬化腹水患者存在肠通透性增加、毒素及细菌移位,可诱发自发性腹膜炎、肝性脑病等并发症.笔者通过制备中药巴布剂腹部穴位贴敷辅助治疗肝硬化中重度腹水患者,观察其临床疗效及对肠通透性影响,报道如下.