Volume 88  ·   Issue 20  ·  2008

Infectious diseases are an important killer that threatens human health seriously at present, among which bacterial infections account for a considerable proportion, and the application of antibacterial drugs is the main means to treat bacterial infections. However, the rate of bacterial resistance to antibacterial drugs is increasing year by year, and the emergence of multi-drug resistant strains and new drug resistant strains [such as vancomycin-resistant Staphylococcus aureus (Staphylococcus aureus)] bring great difficulties to clinical treatment. More importantly, multi-drug resistant bacteria are not only limited to hospital-acquired bacteria, but the emergence of community multi-drug resistant bacteria (such as Streptococcus pneumoniae) and community high virulence drug resistant bacteria (such as community-acquired methicillin-resistant Staphylococcus aureus) make the prevention and treatment of infectious diseases face new challenges.

Objective To investigate the genetic features of the community-acquired methicillinresistant Staphylococcus aureus(CA-MRSA)prevalent in West China. Methods Three CA-MRSA isolates obtained in Chengdu, Sichuan, underwent SCCmec(Staphylococcal Cassette Chromosome mec)multi-PCR, Staphylococcal protein A(spa)typing and multi-locus sequence typing(MIST)method, and their PantonValentine leucocidin(PVL)gene was also detected. Results All 3 CA-MRSA isolates were positive of mecA gene(147 bp), and the other PCR product of 750 bp was confirmed to be type Ⅳ a SCCmec. Spa typing showed that the MRSA strains s29635 and s35301 were typed as t437, and the strain s19165 was typed as t008. MLST showed that the MRSA strains s29635 and s35301 were typed as ST59, and the strain s19165 was typed as ST8. The strains s19165 and s35301 were all positive for PVL gene, and the strain s29635 was negative for PVL gene. Conclusion CA-MRSA clones ST8-t008 and ST59-t437 have been isolated in West China.

Objective To determine the rpsL and rrs gene mutation in Mycobacterium tuberculosis (M. tuberculosis)and compare the consistency between the results of denaturing high-performance liquid chromatography(DHPLC)and those of DNA sequencing. Methods The values of streptomycin minimum inhibitory concentration(MIC)against 215 M. tuberculosis clinical isolates, 115 being streptomycinresistant and 100 being susceptible by a routine proportional method, were tested by DHPLC. DNA sequencing was conducted to detect the rpsL and rrs mutation. Results 98 of the 115 streptomycin-resistant isolates(85. 2%)harbored rpsL and/or rrs mutation, 76. 5%of which being rpsL mutation(88/115). There was no significant correlation between the MIC values and mutation types. No mutation was found in all the susceptible isolates. There was a complete consistency between the DHPLC results and those of DNA sequencing. Conclusion DHPLC can be regarded as a useful and powerful tool to detect the streptomycin resistance detection in M. tuberculosis.

Objective To study the drug resistance profiles of extended spectrum beta lactamase(ESBL)producing Escherichia coli(E coli)and provide guidance for pediatric clinical prescription. Methods 5127 strains of ESBL producing E. coli were isolated from 5 children's hospitals in Beijing, Shanghai, Chongqing, and Guangzhou. The minimum inhibitory concentration(MIC)values of 349 strains to 9 antibiotics most in use in pediatrics were measured with agar dilution method. Results The prevalent rate of ESBL producing of E. coli was 46.7%. The resistant rates to ampicllin/clavulanie acid, cefotaxime, ceflazidime, and cefepime were 23.1%, 67.2%, 24.5%, and 48.4%respectively, and the intermediate rates were 38.5%, 26.4%, 5.7%, and 19.1% respectively. The resistant rate to amikacin was 5.4%. All the strains were susceptive to imipenem. The MIC90 values of ampicillin, cefotaxime, cefepime, ciprofloxacin, and gentamicin were 256 mg/L or higher. There were differences in the resistance profile to ampicllin/clavulanic acid, cefepime, ciprofloxacin, and gentamicin among different regions. Conclusion ESBL is extensively prevalent among the E. coli strains isolated from the pediatric clinic that are resistant to most antimicrobial agents except imipenem and amikacin. Regional difference exists in drug resistance to some agents exist.

Objective To analyze the clinical features,especially surgical treatment of superior vena cava syndrome(SVCS).Methods The clinical data of 26 patients with SVCS,19 males and 7 females,aged 37(19-63),diagnosed base on the space occupying lesion in mediastinum and complete or incomplete obstruction of SVC and/or innominate vein by imaging examination without evidence of tumor in other parts and without evidence of lymphoma in the mediastinal lesion by pathological examination,who underwent surgical treatment were analyzed,focusing on the clinical presentation,preoperative examination,surgical treatment,pathological diagnosis,and survival.Results Facial cyanosis and edema,cervical and chest wall varicose veins.headache and dizziness,cough and dyspnea were the most common clinical manifestations.Pre-operative percutaneous needle biopsy guided by CT confirmed the diagnoses of malignant tumor of mediastinum in 6 cases and definite diagnoses failed to be got in the other 20 cases.Resection of the primary lesions combined with artificial blood vessel replacement of SVC was performed.Twenty patients received complete resection,and 6 received only incomplete excision because of extensiveness of lesions.The mean survival time of the former group was 30 months,significantly longer than that of the latter group (11 months,P=0.0036).The overall 1-year survival rate was 69.2%,and 5-year survival rate was 7.6%.Conclusion Resection procedure is an important factor influencing the prognosis of SVCS.

Objective To determine the clinical toxicities and antitumor effects of a chemotherapy regimen of FTQ,a compound preparation of tegafur,the drug prototype of 5-fttracil(5-FU),gimeracil (CDHP),a decomposition inhibitor of 5-FU,oteracil potassium,phosphorylation inhibitor of 5-FU,and combined with cisplatin in patients with inoperable locally or metastatic advanced gastric cancer.Methods 119 patients with inoperable locally or metastatic advanced gastric cancer admitted in 10 hospitals in China were divided into 2 groups:FTQ group(n=59),undergoing a 3-week regime,i.e.oral use of FTQ 80 mg·m-2·d-1 for 14 d and then discontinuance for 1 week and intravenous drip cisplatin 75 mg/m2 on days 1-3;and control group(n=60)undergoing a 3-week regimen including oral use of tegafur 800 mg·m-2·d-1 tid for 14 d and then discontinuance for 1 week and intravenous drip of cisplatin 75 mg/m2 on days 1-3.The curative was evaluated after at least after 2 regimens.Results There were 102 patients in the per-protocol population.The overall response rate of the FTQ group was 28.3%(15.53),significantly higher than that of the control group(4.1%,2/49,P=0.004).The clinical improvement of the FTQ group was 50.9%,significantly higher than that of the control group(24.5%,P=0.006).The main toxieities occurred in bone marrow and the digestive tract.The leucopenia and thrombocytopenia rates of the FTQ group were 47.45%and 32.22%respectively,both similar to those of the control group.There were no differences in the incidence rate of digestive canal side reaction between these 2 groups.Conclusion The regimen of FTQ combined with cisplatin is generally well-tolerated and has substantial antitumor activity.

Objective To evaluate the efficacy of recombinant human tumor necrosis factor receptor-Fc fusion protein(rh TNFR:Fc)in the treatment of active ankylosing spondylitis(AS).Methods 68 patients with active AS underwent subcutaneous injection of rh TNFR:Fc 25 mg twice a week for 24 weeks.The following indexes were observed:improvement of at least 20%of reported symptoms,based on the multicomponent Assessments in AS(ASAS)response criteria(ASAS 20)at weeks 2,6,12 and 24,ASAS 50 and ASAS 70 responses,and improved scores on individual components of ASAS,including Bath AS disease activity index(BASDAI),acute phase reactants,and Bath AS metrology index(BASMI).And the X-ray images of patient's pelvis at weeks 0,12.and 24 were graded based on BASRI.Resuits After treatment of rh TNFR:Fc the primary and secondary efficacy end points of the 68 patients were all improved compared with the baseline values.During the process of treatment,the number of patients with the efficacy achieving ASAS20 was gradually rising:44 cases(64.7%)at week 12 and 58(85.0%)at week 24.The efficacy of 41 cases(60.3%)reached ASAS50 and that of 34 cases reached ASAS70 at week 24.Other efficacy end points also reflected the similar effect and were improved significantly compared with the baseline values at different time points(all P＜0.01).BASRI showed that the radiological improvement of sacroiliac jpint was not significant(P＞0.05)and that the radiological improvement of hip was not obvious at week 12(P＞0.05)but significant at week 24(P＜0.05).Conclusion rh TNFR:Fc rapidly improves the signs and symptoms of active AS.

Objecfive To evaluate the role of local resection in treatment of pancreatic neoplasms.nethods The clinical data of 17patients with pancreatic neoplasms,3 males and 14 females,aged 47.9(34-67),who underwent local resection from January 1996 to June 2007 were analyzed.Results Of the 17 tumors,9 were located in the head,7 located in the body,and 1 located in the tail of pancreas.The diameters of the 17 tumors were 1.5-8.0 cm,3.6 cm on average,and the diameters of 8 tumors were above 4 cm.Pathological examination confirmed 8 tumors as nonfunctioning insulinoma,5 as solid pseudopapillary tumor,1 as neurilemmoma,1 as cyst,1 as gastrointestinal stroma tumor,and 1 as lowgraded malignant tumor.Pancreatic leakage occurred in 7 cases(41.2%)and no death,recurrence,and endocrine and exocfine insufficiency occurred after operation.Conclusion Capable pf preserving endocrine and exocfine functions,local resection is a feasible method for benign or low-graded malignant pancreatic neoplasms,however,with a high rate of pancreatic leakage.

Objective To investigate the relation of the frequency of tumor necrosis factor(TNF)-α-308,TNF-β+252,IL-1 β+3954,and IL-10-1082 gene polymorphisms to female breast cancer.Methods Peripheral blood samples were collected from 102 breast cancer patients with cachexia and 120 breast cancer patients without cachexia.Biallelic polymorphisms were performed by analyzing the incision enzyme-digested DNA fragment obtained using PCR.Results The allele frequencies of TNF-β+252,IL-1β+3954,and IL-10-1082 in the patients with cachexia were comparable with those of the patients without cachexia(all P＞0.05).The patients with cachexia showed a significantly higher prevalence of TNF2 than the patients without cachexia(20.6%vs 10.0%,P=0.027).Logistic regression analysis indicated TNF2 as a risk factor for cachexia in breast cancer(OR=2.333,95%CI:1.085-5.017).Conclusion TNF2 plays an important role in the susceptibility ofcachexia in breast cancer.

objeetive To investigate the influences of different treatment patterns on the costeffectiveness in treating acute myocardial infarction(AMI).Methods Data about referral of AMI patients who called for help because of chest pain to the nearby hospitals from October 2003 to December 2005 were collected from the Guangzhou 120 Call Center.All these patients were followed uD 6 months after discharge to survey the cost during hospitalization,major treatment,prognosis(death,re-infarction,stroke etc.),and secondary prevention for coronary heart disease.We used SF-36 scale was used to quantify the health status.Results 101 AMI patients referred to grade 2 A hospitals(Group A)and 137 patients referred to grade 3 A hospitals(Group B)were successfully followed up.The cost during hospitalization of Group B was (33 965±963)yuan RMB,significantly higher than that of Group A(18 943±893)yuan,P=0.021).11 patients of Group B died,and 5 patients suffered from stroke with the mortality and stroke rate both significantly lower than those of Group A(18/101 and 12/101,P=0.022,P=0.015).There was no significant difference in the re-infarction rate between the 2 groups.The scores in physical function.general health status,vitality,social function,role-emotional,mental health of Group B were all significantly higher than those of Group A(all P＜0.05),however,there were not significant differences in bodv pain and role-physical between these 2 groups.The smoking cessation rate,specialist outpatient department follow-up rate,statins use rate of Group B were significantly higher than those of Group A(P=0.017,P=0.016,P=0.038).Conclusion The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.

Objective To investigate the natural outcome in the second year of the patients with impaired glucose regulation(IGR)that reverted to normal glucose tolerance(NGT).Methods 463 adults diagnosed as with IGR in the baseline survey based on the criteria of America Diabetic Association 2003 underwent treatment including health education.One and 2 years later blood samples were collected to examine the glucose and lipids.Blood pressure,heart rate,waist,and hip were examined.Questionnaire survey was conducted.Resuits One year later 55 of the patients(32.5%)were diagnosed as with isolated impaired glucose tolerance(I-IFG),86(50.9%)with I-IGT,and 28(16.6%)with IFG/IGT at the baseline survey had their diseases reverted to NGT.53.3%of them remained to be with NGT.45.6%of them showed the diagnosis transformed into IGR.and the disease in 1.2%of them progressed into diabetes mellitus.In the second year.insulin resistance was significanfly relieved and islet β cell function was significantly improved in the pattern IGR→NGT→NGT.Stepwise logistic regression analysis showed that fasting plasma glucose(FPG)in the baseline survey and 1 year later were negatively correlated and HBCI were positively correlated with the reversion and maintenance of NGT.In the second year,the ratio of elevated waist circumference,elevated blood pressure,elevated TG,reduced HDL-c,elevated FPG.more than two metabolic abnormalities and metabolic syndrome of the IGR→NGT→NGT group were significantly lower than in the IGR→NGT→IGR group(all P＜0.05).Conclusion FPG,islet Bcell function and TG can be considered as indicators for reversion from IGR to NGT and maintenance of NGT.Those with less metabolic abnormalities at baseline and with more obvious improvement would be more likely to revert to and maintain NGT.

OMective To assess the values of endoscopy,24-hour esophageal pH monitoring,symptom index,24-hour esophageal bile monitoring,and proton pump inhibitor(PPI)trail in the diagnosis of gastroesophgeal reflux disease(GERD)-related noncardiac chest pain(NCCP).Methods 27 NCCP patients,selected from a consecutive sample of 255 patients who had received coronary angiography owing to chest pain,underwent upper endoscopy,and 24-hour esophageal pH and bile monitoring,then they took esomeprazole 20 mg orally twice dally for 14 days.Symptom score(SI)was used to measure the severity and frequency of chest pain before and after treatment.The patients also underwent an initial questionnaire survey including the general personal data and symptom characters,reflux diagnostic questionnaire(RDQ),self-rating anxiety scale(SAS)survey,and self-rating depression scale(SDS)survey.Results If only based on erosive esophagitis and/or abnormal 24-hour esophageal pH monitoring,9 of the 27 patients (33%)were classified as GERD-related NCCP.Otherwise,74%(20 of the 27 patients were classified as GERD-related NCCP based on erosive esophagitis and/or abnormal 24-hour esophageal pH monitoring,or positive SI or abnormal bile monitoring.15 of the 20 GERD patients(75%)had a significant symptom impmvement on PPI compared with 14%(1/7)of non-GERD pailents(P=0.009).The calculated sensitivity and specificity of the PPI trail was 75%and 86%respectively.The typical reflux symptoms presented more frequently among GERD patients than non-GERD patients[65%(13/20)vs 29%(2/7),P=0.185].There was no significant RDQ score difierence between the 2 groups(10±4 vs 8±4,P=0.411).The sensitivity and specificity of RDQ to GERD-related NCCP were 35%and 86%respectively.The SAS scores of GERD and non-GERD-related NCCP patients were both significantly higher than that of the normal controls(P=0.008 and P=0.011),while the SDS scores of the GERD and non-GERD-related NCCP patients were both similar to that of the normal controls(P=0.090 and P=0.113).Conclusion Combination of endoscopy,24-hour esophageal pH monitoring,SI,and 24-hour esophageal bile monitoring helped to improve the diagnosis of GERD-related NCCP.PPI trail is the first clinical diagnostic tool in the evaluation of GERD-related NCCP.

Objective To investigate the expression of early growth response 1(EGR1)in gastroenterological cancers and its significance in the pathogenesis.Methods RT-PCR was used to determine the expression of EGR1 in normal gastric mucosa tissues from 20 non-tumor patients,gastroenterological tumor tissues and matched para-cancer tissues normal morphologically.RT-PCR and Western blotting were used to analyze the mRNA and protein expression of EGR1 in 20 cancer cell lines.Immunohistochemistry(IHC)was preformed to measure the expression level of EGR1 protein on tissue microarray ineluding 179 tumors and 159 normal tissues.Results EGR1 was overexpressed in gastric cancer (GC)and its matched adjacent normal tissue(ANT),but not expressed or expressed at a low level in the normal gastric mucesa from the non-tumor patients,which was consistent with the GC gene expression profiling data.Overexpression of EGR1 was seen in the 20 cancer cell lines at both mRNA and protein levels. IHC showed strong positive staining of EGR1 protein in the cytoplasm of both tumor tissues and matched normal tissues and showed negative or weaker nuclear staining in the normal gastric mucosa tissues from non-tumor patients. Overexprossion of EGR1 was detected in 87% (49/56) of the GC tissues and 79%(43/54) of their ANTs ; 83% (43/52) of the hepatocellular carcinoma tissues and 79% (32/42) of their ANTs ; 78% (41/52) of colorectal cancer tissues and 63% (22/35) of their ANTs ; and 79% (15/19) of the squamous cell carcinoma tissues and 78% ( 14/18 ) of their ANTs. Conclusion EGR1 may be correlated with the abnormal proliferation of cells at the early stage of malignant transformation.

Objective To construct PEGylated trichosanthin(TCS)mutein and analyze its bioactivities,immunogenicity,acute toxicity,and pharmacokineties.Methods The potential antigenic determinant site YFF81-83 in the molecule of TCS was selected to undergo site-directed mutagenesis.Thus,a TCS mutein named TCSYFF81-83ACS was constructed and expressed in Escherichia coli of the line BL21 (DE3).Wild TCS(wTCS),TCSYFF81-83ACS,and PEGylated TCSYFF81-83ACS(PEG-TCSYFF81-83ACS)of different concentrations were incubated with the supercoiled plasmid pUCl9 to detect the DNAse activity,mixed with rabbit reticulocyte lysate to detect the ribosome inactivation activity,subcutaneously injected into 6 mice respectively to measure the serum IgG and IgE levels,intravenously injected into mice to observe the toxicity,and intravenously injected into SD rats to observe its-plasma half-life.Results The DNAse activity of the PEG-TCSYFF81-83ACS was similar to that of the wTCS.The ribosome inactivation activity of the PEG-TCSYFF81-83ACS was 1/9-1/8 of that of the wTCS(P＜0.05).The serum IgE and IgG levels of the PEG-TCSYFF81-83ACS were both significantly lower than those of the wTCS(both P＜0.05).The LD50 of the PEG-TCSYFF81-83ACS was 1.8 times that of the wTCS(P＜0.05).The mean residence time and plasma half-life of the PEG-TCSYFFF81-83ACS were significantly increased and its plasma clearance was significantly decreased(all P＜0.05).Conclusion Site-directed mutagenesis and PEGylation of TCS provide a new approach for reconstructing TCS.

Objective To search for a non-culture method to impmve the efficiency of etiological diagnosis of infective endophthalmitis and other infectious diseases.Methods Fifty clinical specimens of infective endophthalmitis were collected.DNA of bacterium was extracted directly from the aqueous fluid or vitreous fluid and then amplified with universal primers.The PCR products were sequenced subsequendy.Results Twenty-two(44%)bacterial smears and 13(26%)cultured specimens were positive.PCR positivity was seen in 28 of the 50 cases(56%)and 22 specimens(44%)were sequenced successfully.The results of 16s rRNA gene sequence analysis did not completely conform to the resuhs obtained from culturedependent approach.Conclusion Molecular identification method is a rapid and efficient approach for the diagnosis of bacterial infeetive endophthalmitis.

Objective To investigate the feasibility to transfect human β defensin 2(hBD2)gene into the lung so as to enhance the endogenous hBD2 expression to defend infectious diseases.Methods Recombinant plasmid containing hBD2 gene,pLXSN-hBD2,was mixed with a new cationic liposome prepared by film at different weight ratios.Sixteen Wistar rats were divided into 2 groups:experimental group(n=11),undergoing aerosol inhalation ofliposome/pLXSN-hBD2 complex,and control group(n=5),undergoing aerosol inhalation of blank vector PLXSN.The tracheae were taken out from 5 rats of the experiment and control groups each 2 days later,and from 2 rats of the experimental group 6,15,and 21 days later respectively so as to obtain the epithelial ceils of trachea.DNA was extracted from the tracheal epithelial cells and PCR Was used to examine the transfection and integration of hBD2.Western blotting was used to detect the protein expression of hBD2.Results Aerosolization impacted obviously the microcapsule structure of hposome/plasmid complexes,and there was the least structural destruction of complex at a ratio of 10:1 that suited for aerosotization best.After the inhalation the relevant plasmids were all successfully integrated into the epithelial cells in both groups.Protein expression of hBD2 was not detected in the control group and the hBD2 protein expression level 2 days after transfection of the experimental group was 4866.9±148.2,and then decreased gradually,and reached 3.2±1.5 twenty-one days after the transfection.Conclusion The recombinant plasmid PLXSN-hBD2 can be transfect into the airway epithelial cells via aerosol inhalation and the expression of hBD2 sustains for a period of time.

Objective To study the expression level of calbindin-D28k,a kind of calcium binding protein,in the kidneys of genetic hypercalciuric stone-forming(GHS)rats and to investigate its role in idiopathic hypercalciuria(IH).Methods Kidneys were taken out from 16 GHS rats and 6 normal control (NC)rats.Westem blotting and real time quantitative PCR were used to detect the protein and mRNA expression levels of calbindin-D28k respectively.Resuits Western blotting showed that the A value of calbindin-D28k of the GHS rats was 0.49±0.02.significantly higher than that of the NC rats (0.20±0.01,P＜0.05).The 2-(△△CT)value of mRNA of calbindin-D28k of the GHS rats was 1.21,remarkably higher than that of the Nc rats[with the of 2-(△△CT)value of 1.0].There was not significant difference in tIle △CT value between the two groups(P＞0.05).Conclusion The up-regulation of calbindin-D28k in the GHS rats is possibly caused by hyperexpression of VDR and hypercalcinuria,and plays an important role in urine calcium reabsorption;however,it is not the key protein that results in IH.

Objective To investigate the potencial mechanism of non-restrictive external stent in preventing re-stenosis of vein grafts.Methods Thirty-six rabbits underwent reversed bypass grafting of autologous external iugular vein into common carotid artery and then were randomly divided into two equal groups,stenting group(Group S),with an external stent 6 mm in diameter(Dacron vascular prosthesis)surrounding the vein graft,and control group(Group NS),without stenting.The vein grafts were harvested 7.14.and 28 days after the operation respectively.Immunocytochemistry was used to detect the plateletderived growth factor B(PDGF-B)positive cells.The mRNA expression of PDGF-B was detected with RTPCR.Results The PDGF-B positive cell percentages in the intima of Group S7 and 14 days later were both significantly lower than those of Group NS(15.2%±3.6%vs 21.6%±4.6%.and 6.5%±2.6%vs12.5%±4.4%,both P＜0.05).The PDGF-B positive cell percentages in media 7,14 and 28 days later of Group S were all significantly lower than those of Group NS(13.8%±4.6%vs 25.4%±6.2%,21.3%±4.4%vs 35.7%±7.3%,and 7.2%±3.2%vs 19.2%±5.4%,all P＜0.01).The PDGF-B positive cell percentage in adventitia peaked 28 days later in Group S and 14 days later in Group NS,and the PDGF-B positive cell percentage in adventitia 28 days later of Group S was significantly higher than that of Group NS(42.5%±8.6%vs 31.9%±4.6%%,P＜0.01).RT-PCR analysis revealed that PDGF-B amplification products(457 bp)appeared in both group S and NS from 7 to 28 days,and the PDGF-B mRNA expression levels 7,14,and 28 days later of Group S were all significantly lower than those of Group NS(31.2%±6.5%vs 45.4%±8.4%,P＜0.05:42.3%±6.2%vs 65.2%±11.5%,P＜0.01:and 21.3%±5.6%vs 36.2%±9.4%,P＜0.01).Conclusion Non-restrictive external stenting can inhibit the synthesis of PDGF and change its distribution,which may be one of the mechanisms of external stent in preventing re-stenosis of vein grafts.

A 63-year-old female was admitted to hospital on March 20, 2007 due to amenorrhea for 28 years, fatigue and cold-sensitivity for 3 years, and coma for 8 days. The patient had massive bleeding during delivery 28 years ago, followed by postpartum agalactia, amenorrhea, pubic hair and axillary hair loss, and decreased libido.

According to a news article published on the Health Day website on February 28, 2008, a new study has found that vitamin supplements do not protect people from lung cancer, but rather increase the risk of it. The research work was conducted in Washington state, involving 78,000 adults over a four-year period, on the relationship between vitamin supplements and lung cancer incidence.

A 56-year-old female patient found a mass in her upper chest 5 years ago, which was hard, painless and slowly growing. One year ago, the local skin was red, swollen and ulcerated, and a sinus tract with a diameter of about 2 cm and a depth of about 5 cm formed on the left side of the upper sternum. There were intermittent purulent and bloody secretions discharged from the sinus tract, which smelled fishy. Six months ago, another hard mass grew on the lower right side of the sinus tract, about 1 cm high, with a broad base, local skin thinning and a small amount of pigmentation, and the skin temperature was normal.