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Objective:To analyze the expression of mismatch repair genes MLH1 and PMS2 in elderly colorectal cancer patients and its association with the clinicopathological features.Methods:This study was a single-center retrospective cohort study.According to the loss of MLH1 and PMS2 gene expression, elderly patients with colorectal cancer admitted to Beijing Hospital from January 2014 to December 2018 were consecutively enrolled and divided into the MLH1 group(n=65)and the PMS2 group(n=80). Pathological features were compared between the MLH1 group, the PMS2 group and patients with normal MLH1 and PMS2 gene expression.Results:Among patients with the loss of MHL1 protein expression, pathological features were similar in males and females.A minority of patients(16.9%)had a family history of tumors.Most lesions were either moderately differentiated(63.1%)or poorly differentiated(24.6%). Regarding staging, 44.6% were in stage T4, 27.7% were in stage T3, 61.5% were in N0, 89.2% were in M0, and most patients were in TNM stage Ⅲ.Lesions were mostly located in the ascending colon(61.5%). Compared with patients with normal expression of MHL1, patients with the loss of MHL1 protein expression were younger[(74.6±8.8) years old vs.(77.3±6.2) years old, t=-2.072, P=0.040]and had greater maximal tumor length[(5.7±2.3) cm vs.(4.4±1.3) cm, t=3.753, P<0.001], and there were significant differences in lesion differentiation, T staging and tumor location between the two groups( P<0.05). Conclusions:Loss of MLH1 or PMS2 gene expression in elderly colorectal cancer patients is associated with an early age of onset, rapid tumor progression, poor differentiation, and pathological staging.
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Objective@#To determine the frequency and extent of left ventricular amyloid deposition in patients aged over 85 years with heart failure and preserved ejection fraction (HFpEF).@*Methods@#A total of 43 patients aged 85 to 100 years old were enrolled in this study based on the autopsy database of Beijing Hospital from February 1, 2003 to October 31, 2016. The frequency and extent of left ventricular amyloid deposition and myocardial fibrosis were determined in left ventricular specimens from patients with antemortem diagnosis of HFpEF without clinically apparent amyloid (n=28) and from control subjects (n=15) post Congo red staining and Masson's trichrome staining. Kappa test was used to evaluate the consistency of the myocardial amyloidosis and fibrosis.@*Results@#The heart weight of the patients in HFpEF group and in control group were similar((452.7±107.7)g vs. (415.0±70.8)g, t=-1.218, P=0.23)). Positive Congo-red staining was found in 24 examples (24/28) in HFpEF group and 5 examples (5/15) in the control group; severe amyloid deposition was found in 7 examples (7/28) in HFpEF group, but not in the control group. Amyloid deposition was more severe in HFpEF group than in control group (χ2=12.205, P<0.01). Masson's trichrome staining evidenced moderate to severe fibrosis in 19 cases (19/28) in HFpEF group and 8 cases (8/15) in control group (χ2=1.019, P=0.35). A consistent evaluation of the degree of myocardial fibrosis and the degree of myocardial amyloid deposition in all selected participants was performed and results showed that these two parameters were not consistent (Kappa value=0.2, P=0.820).@*Conclusion@#Amyloid deposition is common in the elderly patients with heart failure and preserved ejection fraction, suggesting that myocardial amyloidosis may be related to the development of HFpEF. There is no significant correlation between myocardial amyloidosis and myocardial fibrosis in this cohort.
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Objective To investigate the accuracy of transthoracic echocardiography (TTE) for diagnosing left cardiac valve calcification in elderly patients.Methods In this retrospective study,410 elderly patients died in Beijing Hospital from 1982 to 2015 were collected.They all had full pathological cardiac valve examination data in the autopsy examination and full mortem TTE data.They were classified into three groups according to the year of death:group 1982-1995,group 1996-2005 and group 2006-2015,as well as into three groups according to the age of death:group 60-75,group76-90 and group 91-106.Results The sensitivity,specificity,diagnostic coincidence rate,positive likelihood ratio (PLR),negative likelihood ratio (NLR),positive predictive value (PPV) and negative predictive value(NPV) of TTE versus autopsy pathological findings as golden standard for diagnosing left cardiac valve calcification were 88.6％,28.2％,43.7％,1.234,0.405,0.298 and 0.878.Compared with group 1982-1995,the group 1996-2005 and group 2006-2015 showed the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification in the elderly were increased while the specificity,PLR,NLR and NPV were decreased.Compared with group 60-75,the group 76-90 and group 91-106 showed that the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification were increased,while the specificity and diagnostic coincidence rate were decreased.The sensitivity,specificity,diagnostic coincidence rate,PLR,NLR,PPV,NPV of TTE versus golden standard autopsy findings for the diagnosis of aortic valve calcification and mitral valve calcification in the elderly were 88.2％ and 44.0％,30.8％ and 75.3％,42.7％ and 71.5％,1.275 and 1.780,0.382 and 0.744,0.250 and 0.198,0.909 and 0.906,respectively.Conclusions TTE provides high sensitivity for diagnosing left cardiac valve calcification in the elderly,especially for diagnosing the aortic valve calcification,but the specificity is not satisfactory.
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Objective To investigate the prevalence rate of heart valve calcification and its relativity with pathological changes and clinical pathogenic factors in elder patients at autopsy Methods Pathology data at autopsy of 1047 patients with age from 60 to 106 years in Beijing Hospital from November 1954 to March 2016 were collected.Cases of heart valve calcification verified at autopsy were retrospectively reviewed.The prevalence of heart valve calcification and its relativity with age,clinical disease and coronary atherosclerosis was investigated.Results Among 1047 autopsies,aortic valve calcification(AVC)was found in 15.2 ％ (n=159),mitral valve calcification(MVC)in 9.6 ％ (n=101),both AVC and MVC calcification in 5.4 ％ (n =57)and heart valve calcification in 19.4 ％ (n =203).The prevalence of heart valve calcification was 6.4％ (15/234)at age of 60-69,12.8％(37/289)at age of 70-79,22.5％(70/311)at age of 80-89 and 38.0％ (81/213) at age of 90-106 years,respectively(tendency x2 =82.523,P＜0.01).Calcification prevalence was significantly increased when complicated with coronary artery stenosis,hypertension,coronary artery disease (CAD),diabetes and chronic kidney disease (CKD).Multivariate regression analysis showed that age and CAD were independently risk factors for heart valve calcification(OR=1.066,95％ CI:1.048-1.086,P＜ 0.01;OR =2.238,95％ CI:1.396-3.589,P＜0.01,respectively),while hypertension,diabetes and CKD were not independent risk factors(OR =1.223,95％ CI:0.859-1.741,P＞ 0.05;OR =1.053,95％ CI:0.700-1.586,P ＞0.05;OR =0.924,95％ CI:0.610-1.399,P＞ 0.05,respectively).As compared with patients without heart valves calcification,patients with heart valve calcification had more increased risk for coronary atherosclerosis(OR =2.983,95a％CI:1.868-4.765,P＜0.01).Conclusions Prevalence of heart valve calcification is increased in elder patients with increasing age.Prevalence of heart valve calcification is higher in CAD patients than in non-CAD patients.And heart valve calcification is sigmficantly associated with coronary atherosclerosis.
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Objective To analyze ultrasonic elastography (UE) score of breast carcinoma and to explore the correlation between UE and pathological collagen content in stroma.Methods UE scores of 60 breast carcinoma before operation were retrospectively studied.The correlation between the UE scores and the pathological collagen content grading in stroma after operation were analyzed.Results UE score of 60 breast carcinoma were (4.07 ± 0.78) scores,the diagnosis coincidence rate of UE score was 80.0％ (48/60).Positive correlation existed between UE score and the pathological collagen content grading in stroma of breast carcinoma (r =0.440,P =0.015).Conclusion UE score of breast carcinoma is related to the pathological collagen content in stroma,and it can evaluate collagen content in stroma of breast masses in some degree.
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Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of calcification was higher in elderly group than in non elderly group [71.8％ (526/733) vs.14.6％ (34/233),x2＝237.10,P＜0.01].In elderly group,the incidence of aortic valve stenosis was 2.1％ (11/526) in calcification subgroup and 1.9％ (4/207) in non calcification subgroup (x2＝0.81,P＞0.05).In elderly group,the incidence of aortic valve regurgitation was 63.3％ (333/526) in calcification subgroup and 19.3％ (40/207) in non calcification subgroup (x2＝116.10,P＜0.01).The hazard ratio of aortic valve calcification in different diseases were as follows:hypertension (OR＝2.06,95％CI:1.400-3.031),coronary heart disease (OR＝3.46,95％CI:2.217-5.384),diabetes mellitus (OR ＝ 2.66,95％CI:1.652-4.278),renal dysfunction (OR＝ 2.34,95％ CI:1.415-3.869),osteoporosis (OR＝ 2.33,95％CI:1.119-4.838).Conclusions The incidence of calcification,mainly causing aortic valve regurgitation,is high in elderly patients.Patients with hypertension,coronary heart disease,diabetes mellitus,renal dysfunction and osteoporosis are prone to the development of aortic valve calcification.
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Objective To explore the diagnosis and treatment of non traumatic chylothorax in non-Hodgkin's lymphoma (NHL) and to understand the differences in diagnosis and treatment between chylothorax and pseudochylothorax. Methods The patient aged 83 years was confrimed as chylothorax and NHL after lymph node biopsy.We reviewed literatures about chylothorax in NHL to analyse the possible mechanism,its diagnosis and treatment. Results The patient was sufferring from unilateral chylothorax diagnosed as true chylothorax by thoracentesis,and progressed to bilateral chylothorax after 1 year.PET/CT examination showed intrathoracic and right cervical lymph nodes enlargement and an increasing metabolic activity.Cervical lymph node biopsy revealed diffuse large B cell type non-Hodgkin's lymphoma.The patient refused any other treatment except the diet therapy and died after 19 months.We searched 19 cases with NHL chylothorax in associated literatures about the treatments including radiotherapy (6/6 improved),chemotherapy (6/11 improved),thoracic duct ligation (I/1 improved),thoracic duct ligation and drug pleurodesis(1/1 improved). Conclusions PET/CT is useful in finding the hidden clues of chylothorax in NHL.There is no standard mangement for NHL chylothorax and the treatment must be individualized. The overall prognosis of NHL chylothorax is similar to that of non-Hodgkin's lymphoma and the patient needs early diagnosis and general treatment in order to prolong the survival time.
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Objective To construct the recombinant adenovirus vector with hTERT-HSV-TK and observe the killing effect of Ad-hTERTp-HSV-TK/GCV system on hepatocellular carcinoma cells. Methods A recombinant replication defective adenoviral vector of Ad-hTERTp-HSV-TK was constructed via homologous recombination which both shuttle plasmid pSU-Tp-TK and adenovirus backbone plasmid pBHGE3 transfected into the HEK293 packaging cells. Then the Ad-hTERTp-HSV-TK was amplified and purified through PCR. The activity of the HepG2 cells and the L-02 cells were tested by methyl thiazolyl terazolium (MTT) after they were transfected by the recombinant adenovirus of different multiplicities of infection (MOI) and then were added GCV of different conc.entration. Results The recombinant replication defective adenoviral vector of Ad-hTERTp-HSV-TK were identified by PCR successfully. The viral titer was 1.5×1010 pfu/ml after amplification and purification. The HepG2 cells were targetedly suppressed by Ad-hTERTp-HSV-TK/GCV system. The survival rate of cells decreased gradually along with the increase of the MOI and the GCV' s concentration. Conclusion The recombinant replication defective adenoviral vector of Ad-hTERTp-HSV-TK can inhibit the HepG2 cells significantly, but has not influence on the L-02 cells.
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Objective To investigate the values of tCho concentration in early assessment therapeutic response of tumor to neoadjuvant chemotherapy with 1HMR spectroscopy. Methods Twenty patients with breast cancer were recruited. All patients underwent biopsy before neoadjuvant chemotherapy and surgery after chemotherapy. The pathologic results before and after neoadjuvant chemotherapy were compared. The patients were divided into effective response group (R) and ineffective response group (IR). MRS acquisitions were performed within 1 week before chemotherapy and within 3 week after the first cycle of chemotherapy, respectively. The tCho concentration was calculated quantitatively using external standard method. The tCho concentrations before and after chemotherapy and the tumor sizes between R group and IR group were compared using t test and nonparametrie test. The values of tCho concentration in early assessment of the effectiveness of chemotherapy were analyzed by ROC. Results Of 20 cases, 16 were included in R group and 4 in IR group. In R group, significant differences of tCho concentration (t=5. 040, P < 0. 01 ) existed between before and after chemotherapy [ (4. 24 ± 3.09 ), ( 1.13 ± 1.14 ) mmol/L ], while not in I R group [ ( 3.72 ± 2. 69), ( 3.06 ± 2. 21 ) mmol/L, t = 1. 785, P > 0. 05 ]. The median sizes of tumor between R and IR group had no significant differences (0. 00,0. 00 cm, U = 23.00, W = 33.00, P = 0. 437). The area under ROC curve of tCho concentration was 0. 984. Conclusion With in vivo 1HMRS, the tChn concentration in breast cancer can serve as an indicator for predicting response to neoadjuvant chemotherapy with relatively high sensitivity and specificity.
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<p><b>OBJECTIVE</b>To study the clinicopathological characteristics diagnosis, differential diagnosis and etiology of demyelination pseudotumors of the brain.</p><p><b>METHODS</b>The clinical features, CT, MRI scan findings, corticosteroid therapeutic effects and follow-up data of 3 cases of demyelination pseudotumors of the brain were analysed, and pathological changes were observed by histologic (HE, Luxol fast blue and Bodian) and immunohistochemical (S-P method) techniques.</p><p><b>RESULTS</b>The acute onset of demyelination pseudotumors appeared to be more predominant in our data. Clinical manifestations included headache, vomiting, a depressed conscious level, dysphasia, and paresis. CT, MRI scans showed solitary or multiple lesions in cerebral hemisphere. All the patients presented excellent response to steroid treatment. Follow-up for a period of 6 to 31 months, revealed the absence of progression or recurrence. The pathological changes were mainly located in both cerebral hemispheres, in which there were relative axonal preservation in foci loss of myelin, reactive gliosis, profuse perivascular lymphocytic infiltration and mixtures of foamy macrophages.</p><p><b>CONCLUSION</b>Demyelination pseudotumor is a distinct clinicopathologic encephalitic entity. The findings of this study suggest that the cause of tumefactive demyelination may be related to an allergic reaction triggered by viral infection.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Demyelinating Diseases , Diagnostic Imaging , Metabolism , Pathology , Immunohistochemistry , Methods , Magnetic Resonance Imaging , Pseudotumor Cerebri , Diagnostic Imaging , Metabolism , Pathology , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.</p><p><b>METHODS</b>Eighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.</p><p><b>RESULTS</b>With the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.</p><p><b>CONCLUSIONS</b>Brain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.</p>