Clinicopathological features of intravascular large B-cell lymphoma and collision tumors of five cases / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of intravascular large B-cell lymphoma (IVLBCL) and its collision tumors. Methods: Five cases of IVLBCL were collected, including 2 cases of collision tumors, and 1 case complicated with liver cirrhosis. The morphology and immunophenotype were analyzed. The related literature was reviewed. Results: There were 2 females and 3 males, aged from 53 to 73 years, with a median age of 65 years. The tumors were located in the lower extremities, right cerebellar hemisphere, left kidney, bilateral nasal cavity, and liver, respectively. Cases 2 and 3 were incidentally found in meningioma and renal cell carcinoma tissues, respectively. Case 5 had a background of liver cirrhosis. Morphologically, atypical large lymphoid cells were located in small blood vessels and capillary lumen, with little cytoplasm, hyperchromasia, prominent nucleoli, and obvious mitotic figures. Immunohistochemically, the IVLBCL tumor cells expressed CD20 and PAX5; 2 cases were CD5 positive. One of the 5 cases was GCB phenotype, and 4 cases were non-GCB phenotype. All cases expressed C-MYC (positive rate was 10%-40%). PD-L1 was positive in 4 cases (positive rate was 60%-90%). Ki-67 proliferation index was 70%-90%. CKpan, CD3, TDT, and CD34 were negative. In case 2, meningioma cells were positive for PR, EMA, and vimentin, but negative for CKpan and PD-L1. In case 3, renal carcinoma cells were positive for CKpan, PAX8, EMA, vimentin, CAⅨ and CD10, while PD-L1 was negative. No EBER expression (by in situ hybridization) or C-MYC gene translocation (FISH, break-apart probe) was detected in any of the 5 cases. Three patients were followed up, and all died within 1-13 months. Conclusions: IVLBCL is a highly aggressive lymphoma, with occult clinical manifestations and poor prognosis. Collision tumors of IVLBCL are extremely rare. A better understanding of IVLBCL would help pathologists avoid misdiagnoses.

Network Meta-analysis of Chinese patent medicines in treatment of idiopathic membranous nephropathy / 中国中药杂志

This study aimed to systematically evaluate the efficacy and safety of different Chinese patent medicines in the treatment of idiopathic membranous nephropathy. The relevant randomized controlled trial(RCT) was retrieved from PubMed, EMbase, Cochrane Library, CNKI, SinoMed, Wanfang, and VIP with the time interval from database inception to December 2022. The Cochrane risk of bias assessment tool was employed to evaluate the quality of the included RCT, and Stata 15.0 and GEMTC to perform the Bayesian network Meta-analysis. Finally, 51 RCTs were included, involving 9 Chinese patent medicines and 3 591 patients. The results of network Meta-analysis showed that in terms of the total effective rate and the increase in plasma albumin, the top three interventions were Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine, Bailing Capsules + conventional western medicine, and Tripterygium Glycosides Tablets + conventional western medicine. In terms of reducing 24-hour urine total protein, the top three interventions were Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine, Shenfukang Capsules +conventional western medicine, and Huangkui Capsules + conventional western medicine. In terms of reducing serum creatinine, the top three interventions were Shenfukang Capsules + conventional western medicine, Bailing Capsules + conventional western medicine, and Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine. In terms of safety, Chinese patent medicines combined with conventional western medicine had fewer adverse reactions than the control group. The results suggest that Chinese patent medicines combined with conventional western medicine can improve the therapeutic effect on idiopathic membranous nephropathy, and differentiated medications can be adopted according to the specific symptoms of patients in clinical treatment. Further validation needs to be carried out in the future with multi-center, large-sample, and high-quality RCT.

Effect of Fufang Shelong Capsules on Rats with Membranous Nephropathy Based on p38 MAPK Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the nephroprotective and anti-inflammatory effects of Fufang Shelong capsules （FFSL） in rats with membranous nephropathy （MN）， and the role of the p38 mitogen-activated protein kinase （MAPK） signaling pathway. MethodMale SD rats of SPF grade were divided into a normal group and an experimental group. The MN model was induced by tail vein injection of cationized bovine serum albumin in the experimental group. After screening， the eligible model rats were included and divided into a positive control group （tripterygium glycosides tablets） and low-， medium-， and high-dose FFSL groups （0.375， 0.75， 1.5g·kg-1）. The rats were treated correspondingly for eight weeks， and urine protein was detected during drug intervention. Renal function and inflammation-related indicators were detected after drug intervention. The changes in 24-hour urine total protein （24 h UP）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， tumor necrosis factor-α （TNF-α）， creatinine （Cr）， blood urea nitrogen （BUN）， total protein （TP）， albumin （Alb）， and total cholesterol （TC） were detected. Flow cytometry was used to detect CD4+/CD8+ changes. Kidney tissues were collected to observe pathological changes under a light microscope and an electron microscope. The protein expression of p38 MAPK and phosphorylated p38 MAPK （p-p38 MAPK） in kidney tissues was detected by Western blot. ResultCompared with the normal group， the model group showed increased 24 h UP （P<0.01）， elevated serum Cr， BUN， TC， IL-6， IL-8， and TNF-α （P<0.05，P<0.01）， decreased serum Alb and TP levels （P<0.05，P<0.01）， increased CD4+/CD8+ in the peripheral blood （P<0.01）， and up-regulated protein expression of p38 MAPK and p-p38 MAPK in kidney tissues （P<0.05）. Additionally， in the model group， immune complex deposition and foot process fusion， accompanied by infiltration of inflammatory cells， were observed on the epithelial side of the basement membrane in the pathological kidney tissues. Compared with the model group， the groups with drug intervention showed declining 24 h UP levels at six weeks （P<0.05，P<0.01）， decreased serum Cr， BUN， TC， IL-6， IL-8， and TNF-α （P<0.05，P<0.01）， increased serum Alb and TP levels （P<0.05，P<0.01）， reduced CD4+/CD8+ in the peripheral blood （P<0.01）， improved renal pathological damage， and down-regulated p38 MAPK and p-p38 MAPK in kidney tissues （P<0.05，P<0.01）. ConclusionFFSL can decrease the expression of inflammatory factors， reduce proteinuria， delay kidney damage， and protect kidney function by inhibiting the expression of the p38 MAPK signaling pathway.

Treatment of Renal Proteinuria by Traditional Chinese Medicine and Its Mechanism / 中国实验方剂学杂志

Chronic kidney disease (CKD) refers to abnormal renal structure and function for more than 3 months, and is characterized by abnormal urine, blood and kidney structure. As an important clinical manifestation of CKD, proteinuria is closely related to glomerular damage. It is not only a pathological manifestation of CKD, but also an important pathological factor to accelerate the development of CKD. After thousands of years of development, traditional Chinese medicine (TCM) has a systematic theoretical foundation and rich clinical experience in the treatment of CKD. By referring to the treatment principles and methods of "leakage of vital essence", "low back pain", "asthenia", "blood urine" and "edema" in TCM, the general treatment principle of proteinuria is to coordinate the body Yin and Yang and restore the balance of Yin and Yang. Specific methods include removing blood stasis, sweating, urinating, invigorating the spleen and strengthening the kidney, smoothing liver and activating collaterals, and removing dampness and detoxification. Both ancient and modern physicians have established effective prescriptions according to the treatment principles and methods. Modern studies have showed that the mechanism of TCM to reduce proteinuria is mainly to improve the pathological manifestations of large area fusion of podocyte processes and complete disappearance of poddout, up-regulate the expression of nephrin and podocin, regulate immune, alleviate systemic inflammation, and improve the serum superoxide dismutase (SOD)level and the ability of the body to remove free radicals. The method and mechanism of treating renal proteinuria are discussed from three aspects:classical prescriptions, empirical prescriptions and the Chinese patent medicine. It provides a theoretical reference for the clinical treatment of chronic kidney disease, reducing the excretion of proteinuria and improving the clinical symptoms of the patients.

Analysis of the microbial contamination status of trichosanthis fructus decoction pieces / 中国药学杂志

OBJECTIVE: To investigate the microbial contamination of trichosanthis fructus decoction pieces, and provide a reference for the test method and standard of the microbial limit. METHODS: Trichosanthis fructus decoction pieces were tested for the total aerobe microbial count, the total combined yeasts and molds count, the thermoduric bacteria count, the bile-tolerant gram-negative bacteria, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Salmonella. RESULTS: The total contamination percentages of aerobes, combined yeasts and molds, thermoduric bacteria, bile-tolerant gram-negative bacteria of trichosanthis fructus are 100%, 59%, 91%, and 91%, respectively. Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and salmonella of trichosanthis fructus were not detected. CONCLUSION: To assure the safety of trichosanthis fructus decoction pieces, it is recommended to control the total aerobe microbial count, the total combined yeasts and molds count, the thermoduric bacteria count, the bile-tolerant gram-negative bacteria, escherichia coli, staphylococcus aureus, pseudomonas aeruginosa and salmonella.

Observation on short and long-term effects of Tuina for treatment of infants eczema / 中国针灸

<p><b>OBJECTIVE</b>To access the therapeutic effect of Tuina for treatment of infants eczema.</p><p><b>METHODS</b>Two hundred and forty children with eczema were randomly divided into a Tuina group and a medication group, 120 cases in each group. The Tuina group was treated with Tuina on ten points using the thumb and middle finger, and the medication group was treated with oral administration of Chlorpheniramine and topical application of zinc oxide ointment or Youzhuoer ointment, etc. The therapeutic effects were evaluated after 3 weeks.</p><p><b>RESULTS</b>The cured-markedly effective rate and total effective rate were 94.2% and 99.2% in the Tuina group and 98.0% and 100.0% in the medication group, respectively, the therapeutic effects were similar in the two groups (both P>0.05); 6 months after treatment, the recurrence rate of 3.8% in the Tuina group was significantly lower than 42.9% in the medication group (P<0.01), and there were no adverse reactions in the whole research process.</p><p><b>CONCLUSION</b>Tuina on ten points for treatment of infants eczema has unequivocal short-term effect, a stable long-term effect, and low recurrence rate.</p>

Roles of immunohistochemistry in prognostic assessment of basal-like breast cancer / 中华病理学杂志

<p><b>OBJECTIVES</b>Basal cell-like breast cancer is one of the subtypes using molecular typing, and this subtype attracted a wide spread attention. Currently, no uniform diagnostic criteria are available. Most studies demonstrated poor outcomes, but contradictory conclusions appeared recently. The prognosis of basal cell-like breast cancer using different immunohistochemical criteria were analyzed.</p><p><b>METHODS</b>Two hundred and eighty-four invasive breast cancers with a follow-up information over 5 years were evaluated for ER, PR, HER2, CK5/6, CK14, EGFR expression on tissue microarray immunohistochemically. Based on the results, these cases using four different diagnostic criteria were categorized, namely: Nielsen (ER-/HER2-, CK5/6+ and/or EGFR+), Kim (ER-/PR-/HER2-, CK5/6+ and/or CK14+ and/or EGFR+), Triple-negative (ER-/PR-/HER2-), and basal-CK (CK5/6+ and/or CK14+). 5-year survival information was compared between groups.</p><p><b>RESULTS</b>The prevalence of basal cell-like breast cancer by Nielsen, Kim, Triple-negative and basal-CK were 15.5% (44/284), 14.8% (42/284), 43.3% (123/284) and 21.1% (60/284) respectively; the recurrence rates were 18.2% (8/44), 21.4% (9/42), 10.6% (13/123) and 11.7% (7/60) respectively. These were higher than recurrence rates for other subtypes, but only the differences by Nielsen's and Kim's criteria were significant. Using Nielsen's and Triple-negative's criteria, basal-like tumors showed shorter 5-year disease-free survival (both P < 0. 01) and overall survival (P < 0.05 and 0.01) than luminal A subtype, using Kim's criteria, basal-like tumors showed a lower 5-year disease-free but not overall survival than luminal A subtype (P < 0.01); no significant difference was found on 5-year survival between basal-like and non-basal-like tumors when typed by basal-CK.</p><p><b>CONCLUSION</b>Basal cell-like breast cancers are more likely to show more recurrence and worse outcome, but different immunohistochemical diagnostic criteria have an influence on their prognostic analysis, so a uniform diagnostic criteria is essential for the further study of basal-like breast cancers.</p>

Clinicopathologic features and prognostic significance of basal-like breast cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To analyzed a large group of invasive breast cancers with long-term follow-up information to evaluate the clinicopathologic, morphological and prognostic features of basal-like breast cancers in Chinese population.</p><p><b>METHODS</b>Immunohistochemistry was used to detect the expression of ER, HER2, CK5/6, EGFR on tissue microarray with 1311 invasive breast cancers. Based on the results, these cases were categorized into luminal A, luminal B, basal-like, HER2-overexpressing and null subtypes. Clinicopathological features and survival rates were compared between these groups.</p><p><b>RESULTS</b>Basal-like breast cancers constituted 17.0% of 1311 invasive breast cancers with a significantly larger size, higher grade and higher incidence of the medullary carcinoma, frequent recurrence and infrequent node metastasis. Morphologically, basal-like breast cancers showed a significantly more solid architecture and ribbon-like architecture associated with necrosis (more geographic necrosis) and central scar, a more pushing margin, lymphocytic infiltration and a higher mitosis score, more syncytial growth, presence of basaloid cells, spindle cells and squamous metaplasia. The disease-free survival and overall survival of basal-like breast cancers were significantly poorer than that of luminal A subtype, but similar to the other ER-negative subtypes. Basal markers were not independent prognostic factors.</p><p><b>CONCLUSIONS</b>Basal-like breast cancers in Chinese population has a similar prevalence to that of the western populations. They have distinct clinicopathologic features compared to other non-basal breast cancers, but overlapping with other ER-negative breast cancers. Morphological features are strongly associated with basal-like breast cancers although they are not very specific. The survival of basal-like breast cancers is poorer than luminal A, but similar to the other ER-negative breast cancers, and basal markers are not independent prognostic factors of breast cancers.</p>