Effect of Serum Free Light Chain on Renal Function and Prognosis in Patients with Newly Diagnosed Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To analyze the effect of serum free light chain (sFLC) on renal function and prognosis in patients with newly diagnosed multiple myeloma (MM).@*METHODS@#The clinical data of 70 newly diagnosed MM patients who received sFLC examination in Fujian Medical University Union Hospital were retrospectively analyzed from April 2012 to November 2016. Univariate analysis was used to analyze the risk factors that associated with renal impairment (RI) and prognosis. Logistic regression and Kaplan-Meier analyze were used to analyze the roles of sFLC in RI and the prognosis.@*RESULTS@#Out of the 70 patients, 20 patients had RI at the initial diagnosis. Compared to normal renal function group, RI group had lower level of hemoglobin, elevated levels of serum uric acid, corrected calcium, serum creatinine, serum β2 microglobulin, and involved sFLC, higher proportion of patients with ISS stage III, involved sFLC≥500 mg/L, hemodialysis (all P＜0.05). Multivariate logistic regression analysis showed that serum uric acid≥430 μmol/L, ISS stage III and a involved sFLC≥500 mg/L were all the independent risk factors for RI in patients with newly diagnosed MM patients (all P＜0.05). Receiver operating characteristic (ROC) curves analysis showed that the involved sFLC was 705.0 mg/L, which was a best cut-off value area under curve (AUC) for prediting RI in patients with MM was 0.727 (P=0.003), sensitivity was 65.0% and specificity was 82.0%). After a median follow-up period of 31 (1-84) months, the median overall survival (OS) of patients with involved sFLC≥500mg/L and involved sFLC＜500 mg/L were 52.0 and 27.0 months, respectively, there was no statistically significant difference (P=0.137). There was also no statistically significant difference in median OS between the high sFLC ratio group (κ/λ＞32 or ＜0.03) and the low sFLC ratio group (0.03≤κ/λ≤32) (27 months vs 40 months, P=0.436).@*CONCLUSION@#The involved sFLC in the RI group is significantly higher than that in the normal renal function group in newly diagnosed MM patients. Serum uric acid≥430 μmol/L, ISS stage III and involved sFLC≥500 mg/L are the independent risk factors for RI. Monitoring sFLC in newly diagnosed MM patients is helpful to the prediction of RI, and the involved sFLC level or sFLC ratio may not affect the prognosis of newly diagnosed MM patients.

The significance of serum homocysteine and neutrophil gelatinase associated lipocalin detection in patients with hypertensive nephropathy / 国际检验医学杂志

Objective To analyse the clinical significance of serum homocysteine(Hcy) and neutrophil gelatinase‐associated li‐pocalin(NGAL) in patients with hypertensive nephropathy ,and explore the relationship between serum homocysteine ,NGAL con‐centration and Urinary albumin excretion rate(UAER) .Methods 103 patients with hypertension treated in renal and cardiovascular department of Huangshi Central Hospital from January 2012 to June 2014 were enrolled in the study and were divided into 3 groups :macroalbuminuria group (36 cases) ,microalbuminuria group (35 cases) and negative albuminuria group (32 cases) .In addi‐tion to that ,33 healthy people were recruited as control group .Serum homocysteine ,NGAL concentration and UAER were meas‐ured for the peple enrolled in the study .Results Serum homocysteine and NGAL concentration of macroalbuminuria group and mi‐croalbuminuria group were much higher than negative albuminuria group and control group(P0 .05) .UAER was positively correlated with serum homocysteine and NGAL concentration(r=0 .792 ,0 .658 ,P<0 .05) . Conclusion The detection of serum homocysteine and NGAL are helpful in understanding the changes of disease in patients with hypertensive nephropathy .

Observation of homocysteine and blood uric acid in patients with type 2 diabetes mellitus complicating hypertension / 国际检验医学杂志

Objective To investigate the relationship between homocysteine(Hcy)and blood uric acid(UA)in the patients with type 2 diabetes mellitus(T2DM)complicating hypertension.Methods 85 patients with T2DM complicating hypertension were se-lected as the groupⅠ,78 patients with simple T2DM as the group Ⅱ and 74 individuals with healthy physical examination as the group Ⅲ.Hcy,UA,TC,TG and HDL-C were measured in all the subjects.Results Compared with group Ⅲ(control),the levels of Hcy,UA,TC and TG in the group Ⅰand groupⅡwere significantly increased(P <0.05),but the level of HDL-C was significantly decreased(P <0.05).Compared with the group Ⅱ(T2DM),the levels of Hcy,UA,TC and TG in the group Ⅰwere significantly in-creased(P <0.05 ),but the level of HDL-C was obviously decreased,the difference had statistical significance (P <0.05 ).There was good positive correlation between the Hcy level and the UA level in the patients with T2DM complicating hypertension (r =0.658,P <0.05).Conclusion The levels of Hcy and UA are significantly increased in the patients with T2DM especially complica-ting hypertension.High Hcy and high UA are the important risk factors of T2DM complicating cardiocerebrovascular diseases.

Cervical glandular intraepithelial neoplasia: a clinicopathologic and immunohistochemical analysis of 80 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To assess the clinicopathologic characteristics of cervical glandular intraepithelial neoplasia (CGIN) and to evaluate the usefulness of EnVision immunohistochemistry of various markers in identifying early invasive cervical adenocarcinoma (ICA) and its precursor lesions.</p><p><b>METHODS</b>Clinical and pathological characteristics of 80 cases of high grade CGIN (HCGIN), 20 ICA, and 20 cervicitis were reviewed along with immunohistochemical studies of p16, Ki-67, CEA, CA125 and bcl-2.</p><p><b>RESULTS</b>The clinical features of HCGIN were similar to those of high grade cervical intraepithelial neoplasia (CIN). Fourty four cases (55.0%) accompanied with CIN and 9 cases (11.3%) accompanied with early cervical squamous cell carcinoma (SCC). The positive rates of p16, CEA and Ki-67 in 80 cases of HCGIN were 100.0%, 63.8% and 73.8%, respectively. The positive rates of p16, CEA and Ki-67 in 20 ICA were 18/20, 16/20 and 20/20, respectively. The positive rates of p16, CEA and Ki-67 in 20 cervicitis were 1/20, 1/20 and 3/20, respectively. There was a significantly increased expression of p16, CEA and Ki-67 in ICA and HCGIN compared with cervicitis (P < 0.01). Ki-67 expression increased in ICA compared to HCGIN (P < 0.05). There was no statistical difference in CEA expression between ICA and HCGIN (P > 0.05). CA125 showed strong but nonspecific expression. Bcl-2 was negative or occasionally positive in each groups.</p><p><b>CONCLUSIONS</b>HCGIN is frequently accompanied with CIN and SCC. The combined staining of p16, CEA and Ki-67 provides additional aid in the diagnosis of early stage cervical adenocarcinoma and its precursor lesions. The sensitivity of p16 and Ki-67 markers for HCGIN is higher than that of CEA. CA125 and bcl-2 immunostains offer no helpful in identifying HCGIN.</p>

Histological evaluation of cervical carcinomas in FIGO stage Ib2/IIa after neoadjuvant chemotherapy / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the histological changes of cervical cancer after neoadjuvant chemotherapy (NACT) and to establish histological criteria for interpretation of chemotherapeutical effects.</p><p><b>METHODS</b>Fifty-six patients with FIGO stage Ib2-IIa cervical cancers treated by NACT and subsequent radical surgery were retrospectively analyzed, in which the pre- and post-chemotherapeutic histopathological changes were assessed.</p><p><b>RESULTS</b>The post-chemotherapeutic histopathological changes of 56 cases included grade 3 effects in 11 cases (19.6%), grade 2 in 24 cases (42.9%), grade 1 in 13 cases (23.2%) and no response in only 8 cases (14.3%). The histologic response rate was 62.5% (35/56) and the overall clinical response rate was 67.9% (38/56). The overall coincidence by both criteria was 78.6% (44/56). Four cases (7.1%, 4/56) had only histological response and 8 cases (14.3%, 8/56) had response by imaging. In comparison with the pre-chemotherapy specimens, the chemotherapy-associated histological changes included shrinkage and scattering of tumor nests,decrease of tumor cellularity,tumor cell degeneration and necrosis.</p><p><b>CONCLUSIONS</b>The histological changes in locally advanced cervical cancers induced by NACT are significant, which may challenge the diagnosis in the final specimens. There are some discreqancies between the histological criteria and imaging/gynecological ones for the therapeutic evaluation of cervical cancers,and it is thus recommended to use the pathological criteria for clinic practice.</p>

Value of P16 expression in the triage of liquid-based cervical cytology with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The management of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL) is still controversial and it is advisable to make a triage for these two cytological abnormalities. P16(INK4) (P16) has been shown to be a potential biomarker for predicting high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of the study was to determine the value of P16 expression by immunostaining method compared with high-risk human papillomavirus (HR-HPV) DNA test in the triage of ASCUS/LSIL women.</p><p><b>METHODS</b>Totally 86 eligible residual liquid-based cytological specimens with ASCUS and 45 with LSIL were obtained. All specimens were submitted to HR-HPV DNA test (HC2) and P16 immunocytochemical staining simultaneously. And all women underwent colposcopy and biopsy after cytology.</p><p><b>RESULTS</b>The positive rate of P16 staining was 32.6% in ASCUS and 42.2% in LSIL, which was significantly lower than that of HR-HPV test in both ASCUS (P < 0.05) and LSIL (P < 0.05). Moreover, the positive rate of P16 staining was 12.7% in normal histology, 61.5% in CIN 1, 87.0% in CIN 2-3, and 100.0% in cancer, in which P16 positive rate was significantly lower than HR-HPV positive rate in normal group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of P16 staining for predicting CIN 2 or more were 87.5%, 68.6%, 38.9%, 96.0%, and 72.1%, respectively in the ASCUS; while 90.0%, 71.4%, 47.4%, 96.2% and 54.7%, respectively in the LSIL, in which the specificity and accuracy of P16 staining were significantly higher than those of HR-HPV test in both ASCUS and LSIL (P < 0.05).</p><p><b>CONCLUSION</b>P16 immunostaining had significantly higher specificity and accuracy than HR-HPV DNA test for predicting for high-grade CIN and cervical cancer in ASCUS and LSIL and can be used for the triage of women with ASCUS/LSIL cytological abnormality.</p>

Clinicopathologic analysis of uterine epithelioid trophoblastic tumor / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype, differential diagnosis and prognosis of uterine epithelioid trophoblastic tumor(ETT).</p><p><b>METHODS</b>From 2000 to 2007, 5 ETTs cases were diagnosed in the affiliated Women's Hospital, School of Medicine, Zhejiang University. The pathologic characteristics and immunophenotype of the tumors were analyzed by histological examination and immunohistochemistry of CK18, p63, inhibin-alpha, HCG, HPL, PLAP and Ki-67. The clinical prognostic factors were evaluated based on a following-up data with a period of 11 - 50 months.</p><p><b>RESULTS</b>The overall prevalence of ETT was 0.48% among all the gestational trophoblastic diseases patients received in the same period. Five ETT patients were in the reproductive ages with a median of 33 years. Histologically, the tumor showed an invasive, nodular growth consisting of uniform mononuclear trophoblastic cells. There were zones of hyaline material in the tumour nests. Necrosis was commonly seen with a characteristic geographic pattern. Immunohistochemically, all cases displayed a diffuse CK18 and p63 positivity, to be either positive focally or negative for HCG, HPL and PLAP staining. Inhibin-alpha staining was positive or negative either in the 5 cases. Two patients died of the tumour relapse: one died after 1 year with the tumor having a high mitotic activity (averagely 15 mitotic figures per 10 high-power fields), and the other died of lung metastasis 2 years after the diagnosis.</p><p><b>CONCLUSIONS</b>ETT is a rare trophoblastic disease with distinct clinicopathological features and immunostaining patterns. A high mitotic index and lung metastasis are indicators for an unfavorable prognosis.</p>

Accuracy of tumor grade by preoperative curettage and associated clinicopathologic factors in clinical stage I endometriod adenocarcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage I endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage I endometriod adenocarcinoma.</p><p><b>METHODS</b>Clinical data of totally 687 patients with clinical stage I endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed.</p><p><b>RESULTS</b>In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% (281/687) and an upgraded rate of 24.7% (170/687). The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively.</p><p><b>CONCLUSIONS</b>Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage I endometriod adenocarcinoma.</p>

Molecular characteristics of three new isolates of Japanese encephalitis virus in Fujian Province / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analyze the genotype of newly isolated Japanese encephalitis viruses in Fujian province and the characteristics of amino acid sequence in the E gene.</p><p><b>METHODS</b>PrM and E segments of newly isolated Japanese encephalitis viruses were amplified by RT-PCR, the PCR products were cloned into T vector for sequencing. Phylogenetic analysis was carried out by PHYLIP program.</p><p><b>RESULTS</b>Newly isolated Japanese encephalitis viruses belonged to genotype III, the nucleotide and amino acid of E gene showed high homology to vaccine strain SA14-14-2, but had some difference in some domains.</p><p><b>CONCLUSION</b>Newly isolated viruses in Fujian province belonged to Japanese encephalitis virus genotype III. E protein of the isolates showed some differences as compared with vaccine strains.</p>

Clinicopathologic analysis of 102 cases of mixed epithelial and mesenchymal tumors of the uterus / 中华妇产科杂志

Objective To study the clinical and pathologic features,histological criteria and pathologic factors contributing to diagnosis of mixed epithelial and mesenchymal tumors(mixed m?llerian tumors,MMT)of the uterus.Methods A retrospective study of 102 cases of MMT of the uterus (74 adenofibromas including 9 recurrent cases,3 atypical polypoid adenomyomas,2 carcinofibromas,10 adenosareomas and 13 carcinosarcomas)was undertaken.Clinical records,gross features and tissue slices were reviewed.The follow-up data were analysed.Results The most common symptom was vaginal bleeding.Clinical signs included pelvic mass,uterine polyps,and enlarged uterus.Benign MMT usually presented as exophytic polypoid masses extending into the uterine cavity or protruding through the external os,often broad-based,lobulated and papillary.It was hard to distinguish low-grade malignant MMT from the benign ones by gross appearance.High-grade malignant MMT had the common gross features of carcinoma and sarcoma.Histologically,MMT showed a biphasic differentiation of mesenchymal and epithelial components.MMT were classified according to whether these elements were benign or malignant.Nine cases of adenofibroma without unique features for the diagnosis of adenosarcoma recurred at postoperative intervals of 3 to 96 months.Recurrent tumors were almost always confined to the original site.Conclusions Uterine MMT tumors according to WHO diagnostic criteria are not rare.The differential diagnosis depends on a multifactorial analysis.The recurrent adenofibromas may be a kind of borderline tumors with benign appearances and malignant behavior.

The Study on Improving Method of Extracting Bacteria Plasmid / 昆明医科大学学报

Objective To establish a simple,accurate and practi cal method of extracting plasmid from gram-negative and gram-positive bacteria ,Method we selected,Biswajit sahas method and comported others method, such as controlling pH andtemperature strictly and increasing EDTA-Na2 capacity． Result The eight strip s of Ecliv 5l7 can not be found completely in original method, but can be found in our one．We found the largest plasmid molecular weight was l86.3?kb, and t he minimum was l.l?kb from each 30 strains STA, EC, PA． Plasmid profile is alike through repeating ex p eriment three times． Conclusion:The method can be widely used in extracting bac teria plasmid and fit gram-negative and gram-positive bacteria whenever molecular weight ma x or min． These conditions can be obtained in general laboratory．

Urine Infection Reoccurrence and Analysis Plasmid of Inspection L-form Bacteria / 昆明医科大学学报

To discuss bacteria of urine infection reoccurrence , the routine culture and L-form bacteria culture of urine tract infection on 850 cases were adopted and clinica l watching and analysis of the bacteria plasmid were held ．Result: of the l28 cases, re-infec tion rate l5.0%．,the positive rate of the routine bacteria culture for those initial diagnosis patie nts was 58.3% while that of the re-infection patients was 34.0% P<0.0l ．The initia l diagnosis L-form inspected rate 5.6%yet that of re-infection was up to 32.0 % P<0.01 ．The analysis of the pla smid bacteria of re- infection were of the same origins ．Conclusion: the first infection dont nee d L-form culture but re- infection should have L-form culture ．Analysis: plasmid positive bacteria of r e-infection was the result of the first infection not completely cured．