Fibroma of tendon sheath: a clinicopathological and genetic analysis of 134 cases / 中华病理学杂志

Objective: To investigate the clinicopathological features, immunophenotypes and molecular genetics of fibroma of tendon sheath (FTS). Methods: One hundred and thirty-four cases of FTS or tenosynovial fibroma diagnosed in the Department of Pathology, West China Hospital, Sichuan University, Chengdu, China from January 2008 to April 2019 were selected. The clinical and histologic features of these cases were retrospectively reviewed. Immunohistochemistry, fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR) were performed on the above cases. Results: There were a total of 134 cases of FTS, including 67 males and 67 females. The patients' median age was 38 years (ranged from 2 to 85 years). The median tumor size was 1.8 cm (ranged from 0.1 to 6.8 cm). The most common site was the upper extremity (76/134, 57%). Follow-up data was available in 28 cases and there was no detectable recurrence. Classic FTS (114 cases) were well-defined and hypocellular. A few spindle-shaped fibroblasts were scattered in the dense collagenous sclerotic stroma. Characteristically elongated slit-like spaces or thin-walled vessels were observed. Most of cellular FTSs (20 cases) were well-defined and the area with increased cellularity of the spindle cells coexisted with classic FTS. There were occasional mitotic figures, but no atypical mitotic figures. Immunohistochemistry was performed in 8 cases of classic FTS and most cases were positive for SMA (5/8). Immunohistochemistry was also performed in 13 cases of cellular FTS and showed 100% positive rate for SMA. FISH was conducted on 20 cases of cellular FTS and 32 cases of classical FTS. USP6 gene rearrangement was found in 11/20 of cellular FTS. Among 12 cases of CFTS with nodular fasciitis (NF)-like morphological feature, 7 cases showed USP6 gene rearrangement. The rearrangement proportion of USP6 gene in cellular FTS without NF-like morphological features was 4/8. By contrast, 3% (1/32) of the classic FTS showed USP6 gene rearrangement. RT-PCR was performed in those cases with detected USP6 gene rearrangement and sufficient tissue samples for RT-PCR. The MYH9-USP6 fusion gene was detected in 1 case (1/8) of the cellular FTSs, while no target fusion partner was detected in the classic FTS. Conclusions: FTS is a relatively rare benign fibroblastic or myofibroblastic tumor. Our study and recent literature find that some of the classic FTS also show USP6 gene rearrangements, suggesting that classical FTS and cellular FTS are likely to be at different stages of the same disease (spectrum). FISH for USP6 gene rearrangement may be used as an important auxiliary diagnostic tool in distinguishing FTS from other tumors.

Cryptic COL1A1-PDGFB fusion in dermatofibrosarcoma protuberans: a clinicopathological and genetic analysis / 中华病理学杂志

Objective: To investigate the clinicopathological and cytogenetic features of cryptic COL1A1-PDGFB fusion dermatofibrosarcoma protuberans (CC-DFSP). Methods: Three cases of CC-DFSP diagnosed in West China Hospital, Sichuan University, Chengdu, China from January 2021 to September 2021 were studied. Immunohistochemistry for CD34 and other markers, fluorescence in situ hybridization (FISH) for PDGFB, COL1A1-PDGFB and COL1A1, next-generation sequencing (NGS), reverse-transcriptase polymerase chain reaction (RT-PCR) and Sanger sequencing were performed. Results: There were three cases of CC-DFSP, including two females and one male. The patients were 29, 44 and 32 years old, respectively. The sites were abdominal wall, caruncle and scapula. Microscopically, they were poorly circumscribed. The spindle cells of the tumors infiltrated into the whole dermis or subcutaneous tissues, typically arranging in a storiform pattern. Immunohistochemically, the neoplastic cells exhibited diffuse CD34 expression, but were negative for S-100, SMA, and Myogenin. Loss of H3K27me3 was not observed in the tumor cells. The Ki-67 index was 10%-15%. The 3 cases were all negative for PDGFB rearrangement and COL1A1-PDGFB fusion, whereas showing unbalanced rearrangement for COL1A1. Case 1 showed a COL1A1 (exon 31)-PDGFB (exon 2) fusion using NGS, which was further validated through RT-PCR and Sanger sequencing. All patients underwent extended surgical resection. Except for case 3 with recurrence 2 years after surgical resection, the other 2 cases showed no recurrence or metastasis during the follow-up. Conclusions: FISH has shown its validity for detecting PDGFB rearrangement and COL1A1-PDGFB fusion and widely applied in clinical detection. However, for cases with negative routine FISH screening that were highly suspicious for DFSPs, supplementary NGS or at least COL1A1 break-apart FISH screening could be helpful to identify cryptic COL1A1-PDGFB fusions or other variant fusions.

Spindle cell hemangioma: a clinicopathological and molecular analysis of eight cases / 中华病理学杂志

Objective: To investigate the clinicopathological and genetic characteristics of spindle cell hemangioma (SCH). Methods: The clinical, morphological and immunohistochemical features of 8 SCHs diagnosed from January 2013 to September 2021 in West China Hospital, Sichuan University, Chengdu, China were retrospectively analyzed. Hotspot mutations for IDH1 codon 132 and IDH2 codon 172 were tested in 4 SCHs and 29 other non-SCH lesions using Sanger sequencing. Results: The 8 cases occurred in patients with a wide age range, from neonate to 46 years (mean 28 years, median 32 years). Both genders were equally affected. The course of the disease spanned from half a year to 31 years. Two SCHs were recurrent tumors. All tumors involved the distal extremities (4 of foot, 2 of ankle and 2 of hand). Six cases were presented as a single lesion and 2 cases as multiple lesions. The tumor diameters were 1-5 cm. All the 8 SCHs were typically composed of cavernous vascular space and solid components consisting of slit-like vessels, spindle cells and epithelioid endothelial cells which often exhibited cytoplasmic vacuolation. These two alternating components and the vacuolated epithelioid endothelial cells were the distinctive diagnostic clues for SCH. Vascular endothelial cells including epithelioid cells in the solid areas expressed CD31 (8/8), ERG (4/4), CD34 (5/8) and D2-40 (2/3). The spindle cells expressed SMA (8/8). Neither endothelial cells nor spindle cells expressed HHV8 (0/7), Desmin (0/5) or S-100 (0/3). Mutations were revealed in 2 SCHs, with IDH1 mutation (p.R132C) and IDH2 mutation (p.R172G), respectively. The IDH1/2 gene hotspot mutations were not found in the remaining 2 SCHs or the other 29 non-SCH lesions. Simple excisions were performed for 7 cases, and partial resection for 1 case. Follow-up information was obtained in 6 cases, with follow-up time ranging from 5 to 90 months (average, 46 months). No metastasis occurred in the 6 cases. No recurrence occurred in cases treated with simple excision. The residual lesions of the patient who received partial resection were stable. Conclusions: SCH is rare and should be differentiated from a variety of benign and malignant vascular lesions. An accurate diagnosis of SCH is clinically important and can be achieved by combining clinical information and typical pathological presentation. IDH1/2 gene hotspot mutations are specific to SCH in vascular lesions. Genetic detection is helpful in the diagnosis of challenging cases.

Diagnostic value of MDM2 RNA in situ hybridization in atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma / 中华病理学杂志

Objective: To investigate the value of MDM2 RNA in situ hybridization (RNA-ISH) in diagnosing atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and dedifferentiated liposarcoma (DDL). Methods: A total of 26 ALT/WDL/DDLs diagnosed from March 2017 to May 2019 in West China Hospital, Sichuan University, Chengdu, China and 18 control cases were included. MDM2 RNA-ISH was performed on all samples and compared with the fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) regarding their performance in detecting MDM2. Results: All samples were detected successfully using the three methods. Among 26 ALT/WDL/DDLs, all cases showed MDM2 amplification and positivity for MDM2 RNA-ISH (26/26, 100%). Twenty-four (24/26, 92.3%) of the 26 tested cases were positive for MDM2 IHC while two of them were negative. Eighteen control cases were all negative for MDM2 FISH and RNA-ISH, and 15 (15/18) cases were negative for MDM2 IHC. The sensitivity and specificity of RNA-ISH were both 100%, and those of MDM2 IHC were 92.3% and 83.3%, respectively. Diffuse staining was identified in all MDM2 RNA-ISH positive ALT/WDL/DDLs, but identified in only 8/24 (33.3%) of the MDM2 IHC positive cases. Among the 11 ALT/WDL/DDL samples evaluated on tissue microarray, the positive rate of MDM2 RNA-ISH was 100% with diffuse staining in all cases. The positive rate of MDM2 IHC was 9/11 while only 1 of the 9 cases showed diffuse staining. The result of MDM2 RNA-ISH was identical to that of MDM2 FISH and was overall consistent with that of MDM2 IHC (Kappa=0.763, P<0.001). Conclusions: In ALT/WDL/DDLs, results of MDM2 RNA-ISH are highly consistent with those of FISH. MDM2 RNA-ISH is more sensitive and more specific and has more diffuse positive signals than the IHC. The findings indicate that MDM2 RNA-ISH is highly valuable for the diagnosis and differential diagnosis of ALT/WDL/DDLs.

Investigation of Toxoplasma gondii infection among special populations in Nanjing City, Jiangsu Province / 中国血吸虫病防治杂志

Objective To understand the prevalence of Toxoplasma gondii infection among special populations in Nanjing City, so as to provide the reference for formulating the interventions for the prevention and control of T. gondii infections in this population. Methods The HIV/AIDS patients, tumor patients, pregnant women, and people with livestock and poultry breeding or processing works were selected as the study subjects from September to November 2015. The venous blood samples were collected from each participant for detecting IgG and IgM antibodies against T. gondii by ELISA. Results The overall prevalence of T. gondii infection was 10.2% in the study subjects in Nanjing City. The T. gondii infection rates were 12.2%, 11.3%, 4.0%, and 13.0% among the HIV/AIDS patients, tumor patients, pregnant women, and people with livestock and poultry breeding or processing works, respectively, and there was no statistically significant difference among the four groups (χ2 = 5.668, P = 0.130). The prevalence of T. gondii infection was higher in men than in women (15.3% vs. 5.8%; χ2 = 10.213, P = 0.001), and there were significant differences in the prevalence of T. gondii infection in terms of gender (χ2 = 9.501, P = 0.023), education levels (χ2 = 9.850, P = 0.043) or occupations (χ2 = 8.983, P = 0.062). Conclusions The infection rate of T. gondii among the special population in Nanjing City is high. Therefore, the health education intervention should be strengthened in the follow-up work for the special population.

Impact of CYP3A4*1G Polymorphism on Fentanyl Analgesia Assessed by Analgesia Nociception Index in Chinese Patients Undergoing Hysteroscopy / 中华医学杂志(英文版)

<p><b>Background</b>The clinical efficacy of fentanyl for pain control differs greatly across individuals. The purpose of this study was to investigate the impact of CYP3A4*1G polymorphism including wild-type homozygote (CYP3A4*1/*1, GG), mutant heterozygote (CYP3A4*1/*1G, GA), and mutant homozygote (CYP3A4*1G/*1G, AA) on fentanyl analgesia in Chinese patients undergoing hysteroscopy by the assessment of analgesia nociception index (ANI).</p><p><b>Methods</b>A total of 200 gynecologic patients scheduled for elective hysteroscopy under general anesthesia at Peking University People's Hospital from May to December in 2017 were enrolled in this study. Venous blood was withdrawn for genotyping of CYP3A4*1G before operation. Fentanyl 1 μg/kg was administered preoperatively followed by target-controlled infusion of propofol for induction and maintenance. Intraoperative analgesic efficacy of fentanyl was assessed by ANI monitoring at T0 (entering room), T1 (cervical dilation), T2 (start of cervical aspiration), and T3 (end of cervical aspiration) time points. The duration of propofol infusion and total dosage of propofol were recorded as well.</p><p><b>Results</b>The patients were divided into three groups according to CYP3A4*1G polymorphism, including 143 in GG group, 47 in GA group, and 10 in AA group. There was no significant difference in clinical demographics among three groups. The frequency of CYP3A4*1G variant alleles accounted for 16.8% and the distribution of variant alleles was consistent with Hardy-Weinberg equilibrium. Using a multilevel model, ANI values at T1 (63.81 ± 19.61), T2 (63.63 ± 17.82), and T3 (65.68 ± 17.79) were significantly lower than that at T0 (77.16 ± 12.93) in the study population (F = 23.50, P < 0.001), suggesting that higher levels of pain at T1, T2, and T3 than T0. Patients with GG genotype showed significantly lower ANI than those with GA or AA genotypes during hysteroscopy under the same dose of fentanyl.</p><p><b>Conclusion</b>CYP3A4*1G polymorphism associated with the analgesic efficacy of intraoperative fentanyl in the patients undergoing hysteroscopy under general anesthesia.</p>

The observation of curative effect of CBP at bedside for pregnancy complicating SAP / 中国医学装备

Objective: To explore curative effect of bedside continuous blood purification (CBP) for pregnancy complicating severe acute pancreatitis (SAP). Methods: 85 patients with pregnancy complicating SAP were divided into observation group (n=45) and control group (n=40). Patients of control group received series of symptomatic and supportive treatment included surgical termination of pregnancy, drainage, fasting, gastrointestinal decompression, fluid infusion, acid suppression, enzyme suppression and so on. And patients of control group were implemented the above treatments of control group combined with CBP at bedside. The acute physiology age and chronic health evaluation II (APACHE II) score, multiple organ dysfunction syndrome (MODS) score, the change of serum biochemical and inflammatory markers, and the mortality of pregnant woman and fetus pre and post treatment between the two groups were recorded and compared. Results: The mortality rates of pregnant women and fetus in the observation group was 4.44% 15.56%, and they were 7.50% and 20% in control group, respectively. The difference of mortality rate between the two groups were no significant. The APACHE Ⅱ score, MODS score, the serum levels of glutamic pyruvic transaminase (ALT), total bilirubin (TBIL), serum amylase (AMS), urea nitrogen (BUN) and creatinine (SCr) of observation group were significantly lower than that of control group at 72h after the treatment (t=11.13, t=9.79, t=17.79, t=12.55, t=10.13, t=15.25, t=12.29, P<0.05), while the PaO2/FiO2of observation group were significantly higher than that of control group at 72h after the treatment (t=11.44, P<0.05). Besides, the serum tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), procalcitonin (PCT), and C reactive protein (CRP) of observation group were significantly lower than those of control group at 72h after the treatment (t=17.25, t=14.29, t=12.44, t=11.29, t=13.44, P<0.05). Conclusion: CBP can effectively improve the clinical symptoms of patients with pregnancy complicating with SAP, and protect function of important organs, and improve blood biochemical indexes and remove inflammatory medium. Therefore, CBP is effective method which cure pregnancy complicating SAP, and it can effectively improve the state of this disease.

Investigation of Toxoplasma gondii infection among special populations in Nanjing City, Jiangsu Province / 中国血吸虫病防治杂志

Objective To understand the prevalence of Toxoplasma gondii infection among special populations in Nanjing City, so as to provide the reference for formulating the interventions for the prevention and control of T. gondii infections in this population. Methods The HIV/AIDS patients, tumor patients, pregnant women, and people with livestock and poultry breeding or processing works were selected as the study subjects from September to November 2015. The venous blood samples were collected from each participant for detecting IgG and IgM antibodies against T. gondii by ELISA. Results The overall prevalence of T. gondii infection was 10.2% in the study subjects in Nanjing City. The T. gondii infection rates were 12.2%, 11.3%, 4.0%, and 13.0% among the HIV/AIDS patients, tumor patients, pregnant women, and people with livestock and poultry breeding or processing works, respectively, and there was no statistically significant difference among the four groups (χ2 = 5.668, P = 0.130). The prevalence of T. gondii infection was higher in men than in women (15.3% vs. 5.8%; χ2 = 10.213, P = 0.001), and there were significant differences in the prevalence of T. gondii infection in terms of gender (χ2 = 9.501, P = 0.023), education levels (χ2 = 9.850, P = 0.043) or occupations (χ2 = 8.983, P = 0.062). Conclusions The infection rate of T. gondii among the special population in Nanjing City is high. Therefore, the health education intervention should be strengthened in the follow-up work for the special population.

Detection effect of an automatic identification system of Schistosoma japonicum miracidia / 中国血吸虫病防治杂志

To evaluate the effect of an automatic identification system of Schistosoma japonicum miracidia, and compare it with the traditional eye detection method in the simulation field.A total of 260 fecal samples were collected from schistosomiasis non-endemic areas, and the test sample bottles containing schistosome miracidia were prepared according to different experimental needs. Thirty fecal samples for the sensitivity test were separately added with five fresh miracidia per sample, and then the mixed samples were detected by two experienced technicians (with more than 15 years’ traditional test experience) or the automatic system. The positive detection rates were compared between the two methods. Thirty fecal samples for repetition test were separately added with ten fresh miracidia per sample, and then the mixed samples were detected separately with the automatic identification system by two experienced technicians. The results were compared between two persons. The two methods including the automatic identification system and the traditional eye detection method were carried out blindly with totally 200 samples in the simulation field. There were three groups (each with 30 samples) : Group 1 with more than 21 fresh miracidia, Group 2 with 6 to 20 fresh miracidia, and Group 3 with 1 to 5 fresh miracidia. The other 110 samples were as a negative group. The detection time, accuracy, missed detection rate, and false detection rate of the two methods were statistically compared.The positive detection rates of the 30 positive samples were 43.33% and 33.33% by the two technicians with the traditional eye detection method, respectively, while the detection rate was 80.00% by the automatic identification system, and the difference was statistically significant (χ2 = 7.05, χ2 = 12.97, both P < 0.01). Thirty positive samples were detected by the two technicians using the same automatic identification system, and the positive detection rates of the two were 96.67% and 86.67%, respectively, with no significant difference (χ2 = 0.27, P > 0.05). The experiments showed that the correct detection rate of the positive samples was 98.00% by the automatic identification system, which was higher than 79.75% by the traditional eye detection method. The detection time of the automatic identification system was shortened by half compared with that of the traditional eye detection method. The missed detection rate, and false detection rate of the automatic identification system were 2.22% and 1.82%, respectively, which were much lower than 35.56% and 7.73% of the traditional eye detection method.Compared with the traditional eye detection method, the automatic identification system of S. japonicum miracidia has the advantages of high sensitivity, good repeatability, short detection time, high accuracy, low missed detection rate, and low false detection rate. It can be used in the field and clinical detection in replacement of the traditional eye detection method.

The application of "preventive treatment theory" in chronic airway inflammatory disease / 中国中西医结合杂志

Bronchial asthma and chronic obstructive pulmonary disease (COPD), as chronic airway inflammatory diseases, seriously threaten the health of human beings. Chinese medicine has obvious advantages in prevention and treatment of them. "Preventive treatment theory" is a sort summarization of preventive medicine in Chinese medicine. The theory is not only reflected at the disease prevention levels, also embodied in the active treatment and the rehabilitation process. It was especially deep and colorfully embodied in the prevention and treatment of chronic airway inflammatory diseases such as asthma and COPD. In this paper,clarified were the prevention and treatment targets, ways of thinking and methods in different stages of asthma and COPD from various viewpoints including prevention before disease occurrence, treating disease at disease onset, preventing the aggravation once disease occurs, and consolidation after disease occurs. We hope to improve ways of thinking and prevention and treatment levels of bronchial asthma and COPD by Chinese medicine.

Impact of psychosocial stress on airway inflammation and its mechanism in a murine model of allergic asthma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has already been recognized that psychosocial stress evokes asthma exacerbation; however, the mechanism of how stress gets inside the body is not clear. This study aimed to observe the impact of psychosocial stress on airway inflammation and its mechanism in the ovalbumin-induced asthmatic mice combined with social disruption stress.</p><p><b>METHODS</b>Thirty-six male BALB/c mice were randomly divided into: control group, asthma group (ovalbumin-induced), asthma plus social disruption stress group (SDR), and SDR group. The open field video tracking system was used to assess animal behaviors. The invasive pulmonary resistance (RL) and dynamic lung compliance (cdyn) test system from Buxco was applied to detect pulmonary function. The enzyme-linked immunosorbent assay (ELISA) was utilized to determine OVA-IgE, T-helper type 2 (Th2) cytokines (IL-4, IL-5, IL-13) and corticosterone in mouse serum, the Th2 cytokines (IL-4, IL-5, IL-13, IL-6, TNF-α) in bronchoalveolar lavage fluid (BALF), and IL-6 and TNF-α levels in the supernatant of splenocytes cultured in vitro. Hematoxylin-eosin (H&E) staining was used to assess airway inflammation in lung histology. The cell count kit-8 assay (CCK-8) was applied to evaluate the inhibitory effect of corticosterone on splenocyte proliferation induced by lipopolysaccharide (LPS). Real time-PCR and Western blotting were utilized to determine glucocorticoid receptor (GR) mRNA and GR protein expression in lungs.</p><p><b>RESULTS</b>The open field test showed that combined allergen exposure and repeated stress significantly shortened the time the mice spent in the center of the open field (P < 0.01), increased ambulatory activity (P < 0.01) and the count of fecal boli (P < 0.01), but deceased vertical activity (P < 0.01). Results from pulmonary function demonstrated that airway hyperresponsiveness (AHR) was enhanced by psychosocial stress compared with allergy exposure alone. The ELISA results showed that cytokines in serum and BALF were significantly increased (P < 0.05). Moreover, the lung histology showed that infiltrated inflammatory cells were significantly increased in the asthma-SDR group compared with the asthma group (P < 0.05). Interestingly, serum corticosterone was remarkably raised by psychosocial stress (P < 0.05). In addition, the inhibitory effect of corticosterone on IL-6 and TNF-α in LPS-stimulated splenocyte cultures in vitro was diminished in the asthma-SDR group compared to the asthma group. The CCK-8 test revealed that the inhibition effect of corticosterone on splenocyte proliferation induced by LPS was significantly impaired in the SDR and asthma-SDR groups, while no significant effect was observed in the control and asthma groups. Furthermore, expression of GR mRNA and GR protein were significantly reduced in the lung tissues of the asthma-SDR group (P < 0.05).</p><p><b>CONCLUSIONS</b>Social disruption stress can promote anxiety behavior, activate the hypothalamic-pituitary-adrenal (HPA) axis, increase AHR and inflammation, and also impair glucocorticoid sensitivity and its function in a murine model of asthma. The down-regulation of GR expression induced by social disruption stress is in part associated with glucocorticoid insensitivity, which leads to asthma exacerbation.</p>

Analysis of 'treating different diseases by the same method' from aspect of theoretical research and clinical application of 'replenishing Qi and strengthening Shen' / 中国中西医结合杂志

Treating different diseases by the same method is one of the most important characteristics in Chinese medicine, and as the main principle of treatment it has been widely applied in Chinese clinics. Its clinical effect is clear. The integration of 'differentiation of diseases' and 'differentiation of syndrome' should be the prerequisite and basis of 'treating different diseases by the same method'. Only if different diseases have the same syndrome, the same treatment can be used on them. Replenishing qi and strengthening Shen is a widely used method that carries out 'treating different diseases by the same method'. It is indicated that the method of 'replenishing qi and strengthening Shen' has preferable effects on many diseases. Part of its mechanism is associated with the improvement of function of neuro-endocrine-immune network, and therefore, it has the clinical effect of 'adjustment of the whole and improvement of the part' on partial disorders. Asthma, chronic obstructive pulmonary disease (COPD), uterine bleeding in puberty, anovulatory infertility, Kidney syndrome and aging, although they are attributed to different diseases and states, only if they have the syndrome of Shen deficiency, the principle of 'treating different diseases by the same method' and the method of 'replenishing qi 'and strengthening Shen' can be used effectively.

Detection and preliminary study of a family carrying a CCR5Δ32 deletional mutation / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the frequencies of chemokine (C-C motif) receptor 5 gene (CCR5)Δ32 deletional mutation of in Han and Dai populations from Yunnan province. Immortalized cell lines were derived from a family carrying the CCR5Δ32 mutation.</p><p><b>METHODS</b>Blood samples of 346 Han and 355 Dai individuals were collected for genotyping. The coding regions of CCR5 gene were amplified with PCR followed by agarose gel electrophoresis. Suspected mutations were verified with DNA sequencing. Immortalized cell lines were constructed by using Epstain Barr virus and cyclosporine A. The difference between the cell lines and original blood samples was verified with PCR.</p><p><b>RESULTS</b>One ethnic Han individual was confirmed to be heterozygous for a deletional mutation by sequencing, which has led to discovery of a family with CCR5Δ32. Nine immortalized cell lines were established from this family, and no difference between the cell lines and original blood samples was detected by PCR.</p><p><b>CONCLUSION</b>Together with previous reports, this study has indicated a significant difference in CCR5Δ32 among different ethnic groups in China. Established immortalized cell lines can also provide material for future research.</p>

125I brachytherapy combined with chemotherapy for patients with inoperable stage Ⅲ non-small cell lung cancer / 中华核医学杂志

Objective To assess the therapeutic effect of radioactive seed 125I brachytherapy combined with GP chemotherapy regimen (gemcitabine 1000 mg/m2, cisplatin 75 mg/m2) for inoperabale stage Ⅲ non-small cell lung cancer (NSCLC). Methods Thirty-nine documented inoperable stage Ⅲ NSCLC patients, enrolled between January 2005 and June 2008 for the study group, were treated with the combination of 125I brachytherapy and GP regimen. The brachytherapy methods were conducted according to TPS and each patient was treated under those patients were treated with standard GP regimen. Chest CT scans were performed every three months post-procedurally, until disease progression or recurrence. The follow-up time was up to twenty four months after treatment. In the control group, equal amount of Ⅲ stage NSCLC patients were treated with standard GP regimen alone. Chi-square test and survival analysis with Kaplan-Meier and Log-rank were used to compare the differences of recent (3 months after therapy)efficiency, survival rate, survival time between two groups. Results The re-cent effective rates of the study group (71.8%, 28/39) and control group (61.5%, 24/39) were not statistical different (χ2=0.93, P>0.05), yet the tumor CR rates in two groups showed significant disparity (χ2=4.48, P0.05). However, singificant differences (χ2=4.07, 4.63,both P<0.05) were found in 2-year survival rate and median survival time, with 41.0% (16/39) vs 23.1% (9/39) and 18.9±2.7 months vs 14.2±0.7 months. Conclusions 125I brachytherapy combined with GP regimen chemotherapy could be an effective treatment method and could improve the tumor CR rate and survival rate for patients with inoperable stage Ⅲ NSCLC.

Reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson histological grading system and the complementary value of Ki-67 to this system / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The reproducibility of the Nottingham modification of the Scarff-Bloom-Richardson (NSBR) histological grading system for invasive breast cancer (IBC) adopted by the World Health Organization (WHO) has previously not been studied in Chinese hospitals. The proliferation marker, Ki-67, has been widely applied in detecting IBC. The objective of this study was to assess the reproducibility of the NSBR system among Chinese pathologists and the complementary value that Ki-67 brings to this system.</p><p><b>METHODS</b>Four general pathologists graded 100 IBC cases independently, which had previously been graded by specialists in breast pathology. The interobserver reproducibility among four general pathologists and pairwise reproducibility between each of them and the specialists were assessed. The Ki-67 labeling index (Ki-67LI) was determined by immunohistochemistry, and its correlations with histological grade and survival were determined.</p><p><b>RESULTS</b>With respect to interobserver reproducibility, NSBR grading was fairly reproducible (kappa = 0.34); as for the components of NSBR grading, agreement was best for tubule formation (kappa = 0.46), intermediate for nuclear pleomorphism (kappa = 0.42), and poorest for mitotic count (kappa = 0.28). In terms of pairwise reproducibility, agreement was fair to substantial with NSBR grading (kappa = 0.30 - 0.69) and nuclear pleomorphism (kappa = 0.28 - 0.69), moderate to substantial for tubule formation (kappa = 0.51 - 0.78), and slight to substantial for mitotic count (kappa = 0.19 - 0.71). There were characteristic Ki-67LI ranges for grades 1, 2 and 3 tumors. Univariate analysis showed that Ki-67 was able to divide grade 2 patients into two different prognostic subgroups. Multivariate analysis of grade 2 patients with negative lymph node demonstrated that Ki-67 was an independent prognosticator for overall survival.</p><p><b>CONCLUSIONS</b>The reproducibility of grading by general pathologists could be enhanced. Specialization in breast pathology is essential for accurate grading and treatment for IBC. Ki-67, with proven prognostic significance, adds complementary value to the NSBR system.</p>

Discussion on transmission mechanism of wild rodent plague to human in the northwestern area of Yunnan province / 中国地方病学杂志

Objective To explore the relationship between wild rodent plague and human in wild rodent plague foci of the northwestern area in Yunnan to probe the possible transmission mechanism of wild rodent plague to human. Methods Data of component ratio of rodents and fleas was collected in different areas from 1985 - 1995. Activities and habits of residents regarding the way they keep cats and dogs and parasitic fleas and free fleas indoor were investigated, the dog serum was collected for detecting F1 antibody. Results Eothenomys miletus were main rodents in farmland and shrub, accounting for 48.00% (4753/9902) and 54.50% (4282/7857), Apodemus chevrieri were main rodents in garden, being 50.47% (1332/2639). The component ratio of Neopsylla specialis specialis was 13.31%(229/1720), 12.31%(1678/13 739) and 10.87%(957/8802) respectively in garden, farmland and shrub, higher than in indoor. The component ratio of Frantcpsylla spodix was 39.88% (686/1720), the highest in garden. Thirty-two per cent (32/100) of residents kept cats,in which 63% (20/32) with cat fleas, 68% (68/100) of villages kept dogs, in which 76%(52/68) with fleas. Eighteen parasitic fleas were caught from 43 dogs with a flea index of 0.119 and a rate for fleas of 11.63%, 7 pulex were collected from 17 indoor. Forty-three blood serum samples were obtained from dogs, among which 3 were positive blood serum. Conclusions Residents touch affected animals or media in different situations. The possibility of transmission for wild rodent plague to human exists in loci in a chain of wild rodent plague → fleas or predation → homebred animal plague (cats or dogs) →touching or respiratory → human.

To study the evolution of Yersinia pestis from the point of codon and 16S-ribosome / 中国地方病学杂志

Objective To explore the mutation and evolution of Yersiniapestis(Y. pestis) from the point of codon and 16S-ribosome. Methods Codon preference and 16S-ribosome of Y. pestis were analyzed by bioinformatics. Results Similar codon preference was found among 4 PCD1 Y. pestis, of the 3 old Y. pestis the codon preference between PMT1 and PCD1 was similar. There were some differences between PCD1, PCP1 and Yunnan 6 kb plasmid. Through the analysis of 16S-ribosome, the sequences were found similar in 11 strains of Y. pestis,Yersinia pseudotuberculosis was very close to Y. pestis, with only one nucleotide difference, mutated G-T, and corresponding amino acid methionine (M)-isoleucine (I). There were some differences in sequences of 16S-ribosome in Y. pestis, Escherichia coli and Pulex irritans. Conclusions The time for Y. pestis to obtain PCP1 is later than PMT1 does, in other words, the affinity of Y. pestis with PMT1 was closer than PCP1 with 6 kb plasmid;alteration of 16S-ribosomal nucleotide sites may cause changes in function and structure of 16S rRNA. The lower similarity between 16S-ribosomal sequences of Y. pestis and Pulex irritans indicates the time for co-evolution is very short,and the late emergence of Y. pestis.

A retrospective analysis of the six-year data of peritoneal dialysis in a single center / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the epidemiology, peritoneal dialysis (PD) related complications and survival outcomes of 236 patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) in our center from January, 2004 to November, 2009.</p><p><b>METHODS</b>The data including patient gender, age, time of PD initiation, addresses, types of medical reimbursement, primary diseases, modes of PD catheter placement surgery, types of PD catheter, PD-related complications, and time of drop out were retrospectively analyzed. PD catheter migration rate, peritonitis rate, drop out rate (DOR), length of the time of PD therapy (TOT), and survival rate were calculated and compared with those of patients in other PD centers.</p><p><b>RESULTS</b>The number of newly introduced patients increased gradually in the years from 2004 to 2009. The mean age of newly introduced patients was 47-/+16 years, and patients with age below 60 years accounted for 77.96%. Patients who paid for their own expenses accounted for 67.37% of all, and the rate of these patients decreased gradually. Similar to that in Asian-Pacific region, chronic glomerulonephritis was the most frequent cause of ESRD followed by diabetic nephropathy. The number of patients with chronic glomerulonephritis or obstructive nephropathy as the primary diseases was greater in this center than that reported in the Asian-Pacific region, accounting for 54.66% and 11.02% of all patients, respectively. In contrast, the patients with diabetic nephropathy or benign arteriolar renal sclerosis were less, accounting for 12.29% and 10.17% of all, respectively. PD catheter migration rate (8.05%) and peritonitis rate (1:44.22 patient-months) were both lower than those reported. The patient survival rates at 1, 2, 3 years were 83.65%, 51.59% and 29.81%, respectively, lower than those of other centers in the developed countries but higher than the mean levels in China. DOR decreased gradually to 11.56% in 2009, and TOT increased to 23.61 months.</p><p><b>CONCLUSION</b>The above characteristics of the patients are related to many factors, including the "PD first" principle, high prevalence of urinary calculosis in the primary source regions of most patients, preventive partial omentum resection in some patients, education and follow-up for patients, and increased expense cover by medical insurance.</p>

Inflammatory airway features and hypothalamic-pituitary-adrenal axis function in asthmatic rats combined with chronic obstructive pulmonary disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are both inflammatory airway diseases with different characteristics. However, there are many patients who suffer from both BA and COPD. This study was to evaluate changes of inflammatory airway features and hypothalamic-pituitary-adrenal (HPA) axis function in asthmatic rats combined with COPD.</p><p><b>METHODS</b>Brown Norway (BN) rats were used to model the inflammatory airway diseases of BA, COPD and COPD + BA. These three models were compared and evaluated with respect to clinical symptoms, pulmonary histopathology, airway hyperresponsiveness (AHR), inflammatory cytokines and HPA axis function.</p><p><b>RESULTS</b>The inflammatory airway features and HPA axis function in rats in the COPD + BA model group were greatly influenced. Rats in this model group showed features of the inflammatory diseases BA and COPD. The expression of inflammatory cytokines in this model group might be up or downregulated when both disease processes are present. The levels of corticotrophin releasing hormone mRNA and corticosterone in this model group were both significantly decreased than those in the control group (P < 0.05).</p><p><b>CONCLUSIONS</b>BN rat can be used as an animal model of COPD + BA. By evaluating this animal model we found that the features of inflammation in rats in this model group seem to be exaggerated. The HPA axis functions in rats in this model group have been disturbed or impaired, which is prominent at the hypothalamic level.</p>

Nucleic acid sequence homologous analysis of the 6 kb plasmid of Yersinia pestis / 中国地方病学杂志

Objective To analyze nucleic acid sequence homology of the 6 kb(pYC) plasmid of Yersina. pestis (Y. pestis) isolated from Yurman by searching GenBank. Method The search of sequence similarity was accomplished with BLAST. Results The pYC plasmid sequence had high homology with some genes in nueleotide sequence, such as: 97.1% homology with Shigella sonnei pKYM, 92.1% homology with Haemophilus influenzae(H. influenzae) gene, Salmonella typhi (S. typhi) gene LT2 and plMVSI with 88.2% and 87.2% of homology respectively, Escherichia coli(E, coli) O157:H7 and K-12, ECOR31 with 81.4%, 81.4% and 84.7% of homology respectively. This plasmid ORFs could code for some proteins which were similar with others in GenBank, such as: ORFi and H. paragallinarum replication protein B(47.2%), ORF4 and E. coli hypothetical protein(52.7%), ORF5 and Y. pseudotuberculosis Tile (48.3%), ORF6 and E. coil Pilx5/VirB5-1ike protein (42.3%), Y. enterocolitica TriD protein(38.5%), ORFIO and S. typhimurium LT2, E. coli O157:H7 hypothetical protein(83.1% and 81.9%, respectively), ORF11 and E. coli, damage-inducible protein J(81.4%). Conclusions The pYC plasmid sequence has high homology with a few bacterial genes of Enterobacteriaceac. This plasmid may code for some proteins that are similar with hypothetical protein, damnge-indncible protein, TriD and TilE protein, Pilx5/VirB5-hke protein of Escherichia or Yersinia.