Histopathological Diagnosis System for Gastritis Using Deep Learning Algorithm / 中国医学科学杂志(英文版)

Objective To develope a deep learning algorithm for pathological classification of chronic gastritis and assess its performance using whole-slide images (WSIs). Methods We retrospectively collected 1,250 gastric biopsy specimens (1,128 gastritis, 122 normal mucosa) from PLA General Hospital. The deep learning algorithm based on DeepLab v3 (ResNet-50) architecture was trained and validated using 1,008 WSIs and 100 WSIs, respectively. The diagnostic performance of the algorithm was tested on an independent test set of 142 WSIs, with the pathologists' consensus diagnosis as the gold standard. Results The receiver operating characteristic (ROC) curves were generated for chronic superficial gastritis (CSuG), chronic active gastritis (CAcG), and chronic atrophic gastritis (CAtG) in the test set, respectively.The areas under the ROC curves (AUCs) of the algorithm for CSuG, CAcG, and CAtG were 0.882, 0.905 and 0.910, respectively. The sensitivity and specificity of the deep learning algorithm for the classification of CSuG, CAcG, and CAtG were 0.790 and 1.000 (accuracy 0.880), 0.985 and 0.829 (accuracy 0.901), 0.952 and 0.992 (accuracy 0.986), respectively. The overall predicted accuracy for three different types of gastritis was 0.867. By flagging the suspicious regions identified by the algorithm in WSI, a more transparent and interpretable diagnosis can be generated. Conclusion The deep learning algorithm achieved high accuracy for chronic gastritis classification using WSIs. By pre-highlighting the different gastritis regions, it might be used as an auxiliary diagnostic tool to improve the work efficiency of pathologists.

Clinicopathologic features of primary thymic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of primary thymic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT).</p><p><b>METHODS</b>The clinical and pathologic findings were evaluated in 3 cases of biopsy confirmed thymic MALT lymphoma. The clincopathologic features, treatment and prognosis were discussed and literatures reviewed.</p><p><b>RESULTS</b>One male and two female patients presented with asymptomatic mediastinal masses with a history of Sjögren syndrome. They were aged 36, 35 and 41 years respectively, and only one patient had B symptoms. Grossly, all three tumors were encapsulated and had multiple variable-sized cysts on cut-surface. Histopathologically, the normal thymic lobular architecture was effaced by abnormal dense lymphoid infiltration. Prominent lymphoepithelial lesions were formed by centrocyte-like cells infiltrating and expanding Hassall's corpuscles and epithelial cyst lining. All cases showed apparent plasmacytic differentiation. Immunohistochemically, the tumor cells were positive for CD20, CD79a, bcl-2 and negative for CD3, CD5, cyclin D1, CD43, CD10, bcl-6, and CD23. The plasma cells showed kappa light chain restriction. Immunoglobulin heavy chain rearrangement in three cases was confirmed by PCR. All patients were at early stage and received routine chemotherapy with or without radiotherapy after surgical removal. All patients achieved complete remission with 24, 18 and 3 months follow-up, respectively.</p><p><b>CONCLUSIONS</b>Primary thymic MALT lymphoma may be a rare distinctive lymphoma. It can be diagnosed by HE and immunohistochemical study and should be differentiated from reactive lymphoid proliferation, other types of lymphoma and mediastinal thymoma.</p>

Expression of glypican-3, hepatocyte antigen, alpha-fetoprotein, CD34 and CD10 in hepatocellular carcinoma: a clinicopathologic analysis of 375 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore prognostic factors and the expression of glypican-3, hepatocyte antigen (HEP), alpha-fetoprotein (AFP), CD34 and CD10 in hepatocellular carcinoma (HCC) and their prognostic value.</p><p><b>METHODS</b>Clinicopathologic data were analyzed in 375 cases of HCC, in which 80 cases with follow-up were examined by immunohistochemical staining to detect the expression of glypican-3, HEP, AFP, CD34 and CD10 proteins. The relationship between the proteins expression and clinicopathologic features was also evaluated.</p><p><b>RESULTS</b>Tumor number (P = 0.000), tumor size (P = 0.025), tumor differentiation (P = 0.001) and vessel invasion (P = 0.000) were closely related to prognosis of HCC patients; the expression of glypican-3 (66/80,82.5%; P = 0.002), HEP (64/80,80.0%; P = 0.021), AFP (38/80,47.5%; P = 0.014) and CD10 (28/80,35.0%; P = 0.002) was significantly related to tumor differentiation; that of glypican-3 was significantly correlated with tumor number and presence of satellite nodules (P = 0.028) and that of AFP and CD10 was significantly correlated with portal vein thrombi (P = 0.000, P = 0.010). On Kaplan-Meier regression analysis, both low expression of HEP and high expression of AFP were closely related to poor prognosis.</p><p><b>CONCLUSIONS</b>Tumor number, size, differentiation and vessel invasion were important factors affecting the prognosis of patients with HCC. HEP and AFP have prognostic significance in HCC.</p>

Granulocytic sarcoma: a clinical and pathologic analysis of ten cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinical and pathological features, differential diagnosis of granulocytic sarcoma.</p><p><b>METHODS</b>The clinical manifestations, histopathological features, immunohistochemistry, treatment and prognosis were analyzed retrospectively in 10 cases of granulocytic sarcoma.</p><p><b>RESULTS</b>The age of patients ranged from 10 to 56 years (means = 35.8 years). The male-to-female ratio was 1.5:1. Histologically, the malignant cells of granulocytic sarcoma grew in a diffuse pattern. The cytoplasm was scanty, with eosinophilic fine granularity in some cells. The nuclei were round or focally irregular, and had finely dispersed chromatin. The mitotic figures were visible. Immunohistochemical stains for MPO, CD43, CD117, CD34 and CD99 were positive.</p><p><b>CONCLUSIONS</b>Granulocytic sarcoma can occur in patients of all ages with a male predominance. The diagnosis of granulocytic sarcoma is assisted by the cytochemical stain for naphthol-ASD-chloroacetate esterase and/or immunophenotypic analyses for MPO, CD43, CD117, CD34, CD99. These stains aid in the distinction of granulocytic sarcoma from: lymphoblastic lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma, small round cell tumours, particularly in children, and blastic plasmacytoid dendritic cell neoplasm.</p>

Clinical and pathologic features of gastric schwannoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical and pathologic features of gastric schwannomas.</p><p><b>METHODS</b>The macroscopic and microscopic features of 9 cases of gastric schwannoma were analyzed. Immunohistochemical study for S-100 protein, CD117, CD34, neurofilament, desmin, nestin, glial fibrillary acidic protein, platelet derived growth factor-alpha (PDGFR-α) and vimentin was carried out. Mutation analysis of c-kit gene (exon 9, 11, 13 and 17) and PDGFR-α gene (exon 12 and 18) in 1 case was examined by PCR amplification and direct sequencing.</p><p><b>RESULTS</b>The patients included 5 males and 4 females. The age of patients ranged from 42 to 81 years (median = 56.5 years). The size of the tumors ranged from 2 to 9 cm in greatest diameter. Follow-up data in 8 cases (from 1 month to 65 months) showed no evidence of recurrence or metastasis. Gross examination showed that gastric schwannomas were homogeneous, firm, yellow-white and bore no true fibrous capsule. Histologically, all cases were composed of fascicles of spindle cells associated with nuclear palisading, Verocay body formation and peripheral cuff of reactive lymphoid aggregates. Some of them showed degenerative changes including cyst formation, calcification, hemorrhage, necrosis and hyalinization. Immunohistochemical study showed that the tumor cells were strongly positive for S-100 protein and vimentin. There was various degree of staining for nestin (8/9) and glial fibrillary acidic protein (6/9). They were negative for CD117, CD34, neurofilament, desmin and smooth muscle actin. One case showed focal positivity for PDGFR-α (1/9), with no mutations found.</p><p><b>CONCLUSIONS</b>Gastric schwannomas share similar histologic features with conventional soft tissue schwannomas, in addition to the presence a reactive lymphoid cuff. The clinical, macroscopic, histologic and immunohistochemical features of gastric schwannomas were different from those of gastrointestinal stromal tumors and leiomyomas.</p>

Expression of granulocyte colony stimulating factor in patients with non-small cell lung cancer and its clinicopathological significance / 中华病理学杂志

<p><b>OBJECTIVE</b>To examine granulocyte colony stimulating factor (G-CSF) expression in human non-small cell lung cancer (NSCLC) as well as discuss its clinicopathological significance.</p><p><b>METHODS</b>Specimens were obtained from 114 cases (53 cases with granulocyte infiltration) diagnosed pathologically as NSCLC in General Hospital of PLA. Paraffin-embedded tissues from these 114 cases of NSCLC were examined for expression of G-CSF by immunohistochemical staining. Correlation between G-CSF expression and pathological features, clinical manifestation, prognosis of patients with NSCLC was analyzed statistically. All the patients were retrospectively followed-up.</p><p><b>RESULTS</b>Fifty-five of the 114 NSCLC specimens expressed G-CSF, and among these 41 (41/54, 75.9%) were large cell carcinoma, nine (9/30, 30.0%) were adenocarcinoma and five (5/30, 16.7%) were squamous cell carcinoma. The expression was significantly correlated with infiltration of tumor mass by neutrophilic granulocytes, histological type, necrosis, differentiation, lymph node metastases, distant metastases, recurrence and survival period (P < 0.01). There was no significant correlation with primary tumor size (P > 0.05). Logistic multi-factor analysis revealed that necrosis, lymph nodes metastases and distant metastases RR (risk ratio) in G-CSF positive group was 5.57, 6.28 and 5.24 times higher than those of G-CSF negative group (P < 0.05). There were remarkable difference of 5-year survival rates (0 and 12.1% respectively) and survival period (42 and 62 months respectively) between positive and negative groups (P < 0.01).</p><p><b>CONCLUSIONS</b>NSCLC with G-CSF excretion are mainly large cell lung cancer. The pathologic characteristics of these cases with G-CSF expression included poor differentiation, remarkable atypia, prominent necrosis and infiltration of tumor mass by neutrophils or emperipolesis. These tumors are usually more aggressive in biological behavior and have worse prognosis than those without G-CSF expression.</p>

Clinicopathologic features of hepatocellular carcinoma: an analysis of 185 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathologic features and prognostic factors of hepatocellular carcinoma.</p><p><b>METHODS</b>Clinicopathological data of 185 cases of hepatocellular carcinoma treated in our hospital between 2000 and 2005 were collected and their follow up information was obtained. The clinicopathological features and prognostic factors were analyzed by Kaplan-Meier and multivariate Cox regression analysis.</p><p><b>RESULTS</b>The 185 patients had a median age of 51.0 ± 11.0 (range, 19 - 72) years. The apparent peak incidence age was 40 to 60 years old, and the ratio of male to female was 10.6:1; the 3- and 5-year postoperational survival rates were 52.0% and 38.0%; respectively. The tumour numbers (P = 0.000), tumor size (P = 0.025), histological pattern (P = 0.000), nuclear features (P = 0.000), differentiation (P = 0.001) and vascular invasion (P = 0.000) were significantly correlated with prognosis. The postoperational survival times of patients with thin trabeculae pattern, compact pattern and pseudoglandular pattern were significantly longer than that of thick trabeculae, scirrhous pattern, and solid pattern (P ≤ 0.009). The postoperational survival time of patients with nuclear features grade 1 and 2 was significantly longer than that of grade 3 and 4 (P = 0.000). Multivariate Cox regression analysis showed that the tumor number (P = 0.001), tumor size (P = 0.042), nuclear features (P = 0.023) and vascular invasion (P = 0.000) were independent prognostic factors.</p><p><b>CONCLUSION</b>The postoperational survival rate of HCC patients is low. The tumor size, tumor number, differentiation and vascular invasion are major prognostic factors of hepatocellular carcinoma, The higher is the tumor number, tumor size, degree of differentiation and presence of vascular invasion, the higher risk of mortality is.</p>

Cardiac and renal arteriolar pathological changes in the autopsied elderly hypertensive patients with left ventricular hypertrophy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the cardiac and renal arteriolar pathological changes in autopsied elderly hypertensive patients with left ventricular hypertrophy (LVH).</p><p><b>METHODS</b>Autopsy samples from 25 essential hypertension (EH) patients with LVH aged over 60 years and age-matched 8 controls were analyzed. LVH was further divided into three degrees from I to III according to left ventricular free wall thickness in EH patients. Quantitative measurements of arteriolar morphometric parameters in heart and kidney were performed under light microscope with computer image analysis post HE and Masson staining. The lesion index and plasma albumen infiltration of arteriole were evaluated by the semiquantitative method.</p><p><b>RESULTS</b>The inner diameter (ID) and luminal cross-sectional area (LCSA) were significantly decreased while wall thickness (WT), wall cross-sectional area (WCSA), ratio of WCSA to LCSA (WCSA/LCSA) and ratio of WT to ID (WT/ID) were significantly increased in EH patients in proportion to LVH degree. Both cardiac and renal arterioles WCSA/LCSA and WT/ID were significantly decreased with increasing outer diameters (OD). Under the same OD rang, the pathological changes were more significant in the renal arterioles compared to those in the cardiac arterioles (P < 0.05). The arteriolar lesion index and the plasma albumen infiltration index of cardiac and renal arterioles in EH group were significantly higher than those in the control group (P < 0.01) and the arteriolar lesion index and the plasma albumen infiltration of arteriole in the renal tissue were significantly higher than those in the cardiac tissue (P < 0.01).</p><p><b>CONCLUSION</b>Concentric remodeling occurs in the cardiac and renal arterioles of EH patients in proportion to LVH degree and renal arterioles lesions were significantly severer than that of cardiac arterioles in EH patients with LVH.</p>

An autopsy specimen study of benign hyperplastic nodules in the peripheral zone of the prostate / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the correlation and anatomic association of benign hyperplastic nodules in the peripheral zone (PZ) with those in the transition zone (TZ) of the prostate, and to compare the histological components of the two kinds of nodules.</p><p><b>METHODS</b>We obtained benign hyperplastic nodules specimens from the PZ and TZ by autopsy, measured the distance between the outer surface of the nodules and the inner gland, observed the integrity of the surgical envelope of the prostate, and determined the histological components of the two kinds of nodules by HE staining, immunohistochemistry and automatic quantitative image analysis.</p><p><b>RESULTS</b>The surgical envelope of the prostate was integrated and the distance between the nodules of the PZ and the outer surface of the inner gland was about 2.5 to 5 mm ([3.9 +/- 0.8] mm), with no signs of anatomic connection in between. The stromata and epithelia in the nodules accounted for (69.32 +/- 8.35)% and (16.08 +/- 5.36)% in the PZ and (74.58 +/- 8.95)% and (15.82 +/- 6.41)% in the TZ.</p><p><b>CONCLUSION</b>Benign hyperplastic nodules may originate from the PZ of the prostate and not correlate with the inner gland hyperplasia in the TZ, but with no statistical difference between the histological components of the two kinds of nodules.</p>

A preliminary study of contrast-enhanced ultrasound in benign prostatic hyperplasia / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze and evaluate the characteristics of benign prostatic hyperplasia (BPH) on contrast-enhanced ultrasound.</p><p><b>METHODS</b>Forty-eight BPH patients confirmed by transrectal ultrasound-guided biopsy underwent contrast-enhanced ultrasound. Contrast pulse sequencing technique (CPS) and quantitative software-ACQ were used, and the parameters of beginning enhancement time, disappearing and transit time and peak intensity (PI) of the inner gland and outer gland were recorded and analyzed.</p><p><b>RESULTS</b>The prostate was rich with blood and enhanced significantly on contrast-enhanced ultrasound. The beginning enhancement time of the prostatic inner gland, especially the area around the urethra, was much earlier than that of the outer gland, (26.68 +/- 3.76) and (31.24 +/- 5.33) s, respectively (P = 0.000). The contrast disappeared later in the inner gland than in the outer gland, (200.68 +/- 59.40) and (157.56 +/- 50.66) s, respectively (P = 0.000). The transit time of the contrast in the inner gland was much longer than in the outer gland, (173.94 +/- 60.14) and (129.21 +/- 56.91) s, respectively (P = 0.000). PI of the inner gland was much higher than that of the outer gland, (90.45 +/- 42.19) and (65.32 +/- 25.15) dB, respectively (P = 0.000).</p><p><b>CONCLUSION</b>Contrast-enhanced ultrasound makes it possible to continuously observe the blood perfusion process of BPH, and promises to be an effective means for observing the blood supply in BPH.</p>

Apopotic gene Bax expression in carotid plaque / 神经科学通报·英文版

The expression of BAX in carotid atherosclerosis and its regulation is far from defined. Objectives To investigate BAX expression in stable/fibrous and instable/vulnerable carotid plaque and its clinical significance. Methods Twenty-five cases of carotid plaque specimens obtained from endarterectomy were divided into two groups, stable/fibrous 14 cases, vulnerable/instable 11 cases; aortic artery and its branches from hepatic transplantation donors 6 case as control. The expression of proapoptotic BAX was detected by immunohistochemistry (IHC), in situ hybridization(ISH) and in situ TdT dUTP nick end labeling (TUNEL). Results Five cases of BAX ( + ) were detected by ICH and ISH, 4 case of TUNEL ( + ) were detected by TUNEL in stable/fibrous carotid plaque , while 10 cases were BAX ( + )by IHC(P < 0.05) , 11 cases by ISH and 9 cases by TUNEL were detected in instable/vulnerable carotid plaque ( P < 0.01 ), respectively. The intensity of BAX ( + ) cells by IHC and ISH was (8.63 +/- 2.62) and (10.32 +/- 3.12) in fibrous plaques, whereas (122 +/- 21.64) and (152 +/- 23.35) in vulnerable plaques, respectively. No expression of BAX was found in controlled group. Conclusion The higher expression of Bax in vulnerable carotid plaque may be one mechanism in molecular pathogenesis of carotid atherosclerosis which affect plaque stability and be the cause of higher incidence of stroke than fibrous carotid plaques, the regulation of BAX expression in different stage of atherosclerosis may provide targets in gene therapy for carotid atherosclerosis.

Relationship between oxidized lipoprotein, angiogenesis and human coronary atherosclerotic plaque stabilization / 中华病理学杂志

<p><b>OBJECTIVES</b>To analyze the relationship between oxidized low density lipoprotein (oxLDL), angiogenesis and stabilization of atherosclerotic plaques in human coronary arteries; and to investigate the role of oxLDL in creating vulnerable sites in atherosclerotic plaques.</p><p><b>METHODS</b>Samples of coronary arteries were obtained at autopsies of 42 patients with acute coronary syndrome. Eighty randomly selected blocks were studied by immunohistochemistry using antibodies against oxLDL and endothelial cells (factor VIII). Computer-aided planimeter was used for quantitative analysis.</p><p><b>RESULTS</b>In unstable plaques, percentage of immunoreactive areas for oxLDL was significantly higher than that in stable plaques. Most of the oxLDL were located in shoulder region of these plaques, as compared to the fibrous cap and basal regions. The details of distribution of oxLDL were as follows: shoulder region (20.43 +/- 3.12 for unstable plaques and 17.65 +/- 4.22 for stable plaques), fibrous cap (4.77 +/- 2.03 for unstable plaque and 2.80 +/- 0.22 for stable plaques) and basal region (5.65 +/- 1.65 for unstable plaques and 3.22 +/- 1.02 for unstable plaques). OxLDL was also a main component in the lipid core. In the shoulder region, there was a significant positive correlation between neovascularization and oxLDL (r = 0.8247, P = 0.000).</p><p><b>CONCLUSIONS</b>The amount of oxLDL is significantly higher in unstable atherosclerotic plaques, especially over the shoulder region. OxLDL in coronary atherosclerotic plaques is thus an important factor in determining stabilization of the plaques. OxLDL may induce influx of inflammatory cells which subsequently leads to decreased plaque stabilization.</p>

Morphologic diagnosis and clinical significance of prostatic atypical small acinar proliferation suspicious but not diagnostic of cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the morphologic features and clinical significance of atypical small acinar proliferation (ASAP) suspicious but not diagnostic of cancer in prostatic biopsies.</p><p><b>METHODS</b>The slides of 11 cases of prostatic needle biopsies collected during a two-year period with the diagnosis of ASAP were reviewed. Immunohistochemical study for 34betaE12, p63 and P504S was performed on the archival paraffin sections.</p><p><b>RESULTS</b>All the 11 ASAP cases were characterized by the presence of a few compacted small acini in the prostatic stroma. Six cases had acini of less than three in number. The acini were round or slightly irregular in shape. The nuclei were enlarged, round or irregular, arranged in single layer and focally separated by broad interval. The nucleoli were usually prominent. Cytoplasm was amphophilic or pale and the lumen border was often well-defined. Basophilic mucus was also seen in some of the lumen. Immunohistochemical study for 34betaE12 and p63 was negative, while that for P504S was positive. In 4 of the 11 cases, the acini were more than three in number, round or slightly irregular, but without cytologic atypia. The nuclei were slightly enlarged with small or inconspicuous nucleoli. Immunohistochemical study for 34betaE12 and p63 was negative or at most focally positive. P504S staining was either negative or weakly positive. Second repeat biopsy was carried out in all cases, and 4 of them (36%) showed definite adenocarcinomatous changes. The positive cases were those with fewer acini but definite cytologic atypia in the initial biopsy.</p><p><b>CONCLUSIONS</b>ASAP is a morphologic interpretation closely associated with prostatic adenocarcinoma. The histologic features are suspicious of but not diagnostic of cancer, due to insufficient criteria in terms of acinar number, cytologic or architectural abnormalities. The positive rate in subsequent repeat biopsy is higher than that for cases with usual nodular hyperplasia.</p>

Quantitative morphometry of hyperplastic hypoechoic nodules in the prostatic outer gland / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the morphotic characteristics of hypoechoic nodules in the outer gland of the prostate with benign</p><p><b>METHODS</b>Twenty-two hyperplastic hypoechoic nodules in the prostatic outer gland were biopsied guided by prostatic hyperplasia. transrectal ultrasound. The hematoxylin-eosin (HE) staining and immunohistochemistry combined with computer assisted quantitative image analyses were adopted to examine the mean percentages of the area densities of stroma, epithelium, glandular lumen and smooth muscle cells.</p><p><b>RESULTS</b>The area densities of stroma, epithelium, glandular lumen and smooth muscle cells were (72.52 +/- 13.14)%, (20.57 +/- 9.01)%, (6.85 +/- 4.51)% and (24.14 +/- 6.31)%, respectively.</p><p><b>CONCLUSION</b>Hyperplastic hypoechoic nodules may develop in the outer gland as well as in the inner gland of the prostate, but the mean percentages of the components are different between the two kinds of nodules.</p>

Bcl-2/Bax gene expression in different types of carotid plaque / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate Bcl-2/Bax gene expression in different types of carotid plaque, and examine the relationship between gene expression and atherosclerotic plaque instability and the main cause of brain ischemic events.</p><p><b>METHODS</b>Totally 42 human carotid plaque specimens obtained during carotid endarterectomy were divided into stable group (n=19) and unstable group (n=23) based on histopathological studies (HE staining). Eight aortic arteries and their branches from hepatic transplantation donors were taken as control group. Bcl-2/Bax was detected by immunohistochemistry (IHC) staining (n=42) and in situ hybridization (ISH) (n=25, stable 13/unstable 12).</p><p><b>RESULTS</b>Bcl-2 gene expression, which was expressed in smooth muscle cells (SMC), endothelial cells (EC), macrophages (MP) and foam cells, was detected in 20 and 9 cases in unstable plaque while 11 and 4 cases in stable plaque by IHC and ISH, respectively (P < 0.05). Bax, which was expressed in SMC and MP, was detected in 18 and 11 cases in unstable plaque, while 8 and 5 cases in stable plaque by IHC and ISH, respectively (P < 0.05).</p><p><b>CONCLUSION</b>The expression rate of Bcl-2/Bax in unstable plaques was higher than in stable plaques. Bcl-2 was one of the elements that maintain plaque stability whereas Bax was one element that facilitates plaque instability. Therefore, Bcl-2/Bax expression in different stage of atherosclerosis may be one of the molecule regulation mechanisms in carotid atherosclerosis.</p>

Surgery for extraperitoneal pelvic neoplasms / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the methods of surgery for extraperitoneal pelvic neoplasms.</p><p><b>METHODS</b>Clinical data related to surgery of 84 cases of extraperitoneal pelvic neoplasms were extracted and retrospectively analyzed.</p><p><b>RESULTS</b>All 84 patients underwent operations, including one of them who received 4 operations within 6 months for resection of a single tumor. 58 abdominal, 16 buttock and 10 combined incisions were made in the series. Pelvic organs and structures were co-resected in 35 cases, including total pelvic exenteration in 2 cases and anterior pelvic exenteration in 2 cases. Common and/or external iliac vessels were resected and transplantations of artificial vessel were carried in 5 cases. Internal iliac arteries were ligated in 10 cases. The mean blood lose was 2 385 ml in our series and the largest was 15 000 ml. The complete resection rate of tumor was 81% for 84 operations and the largest resected tumor was 30 cm x 30 cm x 25 cm. There was no hospitalized death, and postoperative complication rate was 7% (6/84) in our series. Only 1 death were seen during the mean period of postoperative follow-up of 54 months, 22 operations were carried for 21 cases of recurrence, including 7 operations for 7 recurrences in a case within 12 years.</p><p><b>CONCLUSIONS</b>Making adequate abdominal or/and buttock incisions, exenterations of involved pelvic organs and structures, total pelvic exenteration if necessary, appropriate management of iliac vessels, planned re-operation for one tumor, and re-operation for recurrences are important methods for the treatment of extraperitoneal pelvic neoplasms.</p>

Differences in coronary microvascular lesions in coronary heart disease and hypertension: an autopsy study of elderly patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the case of hypertension, lesions in the microvessels of the target organs precede and deteriorate further after arteriosclerosis in the small arteries. Thus coronary microvascular lesion (CML) was considered the crucial factor contributing to damage to the target organs. The purpose of this study is to observe the characteristics and differences of CML in autopsies of elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or EHT with CHD, given the same degree of left ventricular wall thickness (LVWT).</p><p><b>METHODS</b>A retrospective study was performed on 246 cases of patients over 60 years old with EHT, CHD, or EHT with CHD, and on 26 cases without cardiovascular disease as controls, out of a total of 3195 consecutive autopsied cases. The arterioles (with diameter 10 - 60 microm) and the capillaries in the cardiac muscle layer were examined by haematoxylin and eosin staining, elastic van Gieson staining, and CD31 immunohistochemistry. To quantify CML severity, measurements were taken of arteriole density (AD), the ratio of wall-to-lumen area of arteriole (RWL), and capillary density (CD), using light microscopy and computer image analysis. Based on LVWT, the cases were divided into four degrees, from I to IV. The EHT, CHD, and EHT with CHD groups all rated LVWT I-IV, and the control group rated LVWT I. SAS software was used for statistical analysis.</p><p><b>RESULTS</b>With the aggravation of LVWT, both AD and RWL increased while CD decreased significantly in the EHT group (P < 0.05 - 0.0001); there were similar but more severe changes in the EHT with CHD group (P < 0.001 - 0.0001); and AD increased (P < 0.001) while RWL and CD did not change significantly in the CHD group.</p><p><b>CONCLUSION</b>Comparing EHT with CHD patients, there are similar patterns of change to AD, but different patterns of change to RWL and CD. CML is much more severe in EHT patients with CHD. We conclude that CML is one of the main causes of decreased coronary flow reserve and myocardial damage in both EHT patients and EHT patients with CHD.</p>

Angiogenesis in coronary atherosclerotic plaques and its relationship to plaque stabilization / 中华病理学杂志

<p><b>OBJECTIVE</b>To compare the angiogenesis in unstable and stable plaques and to investigate the potential role of neovessels in creating vulnerable sites for atherosclerotic plaques.</p><p><b>METHODS</b>Specimens of coronary arteries were obtained from 52 autopsy cases with acute coronary syndromes. Plaque morphology was studied by use of stained slides. 922 tissue blocks of late-stage lesions were classified into two groups: (1) unstable plaque (n = 153), the plaque was characterized by a large extracellular lipid core (more than 40% of the plaque area); (2) stable plaque (n = 769), lipid core less than 40% of the plaque area. Forty blocks were selected randomly from each group and serial sections were stained immunohistochemically with a polyclonal antibody against F VIII RAg. Computer-aided planimeter was used for quantitative analysis.</p><p><b>RESULTS</b>In unstable plaques, the occurrence of neovessels was more frequent and the neovessel density (number/mm(2)) was significantly increased as compared to that of stable plaques (frequency: 80.4% vs 66.6%, P < 0.01; shoulder: 22.16 +/- 19.96 vs 10.04 +/- 11.52, base: 21.68 +/- 20.44 vs 9.68 +/- 11.52, fibrous cap: 3.80 +/- 5.32 vs 1.48 +/- 2.28, P < 0.05). Most neovessels were located in the shoulder region and at the base of plaques.</p><p><b>CONCLUSIONS</b>These findings suggest that neovessels in coronary atherosclerotic plaques are closely associated with the decreased stabilization of the plaques.</p>