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Objective:To understand the clinical and laboratory characteristics of primary Epstein-Barr virus (EBV) infection in children.Methods:Totally 210 cases with primary EBV infection from September 2016 to March 2017 in Department of Infectious Diseases, Children′s Hospital of Fudan University in Shanghai were retrospectively collected. The clinical information (fever, rash, etc), and laboratory data such as liver function, EBV test (serological test, polymerase chain reaction (PCR)-DNA) were analyzed.Results:The age of children with primary EBV infection was (4.2±2.4) years. Numbers of patients with fever, tonsil and/or pharynx exudation, cervical lymphadenopathy, eyelid edema and rash were 187 (89.0%), 130 (61.9%), 204 (97.1%), 95 (45.2%) and 21 (10.0%), respectively. A total of 120 cases (57.1%) presented with typical triplets of infectious mononucleosis. Absolute lymphocyte count ≥5.0×10 9/L was found in 177 cases (84.3%), and abnormal lymphocyte ratio≥0.10 was found in 184 cases (87.6%). Elevated transaminase level was found in 96 cases (45.6%), and 72 cases were followed until transaminase level back to normal, in whom 97.2% (70/72) patient returned to normal within six weeks. Epstein-Barr viral capsid antigen (EBV-VCA)-IgM was positive in 192 cases (91.4%). EBV-VCA-IgG and Epstein-Barr viral early antigen (EBV-EA)-IgG positive were presented in 182 cases (86.7%) and 62 cases (29.5%), respectively. Epstein-Barr viral nuclear antigen (EBV-NA)-IgG was negative in all cases. EBV DNA test was carried in 199 cases, of which 122 cases (61.3%) were positive. Conclusions:Pediatric primary EBV infection mainly occurs in preschoolers. Most patients are presented with enlarged cervical lymph nodes, fever, and positive EBV serological markers. Transient transaminase elevation is observed in some cases.
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Primary ureteral plasmacytoid carcinomas is a rare tumor with high grade and poor diagnosis. Pathological and immunohistochemical staining play an extremely key role in diagnosis since there is no specific clinical and radiological evidence. The surgical removement is the first line treatment. Herein, we report a case of ureteral plasmacytoid carcinoma that was well controlled with multimodal therapy.
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Primary ureteral plasmacytoid carcinomas is a rare tumor with high grade and poor diagnosis.Pathological and immunohistochemical staining play an extremely key role in diagnosis since there is no specific clinical and radiological evidence.The surgical removement is the first line treatment.Herein,we report a case of ureteral plasmacytoid carcinoma that was well controlled with multimodal therapy.
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Objective@#To evaluate the risk factors of postoperative upgrade to pT3a of cT1 renal cell carcinoma, and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making.@*Methods@#Clinical data of 1 376 patients with cT1 (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed. There were 979 males and 397 females, with the mean age of (57.65±10.92) years. The mean body mass index (BMI) was (25.47±3.27) kg/m2 and the average tumor size was (4.02±1.52) cm. There were 711 tumors on the left and 665 on the right. There were 363 cases with clinical symptoms, 567 patients with smoking history , 732 cases with history of chronic disease. There were 289 cases with tumor necrosis, 636 cases with tumor protrusion, 822 cases with irregular tumor , and 738 cases with renal sinus compression. Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively. Mann-whitney U test and chi-square test were used for univariate analysis, logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading, R software was used to construct the nomogram predictive model, C-index was used to evaluate the model discrimination, and calibration curve method was used to evaluate the consistency of the model.@*Results@#Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney, 48 cases of papillary cell carcinoma, 57 cases of chromophobe cell carcinoma, and 76 cases of other types. Among the 1 376 patients with cT1 renal tumor, 75 patients were upgraded to pT3a, accounting for 5.5% of all patients. Univariate analysis showed that the patients who upgraded to pT3a were older [(63.08±10.17) years old and (57.34±10.88) years old], and the tumor length and diameter were larger [(5.24±1.35) cm and (3.95±1.51) cm]. Patients with clinical symptoms [46.7% (35/75) vs. 25.2%(328/1 301)], patients with CT indication of tumor necrosis [40.0%(30/25 975) vs. 19.9% (259/1 301)], patients with irregular tumor contour [73.3%(55/76 775) vs. 59.0%(767/1 301)], and patients with radical nephrectomy were higher [(92.1% (70/91 075) vs. 70%(910/1 301)]. All the differences were statistically significant (P<0.01). Multivariate analysis showed that the independent predictors of upgrading were age (OR=1.046, P<0.001), larger tumor (OR=1.504, P<0.001), clinically symptom (OR=2.153, P=0.004), irregular tumor profile (OR=2.466, P=0.002), and tumor necrosis on CT (OR=2.588, P<0.001). The C-index was 0.808, the calibration curve of forecasting curve with the standard curve fit was good, and the prediction of renal cancer are better in predict consistency.@*Conclusions@#Based on the five preoperative predictors, including age, tumor size, clinical presence or absence of symptoms, tumor profile, and whether or not the tumor necrosis indicated by CT, this study developed a nomogram of cT1 renal cancer upgrade to pT3a. This nomogram has a good statistical significance, and this model can provide prognosis consultation for patients and provide reference for doctors to make decisions before treatment.
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Objective To evaluate the risk factors of postoperative upgrade to pT3a of cT1 renal cell carcinoma,and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making.Methods Clinical data of 1 376 patients with cT1 (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed.There were 979 males and 397 females,with the mean age of (57.65 ± 10.92) years.The mean body mass index (BMI) was (25.47 ± 3.27) kg/m2 and the average tumor size was (4.02 ±1.52) cm.There were 711 tumors on the left and 665 on the right.There were 363 cases with clinical symptoms,567 patients with smoking history,732 cases with history of chronic disease.There were 289 cases with tumor necrosis,636 cases with tumor protrusion,822 cases with irregular tumor,and 738 cases with renal sinus compression.Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively.Mann-whitney U test and chi-square test were used for univariate analysis,logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading,R software was used to construct the nomogram predictive model,C-index was used to evaluate the model discrimination,and calibration curve method was used to evaluate the consistency of the model.Results Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney,48 cases of papillary cell carcinoma,57 cases of chromophobe cell carcinoma,and 76 cases of other types.Among the 1 376 patients with cT1 renal tumor,75 patients were upgraded to pT3a,accounting for 5.5％ of all patients.Univariate analysis showed that the patients who upgraded to pT3a were older [(63.08 ± 10.17) years old and (57.34 ± 10.88) years old],and the tumor length and diameter were larger [(5.24 ± 1.35) cm and (3.95 ± 1.51) cm].Patients with clinical symptoms [46.7％ (35/75) vs.25.2％ (328/1 301)],patients with CT indication of tumor necrosis [40.0％ (30/25 975) vs.19.9％ (259/1 301)],patients with irregular tumor contour [73.3％ (55/76 775) vs.59.0％ (767/1 301)],and patients with radical nephrectomy were higher [(92.1％ (70/91 075) vs.70％ (910/ 1 301)].All the differences were statistically significant (P ＜0.01).Multivariate analysis showed that the independent predictors of upgrading were age (OR =1.046,P ＜0.001),larger tumor (OR =1.504,P ＜0.001),clinically symptom (OR =2.153,P =0.004),irregular tumor profile (OR =2.466,P =0.002),and tumor necrosis on CT (OR =2.588,P ＜ 0.001).The C-index was 0.808,the calibration curve of forecasting curve with the standard curve fit was good,and the prediction of renal cancer are better in predict consistency.Conclusions Based on the five preoperative predictors,including age,tumor size,clinical presence or absence of symptoms,tumor profile,and whether or not the tumor necrosis indicated by CT,this study developed a nomogram of cT1 renal cancer upgrade to pT3a.This nomogram has a good statistical significance,and this model can provide prognosis consultation for patients and provide reference for doctors to make decisions before treatment.
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Objective To investigate the clinical features and prognosis of the patients with renal cell carcinoma and venous tumor thrombus.Methods Fifty-six patients with renal cell carcinoma and venous tumor thrombus were selected as our subjects,who underwent radical nephrectomy and thrombectomy in the Second Hospital of Tianjin Medical University from June 2002 to May 2014.There were 28 patients with stage Ⅰ tumor thrombus,l5with stage Ⅱtumor thrombus,9 with stage Ⅲ tumor thrombus and 4 with stage Ⅳtumor thrombus.All patients underwent renal tumor resection and embolectomy,and were follow-up.Results Of all the patients,46 were male and 10 were female with a mean age of 61.7(age ranging from 42 to 83).Twenty-four were presented on the left kidney and 32 were right.The clinical features were as follows:The tumor size was 2.5 to 14 cm in diameter(mean:6.2 cm),there were 21 cases with low back pain,18 cases with hematuria,lcases with abdominal.Pathological results showed that 39 with clear cell carcinoma,9 with papillary cell carcinoma,3 with chromophobe cell carcinoma,1 with low-differentiated cell carcinoma and 1 with undifferentiated cell carcinoma,3 with sarcomatoid differentiation.Forty-three patients were followed up,and the median follow up period was 20.4 months (2-90 months).The median survival time for the patients was 47 months and the 5 year overall survival was 45.2％.The survival time of the patients with early tumor thrombus(below hepaticvein) was (55.3 ± 4.9) month,significantly longer than that of the patients with advanced tumor thrombus (above hepaticvein) ((24.8 ± 5.3) months,P =0.047).Conclusion Patients with renal cell carcinoma and venous tumor thrombus are characterized with high malignancy and poor prognosis.Surgical operations are effective therapies for the patients.Long term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor.
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Objective To observe the effect of MAP4K4 targeted shRNA on biological characteristics such as proliferation,invasiveness,and apoptosis in human bladder cancer cell.Methods Differentially expressed genes was screened out through cDNA microarray analysis in 5 pairs of fresh-frozen muscle-invasive bladder cancer(MIBC) and adjacent normal tissue obtained from radical cystectomy.Combining the results of genechip and literature review,MAP4K4 was picked up for further analysis.To verify the result of microarray analysis,16 pairs of fresh muscle-invasive bladder cancer (MIBC) and adjacent tissues were assessed for the expression of MAP4K4 mRNA and protein through RT-PCR,qRT-PCR and Western-blot.T24 cell line was stably trasfected with MAP4K4 targeted shRNA and control shRNA,respectively.The effects of MAP4K4 silencing on proliferation,invasiveness and apoptosis of T24 cells transfected with MAP4K4 targeted shRNA and control shRNA were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),transwell and flowcytometry (FCM) assay.Results MAP4K4 was overexpressed in muscle invasive bladder cancer than in normal tissue.Down regulation of MAP4K4 expression decreased bladder cancer cell proliferation(MAP4K4-targeted versus control,P＜0.001),invasiveness(MAP4K4-targeted versus control,P=0.004)and promoted cell apoptosis(MAP4K4-targeted versus control,P=0.023).Conclusions MAP4K4 is overexpressed in muscle invasive bladder cancer than in normal tissue.Down-regulation of MAP4K4 expression inhibits the invasive ability of bladder cancer.Therefore,MAP4K4 might be a potential therapeutic target for bladder cancer.
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Objective To explore the function and mechanism of estrogen receptor α (ERα) in bladder cancer cell proliferation and aggressivity.Methods The ERα expression bladder cancer cell line T24ERα model was established.The cell growth was detected by MTT assay,apoptosis by flow cytometry,cell invasion by matrigel transwell.Western blot was used to check signals by ERα regulation in bladder cancer cells related to the proliferation and metastatic ability.Results Compared to the control group,the cell inhibition rates of experimental group in 96 h and 144 h were 18.85％ and 37.21％,respectively.The difference was significant compared with the control group (P ＜ 0.05).The apoptosis rates of the experimental group and control group were (18.93 ±1.41)％ and (9.91 ±1.08)％ (P＜0.05).The experimental group through matrix adhesive cell proportion was (10.00 ± 2.00)％,significantly lower than that of the control group (26.00 ± 3.61) ％ (P ＜ 0.05).Western blot showed integrin-β1,p-FAK,p-Src and Scr expression were reduced compared to control group (P ＜ 0.05).Conclusion ERα could inhibit bladder cancer cell growth and metastasis through down-regulating integrin-β1-FAK/Src signal pathway,while promote the apoptosis of bladder cancer cells.
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Objective To summarize the pathological and imaging features and treatment of retroperitoneal bronchogenic cyst.Methods The clinical data of 2 cases treated from October 2001 to November 2009 were summarized.The first patient was a 55-year-old woman with the chief complaint of lumbago in the left flank for 10 d.B-ultrasound showed mixed solid and cystic mass in spleen space with a diameter of 3.9 cm with thin wall and without rich blood supply.CT showed the lesion in the left adrenal gland region measured about 4 cm ×4 cm with low density with CT value of 10 HU,and enhanced scan was not obvious with CT value of 20 HU.It was diagnosed as left adrenal tumor and tumor resection was performed.The second case was a 17-year-old young man with the chief complaint of gross hematuria for 3 weeks after strenuous exercise.Ultrasonography found a 8.4 cm × 7.7 cm × 9.0 cm anechoic area surrounding the bladder.CT showed about 9.0 cm × 7.2 cm × 9.0 cm cystic lesion with thin wall,and the center density was uniformity in presacral space with CT value of8 HU.IVU showed visible semi-circular lower edge on the right edge of the bladder.The patient was diagnosed of presacral cyst and cystectomy was performed successfully.Results The pathology report of the first case:organizing wall with fibrous connective tissue,with most of the lining overlying pseudostratified ciliated columnar epithelium,goblet cells and subepithelial basement membrane.Pathological diagnosis was bronchogenic cyst,and the patient was followed up for 9 months without recurrence.The pathology report of the second case:pathological tissue fibers false wall tissue lining ciliated columnar epithelium,goblet cells seen in epithelium,fibrous tissue in the visible structure of mixed glands,a small amount of cartilage and muscle tissue.The diagnosis was bronchogenic cyst,and the patient was followed up for 2 years without recurrence.Conclusions Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed.Radiology imaging can identify cystic features,while a few may be with high density without specificity.Surgical removal of retroperitoneal bronchogenic cyst with symptoms has good prognosis and may prevent malignant transformation and secondary infection.