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Objective:To investigate the clinicopathological characteristics of renal leukocyte chemotactic factor 2 amyloidosis (ALECT2).Methods:The patients with renal ALECT2 diagnosed by renal biopsy in Peking University First Hospital, Shanxi Medical University Second Hospital and Shanxi Bethune Hospital from January 2001 to October 2021 were retrospectively enrolled. According to whether the patients had concurrent glomerular diseases, they were classified into two groups: isolated ALECT2 group and ALECT2 with concurrent renal diseases group. Clinicopathological data of the two groups were compared. Light microscopy, immunofluorescence and immunoelectron microscopy were applied to investigate pathological characteristics of renal tissues. Mass spectrometry was used to analyze the composition of renal amyloid deposits. Gene sequencing was employed to detect the leukocyte chemotactic factor 2 ( LECT2) gene sequence in peripheral blood of the patients. Results:Sixteen patients with ALECT2 were enrolled in this study and nine of them had concurrent renal diseases. The age of 16 patients was (65.00±8.45) years old. The sex ratio of males to females was 7 to 9. Most of patients were Han ethnicity (15/16). Eight patients came from Shanxi province. Fifteen patients presented with varying degree of proteinuria [2.16(1.07, 4.72) g/24 h]; 5 patients had nephrotic syndrome; 11 patients had renal insufficiency; 12 patients had microscopic hematuria. Part of patients also had hypertension (12/16) and diabetics (6/16). Compared with isolated ALECT2, the ALECT2 group with concurrent renal diseases had a higher proportion of nephrotic syndrome (5/9 vs 0/7, P=0.034). Renal biopsy results showed that all patients (16/16) had amyloid deposits in the interstitium of renal cortex with varying degree of inflammatory cell infiltration and fibrosis, and glomeruli (12/16) and arterioles (14/16) were involved by amyloid deposits. The amyloid deposits were strongly congophilic and immunohistochemistry for LECT2 was positive. By semi-quantitative analysis, the proportions of glomerular and overall amyloid loads in ALECT2 with concurrent renal diseases group were lower than those in isolated ALECT2 group (both P<0.05). Electron microscopy revealed randomly oriented and non-branching fibrils with a diameter of 8-12 nm. The LECT2 peptides were detected by mass spectrometry in renal amyloid deposits of 8 patients, and homozygous G allele of LECT2 was found in 7 patients by gene sequencing. Complete follow-up data of 13 patients showed that 2 patients died, 1 patient developed end-stage renal disease at the time of renal biopsy, and most of the rest patients had stable renal function (8/10). Conclusions:Patients with renal ALECT2 mainly present with proteinuria, along with a high incidence of renal insufficiency, microscopic hematuria, and concurrent renal diseases. The pathologic feature is the preferential deposition of amyloid in renal cortical interstitium.
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Objective:To summarize and analyze the clinicopathological characteristics of patients with DNAJ heat shock protein family member B9 (DNAJB9)-positive fibrillary glomerulonephritis (FGN).Methods:The clinical and pathological data of 5 patients with DNAJB9-positive FGN diagnosed in Peking University First Hospital from January 2011 to January 2021 were retrospectively collected and analyzed.Results:Among the 5 patients, the female to male ratio was 4∶1, and the median age was 29 years old (24-71 years old). The clinical manifestations included 2 cases with nephrotic syndrome and 3 cases with proteinuria. One patient had gross hematuria, and 4 cases had mild microscopic hematuria. None of the 5 patients had evidence of monoclonal gammopathy. The renal pathological pattern of FGN showed mesangial-proliferative glomerulonephritis, mesangial nodular sclerosis, membranoproliferative glomerulonephritis, and atypical membranous nephropathy. Crescents formation could be accompanied. Immunofluorescence staining showed smudgy and granular IgG and C3 deposition in the mesangial region and capillary wall, and the subtypes of IgG were mainly IgG1 and IgG4. Under electron microscopy, fibrillary deposits with a diameter of 8-30 nm were observed in the mesangial and subendothelial area, accompanied by deposition in basement membrane and occasionally subepithelial area. The renal prognosis of FGN patients was poor. One patient entered end-stage renal disease within one week, and another patient entered end-stage renal disease within one year despite immunosuppressant therapy in 2 cases with nephrotic syndrome at onset. One patient had worsening proteinuria despite renin-angiotensin system (RAS) blocker treatment. Two patients achieved complete renal remission and stable renal function after RAS blocker treatment.Conclusions:Most FGN patients in China are young people. The main clinical manifestations are proteinuria or mild microscopic hematuria. The diagnosis depends on the discovery of fibrillary deposits in the mesangial area and subendothelial area with a diameter of about 10-30 nm under the electron microscope. DNAJB9 protein immunohistochemical staining can be used as an important marker for the diagnosis of FGN. The prognosis of FGN kidney is poor, and there is no effective targeted treatment option now.
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Objective:To investigate the characteristics of human papillomavirus (HPV) infection and genotype distribution among cervical cancer patients in northern Jiangsu Province and southern Anhui Province, so as to provide references for cervical cancer prevention and HPV vaccination.Methods:The clinical data of 505 cervical cancer patients who were admitted to Xuzhou Cancer Hospital of Jiangsu Province and Jiangsu Cancer Hospital from July 2016 to June 2019 were retrospectively analyzed. The patients were mainly from northern Jiangsu Province and southern Anhui Province, and among them, 347 patients (68.7%) were 41-60 years old. The patient's HPV infection and genotype distribution characteristics were analyzed.Results:The total infection rate of HPV among 505 patients was 96.6% (488/505), of which patients aged 41-60 years old accounted for 68.4% (334/488); the single infection rate was higher than the multiple infection rate [69.7% (352/505) vs. 26.9% (136/505)]. There was a statistical difference in the total HPV infection rate of patients with different clinical stage ( χ2 = 14.528, P < 0.05), but the infection rate did not increase with the increase of stage. Among 488 HPV-positive patients, single infection accounted for 72.1% (352/488), double infection accounted for 17.4% (85/488), triple infection accounted for 6.2% (30/488), and more than triple infection accounted for 4.3% (21/488). Among 352 patients with HPV single infection, low-risk type infection accounted for 8.0% (28/352), and high-risk type infection accounted for 92.1% (324/352). The top three high-risk HPV genotypes were type 16, type 52 and type 58, and there were 174 cases in total. Among 136 patients with multiple HPV infections, 115 cases (84.6%) were infected with at least one of type 16, type 52 and type 58. Among them, the infection of type 16 combined with other types accounted for 53.7% (73/136). Conclusions:The infection rates of high-risk HPV genotypes among cervical cancer patients in northern Jiangsu Province and southern Anhui Province are high, and type 16 is the most common. It is more valuable to inoculate the nine-valent vaccine to prevent cervical cancer in these areas; 41-60 years old is the age at which HPV infection and cervical cancer are highly prevalent, so the prevention and control should be strengthened.
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Objective:To investigate the clinicopathological characteristics of renal light and heavy chain amyloidosis (AHL).Methods:Ten patients with renal AHL diagnosed by renal biopsy in Peking University First Hospital and Institute of Nephrology of Peking University from January 2015 to June 2020 were enrolled. Clinicopathological data of these patients was collected and reviewed.Results:AHL typically affected older patients, with a male/female ratio of 7:3. The clinical manifestations were mainly edema and heavy proteinuria. At the same time, 7/10 of patients presented with nephrotic syndrome, 7/10 presented with microscopic hematuria, and 3/10 presented with renal insufficiency. Laboratory examinations showed monoclonal immunoglobulin in blood and urine in all patients, and IgGλ was the most common one (5/10). Decreased serum complement could be seen in some patients. The ratio of serum free κ light chain and free λ light chain was abnormal in all patients who underwent serum free light chain test. None of the 10 patients met the diagnostic criteria of multiple myeloma. Except for one of the 10 patients who was diagnosed as Waldenstrom's macroglobulinemia, the rest were diagnosed as monoclonal gammopathy of renal significance (MGRS). Bone marrow of 2/6 of patients were positive for amyloid. Cardiac involvement was confirmed in only one patient. Renal biopsy demonstrated amorphous eosinophilic material, which was Congo red positive, was deposited in glomerular mesangial area (10/10), capillary vessels (8/10), renal interstitium (9/10), peritubular capillary walls (9/10) and arterioles (8/10). This material showed apple green birefringence under polarized light. Immunofluorescence showed that single heavy chain and single light chain were positive at the same time, which was consistent with the results of mass spectrometry analysis. Ultrastructural evaluation revealed randomly oriented, non-branching fibrils with a diameter of 8-12 nm.Conclusions:Main clinical manifestations of AHL amyloidosis are edema and massive proteinuria, along with a high incidence of hematuria, a low portion of heart involvement and high frequency of whole molecule of monoclonal immunoglobulin (IgGλ dominant) by serum immunofixation electrophoresis. Renal pathology shows the commonly involved kidney compartments of amyloid deposits are glomerular capillary walls and peritubular capillary walls in patients with AHL amyloidosis.
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Objective@#To investigate the clinical and pathological features of ischemia renal injury.@*Methods@#Patients with biopsy-proven ischemia renal injury in the Department of Nephrology, Peking University First Hospital from 2010 to 2018 were retrospectively enrolled in the present study. The demographic information and laboratory data were collected. And the severity of pathologic changes including glomeruli, arteriole and tubulo-interstitial fibrosis (IFTA) were semi-quantitatively scored. Arterioles with a ratio of inner/outer luminal diameter greater than 0.5 without hyalinosis were diagnosed as normal ones. The relationships between estimated glomerular filtration rate (eGFR), urine protein excretion and pathological changes were analyzed.@*Results@#A total of 52 patients were enrolled in the study, including 39 males (75.0%). The age of the patients was (45.0±12.7) years at biopsy. Among them, 50 patients (96.2%) had a history of hypertension with a median duration of 66 (24, 138) months. Forty-one patients (78.9%) were overweight or obese. The median urinary protein excretion was 0.75 (0.27, 1.32) g/d with 3 cases over 3 g/d. Fifteen patients (28.8%) presented with microhematuria and twenty-seven patients (51.9%) with eGFR lower than 60 ml·min-1·(1.73 m2)-1, respectively. The ratio of arteriolar inner/outer luminal diameter was 0.43±0.05 and the percentage of normal arterioles was 29.0%±17.0%. There were 21 patients (40.4%) found with arteriole hyalinosis. The ratio of arteriolar inner/outer luminal diameter correlated with the percentage of glomerular lesions (rs=-0.312, P=0.024), the semiquantitative scale of IFTA (rs=-0.291, P=0.037) and eGFR (r=0.339, P=0.014), respectively. Hypertension duration and body mass index (BMI) showed a negative correlation with the ratio of arteriolar inner/outer luminal diameter (rs=-0.303, P=0.029 and rs=-0.274, P=0.050, respectively) and a positive correlation with serum complement 3 level (rs=0.358, P=0.020 and rs=0.432, P=0.004, respectively).@*Conclusions@#Renal ischemia injury may be found in young and middle-aged patients. The characteristic of clinical features is mild to moderate proteinuria accompanied with a certain degree of eGFR decline, while a small number of patients may have microhematuria and marked proteinuria. The ratio of arteriolar inner/outer luminal diameter has a negative correlation with the percentage of glomerular lesions and the semiquantitative scale of IFTA and a positive correlation with eGFR, respectively. Hypertension and obesity are closely related to vascular lesions.
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Objective:To evaluate the clinicopathological characteristics and prognosis of IgA nephropathy (IgAN) patients with microangiopathy lesions and with no hypertension.Methods:Adult IgAN patients without hypertension were selected from Peking University First Hospital. All kidney biopsies were independently reviewed by 2 investigators. Patients were divided into three groups (microangiopathy group, simple arterio/arteriolosclerosis group and normal vascular group) by renal arteriolar lesions. Composite kidney end point event defined as a ≥30% reduction in estimated glomerular filtration rate (eGFR) and end-stage kidney disease. Cox regression analysis was used to test the association between microangiopathy lesions and the outcomes.Results:A total of 420 patients were included in this study, of which 37(8.8%) patients had renal arteriolar microangiopathy lesions, 134 (31.9%) patients had simple arterio/ arteriolosclerosis, and the others had no vascular lesion. Compared with simple arterio/arteriolosclerosis group or non-vascular lesion group, patients with renal arteriolar microangiopathy lesions had more severe urine protein ( P=0.002), worse renal function ( P<0.001), higher proportion of segmental glomerulosclerosis and/or balloon adhesion (S1), tubular atrophy/interstitial fibrosis (T1/2), cellular/fibrocellular crescents (C1/2) (all P<0.05). During the follow-up, 20(54.1%) patients with microangiopathy lesions, 45(33.6%) patients with simple arterio/arteriolosclerosis and 82(32.9%) patients without vascular lesion reached the composite kidney end points ( χ2=6.491, P=0.039). In a multivariable Cox regression model, the presence of microangiopathy lesions was an independent risk factor for kidney disease progression in IgAN patients ( HR=1.872, 95% CI 1.044-3.357, P=0.035), and simple arterio/arteriolosclerosis was not a risk factor for kidney disease progression. Conclusion:It is not uncommon for non-hypertensive patients with IgAN having microangiopathy lesions, which suggests that hypertension is not the sole risk factor for microangiopathy lesions.
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Objective To investigate the clinical and pathological features of ischemia renal injury.Methods Patients with biopsy-proven ischemia renal injury in the Department of Nephrology,Peking University First Hospital from 2010 to 2018 were retrospectively enrolled in the present study.The demographic information and laboratory data were collected.And the severity of pathologic changes including glomeruli,arteriole and tubulo-interstitial fibrosis (IFTA) were semiquantitatively scored.Arterioles with a ratio of inner/outer luminal diameter greater than 0.5 without hyalinosis were diagnosed as normal ones.The relationships between estimated glomerular filtration rate (eGFR),urine protein excretion and pathological changes were analyzed.Results A total of 52 patients were enrolled in the study,including 39 males (75.0％).The age of the patients was (45.0±12.7) years at biopsy.Among them,50 patients (96.2％) had a history of hypertension with a median duration of 66 (24,138) months.Forty-one patients (78.9％) were overweight or obese.The median urinary protein excretion was 0.75 (0.27,1.32) g/d with 3 cases over 3 g/d.Fifteen patients (28.8％)presented with microhematuria and twenty-seven patients (51.9％) with eGFR lower than 60 ml· min-1·(1.73 m2)-1,respectively.The ratio of arteriolar inner/outer luminal diameter was 0.43+0.05 and the percentage of normal arterioles was 29.0％+17.0％.There were 21 patients (40.4％) found with arteriole hyalinosis.The ratio of arteriolar inner/outer luminal diameter correlated with the percentage of glomerular lesions (rs=-0.312,P=0.024),the semiquantitative scale of IFTA (rs=-0.291,P=0.037) and eGFR (r=0.339,P=0.014),respectively.Hypertension duration and body mass index (BMI) showed a negative correlation with the ratio of arteriolar inner/outer luminal diameter (rs=-0.303,P=0.029 and rs=-0.274,P=0.050,respectively) and a positive correlation with serum complement 3 level (rs=0.358,P=0.020 and rs=0.432,P=0.004,respectively).Conclusions Renal ischemia injury may be found in young and middle-aged patients.The characteristic of clinical features is mild to moderate proteinuria accompanied with a certain degree of eGFR decline,while a small number of patients may have microhematuria and marked proteinuria.The ratio of arteriolar inner/outer luminal diameter has a negative correlation with the percentage of glomerular lesions and the semiquantitative scale of IFTA and a positive correlation with eGFR,respectively.Hypertension and obesity are closely related to vascular lesions.
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Varicella(chickenpox)is an acute infectious disease with high incidence in children. It is mainly transmitted through the airborne route and vaccination is the best measure for the prevention and control. Data from post-marketing studies show the effectiveness of varicella vaccines is 80%-85%, and two-dose regimen is significantly more effective than one-dose. After inclusion of varicella vaccines into the national immunization programme, there has been a clear decrease in varicella morbidity. Despite the lack of direct evidence, there remains the risk that varicella-zoster virus might latent in the dorsal route ganglia after vaccination. Therefore, more safe and effective novel varicella vaccines are under development. This paper reviewed the progress in varicella vaccine development and their long-term efficacy and safety.
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Objective@#To investigate the clinical significance and pathological features of lymphocytes and plasma cells infiltration and related ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis (IgG4-TIN).@*Methods@#Complete data was collected from 24 patients with IgG4-TIN confirmed by pathology in the Peking University First Hospital. The renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy examination. In addition, immunohistochemistry was used to detect the distribution of CD20+ B lymphocytes, CD3+ T lymphocytes and CD138+ plasma cells.@*Results@#A total of 24 patients were enrolled in the study, including 21 males (87.5%), 3 females (12.5%). The age was (58.0±10.8) years (38-75 years). Pathology analysis showed ectopic lymphoid-like structures were located in 16 (66.7%) cases and Russell bodies were detected in infiltrative plasma cells of 19(79.2%) cases with IgG4-TIN. Compared with cases without Russell body formation, cases with Russell body formation in renal interstitial plasma cells were more prone to show ectopic germinal center-like structure formation (P=0.001), tubular basement membrane (TBM) electron dense deposits (P=0.040) and reduced blood C3 levels (P=0.028).@*Conclusions@#Abnormal tubulointerstitial infiltration of ectopic lymphoid-like structures and plasma cells with prominent Russell body exist in IgG4-TIN patients, which suggests the persistent activation of lymphocytes and plasma cells in renal interstitium may contribute to the pathogenesis of IgG4-TIN.
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Varicella( chickenpox) is an acute infectious disease with high incidence in children. It is mainly transmitted through the airborne route and vaccination is the best measure for the prevention and control. Data from post-marketing studies show the effectiveness of varicella vaccines is 80％-85％, and two-dose regimen is significantly more effective than one-dose. After inclusion of varicella vaccines into the na-tional immunization programme, there has been a clear decrease in varicella morbidity. Despite the lack of direct evidence, there remains the risk that varicella-zoster virus might latent in the dorsal route ganglia after vaccination. Therefore, more safe and effective novel varicella vaccines are under development. This paper reviewed the progress in varicella vaccine development and their long-term efficacy and safety.
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OBJECTIVE： To conduct virtual screening for active component， target and pathway of TCM Yiqi ziyin decoction in the treatment of type 2 diabetes mellitus， and to elucidate the pharmacodynamic mechanism of this decoction in the treatment of type 2 diabetes mellitus at molecular level so as to provide theoretical basis for its popularization， application and rational organization. METHODS： Chemical compounds isolated from 10 ingredients of Yiqi ziyin decoction were retrieved from Handbook of Chemical Constituents of Original TCM Plants. Drug/drug-like molecules for the treatment of type 2 diabetes mellitus were retrieved from DrugBank database. Three-dimensional molecular structures of each component were downloaded from PubChem Compound database. The structure was optimized by using Cerius2 4.10 software， and the small molecular data set of Yiqi ziyin decoction was established. Using “type 2 diabetes mellitus” as keywords， target protein of type 2 diabetes mellitus were retrieved and screened from target protein databases， and their three-dimensional structures were downloaded from protein database. The selected compound molecules （ligands） were docked with target proteins （receptors）， and small molecules with high activity （sorted according to the values of Degree and Betweenness） and target proteins with high correlation were found. The interaction mechanism between ligand and receptor was discussed by taking the fine docking of selected small molecules with target protein （N-trans-caffeoyl tyrosine molecule and glycogen synthase kinase-3β） as an example. RESULTS： There were 732 kinds of chemical components and 127 drug/drug-like molecules； 30 target proteins of type 2 diabetes mellitus were screened. According to the values of Degree and Betweenness， 8 molecules with high activity （such as N-trans-caffeoyl tyrosine， hyperin and so on） and 10 target proteins with high correlation （such as carbonic anhydrase1， glycogen synthetase kinase-3β and so on） were screened out. The interaction between N-trans-caffeoyl tyrosine and glycogen synthase kinase-3β could form hydrogen bonds and π alkylation， thus affecting the structural stability and activity of the latter and reducing blood glucose. CONCLUSIONS： In this study， it found there existed not only one molecule compound interacting with multiple targets， but also different molecule compound interacting with the same target on Yiqi Ziyin decoction for the treatment of type 2 diabetes mellitus by virtual screening， it revealed the characteristics of multi-component and multi-target synergism of TCM prescriptions at the molecular level， providing reference for screening lead compounds and structural modification of new drug for diabetes mellitus.
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Objective To investigate the clinicopathological characteristics of renal light chain deposition disease coexisted with cast nephropathy (LCDD&LCN).Methods Patients with LCDD&LCN (n=10),isolated LCDD (I-LCDD,n=21) and isolated LCN(I-LCN,n=17) diagnosed byrenal biopsy in Peking University First Hospital from January 1,2000 to March 31,2018 were enrolled,and all cases were examined by light microscopy,immunofluorescence (IF) (including light chain) and electron microscopy (EM).The semi-quantitative evaluation of the main features of renal pathology was performed.The clinical manifestations and pathological features were reviewed and compared.Results LCDD&LCN was more prevalent in middle-aged males.Nine patients showed acute renal insufficiency with small molecular proteinuria (97.1％) and microscopic hematuria.The hematologic diseases included 9 patients of multiple myeloma.The type of monoclonal light chain in serum and urine by immunofixation electrophoresis showed λ dominant (5/8).By light microscopy,glomerular lesions presented with mild mesangial proliferation in most patients,and only one of them displayed mesangial nodular sclerosis.At the same time,acute tubular injury with light chain casts was the prominent feature,and the clinical manifestations and histological features of LCDD&LCN were similar to that of I-LCN.IF revealed linear staining of monoclonal light chain along the glomerular basement membrane (GBM),tubular basement membrane (TBM) and Bowman's capsule,and also positive in tubular casts.By electron microscopy,diffuse powder-like or granular electron-dense deposits located in the inner side of the GBM,the outer layer of the TBM,renal interstitium and arteriolar walls were observed.Conclusions Patients with LCDD&LCN manifest as acute renal insufficiency,and the majority have multiple myeloma.The pathology of LCDD&LCN possesses the features of both I-LCDD and I-LCN.The IF stain of light chains(κ,λ) and ultrastructural examination by electron microscopy are the inevitable methods for the diagnosis of LCDD&LCN.
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Objective To investigate the clinical significance and pathological features of lymphocytes and plasma cells infiltration and related ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis (IgG4-TIN). Methods Complete data was collected from 24 patients with IgG4-TIN confirmed by pathology in the Peking University First Hospital. The renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy examination. In addition, immunohistochemistry was used to detect the distribution of CD20+ B lymphocytes, CD3+ T lymphocytes and CD138+ plasma cells. Results A total of 24 patients were enrolled in the study, including 21 males (87.5％), 3 females (12.5％). The age was (58.0 ± 10.8) years (38-75 years). Pathology analysis showed ectopic lymphoid-like structures were located in 16 (66.7％) cases and Russell bodies were detected in infiltrative plasma cells of 19(79.2％) cases with IgG4-TIN. Compared with cases without Russell body formation, cases with Russell body formation in renal interstitial plasma cells were more prone to show ectopic germinal center-like structure formation (P=0.001), tubular basement membrane (TBM) electron dense deposits (P=0.040) and reduced blood C3 levels (P=0.028). Conclusions Abnormal tubulointerstitial infiltration of ectopic lymphoid-like structures and plasma cells with prominent Russell body exist in IgG4-TIN patients, which suggests the persistent activation of lymphocytes and plasma cells in renal interstitium may contribute to the pathogenesis of IgG4-TIN.
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Objective@#To investigate the clinical values of colposcopy and cervical biopsy and/or endocervical curettage (ECC) in the diagnosis of cervical lesion.@*Methods@#Clinical data of 128 cases of cervical lesion diagnosed by Xuzhou Cancer Hospital from January 23, 2014 to October 11, 2016 were collected and retrospectively analyzed, all patients underwent colposcopy and cervical biopsy and/or ECC.@*Results@#Among them, the age between 30 to 50 years old were 70 cases, whose transformation zone types of Ⅰ, Ⅱ and Ⅲ were 28 cases (40.0%), 23 cases (32.9%) and 19 cases (27.1%), respectively. The age older than 50 years were 45 cases, whose transformation zone types of Ⅱ and Ⅲ were 1 case (2.2%) and 44 cases (97.8%), respectively. Among the 128 cases of cervical lesions, diagnostic results of colposcopy showed that the chronic inflammation were 57 cases, cervical intraepithelial neoplasia (CIN)Ⅰwere 35 cases, CINⅡor CINⅡ~Ⅲ were 8 cases, CIN Ⅲ were 5 cases and cervical cancer were 23 cases. Alternatively, the pathological results showed that the chronic inflammation were 81 cases, CINⅠwere 17 cases, CINⅡor CINⅡ~Ⅲ were 7 cases, CIN Ⅲ were 5 cases and cervical cancer were 18 cases, respectively. Among the 81 cases of chronic inflammation diagnosed by pathology, 52 cases (64.2%) were consistent with the diagnostic results of colposcopy. Among the 17 cases of low grade squamous epithelial cell lesion (LSIL) diagnosed by pathology, 10 cases were in agree with the diagnostic results of colposcopy. Among the 12 cases of high-grade squamous epithelial cell lesion (HSIL) diagnosed by pathology, 9 cases were concordant with the diagnostic results of colposcopy. Among the 18 cases of cervical cancer diagnosed by pathology, 17 cases were consistent with the diagnostic results of colposcopy.@*Conclusions@#The type of transformation zone is positively correlated with the age, and it can help to choose biopsy and therapeutic manner. The diagnostic accuracies of HSIL and early stage of cervical cancer by multi-point biopsy of colposcopy and/or ECC are high. The cervical lesions which are difficultly found by direct visualization can be identified by colposcopy, and thus provides objective evidence to determine the therapeutic manner for patients with stage ⅡA of cervical cancer.
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Objective To elucidate the clinical and pathological characteristics of the patients with thymoma-associated glomerulonephropathy.Methods In this retrospective study,the clinicopathologic characteristics of patients diagnosed as thymoma-associated glomerulonephropathy inPeking University First Hospital during the period between Oct 2008 and Jun 2017 were analyzed,including the histological classfication of thymoma,the clinicopathological features and the short-term prognosis.Results Altogether twelve patients were included with an average age of (55+ 16) years;male/female ratio was 3∶ 1.The B2 type thymoma was the most common type.Nine cases also suffered from myasthenia gravis,and eight cases of glomerulopathy accompanied by thymoma activity.The clinical presentation of glomerulopathy included nephrotic syndrome (11/12),acute kidney injury (10/12).Eleven patients received renal biopsy,among which five cases were minimal change nephropathy,three cases were membranous nephropathy,and the other three cases were focal segmental glomerulosclerosis,thrombotic microangiopathy and endocapillary proliferative glomerulonephritis,respectively.Eleven patients received immunosuppression therapy.After a median 12 months follow up,the proteinuria decreased in 7 cases,and renal function completely or partially recovered in 6 cases.Conclusions Minimal change disease is the most frequent pathological type of thymoma-associated glomerulonephropathy.Immunotherapy with glucocorticoid as first-line drug may be considered for thymoma-associated glomerulonephropathy with surgery,chemoradiation contraindications or non-remission of kidney disease after anti-tumor therapy.
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Objective To investigate the clinical and pathological characteristics of light chain proximal tubulopathy (LCPT).Methods Nine patients with LCPT diagnosed by renal biopsy in Peking University First Hospital from January 1,2011 to September 30,2016 were enrolled,and their clinical findings and pathological features were reviewed.Immunofluorescence (IF) of light chains (κ,λ) on paraffin sections after protease digestion and immunogold labeling of light chains (κ,λ) on ultrathin sections were performed in some cases.Results The main clinical manifestation of the nine patients was proteinuria of small molecules,with acute or chronic renal insufficiency,and six of them led to partial or complete Fanconi syndrome (FS).The hematologic diseases included 3 cases of multiple myeloma and 6 cases of monoclonal gammopathy of renal significance (MGRS).Pathological examination of renal biopsy showed two types:crystalline and noncrystalline LCPT.Seven cases of crystalline LCPT were stained for κ light chain,the proximal tubular epithelial cytoplasm exhibited fine granular vacuolation,with needle-shaped crystals and clear clefts by light microscopy,the intracytoplasmic inclusions of various shapes including rhomboidal,rectangular and rod-shaped crystals were identified by electron microscopy.Two cases of noncrystalline LCPT were stained for λ light chain,the prominent argyrophilic granules in cytoplasm of proximal tubular epithelia were observed by light microscopy,and intracytoplasmic large and irregular shaped phagolysosomes were found by electron microscopy,cast nephropathy were coexisted in these 2 cases,the additional light chain deposition disease were confirmed in one of them by electron microscopy and IF.All cases had monotypic staining of light chains in cytoplasm of proximal tubules by IF on frozen tissue and paraffin sections after protease digestion,with the latter method being more sensitive than the routine IF.The immunogold labeling showed specific monotypic labeling of κ and λ light chain on intracytoplasmic crystals and phagolysosomes respectively by immunoelectron microscopy.Conclusions LCPT is a rarely reported entity that manifested as acquired Fanconi syndrome and dysfunction of proximal tubules clinically.Pathologically it is divided into two types:crystalline and noncrystalline LCPT,with more prevalent of κ light chain related crystalline type,noncrystalline LCPT is mostly λ type,and is easily coexisted with cast nephropathy.The IF and immunoelectron microscopy of light chains(κ,λ) and ultrastructural examination by electron microscopy are important methods for the diagnosis of LCPT.
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Autoimmune diseases are characterized by the presence of various autoantibodies and may cause injuries to multiple organs,with kidney as the most common and important organ involved.Autoantibodies are of great importance in the diagnosis,treatment and prognosis of autoimmune renal diseases.Lupus nephritis,anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis and antiglomerular basement membrane (GBM) disease are the most common autoimmune renal diseases.Anti-C1q antibody,ANCA and anti-GBM antibody play important roles in those diseases,respectively.Appropriate and steady detecting methods are crucial to clinicians,and the results should also be interpreted with great cautions.
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Objective To describe the work experience and needs of enterostomal therapist in Shanghai.Methods Phenomenological methodology was adopted in this study.In-depth interview was conducted on 9 enterostomal therapists.Data were analyzed by inductive codes and coding methods.Results Five themes were extracted,including responsibility and mission,pride,accomplishment,helplessness,and satisfaction.When they began their new jobs,they confronted many challenges,but they conquered them with responsibility and mission.Finally,they felt growing up and harvested a lot during this time.Conclusions Hospital managers should pay attention to problems they encountered in their work and provide necessary supports for their training,work and development.
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Objective To compare the clinical and follow-up results of different ways of operation for the treatment of patients with hilar cholangiocarcinoma ,and to explore its e key technology and related prognosis .Methods 31 out of 50 patients with biliary and partial liver resection(control group) ,19 patients with hemihepatectomy (observation group) .Radical resection rate and surviv-al rate were compared in the two groups .Results radical resection rate control group and observation group was 35 .48% (11/31) and 68 .42% (13/19) ,the difference was statistically significant (P=0 .014);the difference of 1 ,3 ,5 year survival rates between the two groups were statistically significant (P= 0 .03) ,observation group :85 .4% ,58 .6% ,32 .2% ,control group:86 .1% ,65 .2% , 20 .0% .Conclusion Radical resection is still the most important measures the patients for cure and long-term survival ,radical re-section rate ,survival rate ,and prognosis could be improved greatly by improving operation skills and experience accumulation ,com-bined with hepatectomy .
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Objective To investigate the associated effect of 125I implantation plus chemotherapy in local recurrent stage Ⅲ NSCLC patients.Methods From January 2006 to January 2009,34 patients documented with local recurrent stage Ⅲ NSCLC were divided into two groups by random number table.The treatment group was treated with 125I permanent implantation combined with DP regimen (docetaxel 60 mg/m2 + cisplatinum 75 mg/m2),while the control group received only DP chemotherapy.According to the TPS,the treatment group received CT-guided percutaneous implantation of 125 I seeds with a particle activity of 2.22 ×107-2.59 × 107 Bq.The prescribed dose was in the range of 90-110 Gy and the postoperatively matched peripheral dose (mPD) and D9o were verified by TPS.The control group received a DP chemotherapy regime for 4 cycles after the procedure.This study was approved by the ethics committee,and all patients signed informed consents.The follow up time was up to disease progression.Kaplan-Meier survival analysis was used to describe the local lesion control (LLC) time and progression free survival (PFS).Log-rank test was used in the comparison of the survival rates between the two groups.Fisher's exact test was used to analyze the differences of CR rate and recent efficiency between two groups.Results In the treatment group,postoperative mPD was 93.9-130.4 (M 116.7) Gy,and D90 was 103.6-148.2 (M 130.6) Gy.The LLC time was 4.7 to 24.0 months with a median of 11.6 (95％ CI:8.7-14.6) months.In two cases,there was no recurrence during the follow-up time of 24 months.PFS was 4.7 to 24.0 months with a median of 10.5 (95％ CI:7.4-13.6) months.The recent effective rate of the treatment group was 64.7％ (11/17).CR,PR,SD and PD were 41.2％ (7/17),23.5％ (4/17),23.5％ (4/17) and 11.8％ (2/17),respectively.In the control group,the LLC time was 4.5 to 11.4 months with a median of 7.5 (95 ％ CI:6.7-8.3) months,and the median of PFS was 6.5 (4.5-10.5) (95％ CI:5.7-8.3) months.The response rate,CR,PR,SD and PD were 41.2％ (7/17),5.9％ (1/17),35.3％ (6/17),35.3 ％ (6/17) and 23.5％ (4/17),respectively.There was no statistical significance of the recent effective rate between the treatment group and control group (P =0.30),but the LLC time (x2 =8.40,P ＜ 0.01),the median of PFS time (x2 =6.27,P ＜ 0.05) and CR (P =0.04) of the treatment group were all significantly higher than those of the control group.Concltusion The implantation of 125I seeds combined with chemotherapy for recurring stage Ⅲ NSCLC patients is safe and effective,and its efficacy is superior to the second line chemotherapy alone.