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Objective To quantitatively evaluate the diagnostic value of blood oxygen leveldependent (BOLD) MRI in the diagnosis of different degrees of liver warm ischemia-reperfusion injury (WIRI) in rabbits and evaluate the intervention effect of liposomal prostaglandin E1 (Lipo-PGE1).Methods Seventy healthy adult New Zealand white rabbits were randomly divided into sham -operated group (A0),thermal ischemic groups (A1～A3) and intervention groups (A4～A6).All experimental rabbits were scanned by routine MR and BOLD MRI after 6-hour reperfusion.R2* images were calculated by two radiologists.The levels of alanine aminotransferase (ALT),asparate aminotransferase (AST) and lactate dehydrogenase (LDH) were examined.And liver pathological sectioning was performed.All data were processed by one-way,Spearman's correlation and receiver operating characteristic curve analyses.Results The intraclass correlation coefficient (ICC) was 0.805 of two measurements suggesting that the repeatability of the outcome was decent.R2* values among sham-operated,thermal ischemia and intervention groups were statistically significant (P＜0.05).R2 * values in sham-operated and ischemia groups were statistically significant (P＜0.05).As warm ischemia time elapsed,R2* value showed a rising trend.R2* values in sham-operated and intervention groups were statistically significant (P＜0.05).R2* values of sham-operated group at the same timepoint of thermal ischemia and intervention groups were statistically significant (P＜0.05).Under the same ischemic time,R2* values of intervention groups were smaller than those of thermal ischemia groups.With the prolongation of ischemia time,reduction of R2* values became more pronounced.However,it did not reach the level of A0 group.R2* values were significantly positively correlated with ALT,AST and LDH (r＞0.5,P＜0.05).ROC analysis indicated that R2* had an excellent diagnostic performance.Conclusions BOLD MRI may be applied for noninvasive assessment of liver ischemia-reperfusion injury in different degrees.Lipo-PGE1 alleviates ischemia -reperfusion injury and BOLD MRI can evaluate the relieving degree of Lipo-PGE1.
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Objective@#To investigate the clinicopathologic characteristics, molecular and genetic features, differential diagnoses and prognosis of fumarate hydratase-deficient renal cell carcinoma (FH-RCC).@*Methods@#The immunohistochemical (IHC) expression of FH in 391 renal neoplasms in tissue chips collected from the Affiliated Hospital of Qingdao University and 971 Hospital of PLA Navy from January 2011 to December 2017 was evaluated. The clinicopathologic data of eight FH negative cases were collected.Polymerase chain reaction (PCR) and sequencing were used to detect the changes in FH gene in three cases. Interphase FISH with a dual color and break-apart probe was applied to detect the TFE3 gene alteration in the cases showing TFE3 protein expression.@*Results@#Among the eight patients, seven were male and one was female, and age ranged from 28 to 50 years (mean 39 years). Tumor size ranged from 3.5 cm to 12.0 cm (mean 7.9 cm). Renal pelvis invasion was identified in six cases, and the tumor emboli in renal vein and inferior vena cava were found in four patients. The cut surface of most tumors was solid, colorful, grayish white or yellow with no clear border showing invasive growth pattern. Microscopically, the tumors showed different proportions of papillary, tubular cystic, cribriform and solid structures. The tumor cells were rounded or polygonal with eosinophilic or amphotropic cytoplasm, round or oval nuclei, and focal large and prominent nucleoli (WHO/ISUP grade 3-4). Two cases had sarcomatoid or rhabdoid components. Intravascular tumor emboli were found in five cases. IHC staining showed most tumors expressed PAX8(7/8), CK19(7/8), vimentin (6/8) and P504s(8/8). However, other immunomarkers including CK7, CD10, CD117, RCC, 34βE12, HMB45 and Melan A were all negative. Sequencing showed all three cases had FH gene mutations in exon 1. FISH revealed no TFE3 gene translocation or amplification in the two cases with TFE3 IHC expression. Follow-up data were available in seven patients with the follow-up period from 11 to 66 months. Among them, five patients died between 11 to 31 months after the surgery because of extensive distant metastases of the tumor to the lung, liver and lymph nodes. The other two patients were alive at the 36th and 66th month after the surgery.@*Conclusions@#Morphologically, FH-RCC overlaps with papillary RCC, collecting duct carcinoma and tubular-cystic RCC, showing a mixture of papillary, tubular cystic, cribriform or tubular papillary structures with at least focal large and prominent nucleoli. The negative expression of FH and the detection of FH gene mutation could facilitate the diagnosis of the tumor. FH-RCC is a high aggressive tumor, prone to metastasize, and is associated with poor prognosis. The timely diagnosis of FH-RCC could benefit the patients and their relatives as well.
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Objective@#To investigate the clinicopathological characteristics and prognosis of renal cell carcinoma (RCC) in patients with end-stage renal disease (ESRD).@*Methods@#The clinicopathological data of patients of renal cell carcinoma arising in end-stage renal disease were collected from the Affiliated Hospital of Qingdao University (ten cases) and 971 Hospital of PLA Navy (five cases) from January 2009 to August 2018.@*Results@#Among 15 patients, 14 were male and 1 was female, and the age ranged from 38 to 78 years (mean 51 years, median 49 years). All patients had history of chronic renal failure (7-192 months), including 9 patients treated with hemodialysis for 6 to 132 months. In 12 cases the tumor border was distinct and the tumor size ranged from 1.8 to 11.0 cm. Two cases were multifocal and one case showed extensive renal hemorrhage with an inconspicuous tumor mass. Microscopically, 9 cases were clear cell reanl cell carcinoma including one with sarcomatoid differentiation, 4 were acquired cystic kidney disease-associated(ACKD-RCC) and two were papillary renal cell carcinoma. All patients had a follow-up of 3 to 120 months. Four patients died during a follow-up of 6 to 60 months (mean 30 months) as a result of extensive distant metastases (two cases) and renal failure (two cases), while other eleven patients were alive without tumor recurrence or metastasis (median 40.8 months of follow-up ranging from 3 to 120 months).@*Conclusions@#ESRD-RCC is more often seen in younger male patients. The time intervals from the onset of chronic renal failure to the diagnosis of renal cell carcinoma differ and tumors are frequently incidental findings. The histological types can be sporadic renal cell carcinoma or unique ACKD-RCC. Tumors are often hemorrhagic and necrotic. Routine physical examination and early detection could benefit ESRD-RCC patients. ESRD-RCC may have a favorable prognosis despite of a large tumor size or the presence of sarcomatoid differentiation.
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Objective@#To study the clinicopathologic, immunohistochemical (IHC), histogenetic and prognostic features of acquired cystic kidney disease-associated renal cell carcinoma (ACKD-RCC).@*Methods@#Three cases of ACKD-RCC, including two from 401 Hospital of PLA and one from the Affiliated Hospital of Qingdao University were studied by clinical, histological and IHC analysis with review of relevant literature.@*Results@#All the three patients were male, ranging from 46 to 78 years old. All patients had history of chronic renal failure; two patients were treated with hemodialysis for 9 years and 11 years, respectively. In two cases the tumor sizes were 2.5 cm and 3.5 cm, respectively, and the tumor border was distinct. The remaining case showed extensive renal hemorrhage with an inconspicuous mass. Microscopically, the tumor cells were arranged in cribriform, microcystic or acinar structures, with variable papillary structure in one case. Hemorrhage of varying degrees was seen in all three cases, and obvious necrosis was noted in two. The tumor cells had deeply eosinophilic cytoplasm, indistinct cell border, round or oval nuclei, and prominent nucleoli (WHO/ISUP grade 3). Mitoses were rare. Abundant oxalate crystals were seen in two cases. The renal mesenchyme of all three cases were atrophic with variable cystic changes of the renal tubules, the lining cells showed atypical hyperplasia. IHC staining showed all tumors were diffusely positive for vimentin, CD10, RCC, CAM5.2, P504s and mitochondria in the cytoplasm, and were variably positive for EMA (2/3), CK7 (1/3), CA9 (1/3) and PAX8 (3/3). All cases were negative for CD117, HMB45, Melan A and TFE3. After 3-14 months follow-up, one patient died from renal failure six months after surgery. The other two patients were alive without tumor recurrence or metastasis.@*Conclusions@#ACKD-RCC is a very rare renal cell carcinoma. The specific cribriform structure, deeply eosinophilic cytoplasm, prominent nucleoli (WHO/ISUP grade 3), and oxalate crystals deposition, associated with the history of ACKD could aid the diagnosis. ACKD-RCC arises from the proximal renal tubule and its histogenesis might be associated with proliferation and malignant change of the atypical epithelial cells of the cystic renal tubules. ACKD-RCC may have a favorable prognosis except for tumors with sarcomatoid differentiation.
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Objective To prospectively investigate the changes of hepatic CT perfusion parameters and the correlation with serum amylase (AST,ALT,LDH,SOD,MAD and MPO) in rabbits hepatic warm ischemia-reperfusion injury (WIRI) models undergoing different warm ischemia time.Methods New Zealand rabbits underwent 40 min and 60 min of right posterior lobe ischemia followed by 6 h reperfusion (n =10 each),named as W1,W2 groups respectively.Ten rabbits served as normal controls (W0).All the rabbits were given CT perfusion protocol.The perfusion indices of arterial flow (AF),portal flow (PF),and perfusion index (PI) were measured after obtaining perfusion index maps on the workstation.Blood samples were taken from the rabbit ear vein to measure the levels of ALT,AST,and LDH.The contents of SOD,MDA and MPO in liver tissues were determined,and histopathological changes were examined.Results Significant differences were found between the group W0,W1and W2 in the infarcted areas and non-infarcted areas by PI and AF and PF (P＜0.05),except that in the infarcted areas the AF value betwween the group W0 and W2,the PF value between the group W1 and W2 had no statistical difference,and in the non-infarcted areas the difference of the PI and AF value betwween the group W1 and W2,the PF value between the group W0 and W2 was not significant eihter.In the infracted area,PI and PF of WIRI groups positively correlated with biochemical parameters.AF was not correlated with biochemical parameters.In the non-infracted area,PI,AF was correlated with biochemical parameters,PF was not correlated with biochemical parameters.The PI and PF value could efficiently diagnose rabbit hepatic WIRI in the infarcted area (for PI,AR and PR,AUC=0.965,0.736 and 1.00 respectively),and PI and AF value could efficiently diagnose rabbit hepatic WIRI in the non-infarcted area (for PI,AF and PF,AUC=0.938,0.993 and 0.618 respectively).Conclusion CT perfusion can dynamically monitor the hemodynamic changes after WIRI and may suggest potential microcirculatory disturbances.
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Objective To evaluate the feasibility and diagnostic value of diffusion tensor imaging (DTI) in hepatic warm ischemia-reperfusion injury (WIRI) in rabbits.Methods Fifty healthy adult New Zealand white rabbits were randomly divided into control group (n =10) and four experimental groups (n =10 per group) according to different periods of hepatic warm ischemia.Four experimental groups were given hepatic arteries and portal veins clamp for 10,20,30,40 min respectively and reperfusion for 6 h to establish the rabbit model of hepatic WIRI.The control group was given perihepatic ligament separation but no vessel clamp.All the rabbits were scanned with MAGNETOM Trio Tim 3.0T MRI DTI MR Siemens and the data were collected by Nero 3D Siemens.The apparent diffusion coefficient (ADC),and fractional anisotropy (FA) values were separately measured by 2 qualified radiologists.Then intra class correlation coefficient (ICC) was used to check their consistency and repeatability.The liver function of rabbits was tested after MR examination,and pathologic examination was performed after sacrifice.Spearman correlation analysis was used to evaluate the correlation between ADC value and liver function parameters.The ROC curve was used to evaluate the diagnostic value of ADC value.Results The ADC and FA values of the two observers were consistent,with ICC values of 0.824 and 0.807,respectively.There were significant differences in ADC value between the control group and 4 experimental groups [P =0.000,(1.42 ± 0.15) 10-3mm2/s,(1.34± 0.11) 10-3mm2/s,(1.22 ± 0.20) 10-3mm2/s,(1.19 ± 0.13) 10 3mm2/s,(1.83 ±0.20) 10-3 mm2/s respectively],but there was no significant difference in the FA value among groups (0.40 ± 0.04,0.38 ± 0.03,0.41 ± 0.04 and 0.37 ± 0.04,respectively;P＞0.05).The differences in serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),lactate dehydrogenase (LDH),the total superoxide dismutase (SOD),malondialdehyde (MDA) and myeloperoxidase (MPO) were statistically significant (P＜0.01).There was a negative correlation between ADC value and ALT,AST,LDH,MPO and MDA (P＜0.05),and a positive correlation between ADC value and total SOD (P =0.000).ADC value has a higher diagnostic efficacy to evaluate hepatic WIRI in T1,T2,T3,T4 group and the AUC was 0.985,0.900,0.970 and 0.833 respectively.Conclusion DTI can quantitatively and noninvasively evaluate the changes of liver water molecule diffusion caused by hepatic I/R injury in rabbits,and the ADC value could dynamically evaluate the degree of hepatic WIRI in rabbits.
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Objective@#To investigate the clinicopathologic characteristics, diagnostic features and prognosis of primary renal neuroendocrine carcinoma (NEC). @*Methods@#The clinicopathologic data of eight cases of renal NEC was collected from January 2008 to December 2017 from Affiliated Hospital of Qingdao University. Immunohistochemical staining was performed, and follow-up information was analyzed, and the relevant literature reviewed. @*Results@#The patients′ mean age at diagnosis was 45 years (range, 27-66 years); five were women, and three were men. The tumors located on the left side in five patients, and on the right side in three. Five cases were detected incidentally, and three patients presented with loin pain. Microscopically, these cases included five well-differentiated NECs (three carcinoids, two atypical carcinoids), two small cell NECs, and one large cell NEC according to the World Health Organization classification of 2016. The tumors infiltrated the renal capsule in six cases. Necrosis was found in five cases. Vascular invasion with tumor emboli was seen in three cases. Lymph node metastasis was identified in one case. Immunohistochemically, the expression rates of neuroendocrine markers CD56, chromogranin A (CgA) and synaptophysin (Syn) were 6/8, 4/8, and 8/8 respectively. Some of the NECs were positive for epithelial markers CKpan (6/8, with three cases showing focal positivity) and CAM5.2 (4/8) of variable degrees. The Ki-67 proliferation index was≤3% in the carcinoids; ≥50% in the small cell carcinoma and large cell carcinoma; and 5% and 8% for the two cases of atypical carcinoid, respectively. All cases were negative for EMA, CK7, CA9, CD10, CD117, PAX2, PAX8, WT1, p63, S-100 and TTF1. Three patients (two with small cell carcinoma and one with large cell carcinoma) died of extensive metastases at 3 months, 4 months and 9 months after operation, while five patients were well, without recurrence or distant metastasis for follow-up period of one to nine years. @*Conclusions@#Primary renal NEC is rare. Carcinoid is the most common histological type. The pathomorphological features and neuroendocrine markers (CD56, CgA, Syn), epithelial markers (CKpan, CAM5.2) and nephrogenic markers (PAX2, PAX8) are important for the diagnosis. Renal carcinoid tumors are indolent and prone to early metastasis, but are associated with prolonged survival. The small cell renal cell carcinoma and large cell carcinoma are highly malignant renal tumors with poor prognosis and short survival.
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Objective To investigate the prevalence of chronic kidney disease (CKD) in hospitalized patients with essential hypertension (EH) and analyze the related risk factors.Methods A retrospectivc analysis of chronic kidney disease and its influencing factors was taken from March 2014 to March 2015 in the Second Affiliated Hospital of Nanjing Medical University.People were diagnosed EH patients (1 020 cases).Results (1) The detection rates of proteinuria,estimated glomerular filtration rate (eGFR) and CKD in patients with EH were 22.3％,13.3％,and 26.1％,respectively.The ratio of CKD in male and female was 26.8％ vs 25.5％ (P＞0.05);(2) With the increase in systolic blood pressure levels (as the systolic blood pressure increased 20 mmHg),the constituent ratio of CKD increased with statistically significant difference (P ＜ 0.05);(3) The risk factors of essential hypertension complicated with chronic kidney disease were high uric acid,the history of diabetes,SBP ≥ 140 mmHg and the age (OR =2.682,2.224,1.932,1.065).Conclusions The detection rate of CKD in patients with hypertension in was high,and the blood pressure,blood glucose,and serum uric acid should be controlled to prevent and delay the occurrence and development of CKD.
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Objective To investigate the prevalence of chronic kidney disease (CKD) in hospitalized patients with essential hypertension (EH) and analyze the related risk factors.Methods A retrospectivc analysis of chronic kidney disease and its influencing factors was taken from March 2014 to March 2015 in the Second Affiliated Hospital of Nanjing Medical University.People were diagnosed EH patients (1 020 cases).Results (1) The detection rates of proteinuria,estimated glomerular filtration rate (eGFR) and CKD in patients with EH were 22.3％,13.3％,and 26.1％,respectively.The ratio of CKD in male and female was 26.8％ vs 25.5％ (P＞0.05);(2) With the increase in systolic blood pressure levels (as the systolic blood pressure increased 20 mmHg),the constituent ratio of CKD increased with statistically significant difference (P ＜ 0.05);(3) The risk factors of essential hypertension complicated with chronic kidney disease were high uric acid,the history of diabetes,SBP ≥ 140 mmHg and the age (OR =2.682,2.224,1.932,1.065).Conclusions The detection rate of CKD in patients with hypertension in was high,and the blood pressure,blood glucose,and serum uric acid should be controlled to prevent and delay the occurrence and development of CKD.
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Objective@#To analyze the prognostic significance of TP53, Bcl-2, Bcl-6, Myc proteins expression by immunohistochemical method (IHC) in diffuse large B cell Lymphoma (DLBCL) .@*Methods@#Clinical and pathologic data of 223 patients with DLBCL hospitalized in Zhejiang First Hospital from March 2009 to June 2015 were retrospectively analyzed.@*Results@#The 223 cases, a median age of 56 years old with a male predominance, had shown a 39.0% of TP53 positive expression, 38.6% of Myc, 69.1% of Bcl-2, 56.5% of Bcl-6, and 22.7% of Myc/Bcl-2 double expression. According to Hans’ classification, 27.4% were GCB and 72.6% were non-GCB. With a median follow-up of 38 (2-97) months, the 3 and 5 years survival rates were 70% and 66% , respectively. By multivariate analysis, TP53 over-expression and Myc/Bcl-2 double expression were independently associated with poor outcomes. 3-year and 5-year overall survival were 59% and 57% for patients with TP53 positive, 77% and 71% for patients with TP53 negative expression. Patients with non-GCB subtype receiving chemotherapy combined with rituximab had a higher OS than those without rituximab. But rituximab did not improve the prognosis of patients with TP53 positive.@*Conclusion@#Myc/Bcl-2 double expression and TP53 over-expression are poor prognosis for DLBCL patients. Patients with Myc/Bcl-2 double expression have shorter OS. Patients with non-GCB subtype who received chemotherapy combined with rituximab have a better OS than those without rituximab. But rituximab does not improve the prognosis of patients with TP53 positive.