Tumoral calcinosis on thigh in a hemodialysis patient and literature review / 中华肾脏病杂志

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Clinicopathological features of diffuse pulmonary meningotheliomatosis / 中华病理学杂志

Objective@#To study the clinicopathological characteristics, immunophenotype, pathologic diagnosis and differential diagnosis of diffuse pulmonary meningotheliomatosis (DPM).@*Methods@#The clinical data, histological features and immunohistochemical results of three cases of DPM collected from January 2016 to May 2018 at Guangdong Provincial People′s Hospital were analyzed, and the relevant literature reviewed.@*Results@#The three DPM patients age was 53, 69 and 74 years. The lesions consisted of multiple minute pulmonary meningothelial-like nodules profusely involving the lungs. Microscopically, they showed typical morphology, characterized by medium-sized elongated tumor cells resembling meningothelial cells with whorled/nested clusters. The cells were uniform and had abundant eosinophilic cytoplasm with oval nuclei with delicate chromatin. Immunohistochemical staining showed tumor cells were diffusely and strongly positive for EMA, vimentin and PR, but were negative for CAM5.2, CgA, Syn, CK7 and TTF1.@*Conclusions@#DPM is extremely rare, and may be confused with primary interstitial pulmonary processes and metastatic malignant tumors of lung. Recognition of this entity is essential for pathologists to avoid misdiagnosis and unnecessary treatment.

Clinicopathologic features of myxoid adrenocortical adenomas / 中华病理学杂志

Objective@#To study the clinicopathologic characteristics, immunophenotype, pathologic diagnosis and differential diagnosis of myxoid adrenocortical adenomas.@*Methods@#The clinical data, histological features and immunohistochemical results of 4 cases of myxoid adrenocortical adenomas were analyzed, which were collected from January 2014 to December 2016 at Guangdong General Hospital, with review of literature.@*Results@#Four cases of myxoid adrenocortical adenomas were presented. The patients ages ranged from 26 to 45 years (mean =35 years). Microscopically, it showed a typical morphology, characterized by small-sized tumor cell cords or pseudo-glands embedded in an abundant extracellular myxoid matrix. Immunohistochemical staining showed tumor cells were strongly positive for Melan A, vimentin and focally for α-inhibin, one case showed strong and diffuse positivity for CAM5.2, and two cases showed diffuse positivity for synaptophysin, while negative for CgA, S-100 protein, epithelial antigen, CK7, CK20 and CKpan.@*Conclusions@#Myxoid adrenocortical adenomas are extremely rare, which may cause confusion with metastatic well-differentiated neuroendocrine tumours, sex cord-stromal tumoursor metanephric adenoma. Recognition of this entity would be beneficial for pathologists to avoid misdiagnosis, and unnecessary treatment.

Influence of Xingnaojing injection on levels of NO ,IGF-1 ,MIF and it therapeutic effect in patients with hypertensive cerebral hemorrhage / 心血管康复医学杂志

Objective :To explore influence of Xingnaojing injection on levels of nitric oxide (NO) ,insulin-like growth fac-tor 1 (IGF-1) ,macrophage migration-inhibitory factor (MIF) and its therapeutic effect in patients with hypertensive cere-bral hemorrhage (HCH).Methods :A total of 96 HCH patients treated in our hospital were selected .According to random number table ,they were randomly and equally divided into routine treatment group and Xingnaojing group ,both groups were treated for two weeks .Levels of serum inflammatory factors ,NO ,IGF-1 ,MIF and United states national institutes of health stroke score (NIHSS) before and after treatment ,and therapeutic effect were compared between two groups .Re-sults :Compared with before treatment ,after treatment ,there were significant reductions in levels of CRP ,TNF-α ,IL-6 , MIF and NIHSS score ,and significant rise in levels of NO and IGF-1 in two groups ,P＝0.001 all ;compared with routine treatment after treatment ,there were significant reductions in levels of CRP [ (18.59 ± 4.90) mg/L vs.(12.48 ± 2.56) mg/L] ,TNF-α [ (29.45 ± 5.80) μg/ml vs.(23.02 ± 6.89) μg/ml] ,IL-6 [ (97.56 ± 21.25) μg/ml vs.(88.56 ± 20.12) μg/ml] ,MIF [(50.78 ± 4.90) ng/L vs.(42.02 ± 6.12) ng/L] and NIHSS score [(7.45 ± 2.23) scores vs.(5.12 ± 1.23) scores] ,and significant rise in levels of NO [ (43.56 ± 5.88) μmol/L vs.(50.46 ± 6.39) μmol/L] and IGF-1 [ (55.78 ± 6.03) nmol/L vs.(61.56 ± 8.02) nmol/L] in Xingnaojing group , P＜0.05 or ＜0.01. After treatment ,total effective rate of Xingnaojing group was significantly higher than that of routine treatment group (93.75% vs.72.92%,P＝0.006). Conclusion : Xingnaojing injection can significantly reduce inflammation level ,improve cerebral neurological function and clinical therapeutic effect in HCH patients .

The analysis of seeking behavior and medical expenses for diabetic outpatients of New Rural Cooperative Medical Scheme in eastern areas of China / 中国卫生政策研究

Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme,and provide suggestions and theoretical basis for the implementation and pro-motion of hierarchical medical policy systems.Methods:In this study,13 counties in the eastern part of China were selected.By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013,the diabetes mellitus were divided in-to two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense,the average cost,the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed.Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010.Outpatient medical expenses varied widely between pa-tients with and without complications and the higher the level,the greater the difference between the two.At the first-class,secondary-and tertiary-level institutions,the average expenses per time of diabetes mellitus with complications were 2.50,3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pock-et expenses per time were 2.62,3.66 and 3.96 times higher than the latter respectively.Conclusions:From 2009 to 2013,the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications.Compared with outpatients without complications,patients with complications face up to a larger direct-economic burden of disease.The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened,and the distribution of pa-tient needs to be reasonably led to enhance the service quality and ability of preventing,treating and controlling dia-betes and complications,and to guide patients with diabetes to seek medical treatment in primary healthcare institu-tions.

A Special Electroencephalography Pattern Might Help in the Diagnosis of Antibody-positive Encephalitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patterns observed with electroencephalography (EEG) for patients who have encephalitis are usually known as generalized nonspecific cerebral abnormalities. The aim of this study was to investigate the presence of a special EEG pattern for patients with encephalitis and to explore features related to this special and uncommon pattern.</p><p><b>METHODS</b>EEG monitoring was performed for every patient aged >15 years with encephalitis who was hospitalized between December 2011 and March 2014. Clinical characteristics and EEG recordings were collected and evaluated.</p><p><b>RESULTS</b>Fifty-two patients with encephalitis were enrolled in our study with a 2-h median EEG recording time, and extreme beta brushes (EBBs) occurred in 17 patients (32.7%). Its presence was not significant regarding gender, age, psychiatric medication use, EEG rhythmic disorganization (P > 0.05). Nevertheless, among the patients with EBBs, nine patients (52.9%) had epileptic seizures that had a significant detection rate (P < 0.05); moreover, the cerebrospinal fluid (CSF) or serum of 15 patients (88.2%) with EBBs was positive for antibodies (P < 0.05). Four patients (23.5%) who had EBB had corresponding regional distributions on neuroimaging scans. The EBBs completely correlated with the regional distributions of spike discharges for four patients.</p><p><b>CONCLUSION</b>EBB is a special EEG pattern for patients with encephalitis, especially those with epileptic seizures or who have antibody-positive CSF/serum, and should be considered in clinical practice.</p>

Renal expression of RANK-RANKL in a rat model of puromycin aminonucleoside nephropathy / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN).</p><p><b>METHODS</b>Thirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.</p><p><b>RESULTS</b>The PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group.</p><p><b>CONCLUSION</b>The PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.</p>

Accuracy of liquid-based cytology in diagnosis of high-grade squamous cervical intraepithelial neoplasia / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate factors affecting the diagnostic accuracy of cervical liquid-based cytology for high-grade squamous intraepithelial lesion (HSIL).</p><p><b>METHODS</b>A retrospective evaluation of cytological and histological slides was performed in 415 patients who had cytological HSIL between 2007 and 2010.</p><p><b>RESULTS</b>Among 42 209 cases screened by ThinPrep liquid-based cytology, 415 cases (1.0%) of HSIL were eventually identified. The mean age of HSIL patients was 41.6 years, and 30-49 years were the most common age group. Among 415 cases, 325 patients had available histological diagnosis as follows: 23 (7.1%) negative, 22 (6.8%) CIN1/HPV, 223 (68.6%) CIN2/CIN3, and 57 (17.5%) squamous cell carcinoma (SCC). The positive predictive values of HSIL to predict CIN2 (or higher grade of dysplasia) and CIN1 were 86.2% (280/325) and 92.9% (302/325), respectively. Inadequate biopsy, reactive glandular cells, islet atrophy, chemo/radiotherapy and others were responsible for the cytologically false-positive diagnosis. Fifty-seven (17.5%) cases of HSIL had a histological diagnosis of SCC. The possible causes of misdiagnosis were social factors, under-recognized cytological features of poorly-differentiated SCC and absence of typical diagnostic features in cytology slides.</p><p><b>CONCLUSIONS</b>Cytology of HSIL has a high positive predictive value for the presence of CIN2/CIN3 and SCC. Cytologists and gynecologists should be aware of the diagnostic pitfalls that may lead to the discrepancy between cytology and histology.</p>

Renal Behcet's disease: a report of one case, with literature review / 中华风湿病学杂志

Objective To analyze the clinical features of renal involvement associated with Behcet's disease (BD) through 1 case and to make a review of the literature in order to early diagnose and cure in time,thus decrease misdiagnosis and mistreatment.Methods This is a retrospective study.The case was diagnosed with BD and the renal damage was confirmed by renal biopsy.The clinical features and histology features were analyzed.Results The presentation of renal disease was edema,proteinuria and microscopic hematuria.The clinical spectrum of renal BD showed a wide variation.Amyloidosis (AA type),GN (nephritis),and microscopic vascular disease were the main causes of renal BD.Patients with vascular involvement had a high risk of amyloidosis and amyloidosis was the most common cause of renal failure in BD.Conclusion Kidney is one of the organs that can alter the prognosis of the BD,so the screening for renal damage must be done for each patient with this disease.Routine urine analysis and measurement of serum creatinine level are needed for early diagnosis of renal BD.Immunosuppressive drugs can be useful in selected cases.

Immunohistochemical study of tumor necrosis factor-alpha expression in the lungs and small intestines in hyperthermia-LPS co-stressed rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of co-exposure to hyperthermia and lipopolysaccharides (LPS) on tumor necrosis factor-alpha (TNF-alpha) expression in the lungs and small intestines of rats.</p><p><b>METHODS</b>Male pathogen-free Wistar rats were randomly assigned into saline-injected normothermic control (C), saline heat exposure (H), LPS normothermic control (L), and LPS plus heat exposure (HL) groups. The rats in H and HL groups were exposed in a chamber at an ambient dry bulb temperature (Tdb) of 35.0-/+0.5 degrees celsius;, and those in C and L groups to 26-/+0.5 degrees celsius;. In L and HL groups, the rats were given an intravenous injection of LPS 10 mg/kg via the tail vein to induce endotoxemia, and those in C and H group received 10 ml/kg injection. The plasma levels of sTNFrI and sTNFrII were detected at different time points using ELISA. The expression of TNF-alpha in the lungs and small intestines was detected by immunohistochemical SABC method, and the damage of the lungs and small intestines evaluated histologically 120 min after the treatment.</p><p><b>RESULTS</b>Co-exposure to hyperthermia and LPS caused significantly enhanced expressions of TNF-alpha and its receptor sTNFrI and sTNFrII in the plasma and tissues and obvious histopathological damage in the lung and small intestines.</p><p><b>CONCLUSION</b>Co-stress of hyperthermia and LPS-induced toxicity is associated with the expression of TNF-alpha in the lung and small intestines.</p>

Analysis of diagnosis accuracy of frozen sections in 73 cases of borderline tumor of ovary / 中华病理学杂志

<p><b>OBJECTIVE</b>To assess the sensitivity and positive predictive value (PPV) of intraoperative frozen section diagnosis of the borderline tumor of ovary (BTO).</p><p><b>METHODS</b>A retrospective analysis and comparison were done respectively between the accuracies of diagnoses made by using frozen and paraffin sections from the same tissue blocks for BTO from March 1995 to May 2008 achieved in the Department of Pathology, Guangdong General Hospital. Univariate and multivariate regression models were used to assess the influence of patient and tumor characteristics on the likelihood of underdiagnosis and overdiagnosis.</p><p><b>RESULTS</b>Of the 73 patients analyzed, 39 cases (53.42%) were histologically serous tumors, 32 (43.84%) were mucinous and 2 (2.74%) were endometrioid tumors. Diagnoses identical in those made by using either frozen or routine paraffin sections were 55/73 (75.34%). The sensitivity and positive predictive value of frozen section diagnosis were 87.30% and 85.94%, respectively. Underdiagnosis of frozen section were 18/73 (24.66%). There was no overdiagnosis cases obtained. Univariate analysis showed that tumor diameter and tumor histology were the predictors of underdiagnosis in frozen section analysis. And in multivariate analysis, only tumor diameter, rather than patient age, tumor histology and stage, bilateral side tumor, serum CA-125 and concurrent presence of endometriosis was a predictor of underdiagnosis.</p><p><b>CONCLUSIONS</b>Intraoperative frozen section diagnosis of BTO has a low sensitivity and PPV. Underdiagnosis is not uncommon. Surgical management based on intraoperative frozen section diagnosis should be used with caution.</p>

Significance of high-risk human papillomavirus DNA in atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore significance of high-risk human papillomavirus (HR-HPV) testing in atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H).</p><p><b>METHODS</b>Presence of HR-HPV DNA was examined in 45 patients with ASC-H using hybrid capture II (HC-II) test. Colposcopic examination and biopsy were taken all results were evaluated.</p><p><b>RESULTS</b>Overall, 33 of 45 (73.3%) ASC-H cases were biopsy proven cervical intraepithelial lesion (CIN). 36 of 45 ASC-H cases were HPV-DNA positive, including 19 cases of HSIL and over lesion; whereas no HSIL or over was found in 9 HR-HPV negative cases. Sensitivity and negativity predictive value of HR-HPV in ASC-H with HSIL and over lesion were both 100%.</p><p><b>CONCLUSIONS</b>ASC-H strongly predicts the presence of HSIL, HR-HPV may serve as a predict select whether a patient with ASC-H should take colposcopic examination immediately, patients with positive HR-HPV should undergo immediate colposcopic examination, while negative HR-HPV is an excellent predictor of the absence of HSIL.</p>

Immunohistochemical study of TNF-alpha expression in the kidney of rats with lipopolysaccharide and heat stresses / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of co-exposure of LPS and heat on TNF-alpha expression in rat kidneys.</p><p><b>METHODS</b>Male pathogen-free Wistar rats were randomly assigned in saline-injected normothermic control (C group), saline-injected heat exposure (H group), LPS-injected normothermic control (L group), and LPS-injected heat exposure (HL group). The rats in H and HL groups were exposed in a chamber at an ambient dry bulb temperature (Tdb) of 35.0-/+0.5 degrees, and those in C and L groups were exposed to a Tdb of 26-/+0.5 degrees. The rats in L and HL groups were given an intravenous injection of LPS (10 mg/kg) via the tail vein to induce endotoxemia, and equivalent normal saline was injected in C and H groups. TNF-alpha expression in the kidney was detected by immunohistochemical SABC method, and the renal damage was evaluated histologically at 120 min after the treatment.</p><p><b>RESULTS</b>Co-exposure of the rats with LPS and heat caused significantly enhanced TNF-alpha expression and histopathological damage in the kidneys.</p><p><b>CONCLUSION</b>LPS combined with heat exposure causes renal toxicity, while is closely associated with the expression of TNF-alpha in the kidneys.</p>

Effect of pAdKDR-tk suicide gene system on tumor vascular endothelial cells in nude mice with nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the therapeutic effect of pAdKDR-tk suicide gene system on tumor vessel endothelium cells (VEC) of human NPC in nude mice.@*METHOD@#Sixteen nude mice with transplantation tumor were randomized into AdKDR tk/GCV group and AdKDR-tk/PBS group, with 8 in each group. The tumor size changes and histomorphology were observed before and after treatment. Immunohistochemistry was used to detect the tumor microvessel density and VEGF expression.@*RESULT@#There's significant difference among the gross tumor volume of groups after experiment. The tumor volume in control group grew continuously and rapidly, while for the AdKDR-tk/GCV treatment group, tumor grew slowly at the first 6 days, and the tumor growth was inhibited after the 6th day, then the transplantation tumor volume gradually grew smaller. Tumor volume in treatment group was significantly smaller than that of control group after the 6th day, the 9th day and the 14th day (P<0.01). HE staining morphological observation that there's no significant difference in cell morphology of NPC between the two groups, but large amount of necrobiosis focus were found among tumor tissue. The MVD mean value of CD34 in control group was 6.63+/-1.41, with 3.50+/-0.93 of the treatment group. The statistics results demonstrated significant difference of vessel density around tumors between groups (P<0.05). The VEGF positive expression in control group was higher than that in treatment group, with significant difference of VEGF expression between two groups.@*CONCLUSION@#Adenovirus (ADV) mediated KDR promoter single herpes simplex virus thymidine kinase (AdKDR-tk)/GCV system could effectively inhibit vascular proliferation in tumors, thus inhibit the tumor growth in nude mice with NPC.

Diagnostic value of p16INK4a in squamous intraepithelial lesion in gynecologic cytology / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the diagnostic value of p16(INK4a) in squamous intraepithelial lesion in gynecologic cytology and its relationship with types of human papillomavirus (HPV).</p><p><b>METHODS</b>88 liquid-based gynecologic cytology cases with histologic correlation, including 20 cases of cervicitis, 18 cases of low-grade squamous intraepithelial lesion (LSIL), 34 cases of high-grade squamous intraepithelial lesion (HSIL) and 16 cases of squamous cell carcinoma (SCC), were enrolled into the study. Immunocytochemistry for p16(INK4a) protein and polymerase chain reaction-based HPV DNA testing (for HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68, as well as HPV types 6, 11, 42, 43 and 44) were performed.</p><p><b>RESULTS</b>The rate of expression of p16(INK4a) protein was 0, 27.8%, 100% and 100% in the cervicitis group, LSIL group, HSIL group and SCC group, respectively. The expression was significantly higher in the latter 3 groups than that in the cervicitis group (P < 0.01). Besides, the expression was significantly higher in cases associated with high-risk HPV genotypes (96.4%) than in cases associated with low-risk HPV genotypes (7.7%).</p><p><b>CONCLUSION</b>p16(INK4a) is a valuable biomarker for detection of HPV-related dysplastic squamous cells, with high sensitivity and specificity.</p>

Immunohistochemical study of RET protein in Hirschsprung's disease and allied Hirschsprung's disorder / 中华儿科杂志

<p><b>OBJECTIVE</b>Hirschsprung's Disease (HD) and allied Hirschsprung's disorder (HAD) have very similar clinical manifestations, but there are many different theories about the two diseases. The present study was designed to understand the expression of Ret protein in HD and HAD, and to explore the role of Ret protein in the pathogenesis of HD and HAD.</p><p><b>METHODS</b>Colon specimens from patients with confirmed HD and HAD, including 15 cases of HD (male 12, female 3) and 11 cases of HAD (male 8, female 3) were collected for this study. At the same time normal colon specimens from 10 individuals with other diseases were used as control. The expression of Ret protein in the intestinal tissue was detected by using immunohistochemical SABC technique with mouse anti-Ret monoclonal antibody.</p><p><b>RESULTS</b>In the colon specimens from normal controls and the dilated segments of colon from HD and HAD patients, moderate to large number of Ret-positive cells were observed among the ganglion cells of myenteric plexuses and submucosal plexuses (P > 0.05). On the contrary, Ret-positive cells were not seen in the stenotic segment of colon from HD patients. But there was positive staining in the stenotic segment of the colon from HAD. Moreover, giant ganglion cells showing strongly positive staining could be seen. There were also displastic cells, small cells, and cells with irregular shape. Statistical analysis showed significant differences in Ret cells positivity between the stenotic segment of colon of HD and the normal control (P < 0.001) as well as between HD and HAD (P < 0.001).</p><p><b>CONCLUSION</b>Ret protein may play an important role in the pathogenesis of HD and could not have definite relationship with HAD.</p>