Role of Macrophage Polarization in Chronic Low-grade Inflammation of PCOS Based on Theory of Spleen Being in Charge of Defensive Function / 中国实验方剂学杂志

Polycystic ovary syndrome （PCOS） is a reproductive endocrine disorder characterized by coexisting reproductive dysfunction and glucolipid metabolic disturbance， affecting 8%-13% of women of reproductive age and 3%-11% of adolescent females. Due to the highly heterogeneous clinical features， symptom-oriented individualized strategies are commonly adopted for the treatment of PCOS. Chronic low-grade inflammation is one of the core mechanisms for the occurrence of PCOS. Macrophages， as foundational cells of innate immunity， play an indispensable role in modulating systemic inflammatory responses. The imbalance of macrophage M1/M2 polarization is involved in chronic low-grade inflammation in PCOS via pathways such as activating pro-inflammatory responses， disrupting ovarian tissue repair， stimulating excessive synthesis of androgens， and promoting the occurrence of insulin resistance. Reshaping the phenotype of macrophages might serve as a potential therapeutic strategy for PCOS. Traditional Chinese medicine （TCM） holds that spleen deficiency and phlegm dampness is a crucial pathogenesis of PCOS. The spleen， being in charge of defensive function， plays a key role in ensuring normal physiological functions such as transportation and defense against external pathogen during the occurrence and development of PCOS. The imbalance of macrophage polarization resembles the transition from spleen being in charge of defensive function to spleen losing its defensive role in TCM. Therefore， this paper， for the first time， explores the deep connection between macrophage polarization and the pathogenesis of chronic low-grade inflammation in PCOS from the TCM theory of spleen being in charge of defensive function， providing theoretical support and new research directions for the treatment and drug research of PCOS.

Biphenotypic sinonasal sarcoma—A recently described entity with many mimics: A case report

Biphenotypic sinonasal sarcoma (BSNS) is a recently described, low-grade, slow-growing sarcoma with neural and myogenic features with exclusive location in sinonasal track and characteristic PAX3- MAML3 gene fusion. Differentiating this tumor from its commoner mimics needs knowledge of this entity to avoid over treatment. This tumor has unique morphology, clinical course, and genetics. We report this in a 47-year-old female who was diagnosed with such a rare, solitary fibrous tumor—hemangiopericytoma (HPC-SFT) on limited initial biopsy. On subsequent excision, typical morphology and immunohistochemistry helped to clinch the diagnosis.

Reconstrucción de aparato extensor en sarcoma fibromixoide de bajo grado en rodilla: reporte de caso

Introducción: El sarcoma fibromixoide de bajo grado es una tumoración maligna con alto riesgo de desarrollar recurrencia y metástasis, siendo la resección quirúrgica con márgenes amplios el tratamiento principal, la preservación de la extremidad y su reconstrucción es de alta demanda para los cirujanos. Reporte de caso: Presentamos el caso de una mujer de 67 años con recurrencia de tumoración en rodilla desde hace 12 meses, operado dos años antes. Se realizo resección oncológica de tumoración con reconstrucción de articulación de rodilla con prótesis Endo Model y reconstrucción de aparato extensor con injerto sintético de malla de polipropileno más autoinjerto de semitendinoso y gracilis. La patela se reconstruyó con autoinjerto de cóndilo femoral posterior. A los 16 meses de seguimiento la paciente se encuentra libre de enfermedad, con puntaje de 27 en la escala para miembro inferior de la MSTS (Musculoskeletal Tumour Society). Conclusión: La combinación de injerto sintético con autoinjerto de isquiotibiales puede disminuir la tasa de falla de la reconstrucción del aparato extensor por resecciones oncológicas.

Introduction: Low-grade fibromyxoid sarcoma is a malignant tumor with a high risk of developing recurrence and metastasis, surgical resection with wide margins is the main treatment, limb preservation and reconstruction is in high demand for surgeons. Case of report: We present the case of a 67-year-old woman with a recurrence of a knee tumor that had been operated on two year earlier. Oncological resection of the tumor was performed with reconstruction of the knee joint with an Endo Model prosthesis and extensor mechanism reconstruction with a synthetic polypropylene mesh graft plus a semitendinosus and gracilis autograft. The patella was reconstructed with posterior femoral condyle autograft. At 16 months of patient follow-up, she is free of disease, with a score of 27 on the lower limb scale of the MSTS (Musculoskeletal Tumor Society). Conclusion: The combination of synthetic graft with hamstring autograft can reduce the failure rate of extensor mechanism reconstruction due to oncological resections.

Concordancia de los hallazgos citológicos, colposcópicos e histológicos en lesiones premalignas del cuello uterino / Concordance in cytological, colposcopic and histological findings in premalignant lesions of the cervix

Resumen OBJETIVO: Determinar la concordancia de los hallazgos citológicos, colposcópicos e histopatológicos en lesiones premalignas del cuello uterino. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo y comparativo, efectuado en la Clínica de Displasias del Hospital General Regional 1 del estado de Querétaro, México, del 1 de enero a diciembre del 2020, con base en la información de los expedientes de mujeres con reporte citológico, colposcópico e histopatológico (biopsia) de lesión intraepitelial de bajo y alto grado. El plan de análisis estadístico incluyó intervalos de confianza para promedios y porcentajes. Se utilizó el Índice de Kappa ponderado para conocer el nivel de concordancia. RESULTADOS: Se analizaron 290 expedientes. La edad promedio de las pacientes fue 36 años, el índice de kappa ponderado fue k = 0.41 (IC95%: 0.33-0.53) para la citología y la colposcopia con un valor moderado (regular). Para la citología y la biopsia fue de k= 0.33 (IC95%: 0.22-0.49) con un valor escaso (medio). En cuanto a la colposcopia y la biopsia fue de k = 0.61 (IC95%: 0.49-0.72) con un valor de buena (sustancial) concordancia. CONCLUSIÓN: Entre la citología y la colposcopia el coeficiente de concordancia fue moderado, para la citología y la biopsia fue escaso, mientras que para la colposcopia y la biopsia fue un sustancial.

Abstract OBJECTIVE: To determine the concordance in cytologic, colposcopic and histopathologic findings in premalignant lesions of the uterine cervix. MATERIALS AND METHODS: Cross-sectional, retrospective and comparative study, carried out in the dysplasia clinic of the Hospital General Regional 1 of the state of Querétaro, Mexico, from January 1 to December 2020, based on information from the records of women with cytology, colposcopy and histopathology (biopsy) report with low- and high-grade intraepithelial lesion. The statistical analysis plan included confidence intervals for averages and percentages. The weighted Kappa Index was used to determine the level of concordance. RESULTS: Two hundred and ninety records were analyzed. The mean age of the patients was 36 years, the weighted kappa index was k = 0.41 (95%CI: 0.33-0.53) for cytology and colposcopy with a moderate value (fair). For cytology and biopsy, it was k= 0.33 (95%CI: 0.22-0.49) with a poor value (medium). For colposcopy and biopsy, it was k = 0.61 (95%CI: 0.49-0.72) with a value of good (substantial) agreement. CONCLUSION: Between cytology and colposcopy the concordance coefficient was moderate, for cytology and biopsy it was poor, while for colposcopy and biopsy it was a substantial.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study

Abstract BACKGROUND: Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. OBJECTIVES: Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. DESIGN AND SETTING: This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. METHODS: We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. RESULTS: We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. CONCLUSION: This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Large mucinous tubular and spindle cell carcinoma of left kidney: a case report / 中华泌尿外科杂志

In November 2019, we received and treated a patient with MTSCC of the left kidney. The tumor was located at the upper pole of the left kidney, with a size of 23.3 cm×18.0 cm×21.8 cm. She underwent transperitoneal radical nephrectomy. There was no local recurrence or distant metastasis during the follow-up of 3 years and 2 months. MTSCC of the kidney is a rare subtype of renal carcinoma, with slower disease progression, a clear and smooth rim, and fewer invasion or metastasis. Its final diagnosis should depend on pathology examination. Surgical treatment is the only effective intervention for this disease at present.

Sarcoma del estroma endometrial de bajo grado

El sarcoma del estroma endometrial es una neoplasia maligna poco frecuente que se origina en el estroma endometrial. Puede tener varias formas de diferenciación, entre ellas del músculo liso y del cordón sexual. El sarcoma del estroma endometrial de bajo grado es un tipo de tumor endometrial raro, que constituye solo el 0,2% de todas las neoplasias uterinas. Su etiología es desconocida, pero algunos casos se asocian con obesidad, síndrome de ovario poliquístico, diabetes mellitus, menarquia temprana y terapia de sustitución de estrógenos o al tamoxifeno. La sintomatología es inespecífica, varía desde el dolor pélvico hasta el sangrado genital anormal progresivo y es difícil de reconocer por las imágenes radiológicas. En la mayoría de los casos, el diagnóstico se realiza mediante una evaluación anatomopatológica. La tinción inmunohistoquímica también puede ayudar a diferenciarlo de otras neoplasias. Por lo tanto, es importante tener un alto índice de sospecha para este tipo de neoplasia rara. Su tratamiento es quirúrgico y su seguimiento debe ser a largo plazo, debido al alto riesgo de recidivas tardías y metástasis. Se presenta un caso de sarcoma estromal endometrial de bajo grado.

Endometrial stromal sarcoma is a rare malignant neoplasm that originates in the endometrial stroma. It can have several forms of differentiation, including smooth muscle and sex cord. Low-grade endometrial stromal sarcoma is a rare type of endometrial tumor, constituting only 0.2% of all uterine neoplasms. Its etiology is unknown, but some cases are associated with obesity, polycystic ovary syndrome, diabetes mellitus, early menarche, and estrogen replacement therapy or tamoxifen. Symptomatology is nonspecific, ranging from pelvic pain to progressive abnormal genital bleeding, and is difficult to recognize by radiological imaging. In most cases, the diagnosis is made by pathological evaluation. Immunohistochemical staining can also help differentiate it from other neoplasms. Therefore, it is important to have a high index of suspicion for this type of rare neoplasm. Its treatment is surgical and its follow-up should be long term, due to the high risk of late recurrences and metastasis. A case of low-grade endometrial stromal sarcoma is presented.

Mucinous appendiceal neoplasms and pseudomyxoma peritonei: Morphological and clinical findings, differential diagnosis, and prognosis

Background: Low-grade appendiceal mucinous neoplasms (LAMN) of the appendix have bland cytological features and well-differentiated morphology. Despite this, they may cause a pseudomyxoma peritonei (PMP) disease characterized by mucinous deposits in the peritoneal cavity and may exhibit malignant behavior. Aims and Objectives: In this study, we evaluated the clinical course and histopathological findings of LAMN. The rate of progression to PMP, factors affecting its development, and the clinical course of cases with PMP were investigated. Materials and Methods: Twelve thousand and forty-seven cases who underwent appendectomy were reviewed, and 71 mucinous lesions cases whose slides are in our archive were included in the study. Histopathological findings were re-evaluated. Morphological findings that guide the differential diagnosis, the clinical course of the patients, and factors affecting PMP development were determined. Results: The cases were divided into group 1 non-neoplastic (9.9%), group 2 benign (18.3%), group 3 LAMN (60.6), and group 4 malignant neoplasms (11.3%). Age, gender, appendix diameter, gross appearance, epithelial characteristics, and presence of microcalcification were significantly different between the patient groups. The presence of mucin in the ileocecal region was found to be significant in the development of PMP. It was observed that the additional procedure performed after the appendectomy did not prevent a recurrence. Conclusion: LAMNs are lesions with characteristic findings and different behaviors. The only method to distinguish from the lesions included in the differential diagnosis is to interpret the histopathological findings correctly. Additional operations after appendectomy do not contribute to preventing recurrence.

Pediatric-type diffuse low grade gliomas: Histomolecular profile and practical approach to their integrated diagnosis according to the WHO CNS5 classification

Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Department of Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Advances in Study on Role of Food Intolerance in Pathogenesis of Irritable Bowel Syndrome / 胃肠病学

At present，many studies showed that food intolerance (FI) is one of the important factors for the occurrence and aggravation of irritable bowel syndrome (IBS). The FI in IBS patients is related to low grade inflammation of intestine. Fermentable oligo‑，di‑，monosaccharides and polyols (FODMAPs) diet can improve the symptoms of IBS and provide a new idea for exploring the pathogenesis and treatment of IBS. This article reviewed the advances in study on role of FI in pathogenesis of IBS.

A case of pseudomyogenic hemangioendothelioma misdiagnosed as low-grade malignant fibrous histiocytoma and review of literature / 中南大学学报(医学版)

Pseudomyogenic hemangioendothelioma (PHE) is a rare angiogenic tumor. Histologically, the morphological characteristics of neoplastic vessels and endothelial differentiation are not obvious, and it is easy to be confused with epithelioid sarcoma, epithelioid hemangioendothelioma and myogenic tumor. PHE usually occurs in arms and legs in young people and has a significant male predominance. The tumor has a predilection for the distal extremities and its typical manifestation is multiple center invasion of a single limb, which can involve all layers of skin and subcutaneous tissues,and is often accompanied by abvious pain. Histologically, PHE is characterized by infiltrative growth of tumor. Most tumor lesions are composed of sheets and loose fascicles of plump spindle or epithelioid cells within a background of variably prominent inflammatory infiltration, which was commonly composed of neutrophils. Some cells may resemble rhabdomyoblasts, and nuclear atypia and mitosis were rare. The tumor cells generally expressed positive cytokeratin (CK), ETS-related gene (ERG), Friend leukemia virus integration 1 (FLI1) and integrase interactor 1(INI1). In some cases, the tumor cells expressed CD31. A case of a young woman was reported in this paper, who presented with a subcutaneous mass with severe pain and was chronologically misdiagnosed with herpes zoster, low-grade malignant fibrous histiocytoma and epithelioid hemangioendothelioma. In this study, the clinical and pathological features, differential diagnosis and the latest progress in therapy of PHE were analyzed based on relevant literature.

Clinicopathological analysis and surgical strategy of primary appendiceal neoplasms / 中华胃肠外科杂志

Objective: To investigate the clinicopathological features, surgical methods and prognosis of primary appendiceal neoplasms. Methods: A descriptive case series study was performed. Clinical data of patients diagnosed with primary appendiceal neoplasms in Peking University First Hospital from 2006 to 2017 were retrospectively analyzed. Patients who underwent surgery and were confirmed as appendiceal neoplasms by postoperative pathology were included. Cases of cecal tumor invading the appendix and other organ tumors implanting in the appendix and cases of recurrent appendix tumors were excluded Pathological classification was based on the 4th edition of the WHO classification of digestive tract tumors (2010 edition), and the efficacy of operation methods of low grade appendiceal mucinous neoplasm (LAMN) were analyzed. Results: A total of 115 patients were enrolled, including 52 males and 63 females with a median age of 59 (51, 71) years. Clinical symptoms usually manifested as dormant pain in the right lower quadrant, migrating right lower abdominal pain, fever and bloating. Twenty-four cases were accidentally discovered during surgery, and 21 cases were found by physical examination. The preoperative diagnosis rate of CT and ultrasound was 40.2% (43/107) and 25.5% (24/94) respectively. The postoperative pathological types contained 83 cases of LAMN, 12 cases of mucinous adenocarcinoma, 9 cases of appendiceal neuroendocrine neoplasms (aNEN), 2 cases of mucinous adenocarcinoma with signet ring cells, 3 cases of serrated adenoma, 2 cases of goblet cell carcinoid, 2 cases of lymphoma, 1 case of leiomyoma and 1 case of schwannomas. All the patients underwent surgical resection, including 41 cases of appendectomy, 21 cases of partial cecectomy, 48 cases of right hemicolectomy, and 5 cases of combined organ resection due to appendiceal tumor infiltration or dissemination. Eighteen cases were diagnosed with pseudomyxoma peritonei (PMP) during operation. A total of 98 patients were enrolled for follow-up. The median follow-up time was 58 (5-172) months. The 5-year disease-free survival (DFS) rate was 84.5% and 5-year overall survival (OS) was 88.2%. Multivariate analysis revealed that high-grade malignancy tumors (HR=25.881, 95% CI: 2.827-236.935, P=0.004) and PMP formation (HR=42.166, 95% CI: 3.470-512.439,P=0.003) were independent risk factors for prognosis. Patients undergoing right hemicolectomy presented longer operation time, more blood loss and higher morbidity of complication as compared to those undergoing appendectomy and partial cecectomy (all P<0.05), while no significant differences in 5-year DFS (P=0.627) and 5-year OS (P=0.718) were found. Conclusions: Primary appendiceal neoplasms usually have no typical features, accompanied with low preoperative diagnosis rate. The common pathological types are LAMN, mucinous adenocarcinoma and aNEN. Appendectomy or partial cecectomy for LAMN may achieve satisfactory prognosis. High-grade malignancy tumors and PMP formation are independent risk factors for prognosis.

LG-ESSs and HG-ESSs: underlying molecular alterations and potential therapeutic strategies / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Endometrial stromal tumors (ESTs) include endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and undifferentiated uterine sarcoma (UUS). Since these are rare tumor types, there is an unmet clinical need for the systematic therapy of advanced LG-ESS or HG-ESS. Cytogenetic and molecular advances in ESTs have shown that multiple recurrent gene fusions are present in a large proportion of LG-ESSs, and HG-ESSs are identified by the tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein epsilon (

Analysis of clinical and endoscopic characteristics and progress-related risk factors of gastric low-grade intraepithelial neoplasia / 中华消化杂志

Objective:To analyze the clinical and endoscopic characteristics of gastric low-grade intraepithelial neoplasia (LGIN), and to explore the risk factors related to the progression of LGIN.Methods:The clinical, endoscopic and pathological data of 411 patients with LGIN diagnosed by initial pathological biopsy in the Department of Gastroenterology, the First People′s Hospital of Yichang (the People′s Hospital of China Three Gorges University) from January 1, 2012 to December 30, 2020 were retrospectively analyzed, and were followed up every three to six months and endoscopy and pathological biopsy were performed. The clinical data of patients were collected, which included age, gender, lesion location, lesion size, lesion type, lesion color, lesion appearance, family history of gastric cancer, history of smoking and alcohol intake, history of pickled food, whether complicated with intestinal metaplasia or gastric atrophy and the degree, whether there was Helicobacter pylori infection. According to the results of last follow up, the differences in above factors between progressive and non-progressive patients, and the risk factors for the progression of LGIN were analyzed. Indenpendent sample t test, chi square test, and univariate and multivariate logistic regression were used for statistical analysis. Results:Among the 411 patients with LGIN, there were 261 males and 150 females, the ratio of male to female was 1.74 ∶1; the mean age was (57.5±10.3) years old (30 to 86 years old). The most common clinical symptoms were abdominal pain, abdominal discomfort and abdominal distension, which accounted for 30.7% (126/411), 25.8% (106/411) and 20.9% (86/411), respectively. The lesions of 245 cases (59.6%) located in gastric antrum; the maximum diameter of lesions of 344 cases (83.7%) was 0.5 to less than 2.0 cm; the lesion types of 232 cases (56.4%), 104 cases (25.3%) and 75 cases (18.2%) were prominent type, flat type and depressed type, respectively. The lesion color of 298 cases (72.5%) was red, and that of 113 cases (27.5%) was normal or white. One hundred and seventy-one cases (41.6%) had surface erosion and 61 cases (14.8%) had surface ulcer. Two hundred and seventy-two cases (66.2%) of LGIN were complicated with intestinal metaplasia, and the proportions of mild, moderate and severe intestinal metaplasia were 50.4% (137/272), 33.8% (92/272) and 15.8% (43/272), respectively; 196 cases (47.7%) of LGIN were with gastric atrophy, and the proportions of mild, moderate and severe degree of gastric atrophy were 58.2% (114/196), 29.1% (57/196) and 12.7% (25/196), respectively. Rapid urease test or 14C urea breath test were carried out in 368 cases (89.5%), the positive rate of Helicobacter pylori infection was 45.1% (166/368), and the proportion of male was higher than that of female (59.6%, 99/166 vs. 40.4%, 67/166), and the difference was statistically significant ( χ2=4.537, P<0.05). All 174 patients with LGIN were successfully followed up, and the LGIN lesion of 11.5% (20/174) patients was progressive. The results of univariate analysis indicated that there were statistically significant differences in the lesion location, lesion size, lesion type, lesion appearance, atrophy, family gastric cancer history, history of alcohol intake, and history of pickled food between the patients with progressive lesions (20 cases) and the patients with non-progressive lesions (154 cases) ( χ2=11.950, 22.370, 8.964, 8.552, 10.362, 7.139, 5.913 and 4.668, all P<0.05). The results of multivariate logistic regression analysis showed that lesions in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer, history of alcohol intake, history of pickled foods were independent risk factors of the progression of LGIN (odds ratio=4.796, 5.457, 4.431, 3.521, 1.380, 21.405, 3.294 and 1.832, 95% confidence interval 2.028 to 6.431, 3.256 to 8.943, 1.356 to 6.410, 1.305 to 5.706, 1.013 to 2.805, 5.062 to 25.391, 2.012 to 5.826, 1.072 to 3.790, all P<0.05). Conclusions:The lesions located in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer history, history of alcohol intake, history of pickled foods are independent risk factors of the progression of LGIN. When the patients with LGIN have these characteristics, endoscopic resection should be considered.

Application of narrow band imaging-magnifying endoscopy to the further assessment of gastric low-grade intraepithelial neoplasia in biopsy / 中华消化内镜杂志

Objective:To evaluate narrow band imaging-magnifying endoscopy (NBI-ME) for the further assessment of lesions of low-grade intraepithelial neoplasia (LGIN) in the gastric biopsy.Methods:Data of 180 patients who underwent NBI-ME before endoscopic submucosal dissection (ESD) for biopsy of gastric LGIN at the First Affiliated Hospital of Soochow University from January 2017 to October 2020 were analyzed retrospectively. Taking the pathological results after ESD as the gold standard, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were calculated, and the receiver operator characteristic (ROC) curve was drawn.Results:Among 180 gastric LGIN lesions, 115 (63.89%) were pathological upgraded and 65 (36.11%) were not after ESD. There were 10 missed diagnoses, 19 misdiagnoses, and 151 correct diagnoses in NBI-ME examination before ESD. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were 91.3% (105/115), 70.8% (46/65), 84.7% (105/124), 82.1%(46/56) and 83.9% (151/180), respectively. The area under the ROC curve was 0.810 (95% CI: 0.737-0.883). Conclusion:Further NBI-ME examination of gastric LGIN lesions diagnosed by biopsy pathology can accurately predict whether the lesions have pathological upgrading after ESD, which is of important guiding significance for the patients to choose the treatment strategy of further follow-up or endoscopic resection.

Use of MRI Apparent Diffusion Coefficient to Noninvasively Differentiate between the Histologic Grades of Meningioma.

It is well known in the literature that Apparent Diffusion Coefficient (ADC) obtained during diffusion-weighted MRI of brain is sensitive in detecting and differentiating low-grade and aggressive meningiomas. However, other studies establish no correlation between mean-ADC and ultimate classification as benign, atypical or malignant. We wanted to assess the correlation between, A. mean of MRI Apparent Diffusion Coefficient (mean-ADC) and B. meningioma biomarker Ki-67 proliferation index, in cases of both low-grade and aggressive meningioma. We also wanted to assess the sensitivity of mean-ADC for diagnosing an aggressive meningioma.METHODSWe analysed 66 surgically treated meningioma patients with complete histopathology report (HPR) in Government Medical College, Kozhikode during the period of study (Nov-2017-Oct-2018), also having a pre-operative mean-ADC value during Diffusion Weighted Imaging (DWI) investigation at the same centre. For the latter, a standard MRI brain protocol including diffusion imaging was conducted and ADC map was generated. Regions of interest (ROIs) were manually drawn within the tumour on ADC map and mean-ADC values were measured.RESULTSUsing Pearson correlation coefficient, we found a significant negative correlation between Ki-67 proliferation index and mean-ADC in meningioma cases. We also calculate 0.79 x 10-3 mm2/s being a reasonable mean-ADC cut-off value due to its sensitivity of 84% and specificity of 77% in differentiating between typical and atypical meningiomas.CONCLUSIONSThe non-invasive calculation of mean-ADC is a valid diagnostic tool. Further, mean ADC can be used as a good test to differentiate typical and atypical meningiomas. The latter is a particularly valid conclusion, since there were few results from conventional MRI studies to differentiate between various typical and atypical meningiomas.

Level of C-reactive Protein in Obese and Overweight Individuals at Indira Gandhi Institute of Medical Sciences: A Tertiary Care Center of Bihar

Introduction: Human adipose tissue releases interleukin-6 which is a pro-inflammatory cytokine that causes low-grade systemicinflammation. Acute-phase C-reactive protein (CRP) is a sensitive marker for systemic inflammation. Low-grade systemicinflammation in overweight and obese can be measured by serum CRP level.Objective: The objective of this study was to find out the prevalence of raised serum CRP level among the obese and overweightperson.Materials and Methods: Overweight and obese persons were screened for raised CRP (≥3.0 mg/L) after excluding comorbidity.Results: The prevalence of raised CRP among obese and overweight is 23%, the female has higher prevalence of 25.45% ascompared to male 20%. The prevalence among overweight and obese participants is 18.88% and 60%, respectively.Conclusions: The finding suggest a higher prevalence of low-grade systemic inflammation in obese as compared to anoverweight person.

Analytical study of Pap smear reports over a period of 1 year in a tertiary care centre

Background: Cervical cancer is the fourth most common cancer in women. In India and other developing countries cervical cancer is the leading cause of morbidity and mortality. Cancer cervix continues to be most common genital carcinoma in India accounting for 80% of all female genital malignancies. Pre-invase lesions can spontaneously regress to normal or remain stable for long period or progress to a higher degree of dysplasia. Cancer of cervix is preventable if diagnosed at the pre-invasive stage with regular intervals of cytological screening by Papanicolaou (Pap) smears. The aim of the study is to analyse the pap reports in terms of normal findings, infections, premalignant lesions and invasive cancers.Methods: All women attending the outpatient department gynaecology at TMMC and RC Moradabad, Uttar Pradesh over a period of 1 year from august 2017-18 presented of obstetrics and with white discharge per vagina were screened for cervical cancer using pap smear. All the smears were reported as per the 2014 Bethesda system.Results: Out of 1392 Pap smear reports ASCUS was reported in 27 cases (2%), LSIL in 27 cases (2%), HSIL in 15 cases (1%), malignant cells in 15 cases (1%) and normal including the infection is reported in 1308 cases (94%).Conclusions: Early cervical epithelial changes can be identified by a Pap smear test, which is the primary screening test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer.

Experience of cervical Pap smear screening in tertiary care hospital

Background: Cervical cancer is the leading cause of death in women in developing countries like India. It is preventable by regular screening by Pap smear and can be detected at pre-invasive stage. Thus, reducing the morbidity and mortality related with cervical cancers. Objective: This study aims at detecting the prevalence and current trends of various epithelial cell abnormalities (ECAs) in females attending a tertiary care hospital. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital between July 2015 and May 2019. A total of 15,270 cases comprising 11,494 conventional and 3776 liquid-based cytology Pap smears were included in the study. Clinical data and history of the patients were retrieved. All cases were reported according to Bethesda system 2014. Results: Among 15,270 cases, 793 Pap smears were unsatisfactory, 14,153 Pap smears were negative for intraepithelial lesion/malignancy, and 325 cases had ECA. Conclusion: Large hospital-based studies are required for proper implementation of health services and for the selection of a feasible as well as sensitive screening test for early detection of cervical dysplasias which can be helpful in decreasing the burden of cervical cancer in our community.