[Clinicopathological features of mixed cervical carcinoma with adenoid cystic pattern].

Objective: To investigate the clinicopathological characteristics, immunophenotype, molecular characteristics, differential diagnosis, clinical treatment and prognosis of mixed carcinoma of cervix with adenoid cystic pattern. Methods: Three cases of mixed cervical carcinoma with adenoid cystic pattern were collected at the Affiliated Hospital of Xuzhou University Medical School from 2018 to 2021.The clinicopathological characteristics were analyzed, immunohistochemistry (IHC) and in situ hybridization (ISH) were performed. The related literature was reviewed. Results: The three patients were postmenopausal women with a median age of 74.7 years. The clinical symptom was vaginal bleeding without obvious causes. One case was an endophytic tumor, and the others were exophytic. The median diameter of the three cases was 3.3 cm. Two patients underwent hysterectomy, the tumors infiltrated the external 1/3 and middle 1/3 of the cervix respectively. All the lymph nodes were negative. One patient had a previous biopsy. Microscopically, all three tumors were characterized by a cribriform structure, which were filled with basophilic myxoid substance and surrounded by tubules lined by two layers of cells. The tumor cells had scanty cytoplasm and showed the characteristics of cervical basal-like cells. All three cases were accompanied by high-grade squamous intraepithelial lesions and squamous cell carcinoma, and one also showed a non-specific spindle cell sarcomatoid component. Within the double-layered epithelial structure, the outer epithelium was positive for p63, CD117, p16INK4a (clone E6H4) and MYB protein and negative for S-100 by IHC. The combined positive score of PD-L1 (clone 22C3) was less than 1 in all three cases. Human papillomavirus (HPV) types 16 and 18 were detected in one patient preoperatively, while high-risk HPV were positive in the other two patients by RNAscope ISH postoperatively. None of the three cases showed MYB gene rearrangement by FISH. The mean follow-up time was 23.3 months (36, 28 and 6 months, respectively). Two patients underwent hysterectomy and radiotherapy survived without disease. One patient survived with tumor just by radiotherapy and drug therapy. Conclusions: Mixed cervical carcinoma with adenoid cystic pattern is extremely rare. It is a high-grade malignancy with poor prognosis. The tumor is associated with high-risk HPV infection, without MYB gene rearrangement, and with low PD-L1 immunoreactivity. Radical surgery combined with radiotherapy and chemotherapy is the mainstay of treatment at present.

[Clinical analysis and laboratory diagnosis of three cases with infantile botulism caused by Clostridium botulinum type B].

Objective: To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by Clostridium botulinum type B. Methods: Clinical data of 3 infants with type B botulism who were admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and Clostridium botulinum was cultured and isolated from fecal samples. Results: The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case's family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. Clostridium botulinum B was identified from the feces of 3 infants after culture, isolation and purification. Conclusions: Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of Clostridium botulinum are helpful for the diagnosis.

[Clinical effectiveness of pleural abrasion in video-assisted thoracic surgery for bullae resection].

Objective: To evaluate the efficacy of pleural abrasion in treatment of spontaneous pneumothorax with video-assisted thoracic surgery (VATS) for bullae resection. Methods: The clinical data of 158 patients with initial spontaneous pneumothorax who underwent video-assisted thoracic wedge resections with or without pleural abrasion in Henan Provincial People's Hospital from June 2010 to June 2015 were retrospectively analyzed. The patients were assigned to two equal groups according to whether pleural abrasion was applied or not: experimental group (with pleural abrasion) and control group (without pleural abrasion); and there were 79 patients in each group.There were 62 males and 17 females aged 15-60 years (mean age 34 years) in pleural abrasion group. And there were 70 males and 9 females aged 18-60 years (mean age 38 years) in non-pleural abrasion group.After surgery, all patients were evaluated for postoperative pain, chest tube removal time, hospital stay and other complications.Independent samples t test was used to compare the data between groups. Results: Surgeries for 158 patients were performed successfully.No mortality occurred.There was no conversion to thoracotomy.Postoperative pain, operation time, intraoperative blood loss, chest tube removal time, pleural canals flowand average hospital stay in non-pleural abrasion group was significantly lower for 4.4, 19 minutes, 10 ml, 21 hours, 87 ml and 1.4 days respectively when compared with those in pleural abrasion group (t=32.478, 7.140, 11.093, 7.288, 10.246, 8.070, all P<0.05). There was no missing case with a follow-up of 30 months.No complications, such as pneumothorax, was observed. Conclusions: Postoperative pain, chest tube removal time and hospital stay in non-pleural abrasion group are all lower than those in pleural abrasion group.And there is no significant difference in the recurrence of pneumothorax between the two groups after VATS bullae resection.

Identification of infarct core and penumbra in acute stroke using CT perfusion source images.

BACKGROUND AND PURPOSE: CT perfusion (CTP) mapping has been reported to be useful in the differentiation of the infarct core and ischemic penumbra. However, the value of the CTP source imaging (CTP-SI) during the arterial and venous phases has not been fully investigated. The purpose of this study was to develop a CTP-SI methodology for acute ischemic stroke and compare its efficacy with cerebral blood flow (CBF) and cerebral blood volume (CBV) in predicting infarct core and penumbra. MATERIALS AND METHODS: CT examinations, including non-contrast-enhanced CT, CTP, and CT angiography (CTA), were performed in 42 patients with symptoms of stroke for <9 hours. The Alberta Stroke Program Early CT Score (ASPECTS) was analyzed on the arterial phase CTP-SI and venous phase CTP-SI and then compared with the ASPECTS on CBF and CBV for efficacy assessment. RESULTS: The ASPECTS on the arterial phase CTP-SI was closely correlated with the ASPECTS on CBF, the Pearson correlation coefficient was 0.88 (P < .001), and the concordance correlation coefficient was 0.7603 (95% confidence interval [CI], 0.6331-0.8476). The ASPECTS on the venous phase CTP-SI revealed a significant correlation with the ASPECTS on CBV, the Pearson correlation coefficient was 0.92 (P < .001), and the concordance correlation coefficient was 0.8880 (95% CI, 0.8148-0.9334). Significant differences were shown between the arterial phase CTP-SI/ venous phase CTP-SI (P < .001) and CBF/CBV (P < .001). CONCLUSIONS: This study provides preliminary evidence that the arterial phase and venous phase CTP-SI mismatch model could possibly be applied to ischemic regions in the acute stage of stroke to determine penumbra and infarct core.

Contrast-enhanced MR imaging of brain lesions: a large-scale intraindividual crossover comparison of gadobenate dimeglumine versus gadodiamide.

BACKGROUND AND PURPOSE: The higher relaxivity of gadobenate dimeglumine compared with gadodiamide is potentially advantageous for contrast-enhanced brain MR imaging. This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative lesion enhancement. MATERIALS AND METHODS: Adult patients with suggested or known brain lesions underwent 2 identical MR imaging examinations at 1.5T, one with gadobenate dimeglumine and the other with gadodiamide. The agents were administered in randomized order separated by 3-14 days. Imaging sequences and postinjection acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, and global preference) and quantitatively for contrast-to-noise ratio (CNR). RESULTS: One hundred thirteen of 138 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumor, metastasis, extra-axial tumor, or other (47, 27, 18, and 21 subjects, respectively). Readers 1, 2, and 3 demonstrated global preference for gadobenate dimeglumine in 63 (55.8%), 77 (68.1%), and 73 (64.6%) patients, respectively, compared with 3, 2, and 3 patients for gadodiamide (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all qualitative end points and for CNR (increases of 23.3%-34.7% and 42.4%-48.9% [spin-echo and gradient-refocused echo sequences, respectively] for gadobenate dimeglumine compared with gadodiamide). Inter-reader agreement was good for all evaluations (kappa = 0.47-0.69). Significant preference for gadobenate dimeglumine was demonstrated for all lesion subgroup analyses. CONCLUSION: Significantly greater diagnostic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadodiamide at an equivalent dose.

Preliminary study of hemodynamic distribution in patient-specific stenotic carotid bifurcation by image-based computational fluid dynamics.

BACKGROUND: Regions prone to atherosclerosis, such as bends and bifurcations, tend to exhibit a certain degree of non-planarity or curvature, and these geometric features are known to strongly influence local flow patterns. Recently, computational fluid dynamics (CFD) has been used as a means of enhancing understanding of the mechanisms involved in atherosclerotic plaque formation and development. PURPOSE: To analyze flow patterns and hemodynamic distribution in stenotic carotid bifurcation in vivo by combining CFD with magnetic resonance angiography (MRA). MATERIAL AND METHODS: Twenty-one patients with carotid atherosclerosis proved by digital subtraction angiography (DSA) and/or Doppler ultrasound underwent contrast-enhanced MR angiography of the carotid bifurcation by a 3.0T MR scanner. Hemodynamic variables and flow patterns of the carotid bifurcation were calculated and visualized by combining vascular imaging postprocessing with CFD. RESULTS: In mild stenotic cases, there was much more streamlined flow in the bulbs, with reduced or disappeared areas of weakly turbulent flow. Also, the corresponding areas of low wall shear stress (WSS) were reduced or even disappeared. As the extent of stenosis increased, stronger blood jets formed at the portion of narrowing, and more prominent eddy flows and slow back flows were noted in the lee of the stenosis. Regions of elevated WSS were predicted at the portion of stenosis and in the path of the downstream jet. Areas of low WSS were predicted on the leeward side of the stenosis, corresponding with the location of slowly turbulent flows. CONCLUSION: CFD combined with MRA can simulate flow patterns and calculate hemodynamic variables in stenotic carotid bifurcations as well as normal ones. It provides a new method to investigate the relationship of vascular geometry and flow condition with atherosclerotic pathological changes.

Magnetic resonance elastography of brain tumors: preliminary results.

PURPOSE: To investigate the potential value of magnetic resonance elastography (MRE) in evaluating the consistency of brain tumors. MATERIAL AND METHODS: Six patients with known solid brain tumor underwent brain MRE studies. Consistency of brain tumors was evaluated at surgery. Correspondence of MRE evaluation with operative result was studied. RESULTS: The elasticity of tumors in six patients evaluated by MRE agreed with the tumor consistency given by the operative results. CONCLUSION: MRE could be used as an imaging technique for noninvasive assessment of the consistency of brain tumor in vivo.

Magnetic resonance elastography of the human brain: a preliminary study.

PURPOSE: To study the application of magnetic resonance elastography (MRE) in the human brain. MATERIAL AND METHODS: An external force actuator was developed, which produced propagating shear waves in brain tissue. A modified phase-contrast gradient-echo sequence was developed. The propagating shear waves within the brain were directly imaged. The wave images were processed to obtain the elasticity image. Shear waves at 100 Hz, 150 Hz, and 200 Hz were applied. RESULTS: The propagating shear waves in the brain were visualized on wave images. The elasticity image revealed the difference in tissue elasticity between gray and white matter of the brain. CONCLUSION: MRE could be an imaging technique for assessing the elasticity of brain tissue.

Radon measurements in underground dwellings from two prefectures in China.

Radon, an established lung carcinogen, remains the single most important environmental radiation exposure. Yet, an excess of lung cancer from breathing radon in homes has not been consistently demonstrated in studies conducted to date. To address several major problems that have hindered previous studies of lung cancer and radon in homes, we have embarked upon a lung cancer case-control study in Gansu Province, China, where a substantial proportion of the population live in underground dwellings. In this paper, we report on results of a pilot study in which radon measurements were made for 3 days in the summer in 40 homes under normal occupancy conditions using short-term E-PERM detectors and for 6 months from February through August in 49 homes using long-term alpha-track detectors. Useable E-PERM data were obtained from 38 homes and useable alpha-track data from 47 homes. For both types of detectors, measurements were approximately log-normally distributed. Arithmetic and geometric means were 233 and 185 Bq m-3 (range 74-1,590 Bq m-3) for E-PERM measurements and 165 and 158 Bq m-3 (range 74-592 Bq m-3) for alpha-track measurements, respectively; 68% of E-PERM measured homes and 55% of alpha-track measured homes exceeded 148 Bq m-3. Alpha-track measurements made at the entry, middle, and rear areas of the underground dwellings did not differ significantly (arithmetic means of 168, 162, and 165 Bq m-3 with standard deviations 63, 73, and 48, respectively), which suggests that air circulation may be minimal. The underground dwellings measured in the pilot study had high radon levels and the underground dwellers may provide an excellent population for studying indoor radon and risk of lung cancer.

Radiologic-pathologic correlation. Epidermoid tumor of the cerebellopontine angle.

This case demonstrated the classic gross pathologic, CT, and MR appearances of epidermoid tumors. The imaging features and differential diagnosis are summarized.

[Magnetic resonance imaging of occult intracranial malformations].

11 patients with angiographically occult intracranial vascular malformations proved by surgery and pathology were studied by magnetic resonance imaging (MRI). The chief MRI findings were: On T1-weighted imaging, there was a homogeneous or heterogeneous hyperintensity or isointensity signal at the centre of the lesion with a surrounding rim of hypointensity signal; On T2-weighted imaging, there was a hyperintensity signal at the centre and hypointensity signal at the peripheral region. Differential diagnosis between hemorrhagic tumor and occult vascular malformation lies in that the latter has no edema and is often single. comparing with CT, the size of occult vascular malformation on MRI was equal to that on CT.

[Magnetic resonance imaging and CT diagnosis of small acoustic neuromas in the internal auditory canal].

The MRI findings of 6 small acoustic neuromas proved by surgery and pathology were analyzed in detail and compared with CT air cisternography. The MRI features of small acoustic neuromas include that small lesions produce thickening of the nerve or partial or entire filling of the internal auditory canal. In T1-weighted images, the tumor is of higher signal intensity than CSF, but is the same as the brain in T 2-weighted images, the tumor is brighter than the brain. MRI makes possible the diagnosis of small acoustic neuromas without subjecting the patients to invasive procedures or exposing them to X-radiation. Comparing MRI with CT air cisternography, we conclude that MRI is more convenient than CT and causes no postoperative complications.

[Intra-arterial digital subtraction angiography (IADSA) of intracranial lesions (an analysis of 600 cases)].

Intracranial vessels were evaluated in 600 patients with IADSA. Among them, 100 cases were studied with both conventional angiography and IADSA. The advantages of IADSA are: (1) Good image quality; (2) Examination time shortened; (3) Very useful for interventional neuroradiology, hence it can replace conventional cerebral angiography for preoperative evaluation in most cases.

[CT diagnosis of neuron migration anomalies].

CT findings of 17 patients with neuron migration anomalies, 5 with lissencephaly, 6 with schizencephaly and 6 with heterotopic gray matter were reviewed. Migratory anomalies are congenital malformations caused by insult to the neurons during the time of migration. CT is effective in detecting these malformations.

Studies on hexachlorocyclohexane and DDT contents in human cerumen and their relationships to cancer mortality.

Organochlorine pesticides in cerumen were used as a biological marker to monitor the exposure of organochlorine pesticides in the human body. The amount of sample used was about 10 mg. The order of magnitude of HCH (hexachlorocyclohexane) isomer content in cerumen was beta greater than alpha greater than gamma greater than delta; for DDT, the order was p,p'-DDE greater than p,p'-DDT. There was little o,p'-DDT and p,p'-DDD. The contents of beta-HCH and p,p'-DDE in cerumen were highly significantly correlated with those in adipose tissue of the same individuals. Approximately 3800 cerumen samples collected from 35- to 54-year-old healthy adults in the general populations of 35 counties were analyzed for HCH and DDT. The accumulation levels of beta-HCH had a geographical character with obvious gradient differences, and the levels were higher in males than in females. The accumulation levels of beta-HCH in the populations studied were highly significantly correlated with the mortality rates from liver cancer, colon/rectum cancer, and lung cancer in males as well as colon/rectum cancer in females (P less than 0.01), suggesting that the effect of HCH on the above cancers should be studied further.