Based on the collation and analysis of 178 informed consent forms of clinical research projects related to human accepted by the ethical review committee of one hospital in 2007 and 2008,major problems were summarized as follows:the expression was difficult to be understood and was unsuitable for popular apprehension;lack of basic elements or insufficiently informed;inductive or advertising expressions existed,etc.Accordingly,the discussion was made for some recommendations of improvement.

Objective To investigate the short-term efficacy of CT-guided radiofrequency ablation (RFA) for the treatment of advanced non-small cell lung cancer. Methods During the period from June 2010 to June 2013, a total of 100 patients with advanced non-small cell lung cancer were admitted to authors’ hospital. The patients were equally and randomly divided into the study group (n=50) and the control group (n=50). The patients of the control group received concurrent radiotherapy and chemotherapy treatment, while the patients of the study group received CT-guided RFA. The clinical effect, changes in CT values after the treatment, the improvement of physical condition and postoperative complications were recorded, and the results were compared between the two groups. Results The remission rate of the disease in the study group was 86.0%, which was much higher than that in the control group (52.0%), and the difference between the two groups was statistically significant (P<0.05). After the treatment, the CT value of the study group was (14.1±3.9) HU, which was significantly lower than that of the control group (29.8±4.7 HU, P<0.05). The physical improvement rate of the study group (66.0%) was significantly higher than that of the control group (44.0%), the difference between the two groups was statistically significant (P<0.05). The occurrence of postoperative complications, such as pulmonary infection, chest pain, fever, thoracic effusion and gastrointestinal reaction, in the study group was strikingly lower than that in the control group (P<0.05). Conclusion For the treatment of advanced non-small cell lung cancer, CT-guided radiofrequency ablation is safe and less-invasive, it can improve the clinical short-term effect as well as the quality of life. Therefore, this technique should be recommended in clinical practice.

Objective:To investigate the quantification of CD4~+CD25~+ regulatory T cells and distribution of CD4~+CD8~+ T lymphocyte subgroup in peripheral blood of patients in chronic hepatitis B (CHB),and to reveal relationship between CD4~+CD25~+ regulatory T cells,CD4~+CD8~+ T lymphocyte subgroup and HBV infetion as well.Methods:CD4~+CD25~(high),CD4~+CD25~+Foxp3~+Treg and CD3~+CD4~+CD8~+T lymphocyte subgroup in peripheral blood from 50 patients with CHB and 20 healthy controls was analyzed using flow cytometry.HBV DNA was detected by fluorescence quantitative PCR.Results:The number of CD4~+CD25~(high)Tregs in patients with CHB was obviously higher than that in healthy controls(P＜0.01)and increased with copies of HBV DNA.The same with the change of CD4~+CD25~+Foxp3~+Tregs in patients with CHB and there was a positive correlation between CD4~+CD25~(high)Tregs and CD4~+CD25~+Foxp3~+Tregs(r=0.890,P＜0.001).Compared with healthy controls,the frequency of CD4~+T cells and the ratio of CD4~+/CD8~+ in patients with CHB was declined,but there was no significant difference in the frequency of CD3~+T cells and CD8~+T cells between them(P＞0.05).The variation in the number of CD4~+CD25~(high)Tregs was correlated positively with the copies of HBV DNA(r=0.782,P＜0.001)and glutamic-pyruvic transaminase(ALT)(r=0.432,P＜0.005)separately,but negatively with the frequency of CD3~+,CD4~+,CD8~+T cells and the ratio of CD4~+/CD8~+(P＞0.05).The variation in the frequency of CD3~+,CD4~+,CD8~+T cells and the ratio of CD4~+/CD8~+ was also correlated negatively with the copies of HBV DNA(P＞0.05).Conclusion:The number of CD4~+CD25~(high)Tregs increases in patients with CHB and is in accordance with the copies of HBV DNA and increased level of ALT.Further studies should be done to investigate weather CD4~+CD8~+ T lymphocyte subgroup could be used to monitor the state of community.

Objective To investigate the clinical efficacy of combined detection of VCA-IgA and Rta-IgG in the diagnosis of nasopharyngeal carcinoma.Methods From May 2013 to November 2014, 3 913 serum samples(male 2 367,female 1 546) from healthy people who had health examination in our medical center were collected and 169 serum samples(male 118,female 51) were collected from the patients who were diagnosed as nasopharyngeal carcinoma by pathological biopsy.Serum samples in two groups were detected by EBV RTA-IgG, VCA-IgA assay ( ELISA ) respectively.SPSS17.0 statistical software and receiver operating characteristic curve ( ROC) were applied to data analysis.Results The Rta-IgG positive rates of EB virus were 93.5%in NPC group (158/169) and 2.4%(93/3 913) in healthy group;while the VCA-IgA positive rates were 79.3%in NPC group ( 134/169 ) and 8.9% ( 349/3 913 ) in healthy group. The sensitivity(χ2 =14.49,P<0.05) and specificity(χ2 =157.15,P<0.05) of Rta-IgG in the diagnosis of nasopharyngeal carcinoma were significantly better than that of VCA-IgA. Using VCA-IgA/Rta-IgG combined detection analysis, not only failed to effectively improve the diagnosis of nasopharyngeal cancer, but to reduce the detection sensitivity to 72.8%( 123/169 ) , compared with Rta-IgG detection only. Conclusions Rta-IgG is significantly better than that of VCA-IgA.There was no significant improvement in the clinical diagnostic efficacy of nasopharyngeal carcinoma using VCA-IgA/Rta-IgG combined detection mode.

Objective To analyze the results of syphilis serology test results among hospitalized patients ,and to investigate the prevalence of syphilis .Methods T he results of syphilis antibody test of 199498 patients of Haikou People′s Hospital from 2011 to 2016 were retrospectively analyzed . All samples were screened by Treponema pallidum (TP) antibody using enzyme linked immunosorbent assay (ELISA) .Syphilis toluidine red unheated serum reagin test (TRUST ) was used to test nontreponemal antibody .The TP-ELISA positive samples were confirmed by Treponema pallidum particle agglutination test (TPPA) .Chi-square test was used for statistical analysis .Results A total of 7616 cases were positive of anti-TP ,with positive rate of 3 .82％ .From 2011 to 2016 ,the annual cases tested were 23188 ,32010 ,35079 ,35734 ,35406 and 38081 ,respectively .The annual positive rates of anti-TP w ere 4 .11％ (952/23188 ) ,3 .94％ (1261/32010 ) ,4 .55％ (1597/35079 ) ,3 .85％ (1376/35734 ) , 3 .47％ (1229/35406) ,and 3 .15％ (1201/38081) ,respectively ,and the difference was statistical significant (χ2 =108 .167 ,P<0 .05) .Anti-TP positive rate in male patients was 4 .85％ (4899 cases) , and 2 .76％ (2717 cases) in female ,and the difference was statistically significant ( χ2 =593 .443 , P<0 .05) .The positive rate of TP antibody in the elderly over 80 years old was 6 .09％ ,and 5 .03％ in patients older than 60 years old .In all samples ,TRUST was positive in 3413 cases (1 .71％ ) .From 2011 to 2016 , the annual positive cases were 179 , 390 , 585 , 768 , 816 and 675 , respectively , with coresponding rates of 0 .77％ ,1 .22％ ,1 .67％ ,2 .15％ ,2 .3％ and 1 .77％ ,respectively .The difference was statistically significant (χ2 = 763 .779 , P< 0 .05) .TRUST was positive in 2022 (2 .01％ ) male patients and 1391 (1 .41％ ) female patients ,and the positive rates were significantly different (χ2 =102 .887 ,P<0 .05) .From 2011 to 2016 ,the annual TRUST positivities among patients -9 years old and -19 years old were not different (χ2 = 1 .198 and 11 .018 ,both P> 0 .05) ,while those among patients aged -29 ,-39 ,-49 ,-59 ,-69 ,-79 ,and ≥80 years old were statistically different (χ2 =20 .100 ,38 .387 ,89 .360 ,75 .874 ,87 .743 ,71 .035 and 30 .593 ,respectively ,all P<0 .05) .Conclusions From 2011 to 2016 ,the positive rates of syphilis is increased and then decreased .And it is significantly different among different genders and age groups .The positive rate in elderly is significantly higher .

OBJECTIVE: To explore the genetic etiology of a child featuring global developmental and mental retardation. METHODS: Chromosome G-banding karyotype analysis, copy number variation sequencing (CNV-seq) and high-resolution chromosome banding were used to screen the genomic variant in the child and his parents. RESULTS: Both the child and his father were found to have a karyotype of 46,XY,del(18)(q21.1q21.3), whilst his mother was 46,XX. CNV-seq analysis showed that the child was arr[19]18q21.2-q21.32(chr18:48 422 190-58 039 582)×1, with a 10.58 Mb deletion which encompassed the TCF4 gene. The same deletion was found in neither parent. High-resolution banding revealed that the father has a fragment of 18q21.1q21.3 inserted into 5p13.1. CONCLUSION The child was diagnosed with Pitt-Hopkins syndrome due to the 18q21.2q21.32 deletion. Chromosome karyotyping and CNV-seq can effectively identify submicroscopic chromosome anomalies.
Child ; Chromosome Banding ; Chromosome Deletion ; DNA Copy Number Variations ; Facies ; Humans ; Hyperventilation ; Intellectual Disability/genetics*

With the promulgation of a series of laws and regulations in our country, the requirement for stand-ardized management of clinical research process are gradually clear, and higher requirements on the following-up review management of ethics committee also are put forward. Through concluding and summarizing 128 noncompli-ance/violation or protocol deviation reports accepted by a hospital in recent two years, this paper analyzed four main problems including that the researchers at management level failed to report or report timely; the researchers reported in irregular filling;the same type of violation/deviation program happened repeatedly and the rectification to the review opinions of ethics committee was ineffective, and also put forward the corresponding suggestions, in order to strengthen and perfect the standard management of noncompliance/violation or protocol deviation report.

Objective: To investigate the clinicopathologic and molecular characteristics, diagnostic, differential diagnostic and prognostic features of malignant gastrointestinal neuroectodermal tumor. Methods: Two cases of malignant gastrointestinal neuroectodermal tumor were retrieved; the clinical and radiologic features, histomorphology, immunophenotype, molecular genetics and prognosis were analyzed and the relevant literature reviewed. Results: Case 1 was a 57-year-old male, presented with recurrent abdominal pain and melena. Pelvic imaging showed a circumscribed thickening of the wall of a small intestinal segment, and a malignant lymphoma was favored. Case 2 was a 24-year-old male, presented with recurrent small intestinal malignancy. Imaging demonstrated multiple masses in the peritoneal and pelvic cavities, and a malignant gastrointestinal stromal tumor with multiple metastases was suspected. Grossly both tumors were located mainly in the muscularis propria of small intestine. Case 1 showed a single 5.5 cm tumor; and case 2 consisted of two tumors measuring 4 cm and 6 cm respectively. Microscopic examination of both tumors showed small round blue, but focally spindled or clear tumor cells in solid pattern. The tumor cells had scanty cytoplasm, indistinctive nucleoli and brisk mitoses. Osteoclast-like giant cells were dispersed within the stroma. In case 1 rosette-like and pseudo-papillary growth patterns were noted, and in case 2 there were variable-sized hemorrhagic cysts. By immunohistochemistry, both tumors showed strong and diffuse expression of SOX10 and S-100, and focal to diffuse expression of neuroendocrine markers (CD56 or synaptophysin). Case 2 exhibited focal reactivity to pan-cytokeratin. Both tumors lacked expression of markers associated with gastrointestinal stromal tumor, smooth muscle tumor, melanoma (HMB45 or Melan A), dendritic cell tumor and Ewing sarcoma. Fluorescence in situ hybridization analysis demonstrated EWSR1 rearrangement in both tumors and the next generation sequencing confirmed EWSR1-ATF1 gene fusion in case 2. At follow-up of 16 months, case 1 was recurrence or metastasis free; whereas case 2 showed multiple recurrences and metastases within 19 months although stable disease was transiently achieved when treated with combinations of multidrug and targeted chemotherapy. Conclusions Malignant gastrointestinal neuroectodermal tumor is a rare and aggressive soft tissue sarcoma with a predilection for small intestine. It has distinctive morphologic, immunohistochemical and molecular characteristics and needs to be distinguished from other small blue round and spindle cell tumors that occur in the gut. Careful attentions to its characteristic histomorphology with the judicious use of immunohistochemistry and molecular genetics can help to distinguish this tumor from its many mimickers.

Objective:To explore the incremental value of subtraction technique in evaluating the major features of liver reporting and data system version 2018 (LI-RADS v2018) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI.Methods:The Gd-EOB-DTPA enhanced MRI of 117 pathologically verified hepatocellualr carcinoma(HCC) from 87 high-risk patients in Henan Provincial People′s Hospital from January 2019 to July 2020 was analyzed retrospectively. The major features of LI-RADS in arterial phase, portal venous phase, subtraction and combined images were evaluated including nonrim arterial phase hyperenhancement (Nonrim APHE), nonperipheral washout and enhancing capsule. The lesions were graded according to LI-RADS v2018. According to the lesion size (<20 mm, ≥20 mm) and T 1WI signal intensity (hypointensity, isointensity or hyperintensity), the patients were divided into different subgroups. Cochran′s Q test was used for the comparison of the detection rate of the major features of LI-RADS and the accurate diagnosis rate based on LR-5 as the diagnostic standard among multiple groups. McNemar test was used for the comparison between two groups. Results:For all HCC, hypointensity HCC and HCC ≥20 mm, the detection rate of Nonrim APHE (χ2=12.190, 12.500, 10.083, all P<0.001) and the accurate diagnosis rate of HCC (χ2=14.450, 12.500, 10.083, all P<0.001) of subtraction images from arterial phase were significantly higher than that of arterial images. For HCC<20 mm, the detection rate of Nonrim APHE combined with arterial phase images was significantly higher than that in arterial phase images (χ2=5.143, P=0.016). For all HCC and isointensity or hyperintensity HCC, the detection rate of nonperipheral washout combined with portal venous phase images was higher than that in portal venous phase images (χ2=7.111, 6.125, P=0.004, 0.008). The detection rate of enhancing capsule of subtraction images from portal venous phase was higher than that of portal venous phase images in all groups (all P<0.017). The accurate diagnosis rate of subtraction images from portal venous phase in all HCC and HCC≥20 mm was higher than that in portal venous phase images (χ2=6.722, 6.750, P=0.008, 0.006). The accurate diagnosis rate of LR-5 in all groups using subtraction images from arterial phase and portal venous phase was higher than that of MRI images (all P<0.013). Conclusion:For Gd-EOB-DTPA dynamic enhanced MRI, subtraction images from arterial phase and portal venous phase are better than arterial phase and portal venous phase images in displaying Nonrim APHE, nonperipheral washout and enhancing capsule, which can improve the LI-RADS classification of HCC.

Based on the characteristics of forensic pathology, this paper explains the concept, connotation and advantages of holistic medicine and integrated medicine in the teaching of forensic pathology. Then, through the introduction of the specific teaching process design and effect analysis of the death cause analysis practical cases, it clarifies the necessity and effectiveness of integrated medicine and holistic medicine in the teaching of forensic pathology, and provides new ideas for the reform of the overall teaching of forensic pathology.