Objective To explore the effect of low molecular weight heparin (LMWH ) in immunoglobulin A nephropathy (IgAN) .Methods Totally 57 patients with IgAN were randomly assigned to two groups :the control group[(treatment with angio‐tensin‐converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus statins and oral anticoagulant ];the observa‐tion group(treatment of the same as the control group but instead LMWH for oral anticoagulant ) .All patients were treated for 6 months .24 h urinary protein excretion ,serum creatinine ,prothrombin time(PT ) ,thrombin time(T T ) and activated partial thrombo‐plastin time(APTT) were measured before treatment and at 1 ,3 ,6 months after treatment respectively .The level of urinary trans‐forming growth factor‐β1 (TGF‐β1 ) and laminin(LN) were assayed with the enzyme linked immunosorbent assay (ELISA) .Results Compared with the control group ,24 h urinary protein excretion ,urinary TGF‐β1 and LN levels in the observation group were all decreased at 1 ,3 ,6 months after treatment (P<0 .05) .After 6‐month treatment ,serum Scr level in the observation group(syub‐group) was decreased significantly compared with the control group (subgroup)(P<0 .05) .There were no significant differences in PT ,TT and APTT before and after treatment between the two groups (P>0 .05) .Conclusion The combination therapy with LM‐WH can further decrease proteinuria and ameliorate the renal function of IgAN .

Objective The stress reaction in double-balloon enteroscopy was investigated,the influencing factors and intervention countermeasures were studied.Methods Cardiovascular effects and physiological reactions of 60 double-balloon enteroscopy patients were surveyed.The patients were divided into 2 groups according to the cardiovascular effects to underwent single factor analysis of related factors.Results The incidence of physiological reactions was 68.3%,the incidence of cardiovascular reactions was 56.7%.Evident difference existed in blood pressure,heart rate and blood oxygen saturation rate before,during and after examination.The grouping analysis showed cardiovascular effects were influenced by many kinds of factors.Conclusions Different degrees of the stress reactions in double-balloon enteroscopy might appear.The influencing factors included the enteroscopy mode and time,gender,age,mood,and physician operation experience.The stress reactions might be reduced by taking the corresponding intervention measures according to the influencing factors.

Background and purpose:EGFR-TKI (EGFR-tyrosine kinase inhibitors), represented by geiftinib and erlotinib, have exhibited signiifcant antiproliferative effects against non-small cell lung cancer (NSCLC) with low toxicity.EGFR gene mutation was discovered to be a predictive biomarker for EGFR-TKI treatment. Although the efifcacy of EGFR-TKI is limited toEGFR wild-type patients, it is still noticeable suggesting that some other mechanisms are responsible for it. The current study is aimed at evaluating the expression of phosphorylated EGFR in advanced NSCLC, investigating its relationship withEGFR mutations and EGFR-TKI efifcacy.Methods:EGFR gene mutations were detected by denaturing high performance liquid chromatography (DHPLC) in 205 stageⅢB-ⅣNSCLC patients. The expressions of phosphorylated tyrosine 1068 (pTyr1068) and 1173 (pTyr1173) were detected by immunohistochemistry.Results:The positive expressions of pTyr1068 and pTyr1173 were 80.0% (164/205) and 57.6% (95/165) respectively. None of them were related to clinical pathological characteristics (age, gender, pathological type, smoking status, disease stage).EGFR gene mutation rate was 44.9% (92/205), which was only related to smoking status (P=0.024) compared to other clinical pathological characteristics.EGFR gene mutations were poorly related to pTyr1068 expression (P<0.001) and not related to pTyr1173 expression (P=0.297). The objective response rate (ORR),disease control rate (DCR), and progressive free survival (PFS) of EGFR-TKI treatment in patients withEGFR mutations were 48.3% (43/89), 80.9% (72/89) and 8 months (95%CI: 6.11-11.42) respectively, which were signiifcantly higher than that ofEGFR wild-type patients [ORR=16.2% (17/105,P<0.001); DCR=56.2%(59/105,P<0.001); Median PFS: 2.1 months, (95%CI: 0.89-3.24;P=0.001)]. Superior ORR: DCR and PFS appeared in patients with pTyr1068 positive expression compared to negative [ORR: 37.7% (58/154)vs 5.0% (2/40,P<0.001); DCR: 74.7% (115/154)vs 40.0% (16/40,P<0.001); Median PFS: 7.0 monthsvs 1.2 months,P<0.001)]. Inversely, the patients with pTyr1173 positive expression had lower ORR, DCR and shorter PFS [ORR: 27.8% (25/90)vs 37.9%(25/66,P=0.123); DCR: 64.4% (58/90)vs 83.3% (55/66,P=0.007); Median PFS: 4.8 monthsvs 7.7 months (P=0.016)]. In subgroup ofEGFR wild-type patients, positive expression of pTyr1068 was 69.0% (69/100).EGFR wild-type patients with pTyr1068 positive expression had a prolonged PFS and elevated ORR and DCR compared to negative [median PFS: 3.6 monthsvs 1.2 months (P<0.001); ORR: 23.2%vs 3.2% (P=0.010); DCR: 69.6%vs 35.5% (P=0.001)]. Sixteen patients with pTyr1068 positive expression who responded to EGFR-TKI treatment in this subgroup had a remarkable PFS [median PFS: 15.6 months (95%CI:7.28-23.9)]. Multiple factor analysis showed that the expression of pTyr1068 was an independence predictor factor for EGFR-TKI treatment (OR=0.24, 95%CI: 0.16~0.37,P<0.001). Conclusion:Phosphorylation at Tyr1068 of EGFR might be a potential predictive factor for clinical response and survival of EGFR-TKI treatment in patients with advanced NSCLC, especially inEGFR wild-type patients.

Objective: To investigate MAML2 gene-translocation in primary pulmonary mucoepidermoid carcinoma (PMEC) and pulmanary adenosquamous carcinoma, and the optimal diagnostic immunohistiochemical (IHC) panel in distinguishing PMEC from adenosqumous carcinoma. Methods: Twenty-four cases of PMEC and 44 adenosqumous carcinoma diagnosed in the Guangdong General Hospital were tested for MAML2 translocation by fluorescent in-situ hybridization (FISH) using tissue array. An IHC panel including TTF1, Napsin A, CK5/6, p63, p40 and Ki-67 was performed on the cohort. The clinical data for all cases were collected and all PMEC patients had follow-up information. Results: The patients′ age ranged form 6 to 73 years, with a median age of 32 years. The male to female ratio was 1.4∶1.0. MAML2 translocation was found in 16/24 (66.7%) cases of PMEC whereas all 44 cases adenosqumous carcinoma were negative for translocation. All the cases of the PMEC were negative for TTF1 and Napsin A but positive for CK5/6, p63 and p40 in the intermediate cells and epidermal-like cells. In most PMEC cases, the Ki-67 expression index was lower than 10%. In contrast, most cases of adenosqumous carcinomas expressed TTF1 and Napsin A in the adenomatous component and CK5/6, p63 and p40 in the squamous component, which expression pattern was different from that of PMEC. Based on IHC staining, 2 cases of highly invasive ALK-positive adenocarcinoma mimicing PMEC were also found in the study. Conclusions MAML2 gene translocation can be detected in about two-third of PMEC. Translocation of MAML2 gene and lower morphology grading are associated with good prognosis. The combined use of IHC antibodies panel is helpful to distinguish PMEC from the adenosqumous carcinoma and adenocarcinoma mimicing PMEC.

OBJECTIVETo evaluate the diagnostic value of HGAL and LMO2 expression and compare with CD10 and bcl-6 in follicular lymphoma (FL).

METHODS63 cases of FL were collected from Guangdong General Hospital. The expression of HGAL, LMO2, CD10 and bcl-6 was assessed by immunohistochemistry.

RESULTSThe expression rates of HGAL, LMO2, CD10 and bcl-6 were 98.4% (62/63), 82.5% (52/63), 82.5% (52/63) and 87.3% (55/63), respectively. The expression rate of HGAL was higher than those of LMO2, CD10 and bcl-6, but the differences were not significant (P>0.05). There was no significant difference in HGAL, LMO2 and bcl-6 expression among FL1, FL2 and FL3 cases. The CD10 expression rate of FL1-3A cases was significantly higher than that of FL3B cases(P<0.01).

CONCLUSIONSHGAL and LMO2, especially HGAL, can be used in FL particularly high grade FL as useful germinal center marker.

Adaptor Proteins, Signal Transducing ; metabolism ; Biomarkers, Tumor ; metabolism ; Germinal Center ; Humans ; Immunohistochemistry ; LIM Domain Proteins ; metabolism ; Lymphoma, Follicular ; metabolism ; Neoplasm Proteins ; metabolism ; Neprilysin ; metabolism ; Proto-Oncogene Proteins ; metabolism ; Proto-Oncogene Proteins c-bcl-6 ; metabolism

Objective: To assess clinical features and treatment outcomes in immunocompetent patients with primary central nervous system lymphoma (PCNSL). Methods: Sixty-two patients with PCNSL who attended Guangdong General Hospital between January 1998 and January 2012 were included. Survival curves were estimated using Kaplan-Meier survival methodology and statistical significance of continuous was assessed via the Cox proportional hazard model. Results: The median age of the patient cohort was 56 years, and the male to female ratio was 1.14∶1.00. The common presentations were increased intracranial pressure symptoms and neuron damage. Performance status of 54 (54/62, 87.1%) patients were the international prognostic index (IPI) 0-2. Diffuse large B-cell lymphoma (57/62, 91.9%) was most common, and the rest were T-cell lymphoma (4/62,6.4%) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (1/62, 1.6%). In the series, 32 patients (32/62, 51.6%) had multiple lesions. Involvement of deep structures was found in 30 (30/62, 48.4%) patients. An elevated serum LDH level was detected in 19 (19/62, 30.6%) patients and the Ki-67 index was ≥90% in 38 (38/62, 61.3%) patients. Univariate analysis showed patients who were female, age<60 years, had WHO Eastern Cooperative Oncology Group performance status grade 0-2, single lesion, absence of deep structures involvement and normal LDH level showed better 2-year survival rate and longer median survival time. Significance was only seen in the normal LDH level group. Multivariate Cox regression analysis revealed that radical surgery only and Rituximab+ high-dose of methotrexate+ whole brain radiation therapy (WBRT) were independent prognostic indicators in PCNSL patients (P<0.05). Conclusions PCNSL is a rare but aggressive tumor with poor prognosis. Patients treated with high-dose of methotrexate combining with rituximab, followed by WBRT have a better prognosis and longer survival time, and thus these could probably be a promising treatment.

OBJECTIVETo study the clinical, pathologic, immunophenotype, molecular characteristics and prognosis of HIV-negative plasmablastic lymphoma (PBL).

METHODSTwelve cases of HIV-negative PBLs diagnosed between 2005 and 2014 in Guangdong General Hospital were identified according to WHO classification of tumors of haematopoietic and lymphoid tissues (2008). The clinicopathologic features and outcome were analyzed and the relevant literatures were reviewed.

RESULTSThe patients were predominantly male (11/12) with a median age of 55.5 years. The tumor cells showed the characteristic combination of immunoblastic/plasmablastic morphology, plasma cell phenotype and high proliferation, no expression of mature B cell markers. 7/10 of the cases were EBER positive. Two cases were positive for C-myc translocation. Four of twelve patients were died.

CONCLUSIONSPBL is a rare, aggressive B-cell lymphoma. HIV-negative PBL has lower rate of oral involvement and EBER expression than HIV-positive patients, the differential diagnosis is very challenging, and the prognosis is worse.

Diagnosis, Differential ; Female ; HIV Seronegativity ; Humans ; Immunophenotyping ; Lymphoma, B-Cell ; diagnosis ; Male ; Middle Aged ; Plasma Cells ; classification ; Plasmablastic Lymphoma ; diagnosis ; pathology ; Prognosis ; Translocation, Genetic

【Objective】 To understand the current status and shortcomings of the informed consent of blood donors, and to ensure that the informed consent of blood donors complies with ethical norms and management requirements. 【Methods】 From January 1 to 31, 2022, the " Informed Consent Form for Blood Donor" and " Health Status Consultation Form", issued by 6 blood services in Beijing, Shanghai, Tianjin, Chongqing, Guangzhou and Zhejiang, were collected. The contents regarding individual informed consent were set as an analysis unit; 7 first-level codes such as the form of information disclosure, 19 second-level codes such as the title of the content to be informed, and 56 items such as the content to be informed before blood donation were established to make frequency statistics. 【Results】 The informed consent, issued by six blood centers, included such elements as the form of information disclosure, blood donation process and risks, authenticity of information, donor shielding requirements, screening for transfusion-transmitted infections, other uses of blood, and consent decisions. The second-level coding with frequency≥ 4 included 12 items(63.16%), such as the title of informed consent, truthful provision of health consultation information, and blood donation under real-name, of which precautions after blood donation, privacy statement, and withdrawal were " unexplained" frequency codes. The proportion of 56 items with frequency 1~6 was 55.36%, 12.50%, 10.71%, 17.86%, 1.79% and 1.79%, respectively. 【Conclusion】 The informed consent forms and health status consultation forms play a certain role in explaining and conducting informed consent in different places, but some contents are scattered and lack of specifications, information notification weights in shielding requirements while lacks post-donation care and privacy protection, and the decision-making process is inadequate. A standardized content framework for informed consent of blood donors should be established, the caring for blood donors should be promoted, and the full process of consent decision-making should be valued seriously.

Objectives: To investigate the clinicopathological features, therapy and prognosis of primary cardiac CD5-positive diffuse large B-cell lymphoma with C-MYC and bcl-2 double expression. Methods: Two cases diagnosed at Guangdong Provincial People′s Hospital were included, the clinical data were collected; the tumor morphology, immunophenotypic profiles, therapy and prognosis were analyzed. Results: Case 1 was a 55-year-old man and case 2 was a 61-year-old women. Intraoperatively, both cases showed large masses in the right atrium or ventricle, involving adjacent tissue. Pathologically, the tumors were composed of diffusely infiltrating large lymphoid cells with high mitotic activity and apoptosis. The tumor cells were positive for CD20, CD5, bcl-6, MUM1, C-MYC and bcl-2, and the Ki-67 index was equal or greater than 90%. Case 1 had bcl-6, but not bcl-2 or MYC gene rearrangements. No MYC, bcl-2 or bcl-6 gene rearrangements were detected in case 2. Case 1 defaulted chemotherapy after operation and died 1 month after diagnosis. Case 2 was treated with 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) therapy after surgery and attained partial remission, and was then treated with apatinib and ibrutinib, and remained stable 18 months after initial diagnosis. Conclusion Primary cardiac CD5-positive diffuse large B-cell lymphoma with C-MYC and bcl-2 double expression usually shows large infiltrative mass in the right atrium or ventricle, non-germinal center like immunophenotype and high proliferation index, and this may contribute to the aggressiveness of primary cardiac lymphoma.