Objective To analyze the expression of muscle scinderin(SCIN)in primary hepatocellular carci-noma(HCC)with portal vein tumor thrombus (PVTT)and its clinical significance.Methods 46 primary HCC patients with PVTT were selected.All patients'carcinoma adjacent tissues,HCC tissues,PVTT tissues were collected. SCIN expression in three kinds of surgical specimen was detected by immunohistochemical staining,the results were compared.All patients were followed up for three years,the recurrence rate within half a year and 3 -year mortality were compared.Results The positive expression rates of SCIN in carcinoma adjacent tissues,HCC tissues and PVTT tissues were 69.57%,45.65%,23.91%,which showed a decreasing trend.The relapsed within six months and 3 -year mortality rate of the SCIN -negative patients were 85.71%,95.24%,which were significantly higher than those of the SCIN -positive patients.The SCIN expression level was closely related to tumor size,with or without coating and alpha -fetoprotein level,the differences were statistically significant (χ2 =0.000,0.007,0.035,all P <0.05). Conclusion The SCIN expression level in primary HCC patients with PVTT is low,and it can be used as a prognos-tic indicator for primary HCC patients with PVTT.

Objective To analyze the expressions of tumor stem cell markers Lgr5 and CD44 in esophageal carcinoma and its clinical pathological significance.Methods A total of 108 cases of patients with esophageal cancer, 35 cases of stage Ⅱ, 40 cases of stage Ⅲ, 4 cases of stage Ⅳ. After tumor specimens were stained, the expressions of Lgr5 and CD44 in esophageal cancer tissue were detected and its relationship with the clinical features were analyzed.Results There were relations between expressions of Lgr5 and CD44 in esophageal cancer tissue and clinical staging, the later the stageing, the higher expression rate of Lgr5 and CD44, but there was no significant differece with Chi-square test. The Spearman correlation analysis showed there was no correlation between Lgr5 or CD44 and esophageal cancer condition. Conclusion CD44 and Lgr5 are highly expressed in esophageal cancer tissue, but the correlation between CD44 and Lgr5 expression and esophageal cancer condition is uncertain.

Objective To explore the effect of amifostine combined with low-dose cyclosporine in treatment of refractory immune thrombocytopenia effect and related mechanisms.Methods 60 cases of refractory immune thrombocytopenia patients using parallel randomized controlled groups, divided into three groups, 20 cases in each group, amifostine group were treated with amifostine, cyclosporine group were treated with cyclosporine, amifostine+CSA group received amifostine+cyclosporine A treatment.The platelet count, platelet membrane glycoprotein antibody, lymphocyte subsets and bone marrow megakaryocyte count were observed and compared.Results After different treatment of three, six months, the level of platelet count of patients in three groups were compared with the group before treatment were significantly increased, and the treatment of platelet count level of amifostine group and cyclosporine group were significantly lower than that of amifostine +CSA group, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.The total efficacy of amifostine+CSA group was significantly higher than the other two groups, the difference was statistically significant ( P<0.05 ) , there was no significant difference between amifostine group and cyclosporine group.After the treatment, the platelet membrane glycoprotein GPIIb/IIIa antibody levels in three groups were significantly increased, and ring the detection level of amifostine+CSA group after treatment was significantly higher than the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the three groups of CD4 +, CD4 +/CD25 +and CD4 +/CD8 +levels were significantly increased, CD8 +decreased significantly, the difference was statistically significant (P<0.05).And the level of change after treatment with amifostine +cyclosporine group was significantly higher than that of the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the number of bone marrow megakaryocytes in the three groups was significantly lower than that before treatment , the level of count after treatment with amifostine +cyclosporine was significantly lower than that of the other two groups, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and cyclosporine group.The adverse reactions of amifostine group and amifostine+CSA group were significantly lower than that in cyclosporine group, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and amifostine+CSA group.Conclusion Amifostine combined with low dose of cyclosporine in treatment of refractory immune thrombocytopenia can play a synergistic effect, improve the therapeutic effect, and effectively reduce the dosage and adverse reactions.

Objective To explore the clinicopathological characteristics and prognosis of invasive micropapillary carcinoma of the breast (IMPC),and the distinction between IMPC and invasive ductal carcinoma of the breast (IDC).Methods From February 2004 to November 2013,195 IMPC patients and 420 IDC patients were analyzed retrospectively.Results There were significant differences in mammilla invasion,lymph vessel invasion,orange peel sign,soft tissue encroachment,neoadjuvant chemotherapy,radical mastcctomy,lymph node metastasis,clinical stages,tumor size,lymph node staging,estrogen receptor (ER),progestin receptor (PR),human epidermal growth factor receptor 2 (HER2),molecular subtyping,ratio of radiation,ratio of endocrine therapy,disease-free survival (DFS),overall survival (OS)between the two groups,all P ＜0.05.Patients with IMPC had lower 5-year DFS and OS rates (68.2％ and 73.8％,respectively) than IDC patients (85.7％ and 88.6％,respectively),all P ＜ 0.05.In IMPC patients with positive ER/PR,HER2-negative,smaller tumor volume,less lymph node metastasis,negative nipple invasion,negative lymphatic vessel tumor thrombus,negative orange peel change had higher 5-year DFS and OS rates than those with negative ER/PR,HER2 overexpression,larger tumor volume,more lymph node metastasis,positive nipple invasion,positive lymphatic vessel tumor thrombus,positive orange peel change,all P ＜ 0.05.Besides,the patients with pathologic stage Ⅰ had higher OS than those with stage Ⅲ (P ＜ 0.05).Cox regression analysis found that orange peel change,lymph vessel invasion and HER2 were the independent risk factors for the survival time of patients with IMPC.Conclusions IMPC patients have lower DFS and OS compared with IDC.

Objective To investigate the clinicopathologic characteristics and prognosis of medullary breast carcinoma.Methods We conducted a retrospective analysis on clinical and pathologic data of 166 patients with medullary breast cancer.Results All the patients were female with a median age of 52 years old.The proportion of patients with stage Ⅰ,Ⅱ and Ⅲ disease was 16.9％,68.1％,15.0％,respectively.The Luminal,HER-2 overexpressing and triple-negative subtypes constituted 31.3％,8.4％,and 60.3％,respectively.There was significant difference in regional lymph node status of medullary breast cancer patients with different molecular types (x2 =18.248,P =0.003),but not in tumor size,TNM stage,histological grade,and expression of Ki67 (all P ＞ 0.05).Multivariate survival analysis indicated that TNM stage was an independent predictor in the prognosis of medullary breast cancer (HR =5.664,P =0.001).All the patients were followed up from 15 months to 145 months with a median follow-up time of 108 months.The 5-year survival rate was 91.5％ and the 10-year survival rate was 87.2％.Conclusions The prognosis of medullary breast cancer is favorable.Personalized treatment according to the TNM stage and histopathologic characteristics achieve a favorable prognosis.

Objective To investigate the clinical and pathologic features of squamous cell carcinoma of the breast.Methods The clinical and pathologic data of 23 squamous cell carcinoma of the breast patients admitted between 1984 and 2013 to Tianjin Medical University Cancer Hospital was analyzed retrospectively.Results Primary squamous cell carcinoma of the breast was a very rare tumor accounting for 0.06％ of all breast cancers.All of the 23 patients were females aged 28 years to 87 years(median age 49 years).Average tumor size was 4.5 cm.9 patients suffered from lymph node metastasis at admission (39.1％).The positive rates of estrogen receptor (ER),progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) were 13.6％ (3/23),4.5％ (1/23) and 0 (0/20) respectively.With a follow-up time varying from 5 months to 36 months recurrence or metastasis were found in 8 patients,and another 1 patient was found having distant metastasis at admission.Lung metastasis (7/9) was most common.6 patients died.Conclusions Squamous cell carcinoma of the breast is highly invasive,with low rate of positive receptors and early distant metastasis or recurrence after operation,and poor patients' survival.

[ABSTRACT]OBJECTIVETo study the expressions of 34βE12, Galectin-3 and HBME-1 in thyroid nodules, and to explore its diagnostic value for papillary thyroid carcinoma (PTC).METHODSEn VisionTM immunohistochemical technique was used to detect the expression of 34βE12, Galectin-3 and HBME-1 in 352 thyroid lesions. The correlation between the expressions of the 3 protein markers and clinicopathological characteristics was evaluated. The receiver operating characteristic area under the curve (ROC-AUC) and their index for diagnosis evaluation were also calculated.RESULTSThe positive rates of 34βE12, Galectin-3 and HBME-1 in 246 PTC lesions were significantly higher than those in benign nodules (P<0.001). There was no relationship between the expression of the 3 protein markers and clinicopathological characteristics (eg. gender, age, numbers of lesions, tumor size, capsular invasion, lymph node metastasis, TNM staging). The ROC-AUC of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 0.936, 0.915 and 0.898 respectively. The sensitivity of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 94.3%, 95.5% and 91.1% respectively, while the specificity was 81.1%, 71.7% and 83.0% respectively, and the diagnostic accuracy rate was 90.3%, 88.4% and 88.6% respectively.CONCLUSION The expressions of 34βE12, Galectin-3 and HBME-1 are statistically different between PTC and benign lesions, but no associations are found with clinicopathological characteristics, indicating the three protein markers have important diagnostic value for PTC.

Objective To explore the clinical features and causes of misdiagnosis of the patients with acquired deficiency of vitamin K-dependent coagulation factors (ADVKDCF). Methods Retrospective analysis was performed with the data from 62 patients with ADVKDCF for etiological factors, clinical manifestations,laboratory examinations, diagnosis and treatments. Results Among the 62 patients, 51 patients were with unknown causes( subgroup A) and 11 were with clear histories of anticoagulant rodenticide poisoning( subgroup B). The presentations of hemorrhage of the patients varied with hematuria as the most common first symptom,followed by skin, mucosa, muscle, internal organs bleeding (28/62). The most common hemorrhage symptom is hematuria. 35 of the 62 patients had hemoglobin(Hb) levels less than 100 g/L due to blood loss( the lowest level was 32 g/L). Thirty-eight patients were misdiagnosed at the first visit and the median time from hemorrhage manifestation to definite diagnosis was 8 days (range,2 to 192 days). ADVKDCF was mostly misdiagnosed as the urinary system diseases (23/38), followed by hemophilia (8/38). Laboratory examinations showed normal platelet count , throm bin time (TT) and normal fibrinogen(Fg) concentration, but prolonged plasma prothrombin time (PT), activated partial prothrombin time (APTT) and international normalized ration (INR). All of patients received high dose vitamin K ( intravenous vitamin K1 with a initial dose of 20 to 240 mg/d and then oral vitamin K4 maintenance) . The bleeding symptoms disappeared 1 day after treatment and the Hb levels increased dramatically. There were significant differences in PT, APTT and INR of the patients before and after treatment( P ＜0. 01 ). Followed by a median follow - up of 8 months , no patient had severe adverse effects or recurrence. Conclusion The hemorrhage presentations of the patients with ADVKDCF are various. The most common hemorrhage symptom is hematuria. The misdiagnosis rate of ADVKDCF is high with urinary systems disorders as the most common misdiagnosis. Sequential treatment with vitamin K is an effective and safe method to prevent recurrence. Early detection of coagulation function is helpful to reduce misdiagnosis possibility.

AIM:To explore the therapeutic effect of a novel Rho kinase inhibitor WAR 5 on the experimental autoimmune encephalomyelitis (EAE) and its possible mechanism.METHODS: Female C57BL/6 mice were randomly divided into EAE group and WAR5 group.EAE model was induced by the application of MOG 35-55 peptide.WAR5 was in-jected intraperitoneally every other day from post-immunization (PI) day 3 to PI day 27.The clinical score and body weight were recorded every other day .On PI day 28, the animals were sacrificed and spinal cords were obtained for HE and mye-lin staining .The splenocytes were isolated and the expression of CD 16/32 and CD206 were analyzed by flow cytometry . The protein extracts from the brains and spinal cords were collected for the measurement of inducible nitric oxide synthase ( iNOS) by Western blotting .RESULTS:The administration of WAR 5 delayed the onset of EAE and attenuated the clini-cal symptoms .The results of the pathological examination revealed that WAR 5 inhibited the infiltration of inflammatory cells and improved myelination in spinal cords , accompanied with the poralization of M 1 macrophages to M2 phenotype in the spleen.WAR5 inhibited the expression of iNOS in the central nervous system , especially in the spinal cords .CON-CLUSION:The therapeutic effect of WAR5 on EAE may be related to the shift of M1 macrophages to M2 phenotype and inhibition of inflammation in the central nerve system .

Objective:To investigate the clinic diagnostic value of multi-slice CT (MSCT) imaging features in various subtypes of nodular lung adenocarcinoma.Methods:The imaging information and general clinical data of 160 patients with nodular lung adenocarcinoma who were admitted to Yantai Affiliated Hospital of Binzhou Medical University and received surgical treatment from January 2017 to May 2019 were retrospectively analyzed. Univariate analysis was used to screen statistically significant imaging features of each pathological subtype, and binary logistic regression analysis was performed. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was calculated, and the diagnostic efficacy was compared.Results:The age of patients with atypical adenomatous hyperplasia and adenocarcinoma in situ (AAH+ AIS), minimally invasive ademocarcinoma (MIA), invasive adenocarcinoma cancer (IAC) and variant of invasive adenocarcinoma cancer (VIAC) were (57.07±7.92), (59.37±6.96), (60.68±8.83), (63.33±6.89) years old, with no statistically significant difference ( F=1.221, P=0.304). The age of patients with VIAC, IAC, MIA and AAH+ AIS decreased in turn. The imaging features of AAH+ AIS, MIA, IAC and VIAC that exhibited statistically significant differences were as following in turn: the maximum diameter of lesion [6.85 (3.73) mm vs. 8.00 (5.00) mm vs. 16.00 (11.90) mm vs. 17.20 (9.08) mm, H=55.107, P<0.001], CT value [-563.50 (176.63) HU vs. -536.00 (293.50) HU vs. -235.50 (346.50) HU vs. -23.00 (30.50) HU, H=47.499, P<0.001], solid ratio [0 (0) vs. 0 (0) vs. 49.00% (100.00%) vs. 100.00% (0), H=44.242, P<0.001], vacuolar sign [14 (87.50%) vs. 35 (100.00%) vs. 84 (81.55%) vs. 3 (50.00%), χ2=13.925, P=0.002], inflatable bronchus sign [1 (6.25%) vs. 2 (5.71%) vs. 36 (34.95%) vs. 2 (33.33%), χ2=16.578, P=0.001], intratumoral vascular sign [13 (81.25%) vs. 28 (80.00%) vs. 64 (62.14%) vs. 1 (16.67%), χ2=11.168, P=0.009], vessel convergence sign [1 (6.25%) vs. 3 (8.57%) vs. 66 (64.08%) vs. 6 (100.00%), χ2=54.232, P<0.001], short burr sign [3 (18.75%) vs. 11 (31.43%) vs. 77 (74.76%) vs. 6 (100.00%), χ2=36.218, P<0.001], lobulation sign [4 (25.00%) vs. 18 (51.43%) vs. 93 (90.29%) vs. 6 (100.00%), χ2=43.302, P<0.001], pleural traction sign [0 (0) vs. 6 (17.14%) vs. 70 (67.96%) vs. 5 (83.33%), χ2=50.794, P<0.001]. The maximum diameter of lesion ( OR=0.858, 95% CI: 0.754-0.977, P=0.021) and pleural traction sign ( OR=0.288, 95% CI: 0.084-0.993, P=0.049) were independent influencing factors of MIA. The maximum diameter of lesion ( OR=1.131, 95% CI: 1.030-1.241, P=0.010) and pleural traction sign ( OR=3.441, 95% CI: 1.279-9.254, P=0.014) were independent influencing factors of IAC. The optimum threshold of the maximum diameter of lesion in diagnosis of MIA was 11.05 mm, AUC was 0.798 (95% CI: 0.724-0.872) sensitivity was 68.00%, and specificity was 85.70%. The AUC of pleural traction sign in diagnosis of MIA was 0.714 (95% CI: 0.623-0.806). The diagnostic efficacy exhibited no statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of MIA ( Z=1.838, P=0.066). The optimum threshold of the maximum diameter of lesion in diagnosis of IAC was 11.05 mm, AUC was 0.827 (95% CI: 0.759-0.895), sensitivity was 75.70%, and specificity was 78.90%. The AUC of pleural traction sign in diagnosis of IAC was 0.743 (95% CI: 0.663-0.823). The diagnostic efficacy exhibited statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of IAC ( Z=2.114, P=0.035), and the maximum diameter of lesion > 11.05 mm was better for the diagnosis of IAC. Conclusion:The maximum diameter of lesion and pleural traction sign are independent influence factors in diagnosis of MIA and IAC, and the maximum diameter of lesion > 11.05 mm is better for the diagnosis of IAC.