Objective To investigate the effects of splenctomy on the idiopathic thrombocytopenic purpura (ITP) patients. Methods 9 patients with ITP were involved in the present study,who were performed with splenecto-my because of refractoriness, contraindicatiun and intolerance during corticosteroids therapy. Results The average platelet count of the patients before operation was 35×109/L,while the first,4th and 7th day after operation,the aver-age platelet count was 98×109/L, 179×109/L and 235×109/L. After follow-up for 6 months,there were 7 cases having marked improvement, and the total effective rate was 88.9%. Conclusion Splenectomy is a recommendable method for ITP, expecially for those are inefficient,incompatible and intolerated to continually pharmacotherapy.

OBJECTIVETo investigate the clinicopathological features and the differential diagnosis of poroma and porocarcinoma.

METHODSHistopathological characteristics and clinical data of 35 cases of poroma and 10 cases of porocarcinoma were analyzed retrospectively.

RESULTSThe average age of 35 patients of poroma was 48 years. The average age of 10 patients of porocarcinoma was 65 years. Both poroma and porocarcinoma occured most frequently on the scalp and face,as well as the extremities. Histologically, cases of poroma were divided into three subtypes, including classic poroma (23 cases), hidroacanthoma simplex (3 cases) and dermal duct tumor (9 cases). Residual foci of benign poroma were found in all cases of porocarcinoma, most of which were classic poroma. The malignant components showed severe dysplasia and/or stromal infiltration.

CONCLUSIONThe diagnosis of poroma and porocarcinoma is mainly based on the microscopic characteristics. An invasive architectural pattern and/or significant cytologic pleomorphism are the most important clues for the diagnosis of porocarcinoma. Neither focal mitotic activity nor the presence of necrosis was the diagnostic feature of porocarcinoma. Malignant transformation can occur in some cases of long existing poroma with recent, rapid tumor enlargement.

Aged ; Cell Transformation, Neoplastic ; Diagnosis, Differential ; Eccrine Porocarcinoma ; pathology ; Extremities ; Head and Neck Neoplasms ; pathology ; Humans ; Middle Aged ; Poroma ; pathology ; Retrospective Studies ; Scalp ; Skin Neoplasms ; pathology ; Sweat Gland Neoplasms ; pathology

Objective To detect the expressions of CD70 mRNA and protein and to determine the methylation status of CD70 gene promoter in T cells from patients with systemic lupus erythematosus (SLE).Methods Peripheral blood CD4+ and CD8+ T cells were isolated from 15 patients with active SLE,15 patients with inactive SLE and 15 healthy control subjects.Real-time quantitative reverse transcription-PCR was carried out to quantify the mRNA expression of CD70,flow cytometry to determine the frequency of CD4+CD70+ and CD8+ CD70+ T cells,and bisulfite sequencing to evaluate the methylation status of CD70 gene promoter in CD4+ and CD8+ T cells.Differences in these parameters among these groups were analyzed by one-factor analysis of variance and SNK-q test.Results Compared with the healthy controls,the patients with active SLE and inactive SLE showed a significant increase in CD70 mRNA expression in CD4+ T cells (0.82 ± 0.12 and 0.73 ± 0.11 vs.0.45 ±0.09,F =53.017,P ＜ 0.01) and in the frequency of CD70+CD4+ T cells (80.30％ ± 11.04％ and 66.80％ ± 3.98％ vs.12.48％ ± 3.45％,F =311.517,P ＜ 0.01).Also,the expression of CD70 mRNA in CD4+ T cells and the frequency of CD70+CD4+ T cells were significantly higher in patients with active SLE than in patients with inactive SLE (both P ＜ 0.05).There was a positive correlation between the frequency of peripheral CD70+CD4+ T cells and disease activity in SLE in these patients (r =0.792,P ＜ 0.01).The average methylation index of the region between-600 bp and-300 bp of CD70 gene promoter in CD4+ T cells was 0.32 ± 0.05 and 0.36 ± 0.05 respectively in the patients with active and inactive SLE,significantly lower than that in the healthy controls (0.62 ± 0.05,F =152.64,P ＜ 0.01),and the patients with active SLE showed a significantly lower methylation index than those with inactive SLE (P ＜ 0.05).Conclusions The CD70 gene promoter in CD4+ T cells is significantly hypomethylated in patients with SLE,which may directly lead to the overexpression of CD70.

Objective To analyze clinicopathologic features and malignant transformation of spiradenoma (SA).Methods Clinicopathologic data on 25 cases of SA were retrospectively analyzed.An immunohistochemical study was conducted on 5 of the 25 patients.Clinicopathologic features of SA were summarized based on clinicopathologic data,immunohistochemical results and relevant literature.Results The average age of these patients was 40 years.Lesions were acquired and solitary in 24 cases (96％,24/25),and occurred most frequently in the extremities.The diameter of tumors was less than 2 cm in 20 cases (87％,20/23).Twenty-three cases were benign SA with various histological manifestations,including 15 cases (65％,15/23) of typical SA,8 cases (35％,8/23) of cylindroma.VarTing numbers of mitotic figures were observed in different cases.The immunohistochemical study showed epithelial and myoepithelial differentiation.Two cases of SA experienced malignant transformation into poorlydifferentiated basal cell adenocarcinoma and well-differentiated adenocarcinoma respectively.Lymphocytes decreased significantly in number or disappeared in the malignant area,and both the malignant tumors exceeded 2 cm in diameter.Conclusions SA is a kind of neoplasm with distinct histological characteristics and nonspecific clinical manifestations.Most SA cases have a benign clinical course,but malignant transformation should be considered in some cases with longterm clinical course and large size.

Objective To isolate and culture the rat limbal stem cells ( LSCs) in vitro,and investigate briefly their capacity for transdif-ferentiation into neural stem cells ( NSCs) with cytokine EGF,bFGF and RA.Methods LSCs derived from rats were cultured and identified by immunohistochemistry in vitro.LSCs were induced to differentiate into NSCs in the presence of EGF (20 ng/mL) ,bFGF (10 ng/mL) and with or without of RA(group 1 or group 2)(25 ng/mL) for seven days.Cultures without factors were used as control group.Then the neural marker Nestin of the coultured cells were measured by immunohistology staining.Furthermore,the positive cell rate was counted under micro-scope between the 2 groups and analyzed by statistical software.Results It showed that P63 was positive in LSCs.Nestin in both of the dif-ferentiation groups was positive at the rate of (77.01 ±6.32)%and (84.01 ±5.43)%respectively,of which the second group was higher than the first one (P<0.05).However,it was negative in the control group.A band of Nestin protein from cells was detected by western blot assay.Conclusion LSCs are successfully isolated and cultured in vitro.LSCs could be induced to differentiate into NSCs in the presence of EGF and bFGF.Moreover,the differentiation capability is enhanced in the condition of RA.

Objective To investigate pathological characteristics and differential diagnosis of desmoplastic melanocytic nevus.Methods Four cases of desmoplastic melanocytic nevus were analyzed based on the clinical manifestations and histological,immunohistochemical and fluorescence in situ hybridization (FISH) features.Results Of the 4 cases,2 were male and 2 were female.Their age ranged from 19 to 30 years with the average age being 26.5 years.The skin lesions were located on the extremities in 3 cases,on the vulva in 1 case.Histologically,the lesions were bilaterally symmetrical intradermal nevus.Nevus cells appeared epithelioid and/or fusiform,some were clustered or scattered in the proliferative fibrous tissue.None of lymphocyte aggregation,necrosis or ulceration was observed.Immunohistochemical examination showed positive staining for S100 and Melan A in 3 cases,positive staining for P16 in 2 cases,Ki-67-1abeling index less than 5％ in all the 4 cases,and negative staining for factor XⅢ (FXⅢ) and CD34 in 2 cases.FISH assay showed no copy-number variations in gene loci 6p25 (RREB1),6q23 (MYB),6p11.1-q11.1 (Cep6) and 11q13 (CCND1) in desmoplastic nelanocytic nevus.Conclusion Desmoplastic melanocytic nevus is a kind of histologically unique,benign melanocytic nevus,and immunohistochemical staining for Ki-67,S-100,Melan A and FXmand FISH assay on melanoma can be helpful for the differential diagnosis between cutaneous fibrous histiocytoma and melanoma.

Objective: To investigate the incidence of coutrast media iodixanol-induced delayed adverse reaction with the risk factors in general clinical practice.
Methods: A total of 20,185 patients with contrast iodixanol were recruited from 95 medical centers in China. The risk factors for adverse drug reaction as hypertension, asthma, previous contrast reaction were assessed;the administrative processes as route, injection manner, lfow rate of injection, prior heating of iodixanol were monitored and the demographic information was documented. The immediate adverse reaction within 1 hour of media administration and the delayed adverse reaction from 1 hour to 7 days after administration were recorded. The risk factors for iodixanol-induced delayed adverse reaction were studied by singlevariate and multivariate logistic regression analysis.
Results: The overall iodixanol-induced adverse reaction rate was 1.52%, of which the immediate reaction was 0.58%and delayed reaction was 0.97%. The major delayed reaction was mild and it mostly happened in skin (0.68%) including rash, pruritus and urticaria. Multivariate logistic regression analysis revealed that male gender (OR=0.71, P=0.036), age (OR=0.82, P=0.001), route of administration (OR=0.21, P<0.001), prior heating of iodixanol (OR=1.44, P=0.036), lfow rate of injection (OR=1.28, P=0.001) and previous contrast reaction (OR=16.04, P<0.001) were the independent risk factors for delayed adverse reactions.

Objective:To compare the dose distribution among CyberKnife, Tomotherapy, Edge, Triology and γ-knife in stereotactic body radiation therapy (SBRT) for pancreatic cancer.Methods:Clinical data of 10 panreatic cancer patients receiving CyberKinife treatment were retrospectively analyzed. The treatment plans were designed by five apparatuses from five centers according to the uniform requirement. All plans were transferred to MIM system for the extraction of parameters, which mainly included D min, D mean and D max of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, D max and dose-volume of the stomach and bowel. Results:The best CI and nCI were obtained in Triology ( P<0.001), and the worst HI was found in γ-knife ( P<0.001). The best GI was found in CyberKnife, followed by γ-knife and Tomotherapy, and Edge showed the worst GI ( P<0.001). The highest D min of PTV was found in both Edge and Triology, while lower D min of PTV was found in CyberKnife and Tomotherapy ( P<0.001). Additionally, γ-knife provided the highest D mean and D max of PTV ( P<0.001). Regarding the organs at risk, the lowest D max and D 5cm 3 of the bowel ( P<0.001), D max of the stomach ( P=0.003), D max( P=0.001), D 5cm 3 ( P<0.001) and D 10cm 3 ( P=0.005) of the duodenum, D max( P<0.001) and D 0.35cm 3 ( P<0.001) of the spinal cord were found in CyberKnife. The highest D max of the bowel was found in γ-knife. Furthermore, the highest D 5cm 3 of the duodenum was demonstrated in Edge ( P<0.001) and Tomotherapy provided the highest D max( P<0.001) and D 0.35cm 3 of the spinal cord ( P<0.001). Conclusions:All five radiotherapy apparatuses can meet the requirement of SBRT for pancreatic cancer. More rapid dose fall-off could be obtained via CyberKnife and γ-knife. Triology and Edge provide better target conformity. CyberKnife can better protect the gastrointestinal tract.

Objective:To investigate the relationship of the acute radiation reactions of totalbody irradiation before hematopoietic stem cell transplantation with the different total and fractionated doses of irradiation.Methods:The clinical data of 48 patients who underwent 6 MV X-ray total body irradiation pretreatment from May 2015 to December 2019 in Shijiazhuang Ping'an Hospital before undergoing hematopoietic stem cell transplantation were retrospectively analyzed. The patients were divided into 8 Gy group (12 cases), 10 Gy group (31 cases) and 12 Gy group (5 cases) according to the total radiation dose, and divided into 4 Gy/f group (17 cases) and 5 Gy/f group (31 cases) according to the fractionated radiation dose. Acute radiation reactions in the oral mucosa, pharynx, salivary glands, upper gastrointestinal tract, lower gastrointestinal tract and lung of patients in each group after radiotherapy were summarized and compared.Results:Acute pharyngeal reaction in the total radiation dose of 8 Gy group showed that 11 cases (91.7%) were grade 0 and 1 case (8.3%) was grade 1; in the total radiation dose of 10 Gy group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4; in the total radiation dose of 12 Gy group, 2 cases (40.0%) were grade 0, 1 case (20.0%) was grade 1, 1 case (20.0%) was grade 2, and 1 case (20.0%) was grade 3. The severity of acute pharyngeal radiation reaction in the total radiation dose of 8 Gy group was better than that in the 10 Gy and 12 Gy groups, and the difference was statistically significant ( χ2 = 11.338, P = 0.003); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Acute pharyngeal radiation reaction in the fractionated radiation dose of 4 Gy/f group showed that 13 cases (76.5%) were grade 0, 2 case (11.8%) was grade 1, 1 case (5.9%) was grade 2, and 1 case (5.9%) was grade 3; in the 5 Gy/f group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4. The severity of acute pharyngeal radiation reaction in the fractionated radiation dose 4 Gy/f group was better than that in the 5 Gy/f group, and the difference was statistically significant ( Z = -2.606, P = 0.009); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Conclusion:The total dose of 8 Gy and fractionated dose of 4 Gy/f in the total body irradiation before hematopoietic stem cell transplantation can alleviate the acute pharyngeal radiation reaction.

Objective To investigate the clinical manifestation and electrophysiological, muscle imaging and pathological, molecular features of oculopharyngodistal myopathy (OPDM). Methods The clinical electrophysiological, muscle imaging and pathological, molecular data was collected from a case of OPDM. Data analysis was conducted together with a literature. Results The onset age of the patient was 25 years old. The sequential order of involved muscle was upper eyelid muscle, external ocular, laryngopharyngeal, facial, distal limb muscle and proximal upper limb. Serum creatine kinase was mildly elevated. Electromyography revealed myogenic changes with demyelinating peripheral neuropathy. Myopathological findings showed myopathic changes with rimmed vacuoles . Muscle image showed that fatty replacement of was more severe in lower legs than in thigh. Posterior muscle was severely involved in lower legs. All known genes responsible for distal and myofibrillar myopathies, vacuolar myopathies, and muscular dystrophies were excluded by targeted next-generation sequencing. Conclusion The case is a sporadic case. OPDM is a disease with a unique phenotype which not only affects muscle but also involves multiple system (demyelinating peripheral neuropathy、heart disease and so on).