Objective To summarize the expression of CK19, HBME-land 34βE12 in papillary carcinoma of the thyroid (PCT) and their differential diagnostic value. Methods Clinical data of papillary carcinoma of the thyroid,nodular goiter and paraeareinoma were reviewed. All HE slides were reexamined and immunostains for CK19, HBME-land 34βEI2 were performed in selected case. Staining results were evaluated. Results Those cases typically showed complex papillary structures and interstitial fibrosis, while nuclear features included ground class appearance, grooves and nuclear pseudoinelusion. The positive rates for CKI9, HBME-1 and 34βE12 in PCT were 100.0 %, 89.4 % and 42.6 % respectively, the differences were statistically significant(P <0.01). Conclusion PCT occurs preferentially in the group of middle-aged women. The diagnosis of PCT should be distinguished from other plesiomorphous benign papillary lesions. Combined detection of CK19, HBME-1, 34βE12 can be most helpful for diagnosis for of PCT.

Objective To investigate the feasibility and clinical value of medical history and clinical manifestation-based protocol(MHCMP) for the diagnosis of spontaneous coronary artery dissection(SCAD)using intravascular ultrasound (IVUS).Methods Based on the MHCMP designed in our centre,intraoperative sequential analysis was performed in patients with acute coronary syndrom and clinical tip of SCAD,SCAD and its classification were defined according to the result of IVUS.Results Of the 37 patients admitted with ACS at the Cardiology Service,29 patients had SCAD as the cause(78.4 ％).All the patients underwent coronary angiography and IVUS,of which 9 patiens were type I (24.3 ％),15 patients were type Ⅱ (40.5％) and 5 patients were type Ⅲ (13.5％).The left anterior descending artery was the most frequently affected (16 patients),followed by the the right coronary artery (7 patients),while 5 patients had dissection of the circumflex artery and 1 patient had dissection of the left main coronary artery.Type I (evident arterial wall stain):this was the pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens.Type Ⅱ (diffuse stenosis of varying severity):this angiographic appearance was not well appreciated and was often missed or misdiagnosed.SCAD commonly involved the mid to distal segments of coronary arteries,and could be so extensive that it reached the distal tip.There was an appreciable (often subtle) abrupt change in arterial caliber,with demarcation from normal diameter to diffuse narrowing.This diffuse and usually smooth narrowing could vary in severity from inconspicuous mild stenosis to complete occlusion.Type Ⅲ (mimic atherosclerosis):this appearance was the most challenging to differentiate from atherosclerosis and most likely to be misdiagnosed,while IVUS was helpful for the differential diagnosis.Conclusions MHCMP is able to screen out all kinds of SCAD and guide the treatment decisions making.

ObjectiveTo evaluate the safety, feasibility and efficacy of transplantation of purified peripheral blood CD34+ cells in treatment of critical ischemia of the lower extremities.MethodsFrom May 2009 to March 2010, seven cases of critical ischemia of the lower extremities received purified peripheral blood CD34+ cells transplantation, among those 6 were caused by thromboangiitis obliterans and 1 by thrombosis coexistent with nodular erythema. Mean age was ( 39 ± 11 ) years ( range 23 - 54 ), and all patients were not suitable for surgical or endovascular revascularization. G-CSF was subcutaneously injected for 5 days before apheresis for peripheral blood mononuclear cells. Then CliniMACS system was used to isolate the CD34+ cells. If the number of CD34+ cells was between 105/kg and 106/kg , they were all intramuscular injected into patients' calf and foot. ResultsTechnical success and limb salvage were achieved in all cases. The mean number of transplanted cells was (7. 1 ±2.3) × 105/kg [ range(4.6 ×105 -1 × 106 )/kg]. All cases were followed-up, ranging from 6 - 14 months (mean 8 ± 3 months). One month after transplantation, the rest pain was obviously relieved in all cases, and the Wong-Baker FACES pain rating scale score significantly decreased from 7. 1 ±2. 0(4 - 10)to 1. 1 ± 1.1 (0 -2) ,P =0. 0000. The pain-free walking distance was significantly improved from (4 ± 4) min (range 1 -10 min)to (12 ± 7 ) min (range 5 - 21min , P =0.04) at 3 months and(20.4 ± 12.5) min(range 6 -40 min, P = 0.02) at 6 months, respectively. The ankle-brachial index increased from 0. 54 ± 0. 18 ( range 0. 41 - 0. 87 ) to 0.66 ±0. 13(range 0. 52-0. 86 , P=0. 17)at 3 months and 0.72 ±0. 13(range 0.56 -0.91, P=0. 07)at 6 months, respectively. Of 6 cases with the toe ulcer, the ulcer was healed in 3 and apparently shrank in 3. Transcutaneous partial oxygen pressure rose from (29 ± 14)mm Hg(range 10 -52 mm Hg)to 46 ±14 mm Hg ( range 27 - 63 mm Hg, P = 0. 04) at 3 months and (57 ± 10) mm Hg( range 41 - 66 mm Hg, P =0.001) at 6 months,respectively.No serious complications were found either perioperatively or postoperatively.ConclusionsTransplantation of purified peripheral blood CD34+ cells is safe, feasible and effective in the treatment of critical ischemia of the lower extremities.

Objective:To investigate the value of whole-lesion histogram parameters of apparent diffusion coefficient (ADC) in evaluating and predicting the pathological complete response(PCR) to neoadjuvant chemotherapy (NAC) in different subtypes of breast cancer.Methods:This retrospective study included 117 patients with breast cancer who underwent MRI examination before NAC prior to surgery from January 2016 to December 2017 in the First Affiliated Hospital of Nanjing University. All cases were divided into Luminal B, HER2 positive ( n=21) and triple negative ( n=26) groups. The surgical pathology after chemotherapy was evaluated by Miller-Payne (M-P) system and the patients were divided into PCR group and non-PCR (nPCR) group. Firevoxel software was used to generate the whole-lesion ADC histogram. The parameters included mean (ADC mean), skewness, kurtosis, the minimum (ADC min), the maximum (ADC max), 10th percentile(ADC 10%), 50th percentile (ADC 50%) and 90th percentile (ADC 90%). The two independent samples t test or Mann-Whitney U test was used to compare the differences between PCR and nPCR groups in each subtype. The diagnostic performance of statistically different ADC parameters for predicting PCR was evaluated by receiver operating characteristic (ROC) curve. Results:Kurtosis was significantly higher in PCR group than that in nPCR group in HER2 positive subtype ( P=0.039). It achieved an area under the curve (AUC) of 0.813 with sensitivity of 100% and specificity of 68.7% at the optimal cutoff value (1.861) for differentiating PCR from nPCR cases. In triple negative subtype, ADC mean and ADC 50% were smaller in PCR group than those in nPCR group ( P=0.028,0.013). They achieved AUCs of 0.800, 0.842, respectively. When ADC mean of 1.030×10 -3 mm 2/s and ADC 50% of 0.976×10 -3 mm 2/s were used as cutoff value to differentiate PCR from nPCR, the sensitivities were 75.0%, 80.0% and the specificities were 83.3%, 83.3%, respectively. Conclusion:Kurtosis can predict post-NAC PCR in patients with HER2 positive breast cancer, while ADC 50% has a high value in predicting post NAC PCR of triple negative breast cancer patients.

Purpose To investigate the clinicopathological characteristics and prognostic correlation of the WHO(2021)new grading system of invasive pulmonary adenocarcinoma in stageⅠ pulmonary adenocarcinoma.Methods The clinical data of 447 patients with stage Ⅰ pulmonary adenocarcinoma were collect-ed,and all cases were evaluated according to the new grading system for invasive pulmonary adenocarcinoma.The immunohis-tochemical EnVision two-step method and elastic fiber staining were used to analyze the clinicopathological features with review of the relevant literature.Results In 447 patients with stage Ⅰlung adenocarcinoma,Napsin A and TTF-1 expression were posi-tive,p40 expression was negative,and Ki-67 proliferation index was higher than 5％in 177 patients(39.6％).There were 39 cases(8.7％)of positive pleural invasion in the visceral layer revealed by elastic fiber staining.The pleural invasion in stage Ⅰpulmonary adenocarcinoma patients was significantly higher than that in grades 2 and 3,the difference was statistically significant(P＜0.05).Patients with different grades of stage Ⅰ pulmonary adenocarcinoma were associated with gender,smoking history,surgical mode,chemotherapy,targeted medication,clinical stage,pathological classification,degree of differentiation,tumor size,vascular invasion,visceral pleural invasion,spread through air space(STAS)and Ki-67 index(P＜0.05).Survival analy-sis showed that there were statistically significant differences in disease free survival(DFS)and overall survival(OS)among different grades(grade 1＞grade 2＞grade 3)(P＜0.05).Cox regression analysis showed that WHO(2021)new grading of invasive pulmonary adenocarcinoma,visceral pleural invasion and Ki-67 proliferation index were independent risk factors for prognosis of patients with stage Ⅰ pulmonary adenocarcinoma.Conclusion The WHO(2021)new grading system of invasive pulmonary adenocarcinoma has good prognostic significance for stage Ⅰ pulmonary adenocarcinoma,and appropriate intervention for high-risk patients.It can effectively assist its postoperative treatment and has application value.

Objective Cell cycle-associated protein 1 (Caprin-1) is closely related to the development and progression of cancer. This study aimed to explore the expression of Caprin-1 in the clinical glioma specimen and its influence on the biological char-acteristics of the glioma cell line. Methods Brain tissue specimens were collected from 29 glioma patients and 2 normal humans that died of accidental trauma. A stably transfected U251 cell line with overex-pressed Caprin-1 was established,and the U251 cells were transfected with the pEGFP-C1 plasmid (the negative control group), or the pEGFP-C1-Caprin-1 plasmid (the experimental group), or left un-transfected (the blank control group). The expressions of Caprin-1 mRNA and protein in the cells were determined by RT-PCR and Western blot, and the proliferation and migration of the cells exam-ined by scratch test and Transwell assay,respectively. Results The expression of Caprin-1 was upregulated with the increased grade of glioma,145.9±22.0,444.4±110.0,and 1661.0±54.5 in WHO gradeⅡ,Ⅲ,andⅣglioma,respectively,significantly higher than in the normal brain tissue (P<0.05). Both the mRNA and protein expressions of Caprin-1 were remarkably higher in the experimental group (1.70±0.19 and 1.07±0.09) than in the blank control(0.89±0.10 and 0.52±0.04) and negative control(0.98±0.08 and 0.58± 0.03) (P<0.05).The A value was also markedly higher in the former group(2.55±0.14) than in the latter two(1.40±0.06 and 1.35± 0.04) (P<0.01),and so were the count of migrated cells(526.00±42.19 vs 289.00±29.24 and 279.00±32.48,P<0.01) and the ex-pression of CyclinD1 (0.60±0.05 vs 0.13±0.03 and 0.15±0.05, P<0.01). Conclusion The expression of Caprin-1 in the U251 cells was upregulated with the increased WHO grade of glioma,and the overexpression of Caprin-1 accelerated the proliferation and mi-gration of the U251 cells.

【Objective】 To explore the risk factors of transfusion-related acute lung injury (TRALI). 【Methods】 The clinical symptoms, signs, imaging examinations, and laboratory test results of two patients with TRALI after blood transfusion were retrospectively analyzed, and human leukocyte antigen (HLA) genotyping of the patient and HLA antibodies typing of the plasma donors were performed. 【Results】 The clinical manifestations and laboratory parameters of two patients were consistent with those of TRALI after blood transfusion. After timely clinical respiratory support treatment, all patients were improved. Blood donors produced high titers of HLA-Ⅱ antibodies after pregnancy, including antibodies that specifically recognize the patient′s HLA antigen. 【Conclusion】 Two patients developed TRALI after platelet transfusion from a female blood donor, which was caused by HLA-Ⅱ antibodies.

BACKGROUNDThe prevalence of metabolic syndrome (MetS) increased recently and there was still not a screening index to predict MetS. The aim of this study was to estimate whether brachial-ankle pulse wave velocity (baPWV), a novel marker for systemic arterial stiffness, could predict MetS in Chinese community population.

METHODSA total of 2 191 participants were recruited and underwent medical examination including 1 455 men and 756 women from June 2011 to January 2012. MetS was diagnosed according to the criteria of the International Diabetes Federation (IDF). Multiple Logistic regressions were conducted to explore the risk factors of MetS. Receiver operating characteristic (ROC) curve was performed to estimate the ideal diagnostic cutoff point of baPWV to predict MetS.

RESULTSThe mean age was (45.35±8.27) years old. In multiple Logistic regression analysis, the gender, baPWV and smoking status were risk factors to MetS after adjusting age, gender, baPWV, walk time and sleeping time. The prevalence of MetS was 17.48% in 30-year age population in Shanghai. There were significant differences (χ(2) = 96.46, P < 0.05) between male and female participants on MetS prevalence. According to the ROC analyses, the ideal cutoff point of baPWV was 1 358.50 cm/s (AUC = 60.20%) to predict MetS among male group and 1 350.00 cm/s (AUC = 70.90%) among female group.

CONCLUSIONBaPWV may be considered as a screening marker to predict MetS in community Chinese population and the diagnostic value of 1 350.00 cm/s was more significant for the female group.

Adult ; Ankle Brachial Index ; methods ; Female ; Humans ; Logistic Models ; Male ; Metabolic Syndrome ; diagnosis ; Middle Aged ; ROC Curve

Aim To elucidate the mechanism by which Rg3 regulates the function of CD8