Purpose To explore the clinicopathological features,immunophenotype,differential diagnosis and prognosis of the composite pheochromocytoma (CP)-ganglioneuroma.Methods 3 cases of CP-ganglioneuroma were stained by immunohistochemical SP method,and the related literatures were reviewed.Results 3 cases of CP-ganglioneuroma were one male and 2 females,the age were 37-64.Case 3 were of primary mediastinal.Microscopically,the tumor tissues were composed of two components:one type of tumor cells were arranged in nests with a predominant Zellballen pattern,round or oval nuclei,fine granular cytoplasm and rare mitotic,another part of the neoplasm showed scattered and aggregated distributed ganglion cells in the background of neurofibromatosis which aligned bundles and interwoven,the edge of the tumor was still residual adrenal tissue.Immunohistochemically,components of pheochromocytoma were positive for CD56,CgA,Syn,vimentin and negative for SMA,Melan-A,α-inhibin NF with low Ki-67 proliferation index.S-100 was positive in supporting cells,ganglioneuroma components were positive for NF,S-100 with low Ki-67 proliferation index.CgA and Syn were weakly positive or negative in the ganglion cells.Conclusion CP is a relatively rare tumor,which can not be distinguished from pheochromocytoma in clinical and radiological diagnosis.The corresponding clinical treatment and follow-up management should be taken according to the different ingredients (benign or malignant).

Objective To explore the optimal method of treatment for radiation proctitis by keeping coloclysis with traditional Chinese medicine (TCM), including administation temperature, infusion time, dosage and catheter depth. Methods The orthogonal experimental design was adopted. Sixty-three patients with radiation proctitis were randomly divided into 9 groups, and they were under enema for 6 weeks according to different test conditions. TCM syndrome score, radiation injury effect and Karnofsky scores were set as evaluation indexes. An orthogonal design and analysis of variance were conducted for optimization. The best technical schemes for traditional Chinese herb in treating radiation proctitis were obtained. Results The obtained optimum methods are:drug temperature of (39±0.5)℃, infusion time of 30 minutes, dosage of 100 mL, catheter depth of 20 cm. Conclusion The optimal scheme of enema for the treatment of radiation proctitis is reasonable and feasible.

Objective To study the change curve of ADH in central diabetes insipidus after neurosurgical operation,and analyse the clinical significance of differentiating the types of central diabetes insipidus through the change curve.Methods The serum level of ADH was observed in 158 central diabetes insipidus patients undergone neurosurgical operation.The change curve of ADH in different types of central diabetes insipidus were painted,including transient,continuous and triphasic diabetes insipidus.Results The serum concentrations of ADH in transient and triphasic diabetes insipidus decreased after operation,and arrived the low point(41.7% and 63.6% of the preoperative serum concentration of ADH) after 2 d. The serum concentration of ADH in transient diabetes insipidus recovered to the preoperative level after 10 d.The serum concentration of ADH in triphasic diabetes insipidus arrived the peak after 7 d,then descended.The serum concentration of ADH in continuous diabetes insipidus fell in postoperative 1 d,and arrived the low point(33.3% of the preoperative serum level of ADH) after 7 d.The serum concentration of ADH in continuous diabetes insipidus postoperative 2 weeks was lower than preoperation.Conclusion Though the concentration change curve of ADH,the transient diabetes insipidus can be distinguished from continuous and triphasic diabetes insipidus.The correct differential diagnosis and seemly treatment are beneficial for patients' prognosis.

Objective To study the effects of Panax Notoginseng Saponins (PNS) on the damaged expression of ZO-1 of brain microvascular endothelial cells caused by Aβ42.MethodsBrain microvascular endothelial cells were divided into normal control group, model group, PNS low-, medium- and high concentration groups. They were incubated for 24h in 5% CO2 incubator at 37℃ . Then cell vitality was detected by MTT colorimetric method and ZO-1 protein expression was tested by Western blot.Results Stimulation of Aβ42 reduced the activity of microvascular endothelial cells (P<0.01) and suppressed the expression of ZO-1 protein (P<0.01). Compared with the model group, the activity of microvascular endothelial cells of PNS groups, especially the high and medium dose groups (P<0.05), and increased the ZO-1 protein expression. Conclusion PNS can partly recover the barrier function of blood brain barrier through inhibiting the decrease of the activity of microvascular endothelial cells caused by Aβ42.

Objective To explore the clinicopathological features and diagnosis of adenoid cystic carci noma of the breast (ACCB).Methods Clinical data of 3 cases of ACCB were collected and followed up to observe the clinical pathological features.Immunohistochemistry was used to determine the immune phenotype.Results All the 3 cases were female,aging from 55 to 72 years old (61 years old as the average).The tumors were found in subareolar region well-circumscribed.ACCB was characterized by the presence of a dual cell population of luminal and basaloid cells arranged in cribriform and tubular-trabecular patterns.On immunohistochemical staining,the myoepithelial cells expressed SMA,CK5/6,P63,CD117 and the glandular epithelium cells were mostly positive for CK18,EMA,CK7,while no expression of ER,PR,HER-2,CD10 was observed.Conclusions ACCB is a rare neoplasm with a triple-negative,basal-like phenotype,but exhibits an indolent clinical behavior.The diagnosis can be worked out by evaluation of clinical characterstics,histological and immunohistochemical features.

Objective To observe the expression of transforming growth factor factor-β1 (TGF-β1) and vas cular endothelial growth factor (VEGF) in breast cancer to explore the correlation between each other and their relationship with invasion,metastasis and prognosis of breast cancer.Methods Immunohistochemistry was used to detect the expression of TGF-β1 and VEGF in 230 breast cancer tissues and adjacent tissues.The correlation between them and the relationship between their expression and the clinical pathological parameters of breast cancer were analyzed.Results The positive rates of TGF-β1 and VEGF in breast cancer were 72.6％ and 68.3％,respectively.But in adjacent breast tissues,the positive rate was 21.3％ and 42.2％,respectively.The expression of TGF-β1 was closely related to the histological grade,ER state and 5-year recurrence (P＜0.05),while ER status and 5-year recurrence were independent predictors of the positive expression of TGF-β1.The expression of VEGF was significantly correlated with ER status and 5-year recurrence (P＜0.05),while ER status was independent predictor of the positive expression of TGF-β1.The expression of VEGF was significantly positively correlated with the expression of TGF-β1 (γ=0.419,P＜0.01).Conclusion The expression of TGF-β1 and VEGF in breast cancer is closely related to the invasion,metastasis and prognosis of breast cancer,which has a certain clinical significance.

Objective: To compare droplet digital PCR (ddPCR) and Super-amplification refractory mutation system (ARMS) in the detection of T790M mutation of epidermal growth factor receptor (EGFR) in the plasma of non-small cell lung cancer patients who had developed resistance to EGFR tyrosine kinase inhibitor (TKI) , and to investigate the clinical application of ddPCR. Methods: Plasma samples were collected from non-small cell lung cancer patients who had acquired EGFR-TKI resistance at Shanghai Pulmonary Hospital, Tongji University, from May 2017 to November 2017. Extracted ctDNA was analyzed by ddPCR and Super-ARMS to evaluate the T790M mutation status of EGFR gene. Results: A total of 37 patients with activating EGFR mutation that acquired resistance to EGFR-TKI were selected in the study, including 17 male and 20 female with a median age of 64 years (range 40-83 years). Before TKI treatment, all the patients harbored EGFR inhibitor sensitive mutations but without T790M mutation. After acquiring resistance to EGFR-TKI treatment, the T790M mutation rate detectable by ddPCR was 45.9% (17/37). In contrast, the mutation rate of T790M detectable by Super-ARMS was 35.1% (13/37, P<0.05). For the 13 positive cases detected by Super-ARMS (ΔCt<8), they were all positive by ddPCR assay; Among the 10 negative cases detected by Super-ARMS (ΔCt≥8), there were 3 cases positive by ddPCR assay. For patients without ΔCt by Super-ARMS assay, there was one weak positive case detectable by ddPCR assay. Among 17 EGFR T790M positive patients, 9 received EGFR inhibitor Osimertinib treatment, and 7 of them had good therapeutic response after the treatment. Conclusions While a significant correlation between the two methods is shown. ddPCR is more sensitive than Super-ARMS in the detection of EGFR T790M mutation, indicating that it is a better method in guiding target drug therapy of non-small cell lung cancer patients after acquiring the resistance to EGFR-TKI.

Objective:To explore the value of tumor stroma ratio (TSR) in non-small lung cancer (NSCLC) tissue in predicting the efficacy of tumor immunotherapy.Methods:The clinical and histopathological data of patients with stage ⅢB-Ⅳ NSCLC treated with immune checkpoint inhibitors in the Renmin Hospital of Wuhan University from January 2017 to December 2020 were collected. Taking 50% as the TSR boundary value, the patients were divided into low TSR group (≤50%) and high TSR group (>50%) . The histopathological features, 4-cycle objective response rate (ORR) and disease control rate (DCR) , 6-cycle ORR and DCR, and progression-free survival (PFS) were compared between the two groups. Univariate and multivariate Cox regression models were used to analyze the prognostic factors related to PFS.Results:A total of 50 patients were included, including 27 with low TSR and 23 with high TSR. There were no significant differences between the two groups in age ( χ2=0.59, P=0.441) , gender ( P=0.578) , smoking history ( χ2=0.12, P=0.730) , histopathological type ( χ2=2.33, P=0.313) , TNM stage ( χ2=0.22, P=0.636) , 4-cycle ORR ( χ2=0.48, P=0.487) and DCR ( P=0.593) , 6-cycle ORR ( χ2=0.05, P=0.818) and DCR ( P=0.641) . The incidence of brain metastasis was higher in the high TSR group than that in the low TSR group [34.8% (8/23) vs. 7.4% (2/27) , χ2=4.23, P=0.040]. Kaplan-Meier survival analysis showed that the PFS in the low TSR group was significantly longer than that in the high TSR group (15.6 months vs. 10.2 months, χ2=13.84, P<0.001) . Univariate analysis showed that TSR value ( HR=0.29, 95% CI: 0.14-0.58, P<0.001) and brain metastasis ( HR=2.38, 95% CI: 1.12-5.05, P=0.024) were correlated with the worse prognosis of NSCLC patients. Multivariate Cox regression analysis showed that TSR value was an independent prognostic factor for NSCLC immunotherapy ( HR=0.32, 95% CI: 0.14-0.70, P=0.004) . Conclusion:TSR is an independent predictor of immunotherapy for NSCLC, but whether it can predict the short-term efficacy of immunotherapy for advanced NSCLC still needs further research.

Objective:To investigate the incidence of social isolationin community elderly patients with knee osteoarthritis and analyze its influencing factors.Methods:From January to April 2021, 240 community elderly with knee osteoarthritis in three community health service centers in Taiyuan (Yingbin community, Dawang community and Pingyang second community) were selected as research objects by convenient sampling method. They were investigated by general data questionnaire, Lubben Social Network Scale-6(Lubben-6), Geriatric Depression Scale-15, Perceived Social Support Scale, Numerical Rating Scale. Single factor analysis and binary Logistic regression analysis were used to explore the influencing factors of social isolation in elderly patients with knee osteoarthritis.Results:The prevalence of social isolation among community elderly patients with knee osteoarthritis was 43.33% (104/240) . The results of binary logistic regression analysis showed that age ( OR = 2.228, 95% CI 1.436-3.457), complicated diseases ( OR = 1.733, 95% CI 1.028-2.919), exercise ( OR = 0.560, 95% CI 0.360-0.869), depression ( OR = 3.603, 95% CI 1.768-7.339), comprehension of social support ( OR = 0.424, 95% CI 0.253-0.710) and pain ( OR = 1.792, 95% CI 1.147-2.799) were the influencing factors of social isolation in elderly patients with knee osteoarthritis ( P<0.05). Conclusions:The degree of social isolation in community elderly patients with knee osteoarthritis is relatively high, and is affected by many factors. Community medical staff should formulate targeted nursing intervention plans based on their influencing factors to reduce the occurrence of social isolation.

OBJECTIVETo investigate the effects of Hydroxy Safflor yellow A (HSYA) on the growth of blood vessel of transplantation tumor of gastric adenocarcinoma cell line BGC-823 in nude mice and its underlying mechanism of antagonizing tumor angiogenesis.

METHODThe BGC-823 cells was subcutaneouly injected into the right anterior armpit of BALB/C nu/nu nude mice and established the animal model of transplantation tumor. Then nude mice were divided into 4 groups at random: model group, control group, high or low dosage of HSYA group. The model group were treated with normal sodium by intraperitoneal injection, HSYA groups were treated with HSYA at concentration of 0.056 g x L(-1) and 0.028 g x L(-1) by intraperitoneal injection, and in these groups each mouse was injected 2 times everyday with 0.2 mL by 4-6 hours interval. The control group were injected in enterocoelia 1 times every 2 days starting from the third day with cytoxan at 2 g x L(-1). 20 days later, the volume and weight of nude mice were observed. The pathological change of tumor tissue was observed under optical microscope. The mRNA expression of VEGF and bFGF of transplantation tumor were detected by real time quantitative PCR.

RESULTThe volume (607.42 +/- 252.96) mm3, weight (0.88 +/- 0.14) g of transplantation tumor, the mRNA expression level of VEGF 0.49 +/- 0.13 and bFGF 0.60 +/- 0.48 are reduced significantly after treatment with HSYA at the concentration of 0.028 g x L(-1) compared with physiologic saline-treated group (P < 0.05 or P < 0.01). The tumor pathological angiogenesis of HSYA group is also less obvious than the normal sodium-treated group.

CONCLUSIONHSYA in given concentration can inhibit the growth of BGC-823 transplantation tumor, and decreasing the mRNA expression of VEGF and bFGF, which suggests that inhibiting tumor angiogenesis may be one of the mechanisms of HSYA antagonizing tumor.

Adenocarcinoma ; drug therapy ; genetics ; metabolism ; Angiogenesis Inhibitors ; administration & dosage ; Animals ; Blood Vessels ; drug effects ; Cell Line, Tumor ; Chalcone ; administration & dosage ; analogs & derivatives ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Fibroblast Growth Factors ; genetics ; metabolism ; Gene Expression Regulation, Neoplastic ; drug effects ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Quinones ; administration & dosage ; Random Allocation ; Stomach Neoplasms ; drug therapy ; genetics ; metabolism ; Vascular Endothelial Growth Factor A ; genetics ; metabolism