Purpose To investigate the clinicopathological characteristics and genetic variations of stage Ⅰ lung adenocarci-noma with high-grade components,according to the new grading system of the WHO classification of thoracic tumors(2021).Methods A retrospective analysis was conducted on the clini-cal data of 785 patients with stage Ⅰ lung adenocarcinoma.HE,EnVision immunohistochemistry and Victoria blue staining were used,common genetic variation(EGFR/KRAS/ALK/ROS1/RET)were detected by PCR method.The correlation between different high-grade components and clinical pathological charac-teristics as well as genetic variations in stage Ⅰ lung adenocarci-noma were analyzed.Results A total of 785 cases of stage Ⅰlung adenocarcinoma were enrolled,including 332 cases with high-grade components and 453 cases without high-grade compo-nents.Among the adenocarcinomas with high-grade components,there were 7 cases of grade 1,150 cases of grade 2,and 175 ca-ses of grade 3.The positive rates of tumor cells spreading through airspace(STAS),vascular invasion,and pleural inva-sion in grade 2 adenocarcinoma with two high-grade components(61.5％,21.2％,26.9％)were significantly higher than that of the adenocarcinomas with only one high-grade component(20.4％,7.1％,5.1％),but there was no significant differ-ence in grade 3 adenocarcinoma.The positive rate(39.0％)of STAS in the micropapillary group with one high-grade component in grade 2 adenocarcinoma was significantly higher than that in the complex glandular group(9.3％)and the solid group(0),while there was no significant difference between the latter two groups.Among the three groups there were no statistically signif-icant differences in grade 3 adenocarcinoma.In 167 cases of ad-enocarcinoma with two or more high-grade components,there were 74 cases(44.3％)of complex glands combined with mi-cropapillary components,67 cases(40.1％)of complex glands combined with solid components,8 cases(4.8％)of micropap-illary combined with solid components,and 18 cases(10.8％)of three types of components.The positive rates of pleural inva-sion and KRAS gene mutation or fusion gene(ALK/ROS1/RET)in the group of complex glands combined with solid(49.3％,28.3％)were significantly higher as compared to those in the group of complex glands combined with micropapil-lary(27.0％,8.6％).The positive rate of psammoma bodies in the group with high-grade components(24.7％)was significant-ly higher than that in those without high-grade components(3.5％,P＜0.001),and the positive rate of psammoma bodies in group of gene mutation(EGFR/KRAS)(40.4％)was higher than that in the no-gene mutation group(26.7％,P＜0.05).Conclusion The clinicopathological features of different high-grade components in stage Ⅰ lung adenocarcinoma are not identi-cal,suggesting that their invasiveness may have different biologi-cal backgrounds.Characteristic morphological observations are helpful.

Objective ToexploretheclinicopathologicalfeaturesandMRImanifestationsofseveralspecialtypesofuterineleiomyomato improvethediagnosticlevelofit.Methods TheclinicopathologicalfeaturesandMRImanifestationsof18caseswithuterineleiomyomathatwere verifiedbypathologicanalysiswereanalyzedretrospectively.Results Amongthe18cases,therewere11casesofcellularleiomyoma,5casesof fattyleiomyomaand2casesofintravenousleiomyoma.Thetumorswereroundorirregular,withaclearmarginandamaximumdiameterof3.2cm to12.5cm.CellularleiomyomashowedisointensityonT1WI,homogeneouslyorslightlyhyperintensityonT2WI,and mostofthem werehyperintenseonDWI,whileafewisointense.Thelesionshowedearlyobviousenhancementandcontinuedtostrengthen,higher thanthemyometriumofthesameperiod.Fattyleiomyomaconsistsofsmooth musclecellsandadipocytesindifferentproportions, smoothmuscletissueshowedisointensityonT1WI,andisointensityorslightlyhyperintensityonT2WI,whileadiposetissueshowed hyperintensityonT1WIandT2WI,hypointensityonfatsequence,lighttomoderateenhancementforsmooth muscletissueandadiposetissue ntravenousleiomyomashowedirregularcircuity,shuttlesolidlumpin myometriumorneartheuterus,whichshowedisointenseon T1WI,andunevenorhyperintensityonT2WI,moderateheterogeneousenhancement,multiplecircuityvesselswithinoraroundthelesions.Allthe threetypesofuterineleiomyomaabovehavecertainMRIfeaturesandareassociatedwithpathology.Conclusion TheMRIfindingsof thecell-richleiomyomashowthattheedgeofthetumorisclear,ofwhichshowhyperintensityonDWI,andearlyandcontinuousenhancement, whilethedegreeofenhancementishigherthanthatinthemyometriumofuterusatthesameperiod.MRIofuterineadiposeleiomyomashows"whirlpool"or "braided"distributionoffatsignalinthetumor,andnoenhancementinadiposetissue;MRIofvenousleiomyoma showsirregulartwistsandturnsbetweenthewallofuterusorbesidetheuterus,andmoderateorunevenintensificationafterenhancement. withoutI.

Objective:To investigate the clinical significance of inflammatory factors in bacterial infection children with glucose-6-phosphate dehydrogenase (G6PD) deficiency in PICU.Methods:A prospective cohort study was carried out from June 2014 to December 2017. 77 bacterial infection children with pediatric critical illness score less than 80 who were admitted to the PICU, were recruit in the study.The patient diagnosed as other basic diseases,with history of high-dose glucocorticoid use, discharged or died within 24 hours were excluded.The recruited patients were divided into G6PD deficiency group (observation group with 36 cases) and non-G6PD deficiency group (control group with 41 cases) according to the presence or absence of G6PD deficiency.Blood samples were taken at admission, 12 hand 24 h after hospitalization to detect the concentrations of tumor necrosis factor (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10) andC-reactive protein (CRP). T test, χ2 test and Fisher exact test were used to analyze the changes of the above inflammatory factors, complications, prognosis, PICU stay time and hospitalization costs. Results:The levels of inflammatory factors in the observation group were significantly higher than those in the control group at admission, 12 and 24 hours after hospitalization, the differences were statistically significant (all P< 0.05). There was no statistically significant difference in thechangerate of inflammatory factors between the two groups during treatment; The PICU stay time of observation group was longer [(7.98 ± 6.55) vs (5.01 ± 6.21)] and the hospitalization cost (yuan) was higher [(36 634.09 ± 11 876.67) vs (31 571.42 ± 10 245.80)], P<0.05; Compared to the control group, the incidence ofsevere sepsis, septic shock, MODS increased significantly, and the curative rate decreasedsignificantly in observation group( P<0.05). Conclusions:G6PD-deficient children with bacterial infections had serious inflammatory reactions with poor prognosis and higher hospitalization costs and were susceptible to the occurrence of severe sepsis, septic shock and MODS.

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.