Objective:To investigate the clinical characteristics and therapy of laryngeal neuroendocrine carcinoma(LNEC).Method:Ten cases of LNEC treated in our department were retrospectively analyzed.Result:Eight out of 10 cases were were atypical carcinoid:1 case treated as supraglottic horizontal partial laryngectomy died 22 months after operation; 1 case was lost;the other 6 cases were followed up for more than 2 years. Two cases were small cell type,one received supra-cricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP) ,neck dissection,and radiotherapy,but died after 14 months;the other was receiving radiotherapy.Conclusion:LNEC is a rare malignant tumor and the diagnosis relies on clinical characteristics, histopathological and immunohistochemistry examination. The different types of LNEC should give different treatment protocols.

Objective To observe the apoptosis of retina and the expression of caspase-3 in mice with premature myopia and to explore the pathogenesis of premature myopia.Methods Together 60 newborn C57BL/6J mice were selected and divided randomly into three groups (n =20):P6 group (opening the eyelid on day 6 after birth),P10 group (opening the eyelid on day 10 after birth) and normal group (opening the eyelid naturally).The right eyes of mice in the P6 and P10 group were subjected to lighting exposure,and the left eyes were left untreated serving controls with its right eyes;while the eyes in the normal group open naturally without any treatment.Then the refraction was checked on day 15 through retinophotoscopy,and ocular axial length was measured by micrometer with electronic digital display.TUNEL assay was used to determine retinal apoptosis.Immunohistochemistry and Western blot were used to detect the expression of caspase-3 in mice retina.Results The right eyes developed significant myopia in the P6 group [(-7.55 ±0.15)D] and P10 group [(-5.25 ±0.10)D],while the eyes in the normal group did not suffer from myopia,and there was significant difference in the three groups (P ＜0.05).The average axial length of right eyes in the P6 group [(2.49 ± 0.08) mm] and the P10 group [(2.51 ±0.03)mm] was shorter than that in the normal group [(2.58 ± 0.04) mm],with significant difference (P ＜ 0.05).Immunohistochemistry showed that the expression of caspase-3 had a dramatically increase in ganglion cell layer and inner nuclear layer of retina of mice in P6 group and P10 group.TUNEL results showed that brown-stained positive apoptotic cells appeared in ganglion cell layer in the P6 and P10 group,while Western blot showed that the expression of caspase-3 protein in mouse retina in P6 group (gray value 52.70％) and P10 group (gray value 35.76％) was upregulated.Conclusion Early lighting exposure can induce premature myopia of mice,and the earlier the mice receive light,the higher the relative degree of myopia is;meanwhile during the process of premature myopia,ganglion cells and nuclear layer cells suffer apoptosis,as well as caspase-3 protein involves in the occurrence of apoptosis.

ObjectiveTo investigate the managements of complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).MethodsData of 119 EA patients who underwent POEM from October 2010 to July 2011 were collected.Complications during and after POEM and during follow-up were analyzed.Results Complications during operation included bleeding in 19 patients ( 16.0％ ),mucosa rupture in 9 (7.6％),mediastinal and subcutaneous emphysema in 27 (22.7％ ) and pneumothorax in 3 (2.5％ ).Complications occurred at the night of procedure included pain in 43 (36.1％ ) patients and pneumothorax in 7 ( 5.9％ ).Postoperative complications included asymptomatic pneumothorax in 23 patients (19.3％),delayed hemorrhage in 1(0.8％),pleural effusion in 58 (48.7％ ),minor pulmonary inflammation or segmental atelectasis in 59 (49.6％),emphysema of mediasti-na and subcutaneous tissue in 76 (63.9％ ),and gas under diaphragm or aeroperitoneum in 47 (39.5％ ).Complications during follow-up included one case of dysphagia caused by stricture of mucosa and one case of dehiscence at the tunnel entry with food retention.No POEM-correlated death occurred.All the complications were cured by conservative treatments.No additional surgery was needed.ConclusionMain complications as emphysema of mediastina and subcutaneous tissue,pneumothorax,aeroperitoneum and bleeding during and after POEM can be treated timely and effectively with conservative treatment.

To study the relationship between the late postmortem interval (PMI) and trimethylamine-nitrogen (TMA-N) in postmortem tissues of cadaver, TMA-N in muscles, livers and kidneys of rats was measured at different postmortem intervals (PMI) by using a modified spectrophotometric method. The results indicated that the detection sensitivity of TMA-N was 1 mg/L, and there was a good linear correlation between the value of absorbance (A value) and TMA-N at the concentration of 1-10 mg/L (R (2) = 0.9991). Although TMA variation in muscles was different from that in inner organs during the time since death, TMA-N changes in cadaver tissues was positively correlated with PMI. During 2 to 7 d since death, the best correlation between PMI and TMA-N concentration was found in muscles. With PMI as an independent variable, the cubic polynomial regression equation was y= -0.457x(3)+6.519x(2)-24.574x+27.207 (R (2)=0.969). During 3 to 8 days since death, PMI was best correlated with TMA-N concentration in inner organs. With PMI as the independent variable, the cubic polynomial regression equation was y=0.509x(3)-9.153x(2)+55.727x-95.819 (R (2)=0.953). It was concluded that TMA-N in tissues could be used as a new estimator for late PMI. The method used in this study offered advantages such as accuracy, sensitivity, little samples required and wide PMI estimation.
Cadaver ; Forensic Pathology ; Methylamines/*analysis ; Nitrogen/*analysis ; Pilot Projects ; Postmortem Changes ; Random Allocation ; Rats, Sprague-Dawley ; Spectrophotometry ; Time Factors

It is known that LINC01018 and CDK6 are associated with the occurrence, progression and recurrence of malignant tumor. Our preliminary data showed that the expression of LINC01018 was down-regulated and that of CDK6 was up-regulated, which were related with the malignancy grade. Bioinformatics suggested that E2F1 binding site exist in the CDK6 promoter region, and LINC01018 might interact with E2F1. Thus we speculate that the expression of LINC01018 in malignant tumor is decreased. The interaction between LINC01018 and E2F1 activates E2F1, promotes the transcription activation of CDK6, and affects tumor proliferation, invasion and metastasis. All these are expected to reveal the effect and mechanisms of LINC01018 in the development and regulation of malignant tumor, and provide new ideas and evidences for its treatment.

Objective To observe the effects of early intravenous administration of Astragalus on brain inju-ry in neonates with severe asphyxia. Methods According to hospital serial number, 80 neonates with severe as-phyxia were divided into conventional treatment group (control group) (n=40), which was on the basis of symp-tomatic support treatment for the use of cerebrolysin and citicoline treatment; Astragalus injection treatment group (n=40), which, apart from the conventional treatment, Astragalus injection was given as soon as possible (within six hours after birth). The incidence of convulsions or frequent seizures convulsions and the mortality in two groups, the clinical degree of hypoxic ischemic encephalopathy (HIE) and the behavior nerve score determination were ob-served and compared. Results The incidence of convulsions or frequent seizures convulsions was significantly lower in the Astragalus treatment group than in the control group (45.00% vs 67.50%, χ24.501,P<0.05). The per-centage of the behavior nerve score determination in 7 d-8d and 12 d-14d after birth was obviously lower in the for-mer group than the latter one (48.57% vs 74.19%, χ2 4.642,P<0.05; 31.42% vs 58.06%, χ24.601, P<0.05). The mortality was not significant different between the two groups (12.50 % vs 22.50%, χ22.000, P>0.05). Conclusion For severe asphyxia neonates, on the basis of the symptomatic support treatment, the use of Astragalus injection, as soon as possible, can significantly reduce the hypoxic ischemic brain injury.

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

Purpose To analyze the clinicopathologic and immunohistochemical features, differential diagnosis and prognosis of papil-lary renal cell carcinoma (PRCC). Methods Thirty-two cases of PRCC diagnosed were reviewed. A retrospective study was per-formed including reviewing the clinical documents, pathological sections and immunohistochemical stainning and follow-up was made of 32 cases of PRCC. Twenty-one patients were treated with radical nephrectomy, eleven patients were treated with partial nephrectomy. Results Among 770 cases of renal epithelial tumors 32(4. 2%) cases of PRCC were detected. Histologically, the PRCC were charac-terized by varying proportions of papillary and tubular architecture covered by single or multiple layer of tumor cells with scanty or volu-minous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma, and the cytoplasm of some tumor cells contained hemosiderin. Of these 32 patients, 18 and 14 were diagnosed type-Ⅰand type-IIPRCC, re-spectively. Type-I, with small cuboid cell and pale cytoplasm, 16 of them were low in Fuhrman grading, Type-II, with large colunmar cells, rich in eosinophilic cytoplasm, 12 of them were high in Fuhrman grading. Immunohistochemically, the PRCC showed positive immunostaining for vimentin, EMA, CK(AE1/AE3), CK7, CD10 and AMACR. All the tumors studied were negative for CK (34βE12) and TFE-3. Follow-up data were available for 31 cases, 4 patients died of cancer specific causes, 1 with type-Ⅰand 3 with type-II tumors after surgery. The other 27 patients were alive without recurrence or metastasis. High Fuhrman grading, intravascular tumor emboli, lymph node metastasis and high clinical stage were prognostic indicators in PRCC. Conclusions PRCC with unique pathological features is not a common subtype of renal cell carcinoma in China. The presence of higher nuclear grade, sarcomatoid ele-ments or clear cell carcinoma structure may indicate an aggressive biologic behavior and poor prognosis. Close attention to the cytologic and growth pattern characteristics will allow us to arrive at the proper diagnosis in most cases, although sometimes immunohistochemis-try and rarely molecular genetic evaluation may be needed.

Objective To investigate the clinical features and prognostic factors of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in adults.Methods Clinical data of 40 adult patients with EBV-HLH admitted in the First Affiliated Hospital of Nanjing Medical University during January 2010 and September 2013 were retrospectively analyzed.The patients were divided into fatal group or survival group based on the results of 1-month follow-up.Logistic regression analysis was performed to identify risk factors of early death.Results EBV-HLH in clinic were characterized by fever,hepatosplenomegaly and lymphadenopathy.The incidences of peripheral blood cytopenias in 2 or 3 lines,hepatic dysfunction and hyperferritinemia in EBV-HLH patients were 60.0％ (24/40),95.0％ (38/40) and 94.9％ (37/39),respectively.Hemophagocytic phenomenon in bone marrow was observed in 83.8％ patients (31/37).Soluble CD25 (sCD25) was detected in 12 patients,and all were higher than 2 400 pg/mL.Nineteen patients died 1 month after fiual diagnosis with a fatality rate of 47.5％.Univariate logistic regression analysis indicated that EBV-DNA ＞ 105 copies/mL (OR =4.85,95％ CI:1.14-25.83,P ＜ 0.05),PLT ＜ 50 × 1012/L (OR =6.81,95 ％ CI:1.41-32.83,P ＜ 0.05),total bilirubin ＞ 50 μmol/L (OR =6.91,95％ CI:1.24-38.52,P ＜0.05),albumin ＜ 30 g/L (OR =7.50,95％ CI:1.80-31.28,P ＜ 0.01),serum ferritin ＞5 000 μg/L (OR =8.75,95％ CI:2.03-37.67,P ＜0.01) and polyserositis (OR =5.40,95％ CI:1.18-24.64,P ＜0.05) were risk factors of death within 1 month after final diagnosis,while chemotherapy was a protective factor of early death (OR =0.15,95％ CI:0.03-0.81,P ＜ 0.05).Conclusions EBV-HLH in adult has a poor prognosis.Significant elevated EBV-DNA,total bilirubin or serum ferritin,and notable decrease of peripheral blood platelet count or albumin level may indicate a poor prognosis,while chemotherapy may reduce the risk of early death.

Carcinoma, Non-Small-Cell Lung ; genetics ; Exons ; genetics ; Genes, erbB-1 ; genetics ; Humans ; Lung Neoplasms ; pathology