Objective To investigate the tubulocystic carcinoma (TC) of kidney in diagnosis and differential diagnosis,clinical and pathological features.Methods A case of TC was performed with HE and immunohistochemical staining,with review of the related literature.Results A man of 43 years old,who was found an occupying in the upper pole of the right kidney by B ultrasound,was performed ill-circumscribed of the right kidney.A gray solid ill-circumscribed mass was found within the renal parenchyma,which was sized of 1.5 cm × 1.5 cm × 1.0 cm.Microscopically,the tumor showed an invasive growth,and that it was composed of small tubular and vesicular structure closely spaced with slender fibrosis mesenchymal.The epithelial cells lining the tubules and cysts were flattened,cuboidal and hobnail cells,with abundant eosinophilic cytoplasm and obvious nucleolus of Fuhrman grade 3.The tumor showed positive of cytokeratin,CD10+++ and P504S+++,with low Ki-67 labeling index.Postoperative follow-up of 6 months,the patient showed no tumor recurrence and metastasis.Conclusions TC is a special subtype of renal cell carcinoma,with a tubular and cystic structure,high nuclear grade and rare mitotic.The differential diagnosis mainly includes other renal cystic lesions.The biological behavior of TC is indolent with less recurrence and distant metastasis.

OBJECTIVETo observe the therapeutic effect of transcutaneous electrical acupoint stimulation (TEAS) combined with auricular acupoint sticking (AAS) for treatment of primary nocturnal enuresis (PNE).

METHODSTwo hundred and fifty cases of PNE patients were randomly divided into an observation group and a control group, 125 cases in each group. Two groups were treated on basis of the routine treatment, the observation group was treated with TEAS at Zhongji (CV 3), Qihai (CV 6) and Sanyinjiao (SP 6) etc. combined with AAS at Xin (heart), Shen (kidney), and Jiaogan (sympathytic) etc., once each day, 15 days constituting one course, an interval of 5 days between two courses, the therapeutic effect was evaluated after 3 courses of continuous treatment. The control group was treated with oral administration of Desmopressin Acetate (DA) and Meclofenoxate, the therapeutic effect was evaluated after 2 months of continuous treatment.

RESULTSThe total effective rate of 96.8% (121/125) in observation group was superior to that of 90.4% (113/125) in control group (P < 0.05), the observation group was superior to control group in reducing the times of nocturia and enuresis, onset time and duration of effect (all P < 0.05).

CONCLUSIONTEAS combined with AAS can reduce the times of nocturia and enuresis of PNE children, with significant therapeutic effect, taking quick effect and keeping long effect duration.

Acupuncture, Ear ; methods ; Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy ; Electroacupuncture ; methods ; Female ; Humans ; Male ; Nocturnal Enuresis ; therapy

Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University,After admission,blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHEⅡ) and CURB-65 score were carried out. According to the prognosis,the patients were divided into death group (16 cases) and survival group (62 cases),The difference of PCT,white blood cell(WBC),CURB-65 score and APACHE Ⅱ score in the two groups were compared. The differences of area under ROC curve of APACHE II score,procalcitonin (PCT),CURB-65 score,PCT and CURB-65 score were compared. Results The PCT,CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3. 35±1. 79) μg/L vs. (2. 05±1. 89) μg/L,(2. 06±0. 85) points vs. (1. 40±0. 99) points,(20. 50±4. 06) points vs. (14. 13+5. 63) points,respectively. There were significant differences between the two groups ( P＜0. 05) . The number of WBCs in survival group and survival group were ( 9. 90 ± 3. 04)×109/L and ( 8. 77 ± 3. 70)×109/L, respectively, with no significant difference between the two groups (P＝0. 263); the area under the ROC curve of PCT predicting death was 0. 716 (P＝0. 001),the area under the ROC curve of CURB-65 predicting death was 0. 679 ( P＝0. 005), and the area under the ROC curve of APACHE II score was 0. 836 (P＝0. 001) ,which was larger than PCT and CRUB-65 (P＜0. 05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0. 775 (P＝0. 001). There was no significant difference between PCT and CRUB-65 and APACHE II (P＝0. 345) . Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia,and has important application value.

Objective To study the prevalence of the BRAF V600E mutation in papillary thyroid carcinoma ( PTC) and its association with clinicopathologic features.Methods Two hundred and ninety-two patients with primary PTC encountered during the period from December 2010 to December 2012 and underwent surgery in Cancer Hospital, Chinese Academy of Medical Science were enrolled into the study. Polymerase chain reaction was used to amplify exon 15 of the BRAF gene from paraffin-embedded thyroid tumor specimens, followed by direct sequencing to detect the BRAF V600E mutation.Statistical analysis was performed with SPSS 16.0 for Windows. Association between BRAF mutation and clinicopathologic parameters was tested with theχ2 test or Fisher exact test as appropriate.Results There were 87 males and 205 females in the cohort. The age of patients ranged from 13 to 84 years ( mean =43.1 years ) . BRAF V600E mutation was found in 190 cases ( 65.1%) . The presence of BRAF V600E mutation correlated with age at diagnosis (older than 45 years), tumor volume (larger than 1 cm), extrathyroidal extension, classic type/tall-cell variant and advanced disease stage ( P<0.05).BRAF V600E mutation did not correlate significantly with gender, multicentricity, lymph node metastasis or anatomic location ( P >0.05).Conclusion BRAF V600E mutation is associated with high-risk clinicopathologic characteristics in patients with PTC.The BRAF V600E mutation may be a potential prognostic factor in PTC patients.

Objective: To analyze the expression of programmed death ligand 1 (PD-L1) in patients with advanced lung adenocarcinoma and the consistency of four PD-L1 immunohistochemical detection platforms, with an aim of establishing baseline information to predict and select patients for programmed death 1 (PD-1)/PD-L1 immune inhibitor therapy. Methods: This was a multi-center retrospective study, collecting totally 57 advanced lung adenocarcinoma biopsy specimens from four centers from August 2017 to December 2017.The mean age of 57 patients was 59 (range 34-81) years, and 29 cases were male, 28 cases were female. Four PD-L1 immunohistochemical stains were done for each case, including 22C3 (Dako), 28-8 (Abcam), SP263 (Ventana), and SP142 (Ventana). Among them, 22C3 staining was done using Dako autostainer, and for the other three antibodies, Ventana Ultraview detection system and autostainer was used. The immunohistochemical slides were read by two trained histopathologists in a double-blinded way, and the percentage of PD-L1 positive tumor cells was assessed as <1%, 1%-24%, 25%-49% and more than 50%. Results: The Dako 22C3 was used as the standard. There were eight cases in which the PD-L1 staining was more than 50% (14.0%, 8/57). The staining consistency of tumor cells was higher in 22C3, 28-8 and SP263 (ρ=0.729-0.809). The two scoring doctors had a high degree of concordance in PD-L1 positive tumor cells (ρ=0.707-0.896), and this was most noticeable in 22C3 and SP263. Conclusions 22C3, 28-8 and SP263 show high consistency in tumor cell staining. The study can provide an effective basis for screening for potential patient population that may benefit from immunotherapy.

Objective:To analyze the pathologic features of responses to neoadjuvant immunotherapy of squamous cell carcinoma (SCC) of the lung.Methods:The study included 31 patients with resected lung SCC post neoadjuvant immunotherapy. All patients were recruited from the neoadjuvant anti-PD-1 (Sintilimab) phase Ⅰb clinical trial (ChiCTR-OIC-17013726). The histopathological morphology and different degrees of pathologic response to immunotherapy were evaluated basing on irPRC standard.Results:According to the percentage of residual viable tumor (% RVT), pathologic responses of complete pathologic response (cPR), major pathologic response (MPR) and non-MPR were noted in 19% ( n=6), 29% ( n=9), and 52% ( n=16) of patients respectively. In addition, extensive immune activation phenomena (immune cell infiltration, including infiltration of lymphocytes, plasma cells, foamy macrophages, lymphocyte aggregation and tertiary lymphoid structures formation) and tissue repair features (giant cells, granuloma formation, proliferative fibrosis and neovascularization) were observed in tumor regression bed. Conclusions:Neoadjuvant immunotherapy has favorable effect on lung SCC. Pathologic assessment of resected lung cancer specimens after neoadjuvant immunotherapy shows unique histopathological features consistent with its mechanism.

Treatment position recognition in medical images is a key technique in medical image processing. Due to the excellent performance of convolutional neural networks on features extraction and classification, an architecture of parallel convolutional neural networks is proposed to recognize treatment positions in X-ray images, which uses convolution kernels of different sizes to extract local features of different sizes in these images. The experimental analysis shows that parallel convolution neural networks, which can extract representative image features with more dimensions, are competent to classify and recognize treatment positions in medical images.
Algorithms ; Image Processing, Computer-Assisted ; Neural Networks (Computer) ; X-Rays

OBJECTIVETo study the prevalence of the BRAF V600E mutation in papillary thyroid carcinoma (PTC) and its association with clinicopathologic features.

METHODSTwo hundred and ninety-two patients with primary PTC encountered during the period from December 2010 to December 2012 and underwent surgery in Cancer Hospital, Chinese Academy of Medical Science were enrolled into the study. Polymerase chain reaction was used to amplify exon 15 of the BRAF gene from paraffin-embedded thyroid tumor specimens, followed by direct sequencing to detect the BRAF V600E mutation. Statistical analysis was performed with SPSS 16.0 for Windows. Association between BRAF mutation and clinicopathologic parameters was tested with the χ(2) test or Fisher exact test as appropriate.

RESULTSThere were 87 males and 205 females in the cohort. The age of patients ranged from 13 to 84 years (mean = 43.1 years). BRAF V600E mutation was found in 190 cases (65.1%). The presence of BRAF V600E mutation correlated with age at diagnosis (older than 45 years), tumor volume (larger than 1 cm), extrathyroidal extension, classic type/tall-cell variant and advanced disease stage (P < 0.05). BRAF V600E mutation did not correlate significantly with gender, multicentricity, lymph node metastasis or anatomic location (P > 0.05).

CONCLUSIONBRAF V600E mutation is associated with high-risk clinicopathologic characteristics in patients with PTC. The BRAF V600E mutation may be a potential prognostic factor in PTC patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Carcinoma ; genetics ; pathology ; Carcinoma, Papillary ; Exons ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mutation ; Polymerase Chain Reaction ; Proto-Oncogene Proteins B-raf ; genetics ; Thyroid Neoplasms ; genetics ; pathology

Objective: To investigate the clinicopathological characteristics, treatment and prognosis of head and neck carcinosarcoma. Methods: The clinical data of 14 patients with head and neck carcinosarcoma treated in the First Affiliated Hospital of Zhengzhou University from January 2010 to May 2020 were retrospectively analyzed, including 11 males and 3 females, with age range from 30 to 72 years old. Clinicopathological characteristics, treatments and follow-up results of patients were evaluated. Kaplan-Meier method was used to estimate the cumulative survival rate. Results: Histopathological examination showed the co-existence of malignant epithelial and mesenchymal components in all cases. Immunohistochemical staining of 13 cases showed cytokeratin and epithelial membrane antigens were positively expressed in the epithelial areas, whereas vimentin was positive in the malignant mesenchymal tissue area. Among 14 cases, 5 cases were treated with surgery, 3 cases with surgery and radiotherapy, and 6 cases with surgery, radiotherapy and chemotherapy. The follow-up time was 2-81 months, with a median follow-up time of 22.5 months. Except for one patient who was lost to follow-up in 21 months after treatment, among the remaining 13 patients, 4 patients had recurrence, 8 patients died, and 5 patients had a tumor-free survival. The Kaplan-Meier analysis showed that the 1, 3, and 5-year cumulative survival rates of 14 patients with head and neck carcinosarcoma were 64.3%, 57.1%, and 42.9%, respectively. Conclusions: Carcinosarcoma of the head and neck is rare in clinic, histopathological and immunohistochemical examinations are important basis for diagnosis, and surgery is a preferred treatment. Carcinosarcoma of the head and neck has a poor prognosis, and patients should be followed up for a long time.
Adult ; Aged ; Carcinosarcoma/therapy* ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies

OBJECTIVE: Medical image segmentation is a key step in medical image processing. An architecture of fully convolutional networks was proposed to realize automatic segmentation of anatomical areas in X-ray images. METHODS: Enlightened by the advantages of convolutional neural networks on features extraction, fully convolutional networks consisting of 9 layers were designed to segment medical images. The networks used convolution kernels of various sizes to extract multi-dimensional image features in the images, meanwhile, eliminated pooling layers to avoid the loss of image details during downsampling procedures. RESULTS: The experiment was conducted in accordance with the specific scene of X-ray images segmentation. Compared with traditional segmentation methods, this approach achieved more accurate segmentation of anatomical areas. CONCLUSIONS Fully convolutional networks can extract representative and multidimensional features of medical images, avoid the loss of image details during downsampling procedures, and complete automatic segmentation of anatomical areas accurately in X-ray images.
Algorithms ; Image Processing, Computer-Assisted ; Neural Networks (Computer) ; X-Rays