Objective To analyze the characteristics of the dynamic changes of the radiological X-ray images in chest after applying a pulmonary surfactant(PS) named curosurf to hyaline membrane disease in grade Ⅲ～Ⅳ of the premature lungs,and to study the clinical values of the follow-ups with chest films after applying PS to evaluate its effects and to detect the complications in chest. Methods To review the definite cases of HMD in grade Ⅲ～Ⅳ with final clinical and radiological diagnosis so as to analyze the radiological image manifestations in ehest after applying PS to the premature lungs for half an hour, for 6 hours,for 24 hours, for 48 hours and for 5 days. Results Shortly after the application of PS,according to the chest films,just half an hour later, 15 cases improved their degrees of the transmittance of the two lungs; 16 cases progressively ameliorated their manifestations in chest, taking the turn for the better than the previous images; 5 cases had no improvement, among which 1 developed a complication of pulmonary hemorrhage,and 3 developed pulmonary air leakage; 3 eases accompanied with pulmonary inflammation-like lesions; 11 cases presented patent arterial duets(PDA). Generally speaking, the X-ray image manifestation was the same as the clinical symptoms. Conclusion A dynamic observation of the X-ray films in chest after the application of PS is able to make a correct iudgement of the lesions of HMD in grade Ⅲ～Ⅳ,and can promptly detect its complications if taking a short-term review.

Objective To observe the changes of fasting plasma glucose (FPG) and glycated hemoglobin(HbAcl) in patients with progressive ischemic stroke(SIP),and to provide scientific basis for the prevention and treatment of SIP.Methods Two hundred and twenty-one cases of acute ischemic stroke in Aerospaceplane General Hospital of Beijing were enrolled in this study.They were divided into progressive ischemic stroke group(123 cases) and non-progressive ischemic stroke group(98 cases) according to the NIHSS score.The changes of FPG and FPG were observed and compared between the two groups after admission to the hospital.Results The incidence of diabetes in group SIP (51.22％,63/123) was significantly higher than that in non SIP group(15.31％,15/98),and the difference was statistically significant(P=0.000).The FPG and HbAlc of SIP group were (8.35± 3.76) mmol/L,(7.31 ± 2.07) ％,of non SIP group were (6.47± 2.86)mmol/L,(6.25± 1.31)％,the difference between the two groups was statistically significant (P =0.000).Distribution rate of FPG＜6.1 mmoL/L,6.1 mmol/L ≤FPG＜7.0 mmol / L,FPG≥7.0 mmol/L in SIP group patients were 38.21％,14.64％,47.15％ respectively,in non SIP group were 64.39％ and 16.33％,19.39％ respectively,the differences between the two groups were statistical significance(P=0.000).Distribution rate of HbA1c≤7.0％,7.0％＜HbA1c ≤.0％,HbA1c＞9.0％ of patients in the SIP group were 53.66％ (66/123),25.20％(31/123),21.14％(26/123) respectively,and in non SIP group were 79.59％(78/98),16.33％(16/98),4.08％ (4/98) respectively,the differences between the two groups were statistical significance (P =0.000).Conclusion The occurrence and development of SIP is not only related to diabetes,but also closely related to blood glucose and HbA1c levels.High blood glucose and high levels of HbA1c have important significance for early identification and prediction of SIP.

Objective To analyze clinical and pathological features of dermatomyositis with panniculitis as a skin manifestation.Methods Clinical data were collected from 9 cases of dermatomyositis with panniculitis as a skin manifestation in Department of Dermatology of Zhongshan Hospital affiliated to Fudan University from October 2012 to July 2016,and their clinical and pathological features were analyzed.Results Of the 9 cases,6 were female and 3 were male,and the age ranged from 28 to 73 years.Panniculitis lesions of the 9 patients all manifested as painful indurated plaques or nodules on the buttock,thigh,waist,back,abdomen,upper extremities and cheeks.These lesions occurred before,after or simultaneously with the onset of characteristic skin and muscle lesions of dermatomyositis,especially preceded the onset of characteristic lesions of dermatomyositis by 30 years in 1 case.Histopathological examination of lesions showed liquefaction degeneration of basal cells,inflammatory infiltration of lymphocytes and plasma cells around blood vessels,in the fat lobules as well as between the lobules and septa in the dermis.The necrosis and calcification of lipocytes,lipomembranous changes,fibrinoid necrosis of damaged vessel walls and microvascular occlusion were observed in some cases.Because panniculitis preceded the onset of characteristic lesions of dermatomyositis,2 patients were misdiagnosed with lupus panniculitis and morphea profunda for several times.Most patients had good response to systemic glucocorticoids combined with immunosuppressive agents,while the patients with lipomembranous fat necrosis had poor response to the combination therapy.Conclusions Panniculitis lesions of dermatomyositis are histologically characteristic,and may do not coincide with the onset of characteristic lesions of dermatomyositis.If panniculitis lesions precede characteristic lesions of dermatomyositis,patients will be easily misdiagnosed.Thus,persistent follow-up visit will be of great importance for the diagnosis.

Objective To investigate the value of dual-phase 18F-FDG PET/CT for differentiating pancreatic cancer from pancreatitis.Methods Dual-phase 18F-FDG PET/CT scanning was prospectively performed on patients with suspicious pancreatic lesions.Patients with solid focal pancreatic lesions proved by histopathology or clinical follow-up were enrolled and divided into 3 groups according to the maximum diameter of the focus: ≤2.0 cm (group A), >2.0 cm and ≤ 4.0 cm (group B), >4.0 cm (group C).SUVmax at (60±10) min and (120±15) min after FDG injection was defined as early and delayed SUVmax (SUVearly and SUVdelayed), respectively, and retention index (RI) was calculated.The differences of SUVearly, SUVdelayed and RI between pancreatic cancer and pancreatitis were analyzed with Mann-Whitney u test.ROC curve was used to determine the optimal cutoff values of the above three parameters and corresponding diagnostic efficiencies were obtained.The AUC was compared with MedCalc software.Results A total of 196 patients (152 pancreatic cancers and 44 pancreatic inflammatory lesions) with solid focal pancreatic lesions were enrolled.The AUC of SUVdelayed was significantly larger than that of SUVearly (0.83 vs 0.79, z=3.64, P<0.01).Numbers of patients in group A, B and C were 45, 96 and 55 respectively.There was no significant difference of the maximum diameter between pancreatic cancers and pancreatitis lesions in all three groups (z values:-0.39,-1.52,-1.41, all P>0.05).The SUVearly, SUVdelayed and RI of pancreatic cancers were all higher than those of pancreatitis in group A and B (z values: from-4.59 to-3.00, all P<0.01).The diagnostic sensitivity and accuracy of SUVearly > 3.6 combined with RI > 0 for diagnosing pancreatic cancer were higher than those of SUVearly > 3.6: 96.4%(27/28) vs 75.0%(21/28), 95.6%(43/45) vs 82.2%(37/45).The AUC of SUVdelayed was significantly larger than that of SUVearly in group B (0.81 vs 0.77, z=2.06, P<0.05).The optimal cutoff value of SUVdelayed in group B was 5.3, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.4%(65/77), 13/19, 91.5%(65/71), 52.0%(13/25) and 81.2%(78/96), respectively.RI of pancreatic cancers was significantly higher than that of pancreatitis (25.0%(15.8%-35.7%) vs 14.4%(4.6%-18.7%), z=-2.39, P<0.05) in group C.The optimal cutoff value of RI in group C was 19.0%, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 68.1%(32/47), 7/8, 97.0%(32/33), 31.8%(7/22) and 70.9%(39/55).Conclusions The SUVdelayed and RI of dual-phase 18F-FDG PET/CT might be useful for diagnosis of pancreatic tumors.SUVearly > 3.6 combined with RI >0 could be helpful to improve the diagnostic sensitivity and accuracy in patients with the maximum diameter of lesions ≤2.0 cm.The diagnostic value of SUVdelayed might be better than that of SUVearly in patients with the maximum tumor diameter of >2.0 cm and ≤4.0 cm.Only RI could be used for diagnosing pancreatic tumors in patients with the maximum tumor diameter > 4.0 cm.

BACKGROUND:The living standard of farmers and herdsmen in Xinjiang Uygur Autonomous Region, China is significantly lower than that of urban residents in general. Meanwhile, the shortage of doctors and medicines and lack of medical knowledge are the main reasons for local farmers and herdsmen to suffer from knee osteoarthritis. Most of the farmers and herdsmen are not aware of or prevent knee osteoarthritis in the early days to remove pathogenic factors, which results in a serious condition at the time of their medical treatment. OBJECTIVE: To investigate the main pathogenic factors of knee osteoarthritis in Uygur, Kazakh and Han populations in pastoral areas of northern Xinjiang Uygur Autonomous Region, China.METHODS:The permanent residents of Uygur, Kazakh and Han ethnic groups in northern Xinjiang, China who met the criteria were selected by the method of stratified, multistage and cluster random sampling during June 2012 to October 2014. The investigation of knee osteoarthritis was conducted among al the residents who meet the inclusion criteria using the method of home scene closed questionnaire. X-ray lateral plain film examination of the knee joint was performed among the patients presenting with the symptoms of knee osteoarthritis. The database was established. The multi-factor and unconditional Logistic regression analysis was conducted among the 40 variables using SPSS 20.0 software. RESULTS AND CONCLUSION:The 3 402 of 3 540 questionnaires were valid. The Logistic regression analysis suggest that the common pathogenic factors in Han, Uygur and Kazakh ethnic groups are associated with older ages, female gender, high body mass and drink alcohol. Smoking, history of internal disease, high education level, standing position, climbing, trauma, family history, fried food, housing conditions and amenorrhea, different nationalities, churchgoing of ethnic minorities are also the major risk factors. Among the three ethnic groups, the prevalence of female patients in Uygur and Kazak ethnic groups is significantly higher than that of Chinese Han nationality. The morbidity is different among these three nationalities. The dietary preferences cannot be determined as the related influencing factor of knee osteoarthritis. Whether the means of transportation, residence climate and environment, the number of pregnancies and deliveries, drinking tea or not, the type of tea are related to knee osteoarthritis remains unclear.

Objective To analyze the clinical characteristics of 110 cases of infectious mononucleosis in children. Methods The clinical data of 110 children with infectious mononucleosis in the period from January 2015 to January 2018 were analyzed retrospectively. Results The 110 patients included 74 males(67.3％)and 36 females(32.7％). The male to female ratio was 2.1:1.The age distribution: 2～<3 years old, 29 cases(26.4％); 3-6 years old, 67 cases(60.9％);>6-13 years old, 14 cases(12.7％).The main symptoms and signs included fever in 101 cases(91.8％), pharyngitis in 100 cases(90.9％), lymphadenomegaly in 95 cases(86.4％), eyelid edema in 79 cases(71.8％), splenomegaly in 55 cases(50.0％), and liver enlargement in 37 cases(33.6％).The complications were pneumonia in 61 cases(55.5％), myocardial damage in 53 cases(48.2％), neutropenia in 35 cases(31.8％), and thrombocytopenic purpura in 4 cases(3.6％). The prevalence of IgM antibody against Epstein-Barr virus capsid antigen was43.6％. The prevalence of IgM antibody against Epstein-Barr virus early antigen was 31.8％. The positive rate of IgG antibody against Epstein-Barr virus nuclear antigen was 56.4％. The prevalence of atypical lymphocytes in peripheral blood was 46.4％.Conclusions Infectious mononucleosis in children is more common in males and during the period from 3 to 6 years of age. The clinical symptoms include pneumonia and myocardial damage. Epstein-Barr virus detection and serological assay are helpful for diagnosis.

Background and purpose: Adequate tissue ifxation, transparent dewaxing is an important step of hematoxylin eosin (HE) staining and lfuorescence in situ hybridization (FISH) in detection of breast cancerHER-2 gene. The purpose of this study was to make a comparison between poly hydroxyl acrylic acid which is an environmen-tally friendly ifxation liquid and 4% neutral buffered formaldehyde in tissue ifxation for HE staining and FISH to detect theHER-2 gene in the breast cancer tissue sections. The study aimed to evaluate the feasibility of replacing 4% buffered formaldehyde, a traditional ifxation liquid, with the poly hydroxyl acrylic acid, an environmentally friendly ifxation lfuid.Methods:This project was performed on tissue samples collected from 69 cases of breast cancer, 41 cases of breast ifbroadenoma, 40 cases of uterine leiomyoma, 25 cases of cervical tissue, 25 cases of placenta obtained from the outpatient and inpatient departments of Zhongshan Boai Hospital from Mar. 2011 to Jan. 2015, from each of which two samples were drawn and two blocks of each specimen were divided into two groups randomly. Then one group was ifxed with 4% neutral buffered formaldehyde and made into 200 sections by HE while the other group was ifxed with poly hydroxyl acrylic acid and made into another 200 sections. The slice level of the two groups was determined by the staining condition of the sections, and SPSS 19.0 was employed to compare the excellent and good rate of HE staining. Additional 69 sections were produced with two groups of breast invasive ductal carcinoma tissues, and SPSS 19.0 was used to detect the ampliifcation ofHER-2 gene by FISH.Results:First, the number of best-quality slices stained with HE ifxed separately by poly hydroxyl acrylic acid and 4% neutral buffered formaldehyde was 155 and 166, respectively. The number of excellent pieces was 41 and 33, respectively, while the number of mediocre pieces was 3 and 1 with bad pieces being 1 and 0, respectively. The excellent and good rates of HE staining were 98% and 99.5%, respectively. There was no significant difference between the two groups (χ2=1.33,P>0.05).Second, the positive rates of the tis-sue slices by FISH ifxed separately by poly hydroxyl acrylic acid and 4% neutral buffered were 26.09% and 23.19%, respectively. There was no signiifcant difference between the two groups (χ2=0.50,P>0.05).Conclusion:The results obtained with HE staining and FISH using poly hydroxyl acrylic acid as a ifxation liquid are not signiifcantly different from those using 10% neutral buffered formaldehyde. Therefore, poly hydroxyl acrylic acid meets the requirements of environmental protection, and thus has the potential to be promoted and widely used.

Objective:To observe the difference of the human telomeres RNA component (hTERC) genes’amplification in the cervical tissue by applying the environment-friendly fixative poly hydroxy acrylic acid and the transparent dewaxing solution Van-clear separately or jointly to replace the traditional fixative 4% (volume fraction)neutral buffered formalin and the conventional transparent dewaxing solu-tion xylene in the use of fluorescence in situ hybridization (FISH)for detection.Methods:In the study, 255 cases of cervical tissue specimens submitted by the Department of Gynecology in Zhongshan Boai Ho-sipital were collected from Mar.2013 to Apr.2015.Four samples were taken from the same lesion site. All the cases were divided into 4 groups and named group A,B,C,and D.Group A used 4% neutral buffered formalin fixed and xylene dewaxing to make slices.Group B used poly hydroxy acrylic fixed and xylene dewaxing to make slices.Group C used 4% neutral buffered formalin fixed and Van-clear trans-parent to make slices.Group D used poly hydroxy acrylic fixed and Van-clear transparent dewaxing to make slices.The amplification of hTERC genes in the four groups of cervical specimens was also detected by FISH technique.Results:When the hTERC genes were detected by FISH method under the fluore-scence microscope,it was obvious that the tissue profile and the background of group A,B,C and D were all clear.The probe was fixed in the accurate position so that the bright red or green fluorescence signals were easily found in these four groups.Compared with the positive rate of group A,there was no statistical significance in that of group B,C and D (P>0.05).At the same time,the coincidence rate of the FISH results was high,which showed that the new environment-friendly reagent had no significant difference in the detection of cervical hTERC genes by FISH technique.Conclusion:It is possible for the environment-friendly reagent poly hydroxy acrylic acid and Van-clear to replace 4%neutral buffered for-malin and xylene separately or jointly to detect the cervical hTERC genes by adopting FISH technique.

Objective To compare two different methods to detect the differences of gene mutation rate, sensitivity, specificity and coincidence rate of epidermal growth factor receptor (EGFR) in non-small-cell lung cancer (NSCLC) so as to assess the clinical value of qRT-PCR method and its environmental-friendly technologyplatforms.One uses environmental fixative poly hydroxyl acrylic acid and green transparent liquid dewaxing Van-clear alone or in combination to replace the traditional fixative 4％ (volume fraction) neutral buffered formalin and the traditional transparent dewaxing liquid xylene in application of quantitative real-time polymerase chain reaction (qRT-PCR).The other uses traditional reagents in direct sequencing.Methods We selected 91 cases of primary NSCLC specimens resected between May 2013 and March 2016 in Zhongshan Bo`ai Hospital and Zhongshan Hospital of Traditional Chinese Medicine.Five samples were taken from the same tumor lesion.We used a random number table to randomly divide these samples into Groups A, B , C, D, and E.Group A received direct sequencing method in detection of EGFR gene mutations.Besides, during the experiment, 4％ neutral buffered formalin was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group B received qRT-PCR method to detect EGFR gene mutations.Meanwhile, during the experiment, 4％ neutral buffered formalin was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group C received qRT-PCR method in detection of EGFR gene mutations.At the same time, during the experiment, polyhydroxy acrylic acid was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group D received qRT-PCR method to detect EGFR gene mutations.In the meantime, 4％ neutral buffered formalin was used for fixing, Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.Group E received qRT-PCR method in detection of EGFR gene mutations.In addition, during the experiment, polyhydroxy acrylic acid was used for fixing, and Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.In addition, during the experiment, polyhydroxy acrylic acid was used for fixing, and Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.The mutations of Exons 18, 19, 20, and 21 in EGFR genes were respectively determined in the five groups of NSCLC.Results ① Groups B, C, D, E and A did not significantly differ in the percentage of people with mutations or target site mutation rates of EGFR genes in NSCLC (P> 0.05).② The detection results of EGFR target site mutation in Groups B, C, D, E and A had good sensitivity, strong specificity, and high compliance rate.Conclusion The green transparent liquid dewaxing Van-clear alone or in combination to replace the traditional fixative 4％ neutral buffered formalin and the traditional transparent dewaxing liquid xylene in the application of qRT-PCR so as to detect EGFR gene mutations in NSCLC has good consistent results compared with the method that uses traditional reagents in direct sequencing.It has the significance and value in clinical application.

Objective To firstly report 4 cases of dermatomyositis characterized by painful palmar eruptions complicated by fatal rapidly progressive interstitial lung disease (RP-ILD) in China.Methods Four patients with dermatomyositis with painful palmar eruptions complicated by fatal RP-ILD were enrolled from the Department of Dermatology,Zhongshan Hospital,Fudan University between December 2014 and April 2017,and their clinical and pathological features were analyzed.Results Among these patients,3 were female and 1 was male.Their age ranged from 47 to 59 years.Of the 4 patients,3 had no muscular involvement.All of the 4 patients had multiple solid red papules or nodules on the bilateral palms,palmar and lateral surfaces of fingers,which preceded,followed or concurred with the onset of other skin lesions of dermatomyositis.The occurrence of type Ⅰ respiratory failure was preceded by 3 weeks to 5 months of painful palmar eruptions in the 4 patients.Early-stage palmar eruptions were easily misdiagnosed as contact dermatitis,eczema or erythema multiforme.Histopathological examination of the skin lesions on the finger palmar surface showed perivascular infiltration of a few lymphocytes in the dermis,and deposition of varying amounts of mucin-like substances around blood vessels and appendages.Of the 4 patients,3 showed positive staining for anti-melanoma differentiation-associated gene 5 antibody.Although the 4 patients received anti-inflammatory and immunosuppressive therapies,they all finally died of respiratory failure.Conclusions Dermatomyositis with painful palmar eruptions may indicate the occurrence of fatal RP-ILD,and early biopsy of skin lesions is needed to help to identify the disease.Immunosuppressive treatment should be performed timely to improve the prognosis in these patients.