Purpose To describe the clinical and pathological features of atypical vascular lesions (AVLs) after conservative surgery and radiation of the breast cancer,and to discuss the association with post-radiation angiosarcoma.Methods The clinical and pathological features in one case of AVLs was evaluated.The literatures were reviewed.Results The patient is a 57-yeAR~-old female who underwent a conservative surgery of the right breast because of a carcinoma.She received standard dose of radiation as adjuvant therapy.Three years later, multiple erythematous plaques developed around the former scar, which radiated to the nipple.Clinically,the plaques were considered as relapses of the carcinoma.However, fine needle aspiration gave negative results.Biopsy of one large plague revealed a circumscribed vascular lesion confined to the superficial dermis.It was composed of thin-walled anastomosing lymphatic vessels lined by attenuated endothelial cells.In focal areas, the vessels extended to the mid-dermis.Immunohistochemically, the endothelial cells were positive for CD31, CD34 and D2-40,with absent of α-SMA positive pericytes.Review of the breast tumor sections showed an invasive micropapillary carcinoma.Conclusions AVLs is a rare vascular lesion related with conservative surgery and post-radiation therapy of the breast.AVLs may represent as a precursor of breast angiosarcoma.Being familiar with the clinicopathologic characteristics of AVLs is important not only for the pathologists but also for the clinicians.

Objective To explore the status of lymph node dissection under thoracoscopic surgery and open surgery in patients with thoracic esophageal carcinoma. Methods 16 cases of thoracic esophageal cancer received thoracoscopic surgery from August 2012 to June 2015 as minimally invasive group (group M), 17 cases of thoracic esophageal cancer with the same pathological staging received traditional open surgery during the same period as control group (group C), the number of lymph nodes and the positive rate of lymph node metastasis were compared. Results In group M, the total number of 228 lymph nodes, mean (14.27 ± 5.61) pieces, the positive rate was 12.50%; while in group C, the total number of 241 lymph nodes, mean (16.20 ± 6.24) pieces, the positive rate was 11.76%. Two different pathological staging in patients with lymph nodes dissection has no significant difference ( >0.05). In group M, 7 cases with lymph node metastasis, 45 metastatic lymph nodes, metastasis rate was 43.75 %, 19.74 % degree of metastasis; while in group C, 8 cases with lymph node metastasis, 55 metastatic lymph nodes, metastasis rate was 47.06%, transfer degree was 22.82%.Conclusions Minimally invasive surgery can achieve the same effect with the traditional open chest surgery, in treatment of thoracic esophageal cancer with high operability.

Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of critically ill neonates.Methods Totally ten critically ill neonates were hospitalized in Department of Neonatal Intensive Care Unit (NICU) in Shanghai Children's Hospital from June 2011 to May 2015, and managed with CBP treatment.The indications of CBP therapy were multiple organ dysfunction syndrome (MODS) failed to conventional treatment or combined with acute renal failure (ARF).The model for CBP was continuous veno-venous hemofiltration dialysis (CVVH).The clinical outcomes included blood electrolytes, serum bio markers, urine output, hemodynamic indicators, dose of intravenous epinephrine before treatment, 6, 12, 24, 48 h after treatment and at the end of CBP.Complications of CBP were also observed.Statistical analysis was performed with ANOVA and Dunnett-t test.Results The underlying problems of the ten newborns were septicemia (n=5), severe neonatal asphyxia (n=2), congenital hereditary metabolic disease (n=2) and traumatic asphyxia (n=l).The venous catheter was successfully inserted for all babies and CBP treatment continued for (86.7 ± 25.9) h averagely with obvious effect.Four of the ten cases were cured and discharged, and the rest six refused to treatment and died after due to irreversible injury of the nervous system although they had survived from the oliguric stage of ARF.The complications of CBP included thrombocytopenia (n=3), catheter blockage (n=2), hypotension (n=l).No hypothermia, thrombosis, bleeding or infection occurred.The mean blood pressure and partial pressure of oxygen in arterial blood/fraction of inspiration oxygen (PaO2/ FiO2) of the ten cases 6 h after the beginning of treatment were higher than those before [(46.4 ± 7.5) vs (36.5 ±8.3) mmHg, 1 mmHg=0.133 kPa;(210.0±62.0) vs (93.0±43.0) mmHg;t=2.647 and 6.378, both P ＜ 0.05].At the 12th hour since treatment start, the blood pH value was 7.4 ± 0.2, which was higher than that before treatment (6.9 ± 0.2, t=2.731, P ＜ 0.05), and kept in normal range.At the 24th hour, the serum levels of potassium, urea nitrogen and creatinine dropped to normal range compared to those before treatment [(4.8±2.9) vs (9.6± 3.6) mmol/L;(7.2±2.3) vs (13.6±6.3) mmol/L;(51.0± 12.0) vs (172.0±23.0) μ mol/L;t=4.571, 5.427 and 21.672, all P ＜ 0.05].Urine output increased from zero before the treatment to (0.7±0.3) ml/(kg · h) after 24 h (t=3.284, P ＜ 0.05).The maintaining dose of intravenous epinephrine decreased since 12 h after the beginning of treatment and was ceased at the 48th hour.Conclusion CBP is an effective and feasible treatment for critically ill neonates.

Objective To identify distinct subgroups of military personnel from Paracel Islands based on mental status for providing basis to intervention measures.Methods 174 enlisted military personnel were interviewed by symptom checklist-90 (SCL-90).The factor scores of SCL-90 were compared with army man norm and control group,then the cluster analysis was conducted.Results Interpersonal sensitivity,phobic and psychoticism of military personnel on Paracel Islands((1.65±0.56),(1.24±0.33),(1.44±0.46)) scored lower than those of army man norm (P＜0.05).Interpersonal sensitivity of military personnel on Paracel Islands scored lower than those of control (P＜0.05),depression and anxiety of them had no difference to control (P＞0.05),while other factors of them scored higher than control.According to cluster analysis,174 military personnel were divided into three subgroups.The first subgroup with high scores for all nine SCL-90-R dimensions,the second cluster showed moderate scores and the third cluster had lowest scores.Statistically significant sociodemographic differences could be found between the cluster groups (P＜0.05).Conclusion The mental health status of military personnel stationed in Paracel Islands is good on the whole,and can be divided into three clusters with different demographic and service characteristics.

Objective To explore the clinical features, diagnosis, and treatment of non-immunologic hydrops fetalis (NIHF). Methods The clinical data of 10 cases of NIHF in neonatal intensive case unit during January 2011 to December 2016 were analyzed retrospectively. The related literatures were reviewed. Results In 10 cases of NIHF (6 males and 4 females). the gestational age were 32-42 weeks, and the birth weight was 2.25-3.95 kg. Among them, there were 3 cases of infectious diseases (cytomegalovirus, Streptococcus agalactiae, and parvovirus infection, one case each), 2 cases of fetal cardiovascular abnormalities, 2 cases of chromosomal abnormalities, 1 case of abnormal thoracic structures, 1 case of twin transfusion syndrome, and 1 case of etiology unknown of fetal hydrops. The clinical manifestations showed that there were 8 cases with 2 or more areas of edema (or hydrops), and only 2 cases with skin edema. Finally, 6 cases were cured and discharged, 2 cases were discharged by themself, and 2 cases died. Conclusions Prenatal ultrasound is a reliable method for the diagnosis of NIHF. Fetal edema in early pregnancy, especially with congenital malformations, is recommended for termination of pregnancy. After birth, NIHF should be diagnosed promptly so as to avoid or reduce severe complications.

Head ; surgery ; Humans ; Neck ; surgery ; United States

OBJECTIVETo compare the efficacy of different points combination in the treatment of menopausal insomnia.

METHODSNinety-six cases of menopausal insomnia were randomized into 3 groups, Xinshu (BL 15), Shenshu (BL 23), Sishencong (EX-HN 1), Shenmen (HT 7), Sanyinjiao (SP 6) were chosen in the restore interaction between the heart and the kidney group (group A, 32 cases); Zhaohai (KI 6), Jiaoxin (KI 8), Shenmai (BL 62), Pucan (BL 61) were chosen in the acupuncturing qiao mai group (group B, 32 cases); auricular Shenmen (TF4) and sensitive spot at the distribution area of auricular vagus nervus were chosen in the ear acupuncture group (group C, 32 cases). Six days made one session and the treatments were finished after 4 courses. The polysomnography (PSG) and Pittsburgh sleep quality index (PSQI) were employed before and after treatment to evaluate the alleviation of insomnia.

RESULTSThe parameters of the sleep latency (SL), rapid wave sleep latency (RL) and sleep efficiency (SE) were significantly improved in the three groups, and the differences were statistically significant (P < 0.05, P < 0.01). The SL and awaking time (AT) in group C [SL (401.08 +/- 16.54) min and AT (4.87 +/- 2.64) times] were significantly superior to those in the other two groups [SL (50.36 +/- 18.47) min, (54.87 +/- 20.92) min, AT (5.98 +/- 2.11) times, (6.13 +/- 3.04) times, all P < 0.05]. The S(3+4) (%) in group C was also significantly higher than those in the other two groups (both P < 0.05). It was indicated by PSQI that the sleep quality of group C (0.78 +/- 0.12) was significantly superior to that in group B (1.32 +/- 0.29), the total score and cured and markedly effective rate in group C [(4.34 +/- 1.43), 68.8% (22/32)] were superior to those in group A [(7.48 +/- 3.09), 53.1% (17/32), both P < 0.05].

CONCLUSIONEar acupuncture has a better curative effect than the restore interaction between the heart and the kidney group and acupuncturing qiao mai group, it is worth of being promoted.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Humans ; Menopause ; psychology ; Middle Aged ; Sleep ; Sleep Initiation and Maintenance Disorders ; therapy ; Treatment Outcome

Adult ; Female ; Humans ; Inhalation Exposure ; Male ; Middle Aged ; Paraquat ; poisoning

Objective:To investigate the effects of estradiol on ~(60)Co?-ray induced apoptosis of bone marrow hematopoietic cells of mice,and to discuss the related anti-irradiation mechanism.Methods:KM mice were randomly divided into 3 groups(15 mice/each group):control group(without radiation),pure radiation group and estradiol+radiation group(ER group).The pure radiation group was irradiated by 4.0 Gy?-ray at a dose rate of 1.15Gy/min;the ER group was administered with 0.1 mg estradiol(IM)at 10 days before 4.0 Gy?-ray radiation;and the control group received no special treatment.The apoptotic DNA segments of bone marrow hematopoietic cells were analyzed by DNA agarose gel electrophoresis;flow cytometry was used to examine the apoptosis rate of cells and expression of Fas and Bcl-2 at 4 h,8 h,and 12 h after irradiation.Results:Eight hours after radiation,the apoptotic DNA segments were obviously increased and apoptotic DNA ladder appeared,which was not seen in the other 2 groups.The apoptosis rate of bone marrow hematopoietic cells in ER group was significantly lower than that in the pure radiation group at 4,8,and 12 h after irradiation(P

OBJECTIVETo explore the possibility of peripheral nerve damage induced by antiepileptic drugs (AEDs) in different age rats and its pathogenesis.

METHODSAdult (2-month-old) and infant (7-day-old) rats were divided into 8 groups (n = 16 in each) and treated with the following 7 AEDs respectively: phenytoin [PHT, 62.5 mg/(kgxd)], phenobarbital [PB, 30.0 mg/(kgxd)], sodium valproate [VPA, 312.5 mg/(kgxd)], clonazepam [CZP, 1.25 mg /(kgxd)], carbamazepine [CBZ, 187.5 mg/(kgxd)], topiramate [TPM, 40 mg/(kgxd)], oxcarbazepine [OXC, 312.5 mg/(kgxd)], remaining one group was used as control. Four weeks later, 8 rats were sacrificed randomly from each group and serum, sciatic nerves and spinal cord samples were collected. The rest half rats were sacrificed 4 week after AEDs withdrawal. Histological observations were performed on the sciatic nerves samples, including teased fibers, semi-thin sections and electron microscopy. The activity of total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in serum and sciatic nerves were detected respectively. Expression of apoptosis-related proteins Bcl-2 and Bax was detected by immunohistochemistry. Neurons apoptosis in the anterior horns of spinal cord were detected by TUNEL.

RESULTS(1) Except for TPM group, various incidence (7.2% - 20.2%) of teased fibers abnormalities were observed in all the other different age groups. PHT group showed the most serious changes followed by PB (adult) or VPA (infant), CBZ, CZP and OXC groups. The predominant abnormality of teased fibers was demyelination. (2) There was no significant difference in the incidence of pathologic changes in teased fibers between adult and infant groups. Four weeks after AEDs withdrawal, recovery of pathologic changes in teased fibers in infant groups was much better than adult. (3) Significantly increased expression of Bax protein and ratio of Bax/Bcl-2 was only found in infant rats treated with PB, CNP or VPA compared with control (P < 0.05), the results of TUNEL was in accordance with immunohistochemistry. (4) Compared with control, the activity of T-AOC and SOD decreased in both infant and adult rats treated with PHT, CZP, CBZ and OXC, and the reduction of SOD activity in serum and sciatic nerves samples was also found in PB groups. Serum activity of GSH-PX was decreased in both age groups treated with PHT, PB, VPA, CZP, CBZ and OXC. The reduction of GSH-PX activity in sciatic nerves samples was remarkably in both adult and infant rats treated with PHT, PB, CBZ, OXC as well as the infant rats treated with CZP.

CONCLUSIONSSix AEDs (PHT, PB, CBZ, VPA, CZP, OXC) showed the potential to cause peripheral nerves damage. Demyelination was the predominant pathologic change. Both adult and infant rats had the same susceptibility. Recovery of pathologic changes in teased fibers in both age groups was slow, but infant rats were prone to revive more quickly. There was no significant correlation between spinal cord neuron apoptosis and peripheral nerves damages in rats treated with AEDs. Breakdown of oxidation-antioxidation balance was closely related to development of peripheral nerves damages caused by most AEDs.

Animals ; Anticonvulsants ; adverse effects ; Demyelinating Diseases ; chemically induced ; pathology ; Oxidative Stress ; Peripheral Nerves ; drug effects ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; pathology ; Spinal Cord ; pathology