Objective To study the frequency of diffuse large B-cell lymphoma (DLBCL) with multi-genetic alteration, and its correlation with c-myc, bcl-2 and bcl-6 protein expression. Methods 50 cases diagnosed with DLBCL from January 2012 to December 2016 were collected. The expression of c-myc, bcl-2 and bcl-6 was analyzed by immunohistochemistry. Interphase fluorescence in situ hybridization (I-FISH) analysis was performed to identify the genetic alteration of c-myc, bcl-2 and bcl-6. Results In all cases, there were 27 males and 23 females with a median age of 50 years (range: 3-85 years). 23 (46.00 %) cases were defined as primary nodal DLBCL and 27 (54.00 %) cases were primary extra-nodal DLBCL, with gastrointestinal tract (48.15 %, 13/27) being the most common site of involvement. c-myc protein expression was detected in 94.00 % (47/50) cases, in which 82.00 % (41/47) cases exhibited high levels of c-myc expression with positive nuclear staining observed in over 40.00 % of tumor cells. The positive rate of bcl-2 protein was 84.00 % (42/50), 76 % (38/50) cases presented with high-level bcl-2 expression. Concurrent high expression of c-myc and bcl-2 were presented in 18 cases (36.00%). FISH analysis demonstrated c-myc gene rearrangement in 7 cases (14.00 %) and amplification in 2 cases (4.00 %). bcl-2 gene rearrangement was detected in 6 cases (12.00 %) and 4 cases (8.00 %) exhibited gene amplification. bcl-6 gene rearrangement was identified in 8 cases (16.00%), amplification in 3 cases (6.00%), and 1 case concomitantly harbored the rearrangement and amplification of bcl-6. Multi-genetic alterations were defined in 4 cases with 3 cases fulfilling the criteria for double-hit lymphoma (DHL) and 1 case for triple-hit lymphoma (THL). For the cases with concomitant high-level expression of c-myc and bcl-2 proteins, 3 cases (16.67 %) was detected with multi-genetic alterations, including 2 cases for DHL and 1 case for THL. Conclusions The proportion of DLBCL with multi-genetic alterations is 8.00 % in this study. The genetic alterations are not consistently correlated with the protein expression. The molecular genetic testing is reliable for the identification of DHL.

Objective To identify anatomical characteristics of neurovascular compression associated with trigeminal newralgia(TN).Methods Fifty patients with TN (23 of 50 patients underwent microvascular decompression) and 50 patients without facial pain underwent 3.0 T MRI scanning for analysis of 50 trigeminal nerves ipsilaterai to TN symptoms,50 contralateral to TN symptoms,and 100 in asymptomatic patients.MRI sequences included balanced fast-field echo and 3D MR angiography.Images were fused and reconstructed into virtual cisternoscopy images to determine the degree (severity of compression was defined as follows:1=no compression; 2 =compressed by a vein; 3 =contacted by an artery; 4 =indented by an artery; and 5 =nerve displaced or distorted by an artery) and site of neurovascular compression ( the point of each offending vascular structure:proximal was defined as located in 1/3 length of the cisternal segment of the trigeminal nerve near root entry zone; the place of superior was defined as above the cisternal segment of the trigeminal nerve).Reconstructed MPR images were used to measure nerve length and cross sectional area.The chi-square test was used for all 2 × 2 contingency tables.The t-test was used for dependent samples.The Logistic regression was used for prediction of occurrence of the event of TN.Results Twenty-three of 50 patients with TN underwent microvascular decompression,which confirmed predicted neurovascular relationships in all cases,and 21of 23 patients were pain free after the operation.The incidence of neurovascular compression on asymptomatic nerves ( no.of level 1=79,level 2 =5,level 3 =8,level 4 =8),on nerves contralateral to TN symptoms( no.of level 1=27,level 2 =6,level 3 =9,level 4 =8),and on nerves ipsilateral to TN symptoms(no.of level 1=4,level 2 =12,level 3 =12,level 4 =7,level 5 =15) was 21.0％ (21/100),46.0％ (23/50),and 92.0％ (46/50),respectively.The difference between symptomatic and asymptomatic nerves was significant regarding nerve distortion ( level 4 and 5,x2 =27.0,P ＜ 0.01),the point of compression ( no.of proximal of symptomatic nerves =32,not proximal of symptomatic nerves =14,proximal of asymptomatic nerves =4,not proximal of asymptomatic nerves =17,x2 =14.8,P ＜ 0.01),the place of vascular compression ( no.of superior of symptomatic nerves =36,not superior of symptomatic nerves =10,superior of asymptomatic nerves =5,not superior of asymptomatic nerves =16,x2 =18.0,P ＜0.01) and the mean cross-sectional area of the CPA cistern [ ipsilateral:( 183.9 + 52.5 ) mm2,contralateral:( 217.8 + 58.8 )mm2,t =- 3.04,P ＜ 0.01].Decreased nerve size was observed in patients with TN [ the section area of ipsilateral nerve ( 6.3 ±1.3) mm2,contralateral (7.7+1.6) mm2,t =-4.80,P ＜0.01; length of ipsilateral nerve:(8.0 ±1.9) mm,contralateral:(9.0 + 2.0) mm,t =- 2.64,P ＜ 0.05 ].Conclusions Trigeminal neurovascular compression can occur in asymptomatic patients,but is more severe,more proximal,more superior and with smaller size of cross-sectional area of the CPA cistern in patients with TN.This information may help identify patients who are likely to benefit from microvascular decompression.

Objective To investigate the accuracy of careful clinical evaluation in hemodynamic status and guidance of PiCCO monitor in clinical treatment.Methods A total of 96 hemodynamic unstable cases were evaluated prior to the insertion of the PiCCO catheter.The attending physician in charge of the patient was required to complete a questionnaire to predict the range of key hemodynamic variables for CI,GEDI,SVRI and EVLWI.Additionally,the attending was also asked to indicate a plan for therapy based on the predicted hemodynamic profile and decide if the predicted therapy plan was altered after the the first measurement of hemodynamic variables.Results The accurate prediction of hemodynamic variables was CI (55.2％),GEDI(60.4％),SVRI(63.5％) 和 EVLWI (78.1％),among which EVLWI had a higher accuracy(P ＜ 0.05).49％ doctors altered their planned therapy according to the result of the PiCCO information.Doctors had more difficulty in accurately predicting hemodynamic values in critical patients which APACHE Ⅱ scored 15 ～25 (42.3％ vs 67.9％ and 42.3 ％ vs 75.0％,x2 =4.755,5.231,P ＜ 0.05).The prediction of patients with acute myocardial infarction was more accurate than those of without acute myocardial infarction,and less to alter the planned therapy(21.1％ vs 55.8％,x2 =7.382,P =0.007).The patients of impaired oxygenation had less accurate predictions and less therapy alterations(32.3％ vs 56.9％,x2 =5.110,P =0.024).Attending was able to predict the hemodynamic status more accurately(63.9％ vs 40％,x2 =5.152,P =0.023) and alter the predicted therapy less(39.3％ vs 65.7％,x2 =6.189,P =0.013) in patients who were enrolled later.Conclusions Clinical evaluation in hemodynamic status of critically ill patients had a lower accuracy,the information obtained by PiCCO often instruct clinical doctors to choose the optimal treatment.

Objective : To explore the reform of the operating mechanism of centers for disease control and prevention ( CDCs ) in the new era, and to put forward recommendations. Methods : We collected the financial investment and staffing of CDCs in Zhejiang Province from 2018 to 2020 through China Disease Prevention and Control Information System and Zhejiang Health Statistical Yearbook. We conducted a questionnaire survey among 620 staffs selected by convenience sampling, and a qualitative interview among 40 leaders and experts from CDCs and general hospitals in Zhejiang Province. Results : By the year 2020, there were 105 CDCs in Zhejiang Province, including 1 province-level, 11 prefecture-level, 90 county-level and 3 development zone-level ones. The revenues were mainly from financial subsidy and business incomes, which were over expenditures. There were 7 008 posts in CDCs, with a staffing allocation ratio of 1.29/10 000. Among the reform measures of operation mechanism of CDCs, the flexible communication between clinicians and public health doctors was highly approved (90.03%); among the reform measures of enhancing the integration of prevention and treatment, further clarifying the public health functions of hospitals and ensuring financial compensation was highly approved (74.01%). Conclusion We should further stimulate the endogenous power and vitality of CDCs, strengthen the construction of talent team, promote the active integration of hospitals and CDCs, and improve public health level.

Pseudomonas aeruginosa (PA) pneumonia is a refractory,even lethal complication in immunosuppressive individuals and immune disturbances may promote the pathological process.We aimed to investigate the regulatory T (Treg) cell activity in an immunosuppressive mice model of PA pneumonia by estimating levels of main transcription factor and the main effector of Treg cells,i.e.,Forkhead box protein 3 (FOXP3) and interleukine-10 (IL-10).Seventy-two BALB/c mice were divided into four groups randomly:control (A),PA pneumonia (B),immunosuppression (C) and immunosuppression with PA pneumonia (D).Mice were sacrificed at 4,8 and 24 h after establishing experimental models.The pathological changes of lung tissue were graded,and the FOXP3 mRNA and serum IL-10 levels were detected.Histological analysis of lung tissues showed there were no significantly pathological changes in groups A and C,but significantly pathological changes were found in groups B and D,especially in group D at 8 h (P＜0.05).The expression levels of FOXP3 mRNA in groups A and C showed no significant changes at the three time points,which were significantly lower than those in groups B and D (P＜0.05).FOXP3 mRNA levels were lowest at 4 h,and there was significant difference between groups B and D (P＜0.05).The serum levels of IL-10 in groups A and C were almost normal at the three time points,but decreased significantly in groups B and D (P＜0.05).The serum levels ofIL-10 decreased to the lowest at 8 h,especially in group D (P＜0.05).The results indicate that PA pneumonia in immunosuppressive individuals worsens rapidly,which may be associated with Treg cells function disturbance.And Treg cells may be promising as adjuvant therapeutics for PA pneumonia in immunosuppressive individuals.

Objective To investigate the relationship between fragmented QRS (fQRS) complex and the early left ventricular remodeling or heart function in patients with acute myocardial infarction(AMI).Methods A total of 76 patients with AMI hospitalized in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study.Patients were divided into fQRS group (n=29) and non-fQRS group (n=47). The clinical data including ECG, laboratory indicators, coronary angiography results and real-time three-dimensional (RT-3D) echocardiography parameter were collected in two groups.The relationship between fQRS and baseline data,fQRS and RT-3D echocardiography parameter were analyzed.At the same time,the influencing factors of left ventricular remodeling and heart function were discussed in the study. Results Compared with non-fQRS group, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV)were significantly higher,and left ventricular ejection fraction(LVEF)was significantly lower in fQRS group(P<0.05).Several three-dimensional parameters including Tmsv16-SD(%)and Tmsv 16-Dif(%)were significantly higher in fQRS group than those in non-fQRS group(P<0.05).There were no significant differences in Tmsv 16-SD(ms),Tmsv 12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 16-Dif(ms),Tmsv 12-Dif(ms),Tmsv 12-Dif(%),Tmsv 6-Dif(ms)and Tmsv 6-Dif(%)between two groups.Logistic regression analysis showed that fQRS and Gensini scores had effects on heart function.At the same time,fQRS was an independent predictor for left ventricular remodeling. Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with fQRS,and fQRS can predict left ventricular remodeling better.

Objective To set up a system in vitro to rapidly recover plasma proteins lost during artificial-liver treatment.Methods The polyprotein precipitation was obtained by all proteins whose isoelectric point pH value were between 7.3 and 5.1,which collided with each other and aggregated using gradient pH co-precipitation(adding 1 mol/L citric acid slowly in the plasma solution to change the pH values gradually from 7.3 to 5.1 in 5 h)combined with salting out(degree of saturation of NaCl is 33%,reacted for 5.5 h at 4℃)or low-temperature ethanol precipitation(40% ethanol, reacted for 5.5 h at -7℃)so that to get rid of toxicants by discarding the supernatant.Results In the range of pH 5.1-7.3,50%(29g/57g)of the total plasma proteins had been recovered by the gradient pH salting out and 41%(25 g/61g)by the gradient pH low-temperature ethanol co-precipi- tation.The protein remained in the supernatant was mostly albumin and its combined bilirubin.The levels of total bilirubin decreased to 0.07% and 0.06% of the original levels by these two methods respectively and the serum HBV DNA level decreased to be undetected(quantitative PCR).Conclu- sions The proteins with close isoelectric point can co-precipitated with the presence of high concen- tration of NaCl or low-temperature ethanol and by changing the pH value gradually.The total protein in the discarded plasma during artificial-liver treatment can be recovered rapidly using the gradient pH coprecipitation.

Objective To introduce a new technique for urethral coverage in Snodgrass hypospadias repair,and to evaluate its effectiveness and complications.Methods From April 2003 to February 2006, this new procedure was performed in 289 children with hypospadias aged 3 months to 12 years (mean age,2. 4 years).The native meatus of urethra was identified subcoronal in 78 cases,penile/shaft in 136,penoscrotal in 36 and scrotal in 16;and 23 cases had undergoneⅡstage operation and re-operation.The overlapping coverage with bilateral shaft based vascularized dartos pedicle was done in the new urethra by Snodgrass hy- pospadias repair in these children.Results All the cases were followed for 3 months to 2 years.Postoper- atively,urinary fistulas developed in 32 cases (11%).Of them,11 were cured spontaneously within 4 weeks. The incidence of actual urinary fistula was 7% (21/289).Of the 21 fistulas which were not cured,11 (5%) occurred in 214 cases of distal hypospadias;and 10 (13%) in 75 cases of proximal hypospadias,Ⅱstage and re-operation.No dehiscence and diverticulum was found.Combined with mucosal collar technique,the ventral skin of the penis was sewn on the midline.During the follow-up,excellent cosmetic results with normal-ap- pearing circumcised penis were achieved in most patients.Conclusions Bilateral shaft based vascularized dartos pedicle urethral coverage procedure is a reliable and effective method for preventing urethral cutaneous fistulas and dehiscence.This method can reconstruct a satisfactory cosmetic appearance of the penis.

OBJECTIVETo evaluate the diagnosis and management of adrenal myelolipoma.

METHODSThe clinical data of 26 cases were analyzed retrospectively and the selected articles were reviewed. There were no specific clinical symptom and endocrine abnormality, except increasing catecholamine in 2 cases. All cases but two were diagnosed by B-model ultrasound scanning (B-US), CT or magnetic resonance imaging (MRI).

RESULTSTwenty-six cases were surgically treated, the diameter of the tumor was 5 - 10 cm, simple tumor resection was performed in 16 cases, and complete adrenal resection was performed in 10 cases. All the operated cases were proved by pathologists. The duration of follow-up was from 6 - 28 months after surgery. No recurrence was observed.

CONCLUSIONSThe diagnosis of adrenal myelolipoma could be established based on B-US, CT or MRI. The tumors whose diameter is larger than 5 cm in size should be removed.

Adrenal Gland Neoplasms ; diagnosis ; surgery ; Adrenalectomy ; Adult ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelolipoma ; diagnosis ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDProteasome subunits (PSMB) and transporter associated with antigen processing (TAP) loci are located in the human leukocyte antigen (HLA) Class II region play important roles in immune response and protein degradation in neurodegenerative diseases. This study aimed to explore the association between single nucleotide polymorphisms (SNPs) of PSMB and TAP and Parkinson's disease (PD).

METHODSA case-control study was conducted by genotyping SNPs in PSMB8, PSMB9, TAP1, and TAP2 genes in the Chinese population. Subjects included 542 sporadic patients with PD and 674 healthy controls. Nine identified SNPs in PSMB8, PSMB9, TAP1, and TAP2 were genotyped through SNaPshot testing.

RESULTSThe stratified analysis of rs17587 was specially performed on gender. Data revealed that female patients carry a higher frequency of rs17587-G/G versus (A/A + G/A) compared with controls. But there was no significant difference with respect to the genotypic frequencies of the SNPs in PSMB8, TAP1, and TAP2 loci in PD patients.

CONCLUSIONChinese females carrying the rs17587-G/G genotype in PSMB9 may increase a higher risk for PD, but no linkage was found between other SNPs in HLA Class II region and PD.

ATP-Binding Cassette Sub-Family B Member 2 ; genetics ; ATP-Binding Cassette, Sub-Family B, Member 3 ; genetics ; Adult ; Aged ; Antigen Presentation ; Case-Control Studies ; Cysteine Endopeptidases ; genetics ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease ; genetics ; immunology ; Polymorphism, Single Nucleotide ; Proteasome Endopeptidase Complex ; genetics