Objective: To investigate the clinicopathologic and molecular characteristics, diagnostic, differential diagnostic and prognostic features of malignant gastrointestinal neuroectodermal tumor. Methods: Two cases of malignant gastrointestinal neuroectodermal tumor were retrieved; the clinical and radiologic features, histomorphology, immunophenotype, molecular genetics and prognosis were analyzed and the relevant literature reviewed. Results: Case 1 was a 57-year-old male, presented with recurrent abdominal pain and melena. Pelvic imaging showed a circumscribed thickening of the wall of a small intestinal segment, and a malignant lymphoma was favored. Case 2 was a 24-year-old male, presented with recurrent small intestinal malignancy. Imaging demonstrated multiple masses in the peritoneal and pelvic cavities, and a malignant gastrointestinal stromal tumor with multiple metastases was suspected. Grossly both tumors were located mainly in the muscularis propria of small intestine. Case 1 showed a single 5.5 cm tumor; and case 2 consisted of two tumors measuring 4 cm and 6 cm respectively. Microscopic examination of both tumors showed small round blue, but focally spindled or clear tumor cells in solid pattern. The tumor cells had scanty cytoplasm, indistinctive nucleoli and brisk mitoses. Osteoclast-like giant cells were dispersed within the stroma. In case 1 rosette-like and pseudo-papillary growth patterns were noted, and in case 2 there were variable-sized hemorrhagic cysts. By immunohistochemistry, both tumors showed strong and diffuse expression of SOX10 and S-100, and focal to diffuse expression of neuroendocrine markers (CD56 or synaptophysin). Case 2 exhibited focal reactivity to pan-cytokeratin. Both tumors lacked expression of markers associated with gastrointestinal stromal tumor, smooth muscle tumor, melanoma (HMB45 or Melan A), dendritic cell tumor and Ewing sarcoma. Fluorescence in situ hybridization analysis demonstrated EWSR1 rearrangement in both tumors and the next generation sequencing confirmed EWSR1-ATF1 gene fusion in case 2. At follow-up of 16 months, case 1 was recurrence or metastasis free; whereas case 2 showed multiple recurrences and metastases within 19 months although stable disease was transiently achieved when treated with combinations of multidrug and targeted chemotherapy. Conclusions Malignant gastrointestinal neuroectodermal tumor is a rare and aggressive soft tissue sarcoma with a predilection for small intestine. It has distinctive morphologic, immunohistochemical and molecular characteristics and needs to be distinguished from other small blue round and spindle cell tumors that occur in the gut. Careful attentions to its characteristic histomorphology with the judicious use of immunohistochemistry and molecular genetics can help to distinguish this tumor from its many mimickers.

BACKGROUNDIt has been proved that EphB4 and HIF-1α are closely related to the oncogenesis and development of lung cancer. The aim of this study is to investigate the biological significances of EphB4 and HIF-1α in lung cancer and their relationship with each other.

METHODSThe expression of EphB4 and HIF-1α was detected in 54 lung cancer tissues and 10 normal lung tissues as control by immunohistochemical method.

RESULTSEphB4 and HIF-1α proteins were detectable in 50.0% and 42.6% of all 54 lung cancer tissues respectively, which were significantly higher than those of the control (P < 0.05); the positive ratios and the levels of the expressions of EphB4 and HIF-1α proteins were closely related to gross types, differentiations and clinical stages (P < 0.05), but not to histological classification, age, sex and lymph node metastasis (P > 0.05). A highly positive correlation was observed between EphB4 and HIF-1α expression (P < 0.01 ).

CONCLUSIONSOverexpression of EphB4 and HIF-1α may play an important role in the pathogenesis, progression and malignant degree of lung cancer. Detection of EphB4 and HIF-1α expression might be helpful to predict prognosis of patients with lung cancer.

Objective To analyze the influencing factors of ovulation induction therapy in pa-tients with polycystic ovary syndrome(PCOS),and to construct a predictive model for the efficacy of ovulation induction therapy in PCOS patients.Methods A total of 200 infertile PCOS patients suit-able for ovulation induction therapy were selected as the study subjects.All patients underwent ovula-tion induction with letrozole or letrozole combined with urinary gonadotropins.They were divided into effective group(n=160)and ineffective group(n=40)based on the efficacy of ovulation induction.The clinical data of the two groups were retrospectively collected and analyzed.Logistic regression a-nalysis was used to analyze the influencing factors of ovulation induction therapy in PCOS patients,and a nomogram prediction model for the efficacy of ovulation induction was constructed.The predictive performance of the nomogram model for ovulation induction therapy in PCOS patients was evaluated.Results The number of ovulations and mature follicles,proportion of ovulation patients and endome-trial thickness in the effective group were significantly higher,and the androgen level in the effective group was significantly lower than that in the ineffective group(P＜0.05).Logistic regression analysis showed that androgen level,ovulation count,the number of mature follicles and endometrial thickness were influencing factors for the efficacy of ovulation induction in PCOS patients(OR＜1,P＜0.05).Receiver operating characteristic(ROC)curve analysis revealed that the area under the curve(A1UC)values for ovulation count,the number of mature follicles,endometrial thickness and androgen level in assessing the efficacy of ovulation induction therapy in PCOS patients were greater than 0.60.The verifi-cation results of the nomogram prediction model showed that the consistency index value of the calibration curve was 0.984.Conclusion Androgen level,ovulation count,the number of mature follicles and endometrial thickness areinfluencing factors for the efficacy of ovulation induction therapy in PCOS pa-tients.The evaluation performance of the nomogram prediction model based on the above factors is good.

Objective To analyze the influencing factors of ovulation induction therapy in pa-tients with polycystic ovary syndrome(PCOS),and to construct a predictive model for the efficacy of ovulation induction therapy in PCOS patients.Methods A total of 200 infertile PCOS patients suit-able for ovulation induction therapy were selected as the study subjects.All patients underwent ovula-tion induction with letrozole or letrozole combined with urinary gonadotropins.They were divided into effective group(n=160)and ineffective group(n=40)based on the efficacy of ovulation induction.The clinical data of the two groups were retrospectively collected and analyzed.Logistic regression a-nalysis was used to analyze the influencing factors of ovulation induction therapy in PCOS patients,and a nomogram prediction model for the efficacy of ovulation induction was constructed.The predictive performance of the nomogram model for ovulation induction therapy in PCOS patients was evaluated.Results The number of ovulations and mature follicles,proportion of ovulation patients and endome-trial thickness in the effective group were significantly higher,and the androgen level in the effective group was significantly lower than that in the ineffective group(P＜0.05).Logistic regression analysis showed that androgen level,ovulation count,the number of mature follicles and endometrial thickness were influencing factors for the efficacy of ovulation induction in PCOS patients(OR＜1,P＜0.05).Receiver operating characteristic(ROC)curve analysis revealed that the area under the curve(A1UC)values for ovulation count,the number of mature follicles,endometrial thickness and androgen level in assessing the efficacy of ovulation induction therapy in PCOS patients were greater than 0.60.The verifi-cation results of the nomogram prediction model showed that the consistency index value of the calibration curve was 0.984.Conclusion Androgen level,ovulation count,the number of mature follicles and endometrial thickness areinfluencing factors for the efficacy of ovulation induction therapy in PCOS pa-tients.The evaluation performance of the nomogram prediction model based on the above factors is good.

Objective? To investigate the effects of Ramsay sedation score on the nursing intervention for children undergoing continuous renal replacement therapy(CRRT). Methods? By retrospective non-random sampling, a total of 30 children treated with CRRT in Anhui Children＇s Hospital from January 2016 to May 2017 were assigned into the control group and nursed according to the standard operating procedures of CRRT for children. Another 30 children treated with CRRT from June 2017 to September 2018 were put into the observation group and the Ramsay sedation score was applied to adjust the sedation administration plan according to the results and doctors＇ prescriptions, and nursing intervention was given at the early stage of agitation. Machine alarm, complications and adverse events were compared between the two groups. Results? After nursing intervention with Ramsay sedation score, the incidence of complications including machine alarm (1 time), failed bloodletting (1 time), bleeding at catheter puncture point (4 cases) and unplanned accidental termination of treatment (1 time) in the observation group were lower than those in the control group with statistical significance (P＜0.05). Conclusions? Ramsay sedation score is simple and practical to apply and it is convenient for pediatric blood purification specialized nurses to evaluate its function. It can effectively reduce incidences of CRRT machine alarm, complications and adverse events.

Objective To determine the role of serum procalcitonin(PCT)and C-reactive protein (CRP)in predicting spontaneous bacterial peritonitis(SBP)in patients with liver cirrhosis combined with ascites. Methods Ninety-eight patients with liver cirrhosis combined with ascites were enrolled, including 48 cases with SBP(SBP group)and 50 cases without SBP(non-SBP group).The levels of serum PCT and CRP were compared between 2 groups.The receiver operating characteristic(ROC)curves were used to evaluate the diagnostic SBP value of PCT and CRP levels in patients with liver cirrhosis combined with ascites.Results The serum PCT and CRP levels in SBP group were significantly higher than those in non-SBP group:3.90(6.95)μg/L vs.0.50(0.43)μg/L and 20.80(11.27)mg/L vs.10.87(6.22)mg/L, and there were statistical differences(P<0.01).The ROC cures results showed that the areas under the curve of serum PCT and CRP levels were 0.924(95% CI 0.860-0.987)and 0.852(95% CI 0.777-0.926), and the optimal cut-off of predicting SBP in patients with liver cirrhosis combined with ascites were 0.81 μg/L and 13.89 mg/L. The sensitivity was 91.7% and 85.4%, and the specificity was 80.0%and 70.0% respectively.The mortality in SBP group was significant higher than that in non-SBP group:20.83%(10/48)vs.6.00%(3/50),and there was statistical difference(P<0.05).In SBP group,the serum PCT and CRP levels in death patients were significant higher than those in survival patients: 13.00 (10.90) μg/L vs. 2.50 (5.30) μg/L and 35.40 (31.22) mg/L vs. 18.05(10.15) mg/L, and there were statistical differences(P<0.01 or<0.05).Conclusions The increase of serum PCT and CRP levels can be used as an important diagnostic index for SBP in patients with liver cirrhosis combined with ascites, and has predictive value for prognosis.

【Objective】  To study the effects of soil environment on the growth, yield, and quality of Sharen (Amomi Fructus) under different planting patterns. 【Methods】  Soil physical and chemical indices and enzyme activities in four periods including early flowering (March), full flowering (June), fruit ripening (September), and late fruit picking (December), were measured under three planting patterns including natural forest, greenhouse, and rubber forest in Xishuangbanna, China. The changes in soil indices during the growth periods of Sharen (Amomi Fructus) under different planting patterns were analyzed, and the differences in plant growth, yield, and quality under different planting patterns were explored. Pearson correlation analysis was used to analyze the relationship between soil indices and Sharen (Amomi Fructus) growth, yield, and quality. Principal component analysis was used to investigate the effects of soil environment under different planting patterns on Sharen (Amomi Fructus) growth, yield, and quality. 【Results】  The soil moisture, available potassium content, and urease activity of the three planting patterns of Sharen (Amomi Fructus) increased initially and decreased afterwards throughout the year; pH and organic matter content showed little change in the whole year. Exchangeable manganese content and acid phosphatase activity gradually increased throughout the year. Hydrolyzed nitrogen content, exchangeable calcium content, available zinc content, protease activity, and sucrase activity decreased initially and increased afterwards throughout the year. Exchangeable magnesium content, available iron content, and catalase activity decreased annually. Total nitrogen content, total phosphorus content, and available phosphorus content fluctuated throughout the year. The total potassium content under natural forest and greenhouse planting decreased throughout the year, while the total potassium content under rubber forest showed an upward trend all year round. The organic matter content, total nitrogen content, total potassium content, available potassium content, available zinc content, urease activity, acid phosphatase activity, and catalase activity under greenhouse were significantly lower than those under natural and rubber forests (P < 0.05). Correlation analysis showed that plant growth, yield, and quality of Sharen (Amomi Fructus) were significantly correlated with soil organic matter, total nitrogen, hydrolyzed nitrogen, total phosphorus, available phosphorus, total potassium, available potassium, exchangeable manganese, exchangeable magnesium, exchangeable calcium, available zinc, urease, acid phosphatase, and invertase (P <  0.05). The results of the principal component analysis indicated that the soil environment of Sharen (Amomi Fructus) under natural forest was the best, followed by rubber forest and greenhouse. The order of its advantages and disadvantages is consistent with the growth index of Sharen (Amomi Fructus), but contrary to the yield of Sharen (Amomi Fructus), indicating that the soil environment directly affects the growth index and nutritional components of plants. 【Conclusion】  Different planting patterns of Sharen (Amomi Fructus) have different soil nutrient content, and the change rules in the growths period are not similar, with some differences. Soil indices have impacts on plant growth, yield, and quality of Sharen (Amomi Fructus). Soil ecological environment is positively correlated with the growth characteristics of Sharen (Amomi Fructus) plants, but has no direct correlation with yield and quality.