Objective To analyze the expressions of tumor stem cell markers Lgr5 and CD44 in esophageal carcinoma and its clinical pathological significance.Methods A total of 108 cases of patients with esophageal cancer, 35 cases of stage Ⅱ, 40 cases of stage Ⅲ, 4 cases of stage Ⅳ. After tumor specimens were stained, the expressions of Lgr5 and CD44 in esophageal cancer tissue were detected and its relationship with the clinical features were analyzed.Results There were relations between expressions of Lgr5 and CD44 in esophageal cancer tissue and clinical staging, the later the stageing, the higher expression rate of Lgr5 and CD44, but there was no significant differece with Chi-square test. The Spearman correlation analysis showed there was no correlation between Lgr5 or CD44 and esophageal cancer condition. Conclusion CD44 and Lgr5 are highly expressed in esophageal cancer tissue, but the correlation between CD44 and Lgr5 expression and esophageal cancer condition is uncertain.

Objective To investigate the prevalence of plasmid-mediated quinolone resistance ( PMQR ) determinants [ qnr,aac ( 6' ) -Ib-cr and qepA ]and mutations in quinolone resistance-determining regions (QRDRs) of gyrA and parC and their association with fluoroquinolone susceptibility in clinical isolates of Serratia marcescens in Anhui.Methods The minimum inhibition concentration ( MIC ) of 104 strains of S.rnarcescens collected from various clinical specimens from 34 hospitals during 2005 to 2010 were determined by agar dilution method.The qnr,aac (6')-Ib,qepA,gyrA and parC genes were screened by polymerase chain reaction (PCR) in 31 strains resistant to ciprofloxacin,and positive results were subsequently confirmed by sequencing.The conjugation experiments were performed for qnr and aac(6')-Ib-cr positive strains.The MIC of S.marcescens isolates,recipient strains and conjugants were tested by agar dilution method for quinolones and other antimicrobial agents.Results Six strains of the 31 S.marcescens isolates harboured qnr and/or aac(6')-Ib-cr genes.Among those 6 strains,2 strains harboured a qnrB6 gene,1 harboured a qnrS2 gene,and 4 harboured aac( 6' ) -Ib-cr,whereas no qnrA-,qnrC- or qnrD-positive isolate was detected.None of the 31 isolates carried the qepA gene.Mutations in the QRDR of gyrA and parC genes were detected in 9 and 7 isolates,respectively.The conjugation experiments were successfully carried out in 5 isolates of 6 PMQR determinants-postive strains.The MIC of conjugants for quinolones were increased evidently compared to recipient strains.Conclusions Chromosome and plasmid-mediated resistance determinants play an important role in quinolone resistance in clinical isolates of S.marcescens.And more important is that the PMQR determinants can be horizontal transmitted.It is necessary to continuously survey and watch for the spread of PMQR in S.marcescens in public health control program.

[ABSTRACT]OBJECTIVETo study the expressions of 34βE12, Galectin-3 and HBME-1 in thyroid nodules, and to explore its diagnostic value for papillary thyroid carcinoma (PTC).METHODSEn VisionTM immunohistochemical technique was used to detect the expression of 34βE12, Galectin-3 and HBME-1 in 352 thyroid lesions. The correlation between the expressions of the 3 protein markers and clinicopathological characteristics was evaluated. The receiver operating characteristic area under the curve (ROC-AUC) and their index for diagnosis evaluation were also calculated.RESULTSThe positive rates of 34βE12, Galectin-3 and HBME-1 in 246 PTC lesions were significantly higher than those in benign nodules (P<0.001). There was no relationship between the expression of the 3 protein markers and clinicopathological characteristics (eg. gender, age, numbers of lesions, tumor size, capsular invasion, lymph node metastasis, TNM staging). The ROC-AUC of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 0.936, 0.915 and 0.898 respectively. The sensitivity of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 94.3%, 95.5% and 91.1% respectively, while the specificity was 81.1%, 71.7% and 83.0% respectively, and the diagnostic accuracy rate was 90.3%, 88.4% and 88.6% respectively.CONCLUSION The expressions of 34βE12, Galectin-3 and HBME-1 are statistically different between PTC and benign lesions, but no associations are found with clinicopathological characteristics, indicating the three protein markers have important diagnostic value for PTC.

Multiple myeloma is a malignant proliferative disease of plasma cells,and some patients may develop systemic amyloidosis.Cardiac amyloidosis is a common cause of death in these patients.Secondary adrenal insufficiency is caused by dysfunction of the hypothalamus and/or the pituitary gland,and multiple myeloma cases combined with secondary adrenal cortical dysfunction have been rarely reported in China.The patient,55-year-old,male,was admitted to the Emergency Department of Shenzhen Luohu People's Hospital on June 5,2018 due to"repeated chest tightness and fatigue for 7 months,and fainting for 1 hour".Later,he was transferred to Department of Hematology and was diagnosed as having multiple myeloma(λ light chain type)with systemic amyloidosis through bone marrow puncture and other examinations.The first course regimen of chemotherapy was bortezomib,cyclophosphamide,and dexamethasone.After the course,the patient was infected with a mixture of bacteria and fungi in the lung and had improvement after treatment.Then the regimen was adjusted to bortezomib and dexamethasone from the second course.After the fourth course,the patient achieved complete remission of multiple myeloma.After the fifth course,the patient experienced severe pulmonary-mixed infection again,which was improved after treatment.Thereafter,the patient presented with refractory hypotension,and decreased levels of cortisol and adrenocorticotropic hormone(ACTH),which was diagnosed as secondary adrenal cortical dysfunction.Hydrocortisone replacement therapy was administered.After 9 courses of chemotherapy,the patient received maintenance treatment with ixazomib.Multiple myeloma was evaluated as a stringent complete response.Cardiac amyloidosis was evaluated as a very good partial response,and secondary adrenal cortical dysfunction was treated with hydrocortisone maintenance therapy and with the cortisol level in the normal range.

Objective: Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves. Methods: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nervesparing was performed. The surgical, functional and oncological outcomes were evaluated. Results: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate. Conclusion NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.

Objective: Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves. Methods: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nervesparing was performed. The surgical, functional and oncological outcomes were evaluated. Results: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate. Conclusion NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.

Objective: Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves. Methods: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nervesparing was performed. The surgical, functional and oncological outcomes were evaluated. Results: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate. Conclusion NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.