Objective:To analyze the changes of mean arterial pressure (MAP) and end expiratory carbon dioxide (ETCO 2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO 2 monitoring in early prediction of severe cardiovascular collapse (CVC) after emergency ETI. Methods:The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital. The values of MAP and ETCO 2 were observed and recorded at 5, 10, 30, 60 and 120 min after intubation. According to whether severe CVC occurred after ETI, the patients were divided into the severe CVC group and non-severe CVC group. The values of MAP and ETCO 2 were compared at the same time points between the two groups and the adjacent time points within the groups. The correlation between MAP and ETCO 2 after ETI was also analyzed. ROC curve was used to analyze the ability of MAP and ETCO 2 at 5 min and 10 min after ETI to predict severe CVC. Results:Totally 116 patients were enrolled in this study, among them 75 (64.7%) cases had severe CVC after ETI. The majority were male and elderly patients in the severe CVC group. The values of MAP and ETCO 2 in 5, 10, 30, 60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group. The values of MAP and ETCO 2 in the two groups showed simultaneous decrease from 5 min to 30 min after ETI, reached the lowest value at 30 min after ETI, and appeared the synchronous recover from then to 120 min after ETI. After ETI, the changes of MAP was correlated with that of ETCO 2 ( rs = 0.653, P<0.01). At 5 min after ETI, MAP could predict severe CVC (AUC=0.86, P<0.01), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%); ETCO 2 could also predict severe CVC (AUC=0.85, P<0.01), and ETCO 2≤35 mmHg was the best cutoff value (sensitivity 77.3%, specificity 85.4%). At 10 min after ETI, MAP could predict severe CVC (AUC = 0.90, P<0.01), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), ETCO 2 could also predict severe CVC (AUC=0.87, P<0.01), and ETCO 2≤33 mmHg was the best cutoff value (sensitivity 81.3%, specificity 78.0%). There was no significant difference in the ability of prediction between any two indexes of the MAP and ETCO 2 at 5 min and 10 min after ETI ( P>0.05). Conclusions:Patients with severe CVC after ETI have early signs of decreased MAP and ETCO 2, but the delayed recognition and insufficient intervention may be related to the occurrence and development of severe CVC. MAP and ETCO 2 at the early stage after ETI have high accuracy in predicting severe CVC. MAP≤72 mmHg, ETCO 2≤35 mmHg at 5 min after intubation, MAP≤67 mmHg and ETCO 2≤33 mmHg at 10 minutes after intubation all suggest the possibility of severe CVC.

Objective: To investigate and analyze serological and hepatic morphological changes in aged rats with non-alcoholic fatty liver disease(NAFLD)by establishing NAFLD model with SD rats at different months of age. Methods: Male SD rats were randomly divided into four groups according to age: the aged model group(18-months-old), the aged control group(18-months-old), the young model group(2-months-old)and the young control group(2-months-old), with 12 rats in each group.Rats in the model groups and the control groups were fed a 45% high-fat diet and a normal diet, respectively, for eight weeks.Serum biochemical indexes and the insulin index were measured.Hepatic histological changes were evaluated under a light microscope following HE staining and Oil red staining. Results: The body and liver weights of the rats increased with age, and the average rate of weight growth and liver wet weight of the model groups were higher than those of their corresponding control groups(P<0.01). Levels of serum alanine aminotransferase(ALT), triglycerides(TG), cholesterol(CHOL), glucose(GLU), fasting insulin(FINS)and homeostatic model assessment of insulin resistance(HOMA-IR)in the aged model group were higher than those in the corresponding control group and of the young model group(P<0.05). Under the light microscope, hepatic cells stained with HE and Oil red showed diffuse swelling and were full of lipid vacuoles in the model groups.In the aged model group, hepatic cells were characterized by macrovesicular steatosis with focal necrosis. Conclusions Clear hyperlipemia, hyperglycemia and hyperinsulinemia can be seen in a NAFLD model induced by short-term high-fat feeding.Insulin resistance and decreased insulin sensitivity are more significant in aged rats with NAFLD.

Objectives:To explore the impact of attentional distribution principle on balance and arithmetic ability when performing calculation-balance dual task. Methods:From October, 2016 to December, 2017, 20 healthy young subjects were selected, and asked to perform eyes opened + calculation and eyes closed + calculation tests under sitting position, and perform single leg standing + eyes opened, single leg standing + eyes closed, single leg standing + eyes opened+ calculation and single leg standing + eyes closed + calculation tests in the static balance instrument. The maximum displacement in mediolateral direction and anteroposterior direction of center of gravity, sway area and sway path length were recorded, as well as the accuracy of counting backwards in steps of seven. Results:The maximum displacement in mediolateral direction and anteroposterior direction, sway area, sway path length were significantly less when eyes opened than eyes closed (t > 8.775, P < 0.001). The maximum displacement in mediolateral direction and anteroposterior direction, and sway area were less when eyes closed during the dual task than single task (t > 2.276, P < 0.05). There was no statistical difference in the maximum displacement in mediolateral direction and anteroposterior direction, and sway area and sway path length when eyes opened during the dual task compared with single task (t < 1.379, P > 0.05). There was no significant difference in the calculation accuracy among the eyes opened + sitting group, the eyes closed + sitting group, the eyes opened + balance test group and the eyes closed + balance test groups (P > 0.05). Conclusion:The low-difficult cognitive dual task does not affect the balance stability and arithmetic ability through the attentional distribution principle, on the contrary, the arithmetic task improves the static balance ability of single leg standing when eyes closed, however, it has no effect on the static balance ability of single leg standing when eyes opened.

OBJECTIVETo study the cytogenetic profiles of follicular lymphoma (FL) in Chinese patients.

METHODSConventional karyotype in 57 FL patients from Shanghai area was analyzed. Fluorescence in-situ hybridization (FISH) for t(14;18) and Bcl-6 and IgH gene rearrangement was performed in these cases.

RESULTSThe most frequent breakpoints (frequency > or = 10% ) of the 57 FL cases were at band 14q32 (68.4%), 18q21 (38.6%), 3q27 (21.1%), 1q10 (15.8%) and 1q21 (12.3%). Nineteen (33.3%) of the 57 cases had t(14;18). The breakpoint of 18q21 and t(14;18) were more frequent in FL grade 1-2 and less frequent in FL grade 3 (57.6% vs. 12.5%; 54.5% vs. 4.2%, P < 0.05), whereas the 3q27/Bcl-6 rearrangement was more frequent in FL grade 3 and less frequent in FL grade 1-2 (37.5% vs. 9.1% , P < 0.05). The cohort of FL was more frequent in gains of chromosomes X, 1q, 5, 6p, 7 and 12q and losses of chromosomes 1p, 6p and 14q32. Gain of 18q was more frequent in FL grade 1-2 than in FL grade 3 (P < 0.05). Loss of 14q32 was more frequent in t(14;18) negative FL than in t(14;18) positive FL (P < 0.05).

CONCLUSIONSCompared with the data of Western patients reported in the literature, Chinese FL cases had distinct cytogenetic profiles from Western FL cases that the t(14;18) is less frequent and the gain of 1q is more frequent in Chinese FL cases, which are more significant in high grade FL.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Chromosome Breakage ; Chromosome Deletion ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, Pair 18 ; Female ; Gene Rearrangement ; Genes, bcl-2 ; Humans ; In Situ Hybridization, Fluorescence ; Lymphoma, Follicular ; genetics ; pathology ; Male ; Middle Aged ; Neoplasm Grading ; Translocation, Genetic ; Young Adult

OBJECTIVETo study the clinicopathologic features of urothelial hyperplastic lesion with an endophytic growth pattern and the role of immunohistochemistry and multitargeted fluorescence in situ hybridization (FISH) in the differential diagnosis.

METHODSForty-one cases of urothelial lesions exhibiting endophytic growth patterns were reviewed and reclassified as inverted papilloma, urothelial carcinoma with an endophytic growth pattern, and florid von Brunn nest. The gains of chromosomes 3, 7, and 17 and loss of 9p21 was detected by FISH, and performed immunohistochemical staining for CK20, p53, and Ki-67. Follow-up data of 12 cases were obtained.

RESULTS(1) Twelve inverted papillomas sized 1.2 cm in average, consisted of anastomosing cords and nests with uniform width distribution involving the lamina propria, the central portion contained streaming cells with squamous metaplasia, and the periphery showed palisading. No or rare atypia and mitosis were found. Focal exophytic papillary component lined by less than 6 layers of normal urothelium were observed in 4 cases. (2) Twenty-four urothelial carcinomas with an endophytic growth pattern sized 2.1 cm in average, demonstrated the similar architecture with inverted papilloma, but exhibited thick columns and variable thickness of the cords, irregular size and shape of large nests with transition into solids. Mild to moderate cytologic atypia was shown, and mitotic figures ranged 1 to 8 per 10 HPFs. Exophytic papillary component was not observed in 3 cases, but the superficial urothelium showed dysplasia, while coexisted exophytic component in other cases was associated with low malignant potential or low grade tumor. (3) Five florid von Brunn nests sized 0.9 cm in average, had normal or hyperplastic urothelium, variable nests with cysts compacted in lamina propria, no cytologic atypia and mitosis. Twenty-one of 24 (79.1%) urothelial carcinomas with an endophytic growth pattern displayed abnormally positive results by multitargeted FISH, whereas all inverted papillomas and florid von Brunn nests were negative. Immunohistochemically, CK20 was weakly positive in 2 cases of urothelial carcinoma with an endophytic growth pattern, and negative in all inverted papillomas and florid von Brunn nests. p53 weakly stained 5% to 50% nuclei of the tumor cells in 16 cases of urothelial carcinomas with an endophytic growth pattern and 1 inverted papilloma. 1%-5% tumor cells expressed Ki-67 in urothelial carcinoma with an endophytic growth pattern, and less than 1% in inverted papilloma and florid von Brunn nests. Follow-up study revealed that 2 cases of urothelial carcinoma with an endophytic growth pattern had developed invasive carcinoma, underwent cystectomy, and metastasized remotely. No recurrence occurred in cases of inverted papilloma.

CONCLUSIONSBenign and malignant urothelial lesions with an endophytic growth pattern present histologic overlapping. Urothelial carcinoma with an endophytic growth pattern displays unique characteristics in morphology and immunohistochemistry. Multitargeted FISH analysis is helpful in the differential diagnosis.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell ; genetics ; metabolism ; pathology ; surgery ; Chromosome Aberrations ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Hyperplasia ; In Situ Hybridization, Fluorescence ; Keratin-20 ; metabolism ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; genetics ; metabolism ; pathology ; surgery ; Tumor Suppressor Protein p53 ; metabolism ; Urinary Bladder Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Urothelium ; metabolism ; pathology

Purpose: Caspase recruitment domain containing protein 9 (CARD9) has been demonstrated to be a pro-tumor factor in various cancers. However, our previous study found a significant decrease of CARD9 in malignant pleural effusion compared with benign pleural effusion. So we investigated the role of CARD9 in non-small cell lung cancer (NSCLC) and its working mechanism. Materials and Methods: Immunohistochemistry, western blot, and quantitative real-time polymerase chain reaction were used to detect the expression of CARD9 in specimens of NSCLC patients. The Cancer Genome Atlas (TCGA) databasewas also used to analyze the expression of CARD9 in NSCLC and its predicting value for prognosis. Immunofluorescence was used for CARD9 cellular location. Cell growth assay, clonal formation assay, wound healing assay, matrigel invasion assay, and flow cytometry were used to test cell proliferation, migration, invasion, apoptosis, and cycle progression of NSCLC cells with CARD9 knockdown or CARD9 overexpression. Co-immunoprecipitation was used to identify the interaction between CARD9 and B-cell lymphoma 10 (BCL10). SB203580 was used to inhibit p38 activation. Results: CARD9 was decreased in NSCLC tissues compared with normal tissues; low CARD9 expression was associated with poor survival. CARD9 was expressed both in tumor cells and macrophages. Downregulation of CARD9 in NSCLC cells enhanced the abilities of proliferation, invasion and migration via activated MAPK/p38 signaling, while overexpression of CARD9 presented antitumor effects. BCL10 was identified to interact with CARD9. Conclusion We demonstrate that CARD9 is an independent prognostic factor in NSCLC patients and inhibits proliferation, migration, and invasion by suppressing MAPK/p38 pathway in NSCLC cells.

Objective:To verify the synthetic CT(sCT) images generated by the adaptive radiation therapy (ART) workflow guided by magnetic resonance imaging (MRI), and to evaluate its feasibility for dose calculation in ART for head and neck.Methods:The plan CT (pCT) and T 2WI MRI images before each fraction of treatment were collected from 300 patients with head and neck tumors admitted to Shandong Cancer Hospital from January 1, 2022 to December 1, 2023. MRI was converted into sCT using RegGAN model. Among 300 patients, 240 cases were used for training and validation and 60 for testing. The mean absolute error (MAE), peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) were used to evaluate the image quality of sCT. The original pCT plan conditions were copied to sCT, and the accuracy of sCT was recalculated and verified. Finally, the radiation treatment plan of sCT was verified, and the γ-passing rate was calculated to further verify the accuracy of sCT dose calculation. Results:In terms of index calculation, the MAE of sCT was 32.50±5.46, 31.39±1.14 for PSNR, and 0.93±0.01 for SSIM, respectively. Slight difference was observed in the comparison of CT values. Regarding dose calculation, the accuracy of sCT dose calculation was high. According to the dose volume histogram (DVH), the difference in dose calculation was slight, and the average dose difference was only 0.16%. sCT exhibited a high degree of coincidence with pCT in the evaluation of target delineation for planning target, clinical target and gross tumor volume. The average Dice similarity coefficients were 0.97, 0.95 and 0.94, respectively. The γ-passing rate reached 100% using 3%/2 mm. The total treatment time of all patients was (155.14±9.41) s.Conclusions:The ART workflow has high work efficiency, and the accuracy of the generated sCT can meet the dose calculation accuracy requirements of the online plan. It can be used as a reference image for MRI-guided accelerator ART of nasopharyngeal carcinoma, and is expected to achieve MR radiotherapy based on nasopharyngeal carcinoma.

OBJECTIVETo investigate the image features and the diagnostic value of spiral CT for cystic renal cell carcinoma.

METHODSThe clinical data and CT manifestations of 17 operated and pathologically proven cystic renal cell carcinoma were retrospectively analyzed. There were 12 males and 5 females with an average age of 47.3 years (33 - 82 years). Plain and contrast CT scan (Siemens somatom) single layer sensation 16 layer spiral CT had been performed before operation. The image of artery phase (30 - 40 s), venous (60 - 70 s) and excretory (120 - 180 s) were respectively obtained after contrast administration. Various image reconstructions were done using Siemens Wizard workstation based on the raw images.

RESULTSIt was found that 5 cystic renal cell cancers located in the right kidney and 12 in the left kidney. The long dimension of the tumor arranged from 21 - 100 mm with an average of 57 mm. The tumor looked like a round or round-like shape with density similar to fluid on plain CT scan. Some cystic renal carcinomas had a thick wall. Some had single or multiple cystic spaces filled with fluid of different densities. Some had infiltrated out of kidney surface or into renal sinus. Some showed enhanced nodules on the wall.

CONCLUSIONCystic renal cell carcinoma has its own specific morphologic features in spiral CT scan. Spiral CT may be very helpful in the diagnosis of cystic renal cell carcinoma before operation.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Kidney Diseases, Cystic ; diagnostic imaging ; Kidney Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Radiographic Image Enhancement ; Retrospective Studies ; Tomography, Spiral Computed ; methods

OBJECTIVETo study the immunohistochemical classification and prognosis of diffuse large B-cell lymphoma (DLBCL).

METHODSA total of 148 cases of DLBCL were classified into germinal center B-cell-like (GCB) and non-GCB/activated B-cell-like (ABC) subtypes by Hans, Choi and Tally immunohistochemical stain algorithms. The clinical features and survival data of GCB and non-GCB/ABC subtypes were compared. Multivariate analysis about clinical features and results of immunohistochemical stain algorithms was carried out by using Cox regression, with overall survival as the outcome.

RESULTSThe prevalence of GCB subtype was significantly lower than that of non-GCB/ABC subtype, as classified by whichever algorithms in the 148 DLBCL cases studied. The prevalence of GCB subtype by Tally algorithm was lowest. The prevalence of GCB subtype (19 cases, 16.7%) was also significantly lower than non-GCB/ABC subtype (95 cases, 83.3%; P = 0.000 1) in the 114 (77.0%) concordant cases by the three algorithms. There was no difference between GCB and non-GCB/ABC subtypes by the three algorithms in five-year overall survival rate and survival curve of the 80 DLBCL patients with follow-up data available (P > 0.05). Primary gastric DLBCL tended to show a higher prevalence of GCB subtype, a better five-year overall survival rate and survival curve than the other groups. Multivariate analysis showed that patient age (HR = 1.036, P = 0.001) and tumor stage (HR = 1.997, P = 0) were also significantly adverse predictors of overall survival.

CONCLUSIONThe Hans, Choi and Tally immunohistochemical stain algorithms cannot effectively classify Chinese DLBCL into different prognostic subtypes. Primary gastric DLBCL has different immunophenotype and outcome, as compared with DLCBL in other sites.

B-Lymphocytes ; pathology ; China ; Humans ; Immunophenotyping ; Lymphoma, Large B-Cell, Diffuse ; classification ; diagnosis ; Lymphoma, Non-Hodgkin ; diagnosis ; Prognosis ; Stomach Neoplasms ; diagnosis ; Survival Rate

Objective:To explore the correlation between carotid blood flow and the parameters derived by pulse oximetry Plethysmographic waveform in cardiopulmonary resuscitation, so as to provide a new index for carotid blood flow monitoring in cardiopulmonary resuscitation.Methods:Seven male domestic pigs were utilized for cardiac arrest model through ventricular fibrillation induced by electrical stimulation. Eight minutes after cardiac arrest, artificial chest compression was given for 4 min, and epinephrine 20 μg/kg was injected intravenously at 2 min after chest compression. The compression frequency, compression depth, right carotid blood flow, pulse oximetry plethysmographic waveform, aortic pressure, right atrium pressure and end tidal carbon dioxide partial pressure were continuously monitored and recorded. From 30 s to 4 min after chest compression, the values of the mean right carotid blood flow, the area under curve (AUC) of pulse oximetry plethysmographic waveform, the mean perfusion index, the mean coronary perfusion pressure and the average end-tidal carbon dioxide partial pressure during 6 s before time point were calculated every 30 s. The correlations between right carotid blood flow and the AUC of pulse oximetry plethysmographic waveform and perfusion index were analyzed respectively.Results:Ventricular fibrillation was induced successfully in seven animals. There were no significant differences in the mean chest compression frequency and depth per min during 4 min of chest compression. Right carotid blood flow at 30 s after chest compression was (92.7±32.7) mL/min, and decreased to (48.5±23.5) mL/min at 1 min after chest compression ( P<0.05). There was no significant difference in blood flow before and after epinephrine injection ( P>0.05). The AUC of the blood oxygen plethysmographic waveform and perfusion index showed synchronous change trends with right carotid blood flow. Both coronary perfusion pressure and end-tidal carbon dioxide partial pressure showed different change trends with right carotid blood flow. There was a positive correlation between the right carotid blood flow and the AUC of blood oxygen plethysmographic waveform ( r=0.66, P<0.01), and also a positive correlation between right carotid blood flow and perfusion index ( r=0.57, P<0.01). Conclusions:Carotid blood flow is positively correlated with the AUC of blood oxygen plethysmographic waveform and perfusion index in a porcine model of cardiopulmonary resuscitation. Real-time monitoring of the two parameters derived by pulse oximetry plethysmographic waveform can reflect the changes of carotid blood flow to a certain extent.