Objective To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG).Methods Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group. The difference in body temperature (T), heart rate (HR), mean arterial pressure (MAP), CVP, oxygenation index (PaO2/FiO2), mixed venous oxygen saturation (SvO2), Pv-aCO2, blood lactate (Lac), fluid intake, scores of the vasoactive agents at 6 hours post-operation, sequential organ failure assessment (SOFA) of 24 hours, mechanical ventilation time, the length of intensive care unit (ICU) stay, and hospitalization time were compared. The correlation between Pv-aCO2 and cardiac index (CI), Pv-aCO2 and Lac were analyzed by Spearman analysis in observation group.Results The T, HR, MAP, CVP, PaO2/FiO2, SvO2 and Lac at 6 hours post-operation were higher than those at admission in two groups, and Pv-aCO2 were significantly decreased. The SvO2 and fluid intake in observation group were higher than those in control group [SvO2: 0.671±0.068 vs. 0.634±0.052, fluid intake (mL): 454±151 vs. 304±106, bothP < 0.05], Pv-aCO2, Lac and scores of the vasoactive agents were lower than those in control group [Pv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.1±1.8 vs. 7.0±1.8, Lac (mmol/L): 1.7±0.5 vs. 2.8±0.6, scores of the vasoactive agents: 3.18±1.01 vs. 4.48±1.50, allP < 0.05], mechanical ventilation time and the length of ICU stay were less than those in the control group (hours: 16.52±6.41 vs. 21.96±9.00, 45.51±9.36 vs. 51.76±13.66, bothP< 0.05). There was no significant difference in SOFA, hospitalization time between the two groups. There was negative correlation with Pv-aCO2 and CI (r = -0.752,P < 0.01), and no correlation with Pv-aCO2 and Lac (r = -0.154,P = 0.171).Conclusion Pv-aCO2 combined with PLR can better guide volume management in the patients post OPCABG, reduce the usage of vasoactive agents and decrease the mechanical ventilation time and the length of ICU stay.

Objective To systematically evaluate the clinical efficacy and safety of the traditional Chinese medicine(TCM) therapy on perimenopausal insomnia from the standpoint of regulating liver and kidney.Methods Randomized controlled trials(RCT) on PubMed, EMbase, CNKI, Wanfang Database and VIP database from their inception to April 2016 were searched.Two researchers separately screened the literature, extracted data and evaluated the literature bias risk according to inclusive criteria and exclusive criteria.Then the Meta-analysis was operated using Rev Man 5.3 software.Results Altogether nine RCT with 678 patients were eligible.The result of Meta-analysis showed: the clinical effectiveness of experimental group (TCM therapy group) was superior to that of control group(RR=1.30,95%CI[1.11,1.52],P<0.05);the PSQI scores showed significant differences between the two groups (SMD=-1.16,95%CI[-2.12,-0.20],P<0.05),but SPIEGEL score did not.Although adverse reactions were appeared in five studies, the adverse reaction rate of the experimental group was lower significantly (RR=0.09,95%CI[0.04,0.22],P<0.05).Conclusion The experimental group achieved obvious clinical efficacy with less adverse effect.

Objectives:A clinical case caused by Chikungunya virus (CHIKV) was introduced into Tianjin, China from Myanmar. The current study is aimed to phylogenetically analyzing this imported strain and to reveal the relationship between this virus and other circulating CHIKV strains.Methods:RNA was extracted from serum of the suspected patient presenting with symptoms compatible with CHIKV infections. Real-time reverse transcription PCR (RT-PCR) assay was used for diagnoses of the patient. For phylogenetic analysis, envelope glycoprotein 1 (E1) gene of CHIKV was amplified by two-step RT-PCR and the products were sequenced.Results:The phylogenetic analyses revealed that the imported CHIKV belong to Indian Ocean Lineage (IOL) derived from ECSA genotype and sharing the same cluster with the Aede albopitus-adapted strains that triggered the outbreaks in Pakistan (2016), Italy (2017) and Bangladesh (2017). Conclusion:The imported CHIKV strain has the potential to cause explosive outbreaks in China and this event happened in Tianjin calls for strengthening the monitoring programs on mosquito-borne diseases in China.

OBJECTIVETo investigate the effects of Hydroxy Safflor yellow A (HSYA) on the growth of blood vessel of transplantation tumor of gastric adenocarcinoma cell line BGC-823 in nude mice and its underlying mechanism of antagonizing tumor angiogenesis.

METHODThe BGC-823 cells was subcutaneouly injected into the right anterior armpit of BALB/C nu/nu nude mice and established the animal model of transplantation tumor. Then nude mice were divided into 4 groups at random: model group, control group, high or low dosage of HSYA group. The model group were treated with normal sodium by intraperitoneal injection, HSYA groups were treated with HSYA at concentration of 0.056 g x L(-1) and 0.028 g x L(-1) by intraperitoneal injection, and in these groups each mouse was injected 2 times everyday with 0.2 mL by 4-6 hours interval. The control group were injected in enterocoelia 1 times every 2 days starting from the third day with cytoxan at 2 g x L(-1). 20 days later, the volume and weight of nude mice were observed. The pathological change of tumor tissue was observed under optical microscope. The mRNA expression of VEGF and bFGF of transplantation tumor were detected by real time quantitative PCR.

RESULTThe volume (607.42 +/- 252.96) mm3, weight (0.88 +/- 0.14) g of transplantation tumor, the mRNA expression level of VEGF 0.49 +/- 0.13 and bFGF 0.60 +/- 0.48 are reduced significantly after treatment with HSYA at the concentration of 0.028 g x L(-1) compared with physiologic saline-treated group (P < 0.05 or P < 0.01). The tumor pathological angiogenesis of HSYA group is also less obvious than the normal sodium-treated group.

CONCLUSIONHSYA in given concentration can inhibit the growth of BGC-823 transplantation tumor, and decreasing the mRNA expression of VEGF and bFGF, which suggests that inhibiting tumor angiogenesis may be one of the mechanisms of HSYA antagonizing tumor.

Adenocarcinoma ; drug therapy ; genetics ; metabolism ; Angiogenesis Inhibitors ; administration & dosage ; Animals ; Blood Vessels ; drug effects ; Cell Line, Tumor ; Chalcone ; administration & dosage ; analogs & derivatives ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Fibroblast Growth Factors ; genetics ; metabolism ; Gene Expression Regulation, Neoplastic ; drug effects ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Quinones ; administration & dosage ; Random Allocation ; Stomach Neoplasms ; drug therapy ; genetics ; metabolism ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

Objective:To retrospectively analyze the test results of novel coronavirus (2019-nCoV) in different samples (throat swab, sputum and feces) collected from recovered COVID-19 patients in order to provide a more reliable basis for discharge and reduce the risk of recurrence after discharge.Methods:Throat swabs and sputum were sampled in pairs from 78 patients before discharge and sampled in pairs twice from 54 cases with an interval of 1-5 d. Real-time fluorescence quantitative RT-PCR was used to detect the virus in the two types of samples. Throat swab, sputum and fecal samples of six patients were tested for 2019-nCoV during follow-up.Results:The detection rate of viral nucleic acid was 46.15% in throat swabs and 50.00% in sputum samples. Test results of the second paired samples showed that the detection rate of viral nucleic acid was 25.93% in throat swabs and 46.30% in sputum samples, and the difference between the two types of samples was statistically significant ( P<0.05). During follow-up, 2019-nCoV nucleic acid could be detected in the fecal samples of the six patients, but not in their throat swab and sputum samples. Their fecal samples remained positive up to 52 d. Conclusions:In the late convalescence, the respiratory symptoms of COVID-19 patients gradually disappeared with the improvement of clinical symptoms. Moreover, the virus might enter the gastrointestinal tract from respiratory tract, and could long-term exist in recovered patients and be excreted in feces. In order to reduce the rate of missed detection and avoid false negative results, it was suggested to test the viral nucleic acid in different types of samples before a COVID-19 patient was discharged.

Objective:To study the characteristics and evolution of the whole genome sequence of an imported Chikungunya virus (CHIKV) case in Tianjin, China, and to provide a scientific basis for the surveillance and control of CHIKV.Methods:The serum specimen of CHIKV was collected at Tianjin Second People's Hospital, on November 4th, 2019, and the viral RNA was extracted. Eleven overlapping primers were used to amplify the complete genome of CHIKV by RT-PCR. The amplification products were then subjected to next generation sequencing (NGS) using Illumina Miniseq platform.Results:The complete genome sequence of the Tianjin CHIKV obtained had similarities ranging from 92.72% to 99.86% with other Chinese isolates. Phylogenetic analysis indicated that the Tianjin CHIKV belonged to the Indian Ocean Lineage (IOL), East/Central/South African (ECSA) cluster, consistent with most strains from China. The Tianjin CHIKV is most similar (99.74%) to a Pakistan strain. Compared with the reference strain S27, 37 non-structural and 28 structural protein amino acid substitutions had been detected in Tianjin CHIKV genome, including two key site mutations, E1-D284E and E2-I211T, in accordance with other strains in the ECSA cluster. Besides, Tianjin CHIKV possessed two point virulent residues at position 12 and 82 in E2, and also a nsP3-R524Opal nonsense mutation.Conclusions:Tianjin CHIKV showed stronger virulence and greater transmissibility in Aedes albopictus. Therefore, the surveillance and monitoring of CHIKV in China should be strengthened.

Objective To study the expression of squamous cell markers p63, p40 and CK5/6 in small cell carcinoma of lung ( SCLC ).Methods Immunohistochemical study for squamous cell markers (p63, p40 and CK5/6), neuroendocrine markers (chromogranin A, synaptophysin and CD56) and TTF1 was carried out in 283 cases of SCLC.The diagnostic value of these markers was evaluated.Results The expression rate of p63, p40 and CK5/6 were 20.7% (54/261), 7.9% (5/63) and 0.5% (1/221), respectively in the cases of SCLC studied.Amongst the squamous cell markers, CK5/6 had the lowest rate of positivity ( P <0.01 ).On the other hand, chromogranin A, synaptophysin and CD56 were positive in 61.8%( 170/275 ) , 85.5% ( 242/283 ) and 89.2% ( 248/278 ) , respectively.The positivity rate for chromogranin A was lower than that for synaptophysin and CD56 ( P <0.01 ).TTF1 was expressed in 77.2%(217/281).Conclusions p63 and p40 are expressed in a subset of SCLC.In contrast, CK5/6 is rarely positive in SCLC.An immunohistochemical panel of CK5/6, synaptophysin and CD56 is recommended for differential diagnosis of SCLC.

Objective:To investigate the clinicopathological features, diagnosis and differential diagnosis of primary pleural epithelioid hemangioendothelioma (EHE).Methods:Five cases of pleural EHE diagnosed from 2012 to 2019 in the Shanghai Pulmonary Hospital of Tongji University, China, were collected. They were subjected to review of clinical and image data, reevaluation of histological sections, immunohistochemistry study, clinical follow up and literature review.Results:There were 1 male and 4 females (male to female ratio of 1∶4). The age ranged 19?58 years, with a median age of 52 years. There was no smoking history in all 5 cases. Clinical manifestations included chest distress, chest pain, cough and hemoptysis. CT scan showed pleural effusion, pleural thickening, multiple pleural nodules and pneumothorax. All of the 5 cases were diagnosed based on thoracoscopic biopsies, which were performed for the suspicion of malignancy in 3 cases and for the suspicion of tuberculosis upon the failure of anti-tuberculosis treatment in 2 cases. Histologically, the tumors grew in the mesenchyme, forming cords, nests and solid sheets. The tumor cells were round, oval, short spindle, and polygonal in shape. They were epithelioid and had abundant cytoplasm and prominent nucleoli. Blister cells (vacuoles in cytoplasm) could be seen, and for mednewly-generated vessel lumen. Mucoid degeneration and collagenization were common in the tumor stroma. The positive-stainin grate was 5/5 for vimentin, 5/5 for D2-40, 4/5 for CD31, 4/5 for ERG, 4/5 for CAMTA1, 2/5 for CD34 and 2/5 for CKpan. WT1, calretinin and CK5/6 were all negative. The follow-up time ranged from 4?18 months. During the follow-up, 4 patients were treated with chemotherapy (2 patients died, and 2 survived with tumor), and 1 patient lost to the follow-up.Conclusions:Primary pleural EHE is rare. Its imaging and clinical features are very similar to those of tuberculosis. The correct diagnosis relies on pathological biopsy. Tumor cells are epithelioid. When CD34 is negative and D2-40 is positive, it is easy to be misdiagnosed as malignant mesothelioma. The combination of CD31, ERG and CAMTA1, which have high specificity of EHE, is helpful for the differential diagnosis.

Objective:To investigate the clinicopathological features and genetic characteristics of congenital cystic adenomatoid malformation (CCAM) of lung and CCAM associated lung cancer in adults.Methods:A total of 13 cases of CCAM of lung in adults, diagnosed from June 2015 to May 2023, were collected from the Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China. Their histopathological features were correlated with probable development into lung cancer. Next-generation sequencing was performed on the benign and malignant areas of all cases.Results:The pathological classification of all cases were of CCAM of lung type 1. There were 4 male and 9 female cases, age ranged from 18 to 65 years, with a mean age of 41 years. Six cases were accompanied by lung cancer, all of them were mucinous adenocarcinoma. Next-generation sequencing showed no gene mutation in 2 of the 13 cases; KRAS mutations in exon 2 were detected in 7 cases, in which there were 6 cases complicated with lung mucinous adenocarcinoma and no matter in the malignant or benign regions, the same case exhibited the same mutation sites in KRAS gene.Conclusions:CCAM of the lung is a congenital disease, and in adults, type 1 is most commonly found in the pathological classification, and it is often accompanied by cancer. Gene mutations are frequently detected in CCAM of the lung, KRAS being the most recurrent mutation which may play an important role in the carcinogenesis.

OBJECTIVE: To investigate the relationship between serum 25(OH) vitamin D and liver fat content in nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 120 patients with NAFLD admitted in our hospital between June and August, 2017 were enrolled and divided into 4 groups with different serum 25 (OH) vitamin D levels: >75 nmol/L (group A, =25), 50-75 nmol/L (group B, =35), 25-50 nmol/L (group C, =32), and < 25 nmol/L (group D, =28). For all the patients, serum 25 (OH) vitamin D level was measured by ELISA, and liver fat content was determined using in-phase opposed-phase TWI sequences. The measurement data were compared among the 4 groups to assess the association between serum 25(OH) vitamin D level and liver fat content. RESULTS: The liver fat content appeared to be higher in group B (28.66±6.45%) and group C (38.74±11.47%) than in group A (22.79 ± 6.10%), but the difference was not statistically significant (>0.05); the liver fat content in group D (54.79 ± 5.28%) was significantly higher than that in the other 3 groups (>0.05). Liver fat content increased significantly as serum 25(OH) vitamin D level decreased, showing an inverse correlation between them in these patients ( < 0.05, =-0.125). CONCLUSIONS In patients with NAFLD, a decreased serum 25(OH) vitamin D level is associated with an increased liver fat content, suggesting the value of serum 25(OH) vitamin D as a predictor of NAFLD.
Humans ; Liver ; pathology ; Non-alcoholic Fatty Liver Disease ; blood ; pathology ; Vitamin D ; blood