Purpose To explore the clinicopathological features,immunophenotype,differential diagnosis and prognosis of the composite pheochromocytoma (CP)-ganglioneuroma.Methods 3 cases of CP-ganglioneuroma were stained by immunohistochemical SP method,and the related literatures were reviewed.Results 3 cases of CP-ganglioneuroma were one male and 2 females,the age were 37-64.Case 3 were of primary mediastinal.Microscopically,the tumor tissues were composed of two components:one type of tumor cells were arranged in nests with a predominant Zellballen pattern,round or oval nuclei,fine granular cytoplasm and rare mitotic,another part of the neoplasm showed scattered and aggregated distributed ganglion cells in the background of neurofibromatosis which aligned bundles and interwoven,the edge of the tumor was still residual adrenal tissue.Immunohistochemically,components of pheochromocytoma were positive for CD56,CgA,Syn,vimentin and negative for SMA,Melan-A,α-inhibin NF with low Ki-67 proliferation index.S-100 was positive in supporting cells,ganglioneuroma components were positive for NF,S-100 with low Ki-67 proliferation index.CgA and Syn were weakly positive or negative in the ganglion cells.Conclusion CP is a relatively rare tumor,which can not be distinguished from pheochromocytoma in clinical and radiological diagnosis.The corresponding clinical treatment and follow-up management should be taken according to the different ingredients (benign or malignant).

0.05).MMP-9 reached the peak at 1 month after PCI in DM group,and had significant difference compared with the concentration before or 24h after PCI in DM group 34.74?10.70 ?g/L vs 19.64?6.03 ?g/L,20.00?7.06 ?g/L(P

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 evaluate the possibility of detection mutations of multiple genes in stool for secondary screening for colorectal cancer.Methods Tumor specimens and stool samples from 40 patients with colorectal cancer and 40 normal persons were examined for mutations of p53,K-ras and APC gene by polymerase chain reaction single strand conformation polymorphism(PCR-SSCP) and silver nitrate staining.Results ①The mutation rate of p53,K-ras and APC gene in the tissues and stools of colorectal cancer respectively were 57.50%,50.00%,60.00% and 42.86%,40.00%,51.43%,and no mutations were found in normal mucosa and stool.②The mutation ratioes between multiple gene and single gene had significant difference(P

Objective To explore the clinicopathological features and diagnosis of adenoid cystic carci noma of the breast (ACCB).Methods Clinical data of 3 cases of ACCB were collected and followed up to observe the clinical pathological features.Immunohistochemistry was used to determine the immune phenotype.Results All the 3 cases were female,aging from 55 to 72 years old (61 years old as the average).The tumors were found in subareolar region well-circumscribed.ACCB was characterized by the presence of a dual cell population of luminal and basaloid cells arranged in cribriform and tubular-trabecular patterns.On immunohistochemical staining,the myoepithelial cells expressed SMA,CK5/6,P63,CD117 and the glandular epithelium cells were mostly positive for CK18,EMA,CK7,while no expression of ER,PR,HER-2,CD10 was observed.Conclusions ACCB is a rare neoplasm with a triple-negative,basal-like phenotype,but exhibits an indolent clinical behavior.The diagnosis can be worked out by evaluation of clinical characterstics,histological and immunohistochemical features.

Objective To investigate the expression of DNA binding protein A (dbpA) in patients with colorectal carcinoma of different stages and its significance.Methods Expression of dbpA protein and mRNA in specimens of normal tissues and colorectal cancer were detected by immunohistochemistry,expression of dbpA mRNA and protein of colorectal cancer cell lines SW480,RKO,SW620,DLD-1,HT-29,SW1463 and tissues were detected by immunohistochemistry,RT-PCR and Western blot.Results There was no positive staining dbpA protein and mRNA in normal colorectal tissues.However,dbpA was expressed in epithelial cells of colorectal mucosa [dbpA mRNA:80.0 ％ (48/60),10.0 ％ (6/60);dbpA protein:83.3 ％ (50/60),10.0 ％ (6/60),P ＜ 0.01].And there was no expression in normal colorectal cell,but its expression was high in 6 colorectal cancer cells (P ＜ 0.05).The high expression of dbpA was correlation with the infiltration depth,lymph node metastasis and type of histology (P ＜ 0.05),and had effect in prognosis of colorectal cancer (P ＜ 0.05).Conclusion Elevated dbpA may be related to the pathogenesis and development of colorectal carcinoma,and dbpA may be a prognostic factor of colorectal carcinoma.

Objective: To investigate the clinicopathologic features and genetic profile of large cell lung carcinoma (LCC) redefined by new classification. Methods: Basing on 2015 WHO classification criteria in redefining large cell lung carcinoma, the expression of specific markers (TTF1, Napsin A, p40, CK5/6, CK, vimentin and ZEB1) was detected by immunohistochemistry and D-PAS staining in 303 surgically-removed lung specimens previously diagnosed as large cell lung carcinoma. The clinicopathologic and genetic characteristics (including EGFR, KRAS, BRAF, ALK and ROS1 gene mutation) were analyzed. Results: Based on the new definition of LCC, 116 cases (116/303, 38.3%) of LCC formerly diagnosed were reclassified as solid adenocarcinoma, 49 cases (49/303, 16.2%) as squamous cell carcinoma, 6 cases (6/303, 2.0%) as adenosquamous carcinoma, 22 cases (22/303, 7.3%) as spindle cell carcinoma and only 110 cases (110/303, 36.3%) as large cell carcinoma. Redefined LCCs were characterized as middle-age (range 40-80), male (102/110, 92.7%) and smoking patients (64/110, 58.2%) with intermediate-advanced stage. Among 110 cases, 9 cases with EGFR mutation and 10 cases with KRAS mutation and 1 case with ALK fusion were found. No BRAF and ROS1 alterations were identified. Conclusions According to the new classification, LCCs formerly diagnosed are mostly reclassified as adenocarcinoma and non-keratinizing squamous cell carcinoma. The newly defined LCC may significantly benefit from clinical therapy.

Objective: To investigate the prevalence of work-related musculoskeletal disorders(WMSDs) among intensive care unit (ICU) nurses, assess its relationship with ergonomic load and overall exposure levels. Methods: A total of 272 ICU nurses from two tertiary hospitals in a city were selected as the research subjects using convenient sampling method. The Chinese Musculoskeletal Disorder Questionnaire was used to investigate the prevalence of WMSDs among the ICU nurses. The Quick Exposure Check (QEC) was used to assess the ergonomic load on the back, shoulder/arm, hand/wrist, and neck during different clinical nursing operations. Results: The annual prevalence of WMSDs was 75.7% among ICU nurses. The annual prevalence of WMSDs in different body parts, from high to low, was as follows： lower back, neck, shoulder/arm, back, knee, hip/leg, hand/wrist, ankle/foot, and elbow (54.8% vs 43.4% vs 40.8% vs 36.0% vs 21.3% vs 19.9% vs 18.8% vs 18.4% vs 8.1%, P<0.01). ICU nurses had the highest QEC scores on the back (dynamic), shoulder/arm, hand/wrist, and neck with assisting patient turning (all P<0.05) among the six clinical nursing items. During the operation of patient turning, patient lifting, patient bathing, and bed sheet changing for bedridden patients, the back (dynamic) and shoulder/arm were at a high load level, while the hand/wrist and neck were at a mild load level. When nurses were providing tracheostomy care and oral care for intubated patients, their back (static), shoulder/arm, hand/wrist, and neck were at a mild load level. The overall exposure rate for assisting patient turning, patient lifting, oral care for intubated patients, bed sheet changing for bedridden patients, patient bathing, and tracheostomy care were 77.8%, 66.5%, 63.6%, 60.2%, 58.5%, and 57.4%, respectively. The risk for assisting patient turning was classified as level four, while the risk for other clinical nursing items was level three. Conclusion: The prevalence of WMSDs in ICU nurses is high. Both ergonomic load level and total exposure rate of back, shoulder/arm, hand/wrist and neck were high during clinical nursing operations.

OBJECTIVEThis study aims to investigate the feasibility of tongue reconstruction by a rectus abdominis musculoperitoneal flap with neurovascular pedicled in a canine model.

METHODSTwelve Beagle dogs were enrolled to the experiment. The animals were randomly divided into thee groups, two of which (group A and B) had nerve anastomosis. The left sides were experimental sides, whereas the right sides were control sides. Twelve weeks after operation, electrophysiological test was performed to detect hypoglossal nerve latency amplitude and conduction velocity as well as to evaluate the reinnervation of the rectus abdominis musculoperitoneal flap.

RESULTSAmong the 12 Beagle dogs, nine animal tongue reconstruction models by rectus abdominis musculoperitoneal flap with neurovascular pedicled were successful, whereas one male Beagle dog died from ventral hemia 3 d after the operation, two female rectus peritoneal flaps were abandoned because their arterial anatomy differed from the male, which was not ideal. Hypoglossal nerve conduction velocity of group A and B were restored to the normal side of the 40%, 30%.

CONCLUSIONAnimal models of tongue reconstruction can be established by a rectus abdominis musculoperitoneal flap with neurovascular pedicled in Beagle dogs. Denervated rectus abdominis musculoperitoneal flap can regain hypoglossal nerve innervation. Hypoglossal nerve functions partly recover.

Objective To explore the value of T2 mapping MRI in predicting Graves ophthalmopathy (GO) activity. Methods 74 patients with GO and 30 normal individuals underwent coronal T2 mapping MRI were analyzed prospectively from August 2010 to June 2013 in Beijing Tongren Hospital, Capital Medical University. All the GO patients met Mourits criterion, with hyperthyroidism history, and enlargement of extraocular muscles (EOMs) found by MRI. GO patients were grouped by CAS. Of which, 52 patients in CAS≥3, 22 patients in CAS<3, 12 patients in CAS=0, and 10 patients in CAS=0 or 1. T2 values of EOMs (superior rectus muscle, inferior rectus muscle, medial rectus muscle, external rectus muscle and superior oblique muscle) were calculated. The differences of mean T2 values between two eyes, among EOMs, different CAS groups and controls were evaluated by paired-sample t test and one-way ANOVA, respectively. The correlation between maxT2 and CAS was conducted by Spearman rank correlation analysis in GO patients. The cut-off value of maxT2 in predicting GO activity was determined by ROC curve. Results There was no significant difference on T2 values between sides and among EOMs in control (P>0.05), while GO group showed significant difference(P<0.05). T2 value increased by sequence of superior oblique muscle, external rectus muscle, superior rectus muscle, medial rectus muscle and inferior rectus muscle, failed to show significant difference between medial and superior rectus muscle (P=1.00). T2 value increased by sequence of normal control, CAS=0, CAS=1/2 and CAS≥ 3 group(P<0.05). Spearman rank correlation revealed positive correlation between maxT2 and CAS (r=0.898, P<0.01). The cut-off value of maxT2 was 138.68 msec, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 63.5％(33/52), 90.9％(20/22), 94.3％(33/35), 51.3％(20/39), 71.6％(53/74), respectively. Conclusion T2 mapping MRI is valuable in predicting GO activity.