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 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 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 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 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.

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.

Objectives To investigate the regression pattern of mid and low rectal cancer treated with neoadjuvant chemoradiotherapy and then to provide the pathological proofs for reasonable resectional margin in rectal cancer surgery. Methods Forty cases of mid and low rectal cancer patients received concurrent chemoradiotherapy and then underwent radical operation. The whole-mount serial sections of resected rectal cancer specimen were stained with cytokeratin antibody using immunohistochemical techniques to show the reridual cancer cells under the mucosa. The microscopic measurement was performed to determine the reverse infiltration of cancer cells in the rectal wall and to describe the cancer cells scatter ways in the cancer mass. The Ki-67 immunohistochemical stain was also performed to show the proliferation activity of residual cancer cells after neoadjuvant chemoradiotherapy. Results The length of specimen was shrinking continuously during the pathologic section production and the shrink rate was 18%. There were remanent cancer cells which showed positive Ki-67 expression and the chemoradiotherapy decreased the Ki-67 expression significantly. The lower edge of remaining ulcers or scars could be used as the reference point from which the cancer infiltration could be measured. According to our measurement, the average reverse infiltration of cancer cells in the whole-mount section was (6.1±4.7) mm, the deepest one was 11.0 mm in the section which could be converted into fresh bowel length of 12.98 mm. The pathology showed that the residul cancer cells scattered in the fibrous tissue of ulcers, scars and manifested a regression of spatial distribution. Conclusions The rectal cancers show regression in different degrees after neoadjuvant chemoradiotherapy. The residual cancer cells in the fiber tissues manifest proliferation activity. The distal end of resection should be at least 2 cm away from the lower edge of ulcers or scars of primary tumor in the rectal wall in patients after neoadjuvant chemoradiotherapy. The circumferential resection margin should include all the fibrous scar of the tumor area to ensure the remove of tumor cells completely.

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.

Objective To observe the expression of transforming growth factor factor-β1 (TGF-β1) and vas cular endothelial growth factor (VEGF) in breast cancer to explore the correlation between each other and their relationship with invasion,metastasis and prognosis of breast cancer.Methods Immunohistochemistry was used to detect the expression of TGF-β1 and VEGF in 230 breast cancer tissues and adjacent tissues.The correlation between them and the relationship between their expression and the clinical pathological parameters of breast cancer were analyzed.Results The positive rates of TGF-β1 and VEGF in breast cancer were 72.6％ and 68.3％,respectively.But in adjacent breast tissues,the positive rate was 21.3％ and 42.2％,respectively.The expression of TGF-β1 was closely related to the histological grade,ER state and 5-year recurrence (P＜0.05),while ER status and 5-year recurrence were independent predictors of the positive expression of TGF-β1.The expression of VEGF was significantly correlated with ER status and 5-year recurrence (P＜0.05),while ER status was independent predictor of the positive expression of TGF-β1.The expression of VEGF was significantly positively correlated with the expression of TGF-β1 (γ=0.419,P＜0.01).Conclusion The expression of TGF-β1 and VEGF in breast cancer is closely related to the invasion,metastasis and prognosis of breast cancer,which has a certain clinical significance.