Objective To investigate the related risk factors for progress of the elderly frontal lobe contusions. Methods The clinical data of 118 cases of elderly frontal lobe contusions from August 2012 to August 2014 were retrospectivelyanalyzed.118 patients were given conventional therapy after admission,received dynamic review of brain CT.The progress of patients were performed surgery of frontal coronary approach,removed contusion brain tissue by bone flap of single frontal or double the frontal lobe.No progress of patients were given conventional conservative treat-ment.Selected seven indicators combining with hypertension,oral aspirin,diabetes mellitus,contrecoup injury,Cushing response,sylvian cistern exist or not and subdural hematoma did a statistical analysis.Results This group of 118 patients,68 cases (57.6%)had progress and 50 cases (42.4%)had no progress.Statistical analysis showed that oral aspirin (P =0.006 ),sylvian cistern exist or not (P =0.001 ),Cushing response (P =0.025 )were independent risk factors of progress of the elderly frontal lobe contusions.Conclusion For elderly patients with fron-tal lobe contusion,oral aspirin,sylvian cistern exist or not,whether there is any Cushing response were risk factors for deterioration of disease progression.If one or more risk factors appeared,clinical need to prevent disease progression.

Objective To investigate the treatment strategy of operation in torcular herophili meningiomas.Methods Retrospectively analyzed the treatment strategy of operation and follow-up data of 16 cases torcular herophili meningiomas patients.Results Grade Ⅰ resection was 9 cases,grade Ⅱ resection was 5 cases,grade Ⅳ resection was 2 cases.One patient appeared transverse thrombosis in postoperative.Followed up for 26-61 months,all patients had no recurrence.Conclusion By detailed preoperative evaluation,selection of appropriate operative approach,reasonable treatment of venous sinus adhesion tumor,supplemented by the necessary radiotherapy,can reduce the risk of operation and recurrence rate to torcular herophili meningiomas.

Objective:To report a rare case of renal injury secondary to Strongyloides stercoralis infection, and investigate common pathological subtypes, pathogenesis and differential diagnosis of Strongyloides stercoralis infection-associated renal injury combined with literature. Methods:The pathological features of renal biopsy were analyzed by immunofloruscence, light microscope and electronic microscope. The pathological changes of digestive tract and pathogen morphology were observed through endoscope and digestive tract biopsy. The correlation between clinical-pathological features and pathological changes of kidney and digestive tract was analized.Results:The 26-year-old male patient presented with nephrotic syndrome. The pathological changes of renal biopsy were consistent with minimal change disease with interstitial focal eosinophil infiltration. Laboratory examination showed that the patient had unexplained eosinophilia and increased IgE level. Hence the patient was treated with glucocorticoid. After 2 months of therapy, proteinuria decreased and turned to negative while the patient developed progressive headache, gastrointestinal bleeding and progressive decrease of hemoglobin. Emergency gastroscopy showed extensive congestion and erosion of the stomach and duodenum. Gastric mucosal biopsy showed a large number of slender "s" shape larvae in the mucosa. The patient also had bilateral lung infection, positive Escherichia coli in cerebrospinal fluid and purplish skin rash around the umbilicus. A serious infection of Strongyloides stercoralis was diagnosed. After antibiotics and anthelmintic treatment, gastrointestinal symptoms and headache disappeared, and no parasite was found in endoscopy. No recurrence of nephrotic syndrome was found during 2 years of follow-up. Conclusions:Strongyloides stercoralis infection might first present with nephrotic syndrome with handful hints of digestive tract combined with eosinophilia and increased IgE levels. Therefore, in epidemic areas or patients with suspicious exposure history, it is necessary to exclude Strongyloides stercoralis infection before immunosuppressive therapy to avoid fatal complications.

Objective:To explore the application value of modified technique of ureter implantation in murine renal transplantation.Methods:Thirty left donor kidneys from BALB/c mice was transplanted into syngeneic mice. Cuff technique was applied for anastomosing kidney artery and vein. The procedure of ureter-bladder anastomoses shifted from implication-fixation-embedding to fixation-implication-embedding. Operative duration, recipient survival rate and complications were recorded.Results:Time for separating vessels, perfusion and excision of donor graft was (25±3) min, (10±6) s for warm ischemia and (25±5) min for cold ischemia. Time for separating recipient vessels was (12±5) min, (7±1) min for arterial anastomosis, (7±1) min for venous anastomosis, (13±2) min for ureter-bladder anastomosis, (5±1) min for right kidney excision and (5±1) min for abdominal closure. Operative duration was(77±3)min. Twenty-six recipients survived over 3 months. The successful operative rate was 86.7%.Conclusions:With a shorter learning curve, modified technique of ureter implantation is easier and faster so as to reduce the postoperative incidence of urinary tract complications during murine renal transplantation.

Objective To analyze the distributions of Chinese medical syndrome types of polycystic ovary syndrome(PCOS),and explore the differences of clinical features between different syndromes. Methods The data of 496 PCOS patients and the data of reproductive endocrine and metabolic indexes were collected and ana-lyzed retrospectively. Results The results of retrospective analysis:of the 469 patients with PCOS,163 cases were phlegm and blood stasis syndrome(34.75%),157 phlegm dampness syndrome(33.48%),90 kidney liver depression syndrome(19.19%),and 59 kidney deficiency and blood stasis syndrome(12.58%). Compared with the patients with PCOS of kidney liver depression syndrome and kidney deficiency and blood stasis syndrome,the score of acanthosis nigricans as well as the levels of BMI,WC,HC,SHBG,FAI,FPG,FINS,HOMA-IR,TG, CHOL,LDL,ApoB,and ApoB/ApoA-I ratio were significantly increased(P < 0.05),but the level of HDL and ApoA-I significantly decreased in the patients of phlegm and blood stasis syndrome and phlegm dampness syndrome (P<0.05).WHR was higher in the patients of phlegm and blood stasis syndrome than in the patients of kidney liver depression syndrome and kidney deficiency and blood stasis syndrome(P<0.05).Compared with the patients with phlegm and blood stasis syndrome,the level of ApoB and the ApoB/ApoA-I ratio were lower in the patients of phlegm dampness syndrome(P<0.05),the level of FSH and LH were higher in the patients of kidney deficiency and blood stasis syndrome(P<0.05).When compared with the patients of phlegm dampness syndrome,the level of LH was higher in the patients of kidney deficiency and blood stasis syndrome(P<0.05),but the level of T was lower in the patients of kidney liver depression syndrome(P < 0.05). Conclusions Compered with the PCOS patients with phlegm dampness syndrome,kidney liver depression syndrome,kidney deficiency and blood stasis syndrome, phlegm and blood stasis syndrome patients show more serious reproductive endocrine and metabolic disorder.

Objective To investigate the influence of breast pure mucinous carcinoma size on sonographic characteristics and diagnostic accuracy.Methods Sonographic characteristics of 101 breast pure mucinous carcinoma in 1 00 patients were analyzed retrospectively.All lesions were divided into three groups according to maximum diameter at ultrasound.These were group Ⅰ with lesions less than 20 mm,group Ⅱwith lesions greater than or equal 20 mm,less than 40 mm,and group Ⅲ with lesions greater than or equal 40 mm.The relationship between lesions size and ultrasound parameters were analyzed.Results There were 38 lesions in group Ⅰ,52 lesions in group Ⅱ and 1 1 lesions in group Ⅲ.The patients age in group Ⅲwere older than that in group Ⅰ(F=3.442,P =0.036).Among these sonographic appearances,only shape (χ2=9.813,P =0.005)and blood flow (χ2=27.952,P =0.000)indicated significant differences.The accuracy of ultrasound diagnosis of breast cancer was 85.1%,the smaller the lesions were,the higher misdiagnosis rate the lesions were.Conclusions With lesions size increased,the lobular and internal blood flow of pure mucinous carcinoma increased.More smaller the lesions were,more higher misdiagnosis rate of lesions were.

Objective To summarize the pathological characteristics of polyomavirus-associated nephropathy combined with acute rejection after renal transplantation.Methods The pathological data of 172 patients diagnosed as having polyomavirus nephropathy in our hospital from 2007 to 2018 were reviewed.Results One hundred and seventy-two patients were diagnosed as having polyomavirus nephropathy without acute rejection for the first time.In 75 (43.6％,75/172) patients who received repeat biopsy,10 (5.8％,10/172) patients developed acute rejection with an average interval of 4.8 ± 3.3 months.Common pathological features included:renal tubular epithelial cells virus inclusions reduced or even disappeared or only hyperchromatic nuclei revealed,SV40-T antigen (70％,7/10) staining negative or decreased significantly (30％,3/10),and varying degrees of interstitial inflammation,tubulitis,interstitial fibrosis and tubular atrophy.Four patients developed acute T cell-mediated rejection (Banff ⅡA),revealing aggravating tubulitis and interstitial inflammation in the area of negative SV40-T antigen (70％,7/10) staining,as well as mild endarteritis.Three patients developed acute antibody-mediated rejection,revealing glomerulitis and peritubular capillaritis and positive panel reactive antibody.Only 1 patient revealed C4d deposition of peritubular capillaries.Two patients developed mixed rejection,revealing tubulitis,interstitial inflammation,glomerulitis,peritubular capillaritis,mild endarteritis and C4d deposition of peritubular capillaries.One patient developed suspicious T cell-mediated rejection (Banff IB),revealing aggravating tubulitis and interstitial inflammation in the non-fibrotic areas but without intimal arteritis.Besides,the positive SV40-T antigen (70％,7/10) staining area was reduced significantly.Conclusion The pathological characteristics of polyomavirus nephropathy combined with acute rejection include endarteritis,glomerulitis,peritubular capillaritis and C4d deposition of peritubular capillaries.It is difficult to distinguish polyomavirus nephropathy from Banff I T cell-mediated rejection.Clinical information and repeat biopsy results are helpful for differential diagnosis.

Objective To improve clinicians’ understanding of post transplant lymphoproliferative disorder (PTLD) after renal transplantation,a rare case of this disease was reported and literature was reviewed.Method The clinical data and pathological changes of the allograft,immunohistochenmistry (IHC) and in situ hybridization (ISH) were analyzed.In addition,the relevant literature was reviewed.The clinicopathological features and differential diagnoses of PTLD were discussed.Result A renal mass (5.6 cm × 5.4 cm),which was suggestive of primary renal malignancy,had been detected on the patient after received renal transplantation for a year and a half.Grossly,the mass was 7cm in diameter,with fleshy texture.Microscopically,the renal parenchyma was destructed and infiltrated with massive inflammatory cells,mostly lymphoid cells and occasionally Reed-Steruberg-like cells.IHC showed CD20 and CD79a were predominantly expressed in lymphoid cells.ISH showed diffused Epstein-Barr virus encoded RNAs (EBERs) positivity.The above findings were consistent with PTLD,polymorphic B cell hyperplasia (polymorphic PTLD),with concurrent EpsteinBarr virus infection.Conclusion Lymphoid infiltration in a renal allograft needs to be differentiated from T-cell rejection,viral infection,nephropyelitis,as well as PTLD.Early detection and proper management of PTLD may help improve the graft survival rate.

Objective To explore the clinicopathologic characteristics of polyomavirus nephropathy (PyVN) in renal transplantation.Methods Clinicopathological data from 101 cases of PyVN from January 2006 to October 2016 in our hospital were collected and analyzed retrospectively.There were 72 males and 29 females.The mean time from operation to the diagnosis of PyVN was 16.5 months (2.2-63.9 months),with 86 cases (85.1％) occurring within 2 years.The indications for biopsy included elevated serum creatinine in 81 cases (80.2％),elevated serum creatinine with proteinuria in 13 (12.9％) cases,active BK virus(BKV) infection in 5 cases (5.0％) and proteinuria in 2 cases (2.0％).Results BK viruia was detected in 98 (97.0％) recipients with viral loads of 1.5 × 109 (0-9.0 × 1011) copies/ml,and BK viremia in 80 (79.2％) recipients with viral loads of 1.8 × 104 (0-2.1 × 107) copies/ml.5 patients lost their graft function at biopsy and the other 96 patients reserved graft function with serum creatinine of 187.0 μmol/L.After 20.1 (3.7-109.6) months of follow-up,19 (18.8％) patients lost their graft function.The average serum creatinine of the 77 patients with graft function was 165.0 μmol/L,with no statistical difference (P ＞ 0.05) compared with that of patients at diagnosis.There were 18 cases of stage A,72 cases of stage B and 11 cases of stage C with 5-year allograft cumulative survival of 92.9％,82.8％ and 55.6％,respectively.Conclusions PyVN can occur within 5 years after renal transplantation,mostly within 2 years.The typical clinical manifestations include elevated serum creatinine,BK viruia and BK viremia.The severe the histopathological lesions were correlated the worse the clinical prognosis.

Pien Tze Huang(PZH),a class-1 nationally protected traditional Chinese medicine(TCM),has been used to treat liver diseases such as hepatitis;however,the effect of PZH on the progression of sepsis is un-known.Here,we reported that PZH attenuated lipopolysaccharide(LPS)-induced sepsis in mice and reduced LPS-induced production of proinflammatory cytokines in macrophages by inhibiting the acti-vation of mitogen-activated protein kinase(MAPK)and nuclear factor-kappa B(NF-κB)signalling.Mechanistically,PZH stimulated signal transducer and activator of transcription 3(STAT3)phosphory-lation to induce the expression of A20,which could inhibit the activation of NF-κB and MAPK signalling.Knockdown of the bile acid(BA)receptor G protein-coupled bile acid receptor 1(TGR5)in macrophages abolished the effects of PZH on STAT3 phosphorylation and A20 induction,as well as the LPS-induced inflammatory response,suggesting that BAs in PZH may mediate its anti-inflammatory effects by acti-vating TGR5.Consistently,deprivation of BAs in PZH by cholestyramine resin reduced the effects of PZH on the expression of phosphorylated-STAT3 and A20,the activation of NF-κB and MAPK signalling,and the production of proinflammatory cytokines,whereas the addition of BAs to cholestyramine resin-treated PZH partially restored the inhibitory effects on the production of proinflammatory cytokines.Overall,our study identifies BAs as the effective components in PZH that activate TGR5-STAT3-A20 signalling to ameliorate LPS-induced sepsis.