Ultrasound-guided thoracic nerve block plays an important role in anesthesia and analgesia, but it is not easy to be mastered. This article discusses the application value of flipped classroom combined with 3D Body anatomy software for anesthesia specialty residents to learn ultrasound-guided thoracic paravertebral nerve block. This innovative education model includes three parts: before class, during class and after class. Before class, the teachers study the syllabus and make teaching micro-videos, and the cross-sectional anatomy added into the 3D Body anatomy software helps the residents understand. During class, teachers divide the residents into groups to report and exchange their learning experience, organize discussions, and finally give them comments. After class, the instructor will assign homework, assess the residents, and evaluate their satisfaction. This teaching model helps residents master the ultrasound-guided thoracic nerve block, and obtains satisfactory evaluation from the trainees, which is helpful for promotion.

Objective: To study the molecular features of metanephric adenoma (MA) and discuss their values in differential diagnosis. Methods: BRAF V600E immunohistochemistry (IHC) using the mutation-specific VE1 monoclonal antibody and Sanger sequencing of BRAF mutations were performed on 21 MAs, 16 epithelial-predominant Wilms tumors (e-WT) and 20 the solid variant of papillary renal cell carcinomas (s-PRCC) respectively. p16 protein was detected by IHC also. Fluorescence in situ hybridization (FISH) analyses using centromeric probes for chromosome 7 and 17 were performed on the three renal tumors in parallel. Results: Fourteen (14/21, 66.7%) of 21 MA cases demonstrated diffuse, moderate to strong cytoplasmic BRAF V600E IHC staining and the BRAF V600E protein expression was detected in 2 (2/16) of 16 e-WT cases for the first time, whereas all s-PRCCs were negative (P<0.05). All cases (including 14 MAs and 2 e-WTs) with diffuse, moderate to strong cytoplasmic BRAF V600E IHC staining were confirmed to harbor BRAF V600E missense mutations using Sanger sequencing, and no BRAF mutations were detected in cases with negative BRAF V600E protein expression. One case (1/21, 4.8%) showed trisomy of chromosome 7 alone, and another one (1/21, 4.8%) showed trisomy of chromosome 17 alone in 21 MAs. Two cases (2/16) of 16 e-WTs showed trisomy of chromosome 17 alone. In 20 s-PRCCs, trisomy of chromosomes 7 alone was reported in 2 cases (2/20), trisomy of chromosome 17 alone in 3 cases (3/20) and trisomy of chromosome 7 and 17 in 14 cases (14/20). The total positive rates of trisomy of chromosome 7 and/or 17 in MAs, e-WTs and s-PRCCs were 9.6% (2/21), 2/16 and 95.0% (19/20). p16 protein was positive in 81.0% (17/21) MAs, whereas the positive rates in e-WTs and s-PRCCs were 2/16 and 5.0% (1/20). Conclusions Most MAs harbor BRAF V600E mutations, and MAs lack the gains of chromosome 7 and 17 that are characteristic of papillary renal cell carcinoma. These molecular features can be used to distinguish MA from its mimics. BRAF V600E IHC using the mutation-specific VE1 monoclonal antibody provides an effective method in BRAF V600E mutations detection of renal tumors. p16 is overexpressed in MA, and the finding suggests that the low proliferative rate of the tumor might be attributed to BRAF V600E-induced senescence mediated by p16.

Objective To study the expression of cadherin 17 ( CDH17 ) in metanephric adenoma ( MA ) , and to explore the value of CDH 17 in the diagnosis of metanephric adenoma.Methods Immunohistochemical EnVision method was used to detect the expression of CDH 17, WT1, CD57, P504S and EMA in 21 cases of MAs, 16 epithelial-predominant Wilms tumors ( e-WT), and 20 solid variant of papillary renal cell carcinomas ( s-PRCC).The expression of CDH17 was also examined in other common renal epithelial tumors , including 10 cases of clear cell renal cell carcinomas ( CCRCC ) , 10 chromophobe renal cell carcinomas ( CHRCC), and 10 oncocytomas.Results Twenty (95.2%) of 21 cases of MAs demonstrated membranous CDH 17 immunoreactivity in all components ( acinar , tubular , and papillary ) , whereas only 1 (1/16) e-WT was positive for CDH17 and all s-PRCCs were negative ( P<0.05).WT1 was negative in s-PRCC and was positive in all cases of e-WT ( 16/16 ) and MA ( 100%,21/21 ).All MAs (100%) were strongly positive for CD57;however, this marker was also positive in 13 (13/16) e-WTs and 9 (45.0%,9/20) s-PRCCs.P504S was strongly positive in all s-PRCCs (100%), but reactivity was seen in 3 (14.3%,3/21) MAs and all e-WTs were negative.The positive rates of EMA in MAs, e-WTs and s-PRCCs were 19.0%(4/21),14/16 and 17/20, respectively.The sensitivity and specificity of CDH17 in the diagnosis of MA were 95% and 97%.CDH17 was negative in all cases of CCRCC , CHRCC and oncocytoma.Conclusions CDH17 is a highly sensitive and specific marker for MA and should be considered in the immunohistochemistry panel for distinguishing MA from its mimics and other common renal epithelial tumors.

Objective To understand the sense of gain of elderly chronic patients,explore their influencing factors,and provide a basis for the subsequent enhancement of the sense of gain of elderly chronic patients.Methods The data for this study were obtained from a survey of elderly chronic patients in the affiliated hospital of Guangdong Medical University.Convenience sampling was used to survey 380 elderly chronic patients with hypertension,coronary heart disease and benign prostatic hyperplasia treated in the hospital.The questionnaire included sense of gain,demographic factors,physical function,psychological function,and social function,etc.One-way multi-sample rank test,Spearman′s correlation analysis,multifactorial ordered logistic regression model and CHAID categorical decision tree analysis were performed using SPSS 26.0.Results Among the 380 older chronically ill people surveyed,2.9%had no sense of gain at all,40.5%had unclear or moderate sense of gain,and 66.6%had a very strong sense of gain.The results of multifactorial ordered logistic regression showed marital status,education level,social support and spiritual pillars are associated with sense of gain with all above variables being statistically significant(P＜0.05).The OR values for unmarried,below junior high school level,high school and specialist,able to interact with others as they did before they got sick,spiritual pillars to make them no/a little feel the meaning of life,and limited moderate activities are 0.318,0.172,0.307,0.500,0.145,0.407,0.545,respectively,indicating relatively low sense of gain.The elderly chronic patients who usually did not feel depressed or sad,and did not have financial difficulties in their families due to their illness and treatment had a higher sense of gain with OR values being 3.042 and 1.988,respectively.The results of categorical decision tree analysis showed that whether or not spiritual support can make feel the meaning of life or the value of life,whether or not interact with other people as did before the disease,whether or not the disease has caused family′s financial difficulties,and whether or not have limitations on moderate activities are the most important factors influencing the sense of gain of the elderly chronic patients.Conclusion It is necessary to pay attention to the mental aspects of the elderly chronic patients and maintain interpersonal communication,and take targeted measures to help them reduce the degree of activity limitation as much as possible,so as to enhance the sense of gain of the elderly chronic patients.