ObjectiveTo investigate the prevalence and influencing factors of overweight， obesity and central obesity among elderly residents in Xuhui District， and to analyze the epidemiological status of central obesity in elderly people with different body mass indexes. MethodsThe third round of health status and health service utilization monitoring data in Xuhui District was used. The information collected from questionnaire survey and physical examination were analyzed. SPSS 20.0 software was used for χ² test， trend χ² test and multinominal logistic regression analysis. Results5 096 survey subjects were included. The prevalence of overweight， general obesity， and central obesity in the residents aged 60 and above in Xuhui District were 34.3%， 6.5%， and 29.2%， respectively. There was gender difference in the rates of overweight， obesity， and central obesity among the residents. The overweight and central obesity rates in males were higher than those in females， while the obesity rate was lower than that in females （P<0.05）. Multinominal logistic regression analysis showed that in comparison with the normal weight non-central obesity group drinking only at party （OR=1.729， 95%CI： 1.184‒2.525）， and hypertension （OR=1.637， 95%CI： 1.305‒2.053）， were highly associated with normal weight with central obesity. Aged 60‒ years （OR=1.589， 95%CI： 1.190‒2.120）， aged 70‒ years （OR=1.763， 95%CI： 1.327‒2.342）， male （OR=1.379， 95%CI： 1.134‒1.676）， hypertension （OR=2.231， 95%CI： 1.878‒2.649）， former smokers （OR=1.437， 95%CI： 1.027‒2.011）， drinking at party only （OR=1.491， 95%CI： 1.107‒2.006）， and drinking ≥3 times per week （OR=1.611， 95%CI： 1.116‒2.325）， were highly associated with overweight combined with central obesity. Aged 60‒ years （OR=3.817， 95%CI： 2.251‒6.474）， aged 70‒ years （OR=3.084， 95%CI： 1.838‒5.175）， hypertension （OR=3.683， 95%CI： 2.753‒4.929）， diabetes （OR=2.085， 95%CI： 1.511‒2.878）， former smokers （OR=1.835， 95%CI： 1.043‒3.226）， were highly associated with compound obesity. Central obesity was found in the elderly residents with different BMI categories， and the rate of central obesity increased with the increase of BMI grade. ConclusionThe prevalence of overweight， obesity and central obesity among the elderly aged 60 years and above in Xuhui District is not optimistic. Attention should be paid to the elderly under 80 years old who are with hypertension and/or diabetes， alcohol consumption， low educational level and not doing physical exercise. Especially for the central obesity population with normal BMI， measures should be taken to prevent and intervene the occurrence of obesity and related diseases.

Purpose To evaluate the feasibility of droplet digital PCR(ddPCR)for gene fusion detection of neurotrophic receptor kinase(NTRK).Methods A total of 830 cases of primary colorectal adenocarcinoma(CRAC)and 560 cases of gastric adenocarcinoma(GAC)were retrospectively studied.Im-munohistochemistry(IHC)and fluorescence in situ hybridization(FISH)were used to detect pan-TRK protein expression and NTRK1/2/3 gene fracture in formalin-fixed paraffin-embedded(FFPE)tumor tissues,respectively.FISH or IHC positive sam-ples were further detected by next generation sequencing and ddPCR.Results All FFPE samples were tested successfully by IHC and FISH methods.A total of 26 samples with NTRK gene breaks or pan-TRK expression were detected by IHC,among these 26 cases,21 FISH were positive and 18 IHC positive.A total of 14 cases of NTRK fusion and 2 cases of amplification were detected by DNA sequencing.A total of 3 cases carrying NTRK gene fusion were detected by RNA sequencing,and the results of ddPCR were completely consistent with RNA sequen-cing.Conclusion ddPCR can effectively distinguish false posi-tive CRAC and GAC cases harboring NTRK fusion detected by FISH and DNA sequencing,which can be used as the effective method for screening NTRK gene fusion.

Purpose To investigate the clinicopathological characteristics,diagnosis,and differential diagnosis of invasive mucinous adenocarcinoma(IMA)and mixed invasive mucinous and non-mucinous adenocarcinoma(mIMA).Methods The clinical data were collected in 36 patients with primary IMA and 17 patients with mIMA,and the expression of TTF-1,CK7,CK20,SATB2,CDX2,EGFR,HNF4a,etc.was detected by immunohistochemical EnVision two-step method.The Sanger se-quencing and the FISH were used for KRAS mutation and NRG1 gene rearrangement detection.The clinicopathological character-istics were analyzed with review of relevant literature.Results There were 9 cases(25.0％)and 3(8.3％)cases of papillary and micropapillary structures in IMA,while 13 cases(76.5％)(P＜0.001)and 9 cases(52.9％)(P=0.001)were present in mIMA.There were 5 cases(13.9％)of high nuclear grade of IMA and 10 cases(58.8％)of high nuclear grade of mIMA(P=0.002).TTF-1 had a positive rate of 37.5％in IMA,but 60.0％and 80.0％in the mucinous adenocarcinoma and non-mucinous adenocarcinoma components of mIMA(P=0.021),respectively.The positive rates of CK7,CK20,and CDX2 in IMA were 90.6％,21.9％,and 9.4％,and the positive rates in mucinous adenocarcinoma and non-mucinous adenocarcinoma components of mIMA were 100％,20％,20％and 100％,6.7％,6.7％,respectively and no SATB2 expression was found in all cases.There was no significant difference in the expres-sion of total EGFR and two EGFR mutation-specific antibodies(L858R,DEL19)between IMA and mIMA.There were 3 cases of mucinous adenocarcinoma with L858R positive in mIMA,and 2 of them were negative for non-mueinous adenocarcinoma.In another case,the non-mueinous adenocarcinoma component of mIMA expressed DEL19,but the mucinous adenocarcinoma component was not expressed.The positive rate of HNF4a in IMA was 72.0％(18/25),and those of HNF4a in mucinous adenocarcinoma and non-mucinous adenocarcinoma in mIMA were 41.7％(5/12)and 33.3％(4/12),respectively(P=0.048).KRAS gene sequencing was carried out in 19 cases of IMA,among which 9 cases(47.4％)had mutations,G12D and G12V were most commonly detected,and 4 cases of mIMA were sequenced,but none of them showed KRAS mutations.FISH detection showed that 2 cases(7.1％)IMAs had NRG1 translocation rearrangement.Conclusion Pulmonary mIMA is more aggressive than IMA.For example,mIMA has significantly more papillary structure,micropapillary structure,and high nu-clear grade cases than IMA.The differences in immunohisto-chemical expression and KRAS mutation between the two are sta-tistically significant.

Objective:To explore the distribution characteristics of memory B cells and its relationship with bone erosion in patients with rheumatoid arthritis (RA), and to further understand the mechanism of B cells in the pathogenesis of RA.Methods:B cell subsets in peripheral blood of 200 RA patients and 50 healthy individuals were detected by flow cytometry. According to the surface markers CD19, CD27 and lgD, B cells were divided into CD19 +CD27 +lgD - switched memory B cells, CD19 +CD27 +lgD + non-switched memory B cells, CD19 +CD27 -lgD - double-negative memory B cells and CD19 +CD27 -lgD + naive B cells. B cells in RA patients with various disease activity score, course of disease and treatment were analyzed. Patients were divided into four groups according to the results of joint ultrasonography, including patients without bone erosion, patients with hand bone erosion, patients with knee bone erosion and patients with hand and knee bone erosion. The relationship between the distribution of B cell subsets, autoantibodies and RA bone erosion were analyzed. Differences between the groups were analyzed by independent-samples t test, Mann-Whitney U test and χ2 test. The analysis of variance, Kruskal-Wallis analysis were used for multi-group comparison, Spearman correlation analysis was also used for correlation analysis. Results:①RA patients showed significantly decreased non-switched memory B cells [(9.5±6.7)% vs (12.1±4.7)%, t=2.46, P=0.015] and increased double negative memory B cells [(3.8±2.5)% vs(2.7±1.3)%, t=-4.74, P<0.001] in comparison to healthy individuals. The percentage of non-switched memory B cells were decreased in RA patients with moderate disease activity [(8.4±4.7 )% vs (12.4±7.5)%, t=3.13, P=0.001] and high disease activity [(7.8±7.6)% vs (12.4±7.5)%, t=3.00, P=0.003] in comparison to those in RA patients who achieved remission. Meanwhile, the na?ve B cells [(70.3±15.0)% vs (63.9±14.6)%, t=-2.15, P=0.034] were increased in RA patients with moderate disease activity. No difference was found in RA patients with different disease courses. Total B cells [(4.8±2.9)% vs (7.2±4.1)%, t=-3.24, P=0.001], non-switched memory B cells (7.6±4.3)% vs (10.0±7.1)%, t=-2.63, P=0.010) in RA patients who received prednisone treatment were decreased, while double-negative memory B cells (4.9±3.0)% vs (3.6±2.3)%, t=-2.79, P=0.006] were increased compared with those in RA patients without prednisone treatment. Non-switched memory B cells was decreased in RA patients with hand and knee erosion compared with RA patients without erosion [6.8%(2.5%, 9.5%) vs 9.7%(5.5%, 17.5%), Z=-2.12, P=0.034]. Double negative memory B cells in subgroup with keen erosion [3.3%(2.7%, 5.0%) vs 2.6%(1.9%, 3.8%), Z=-2.09, P=0.036]as well as with hand and knee erosion [3.9%(2.3%, 5.6%) vs 2.6%(1.9%, 3.8%), Z=-2.41, P=0.016] were higher than those in patients without erosion. In addition, higher serum RF level was found in subgroup RA patients with hand and knee erosion compared with subgroup of RA patients without erosion [141.0 (38.0, 874.0) U/ml vs 53.5 (10.0, 106.0)U/ml, Z=-2.07, P=0.039]. Meanwhile, the positive rate of ACPA in RA patients with bone erosion of hand was significantly higher than that of RA patients without bone erosion [81%(52/64) vs 64%(38/59), χ2=4.44, P=0.043). Conclusions:The results suggest that the increase of double negative memory B cells, the decrease of non-switched memory B cells and higher level of autoantibodies may closely relate to bone erosion of RA, which may be one of the pathogenesis of disability in RA.

To compare the performance of self-inflating bag (SIB) with T-piece resuscitator (TPR) in neonatal resuscitation.Methods:This study involved the trainees participating in a Neonatal Resuscitation Simulation Camp (NRSC) organized by Shanghai First Maternity and Infant Hospital in December 2019. They were trained to provide positive pressure ventilation with the two devices on artificial lungs. Ventilation parameters including peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), PIP in pulmonary alveoli (PIP alv), mean airway pressure (MAP), frequency, inspiratory time (Ti), tidal volume and minute ventilation volume were recorded and analyzed by independent sample t-test or rank sum test. Results:The PIP alv, PIP, oxygen flow rate, tidal volume and minute ventilation volume delivered by TPR were significantly lower than those by SIB [(17.18±1.61) vs (24.05±4.29) cmH 2O (1 cmH 2O=0.098 kPa), t=－6.87; (17.91±1.35) vs (29.97±4.50) cmH 2O, t=－14.06; (3.65±0.25) vs (6.88±1.59) L/min, t=－11.33; (15.90±1.81) vs (24.02±4.29) ml/min, t=－10.99; (664.71±88.94) vs (1 069.49±205.68) ml/min, t=－9.89; all P<0.001]. However, compared with SIB, the PEEP in pulmonary alveoli, Ti, duration of ventilation, inspiratory to expiratory ratio were increased when using TPR [(4.76(4.69-5.57) vs 0.19(0.12-4.10) cmH 2O, T=1 190.00; (0.59±0.15) vs (0.43±0.09) s, t=5.01; (1.46±0.23) vs (1.36±0.11) s, t=2.15; 0.71±0.22 vs 0.47±0.13, t=5.14; all P<0.05]. Conclusion:TPR could deliver more stable and safer PIP, PEEP and tidal volume than SIB and keeping MAP at a stable level during positive pressure ventilation on artificial lungs.

Objective:To investigate the frequency of myeloid dendritic cells (mDC) and plasmacytoid dendritic cells (pDC) in peripheral blood of patients with systemic lupus erythematosus (SLE) and their relationship with renal injury.Methods:The frequency of peripheral mDC and pDC in 102 SLE patients and 10 healthy controls were detected by flow cytometry. The quantitative data were expressed by [ M( P25, P75)]. The measurement data of the two groups with non-normal distribution was analyzed by Mann Whitney U test. The correlation between the two groups was analyzed by Spearman rank correlation analysis and multiple linear regression. Results:The frequency of pDC [14.00%(7.92%, 19.65%) vs 24.55%(19.68%, 32.90%), Z=-3.163, P<0.01] and mDC [21.25%(13.28%, 32.83%) vs 34.85%(24.58%, 41.93%), Z=-2.607, P<0.01] in the peripheral blood of 102 patients with SLE were significantly lower than those of healthy controls. The frequency of pDC [9.09%(7.31%, 17.38%) vs 24.55%(19.68%, 32.90%), Z=-3.033, P=<0.01] and mDC [9.40%(7.88%, 21.60%) vs 34.85%(24.58%, 41.93%), Z=-3.231, P<0.01] in 12 patients with newly diagnosed SLE were also significantly lower than those in healthy controls. After adjustedfor confounding factors, multivariate analysis showed that SLEDAI level was the main factor influencing the frequency of pDC ( P=0.019) and mDC ( P<0.01). In addition, pDC[8.02%(2.25%, 9.97%) vs 16.70%(11.80%, 24.60%), Z=-2.490, P=0.015] and mDC[8.80%(5.99%, 12.80%) vs 20.20%(11.20%, 42.80%), Z=-2.226, P=0.029] in patients with active LN were also significantly lower than that of patients with stable LN. The mDC frequency was positively correlated with the levels of complement C3 ( r=0.455, P<0.01) and C4 ( r= 0.289, P, P<0.01). Conclusion:The frequency of mDC and pDC in SLE patients is significantly abnormal, which is closely related to disease activity. In addition, pDC and mDC may be involved in the occurrence and development of LN.

【Objective】 To detect autoantibodies in Chinese systemic sclerosis (SSc) patients and analyze the relationship between clinical phenotype and autoantibodies in SSc. 【Methods】 We sequentially included 93 SSc patients. Their general information and clinical data were gathered. The differences in clinical characteristics among autoantibody negative and positive groups were analyzed statistically. 【Results】 Anti-nuclear antibodies were detected in 82 (88.2%) SSc patients. The positive rate of autoantibodies was detected in 26 cases (28.0%) of anti-Scl-70 antibody, 24 cases (25.8%) of anti-SSA/Ro-52 antibody, 19 cases (20.4%) of anti-U1-snRNP antibody, and 16 cases (17.2%) in anti-CENP-B antibody, respectively. The patients with positive anti-SSA/Ro-52 antibody had a significantly higher morbidity rate of pulmonary arterial hypertension (P=0.016). Patients with anti-Scl-70 antibody showed a higher incidence rate of digital tip ulcers or gangrene (P=0.004) and cardiac damage (P=0.014). The patients with anti-U1-snRNP antibody had a higher prevalence of pulmonary arterial hypertension (P=0.047) and Raynaud’s phenomenon (P=0.019), and showed an increased trend in the occurrence of interstitial lung disease (P=0.058). Those with anti-CENP-B antibody had a lower IgG level (P=0.049) and higher ALP (P=0.010) and γ-GT (P=0.003). The incidence of autoimmune liver disease was increased in anti-CENP-B positive patients (P=0.001). 【Conclusion】 Different autoantibodies in SSc are associated with clinical phenotype, and may contribute to the diagnosis, evaluation, and prognostic judgment of the disease.

【Objective】 To evaluate musculoskeletal ultrasound (MSUS) detected subclinical synovitis of rheumatoid arthritis (RA) with different clinical remission criteria so as to explore the clinical characteristics of subclinical synovitis. 【Methods】 Forty-six consecutive patients with RA in clinical remission [disease activity score-28 (DAS28)≤2.6] underwent clinical and MSUS examinations at baseline and 1 year follow-up. Clinical remission was defined according to the DAS28 using the erythrocyte sedimentation rate (DAS28-ESR) and C-reactive protein level (DAS28-CRP), clinical disease activity index (CDAI), simplified clinical disease activity index (SDAI), and American College of Rheumatology/European League Against Rheumatism criteria Boolean (ACR/EULAR criteria). Subclinical synovitis was assessed by MSUS. Differences between the subclinical synovitis and non-subclinical synovitis groups were analyzed. 【Results】 The percentages of patients who achieved DAS28-ESR, DAS28-CRP, CDAI, SDAI, and ACR/EULAR remission at baseline and 1 year were 97.8%, 95.6%, 67.4%, 54.3%, 52.2% and 91.3%, 93.5%, 54.3%, 50.0%, and 45.6%, respectively. Subclinical synovitis was detected in 55.5%, 54.5%, 45.2%, 40.0%, 41.6% and 45.2%, 46.5%, 40.0%, 39.1%, and 38.1% of these patients, respectively. There were 45.6% and 41.3% patients who fulfilled all the criteria, yet 38.1% and 36.8% still had evidence of subclinical synovitis at baseline and 1 year. Compared with the patients without subclinical synovitis, those with subclinical synovitis had a significantly positive rate of anti-CCP antibody and a higher disease activity score at baseline (P<0.05). 【Conclusion】 MSUS detected subclinical synovitis is common. The positive anti-CCP antibody and higher disease activity score at baseline may be related to subclinical synovitis in patients with RA in clinical remission.

Objective:To investigate the expression status and diagnostic value of SRY related high mobility group box 11 (SOX-11) and transcription factor E-3 (TFE3) in solid pseudopapillary tumors of pancreas (SPTPs).Methods:Thirty-eight cases of SPTPs, 36 cases of well-differentiated pancreatic neuroendocrine tumors (PanNETs) and six cases of pancreatic acinar cell carcinomas (PACCs) were collected at the Affiliated Drum Tower Hospital of Nanjing University Medical School from 2012 to 2019. The expression of SOX-11, TFE3 and β-catenin was detected by immunohistochemistry, and the TFE3 gene status was detected by FISH in 18 cases of SPTPs.Results:Among the 38 SPTP patients, 29 were female and 9 were male, with a mean age of 50 years; among 36 PanNET patients, 32 were female and 4 were male, with a mean age of 39 years; for the six PACC patients, four were male and two were female, with a mean age of 60 years. β-catenin was positive in all 38 SPTPs, but was negative in all 36 PanNETs and 5/6 PACCs. SOX-11 was positive in 35/38 (92.1%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. TFE3 was positive in 36/38 (94.7%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. Among these three tumors, the specificity and sensitivity of β-catenin were 97.6% and 100.0%, the specificity and sensitivity of SOX-11 were 92.1% and 100.0%, the specificity and sensitivity of TFE3 were 94.7% and 100.0%, respectively. There was a significant difference of the expression status of all three markers in SPTPs compared with PanNETs and PACCs ( P<0.01). The results of SOX-11 and TFE3 immunostaining showed high consistency (Kappa>0.6). No gene rearrangement (0/18) of TFE3 was found in SPTPs. Conclusion:SOX-11 and TFE3 are highly expressed in SPTPs, and their specificity in the differential diagnosis of SPTPs is better than that of β-catenin.

Objective To explore the prevalence of vitamin D deficiency in the new onset and treatment-naive systemic lupus erythematosus (SLE) patients and study the correlation between serum 25(OH)D values and disease activity of SLE. Methods A retrospective case series analysis was done in 117 new-onset and treatment-na?ve SLE hospitalized patients during May 2016 and May 2017 in the Department of Rheumatology of the First Affiliated Hospital of Xi'an Jiaotong University and 39 age and gender matched healthy controls. Cinical and demographic details were collected. Disease activity of SLE was evaluated according to the systemic lupus erythematosus disease activity index (SLEDAI) score. The t-test, Mann-Whitney U test, Chi-square test, Spearman rank correlation coefficient test and multivariate linear regres sion were performed. Results Among the 117 SLE patients, 102 were female (87.2％) with the mean age of (36 ± 15) years. The median duration before diagnosis was 5(1, 12) months and the mean SLEDAI score was (12 ±7). The mean level of 25(OH)D was significantly lower in SLE patients [(10.1±6.0) ng/ml] than in healthy controls [(17 ±8) ng/ml, t=-5.273, P<0.01 ], and the prevalence of vitamin D deficiency was higher in SLE patients (109/117, 93.2％) than in healthy controls (28/39, 71.8％, x2=12.486, P<0.01). With 10 ng/ml as the cut-off point of serum 25 (OH)D, patients were divided into two groups. The percentages of haematological damage (84.3％ vs 66.0％, x2=5.321, P=0.021), lupus nephritis (32.9％ vs 14.9％, x2=4.759, P=0.029) and serositis (28.6％ vs 8.5％, x2=6.940, P=0.008), SLEDAI score [(13±8) vs (9±5), t=3.503, P=0.001)] and 24-hour urinary protein [(0.57±1.05) vs (0.21±0.46), t=2.437, P=0.017] were significantly higher in the 25 (OH)D<10 ng/ml group, but complement C3 [(0.5±0.3) g/L vs (0.7±0.3) g/L t=-2.441, P=0.016] and hemoglobin [(93±19) g/L vs (104 ±19) g/L, t=-3.052, P=0.003) were significantly lower in this group. The differences were statistically significant. SLEDAI score (r=-0.433, P=0.000), 24-hour urinary protein (r=-0.434, P=0.000)was significantly inversely correlated and complement C3 (r=0.296, P=0.001), hemoglobin (r=0.323, P=0.000) was significantly positively correlated with serum 25(OH)D level. There was an independent inverse correlation between SLEDAI score and serum 25(OH)D levels (β=-0.376, P=0.000). Conclusion The prevalence of vitamin D deficiency in the new-onset and treatment-naive systemic lupus erythematosus patients is significantly higher than that in healthy controls. There is an independent inverse correlation between serum 25 (OH)D values and disease activity of SLE.