Objective To evaluate the systolic function of left ventricle in myocardial infarction(MI)patients with ventricular aneurysm and the changing law of blood flow in ventricle with regional abnormality of wall movement by vector flow mapping (VFM).Methods Tirty-one MI patients with ventricular aneurysm and 35 healthy participants were enrolled in this study.The characteristic of vector and streamline,and the changing of the velocity gradient in left ventricular outflow tract (LVOT), and the average flow quantity through aneurysm neck were detected in the isovolumic contraction period, the rapid ejection period and the slow ejection period by VFM.Results The distinction between aneurysm and control group was mainly the persistance of vortex in aneurysm.The size of vortex in aneurysm was highly correlated with that measured by 2-D ultrasound(P ＜0.01).The percentage of vortex duration to cardiac cycle in patients group was significantly greater than that in control group(P ＜0.01).In the early systolic contraction the velocity gradient in LVOT in patients with ventricular aneurysm was smaller than that of control group(P ＜0.05).The average flow through aneurysm neck was notablely decreased compared with control group(P ＜0.01).Conclusions VFM can reveal the hemodynamics of left ventricle with aneurysm directly as well as quantitively measure the regional velocity and flow quantity.VFM can evaluate the systolic function of left ventricle exactly.

Objective To investigate the clinical and pathological diagnosis of cutaneous calcifying epithelioma.Methods Thirty cases of calcified epithelioma were diagnosed and treated by our hospital.The clinical features and pathological features were retrospectively reviewed.Results The main pathological features of the tumor were that the main tumor (basophilic cells) basal cells and shadow cells were mixed composition,combined with ossification and calcification and with no recurrence after surgical resection.Conclusion The clinical manifestations of calcifying epithelium are lack of characteristics and diverse pathological features.It is necessary to make the correct pathological diagnosis with the time,location and imaging of tumor growth.

Objective:To investigate the expression of NKG2D receptor on natural killer(NK)cells and the expression of its ligand MHC classⅠ-related chain A and B(MICA/B)whereby to analyze the mechanism for escaping killing were deteced by NK cells of leukemic cells.Methods:Detection of NKG2D receptor and MICA/B ligand were aleteced by flow cytometry analysis.Results:The expression of NKG2D receptor were significantly lower in both pretherapy and complete remission group,compared with that in health group(P0.05).Conclusion:NK cell function mediated by NKG2D-MICA/B was inhibited,with possibly leads to the escape of leukemic cell from NK cell cytotoxicity;And after therapy the function of NK cells mediated by MICA/B in complete remission patients may be not ameliorated indicated by farther decrease of NKG2D-cells in the patients.

Objective To detect NRAS gene mutations in patients with acral melanoma, and to analyze their relationship with the prognosis of acral melanoma. Methods Clinical and pathological data were collected from 55 patients with pathologically diagnosed acral melanoma. DNA was extracted from paraffin?embedded specimens from lesions of the 55 patients and 15 patients with nevus. PCR and direct DNA sequencing were performed to detect NRAS gene mutations. Univariate and multivariate analyses were performed using the Cox′s proportional hazards regression model. Results Of the 55 patients, 6(10.9%)carried the Q61R mutation in codon 61 of the NRAS gene. No mutations were found in exon 1 or 2 of the NRAS gene in any of these paraffin?embedded specimens, and none of the pigmented nevus specimens harbored NRAS gene mutations. Of the 6 patients carrying NRAS gene mutations, 4 had lymph node metastasis. Multivariate Cox regression analysis showed that independent factors of poor prognosis included advanced clinical stage(RR = 2.54, 95% CI: 1.062- 6.066, P < 0.05), not receiving surgical resection(RR = 2.98, 95% CI:1.316- 3.525, P < 0.05), and carrying NRAS gene mutations (RR = 2.73, 95% CI: 0.932- 3.257, P < 0.05). Conclusions NRAS gene mutations may be associated with lymph node metastasis in patients with acral melanoma. The prognosis of acral melanoma may be associated with clinical staging, treatment strategies and NRAS gene mutations. Additionally, NRAS gene mutations may serve as a new index for predicting prognosis of acral melanoma.

Objective:To explore the clinical characteristics and treatment of a family with inherited generalized epilepsy with febrile seizures plus (GEFS + ) caused by the KCNT2 gene mutation and review the literature. Methods:Clinical data of a child with GEFS + and his family members who visited Department of Pediatric Neurology, Guangzhou Women and Children′s Medical Center in May 2019 were collected.DNA samples were collected from the peripheral blood of the proband, his parents, his elder brother, and his maternal grandparents, and genetic analysis and verification were performed using the next-generation sequencing technique.Using " KCNT2" as the key word, literature was retrieved from PubMed, China National Knowledge Infrastructure and Wanfang databases (up to August 2019). Results:The proband was a 3-year-old boy who was admitted to Guangzhou Women and Children′s Medical Center because of frequent epileptic seizures in the past 5 months.He presented with a binocular gaze and experienced 3 to 8 times of extremities myoclonic-spastic epileptic attacks every day.He had a history of 3 times of febrile seizures at the age of 2 years old.His seizures were refractory to Sodium valproate, Topiramate, Nitrazepam and Levetiracetam.His elder brother and mother had a history of childhood febrile seizures.Other members in the family had no history of convulsion.Ictal electroencephalogram showed general 1 Hz high voltage spike-slow waves.A heterozygous nonsense mutation of KCNT2 gene c. 574C>T(p.Q192X) that was never reported previously was detected in the proband, his brother, mother and maternal grandmother.Furthermore, no other family members carried the mutation at the c. 574 locus of the KCNT2 gene.No article in Chinese was found, and 2 articles in a language other than Chinese provided the complete data of 3 sporadic cases.Together with 4 cases in the family studied in this article, there were 7 cases and 4 mutation sites in KCNT2 gene.Of these mutations, there were 3 missense mutations and 1 nonsense mutation.Three sporadic patients presented with early infantile epileptic encephalopathy.The family of this study was characterized with febrile seizures and febrile seizures plus. Conclusions:A de novo mutation and phenotype of the KCNT2 gene is found in a family with GEFS + .It would expand the gene mutation spectrum and provide basis for family genetic counseling. KCNT2 mutation induced GEFS + is refractory to antiepileptic drugs.

Objective To detect the expression of human telomerase reverse transcriptase (hTERT) mRNA in the melanoma, and to analyze the relationship between the expression and subtypes and clinicopathological features of melanoma. Methods Expression of hTERT mRNA was detected by real-time quantitative PCR in 64 cases of melanoma and 30 cases of nevus. SPSS 17.0 software was used to analyze the relationship between hTERT mRNA expression and clinical pathological features of melanoma. Results The relative expression of hTERT mRNA in melanoma tissues was higher than that in nevus tissues [(52.43±5.42) vs (21.38±3.73), t= 4.72, P= 0.000]. The expression of hTERT mRNA in melanoma had no significant correlation with age, gender, ethnicity (all P> 0.05), but had relationship with subtypes, lymph node metastasis, Clark classification (all P< 0.05). The expression of hTERT mRNA in mucosal melanoma was significantly higher than that of acral and non-acral melanoma (t= 7.71, P= 0.001), while the expression of acral and non-acral melanoma had no difference (P> 0.05). Conclusions The expression of hTERT mRNA in melanoma is high, especially in mucosal melanoma. hTERT may play an important role in the occurrence and development of melanoma.

ABSTRACT:In order to explore the spatial clustering and influential factors of HFMD in Chongqing ,China from 2008 to 2012 ,spatial autocorrelation and spatial regression analysis (using the spatial lag model in this study ) were carried out using the HFMD data of 38 districts (counties) from 2008-2012 in Chongqing by OpenGeoDa ,and the HFMD case‐based data was collected from the Disease Supervision Information Management System of Chongqing Center for Disease Control and Preven‐tion .We found that the global Moran’s I coefficient of Chongqing from 2009 to 2012 was 0 .458 7 ,0 .567 5 ,0 .398 6 ,and 0 .606 0(P<0 .01) ,respectively ,indicating that the incidence of HFMD in Chongqing had a positive spatial correlation in this four years and a spatial clustering distribution was displayed .However ,no global spatial autocorrelation was founded in 2008 and the global Moran’s I coefficient was 0 .133 2 (P>0 .05) .Results of multi‐factor spatial lag regression analysis demonstra‐ted that the incidence of HFMD was positively related with urban rate (β=1 .667 6 , P=0 .001 6) ,and negatively correlated with medical technical personnel per thousand (β= -0 .000 2 ,P=0 .019 8) .In general ,the incidence of HFMD was found ge‐ographically clustered in Chongqing from 2009 to 2012 which was significantly influenced by urban rate and medical technical personnel per thousand population ,and while the urban rate was the main factor .

Objective To compare the value of transvaginal ultrasound and MRI in diagnosis of the first-trimester cesarean scar pregnancy (CSP).Methods The transvaginal ultrasound and MRI data of 28 patients who were initially diagnosed as CSP were analyzed. Regarding the surgery and postoperative pathology as a gold standard,the differences between transvaginal ultrasound and MRI were compared in the sensitivity,specificity,diagnostic coincidence rate and the ability in showing the internal structure of gestational sac and its relationship with the surrounding tissue.Results 22 CSP patients were confirmed by surgical pathology in a total of 28 patients,while 20 CSP patients using transvaginal ultrasound and 1 9 using MRI were correctly diagnosed respectively,and the sensitivity,specificity and diagnostic coincidence rate were 90.9%,50.0%,82.1% vs 86.4%,83.3%,85.7%,respectively,exhibiting no statistical difference in the coincidence rates between two methods (χ2 =0.132,P=0.72 ).The pregnant bursa in 20 patients was found by pathology in 22 CSP patients,and 19 pregnant bursa with transvaginal ultrasound and 17 with MRI were confirmed respectively,exhibiting no statistical difference between two methods (χ2 =1.11,P =0.29).The yolk sac in 12 patients,embryos in 8,original heart tube in 5 and local scar pregnancy sac infiltration in 3 were found with transvaginal ultrasound,meanwhile those in 2,2,0 and 9 respectively were also found with MRI,exhibiting significant differences between the two methods (χ2 =13.8,P =0.000;χ2 =7.7,P =0.006;χ2 =7.2,P =0.007;χ2 =7.1,P=0.008).The pregnancy capsule hemorrhage in 7 patients and hemorrhage in uterine cavity in 9 were found with transvaginal ultrasound, meanwhile those in 14 and 1 5 were found with MRI,exhibiting significant differences (χ2 =6.6,P =0.01;χ2 =5.0,P =0.026). Conclusion The coincidence rate in diagnosis of CSP using transvaginal ultrasound or MRI is higher.Transvaginal ultrasound is superior to MRI in showing the yolk sac,embryos and original heart tube,while MRI is better than transvaginal ultrasound in showing the hemorrhage of uterine cavity or gestational sac and the relationship between pregnant bursa and the surrounding tissue.Combination of the two methods shows more value in early diagnosis of CSP.

BACKGROUNDTo investigate the effect and complication of three-dimensional conformal radiotherapy (3D-CRT) for elderly patients with stage I-III non-small cell lung cancer.

METHODSThirty elderly patients with stage I-III NSCLC who were treated with 3D-CRT from January, 1998 to January, 2002 were retrospectively analyzed. In the 30 patients, 46 targets were treated with 3-5 Gy per fraction to a total dose of 42-66 Gy. The effect and complication were analysed.

RESULTSThe overall 1-, 2-, 3-year survival rates and the median survival time were 65.8%, 41.2%, 20.6%, and 23 months respectively. The overall 1-, 2-, 3-year local control rates were 59.8%, 31.1%, and 28.3%. The overall incidence of radiation pneumonitis was 16.7% (15/30) with grade≥3 of 6.7%, and one case was died from rediation pneumonitis. The incidence of radiation pulmonary fibrosis was 10.0% (3/30), and the incidence of radiation esophagistis was 43.3% (13/30), but both two side effects were slight.

CONCLUSIONS3D-CRT can improved the survival in elderly patients with stage I-III non-small cell lung cancer by escalating radiotherapy doses.

Objective To investigate the expression of Notch1,Notch3 and Hes1 in gastrointestinal stromal tumors(GIST) and their clinical significance.Methods Quantitative real-time polymerase chain-reaction(Q-PCR) and Western blot were applied to detect the mRNA and the expression of Notch1,Notch3 and Hes1 in 135 matched GIST specimens and adjacent tissues.Meanwhile,the expression of Notch1,Notch3 and Hes1 was detected by immunohistochemistry,and the relationship between their expression and clinicopathological factors in GIST patients was analyzed.In addition,a total of 40 wild type mice(WT) and Notch1 knockout mice(KO) was divided into WT group,KO group,WT+ GIST group and KO+GIST group,and the expression of Notch1,Notch3 and Hes1 in each group was detected.Results Compared with adjacent tissues,the mRNA andthe expression of Notch1,Notch3 and Hes1 were up-regulated in GIST tissues(P＜0.05).The positive rates of Notch1,Notch3 and Hes1 in the GIST specimens (59.26 ％,65.19 ％ and 62.22 ％) were higher than those in the adjacent tissues(17.780％,22.22 ％ and 17.78 ％),and the difference was statistically significant(P＜0.05).Statistical analysis showed that the expression of Notch1 was significantly correlated with the NIH grade of GIST(x2 =8.532,P=0.002);the expression of Notch3 was significantly related with tumor metastasis of GIST (x2 =7.532,P=0.003);the expression of Hes1 was significantly associated with the tumor size of GIST(x2 =6.781,P=0.012).The expression of Notch1,Notch3 and Hes1 was higher in WT+GIST group compared to the expression found in WT group(all P＜0.05).There were no significant differences in the expression of Notch1,Notch3 and Hes1 between WT+ GIST group and KO+GIST group.The expression of Notch1,Notch3 and Hes1 was lower in KO+ GIST group compared to the expression found in WT+GIST group(all P＜0.05).Conclusion The expression of Notch1,Notch3 and Hes1 related to Notch signaling pathway is elevated in GIST tissues,and the activation of Notch signaling pathway may play an important role in the occurrence and progression of GIST.