Malignant transformation of ovarian endometriosis is known as endometriosis associated ovarian cancer (EAOC). However, the carcinogenic pathways by which EAOC develops remained poorly understood, and numerous studies found the risk factors of malignant transformation. Recent studies have provided evidence that estrogen receptor-β(ER-β) can influence the proliferation, motility and apoptosis of ovarian cancer cells. The signal pathway of tyrosine kinase receptor-B (TrkB)/brain-derived neurotrophic factor (BDNF) has a direct relation with the endometriosis, and its anti-anoikis plays a prerequisite role in proliferation of cancer. In the nervous system, estradiol and estrogen receptor can be combined through a variety of ways to promote BDNF/TrkB high expression and activity enhancement. Therefore,the relationship between high-risk factors of malignant transformation and ER-β expression and ER-β and TrkB/BDNF signal pathways need to be explored in EAOC.

Fine needle aspiration cytopathology of the breast is an effective means of distinguishing malignant from benign,and the aspirated sample collections techniques is the primary and key part of fine needle aspiration.Fine needle aspiration cell block has been improved and used on preoperative breast cancer molecular portraits.This paper will provide an introduction to application of specimens collection techniques,application and development of fine needle aspiration cell block on preoperative breast cancer molecular portraits.

Objective To improve the efficacy of the Nd : YAG laser-induced chorioretinal venous anastomosis in the rabbits'eyes. Methods Immediately after branch retinal vein occlusion (BRVO) model was made by argon laser in 40 eyes of 20 normal rabbits, the rabbits were divided into two groups. In the first group (experimental group), there were 10 rabbits treated with the argon laser followed by the Nd : YAG laser induced chorioretinal venous anastomosis. In the second group (control group), the rabbits were treated only with the argon laser induced chorioretinal venous anastomosis. Results An anastomosis in experimental group was formed in 6 rabbits within 4 - 6 weeks after treatment while no anastomosis was formed in control group. During 2 - 6 months the hemorrhage of retina or vitrous with laser photocoagulation were absorbed within 8 weeks and no other severe complications were found. Conclusion Applying Nd : YAG laser can improve the efficacy of chorioretinal venous anastomosis in the rabbils eyes.

Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective:To evaluate the feasibility of fine-needle aspiration cytology (FNAC) in diagnosing vascular abnormality in oral and maxillofacial region.Methods: The method of retrospective study was used.The data from the patients who underwent FNAC from 2011 to 2014 in Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology were collected.All the included patients were divided into surgery group and non-surgery group.The patients in surgery group underwent lesion resection and the postoperative pathological results were gained.The patients in non-surgery group underwent periodical sclerotherapy.The accuracy of FNAC was identified by histopathologic diagnosis in surgery group and the effect of sclerotherapy in non-surgery group.Results: In this study, 93 patients were involved, including 51 males and 42 females.The median age was 2.5 years.Among them, 67 cases were judged as vascular abnormality by FNAC, and 63 cases were in consistent with final diagnosis and 4 cases were not.Among the other 26 cases which were diagnosed as other diseases by FNAC, 5 cases were accorded with final diagnosis.Therefore, the sensitivity of FNAC on diagnosis of vascular abnormity was 93% and its specificity was 84%.Among them, there were 29 cases in the surgery group and 64 cases in the non-surgery group.FNAC results were in consistent with the postoperative pathological results in 20 cases in surgery group (69%), and not consistent with pathological results in 9 cases.The pathological diagnoses included vascular malformations (3 cases), neurofibromas (2 cases), hamartoma (1 case), sebaceous cyst (1 case), adenolymphoma (1 case), and descriptive diagnosis (1 case).In non-surgery group, FNAC results were in consistent with the clinical effect of sclerotherapy in 61 cases (95%).There were 3 misdiagnosed cases.The coincident rate between the result of FNAC and that of pathological or clinical diagnosis was 86%.Conclusion: FNAC is a feasible and minimal invasive method to diagnose vascular abnormality in oral and maxillofacial region.

Objective:To analyze the causes and risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) in the treatment of femoral intertrochanteric fractures.Methods:A retrospective analysis was conducted of the 568 patients with femoral intertrochanteric fracture who had been treated with PFNA fixation at Department of Orthopaedic Surgery, The Fifth Central Hospital of Tianjin from March 2013 to March 2018. They were 348 males and 220 females, aged from 44 to 93 years (average, 74.6 years). According to the fracture stability classification, the patients were divided into a stable group of 424 cases and an unstable group of 144 cases. According to the AO classification, the stable group had type 31-A1 and type 31-A2.1 while the unstable group type 31-A2.2, type 31-A2.3 and type 31-A3. The 2 groups were compared in terms of reduction quality, rate of internal fixation failure, and function of the affected hip. Single factor and multi-factor binary logistic regression analyses were conducted to determine the risk factors responsible for failure of PFNA fixation of femoral intertrochanteric fracture.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability between groups ( P> 0.05). Internal fixation failure occurred in 19 cases, which was caused by spiral blade withdrawal in 13 cases, femoral neck shortening in 17 cases, hip varus in 14 cases, and spiral blade cut-out in 14 cases. The failure rate for the stable group was 1.2% (5/424), significantly lower than that for the unstable group [9.7%,(14/144)] ( P<0.05). The Harris hip score at the last follow-up for the stable group [98(95,100)] was significantly higher than that for the unstable group [84 (82, 87)] ( P<0.05). There was no significant difference in reduction quality between the 2 groups ( P>0.05). The multivariate analysis showed that osteoporosis ( OR=7.283, 95% CI: 1.626 to 32.623, P=0.009) and unstable fracture ( OR=11.607, 95% CI: 4.039 to 33.355, P<0.001) were risk factors responsible for the failure of PFNA fixation of femoral intertrochanteric fracture. Conclusions:PFNA fixation for unstable intertrochanteric fracture can lead to a high failure rate. It forms a lever like structure so that the main stress is shifted to the internal fixation. Its lever fulcrum is located at the angle of intramedullary fixation so that a long arm forms at the load-bearing side, leading to a high failure rate. The weight-free time should be longer for patients with osteoporosis and unstable fracture after operation.

Objective To estimate the value of confocal laser endomicroscopy (CLE)for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The eonfocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopathological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83.54% and 85.92%, respectively, with positive predictive value of 86.84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53.57% and 88.52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89.26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88.37% and 93.46%, respectively, with positive predictive value of 84.44 % and negative predictive value of 95.24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased.

Objective To analyze the adverse drug reactions (ADR) during the standardized treatment of multidrug-resistant pulmonary tuberculosis (MDR-PTB), and to evaluate its impact on treatment outcomes.Methods A retrospective study was carried out on 305 MDR-PTB patients.Medical records of clinical treatment and laboratory examinations were collected, and the ADR data were analyzed.Chi-square test or Fisher exact test was used for discontinuous variables, and t test or non-parametric test was used for continuous variables.Results Among 305 MDR-PTB patients , 282 (92.5%) had at least one ADR.The major ADR were gastrointestinal reaction (46.9%), thyroid dysfunction (41.3%), hypokalemia (34.1%), renal injury (29.8%), hematological system impairment (21.6%), hepatotoxicity (19.0%), arthralgia or courbature (11.1%), and ototoxicity and vestibular dysfunction (8.5%).Sex, age, native place, the history of using second-line TB drugs or the history of diabetes mellitus had no significant effect on the incidence of ADR (all P>0.05).As per the Naranjo causality assessment of ADR, 34 patients had definite, 236 had probable, 12 had possible and 0 had doubtful causal relations.Among the 282 cases with ADR, 175 (62.1%) patients continued the original treatment regimen, 89 (31.6%) patients changed or stopped ADR-related drugs, only 18 (6.4%) cases stopped MDR-PTB treatment.The episodes of ADR had no significant effect on the treatment outcomes (P>0.05).Conclusions Although ADR are common in MDR-PTB patients during the treatment course, most of the ADR can be managed.Through timely monitoring and appropriate treatment of ADR, most of the patients could continue MDR-PTB treatment.

Objective To analyze the epidemic characteristics of tuberculosis (TB) cases in Zhejiang province from 2005 to 2014, and to identify the cluster spots.Methods TB notification data in Zhejiang province from 2005 to 2014 were analyzed at county and district level by using spatial scan statistic analysis method, which was showed on the digital map.Results In zhejiang province from 2005 to 2014, a total of 377 707 cases of patients with tuberculosis were reported.The average annual registration rates of the entire province was 72.61/100 000 (range: 28.85/100 000-182.90/100 000).Spatial analysis identified 14 clusters (RR=1.05-1.62) with statistical significance.Temporal analysis revealed that there were clusters between 2005 and 2009 in terms of the notification data on TB cases (RR=1.27,P=0.001).Spatio-temporal analysis identified 6 clusters (RR=1.19-3.55) with statistical significance.Counties and districts included in the first class cluster were similar by using the two different methods-spatial analysis and spatial-temporal analysis.Conclusions There is a descending trend of TB cases notification rates from western to eastern Zhejiang during the study period.The distribution of the TB case notified is not random at spatial, temporal and spatio-temporal levels.

ObjectiveTo investigate the relationship between microalbuminuria (MAU) and short-term outcome in patients with acute ischemic stroke.MethodsThe consecutive patients with acute ischemic stroke admitted to hospital were enrolled prospectively.The first urine specimen was taken on the following morning after admission for detecting urine albumin/creatinine ratio (UACR).UACR 30-300 mg/g was defined as MAU positive.Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin Scale (mRS) was used to evaluate functional outcome at discharge, and good outcome was defined as mRS score of 0 to 2.ResultsA total of 244 patients with acute ischemic stroke were enrolled, including MAU positive in 53 patients (27.12%), and poor outcome in 67 patients (27.50%).Univariate analysis showed that age, baseline NIHSS score, systolic blood pressure, fasting blood glucose, globulin, D-dimer, white blood cell count, neutrophils, and the proportions of ischemic heart disease in patients of the MAU positive group were significantly higher than those of the MAU negative group (all P<0.05).Multivariate logistic regression analysis showed that MAU (odds ratio [OR] 1.520, 95% confidence interval [CI] 1.151-1.794;P=0.031), baseline NIHSS score (OR 1.570,95% CI 1.357-1.808;P<0.001) were the independent risk factors for short-term poor outcome in patients with acute ischemic stroke.ConclusionsThe incidence of MAU is high in patients with acute ischemic stroke.MAU positive can be used as one of the independent predictors of short-term poor outcome in patients with acute ischemic stroke.