Infusion misdirection syndrome(IMS)is a rare and troublesome intraoperative complication during phacoemulsification cataract surgery, which usually occurs in hydrodissection, phacoemulsification or irrigation/aspiration(I/A). Under the factors of lax zonular fibers, lens dislocation, posterior capsular rupture, the anterior segment crowding, high perfusion pressure, the infusion fluid accumulates in the vitreous cavity or behind the vitreous, leading to intraocular hypertension, shallowness or even disappearance of the anterior chamber and eventually causing the suspension of surgery. It needs to be differentiated from suprachoroidal hemorrhage(SCH), capsular block syndrome(CBS), etc. After intraoperative emergency treatments, such as rest combined with intravenous drip of mannitol, pars plana needle aspiration or vitrectomy, a favorable prognosis can be obtained. This review discusses the pathogenesis, diagnosis, emergency management, prevention and prognosis of IMS during phacoemulsification cataract surgery, with the aim of providing clinical guidance for ophthalmologists.

Objective: To evaluate the clinicopathologic characteristics of lung non-terminal respiratory unit (non-TRU) type adenocarcinoma. Methods: Seventy-two cases of lung non-TRU type adenocarcinoma that underwent complete resection and diagnosed at Departments of Pathology, Affiliated Suzhou Hospital of Nanjing Medical University and Nanjing General Hospital of the PLA from January 2005 to December 2016 were retrospectively studied. The histomorphological changes and precursor lesions were observed under microscope. The expression of lineage-specific markers and tumor stem cell markers was detected by immunohistochemistry (IHC). The major driver mutations of lung adenocarcinoma were tested by ARMS and directive gene sequencing. Results: Non-TRU type adenocarcinomas were more commonly found in male (65.3%, 47/72), former or current smokers (68.1%, 49/72), the elder (mean 61 years old), central adenocarcinoma (75.0%, 54/72), tumors with necrosis (61.1%, 44/72) and higher grade (73.6%, 53/72). Histologically, non-TRU type adenocarcinoma displayed complex histomorphology and was often composed of large irregular gland-like and acinar pattern accumulating extracellular mucin, necrotic tumor cell debris and neutrophils, or invasive adenocarcinoma with mucin production. The tumor cells were composed of bronchial surface epithelial cells, mucinous column cells, polygonal cells and goblet cells. Eighteen (25.0%), 23 (31.9%) and 28 (38.9%) cases exhibited ciliated columnar cell metaplasia (CCCM), mucous columnar cell change (MCCC) and bronchiolar columnar cell dysplasia (BCCD) (precursor lesion of lung adenocarcinoma). IHC showed the expression of CK7 (100.0%, 72/72), TTF1 (12.5%, 9/72), Napsin A (5.6%, 4/72), MUC5AC (81.9%, 59/72), MUC5B (87.5%, 63/72), p53 (66.7%, 48/72), CK5/6 (12.5%, 9/72), p63 (18.1%, 13/72), CK20 (19.4%, 14/72) and CDX2 (16.7%, 12/72) in the tumor cells. The expression of tumor stem cell markers was detected in 43.1% cases (31/72) for CD44, 31.9% (23/72) for CD133, 58.3% (42/72) for β-catenin, 36.1% (26/72) for ALDH1, 12.5% (9/72) for GATA6, 20.8% (15/72) for SOX2 and 29.2% (21/72) for OCT4. The driver mutations were 26.4% (19/72) for KRAS, 2.8% (2/72) for EGFR and 1.4% (1/72) for EML4-ALK, and none for BRAF and ROS1. Conclusion Non-TRU type adenocarcinoma is an uncommon subtype of lung adenocarcinoma with distinct clinicopathologic characteristics, histologic appearances, immunophenotype and molecular genetic alterations.

【Objective】 To investigate the expressions of ubiquitin-conjugating enzyme(UBE2) family and ubiquitin-conjugating enzyme E2T(UBE2T) gene and their relationships with the clinicopathology in lung adenocarcinoma. 【Methods】 Based on Linkedomics database, the expression levels of UBE2C, UBE2M, UBE2S, UBE2T and UBE2V2 mRNA and their associations with the clinical characteristics of lung adenocarcinoma were collected and detected. Kruskal-Wallis H test was applied to compare the differences of pathologic stage, T stage and N stage, Wilcoxon rank sum test for M stage and Cox regression test for overall survival(OS). The expression profiles of UBE2T gene in lung adenocarcinoma and paracancerous tissues were obtained from the Cancer Genome Atlas(TCGA) database and then analyzed with independent samples t test. The Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway and the enrichment were examined by using Gene Set Enrichment Analysis(GSEA) software. 【Results】 The expressions of UBE2C, UBE2M, UBE2S, UBE2T and UBE2V2 mRNA correlated with the clinicopathological features of lung adenocarcinoma. Compared with low UBE2T expression, high UBE2T expression predicted shorter OS time and advanced TNM stage. Their differences were statistically significant(P < 0.05). The UBE2T mRNA expression level was significantly upregulated in lung adenocarcinoma(P < 0.01). The gene enrichment analysis showed that the overexpression of UBE2T was closely related to 36 signal pathways(FDR < 0.05), including cell cycle(FDR = 0), spliceosome(FDR = 0), DNA repair(FDR = 0) and the glucose metabolism. The expressions of UBE2C, UBE2M, UBE2S, UBE2T and UBE2V2 mRNA in UBE2 family correlated with the clinicopathological features of lung adenocarcinoma. UBE2T was further identified as a factor most closely related with pathological grade, prognosis in lung adenocarcinoma and glycolysis process of tumor cells. 【Conclusion】 UBE2 family correlates with clinicopathological features of lung adenocarcinoma. UBE2T mRNA could be a new biomarker for lung adenocarcinoma.