Purpose To analyze EGFR exon 18 ~21 gene mutations in lung cancer, and compare xTAG liquidchip technology and Sanger sequencing technology in clinical practice. Methods 1 139 tumor tissue samples from phaseⅠtoⅣlung cancer patients were randomly collected. DNA was extracted from the samples. EGFR gene mutation status in exon 18~21 was detected by xTAG liquidchip technology and Sanger sequencing technology respectively. Results The mutation status of EGFR was obtained by xTAG liquidchip technology in 1 134 patients, and 1 105 by Sanger sequencing technology, detection success rate was 99. 56% and 97. 01% respective-ly. The sensitivity and specificity of xTAG liquidchip technology Comparing with Sanger sequencing was 99. 59% and 94. 54%. Sever-al cases of multiple mutations were detected by both methods. All mutation types detected by two methods are fully consistent. Conclu-sions Comparing with Sanger sequencing technology, xTAG liquidchip technology, which is able to detect mutations of exon 18~21 simultaneously, is more convenient and efficient for EGFR gene mutation detection in lung cancer.

Objective To summarize the pathological and imaging features and treatment of retroperitoneal bronchogenic cyst.Methods The clinical data of 2 cases treated from October 2001 to November 2009 were summarized.The first patient was a 55-year-old woman with the chief complaint of lumbago in the left flank for 10 d.B-ultrasound showed mixed solid and cystic mass in spleen space with a diameter of 3.9 cm with thin wall and without rich blood supply.CT showed the lesion in the left adrenal gland region measured about 4 cm ×4 cm with low density with CT value of 10 HU,and enhanced scan was not obvious with CT value of 20 HU.It was diagnosed as left adrenal tumor and tumor resection was performed.The second case was a 17-year-old young man with the chief complaint of gross hematuria for 3 weeks after strenuous exercise.Ultrasonography found a 8.4 cm × 7.7 cm × 9.0 cm anechoic area surrounding the bladder.CT showed about 9.0 cm × 7.2 cm × 9.0 cm cystic lesion with thin wall,and the center density was uniformity in presacral space with CT value of8 HU.IVU showed visible semi-circular lower edge on the right edge of the bladder.The patient was diagnosed of presacral cyst and cystectomy was performed successfully.Results The pathology report of the first case:organizing wall with fibrous connective tissue,with most of the lining overlying pseudostratified ciliated columnar epithelium,goblet cells and subepithelial basement membrane.Pathological diagnosis was bronchogenic cyst,and the patient was followed up for 9 months without recurrence.The pathology report of the second case:pathological tissue fibers false wall tissue lining ciliated columnar epithelium,goblet cells seen in epithelium,fibrous tissue in the visible structure of mixed glands,a small amount of cartilage and muscle tissue.The diagnosis was bronchogenic cyst,and the patient was followed up for 2 years without recurrence.Conclusions Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed.Radiology imaging can identify cystic features,while a few may be with high density without specificity.Surgical removal of retroperitoneal bronchogenic cyst with symptoms has good prognosis and may prevent malignant transformation and secondary infection.

ObjectiveTo discuss the characters and management of renal lymphangiectasia.MethodsThe clinical data of two cases of renal lymphangiectasia were reviewed. The first patient was a 37-year-old woman with the chief complaint of lumbago in the right flank for 8 days.B-ultrasound showed mixed echo in perinephric space. On CT, similar appearances of fluid collections were seen, but not conspicuous. Conservative treatment was taken for three weeks and the symptoms were relieved. Three month later the patient had right lumbago relapse. CT scan revealed a large amount of fluid collection under the capsule of the right kidney. Percutaneous drainage was carried out. Two months later B-ultrasound showed fluid collection in perinephric space and percutaneous drainage again the fluid was sent to pathology. The second case was a 32-year-old woman with the chief complaint of lumbago in the left flank for the past three years. Ultrasonography revealed hyperechoic surrounding the left kidney. CT scan showed a left perinephric collection of fluid attenuation and circumferentially draping around the kidney. Renal lymphangioma was diagnosed and the patient underwent surgery.ResultsNeedle aspiration of the perinephric fluid was carried out, and laboratory analysis showed most leucocytes were lymphocytes. The pathologic diagnosis of the first case was renal lymphangiectasia. There was no recurrence during follow - up of two months. The second case was diagnosed renal lymphangioma pathologically. Follow - up for nine years, revealed no relapse.ConclusionsUltrasonography and CT contributed to the diagnosis of renal lymphangiectasia. Needle aspiration bioposy and histology could confirm it. Treatment of asymptomatic cases is not required. When collections are very large and cause symptoms, percutaneous drainage may be carried out however there is a risk of relapse.

Objective To investigate the clinical and pathological features of small cell carcinoma of the urinary bladder. Methods The pathological and clinical data of 9 cases of small cell carcinoma were analyzed retrospectively. There were 6 males and 3 females, ages 45 to 79 years (mean age, 62 years). Clinical manifestations of 7 cases included gross hematuria and dysuria, the other 2 cases experienced lower abdominal pain. The mean tumor size was 2.0 cm (ranged, 0.5 to 7.0 cm). Two cases had multiple tumors and 5 cases had single tumors. The growth pattern in 2 cases was diffuse growth in the whole bladder. In 4 cases tumor cells were found in urine cytology. All 9 patients underwent surgical treatment, including TURBt. Four patients were diagnosed as superficial tumors before operation. All the patients underwent regular theprubicine irrigation in the bladder. One case underwent additional intravenous chemotherapy for 3 cycles. Partial cystectomy was performed in 2 cases, with regular theprubicine irrigation in bladder and 1 case underwent intravenous chemotherapy for 2 cycles. Radical cystectomy was performed in 3 cases, with 2 cases undergoing intravenous chemotherapy after operation. Results Pathological findings showed that tumor cells were small and round in shape. These hyperchromatic nuclei showed limited cytoplasm with lack of nesting characters. CgA and NSE were positive in immunohistochemistry. The final diagnosis was small cell carcinoma, with 1 case accompanied with transitional cell carcinoma and 1 case accompanied with prostate cancer. One case showed high preoperative serum calcium (3.15 mmol/L) and low serum phosphate (0.61 mmol/L), which returned to normal 1 month after operation. Four cases who′s bladder was preserved were followed up, 3 cases were alive for 4, 9 and 25 months after operation. The 1 case who underwent intravenous chemotherapy was followed up for 24 months and there was no sign of relapse or metastasis. In all the 3 cases with radical cystectomy, 2 cases died 2 and 28 months postoperativly. Another case with adjuvant chemotherapy was followed up for 24 months without recurrence or metastasis. Conclusions Small cell carcinoma of the urinary bladder is highly malignant with poor prognosis. Radical cystectomy in combination with systemic chemotherapy has better efficacy. Retained bladder surgery with systemic chemotherapy is an alternative choice. The most important factors which influence the prognosis of the tumor are clinical stage and therapeutic methods.

Objective To explore the clinical and histopathological features of metanephric adenoma (MA). MethodsClinical and pathological data of 10 cases of MA were analyzed retrospectively.There were 4 males and 6 females,aged from 33 to 65 years,with an average of 45 years.2 patients had flank pain,4 patients had gross hematuria,and 4 patients were found by physical examination.The average diameter of tumor was 4.5 cm (2.5 - 8.0 cm).All patients were diagnosed as renal tumor by CT scan.9 patients underwent radical nephrectomy and 1 patient underwent partial nephrectomy. Results Pathological examination found that the tumors are composed of densely packed small uniform cells with regular nuclei that formed a tubular or adenoid pattern.Mitotic figures were absent or rare.4 patients were diagnosed as MA,2 cases were diagnosed as low-grade malignant MA,and 4 cases were diagnosed as MA with malignant component (2 cases of adenocarcinoma,1 case of chromophobe cell carcinoma,and 1 case of well differentiated papillary adenocarcinoma),7 cases were followed up for 22 months ( 10 to 34 months) without recurrence or metastasis. Conclusions MA is very rare benign renal tumor originating from epithelium,and a few are malignant,and some may contain malignant ingredients.Nephron-sparing surgery and radical nephrectomy are eligible for the treatment of MA.Considering the uncertainty of the biological behavior and cellular origin of MA,a long-term follow-up is necessary.

OBJECTIVE:To investigate characteristics and regularity of ADR induced by antineoplastic drugs and provide ref-erence for the safe drug use. METHODS:7 417 ADR reports induced by antineoplastic drugs from 91 hospitals from 2009 to 2013 were collected in the ADR monitoring center of PLA. According to the classification in national ADR monitoring cencer,Excel soft-ware was performed to statistically analyze the data. RESULTS:Among 7 417 ADR reports,1 475 were severe ADR(19.89%), 196 were the new and general ADR(2.64%),and 44 were new and severe ADR(0.59%);the elderly patients aged from 45-59 years accounted for the highest proportion (41.01%);intravenous administration was the main administration route causing ADR (88.96%);the incidence of antineoplastic drugs was higher in plant-derived drugs(26.55%),platinum drugs(24.86%)and an-ti-metabolism drugs (19.46%);ADR mostly manifested as lesions of digestive system (38.80%),blood system (16.53%) and general system(12.79%);43.60%ADR occurred within 12 hours after administration. CONCLUSIONS:Highly poisonous,nar-row-range security antineoplastic drugs could easily induce ADR. Risk prevention of antineoplastic drugs should be strengthened to undertake monitoring for high-risk patients and antineoplastic drugs,and severe ADR. More attention should be attached to the reac-tions after 12 h administration to reduce ADR incidence as much as possible.

Objective:To investigate the predictive value of circulating miR-143 and miR-182 for the short-term clinical outcomes in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to Danzhou People's Hospital from January 2018 to June 2020 were included prospectively. The modified Rankin Scale was used to evaluate the short-term clinical outcome at 14 d after onset or at discharge. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to identify the independent risk factors for poor short-term clinical outcomes in patients with AIS. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of miR-143 and miR-182 for the short-term clinical outcomes in patients with AIS. Results:A total of 158 patients with AIS, aged 65.80±12.36 years, were enrolled, including 105 males (66.46%), 95 patients with good outcome (60.1%) and 63 with poor outcome (39.9%). The age, total cholesterol, triglyceride, low-density lipoprotein cholesterol, baseline National Institutes of Health Stroke Scale (NIHSS) score, serum miR-143 and miR-182 level in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.984, 95% confidence interval [ CI] 1.315-3.617; P=0.036), low-density lipoprotein cholesterol ( OR 2.108, 95% CI 1.406-4.103; P=0.013), baseline NIHSS score ( OR 2.584, 95% CI 1.675-4.505; P=0.005), miR-143 ( OR 3.205, 95% CI 2.370-6.180; P<0.001) and miR-182 ( OR 2.802, 95% CI 1.905-5.516; P<0.001) were the independent risk factors for poor outcomes in patients with AIS. ROC curve analysis showed that the combined area under the curve of miR-143 and miR-182 to predict the poor outcome in patients with AIS was 0.935 (95% CI 0.873-0.992), the sensitivity and specificity were 96.5% and 87.0% respectively. Conclusions:The increase of serum miR-143 and miR-182 was closely associated with the poor short-term outcomes in patients with AIS. The combination of the two has a good predictive value for the poor short-term outcomes in patients with AIS.

OBJECTIVE:To investigate the condition and characteristics of drug-induced liver injury (DILI) of anti-infective agents and provide reference for the prevention and treatment of anti-infective agents related DILI. METHODS:Based on retrospective analysis,a total of 572 DILI reports of anti-infective agents were collected from PLA ADR monitoring center during 2009 to 2013, and then analyzed statistically in terms of patient’s age and gender,main diagonosis,categories of DILI-inducing drugs,type,route of administration,occurrence time,lab indicator,DILI types and clinical manifestations,the application of liver protective drugs,out-comes,etc. RESULTS:Among 572 DILI cases,there were 412 cases(72.03%)of male patients and 160 cases(27.97%)of female patients,and average age of the patients was(44.54±23.75)years old. ADRs were related to 57 kinds of anti-infective agents in 6 cat-egories. Rifampin was the most frequent in suspected drugs,followed by isoniazid,moxifloxacin,fluconazole,azithromycin,cefurox-ime, cefoperazone/sulbactam, levofloxacin, cefoxitin and voriconazole. Intravenous infusion was the main administration route (74.48%). The occurrence time of ADRs was mainly within two weeks (86.19%). Hepatocellular damage (93.33%) was the main type in 360 cases of ADR for evaluation of liver injury types. The majority of cases(82.17%)were cured or improved after drug with-drawal and symptomatic treatment. CONCLUSIONS:Cephalosporin,fluoroquinolones,antituberculosis and antifungal drugs might be the common agents which caused liver injury. Hepatocellular damage is the most frequent type. Most of patients have a favourable prognosis. Clinical medical staffs should strengthen the awareness of DILI caused by anti-infective agents and ehance the prevetion of it.

AIM: To observe the changes of the number of NKT cells in spleens and livers of induced model of experimental autoimmune encephalomyelitis (EAE), and to study the role NKT cells play in the immunoregulation of EAE. METHODS: C57BL/6 mice were immunized with MOG<,35-55> peptide and received clinical evaluation daily. The mice were sacrificed at the fastigium and the splenic and hepatic lymphocytes were isolated. The changes of NKT cells in normal and EAE C57BL/6 mice were detected by flow cytometry. RESULTS: The percent of NKT cells in lymphocytes of different organs of EAE model were greater decreased than in that of normal mice. The percent of NKT cells in splenic lymphocytes of normal mice was 2.22± 0.14, while that in EAE mice was 1.94±0.07 (P < 0.05). The percent of NKI cells in hepatic lymphocytes of normal mice was 5.52±2.17, while that in EAE mice was 2.67± 1.41 (P < 0.05). CONCLUSION: The proliferation of splenic and hepatic NKT cells in C57BL/6 mice are inhibited in EAE model, which may indicate that the immune function conducted by NKT cell is down regulated in EAE mice.

Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .