Purpose To compare the CT features of hepatic metastases of gastro-entero-pancreatic adenocarcinomas with and without neuroendocrine differentiation [NED(+) and NED(-)] and to explore the value of CT features in differentiation of the two groups.Material and Methods From January 2009 to December 2015,abdominal CT scans of 17 pathologically proved cases of NED(+) gastro-entero-pancreatic adenocarcinomas with hepatic metastases and 34 pathologically proved cases of NED(-) hepatic metastases with sex,age and primary site matched were retrospectively reviewed.CT features including hepatic metastases number,size,distribution,shape and enhancement were assessed,as well as presence of lymphadenopathy or ascites.Differences of CT features between the two groups were analyzed.Results Compared with NED(-) group,hepatic metastases of NED(+) group more frequently demonstrated a peripheral enhancement on artery phase (94.1％ vs.44.1％,P＜0.05),and more washout on portal venous phase (41.2％ vs.5.9％,P＜0.05),while hepatic metastases of NED(--) group showed more plateau type (91.2％ vs.58.8％).There was no significant difference of other findings between the two groups (P＞0.05).Logistic regression revealed that enhancement area in hepatic artery phase and enhancement changes in portal venous phase were independent factors for differential diagnosis (P＜0.05).The area under the ROC curve of combining the two features was 0.811 (P＜0.05).Conclusion There are some different CT enhancement features between NED(+) and NED(-) hepatic metastases of gastro-entero-pancreatic adenocarcinomas,which are helpful in differential diagnosis.

Objective:There are limited data describing the clinical characteristics and prognosis of culture negative pyogenic spondylitis.The aim of this study was to investigate the treatment,prognosis and clinical characteristics of culture negative pyogenic spondylitis.Methods: A retrospective study reviewed 74 patients who were diagnosed with spondylitis in Peking University First Hospital from January 2010 to December 2015.A total of 27 patients suffered from pyogenic spondylitis.According to the pa-thogenic culture results,the patients were divided into two groups: culture negative group and culture positive group.The clinical characteristics and treatment outcomes between the two groups were compared.Results: The elder were more vulnerable to pyogenic spondylitis,and of the 27 patients,12 patients were female and 15 male.All patients had no history of administration of antibiotics prior to obtaining culture samples.A causative germ was identified in 14/27 patients (51.9％) with Staphylococcus aureus being the most common pathogen.There was no significant difference between the two groups in the patient's age,gender,visual analogue score (VAS),predisposing factor,clinical symptom,sign and spinal segment (P>0.05).Erythrocyte sedimentation rate (ESR) (P=0.056) and C-reactive protein (CRP) (P=0.040) of culture negative group were lower in contrast to culture positive group.The incidence of vertebral abscess in culture negative group was higher than in culture positive group (P=0.046).After treatment,ESR dropped almost equally in both groups,and CRP dropped faster in the culture positive group (P=0.192).At last,there was no significant difference between the two groups in hospital stay,pain relief,open debridement operation rate,and recurrence rate of infection.Conclusion: ESR and CRP of the culture negative patient were lower than those of the culture positive patient,and the incidence rate of paravertebral abscess was higher than that of the culture positive patient.After administration of antibiotics,there was no significant difference between the two groups in duration of antibiotics,open debridement operation rate and recurrence rate of infection.So,culture negative may not necessarily be a negative prognostic factor for pyogenic spondylitis.However,we should watch out for the drug resistant bacteria or double infection,due to the long term use of wide-spectrum antibiotic in culture negative patients.

Objective To investigate the effects of hemolysis on glycated albumin (GA) determined by ketoamine oxidase method and its correction.Methods GA concentration and hemolytic parameter(optical density,A) in non-hemolytic serum and different degree hemolytic serum samples were measured.The impact of hemolysis on GA and the relationship between hemolysis and GA were analysed.A formula was developed to correct the interference of hemolysis on GA measurement using regressive Multiple analysis.Results Compared with non-hemolytic serum,hemolysis resulted in the significantly decreased concentrations of GA detected by ketoamine oxidase method(P ＜ 0.01),which were significantly associated with the degree of hemolysis (R2 =0.943 4).Y and Z represented GA concentration of non-hemolytic serum and different degree hemolytic serum,while X represented optical density of hemolytic parameter.Formulas for GA measurement were presented:Y =2.468X + Z-0.015 73,GA concentrations of hemolytic samples can be reverted to the values without statistical difference from the GA concentration in corresponding non-hemolytic samples.The bias of corrected GA was less than 10％.Conclusion Our results indicate that the level of GA measured through ketoamine oxidase method is negatively affected by hemolysis.The formula of mathematical correction of GA results in hemolytic samples should be suitable for the requirements of clinical laboratory.

BACKGROUND:Percutaneous vertebroplasty is a minimal y invasive treatment for spinal metastasis tumor, but the mechanism of the injected polymethylmethacrylate (PMMA) bone cement in the treatment of tumor is not ful y understood. OBJECTIVE:To explore the cytotoxicity of PMMA bone cement and its monomers on tumor cel s. METHODS:PMMA extracts in the wire drawing and curing periods and different mass concentrations of monomer dilutions were co-cultured with human lung cancer cel s spc-A1. The cel morphology was observed using inverted microscope, the absorbance (A) values were detected by cel counting kit-8 assay, the relative growth rate was calculated, and the toxicity of PMAA bone cement and its monomers was evaluated at 1 and 3 days of culture, respectively. RESULTS AND CONCLUSION:At 1 day of culture, the absorbance values in the 1 and 10 g/L groups were significantly lower than that in the negative control group (P<0.01). The absorbance values in the 1 g/L, 10 g/L, 100 mg/L and wire drawing extract groups were significantly lower than those in the negative control group at 3 days of culture (P<0.05). The relative growth rate in the 1 and 10 g/L groups was 26%-29%, and the level of toxicity was grade 4 after 1-day culture;at 3 days, the relative growth rate was decreased to 12%-16%, and the level of toxicity was grades 4-5. After 3-day culture, the level of toxicity reached to grade 2 in the 100 mg/L and wire drawing extract groups. These results indicate that PMMA bone cement in wiredrawing period and its monomers exert toxic effects on tumor cels.

Objective: To observe the influence of moxibustion sertma of mice on the expression of Fas, bcl-2 mRNA and protein of EL-4 lymphoma cells in vitro. Method: The EL-4 lymphoma cells were cultivated for 24 h in the moxibustion serum of mice. The expression of Fas and bcl-2 mRNA of EL-4 lymphoma cells were detected by in-situ hybridization method, and the protein expression of Fas and bcl-2 were observed by the immuocytochemistry method. Results: The expression of bcl-2 mRNA and protein decreased, and the expression of Fas rnRNA and protein increased significantly in EL-4 cells, which were cultivated in the moxibustion serum compared those cultivated in normal mice serum (P<0.05). Conclusion: Moxibustion serum could down-regulate the bcl-2 mRNA and protein and up-regulate the Fas mRNA and protein of EL-4 cells.

Objective To study clinical characteristics and prognostic factors in primary systemic anaplastic large cell lymphoma (S-ALCL). Methods Clinical data of 56 S-ALCL were retrospectively analysed, who were diagnosed in Lymphoma Lab of Peking University Health Science Centre. Immunohistochemical staining for ALK-1 and bcl-2 were performed by standard SP method. Results The median age of patients is 17 years, and the ratio of sex was1.67:1 (male : female) in 56 cases of S-ALCL. Among of the 49 cases who were followed up, 32.65 % (16/49) of patients died, and all of them died within two years after diagnosis. The 3-year and 5-year overall survival were 64.28 %. 41 out of 56 cases (73.21 %) was positive for ALK-1 protein, while 10 cases out of 56 S-ALCL cases (17.86 %) positive for bcl-2. Clinical staging, extranodal sites of involvement or with extranodal sites of involvement and ALK were important prognostic factors with statistic significance by Long-rank test. Among of them, Clinical staging was the most independent prognostic factor by COX multivariate analysis. Conclusion S-ALCL was mostly seen in the young and middle-aged male patients. The death were most frequently occurred within two years after diagnosis. Most of the patients who have good responses to chemotherapy can get the complete remission and long-term survival. Clinical staging, extranodal sites of involvement or with extranodal sites of involvement and ALK were very important prognostic factors which can be used to predict the patients long term survival, and guide the treatment.

Objective To analyze the related risk factors for Lisfranc injury resulting from low energy violence.Methods A retrospective study was performed for 61 cases (35 males,26 females) with low-energy foot injury hospitalized from June 2008 to June 2014.Mean age was 36.7 years (range,16-57 years).Fall injuries were noted in 24 cases,sports injuries in 21 cases,and twist injuries in 16 cases.The cases were divided into Lisfranc injury group(n =23) and non-Lisfranc injury group (n =38) according to the different diagnosis.Univariate analysis and multi-factor logistic regression analysis were used to identify the factors that may lead to the occurrence of Lisfranc injury including age,gender,body mass index,operation history,smoking,alcohol abuse,injury reason,medial depth of the mortise/ second metatarsal length (b/a),lateral depth of the mortise/ second metatarsal length (c/a),first metatarsal-to-talus angle,first intermetatarsal angle,second metatarsal length/foot length(a/g),calcaneal inclination angle and cuboid-navicular overlap/cuboid vertical height (e/e + f).Results Univariate analysis showed between-group differences were significant in age (x2 =7.385,P ＜0.05),injury reason (x2 =8.663,P ＜ 0.05),calcaneal inclination angle (t =3.958,P ＜ 0.05),b/a (t =5.051,P ＜ 0.05) and a/g(t =4.618,P ＜ 0.05).Logistic regression analysis identified b/a(OR =1.036,95 ％ CI 0.018-0.450,P ＜ 0.01) and a/g(OR =1.013,95％ CI 0.005-0.374,P ＜ 0.01) as independent risk factors for low-energy Lisfranc injury.Conclusion Low-energy Lisfranc injury is independently associated with b/a and a/g,and may relate to the decreased medial depth of the mortise and increased foot length.

Objective:To analyze Traditional Chinese Medicine(TCM) prescriptions in COVID-19 patients in Shanghai area.Methods:Two hundred and forty patients were enrolled in the study, including 19 mild cases, 199 moderate cases, 16 severe case and 6 critical cases. The COVID-19 formula in Shanghai area was extracted and input in TCM Inheritance platform. Data association method such as software association rules,improved mutual information method,complex system entropy clustering,unsupervised entropy hierarchical clustering were used to analyze the frequency,herb flavor and meridian, combination rule and core combination of different types of Chinese herbs in the treatment of COVID-19 in Shanghai area.Results:According to the frequency analysis of 240 prescriptions of Chinese medicine,194 herbs were found. The COVID-19 formula herbs were all "cold", the frequency of use in mild, moderate, severe and critical cases was [46.02%(104/226), 46.31%(1 230/2 656), 37.06%(146/394), 39.24%(31/79)]. The flavor was mainly "bitter" and the frequency of use in 4 types of disease were [36.53%(122/332), 37.33%(1 445/3 857), 35.96%(205/564), 33.62%(39/113)]. Scutellaria was the most frequently used TCM of "bitter and cold". The drugs used were mainly lung,stomach and spleen meridians. By comparing the formulas between mild and moderate cases,herb combinations with the highest frequency were all "scutellaria glycyrrhiza" and "tangerine glycyrrhiza". The formulas for 19 mild cases were collected,and 197 drug combinations were counted, and 125 Chinese medicine association rules,including 13 Chinese herbs. The formulas were extracted in 199 moderate cases of COVID-19, a total of 92 drug combinations and 38 Chinese medicine association rules were collected,including 19 Chinese herbs. In 16 severe cases, a total of 62 drug combination models and 46 Chinese medicine association rules were collected,including 17 Chinese herbs. For the 6 critical cases,80 Chinese medicine prescriptions were combined,and 10 Chinese medicine association rules, including 12 Chinese herbs.Conclusions:The herbal prescriptions of COVID-19 in Shanghai are characterized by clearing away heat and resolving dampness. By analyzing prescription rules with complex system entropy clustering, association compatibility ideas of different types of traditional Chinese medicine are found to be different among four types of COVID-19 cases. Analyzing the connection rules in formulas, by using the theory of TCM and pharmacology of traditional Chinese medical formula in different COVID-19 patients may be helpful for general practitioners.

Objective To investigate the molecular genetic changes of anaplastic lymphoma kinase (ALK) gene and c-myc gene in anaplastic large cell lymphoma (ALCL). Methods The structural aberrations and changes of copy numbers in ALK and c-myc genes in 72 paraffin-embedded ALCL specimens were detected by interphase fluorescence in situ hybridization (FISH). Results Among 72 ALCL specimens, ALK protein was expressed in 42, ALK gene translocation was detected in 40 specimens in which extra copies of ALK gene were detected in 17. ALK gene translocation was not found in all 30 ALK negative specimens, but extra copies of ALK gene were detected in 14 cases. The difference of incidence rates of extra copies in ALK gene between ALK positive and ALK negative specimens was not significant (P＞0.05). c-myc gene translocation was not found in any of 72 ALCL specimens, but extra copies were detected in 24 cases.Conclusion Most (75.0%) ALCL have ALK gene aberration, in which ALK gene translocations are most common (55.6%), and the extra copies of ALK gene are relatively common genetic changes (43.1%). The ALK gene aberration is only detected in ALK positive ALCL and the gene translocations are in either ALK positive and negative ALCL. There is no or rare c-myc gene translocation in ALCL, but extra copies of c-myc gene are relatively common (33.3%).

Objective To estimate heart function among patients with diabetic foot ulcer,and to investigate the characteristics of heart failure(HF) before and after treatment of ulcer. Methods Items associated with diabetes and some physiological and biochemical indicators were observed in patients with diabetic foot ulcer(162 cases) and with high risk factors of ulcer(75 cases). Heart function was evaluated at patients′ admission, during ulcer related treatment, and prior to discharge. Left ventricular ejection fraction and other cardiac assessment were measured with ultrasonic scan.Results During hospitalization, 23.6%(56/237) patients underwent HF with normal left ventricular ejection fraction, and it was 27.2%(44/162) in patients with foot ulcers. The prevalence of HF was 8.9%(21/237) in all patients studied on admission, and that was 10.5%(17/162) in patients with foot ulcer, more than that without foot ulcer(P＜0.01). More patients with HF were found, being 14.8%(35/237) during 2-7 days after ulcer related treatment initiated, and peak was on the 4th day. There was statistical difference among different Wagner grades(P＜0.05) about the morbidity rate of HF. All patients with HF were improved and tolerant to ulcer related treatment. Conclusion The prevalence of HF with normal left ventricular ejection fraction was relatively high in patients with diabetic foot ulcer, especially after ulcer treatment.