Objective To evaluate the predictive value of ABCD3-I score for early stroke risk after transient ischemic attack (TIA). Methods A total of 136 consecutive patients with TIA admitted to the Department of Neurology,the First Hospital of Shangqiu from January 2010 to December 2012 were enrolled. The clinical data,medical history and image findings of the patients were collected. The incidence of stroke was observed within 90 days. The occurrence of stroke risk after TIA were scored with the ABCD2 and ABCD3-I. Logistic regression analysis was used to analyze the impact of risk factors for early stroke after TIA. The area under the curve (AUC)of receiver operating characteristic was used to compare the predictive values of the two kinds of scores. Results Of the 136 eligible patients with TIA,19 cases (14. 0%)had cerebral infarction within 90 days after TIA. There were no death and hemorrhagic stroke. The results of multivariate regression analysis showed that the duration of TIA≥60 min (OR,1. 060,95%CI 1. 012-1. 112)was an independent risk factor for early progressing stroke after TIA (P<0. 05). In the ABCD2 scoring model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 5. 6%(4/72),18. 5%(10/54),and 50. 0%(5/10),respectively. In the ABCD3-I score model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 0,7. 1%(6/84),and 52. 0%(13/25),respectively. In the low-,moderate-,high-risk groups,there were significant differences in the incidences of stroke in 90 days between the ABCD3-I and ABCD2 scoring models (P<0.01). The AUC of ABCD3-I score (0. 839,95%CI 0. 766-0. 896)was higher than that of ABCD2 score (0.783,95%CI 0. 704-0. 849;P<0. 01). Conclusion The ABCD3-I score may effectively predict the risk of early stroke after TIA,and its accuracy is better than ABCD2 score.

Objective To explore the diagnosis and treatment of penile verrucous carcinoma,a distinctive variant of squamous cell carcinoma. Methods The clinical data of 8 patients (mean age,46 years) with penile verrucous carcinoma were analyzed retrospectively.All the tumors showed exophytic,papillary lesions,ranging from 2 to 6 cm in the greatest dimension.The tumors were located at glans in 5 patients and invaded to shafts in the other 3.The diagnosis was established by biopsy of the lesion.Three patients with tumor invading to shafts and 1 patient with large tumor at glans underwent partial penectomy, while the other 4 with the tumors localized at glans were treated by local excision. Results Histopathologic examination of the specimens confirmed tumors-free surgical margins in all the cases.The tumor cells were mostly well-differentiated.Fourteen months postoperatively,local recurrence occurred in 1 patient with local excision and partial penectomy was performed; postoperative follow-up of 9 years showed no recurrence and metastasis. During a follow-up of 4 to 13 years,the other 7 patients were disease-free.The patients with local excision of the tumors reported satisfaction of their sexual lives. Conclusions Verrucous carcinoma of penis is characterized by slow growth and a locally aggressive nature.It seldom develops metastasis to regional lymph nodes or distant areas.The prognosis is favorable after appropriate treatment.

Objective To review the diagnosis and treatment of basal cell carcinoma of the scrorum. Methods Clinical data of 7 patients with basal cell carcinoma of the scrotum were analyzed retrospectively. The mean age of the patients was 66 years. The most common presenting symptom was a plaque or nodular lesion with pruritis on the scrotum. The lesions ranged from 1.5 cm to 4.5 cm in diameter. Five of the 7 patients had a history of misdiagnosis. The diagnosis was established by biopsy of the lesion in all the patients. All of the 7 patients had no distant metastasis at the time of diagnosis and were treated by wide surgical resection.Results Histopathologic examination of the specimens confirmed the negative surgical margins in all cases.The most common histological feature was lobules, columns, bands and cords of basaloid cells associated with a surrounding loose fibromucinous stroma.One patient developed left inguinal lymph node metastasis at 21 months postoperatively,and was treated by bilateral inguinal lymph node dissection.The patient was free of cancer for 36 months after that. Another patient developed lung metastasis 48 months after the first operation.He was treated by systemic chemotherapy with cyclophosph amide, epirubicin and cisplatin for 6 cycles and obtained complete remission.This patient was free of cancer for 13 months after the chemotherapy.The remaining 5 patients were all free of cancer after the operation. Conclusions Basal cell carcinoma of the scrotum is rare.Wide surgical resection alone is usually considered to be curative. Because of its potential of metastasis, long-term followup is indicated for this disease.

Objective:To explore the effect of aspirin resistance(AR)on the recurrence of cerebral infarction and to analyze risk factors related to the development of AR in such patients.Methods:A retrospective study was conducted to analyze the data of 202 cerebral infarction patients admitted to Shangqiu First People's Hospital between January 2020 and January 2022.All patients were given continuous treatment in accordance with their conditions for more than one week.The AR status of the patients was examined by the turbidimetric platelet aggregation test.Based on AR status, 202 patients were divided into an AR group(63)and an aspirin-sensitive(AS)group(139).General data of the two groups were compared concerning sex, age, hypertension, diabetes, coronary heart disease, hyperlipidemia, smoking, drinking, atrial fibrillation, AR, triglycerides, total cholesterol(TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, homocysteine, compliance with antiplatelet drug therapy, and oxidized low-density lipoprotein(ox-LDL), among others.Parameters showing statistical significance in the comparison were further examined in multivariate logistic regression analysis to identify independent risk factors for the occurrence of AR in patients with cerebral infarction.The 2-year recurrence rates between the two groups were compared.Results:There were statistically significance differences in cerebral infarction recurrence, TC and ox-LDL between patients in the AR group and in the AS group( P<0.05).Subsequent multivariate logistic regression analysis showed that cerebral infarction recurrence( OR=15.410, 95% CI: 5.504-43.146, P<0.001)and TC( OR=0.454, 95% CI: 0.313-0.660, P<0.001)were independent risk factors affecting AR in patients with cerebral infarction.The 2-year recurrence rate in the AR group(11.11% or 7/63)was significantly higher than in the AS group(3.60% or 5/139)( P<0.05). Conclusions:Cerebral infarction recurrence and TC are independent risk factors for AR in patients with cerebral infarction, and AR will further increase the risk of cerebral infarction recurrence.Therefore, monitoring the presence of AR in patients has practical value in preventing cerebral infarction recurrence.

Objective To investigate the influence factors of re-occlusion after intravenous thrombol-ysis of alteplase in patients with cerebral infarction and the therapeutic effect of tirofiban.Methods A total of 100 patients with cerebral infarction were selected as the study objects.The patients were di-vided into occlusion group(n=42)and non-occlusion group(n=58)according to whether re-occlu-sion after intravenous thrombolysis with alteplase.The occlusion group was given tirofiban treatment.General data were compared between two groups.Logistic regression model was used to analyze the in-fluencing factors of re-occlusion after alteplase intravenous thrombolysis in patients with cerebral infarc-tion.The total effective rate,recombinant human tissue plasminogen activator(rPA),plasminogen acti-vator inhibitor-1(PAI-1)levels and the score of National Institutes of Health Stroke Scale(NIHSS)and Simple Mental State Scale(MMSE)in the occlusion group were observed.Results There were statistically significant differences in type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score and onset-thrombolysis time between the two groups(P＜0.05).Logistic regression a-nalysis showed that type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score,and onset-thrombolytic time were the influential factors of re-occlusion after intravenous thrombolytic alte-plase in cerebral infarction patients(P＜0.05).The total effective rate was 88.10％(37/42)in 42 pa-tients with re-occlusion after thrombolytic therapy.After 3 and 7 days of treatment,rPA was significantly higher than before treatment,PAI-1 was significantly lower than before treatment(P＜0.05);after 1 week,2 and 4 weeks of treatment,MMSE score was significantly higher than before treatment,NIHSS score was significantly lower than before treatment(P＜0.05).Conclusion Type 2 diabe-tes mellitus,blood glucose,systolic blood pressure,NIHSS score,and time of onset and thrombolyt-ic therapy may affect the re-occlusion of patients with cerebral infarction after alteplase intravenous thrombolytic therapy.The effect of tirofiban after re-occlusion is better,which is beneficial to im-prove the neurological function,rPA and PAI-1 levels of patients.

Objective To investigate the influence factors of re-occlusion after intravenous thrombol-ysis of alteplase in patients with cerebral infarction and the therapeutic effect of tirofiban.Methods A total of 100 patients with cerebral infarction were selected as the study objects.The patients were di-vided into occlusion group(n=42)and non-occlusion group(n=58)according to whether re-occlu-sion after intravenous thrombolysis with alteplase.The occlusion group was given tirofiban treatment.General data were compared between two groups.Logistic regression model was used to analyze the in-fluencing factors of re-occlusion after alteplase intravenous thrombolysis in patients with cerebral infarc-tion.The total effective rate,recombinant human tissue plasminogen activator(rPA),plasminogen acti-vator inhibitor-1(PAI-1)levels and the score of National Institutes of Health Stroke Scale(NIHSS)and Simple Mental State Scale(MMSE)in the occlusion group were observed.Results There were statistically significant differences in type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score and onset-thrombolysis time between the two groups(P＜0.05).Logistic regression a-nalysis showed that type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score,and onset-thrombolytic time were the influential factors of re-occlusion after intravenous thrombolytic alte-plase in cerebral infarction patients(P＜0.05).The total effective rate was 88.10％(37/42)in 42 pa-tients with re-occlusion after thrombolytic therapy.After 3 and 7 days of treatment,rPA was significantly higher than before treatment,PAI-1 was significantly lower than before treatment(P＜0.05);after 1 week,2 and 4 weeks of treatment,MMSE score was significantly higher than before treatment,NIHSS score was significantly lower than before treatment(P＜0.05).Conclusion Type 2 diabe-tes mellitus,blood glucose,systolic blood pressure,NIHSS score,and time of onset and thrombolyt-ic therapy may affect the re-occlusion of patients with cerebral infarction after alteplase intravenous thrombolytic therapy.The effect of tirofiban after re-occlusion is better,which is beneficial to im-prove the neurological function,rPA and PAI-1 levels of patients.

OBJECTIVETo study the clinicopathologic features, differential diagnosis and prognosis of proliferative nodules(PNs) in congenital melanocytic nevi(CMN).

METHODSHistopathologic evaluation and immunohistochemical study by EnVision method were carried out in 8 cases of PNs in CMN. The clinical information and follow-up data were analyzed.

RESULTSThe age of patients ranged from 1 to 54 years (mean 27.6 years). Tumors were located on face (3 cases), on back (2 cases), upper extremities (2 cases) and lower extremities(1 case). Microscopically, PNs with expansile growth were observed in 8 cases of CMN. Melanocytes in PNs show variable pleomorphism with a mitotic activity of 0 to 4 per 10 high power fields. Blending of cells with adjacent CMN was noted in 6 cases. According to the morphology of melanocytes in PNs, it was classified into different types including large oval melanocytes (4 cases), small melanocytes (2 cases) and Spitz-nevus-like forms (2 cases). Immunohistochemically, melanocytes in PNs were consistent with those in adjacent CMN. They were diffusely positive for S-100 protein, but were either negative or focally positive for HMB45. Less than 5% of melanocytes were positive for Ki-67 in 8 cases of PN. Follow-up was available in all cases, ranging from 9 to 82 months. Seven patients with excision of single PN in CMN were alive with no evidence of disease, while 1 patient with multiple PNs in CMN was stable with disease after 62 months follow-up.

CONCLUSIONSPN is a rare melanocytic lesion arising in CMN. Recognition of its specific histologic features can help to avoid being misdiagnosed as melanoma. Long term follow-up should be recommended in patients with PNs, especially in those with atypical histologic features. Further investigation is needed to elucidate its clinical behavior.

Adolescent ; Adult ; Back ; Child ; Child, Preschool ; Diagnosis, Differential ; Extremities ; Facial Neoplasms ; pathology ; Female ; Humans ; Infant ; Male ; Melanocytes ; pathology ; Middle Aged ; Nevus, Pigmented ; pathology ; Prognosis ; Skin Neoplasms ; pathology

OBJECTIVETo investigate the impact of androgen receptor splice variant 7 (AR-V7) expression on overall survival for patients with metastatic prostate cancer.

METHODSThe data of 113 diagnosed metastatic prostate cancer patients from January 2002 to June 2010 were collected retrospectively, including patient's age at diagnosis, prostate-specific antigen (PSA) level at diagnosis,Gleason score, clinical stage, PSA nadir during hormonal therapy, the time to PSA nadir, vital status, survival time and cause of death. The expression of AR-V7 in prostate cancer tissue was detected by using immunohistochemical staining. The correlation of AR-V7 expression and patient clinicopathological characteristics in all patients were analysed using Student t-test or Chi-square test. Cox proportional hazards regression models were used to evaluate the predictive role of AR-V7 expression and patient characteristics for overall survival.

RESULTSThe median PSA nadir was 0.7 µg/L (ranged from 0.0 to 143.0 µg/L). The median time to PSA nadir was 8.1 months (ranged from 0.9 to 71.0 months). The follow-up was performed until March 12, 2014. During the follow-up period, 67 of 113 metastatic prostate cancer patients (59.3%) died and the median overall survival was 96 months (ranged from 5 to 135 months). The AR-V7 detection rate was 20.4% (23/113). The serum PSA level in patients with positively expression of AR-V7 was significantly higher than that without AR-V7 expression (t = 2.521, P = 0.013). Multivariate Cox regression analysis indicated that the expression of AR-V7 (HR = 2.421, P = 0.002) and time to PSA nadir (HR = 1.019, P = 0.022) were independent prognostic factors of overall survival for metastatic prostate cancer patients.

CONCLUSIONSThe expression of AR-V7 in prostate cancer tissues and time to PSA nadir during hormonal therapy are independent prognostic factors of overall survival for metastatic prostate cancer patients. Therapy targeting AR-V7 may improve prognosis of metastatic prostate cancer patients.

Adult ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; metabolism ; pathology ; Protein Isoforms ; metabolism ; Receptors, Androgen ; metabolism ; Retrospective Studies

Objective:To investigate the correlation and predictive value of serum miR-149-5p and matrix metalloproteinase-9 (MMP-9) and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolytic therapy in Shangqiu First People's Hospital from September 2019 to February 2022 were enrolled prospectively. They were divided into HT group and non-HT group according to whether HT occurred after intravenous thrombolysis. Serum miR-149-5p and MMP-9 were measured by real-time fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay respectively. Multivariate logistic regression analysis was used to determine the independent risk factors for HT after thrombolysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum miR-149-5p, MMP-9 and their combination for HT after intravenous thrombolysis. Results:A total of 358 patients with AIS received intravenous thrombolytic therapy were enrolled, 71 of them (19.83%) developed HT. The serum MMP-9 in the HT group was significantly higher than that in the non-HT group (273.95±35.23 μg/L vs. 202.71±30.52 μg/L; t=17.062, P<0.001), while the serum miR-149-5p was significantly lower than that in the non-HT group (0.26±0.06 vs. 1.03±0.15; t=42.387, P<0.001). Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [ OR] 2.282, 95% confidence interval [ CI] 1.731-3.008; P<0.001), time from onset to intravenous thrombolysis ( OR 2.334, 95% CI 1.458-3.735; P<0.001), miR-149-5p ( OR 1.758, 95% CI 1.142-2.705; P=0.010) and MMP-9 ( OR 1.535, 95% CI 1.106-2.129; P=0.010) were the independent risk factors for HT after intravenous thrombolysis. Serum miR-149-5p (area under the curve 0.856, 95% CI 0.803-0.909; when the optimal cut-off value was 0.741, the sensitivity was 80.3% and the specificity was 89.9%), MMP-9 (area under the curve 0.875, 95% CI 0.821-0.929; when the optimal cut-off value was 240.051 μg/L, the sensitivity was 83.1% and the specificity was 90.2%) and their combination (area under the curve 0.897, 95% CI 0.854-0.941; sensitivity 84.5% and specificity 90.6%) had better predictive value for HT after thrombolysis, and there were no significant differences in the predictive value among the three. Conclusions:After intravenous thrombolysis, the serum miR-149-5p is lower and MMP-9 is higher at admission in patients with HT in patients with AIS. Both of them and their combination have better predictive value for HT after intravenous thrombolysis.

Objective To study the clinicopathologic features , differential diagnosis and prognosis of proliferative nodules ( PNs) in congenital melanocytic nevi ( CMN).Methods Histopathologic evaluation and immunohistochemical study by EnVision method were carried out in 8 cases of PNs in CMN.The clinical information and follow-up data were analyzed.Results The age of patients ranged from 1 to 54 years ( mean 27.6 years).Tumors were located on face (3 cases), on back (2 cases), upper extremities (2 cases) and lower extremities(1 case).Microscopically, PNs with expansile growth were observed in 8 cases of CMN.Melanocytes in PNs show variable pleomorphism with a mitotic activity of 0 to 4 per 10 high power fields.Blending of cells with adjacent CMN was noted in 6 cases.According to the morphology of melanocytes in PNs, it was classified into different types including large oval melanocytes ( 4 cases ) , small melanocytes (2 cases) and Spitz-nevus-like forms ( 2 cases ).Immunohistochemically , melanocytes in PNs were consistent with those in adjacent CMN.They were diffusely positive for S-100 protein, but were either negative or focally positive for HMB45.Less than 5% of melanocytes were positive for Ki-67 in 8 cases of PN.Follow-up was available in all cases , ranging from 9 to 82 months.Seven patients with excision of single PN in CMN were alive with no evidence of disease , while 1 patient with multiple PNs in CMN was stable with disease after 62 months follow-up.Conclusions PN is a rare melanocytic lesion arising in CMN.Recognition of its specific histologic features can help to avoid being misdiagnosed as melanoma .Long term follow-up should be recommended in patients with PNs , especially in those with atypical histologic features.Further investigation is needed to elucidate its clinical behavior.