Objective To evaluate effectiveness of peripheral Mohs micrographic surgery for the treatment of extramammary Paget′s disease (EMPD). Methods A total of 28 patients with EMPD were treated with peripheral Mohs micrographic surgery. The depth and extent of tumor infiltration were evaluated before the surgery. One day before the surgery, 20% aminolevulinic acid hydrochloride was topically applied to determine and label surgical margins under a Wood′s lamp. After fluorescence-based localization, peritumoral skin tissues were resected and underwent frozen-section examination according to the protocol for Mohs micrographic surgery. Meanwhile, the tumor was resected. After surgery, patients were followed up every 3 - 6 months to detect local recurrence and metastasis. Results Of the 28 patients, 25 were male and 3 were female. Six patients each underwent 3 sessions of frozen-section examination, and 12 patients each received 2 sessions, with an average of 1.86 sessions for each patient. During the follow-up for 5 - 72 months, local recurrence occurred in 3 cases, and 1 patient died of tumor metastasis and uremia after 2 years of follow-up. Conclusion Peripheral Mohs micrographic surgery is a time-saving and effective treatment for EMPD.

A low-temperature hydrocarbon-degrading strain T7-2, isolated from sea-mud of Bohai polluted area and identified as Rhodococcus erythropolis, was found to produce an extracellular, nondialyzable emul- sifying agent (referred to as bioemulsifier) when grew with hexadecane as carbon source. The results showed that, this bioemulsifier which could remarkably emulsify hydrocarbons such as diesel oil, is consisted of three parts-carbohydrates, lipids and proteins, the proportion of which was 55.43:31.24:12.65. The mono- saccharide compositions were identified as mannose and rhamnose; the lipid compositions included de- canoic acid, lauric acid, hexadecanoic acid and stearic acid, and the protein constituents were composed of sixteen amino acids. Besides, according to the study of the physic-chemical properties of the bioemulsifier, it possesses the obvious advantages of character stability, high function efficiency and wide adaptation range, therefore this bioemulsifier is believed to have extensive application values for bioremediation of marine oil pollution, petroleum exploitation and etc.

OBJECTIVETo improve the surgeon's understanding of pyoderma gangrenosum (PG) and avoid misdiagnosis and incorrect treatment.

METHODSThree cases of PG managed in the department of general surgery during the past 10 years were retrospectively reviewed.

RESULTSAll of the 3 cases mainly presented with necrosis of skin and soft tissues, followed by formation of painful and extensive creeping ulcer. They all had fever and were initially diagnosed and managed as "infection", but repeated wound exudates culture showed negative results and antimicrobial therapy was not effective. The ulcers were enlarged quickly despite of active debridement. Histopathology of ulcer biopsy suggested nonspecific inflammation. After the diagnosis of PG was established, systemic therapy with steroids and immunosuppressants were administered together with local wound care. The progress of the disease was controlled soon and fully resolved finally.

CONCLUSIONSPyoderma gangrenosum is misdiagnosed frequently. For severe patients, systemic therapy with steroids and immunosuppressants should be used as early as possible and skin lesions would heal together with mild local wound care.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Pyoderma Gangrenosum ; diagnosis ; therapy ; Retrospective Studies ; Steroids ; therapeutic use ; Treatment Outcome ; Wound Healing

BACKGROUNDLaparoscopic liver resection (LLR) has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area.

METHODSIn this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon.

RESULTSDuring nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group (4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001). Patients who underwent anatomic resection had longer operation time (364.09 ± 131.22 vs. 252.00 ± 135.21 min, P < 0.001) but less blood loss per unit area (7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm 2 , P = 0.018). Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days after the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups.

CONCLUSIONSBoth anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

Aged ; Blood Loss, Surgical ; Female ; Humans ; Laparoscopy ; methods ; Length of Stay ; Liver ; pathology ; surgery ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Prospective Studies

OBJECTIVETo investigate the relationship between the levels of antidesmoglein (DSG) 1, 3 antibodies in the sera of patients with paraneoplastic pemphigus (PNP) and alopecia.

METHODSSera from PNP patients, bullous pemphigoid patients, and normal healthy subjects were collected and 2 tissue samples from 2 healthy scalps were resected. Anti-DSG 1, 3 antibodies in the sera of PNP patients were detected by enzyme-linked immunosorbent assay (ELISA). Indirect immunofluorescent assay was used to detect whether the antibodies in the sera of PNP patients binds with the follicular epithelium of normal healthy scalp.

RESULTSAnti-DSG3 autoantibody was strongly positive and anti-DSG1 weakly positive in one patient, while both two antibodies were negative in the other patient. Their sera could bind to keratinocytes and follicular epithelium in human scalp. Immunofluorescent signals were found on the intercellular epidermal cell surface and outer root sheath of the follicular epithelium. However, the immunofluorescent signals in the section incubating with serum of bullous pemphigoid were only found on basal membrane zone. No signals were found in the section incubating with normal healthy serum.

CONCLUSIONAlopecia in PNP patients are correlated with the anti-DSG3.

Adult ; Alopecia ; etiology ; immunology ; Autoantibodies ; blood ; Desmoglein 1 ; immunology ; Desmoglein 3 ; immunology ; Female ; Humans ; Male ; Paraneoplastic Syndromes ; complications ; immunology ; Pemphigus ; complications ; immunology

Objective To evaluate the value of cardiac MR imaging in chronic ischemie mitral regurgitation (IMR) in patients with myocardial infarction. Methods All patients clinically diagnosed with coronary heart disease and myocardial infarction in our hospital from January 2016 to September 2018 were retrospectively selected, myocardial infarction time more than 3 months and confirmed to have necrotic myocardium by cardiac magnetic resonance examination. All patients underwent echocardiography at the same time. Based on the results of echocardiography, patients were divided into the myocardial infarction group without IMR (40 cases), the mild IMR group (39 cases) and the moderate to severe IMR group (51 cases). Cardiac MR and delayed enhancement (LGE) scan images were analyzed. Cardiac function indexes were measured and left ventricular LGE positive segments were recorded. The indexes of myocardial global longitudinal strain (GLS), global peripheral strain (GCS) and global radial strain (GRS) of left ventricle of IMR patients were measured by feature tracking(FT). Cardiovascular history, coronary artery stenosis and location of myocardial infarction were compared by chi?square test between the without IMR, mild IMR and moderate to severe IMR groups.Univariate analysis of variance was used to compare the measurement data of left ventricular myocardial infarction volume, left heart function and left ventricular myocardial globle strain, and LSD test was used for pair?wise comparison. Results There was no difference in age, sex and cardiovascular history among the three groups. Comparison of myocardial infarction patients in the three groups: (1) There was no statistically significant difference in the myocardial infarction volume between the three groups (P=0.052), while the myocardial infarction volume tended to increase as the grade of mitral regurgitation increased. The number of patients with myocardial infarction in the inferior wall and the inferolateral wall in the moderate to severe IMR group were significantly higher than those of the other two groups (P<0.05), and there was no significant difference in the volume of myocardial infarction between the without IMR group and mild IMR group, and no difference in the number of patients with inferior wall and inferolateral wall. (2) Cardiac function measured by CMR: ejection fraction (EF) was significantly reduced in the moderate to severe IMR group compared with the without IMR group and the mild IMR group (P<0.05), the end diastolic volume (EDV) increased significantly and the end systolic volume (ESV) increased significantly (P<0.05). Mass of myocardium increased significantly (P<0.05); Stroke volume (SV) and cardiac output (CO) there was no significant difference among the three groups. (3) Comparison of the moderate to severe IMR group to the without IMR group and the mild IMR group respectively: left ventricular GLS and GRS decreased (P<0.05), the difference of the GCS was no statistically significant. There was no statistical difference in the three strain values between the without IMR group and the mild IMR group. Conclusion The globe myocardial strain of the left ventricle in myocardial infarction patients with chronic moderate to severe IMR was significantly impaired, the myocardial infarction in the inferior wall and the inferolateral wall in the level of the papillary muscle may be correlated with chronic moderate to severe IMR, and the myocardial infarction volume of the left ventricle may also be related.

Amniotic Fluid ; metabolism ; Biomarkers ; metabolism ; Diagnosis, Differential ; Embolism, Amniotic Fluid ; metabolism ; pathology ; Female ; Humans ; Infant, Newborn ; Keratin-13 ; metabolism ; Pregnancy ; Respiratory Aspiration ; metabolism ; pathology

OBJECTIVETo study the changes of platelet in May-Hegglin anomaly (MHA) and the molecular pathogenesis mechanism.

METHODSPeripheral blood was drawn from the MHA proband, her father and her uncle. Platelet count and morphology were examined by automatic blood cell counter and microscopy, respectively. The platelet membrane protein was examined by flow cytometry. Membrane antibodies were determined by ELISA. PCR was used to amplify the exons 25, 31 approximately 32, 38 and 40 of the MYH 9 gene in the MHA patient and her diseased father. Furthermore, PCR products were sequenced, a specific point mutation was identified and inclusions (Dohle's body) in the neutrophil was detected by indirect immunofluorescence technique.

RESULTSIt was proved that in MHA patients, platelet count was higher by cell counter than by microscope (P < 0.01). Giant platelet was 94% but platelet membrane proteins (CD41, CD61, CD42A, CD42b) were in normal range. Membrane antibodies was undetectable. An A5521G mutation (GAG-->AAG) in the exon 38 was found in the proband and her diseased father, resulting in a characteristic change of NMMHC-A1841 (Glutamic acid-->Arginine), which was not found in other members of the family and in normal controls. Spindle-like inclusions with fluorescence were clearly displayed in neutrophil cytoplasm.

CONCLUSIONThe molecular pathogenesis mechanism of May-Hegglin anomaly is the mutation in MYH 9 gene.

Adult ; Base Sequence ; Blood Platelets ; metabolism ; pathology ; DNA Mutational Analysis ; Enzyme-Linked Immunosorbent Assay ; Female ; Flow Cytometry ; Granulocytes ; metabolism ; pathology ; Humans ; Inclusion Bodies ; metabolism ; pathology ; Male ; Molecular Motor Proteins ; genetics ; Mutation ; Myosin Heavy Chains ; genetics ; Pedigree ; Platelet Count ; Platelet Membrane Glycoproteins ; metabolism ; Thrombocytopenia ; blood ; genetics ; pathology

OBJECTIVE This study aimed to determine the relationship between individual allergens with current wheezing and bronchial hyperresponsiveness (BHR) in schoolchildren from three chinese cities: Beijing, Guangzhou and Hong Kong. METHODS Community-based random samples of 10-yr-old schoolchildren from the 3 cities were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. The subjects were studied by parental questionnaires (n = 10,902), skin-prick tests (n = 3478), and methacholine challenge tests (n = 608). RESULTS The highest prevalence rates of wheezing in the past 12 months (Beijing, 3.8%; Guangzhou, 3.4%; Hong Kong, 5.8%) and atopy (Beijing, 23.9%; Guangzhou, 30.8%; Hong Kong, 41.2%, defined as having Allergens ; classification ; immunology ; Asthma ; etiology ; immunology ; Bronchial Hyperreactivity ; etiology ; immunology ; Child ; China ; Hong Kong ; Humans ; Risk Factors ; Skin Tests ; Surveys and Questionnaires

OBJECTIVETo study the clinicopathologic and immunohistochemical features, biological behavior, diagnosis and treatment of solid pseudopapillary tumor of the pancreas (SPTP).

METHODSA retrospective clinical and clinicopathologic analysis was made on 33 cases of SPTP admitted from May 2001 to 2010 July. There were 7 male and 26 female patients, aging from 13 to 66 years with a mean of 34.3 years.

RESULTSThe tumor was located in pancreatic head of 10 patients, in pancreatic neck of 5 patients, in pancreatic body and tail of 18 patients. Of the 33 patients treated with surgery, 8 underwent simple resection of pancreatic tumor, 6 underwent pancreaticoduodenectomy, 3 underwent tumor resection plus pancreaticojejunostomy, 1 underwent tumor resection plus pancreaticogastrostomy, 11 underwent distal pancreatectomy, 4 underwent distal pancreatectomy plus spleen resection (1 underwent mesohepatectomy for hepatic metastasis). Sixteen of the 33 operations were completed by laparoscopy. Histologically, tumors were composed of papillary and microcystic solid structures, with uniformed population of cells. The pancreas and blood vessels invasion were identified in 3 cases, one of them was combined with liver metastasis, and they are male. Immunohistologically, the tumors were positive for α1-antitrypsin, α1-antichymotrypsin, β-catenin, CD10, CD56 and vimentin (all cases), neuron-specific enolase (3 cases), synaptophysin (6 cases), chromogranin A (4 cases), progesterone receptor (28 cases), estrogen receptor (3 cases), S-100 (6 cases). Totally 33 cases were followed up with a median period of 49 months without tumor recurrence.

CONCLUSIONSSPTP is of low graded malignancy. It primarily affects young women. It may be located in any part of pancreas. Immunohistochemistry is very important for the diagnosis and differential diagnosis of SPTP. Surgical resection is recommended as the treatment of choice. Laparoscopic distal pancreatectomy or tumor resection is feasible and safe for some selected patients, and the prognosis is good.

Adolescent ; Adult ; Aged ; Carcinoma, Papillary ; diagnosis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Young Adult