Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours(IMT)in middle-aged and elderly patients.Methods The clinical,pathologi-cal morphology,immunophenotype and follow-up results of 5 cases of intestinal IMT in middle-aged and elderly patients were retrospectively analyzed.Results 4 cases of IMT occurred in the right half colon and 1 in the ileum.Most patients(3/5)had a history of intestinal injury,starting the digestive tract symptoms and increased leukocytes.The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern,with an infiltrative growth pattern,accompanied by a large number of lymphocytes and plasma cells infiltration,collagen formation and myxedema.One case was atypically large and deformed.Immunophenotype:vimentin(5cases),SMA(5 cases),desmin(3 cases),ALK(3 cases),CK(2 cases)were positive.Caldesmon,CD34,β-catenin,MC,CD117,DOG1,S-100,BCL-2,CD99,CD68 were negative,and Ki-67 proliferation index was 1.28%to 10.01%.All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months.Among them,1 patient aged 83 was considered to have tumor recurrence 27 months after surgery.The other patient survived 122 months without tumor and died of other causes.All the others survived without tumor and were in good condition.Conclusion(1)Intestinal IMT in the middle-aged and elderly people in this group was more common in the right half colon,and most of them had a history of intestinal injury,first gastrointestinal symptoms and elevated white blood cells;(2)Vimentin and SMA were positive at the same time,and ALK was more positive;(3)4/5 patients had good surgical resection,and 1/5 patients could relapse 2～3 years after surgery;old age,ALK-positive,Ki67 up to 10%,atypia may be an important risk factor for intestinal IMT recurrence in the elderly,of which ALK-positive patients may have a recurrence risk of 1/3.

Objective:To study the clinicopathological characteristics, treatment and prognosis in lupus nephritis (LN) patients with renal thrombotic microangiopathy (TMA), so as to provide more theoretical basis for clinicians to recognize and treat this disease.Methods:The clinical data of LN patients who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from January 1, 2012 to May 31, 2019 were retrospectively collected and analyzed. According to renal clinicopathological examination, the patients were divided into renal TMA group and non-renal TMA group. The clinical data, laboratory examination, renal pathological examination, therapeutic measures and prognostic between the two groups were compared. Follow-up end points were defined as composite ends, including all-cause death, entry into end-stage renal disease, and estimated glomerular filtration rate decrease>50% of baseline. Kaplan-Meier survival curve and log-rank test were used to compare the difference of survival rate between the two groups, and multivariate Cox regression equation was used to analyze the risk factors of endpoint events in LN patients.Results:A total of 1 133 patients with LN were enrolled in this study. Patients with renal TMA were more likely to have hypertension ( χ2=16.310, P<0.001), higher baseline serum creatinine ( Z=-6.918, P<0.001) and 24-hour urine protein ( Z=-2.232, P=0.026), and higher renal pathology activity index (AI) score ( Z=1.957, P=0.001)and chronic index (CI) score ( Z=1.836, P=0.002). The proportions of hormone shock ( P<0.001) and plasma exchange ( P<0.001) in the renal TMA group were higher than those in non-renal TMA group. After treatment of (12±2) months, patients in the renal TMA group had a lower complete response rate ( χ2=10.455, P=0.001) and a higher non-response rate ( χ2=6.047, P=0.014) than those in non-renal TMA group, and were associated with worse prognosis (Log-rank test χ2=26.490, P<0.001). Renal TMA was an independent risk factor for poor prognosis ( HR=2.347, 95% CI 1.210-4.553, P=0.012). Conclusions:Compared with LN patients without renal TMA, LN patients with renal TMA are more likely to have hypertension, with higher serum creatinine, 24-hour urinary protein, AI and CI, suggesting poorer treatment response and renal prognosis. Moreover, renal TMA is an independent risk factor for poor prognosis in patients with LN.

Objective: To explore the risk factors of cytomegalovirus (CMV) infection or reactivation in ulcerative colitis (UC) patients. Methods: We performed a search at the databases of Pubmed, Cochrane, Embase, CNKI, Wanfang, SinoMede and VIP up to March 2017. A search strategy was constructed by using a combination of the following words: "inflammatory bowel disease or IBD" or "ulcerative colitis or UC" and "cytomegalovirus or CMV" . Literature was screened according to the inclusion and exclusion criteria and statistics was analyzed using RevMan 5.3 software provided by Cochrane collaboration network and analyzed using Stata 12.0 software to evaluate publication bias. Results: After searching and screening, we included 18 case-control studies finally. Meta-analysis showed that the risk of CMV infection or reactivation in severe UC was 1.45 times that in mild to moderate UC and the risk in whole colon was 1.54 times that of patients with left colon and rectum with the pooled OR values as 1.45 (1.02-2.05) and 1.54 (1.05-2.27). The risk of CMV infection in middle-aged patients with UC was higher than that in young patients with the pooled MD values of 4.60(2.13-7.07). The therapies with glucocorticoid and immunosuppressive agents such as azathioprine, cyclosporine and methotrexate were high risk factors of CMV infection or reactivation in UC patients, with the pooled OR values as 3.87 (2.70-5.53) and 2.07 (1.29-3.32), but the duration of UC, treatment with 5-Amino salicylic acid/salazosulfapyridine (5-ASA/SASP) and infliximab had no statistically significant correlation with the CMV infection or reactivation in UC patients, with the pooled OR values as -1.20 (-2.64-0.24), 0.94 (0.61-1.42) and 1.50 (0.65-3.44). Conclusions In patients with severe UC, whole colon lesions and the therapy with glucocorticoid and immunosuppressive agents were the risk factors of CMV infection or reactivation. The risk of CMV infection or reactivation in middle-aged patients was higher than that in young patients.

Background:Ulcerative colitis(UC)patients are the high risk population of cytomegalovirus(CMV)infection. CMV infection may aggravate the disease progression of UC,and the prognosis of UC patients with CMV infection may be improved by antiviral therapy. Aims:To systematically evaluate the effects of CMV infection and antiviral therapy on prognosis of UC patients. Methods:PubMed,Cochrane Library,Embase,CNKI,Wanfang,SinoMed and VIP database were retrieved to collect the case-control studies studying the effects of CMV infection and antiviral therapy on prognosis of UC patients. Meta-analysis was conducted by RevMan 5.3 software. Results:Twenty case-control studies were enrolled. Meta-analysis showed that UC patients in CMV infection group were more serious(OR=1.62,95% CI:1.13-2.33),and had larger intestinal lesions(OR=0.63,95% CI:0.43-0.92),higher risks of steroid dependence/resistance(OR=6.13, 95% CI:1.98-19.00)and colectomy(OR=1.64,95% CI:1.14-2.36). Antiviral therapy for UC patients with CMV infection significantly improved the early clinical remission rate(OR =2.08,95% CI:1.03-4.17),decreased risk of colectomy(OR=2.12,95% CI:1.06-4.22). Conclusions:CMV infection can aggravate the progress of UC,enlarge the extent of intestinal lesion,increase the risks of steriod dependence/resistance and colectomy. Antiviral therapy significantly improves the early clinical remission rate,and decreases the risk of colectomy.

Objective To evaluate of left atrial(LA) function in patients with rheumatic mitral stenosis(MS) by real time three‐dimensional echocardiography (RT‐3DE) .Methods Thirty patients with MS and 50 healthy volunteers underwent RT‐3DE . The left atrial end‐diastolic volume (LAVmax ) ,end‐systolic volume (LAVmin ) and pre‐systolic volume (LAVpre ) were measured to calculate the total ,passive and active atrial stroke volume (TASV ,PASV ,AASV) ,left atrial expansion index (LAEI) ,left atrial to‐tal ,passive ,active ejection fraction (LAEF ,LAEFpassive ,LAEFactive ) .The volume data were corrected by body surface area (BSA) to gettheleftatrialend‐diastolicvolumeindex (LAVmaxI),end‐systolicvolumeindex(LAVminI),pre‐systolicvolumeindex(LAVpreI) and the total ,passive and active atrial stroke volume index (TASVI ,PASVI ,AASVI) .The correlations between the LA volume , stroke volume ,function indices and the mitral valve area (MVA) were analyzed .Results (1)LAVmaxI ,LAVminI and LAVpreI were significantly greater in patients with MS than the controls(all P<0 .05) .(2)There was no significant difference in TASVI ,PASVI and AASVI between the two groups(all P>0 .05) .(3) LAEI ,LAEF ,LAEFpassive and LAEFactive were significantly lower in patients with MS than the controls(all P<0 .05) .(4)There was a significant correlation between the LAVmax I ,LAVmin I ,LAVpre I ,LAEF , LAEFpassive and MVA (r= -0 .432 ,-0 .421 ,-0 .440 ,0 .352 ,0 .401 ,all P<0 .05) ,there was no correlation between the TAVSI , PASVI ,AASVI ,LAEI ,LAEFactive and MVA(all P>0 .05) .Conclusion LA function in patients with mitral stenosis decreased .RT‐3DE can be used to evaluate LA function in patients with MS and sinus rhythm .

Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.

Objective To evaluate the continuation of care for colorectal cancer patients with stoma mental state and a-bility of self-care. Methods Fifty-six cases Miles patients in the observation group and 30 patients Miles patients in the control group were treated with extended care and routine care respectively, the depression, anxiety, self-care, quality of life and the incidence of complications of patients in two groups were compared after discharging for three months. Results After discharging for three months, the SDS scores and depression levels in the observation group were significantly lower than the control group(P<0.05), SAS score the of observation group were significantly lower than the control group(P<0.05), moderate and mild depression were significantly lower in the control group (P <0.05), ESCA to-tal score, skill, responsibility, self-concept and health knowledge scores of the observation group were significantly higher (P <0.05), SF-36 physical function scale, social function, emotional function, mental health, energy and overall health scores of the observation group were significantly higher (P <0.05), stoma complications in the observation group was significantly lower than the control group(P<0.05). Conclusion Extended care effectively improve colorectal cancer ostomy patients mental state, improve their self-care ability stoma, thereby improving the quality of life and reduce the incidence of stoma complications.

Library of China Academy of Traditional Chinese Medical Sciences has retained video data of the early 1980s,which were clinical experiences of the national-level experts of traditional Chinese medicine.To meet the research needs,to rescue the valuable film resources,and to expand continuing education programs,we took use of the hospital's research and LAN infrastructure,combined with multimedia technology,designed and built a “Chinese multimedia resource management platform”,in compliance with the idea of “base on Chinese medicine,focuse on clinical practice and respect for the classics.

Objective To enhance and improve the accuracy of data,security of system and user friendliness of on-line editing system processing ancient TCM books.Methods Web and java technology were applied to implement and demonstrate the key algorithm.Results In these solutions,pictures could be watermarked,on-line editing was supported,picture-naming was standardized with 7-characters,multi-user on-line editing was available,etc.The ancient TCM books on-line editing system became more practical,effective and user-friendly.Conclusion The solutions mentioned above have achieved the expected effects in digitalization research of ancient TCM books,showing its feasibility and practicability.

Objective To study the mutation of FLCN gene in Chinese patients with sporadic and familial primary spontaneous pneumothorax. Methods A complete genetic analysis of FLCN by use of SSCP-PCR was performed in 102 unrelated Chinese patients with isolated PSP. Results Three novel mutations (c. 924_926del, c. 1611_1631del and c. 1740C.T) and a previously reported mutation (c. 1733insC) were identified in five familial and five sporadic PSP patients. Of the 21 family members of patients with PSP including 3 previous considered as sporadic, 4 ( 19% ) had history of at least one episode of PSP and 9 (43% ) were FLCN mutant carriers without PSP. Seven of the nine (78% ) mutant carriers had pulmonary cysts detected by high-resolution computed tomography ( HRCT) . Although c. 924_926del and c. 1611 _1631 del were found in eight patients from the same geographic district, haplotype analysis demonstrated that they did not share the same affected haplotype,thus excluding common ancestry. Conclusion This study first demonstrates that FLCN mutation contributes to not only familial but also apparently sporadic' patients with isolated PSP. It suggests that mutation analysis and HRCT scan may be recommended for first-degree family members of PSP patients with FLCN mutations, irrespective of their family history status of PSP.