Objective To analyze the effects of different age groups of children and different routes of administration on the sedation effect of chloral hydrate.Methods A retrospective analysis was performed on 10 671 children who underwent MRI examination.Children sedated with chloral hydrate were selected and divided into four groups according to their age:group A(0-1 month),group B(>1 month-1 year old),group C(>1-2 years old),group D(>2-6 years old),and each group was further divided into oral administration and enema administration.The success rate of sedation in each group was recorded.Data were analyzed using SPSS 22.0 software.Results(1)The sedation success rate of chloral hydrate in group A was 82.5%,including 87.5%by oral administration and 85.1%by enema administration;(2)The sedation success rate of chloral hydrate in group B was 71.8%,including 78.5%by oral administration and 71.2%by enema administration;(3)The sedation success rate of chloral hydrate in group C was 87.7%,including 89.6%by oral administration and 82.2%by enema administration;(4)The sedation success rate of chloral hydrate in group D was 89.6%,including 89.5%by oral administration and 90.8%by enema administration.There was a difference in the sedation success rate between group B and groups A,C and D,and there was a difference in the sedation success rate between group D and groups A,B,and C.There was a difference in the sedation success rate of oral administration versus enema administration between groups B and D.The differences were statistically significant(P<0.05).Conclusion The sedation success rate of chloral hydrate is different in different age groups,the sedation success rate in the same age group is also different due to different administration methods.Therefore,it is necessary to choose the appropriate sedation strategy according to the age of children.

Objective To investigate the expression characteristics of BRAF,RAS and TERT genes in ultrasound-guided fine needle aspiration specimens and their application value in the preoperative diagnosis of thyroid nodules.Methods A retrospective analysis was performed on 537 cases of fine needle aspiration speci-mens of thyroid nodules in the Aviation General Hospital.The cell smear and liquid-based cell section prepara-tion from each specimen conducted the Papanicolaou's stain and the results were interpreted according to the Bethesda grading system.The gene mutation situation in punctured tissues was analyzed by real-time quantita-tive PCR.Results There were 65 cases (12.10％) of Bethesda class Ⅰ nodules,153 cases (28.49％) of class Ⅱ,84 cases (15.64％) of class Ⅲ,9 cases (1.68％) of class Ⅳ,73 cases (13.59％) of class Ⅴ and 153 cases (28.49％) of class Ⅵ.There were 220 cases (40.97％) of BRAF V600E mutation,21 cases (3.91％) of NRAS mutation,6 cases (1.12％) of KRAS mutation and 2 cases (0.37％) of HRAS mutation.Among them,there was BRAF V600E and KRAS co-mutation in 1 case.BRAF V600E gene mutation had the correlation with cytological diagnostic results (P<0.05),BRAF V600E mutation was more likely to occur in younger ones (P<0.05),and BRAF V600E mutation was more common in males than in females (P<0.05).KRAS mutation was more likely to occur in nodules in the left lobe of the thyroid gland (P<0.05).Conclusion BRAF V600E gene mutation is the most common among thyroid fine needle puncture specimens,and the NRAS mu-tation is in the majority for RAS gene mutations.

Objective:Platelet-derived growth factor alpha (PDGFRA) mutations are respectively rare in gastrointestinal stromal tumors (GIST). Most GIST with PDGFRA exon 18 mutations including D842V mutation are highly resistant to imatinib. The treatment of GIST harboring PDGFRA primary drug-resistant mutation is a major challenge. This article aims to investigate clinicopathologic features of GIST with PDGFRA-D842V mutation and the efficacy of comprehensive treatment, providing a reference for clinical practice. Methods:A retrospective cohort study was conducted to collect the clinicopathological and follow-up data of patients with GIST harboring PDGFRA mutation who were diagnosed and treated in the GIST Clinic of Renji Hospital from January 2005 to May 2020. According to the mutation site, the enrolled patients were divided into D842V mutation group and non-D842V mutation group. The differences of clinicopathologic characteristics between the two groups were compared. Furthermore, overall survival and prognostic factors were analyzed. Results:A total of 71 patients with PDGFRA-mutant GIST were included in this study, including 47 cases of D842V mutation (66.2%) and 24 cases of non-D842V mutation (33.8%). There were 28 male patients and 19 female patients in D842V mutation group, with a median age of 60 (36-82) years. There were 16 male patients and 8 female patients in non-D842V mutation group, with a median age of 62 (30-81) years. There were no significant differences in age, gender, primary location, surgical procedure, tumor size, mitotic count, expression of CD117 and DOG1, Ki-67 proliferation index and modified NIH grade between the two groups (all P>0.05). The positive rate of CD34 was 89.4% (42/47) and 62.5% (15/24) in the D842V mutation group and the non-D842V mutation group, respectively, with a statistically significant difference (χ 2=5.644, P=0.018). Among all the cases, 66 cases underwent R0 resection without preoperative treatment; two cases underwent emergency operation with R1 resection because of tumor rupture; 2 cases were not operated after the pathological and mutation types were confirmed by biopsy (one case received avapritinib treatment and obtain partial remission). One case was diagnosed as wild-type GIST per needle biopsy in another institute, and underwent R0 resection after preoperative imatinib treatment for 6 months. After surgery, 5 high-risk GIST patients with D842V mutation and 5 high-risk GIST patients with non-D842V mutation were treated with imatinib for more than one year. The median follow-up time was 37 (1-153) months. As of the last follow-up among the patients who received R0 resection, 4 patients with D842V mutation had relapse, of whom 1 was in the period of imatinib administration, and the 3-year relapse-free survival rate was 94.2%; none of the patients with non-D842V mutation had relapse. There was no statistically significant difference in relapse-free surivval between two groups ( P=0.233). Univariate analysis revealed that mitotic count ( P=0.002), Ki-67 proliferation index ( P<0.001) and modified NIH grade ( P=0.025) were the factors associated with relapse-free survival of patients with D842V mutation after R0 resection (all P<0.05). However, the above factros were not testified as independant prognostic facors in multivariate Cox analysis (all P<0.05). Conclusion:Clinicopathologic features and the efficacy of radical resection in patients with PDGFRA-D842V mutation are similar to those in patients with non-D842V mutation.

Objective:Platelet-derived growth factor alpha (PDGFRA) mutations are respectively rare in gastrointestinal stromal tumors (GIST). Most GIST with PDGFRA exon 18 mutations including D842V mutation are highly resistant to imatinib. The treatment of GIST harboring PDGFRA primary drug-resistant mutation is a major challenge. This article aims to investigate clinicopathologic features of GIST with PDGFRA-D842V mutation and the efficacy of comprehensive treatment, providing a reference for clinical practice. Methods:A retrospective cohort study was conducted to collect the clinicopathological and follow-up data of patients with GIST harboring PDGFRA mutation who were diagnosed and treated in the GIST Clinic of Renji Hospital from January 2005 to May 2020. According to the mutation site, the enrolled patients were divided into D842V mutation group and non-D842V mutation group. The differences of clinicopathologic characteristics between the two groups were compared. Furthermore, overall survival and prognostic factors were analyzed. Results:A total of 71 patients with PDGFRA-mutant GIST were included in this study, including 47 cases of D842V mutation (66.2%) and 24 cases of non-D842V mutation (33.8%). There were 28 male patients and 19 female patients in D842V mutation group, with a median age of 60 (36-82) years. There were 16 male patients and 8 female patients in non-D842V mutation group, with a median age of 62 (30-81) years. There were no significant differences in age, gender, primary location, surgical procedure, tumor size, mitotic count, expression of CD117 and DOG1, Ki-67 proliferation index and modified NIH grade between the two groups (all P>0.05). The positive rate of CD34 was 89.4% (42/47) and 62.5% (15/24) in the D842V mutation group and the non-D842V mutation group, respectively, with a statistically significant difference (χ 2=5.644, P=0.018). Among all the cases, 66 cases underwent R0 resection without preoperative treatment; two cases underwent emergency operation with R1 resection because of tumor rupture; 2 cases were not operated after the pathological and mutation types were confirmed by biopsy (one case received avapritinib treatment and obtain partial remission). One case was diagnosed as wild-type GIST per needle biopsy in another institute, and underwent R0 resection after preoperative imatinib treatment for 6 months. After surgery, 5 high-risk GIST patients with D842V mutation and 5 high-risk GIST patients with non-D842V mutation were treated with imatinib for more than one year. The median follow-up time was 37 (1-153) months. As of the last follow-up among the patients who received R0 resection, 4 patients with D842V mutation had relapse, of whom 1 was in the period of imatinib administration, and the 3-year relapse-free survival rate was 94.2%; none of the patients with non-D842V mutation had relapse. There was no statistically significant difference in relapse-free surivval between two groups ( P=0.233). Univariate analysis revealed that mitotic count ( P=0.002), Ki-67 proliferation index ( P<0.001) and modified NIH grade ( P=0.025) were the factors associated with relapse-free survival of patients with D842V mutation after R0 resection (all P<0.05). However, the above factros were not testified as independant prognostic facors in multivariate Cox analysis (all P<0.05). Conclusion:Clinicopathologic features and the efficacy of radical resection in patients with PDGFRA-D842V mutation are similar to those in patients with non-D842V mutation.

The pediatric reference intervals in clinical laboratory play an important role in diagnosis of illness,therapeutic monitoring,prediction of prognosis and health evaluation.Compared with establishing reference interval for adults,there are more challenges to establish pediatric reference intervals.Therefore,the procedure and key technologies of direct method and indirect method are stated based on the characteristics of children population and pediatric,by which to define,transfer and validate pediatric reference intervals.This study will provide systematically methodological ideas for clinical laboratories to establish pediatric reference intervals.

Objective To explore cost effective means for early detection of malignant tumors in individuals undergoing health check-up.Methods This was a retrospective study involving 280,477 participants who had undergone health check-up including essential items from 2012 to 2016 at the Health Assessment and Intervention Research Center of Jiangsu Province.The protocol was composed of four steps.First,essential items were decided and conducted for all health examination participants.Second,cases with a high risk of malignant tumors were collected and additional tests were specified.Third,suspected malignant tumor cases were identified and recommendations for referrals and follow-up were made.Finally,physicians in charge of follow up would urge suspected cases to visit an oncologist,update case files,give regular instructions,and track recall results.Results There were 517 microscopically confirmed cases of malignant tumors,representing a detection rate of 184/100,000(1.84‰)in individuals seeking regular health check-up and of 2,023/100,000 (20.23‰)in those receiving follow ups.The five most prevalent malignant tumors were thyroid cancer (140 cases or 0.499‰),lung cancer(120 cases or 0.428‰),breast cancer(35 cases or 0.374‰),kidney cancer(55 cases or 0.196‰)and prostate cancer (33 cases or 0.177‰).Conclusions Essential examination items in combination with subsequent special tests,specialist referrals and follow ups are a cost effective way for early detection of malignant tumors in people seeking regular health examinations.

Objective:To investigate the KRAS gene mutation features in lung and gastric cancers and their relationship with clinicopathologic characteristics. Methods:A total of 128 lung cancer and 115 gastric cancer patients were included. Polymerase chain reaction amplification and DNA sequencing were conducted to detect mutations in exon 2 of the KRAS gene. Results:The mutation frequency of KRAS was different in lung and gastric cancers;however, it did not show any statistical significance (6.3%vs. 4.3%, P>0.05). The KRAS codon 12 gene mutation ranks the first in both types of cancer. No significant correlation was observed between the prevalence of KRAS mutations and patient's age and gender. KRAS gene mutation rate was higher in lung adenocarcinoma than in non-adenocarcinoma, such as squamous cancer (10.7%vs. 0%, P<0.05). Conclusion:No correlation was found between the KRAS gene mutation and the sex and age of lung and gastric cancer patients in Jiangsu Province. The rate of KRAS mutation was low. KRAS gene mutation rate was relatively higher in lung adenocarcinoma patients;thus, the mutation status of the KRAS gene should be evaluated be-fore undergoing EGFR-TKI therapy.

Objective To explore the clinicopathological and immunohistochemical features, diagnosis and treatment,prognosis of hepatoid adenocarcinoma of the stomach with neuroendocrine tumor.AFP, Syn, CgA, Ki-67, P53 were stained by immunohistochemistry and follow-up was conducted by telephone.Methods Hepatoid adenocarcinoma of the stomach with coexisting neuroendocrine tumor was identified in 13 cases from June 2004 to June 2014 in Ren Ji Hospital.Results Among the 13 cases of hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor patients, there were 7 males and 6 females, with an median age of 62 years.Tumors located in the gastric cardia in 2 cases, in the gastric antrum in 8 cases and in the gastric body in 3 cases.Tumor ranged from 1-19 cm.The follow-up rate was 100％.The median overall survival rate was 12 months, two patients died of liver metastasis and one patient died of anastomotic recurrence.Serum AFP increased in 10 patients with hepatoid adenocarcinoma of the stomach coexisted with neuroendocrine tumor.The structure consisted of hepatoid cell differentiation and adenocarcinoma differentiation and neuroendocrine differentiation area by histological microscope examination.Immunohistochemical staining showed that tumor regional AFP, Syn, CgA, Ki-67, P53 were positive.Conclusions Hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor is very rare, it is made up of three structures : hepatoid cell differentiation, adenocarcinoma differentiation and neuroendocrine differentiation area.Diagnosis relies on immunohistochemical and histological examination.

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.

ObjectiveRetrospectively investigate the characteristics of neoplasma of health checkup participants to find ways to improve cancer detection rate.Methods A total of 186 confirmed cancer patients were enrolled in this study.Personal information,including age,gender,andlocation were collected.The contribution of clinical symptoms,physical examination and laboratory test to cancer detection was investigated.ResultsBiopsy confirmed cancers accounted for 0.133％( 186/140 127 ).Lung (0.036％ ),liver ( 0.017％ ),kidney ( 0.014％ ),colorectal ( 0.013％ ) and gastric cancer ( 0.011％ )were the most commonly found neoplasma.Detection rate of liver cancer in male was significantly higher than that in female (x2 =6.181,P＜0.05 ).Asymptomatic cancer was found in 158 adults (84.9％ ).Ultrasound showed a significantly higher sensitivity to liver,kidney and thyroid cancer than tumor biomarkers.The detection of lung cancer was improved with the combination of X ray,tumor marker( TM ),clinical symptom and low-dose chest CT scan.In 2008,the detection rate for digest system carcinoma (0.083％ ) and lung cancer (x2 =8.538,P＜0.05) was significantly increased (x2 =11.792,P＜0.05).ConclusionsHealth check-up plays an important role in early detection of cancer.The combined use of physical examination,chest X ray,ultrasound test,TM and CT may improve the detection of cancer.