Objective:To investigate the clinicopathological features, classification, and genetic characteristics of common lymphatic malformation (CLM) in superficial soft tissue.Methods:A retrospective study of 110 patients with the diagnosis of CLM at the Henan Province People′s Hospital, China from August 2019 to August 2022 was performed. The clinicopathological features, relevant immunohistochemical (IHC) staining results, and fluorescence quantitative PCR of PIK3CA mutation were analyzed, and patients were followed up.Results:Among the 110 CLM patients, there were 53 males and 57 females; 65 cases (65/110, 59.1%) were first detected when the patients were≤2 years old. The most common location was the head and neck in 41 cases (41/110, 37.3%). Clinically, 102 cases (102/110, 92.7%) were solitary, 83 cases (83/110, 75.5%) were skin-colored, 69 cases (69/110, 62.7%) had indistinct borders, and 10 cases (10/110, 9.1%) had diffuse and severe macroscopic manifestations. There were 52 macrocystic type (52/110, 47.3%), 23 microcystic type (23/110, 20.9%), and 35 combined type (35/110, 31.8%). The macrocystic CLM presented as soft, translucent masses with large cystic cavities on the cut surface, and histologically they were composed of large, irregularly dilated channels that were thicker with irregular smooth muscle and lymphocytic infiltration. Microcystic CLM showed wartlike projections or translucent blisters on the skin, with small honeycomb structures on the cut surface, and histologically consisted of round or angular dilated small lymphatic vessels with little or no smooth muscle. The combined CLM had both macrocystic and microcystic morphologies. IHC staining showed that the lymphatic endothelial cells were positive for LYVE-1, D2-40, PROX1, CD31, and VEGFR3 but negative for CD34; in the macrocystic and combined CLM vessel walls were positive for SMA. Eight of 13 CLM had PIK3CA mutation. All patients were followed up, and 24 (24/110, 21.8%) had relapses, which more frequently occurred in combined type, followed by microcystic type.Conclusions:CLM is a congenital vascular malformation composed of dilated, abnormal lymphatic channels, with PIK3CA mutation. There are significant differences in clinicopathological characteristics among the different types. Since microcystic and combined CLM are prone to recurrence, accurate pathological subtyping is necessary to guide treatment and to predict prognosis.

Objective To investigate the effect of esketamine on postoperative anxiety and cognitive function in gynecological malignant tumor patients with preoperative anxiety and cognitive decline.Methods Eighty-nine patients were selected for resection of gynecological malignant tumors,aged 18-64 years,BMI 18-28 kg/m2,ASA physical status Ⅱ or Ⅲ,the hospital anxiety and depression scale(HADS)anxiety subscale score≥8 points and montreal cognitive rating scale(MoCA)＜26 points 1 day before surgery.The patients were divided into two groups using the random number table method:the esket-amine group(group S,n = 45)and the normal saline group(group C,n = 44).In group S,esketamine 0.2 mg/kg was injected intravenously during anesthesia induction,0.25 mg·kg-1·h-1 was injected by pump during anesthesia maintenance,and esketamine 100 mg was used in the postoperative analgesic pump.Group C was given the same volume of normal saline during anesthesia induction,maintenance and PCIA analgesia,and other medications were the same as those in group S.HADS and MoCA were used to evaluate patients'anxiety and cognitive function 1 day before surgery and the 1 day and 3 days after surgery.The con-centration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),S100 calcium-binding protein(S100β),and brain-derived neurotrophic factor(BDNF)were detected 1 day before surgery and 3 days af-ter surgery.The intraoperative dosage of remifentanil,ephedrine use rate,Ramsay sedation score 10 minutes after admission to PACU,extubation time,the number of total and effective compressions of PCIA within 48 hours after surgery,postoperative remedial analgesia,and the occurrence of adverse reactions,such as hy-pertension,hypotension,nausea and vomiting,chill,dizziness,and fever within 48 hours after surgerywere recorded.Results Compared with group C,the incidence of anxiety were significantly reduced and MoCA cognitive score were increased 1 day and 3 days after surgery,the concentrations of TNF-α,IL-6,and S100β were significantly reduced,the concentration of BDNF was significantly increased,the dosage of remifentanil was significantly reduced,the sedation score of Ramsay was significantly increased,the number of total compressions and effective compressions of PCIA within 48 hours after surgery was significantly re-duced,and postoperative fever was significantly reduced in group S(P＜0.05).There were no statistically significant differences in ephedrine use rate,extubation time,postoperative remedial analgesia rate,the in-cidence of other adverse reactions,such as hypertension,hypotension,nausea and vomiting,chills and diz-ziness within 48 hours after surgery between the two groups.Conclusion Esketamine can decrease the con-centrations of inflammatory factors and reduce nerve damage,help relieve anxiety and cognitive function of patients with gynecological malignant tumors.

Objective:To investigate the clinicopathological features and genevariation of sporadic arteriovenous malformation (AVM) in soft tissue.Methods:Eighty cases of soft tissue sporadic AVM diagnosed in Henan Provincial People′s Hospital from January 2017 to March 2022, were retrospectively collected. The relevant indicators were detected by immunohistochemistry and fluorescent quantitative PCR, and the relevant literature was reviewed.Results:There were 42 males and 38 females patients, aged from 4 to 71 years, with a mean age of 26 years.The sites of the disease included head and neck (34 cases), limbs (24 upper limbs, 17 lower limbs) and trunk (5 cases). The main clinical manifestations were characteristic pulsation, tremor, temperature rise, local pain, ulcer or repeated bleeding, and heart failure in severe cases due to long-term hemodynamic abnormalities.Color Doppler ultrasound (CDFI) can detect the high flow characteristics of AVM.Multiple cavitary vascular shadows were seen on MRI. Microscopically, the pathological tissue involved the skin appendages, deep fat and muscle tissue, in which abnormal vascular proliferation was seen, mostly scattered, the lumen was irregularly expanded, the wall thickness was different, but most of them were thick, the vascular wall was glassy and myxoid, inflammatory cell infiltration, bleeding, thrombosis and organization were visible, and calcification was rare.Clustered proliferative muscular small vessels were found around the abnormal blood vessels.No vascular endothelial cell proliferation was found in the blood vessels of the lesion. Immunohistochemistry showed that vascular endothelial cells expressed CD31, CD34 and ERG, and muscle fibers and smooth muscle tissues in the wall expressed SMA.Elastic fiber staining showed incomplete elastic layer in the wall of the malformed artery.PIK3CA gene was detected in 15 cases, and 1 case (1/15) had mutation (mutation rate 6.7%). All cases underwent surgical resection, 73 cases were followed up for 3 months to 5 years, and 15 cases recurred.Conclusions:Sporadic AVM in soft tissue is a typical lesion of vascular malformation with high flow velocity. There are abnormal arteries and clusters of proliferating small vessels.Because of the significant difference in clinical manifestation, treatment and prognosis, pathological diagnosis should be distinguished from congenital hemangioma, intramuscular hemangioma capillary type, PTEN soft tissue hamartoma and common venous malformation.Very few cases may involve PIK3CA gene mutation, suggesting that there may be abnormal PI3K signal pathway in AVM and may participate in the occurrence and development of the disease. AVM has a high recurrence rate and needs long-term follow-up.

Major depressive disorder (MDD) is a highly heterogeneous mental disorder, and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease. Studies have shown that abnormal functions of the visual cortex have been reported in MDD patients, and the actions of several antidepressants coincide with improvements in the structure and synaptic functions of the visual cortex. In this review, we critically evaluate current evidence showing the involvement of the malfunctioning visual cortex in the pathophysiology and therapeutic process of depression. In addition, we discuss the molecular mechanisms of visual cortex dysfunction that may underlie the pathogenesis of MDD. Although the precise roles of visual cortex abnormalities in MDD remain uncertain, this undervalued brain region may become a novel area for the treatment of depressed patients.
Humans ; Depressive Disorder, Major/pathology* ; Brain/pathology* ; Antidepressive Agents/therapeutic use* ; Visual Cortex/pathology*

Objective:To investigate the risk factors of thrombocytopenia in elderly patients with sepsis-associated acute kidney injury(SA-AKI), and to further evaluate whether the degree of thrombocytopenia is related to the increased risk of death on day 28.Methods:Elderly patients with SA-AKI admitted to ICU of our hospital from June 2017 to June 2020 were selected.The patients were divided into normal platelet group(56 cases)and thrombocytopenia group(72 cases)according to the platelet(PLT)count, and according to the degree of thrombocytopenia, they were further divided into three groups: PLT<20×10 9/L(group A, 22 cases), 20×10 9/L≤ PLT<50×10 9/L(group B, 27 cases), 50×10 9/L≤ PLT<100×10 9/L(group C, 23 cases).The general data, clinical baseline indicators and prognostic indicators of each group were compared to evaluate the risk factors of thrombocytopenia.At the same time, the impact of platelet count on the prognosis of elderly patients with SA-AKI was evaluated according to the length of stay in ICU, total length of stay and whether the patient died, and the correlation between the degree of thrombocytopenia and survival was analyzed. Results:A total of 128 elderly patients with SA-AKI were enrolled, including 73 males and 55 females.59.4 % of the patients were hospitalized in the department of internal medicine.The APACHEⅡ score was(15.5 ± 3.3)points, invasive mechanical ventilation accounted for 78.9%, positive inotropic therapy accounted for 12.8%, and 56 patients had normal platelet count.Thrombocytopenia occurred in 72 patients, including 22 patients with PLT<20×10 9/L, 27 patients with platelet count in 20-50×10 9/L, and 23 patients with platelet count in 50-100×10 9/L.There were significant differences in bloodstream infection, Gram-negative bacteria, APACHEⅡ score and procalcitonin(PCT)among the four groups( P<0.05).Further multivariate logistic regression showed that PCT was an independent risk factor for thrombocytopenia in elderly patients with SA-AKI( OR=1.05, 95% CI: 1.00-1.10, P=0.042).Compared with the normal platelet group, the 28-day mortality rate of the thrombocytopenia group was significantly higher than that of the normal platelet group, while the length of stay in ICU and the total length of stay were prolonged( P<0.05).Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of thrombocytopenia group was lower than that of normal platelet group, and the risk of death increased with the degree of thrombocytopenia( χ2=31.479, P<0.001).Univariate Cox regression analysis showed that thrombocytopenia, bloodstream infection, APACHEⅡ score and PCT were risk factors for 28-day death in elderly patients with SA-AKI.Multivariate Cox analysis showed that bloodstream infection and APACHEⅡ score were independent risk factors for 28-day death.After adjusting these confounding factors, thrombocytopenia was an independent risk factor for death, and the degree of thrombocytopenia was related to the increased risk of death. Conclusions:Thrombocytopenia is common in elderly patients with SA-AKI, and elevated PCT levels increase the risk of thrombocytopenia.The degree of thrombocytopenia is an independent risk factor for 28-day mortality in such patients.

Objective:To analyze the changes in the epidemiological characteristics of scarlet fever cases in Shanghai City before and after the outbreak of coronavirus disease 2019 (COVID-19), and to provide a reference for scientific prevention and control of scarlet fever.Methods:The information of scarlet fever reported cases in Shanghai City from January 2016 to June 2021 in the information system of Chinese Disease Prevention and Control was collected, and the differences in time trend, regional distribution, age and gender distribution of cases before and after the outbreak of COVID-19 in Shanghai City were analyzed by descriptive epidemiologic method.Results:The incidence rate of scarlet fever reported in 2016-2019 was (0.22-4.02)/100 000 in each month, with a median of 1.13/100 000. During January 2020 (the outbreak began in Shanghai City) and June 2021, the incidence rate of scarlet fever was (0.01-1.64)/100 000, with a median of 0.14/100 000, which was 12.39% of that before the outbreak of COVID-19. During February and June 2020, the monthly reported incidence rate of scarlet fever was (0.18-0.58)/100 000, showing an upward trend compared with the same period in 2020 ((0.01-0.05)/100 000). From 2016 to 2019, the annual reported incidence rate of each district was (0.55-65.48)/100 000, with a median of 9.57/100 000; while in 2020, the annual reported incidence rate of each district was (0.29-9.85)/100 000, with a median of 2.18/100 000, which was 22.78% of that before the outbreak of COVID-19. The incidence of scarlet fever dropped significantly. The incidence rate in Minhang District was still the highest. The cases were mainly four to eight years old, and there was no substantial difference of the proportions before and after COVID-19 pandemic, with the incidence rate of six years old group the highest. The proportion of male was more than female in reported case, while the male ratio in reported cases was not significantly different before and after COVID-19 pandemic.Conclusions:The incidence rate of scarlet fever in Shanghai City has dropped sharply after COVID-19 pandemic. The main epidemiological characteristics of the regional and population distribution of cases remain unchanged.

Objective:To explore the effect of Orem self-care model combined with supportive nursing intervention on quality of life of gynecological tumor patients.Methods:A total of 110 gynecological tumor patients who were admitted to Yongkang Maternal and Child Health Hospital were selected from February 2018 to February 2019. According to the random number table method, they were divided into the observation group and the control group, with 55 cases in each group. The control group was given supportive nursing intervention, while the observation group was given Orem self-care model combined with supportive nursing intervention based on the control group. The scores of Exercise of Self-Care Agency Scale (ESCA) , Self-rating Anxiety Scale (SAS) , Self-rating Depression Scale (SDS) and Medical Outcomes Study (SF-36) were compared between the two groups before the intervention and after the intervention.Results:After intervention, the ESCA score of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . The SAS and SDS scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The SF-36 score of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The Orem self-care model combined with supportive nursing intervention is beneficial to improve the self-care ability and quality of life of gynecological tumor patients, improve their anxiety and depression and improve their satisfaction with nursing staff.

Objective:To investigate the role of DDX3 up-regulation in the proliferation of human cervical cancer cells and its correlation with clinical prognosis.Methods:Expression levels of DDX3 in the 59 specimens of cervical cancer and adjacent non-neoplastic tissue collected at Henan Provincial People′s Hospital from April 2012 to March 2013 were detected using immunohistochemistry. A lentivirus-mediated DDX3-over-expression cell line was constructed based on HeLa cells of cervical cancer. CCK-8 assay was used to evaluate cell survival rate. Boyden chamber was used to measure the cell migration and invasion. Real-time fluorescence quantitative PCR was used to detect DDX3 expression level and Western blot was used to detect the expression of EMT and PI3K/Akt signal pathway-related proteins. Results:DDX3 overexpression was associated with FIGO stage, depth of cervical invasion and lymph node metastasis ( P<0.05). Kaplan-Meier analysis revealed that cervical cancer patients with high expression of DDX3 had a poor overall survival ( P<0.05). Compared with the cells transfected with pLVX-Con vector, the expression of DDX3 protein and mRNA was significantly increased in the cells transfected with pLVX-DDX3 (all P<0.01). Cell proliferation was significantly increased following transfection with pLVX-DDX3 for 72 h in HeLa cells compared with that transfected with pLVX-Con ( P<0.05). Compared with the controls, DDX3 overexpression significantly promoted the migration and invasion of HeLa cells ( P<0.05), and increased the expression of N-Cadherin, vimentin and Snail in HeLa cells ( P<0.05). In pLVX-DDX3 group, the expression levels of β-catenin, phosphorylated Akt, and pAkt′s downstream target p-GSK3β were significantly higher than those of pLVX-Con group ( P<0.05). The expression levels of p-Akt, p-GSK3β and β-catenin were decreased when the PI3K/Akt pathway was blocked using the PI3K inhibitor LY294002 ( P<0.05), and the expression levels of N-Cadherin, vimentin and Snail were also significantly decreased ( P<0.05). Conclusions:DDX3 overexpression promotes proliferation, migration and invasion of cervical cancer cells, and induces epithelial-mesenchymal transition (EMT). Its mechanism may be related to activation of the PI3K/Akt signaling pathway.

Objective To investigate the relation between the characteristics of CD8+T lymphocyte infiltration and the prognosis of triple-negative breast cancer patients. Methods We retrospectively analyzed the clinicopathological data of 126 patients with triple-negative breast cancer undergoing preoperative neoadjuvant chemotherapy. Immunohistochemical staining was used to analyze the relation between CD8+T lymphocyte infiltration and clinicopathological characteristics. Kaplan-Meier method was used to draw the survival curve, and Cox risk ratio regression model was used to analyze the prognostic factors affecting disease-free survival time (DFS). Results High-density CD8+Tils was associated with age < 60 years old, high pathological grade and high clinical stage (P < 0.05). The pCR rate of high-density CD8+Tils group was higher than that of the low-density group (66.7% vs. 19.8%, P=0.000). The median DFS of the high-density group was significantly longer than that of the low-density group (49 vs. 25 months, P < 0.05). Multivariate analysis showed that high pathological grade, tumor diameter > 2 cm, lymph node metastasis, vascular invasion and CD8+Tils low-density infiltration were factors for poor prognosis (P < 0.05), and CD8+Tils was an independent prognostic factor. Conclusion CD8+Tils may be an independent prognostic indicator for triple-negative breast cancer. The patients with high-density infiltration have high postoperative pCR rate, long DFS and better long-term efficacy.

Objective:To explore the work experience of nurses in primary medical institutions, and provide a reference for improving the practice environment of nurses in primary medical institutions and enhancing the nursing service capabilities of primary medical institutions.Methods:In November 2019, totally 16 nurses from 10 medical institutions in Shandong Province were selected by convenient sampling for semi-structural interview, and Colaizzi's seven-step phenomenological method was used for data analysis.Results:The work experience of nurses in primary medical institutions in Shandong Province was boiled down to four aspects: the nursing rules and regulations were not complete; the working atmosphere was good but the remuneration was low; the room for career development was small and the willingness of young nurses to resign was high; the demand for nursing services increased but the nursing skills were insufficient.Conclusions:The construction of medical institutions should be enhanced to improve the nursing rules and regulations in primary medical institutions, implement equal pay for equal work to increase the benefits of nurses, broaden the career development path of nurses to reduce their willingness to resign, strengthen nurse training, and promote the sinking of high-quality service resources to the grassroots, in order to improve the poor nurses in primary medical institutions as well as the nursing service capabilities of primary medical institutions in an all-round way.