Tuberculosis is a zoonotic disease posing a substantial public health threat.Immunological diagnosis and vaccine im-munization are both necessary to control tuberculosis prevalence.However,the identical antigenic components in diagnostic reagents and vaccines hinder the use of animal vaccines and limit the specificity of clinical diagnosis in humans.Differentiating infected from vaccinated animals can overcome these problems.This article reviews the progress in differential diagnosis research from three as-pects:the diagnostic effects of antigens,methods for discovering new antigens,and screening of new host immune markers,to provide a theoretical basis for future research.

Objective:To compare the efficacy and safety among traditional open suture, modified Kessler method, and minimally invasive suture with threaded rivets in acute closed Achilles tendon rupture.Methods:A total of 60 patients with acute closed Achilles tendon rupture diagnosed and treated in the Affiliated Hospital of Jining Medical College from January 2018 to August 2022 were selected retrospectively as the study subjects and divided into group A (20 patients with traditional open suture), group B (20 patients with modified Kessler method) and group C (20 patients with minimally invasive suture with threaded rivets) according to operative method. The clinical efficacy, perioperative indexes, Achilles tendon activity, postoperative recovery work and exercise time, visual analog scale (VAS) score and complications were compared among the three groups.Results:The total effective rate in the group C was higher than that in the group A : 18/20 vs. 12/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total effective rate in the group B and group C had no statistical difference ( P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, time to return to work, exercise and VAS scores in the group B and group C were lower than those in the group A: (49.32 ± 4.74), (48.12 ± 4.68) min vs. (66.71 ± 5.84) min; (15.32 ± 1.01), (15.62 ± 0.79) ml vs.(19.86 ± 1.20) ml; (7.69 ± 0.57), (3.76 ± 0.50) cm vs. (8.98 ± 0.62) cm; (7.01 ± 0.91), (6.82 ± 0.83) d vs.(8.74 ± 1.12) d; (56.32 ± 8.01), (55.17 ± 7.84) d vs. (63.17 ± 6.68) d; (6.13 ± 1.20), (5.94 ± 1.04) months vs. (8.21 ± 1.20) months; (2.76 ± 0.50), (2.55 ± 0.76) scores vs. (3.98 ± 0.62) scores, there were statistical differences ( P<0.05). At 1, 6 and 12 months after surgery, the American Society for Foot and Ankle Surgery (AOFAS) scores in the three groups were significantly increased, and the AOFAS scores in the group B and group C were higher than those in the group A, there were statistical differences ( P<0.05). The total incidence of complications in the group C was lower than that in the group A: 2/20 vs. 8/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total incidence of complications in the group B and group C had no statistical difference ( P>0.05). Conclusions:Modified Kessler method and minimally invasive suture with threaded rivets have the advantages of high efficiency and safety in the treatment of acute closed Achilles tendon rupture, and their efficacy is higher than that of traditional open suture.

Tuberculosis is a zoonotic disease posing a substantial public health threat.Immunological diagnosis and vaccine im-munization are both necessary to control tuberculosis prevalence.However,the identical antigenic components in diagnostic reagents and vaccines hinder the use of animal vaccines and limit the specificity of clinical diagnosis in humans.Differentiating infected from vaccinated animals can overcome these problems.This article reviews the progress in differential diagnosis research from three as-pects:the diagnostic effects of antigens,methods for discovering new antigens,and screening of new host immune markers,to provide a theoretical basis for future research.

Objective:To compare the efficacy and safety among traditional open suture, modified Kessler method, and minimally invasive suture with threaded rivets in acute closed Achilles tendon rupture.Methods:A total of 60 patients with acute closed Achilles tendon rupture diagnosed and treated in the Affiliated Hospital of Jining Medical College from January 2018 to August 2022 were selected retrospectively as the study subjects and divided into group A (20 patients with traditional open suture), group B (20 patients with modified Kessler method) and group C (20 patients with minimally invasive suture with threaded rivets) according to operative method. The clinical efficacy, perioperative indexes, Achilles tendon activity, postoperative recovery work and exercise time, visual analog scale (VAS) score and complications were compared among the three groups.Results:The total effective rate in the group C was higher than that in the group A : 18/20 vs. 12/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total effective rate in the group B and group C had no statistical difference ( P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, time to return to work, exercise and VAS scores in the group B and group C were lower than those in the group A: (49.32 ± 4.74), (48.12 ± 4.68) min vs. (66.71 ± 5.84) min; (15.32 ± 1.01), (15.62 ± 0.79) ml vs.(19.86 ± 1.20) ml; (7.69 ± 0.57), (3.76 ± 0.50) cm vs. (8.98 ± 0.62) cm; (7.01 ± 0.91), (6.82 ± 0.83) d vs.(8.74 ± 1.12) d; (56.32 ± 8.01), (55.17 ± 7.84) d vs. (63.17 ± 6.68) d; (6.13 ± 1.20), (5.94 ± 1.04) months vs. (8.21 ± 1.20) months; (2.76 ± 0.50), (2.55 ± 0.76) scores vs. (3.98 ± 0.62) scores, there were statistical differences ( P<0.05). At 1, 6 and 12 months after surgery, the American Society for Foot and Ankle Surgery (AOFAS) scores in the three groups were significantly increased, and the AOFAS scores in the group B and group C were higher than those in the group A, there were statistical differences ( P<0.05). The total incidence of complications in the group C was lower than that in the group A: 2/20 vs. 8/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total incidence of complications in the group B and group C had no statistical difference ( P>0.05). Conclusions:Modified Kessler method and minimally invasive suture with threaded rivets have the advantages of high efficiency and safety in the treatment of acute closed Achilles tendon rupture, and their efficacy is higher than that of traditional open suture.

Objective: To investigate the histopathologic, immunohistochemical, molecular genetic characteristics of dedifferentiated liposarcomas with meningothelial-like whorls(DDLMW). Methods: Six cases of DDLMW diagnosed at Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University) from March 2012 to August 2018 were enrolled. The cases were analyzed by routine HE staining, immunohistochemistry(MDM2, CDK4 and p16) and fluorescent in-situ hybridization(FISH) on MDM2 gene. Related literatures were also reviewed. Results: Three of the 6 patients were male.The patient ages ranged from 40 to 77 years (mean, 58 years). Four tumors occurred in the retroperitoneum and two in the mediastinum. Histologically, the tumors showed, in addition to foci of well-differentied liposarcoma, characteristic, scattered meningothelial-like concentrical whorls. The whorls were composed of tightly, concentrically arranged, spindle to ovoid cells with mild to mederate cytological atypia. Metaplastic bone was present within or in their immediate vicinity in four case. The tumors cell also showed strong and diffuse immunoreactivity to MDM2, CDK4 and p16, but no immunoreactivity to S-100 protein, SMA, SOX10, EMA, CD21, CD23 or CD35. The Ki-67 labeling indexes were low, while FISH showed high levels of MDM2 amplification in all cases. Conclusions DDLMW is a rare morphologic variant of dedifferentiated liposarcoma. The whorls in DDLMW do not represent perineurial or follicular dendritic differentiation. Recognition and familiarity with its existence, as well as combined application of immunohistochemical staining and MDM FISH, are important to avoid confusion with other lesions.

Objective:To study the clinicopathological significance of cyclin D1 expression in Rosai-Dorfman disease (RDD).Methods:Seventeen cases of RDD were evaluated by HE, immunohistochemical staining and molecular genetic analysis. Expression of cyclin D1 was compared between RDDs and control group that included 29 cases of reactive histiocytosis, 9 cases of IgG4-related disease, and 2 cases of Erdheim-Chester disease.Results:Cyclin D1 was expressed in RDDs (17/17), reactive histiocytosis (11/29), IgG4-related diseases (3/9), and Erdheim-Chester disease (2/2), respectively, with nuclear staining in the RDD cells or proliferative histiocytes. Chi-square test showed that expression of cyclin D1 was significantly higher in RDDs than in reactive histiocytosis and IgG4-related diseases ( P<0.01), but not in Erdheim-Chester diseases ( P>0.05). The expression threshold for recalculating the percentage of cyclin D1 positive cells was 27.5% (AUC=0.981 , P<0.01) by ROC curve. However, CCND1 gene had no rearrangement detected by fluorescence in situ hybridization, but with increased copies of gene in some RDD cells. ARMS-PCR analysis also did not detect KRAS, BRAF and NRAS gene mutations in any cases. Conclusions:Cyclin D1 may serve as an additional diagnostic marker for RDDs. Its high expression may be related to activation of MAPK pathway, but the pathogenetic significance of cyclin D1 in RDDs needs further study.

Objective: To investigate the clinicopathological features and differential diagnosis of adamantinoma of long bone. Methods: Seven cases of adamantinoma on long bone were selected at Jiangsu Province People′s Hospital from June 2012 to May 2018. Clinicopathologic details, immunohistochemical and molecular analysis were performed,and the relevant literature reviewed. Results: There were 6 males and 1 female patients,age ranging from 21 to 60 years (mean 38 years). Six cases were on the right side and one case was on the left; in five cases the tumors arose from tibia, one from patella and one from humerus. Microscopically,tumour cells were mainly composed of spindle cells arranged in bundles or braids,with irregular epithelial island. Immunohistochemically,the epithelial island expressed high molecular weight cytokeratin but not CK8/18. Both epithelial and spindle components expressed vimentin. One case that was microscopically similar to intraosseous synovial sarcoma did not show SYT gene rearrangement. Clinical follow-up was available for five patients: one patient had axillary metastases seven months after operation, one patient had recurrence 34 months after surgery, 3 patients were uneventful with follow up duration from half a month to 32 months. Conclusion Adamantinoma occurring in long bones is very rare. The correct diagnosis requires adequate sample selection, careful morphologic observation, immunohistochemistry and molecular genetics.

Objective To investigate the clinicopathological features and differential diagnosis of adamantinoma of long bone. Methods Seven cases of adamantinoma on long bone were selected at Jiangsu Province People′s Hospital from June 2012 to May 2018. Clinicopathologic details, immunohistochemical and molecular analysis were performed,and the relevant literature reviewed. Results There were 6 males and 1 female patients,age ranging from 21 to 60 years (mean 38 years). Six cases were on the right side and one case was on the left; in five cases the tumors arose from tibia, one from patella and one from humerus. Microscopically,tumour cells were mainly composed of spindle cells arranged in bundles or braids,with irregular epithelial island. Immunohistochemically,the epithelial island expressed high molecular weight cytokeratin but not CK8/18. Both epithelial and spindle components expressed vimentin. One case that was microscopically similar to intraosseous synovial sarcoma did not show SYT gene rearrangement. Clinical follow?up was available for five patients: one patient had axillary metastases seven months after operation, one patient had recurrence 34 months after surgery, 3 patients were uneventful with follow up duration from half a month to 32 months. Conclusion Adamantinoma occurring in long bones is very rare. The correct diagnosis requires adequate sample selection, careful morphologic observation, immunohistochemistry and molecular genetics.

Objective To investigate the operative method and clinical rusults of repairing and reconstruction for bone and skin defect at medial malleolus.Methods Form January,2013 to January,2015,11 cases of patients with malleolus complex tissue defect were treated.According to the degree of damage to the cases were divided into four types,according to the type,selected flap,blood vessels,nerves,tendon graft,flap series connection iliac bone flap graft to repair,or direct ankle fusion,amputation to therapy.The Iliac flap donor site remained part of the anterior superior iliac spine and rebuild muscle starting and ending point,the donor sites wound was closed by skin graft.Results Followed-up of 1-24 months,in addition to amputation and ankle fusion each one exception,the remaining 9 patients underwent ankle reconstruction to reserve ankle.One case acquired infection,other 8 patients healed well,had different degree of recovery of the ankle function,the ankle function had recovery in different degree.AOFAS ankle-hindfoot score system:excellent in 4 cases,good in 4 cases,and poor in 1 case.Conclusion Ankle complex tissue defect classification method can be used to guide us to select the treatment options.Iliac bone flap series consisting mainly of composite tissue transplantation is a viable method of the medial malleolus defect reconstruction.