Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

Postoperative pain seriously affects the recovery process of patients, resulting in prolonged hospital stay and increased care costs. Appropriate application of patient-controlled analgesia devices can effectively relieve perioperative acute pain. In 1994 patient-controlled analgesia began to be used in Peking Union Medical College Hospital, and the Acute Pain Service Working Group was established in 2004. With the cooperation of anesthesiologists and specialist nurses, the group jointly has implemented the whole process and standardized management based on patient-controlled analgesia, and constantly improved and innovated working methods, laying a solid foundation for the development of postoperative pain management. This paper systematically reviews and summarizes the work from the aspects of clinical focus, nursing management experience, promotion and dissemination of pain treatment concepts, and development of acute pain service model under the new situation, with the hope of providing valuable reference for comprehensively strengthening pain management in the process of diagnosis and treatment, and enhancing patients' satisfaction with perioperative analgesia services.

Objective·To explore the expression of sorting nexin 1(SNX1)in colorectal cancer(CRC)and its impact on the proliferation and migration of CRC cells.Methods·Transcriptomic data and clinical pathological information of CRC were obtained from The Cancer Genome Atlas(TCGA),Genotype-Tissue Expression(GTEx),and Gene Expression Omnibus(GEO)databases for enrichment analysis with Gene Set Enrichment Analysis(GSEA)software.The expression of SNX1 in CRC tissues and cells was detected by quantitative real-time polymerase chain reaction(qPCR),Western blotting,and immunohistochemistry staining(IHC).Small interfering RNA(siRNA)was used to knock down the expression of SNX1 to observe its effect on tumor cell proliferation and migration.Correlation analysis was conducted to explore the potential molecular mechanisms underlying SNX1-mediated CRC cell migration,and mRNA level validation was performed in SNX1 knockdown cell lines.Results·Analysis of CRC patients data in TCGA and tissue microarrays revealed that SNX1 expression was downregulated in CRC tissues and correlated with tumor diameter and distant metastasis.Knockdown of SNX1 enhanced tumor cell proliferation and migration.The expression of SNX1 was negatively correlated with metastasis associated in colon cancer 1(MACC1),mesenchymal to epithelial transition factor(MET),and Notch;knockdown of SNX1 led to upregulation of these genes.Silencing SNX1 resulted in the downregulation of the epithelial marker cadherin 1(CDH1)and the upregulation of vimentin(VIM)and Snail family transcriptional repressor 1(SNAI1).Conclusion·SNX1 expression was significantly downregulated in CRC tissues and correlated with patient prognosis.Low expression of SNX1 enhanced the proliferation and migration of CRC cells and was associated with the MACC1-MET pathway and EMT.SNX1 may serve as a potential biomarker for poor prognosis and a novel therapeutic target in CRC.

Objective:To investigate the expression of FGD6(FYVE,RhoGEF,and PH domain containing 6)in lung adenocarcinoma(LUAD)tissues and explore its impact on LUAD cells proliferation,apoptosis,migration,invasion,and the possible mechanism.Methods:By searching bioinformatics websites and databases,the differences in the expression of FGD6 gene in LUAD,paracancerous tissues and normal lung tissues were analyzed,and further analyzed the correlation between the expression of FGD6 and the survival prognosis of LUAD patients as well as the correlation with the clinicopathological features of LUAD patients.Two different siRNAs(si-FGD6-1,si-FGD6-2)targeting FGD6 gene were transfected into LUAD cell lines(A549 and NCI-H23)using lipofection.The knockdown efficiency of the siRNAs was detected by real-time fluorescence quantitative PCR and Western blotting.CCK-8 assay,clone formation assay and FCM assay were used to detect the effects of silencing FGD6 expression on the proliferation and apoptosis of A549 and NCI-H23 cells;Wound healing assay assay and Transwell assay were used to detect the effects of silencing FGD6 expression on the migratory and invasive ability of A549 and NCI-H23 cells.Subsequently,Gene Set Enrichment Analysis(GESA)was performed based on the transcriptome data of LUAD patients in The Cancer Genome Atlas(TCGA)database,and it was hypothesized that FGD6 might regulate the Hippo signaling pathway in LUAD cells.Real-time fluorescence quantitative PCR and Western blotting were used to detect the effects of silencing FGD6 expression on the connective tissue growth factor(CTGF)and cysteine-rich 61(CYR61)genes and the phosphorylation of the Hippo signaling pathway downstream in LUAD cells.The effect of the expression level of phosphorylated Yes-associated protein(YAP)in the Hippo signaling pathway.Results:Database analysis showed that FGD6 expression was up-regulated in a variety of tumors,and the expression level in LUAD was significantly higher than that in normal tissues(P<0.001).The overall survival time of patients with high expression of FGD6 was less than that of those with low expression(P<0.05),and it was positively correlated with the clinical stage and lymph node metastatic status of LUAD patients.After knocking down FGD6 expression,the expression levels of FGD6 mRNA and protein in A549 and NCI-H23 cells were significantly down-regulated,and their cell proliferation,anti-apoptosis,migration and invasion abilities were significantly reduced(all P<0.01).The results of real-time fluorescence quantitative PCR showed that knockdown of FGD6 expression led to significant down-regulation of the expression levels of CTGF and CYR61 mRNA,the downstream targeting factors of the Hippo signaling pathway(both P<0.01),while the results of Western blotting showed that the expression levels of phosphorylated Yes-associated protein(p-YAP)were significantly down-regulated in the Hippo signaling pathway(P<0.01).Conclusion:FGD6 is highly expressed in LUAD tissues,and its high expression is associated with poor prognosis.Knockdown of FGD6 gene can inhibit LUAD cells proliferation,apoptosis,migration and invasion,and activate the Hippo pathway,suggesting its potential as a therapeutic target in LUAD.

Objective:To investigate the expression of FGD6(FYVE,RhoGEF,and PH domain containing 6)in lung adenocarcinoma(LUAD)tissues and explore its impact on LUAD cells proliferation,apoptosis,migration,invasion,and the possible mechanism.Methods:By searching bioinformatics websites and databases,the differences in the expression of FGD6 gene in LUAD,paracancerous tissues and normal lung tissues were analyzed,and further analyzed the correlation between the expression of FGD6 and the survival prognosis of LUAD patients as well as the correlation with the clinicopathological features of LUAD patients.Two different siRNAs(si-FGD6-1,si-FGD6-2)targeting FGD6 gene were transfected into LUAD cell lines(A549 and NCI-H23)using lipofection.The knockdown efficiency of the siRNAs was detected by real-time fluorescence quantitative PCR and Western blotting.CCK-8 assay,clone formation assay and FCM assay were used to detect the effects of silencing FGD6 expression on the proliferation and apoptosis of A549 and NCI-H23 cells;Wound healing assay assay and Transwell assay were used to detect the effects of silencing FGD6 expression on the migratory and invasive ability of A549 and NCI-H23 cells.Subsequently,Gene Set Enrichment Analysis(GESA)was performed based on the transcriptome data of LUAD patients in The Cancer Genome Atlas(TCGA)database,and it was hypothesized that FGD6 might regulate the Hippo signaling pathway in LUAD cells.Real-time fluorescence quantitative PCR and Western blotting were used to detect the effects of silencing FGD6 expression on the connective tissue growth factor(CTGF)and cysteine-rich 61(CYR61)genes and the phosphorylation of the Hippo signaling pathway downstream in LUAD cells.The effect of the expression level of phosphorylated Yes-associated protein(YAP)in the Hippo signaling pathway.Results:Database analysis showed that FGD6 expression was up-regulated in a variety of tumors,and the expression level in LUAD was significantly higher than that in normal tissues(P<0.001).The overall survival time of patients with high expression of FGD6 was less than that of those with low expression(P<0.05),and it was positively correlated with the clinical stage and lymph node metastatic status of LUAD patients.After knocking down FGD6 expression,the expression levels of FGD6 mRNA and protein in A549 and NCI-H23 cells were significantly down-regulated,and their cell proliferation,anti-apoptosis,migration and invasion abilities were significantly reduced(all P<0.01).The results of real-time fluorescence quantitative PCR showed that knockdown of FGD6 expression led to significant down-regulation of the expression levels of CTGF and CYR61 mRNA,the downstream targeting factors of the Hippo signaling pathway(both P<0.01),while the results of Western blotting showed that the expression levels of phosphorylated Yes-associated protein(p-YAP)were significantly down-regulated in the Hippo signaling pathway(P<0.01).Conclusion:FGD6 is highly expressed in LUAD tissues,and its high expression is associated with poor prognosis.Knockdown of FGD6 gene can inhibit LUAD cells proliferation,apoptosis,migration and invasion,and activate the Hippo pathway,suggesting its potential as a therapeutic target in LUAD.

Objective To investigate the effect of Erhuang decoction on TGF-β1 expression of lung tiusses and the concentrations of IL-33 in asthmatic rats. Methods Fifty Sprague-Dawley rats were randomly divided into five groups equally:Control group, Asthmatic group, Budesonide aerosol group, High-dose Erhuang decoction group ( 68 g/kg)and Low-dose Erhuang decoction group(17 g/kg). The model of asthma was established by ovalbumin (OVA) sensitizing and challeng-ing. Then Erhuang decoction and budesonide aerosol was used respectively for intervention therapy. Histologic HE staining were used to observe the general pathologic alteration and to analyze the total bronchial wall area (Wat) and the muscle wall area(Wam). The protein expressions of TGF-β1 in the lung tissues were detected by immunohistochemistry. The concentra-tions serum IL-33 and BALF were tested by sandwich ELISA. Results There was significant reduction in the infiltrated inflammatory cells in all drug intervention groups compared with asthma group;The Wat and Wam in asthmatic group was significantly higher in than those in Budesonide aerosol group,High-dose Erhuang decoction group and Low-dose Erhuang decoction group ( Watμm2/μm:54.99±8.82, 52.28±7.61, 58.53±7.63 vs 79.50±5.64, P＜0.05;Wamμm2/μm:22.74±2.73, 20.63±1.72, 21.20±4.50 vs 30.16±1.68, P＜0.05);Compared with control group, BALF and serum IL-33 concentration were significantly higher in asthmatic group. Compared with asthmatic group, all the indicators were significantly decrease in the treatment groups after drug intervention (P＜0.05). Andthere was no significant difference between the treatment groups in all the indicators. TGF-β1 expression in lung tissues in asthmatic group were significantly higher than that in control group (12.60 ± 2.25 vs 1.67 ± 0.17). Compared with asthmatic group, there was significantly reduction of TGF-β1 expression in the Budesonide aerosol group (5.51±2.48), High-dose Erhuang decoction group (5.22±2.52) and Low-dose Erhuang decoction group (6.92 ±2.18) (P＜0.05). There were no significant difference between the treatment groups. TGF-β1 expression and se-rum IL-33 concentration in asthmatic rats were positively correlated with Wat and Wam. Conclusion The effects of Er-huang decotion on ameliorating the progression of airway remodeling about asthmatic rats may be partially by regulating TGF-β1 and IL-33.

Objective To compare the efficacy and complications of the two surgical methods (between type Ⅰ hysterectomy and type Ⅱ hysterectomy),and to explore the feasibility of type Ⅰ hysterectomy in stage ⅠA cervical cancer.Methods The study group,92 cases(48 cases of stage ⅠA1,44 cases of stage ⅠA2) were performed with type Ⅰ hysterectomy plus selective pelvic lymph node dissection;the control group,93 cases (49 cases of stage ⅠA1,44 cases of ⅠA2) were performed with type Ⅱ hysterectomy plus selective pelvic lymph node dissection.Results The survival rate of 5 years and 10 years in study group were 100 ％ (92/92),100 ％ (74/74) and that in control group were 100 ％ (93/93),100 ％(66/66),respectively.There were no signicant difference between the two group (both P ＞ 0.05).When compared with the control group,the urinary tract infection of the study group was significantly reduced (0 versus 13.99 ％,P ＜ 0.05).Moreover,there were a shorter surgical duration [(96.14±17.20) min vs (116.82±16.30) min].The hemorrhage [(117.35±39.61) ml] and blood transfusion (0 ml) in study group was less common than those in control group [(201.74±46.25) ml,(82.07±16.32) ml] (all P ＜ 0.01).Conclusion There are no difference of 5-year and l0-year survival rate in stage ⅠA patients with type Ⅰ or type Ⅱ hysterectomy,however,the rate of the postoperative urinary tract infection in the former is lower than that in the latter,and also there are a shorter surgical duration,less hemorrhage and reduced blood transfusion requirements in study group.Therefore,type Ⅰ hysterectomy can be effective and applicable for the patients of stage ⅠA cervical cancer.

Objective To explore the surgical extent and to improve the surgical techniques of the Piver class Ⅲ hysterectomy on invasivc cervical cancer,so as to reduce the urinary tract complications,shorten the surgical duration,decrease the hemorrhage and blood transfusion.Methods The study group,196 cases with stages Ⅰ b and Ⅱ a carcinoma of the cervix underwent the modified Piver class Ⅲ hysterectomy from June 2000 to May 2005.The control group,176 cases of the same stages underwent the Pivet class Ⅲ hysterectomy between June 1994 and May 1999.The modified Piver class Ⅲ hysterectomy mainly include the surgical extent and some surgical techniques as follows.The cervicovesical and vesicovaginal space are separated with assistance of electrotome.Half of the uterosacral ligaments are removed with electrotome.The tunnel of the ureters is separated and penetrated or not. The anterior leaf of the cervicovesical ligaments is removed and the uterine artery are removed at the same time.while the ureter branch from the uterine artery are preserved.When the ureters aIe drawn to the lateral side of the body with an "S" hook and the urocyst lateral recessus are expanded.the cardinal ligaments can be exposed and be removed of 3/4.But part of the inferior of these ligaments should be preserved.The paracolpium are resected about 2 cm.2-3 cm tissue of the vagina is removed.Results Compare with the control group,the urinary tract complications of the study group were significantly reduced(51.1%versus 23.0%,P<0.01).There were a shorter surgical duration[(132±20)min],less of the hemorrhage[(322±100) ml]and blood transfusion[(154±79)ml] in the study group than those in the control group(all P<0.05).While,there was no significant difference at the survival rates of 5 years between the two groups (87.8% versus 88.6%.P=0.793).Conclusion The modified Piver class Ⅲ hysterectomy is effective and applicable for patients with cervical cancer.

Sodium succinate (0.8 g?kg~ -1,ig) could significantly shorten afterdischarge duration (ADD), lower Racine’s score on amygdala electrical kindling in rat.Additional sodium succinate capsule (0.25g,po) was effective on patients with epilepsy administrated with common antiepileptic drugs which showed little effectiveness on these patients. The results supposed sodium succinate would be effective in epilepsy therapy.