Objective:To explore the clinical features, histopathological morphology, and differential diagnosis of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers.Methods:From 2020 to 2021, 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers diagnosed in Fujian Cancer Hospital (2 cases) and the Second Affiliated Hospital of Fujian Medical University (2 cases) were collected. Different ancillary procedures such as HE, special stains, immunohistochemistry, and in situ hybridization techniques were used to assess the histopathological features and immunophenotypes. The clinical data were collected and literature was reviewed.Results:All 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers were male. They were 32, 45, 67 and 39 years old, respectively. The main clinical manifestations were bloody phlegm, abdominal pain, fatigue and anorexia. The clinical stages at diagnosis were stage Ⅳ (3 cases) and stage Ⅱ (1 case). Cases 2 and 3 had two pathological examinations at different sites, with a total of six pathological examinations. The histomorphology showed singly scattered or nests of tumor cells in a background of abundant small lymphocytes. The tumor cells were enlarged and pleomorphic, some appeared polygonal with inconspicuous cell borders, and they were arranged in a syncytial pattern. There were megakaryocytes, multinucleated tumor cells, and a few spindle-shaped cells seen. Atypical mitosis was commonly noted. By immunohistochemistry, the tumor cells were positive for CKpan(5/6), CK8/18(4/4), CAM5.2(2/5), CK-H(0/4), CK-L(3/4), EMA(4/5), CK5/6(3/6), p63(1/6), p40(1/6), E-cadherin (4/6), SSTR2(6/6), PD-L1(5/5), LCA(0/6), vimentin(5/6), CD2 (6/6), CD23(6/6), CD35(5/6), CXCL-13(4/5) and D2-40(1/5). The Ki-67 proliferative index was 60%-95%. In situ hybridization for EBER were all positive (6/6). Special stain for reticulin showed positive staining surrounding nests of tumor cells.Conclusions:The expression of follicular dendritic cell markers in lymphoepithelioma-like carcinoma is very rare, which may be related to EBV infection. Occasionally, it can overlap with follicular dendritic cell sarcoma by morphology and immunophenotype, which can lead to misdiagnosis. Only by combining clinical information, morphological characteristics and immunophenotype can an appropriate diagnosis be made.

Objective:To explore the clinical features, histopathological morphology, and differential diagnosis of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers.Methods:From 2020 to 2021, 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers diagnosed in Fujian Cancer Hospital (2 cases) and the Second Affiliated Hospital of Fujian Medical University (2 cases) were collected. Different ancillary procedures such as HE, special stains, immunohistochemistry, and in situ hybridization techniques were used to assess the histopathological features and immunophenotypes. The clinical data were collected and literature was reviewed.Results:All 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers were male. They were 32, 45, 67 and 39 years old, respectively. The main clinical manifestations were bloody phlegm, abdominal pain, fatigue and anorexia. The clinical stages at diagnosis were stage Ⅳ (3 cases) and stage Ⅱ (1 case). Cases 2 and 3 had two pathological examinations at different sites, with a total of six pathological examinations. The histomorphology showed singly scattered or nests of tumor cells in a background of abundant small lymphocytes. The tumor cells were enlarged and pleomorphic, some appeared polygonal with inconspicuous cell borders, and they were arranged in a syncytial pattern. There were megakaryocytes, multinucleated tumor cells, and a few spindle-shaped cells seen. Atypical mitosis was commonly noted. By immunohistochemistry, the tumor cells were positive for CKpan(5/6), CK8/18(4/4), CAM5.2(2/5), CK-H(0/4), CK-L(3/4), EMA(4/5), CK5/6(3/6), p63(1/6), p40(1/6), E-cadherin (4/6), SSTR2(6/6), PD-L1(5/5), LCA(0/6), vimentin(5/6), CD2 (6/6), CD23(6/6), CD35(5/6), CXCL-13(4/5) and D2-40(1/5). The Ki-67 proliferative index was 60%-95%. In situ hybridization for EBER were all positive (6/6). Special stain for reticulin showed positive staining surrounding nests of tumor cells.Conclusions:The expression of follicular dendritic cell markers in lymphoepithelioma-like carcinoma is very rare, which may be related to EBV infection. Occasionally, it can overlap with follicular dendritic cell sarcoma by morphology and immunophenotype, which can lead to misdiagnosis. Only by combining clinical information, morphological characteristics and immunophenotype can an appropriate diagnosis be made.

Objective:To compare the efficacy of different drugs in reducing incidence of emergence agitation after tonsillectomy and adenoidectomy in the pediatric patients.Methods:Cochrane Library, PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Databases were searched from inception to July 2023 for the randomized controlled trials involving interventions to reduce the incidence of emergence agitation after tonsillectomy and adenoidectomy in pediatric patients. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. STATA 17.0 software was used to conduct a network meta-analysis according to the frequency-ology framework.Results:Twenty randomized controlled trials were finally included, involving 1 687 patients. Compared with placebo, 10 interventions could reduce the incidence of emergence agitation in pediatric patients after tonsillectomy and adenoidectomy, and the order of probability was as follows: dexmedetomidine ( OR and 95% confidence interval [ CI] 0.13 [0.09-0.20]), ketamine ( OR and 95% CI 0.15 [0.08-0.26]), clonidine ( OR and 95% CI 0.15 [0.05-0.50]), tramadol ( OR and 95% CI 0.16 [0.04-0.61]), remazolam ( OR and 95% CI 0.17 [0.06-0.47]), afentanil ( OR and 95% CI 0.22 [0.08-0.62]), remifentanil ( OR and 95% CI 0.24 [0.12-0.48]), desocine ( OR and 95% CI 0.29 [0.12-0.69]), fentanyl ( OR and 95% CI 0.31 [0.19-0.52]) and propofol ( OR and 95% CI 0.46 [0.24-0.86]). Four interventions cloud reduce the usage rate of postoperative rescue drugs, and the probability was ranked as follows: dexmedetomidine ( OR and 95% CI 0.19 [0.11-0.32]), tramadol ( OR and 95% CI 0.20 [0.10-0.42]), ketamine ( OR and 95% CI 0.49 [0.28-0.86]) and fentanyl ( OR and 95% CI 0.49 [0.32-0.77]). One intervention cloud reduce the incidence of postoperative nausea and vomiting: dexmedetomidine ( OR and 95% CI 0.54 [0.31-0.94]). Conclusions:Dexmedetomidine provides the best effect in reducing the incidence of emergence agitation after pediatric tonsillectomy and adenoidectomy.

Objective:To evaluate the efficacy of visual laryngoscope for tracheal intubation for resuscitation in the premature infants born within 32 weeks of gestation.Methods:A total of 84 premature infants who were born < 32 weeks of gestation in the Third Affiliated Hospital of Zhengzhou University and required tracheal intubation after birth from January 2019 to December 2021 were enrolled and divided into direct laryngoscope group and visual laryngoscope group according to the random number table method, with 42 cases in each group.The glottis exposure, intubation time, successful tracheal intubation at first attempt and complications related to intubation were recorded in the two groups.Results:Compared with direct laryngoscope group, the time of glottis exposure and tracheal intubation was significantly shortened, and the success rate of endotracheal intubation at first attempt was increased in visual laryngoscope group ( P<0.05).There was no significant difference in the glottis exposure during laryngoscope-assisted intubation and incidence of complications related to tracheal intubation between the two groups ( P>0.05). Conclusions:Visual laryngoscope provides better efficacy than direct laryngoscope when used for tracheal intubation for resuscitation in the premature infants born within 32 weeks of gestation.

Objective To evaluate the diagnostic value of related contrast material(Rel.CM)of the dual-energy CT (DECT) virtual noncalcium (VNCa) for detecting acute traumatic bone marrow edema in knee joint.Methods A total of 17 patients(18 knees)with definite trauma history and knee joint disorders were prospectively enrolled. Conventional CT, VNCa and MRI images were obtained by MRI and DECT scan. Each knee was divided into 12 regions, respectively, to observe the performance of MRI and VNCa images. The diagnostic efficacy of different Rel. CM values (1.25, 1.45, 1.75) was analyzed for the knee traumatic bone marrow edema,select the best Rel.CM value.And the CT values of bone marrow and bone marrow damage were measured on VNCa of the optimal Rel. CM parameters. Using ROC to evaluate the efficacy of VNCa in different Rel.CM values for diagnosing traumatic bone marrow edema,the difference of CT value between bone marrow lesion and bone marrow in normal region of bone marrow was obtained by using rank sum test. Results DECT and MRI were performed in 17 patients (18 knees). Eighteen knees were divided into 216 areas.MRI showed 94 areas of bone marrow edema,including 35 in distal portion of femur, 59 in proximal tibia. Rel.CM values of 1.25, 1.45, 1.75 of the VNCa map were used to diagnose traumatic bone marrow edema in the knee with the area under the ROC curve of 0.643, 0.871, 0.656, respectively. Rel.CM with 1.45 VNCa diagram was the most accurate. The CT values of the bone marrow edema region and the normal region were -64.3(-20.6 to-90.8)HU,-93.4(-70.5 to-120.7)HU, respectively, on the VNCa graph with the optimal Rel.CM parameters (1.45) (Z=-8.270, P<0.05). Conclusions The VNCa image with a Rel.CM value of 1.45 has a better diagnostic performance for traumatic bone marrow edema in knee joint. CT value measurement in VNCa image can be used for quantitative analysis of traumatic bone marrow edema.

With the progress of visualization technology, more and more visual tools were applied to anesthesia. It has accurate positioning, mild trauma, a high success rate and less complications for endotracheal intubation, which increase the safety and efficiency of airway management. Disposcope endoscope is an endotracheal intubation tool with a visual stylet, which has many advantages, such as visual, lens barrel can be bent and wireless transmission. This paper summarizes the current progress in the application of Disposcope endoscopy in tracheal intubation.

AIM:To study the parameters of supercritical CO_2 extraction of essential oil from valeriana efficinalis by orthogonal design. METHODS: Four factors,such as extraction pressure,extraction temperature,extraction time and separation temperature were chosen by the observation of orthogonal design,each factor was assigned to three levels.Bornyl acetate content was selected as a marker in a position to determine optimal extraction. RESULTS: Pressure and temperature were the main factors in effecting the extraction of bornyl acetate,extraction time was minor factor relatively. CONCLUSION: The optimal extraction is as follow,parameters were extraction pressure:12 MPa,extraction temperature:45 ℃,extraction time:1 hour,separation temperature:35 ℃,it gave the best recoveries of essential oils and bornylacetate.