Objective:To study the clinicopathological features of Sjogren′s syndrome (SS) with liver injury and to improve the understanding of this disease.Methods:Forty-nine patients with SS complicated with liver injury were collected from Beijing Ditan Hospital, Capital Medical University from October 2008 to January 2022. All patients underwent ultrasound-guided liver biopsy, and all specimens were stained with HE. The histopathologic characteristics were observed and the pathologic indexes were graded. Immunohistochemical stains for CK7, CK19, CD38, MUM1 and CD10 were performed by EnVision method; and special histochemical stains for reticulin, Masson′s trichrome, Rhodanine, Prussian blue, periodic acid Schiff (PAS) and D-PAS stains were conducted .Results:The age of patients ranged from 31 to 66 years, including 3 males and 46 females. SS combined with drug-induced liver injury was the most common (22 cases, 44.9%), followed by autoimmune liver disease (13 cases, 26.5%, including primary biliary cholangitis in eight cases, autoimmune hepatitis in 3 cases, and PBC-AIH overlap syndrome in 2 cases), non-alcoholic fatty liver disease (NAFLD, 9 cases, 18.4%) and other lesions (5 cases, 10.2%; including 3 cases of nonspecific liver inflammation, 1 case of liver amyloidosis, and 1 case of porto-sinusoidal vascular disease). Among them, 28 cases (57.1%) were associated with obvious interlobular bile duct injury, mainly in SS combined with PBC group and drug-induced liver injury group. Twenty-three cases (46.9%) were associated with hepatocyte steatosis of varying degrees. In SS with autoimmune liver disease group, ISHAK score, degree of fibrosis bile duct injury, bile duct remodeling, lymphocyte infiltration of portal area, and plasma cell infiltration, MUM1 and CD38 expression; serum ALP and GGT, IgM; elevated globulin; positive AMA, proportion of AMA-M2 positive and IgM positive were all significantly higher than those in other groups(all P<0.05). Serum ALT, direct bilirubin and SSA positive ratio in SS combined with drug liver group were significantly higher than those in other groups(all P<0.05). The serum total cholesterol level in SS combined with PBC group ( P=0.006) and NALFD group ( P=0.011) were significantly higher than those in other groups ( P<0.05). Conclusions:The pathologic manifestations of SS patients with liver injury are varied. The inflammatory lesions of SS patients with autoimmune liver disease are the most serious, and the inflammatory lesions of SS patients with non-alcoholic fatty liver disease and non-specific inflammation are mild. Comprehensive analysis of liver histopathologic changes and laboratory findings is helpful for the diagnosis of SS complicated with different types of liver injury.

Objectives:To evaluate the clinical value of the Paris system for reporting urinary cytology (TPS) in the diagnosis of urothelial carcinoma (UC).Methods:A total of 1 744 cytological diagnostic records (from 751 cases) were collected retrospectively. All specimens were voided urines and histopathology as the gold standard. The sensitivity and specificity of urinary cytological diagnosis of UC and risk of high grade malignant (ROHM) in each diagnostic category were compared.Results:There were 360 cases with histopathology. The percentage of negative for high-grade urothelial carcinoma (NHGUC) was 30.1% (226/751), atypical urothelial cells (AUC) was 29.8% (224/751), suspicious for high-grade urothelial carcinoma (SHGUC) was 16.8% (126/751), high grade urothelial carcinoma (HGUC) was 21.2% (159/751), and non-urothelial malignancy (NUM) was 2.1% (16/751). The histpathologic ROHM corresponding to each cytological diagnosis category were 27.3% for NHGUC, 32.7% for AUC, 74.7% for SHGUC, 96.6% for HGUC and 100.0% for NUM, respectively. ROHM of SHGUC was significantly higher than that of AUC group, and the difference between the two groups was statistically significant ( P＜0.001). ROHM of HGUC group was significantly higher than that of SHGUC group, and the difference was statistically significant ( P＜0.001). With SHGUC as the cut-off value, the sensitivity and specificity of cytological diagnosis of HGUC were 76.7% (165/215) and 85.7% (18/21), and with HGUC as the cut-off value, the sensitivity and specificity of cytological diagnosis of HGUC were 53.0% (114/215) and 100.0% (21/21), respectively. Conclusions:Urine cytology has high sensitivity and specificity in the diagnosis of HGUC. The malignant risk of TPS varies with different diagnosis category. The high malignant risk population in cancer hospital leads to the relatively high malignant proportion and ROHM in each diagnosis category. Urinary cytology TPS reporting system is helpful to clinical management and has good clinical application value.

Objectives:To evaluate the clinical value of the Paris system for reporting urinary cytology (TPS) in the diagnosis of urothelial carcinoma (UC).Methods:A total of 1 744 cytological diagnostic records (from 751 cases) were collected retrospectively. All specimens were voided urines and histopathology as the gold standard. The sensitivity and specificity of urinary cytological diagnosis of UC and risk of high grade malignant (ROHM) in each diagnostic category were compared.Results:There were 360 cases with histopathology. The percentage of negative for high-grade urothelial carcinoma (NHGUC) was 30.1% (226/751), atypical urothelial cells (AUC) was 29.8% (224/751), suspicious for high-grade urothelial carcinoma (SHGUC) was 16.8% (126/751), high grade urothelial carcinoma (HGUC) was 21.2% (159/751), and non-urothelial malignancy (NUM) was 2.1% (16/751). The histpathologic ROHM corresponding to each cytological diagnosis category were 27.3% for NHGUC, 32.7% for AUC, 74.7% for SHGUC, 96.6% for HGUC and 100.0% for NUM, respectively. ROHM of SHGUC was significantly higher than that of AUC group, and the difference between the two groups was statistically significant ( P＜0.001). ROHM of HGUC group was significantly higher than that of SHGUC group, and the difference was statistically significant ( P＜0.001). With SHGUC as the cut-off value, the sensitivity and specificity of cytological diagnosis of HGUC were 76.7% (165/215) and 85.7% (18/21), and with HGUC as the cut-off value, the sensitivity and specificity of cytological diagnosis of HGUC were 53.0% (114/215) and 100.0% (21/21), respectively. Conclusions:Urine cytology has high sensitivity and specificity in the diagnosis of HGUC. The malignant risk of TPS varies with different diagnosis category. The high malignant risk population in cancer hospital leads to the relatively high malignant proportion and ROHM in each diagnosis category. Urinary cytology TPS reporting system is helpful to clinical management and has good clinical application value.

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Objective:To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA).Methods:From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group ( n=15) and non-fever group ( n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results:Univariate analysis showed that the lesion length ( t=-3.89, P<0.001), lesion range ( χ2=11.52, P=0.001) and ablation energy ( P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference ( r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95% CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95% CI: 0.22-0.85, P=0.015). Conclusion:Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.

Objective:To evaluate the application value of electrical impedance tomography(EIT)imaging combining bedside bronchoscopy sputum suction by observing the changes of pulmonary ventilation, tidal volume and dynamic pulmonary compliance after bedside bronchoscopy sputum suction in elderly stroke-associated pneumonia(SAP).Methods:A randomized controlled study was conducted.Patients with SAP admitted to the respiratory intensive care unit of Henan Provincial People's Hospital from January 2017 to December 2018 were enrolled as research objects.They were divided into the control group versus observation group with the only difference in receiving bedside bronchoscope sputum suction replacing control's receiving conventional sputum suction.Impedance imaging region of interest 4(ROI4)values collected by using EIT at admission and 1, 3, 5 days after fiberoptic bronchoscope sputum suction were compared between the two groups.Meanwhile, the tidal volume, dynamic lung compliance, the duration of mechanical ventilation and hospitalization time in intensive care unit were recorded in the two groups.Results:A total of 78 patients meeting an inclusion and exclusion criterion were enrolled, with 37 cases in the control group and 41 cases in the observation group.Compared with control group, the bronchoscope sputum suction group showed the significantly increased regional gas distribution values(2.24±0.77% vs.0.49±0.65%, 7.05±0.77% vs.2.49±0.87%, 12.34±1.47% vs.5.57±0.50%, t=10.85, 24.56 and 26.54, respectively, all P<0.001)at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The tidal volume and dynamic lung compliance were significantly higher in the observation group than in the control group at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The duration of mechanical ventilation and hospitalization time in the intensive care unit were shorter in the observation group than in the control group(12.22±0.88 d vs.14.65±0.92 d, 18.41±1.12 d vs.21.14±1.06 d, t=11.91 and 11.01, both P< 0.001). Conclusions:For patients with SAP, an intermittent bedside fiberoptic bronchoscope sputum suction can effectively improve the pulmonary ventilation in the dorsal area, optimize pulmonary respiratory dynamics, facilitate the early withdrawal of the mechanic ventilation, and shorten the hospitalization time in the intensive care unit.

Myelodysplastic syndrome (MDS) is characterized by dysplastic and ineffective hematopoiesis that can result from aberrant expansion and activation of myeloid-derived suppressor cells (MDSC) within the bone marrow microenvironment. The proliferation and activation of MDSC lead to the dysfunction and depletion of natural killer cells and CD8 + T cells, and the recruitment of inflammatory cells and factors leads to the further accumulation of genetic abnormalities in MDS patients, leading to the progression of MDS. The accumulation of inflammatory cytokines in the tumor environment induces the expression of programmed death receptor 1 (PD-1) in hematopoietic stem cells and hematopoietic progenitor cells and the overexpression of programmed death receptor ligand 1 (PD-L1) in MDSC, and the interaction of PD-1/PD-L1 leads to the apoptosis of MDS hematopoietic progenitor cells and ineffective hematopoiesis. The experiments and clinical studies targeting MDSC have confirmed that correcting or reversing the bone marrow microenvironment of immune disorders in MDS is a therapeutic strategy to restore effective hematopoietic function.

Objective To analyze the relationship between scar uterine stress and scar thickness/position by using finite element method, so as to study risk factors of scar uterus rupture. Methods Firstly, SolidWorks was used to establish a three-dimensional (3D) model of the uterus with variable scar thickness and position based on uterine size of the pregnant woman at 40th week of gestation, and then the intrauterine pressure was set in the ANSYS software with pressure range of 4.83-23.9 kPa to calculate the uterine stress. Results During the contraction process, the maximum stress was located in uterine scar, the maximum stress on the uterus with scar thickness smaller than 3 mm was greater than tensile strength of the uterus; 3 mm was used as thickness limit of the lower uterine body. If the thickness was smaller than 3 mm, cesarean section should be selected immediately. Otherwise, transvaginal delivery could be selected. When the scar thickness was 3.0 mm, the maximum stress experienced by the uterus decreased at first and then increased with the distance from the uterine floor increasing. The stress at the uterine scar was the smallest when the distance from the uterine floor was 295 mm; when the scar was 285-305 mm from the uterine floor, the ultimate stress on the scar was smaller than its tensile strength, and it was safer to choose a vaginal delivery. Conclusions Risk factors of scar uterine rupture were studied based on ANSYS finite element analysis. The analysis results were consistent with the clinical data, which provided analysis method and theoretical guidance for the choice of delivery method in clinic.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.