This study was aimed at determining the molecular characteristics of Yersinia pestis in the natural plague foci around Qinghai Lake through single nucleotide polymorphism technology,to lay a foundation for molecular epidemiological and source-tracing analysis of Y.pestis in this area.Using the whole genome sequencing technology,we obtained the whole genome sequences of 84 representative Y.pestis strains.Using the sequences of Y.pestis and Yersinia pseudotuberculosis IP32953 from the NCBI database as references,we compared and analyzed the 2 298 SNP loci of these strains.From 1957 to 2020,84 representative strains of Y.pestis from the natural plague foci around Qinghai Lake were divided into two clades:1.IN2 and 3.ANT1.The 1.IN2 clade was the characteristic population of Y.pestis throughout all epidemic years in this area.Additionally,analysis of the SNP distribution and hosts in the region indicated that the 1.IN2 clade was located in five counties except Wulan,whereas the 3.ANT1 clade was isolated from Himalayan marmot and dog in two counties.In conclusion,the population structure of SNP of Y.pestis in the natural plague foci around Qinghai Lake is relatively simple,and SNP analysis of Y.pestis provided a scientific basis for tracing plague epidemic sources and formulating plague prevention and control measures in this area.

Linxian County in Henan Province, Northern China is known as the region with the highest incidence and mortality rate of esophageal cancer worldwide. Since 1959, the Henan medical team has conducted field work on esophageal cancer prevention and treatment in Linxian. Through three generations of effort exerted by oncologists over 65 years of research on esophageal cancer prevention and treatment in Linxian, the incidence rate of esophageal squamous cell carcinoma in this area has dropped by nearly 50%, and the 5-year survival rate has increased to 40%, reaching the international leading level. This article aims to summarize the history, present opportunities and new challenges, and explore the experience of esophageal cancer prevention and treatment in Linxian (referred to as the “Linxian experience”), providing reference and guidance to cancer prevention and treatment research in China.

Objective: To investigate the characteristics of malignant tumor incidence and mortality in cancer registration areas of Sichuan Province in 2021. Methods: Cancer registration data from 142 registries in Sichuan Province in 2021 were collected via the China Cancer Registry Platform. Crude incidence and crude mortality were calculated. The Chinese population-standardized incidence and world population-standardized incidence were standardized using the age structure of the standard population from the Fifth National Population Census in 2000 and Segi's world standard population. Descriptive analyses examined the distribution of rates by genders, urban/rural areas, and ages, and the ranking of leading cancer sites. Results: In 2021, there were 248 600 new malignant tumor cases reported in Sichuan Province, with a crude incidence of 296.37/100 000. The Chinese population-standardized incidence and world population-standardized incidence were 164.67/100 000 and 160.47/100 000, respectively. There were 158 673 malignant tumor deaths, with a crude mortality of 189.16/100 000. The Chinese population-standardized mortality and world population-standardized mortality were 92.47/100 000 and 92.00/100 000, respectively. The Chinese population-standardized incidence and mortality in males were higher than in females (179.56/100 000 vs. 151.62/100 000, 125.09/100 000 vs. 60.35/100 000). The Chinese population-standardized incidence and mortality in urban areas were higher than in rural areas (175.74/100 000 vs. 157.54/100 000, 93.63/100 000 vs. 91.82/100 000). Both the crude incidence and crude mortality increased with age. The top ten malignant tumors by crude incidence were lung cancer, colorectal cancer, liver cancer, breast cancer, esophageal cancer, gastric cancer, cervical cancer, prostate cancer, thyroid cancer, and corpus uteri cancer, accounting for 76.33% of all new cases. The top ten by crude mortality were lung cancer, liver cancer, esophageal cancer, colorectal cancer, gastric cancer, breast cancer, pancreatic cancer, cervical cancer, prostate cancer, and brain tumors, accounting for 82.39% of all cancer deaths. Conclusions In registration areas of Sichuan Province, the incidence and mortality of malignant tumors are relatively low. Key populations such as males, urban residents, and the elderly require focused prevention and control efforts. Comprehensive measures should be prioritized for malignant tumors including lung cancer, liver cancer, esophageal cancer, gastric cancer, colorectal cancer, and breast cancer.

This study was aimed at determining the molecular characteristics of Yersinia pestis in the natural plague foci around Qinghai Lake through single nucleotide polymorphism technology,to lay a foundation for molecular epidemiological and source-tracing analysis of Y.pestis in this area.Using the whole genome sequencing technology,we obtained the whole genome sequences of 84 representative Y.pestis strains.Using the sequences of Y.pestis and Yersinia pseudotuberculosis IP32953 from the NCBI database as references,we compared and analyzed the 2 298 SNP loci of these strains.From 1957 to 2020,84 representative strains of Y.pestis from the natural plague foci around Qinghai Lake were divided into two clades:1.IN2 and 3.ANT1.The 1.IN2 clade was the characteristic population of Y.pestis throughout all epidemic years in this area.Additionally,analysis of the SNP distribution and hosts in the region indicated that the 1.IN2 clade was located in five counties except Wulan,whereas the 3.ANT1 clade was isolated from Himalayan marmot and dog in two counties.In conclusion,the population structure of SNP of Y.pestis in the natural plague foci around Qinghai Lake is relatively simple,and SNP analysis of Y.pestis provided a scientific basis for tracing plague epidemic sources and formulating plague prevention and control measures in this area.

Objective:To explore the clinical manifestations,pathological features,immunophenotype,as well as diagnosis,treatment and prognosis of patients with CD4-CD56+blastic plasmacytoid dendritic cell neoplasm(BPDCN),in order to further understand the rare disease.Methods:The clinical data,laboratory examinations and treatment regimens of two patients with CD4-CD56+BPDCN in the First Affiliated Hospital of Wannan Medical College were retrospectively analyzed.Results:The two patients were both elderly males with tumor involved in skin,bone marrow,lymph nodes,etc.Immunohistochemical results of skin lesions showed that both CD56 and CD123 were positive,while CD4,CD34,TdT,CD3,CD20,MPO and EBER were negative.Flow cytometry of bone marrow demonstrated that CD56,CD123,and CD304 were all positive,while specific immune markers of myeloid and lymphoid were negative.Two patients were initially very sensitive to acute lymphoblastic leukemia or lymphomatoid chemotherapy regimens,but prone to rapid relapse.The overall survival of both patients was 36 months and 4 months,respectively.Conclusion:CD4-CD56+BPDCN is very rare and easily misdiagnosed as other hematological tumors with poor prognosis.Acute lymphoblastic leukemia or lymphomatoid therapy should be used first to improve the poor prognosis.

OBJECTIVE: To observe the effect of fire needling on prostate symptoms, quality of life, average daily number of nightly urination, urine flow rate and prostat volume in patients with mild to moderate benign prostatic hyperplasia (BPH) of kidney yang deficiency. METHODS: A total of 60 patients with mild to moderate BPH of kidney yang deficiency were randomly divided into an observation group (30 cases, 3 cases dropped off) and a control group (30 cases, 4 cases dropped off). The observation group was treated with fire needling at Guanyuan (CV 4), Shuidao (ST 28) and Qugu (CV 2) twice a week (2-3 d interval between each treatment), continuous treatment for 4 weeks. The control group received lifestyle advice and education, once a week for 4 weeks. In the two groups, the international prostate symptom score (IPSS), the quality of life (QoL) score and the average daily number of nightly urination were observed before treatment, after treatment and during the follow-up of the 4th week; the urinary maximum flow rate (Qmax), the average flow rate (Qave), and the prostate volume were assessed before and after treatment in the two groups. The safety was observed in the observation group. RESULTS: After treatment and during follow-up, the IPSS scores, QoL scores, and the average daily number of nightly urination in the observation group were decreased compared with those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax, Qave and prostate volume between the two groups and within the each group (P>0.05). There were no fire needling-related adverse reactions, and no obvious abnormality was found in urine routine and coagulation function tests before and after treatment in the observation group. CONCLUSION Fire needling can improve lower urinary tract symptoms and quality of life, reduce frequency of nightly urination in patients with mild to moderate BPH of kidney yang deficiency, and has good safety.
Male ; Humans ; Prostatic Hyperplasia/therapy* ; Quality of Life ; Yang Deficiency ; Treatment Outcome ; Kidney

Objective:To explore the clinical values of PICaSSO histological remission index (PHRI) in evaluation of ulcerative colitis (UC) .Methods:A cross-sectional study was conducted. Clinical data of UC patients diagnosed in the Department of Gastroenterology of Peking Union Medical College Hospital from June 2018 to October 2019 were collected, including demography characteristics, Montreal classification, serological indicatiors, Mayo score and Mayo endoscopic score (MES), ulcerative colitis endoscopic index of severity (UCEIS), Robarts histopathology index (RHI) and PHRI. Mayo score was used to evaluate the clinical activity of the disease. MES = 0 or UCEIS ≤1 point was defined as endoscopic remission (ER), and RHI ≤3 points or PHRI<1 point as histological remission (HR). Spearman correlation analysis was used to evaluate the correlations of PHRI with serological indicators, endoscopic scores, and RHI. Kappa test was used to analyze the consistency between scores. Results:A total of 60 UC patients (31 men, 29 women; mean age, 40.5±13.7 years) were enrolled. The lesion located in the rectum (E1) in 11 patients, left colon (E2) in 14 and extensive colon (E3) in 35. According to the Mayo score, clinical remission occurred in 20 patients, mild activity in 20, moderate activity in 12 and severe activity in 8. A total of 15 patients with PHRI<1 point were assigned to PHRI-HR group, while 45 patients with PHRI≥1 point were assigned to non-HR group. Spearman correlation analysis showed that there was a negative correlation between PHRI and serum albumin level ( r s = -0.327, P = 0.011) ; there were strong positive correlations of PHRI with MES and UCEIS scores ( r s = 0.698, 0.735, both P<0.001) and there was an extremely strong positive correlation of PHRI with RHI ( r s = 0.868, P<0.001). The difference in serum albumin levels between the PHRI-HR group and the non-HR group was statistically significant ( Z = -2.364, P = 0.018). Kappa consistency test showed that the results of MES-ER and PHRI-HR were moderately consistent ( κ = 0.535, P<0.001), and the specificity and accuracy of PHRI-HR judged by MES-ER were 91.1% and 83.3%, respectively. The results of UCEIS-ER and PHRI-HR were also moderately consistent ( κ = 0.542, P<0.001), and the specificity and accuracy of PHRI-HR judged by UCEIS-ER were 90.5% and 81.7%, respectively. The results of RHI-HR and PHRI-HR were strongly consistent ( κ = 0.644, P<0.001), and the specificity and accuracy of PHRI-HR judged by RHI-HR were 73.3% and 86.7%, respectively. Conclusion:PHRI is strongly correlated with RHI and endoscopic scores and may be a potential optimal histopathological score in evaluation of UC disease activities.

Objective:To explore the clinical values of PICaSSO histological remission index (PHRI) in evaluation of ulcerative colitis (UC) .Methods:A cross-sectional study was conducted. Clinical data of UC patients diagnosed in the Department of Gastroenterology of Peking Union Medical College Hospital from June 2018 to October 2019 were collected, including demography characteristics, Montreal classification, serological indicatiors, Mayo score and Mayo endoscopic score (MES), ulcerative colitis endoscopic index of severity (UCEIS), Robarts histopathology index (RHI) and PHRI. Mayo score was used to evaluate the clinical activity of the disease. MES = 0 or UCEIS ≤1 point was defined as endoscopic remission (ER), and RHI ≤3 points or PHRI<1 point as histological remission (HR). Spearman correlation analysis was used to evaluate the correlations of PHRI with serological indicators, endoscopic scores, and RHI. Kappa test was used to analyze the consistency between scores. Results:A total of 60 UC patients (31 men, 29 women; mean age, 40.5±13.7 years) were enrolled. The lesion located in the rectum (E1) in 11 patients, left colon (E2) in 14 and extensive colon (E3) in 35. According to the Mayo score, clinical remission occurred in 20 patients, mild activity in 20, moderate activity in 12 and severe activity in 8. A total of 15 patients with PHRI<1 point were assigned to PHRI-HR group, while 45 patients with PHRI≥1 point were assigned to non-HR group. Spearman correlation analysis showed that there was a negative correlation between PHRI and serum albumin level ( r s = -0.327, P = 0.011) ; there were strong positive correlations of PHRI with MES and UCEIS scores ( r s = 0.698, 0.735, both P<0.001) and there was an extremely strong positive correlation of PHRI with RHI ( r s = 0.868, P<0.001). The difference in serum albumin levels between the PHRI-HR group and the non-HR group was statistically significant ( Z = -2.364, P = 0.018). Kappa consistency test showed that the results of MES-ER and PHRI-HR were moderately consistent ( κ = 0.535, P<0.001), and the specificity and accuracy of PHRI-HR judged by MES-ER were 91.1% and 83.3%, respectively. The results of UCEIS-ER and PHRI-HR were also moderately consistent ( κ = 0.542, P<0.001), and the specificity and accuracy of PHRI-HR judged by UCEIS-ER were 90.5% and 81.7%, respectively. The results of RHI-HR and PHRI-HR were strongly consistent ( κ = 0.644, P<0.001), and the specificity and accuracy of PHRI-HR judged by RHI-HR were 73.3% and 86.7%, respectively. Conclusion:PHRI is strongly correlated with RHI and endoscopic scores and may be a potential optimal histopathological score in evaluation of UC disease activities.

OBJECTIVE: To evaluate the pathological characteristics of endoscopic submucosal dissection (ESD) specimens for early gastric cancer and precancerous lesions, accumulating experience for clinical management and pathological analysis. METHODS: A total of 411 cases of early gastric cancer or precancerous lesions underwent ESD. According to the Japanese guidelines for ESD treatment of early gastric cancer and classification of gastric carcinoma, the clinicopathological data, pathologic evaluation, concordance rate of pathological diagnosis between preoperative endoscopic forceps biopsies and their ESD specimens (in 400 cases), as well as the risk factors of non-curative resection of early gastric cancer, were analyzed retrospectively. RESULTS: 23.4% (96/411) of the 411 cases were adenoma/low-grade dysplasia and 76.6% (315/411) were early gastric cancer. The latter included 28.0% (115/411) non-invasive carcinoma/high-grade dysplasia and 48.7% (200/411) invasive carcinoma. The concordance rate of pathological diagnosis between endoscopic forceps biopsies and ESD specimens was 66.0% (264/400), correlating with pathological diagnosis and lesion location (P < 0.01). The rate of upgraded diagnosis and downgraded diagnosis after ESD was 29.8% (119/400) and 4.2% (17/400), respectively. Among the 315 cases of early gastric cancer, there were 277 cases (87.9%) of differentiated type and 38 cases (12.1%) of undifferentiated type. In the study, 262 cases (83.2%) met with absolute indication, while 53 cases (16.8%) met relative indication. En bloc and curative resection rates were 98.1% and 82.9%, respectively. Risk factors for non-curative resection included a long diameter >20 mm (OR=3.631, 95%CI: 1.170-11.270, P=0.026), tumor infiltration into submucosa (OR=69.761, 95%CI: 21.033-231.376, P < 0.001)and undifferentiated tumor histology (OR=16.950, 95%CI: 4.585-62.664, P < 0.001). CONCLUSION Several subjective and objective factors, such as the limitations of biopsy samples, the characteristics and distribution of the lesions, different pathological understanding, and the endoscopic sampling and observation, can lead to the differences between the preoperative and postoperative pathological diagnosis of ESD. In particular, the pathological upgrade of postoperative diagnosis was more significant and should receive more attention by endoscopists and pathologists. The curative resection rate of early gastric cancer in ESD was high. Non-curative resection was related to the long diameter, the depth of tumor invasion and histological classification. ESD can also be performed in undifferentiated early gastric cancer if meeting the indication criteria. The comprehensive and standardized pathological analysis of ESD specimens is clinically important to evaluate the curative effect of ESD operation and patient outcomes.
Humans ; Stomach Neoplasms/pathology* ; Endoscopic Mucosal Resection ; Retrospective Studies ; Endoscopy ; Precancerous Conditions

Abstract: Objective　To investigate the clustered regularly interspaced short palindromic repeats (CRISPR) genotypes and regional distribution of Yersinia pestis strains in the natural plague foci of Hainan Tibetan Autonomous Prefecture of Qinghai Province (referred to as "Hainan prefecture") and provide a scientific basis for plague prevention and control in this area. Methods　A total of 36 representative Yersinia pestis strains, which were isolated from different host animals and insect vectors from 1954 to 2009 in Hainan Prefecture, were selected as experimental subjects. The DNAs were extracted using the traditional sodium dodecyl sulfate decomposition and phenol-chloroform method. Three pairs of CRISPR primers (YPa, Ypb, YPc) were used for PCR amplification, sequencing and analysis of the DNA of the tested strains, respectively, as a means to identify the CRISPR genotypes of Yersinia pestis in Hainan Prefecture. Results　A total of 17 spacers were observed among 36 strains of Yersinia pestis, including 9 of YPa, 5 of YPb and 3 of YPc. All strains were divided into 5 CRISPR gene clusters (Cb2, Cb4 ', Ca7, Ca7 ', Ca35 ') and 6 genotypes (G1, G9, G22, G22-A1 ', G26-A1 ', G26-A1 'A4 -). The G26-a1 ' was the main genotype, which was distributed in Gonghe, Guide and Xinghai County, and the G22 is the second type, which was distributed in Gonghe and Guide County. Conclusions　The genetic polymorphism of CRISPR loci of Yersinia pestis strains in Hainan was high, and the regional distribution characteristics of Yersinia pestis strains with different genotypes were significant.