A case of giant liquid tophus in both lower legs was reported. The patient was a 41-year-old man with a history of gout for more than 10 years. The patient had hyperlipidemia and prediabetes, and the long-term use of hormone cortisol drugs was suspected. After standardized treatment for lowering uric acid, reducing blood lipids, and correcting glucose intolerance, the patient lost 12 kg over six months. The patient was admitted to the hospital upon discovering symmetrical enlargement of both calves. Ultrasound showed subcutaneous masses with clear boundaries behind the gastrocnemius muscle, approximately 14.9 cm×6.7 cm on the left and 13.6 cm×4.6 cm on the right. Based on the clinical information and morphological features, a diagnosis of gouty tophus was made. Following ultrasound-guided puncture drainage, aspirate about 200 mL fluid from the subcutaneous masses of each lower legs. The patient continued to receive standardized uric acid-lowering treatment and the patient′s condition improved. For such atypical giant liquid tophus, clinical practitioners should remain vigilant, differentiating them from tumors, infections, autoimmune diseases, and promptly perform pathological examinations through puncture to be diagnosed. After a definitive diagnosis, surgical excision can be performed concurrently with standardized uric acid-lowering treatment to achieve a favorable prognosis.

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Epithelial ovarian cancer (EOC) is one of the leading causes of death from gynecologic cancers and peritoneal dissemination is the major cause of death in patients with EOC. Although the loss of 4.1N is associated with increased risk of malignancy, its association with EOC remains unclear. To explore the underlying mechanism of the loss of 4.1N in constitutive activation of epithelial-mesenchymal transition (EMT) and matrix-detached cell death resistance, we investigated samples from 268 formalin-fixed EOC tissues and performed various in vitro and in vivo assays. We report that the loss of 4.1N correlated with progress in clinical stage, as well as poor survival in EOC patients. The loss of 4.1N induces EMT in adherent EOC cells and its expression inhibits anoikis resistance and EMT by directly binding and accelerating the degradation of 14-3-3 in suspension EOC cells. Furthermore, the loss of 4.1N could increase the rate of entosis, which aggravates cell death resistance in suspension EOC cells. Moreover, xenograft tumors in nude mice also show that the loss of 4.1N can aggravate peritoneal dissemination of EOC cells. Single-agent and combination therapy with a ROCK inhibitor and a 14-3-3 antagonist can reduce tumor spread to varying degrees. Our results not only define the vital role of 4.1N loss in inducing EMT, anoikis resistance, and entosis-induced cell death resistance in EOC, but also suggest that individual or combined application of 4.1N, 14-3-3 antagonists, and entosis inhibitors may be a promising therapeutic approach for the treatment of EOC.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has become a widely used method in the field of microbial identification. Its obvious advantages including rapidity, great accuracy and high throughput attract many researchers to investigate its potential for usage in other microbiological fields. Currently, several studies have reported MALDI-TOF MS-based analysis of bacterial resistance to antibiotics, which can identify the specific heterogeneous spectrum peaks related to drug resistance through simple visual analysis of the spectrum or more complex analysis of the entire spectrum using informatics methods and statistical approaches. Therefore, MALDI-TOF MS has become a potential tool for detecting antibiotic resistance in bacteria. This review mainly summarized the progress in MALDI-TOF MS-based analysis of bacterial resistance to antibiotics.

Objective:To investigate the molecular pathological diagnostic strategy of twin pregnancy(TP) with complex genetic characteristics, using p57 immunohistochemistry and short tandem repeat (STR) genotyping.Methods:Ten cases of TP with suspected hydatidiform mole(HM) according to pathological morphology were collected in Peking University Third Hospital from 2015 to 2019, and were subject to p57 immunohistochemistry, STR genotyping and follow-up.Results:The age of ten patients ranged 23 to 36 years, with an average of 29.5 years. Seven patients accepted assisted reproductive techniques in this conception. Three patients with "divergent" p57 staining pattern were diagnosed as TP with complete HM by STR, in which one had a persistent trophoblastic disease. The villi of five patients were consistently positive for p57, but the genotyping result was polyploid and suspicious as TP. Four of them showed excessive paternal alleles at more than 40% of the loci, suggesting that concomitant partial moles could not be excluded. One patient was diagnosed as TP without HM according to the maternal allelic predominance at all loci in villi. Two patients with p57 "divergent" and "discordant" staining villi were genotyped as TP with mosaic conception.Conclusions:The correct identification of p57 staining pattern and accurate interpretation of STR genotyping results are important in diagnosing TP. It may assist pathologists in making a definite or likely diagnosis of TP with complex genetic features to fulfill clinical triage strategies and contribute to formulate a reasonable follow-up approach.

Objective: To explore molecular characteristics of endometrial endometrioid cancer according to The Cancer Genome Atlas (TCGA) based molecular classification of endometrial carcinomas and to confirm simple and clinically applicable surrogate methodologies in pathological practice. Methods: Two hundred and twenty-eight cases of endometrial endometroid adenocarcinomas (EnACs) collected from August 2001 to August 2017 from Peking University Health Science Center, Peking University Third Hospital were molecularly categorized by using Sanger sequencing for the exonuclease domain mutations (EDM) of POLE, and by immunohistochemistry for p53 and mismatch repair (MMR) proteins. The cohort was classified into polymerase-E exonuclease domain mutation (POLE EDM), mismatch repair deficiency (MMR-D), p53 abnormal (p53-abn) and p53 wild type (p53-wt) groups. The correlation between molecular subgroups and the clinical-pathological features including prognosis were analyzed. Results: The cohort was distributed as follows: 11(4.8%) POLE EDM, 47(20.6%) MMR-D, 9(4.0%) p53-abn and 161(70.6%) p53-wt. p53-wt subgroup patients demonstrated significantly higher lymph node metastasis (P=0.011) and more advanced stage (P=0.036) than those of somatic hypermutation group cases (POLE EDM and MMR-D). In the FIGO grade 2-3 EnACs cohort, TCGA molecular subtyping was significantly correlated with progression-free survival and overall survival (P=0.043). POLE EDM subgroup had the best survival, while p53-abn subgroup had the worst. Conclusions Identification of POLE EDM and MMR-D subgroups provides independent and highly valuable prognostic information beyond established histological classification. Based on immunohistochemistry of MMR, p53 and POLE mutational analysis, this pragmatic molecular classification scheme can be served as a reliable surrogate for TCGA molecular classification, which has potential to be used routinely in Chinese pathological practice.

Objective: To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC). Methods: A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SET Ⅱ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively. Results: The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SET Ⅰ and 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SET Ⅰ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P<0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P<0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio. Conclusions The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.

Objective To investigate the significance of Silva pattern system about clinical application in invasive endocervical adenocarcinoma. Methods Data obtained from the Maternity Affiliated Hospital of Dalian Medical University was analyzed, 78 endocervical adenocarcinoma cases were included from December, 2006 to August, 2017. The average age of patients was (45.1 ± 9.1) years old (ranged 27-71 years old). Clinical stage: stageⅠa 26 cases and Ⅰb 49 cases and stage Ⅱa 3 cases. All pathological slides were reviewed, stratified cases into pattern A, B and C according to Silva system criteria.Clinicopathological parameters of three Silva subgroups were analyzed, χ2 test was used to investigate the correlation of Silva system and clinicopathological parameters. Follow-up data were collected until Jan. 3rd, 2018. The median follow-up time was 41 months (ranged 5-90 months). Kruskal-Wallis H test and Fisher test were used to analyze prognoses among different Silva subgroups. Results (1) Silva A cases accounted for 38％(30/78) of all patients, 24 cases were stageⅠa, 6 cases were stageⅠb. The median tumor thickness was 2.1 mm (ranged 1.0-10.0 mm). No lymph vascular space invasion (LVSI) and perineural invasion (PNI) was detected, and all lymph node (LN) were negative for metastatic carcinoma. All patients were alive and had no evidence of recurrence. About 21％(16/78) cases were classified as Silva B, including 2 stageⅠa and 14 stage Ⅰb. The median tumor thickness was 5.2 mm (ranged 2.0-11.0 mm). Several patients had LVSI (4/16), LN metastasis (1/10) or PNI (1/16), but there was no recurrence or death. Thirty two (41％,32/78) cases were Silva C, including 29 stageⅠb and 3 stageⅡa. The median tumor thickness was 11.5 mm (ranged 4.0-21.0 mm). The incidence of LVSI (53％, 17/32), LN metastasis (31％, 8/26) or PNI (16％, 5/32) was significantly increased. There were two recurrent cases and one death cases. (2) Statistical data demonstrated that Silva pattern system was closely correlated with clinicopathological parameters , such as clinical stage (r=0.754, P=0.000), tumor depth (P=0.000) and LVSI (r=0.534, P=0.000). But there was no correlation between Silva system and LN metastasis or PNI (all P>0.05). (3) Silva subgroups demonstrated no significant difference in recurrence and death (P>0.05). Conclusions The application of Silva pattern system could effectively predict the prognosis of patients. It may be helpful to select reasonable operation before surgery and to realize individualized treatment of cervical adenocarcinoma.

Objective To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC). Methods A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SETⅡ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively. Results The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SETⅠand 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SETⅠand HGSC-SETⅡ(P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SETⅠ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P＜0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P＜0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio. Conclusions The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.

Objective To explore molecular characteristics of endometrial endometrioid cancer according to The Cancer Genome Atlas (TCGA) based molecular classification of endometrial carcinomas and to confirm simple and clinically applicable surrogate methodologies in pathological practice. Methods Two hundred and twenty?eight cases of endometrial endometroid adenocarcinomas (EnACs) collected from August 2001 to August 2017 from Peking University Health Science Center, Peking University Third Hospital were molecularly categorized by using Sanger sequencing for the exonuclease domain mutations (EDM) of POLE, and by immunohistochemistry for p53 and mismatch repair (MMR) proteins. The cohort was classified into polymerase?E exonuclease domain mutation (POLE EDM), mismatch repair deficiency (MMR?D), p53 abnormal (p53?abn) and p53 wild type (p53?wt) groups. The correlation between molecular subgroups and the clinical?pathological features including prognosis were analyzed. Results The cohort was distributed as follows: 11(4.8%) POLE EDM, 47(20.6%) MMR?D, 9(4.0%) p53?abn and 161(70.6%) p53?wt. p53?wt subgroup patients demonstrated significantly higher lymph node metastasis (P=0.011) and more advanced stage (P=0.036) than those of somatic hypermutation group cases (POLE EDM and MMR?D). In the FIGO grade 2?3 EnACs cohort, TCGA molecular subtyping was significantly correlated with progression?free survival and overall survival (P=0.043). POLE EDM subgroup had the best survival, while p53?abn subgroup had the worst. Conclusions Identification of POLE EDM and MMR?D subgroups provides independent and highly valuable prognostic information beyond established histological classification. Based on immunohistochemistry of MMR, p53 and POLE mutational analysis, this pragmatic molecular classification scheme can be served as a reliable surrogate for TCGA molecular classification, which has potential to be used routinely in Chinese pathological practice.