Allogeneic hematopoietic stem cell transplantation is an effective method for treating various hematological diseases. Membranous nephropathy is the second leading cause of novo glomerular disease after transplantation. Protocadherin FAT1 is a target antigen for diagnosing membranous nephropathy, primarily related to hematopoietic stem cell transplantation. Here we report a rare case of membranous nephropathy after hematopoietic stem cell transplantation. The target antigen of membranous nephropathy was confirmed to be FAT1 by pathology combined with mass spectrometry analysis. The nephrotic syndrome achieved partial remission after corticosteroid combined with cyclosporine treatment, and the patient's condition was stable during follow-up.

Objective:To investigate the current application of colonoscopy at hospitals in China.Methods:From November 2019 to January 2020, an online questionnaire survey was conducted among gastroenterologists and colonoscopists in hospitals of different levels. The contents of questionnaire survey included basic information of colonoscopy at the respondent′s hospital, protocols and patient education of bowel preparation, implementation of colonoscopy quality control, and colonoscopists′ understanding of polypectomy techniques and post-polypectomy follow-up.Results:A total of 236 valid questionnaires were collected, involving 187 hospitals, and 143 (76.5%) had an annual operation capacity of more than 5 000 cases. In terms of bowel preparation, split-dosed polyethylene glycol electrolyte powder (PEG) was the most commonly used (60.4%, 113/187) and the most common volume of PEG was 3 L (67.4%, 126/187). Verbal (90.9%, 170/187) and written (79.7%, 149/187) instructions were given more often than other methods for patient education of bowel preparation. Antifoaming agent was routinely used in 124 (66.3%) hospitals. In terms of quality control, only 11.5% (20/174) hospitals implemented all four measures. In terms of polypectomy techniques, 98.1% (203/207) colonoscopists chose hot snare polypectomy or endoscopic mucosal resection for lesions of diameter>1 cm, while options varied for lesions of diameter<1 cm. The interval of follow-up after polypectomy recommended by colonoscopists was shorter than that by guidelines.Conclusion:Several problems are found in the survey in the application of colonoscopy in China, i. e., patient education of bowel preparation is not diversified; quality control of colonoscopy still needs to be strengthened; polypectomy techniques and follow-up after polypectomy need to be further standardized.

Objective:To study the significance of induction chemotherapy and subsequent comprehensive therapy for overall survival rate (OS) and larynx dysfunction-free survival rate (LDFS) in patients with advanced hypopharyngeal carcinoma.Methods:Patients who met the inclusion criteria with the diagnoses of advanced hypopharyngeal carcinoma between 2011 and 2017 received 2 or 3 cycles of TPF regimen induction chemotherapy. Patients who attained complete response (CR) received radical chemotherapy. Patients who attained partial response (PR) and the reduction of tumor volume was more than 70% were defined as large PR and received concurrent chemoradiotherapy. When the tumor volume reduction of PR patients was less than 70%, they were defined as small PR. (CR+large PR) group was defined as effective group. Patients who did not reach CR and large PR were defined as uneffective group and underwent radical surgery and received adjuvant radiotherapy as appropriate after the surgery. The end points of the study were OS, progression-free survival (PFS) and LDFS. Chi-square (χ 2) test was used for correlation analysis. Survival analysis was performed by the Kaplan-Meier method with a Log-rank test. Cox proportional hazards model was used for univariate and multivariate survival analysis. Results:A total of 260 patients were enrolled in the study. The follow-up period ranged from 5 to 83 months, with an average of 24.7 months. The 3-year and 5-year OS rate was 46.0% and 32.6%, respectively. The 3-year and 5-year PFS rate was 41.0% and 26.6%, respectively. The 3-year and 5-year LDFS rate was 37.9% and 24.8%, respectively. Poor outcome of induction chemotherapy, advanced N stage, strong positive Ki-67 immunohistochemistry (all P<0.001) were negative prognostic factors. The advanced clinical stage was positively related to the poor outcome of induction chemotherapy ( P=0.015). There was no significant difference in OS and PFS between the large PR group and the small PR group (all P>0.005). Conclusion:TPF regimen induction chemotherapy and subsequent comprehensive therapy for patients with advanced hypopharyngeal carcinoma may improve the quality of life of patients, with high OS rate and LDFS rate.

Objective:To investigate the intra-observer reproducibility of Ki-67　　　assessment in breast cancers using three methods based on digital slide.Methods:Thirty cases of invasive breast cancer tissues were immunostained for Ki-67 by automatic stainer, and then scanned into digital pathological slides. Ki-67 positive index was measured individually by three pathologists using size-set visual assessment of hot spot (SSVAHS), size-set semi-automatic counting of hot spot(SSSACHS), and size-set automatic counting of hot spot (SSACHS), respectively, and repeated for 10 times. Intraclass correlation coefficient (ICC) of each assessment method was calculated, and the intraobserver reliability was classified as excellent, good, fair and poor according to ICC.Results:The ICC by 3 pathologists using SSVAHS was 0.832, 0.843 and 0.826, respectively, The ICC using SSSACHS was 0.926,0.938,0.929, and the ICC using SSACHS was 0.964, 0.971 and 0.968.The intraobserver reliability level of all three methods was excellent.Conclusion:The three methods of Ki-67 assessment achieve satisfactory intraobserver reproducibility, and the order of reproducibility from high to low is SSACHS, SSSACHS, and SSVAHS.

Objective To explore the clinical effect of three doses of mifepristone on patients with dysfunc-tional uterine bleeding.Methods 150 patients with dysfunctional uterine bleeding were chosen,and they were randomly divided into 3 groups,including low dose group (50 patients),middle dose group (50 patients)and high dose group (50 patients).All patients adopted routine treatment.On the basis of this,the low dose group received 6.25mg/d mifepristone,the middle dose group received 12.5mg/d mifepristone,the high dose group received 18.25mg/d mifepristone,continued 6 months.The influence of follicle stimulating hormone (FSH),luteinizing hor-mone (LH),estradiol (E),progesterone (P),volume of uterine and endometrail thickness of patients were observed. Results After treatment,the FSH,LH,E and P levels in the three groups were significantly decreased compared with before treatment (FSH:t=4.406,5.329,3.610,LH:t=4.563,6.134,4.455,P=0.000,0.000,0.000;P=0.000, 0.000,0.000;E:t=7.173,6.815,7.018,P=0.000,0.000,0.000;E:t=2.367,6.315,4.351,P=0.020,0.000, 0.000),and the difference were statistically significant (all P<0.05).Before and after treatment,FSH,LH,P levels among the three groups had no obvious differences (P>0.05 ).Compared with the low dose group,E levels in the middle dose group and high dose group significantly decreased(t=3.850,2.085,P=0.000,0.004).Before and after treatment,the uterine volume among the three groups had no significant difference (P>0.05 ).After treatment,the functional uterine bleeding symptoms were significantly relieved in the three groups,the effective rate was 100%.The recurrence rate of the low dose group was 32%,which was significantly higher than 8%and 10%of the middle dose group and high dose group.The amenorrhea rate of the middle dose group and high dose group(6% and 2%)was significantly lower than that of the low dose group (46%).Conclusion The treatment of 12.5mg/d mifepristone is effectively adapted to patients with dysfunctional uterine bleeding.

Objective To study the effect of multi-disciplinary teamwork (MDT) nursing mode on perioperative care to breast cancer patients. Methods One hundred and twenty breast cancer patients undergoing surgical operations were evenly randomized into the observation and control groups by random digit number table. The control group was treated with routine nursing care and the observation group with MDT nursing mode. Result The rate of complications (like subcutaneous effusion, lymphatic edema and skin flap necrosis) in the observation group was significantly lower than that of the control group and the hospital stay was significantly shorter than that of the control group as well (all P<0.05). Conclusion The MDT nursing mode can reduce the rate of complications, shorten the hospital stay and relieve patient′s depression.

Objective To analyze the magnetic resonance imaging ( MRI ) appearances of spontaneous intracranial hypotension syndrome ( SIHS) ,in order to improve the understanding of this disease .Methods The clini-cal data of 7 patients with SIHS confirmed by lumbar puncture were retrospectively analyzed .MRI was performed in all cases,in which there were 6 cases with contrast-enhanced MRI.Results All of them showed diffusely thickening of dural.6 cases with brain contrast-enhanced MRI demonstrated linear ,non-nodular and diffusely dural enhancement . The dilation of sinus and great vein were observed in 5 cases,subdural hydroma in 2 cases,brain sagging in 3 cases, pituitary gland plumpness in 2 cases,subdural hematoma in 1 case and 1 case with linear spinal dural enhancement . Conclusion The MRI manifestations of SIHS are characteristic ,and it will be helpful for the diagnosis by combining clinical data.

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.

Objective To investigate the effects of physical exercises on cardiac function and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in hypertensive patients combined with diastolic cardiac dysfunction.MethodsA total of 66 essential hypertension patients who had abnormal left ventricular relaxation and normal systolic function were assigned to the intervention group ( n =33 ; doing physical exercises once a day,5 days a week) or control group (n =33 ).All the patients received standard treatment.At 6 months,body weight,blood pressure,heart rate,NT-proBNP,and echocardiography were measured.ResultsAt 6 months,body weight [ (68 ± 7 ) kg vs (72 ± 8 ) kg ],systolic blood pressure [ (135.4 ±5.1) mm Hg (1 mm Hg =0.133 kPa) vs (141.9 ±5.2) mm Hg ],diastolic blood pressure [ (81.1 ±4.0) mm Hg vs (84.7 ±4.6) mm Hg],New York Heart Association class (1.4 ±0.3 vs 1.8 ±0.4),NT-proBNP level [ (526 ± 126 ) ng/L vs (741 ± 189 ) ng/L] were significantly decreased in the intervention group when compared with the control group ( all P ＜ 0.05 ) although left ventricular ejection fraction (LVEF) (62.9 ±6.7 vs 59.0 ±5.6) and E/A ratio ( 1.1 ±0.3 vs 0.9 ±0.3) were significantly increased ( both P ＜ 0.05).ConclusionPhysical exercises could play a role in reduced blood pressure and body weight and improved cardiac function in hypertensive patients with diastolic cardiac dysfunction.

Objective To investigate the change of CD_4~+CD_(25)~(high)CD_(127)~(low)> regulatory T cells (Trcg cells) sub-group level in peripheral blood of non-Hodgkin lymphama (NHL) patients, and to explore its clinical significance. Methods Treg cells levels in peripheral blood of lymphoma patients and normal were detected by flow cytometry, followed by statistical analysis. Results In the 65 cases of NHL patients, Treg cells in peripheral blood were (6.72±1.38) %, higher than that in the normal control group (5.65±0.68) % (P <0.05). Percentage of Treg cells are significantly different between clinical stages and normal: [P <0.05, normal control group (5.65±0.88) %, Ⅰ -Ⅱ period (6.08±1.18) %, Ⅲ-Ⅳ period (6.95±0.85) %]. The percentage of Treg cells are also different among pathological types of patients and normal [P <0.05, normal control group (5.65± 0.68) %. The percentage of Treg diffuse large B-cell lymphoma (5.83±0.95) % and other subtypes of lymphoma (7.83±1.76) %]were observed. It is not sure that Treg cells percentage among patients with different levels of lactate dehydrogenase and normal are significantly different. [P >0.05, normal control group (5.65±0.68) %, patients with normal LDH group (6.97±1.20) %, patients with lactate dehydrogenase (6.54±1.02) %]. Conclusion Treg cells induced by tumor and could inhibit the immune cells, Treg cells percentage in peripheral blood of tumor patients is higher than that the normal control group, and increased with the clinical staging, so the percentage of Treg cells may serve as a clinical indicator to evaluate tumor load.