Objective To investigate the clinicopathological characteristics of extranodal NK/T cell lymphoma(ENKTL)with B-lymphocytosis.Methods Two cases of ENKTL with B-lymphocytosis diagnosed in Shaanxi Provincial People's Hospital from June to September 2023 were collected.HE staining,immunohistochemistry,and in situ hybridisation Epstein-barr virus encoded small RNA(EBER)testing was used to observe the histological features,immunophenotypes,and results of the in situ hybridisation EBER testing.A review of the relevant literature was conducted.Results In two cases of elderly male patients,whose lesion sites were on both the right side of the nasal cavity,histological characteristics of the tumor cells were diffuse distribution.The cells were of different sizes,mainly medium and large cells,with irregular nuclei,stained or transparent cytoplasm,oval nuclei,granular chromatin and inconspicuous nucleoli.Nuclear schizophrenia was more common and coagulative necrosis and apoptosis were evident.Foci of small lymphocyte aggregates were seen in the background and lymphoid follicles were distributed in a scattered manner.Immunohistochemical CD2,CD3,CD56,TIA-1 and granzyme B(GrB)were positive.CD20,CD79a and PAX-5 were focal positive.CD21,CD23 and CD35 had residual FDC network,and CD5 was negative.Ki-67 proliferation index was approximately 30%.EBER tumor cells detected by in situ hybridisation were positive.Pathological diagnosis showed ENKTL with B-lymphocytosis.Conclusion NKTL with B-lymphocytosis was rare,especially when B-lymphocyte hyperplasia formed lymphoid follicles.Lack of experience can easily cause diagnostic difficulties,and comprehensive analysis and diagnosis should be combined with the clinical manifestations,histological morphology and immunophenotype.

Objective To explore the relationship between the expression levels of serum cingulate protein(CGN)and polyligand glycan 1(SDC-1)and the disease condition and outcome of hypertensive basal ganglia hemorrhage(HBGH).Methods A total of 123 patients with HBGH admitted to the Second People's Hospi-tal of Lianyungang from February 2019 to February 2022 were selected as the study objects,and 120 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the health group.Serum CGN and SDC-1 expression levels were detected in the two groups.According to the dis-ease outcome,the patients were divided into the improved group(92 cases)and the deteriorated group(31 ca-ses).Receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the predictive value of serum CGN and SDC-1 expression levels on the disease outcome of patients with HB-GH.Results Serum CGN and SDC-1 expression levels in the severe group were higher than those in the mod-erate group and the mild group,and serum CGN and SDC-1 levels in the moderate group were higher than those in the mild group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in HBGH patients in three groups were higher than those in health group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in the deteriorated group were higher than those in the improved group,and the differences were statistically significant(P＜0.05).The AUC of serum CGN and SDC-1 for predicting the disease outcome of HBGH patients was 0.742(95％CI:0.792-0.697)and 0.861(95％CI:0.906-0.910),respectively,and the AUC of the combination of the two was 0.917(95％CI:0.962-0.870).The amount of blood loss and ventricular rupture in the deteriorated group were higher than those in the improved group,and the Glasgow Coma Scale(GCS)score on admission was lower than that in the improved group,and the differences were statistically significant(P＜0.05).Multi-variate Logistic regression analysis showed that serum CGN≥51.63 pg/mL(OR=3.815),serum SDC-1≥450.67 μg/L(OR=4.230)and GCS score ≤8(OR=5.333)were the influencing factors for disease outcome of HBGH patients(P＜0.05).Conclusion The increased expression levels of serum CGN and SDC-1 are closely related to the disease aggravation and the deterioration of the disease outcome in patients with HBGH,and they have certain predictive value for the disease outcome in patients with HBGH.

Objective:To investigate the clinical value of ultrasound in evaluating pharyngeal dysphagia after stroke.Methods:Thirty stroke survivors with dysphagia formed the patient group, and 30 healthy persons formed the healthy group. All received pharyngeal ultrasound examinations by the same sonographer. The maximum distance from the hyoid bone to the mandible, the minimum distance, and the required time were measured or calculated. The hyoid bone′s motion, distance shortening rate, geniohyoid muscle activity, activity time, and activity speed were calculated. The differences in each value were compared, and the values were correlated with the videofluoroscopic swallowing study (VFSS) score using Spearman rank correlation. Receiver operating characteristics curves (ROC curves) were used to evaluate the value of hyoid bone and geniohyoid muscle activity for evaluating the severity of pharyngeal swallowing disorders after a stroke.Results:The average range of activity, activity time, and activity speed of the geniohyoid muscle in the patient group were all significantly different from the healthy group′s averages. The hyoid bone′s range of activity, activity time, activity speed, and the rate of shortening of its distance from the mandible were also significantly different, on average. The patients′ VFSS grades correlated strongly with the activity of the geniohyoid muscle, moderately with the geniohyoid muscle′s speed, and weakly with the duration of hyoid bone activity.Conclusion:The speed of geniohyoid muscle activity and hyoid bone activity time can be used to evaluate the severity of pharyngeal swallowing dysfunction after a stroke. Geniohyoid muscle activity is the best indicator.

Objective:To evaluate the feasibility, accuracy, effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods:A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021. There were 16 males and 19 females, with an age of (52.7±13.2) years. The core of this placement was to determine the entry point of cervical 7 pedicle screws. After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B, the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point, with the screw placement angle perpendicular to the lamina line or slightly inclined from 30° to 40° to the head side and outward. The length, diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement. According to the Rampersaud method, the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement. The visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score were compared between preoperation, 1 week and 6 months after operation to evaluate the effectiveness of this placement. The postoperative complications were counted to evaluate the safety of this method. Loosening, displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results:This case series was followed up for (9.8±1.7) months. There was no significant difference in the length, diameter or placement angle of the screws between the left and right sides ( P>0.05). A total of 66 cervical 7 pedicle screws were placed. There was no change in the screw position grading at 1 week or 6 months after surgery. Grade A was achieved in 64 screws, Grade B in 2 screws, and Grade C or D in none. The VAS scores before operation, 1 week and 6 months after operation were respectively 4.4±1.7, 3.8±1.0 and 1.1±1.1, and the JOA scores respectively 6.7±2.2, 13.2±1.5 and 15.3±1.2. The VAS and JOA scores at 1 week and 6 months after operation were significantly improved compared with the preoperative values ( P<0.05). The improvement rates in JOA at 1 week and 6 months after operation were 62.7%±13.3 % and 83.9%±11.6%, respectively. There were no complications related to the placement of cervical 7 pedicle screws; there was no wound hematoma or infection. No loosening, displacement or breakage of the screws was observed by the 6-month follow-up. Conclusion:The novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction is feasible, accurate, effective and safe.

Objective To evaluate the characteristics of spatial distribution and time accumulation of impact acceleration at different parts of human body during backward falling process. Methods Four healthy men and four healthy women (20-20 years old) were enrolled. The tri-axial acceleration on head, chest, left/right arm/hand/foot, left/right front/back hip, left/right femur head, sacrum and coccyx throughout the backward falling were measured by ADXL335 tri-axial acceleration sensor. Systemic acceleration distribution of backward falling was polynomial fitted by signal magnitude vector (SMV) of its first peak. Besides, parameters of impulse mechanics such as zero-g time, total falling time, peak SMV, relative pressure impulse of the vulnerable sites (head, hip and its related sites) were also calculated. Results Compared with the other parts of the body, the peak SMV and relative impulses of left/right back hip and head were significantly higher (P＜0.05). Acceleration that paralleled to the ground in left/right back hip was also relatively large. The rotational transform angles of left/right back hip, left/right femur head, sacrum and coccyx were significantly larger (P＜0.05). In addition, during the process of falling backward to the ground, a sliding tendency toward the sagittal plane 53.58°±6.75° occurred at all testing sites. Conclusions Head and hips are vulnerable during backward falling, and their zero-g time (0.26±0.05) s can be used as the longest starting time of falling protection devices. The large change angle of left/right hip, left/right femoral head, sacrum and coccyx may be the important cause of the sprain during backward falling.

Objective To determine the dose-response relationship of sufentanil blunting responses to double-lumen endotracheal intubation when combined with propofol given by target-controlled infusion (TCI) in patients with pulmonary tuberculosis.Methods One hundred patients of both sexes with pulmonary tuberculosis,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 24-58 yr,with body mass index ＜30 kg/m2,with Mallampati grade Ⅰ or Ⅱ,undergoing thoracic surgery under general anesthesia,were divided into Ⅰ-Ⅴ groups (n =20 each) using a random number table.Anesthesia was induced with iv sufentanil 0.35 μg/kg (group Ⅰ),0.40 μg/kg (group Ⅱ),0.45 μg/kg (group Ⅲ),0.50 μg/kg (group Ⅳ) and 0.55 μg/kg (group Ⅴ),and propofol TCI (target plasma concentration 3.5 μg/ml) and iv vecuronium 0.15 mg/kg.The patients were endotracheally intubated and mechanically ventilated.The response to double-lumen endotracheal intubation was defined as positive when mean arterial pressure increased by＞ 20％ of the baseline value and/or heart rate ＞ 90 bpm within 5 min after intubation.The median effective dose (ED50),ED95 and 95％ confidence interval (95％ CI) of sufentanil blunting the responses to double-lumen endotracheal intubation were calculated by Probit analysis.Results The ED50 (95％ CI) and ED95 (95％ CI) of sufentanil blunting the responses to intubation were 0.411 (0.370-0.441) μg/kg and 0.635 (0.556-0.888) μg/kg,respectively,when combined with propofol given by TCI.Conclusion When combined with propofol given by TCI (target plasma concentration 3.5 μg/ml),the ED50 and ED95 of sufentanil blunting the responses to double-lumen endotracheal intubation are 0.411 and 0.635 μg/kg,respectively,in patients with pulmonary tuberculosis.

Objective To compare the dose, clinical efficacy and acute adverse reactions of intensity modulated radiotherapy(IMRT)and three-dimensional conformal radiotherapy(3D-CRT)combined with three-dimensional brachytherapy (3D-BT) in the treatment of concurrent radiotherapy and chemotherapy for advanced stage cervical cancer patients. Methods Data collection was performed from January 2011 to November 2015 in Chinese PLA General Hospital and Inner Mongolia Cancer Hospital.All 89 patients with advanced stage (Ⅱb-Ⅲb) cervical cancer were treated by pelvic radiotherapy and concurrent chemotherapy, 46 cases of them received IMRT and 3D-BT(IMRT group), 43 cases received 3D-CRT and 3D-BT(3D-CRT group),along with cisplatin chemotherapy.The dose accumulation of external beam radiotherapy and 3D-BT was calculated by deformable image registration to analyze clinical efficacy, acute adverse reactions and prognosis of the two groups.Results (1)Dose of radiotherapy:planning target volume(PTV)coverage of IMRT group and 3D-CRT group were respectively(95.4±4.7)% and(95.1±5.1)%, without significant differences (t=0.289, P=0.773). Compared with the patients treated with 3D-CRT, the volumn receiving at least 30 Gy (V30), V50of rectum, colon, bladder and small intestine and V20of bone marrow in the IMRT group were significantly decreased (P<0.05). Regarding the combined dose, the maximum dose (Dmax) and the minimum dose received by the most exposed 2 cm3volume of the analyzed organ(D2CC)of rectum,colon,bladder and small intestine of IMRT group were significantly lower than those of 3D-CRT group (P<0.05). (2) Short-term efficacy: the effective rate of IMRT and 3D-CRT group were respectively 93% (43/46) and 91% (39/43), with no significant differences (χ2=0.237,P=0.626). (3) Acute adverse reactions: compared with 3D-CRT, IMRT could significantly reduce grade 1-2 acute toxicity in gastrointestinal [63%(29/46) vs 84%(36/43)], genitourinary [17%(8/46) vs 37%(16/43)] and hematologic [57%(26/46) vs 79%(34/43)] system (all P<0.05). There were no significant differences of grade 3 acute adverse reactions of gastrointestinal,genitourinary and hematologic system between two groups(all P>0.05). No grade 4 acute adverse reactions were observed. (4) Prognosis: the overall survival rate at 1, 2-year of IMRT and 3D-CRT group were respectively 95.6%,89.1% and 93.1%,86.1%.The progression-free survival rateat 1, 2-year of IMRT and 3D-CRT group were 91.1%, 89.1% and 88.4%, 86.1%, respectively. There were no significant differences in overall survival rate and progression-free survival rate between two groups (P>0.05). Conclusions Compared with 3D-CRT, IMRT combined with 3D-BT has dosimetry advantages based on dose accumulation algorithms by deformable image registration. IMRT could ensure clinical efficacy and significantly reduce the incidence rate of acute toxicities.

OBJECTIVETo assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.

METHODSA total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March, 2007 and March, 2012, and their post-operative complications, the need for subsequent surgery, symptomatic relief and reproductive outcomes were analyzed.

RESULTSOf these patients, 42.4% had subserosal myomas and 57.6% had intramural myomas. The mean total operative time was 96∓41 min with a mean blood loss of 128∓46.2 ml, and 82.3% of the patients were discharged 48 h after the operation without early complications. A small fraction (2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids. Of the fertility-demanding women who underwent myomectomy, 71% achieved pregnancy, 49.8% underwent caesarean section, 8% had operative vaginal deliveries, and 42.2% had spontaneous deliveries; uterine rupture occurred in none of the cases.

CONCLUSIONLaparoscopic intracapsular myomectomy, by preserving the fibroid pseudocapsule and myometrial integrity, has no early postoperative complications and ensures good fertility rates and reproductive outcomes.

Adult ; Female ; Fertility ; Humans ; Laparoscopy ; Leiomyoma ; surgery ; Prognosis ; Retrospective Studies ; Uterine Myomectomy ; Uterine Neoplasms ; surgery

Objective To investigate the clinical features and management of bile duct injury caused by laparoscopic cholecysteetomy by using harmonic scalpel (UHS-LC), and its prevention. Methods The clinical data of 1863 UHS-LC cases from April 2003 to February 2008 were retrospectively analyzed. There were 11 patients suffering from UHS-LC related iatrogenic bile duct injury including intraoperatively immediate recognized injuries in 9 cases, and postoperatively found injuries in 2 cases. For those patients in which bile duct injury was found during the UHS-LC procedure, the patient was converted to open surgery, the injury was repaired accordingly by end-to-end bile duet anastomosis or Roux-en-Y procedure. For the injuries found postoperatively (all two cases were of CBD perforation), CBD was sutured by second stage. Results All the 11 patients recovered well and no biliary stricture occurred during the follow up of 1-5 years. Conclusions While UHS-LC is suitable for most cases of choleeystectomy, it causes significant porcentage of bile duct injury (0. 6% ) in hands of unskillful surgeons. It is important to be on alert against iatrugenic bile duct injuries.

Objective To explore the mechanism of LMWH therapy for SAP.Methods 48 wistar rats were random divided into 3 groups,sham group(S group),severe acute pancreatitis group(SAP group)and LMWH therapy group(H group).Serum amylase,IL-6,acinar cell apoptosis and the activity of NF-κB were detected and compared.Results The expression of amylase and IL-6 in SAP group was significantly higher than that in H group(P＜0.01).The apoptosis index of acinar cell in SAP group wag significantly lower than that in H group(P＜0.01),while the activity of NF-κB in SAP groupwas stronger than that in H group.Conclusions LMWH therapy may ameliorate SAP by inducing acinar cell apoptosis through suppressing the activity of NF-κB.