Objective:To investigate the clinicopathological, immunohistochemical and molecular genetic characteristics of TFE3-rearranged perivascular epithelioid cell tumor (PEComa).Methods:Eight cases of PEComa with TFE3 rearrangement diagnosed in the First Affiliated Hospital of Air Force Medical University from January 2014 to July 2022 were collected. Three were consultation cases and 5 were collected from our hospital; 7 cases were resection specimens and 1 case was a needle biopsy specimen. Routine histolopathological analysis, immunohistochemical staining, fluorescence in situ hybridization (FISH) and the next-generation sequencing were performed. Clinical data were collected and the prognosis was assessed.Results:The 8 patients consisted of 5 females and 3 males with a median age of 45 years (ranged from 25 to 65 years). The tumor location included 1 uterus, 1 liver, 1 urachus, 2 kidneys, 1 abdominal cavity, 1 colon, and 1 retroperitoneum (3 subsequent recurrences in the abdominal cavity, pelvis and ovary, and abdominal cavity, respectively). Morphologically, the tumor cells were uniform and epithelioid with translucent or eosinophilic cytoplasm. They were arranged in nests or sheets, most of which were separated by thin-walled blood vessels. There were no papillary structures, and no overt smooth muscle or fat components. Atypical features were seen in 3 cases, with bizarre nuclei and tumor giant cells. Large areas of necrosis were visible, and mitosis was common (up to 28/50 HPF). Melanin deposition was present in 3 cases. Immunohistochemical staining showed diffuse and strong positivity for TFE3 in 8/8 cases and for HMB45 in 6/8 cases; focal positivity for Cathepsin K and Melan-A in 6/8 cases and for SMA in 2/8 of cases. All cases were negative for CKpan, PAX8 and Desmin. TFE3 gene break-apart was detected by FISH in all 8 cases, 4 of which underwent next-generation sequencing, and it revealed that 2 cases presented with SFPQ::TFE3 fusion, 1 case with ASPSCR1::TFE3 fusion, and 1 case with no chimeric fusion. Seven cases were followed up for 4—94 months. All cases were alive; 4 cases were disease-free, 2 cases showed recurrence, and 1 case had metastasis at initial diagnosis.Conclusions:TFE3-rearranged PEComa has unique histomorphological, immunohistochemical and molecular characteristics. The biological behavior is aggressive, which could lead to recurrence and metastasis, and warrants close clinical follow-up.

Objective To compare the efficacy and difference of transvaginal natural orifice transluminal endoscopic surgery(v-NOTES),transumbilical laparoendoscopic single site surgery(TU-LESS)and traditional laparoscopic surgery in the treatment of ectopic pregnancy.Methods A total of 121 patients with ectopic pregnancy admitted to Yangzhou Maternal and Child Care Service Centre,Affiliated to Yangzhou University Medical School from June 2019 to June 2022 were retrospectively selected.According to different surgical methods,the included patients were divided into traditional laparoscopic group(49 cases),TU-LESS group(43 cases)and v-NOTES group(29 cases).Age,body mass index(BMI),hemoglobin(Hb),operation time,intraoperative bleeding,postoperative exhaust time,and 24h postoperative visual analogue scale(VAS)score,postoperative hospital stay and satisfaction of patients in each group were observed.Results The exhaust time and postoperative hospital stay in v-NOTES group were significantly shorter than those in traditional laparoscopic group and TU-LESS group,and 24h postoperative VAS score was significantly lower than that in traditional laparoscopic group and TU-LESS group(P<0.05).There was significant difference in postoperative satisfaction among three groups(H=57.364,P<0.001),and v-NOTES group>TU-LESS group>traditional laparoscopic group.Conclusion Compared with TU-LESS and traditional laparoscopic surgery,v-NOTES treatment of ectopic pregnancy recovery faster,less pain,more beautiful appearance,but need to be mastered by the operator.

Humans ; Consensus ; Pancreatic Neoplasms/therapy* ; Neuroendocrine Tumors/therapy*

ObjectiveTo analyze the effect of standardized training on post competency of rehabilitation therapists, based on World Health Organization rehabilitation competency framework (RCF), and combined with the characteristics of rehabilitation and the requirements of standardized training in China. MethodsFrom 2018 to 2022, a total of 30 rehabilitation therapists who participated in the standardized training were selected. Before and after the standardized training, the closed-book theoretical assessment and Mini-clinical Evaluation Exercise (Mini-CEX) assessment were carried out, and a 360-Degree Evaluation scale was distributed to their teachers, peers and patients. Through multi-dimensional post competency analysis, the data obtained from the scales were combined with the five dimensions of basic theoretical knowledge, clinical practice ability, medical humanities literacy, scientific research and teaching ability, and organizational management ability to analyze the effect of standardized training on post competency of rehabilitation therapists. ResultsAfter training, the therapists improved in theory and case analysis (Z > 2.716, P < 0.05). They also improved in medical interview skills, physical examination, humane care/professionalism, clinical judgment ability and overall clinical level (Z > 2.162, P < 0.05) according to Mini-CEX. The medical ethics, daily work, management ability, social ability, interpersonal communication ability, basic professional ability and operation ability improved (Z > 1.978, P < 0.05) according to the 360-Degree Evaluation scale. The effect of standardized training was significant in basic theoretical knowledge, clinical practice ability and medical humanities literacy by the post competency analysis model. ConclusionThe effect of standardized training of rehabilitation therapists is significant, and the therapists can be competent for daily work in diagnosis and treatment after training.

Frailty is one of the most common clinical geriatric syndromes and has become a hot topic in the geriatric field in recent years.Frailty can confer an increased risk of adverse outcomes such as falls, hospitalization and even death.Therefore, timely diagnosis and intervention of frailty is of great practical significance for improving the health status of the elderly and alleviating the burden on the social and medical service systems.This article reviews mechanisms, types and effects of exercise intervention measures and summarizes research progress on exercise intervention in the elderly with frailty, in order to provide a reference for future research on exercise intervention for frailty.

Objective: To describe the molecular epidemiological characteristics of norovirus gastroenteritis outbreaks in Zhuhai from 2011 to 2016. Methods: Anal swab specimens were collected from 576 cases with 56 outbreaks of acute norovirus gastroenteritis from 2011 to 2016. Specimens were tested by real-time RT-PCR. Three to four of norovirus positive specimens were selected from every outbreak to amplify the VP1 gene by RT-PCR and one strain was chosen randomly from every outbreaks to determine the genotype by phylogenetic tree analysis. Results: Eight genotypes were identified from 56 outbreaks and all of them belonged to GⅡ genogroup. The genotype of norovirus strain changed with prevalence time. The GⅡ.4/2006b was dominant from 2011 to 2012, and replaced by GⅡ.4/Sydney _2012 during the 2012—2013 norovirus season, and both of them never appeared after Feb. 2013. GⅡ.17 was the only genotype during the 2014—2015 norovirus season. All the 7 outbreaks occurred from 2015 to 2016 were caused by GⅡ.3 norovirus. The GⅡ.17and GⅡ.3 were identified from Apr. to Sep. 2016; GⅡ.p16-GⅡ.2 were the only genotype in 12 outbreaks from Nov. to Dec. 2016. The GⅠ genogrope was never identified from 2011 to 2016 in Zhuhai. Conclusions The Norovirus GⅡ was the only pathogeny which caused the outbreaks of norovirus gastroenteritis. The recombinant norovirus strain GⅡ.p16-GⅡ.2 emerged and caused large outbreaks in the last two months of 2016 in Zhuhai; several recombinant strains of the GⅡ.p16 RdRp gene were found now, which suggests that attention should be focused on the prevalence and evolution of the recombinant norovirus.

Objective To compare the anesthetic effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA)for cesarean section,and their influence on the incidence rate of supine hypotension syndrome(SHS).Methods 200 patients with cesarean section surgery in our hospital from February 2016 to July 2016 were randomly divided into observation group and control group,all of cases were given CSEA.100 patients in the observation group(the group L)were given ropivacaine in spinal anesthesia,the other 100 patients in the control group(the group B)were given bupivacane in spinal anesthesia.Recorded the relevant indicators,compared the incidence rate of SHS,the effect of anesthesia and neonatal score.Results The incidence rate of SHS of the group L was lower than the group B(χ2 =9.261,P<0.01).The effect of anesthesia and Apgar score of two groups had no statistically significant differences(all P>0.05).Conclusion The application of ropivacaine in CSEA for cesarean section not only has exact anesthesia effect,but also can effectively prevent SHS without any side effects.

After the connotation of the standard system for digitalization of ancient medical documents was analyzed, its construction principles were elaborated with measures proposed for how to construct it.

Objective:To study the expression of B-1a cells in mice with obesity and periodontal infection.Methods:Mouse models of diet induced obesity combined with experimental periodontitis were established,the expression of CD5 protein,anti-collagenⅠ antibody(anti-Col-Ⅰantibody) and IL-10 protein was examined in mouse jaw bone and spleen by immunohistochemistry and Western blot;The mRNA expression of CD5,anti-Col-Ⅰantibody and IL-10 in mouse jaw bone was detected by real time quantitative PCR.Results:The mRNA and protein expressions of CD5 and IL-10 and anti-Col-Ⅰantibody in jaw bone in periodontitis group were significantly higher than those in control group(P<0.001).The protein expressions of CD5 and IL-10 and anti-Col-Ⅰantibody in spleen in obesity group were significantly higher than those in standard group(P<0.05).The protein expression of anti-Col-Ⅰantibody in spleen in standard accompanying periodontal ligature group was significantly higher than that in standard without periodontal ligature group(P<0.05).Conclusion:B-1a cells are activated in the early stage of obesity and periodontal inflammation with a certain pathological significance and without interation between the two inflammatory states in the pathological mechanism.

Objective To explore the possible factors of early postoperative fluid balance and the influence of early postoperative fluid balance on the prognosis of patients undergoing cardiopulmonary bypass. Methods A retrospective study was conducted on the clinical data of 180 adult patients undergoing cardiopulmonary bypass from January 2012 to December 2015.All the patients were from Sun Yat-sen Memorial Hospital, Sun Yat-Sen University. The data were input and analyzed by SPSS 17.0 software. Results The early postoperative fluid balance of cardiovascular surgery with cardiopulmonary bypass was (540.94 ± 135.86) ml. The value of the early postoperative fluid balance (the difference of the total input amount and the total output amount/body quality) in predicting the major clinical outcome was analyzed by ROC curve. The area under the ROC curve from fluid balance was 0.850 (95%CI 0.736-0.965, P<0.01) and it had the sensitivity of 80.0%, and the specificity was 84.6%. The result showed that the cut off values had a good prediction ability for outcome. The cut off values determined by the biggest Youden index were 28.63 ml/kg, indicated that patients may had better outcome when they had the fluid balance of 28.63 ml/kg. The level of early postoperative fluid balance of patients undergoing cardiopulmonary bypass was correlated with mechanical ventilation time, ICU length of stay, higher risk of acute kidney injury, mixed venous oxygen saturation and clinical outcome (P<0.05). Multivariate analysis indicated that European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ), other types of surgery, body mass index, early postoperative urine output and early postoperative drainage flow were independently associated with postoperative fluid balance of patients undergoing cardiopulmonary bypass. Conclusions Early postoperative fluid balance has a good prediction ability for prognosis of patients undergoing cardiopulmonary bypass. Compared with patients having lower level of fluid balance, the patients with a higher level would be more likely to have longer mechanical ventilation time, longer ICU length of stay, higher risk of acute kidney injury and lower level of mixed venous oxygen saturation. By analysis of ROC curves, the cut-off value for early postoperative fluid balance is 28.63 ml/kg, worse prognosis may be predicted if fluid balance is above 28.63 ml/kg. EuroSCORE Ⅱ, other types of surgery, body mass index, early postoperative urine output and early postoperative drainage flow are independently associated with the postoperative fluid balance of patients undergoing cardiopulmonary bypass.