Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.

To evaluate the association between serum anti-tissue transglutaminase antibody (anti-tTG) titers and the severity of histological damage to the duodenal mucosa and to predict a possible anti-tTG cutoff value for diagnosing celiac disease (CD) and villous atrophy in the domestic population. Clinical and pathological data from 76 adult CD patients with positive anti-tTG titers and duodenal biopsy results who were treated at the People′s Hospital of Xinjiang Uygur Autonomous Region from July 2017 to January 2022 were retrospectively analyzed. The correlation between anti-tTG titers and the severity of duodenal mucosal damage was statistically assessed to predict the optimal anti-tTG titer cut-off value for diagnosing CD and villous atrophy. Of the 76 patients, 10 had underlying CD, and of the 66 patients with duodenal histopathology, four were Marsh Ⅰ, six were Marsh Ⅱ, and 56 were Marsh Ⅲa-c grade. In adults with CD, anti-tTG titers were shown to be associated with the severity of histological damage to the duodenal mucosa. When the anti-tTG level was ≥5 times the upper limit of normal (ULN), the sensitivity and specificity for diagnosing CD were 83.9% and 92.9%, respectively. When the anti-tTG titer was ≥8 times the ULN, the sensitivity and specificity for diagnosing villous atrophy were 67.9% and 90.0%, respectively. Anti-tTG levels had a strong predictive value for diagnosing CD in adults when titers exceeded 10 times the ULN. Thus, the anti-tTG cut-off value can be combined with clinical judgment to diagnose CD, limiting the use of invasive endoscopy.

Objective:To search for evidence related to the prevention and management of mechanical complications in patients receiving enteral nutrition and to summarize the evidence.Methods:The evidence published up to March 20, 2022 was systematically retrieved from Cochrane Library, PubMed, American Clinical Guidelines Network, National Institute for Health and Care Excellence, American Society for Parenteral and Enteral Nutrition, CNKI, WanFang Data, SinoMed, etc. The literature evaluation standards and evidence grading system of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia were used to rate the quality of the literature, evaluate and summarize the evidence.Result:A total of 13 articles were included, including 4 guidelines, 4 expert consensuses, 4 evidence summaries, and 1 case-control study. Totally 31 best evidences were formed from 8 aspects: causes of occurrence, prevention and management, proper immobilization, regular flushing, reasonable infusion of nutrient solution/medication, treatment of complications-blockage, treatment of complications-mucosal damage, and treatment of complications-unplanned extubation.Conclusions:Medical and nursing staff can use the best evidence to develop and implement prevention and management programs for mechanical complications in patients receiving enteral nutrition, strengthen the scientific management of mechanical complications in these patients, and improve the quality of life and prognosis of patients.

【Objective】 To establish and evaluate a fluorescent antibody to membrane antigen (FAMA) method for detecting antibodies against varicella-zoster virus (VZV) based on Vero E6 cells. 【Methods】 Based on the adapted VZV-Oka-E6 strain that VZV-Oka live attenuated varicella vaccine strain grew in Vero E6 cells, Vero E6 cells were infected with VZV-Oka-E6 of three different doses (10^4.65, 10^4.95 and 10^5.25 TCID50), and the cytopathic effect was observed under a microscope to determine the optimal infection dose of VZV-Oka-E6 strain. Then the detectable sensitivity of the infected cell antigen slides prepared after fixing the infected cells with different fixatives was compared to determine the optimal fixative. As a result, the FAMA method based on Vero E6 cells for the determination of neutralizing anti-VZV has been developed. The established FAMA assay was used to detect the international standard for varicella zoster immunoglobulin with different titers to determine the sensitivity of the assay. The specificity of the assay was evaluated by detecting specific antibodies against human herpes simplex virus (HSV) type 1 and type 2. The neutralizing anti-VZV antibodies of the international standard for varicella zoster immunoglobulin were detected using VZV-infected cell antigen slides prepared in the same batch and four different batches, respectively, to determine the intra-assay repeatability and inter-assay repeatability. The international standard for varicella zoster immunoglobulin with three known titers was detected to evaluate the relative accuracy of this assay. The anti-VZV titers in 20 apheresis plasma samples were determined with the newly established FAMA test and ELISA test, respectively, and the detection results of the two methods were compared using Spearman’s correlation test. 【Results】 The optimal infection dose of the VZV-Oka-E6 strain in FAMA assay was determined to be 10^5.25 TCID50, and acetone precooled at -20℃ was used as the fixative. The FAMA test has a high sensitivity with a detecting limit of 31.25 mIU/mL for neutralizing anti-VZV titers. The negative result was observed when detecting herpes simplex virus (HSV) type 1 and 2 specific antibodies. The international standard for varicella zoster immunoglobulin was detected by VZV infected cell antigen slides prepared in the same batch and 4 different batches, with the coefficient of variation being 29.95% and 26.71%, respectively. The detection value of the international standard for varicella zoster immunoglobulin with three different titer levels was consistent with their theoretical value. The correlation coefficient of the detection results of 20 apheresis plasma samples by the FAMA test and ELISA test was 0.268. 【Conclusion】 The VZV FAMA assay has good sensitivity, specificity, repeatability, and relative accuracy in detecting neutralizing anti-VZV titers. It can be applied for detecting neutralizing anti-VZV titers in apheresis plasma samples as well as the varicella-zoster immunoglobulin (VZIG) preparations.

Objective:To investigate the protective effect of dihydromyricetin (DHM) on doxorubicin (DOX)-induced myocardial injury and its mechanism.Methods:Twenty-four healthy male SD rats were divided into 4 groups: control group, DOX group, DOX+DHM100 group and DOX+DHM200 group. Echocardiography was used to measure cardiac function. At the end of the 6th week, the rats were anesthetized and sacrificed, and the pathological changes of the cardiac tissues were observed by HE staining, Masson staining and WGA staining. Cardiomyocyte apoptosis was observed by TUNEL staining, and protein levels of NLRP3, caspase-1, IL-1β, bax and bcl-2 were detected by Western blot and immunohistochemistry.Results:Compared with the control group, the left ventricular ejection fraction and left ventricular fractional shortening decreased significantly in DOX group, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole increased. In DOX+DHM group, both left ventricular ejection fraction and left ventricular fractional shortening increased, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole decreased ( P<0.05). Furthermore, DOX group showed significant myocardial injury histologically, while DOX+DHM group significantly inhibited DOX-induced myocardial injury in rats. Meanwhile, cardiomyocyte hypertrophy was found in the DOX group, while the cardiomyocyte hypertrophy was notably inhibited in the DOX+DHM group. Compared with the control group, the apoptotic rates of cardiomyocytes and the levels of bax/bcl-2　ratio were significantly increased in DOX group, which were significantly alleviated in the DOX+DHM group ( P<0.05). In addition, the levels of NLRP3, caspase-1 and IL-1β were increased as compared with control group, while the levels of the above indicators were remarkably reversed in DOX+DHM group as compared with DOX group ( P<0.05). Conclusion:DHM alleviates DOX-induced myocardial injury in rats by inhibiting NLRP3 inflammasome and reducing cardiomyocyte apoptosis.

Objective To explore the situation and risk factors of peripherally inserted central catheter (PICC)-related infections among neonate so as to provide a nursing reference for preventing catheter-related infections. Methods From September 2015 to June 2017, a prospective study was carried out to 811 neonates with PICC from 7 hospitals in Shenzhen City to observe the incidence of catheter-related infections. Simple correlation and multiple factors unconditional Logistic regression was used to analyze the correlative factors of catheter-related infections. Results Among 811 neonates, there were 770 (94.9%) without and 41 (5.1%, 1.95/1 000 catheter days) with catheter-related infections along with 20 cases with exit-site infection and 21 cases with catheter related bloodstream infections (CRBSI). Top three pathogens of CRBSI included Staphylococcus epidermidis, fungus and klebsiella pneumonia. Simple correlation showed that there were statistical differences in gestational age, birth weight of the neonate, disinfection methods of infusion connector, sterile protective barrier during maintenance of catheter between infection group and non-infection group (χ2=4.026,4.964, 4.369,7.463;P＜ 0.05). Multiple factors unconditional Logistic regression revealed that the risk factor contained birth weight＜ 1 200 g (OR=2.099, 95%CI: 1.103-3.996, P＜ 0.05), and the protective factors consisted of sterile protective barrier during maintenance of catheter (OR=0.393, 95%CI: 0.206-0.749,P＜0.01). Conclusions Birth weight ＜1 200 g, sterile protection during maintenance of catheter are the influencing factors of neonatal PICC catheter-related infections. Sterile protective barrier during maintenance of PICC for neonate should include wearing sterile mask, round hat, using aseptic packets and wearing sterile gloving to maintain the catheter. Aseptic technique should be paid more attention to during indwelling catheter and maintaining catheter for premature with birth weight ＜1 200 g.

Xiaochaihu Decoction comes from Shang Han Lun, which is a main formula for Shaoyang diseases. According to the principle of prescriptions corresponding to syndromes, the clinical application of modified Xiaochaihu Decoction for the treatment of swelling, pain, nausea, vomiting, bloating, and constipation after artificial total knee arthroplasty can achieve good efficacy.

Objective To detect the expression of human telomerase reverse transcriptase (hTERT) mRNA in the melanoma, and to analyze the relationship between the expression and subtypes and clinicopathological features of melanoma. Methods Expression of hTERT mRNA was detected by real-time quantitative PCR in 64 cases of melanoma and 30 cases of nevus. SPSS 17.0 software was used to analyze the relationship between hTERT mRNA expression and clinical pathological features of melanoma. Results The relative expression of hTERT mRNA in melanoma tissues was higher than that in nevus tissues [(52.43±5.42) vs (21.38±3.73), t= 4.72, P= 0.000]. The expression of hTERT mRNA in melanoma had no significant correlation with age, gender, ethnicity (all P> 0.05), but had relationship with subtypes, lymph node metastasis, Clark classification (all P< 0.05). The expression of hTERT mRNA in mucosal melanoma was significantly higher than that of acral and non-acral melanoma (t= 7.71, P= 0.001), while the expression of acral and non-acral melanoma had no difference (P> 0.05). Conclusions The expression of hTERT mRNA in melanoma is high, especially in mucosal melanoma. hTERT may play an important role in the occurrence and development of melanoma.

Purpose To exp1ore the c1inicopatho1ogica1 features,diagnosis and differentia1 diagnosis of mu1ti1ocu1ar cystic rena1 ce11 carcinoma( MCRCC). Methods 18 cases of MCRCC were reported by microscopy,immunohistochemistry,differentia1 diagnosis and were fo11owed-up. Results A11 patients were adu1ts inc1uding twe1ve ma1es and six fema1es who aged from 26 to 68 years(mean 55. 6 years). Imaging studies revea1ed a po1ycystic mass,with c1ear boundary. Gross1y,the cut surface of the tumors had more cysts of va-rying sizes,containing serous or b1oody f1uid. Microscopica11y,the cyst wa11s of tumors were often covered with a few simp1e c1ear ce11s,stratified epithe1ium or devoid of epithe1ium. The septa contained aggregates of epithe1ia1 ce11s with transparent cytop1asm which showed gradeⅠ nuc1ear features,these characteristics were diagnostic c1ues of MCRCC. Immunohistochemica11y the c1ear ce11 was positive for CD10,vimentin,EMA and Ki-67 showed 1ow pro1iferative activity. 18 case were fo11owed up,mean fo11ow-up 43 months, no case recurred or with metastasis. Conclusion MCRCC is a rare histo1ogica1 subtype of rena1 ce11 carcinoma with more favorab1e prognosis. It shou1d be distinguished from cystic change of c1ear ce11 rena1 carcinoma and cysts of kidney 1esion.

Objective To analysis the clinical features of elderly diffuse large B-cell lymphoma (DLBCL) patients with Epstein-Barr virus (EBV) infection and their prognostic factors.Methods 250 cases of DLBCL were retrospectively studied by in situ hybridization (ISH) to detect the EBV and by immunohistochemical to evaluate the histological type and Ki-67 protein.Results 36 cases with EBVpositive included 28 elderly (aged ≥ 60 years), of which 21 cases were Han, 15 cases were Uygur, male/ female ratio was 2 : 1.There were 23 cases with nodal presentation only, 13 cases with extra-nodal presentation.Twenty-nine patients presented with advanced disease (Ann Arbor stage Ⅲ/Ⅳ), 30 patients were found with high lactate dehydrogenase (LDH), 22 patients with high IPI score (3-5).Histological observation showed a diffuse and polymorphic proliferation of large lymphoid cells with varying degrees of reactive components.These tumor cells were frequently characterized by a broad range of B-cell maturation, containingcentroblasts, immunoblasts, and Hodgkin-and Reed-Stemberg (HRS)-like giant cells.Immunohistochemical studies showed that tumor cells were positive for CD20 and (or) CD79a in almost cases, most of the cases had a high proliferative index.CD10, bcl-6, Mum-1 performed histological type, 31 cases were non-germinal center.Except the age and location (P ＜ 0.05), no other significant differences were observed in Han and Uygur elderly EBV+ DLBCL (P ＞ 0.05).Conclusion The incidence of elderly EBV+ DLBCL is low, it has some unique clinical and pathological features with poor prognosis.