Objective:To investigate the clinicopathological and molecular genetic features of POLE mutant endometrioid carcinoma.Methods:Genetic test data of 230 cases of endometrial carcinoma that underwent surgical resection and molecular typing by next generation sequencing in the First Medical Center of Chinese PLA General Hospital from January 2021 to June 2023 were retrospectively analyzed. Seventeen cases of endometrioid carcinoma with POLE mutation were selected. Clinical and prognostic information was collected. The paraffin-embedded tissue and immunohistochemical sections were reviewed, and the gene detection data were analyzed.Results:In the 17 cases of endometrioid carcinoma with POLE mutations, 16 cases (16/230, 6.9%) had mutations at known pathogenic sites, and 1 case had a mutation site (S459Y) that had not been reported, which was inferred to be pathogenic based on clinical prognosis. The 17 patients aged from 48 to 79 years (median 56 years, mean 58 years). All cases had typical histological features of endometrioid carcinoma, including 7 cases (7/17) of poorly-differentiated, 4 cases (4/17) of moderately-differentiated and 6 cases (6/17) of well-differentiated. Squamous differentiation was noted, mucous differentiation was less commonly found and often accompanied by superficial muscle infiltration. The number of stromal lymphocyte infiltration was variable. Lymph-vascular embolus was found in 6 cases, and lymph node metastasis was only detected in 1 case. According to the FIGO staging system for endometrial cancer in 2023, all the cases were in FIGO stage ⅠA m-POLEmut except for one case in FIGO stage ⅢC1. There were 8 cases with genetic co-mutation, 5 cases with TP53 mutation (immunohistochemically subclonal expression pattern), 1 case with MSI-H, and 2 cases with both TP53 mutation and MSI-H. Five of 7 patients with POLE mutation (poorly-differentiated) received postoperative chemotherapy and/or radiotherapy, 4 patients received endocrine therapy, and 8 patients had no treatment after surgery. One of the stage ⅠA m-POLEmut tumor patients was found to have pelvic recurrence one year after surgery, and the other 16 patients were followed up for 10-38 months without recurrence or metastasis. Conclusions:POLE mutant endometrioid carcinoma may have different differentiation, and most patients have good prognosis. Correct interpretation of molecular results, accurate identification and classification are important for predicting prognosis and avoiding overtreatment. However, a small number of cases may have recurrence and metastasis, and therefore it is necessary to make a reasonable treatment plan based on the comprehensive judgment of other high risk factors.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the value of high frequency ultrasound elastography in the differential diagnosis of Hashimoto’s thyroiditis (HT) with thyroid nodules.Methods:112 HT patients complicated with thyroid nodule disease in Department of Ultrasound in Yantai Yantaishan Hospital from Jan. 2017 to Jan. 2020 were randomly selected for prospective study. All patients were diagnosed by routine ultrasound and high-frequency ultrasound elastography, and underwent surgical exploration and pathological diagnosis. Taking the postoperative pathological results as the gold standard, the specificity, sensitivity, negative-positive predictive value of conventional ultrasound and high-frequency ultrasound elastography in HT complicated with thyroid nodular disease were compared and analyzed, and the diagnostic efficacy was evaluated.Results:There were 138 nodules in 112 cases, including 47 benign nodules and 91 malignant nodules. The specificity and sensitivity of routine ultrasonography were 80.85% and 78.02%, respectively; The specificity and sensitivity of high frequency ultrasound elastography were 87.23% and 90.11%. Compared with conventional ultrasound, high frequency ultrasound elastography had higher specificity and sensitivity in detecting lesions ( χ2=4.54, 4.25, P=0.026, 0.039) . The negative predictive value of routine ultrasonography was 65.52%, the positive predictive value was 88.75%, and the ROC was 0.775. The best diagnostic cut-off point was 3.04. The negative predictive value of high frequency ultrasound elastography was 82.00%, the positive predictive value was 93.18%, the ROC was 0.812, and the best diagnostic cut-off point was 32.89 kpa. Compared with conventional ultrasound, high frequency ultrasound elastography had higher negative and positive predictive values ( χ2=4.35, 4.48, P=0.031, 0.027) . Conclusion:High frequency ultrasound elastography can improve the negative predictive value and sensitivity in the diagnosis of Hashimoto’s thyroiditis and thyroid cancer, judge the benign and malignant lesions, and provide more accurate data for early surgical treatment.

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy* ; Humans ; SARS-CoV-2 ; Treatment Outcome

Objective:To investigate the clinicpathological, immunohistochemical and molecular genetic features of malignant mixed mesodermal tumor (MMMT) in the female reproductive system.Methods:To analyze its histopathological characteristics, we performed a retrospective review of the MMMT cases diagnosed at PLA General Hospital, Beijing, China during 2005-2019 using its surgical and pathological databases. EnVision immunohistochemical staining was used to detect the expression of ER, PR, p16, p53 and MMR proteins.Results:Fifty cases were conformed to the diagnosis, including 29 cases originated in the uterus, 16 cases in ovary, 4 cases of synchronous occurrence in uterus and ovary, 1 case in cervix. The tumor was histologically composed of two components, namely carcinoma and sarcoma ones, with clear borderline or blend mutually. The proportion of cancer component in the whole tumor ranged from 5%-90%. The proportion of carcinoma was more than 50% in 76% of the cases, and less than 50% in 24% of cases, including 2 cases with<10% of carcinoma. In the cases of primary uterine MMMT, the main carcinoma type was high grade endometrioid carcinoma (55%, 16/29). In ovarian MMMT, the main carcinoma type was serous carcinoma (12/16), while that of cervical MMMT was squamous cell carcinoma. The others were clear cell carcinoma or the undifferentiated carcinoma. There was one carcinoma type in most cases, only 7 cases had two carcinoma types. Homologous sarcomas, including stromal sarcoma, leiomyosarcoma and high-grade spindle cell sarcomas, were more commonly found in uterine MMMT (72.4%, 21/29). While heterogenic sarcomas, including chondrosarcoma, osteosarcoma and rhabdomyosarcoma, were more commonly noted in ovarian MMMT (12/16) than MMMT of other sites. There were 10 cases that consisted of two types of sarcomas. The synchronous MMMT of uterus and ovary had similar morphology and the types of carcinoma and sarcoma. The tumor cells that spread or metastasized to lymph node, omentum, intestinal wall or skin were all carcinoma cells, and were morphologically consistent with the original tumors. Immunohistochemically, ER and PR were both negative (23/25 in uterine, 8/10 in ovarian tumors). p16 was strongly positive (11/11 in uterine tumors, and 6/6 in ovarian tumors), with similar expression patterns in the carcinoma and sarcoma components. p53 showed mutant-type staining (64%, 21/33) and expressed synchronously in carcinoma and sarcoma components. p53 mutation was found in 35% cases of endometrial carcinoma and 46.7% cases of non-endometrial carcinoma. p53 mutation was also found in only 31.8% cases of heterogenic sarcomas, but in 50% of non-heterogenic sarcomas. Twenty-eight cases (28/33, 85%) presented intact mismatch repair proteins, while 5 cases (5/33, 15%) presented deficient mismatch repair proteins.Conclusions:MMMT in female reproductive system is a rare high-grade biphasic tumor with complex and diverse morphology. The immunohistochemical features are characterized by negative ER/PR and strongly positive p16, mostly mutant p53 and proficient mismatch repair proteins. The patients with a high FIGO stage have worse prognosis.

Objective:To investigate the clinical, pathological and immunohistochemical features of seromucinous neoplasms, including seromucinous cystadenoma, borderline tumour and seromucinous carcinomas of the ovary.Methods:A retrospective review of the seromucinous neoplasms collected between June 2006 and December 2018 was conducted at the First Medical Center of PLA General Hospital. EnVision immunohistochemical staining was used to detect the expression of CK7, PAX8, ER, PR, WT1, p16, p53 and Baf250a which was encoded by the ARID1A gene.Results:A total of 75 ovarian seromucinous neoplasms were included. There were 30 cases of benign seromucinous cystadenoma, whose patients aged 12 to 83 years (mean, 36 years). The tumor histologically composed of endocervical-type mucinous epithelium and serous-type cells, each of which accounted for more than 10%. Among the 34 cases of seromucinous borderline tumour including 7 cases with concurrent endometriosis, the patients aged 21 to 72 years (mean, 39 years). Characteristic histologic features were broad papilla structure and an admixture of cell types, predominant endocervical-like mucinous cells (non-intestinal, no goblet cells), eosinophilic cells and others such as clear cells, hobnail cells, ciliated cells, and endometrioid cells. The larger papillae tended to have oedematous stroma containing neutrophils. In the 11 cases of seromucinous carcinomas including 2 cases with concurrent endometriosis, patients aged 26 to 61 years (mean, 40 years). Seromucinous carcinomas exhibited a predominant papillary architecture with smaller components of confluent glandular, microglandular and solid structure, expansive stromal invasion pattern, and sometimes locally destructive infiltration. An admixture of epithelial cell types was in seromucinous carcinomas, as well as borderline tumour. Immunohistochemically, the tumours were positive for CK7, PAX8, p16, estrogen receptor and progesterone receptor (positive in 10% to 80% of the cases). They were negative for WT1, while p53?staining showed a "wild-type" pattern. The Ki-67 positive rate was 20% to 60%. Loss of ARID1A-encoded protein Baf250a staining was observed in 6 (30%) of the 20?seromucinous borderline tumors, and 2 of the 11?seromucinous carcinomas. According to FIGO 2014?staging system, there were 4 cases of ⅠA, 3 cases of ⅡA and 4 cases of ⅢC. Follow-up information was available in 9 patients of seromucinous carcinomas, and 2 lost to follow-up. Eight were alive (follow-up for 6 to 108 months), including 2 patients with relapse, but 1 patient who initially presented with a stage ⅢC tumor died of disease 60 months after the cancer diagnosis. Thirty-four patients of borderline tumour were all alive at the end of follow-up, including 1 with relapse.Conclusions:Seromucinous neoplasms have characteristic histopathological and immunopathological features. Both borderline tumors and carcinomas have complex structures and cellular components. ARID1A as a tumor-suppressor gene plays a role in the oncogenesis of ovarian seromucinous neoplasms. The loss of staining with ARID1A-encoded Baf250a and wild-type p53 in seromucinous neoplasms together support that seromucinous neoplasms could be type Ⅰ tumor of dualistic model of epithelial ovarian cancer, with favourable prognosis.

Objective · To investigate whether the quality of embryos will result in biochemical pregnancy or arrest of embryo development in the freezing and thawing cycles of in-vitro fertiliazation-embryo transfer (IVF-ET). Methods · The clinical data of patients who accepted IVF-ET in Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to June 2016 were retrospectively studied. The data includes 115 cycles of biochemical pregnancy, 64 cycles of arrest of early embryonic development and 871 cycles of ongoing pregnancy after frozen thawed embryo transfer. We compared the embryo score on the third day after embryo transfer (D3), the blastocyst development rate and the blastocyst grade in the three groups. Results · There were no significant differences in the period of infertility, the age of the patients and their spouses, the endometrial thickness, the estrogen and progestogen levels of the day of transplantation among the three groups (P > 0.05). The scores of most frozen thawed embryos on D3 were from 6 to 8, and the scores were not statistically significant among the three groups (P > 0.05). The proportion of transplanted blastocyst on D5 was higher than that on D6 in the three groups, but there was no significant difference among the three groups (P > 0.05). There was no significant difference in the proportion of inner cell mass of blastocysts which were scored as Grade A&B or Grade C among the three groups. Nevertheless, in the arrest of early embryonic development group, the proportion (52.2%) of the trophoblast of blastocysts which were cored as Grade C was significantly higher than the proportion (35%) in biochemical pregnancy group and the proportion (29.3%) in ongoing pregnancy group (P<0.05). Conclusion · The quality of embryos is not necessarily related to biochemical pregnancy, but the score of trophoblastic may be related to the arrest of early embryo growth.

Objective To preliminarily study on the values of microembolic signal(MES)monitoring in the evaluation of anti-Platelet agent or anti-Platelet agent+statins in patients with acute ischemic cerebrovascular disease.Methods Among the patients with acute ischemic cerebrovascular disease in the cm'otid system who performed MES monitoring the MES-positive patients were ramaomly allocated into dual antiplatelet group(aspirin 100 mg/d+clopidogrel 75 mg/d)and dual antiplatelet + atorvastatin goup (aspirin 100 mg/d + clopidogrel 75 mg/d +atorvastatin 20 me4d).MEss were monitored by transcranial Doppler ultrasound.Results Among the 60 patients with acute cerebrovascular disease in the carotid system,13(21.7%)were MES positive.in which,6 and 7 were randomly divided into dual antiplatelet group and dual antiplatelet + atorvastatin group respectively.There were no significant differences in the constituent ratios of sex hypertmsion,diabetes,coronary heart disease,smoking,alcohol consumption,and history of previous stroke as well as the age,time from onset to microembolic monitoring,and time from onset to drug intervention between the 2 groups.There were no significant differences in the numbers of microemboli(8.83±1.17/h vs.9.00±1.83/h)before treatment between the dual alltiplatelet group and dual antiplatdet + atorvastatin group (P=0.851);2 and 7 days after treatment,the numbers of micromixfli were 4.17±1.47 and 2.17±0.75/h respevtively in the dutral antiplatelet group,and they were significantly higher than 1.43±0.976 and 0.71±0.488/h)respevtively in the dual antiplatelet + atorvastatin group (P=0.002 and P=0.003).They were followed up for 8 days;and there were 110 ischemic events in both groups.Conclusions The dual antiplatelet agents or those in combination with statins might reduce the number of MES,but when they were used in combination with statins,the number Of MES reduced more significant.However.because there are only a few patients in the study,this conclusion still needs to be further validatod in a large-scale multicenter randomized controlled trial.The MES monitoring has a certain value in the evaluation of anti-platelet drugs or those in combination with statins

Objective To investigate the braking time in diagnosis of lipohemarthrosis by ultrasound. Methods Experiment group:After 20 tubes containing fresh blood and pig marrow were uniformly mixed, they were instantly continuously detected by high-frequency linear array transducer in fixed-area at short-interval.Clinical group: Ten walking patients with lipohemarthrosis were examined with continuous detection by ultrasound,CT and MR before operation.Results Experiment group: Cloudy echo and slowly floating up of lipoids were detected at the beginning.After 2.7 to 3.7 minutes (average 3.17 minutes), the liquid was divided into two layers with vague boundary.After 5.3 to 8.0 minutes (average 6.75 minutes) ,the liquid was divided into 3 layers with thickening serum laye.Clinical group: Ultrasound findings: Cloudy medium echo was detected at first.After 2.0 to 4.0 minutes (average 3.08 minutes),the liquid was divided into two layers.After 4.4 to 10.0 minutes (average 6.92 minutes) , the liquid was divided into 3 layers with thickening serum layers.Three knees showed fracture line and 2 knees with occult fracture were diagnosed as lipohemarthrosis.CT and MR findings: Ten knees showed fracture line in CT examination,of which 7 knees showed double liquid-liquid layer and 3 knees showed single liquid-liquid layer in the suprapatellar bursa.Ten knees showed fracture line in MR examination,6 knees showed double liquid-liquid layer and 4 knees showed single liquid-liquid layer in the suprapatellar bursa. Conclusions The best braking time in diagnosing lipohemarthrosis by ultrasound can be shorten to 10 minutes and the necessary braking time is 2 to 4 minutes.

Objective To investigate the changes of serum CXCL16 levels in patients with acute cerebral infarction and their relationship with the Trial of Org10172 in Acute Stroke Treatment (TOAST) etiological types of cerebral infarction. Methods The serum CXCL16 levels in 113 patients with acute cerebral infarction were measured by enzyme-linked immunosorbent assay (ELISA), and they were grouped according to TOAST types. The patients between all the subgroups and/or 32 healthy controls were compared. Results The serum CXCL16 levels in patient group were significantly higher than those in control group (2.29 ± 0.21 ng/mlvs.1.75±0.21 ng/ml, t= 12.863, P= 0.000); The serum CXCL16 levels in large artery atherosclerotic (LAA) stroke group were significantly higher than those in small artery occlusive (SAO) stroke group (2.38 ±0.23 ng/mL vs. 2.21 ±0.11 ng/ml, 1 =5. 743, P =0. 000), and both were significantly higher than those in the control group (q = 20. 501, P = 0. 000; q =13. 527, P= 0. 000). In the LAA group, there were no significant differences between the serum CXCL16 levels in ≥2 artery stenosis group and those in only 1 artery stenosis group (2.34 ±0.24 ng/ml vs. 2.46 ± 0. 19 ng/ml, t = - 1.969, P = 0. 054). Multivariate logistic regression analysis showed that CXCL16 (OR =0.972, 95% CI0.956-0. 978, P =0.001)and hyperlipidemia (OR =3.547, 95%CI 1.160-10. 848, P=0. 020) were the independent risk factors for cerebral infarction. Conclusions The serum CXCL16 levels increased in acute cerebral infarction, it closely related with the occurrence of cerebral infarction, and the LAA stroke group was significantly higher than the SAO stroke group.