ABSTRACT: Meningiomas are the most common primary intracranial neoplasm with diverse pathological types and complicated clinical manifestations. The fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5), published in 2021, introduces major changes that advance the role of molecular diagnostics in meningiomas. To follow the revision of WHO CNS5, this expert consensus statement was formed jointly by the Group of Neuro-Oncology, Society of Neurosurgery, Chinese Medical Association together with neuropathologists and evidence-based experts. The consensus provides reference points to integrate key biomarkers into stratification and clinical decision making for meningioma patients. REGISTRATION Practice guideline REgistration for transPAREncy (PREPARE), IPGRP-2022CN234.
Humans ; Meningioma/pathology* ; Consensus ; Neurosurgical Procedures ; Meningeal Neoplasms/pathology*

Objective In tongue diagnosis, the location, color, and distribution of spots can be used to speculate on the viscera and severity of the heat evil. This work focuses on the image analysis method of artificial intelligence (AI) to study the spotted tongue recognition of traditional Chinese medicine (TCM). Methods A model of spotted tongue recognition and extraction is designed, which is based on the principle of image deep learning and instance segmentation. This model includes multiscale feature map generation, region proposal searching, and target region recognition. Firstly, deep convolution network is used to build multiscale low- and high-abstraction feature maps after which, target candidate box generation algorithm and selection strategy are used to select high-quality target candidate regions. Finally, classification network is used for classifying target regions and calculating target region pixels. As a result, the region segmentation of spotted tongue is obtained. Under non-standard illumination conditions, various tongue images were taken by mobile phones, and experiments were conducted. Results The spotted tongue recognition achieved an area under curve (AUC) of 92.40%, an accuracy of 84.30% with a sensitivity of 88.20%, a specificity of 94.19%, a recall of 88.20%, a regional pixel accuracy index pixel accuracy (PA) of 73.00%, a mean pixel accuracy (mPA) of 73.00%, an intersection over union (IoU) of 60.00%, and a mean intersection over union (mIoU) of 56.00%. Conclusion The results of the study verify that the model is suitable for the application of the TCM tongue diagnosis system. Spotted tongue recognition via multiscale convolutional neural network (CNN) would help to improve spot classification and the accurate extraction of pixels of spot area as well as provide a practical method for intelligent tongue diagnosis of TCM.

Causes analysis of death is the most common work in forensic pathology practice. When designing problem-based learning (PBL) teaching objectives, we should take cause analysis of death as the main line and give consideration to other related issues. The selected cases should be typical ones that solve the target problems, which can fully reflect the basic theoretical knowledge of forensic pathology, and have moderate difficulty, delights and clear conclusions. The PBL course is divided into three steps. The first step focuses on providing students with case information to guide them to find out the problems that need to be solved. The second step focuses on discussing the problems and making pathological diagnoses. The third step focuses on answering the question raised at the beginning of the course. Each lesson can also be divided into several sections by which the lesson plans should be prepared. In the teaching process, performing active interaction with students, controlling the direction of classroom development, balancing student opportunities should be done well in order to make the curriculum smoothly and achieve the purpose of teaching.

Objective:To investigate the correlation between UGT1A1 polymorphisms and the irinotecan plus S-1 regimen-induced toxicities in Chinese advanced esophageal squamous cell carcinoma (ESCC) patients.Methods:A total of 46 recurrent or metastatic ESCC patients selected from ESWN 01 trial were randomly assigned to irinotecan plus S-1 group [intravenous infusion of irinotecan (160 mg/m 2) on day 1 and oral S-1 (80-120 mg) on days 1-10, repeated every 14 days]. Peripheral venous blood at baseline was collected and genomic DNA was extracted. The genetic polymorphisms of UGT1A1*6 and UGT1A1*28 were analyzed by polymerase chain reaction (PCR) amplification. Irinotecan plus S-1 regimen-induced toxicities of patients with different UGT1A1 polymorphisms were observed. The correlation between UGT1A1 polymorphisms and the adverse effects was analyzed. Results:Among the 46 patients, the numbers of UGT1A1*6 wild type genotype (GG), mutant heterozygote (GA) and mutant homozygote (AA) were 30, 15 and 1, while those with UGT1A1*28 wild type genotype (TA6/6), mutant heterozygote (TA6/7) and mutant homozygote (TA7/7) were 36, 8 and 2, respectively. Only one patient with UGT1A1*6 AA genotype occurred grade 3 diarrhea, while one of the 2 patients with UGT1A1*28 TA7/7 genotype occurred grade 4 diarrhea. No neutropenia was observed in the patient with UGT1A1*6 AA genotype, however, both of the two patients with UGT1A1*28 TA7/7 genotype occurred grade 3-4 neutropenia. Patients with UGT1A1*28 genetic polymorphism (TA 6/7 or TA7/7) had a higher response rate compared with wild-type TA6/6 carriers. (55.6% versus 26.5%).Conclusions:The homozygous genotype of UGT1A1*6 AA and UGT1A1*28 TA7/7 are rare (<5%) in Chinese ESCC population. Not all homozygous AA and TA7/7 carriers occur severe dose limited toxicities (DLT) when treated with irinotecan (160 mg/m 2) plus S-1 regimen for 2 weeks. However, it′s still necessary torigorously observe the occurrence of severe diarrhea and neutropenia in patients with UGT1A1*6 AA and UGT1A1*28 TA7/7 and adjust the dose timely.

Objective:To investigate the correlation between UGT1A1 polymorphisms and the irinotecan plus S-1 regimen-induced toxicities in Chinese advanced esophageal squamous cell carcinoma (ESCC) patients.Methods:A total of 46 recurrent or metastatic ESCC patients selected from ESWN 01 trial were randomly assigned to irinotecan plus S-1 group [intravenous infusion of irinotecan (160 mg/m 2) on day 1 and oral S-1 (80-120 mg) on days 1-10, repeated every 14 days]. Peripheral venous blood at baseline was collected and genomic DNA was extracted. The genetic polymorphisms of UGT1A1*6 and UGT1A1*28 were analyzed by polymerase chain reaction (PCR) amplification. Irinotecan plus S-1 regimen-induced toxicities of patients with different UGT1A1 polymorphisms were observed. The correlation between UGT1A1 polymorphisms and the adverse effects was analyzed. Results:Among the 46 patients, the numbers of UGT1A1*6 wild type genotype (GG), mutant heterozygote (GA) and mutant homozygote (AA) were 30, 15 and 1, while those with UGT1A1*28 wild type genotype (TA6/6), mutant heterozygote (TA6/7) and mutant homozygote (TA7/7) were 36, 8 and 2, respectively. Only one patient with UGT1A1*6 AA genotype occurred grade 3 diarrhea, while one of the 2 patients with UGT1A1*28 TA7/7 genotype occurred grade 4 diarrhea. No neutropenia was observed in the patient with UGT1A1*6 AA genotype, however, both of the two patients with UGT1A1*28 TA7/7 genotype occurred grade 3-4 neutropenia. Patients with UGT1A1*28 genetic polymorphism (TA 6/7 or TA7/7) had a higher response rate compared with wild-type TA6/6 carriers. (55.6% versus 26.5%).Conclusions:The homozygous genotype of UGT1A1*6 AA and UGT1A1*28 TA7/7 are rare (<5%) in Chinese ESCC population. Not all homozygous AA and TA7/7 carriers occur severe dose limited toxicities (DLT) when treated with irinotecan (160 mg/m 2) plus S-1 regimen for 2 weeks. However, it′s still necessary torigorously observe the occurrence of severe diarrhea and neutropenia in patients with UGT1A1*6 AA and UGT1A1*28 TA7/7 and adjust the dose timely.

Objective:To investigate the clinical features, pathology and prognosis of pulmonary nodules.Methods:The data of patients with pulmonary nodules diagnosed by computed tomography (CT) in the Affiliated Hospital of Yangzhou University from 2015 to 2017 were analyzed retrospectively. The pathological results of all the nodules that were resected by video-assisted thoracoscopic surgery (VATS) were obtained definitely. Moreover, the prognosis of pulmonary nodules was also investigated by analyzing their clinical features and pathology.Results:Of all 117 pulmonary nodules, the number of pure ground glass nodules (pGGN), mixed ground glass nodules (mGGN) and solid nodules was 37, 64, and 16, respectively. Nodules of different compositions are more common in women, and are mostly located in the upper lobe of the right lung. There were significant differences in the pathological types of nodules with different components. The pathological results of pGGNs were mainly adenocarcinoma in situ (AIS) (51.4%, P<0.001), and mGGNs were also characterized by AIS (37.5%, P=0.001), while solid nodules were mainly invasive adenocarcinoma (IAC) and others ( P<0.001). Meanwhile, the diameter of solid nodules was significantly larger than that of mixed ground glass nodules and pure ground glass nodules [(17±8)mm, P<0.001], and the diameter of IAC in the mGGNs [(15±7)mm, P<0.001] and solid nodules [(22±8)mm, P=0.031] was significantly larger than other pathological types. In addition, the prevalence of complications after thoracoscopic surgery was 9.0% (10/111), and symptomatic treatment was effective after 1-3 months. Conclusions:The components and diameter of pulmonary nodules were closely related to lung adenocarcinoma. With the increase of solid components and diameter of nodules, it is possible to develop into IAC. Therefore, CT screening of pulmonary nodules is beneficial to the diagnosis and treatment for early lung cancer, and significant to the improvement of prognosis.

OBJECTIVE: To observe the effects of a traditional Chinese medicine (TCM) capsule for replenishing qi, nourishing yin and activating blood on Notch/Hes1 signaling pathway in the renal tissue and vascular endothelial CD34 and CD144 expressions in a rat model of diabetic nephropathy. METHODS: Rat models of early-stage diabetic nephropathy were established by left nephrectomy and high- fat and high- sugar feeding combined with intraperitoneal injection of STZ. The rats were randomized into model group, benazepril group, and high-, moderate-, and low-dose TCM capsule groups for corresponding treatments, with 6 normal rats as the control group. After 8 weeks of drug treatment, blood glucose and 24-h urinary albumin of the rats were measured, and the renal histopathology was observed with HE staining; Hes1 expression in the renal tissue was detected with immunohistochemical staining, and the renal expressions of CD34 and CD144 were detected using Western blotting. RESULTS: Compared with the normal control group, the rat models of diabetic nephropathy showed obvious abnormalities in 24- h urinary albumin and expressions of Hes1, CD34 and CD144d. The TCM capsule at both the high and moderate doses significantly reduced 24-h urinary albumin in the rats; the renal expressions of Hes1 and CD34 was significantly reduced in all the dose groups, and the expression of CD144 was significantly reduced in the high- dose group. Compared with benazepril group, the TCM capsule obviously reduced CD34 expression at all the 3 doses and lowered CD144 expression at the low dose. Histopathologically, the rats in the model group showed glomerular hypertrophy, increased mesenteric matrix, thickening and widening of the mesenteric membrane, and nodular hyperplasia. These pathologies were obviously alleviated by treatment with the TCM capsule at the high and moderate doses. CONCLUSIONS The Traditional Chinese medicine (TCM) capsule for replenishing qi, nourishing yin and activating blood can reduce Hes1, CD34 and CD144 in kidney tissue of model rats, play a protective role on kidney function and delay the development of DN.
Animals ; Diabetic Nephropathies ; Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; Qi ; Rats ; Signal Transduction ; Transcription Factor HES-1

Objective To evaluate the influences of statin treatment on MR vessel wall imagingobserved characteristics of atherosclerotic plaque in the thoracic aorta of the elderly.Methods Elderly subjects (≥ 60 years) without any serious cerebro-cardiovascular diseases were recruited.Thoracic aorta was imaged on MR scanner for all the subjects.The plaque burden was calculated quantitatively,the composition of plaque in thoracic aorta was evaluated qualitatively,and the contributions of statin treatment to these characteristics were also compared by image interpretation personals.The thoracic aorta was divided into three segments (AAO:ascending aorta;AOA:aortic arch,and DOA:descending aorta)on the imaging.Results Totally 55 recruited subjects had atherosclerotic plaque in thoracic aorta,with 24 subjects receiving statin treatment,and 50 ％ (12/24) male,aged 73.8±6.3 years.The level of LDL C[(2.4±0.7)mmol/L vs.(3.1±0.8)mmol/L(P＜ 0.01)]and total cholesterol[(4.4±0.6)mmol/L vs.(5.1 ±1.0)mmol/L(P＜0.01)]were significantly lower in statin group than in non-statin group.The lumen area,wall area,and total vessel area in all three segments of thoracic aorta were significantly smaller in statin group(all P＜0.05)than in nonstatin group.The average wall thickness in segment of AOA[(2.7±0.3)mm vs.(2.8±0.4)mm(P＜0.01)]and DAO[(2.5±0.4)mm vs.(2.6±0.5)mm(P＜0.01)]were smaller in statin group than in non-statin group.The incidence rate of intraplaque hemorrhage / mural thrombus [6 cases (25.0％) vs.8 cases(25.8 ％)]in thoracic aorta was a little lower in statin group than in non-statin group,with no significant difference(P＞0.05).Conclusions Statin treatment decreases LDL-C level,reduces the burden of atherosclerotic plaque in thoracic aorta,and maintains the atherosclerotic plaque stability.

Purpose The thoracic aortic atherosclerotic plaque is an important source of ischemic stroke embolism in the elderly.This study aims to explore the characteristics of vulnerable plaque of atherosclerosis in the thoracic aorta in the elderly by using three-dimensional multi-contrast magnetic resonancewall imaging technique,so as to actively prevent the occurrence of cardiovascular and cerebrovascular complications.Materials and Methods Fifty-three cases of elderly subjects (＞60 years old) without serious cerebrovascular diseases were recruited in this prospective study.All subjects were divided into A and B groups (60-74 and 75-90 years old).All subjects underwent MRI of multiple contrast sequences of the aortic wall.The thoracic aorta was divided into three segments of ascending aorta,aortic arch and descending aorta,and the characteristics of the atherosclerotic plaque were evaluated.The load characteristics of thoracic aortic atherosclerotic plaques in the elderly were calculated quantitatively,and the compositional characteristics were evaluated qualitatively.Results The incidence of intraplaque hemorrhage in the thoracic aortic atherosclerotic plaque in the elderly was 26.4％ (14/53),and the incidence of lipid nucleus was 94.3％ (50/53).Meanwhile,the maximum wall thickness of three segments of ascending aorta,aortic arch and descending aorta in group B was significantly higher than that in group A [(3.1±0.6) mm vs (3.0±0.4) mm,P＜0.05;(3.2±0.7) mm vs (3.1 ±0.7) mm,P＜0.05;(3.0±0.8) mm vs (2.9±0.7) mm,P＜0.001];the normalized wall index of the three segments in group B was significantly higher than that in group A [(26.9±3.5)％ vs (26.7±2.9)％,P＜0.001;(31.9±5.1)％ vs (31.0±5.1)％,P＜0.001;(34.6±5.0)％ vs (34.1 ±4.6)％,P＜0.001)].Conclusion The incidence of hemorrhage in the atherosclerotic plaque in the thoracic aorta in the elderly is higher,and the plaque load increases with age.Therefore,early screening of vulnerable plaque in the thoracic aorta in the elderly using magnetic resonance wall imaging will be helpful for prevention and treatment of stroke.

Objective To investigate the feasibility and safety of reoperation of laparoscopic common bile duct exploration in the management of choledocholithiasis in patients with biliary surgical history. Methods Thirty-one patients with choledocholithiasis and biliary surgical history were performed by reoperation of laparoscopic common bile duct exploration between January 2012 and January 2014 in our hospital.The adhesion was disconnected under the laparoscopy, and then the common bile duct was opened to introduce an endoscope for stone removal.A T-tube was placed for drainage. Results The operations were successfully completed in all the 31 cases, without conversion to open surgery.The vital signs of those patients were smooth during the operation.The operation time was 65-125 min, with a mean of (118 ±21) min.The volume of blood loss was 10-75 ml during operations, with a mean of (39 ±19) ml.The patients could take food normally 24-48 h after operation, with a mean of (27 ±13) h.The drainage tubes were pulled out 48 -72 hours after operation.No severe complications, such as residual stones, bleeding, gastrointestinal leakage, or pancreatitis happened during hospitalization, except for 1 case of biliary leakage and 1 case of incision infection.The patients stayed in hospital for 6-9 days after operation, with a mean of (7.0 ±1.5) days.No biliary stricture or recurrence was found during a 3-24 months of follow-up (mean, 15.6 months) in 31 cases. Conclusion Reoperation of laparoscopic common bile duct exploration by experienced laparoscopic specialists for choledocholithiasis in patients with biliary surgical history is relatively safe and effective.