Objective To evaluates the impact of early application of neuromuscular electrical stimulation(NMES)on muscle strength,clinical outcomes,and long-term quality of life improvements in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS).Methods A total of 75 patients diagnosed with SAP and ARDS admitted in Department of Critical Care Medicine of our hospital from September 2022 to August 2023 were recruited and then randomly divided into NMES group(n=37)and control group(n=38).After 16 patients were excluded,including 8 died during treatment,3 discharged and 5 received palliative care,there were finally 29 patients in the NMES group and 30 in the control group.Within 48 h after ICU admission,the NMES group received NMES 1 h per day,for 7 d in addition to standard rehabilitation intervention.While,the control group were given conventional interventions for rehabilitation.Assessments at baseline and post-treatment included the incidence of ICU-acquired weakness(ICU-AW),Medical Research Council(MRC)score,duration of mechanical ventilation,lengths of ICU and total hospital stays,and activity,thickness and thickening fraction of the diaphragm.Mortality rates and Barthel index(BI)for self-care ability in 1,3 and 6 months after discharge were recorded for follow-up assessments.Results The NMES group had significantly lower incidence of ICU-AW(P＜0.05),higher upper and lower limb MRC scores and overall MRC score at ICU discharge(P＜0.05),shorter durations of mechanical ventilation,ICU stay,and total hospital stay when compared with the control group(P＜0.05).There was no statistical difference in the BI at 1 month post-discharge between the 2 groups,but the indexes at 3 and 6 months were notably higher in the NMES group than the control group(P＜0.05).No obvious differences were observed between the 2 groups in terms of diaphragm activity,thickness,or thickening scores at enrollment,ICU discharge,or hospital discharge,nor in mortality rates at 1,3,and 6 months after discharge.Conclusion Combined NMES and early rehabilitation therapy can improve muscle strength and reduce length of hospital stay in SAP patients complicated with ARDS,and may enhance long-term quality of life.However,it does not significantly affect diaphragm function or mortality rates.

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is very rare. This 39-year-old female patient, more than 10 years after breast augmentation surgery, had suffered left breast swelling and pain for more than 1 year. The original implant (domestic anatomic shape silicone implant, 260 ml) was surgically removed and the capsule of the left breast implant was completely removed. Postoperative pathology confirmed the diagnosis of BIA-ALCL. The patient recovered well after the surgery. This case is the first reported in China mainland, suggest that doctors should attach great importance to the diseases, and diagnose and treat it timely and accurately.

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is very rare. This 39-year-old female patient, more than 10 years after breast augmentation surgery, had suffered left breast swelling and pain for more than 1 year. The original implant (domestic anatomic shape silicone implant, 260 ml) was surgically removed and the capsule of the left breast implant was completely removed. Postoperative pathology confirmed the diagnosis of BIA-ALCL. The patient recovered well after the surgery. This case is the first one reported in China mainland, which suggest that doctors should attach great importance to the diseases, and diagnose and treat it timely and accurately.

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is very rare. This 39-year-old female patient, more than 10 years after breast augmentation surgery, had suffered left breast swelling and pain for more than 1 year. The original implant (domestic anatomic shape silicone implant, 260 ml) was surgically removed and the capsule of the left breast implant was completely removed. Postoperative pathology confirmed the diagnosis of BIA-ALCL. The patient recovered well after the surgery. This case is the first reported in China mainland, suggest that doctors should attach great importance to the diseases, and diagnose and treat it timely and accurately.

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is very rare. This 39-year-old female patient, more than 10 years after breast augmentation surgery, had suffered left breast swelling and pain for more than 1 year. The original implant (domestic anatomic shape silicone implant, 260 ml) was surgically removed and the capsule of the left breast implant was completely removed. Postoperative pathology confirmed the diagnosis of BIA-ALCL. The patient recovered well after the surgery. This case is the first one reported in China mainland, which suggest that doctors should attach great importance to the diseases, and diagnose and treat it timely and accurately.

OBJECTIVE： To prepare Baicalin-loaded Polyethylene glycol-derivatized phosphatidylethanolamine （BAI@PEG-PE） nanomicelles， and to characterize it and study its cytotoxicity. METHODS： BAI@PEG-PE nanomicelles were prepared by film hydration method and their appearance characteristics were observed. The particle size， polydispersity index， Zeta potential， drug-loading amount and encapsulation efficiency of the nanomicelles were detected. Drug release of BAI raw material and BAI@PEG-PE nanomicelles in pH 7.4 phosphate buffer were compared within 1-84 h. Using coumarin 6 as fluorescent probe， the distribution of PEG-PE nanomicelles in H9c2 cardiomyocytes were observed. H9c2 cardiomyocytes were divided into model group， BAI raw material group and BAI@PEG-PE nanomicelles group. After treated with serum-free DMEM medium containing no or corresponding drugs for 0.5 h， isoproterenol was used to induce cardiomyocyte apoptosis. Nuclear morphology， cell apoptosis rate and protein expression of Bcl-2 and Bax were compared with among 3 groups. RESULTS： Prepared BAI@PEG-PE nanomicelles were uniform globular shape. The particle size was （16.7±0.8） nm， PDI was 0.11±0.01 and Zeta-potential was （－18.4±0.6） mV； drug-loading amount was （7.84±0.65）％， encapsulation efficiency was （85.7±4.9）％ （n＝3）. Accumulative release rate was 76.5％ within 84 h. BAI raw material was released completely within 24 h. PEG-PE nanomicelles could strengthen the intake of coumarin 6 in H9c2 cardiomyocytes， mainly gathering around mitochondria. Compared with model group， the apoptosis morphology of cardiomyocytes were improved significantly in BAI raw material group and BAI@PEG-PE nanomicelles group； apoptosis rate was decreased significantly； protein expression of Bcl-2 was increased significantly； protein expression of Bax was decreased significantly with statistical significance （P＜0.05 or P＜0.01）. Above effects of BAI@PEG-PE nanomicelles group were more significant （P＜0.05 or P＜0.01）. CONCLUSIONS： BAI@PEG-PE nanomicelles are prepared successfully， and show significant sustained-release effect and myocardial targeting， and can prevent cardiomyocyte apoptosis.

Objective: To investigate clinic-pathological characteristics, diagnosis, treatment and prognosis of intravascular large B cell lymphoma (IVLBCL) in China. Methods: Clinical and pathological records were analyzed from 12 IVLBCL patients diagnosed between Jan 2010 to Jun 2016. Kaplan-Meier method was used to estimate overall survival (OS), and univariate analysis was performed to identify prognostic factors. Results: A series of 12 patients with IVLBCL (median age, 53.8 years; range, 32-76 years; 6 males and 6 females) was reviewed. Fever was the most common symptom (10/12), respiratory symptoms (cough, pleural effusion, dyspnea, 50%) and hemophagocytic lymphohistiocytosis (50%) were frequently observed, and only 12 patients had neurological symptom. All patients had elevated lactic dehydrogenase and serum ferritin. International Prognostic Index score was high in 75% of total patients. All patients had extra-nodal involved, pulmonary (6/12) and bone marrow (4/12) were frequently involved. Large lymphoid cells within vessel lumina or sinuses were observed in all patients. These cells were large, with scant cytoplasm, vesicular nuclei, and one or more nucleoli, and the structures of vessels and sinus were reserved. CD20 and CD79a were positive in all cases. 11patients received rituximab combined CHOP regimen chemotherapies, overall response rate (ORR) was 90.1%, and complete response rate was 66.7%. Median survival time and median progression time were not reached after a median follow-up of 20 months. Univariate analysis revealed that no clinical characters were associated with OS. Conclusion As a rare variant of DLBCL, IVLBCL presented with pulmonary involved frequently, and trans-bronchial lung biopsy had good positive rates. Rituximab contained chemotherapy was the backbone for IVLBCL.

Objective To investigate the diagnosis strategy,radiology and clinical pathology feature of craniomaxillofacial primary tumor induced osteomalacia.Methods Twelve cases of craniomaxillofacial primary tumor induced osteomalacia were reviewed,including 5 male and 7 female with a age range from 16 to 69 years.The clinical characteristics,radiology examinations and pathological features were analyzed.Results The craniomaxillofacial primary tumor induced osteomalacia occurred in different ages,with 2 to 30 years of medical history.Seven of the twelve cases were octreotide scintigraphy positive,nine of the twelve cases invaded bone,exhibiting destruction of the adjacent cortex,ten of the twelve showed gingival lesions of local thickening or epulis.The tumor arises from mesenchymal tissue,infiltrating local gingiva and bone trabeeular with spindle like fibroblasts and dental epithelial rests.Conclusions The concealed nature of the tumor induced osteomalacia requires multiple methods to locate the primary tumor and the tumors located in craniomaxillofacial region have unique clinical and pathological features.

OBJECTIVETo establish a novel method to determine specific type of amyloidosis through laser microdissection and mass spectrometry (LMD/MS) based proteomic analysis.

METHODSThere were 138 formalin-fixed and paraffin-embedded (FFPE) biopsy samples of patients who were diagnosed as systemic amyloidosis used in this study. For each case, a 10 μm section stained with congo-red and positive amyloid deposits were identified under fluorescent light, followed by micro-dissection and mass spectrometry analysis. The amyloidosis subtype was confirmed based on the most abundant amyloid protein.

RESULTSThe tissue types of 138 specimens were as following: subcutaneous abdominal fat accounted for 26%, tongue for 19%, gingiva for 11%, kidney for 9%, intestine for 9%, heart for 6% and others for 20%. Specific types of amyloid were accurately detected in 121 cases, including 106 (87.6%) amyloid light chain (AL) type, 7 (5.8%) amyloid trans-thy-retin (ATTR), 2 (1.7%) amyloidogenic protein A (AA), 2 (1.7%) amyloid heavy chain (AH)/AL+AH, 2 (1.7%) fibrinogen alpha chain (AFib), 1(0.8%) amyloid apolipoprotein A-type II (AApoA-II) and one (0.8%) amyloid lysozyme (ALys). Diagnosis of amyloidosis was excluded in 5 cases. The types of twelve cases were indeterminate by LMD/MS. On the whole, LMD/MS reached 91.3% accuracy rate in amyloid typing. Commonly involved organs (for example, heart, kidney and liver) turned out to be suitable sources of FFPE samples with typing success rate of almost 100%. In contrast, MS analysis was successful in only 83.3% of subcutaneous abdominal fat samples.

CONCLUSIONLMD/MS method provided a more direct technique for accurate typing of amyloidosis in a single procedure.

Objective To analyze the clinical characteristics of AIDS-related non-Hodgkin lymphoma(ARL)and review relative literature for the diagnosis and treatment of ARL.Method The clinical data of ARL patients admitted to Peking Union Medical College Hospital from April 2009 to April 2011 were retrospectively analyzed.Results Five male ARL patients aged 32 to 65 years old were included in this retrospective study.Among them,two patients were found to be HIV-positive for the first time,three were on regular highly active anti-retroviral therapy(HAART)for 7-8 months before the emergence of lymphoma-related symptoms.CD4+ T cell count was(69-232)× 106/L at presentation.Two patients firstly presented with sore throat and throat ulcer,one with cervical nodules,one with pelvic mass,one with fever and edema in right thigh.Through pathological analysis,four patients had B cell-originated lymphoma,with one Burkitt lymphoma and three diffuse large B cell lymphomas; one patient had T-cell lymphoma.Four patients were treated with chemotherapy,with one complete remission,one relapse,one non-response,and one death.One patient had radiotherapy only and had progressed disease.Bone marrow suppression and gastrointestinal disturbance were the main adverse effects of chemotherapy.Conclusions Lymphoma should be considered in any HIV-infected patients presented with unexplainable adenopathy,recurrent sore throat or throat ulcer,or fever of unknown origin.Biopsy should be rigorously carried out.Appropriate chemotherapy,together with HAART,may improve the prognosis greatly.