Purpose To investigate the clinical and patho-logical characteristics,molecular characteristics,treatment and prognosis of systemic ALK-negative anaplastic large cell lympho-ma(ALCL).Methods Retrospective analysis was conducted on the clinical pathology,immunophenotype,molecular charac-teristics,treatment and prognosis of 18 cases of systemic ALK-ALCL.HE,immunohistochemistry,FISH,and NGS tests were performed,and relevant literatures were reviewed.Results Systemic ALK-ALCL tended to occur in elderly men,often in the advanced stage,mainly in lymph node lesions.The extran-odal primary sites included the primary pancreas and primary thoracic vertebrae.Morphological examination showed 17 cases belong to common type,1 case belong to"Hodgkin like"type.CD30 was diffuse and strongly positive in tumor cells(＞75％),CD2(16/17),CD3(13/18),CD5(4/18),CD7(8/18),CD4(14/18),TIA-1(16/18),CD8(2/16),GATA-3(10/12),EMA(3/5),MUM1(12/12),CD43(6/6)and CD56(2/8)were positive to varying degrees.The Ki67 proliferation index of 30％to 90％,PD-L1(22C3)(TPS=0-100％),ALK,CD15,CD79α and CD20 were all negative.FISH detection:5 cases of TP63 deficiency and 2 cases of DUSP22 deficiency;NGS detection:16 cases of gene mutations occurred,with a fre-quency of 0-11 gene mutations and an average of 4.2 gene mu-tations;ALK-ALCL with TP63 rearrangement was more likely to occur in women,mostly in lymph nodes,late clinical staging,susceptibility to p53 gene abnormalities,low PD-L1 expression rate and high mortality rate.Conclusion Systemic ALK-ALCL with TP63 rearrangement is associated with many adverse factors,the clinical process is often invasive with poor progno-sis.

Objective To explore the relationship between body mass index(BMI)and blood pressure(BP),blood lipids,waist-to-hip ratio(WHR),and hemoglobin(Hb)in the elderly.Methods A total of 10 978 elderly individuals aged≥65 years old in a community in Baoshan District,Shanghai from February 2023 to October 2023 were selected as the research subjects.Height,body mass,waist circumference(WC),hip circumference(HC),systolic blood pressure(SBP),diastolic blood pressure(DBP),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),Hb were measured,and BMI and WHR were calculated.According to the Chinese BMI reference standard,the elderly were divided into a lean group(BMI＜18.5 kg/m2,n= 310),a normal body mass group(18.5 kg/m2≤BMI＜24 kg/m2,n=4 692),a overweight group(24 kg/m2≤BMI＜28 kg/m2,n= 4 615),and an obese group(BMI≥28 kg/m2,n=1 361).The levels of BP,blood lipids,WHR,and Hb in the four groups were compared and correlation analysis was conducted.Results The levels of BMI,WC,HC,WHR,SBP,DBP,and Hb in elderly men were higher than those in elderly women(all P＜0.01),while the levels of TC,HDL,and LDL were lower than those in elderly women(all P＜0.01).The differences in SBP,DBP,TC,HDL,LDL,WHR,and Hb among the four groups were statistically significant(all P＜0.05),and BMI was positively correlated with SBP,DBP,TC,LDL,WHR,and Hb(r=0.109,0.064,0.041,0.042,0.108,0.089,all P＜0.01),and negatively correlated with HDL(r=﹣0.106,P＜0.01).The BMI of elderly men in the normal body mass group was higher than that of elderly women,while the BMI of elderly women in the obesity group was higher than that of elderly men(both P＜0.01).In the normal body mass group,the BMI of elderly people aged＜75 years old was higher than that of elderly people aged≥75 years old(P＜0.05).Conclusions BMI is closely related to the health of the elderly,and maintaining an ideal BMI is the foundation for health management and prevention of chronic diseases in the elderly.

Objective To observe the clinical efficacy of Jiangshabanxia nano-paste on nausea and vomiting in end-stage patients and its effect on the quality-of-life (QOL) in cancer patients. Methods 120 end-stage patients with nausea and vomiting symptoms above grade III were randomly divided into observation group and control group. They were treated with Jiangshabanxia nano-paste and placebo paste respectively. The paste patch was changed every 24 hours and used continuously for 7 days. The nausea and vomiting symptom score, the quality-of-life measurement score and KPS score of cancer patients in the two groups were observed to evaluate the curative effect. Results After 7 days of treatment, the symptom scores of nausea and vomiting in the observation group decreased significantly, the KPS score of the observation group increased, and the effective rate was higher than that in the control group. The score of QOL measurement showed that after treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group decreased, and the score of overall health area increased. After treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group was lower than that in the control group, and the scores of overall health area in the observation group were higher than those in the control group. Conclusion Jiangshabanxia nano-paste has a good clinical efficacy nausea and vomiting in end-stage patients, it also can improve the quality of life end-stage cancer patients.

Objective:To investigate the clinical efficacy and safety of intravenous thrombolysis with different doses of alteplase in the treatment of acute cerebral infarction in older adult patients.Methods:A total of 65 older adult patients with acute cerebral infarction (onset within 4.5 hours, age ≥ 75 years) who underwent intravenous thrombolysis in Wenzhou Central Hospital from February 2021 to February 2022 were included in this study. They were randomly assigned to undergo intravenous thrombolysis with either low dose alteplase (0.6 mg/kg, low dose group, n = 32) or standard dose alteplase (0.9 mg/kg, standard dose group, n = 33). The National Institutes of Health Neurological Stroke Scale score before and 24 and 48 hours after treatment, modified Rankin scale score before and 7, 14 and 90 days after treatment, serum C-reactive protein (CRP), neuron-specific enolase (NSE) and tumor necrosis factor-α (TNF-α) levels before and 24 hours after treatment, 24-hour incidence of intracranial hemorrhage, 24-hour incidence of symptomatic intracranial hemorrhage, and 90-day mortality were compared between the two groups. Results:Compared with before treatment, the National Institutes of Health Neurological Stroke Scale scores in each group were significantly decreased at 24 and 48 hours after treatment (low dose group, t24 h = 6.78, t48 h = 7.86; standard dose group: t24 h = 8.09, t48 h = 10.13, all P < 0.001). Compared with before treatment, the modified Rankin scale score in each group was significantly decreased at 7, 14 and 90 days after treatment (low-dose group: t7 d = 5.19, t14 d = 8.47, t90 d = 9.85; standard dose group: t7 d = 6.83, t14 d = 7.74, t90 d = 13.66, all P < 0.001). At 24 hours after treatment, serum levels of CRP, NSE, TNF-α in each group were significantly decreased (low-dose group: tCRP = 5.13 , tNSE = 4.22, tTNF-α = 34.29; standard dose group: tCRP = 4.87, tNSE = 5.53, tTNF-α = 31.98, all P < 0.001). At each time point after treatment, there were no significant differences in these indices between the two groups (all P > 0.05). The 24-hour incidence of intracranial hemorrhage in the low dose group was significantly lower than that in the standard dose group ( χ2 = 4.58, P = 0.032). There were no significant differences in incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (all P > 0.05). Conclusion:Intravenous thrombolysis with low dose alteplase (0.6 mg/kg) for the treatment of acute cerebral infarction in older adult patients exhibits equivalent clinical efficacy to that with standard dose alteplase (0.9 mg/kg), and the former is much safer than the latter.

Objective:To investigate the relationship between the protein expression of C-MYC, bcl-2 and bcl-6 and the clinicopathological characteristics in patients with de novo CD5-positive diffuse large B cell lymphoma (CD5 +DLBCL). Methods:Fifty seven cases of de novo CD5 +DLBCL were collected at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from February 2013 to September 2018. The hematoxylin-eosin stained slides were reviewed, and immunohistochemical (IHC) staining and FISH were used to analyze the relationship between C-MYC, bcl-2, bcl-6 expression and the clinicopathologic characteristics of patients. Results:Among these 57 cases, 27 were male and 30 were female. The age of onset was 35-99 years old. The IHC expression rates of C-MYC, bcl-2 and bcl-6 were 50.9% (29/57), 84.2% (48/57), and 75.4% (43/57) respectively; and co-expression rate of C-MYC and bcl-2 proteins was 40.4 (23/57). There was no significant correlation between protein expression and patients′ genders, clinical stage, the level of serum LDH,β2 microglobulin, IPI,B symptoms, bone marrow involvement and central nervous system recurrence ( P>0.05). Univariate analysis showed that the median OS of C-MYC negative patients was significantly longer than C-MYC positive patients ( P<0.05); and the median OS of patients without double expression was significantly longer than that of patients with positive expression ( P<0.05), and bcl-6 positive patients had longer median OS than bcl-6 negative patients ( P<0.05). There was no significant correlation between prognosis and bcl-2 protein expression ( P>0.05) . Cox multivariate analysis showed C-MYC protein expression was an independent predictor of OS in de novo CD5 +DLBCL ( P<0.05). Conclusions:Bcl-2 protein expression has no effect on the prognosis in de novo CD5 +DLBCL whereas bcl-6 expression is correlated with good prognosis. C-MYC protein expression could be used as an independent and effective index to predict the prognosis of patients with de novo CD5 +DLBCL.However, the relationship between protein expression and gene rearrangement of C-MYC, bcl-2 and bcl-6 needs to be further explored.

Objective To investigate the mechanism of rapamycin inhibiting the differentiation and proliferation of newborn porcine pancreatic adult stem cells, and to explore the therapeutic methods that may effectively reduce the side effects of rapamycin. Method Porcine NPCCs were treated with rapamycin alone or in combination with IGF-Ⅱ, and the caspase-3 and [ 3 H ]-thymidine uptake assays were performed to detect apoptosis and proliferation. The expression of insulin, PDX-1, NeuroD/Beta2, and Foxo1, a downstream transcription factor of IGF-Ⅱ, were analyzed by RT-PCR and Western blot to evaluate the differentiation ability of pancreatic adult stem cells. Results The NPCCs treated with rapamycin inhibited the proliferation ofβ-cells, increased apoptosis, reduced insulin secretion, inhibited the expression of PDX-1 and NeuroD/Beta2, and decreased the expression of IGF-Ⅱ. Foxo1 expression and induction of Foxo1 from the cytoplasm to the nucleus of the ectopic. The combined treatment of rapamycin and IGF-Ⅱcan reduce the side effects of rapamycin, inhibit the decrease ofβ-cell number and insulin content, repair the expression of insulin, PDX-1, NeuroD/Beta2, inhibit Foxo1 expression and intracellular ectopic. Conclusion Aberrant expression of IGF-Ⅱ and Foxol genes is the key inducing factor of rapamycin inhibiting the proliferation and differentiation of NPCCs, and IGF-Ⅱtreatment can effectively reduce the side effects of rapamycin on NPCCs differentiation.

Objective To explore a scientific and reasonable fiscal input mechanism for public hospitals, in order to fully leverage the policy guidance and efficiency of such funding.Methods With literature review, expert consultation and demonstration, a basic subsidy model for public hospitals was established.According to the past operation data of 4 public hospitals in Baoshan district of Shanghai, the study figured out specific subsidy standards.Results The basic subsidy for public hospitals should be determined according to the number of approved beds, the number of outpatients and emergency visits, hospital bed days, surgeries, key services, and the quality and efficiency of work.In Baoshan district, the standard reference value of subsidy for each approved bed, each outpatient and emergency visit, each bed-day, each surgical operation is 42 096 yuan, 27.9 yuan, 104.9 yuan and 244 yuan respectively.The standard value of subsidy is 100 yuan per bed for critically ill inpatients.For patients under clinical pathway management, the subsidy is 300 yuan per case, and for hospital maternal care, it is 150 yuan per person.Conclusions The basic subsidy model for public hospitals has overcome the shortcomings of fiscal input based on hospital scale or hospital workload, and established an incentive mechanism to promote the implementation of key services.These measures can improve the operation mechanism of public hospitals and encourage them to play their role of public welfare as designed.

Ninety-one patients over 60 year old with type 2 diabetes mellitus(T2DM) were selected from our outpatient department. The patients of experimental group uploaded their blood glucose data detected with glucometers, and obtained integrated management called " Mobile Health(M-health)" management such as medicines,diet,exercise from medical groups. The patients of control group got medical care in a traditional way without receiving other interventions. Regular follow-up was conducted in 2 groups every 3 months. The results showed that 3 months later,postprandial 2h plasma glucose in the experimental group was significantly improved compared with that of control group (P<0.05). Six months later, postprandial 2h plasma glucose and HbA1Clevels in the experimental group showed a decline comparing to the baseline, showing a statistical significance compared with control group(P<0.05). These results suggest that smartphone-based telemedicine is helpful of blood glucose control in elderly T2DM patients.

Objective To study effects of oligo-peptide I-C-F-6 in carapax trionycis on rats with liver fibrosis induced by CCl4;To discuss its anti-liver fibrosis effects and possible mechanisms. Methods Forty-eight SD male rats were randomly divided into normal control group, model group, bifendate group, and oligo-peptide I-C-F-6 group, 12 in each group.CCl4 was injected intraperitoneally to build rat liver fibrosis model.Oligo-peptide I-C-F-6 group and bifendate group were given subcutaneous injection of oligo-peptide I-C-F-6 (0.12μg/g) or bifendate (0.12μg/g). At the same time, normal control group and model group were giventhe same volume of saline for seven weeks. The levels ofALT, AST,MDA, SOD, IL-4, IL-10 and TNF-α were tested.The histomorphology changes were observed under optical microscopeby HE, and the expressions of transforming growth TGF-β1 were determined by immunohistochemistry.Results Compared with model group, serum levels of ALT and AST were reduced evidently in oligo-peptide I-C-F-6 group. Hepatic content of MDA, IL-4 and TNF-α decreased, while SOD activity and IL-10 were found significantly increased. Liver fibrosis was ameliorated significantly. Hepatic expressions of TGF-β1 were weakly positive.Conclusion Oligo-peptide I-C-F-6 can ameliorate hepatocyte damage of model rats, thus it has anti-oxidative and anti-liver fibrosis effects on liver fibrosis in rats.

Objective To analyze the cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy (MPCNL). Methods A retrospective analysis involved total 612 patients with upper urinary tract lithialisis treated with MPCNL from May 2005 to May 2010.382 cases were acupunctured by traditional G18 puncturing instrument (group A),and the other 230 cases were performed by the improved ARROW Raulerson blue syringe (group B).The average renal pelvis range was 24 mm vs.21 mm before operation,and largest diameter of renal calculi was 3.7 cm vs.3.8 cm (P ＞ 0.05).Success rate and time cost as well as therapeutic effect were compared between the 2 groups. Results There were 29 cases of puncturing failure in group A (totally 382 cases) while only 2 in group B (totally 230 cases).The successful rate of establishment of working channel was significantly higher in group B (P ＜ 0.05).Average time of puncture procedure was 5.1 min and 4.8 min respectively (P ＞ 0.05).There was no puncturing-related severe complication in any group.The unsuccessful cases in the group A and related causes were:5 cases for obesity,13 cases for puncture needle slipping,9 cases for channel dropout,and 2 cases for needle route dropout.However,only 2 cases failed in group B,the accurate position of calculi was at upper and lower calyx.One case was over-weighted,another was because of pathway-loss during the calculi elimination processs.And the one-off puncture successful rate of A and B group was 92.4％ vs.99.1％,and the one-off puncture successful rate was significantly higher in group B. Conclusions Overobesity of patients is an important cause of puncturing failure for sonographically MPCNL.The establishment of working-channel with ARROW Raulerson blue syringe could be feasible and the success rate was significantly higher.