Objective:To study the clinical, imaging and pathological features of duodenal gangliocytic paraganglioma (DGP).Methods:The clinical, imaging and pathological data of patients with DGP treated at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2012 to October 2021 were retrospectively analyzed.Results:Of 8 patients with DGP, there were 7 males and 1 female, with a median age of 52 years (range 37 to 57 years). Five patients were asymptomatic and they were diagnosed on physical examination followed by investigations. Three patients presented with black stools. CT examination showed localized nodular thickening of the duodenum, with enhanced scanning showing obvious progressive contrast enhancement. Endoscopic ultrasonography showed a hypoechoic submucosal lesion in duodenal wall. Histologically, the neoplasm composed of three different cell types which included Schwann cells, epithelioid cells, and ganglioid cells. The Schwann cells expressed NF, NSE and S-100 proteins; the epithelioid cells expressed CK, NSE, Syn and CgA proteins; while the ganglioid cells expressed NSE, Syn, CgA and NF proteins. Endoscopic submucosal dissection was performed in 2 patients and surgical resection was performed in 6 patients.Conclusion:DGP is a rare benign neurogenic tumor which is most commonly found in the duodenum. It has a good prognosis. Imaging and endoscopic examinations demonstrated a submucosal mass. The main treatment are endoscopic resection and local surgical resection.

Objective:To provide theoretical reference for the construction of effective prevention and control strategies. The study deeply investigates the impact of traumatic birth events on compassion fatigue and inner feelings of midwives.Methods:Fifteen midwives from five tertiary hospitals in Guangzhou were interviewed in depth by semi-structured interview method from April to June 2021. Colaizzi analysis and Nvivo12 plus software were used to analyze and integrate the data and extract themes.Results:Three main themes were extracted, including the characteristics of traumatic birth events (high incidence, sudden and dangerous, preventable and controllable); exacerbating compassion fatigue (reducing compassion satisfaction levels; exacerbating burnout; and aggravating traumatic stress responses); and exploring effective coping strategies (time required for adjustment, seeking stress release).Conclusions:As a strong stressor, traumatic birth events aggravate the symptoms of compassion fatigue in midwives. Managers should pay attention to the occupational exposure of traumatic childbirth events, actively guide midwives to make psychological adjustments. In addition, managers can increase social support and strengthen the ideological and political education of midwives, so that they have good stress tolerance and excellent professional psychological quality.

Objective:To evaluate the value of next generation sequencing (NGS) in the genetic testing of Lynch syndrome.Methods:Immunohistochemical method was used to detect the expressions of DNA mismatch repair (MMR) proteins, including MutL homolog 1 (MLH1), PMS1 homolog 2 (PMS2), MutS homolog 2 (MSH2) and MutS homolog 6 (MSH6) in colorectal cancer, gastric cancer and endometrial cancer tissues collected from Shandong Provincial Hospital between 2016 and 2018. The genomic DNA of 45 patients who were suspected with Lynch syndrome was extracted from non-cancerous tissue paraffin samples, which were postoperatively confirmed by microscope. The mutations of 12 genes including MLH1 and MSH2 were detected using NGS. The germline mutant sites and significance were analyzed by bioinformatics technology and further confirmed by using Sanger sequencing.Results:The immunohistochemical results showed that the 45 cases of suspected Lynch syndrome included 22 cases of MLH1 and PMS2 deficient expression, 16 cases of MLH2 and MSH6 deficient expression, and 7 cases of MMR proteins normal expression. The NGS result showed that 28 cases of adjacent sample from colon cancer patients included 4 cases of MLH1 pathogenic mutation, 1 case of suspected MLH1 mutation, 2 cases of MLH2 pathogenic mutation, 2 cases of suspected MLH2 mutation. No MMR gene mutation was found in adjacent samples of 6 cases of rectal cancer, 6 cases of gastric cancer and 7 cases of colorectal cancer with MMR normal expression. One case of MLH1 or MHL2 pathogenic mutation and one case of MLH1 suspected mutation was detected in adjacent samples of 5 cases of endometrial cancer. Moreover, NGS also detected many other genes mutations and unreported gene mutation sites. Pathogenic and suspected MLH1 and MSH2 mutations were verified by Sanger sequencing.Conclusions:High-throughput NGS is a quick, accurate and reliable technique to identify gene variants in suspected Lynch syndrome patients. It has a wide application prospect for gene testing of tumors associated with Lynch syndrome.

Objective:To evaluate the value of next generation sequencing (NGS) in the genetic testing of Lynch syndrome.Methods:Immunohistochemical method was used to detect the expressions of DNA mismatch repair (MMR) proteins, including MutL homolog 1 (MLH1), PMS1 homolog 2 (PMS2), MutS homolog 2 (MSH2) and MutS homolog 6 (MSH6) in colorectal cancer, gastric cancer and endometrial cancer tissues collected from Shandong Provincial Hospital between 2016 and 2018. The genomic DNA of 45 patients who were suspected with Lynch syndrome was extracted from non-cancerous tissue paraffin samples, which were postoperatively confirmed by microscope. The mutations of 12 genes including MLH1 and MSH2 were detected using NGS. The germline mutant sites and significance were analyzed by bioinformatics technology and further confirmed by using Sanger sequencing.Results:The immunohistochemical results showed that the 45 cases of suspected Lynch syndrome included 22 cases of MLH1 and PMS2 deficient expression, 16 cases of MLH2 and MSH6 deficient expression, and 7 cases of MMR proteins normal expression. The NGS result showed that 28 cases of adjacent sample from colon cancer patients included 4 cases of MLH1 pathogenic mutation, 1 case of suspected MLH1 mutation, 2 cases of MLH2 pathogenic mutation, 2 cases of suspected MLH2 mutation. No MMR gene mutation was found in adjacent samples of 6 cases of rectal cancer, 6 cases of gastric cancer and 7 cases of colorectal cancer with MMR normal expression. One case of MLH1 or MHL2 pathogenic mutation and one case of MLH1 suspected mutation was detected in adjacent samples of 5 cases of endometrial cancer. Moreover, NGS also detected many other genes mutations and unreported gene mutation sites. Pathogenic and suspected MLH1 and MSH2 mutations were verified by Sanger sequencing.Conclusions:High-throughput NGS is a quick, accurate and reliable technique to identify gene variants in suspected Lynch syndrome patients. It has a wide application prospect for gene testing of tumors associated with Lynch syndrome.

Objective To investigate the MRI features of peliosis hepatis (PH).Methods Nine patients with pathologically proven PH were retrospectively included.Plain scan and contrast-enhanced MRI of the abdomen were performed on all patients before operation.All clinical,pathological and MR imaging data of patients were collected.The MR image analysis of the lesion included the number,location,size,shape,lesion margins,signal intensity,and enhancement pattern.Results Eleven lesions were detected in 9 patients,with 10 lesions in the right lobe of the liver and 1 lesion in the left lobe.The maximum diameter of the 11 lesions was 0.7 cm to 8.8 cm (mean 3.7 cm).All 11 lesions were round or oval in the shape.Seven lesions had clear boundaries and 4 lesions had blurred boundaries.Signal intensity of 2 lesions were homogeneous,while 9 lesions had heterogenous signal intensity on plain san.Ten lesions showed slightly hypointense on T1WI,slightly hyperintense on T2WI and mildly progressive enhancement.These lesions were weakly enhanced and showed slight cluster-like mild enhancement in the arterial phase.The enhancement scope of the lesions gradually filled into the interior in the portal vein phase and the signal intensity was slightly higher than liver in delay phase.One lesion showed hypointense on T1WI and hyperintensity on T2WI.After the enhancement,the lesion was evenly enhanced and showed continuous enhancement.On DWI,11 lesions were slightly hyperintense.The signal intensity of 9 lesions were equal to that of the liver,and the signal intensity of the 2 lesions was slightly higher than that of the liver on the ADC map.Conclusion MRI signs of PH have certain characteristics,which can help diagnosis and differential diagnosis.

Objective To analyze magnetic resonance imaging (MRI) features of adenosquamous carcinoma of the pancreas and to summarize MRI signs with diagnostic value.Methods From August 2010 to June 2017,at Zhongshan Hospital Affiliated to Fudan University,the MRI data of 20 patients with pathologically diagnosed adenosquamous carcinoma of pancreas were retrospectively analyzed.The image analysis included tumor location,size,morphology,lesion borders,signal intensity,enhancement pattern,bile duct and main pancreatic duct dilatation,pancreatic atrophy,extrapancreatic invasion,lymph node metastasis and liver metastasis.Results The lesions of all the 20 patients with pancreatic adenosquamous carcinoma were single,and the diameter was (3.39 ± 1.17) cm (1.37 to 5.87 cm).The lesions of 12 patients were located in the head of pancreas,and eight cases were located in body and (or)tail.Eleven lesions were round and nine lesions were irregular.Eight lesions had clear lesion boundaries,and 12 lesions had blurred lesion boundaries.The imagines of 20 lesions showed slightly lower or hypointensity signal on T1 weighted imaging (T1WI),and equal or slightly higher signal on T2 weighted imaging (T2WI).There were different sizes of necrosis or cystic areas in 18 lesions,and two lesions were complete solid masses.The imagines of 19 lesions showed uneven enhancement during dynamic enhanced scan,which were ring-shaped or separated.The enhancement started from the periphery of tumors,and the signal intensity of the enhanced areas within the lesions approached or exceeded the signal intensity of the normal pancreatic tissue.Conclusion Pancreatic adenosquamous carcinoma is prone to cystic necrosis,and its enhanced MRI imaging has certain characteristics.

Objective: To investigate the clinical features, immunohistochemical and differential diagnosis of desmoplastic fibroblastoma. Methods: The clinical data and pathology features of 7 cases of desmoplastic fibroblastoma were collected and immunohistochemical study were carried out in all cases with a review of the literatures. Results: There were 2 males and 5 females, with age ranging from 31 to 71 years (average and mean age were 59 and 61 years, respectively). The tumors were located in extremities and abdomen (left toe and right toe, right foot back, left leg and right thigh, right forearm and left hepatic lobe). Clinically, the tumors presented as slow growing painless masses of long standing duration. Grossly, the tumors were well-circumscribed with firm, white to gray cut-off surface. Tumor size ranged from 1.2 to 4.0 cm in maximum diameter (average 3.0 cm). Microscopically, 2 cases were located in dermis, 4 cases were located in subcutaneous and 1 case was located in liver parenchyma. It was composed of spindle-shaped or stellate cells with a fibroblastic or myofibroblastic appearance, and sparsely scattered in densely fibrous or fibromyxoid background. There was small vascular component in tumor background. At high magnification, the tumor cells were medium size with abundant cytoplasm, and the nucleus were small and always with small nucleoli. In some cases, the tumor cells were slightly larger with enlarged nuclei, but without cellular atypical and mitosis. Immunohistochemical study showed that the tumor cells were strongly positive for vimentin, desmin, S-100 protein and CD34, but CKpan was negative. α-SMA showed focal positive in one case. Ki-67 index ranged from 1% to 2%. Four cases were followed-up (ranged from 11 to 21 months, average 16.5 months) and the patients had no recurrence after surgery. Conclusions Desmoplastic firoblastoma is a rare soft benign tumor. The differential diagnosis includes other benign or low-grade fibroblastic/myofibroblastic lesions.

Background and purpose:Epidermal growth factor receptor (EGFR) gene mutation is the most important predictive factor for determining the effectiveness of EGFR tyrosine kinase inhibitors (TKIs) for non-small cell lung cancer (NSCLC). This study aimed to determine the clinical application value of mutation-speciifc immu-nohistochemistry forEGFR mutation detection in NSCLC.Methods:Mutation-specific immunohistochemistry and ampliifcation refractory mutation system (ARMS) were used simultaneously to detectEGFR gene mutation status in 290 lung cancer specimens. The sensitivity, speciifcity, positive predictive value (PPV) and negative predictive value (NPV) of mutation-speciifc immunohistochemistry for detectingEGFR gene mutations were evaluated. The consistency was analyzed between mutation-speciifc immunohistochemistry results and ARMS results.Results:With ARMS testing as the gold standard, when a cutoff value of score 1+ was used as positive by immunohistochemistry, the sensitivity of mutation-speciifc immunohistochemistry forEGFR gene mutation was 72.92%, speciifcity 95.20%, positive predictive value 93.75% and negative predictive value 78.08%. The accuracy of immunohistochemistry was obviously different when variousEGFR gene mutations were detected. The sensitivity of immunohistochemistry for exon 19 deletion was only 55.55%, but speciifcity was above 99%. When immunohistochemistry score was 1+, the sensitivity for L858R mu-tation was 90.27%, whereas speciifcity was 95.86%. When immunohistochemistry score was 2+ or 3+, the speciifcity for L858R mutation was 98.63%-100%. The results of mutation-speciifc immunohistochemistry were ifnely correlated with mutation status determined by ARMS assay (P<0.001, Kappa value: 0.612-0.864). Mutation-speciifc immunohis-tochemistry can directly determineEGFR gene mutation abundance at the cellular level.Conclusion:Mutation-speciifc immunohistochemistry could be an effective supplemental method toEGFR molecular tests.

OBJECTIVE: To evaluate the association between single nucleotide polymorphisms of calcium/calmodulin-dependent kinase 4 (CAMK4) and the therapeutic effect of amlodipine in essential hypertensive patients in Chinese Han nationality.
 METHODS: A total of 108 mild-to-moderate essential hypertension patients in Chinese Han nationality were treated with amlodipine for 8 weeks at a dosage of 5 mg/d. Polymerase chain reaction-restriction fragment length polymorphism was performed to detect the genotypes (rs10491334). Blood pressure was measured and analyzed.
 RESULTS: The result of rs10491334 polymorphism of CAMK4 was consistent with Hardy-Weinberg equilibrium distribution and the frequencies of C allele and T allele were 88.89% and 11.11%, respectively. The systolic blood pressure and diastolic blood pressure before amlodipine treatment were not statistically different among different genotype carriers (P>0.05). The blood pressure was significantly reduced in all patients after amlodipine treatment (P<0.05). Systolic blood pressure was significantly decreased in patients with rs10491334 CC genotype and CT genotype compared with those patients with rs10491334 TT genotype. Total effective rates of CT and TT carriers were higher than those of the CC genotype carriers (P<0.01).
 CONCLUSION The CAMK4 gene polymorphism might be associated with the efficacy of calcium channel blocker in treating mild-to-moderate essential hypertension patients.
Alleles ; Amlodipine ; Asian Continental Ancestry Group ; Blood Pressure ; Calcium-Calmodulin-Dependent Protein Kinase Type 4 ; Calmodulin ; Essential Hypertension ; Ethnic Groups ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide

Objective To evalutate the safty of hBMSCs transpalntation and to observe their migration and distribution in the brain of young macaca fascicularis. To establish a new technology platform and theoretical basis for the treatment of central nervous system diseases in children. Methods Labelled hBMSCs were transplanted into the striatum of young macaca fascicularis. Brain sections were examined to evalutate the inflammatory reaction and immunological rejection of local injection sites by HE observation and immunohistochemical staining. Migration and distribution of transplanted?hBMSCs was observed by real?time fluorescence quantitative PCR of male DNA and fluorescence microscope. Results The results showed that the direct intracerebral injection of hBMSCs did not cause systemic symptoms in animals. There is no inflammatory reaction and immunological rejection was detected, and degeneration and necrosis of neural cells and proliferation of glial cells were absent in the local injection sites. The transplanted hBMSCs survived, and migrated into the brain after 4 weeks transplantation. Its migration and distribution have certain regularity and were overlapping between transplant recipients. In addtion, hBMSCs tended to extend rostrally into the forebrain and showed preference of migrating toward the blood vessels and below the ependyma. Conculsions Intracerebral transplantation of hBMSCs is safe. And hBMSCs can survive and migrate into the brain.