Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours(IMT)in middle-aged and elderly patients.Methods The clinical,pathologi-cal morphology,immunophenotype and follow-up results of 5 cases of intestinal IMT in middle-aged and elderly patients were retrospectively analyzed.Results 4 cases of IMT occurred in the right half colon and 1 in the ileum.Most patients(3/5)had a history of intestinal injury,starting the digestive tract symptoms and increased leukocytes.The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern,with an infiltrative growth pattern,accompanied by a large number of lymphocytes and plasma cells infiltration,collagen formation and myxedema.One case was atypically large and deformed.Immunophenotype:vimentin(5cases),SMA(5 cases),desmin(3 cases),ALK(3 cases),CK(2 cases)were positive.Caldesmon,CD34,β-catenin,MC,CD117,DOG1,S-100,BCL-2,CD99,CD68 were negative,and Ki-67 proliferation index was 1.28%to 10.01%.All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months.Among them,1 patient aged 83 was considered to have tumor recurrence 27 months after surgery.The other patient survived 122 months without tumor and died of other causes.All the others survived without tumor and were in good condition.Conclusion(1)Intestinal IMT in the middle-aged and elderly people in this group was more common in the right half colon,and most of them had a history of intestinal injury,first gastrointestinal symptoms and elevated white blood cells;(2)Vimentin and SMA were positive at the same time,and ALK was more positive;(3)4/5 patients had good surgical resection,and 1/5 patients could relapse 2～3 years after surgery;old age,ALK-positive,Ki67 up to 10%,atypia may be an important risk factor for intestinal IMT recurrence in the elderly,of which ALK-positive patients may have a recurrence risk of 1/3.

Pathological dry skin is a disturbing and intractable healthcare burden,characterized by epithelial hy-perplasia and severe itch.Atopic dermatitis(AD)and psoriasis models with complications of dry skin have been studied using single-cell RNA sequencing(scRNA-seq).However,scRNA-seq analysis of the dry skin mouse model(acetone/ether/water(AEW)-treated model)is still lacking.Here,we used scRNA-seq and in situ hybridization to identify a novel proliferative basal cell(PBC)state that exclusively expresses transcription factor CUT-like homeobox 1(Cux1).Further in vitro study demonstrated that Cux1 is vital for keratinocyte proliferation by regulating a series of cyclin-dependent kinases(CDKs)and cyclins.Clinically,Cux1+PBCs were increased in patients with psoriasis,suggesting that Cux1+ PBCs play an important part in epidermal hyperplasia.This study presents a systematic knowledge of the tran-scriptomic changes in a chronic dry skin mouse model,as well as a potential therapeutic target against dry skin-related dermatoses.

Objective:To evaluate the effect of combined use of Guben-Tiaoping Decoction on the success rate of stepwise treatment and life quality of asthma patients. Methods:A total of 76 patients with asthma in remission stage who were using ICS were divided into treatment group (38 cases) and control group(38 cases) according to random number table. Both groups were treated with ICS reduction based on the 2017 Gina Protocol. The treatment group was treated with Guben-Tiaoping Decoction for 12 weeks. The number of patients who were able to successfully complete the stepwise treatment after the end of the trial was calculated, the relevant indexes of Asthma Control Test (ACT), TCM Syndrome score, St. George’s respiratory questionnaire (SGRQ) and lung function were collected before and after treatment. Result:After 12 weeks’ treatment, the success rate of stepwise was 89.5% (34/38) in the treatment group and 78.9% (30/38) in the control group ( χ2=14.862, P=0.001). Meanwhile, the ACT score of the treatment group were better than those in the control group (Daytime symptoms t=-3.860, P=0.001, Dyspnea t=-2.007, P=0.40, Night waking t=-2.732, P=0.009, Reliever needed for symptoms t=-2.262, P=0.031, Control situation t=-6.994, P=0.001, Total Score t=-9.562, P=0.001). The score of TCM Syndrome in the treatment group was significantly lower than that of the control group ( P=0.001); PEF in treatment group [(6.92 ± 1.71) L vs. (5.84 ± 1.22) L; t=-2.880, P=0.005] was significantly better than that of the control group. Conclusion:Guben-Tiaoping Decoction is helpful to improve the success rate of ICS stepwise treatment and the life quality of patients.

Objective: To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension. Methods: The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018. They were performed OBP measurements on other two days in 4 weeks and ABPM in a week. There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours, daytime, nighttime and either of the above time. Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPM criteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH). Results: Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH. The Kappa values were all less than 0.6,known as low consistency. Taking either time of ABPM as a golden standard,24 hours,daytime and nighttime ABPM criteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00% in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency. Conclusions If limited by options, 1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy; 24 hours or daytime ABPM instead of either time of ABPM was reliable.

Objective: To explore the risk factors of cytomegalovirus (CMV) infection or reactivation in ulcerative colitis (UC) patients. Methods: We performed a search at the databases of Pubmed, Cochrane, Embase, CNKI, Wanfang, SinoMede and VIP up to March 2017. A search strategy was constructed by using a combination of the following words: "inflammatory bowel disease or IBD" or "ulcerative colitis or UC" and "cytomegalovirus or CMV" . Literature was screened according to the inclusion and exclusion criteria and statistics was analyzed using RevMan 5.3 software provided by Cochrane collaboration network and analyzed using Stata 12.0 software to evaluate publication bias. Results: After searching and screening, we included 18 case-control studies finally. Meta-analysis showed that the risk of CMV infection or reactivation in severe UC was 1.45 times that in mild to moderate UC and the risk in whole colon was 1.54 times that of patients with left colon and rectum with the pooled OR values as 1.45 (1.02-2.05) and 1.54 (1.05-2.27). The risk of CMV infection in middle-aged patients with UC was higher than that in young patients with the pooled MD values of 4.60(2.13-7.07). The therapies with glucocorticoid and immunosuppressive agents such as azathioprine, cyclosporine and methotrexate were high risk factors of CMV infection or reactivation in UC patients, with the pooled OR values as 3.87 (2.70-5.53) and 2.07 (1.29-3.32), but the duration of UC, treatment with 5-Amino salicylic acid/salazosulfapyridine (5-ASA/SASP) and infliximab had no statistically significant correlation with the CMV infection or reactivation in UC patients, with the pooled OR values as -1.20 (-2.64-0.24), 0.94 (0.61-1.42) and 1.50 (0.65-3.44). Conclusions In patients with severe UC, whole colon lesions and the therapy with glucocorticoid and immunosuppressive agents were the risk factors of CMV infection or reactivation. The risk of CMV infection or reactivation in middle-aged patients was higher than that in young patients.

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.
Adult ; Amoeba ; Amphotericin B ; Brain Edema ; Central Nervous System Infections ; Central Nervous System Protozoal Infections ; Diagnosis ; Diagnosis, Differential ; Encephalitis ; Encephalocele ; Fresh Water ; Humans ; Male ; Meningoencephalitis ; Naegleria fowleri ; Seasons ; Soil

Background:Ulcerative colitis(UC)patients are the high risk population of cytomegalovirus(CMV)infection. CMV infection may aggravate the disease progression of UC,and the prognosis of UC patients with CMV infection may be improved by antiviral therapy. Aims:To systematically evaluate the effects of CMV infection and antiviral therapy on prognosis of UC patients. Methods:PubMed,Cochrane Library,Embase,CNKI,Wanfang,SinoMed and VIP database were retrieved to collect the case-control studies studying the effects of CMV infection and antiviral therapy on prognosis of UC patients. Meta-analysis was conducted by RevMan 5.3 software. Results:Twenty case-control studies were enrolled. Meta-analysis showed that UC patients in CMV infection group were more serious(OR=1.62,95% CI:1.13-2.33),and had larger intestinal lesions(OR=0.63,95% CI:0.43-0.92),higher risks of steroid dependence/resistance(OR=6.13, 95% CI:1.98-19.00)and colectomy(OR=1.64,95% CI:1.14-2.36). Antiviral therapy for UC patients with CMV infection significantly improved the early clinical remission rate(OR =2.08,95% CI:1.03-4.17),decreased risk of colectomy(OR=2.12,95% CI:1.06-4.22). Conclusions:CMV infection can aggravate the progress of UC,enlarge the extent of intestinal lesion,increase the risks of steriod dependence/resistance and colectomy. Antiviral therapy significantly improves the early clinical remission rate,and decreases the risk of colectomy.

The safety and efficacy of radiofrequency ablation (RFA) in the treatment of liver tumors are widely recognized.However,for refractory liver cancer,RFA treatment had more difficulties and risks.Focusing on standardized operation under imaging guidance and individualized treatment,relatively good efficacy and safety can also be achieved in patients with refractory liver cancer.

Objective To investigate the value of percutaneous radiofrequency ablation (RFA) in the treatment of large hepatic carcinoma adjacent to diaphragm.Methods Totally 176 patients with larger hepatic carcinoma adjacent to diaphragm (adjacent diaphragm group) and 157 patients with larger hepatic carcinoma not adjacent to the diaphragm (control group) underwent ultrasound-guided percutaneous RFA treatment,and the data of these patients were retrospectively analyzed.The patients,age,gender,the largest diameter of lesions,ablation information,early necrosis rate,recurrence rate,new tumor rate and survival rate were analyzed and compared between the two groups.Results Cases of injection physiological saline below the diaphragm during RFA were significantly higher in adjacent diaphragm group than that in control group (P=0.016).The recurrence rate of adjacent diaphragm group was significantly higher than that of control group (P=0.028).There was no significant difference of patients,age,gender,the largest diameter of lesion,RFA instrument,RFA needles,early necrosis rate,new tumor rate,nor complications rate between the two groups (all P＞0.05).There was no significant difference of the 1-,2-,3-,4-and 5-year survival rate between the two groups (P=0.203).Conclusion Large hepatic carcinoma adjacent to diaphragm is more likely to recur after ultrasound-guided percutaneous RFA.The method of injection physiological saline below diaphragm and other individualized treatment plan and strategy should be used during RFA treatment.

Objective To investigate the efficacy and prognostic factors of percutaneous ultrasound-guided radiofrequency ablation (RFA) for liver metastases from gastric cancer.Methods Clinical and imaging data of 55 patients with liver metastasis from gastric cancer who underwent percutenous ultrasound-guided RFA were retrospectively analyzed,and the overall survival rates and prognostic factors were assessed.Results The overall survival rates of 1-,2-,3-and 5-year was 70.45％,42.90％,20.32％ and 10.16％,respectively.The ablation rate was 94.12％ (96/102) 1 month after RFA,and the local recurrent rate was 15.69％ (16/102),the new metastasis rate was 52.73％ (29/55).Age (P=0.015),tumor number (P=0.011),extrahepatic metastasis before RFA (P=0.026) and chemotherapy after RFA (P=0.031) were significantly prognostic factors.Age (P=0.033),tumor number (P=0.004) as well as chemotherapy after RFA (P=0.001) were independent prognostic factors.The severe complication rate was 1.82％ (1/55),while no treatment-related death occurred.Conclusion Percutaneous ultrasound-guided RFA is a safe and effective therapeutic option for liver metastases from gastric cancer.Age,tumor number,chemotherapy after RFA are independent prognostic factors.