[Diagnosis and differential diagnosis of large B-cell lymphoma with IRF4 rearrangement].

Objective: To analyze the clinicopathological features and differential diagnosis of large B-cell lymphoma with IRF4 rearrangement, aiming enhance its recognition and prevent misdiagnosis. Methods: The clinicopathological features, immunophenotype, and fluorescence in situ hybridization (FISH) results of six cases diagnosed with IRF4 rearrangement-positive B-cell lymphoma at the Affiliated Hospital of Xuzhou Medical University from 2015 to 2023 were retrospectively analyzed. Additionally, a comprehensive review of the literature was conducted. Results: Six patients with IRF4 rearrangement-positive large B-cell lymphoma were included. Patients 1 to 5 included three males and two females with a median age of 19 years ranging from 11 to 34 years. Four patients presented with head and neck lesions, while the other one had a breast nodule; all were in clinical Ann Arbor stages I to Ⅱ. Morphologically, entirely diffuse pattern was present in two cases, purely follicular pattern in one case, and diffuse and follicular patterns in other two cases. The tumor cells, predominantly centroblasts mixed with some irregular centrocytes, were of medium to large size, with a starry sky appearance observed in two cases. Immunophenotyping revealed all cases were positive for bcl-6 and MUM1, with a Ki-67 index ranging from 70% to 90%, and CD10 was positive in two cases. IRF4 rearrangement was confirmed in all cases by FISH analysis, with dual IRF4/bcl-6 rearrangements identified in two cases, leading to a diagnosis of LBCL-IRF4. Case 6, a 39-year-old female with a tonsillar mass and classified as clinical Ann Arbor stage Ⅳ, displayed predominantly diffuse large B-cell lymphoma (DLBCL) morphology with 20% high-grade follicular lymphoma characteristics. Immunohistochemistry showed negative CD10 and positive bcl-6/MUM1, with a Ki-67 index of approximately 80%. Triple rearrangements of IRF4/bcl-2/bcl-6 were identified by FISH, leading to a diagnosis of DLBCL with 20% follicular lymphoma (FL). All six patients achieved complete remission after treatment, with no progression or relapse during a follow-up period of 31-100 months. Conclusions: Large B-cell lymphoma with IRF4 rearrangement is a rare entity with pathological features that overlap with those of FL and DLBCL. While IRF4 rearrangement is necessary for diagnosing LBCL-IRF4, it is not specific and requires differentiation from other aggressive B-cell lymphomas with IRF4 rearrangement.

[Expression of MSI1 and HER2 in mammary Paget's disease and their correlation with clinicopathological features and prognosis].

Objective: To investigate the expression of MSI1 and HER2 in mammary Paget's disease, and the correlation between the expression levels of MSI1 and HER2 and the clinicopathologic characteristics and prognosis of the patients. Methods: Clinical data and paraffin-embedded specimens of 34 pairs of mammary Paget's disease and underlying breast cancer were collected at the Department of Pathology, Affiliated Lianyungang Oriental Hospital of Xuzhou Medical University from March 2011 to December 2019. Immunohistochemistry was used to detect the expression of MSI1 and HER2 in mammary Paget's disease and the accompanying breast cancer, and to analyze the correlation between the expression levels of MSI1 and HER2 and their clinicopathologic features, as well as their influence on prognosis. Results: In mammary Paget's disease, the positive rate of MSI1 was 91.2% (31/34) and the positive rate of HER2 was 88.2% (30/34); the expression of MSI1 and HER2 was positively correlated (P=0.001, r=0.530). The expression of MSI1 was positively correlated with menopausal status (r=0.372, P=0.030) and lymph node metastasis (r=0.450, P=0.008). HER2 expression was positively correlated with menopausal status (r=0.436, P=0.010), and negatively correlated with ER expression (r=-0.365, P=0.034). The co-expression of MSI1 and HER2 was positively correlated with age (r=0.347, P=0.044) and menopausal status (r=0.496, P=0.003), and negatively correlated with ER expression (r=-0.461, P=0.006). Conclusions: MSI1 and HER2 are highly expressed in mammary Paget's disease and their expression levels are positively correlated. The correlation analysis between clinicopathological features and prognosis suggests that both of them may be involved in the occurrence and development of mammary Paget's disease and are potential therapeutic targets for mammary Paget's disease.

[Comparative study on imaging and clinical results of patellofemoral joint with kinematic alignment and mechanical alignment in total knee arthroplasty].

Objective: To investigate the changes of imaging parameters of patellofemoral joint after kinematic alignment total knee arthroplasty (KA-TKA) and mechanical alignment total knee arthroplasty (MA-TKA) and the effects on clinical outcomes. Methods: A retrospective analysis was performed on 227 patients diagnosed with knee osteoarthritis, 105 males and 122 females, with the age of (68.6±7.2) years (range: 52 to 86 years). The patients underwent unilateral TKA at the Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, from January 2020 to July 2021. The patients were divided into the KA-TKA group (n=102) and the MA-TKA group (n=125) according to the alignment method. The Blackburne-Peel index, lateral patellofemoral angle, patellofemoral tilt angle and patellofemoral index of the two groups were recorded before and 6 months after operation. The frequency of lateral patellar retinaculum release, preoperative and postoperative knee range of motion (ROM), and Oxford knee score(OKS) were also recorded. The differences between preoperative and postoperative measurement data of each group were calculated. If the difference was in line with normal distribution, the independent sample t-test or t'-test was used for comparison between the two groups. If it did not conform to normal distribution, Mann-Whitney U test was used. Paired sample t-test was used for comparison before and after treatment. Chi-square test was used for comparation of categorical data between the two groups. Results: After 6 months of operation, the patellar tilt angles of the KA-TKA group and the MA-TKA group were (14.22±3.26)° and (13.35±2.27)°, and the lateral patellar angles were (9.73±4.86)° and (11.91±3.89)°, respectively. The change of lateral patellofemoral angle in the KA-TKA group was significantly less than that in the MA-TKA group ((1.68±4.86)° vs. (4.15±4.88)°, t=3.805, P<0.01). OKS and ROM were improved in the both groups at 6 months after operation (all P<0.05), but there were no statistic significance in preoperative and postoperative difference between the two groups (all P>0.05). The intraoperative lateral patellar retinacular release rate was 14.4% (18/125) in the MA-TKA group and 6.9% (7/102) in the KA-TKA group, with no statistical difference (χ2=3.256,P=0.071). Conclusions: There are greater patella lateral tilt at 6 months postoperatively in the KA-TKA group compared with the MA-TKA group, but this radiographic difference could not show differences of clinical outcomes and postoperative ROM, the frequency of intraoperative lateral patellar retinacular release wouldn't increase. Therefore, KA-TKA does not increase the difficulty of postoperative patellofemoral joint complications and intraoperative lateral patellar release.

[ALK-positive large B-cell lymphoma with EBV infection or cyclin D1 expression: a clinicopathological analysis of 3 cases].

Objective: To investigate the clinicopathological features and misdiagnosis factors of ALK positive large B-cell lymphoma (ALK+LBCL). Methods: The clinicopathological data of 3 patients with ALK+LBCL in the Department of Pathology, the Affiliated Hospital of Xuzhou Medical University from 2010 to 2021 were collected retrospectively. Immunohistochemistry (IHC) was used for immunophenotyping, in-situ hybridization (ISH) for EBV-encoded RNA (EBER) detection, in-situ fluorescence hybridization (FISH, break-apart probes) for ALK, MYC, and CCND1 translocations. Next-generation sequencing (NGS) was used for the detection of gene fusions and mutations. And clinicopathological features and prognosis of patients were analyzed. Results: Among the 3 ALK+LBCL patients, there were 2 males and 1 female, aged 42, 59, and 39 years, respectively, none of which presented with B symptoms. Case 1 showed systemic lymphadenopathy with elevated serum EBV DNA loading, while cases 2 and 3 presented with extranodal lesions in the nasal and hard palate, respectively. Bone marrow biopsies were performed in cases 1 and 3, and neither showed involvement. Case 1 was at clinical stage Ⅲ while both cases 2 and 3 were at stage Ⅰ, and IPI score ranged 0-1 in all cases. The morphology of these cases was similar. The architecture was effaced by sheets of cohesive large cells growing in extensive infiltration and intra-sinus growth pattern. The neoplastic cells showed immunoblastic or plasmablastic morphology, and large anaplastic cells were easily found. The tumor cells expressed ALK protein cytoplasmically in almost all cells, with ALK gene translocations detected by FISH. Common B-cell and T-cell markers, including CD20, PAX5, CD19, CD2, CD3, CD5, CD7, CD43, CD56, and bcl-2, were negative, while plasmacytic differentiation markers, including CD138, CD38, and MUM1, were positive; CD22, BOB1 and OCT2 were variably expressed. CD10 was strongly expressed only in case 3. All cases were negative for bcl-6 but positive for CD4, perforin, CD30 (partial cells), pSTAT3 (diffusely), and MYC (40%-50%). The Ki-67 index was ranged 60%-70%. MYC translocation was not detected in any case by FISH. In case 1, EBER was strongly positive in>90% of tumor cells. Case 3 was diffusely positive for cyclin D1 but negative for SOX11 expression and CCND1 translocation. All cases harbored ALK fusion genes detected by NGS. In case 1, the fusion partner was TFG, which had not been reported in DLBCL, while in the other 2 cases, ALK fused with the CTCL gene, which was commonly seen in ALK+LBCL. Cases 1 and 3 were treated with ECHOP-based chemotherapy for six cycles and were followed up for 70 and 27 months, respectively, and both achieved complete remission. Conclusions: ALK+LBCL cases with diffuse EBER-positivity reported in this study show TGF as a new fusion partner of ALK in DLBCL, together with cyclin D1 expression. These rare cases are easily confused with EBV positive diffuse large B-cell lymphoma, not otherwise specified (EBV+DLBCL, NOS), cyclin D1 positive diffuse large B-cell lymphoma (cyclin D1+DLBCL) and ALK positive anaplastic large cell lymphoma (ALK+ALCL), resulting in misdiagnosis. Being aware of these rare phenotypes is essential for pathologists to diagnose ALK+LBCL and guide appropriate treatment accurately.

[Early clinical effects of total knee arthroplasty with kinematic alignment assisted by patient-specific instrumentation].

Objective: To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). Methods: The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results: The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) (M(Q(R))) preoperative to 5.5 (5.25) postoperative (Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions: PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.

[Early efficacy of lateral unicondylar replacement for lateral compartment osteoarthritis of the knee].

Objective: To discuss the surgical technique of lateral unicondylar knee replacement (UKR) for patients with lateral compartment osteoarthritis and evaluate its recent clinical efficacy. Methods: A retrospective analysis was conducted on 22 cases of lateral compartment osteoarthritis patients receiving lateral UKR at Orthopedic Department, Beijing Chao Yang Hospital, Capital Medical University from January 2016 to January 2019.There were 8 males (8 knees) and 14 females (14 knees), aged 65.7 years(range: 54 to 83 years). All patients completed preoperative imaging examination and excluded extra-articular deformity. Lateral parapelatellar approach was used for the operation and the tibial osteotomy was performed by extramedullary positioning.The residual cartilage of the external condyle was removed by pendulum saw to subchondral bone.Appropriate prosthesis were selected, and the tightness of the gap and the stability of the joints were repeatedly confirmed during the operation. The postoperative complications and the results of physical and imaging examinations were collected. The preoperative and postoperative Oxford knee Score (OKS) and knee society score (KSS) of patients were recorded and compared by paired t test. Results: All patients were followed up for 24.6 months (range: 8 to 40 months). No complications such as incision exudation, skin necrosis and deep venous thrombosis of lower limbs were found after the operation.No cases of prosthesis loosening, excessive wear of pads, dislocation and postoperative infection were found at the last follow-up.The OKS decreased from 46.5±3.1 preoperative to 22.4±3.3 postoperative(t=13.4, P=0.00) and KSS improved from 69.5±8.7 preoperative to 90.2±7.4 postoperative (t=16.9, P=0.00). Conclusions: For the treatment of lateral compartment osteoarthritis, UKR has the advantages of rapid recovery of knee function, less complications and less trauma.The short-term efficacy is satisfactory, but the long-term efficacy remains to be observed.

[The treatment effect of opening,debridement and double-row fixation using suture anchor for severe patellar tendinopathy].

Objective: To evaluate clinical treatment efficacy of double-row fixation with bridging suture anchors for chronic, severe patellar tendinopathy. Methods: A retrospective study of 18 patients suffered from severe patellar tendinopathy and underwent surgical treatment during January 2009 and June 2014 at Department of Orthopedic, Beijing Chao Yang Hospital, Capital Medical University was conducted. All patients had received conservative therapy for more than 6 months(range: 6-30 months) but the effect was unsatisfactory. There were 10 males (12 knees) and 8 females (12 knees)with age of 47.2 years(range: 32-63 years). Seven cases on the left and 17 cases on the right. The surgical treatment included a midline incision at patellar tendon, complete debridement, and double-row fixation with bridging suture anchors. Visual analogue scale(VAS), Lysholm score were collected preoperatively and postoperatively, and compared by paired-t test. The postoperative complications was recorded. Results: All patients were followed up for 35.7 months (range:24-64 months) without any dropout.VAS decreased from 7.5±1.6 preoperative to 1.4±1.0 (t=4.45, P=0.00) postoperative, Lysholm score increased from 48.3±5.2 to 89.6±5.4 (t=-4.88,P=0.00).The Lysholm score was excellent in 3 cases and good in 15 cases.No patellar tendon rupture or suture fixation failure was recorded during the follow-up period. Conclusions: The effect of double-row fixation with bridging suture anchors is satisfactory with few postoperative complications.It can not only improve clinical symptoms of patients, but also restore knee joint function.

[The clinical effects of reverse shoulder arthroplasty for the patients with the cuff tear arthritis].

Objective: To analyze the clinical effects of reverse shoulder arthroplasty (RSA) for the patients with the cuff tear arthritis(CTA). Methods: A retrospective analysis of 12 patients who had underwent primary RSA for treatment of CTA from January 2012 to June 2017 in Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University. There were 8 males and 4 females, aged 69.4 years (range: 64-73 years). The operation was performed in a conventional manner, the subscapularis and biceps tendon were repaired separately.The preoperative and postoperative American shoulder elbow surgeons score and university of California at LosAngeles score of patients were recorded. The complications and the images of radiological examinations were collected. Data were analyzed by paired-samples t-test. Results: At mean follow-up of (34.7±18.1) months (range:3-66 months), the preoperative ASEA score improved from 58.2±8.2 to 92.9±2.9 (t=14.32, P=0.00) and UCLA score improved from 13.2±1.5 to 30.8±1.7(t=23.14, P=0.00). No complications like loosening of prosthesis, superficial wound infection and shoulder dislocation were noted. Conclusion: Reverse shoulder arthroplasty have satisfactory effect for the patients with the cuff tear arthritis.

Modulation of the host response by probiotic Lactobacillus brevis CD2 in experimental gingivitis.

OBJECTIVE: Probiotic Lactobacillus brevisCD2 (CD2) exerts anti-inflammatory properties by preventing nitric oxide synthesis. It is hypothesized that oral application of CD2 can inhibit naturally occurring gingival inflammation. MATERIALS AND METHODS: Thirty-four healthy adults were randomized to receive L. brevisCD2 lozenges or placebo, three times daily for 14 days. The subjects refrained from oral hygiene, the extent of which was determined at various time points. RESULTS: In both groups, bleeding on probing scores increased continuously throughout the study except on day 3. In the placebo group, scores increased significantly from 9.50 at baseline to 14.75 and 14.81 on days 10 and 14, respectively (P < 0.05). No significant change from baseline was observed in the CD2 group. However, scores were consistently higher with placebo, and significant intergroup differences were observed on day 10. Plaque and gingival indices increased from baseline in both treatment groups, but no intergroup differences were observed. Measurements of immune markers in gingival crevicular fluid revealed increased production of nitric oxide in the placebo group (P < 0.05). Prostaglandin E2 production decreased over time in both groups. CONCLUSION: Lactobacillus brevisCD2 may delay gingivitis development in this model by downregulating an inflammatory cascade.

Development of an in vitro model for assessing the in vivo stability of lanthanide chelates.

An in vitro model was developed to evaluate the in vivo stability of lanthanide polyaminocarboxylate complexes. The ligand-to-metal ratios for the chelates EDTA, CDTA, DTPA, MA-DTPA (monoamide-DTPA) and DOTA with the lanthanides lanthanum, samarium, and lutetium were optimized to achieve > or = 98% complexation yield for the resultant radiolanthanide complexes. The exchange of the radiolanthanides from their EDTA, CDTA, DTPA, MA-DTPA and DOTA complexes with Ca(2+) was determined by in vitro adsorption and in vitro column studies using hydroxyapatite (HA), an in vitro bone model. In vitro serum stability of these radiolanthanide complexes was used as an additional indicator of in vivo stability, although the mechanism of instability in serum will be different than with bone. The in vitro studies were consistent with the expected findings that the smallest lanthanide (Lu) formed the most stable complexes. In vivo studies were done to validate the in vitro model. Biodistribution studies in normal CF-1 mice showed that in vivo stability of the complex (i.e., the more lanthanide remaining in complex form) could be assessed by a combination of the urinary, bone and liver uptake. For example, biodistribution studies demonstrate that high urinary excretion correlated with complex stability, while high liver plus bone uptake correlated with complex instability. The urinary excretion of the EDTA complexes decreased from (177)Lu to (140)La indicating a loss in stability in the direction of (140)La, consistent with the in vitro studies. The more stable a lanthanide complex is, the lower its exchange with HA in vitro will be, and the lower its combined bone plus liver uptake and higher its urinary excretion will be in vivo. This investigation indicates that the in vivo stability can be determined by a screening method that measures the degree of exchange from the lanthanide chelate with hydroxyapatite (HA) and its serum stability.

Korean dental hygienists' knowledge and opinions about etiology and prevention of dental caries.

OBJECTIVES: Because of their formal education Korean dental hygienists have the potential to be the primary source of information on caries prevention for patients and the general public, and influence the use and adoption of caries preventive procedures. The purposes of this study were to determine the knowledge and opinions about caries etiology and prevention among Korean dental hygienists, and to describe associated factors. METHODS: A pre-tested, 20-item questionnaire was mailed to 1120 dental hygienists selected by stratified random sampling and allocated proportionately. A postcard reminder was sent to all dental hygienists after 1 week. Non-respondents were sent additional complete mailings after 3 and 7 weeks. The response rate was 77% (n=863). RESULTS: Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that dental hygienists who were taught to provide oral health education and believe that it is desirable to practice oral health education during dental hygiene school and those employed in health centers were likely to be more knowledgeable about caries etiology and prevention than other hygienists (P<0.05). In regression analysis of the perceived effectiveness of caries preventive procedures, hygienists who provided oral health education during their formal training tended to rate caries preventive procedures as being more effective than other dental hygienists (P<0.05). CONCLUSIONS: Overall, the results of this study suggest that most dental hygienists do not have up-to-date information on the etiology and prevention of dental caries, mechanisms of action of fluoride and effectiveness of preventive procedures. Efforts to increase the level of knowledge of Korean dental hygienists about caries prevention should focus on strategies to educate dental hygienists who have not been taught to provide oral health education, who do not have favorable opinions about the desirability of oral health education, and who had no experience with providing oral health education as part of their work, especially hygienists working in private clinics. Further, these efforts should include the revision of dental hygiene curricula and continuing education courses.

[Hand grip strength as a nutritional indicator of patients with oral and maxillofacial malignancies to predict post-operative complications]

The correlation between hand grip strength(HGS),arm muscle circumference(AMC) and creatinine-height index (CHI) were studied in 127 patients with oral and maxillofacial malignancies.Prediction of postoperative complications by using HGS was also attempted in the patients undergoing surgical treatment.The results showed:(1)HGS correlated well with AMC and CHI,indicating that HGS can be used as a nutritional parameter to reflect the skeletal muscle condition(depletion or repletion);(2)comparison of the operative patients whose HGS<85% of the standard value(Group I)with those HGS>/=85% of the standard value(Group II)demonstrated that Group I hand a much higher incidence of postoperative complication(48.4%) than that of Group II (18.5%)(X=9.30;P<0.005),which means that HGS can be served as a nutritional prognostic indicator to predict postoperative complications.