A case of COVID-19 associated ischemic colitis / 北京大学学报(医学版)

Ischemic colitis is a disease in which local tissue in the intestinal wall dies to varying de-grees due to insufficient blood supply to the colon.Risk factors include cardiovascular disease,diabetes,chronic kidney disease,chronic obstructive pulmonary disease,etc.Typical clinical manifestations of the disease are abdominal pain and hematochezia.The most common locations are the watershed areas of splenic flexure and rectosigmoid junction.The lesions are segmental and clearly demarcated from normal mucosa under endoscopy.The digestive tract is a common extra-pulmonary organ affected by the novel coronavirus,which can be directly damaged by the virus or indirectly caused by virus-mediated inflamma-tion and hypercoagulability.The corona virus disease 2019(COVID-19)associated intestinal injury can be characterized by malabsorption,malnutrition,intestinal flora shift,etc.CT can show intestinal ische-mia,intestinal wall thickening,intestinal wall cystoid gas,intestinal obstruction,ascites,intussusception and other signs.In this study,we reported a case of ischemic colitis in a moderate COVID-19 patient.The affected area was atypical and the endoscope showed diffuse lesions from the cecum to the rectosig-moid junction.No signs of intestinal ischemia were found on imaging and clear thrombosis in small inter-stitial vessels was found in pathological tissue.Combined with the fact that the patient had no special risk factors in his past history,the laboratory tests indicated elevated ferritin and D-dimer,while the autoanti-bodies and fecal etiology results were negative,we speculated that the hypercoagulability caused by novel coronavirus infection was involved in the occurrence and development of the disease in this patient.After prolonged infusion support and prophylactic anti-infection therapy,the patient slowly resumed diet and eventually went into remission.Finally,we hoped to attract clinical attention with the help of this case of moderate COVID-19 complicated with ischemic colitis which had a wide range of lesions and a slow reco-very.For patients with abdominal pain and blood in the stool after being diagnosed as COVID-19,even if they are not severe COVID-19,they should be alert to the possibility of ischemic colitis,so as not to be mistaken for gastrointestinal reactions related to COVID-19.

Analysis of Health Human Resource Allocation Situation in All Tertiary Maternal and Child Health Hospitals from 2015-2022 / 中国医院管理

Objective To analyse the health human resource allocation of all tertiary maternal and child healthcare(MCH)hospitals from 2015 to 2022 in China,and to propose basis for further strengthening the talent team construction and management of MCH hospitals.Methods Data were collected through the national MCH institution monitoring system to provide a descriptive analysis of the health human resources of all tertiary MCH hospitals in China.Results From 2015 to 2022,the number of health technicians in tertiary MCH hospitals increased with an average annual growth rate of 10.2%;The proportions of highly educated and professional health technicians increased year by year;The proportion of tertiary MCH hospitals with qualified health technicians has increased to 93.8%;The ratio of doctors to nurses has exceeded 1:1.4.Conclusion The allocation of health human resources in the tertiary MCH hospitals in China shows a good upward trend,which lays a foundation for improving the overall service level and service capacity of MHC hospitals.

Clinical study of high frequency repetitive transcranial magnetic stimulation in chronic tension-type headache / 中华神经医学杂志

Objective:To observe the efficacy and safety of high frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tension-type headache (CTTH) patients.Methods:Thirty-eight patients with CTTH, admitted to our hospital from February 2019 to September 2021, were randomly divided into rTMS group and control group ( n=19). In the rTMS group, the hot spot of the right abductor pollicis brevis was surface-labeled and the resting movement threshold (RMT) was calculated; the intensity of the stimulus was then adjusted to 70% of RMT, and stimulus was then located at 5 cm in front of the previously identified hot spot of the right thumb, namely the left dorsolateral prefrontal cortex (LDLPFC); the stimulus was delivered once every Monday, Wednesday and Friday, and lasted for 4 weeks with 12 rounds of stimulation. In the control group, the hot spot was not located and RMT was not calculated; the coil was placed perpendicular to LDLPFC; and the stimulation frequency was the same as that in the rTMS group with minimum stimulation intensity. Visual analogue scale (VAS), Headache Impact Test-6 (HIT-6), simplified McGill Pain Questionnaire (SF-MPQ) were used to evaluate the subjective pain status. The electrophysiological indices in the nociceptive flexion reflex (NFR) and conditioned pain modulation (CPM) were used to evaluate the objective pain status. Adverse events during treatment and 1-month follow-up were recorded in the two groups. Results:(1) Rating scales: scores of all rating scales in the rTMS group after treatment were significantly decreased as compared with those before treatment ( P <0.05); however, no significant difference was noted in the control group ( P>0.05). After treatment, the scores of VAS, HIT-6, present pain intensity (PPI) scale, and trait anxiety inventory in the rTMS group were significantly decreased as compared with those in the control group ( Z=-4.054, P<0.001; t= -6.083, P<0.001; Z=-4.246, P<0.001; Z=-3.740, P<0.001). (2) NFR RIII parameters: as compared with that before treatment, the minimum threshold in rTMS group after treatment was significantly increased ( P<0.05). There were no significant differences in NFR RIII parameters in the control group between those after treatment and before treatment ( P>0.05). After treatment, the minimum NFR minimumthreshold in the rTMS group was significantly increased as compared with that in the control group ( P<0.05). Cold compression test results showed that as compared with basic NFR RIII area, NFR RIII area before and after treatment in both rTMS group and control group was statistically increased ( P<0.05). (3) Adverse reactions: no serious adverse reactions occurred in the two groups during treatment and follow-up. Conclusion:Treatment with rTMS in CTTH patients enjoys good short-term efficacy without obvious adverse reactions.

Role and mechanism of Müller cells in retinal injury / 中华实验眼科杂志

In mammalian retina,Müller cells are dominating macroglial cells and span the entire retina.These cells perform a variety of physiological roles to maitain the normal function of retina.However,Müller cells become ‘reactivity'in response to every pathological changes in the retina.Reactive Müller cells play an important role in retinal damage and repair.Reactive gliosis is a complex process that is considered to represent a cellular response to protect the retina from further damage and to promote its repair following pathological insult in the early stage of retina injury.Reactive Müller cells protect the tissue and preserve tissue function by releasing neurotrophic factors,and may contribute to retinal regeneration by generating neural progenitor.However,continued proliferation of Müller cells can also lead to cell dysfunction and damage of photoreceptors and neurons.What's more,Müller cell gliosis may result in the formation of glial scars,which can inhibit retinal remodeling and reprograming of the injured retina.A better understanding of the role and mechanism of Müller cells in retinopathy is essential for the efficient therapeutic strategies of retina diseases.

Distribution of choroidal thickness and its influencing factors in undergraduate students of Tianjin Medical University / 中华眼底病杂志

Objective To explore the distribution ofchoroidal thickness and its influence factors in university students.Methods A cross-sectional study.A total of 896 eyes of 896 college students were included in the study.Among them,there were 350 males (350 eyes) and 546 females (546 eyes).All the eyes were right eyes.The average age was 19.18 ± 1.36 years old.According to the spherical equivalent refraction (SER),the eyes were divided into non-myopia group,low myopia group,moderate myopia group and high myopia group,which were 59,251,356 and 230 eyes,respectively.The subfoveal ChT (SFCT) was measured using a swept-frequency source optical coherence tomography scanner.According to the ETDRS,the choroid within 6 mm of the fovea was divided into three concentric circles centered on the fovea of the macula,which were the central area with a diameter of 1 mm,the inner ring area of 1-3 mm and the outer ring area of 3-6 mm.The outer ring area of 3-6 mm has a total of 9 zones.The inner ring and outer ring 4 regions were superior,inferior,nasal and temporal,respectively.The distribution characteristics of ChT in different regions,genders and diopter groups were observed.Bivariate correlation analysis were used to analyze the correlation of ChT and SER,axial length (AL).Results The average SFCT of 896 eyes was 221.28± 67.35 μm.The mean SFCT of males and females were 227.20 ± 69.38 and 217.50± 65.80 μm,respectively.The difference of SFCT between different genders was statistically significant (t=2.075,P=0.038).Compared with the central region ChT,there was no significant difference in ChT between the outer ring and the outer region (t=0.086,P=0.932).The difference of ChT in other regions was statistically significant (t=-21.973,-5.818,36.328,-3.065,-18.017,-10.595,57.007;P＜0.001,＜0.001,＜0.001,＜0.002,＜0.001,＜0.001,＜0.001).In the horizontal direction,ChT gradually thickens from nasal to temporal (F=2 251.558,P＜0.001);in the vertical direction,ChT gradually decreases from superior to the central,but have a little increased from central to inner inferior,then decreased to outer inferior again (F=45.425,P＜0.05).Correlation analysis showed that SFCT was negatively correlated with AL (r=0.478,P＜0.01) and a negative correlation with axial length (r=-0.395,P＜0.01),and positively correlated with SER (r=0.478,P＜0.01).SFCT decreased by 12.29 μm for every in myopic refractive error of 1 D,or by 20.14 μm for every increase in AL of 1 mm.Conclusions ChT is changed by different location.The horizontal direction is gradually thickened from nasal to temporal.The vertical direction is thicker than the center.The inferior inner ring area is thicker than the outer ring area.Gender,SER and AL are the influencing factors of SFCT.

Analysis of influencing factors of early neurological deterioration in acute cerebral infarction patients with middle cerebral artery occlusion / 中风与神经疾病杂志

@#Objective　To analyze the influencing factors of early neurological deterioration in acute cerebral infarction patients with middle cerebral artery (MCA) occlusion.Methods　One hundred and thirty-four acute cerebral infarction patients with MCA occlusion in the department of neurology of our hospital from January 2017 to December 2019 were enrolled retrospectively.The definition of early neurological deterioration (END) was the national institutes of health stroke scale (NIHSS) score increased by ≥ 2 compared with the baseline NIHSS score of admission within 72 hours.Forty-eight cases in END group and 86 cases in non-END group.Baseline and clinical data at admission were compared between the two groups.Binary multivariate logistic regression analysis were used to assess the influencing factors of END in acute cerebral infarction patients with MCA occlusion.Results　(1)Gender,age,time of onset,admission NIHSS score,collateral circulation and parameters of blood pressure variability (SBPsd,SBPcv,SBPmax-min,DBPsd,DBPcv,DBPmax-min) were statistically significant between non-END group and END group.(2)Multivariate logistic regression analysis suggested that poor collateral circulation(OR=8.330，95%CI 1.629~42.587,P=0.011) and SBPmax-min (OR=1.139,95%CI 1.032~1.258,P=0.01) were independent risk factors for END in acute cerebral infarction patients with MCA occlusion.SBPmax-min predicted effectively END with best cutoff value 35.5,sensitivity 93.8%,specificity 64% and AUC0.85 (95%CI 0.788~0.912,P<0.001).Conclusion　There were many factors affecting END in patients with acute cerebral infarction with MCA occlusion.Poor collateral circulation and Blood pressure variability (BPV) were independent risk factors for END.

Metastatic tumors in the colorectum:a clinicopathologic analysis of 53 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic characteristics of colorectal metastatic tumors. Methods Cases which were clinically diagnosed as metastatic tumors to the colorectum were retrieved from the data base of the Department of Pathology, Peking U-niversity Third Hospital. The clinicopathologic features were studied and immunohistochemical stains were performed on some of the ca-ses for differential diagnosis. Results Fifty three cases which showed intestinal wall involvement were studied. In 43. 4% (23/53) of them, only serosa/subserosa was involved and mucosal involvement was observed in 37. 7% (20/53) of the cases. Sigmoid colon and rectum were the most frequently involved intestinal segments (24/53, 45. 3%). Female reproductive system was the most common ori-gin of the metastatic tumors (33/53, 62. 3%), followed by the digestive system (15/53, 28. 3%). The most common histological type was ovarian serous carcinoma (22/53, 41. 5%). 96. 2% (51/53) of the metastatic tumors were centrally located at the serosa/subserosa or the muscular propria and prominent lymphovascular invasion was observed in 26. 4% (14/53) of the cases. In cases with mucosal involvement, 35% ( 7/20 ) had foci that were lack of desmoplastic reaction, 20% ( 4/20 ) exhibited in-situ growth and/or paradoxical maturation of tumor cells which led to misdiagnosis in 2 of the 17 pre-operative biopsies. Conclusions Metastatic carcino-ma in the colorectum can be highly informed by predominantly involving the serosa/subserosa or muscular propria and prominent lym-phovascular invasion. In-situ growth and paradoxical maturation of tumor cells in the mucosa are diagnostic pitfalls in pre-operative co-lonic biopsy and should be aware in practice.

Adult-onset generalized autoimmune enteropathy involving small intestine and colon: report of a case and review of literature / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic features of adult-onset autoimmune enteropathy (AIE).</p><p><b>METHODS</b>A case of adult-onset AIE was described along with a literature review.</p><p><b>RESULTS</b>A 41-year-old male patient was admitted for intractable diarrhea for more than three months despite of any dietary restriction or anti-inflammatory therapy. Fat globule was observed by stool examination and Sudan III staining of the stool was positive. Enteroclysis showed weak movement and few plica of small intestine, while colonoscopy appeared normal. Small bowel biopsies revealed villus atrophy and increased crypt apoptotic bodies and lymphocytic infiltration in deep crypt. Although without significant surface intro-epithelial lymphocytosis, there were a large number of monocytes, lymphocytes, plasmacytes and neutrophilic granulocytes infiltrating in the lamina propria. Morphologically, the colonic mucous was similar to the small intestine although cryptitis and crypt abscess were significant in the former. Serum IgG anti-goblet cell antibody was demonstrated by indirect immunofluorescence. Other causes of diarrhea were excluded on the base of medical history, histopathology and other accessory examinations before the diagnosis of AIE was made. The patient had a complete remission after steroid treatment without recurrence for eight months during the follow-up even after steroid withdrawal for five months.</p><p><b>CONCLUSIONS</b>AIE is exceedingly rare and timely diagnosis is important for successful therapy. Histological differential diagnoses should include ulcerative colitis, celiac disease, lymphocytic colitis, etc. The final diagnosis should be based on histological examination combined with the patient history, clinical manifestation, endoscopy finding and serological testing.</p>

High-risk factors of stroke in people over 40 years old in Anqing area and intervention for high-risk population / 公共卫生与预防医学

Objective To investigate the high-risk factors of stroke in Anqing area, and to analyze the value of standard treatment for the intervention of high-risk population for stroke. Methods A total of 3 062 permanent residents over 40 years of age in Anqing were surveyed by a questionnaire for the high-risk population of stroke. Physical examination was carried out for people at a high risk of stroke. The physical examination included general physical examination, laboratory tests, and carotid artery color Doppler ultrasound examination. People at a high risk of stroke were investigated on whether or not they received standardized symptomatic treatment and prevention interventions. Results Hypertension or taking antihypertensive drugs accounted for the highest risk factors of stroke in Anqing area, followed by smoking and seldom physical exercise. The abnormal rates of body mass index, blood pressure, contents of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL) , homocysteine (HYC), and blood glucose (GLU), as well as intimal thickening, plaque and carotid artery stenosis in people at high risk of stroke receiving standardized treatment were significantly lower than those in people receiving no standardized treatment, and the difference was statistically significant (P<0.05). The standard treatment was an independent factor influencing the body mass index, blood pressure, TC, TG, LDL, HDL, HYC, GLU, intimal thickening, plaque and carotid artery stenosis (P<0.05). Conclusion Hypertension accounted for the highest proportion of high-risk factors for stroke in Anqing area. Standardized symptomatic treatment can effectively control the physical indicators, laboratory test indicators and carotid artery state of stroke high-risk populations, which can play a positive role in the prevention of stroke.

Clinical study on umbilical cord leptin levels associated with fetal growth and neonatal birth weight / 中华实用儿科临床杂志

Objective To study the relationship between umbilical cord leptin levels and fetal growth as well as neonatal birth weight. Methods One hundred and forty - two neonates selected from February 2009 to June 2013 in Shangqiu First People's Hospital according to the different gestational age and birth weight were divided into 3 groups. Group A included 44 cases(small for gestational age,birth weight below the average weight of the 10th percentile at the same gestational age),23 boy cases,21 girl cases;group B included 56 cases(appropriate for gestational age,birth weight at the average weight of the 10th to 90th percentile at the same gestational age),30 boy cases,26 girl cases;group C included 42 cases(large for gestational age,birth weight above the average weight of the 90th percentile at the same gestational age),22 boy cases,20 girl cases. Neonatal body mass index,birth weight,placenta weight and umbilical lep-tin levels of three groups were compared. Results Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group A were significantly lower than those of group B,having statistically significant difference(all P ﹤ 0. 001);Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group C were significantly higher than those in group B,with statistically significant difference( all P ﹤0. 001). Neonatal birth weight in the boy group was obviously higher than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). Neonatal leptin levels in the boy group were significantly lower than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). There were positive correlations between the umbili-cal cord leptin levels and the neonatal birth weight,neonatal length,neonatal weight index and the placenta weight(r =0. 382,0. 276,0. 358,0. 412,all P ﹤ 0. 01). Conclusions The umbilical cord leptin levels are closely associated with neonatal birth weight and intrauterine growth retardation,and it can be used as one of the important indicators for reflec-ting neonatal birth weight and fetal growth.

Value of detection of DNA mismatch repair proteins deficiency by immunohistochemistry in predicting tumor microsatellite status / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the sensitivity and specificity of immunohistochemical (IHC) staining of DNA mismatch repair (MMR) protein for the screening of microsatellite instability (MSI) colorectal cancer (CRC).</p><p><b>METHODS</b>A total of 255 CRC cases were studied, including 140 cases of routine paraffin-embedded tissue samples and 115 cases constructed on tissue microarray. Expressions of 4 MMR proteins including MHL1, MSH2, MSH6 and PMS2 were investigated by IHC. Negative protein expression was defined as complete absence of nuclear staining within tumor cells in the presence of positively labeled internal non-neoplastic cells. Focal staining was defined as the presence of staining in < 5% of the tumor cells. CRCs showing negative staining for any MMR proteins were interpreted as MMR deficient tumors. PCR-genescan MSI analysis was performed in each case by a five marker panel including Bat26, Bat25, NR-21, NR-24 and MONO-27.</p><p><b>RESULTS</b>Among the 140 CRCs with routine formalin-fixed paraffin embedded tissue sections, concordance rate between IHC and PCR-genescan was 98.6% (138/140), the sensitivity and specificity of IHC in detecting MSI tumors were 94.9% (37/39) and 100.0% (101/101), respectively. The 2 disconcordant cases showed focal staining in at least one of the MMR proteins but were confirmed to be MSI-H CRCs by PCR-genescan assay. On tissue microarray, 91.3% (105/115) of the cases had informative results. The concordance rate between IHC and PCR-genescan was 100.0% (105/105). Both the specificity and sensitivity of IHC in detecting MSI tumors on available tissue microarray samples were 100.0%. Ten cases were inclusive due to the presence of negative stains of MMR proteins in both the tumor and internal control cells.</p><p><b>CONCLUSIONS</b>Detection of 4 MMR proteins expression by IHC is reliable for identifying MSI CRCs and is recommended for routine practice. Tumors with focal MMR protein staining are highly suspected for the presence of MSI-H and PCR-genescan based MSI analysis should be performed to confirm.</p>

Anxiety life interference among primary and middle school students in Henan Province and its influencing factors / 中国学校卫生

Objective@#To investigate anxiety life interference among primary and middle school students in Henan Province and its influencing factors, and to provide scientific basis for health education in primary and secondary school students.@*Methods@#By using cluster sampling method, 3 573 primary school students and 2 748 secondary school students in Henan Province were investigated with Child Anxiety Life Interference Scale(CALIS), Resilience Scale for Chinese Adolescents(RSCA), Perceived Social Support Scale(PSSS), Self-Esteem Scale(SES), General Self-efficacy Scale(GSES).@*Results@#There were significant differences in anxiety life disturbance in primary and middle school students by gender(t=2.07, P=0.04), school level(t=-2.29, P=0.02), degree of anxiety(F=119.93, P<0.01), educational level of fathers (F=13.38, P<0.01) and educational level of mothers(F=9.65, P<0.01). The degree of life disturbance caused by anxiety was negatively correlated with mental resilience, social support and self-efficacy(r=-0.25, -0.09, -0.12, P<0.01), and was positively related to self-esteem(r=0.23). Mental resilience (β=-0.21) significantly negatively predicted anxiety interference with life, while self-esteem (β=0.13) and social support (β=0.06) significantly positively predicted anxiety interference with life.@*Conclusion@#The life of primary and middle school students is seriously disturbed by anxiety, and mental resilience is the primary psychosocial factor that affects the level of anxiety life interference among primary and middle school students.

Allergic diseases, immunoglobulin E, and autoimmune pancreatitis: a retrospective study of 22 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Autoimmune pancreatitis (AIP) is a chronic inflammatory disease of pancreas. We evaluated the clinical manifestations, imaging, and histological presentations of AIP in Chinese patients, and investigated the roles of immunoglobulin E (IgE) and allergic diseases in the diagnosis and pathogenesis of AIP.</p><p><b>METHODS</b>The clinical records of 22 patients diagnosed with AIP were reviewed and analyzed. All patients with AIP fulfilled the 2006 revised diagnostic criteria proposed by Japan Pancreas Society or the Korean Criteria for AIP.</p><p><b>RESULTS</b>Half (11/22) of AIP patients had allergic diseases. Twenty-one patients had elevated serum IgE levels, and 14 patients had IgE levels more than 3 times that of normal. There were no significant differences between the patients with higher or lower IgE, with or without allergic disease, in clinical features, laboratory tests, diffuse or focal lesions, or the choice of treatment methods; however, more complaints of body weight loss were observed in patients with higher IgE levels. Patients with higher IgE levels and with allergic diseases were more likely to have onset in March, April, May, August, September, or October. IgE levels decreased after therapy, but increased again during recurrence. Increased number of mast cells was found in the pancreatic tissue in AIP.</p><p><b>CONCLUSIONS</b>IgE maybe a useful marker for monitoring therapeutic response and recurrence of AIP. Allergic processes may play an important role in the pathogenesis of AIP.</p>

A clinical study about applying different R1 criteria to evaluate pancreatic head ductal adenocarcinoma specimens / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the R1 rate of the pancreatic head carcinoma resection specimens which delt with a unified protocol by two different R1 criteria.</p><p><b>METHODS</b>Between November 2011 and October 2013, a unified pathological protocol was prospectively used to handle 70 consecutive pancreatioduodenectomy specimens for pancreatic ductal adenocarcinoma. Apart from the pancreatic transection margin, the bile duct and stomach/jejunum margins, different colors were used to stain the anterior surface, the superior mesenteric vein (SMV) groove margin, the superior mesenteric artery (SMA) margin, and the posterior surface. Axial slicing technique was used to dissect the pancreatioduodenectomy specimens.</p><p><b>RESULTS</b>Among the 70 patients, 3, 30 and 37 patients were classified as well, moderately and poorly differentiated respectively;7, 15 and 48 patients were classified as pT1, pT2 and pT3 respectively.Forty patients (57.1%) had metastases in regional lymph nodes (pN1) , and 16 patients (22.9%) had metastases in para-aortic nodes.Resection of the portal vein and/or the superior mesenteric vein was performed in 13 patients (18.6%) .When applying the UICC criteria, 26 cancer resections were classified R1 (37.1%) , 33 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 13 specimens (13/33, 39.4%) respectively.When applying the Royal College of Pathologist's criteria, 39 cancer resections were classified R1 (55.7%) , 51 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 18 (18/51, 35.3%) and 19 (19/51, 37.3%) specimen respectively.Until April 2014, the median follow-up was 18(range 6-42) months.</p><p><b>CONCLUSIONS</b>Applying the unified protocol for pancreatic head ductal adenocarcinoma specimens results in an significant R1 rate of the resection margins, and the R1 rate is related to the R1 criterion. The SMV groove margin and SMA margin are the two most frequent sites of R1.</p>

Analysis of risk factors affecting the prognosis of pancreatic neuroendocrine tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreatic neuroendocrine tumors (pNETs) are a type of tumors with the characteristics of easy metastasis and recurrence. Till date, the risk factors affecting the prognosis are still in the debate. In this study, several risk factors will be discussed combined with our cases and experience.</p><p><b>METHODS</b>Thirty-three patients diagnosed as pNETs were enrolled and the clinical features, blood tests, pathological features, surgical treatment, and follow-up data of these patients were collected and analyzed.</p><p><b>RESULTS</b>In this study, operation time of G3 cases was longer than G1/G2 cases (P = 0.017). The elevated level of tumor markers such as AFP, CEA, Ca125, and Ca19-9 may predict easier metastasis, earlier recurrence, and poor prognosis (P = 0.007). The presence of cancer embolus and nerve invasion increases along with the TNM stage (P = 0.037 and P = 0.040), and the incidence of positive surgical margin increased (P = 0.007). When the presence of nerve invasion occurs, the chance of cancer embolus and lymph node metastasis also increases (P = 0.016 and P = 0.026).</p><p><b>CONCLUSIONS</b>pNETs were tumors with the features of easy recurrence and metastasis and many risk factors could affect its prognosis such as the elevated levels of tumor markers and the presence of nerve invasion, except some recognized risk factors. If one or more of these factors existed, postoperative treatments may be needed to improve prognosis.</p>

Minimally invasive surgery for resectable colorectal cancer with liver metastases: a prospective study / 中华肝胆外科杂志

Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.

Expression of co-stimulatory molecule CD86 and its inducible co-stimulator in Crohn disease and their pathologic significance / 北京大学学报(医学版)

Objective: To investigate the expression of co-stimulatory molecule CD86 and inducible costimulator(ICOS) in the intestinal mucosa of Crohn disease (CD) and to exlpore its pathologic significance. Methods: Expression of co-stimulator CD86 and ICOS was examined by immunohistoehemistry on paraffin embedded tissue from patients with CD (30 cases) and normal controls (20 cases). The subsets of lamina propria mononuclear cells (LPMC) were also analysed via immunostaining for CD4, CD8 and CD20. Results: Increased amount of CD86 or ICOS positive LPMC was observed in the lesional area of CD when compared with the essentially normal area of CD and normal controls (q = 9. 23 ,P ＜0. 01 and q =5. 46 ,P＜0. 01). In addition, the expression of CD86 or ICOS was higher in intestinal epithelium of CD than that in normal controls (H = 24. 93, P＜0. 01 and H = 4. 66, P＜0. 01 ) , whereas no significant difference was seen between the diseased and the essentially normal area of CD. The amount of CD4 or CD8 positive lymphocytes in lamina propria, epithelium and small vascular walls was also significantly increased in CD than that in normal controls (P＜0. 05 or P＜0. 01). Conclusion: Increased amount of CD86 or ICOS positive LPMC and enterocytes in CD suggests that co-stimulatory molecules may play a role in the pathogenesis of CD. The enterocytes may act as non-specific antigen presenting cells in the process of cellular immunity activation in CD.

Pathological characteristics mixed epithelial and stromal tumor of kidney / 北京大学学报(医学版)

Objective:To study the clinicopathological features of mixed epithelial and stromal tumor of the kidney(MESTK). Methods:Clinical and pathological characteristics of one case of MESTK was stu-died. Results:A case of MESTK which uncommonly occurred in a 16-year old adolescent male presented with dysuria and a large mass in the right renal region without a history of estrogen/progestogen treatment and/or obesity or urogenital surgery. Radiology revealed a large cystic/solid mass within the right kidney. Grossly, it was well demarcated and had a solid and cystic appearance on sectioning. Microscopically, the tumor was composed of a mixture of stromal and epithelial components. The epithelial component was composed of flat to columnar cells forming glands or tubules. The stromal components essentially consisted of bland, loosely packed spindle cells in an edematous and myxoid background. In some areas, there were smooth muscle cells forming bands and fascicles but no ovarian-type stroma was present. Immunohistochemical staining revealed that the epithelial components were positive for AE1/AE3 and focally positive for estrogen receptor(ER),progesterone receptor(PR), CD10 and Vimentin, whereas the stromal components were positive for ER, PR, Desmin and smooth muscle actin(SMA). Both epithelial and stromal components were negative for HMB-45, S-100,?-inhibin and WT-T. Five months after resection, the patient was well without evidence of recurrence. Conclusion:MESTK occurred in a pubertal male, as in the current case, supports the hypothesis that proliferation of remnants of the primitive mesenchyme in the kidney in situation of sex-steroid abnormity may play an important role in the pathogenesis of male MESTK.

A study on clinical topography of lateral ligament of the rectum / 中国普通外科杂志

Objective To study the clinical topography of lateral ligament of the rectum.MethodsDissection in the mesorectal plane was performed on cadavers of semi-pelvis sectioned in the sagittal plane. Results Ten of 14 semi-pelvises had substantial connective tissue between the mesorectum and the pelvic side wall. Eight of 10 lateral ligaments had middle rectal artery. Six of 8 middle rectal arteries run in the lateral ligament. The median height of the lateral ligament above the denticulate line was 14 mm (ranging 10～44 mm). Eight of 12 surgical cases had lateral ligament bilaterally, the remaining had lateral ligament unilaterally. Histologically the lateral ligament was composed of connective tissue. It consisted of vessel and nerve. The outer diameter of vessel in the lateral ligament was no more than 1.5 mm. Conclusions 1. The lateral ligament of the rectum presents in most people. The site and structure of lateral ligament was not constant, especially in vascular tissue. 2. Half of the cadavers have middle rectal artery. The rectal artery was tiny. Most of middle rectal artery runs in the lateral ligament. 3. The nerve in the lateral ligament was the part of rectal nerve plexus.