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Objective: To study the clinicopathological characteristics, and further understand primary central nervous system T-cell lymphoma (PCNSTCL) in children and adolescents. Methods: Five cases of PCNSTCL in children and adolescents were collected from December 2016 to December 2021 at the First Affiliated Hospital of Zhengzhou University. The clinicopathological characteristics, immunophenotypic, and molecular pathologic features were analyzed, and relevant literatures reviewed. Results: There were two male and three female patients with a median age of 14 years (range 11 to 18 years). There were two peripheral T-cell lymphomas, not otherwise specified, two anaplastic large cell lymphoma, ALK-positive and one NK/T cell lymphoma. Pathologically, the tumor cells showed a variable histomorphologic spectrum, including small, medium and large cells with diffuse growth pattern and perivascular accentuation. Immunohistochemistry and in situ hybridization showed CD3 expression in four cases, and CD3 was lost in one case. CD5 expression was lost in four cases and retained in one case. ALK and CD30 were expressed in two cases. One tumor expressed CD56 and Epstein-Barr virus-encoded RNA. All cases showed a cytotoxic phenotype with expression of TIA1 and granzyme B. Three cases had a high Ki-67 index (>50%). T-cell receptor (TCR) gene rearrangement was clonal in two cases. Conclusions: PCNSTCL is rare, especially in children and adolescents. The morphology of PCNSTCL is diverse. Immunohistochemistry and TCR gene rearrangement play important roles in the diagnosis.
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Neoplasias del Sistema Nervioso Central , Infecciones por Virus de Epstein-Barr , Linfoma de Células T Periférico , Linfoma de Células T , Femenino , Humanos , Masculino , Sistema Nervioso Central/patología , Neoplasias del Sistema Nervioso Central/genética , Neoplasias del Sistema Nervioso Central/patología , Herpesvirus Humano 4 , Linfoma de Células T/genética , Linfoma de Células T/patología , Linfoma de Células T Periférico/genética , Proteínas Tirosina Quinasas Receptoras/genética , Receptores de Antígenos de Linfocitos T , Niño , AdolescenteRESUMEN
Objective: To investigate the clinicopathological features and molecular genetics of diffuse large B-cell lymphomas (DLBCL) with concurrent or secondary to nodal T-follicular helper cell lymphoma, angioimmunoblastic-type (nTFHL-AI). Methods: The clinicopathological features and molecular genetics of DLBCL associated with nTFHL-AI diagnosed between January 2015 and October 2022 at the First Affiliated Hospital of Zhengzhou University were analyzed using histology, immunohistochemistry, PCR, EBV-encoded RNA in situ hybridization and fluorescence in situ hybridization (FISH). Clinical information was collected and analyzed. Results: A total of 6 cases including 3 nTFHL-AI with secondary DLBCL and 3 composite lymphomas were reviewed. There were 4 male and 2 female patients, whose ages ranged from 40 to 74 years (median 57 years). All patients presented with nodal lesions at an advanced Ann Arbor stage â ¢/â £ (6/6). Bone marrow involvement was detected in 4 patients. All cases showed typical histologic and immunophenotypic characteristics of nTFHL-AI. Among them, 5 cases of DLBCL with concurrent nTFHL-AI exhibited numerous large atypical lymphoid cells and the tumor cells were CD20 and CD79α positive. The only case of DLBCL secondary to nTFHL-AI showed plasma cell differentiation and reduced expression of CD20. All of cases were activated B-cell (ABC)/non-germinal center B-cell (non-GCB) subtype. Three of the 6 cases were EBV positive with>100 positive cells/high power field, meeting the diagnostic criteria of EBV+DLBCL. The expression of MYC and CD30 protein in the DLBCL region was higher than that in the nTFHL-AI region (n=5). C-MYC, bcl-6 and bcl-2 translocations were not detected in the 4 cases that were subject to FISH. Four of the 6 patients received chemotherapy after diagnosis. For the DLBCL cases of nTFHL-AI with secondary DLBCL, the interval was between 2-20 months. During the follow-up period ranging from 3-29 months, 3 of the 6 patients died of the disease. Conclusions: DLBCL associated with nTFHL-AI is very rare. The expansion of EBV-infected B cells in nTFHL-AI may progress to secondary EBV+DLBCL. However, EBV-negative cases have also been reported, suggesting possible other mechanisms. The up-regulation of MYC expression in these cases suggests a possible role in B-cell lymphomagenesis. Clinicians should be aware that another biopsy is still necessary to rule out concurrent or secondary DLBCL when nodal and extranodal lesions are noted after nTFHL-AI treatment.
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Linfoma de Células B Grandes Difuso , Femenino , Masculino , Humanos , Hibridación Fluorescente in Situ , Linfocitos B , Biopsia , Linfocitos T Colaboradores-InductoresRESUMEN
Objective: To investigate the clinicopathological features and molecular genetics of cyclin D1-negative mantle cell lymphoma (MCL). Methods: The clinicopathological features and molecular genetics of CyclinD1-negative MCL diagnosed between January 2016 and July 2021 at the First Affiliated Hospital of Zhengzhou University were analyzed using immunohistochemistry and fluorescence in situ hybridization. Clinical information was collected and analyzed. Results: A total of five Cyclin D1-negative MCL cases from all 212 MCL patients (5/212, 2.4%)were included. There were three male and two female patients,age ranged from 59 to 70 years (median 64 years). All patients presented with nodal lesions. None of the patients had B symptoms but four had bone marrow involvement. Histopathologically, four cases were classic MCL and one case was pleomorphic variant type. All five cases were negative for Cyclin D1 but SOX-11 were positive in all cases. CD5 was positive in four cases and one case was weakly positive for CD23. CD10 and bcl-6 were negative in all cases. CCND1 translocation was identified in three cases and CCND2 translocation in one case by FISH analysis. However,CCND3 translocations were not found in the five cases. Conclusions: Cyclin D1-negative MCL are uncommon, its accurate diagnosis needs combined analysis with morphologic and immunophenotypic characteristics and genetic changes. It may be particularly difficult to distinguish from other small cell type B cell lymphomas. FISH analyses for CCND1/CCND2/CCND3 translocations and immunohistochemistry for SOX-11 are helpful to resolve such a difficult distinction.
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Linfoma de Células del Manto , Anciano , Ciclina D1/genética , Femenino , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ , Linfoma de Células del Manto/genética , Linfoma de Células del Manto/patología , Masculino , Persona de Mediana Edad , Biología MolecularRESUMEN
Objective: To study the clinicopathological and genetic features of natural killer (NK)-cell enteropathy for better understanding of this rare disease and prevention of its misdiagnosis. Methods: Two cases of NK-cell enteropathy were diagnosed in the First Affiliated Hospital of Zhengzhou University, China from October 2017 to February 2021. The clinical characteristics, morphology, immunohistochemistry, Epstein-Barr virus-encoded RNA (EBER) in situ hybridization and T cell receptor gene rearrangement were analyzed. The patients were followed up by a telephone interview. Results: The patients were both male, aged 40 and 28 years, respectively. Both patients were admitted to the hospital for an annual checkup without obvious gastrointestinal symptoms. The endoscopy showed that the gastric body of case 1 had a mucosal bulge, small area of congestion and erosion, while the rectum of case 2 had congestion and erosion. Microscopically, the lesions of the 2 cases were relatively limited. Many lymphoid cells infiltrated within the lamina propria of the mucosa and into the muscularis mucosa in case 2. In case 1, the glands were reduced in the lesion, and the glandular cavity was slightly compressed and deformed. There was no infiltration or destruction of the glands in either case. Lymphoid cells were atypical, with medium-to-large cell sizes. Their cytoplasm was medium-to-slightly abundant and appeared eosinophilic or translucent. In case 2, characteristic eosinophilic granules were seen in the cytoplasm of a few cells. The nuclei in both cases were round, oval and irregular, with fine chromatin, inconspicuous nucleoli, and no mitotic figures were noted. Necrosis was seen in case 1 while both cases had no central growth or destruction of blood vessels. Immunophenotyping showed that CD56, granzyme B and TIA-1 were positive in both cases, part of the cells was CD3-positive, and some cells were weakly CD4-positive in case 2. The CD5, CD8, CD30, ALK and B-lineage markers (CD20, CD79α) were all negative. The Ki-67 proliferation index was about 60% and 30%, respectively. Both cases were EBER negative. TCR gene rearrangement was polyclonal. Follow-up showed that none of the 2 patients had any special treatments and stayed well. Conclusions: NK-cell enteropathy is rare, with biological behaviors similar to benign tumors, and occasional recurrence. Its histology and immunophenotype are easily confused with NK/T cell-derived lymphomas. Combination of its unique endoscopic features, EBER negativity, polyclonal TCR gene rearrangement and good prognosis can confirm the diagnosis and avoid misdiagnosis and overtreatment.
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Infecciones por Virus de Epstein-Barr , Trastornos Linfoproliferativos , Herpesvirus Humano 4/genética , Humanos , Inmunofenotipificación , Células Asesinas Naturales , MasculinoRESUMEN
Objective: To investigate the clinicopathological features, molecular genetics, treatment and prognosis of Burkitt-like lymphoma with 11q aberration (BLL-11q). Methods: Six cases of BLL-11q diagnosed at the First Affiliated Hospital of Zhengzhou University, from January 2016 to January 2020 were reviewed and analyzed using hematoxylin-eosin staining, immunohistochemistry, EBER in situ hybridization and fluorescence in situ hybridization. Clinical information including follow-up data was collected and analyzed. Results: The median age of the six immunocompetent patients was 29 years (range 20-38 years) and the male to female ratio was 5â¶1. All patients had nodal disease in the head and neck region. Five patients had Ann Arbor stage â -â ¡ disease, while one patient had stage â £ disease. Lymph nodes showed partial or total architectural effacement by a diffuse proliferation of monomorphic lymphocytes. Four cases were morphologically similar to Burkitt lymphoma, and two cases were unclassified with histological features between Burkitt lymphoma and diffuse large B-cell lymphoma. Mitotic figures, apoptosis and necrosis were conspicuous. Five cases exhibited the"starry sky"pattern. CD20, CD10 and bcl-6 were diffusely and strongly positive. The Ki-67 index was more than 95%. The follicular-dendritic-cell meshwork was noted in one case using CD21 stain. C-MYC was expressed variably. CD3, bcl-2, MUM-1, CD30 and TDT were negative in all cases. EBER in situ hybridization was also all negative. FISH analyses using C-MYC, bcl-2 and bcl-6 break-apart probes were all negative. All cases had the 11q23.3 gain/11q24.3 loss pattern, and 11q23.3 amplification was found in one case. IgH and IRF4 break-apart probes analysis was also negative. All patients were alive with no disease after a follow-up of 4 to 19 months. Conclusion: BLL-11q is a rare lymphoma that resembles Burkitt lymphoma morphologically and phenotypically, but lacks C-MYC gene rearrangements. Instead, it has a chromosome-11q alteration characterized by proximal gains and telomeric losses. It's necessary to improve our understanding of BLL-11q to avoid misdiagnosis and missed diagnosis.
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Linfoma de Burkitt , Linfoma de Células B Grandes Difuso , Adulto , Linfoma de Burkitt/genética , Aberraciones Cromosómicas , Femenino , Genes myc/genética , Humanos , Hibridación Fluorescente in Situ , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/genética , Masculino , Biología Molecular , Translocación Genética , Adulto JovenRESUMEN
Objective: To study the clinicopathological features and prognosis of nodal lymphoplasmacytic lymphoma/Waldenstrom's macroglobulinemia (n-LPL/WM). Methods: A total of 19 cases of n-LPL/WM were collected from May 2009 to January 2020 at First Affiliated Hospital of Zhengzhou University. The clinicopathologic features, immunophenotype, Ig gene rearrangement (BIOMED-2), MYD88 L265P mutation status (by Sanger sequencing) and follow-up data (by telephone) were analyzed. Results: There were 15 males and 4 females with a median age of 61 years (range 43 to 82 years). There were 14 WM and five LPL. The most common symptoms were weakness, fatigue (9/19) and B symptoms (11/19). Majority of the patients (16/18) presented with systemic multiple lymphadenopathies. Eighteen patients presented at advanced stages (â ¢/â £ stage). Serum M protein status was IgM (15 cases), IgG (1 case), IgA (1 case) and no-secretory type (2 cases). Seventeen patients had bone marrow involvement. Morphologically, all 19 cases were divided into two groups: typical group (9 cases) or atypical group (10 cases). In the typical group, the structures of the lymph nodes were preserved; the neoplastic cells were predominantly plasmacytoid lymphocytes or mixed small lymphocytes, plasmacytoid lymphocytes and plasma cells, without proliferation of FDC network and follicular implantation. In the atypical group, the tumor showed effaced nodal architecture (5 cases), mainly proliferation of small lymphocytes (6 cases), FDC proliferation and/or follicular implantation (6 cases), marginal zone B cell differentiation (4 cases) and diffuse amyloidosis (1 case). Hemosiderin deposition (19 cases), infiltration of fatty tissue (19 cases) and interstitial sclerosis (9 cases) were commonly seen in both groups. Immunohistochemically, the neoplastic B cells expressed CD20 and CD79α, and the neoplastic plasma cells were positive for CD38, CD138 and MUM-1; eight cases showed light chain restriction; of the seven detected cases, five expressed IgM and the other two expressed IgG and IgA respectively; four cases expressed CD23 weakly, Ki-67 index was 10%-30%. MYD88 L265P mutation was seen in 18/18 cases. There was no significant difference in clinicopathologic features and prognosis between the two groups (P>0.05). The median follow-up time was 61 months, 11 patients were alive, while eight died; the 5-year survival rate was 21.1%. Conclusions: n-LPL/WM is rare, but patients usually present in advanced stages. It is easily confused with other small B-cell lymphomas with plasma cell differentiation, especially basing on morphologic features alone; thus the accurate diagnosis of n-LPL/WM requires a combination of clinical features, serum M protein, immunohistochemistry, bone marrow morphology,flow cytometry and MYD88 L265P mutation status etc. The prognosis of n-LPL/WM may be not very good, and further studies with more cases are needed.
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Leucemia Linfocítica Crónica de Células B , Linfoma de Células B , Macroglobulinemia de Waldenström , Adulto , Anciano , Anciano de 80 o más Años , Antígenos CD20 , Femenino , Humanos , Inmunofenotipificación , Masculino , Persona de Mediana Edad , Macroglobulinemia de Waldenström/genéticaRESUMEN
Objective: To investigate the clinicopathological features and differential diagnosis of primary cutaneous nasal extranodal NK/T cell lymphoma (pcENKTCL-NT). Methods: Fifteen cases of pcENKTCL-NT were collected at the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019. The clinical characteristics, morphological features, immunophenotypes, and results of in situ hybridization and gene detection were analyzed. Results: Among the 15 patients, 7 were male and 8 were female, with a male to female ratio of 1.0â¶1.1. Their ages ranged from 29 to 86 years, and the median age was 59.3 years. All patients were hospitalized for skin lesions, including skin ulcers, scattered patchy red papules, and local blisters. The skin lesion might be a hard nodular mass, and part of it was a confluent patchy erythema; it could be manifested as multiple scattered nodules of different sizes, and some lesions were like round ulceration. There were 8 cases of lower limbs, 4 cases of chest (1 case with upper limb lesions), 2 cases of trunk and 1 case of neck. Most of the patients were sensitive to GGDP regimen (cisplatin, dexamethasone, gemcitabine and pemostatin). Histologically, most lesions showed tumor cells invading the epidermis and skin appendages, dermal infiltration, diffuse distribution, vascular and peritubular destruction, and some subcutaneous adipose tissue involvement. Morphologically, most of the tumor cells were mixed with small-to medium-size lymphocytes, and some were large cells, mixed cells or small cells. Immunohistochemistry showed that CD3, CD3 ε and TIA-1 were expressed in all cases, but not CD20 and CD8. CD56 and granzyme B were expressed in most of the cases, and CD5 was not expressed. Ki-67 positive index was about 50%-90%. EBV in situ hybridization was positive in all cases. The clonal rearrangement of T cell receptor gene was found in some CD56 negative cases. The 15 patients were followed up for 5-45 months, and one of them was lost to follow-up. Five patients died within 5-13 months after the diagnosis, accounting for 35.7% (5/14) of the 14 patients. The average survival time of the deceased patients was 8.6 months. Conclusions: The incidence rate of pcENKTCL-NT is relatively low, but its biological behavior is aggressive and its prognosis is overall poor. Its skin lesions and histopathological features are relatively diverse. The diagnosis should be determined with using clinical data, histological morphology, immunophenotype and EB virus in situ hybridization. At the same time, attention should be paid to differential diagnosis from other cutaneous lymphoma with cytotoxic phenotype to avoid missed diagnosis and misdiagnosis.
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Infecciones por Virus de Epstein-Barr , Linfoma Extranodal de Células NK-T , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Herpesvirus Humano 4/genética , Humanos , Inmunofenotipificación , Hibridación in Situ , Linfoma Extranodal de Células NK-T/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
Objective: To study the clinicopathologic features and MYD88 L265P mutation status of intravascular large B cell lymphoma (IVLBCL). Methods: Fourteen cases of IVLBCLs were diagnosed from March 2014 to December 2019 at the First Affiliated Hospital of Zhengzhou University. The clinicopathologic features and prognosis were analyzed. Epstein-Barr virus encoded RNAs and MYD88 L265P mutation status were detected using in situ hybridization and Sanger sequencing, respectively. The follow-up data were obtained by telephone interview. Results: There were 6 males and 8 females with a median age of 62 years (range: 48-73 years). The involved anatomic locations were demonstrated by positron emission tomography-computed tomography, including adrenal gland (7/14), bone (6/14), central nerve system (4/14), skin (3/14), female reproductive system (3/14), local lymph nodes (3/14), prostate (2/14), liver and spleen (2/14), sphenoid sinus (1/14), penis (1/14), bladder (1/14), and right lung (1/14). Fever was the most common symptom (7/14), followed by neurologic symptoms and lower abdominal pain (2/14 each). The reminder symptoms included rash with edema, legs weakness and numbness, or postmenopausal bleeding (1/14 each). Eleven cases were at Lugano stage â £. Four cases were associated with the hemophagocytic syndrome, while 6 cases with bone marrow involved. Microscopically, the tumor cells were generally concentrated within the small-to-medium vascular lumens or sinusoids; they had centroblast-like appearance and showed large round or oval nuclei with slightly irregularities, coarse chromatin and 1-3 distinct nucleoli. One exception was the one case with an embryoid nuclei, reminiscent of anaplastic large cell lymphoma. The mitosis was not uncommon. Extravascular neoplastic cells were seen in two cases. The neutrophils could be appreciable in most of the cases (10/14). Immunophenotyping showed that CD20 and CD79α were diffusely and strongly positive in 14 cases; 12 cases were classified as the non-GCB subtype; 6 out of the 11 cases were double expressor lymphoma; 7 out of the 12 cases were CD5-positive. Twelve cases were EBER negative. The MYD88 L265P mutation was detected in 1 case (1/10). The duration of the follow-up ranged from 0.5 to 24.0 months, and 11 patients survived and 3 died. Conclusions: IVLBCL is rare. The most common type of IVLBCL in China is Asian type with scant tumor cells. Combination of clinical and immunohistochemical features can avoid most, if not all, misdiagnoses and missed diagnoses. Some IVLBCL cases may harbor the MYD88 L265P mutation, but the prevalence of MYD88 L265P mutation in the population still warrants additional studies.
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Linfoma de Células B Grandes Difuso , Factor 88 de Diferenciación Mieloide , Anciano , China , Femenino , Humanos , Linfoma de Células B Grandes Difuso/genética , Masculino , Persona de Mediana Edad , Mutación , Factor 88 de Diferenciación Mieloide/genética , PronósticoRESUMEN
Objective: To investigate the clinicopathological features of primary Epstein-Barrvirus (EBV) positive nodal T/NK-cell lymphomas (EBV+nodal TNKL). Methods: The clinicopathological features of 7 cases of EBV+nodal TNKL diagnosed between November 2015 and May 2019 at the First Affiliated Hospital of Zhengzhou University were analyzed using immunohistochemistry, PCR gene rearrangement and in situ hybridization.Follow-up data were also collected. Results: There were 5 males and 2 females with a median age of 54 years (ranged from 41 to 75 years). All patients presented with multiple lymphadenopathies and common B symptoms (5/7) and at an advanced Ann Arbor stage â ¢/â £(6/7). Bone marrow involvementwas detected in 1 patient.Six cases of T-cell origin had monomorphic patterns, and the tumor cells showed CD56 negativity and TCRαß+/TCRÎ³Î´ï¼ with T-cell clonality. One case of NK-cell origin had polymorphic pattern, and the tumor cells showed CD56 positivity and TCRαß-/TCRγδ-without T-cell clonality. All cases were positive for the cytotoxic markers, but showed various CD4/CD8 expression. All 7 cases were diffusely positive for EBV (>100 cell/high power field). Six of the patients received chemotherapy, and 1 patient declined the treatments. During the follow-up period ranging from 3 to 48 months, 5 of the 7 patients died of the disease. Conclusions: EBV+nodal TNKL is a rare entity and is characterized by cytotoxic molecule expression, T/NK-cell derivation, and a predominance of nodal involvement at an advanced stage. It should be differentiated from other EBV+T/NK cell lymphoproliferative disorders, especially extranodal NK/T cell lymphoma.
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Infecciones por Virus de Epstein-Barr , Linfoma Extranodal de Células NK-T/tratamiento farmacológico , Linfoma de Células T Periférico/tratamiento farmacológico , Adulto , Anciano , Femenino , Herpesvirus Humano 4/genética , Humanos , Células Asesinas Naturales , Masculino , Persona de Mediana EdadRESUMEN
Objective: To study the clinicopathologic and genetic features of Waldeyer's ring peripheral T-cell lymphoma with follicular helper T cell immunophenotypes (wPTCL-TFH), with comparison to the nodal peripheral T-cell lymphoma with TFH immunophenotypes (nPTCL-TFH) and angioimmunoblastic T-cell lymphoma (AITL), as to know this rare tumor better. Methods: The clinical data, histopathology features, EBV positivity, T cell clonality and IDH2(R172) gene mutation in 8 cases of wPTCL-TFH were collected at the First Affiliated Hospital of Zhengzhou University from December 2015 to April 2019, and analyzed by immunohistochemistry, in situ hybridization, TCR gene rearrangement (BIOMED-2) and Sanger sequencing.Follow-up data were obtained by telephone. Results: There were 6 males and 2 females with a median age of 62.5 years (age ranging from 30 to 75 years). All patients had neither fever nor skin manifestations, but were all found mucosa thickened or mass of waldeyer's ring with multiple lymph nodes enlarged by PET-CT/CT scans. Five of the 7 patients were at advanced stages (â ¢/â £ stage). Microscopically, the mucosa was infiltrated diffusely and characteristically by numerous small-medium sized lymphocytes, lacking polymorphous inflammatory background and extra-follicular expansion of follicular dendritic cell networks (FDC networks). The clear T cells presented in 5 cases. Ulcers on mucosal surfaces (6 cases) and local-extensive loss of intramucosal glands (7 cases) were commonly noted. Granulomas composed of epithelioid histiocytes were observed in 2 cases. Immunohistochemically, all the tumor cells expressed CD4 and at least 2 types of follicular helper of T cell (TFH) markers: PD-1 (8/8), bcl-6 (8/8), CXCL13 (7/8) and CD10 (1/8). Most of the cases (6 cases) expressed CD30. EBV positive appeared in 4 cases. All 8 cases were T cell monoclonal. IDH2(R172) were wild-type in 6 cases. One patient died at the follow-up time on 18 months; the other 7 survived (the follow-up time varied from 3 to 10 months). Conclusions: wPTCL-TFH is rare, and its clinicopathological features are similar to nPTCL-TFH which may be the manifestation of the same disease at different stage, and partly overlapped with AITL. The differential diagnosis from PTCL-NOS is necessary and comprehensive analyses of clinical, morphological, immunohistochemical and genetic features can help make a correct diagnosis.
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Linfoma de Células T Periférico , Adulto , Anciano , Femenino , Humanos , Linfadenopatía Inmunoblástica , Masculino , Persona de Mediana Edad , Fenotipo , Tomografía Computarizada por Tomografía de Emisión de Positrones , Linfocitos T Colaboradores-InductoresRESUMEN
It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .
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Desnutrición/diagnóstico , Desnutrición/terapia , Evaluación Nutricional , China , Personal de Salud , Humanos , Estado NutricionalRESUMEN
Objective: The incidence of gastrointestinal symptoms in diabetes is higher than that of non-diabetes. Thus, the aim of the present study was to observe the efficacy and safety of bifidobacterium tetragenous viable bacteria tablets in the treatment of constipation in patients with type 2 diabetes mellitus. Methods: This is a multicenter, randomized, double-blind, placebo-controlled, parallel group-comparison clinical research. The subjects were randomly divided into study group and control group according to 1â¶1 ratio by computer generated random number method. The subjects were either treated with bifidobacterium tetragenous viable bacteria tablets (study group) or placebo (control group) for eight weeks, and they were followed up for four weeks without changing foundation therapy for diabetes. The primary outcome was the change of complete spontaneous bowel movements (CSBMs). Results: A total of 234 subjects (the study group:116 cases; the control group: 118 cases) from 7 centers were included in the present study. The baseline characteristics were comparable between the two groups. In the study group, the CSBMs at 0, 2, 4, 8 and 12 weeks were 0.0 (0.0, 1.0) , 1.0 (0.5, 2.0) , 2.0 (1.0, 3.0) , 3.0 (2.0, 3.5) , 2.0 (1.0, 3.0) times per week, respectively, while the CSBMs of the control group at each corresponding weeks were 0.0 (0.0, 1.0) , 1.0 (0.0, 1.5) , 1.0 (0.0, 1.5) , 1.0 (0.0, 2.0) , 1.0 (0.0, 1.5) times per week, respectively. There is significant difference in CSBMs between the two groups (P<0.05). Moreover, after 12 weeks treatment, the CSBMs over spontaneous bowel movements (SBMs) ratio in the study group was higher than that in the control group [0.53 (0.40, 0.67) vs 0.33 (0.00,0.50), P=0.048], indicating a more complete evacuation sensation in the study group. More subjects in the study group (66.38%) reached Bristol stool classification of normal criteria than those in the control group (48.31%, P=0.005). There were significantly improvement of bowel function index in the study group [study group 42.7 (33.3, 56.7), control group 60.6 (51.7, 75.7), P<0.000 1]. Furthermore, the symptoms of constipation was improved, and the satisfaction for the treatment was high in the study group. There were no significant differences of the safety indicators between the two groups. Conclusions: Bifidobacterium tetragenous viable bacteria tablets can be used in patients with type 2 diabetes mellitus and constipation. Compared with placebo, it improves constipation and has no obvious adverse effects.
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Bifidobacterium , Estreñimiento/terapia , Diabetes Mellitus Tipo 2/complicaciones , Comprimidos/administración & dosificación , Estreñimiento/complicaciones , Método Doble Ciego , Heces , Humanos , Resultado del TratamientoRESUMEN
Objective: To modify the individual neuroendoscopic surgical approach of pituitary tumors with specific imaging features, and to analyze the clinical outcomes. Methods: The clinical data of 116 patients with pituitary tumors who underwent surgical treatment at the pituitary tumor diagnosis and treatment center of Ruijin Hospital from April 2014 to December 2017 were collected, then the resection effects and complication rates of pituitary tumors from three different kinds of transsphenoidal approaches (e.g. classical single nostril approach, bilateral approach, "one-and-a-half" approach) were compared. Results: Pituitary tumor resection with "one-and-a-half" trans-nasal-sphenoidal approach achieved the same surgical effects with the bilateral approach, which was difficult to resect with the single-nostril classical approach. And it had significant advantages in the average length of postoperative hospitalization ( "one-and-a-half" : 6.9 days, bilateral: 12.5 days, P<0.01), the average postoperation VAS of olfactory retention ( "one-and-a-half" : 8.6, bilateral: 7.0, P<0.01) and preventing posterior nasal septum perforation (the occurrence rate of "one-and-a-half" : 0%, bilateral: 27%). Conclusion: The "one and a half" approach increases the ability to control and completely resect the lesion beyond the medial edge of the internal carotid artery on the same side of the nostril involving endoscope. It is a good supplement and improvement to the bilateral approach.
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Endoscopía , Neoplasias Hipofisarias , Humanos , Cavidad Nasal , Neuroendoscopios , Neuroendoscopía , Nariz , Neoplasias Hipofisarias/cirugíaRESUMEN
A full-length cDNA sequence coding ribosomal protein S3a of mulberry tree, which we designated MmRPS3a (GenBank accession No. KR610331), was cloned based on mulberry expressed sequence tags. Sequence analysis showed that the MmRPS3a is 1089 bp long and contains a 80-bp 5'-UTR (untranslated region) and a 220-bp 3'-UTR. Its open reading frame consists of a 789-bp encoding 262 amino acids with a predicted molecular weight of 30.053 kDa and an isoelectric point of 9.84. Homology analysis revealed that MmRPS3a gene is highly conservative in mulberry and other species including Morus notabilis, Theobroma cacao, and Ricinus communis. Phylogenetic analysis based on MmRPS3a of other species showed that mulberry had a closer relationship with Prunus persica, Arabidopsis thaliana, Solanum tuberosum, Solanum lycopersicum, and Vitis vinifera. The results of quantitative PCR analysis showed that the transcriptional level of MmRPS3a mRNA changed significantly under the conditions of hypothermia, aridity, salt stress, and varieties of differing resistances.
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Respuesta al Choque por Frío , Regulación de la Expresión Génica de las Plantas , Morus/genética , Proteínas de Plantas/genética , Proteínas Ribosómicas/genética , Regiones no Traducidas 3' , Secuencia Conservada , Variación Genética , Morus/clasificación , Filogenia , Proteínas de Plantas/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , Proteínas Ribosómicas/metabolismo , SalinidadRESUMEN
Pituitary adenomas can cause endocrine disorder and organ damage, with some aggressive ones leading to a high postoperative recurrence rate. The occurrence and development of these type of tumors is closely related with matrix metalloproteinases (MMPs) and endogenous specific tissue inhibitor of MMPs (TIMPs). In this study, the relationship between pituitary adenoma invasion and the changes in MMP-8 and TIMP-1 expressions is analyzed. Specimens from sixty patients with pituitary adenoma were collected in our hospital after surgery, including thirty cases of invasive pituitary adenomas and thirty cases of noninvasive pituitary adenomas. Western blotting and real-time PCR were used to detect MMP-8/TIMP-1 protein and mRNA levels, respectively, in the two types of pituitary adenomas, while ELISA was used to detect both compounds' levels in the patient's serum. Compared with noninvasive pituitary adenomas, MMP-8 was significantly overexpressed in invasive pituitary adenomas, while TIMP-1 was obviously lower (P < 0.05 for both). Moreover, MMP-8 mRNA expression in invasive pituitary adenomas was significantly higher than in noninvasive pituitary adenomas, while TIMP-1 mRNA expression was markedly lower (P < 0.05 for both). Finally, MMP-8 expression in the serum is upregulated in patients with invasive pituitary adenomas relative to the noninvasive ones, and the expression of TIMP-1 significantly reduced (P < 0.05 for both). These results show that increased MMP-8 and decreased TIMP-1 expressions are closely related to the invasive pituitary adenoma, and can be helpful for the evaluation.
Asunto(s)
Adenoma/genética , Adenoma/patología , Metaloproteinasa 9 de la Matriz/genética , Neoplasias Hipofisarias/genética , Neoplasias Hipofisarias/patología , Inhibidor Tisular de Metaloproteinasa-1/genética , Adenoma/metabolismo , Adulto , Biomarcadores , Femenino , Expresión Génica , Humanos , Masculino , Metaloproteinasa 9 de la Matriz/sangre , Metaloproteinasa 9 de la Matriz/metabolismo , Persona de Mediana Edad , Neoplasias Hipofisarias/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , Inhibidor Tisular de Metaloproteinasa-1/sangre , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Carga Tumoral , Adulto JovenRESUMEN
Moyamoya disease (MMD) is a progressive occlusive disease of the distal internal carotid artery that is primarily treated by superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Despite its effectiveness, several postoperative complications have been reported with STA-MCA bypass. Cerebral hyperperfusion syndrome (CHS) after STA-MCA has attracted considerable attention as a hemodynamics-related complication because more cases of CHS after STA-MCA bypass are reported in MMD than in non-MMD patients. The mechanisms underlying CHS after revascularization in MMD patients are poorly understood. This report presents a comprehensive review of the literature on CHS after revascularization in MMD patients, focusing on the pathogenesis, clinical features, imaging techniques, treatment, and prognosis of CHS. Impaired cerebrovascular autoregulation has been implicated in the pathogenesis of CHS, which is characterized by unilateral headache, face and eye pain, seizures, and focal neurological deficits secondary to cerebral edema, and intracranial hemorrhage. Imaging techniques, such as single photon emission computed tomography (SPECT), 3-T magnetic resonance imaging/angiography, and selective arterial spin-labeling magnetic resonance imaging, are valuable for identifying patients at risk for CHS. Treatment strategies include strict blood pressure control, intracranial hemorrhage prevention, and free oxygen radical scavenger administration. Most patients can achieve a satisfying prognosis after effective treatment.
Asunto(s)
Revascularización Cerebral/efectos adversos , Trastornos Cerebrovasculares/etiología , Hiperemia/etiología , Enfermedad de Moyamoya/cirugía , Circulación Cerebrovascular/fisiología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/terapia , Humanos , Hiperemia/diagnóstico , Hiperemia/terapia , Enfermedad de Moyamoya/fisiopatología , Pronóstico , SíndromeRESUMEN
The multilayer one-class classification (OCC) frameworks have gained great traction in research on anomaly and outlier detection. However, most multilayer OCC algorithms suffer from loosely connected feature coding, affecting the ability of generated latent space to properly generate a highly discriminative representation between object classes. To alleviate this deficiency, two novel OCC frameworks, namely: 1) OCC structure using the subnetwork neural network (OC-SNN) and 2) maximum correntropy-based OC-SNN (MCOC-SNN), are proposed in this article. The novelties of this article are as follows: 1) the subnetwork is used to build the discriminative latent space; 2) the proposed models are one-step learning networks, instead of stacking feature learning blocks and final classification layer to recognize the input pattern; 3) unlike existing works which utilize mean square error (MSE) to learn low-dimensional features, the MCOC-SNN uses maximum correntropy criterion (MCC) for discriminative feature encoding; and 4) a brand-new OCC dataset, called CO-Mask, is built for this research. Experimental results on the visual classification domain with a varying number of training samples from 6131 to 513 061 demonstrate that the proposed OC-SNN and MCOC-SNN achieve superior performance compared to the existing multilayer OCC models. For reproducibility, the source codes are available at https://github.com/W1AE/OCC.