Mammary myofibroblastoma: a clinicopathological analysis of fifteen cases / 中华病理学杂志

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of breast myofibroblastoma. Methods: The clinicopathological data and prognostic information of 15 patients with breast myofibroblastoma diagnosed at the Department of Pathology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from 2014 to 2022 were collected. Their clinical characteristics, histological subtypes, immunophenotypes and molecular characteristics were analyzed. Results: There were 12 female and 3 male patients, ranging in age from 18 to 78 years, with a median and average age of 52 years. There were 6 cases in the left breast and 9 cases in the right breast, including 12 cases in outer upper quadrant, 2 cases in inner upper quadrant and 1 case in outer lower quadrant. Most of the cases showed a well-defined nodule grossly, including pushing growth under the microscope in 13 cases, being completely separated from the surrounding breast tissue in 1 case, and infiltrating growth in 1 case. Among them, 12 cases were classic subtype and composed of occasional spindle cells with varying intervals of collagen fiber bundles; eight cases had a small amount of fat; one case had focal cartilage differentiation; one case was epithelioid subtype, in which epithelioid tumor cells were scattered in single filing or small clusters; one case was schwannoma-like subtype, and the tumor cells were arranged in a significant palisade shape, resembling schwannoma, and one case was invasive leiomyoma-like subtype, in which the tumor cells had eosinophilic cytoplasm and were arranged in bundles, and infiltrating into the surrounding mammary lobules like leiomyoma. Immunohistochemical studies showed that the tumor cells expressed desmin (14/15) and CD34 (14/15), as well as ER (15/15) and PR (15/15). Three cases with histologic subtypes of epithelioid subtype, schwannoma-like subtype and infiltrating leiomyoma-like subtype showed RB1 negative immunohistochemistry. Then FISH was performed to detect RB1/13q14 gene deletion, and identified RB1 gene deletion in all three cases. Fifteen cases were followed up for 2-100 months, and no recurrence was noted. Conclusions: Myofibroblastoma is a rare benign mesenchymal tumor of the breast. In addition to the classic type, there are many histological variants, among which the epithelioid subtype is easily confused with invasive lobular carcinoma. The schwannoma-like subtype is similar to schwannoma, while the invasive subtype is easily misdiagnosed as fibromatosis-like or spindle cell metaplastic carcinoma. Therefore, it is important to recognize the various histological subtypes and clinicopathological features of the tumor for making correct pathological diagnosis and rational clinical treatment.

Prevalence of atherosclerotic cardiovascular disease in patients with type 2 diabetes and risk assessment of its occurrence in the next 10 years / 公共卫生与预防医学

Objective To investigate the prevalence of ASCVD in adult with type 2 diabetes (T2DM) in Tianshui City and assess the incidence risk in the next 10 years, so as to provide a theoretical basis for the prevention and treatment of ASCVD. Methods A total of 904 T2DM patients aged 20~88 years admitted in the cardiology department of Tianshui Hospital from May 2018 to June 2022 were grouped according to physical index (BMI), blood pressure, triglyceride (TG) ，glycosylated hemoglobin (HbA1c) and serum levels of asprosin and the risk of ASCVD by China-PAR model. Results The prevalence of ASCVD in adults with T2DM was 36.06%, and there were significant differences in the prevalence of ASCVD between different gender, hypertension grade, BMI and serum albumin (P310 pg/mL （OR=2.873, 95% CI:2.332-4.103), grade 3 hypertension （OR=1.726, 95% CI:1.281-1.981) and BMI>24（OR>1.5）. Conclusion The occurrence of ASCVD in T2DM patients is related to a variety of factors , it is very important to control the serum albumin , BMI , hypertension to reduce the incidence rate of ASCVD within 10 years.

Danshen Injection Inhibits Platelets-induced Metastasis of Breast Cancer Cells In Vitro / 中国实验方剂学杂志

ObjectiveTo observe the effect of Danshen injection （DAN） on platelet （PLT）-induced metastasis of breast cancer cells in vitro. MethodThe 3-（4，5-dimethylthiazol-2-yl）-2，5-diphenyltetrazolium bromide （MTT） assay was used to observe the effect of DAN on the growth of MDA-MB-231 cells in vitro. Oris™ migration assay was used to determine the effect of DAN （final mass concentrations 4， 8， 16 g·L-1） on PLT （1.5×1010 cells/L）-induced migration of breast cancer cells in vitro. The effect of DAN on PLT-induced cell invasion was detected by Transwell assay. Immunofluorescence and Western blot were used to detect the effect of DAN on the protein expression associated with PLT-induced epithelial-mesenchymal transition （EMT）. In addition， enzyme-linked immune-sorbent assay （ELISA） was used to determine the effect of DAN （final mass concentrations 4， 8， 16， 32， 64 g·L-1） on the secretion of transforming growth factor-β1 （TGF-β1）. Western blot was used to observe the effect of DAN on the expression of podoplanin （PDPN） protein in MDA-MB-231 cells induced by PLT. ResultCompared with the blank group， the DAN groups （32 and 64 g·L-1） showed decreased A570 （P<0.05， P<0.01）， and there was no significant difference in A570 between DAN groups （4， 8， 16 g·L-1）. Compared with the blank group， the PLT group showed increased cell migration and invasion， while DAN groups significantly inhibited PLT-induced cell migration and invasion. Compared with the blank group， the PLT group showed decreased expression of E-cadherin， while DAN could significantly reverse this effect of PLT. Compared with the blank group， the PLT group showed increased Slug and Snail protein expression （P<0.05， P<0.01）， while DAN significantly reversed Snail protein expression induced by PLT （P<0.05， P<0.01）. The content of TGF-β1 in the PLT group increased （P<0.01）， while the secretion of TGF-β1 induced by PLT decreased in the DAN groups （16， 32， and 64 g·L-1） （P<0.05， P<0.01）， and the secretion of TGF-β1 was not significantly affected in other DAN groups. PDPN protein expression in the PLT group increased （P<0.01）， while DAN could significantly inhibit PLT-induced PDPN expression （P<0.01）. ConclusionDAN can inhibit PLT-induced migration， invasion， and EMT of breast cancer cells. The mechanism may be related to the direct action between breast cancer cells and tumor cells by down-regulating PDPN expression and interfering with PLT and has nothing to do with the effect of TGF-β1 secretion of PLT.

Clinical characteristics of patients with systemic amyloidosis involved in digestive tract / 中华消化杂志

Objective:To study the clinical characteristics and endoscopic manifestations of patients with systemic amyloidosis involved in digestive tract.Methods:Clinical and endoscopic features, biopsy locations and positive rate of patients with systemic amyloidosis involved in digestive tract at Peking Union Medical College Hospital from December, 1991 to December, 2004 (1991 to 2004 diagnosed group, 18 cases) and from March 17th, 2009 to November 4th, 2020 (2009 to 2020 diagnosed group, 47 cases) were retrospectively analyzed and compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among 47 patients in 2009 to 2020 diagnosed group, 41 were primary amyloid light chain (AL) amyloidosis, and the age of onset was older than that of 1991 to 2004 diagnosed group ((57.15±9.10) years old vs. (50.75±10.90) years old), and the time from disease onset to diagnosis was shorter than that of 1991 to 2004 diagnosed group ((13.48±11.72) months vs. (26.38±23.02) months), and the differences were statistically significant ( t=2.08 and -2.13, P=0.048 and 0.047). There was no significant difference in time from disease onset to diagnosis between patients with gastrointestinal manifestations at disease onset and patients without gastrointestinal manifestations at disease onset (10.5 months (6.0 months, 17.3 months) vs.14.0 months (5.8 months, 25.0 months), P>0.05). Among primary AL amyloidosis patients in 2009 to 2020 diagnosed group, weight loss was the most common clinical symptom, the proportion of patients was 87.8%(36/41); secondary was gastrointestinal bleeding, among which 18 patients (43.9%) were stool occult blood test positive and 4 patients (9.8%) were with melena or bloody stool. The endoscopic features of patients with biopsy-confirmed digestive tract involvemen vary, including mucosa hemorrhage and oozing of blood in 4 cases, fragile mucosa and easy to bleed in 3 cases, and 4 cases with bulged mucosa and all the 4 cases of biopsy at bulged mucosa was positive. Gingiva and tongue were the most common biopsy locations and the positive rate of biopsy was ≥60.0%. Rectal mucosa biopsy was performed in 15 patients and 6 were Congo red staining positive. Heart or kidney biopsy was performed in 3 and 6 patients, and the number of positive cases was 2 and 4, respectively. Conclusions:Weight loss and gastrointestinal bleeding are the common gastrointestinal symptoms of primary AL amyloidosis. The common endoscopic manifestations included mucosal bleeding, fragile and bulged mucosa. Biopsy at multiple locations according to experience may help earlier diagnosis and treatment.

Application Law of Coptidis Rhizoma to Diabetes and Its Complications： Based on Data Mining / 中国实验方剂学杂志

ObjectiveTo explore the application law of compound prescriptions containing Coptidis Rhizoma to diabetes and its complications based on data mining. MethodA total of 288 records on formulas containing Coptidis Rhizoma in the treatment of diabetes and its complications and the corresponding syndromes and symptoms were retrieved from the medical records of modern physicians， with 218 on the treatment of diabetes and 70 on the treatment of diabetes complications. The Traditional Chinese Medicine Inheritance Computing Platform （V3.0） was used or data mining on the compositions of the formulas. Moreover， it was employed for the frequency statistics， formula analysis， symptom analysis， association rules analysis， network visualization， and cluster analysis. ResultThe 218 formulas containing Coptidis Rhizoma for the treatment of diabetes involved 190 Chinese medicinals. A total of 12 syndromes showed the occurrence frequency ≥ 6， and the one with the highest frequency was deficiency of both qi and yin， followed by the syndrome of excessive heat in lung and stomach， syndrome of Yin deficiency and effulgent fire， and syndrome of excessive heat and fluid consumption. The dose of Coptidis Rhizoma for the treatment of diabetes ranged from 1.5-30 g， and the most frequently used doses were 10， 6， and 5 g. The medicinal was frequently applied for the traditional Chinese medicine symptoms of dry stool， dry mouth and tongue， and swift digestion with rapid hungering. Moreover， 26 core medicinal pairs， 17 association rules， 3 diagrams on medicinal relationship， and 3 core combinations were yielded. The 70 formulas containing Coptidis Rhizoma for the treatment of diabetes complications involved 184 Chinese medicinals， and the top 3 complications were diabetic nephropathy， diabetic peripheral neuropathy， and diabetic gastroenteropathy. The dose of Coptidis Rhizoma in the treatment of diabetes complications fell in the range of 2-15 g， and 10， 6， and 5 g were most frequently used. ConclusionFormulas containing Coptidis Rhizoma for the treatment of diabetes and its complications mainly target the syndrome of dampness-heat transforming into fire and the syndrome of excessive heat damaging yin. This study can serve as a reference for standard use of Coptidis Rhizoma in the prevention and treatment of diabetes and its complications.

Effect of Extracts from Veronica peregrine on Breast Cancer Cell-induced Osteoclastic Bone Metastasis via Inhibiting Runx2 Activation / 中国实验方剂学杂志

ObjectiveTo investigate inhibitory effect of extracts from Veronica peregrina （EVP） on the osteoclastic bone metastasis induced by breast cancer cells. MethodBone metastasis model was established by injection of MDA-MB-231 cells， a human breast cancer cell line， into the left ventricle of BALB/c nude mice. The expression of human cytokeratin-19 （Ck-19） gene in mouse bone marrow was determined by nested polymerase chain reaction（PCR） to assess the bone metastasis of MDA-MB-231 cells. To assess the effects of EVP on the activation of bone marrow macrophages （BMMs）， we counted the multinuclear cells and measured the secretion of Cathepsin K. Western blot was adopted to assess the effects of EVP on receptor activator of nuclear factor-κB （RANK）， Runt-related transcription factor 2 （ Runx2 ）， phosphorylated Runx2 （p-Runx2）， and matrix metalloproteinase-9 （MMP-9） in BMMs. Gelatin zymography was employed to determine the activities of matrix metalloproteinases （MMPs）. ResultCompared with that in the blank group， Ck-19 expression was down-regulated in EVP groups （P<0.05）. The multinucleated cells increased when the BMMs were induced by soluble receptor activator of nuclear factor-κB ligand （sRANKL）， which was inhibited by EVP （P<0.05）. The level of cathepsin K in the supernatant of sRANKL group increased compared with that of the blank group， while EVP groups had lower cathepsin K levels than sRANKL group （P<0.05）. Compared with the blank group， the sRANKL group showed up-regulated RANK expression， Runx2 phosphorylation， and MMP-9 expression （P<0.05）， while the expression levels of RANK， p-Runx2， and MMP-9 were down-regulated when the cells were incubated with EVP （P<0.05）. Furthermore， exposure of BMMs to sRANKL resulted in an increase in gelatin hydrolyzation compared with the blank group （P<0.01）， which， however， was reversed in EVP groups （P<0.05）. ConclusionEVP significantly inhibits bone marrow metastasis of MDA-MB-231 cells， which may be associated with the suppression of osteoclast activation by inhibiting Runx2 phosphorylation.

Study on the influencing factors of hospitalization in a long-term follow-up cohort of 123 patients with Crohn′s disease / 中华消化杂志

Objective:To explore the influencing factors of hospitalization in patients with mild active Crohn′s disease or in clinical remission during long-term follow-up.Methods:This was a prospective cohort study. From August 5, 2013 to January 5, 2015, 123 patients with mild active Crohn′s disease or in clinical remission visited the Department of Gastroenterology, Peking Union Medical College Hospital were selected. The baseline information of all the patients were collected, including the general data such as age and gender, clinical data such as extra-intestinal manifestations, complications, efficacy of glucocorticoid usage, serum hypersensitive C-reactive protein (hsCRP), serum albumin, and the total score and the subscore in systemic symptoms of inflammatory bowel disease questionnaire (IBDQ). All the patients were followed up for a long time till May 31, 2022 or the date of hospitalization due to the disease. Receiver operating characteristic curve (ROC) was used to define the optimal cut-off values of hsCRP and serum albumin for hospitalization prediction. Multivariate Cox regression model was used to analyze the influencing factors of hospitalization.Results:The median age of 123 patients was 32.0 years old (25.0 years old, 49.0 years old), 32.5% (40/123) were female, and 71 cases (57.7%) were hospitalized because of disease, and the median follow-up time was 29.2 months (9.0 months, 57.9 months). ROC analysis showed that the optimal cut-off value of hsCRP and serum albumin in predicting hospitalization because of disease in patients with Crohn′s disease was 1.5 mg/L and 40 g/L (both P<0.001), respectively.Multivariate Cox regression model showed that the extra-intestinal manifestations ( HR=1.869, 95% confidence interval (95% CI) 1.014 to 3.443), complications ( HR=2.511, 95% CI 1.368 to 4.608), glucocorticoid dependence or refractory ( HR=1.958, 95% CI 1.128 to 3.396), serum hsCRP≥1.5 mg/L ( HR=2.116, 95% CI 1.111 to 4.029) and serum albumin≤40 g/L ( HR=3.040, 95% CI 1.716 to 5.386) were independent risk factors of hospitalization because of disease in patients with Crohn′s disease ( P=0.045, 0.003, 0.017, 0.023, and <0.001). However, IBDQ subscore in systemic symptoms ( HR=0.873, 95% CI 0.805 to 0.948) was an independent protective factor of hospitalization because of disease ( P=0.001). Conclusions:Patients with Crohn′s disease at remission stage or mild activity stage who have extra-intestinal manifestations, complications, glucocorticoid dependence or refractory, serum hsCRP≥1.5 mg/L or serum albumin≤40 g/L are at high risk of hospitalization because of disease, and should be given more active treatments and more frequent follow-up. Patients with higher IBDQ subscore in systemic symptoms are more likely to gain a long-term stable condition.

High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

Anesthesia management for resection of adrenal cortical carcinoma in children / 中华麻醉学杂志

The medical records of 11 pediatric patients undergoing resection of adrenal cortical carcinoma from January 2012 to January 2019 in our hospital were collected.Anesthesia management for resection of adrenal cortical carcinoma in children was analyzed and investigated.Anesthesia was induced by intravenously injecting atropine 0.01 mg/kg, dexamethasone 2-5 mg, propofol 2-3 mg/kg, sufentanil 0.3-0.5 μg/kg or fentanyl 1-2 μg/kg, rocuronium 0.5 mg/kg or cis-atracurium 0.1-0.2 mg/kg.Radial artery catheterization and femoral vein catheterization were performed under ultrasound guidance.Arterial blood pressure was continuously monitored.The esophageal thermometers probe was placed to continuously monitor body temperature.The catheter was placed to monitor urine volume.Intermittent positive pressure ventilation was performed after endotracheal intubation with the inspiratory oxygen fraction set 60%-100%, oxygen flow rate 2-3 L/min, tidal volume 7-10 ml/kg, ventilation frequency 20-26 times/min, inhalation/respiration ratio 1∶(1.5-2.0) and airway pressure 16-20 cmH 2O, and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Anesthesia was maintained by inhaling 2%-4% sevoflurane and/or intravenously infusing propofol 0.10-0.15 mg·kg -1·min -1, and continuously infusing remifentanil 0.2-0.5 μg·kg -1·min -1.Hemodynamics was maintained within the normal range, and the bispectral index was maintained at 40-60 during the surgery.Before the tumor was completely removed, 5-10 mg/kg sodium hydrocortisone succinate was intravenously infused.At the end of the operation, sufentanil 0.75-1.00 μg·kg -1·d -1 or fentanyl 7.5-10.0 μg·kg -1·d -1 was continuously infused for postoperative analgesia until 48 h after operation.Operation was smoothly completed with stable anesthesia in all the pediatric patients.The tracheal tube was removed successfully after the operation.All children in this group were discharged from hospital and no death occurred.Anesthesia management for resection of adrenal cortical carcinoma required an appreciation of the clinical characteristics and perioperative pathophysiological changes.Paying attention to the changes in hormone levels during perioperative period and timely adjusting the children′s internal environment to maintain the stability of anesthesia and reduce the stress response were the keys to anesthesia management.

Epidemiological characteristics of sexually transmitted diseases from 2005 to 2017 in Mengla County， Yunnan Province / 上海预防医学

Objective:To determine the epidemiological characteristics and incidence trends of sexually transmitted diseases （STD） in Mengla County of Yunnan Province， and provide evidence for future prevention and control of STD. Methods:STD case information from 2005 to 2017 was extracted from the National Notifiable Infectious Disease Report Information System. Data were collected by year and disease type，and the incidence rate， epidemic characteristics and suspicious contact history of STD were statistically analyzed. Results:A total of 1 251 STD cases were reported in Mengla county from 2005 to 2017， including 490 gonorrhea， 483 syphilis， 216 condyloma acuminatum， 16 genital chlamydial infection and 46 genital herpes. The average annual incidence of STD was 35.57/100 000. The majority of STD cases were 20-29 years old （n=541，43.25%）， married （n=603，48.20%）， Han people （n=638，50.10%）， with education of middle school （n=536，42.85%）， and occupation of farmers （n=702， 56.12%）. The 42.61% of STD cases had non-marital sexual contact history， in which the proportion was significantly higher among male （55.05%） than female （28.98%）. In addition， the proportion of non-marital sex among STD cases increased gradually by year and significantly differed. Conclusion:The epidemic status of STD in Mengla county is relatively low. However， STD incidence increased gradually by year， which warrants more and specific measures on the STD control and prevention.

Study on Periplaneta americana Polypeptide PAE2 in Reversing Multidrug Resistance for Liver Cancer / 中国实验方剂学杂志

Objective:To investigate the effect and mechanism of PAE₂， a polypeptide of <italic>Periplaneta americana， </italic>in reversing multidrug resistance （MDR） for liver cancer <italic>in vivo</italic>. Method:Balb/c-nude mice were inoculated with HepG2 and HepG2/ADM cells under the armpits to establish animal models of liver cancer sensitive strains and animal models of MDR respectively. After successful modeling， the nude mice were randomly divided into normal group， HepG2 model group， HepG2/ADM model group， sorafenib group （positive drug control group， <italic>ig</italic> 30 mg·kg^-1）， HepG2/ADM+PAE₂ （<italic>iv</italic>） low， medium and high dose groups （50， 100， 200 mg·kg^-1）， HepG2/ADM+PAE₂ （<italic>ig</italic>） low， medium， and high dose groups （50， 100， 200 mg·kg^-1）， skim cream group （<italic>ig</italic> 200 mg·kg^-1）， and CⅡ-3 group （<italic>ig</italic> 200 mg·kg^-1）， all of which received corresponding drug treatment. The body weight and tumor volume of nude mice were measured and recorded every 2 days. The next day after the last administration， tumor tissues of nude mice were taken to record the tumor weight. The effect of <italic>P. americana </italic>polypeptide PAE₂ on permeability-glycoprotein（P-gp）， lung resistance protein（LRP） ， breast cancer resistance protein（BCRP）， protein kinase C（PKC）， glutathione S-transferase-π（GST-π）， topo-isomerase typeⅡ（ToPoⅡ）， multidurg resistance gene 1（MDR1）and Multidrug resistance-associated proteins（MRP1） of the protein level and gene level expression in tumor tissues were determined by immunohistochemistry （IHC） and real-time quantitative polymerase chain reaction （Real-time PCR）. In addition， both oral and intravenous administration groups were set up at the same time for preliminary study on the basic pharmacokinetic characteristics of <italic>P. americana </italic>polypeptide PAE₂. Result:After the successful modeling， the body weight of the nude mice was significantly lower than that in the normal mice（<italic>P</italic><0.05）. After treatment with corresponding drugs， the body weight increased to a certain extent， but it was still not as good as the normal nude mice. In <italic>iv</italic> administration， the medium-dose <italic>P. americana </italic>polypeptide PAE₂ showed the best anti-tumor effect as compared with the model group （<italic>P</italic><0.05）， while in oral administration， the anti-effect increased with the increase of the dose， so the high-dose group showed the best effect （<italic>P</italic><0.05）. Preliminary crude extract CII-3 had no obvious anti-tumor effect， and skim cream showed a certain anti-tumor effect （<italic>P</italic><0.05）. <italic>P. americana </italic>polypeptide PAE₂ had certain effects on MDR related proteins and enzymes<italic> in vivo</italic>， mainly by inhibiting the expression of LRP and BCRP in tumor tissues and affecting the expression of these related proteins and genes to different degrees to inhibit intracellular drugs outflow， thereby promoting tumor apoptosis， and the effect was superior to that of the <italic>P. americana</italic> crude extract CⅡ-3 and skim cream. Conclusion:<italic>P. americana</italic> polypeptide PAE₂ may reduce the drug efflux， promote intracellular drug accumulation and apoptosis by affecting the expression of related proteins and enzymes that mediate multidrug resistance， thereby exerting a reverse effect on HepG2/ADM cells Balb/c MDR in nude mice.

Evaluation of the measures in early warning and disposal of snail environment in a forest land in Songjiang District, Shanghai / 上海预防医学

Objective To evaluate the methods in early warning of schistosomiasis and elimination of snails in an ecological public forest in Yexie Town of Songjiang District, and provide the basis for monitoring and controlling snails in forest land in the future. Methods The monitoring data of snails, schistosomiasis and snail elimination in the public forest were collected to evaluate the effect of controlling snails. Results The area with existence of snails was found to be 10.47 hm2, and it was decreased by 98.28% after three times of snail elimination.A total of 1 904 serological tests was performed (test rate of 88.76%) with the positive rate of 0.16%.Pathogenic test result was negative in 3 subjects examined.Serological samples of 11 dogs and 1 sheep were all negative for the test.None of the 1 480 live snails tested was found to be positive in infection.The awareness rate of schistosomiasis control knowledge and behavior formation in 275 students were 98.2% and 95.3%, respectively. Conclusion The snails in the public forest in Yexie Town have been effectively controlled, but there are still scattered living snails.The measures in eliminating and monitoring of snails should be continued and strengthened.

The 477th case: muscular spasms, alopecia, diarrhea / 中华内科杂志

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.

The 477th case: muscular spasms, alopecia, diarrhea / 中华内科杂志

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.

Study on the Mechanism of Periplaneta americana Extract Reversing Multi-drug Resistance of Human Hepato- cellular Carcinoma HepG 2/ADM Cells / 中国药房

OBJECTIVE：To study the mechanism of Periplaneta americana extract degreasing cream and CⅡ-3（shorted for “degreasing cream ”and“CⅡ-3”）reversing the multi-drug resistance of human HepG 2/ADM cells. METHODS ：MTT assay was used to investigate the toxicity effects of different concentrations of sorafenib （positive control ），degreasing cream and C Ⅱ-3 on HepG2/ADM cells ，then IC 20 was calculated. The experiment was divided into sensitivity drug ，drug-resistance group ，sorafenib group，degreasing cream group and C Ⅱ-3 group. HepG 2 cells were included in sensitivity group ，and HepG 2/ADM cells were included in the latter 4 groups. Sensitivity group and drug-resistance group were treated with routine medium ，and other 3 groups were treated with relevant medicine （IC20 as drug concentration ）. The content of ADM in HepG 2/ADM cells was determined by Laser scanning confocal microscopy. The expression of apoptosis-related protein as Bcl- 2 and Cleaved-Caspase- 9 p37 were detected by Western blotting assay. RT-qPCR and immunocytochemistry were adopted to detect mRNA and protein expressions that related to multidrug resistance [P-gp （expression produce of MDR1 gene），LRP，BCRP] and that related to enzyme-mediated multidrug resistance pathway （GST-π and Topo Ⅱ）. RESULTS ：The IC 20 of degreasing cream ，CⅡ-3 and sorafenib were （2.40±0.16）， （200.44±27.52），（18.00±1.82）μg/mL，respectively. Compared with sensitivity group ，the protein expressions of Bcl- 2，P-gp， LRP，BCRP and Topo Ⅱ，the mRNA expressions of MDR 1， LRP，BCRP and GST-π were increased significantly in drug resistance group （P＜0.05 or P＜0.01）. Compared with @qq.com drug-resistance group ，the mRNA and protein expression of MDR1 mRNA and LRP ，BCRP，GST-π were significantly decreased in degreasing cream group and C Ⅱ-3 group（P＜ 0.05 or P＜0.01）；the protein expression of Bcl- 2 and the mRNA expression of Topo Ⅱ were significantly decreased （P＜0.01）， while the protein expression level of Cleaved-Caspase- 9 p37 was significantly increased in C Ⅱ -3 group （P＜0.05）. CONCLUSIONS：Degreasing cream and C Ⅱ-3 can reverse multidrug resistance of HepG 2/ADM cells by reducing drug efflux ， promoting cell apoptosis ，reducing the mRNA and protein expression of multi-drug resistance gene as well as gene in enzyme-mediated multi-drug resistance pathway. The effect of C Ⅱ-3 is better than that of degreasing cream.

Invasive breast lobular carcinoma with extracellular mucin: a clinicopathological analysis / 中华病理学杂志

Objective@#To study the clinicopathological features of invasive lobular carcinoma (ILC) of the breast with extracellular mucin and outcomes of patients.@*Method@#Clinicopathological features and clinical follow-up (39-123 months and a median follow-up of 55 months) of seven ILC with extracellular mucin were obtained. Hematoxylin-and-eosin (H&E) and immunohistochemistry (IHC) stained sections were reviewed, and fluorescence in situ hybridization (FISH) assay was performed for tumors with HER2 IHC 2+. Patient prognosis was analyzed and literatures related to ILC with extracellular mucin were reviewed.@*Results@#All seven patients were female, aged from 43 to 73 years (median age, 55 years). The tumors ranged in size from 1 to 5 cm (median size 2 cm). All seven cases were of histological grade 2. Most areas of the tumors presented with the morphology of classic ILC, and variable amount of extracellular mucin were observed focally. In six cases, part of the tumor cells contained intracellular mucin, and the nucleus were pushed to one side of the cells, creating the impression of signet-ring cells. Two patients had lymph node metastases at diagnosis, and developed liver and bone metastases at 38th and 48th month, respectively, after surgery, and died at 48th and 123th month, respectively. While the other five patients, except one lost to follow-up, had been disease-free during the follow-up period. IHC results showed estrogen receptor (ER) and progesterone receptor (PR) positivity in 7/7 and 6/7 cases, respectively. Tumors of six patients were HER2 IHC 0/1+. The remaining one was HER2 IHC 2+, while FISH assay revealed HER2 gene amplification in that tumor. The proportion of cases with HER2-positivity was 1/7. The proliferation index Ki-67 ranged from less than 5% to 30%, and Ki-67 less than or equal to 10% were in 5/7 cases. According to the 2013 St. Gallen International Expert Consensus on breast cancer, all tumors were of luminal types; of those, two were luminal A and five were luminal B.@*Conclusions@#ILC with extracellular mucin tends to occur in women over 50 years old. All tumors in the study are grade 2 classic ILC, with signet-ring cells as a common feature. All seven tumors are classified as luminal types, with luminal B as the main molecular subtype.

Value of shear wave elastrography image classification in the diagnosis of breast masses / 中华肿瘤杂志

Objective@#To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions.@*Methods@#A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated.@*Results@#The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01).@*Conclusion@#The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

Study on Anti-tumor Effects of Periplaneta americana Polypeptide PAP- 2 on H 22 Tumor-bearing Mice / 中国药房

OBJECTIVE： To investigate anti-tumor effects of Periplaneta americana polypeptide PAP-2 on H22 tumor-bearing mice. METHODS： The mice tumor-bearing model was established by subcutaneous injection of ascites of H22 hepatocellular carcinoma mice via axilla. 70 mice were randomly divided into model group （normal saline）， 5-FU group （positive drug control， 20 mg/kg）， P. americana extract skimmed cream group （200 mg/kg， calculated by extract）， CⅡ-3 group （polypeptide isolated from skimmed cream as main active ingredient， 200 mg/kg， calculated by extract） and polypeptide PAP-2 high-dose， medium-dose and low-dose groups （isolated from CⅡ-3， 200， 100， 50 mg/kg， calculated by monomer）， with 10 mice in each group. The mice in the 5-FU group were given intraperitoneal injection once every other day， while the mice in the other groups were given intragastric administration once a day， the administration cycle was 10 d. After medication， the changes of tumor were observed and the organs （spleen， thymus and liver） index were measured. Histopathological changes of tumor tissue were observed after HE staining. The contents of VEGF， IL-1β and IL-4 in serum were determined by ELISA. RESULTS： Skimmed cream， CⅡ-3 and different doses of PAP-2 could inhibit the growth of tumor in tumor-bearing mice to different extent and increase organ index， and PAP-2 showed a dose-effect relationship. The tumor inhibition rate （38.95％） of PAP-2 high dose group was significantly higher than those of skimmed cream group and CⅡ-3 group （P＜0.05）， which was close to that （40.87％） of 5-FU group （P＞0.05）. Spleen index， thymus index and liver index of mice in PAP-2 high dose group were significantly those of model group and CⅡ-3 group （P＜0.05）； and the liver index of mice in PAP-2 high dose group was significantly higher than that of skimmed cream group （P＜0.05）. In addition， PAP-2 could decrease the serum contents of VEGF and IL-4， and increased serum content of IL-1β， with high dose group showed significant difference compared with model group （P＜0.05）； the serum content of IL-1β of mice in PAP-2 high dose group was significantly higher the that of skimmed cream group and CⅡ-3 group （P＜0.05）， serum contnet of IL-4 in PAP-2 high dose group was significantly lower the  that of skimmed cream group and CⅡ-3 group （P＜0.05）， but the serum content in which was significantly lower than that of skimmed cream group and CⅡ-3 group（P＜0.05）. CONCLU- SIONS： P. americana polypeptide PAP-2 it has a certern anti-tumor effects on H22 tumor-bearing mice， and its can increase the index of organs of H22 tumor-bearing mice， decrease the contents of VEGF and IL-4 in serum， increase the content of IL-1β in serum.

Epidemiological and lethal risk factors of Klebsiella pneumoniae infection in neurosurgical patients / 中国综合临床

Objective We performed a retrospective study to determine the epidemiological characteristics of Klebsiella pneumoniae infection after neurosurgery and to elucidate the risk.Methods Patients who underwent neurosurgery between January 2012 and December 2016 were included.Demographic,clinical,laboratory,and microbiological data were systemically recorded.17 clinical trials and 7 clinical laboratory indicators were evaluated as risk factors for meningitis.Results Forty-five cases of neurosurgery patients led to K.pneumoniae infection were analyzed,K.pneumoniae ESBLs production ratio is 37.8％ (17/45),the sensitivity rate of carbapenem antibiotics was more than 80.0％ (36/45).The patients were mainly in the north of China with an average age of 36.3±18.3 years old and a male ratio of 53.3％ (24/45).The highest proportion of patients are pituitary adenoma and glioblastoma and the mortality rate was 22.2％ (10/45).The mean length of hospital stay was 29.2± 13.7 days,and the most likely to develop K.pneumoniae were 7.8±6.9 days after neurosurgery.The ICU occupancy rate was 51.1％ (23/45).Chi-square test showed that older age (＞50 years old) and sepsis were risk factors for death from K.pneumoniae infection after neurosurgery.Multivariate logistic analysis showed that the risk of infection was associated with the incidence of sepsis (OR 16.199,P =0.010).There were no statistically significant differences between the survival and death patients by seven laboratory tests (P＞0.05).Conclusion The infection of neurosurgery caused by K.pneumoniae has a high mortality rate.Among them,concurrent sepsis is the lethal risk factor of infection.Clinically,identification of the risk factors as soon as possible will help physicians to improve patient care and improve the surgical success.

Application of PDCA circulation method in critical value management in ultrasound department / 中华医学超声杂志（电子版）

Objective To analyze the current situation of the quality of critical value management in ultrasound department,and to explore the application and effect of PDCA cycle method in critical value management.Methods The quality status of emergency data during the period from January 2015 to January 2019 after the PDCA cycle was adopted was analyzed.The PDCA cycle method was applied to improve the overall quality.The reporting rate,awareness rate,qualified rate of writing,and timely rate of clinical treatment were compared before and after the PDCA cycle was adopted to evaluate the effect of PDCA cycle method.Results From January 2015 to January 2019,the reporting rate was 96.4％,98.0％,94.5％,and 96.7％,the awareness rate of critical value was 63.2％,78.6％,84.8％,and 92.2％,the qualified rate of writing was 70.4％,77.2％,85.3％,and 94.0％,and the timely rate of clinical treatment was 50.9％,71.7％,81.1％,and 85.5％,respectively.The awareness rate,the qualified rate of writing,and the timely rate of clinical treatment were significantly improved (x2=12.464,38.184,52.926,all P ＜ 0.05).Conclusion PDCA cycle method can improve the quality of emergency management in ultrasound department.