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

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

[Clinical comparison of modified laparoscopic and conventional placement of peritoneal dialysis catheters].

Objective: To explore the clinical efficacy of the modified laparoscopic placement of peritoneal dialysis catheters by nephrologists. Methods: A total of 188 patients diagnosed as end-stage renal disease (ESRD) were enrolled, who received catheter and continuous ambulatory peritoneal dialysis (CAPD) therapy from January 2011 to May 2016 in Zhejiang Provincial People's Hospital. They were divided into group A (with modified laparoscopic placement of peritoneal dialysis catheters, n=59) and group B (with conventional placement of peritoneal dialysis catheter, n=129). The demographic and clinical characteristics, past abdominal operation history, surgery time, hospital stay after operation, expenses for surgery and hospitalization, early and late complications including bleeding, pain, leakage, peritonitis and catheter displacement were observed. Results: Patients with previous abdominal surgery accounted for 11.9% in group A and 0 in group B(χ2=15.897, P<0.001). The duration of the operation was (38.9±12.8)min in group A and (64.1±12.7)min in group B(t=-6.466 6, P=0.000 0). The cost of the operation was (5 488.4±156.1) yuan in group A and (1 602.7±48.92) yuan in group B (t=257.129, P=0.000 0). Catheter displacement within one month was observed in 0 and 11.6%(χ2=7.455 3, P=0.003), pain in 15.3% and 41.9% (χ2=12.862 2, P=0.000), and catheter displacement after one month in 0 and in 16.3% (χ2=10.812 4, P=0.000) of the patients, respectively in group A and group B. The incidences of peritonitis within one month and beyond one month, leakage, bleeding and so on showed no difference between the two groups(P>0.05). Conclusions: Placement of PD catheter with laparoscope is suitable for renal failure patients with abdominal operation history and replacement PD catheter. It also has the advantages of shorter surgery time, less pain and lower incidences of catheter displacement, expanding the application of PD. However, bleeding, leakage, hernia and other complications are frequently seen.

The effect of edaravone combined with DL-3-N-butylphthalide on the levels of tumor necrosis factor-alpha, interleukin-10, neuron-specific enolase and effect in patients with acute cerebral infarction.

This study observed the effects of edaravone combined with Dl-3-N-butylphthalide (NBP) on the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), and neuron-specific enolase (NSE), and its therapeutic effect in patients with acute cerebral infarction (ACI). The purpose of this study was to explore whether edaravone combined with NBP could improve the neurological function of patients with ACI. A total of 86 patients with ACI were enrolled in this study; 43 patients were randomly assigned to the control group and treated with edaravone only, while the other 43 patients were assigned to the intervention group and treated with a combination of edaravone and NBP. The course of treatment lasted 14 days, and the basic drug treatment was the same in both groups. The effective rate of activity of daily living scores (ADL) was significantly higher in the intervention than in the control group, and the difference was statistically significant (P<0.05). After the treatment had been administered, the National Institute of Health Stroke Scale scores of the two groups were lower than before the treatment, and the scores were lower in the intervention compared with the control group; the difference was statistically significant (P<0.05). After the treatment had been administered, the serum levels of TNF-α and NSE were significantly lower in the intervention than in the control group, and the serum IL-10 level was significantly higher in the intervention than in the control group; the differences were statistically significant (P<0.05). Edaravone combined with NBP improved the neurological function of patients with ACI, improved their quality of life, significantly decreased the serum levels of TNF-a and NSE, increased the serum IL-10 level, and had a better effect. This combination therapy method can be adopted in clinics to treat patients with ACI.

[Studies on the chemical constituents from Chrysanthemum morifolium Ramat].

OBJECTIVE: To study the chemical constituents of Chrysanthemum morifolium. METHOD: Separated the constituents by means of chromatography and identified their structures by chemical and spectroscopic analysis. RESULT: Three compounds of flavonoid were identified as acacetin-7-O-beta-D-glucoside, apigenin-7-O-beta-D-glucoside and luteolin-7-O-beta-D-glucoside. CONCLUSION: These compounds were obtained from C. morifolium for the first time.