[A pathological report of three COVID-19 cases by minimal invasive autopsies].

Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

[HER2 status in gastric adenocarcinoma of Chinese: a multicenter study of 40 842 patients].

Objective: To investigation HER2 status in gastric adenocarcinoma of Chinese and contributing factors to the HER2 expression. Methods: HER2 status of 40 842 gastric adenocarcinomas and clinical data were retrospectively collected from 23 hospitals dated from 2013 to 2016. The association between HER2 positivity and clinicopathologic features was analyzed. Results: Of the 40 842 patients the median age was 62 years, the male female ratio was 2.6∶1.0. The rate of HER2 positivity was 8.8% (3 577/40 842). HER2 expression was related to the tissue type, tumor location, Lauren classification and tumor differentiation (P values: 0.009, 0.001, <0.01 and <0.01, respectively). Different HER2 expression status was observed between primary and recurrent tumors in 7.6% (48/635) cases. The rates of HER2 positivity ranged from 2% to 10% among different institutions. The rates of HER2 FISH amplification were dramatically different among the 23 hospitals (0-100%) with an average rate of 10% (810/8 156) in patients with HER2 IHC 2+ . Conclusions: HER2 expression is associated with clinicopathologic characteristics. HER2 re-assessment of tumor tissue and use of in situ hybridization techniques increase HER2 positivity. The current retrospective study should reflect the HER2 status in gastric adenocarcinoma of Chinese patients.

Intraosseous schwannoma of rib.

A case of intraosseous schwannoma of rib is presented. A 22-year-old woman was admitted with paroxysmal thoracic pain, unproductive cough and a hard mass of the thorax. CT scan showed a unilocular osteolystic lesion in the rib. A needle biopsy was performed, and a diagnosis of intraosseous schwannoma was made. The patient underwent a partial excision of rib and the tumour was removed. Macroscopic examination revealed a 4 x 2 x 1.5 cm solid lesion with destruction of bone. Microscopically, the tumour showed typical features of schwannoma characterised by Antoni A and Antoni B tissues and Verocay bodies. Immunohistochemically, the tumour was positive for S-100 protein, vimentin, neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP). The patient is well without local recurrence or metastasis after a 1-year follow-up. This is believed to be the second case report of primary schwannoma of rib.

Evaluation of prenatal nutrition counseling: maternal nutrition status and infant birthweight.

A prospective study on the effect of prenatal nutrition counseling on maternal nutrition status and infant birthweight was conducted at an antenatal care clinic by comparing a group of 80 women who attended nutrition counseling sessions with another group of 63 women who did not participate in nutrition counseling (controls). The daily intake of protein, calcium, iron, retinol, and riboflavin in the counseled group was higher than that in the control group. Moreover, the daily intake of nutrients of the counseled women met the recommended dietary allowance. Blood constituent determinations revealed that the levels of serum total protein, albumin, vitamin A, vitamin E, zinc, copper, magnesium, and hemoglobin in the blood of mothers and in umbilical blood at delivery were higher in the counseled group than in the control group (P less than 0.01). The women receiving counseling had fewer low-birthweight infants (1.52% vs 2.70%) and the incidence of maternal anemia was 39.1% against 55.6%, a significant difference (P less than 0.01).