High-grade fetal adenocarcinoma of the lung with abnormal expression of alpha-fetoprotein in a female patient: Case report.

INTRODUCTION: Fetal adenocarcinoma of the lung (FLAC) is an extremely rare tumor. Due to its rarity, most of the knowledge about FLAC comes from case reports. FLAC is an invasive adenocarcinoma that is similar to the fetal lung in the pseudo-glandular stage (8-16 weeks of gestation). Owing to the differences in histopathology and clinical process, FLAC has been further divided into low-level (L-FLAC) and high-level (H-FLAC). H-FLAC is usually associated with other conventional types of lung adenocarcinoma. Lung adenocarcinoma that produces alpha-fetoprotein (AFP) is a rare type of lung cancer. Its characteristics have not been fully elucidated. PATIENTS CONCERNS: We recently encountered this type of FLAC in a 51-year-old female patient. A computed tomography (CT) scan of the chest revealed a 74 × 51-mm sized tumor in the lingual segment of the superior lobe of the left lung. Among the tumor markers, serum AFP was elevated (816.2 ng/mL). PRIMARY DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: The diagnosis of FLAC in this patient was confirmed by bronchoscopy with lung biopsy. Through a thoracoscope, left lung pneumonectomy, and mediastinal lymph node dissection were performed. The postoperative pathological results were consistent with the preoperative diagnosis of H-FLAC. Western blotting showed the difference in the AFP expression between the normal lung tissue and the cancerous lung tissue. Eventually, the diagnosis was AFP-producing H-FLAC. Using an immunohistochemical marker for AFP, cancer cells were shown to express AFP, specifically in their nuclei. After the operation, the patient underwent conventional chemotherapy. Her serum AFP gradually decreased over the course of 2 weeks. CONCLUSION: Presently, specific tumor markers for the diagnosis of lung cancer have not been established. To the best of our knowledge, this is the first case of abnormal AFP expression in a patient with H-FLAC. It may provide a basis for the clinical diagnosis of H-FLAC, a rare tumor, and AFP may be considered as a specific tumor marker.

A multi-center cross-sectional survey of medicine application in patients with osteoarthritis in China / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics, the medicine application and to evaluate the disease activity in patients with osteoarthritis (OA) in China.@*METHODS@#This was a cross-sectional study. Totally 1 066 cases of OA from 40 hospitals in China from April to October 2017 were retrospectively enrolled. Demographic characteristics, clinical data, medicine application, and joint function were evaluated. All the data were analyzed by SPSS software 19.0. t test, Mann-Whitney U test and chi-square test were used for statistical analysis.@*RESULTS@#In the 1 066 cases, the male-to-female ratio was 1:3.6 and the average age was (61.9±11.0) years, with an age range from 36 to 94 years. The incidence of knee OA, hip OA, and hand OA were respectively 81.9% (873/1 066), 14.1% (150/1 066), and 36.3% (387/1 066). In the study, 242 (22.7%) cases had two kinds of joint areas involved and three joint areas were involved in 51 cases (4.8%), and 56.6% (603/1 066) of the patients used more than one kind of non-steroid anti-inflammatory drugs (NSAIDs) while 61.2% (652/1 066) used disease modifying osteoarthritis drugs (DMOADs), including glucosamine (37.5%, 400/1 066), chondroitin sulfate (2.0%, 21/1 066), diacetate (5.9%, 63/1 066), and the combination of these drugs (15.8%, 168/1 066). 8.6% (92/1 066) patients only took analgesics to relieve the pain, not using any kind of NSAIDs or DMOADs. And 232 patients (21.7%) had intra-articular injections, including 9.2% (98/1 066) sodium hyaluronate, 4.5%(48/1 066) glucocorticoid, and 8.1% (86/1 066) combination of the two drugs. The proportion of the patients taking topical drugs accounted for 26.5% (283/1 066) and physical therapy accounted for 15.8% (168/1 066). Compared with those who suffered from knee OA, the patients who suffered from hip OA had more severe disease assessment. Moreover, there were significant differences in pain (Z=-7.625, P<0.001), morning stiffness (Z=-6.229, P<0.001), and joint function (Z=-6.777, P<0.001) between the two groups of the patients who suffered from knee or hip OA with The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Furthermore, patients with hip OA took more analgesics (χ2=24.838, P<0.001).@*CONCLUSION@#Oral NSAIDs and DMOADs are wildly used in patients with OA in China. However, the treatment of some patients still need to be improved. Patients with hip OA are more seriously ill and require aggressive treatment.

Single-incision laparoscopic surgery with self-made port for totally extraperitoneal hernioplasty: a report of 7 cases / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the feasibility of single-incision laparoscopic totally extraperitoneal hernioplasty (SILS-TEP) with self-made port for repairing of inguinal hernia.</p><p><b>METHODS</b>SILS-TEP was performed in 7 inguinal hernia patients (9 sides) with conventional laparoscopic instruments and self-made port, which composed of a wound retractor, surgical gloves and 3 ordinary trocars. The clinical data and follow-up results of 7 cases were retrospectively collected and analyzed.</p><p><b>RESULTS</b>The self-made port was applied for SILS-TEP uneventfully without the need of additional ports in all 7 patients (9 inguinal hernias). The median operating time was 90. 0 (70-125) min, intraoperative blood loss was 10. 0 (5. 0-20. 0) mL and postoperative hospital stay was 2.0 (2. 0-4. 0) d. The median pain scores of visual analog scale (VAS) at 6 h,12 h, 24 h and 14 d were 3(2~4), 2(1~2), 1(0~2) and 0(0~1), respectively. There were no intraoperative complications reported, and all patients were satisfied with wound healing. No hernia recurrence was observed during the 3-months of follow-up.</p><p><b>CONCLUSION</b>Our initial experiences show that SILS-TEP with self-made port is a safe and feasible surgery, which can simplify the procedure with available equipments and reduce the cost, therefore can be applied in grass-root hospitals.</p>

The clinical value of F-18 FDG PET/CT in patients with secondary hemophagocytic syndrome / 中国实验血液学杂志

The aim of this study was to investigate the role of F-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in diagnosis and prognostic evaluation of secondary hemophagocytic syndrome (HPS). A total of 11 secondary HPS patients examined with 18F-FDG-PET/CT were retrospectively analyzed. The diagnostic value of F-18 FDG PET/CT for malignancy detection was assessed. The values of maximum standardized uptake value (SUV(max)) in spleen (SUVS(p)) and in bone marrow (SUVBM) were measured to analyze their relationship with various laboratorial parameters and clinical outcome of secondary HPS patients. The results showed that 4 out of the 11 patients had malignancies, the sensitivity, specificity and diagnostic accuracy of F-18 FDG PET/CT for malignancy detection were 100%, 66.7% and 75% respectively, the SUV(max) of spleen and bone marrow showed no significant correlation with laboratorial parameters, a maximum SUVS(p) of 3.10 and a maximum SUVBM of 3.47 were the optimal cutoffs for predicting patients' outcome, the increased uptake of F-18 FDG in the BM and spleen were significantly associated with shorter survival time according to univariate analysis. It is concluded that 18F-FDG PET/CT may especially play an important role in diagnosis and predicting outcome of secondary HPS for the small sample size.

Effects of co-exposure to paraquat and maneb on system of substantial nigra and striatum in rats / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the effects of exposure of paraquat and maneb on the behavior, the morphology and electrical activity of the Substantia nigra and striatum, and to discuss the relationship between this two pesticides and Parkinson's disease.</p><p><b>METHODS</b>37 rats were divided randomly into 3 groups: control group (n = 11), paraquat (10 mg/kg) group (n = 13) and combinative group of paraquat (10 mg/kg) and maneb (30 mg/kg) (n = 13), and were exposed twice a week for 6 weeks by intraperitoneal injection. The behavior of animals in the declined-plane, the vertical-grid and the open-field test were observed. The morphology of substantia nigral neurons were investigated by HE pathology. The spontaneous discharge of striatum neurons were recorded after exposure.</p><p><b>RESULTS</b>Compared to the control group and the pre-exposure group, both the numbers of animals sliding down from the declined-plane and the latency of rats' moving on the vertical-grid significantly increased, and the animals' autonomic movement decreased significantly (P < 0.05, P < 0.001). After the combinative exposure, the neurons of the Substantial nigra pars compacta (SNPc) were progressively impaired, the cell density of the paraquat group [(82.17 ± 12.91) n/mm(2)] and the combined group [(41.15 ± 6.44) n/mm(2)] were lower than that in control group (143.10 ± 20.85 n/mm(2)] (P < 0.01). In the paraquat group (5.97 ± 7.30 Hz) and the combined group [(6.95 ± 9.87) Hz], the average discharge rates of the striatum neurons were increased significantly compared to the control group [(1.78 ± 5.05) Hz] (P < 0.01). The bursting discharge was increased significantly in the combined group (22.3%) compared to the control group (9.8%) and the paraquat group (5.6%) (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>The co-exposure of paraquat and maneb could induce similar symptoms to Parkinsonism syndrome of rats such as rigidity, moving reduction and etc, and the combined exposure had a certain enhanced effect compared to alone paraquat exposure. The combinative exposure of paraquat and maneb could cause neural loss in SNPc and it is involved with the enhanced electrophysiological activity in striatum. The synergy toxicity of paraquat and maneb in nigrostriatal system is related to Parkinson's disease.</p>

Correlative study between JAK2 mutation and thrombosis in patients with myeloproliferative neoplasm / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the frequency and clinical implication of JAK2 mutation in patients with myeloproliferative neoplasm(MPN)and the correlation between the mutation and thrombosis.</p><p><b>METHODS</b>The clinical and laboratory data of 107 MPN patients was retrospectively analyzed. JAK2 mutation were detected with allele-specific polymerase chain reaction (AS-PCR) and sequencing. The significance of the mutation in disease diagnosis and molecular pathogenesis and the correlation between the mutation and thrombosis was analysed.</p><p><b>RESULTS</b>JAK2 mutation was detected in 71 (66.4%) and thrombosis in 34 (31.8%) of the 107 MPN patients. Thrombosis occurred in 34.8% (16/46) of polycythemia vera (PV), 32.6% (14/43) of essential thrombocythemia (ET), and 22.2% (4/18) of primany myelofibrosis (PMF) patients. The difference among the 3 groups was not significant (χ(2) = 0.96, P > 0.05). The frequency of thrombosis in JAK2(+) MPN patients (82.4%, 28/34) was higher than that in JAK2(-) MPN patients (17.6%, 6/34) (χ(2) = 5.71, P < 0.05). The frequency of thrombosis in MPN patients > 60 years was higher (41.5%, 27/65) than that in patients < 60 years (16.7%, 7/42) (χ(2) = 7.28, P < 0.01).</p><p><b>CONCLUSION</b>JAK2 V617F mutation occurs in significant percentage of Chinese patients with MPN. Patients with JAK2 mutation and older age are more succeptible to thrombosis. JAK2 mutation screening in patients with unknown thrombosis is helpful to reveal the underlying latent-MPN.</p>

The anatomic features of supratrochlear artery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the anatomical features of supratrochlear artery which is related to the blood supply of paramedian frontal flap in nasal reconstruction.</p><p><b>METHODS</b>10 adult head specimens (20 sides) were used for observation of the course, layer and anastomosis of the supratrochlear artery. The horizontal line of supraorbital rim and the frontal middle line were used as X and Y axis to locate the position of supratrochlear artery.</p><p><b>RESULTS</b>Supratrochlear artery is directed medially and upward after it gets out from orbit. Some arteries (9/20) have one sharp bend at the beginning. The frontal muscle penetration point of the artery is (15.2 +/- 2.6) mm above the X axis and (12. 1 +/- 1 .4) nun lateral to the Y axis. The artery goes subcutaneously after muscle penetration point. It goes more superficially and is anastomosed to the supraorbital artery and frontal branches of the superficial temporal artery at the same side, and also the contra-lateral supratrochlear artery.</p><p><b>CONCLUSION</b>The pedicle of the paramedian frontal flap should not be too narrow. The dissection of the pedicle should not be too near to the artery, so as to protect the bend at the beginning. The flap elevation must be performed beneath the frontal muscle, when it is 2-3 cm above the supraorbital rim.</p>

Clinical significance of anticoagulant proteins detection in patients with thrombotic events / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence and the risk of natural anticoagulants such as plasma protein C (PC), protein S (PS) and antithrombin (AT) deficiency in thromboembolic patients with no evident acquired factors.</p><p><b>METHODS</b>Clotting assays on French STAGO autoanalyzer were used to detect the activity of plasma PC, PS and AT in 85 patients with thrombotic disease and 50 sex and age matched healthy controls.</p><p><b>RESULTS</b>Among the 85 enrolled patients (18 arterial and 67 venous thromboembolism), male to female ratio was 1.4 and the median age was 42 years (17-69). The activity of plasma PC, PS and AT in the pre-therapy thrombotic disease group, the thrombo-recurrence group, and the age < or = 45 years group were significantly lower than that is the healthy control group, the first thrombotic episodes group and the age > 45 years group respectively (P < 0.001, P < 0.01, P < 0.01). The overall deficiency rate of these three natural anticoagulants was 30.6%, PS deficiency was the commonest (10.6%), the second was PC deficiency (8.2%), AT deficiency and combined deficiency each accounted for 5.9%.</p><p><b>CONCLUSION</b>The PC, PS and AT protein deficiencies are frequent in Chinese thromboembolic patients, they are the independent risk factors for the thrombotic events and recurrence.</p>

Effects of radix Astragali injection on apoptosis of lymphocytes and immune function in patients with systemic lupus erythematosus / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of Radix Astragali Injection on apoptosis of lymphocytes and immune function in treating patients with systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>Eighty SLE patients were randomly assigned into the routine treatment group (RT) treated with conventional therapy and the Radix Astragali treated group (RA) treated with Radix Astragali Injection besides routine treatment. The expressions of Fas and Bcl-2 antigen on lymphocytes and the changes of T lymphocyte subsets in peripheral blood before and after treatment were observed.</p><p><b>RESULTS</b>After treatment, the expression of Fas antigen on lymphocytes significantly lowered (P < 0.01), and that of Bcl-2 antigen, CD4+ lymphocyte subset and CD4+ / CD8+ ratio significantly increased in both groups (all P < 0.01). However, the changes of Fas antigen expression, CD4+ and CD4+ / CD8+ ratio were more significant in the RA group than those in the RT group (P < 0.05).</p><p><b>CONCLUSION</b>Radix Astragli Injection can enhance the inhibitory function of corticosteroid/immunosuppressant on apoptosis, and regulate the ratio and function of T lymphocyte subsets to normal range, which may be a useful approach for enhancing the efficacy of treatment to SLE.</p>

Deletion of P16 gene exon 2 in bronchofibroscopic brush-off cells of human lung carcinoma / 浙江大学学报·医学版

OBJECTIVE: To analyze the relationship between deletion of P16 gene exon 2 and lung cancer and to evaluate the possibility of detecting P16 gene exon 2 deletion in brush-off cell instead of resected lung cancer mass. METHODS: P16 gene exon 2 deletion in bronchofibroscopic brush-off cells of lesion side and corresponding normal side was detected through PCR-electrophoresis-Image. Image value of P16 Vs beta-actin <0.6 was considered as P16 gene exon 2 deletion. RESULTS: The rate of P16 gene exon 2 deletion in normal side was 0 (0/19), whereas in lesion side was 35.5%(11/31), there is a significant statistical difference (P<0.01). In SCLC (small -cell lung carcinoma) samples, the rate of P16 gene exon 2 deletion was 0(0/7). whereas in NSCLC (non-small cell lung carcinoma) samples, that was 50%(11/12)(P<0.05). CONCLUSION: P16 gene exon 2 deletion might be related to the oncogenesis and development of lung carcinoma, especially NSCLC. Brush-off cell specimens may replace surgical specimens in Detecting P16 gene exon 2 deletion.

Clinical significance of protein Z alteration in patients with cardio-cerebral thrombotic diseases / 中华血液学杂志

<p><b>OBJECTIVE</b>To study the alteration of protein Z (PZ) in patients with cardio-cerebral thrombotic diseases, its clinical significance and relations with FX.</p><p><b>METHODS</b>PZ and FX:Ag were measured by ELISA, and plasma FX:C by first stage method. In 170 patients with acute ischemic stroke (AIS), 40 acute myocardial infarction (AMI) and 60 healthy adults as contrast, PZ, FX:C and FX:Ag were measured and compared between incipience and recurrence, different ages and genders.</p><p><b>RESULTS</b>In AIS and AMI groups, PZ levels decreased significantly to (940.02 +/- 229.82) microg/L and (1071.44 +/- 180.52) microg/L, respectively \[the contrast group was (2257.97 +/- 479.76) microg/L, P < 0.001\]. But FX:C and FX:Ag raised to (136.73 +/- 34.93)% and (135.54 +/- 54.39)% in AIS group; and to (139.53 +/- 29.18)%, (129.75 +/- 21.91)% in AMI group, respectively, while in the contrast group they were (94.33 +/- 22.00)% and (77.22 +/- 13.19)% (P < 0.001). In the comparative research between the AIS group, AMI group and the contrast group, PZ level was clearly found to negatively relate to the level of FX:C and FX:Ag (P < 0.001). Meanwhile, PZ level, FX:C and FX:Ag in recur-AIS group and recur-AMI group exhibited significant differences (P < 0.05) from those in the primary AIS and AMI groups, suggesting that the decrease of PZ levels reflected the pathological process of the disease. In addition, PZ level gradually decreased with the increase of age (P < 0.05), while FX:C and FX:Ag had no relations with age (P > 0.05). No correlation was found in sex with PZ level, FX:C, FX:Ag (P > 0.05).</p><p><b>CONCLUSION</b>PZ level was significantly decreased in AIS and AMI patients and was negatively related to FX:C and FX:Ag. The mechanism leading to FX increase may partially related with the decreased of PZ. PZ level was different in the primary and recurrent disease and was gradually decreased with the increase of age. Lack of PZ might be a etiological factor of cardio-cerebral thrombotic diseases.</p>