Double Lesions Research Articles

Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi

PurposeTo explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi. Methods136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values. ResultsIn 136 patients (mean age, 75.9 +/− 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78). ConclusionIn contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.

Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan.

Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.

Acetylcholine and noradrenaline differentially regulate hippocampus-dependent spatial learning and memory.

Severe loss of cholinergic neurons in the basal forebrain nuclei and of noradrenergic neurons in the locus coeruleus are almost invariant histopathological hallmarks of Alzheimer's disease. However, the role of these transmitter systems in the spectrum of cognitive dysfunctions typical of the disease is still unclear, nor is it yet fully known whether do these systems interact and how. Selective ablation of either neuronal population, or both of them combined, were produced in developing animals to investigate their respective and/or concurrent contribution to spatial learning and memory, known to be severely affected in Alzheimer's disease. Single or double lesions were created in 4-8 days old rats by bilateral intraventricular infusion of two selective immunotoxins. At about 16 weeks of age, the animals underwent behavioural tests specifically designed to evaluate reference and working memory abilities, and their brains were later processed for quantitative morphological analyses. Animals with lesion to either system alone showed no significant reference memory deficits which, by contrast, were evident in the double-lesioned subjects. These animals could not adopt an efficient search strategy on a given testing day and were unable to transfer all relevant information to the next day, suggesting deficits in acquisition, storage and/or recall. Only animals with single noradrenergic or double lesions exhibited impaired working memory. Interestingly, ablation of cholinergic afferents to the hippocampus stimulated a robust ingrowth of thick fibres from the superior cervical ganglion which, however, did not appear to have contributed to the observed cognitive performance. Ascending cholinergic and noradrenergic afferents to the hippocampus and neocortex appear to be primarily involved in the regulation of different cognitive domains, but they may functionally interact, mainly at hippocampal level, for sustaining normal learning and memory. Moreover, these transmitter systems are likely to compensate for each other, but apparently not via ingrowing sympathetic fibres.

Multiple tumorous lesions of the pituitary gland

Purpose/ObjectiveMultiple tumorous lesions in one pituitary gland are rare and mostly described in case reports. Their incidences and combinations are defined in larger collectives. Therefore, we analyzed our large collection for double tumors and combinations of tumors, cysts, and inflammation.MethodsThe German Registry of Pituitary Tumors, including cases from 1990 to 2018, served as the database. Our collection comprises a total of 16,283 cases up until the end of 2018. Of these cases, 12,673 originated from surgical and 3,610 from autopsy material. All specimens were fixed in formalin and embedded in paraffin. The sections were stained with hematoxylin–eosin and PAS. Monoclonal (prolactin, TSH, FSH, LH, and α subunit) or polyclonal (GH and ACTH) antibodies were used to detect pituitary hormones in the lesions. Since 2017, antibodies against the transcription factors Pit-1, T-Pit, and SF-1 have been used in difficult cases. The criteria of the 2017 WHO classification have been basic principles for classification since 2018 (Osamura et al. 2017). For differentiation of other sellar tumors, such as meningiomas, chordomas, or metastases, the use of additional antibodies was necessary. For these cases, it was possible to use a broad antibody spectrum. Autopsy pituitaries were generally studied by H&E and PAS sections. If any lesions were demonstrated in these specimens, additional immunostaining was performed.ResultsMultiple tumorous lesions with more than one pituitary neuroendocrine tumor (PitNET) respectively adenoma make up 1.4% (232 cases) in our collection. Within the selected cases, synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17.3%, PANCH cases (pituitary adenoma with neuronal choristoma) for 14.7%, PitNETs and posterior lobe tumors for 2.2%, PitNETs and metastases for 5.2%, PitNETs and mesenchymal tumors for 2.6%, PitNETs and cysts for 52.2%, and PitNETs and primary inflammation for 6.0%. The mean patient age was 53.8 years, with a standard deviation of 18.5 years. A total of 55.3% of the patients were female and 44.7% were male. From 1990 to 2018, there was a continuous increase in the number of multiple tumorous lesions.ConclusionFrom our studies, we conclude that considering possible tumorous double lesions during surgeries and in preoperative X-ray analyses is recommended.

Effects of Hypertension on the Incidence of Acute Coronary Syndrome and Severity of Coronary Artery Disease in Young Women

Abstract Background To investigate the effects of hypertension on the prevalence of acute coronary syndrome (ACS) and the severity of coronary artery disease in young women in northern China. Methods A retrospective analysis was performed on 840 young female patients (age &amp;lt;45 years old) underwent coronary angiography due to chest pain or chest discomfort between January 2007 and December 2016. The patients were divided into hypertension group (256 cases) and control group (584 cases). The risk factors and prevalence of ACS, and coronary stents implantation in the 2 groups were studied. Results The prevalence of ACS was higher in the hypertension group compared with the control group (80.9% vs. 36.5%, P &amp;lt; 0.05). The rates of hyperlipidemia (37.1% vs. 14.9%), hypercholesterolemia (8.6% vs. 3.4%), hyperuricemia (18.4% vs. 7.2%), and hyperhomocysteinemia (10.9% vs. 3.9%) were all significantly higher in the hypertensives compared with controls (all P &amp;lt; 0.05). The hypertension group had higher rates of overweight (63.7% vs. 29.5%), family history of early coronary heart disease (15.2% vs. 5.5%), smoking (5.5% vs. 4.3%), menopause (4.7% vs. 1.7%), and type 2 diabetes (24.2% vs. 8.9%) compared with the control group (all P &amp;lt; 0.05). Double branch lesions of coronary artery in hypertension and control groups were 14.1% and 5.7%, respectively (P &amp;lt; 0.05). Further, hypertensive patients with ACS had higher number (1.67 ± 1.05 vs. 1.41 ± 0.85) and longer (24.44 ± 6.97 vs. 22.85 ± 7.80 mm) stents implantation than the control group (P &amp;lt; 0.05). Conclusions Hypertension is the main risk factor of ACS in young women in northern China. Young women with hypertension have more risk factors for atherosclerotic cardiovascular disease.

Cutaneous Leishmaniasis: Knowledge, Attitude and Practice among Physicians in Healthcare Centers of Endemic Area, Biskra district, Algeria

In Algeria Cutaneous Leishmaniasis remain a public health concern, which is endemic in different provinces including Biskra; the highest focus of the dis-ease in the country. There for our aim was to assess the knowledge, attitude and practice on CL among health care physicians in Biskra province. A de-scriptive cross sectional study was carried out among 120 doctors practicing in private and state health centers areas of the eight localities of the prov-ince. Data were collected through a structured self-administered question-naire from December 2018 to March 2019. Questionnaire consisted of ques-tions related to the knowledge, attitude and practice (KAP) of the disease. The most of the staff (98.3%) knew that the Upper limb is a commonly affect-ed body parts. And at risk groups were observed in 0–10 years persons (82.5%). Most of the respondents believed the disease incidence is higher in men than women. Number of lesions varied with single and double lesions being observed in the majority of patients (50%) and (66.7%) respectively. Some believed that autumn was the main peak incidence of the disease. There was also good Knowledge regarding the clinical features. Majority (89.2%) of respondents knew Wound swab for microscopy culture and sensi-tivity as a definitive diagnostic test for CL. However, most of the respondents knew the pentavalent antimony compound (Glucantime) the conventional drugs for treating CL (95.83%). The study results demonstrated that majority of physicians had adequate knowledge about the disease. Having well trained technical personnel is important to empower the public health con-tribution.

Predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction

ObjectiveTo evaluate the predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsA total of 524 patients who were diagnosed with STEMI from January 2016 to August 2017 were retrospectively reviewed. The correlation between CHADS2 and CHA2DS2-VASc scores with the patients’ clinical data, number of coronary lesions, Gensini scores, the target vessel and hospitalization time and in-hospital adverse events (AEs) was analyzed.ResultsThe number of coronary lesions in STEMI patients was mainly single and double lesions. The CHADS2 and CHA2DS2-VASc scores were not meaningful for predicting the number of coronary lesions. However, for left main coronary artery lesion, CHADS2 score was significantly increased when the number increased (P < 0.05), but CHA2DS2-VASc score showed no statistical difference (P > 0.05). The incidence of target lesions in STMEI patients was mainly left anterior descending coronary artery (LAD) and right coronary artery (RCA). The two scores were not meaningful for predicting target lesions (P > 0.05). For the severity of coronary lesions, there was positive correlation between CHADS2 score with Gensini score (P < 0.05), but no exact correlation between CHA2DS2-VASc score and Gensini score (P > 0.05). The stratifications of CHADS2 score and CHA2DS2-VASc score were significantly associated with hospitalization time and adverse events during hospitalization (P < 0.05). The high score group had longer hospitalization time and more AEs during hospitalization than the low score group and the middle group statistically (P < 0.05).ConclusionCHADS2 score had a certain value to predict the severity of coronary lesion and the presence of left main coronary artery in STEMI. The CHA2DS2-VASc score had no predictive ability to do it. There was no significant value in predicting the number of coronary lesions and the location of the target lesions in STEMI patients. However, both scores had the predictive ability for patient hospitalization and AEs during hospitalization.

Mutational concordance analysis provides supportive information for double cancer diagnosis

BackgroundMutation analysis using next-generation sequencing highlights the features of tumors with somatic alterations. However, the mutation profile of double cancer remains unclear. Here, we analyzed tumors derived from the same patient using whole exome sequencing (WES) to investigate the coherence of somatic mutations in double cancer.MethodsFirst, the tumor mutational burden (TMB) was investigated using WES of 5521 tumor specimens from a Japanese pan-cancer cohort. The frequencies of mutation concordance were then compared in these cancers. Finally, we calculated the expected value of mutational concordance fitting a Poisson distribution to determine the relationship between double and metastatic cancers.ResultsIn all, 44, 58, and 121 paired samples were diagnosed as double cancer, multifocal lesions (derived from identical tissues), and metastasis, respectively. Our analysis revealed that common somatic mutations were almost entirely absent in double cancer, whereas primary tumors and metastatic foci harbored several identical alterations. Concordance of the mutation profile in the same patient reflects the tumor origin and development, suggesting the potential for identifying double cancer based on common somatic mutations. Furthermore, according to a Poisson distribution, double cancer could be discriminated based on paired samples from the same patient. The probability of double cancer with more than 10 mutations was ≤1 part-per-billion (ppb, 10− 9). In multifocal lesions, 74% of tumor pairs accumulated ≤10 common mutations, implying a difference in tumor origin within identical tissues.ConclusionsThese findings indicate that counting common somatic mutations can indicate the differences in origin between tumors derived from the same patient. Our mutation coherence analysis can thus provide beneficial information for diagnosing double cancer.

A correlation study ofCT and clinical features of different clinical types of 2019 novel coronavirus pneumonia/ 中华放射学杂志

Objective To investigate the CT and clinical features of 2019 novel coronavirus (NCP) pneumonia. Methods Chest CT and clinical data of confirmed 103 patients with 2019 novel coronavirus pneumonia in January 2020, retrospectively. According to diagnosis and treatment of NCP infected pneumonia (trial version 5), all the patients were classified into mild(n=58), severe (n=36) and very severe (n=9) type, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included lesions’ distribution, location, size, shape, edge, number, density, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features of different clinical subtypes were compared using χ2test or Fisher's exact probability. Comparisons between the percentage of pneumonic lesions to total lung volume were computed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results In terms of clinical manifestations, the patients with severe NCP were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 patients with NCP, and fever was the first symptom in both severe and critical NCP patients. The incidence of cough in severe (25 / 36, 69%) and critical (6 /9, 67%) NCP patients was higher than that in general (20 /58, 34%). All critical patients have dyspnea. In terms of CT findings, common NCP showed double lung (40/58,71%) multiple (40 / 58,69%) ground glass (31/58,52%) or mixed (25 / 58,43%) lesions (56 / 58,97%); severe and critical NCP showed double lung lesions, heavy NCP mainly showed multiple (34 / 36,96%) patches (33 / 36,92%) mixed density lesions (26 / 36,72%); 9 severe NCP lesions were more than 3 cm Mixed density lesions. The percentage of pneumonia focus in the whole lung volume: the common type (12.5% ± 6.1%) was significantly lower than the severe type (25.9% ± 10.7%) and the critical type (47.2% ± 19.2%) NCP, the difference was statistically significant (P values were < 0.001 and 0.002 respectively), and the severe type NCP was also significantly lower than the critical type (P = 0.032). Conclusions CT and clinical features of different clinical types of NCP pneumonia are different. Chest CT findings have unique characteristic, which can not only make early diagnosis, but also evaluate its clinical course and severity. Key words: Coronavirus infection; Pneumonia; Tomography, X-ray computed

Talar-sided osteochondral lesion of the subtalar joint following the intra-articular calcaneal fracture: study via a modified computed tomography mapping analysis.

This study is to report the prevalence of osteochondral lesions in subtalar joint following intra-articular calcaneal fracture, including the relationship between fracture severity and lesion characteristics, using modified computed tomography (CT) mapping analysis. Thirty patients with intra-articular calcaneal fracture who were preoperatively imaged with modified CT mapping analysis were recruited. The presence of talar-sided osteochondral lesions (OLTS) of subtalar joint was noted with lesion area defined by Akiyama's mapping classification. Lesion severity was assessed via Ferkel's classification, and fracture severity via Sanders' classification. Lesions were found in 28 patients (93.3%), mostly at anterior [16 (57.1%) lesions] or central [13 (46.4%) lesions] areas of posterior talar facet. Most common grade of lesion severity was grade I (mild) seen in 24 (80%) patients. Most fractures were classified as Sanders' grade III and IV with 12 (40%) and 12 (40%) patients noted, respectively. High severity of fracture denoted by Sanders' grade IV showed a trend of higher prevalence of OLTS at anterior and central sites of posterior talar facet (P = 0.181). Lesion severity was significantly higher in patients with double lesions than patients with single lesions (P = 0.005). However, OLTS were not significantly related with osteoarthritic changes in follow-up radiographs (P > 0.05). The prevalence of OLTS is very high following intra-articular calcaneal fractures. Most lesions occur at anterior or central area of posterior talar facet and are more likely to occur in patients with higher fracture severity. Lesion severity was significantly higher in patients with double lesions than patients with single lesions.

Effects of autonomic denervations on the rhythms in axial length and choroidal thickness in chicks.

In chicks, axial length and choroidal thickness undergo circadian oscillations. The choroid is innervated by both branches of the autonomic nervous system, but their contribution(s) to these rhythms is unknown. We used two combination lesions to test this. For parasympathectomy, nerve VII was sectioned presynaptic to the pterygopalatine ganglia, and the ciliary post-ganglionics were cut (double lesion; n = 8). Triple lesions excised the sympathetic superior cervical ganglion as well (n = 8). Sham surgery was done in controls (n = 7). 8-14days later, axial dimensions were measured with ultrasonography at 4-h intervals over 24h. Rhythm parameters were assessed using a "best fit" function, and growth rates measured. Both types of lesions resulted in ultradian (> 1 cycle/24h) rhythms in choroidal thickness and axial length, and increased vitreous chamber growth (Exp-fellow: double: 69µm; triple: 104µm; p < 0.05). For double lesions, the frequency was 1.5 cycles/day for both rhythms; for triples the choroidal rhythm was 1.5 cycles/day, and the axial was 3 cycles/day. For double lesions, the amplitudes of both rhythms were larger than those ofsham surgery controls (axial: 107 vs 54µm; choroid: 124 vs 29µm, p < 0.05). These findings provide evidence for the involvement of abnormal ocular rhythms in the growth stimulation underlying myopia development.

Breast cancer and synchronous multiple primary lung adenocarcinomas with heterogeneous mutations: a case report

BackgroundMultiple primary malignant tumors (MPMT) refers to the presence of two or more primary cancers of different organs in the same patient. MPMT is a sparse disease in the past, but there has been a gradual increase in the morbidity. Since multiple primary malignant tumors treatment methods differ, it is essential for clinicians to be able to distinguish between separate primary lesions and metastasis.Case presentationWe present the case of a 57-year-old woman with MPMT presenting with cancer in the left breast and synchronous double primary lung adenocarcinomas. We used IHC and epidermal growth factor receptor(EGFR)mutation to analyze genomic alteration profiles in the patient to validate the difference among the pathological assessments and the clinical differences between double primary lesions of lung and breast. EGFR gene analysis of breast cancer lesion revealed no mutations. The left and right lower lobe lung adenocarcinomas contained EGFR gene mutations: an L858R point mutation in exon 21 in the left lesion and a deletion mutation in exon 19 in the right lesion. The breast cancer and both lung adenocarcinomas were surgically resected. To date, the patient has remained disease-free.ConclusionsBoth pathological and molecular assessment adapted in the current study appeared necessary. Mutational analysis of the EGFR gene provided important information not only in the diagnosis and but also in the treatment of MPMT.

Cutaneous Leishmaniasis in Pediatric Patients in a Single Tertiary Hospital in Ankara.

Leishmaniasis is an infectious disease that is caused by a protozoan parasite of the Leishmania genus and that occurs worldwide. Leishmaniasis is endemic in southeastern Turkey and the neighboring Middle Eastern countries. The purpose of this study was to describe the clinical characteristics of patients admitted to our hospital with a diagnosis of cutaneous leishmaniasis (CL). A total of 16 CL patients [11 (69%) boys and five (31%) girls] were admitted between January 2014 and December 2015. The data of the patients were retrospectively recorded from their medical records. Their mean age was 74.3±32.3 months (range: 1-10.5 years). Double lesions were most commonly seen in eight (50%) patients. The face and neck was the most commonly involved site (87.5% of the patients). Skin smears for a parasitological examination were positive in nine (56%) patients. Two patients (12.5%) with limb lesions were treated with intralesional meglumine antimoniate. Fourteen patients were treated with systemic agents. We felt that the increase in human movement that include travels and forced migration due to the war might make it possible for CL to appear in non-endemic provinces such as Ankara. In particular, in patients with painless cutaneous lesion(s) who came from endemic areas such as Syria, CL should be kept in mind by the clinicians that residing in even non-endemic areas .

Stereological assessment of the total number of hypoglossal neurons after repeated crush injuries to the hypoglossal nerve in adult rats

Objective: Retrograde neuronal cell death does not occur in mature motoneurons following the axonal injury of peripheral nerves. However, a previous study suggested that retrograde neuronal cell death does occur in adult rats after the creation of double lesions on the hypoglossal (XII) nerve based on a substantial decrease in the number of XII neurons. Using stereological methods, we examined neuronal apoptosis in XII neurons and the total number of XII neurons following repeated crush injuries to the XII nerve.Methods: The right XII nerve of adult rats was crushed three times at one-week intervals with a brain aneurysm clip. At 4 weeks after the final crush, the total numbers of XII neurons on the injured right and uninjured left sides were estimated stereologically.Results: After repeated crush injuries, no apoptosis was evident in XII neurons as indicated by immunostaining for cleaved caspase-3. Moreover, immunohistochemistry for the vesicular acetylcholine transporter revealed axonal elongation in the tongue 4 weeks after repeated crush injuries. At 4 weeks, the total numbers of XII neurons were 7800 ± 290 on the injured right side and 8000 ± 230 on the uninjured left side, and no significant difference was evident between the injured and uninjured sides.Conclusion: Neuronal cell death does not occur in XII neurons and the total number of XII neurons does not decrease after repeated crush injuries of the XII nerve in adult rats.

P3.04-038 Pulmonary Resection for Metastatic Pancreaticobiliary Cancer: Can It Be Justified as a Treatment of Choice?: Topic: Miscellaneous II

Patients with distant metastases of pancreaticobiliary cancers still have poor prognoses of 3-7% of 5-year survival, and the best reported median overall survival time (MST) of pancreatic carcinoma patients with metastatic stage IV disease treated with optimal chemotherapy was only 11 months. Surgical resection for metastatic lesions from pancreaticobiliary cancer is scarcely performed because of their malignant potential, therefore, few studies have reported on pulmonary metastasectomy for those patients. The purpose of this study is to review our experience of pulmonary resection for metastatic pancreaticobiliary cancer, and to assess whether this treatment offers them better survival. Between 2007 and 2015, 21 patients of pancreaticobiliary cancer had potentially resectable pulmonary metastases after definitive resection of primary site (pancreatic cancer, n=9; cholangiocarcinoma, n= 10; gallbladder cancer, n= 2). There were 14 males and 7 females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion. The median DFI was 51 months (4-145 months), and 11 patients had solitary pulmonary lesion, 5 had double lesions, and 6 had three or more. Operative procedures of metastasectomy consisted of 15 wedge resections, 2 segmentectomies, and 4 lobectomies. Although no surgical complications and operative mortalities occurred, 9 patients died of primary diseases after pulmonary resection. The estimated MST after pulmonary resection was 35 months, and 3 and 5-years survival was 32% and 16%, respectively. Overall 3-year survival of patients with longer DFI (DFI> 36months) was marginally significantly better than that of those with shorter DFI (DFI≤36months) (49% vs. 19%, p=0.17). The longest survivor was still alive more than 5 years without recurrence after lung resection. Pulmonary resection for metastatic pancreaticobiliary cancer could be performed safely and might offer better survival. Although the optimal operative indication is still unclear, our results suggest that pulmonary resection could be a treatment of choice in selected patients with those diseases. Longer DFI before pulmonary metastasis might be helpful to select proper patients for the metastasectomy.

Convergent Mutations and Kinase Fusions Lead to Oncogenic STAT3 Activation in Anaplastic Large Cell Lymphoma

A systematic characterization of the genetic alterations driving ALCLs has not been performed. By integrating massive sequencing strategies, we provide a comprehensive characterization of driver genetic alterations (somatic point mutations, copy number alterations, and gene fusions) in ALK(-) ALCLs. We identified activating mutations of JAK1 and/or STAT3 genes in ∼20% of 88 [corrected] ALK(-) ALCLs and demonstrated that 38% of systemic ALK(-) ALCLs displayed double lesions. Recurrent chimeras combining a transcription factor (NFkB2 or NCOR2) with a tyrosine kinase (ROS1 or TYK2) were also discovered in WT JAK1/STAT3 ALK(-) ALCL. All these aberrations lead to the constitutive activation of the JAK/STAT3 pathway, which was proved oncogenic. Consistently, JAK/STAT3 pathway inhibition impaired cell growth in vitro and in vivo.

Role of charcoal tattooing in localization of recurred papillary thyroid carcinoma: initial experiences.

PurposeSurgical excision is the definitive treatment for localized recurrence of papillary thyroid carcinoma. Reoperation for recurrence, however, is challenging and associated with increased operative times and complication rates. For safe and effective reoperation, ultrasound-guided charcoal tattooing localization can be used. The aim of this study was to investigate the feasibility and safety of the ultrasound-guided charcoal tattooing localization.MethodsBetween November 2012 and August 2013, ten patients underwent preoperative charcoal tattooing localization for twelve recurrent lesions. Patient demographics, pathologic features, and operation results were reviewed.ResultsThe technical success rate of charcoal tattooing was 100%. Eight patients had one recurrent lesion, and two patients had double lesions. Among these 12 recurrent lesions, three (25%) were found in level II, four (33%) in level IV, four (33%) in level VI, and one (8%) was found in the thyroidectomy bed site. The mean size of lesions was 0.87 ± 0.35 cm. Of these 10 patients, eight patients underwent selective lymph node dissection, one patient underwent modified radical neck dissection, and one patient underwent recurrent mass excision. Transient hypocalcemia developed in one patient, and no recurrent laryngeal nerve palsy occurred. There were no major complications related to the injection of the charcoal. The mean follow-up period after reoperation was 8.6 ± 2.7 months; in the follow-up ultrasound, there were no remnant lesions in all patients.ConclusionPreoperative ultrasound-guided charcoal tattooing localization for recurrent thyroid cancer appears to be a feasible and safe procedure for reoperation. Further evaluation is warranted in larger patients' cohorts.

Neurologic Outcomes of Preoperative Acute Silent Cerebral Infarction in Patients with Cardiac Surgery

BackgroundAcute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI.MethodsWe retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was 68.8±9.5 years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies.ResultsThere were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions.ConclusionPatients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

ASSA14-12-01 Long-term outcome of bare-metal stent implantation in patients with coronary artery stenosis

Objectives To evaluate the long-term effects of bare-metal stent (BMS) implantation in patients with coronary artery stenosis or occlusion lesions and with symptoms of angina pectoris. Methods 224 patients with serious stenosis (75% to 100%) of a native coronary artery presenting with symptoms of angina pectoris were enrolled from1 Mach, 2001 to 1 Mach, 2010. Among them there were 123 cases with hypertension (54.9%), 52 cases with diabetes mellitus (23.2%), 3 cases (1.3%) with old myocardial infarction and 32 cases (14.3%) with hyperlipidemia. 74 patients (33.0%) were smoker. The coronary angiography showed that the type 1 lesion characteristics were 95 cases (42.4%), type 2a lesion characteristics were 50 cases (22.3%), type 2b lesion characteristics were 46 cases (20.5%) and type 3 lesion characteristics were 33 cases (14.7%). Single coronary vessel lesion was 143 cases (63.8%), double coronary vessel lesions were 64 cases (28.6%) and three coronary vessel lesions were 17 (7.6%). BMS was implanted in the ischemia related coronary lesion. The diameter of the implanted stents was (3.16 ± 0.42) mm with length of (18.38 ± 6.15) mm. After the procedure of PCI recommended antiplatelet regimen included clopidogrel and aspirin for 2 months and followed by chronic aspirin therapy. All patients were followed for 24 to 157 months with an average of (93.50 ± 39.20) months. The main endpoint of follow-up was the occurrence of the first major adverse cardiac event (MACE), defined as death due to all cause, nonfatal recurrent myocardial infarction, and target lesion revascularisation (TLR) and target vessel revascularisation (TVR), heart failure with III class and over, very late thrombosis in stent and stroke. Results Complete clinical status was available in 224 patients to the end of follow-up. The combined cumulative MACE rate was 37.5% (84 cases) with an average of 4.81% per year. The number of death due to all cause was 32 cases (14.29%) with an average of 1.83% per year. The rate of TLR was 14.29% (32 cases) with an average of 1.83% per year. The rate of TVR was 6.25% (14 cases) with an average of 0.80% per year. The rate of heart failure with III class was 1.33% (3 cases). CABG was need in 2 cases (0.89%). The very late thrombosis in stent (1 case, 0.45%) presenting STEMI was very low. 2 case (0.89%) died to cerebral haemorrhage occurring within 24 month after the PCI. Conclusions It was the low incidence rate of MACE in the long-term follow-up for more than 2 years that BMS was used to treat unselective coronary artery stenosis lesions.

Fragmented QRS scale and brain natriuretic peptide predict infarction in patients with acute myocardial infarction and heart attacks

Objective To investigate the acute myocardial infarction (AMI) patient's electrocardiogram appearing fragment QRS wave (fQRS) and brain natriuretic peptide (BNP) level and scope of coronary lesions,severe cardiac complications,and the cor relation of cardiac death.Methods For selected patients with AMI,whether based on electrocardiogram (ECG) appeared in fQRS group and non fQRS groups; immunofluorescence technique was used to detect the plasma BNP level in patients with AMI.Two groups of patients with serious cardiac events and coronary artery lesions scope were observed; Coronary artery lesion count and BNP level were recorded.Results The incidence of fragment QRS wave in patients with AMI was 34.0％,fQRS wave group height/three degree atri oventricular block,ventricular tachycardia/ventricular fibrillation,cardiac shock,cardiac death rate was higher than non fQRS wave group (P ＜0.05).fQRS wave group of plasma BNP and left ventricular end-diastolic diameter,the double branch lesion,multivessel lesions were significantly higher than that of non fQRS group (P ＜ 0.01) ; left ventricular ejection fraction,the single lesion was sig nificantly lower than non fQRS wave group (P ＜0.01).The BNP levels in single,double,and multivessel lesions in the group with the increase of the lesion count were increased.Conclusions The AMI patients with fQRS easily complicated with severe arrhythmia,and case fatality rate was high,the prognosis was poor.fQRS on electrocardiogram (ECG) and BNP level had a certain relationship with range and degree of coronary artery lesions,degree of indexes might be used as a prediction of coronary lesions,and multivessel lesions had certain prediction value. Key words: Electrocardiography; Natriuretic peptide, brain ; Myocardial infarction/complications; Acute disease; Heart diseases/etiology; Arrhythmias, cardiac/etiology; Shock, cardiogenic