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Background Roux-en-Y (R-Y) anastomoses have been widely used in distal gastrectomy, while the incidence of Roux stasis syndrome remains common. Uncut R-Y anastomosis maintains the neuromuscular continuity, thus avoiding the ectopic pacemaker of the Roux limb and reducing the occurrence of Roux stasis. However, retrospective studies of Uncut R-Y anastomosis remain scarce and randomized controlled trials have not been reported. Methods We conducted a randomized controlled trial to compare the surgical safety, nutritional status, and postoperative quality of life (QOL) between uncut and classic Roux-en-Y (R-Y) reconstruction patients. Patients with Stage I gastric cancer were randomly enrolled and underwent laparoscopic distal gastrectomy followed by uncut or classic R-Y reconstruction. Body mass index and blood test were used to evaluate the nutritional status. QOL was evaluated using European Organization for Research and Treatment of Cancer QOL Questionnaire (STO22) and laboratory examinations at postoperative month (POM) 3, 6, 9, and 12. Computed tomography scanning was used to evaluate the skeletal muscle index (SMI) at POM 6 and 12. Endoscopy was performed at POM 12. Results Operation time, blood loss, time to recovery, complication morbidities, and overall survival were similar between the two groups. Compared with the classic R-Y group, the uncut R-Y group displayed a significantly decreased QOL at POM 9, possibly due to loop recanalization, determined to be occupied 34.2% of the uncut R-Y group. Post-exclusion of recanalization, the QOL was still higher in the classic R-Y group than in the uncut R-Y group, despite their hemoglobin and total protein levels being better than those in the classic R-Y group. Preoperative pre-albumin level and impaired fasting glycemia significantly correlated with the postoperative recanalization. Conclusion We found no significant benefit of uncut over classic R-Y reconstruction which challenges the superiority of the uncut R-Y reconstruction. Trial registration ClinicalTrials.gov Identifier: NCT02644148.

BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable. CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation. CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital’s epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.

In this paper, uniaxial compression tests were carried out on a series of composite rock specimens with different dip angles, which were made from two types of rock-like material with different strength. The acoustic emission technique was used to monitor the acoustic signal characteristics of composite rock specimens during the entire loading process. At the same time, an optical non-contact 3D digital image correlation technique was used to study the evolution of axial strain field and the maximal strain field before and after the peak strength at different stress levels during the loading process. The effect of bedding plane inclination on the deformation and strength during uniaxial loading was analyzed. The methods of solving the elastic constants of hard and weak rock were described. The damage evolution process, deformation and failure mechanism, and failure mode during uniaxial loading were fully determined. The experimental results show that the $$\theta = 0{^{\circ }}$$ – $$45{^{\circ }}$$ specimens had obvious plastic deformation during loading, and the brittleness of the $$\theta = 60{^{\circ }}$$ – $$90{^{\circ }}$$ specimens gradually increased during the loading process. When the anisotropic angle $$\theta $$ increased from $$0{^{\circ }}$$ to $$90{^{\circ }}$$ , the peak strength, peak strain, and apparent elastic modulus all decreased initially and then increased. The failure mode of the composite rock specimen during uniaxial loading can be divided into three categories: tensile fracture across the discontinuities ( $$\theta = 0{^{\circ }}$$ – $$30{^{\circ }})$$ , sliding failure along the discontinuities ( $$\theta = 45{^{\circ }}$$ – $$75{^{\circ }})$$ , and tensile-split along the discontinuities ( $$\theta = 90{^{\circ }})$$ . The axial strain of the weak and hard rock layers in the composite rock specimen during the loading process was significantly different from that of the $$\theta = 0{^{\circ }}$$ – $$45{^{\circ }}$$ specimens and was almost the same as that of the $$\theta = 60{^{\circ }}$$ – $$90{^{\circ }}$$ specimens. As for the strain localization highlighted in the maximum principal strain field, the $$\theta = 0{^{\circ }}$$ – $$30{^{\circ }}$$ specimens appeared in the rock matrix approximately parallel to the loading direction, while in the $$\theta = 45{^{\circ }}$$ – $$90{^{\circ }}$$ specimens it appeared at the hard and weak rock layer interface.

For better research on rock breaking mechanism of shield disc cutter, a kind of vertical experimental platform was designed after the characteristic analysis of existing linear cutting rig, using rock box turning to realize the rotary simulated motion of shield disc cutter. Compared with the linear device, this experiment platform overcomes the lack of real simulation of shield disc cutter movement condition. The design of comprehensive experimental platform was described particularly from the three aspects of electronic control system, hydraulic system and an adjusting device for cutter space. On the produced platform, which is the first one in China, the experiments of rolling experiment under three cutters sequential indentation were performed. The experimental data and analysis result were basically consistent with engineering data and simulation result based on RFPA. The correctness of design scheme, advancement and scientificalness of experiment platform were confirmed, with the hoping of providing dependable platform for the research on rock breaking mechanism of shield disc cutter.

Bi2Te3 bulk materials were prepared by combining chemical bath method and hot pressing at 80 MPa and 375 °C for 1 h. The samples before and after hot pressing were examined by X-ray diffraction, and the fracture surface of the bulk materials was observed by field emission scanning electron microscopy (FESEM). The electrical transport properties of the bulk materials were measured from room temperature up to 250 °C under Ar. The results indicate that sulfur addition can prevent the oxidation of Bi2Te3 nanostructures; however, it is not good to the thermoelectric properties of Bi2Te3 under the present synthesis conditions.

In order to improve the dynamic coordinated control performance of shield thrust hydraulic cylinder during the shield construction process, we used the shield electro-hydraulic control synthetic experimental platform as research object. The simulation models of thrust system and external loading were built in AMESim. The result of PID closed-loop simulation indicated that thrust system can enable the compound control of thrust pressure and velocity by using the compound control technique of pressure and flow. In view of the complex and varied external load condition of shield thrust system, we simulated the fuzzy and fuzzy-PID control strategy of thrust system in passive automatic adjustment mode, based on the Joint Modeling and Simulation Environment (JMASE) of AMESim and Matlab/Simulink. The multi-external loads of thrust system mainly contained unequal-fixed load, equal-variable load and unequal-variable load. Finally, a coordinated control theory of shield thrust system was put forward. Such theory could provide some theoretical guidance for the design of shield machine and control of shield construction.

Several modals on Tunnel Boring Machine (TBM) in tunneling are introduced, the revolving rock tunneling simulator set-up is designed, the finite element model of cutter parts of the experimental bench is built, and free mode analysis of it is performed, and the model on system of cutter head, cutter and rock is established. It is shown that natural frequency on the cutter parts is higher, the frequency of first step is 4536Hz, and the most modes are deformations of the cutter loop, vibration acceleration of the cutter decreases with fracture tunnel width increasing, in some degree broken rock mechanics is achieved, foundation is provided for improving using life and adaptability of the cutter, and optimizing arrangement of plate cutter on the cutter head, and finally realizing high efficiency and low energy consumption.

Most adrenocortical tumors (ACTs) can be diagnosed directly by a combination of morphologic features and clinical findings. However, sometimes it may be difficult to distinguish ACTs from other neoplasms such as pheochromocytomas and some metastatic tumors, particularly for small biopsy specimens because they may be morphologically similar. Expression of calretinin has recently been suggested as a valuable immunomarker for the differential diagnosis between ACTs and other tumors; however, its diagnostic value is still under debate. To determine the diagnostic value of calretinin in Chinese patients with adrenocortical and non-ACTs, we employed both polyclonal and monoclonal anticalretinin to characterize the expression of calretinin in adrenal tissues and compared its expression with that of inhibin alpha, Melan-A, cytokeratin, or CD99 by immunohistochemistry in tissue microarrays and standard tissue sections of 414 specimens. Our results revealed that calretinin was expressed by adrenocortical cells, but not by the other cells tested and the percentage of calretinin-positive ACTs reached 99% when stained with polyclonal antibodies, which was higher than that with monoclonal anticalretinin (91.3%), anti-Melan-A (90.3%), antiinhibin alpha (81.6%). In addition, our results also revealed that ACTs were stained by cytokeratin (AE1/AE3) with variable degrees (58.7%). Furthermore, unlike anti-Melan-A that stained all metastatic malignant melanoma, anticalretinin did not recognize other tested tumors. Therefore, immunohistologic staining with polyclonal anticalretinin is more sensitive than other antibodies tested for the diagnosis of ACTs. However, monoclonal anticalretinin appeared to be more specific. Importantly, our data suggested that the fried-egg-like staining pattern, but not the mere cytoplasmic staining, was characteristic of anticalretinin staining in adrenocortical tissues. Notably, a few anticalretinin negative-ACTs were stained by other immunomarkers that we tested. Thus, the combinational characterization of calretinin (either by polyclonal or monoclonal antibody), inhibin alpha, and Melan-A expression is of great significance in the differential diagnosis of ACTs.

The present study investigated the effects of acutely administered dihydroetorphine on mitogen-stimulated lymphocyte proliferation and lymphokine production in mice. These immune functions were significantly suppressed by dihydroetorphine at 24 microg/kg and 128 microg/kg in a dose-dependent fashion. This study further examined the involvement of micro-opioid receptors and alpha-adrenoceptors in the immunomodulatory effects of dihydroetorphine. The micro-opioid receptor antagonist, naloxone (4 mg/kg), and alpha-adrenoceptor antagonist, phentolamine (10 mg/kg), but not the beta-adrenoceptor antagonist, propranolol (10 mg/kg), effectively blocked dihydroetorphine-induced suppression of splenic lymphocyte proliferation and lymphokine production. These results demonstrate that dihydroetorphine has significant immunosuppressive effects in mice and the mechanisms of these effects may lie in its interactions with opioid receptors and adrenergic pathways.

To study the clinicopathologic and immunohistochemical features of mesenchymal chondrosarcoma.The clinical and histologic features of 23 cases of mesenchymal chondrosarcoma were analyzed. Immunohistochemical study was also performed in 14 of the cases.The age of patients ranged from 12 to 47 years. Fourteen of them occurred in males. Thirteen cases involved the bony skeleton and 5 cases affected the soft tissue. The patients presented with pain and/or swelling. Histologically, the tumor consisted of a mixture of undifferentiated small round cells and hyaline cartilage. Transition between the two components was demonstrated and growth plate-like cartilage was observed. Immunohistochemical study showed that the small round cells were positive for Sox9 (14/14), CD99 (12/14), vimentin (6/14), CD56 (4/14), CD57 (4/14), neuron-specific enolase (3/14) and desmin(1/14). They were negative for Coll-II, S-100 protein, epithelial membrane antigen, pan-cytokeratin, synaptophysin, chromogranin A, CD34 and c-erbB2.Mesenchymal chondrosarcoma is a rare malignant tumor. Thorough histologic examination, when coupled with immunohistochemical findings, is helpful in arriving at a correct diagnosis.

To study the clinicopathologic features, immunohistochemical findings and prognosis of precursor lymphoblastic lymphoma/acute lymphoblastic leukemia (LBL/ALL).One hundred and fifty-three cases of LBL/ALL were retrospectively analyzed. Immunohistochemical study was carried out. The pathologic findings were correlated with Ann Arbor tumor stage, Ki-67 index, other clinical parameters (including mediastinum/bone marrow involvement, hepato-splenomegaly, age and gender of the patients) and the survival data.Staining for TdT and CD99 was positive in 79.1% (121/153 cases) and 96.3% (131/136 cases), respectively. The cases were categorized into three groups according to the immunohistochemical findings, as follows: precursor T-cell, precursor B-cell and undefined. T-LBL/ALL accounted for 69.3% (106/153 cases) of all of the cases. The male-to-female ratio was 2.4:1 (including 75 males and 31 females). The median age at diagnosis was 17.5 years (ranged from 2 years to 68 years). Ninety-two patients (86.8%) presented with peripheral lymphadenopathy and 59 of them (55.7%) had mediastinal masses. Ninety-one cases (85.8%) were in stage III or IV at diagnosis. The 1-year and 5-year survival rates in patients with T-LBL/ALL were 36.1% and 8.1%, respectively. Patients older than 25 years and those presented in stage III or IV suggested a poor prognosis (P = 0.049 and 0.001, respectively). On the other hand, 29 of the 153 cases (19.0%) belonged to B-LBL/ALL. The median age of the patients was 14 years (ranged from 9 months to 75 years). The male-to-female ratio was 1.6:1 (including 18 males and 11 females). Seventeen patients (58.6%) presented with peripheral lymphadenopathy and 13 of them (44.8%) had involvement of bone marrow or peripheral blood. Mediastinal involvement was found only in 5 cases (17.2%). Twenty-one patients (72.4%) were in stage III or IV at diagnosis. The 1-year and 5-year survival rates were 53.3% and 36.7%, respectively. The remaining 11.7% cases (18/153 cases) were categorized as undefined type, with a negative staining for the following immuno-markers including: CD3ε/CD3, CD45RO, CD79a, CD20, MPO, CD5, CD56, cyclin D1, cytokeratin, neuron-specific enolase, chromogranin A and synaptophysin. The median age of the patients was 15.5 years (ranged from 4 to 53 years). The male-to-female ratio was 2.6:1 (including 13 males and 5 females). The percentage of T-LBL/ALL patients with mediastinal masses were significantly higher than that of B-LBL/ALL cases (P = 0.0003). There was no significant difference in prognostic parameters of T-LBL/ALL and B-LBL/ALL (P = 0.07). The difference in median survival time however was statistically significant (6.0 months +/- 1.1 months versus 15.0 months +/- 7.0 months).Both TdT and CD99 are useful markers for the diagnosis of precursor lymphoblastic malignancy. T-LBL/ALL predominantly affects children or adolescent males and frequently presents with lymphadenopathy and mediastinal masses, whereas B-LBL/ALL are often accompanied by bone marrow and peripheral blood involvement. In general, T-LBL/ALL carries a poor prognosis. The prognostic criteria include age of older than 25 years and a classification of stage III or IV disease.

To investigate the clinicopathologic features of lymphoplasmacytic lymphoma (LPL) with Waldenström's macroglobulinemia (WM) and to evaluate the usefulness of immunophenotype analysis in diagnosis and differential diagnosis of the tumor.A total of 40 cases of LPL with WM diagnosed according to the 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues were analyzed using immunophenotype and follow-up information.The mostly common initial clinical presentations were non-specific symptoms, such as fatigue, anemia and hemorrhage. Lymphadenopathy, splenomegaly and hepatomegaly were found in 42.5%, 20.0% and 12.5% of the patients respectively. The pattern of bone marrow involvement included mixed type (47.2%), diffuse type (41.7%) and interstitial type (11.1%). The nodal architecture was completely destroyed in one case and partially effaced with residual germinal centers and dilated sinuses in 8 cases. All of the neoplastic cells expressed CD20 and CD79a. Neoplastic plasma cells were positive for CD138 and CD79a. No cases expressed CD5. Four cases weakly expressed CD23. No significant prognosis related factors were identified in the survival analysis.LPL with WM is a rare indolent small B-cell lymphoma, which is commonly seen, in older male patients. The tumor frequently involves bone marrow and shows various clinical manifestations. Combination analyses of the bone marrow biopsy histology, immunophenotypic study and clinical data, especially the serum examination are important for the diagnosis of LPL with WM.

To study the clinicopathologic features, immunophenotype and prognosis of primary cutaneous anaplastic large cell lymphoma (C-ALCL).Eight cases of C-ALCL were enrolled into the study. The clinicopathologic features, immunohistochemical findings and results of in-situ hybridization for EBER 1/2 were analyzed.Three of the 8 patients were males and 5 were females. The median age was 49.5 years. C-ALCL often presented with solitary skin nodule, without systemic symptoms. Histologically, the lymphoma cells infiltrated the dermis and subcutis in a sheet-like pattern. They were of large size and showed conspicuous nuclear atypia. Immunohistochemical study showed that more than 75% of the lymphoma cells were positive for CD30. All cases expressed one to three T cell markers (CD3, CD5 or CD45RO) and cytotoxic granule-associated antigens (TIA-1, granzyme B or perforin). The staining for leukocyte common antigen was positive in all cases, while the expression of CD5, CD8, ALK-1 and epithelial membrane antigen was noted in 5, 1, 1 and 3 cases, respectively. The staining for CD15, CD20, CK and HMB45 was negative. In-situ hybridization for EBER 1/2 was also negative in all the cases studied. Follow-up information was available in 6 patients. Five of them were still alive and 1 died of unclear cause.C-ALCL has distinctive clinicopathologic and immunophenotypic features. It is not Epstein-Barr virus-related and often carries a favorable prognosis.

To investigate the intralaboratory reproducibility of immunohistochemistry (IHC) testing for HER2 status in breast cancer, and to evaluate the factors which influence the reproducibility. The concordance between monoclonal antibody CB11 and HercepTest was also assessed.HER2 overexpression on paraffin sections from thirty-seven cases of breast invasive ductal carcinoma was evaluated using CB11 and the evaluation procedure had been repeated for five times scored the tests together according to the HercepTest and new American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) grading schemes by 2 experienced pathologists together. Reproducibility rates of the five rounds were assessed using Kappa statistic, and the results from two scoring systems were compared. HercepTest kit was applied to the same cases afterward and the results were compared with CB11.Substantial intralaboratory reproducibility was achieved among 5 rounds tests. Excluding the influence effect of changing antibody lots, the intralaboratory reproducibility was closed to the perfect threshold (Kappa = 0.7858, HercepTest scheme). The results derived from the two grading schemes had an almost perfect agreement (Kappa = 0.8549). The concordance (positive vs. negative) between CB11 and HercepTest was 83.78%.Laboratory work with strict supervision and more experience will ensure a reliable testing consistency. Reproducibility analysis could be adopted to evaluate the intralaboratory staining quality on HER2 testing. Different antibody lots bring some influence to the intralaboratory reproducibility, but not significant. CB11 could be accepted to screen HER2 status in routine practice after testing validation.

Soft tissue clear cell sarcoma usually occurred in the end of the limbs, especially foot and ankle. Soft tissue clear cell sarcoma occurring in the torso and head and neck were even fewer. In this article, parapharyngeal soft tissue clear cell sarcoma was reported.

To study the expression of anaplastic lymphoma kinase (ALK) and the phosphorylation status of AKT, mammalian target of rapamycin (mTOR), 4E-binding protein 1 (4E-BP1) and ribosomal protein S6 kinase (p70S6K) and their interrelationships and clinical pathological significance in anaplastic large cell lymphoma (ALCL) patients.Immunohistochemical and EnVision methods were used to detect the expression of ALK, p-AKT, p-mTOR, p-4E-BP1 and p-p70S6K.Among the 81 ALCL patients, 51 (63.0%) expressed ALK, whereas the other 30 (37.0%) did not. Patients with ALK(+) ALCL had a better prognosis than those with ALK-ALCL (P0.05). Out of the 71 ALCL samples studied, p-AKT was detected in 54 (76.1%) samples and its phosphorylation was correlated with ALK expression (P0.05); p-mTOR was detected in 57 (80.3%) samples and its expression was correlated with both ALK and p-AKT (P0.05); p-4E-BP1 and p-p70S6K were detected in 64 (90.1%) and 66 (93.0%) samples respectively, and their expressions were related with p-mTOR (P0.05), but not with ALK or p-AKT (P0.05). COX Proportional Hazard Model analysis showed that both the expression of ALK and the B symptoms affected the prognosis (P0.05), moreover, the former had greater impact than the later.Expressions of p-AKT, p-mTOR, p-4E-BP1 and p-p70S6K are detected in ALCL, while ALK(+) cases have higher incidence than those with ALK(-) cases. Phosphorylation of AKT and mTOR is correlated with ALK expression, suggesting that there is an activated pathway of AKT/mTOR in patients with ALK(+) ALCL, but the activation have no obvious prognostic significance.

To study the clinicopathologic features and prognostic factors of Chinese patients with mantle cell lymphoma.One hundred and two cases of mantle cell lymphoma occurring in Chinese patients were studied by light microscopy and immunohistochemistry. The follow-up information was also analyzed. The cases were classified as mantle zone, nodular or diffuse patterns and as typical or blastoid variants. Age, Ann-Arbor staging, B symptoms, hematologic parameters, histologic variants, mitotic index and immunophenotype were assessed for possible prognostic implication.The median age of the patients was 59 years (range: 30 to 79 years) and the male-to-female ratio was 2.92:1. Seventy-one patients (87.65%) presented with advanced stage disease (Ann Arbor stage III to IV). B symptoms were present in 45.45% of patients. The commonest site of involvement was lymph node (100%). The other involved sites included bone marrow (64.44%), spleen (63.16%), Waldeyer's ring (31.25%), peripheral blood (29.41%), liver (22.64%) and gastrointestinal tract (14.71%). All cases expressed B-cell markers but were negative for T-cell marker. Majority of cases were positive for cyclin D1 (94.12%) and CD5 (71.43%). Blastoid variant accounted for 24.51% of cases. Amongst the 68 cases with follow-up data available, the median survival was 10 months. Parameters associated with shorter survival included diffuse pattern, blastoid variant, high mitotic index, high proliferative activity and presence of bone marrow involvement.The clinicopathologic features and prognostic factors of mantle cell lymphoma occurring in Chinese are similar to those in Caucasians. Diffuse pattern, blastoid variant, high mitotic index, high proliferative activity and involvement of bone marrow indicate poor prognosis.

To investigate the regional spread of microscopic tumor nodules in the mesorectum of patients with low rectal cancer, and to provide further pathological evidence for optimal procedure selection of radical resection for rectal cancer.Sixty-two patients with low rectal cancer underwent low anterior resection and total mesorectal excision (TME). Surgical specimens were sliced transversely on serial embedded blocks at 2.5-mm intervals, and stained with hematoxylin and eosin (HE). On whole-mount sections the mesorectum was divided into 3 regions: the outer region of the mesorectum (ORM), the middle region of the mesorectum (MRM), and the inner region of the mesorectum (IRM). Microscopic metastatic foci were investigated for metastatic mesorectal region, frequency, types, involvement of the lymphatic system, and correlation with the primary tumor. Tumor-suspect nodules previously considered disease free by HE stain on whole-mount section were examined by in situ hybridization (ISH) on tissue microarray (TMA) through detecting mRNAs of CEA and CK20 with non radioactive biotin-tagged oligonucleotide probes.Microscopic spread of the tumor was observed in 50.0 percent of patients (31 out of 62, 24 by HE stain on whole-mount section and 7 by ISH on TMA) and that in the ORM was observed in 38.7 percent of the patients (24 out of 62, 16 observed by HE stain on whole-mount section and 8 by ISH on TMA). Microscopic tumor foci spread in the circumferential resection margin (CRM) occurred in 8.1 percent of the patients (5 out of 62, 4 observed by HE stain on whole-mount section and one by ISH on TMA), and distal mesorectum (DMR) involvement was detected in 6.5 percent (4 out of 62, all observed by HE stain on whole-mount section), with the spread extending to within 3 cm from the lower margin of the tumor. Most (26 of 31) of the patients with microscopic spread in mesorectum had TNM Stage III diseases.The results of the present study support the theory that complete excision of the mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer, and an optimal DMR clearance resection margin of no less than 4 cm was referenced. Five patients with microscopic tumor nodule spread in the CRM observed in the study suggested that microscopic metastases exist in pelvic lateral areas and in the mesorectum simultaneously, indicating the significance of preoperative and/or postoperative radiochemotherapy.

To investigate the significance of bcl-10 protein expression in extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma.Sixty-two cases of MALT lymphoma were reviewed and immunohistochemical studies for bcl-10 and Ki-67 were performed.Sixty out of the 62 cases studied (96.8%) were positive for bcl-10. Thirty-three (53.2%) showed bcl-10 expression in both the nuclei and cytoplasm, while 27 cases (43.6%) showed only cytoplasmic staining. The 10 cases with Hashimoto's thyroiditis demonstrated bcl-10 expression in the cytoplasm. The mean age of patients with bcl-10 nuclear expression (51.4 years old) was 5.2 years younger than those (56.6 years) without bcl-10 nuclear expression. The former category also showed a male predilection (male to female ratio = 19:14, in contrast to 10:19 in the latter category). The frequency of bcl-10 nuclear expression was lower in cases from thyroid but higher in cases from lung, stomach and intestine (P0.05). There was no statistically significant correlation between bcl-10 nuclear expression and clinical tumor stage (P0.05) or tumor cell morphology (P0.05). Amongst the 40 cases of gastrointestinal MALT lymphoma, bcl-10 nuclear expression correlated with extent of tumor involvement. The protein was expressed in 36.4% (4 out of 11 cases) of MALT lymphoma confined to mucosa or submucosa, 65.2% (15 out of 23 cases) of those invading down to muscularis propria or subserosa, and 100% (all 6 cases) of those extending beyond serosa (P0.05). There was no statistically significant difference in Ki-67 proliferative index between bcl-10-positive and bcl-10-negative groups (P0.05). Follow-up data were available in 52 patients (83.9%) and the five-year survival rate was no statistically significant difference in survival between bcl-10-positive (29 patients, 96.3%) and bcl-10-negative groups (23 patients, 66.4%, P0.05).Two expression patterns of bcl-10 protein were observed in MALT lymphoma: mixed nuclear-cytoplasmic and cytoplasmic only. The bcl-10 nuclear expression appears more important and correlates with anatomic site of tumor and extent of tumor involvement. Immunohistochemical detection of bcl-10 may carry some diagnostic and prognostic implications in assessment of MALT lymphoma.

To investigate the clinicopathologic and immunophenotypic features of solitary plasmacytoma and discuss the diagnosis and differential diagnosis of the tumor.Clinicopathological study and follow up study were made on 43 cases of solitary plasmacytoma, including 24 cases of extramedullary plasmacytoma (EMP) and 19 cases of solitary plasmacytoma of bone (SPB). Immunohistochemical staining was performed by SP method using antibodies CD20, CD79a, PC, Ig kappa, Ig lamda, IgA, IgD, IgE, IgG and IgM.Rgarding EMP, the male/female ratio is 2.5 to 1, the age ranges from 3 to 70 years (mean 49). Clinically, the neoplasms of 22 cases were located in nasal cavity or nasosinus, 2 cases were located in lung and tonsil respectively. Rgarding SPB, the male/female ratio is 1:1, the age ranges from 36 to 72 years (mean 53). Clinically, the neoplasms of 8 cases were located in vertebrae, 3 cases in pelvis, 6 cases in clavicle, rib and femur respectively, 2 case in radius and tibia respectively. Histopathological examination revealed tumor cells diffuse infiltration with necrosis and ulceration; the well-differentiated tumor cells were similar to the normal plasmacyte in shape; the poorly-differentiated tumor resembled centroblasts; there were a few interstitial tissues with plenty of vessels or formation of blood lakes; and there was deposition of amyloid materials. Immunophenotypic analysis showed that all tumor cells were positive for CD79a and negative for CD20; that plasma cell marker (VS38C) was expressed in 41 cases; that light chain restriction was detected in all 43 cases( 31 for lamda and 12 for kappa), and that heavy chain expression was detected in 39 for IgG, 1 for IgA, 2 for both IgG and IgM, and 1 for IgA/IgG.The special histopathology in this group of solitary plasmacytomas is presented. The well-differentiated tumors should be distinguished from reactive plasmacytosis and MALT. And, when poorly-differentiated solitary plasmacytomas were tentatively diagnosed, large cell lymphoma, melanoma and poorly differentiated carcinoma should be considered in differential diagnosis.

Intestinal T-cell lymphoma (ITCL) is a heterogeneous lymphoid neoplastic group with variable clinical and pathological features. ITCL in oriental countries is different from enteropathy-type intestinal T-cell lymphoma (ETCL) in relation to celiac disease and Epstein-Barr virus (EBV). The objective of this study was to investigate the clinicopathological features, immunophenotype, expression of cytotoxic molecule (TIA-1), T-cell receptor (TCR)-gamma gene rearrangement, and Epstein-Barr virus (EBV) latent infection in primary ITCL without celiac disease in Chinese.The clinical data of 42 patients were analyzed, and the patients were followed up. Compared with human reactive lymphoid tissues, in situ hybridization for EBER1/2, polymerase chain reaction for TCR-gamma gene rearrangement, and immunohistochemical staining for immunophenotypes, TIA-1 and EBV latent membrane proteins (LMP-1) were investigated. Survival curves of different clinicopathological features, immuno-phenotypes, expression of LMP1, TCR-gamma gene rearrangement and therapy were analyzed.Three fourths of the patients suffered from ITCL in China were men with a peak age incidence in the 4th decade. Common presenting features included fever and hemotochezia. The prognosis was poor with a median survival of 3.0 months. The lesions were mostly localized in the ileocecum and colon. About 38/42 (90.5%) patients demonstrated pleomorphic medium-sized on large cells. Histological features of celiac disease were rarely seen. All 42 patients with ITCL revealed CD45RO positive. Neoplastic cells partially expressed T-cell differentiated antigens (CD3epsilon, CD4, CD8) and NK cell associated antigen (CD56). The positive frequency of CD3epsilon, CD4, CD8 and CD56 was 28/42 (66.7%), 7/42 (16.7%), 10/42 (23.8%) and 12/42 (28.6%) respectively. Thirty-nine cells (92.9%) expressed TIA-1, but none expressed CD20 and CD68. More than half of the patients (64.3%, 64.3% and 59.5%) revealed TCR-gamma gene rearrangement by three different TCR-gamma primers respectively. EBER1/2 was detected in 41 (97.6%) of the 42 patients. The expression frequency of LMP-1 was 38.1% (16/42).Primary ITCL without celiac disease in Chinese is a special highly EBV-associated clinicopathological entity. There are few similarities in patients with celiac disease in western countries. A small proportion of primary ITCLs in Chinese and extranodal NK/T-cell lymphoma of nasal type belong to the same spectrum.

To investigate the expression of B cell-specific activator protein (BSAP)/Pax-5 in lymphomas.One hundred and two cases of diffuse large B-cell lymphoma (DLBCL), 3 cases of follicular lymphoma (FL), 3 cases of extranodal marginal zone B-cell lymphoma, 1 case of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), 10 cases of anaplastic large cell lymphoma (ALCL) and 10 cases of plasmacytoma were studied immunohistochemically for BSAP and CD20.The tumor cells in the 102 cases of DLBCL all expressed CD20, amongst which 100 cases also expressed BSAP. Three cases of FL, 3 cases of extranodal marginal zone B-cell lymphoma and 1 case of NLPHL also expressed BSAP and CD20. All the ALCLs and plasmacytomas did not express BSAP and CD20. The expression rates of CD20 and BSAP were highly consistent. The intensity of staining showed no statistical significance.BSAP/Pax-5 is a novel B-cell marker expressed in tumor nuclei of B-cell lymphomas. Though less sensitive than CD20, anti-BSAP has diagnostic value in routine surgical pathology practice.

Mucosal microvascular thrombi in rectal biopsies were observed in some ulcerative colitis (UC). Heparin may be effective in steroid resistant UC in some studies, however, the new results of meta-analysis demonstrated a non-significant effect of heparin in controlled clinical trials, differing markedly from observational studies. The objective of this study was to identify colonic microvascular thrombi in larger cases with UC, and analyse its possible risk factors: age, gender, histologic score, extent of lesions and operation or biopsy specimens, and assess the significance of microvascular thrombosis in patients with UC. The microvascular thrombi were identified by immunohistochemical staining with anti-CD61 monoclonal antibody and Martius scarlet blue (MSB) staining in 40 colonic tissue samples of UC (31 biopsy specimens and nine operated cases) and 12 cases of normal colon tissue from operated colonic carcinoma. Logistic regression analysis was used to assess the relationship of age, gender, degree of histology, origin of the specimens, extent of lesions and microvascular thrombi examined. Microvascular thrombi were positive in 14 of 40 UC cases, and none in the controls. The presence of microvascular thrombi was related to operation specimens with odds ratio 11.667, P=0.0179, it might be also related to histologic score (OR=1.350) and extent of lesions (OR=1.619). These results suggest that microvascular thrombosis may be one of the important pathogenesis in some UC, and that the effect of anticoagulant treatment still needs to be assessed.

To study the local immune status and its relation to immunotherapy in patients with condyloma acuminatum.Clinical efficacy of 5% imiquimod cream in treating 30 patients with condyloma acuminatum was observed. The expressions of Human Leukocyte Antigen (HLA)-DR, CD1a, CD16 and Intercellular Adhesion Molecule (ICAM)-1 were detected by immunohistochemistry in lesions of these patients before treatment.The imiquimod cream was found to be efficacious in 20 cases after 8 weeks' treatment. Before treatment, the expressions of HLA-DR, CD1a, CD16 and ICAM-1 in the lesions of responders were significantly higher than those in the lesions of nonresponders (P0.05).Higher expressions of HLA-DR, CD1a, CD16 and ICAM-1 suggested that immunotherapy might have efficacy in treating condyloma acuminatum.

To investigate the clinicopathological and immunohistochemical features of lymphoblastic lymphoma (LBL).A retrospective clinicopathological study of 96 cases LBL was carried out. Immunohistochemical staining was used for the characterization and immunophenotyping.The patients age ranged from 4 to 72 years, with a median of 16 years, 69 patients were male and 27 female. Seventy-three cases had superficial or multi-lymphoadenopathy and 31 of them had mediastinal masses. Bone marrow was involved in 15 cases. Seventy-three cases were in clinical stages III and IV. The median survival of the followed-up patients was 5.5 (2 approximately 120) months. TdT and CD99 positive reactions were 75.0% and 92.7%, respectively. Of the 96 cases, 78 displayed T-cell marker positivity and 18 B-cell markers. 82.1% of the patients younger than 30 years of age had significantly higher incidences of T-LBL (64 patients), and 93.6% of the patients with mediastinal masses expressed T-cell markers. The poor prognostic factors were T-cell tumors, clinical stages III and IV, Ki-67 PI80% and no chemotherapy (P0.01).In children and young males, mediastinal masses with superficial or multi-lymphoadenopathy favors the diagnosis of LBL, but negative TdT reaction can not exclude this diagnosis. T-LBL is more common than B-LBL. Clinical stages, immunophenotypes and the level of Ki-67 expression were closely related with prognosis of LBL.

To explore the prognostic factors of primary nodal diffuse large B-cell lymphomas (N-DLBCL).According to the 2001 WHO classification of tumors of hematopoietic and lymphoid tissue, 51 cases of primary N-DLBCL were collected for clinical data analysis and immunohistochemical assay. Antibodies used for study were anti-CD20, CD79alpha, CD45RO, CD3, Bcl-2, Ki-67, CD30, CD15, kappa, lambda, Cyclin D1, TdT, GFAP, CK, MPO. The survival data was analyzed.Of the 51 cases of N-DLBCLs, 40 were reclassified as centroblastic, 3 B-immunoblastic, 1 T-cell/histiocytes rich, 2 B-cell anaplastic large cell, 1 plasmablastic, and 4 unclassified. Expression of Bcl-2 oncoprotein was observed in 24 cases (47.1%). The median Ki-67 index was 50.0% and the index more than 40% was found in 35 cases (68.6%). Survival analysis of 35 cases had follow up data showed that the 2 year and 5-year overall survival (OS) rates were 48.54% and 35.30%, respectively. The 5-year OS rates patients with International Prognosis Index (IPI)/= 3 was lower than that with IPI3 (P0.01). The 5-year OS rates for patients with B symptoms was lower than that without B symptoms (P0.05). The 5-year OS rates for patients with Ki-67 index more than 40% was lower than that with less than 40% (P0.05). The expression of Bcl-2 oncoprotein was uncorrelated to prognosis (P0.05).IPI, B symptoms and Ki-67 index are the prognostic factors for patients with N-DLBCL.

To study the role of the dendritic cells, natural killer cells and adhesion molecules play in the pathogenesis of psoriasis.The expression levels of human leukocyte antigen (HLA)-DR, CD1a, CD16, CD57, tumor necrosis factor (TNF)-alpha and intercellular adhesion molecule (ICAM)-1 were detected by immunohistochemistry in lesions of 26 patients with psoriasis before and after treatment.The expression of HLA-DR, CD1a, CD16, CD57, TNF-alpha and ICAM-1 showed no significant difference between the active phase and the static phase of psoriatic lesions (P0.05). After treatment, the positive expression of all markers decreased evidently or even disappeared with histopathological improvement in the resolvent phase of psoriatic lesions. There were statistically significant difference by Wilcoxon rank sum test (P0.05).Dendritic cells, natural killer cells and adhesion molecules play an important role in the pathogenesis of psoriasis.

To investigate the characteristic of ALK protein expression in anaplastic large cell lymphoma (ALCL) and the relationship between ALCL and Epstein-Barr virus (EBV).Histopathological method was used to study the morphological characteristic. Immunohistochemical staining was used to detect ALK protein and other antigen. EBV-encoded EBER was detected by in situ hybridization.All 2 cases of primary cutaneous ALCL were ALK protein negative. 20 cases of systemic ALCL were found to be ALK protein positive in 12 cases (60%), which included 8 cases of common variant, 3 cases of lymphohistiocytic variant and 1 case of small cell variant; the expression of ALK protein showed no significant difference between these 3 variants (P0.05). The ALK protein expression pattern was characterized by the brown-stained nucleus and cytoplasm of the cells, but in 2 cases only the cytoplasm was stained. The patients with ALK protein expression were younger than those without ALK protein expression (P0.05); all 22 cases were EBER negative.High incidence of the expression of ALK protein was seen in ALCL, especially in ALCL of younger patients. No relationship was observed between EBV and ALCL in this study.

To investigate the lineage of the malignant cells in malignant histiocytosis.Polymerase chain reaction with two groups of common primers for TCR-gamma gene was used to analyze the malignant cells of 28 autopsied cases of malignant histiocytosis.Monoclonal TCR-gamma gene rearrangements were detected in 12 out of the 28 samples (43%).Most cases diagnosed as malignant histiocytosis in Southwest China seems to be peripheral T-cell lymphomas.

Glucocorticoid (GC) resistant ulcerative colitis (UC) remains a serious disease and is difficult to manage. Although the molecular basis of GC insensitivity is still unknown, GC receptors (GRalpha and GRbeta) may play an important role in it. This study was aimed to investigate the relationship between the expression of GRalpha and GRbeta in colonic mucosal cells of patients with UC, the efficacy of GC therapy and the intensity of inflammation.Twenty-five cases of UC were classified into: GC sensitive (n = 16) and GC resistant (n = 9) cases. Patients consisted of mild (n = 6), moderate (n = 8) and severe (n = 11) cases. GRalpha and GRbeta expression in colonic mucosal specimens were investigated by immunohistochemistry, and compared between GC resistant and sensitive groups, and also among various degrees of inflammation.All cases were positive for GRalpha and GRbeta expression. Both positive association between GRalpha expression and the response of UC to GC and strong negative association between GRbeta expression and the response of UC to GC were identified. There was no significant association between GRalpha/GRbeta expression and the degree of inflammation of UC.These findings suggest that both GRalpha and GRbeta may play an important role in the action of GC, and that GRbeta functions as a dominant negative inhibitor of GRalpha. Expression of GRalpha and GRbeta in colonic mucosal cells of patients with UC may serve as predictors of glucocorticoid response, but can not function as markers of inflammatory intensity.