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2015 Vol. 6, No. 1

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Original Contributions
Difference in Clinicopathological Features of Triple Negative Breast Cancer and Non-triple Negative Breast Cancer and Relationship between Clinicopathological Features and Expressions of Estrogen Receptor β/Epidermal Growth Factor Receptor
Li YUAN, Huan-wen WU, Xin-yu REN, Zhi-yong LIANG
2015, 6(1): 1-8. doi: 10.3969/j.issn.1674-9081.2015.01.001
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  Objective  To analyze the differences in clinicopathologic features and expressions of some immunohistochemical indicators between triple negative breast cancer and non-triple negative breast cancer, and to investigate the relationship between clinicopathological features and immunohistochemical indicators.  Methods  A total of 863 patients (135 triple negative breast cancer and 728 non-triple negative breast cancer) with histopathologically confirmed breast cancer were collected in Peking Union Medical College Hospital from January 2010 to December 2013.We retrospectively analyzed the difference in the onset age, histological subtype, tumor size, tumor differentiation, tumor stages, lymph node metastasis, nipple involvement and operation method between triple negative breast cancer and non-triple negative breast cancer, then explored the difference between them in the expressions of estrogen receptor β (ERβ), epidermal growth factor receptor (EGFR), P53, and Ki67 by immunohistochemical staining. Prognostic factors of triple negative breast cancer were further discussed by univariate survival analysis.  Results  The proportion of invasive ductal carcinoma in triple negative breast cancer was higher than that in non-triple negative breast cancer (86.7% vs. 65.2%, P < 0.001); the age of onset was younger in triple negative breast cancer[(46.0±10.6) years vs. (51.0±3.3) years, P < 0.05];significant differences were also found in lymph node metastasis, tumor size, differentiation grade, surgical procedure, and tumor stages between the two groups(P < 0.05); no statistically significant inter-group difference in nipple involvement (P > 0.05). Immunohistochemical results showed that compared with non-triple negative breast cancer, ERβ expression rate decreased significantly(63.7% vs. 75.6%, P < 0.05)while EGFR expression rate increased significantly in triple negative breast cancer(62.2% vs. 33.3%, P < 0.05); the expression of P53 and Ki67 demonstrated no significant difference(P > 0.05). The overall survival(OS)and relapse-free survival(RFS)were both lower in triple negative breast cancer(P < 0.05). Univariate survival analysis showed that both ERβ negative expression and EGFR positive expression were related to the poor prognosis of triple negative breast cancer (P < 0.05).  Conclusions  Compared with non-triple negative breast cancer, triple negative breast cancer shows completely different clinicopathological features:younger age of onset, larger tumor size, lower degree of differentiation, higher incidence of lymph node metastasis, lower ERβ expression, higher EGFR expression, and lower OS and RFS.ERβ and EGFR may be important prognostic indicators in triple negative breast cancer.
Effectiveness of Intraoperative Autotransfusion in Mild-bleeding Surgery: a Randomized Controlled Trial
Han-ge LI, Zhi-yong ZHANG, Yu-guang HUANG, Xue-rong YU
2015, 6(1): 9-13. doi: 10.3969/j.issn.1674-9081.2015.01.002
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  Objective  To investigate the effectiveness of intraoperative autotransfusion (IAT) in improving tissue oxygenation and postoperative recovery in patients undergoing mild-bleeding surgery.  Methods  We selected patients scheduled for posterior lumbar surgery at Peking Union Medical College Hospital from December 2011 to April 2012, at American Soceity of Anesthesiologists grade Ⅰ-Ⅱ, and with estimated blood loss less than 20% of their blood volume. The patients were randomly divided into the IAT group (given salvaged autologous blood) and the control group (given equal volume of colloid solution instead). Hemoglobin (Hb) level, lactate level, and cerebral oxygen saturation before, during, and after the surgery were compared between the two groups. Postoperative recovery indexes of the 2 groups were compared, including body temperature, chief complaint, wound healing, ambulation time, and postoperative length of stay.  Results  Thirty-eight patients were enrolledand randomly divided into the IAT group (n=19) and the control group (n=19). In the IAT group, postoperative half-hour and postoperative 1-day Hb levels were (116.5±10.7)g/L and (115.4±12.3)g/L, respectively, both significantly higher than the intraoperative level[(106.6±12.6)g/L; P=0.001, P=0.004]; while no such significant differences were found in the control group (P > 0.05). Lactate level was significantly elevated at postoperative half-hour compared with preoperative level in the control group[(2.5±1.0)mmol/L vs. (1.3±0.6)mmol/L, P=0.016], while the trend was absent in the IAT group. There were no significant differences in postoperative Hb level, lactate level, and cerebral oxygen saturation between the two groups (P > 0.05), nor in any of the postoperative recovery indexes (P > 0.05).  Conclusion  The use of IAT in healthy adult patients undergoing surgery with estimated small blood loss could improve early tissue oxygenation after the surgery, but with no significant influence on postoperative recovery.
Cytological Features of Cerebrospinal Fluid in Guillain-Barré Syndrome and Their Diagnostic Value
Hong-zhi GUAN, Lin CHEN, Li-ying CUI, Yu-zhou GUAN, Xiu-li LI, Min QIAN, Hai-tao REN, Yan-huan ZHAO
2015, 6(1): 14-17. doi: 10.3969/j.issn.1674-9081.2015.01.003
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  Objective  To investigate the cytological features of cerebrospinal fluid (CSF) in Guillain-Barré syndrome (GBS) and the role of the cytological features in the diagnosis of GBS.  Methods  We reviewed the clinical, neurophysiological, and CSF cytological findings of GBS patients treated in Peking Union Medical College Hospital from January 2010 to December 2012. The included patients all met the diagnostic criteria in 2010 China Guidelines for Diagnosis and Treatment of GBS. CSF cytological tests were performed using sedimentation chamber and MGG staining. CSF routine cell count and CSF cytological-finding positive-rate were compared with Chi-square test.  Results  Twenty-eight cases of GBS were included, at a mean age of 39 years (8-69 years), including 19 males and 9 females. The 28 patients all had acute onset, with 22 demonstrating limb weakness, 13 hypoesthesia, 3 hyperesthesia, 7 bulbar paralysis, 3 with the need of assisted ventilation, 5 urinary retention, 1 positional hypotension, 5 ophthalmoplegia, 10 facial paralysis, and 4 ataxia. The patients were clinically classified to acute inflammatory demyelinating polyneuropathy (20 cases), acute motor axonal neuropathy(1 case), acute motor-sensory axonal neuropathy (1 case), acute sensory neuropathy (1 case), Miller Fisher syndrome (4 cases), and GQ1b antibody-positive ophthalmoplegia (1 case). CSF protein was 0.39-4.23 g/L, increased in 26 cases, and >1.0 g/L in 11 cases. CSF white blood cell count was 0×106-5×106/L in 26 cases, and 6×106-10×106/L in 2 cases. Oligoclonal band test of CSF produced positive results in 14 cases, and myelin basic protein was found increased in 18. Anti-GM1 antibodies were positive in 3 cases and anti-GQ1b antibodies in 2 cases. Abnormal CSF cytological results were found in 12 patients, including lymphocytic inflammation in 9 and monocyte-lymphocytic inflammation in 3. The percentage of neutrophils reached 2% in 1 case. Activated lymphocytes were present in 6 cases, activated mononuclear macrophages in 2, and plasma cells in 3. The CSF cell count was over 5/μl in 2 patients (7.1%), significantly lower than the positive rate of CSF cytological test (12 cases, 42.9%, P < 0.01).  Conclusions  CSF cytological test in GBS could detect inflammatory changes such as lymphocyte inflammation, consistent with the pathological mechanism of polyradiculitis in GBS. Compared with CSF routine cell count, cytological test is more sensitive in revealing the inflammatory status of CSF, showing larger diagnostic value for GBS.
Video-electroencephalography Applied in Interpretation of Cortical and Subcortical Hypermetabolic Foci in Interictal 18F-fluorodeoxyglucose Positron Emission Tomography Imaging in Patients with Epilepsy
Na NIU, Rui-xue CUI, Ying ZHANG, Fang LI
2015, 6(1): 18-23. doi: 10.3969/j.issn.1674-9081.2015.01.004
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  Objective  To evaluate the role of vedio-electroencehpalography (VEEG) monitoring in interpreting the cortical and subcortical hypermetabolic foci in interictal 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography (PET) imaging in patients with epilepsy.  Methods  From January 2008 to March 2014 in Peking Union Medical College Hospital, 3 epileptic patients whose first 18F-FDG PET scan showed unexplained hypermetabolic foci without seizure underwent repeated 18F-FDG PET scan in the interictal status proved by VEEG monitoring after discharge suppression by intravenous diazepam. Then compared the first and second scan images.  Results  For case 1 who suffered from epilepsy originating from medial right temporal lobe, unexplainable hypermetabolic foci in right frontal lobe, basal ganglia, thalamus, and left cerebellum were present in interictal 18F-FDG PET scan. After suppressing cortical discharge under VEEG monitoring, the second 18F-FDG PET scan showed that the cortical and subcortical hypermetabolism disappeared, indicating that the hypermetabolic foci in the first scan was due to the subclinical discharge in a potential extratemporal seizure origin site, and the existence of efferent network activity from that origin site to ipsilateral basal ganglia and thalamus and contralateral cerebellum. The original clinical decision of simple anterior temporal lobectomy was altered based on the findings. For case 2, hypermtabolism was present in a large part of right frontal lobe, which persisted after suppressing discharge under VEEG monitoring. While the hypermetabolic foci in ipsilateral basal ganglia and contralateral cerebellum became less obvious in the second 18F-FDG PET scan, proving that the original lesion (inflammation) with hypermetabolism existed in the cortex, and the hypermetabolic foci in basal ganglia and thalamus were due to secondary functional change. Case 3 suffered from temporal lobe epilepsy with origin undeterminable with clinical information, electroencephalogram, or magnetic resonance imaging. Hypermtabolic left hippocampus was shown in both the first 18F-FDG PET scan and the second PET scan under definite interictal status with VEEG monitoring, suggested the existence of a hypermetabolic lesion (tumor), facilitating the clinical decision on surgical site.  Conclusions  For the epileptic patients with hypermetabolic foci in 18F-FDG PET without seizure, repeated 18F-FDG PET imaging in definite interictal status under VEEG monitoring can help interpret the etiology and define the extent of lesions for better clinical decision-making.
Clinical Characteristics of 10 Cases with Polymyositis and Malignancy
Na XV, Yang JIAO, Xue-jun ZENG, Feng-chun ZHANG
2015, 6(1): 24-28. doi: 10.3969/j.issn.1674-9081.2015.01.005
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  Objective  To summarize the clinical features of patients with polymyositis and malignancy.  Methods  We retrospectively reviewed the clinical records of patients with polymyositis and malignancy hospitalized at Peking Union Medical College Hospital from October 1989 to June 2013.  Results  Malignancy was identified in 2.4%(10/424)of patients with polymyositis in the hospital during the studied period. The median age of the 10 patients (3 males and 7 females) was 57 years.All patients had significant proximal muscle weakness. Difficulty in head-lifting, bucking, and hoarseness were each observed in one case. Interstitial lung disease, respiratory muscle involvement, and cardiac involvement were observed in 5, 2, and 6 patients, respectively. The most common types of cancer were lymphoma and lung cancer (3 cases each). Other types included esophageal, gastric, renal, and cervical cancers (1 case each). Malignancies in 7 cases were discovered within 1 year before or after polymyositis diagnosis. The initial demonstrations of malignancies included lymphadenectasis, cough and dyspnea, dysphagia, gross hematuria, and postmenopausal vaginal bleeding. Three asymptomatic patients were identified through screening based on positive feces occult blood test or lung mass. Five out of the 9 patients receiving adequate dose of glucocorticoid recovered completely from polymyositis within 1 month, whereas the remaining 4 patients improved but did not fully recover. Of the 4 patients, 3 patients achieved complete recovery after treatment for cancer.  Conclusions  Malignancy may interfere with the treatment response and prognosis of polymyositis, therefore patients with polymyositis should have a complete screening for the underlying malignancy. Early cancer treatment should be prescribed to better mitigate symptoms and manage conditions in patients with polymyositis and cancer.
Clinicopathological Features of Adenoid Cystic Carcinoma of the Upper Trachea
Zhen HUO, Yun-xiao MENG, Huan-li DUAN, Jie SHEN, Yu-feng LUO, Jin-ling CAO, Shu-ying ZHANG, Zhi-yong LIANG
2015, 6(1): 29-34. doi: 10.3969/j.issn.1674-9081.2015.01.006
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  Objective  To investigate the clinicopathological features and key points in diagnosis and differential diagnosis of adenoid cystic carcinoma of the upper trachea.  Methods  From January 2000 to February 2014, 4 cases of adenoid cystic carcinoma of the upper trachea were diagnosed in Peking Union Medical College Hospital. Microscopic, immunohistochemical, and histochemical staining results of the patients were reviewed to summarize the clinicohistological and immunohistochemical features as well as key points of diagnosis and differential diagnosis of adenoid cystic carcinoma of the upper trachea.  Results  The 4 patients of adenoid cystic carcinoma of the upper trachea included 1 male and 3 females, aged 38-57 years (mean age 47 years). None had history of adenoid cystic carcinoma, and one had the history of nodular goiter surgery. Microscopically, 4 cases all appeared as cribriform/tubular type, with thyroid tissue involvement in 3 cases, nervous tissue involvement in 3 cases, and no lymph node involvement. Immunohistochemically, P16, CD117, BCL-2, P63, SMA, and type Ⅳ collagen were positive in all 4 patients, average Ki-67 index was 8%, and TTF-1 and P53 were negative in all patients. Histochemically, AB/PAS was positive in all patients. All the 4 cases received postoperative radiotherapy (total dose 48-56 Gy) and were followed up for 6-120 months (mean 72.5 months). One case had relapse after 96 months, and the other 3 had no recurrence or metastasis during the follow-up period.  Conclusions  Adenoid cystic carcinoma of the upper trachea is a rare low-grade malignant tumor. It is slow-growing and the majority of patients have invasion of thyroid tissue at presentation. It has to be differentiated from primary thyroid cancer, especially in fine-needle aspiration cytology and intraoperative frozen section of the thyroid. Accurate diagnosis can be made based on laryngotracheoscopical findings, typical morphological, immunohistochemical and histochemical features. Complete resection of the tumor is hard to achieve, therefore radiotherapy may be useful to prevent recurrence.
Negative Results of Laparotomy for Acute Abdomen: Causes and Preventions
Li-yang ZHANG, Zi-wen LIU, En-ling MA, Jian-chun YU, Hui-zhong QIU
2015, 6(1): 35-37. doi: 10.3969/j.issn.1674-9081.2015.01.007
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  Objective  To analyze the causes of negative results of laparotomy for acute abdomen, and to propose strategies for the prevention of unnecessary laparotomy.  Methods  We reviewed the medical records of 27 cases with negative findings in laparotomy for acute abdomen in Peking Union Medical College Hospital from January 1997 to December 2010, classifying the causes of negative laparotomy results.  Results  In the 27 cases of acute abdomen, 6 had primary peritonitis, 6 rupture of corpus luteum, 4 acute pelvic inflammation, 3 paralytic intestinal obstruction, 3 autoimmune disease, 1 organic phosphorus poisoning, 1 acute myocardial infarction, and 3 were of unknown causes. The main reasons for negative laparotomy results were:inadequate medical history taking (6 cases, 22%), inaccurate physical examinations (3 cases, 11%), and lack of necessary laboratory tests (6 cases, 22%).  Conclusions  Adequate medical history taking, accurate physical examination, and necessary laboratory tests constitute the key of preventing the occurrence of negative results of laparotomy for acute abdomen.
Application of High-speed Vitrectomy System in Combined Surgery of Anterior and Posterior Segments of the Eye
Jian-ping XIA, Ming-yue CUI, Yuan-yuan QI, Li-na CHEN, Sheng LI, Fang-tian DONG
2015, 6(1): 38-41. doi: 10.3969/j.issn.1674-9081.2015.01.008
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  Objective  To observe the application of high-speed vitrectomy system in combined surgery of phacoemulsification and vitrectomy.  Methods  Eighty-one patients (86 eyes) aged over 60 years with degree Ⅱ lens opacity and vitreous retinal disorders treated between October 2012 and March 2013 were enrolled. The patients included 43 males (46 eyes) and 38 females (40 eyes), at a mean age of (72.1±10.5)years (60-83 years). All the patients received routine ophthalmological examination, A/B mode ultrasound, and intraocular lens degree testing. With a 23G minimally invasive incision, phacoemulsification and intraocular lens implantation were performed after closed the intraocular perfusion. With the viscoelastic agent left in the anterior chamber, high-speed vitrectomy was conducted using Resight noncontact wide-angle lens system, finished by filling with silicone oil, C3F8, or intraocular infusion fluid. Visual acuity, fundus condition, and postoperative complications of the patients were observed.  Results  The combined surgery was successfully performed in all the patients, with a mean operation time of (48.0±12.6)minutes (35-65 minutes). Among the 86 eyes, vision was improved in 80 eyes (93.0%), unchanged in 5 eyes (5.8%), and deteriorated in 1 eye (1.2%). After the surgery, 10 eyes (11.6%) developed corneal edema, and 25 (29.1%) showed anterior chamber reaction, all mitigated by treatment after 1 week. No other complications were reported.  Conclusions  For the elderly patients with degree II lens opacity and the need of vitrectomy, the high-speed vitrectomy combined with phacoemulsification and intraocular lens implantation can rapidly improve eyesight and reduce the incidence of postoperative complications.
2015, 6(1): 13-13.
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Implantable Cardiac Devices Technology(2013)
2015, 6(1): 41-41.
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2015, 6(1): 42-46. doi: 10.3969/j.issn.1674-9081.2015.01.009
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2015, 6(1): 46-46.
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2015, 6(1): 47-51. doi: 10.3969/j.issn.1674-9081.2015.01.010
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2015, 6(1): 52-55. doi: 10.3969/j.issn.1674-9081.2015.01.011
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2015, 6(1): 56-60. doi: 10.3969/j.issn.1674-9081.2015.01.012
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2015, 6(1): 61-65. doi: 10.3969/j.issn.1674-9081.2015.01.013
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2015, 6(1): 66-70. doi: 10.3969/j.issn.1674-9081.2015.01.014
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2015, 6(1): 71-73. doi: 10.3969/j.issn.1674-9081.2015.01.015
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2015, 6(1): 74-77. doi: 10.3969/j.issn.1674-9081.2015.01.016
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