2017 Vol. 8, No. 2-3

Specialist Forum
Abstract:

Breast cancer is one of the common diseases in women, and its mortality now ranks first among the female malignancies in China. Therefore, early detection, early diagnosis and early treatment have become the focus of the treatment for breast diseases. Neoadjuvant chemotherapy is a standard treatment for locally progressive breast cancer, and magnetic resonance imaging (MRI) is superior to ultrasonography, X-ray and clinical examination in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer. MRI can provide not only structural imaging, but also functional imaging. MRI dynamic contrast enhanced imaging, diffusion weighted imaging, perfusion weighted imaging and magnetic resonance spectroscopy have received extensive attention in the evaluation of therapeutic efficacy for breast cancer.

Abstract:

Preoperative neoadjuvant chemoradiotherapy is a routine treatment for rectal cancer. It helps to reduce rectal cancer staging, improve anus preservation rate, reduce local recurrence and achieve complete response. Diffusion-weighted imaging (DWI) provides information of molecular function of tumor. It can be used to evaluate the effect of neoadjuvant chemoradiotherapy treatment for rectal cancer. The value of DWI in preoperative neoadjuvant chemotherapy of patients with rectal cancer including monitoring early stage of therapy effect, tumor remnants, clinical and pathological response, as well as its limitations are focused in this review.

Abstract:

Esophageal cancer is the eighth most common carcinoma in the world, with a high mortality rate. The main reason is that it is difficult for early diagnose and accurate staging. The commonly used preoperative staging imaging tools can not meet the clinical needs. Therefore, the new technologies and new sequences of magnetic resonance imaging(MRI), including diffusion weighted imaging-intravoxel incoherent motion(DWI-IVIM), T2-mapping, radial-VIBE, and T2-TSE-BLADE, have a great advantage in the preoperative T staging of resectable esophageal cancer.

Abstract:

The development of precision medicine has been the focus of medical field in the world. With the promotion of emerging biotechnology and information technology, pathology is experiencing subject redistribution and reconstruction. With the integratation of organ, tissue, cell, subcellular organelle and molecular complex, and with the combination of radiology, magnetic resonance and ultrasonic imaging, morphomics is established. At the same time, morphomics has established relevance with genomics and other molecular biology to establish connection between morphology and function, and has integrated with environmental, social and human factors to achieve molecular pathologic epidemiology based on large medical data analysis. It is believed that these developments will redefine the bridge role of the pathology in the coming era of precision medicine.

Opinions
Abstract:

International Stroke Conference 2017 was held on Februrary 22-24, 2017 in Houston, USA. The use of antiplatelet agents in ischemic stroke has become the highlight of this conference, and results of several studies were presented during the conference. Triple antiplatelet therapy was not superior to guideline-recommended treatment in preventing recurrent strokes in patients who suffered a recent ischemic stroke or transient ischemic attack (TIA). Ticagrelor showed stronger efficacy than aspirin in the prevention of recurrent acute stroke or TIA especifically related to ipsilateral atherosclerotic stenosis. The antiplatelet agent cilostazol was noninferior to aspirin in preventing vascular events in patients with a recent ischemic stroke and a history of intracerebral hemorrhage (ICH) or multiple microbleeds. Patients with mild acute ischemic stroke did not derive more benefit from initiating statins in the first 24 hours after stroke than a week after the event in a randomized controlled study. There was no significant correlation between head position and prognosis in the first 24 hours after stroke.

Original Contributions
Abstract:
    Objective       To discuss the surgical management and prognosis factors of ectopic adrenocorticotropic hormone syndrome (EAS) caused by thoracic neuroendocrine tumors(NETs).    Methods       The clinical manifestations, radiological findings, outcome of surgical treatment and follow-up of consecutive 33 cases(20 males and 13 females) of EAS caused by thoracic NETs from December 1983 to December 2013 in Peking Union Medical College Hospital were retrospectively analyzed.    Results       The median age was 33 years old (13~65 years)and the median duration of disease was 12 months(1~156 months). Cushing's syndrome was demonstrated in all cases by clinical and biochemical evidences. All the thoracic NETs were located by computed tomography (CT) eventually. The serum cortisol and adrenocorticotropic hormone levels decreased significantly after surgery(both P < 0.05).One patient(3.0%) died after surgery and two patients(6.1%) had postoperative complications.The overall 5-year survival rate was 65.8%.Pulmonary diseases had better survival rate versus thymic diseases(84.2% vs. 36.3%, P < 0.05).The 5-year survival rate was 76.2% in typical carcinoid and 45.7% in atypical carcinoid(P=0.056).The 5-year survival rate was 80.0% in stage Ⅰ and Ⅱ, 50.5% in stage Ⅲ and Ⅳ respectively(P=0.072).    Conclusions       Due to the varity and atypical clinical features, early diagnosis and therapy in EAS is very challenging for clinicians. CT scan plays a key role in localization of the thoracic NETs. Pulmonary diseases have better prognosis than thymic diseases.Pathological type and stage of tumors might be prognostic factors for this rare syndrome.
Abstract:
    Objective       To investigate the value of combined detection of CK5/6, CK14 and epidermal growth factor receptor (EGFR) in diagnosing basal-like subtype triple negative breast cancer (TNBC).    Methods       The clinical and pathological data of 115 patients diagnosed with TNBC were recorded from January 2000 to December 2011. The expression of CK5/6, CK14 and EGFR were detected with immunohistochemical methods using paraffin specimens. Combined detection result of the three markers was used as gold standard, then the sensitivity and specificity of CK5/6, CK14 and EGFR were detected by single marker and two combined assays.The differences between basal-like and non basal-like subtype TNBC in age, tumor size, tumor histological type and other clinicopathological issues were compared.    Results       The mean age of 115 patients with TNBC was (50.7±13.6) years. Immunhistochemical result showed that single marker positivity was 29.6% (34/115), 21.7% (18/83), and 60.9% (70/115) for CK5/6, CK14, and EGFR, respectively. Combined detection of the three markers, the positive rate was 67.8% (78/115). Taking three markers combination as a golden standard, the sensitivity and specificity of EGFR and CK5/6 combination were 98.7% and 100%. There were significant differences between basal-like and non basal-like subtype TNBC in histological type, tumor grade, lymph node metastasis and mortality(all P < 0.05). Survival analysis showed that the overall survival period of basal-like subtype TNBC was significant shortened(HR=0.363, 95% CI:0.139~0.947).    Conclusions       Combined detection of CK5/6, CK14 and EGFR could identifiy the largest number of basal-like subtype TNBC. The prognosis of basal-like subtype TNBC is worse than that of non basal-like subtype TNBC, and it is important to identify the subtype.
Abstract:
    Objective       To summarize the clinical and laboratory characteristics of HIV-negative adult patients with Mycobacterium tuberculosis(MTB) blood stream infection (BSI).    Methods       We searched databases of the Clinical Laboratory and enrolled HIV-negative patients with blood culture positive for MTB, or the microbiologically confirmed pulmonary TB patients with blood culture negative for MTB from January 2010 to January 2016 in Peking Union Medical College Hospital, and analyzed the clinical and laboratory characteristics of these patients retrospectively.    Results       A total of 6999 patients with blood culture for Mycobacterium were screened, and 28 patients with MTB BSI (case group) and 32 patients with negative MTB blood culture but microbiologically confirmed pulmonary TB (control group) were enrolled in the present study. The proportion of female (57% vs. 25%, P=0.011), the peak temperature[(39.70±0.78)℃ vs. (38.70±0.98)℃, P < 0.001], the proportion of patients with more than one organ involved (71% vs. 3%, P < 0.001), the proportion of patients with severe complications (32% vs. 3%, P=0.008) and the hypersensitive C reactive protein(hsCRP) level[94.74 (61.63-144.21)mg/L vs. 59.97 (28.88-104.50)mg/L, P=0.016] in the case group were significantly higher than those in the control group. The lymphocyte count in the case group was significant lower than that in the control group[0.44(0.27-0.77)×109/L vs. 1.03(0.52-1.42)×109/L, P=0.001].    Conclusions       HIV negative patients can also have MTB BSI. MTB BSI should be considered when female patients with higher temperature, multiple organs involvement, severe complications, lower lymphocytes and higher hsCRP level.
Abstract:
    Objective       To investigate the clinical characteristics and perinatal outcomes of unicornuate uterus pregnancy.    Methods       The clinical data of patients with unicornuate uterus pregnancy who delivered between January 2007 and December 2016 in the Peking Union Medical College Hospital were retrospectively reviewed, and the general characteristics, diagnostic methods, complications during gestational and delivery period, mode of delivery and perinatal outcomes were analyzed.    Results       Twenty-three patients with unicornuate uterus pregnancy (24 successful pregnancies) were included in this study. The age of the patients at delivery was (30.96±3.61) years, 4 cases(17.4%) were diagnosed with ultrasound before pregnancy, 3 cases (13.0%) were diagnosed by ultrasound during the first trimester, 6 cases(26.1%) were diagnosed by hysterosalpingography, 7 cases (30.4%) were diagnosed based on previous surgical exploration, and 3 cases (13%) were diagnosed during the present deliveries. Adverse outcomes were observed in 9 cases(60%) among 15 previous deliveries, including mainly spontaneous abortion or embryo arrest. Adverse outcomes during the present pregnancies included nuchal cord (45.84%), breech position (29.17%), and fetal growth restriction (16.67%). Gestational age at birth was (37.55±2.38) weeks, cesarean section rate was 95.8%, intrapartum bleeding volume was (177±49)mL, neonatal survival rate was 100%, and neonatal body weight was (2826.0±692.8)g.    Conclusions       The incidence rate of fetal complications in unicornuate uterus pregnancy is higher than that in the general population, but most of them can achieve good pregnancy outcomes.
Complicated and Rare Disease
Abstract:
  Objective      The microarray data of autosomal dominant polycystic kidney disease(ADPKD) was downloaded from the Gene Expression Omnibus (GEO) and analyzed to identify the differential expression genes (DEGs) and to explore the possible signal pathways and protein interaction mechanisms in ADPKD by bioinformatics analysis.  Methods      Two microarray datasets (GSE7869 and GSE35831)of renal cyst tissue of ADPKD patients and dataset of normal controlled tissue were downloaded and screened from GEO database. The DAVID database and Funrich software were used to analyze biological information and signal pathway analysis, and the STRING database was used to analyze protein interaction mechanisms.  Results      There were 3970 DEGs in GES7869 and 147 DEGs in GSE35831. There were 28 up-regulated genes in the two groups of DEGs and 24 identical down-regulated genes. Up-regulated of DEGs focused on ion channel-related pathways, enriched in autophagy relted pathways, such as mTOR and PI3K/Akt pathways, growth factors and integrin-related pathways, and down-regulated of DEGs focused on energy metabolism and related signaling pathways.  Conclusions      Analysis of the 52 DEGs and related enrichment signal pathways of the ADPKD could provide potential biomarkers and directions for the future study of ADPKD. Regulation of renal cell autophagy to delay cystic progression might become a new research focus in ADPKD.
Clinical Research and Evidence Based Medicine
Abstract:

Clinicians are enthusiastically involved in etiologic research since they are paying more attention to the effect of etiology in management of disease in recent decades. However, there is a lack of understanding of the etiological view and etiologic research methods of clinical medical field. This article briefly introduces the etiologic concept, classification and research framework in epidemiology, in order to help clinicians to form a more integrated top-level design before the etiologic research.

Case Report
Abstract:

Generalized pustular psoriasis (GPP) is a systemic inflammatory disease with recurrent episodes of erythema, pustules, fever and leukocytosis. Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease between discoid lupus erythematosus and systemic lupus erythematosus.Coexistence of the two diseases is uncommon. Here we report a case of generalized pustular psoriasis combined with subacute skin lupus erythematosus. The clinical manifestations and laboratory results are presented and the possible reasons for coexistence are discussed.

Teaching and Research
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    Objective      To explore the scientific and objective assessment methods for evaluating the clinical practice skills of residents undergoing standardized training.Methods    Methods      Multivariate generalizability theory was used to analyze the scores of objective structured clinical examination(OSCE) of clinical skills of trainees in Department of Radiology in Peking Union Medical College Hospital by analysis of variance, D analysis and G analy-sis.    Results      The total relative generalizability coefficient of OSCE was 0.917, and the absolute generalizability coefficient was 0.912, which showed that the reliability of this assessment was higher. Test site increased to 6 stations which would greatly improve the test reliability, the relative generalizability coefficient increased to 0.976.    Conclusions      Multivariate generalizability theory is an objective and scientific tool to evaluate the OSCE stations, and the analysis results are helpful to improve the practice for future OSCE.
2017, 8(2-3): 81-81.
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Abstract:

Targeted therapy is an important component of the individualized precision medical treatment for abdominal tumors. It is especially effective in the treatment of gastrointestinal stromal tumors, which is regarded as "a model of modern anti-cancer therapy". Radiology is the common method to evaluate the response of abdominal tumors to targeted therapy. The morphological bias is demonstrated in response evaluation criteria in solid tumors (RECIST) because of the diverse change of post-treatment tumor tissue. The problem of enlarged tumor caused by necrosis and cystic degeneration was resolved by combination of Choi, mChoi, size and morphology(SACT), morphology, attenuation, size and structure(MASS), and CT values. The new technologies of positron emission tomography (PET), diffusion-weighted imaging (DWI), dynamic contrast enhanced magneticresonance imaging(DCE-MRI) and monochromatic CT, and a series of functional imaging parameters including standard uptake value (SUV), apparent diffusion coefficient (ADC), Ktrans value and iodine concentration, provide potential surrogate for the prediction and early evaluation of tumors to targeted therapy. Texture analysis technique in radiology can further explore the radiological information, to provide rich quantitative parameters for response evaluation. The radiologists should strengthen the communication with clinicians and initiate cooperative research through multi-disciplinary team (MDT) patterns, actively explore new parameters and criteria to further improve the response prediction and evaluation of targeted therapy for abdominal tumors.

2017, 8(2-3): 89-89.
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The surgical technique of colorectal surgery in China is developing rapidly, but it is far behind the western countries in the fields of specialization, standardization of diagnosis and treatment, clinical research and so on. Therefore, in the future, we should focus on strengthening the specialization of colorectal surgery, improving the standardization of diagnosis and treatment of colorectal diseases, boosting the standardization of colorectal surgery, and promoting application of minimally invasive surgery. More importantly, it's time to figure out how to conduct the surgical research related to Chinese patients with colorectal disease under the organization of national academic institutions, and obtain high-level "evidence-based medicine" research to form Chinese guidelines for surgical treatment of colorectal diseases. These guidelines can be used for surgical management of colorectal disease in China. Colorectal surgeons in China still have a long way to achieve the above-mentioned objectives.

2017, 8(2-3): 99-99.
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Endometrial carcinoma is the most common gynecological malignancy in developed countries and the incidence is rising in China. The stage of the endometrial carcinoma at diagnosis plays an important role in treatment planning, and is correlated with prognosis. Accurate preoperative staging of the tumor is helpful for risk stratification before surgery, which is crucial for optimal personalized management and subsequent follow-up regiments. Magnetic resonance imaging (MRI) has long been established as the most accurate noninvasive imaging modality for staging of endometrial carcinomas. And functional MRI techniques, providing more detailed characterization of tumors-vascularity, cellilarity and metabolism, are currently being intensively investigated all round the world. This review discusses the value of MRI in endometrial carcinoma.

Abstract:

Epilepsy is a common chronic disease of central nervous system with high disability rate and long duration, which is a medical and social public health problem urgently to be solved globally. In this context, the promotion of the clinical guidelines of epilepsy can help standardize the diagnosis and treatment of epilepsy, and to achieve the goal of controlling seizures and improving the prognosis of patients. At present, there is a large gap in the recognition of this disease in different countries and regions, and the uneven distribution of health resources is still quite common. There is still a lot of room for improvement of clinical guidelines of epilepsy. In this paper, we summarize the latest clinical guidelines of epilepsy and provide an outlook of its future.

2017, 8(2-3): 131-138. doi: 10.3969/j.issn.1674-9081.2017.03.010
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2017, 8(2-3): 139-146. doi: 10.3969/j.issn.1674-9081.2017.03.011
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Pelvic organ prolapse (POP) is a common disease in middle-aged and old women. Both genetic and environmental factors contribute to the development of POP.Predisposing hereditary factor is an important risk factor for POP. The latest progress of genetic research in POP will be discussed in this article. Most studies focused on genes involved in the synthesis and degradation of connective tissue.The genetics of POP remain to be further explored since no definitive conclusions have been reached so far.

2017, 8(2-3): 190-191. doi: 10.3969/j.issn.1674-9081.2017.03.020
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2017, 8(2-3): 196-200. doi: 10.3969/j.issn.1674-9081.2017.03.022
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