简介：AbstractBackground:Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.Methods:A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.Results:Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001).Conclusions:Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.

简介：无

简介：Objective:Toexploretheeffectofmorphologicalchangesinthedevelopmentofcondylomaacuminatum(CA)MaterialsandMethods:LesionsinfivepatientswithCAwereobserved.Results:Uponelectronmicroscopy,themostcharacteristicfeatureofthelesionsimportantfordiagnosis,wasthepresenceofdistinctperinuclearvacuolizations,orso-calledkoilocytes,amongsomeepithelialcells.Thesecellspossessedhyperchromaticnuclei,swollenmitochondria,dilatedendoplasmicreticulumanddissolvedglycogen.Therewereinterchromatingranulesandperichromatingranulesinsomenuclei.Moreoversomevirusparticleswerealsoseeninthenucleiofsomeinfectedcells.Conclusions:Theultrastructuralfindingsmaybeusedtohistopathologicallyexplainthepathogenesisandmechanismofthisdisease,anditishelpfulfordiagnosisofCA.

简介：AbstractBackground:Thermal ablation of thyroid nodules is new modality for the management of the benign and malign lesions. This minimally invasive treatment is performed as an outpatient, local anesthetic, single professional procedure that can treat neoplastic lesions without removing normal thyroid tissue and thus avoiding hypothyroidism.Method:A comprehensive review of the most relevant literature regarding the thermal ablation of benign and malign nodules was performed in order to currently define its role on the management of the nodular thyroid disease. The data was divided into benign and malign literature.Results:The benign nodules can be effectively treated by radiofrequency ablation (RFA) but some limitation exists regarding the nodule’s size but not nodules characteristics. The RFA of primary malign tumors of the thyroid recently demonstrated positive and safe long-term follow-up and encouraged additional investigation and possibly a definitive role in the management of these low risk nodules.Conclusion:RFA is a safe, cost-effective minimally invasive procedure that avoids thyroid tissue removal while destroying neoplastic one thus, preventing hypothyroidism.

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractPediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.

简介：Serumspermidinewasassayedbyradioimmuno-assayindifferentstagesofesophagealcarcinogenesisinthepopulationfromhighriskareaofesophagealcancer,LinxianCounty.Theserumspermidinevalueswere76.94+74.38ngmlin36normalindividuals;115.71+113.45ng/mlin35patientswithmarkedepithelialhyperplasia(MEH)and294.48+135.36ng/mlin31patientswithearlyesophagealcancer.PatientswithMEHweregiveninterventiontreatmentbyAminoretinoicEsterorAnticancerBorplacebo(starch)ascontrols.Oneyearlater,samplesfromthepopulationwerecollectedagainforserumspermidinemsasurement.Thevalueswere95.8+68.2ng/mlin27normals;125.1±72.9ng/mlin62patientswithMEHtreatedbyAnticancerB;125.6±117.2ng/mlin64patientswithMEHtreatedbyAminoretinoicEster;162.4±76.6ng/mlin62controlsand210.5±182.9ng/mlin44patientswithearlyesophagealcancer.Theresultsshowedthatspermidineradioim-munoassaycouldreflectthetendencyofesophagealprecancerous

简介：ObjectivesToassesstheefficiencyandsafetyofdual-wireballoonangioplastysidebranchcombinedstentingthemainbranchinthetreatmentofcoronarybifurcationlesions.MethodsThisstudyincludedthirty-sixpatientswith41coronarybifurcationlesions.Selectivedual-wireballoonangioplastywasperformedinsidebranchand/orinmainbranch,andimplantationofstentswasperformedinmainbranchonly.Clinicaloutcomeandmajoradversecardiaceventswereobservedin-hospitalandfollow-up.ResultsSuccessrateofsidebranchdilatationbeforemainbranchstentingwas100%;mainbranchdirectstentingperformedin4cases;successmainbranchdilatationperformedintheother37cases;kissingtechniquewasperformedsuccessfullyin5cases,whichsidebranchwasjailedaftermainbranchstentingwithTIMIgrade0-2flow.NoQ-wavemyocardialinfarction,acuterevascularizationanddeathoccurredduringin-hospital.Clinicalfollow-upwasavailableinallpatients.NoQ-wavemyocardialinfarction,revascularizationanddeathoccurred,anginapectorisrecurredinthreepatients,releasedbystrengthendrugtreatment.ConclusionsDual-wireballoonangioplastysidebranchcombinedstentingthemainbranchissimple,safeandeffectiveforthetreatmentofcoronarybifurcationlesions.

简介：AbstractIntroduction:Behçet disease is a chronic multisystem vasculitis disease, however generalized polymorphous cutaneous lesions are uncommon.Here, we reported a case of Behçet disease with multiple parts of the body and complex lesions, which may lead to misjudging in clinical diagnosis.Case report:A 69-year-old man presented with a seven-year history of recurrent generalized polymorphous mucocutaneous lesions (erythematous papules, nodules, ulcers, and necrosis) over his entire body, and the lesions had been painful for the past three years. Based on the past medical history, clinical presentation, histological examination excluded other diseases, and the 2014-amended International Criteria for Behget disease, the patient had a score of 6 points and was diagnosed as Behçet disease.Discussion:The common clinical feature in patients with Behçet syndrome is the presence of recurrent and usually painful mucocutaneous ulcers. Other clinical manifestations of this disorder are more variable among different patients. A diagnosis of generalized polymorphous cutaneous lesions should remain on the list of differential diagnosis of Behçet disease after excluding other diseases.Conclusion:The mucocutaneous lesions of Behçet disease are often preceded by other manifestations, and timely diagnosis may benefit early treatment and prognosis.

简介：AbstractPurpose:Osteochondral lesion of talus (OLT) is one of the common causes of ankle pain. This disorder is common in young athletes after ankle injury. There are various therapeutic options. One of the options is mosaic plasticizer. The purpose of this study was to investigate the effect of mosaicplasty on improvement of symptoms of patients with osteochondral lesions of talus.Methods:Nineteen patients with osteochondral lesions of talus participated in this study, who were treated with mosaicplasty. Before and after treatment, pain (visual analogue scale), function (American Orthopaedic Foot and Ankle Society), range of motion and radiographic signs were evaluated.Results:The results of this study showed that mosaicplasty could significantly reduce pain, increase function and improve radiographic symptoms. The range of motion increased after treatment, which was not significant.Conclusion:We can confirm the effect of mosaicplasty on the improvement of patients with osteochondral lesions of the ankle, suggesting it as a treatment option.

简介：Toevaluatetheeffectofatrovastatintherapyonborderlinevulnerablelesionsinpatientswithacutecoronarysyndrome(ACS).MethodsPatientswithACSunderwentcoronaryangiography(CAG)andintravascularultrasound(IVUS)investigation.Patientswithculpritvulnerableborderlinelesionswereenrolled.Nocoronaryinter-ventionwasperformedontheselesions.Allthepatientsreceivedatrovastatintherapyfor12monthsandunderwentclin-icalfollow-upalongwithIVUSfollow-up.Crosssectionarea(CSA)ofthetargetedlesion,CSAofthereferencearter-ies(extraelasticmembrane),minimallumenCSA,andplaqueareaweremeasuredatbaselineandfollow-ups.Ad-verseeventsincludedrecurrentangina,recurrentmyocardialinfarction,revascularizationanddeath.ResultsNoad-verseeventswasreportedduringfollow-upperiod.Comparedwithbaselinedata,thelevelofApoBdecreasedsignifi-cantlyattheendofthestudy(0.589±0.136g/Lvs0.681±0.132g/L,P=0.03).Boththepercentdiametersteno-sisandthepercentareastenosisdetectedbyCAGdisplayedminimalchange((62.50±10.21)%vs(54.79±12.35)%,P=0.48and(58.61±8.36)%vs(48.18+10.56)%,P=0.78).DetectedbyIVUS,theminimallu-minalCSAofthetargetedlesionincreasedsignificantly(6.32±2.42mm2vs5.63±2.51mm2,P<0.01),theplaqueareaandCSAstenosisdecreased(7.70±2.19mm2vs8.17±2.55mm2,P<0.05and56.94±8.47%vs61.4±110.34%,P<0.01).Atotalof25softplaques(50%)transformedintofibrousplaque.ConclusionsAtro-vastatintherapystabilizesborderlinevulnerableplaqueandreversesatherosclerosisprogressioninpatientswithACS.

简介：AbstractBackground:Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods:This was a retrospective study based on a consecutive cohort of 1191 SLE patients; 273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions associated with SLE. Patients were assigned to two groups, ie, with or without hyperintense WM lesions. The MRI assessment showed that the hyperintense WM lesions could be classified into three categories: type A, periventricular hyperintense WM lesions; type B, subcortical hyperintense WM lesions; and type C, multiple discrete hyperintense WM lesions. The clinical and MRI characteristics were analyzed. Factors related to hyperintense WM lesions were identified by multivariate logistic regression analysis.Results:Among the 273 SLE patients with available cerebral MRI scans, 35.9% (98/273) had hyperintense WM lesions associated with SLE. The proportions of types A, B, and C were 54.1% (53/98), 11.2% (11/98), and 92.9% (91/98), respectively. Fifty-one percents of the patients showed an overlap of two or three types. Type C was the most common subgroup to be combined with other types. Compared with those without hyperintense WM lesions, the patients with hyperintense WM lesions were associated with neuropsychiatric SLE (NPSLE), lupus nephritis (LN), hypertension, and hyperuricemia (P = 0.002, P = 0.018, P = 0.045, and P = 0.036, respectively). Significantly higher rates of polyserous effusions and cardiac involvement were found in the patients with hyperintense WM lesions (P = 0.029 and P = 0.027, respectively), and these patients were more likely to present with disease damage (P < 0.001). In addition, the patients with hyperintense WM lesions exhibited a higher frequency of proteinuria (P = 0.009) and higher levels of CD8+ T cells (P = 0.005). In the multivariate logistic analysis, hyperuricemia and higher CD8+ T cells percentages were significantly correlated with hyperintense WM lesions in SLE patients (P= 0.019; OR 2.129, 95% confidence interval [CI] 1.313-4.006 and P < 0.001; OR 1.056, 95% CI 1.023-1.098, respectively).Conclusions:Hyperintense WM lesions are common in SLE patients and significantly associated with systemic involvement, including NPSLE, LN, polyserous effusions, cardiac involvement, and disease damage. Hyperuricemia and a higher number of CD8+ T cells were independent factors associated with hyperintense WM lesions in SLE.

简介：Pancreaticcysticlesions(PCLs)areincreasinglybeingidentifiedbecauseofthewidespreaduseofhighresolutionabdominalimaging.Thesecystsencompassaspectrumfrommalignantdiseasetobenignlesions,andtherefore,accuratediagnosisiscrucialtodeterminethebestmanagementstrategy,eithersurgicalresectionorsurveillance.However,thecurrentstandardofdiagnosisisnotaccurateenoughduetolimitationsofimagingandtissuesamplingtechniques,whichentailtheriskofunnecessaryburdensomesurgeryforbenignlesionsormissedopportunitiesofprophylacticsurgeryforpotentiallymalignantPCLs.Inthelastdecade,endoscopicinnovationsbasedonendoscopicultrasonography(EUS)imaginghaveemerged,aimingtoovercomethepresentlimitations.ThesenewEUS-basedtechnologiesarecontrastharmonicEUS,needle-basedconfocalendomicroscopy,through-the-needlecystoscopyandthrough-theneedleintracysticbiopsy.Here,wepresentacomprehensiveandcriticalreviewoftheseemergingendoscopictoolsforthediagnosisofPCLs,withaspecialemphasisonfeasibility,safetyanddiagnosticperformance.

简介：包括肠的组织变形(IM)和发育异常(Dys)评估在前列腺干细胞抗原(PSCA)和先进癌症前期的胃的损害的风险的基因多型性之间的关系的目的，基于人口的研究在Linqu被进行县，在中国的胃的癌症(GC)的一个高风险的区域。包括表面的胃炎(SG)的胃的损害的流行，长期的衰退胃炎(CAG)，IM和Dys被组织病理学说的检查决定的方法。遗传型被聚合酶链反应限制决定碎片长度多型性(PCR-RFLP)技术。IM和Dys的风险上的PSCA基因变体的效果被无条件的逻辑回归计算。结果Multivariate分析表明带PSCArs2294008CT/TT遗传型的题目与IM的增加的风险被联系(OR=1.38，95%CI=1.111.71)并且Dys(OR=1.75，95%CI=1.362.26)，特别为有H.pylori感染的题目(IM：OR=1.34，95%CI=1.051.71；Dys：OR=1.82，95%CI=1.372.42)。而且，H。pylori感染和PSCArs2294008CT/TT遗传型被观察联合提高IM的风险(OR=3.32，95%CI=2.334.71)并且Dys(OR=4.58，95%CI=2.997.04)。这研究建议了那PSCArs2294008的结论可能在GC的高风险人口之中影响IM或Dys的风险。

简介：AIM:Toinvestigatethefactorsinfluencingtheoccurrenceofgastricvarioliformlesions(GVLs)andtheirpossiblelinkwithgastriccancer.METHODS:A1:1matchedcase-controlstudywasperformedtoretrospectivelyanalyzedatafrom1638chronicgastritispatientswhohadundergonegastroscopyatoneoftwoChinesehospitalsbetween2009and2014.PatientswithGVLs(cases)werecomparedtothosewithoutsuchlesions(controls).Endoscopicandpathologicalfindingswererecorded,alongwithinterviewinformationonHelicobacterpylori(H.pylori)infection,medical,drugandfamilyhistories,lifestyleandeatinghabits.TheassociationbetweeneachfactorandtheoccurrenceofGVLswasestimated,andthenmultivariateconditionallogisticregressionwasusedtoevaluatetheindependentfactors.RESULTS:Thefrequencyandseverityofglandularatrophy,intestinalmetaplasia(IM)andlow-gradeintraepithelialneoplasiaweresignificantlyincreasedintheGVLgroup(P<0.01).OverallanalysisshowedthatH.pyloriinfection[3.051(2.157,4.317),P<0.001],allergicrespiratorydiseases[3.636(2.183,6.055),P<0.001],work-relatedstress[2.019(1.568,2.600),P<0.001],irregularmeals[2.300(1.462,3.619),P<0.001],highintakeofspicyfood[1.754(1.227,2.507),P=0.002]andhighintakeoffreshfruit[0.231(0.101,0.529),P=0.001]weresignificantlycorrelatedwiththeoccurrenceofGVLs(positively,exceptforthelatter).Stratifiedanalysesindicatedthatpickledfoodconsumptioninpatientsover50yearsold[7.224(2.360,22.115),P=0.001]andexcessivesmokinginmen[2.013(1.282,3.163),P=0.002]werealsopositivelycorrelated,andthat,forantralGVLs,vegetableconsumption[0.491(0.311,0.776),P=0.002]wasnegativelycorrelated.CONCLUSION:SevenriskfactorsandtwoprotectivefactorsaredeterminedforGVLs,whichwerefoundtobeassociatedwithpremalignantabnormalities.

简介：

简介：Objective:ToexaminetheexpressionsofMDM2,P53andP27proteinsinchronicesophagitis,para-cancermucosaandesophagealcarcinoma.Methods:ImmunohistochemistrywasusedtodetecttheexpressionsofMDM2,P53andP27proteinsinforty-sevenpatientssufferingfromchronicesophagitisandeighty-fivecasesofesophagealcarcinomaandcorrespondingpara-cancermucosa.Flowcytometry((FCM)wasappliedtodetectthequantitiesoftheseproteinsexpressedinfreshtissuesof48casesofesophagealcancerandtheirpara-cancertissuesand24casesofrelativenormalmucosaatthesurfaceofcuttingedge.Results:Immunohistochemistryresultsshowedthattheexpressionsofthethreestudiedproteinswereverysimilarintheepitheliaofchronicesophagitisandpara-cancermucosa(P>0.05).BoththequalitativeandquantitativestudiesdisplayedthattheP53proteinhadnoexpressionanditsaccumulationswouldappearonlyintheearlystagesofesophaguscancerationwhiletheMDM2andP27proteinshaddifferentdegreesofexpressionsincasesofnormalesophagealmucosa.MDM2proteinmarkedlyincreasedintheadvancedstagesofesophagealcanceration.AquantitativestudyshowedthattheexpressionofP27proteinhadalinearityofdecreasingtendency(F=9.132,P=0.002)inthecourseofesophagealcanceration.Conclusion:Chronicesophagitismaybeaprecancerouslesion.OwingtothechangesoftheP53andP27proteins,wecanalsoconcludethattheseoccurintheearlystagesofesophagusoncogenesis,howeverthechangesofMDM2expressionmayoccurintheadvancedstageofesophagealcanceration.

简介：

简介：Weobservedthecharacteristicsofwhitematterfibersandgraymatterinmultiplesclerosispatients,toidentifychangesindiffusiontensorimagingfractionalanisotropyvaluesfollowingwhitematterfiberinjury.Weanalyzedthecorrelationbetweenfractionalanisotropyvaluesandchangesinwhole-braingraymattervolume.Theparticipantsincluded20patientswithrelapsing-remittingmultiplesclerosisand20healthyvolunteersascontrols.Allsubjectsunderwentheadmagneticresonanceimaginganddiffusiontensorimaging.Ourresultsrevealedthatfractionalanisotropyvaluesdecreasedandgraymattervolumeswerereducedinthegenuandspleniumofcorpuscallosum,leftanteriorthalamicradiation,hippocampus,uncinatefasciculus,rightcorticospinaltract,bilateralcingulategyri,andinferiorlongitudinalfasciculusinmultiplesclerosispatients.Graymattervolumesweresignificantlydifferentbetweenthetwogroupsintherightfrontallobe(superiorfrontal,middlefrontal,precentral,andorbitalgyri),rightparietallobe(postcentralandinferiorparietalgyri),righttemporallobe(caudatenucleus),rightoccipitallobe(middleoccipitalgyrus),rightinsula,rightparahippocampalgyrus,andleftcingulategyrus.Thevoxelsizesofatrophicgraymatterpositivelycorrelatedwithfractionalanisotropyvaluesinwhitematterassociationfibersinthepatientgroup.Thesefindingssuggestthatwhitematterfiberbundlesareextensivelyinjuredinmultiplesclerosispatients.Themainareasofgraymatteratrophyinmultiplesclerosisarethefrontallobe,parietallobe,caudatenucleus,parahippocampalgyrus,andcingulategyrus.Graymatteratrophyisstronglyassociatedwithwhitematterinjuryinmultiplesclerosispatients,particularlywithinjurytoassociationfibers.

简介：Insularlesionsremainsurgicallychallengingbecauseoftheneedtobalanceaggressiveresectionandfunctionalprotection.Motorfunctiondeficitsduetocorticospinaltractinjuryareacommoncomplicationofsurgeryforlesionsadjacenttotheinternalcapsuleanditisthereforeessentialtoevaluatethecorticospinaltractadjacenttothelesion.Weuseddiffusiontensorimagingtoevaluatethecorticospinaltractin89patientswithinsularlobelesionswhounderwentsurgeryinChinesePLAGeneralHospitalfromFebruary2009toMay2011.Postoperativemotorfunctionevaluationrevealedthat57patientshadnochangesinmotorfunction,and32patientssufferedmotordysfunctionoraggravatedmotordysfunction.Oftheaffectedpatients,20recoveredmotorfunctionduringthe6-12-monthfollow-up,andanadditional12patientsdidnotrecoverovermorethan12monthsoffollow-up.Followingreconstructionofthecorticospinaltract,fractionalanisotropycomparisondemonstratedthatpreoperative,intraoperativeandfollow-upnormalizedfractionalanisotropyinthestablegroupwashigherthaninthetransientdeficitsgrouporthelong-termdeficitsgroup.Comparedwiththetransientdeficitsgroup,intraoperativenormalizedfractionalanisotropysignificantlydecreasedinthelong-termdeficitsgroup.Weconcludethatintraoperativefractionalanisotropyvaluesofthecorticospinaltractscanbeusedasaprognosticindicatorofmotorfunctionoutcome.