Volume 94  ·   Issue 34  ·  2014

To evaluate the clinical values of computed tomography angiography (CTA) for severe hemorrhage after percutaneous nephrolithotomy (PCNL).

A total of 50 patients with bleeding after PCNL were enrolled. All patients underwent renal artery CTA. There were 34 males and 16 females with an average age of 45.7 years. Left (n=31) and right (n=19) sides were affeacted. The criteria of severe bleeding included a one-off amount of bleeding over 400 ml after PCNL or/and hemoglobin decreased 20 g/L after PCNL.

Among them, CTA showed pseudoaneurysm (n=24), arteriovenous fistula (n=6), suspicious bleeding spot (n=4) and no obvious bleeding spot (n=16). And 24 pseudoaneurysm and 6 arterovenous fistula patients underwent digital subtracton angiography (DSA) immediately. The bleeding spots were successfully intervened and coil embolization treatment was performed. Three of 4 suspicious bleeding cases had rebleeding mini-pseudoaneurysms. The remaining one case of rebleeding was successfully controlled by conservative measures.

Renal artery CTA is the first-line screening technique for severe bleeding after PCNL. But for arterial hemorrhage patients, DSA examination may be directly conducted.

To explore the clinical manifestations and biochemical characteristics of patients with ornithine transcarbamylase deficiency (OTCD) so as to increase the clinician awareness for this disease.

The clinical manifestations, blood ammonia levels, citrulline levels, urinary orotic acid and uracil levels were analyzed for 40 patients with OTCD from 2005 to 2013. And comparisons were made with 25 healthy children.

Among them, the median age of onset was 1.4 years (3 days-29 years). The major clinical manifestations were feeding difficulties, persistent vomiting, convulsions, unconsciousness and hyperammonemia, etc. The blood levels of citrulline in these patients were significantly lower than those of the control group(6.35 (1.84-21.11) vs 13.65(10.23-24.52) μmol/L, P<0.05). The urinary levels of orotic acid and uracil in these patients were significantly higher than those in the control group (167.77(1.21-1 650.45) vs 0.25(0-2.32) mmol/molCr, 52.67(3.50-338.64) vs 0.69(0-2.87) mmol/molCr,P<0.05).

For patients with hyperammonemia, the decreased levels of citrulline in blood tested by tandem mass spectrometry and increased orotic acid and uracil in urine on gas chromatography-mass spectrometry may aid the diagnosis OTCD.

To explore the expression of cancerous inhibitor of PP2A(CIP2A)and evaluate its role in bladder cancer.

RT-PCR was used to detect the expression of CIP2A mRNA from 38 cases of patients with bladder cancer and 12 cases of normal bladder tissue. The CIP2A protein expression levels in 99 cases of patients with bladder cancer and 12 cases of normal tissue was detected by immunohistochemical staining.And the serum contents of CIP2A protein of 38 patients with bladder cancer and 40 normal controls were detected by ELISA.

The expression of CIP2A mRNA was detected in 29/38 cases (76.32%) of bladder cancer. And there was no expression in normal tissue (P<0.05). The positive rate of CIP2A protein was 63.64% in 99 cases of bladder cancer tissues and no expression detected in normal tissues(P<0.05). ELISA results showed that the serum content of CIP2A in patients with bladder cancer was significantly higher than that in normal controls(median: 0.015 2 vs 0.001 8 ng/L,P<0.05).

The tissue and serum expressions of CIP2A in patients with bladder cancer are higher than those in normal controls. And CIP2A may be used as an indicator of the biological behavior of bladder cancer.

To explore the sensitivity, specificity and clinical validity of fetal Rh genotyping from maternal blood.

A comprehensive literature search of PubMed, Embase and Web of Science was performed for describing fetal RhD determination from maternal blood. The inclusion criteria were established based on the validity criteria for diagnostic research. And the eligible entries were collected and analyzed with MetaDisc4.0.

This meta-analysis included 55 studies with a total of 17 138 samples. The random-effect model was used for analysis because of heterogeneity. The pooled sensitivity and specificity were 98.5% and 97.3% respectively. The SROC curve was plotted and the area under the curve (AUC) calculated (AUC=0.994). The subgroup and sensitivity analyses were performed. The sensitivity of 25 studies with samples<100 (94.6%) was significantly lower than those of 19 studies with samples 100-300 (98.5%) and 11 studies with samples>300 (99.0%) (χ²=36.800, 106.062, P<0.05). The sensitivity of 19 studies with samples 100-300 (98.5%) was not different from that of 11 studies with samples >300 (99.0%)( χ²=3.068, P>0.05).

Noninvasive prenatal diagnosis of fetal RhD status from maternal blood represents a significant achievement in the application of research with high sensitivity and specificity. It may be applied for screening testing of all RhD^-negative pregnant women.

To investigate the safety and efficacy of low intensity anticogulation therapy for chinese population underwent heart valve replacemnt.

From January 1999 to October 2010, the literatures concering anticoagulation therapy for chinese population with heart valve replacement were researched in following databases: CBM, CNKI, VIP, Pubmed as well as cochrane library. Screening and quality evaluation was conducted according to the inclusion and exclusion criteria. Meta-analysis of control studies and descriptive analysis of descriptive studies were conducted.

Total 61 articles were reviewed, including 4 control studies and 57 descriptive studies. Both Meta analysis and descriptive analysis results showed also that the rates of total anticoagulation-related complications as well as bleeding events were significantly decreased in patients receiving low intensity anticoagulation therapy in compared with classical intensity strategy(RR=-0.06, 95%CI: -0.08--0.03, P<0.001;RR=-0.06, 95%CI: -0.08-0.04, P<0.001), while no significant differeces were noted as for risk of thrmoboembolic events among two different intensity groups(RR=0.01, 95%CI: -0.01-0.03, P>0.05).

Low intensity anticoagulation therapy(INR≤2.5) could effectively miminze the anticoagulation-related hemorrhage and mortality rates and while without increasing the rates of thrmoboembolic event. This therapy was safe, effective and suitable for the coagulation characteristics of Chinese population.

To evaluate the efficacy and safety of tigecycline in treating secondary infections of patients with hematological diseases.

A total of 85 cases of hematological patients with secondary infections were classified into empirical and targeted therapy groups. Empirical therapy group was composed of patients receiving tigecycline as an alternative due to ineffective anti-infection treatment for 3-5 days in the absence of microbiological evidence while those taking tigecycline based on microbiological evidence belonged to targeted therapy group. Dosage regimen of tigecycline: loading dose 100 mg, 50 mg every 12 hours as maintenance therapy for 2-4 weeks.

Among them, except for 11 cases of bloodstream infections and 2 cases of fever for unknown reasons, the most common site for infection was lower respiratory tract. Among 45 isolated bacterial strains, Stenotrophomonas maltophilia (40%) was the most commonly seen while extended spectrum beta-lactamases (ESBLS)+ multidrug resistant gram negative bacilli 15.6%. Among 5 bacterial strains, there were 3 methicillin-resistant Staphylococcus aureus+ golden staphylococci strains and 2 excrement enterococci. The total effective rate of tigecycline was 72.9%. And the bacterial clearance rates of acinetobacter baumannii, ESBLS+ gram-negative bacillus and stenotrophomonas maltophilia were 85%, 70% and 55% respectively. The effect of tigecycline was equivalent for two groups. Pneumonia patients obtained an effective rate of 71%, compared to those with bloodstream infections (54.5%). For patients whose absolute neutrophil counts were less than 0.2×10⁹/L, the effective rate decreased obviously (45% vs 81.5%, P=0.003). Adverse reaction was mild due to mostly gastrointestinal symptoms.

Tigecycline is a new treatment choice in treating secondary multidrug resistant infections of patients with hematological diseases. Empirical therapy of tigecycline may improve the therapeutic efficacy of patients non-responding favorably to conventional anti-infectives.

To summarize the experiences of using continuous renal replacement therapy in the treatment of myonephropathic metabolic syndrome caused by acute lower limb ischemia.

Retrospective study of patients diagnosed acute lower limb ischemia with surgical treatment between January 2008 and December 2013, among which 22 patients with myonephropathic metabolic syndrome received continuous renal replacement therapy. Summarize the change tendency of myoglobin, urine volume and serum creatinine levels during treatment and analysis the condition changes and prognosis of the patients.

Among them, 2 patients were amputated and two died after surgery. The major causes of death were acute renal failure, metabolic acidosis, circulation failure and liver failure, etc. Myoglobin was significantly higher at Day 1 after surgery than that was before surgery (P<0.05). Urine volume was significantly lower at Day 1 after surgery than that on the day of surgery (P<0.05). CK was significantly lower at Day 2 after surgery than the day before (P<0.05). Hemoglobin was significantly lower at Day 1 after surgery than that before surgery (P<0.05). Serum creatinine levels remained steady.

In patients of acute lower limb ischemia with myonephropathic metabolic syndrome, early targeted continuous renal replacement therapy may decrease the serum concentrations of myoglobin and CK, improve urine volume, maintain homeostasis, prevent renal function deterioration and improve the prognosis of patients. And it is highly recommended.

To evaluate the risk factors for non-sentinel lymph node(NSLN) metastasis in patients after neoadjuvant chemotherapy(NCT)so as to develop a new predictive model.

A total of 512 consecutive patients with metastasis in sentinel lymph node(SLN) on neoadjuvant chemotherapy between August 2005 and March 2013 were recruited to evaluate the factors affecting the involvement of NSLN. Logistic regression analysis was performed to construct a predictive model.

There were 115(22.4%) patients with metastasis in NSLN after axillary lymph node dissection. Univariate analysis showed that tumor size, number of positive SLN, hormone receptor(HR), micrometastasis and clinical response of primary tumor after NCT were associated with the involvement of NSLN(P<0.05). Multivariate analysis indicated that tumor size, number of positive SLN, HR, micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis. Area under the curve was 0.779.

Tumor size, number of positive SLN, HR, micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis in patients after NCT. The new model is to be further validated.

To explore the expression level and clinical significance of interleukin-11 (IL-11) in the tissue and serum samples of in breast cancer bone metastasis patients.

Peripheral blood samples were collected from 180 breast cancer patients at Tianjin Medical University Cancer Hospital from May 2007 to January 2009 and confirmed by histological pathology. According to the occurrence of bone metastases, they were divided into 2 groups of bone metastasis (MBC-B) and without bone metastasis (PBC) (n=90 each). Another 20 healthy controls were selected from the same hospital during the same period after excluding a history of endocrine and metabolic diseases and other chronic diseases. Peripheral blood samples were collected to detect the expression level of IL-11 by enzyme-linked immunosorbent assay. At the same time, tumor tissue samples were collected from 40 breast cancer patients with bone metastasis and 40 breast cancer patients without bone metastasis. And their complete archive data were available. The expression levels of IL-11 in tumor tissue samples were detected by tissue chip and immunohistochemistry. The IL-11 mRNA expression levels of different breast tissue samples were analyzed by fluorescent quantitative reverse transcription-polymerase chain reaction (RT-PCR). Independent prognostic indicators of postoperative patient survival were screened and layered by the median level of serum concentration. Log-rank test was employed for survival analysis.

The serum concentrations of IL-11 in MBC-B, PBC and healthy control groups were (242.9±56.3), (85.9±35.7) and (66.4±20.3) μg/L. And it had statistically significant difference ( F= 43.532, P<0.05); MBC-B group was significantly higher than PBC group (t=40.44, P<0.001). High expression rates of IL-11 were 57.5% and 14.3% in MBC-B and PBC groups. MBC-B group was significantly higher than PBC group (χ²=36.626, P<0.01). The survival time of breast cancer patients with bone metastases and high levels of IL-11 was 25.2 months and it was shorter than those with bone metastases and low levels of IL-11 (44.6 months). The difference was statistically significant (χ²=9.550, P<0.01).

The expression level of IL-11 is associated with the occurrence of bone metastasis in breast cancer. And breast cancer with a high expression level of IL-11 may be more susceptible to bone metastases.

To analyze the esophageal motility characteristics of refractory heartburn with different reflux patterns and preliminarily clarify the roles of esophageal disorder in refractory heartburn.

A total of 176 refractory heartburn patients were enrolled from 2009 to 2013. After gastroscopy and 24 hour pH-impedance monitoring, they were divided into 4 groups of reflux esophagitis (RE, n=29), non-erosive reflux disease with acid reflux (NERD-acid, n=51), NERD with weakly acidic reflux (NERD-weakly acid, n=51) and non-reflux associated heartburn (n=45). All subjects undertake high resolution manometry test and their esophageal motility functions were analyzed by the Chicago classification criteria 2012.

Among them, 60.23% (106/176) patients presented esophageal motility disorders. And 42.61% (75/176) fulfilled the criteria of weak peristalsis, 7.39% (13/176) distal esophageal spasm, 4.55% (8/176) rapid contraction, 3.98% (7/176) EGJ outflow obstruction, 1.14% (2/176) hiatus hernia and 1 Jackhammer esophagus. The detection rates of esophageal motility disorder were similar among 4 groups and weak peristalsis was the most common disorder in all groups (41.38% in RE, 37.25% in NERD-acid patients, 54.90% in NERD-weakly acid and 35.56% in non-reflux associated heartburn patients). However, hypertensive motility disorders in non-reflux associated heartburn group (31.11%, 14/45) were more than GERD subgroups (11.45%, 15/131)(P<0.05). The relax ratio of low esophagus sphincter (LES) in GERD subgroups were higher than that in non-reflux associated heartburn patients. And the relax ratio of NERD-weakly acid was significantly higher than that in non-reflux associated heartburn patients (65%(50%-80%)vs 58%(42%-67%),P<0.05). The integrated relaxation pressure in GERD subgroups were lower than that of non-reflux associated heartburn patients without significant differences (P>0.05).

Esophageal weak peristalsis is one of the most common motility disorders in refractory heartburn patients, and esophageal hypertensive motility disorders are common in non-reflux associated heartburn patients. Esophageal manometry is necessary for the diagnosis and treatment of refractory heartburn.

To observe the effects of normal human renal fibroblast (NHRF) on renal cell carcinoma cell lines.

Renal cell carcinoma (RCC) cell lines 786-O and Caki-1 were co-cultured with NHRF for assessing the proliferation and migratory capacities of renal cell carcinoma cell lines and the sensitivity to everolimus.

Co-culturing with NHRF substantially increased the proliferation capacity of both RCC cell lines (786-O: 2.35±0.05 vs1.93±0.15, P=0.01; Caki-1: 2.35±0.21 vs 1.24±0.11, P=0.001). Similarly the migratory capacities of both cell lines became significantly enhanced after co-culturing (786-O: 1.53±0.11 vs 0.98±0.11, P=0.04; Caki-1: 1.53±0.11vs 0.98±0.11, P=0.04) compared with untreated control. Furthermore, the sensitivities of both cell lines to everolimus (1, 5, 10 μmol/L) dramatically decreased in those pre-co-cultured with NHRF (786-O: P value 0.04, 0.35, 0.18); Caki-1: P value 0.02, 0.03, 0.024).

NHRF promotes the proliferation and migration capacities of 786-O and Caki-1. And it may be involved in the resistance of RCC to everolimus.

To explore the effects of smoking on airway inflammation through the expressions of hypoxia-inducible factor-1α (HIF-1α) and histone deacetylase-2 (HDAC2) in asthmatic mice.

A total of 30 female SPF BALB/c mice were divided randomly into 3 groups of control (C), asthma (A) and smoking asthma (S). The latter two groups were sensitized and challenged with ovalbumin (OVA) for asthmatic modeling. The mice of group S were placed into a self-made fumigating box for passive smoking. While group S was sensitized and challenged with normal saline instead of OVA. The pathological changes of different groups were observed. The different cell counts of bronchoalveolar fluid (BALF) were analyzed. The expressions of HIF-1α and HDAC2 were detected by immunohistochemistry. The level of interleukin (IL)-8 in BALF was detected by enzyme-linked immunosorbent assay (ELISA). And the levels of HIF-1α and HDAC2 in lung homogenate were measured by Western blot.

The ratios of eosinophil (EOS) to total cell numbers of BALF in groups A and S were significantly higher than that in group C ((8.90±1.60)%, (7.52±0.63)% vs (0.60±0.10)%, both P<0.01), while the ratio of neutrophile (NEU) in group S was higher than that in group A ((18.24±5.19)% vs (8.46±1.58)%,P<0.01). Western blot showed that HIF-1α expressions in lung homogenate of groups A and S were significantly elevated than that in groups C (0.144±0.008, 0.238±0.015 vs 0.081±0.005, bothP<0.01). While the HIF-1α level of group S was higher than that of group A (P<0.01). And the expressions of HDAC2 in groups A and S significantly decreased than that in group C (0.287±0.008, 0.164±0.015 vs 0.452±0.041, bothP<0.01). While the HDAC2 level of group S was lower than that of group A (P<0.01). The BALF level of IL-8 in group S was higher than those in groups A and C ((42.07±4.54) vs (21.66±2.78), (14.33±3.73) pg/ml, bothP<0.01). There were significantly negative correlations between the expressions of HIF-1α and HDAC2 (r=-0.950, P<0.01) in lung as well as HDAC2 in lung and IL-8 (r=-0.855, P<0.01)in BALF.

Cigarette smoking aggravates the airway inflammation through a down-regulated expression of HDAC2 by activating HIF-1α.

To explore the effects of mannose-binding lectins (MBL) in pulmonary aspergillosis.

A total of 96 adult Wistar rats were randomly divided into 3 groups of aspergillus fumigatus (A.fumigatus) pulmonary, colonization and normal (n=32 each). An intramuscular injection (0.6 mg/kg×3 d) of dexamethasone sodium phosphate and a nostril drop (1×10⁷ cfu/ml)were administered for modeling. The animals were sacrificed at Days 3, 7, 14 and 28 post-inoculation and blood samples were obtained by cardiac puncture for MBL detection. Lung tissues were prepared for routine pathology examinations. The lung tissues infected with A. fumigatus showed remarkable inflammatory reactions. The serum value of MBL was detected by enzyme-linked immunosorbent assay (ELISA). And the results were compared and analyzed.

All infected lung tissues showed remarkable inflammatory reactions. The serum MBL levels of A. fumigatus pulmonary and colonization groups were (8.57±0.88) and (7.87±0.45) ng/ml and both significantly increased compared with non-pulmonary aspergillosis group (P<0.05). The area under the curve was 0.744 (P=0.002). The diagnosis of MBL had a sensitivity of 75.0%, a specificity of 86.7%, a positive predictive value of 87.1% and a negative predictive value of 74.3% for pulmonary aspergillosis.The inflammatory cells infiltration were detected in pathology in infection and colonization groups at Day 3 and Day 7.

The detection of serum MBL may be used for the diagnosis of pulmonary aspergillosis.

To explore the absence of CD4⁺ T cells, naïve CD8⁺ T cells and memory CD8⁺ T(CD8⁺ Tm) cells in the role of mediated acute graft rejection and discuss its possible mechanism.

Mice were randomly divided into three groups (n=6). And at Day 2 pre-transplantation, two types of cells (CD8⁺ T cells (CD8⁺ T group) or CD8⁺ Tm cells(CD8⁺ Tm group) ) were transferred into nude mice (1×10⁶ cells/one mice) via tail vein injections. At Day 0, C57BL/6 mice were used as donors for cervical heterotopic heart transplantation with nude mice as recipients(control group without transplantation). The survival of transplants was recorded and the mean survival time (MST) calculated. Then at Day 10 post-transplantation, the recipient′s heart graft, spleen and lymph node were collected for immunological detections. And the ratio of CD8⁺ cells in spleen and lymph nodes and serum levels of IL-2 in recipients were tested.

In the group of adoption naïve CD8⁺ T cells and heart grafting, there was no occurrence of acute graft rejection(MST>60 d), while in the group of adoption memory CD8⁺ Tm cells and heart grafting, there was serious rejection(MST: (8.9 ± 0.5) d) (P<0.01). In the group of adoption naïve CD8⁺ T cells and heart grafting, cell proliferation of transferred CD8⁺ T cells in spleen and lymph node showed no statistical difference compared with non-transplanted mice (2.70%±0.08% vs 2.27%±0.22%, 3.41%±0.25% vs 2.80%±0.62%, both P>0.05). However, in the group of adoption CD8⁺ Tm cells and heart grafting, cell proliferation of transferred CD8⁺ Tm cells in spleen and lymph node showed significant statistical difference with non-transplanted mice(9.65%±0.60% vs 2.12%±0.18%, 11.15%±1.35% vs 3.03%±0.10%, both P<0.01). The levels of IL-2 secretion before and after transplantation, naïve CD8⁺ T cells showed no statistical difference(P>0.05), CD8⁺ Tm cells showed significant statistical difference(P<0.01).

In the absence of CD4⁺ T lymphocyte helping, naïve CD8⁺ T cells can not activate and show immunological functions. But memory CD8⁺ T can activate, proliferate and generate effector cells to mediate immune response.

At present, most clinical microbiology laboratories in China still adopt traditional identification methods, such as API or Vitek system, but time consumption, high cost and limited identification capability are obvious bottlenecks. 16S rDNA sequencing can directly identify sterile specimens, but the standardization of the method, specimen pretreatment and timeliness have not been solved, so it is difficult to become a routine technology. In 2006, Fox^[1]InJournal of Clinical MicrobiologyPublished the first article on the application of mass spectrometry technology in clinical microorganisms, which attracted the attention of peers. He believes that there are still many technical difficulties to overcome in the identification of bacteria by this technology, and it is not easy to become a conventional method. However, after 2009, microbial mass spectrometry technology quickly swept into Europe, North America and some countries in Asia. Matrix-assisted laser desorption ionization ion source and time-of-flight mass analyzer mass spectrometry (matrix-assisted laser desorption ionization time of flight mass spectrometry, MALDI-TOF MS) The technology meets the expectations of microbiologists: simple operation, rapid identification, low running cost and automatically updated database^[2]。 It is particularly outstanding in the identification of microaerobic bacteria, anaerobic bacteria, fungi and mycobacteria, which are difficult to culture. The identification time is advanced from several days to minutes and seconds. New developments, such as direct identification of sterile fluids, drug-resistant phenotype identification, pathogenic toxin analysis and genetic tracing of nosocomial infection pathogens, are even more encouraging^[3,4]。

Obesity in children and adolescents has become a global public health concern^[1]And often to adulthood. The incidence of metabolic syndrome increases with increasing obesity rates. Habitual sleep length is associated with type 2 diabetes, epidemiological study finds^[2,3]Occurrence of heart disease^[4]And even related to case mortality^[5,6,7]。 The sleep length of children and adolescents declined continuously in the past 20~30 years, and the decrease of sleep length was parallel to the increase of body weight^[1,8]。 The relationship between children's sleep length and metabolic syndrome has become a hot topic. Recent research progress on sleep length and metabolic syndrome in children and adolescents is reviewed below.

A 71-year-old male was seen on November 8, 2010 due to painless full-course macroscopic hematuria for 10 days without obvious trigger. He has been in good health and has no symptoms of urinary system diseases such as frequent urination, urgency, painful urination, dysuria, low back pain, abdominal pain and abdominal distension. Serum prostate specific antigen (PSA) 1.7 μ g/L. B-ultrasound showed: bladder occupation, prostatic hyperplasia. CT showed that there was a nodule about 15 mm ×17 mm in size in the posterior wall of the bladder, which was enhanced followed by enhancement, and the CT value was about 60 HU (Figure 1), the prostate was slightly enlarged with calcification, there were no abnormalities in the seminal vesicles on both sides, no effusion in the pelvic cavity, and no obvious lymph node swelling around the pelvic wall and retroperitoneum. On November 23rd, transurethral plasma resection of bladder tumor was performed under general anesthesia. During the operation, a spherical pedicled mass with a diameter of about 20 mm was seen at 12 o'clock of the bladder neck, and the pedicle was connected to prostate tissue. The hyperplasia of both lobes of the prostate was obvious, and the bladder tumor resection plus prostate resection was immediately changed and sent for pathological examination. HE morphological characteristics: The bladder mass is similar in shape to prostate lesions under the microscope. The tumor consists of a small solid nest and a slightly larger nest with a nest-like structure with a single or multiple cystic cavities in the center. The tumor cells around the nest are arranged in a palisade shape (Figure 2)； The acinar cavity of the dysplastic prostate contains eosinophilic substances; Some nested structures contain multiple cystic cavities in the center, and the cystic cavities contain light blue mucoid substances, which are mesh-like structures, like adenoid cystic carcinoma; The tumor cells are round or oval, the size is more consistent, the nucleus is dark stained, the mitotic image can be seen, and necrosis is not seen. Immunohistochemistry showed that the expression of 34 β E-12 and p63 in basal-like tumor cells was strong (+), and the glandular epithelial cells near the lumen surface were weakly positive or negative; The expression of CK7 in glandular epithelial cells near the luminal surface was strong (+), but the expression of CK7 in basal-like tumor cells was negative; The remaining CK20, P504S, PSA and PSAP were all negative; The proliferation index of Ki-67 was 5%, and the pathological diagnosis: basal cell carcinoma of the prostate (BCC), infiltrated into the mucosal layer of the bladder. The patient was given postoperative radiotherapy, anti-tumor therapy with Xiaoaiping tablets and endocrine therapy with oral flutamide tablets. The patient was followed up for 27 months. The patient was in good condition, and no tumor recurrence or metastasis was observed.

A 46-year-old female was found to have two painless masses about the size of "broad beans" on her right neck in early April 2013, accompanied by fever and weight loss. She went to a local hospital and felt that the masses were smaller than before after 10 days of treatment. In June, the mass increased again as the size of a "ping-pong ball", without fever, nausea, vomiting, etc., and was not treated. In August, the supraclavicular, subclavicular, axillary and inguinal lymph nodes gradually swelled, accompanied by afternoon fever, and went to the local hospital again for cervical lymph node biopsy. The pathological report considered peripheral T lymphoma, and the bone marrow biopsy showed abnormal lymphocytes, which was considered lymphoma. On August 21st, he came to our department for consultation and performed cervical lymph node puncture again for examination to consider lymphoma. It was recommended that the patient take intact lymph nodes for examination. On September 28th, the patient had local pain in swollen lymph nodes in the neck, accompanied by anorexia, abdominal distension, fatigue, blood in sputum, etc., so he underwent bone marrow puncture and inguinal lymph node resection in our hospital on the same day.