Volume 98 ·  Issue 36 ·  2018

Coronary artery bypass grafting (CABG) has become a routine treatment for coronary heart disease, with low complication rate and good safety. However, the problem of venous bridge stenosis after CABG has been paid more and more attention. In the past 20 years, with the deepening of coronary angiography follow-up, the patency rate of arterial bridges was significantly better than that of great saphenous vein (SVG) bridges. The occlusion rate of SVG bridges occurred in 10% ~20% in the first year, and the occlusion rate increased by 5% every year^[1,2,3,4,5]。 In the SYNTAX study, almost all patients undergoing CABG underwent at least one artery graft compared with percutaneous coronary intervention (PCI), and 35.3% of patients underwent multiple artery graft. The use rate of multiple artery graft in the United States is low, only 17%^[6]。 In the past few decades, most surgeons in the United States have used only a single vessel bridge from the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), and the remaining target vessels are still SVG bridges. The average multi-vessel bridge utilization rate in the Adult Cardiac Surgery Database (ACSD) of the North American Society of Thoracic Surgeons (STS) is about 7%^[7]。

PTE and DVT are collectively referred to as VTE. The thrombus causing PTE mainly originates from DVT in the lower extremities, and PTE is a complication of DVT. PTE and DVT have the same predisposition factors and are two clinical manifestations of VTE at different sites and stages.

To investigate the expression of tumor necrosis factor alpha-inducible protein 8 like-2 (TIPE2) and tissue factor (TF) in patients with bronchial asthma. And to explore the regulation of TIPE2 on TF.

Sixty-five asthmatic patients and 40 healthy controls were selected from the First Affiliated Hospital of Zhengzhou University from July to November, 2017. The expression of TIPE2 and TF in peripheral blood mononuclear cells of asthmatic patients and healthy controls were detected by Western blot.The level of TF protein in plasma was detected by enzyme-linked immunosorbent assay. The changes of TIPE2 and TF mRNA expression in THP-1 cells stimulated by house dust mite extract were detected by real-time fluorescence quantitative PCR (RT-PCR). The recombinant adenovirus Adv-TIPE2 was constructed and transfected into THP-1 cells and the effect of over-expression TIPE2 on TF expression in THP-1 cells was detected by RT-PCR.

The relative level of TIPE2 protein in asthmatic patients and healthy controls was 0.025±0.010 and 0.087±0.070, while that of TF was 0.40±0.27 and 0.15±0.10, respectively. Compared with healthy controls, the levels of TIPE2 protein decreased and TF protein increased in asthmatic patients, the differences were statistically significant (t=-5.06, 9.04, P<0.05) . TIPE2 protein level was negatively correlated with TF protein level (r=-0.460 3, P<0.05). The house dust mite extract reduced the expression level of TIPE2 mRNA in THP-1 cells, but increased the level of TF mRNA expression. When the concentration was 1 μg/ml, the change of TIPE2 mRNA was the most obvious at 4 h (P<0.05). The recombinant adenovirus Adv-TIPE2 was successfully constructed. The level of TF mRNA expression in THP-1 cells over-expressing TIPE2 gene was reduced (P<0.05).

TIPE2, a negative regulator of inflammation, has a negative control effect on TF, and may be involved in the hyper-coagulable state of bronchial asthma by regulating TF expression.

To clarify distribution and drug resistance characteristics of anaerobes isolated from clinical infectious samples, and to provide experimental data for guiding on treatment of infections caused by anaerobes.

The anaerobes, isolated from 1 057 different clinical specimens from inpatients admitted to the Affiliated Hospital of Inner Mongolia Medical University from March 2016 to November 2017, were identified by VITEK-2 anaerobes and corynebacterium (ANC) card and bacteroides fragilis isolates were further verified by 16S-rRNA sequencing. Meanwhile, broth dilution method was employed to detect the drug sensititities of bacteroides fragilis and PCR method was used to detect the carbapenem resistance gene cfiA.

Totally 303 strains of anaerobic bacteria were isolated, among which 199 strains were gram-negative bacteria, accounted for 65.68%. Among the gram negative anaerobes, bacteroides species were the most common, accounted for 35.64%, followed by prevotella spp., which accounted for 19.14%. B. fragilis were the most common among Bacteroides spp., accounted for 21.54%, followed by Prevotella bivia, accounted for 5.94%. The coincidence rate of 16S-rRNA sequencing results of Bacteroides fragilis and that of ANC card identification results was 100% (65/65). The drug resistance of B. fragilis to penicillin, clidamycin, ampicillin/sulbactam, amoxicillin/clavulanic, were 100%, 90.77%, 56.92% and 66.67%, respectively. The resitance rate of B. fragilis to chloramphenicol was the lowest, which was 1.54%.Moreover, the resistance rate of B. fragilis to imipenem and metronidazole were both higher, which were 38.46%(25/65) and 23.08%(15/65), respectively, and the positive rate of beta lactamase was 100% (65/65). The carrying rate of carbapenems resistance gene cfiA for 65 strains of Bacteroides fragilis was 52.3% (34/65), and 72.00%(18/25)for imipenem resistant strains.

The obligate anaerobic bacteria are widely distributed in clinical specimens, and the great majority are gram negative anaerobic bacteria, and the most frequently isolated one is Bacteroides fragilis. Bacteroides fragilis isolates are found to be resistant to several kinds of common antibiotics, especially for imipenem and metronidazole, which should be given more attention to.

To investigate the relationship between the expression of stem cell markers CD44 and Lgr5 and the clinicopathological features, lymph node and liver metastasis, and to analyse the value of both in evaluating the prognosis of colorectal cancer.

A total of 90 cases of colorectal cancer, 20 cases of adjacent tissues, 30 cases of lymph node metastases, 28 cases of cancer nodules and 30 cases of liver metastasis of colorectal cancer were collected from Department of Pathology of the Second Hospital of Tianjin Medical University from January 2011 to June 2016. The expression of CD44 and Lgr5 protein was detected by immunohistochemistry, and the relationship between them and clinical pathological data, lymph node metastasis and liver metastasis were analyzed.

The positive expression rates of CD44 and Lgr5 in colorectal cancer tissues were 68.9% and 62.2%, which were significantly higher than 30.0% and 15.0% of adjacent tissues(P=0.001 and P<0.001). The expression of CD44 and Lgr5 in colorectal cancer was associated with histological differentiation, depth of tumor invasion, lymph node metastasis, soft tissue nodules, hepatic metastasis, and TNM staging(P=0.021, 0.032, 0.030, 0.011, 0.015, 0.007 and P=0.011, 0.027, 0.017, 0.008, 0.011, 0.021). The positive rates of CD44 and Lgr5 expression in lymph node metastases, cancer nodules and liver metastases (93.3%, 89.3%, 90.0%, and 83.3%, 89.3%, 86.7%) were higher than those in the primary lesions(68.9% and 62.2%)(P=0.007, 0.032, 0.022 and P=0.033, 0.007, 0.013). There is a positive correlation between the expression of CD44 and Lgr5 in colorectal cancer(r=0.615, P<0.001), and both positive expression of CD44 and Lgr5 is associated with histological differentiation, lymph node metastasis and cancer nodules, liver metastasis and TNM staging(P=0.005, 0.003, 0.003, 0.026, 0.014). The Kaplan-Meier survival curve showed that the survival rate of positive expression of CD44 and both positive expression of CD44 and Lgr5 in patients with colorectal cancer was low(P=0.030 and 0.001). Log-rank univariate survival analysis showed that histological differentiation, depth of invasion, lymph node metastasis, liver metastasis, and clinical stage were the influencing factors of postoperative survival time(P=0.035, 0.035, 0.018, 0.016, 0.004). Cox proportional hazards regression model multivariate analysis showed that both positive expression of CD44 and Lgr5, lymph node metastasis, liver metastasis, and clinical stage were independent factors affecting the prognosis of patients with colorectal cancer(P=0.004, 0.044, 0.031, 0.008).

The expression of CD44 and Lgr5 is related to the malignant biological behavior of colorectal cancer, and they are important factors in promoting local and distant metastases. Both positive expression of them have a hint of bad prognosis.

To analyze the associated factors of intraoperative hemodynamic instability (HI) in patients with incidental pheochromocytomas.

The data of 104 patients with a pathological diagnosis of pheochromocytoma at Chinese PLA General Hospital between January 2011 and December 2016 was retrospectively analyzed. The patients were divided into hemodynamic stability (HS) group (n=56) and HI group (n=48) according to hemodynamic characteristics. The clinical features, biochemical test, preoperative and intraoperative hemodynamics were analyzed. Multivariate logistic regression analysis was used to explore the associated factors of HI.

The age [(44.7±12.7) years vs (52.1±12.8) years], tumor diameter [(47.9±16.3) mm vs (57.9±21.6) mm], preoperative blood pressure [(121.3±11.5) mmHg vs (127.2±13.3) mmHg] in HS group were less than those in HI group (allP<0.05). The proportion of age ≥ 50 years (28.6% vs 64.6%), tumor diameter ≥ 45 mm (48.2% vs 68.8%) and hematocrit < 0.38 (25.0% vs 51.3%) in HS group were less than that in HI group (allP<0.05). Multivariate logistic regression analysis indicated that age ≥ 50 years (OR=7.940, 95% CI: 2.480-25.417, P<0.001), tumor diameter ≥ 45 mm (OR=5.042, 95% CI: 1.482-17.156, P=0.010), blood pressure ≥ 130/80 mmHg (OR=3.127, 95% CI: 1.034-9.463, P=0.044) and hematocrit < 0.38 ( OR=6.273, 95% CI: 1.893-20.788, P=0.003) were independent associated factors of HI. The proportion of HI ( χ ²=9.033, P=0.003) and intensive care unit (ICU) admission ( χ ²=16.641, P<0.001) increased along with increasing associated factors.

Adequate preoperative medical preparation and volume expansion for appropriate blood pressure are important for elder patients with large tumor to prevent HI in patients with incidental pheochromocytomas.

To investigate the clinicopathologic features of lipoprotein glomerulopathy (LPG).

A total of 6 cases (5 males and 1 female, with a mean age of 27.5 years and age range of 11-53 years) of lipoprotein glomerulopathy with complete clinicopathologic data were enrolled. Except for light microscope, immunofluorescence and electron microscopic examination, renal biopsy tissues were checked by oil red O staining. The gene map of apolipoprotein E (ApoE) of 2 cases were analyzed.

All 6 cases presented with heavy proteinuria or nephrotic syndrome, and high level of low-density lipoprotein (LDL), very low-density lipoprotein (vLDL), ApoE. Family history of LPG was found in 3 cases, and 2 patients progressed to uremia, or even to death. Pathologic features showed that lipoprotein deposited in glomerulus capillary lumen and renal tubular epithelial cells. Gene analysis demonstrated that 2 cases expressed abnormal ApoE gene (162G>C and 455G>C).

Lipoprotein glomerulopathy is autosomal-recessive disease with mutation of ApoE. Common clinical manifestations of LPG are heavy proteinuria or nephrotic syndrome, with a poor prognosis. Renal biopsy pathologic diagnosis can confirm this kidney disease. Emboli of lipoprotein being observed in glomerulus capillary lumen is the pathological feature of LPG.

To evalute the clinical outcomes of intracytoplasmic sperm injection(ICSI) for infertility male with severe asthenospermia induced by multiple morphological anomalies of the flagella (MMAF).

The clinical data of 15 patient with MMAF were retrospectively analyzed, who underwent ICSI treatment using hyponotic swelling test the "live" sperm in the Department of Reproductive Medicine of Yantai Yuhuangding Hospital from January 2011 to December 2016. Another 30 obstructive azoospermia (OA)patients are matched strictly who also accepted ICSI in the same treatment time. The two groups were compared in the couples′age, the body mass index(BMI), the duration of infertility, the retrieved oocytes, the number of ICSI oocytes, and the rates of fertilization, cleavage, transferrable embryos, good embryos, embryos implanted, clinical pregncncy, early abortion, singleton and twins.

After 27 cycles of ICSI, all of the MMAF patients achieved clinical pregnancy, including 11 cases of live birth, 2 cases of spontaneous abortion, and 2 cases of pregnancy maintenance. There were no significant difference between MMAF and OA groups in the couples′age and BMI, or the numbers of retrieved oocytes and ICSI oocytes(P>0.05), but the differences in the infertility duration had statistical meaning(P<0.001). No statistical differences were observed among groups in ICSI fertility rate(92.0% vs 91.6%), clesvage rate(95.4% vs 96.5%), high-quality embryonic rate(56.5% vs 57.5%), good blastocyst rate(23/61 vs 35/94), embryo implantation rate(20/48 vs 35/75), early abortion rate(4/19 vs 8/36), clinical pregncncy rate(15/27 vs 28/50), singleton rate (10/13 vs 20/25)and twinning rate(3/13 vs 5/25)(P>0.05).

MMAF may not affect ICSI treatment outcomes, but genetic defects can be transmitted through ICSI. The affected couples should be informed of the necessity of prenatal genetic diagnosis before embryo implantation and the inevitable vertical transmission of genetic problems to the offspring.

To analyze the clinical characteristics of hereditary coagulation factor Ⅴ deficiency (FⅤD) and to improve the diagnosis and treatment ability of hereditary FⅤD.

A total of 17 patients with hereditary FⅤD admitted to the Department of Hematology, Peking University People′s Hospital from February 2013 to January 2018 were selected, and their clinical characteristics, laboratory examination, treatment and prognosis were retrospectively analyzed.

There were 9 males and 8 females patients with FⅤD, the median age was 36 (1-72 ) years. The median age of men was 39 (1-72)years, and the median age of women was 33 (8-56)years. There was no significant difference between them (P=0.793). The median prothrombin time(PT) and activated partial thromboplastin time(APTT) values were 21.0(13.0-39.6) s and 54.6(38.2-121.2) s, and the median level of plasma FⅤ was 8.2% (0.9%-39%). Thirteen cases (13/17) were mild, 3 cases (3/17) were moderate, and only 1 case (1/17) was severe according to the FⅤ level. Five cases (5/17) had bleeding, including 3 cases with skin ecchymosis, 1 case with vaginal bleeding, and 1 case with gastrointestinal bleeding. According to the severity of bleeding, 1 case (1/17) had severe bleeding, and the other 4 cases (4/17) were mild bleeding.

Patients with hereditary FⅤD either have or do not have bleeding symptoms, with prolonged PT and APTT and decreased plasma of FⅤ activity. There is no need for treatment for those without bleeding symptoms. Fresh frozen plasma is the first choice for patients who have bleeding, and the overall prognosis is good.

To report the epidemiological and clinical characteristics of liver hemangioma in health adults from a large sample of Health Examination Database.

A retrospective study was performed to analyze the epidemiological and clinical Characteristics of liver hemangioma from people who underwent examination in China-Japan friendship hospital from 2014 to 2016. The analysis was also included the relationship between gender or age and the incidence and tumor size.

A total of 83 964 healthy adults (age≥18) were included in the study. The overall incidence of liver hemangioma was 2.95%. There was no significant difference of liver hemangiomas incidence between male which was 3.03%, and which was 2.88% in female. Liver hemangiomas incidence had shown obviously increased with patients′ age, as the evidence indicating that the prevalence of liver hemangioma in <30 age group was only 1.87%, and the prevalence of liver hemangioma in 41-50 age group raised to 3.72%. While the size of liver hemangioma in different genders was also increasing with age, the tumor size of liver hemangioma in <30 age group was the smallest. Under 50 years old, the size of female patients′ liver hemangioma was larger than that of male patients in each age group. The size of female patients′ liver hemangioma had obviously decreased over 60 years old.

The progress of liver hemangioma was highly influenced by age and gender.

To evaluate the effect of dexemdetomidine on perioperative inflammatory response and cellular immune in patients undergoing radical operation of thoracoscopic lung cancer.

One hundred and twenty patients undergone radical operation of thoracoscopic lung cancer were randomly divided into control group(group B) and dexemdetomidine group(group A), 60 patients in each group. They were all implemented one-lung ventilation. In group A, dexmedetomidine at a loading dose of 1.0 μg/kg was intravenously infused starting from 20 min before anesthesia induction, followed by continuous infusion of 0.5 μg·kg ^-1·h^-1 until 20 min before the end of operation. The equal volume of normal saline was given in group B. venous blood samples were collected for determination of the serum concentrations of TNF-α, IL-6 and IL-8. peripheral blood T-lymphocyte subsets(CD₃⁺, CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺) and NK cell were also detected at 30 min before anesthesia induction(T₀), at the end of operation(T₁), 12 h after operation(T₂) and 24 h after operation(T₃).

Compared with the T_0,the plasma concentration of TNF-α , IL-6 and IL-8 were increased(P<0.05). The levels of CD₃⁺ and CD₄⁺, CD₄⁺/CD₈⁺ ratio and NK cells were decreased in both groups at T₁-T₃(P<0.05). Compared with group B, the plasma concentration of TNF-α , IL-6 and IL-8 were decreased more obviously in group A(P<0.05). The levels of CD₃⁺ and CD₄⁺, CD₄⁺/CD₈⁺ ratio and NK cells were significantly increased in group A at T₁-T₃(P<0.05).

Dexemdetomidine can decrease perioperative inflarnmatory response and improve cellular immune function in the patients undergoing radical operation of thoracoscopic lung cancer

Investigating a novel approach to treat a midline ventral hernia——totally endoscopic sublay repair (TES). The procedure will be described in detail and the safety and efficacy evaluated.

During July and December 2017, eleven consecutive cases of primary and secondary epigastric midline ventral hernias were repaired using the TES procedure. A large mesh should be placed in the retrorectus position using this minimally invasive procedure. The indications for this procedure include umbilical, epigastric and incisional hernia equal in length to the rectus diastasis.

All operations were successful without open conversion. The mean operation time was 120 mins(80-205 min), postoperative pain was mild and the mean VAS was 2.5 on first postoperative day. The average postoperative stay in hospital was 3.3 days (2-5 days). 2 cases experienced postoperative seroma but without adverse effect on the final outcome and no recurrences during the follow-up period of 1 to 6 months.

TES procedure is safe, practical and minimally invasive requiring no specific device and highly reproducible. Besides there is no need for expensive anti-adhesion mesh and fixation tacker which make it more cost effective. TES is a good technique for the surgical treatment of midline ventral hernia.

To investigate the regulation and possible mechanism of microRNA (miR)-1249 on myocardial apoptosis in chronic intermittent hypoxia rats.

A total of 16male SD rats aged 8 weeks were randomly divided into 2 groups by the random number table: normoxia control group and chronic intermittent hypoxia group (CIH) (n=8 each). The CIH group was exposed to intermittent hypoxia every day from 9: 00 to 17: 00 for 8 consecutive weeks, while the control group received the same frequency of pulse air. Hemodynamic values were measured via a cannula inserted into right common carotid artery. The expressions of miR-1249 and microtubule-associated protein light chain 3 (LC3) mRNA were observed by real-time PCR. The expressions of LC3 and Cleaved Caspase-3 were detected by Western bolt. TUNEL staining was performed to detect myocardial apoptosis. The rat cardiomyocyte cell H9C2 was divided into normoxia group, intermittent hypoxia (IH) group and miR-1249 inhibitor transfected and IH treatment group (inhibitor group). At the end of the experiment, the activation of LC3 protein in each group of cells was determined.

Compared with normoxia control group, left ventricle end diastolic pressure (LVEDP) increased [(4.6±0.4) vs (2.2±0.1) mmHg (1 mmHg=0.133 kPa)], left ventricular systolic pressure (LVSP) , maximal rate of pressure decline (-dp/dtmax), and maximal rate of pressure development (+ dp/dtmax) decreased in CIH group [(92.7±4.1) vs (135.3±3.2) mmHg, (4 247±108) vs (7 626±235) mmHg/s, and (3 168±105) vs (6 028±81) mmHg/s] (allP<0.001). The expression of miR-1249 and LC3 mRNA were significantly higher in CIH group than that in normoxia control group (allP<0.001), and a positive correlation was found between the expression of LC3 mRNA and miR-1249. The expression of LC3 and Cleaved Caspase-3 protein in myocardial tissue of CIH rats were significantly higher than that of the normoxia control group (allP<0.001). The proportion of myocardial cell apoptosis in CIH rats was significantly higher than that in the normoxia control group [(23.84±4.94)% vs (2.93±0.73)%] (P<0.001). The activation of LC3 in myocardial cells of inhibitor group was significantly lower than that of IH group, but higher than that in normoxia group.

CIH could induce LC3 by raising the expression of miR-1249, and then induce the activation of apoptosis protein Caspase3. It ultimately induces myocardial apoptosis.

A 64-year-old female was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in September 2014 due to "repeated dull pain in the upper abdomen for more than 20 years". Vital signs are stable and general condition is acceptable. B-ultrasound showed that bilateral cervical lymph nodes were detected. Abdominal enhanced CT (Figure 1) and magnetic resonance examination revealed lymphoma and splenomegaly. There were no obvious abnormal X-ray signs in the lung and diaphragm in the anterolateral position of the chest. Liver function: total bile acid 22.5 μ mol/L, triacylglycerol 1.99 mmol/L, low density lipoprotein 3.60 mmol/L; Blood routine: white blood cell count 6.0×10⁹/L, mature neutrophils 79.1%, hemoglobin 125 g/L, platelet count 135×10⁹/L. The patient underwent "laparoscopic retroperitoneal tumor biopsy" under general anesthesia. During the operation, multiple retroperitoneal enlarged lymph nodes were found, partially fused into masses and adhered to the mesenteric membrane. Intraoperative intestinal membrane root and retroperitoneal lymph node pathology considered as small cell lymphoma (FIG. 2A)。 Conventional pathology showed that small lymphoid cells (retroperitoneal lymph nodes and mesenteric root lymph nodes) were obviously proliferated, and combined with immunohistochemical staining, it was consistent with B-cell small lymphocytic lymphoma (B-SLL) /chronic lymphocytic leukemia (CLL). Immunohistochemical results (Figure 2B): CD3 scattered +, CD20^＋, CD79a^＋CD10^－, Bcl-6^－, MUM-1 focal +, Bcl-2^＋, CD5^＋, CD23^＋, CyclinD1^－CD38^－, Ki-67 5%, P53 scattered^＋, TdT^－CD99 scattered^＋。

The patient, female, 48 years old, was admitted to hospital due to "repeated melena with dizziness and fatigue for 2 months". She was anemic, and the blood routine showed: red blood cell count 1.53×10¹²/L, hemoglobin 39 g/L; Abdominal MR showed irregular thickening and abnormal enhancement of the walls of the descending colon and sigmoid colon, diffuse abnormal signals in the abdominal cavity, pelvic cavity and retroperitoneal cavity, and angiomas were mostly considered (Figure 1)； Mesenteric arteriovenography showed dilated lymphatic vessels in the intestinal wall and delayed return in the venous phase (Figure 2)； Electronic colonoscopy showed that congestion and edema of intestinal mucosa could be seen at 28~50 cm from the anus, and obvious ecchymosis could be seen. Preliminary diagnosis: ischemic bowel disease? Colonic angioma? Concurrent hemorrhage. Surgical treatment was performed after correction of anemia. Surgical exploration showed that the inferior mesenteric vein was the main trunk, and the branch veins on the mesenteric were tortuous and dilated obviously, with multiple cystic protuberances. The intestinal wall above the splenic flexure of transverse colon, descending colon, sigmoid colon and rectal peritoneal reflux all had cystic protuberances, tortuous and dilated vessels, and the intestinal wall was dark purple, edematic, thickened and stiff (Figure 3)。 Exploration decided to perform extended left hemicolectomy. The intestinal tube was separated from the normal intestinal wall approximately 2.0 cm each near and distal to the vessel tortuosity of the intestinal wall under the transverse colon near the splenic flexure and peritoneal reflux. The examination specimens confirmed that the diseased intestinal tube and mesangium were completely removed, and end-to-end transverse colonorectal anastomosis and prophylactic ileostomy were performed. A large amount of blood and white turbid fluid flowed out when the specimen was cut after operation (lymphatic fluid may be) (Figure 4), postoperative pathology: cavernous angiolymphangioma of the left colon. Immunohistochemistry : CD31 (+), CD34 (+), Ki-67 (index 2%), CKp (+), D2-40 (+), FVIII-RAG (+) (Figure 5，Figure 6，Figure 7，Figure 8，Figure 9)。

A 41-year-old female was admitted to the hospital on January 5, 2018 due to "discovery of abdominal tumor for 1 week". One week ago, the patient planned to undergo appendectomy in the local hospital due to right lower abdominal pain. During the operation, the lesion was found to be an abdominal tumor, which could not be removed. The biopsy pathology showed "malignant tumor" and was transferred to our hospital. Admission physical examination: vague palpable movable mass in the lower abdomen. Relevant examination and pathological consultation diagnosis in our hospital: The tumor cells in the tissue submitted for examination are composed of a large number of naive mesenchymal cells, and the tumor cells are mostly short spindle-shaped, some of which are nodular (Figure 1)； Cells are abundant, arranged in clusters or cords, and mitotic images are common, showing pathological mitosis (Figure 2)； Interstitial mucoid, with focal and lamellar necrosis. Immunohistochemistry: Vimentin (+), CD117 (-), CD34 (-), CD99 (-), CK (-), Desmin (-), epithelial membrane antigen (EMA) (-), Ki-67 (60% +), MyoD1 (-), neuron-specific enolase (NSE) (-), S100 (-), smooth muscle actin (SMA) (-), Syn (-); A spindle cell malignancy of the abdominal cavity is considered, with a tendency towards extraosseous mucinous chondrosarcoma. CT: Consider cystic-solid mass of lower abdomen (Figure 3), possibly from the intestine, peritoneum, or ovary. Female tumor marker: CA125 was 104.5 U/ml.

Cornelia de Lange syndrome (CdLS) is a rare genetic disease involving multiple organs. The main clinical manifestations include characteristic facial appearance, growth and development retardation, limb defects, congenital heart disease and gastrointestinal dysfunction^[1]。 In 1933, Dutch pediatrician Cornelia de Lange first reported the syndrome and named it after her. At present, the global incidence of CdLS is about (1.6~2.2) /100,000, but due to the diversity of disease manifestations, some cases with atypical or mild clinical manifestations may be missed^[2]。

Acinetobacter baumannii is a class of Gram-negative coccidia, which exist widely in natural environment, especially in hospital environment, and is one of the most widespread nosocomial acquired infection pathogens worldwide. In recent years, the study of virulence of Acinetobacter baumannii has become a research hotspot, and many potential virulence factors have been identified, including outer membrane proteins, lipopolysaccharides, capsular polysaccharides, phospholipases, penicillin-binding proteins, outer membrane vesicles, iron acquisition, etc. This article will briefly review the virulence factors of Acinetobacter baumannii.