Uterine rupture due to adenomyosis in an adolescent:A case report and review of literature

BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.

Early expressions of hypoxia-inducible factor 1alpha and vascular endothelial growth factor increase the neuronal plasticity of activated endogenous neural stem cells after focal cerebral ischemia

Endogenous neural stem cells become "activated" after neuronal injury, but the activation sequence and fate of endogenous neural stem cells in focal cerebral ischemia model are little known. We evaluated the relationships between neural stem cells and hypoxia-inducible factor-1α and vascular endothelial growth factor expression in a photothromobotic rat stroke model using immunohistochemistry and western blot analysis. We also evaluated the chronological changes of neural stem cells by 5-bromo-2′-deoxyuridine(BrdU) incorporation. Hypoxia-inducible factor-1α expression was initially increased from 1 hour after ischemic injury, followed by vascular endothelial growth factor expression. Hypoxia-inducible factor-1α immunoreactivity was detected in the ipsilateral cortical neurons of the infarct core and peri-infarct area. Vascular endothelial growth factor immunoreactivity was detected in bilateral cortex, but ipsilateral cortex staining intensity and numbers were greater than the contralateral cortex. Vascular endothelial growth factor immunoreactive cells were easily found along the peri-infarct area 12 hours after focal cerebral ischemia. The expression of nestin increased throughout the microvasculature in the ischemic core and the peri-infarct area in all experimental rats after 24 hours of ischemic injury. Nestin immunoreactivity increased in the subventricular zone during 12 hours to 3 days, and prominently increased in the ipsilateral cortex between 3–7 days. Nestin-labeled cells showed dual differentiation with microvessels near the infarct core and reactive astrocytes in the peri-infarct area. BrdU-labeled cells were increased gradually from day 1 in the ipsilateral subventricular zone and cortex, and numerous BrdU-labeled cells were observed in the peri-infarct area and non-lesioned cortex at 3 days. BrdU-labeled cells rather than neurons, were mainly co-labeled with nestin and GFAP. Early expressions of hypoxia-inducible factor-1α and vascular endothelial growth factor after ischemia made up the microenvironment to increase the neuronal plasticity of activated endogenous neural stem cells. Moreover, neural precursor cells after large-scale cortical injury could be recruited from the cortex nearby infarct core and subventricular zone.

Undifferentiated embryonal sarcoma of the liver presenting as a hemorrhagic cystic tumor in an adult

BACKGROUND:Undifferentiated embryonal sarcoma (UES) of the liver is a rare,highly malignant neoplasm with a poor prognosis occurring almost exclusively in late childhood (6-10 years of age).Only a few cases have been reported in adults accounting for less than 1% of all primary liver neoplasms.METHODS:A 47-year-old woman presented with a palpable mass in the left upper abdomen.Magnetic resonance imaging revealed a 12×10 cm cystic mass with hemorrhage in the left lateral segment of the liver.The initial impression was a hemorrhagic cystic tumor of the liver.The patient underwent a left lateral sectionectomy of the liver.Histopathology and immunohistochemistry helped make a diagnosis of UES.RESULTS:The patient recovered uneventfully and received systemic chemotherapy.Radiologic examination for follow-up revealed a metastatic lesion in the lumbar spine (L5).She was subjected to radiotherapy at the lumbar spine.She survived 48 months.CONCLUSION:Although hepatic cyst as UES of the liver is difficult to diagnose because of its rarity in adults and lack of specific findings,it should be considered in a differential diagnosis.

Transplantation of human adipose tissue-derived stem cells for repair of injured spiral ganglion neurons in deaf guinea pigs

Excessive noise, ototoxic drugs, infections, autoimmune diseases, and aging can cause loss of spiral ganglion neurons, leading to permanent sensorineural hearing loss in mammals. Stem cells have been confirmed to be able to differentiate into spiral ganglion neurons. Little has been reported on adipose tissue-derived stem cells(ADSCs) for repair of injured spiral ganglion neurons. In this study, we hypothesized that transplantation of neural induced-human ADSCs(NI-h ADSCs) can repair the injured spiral ganglion neurons in guinea pigs with neomycin-induced sensorineural hearing loss. NI-h ADSCs were induced with culture medium containing basic fibroblast growth factor and forskolin and then injected to the injured cochleae. Guinea pigs that received injection of Hanks' balanced salt solution into the cochleae were used as controls. Hematoxylin-eosin staining showed that at 8 weeks after cell transplantation, the number of surviving spiral ganglion neurons in the cell transplantation group was significantly increased than that in the control group. Also at 8 weeks after cell transplantation, immunohistochemical staining showed that a greater number of NI-h ADSCs in the spiral ganglions were detected in the cell transplantation group than in the control group, and these NI-h ADSCs expressed neuronal markers neurofilament protein and microtubule-associated protein 2. Within 8 weeks after cell transplantation, the guinea pigs in the cell transplantation group had a gradually decreased auditory brainstem response threshold, while those in the control group had almost no response to 80 d B of clicks or pure tone burst. These findings suggest that a large amount of NI-h ADSCs migrated to the spiral ganglions, survived for a period of time, repaired the injured spiral ganglion cells, and thereby contributed to the recovery of sensorineural hearing loss in guinea pigs.

SPECIFIC IDENTIFICATION OF HERPES SIMPLEX VIRUS IN HUMAN ESOPHAGUS WITH RAPID IN SITU HYBRIDIZATION IN 5 CASES

HUMAN herpes simplex virus esophagitis(HSVE)was first reported in 1940 by Johnson HSVE usually occurs in immunocompromised patients,such as those with acquired immunodeficiency syndrome(AIDS),malignancies,cutaneousburns,connective tissue diseases,inflammatory boweldisease,those taking immuno-suppressive therapy,and those undergoing organ transplantation,et.

Clinicopathological features of patients with middle third gastric carcinoma

AIM: To compared the prognosis of middle third gastric carcinoma(MGC) patients with those of patients with proximal/distal gastric carcinoma(PGC/DGC).METHODS: Of 3299 patients diagnosed with gastric carcinoma who underwent surgery at our hospital over a 15-year period, 919(27.9%) were diagnosed with MGC. For each patient, the following information was obtained from hospital records: Age, sex, tumor size, depth of invasion, histologic type, nodal involvement, extent of lymph node dissection, hepatic metastasis, peritoneal dissemination, stage at initial diagnosis, operative type, curability, and survival rate.RESULTS: T1 category tumors were more common in patients with MGC than in patients with PGC(P < 0.001). Tumor stage(stage Ⅰ), N category(N0), and T category(T1) significantly influenced the 5-year survival rates for patients with curatively resected tumors. A multivariate analysis showed that age, tumor size, serosal invasion, lymph node metastasis, and curability were significant predictors of survival in patients with MGC. The survival rate for MGC patients was similar to that for PGC/DGC patients(52.8% vs 44.4%/51.4%, P = 0.1138). The 5-year survival rate for MGC patients with curative resection was higher than that for MGC patients with non-curative resection(62.9% vs 8.7%, P < 0.001).CONCLUSION: These results indicate that tumor location did not affect the prognosis. Curative resection is important for improving the prognosis of patients with MGC.

Glutathione-S-transferase (GSTM1,GSTT1) and the risk of gastrointestinal cancer in a Korean population

AIM: To evaluate the association of glutathione S-transferase mu (GSTM1) and glutathione S-transferase theta (GSTT1) null genotypes with the risk of gastric cancer (GC) and colorectal cancer (CRC) in a South Korean population.METHODS: We conducted a population-based, largescale case-control study including 2213 GCs, 1829 CRCs, and 1699 controls. Null and non-null genotypesof GSTM1 and GSTT1 were determined using realtime PCR.RESULTS: The null genotypes of GSTM1 and GSTT1 were not signifi cantly associated with elevated risk of gastric (OR = 1.070, 95% CI = 0.935-1.224; OR = 1.101, 95% CI = 0.963-1.259, respectively) or colorec-tal cancer (OR = 1.065, 95% CI = 0.923-1.228; OR = 1.041, 95% CI = 0.903-1.200, respectively). The frequency of the combined null GST genotype was not different between the two cancer groups and controls. Moreover, smoking, drinking, and age did not modify the association between these genotypes and the risk of gastric or colorectal cancer.CONCLUSION: GSTM1 and GSTT1 null genotypes were not associated with increased risk of GC or CRC in Koreans.

Primary rectal mucosa-associated lymphoid tissue lymphoma treated with only endoscopic submucosal dissection:A case report

BACKGROUND Mucosa-associated lymphoid tissue(MALT)lymphoma is a distinct subtype of non-Hodgkin B cell lymphoma that mostly involves the gastrointestinal tract.The stomach is the most commonly affected site whereas colorectal involvement occurs very rarely.Given its rarity,the management and clinical outcome of colorectal MALT lymphoma are not well established yet.CASE SUMMARY From the superficial capillary bed in the lower rectum.Endoscopic ultrasonography showed homogenous hypoechoic lesions in the deep mucosal layer.Endoscopic submucosal dissection(ESD)was done for accurate histologic diagnosis and treatment and both the rectal lesions were completely removed en bloc and subsequently diagnosed as primary rectal MALT lymphoma.Herein,we report a case of primary rectal MALT lymphoma in a 68-year-old woman that was treated by only ESD,and the 12-month follow-up revealed no tumour recurrence.CONCLUSION These results of our case and previous reports suggest that endoscopic resection alone may be a feasible and safe treatment for primary colorectal MALT lymphoma and allows organ preservation.

Chorioamnionitis caused by Serratia marcescens in a healthcare worker: A case report

BACKGROUND Healthcare workers(HCWs)are at an increased risk for exposure to infections.Serratia marcescens(S.marcescens)is a gram-negative,opportunistic and nosocomial pathogen belonging to the Enterobacterieae family.A few case reports have been published of chorioamnionitis caused by S.marcescens infection.Immunological changes during pregnancy can also affect the risk of infection.However,few studies have examined hospital-acquired bacterial infection in pregnant HCWs.CASE SUMMARY A 33-year-old woman,a resident in anesthesiology,was admitted at 14 wk gestation for fever with chills.She had no medical history other than contact dermatitis of both hands that started from the beginning of the trainee.There was no obvious infection focus and no bacterial growth in blood cultures.She was discharged after 1 wk of empirical antibiotic treatment.At three weeks before the fever started,she had a blister on the site of contact dermatitis on both hands,she applied antibiotic ointment for three days and the blisters had healed.At 19 wk gestation,she had a high fever and was readmitted.Physical examination and image studies were nonspecific and the patient had no other symptoms.S.marcescens grew in blood cultures at 19 wk gestation.Treatment with intravenous antibiotics was started.However,she suffered a miscarriage at 224/7 wk gestation.Pathologically,the amniotic membrane showed chorioamnionitis with a focal infarct.Subsequently,a placenta tissue culture grew S.marcescens.CONCLUSION HCWs can be exposed to pathogens that can cause opportunistic infections such as S.marcescens.Pregnancy affects the immune system,making it susceptible to opportunistic infections.Therefore,pregnant HCWs may require more preventive measures,including hand hygiene and avoid risk factors(ex.wrapping the skin).

Renal cell carcionoma with synchronous metastases to the bladder and lung

Renal cell carcinoma can metastasize to virtually any organ, yet synchronous metastasis to the bladder is extremely rare. A 77-year-old woman presented with gross hematuria. Abdominal and chest computed tomography showed a bilateral renal masses, bladder dome mass, and multiple lung metastasis. Transurethral resection of the bladder tumor and sonography guided renal biopsy were performed. Both pathology diagnoses were clear cell renal cell carcinoma. Targeted therapy using pazopanib was administered to the patient without surgical resection of primary tumors and metastatic lung lesions. Herein, we report the synchronous metastasis of renal cell carcinoma to the bladder and lung.

Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy

几研究表明了外科手术前的浆液睾丸激素和百分比肿瘤体积(PTV ) 在激进的前列腺切除术以后预言 extra-prostatic 扩展(EPE ) 和生物化学的复发(BCR ) 。这研究在 laparoscopic 激进分子前列腺切除术(LRP ) 以后在与 EPE 和 BCR 的关系调查了浆液睾丸激素和 PTV 的预示的意义。我们考察了经历了在 2004 和 2012 之间的 LRP 的 520 个病人。PTV 在每节作为所有视觉上估计的肿瘤 foci 的和被决定。BCR 被定义为手术后的前列腺特定的抗原(PSA ) 的二连续增加 > 0.2 ng ml 1 。为浆液总数睾丸激素的阀值是 3.0 ng ml 1 。Multivariate 逻辑回归被用来在 EPE 和 BCR 的风险上定义变量的效果。低浆液睾丸激素(< 3.0 ng ml 1) 与高浆液 PSA，格利森分数，前列腺活体检视的积极核心百分比， PTV，和所有病理学的变量被联系。在 multivariate 分析上，类似于以前的研究，浆液 PSA，活体检视积极核心百分比，格利森分数，和病理学的变量预言了 EPE 和 BCR。另外，低浆液睾丸激素(< 3.0 ng ml 1 ，调整或， 8.52；95% CI， 5.04-14.4， P= 0.001 ) 预言的 EPE 和 PTV (调整或， 1.02；95% CI， 1.01-1.05， P= 0.046 ) 预言的 BCR。除了 EPE 和 BCR 的以前的预言者，低浆液睾丸激素和 PTV 在 LRP 以后是 EPE 和 BCR 的珍贵预言者。

Expanded natural killer cells augment the antimyeloma effect of daratumumab, bortezomib, and dexamethasone in a mouse model

The use of natural killer(NK)cells is a promising and safe immunotherapeutic approach in the field of cancer immunotherapy.However,combination treatments are required to enhance the effector functions and therapeutic efficacy of NK cells.In this study,we investigated the potential of daratumumab(Dara),bortezomib,and dexamethasone(Dvd)to augment the antitumor effects of NK cells in a multiple myeloma(MM)xenograft mouse model.NK cells were expanded and activated using the K562-OX40 ligand and membrane-bound IL-18 and IL-21 in the presence of IL-2 and IL-15 from peripheral blood mononuclear cells from MM patients.A human MM xenograft model was established using human RPMI8226-RFP-FLuc cells in NOD/SCID IL-2Rγnull(NSG)mice.Tumor-bearing mice were divided into six treatment groups:no treatment,expanded NK cells(eNKs),Dara,Dara+eNKs,Dvd,and Dvd+eNKs.Dvd treatment strongly enhanced the cytotoxicity of eNKs by upregulating expression of NK cell activation ligands,downregulating expression of NK cell inhibitory ligands,and promoting antibody-dependent cellular cytotoxicity.The combination of eNKs with Dvd significantly prolonged mouse survival and reduced the tumor burden and serum M-protein level.Furthermore,Dvd pretreatment significantly increased eNK persistence and homing to MM sites.Our findings suggest that Dvd treatment potentiates the antimyeloma effects of NK cells expanded and activated ex vivo by modulating immune responses in MM-bearing mice.