Objective To explore the mutation status of KRAS, NRAS, PIK3CA, and BRAF, and the relations with clinicopathological features and hormone expression levels in ovarian low-grade serous tumors. Methods Tissue specimens (23 cases of common-type serous borderline tumor, 27 cases of micropapillary serous borderline tumor and 14 cases of low-grade serous carcinoma) were collected from the First People's Hospital of Yunnan Province during January 2017 to April 2021, and then retrospectively analyzed. The mutation status of human KRAS, NRAS, PIK3CA and BRAF genes were detected by expression status in tumor tissues was detected by immunohistochemistry, the relationship was analyzed between gene mutation status and clinicopathological features and hormone expression levels. Results A total of 36 mutations were detected in 64 tumor tissues,including 21 KRAS mutation, 12 BRAF mutation, 2 PIK3CA mutation and 1 NRAS mutation. KRAS and BRAF mutations were common in younger women ≤35 years old. In the KRAS mutant subtype, G12S and G12D mutations are common in micropapillary serous borderline tumor (P<0.05); G12C, G12R*, G12V, G12A, and G13C* mutations are common in common-type serous borderline tumor (P<0.05); G13D mutation was only detected in low-grade serous carcinoma. Patients with BRAF mutations were all seen in the early stages of the disease. Immunohistochemistry showed the positive expression rates of both estrogen receptor and progesterone receptor were 76.6% (49/64). The positive expression rate of common-type serous borderline tumor was similar to that of micropapillary serous borderline tumor, and both of them were significantly higher than that in lower-grade serous carcinoma(P<0.05). KRAS G13D mutation was significantly associated with low progesterone expression (P<0.05). Conclusion Gene mutations were mutual exclusion. KRAS mutation was an oncogenic driving factor in serous tumors, and different mutant subtypes were associated with histological type and progesterone receptor expression status. As the disease progresses, BRAF mutation rate gradually decreased and associated with a variety of clinicopathological features and good prognosis and might have a protective effect against disease progression. The mutation rates of NRAS and PIK3CA were lower.

Objective To report a case of gastric ulcer associated with cytomegalovirus (CMV) infection in immunocompetent for improving the clinical recognition of the disease. Methods A 69-year-old patient with gastric ulcer caused by CMV infection was admitted to the 900th Hospital of the Joint Logistics Team on August 10, 2020. Biopsies were performed at the gastric ulcer and biopsy gastric mucosa samples were measured by hematoxylin-eosin (HE) staining and immunohistochemistry.The microscopic characteristics of the mucosal tissues, diagnosis and treatment experience of this case were analyzed and summarized. A literature review about CMV infection in gastric in inmmunocompetent patients was performed using PubMed search from database inception to July 2021. Results A total of 20 literatures were retrieved, involving 57 patients. A total of 58 patients were included in this article, including 39 males (67.2%) and 19 females (32.8%), with a ratio of men to women of 2.05:1. The average onset age of male was (52.4±16.0) years old, while (72.3±17.7) years old in female. The overwhelming majority of those patients were complicated with hypertension or type 2 diabetes mellitus. The most common symptoms were upper abdominal pain and gastrointestinal bleeding. The antrum of stomach was the most frequently affected site in gastric CMV disease, isolated gastric ulcer and multiple mucosal erosion were the main endoscopic appearance. CMV inclusion bodies were found either at the ulcer base or at the ulcer edges. There were 51.1% (24/47) of the patients treated with ganciclovir. However, 48.9% (23/47) of the patients were cured by symptomatic treatment. Conclusions On no consideration can clinically ignore CMV gastritis in adults without apparent immunosuppression when the symptoms as hematemesis, melena, and abdominal pain occur and antral gastric ulcer or multiple mucosal inflammation is seen endoscopically. Biopsies for CMV related tests, especially for pathological examination or histopathologic diagnosis are recommended. Antiviral therapy in people with clinical risk factors is essential for management of gastric CMV disease.

Vascular complications of type 2 diabetes mellitus (T2DM) include macrovascular complications and microvascular complications, of which the increased incidence is often accompanied with a high incidence of obesity. Obesity is an independent risk factor for T2DM. In obese patients, body fat distribution rather than total body fat is associated with metabolic and cardiovascular risk. Body mass index (BMI) and waist circumference (WC) cannot accurately reflect body fat distribution in obese patients, so visceral fat has received more and more attention and may be as a related risk factor for vascular complications in T2DM.The research progress on the relationship between visceral fat and vascular complications of T2DM and its action mechanism have been reviewed in present paper, in order to provide a reference for in-depth research and clinical examination of visceral fat.

The incidence and mortality of malignant tumors are gradually increasing all the world, and the existing diagnosis and treatment methods still can not effectively block the occurrence and development of tumors. Some studies have found that cancer stem cells (CSCs) are the cells of tumor origin, and closely related to the occurrence, development and metastasis of tumors.Early detection and intervention with effective treatment of CSCs are expected to prevent the occurrence and development of tumors. Many studies have shown that the activation of Wnt/β-catenin signaling pathway is an important link in the initiation of CSCs and the formation of tumors. Therefore, by regulating the key upstream and downstream factors of the Wnt/β-catenin pathway in CSCs, thereby regulating the activity of the Wnt/β-catenin signaling pathway, controlling tumor growth and metastasis,can provide new targets and directions for the treatment and prevention of malignant tumors. The key role of Wnt/β-catenin signal pathway in CSCs, and the related mechanisms of the important factors of the pathway in regulating the tumor growth, development and metastasis of CSCs in different organs are reviewed in present paper.

Small cell lung cancer (SCLC) is an aggressive malignancy with a 5-year survival rate of 7.2%, which is characterized by exceptionally high proliferation rate, early metastasis, and poor prognosis. In the face of DNA damage and replicative stress, the DNA damage response (DDR) elicits activation of cell cycle checkpoints to promote repair by pausing the cell cycle or, in cases of unrepairable DNA damage, stimulate programmed cell death. SCLC carries a high mutation burden and genomic instability, and almost all SCLC tumors have functional inactivation of both TP53 and RB1, which leads to the form of a dysfunctional G₁/S checkpoint and results in an increased reliance on subsequent cell cycle checkpoints (S, G₂/M) to ensure genome stability and correct chromosomal segregation. Therefore, under the use of radio-chemotherapy for DNA damaging, promoting the cell cycle progress by inhibiting the cycle checkpoints and increasing DNA damage by inhibiting DNA damage repair can be new strategies for targeted therapies in SCLC. In the present article, we review the advances of targeting DDR and it's pathway inhibitors in SCLC, and provide some thoughts for the targeted treatment strategies of SCLC.

Artificial intelligence has made breakthroughs in medicine in the past decade. Compared with the traditional statistical model, the advantage of artificial intelligence is that it can establish algorithm and prediction model through machine learning to efficiently and effectively identify the patterns in large data sets, and combine a variety of factors to create more accurate prediction model. Therefore, artificial intelligence is particularly suitable for huge and complex or high-dimensional clinical data analysis and predictive modeling tasks. There are many kinds of data formats in the clinical practice of hepatology. Many studies have applied artificial intelligence in the diagnosis and classification of liver diseases, assisting treatment, predicting efficacy and prognosis, and evaluation of liver imaging and pathology. Based on the study outcomes in related fields at home and aboard, this paper summarizes the research progress and application of artificial intelligence in the field of diagnosis and treatment of chronic liver diseases.

Status epilepticus is one of the critical illnesses involving multiple clinical disciplines. Although treatment is comprehensive, rapid termination of status epilepticus episodes is critical. The purpose of this article is to provide an actionable approach to rapidly terminating status epilepticus episodes by organizing multidisciplinary experts to improve patient outcomes.In the consensus, the experts put forward the purpose of the consensus, the scope of adaptation, the method and clinical practice of rapid termination of status epilepticus, and discuss several issues that need to be paid attention to in the treatment of status epilepticus, hoping to provide clinicians with an alternative when faced with status epilepticus.

Surgical injury is a major stressor, because patients with adrenal insufficiency are unable to secrete enough cortisol during perisurgery, such as giving only physiological alternative doses of glucocorticoids can induce adrenal crisis, life-threatening.Based on this, in February 2020, the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK published the Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency.In order to better understand and learn from the guide and promote the standardization of perioperative glucocorticoid replacement therapy in patients with adrenal insufficiency in China, this paper explains the epidemiology of glucocorticoid, adrenal cortex and adrenal crisis and perioperative glucocorticoid supplementation from the main content of the guide.

Objective To analyze the clinical characteristics of pheochromocytoma/paraganglioma (PPGL) patients with normal level of plasma free metanephrines (MNs), and offer a proposal for the diagnosis and treatment of such patients. Methods A retrospective study was conducted of 99 patients hospitalized from January 2019 to April 2021 and diagnosed as PPGL, of which 98 patients were pathologically confirmed as PPGL and 1 patient was clinically diagnosed as Von Hippel-Lindau (VHL) syndrome.Plasma free MNs were detected, and according to the MNs level, all the patients were divided into PPGL with normal MNs group(n=10) and PPGL with elevated MNs group (n=89). The differences were contrasted and analyzed between the two groups in clinical manifestation, imaging characteristics, preoperative preparation and intraoperative blood pressure fluctuation. Results No significant difference was detected in the incidence of typical triad between the two groups, but the incidence of nausea and vomiting in PPGL with normal MNs group was higher (40.0% vs. 13.5%, P=0.031). The proportion of retroperitoneal paraganglioma was obviously higher in PPGL with normal MNs group than in PPGL with elevated MNs group (60.0% vs. 20.2%, P=0.027), and the proportion of patients possessing typical PPGL imaging manifestations (70.0% vs. 92.1%, P=0.028) and tumor necrosis (40.0% vs.71.9%, P=0.039) was lower in PPGL with normal MNs group than in PPGL with elevated MNs group. Among 10 patients in PPGL with normal MNs group, 2 cases had slightly increased urinary metanephrine (MN) or 3-MT, and the maximum diameter of tumor in 8 cases was ≥3 cm. CT or MRI showed that tumors with typical PPGL imaging features in 7 cases, and functional imaging was positive in 6 cases. Conclusions Normal plasma MNs can not be used as sufficient exclusion of PPGL diagnosis. For patients suspected with PPGL, when normal MNs are obtained, it is recommended to measure extra indexes such as 24 h urine MNs and 3-MT.In addition, functional imaging is of great value in this condition.

Objective To investigate the current situation of patients with adrenocortical carcinoma (ACC) in China,for providing references to clinical diagnosis and treatment of ACC. Methods The information was collected of patients (from adrenocortical tumor patient group) definitely diagnosed as ACC from 2010 to 2019 by questionnaire, including gender, age, clinical manifestations, course of disease, surgical and adjuvant treatment methods and curative effects, and retrospective analysis was conducted. Results A total of 156 ACC patients were included with a male to female ratio of 1:1.33. Patients aged 40-60 years accounted for the highest proportion. Except one patient with bilateral adrenal tumors, the others were unilateral involved, and the proportion of left adrenal tumor was slightly higher than that of the right side. Eighty-one (51.9%) patients had adrenocortical hormone hypersecretion, 33 patients (21.2%) of them had manifestations of hypercortisolism such as full moon face, buffalo back,centripetal obesity, and muscle weakness, and 12 patients (7.7%) had spontaneous hypersecretion of two or more adrenal hormones, including cortisol. One hundred and forty-seven patients underwent surgery, of which open surgery accounted for the highest proportion (n=86, 55.1%), followed by laparoscopic surgery (n=51, 32.7%). The most common distant metastasis sites were liver(n=50, 32.1%), lung (n=46, 29.5%) and retroperitoneal lymph nodes (n=34, 21.8%). 79.5% of the studied population (n=124)used mitotane for adjuvant treatment, and 66.9% (n=83) of the patients started medication due to postoperative recurrence and metastasis. The median stable dosage of mitotane was 2.0 g. 64.4% (n=58) of the patients could achieve partial or complete response,26.7% (n=24) of the patients were in stable condition, and the remaining 8.9% (n=8) had disease progression. After the combined application of other adjuvant treatments was included in the analysis, no significant difference was observed in the response among the three groups of mitotane alone, mitotane combined with chemotherapy, and mitotane combined with other treatments (P>0.05). Conclusions Functional occupancy accounted for more than 50% in ACC patients, and the proportion of cortisol hypersecretion is the highest. Some patients are prone to retroperitoneal lymph node metastasis, therefore, lymph node dissection should be performed routinely in radical operations. As an essential adjuvant therapy, mitotane possesses high response rate when used alone or in conjunction with chemotherapy or other adjuvant medicines.