Gastrointestinal tissue-based molecular biomarkers: a practical categorisation based on the 2019 World Health Organization classification of epithelial digestive tumours

Molecular biomarkers have come to constitute one of the cornerstones of oncological pathology. The method of classification not only directly affects the manner in which patients are diagnosed and treated, but also guides the development of drugs and of artificial intelligence tools. The aim of this article is to organise and update gastrointestinal molecular biomarkers in order to produce an easy-to-use guide for routine diagnostics. For this purpose, we have extracted and reorganised the molecular information on epithelial neoplasms included in the 2019 World Health Organization classification of tumours. Digestive system tumours, 5th edn.     

Increased fracture risk in patients with type 2 diabetes mellitus: An overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools

Type 2 diabetes mellitus has recently been linked to an increased fracture risk. Since bone mass seems to be normal to elevated in patient with type 2 diabetes, the increased fracture risk is thought to be due to both an increased falling frequency and decreased bone quality. The increased falling frequency is mainly a result of complications of the disease such as a retinopathy and polyneuropathy. Bone quality is affected through changes in bone shape, bone micro-architecture, and in material properties such as bone mineralization and the quality of collagen. Commonly used methods for predicting fracture risk such as dual energy X-ray absorptiometry and fracture risk assessment tools are helpful in patients with type 2 diabetes mellitus, but underestimate the absolute fracture risk for a given score. New imaging modalities such as high resolution peripheral quantitative computed tomography are promising for giving insight in the complex etiology underlying the fragility of the diabetic bone, as they can give more insight into the microarchitecture and geometry of the bone. We present an overview of the contributing mechanisms to the increased fracture risk and the usefulness of imaging modalities and risk assessment tools in predicting fracture risk in patients with type 2 diabetes.     

新疆地区645例淋巴组织肿瘤的构成分析

目的：探讨新疆645例淋巴瘤的病理类型和亚型分布特点。方法收集2008年4月~2013年3月新疆自治区人民医院存档的645例淋巴瘤,复习HE、免疫组化切片及临床相关资料,按WHO(2008)造血和淋巴组织肿瘤分类标准进行诊断、分类。结果645例淋巴瘤中,非霍奇金淋巴瘤(non-Hodgkin's lymphoma, NHL)558例(86.51%),霍奇金淋巴瘤(Hodgkin's lymphoma, HL)82例(12.71%)。 NHL中B细胞淋巴瘤448例(80.29%),T/NK细胞淋巴瘤110例(19.71%)。 B细胞淋巴瘤中最常见的类型是弥漫性大B细胞淋巴瘤(258例,占所有病例40%)。 T/NK细胞淋巴瘤以结外NK细胞淋巴瘤多见(41例,占所有病例6.36%)。伯基特淋巴瘤、淋巴母细胞性淋巴瘤均以维吾尔族多见,套细胞淋巴瘤、滤泡性淋巴瘤和结外黏膜相关组织边缘区淋巴瘤以汉族多见。 HL最常见的亚型是混合细胞型、结节硬化型、富于淋巴细胞型。 HL在不同民族中亚型分布有一定差异,发病年龄未见双峰,其中儿童所占比例最高。结论新疆不同民族淋巴瘤亚型分布存在一定差异,具有独特的民族特征。     

白花香莲解毒方联合阿德福韦酯对HBeAg阳性慢性乙望肝炎患者病毒学及生存质量的影响

目的：通过观察壮药白花香莲解毒方联合阿德福韦酯对HBeAg阳性的慢性乙型肝炎（CHB）患者病毒学及生存质量的影响，评估其临床疗效。方法：采用多中心随机临床研究方法，将240例HBeAg阳性的CHB患者随机分为治疗组和对照组，对照组给予阿德福韦酯胶囊10mg／次，1；L,／d，治疗组在对照组基础上加用白花香莲解毒方，两次／d，疗程为48周。分别观察治疗12周、24周、48周两组患者在病毒学、生存质量（QOL）、慢性肝病量表（CLDQ）评分情况。结果：①病毒学方面：从治疗12周始，治疗组HBVDNA下降的对数值与对照组比较，差异有显著性意义（P〈0．05）；治疗组治疗12周、24周病毒学应答率分别为65．48％（74例）、82．3％（92例），对照组为51．78％（58例）、70．53％（79例），差异有显著性意义（P〈0．05）；治疗48周，两组患者总的病毒学应答率比较差异无显著性意义（P〉0．05）；治疗组治疗12周、24周、48周的HBVDNA阴转率分别为22．12％（25例）、43．36％（49例）、57．52％（65例），对照组为11．61％（13例）、21．4％（24例）、32．14％（36例），差异有显著性意义（P〈0．05）。②QOL方面：治疗24周，治疗组在生理领域、心理领域改善作用优于对照组；治疗48周治疗组在总的生存质量、总的健康状况、生理领域、心理领域、社会关系领域均优于对照组，两组比较差异有显著性意义（P〈0．05）。③CLDQ评分方面：治疗24周，治疗组患者在乏力、情感功能、焦虑三方面改善程度优于对照组；治疗48周治疗组患者在乏力、全身症状、情感功能、焦虑四方面改善程度优于对照组，两组比较差异有显著性意义（P〈0．05）。④不良事件：两组患者主要不良反应为头痛、腹痛、恶心；研究期间共发生磷酸肌酸激酶（CK）升高9例，发生率为4％。结论：白花香莲解毒方联合阿德福韦酯治疗HBeAg阳性CHB患者，能显著提高其对HBVDNA的抑制作用，改善患者生存质量。     

Utility of the WHO‐five well‐being index as a screening tool for depression in Parkinson's disease

Beck depression inventory (BDI‐1A) is the gold standard screening tool for Parkinson's disease (PD) depression, but as a result of its complexity, it is of limited suitability as a quick and easy screening device. We, therefore, validate the 5‐item WHO‐Five Well‐being Index (WHO‐5) as a screening tool for PD depression. Two hundred thirteen of 215 recruited PD patients (99.1%) completed the WHO‐5. Receiver operating characteristic plots were used to calculate sensitivity/specificity for all cut‐off scores for the detection of depression and combined depression/dysthymia as assessed by an independent investigator using the Mini International Neuropsychiatric Interview (MINI). Internal consistency of the WHO‐5 was good (Cronbach's α = 0.83). WHO‐5 showed high validity with adequate detection of depression without differences in the validity indices compared to BDI‐1A (P = 0.234). The optimal cut‐off value for detection of depression was 12 of 13 points. WHO‐5 is a useful, brief, and easy instrument for identifying PD subjects with depression in daily practice. © 2010 Movement Disorder Society     

Immunophenotypic analysis of T‐acute lymphoblastic leukemia. A CD5‐based ETP‐ALL perspective of non‐ETP T‐ALL

T‐cell antigens [CD5,CD1a,CD8] define early T‐cell precursor acute lymphoblastic leukemia (ETP‐ALL). To understand immature T‐ALL of which ETP‐ALL is part, we used these antigens to subcategorize non‐ETP T‐ALL for examining expression of myeloid/stem cell antigens (M/S) and clinical features. Using CD5 (+/?) to start categorization, we studied 69 routinely immunophenotyped patients with T‐ALL. CD5^? was a homogenous (CD8,CD1a)^? M/S⁺ ETP‐ALL group (n = 9). CD5⁺ cases were (CD8,CD1a)^? pre‐T‐ALL (n = 22) or (CD8,CD1a)⁺ (n = 38) thymic/cortical T‐ALL; M/S⁺ 20/22 (90.91%) in former and 22/38 (57.89%) in latter (P = 0.007). ETP‐ and pre‐T‐ALL together (CD1a^?,CD5^?/+ immature T‐ALL group) were nearly always M/S⁺ (29/31; 93.55%). In multivariate analysis, only ETP‐ALL predicted poor overall survival (P = 0.02). We conclude (i) CD5 negativity in T‐ALL almost always means ETP‐ALL. CD1a and CD8 negativity, as much as CD5, marks immaturity in T‐ALL, and the CD5^+/?/CD1a^?/CD8^? immature T‐ALL group needs further study to understand the biology of the T‐ALL–myeloid interface. (ii) ETP‐ALL patients may be pre‐T‐ALL if CD2⁺; CD2⁺, conversely, CD5^?/CD1a^?/CD8^? pre‐T ALL patients are ETP‐ALL. (iii) Immunophenotypic workup of T‐ALL must not omit CD1a, CD5, CD8 and CD2, and positivity of antigens should preferably be defined as recommended for ETP‐ALL, so that this entity can be better evaluated in future studies of immature T‐ALL, a group to which ETP‐ALL belongs. (iv) ETP‐ALL has poor prognosis.