Clinical features,diagnosis,and treatment of Peutz-Jeghers syndrome:Experience with 566 Chinese cases

BACKGROUND Peutz-Jeghers syndrome(PJS)is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities,scattered gastrointestinal polyps,and susceptibility to tumors as clinical manifestations.Effective preventive and curative methods are still lacking.Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features,diagnosis,and treatment.AIM To explore the clinical features,diagnosis,and treatment of PJS in a Chinese medical center.METHODS The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized.A clinical database was established covering age,gender,ethnicity,family history,age at first treatment,time and sequence of appearance of mucocutaneous pigmentation,polyp distribution,quantity,and diameter,frequency of hospitalization,fre-quency of surgical operations,etc.The clinical data was retrospectively analyzed using SPSS 26.0 software,with P<0.05 considered statistically significant.RESULTS Of all the patients included,55.3%were male and 44.7%were female.Median time to the appearance of mucocutaneous pigmentation was 2 years,and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years.The vast majority(92.2%)of patients underwent small bowel endoscopy and treatment,with 2.3%having serious complications.There was a statistically significant difference in the number of enteroscopies between patients with and without canceration(P=0.004,Z=-2.882);71.2%of patients underwent surgical operation,75.6%of patients underwent surgical operation before the age of 35 years,and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer(P=0.000,Z=-5.127).At 40 years of age,the cumulative risk of intussusception in PJS was approximately 72.0%,and at 50 years,the cumulative risk of intussusception in PJS was approximately 89.6%.At 50 years of age,the cumulative risk of cancer in PJS was approximately 49.3%,and at 60 years of age,the cumulative risk of cancer in PJS was approximately 71.7%.CONCLUSION The risk of intussusception and cancer of PJS polyps increases with age.PJS patients≥10 years old should undergo annual enteroscopy.Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer.Surgery should be conducted to protect the gastrointestinal system by removing polyps.

E-Cervix imaging displaying cervical elasticity characteristics of healthy adult nulliparous women at different age groups and different menstrual cycle stages

Objective To observe the cervical elasticity of healthy adult nulliparous women at different age groups and different stages of menstrual cycle with E-Cervix imaging technology.Methods A total of 218 healthy adult nulliparous women who underwent transvaginal ultrasound examination for routine physical examination were retrospectively enrolled,including 103 in follicular phase,78 in ovulation phase and 37 in luteal phase.Cervical canal length(CL)and E-Cervix elasticity parameters were compared among different age groups and different stages of menstrual cycle,including elasticity contrast index(ECI),hardness ratio(HR),cervical internal and external orifice strain values(IOS and EOS)and IOS/EOS ratio.Results No significant difference of CL nor cervical elasticity parameters was detected among healthy adult nulliparous women at different age groups(all P>0.05).There were significant differences of ECI,HR and IOS among different menstrual cycle stages(all P<0.05),among which women in follicular phase had higher ECI and IOS but lower HR than those in luteal phase(all P<0.05).Conclusion No significant difference of cervical elasticity existed among healthy adult nulliparous women at different age groups.Meanwhile,cervical elasticity of healthy adult nulliparous women changed during menstrual cycle,in follicular phase had higher ECI and IOS but lower HR than in luteal phase.

Degradation of FAK-targeting by proteolytic targeting chimera technology to inhibit the metastasis of hepatocellular carcinoma

Liver cancer is a prevalent malignant cancer,ranking third in terms of mortality rate.Metastasis and recurrence primarily contribute to the high mortality rate of liver cancer.Hepatocellular carcinoma(HCC)has low expression of focal adhesion kinase(FAK),which increases the risk of metastasis and recurrence.Nevertheless,the efficacy of FAK phosphorylation inhibitors is currently limited.Thus,investigating the mechanisms by which FAK affects HCC metastasis to develop targeted therapies for FAK may present a novel strategy to inhibit HCC metastasis.This study examined the correlation between FAK expression and the prognosis of HCC.Additionally,we explored the impact of FAK degradation on HCC metastasis through wound healing experiments,transwell invasion experiments,and a xenograft tumor model.The expression of proteins related to epithelial-mesenchymal transition(EMT)was measured to elucidate the underlying mechanisms.The results showed that FAK PROTAC can degrade FAK,inhibit the migration and invasion of HCC cells in vitro,and notably decrease the lung metastasis of HCC in vivo.Increased expression of E-cadherin and decreased expression of vimentin indicated that EMT was inhibited.Consequently,degradation of FAK through FAK PROTAC effectively suppressed liver cancer metastasis,holding significant clinical implications for treating liver cancer and developing innovative anti-neoplastic drugs.

Polo-like kinase 1 as a biomarker predicts the prognosis and immunotherapy of breast invasive carcinoma patients

Invasive breast carcinoma(BRCA)is associated with poor prognosis and high risk of mortality.Therefore,it is critical to identify novel biomarkers for the prognostic assessment of BRCA.Methods:The expression data of polo-like kinase 1(PLK1)in BRCA and the corresponding clinical information were extracted from TCGA and GEO databases.PLK1 expression was validated in diverse breast cancer cell lines by quantitative real-time polymerase chain reaction(qRT-PCR)and western blotting.Single sample gene set enrichment analysis(ssGSEA)was performed to evaluate immune infiltration in the BRCA microenvironment,and the random forest(RF)and support vector machine(SVM)algorithms were used to screen for the hub infiltrating cells and calculate the immunophenoscore(IPS).The RF algorithm and COX regression model were applied to calculate survival risk scores based on the PLK1 expression and immune cell infiltration.Finally,a prognostic nomogram was constructed with the risk score and pathological stage,and its clinical potential was evaluated by plotting calibration charts and DCA curves.The application of the nomogram was further validated in an immunotherapy cohort.Results:PLK1 expression was significantly higher in the tumor samples in TCGA-BRCA cohort.Furthermore,PLK1 expression level,age and stage were identified as independent prognostic factors of BRCA.While the IPS was unaffected by PLK1 expression,the TMB and MATH scores were higher in the PLK1-high group,and the TIDE scores were higher for the PLK1-low patients.We also identified 6 immune cell types with high infiltration,along with 11 immune cell types with low infiltration in the PLK1-high tumors.A risk score was devised using PLK1 expression and hub immune cells,which predicted the prognosis of BRCA patients.In addition,a nomogram was constructed based on the risk score and pathological staging,and showed good predictive performance.Conclusions:PLK1 expression and immune cell infiltration can predict post-immunotherapy prognosis of BRCA patients.

Peutz-Jeghers syndrome without STK11 mutation may correlate with less severe clinical manifestations in Chinese patients

BACKGROUND Peutz-Jeghers syndrome(PJS) is an autosomal dominant genetic disease with skin mucosal pigment spots and gastrointestinal(GI) multiple hamartoma polyps as clinical characteristics. At present, it is considered that the germline mutation of STK11 gene is the genetic cause of PJS. However, not all PJS patients can be detected STK11 germline mutations. The specific clinical characteristics of these PJS patients without STK11 mutation is an interesting clinical question. Or, like wild type GI stromal tumor, whether these PJS without STK11 mutation are also called PJS is worth discussing. Therefore, we designed the study to understand the clinical characteristics of these PJS patients without STK11 mutation.AIM To investigates whether PJS patients with known STK11 mutations have a more severe spectrum of clinical phenotypes compared to those without.METHODS A total of 92 patients with PJS admitted to the Air Force Medical Center from 2010 to 2022 were randomly selected for study. Genomic DNA samples were extracted from peripheral blood samples, and pathogenic germline mutations of STK11 were detected by high-throughput next-generation gene sequencing. Clinicalpathologic manifestations of patients with and without STK11/LKB1 mutations were compared.RESULTS STK11 germline mutations were observed in 73 patients with PJS. Among 19 patients with no detectable STK11 mutations, six had no pathogenic germline mutations of other genes, while 13 had other genetic mutations. Compared with PJS patients with STK11 mutations, those without tended to be older at the age of initial treatment, age of first intussusception and age of initial surgery. They also had a lower number of total hospitalizations relating to intussusception or intestinal obstruction, and a lower load of small intestine polyps.CONCLUSION PJS patients without STK11 mutations might have less severe clinical-pathologic manifestations than those with.

Analysis of clinicopathological features and prognostic factors of breast cancer brain metastasis

BACKGROUND Breast cancer(BC)has become the most common malignancy in women.The incidence and detection rates of BC brain metastasis(BCBM)have increased with the progress of imaging,multidisciplinary treatment techniques and the extension of survival time of BC patients.BM seriously affects the quality of life and survival prognosis of BC patients.Therefore,clinical research on the clinicopathological features and prognostic factors of BCBM is valuable.By analyzing the clinicopathological parameters of BCBM patients,and assessing the risk factors and prognostic indicators,we can perform hierarchical diagnosis and treatment on the high-risk population of BCBM,and achieve clinical benefits of early diagnosis and treatment.AIM To explore the clinicopathological features and prognostic factors of BCBM,and provide references for diagnosis,treatment and management of BCBM.METHODS The clinicopathological data of 68 BCBM patients admitted to the Air Force Medical Center,Chinese People’s Liberation Army(formerly Air Force General Hospital)from 2000 to 2022 were collected.Another 136 BC patients without BM were matched at a ratio of 1:2 based on the age and site of onset for retrospective analysis.Categorical data were subjected to χ^(2) test or Fisher’s exact probability test,and the variables with P<0.05 in the univariate Cox proportional hazards model were incorporated into the multivariate model to identify high-risk factors and independent prognostic factors of BCBM,with a hazard ratio(HR)>1 suggesting poor prognostic factors.The survival time of patients was estimated by the Kaplan-Meier method,and overall survival was compared between groups by log-rank test.RESULTS Multivariate Cox regression analysis showed that patients with stage Ⅲ/Ⅳ tumor at initial diagnosis[HR:5.58,95% confidence interval(CI):1.99–15.68],lung metastasis(HR:24.18,95%CI:6.40-91.43),human epidermal growth factor receptor 2(HER2)-overexpressing BC and triple-negative BC were more prone to BM.As can be seen from the prognostic data,52 of the 68 BCBM patients had died by the end of follow-up,and the median time from diagnosis of BC to the occurrence of BM and from the occurrence of BM to death or last follow-up was 33.5 and 14 mo,respectively.It was confirmed by multivariate Cox regression analysis that patients with neurological symptoms(HR:1.923,95%CI:1.005-3.680),with bone metastasis(HR:2.011,95%CI:1.056-3.831),and BM of HER2-overexpressing and triple-negative BC had shorter survival time.CONCLUSION HER2-overexpressing,triple-negative BC,late tumor stage and lung metastasis are risk factors of BM.The presence of neurological symptoms,bone metastasis,and molecular type are influencing prognosis factors of BCBM.

Expression and clinical significance of serum galactose lectin-2 and transforming growth factor-β2 in patients with atrial fibrillation

Objective:To investigate the expression of serum transforming growth factorβ2(TGF-β2)and galectin-2(Galectin-2)in patients with atrial fibrillation and its clinical significance.Methods:A total of 150 inpatients in the Department of Cardiology of the First Affiliated Hospital of Bengbu Medical College from January 2019 to June 2019 were selected,including 84 patients in the paroxysmal atrial fibrillation group,66 patients in the persistent atrial fibrillation group,and 120 patients with sinus rhythm excluding atrial fibrillation who were hospitalized during the same period were selected as the control group.Blood routine,biochemical routine and cardiac ultrasonic morphological examination were improved after admission.In addition,the serum levels of TGF-β2 and Galectin-2 in each group were detected by Elisa and Western Blot,and the differences and clinical significance of TGF-β2 and Galectin-2 in different groups were statistically analyzed.The correlation between TGF-β2,Galectin-2 and left atrial end-diastolic diameter(LAD)was further determined by Pearson correlation analysis.By means of binary logistics regression analysis,the factors affecting atrial fibrillation were obtained.Results:Compared with the control group,age and LAD in atrial fibrillation group were significantly increased(P<0.05).The serum concentrations of TGF-β2 and galectin-2 in persistent af group were significantly increased compared with those in paroxysmal af group and control group(P<0.05),while those in control group were significantly decreased compared with paroxysmal AF group(P<0.05).Pearson correlation analysis showed that TGF-β2 and Galectin-2 concentrations were significantly positively correlated with LAD size in the experimental group(P<0.05).Binary logistic regression analysis showed that TGF-β2,galectin-2 and LAD were risk factors for atrial fibrillation(P<0.05).Conclusion:TGF-β2 and Galectin-2 are closely related to the occurrence and development of atrial fibrillation.Both TGF-β2 and Galectin-2 were positively correlated with LAD.The three have a synergistic effect on the occurrence and progression of atrial inflammatory fibrosis in patients with ATRIAL fibrillation,jointly promoting mechanical and electrical remodeling of atrial,and can be used as risk factors to evaluate the occurrence and progression of atrial fibrillation.

Clinical research on curative effect of treatment on patients with gouty renal stone by hydration-alkalization therapy

Objective:Study the clinical effect of intravenous hydration and alkalization therapy on uric acid nephrolithiasis.Methods: Sixty-five patients with 86 stones admitted to Department of Endocrinology and Urinary Nephropathy from December 2015 to December 2017 in our hospital were divided into control group (n= 31) and Treatment group (n = 34) with at random. Both groups were given basic treatment with low purine diet and the control group was treated with oral sodium bicarbonate tablets + oral rehydration 1000 mL / d. The treatment group was treated with hydration alkalosis treatment by 0.9% saline 500 mL + 5% sodium bicarbonate injection of 60 mL + 10% potassium chloride injection 10 mL intravenous infusion, 2 times/d. Two groups were treated for a course of treatment (10 d), respectively, detecting relevant laboratory parameters and imaging studies before and after treatment for assessing the effectiveness of treatment.Result: The total effective rate of the treatment group was 86.67%, which was significantly better than the control group (4.88%).Conclusion: It is a significant effect that Intravenous hydration alkalosis therapy for the treatment of uric acid nephrolithiasis. The diameter of less than 0.5 cm stones disappears, and the diameter of 0.5-0.8 cm stone was significantly reduced. As it can improve stone related renal insufficiency with low cost, it is widely recommended in clinical.

Analysis of differentially expressed genes related to cerebral ischaemia in young rats based on the Gene Expression Omnibus database

BACKGROUND The incidence rate of cerebral infarction in young people is increasing day by day,the age of onset tends to be younger,and its internal pathogenesis and mechanism are very complicated,which leads to greater difficulties in treatment.Therefore,it is essential to analyze the key pathway that affects the onset of cerebral infarction in young people from the perspective of genetics.AIM To compare the differentially expressed genes in the brain tissue of young and aged rats with middle cerebral artery occlusion and to analyse their effect on the key signalling pathway involved in the development of cerebral ischaemia in young rats.METHODS The Gene Expression Omnibus 2R online analysis tool was used to analyse the differentially expressed genes in the GSE166162 dataset regarding the development of cerebral ischaemia in young and aged groups of rats.DAVID 6.8 software was further used to filter the differentially expressed genes.These genes were subjected to Gene Ontology(GO)function analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis to determine the key gene pathway that affects the occurrence of cerebral ischaemia in young rats.RESULTS Thirty-five differentially expressed genes(such as Igf2,Col1a2,and Sfrp1)were obtained;73 GO enrichment analysis pathways are mainly involved in biological processes such as drug response,amino acid stimulation response,blood vessel development,various signalling pathways,and enzyme regulation.They are involved in molecular functions such as drug binding,protein binding,dopamine binding,metal ion binding,and dopamine neurotransmitter receptor activity.KEGG pathway enrichment analysis showed a significantly enriched pathway:The cyclic adenosine monophosphate(c-AMP)signalling pathway.CONCLUSION The c-AMP signalling pathway might be the key pathway in the intervention of cerebral infarction in young people.

Anlotinib in combination with pembrolizumab for low-grade myofibroblastic sarcoma of the pancreas: A case report

BACKGROUND Low-grade myofibroblastic sarcoma(LGMS)is a rare spindle cell sarcoma espe-cially in the pancreas,with myofibroblastic differentiation.Hitherto,only a few cases have been reported.CASE SUMMARY Herein,we report a case involving the discovery of a pancreatic mass detected during a routine physical examination.Subsequent imaging and pathological tests of the patient led to the diagnosis of LGMS of the pancreas.Following surgical intervention,the patient experienced recurrence and metastasis.Conventional treatment is not effective for postoperative recurrent pancreatic LGMS with multiple metastases.After communicating with the patients and their families,informed consent was obtained for the treatment of anlotinib combined with pembrolizumab.Evaluation of imaging and clinical symptoms post-treatment revealed a relatively favorable response to the combination of anlotinib and pembrolizumab.CONCLUSION Based on the comprehensive literature review,our report aimed to provide evidence for a better understanding of the disease characteristics,diagnostic criteria,imaging findings,and identification of LGMS.And explore novel treatment strategies for this disease.

An early neuroprotective effect of atorvastatin against subarachnoid hemorrhage

Atorvastatin has been shown to reduce early brain edema and neuronal death after subarachnoid hemorrhage,but its mechanism is not clear.In this study,rat models of subarachnoid hemorrhage were established by autologous blood injection in the cisterna magna.Rat models were intragastrically administered 20 mg/kg atorvastatin 24 hours before subarachnoid hemorrhage,12 and 36 hours after subarachnoid hemorrhage.Compared with the controls,atorvastatin treatment demonstrated that at 72 hours after subarachnoid hemorrhage,neurological function had clearly improved;brain edema was remarkably relieved;cell apoptosis was markedly reduced in the cerebral cortex of rats;the number of autophagy-related protein Beclin-1-positive cells and the expression levels of Beclin-1 and LC3 were increased compared with subarachnoid hemorrhage only.The ultrastructural damage of neurons in the temporal lobe was also noticeably alleviated.The similarities between the effects of atorvastatin and rapamycin were seen in all the measured outcomes of subarachnoid hemorrhage.However,these were contrary to the results of 3-methyladenine injection,which inhibits the signaling pathway of autophagy.These findings indicate that atorvastatin plays an early neuroprotective role in subarachnoid hemorrhage by activating autophagy.The experimental protocol was approved by the Animal Ethics Committee of Anhui Medical University,China(904 Hospital of Joint Logistic Support Force of PLA;approval No.YXLL-2017-09)on February 22,2017.

A Panel of Genes Identified as Targets for 8q24.13-24.3 Gain Contributing to Unfavorable Overall Survival in Patients with Hepatocellular Carcinoma

Copy number aberrations （CNAs） in chromosome arm 8q have been associated with unfavorable clinical outcomes of several cancers and progressive tumor characteristics of hepatocellular carcinoma （HCC）. This study was to identify correlation of CNAs in 8q with clinical outcomes of HCC patients, and further screen for differentially expressed genes in outcome-related CNAs. Array comparative genomic hybridization and expression arrays were performed to detect CNAs and expression levels, respectively. The correlations between CNAs in 8q and outcomes were analyzed in 66 patients, with a median follow-up time of 45.0 months （range, 2.6-108.6 months）. One hundred and nine cases were further evaluated to identify differentially expressed genes in the potential outcome-related CNAs. Copy number gain in 8q was observed in 22 （33.3%） of the 66 HCC cases. The most recurrent gains （with frequencies 〉20%） were 8q 13.3-21.3, 8q21.3-23.3, 8q23.3-24.13, 8q24.13-24.3, and 8q24.3. Survival analysis showed that 8q24.13-24.3 gain was significantly associated with reduced overall survival （P=0.010）. Multivariate Cox analysis identified 8q24.13- 24.3 gain as an independent prognostic factor for poor overall survival （HR=2.47; 95% CI=1.16-5.26; P=0.019）. A panel of 17 genes within the 8q24.13-24.3 region, including ATAD2, SQLE, PVT1, ASAP1, and NDRG1 were significantly upregulated in HCCs with 8q24.13-24.3 gain compared to those without. These results suggest that copy number gain at 8q24.13-24.3 is an unfavorable prognostic marker for HCC patients, and the potential oncogenes ATAD2, SQLE, PVT1, ASAP1, and NDRG1 within the regional gain, may contribute coordinately to the 8q24.13-24.3 gain-related poor prognosis.

Bioinformatics-based Identification of Key Pathways and Hub Genes of Traumatic Brain Injury in a Rat Model

Traumatic brain injury(TBI)is a common injury caused by external forces that lead to damaged brain function or pathological changes in the brain tissue.To explore the molecular mechanism and the hub genes of TBI,we downloaded gene expression profiles of the TBI model of rat and the sham control for the subsequent gene set enrichment analysis,pathway analysis and protein-protein interactions analysis.The results of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis indicated that multiple biological pathways,including immune response,inflammatory response and cellular response to interleukin-1,as well as signaling pathways,such as tumor necrosis factor signaling pathway,chcmokine signaling pathway,cytokine-cytokine receptor interaction,Toll-like receptor signaling pathway and nuclear factor kappa B signaling pathway were implicated in the TBI.In conclusion,this study provides insights into the molecular mechanism of TBI by screening the differentially expressed genes and hub genes that can be used as biomarkers and therapeutic targets.

Profiles of immune status and related pathways in sepsis: evidencebased on GEO and bioinformatics

Sepsis,characterized as life-threatening sequential organ failure,is caused by a dysregulated host immune response to a pathogen.Conventional practice for sepsis is to control the inflammation source and administer highgrade antibiotics.However,the mortality rate of sepsis varies from 25–30%and can reach 50%if a septic shock occurs.In our current study,we used bioinformatics technology to detect immune status profiles in sepsis at the genomic level.We downloaded and analyzed gene expression profiles of GSE28750 from the Gene Expression Omnibus(GEO)database to determine differential gene expression and immune status between sepsis and normal samples.Next,we used the CIBERSORT method to quantify the proportions of immune cells in the sepsis samples.Then we explored the differentially expressed genes(DEGs)related to sepsis.Furthermore,gene ontology(GO)function and the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis were used to present potential signaling pathways in sepsis.We found that in the sepsis samples,the CD8+T cell fraction was consistently lower,based on the CIBERSORT method,whereas the neutrophil fraction was significantly higher in the sepsis samples.The GO function and KEGG pathway enrichment analysis identified 1573 DEGs that were significantly associated with neutrophil activation,neutrophil degranulation,neutrophil activation involved in the immune response,neutrophil-mediated immunity,and T cell activation in the biological processes group.In our study,we provided a first glance of associations between immune status and sepsis.Furthermore,our data regarding the reciprocal interaction between immune cells(neutrophils and CD8+T cells)could improve our understanding of immune status profiles in sepsis.However,additional investigations should be performed to verify their clinical value.

Positive correlations between the health locus of control and self-management behaviors in hemodialysis patients in Xiamen

Objective:To investigate the association between the health locus of control and selfmanagement behaviors in patients receiving hemodialysis.Methods:Patients receiving hemodialysis in Xiamen,Fujian province,from December 2014 to March 2015 answered the Chinese version of the Multidimensional Health Locus of Control scale and the self-management behavior questionnaire.Results:The participants in this study indicated that they believed others exerted more control over their health than themselves or chance.In addition,the majority of participants had a medium to low level of self-management behaviors.Positive correlations were also observed between a participant's health locus of control and their level of selfmanagement behaviors.Internal health locus of control and external(others)health locus of control were significant predictors of self-management behaviors controlling for the effect of payment method.Conclusion:The results of this study provided evidence that there is a strong relationship between the health locus of control and self-management behaviors in hemodialysis patients.This study provides important information for medical professionals as they design strategies to educate hemodialysis patients on their health locus of control and selfmanagement behaviors.

Treatment of cutaneous lichen planus with ALA-mediated topical photodynamic therapy

Purpose:To evaluate the efectiveness of topical 5-aminolevulinie acid(ALA)-mediated pho-todynamic therapy(PDT)for the treatment of cutaneous lichen planus(LP).Methods:A total of 17 symptomatic LP lesions in 7 Chinese patients were assessed.ALA cream(10%)was applied topically to LP lesions for 3h.The lesions were iradiated with a 635 nm diode laser at the dose level of 100J/cm^(2).The treatment was repeated at two week intervals.Clinical assessmnent was conducted before each treatment.Follow-up was performed once a month for up to six months.Results:Lesions showed significant improvement after one to four courses of treatments.Complete response was achieved in 13 lesions(five patients)and partial remission in four lesions(two patients).The complete response rate was 71%.There was no significant side ffects except the feeling of pain that most patients could tolerate.Follow-up of five patients who achieved complete response showed no signs of recurrence.Conclusion:Topical ALA PDT is effective in the treatment of cutaneous LP.

Effects of perioperative rosuvastatin on postoperative delirium in elderly patients:A randomized,double-blind,and placebo-controlled trial

BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes,while some studies have reported negative results.AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODS This randomized,double-blind,and placebo-controlled trial was conducted in a single center in Jiangsu,China.This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent.A computer-generated randomization sequence(in a 1:1 ratio)was used to randomly assign patients to receive either rosuvastatin(40 mg/d)or placebo.Participants,care providers,and investigators were all masked to group assignments.The primary endpoint was the incidence of delirium,which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days.Analyses were performed on intention-to-treat and safety populations.RESULTS Between January 1,2017 and January 1,2020,3512 patients were assessed.A total of 821 patients were randomly assigned to receive either placebo(n=411)or rosuvastatin(n=410).The incidence of postoperative delirium was significantly lower in the rosuvastatin group[23(5.6%)of 410 patients]than in the placebo group{42(13.5%)of 411 patients[odds ratios(OR)=0.522,95%confidence interval(CI):0.308-0.885;P<0.05]}.No significant difference in 30-d all-cause mortality(6.1%vs 8.7%,OR=0.67,95%CI:0.39-1.2,P=0.147)was observed between the two groups.Rosuvastatin decreased the hospitalization time(13.8±2.5 vs 14.2±2.8,P=0.03)and hospitalization expenses(9.3±2.5 vs 9.8±2.9,P=0.007).No significant differences in abnormal liver enzymes(9.0%vs 7.1%,OR=1.307,95%CI:0.787-2.169,P=0.30)or rhabdomyolysis(0.73%vs 0.24%,OR=3.020,95%CI:0.31-29.2,P=0.37)were observed between the two groups.CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia.However,the evidence does not reveal that rosuvastatin improves clinical outcomes.The therapy is safe.Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.

Establishment of blood glucose control model in diabetic mice

AIM:To explore the established method of the diabetic mouse blood glucose control model and preliminar y observation of its influence on the retinas of diabetic mice.METHODS:The db/db BKS-DB(Lepr^(ko/ko))mice were randomly divided into two groups:the poor blood glucose control group(PG group,n=18)and the stable blood glucose control group(SG group,n=12),with BKS-DB(Lepr^(wt/wt))as the normal blood glucose control group(NG group,n=18).According to the blood glucose values for 5 intervals which were monitored during the period of adaption,the PG group was injected with insulin aspart twice daily,fasted for 2h and then returned to normal.The SG group was injected with insulin aspart twice and insulin glargine once daily and fed with a quantitative ration.Fundus images were collected after eight weeks.The glycosylated hemoglobin(Hb A1c),mean blood glucose level(MBG),standard deviation of blood glucose(SDBG),coefficient of variation of blood glucose(CVBG),and mean amplitude of glycemic excursion(MAGE)in each group were examined and calculated.RESULTS:The Hb A1c,MBG,SDBG,CVBG,and MAGE levels in the PG group were significantly higher than those in the NG and SG groups(all P<0.05).MBG,SDBG,CVBG,and MAGE levels in the SG group were higher than those in the NG group(all P<0.05).There was no significant difference in Hb A1c levels between the NG and SG groups(P>0.05).Preliminary observation of fundus images in the PG group and SG groups showed scattered retinal bleeding spots,while bleeding was more obvious in the PG group.CONCLUSION:The blood glucose control model of type 2 diabetes mellitus mice can be successfully established by subcutaneous injection of insulin aspart insulin glargine and rationed food,which is valuable for studying the mechanism of blood glucose fluctuations in diabetic complications in vivo.

Risk factors for stroke recurrence in young patients with first-ever ischemic stroke:A meta-analysis

BACKGROUND At present,the incidence rate of ischemic stroke in young people is increasing yearly,and the age of onset is increasingly young.Therefore,primary and secondary prevention of ischemic stroke in young people,especially secondary prevention,is particularly crucial.AIM We aimed to comprehensively evaluate risk factors for stroke recurrence in firstever young ischemic stroke(YIS)patients.METHODS The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally.Stata12.0 software was used for heterogeneity testing,publication bias analysis,sensitivity analysis,and the calculation of combined odds ratios and 95%confidence intervals.RESULTS The odds ratio(OR)values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54(1.05-2.26)and 1.12(1.00-1.25),respectively.The OR values of male sex,type 2 diabetes,smoking,drinking and YIS recurrence were 1.66(0.98-2.79),1.01(0.64-1.59),1.21(0.83-1.76),and 1.28(0.82-2.53),respectively.The relationship between male sex,type 2 diabetes,smoking,drinking and YIS recurrence was ambiguous.CONCLUSION Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients,and active intervention should be taken.

Resveratrol Prevents Vibrio vulnificus-Induced Sepsis by Attenuating Necroptosis

Objective This study investigated how the natural phytophenol and potent SIRT1 activator resveratrol(RSV)regulate necroptosis during Vibrio vulnificus(V.vulnificus)-induced sepsis and the potential mechanism.Methods The effect of RSV on V.vulnificus cytolysin(VVC)-induced necroptosis was analyzed in vitro using CCK-8 and Western blot assays.Enzyme-linked immunosorbent assays and quantitative real-time polymerase chain reaction,western blot,and immunohistochemistry and survival analyses were performed to elucidate the effect and mechanism of RSV on necroptosis in a V.vulnificus-induced sepsis mouse model.Results RSV relieved necroptosis induced by VVC in RAW264.7 and MLE12 cells.RSV also inhibited the inflammatory response,had a protective effect on histopathological changes,and reduced the expression level of the necroptosis indicator pMLKL in peritoneal macrophages,lung,spleen,and liver tissues of V.vulnificus-induced septic mice in vivo.Pretreatment with RSV downregulated the mRNA of the necroptosis indicator and protein expression in peritoneal macrophages and tissues of V.vulnificusinduced septic mice.RSV also improved the survival of V.vulnificus-induced septic mice.Conclusion Our findings collectively demonstrate that RSV prevented V.vulnificus-induced sepsis by attenuating necroptosis,highlighting its potency in the clinical management of V.vulnificus-induced sepsis.