[Research progress on HEG1 in cardiovascular generation and tumor development].

Heart development protein with EGF-like domains 1 (HEG1) is a novel mucin-like membrane protein with a long O-glycosylation region and EGF domain. HEG1 plays critical roles in embryo development and cardiogenesis, and is closely related to the occurrence and progression of malignant tumors. Here this article demonstrates the research progress on HEG1 in cardiovascular formation and tumor development in recent years, to inspire new ideas for the pathogenesis, diagnosis and treatment of related diseases.

[Interpretation of the surgical treatment of pancreatic cancer of the 2024 edition of the NCCN guidelines].

Pancreatic cancer is a highly malignant tumor in the digestive system, and radical surgery is the only possible means to cure pancreatic cancer at present. In the past decade, pancreatic surgery has been developing rapidly, with various new technologies and concepts emerging, among which the use of minimally invasive techniques and the popularization of neoadjuvant therapy concepts are the most notable. At the same time, the surgical treatment of pancreatic cancer still has a long way to go, and many problems need to be solved urgently. This article introduces the surgical treatment of pancreatic cancer in the 2024 edition of the NCCN guidelines, focusing on minimally invasive and open surgical treatments, expanded lymph node dissection, combined vascular resection and reconstruction, surgical treatment of pancreatic neck cancer and neoadjuvant therapy, and briefly discussing the unresolved issues.

[Progress and reflection of conversion therapy for locally advanced pancreatic cancer].

With the improvement of nonsurgical treatment in pancreatic cancer, the increasing accuracy of subclassification of anatomy, and the continuous refinement of surgical resection techniques, more and more locally advanced pancreatic cancer(LAPC) patients have the opportunity to undergo conversion surgery and achieve survival benefits,which has attracted the attention of scholars in this field. Despite the numerous prospective clinical studies conducted, there is still a lack of high-level evidence-based medical evidence in terms of conversion treatment strategies, efficacy evaluation, surgical timing and survival prognosis, and there are not yet specific quantitative standards and guiding principles for conversion treatment for these patients in clinical practice, and the indications for surgical resection rely more on the experience of each center or surgeon, lacking consistency. Therefore,the indicators for the evaluation of the efficacy of conversion treatment in patients with LAPC were summarized to reflect on the different modes of conversion treatment and clinical outcomes currently being explored, expecting to provide more accurate recommendations and guidance for the clinic.

Beamline simulations using monochromators with high d-spacing crystals.

Monochromators for synchrotron radiation beamlines typically use perfect crystals for the hard X-ray regime and gratings for soft X-rays. There is an intermediate range, typically 1-3 keV (tender X-rays), which common perfect crystals have difficulties covering and gratings have low efficiency, although some less common crystals with high d-spacing could be suitable. To evaluate the suitability of these crystals for a particular beamline, it is useful to evaluate the crystals' performance using tools such as ray-tracing. However, simulations for double-crystal monochromators are only available for the most used crystals such as Si, Ge or diamond. Here, an upgrade of the SHADOW ray-tracing code and complementary tools in the OASYS suite are presented to simulate high d-spacing crystals with arbitrary, and sometimes complex, structures such as beryl, YB66, muscovite, etc. Isotropic and anisotropic temperature factors are also considered. The YB66 crystal with 1936 atomic sites in the unit cell is simulated, and its applicability for tender X-ray monochromators is discussed in the context of new low-emittance storage rings.

[The diagnosis and treatment of G3 neuroendocrine tumors according to the new NCCN guideline].

Gastrointestinal pancreas (GEP) is the most common site of neuroendocrine neoplasms (NENs). In 2019, the World Health Organization (WHO) classification for GEP NET was updated to include a new category of well-differentiated high-grade (Ki 67>20%) GEP-NET G3, distinct from high-grade poorly differentiated neuroendocrine carcinoma (NEC). As a new category, NET G3 are considered a molecularly, radiologically, and prognostically distinct entity compared to NEC and NET G1/G2. The management of NET G3 remains a challenge awaiting future trials taking into consideration the unique characteristics of this new category. The latest NCCN clinical guidelines of neuroendocrine and adrenal tumors firstly gave the recommendation of diagnosis and treatment of G3 NET separately from NEC and G1/G2 NET. Hereon,we aim to summarize the management of G3 NET in combination with the new NCCN guidelines and the current evidences.

[Efficacy of conversion therapy and direct surgical resection in patients with metastatic pancreatic neuroendocrine tumors].

Objective: To explore the prognosis of Chinese patients with metastatic pancreatic neuroendocrine tumor (PanNET) treated with conversion therapy and surgical resection. Methods: The pathological data and prognostic information was retrospectively collected of patients with metastatic PanNET treated in Fudan University Shanghai cancer center from January 2010 to May 2021, and propensity score matching was used to analyze the prognosis difference between conversion treatment followed surgery and direct surgery. Results: There were 58 males and 43 females in 101 patients with metastatic PanNET. The age raged from 18 to 74 years, with a median age of 51 years. A total of 88 patients received primary tumor with liver metastases resection, 1 receied of primary tumor resection and 12 received primary tumor resection and combined organs or extrahepatic metastases. Multivariate analysis showed that R2(HR=1.943,95%CI:1.262-2.990,P=0.003)resection and G3(HR=1.876,95%CI:1.001-3.516,P=0.05) were independent risk factors for postoperative progression of metastatic patients. There were 63 patients (62.4%) who had received direct surgery, and 38 patients (37.6%) who had received preoperative conversion therapy. The conversion therapy had a higher proportion of T3/T4 stage (68.1% vs 39.7%, P=0.007), resection with combined organs/extrahepatic metastasis (26.3% vs 9.5%, P=0.005) and R2 resection (71.1% vs 42.9%, P=0.005). The median progression-free survival (mPFS) between conversion therapy and direct surgery had no statistically significant, but after the propensity score matching the mPFS of the conversion therapy group was significantly longer than direct surgery group (HR=0.442,95%CI:0.207-0.943,P=0.027). Conclusions: Conversion therapy for partially metastatic PanNET is better than that of direct surgery. Radical resection and grade are independent prognostic factors for metastatic PanNET after resection.

[Changes of brain network characteristics in patients with depression before and after precise repetitive transcranial magnetic stimulation].

Objective: To investigate the changes of brain network characteristics in patients with depression before and after precise repetitive transcranial magnetic stimulation (rTMS) treatment. Methods: Patients with depression in the Second Affiliated Hospital of Xinxiang Medical University and healthy volunteers in the community of Xinxiang city from February 2018 to March 2019 were simultaneously recruited. The left dorsolateral prefrontal cortex was precisely selected as the stimulation target through the latest Human Brainnetome Atlas, and the near infrared navigation was used to achieve accurate brain stimulation treatment in combination with the structural magnetic resonance data. Moreover, functional connectivity was analyzed before and after rTMS treatment in significantly altered brain areas of patients with depression. Results: Nineteen patients (11 males and 8 females) with depression were included, aged (34±11) years. Meanwhile, 22 healthy controls (9 males and 13 females), aged (30±9) years, were also enrolled. Functional connectivity of insular cortex was decreased in depression patients when the insula was analyzed as the target area (P<0.05). The functional connection from insula to middle frontal lobe and superior parietal lobe in patients with depression decreased before rTMS treatment (P<0.05), but increased after rTMS treatment (P<0.05). The functional connection between dIg_L of the insula and the right middle prefrontal lobe was correlated with Beck Anxiety Index (BAI) before rTMS treatment and Beck Depression Index (BDI) after rTMS treatment (r=0.737, P=0.003; r=0.696, P=0.005). Conclusions: Abnormal functional connectivity of insula may be the brain imaging mechanism of rTMS treatment. Precise brain region selection based on Human Brainnetome Atlas provides a new technical method for clinical rTMS precision treatment.

[Establishment and validation of prediction model of new-onset pelvic organ prolapse in early postpartum period].

Objective: To analyze the risk factors of pelvic organ prolapse (POP) and to establish the prediction model. Methods: A study was conducted on the prevalence of POP among 2 247 parturient women at 6 weeks postpartum in Peking University People's Hospital from December 2018 to October 2019, and relevant influencing factors were analyzed to construct a prediction model of early postpartum POP using logsitic regression, which was validated internally. Data from November 2019 to December 2019 (403 parturient women) were collected for external validation of the prediction model. In addition, the obstetrical factors affecting the occurrence of early postpartum POP in 885 primiparas with vaginal delivery (from January 2019 to November 2019) were further discussed. Results: A total of 2 247 cases were included in the modeling group, and 403 cases were included in the external validation data set. POP accounted for 24.3% (545/2 247). Age, parity, body mass index before pregnancy, vaginal delivery and newborn birth weight were negative factors for early postpartum POP (all P<0.05). The nomogram was established based on the above factors, and internal and external verification indicated that the model had a good discrimination (C-index were 0.759 and 0.760, respectively). In addition, this study found that age and newborn birth weight were the main causes of early postpartum POP in primiparas with vaginal delivery (P=0.044, P=0.004). Conclusions: The incidence of early postpartum POP is high. The prediction model of POP constructed in this study could be used to guide clinical practice to a certain extent and give corresponding treatment suggestions to pregnant women scientifically, so as to provide theoretical support for primary prevention.

[Risk assessment of Cronobacter sakazakii in infant formula powder].

Objective: To assess the risk of foodborne diseases caused by Cronobacter sakazakii in infant formula powder from retail to feeding and provide formulate suggestions for safe feeding of infants at home. Methods: This study used the special monitoring and risk monitoring data of infant formula powder in Heilongjiang Province and combined data at home and abroad. The @RISK software was used to evaluate the disease risk caused by Cronobacter sakazakii in the process of infant formula powder from retail to feeding. Results: According to the results of this quantitative risk assessment, the risk of foodborne diseases caused by Cronobacter sakazakii at the current consumption pattern in Heilongjiang Province was 5.158×10-5 persons/million (40.0 ℃ and 50.0 ℃), 1.072×10-7 persons/million (60.0 ℃), 5.544×10-14 persons/million (70.0 ℃). When the feeding time of infant formula powder was adjusted to 0-2 h and 2-3 h respectively, the above prediction results did not change. When it was adjusted to 3-4 h, the risk increased. If it was adjusted to 4-24 h, the number of Cronobacter sakazakii increased by 14-24 orders of magnitude at room temperature. If the initial pollution concentration (after flushing) was adjusted to 1 MPN/ml, the average disease risk per meal was 805.7 persons/million (40.0 ℃ and 50.0 ℃), 1.7 persons/million (60.0 ℃) and 9.1 × 10-7 persons/million (70.0 ℃). The results of sensitivity analysis showed that the water temperature (70.0 ℃), initial pollution concentration, room storage time and temperature were important factors of risk. Conclusion: Controlling the contamination level of Cronobacter sakazakii in infant formula powder, controlling the feeding time within 3 h, storing in refrigerator and mixing with water with temperature not lower than 70.0 ℃ are effective measures to prevent infants from eating infant formula powder infected by Cronobacter sakazakii.

[Minimally invasive enucleation for benign and low-grade malignant pancreatic tumors: an analysis of 60 cases].

Objective: To investigate the safety and feasibility of minimally invasive pancreatic tumor enucleation. Methods: The clinicopathological data of 60 patients with minimally invasive pancreatic tumor enucleation admitted to the Department of Pancreatic Surgery of Fudan University Cancer Center from November 2019 to August 2021 were retrospectively analyzed. There were 17 males and 43 females,with age of (50.0±13.2)years(range: 23 to 73 years). Tumors were located in the head of pancreas in 40 cases(66.7%),neck and tail of pancreas in 20 cases(33.3%). Patients were divided into robotic group(n=25) and laparoscopic group(n=35) according to surgical methods. The measurement data were compared by t-test or Mann-Whitney U test, and the categorical data were compared by χ2 test or Fisher exact probability method. The influencing factors of postoperative pancreatic fistula were analyzed by univariate and multivariate Logistic regression. Results: All patients successfully completed tumor enucleation without conversion to laparotomy. The operation time was (183.5±67.3)minutes(range:90 to 410 minutes). Twelve patients(20.0%) underwent stent placement and pancreatic duct repair during operation. The removal time of abdominal drainage tube after operation was (24.7±22.9)days(range:2 to 113 days). The tumor diameter in the robotic group was larger than that in the laparoscopic group((3.5±0.9)cm vs. (2.9±0.7)cm,t=-2.825,P=0.006). The incidences of postoperative biochemical fistula and grade B pancreatic fistula were 20.0%,22.9% and 36.0%,51.4%,respectively(χ²=2.289,P=0.318). There were no grade C pancreatic fistula,lymphatic fistula,biliary fistula,delayed gastric emptying,secondary operation and perioperative death in both groups. Multivariate logistic regression analysis was performed on the occurrence of clinically related pancreatic fistula(above grade B). The results showed that the increase of body mass index(OR=1.285,95%CI:1.053 to 1.569,P=0.014),the larger diameter of the tumor(OR=3.703,95%CI:1.465 to 9.360,P=0.006) and intraoperative pancreatic duct repair(OR=7.889,95%CI:1.471 to 42.296,P=0.016) were independent risk factors,whereas robotic surgery(OR=0.168,95%CI:0.036 to 0.796,P=0.025) was a protective factor. No case of pancreatin dependent dyspepsia and new onset diabetes mellitus was observed. Conclusions: Minimally invasive tumor enucleation is feasible in the treatment of benign and low-grade pancreatic tumors. The incidence of pancreatic fistula is high in the short term after operation,but serious complications are rare. The robot assisted system can reduce the risk of postoperative pancreatic fistula and has more advantages in dealing with larger diameter tumors because of clearer surgical vision and more accurate operation.

[Effect of laparoscopic surgery for pancreatic cancer after neoadjuvant chemotherapy].

Objective: To evaluate the safety and feasibility of laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer. Methods: Clinical data of 8 patients underwent laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer at Fudan University Shanghai Cancer Center from September 2019 to June 2020 were reviewed retrospectively. There were 5 males and 3 females,aged from 47 to 72 years old. All patients underwent abdominal enhanced CT and PET-CT before operation to accurately evaluate the tumor stage and exclude distant metastasis. Results: Neoadjuvant chemotherapy with AG regimen(gemcitabine 1 000 mg/m2 and albumin bound paclitaxel 125 mg/m2) was received for 2 to 6 cycles before surgery. All 8 patients successfully completed the operation,including 5 cases of pancreaticoduodenectomy,2 cases of radical antegrade modular pancreatosplenectomy(RAMPS),and 1 case of total pancreatectomy. No conversion to laparotomy or laparoscopic assisted surgery. The operation time was 240 to 450 minutes,the blood loss was 100 to 500 ml,the postoperative length of stay was 10 to 16 days. During the follow-up period up to December 31, 2020, there was 1 case suffered grade B pancreatic leakage and abdominal infection. The numbers of resected lymph nodes were 9 to 31. All patients received R0 resection. The follow-up times were 4.5 to 9.5 months. One patient underwent RAMPS was diagnosed as liver metastasis after 2 months of the operation,and the other 7 patients still survived without tumor recurrence. Conclusion: Minimally invasive surgery of pancreatic cancer after neoadjuvant chemotherapy is safe and feasible in experienced pancreatic minimally invasive centers.

[Impact of neoadjuvant therapy on the perioperative complications of pancreatic cancer].

Pancreatic cancer is one of the most malignant digestive tract tumors with a 5-year survival rate of less than 10%. Surgery remains the basis of long-term survival of pancreatic cancer patients. With the progress of chemotherapy, neoadjuvant therapy has been gradually carried out in pancreatic cancer. There are more and more studies on the effects of neoadjuvant therapy on perioperative complications of pancreatic cancer, but the results are not consistent. This article reviews the recent studies on neoadjuvant therapy for pancreatic cancer and analyzes the impact of some key factors on perioperative complications.

[Analysis of magnetic resonance imaging findings of fungal spondylitis].

The clinical and magnetic resonance imaging(MRI) data of 8 cases of fungal spondylitis were retrospectively enrolled in the study, and the typical MRI findings were mainly discussed. The results released that fungal spondylitis should be suspected when the infection spreads along paraspinal ligament, and vertebral lesions show jumping discontinuous distribution. A blurred and incomplete outline of endplate on T1 weighted imaging sequence, loss of hyperintensity of the vertebral body, and banded like hypointensity under endplate on T2 weighted imaging sequence, indicate fungal spondylitis. These features contribute to the diagnosis and differential diagnosis of fungal spondylitis.

[Surgical treatment for pancreatic cancer with liver metastasis:exploration and innovation].

The prognosis of pancreatic cancer patients with liver metastasis (PCLM) is very poor and the median overall survival(OS) is less than 6 months.The current standard treatment for PCLM is systematic chemotherapy.Though the chemotherapeutic regimens are better than gemcitabine only,the OS remains dissatisfied.A lot of retrospective studies identified that surgical treatment can only offer survival benefits for highly selected rather than entire PCLM patients.The Chinese Study Group for Pancreatic Cancer (CSPAC) has initiated a multiple-center,prospective,randomized comparison clinical trial,named CSPAC-1 to identify the standard and value of surgical treatment of PCLM patients.This manuscript reviewed the current progress of surgical treatment for pancreatic cancer with liver metastasis and looked forward to opportunities and challenges in the future.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)].

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Skimmed Milk Diluent Promotes the Sperm Motility and Conception Rate of Dorper Sheep Compared to Vitamin B12 Diluent.

BACKGROUND: Dorper sheep is an ideal breed for improvement, with higher meat production and increased adaptability. Artificial insemination is an efficient technique for Dorper genetic improvement and reproduction management. However, there is no uniform diluent for Dorper semen dilution. OBJECTIVE: To compare the effects of vitamin B12 (VB12) and skimmed milk diluents on sperm motility at different ratios and time points, and the effects on conception rate. MATERIALS AND METHODS: We detected the effect of diluents on sperm density, deformity, motility and conception rate of Dorper sheep. RESULTS: We found the optimal dilution ratio of skimmed milk is 1:3. Compared to VB12, skimmed milk at 1:3 ratio prolonged semen storage time (48 h vs. 18 h, storage at a low temperature of 4°C) and increased the survival index of sperm (44.7 ± 2.8 vs. 18.5 ± 0.6, P<0.01). CONCLUSION: Skimmed milk is more effective, nutritious and convenient than vitamin B12, representing a more advantageous diluent.

Persistence and gender differences in protection against severe fever with thrombocytopaenia syndrome virus with natural infection: a 4-year follow-up and mathematical prediction study.

Severe fever with thrombocytopaenia syndrome (SFTS) is an emerging infectious disease discovered in 2010 and has a case fatality as high as 30%. We intended to study the immune protection conferred by SFTS with natural infection. We collected and analysed 4-year follow-up data to study the characteristics of neutralising antibodies against SFTS virus (SFTSV). The 50% plaque reduction neutralisation test was used for the detection of neutralising antibodies against SFTSV. Geometric mean titres (GMTs) and proportions of patients with a protective titre were analysed, and the persistence of protection was predicted. The titre of antibodies declined yearly in the 4-year study period. Approximately 3 months after infection, the GMT was 143 (95% confidence interval (CI): 89-231), and 100% of patients had a protective titre. In the fourth year, the GMT declined to 53 (95% CI: 37-76), and 95% of patients had a protective titre. The titre was higher in females than in males. On average, the protection offered by neutralising antibodies against SFTSV could last as long as 9 years. The durations of protection were different for different initial titres. The characteristics of neutralising antibodies can be used as a reference for the vaccination doses and schedules of forthcoming vaccines.

[Postpartum pelvic organ prolapse in women with cesarean section at different time during delivery].

Objective: To study and analyze the incidence of pelvic organ prolapse (POP) in women who underwent cesarean section. Methods: A cross-sectional study was conducted. The clinical data of the women who underwent regular antepartum examination and cesarean delivery in Peking University People's Hospital from January 2019 to June 2019 were collected, including the cervical dilatation. The incidence of POP was analyzed. Results: (1) A total of 345 women met the inclusion criteria, with cervical dilatation of 0-10 cm before cesarean section, the cervix was not dilatated in 58.6% (202/345) of the women, and the cervix was fully dilatated in 2.9% (10/345) of the women. There were 109 cases of POP stage Ⅰ or above, 13 cases of POP stage Ⅱ, and no stage Ⅲ or Ⅳ. The incidence of POP was 31.6% (109/345). (2) Statistical analysis showed that the cervical dilatation of the POP group was significantly larger than that of the non-prolapse group (median: 1.0 vs 0 cm;Z=-2.227, P=0.026). The risk of POP of vaginal trial-birth transfer to cesarean section was higher than that of elective cesarean section [42.4% (36/85) vs 28.1% (73/260), P=0.014]. However, the further analysis of Spearman correlation between cervical dilatation, elective cesarean section and POP, as well as the receiver operating characteristic curve showed that the correlation and prediction value were poor. Conclusion: Elective cesarean section has a certain protective effect on postpartum prolapse, but the protective effect of vaginal trial-birth transfer to cesarean section on pelvic floor is weakened.

[Pelvic floor function of 5 143 women in early postpartum stage and analysis on the effect factors].

Objective: To describe the situation of early stage of pelvic floor function and investigate the effect factors in postpartum women. Methods: A retrospective survey was conducted, and women who did regular examination and gave birth in Peking University People's Hospital and had an annual pelvic floor examination at 6-12 weeks after delivery from Sep. 2012 to Dec. 2017 were interviewed. General information and pelvic floor electrical physiological indexes were collected and analyzed. Results: Totally 5 143 puerpera were included in the study. The normal strength of type Ⅰ muscle was 52.40% (2 695/5 143) and the normal strength of type Ⅱ muscle was 52.69% (2 710/5 143). The abnormal degree of fatigue of type Ⅰ muscle was 55.84% (2 872/5 143) and the abnormal degree of fatigue of typeⅡmuscle was 27.34% (1 406/5 143). Pelvic floor dynamic pressure was (93±37) cmH(2)O (1 cmH(2)O=0.098 kPa). The incidence of stress urinary incontinence (SUI) was 23.49% (1 208/5 143) after delivery and it was as high as 57.58% (95/165) for women who had family history of pelvic floor dysfunction. Family history of pelvic floor dysfunction was the risk factor of the fatigue index of type Ⅰ and type Ⅱ muscle (P<0.05). The incidence of SUI was associated with vaginal delivery and age (≥30 years old) and family history of pelvic floor dysfunction (P<0.01). Conclusions: Pelvic floor electrical physiological indicators are reduced in about half of women in early postpartum stage. Age (≥30 years old) and vaginal delivery and family history of pelvic floor dysfunction are the risk factors.

[Contamination and pathogenicity analysis of listeria monocytogenes in restaurant in Heilongjiang Province].

Objective: To study the contamination, serotype, pulsed field gel electrophoresis (PFGE) and drug resistance of listeria monocytogenes (L.monocytogenes) in the process of restaurant kitchens in Heilongjiang Province. Methods: Seventeen typical restaurants were selected from three cities in Heilongjiang Province in 2016, and 590 kitchen samples were collected and tested according to the national standard method. The serotype, pulsed field gel electrophoresis (PFGE) and drug resistance of isolated strains were analyzed. Results: L. monocytogenes was found in 104 of 590 of the samples analysed (17.63%). The isolates belong to six serotypes (1/2 a, 1/2 b, 1/2c, 3a, 3 b, 4 b) and self-condensing bacteria, and 57.38% (70 strains) of the strains belong to serotype 1/2b. Two highly pathogenic serotype 4b was detected for human listeria disease. The results of PFGE analysis show that the bacteria have cross-contamination in the environment, tools, equipment, food and personnel. The drug resistance results showed that 2 strains were resistant to tetracycline, 1 strain was resistant to erythromycin, 13 strains were intermediate to tetracycline, and 2 strains were resistant to tetracycline and erythromycin. Conclusion: There is a certain degree of L. monocytogenes cross-contamination in the catering kitchen in Heilongjiang Province. And an important serotype 4b that can cause human Listeria disease was detected.