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ObjectiveTo investigate the clinicopathological features， diagnosis and treatment methods， and prognosis of gallbladder sarcomatoid carcinoma （GBSC）. MethodsA retrospective analysis was performed for the clinical data of 16 patients with GBSC who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2015 to April 2023， including general information， clinical manifestations， imaging features， pathological features， and treatment modality， and follow-up was performed for all patients. The Kaplan-Meier method was used to perform the survival analysis and plot the survival curve， and the Log-rank test was used for comparison between groups. ResultsAmong the 16 patients， there were 6 male patients and 10 female patients， with a mean age of 62.9±8.4 years. The main clinical manifestations were right upper abdominal pain in 13 patients （81.3%）， nausea in 5 patients （31.3%）， abdominal distension in 4 patients （25.0%）， poor appetite in 3 patients （18.8%）， weakness in 2 patients （12.5%）， fever in 2 patients （12.5%）， and jaundice in 1 patient （6.3%）， and 3 patients were asymptomatic and were found to have this disease by physical examination. Of all patients， 81.3% （13/16） were in the advanced stage （stage Ⅲ/Ⅳ） at the time of initial diagnosis. Histopathological examination showed that some cancer cells were spindle-shaped under the microscope， with marked nuclear division and noticeable heteromorphism. Immunohistochemistry showed a positive expression rate of 100% （16/16） for Vimentin， AE1/AE3， and CK8/18， and Ki-67 proliferation index was highly expressed in 81.3% （13/16） of the patients （≥50%）， with a median of 70% （range 20% — 90%）. All 16 patients underwent surgical treatment， with radical surgery in 11 patients and palliative surgery in 5 patients， among whom 9 received R0 resection， 2 received R1 resection， and 5 received R2 resection， and 7 patients received adjuvant therapy after surgery. Effective follow-up was achieved for all 16 patients， with a follow-up time of 0.5 — 26.0 months and a median follow-up time of 11.0 months. By the end of follow-up， 2 patients survived and 14 patients died due to tumor recurrence or metastasis， with a median survival time of 10.0 months， and the 1- and 2-year cumulative survival rates after surgery were 31.3% and 8.3%， respectively. The prognostic analysis showed that TNM stage （χ2=6.727， P=0.009）， surgical approach （χ2=7.508， P=0.006）， margin condition （χ2=7.934， P=0.005）， and adjuvant therapy （χ2=4.608， P=0.032） were associated with the prognosis of patients. ConclusionThe clinical manifestations of GBSC lack specificity， and a confirmed diagnosis relies on immunohistochemical analysis. Most patients are in the advanced disease at the time of initial diagnosis and tend to have a poor prognosis. There are currently no targeted therapies for this disease， and radical surgery with negative margins and adjuvant therapy can improve the survival rate of patients.
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Staphylococcus utilizes vancomycin-resistance associated sensor/regulator ( VraSR) , a two-component signal transduction system ( TCS) , to sense and respond to cell wall damage and to adapt to environmental changes through regulating transcriptions of downstream genes. It has been indicated that VraSR can regulate the transcription of a series of genes involved in the synthesis of peptidoglycan, drug re-sistance, and virulence in Staphylococcus aureus ( S. aureus) . A similar two-component system, VraSR, is also present in Staphylococcus epidermidis ( S. epidermidis ) , sharing a high homology with the VraSR of S. aureus. Little is known about the functions of VraSR in S. epidermidis and it is not yet clear what the simi-larities and differences in resistance and pathogenicity are. Based on the previous work of our group, a brief review on the regulation mechanism of staphylococcal VraSR was performed.
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Objective To evaluate the value of Alberta Stroke Program Early CT Score on diffusion weight-ed imaging(DWI-ASPECTS)in predicting the leptomeningeal collateral circulation(LMA)compensation of isch-emic stroke with middle cerebral artery stenosis or occlusion after intravenous thrombolysis. Methods A total of 178 patients with ischemic stroke confirmed as severe middle cerebral artery stenosis or occlusion by imaging were enrolled in the study.All the patients were treated by rt-PA intravenous thrombolysis.The baseline clinical date, DWI-ASPECTS,mRS and NIHSS were collected. LMA was assessed by cranio-cervical CTA. Results Compared with the poor collateral circulation group,the triglyceride level and DWI-ASPECTS were significantly increased in good collateral circulation group(P<0.05).The proportion of hypertension,NIHSS score,mRS score in good col-lateral circulation group were significantly lower than those in the poor collateral circulation group(P < 0.05). Compared with the poor collateral circulation group,insula,the ASPECTS areas M1 to M4,M6 and insula showed significantly fewer infarctions in good collateral circulation group(P<0.05).ROC analysis showed the area under ROC curve(AUC)of DWI-ASPECTS to predict LMA compensation were 0.932,the cutoff point of DWI-ASPECTS was 7.5.the sensitivity and specificity were 81.% and 94.1%.Conclusions The tissue protective role of good lepto-meningeal collateralization seems to be more pronounced in cortical and subcortical areas M1 to M4,M6 and the in-sula.DWI-ASPECTS can effectively predict the collateral circulation compensation in patients with acute middle ce-rebral artery infarction.
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Objective To determine the 50％ minimum effective concentration (EC50) of ropivacaine for postoperative analgesia after shoulder arthroscopy under general anesthesia combined with interscalene brachial plexus block.Methods Patients undergoing selective shoulder arthroscopy were included in this study.There were 9 males and 13 females,BMI 18-28 kg/m2,falling into ASA physical status Ⅰ or Ⅱ.The interscalene brachial plexus block was achieved under the guidance of ultrasound and nerve stimulator at the level of C6.The upper trunk of interscalene brachial plexus was blocked with 5 ml ropivacaine.The concentration of ropivacaine intially was 0.5 ％ and then depended on the response of the previous patient's postoperative NRS scale.The target ropivacaine concentration was determined by up and down sequential method.The ratio of two consecutive ropiva caine was 1.2.Two termination conditions were,firstly,to achieve seven negative-positive up-anddown deflections required to calculate EC50,and secondly,to deriminate if 7 were positive outcomes using 5 ml of 0.1 ％ ropivacaine or 7 were negative outcomes using 5 ml of 1 ％ ropivaciane.EC50 and 95％CI of ropivacaine was calculated using the formula of Dixon-Massey sequential method.The incidence of hemidiaphragmatic paresis was evaluated.Pre-and post-operative pulmonary function was compared using paired t test.Results The EC50 of ropivacaine was 0.21％ (95 ％CI 0.18％-0.25 ％).The incidence of hemidiaphragmatic paresis was 9 cases(40.90％).Postoperative FVC and FEV1/FVC was significantly decreased than preoperative,but FEV1 (P =0.116) was not.Conclusion For patients undergoing shoulder arthroscopy under general anesthesia and interscalene brachial plexus block,the minimum effective concentration of ropivacaine for analgesia of EC50 is 0.21％,95％ CI 0.18％-0.25％.
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Objective To evaluate the neuroprotective effects of erythropoiet (EPO) for traumatic brain injury (TBI) in rats and investigate the possible role of endoplasmic reticullum stress response and Caspase-12-induced apoptosis.Methods According to the random number table,140 male Sprague-Dawley rats were divided into sham injury group,sham injury plus EPO group,TBI group and TBI plus EPO group,with 35 rats per group.TBI was induced by a fluid percussion device.EPO (5 000 U/kg in saline) was administered intraperitoneally at 6 hours after injury.The rate of TUNEL positive cells in injured cortex were measured to evaluate cell apoptosis status.Neurological function was assessed at days 1,4,7,21,28 and 35 after intervention using a modified neurological severity score (mNSS).At 24 hours after injury,the expressions of Caspase-12 in injured cortex and C/EBP-homologous protein (CHOP) which was the symbol of ERS response were measured by Western blot and immunofluorescent staining to assess the changes of ERS response after TBI and EPO treatment.Results TUNEL-positive staining cell density was significantly increased by (30.3 ± 2.3) ％ in the injured cortex 24 hours after injury (P ＜ 0.01).Compared with TBI group,TBI plus EPO group had a significant decrease of the positive rate of TUNEL cells [(14.6 ± 1.5) ％] (P ＜ 0.01).Compared with TBI group,mNSS score significantly was decreased in TBI plus EPO group at 7-35 days after injury (P ＜ 0.05).At 24 hours after injury,the results of Western blot showed that the expression levels of Caspase-12 and CHOP in the injured cortex in TBI group were higher than those in sham group,but that in TBI plus EPO group was lower than those in TBI group (P ＜ 0.01).At 24 hours after injury,the results of immunofluorescent staining showed the rates of Caspase-12 and CHOP positive cells in the injured cortex in TBI group were higher than sham group (P ＜ 0.01).But the rates of Caspase-12 and CHOP positive cells in TBI plus EPO group was lower than that in TBI Group (P ＜ 0.01).Conclusion Exogenous EPO has significant neuroprotective effects on TBI rats.EPO may exert its neuroproective effects through suppression of ERS response and inhibition of Caspase-12-induced apoptosis.
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Objective Few studies are reported on the radicular groove and root canal variation of the mandibular first premolar.This study aimed to observe the root canal system and root variation of the mandibular first premolar by cone-beam computed tomography (CBCT).Methods We selected CBCT images of 643 mandibular first premolars of 336 patients and subjected the data obtained to statistical analysis.Results Of the 643 mandibular first premolars, 637 (99.1％) had a single root and the other 6 had double roots;502 (78.1％) had a single root canal, 133 (20.7％) had two, 5 (0.78％) had three, and 3 (0.47％) presented C-shaped root canal morphology.The average length of the 643 mandibular first premolars was (13.2±1.5) mm and the mean distance from the apical foramen to the anatomical apical end of the root was (0.93±0.35) mm.Totally, 123 (19.1％) of the mandibular first premolars had a radicular groove, of which 94 (76.4％) had double root canals and the root canal systems included typesⅠ in 24 (19.5％), Ⅱ in 2 (1.6％), Ⅲ in 19 (15.4％), Ⅳ in 1 (0.8％), Ⅴ in 69 (56.1％), and Ⅶ in 3 (2.4％).Conclusion The root canal system of the mandibular first premolar has a significant variation.CBCT can reveal the complex anatomical structure of the mandibular first premolar and provide reliable evidence for the root canal treatment.
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Objective To evaluate the relationships of the serum levels of matrix metalloproteinase-9 (MMP-9), intercellular adhesion molecule-1 (ICAM-1) and adiponectin with the mild cognitive impairment (MCI) in senile metabolic syndrome (MS)patients. Methods The 74 cases with MS and 30 health controls (control group) were enrolled. Mini-mental state examination (MMSE), montreal cognitive assessment (MoCA), digit-symbol test (DST), auditory verbal memory test (AVMT), trail making test(TMT), sunderland clock drawing test (CDT) and verbal fluency test (VFT) were applied to evaluate cognitive function. Based on the cognitive assessment, MS patients were divided into two groups: 39 cases with MCI (MS+MCI group) and 35 cases without cognitive impairment (MS group). The levels of MMP-9, ICAM-1 and adiponectin were measured by ELISA. Biochemical variables were measured by routine methods in all subjects. Results (1)MS+MCI group showed the higher levels of BMI, SBP, FBG and MMP-9 (all P＜0.05) and lower level of adiponectin (P＜0.05) than did the MS group. And MS group had higher levels of MMP-9 and ICAM-1 (P＜0.01) and lower adiponectin level (P＜0.01) than did the control group. (2)Spearman's correlation analysis showed that the serum levels of MMP-9 (r=-0.794, P＜0.001) and ICAM-l (r=-0.501, P＜0.001) were negatively correlated with adiponectin. However, MMP-9 was positively correlated with ICAM-1 (r=0.481, P=0.006). (3)Multiple linear regression analysis indicated that there was linear relationship of MoCA with MMP-9 (β=-3.438, P=0.0019), adiponectin (β=1.337, P=0.006), SBP (β=-0.058, P=0.003) and FBG (β=-0.227, P=0.049). (4)Stepwise logistic analysis showed that both high MMP-9 (OR=1.007) and low adiponectin (OR=0.359) were risk factors for the decline of cognitive function. Conclusions Elderly patients with MS may show deterioration in memory, calculation and visuospatial perception. Elevated inflammatory factors might contribute, in combination with abnormal metabolism, to MCI. MMP-9 might contribute to neuronal degeneration. However, adiponectin could strongly counteract the risk factors for cognitive impairment.
