Oncocytoma is a benign tumor of the salivary gland.Its incidence is very low and very seldom documen-ted in literature.Clear-cell dominant oncocytoma is even less common.The tumor's clinical symptoms and imaging re-sults are nonspecific,so distinguishing other salivary gland tumors(such as oncocytic carcinoma)from clear-cell renal carcinoma is difficult,possibly leading to misdiagnosis and maltreatment.Here,a case of clear-cell dominant oncocyto-ma was presented,and the relevant literature was evaluated to investigate the diagnosis and management of clear-cell dominant oncocytoma.

This study was performed to investigate the impact of nobiletin(NOB)on fracture healing in osteoporosis(OP)rats through the stimulator of interferon gene(STING)/nuclear transcription factor kappa B(NF-κB)signal pathway.A rat model of OP fracture was established by ovariectomy and right femoral shaft fracture intramedullary fixation;the rats after modeling were randomly grouped into model group,high dose(NOB-H,30 mg/kg NOB),medium dose(NOB-M,20 mg/kg NOB),low dose(NOB-L,10 mg/kg NOB)NOB group and NOB-H+ STING activator(DMXAA)group(30 mg/kg NOB+25 mg/kg DMXAA),and 18 rats experienced only ovaries expose were used as sham operation group.After the intervention,the fracture healing status of rats were measured;Micro-CT was used to detect the changes of bone trabecular microstructure in rats;commercial kits were used to detect the serum levels of bone metabolism related indicators(alkaline phosphatase(ALP),calcium,phosphorus)and inflammatory factors(tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β));HE was used to detect the morphological changes and trabecular area of femur,while Western blot was applied to detect the expression of STING/NF-κB pathway related proteins.Compared with the control group,the fracture line in the model group was clear,the trabecular structure was disordered and the gap was large,furthermore,the levels of TNF-α and IL-1β,the expression of STING and p-NF-κB p65/NF-κB p65 were significantly increased,the trabecular area,the levels of ALP,calcium,phosphorus,and bone mineral density(BMD),bone volume fraction(BV/TV),bone trabecular number(Tb.N)and bone trabecular thickness(Tb.Th)were significantly decreased(P<0.05);compared with the model group,the fracture line of NOB-L group,NOB-M group and NOB-H group gradually blurred,the trabecular structure arranged orderly,and the gap gradually decreased,and the trend of the index changes mentioned above were opposite to that of the model group(P<0.05).STING activators attenuated the promotion of fracture healing by NOB in OP rats and increased the inflammatory responses.In conclusion,NOB can reduce inflammatory reaction and promote fracture healing in OP rats,which may be related to the inhibition of STING/NF-κB signal pathway.

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.
Male ; Female ; Humans ; Aged ; Natriuretic Peptide, Brain ; Simendan/therapeutic use* ; Non-ST Elevated Myocardial Infarction ; Heart Failure/drug therapy* ; Peptide Fragments ; Arrhythmias, Cardiac ; Biomarkers ; Prognosis

OBJECTIVES: To study the clinical features and prognosis of children and their family members with family clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection under the admission mode of parent-child ward. METHODS: A retrospective analysis was performed on the medical data of 190 children and 190 family members with SARS-CoV-2 Omicron variant infection who were admitted to Shanghai Sixth People's Hospital, the designated hospital for coronavirus disease 2019 (COVID-19), April 8 to May 10, 2022. RESULTS: Both the child and adult groups were mainly mild COVID-19, and the proportion of mild cases in the child group was higher than that in the adult group (P<0.05). Respiratory symptoms were the main clinical manifestations in both groups. Compared with the adult group, the child group had higher incidence rates of fever, abdominal pain, diarrhea, and wheezing (P<0.05) and lower incidence rates of nasal obstruction, runny nose, cough, dry throat, throat itching, and throat pain (P<0.05). Compared with the child group, the adult group had higher rates of use of Chinese patent drugs, traditional Chinese medicine decoction, recombinant interferon spray, cough-relieving and phlegm-eliminating drugs, and nirmatrelvir/ritonavir tablets (P<0.05). Compared with the adult group, the child group had a lower vaccination rate of SARS-CoV-2 vaccine (30.5% vs 71.1%, P<0.001) and a shorter duration of positive SARS-CoV-2 nucleic acid (P<0.05). The patients with mild COVID-19 had a shorter duration of positive SARS-CoV-2 nucleic acid than those with common COVID-19 in both groups (P<0.05). The patients with underlying diseases had a longer duration of positive SARS-CoV-2 nucleic acid than those without such diseases in both groups (P<0.05). CONCLUSIONS Both children and adults with family clusters of SARS-CoV-2 Omicron variant infection manifest mainly mild COVID-19. Despite lower vaccination rate of SARS-CoV-2 vaccine in children, they have rapid disease recovery, with a shorter duration of positive SARS-CoV-2 nucleic acid than adults, under the admission mode of parent-child ward.
Adult ; Humans ; COVID-19/epidemiology* ; SARS-CoV-2 ; Cough ; Retrospective Studies ; COVID-19 Vaccines ; China/epidemiology* ; Family ; Nucleic Acids

Objective:To investigate the clinical and imaging features of pancreatic intraductal oncocytic papillary neoplasm (IOPN).Methods:From January 2011 to August 2021, at the First Affiliated Hospital (Changhai Hospital) of Naval Medical University, 12 patients pathologically diagnosed with pancreatic IOPN after surgical resection were enrolled. Before operation, all patients underwent plain and enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The clinical data (general conditions, main complaints, tumor related indicators and past medical history), CT and MRI features, surgical methods and pathologic results of the 12 patients with pancreatic IOPN were retrospectively analyzed. Descriptive method was used for statistical analysis.Results:Among 12 pancreatic IOPN patients, there were 7 males and 5 females, aged (54.0±13.0) years old (ranged from 31 to 75 years old). The symptoms were abdominal pain in 3 cases, jaundice in 1 case and 8 cases were detected during regular health checkups. Serum carbohydrate antigen 19-9 increased in 3 cases and carcinoembryonic antigen increased in 2 cases. One pancreatic IOPN patient with pancreatitis history and 3 pancreatic IOPN patients with diabetes history. Six cases were with the lesions located in the head of pancreas, 5 cases were located in the body and tail of pancreas and 1 case were diffused in the all the pancreas. Five cases were branch duct type, 2 cases were main duct type and 5 cases were mixed duct type. Ten pancreatic IOPN patients presented cystic or cystic-solid tumor, the maximum diameter (range) of the tumor was (50.3±31.1) mm (28 to 127 mm). The cyst walls of 6 patients were thickened and those of 9 patients were found with enhanced mural nodule or solid component, and none of them were growing outside the cystic wall. Two patients presented solid tumor located in the dilated pancreatic duct, and the maximum diameter (range) of the tumor was (25.5±0.5) mm (25 to 26 mm). The solid tumor demonstrated as slightly lower density on plain CT scan, lower signal on T1-weighted MRI imaging, high signal on T2-weighted MRI imaging, and limited diffusion on diffusion weighted imaging, and mild enhancement after CT and MRI enhanced scan. The main pancreatic duct dilated in 11 cases, and the inner diameter (range) was (10.5±8.1) mm (3 to 28 mm). The pancreatic parenchymal of 4 pancreatic IOPN patients was atrophy, 4 patients with calcification and 1 patient with lymphadenopathy. None of the 12 pancreatic IPON patients had peripheral blood vessel and tissue invasion. Six cases were received pancreaticoduodenectomy, 4 cases were underwent distal pancreatectomy, 2 cases underwent total pancreatectomy. The pathological classification of 7 pancreatic IOPN patients was invasive carcinoma, 4 cases were with high-grade dysplasia and 1 case with low-grade dysplasia.Conclusion:The clinical features of pancreatic IOPN are atypical and the imaging findings are mostly solid or cystic-solid tumor, pancreatic duct dilation, solid component of tumor located in the dilated pancreatic duct, and no peripheral tissue invasion.

Objective:To verify the predictive value of fully-automated 3D volume segmentation of CT images for the overall survival prognosis of resectable pancreatic ductal adenocarcinoma (PDAC).Methods:From July 2018 to March 2019, the clinical data of 198 cases of resectable PDAC were continuously collected in the First Affiliated Hospital of Naval Medical University. According to the level of carbohydrate antigen(CA)19-9 and carcinoembryonic antigen(CEA), the patient were divided into low CA19-9 group(≤210 U/ml ), high CA19-9 group (>210 U/ml ), normal CEA group (<5 ng/ml ) and high CEA group (≥5 ng/ml). Using our fully-automated segmentation tool developed in the early stage, images at the plain phase and portal phase were matched to those at the late artery phase by taking the artery phase as the matching target to establish UNet model; and the PDAC tumor and pancreatic glands were three-dimensionally segmented to estimate the tumor 3D volume. Univariate and multivariate logistic regression analysis were performed to compare the tumor 3D volume with the common preoperative risk factors (tumor 2D long diameter, CA19-9 level, CEA level, etc.) in predicting the patients′ survival. C-index was used to estimate the accuracy for predicting the survival. Receiver operating characteristics curve (ROC) was drawn and AUC was calculated to evaluate the accuracy for predicting the 1-year and 2-year overall survival and the influence of CA19-9 and CEA level on the patients′ overall survival.Results:Univariate logistic analysis showed that age, tumor 3D volume, tumor location, CA19-9 and CEA level were correlated with the patients′ overall survival. Multivariate logistic analysis showed that tumor 3D volume, CA199 and CEA were correlated with the overall survival. Among them, tumor 3D volume was most strongly correlated with the overall survival ( HR=2.25, 95% CI1.49-3.39, P<0.0001). The prognostic C-index of automatic 3D tumor volume, tumor long diameter, serum CEA and CA19-9 was 0.667(95% CI0.617-0.717), 0.637(0.583-0.691), 0.593(0.527-0.659) and 0.585(0.526-0.644), respectively. The AUCs of 3D tumor volume, tumor location, tumor long diameter, serum CEA and CA19-9 for predicting 1-year and 2-year survival were 0.726 and 0.698, 0.562 and 0.562, 0.703 and 0.660, 0.583 and 0.624, 0.602 and 0.609 respectively. C-index and AUC of tumor 3D volume was significantly better than those of the other common preoperative risk factors, and the difference was statistically significant (all P value <0.05). The survival of patients with large tumor 3D volume was greatly poorer than that of patients with small tumor 3D volume in low CA19-9 group, high CA19-9 group, normal CEA group and high CEA group, and the differences were all statistically significant ( HR=2.27, 95% CI 1.39-3.72; HR=2.42, 95% CI1.23-4.74; HR=2.08, 95% CI1.07-4.06; HR=2.67, 95% CI1.63-4.38, all P value <0.01). And the automatic 3D volume was the strongest predictor for the survival in high CA19-9 group. Conclusions:The tumor 3D volume obtained by automatic CT segmentation was an objective and reliable prognostic biomarker, which can supplement the established preoperativel risk factors and was expected to guide the personalized choice of neoadjuvant therapy.

Objective:To investigate the imaging features of colloid carcinoma arising from intraductal papillary mucinous neoplasm (IPMN) of pancreas and the differentiation features from ductal adenocarcinoma arising from IPMN, using the pathological findings as the reference.Methods:Twenty-four patients with pathologically confirmed colloid carcinoma from November 2013 to January 2020 in Changhai Hospital, Navy Medical University were included in this study. The clinical manifestations, imaging features and pathological data were retrospective reviewed. Thirty patients of ductal adenocarcinoma arising from IPMN confirmed by pathology were selected as the control group. CT and MRI features of two groups were blindly analyzed by two radiologists, including the lesions location, type of IPMN, size, components, density or signal, calcification, dilation and size of the main pancreatic duct (MPD), pancreatic parenchymal atrophy, fistula formation. The χ 2 test or Fisher exact probability was used to compare the imaging features between the two groups. Results:As for IPMN with colloid carcinoma, 16 cases were located in the head of the pancreas, 7 cases in the body and tail of the pancreas, and 1 case showed diffused changes of the pancreas. Mass was found in twenty-two cases, with the size of 54.5 (29) mm. Nineteen cases were solid-cystic, 4 were cystic and 1 was solid. Thick wall and internal separation with mild enhancement were displayed. Five cases were found with high signal on T 1WI. Thirteen cases had calcification and 2 cases had gas in the tumor. The size of MPD was (13±5) mm. Pancreatic parenchymal atrophy was found in 21 cases and fistula formation was found in 8 cases. The mass size of IPMN with colloid carcinoma was significantly greater than that of IPMN with ductal adenocarcinoma [31 (16) mm, Z=-3.758, P<0.001]. Solid-cystic mass was more found in IPMN with colloid carcinoma and solid mass was more found in IPMN with ductal adenocarcinoma ( P<0.001). Calcification ( P=0.001), fistula formation ( P=0.031), and high signal on T 1WI ( P=0.034) were more found in IPMN with colloid carcinoma than IPMN with ductal adenocarcinoma. Conclusion:Compared with IPMN with ductal adenocarcinoma, the solid-cystic mass, calcification, fistula formation and high signal on T 1WI were more commonly found in IPMN with colloid carcinoma.

To evaluate the efficacy and safety of Chinese patent medicines in the treatment of insomnia by frequency network Meta-analysis. Randomized controlled trials of Chinese patent medicines for insomnia were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library databases from the time of database establishment to October 2020. The quality of the included RCTs was evaluated according to the Cochrane bias risk standard, and the data was analyzed by RevMan 5.3 and Stata/MP 15.1. A total of 11 kinds of Chinese patent medicines in 27 RCTs were included. According to Meta-analysis, in term of the effective rate, Tianmeng Liquid, Zaoren Anshen Capsules, Shumian Capsules, Shensong Yangxin Capsules, Shenqi Wuweizi Tablets, Shugan Jieyu Capsules, Anshen Bunao Liquid and Qiye Anshen Tablets combined with nonbenzodiazepine drugs(NBZDs) were superior to NBZDs alone. In term of the improvement of Pittsburg sleeping quality index(PSQI) score, Tianmeng Liquid, Shumian Capsules, Shensong Yangxin Capsules, Bailemian Capsules, Shenqi Wuweizi Tablets, Shugan Jieyu Capsules, Yangxue Qingnao Granules and Yindan Xinnaotong Capsules combined with NBZDs were superior to NBZDs alone. In terms of the safety, Shumian Capsules, Shensong Yangxin Capsules, Shenqi Wuweizi Tablets and Qiye Anshen Tablets combined with NBZDs were superior to NBZDs alone. In terms of the avoidance of dizziness and headache, Qiye Anshen Tablets combined with NBZDs were superior to NBZDs alone. The results of Network Meta-analysis indicated that in term of the effective rate, top three optimal medication regimens were NBZDs combined with Shugan Jieyu Capsules, combined with Zaoren Anshen Capsules and combined with Shensong Yangxin Capsules in the order from high to low. With the respect of improvement of PSQI score, top three optimal medication regimens were NBZDs combined with Yangxue Qingnao Granules, combined with Tianmeng Liquid and combined with Yindan Xinnaotong Capsules in the order from high to low. In terms of the safety, top three optimal medication regimens were NBZDs combined with Qiye Anshen Tablets, combined with Shensong Yangxin Capsules and combined with Shenqi Wuweizi Tablets in the order from high to low. In terms of the avoidance of dizziness and headache, top three optimal medication regimens were NBZDs combined with Qiye Anshen Tablets, combined with Zaoren Anshen Capsules and combined with Shumian Capsules in the order from high to low. In terms of the avoidance of fatigue, top three optimal medication regimens were NBZDs combined with Shensong Yangxin Capsules, combined with Shumian Capsules and combined with Qiye Anshen Tablets in the order from high to low. In conclusion, Chinese patent medicines combined with NBZDs can effectively alleviate the symptoms of insomnia with a high safety. However, the conclusion of this study needs to be verified by more high-quality studies because of the low methodological quality of the included studies.
China ; Drugs, Chinese Herbal ; Humans ; Medicine, East Asian Traditional ; Network Meta-Analysis ; Nonprescription Drugs ; Sleep Initiation and Maintenance Disorders/drug therapy*

Objective:To investigate the effect of Chloriti Lapis on metal elements in brain tissue and plasma of epileptic rats kindled by pentylenetetrazol （PTZ）， and to explore the possible material basis of Chloriti Lapis. Method:PTZ kindling method was used to establish epileptic rat model. Inductively coupled plasma mass spectrometry （ICP-MS） and inductively coupled plasma optical emission spectrometer （ICP-OES） were used to determine the contents of metal elements in brain tissue and plasma of the blank group， model group， carbamazepine group （0.1 g·kg^-1） and Chloriti Lapis group （2 g·kg^-1）. The data were statistically analyzed by SPSS 18.0 software. Result:Compared with the blank group， the contents of Sr， Sb and Ba in brain tissue of rats in the model group were significantly increased （P<0.05， P<0.01）， while the contents of Zn， Fe， Cu， K， Li， Co， Sn and Pb were significantly decreased （P<0.05， P<0.01）. Compared with the model group， the contents of Zn， Fe， K， Li， Co， As and Pb in brain tissue of rats in the Chloriti Lapis group were obviously increased （P<0.05， P<0.01）， while the contents of Sr and Sb were significantly decreased （P<0.01）. These results showed that Chloriti Lapis had positive effect on the regulation of the content of metal elements in rat brain tissue to normal level， the intervention effect was clear， and the overall effect was better than that of carbamazepine group. The determination of 21 metal elements in plasma showed that compared with the blank group， the levels of K， Sr and Cd in the model group were significantly increased （P<0.05）， and the contents of Li， Al， Ti and Cr were significantly decreased （P<0.05）. Compared with the model group， the contents of Ca， K， Li， Al and V in the Chloriti Lapis group were obviously increased （P<0.05， P<0.01）， and the contents of Fe， Ti， Sr and Cd were significantly decreased （P<0.05，P<0.01）. The correlation analysis of metal elements among the groups showed that there were 17 pairs of elements had positively correlation in the brain tissue of rats， 2 pairs of elements had significant negative correlation. In the plasma of rats， 8 pairs of elements had significant positive correlation and 6 pairs of elements had significant negative correlation. Conclusion:The metal element groups represented by Zn， Fe， K， Li， Co， As， Pb， Sr， Sb， Ca， Al， V， Ti and Cd may be the effective material basis for Chloriti Lapis to interfere PTZ-kindled epileptic model rats， which may be related to the influence of these metal element groups on the release of neurotransmitters and the electrical balance of neurons， the regulation of abnormal synchronous discharge induced by Na⁺， K⁺， Ca²⁺ channel disorders and intervention of metabolism pathways in brain tissue related to epilepsy. It can make the excitatory and inhibitory activities restrain each other， and finally reach the normal physiological state of neurons and cells. The intervention effect of Chloriti Lapis group was better than that of carbamazepine group.

Objective:To explore the possible mechanism of Chloriti Lapis in the treatment of epilepsy by the metabonomics of brain tissue in pentylenetetrazol （PTZ）-kindled epileptic rats treated with Chloriti Lapis. Method:The epileptic animal model in rats was established by PTZ kindling， and the rats were divided into the control group， model group， carbamazepine group and Chloriti Lapis group. The brain tissue samples were detected by ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry（UPLC/Q-TOF-MS）， and the experimental results were statistically analyzed by partial least squares-discriminant analysis （PLS-DA） and SPSS 18.0. Result:The metabolic fingerprints and metabolic profiles of the rat brain tissue were established， which showed that the metabolic profiles of each group had changed significantly and could be separated well among the groups. Moreover， the Chloriti Lapis group had a tendency to be closer to the control group than the carbamazepine group. Seven differential metabolites were screened， including phosphatidylserine （PS） （18∶0/18∶0）， L-glutamic acid， docosahexaenoyl ethanolamide， arachidonic acid， glucosylsphingosine， cholestane-3，7，12，24，25-pentol and lysophosphatidylcholine （LysoPC） （P-18∶0）. Except for docosahexaenoyl ethanolamide and LysoPC （P-18∶0）， Chloriti Lapis had significant intervening and regulating effects on the other five differential metabolites. There were 12 possible metabolic pathways that affected the metabolic disorder of PTZ-kindled rats， and 3 important metabolic pathways （pathway impact>0.1）， namely， D-glutamine and D-glutamate metabolism， alanine， aspartate and glutamate metabolism， and arachidonic acid metabolism， among which D-glutamine and D-glutamate metabolism was the most important metabolic pathways. Conclusion:From this point of view， Chloriti Lapis has a clear intervention effect on PTZ-kindled epileptic rats， which may be related to the intervention of the above differential metabolite contents and related metabolic pathways. It can reduce the toxic effect of excitatory neurotransmitters on neurons in brain tissue and inhibit the development of inflammation in brain tissue， so as to maintain the biological function of brain cells and slow down the occurrence of epilepsy.