Objective To investigate the application value of pancreaticojejunostomy with double-layer continuous suture in total laparoscopic pancreaticoduodenectomy (TLPD).Methods The retrospective crosssectional study was conducted.The clinicopathological data of 21 patients who underwent TLPD with pancreaticojejunostomy using double-layer continuous suture in the Second Hospital of Jilin University between January and December 2017 were collected.The anastomosis used Child method,and pancreaticojejunostomy,choledochojejunostomy and gastroenteric anastomosis in turn were done.Observation indicators:(1) surgical and postoperative recovery;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (P25,P75).Results (1) Surgical and postoperative recovery:21 patients underwent successful TLPD with pancreaticojejunostomy with double-layer continuous suture.The operation time,time of pancreaticojejunostomy and volume of intraoperative blood loss were respectively (352±25)minutes,(46±8)minutes and (168±34) mL.There was no intraoperative blood transfusion.The time of postoperative abdominal drainage-tube removal was (10.1±4.4)days.Of 21 patients,12 were complicated with biochemical fistula,and 3 with grading B of pancreatic fistula (pancreatic duct in type Ⅱ),and they were improved by inhibiting pancreatic secretion and drainage patency.There was no occurrence of biliary fistula,chylous fistula,postoperative bleeding,abdominal infection and delayed gastric emptying.The duration of postoperative hospital stay of 21 patients was (11.3± 2.0) days.(2) Postoperative pathological examination:surgical margins of 21 patients were negative.The pathological type:8,6,4,2 and 1 patients were diagnosed as distal bile duct cancer,ampulla cancer,duodenal papilla and duodenal cancer,pancreatic head cancer and neuroendocrine cancer of ampulla,respectively.(3) Follow-up and survival situations:21 patients were followed up for 3-12 months,with a median time of 7 months.During the follow-up,all the patients survived,and there was no tumor recurrence and metastasis.Conclusion Pancreaticojejunostomy with double-layer continuous suture is safe and feasible for TLPD,with advantages of exact anastomosis effect and good application value.

Objective:To investigate the relationship between double mutations of myosin heavy chain gene (MYH6) p.Gly743Arg and p.Glu1389Lys and the cardiac phenotype.Methods:Patients carrying double mutations in the MYH6 gene p.Gly743Arg and p.Glu1389Lys were screened from 52 unrelated left ventricular hypertrophy (LVH) who were admitted to the Second Hospital of Chongqing Medical University from 2015 to 2020, and the genetic testing of peripheral blood of patients by second-generation whole-exome sequencing assay technology and genomic DNA of their family members Sanger sequencing was performed to validate the genomic DNA of the family members. The cardiac phenotype was evaluated by electrocardiogram, coronary computed tomography angiography (CTA), echocardiography, and cardiac magnetic resonance imaging (MRI) as adjuncts.Results:All whole-exome gene were detected in 52 unrelated patients with LVH, of which 1 patient (1.9%) had double mutations in MYH6 gene p.Gly743Arg and p.Glu1389Lys (proband). Two members of the maternal line of this patient carried p.Glu1389Lys mutation, but there was no obvious clinical phenotype. Two members of the paternal line carried p.Gly743Arg mutation and had obvious clinical phenotype of bradycardia, but there was no LVH. The male proband, aged 21 years old, presented with LVH and sinus bradycardia but no coronary artery stenosis on CTA before treatment, MRI showed that the left ventricular end diastolic diameter was 58 mm. After treatment with angiotensin receptor-enkephalinase inhibitor (ARNI), electrocardiogram showed that the heart rate increased significantly (from 43 bpm to 72 bpm). Echocardiography showed that the left ventricular end diastolic diameter decreased significantly (from 60 mm to 49 mm).Conclusions:The p.Glu1389Lys mutation of the MYH6 gene may not manifest the phenotype of heart disease. MYH6 gene p.Gly743Arg mutation may be manifested asymptomatic sinus bradycardia, but there is no LVH phenotype. The cardiac disease phenotype caused by the double mutations of p.Gly743Arg and p.Glu1389Lys in the MYH6 gene is more obvious. Asymptomatic LVH and sinus bradycardia can appear in adolescence, but the LVH phenotype can be reversed in a short period of time after ARNI treatment.

Purpose To investigate the clinical value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI for the preoperative evaluation of colorectal cancer liver metastases(CRCLM).Materials and Methods Fifty-six CRCLM patients with 156 CRCLM lesions confirmed by surgical pathology in the First Affiliated Hospital of Henan University of Chinese Medicine from September 2019 to March 2023 were collected,and all underwent dynamic Gd-EOB-DTPA-enhanced MRI.The characteristic manifestations of T2WI,diffusion-weighted imaging(DWI),arterial phase and hepatobiliary phase(HBP)were observed,and the detection rate of each sequence was calculated,and then the signal intensity ratio of lesions to liver parenchyma on HBP and the apparent diffusion coefficient(ADC)were calculated.The ADC values of lesions with reversed target and target signs and lesions with homogeneous and heterogeneous hypointensity on HBP and the detection rate of each sequence were compared.Results Among 156 CRCLM lesions,20.51%(32/156)and 38.46%(60/156)exhibited a target appearance on T2WI,51.28%(80/156)displayed a target sign on DWI,73.72%(115/156)showed rim enhancement on the arterial phase,and 34.62%(54/156)presented a target sign on HBP.The mean ADC value of lesions with reversed target and target signs on HBP did not significantly differ from that of lesions with homogeneous and heterogeneous hypointensity on HBP[(0.98±0.43)×10-3 mm2/s vs.(1.01±0.47)×10-3 mm2/s;t=-0.340,P=0.327].Based on the size of CRCLM lesions,three groups were categorized,including<1.0 cm(41 lesions),1.0-2.0 cm(55 lesions),and>2.0 cm(60 lesions).The overall detection rate of HBP(96.79%)was the highest compared with T2WI,DWI and Gd-EOB-DTPA four-phase dynamic contrast-enhanced multiphase imaging(P<0.05).Regarding<1.0 cm lesions,the detection rate of HBP(87.80%)was superior to that of T2WI,DWI and Gd-EOB-DTPA four-phase dynamic contrast-enhanced multiphase imaging(P<0.05).Conclusion Gd-EOB-DTPA-enhanced MRI has important clinical value for the preoperative evaluation of CRCLM,especially the features of target sign or reversed target sign on HBP and the excellent efficacy of detecting microscopic lesions.

Purpose To construct and validate a machine learning-based diagnostic model for distinguishing between Mycobacterium avium-intracellular complex pulmonary disease(MAC-PD)and pulmonary tuberculosis(PTB)via chest CT images.Materials and Methods Retrospective data from patients diagnosed with MAC-PD and PTB between May 2021 and August 2022 at Beijing Chest Hospital,Capital Medical University,which were collected as the training set.The prospective external validation set was obtained from patients at the First Affiliated Hospital of Henan University of Chinese Medicine between September 2022 and May 2023.Clinical and radiological data were analyzed,and multivariable logistic regression,random forest and support vector machine(SVM)models were established and externally validated using the validation set.The diagnostic performance of models were evaluated using receiver operating characteristic curve and precision-recall curve,and the differences of the areas under the curve of various models were compared via the Delong test.Results There were significant differences in age and hemoptysis rate between the two groups(t=30.414,P<0.001;χ2=6.186,P=0.013).There were statistically significant differences in cavity types and morphology between the two groups(χ2=6.546,P=0.011;χ2=24.113,P<0.001),but there was no significant difference in the distribution and characteristics of cavitary lesions(P>0.05).There were significant differences in the types and distribution of bronchiectasis between the two groups(χ2=4.634,P=0.031;χ2=23.145,P<0.001).Compared with logistic regression and random forest models,the SVM model had better differential diagnostic performance,and the area under the receiver operating characteristic curve,sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 0.960(95%CI 0.935-0.985),85.7%,93.6%,90.5%,93.3%,88.0%and 0.885(95%CI 0.803-0.967),respectively,76.7%,80.0%,78.3%,79.3%,77.4%.The precision-recall curve showed that the SVM model had high precision and low recall,that was,the model performs well.Conclusion The machine learning-based models exhibits excellent diagnostic performance and can assist in differentiating MAC-PD and PTB.

Vesicular glutamate transporter 2(VGlut2)is expressed in the PVN of the hypothalamic paraventricular nucleus(PVNVG1ut2)as an excitatory neurotransmitter,which regulates food intake and energy metabolism and plays an important role in maintaining homeostasis.However,it is not clear that the upstream and downstream projection network of PVNVGut2 neurons hinders the anal-ysis of glutamatergic neuron circuit function.Anterograde and retrograde tracer viruses were injec-ted into the PVN of VGlut2 mice by stereotactic brain injection technique to find the input and output nuclei of PVNVGlut2 neurons.Anterograde tracing results showed that PVNVGlut2 neurons pro-jected to the downstream medial amygdala(MeAD)and arcuate nucleus(ARC).Retrograde trac-ing results showed that PVNVGlut2 received input from the prefrontal nucleus(Pr),the reticular tegmental nucleus(RtTg),and the hypoglossal nucleus(12N).In addition,VGlut2 was found to be co-expressed with neuronal nitric oxide synthase(nNOS)neurons in the PVN.The anatomical net-work of PVNVG1ut2 neurons was analyzed by virus tracking tool,which laid the anatomical founda-tion for further study on the functional regulation of PVNVGlut2.

OBJECTIVETo dynamically observe the effects of electroacupuncture (EA) on repair of gastric mucosal lesion in rats with gastric ulcer, and to explore the time-effect relationship and molecular mechanism of EA for gastric ulcer.

METHODSA total of 72 SD rats were randomly assigned to a normal group, a model group, a acupoint group and a sham acupoint group, and each group were further divided into a 1-day subgroup, a 4-day subgroup and a 7-day subgroup, 6 rats in each subgroup. The rat model of gastric ulcer was established by using intragastric administration of ethyl alcohol. The rats in the acupoint group were treated with EA at"Zusanli"(ST 36) and"Liangmen"(ST 21); the rats in the sham acupoint group were treated with EA at points 5 mm next to"Zusanli"(ST 36) and"Liangmen"(ST 21); the EA was given 30 min per treatment, once a day. The rats in the normal group and model group were treated with immobilization for 30 min per day, and no EA was given. PR-PCR method was applied to test the expression of proliferating cell nuclear antigen (PCNA) and substance P (SP); Western blot method was applied to test the expression of neurotensin (NT).

RESULTSAfter 1-day treatment, the ulcer index in the model group was higher than that in the normal group (<0.01), and the expression of PCNA, SP and NT was decreased (<0.01, <0.05); compared with the model group and sham acupoint group, the ulcer index was decreased in the acupoint group (both <0.05), and the expression of PCNA and SP was up-regulated (all <0.05) while that of NT was up-regulated (both <0.01). After 4-day treatment, the ulcer index in the model group was reduced but still higher than that in the normal group (<0.05), and the expression of PCNA, SP and NT was up-regulated and higher than that in the normal group (all <0.01); the ulcer index in the acupoint group was similar to that in the normal group (>0.05), and the expression of PCNA and SP was lower than that in the model group (<0.01, <0.05), and the expression of NT was not significantly different from that in the model group (>0.05). After 7-day treatment, the differences of indexes above were not significant among the four groups (all >0.05).

CONCLUSIONEA at acupoints of stomach meridian has two-way regulation on PCNA and SP and improve the expression of NT in different pathological state of gastric ulcer, which could further improve the repair of gastric ulcer.

The recent discovery of activator compounds binding to an allosteric site on the NAD

A small proportion of mononuclear diploid cardiomyocytes (MNDCMs), with regeneration potential, could persist in adult mammalian heart. However, the heterogeneity of MNDCMs and changes during development remains to be illuminated. To this end, 12 645 cardiac cells were generated from embryonic day 17.5 and postnatal days 2 and 8 mice by single-cell RNA sequencing. Three cardiac developmental paths were identified: two switching to cardiomyocytes (CM) maturation with close CM-fibroblast (FB) communications and one maintaining MNDCM status with least CM-FB communications. Proliferative MNDCMs having interactions with macrophages and non-proliferative MNDCMs (non-pMNDCMs) with minimal cell-cell communications were identified in the third path. The non-pMNDCMs possessed distinct properties: the lowest mitochondrial metabolisms, the highest glycolysis, and high expression of Myl4 and Tnni1. Single-nucleus RNA sequencing and immunohistochemical staining further proved that the Myl4⁺Tnni1⁺ MNDCMs persisted in embryonic and adult hearts. These MNDCMs were mapped to the heart by integrating the spatial and single-cell transcriptomic data. In conclusion, a novel non-pMNDCM subpopulation with minimal cell-cell communications was unveiled, highlighting the importance of microenvironment contribution to CM fate during maturation. These findings could improve the understanding of MNDCM heterogeneity and cardiac development, thus providing new clues for approaches to effective cardiac regeneration.
Animals ; Mice ; Diploidy ; Heart ; Myocytes, Cardiac/metabolism* ; Cell Communication ; Gene Expression Profiling ; Mitochondria ; Regeneration ; Mammals/genetics*