This case report describes a 68-year-old male patient diagnosed with primary hepatocellular carcinoma (HCC). After receiving Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT), the tumor significantly reduced in size, and tumor markers alpha fetoprotein (AFP) and abnormal prothrombin (PIVKA-Ⅱ) decreased. Postoperative pathological results showed minimal residual tumor cells, indicating that ⁹⁰Y-SIRT has good efficacy and safety in downstaging and conversion of HCC, thereby facilitating subsequent surgical resection.

Myocardial fibrosis is a serious cause of heart failure and even sudden cardiac death. However, the mechanisms underlying myocardial ischemia-induced cardiac fibrosis remain unclear. Here, we identified that the expression of sterile alpha and TIR motif containing 1 (SARM1), was increased significantly in the ischemic cardiomyopathy patients, dilated cardiomyopathy patients (GSE116250) and fibrotic heart tissues of mice. Additionally, inhibition or knockdown of SARM1 can improve myocardial fibrosis and cardiac function of myocardial infarction (MI) mice. Moreover, SARM1 fibroblasts-specific knock-in mice had increased deposition of extracellular matrix and impaired cardiac function. Mechanically, elevated expression of SARM1 promotes the deposition of extracellular matrix by directly modulating P4HA1. Notably, by using the Click-iT reaction, we identified that the increased expression of ZDHHC17 promotes the palmitoylation levels of SARM1, thereby accelerating the fibrosis process. Based on the fibrosis-promoting effect of SARM1, we screened several drugs with anti-myocardial fibrosis activity. In conclusion, we have unveiled that palmitoylated SARM1 targeting P4HA1 promotes collagen deposition and myocardial fibrosis. Inhibition of SARM1 is a potential strategy for the treatment of myocardial fibrosis. The sites where SARM1 interacts with P4HA1 and the palmitoylation modification sites of SARM1 may be the active targets for anti-fibrosis drugs.

ObjectiveTo observe the effect of deep muscle stimulation on muscle structure and function in children with spastic cerebral palsy. MethodsFrom January, 2023 to March, 2024, 30 children with spastic cerebral palsy in Beijing Bo'ai Hospital were randomly divided into control group (n = 15) and intervention group (n = 15). Both groups received conventional rehabilitation therapy, while the intervention group added deep muscle stimulation, for four weeks. Before and after training, the gastrocnemius muscle was examined by ultrasound diagnosis system in two aspects: transverse incision and longitudinal incision. Indicators included fascicle length, muscular thickness, cross sectional area and pennation angle. The modified Ashworth Scale (MAS) was used to assess the muscle tension of the lower extremity of the affected side. The standing, walking, running and jumping function were evaluated by Gross Motor Function Measure (GMFM) D and E areas. ResultsAfter training, the fascicule length and pennation angle improved significantly in both groups (|t| > 6.329, P < 0.001), and they were better in the intervention group than in the control group (|t| > 2.347, P < 0.05); the scores of MAS decreased in both groups (t > 2.432, P < 0.05), and were better in the intervention group than in the control group (t = 2.140, P < 0.05); the scores of GMFM D and E areas significantly decreased in both groups (|t| > 8.473, P < 0.001), and were better in the intervention group than in the control group (|t| > 2.191, P < 0.05). ConclusionDeep muscle stimulation could improve the fascicule length and pennation angle, and improve the spasticity and motor function of lower extremities in children with spastic cerebral palsy.

Objective:To evaluate the effect of venous excess ultrasound score (VExUS Score) in the acute kidney injury(AKI) in Patients with sepsis, so as to reduce the risk of disease and improve the prognosis of patients.Methods:This experiment was a single-center prospective cohort study. Include septic patients with AKI who were admitted to the Department of Emergency Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University from February 2022 to February 2023, Those with inadequate window, inferior vena cava (IVC) thrombus, age<18 years and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis.Results:Totally 86 patients were enrolled for the study. The mean age was (60.43±15.48) with 50 (58.1%) males. Mean sequential organ failure assessment (SOFA) score was (6.23±1.87). 38 patients (44.2%) were in AKI stage 1, while 24 patients (27.9%) were in AKI stage 2 and stage 3 each. 52 patients (60.5%) had VExUS grade Ⅲ. Resolution of AKI injury showed significant correlation with improvement in VExUS grade ( p value 0.003). Similarly, there was significant association between changes in VExUS grade and fluid balance ( p value 0.005). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VExUS grade. Conclusions:The study shows a significant correlation between the VExUS Score and AKI staging, With improvement in kidney function, there is decline in the VExUS grade as well. Moreover VExUS Score might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal.

Cardiovascular disease presents a serious threat to human life,and oxidative stress has been identified as an important factor affecting the occurrence and development of cardiovascular disease.The construction of reliable animal models of oxidative stress is important for the in-depth study of the pathogenesis of cardiovascular diseases and the development of therapeutic drugs.Zebrafish have often been for research into cardiovascular diseases,due to their advantages of easy reproduction,a short developmental cycle,transparent embryos for easy observation,and a highly homologous cardiovascular genetic background with humans.In this paper,we review the application of the zebrafish oxidative stress model in cardiovascular disease and related research progress,to provide a reference for its further application in cardiovascular disease-related research.

AIM:To explore the possible mechanism of Yiqi-Huoxue formula(YQHXF)in treating cerebral ischemia-reperfusion injury.METHODS:Male SD rats were randomly divided into six groups,namely,the sham,mod-el,nimodipine,and low-,middle-and high-dose YQHXF groups.The middle cerebral artery occlusion/reperfusion(MCAO/R)model was established in all groups except the sham group.After successful modeling,the YQHXF low-,me-dium-,and high-dose groups were given 3.8,7.5,and 15 g?kg-1?d-1 of YQHXF,respectively,by gavage,while the ni-modipine group was given 12 mg?kg-1?d-1 of nimodipine tablets by gavage.The sham and model groups were given 10 mL?kg-1?d-1 of distilled water by gavage.After 14 days of drug intervention,the rats were euthanized and the neurological func-tion was evaluated.The infarct volume was assessed using 2,3,5-triphenyltetrazolium chloride(TTC)staining and brain histopathological changes were determined by hematoxylin-eosin(HE)staining.Transmission electron microscopy was used to investigate changes in autophagosomes,with immunofluorescence used to assess expression of microtubule-associ-ated protein 1 light chain 3(LC3)protein in the cerebral cortex,Western blot was used to measure protein levels of p-PI3K,PI3K,p-Akt,Akt,p-mTOR,mTOR,LC3B,p62,beclin-1,and Atg5,and RT-qPCR was used to determined LC3 and P62 mRNA expression.RESULTS:Compared with the sham group,the neural function scores of rats in the model group rats were significantly increased,and TTC staining revealed large areas of white cerebral infarction.There was severe pathological damage to the cerebral tissue in the ischemic cortical area,and large numbers of autophagosomes were seen inside the cells.Immunofluorescence staining showed significant numbers of LC3B-positive cells(P<0.01).Protein expression of beclin-1,Atg5,and LC3-Ⅱ/LC3-Ⅰ was significantly upregulated(P<0.01),while that of p62 was markedly downregulated(P<0.01).The expression of p-PI3K/PI3K,p-Akt/Akt,and p-mTOR/mTOR proteins was also significantly reduced(P<0.01).In addition,the mRNA expression of LC3 was significantly upregulated(P<0.01),with downregulation of P62 mRNA levels(P<0.01).Compared with the model group,both the YQHXF medium-and high-dose groups showed upregulated LC3-Ⅱ/LC3-Ⅰ values after 12 h of reperfusion(P<0.01),followed by downregulation of the ratios(P<0.05)after 3,7,and 14 days of reperfusion.Furthermore,after 14 days of reperfusion,compared with the model group,the middle-and high-dose YQHXF groups and the nimodipine group showed reduced neurological function scores(P<0.01),reduced cerebral infarction volumes(P<0.01),improvements in the pathological damage to cortical tis-sue,and reduced autophagosome formation to varying degrees.At the same time,the number of LC3B-positive cells was reduced(P<0.01).Protein expression of beclin-1,Atg5,and LC3-Ⅱ/LC3-Ⅰ was significantly downregulated,while that of p62 was upregulated(P<0.01).The mRNA expression of LC3 and p62 was consistent with the protein levels(P<0.01).In addition,the expression of p-PI3K/PI3K,p-Akt/Akt,and p-mTOR/mTOR proteins was upregulated(P<0.01).CONCLUSION:YQHXF can dynamically regulate autophagy in ischemic brain tissue,with inhibition of excess autophagy by activation of the PI3K/Akt/mTOR signaling pathway,thus reducing the infarct volume,alleviating brain dam-age,and promoting the recovery of neurological function.

Objective:To investigate the correlation between plasma total α-synuclein (α-syn), phosphorylated α-synuclein (p-α-syn), neurofilament light chain(NfL) and subtypes of Parkinson disease(PD).Methods:A total of 62 PD patients admitted to the Department of Neurology, the Affiliated Huai 'an No. 1 People 's Hospital of Nanjing Medical University from September 2021 to January 2023 were selected and scored on the Hoehn-Yahr stage(H-Y), unified Parkinson's disease rating scale Ⅲ(UPDRS-Ⅲ), levodopa equivalent daily dosage(LEDD), mini-mental state examination(MMSE), Parkinson disease quality of life questionnaire(PDQ-39) and activities of daily living(ADL). During the same period, 25 healthy individuals matched in age and sex were enrolled as the control group (HC). Clinical characteristics and blood samples were collected. The plasma levels of α-syn, p-α-syn and NfL were detected by enzyme-linked immunosorbent assay(ELISA). PD patients were divided into tremor dominant type (TD, n=27) and akinetic-rigid dominant type (AR, n=35) based on UPDRS-Ⅲ scores. Multifactorial Logistic regression analysis was performed by SPSS 25.0 software to determine the influencing factors of subtypes of Parkinson disease. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of plasma NfL between the AR type and the TD type. Results:Plasma α-syn, p-α-syn, NfL levels in the PD group were significantly higher than those of the HC group ( Z=-2.537, -6.580, -7.101, all P<0.05). There were statistically significant differences between the AR type and the TD type in disease duration, H-Y stage, UPDRS-Ⅲ scores, LEDD and MMSE scores ( Z=-2.503, -3.021, -2.025, -2.086, -2.409, all P<0.05). While no significant difference was found in plasma α-syn and p-α-syn levels between the AR type and TD type ( Z=-0.341, -0.085, both P>0.05), the plasma NfL levels were notably higher in the AR type(92.79(16.84, 117.53) pg/mL) compared to the TD type (12.10(6.99, 100.17) pg/mL)( Z=-2.236, P<0.05). Plasma NfL levels were correlated with rigidity scores ( r=0.438, P<0.001), UPDRS-Ⅲ scores ( r=0.337, P<0.05) and motor subtypes ( r=0.286, P<0.05) in PD patients. Multivariate Logistic regression analysis showed that NfL was risk factor for AR( B=0.002, OR=1.002, 95% CI=1.001-1.003, P=0.017). The ROC curve analysis indicated that plasma NfL levels could predict different subtypes of PD with an AUC=0.667, optimal cutoff =26.527. Conclusion:There is a correlation between elevated plasma NfL levels and the occurrence of AR type of PD, suggesting that nerve injury is probably involved in the occurrence and progression of various motor subtypes of PD.

Objective:To explore the influence of pancreatic stents of different lengths on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Data of 299 patients with biliary tract diseases who received endoscopic retrograde cholangiopancreatography (ERCP) and 5 Fr prophylactic pancreatic stents placement at the First Affiliated Hospital of Air Force Medical University from January 2013 to January 2022 were retrospectively analyzed. Patients were divided into the short-stent group (<5 cm, n=163) and the long-stent group (>5 cm, n=136). Baseline data, intraoperative procedures, and postoperative outcomes were compared between the two groups and propensity score matching (PSM) was used for complementary analysis. The primary endpoint was the incidence of PEP. The risk factors for PEP in patients with prophylactic pancreatic stents placement was explored by logistic regression analysis . Results:The overall PEP incidence was 11.0% (33/299). There was no significant difference in the PEP incidence [11.7% (19/163) VS 10.3% (14/136), χ 2=0.140, P=0.708], moderate-to-severe PEP incidence [1.8% (3/163) VS 2.2% (3/136), χ 2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [81.7% (103/126) VS 78.4% (87/111), χ 2=0.421, P=0.516] between the two groups. After PSM, 123 patients were included in each group, and the overall PEP incidence was 8.9% (22/246). There was no significant difference in PEP incidence [8.9% (11/123) VS 8.9% (11/123), χ 2=0.000, P=1.000], moderate-to-severe PEP incidence [0.8% (1/123) VS 1.6% (2/123), χ 2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [80.6% (75/93) VS 78.6% (77/98), χ 2=0.126, P=0.722] between the two groups. Logistic regression analysis showed that normal liver function ( OR=2.36, 95% CI:1.01-5.51, P=0.046) and failed bile duct cannulation ( OR=7.51, 95% CI:2.18-25.96, P=0.001) were independent risk factors for PEP in patients with biliary tract diseases who received prophylactic pancreatic stents placement. Conclusion:Longer 5 Fr pancreatic stents (>5 cm) do not further reduce the overall risk of PEP or moderate-to-severe PEP compared with 5Fr-5 cm stent. Normal liver function and failure of bile duct intubation were independent risk factors for PEP after prophylactic pancreatic stent placement in patients with biliary diseases.

Objective:To investigate the correlation between plasma glial fibrillary acidic protein (GFAP), total α-synuclein (α-syn), phosphorylated α-synuclein (p-α-syn) and the disease progression in patients with Parkinson disease(PD).Methods:Sixty-three patients with PD including the outpatients and inpatients from Department of Neurology of Huai'an First People's Hospital were continuously collected as a PD group, and 25 healthy people matched in age and sex were selected as a healthy control (HC) group at the same time. The plasma levels of GFAP, α-syn, and p-α-syn levels in the PD group and HC group were detected by ELISA. SPSS 25.0 software was used for statistical analysis. Mann-Whitney U test was performed to assess the differences of GFAP, α-syn and p-α-syn levels between the two groups, and the correlation between GFAP and α-syn and p-α-syn levels in PD group was examined by Spearman correlation analysis. The levels of GFAP, α-syn and p-α-syn in different Hoehn-Yahr(H-Y) stages of PD group were compared by Mann-Whitney U test and Spearman correlation analysis. Results:The levels of GFAP (0.80(0.62, 0.97)ng/mL, 0.54(0.27, 0.88)ng/mL, Z=-3.216, P=0.001), α-syn (3.93(3.16, 6.02)ng/mL, 2.67(1.74, 4.47)ng/mL, Z=-2.600, P=0.009), and p-α-syn (5.80(1.31, 15.62), 0.71(0.61, 0.83), Z=-6.607, P<0.001) in PD group were higher than those in HC group, and the difference was statistically significant. In PD group, there was a significant positive correlation between GFAP and α-syn ( r=0.442, P<0.001) and p-α-syn ( r=0.493, P<0.001). GFAP in the advanced PD group was higher than that in the early PD group, and the difference was statistically significant( P=0.039). There was no significant difference in α-syn and p-α-syn between different H-Y stages of PD patients( P>0.05). Plasma GFAP was positively correlated with H-Y stages ( r=0.277, P=0.018). Conclusion:The level of plasma GFAP in PD patients is positively correlated with disease progression, which can be used as a potential biomarker for PD disease assessment.

Objective:To study the effect of ultrasound guided transabdominal plane block (TAPB) on postoperative nausea and vomiting (PONV) in obese patients after laparoscopic sleeve gastrectomy (LSG) .Methods:From Jan. 2017 to Jan. 2022, 285 patients who underwent LSG surgery in the Department of General Surgery, Tianjin Medical University General Hospital were selected and randomly divided into two groups, including 145 patients in TAPB group and 140 patients in the control group (The TAPB group was injected with ropivacaine; the control group injected with physiological saline) . Data between TAPB group and control group were compared, including operation related data, postoperative acute pain assessment, and postoperative recovery assessment.Results:There was no significant difference between the two groups in ASA grading, operation duration, awakening time, extubation time or intraoperative hemodynamic index. The dosage of remifentanil [ (2.0±0.6) vs (2.9±0.9) mg], sufentanil [ (24.7±2.5) vs (50.0±3.2) μg], and dexmedetomidine [ (60.0±0.4) vs (65.0±0.5) μg] in TAPB group was significantly reduced compared with that in the control group, and there was no significant difference in the dosage of propofol. The VAS score and NRS score of resting state and motor state in TAPB group at 1, 3, 6, 12, 24, 48 h after operation were significantly lower than those in the control group. In TAPB group, the first use time of PCIA [ (2.0±0.8) vs (1.1±0.9) h] was significantly prolonged, the number of effective pressing of PCIA (3±1 vs 5±2) within 48 hours and the incidence of rescue analgesia in wards (19.3 % vs 31.4 %) were significantly lower than those in the control group. The frequency (3.0±1.5 vs 3.6±1.8) and severity (2.8±1.4 vs 3.4±1.8) of PONV and the incidence of additional antiemetic drugs (15.9 % vs 27.9 %) in TAPB group were significantly lower than those in the control group. The ambulation time [ (1.4±0.3) vs (1.5±0.3) h] and exhaust time [ (1.2±0.9) vs (1.4±1.0) h] in TAPB group was significantly earlier than those in the control group. There was no significant difference in postoperative length of hospitalization.Conclusion:TAPB for LSG can significantly reduce postoperative pain and PONV, reduce the use of opioid analgesics and antiemetics, and promote recovery of patients.