Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.

OBJECTIVETo study clinicopathological features, diagnosis, differential diagnosis of oral Langerhans cell histiocytosis (LCH), retrospective clinicopathologic study was carried on and a variety of immune phenotype were detected.

METHODSThe clinicopathological features of 29 cases of oral LCH were analyzed. The immunohistochemical staining of S-100 protein, CD1a, CD83 and Ki-67 were used in above cases by immunohistochemical streptavidin-biotin peroxidase (SP) and Elivison two-step method. Statistical analysis was adopted for the results.

RESULTSOf the 29 cases of LCH, the expression of S-100 protein and CD1a were positive in 24 cases and negative in 5 cases, so 5 cases were excluded from the diagnosis of LCH. Among 24 cases of LCH, 15 patients were male and 9 were female. The median age was 7.50 years. 14 lesions were in the mandible, 5 were in the maxilla and 5 involved the mandible and maxilla. 9 cases were in stage I, 13 in stage II and 2 in stage III, according to Bartnick classification. Immunohistochemistry showed all 24 cases staining for S-100 protein and CD1a were positive. Comparing with maxillofacial lesions involved soft tissue, Ki-67 positive rate was lower and CD83 positive rate was higher in maxillofacial single bone lesion.

CONCLUSIONThe immunohistochemical staining of S-100 protein and CD1a are important for the diagnosis of LCH. Maxillofacial bone single LCH might have lower proliferative activity and a higher state of maturity. Maxillofacial LCH involved soft tissue might have a higher proliferative activity and a lower state of maturity.

Antigens, CD1 ; Diagnosis, Differential ; Female ; Histiocytosis, Langerhans-Cell ; Humans ; Immunohistochemistry ; Male ; Mandible ; Maxilla ; Retrospective Studies ; S100 Proteins

Diabetes mellitus and its consequences have gained increased attention with the incidence rate rising.Diabetic cognitive impairment (DCI), a neurological consequence of diabetes mellitus, has shown a significant increase in recent years, and its related mechanisms need to be elucidated. Short-chain fatty acids (SCFAs), which are metabolites of dietary fiber fermented by gut microbiota and play a significant role in the "microbial-gut-brain axis", have become a popular research topic in recent years for their link to diabetes mellitus and brain function. Therefore, it is important to explore the relationship between SCFAs and DCI. This review summarized the changing characteristics of SCFAs in diabetes mellitus, cognitive impairment and DCI populations, as well as the mechanisms of SCFAs in DCI, which include glucose-lipid metabolism, pathological protein aggregation, inflammation, and mitochondrial autophagy.Future studies should address the common pathophysiological mechanisms of diabetes mellitus and cognitive impairment, in order to explore the effects of different types and doses of SCFAs in DCI and the underlying mechanisms, so as to provide a theoretical basis for the prevention and treatment of the disease in the context of the "co-morbidity model" .

Mucinous adenocarcinoma is a rare epithelial malignant tumor which usually arises in appendix, pancreas, breast and other sites, rarely occurs in salivary gland. In this article, a mucinous adenocarcinoma of salivary gland was reported and relevant literatures were reviewed.
Adenocarcinoma, Mucinous ; Carcinoma ; Humans ; Salivary Glands

Diabetes mellitus type 2 might cause mild cognitive impairment in its advanced stages,potentially progressing to dementia.Diabetic cognitive impairment(DCI)stands as a chronic complication of diabetes mellitus,with its underlying pathogenesis still remaining elusive.Research has revealed that gut microbiota dysbiosis influenced the central nervous system through the"microbiota-gut-brain axis",thereby contributing to the progression of cognitive impairment.Therefore,the regulation of gut microbiota emerges as a promising approach to the prevention and treatment of DCI.This article comprehensively reviews the mechanisms through which gut microbiota influences DCI.Furthermore,it delves into experimental studies exploring targeted therapies for gut microbiota,including probiotics,fecal microbiota transplantation,dietary and nutrient interventions,as well as traditional Chinese medicine.These studies not only address diabetes-related cognitive impairment but also consider aspects such as glycolipid metabolism and inflammation.The insights gleaned from these studies provide valuable guidance for the clinical application of gut microbiota-targeted intervention in DCI.

[Abstract] Objective: To investigate the influence of glutathione S-transferase P-1 (GSTP1) genetic variation on the recurrence risk and prognosis of colorectal cancer (CRC) patients received postoperative adjuvant chemotherapy. Methods: The clinical data of 195 CRC patients, who received postoperative adjuvant chemotherapy in the Department of Gastroenterology of the FirstAffiliated Hospital of Zhengzhou University from January 2010 to December 2018, were collected for this study. 5-fluorouracil (5-FU) based adjuvant chemotherapy was given after surgical resection. The recurrence status of the patients was assessed during hospitalization period, and the long-term survival data of patients were obtained by telephone follow-up after finishing the scheduled adjuvant chemotherapy. GSTP1 genotyping was performed with the DNA extracted from peripheral blood specimens, and its correlation with patients’clinical characteristics wasanalyzed.Additionally, RNAwasextractedfrom peripheral blood mononuclear cell (PBMC) specimens of some CRC patients that prior to chemotherapy for GSTP1 mRNA expression analysis. The univariate analysis of genotypes and prognosis was carried out by Kaplan-Meier survival analysis, and adjusted by multivariate Cox regression model. Results: The median disease-free survival (DFS) of the 195 CRC patients was 4.8 years, and the median overall survival (OS) was 6.2 years. Polymorphism analysis indicated that the I105VlocusofGSTP-1coding region was correlated with prognosis. The prevalence of I105V in the study population: AA genotype of 135 cases (69.23%), AG genotype of 56 cases (28.72%) and GG genotype of 4 cases (2.05%), the minor allele frequency of I105V was 0.16. The genotype distribution was in accordance with Hardy-Weinberg equilibrium (P>0.05). The analysis of recurrence risk and prognosis found that the median DFS of patients with AA genotype and AG/GG genotype was 5.7 and 3.9 years respectively (P<0.01), while the median OS of two groups of patients was 7.0 and 4.5 years respectively (P<0.01). The multivariate Cox regression results indicated that AG/GG genotype was an independent factor for OS (OR=1.54, P<0.05). The mRNA expression of GSTP1 in PBMC of the patients with AG/GG genotypes were significantly higher than those patients with AA genotype (P<0.01). Conclusion: GSTP1 I105V genetic variation influences the recurrence risk and prognosis of CRC patients received postoperative adjuvant chemotherapy possibly via mediating the mRNAexpression of GSTP1.

In traditional Chinese medicine， it is believed that the disease of tubal infertility is located in the uterus vessels， with stasis blocking uterus vessels as the core mechanism， and according to the characteristics of pathological changes in the course of treatment， the "three-stage advanced method" is proposed as the treatment plan. In the first stage of eliminating evil， the disease mechanism is characterized by externally-contracted heat toxin combined with endogenous dampness， stagnation and stasis in the uterus vessels， and the treatment is to clear heat and promote dampness， move qi and activate blood， and the self-prescribed Penyan Xiao Formula （盆炎消方）. In the second stage of dissolving fixed abdominal mass， the disease mechanism is characterized by qi and blood stagnation and uterus vessels obstruction， and the treatment is to break up the stagnation of blood and move qi， drive away blood stasis and clear the channels， with self-prescribed Tongguan Formula （通管方）. In the third stage of reinforcing healthy qi to support pregnancy， the disease mechanism is characterized by stasis of uterus vessels for a long period， and loss of kidney essence， therefore the treatment is to warm up the kidneys and eliminate the stasis， boost qi and nourish yin， with self-prescribed Yulin Zhuyun Formula （毓麟助孕方）. At the same time， attention should be paid to the synergistic diagnosis and treatment of traditional Chinese medicine and Western medicines， and combination of syndrome differentiation with the identification of diseases.

[Abstract] Objective: To investigate the efficacy and safety of apatinib monotherapy in the treatment for patients with advanced colorectal cancer (CRC) who failed standard regimen. Methods: The required sample size in this prospective study was calculated with the PASS 15 software. A total of 52 patients with advanced colorectal cancer who failed standard regimen from July 2017 to August 2018 were included in this study. The patients were given apatinib monotherapy with an initial dosage of 750 mg or 500 mg. The objective remission rate (ORR) and disease control rate (DCR) were evaluated; the patients were followed up and progression-free survival (PFS) and overall survival (OS) were evaluated, and adverse events during treatment were recorded. The primary endpoint of this study was PFS, and secondary endpoints were ORR, DCR, OS and safety. Result: Of the 52 patients included, 45 patients, all of whom were late stage CRC patients with at least two systematic chemotherapeutic treatments, were available for efficacy evaluation. Treatment efficacy evaluation showed complete response of 0 case, partial response of 5 cases, stable disease of 30 cases and progression disease of 10 cases; the ORR was 11.11%, and the DCR was 77.78%. The prognosis data indicated that the median PFS of the 45 CRC patients was 3.95 months (95% CI=3.16-4.74), and the median OS was 10.3 months (95% CI=5.70-14.90). In terms of adverse events evaluation, the adverse reactions with grade 3 or above were hand-foot syndrome (6 cases, 13.33%), hypertension (5 cases, 11.11%), proteinuria (3 cases, 6.67%), diarrhea (3 cases, 6.67%), fatigue (2 cases, 4.44%) and bleeding (1 case, 2.22%). Conclusion: Apatinib monotherapy for patients with advanced colorectal cancer, who failed the standard regimens, has potential clinical benefits, and the overall toxicity profile is manageable.