Objective To study the clinical features and pathological changes of muscles and peripheral nerves in Sjogren's syndrome cases accompanied with neuromuscular complications. Methods The muscle and peripheral nerve biopsies of 7 cases were performed and the specimens were tested by using histochemical and electron microscopic methods. Results The results revealed that myelinated fiber number in peripheral nerves was severely decreased in 2 cases, and the manifestations of atrophy, necrosis, vasculitis and mononuclear cell inflitration could be found in the muscle tissues in 5 cases. Conclusions The neurologic complications of Sjogren's syndrome appear commonly and early. The muscle and peripheral nerve biopsies indicate that complications and its degree,in patients with Sjogren's syndrome should be early diagnosed and treated.

Objective To explore the feasibility of one-stage operation in periappendicural abscess.Methods The clinical data of 111 patients with periappendicural absecess from 1990 to 2007 were analyzed retrospectively.Results A1l operation were successful.the rate of wound infection was 7.2%(8/111),there was no operative death and no severe complication occurred.Conclusion Timely and appropriate one-stage operation in early periappendicural absecess is safe and feasible.

Objective To report clinical and pathological features in a Chinese family with CharcotMarie-Tooth disease type 2A2 (CMT2A2). Methods There were 5 patients (2 male and 3 female) in a family with an autosomal dominant inheritance pattern. The index case was a 36 years old woman. She developed progressive distal limb weakness at the age of 6, with pescavus at the age of 8. Other 4 family members presented with similar symptoms between the age of 3-7. Physical examination showed distal limb weakness and wasting, loss of sensory and contracture in all of them. Nerve conduction velocity revealed non-potential in several motor and sensory nerves in the proband and her son. Sural nerve biopsy was performed on the proband. The sequence of MFN2 gene was analyzed in DNA from 5 patients and 3 asymptomatic members. Results Sural nerve biopsy revealed severe loss of myelinated fibers with few regenerating clusters. Electron microscopy revealed aggregation of mitochondrian in the axons. A R94W mutation in MFN2 gene has been identified in 5 patients, but not in unaffected members. Conclusions We confirmed Chinese CMT2A2. Absent of regenerating cluster in the nerve indicated that MFN2 mutation predominantly resulted in lesions in the neurons.

Objective Our objective was to design a new type of bedpan (inflatable, bed urinal) and compare its effect with common bedpan. Methods We divided 144 patients with bone fracture and lying in bed into the test group and the control group with 72 cases in each group from May 2006 to February 2007. Inflatable bed urinals were used in the test group and common bedpans were used in the control group. The pain alleviation, comfort degree, staining of bed sheet and skin injury were observed and evaluated in each group. Results Application of inflatable bed urinal was superior to common bedpan in the following aspects: alleviation of pain, comfort degree, staining of bed sheets and skin injury. Conclusions Adoption of inflatable bed urinal could alleviate pain, prevent the incidence of complication and reduce the workload of nurses.

Objective To establish the model of VX2 soft tissue xenograft in rabbit, and choose the best time for PET-CT imaging. To analyze the result of the imaging with semi-quantitative, and evaluate the feasibility of the study with VX2 soft-tissue tumor model in rabbit for PET-CT imaging. Methods 20 Japanese white rabbits were successfully implanted with VX2 tumors in thighs by the injection of tissue mass suspension.Then they were scanned with PET-CT after the diameter of the tumor is ＞2 cm. Results The diameter of the tumor＞2 cm at 14 d post implant. The average volume of tumor was (114.57±9.87) cm3.The average SUVmax of tumor's and normal tissue's in the other thigh was 5.85±0.92 and 0.22±0.09 (t=27.03, P＜0.01). SUVmax was not associated with tumor volume (r=0.02, P=0.93).Conclusion The imaging of VX2 soft tissue xenograft is clear by clinic PET-CT, and it is suitable for the study of PET-CT.PET-CT imaging performed at 14 d post implantation had the highest imaging quality.

Objective:To investigate the clinical, endoscopic and pathological characteristics of synchronous multiple early gastric cancer (SMEGC), and to reduce the rate of missed diagnosis.Methods:Clinical data of 227 early gastric cancer patients treated by endoscopic submucosal dissection (ESD) and/or surgery in Songjiang Hospital, Shanghai Jiaotong University School of Medicine from January 2017 to December 2019 were retrospectively analyzed. The differences of clinical, endoscopic and pathological characteristics between solitary early gastric cancer (SEGC) group (200 cases) and SMEGC group (27 cases) were compared. The relevance of endoscopic and pathological features of major and minor lesions of SMEGC was also analyzed.Results:Among the 227 early gastric cancer patients, 27 (11.9%) were SMEGC (58 lesions), of which 25 cases were detected preoperatively, and 2 cases were reexamined within 6 months after surgery with another lesion found at a different site from the previous lesion. In the SMEGC group, the percentages of male and atrophy and intestinal metaplasia in surrounding mucosa were significantly higher than those of the SEGC group [85.2% (23/27) VS 61.5% (123/200), χ2=5.815, P=0.016; 96.3% (26/27) VS 81.0% (162/200), χ2=3.912, P=0.048]. The mean age of the SMEGC group was significantly higher than that of the SEGC group (68.7±6.7 years VS 63.8±9.8 years, t=-2.561, P=0.011). The correlation analysis showed a significant correlation between the major and minor lesions of SMEGC in the size of lesion ( r=0.640, P<0.001), vertical location ( r=0.518, P=0.006), macroscopic type ( r=0.904, P<0.001) and depth of invasion ( r=0.470, P=0.013). Conclusion:SMEGC is prevalent in elderly males with atrophic gastritis and intestinal metaplasia. It is necessary to be alert to the possibility of multiple cancer lesions, if an early cancer lesion is found under endoscopy, especially those that may have the same or similar shape and invasion depth in the same vertical distribution range.

ObjectivesTo report pathological and genetic features of 6 Chinese families with Xlinked Charcot-Marie-Tooth disease type 1 ( CMTX1 ).Methods The index cases from 6 families with CMTX1 are males with onset of disease between 11 and 24 years old.All of them had distal leg muscle weakness,accompanied with areflexia and sensory loss in the feet.Additionally,the index 1 presented with recurrent encephalopathy and the index case 5 with cerebellar ataxia.Peripheral neuropathy was found in 12 family members,while other 7 members showed talipescavus and hyporeflexia.Sural nerve biopsies were performed in all index cases.Connexin 32(Cx32) gene was analyzed in the index cases,8 affected and 10unaffected family members as well as 50 healthy women control subjects.ResultsMild to moderate loss of myelinated fiber with axonal degeneration and regeneration clusters were found in all index cases. Thin myelin fibers were found in 5,small onion bulbs in 3 and inflammatory infiltrates in 2.Five novel mutations (I20T,I127F,D178G,A197V,403_404insT) and one L10L synonymous mutation were detected in the 6index cases and their affected family members.The same mutations,in heterozygous state,were detected in 4 female family members without clinical symptoms,but not found in 6 male unaffected family members.The same mutations were not found in healthy control subjects.ConclusionsThe CMTX1 patients in our study present predominantly axonal lesions.Frequent novel Cx32 gene mutations indicated that private mutations may be common in Chinese CMTX1 patients.

ObjectiveTo investigate the pathologic characteristics of the sural nerve in amyotrophic lateral sclerosis. MethodsClinical, electrophysiologic, laboratory data and sural nerve biopsy of 11 patients were reviewed. The clinical and laboratory data were compatible with the diagnosis of ALS. The sural nerve was removed and immediately fixed in 10% formalin and phosphate-buffered 2.5% glutaraldehyde and processed according to the procedure used in our laboratory for light and ultrastructural examination.Results4 groups were distinguished based on pathologic changes: normal; with mild axon degeneration and demyelination; with mild loss of the myelinated nerve, axon degeneration and demyelination; with severe loss of the myelinated nerve, axon degeneration and demyelination.ConclusionPredominantly axonal neuropathies are common and occur early in ALS. Axon degeneration of the nerve fibers is predominant, and demyelination also can be performed in patients with ALS.

Objective To investigate the expressions of Toll-like receptors and NOD-like receptor (TLR/NLRP) in septic rats with acute kidney injury (AKI) and influence of Radix notoginseng. Methods One hundred and fifty male Sprague-Dawley (SD) rats were selected, and they were divided into three groups: sham operation group, model group and Radix notoginseng pretreatment group with 50 rats in each group. Sepsis rats with AKI models were established by cecal ligation puncture (CLP); only was laparotomy performed in the sham operation group without ligation. The rats in Radix notoginseng pretreatment group were given Radix notoginseng (3 g/kg) for consecutive 3 days by gastric perfusion before treatment, and the sham operation group and sepsis model group rats were given equal amount of normal saline by gastric perfusion. After their blood was collected, at each following time points 6, 12 and 24 hours after modeling, 10 rats in each group were sacrificed, and the kidney specimens were collected. The endotoxin levels were detected by limulus assay; the levels of serum creatinine (SCr) and urea nitrogen (BUN) were detected by automatic biochemical analyzer; serum levels of interleukins (IL-1β, IL-18, IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA); the expression levels of NLRP1/3 and TLR2/4 mRNA and protein in renal tissue were detected by real-time fluorescence quantitative polymerase chain reaction (qPCR) and Western Blot, respectively; the pathological changes of renal tissues were observed by optical microscope. The 4-day and 7-day survival rates were observed in the remaining 20 rats in each group. Results The levels of endotoxin, SCr, BUN, IL-1β, IL-6, IL-18, and TNF-α and the expressions of NLRP1/3, TLR2/4 mRNA and proteins in sepsis model group and Radix notoginseng pretreatment group were significantly higher than those in sham operation group, and the levels of endotoxin, IL-18, and the expressions of NLRP1/3, TLR2/4 mRNA and proteins showed statistically significant differences at 6-hour after operation [endotoxin (kU/L): 61.3±25.7, 56.9±18.6 vs. 0.2±0.1, IL-18 (ng/L): 16.7±5.0, 13.8±2.9 vs. 10.6±2.8, NLRP3 mRNA (2-ΔΔCt): 6.3±1.9, 4.0±1.2 vs. 1.1±0.4, TLR mRNA (2-ΔΔCt): 5.7±1.3, 2.0±0.8 vs. 0.9±0.3, TLR4 mRNA (2-ΔΔCt): 4.4±1.2, 2.3±0.7 vs. 0.6±0.2, NLRP3/β-actin: 38.2±9.3, 26.1±7.2 vs. 18.3±5.1, TLR4/β-actin: 21.9±6.1, 16.2±4.4 vs. 10.9±2.8, TLR4/β-actin: 18.3±6.7, 12.0±3.9 vs. 7.5±2.0, all P < 0.05], the levels of SCr, BUN, IL-1β, TNF-α and IL-6 showed statistically significant differences at 12-hour after operation [SCr (μmol/L): 62.3±21.6, 38.1±13.9 vs. 36.0±11.9, BUN (mmol/L): 16.5±7.2, 6.9±2.6 vs. 6.8±2.5, IL-1β (ng/L): 37.6±10.9, 31.2±9.3 vs. 20.3±6.5, TNF-α (ng/L): 15.6±3.9, 10.2±2.8 vs. 7.3±2.1, IL-6 (ng/L):9.3±2.5, 6.8±1.7 vs. 5.0±1.3, all P < 0.05], the levels of expressions of NLRP3 mRNA and protein were obviously lower than those in sham operation group, and there were statistical significant differences immediately after 6-hour after operation [NLRP1 mRNA (2-ΔΔCt): 0.5±0.1, 0.8±0.2 vs. 1.6±0.5, NLRP3/β-actin: 8.0±2.1, 16.8±5.0 vs. 35.6±10.5, all P < 0.05], and the amplitude changes of the above indexes in Radix notoginseng pretreatment group were obviously smaller than those in sepsis model group (all P < 0.05); the survival rates of 4-day and 7-day in sepsis model group were significantly lower than those in sham operation group [4-day: 25% (5/20) vs. 95% (19/20), 7-day: 15% (3/20) vs. 95% (19/20), both P < 0.05], while the survival rate in Radix notoginseng pretreatment group was significantly higher than that in sepsis model group [respectively 65% (13/20) vs. 25% (5/20), 60% (12/20) vs. 15% (3/20), both P < 0.05]. Conclusions TLR2/4 and NLRP1/3 may be involved in the pathogenesis of AKI of septic rats. Traditional Chinese medicine Radix notoginseng possibly via regulating the expressions of TLR2/4 and NLRP1/3 can reduce the inflammatory response, in turn ameliorate kidney injury in septic rats and improve their renal functions.

Objective To investigate the antigen presentation characteristics of dendritic cells (DC) and B cells in cardiac grafts. Methods The heart of BALB/c mice was transplanted into the abdominal cavity of C57BL/6J mice. CD45⁺ cells in the heart graft were extracted and sorted by flow cytometry at postoperative 5 d, and single cell RNA sequencing was performed. Taking DC and B cell subsets in cardiac grafts as the main study cells, the changing trend, antigen presenting ability and intercellular communication with T cells after heart transplantation were analyzed by bioinformatics analysis and flow cytometry. Gene ontology (GO) function enrichment difference analysis was adopted to prove the specific function and the reliability annotation of cell subsets. Results Germinal center-like B cell (GC-L B) was the B cell subset with the largest increase in quantity during the acute rejection phase, accounting for 87%. Classical DC (cDC) 2 was the only DC subset with a significant increase in quantity during acute rejection of heart transplantation, accounting for 44% of DC subset, and it occupied the highest communication intensity with T cells after heart transplantation. Mononucleated DC (moDC) and memory B cell (MBC) were the main transmitters of T cell input signals in non-transplanted hearts, whereas transformed into cDC2 and GC-L B during the acute rejection phase. Among them, MBC and GC-L B were the main sources of T cell input signals in non-transplanted hearts and heart grafts. Conclusions Compared with DC, B cells occupy a higher number and weight in the intercellular communication with T cells in non-transplanted hearts and heart grafts, prompting that the antigen presenting activity of B cells is more active and stronger than DC in the early stage of acute rejection of heart transplantation.