With a low incidence and a non-specific clinical manifestation, medial medulary infarction (MMI) can often be misdiagnosed or missed diagnosis. Magnetic resonance imaging(MRI) played a major role in diagnosing the MMI. This article reviews the epidemiology, etiology, pathogenesis, clinical and imaging manifestations, diagnosis and differential diagnosis, and prognosis of MMI.

Objective To investigate the correlation between 6 common triggers and ischemic stroke.Methods The demographic and clinical data of the consecutive inpatients with acute ischemic stroke were collected.A questionnaire survey of the triggers of the disease was conducted within 4 d after admission.A case cross-over study was used to compare the exposure of the 6 potential triggers (overeating,anger,negative emotion,heavy physical activity,sudden posture changes as response to a startling event,drinking coffee) at 2 h before onset (dangerous period) and at 1 d before onset during the same period (control period),and exposures to potential triggers in patients according to gender,age and etiological subtypes were further analyzed.Results A total of 369 patients were enrolled.They aged 24-93 years old (mean 61.75 ±13.57),220 patients were male (59.6％) and 149 were female (40.4％).A total of 91 patients (24.7％) exposed to at least one of the triggers at 2 h before onset (odds ratio [OR] 6.1,95％ confidence interval [CI] 3.7-9.9);OR for exposure to the sudden posture change in response to a startling event was 12.0 (95％ CI 2.4-59.3),for heavy physical activity 10.7 (95％ CI 4.2-27.6),for anger 8.0 (95％ CI 2.3-27.5),and for negative emotion 4.9 (95％ CI 2.3-10.3).There was no exposure to drinking coffee.There were no significant differences in the exposure to various triggers among the different gender,age,and etiological subtypes.Conclusions Sudden posture changes as response to a startling event,heavy physical activity,anger,and negative emotion are the triggers for ischemic stroke,attention should be paid to the influence of triggers in the prevention of ischemic stroke.

OBJECTIVETo analyse botanical morphology in different populations and give a reference for germplasm evaluation of Changium smyrnioides.

METHODRoots and leaves were comprehensively compared among 10 populations of Ch. smyrnioides in the main distribution area, the foliar morphology similarity coefficient was calculated, and the systematic relationships were constructed based on UPGMA method.

RESULTThere was significant morphological difference among populations of Ch. smyrnioides. Plant shape was divided into the loosed-type, compacted-type and intermediated-type. Leaf split was divided into the lobated-type, parted-type and intermediate-type. Root shape was divided into spherical-type, column-type and spindle-type. Foliar morphology similarity coefficient differed significantly and ranged from 0.234 1 to 0.985 1 among 10 populations of Ch. smyrnioides. Zijinshan population was divided into a unique group when similarity coefficient was 0.37.

CONCLUSIONPlant tightness, lobation depth and root shape could be used as the basis for germplasm evaluation on Ch. smyrnioides. Zijinshan population could be used as a special germplasm to be exploited.

Apiaceae ; anatomy & histology ; classification ; growth & development ; Plant Leaves ; anatomy & histology ; growth & development ; Plant Roots ; anatomy & histology ; growth & development

Objective To explore the mechanism of down-regulation of regulatory T cells (Treg) by immunization with attenuated activated autologous T cells. Methods Aulologous T cells were activated with ConA in vitro. Mice were immunized subcutaneously and inlraperitoneally every 5 days for 3 times (5 ×10~6 per time for each mouse), and the number and function of Treg were examined. PBS was subcutaneously injected for control group. Serum level of anti-mouse CD25 antibody was measured by ELISA. The number and function of Treg was detected by serum adoptive transfer and proliferation and inhibition assays. Results Compared with control group, there were less CD4~+ CD25~+ Foxp3~+ Treg in the mice after immunization (P < 0. 01), the immunosuppression ability decreased (P<0. 01), and the level of anti-CD25 antibody increased (P <0.01). Adoptive transfer of serum from immunized mice to naive mice led to a significant decrease in Treg population and function in recipient mice (P<0. 01). Conclusion Immunization with attenuated activated autologous T cells induces more anti-CD25 antibody, which may further down-regulate CD4~+CD25~+Foxp3~+ Treg expansion and function in vivo.

The angiogenic microenvironment is a new blood vessel with different molecular and functional characteristics that sprouts on the original blood vessels through different mechanisms,which directly affects the process of tumor cell growth,proliferation,and migration and has an important impact on the occurrence and development of precancerous lesions of gastric cancer.Correa mode has shown that precancerous lesions of gastric cancer is the key pathological stage before the occurrence of gastric cancer,and it is of great significance to advance the prevention and treatment strategy to this stage.TCM believes that qi deficiency and blood stasis is the key pathogenesis of precancerous lesions of gastric cancer,and its basic treatment is to replenish qi and remove blood stasis,and based on the syndrome differentiation,drugs with the efficacy of nourishing yin and tonifying stomach,soothing the liver and regulating qi,resolving phlegm and dispersing lumps,and clearing heat and dampness for treatment.This article discussed the correlation between precancerous lesions of gastric cancer and angiogenic microenvironment and its regulatory pathways,and summarized the methods and mechanisms of TCM in the treatment of precancerous lesions of gastric cancer from the perspective of regulating angiogenic microenvironment-related pathways,in order to provide a reference for the treatment of precancerous lesions of gastric cancer with TCM.

With the further development of endoscopic technology and the application of minimally invasive concept in the diagnosis and treatment of colorectal surgery diseases, the diagnosis and treatment of colorectal related diseases have undergone tremendous changes. Surgical diagnosis and treatment of colorectal diseases have achieved great results in the minimally invasive field, ranging from traditional transabdominal surgery to laparoscopic surgery, transvaginal surgery, and transvaginal specimen removal. One of the most cutting-edge surgical methods in the field of minimally invasive colorectal surgery at present, this method avoids the incision in the abdominal wall by taking specimens through the rectum and vagina, thus further minimally invasive colorectal surgery. The NOSES technology combines the advantages of traditional laparoscopic surgery with the concept of modern minimally invasive surgery. It embodies the characteristics of minimally invasive, fast track rehabilitation in surgery, functional surgery and other concepts on the basis of ensuring the operation effect. This paper mainly summarizes the relevant experience, experience and experience in the development of colorectal surgery diagnosis and treatment by carrying out the nose technology at home and abroad.

Objective:To summarize the clinical and gene mutation characteristics of a child with Cowden syndrome and review the literature.Methods:The clinical data of a child with Cowden syndrome treated in the First Affiliated Hospital of Xinxiang Medical University in June 2020 were analyzed retrospectively.Taking " Cowden syndrome" , " PTEN gene" , " hamartoma polyps" , "child" , " Cowden syndrome and child" and " PTEN and child" as key words, literature was retrieved from Chinese databases (China National Knowledge Internet database and Wanfang database) and the PubMed database from the establishment of the database to March 2021. Results:A 13-year-old male had intermittent abdominal pain and abdominal distension for 5 months.Electron microscopic gastroenteroscopy showed multiple polyps, and focal lymphocyte aggregation and infiltration were found in tissue biopsy.Whole exon sequencing revealed a hemizygous mutation of c. 475 (exon5) A>T in PTEN gene, which led to the transformation of the 159 th amino acid from arginine to tryptophan.The prediction results of the tertiary structure of the protein indicated that the variation might affect the spatial structure of the protein and damage the protein function.According to the clinical characteristics, Cowden syndrome was diagnosed.The pedigree confirmed that the variation was inherited from the mother, who had a similar phenotype.No qualified Chinese report was retrieved.Among 41 English studies on PTEN gene mutation in children, there were only two reports related to pediatric Cowden syndrome.The hemizygous mutation of PTEN gene was not reported. Conclusions:The missense mutation of c. 475 (exon5) A>T in PTEN gene in this study is a novel cause of Cowden syndrome, and the case is the first case report in China.

Heat shock protein 47 (HSP47) is mainly involved in regulating collagen folding, secretion and maturation in the tumor microenvironment (TME) and is widely amplified in human cancers. HSP47 has been shown to be overexpressed in a variety of extracranial tumors. In glioma, the expression of HSP47 correlates with the grading of glioma and is involved in proliferation, invasion, angiogenesis, and immune regulation of glioma, regulates the TME of glioma, and promotes the survival of glioma stem cells, which may be related to the heterogeneity of glioma. This article reviews the progress of HSP47 in the development and progression of glioma, and discusses the significances of HSP47 in the proliferation, invasion, targeted therapy and immunotherapy of glioma.

Objective:To investigate the influencing factors for microvascular invasion (MVI) in hepatocellular carcinoma based on three-dimensional visualization and the construction of its nomogram model.Methods:The retrospective cohort study method was conducted. The clinico-pathological data of 190 patients with hepatocellular carcinoma who were admitted to Henan University People′s Hospital from May 2018 to May 2021 were collected. There were 148 males and 42 females, aged (58±12)years. The 190 patients were randomly divided into the training set of 133 cases and the validation set of 57 cases by the method of random number table in the ratio of 7:3. The abdominal three-dimensional visualization system was used to characterize the tumor morphology and other imaging features. Observation indicators: (1) analysis of influencing factors for MVI in hepatocellular carcinoma; (2) construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and non-parametric rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and the chi-square test was used for comparison between groups. Corresponding statistical methods were used for univariate analysis. Binary Logistic regression model was used for multivariate analysis. Receiver operator characteristic (ROC) curves were plotted, and the nomogram model was assessed by area under the curve (AUC), calibration curve, and decision curve. Results:(1) Analysis of influencing factors for MVI in hepatocellular carcinoma. Among 190 patients with hepatocellular carcinoma, there were 97 cases of positive MVI (including 63 cases in the training set and 34 cases in the validation set) and 93 cases of negative MVI (including 70 cases in the training set and 23 cases in the validation set). Results of multivariate analysis showed that alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology were independent factors affecting the MVI of patients with hepatocellular carcinoma ( odds ratio=5.06, 3.62, 1.00, 2.02, 2.59, 95% confidence interval as 1.61-15.90, 1.28-10.20, 1.00-1.01, 1.02-3.98, 1.03-6.52, P<0.05). (2) Construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. The results of multivariate analysis were incorporated to construct a nomogram prediction model for MVI of hepatocellular carcinoma. ROC curves showed that the AUC of the training set of nomogram model was 0.85 (95% confidence interval as 0.79-0.92), the optimal fractional cutoff based on the Jordon′s index was 0.51, the sensitivity was 0.71, and the specificity was 0.84. The above indicators of validation set were 0.92 (95% confidence interval as 0.85-0.99), 0.50, 0.90, and 0.82, respectively. The higher total score of the training set suggested a higher risk of MVI in hepatocellular carcinoma. The calibration curves of both training and validation sets of nomogram model fitted well with the standard curves and have a high degree of calibration. The decision curve showed a high net gain of nomogram model. Conclusions:Alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology are independent influencing factors for MVI in patients with hepatocellular carcinoma. A nomogram model constructed based on three-dimensional visualized imaging features can predict MVI in hepatocellular carcinoma.