Pancreatic acinar cell carcinoma (PACC) is a rare exocrine tumor of the pancreas with distinct clinical and pathological features. In recent years, advancements in molecular biology techniques have led to a deeper understanding of the molecular mechanisms underlying PACC. Progress in imaging, endoscopic, and molecular diagnostic technologies has improved the early detection rate of PACC. The primary treatment modalities for PACC include surgical resection, chemotherapy, targeted therapy and immunotherapy; however, the therapeutic efficacy still requires further improvement. This article reviews the current research status of PACC, covering its epidemiology, pathological characteristics, molecular alterations, diagnostic methods, and treatment strategies, and discusses the controversies and future directions in PACC research.

Objective:To evaluate the clinical efficacy of the Masquelet technique (induced membrane technique) combined with an antibiotic-impregnated bone cement-coated plate for the treatment of infected nonunion following internal fixation of clavicle fractures.Methods:A retrospective analysis was conducted on 12 patients with clavicular infected nonunion who underwent staged treatment using the Masquelet technique combined with an antibiotic-loaded bone cement-coated plate between May 2021 and May 2023 in the Second Ward of Traumatic Orthopedics at Gansu Provincial People's Hospital. The cohort included 8 males and 4 females, with a mean age of 28.8±3.1 years (range: 12-48 years). Among them, 10 cases had mid-third clavicular defects, and 2 cases had lateral third defects. All 12 cases involved nonunion due to bone infection following internal fixation of clavicle fractures, with 6 cases initially fixed with Kirschner wires and 6 with plates. The induced membrane technique was applied in two stages. Stage One: Radical debridement was performed, including removal of the original internal fixation and infected necrotic tissue. A plate was implanted, and the bone defect area was filled with antibiotic-loaded bone cement, fully encapsulating the plate. Stage Two: Bone graft reconstruction was carried out 6-8 weeks later, after infection control was confirmed. The induced membrane was incised, the bone cement was removed, and a bone graft was placed within the membrane. Outcomes included infection control, bone union time, pain visual analogue scale (VAS), and Constant-Murley shoulder score (CMS) at the final follow-up.Results:The interval between the first and second surgeries was 7.42±1.17 weeks (range: 6-10 weeks). All 12 patients were followed up for a mean duration of 16.4±3.9 months (range: 12-24 months). One patient experienced recurrent infection after the first-stage surgery, which was controlled after repeat debridement and replacement of antibiotic-loaded bone cement, with no recurrence during follow-up. All 12 patients achieved bony union, with a mean healing time of 3.42±0.67 months (range: 3-5 months). Radiographs showed continuous bone cortex with no visible fracture lines. At the final follow-up, the mean VAS score was 0.42±0.51, significantly lower than the preoperative score of 6.68±1.12 ( t=18.711, P<0.001). The mean CMS score was 88.93±3.94, significantly higher than the preoperative score of 44.41±7.15 ( t=20.786, P<0.001). Conclusion:The Masquelet technique combined with an antibiotic-loaded bone cement-coated plate is effective in treating infected nonunion after internal fixation of clavicle fractures, significantly improving acromioclavicular joint function.

Objective:To explore the clinical efficacy of membrane induction technique in the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults.Methods:The data were retrospectively analyzed of the 15 adult patients who had been treated for chronic bone infection after internal fixation of intertrochanteric fracture at Department of Traumatic Orthopaedics Ⅱ, Gansu Provincial People's Hospital from May 2019 to May 2022. There were 13 males and 2 females with an age of (55.8±2.6) years. By the Cierny-Mader anatomical classification, 6 cases were type Ⅲ and 9 cases type Ⅳ; by the physiological classification, 10 cases were type A and 5 cases type B. Course of bone infection was (22.1±8.1) months. All patients were treated by membrane induction technique in 2 stages. In the first stage, antibiotic bone cement was implanted after debridement into the defects [(4.50±0.54) cm in length] followed by temporary fixation of broken ends of the fracture. After 6 to 8 weeks when infection was controlled, the second stage repair and reconstruction of bone defects was carried out. Infection control, complications, bone healing time, and Samantha X-ray bone healing score, visual analogue scale (VAS) at standing, Sanders hip score and Paley score for bone defect healing at the last follow-up were recorded.Results:The 15 patients were followed up for (27.5±2.5) months. Infection recurred after the first-stage operation in 2 cases, but was effectively controlled after debridement and follow-up observed no recurrence. Follow-up showed no such complications as donor site infection, deformation or collapse of the bone reconstructed, limb shortening, re-fracture or internal fixation failure in the 15 patients who achieved bony union after (10.3±2.1) months. At the last follow-up, the Samantha X-ray score was 6.0(5.0, 6.0) points and VAS at standing 1.0(1.0, 3.0) point for the 15 patients; by Sanders hip score, the hip function was rated as excellent in 10 cases and as fine in 5 cases; by Paley score for bone defect healing, the efficacy was rated as excellent in 7 cases, as good in 2 cases and as fair in 6 cases.Conclusion:In the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults, membrane induction technique can effectively control infection and improve the hip function of the affected limb, leading to good clinical efficacy.

Objective:To evaluate the clinical efficacy of the Masquelet technique (induced membrane technique) combined with an antibiotic-impregnated bone cement-coated plate for the treatment of infected nonunion following internal fixation of clavicle fractures.Methods:A retrospective analysis was conducted on 12 patients with clavicular infected nonunion who underwent staged treatment using the Masquelet technique combined with an antibiotic-loaded bone cement-coated plate between May 2021 and May 2023 in the Second Ward of Traumatic Orthopedics at Gansu Provincial People's Hospital. The cohort included 8 males and 4 females, with a mean age of 28.8±3.1 years (range: 12-48 years). Among them, 10 cases had mid-third clavicular defects, and 2 cases had lateral third defects. All 12 cases involved nonunion due to bone infection following internal fixation of clavicle fractures, with 6 cases initially fixed with Kirschner wires and 6 with plates. The induced membrane technique was applied in two stages. Stage One: Radical debridement was performed, including removal of the original internal fixation and infected necrotic tissue. A plate was implanted, and the bone defect area was filled with antibiotic-loaded bone cement, fully encapsulating the plate. Stage Two: Bone graft reconstruction was carried out 6-8 weeks later, after infection control was confirmed. The induced membrane was incised, the bone cement was removed, and a bone graft was placed within the membrane. Outcomes included infection control, bone union time, pain visual analogue scale (VAS), and Constant-Murley shoulder score (CMS) at the final follow-up.Results:The interval between the first and second surgeries was 7.42±1.17 weeks (range: 6-10 weeks). All 12 patients were followed up for a mean duration of 16.4±3.9 months (range: 12-24 months). One patient experienced recurrent infection after the first-stage surgery, which was controlled after repeat debridement and replacement of antibiotic-loaded bone cement, with no recurrence during follow-up. All 12 patients achieved bony union, with a mean healing time of 3.42±0.67 months (range: 3-5 months). Radiographs showed continuous bone cortex with no visible fracture lines. At the final follow-up, the mean VAS score was 0.42±0.51, significantly lower than the preoperative score of 6.68±1.12 ( t=18.711, P<0.001). The mean CMS score was 88.93±3.94, significantly higher than the preoperative score of 44.41±7.15 ( t=20.786, P<0.001). Conclusion:The Masquelet technique combined with an antibiotic-loaded bone cement-coated plate is effective in treating infected nonunion after internal fixation of clavicle fractures, significantly improving acromioclavicular joint function.

Objective:To explore the clinical efficacy of membrane induction technique in the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults.Methods:The data were retrospectively analyzed of the 15 adult patients who had been treated for chronic bone infection after internal fixation of intertrochanteric fracture at Department of Traumatic Orthopaedics Ⅱ, Gansu Provincial People's Hospital from May 2019 to May 2022. There were 13 males and 2 females with an age of (55.8±2.6) years. By the Cierny-Mader anatomical classification, 6 cases were type Ⅲ and 9 cases type Ⅳ; by the physiological classification, 10 cases were type A and 5 cases type B. Course of bone infection was (22.1±8.1) months. All patients were treated by membrane induction technique in 2 stages. In the first stage, antibiotic bone cement was implanted after debridement into the defects [(4.50±0.54) cm in length] followed by temporary fixation of broken ends of the fracture. After 6 to 8 weeks when infection was controlled, the second stage repair and reconstruction of bone defects was carried out. Infection control, complications, bone healing time, and Samantha X-ray bone healing score, visual analogue scale (VAS) at standing, Sanders hip score and Paley score for bone defect healing at the last follow-up were recorded.Results:The 15 patients were followed up for (27.5±2.5) months. Infection recurred after the first-stage operation in 2 cases, but was effectively controlled after debridement and follow-up observed no recurrence. Follow-up showed no such complications as donor site infection, deformation or collapse of the bone reconstructed, limb shortening, re-fracture or internal fixation failure in the 15 patients who achieved bony union after (10.3±2.1) months. At the last follow-up, the Samantha X-ray score was 6.0(5.0, 6.0) points and VAS at standing 1.0(1.0, 3.0) point for the 15 patients; by Sanders hip score, the hip function was rated as excellent in 10 cases and as fine in 5 cases; by Paley score for bone defect healing, the efficacy was rated as excellent in 7 cases, as good in 2 cases and as fair in 6 cases.Conclusion:In the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults, membrane induction technique can effectively control infection and improve the hip function of the affected limb, leading to good clinical efficacy.

Studies have suggested that the nucleus accumbens (NAc) is implicated in the pathophysiology of major depression; however, the regulatory strategy that targets the NAc to achieve an exclusive and outstanding anti-depression benefit has not been elucidated. Here, we identified a specific reduction of cyclic adenosine monophosphate (cAMP) in the subset of dopamine D1 receptor medium spiny neurons (D1-MSNs) in the NAc that promoted stress susceptibility, while the stimulation of cAMP production in NAc D1-MSNs efficiently rescued depression-like behaviors. Ketamine treatment enhanced cAMP both in D1-MSNs and dopamine D2 receptor medium spiny neurons (D2-MSNs) of depressed mice, however, the rapid antidepressant effect of ketamine solely depended on elevating cAMP in NAc D1-MSNs. We discovered that a higher dose of crocin markedly increased cAMP in the NAc and consistently relieved depression 24 h after oral administration, but not a lower dose. The fast onset property of crocin was verified through multicenter studies. Moreover, crocin specifically targeted at D1-MSN cAMP signaling in the NAc to relieve depression and had no effect on D2-MSN. These findings characterize a new strategy to achieve an exclusive and outstanding anti-depression benefit by elevating cAMP in D1-MSNs in the NAc, and provide a potential rapid antidepressant drug candidate, crocin.

OBJECTIVE: To explore the characteristics of Shwachman-Diamond syndrome (SDS) in Chinese children in order to provide a reference for early diagnosis. METHODS: With Shwachman-Diamond syndrome, SDS, SBDS gene and inherited bone marrow failure as the keywords, the search period was set from January 2002 to October 2022. Relevant literature was retrieved from the Wanfang Database and China National Knowledge Infrastructure (CNKI) database. In addition, by using Shwachman-diamond syndrome as a keyword, the search period was also retrieved from the Web of Science, PubMed, and MEDLINE databases from January 2002 to October 2022. A child with SDS treated at the Tongji Hospital was also included. A total of 44 cases with complete clinical data were analyzed with reference to the International Standard for SDS Diagnosis. Chi-square test and t test were used for statistical analysis. Evidence-based research was carried out in the form of systematic review. The epidemiology, clinical characteristics and key points of early diagnosis of the Chinese SDS children were summarized and compared with the international data. RESULTS: The main characteristics of SDS in Chinese children were summarized as follows: The ratio of males to females was about 1.3 : 1, the median age of onset was 3 months, and the median age of diagnosis was 14 months. The first symptoms were often exocrine pancreatic insufficiency (31.8%) and granulocytopenia with infection (31.8%). According to the international consensus, the incidence rates of the three major diseases of SDS were hemocytopenia (95.4%), pancreatic disease (72.7%), and bone abnormality (40.9%). The common factors underlying SDS disease were variants of the SBDS gene (c.258+2T>C and c.183_184TA>CT), albeit there was no significant correlation between genotype and phenotype (P > 0.05). Compared with international reports, the clinical manifestations and genotypes of Chinese SDS children are different (P < 0.05). CONCLUSION The SDS children have an early age of onset and significant individual difference. It is necessary to analyze the case-related data to facilitate early recognition, diagnosis and clinical intervention.
Female ; Humans ; Male ; Bone Marrow Diseases/therapy* ; China ; East Asian People ; Exocrine Pancreatic Insufficiency/therapy* ; Shwachman-Diamond Syndrome/therapy*

Objective:To explore the clinical efficacy of adult donor dual kidney transplantation.Methods:Retrospective analysis of case data of 13 adult donor kidney dual kidney transplantation (DKT) performed in the The Second Xiangya Hospital of Central South University from September 2016 to December 2020. For 13 donors, the average age and BMI were (53.5±12.4)years and (24.3±2.8) kg/m 2, respectively. Their mean Serum creatinine (SCr) at admission and before procurement was (132.9±54.1)and (228.7±112.4)μmol/L, respectively. 3 of them had diabetes mellitus history, and 8 had hypertension history. 11 met the United Network for Organ Sharing (UNOS) DKT criteria and 6 met Remuzzi score DKT criteria. For 13 recipients, the average age and BMI were (39.3±8.9)years and (20.2±2.4)kg/m 2, respectively. All of them received ABO blood type-matched kidney transplants. 2 of them had their grafts transplanted in the bilateral iliac. In 12 cases, the grafts filled rapidly and urinated immediately when opening blood flow. In 1 case, the grafts were dark in color and vascular showed weak pulsation after opening blood flow. The time to recovery of perioperative graft function (from the day of surgery to the natural reduction of SCr to the normal range 44-133μmol/L), the occurrence of delayed graft function (DGF), acute rejection (AR), ureteral and surgical incision complications, as well as the recipients’ final follow-up SCr, eGFR, urinary protein, and grafts outcome were observed. Risk factors affecting outcomes were assessed by univariate logistic regression analysis. Results:The SCr dropped to the normal range at discharge in 10 recipients, and the average recovery time was (13.8±13.0) days. In other 3 cases SCr at discharge were 300.0, 149.0, 152.5μmol/L. 4 cases had DGF, 4 had AR, 1 experienced urinary fistula, and 1 experienced incisional dehiscence, which were treated with anti-rejection, J-tube implantation, continuous catheterization to maintain bladder void, secondary suturing, respectively. The follow-up time ranged from 4 to 54 months, with a median of 28(15.5, 31.0) months. At the final follow-up time, 10 cases had good graft function, 2 suffered impaired kidney function, and 1 experienced graft failure. The average SCr and eGFR except for graft failure patient were (144.2±101.3)μmol/L and (52.9±21.2)ml/min, respectively. 4 had positive urine protein. Univariate logistic regression analysis showed that donor age, BMI, history of diabetes mellitus and hypertension, and SCr were not significantly correlated with recipients’ DGF and graft impairment ( P>0.05), and due to the small sample size, multifactorial logistic regression analysis was not performed. Conclusion:The short to medium-term effects of adult donor DKT coule be safe and feasible.

The secondary motor cortex (M2) encodes choice-related information and plays an important role in cue-guided actions. M2 neurons innervate the dorsal striatum (DS), which also contributes to decision-making behavior, yet how M2 modulates signals in the DS to influence perceptual decision-making is unclear. Using mice performing a visual Go/No-Go task, we showed that inactivating M2 projections to the DS impaired performance by increasing the false alarm (FA) rate to the reward-irrelevant No-Go stimulus. The choice signal of M2 neurons correlated with behavioral performance, and the inactivation of M2 neurons projecting to the DS reduced the choice signal in the DS. By measuring and manipulating the responses of direct or indirect pathway striatal neurons defined by M2 inputs, we found that the indirect pathway neurons exhibited a shorter response latency to the No-Go stimulus, and inactivating their early responses increased the FA rate. These results demonstrate that the M2-to-DS pathway is crucial for suppressing inappropriate responses in perceptual decision behavior.
Mice ; Animals ; Motor Cortex ; Corpus Striatum/physiology* ; Neostriatum ; Neurons/physiology* ; Reaction Time

Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.