OBJECTIVES: Managing patients with refractory head and neck cancer pain is one of the more challenging issues in clinical practice, and traditional intrathecal drug delivery also fails to provide adequate analgesia. There are currently no comprehensive and effective treatment methods. This study aims to observe the efficacy and safety of treating intractable head and neck cancer pain with morphine pump via lumbar approach to the prepontine cistern. METHODS: A total of 18 patients with intractable head and neck cancer pain treated with prepontine cistern morphine pumps were selected from the Department of Pain Management, Second Xiangya Hospital, Central South University between September 2019 and July 2023. Statistical analysis was performed on patients' preoperative and postoperative (1 week, 1 month, and 2 months after surgery), Numerical Rating Scale (NRS) scores, Self-Rating Depression Scale (SDS) scores, daily oral morphine consumption, the number of daily breakthrough pain episodes, and postoperative daily intrathecal morphine dosage. RESULTS: The NRS scores, SDS scores, daily oral morphine consumption, and the number of daily breakthrough pain episodes of patients at each time point after surgery were significantly lower than before surgery (all P<0.05). With the gradual increase in the dosage of intrathecal morphine, the daily oral morphine consumption of patients at each postoperative time point was significantly reduced compared to preoperative levels (all P<0.05). The complications related to the operation were mild, including nausea in 5 cases (31.3%), headache in 2 cases (12.5%); hypotension, urine retention, hypersomnia and constipation in 1 case (6.3% each), and no serious adverse events occurred. All improved and were discharged after symptomatic treatment. CONCLUSIONS The implantation of prepontine cistern morphine pump effectively controls intractable head and neck cancer pain, demonstrating characteristics of minimal invasiveness, mild side effects, and low medication dosage under the premise of standardized procedures.
Humans ; Morphine/administration & dosage* ; Male ; Female ; Middle Aged ; Head and Neck Neoplasms/surgery* ; Analgesics, Opioid/administration & dosage* ; Cancer Pain/drug therapy* ; Pain, Intractable/etiology* ; Aged ; Adult ; Infusion Pumps, Implantable ; Pain Management/methods*

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.

The advent of bruton tyrosine kinase inhibitors (BTKi) has offered more therapeutic choices for patients with B-cell malignancies. However, with its widespread application in recent years, the use of BTKi increases the risk of severe infections in patients. Here, we report three cases of B-cell malignancies, including one case of chronic lymphocytic leukemia and two cases of diffuse large B-cell lymphoma. During treatment with BTKi zanubrutinib, different degrees of invasive fungal disease (IFD) of the central nervous system occurred in these patients. All patients fully recovered following antifungal therapy. With a median follow-up of 35 months, all patients remained in a continuous remission state, and none of them had a recurrence of IFD.

Objective To examine the safety, efficacy and durability of totally endoscopic minimally invasive (TEMI) mitral valve repair in Barlow’s disease (BD). Methods A retrospective study was performed on patients who underwent mitral valve repair for BD from January 2010 to June 2021 in the Guangdong Provincial People’s Hospital. The patients were divided into a MS group and a TEMI group according to the surgery approaches. A comparison of the clinical data between the two groups was conducted. Results A total of 196 patients were enrolled, including 133 males and 63 females aged (43.8±14.9) years. There were 103 patients in the MS group and 93 patients in the TEMI group. No hospital death was observed. There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repair techniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265), the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shorter mechanical ventilation time (P<0.001) and postoperative hospitalization time (P<0.001). No statistical difference between the two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% (180/191) with a mean time of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period. The 3-year, 5-year and 10-year overall survival rates of all patients were 100.0%, 99.2%, 99.2%, respectively. Compared with the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P＞0.05). Conclusion TEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.

The liver is one of the organs most commonly affected by rheumatic diseases.Hepatic abnormalities in patients with rheumatic diseases can result from a variety of factors,including direct liver involvement by the disease itself,coexistence with primary liver disease,and drug-induced liver injury.When liver indicators are abnormal,a thorough differential diagnosis is required.For unexplained liver dysfunction,routine testing for autoantibodies should be performed to facilitate early identification of underlying autoimmune liver disease.If the etiology remains unclear,a liver biopsy is recommended for a final diagnosis if feasible.Alongside active management of rheumatic diseases,it is necessary to closely monitor liver function,avoid the use of agents that may exacerbate hepatic damage,particularly anti-rheumatic drugs with strong hepatotoxicity,and tailor treatment strategies according to personal specific conditions,so as to minimize liver damage and improve long-term outcome.

The liver is one of the organs most commonly affected by rheumatic diseases. Hepatic abnormalities in patients with rheumatic diseases can result from a variety of factors， including direct liver involvement by the disease itself， coexistence with primary liver disease， and drug-induced liver injury. When liver indicators are abnormal， a thorough differential diagnosis is required. For unexplained liver dysfunction， routine testing for autoantibodies should be performed to facilitate early identification of underlying autoimmune liver disease. If the etiology remains unclear， a liver biopsy is recommended for a final diagnosis if feasible. Alongside active management of rheumatic diseases， it is necessary to closely monitor liver function， avoid the use of agents that may exacerbate hepatic damage， particularly anti-rheumatic drugs with strong hepatotoxicity， and tailor treatment strategies according to personal specific conditions， so as to minimize liver damage and improve long-term outcome.

Objective:To analyze the clinical characteristics and treatment of eosinophilic angiocentric fibrosis (EAF) involving the orbit.Methods:We described a case and review the literature of EAF involving the orbit.Results:The literature review has shown 34 similar cases. Nineteen patients combined with other site involvement (17 cases had nasal involvement), whereas 15 had primary orbital involvement. Ocular swelling (18 cases) and epiphora (4 cases) were the most common initial presenting symptoms. The typical histopathologic findings include a perivascular, eosinophil-rich infiltrate and a "onion-skin" type of fibrosis concentrated around small vessels and all cases in this group conformed the above typical characteristics. In this series, 20 patients provided immunohistochemical results for IgG4, among them, 16 cases were positive while 4 cases were negative. No manifestations of obliterative phlebitis and storiform fibrosis were observed. The age, gender, and lesion locations (single or multiple) of the IgG4 staining positive group and the negative group were analyzed. There was no statistically significant difference in the age of onset, gender ratio and lesion the two groups ( P>0.05). Conclusion:For patients presented with ocular swelling, epiphora, with or without nasal lesions, EAF should be considered. The diagnosis of EAF is based largely on histopathologic findings. Although some cases were positive for IgG4 by immunohistochemistry, storiform fibrosis and obliterative phlebitis is not seen in our series, which aid in distinguishing EAF from IgG4-related disease.

Objective:To analyze the epidemiological characteristics of drug resistance genes of carbapenemase-producing Escherichia coli (CPECO) in Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023, providing data support and theoretical basis for controlling nosocomial infections of CPECO.Methods:Using a cross-sectional study, 30 carbapenem-resistant Escherichia coli (CRECO) strains confirmed by VITEK-2 Compact identification and drug sensitivity test in the Clinical Microbiology Laboratory of Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023 were tested, using carbapenemase inhibitor enhancement test to conduct preliminary screening of carbapenemases, and colloidal gold immunochromatography and polymerase chain reaction (PCR) were used to determine the phenotypes and genotypes of common carbapenemases ( blaKPC, blaNDM, blaVIM, blaIMP, blaOXA) respectively, and the genotypes ( blaSHV, blaTEM, blaCTX) of common extended Spectrum beta-lactamases (ESBL) were confirmed using PCR. The PCR amplification products of carbapenemase and ESBL positive strains were Sanger-sequenced, and the sequencing products were compared on the Blast website to determine the exact carbapenemase and ESBL genotypes. Sequence typing (ST) was performed on CPECO using the Achtman multi-locus sequence typing scheme to determine the cloning relationship between different strains. Results:A total of 21 CPECO strains were screened. Drug sensitivity test results showed that CPECO strains showed widespread drug resistance, with the resistance rate to monocyclic (aztreonam) and trimethoprim/sulfamethoxazole being over 60%(16/21, 14/21), and the resistance rate to other antibacterial drugs being 100%. Only the sensitivity to aminoglycosides and fosfomycin remained relatively high, and no strains resistant to tigecycline and colistin were found. Colloidal gold immunochromatography detected 18 blaNDM types, 2 blaKPC types, and 1 blaIMP type. Sequencing of drug resistance gene PCR products classified 17 blaNDM-5 strains, 1 blaNDM-4 strain, 2 blaKPC-2 strain, and 1 blaIMP-4 strain, which were completely consistent with the results of screening test and colloidal gold immunochromatography. ESBL resistance gene testing showed that the detection rate of blaTEM was 42.9%(9/21), blaCTX-M was 33.3%(7/21), and blaSHV was 4.8%(1/21). The rate of blaNDM producing CPECO carrying both ESBL resistance genes was 27.8%(5/18). The MLST typing results revealed 11 sequence types (STs), including one ST155 clonal complex and nine singleton STs. Among these, there were seven strains of ST167, five strains of ST410, and one strain each of ST58, ST68, ST69, ST93, ST131, ST155, ST648, ST1114, and ST3268. Conclusion:The main resistance mechanism identified in this study for CPECO was the production of blaNDM-5 carbapenemase, with a high proportion of strains also carrying blaTEM-1D and/or blaCTX-M-15 ESBLs. MLST typing found that the epidemic strain of CPECO showed certain polymorphism, but there were clonal transmission of multiple clonal complexes between ST167 and ST410.

Objective To explore current status of alexithymia in middle-aged and young patients with stroke,and to analyse the influencing factors and summarise the nursing strategies therefore to provide references for nursing interventions.Methods A convenience sampling method was used to select 220 patients who had stroke and admitted to the wards of Neurology and Neurosurgery in our hospital between February and April 2024.The patients were surveyed using a general information questionnaire,the stroke symptom experience scale,the stroke-specific quality of life scale(SSQOL),and the Toronto alexithymia scale-20(TAS-20).Pearson correlation analysis was used to evaluate the relationship between alexithymia,stroke symptom experience and quality of life in middle-aged and young patients with stroke.Multiple linear regression analysis was used to identify the influencing factors of alexithymia.Results A total of 205 middle-aged and young patients with stroke completed the study.The mean score of the TAS-20 was 74.67±19.68,with average subscale scores for difficulty in identifying feelings of 3.45±0.73,difficulty in describing feelings of 3.49±0.74 and externally-oriented thinking of 3.22±0.69.The prevalence of alexithymia was 74.63%.Alexithymia was found positively correlated with stroke symptom experience and negatively correlated with quality of life(all P<0.05).The education,family income and stroke symptom experience were the protective factors for alexithymia,while quality of life was a risk factor(all P<0.05).These factors collectively explained 61.50%of the variance in alexithymia.Conclusion Middle-aged and young patients with stroke have a high level of alexithymia.Patients with higher education,family monthly income≥2,000 yuan,lower quality of life and higher symptom burden are more likely to develop an alexithymia.Nursing staff should seek appropriate methods to guide patients in expressing their emotions in order to prevent the alexithymia.

Objective:To analyze the correlation of bone mineral density (BMD) , serum transforming growth factor β1 (TGF- β1) , and retinol-binding protein 4 (RBP4) with osteoporosis in gestational diabetes mellitus (GDM) . Methods:A total of 180 GDM patients admitted to Department of Gynecology, Second Hospital of Tianjin Medical University from Jan. 2022 to Jan. 2024 were included as the observation group, and 30 healthy pregnant women undergoing examination at the same time were included into the control group. BMD [stiffness index (SI) , broadband ultrasound attenuation (BUA) , speed of sound (SOS) ], serum TGF-β1, and RBP4 levels were compared between the two groups; GDM women with complicated with osteoporosis were included in the osteoporosis subgroup, and pregnant women without osteoporosis were included in the non-osteoporosis subgroup. BMD, serum TGF- β1 and RBP4 levels were compared between the two groups, and the relationship among bone mineral density and serum TGF- β1, RBP4 was analyzed by Pearson correlation. Receiver operating characteristic curve (ROC) curve was drawn to evaluate the diagnostic value of serum TGF- β1 and RBP4 levels in GDM complicated with osteoporosis. Results:The observation group had significantly higher levels of serum TGF- β1 and RBP4 than the control group, while lower BUA, SOS and SI ( t=99.04, 28.48, 4.10, 3.54, 6.29, P < 0.05) ; Among 180 pregnant women with GDM, 38 cases had osteoporosis and 142 cases did not have osteoporosis. The osteoporosis subgroup had significantly higher serum TGF- β1 and RBP4 levels than the other subgroup, while BMD indexes such as BUA, SOS and SI were significantly lower ( t=3.35, 3.48, 3.77, 2.85, 3.41, P < 0.05) ; Pearson correlation analysis showed that BMD indexes, such as BUA, SOS and SI, were significantly correlated with serum TGF- β1 and RBP4 in pregnant women with GDM ( r=-0.61, 0.58, -0.60, -0.58, -0.60, -0.63, P<0.05) ; The area under the curve (AUC) of TGF- β1, RBP4 and combined detection of GDM women with osteoporosis was 0.572, 0.653 and 0.659, respectively. Conclusions:In GDM women complicated with osteoporosis, the levels of serum TGF- β1 and RBP4 increase significantly, and BMD decreases significantly. Serum TGF- β1 and RBP4 in GDM women are closely related to BMD index, which can provide early diagnosis basis for GDM complicated with osteoporosis.