Sepsis remains a challenge in critical care worldwide，with intestinal microbiome dysbiosis implicated in its onset，progression，and organ dysfunction. Germ-free （GF） and human microbiota-colonized animals，by eliminating confounding from resident microbiota and combining induction methods such as CLP/LPS/live-bacterial challenge with fecal microbiota transplantation （FMT） and mono- or combined colonization，enable causal tests and dissection of microbiota-host interactions and drug mechanisms. This review summarizes the application of GF and related models in sepsis research. At the immune level，TLR-related signaling and pathogen community-induced suppression of IRF3-dependent defense affect innate immunity and pathogen clearance. At the barrier level，reprogramming of tight junction proteins and increased permeability drive gut-derived amplification. At the metabolic level，short-chain fatty acids and bile acids function as metabolic valves influencing GPR/HDAC signaling. At the epigenetic level，EZH2 and histone deacetylation emerge as druggable targets. We further synthesize anti-sepsis evidence for traditional Chinese medicine （TCM），mainly from conventional animals and clinical studies，discussing how formulae （e.g.，Xuebijing，Shenfu，and Huanglian Jiedu Tang） and active constituents （e.g.，berberine，luteolin，ginsenosides，and resveratrol） may act through microbiota-related and direct host pathways，with FMT/metabolite replenishment enabling further causal testing. Finally，we propose a closed-loop GF-humanized-clinical stratification paradigm for integrated evaluation of microecology，epigenetics，immunity，and organ outcomes，providing a translational path for precision prevention and treatment based on TCM and the microbiome.

Objective:To assess the long-term outcome and influencing factors of laparoscopic Heller myotomy plus Dor fundoplication(LHM+ Dor) for achalasia by a single operator.Methods:Fifty-four patients who underwent LHM+ Dor consecutively from January 2011 to December 2019 were retrospectively reviewed. Those who had already undergone surgical or endoscopic myotomy and who were complicated with cancer were ruled out. Symptom inquiry and esophagogram were conducted both before and after surgery for assessing surgical results. Esophagoscopy, esophageal manometry and 24 h pH monitoring were performed before surgery, and the effects of these preoperative factors on the long-term outcome were analyzed.Results:All patients had dysphagia for average 6.5 years, ranging from 0.5-30.0 years. Intra-operative mucosal perforation occurred in 4(7.4%) patients, and there were no postoperative morbidity and mortality. At a median follow-up of 5.2 years, the morbidity of dysphagia decreased from 100% before surgery to 5.5% after surgery( P<0.001), Eckardt scores from 4.85±1.64 to 0.71±1.08( P=0.000). After surgery, 94.4% of patients had excellent and good relief of symptoms and good control of gastroesophageal reflux, the morbidity of heartburn being 3.7%. At 5 years after surgery, the probability of being symptoms free(Eckardt score≤1) was 91.7% in patients without preoperative night cough, compared to 54.6% in those with preoperative night cough( P=0.047). The probability was 92.3% in patients with grade Ⅰ and Ⅱ dilation of the esophagus and 79.0% in patients with grade Ⅲ and Ⅳ dilation( P=0.027). At multivariate analysis, heavier esophageal dilation was the independent predicator for poor symptom control after surgery. Conclusion:LHM+ Dor can be safely performed and durably relieve achalasia symptoms. Severe esophageal dilation before surgery is an independent predictor of a poor response to surgery.

Objective To investigate the effect and underlying mechanism of lncRNA MEG3 on the radiosensitivity of nasopharyngeal carcinoma cells.Methods this experiment,overexpression control group,MEG3 overexpression group,miR-NC inhibition group,miR-7-5p inhibition group,overexpression control+4 Gy group,MEG3 overexpression+4 Gygroup,miR-NC inhibition+4 Gy group,miR-7-5p inhibition+4 Gy group,MEG3 overexpression + miR-NC overexpression group,MEG3 overexpression + miR-7-Sp overexpression group were established.The expression of miR-7-5p and MEG3 was detected by qRT-PCR.The radiosensitivity of nasopharyngeal carcinoma cells was measured by clone formation assay.Cell apoptosis was assessed by flow cytometry.The fluorescence activity was evaluated by dual luciferase reporter assay.Results MEG3 was lowly expressed in nasopharyngeal carcinoma tissues and cells.Overexpression of MEG3 and inhibition of miR-7-5p expression increased the radiosensitivity of nasopharyngeal carcinoma cells and promoted radiation-induced cell apoptosis.MEG3 could targetedly regulate the miR-7-5p expression.Overexpression of miR-7-5p reversed the effect of overexpression of MEG3 on the sensitization of nasopharyngeal carcinoma cells and the promotion of apoptosis induced by radiation exposure.Conclusions Overexpression of MEG3 increases the radiosensitivity of nasopharyngeal carcinoma cells and promotes radiation-induced cell apoptosis.The mechanism may be related to the down-regulation of miR-7-5p expression.

Objective: To investigate the clinical value of multimodal navigation-based virtual reality (MNVR) in the needle biopsy of intracranial eloquent lesions. Methods: From January 2016 to January 2017, 20 patients with intracranial deep-seated lesions involving eloquent brain areas underwent MNVR-aided needle biopsy at Department of Neurosurgery, People′s Liberation Army General Hospital. Preoperatively, MNVR was used to propose and revise the biopsy planning. Intraoperatively, navigation helped trajectory avoid the eloquent structures. Intraoperative MRI (iMRI) was performed to prove the biopsy accuracy and detect the intraoperative complications. Perioperative neurological status, iMRI findings, intraoprative complications, surgical outcome and pathological diagnosis were recorded. Wilcoxon rank-sum test was conducted to compare the preoperative and postoperative neurological scores. Results: MNVR helped revised 45%(9/20) initial biopsy trajectories, which would probably injury the nearby eloquent structures. Navigation helped biopsy trajectories spare the eloquent structures during the operation. No statistical difference was found between postoperative and preoperative neurological status, despite all the lesions were adjacent to eloquent areas. Additionally, 20 patients totally received 21 iMRI scanning. iMRI helped revise incorrect biopsy site in one case and detected intraoperative hemorrhage in another case, both of cases were treated immediately and effectively. No MNVR related adverse events and complications occurred. Conclusions MNVR-aided needle biopsy of intracranial eloquent lesions is a safe, novel and efficient biopsy modality. This technique is helpful to reduce the incidence of surgery related neurological deficits.

[A BSTR ACT] OB J ECTI V E To i mprove the recognization of clinical, imaging and pathological characteristics of angioleiomyoma (ALM) in the head and neck region. METHODS We retrospectively reviewed the data of 20 patients with ALM in the head and neck region between 2000 and 2012. RESULTS Seven male and 13 female patients were included in this study. The average age was 52.5 (from 28 to 74 years). The symptom in most cases (n=14) was the painless mass, 4 tumors originating in the nasal cavity presented with nasal obstruction or (and) epistaxis, and the other 3 cases were accidentally found by physical examination. The results of B-ultrasonography in 10 ALM cases of subcutaneous or deep space were homogeneously hypoechoic echo texture, straight and linear vessels in the tumor with convergence to one point with a circumscribed margin. MRI in 5 cases demonstrated typically a well-defined mass, which showed hypointensity or isointensity to muscle on T1WI, and heterogeneous hyperintensity on T2WI. All lesions showed obviously delayed enhancement on contrast MRI. HE stain showed that the tumors were formed by bundles of spindle-shape smooth muscle cells circumscribing numerous slit-like blood vessels in most cases. Immunoperoxidase staining revealed that the tumor cells were strongly positive for calponin, desmin and smooth muscle actin (SMA) in the cytoplasm of the smooth muscle cells. The positive expression of progestogen receptor and estrogen receptor was seen in 7 cases and 4 cases respectively among 10 cases. All patients underwent surgery, and recovered well postoperatively without recurrence or malignancy. CONCLUSION The clinical manifestations of ALM are nonspecific. ALM has distinctive imaging features in B-ultrasonic and MRI examination. Histological examination and immunoperoxidase staining can make a definite diagnosis of the disease. Progestogen receptor and estrogen receptor can be expressed in ALM. The postoperative prognosis is good.

B-Lymphocytes ; Glottis ; Humans ; Lymphoma, B-Cell, Marginal Zone ; diagnosis

OBJECTIVETo evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors.

METHODSFrom September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. All the patients routinely underwent endoscopic third ventriculostomy (ETV) and tumor biopsy as the initial treatment. Twenty-seven cases (62.8%, pure endoscopic group) with histological diagnosis of germinoma (23 cases) or pineoblastoma (4 cases) were treated with chemotherapy with/without radiation therapy after ETV. The rest 16 cases (37.2%, craniotomy group) with histological diagnosis of non-germinoma and non-pineoblastoma (5 astrocytomas, 4 pineocytomas, 4 teratomas, 2 ependymomas, and 1 pineopappiloma) had craniotomy and tumor resection after ETV. All the cases had routine follow-up at 1, 3, and 6 months after the final surgery. The clinical, imaging, and tumor markers analysis were routinely examined at follow-up.

RESULTSIn the pure endoscopic group, 1 case had intra-ventricular hemorrhage after ETV, followed by external ventricular drainage and recovered after 1 week. Endoscopic procedure related short-term ( < 3 months) complication rate was 2.3% (1/43), while long-term morbidity was 0. All cases in the pure endoscopic group had chemotherapy with/without radiation therapy. Long-term follow-up results showed that all cases were cured or had progression free survival (PFS). In the craniotomy group, 2 cases (2/16) developed intra-cranial hemorrhage after surgery, and had to be operated again for hematoma evacuation. In the craniotomy group, the short-term ( < 3 months) morbidity rate was 6/16. At 3 months follow-up, 1 case still had homonymous hemianopia, which made the long-term morbidity rate was 1/16.

CONCLUSIONSFor pineal region tumors with non-communicating hydrocephalus, simultaneous ETV with tumor biopsy can be the most favorable initial diagnostic and therapeutic treatment. Second-stage treatment (chemotherapy, radiation therapy, or craniotomy with tumor resection) can be selected according to the histological diagnosis.

Adolescent ; Adult ; Brain Neoplasms ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Hydrocephalus ; pathology ; Infant ; Male ; Middle Aged ; Pineal Gland ; Pinealoma ; surgery ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Ventriculostomy ; Young Adult

OBJECTIVE: To improve recognization of clinical, imaging and pathological characteristics of basal cell adenoma (BCA) of parotid gland. METHOD: We collected and analyzed the data of the clinical manifestation, imaging features, histological and immunohistochemical characteristics of BCA of parotid gland (n = 9). RESULTS: Among 9 patients, 2 male, 7 female, and the average age was 55.2 (from 34 to 66 years). The clinical manifestation showed the painless mass in the parotid region. Seven cases underwent CT and other 2 cases underwent MRI. Imaging showed all tumors were located in the superficial lobe, roughly spherical and non-lobulated in shape, with well-defined boundary. The maximal diameter was less than 30 mm. Seven cases showed slightly high density shadow of soft tissue on plain CT. Compared with the parotid signal intensity, two cases showed hypointensity on T1WI and high signal on T2WI. All lesions showed obvious enhancement on delayed contrast CT or MRI. Cystic changes occurred in two cases. Gross observation: the tumors were solid in section, grey, medium in nature and clear with the surrounding tissues. Cystic changes occurred in the superficial region of superficial lobe of two cases. The capsule of tumor was well circumscribed in 8 cases and focally involved in another case. Microscopy: The parenchyma of BCA was mainly composed of basaloid cells, with myoepithelial cells palisading at the periphery of the epithelial nests. Basal membrane separated the parenchyma from the stromal, the latter lacking the myxochondroid matrix. Immunohistochemistry: basaloid cells were positive for CKpan, CD117 and CKL, while myoepithelial cells were positive for P63, SMA, and calponin. The Ki-67 lablel ing index of tumour cell was 0-4%. All patients performed superficial lobe parotidectomy and tumor dissection, and they recovered well postoperatively without tumor recurrence or malignancy. CONCLUSION The BCA of parotid gland has distinctive imaging and pathological features with favourable postoperative prognosis.
Adenoma ; pathology ; surgery ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Parotid Neoplasms ; pathology ; surgery

A case of a 67-years-old female with well-differentiated chondrosarcoma of the left lamina of the thyroid cartilage, cricoid cartilage and arytenoid cartilage is reported, in which a total arytenoidectomy and partial resection of the left thyroid cartilage and cricoid cartilage were performed. The postoperative course has been successful except for the existence of a tracheal stoma and slight hoarseness. There has been no evidence of recurrence or metastasis in 6 years of follow-up.
Aged ; Chondrosarcoma ; Female ; Humans ; Laryngeal Neoplasms