ObjectiveTo investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients. MethodsBased on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke. ResultsThe Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea andα1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients. ConclusionElevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

Primary small cell carcinoma of esophagus(PSCCE)is a rare and highly aggressive neuroendocrine tumor,accounting for 0.05%to 3.1%of all esophageal malignancies.Its biological characteristics are similar to those of small cell lung cancer,with highly aggressive behavior and early dissemination tendency.It often metasta-sizes rapidly through lymphatic and hematogenous pathways.The prognosis is extremely poor,with a 5-year overall survival rate of less than 15%.There are no large-scale randomized controlled trials,and no standard treatment strategies have been established.In recent years,the treatment of limited-stage PSCCE has become a focal point of research.In traditional treatment paradigms,endoscopic therapy is feasible for very early-stage cases,while radical surgery serves as the primary approach for relatively early-stage patients.For locally advanced cases,two predominant treatment modalities are commonly employed in clinical practice:a surgery-based comprehensive treatment regimen and a radical chemoradiotherapy-centered therapeutic protocol,with no definitive conclusion yet reached regarding the optimal treatment strategy.Concurrently,emerging therapeutic strategies such as immuno-therapy and molecularly targeted therapy have demonstrated remarkable clinical efficacy,thereby providing novel therapeutic opportunities for limited-stage PSCCE.This article aims to review the recent advances in the treatment of limited-stage PSCCE,summarize the current diagnostic and therapeutic landscape,and outline future directions in this field.

Objective:To establish fingerprints of Faeces Bombycis and simultaneously determine the content of four amino acids; To evaluate the quality of Faeces Bombycis from different regions. The fingerprint of Faeces Bombycis was established and the contents of 4 amino acids were determined.Methods:Kromasil 100-5 C18 (4.6 mm×250 mm, 5 μm) column was used for phenyl isothiocyanate (PITC) pre-column derivation-high performance liquid chromatography with acetonitrile-0.1 mol/L sodium acetate solution (pH adjusted to 6.5 with acetic acid) (7:93) mixed solution, and acetonitrile-water (4:1) mixed solution were mobile phase for gradient elution. The flow rate was 1.0 ml/min; the column temperature was 35 ℃; the detection wavelength was 254 nm; the injection amount was 5 μl. The fingerprints of 17 batches of Faeces Bombycis were established, the common peaks were identified by comparison of reference materials, and the similarity evaluation and principal component analysis (PCA) were carried out. The contents of glycine, alanine, proline and phenylalanine were determined simultaneously.Results:A total of 12 common peaks were identified from the fingerprints of Faeces Bombycis, and 12 amino acids were identified. The similarity of 17 batches of samples was greater than 0.95. PCA analysis showed that the regional difference of the quality of Faeces Bombycis was not significant. Faeces Bombycis produced in Qujing city in Yunnan Province had the highest total contents of 4 amino acids.Conclusion:The method has good repeatability and can provide reference for the quality evaluation and standard improvement of Faeces Bombycis.

Primary small cell carcinoma of esophagus(PSCCE)is a rare and highly aggressive neuroendocrine tumor,accounting for 0.05%to 3.1%of all esophageal malignancies.Its biological characteristics are similar to those of small cell lung cancer,with highly aggressive behavior and early dissemination tendency.It often metasta-sizes rapidly through lymphatic and hematogenous pathways.The prognosis is extremely poor,with a 5-year overall survival rate of less than 15%.There are no large-scale randomized controlled trials,and no standard treatment strategies have been established.In recent years,the treatment of limited-stage PSCCE has become a focal point of research.In traditional treatment paradigms,endoscopic therapy is feasible for very early-stage cases,while radical surgery serves as the primary approach for relatively early-stage patients.For locally advanced cases,two predominant treatment modalities are commonly employed in clinical practice:a surgery-based comprehensive treatment regimen and a radical chemoradiotherapy-centered therapeutic protocol,with no definitive conclusion yet reached regarding the optimal treatment strategy.Concurrently,emerging therapeutic strategies such as immuno-therapy and molecularly targeted therapy have demonstrated remarkable clinical efficacy,thereby providing novel therapeutic opportunities for limited-stage PSCCE.This article aims to review the recent advances in the treatment of limited-stage PSCCE,summarize the current diagnostic and therapeutic landscape,and outline future directions in this field.

Objective:To investigate the utility of cardiac magnetic resonance (CMR) multiparametric imaging in the etiological and differential diagnoses of troponin increase with non-obstructive coronary arteries (TINOCA).Methods:A retrospective analysis was conducted on patients diagnosed with TINOCA and confirmed by coronary angiography in Dongguan Kanghua Hospital from January 2018 to June 2023. CMR examinations were performed within 7 days of onset. The examination sequences included "black blood" single-shot balanced turbo field echo with breath-hold, balanced turbo field echo with breath-hold, T 2-weighted short tau inversion recovery black blood, modified gradient and spin echo black blood with SENSE, dynamic balanced turbo field echo, and phase-sensitive inversion recovery [late gadolinium enhancement (LGE)]. Based on the imaging findings, patients were categorized into 4 groups: myocardial infarction with non-obstructive coronary arteries (MINOCA) group, acute myocarditis group, Takotsubo syndrome group, and CMR negative group. The observed indices included left ventricular function, myocardial edema, first perfusion, and LGE of contrast enhancement. The differences in these parameters among the aforementioned disease groups were statistically compared. The categorical data were analyzed between groups using the chi-square test or Fisher′s exact probability method. The data in line with normal distribution were statistically described by xˉ±s. The independent-sample t test was used to compare the means of the 2 samples. The data with skewed distribution were described by M ( Q1, Q3). The Mann-Whitney U test was used for intergroup analysis. Results:A total of 33 patients were enrolled in this study, the 4 groups comprised 14(42.4%), 12(36.4%), 0, and 7(21.2%) patients, respectively. The positive rate of CMR diagnosis was 78.8%. The onset age in the MINOCA group significantly differed from that in the acute myocarditis group ( Z=3.32, P=0.001). No significant differences were observed in left ventricular function, number of myocardial edema segments, and T 2 value of the diseased myocardium between the 2 groups ( P>0.05), but the number of abnormal first perfusion was significantly distinct ( P<0.001). Significant differences were observed in the quality and volume of LGE between the 2 groups ( P<0.05 for all). Conclusion:CMR multiparameteric imaging technology plays a unique role in the etiological diagnosis of TINOCA, accurately distinguishing TINOCA caused by MINOCA, acute myocarditis, and other cardiac causes.

{L-End}Objective To establish a method for the simultaneous determination of dimethyltin (DMT), trimethyltin (TMT), diethyltin (DET), and triethyltin (TET) in human whole blood using high performance liquid chromatography-inductively coupled plasma-mass spectrometry (ICP-MS). {L-End}Methods The 1.0 mL of blood was added with 4.0 mL 65% aqueous solution (containing 6% acetic acid), extracted and separated by C₄ column (150 mm×3 mm×3 μm) using a mobile phase of methanol and 4% acetic acid aqueous solution (containing 0.25 mmol/L tropolone) at a volume ratio of 35∶65, and detected by ICP-MS. {L-End}Results The linear range of DMT, TMT, DET, and TET was 30.60-550.80, 29.00-522.00, 46.10-829.80, and 34.05-612.90 μg/L, respectively. All correlation coefficients were 0.999. The detection limit of DMT, TMT, DET and TET was 21.40, 20.30, 32.27 and 23.80 μg/L, respectively. The recovery rate was 81.9%-104.9%. The within-run and between-run relative standard deviation was 1.6%-6.9% and 0.1%-10.0%, respectively. The samples can be stored at -20 ℃ and 4 ℃ for at least three days. {L-End}Conclusion This method can be used for trace analysis of DMT, TMT, DET, and TET in whole blood.

Objective:Pretibial myxedema (PTM) is a localized myxedema characterized by excessive dermal hya-luronan (HA) deposition and elevated serum TSH receptor antibody (TRAb). In this study, we investigated the effects of TRAb and its subtypes, stimulating antibody [TSAb (M22)] and inhibitory antibody[TBAb (K1-70)], on the synthesis of hyaluronic acid produced by PTM primary dermal fibroblasts.Methods:Normal and PTM dermal fibroblasts were isolated and stimulated with M22, K1-70, and IgG from patients respectively. HA concentration in the supernatant before and after stimulation was tested by ELISA. The protein level and phosphorylation variation of CEMIP, HAS2 and PI3K-AKT pathway were detected by Western blot.Results:IgG from patients (TRAb 8.4 IU/L) significantly stimulated the extracellular accumulation of HA in PTM primary fibroblasts. Similarly, both M22 and K1-70 also upregulated HA level in the supernatant, though K1-70 seemed much more effecitve. After treatment with IgG, M22, and K1-70, the expression of HAS2 increased and the expression of CEMIP decreased; meanwhile, p-PI3K and p-AkT increased. Among them, further study on K1-70, promoting HA production by regulating PI3K-AkT signal pathway could be inhibited by PI3K inhibitor (LY294002).Conclusion:TSAb (M22) and TBAb (K1-70), especially TBAb, increase HAS2 and inhibit CEMIP expression by activating PI3-AKT signaling pathway in PTM fibroblasts, leading to increased extracellular HA level.

OBJECTIVE: To explore the molecular basis for a child featuring with Floating-Harbor syndrome. METHODS: The 2-year-and-8-month-old child presented with retarded growth and language development. Genomic DNA was extracted from peripheral blood samples from the child and his parents with informed consent and subjected to whole exome sequencing. Suspected variants were verified by Sanger sequencing. Pathogenecity of the variants were predicted by using bioinformatic tools. RESULTS: The child was found to carry a de novo frameshift variant c.7273dupA (p. Thr2425Asnfs*18) in the SRCAP gene. The variant was unreported previously and predicted to be pathogenic by MutationTaster. Analysis using HomoloGene system and MEGA software indicated position 2425 of the SRCAP protein to be highly conserved. Substitution of amino acid (Thr) at this position may cause destruction of three AT-hook domains (Amino acid 2857-2869, 2936-2948 and 3004-3016) and serious damage to the function of SRCAP protein. CONCLUSION The patient's condition may be attributed to the de novo frameshift variant c.7273dupA (p. Thr2425Asnfs*18) of the SRCAP gene. Above finding can facilitate diagnosis of Floating-Harbor syndrome among Chinese population.

Objective:To investigate the clinical efficacy of neoadjuvant chemotherapy for the resectable locally advanced adenocarcinoma at the gastroesophageal junction.Methods:A retrospective cohort study was conducted to analyze 86 patients with resectable locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma at the gastroesophageal junction (T 3-4N +M 0) who were admitted to the Panzhihua Central Hospital of Sichuan Province from January 2013 to January 2016. All the patients were divided into the neoadjuvant chemotherapy group [preoperative XELOX regimen (oxaliplatin + capecitabine) adjuvant chemotherapy + surgery + postoperative XELOX regimen adjuvant chemotherapy, 46 cases] and non-neoadjuvant chemotherapy group (surgery + postoperative XELOX regimen adjuvant chemotherapy, 40 cases) according to whether neoadjuvant chemotherapy was performed before surgery. The total gastrectomy + Roux-en-Y esophagojejunostomy + D 2 lymphadenectomy or proximal subtotal gastrectomy + esophageal gastric remnant anastomosis + D 2 lymphadenectomy were applied to patients by the same team of doctors. The observation indicators included treatment situations, results of postoperative pathological examination and prognosis in the two groups. Results:In the neoadjuvant chemotherapy group, 25 patients (54.3%) had partial remission (PR), 21 patients (45.7%) had stable disease (SD), the clinical response rate was 54.3% (25/46), tumor control rate was 100.0% (46/46), and clinical stage reduction rate was 37.0% (17/46). Compared with the non-neoadjuvant chemotherapy group, the neoadjuvant chemotherapy group had a higher R 0 resection rate [100.0% (46/46) vs. 80.0% (32/40), χ2 = 4.024, P = 0.045], and in the neoadjuvant chemotherapy group, the pathological complete remission [tumor regression grade (TRG) 0] rate was 13.0% (6/46), and the overall pathological response (TRG 1 + TRG 0) rate was 56.5% (26/46). The postoperative pathological examination showed that the neoadjuvant chemotherapy group and the non-neoadjuvant chemotherapy group had statistically significant differences in the longest tumor diameter, vessel carcinoma embolus, perineural invasion, and pathological TNM staging (all P < 0.05). However, there was no statistical difference in the total humber of lymph nodes, the number of positive lymph nodes, pathological T stage, N stage, and human epidermal growth factor receptor 2 (HER2) expression in specimens (all P > 0.05). In the neoadjuvant chemotherapy group, 6 patients had grade 3 adverse reactions, and chemotherapy was suspended or the dose was adjusted. Adverse reactions in the blood system included the red blood cells reduction, white blood cells reduction and thrombocytopenia. Other adverse reactions included nausea, vomiting, and decreased appetite. There were no deaths related to radiotherapy. In the neoadjuvant chemotherapy group, the median tumor-free survival time was 20 months (5-36 months), and the 1-year and 3-year tumor-free survival rates were 89.5% and 52.4%, respectively; the median postoperative overall survival time was 20 months (9-36 months), and the 1-year and 3-year overall survival rates were 91.0% and 48.0%, respectively; 12 patients had tumor recurrence. In the non-neoadjuvant chemotherapy group, the median tumor-free survival time was 19 months (10-35 months), and the 1-year and 3-year tumor-free survival rates were 87.3% and 30.0%, respectively. The median postoperative overall survival time was 20 months (10-35 months), the 1-year and 3-year overall survival rates were 87.0% and 18.6%, respectively; 14 patients had tumor recurrence. There was a statistical difference in the tumor-free survival between the two groups ( χ2 = 4.522, P = 0.03), and there was no statistical difference in the overall survival between the two groups ( χ2 = 3.717, P > 0.05). Conclusions:XELOX regimen neoadjuvant chemotherapy is safe and effective for patients with resectable locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma at the gastroesophageal junction. It can decrease the tumor clinical stage and increase the R 0 resection rate and tumor-free survival rate.

Objective:To observe the effect that covering the nerve suture with CSPGs-gelatin sleeve after the sciatic nerve transection in SD rats, and evaluate its effect to improve nerve regeneration in peripheral nerve transection model.Methods:Covered and protected the sciatic nerve by end-to-end suture in the SD rats with CSPGs-gelatin sleeve. From July, 2019 to September, 2019, 24 SD rats were randomly and evenly divided into 3 groups, which were direct suture group, gelatin sleeve group without CSPGs (blank group), and CSPGs-gelatin sleeve group (CSPGs group). In each group, 3 rats were used to mark fluorescent gold at 5 weeks after operation. At 6 weeks after operation, histological and electrophysiological tests were performed to evaluate the tissue regeneration in the end to end suture and the effect of peripheral nerve regeneration after transection in the other 5 rats. One-way ANOVA was used for data analysis. If the difference between groups was statistically significant, LSD method would be further used for pairwise comparison. P<0.05 was considered statistically significant. Results:The escape distances in direct suture groups, blank group and CSPGs group groups were (787.19±213.77) μm, (547.17±167.71) μm and (350.60±68.58) μm, respectively; The numbers of the axons that grow into the distal basement membrane tube in 3 groups were (6 360±736.89) /mm 2, (8 040±673.05) /mm 2 and (9 000±644.20) /mm 2, respectively; The numbers of sensory nerve cells that were marked by fluorescent gold in the dorsal root ganglion were (124.35±25.88) /mm 2, (165.36±30.74) /mm 2 and (208.98±20.51) /mm 2 in 3 groups, respectively. The differences were significant compared with the CSPGs-gelatin sleeve group ( P<0.05). Thus, it led to a better nerve regeneration after transection in CSPGs-gelatin sleeve group according to the electrophysiological test and histological section observation of gastrocnemius muscles( P<0.05). Conclusion:CSPGs loaded in the gelatin sleeve can inhibit axons regeneration, and prevent the regenerated axons escaping from the end to end suture that may cause disorder axons regeneration or traumatic neuroma, and therefore improve the effective nerve regeneration after sciatic nerve injury in SD rat.