Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.

Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.

Objective:To analyze the impact of preoperative controlling nutritional status (CONUT) score on the prognosis of gallbladder cancer patients with curative resection.Methods:The clinical data of gallbladder cancer patients, treated at Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital from January 2016 to December 2023 were retrospectively analyzed. A total of 184 patients were enrolled in this study, including 84 males and 100 females, aged (67.6±9.5) years. Based on preoperative CONUT score, 184 patients were divided into the low-score group (0-3 points, n=138) and the high-score group (4-12 points, n=46). The clinicopathological features including age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion, postoperative T stage and postoperative hospital length of stay, were compared between two groups. Univariate and multivariate Cox regression analysis were performed to analyze the relationship between preoperative CONUT score and prognosis of gallbladder cancer patients with curative resection. Results:The age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion ratio, postoperative T stage and postoperative hospital length of stay in the high-score group were higher than those in the low-score group, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that high CONUT score (4-12 points) was associated with a higher risk of poor overall survival ( HR=1.932, 95% CI: 1.165-3.203, P=0.011) and poor recurrence-free survival ( HR=1.600, 95% CI: 1.002-2.554, P=0.049). Conclusion:CONUT score (4-12 points) is a risk factor for poor overall survival and recurrence-free survival. Assessment of the CONUT score is an important preoperative consideration.

Objective: To investigate the effect of intraarticular hemorrhage on extending knee joint contracture model in rats . Methods: 18 mature male SD rats were divided into 3 groups by random number table method . The control group ( group C) was not immobilized and was killed after 4 weeks of feeding . In the simple fixation group( M1 group) , the left lower limb knee joint was immobilized in straight position for 4 weeks . The blood fixationgroup (M2 group) was injected into the knee cavity with body blood and immobilized in a straight position for 4 weeks . The knee joint motion of each group was measured by the joint motion measuring instrument under a stand⁃ard torque . The contracture degree was calculated by the joint range of motion of the knee joint before and after muscles separation . HE staining and Masson staining were used to detect the number of cells and collagen deposi⁃tion in the anterior joint capsule . The protein expressions of transforming growth factor 1 (TGF⁃ β1) , wingless⁃type MMTV integration site family , member 1 ( Wnt1) and beta⁃catenin ( β⁃catenin) in the anterior articular capsule were detected by Western blotting . Results: Compared with group C , total knee contracture and arthrogenic con⁃tracture of rats in M1 and M2 groups increased , and the difference was statistically significant (P < 0. 05) . At the same time , the degree of total contracture and arthrogenic contracture in M2 group was higher than that in M1 group , and the difference was statistically significant (P < 0. 05) . Compared with group C , the number of anterior joint capsule cells and collagen deposition in M1 and M2 groups increased , and the difference was statistically sig⁃group were higher than those in M1 group , and the difference was statistically significant (P < 0. 05) . Compared with group C , the protein expressions of TGF⁃ β1 , Wnt1 and β ⁃catenin in the anterior articular capsule of rats in M1 expressions of TGF⁃ β1 , Wnt1 and β ⁃catenin in the anterior articular capsule of the knee joint in M2 group were sig⁃nificantly higher than those in M1 group , with statistical significance (P < 0. 05) . Conclusion Joint immobiliza⁃ tion can lead to joint contracture , and joint bleeding aggravates the degree of joint capsule fibrosis induced by im⁃mobilization .

Objective:To analyze the impact of preoperative controlling nutritional status (CONUT) score on the prognosis of gallbladder cancer patients with curative resection.Methods:The clinical data of gallbladder cancer patients, treated at Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital from January 2016 to December 2023 were retrospectively analyzed. A total of 184 patients were enrolled in this study, including 84 males and 100 females, aged (67.6±9.5) years. Based on preoperative CONUT score, 184 patients were divided into the low-score group (0-3 points, n=138) and the high-score group (4-12 points, n=46). The clinicopathological features including age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion, postoperative T stage and postoperative hospital length of stay, were compared between two groups. Univariate and multivariate Cox regression analysis were performed to analyze the relationship between preoperative CONUT score and prognosis of gallbladder cancer patients with curative resection. Results:The age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion ratio, postoperative T stage and postoperative hospital length of stay in the high-score group were higher than those in the low-score group, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that high CONUT score (4-12 points) was associated with a higher risk of poor overall survival ( HR=1.932, 95% CI: 1.165-3.203, P=0.011) and poor recurrence-free survival ( HR=1.600, 95% CI: 1.002-2.554, P=0.049). Conclusion:CONUT score (4-12 points) is a risk factor for poor overall survival and recurrence-free survival. Assessment of the CONUT score is an important preoperative consideration.

Objective:To summarise and analyse the experience in the diagnosis and management of abdominal aortic endograft infection in recent years.Methods:Retrospectively summarised and analysed the general data, clinical presentation, laboratory and imaging findings, causative organisms and treatment choices of 14 patients with abdominal aortic endograft infection treated in Beijing Friendship Hospital, Capital Medical University, from January 2018 to June 2024, and analysed the prognosis of the patients and the risk factors associated with prognosis.Results:Positive bacterial cultures were 10 out of 14 patients. One non-operatively treated patient died of infectious toxic shock. Thirteen surgically treated patients underwent axillary-bifemoral artery bypass, removal of the infected stent, and closure of the aortic stump. Four of the 13 cases had combined aortoenteric fistula, 3 cases underwent one-stage enterocutaneous fistula repair, 1 case only fistula drainage, 3 cases of gastrojejunal anastomosis, all of them underwent gastric or jejunal nutrient tube implantation. Two of the 13 patients had combined the infection foci spread to the renal artery openings. To save the kidney, intraoperative left kidney autologous renal transplantation was performed in 1 case, and autologous saphenous vein reconstruction from celiac trunk artery-left renal artery and superior mesenteric artery-right renal artery was performed in the other case. All 14 patients were retrospectively summarised and followed up in August 2024, with 5 deaths in the early postoperative period (< 3 months), 3 deaths in the mid- to long-term period (≥3 months), and 5 survivors, with a median follow-up time of 2 years (1-5 years) for surviving patients. Among the 13 operated patients, 4 cases were combined with aortoenteric fistula, and 3 cases died in the early postoperative period; 4 cases of abdominal aortic infection foci involving renal artery openings, 2 cases of early postoperative death; 4 cases with pleural effusion, 4 cases died in the early postoperative period; 2 cases of combined creatinine elevation, 2 cases of early postoperative death; 2 cases of postoperative infection of artificial blood vessels.Conclusions:Abdominal aortic endograft infection are aggressive. The risk of early death is increased in patients who are elderly, in poor general condition, with aortoenteric fistula or with pre-existing cardiac, pulmonary, hepatic and renal insufficiency, but surgery based on adequate anti-infective therapy remains an effective means of saving the patient′s life.

Objective To explore the correlation between clinical distribution characteristics of streptococcal pharyngitis in children and seasonal variations in Ziyang area, so as to provide basis for disease prevention and control. Methods A multistage and stratified random sampling technique was used to investigate 583 children with streptococcal pharyngitis attending Ziyang first people's Hospital from January 2022 to January 2023. The clinical data were recorded. The pharyngeal specimens were cultured for streptococci test. The number of streptococcal pharyngitis cases per season was counted. The metereological conditions (average barometric pressure, temperature, rainfall, and wind speed) were recorded. Pearson method was used to discuss the correlation between metereological factors and streptococcal pharyngitis onset. Results A total of the 583 children, 329 were male and 254 were female. The main age of onset was 7-12 years old, with a total of 227 cases (38.94%), followed by 199 cases (34.13%) aged 3-6 years old, 126 cases (21.61%) aged 1-2 years old, and 31 cases (5.32%) under 1 year old. A total of 614 strains of pathogenic bacteria were detected, of which 479 strains of Streptococcus hemolyticus were dominant, accounting for 78.01%, followed by 175 strains of Streptococcus pyogenes, accounting for 28.50%. Seasonally, 192 cases of streptococcal pharyngitis occurred in spring, 51 in summer, 72 in autumn and 268 in winter. In Ziyang, spring and winter were characterized by high mean wind speeds and barometric pressure, while summer and autumn were characterized by high mean temperatures and heavy rainfall. Pearson correlation analysis revealed that the prevalence rate streptococcal pharyngitis was positively correlated with average wind speed and barometric pressure (P<0.05), and negatively correlated with mean temperature and rainfall (P<0.05). Conclusion In Ziyang, streptococcal pharyngitis occurs mostly in children over 5 years old, and the main pathogen is Streptococcus hemolyticus. The onset of the disease is mostly in spring and winter, which is closely related to the seasonal variations of the region.

Objective:To compare the clinicopathological features between patients with gallbladder adenosquamous carcinoma and gallbladder adenocarcinoma, and analyze the prognostic factors for overall survival.Methods:The clinical data of 135 patients with gallbladder cancer, confirmed by postoperative pathology, treated in Department of Hepatobiliary and Pancreatic Surgery of Ningbo Medical Center Lihuili Hospital within 5 years (from January 2018 to December 2022) were retrospectively analyzed. A total of 122 patients were enrolled in this study, including 55 males and 67 females, aged (68.0±9.8) years. Patients were divided into the adenosquamous carcinoma group ( n=14) and adenocarcinoma group ( n=108). The clinicopathological features (tumor size, differentiation of tumor, tumor TNM stage) and survivals of patients were compared. The survival rates were analyzed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was performed to identify prognostic factors for overall survival. Results:Compared with the adenocarcinoma group, patients with adenosquamous carcinoma had a larger tumor size, higher incidence of liver invasion, higher proportion of poor differentiation of tumor, higher proportion of TNM stage Ⅲ-Ⅳ (all P<0.05). There was also a statistically significant difference in the extent of liver resection between the two groups ( χ2=9.22, P=0.016). The 1- and 2-year cumulative survival rates after surgery in adenosquamous carcinoma group were 28.6% and 9.5%, respectively, lower than those in adenocarcinoma group (78.7% and 60.5%, respectively; χ2=27.88, P<0.001). For patients with gallbladder adenosquamous carcinoma, the cumulative survival rate of patients who received postoperative adjuvant chemotherapy ( n=11) was significantly better than that of patients without postoperative adjuvant chemotherapy ( n=3) ( χ2=5.82, P=0.016). For patients with gallbladder adenocarcinoma, multivariate Cox regression analysis identified that the N stage (N 1/N 0HR=4.521, 95% CI: 1.399-14.612, P=0.012; N 2/N 0HR=8.644, 95% CI: 2.407-31.039, P=0.001) and M stage (M 1/M 0HR=4.699, 95% CI: 1.540-14.340, P=0.007) were associated with a poor survival. Conclusions:Compared to gallbladder adenocarcinoma, adenosquamous carcinoma had more aggressive features and a worse prognosis. For patients with gallbladder adenosquamous carcinoma, postoperative adjuvant chemotherapy was associated with an improved overall survival. For patients with gallbladder adenocarcinoma, N stage and M stage were independent risk factors for overall survival.

BACKGROUND:Previous animal studies have shown that riluzole can inhibit neuroinflammatory response after spinal cord injury and promote functional recovery in injured rats,but the study on whether it can regulate the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome in the acute stage is lacking. OBJECTIVE:To observe whether riluzole can reduce microglial pyroptosis and promote functional recovery after spinal cord injury by modulating NLRP3 inflammasome through animal experiments,histological experiments and molecular biology experiments. METHODS:Female SD rats were divided into sham operation,model and riluzole groups,with 12 rats in each group.In addition to the sham operation group,T10 spinal cord injury was conducted in rats.The model group was treated with intraperitoneal administration of riluzole with solvent cyclodextrin.The riluzole group was treated with a 4 mg/kg dose of riluzole injection.The effect of riluzole on motor function recovery was assessed using the BBB score and inclined plane test.The recovery of sensory-evoked potential and motor-evoked potential was measured by electrophysiology.Hematoxylin-eosin staining was used to evaluate spinal cord tissue repair.The regulatory effects of riluzole on NLRP3,Caspase-1 and gasdermin D protein expression in spinal cord tissues were detected by western blot assay.ELISA was utilized to detect the expression levels of inflammatory factors interleukin-1β and interleukin-18.The effects of riluzole on the expression of NLRP3,Caspase-1,gasdermin D and interleukin-1β in microglial cells of the injured spinal cord were determined by immunofluorescence staining. RESULTS AND CONCLUSION:(1)At 35 days after spinal cord injury,BBB score and inclined plane test score in the riluzole group were higher than those in the model group(P<0.05).(2)At 3 days after spinal cord injury,the protein expressions of NLRP3,cleaved Caspase-1,gasdermin D-N(N-terminal domain),interleukin-1β,and interleukin-18 in the spinal cord homogenate of the riluzole group were significantly lower than those of the model group(P<0.05).(3)At 3 days after spinal cord injury,the fluorescence intensity of NLRP3,Caspase-1,gasdermin D and interleukin-1β in the riluzole group was significantly lower than that in the model group(P<0.05).(4)At day 35 after spinal cord injury,hematoxylin-eosin staining showed that the area of spinal cord injury in the riluzole group was smaller than that in the model group.Electrophysiological tests showed that the latency periods of sensory-evoked potential and motor-evoked potential in the riluzole group were shorter than those in the model group,and the latency period of wave amplitude in the riluzole group was higher than that in the model group.(5)These results suggest that riluzole can promote the repair of injured spinal cord tissue,promote the repair of nerve conduction function,and further promote the recovery of motor function in rats with spinal cord injury,which may be achieved through the regulation of NLRP3 inflammasome and the reduction of microglial pyroptosis.

BACKGROUND:Neuroinflammation is an important factor leading to secondary spinal cord injury,and microglia/macrophage pyroptosis is a significant part of post-spinal cord injury neuroinflammation.Studies have shown that microglia/macrophage undergoes pyroptosis after spinal cord injury,but the regulatory mechanism of circular RNA(circRNA)in microglia/macrophage pyroptosis after spinal cord injury remains unclear. OBJECTIVE:To investigate the role and mechanism of circRNA0005512 in regulating microglia/macrophage pyroptosis after spinal cord injury. METHODS:Female Wistar rats were divided into sham group and spinal cord injury group.Motor function was evaluated using the Basso,Beattie,and Bresnahan(BBB)scale.Cavity volume was assessed by hematoxylin-eosin staining.Differential expression of circRNA in spinal cord tissue was screened using RNA-sequencing and circ0005512 was validated by real-time PCR.Immunofluorescence,western blot assay,ELISA,and real-time PCR were performed to detect cell pyroptosis in the rats and lipopolysaccharide-induced microglial cell line HAPI cell models.Gene knockdown was used to confirm the regulatory role of circRNA0005512 in microglia/macrophage pyroptosis. RESULTS AND CONCLUSION:(1)Seven days after spinal cord injury,evident cavities were observed at the injury site.Immediately after spinal cord injury,the motor function of rats was completely lost.Over time,the motor function of rats in the spinal cord injury group gradually partially recovered,and there was a significant difference in BBB scores compared to the sham group.(2)Circ0005512 was significantly upregulated according to the results of the RNA-sequencing and confirmed in both the animal and cell models.(3)Immunofluorescence,western blot assay,real-time PCR,and ELISA confirmed the significant upregulation of cell pyroptosis markers(NLRP3,GSDMD,and caspase-1)in spinal cord injury tissue and lipopolysaccharide-induced HAPI cells.(4)In the cell model,knockdown of circ0005512 resulted in significantly decreased levels of cell pyroptosis marker-NLRP3.(5)The results above indicate that circ0005512 promotes pyroptosis in microglia/macrophages after spinal cord injury.