Adrenocortical carcinoma(ACC)is the most prevalent malignant tumor of the adrenal gland and is characterized by a poor pro-gnosis in its advanced stages.Surgical resection of the tumors is typically limited to patients diagnosed in the clinical stages Ⅰ and Ⅱ,lead-ing to a high postoperative recurrence rate.The combination of mitotane(M)with etoposide(E),doxorubicin(D),and cisplatin(P)(EDP-M)is currently the only approved first-line treatment regimen for advanced ACC.However,the efficacy of chemotherapy and radiation therapy in ACC remains limited.If the EDP-M regimen proves ineffective,there are no standardized or universally accepted second-line systemic treat-ment alternatives.Research advancements in the molecular mechanisms of ACC in recent years has led to increasing investigations on tyr-osine kinase inhibitors(TKIs)targeting EGFR,VEGFR,and mTOR,as well as immune checkpoint inhibitors(ICIs).Moreover,previous studies have identified mutations in CTNBB1,TP53,KDM5A,CENP-H,and other genes that may serve as therapeutic targets or biomarkers,thereby expanding the treatment options available for ACC.ICIs are effective against diverse cancer types,including non-small cell lung cancer(NSCLC),liver cancer,renal cell cancer,and urothelial cancer.Ongoing exploration into targeted therapies and immunotherapy,especially combination treatments,holds the promise of extending the survival of patients and enhancing their quality of life.

Myelin-forming oligodendrocytes in the central nervous system (CNS) and Schwann cells in the peripheral nervous system (PNS) are essential for structural and functional homeostasis of nervous tissue. Albeit with certain similarities, the regulation of CNS and PNS myelination is executed differently. Recent advances highlight the coordinated regulation of oligodendrocyte myelination by amino-acid sensing and growth factor signaling pathways. In this review, we discuss novel insights into the understanding of differential regulation of oligodendrocyte and Schwann cell biology in CNS and PNS myelination, with particular focus on the roles of growth factor-stimulated RHEB-mTORC1 and GATOR2-mediated amino-acid sensing/signaling pathways. We also discuss recent progress on the metabolic regulation of oligodendrocytes and Schwann cells and the impact of their dysfunction on neuronal function and disease.
Amino Acids ; Myelin Sheath/metabolism* ; Schwann Cells/metabolism* ; Oligodendroglia/metabolism* ; Signal Transduction ; Intercellular Signaling Peptides and Proteins/metabolism*

A 53-year-old female patient with multiple metastases of colon cancer was treated with regorafenib 120 mg/d orally (21 days of medication and 7 days of withdrawal was defined as 1 cycle). On the 7th day of regorafenib treatment, the patient developed intermittent pain in the right upper abdomen and waist, which was gradually aggravated. After 20 days of waist pain, renal ultrasound and abdominal CT examination showed a right perirenal subcapsular hematoma and laboratory tests showed hemoglobin 99 g/L and normal coagulation function. Spontaneous perinephric hematoma due to regorafenib was considered. Regorafenib was discontinued, the patient was instructed to stay in bed, and hemostasis and rehydration therapy was given. After 11 days of drug withdrawal, the patient′s lumbar pain was improved and hemoglobin returned to 102 g/L. After 2 months of drug withdrawal, abdominal ultrasound showed that the right perirenal hematoma was reduced and hemoglobin returned to normal.

A 53-year-old female patient with multiple metastases of colon cancer was treated with regorafenib 120 mg/d orally (21 days of medication and 7 days of withdrawal was defined as 1 cycle). On the 7th day of regorafenib treatment, the patient developed intermittent pain in the right upper abdomen and waist, which was gradually aggravated. After 20 days of waist pain, renal ultrasound and abdominal CT examination showed a right perirenal subcapsular hematoma and laboratory tests showed hemoglobin 99 g/L and normal coagulation function. Spontaneous perinephric hematoma due to regorafenib was considered. Regorafenib was discontinued, the patient was instructed to stay in bed, and hemostasis and rehydration therapy was given. After 11 days of drug withdrawal, the patient′s lumbar pain was improved and hemoglobin returned to 102 g/L. After 2 months of drug withdrawal, abdominal ultrasound showed that the right perirenal hematoma was reduced and hemoglobin returned to normal.

Objective:To understand the current status of mental resilience of patients undergoing hysteroscopy and its influencing factors so as to provide guidance for clinical health education.Methods:By the convenient sampling method, patients who underwent hysteroscopy in the gynecological clinic in a ClassⅢGradeA hospital in Jiaozuo from January to June 2019 were selected as research objects. Connor-Davidson Resilience Scale (CD-RISC) , Perceived Social Support Scale (PSSS) and General Data Questionnaires were used to conduct survey to explore the current status of mental resilience of patients undergoing hysteroscopy and its influencing factors. This study retrieved 157 valid questionnaires.Results:The score of CD-RISC in 157 patients undergoing hysteroscopy was (58.20±27.45) , with a minimum of 16 points and a maximum of 107 points. There were statistically significant differences in the total scores of CD-RISC among patients of different ages, education background and residential area who underwent hysteroscopy ( P<0.05) . The correlation analysis showed that the level of mental resilience of patients undergoing hysteroscopy was positively correlated with the score of social support ( P<0.05) . Multiple linear regression analysis showed that age, education background, living area, family support were the main factors influencing the mental resilience of patients undergoing hysteroscopy ( P<0.05) . Conclusions:The mental resilience of patients undergoing hysteroscopy is relatively poor. Age of patients, educational background of patients, living area, family support are the important factors affecting mental resilience. Targeted disease education and psychological counseling should be carried out for different groups. Multiple channels and diversified ways should be adopted to strengthen social support so as to improve mental resilience of patients, enable them to cope with the disease in a positive way and promote recovery.

Objective To report 1 case with pancreatic cancer after chemotherapy infected by influenza B virus, and complicated with atrial fibrillation, pulmonary infection. Methods Clinical data, treatment, outcome of this case were reviewed and the nursing emphasis was summarized. Results Through active treatment and nursing, with cured influenza, successful cardioversion of atrial fibrillation and controlled lung infection, the patient was transferred to general hospital to treat basic disease. During hospitalization, none infection occurred among medical staff and caregivers. Conclusions Key points of nursing of patient with pancreatic cancer after chemotherapy complicated with influenza B include disease observation of atrial fibrillation, lung infection and influenza B virus infection, nutritional status improvement, skin care, psychological care for patients and care-givers, disinfection and isolation to influenza B virus infection, and staff self-protection.

Objective To investigate the effects of hyperbaric oxygen (HBO on the expressions of endothelin-1 (ET-1),endothelial nitric oxide synthase (eNOS)and endothelin A receptor(ETAR) in cerebral circulation blood vessel in the rabbit model of cerebral ischemia.Methods Forty healthy adult New Zealand rabbits were randomly divided into 2 groups;the surgical group (n =30) and the control group (n =10).The rabbits in the surgical group were further divided into the HBO + cerebral ischemia group (n =15) and the simple cerebral ischemia group (n =15) in accordance with different treatment methods.In the surgical group,cerebral ischemia model was established by thread embolus method.The HBO + cerebral ischemia group was exposed to HBO at a pressure of 0.22 MPa(2.2 ATA)for 60 minutes,one session a day,for a succession of 3 days.In the sham surgical group,neck vessel was only separated and the incision was soon sutured.The animals in the sham surgical group and the cerebral ischemia group did not receive HBO exposure,had normal diet and left there intact for 3 days.Three days later,all the animals were sacrificed,and then immunohistochemical staining was performed by using ET-1,ETAR and eNOS antibodies,and observations were made on the expressions of ET-1,eNOS and ETAR in the internal carotid artery and basilar artery of the 3 groups.Results Experimental results indicated that there were expressions of ET-1,eNOS and ETAR in the internal carotid artery and basilar artery after HBO exposure.As compared with those of the sham surgical group and the cerebral ischemia group,the expression levels of ET-1 and ETAR in the internal carotid artery (51.6 ± 2.1,53.4 ± 1.5) of the HBO + cerebral ischemia group were obviously higher than those in the basilar artery (20.3 ± 2.6,24.3 ± 1.7),and eNOS expression level in the basilar artery (52.1 ± 2.3) was significantly higher than that in the internal carotid artery(22.3 ± 1.2).Conclusions HBO exposure could enhance ET-1 and ETAR expression levels in the internal carotid artery,and could improve eNOS expression in basilar artery,resulting in anterior circulation contraction and posterior circulation dilation.

Objective To investigate the effects of hyperbaric oxygen (HBO on the expressions of endothelin-1 (ET-1),endothelial nitric oxide synthase (eNOS)and endothelin A receptor(ETAR) in cerebral circulation blood vessel in the rabbit model of cerebral ischemia.Methods Forty healthy adult New Zealand rabbits were randomly divided into 2 groups;the surgical group (n =30) and the control group (n =10).The rabbits in the surgical group were further divided into the HBO + cerebral ischemia group (n =15) and the simple cerebral ischemia group (n =15) in accordance with different treatment methods.In the surgical group,cerebral ischemia model was established by thread embolus method.The HBO + cerebral ischemia group was exposed to HBO at a pressure of 0.22 MPa(2.2 ATA)for 60 minutes,one session a day,for a succession of 3 days.In the sham surgical group,neck vessel was only separated and the incision was soon sutured.The animals in the sham surgical group and the cerebral ischemia group did not receive HBO exposure,had normal diet and left there intact for 3 days.Three days later,all the animals were sacrificed,and then immunohistochemical staining was performed by using ET-1,ETAR and eNOS antibodies,and observations were made on the expressions of ET-1,eNOS and ETAR in the internal carotid artery and basilar artery of the 3 groups.Results Experimental results indicated that there were expressions of ET-1,eNOS and ETAR in the internal carotid artery and basilar artery after HBO exposure.As compared with those of the sham surgical group and the cerebral ischemia group,the expression levels of ET-1 and ETAR in the internal carotid artery (51.6 ± 2.1,53.4 ± 1.5) of the HBO + cerebral ischemia group were obviously higher than those in the basilar artery (20.3 ± 2.6,24.3 ± 1.7),and eNOS expression level in the basilar artery (52.1 ± 2.3) was significantly higher than that in the internal carotid artery(22.3 ± 1.2).Conclusions HBO exposure could enhance ET-1 and ETAR expression levels in the internal carotid artery,and could improve eNOS expression in basilar artery,resulting in anterior circulation contraction and posterior circulation dilation.

Objective To investigate the establishment of focal cerebral ischemia model in rabbits with the improved suture method.Methods A total of 45 healthy and clean adult New Zealand rabbits were divided into either a sham operation group (n =5) or a model group (n =40) using random number table method before modeling,and the sex was not limited.The self-made head ends of 2-0 fishing lines dipped in paraffin were used as the sutures.The external carotid artery was cut and inserted into a intracranial artery through the internal carotid artery and blocked the origin of middle cerebral artery.The neurological function score was performed after 6 h.The neurological deficit scores ≥2 was successful modeling.The rabbits were killed by anesthesia.The brain slices were stained with 2％ 2,3,5-triphenyl tetrazolium chloride solution.The infarct foci were observed.The diameters of suture head and the depth of suture insertion were compared in the model rabbits with successful modeling,failure,and death in the model group.Results There were 40 rabbits in the model group,six of them died,including 4 died of subarachnoid hemorrhage within 4 h after operation,and 2 died from anesthetic accident.The mortality rate was 15.0％.Seven rabbits failed,mainly because of cerebral vasospasm and the insertion depth of suture was insufficient.Twenty-seven had successful modeling,and the success rate was 67.5％.All the rabbits in the sham operation group survived.The diameter of the suture head and insertion depth in the successful modeling rabbits were compared with the death and failure outcome in rabbits.The difference was statistically significant (diameter:0.52 ± 0.14 mm vs.0.45 ±0.40 mm and 0.58 ±0.17 mm;depth:5.49 ±0.17 cm vs.6.04 ± 0.11 cm and 4.26 ±0.30 cm;all P ＜ 0.05).Conclusions The improved suture method can successfully prepare the focal cerebral ischemia model of middle cerebral artery in rabbits.The method is simple.Its repeatability and practicability are better.

Objective To investigate the clinical features and pathogenesis of severe congenital neutropenia (SCN) by detecting the gene mutation of a SCN patient suspected by clinical diagnosis. Methods The intravenous anticoagulant and clin-ical data and laboratory results of this child were collected;the phagocyte and oxidation function of neutrophils were evaluated by flow cytometry;ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4 genes were screened by PCR amplification and sequencing. Results The neutrophil function of this patient was normal; sequencing results revealed no mutation occurred in ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4;and granulocyte colony-stimulating factor (G-CSF) can obviously enhance the level of neutrophils. Conclusion SCN is a kind of genetic heterogeneity syndrome associated with multiple gene mutations, gene diag-nosis will contribute to understanding of the pathogenesis of the disease and provide theoretical basis for treatment. Though more and more pathogenic genes were found to be connected with SCN, the cases of unknown mutation still account for a large proportion of this disease.