Objective:To investigate the clinicopathologic features of sarcomatoid carcinoma of the pancreas.Methods:The clinicopathological data of 7 cases with sarcomatoid carcinoma of the pancreas admitted in the Affiliated Lihuili Hospital of Ningbo University from September 2013 to August 2021 were retrospectively analyzed, including clinical manifestations, laboratory examination, imaging examination, pathological examination of tissue specimens, surgical methods and adjuvant treatments. Expressions of mesenchymal markers and epithelial markers in tumor tissues were determined by immunohistochemical staining.Results:Among the 7 cases of sarcomatoid carcinoma of the pancreas, there were 4 male and 3 female. The patient age ranged from 51 to 88 years old, and the mean age was 69 years old. All the patients underwent CT examimation before surgery. 3 tumors were located in the head, 3 in the body and 1 in the tail of the pancreas. CT examination also showed that 4 tumors were cystic solid and 3 were cystic. Six patients underwent radical surgery and one underwent partial resection for biopsy. Microscopically, the tumor was predominantly composed of sarcomatoid spindle-shaped cells. Immunohistochemical staining showed that the tumor expressed both mesenchymal markers vimentin and epithelial marker CK7, CK19, CK(pan) and CAM5.2. The overall prognosis of the patients was poor, 4 cases died within 1 year after surgery, and the other 3 cases survived without recurrence.Conclusions:The clinical manifestations of sarcomatoid carcinoma of the pancreas were not typical, but the pathological and immunohistochemical features are obvious and the prognosis is poor.

OBJECTIVE To explore the effects of pterostilbene （PTE） on wound healing in diabetic skin ulcer model rats and its mechanism. METHODS Ten SD rats were grouped into control group； after diabetic skin ulcer model of other rats was induced by giving high-fat and high-sugar diet+intraperitoneal injection of streptozotocin+cutting off the skin and subcutaneous tissue in the marked area of the back， model rats were randomly divided into model group， PTE low-dose group （40 mg/kg）， PTE high-dose group （80 mg/kg）， PTE high-dose+PP2 group （80 mg/kg PTE+2 mg/kg SRC inhibitor PP2）， with 10 rats in each group. On the second day after modeling， the rats in each drug group were intraperitoneally injected with corresponding drug solutions， while the rats in control group and model group were intraperitoneally injected with normal saline， once a day， for 14 consecutive days. The wound healing rate of rats in each group was measured on the 7th and 14th day of administration； the contents of interleukin-1β （IL-1β）， IL-6， tumor necrosis factor-α （TNF-α） and vascular endothelial growth factor （VEGF） in the serum of rats were detected； the pathological changes of wound granulation tissue were observed， and the expressions of SRC/mitogen-activated protein kinase kinase （MEK）/extracellular signal-regulated kinase （ERK） signaling pathway-related proteins in wound granulation tissue were detected. RESULTS Compared with control group， the wound healing rate， serum content of VEGF， the phosphorylation levels of SRC， MEK1/2 and ERK1/2 were decreased significantly （P＜0.05）， while serum contents of IL- 1β， IL-6 and TNF-α were increased significantly （P＜0.05）； there was obvious infiltration of inflammatory cells in the wound granulation tissue， and the number of new blood vessels decreased. Compared with model group， above indexes of PTE low-dose and high-dose groups were improved significantly （P＜0.05）， and the pathological injury of granulation tissue in wound was improved. PP2 significantly reversed the improvement effects of PTE on the above indexes （P＜0.05）. CONCLUSIONS PTE can promote the wound healing of diabetic skin ulcer model rats， the mechanism of which may be related to activating SRC/MEK/ERK signaling pathway.

Objective To evaluate the impact of customized rehabilitation exercise plans based on the results of cardiopulmonary exercise test(CPET)on cardiac function and prognosis in patients with chronic heart failure(CHF).Methods A total of 52 CHF patients admitted to Chengde Central Hospital from February 2020 to September 2021 were selected as the study subjects,and the patients were divided into observation group and control group according to the principle of randomized controlled study,with 26 cases in each group.The control group received rehabilitation treatment excluding exercise.The observation group was given routine rehabilitation treatment and high-intensity rehabilitation exercise plans based on CPET guidance.Above anaerobic threshold Δ50%power was exercise intensity,exercise time was 30 minutes/day,4 days/week,and intervention period was 12 weeks.Before and 12 weeks after intervention,CPET functional indicators,serum brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and 6-minute walking distance(6MWD)were measured.The Minnesota CHF quality of life questionnaire(LiHFe)was used to evaluate patient's quality of life,readmission rate and cardiogenic mortality within 1 year of follow-up,and univariate and multivariate Logistic regression analysis was used to analyze factors affecting readmission of CHF patients.Results ① Cardiopulmonary function indicators:there was no statistically significant difference in the anaerobic threshold,peak oxygen uptake,and peak oxygen pulse of CPET functional indicators before and after intervention in the control group,after intervention,the CPET functional indicators in the observation group were significantly higher than those before intervention,and the above indexes in the observation group were significantly higher than those of the control group[anaerobic threshold(mL·min-1·kg-1):10.77±1.40 vs.9.59±1.11,anaerobic threshold(%ped):78.95±11.39 vs.70.09±6.48,peak oxygen uptake(mL·min-1·kg-1):15.63±1.36 vs.14.27±1.72,peak oxygen uptake(%ped):72.42±6.91 vs.63.41±7.31,peak oxygen pulse(mL/order):11.38±1.29 vs.9.05±1.64,peak oxygen pulse(%ped):90.23±10.16 vs.80.53±6.73,all P＜0.05].②Serum indicators,cardiac function indicators,exercise ability indicators,and quality of life evaluation:there was no statistically significant difference in serum indicators BNP,cardiac function indicators LVEDD,LVEF,exercise ability indicators 6MWD,and quality of life LiHFe scores between the two groups before intervention.After intervention,BNP and LiHFe scores were significantly reduced compared with before intervention,while LVEF and 6MWD were both increased compared with before intervention,and the changes of the above indexes in the observation group were more significant than those in the control group[BNP(ng/L):313.25±77.91 vs.445.89±110.67,LVEF:0.41±0.08 vs.0.37±0.06,6MWD(m):495.62±91.35 vs.416.04±65.29,LiHFe score:23.27±6.02 vs.29.50±4.61,all P＜0.05].③ Prognostic follow-up:the readmission rate within 1 year in the observation group was significantly lower than that in the control group(23.08%vs.53.85%),and there was no statistically significant difference in the mortality rate of cardiogenic diseases between the two groups.④Logistic univariate analysis showed that hyperlipidemia,New York Heart Association(NYHA)grading,BNP,and rehabilitation exercise were factors that affect the prognosis of CHF patients[odds ratio(OR)and 95%confidence interval(95%CI)were 0.098(0.019-0.494),0.069(0.016-0.294),1.018(1.007-1.029),and 3.889(1.178-12.841),respectively,all P＜0.05].Multivariate analysis showed that after adjusting for other factors,hyperlipidemia,NYHA grading,and BNP were risk factors affecting the prognosis of CHF patients(OR and 95%CI were 0.068(0.007-0.687),0.048(0.005-0.415),1.016(1.002-1.030),respectively,with P＜0.05],the use of rehabilitation exercise therapy was a protective factor affecting the prognosis of CHF patients[OR and 95%CI were 11.179(1.135-10.124),P＜0.05].Receiver operator characteristic curve(ROC curve)analysis showed that hyperlipidemia,NYHA grading,BNP,rehabilitation exercise therapy,and combined testing all had predictive value for the patient's prognosis(all P＜0.05),and the prediction value of joint detection was the highest,with the area under the ROC curve(AUC)=0.984 and P = 0.000.Conclusion Developing a high-intensity individualized cardiac exercise rehabilitation plan under the guidance of CPET can help improve the cardiopulmonary function,cardiac function,and quality of life of CHF patients,which is of great benefit for improving the long-term prognosis of CHF patients and has high safety.

Multiple signaling pathways are involved in the regulation of cell proliferation and differentiation in odontogenesis and dental tissue renewal, but the details of these mechanisms remain unknown. Here, we investigated the expression patterns of a transcription factor, Krüppel-like factor 6 (KLF6), during the development of murine tooth germ and its function in odontoblastic differentiation. KLF6 was almost ubiquitously expressed in odontoblasts at various stages, and it was co-expressed with P21 (to varying degrees) in mouse dental germ. To determine the function of Klf6, overexpression and knockdown experiments were performed in a mouse dental papilla cell line (iMDP-3). Klf6 functioned as a promoter of odontoblastic differentiation and inhibited the proliferation and cell cycle progression of iMDP-3 through p21 upregulation. Dual-luciferase reporter assay and chromatin immunoprecipitation showed that Klf6 directly activates p21 transcription. Additionally, the in vivo study showed that KLF6 and P21 were also co-expressed in odontoblasts around the reparative dentin. In conclusion, Klf6 regulates the transcriptional activity of p21, thus promoting the cell proliferation to odontoblastic differentiation transition in vitro. This study provides a theoretical basis for odontoblast differentiation and the formation of reparative dentine regeneration.
Animals ; Cell Differentiation/physiology* ; Cell Proliferation ; Mice ; Odontoblasts/metabolism* ; Odontogenesis ; Tooth Germ

Objective: This systematic review and meta-analysis was undertaken to evaluate the efficacy of antibacterial photodynamic therapy (aPDT) in the treatment of periodontitis in type-2 diabetes mellitus (T2DM) patients and to provide better treatment for patients with T2DM complicated with periodontitis. Methods: The PubMed, Cochrane, Embase, Web of Science, CNKI, CBM, and Wanfang databases were searched for relevant randomized controlled trials (RCTs). RevMan 5.3 was applied for the meta-analysis, and a systematic evaluation was conducted. Results: A total of 8 RCTs were included. The results showed that compared to simple subgingival scaling and root planing (SRP), aPDT assisted SRP had a better effect on improving the probing depth (PD) at 3 months after treatment, The difference was statistically significant [WMD=-0.32,95%CI（-0.45, -0.2）, P < 0.05], but 6 months after treatment, there was no significant difference in the two groups [ WMD=-0.15,95%CI（-0.40, 0.10）,P=0.23]. During the 6-month follow-up period, there were no significant differences in the clinical attachment level (CAL), bleeding on probing (BOP) or hemoglobin A1c (HbA1c) between the two groups (P> 0.05). Conclusion aPDT-assisted periodontal nonsurgical treatment in T2DM patients can improve PD in the short term but has no significant effect on the improvement of CAL, BOP and HbA1c.

Objective:To explore the effect of extracorporeal membrane oxygenation(ECMO)upon supporting during bilateral lung transplantation(BLTx)for different primary diseases.Methods:The clinical data were retrospectively analyzed for 139 cases of BLTx. They were divided into non-ECMO and ECMO groups. The perieoperative data of two groups were compared.Results:BLTx was successfully performed in all patients. As compared with non-ECMO group, operative duration, mechanical ventilation time and ICU hospitalization time were significantly prolonged in ECMO group ( P<0.05). The proportion of patients with different primary diseases was statistically significant different between two groups( P<0.01). ECMO was employed intraoperatively in all IPAH patients. ECMO proportion was higher in idiopathic pulmonary fibrosis(IPF)patients but lower in chronic obstructive pulmonary disease(COPD)counterparts( P<0.05). In terms of cardiac function indices, patients with a moderate/severe elevation of pulmonary artery pressure had a higher proportion of ECMO application( P<0.001). Moreover, the application of ECMO increased with the severity of tricuspid regurgitation and pulmonary vascular resistance(PVR)( P<0.05). Conclusions:It is both safe and feasible to apply ECMO during BLTx. ECMO support should be given a high priority during BLTx for patients with primary diseases such as IPAH, IPF, severe preoperative PAP, tricuspid regurgitation and PVR. On the other hand, ECMO is sufficient as an alternative choice for COPD patients.

Objective To observe the clinical curative effect of Ginger Vinegar Mud sticking on Shenque acupoint on postoperative nausea and vomiting (PONV) aftertotal hip/knee arthroplasty (THA/TKA), which can provide the basis for application of Ginger Vinegar Mud treatment. Methods A total of 80 patients who used the general anesthesia, were chosen according to the stochastic indicator method. They were divided into the experimental group and the control group with 40 cases in each group.The patients in both groups were given routine drug treatment and nursing according to the THA/TKA clinical pathway, based on this, the experimental group used Ginger Vinegar Mud to stick Shenque acupoint, while the control group was given dressings of the same appearance. The incidence of PONV was recorded 0-8 h, 9-12 h,13-24 h after surgery respectively. Results The incidence of nausea and vomiting in the experimental group 0-8 h was 25%(10/40), 15%(6/40),9-12 h was 20%(8/40), 10%(4/40),13-24 h was 10%(4/40), 0. While in the control group, they were 55%(22/40), 30%(12/40);40%(16/40), 25%(10/40); 30% (12/40) and 15%(6/40) respectively. The difference between the two groups was statistically significant (χ2 =58.23-80.23, P<0.05). Conclusions Using Ginger Vinegar Mud to stick Shenque acupoint can reduce the incidence rate of PONV under general anesthesia, the effect is distinct and this method is worthy of clinical promotion.

Objective To study the long-term efficacy of bladder pressure expansion and perfusion therapy by bladder hydraulic expansion with alkalify lidocaine,heparin,dexamethasone for the treatment of ketamine correlation cystitis Methods From January 2008 to September 2011,the data from 19 male and 3 female patients,who were diagnosed as ketamine-associated cystitis was retrospectively analyzed.The mean age was (26 ± 5)years old.All patients accepted bladder pressure expansion under the spinal and epidural anesthesia.After expansion,the silicon three-channel catheters were left in those patients.2％ lidocaine (20 ml) and 5％ bicarbonate (10 ml) was perfused into the bladder.Meanwhile,the heparin (2.5 U) and dexamethasone (10 mg) were added into the solution,as well.After perfusion,the catheter was clamped until the patient could not tolerate.The perfusion was performed three times every day for 5 days.The volume of urine was recorded each time.The OABSS score,urine volume,maximum urine flow rate,day and night urination frequency were followed within 5 years.And the data was compared with those preoperative and postoperative 1 week,1 month,3 months,6 months.Results 22 patients accepted the procedure successfully.No complications,such as fever or bladder rupture,occurred.At the end of 5 years,the bladder volume daily urinating frequency,night urinating frequency,maximal flow rate,OABSS score were (238.3 ± 37.3) ml,9.2 ± 2.3,2.1-± 1.3,(18.2 ± 8.3) ml/s,4.4-± 2.4,respectively.Compared to the one week and one month after the operation,those results have significant difference (P ＜ 0.01).Compared to the 3 months after the procedure,the bladder volume has significant difference [(238.3-± 37.3) ml vs.(158.3-± 18.3) ml,P ＜ 0.01].No significant differences were noticed in those items 6 months after the procedure (P ＞ 0.05).Conclusion The long-term efficacy of bladder pressure expansion with alkaline lidocaine,heparin and dexamethasone the anesthesia in the treatment of ketamine associated cystitis is good.The outcome is stable,and no obvious complications.

Objective To discuss the influence of Yin yoga for Ⅰ, Ⅱ knee osteoarthritis patients'quality of life and anxiety. Methods Divided 98 patients of Joint department outpatient service with joint specializes into the experimental group and the control group by random number method, there were 49 cases in each group, two group patients all have routine drug therapy that according to the guidelines of diagnosis and treatment of knee osteoarthritis in 2015,and accept the routine health education of orthopaedic. On the basis of this, the experimental group accept Yin yoga exercise training by a professional yoga teacher and nurse, they also followed up the two group of patients for 1 year. And adopting health questionnaire (SF-36) to assess the patient's quality of life on the same day, which they see the doctor ,3 months, 6 months, 12 months, they also use Self-evaluation of the anxiety scale (SAS) to assess the patient's anxiety. Results SAS scores before and after the intervention of patients in the experimental group was (57.14 ± 5.92) and (37.92 ± 3.07) points respectively, the difference was statistically significant (t=15.64, P<0.05), while the difference in the control group was not significant, (57.03 ± 6.18) points vs (53.18 ± 3.16) points , P > 0.05. Physiological function, physiological function, body pain, general health, energy, social function, emotional function, mental health of experimental group patients after 12 months intervention was (79.23 ± 9.15), (56.79 ± 13.20), (78.32 ± 10.15), (44.50 ± 11.92), (64.85 ± 9.72), (83.90 ± 11.61), (62.13 ± 18.72), (67.33 ± 8.50) points respectively, while in the control group was (70.22 ± 10.13), (32.12 ± 11.07), (60.14 ± 9.56), (39.40 ± 10.27), (48.66 ± 7.52), (67.62 ± 12.13), (43.23±14.89), (57.00±8.13) points respectively, the difference between the two groups was significant(t=3.18-15.54, P<0.05 or<0.01). Conclusions Yin yoga can improveⅠ,Ⅱknee osteoarthritis patients quality of life and all ease anxiety. The method is feasible.