ObjectiveTo screen key genes associated with neuroblastoma （NB） diagnosis and prognosis using the Gene Expression Omnibus （GEO） database， and to investigate the expression and clinical significance of nucleoporin 93 （NUP93） in NB tissues. MethodsNB gene chip data （GSE73517， GSE49710， GSE19274） were retrieved from the GEO database. Differentially expressed genes （DEGs） commonly upregulated in high-risk groups were screened. The R2 database was then used to assess the prognostic value of DEGs that were commonly upregulated in the MYCN amplification group. Finally， NUP93 expression levels in the tissues from 60 NB， 25 ganglioneuroblastoma （GNB）， and 26 ganglioneuroma （GN） cases were measured by immunohistochemistry . ResultsTwenty-five DEGs were identified as commonly upregulated in high-risk groups. Among these， 10 genes （SIVA1， NUP93， STIP1， LSM4， RAI14， MYOZ3， KNTC1， TNFRSF10B， TACC3 and CEP152） showed significantly higher expression in MYCN-amplified subgroups （P＜0.05）. Survival analysis revealed that high NUP93 expression was associated with shorter overall survival （HR = 4.0， 95% CI： 3.0，5.3， P = 1.80 × 10⁻³⁴）. Immunohistochemistry results revealed that NUP93 expression in NB tissues was significantly higher than in GNB and GN tissues （P＜0.001）. NUP93 expression was positively correlated with high mitosis-karyorrhexis index （MKI； P=0.040）， poor differentiation （P＜0.001）， and MYCN expression （r_s = 0.793， P ＜0.001）. ConclusionsHigh expression of NUP93 is associated with high MKI and poor differentiation， and predicts unfavorable prognosis in patients with NB， suggesting it may promote tumor progression by regulating MYCN. NUP93 has the potential to be a novel diagnostic biomarker and therapeutic target for NB.

Objective:To compare the quality of sleep and rehabilitation after routine surgery versus day surgery in pediatric patients with snoring.Methods:This was a prospective study.Seventy pediatric patients with snoring, aged 4-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing adenoidectomy and/or tonsillectomy in the Guangzhou Women and Children′s Medical Center from March to June 2023, were divided into routine surgery group (group R) and day surgery group (group D), with 35 cases in each group. A sleep-detecting bracelet was used to monitor the sleep status. The proportion of deep sleep, light sleep and rapid eye movement, sleep continuity score and the maximum and minimum heart rate were recorded on the night before surgery, the first and second night after surgery. Rehabilitation was assessed using Quality of Recovery-15 at 1 day before surgery and 24 and 48 h and 28 days after surgery.Results:Compared with group R, the maximum heart rate at the night before surgery was significantly decreased, the proportion of light sleep on the second night after surgery was increased, the proportion of rapid eye movement sleep on the second night after surgery was decreased, the scores for items on " getting support from hospital doctors and nurses", " feeling comfortable and in control", and " having a feeling of general well-being" and the total score of Quality of Recovery-15 were significantly decreased at 24 and 48 h after operation, and the score for items on " feeling rested" and " have had a good sleep" at 48 h after surgery was decreased in group D ( P<0.05). Conclusions:Pediatric patients with snoring have poor quality of early sleep and rehabilitation after day surgery compared with routine surgery.

Hypercalcemia, a common metabolic complication of malignancies, often referred to as hypercalcemia of malignancy(HCM), is associated with a high incidence and mortality rate. In 2023, the American Society for Bone and Mineral Research and the European Society of Endocrinology released the Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. This guideline aimed to address key clinical issues related to adult HCM, refractory and recurrent hypercalcemia, hypercalcemia associated with calcitriol, and hypercalcemia caused by adult parathyroid cancer. This article provides an overview of this guideline and offers some suggestions for managing related conditions in China.

Objective: To analyze the clinicopathological characteristics and prognosis of diffuse midline glioma (DMG) with H3K27M mutation. Methods: Thirty cases of DMG were collected in Guangdong Sanjiu Brain Hospital from October 2016 to May 2018. The patients′ clinicopathological data including age, tumor site and histological grade, treatment and follow-up data were collected and analyzed. Results: There were 21 males and 9 females, with a mean age of 26 years (range 5-53 years). Fourteen tumors were located in thalamus, 12 in brainstem (one involved both thalamus and brainstem), and one each in hypothalamus, fourth ventricle, and sellar region, respectively. Two cases presented as diffuse intracranial lesions. Three cases (10.0%) were of WHO grade Ⅰ, 10 cases (33.3%) were grade Ⅱ, eight cases (26.7%) were grade Ⅲ, and nine cases (30.0%) were grade Ⅳ.All patients with gradeⅠ tumors were older than 20 years. Histologically, all were pilocytic astrocytoma-like. Immunohistochemical staining demonstrated that all tumors were IDH1 negative. Twenty-eight tumors showed diffuse expression of H3K27M, and two showed focal expression. Twenty-one tumors(100.0%, 21/21) showed absent expression of H3K27me3. Sixteen tumors (57.1%, 16/28) showed strongly positive expression of p53, and ATRX was negative in eight tumors (38.1%, 8/21). The Ki-67 proliferation index ranged from 5% to 40%. Eight cases (including two cases of H3K27M expression of individual cells) showed K27M mutation in H3F3A gene. Intracranial and spinal cord dissemination occurred in six cases (20.0%, 6/30). Median progression-free survival (PFS) was 9.5 months and median overall survival (OS) was 34 months. Mean PFS was 11.2 months and mean OS was 24.3 months. Compared with adults (>20 years old), children/adolescents (no more than 20 years old) had significantly shorter median OS (8 months vs. 34 months, P=0.013). There was no significant difference in PFS and OS between DMGs located in the brain stem/thalamus and other sites within midline (P>0.05). There was no significant difference in PFS and OS between WHO grade ⅠDMGs and WHO grade Ⅱ-Ⅳ DMGs (P>0.05). Conclusions DMGs occur more commonly in children and adolescents with male predominance. DMGs present with WHO Ⅰ-Ⅳ tumors morphologically, and pilocytic astrocytoma-like lesions with WHO Ⅰ are more common in adults. Expression of H3K27M but not H3K27me3 is helpful for diagnosis of DMG. The prognosis of children/adolescents is significantly worse than that of adults, whereas histological grade and tumor location do not affect prognosis.

Objective To study the clinical, laboratorial, histopathological, imaging features of two cases of hypothyroid myopathy. Method Clinical manifestations, thyroid function, electromyography, muscle MRI, muscle biopsy and follow-up results were collected, and analyzed with the literature. Result These two patients were middle-age to old age and the onset of disease was insidious. Their common clinical manifestations included subacute progressive weakness in the proximal muscles,myalgia after sports and reduction in tendon reflex.The blood test showed an increase in serum concentration of CK and TSH, and a decrease in FT3 and FT4. The electromyography showed suspicious myogenic damage.Muscle histopathological findings were largely nonspecific,such as type I fiber predominance and type 2 atrophy. The MRI revealed extensive muscular dystrophy and fatty filtration in the posterior group of thighs. Treatment of replacement therapy with L-T4 relieved the myopathic symptoms quickly. Conclusion When a patient presents with a subacute progressive weakness in the proximal muscles, the hypothyroidism should be consideration. Muscle histopathological findings may be nonspecific. The muscle MRI have a value of differential diagnosis and lesion assessment.

Euphorbia factor L2, a lathyrane diterpenoid isolated from caper euphorbia seed (the seeds ofL.), has been traditionally applied to treat cancer. This article focuses on the cytotoxic activity of Euphorbia factor L2 against lung carcinoma A549 cells and the mechanism by which apoptosis is induced. We analyzed the cytotoxicity and related mechanism of Euphorbia factor L2 with an MTT assay, an annexin V-FITC/PI test, a colorimetric assay, and immunoblotting. Euphorbia factor L2 showed potent cytotoxicity to A549 cells. Euphorbia factor L2 led to an increase in reactive oxygen species (ROS) generation, a loss of mitochondrial electrochemical potential, release of cytochromeactivation of caspase-9 and caspase-3, and cleavage of poly(ADP-ribose) polymerase, suggesting that Euphorbia factor L2 induced apoptosis through a mitochondrial pathway. The cytotoxic activity of Euphorbia factor L2 in A549 cells and the related mechanisms of apoptotic induction provide support for the further investigation of caper euphorbia seeds.

Objective To investigate the effects of peptidoglycan (PGN) with different concentrations on Toll-like receptor 2 (TLR2),Toll-like receptor 4 (TLR4) expression in corneal epithelial cells of mice.Methods Corneal epithelial cells of c57 mice were cultured in vitro.Cells were divided into blank control group and 10 mg · L-1 group,30 mg · L-1 gruop and 80 mg · L-1 group (treated by different concentration of PGN for 12 hours).In the meantime,the cells in 30 mg · L-1 group were cultured for different times(named 12 hours group,24 hours group,36 hours group).Expressions of TLR2 and TLR4 mRNA and protein in different group were measured by RT-PCR and flow cytometry.Results Compared with control group (1.00 ± 0.14,1.00 ± 0.01),the expression of TLR2,LR4 mRNA in 10 mg · L-1 group (4.35 ± 0.46,3.53 ± 0.50),30 mg · L-1 group (8.06 ±0.72,5.31 ±0.34),80 mg · L-1 group (2.93 ±0.46,2.23 ±0.04) were increased,the differences were statistically significant (all P ＜ 0.05).Compared with control group,the expression of TLR2,TLR4 protein in different concentration group and 12 hour group were increased,the differences were statistically significant (all P ＜ 0.05).Conclusion PGN can up-regulate both mRNA and protein expression of TLR2 and TLR4 in corneal epithelial cells of mice,suggest that TLR2 and TLR4 in the corneal epithelial cell can recognize some exogenous pathogen and regulate the inflammatory reaction,which are closely related to the occurrence and development of infectious keratitis.

Objective To investigate the neuroimaging and pathological features of epithelioid glioblastoma (EGBM) to improve the diagnosis.Methods The clinical and pathological features of 4 E-GBM cases were analyzed retrospectively.Results E-GBMs occurred predominantly in young adults.MRI examination showed irregular solidcystic lesion with heterogeneous or ring enhancement in 4 cases.Histological examination revealed uniform population of epithelioid or rhabdoid cells with prominent nucleoli and mitotic activity as well as geographic necrosis..Immunohistochemical staining showed various positive signals of Vimentin and S-100 protein in 4 cases,positive signal of BRAF (VE1) in 3 cases and focal positive signal of GFAP in 1 case.However,IDH-1 was negative and 1p/19q codeletion was lack.All patients were followed-up for 2-6 months.One patient had tumor recurrence 3 months and one patient died of disease 6 months after surgical excision.Conclusion E-GBM has a poor outcome and is closely associated with pleomorphic xanthoastrocytoma.MRI and epithelioid histological features are very important for the differential diagnosis.

[Summary] Hypercalcemia in pregnancy is a rare condition which brings considerable risks to mother and fetus. The most common cause is primary hyperparathyroidism(PHPT). The untypical symptoms and biochemical tests results add obstacles in the diagnosis of PHPT during pregnancy. The management is difficult, due to restrictions in choices of treatments and lack of clinical guidelines. Severity evaluation which takes consideration of calcium homeostasis during pregnancy is crucial for appropriate management. Parathyroidectomy during the second trimester is recommended for those with high serum calcium levels.

In recent years, a number of studies have focused on malignant tumor patients with coagulant function abnormality, which causes thrombus complications, tumor growth, infiltration of closely related cells, transfer, and so on. These factors directly affect prog-nosis. Heparin is a widely known anticoagulant, and anticoagulation drugs have been included in malignant tumor treatment guide-lines. Ameaican Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and American College of Clinical Pharmacy (ACCP) recommend low-molecular-weight heparin as the first choice for the treatment of cancer thrombosis. However, the prophylactic use of anticoagulant drugs in patients with tumor control disease, as well as the prolonged PFS and OS mechanism, is still unclear. The recently publishedReport of incidence and mortality in China(2012) suggests that lung cancer incidence and mortality ranked first place. This review will introduce several aspects of anticoagulant drugs that can be used to control the recurrence of malig-nant tumor metastasis and prolong the survival mechanism of pathophysiology.