Tumor-associated macrophages(TAMs)are the predominant cell group in the tumor microenvironment(TME)and are the most important regulatory cells of immune system suppression and tumor cell proliferation in TIME.Src homology-2 domain-containing protein tyrosine phosphatase 2(SHP-2)is a non-receptor protein tyrosine phosphatase that plays an important role in the transmission of signals from the cell surface to the nucleus.SHP-2 is a key intracellular regulatory factor mediating cell proliferation and differentiation and is involved in a variety of growth factor and cytokine signaling pathways linking the cell surface to the nucleus.Recent studies have shown that SHP-2 is a key enzyme in determining the function of TAMs,but because of its variable function,it plays different or even opposite roles in different solid TMEs.This paper reviews the function of SHP-2 in TAMs and related solid tumors to provide a comprehensive reference for tumor immunity and targeted therapy research.

Objective:To explore the feasibility of using quantitative parameters of double contrast-enhanced ultrasound (DCUS) to noninvasively predict lymphatic metastasis in gastric cancer before operation.Methods:From December 2021 to October 2023, 119 patients undergoing gastrectomy at the Second Hospital & Clinical Medical School, Lanzhou University, were enrolled retrospectively. Based on the pathological findings, they were divided into lymph node metastasis (N1, 94 cases) and non-lymph node metastasis (N0, 25 cases) groups. All patients underwent DCUS within 3 days before surgery. Previous to DCUS, lesions′ location and ultrasonic T-staging were recorded by conventional ultrasound. Quantitative parameters such as arrival time (AT), time to peak (TTP), baseline intensity (BI), peak intensity (PI) and wash-in slope (WIS) were obtained by the time-intensity curve (TIC) automatically, and then manually calculated enhanced intensity (ΔPI=PI–BI) and enhanced time (ΔTTP=TTP–AT). Binary Logistic regression analysis was used to screen independent risk factors for predicting lymph nodes metastasis in gastric cancer, and regression models were established.Results:Statistical tests revealed significant differences in ultrasonic T-staging ( P<0.001) and degree of differentiation ( P=0.015) between N1 and N0 group. Among DCUS quantitative parameters, statistical differences in PI, ΔPI and WIS were observed between the two groups (all P<0.05), while no significant differences were found in BI, AT, TTP and ΔTTP (all P>0.05). Logistic regression analysis showed that ultrasonic T-staging and WIS were independent risk factors for predicting lymphatic metastasis. The regression model built on the above two factors performed well in predicting lymph nodes metastasis, with an area under the curve of 0.905, accuracy of 93.3% (superior to the prediction model based on DCUS quantitative parameters alone, P<0.05), sensitivity of 95.7% and specificity of 84.0%. Conclusions:DCUS quantitative parameters may be helpful to evaluate lymphatic metastasis of gastric cancer prior to surgery, and the accuracy of prediction would be improved by combing with ultrasonic T-staging.

Cases of high-temperature requirement A serine peptidase 1(HTRA1)gene heterozygous mutation associated cerebral small vessel disease are relatively rare.Early and timely diagnosis and treatment can improve prognosis.The authors reported a 37 years old male patient admitted in Department of Neurology,the Second Affiliated Hospital of Nanchang University,whose initial symptom was transient right limb weakness,imaging suggested white matter lesions and the gene screening showed HTRA1(c.854 C＞T/p.Pro285Leu)heterozygous mutation.A family survey has been conducted and the characteristics of patients in this family are as follows:they present with ischemic cerebrovascular disease,coexist with cervical or lumbar disc herniation,male patients have hair loss,some patients have cognitive dysfunction,men tend to develop the disease at an earlier age than women,and the onset age is progressively earlier from generation to generation.Therefore,for young ischemic cerebrovascular disease patients with hair loss,cognitive dysfunction,cervical or lumbar disc herniation,and obvious white matter lesions on imaging,especially those without common risk factors for cerebrovascular disease,a family history should be inquired and genetic testing should be performed to screen for HTRA1 mutations.

Purpose To investigate the relationship between imaging characteristics and shunt grading in acute cerebral infarction patients with right-to-left shunt.Materials and Methods The clinical and imaging data of 697 acute cerebral infarction patients who were hospitalized in the Second Affiliated Hospital of Nanchang University from January 2019 to December 2021 were collected,and the patients were divided into right-to-left shunt negative group(443 cases)and right-to-left shunt positive group(254 cases)according bubble test,compared the difference in demographic data and imaging characteristics between the two groups.In the shunt positive group,the imaging characteristics of the two groups of patients and their relationship with the shunt grade were analyzed.Results There were no statistical differences in gender,age,smoking,hyperlipidemia and history of coronary heart disease between the two groups(P>0.05),but there were statistical differences in the history of hypertension(OR=0.533,95%CI 0.380-0.748),diabetes(OR=0.649,95%CI 0.422-0.999)and cerebral infarction(OR=0.275,95%CI 0.136-0.555)(all P<0.05).The imaging characteristics of the two groups of patients showed that there were significant differences in the number of infarct foci(χ2=53.957,4.219;both P<0.05),but there was no statistical difference in the infarct location between the two groups(P>0.05).Among the patients with acute cerebral infarction combined with positive bubble test,the imaging manifestations of grading I and II patients were mainly unilateral anterior circulation or posterior circulation infarction,and deep and single infarction were more common.In patients with grading III and IV shunts,multiple infarcts with combined bilateral anterior and posterior circulations were more common.Conclusion The imaging manifestations of patients with acute cerebral infarction combined with right-to-left shunt have their own characteristics.Bubble test has high sensitivity in the diagnosis of right-to-left shunt.The comprehensive analysis can provide certain guidance for clinical practice.

The occurrence of eosinophilic leukemia complicated with cardiogenic embolism and L?ffler endocarditis are relatively rare.Early accurate diagnosis and prompt treatment can improve the its prognosis.When patients have symptoms of neurological impairment accompanied by increased eosinophils,the rare etiological type of cerebral infarction should be actively screened.Further improvements are needed in the examination of bone marrow smears,detection of fusion genes associated with leukemia,screening for L?ffler endocarditis,and identification of intraventricular thrombi.In this case,the main manifestations of eosinophilic leukemia were cardiogenic embolism and L?ffler endocarditis.After active treatment,the symptoms improved,and the eosinophil count returned to normal.This study summarizes the case data of this patient and combines it with a literature review,with the hope of raising clinicians'understanding of this rare disease.

Natural killer(NK)cells as intrinsic immune cells kill tumor cells without the need for pre-stimulation by tumor antigens.Therefore,NK cell based immunotherapy has unique advantages and has made significant progress in tumor treatment.In this article,we review the development,classification,and mechanism of NK cells as well as the applications of NK cell based immunotherapies,including immune checkpoint inhibitors,adoptive cell therapy,and NK cell adapters in tumor immunity.Thus,we elucidate the principle,current status,and developmental trend of NK cell-based anti-tumor immunotherapies to provide ideas for their development and application in the field of tumor immunotherapy.

Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.

Familial episodic pain syndrome is characterized by ion channel gene mutation in dorsal root ganglion neurons, and there can be neuropathic pain in different parts. However, the lack of awareness of familial episodic pain syndrome, along with the absence of uniform diagnostic and treatment standards, may lead to frequent missed diagnosis and misdiagnosis. This article will review the concepts, classification, pathogenesis, clinical features, diagnosis and treatment of familial episodic pain syndrome, aimed at deepening the understanding of the diseases as well as facilitating early diagnosis and treatment.

Objective To explore the effect of Qushi-Huaban granule for the allergic purpura and the impact on CD4+CD25+T cells. Methods A total of 80 children with allergic purpura from March 2014 to January 2016 were randomly divided into two groups, the control group and observation group, 40 in each group. The control group was given routine medicine andmontelukast chewable tablets. The observation group was treated with Qushi-Huaban granule on the basis of conventional therapy. The clinical effect, purpura recession time, recurrence rate before and after treatment were observed and compared. The serum levels of IFN-γ (interferon-γ, IFN-γ) and IL-5 were detected by ELISA. The expression level of CD4+CD25+ Treg were observed by flow cytometry before and after treatment. Results The effective rate of the treatment group [92.5% (37/40) vs. 72.5%(29/40), χ2=9.270] was significantly higher than control group (P＜0.01). After treatment, the serum IFN-γ levels in the observation group and the control group were significantly higher than those before treatment (t=3.960, 4.175, P＜0.05). The serum IL-5 levels of two groups were significantly lower than those before treatment (t=8.061, 8.776, P＜0.01).There was no significant differencein the serum INF-γ and IL-5 leves after treatment between two groups (P＞0.05). The regression time of purpura in the observation group (5.2 ± 1.1 d vs. 10.2 ± 2.4 d, t=12.460) was significantly shorter than that in the control group ( P＜0.01). The recurrence rate of the observation group was [7.4% (5/37) vs. 10.3% (3/29)] which was significantly lower than that of the control group, but the difference was not statistically significant (χ2=0.153, P=0.696). The CD4+CD25+T cells (t=7.367, 6.957, P＜0.05) and CD3+CD4+CD25+ T cells (t values were 9.080, 8.885, P＜0.05) of two groupswere significantly higher than those beforetreatment, butthere was no significant difference between the 2 groups after treatment ( P＞0.05). Conclusions The Qushi-Huaban granule combined with montelukast sodium for Henoch Schonlein purpura showed efficacy, and significantly increase the moisture level of T cell subsets.

Objective To analyze the clinical manifestations and imaging features of human brainstem encephalitis with Parkinson syndrome as the main manifestations. Methods Combined with related literature, the clinical, laboratory and imaging features of three patients with brainstem encephalitis, which were mainly manifested as Parkinson syndrome, were analyzed. Results The 3-hour video EEG showed normal in 2 cases and abnormal in one case with more delta wave in each leads. Cerebrospinal fluid examination revealed normal cell numbers in one case, increased cell numbers in 2 case and elevated cerebrospinal fluid proteins in all 3 cases. serum and CSF IgG anti-NMO antibodies as well as autoimmune encephalitis antibodies were negative in 3 cases. Brain MRI showed symmetrical abnormal signal in bilateral midbrain and pia mater enhancement increased in 3 cases. After hormone, and madopar treatment, Parkinson syndrome symptoms were significantly improved in two patients. Conclusion Brainstem encephalitis-induced symmetrical midbrain lesion can manifest as Parkinson syndrome. The laboratory tests reveal an involvement of immune system and hormone therapy may be effective.