BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It ...BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice.Overall survivals are generally poor,ranging from 6 to 16 months.More than 50%of patients died of disease within 2 to 3 years of diagnosis.CASE SUMMARY We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis.The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation,followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation.Postoperative radiotherapy was administered without delay.However,the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.CONCLUSION EA with spinal involvement is extremely rare.Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.展开更多
目的探讨Ⅰ型神经纤维瘤病伴重度脊柱侧后凸畸形的临床特征、诊疗策略及预后。方法回顾性分析上海交通大学医学院附属新华医院收治的1例20岁女性Ⅰ型神经纤维瘤病伴脊柱侧后凸畸形患者的临床资料,结合《Ⅰ型神经纤维瘤病临床诊疗专家共...目的探讨Ⅰ型神经纤维瘤病伴重度脊柱侧后凸畸形的临床特征、诊疗策略及预后。方法回顾性分析上海交通大学医学院附属新华医院收治的1例20岁女性Ⅰ型神经纤维瘤病伴脊柱侧后凸畸形患者的临床资料,结合《Ⅰ型神经纤维瘤病临床诊疗专家共识(2021版)》的诊断标准,总结其临床表现、影像学特征及分阶段手术治疗效果。同时,以“neurofibromatosis type 1 AND spinal deformity”及“Ⅰ型神经纤维瘤病和脊柱侧后凸畸形”为关键词,检索PubMed、Web of Science数据库及万方数据库、中国知网,筛选2010—2023年符合纳入排除标准的相关文献,归纳总结诊疗要点及预后特征。结果患者为20岁女性,自幼全身散布咖啡牛奶斑(≥6处),背部有10 cm×10 cm丛状神经纤维瘤,腋窝及腹股沟区多发皮下结节。脊柱侧后凸病程11年,影像学显示Cobb角145°,伴椎体扇形变及肋骨扭曲。双下肢肌力Ⅳ级,踝阵挛阳性。经过头颅-骨盆牵引(halo-gravity traction,HGT),Cobb角为85°,实施后路经椎弓根截骨矫形术(pedicle subtraction osteotomy,PSO)与全椎弓根螺钉固定术,术后脊柱在冠状面和矢状面上保持良好平衡。随访2年,患者症状显著改善。共纳入2010—2023年公开发表的文献5篇进行分析,涉及117例伴脊柱侧后凸畸形的Ⅰ型神经纤维瘤病患者,这些患者均具有丛状神经纤维瘤。脊柱筛查间隔尚未达成共识,手术多采用后路截骨结合椎弓根固定,而丛状神经纤维瘤常采用切除和椎板切除术。前后关节融合术对营养不良性颈椎后凸畸形的矫正效果最佳。结论Ⅰ型神经纤维瘤病伴脊柱侧后凸畸形的治疗需遵循“牵引-截骨矫形-神经功能保护”的综合策略。PSO联合全椎弓根固定能够有效矫正畸形并维持脊柱稳定性,多学科协作与术中神经电生理监测是减少并发症的关键。展开更多
Emerging two-dimensional MXenes have been extensively studied in a wide range of fields thanks to their superior electrical and hydrophilic attributes as well as excellent chemical stability and mechanical flexibility...Emerging two-dimensional MXenes have been extensively studied in a wide range of fields thanks to their superior electrical and hydrophilic attributes as well as excellent chemical stability and mechanical flexibility.Among them,the ultrahigh electrical conductivity(σ)and tunable band structures of benchmark Ti_(3)C_(2)T_(x) MXene demonstrate its good potential as thermoelectric(TE)materials.However,both the large variation ofσreported in the literature and the intrinsically low Seebeck coefficient(S)hinder the practical applications.Herein,this study has for the first time systematically investigated the TE properties of neat Ti_(3)C_(2)T_(x) films,which are finely modulated by exploiting different dispersing solvents,controlling nanosheet sizes and constructing composites.First,deionized water is found to be superior for obtaining closely packed MXene sheets relative to other polar solvents.Second,a simultaneous increase in both S andσis realized via elevating centrifugal speed on MXene aqueous suspensions to obtain small-sized nanosheets,thus yielding an ultrahigh power factor up to~156μW m^(-1) K^(-2).Third,S is significantly enhanced yet accompanied by a reduction inσwhen constructing MXene-based nanocomposites,the latter of which is originated from the damage to the intimate stackings of MXene nanosheets.Together,a correlation between the TE properties of neat Ti_(3)C_(2)T_(x) films and the stacking of nanosheets is elucidated,which would stimulate further exploration of MXene TEs.展开更多
Osteosarcoma(OS)is the most prevalent type of primary malignant bone cancer and currently lacks effective targeted treatments.Increasing evidence indicates that SOX2 overexpression is a primary driver of OS.By screeni...Osteosarcoma(OS)is the most prevalent type of primary malignant bone cancer and currently lacks effective targeted treatments.Increasing evidence indicates that SOX2 overexpression is a primary driver of OS.By screening a small-molecule kinase inhibitor library,we identified AKT as a kinase essential for robust SOX2 expression in OS cells.AKT was found to be frequently overexpressed in OS and positively correlated with SOX2 protein levels.We demonstrated that AKT has no effect on SOX2 transcription but promotes SOX2 protein stability.Mechanistically,AKT binds to and phosphorylates SOX2 at T116,preventing SOX2 ubiquitination and proteasome-dependent degradation by ubiquitin E3 ligases UBR5 and STUB1.Moreover,we found that AKT-SOX2 axis is a significant modulator of cancer stemness and chemoresistance and that the combination of AKT inhibitor MK2206 and cisplatin resulted in a synergistic and potent inhibition of OS tumor growth in the PDX model.In conclusion,we identified a critical role for AKT in promoting SOX2 overexpression,tumor stemness,and chemoresistance in OS,and provided evidence that targeting AKT combined with chemotherapy may hold promise for treating refractory OS.展开更多
目的 探究基于健康信念模式的智能化健康教育在颈椎病术后恐动症患者中的应用效果。方法 针对单中心神经脊柱中心行前路颈椎间盘切除减压融合术,并在术后存在恐动症的患者,开展前瞻性队列研究,由患者自愿选择是否接受智能健康教育干预治...目的 探究基于健康信念模式的智能化健康教育在颈椎病术后恐动症患者中的应用效果。方法 针对单中心神经脊柱中心行前路颈椎间盘切除减压融合术,并在术后存在恐动症的患者,开展前瞻性队列研究,由患者自愿选择是否接受智能健康教育干预治疗,将患者分为对照组和智能化教育组,从术后第2天进行干预。智能化教育组从术后第2天开始,依托微信小程序进行智能化教育,该小程序以健康信念模式作为理论框架,以患者问题-需求-导向-实践-反馈的思路进行设计,共分为4个板块(知识、智能锻炼、克服障碍、分享互动),包括提醒功能、趣味锻炼跟练功能、监测与记录功能。对照组从术后第2天开始,采用“图文手册+微信群提醒”的健康教育方式。分别于出院前、术后3个月对两组患者进行问卷调查。两组比较的主要结局指标:恐动程度;次要结局指标包括:功能锻炼依从性(功能锻炼依从性量表)、疼痛程度(Visual Analogue Scale评分)、颈椎功能障碍程度(颈椎残障指数)、生活质量(通过quality of life short form 12量表,主要评定心理健康得分和生理健康得分)等方面的差异。结果 共纳入112例患者,108例患者完成了随访。最终智能化教育组53例,对照组55例。患者均未发生运动相关损伤。出院时两组间主要结局指标和次要结局指标差异无统计学意义。术后3个月,智能化教育组恐动程度(25.72±3.90)低于对照组(29.67±6.16),差异有统计学意义(P<0.05)。智能化教育组的疼痛程度[中位数(P25,P75)][0(0,0)]低于对照组[1(1,2)](P<0.05),功能锻炼依从性(63.87±7.26 vs.57.73±8.07,P<0.05)、心理健康(40.78±3.98 vs.47.78±1.84,P<0.05)、身体健康(43.16±4.41 vs.46.30±3.80,P<0.05)均优于对照组,差异有统计学意义。颈椎功能障碍程度[中位数(P_(25),P_(75))][1(1,2)vs.3(2,7),P>0.05],两组间差异无统计学意义。结论 基于健康信念模式的智能化健康教育,可有助于降低颈椎病术后恐动症患者的恐动程度且改善预后。展开更多
Spinal cord injury-induced motor dysfunction is associated with neuroinflammation.Studies have shown that the triterpenoid lupenone,a natural product found in various plants,has a remarkable anti-inflammatory effect i...Spinal cord injury-induced motor dysfunction is associated with neuroinflammation.Studies have shown that the triterpenoid lupenone,a natural product found in various plants,has a remarkable anti-inflammatory effect in the context of chronic inflammation.However,the effects of lupenone on acute inflammation induced by spinal cord injury remain unknown.In this study,we established an impact-induced mouse model of spinal cord injury,and then treated the injured mice with lupenone(8 mg/kg,twice a day)by intrape ritoneal injection.We also treated BV2 cells with lipopolysaccharide and adenosine5’-triphosphate to simulate the inflammatory response after spinal cord injury.Our res ults showed that lupenone reduced IKBa activation and p65 nuclear translocation,inhibited NLRP3 inflammasome function by modulating nuclear factor kappa B,and enhanced the conve rsion of proinflammatory M1 mic roglial cells into anti-inflammatory M2 microglial cells.Furthermore,lupenone decreased NLRP3 inflammasome activation,NLRP3-induced mic roglial cell polarization,and microglia pyroptosis by inhibiting the nuclear factor kappa B pathway.These findings suggest that lupenone protects against spinal cord injury by inhibiting inflammasomes.展开更多
文摘BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice.Overall survivals are generally poor,ranging from 6 to 16 months.More than 50%of patients died of disease within 2 to 3 years of diagnosis.CASE SUMMARY We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis.The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation,followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation.Postoperative radiotherapy was administered without delay.However,the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.CONCLUSION EA with spinal involvement is extremely rare.Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.
文摘目的探讨Ⅰ型神经纤维瘤病伴重度脊柱侧后凸畸形的临床特征、诊疗策略及预后。方法回顾性分析上海交通大学医学院附属新华医院收治的1例20岁女性Ⅰ型神经纤维瘤病伴脊柱侧后凸畸形患者的临床资料,结合《Ⅰ型神经纤维瘤病临床诊疗专家共识(2021版)》的诊断标准,总结其临床表现、影像学特征及分阶段手术治疗效果。同时,以“neurofibromatosis type 1 AND spinal deformity”及“Ⅰ型神经纤维瘤病和脊柱侧后凸畸形”为关键词,检索PubMed、Web of Science数据库及万方数据库、中国知网,筛选2010—2023年符合纳入排除标准的相关文献,归纳总结诊疗要点及预后特征。结果患者为20岁女性,自幼全身散布咖啡牛奶斑(≥6处),背部有10 cm×10 cm丛状神经纤维瘤,腋窝及腹股沟区多发皮下结节。脊柱侧后凸病程11年,影像学显示Cobb角145°,伴椎体扇形变及肋骨扭曲。双下肢肌力Ⅳ级,踝阵挛阳性。经过头颅-骨盆牵引(halo-gravity traction,HGT),Cobb角为85°,实施后路经椎弓根截骨矫形术(pedicle subtraction osteotomy,PSO)与全椎弓根螺钉固定术,术后脊柱在冠状面和矢状面上保持良好平衡。随访2年,患者症状显著改善。共纳入2010—2023年公开发表的文献5篇进行分析,涉及117例伴脊柱侧后凸畸形的Ⅰ型神经纤维瘤病患者,这些患者均具有丛状神经纤维瘤。脊柱筛查间隔尚未达成共识,手术多采用后路截骨结合椎弓根固定,而丛状神经纤维瘤常采用切除和椎板切除术。前后关节融合术对营养不良性颈椎后凸畸形的矫正效果最佳。结论Ⅰ型神经纤维瘤病伴脊柱侧后凸畸形的治疗需遵循“牵引-截骨矫形-神经功能保护”的综合策略。PSO联合全椎弓根固定能够有效矫正畸形并维持脊柱稳定性,多学科协作与术中神经电生理监测是减少并发症的关键。
基金supported by the China Postdoctoral Science Foundation(grant No.2024M750511,J.T.)National Key R&D Program of China(grant No.2022YFB3603804,Y.Z.)National Natural Science Foundation of China(NSFC)under grant Nos.82172470(C.X.)and 22375050(Z.L.).
文摘Emerging two-dimensional MXenes have been extensively studied in a wide range of fields thanks to their superior electrical and hydrophilic attributes as well as excellent chemical stability and mechanical flexibility.Among them,the ultrahigh electrical conductivity(σ)and tunable band structures of benchmark Ti_(3)C_(2)T_(x) MXene demonstrate its good potential as thermoelectric(TE)materials.However,both the large variation ofσreported in the literature and the intrinsically low Seebeck coefficient(S)hinder the practical applications.Herein,this study has for the first time systematically investigated the TE properties of neat Ti_(3)C_(2)T_(x) films,which are finely modulated by exploiting different dispersing solvents,controlling nanosheet sizes and constructing composites.First,deionized water is found to be superior for obtaining closely packed MXene sheets relative to other polar solvents.Second,a simultaneous increase in both S andσis realized via elevating centrifugal speed on MXene aqueous suspensions to obtain small-sized nanosheets,thus yielding an ultrahigh power factor up to~156μW m^(-1) K^(-2).Third,S is significantly enhanced yet accompanied by a reduction inσwhen constructing MXene-based nanocomposites,the latter of which is originated from the damage to the intimate stackings of MXene nanosheets.Together,a correlation between the TE properties of neat Ti_(3)C_(2)T_(x) films and the stacking of nanosheets is elucidated,which would stimulate further exploration of MXene TEs.
基金supporting by the National Natural Science Foundation of China(Grant No.82172964,82141105,82072961,82403066)Shanghai Pujiang Talent Program(2020PJD062).
文摘Osteosarcoma(OS)is the most prevalent type of primary malignant bone cancer and currently lacks effective targeted treatments.Increasing evidence indicates that SOX2 overexpression is a primary driver of OS.By screening a small-molecule kinase inhibitor library,we identified AKT as a kinase essential for robust SOX2 expression in OS cells.AKT was found to be frequently overexpressed in OS and positively correlated with SOX2 protein levels.We demonstrated that AKT has no effect on SOX2 transcription but promotes SOX2 protein stability.Mechanistically,AKT binds to and phosphorylates SOX2 at T116,preventing SOX2 ubiquitination and proteasome-dependent degradation by ubiquitin E3 ligases UBR5 and STUB1.Moreover,we found that AKT-SOX2 axis is a significant modulator of cancer stemness and chemoresistance and that the combination of AKT inhibitor MK2206 and cisplatin resulted in a synergistic and potent inhibition of OS tumor growth in the PDX model.In conclusion,we identified a critical role for AKT in promoting SOX2 overexpression,tumor stemness,and chemoresistance in OS,and provided evidence that targeting AKT combined with chemotherapy may hold promise for treating refractory OS.
文摘目的 探究基于健康信念模式的智能化健康教育在颈椎病术后恐动症患者中的应用效果。方法 针对单中心神经脊柱中心行前路颈椎间盘切除减压融合术,并在术后存在恐动症的患者,开展前瞻性队列研究,由患者自愿选择是否接受智能健康教育干预治疗,将患者分为对照组和智能化教育组,从术后第2天进行干预。智能化教育组从术后第2天开始,依托微信小程序进行智能化教育,该小程序以健康信念模式作为理论框架,以患者问题-需求-导向-实践-反馈的思路进行设计,共分为4个板块(知识、智能锻炼、克服障碍、分享互动),包括提醒功能、趣味锻炼跟练功能、监测与记录功能。对照组从术后第2天开始,采用“图文手册+微信群提醒”的健康教育方式。分别于出院前、术后3个月对两组患者进行问卷调查。两组比较的主要结局指标:恐动程度;次要结局指标包括:功能锻炼依从性(功能锻炼依从性量表)、疼痛程度(Visual Analogue Scale评分)、颈椎功能障碍程度(颈椎残障指数)、生活质量(通过quality of life short form 12量表,主要评定心理健康得分和生理健康得分)等方面的差异。结果 共纳入112例患者,108例患者完成了随访。最终智能化教育组53例,对照组55例。患者均未发生运动相关损伤。出院时两组间主要结局指标和次要结局指标差异无统计学意义。术后3个月,智能化教育组恐动程度(25.72±3.90)低于对照组(29.67±6.16),差异有统计学意义(P<0.05)。智能化教育组的疼痛程度[中位数(P25,P75)][0(0,0)]低于对照组[1(1,2)](P<0.05),功能锻炼依从性(63.87±7.26 vs.57.73±8.07,P<0.05)、心理健康(40.78±3.98 vs.47.78±1.84,P<0.05)、身体健康(43.16±4.41 vs.46.30±3.80,P<0.05)均优于对照组,差异有统计学意义。颈椎功能障碍程度[中位数(P_(25),P_(75))][1(1,2)vs.3(2,7),P>0.05],两组间差异无统计学意义。结论 基于健康信念模式的智能化健康教育,可有助于降低颈椎病术后恐动症患者的恐动程度且改善预后。
基金supported by the National Natural Science Foundation of China,Nos.81801226(to QK and XS)and 82101445(to XJ)。
文摘Spinal cord injury-induced motor dysfunction is associated with neuroinflammation.Studies have shown that the triterpenoid lupenone,a natural product found in various plants,has a remarkable anti-inflammatory effect in the context of chronic inflammation.However,the effects of lupenone on acute inflammation induced by spinal cord injury remain unknown.In this study,we established an impact-induced mouse model of spinal cord injury,and then treated the injured mice with lupenone(8 mg/kg,twice a day)by intrape ritoneal injection.We also treated BV2 cells with lipopolysaccharide and adenosine5’-triphosphate to simulate the inflammatory response after spinal cord injury.Our res ults showed that lupenone reduced IKBa activation and p65 nuclear translocation,inhibited NLRP3 inflammasome function by modulating nuclear factor kappa B,and enhanced the conve rsion of proinflammatory M1 mic roglial cells into anti-inflammatory M2 microglial cells.Furthermore,lupenone decreased NLRP3 inflammasome activation,NLRP3-induced mic roglial cell polarization,and microglia pyroptosis by inhibiting the nuclear factor kappa B pathway.These findings suggest that lupenone protects against spinal cord injury by inhibiting inflammasomes.
