Alzheimer's disease (AD) is characterized by progressive cognitive deterioration and significant depression. However, the mechanisms linking depression to AD pathology remain unclear. Here, we investigated whether Notch2 signaling mediates depression-like behaviors in presenilin-2 (PS2) N141I mutant mice, an early-onset AD model. PS2 wild-type (WT) and mutant (MT) mice aged 12-15 months were subjected to unpredictable chronic mild stress (UCMS) for 4 weeks, followed by sucrose preference, tail-hanging, and forced swimming tests. Behavioral assessments showed that UCMS exacerbated anhedonia and immobility only in PS2 MT mice. Molecular analysis revealed concomitant increases in plasma corticosterone, hippocampal γ-secretase activity, and Notch2 expression, and elevated total and phosphorylated glucocorticoid receptor levels in PS2 MT-UCMS mice. Gene expression profiling of human hippocampal datasets confirmed upregulation of NOTCH2 in Alzheimer's disease and depression. Pharmacological inhibition of γ-secretase and Notch signaling with DAPT normalizes depressive behavior, reduces corticosterone release, attenuates GR phosphorylation, and inhibits Notch2 signaling in PS2 MT mice. These findings identify Notch2 as a pivotal mediator linking chronic stress to molecular changes associated with depression and AD, and suggest that targeting Notch2 signaling may provide therapeutic benefits for comorbid mood and neurodegenerative disorders.

Short-term spinal cord stimulation (st-SCS), as a minimally invasive neuromodulation technique for zoster-associated pain (ZAP), can effectively relieve pain and reduce the incidence of postherpetic neuralgia (PHN). This paper reports two elderly male patients with ZAP admitted to the First Affiliated Hospital, Zhejiang University School of Medicine in August 2024, who developed acute pulmonary embolism (APE) 3 days after st-SCS implantation. Both patients had preoperative high-risk factors, including a history of hypertension and elevated D-dimer levels. Close monitoring of D-dimer levels was performed after st-SCS. When further elevation was observed, computed tomography angiography (CTA) was conducted promptly. After APE was confirmed, anticoagulation therapy with low-molecular-weight heparin bridging to direct oral anticoagulants (DOACs) was initiated, followed by electrode removal. At 3-month follow-up after discharge, repeat pulmonary CTA showed no significant embolism. Advanced age, preexisting cardiovascular and cerebrovascular diseases, elevated preoperative D-dimer levels, perioperative stress, and postoperative immobility due to fear of electrode displacement were all high-risk factors for thrombosis. During the perioperative period, a comprehensive prevention strategy should be established, including preoperative Caprini risk assessment, D-dimer evaluation, and lower-extremity vascular ultrasound screening, intraoperative physical prophylaxis, early postoperative mobilization, and dynamic monitoring of D-dimer levels. Multidisciplinary collaboration should be adopted to optimize individualized management. Based on the above experience, no cases of APE occurred among the subsequent 68 patients with ZAP treated with st-SCS in our hospital, suggesting that APE is preventable and controllable.

Laryngeal adenoid cystic carcinoma (LACC) is a rare malignant tumor, representing less than 1% of all laryngeal cancers. This tumor arises from the minor salivary or mucous glands of the upper respiratory tract and is characterized by slow growth, local invasiveness, and a high propensity for distant metastases. The submucosal extension and lack of symptoms often delay diagnosis. Such features present notable challenges in clinical practice.We report two cases of LACC in elderly male patients with clinically advanced laryngeal tumors. The first case involved a 73-year-old patient with bilateral laryngeal paralysis and subglottic stenosis caused by a tumor. Despite a prior history of tracheal adenoid cystic carcinoma treated 9 years earlier, recurrence was considered unlikely based on the available clinical, radiological, and pathological findings. Histopathological analysis confirmed the diagnosis of LACC. The patient underwent total laryngectomy, bilateral selective neck dissection, and right hemithyroidectomy. Postoperative histopathology classified the tumor as pT4aN0, and the patient remains recurrence-free 24 months post-surgery.The second case involved a 79-year-old patient presenting with persistent hoarseness and right-sided laryngeal immobility. Computed tomography scan of the neck revealed a hyperdense paraglottic mass causing laryngeal stenosis and thyroid cartilage erosion. After histopathological confirmation of LACC on an open laryngeal biopsy specimen obtained during laryngofissure, the patient underwent total laryngectomy with selective neck dissection and received postoperative radiotherapy at a total dose of 63 Gy in 30 fractions. Seventeen months after treatment, the patient remains in good health without recurrence.These two cases of LACC, both presenting in elderly male patients without traditional risk factors, showed advanced transglottic extension with cartilage invasion and differing histological patterns-cribriform/tubular in one case and predominantly solid in the other. Despite the challenges in achieving early diagnosis due to submucosal tumor growth, both patients responded favorably to surgery with or without adjuvant radiotherapy. The observed variability in macroscopic and microscopic features underscores the need for individualized treatment strategies and supports the potential value of detailed histopathological classification in guiding therapeutic decision-making for this rare tumor type.

The aim of this operation is to stabilise a T-type acetabular fracture against secondary dislocation and to restore the patient's preoperative functionality.

Festulolium hybrids are cool-season forage grasses that form symbiotic relationships with the fungus Epichloë uncinata, which produces loline alkaloids that protect the host from herbivores. This study evaluated the nematotoxicity of shoot and root extracts of Festulolium loliaceum against the stubby root nematode Trichodorus primitivus. Methanolic root and shoot extracts from plants aged 8, 12, 16, and 20 weeks were tested in vitro at five concentrations (312.5-5000 µg mL[-1]) over 24, 48, and 72 h. Nematode immobility, mortality, and phytochemical profiles, including flavonoids, loline alkaloids, and phenols, were quantified. Extracts from shoots caused significant concentration and time-dependent immobility of T. primitivus (p = 0.001), reaching ≥90% at 5000 µg mL[-1] after 72 h in 8-12-week-old plants. Endophyte presence enhanced nematotoxicity, where LD50 values for E+ roots were two-fold lower at 12 weeks and fifty-fold lower at 20 weeks compared with E- root extracts. Shoot extracts of E+ grass had the highest nematicidal activity at 8 weeks, with a significantly lower LD50 value than E- (p < 0.05). Loline alkaloid concentrations increased with plant age, while flavonoids and phenols declined. Nematotoxicity of F. loliaceum extracts was strongly influenced by plant age and endophyte presence. Younger E+ shoots produced the most potent shoot extracts, whereas older plants produced the most potent root extracts. Flavonoid content was negatively correlated with shoot biomass (R = -0.94, p < 0.001). Similarly, phenol content was negatively correlated to both root biomass (R = -0.79, p < 0.001) and shoot biomass (R = -0.67, p < 0.005).

Low back pain is a prevalent complaint among patients, leading to the frequent use of various interventional procedures in pain clinics. While these interventions are generally regarded as safe, complications, particularly in elderly patients, can include serious conditions such as infectious spondylitis or spinal hematoma. We report a case of an elderly patient who developed aspiration pneumonia shortly after undergoing a lumbar spinal intervention. The initial clinical suspicion was infectious spondylitis due to the temporal association with the procedure. However, further evaluation revealed that the procedure itself was not the direct cause. Instead, the exacerbation of low back pain following the intervention likely resulted in prolonged bed rest and ineffective coughing, which contributed to the worsening of pre-existing pneumonia. This case highlights the importance of considering aspiration pneumonia as a potential complication following lumbar procedures in elderly patients, especially when symptoms, such as fever and respiratory distress, occur post-intervention. Distinguishing aspiration pneumonia from other serious complications, such as infectious spondylitis, is crucial for appropriate management. Pain clinicians should maintain a high index of suspicion for such complications and exercise caution when treating elderly individuals. Aspiration pneumonia can develop or worsen after lumbar interventions in elderly patients, particularly when post-procedural pain leads to decreased mobility and impairs airway clearance. Clinicians should be vigilant for respiratory complications and carefully differentiate them from procedure-related infections to ensure optimal patient outcomes.