Systemic air embolism associated with endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a key procedure for diagnosing and treating biliary and pancreatic disorders.Although effective,it carries risks,including rare but severe complications such as air embolism.CASE SUMMARY We report a case of a 58-year-old man who developed extensive air embolism during ERCP.He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness.Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery.Imaging confirmed widespread air embolism,which resolved with continued treatment.CONCLUSION Air embolism is a rare,critical complication of ERCP,especially in patients with prior surgery such as pancreaticoduodenectomy.Early detection and prompt treatment,including hyperbaric oxygen therapy,are crucial for favorable out-comes.

Comparison between laparoscopic uncut Roux-en-Y and Billroth Ⅱ with Braun anastomosis after distal gastrectomy:A meta-analysis

BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

Reporting and methodological quality of meta-analyses of acupuncture for patients with migraine:A methodological investigation with evidence map

Background:Acupuncture has been widely used to relieve migraine-related symptoms.However,the findings of previous systematic reviews(SRs)and meta-analyses(MAs)are still not completely consistent.Their quality is also unknown,so a comprehensive study is needed.Objective:To evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine,and summarize evidence about the efficacy and safety of acupuncture for migraine.Search strategy:Pub Med,Embase,Cochrane Library,China National Knowledge Infrastructure,Chinese Biomedical Databases,Wanfang Data,and VIP databases were searched from inception to September 2020,with a comprehensive search strategy.Inclusion criteria:The pairwise MAs of randomized controlled trials(RCTs)concerning migraine treated by acupuncture or acupuncture-based therapies,with a control group that received sham acupuncture,medication,no treatment,or acupuncture at different acupoints were included.Data extraction and analysis:Two independent investigators screened studies,extracted relevant data,and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2009 and A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),then all results were cross-checked.Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores.Results:A total of 20 MAs were included in this study.The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention.There was a high correlation between reporting and methodological quality scores(rs=0.87,P<0.001).The quality of the included SRs needs to be improved mainly with regard to protocol and prospective registration,using a comprehensive search strategy,summarizing the strength of evidence body for key outcomes,a full list of excluded studies with reasons for exclusion,reporting of RCTs’funding sources,and assessing the potential impact of risk of bias in RCTs on MA results.Conclusion:Acupuncture is an effective and safe intervention for preventing and treating migraine,and could be considered as a good option for patients with migraine.However,the reporting and methodological quality of MAs included in this overview is suboptimal.In the future,AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.

Diagnostic Significance of Mycobacterium tuberculosis T-cell Assays for Active Tuberculosis

Background：Active tuberculosis （TB） with negative results of sputum smear is difficult to be identified.Till now,there is no effective and noninvasive diagnostic method.This study evaluated the diagnostic power of Mycobacterium tuberculosis T-cell （T.SPOT（R）.TB） assays for active TB.Methods：We retrospectively screened 450 suspected TB patients that were hospitalized in the Respiratory Department of Henan Province People＇s Hospital from June 2015 to June 2016.The patients were divided into the active,previous,and non-TB groups according to their final diagnosis.We evaluated the diagnostic value of the T-SPOT（R）.TB assay by constructing receiver operating characteristic （ROC） curves and calculating the optimal diagnostic cutoff value.In addition,we compared the levels of A antigen （ESAT-6） and B antigen （CFP-10） in active TB.Results：The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio of T-SPOT（R）.TB for active TB were 89.78%,63.16%,0.56,0.92,2.47,and 0.16,respectively.For active TB,the area under the ROC curve （AUC） of the A antigen （0.89） was higher than that of the B antigen （0.86）.The AUC of the A antigen for active TB was largest at a cutoff value of 13.5 spot-forming cells （SFCs） per 2.5 × 105 peripheral blood mononuclear cells （PBMCs）.The AUC of the A and B antigens was 0.60 and 0.58 for previous TB.The levels of A and B antigen in the active TB group were significantly different from those in the previous-and non-TB groups （A antigen：x2 =105.41,P 〈 0.01 and B antigen：x2 =91.03,P 〈 0.01;A antigen：x2 =12.99,P 〈 0.01 and B antigen：x2 =8.56,P 〈 0.01,respectively）.There were no significant differences in the levels of A and B antigens between the non-TB group and previous TB group （A antigen：x2 =1.07,P 〉 0.05 and B antigen：x2 =0.77,P 〉 0.05）.Conclusions：T-SPOT（R）.TB has high sensitivity and specificity for the diagnosis of active TB at a cutoff value of 13.5 SFCs per 2.5 × 10^5 PBMCs and is not influenced by previous TB.

LncRNA GAS5 enhances tumor stem cell-like medicated sensitivity of paclitaxel and inhibits epithelial-to-mesenchymal transition by targeting the miR-18a-5p/STK4 pathway in prostate cancer

The onset of prostate cancer(PCa)is often hidden,and recurrence and metastasis are more likely to occur due to chemotherapy resistance.Herein,we identified downregulated long noncoding RNA(lncRNA)growth arrest-specific 5(GAS5)in PCa that was associated with metastasis and paclitaxel resistance.GAs5 acted as a tumor suppressor in suppressing the proliferation and metastasis of paclitaxel-resistant PCa cells.GAS5 overexpression in vivo inhibited the tumor growth of xenografts and elevated PCa sensitivity to paclitaxel.Combination of GAS5 and paclitaxel treatment showed great potential in PCa treatment.Moreover,mechanistic analysis revealed a novel regulatory network of GAS5/miR-18a-5p/serine/threonine kinase 4(STK4)that inhibits epithelial-to-mesenchymal transition(EMT)and enhances tumor stem cell-like-mediated sensitivity to paclitaxel in PCa.These findings provide a novel direction for the development of a potential adjunct to cancer chemotherapy that aims to improve the sensitivity of chemotherapy drugs in PCa.

Urinary concentrations of phenols, oxidative stress biomarkers and thyroid cancer: Exploring associations and mediation effects

Phenols have been shown to influence the cellular proliferation and function of thyroid in experimental models. However, few human studies have investigated the association between phenol exposure and thyroid cancer, and the underlying mechanisms are also poorly understood. We conducted a case-control study by age- and sex-matching 143 thyroid cancer and 224 controls to investigate the associations between phenol exposures and the risk of thyroid cancer, and further to explore the mediating role of oxidative stress. We found that elevated urinary triclosan (TCS), bisphenol A (BPA) and bisphenol S (BPS) levels were associated with increased risk of thyroid cancer (all P for trends < 0.05), and the adjusted odds ratios (ORs) comparing the extreme exposure groups were 3.52 (95% confidence interval (CI):2.08, 5.95), 2.06 (95% CI: 1.06, 3.97) and 7.15 (95% CI: 3.12, 16.40), respectively. Positive associations were also observed between urinary TCS, BPA and BPS and three oxidative stress biomarkers measured by 8-hydroxy-2 -deoxyguanosine (8-OHdG), 8-iso-prostaglandin F(8-iso PGF) and 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA), as well as between urinary 8-iso PGFand HNE-MA and the risk of thyroid cancer. Mediation analysis showed that urinary 8-iso PGFmediated 28.95%, 47.06% and 31.08% of the associations between TCS, BPA and BPS exposures and the risk of thyroid cancer, respectively (all P < 0.05). Our results suggest that exposure to TCS, BPA and BPS may be associated with increased risk of thyroid cancer and lipid peroxidation may be an intermediate mechanism. Further studies are warranted to confirm the findings.

PPARγ2 functions as a tumor suppressor in a translational mouse model of human prostate cancer

Peroxisome proliferator-activated receptorsγ(PPARγ)is a master regulator that controls energy metabolism and cell fate.PPARγ2,a PPARγisoform,is highly expressed in the normal prostate but expressed at lower levels in prostate cancer tissues.In the present study,PC3 and LNCaP cells were used to examine the benefits of restoring PPARγ2 activity.PPARγ2 was overexpressed in PC3 and LNCaP cells,and cell proliferation and migration were detected.Hematoxylin and eosin(H&E)staining was used to detect pathological changes.The genes regulated by PPARγ2 overexpression were detected by microarray analysis.The restoration of PPARγ2 in PC3 and LNCaP cells inhibited cell proliferation and migration.PC3-PPARγ2 tissue recombinants showed necrosis in cancerous regions and leukocyte infiltration in the surrounding stroma by H&E staining.We found higher mixed lineage kinase domain-like(MLKL)and lower microtubule-associated protein 1 light chain 3(LC3)expression in cancer tissues compared to controls by immunohistochemistry(IHC)staining.Microarray analysis showed that PPARγ2 gain of function in PC3 cells resulted in the reprogramming of lipid-and energy metabolism-associated signaling pathways.These data indicate that PPARγ2 exerts a crucial tumor-suppressive effect by triggering necrosis and an inflammatory reaction in human prostate cancer.