Single-center retrospective study of the diagnostic value of doubleballoon enteroscopy in Meckel’s diverticulum with bleeding

BACKGROUND The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum(MD)complicated by digestive tract hemorrhage.Moreover,we aimed to evaluate the value of double-balloon enteroscopy(DBE)in MD diagnosis and the prognosis after laparoscopic diverticula resection.AIM To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding.METHODS The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations,auxiliary examination,and follow-up after laparoscopic resection of diverticula.RESULTS(1)Among 84 MD patients complicated with hemorrhage,77 were male,and 7 were female with an average age of 31.31±10.75 years.The incidence was higher in men than in women of different ages;(2)Among the 84 MD patients,65(78.40%)had defecated dark red stools,and 50(58.80%)had no accompanying symptoms during bleeding,indicating that most MD bleeding appeared a dark red stool without accompanying symptoms;(3)The shock index of 71 patients(85.20%)was<1,suggesting that the blood loss of most MD patients was less than 20%–30%,and only a few patients had a blood loss of>30%;(4)The DBE-positive rate was 100%(54/54),99mTcpertechnetate-positive scanning rate was 78%(35/45)compared with capsule endoscopy(36%)and small intestine computed tomography(19%).These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding,especially DBE was a highly precise examination method in MD diagnosis;(5)A total of 54 MD patients with hemorrhage underwent DBE examination before surgery.DBE endoscopy revealed many mucosal manifestations including normal appearance,inflammatory changes,ulcerative changes,diverticulum inversion,and nodular hyperplasia,with ulcerative changes being the most common(53.70%).This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding;and(6)Laparoscopic dissection of diverticulae was performed in 76 patients,The patients who underwent postoperative follow-up did not experience any further bleeding.Additionally,follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding.These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis.CONCLUSION Bleeding associated with MD was predominantly observed in male adolescents,particularly at a young age.DBE was a highly precise examination method in MD diagnosis.Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.

Fluoxetine Ameliorates the Aggravation of UC Symptoms in C57BL/6 Mice Induced by CUMS

Objective Patients with chronic ulcerative colitis(UC)often have mental symptoms such as depression and anxiety,and stress can lead to gastrointestinal diseases.However,the correlation between mental stress and UC is unclear.In this paper,chronic unpredictable mild stress(CUMS)was utilized to evaluate the involvement of mental factors in the pathogenesis of UC.Methods The CUMS model was used to evaluate the direct/indirect involvement of mental factors in the pathogenesis of UC.The behavior was evaluated by the open field,forced swimming,and tail suspension tests.Body weight,the disease activity index(DAI)score,colon length,and HE staining of colon tissue were used to evaluate the action of CUMS and fluoxetine.Results The results showed that weight loss and the DAI score increased in CUMS mice,but they had no meaningful effect on colon length and morphological structure of colon tissue.However,CUMS aggravated dextran sulfate sodium(DSS)-induced colon length shortening and colon morphological structure damage.Fluoxetine significantly improved the DAI score,shortened colon length,and damaged morphology and structure of the colons induced by CUMS combined with DSS in mice.Fluoxetine also decreased the level of IL-6 in the serum and the TNF-αand IFN-γlevels of colon tissue.Fluoxetine simultaneously improved behavioral abnormalities induced by CUMS combined with DSS in mice.Conclusion CUMS aggravated the UC symptoms induced by DSS,and fluoxetine could improve the UC symptoms due to its improvement in the inflammatory level and behavioral abnormalities.

Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: A review

Liver transplantation(LT) has been accepted as an effective therapy for hepatocellular carcinoma(HCC). The Milan criteria(MC) are widely used across the world to select LT candidates in HCC patients. However, the MC may be too strict because a substantial subset of patients who have HCC exceed the MC and who would benefit from LT may be unnecessarily excluded from the waiting list. In recent years, many extended criteria beyond the MC were raised, which were proved to be able to yield similar outcomes compared with those patients meeting the MC. Because the simple use of tumor size and number was insufficient to indicate HCC biological features and to predict the risk of tumor recurrence, some biological markers such as Alphafetoprotein, Des-Gamma-carboxy prothrombin and the neutrophil-to-lymphocyte ratio were useful in selecting LT candidates in HCC patients beyond the MC. For patients with advanced HCC, downstaging therapy is an effective way to reduce the tumor stage to fulfill the MC by using liver-directed therapy such as transarterial chemoembolization, radiofrequency ablation and percutaneous ethanol injection. This article reviews the recent advances in LT for HCC beyond the MC.

Advances in treatment of ulcerative colitis with herbs: From bench to bedside

Ulcerative colitis(UC), an idiopathic inflammatory disorder in the colon, has become a clinical challenge, owing to the increasing incidence and poor prognosis. The conventional treatments for UC including aminosalicylates, corticosteroids, and immunosuppressants, induce remission in only half of patients. Meanwhile, the treatments often come with serious side effects which can be life-threatening. Herbal medicine, one of the most common traditional Chinese medicine modalities, has been introduced for centuries into clinical treatment of many human diseases such as infections and functional disorders. Recently, the potential effectiveness of herbs has been suggested as the treatment of UC, as shown by a variety of clinical trials and experimental studies. The herbs reported in the literature include aloe vera gel, butyrate, tormentil extracts, wheat grass juice, and curcumin. In the review, bioactivity of the herbs and their involvement in UC treatment are discussed.

Liver transplantation for biliary atresia: A single-center study from China's Mainland

AIM: To summarize our single-center experience with liver transplantation(LT) for biliary atresia(BA).METHODS: From October 2006 to December 2012, 188 children with BA were analyzed retrospectively. The stage?Ⅰ?group(from October 2006 to December 2010) comprised the first 74 patients, and the stage Ⅱ group(from January 2011 to December 2012) comprised the remaining 114 patients. Finally, 123 liver transplants were performed in 122(64.9%) patients, whereas 66 patients did not undergo LT due to denial by their parents or lack of suitable liver grafts. The selection of graft types depended on the patients' clinical status and whether a suitable living donor was available. The characteristics of patients in stages?Ⅰ?and Ⅱ were described, and the surgical outcomes of LT recipients were compared between the two stages. The KaplanMeier method was used to estimate the cumulative patient and graft survival rates, and the equality of survival distributions was evaluated using the log-rank test.RESULTS: The 188 children consisted of 102 boysand 86 girls. Their ages ranged from 3 to 144 mo with a median of 8 mo. One hundred and fifteen(61.2%) patients were born in rural areas. Comparing stage?Ⅰ?and stage Ⅱ patients, the proportion of patients referred by pediatricians(43.2% vs 71.1%, respectively; P < 0.001) and the proportion of patients who previously received a Kasai procedure(KP)(32.4% vs 44.7%, respectively; P = 0.092) obviously increased, and significantly more parents were willing to treat their children with LT(73% vs 86%, respectively; P = 0.027). Grafts from living donors(102/122, 83.6%) were the most commonly used graft type. Surgical complications(16/25, 64.0%) were the main reason for posttransplant mortality. Among the living donor liver transplantation recipients(n = 102), the incidence of surgical complications was significantly reduced(34.1% vs 15.5%, respectively; P = 0.029) and survival rates of patients and grafts were greatly improved(81.8% vs 89.7%, respectively, at 1 year; 75.0% vs 87.8%, respectively, at 3 years; P = 0.107) from stage?Ⅰ?to stage Ⅱ.CONCLUSION: The status of surgical treatments for BA has been changing in China's Mainland. Favorable midterm outcomes after LT were achieved as centers gained greater technical experience.

Hepatic artery reconstruction in pediatric liver transplantation:Experience from a single group

Background:The reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation procedure.Hepatic artery thrombosis(HAT)and stenosis are complications which may result in ischemic biliary injury,causing early graft lost and even death.Methods:Two hundred and fifty-nine patients underwent liver transplantation in 2017 in a single liver transplantation group.Among them,225 patients were living donor liver transplantation(LDLT)and 34 deceased donor liver transplantation(DDLT).Results:In LDLT all reconstructions of hepatic artery were microsurgical,while in DDLT either microsurgical reconstruction or traditional continuous suture technique was done depending on different conditions.There were five(1.9%)HATs:four(4/34,11.8%)in DDLT(all whole liver grafts)and one(1/225,0.4%)in LDLT(P=0.001).Four HATs were managed conservatively using anticoagulation,and 1 accepted salvage surgery with re-anastomosis.Until now,3 HAT patients remain in good condition,whereas two developed biliary complications.One of them needed to be re-transplanted,and the other patient died due to biliary complications.Conclusions:Microsurgical technique significantly improves the reconstruction of hepatic artery in pediatric liver transplantation.The risk for arterial complications is higher in DDLT.Conservative therapy can achieve good outcome in selected HAT cases.

Determination of structure-activity relationships between fentanyl analogs and human μ-opioid receptors based on active binding site models

Fentanyl is a potent and widely used clinical narcotic analgesic, as well as a highly selective IJ-opioid agonist. The present study established a homologous model of the human μ-opioid receptor; an intercomparison of three types of μ-opioid receptor protein sequence homologous rates was made. The secondary receptor structure was predicted, the model reliability was assessed and verified using the Ramachandran plot and ProTab analysis. The predictive ability of the CoMFA model was further validated using an external test set. Using the Surflex-Dock program, a series of fentanyl analog molecules were docked to the receptor, the calculation results from Biopolymer/SitelD showed that the receptor had a deep binding area situated in the extracellular side of the transmembrane domains （TM） among TM3, TM5, TM6, and TMT. Results suggested that there might be 5 active areas in the receptor. The important residues were Asp147, Tyr148, and Tyr149 in TM3, Trp293, and His297 in TM6, and Trp318, His319, Ile322, and Tyr326 in TM7, which were located at the 5 active areas. The best fentanyl docking orientation position was the piperidine ring, which was nearly perpendicular to the membrane surface in the 7 TM domains. Molecular dynamic simulations were applied to evaluate potential relationships between ligand conformation and fentanyl substitution.

The utility of two-dimensional shear wave elastography and texture analysis for monitoring liver fibrosis in rat model

Background:Liver fibrosis is a common pathological change caused by a variety of etiologies.Early diagnosis and timely treatment can reverse or delay disease progression and improve the prognosis.This study aimed to assess the potential utility of two-dimensional shear wave elastography and texture analysis in dynamic monitoring of the progression of liver fibrosis in rat model.Methods:Twenty rats were divided into control group(n=4)and experimental groups(n=4 per group)with carbon tetrachloride administration for 2,3,4,and 6 weeks.The liver stiffness measurement was performed by two-dimensional shear wave elastography,while the optimal texture analysis subsets to distinguish fibrosis stage were generated by MaZda.The results of elastography and texture analysis were validated through comparing with histopathology.Results:Liver stiffness measurement was 6.09±0.31 kPa in the control group and 7.10±0.41 kPa,7.80±0.93 kPa,8.64±0.93 kPa,9.91±1.13 kPa in the carbon tetrachloride induced groups for 2,3,4,6 weeks,respectively(P<0.05).By texture analysis,histogram and co-occurrence matrix had the most frequency texture parameters in staging liver fibrosis.Receiver operating characteristic curve of liver elasticity showed that the sensitivity and specificity were 95.0%and 92.5%to discriminate liver fibrosis and non-fibrosis,respectively.In texture analysis,five optimal parameters were selected to classify liver fibrosis and non-fibrosis.Conclusions:Two-dimensional shear wave elastography showed potential applications for noninvasive monitoring of the progression of hepatic fibrosis,even in mild fibrosis.Texture analysis can further extract and quantify the texture features in ultrasonic image,which was a supplementary to further visual information and acquired high diagnostic accuracy for severe fibrosis.

Living-donor or deceased-donor liver transplantation for hepatic carcinoma:A case-matched comparison

AIM:To compare the surgical outcomes between living-donor and deceased-donor liver transplantation in patients with hepatic carcinoma.METHODS:From January 2007 to December 2010,257 patients with pathologically confirmed hepatic carcinoma met the eligibility criteria of the study.Forty patients who underwent living-donor liver transplantation(LDLT)constituted the LDLT group,and deceaseddonor liver transplantation(DDLT)was performed in217 patients.Patients in the LDLT group were randomly matched(1:2)to patients who underwent DDLT using a multivariate case-matched method,so 40 patients in the LDLT group and 80 patients in the DDLT group were enrolled into the study.We compared the two groups in terms of clinicopathological characteristics,postoperative complications,long-term cumulative survival and relapse-free survival outcomes.The modified Clavien-Dindo classification system of surgical complications was used to evaluate the severity of perioperative complications.Furthermore,we determined the difference in the overall biliary complication rates in the perioperative and follow-up periods between the LDLT and DDLT groups.RESULTS:The clinicopathological characteristics of the enrolled patients were comparable between the two groups.The duration of operation was significantly longer(553 min vs 445 min,P<0.001)in the LDLT group than in the DDLT group.Estimated blood loss(1188 mL vs 1035 mL,P=0.055)and the proportion of patients with intraoperative transfusion(60.0%vs 43.8%,P=0.093)were slightly but not significantly greater in the LDLT group.In contrast to DDLT,LDLT was associated with a lower rate of perioperative gradeⅡcomplications(45.0%vs 65.0%,P=0.036)but a higher risk of overall biliary complications(27.5%vs 7.5%,P=0.003).Nonetheless,21 patients(52.5%)in the LDLT group and 46 patients(57.5%)in the DDLT group experienced perioperative complications,and overall perioperative complication rates were similar between the two groups(P=0.603).No significant difference was observed in 5-year overall survival(74.1%vs 66.6%,P=0.372)or relapse-free survival(72.9%vs 70.9%,P=0.749)between the LDLT and DDLT groups.CONCLUSION:Although biliary complications were more common in the LDLT group,this group did not show any inferiority in long-term overall survival or relapse-free survival compared with DDLT.

Expression of mRNA-encoding subunits of N-methyl-D-aspartate receptor in the hypothalamus in sustained monaural block of auditory air-conduction model rats

A sustained monaural block of auditory air-conduction model was established in rats through subcutaneous suture in the right ear canal.The gene expression levels of hypothalamic N-methyl-D-aspartate receptor NR1,NR2A,NR2B and NR2C mRNA in the auditory central nervous system of Sprague-Dawley rats at postnatal 9,23,37 days were determined after an environmental change.Reverse transcription-PCR assay showed that the critical period for the development of NR1,NR2A,and NR2B subunits in the left hypothalamus and NR1-and NR2B-dependent auditory neurons in the right hypothalamus terminated 23 days after the suture in the right ear.The critical period for the development of NR2A subunit-dependent auditory neurons in the right hypothalamus was terminated by postnatal day 37.The results confirmed that N-methyl-D-aspartate receptor subunits in the hypothalamus may be regulated by the auditory environment.

Massage and vocal training in a case of spasmodic dysphonia

A 35-year-old female patient with spasmodic dysphonia underwent massage and vocal training. Chinese manipulation was administered to Tiantu （CV 22） and Lianquan （CV 23）, the convergent acupoints of the conception meridian and Yin link vessel, Yamen （GV 15） and Fengfu （GV 16）, the convergent acupoints of Du meridian and Yang link vessel, as well as large intestine channel of hand Yangming Hegu （LI 4）, by gently pressing and rubbing for stimulation. In addition, throat muscle massage therapy and vocal training were performed. Results were evaluated using acoustic measurements in combination with a single statistical method. A comprehensive treatment combining vocal training and face-neck massage was shown to relieve dystonia of facial-cervical muscles in patients, as well as improve voice quality while providing a safe treatment method.

Computational Analysis of Drought Stress-Associated miRNAs and miRNA Co-Regulation Network in Physcomitrella patens

miRNAs are non-coding small RNAs that involve diverse biological processes. Until now, little is known about their roles in plant drought resistance. Physcomitrella patens is highly tolerant to drought; however, it is not clear about the basic biology of the traits that contribute P. patens this important character. In this work, we discovered 16 drought stress-associated miRNA （DsAmR） families in P. patens through computational analysis. Due to the possible discrepancy of expression periods and tissue distributions between potential DsAmRs and their targeting genes, and the existence of false positive results in computational identification, the prediction results should be examined with further experimental validation. We also constructed an miRNA co-regulation network, and identi- fied two network hubs, miR902a-Sp and miR414, which may play important roles in regulating drought-resistance traits. We distributed our results through an online database named ppt-miRBase, which can be accessed at http：/Poioinfor.cnu.edu.cn/ppt_miRBase/index.php. Our methods in finding DsAmR and miRNA co-regulation network showed a new direction for identifying miRNA functions.

Support induced phase engineering toward superior electrocatalyst

The phase transformation of catalysts has been extensively observed in heterogeneous catalytic reactions that hinder the long cycling catalysis,and it remains a big challenge to precisely control the active phase during the complex conditions in electrochemical catalysis.Here,we theoretically predict that carbon-based support could achieve the phase engineering regulation of catalysts by suppressing specific phase transformation.Taken single-walled carbon nanotube(SWCNT)as typical support,combined with calculated E-pH(Pourbaix)diagram and advanced synchrotron-based characterizations technologies prove there are two different active phases source from cobalt selenide which demonstrate that the feasibility of using support effect regulating the potential advantageous catalysts.Moreover,it is worth noting that the phase engineering derived Co_(3)O_(4)-SWCNT exhibits a low overpotential of 201 mV for delivering the current density of 10 mA/cm^(2)in electrocatalytic oxygen evolution reaction(OER).Also,it reaches a record current density of 529 mA/cm^(2)at 1.63 V(vs.RHE)in the electrocatalytic urea oxidation reaction(UOR),overwhelming most previously reported catalysts.

Association between Metabolic Dysfunction-associated Fatty Liver Disease and Cognitive Impairment

Background and Aims:Metabolic dysfunction-associated fatty liver disease(MAFLD)is a newly proposed term based on modified criteria.Although nonalcoholic fatty liver disease(NAFLD)has been well-documented as a multisystem dis-ease,research on the correlation of MAFLD and extra-hepatic diseases is limited.This study aimed to clarify the association of MAFLD,as well as NAFLD status with cognitive function.Methods:A total of 5,662 participants 20-59 years of age who underwent cognitive tests and liver ultrasonography in the Third National Health and Nutrition Examination Survey were included in the analysis.Cognitive function was evalu-ated using three computer-administered tests,the serial dig-it learning test(SDLT),the simple reaction time test(SRTT)and the symbol digit substitution test(SDST).Results:Par-ticipants with MAFLD had significantly poorer performance on the SRTT[odds ratio(OR)1.47,95%confidence interval(CI):1.14-1.89)].MAFLD with moderate-severe liver stea-tosis was associated with higher risks of scoring low in the SDLT(OR 1.37,95%CI:1.04-1.82)and SRTT(OR 1.55,95%CI:1.19-2.02).NAFLD combined with metabolic dys-function,instead of NAFLD without metabolic disorders,was associated an increased risk of a low SRTT score(OR 1.44,95%CI:1.10-1.82).MAFLD patients had a high probability of fibrosis,prediabetes,and diabetes and were also signifi-cantly associated with increased risks based on the SDST or SRTT score.Conclusions:MAFLD was significantly associ-ated with increased risk of cognitive impairment,especially among MAFLD patients with a high degree of liver fibrosis,moderate-severe steatosis,or hyperglycemia.

Inhibition of neddylation ameliorates DSS-induced colitis

Immune disorders are characterized by excessive immune cell activation and aberrant inflammatory responses.Cell signals have been noted to regulate immune cell functions and to contribute to immune diseases,for example,upon extracellular stimulation,cell receptormediated signals,including mammalian target of rapamycin/signal transducer and activator of transcription factor 31,2 and mitogen-activated protein kinase/nuclear factor-κB,3,4 induce the expression of proinflammatory cytokines and molecules,thereby resulting in immune cell activation and sustained inflammation,as seen in inflammatory bowel diseases and other immune disorders.