Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength,as well as a decline in functional ability,which is associated with malnutrition,hormonal changes,chronic inflammation,distur-bance of intestinal flora,and exercise quality.Pancreatoduodenectomy is a com-monly employed clinical intervention for conditions such as pancreatic head cancer,ampulla of Vater cancer,and cholangiocarcinoma,among others,with a notably high rate of postoperative complications.Sarcopenia is frequent in patients undergoing pancreatoduodenectomy.However,data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy(PD)are both limited and inconsistent.The PubMed,Cochrane Library,Web of Science,and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD.Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria.Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted.Forest and funnel plots were used,respectively,to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis.The patients in the sarcopenia group(n=833)had higher overall postoperative complication rates[odds ratio(OR)=3.42,95%confidence interval(CI):1.95-5.99,P<0.0001],higher Clavien-Dindo class≥Ⅲ major complication rates(OR=1.41,95%CI:1.04-1.90,P=0.03),higher bacteremia rates(OR=4.46,95%CI:1.42-13.98,P=0.01),higher pneumonia rates(OR=2.10,95%CI:1.34-3.27,P=0.001),higher pancreatic fistula rates(OR=1.42,95%CI:1.12-1.79,P=0.003),longer hospital stays(OR=2.86,95%CI:0.44-5.28,P=0.02),higher mortality rates(OR=3.17,95%CI:1.55-6.50,P=0.002),and worse overall survival(hazard ratio=2.81,95%CI:1.45-5.45,P=0.002)than those in the non-sarcopenia group(n=1548).However,no significant inter-group differences were observed regarding wound infections,urinary tract infections,biliary fistulas,or postoperative digestive bleeding.CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD.Patients with preoperative sarcopenia have increased rates of complications and mortality,in addition to a poorer overall survival rate and longer hospital stays after PD.

车辆换挡缓冲阀充油特性的研究

以车辆换挡缓冲阀为研究对象,建立了缓冲阀工作过程的数学模型。然后利用Matlab/simulink分析了其结构参数对缓冲压力特性的影响。结果表明,缓冲阀芯和节流孔直径对缓冲压力特性的影响较大,缓冲弹簧和回位弹簧的刚度对缓冲压力特性有一定的影响。最后通过试验验证了缓冲阀数学模型的准确性。

Anti-hepatoma Effect of DC2.4 Cells Transfected with Tumor-Associated Antigen Cdc25C In Vitro

Objective Cell division cyclin 25 homolog C(Cdc25C)is a tumor-associated antigen candidate gene,and this may be used as an effective target in cancer treatment.The present study aims to evaluate the lysis effect of cytotoxic T lymphocytes(CTLs)induced by dendritic cell line DC2.4 overexpressing Cdc25C,and the feasibility of Cdc25C as a component in hepatoma immunotherapy.Methods The mouse Cdc25C gene was ligated into a lentiviral vector,and transfected into DC2.4 cells.The DC2.4 cell phenotype and cytokine secretion were determined by flow cytometry and ELISA,respectively.CD8^(+)T cells were sorted from the spleens of C57BL/6 mice using a magnetic bead sorting kit obtained from Miltenyi Biotech,Germany,and co-cultured with DC2.4 cells for one week as effector cells.Then,IL-2,granzyme B and perforin were detected in the CTL culture medium by ELISA.Next,time-resolved fluorescence immunoassay was used to detect the immune killing effect of Cdc25C-specific CTLs on target cells.Meanwhile,the effect of blocking MHC-I sites on target cells with a monoclonal anti-MHC-I antibody was evaluated.Results The results revealed that Cdc25C could be stably overexpressed in DC2.4 cells by LV-Cdc25C infection.DC2.4 cells transfected with LV-Cdc25C secreted more IL-6,IL-12,TNF-αand IFN-γ,and had higher expression levels of CD40,CD86,CCR7 and MHC-II than unaltered DC2.4 cells.The elevated Cdc25C in dendritic cells also further increased the secretion of IL-2,granzyme B and perforin to elicit Cdc25C-specific CTLs,and induced the higher cytotoxicity in Hepa1-6 cell lines(P<0.05),but this had no effect on the target cells when MHC-I monoclonal antibodies were blocked.Conclusion DC2.4 cells transfected with LV-Cdc25C can induce specific CTLs,and result in a strong cellular immune response.The dendritic cells that overexpress Cdc25C may be useful for hepatoma immunotherapy.

Buyang Huanwu decoction increases angiopoietin-1 expression and promotes angiogenesis and functional outcome after focal cerebral ischemia

Buyang Huanwu decoction （BYHWD）, a traditional Chinese herbal prescription, has been widely used clinically to treat stroke in China for hundreds of years; however, the mechanisms of this drug for stroke treatment are still unclear. This study aims to observe the cerebral angiogenesis effects of BYHWD on chronic brain injury after focal cerebral ischemia in rats and to explore its possible mechanisms. The ischemia was induced by occlusion of the right middle cerebral artery for 90 min. BYHWD （12.5 and 25.0 g/（kg.d）, equivalent to the dry weight of the raw materials） was orally administered twice a day beginning 2 h after surgery. BYHWD significantly attenuated the neurological dysfunction, infarct volume, and brain atrophy after ischemia. There was a significant increase in the microvessel density, as assessed by immunofluorescence CD31, and a significant increase in angiopoietin-1 （Ang-1） in the pe- numbra areas of the rats was shown by immunohistochemical staining and Western blotting. The results indicate that the neurorestorative effects of BYHWD are associated with angiogenesis and the enhancement of the expressions of Ang-1 on chronic brain injury after focal cerebral ischemia.

Treatment of Acute Cerebral Infarction by Sowthistle-leaf Ixeris Seedling

Objective: To summarize a decade of research on various aspects of Sowthistle-leaf Ixeris seedling for acute cerebral infarction. Methods: Thirty-six papers were collected from searches of CNKI, Wanfang, PubMed, and other databases and then they were summarized. Results: Researchers have carried out widespread and various pharmacological studies of Sowthistle-leaf Ixeris seedling, and have pursued different research directions on its etiology and pathogenesis, syndrome differentiation and treatment methods for acute cerebral infarction (ischemic stroke). With the development of Chinese medicine, its safety and non-toxic side effects have been recognized by the majority of scholars. The research results have contributed significantly to the treatment of acute cerebral infarction by Sowthistle-leaf Ixeris seedling. Conclusion: Sowthistle-leaf Ixeris seedling has extensive medicinal value and unique advantages in the treatment of acute cerebral infarction, especially in expanding brain vessels, increasing blood flow, reducing thrombosis, protecting brain cells, improving neurological impairment, and it has no toxic side effects.