Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis

AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001). CONCLUSION: For treatment of cholecystocholedo-cholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.

Identification of WWTR1 as an immune infiltration-correlated prognostic biomarker in colon cancer

WWTR1,a gene related to the TGF-βsignaling pathway,has been elucidated to be involved in oncogenesis in multiple studies.There is,however,no research on its link to immune infiltration in colon cancer.The TCGA database has identified WWTR1,a gene related to the TGF-βsignaling pathway,which is lowly expressed in colon cancer patients compared to normal subjects.Meanwhile,we produced the Kapan-Meier curve with GEO and the TCGA database,which revealed that colon cancer patients with high WWTR1 expression had a poor prognosis.We discovered that high expression of WWTR1 in colon cancer was associated with clinical stage,pathological T-stage,and lymphatic metastasis after examining the clinical characteristics of colon cancer patients.WWTR1 was found to be an independent predictive factor for colon cancer in a multivariate Cox regression study.Infiltration of immunological cells(B cells,CD8^(+)T cells,CD4^(+)T cells,Macrophage,Neutrophil,Dendritic cells)was linked to WWTR1 expression.In colon cancer,WWTR1 expression was also found to be favorably linked with major immune cell markers.According to an analysis of WWTR1 DCGs,GO,and KEGG enrichment analysis,WWTR1 expression levels were associated with ameboidal-type cell migration,focal adhesion,actin binding,Chemical carcinogenesis-reactive oxygen species,Non-alcoholic fatty liver disease,and Alzheimer disease.These findings imply that WWTR1 is a prognostically valuable and important biomarker for colon cancer,and imply that its expression is strongly linked to colon cancer immune infiltration,making it a potential new target for colon cancer biotherapy.