机器人与腹腔镜手术治疗子宫内膜癌的对比研究

目的对比达芬奇机器人与腹腔镜手术治疗子宫内膜癌的临床疗效,探讨达芬奇机器人手术的有效性、安全性及学习曲线。方法选取2016年8月—2018年2月广西医科大学第一附属医院收治的子宫内膜癌患者,随机分为实验组和对照组。收集患者的基本信息、围手术期指标及手术费用,对数据进行统计学分析。结果两组患者组织学分级比较,差异有统计学意义(P<0.05)。两组患者手术时间、术中出血量、术后排气时间、拔引流管时间、住院时间、手术费用及疼痛评分比较,差异有统计学意义(P<0.05)。结论达芬奇机器人辅助子宫内膜癌分期手术是一种安全有效的手术方式,比腹腔镜手术具有更好的短期手术效果,但手术费用较高。

Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction

AIM To investigate whether fecal microbiota transplantation(FMT) prevents hepatic encephalopathy(HE) in rats with carbon tetrachloride(CCl4)-induced acute hepatic dysfunction.METHODS A rat model of HE was established with CCl4. Rat behaviors and spatial learning capability were observed, and hepatic necrosis, intestinal mucosal barrier, serum ammonia levels and intestinal permeability were determined in HE rats receiving FMT treatment. Furthermore, the expression of tight junction proteins(Claudin-1, Claudin-6 and Occludin), Toll-like receptor(TLR) 4/TLR9, interleukin(IL)-1β, IL-6 and tumor necrosis factor(TNF)-α was examined.RESULTS FMT improved rat behaviors, HE grade and spatial learning capability. Moreover, FMT prevented hepaticnecrosis and intestinal mucosal barrier damage, leading to hepatic clearance of serum ammonia levels and reduced intestinal permeability. The expression of TLR4 and TLR9, two potent mediators of inflammatory response, was significantly downregulated in the liver of rats treated with FMT. Consistently, circulating proinflammatory factors such as interleukin(IL)-1β, IL-6 and tumor necrosis factor-α were remarkably decreased, indicating that FMT is able to limit systemic inflammation by decreasing the expression of TLR4 and TLR9. Importantly, HE-induced loss of tight junction proteins(Claudin-1, Claudin-6 and Occludin) was restored in intestinal tissues of rats receiving FMT treatment. CONCLUSION FMT enables protective effects in HE rats, and it improves the cognitive function and reduces the liver function indexes. FMT may cure HE by altering the intestinal permeability and improving the TLR response of the liver.

Current Perspective in the Discovery of Anti-aging Agents from Natural Products

Aging is a process characterized by accumulating degenerative damages,resulting in the death of an organism ultimately.The main goal of aging research is to develop therapies that delay age-related diseases in human.Since signaling pathways in aging of Caenorhabditis elegans(C.elegans),fruit flies and mice are evolutionarily conserved,compounds extending lifespan of them by intervening pathways of aging may be useful in treating age-related diseases in human.Natural products have special resource advantage and with few side effect.Recently,many compounds or extracts from natural products slowing aging and extending lifespan have been reported.Here we summarized these compounds or extracts and their mechanisms in increasing longevity of C.elegans or other species,and the prospect in developing antiaging medicine from natural products.

Clinical Outcome of Autologous Hematopoietic Stem Cell Infusion via Hepatic Artery or Portal Vein in Patients with End-stage Liver Diseases

Objective To investigate the efficacy of hematopoietic stem cell(HSC) transplantation via the hepatic artery vs.the portal vein for end-stage liver disease(ESLD).Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein.Liver function was examined at 3,6,and 12 months after transplantation.Liver biopsy results were analyzed using the Knodell score.Results Eighty patients(58 males and 22 females) were enrolled in the study.The Child-Pugh score was grade B in 69 cases,and grade C in the remaining 11 cases.HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients.ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation(P<0.05 compared with pre-transplantation levels).Total bilirubin levels decreased significantly in both groups at 3,6,and 12 months after HSC transplantation(P<0.05 compared with pre-transplantation levels).Additionally,prothrombin time decreased in both groups at 12 months after HSC transplantation(P<0.05 compared with pre-transplantation level).There were no significant differences in ALT,total bilirubin and prothrombin time between the two groups either before or after transplantation.Moreover,Knodell score decreased significantly at 6 and 12 months.Histological examination showed that liver cell edema,degeneration,necrosis,and inflammation were significantly relieved at 3,6,and 12 months after transplantation.The incidence of portal vein thrombosis,upper gastrointestinal bleeding,and hepatic encephalopathy were 1.25%,3.75%,and 2.5% respectively.The one-year survival rate was 100%.Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients.The administration route of HSC has no significant impact on the efficacy of transplantation.

Otophylloside B Protects Against AβToxicity in Caenorhabditis elegans Models of Alzheimer’s Disease

Alzheimer’s disease(AD)is a major public health concern worldwide and the few drugs currently available only treat the symptoms.Hence,there is a strong need to find more effective anti-AD agents.Cynanchum otophyllum is a traditional Chinese medicine for treating epilepsy,and otophylloside B(Ot B),isolated from C.otophyllum,is the essential active component.Having previously identified anti-aging effects of Ot B,we evaluated Ot B for AD prevention in C.elegant models of AD and found that Ot B extended lifespan,increased heat stress-resistance,delayed body paralysis,and increased the chemotaxis response.Collectively,these results indicated thatOt B protects against Aβtoxicity.Further mechanistic studies revealed that Ot B decreased Aβdeposition by decreasing the expression of Aβat the mRNA level.Genetic analyses showed that Ot B mediated its effects by increasing the activity of heat shock transcription factor(HSF)by upregulating the expression of hsf-1 and its target genes,hsp-12.6,hsp-16.2 and hsp-70.Ot B also increased the expression of sod-3 by partially activating DAF-16,while SKN-1 was not essential in Ot B-mediated protection against Aβtoxicity.

Identification of hepatitis B virus and liver cancer bridge molecules based on functional module network

BACKGROUND The potential role of chronic inflammation in the development of cancer has been widely recognized.However,there has been little research fully and thoroughly exploring the molecular link between hepatitis B virus(HBV)and hepatocellular carcinoma(HCC).AIM To elucidate the molecular links between HBV and HCC through analyzing the molecular processes of HBV-HCC using a multidimensional approach.METHODS First,maladjusted genes shared between HBV and HCC were identified by disease-related differentially expressed genes.Second,the protein-protein interaction network based on dysfunctional genes identified a series of dysfunctional modules and significant crosstalk between modules based on the hypergeometric test.In addition,key regulators were detected by pivot analysis.Finally,targeted drugs that have regulatory effects on diseases were predicted by modular methods and drug target information.RESULTS The study found that 67 genes continued to increase in the HBV-HCC process.Moreover,366 overlapping genes in the module network participated in multiple functional blocks.It could be presumed that these genes and their interactions play an important role in the relationship between inflammation and cancer.Correspondingly,significant crosstalk constructed a module level bridge for HBV-HCC molecular processes.On the other hand,a series of non-coding RNAs and transcription factors that have potential pivot regulatory effects on HBV and HCC were identified.Among them,some of the regulators also had persistent disorders in the process of HBV-HCC including microRNA-192,microRNA-215,and microRNA-874,and early growth response 2,FOS,and Kruppel-like factor 4.Therefore,the study concluded that these pivots are the key bridge molecules outside the module.Last but not least,a variety of drugs that may have some potential pharmacological or toxic side effects on HBV-induced HCC were predicted,but their mechanisms still need to be further explored.CONCLUSION The results suggest that the persistent inflammatory environment of HBV can be utilized as an important risk factor to induce the occurrence of HCC,which is supported by molecular evidence.

Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature

BACKGROUND Choledocholithiasis removal via endoscopic retrograde cholangiopancreatography(ERCP)then followed by laparoscopic cholecystectomy(LC)has gradually become the principal method in the treatment of gallstones and choledocholithiasis.We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis,with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury.CASE SUMMARY A total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP.The efficacy was evaluated via operation success rate,calculus removal rate,postoperative hospital stay and average hospitalization costs;the safety was evaluated through perioperative complication probability,gallbladder function detection and gallstones recrudesce.The calculus removal rate reached 100%,and patients had mild adverse events,including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase;both were relieved after corresponding treatment,the remaining cases had no complications.The average hospital stay and hospitalization costs were 6.16±1.47 d and 5194±696 dollars.The 3-11 mo follow-up revealed that gallbladder contracted well,without recurrence of gallstones.CONCLUSION This is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity.The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.

Efficacy and safety of laparoscopic radical resection following neoadjuvant therapy for pancreatic ductal adenocarcinoma:A retrospective study

BACKGROUND Multiple studies have demonstrated that neoadjuvant chemotherapy(NACT) can prolong the overall survival of pancreatic ductal adenocarcinoma(PDAC) patients. However, most studies have focused on open surgery following NACT.AIM To investigate the efficacy and safety of laparoscopic radical resection following NACT for PDAC.METHODS We retrospectively analyzed the clinical data of 15 patients with pathologically confirmed PDAC who received NACT followed by laparoscopic radical surgery in our hospital from December 2019 to April 2022. All patients underwent abdominal contrast-enhanced computed tomography(CT) and positron emission tomography-CT before surgery to accurately assess tumor stage and exclude distant metastasis.RESULTS All 15 patients with pancreatic cancer were successfully converted to surgical resection after NACT, including 8 patients with pancreatic head cancer and 7 patients with pancreatic body and tail cancer. Among them, 13 patients received the nab-paclitaxel plus gemcitabine regimen(gemcitabine 1000 mg/m^(2) plus nabpaclitaxel 125 mg/m^(2) on days 1, 8, and 15 every 4 wk) and 2 patients received the modified FOLFIRINOX regimen(intravenous oxaliplatin 68 mg/m^(2), irinotecan 135 mg/m^(2), and leucovorin 400 mg/m^(2) on day 1 and fluorouracil 400 mg/m^(2) on day 1, followed by 46-h continuous infusion of fluorouracil 2400 mg/m^(2)). After each treatment cycle, abdominal CT, tumor markers, and circulating tumor cell counts were reviewed to evaluate the treatment efficacy. All 15 patients achieved partial remission. The surgical procedures included laparoscopic pancreaticoduodenectomy(LPD, n = 8) and laparoscopic radical antegrade modular pancreatosplenectomy(L-RAMPS, n = 7). None of them were converted to a laparotomy. One patient with pancreatic head carcinoma was found to have portal vein involvement during the operation, and LPD combined with vascular resection and reconstruction was performed. The amount of blood loss and operation times of L-RAMPS vs LPD were 435.71 ± 32.37 m L vs 343.75 ± 145.01 m L and 272.52 ± 49.14 min vs 444.38 ± 68.63 min, respectively. The number of dissected lymph nodes was 16.87 ± 4.10, and 3 patients had positive lymph nodes. One patient developed grade B postoperative pancreatic fistula(POPF) after LRAMPS, and one patient experienced jaundice after LPD. None of the patients died after surgery. As of April 2022, progressive disease was noted in 4 patients, 2 patients had liver metastasis, and one had both liver metastasis and lymph node metastasis and died during the follow-up period.CONCLUSION Laparoscopic radical resection of PDAC after NACT is safe and effective if it is performed by a surgeon with rich experience in LPD and in a large center of pancreatic surgery.

Sequential therapy with combined trans-papillary endoscopic nasopancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts

BACKGROUND Endoscopic retrograde pancreatic drainage(ERPD)and stent implantation has become the major treatment method for pancreatic pseudocysts.However,it is associated with a high recurrence rate and infection.AIM To manage pancreatic pseudocysts by sequential therapy with endoscopic nasopancreatic drainage(ENPD)combined with ERPD and evaluate the treatment outcome.METHODS One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed.There were 152 cases of intubation via the duodenal papilla,of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD(two-step procedure).The success rate of the procedure,incidence of complications(infection,bleeding,etc.),recurrence,and length and cost of hospitalization were compared between the two groups.RESULTS The incidence of infection was significantly higher in the ERPD group(12 cases)than in the two-step procedure group(2 cases).Twelve patients developed infection in the ERPD group,and anti-infection therapy was effective in five cases but not in the remaining seven cases.Infection presented as fever and chills in the two-step procedure group.The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group(P<0.05).Similarly,the recurrence rate was significantly higher in the ERPD group(19 cases)than in the two-step procedure group(0 cases).CONCLUSION Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.

Enhancing lithium-ion and electric conductive Li_(2)FeSiO_(4)cathode through in situ boron-doping and carbon-coating strategy

The extremely low electrical conductivity and ion-diffusion coefficient of Li_(2)FeSiO_(4)limits its application as a cathode material in lithium-ion batteries.Therefore,in situ boron-doped Li_(2)FeSi_(1)-xB_(x)O_(4-δ)/C(x=0,0.01,0.03,0.05 and 0.07)at the Si site was prepared via the solid-state reaction method using pitch as the c arbon source.B doping in the lattice structure and a c arbon coating on the surface of the composites could effectively enhance the Li^(+)/electron conductivity.Moreover,the reduced particle size of the active material with the relatively high specific area via borondoped modification could improve the wettability between the electrolyte and cathode.With the synergistic effect of appropriate boron doping and carbon coating,it exhibits a good rate performance,specific capacity,and cycling performance.As a result,the as-prepared Li_(2)FeSi_(0.95)B_(0.05)O_(4-δ)/C cathode showed a high discharge capacity of 160.7mAh·g^(-1)at 0.2C,and the capacity retention rate was 96%after 100 cycles at 1.0C.This work presents an effective path for designing advanced cathode materials for lithium-ion batteries.