TRIANGLE operation,combined with adequate adjuvant chemotherapy,can improve the prognosis of pancreatic head cancer:A retrospective study

BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.

Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy:A propensity score-matched study

BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.

Investigation of Status Quo of Dietary Behavior in Patients with Inflammatory Bowel Disease

Objective: To investigate the status quo of dietary behavior of patients with inflammatory bowel disease (IBD) and analyze its influence factors. Methods: All patients (n = 104) who went to the department of gastroenterology of Hua Dong Hospital were recruited. Dietary behavior of patients was investigated by a questionnaire self-designed while the nutritional status was evaluated using the Patient-generated Subjective Global Assessment (PG-SGA). Results: Among 104 cases with IBD, the numbers of well dietary belief were 58 cases (55.8%) and the poor were 46 cases (45.2%). The good eating habits were 33 cases (31.7%), the general were 25 cases (24.0%) and the poor were 46 (44.2%). The adequate intakes of carbohydrate, protein and fat were separately 36 cases (34.6%), 25 cases (24.0%) and 33 cases (31.7%) while the inadequate intakes were separately 68 cases (65.4%), 79 cases (76.0%) and 71 cases (68.3%). Sex, culture degree and duration were influence factors of the dietary belief (P < 0.05). Conclusion: The problems in dietary behavior are not optimistic. Most patients with IBD are with poor dietary belief and eating habits while the intake of carbohydrate, protein and fat is insufficient although the choice of food is reasonable. And majority of patients were combined with malnutrition. Education of the dietary knowledge about IBD should be strengthened, especially for patients who are female, short-term duration and lower culture degree.

Ductular reaction in non-alcoholic fatty liver disease:When Macbeth is perverted

Non-alcoholic fatty liver disease(NAFLD)or metabolic(dysfunction)-associated fatty liver disease is the leading cause of chronic liver diseases defined as a disease spectrum comprising hepatic steatosis,non-alcoholic steatohepatitis(NASH),liver fibrosis,cirrhosis,and hepatic carcinoma.NASH,characterized by hepatocyte injury,steatosis,inflammation,and fibrosis,is associated with NAFLD prognosis.Ductular reaction(DR)is a common compensatory reaction associated with liver injury,which involves the hepatic progenitor cells(HPCs),hepatic stellate cells,myofibroblasts,inflammatory cells(such as macrophages),and their secreted substances.Recently,several studies have shown that the extent of DR parallels the stage of NASH and fibrosis.This review summarizes previous research on the correlation between DR and NASH,the potential interplay mechanism driving HPC differentiation,and NASH progression.

Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China:A national multicenter survey of 35,566 individuals

Objective:This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in China.Methods:This study was conducted by 45 tertiary Grade-A hospitals in China.Online and offline questionnaire data were obtained from patients infected with COVID-19 between December 28,2022,and February 21,2023.The collected information included basic demographics,medical history,smoking and drinking history,vaccination history,changes in olfactory and gustatory functions before and after infection,and other postinfection symptoms,as well as the duration and improvement status of olfactory and gustatory disorders.Results:Complete questionnaires were obtained from 35,566 subjects.The overall incidence of olfactory and taste dysfunction was 67.75%.Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction.Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction.Before infection,the average olfactory and taste VAS scores were 8.41 and 8.51,respectively;after infection,they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey.The median duration of dysosmia and dysgeusia was 15 and 12 days,respectively,with 0.5%of patients having symptoms lasting for more than 28 days.The overall self-reported improvement rate was 59.16%.Recovery was higher in males,never smokers,those who received two or three vaccine doses,and those that had never experienced dental health issues,or chronic accompanying symptoms.Conclusions:The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in China.Incidence and prognosis are influenced by several factors,including sex,SARS-CoV-2 vaccination,history of head-facial trauma,nasal and oral health status,smoking and drinking history,and the persistence of accompanying symptoms.

Chinese Association for the Study of Pain:Expert consensus on diagnosis and treatment for lumbar disc herniation

Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.

压力式与电磁式体外冲击波治疗肩周炎的对照研究

目的通过压力式冲击波和电磁式冲击波对于肩周炎的疼痛治疗效果和安全性两方面进行对照研究,为肩周炎的无创治疗提供一种治疗方案。方法选取复旦大学附属华东医院疼痛科就诊并明确诊断为肩周炎的患者共98例,随机分为两个实验组:A组予压力式冲击波治疗、B组予电磁式冲击波治疗,所有患者每星期治疗1次,每次治疗间隔为7d,共计进行3个月共12次冲击波治疗。治疗前和最后1次治疗后VAS评分。结果 VAS评分压力组(A组)治疗前6.41±0.123,治疗后1.49±0.11;电磁组(B组)治疗前6.53±0.13,治疗后1.55±0.11。两组患者治疗后的疼痛分值都低于治疗前的疼痛分值,治疗前后的疼痛评分对比差异具有统计学意义(<0.05);两者安全性方面,电磁式冲击波不良反应发生率高于压力式,差异有统计学意义。末次冲击波治疗后两组之间的疗效基本一致,两组的最终疗效无统计学差异(>0.05),压力组的治愈率为75.5%(37例),有效率为100%(49例),不良反应发生率为2.0%(1例);电磁组的治愈率为77.6%(38例),有效率为100%(49例),不良反应发生率为44.9%(22例)。结论压力式冲击波和电磁式冲击波治疗肩周炎均安全有效。

Chinese Association for the Study of Pain:Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China(2020 edition)

Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.

Effect of Feeding Management on Aspiration Pneumonia in Elderly Patients with Dysphagia

Objective： To investigate the effects of feeding safety instructions and dietary intervention on aspiration pneumonia in elderly patients with dysphagia. Methods： The study included 40 long-term hospitalized elderly patients with dysphagia who needed oral intake, According to the voluntary and matching principle, participants were divided into the intervention group （n =20） and control group （n = 20）. We formed a multi-disciplinary team including clinical nurses, rehabilitation therapists and nutritionists. Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management. The patients in the control group were fed with semi-solid food, thick liquid, a partial mushy diet and so on according to their swallowing situations and tastes or preferences. The patients in the intervention group were fed with an all mushy diet. Patients in both groups were able to eat foods on their own or with assistance. Results： After a three-month intervention, the incidence of aspiration pneumonia in both groups was decreased, and the difference was statistically significant （P〈0.05）. In the control group, seven patients had aspiration pneumonia, including two cases who died after nasogastric feeding due to aggravated dysphagia. In the control group, seven patients had aspiration pneumonia, including two cases was given nasogastric feeding due to aggravated dysphagia and then one case died. In the intervention group, four patients had aspiration pneumonia. There was no dropouts in either group. Conclusions： Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management. Nurses should conduct safety guidance for care catering and encouraging patients to actively eat a mushy diet. The diet can reduce the incidence of aspiration pneumonia, maintain oral intake and improve the quality of life.

Effect of Internet technology on extended care in elderly patients with diabetic feet

Objective： To evaluate the effect of Internet technology on continuing nursing in elderly patients with diabetic feet, Method： From January 2015 to July 2016,12 elderly patients with diabetic foot ulcers were enrolled from the Endocrinology Department in our hospital. We used ＂WeChat＂, ＂E nursing＂ and other Internet technologies to perform remote extended care and to observe the foot ulcer outcomes. Results： All foot ulcers healed with a wound healing time between 38 and 73 days （average 57.08 ~ 12.69 days）. Patients did not need to travel long distances to seek medical treatment for foot ulcers, improving their satisfaction. Conclusions： The implementation of extended care for elderly patients with diabetic foot ulcers was based on the application of Internet technology. It is helpful to facilitate medical treatment, share high quality health resources and promote disease rehabilitation.

Long-Term Continuous Light Exposure Affects Body Weight and Blood Glucose Associated with Inflammation in Female Rats

Studies have indicated that night lights interfere with the circadian rhythm in the human body and threaten human health. Our previous studies indicated that continuous light exposure severely damages the reproductive endocrine system of female rats resembles polycystic ovary syndrome in women. In this study, we used the continuous measurement method to observe changes in the basal physiological indicators of female rats in an abnormal light exposure environment. Our study results indicated that in female rats: 1) the body temperature first continuously and gradually increased followed by a gradually decrease;2) the increase in body weight slowed down at the late stage of the experimental process;3) the random blood glucose level increased, and the fasting serum insulin level decreased;and 4) the serum C-reactive protein level increased. Our study investigated for the first time the correlation between the duration of continuous light exposure in female rats and the continuously measured basal physiological indicators and preliminarily discussed the effect of continuous light exposure on female basal metabolism and the possible inflammation mechanism. We propose that long-term continuous exposure to night lights in females severely damages their immune and metabolic systems.

Chemical renal artery denervation with appropriate phenol in spontaneously hypertensive rats

Objective To explore the effectiveness of renal denervation (RDN) on blood pressure with the appropriate dosage of phenol/ethanol solution in spontaneously hypertensive rats (SHRs). Methods RDN was performed on the bilateral renal artery. Forty SHRs were divided into four groups according on the dosage of phenol (10% phenol in absolute ethanol): sham group, 0.5 mL phenol group, 1 mL phenol group and 1.5 mL phenol group (n = 10 in each group). Blood pressure was measured by tail-cuff plethysmography. Plasma creatinine was determined four weeks after the treatment. The kidneys and renal arteries were collected and processed for histological examination. Results A sustained decrease in systolic blood pressure (SBP) was only observed after the application of 1 mL phenol for four weeks, while SBP was lowered during the first week after RDN and increased in the following three weeks in the 0.5 mL and 1.5 mL phenol groups compared with the sham group. Renal norepinephrine (NE) was significantly decreased four weeks after RDN in the 1 mL and 1.5 mL phenol group compared with the sham group, but not in the 0.5 ml group. RDN with 1 mL phenol obviously reduced glomerular fibrosis. Histopathological analysis showed that tyrosine hydroxylase immunoreactivity was lower in the 1 mL and 1.5 mL phenol groups compared with the sham group. Moderate renal artery damage occurred in the 1.5 mL phenol group. Conclusion Chemical denervation with 1 ml phenol (10% phenol in absolute ethanol) effectively and safely damaged peripheral renal sympathetic nerves and contributed to the sustained reduction of blood pressure in SHRs.

Overexpressed NEDD8 as a potential therapeutic target in esophageal squamous cell carcinoma

Objective:The hyperactivated neddylation pathway plays an important role in tumorigenesis and is emerging as a promising anticancer target.We aimed to study whether NEDD8(neural precursor cell expressed,developmentally down-regulated 8)might serve as a therapeutic target in esophageal squamous cell carcinoma(ESCC).Methods:The clinical relevance of NEDD8 expression was evaluated by using The Cancer Genome Atlas(TCGA)database and tissue arrays.NEDD8-knockdown ESCC cells generated with the CRISPR/Cas9 system were used to explore the anticancer effects and mechanisms.Quantitative proteomic analysis was used to examine the variations in NEDD8 knockdown-induced biological pathways.The cell cycle and apoptosis were assessed with fluorescence activated cell sorting.A subcutaneous-transplantation mouse tumor model was established to investigate the anticancer potential of NEDD8 silencing in vivo.Results:NEDD8 was upregulated at both the mRNA and protein expression levels in ESCC,and NEDD8 overexpression was associated with poorer overall patient survival(mRNA level:P=0.028,protein level:P=0.026,log-rank test).Downregulation of NEDD8 significantly suppressed tumor growth both in vitro and in vivo.Quantitative proteomic analysis revealed that downregulation of NEDD8 induced cell cycle arrest,DNA damage,and apoptosis in ESCC cells.Mechanistic studies demonstrated that NEDD8 knockdown led to the accumulation of cullin-RING E3 ubiquitin ligases(CRLs)substrates through inactivation of CRLs,thus suppressing the malignant phenotype by inducing cell cycle arrest and apoptosis in ESCC.Rescue experiments demonstrated that the induction of apoptosis after NEDD8 silencing was attenuated by DR5 knockdown.Conclusions:Our study elucidated the anti-ESCC effects and underlying mechanisms of NEDD8 knockdown,and validated NEDD8 as a potential target for ESCC therapy.

Inflection Point Age in the Middle and Older Women—Jiangxi Province,China,2020-2022

Summary What is already known about this topic?Previous studies have predominantly examined the micro-level aspects of women aging inflection points,while macro-level research using big data on the inflection points of aging among middle-aged and elderly women in China is currently limited.

Comprehensive Management of Daily Living Activities,behavioral and Psychological Symptoms,and Cognitive Function in Patients with Alzheimer's Disease:A Chinese Consensus on Alzheimer's Disease

Alzheimer's disease(AD)is the most common cognitive disorder in the elderly.Its main clinical manifestations are cognitive decline(C),behavioral and psychological symptoms(B),and a decline in the activities of daily living(A),also known as ABC symptoms.Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis,comprehensive treatment,and prognosis of AD.To guide Chinese clinical practice for optimization of the comprehensive management of AD,in 2018,The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD.Based on a review of the evidence,the consensus summarizes the pathogenesis,pathological changes,clinical manifestations,evaluation,diagnosis,drug and non-drug treatment,and patient care for AD.Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients.The new consensus provides a feasible AD management process for clinicians.

Characteristics of Lymphocyte Nuclear Factor-κB Signal Transduction Kinase Expression in Aging Process and Regulatory Effect of Epimedium Flavonoids

Objective：To study the characteristics of lymphocyte nuclear factor kappa B（NF-κB） signal transduction kinase-related molecular mRNA differential expressions at various month age segments in aging process and the intervening effect of Epimedium flavonoids（EF） on it.Methods：Sixty SD rats were divided into six groups,according to animals＇ age,i.e.,the 3 days（d） group,the 4 months（m） group,the 10 m group,the 18 m group,the 27 m group,and the 27 m＋EF group.RNA was extracted from separated splenic lymphocytes. Adopting NF-κB signal path functional genome oligonucleotide gene-chip（128 related genes）,the integral characteristics and differences of NF-κB signal transduction kinase-related mRNA expressions were determined, and the intervening effect of EF was examined.Results：The mean level of the NF-κB signal transduction kinase-related mRNA expressions in rats＇ splenic lymphocytes lowered with aging;the highest expression was presented at 3 d after birth,and then,it lowered gradually,with the lowest level at 18 m or 27 m.After EF intervention,the expression level was raised to the 10-18 m level in the aged rats.Conclusion：The changing rules of lymphocyte NF-κB-signal-transduction-kinase-related mRNA expressions in various stages of aging are helpful for selecting the well time for preventing and intervening aging,and will also give a hint to the molecular index for assessment of senility retarding researches.

The CRL3^(BTBD9) E3 ubiquitin ligase complex targets TNFAIP1 for degradation to suppress cancer cell migration

Tumor necrosis factor alpha-induced protein 1(TNFAIP1)modulates a plethora of important biological processes,including tumorigenesis and cancer cell migration.However,the regulatory mechanism of TNFAIP1 degradation remains largely elusive.In the present study,with a label-free quantitative proteomic approach,TNFAIP1 was identified as a novel ubiquitin target of the Cullin-RING E3 ubiquitin ligase(CRL)complex.More importantly,Cul3-ROC1(CRL3),a subfamily of CRLs,was identified to specifically interact with TNFAIP1 and promote its polyubiquitination and degradation.Mechanistically,BTBD9,a specific adaptor component of CRL3 complex,was further defined to bind and promote the ubiquitination and degradation of TNFAIP1 in cells.As such,downregulation of BTBD9 promoted lung cancer cell migration by upregulating the expression of TNFAIP1,whereas TNFAIP1 deletion abrogated this effect.Finally,bioinformatics and clinical sample analyses revealed that BTBD9 was downregulated while TNFAIP1 was overexpressed in human lung cancer,which was associated with poor overall survival of patients.Taken together,these findings reveal a previously unrecognized mechanism by which the CRL3^(BTBD9) ubiquitin ligase controls TNFAIP1 degradation to regulate cancer cell migration.

B/S Brace as an Alternative Treatment for Ingrown Toenails

To the Editor：Ingrown toenail,also known as onychocryptosis or unguis incarnates,occurs when the periungual skin is punctured by its corresponding nail plate,resulting in a cascade of foreign body,inflammatory,infectious,and reparative processes.Most commonly,big toe is involved.Without proper treatment,it would be very painful and negatively affects the patient＇s walking and greatly hampers the quality of the individual＇s life.Till now,many different treatments have been proposed.In general,the treatment for ingrown toenails can be divided into conservative approaches （including medical and podiatric methods） and surgical approaches.The choice of treatment is usually based on the Heifetz classification stage of the ingrown toenails.Mostly ingrown toenails with Heifetz Stage Ⅱ and Ⅲ need surgical approaches or podiatric methods.