Anti-EGFR antibody monotherapy for colorectal cancer with severe hyperbilirubinemia: A case report

BACKGROUND Hyperbilirubinemia with hepatic metastases is a common complication and a poor prognostic factor for colorectal cancer(CRC).Effective drainage is often im-possible before initiating systemic chemotherapy,owing to the liver’s diffuse metastatic involvement.Moreover,an appropriate chemotherapeutic approach for the treatment of hyperbilirubinemia is currently unavailable.CASE SUMMARY The patient,a man in his 50s,presented with progressive fatigue and severe jaundice.Computed tomography revealed multiple hepatic masses with thick-ened walls in the sigmoid colon,which was pathologically confirmed as a well-differentiated adenocarcinoma.No RAS or BRAF mutations were detected.The Eastern Cooperative Oncology Group(ECOG)performance status(PS)score was 2.Biliary drainage was impossible due to the absence of a dilated bile duct,and panitumumab monotherapy was promptly initiated.Subsequently,the bilirubin level decreased and then normalized,and the patient’s PS improved to zero ECOG score after four cycles of therapy without significant adverse events.CONCLUSION Anti-EGFR antibody monotherapy is a safe and effective treatment for RAS wild-type CRC and hepatic metastases with severe hyperbilirubinemia.

Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage

BACKGROUND Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events(AEs).To overcome these problems,endoscopic gallbladder stenting(EGBS)after percutaneous transhepatic gallbladder drainage(PTGBD)can be effective,as it mitigates inflammation and adhesion.AIM To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs.METHODS We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023.The primary outcomes were technical success and AEs,and the rate of recurrent cholecystitis was evaluated.In addition,the reasons for the failure of the procedure were identified.RESULTS Among the 35 patients,the technical success rate was 77.1%and the final contrast of the cystic duct was successful in 97.1%of patients.The incidence of early AEs was relatively low(11.4%),with no instances of cystic duct perforation.The rate of recurrent cholecystitis was 3.7%,and no other biliary events were observed.CONCLUSION EGBS after PTGBD may be significantly beneficial,with a substantial success rate and minimal AEs in both short-and long-term follow-ups.

Using a novel hemostatic peptide solution to prevent bleeding after endoscopic submucosal dissection of a gastric tumor

BACKGROUND Endoscopic mucosal dissection has become the standard treatment for early gastric cancer.However,post-endoscopic submucosal dissection(ESD)ulcer occurs in 4.4%of patients.This study hypothesized whether applying PuraStat,a novel hemostatic peptide solution,prevents post-ESD bleeding.AIM To investigate the preventive potential of PuraStat,a hemostatic formulation,against bleeding in post-ESD gastric ulcers.METHODS Between May 2022 and March 2023,101 patients(Group P)underwent ESD for gastric diseases at our hospital and received PuraStat(2 mL)for post-ESD ulcers.We retrospectively compared this group with a control group(Group C)com-prising 297 patients who underwent ESD for gastric diseases at our hospital between April 2017 and March 2021.P values<0.05 on two-sided tests indicated significance.RESULTS Post-ESD bleeding occurred in 6(5.9%)(95%CI:2.8-12.4)and 20(6.7%)(95%CI:4.4-10.2)patients in Groups P and C,respectively,with no significant between-group difference.The relative risk was 1.01(95%CI:0.95-1.07).The lesser curvature or anterior wall was the bleeding site in all 6 patients who experienced postoperative bleeding in Group P.In multivariate analysis,the odds ratios for resection diameter≥50 mm and oral anticoagulant use were 6.63(95%CI:2.52-14.47;P=0.0001)and 4.04(1.26-0.69;P=0.0164),respectively.The adjusted odds ratio of post-ESD bleeding and PuraStat was 1.28(95%CI:0.28-2.15).CONCLUSION PuraStat application is not associated with post-ESD bleeding.However,the study suggests that gravitational forces may affect the effectiveness of applied PuraStat.

Severe aconite poisoning successfully treated with veno-arterial extracorporeal membrane oxygenation:A case report

BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.

Cisplatin-induced activation of TGF-βsignaling contributes to drug resistance

Growing evidence suggests an association between epithelial-mesenchymal transition(EMT),a hallmark of tumor malignancy,and chemoresistance to a number of anti-cancer drugs.However,the mechanism of EMT induction in the process of acquiring anti-cancer drug resistance remains unclear.To address this issue,we obtained a number of cisplatin-resistant clones from LoVo cells and found that almost all of them lost cell-cell contacts.In these clones,the epithelial marker E-cadherin was downregulated,whereas the mesenchymal marker N-cadherin was upregulated.Moreover,the expression of EMT-related transcription factors,including Slug,was elevated.On the other hand,the upregulation of other mesenchymal marker Vimentin was weak,suggesting that the mesenchymal-like phenotypic changes occurred in these cisplatin-resistant clones.These mesenchymal-like features of cisplatin-resistant clones were partially reversed to parental epithelial-like features by treatment with transforming growth factor-β(TGF-β)receptor kinase inhibitors,indicating that TGF-βsignaling is involved in cisplatin-induced the mesenchymallike phenotypic changes.Moreover,cisplatin was observed to enhance the secretion of TGF-βinto the culture media without influencing TGF-βgene transcription.These results suggest that cisplatin may induce the mesenchymal-like phenotypic changes by enhancing TGF-βsecretion,ultimately resulting in drug resistance.

Education Programs for Invasive Procedures Involving Nurses: A Scoping Review

Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios alone or combined with prostate-specific antigen for the diagnosis of prostate cancer and clinically significant prostate cancer

Objective:We evaluated whether the blood parameters before prostate biopsy can diagnose prostate cancer(PCa)and clinically significant PCa(Gleason score[GS]7)in our hospital.Methods:This study included patients with increased prostate-specific antigen(PSA)up to 20 ng/mL.The associations of neutrophil-to-lymphocyte ratio(NLR)and platelet-tolymphocyte ratio(PLR)alone or with PSA with PCa and clinically significant PCa were analyzed.Results:We included 365 patients,of whom 52.9%(193)had PCa including 66.8%(129)with GS of≥7.PSA density(PSAD)and PSA had better the area under the curve(AUC)of 0.722 and 0.585,respectively with pZ0.001 for detecting PCa compared with other blood parameters.PSA combined with PLR(PsPLR)and PSA with NLR(PsNLR)had better AUC of 0.608 and 0.610,respectively with p<0.05,for diagnosing GS≥7 population,compared with PSA,free/total PSA,NLR,PLR,and PsNPLR(PSA combined with NLR and PLR).NLR and PLR did not predict PCa on multivariate analysis.For GS≥7 cancer detection,in the multivariate analysis,separate models with PSA and NLR(Model 1:PsNLRþbaseline parameters)or PSA and PLR(Moder 2:PsPLRþbaseline parameters)were made.Baseline parameters comprised age,digital rectal exam-positive lesions,PSA density,free/total PSA,and magnetic resonance imaging.Model 2 containing PsPLR was statistically significant(odds ratio:2.862,95% confidence interval:1.174-6.975,p=0.021)in finding aggressive PCa.The predictive accuracy of Model 2 was increased(AUC:0.734,p<0.001)than that when only baseline parameters were used(AUC:0.693,p<0.001).Conclusion:NLR or PLR,either alone or combined with PSA,did not detect PCa.However,the combined use of PSA with PLR could find the differences between clinically significant and insignificant PCa in our retrospective study limited by the small number of samples.

RANKL^(+) senescent cells under mechanical stress: a therapeutic target for orthodontic root resorption using senolytics

In dentistry,orthodontic root resorption is a long-lasting issue with no effective treatment strategy,and its mechanisms,especially those related to senescent cells,remain largely unknown.Here,we used an orthodontic intrusion tooth movement model with an L-loop in rats to demonstrate that mechanical stress-induced senescent cells aggravate apical root resorption,which was prevented by administering senolytics(a dasatinib and quercetin cocktail).

Determination of esophageal squamous cell carcinoma and gastric adenocarcinoma on raw tissue using Raman spectroscopy

BACKGROUND Cancer detection is a global research focus,and novel,rapid,and label-free techniques are being developed for routine clinical practice.This has led to the development of new tools and techniques from the bench side to routine clinical practice.In this study,we present a method that uses Raman spectroscopy(RS)to detect cancer in unstained formalin-fixed,resected specimens of the esophagus and stomach.Our method can record a clear Raman-scattered light spectrum in these specimens,confirming that the Raman-scattered light spectrum changes because of the histological differences in the mucosal tissue.AIM To evaluate the use of Raman-scattered light spectrum for detecting endoscopically resected specimens of esophageal squamous cell carcinoma(SCC)and gastric adenocarcinoma(AC).METHODS We created a Raman device that is suitable for observing living tissues,and attempted to acquire Raman-scattered light spectra in endoscopically resected specimens of six esophageal tissues and 12 gastric tissues.We evaluated formalin-fixed tissues using this technique and captured shifts at multiple locations based on feasibility,ranging from six to 19 locations 200 microns apart in the vertical and horizontal directions.Furthermore,a correlation between the obtained Raman scattered light spectra and histopathological diagnosis was performed.RESULTS We successfully obtained Raman scattered light spectra from all six esophageal and 12 gastric specimens.After data capture,the tissue specimens were sent for histopathological analysis for further processing because RS is a label-free methodology that does not cause tissue destruction or alterations.Based on data analysis of molecular-level substrates,we established cut-off values for the diagnosis of esophageal SCC and gastric AC.By analyzing specific Raman shifts,we developed an algorithm to identify the range of esophageal SCC and gastric AC with an accuracy close to that of histopathological diagnoses.CONCLUSION Our technique provides qualitative information for real-time morphological diagnosis.However,further in vivo evaluations require an excitation light source with low human toxicity and large amounts of data for validation.

Is There Any Relationship between Total Hip Arthroplasty and Urinary Incontinent?

Introduction: In my daily practice as a hip surgeon, I have observed some circumstances where urinary incontinence (UI) improves after total hip arthroplasty (THA). We investigated UI symptoms before and after THA at our facility and considered the factors that influence UI. Patients and Method: The subjects were 113 female patients who underwent primary THA in our facility. An anterior lateral approach was used in all cases. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), we conducted an investigation into the presence of UI before and 2 weeks after THA. An improvement in UI was defined as a decrease of 1 point or more, a worsening is defined as an increase of 1 point or more. Results: The responses from the 113 subjects were analyzed. Of the 113 patients, prior to THA, UI was prevalent among 59 patients and was absent among 54 patients. In the group where UI was prevalent, it improved after THA in 50 patients (85%), remained unchanged in 5 (8%) and worsened in 4 (7%). In the group where UI was absent, 49 patients (91%) remained unchanged and UI appeared in 5 (9%). Compared with the non-prevalence group (62 patients), the prevalence group (50 patients) had a noticeable improvement rate of internal rotation of the surgical hip side (P Conclusion: UI greatly reduces the quality of life (QOL). In this study, there is a possibility that THA improves UI.

A Radiographic Evaluation of Short Monolithic Femoral Hip Stem (SMF) for Dysplastic Osteoarthritis: Does Stem Alignment Influence on the Stability?

Background: There have been a few reports of SMFTM stem for dysplastic hips. The aim of this study is to evaluate the influence of stem alignment in dysplastic femurs on the stability of the implants and on the bone reaction by means of consecutive radiographical analysis. Methods: The preoperative diagnosis is dysplastic osteoarthritis in all patients. Twenty-nine hips in 28 patients after MIS-THA were followed up for two or more years (3.5 years in average). The average age at the surgery was 60. Those who belonged to Crowe’s classification I were 19 and those of II were 10 hips. The shape of the femur was classified as Dorr’s Type A in 5, B in 21, and C in 3 hips. Results: The varus alignment of the stem was 21 hips and non-varus was 8 hips. Crowe’s Grade did not have influence on the stem alignment. The ratio of non-varus alignment was more with Dorr’s Type C than with others. Achieving rate of mediolateral fixation was significantly higher in the varus alignment than in non-varus. The significant subsidence occurred in 3 hips (10.3%) although all stems became stable within 6 months. No revision was necessary. Conclusion: The varus insertion of the stem seemed more secure also in dysplastic femurs, but even non-varus ones seemed acceptable as they brought about no severe problem. Comprehensively evaluating the result, careful selection of the patient is essential to take the advantage of and to overcome the disadvantage of this short stem for dysplastic hips.

中国部分绵羊群体形态及生态特征多元统计分析

分别以绵羊群体为研究对象直接进行Q型系统聚类,与以群体的数量指标为研究对象,构造主成分值,再以主成分为研究对象进行R型系统聚类,均可在一定程度上揭示群体间的遗传分化,得到了与中国绵羊亲缘系统既有知识相吻合的结果。以群体的数量指标为研究对象直接进行Q型系统聚类分析,可以发现海拔与年降水量是影响绵羊分布的两个重要指标,这与以群体为研究对象进行Q型系统聚类及与以群体的指标为研究对象进行的主成分分析所提供的信息基本一致。生态因子是绵羊品种区域分类的一个重要指标。

中亚以东南绵羊群体亲缘血统判别式的研究

在将中亚以东南绵羊群体划分为“蒙古羊”、“南亚羊”和“欧洲羊”三大集团的既有研究结论的基础上 ,论证了这一广阔地域的血统两个判别式 ;以 10个群体 10个基因座 33个等位基因频率为例对这两个判别式进行验证。根据遗传贴近度的思想确定判别式 2为最理想的判别式。以该式判别一个未知群体的血统是否符合已知的畜牧学逻辑 ,结果肯定判别式 2定义的遗传贴近度是中亚以东南绵羊群体血统判别的可靠依据 ,可以反映湖羊、同羊和云南绵羊的血统育成过程。该式也适用于其它层次的遗传标记。

湖羊、同羊12个同工酶座位的检测

Gene frequencies of Hu sheep and Tong sheep were obtained with“Random sampling in typical colonies of a central area”. Of the 12 loci tested in Hu sheep, 11 loci were polymorphic. Reliability of the estimated frequencies of 27 alleles reached 0.95 except for PoF, TfA,Tff,Hb-βA and CAF which had reliabilities of 0.5222,0.7478,0.5222,0.6212 and 0.899, respectively. Of the 12 loci tested in Tong sheep, 11 loci were polymorphic. Reliability of the estimated frequency of 25 alleles reached 0.95 except for TfA, TfE and CAF which had reliabilities of 0.931,0.6922 and 0.7924, respectively. The average heterozygosity () and average homozygosity (J) was computed and the J of the two sheep colonies was 0.6619 and 0.6448, respectively. Consistent with our conclusions based on genetic data, previous research divided the native sheep populations of East and South Central Asia into three group: the“Mongolian group”,“South-Asian group” and“European group”. Consequently, the degree of genetic similarity between populations and known groups would seem to provide a reliable means of determining the genetic relationships between populations and may reflect the true genetic origin of Hu sheep and Tong sheep in China [Acta Zoologica Sinica 49(1):134-138,2003].

六道木属六道木组种间关系的AFLP分析和黄花六道木中国分布新记录的认定

用荧光标记AFLP技术对东亚产六道木属六道木组作了系统关系分析。我们采用 5对AFLP引物 ,对六道木属 9个物种 ,锦带花属和猬实属各 1个物种共 16份样品进行分析 ,共获得 988个位点。不同引物所获得的结果具有很高的相容性 ,Mantel相关系数为 0 72 5～0 919,说明AFLP技术适用于六道木属的种间关系分析。用邻接法 (neighbor joining)对 16个样品 988个位点的分析生成的系统树获得很高的自展分析 (bootstrap)支持率。树系图表明 ,猬实属与六道木属管花六道木组有密切的关系。在六道啪组内 ,温州六道木与糯米条的关系密切 ,单花六道木与大花六道木差异很小 ,黄花六道木与日本产的近缘种组成一单系分支。本文认定 ,根据形态特征鉴定浙江永嘉的标本为黄花六道木 (AbeliaserrataSieb .etZucc .)是正确的 ,属中国分布新记录。文章最后补充描述了中国产的黄花六道木。黄花六道木在中国的发现进一步证明中国植物区系与日本植物区系的密切关系。

洼地绵羊苹果酸脱氢酶同工酶研究

采用聚丙烯酰胺凝胶垂直板电泳对76只洼地绵羊的苹果酸脱氢酶(MDH)的多态性进行检测和分析结果发现,MDH基因座2个等位基因MDHF和MDHS的频率分别为0.4868和0.5132,3种基因型FF、FS和SS的频率分别为0.1447、0.6842和0.1711。另在MDH同工酶染色方法上也做了新的尝试。

中国忍冬科分布新记录——温州六道木(英文)

温州六道木AbeliaspathulataSieb.&Zucc.原来被认为特产于日本,最近发现也分布在我国浙江省永嘉县四海山。温州六道木与糯米条A.chinensisR.Brown的亲缘关系最近,但温州六道木聚伞花序仅2花,生于小枝顶端;花冠白色或粉红色,长2–3cm,钟状,裂片二唇形;雄蕊不伸出花冠筒外。糯米条聚伞花序多花,集生于小枝顶部叶腋成圆锥花序状;花冠白色,长0.5–1cm,漏斗状,裂片近辐射对称;雄蕊显著伸出花冠筒外。

Irinotecan, a key chemotherapeutic drug for metastatic colorectal cancer

Irinotecan hydrochloride is a camptothecin derivative that exerts antitumor activity against a variety of tumors. SN-38 produced in the body by carboxylesterase is the active metabolite of irinotecan. After irinotecan was introduced for the treatment of metastatic colorectal cancer(CRC) at the end of the last century,survival has improved dramatically. Irinotecan is now combined with 5-fluorouracil,oxaliplatin and several molecularly-targeted anticancer drugs,resulting in the extension of overall survival to longer than 30 mo. Severe,occasionally life-threatening toxicity occurs sporadically,even in patients in relatively good condition who have a low risk of chemotherapyinduced toxicity,often causing the failure of irinotecanbased chemotherapy. Clinical pharmacological studies have revealed that such severe toxicity is related to exposure to SN-38 and genetic polymorphisms in UDPglucuronosyltransferase 1A1 gene. The large interand intra-patient variability in systemic exposure to SN-38 is determined not only by genetic factors but also by physiological and environmental factors. This review first summarizes the roles of irinotecan in chemotherapy for metastatic CRC and then discusses the optimal dosing of irinotecan based on the aforementioned factors affecting systemic exposure to SN-38,with the ultimate goal of achieving personalized irinotecan-based chemotherapy.

Congenital tracheoesophageal fistula successfully diagnosed by CT esophagography

Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.

Relationship between testicular volume and testicular function： comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility

Aim： To evaluate the relationship between testicular function and testicular volume measured by using Prader orchidometry and ultrasonography （US） to determine the critical testicular volume indicating normal testicular function by each method. Methods： Total testicular volume （right plus left testicular volume） was measured in 794 testes in 397 men with infertility （mean age, 35.6 years） using a Prader orchidometer and also by ultrasonography. Ultrasonographic testicular volumes were calculated as length x width x height x 0.71. To evaluate volume-function relationships, patients were divided into 10 groups representing 5-mL increments of total testicular volume by each method from below 10 mL to 50 mL or more. Results： Mean total testicular volume based on Prader orchidometry and US were 36.8 mL and 26.3 mL, respectively. Semen volume, sperm density, total sperm count, total motile sperm count, and serum FSH, LH, and testosterone all correlated significantly with total testicular volume measured by either method. Mean sperm density was in the oligozoospermic range in patients with total testicular volume below 35 mL by orchidometry or below 20 mL by ultrasonography. Mean total sperm count was subnormal in patients with total testicular volume below 30 mL by orchidometry or under 20 mL by ultrasonography. Conclusion： Testicular volume measured by either ultrasonography or Prader orchidometry correlated significantly with testicular function. However, critical total testicular volume indicating normal or nearly normal testicular function was 30 mL to 35 mL using Prader orchidometer and 20 mL using ultrasonography. Prader orchidometry morphometrically and functionally overestimated the testicular volume in comparison to US. （Asian JAndro12008 Mar; 10： 319-324）