Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model.

Ex vivo liver resection combined with autologous liver transplantation offers the opportunity to treat otherwise unresectable hepatobiliary malignancies and has been applied in clinic. The implementation of enhanced recovery after surgery (ERAS) program improves the outcome of surgical procedures. This is a retrospective single-center study including 11 cases of patients with liver cancer that underwent autologous liver transplantation and received ERAS: cholangiocarcinoma of the hilar region (n = 5), intrahepatic cholangiocarcinoma (n = 3), gallbladder cancer (n = 1), liver metastasis from colorectal cancer (n = 1), and liver metastasis from gastrointestinal mesenchymal tumor (n = 1). There were no deaths within 30 days and major complications occurred in two patients, and four patients were readmitted upon the first month after the surgery. Median hospital stay was 20 days (range 13-44) and median open diet was Day 4 (range 2-9) after surgery and median early post-operative activity was Day 5 (range 2-9) after surgery. In conclusion, autologous liver transplantation is feasible in the treatment of otherwise unresectable hepatobiliary malignancies, and our study showed favorable results with autologous liver transplantation in ERAS modality. ERAS modality provides a good option for some patients whose tumors cannot be resected in situ and offers a chance for rapid recovery.

Association Between Long-Term Exposure to Ambient Air Pollution and the Risk of Mild Cognitive Impairment in a Chinese Urban Area: A Case-Control Study.

Background: As a prodromal stage of dementia, significant emphasis has been placed on the identification of modifiable risks of mild cognitive impairment (MCI). Research has indicated a correlation between exposure to air pollution and cognitive function in older adults. However, few studies have examined such an association among the MCI population inChina. Objective: We aimed to explore the association between air pollution exposure and MCI risk from the Hubei Memory and Aging Cohort Study. Methods: We measured four pollutants from 2015 to 2018, 3 years before the cognitive assessment of the participants. Logistic regression models were employed to calculate odds ratios (ORs) to assess the relationship between air pollutants and MCI risk. Results: Among 4,205 older participants, the adjusted ORs of MCI risk for the highest quartile of PM2.5, PM10, O3, and SO2 were 1.90 (1.39, 2.62), 1.77 (1.28, 2.47), 0.56 (0.42, 0.75), and 1.18 (0.87, 1.61) respectively, compared with the lowest quartile. Stratified analyses indicated that such associations were found in both males and females, but were more significant in older participants. Conclusions: Our findings are consistent with the growing evidence suggesting that air pollution increases the risk of mild cognitive decline, which has considerable guiding significance for early intervention of dementia in the older population. Further studies in other populations and broader geographical areas are warranted to validate these findings.

Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature.

BACKGROUND: Perihilar cholangiocarcinoma (pCCA) is a highly malignant tumor arising from the biliary tree. Radical surgery is the only treatment offering a chance of long-term survival. However, limited by the tumor's anatomic location and peri-vascular invasion, most patients lose the chance for curative treatment. Therefore, more methods to increase the resectability of tumors as well as to improve outcomes are needed. CASE SUMMARY: A 68-year-old female patient had a hepatic hilar mass without obvious symptoms. Laboratory results showed hepatitis B positivity. Magnetic resonance imaging indicated that the mass (maximum diameter: 41 mm) invaded the left and right branches of the main portal vein, as well as the middle, left and right hepatic veins; enlarged lymph nodes were also detected in the hilum. The patient was diagnosed with pCCA, and the clinical stage was determined to be T4N1M0 (stage IIIC). Considering the tumor's anatomic location and vascular invasion, systematic conversion therapy followed by ex vivo liver resection and autotransplantation (ELRA) was determined as personalized treatment for this patient. Our original systemic sequential therapeutic strategy (lenvatinib and tislelizumab in combination with gemcitabine and cisplatin) was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment, without severe toxicity. ELRA, anastomotic reconstruction of the middle hepatic vein, right hepatic vein, root of portal vein, inferior vena cava and right hepatic artery, and lymph node dissection were performed at one month after systemic therapy. Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis. Although the middle hepatic vein was partially obstructed four months later, hepatic vein stent implantation successfully addressed this problem. The patient has survived for 22 mo after the diagnosis, with no evidence of recurrence or metastasis. CONCLUSION: An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.

Corrigendum: In vivo total or partial hepatectomy followed by ex vivo liver resection and autotransplantation for malignant tumors: a single center experience.

[This corrects the article DOI: 10.3389/fonc.2023.1214451.].

In vivo total or partial hepatectomy followed by ex vivo liver resection and autotransplantation for malignant tumors: a single center experience.

Background: Ex vivo liver resection and autotransplantation (ELRAT) may provide an opportunity for R0 resection of conventionally unresectable hepatobiliary cancers and hepatic metastases. To date, few studies of the surgery for malignant tumors have been conducted and there are no known reports of in vivo partial hepatectomy followed by ELRAT (IPH-ELRAT) for malignant tumors. Methods: Between December 2021 and November 2022, ten patients with malignant hepatobiliary primary cancers or hepatic metastases underwent ELRAT at our institution. We shared the surgical skills and postoperative prognoses of these patients were assessed. Results: The types of tumors were biliary tract cancer (BTC, n=8), hepatic metastasis of colonic carcinoma (n=1), and hepatic metastasis of small-bowel stromal tumor (n=1). Five patients underwent in vivo total hepatectomy followed by ex vivo liver resection and autotransplantation (ITH-ELRAT), The other five received in vivo partial hepatectomy followed by ex vivo liver resection and autotransplantation (IPH-ELRAT). Four patients underwent inferior vena cava replacement using artificial blood vessels. The survival rate of all ten patients one month after surgery was 100%. Nine patients (90%) are currently alive, with a median follow-up of 8.5 months (range 6-16.5 months). To date, seven of the nine surviving patients have had no cancer recurrence, including six with BTC. Conclusions: We report the world first five cases that received IPH-ELRAT for malignancies. We also demonstrated relatively favorable outcomes in patients who underwent ELRAT. ELRAT may be a recommendable surgical option for selected patients with conventionally unresectable hepatobiliary malignant tumors.

Oxybutynin nanosuspension gel for enhanced transdermal treatment for overactive bladder syndrome.

Oxybutynin (OXY) is the most common drug to treat overactive bladder (OAB) syndrome. Transdermal administration is a more ideal route replacing oral administration to resolve problems of low bioavailability and severe side effects. However, commercial transdermal products of OXY frequently cause skin irritation and low permeation efficiency arising discontinued medication. Here, oxybutynin nanosuspension (OXY-NS) and its gel preparation (OXY-NG) were constructed to resolve these issues. In vitro permeation test and in vivo pharmacokinetics study confirmed that OXY-NG significantly enhanced the transdermal permeation of OXY, about 4-fold and 3-fold higher than oxybutynin coarse suspension (OXY-CG), respectively, and in vitro retention test certified that OXY-NG increased OXY concentration especially in viable epidermis (VE) and Dermis (about 3 times that of OXY-CG), consequently improving the bioavailability. Skin irritation assay demonstrated that OXY-NG would not trigger skin adverse effects. In addition, selectively blocking hair follicles test evidenced that hair follicles pathway played an important role in OXY-NS transdermal delivery. In general, by virtue of excellent drug loading, low toxicity and ease of scale-up, OXY-NG is a promising strategy to ameliorate skin permeation of insoluble OXY for better transdermal treatment for OAB, hence increasing its bioavailability, reducing adverse effects, and achieving good patient compliance.

Comparison of ultrasound guided percutaneous radiofrequency ablation and open thyroidectomy in the treatment of low-risk papillary thyroid microcarcinoma: A propensity score matching study.

PURPOSE: The aim of this study was to evaluate the efficacy, safety and costs of ultrasound guided percutaneous radiofrequency ablation (RFA) versus open thyroidectomy for treating low-risk papillary thyroid microcarcinoma (PTMC) by using propensity score matching (PSM). PATIENTS AND METHODS: 157 patients who underwent RFA and 206 patients who underwent surgery for low-risk PTMC were included in the study. The patients were followed up at 1, 3, 6, 12 months after treatment, and every half year thereafter. A 1:1 PSM method was applied to balance the pretreatment data of the two groups. In the matched group (133 patients for each), the operative time, length of hospital stay, hospitalization expenses, cosmetic results, complications were assessed and compared between two groups. RESULTS: At last follow-up, 39 tumors (29.3%) in the RFA group completely disappeared. Between the well-matched groups, no local recurrence, lymph node metastasis or distant metastases were detected in either group during the follow-up period. After matching, the operation time and hospitalization time in RFA group were shorter than those in surgery group (both P < 0.05). The average hospitalization expense of the patients in RFA group was cheaper than that in surgery group (P < 0.05). Moreover, the cosmetic score was found to be higher in RFA group than that observed in surgery group (P < 0.05). CONCLUSIONS: RFA may be an effective and safe method for treating low-risk PTMC with a superior advantage of being low-cost and having a shorter operation time and hospital stay versus surgery.

Combined chemotherapy for triple negative breast cancer treatment by paclitaxel and niclosamide nanocrystals loaded thermosensitive hydrogel.

Triple negative breast cancer (TNBC) is the most dangerous subtype of breast cancer accompanying by unfavorable prognosis due to lack of specific therapeutic targets. Paclitaxel (PTX) is the first-line chemotherapeutic drug for TNBC and niclosamide (NLM) was identified as an inhibitor for TNBC and breast cancer stem cells (BCSCs). Intratumoral drug delivery system was a hopeful alternative for chemotherapeutic drug administration due to its targeting efficiency with lower systemic toxicity. Herein, an injectable PTX nanocrystals (PTX-NCs) and NLM nanocrystals (NLM-NCs) co-loaded PLGA-PEG-PLGA thermosensitive hydrogel (PNNCs-Ts Gel) was designed for TNBC intratumoral treatment. The final formulation realized high drug loading and appropriate particle size. PNNCs-Ts Gel displayed sustained drug release for up to 8 days in vitro. In vitro antitumor tests observed synergetic effects of combined therapy in terms of inhibiting cell proliferation and migration, inducing apoptosis. In vivo combined therapy presented a tumor growth inhibition rate about 68.8% and desired safety. Moreover, tumors after PNNCs-Ts Gel intratumoral injection possessed the lowest ratio of BCSCs, exhibiting this formulation had good ability in suppressing BCSCs and therefore could possibly prevent TNBC recurrence and metastasis. These results suggested that PNNCs-Ts Gel could be a promising strategy for TNBC treatment.

Autophagy is a defense mechanism controlling Streptococcus suis serotype 2 infection in murine microglia cells.

Streptococcus suis (S. suis) is an important swine and human pathogen, causing severe meningitis with high morbidity and mortality worldwide. Microglial activation and inflammation are responsible for bacterial meningitis. S. suis has been identified to activate microglia, but the role of autophagy following S. suis infection in microglial cells remains elusive. In this study, using western blot, immunofluorescent staining and transmission electron microscopy (TEM), we demonstrated that S. suis serotype 2 (SS2) triggered autophagosome and enhanced autophagic flux in BV2 microglial cells. Autophagy activators, rapamycin, could further promote autophagy in S. suis-infected BV2 cells. Conversely, autophagy inhibitors including siRNA targeting ATG5, Beclin-1, ATG9a and ATG12 attenuated the autophagic process. Consistent with the in vitro results, autophagy was activated following S. suis infection in brain tissue including frontal cortex and hippocampus in a mouse model of meningitis. Further experiment showed that autophagy serves as a cellular defense mechanism to limit invaded bacteria and microglia inflammation in S. suis-infected BV2 cells. This is the first study reporting that the interaction between autophagy and microglia cells in response to S. suis infection. The possible mechanism involved could additionally suggest potential therapeutic approaches for bacterial meningitis.

Microbubble-Mediated Cavitation Promotes Apoptosis and Suppresses Invasion in AsPC-1 Cells.

The aim of this study was to identify the potential and mechanisms of microbubble-mediated cavitation in promoting apoptosis and suppressing invasion in cancer cells. AsPC-1 cells were used and divided into four groups: control group, microbubble-only (MB) group, ultrasound-only (US) group and ultrasound plus microbubble (US + MB) group. Pulse ultrasound was used at a frequency of 360 kHz and a SPPA (spatial peak, pulse average) intensity of 1.4 W/cm2 for 1 min (duty rate = 50%). Then cells in the four groups were cultured for 24 h. Cell Counting Kit­8 (Biosharp, Hefei, Anhui, China) revealed decreased cell viability in the US + MB group. Western blot confirmed that there were increased cleaved caspase­3 and Bcl-2-associated X protein levels and decreased B­cell lymphoma­2 (Bcl-2) levels, as well as increased intracellular calcium ions and downregulated cleaved caspase-8, in the US + MB group. With respect to proliferation, cells in the US + MB group had lower expression of Ki67 and the weakened colony formation ability. The transwell invasion assay revealed that invasion ability could be decreased in AsPC-1 cells in the US + MB group. Further, it was found that cells in the US + MB group had lower levels of hypoxia-inducible factor-1α (HIF-1α) and vimentin and higher levels of E-cadherin compared with the other three groups. Finally, the US + MB cells had less invadopodium formation. In conclusion, these results suggest that microbubble-mediated cavitation promotes apoptosis and suppresses invasion in AsPC-1 cells.

Adverse reactions after the use of SonoVue contrast agent: Characteristics and nursing care experience.

The aim of this study was to analyze the clinical manifestations of adverse reactions after the use of SonoVue contrast agent from a large retrospective database, and to evaluate the nursing care strategies and the efficacy of standardized procedure for adverse reactions of SonoVue (SPARS).From January 1, 2012 to December 30, 2018, 34,478 cases of contrast-enhanced ultrasonography were performed in our center. The clinical manifestations of adverse reactions after the use of SonoVue contrast agent were identified and analyzed. The nursing care strategies were evaluated and the outcomes of patients with moderate and severe adverse reactions before and after the application of SPARS were compared.Of the 34,478 cases, 40 cases (0.12%) of adverse reactions after the use of SonoVue were identified. Adverse reactions included anaphylatic shock, skin allergies, nausea or vomiting, dizziness or headache, numbness, chest distress, back pain, and local reactions of the injection site. Most of the adverse reactions were mild and self-limited. Only 3 cases of anaphylatic shock and 2 cases of severe rash underwent further treatments. The 3 patients who were managed by SPARS recovered quicker and spent less comparing with the other 2 patients who were not.SonoVue was a safe contrast agent, with few and mostly mild adverse reactions. SPARS may be an efficient way in tackling moderate to severe adverse reactions, although of which the incidence was rare.

Promising Approach for High-Performance MoS2 Nanodevice: Doping the BN Buffer Layer to Eliminate the Schottky Barriers.

Reducing the Schottky barrier height (SBH) of metal-MoS2 interface with no deteriorating the intrinsic properties of MoS2 channel layer is crucial to realize the high-performance MoS2 nanodevice. To realize this expectation, a promising approach is present in this study by doping the boron nitride (BN) buffer layer between metal electrode and MoS2 channel layer. Results demonstrate that no matter the types of concentrations and dopants the intrinsic electronic structure, low electron effective mass of MoS2 channel layer, and the weak Fermi level pinning effects of metal/BN-MoS2 interfaces are preserved and not deteriorated. More importantly, the n- and p-type SBHs of metal/BN-MoS2 interfaces are significantly reduced by the electron-poor and -rich dopants, respectively, when the doped BN buffer layer spreads all over the nanodevice, which is in contrast to the traditional doping rule. Moreover, both the n- and p-type SBHs are further decreased and even eliminated when the concentrations of dopants increase. The n-type SBH of doped Au/BxN-MoS2 interface and the p-type SBH of doped Pt/BNx-MoS2 interface can be reduced to -0.21 and -0.61 eV by doping with high concentrations of Li and O, respectively. This theoretical work provides an effective and promising method to realize high-performance MoS2 nanodevices with negligible SBHs.

Dexmedetomidine mitigates CLP-stimulated acute lung injury via restraining the RAGE pathway.

OBJECTIVE: RAGE pathway plays crucial effects in causing acute lung injury (ALI). Dexmedetomidine (DEX) is showed to mitigate sepsis-stimulated ALI. However, its mechanisms have not been verified. The study was to evaluate whether the RAGE pathway participated in the actions of DEX on sepsis-stimulated ALI in rats. METHODS: Male rats were administrated with intravenously DEX 30 min after sepsis. At 24 h of sepsis, lung myeloperoxidase (MPO) and macrophages in the bronchoalveolarlavage fluid (BALF) were observed. The actions of DEX on pro-inflammatory molecules and related mechanisms were determined by immunological methods. RESULTS: It was indicated that DEX markedly attenuated CLP-stimulated augment of lung inflammatory cells infiltration, along with significantly mitigated MPO activity. Besides, DEX obviously reduced lung wet/dry weight ratio and the levels of HMGB1 and RAGE in BALF and lung tissue. Moreover, DEX post-treatment apparently attenuated the histopathological lung injury compared with CLP model group. Furthermore, western blot analysis revealed that DEX efficiently restrained the activation of IκB-α, NF-κB p65, and MAPK. CONCLUSION: Our studies demonstrated that DEX attenuates the aggravation of sepsis-stimulated ALI via down regulation of RAGE pathway, which has a potential value in the clinical therapy.

[Experimental role of cervical sympathetic block during facial nerve injury and regeneration in rats].

OBJECTIVE: To explore the effects of cervical sympathetic block (CSB) on facial nerve regeneration in rats and seek the optimal timing of treatment. METHODS: A total of 72 adult Sprague-Dawley rats were divided randomly into 4 groups of sham-operation (sham), model control (NS), CSB1 and CSB2 (n = 18 each). Except for sham group, the model of peripheral facial paralysis was established for three other groups. After treating facial nerves injury with CSB at different timepoints, the behavioral changes of rats were observed.Electroneurography (ENoG) of injured nerves was performed and the expressions of glial cell derived neurotrophic factor (GDNF) of facial nerve nucleus were detected at different stages. RESULTS: The facial whisker movement function scores in sham, NS, CSB1 and CSB2 groups were 3.87 ± 0.35, 0.50 ± 0.52, 1.07 ± 0.62 and 0.81 ± 0.42 (F = 2.934, P = 0.035) at Day 7, 3.85 ± 0.37, 0.91 ± 0.52, 1.57 ± 0.65 and 1.07 ± 0.62 (F = 2.537, P = 0.038) at Day 14 and 3.85 ± 0.37, 1.71 ± 0.47, 3.00 ± 0.68 and 2.36 ± 0.49 (F = 3.627, P = 0.024) at Day 28. At Day 7, LatSD and AmpSD were not detected in NS, CSB1 and CSB2 groups.However, at Day 14, the values of LatSD were (1.26 ± 0.19), (6.67 ± 0.36), (4.67 ± 0.36) and (6.17 ± 0.36) ms, showing a significant difference (F = 3.052, P = 0.024) and AmpSD (6.42 ± 1.93), (2.16 ± 1.87), (4.16 ± 1.80) and (3.66 ± 1.40) mv, also a significance (F = 3.634, P = 0.021). And at Day 28, LatSD were (1.31 ± 0.17), (3.17 ± 0.19), (1.93 ± 0.12) and (2.60 ± 0.22) ms (F = 2.729, P = 0.032) and AmpSD (6.82 ± 2.30), (4.72 ± 5.23), (6.22 ± 3.50) and (5.82 ± 4.10) mv (F = 3.827, P = 0.019). The expression quantities of GDNF in 4 groups produced significant differences at Day 7 (4.67 ± 0.81, 13.52 ± 0.58, 26.17 ± 1.01 and 14.86 ± 1.03, F = 3.637, P = 0.028), Day 14 (5.67 ± 0.57, 24.41 ± 2.86, 26.52 ± 1.36 and 25.48 ± 1.42, F = 2.946, P = 0.031) and Day 28 (5.37 ± 0.92, 26.64 ± 1.68, 27.38 ± 1.66 and 25.69 ± 1.99, F = 4.273, P = 0.012). CONCLUSION: During early stage of facial nerve injury, the treatment of CSB may increase the expression of GDNF of facial nerve nucleus at early stage and thus accelerate the recovery of facial nerve injury in rats.

Biodelignification of rice straw by Phanerochaete chrysosporium in the presence of dirhamnolipid.

Lignin degradation by white-rot fungi has received considerable attention as a means for reducing accumulation of lignocellulosic wastes in the environment. The stimulatory effect of surfactants on fungal lignocellulose bioconversion also has attracted wide interest. In this study the influence of dirhamnolipid biosurfactant on biodegradation of rice straw by Phanerochaete chrysosporium was investigated. It was shown that the biodelignification process of rice straw can be significantly enhanced by the presence of dirhamnolipid biosurfactant. In particular, the dirhamnolipid at the concentration of 0.007% increased the peak activity of lignin peroxidase (LiP) by 86% without affecting the manganese peroxidase (MnP) activity. The water-soluble organic carbon (WSOC) contents in the straw substrates as well as the microbial growth and activity were effectively improved by dirhamnolipid, while the degradation rate of lignin increased by 54% with dirhamnolipid of 0.007%. Observed chemical structural and morphological changes showed that the straw substrates were delignified in the presence of dirhamnolipid with the formation of terrace-like fragments separated from the inner cellular fibers and the release of simple compounds. Variation partitioning analysis revealed that the dirhamnolipid addition induced a significant straw biodelignification which explained 22.1% (P = 0.013) of the variance.