Effect of acupuncture inclusion in the enhanced recovery after surgery protocol on tumor patient gastrointestinal function: a systematic review and meta-analysis of randomized controlled studies.

Introduction: Acupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The present systematic review and meta-analysis aimed to evaluate the rationality and efficacy of integrating acupuncture in the ERAS strategy to recuperate gastrointestinal function. Methods: We searched eleven databases for relevant randomized clinical trials (RCTs) of acupuncture for the treatment of gastrointestinal dysfunction in tumor patients treated with the ERAS protocol. The quality of each article was assessed using the Cochrane Collaboration risk of bias criteria and the modified Jadad Scale. As individual symptoms, the primary outcomes were time to postoperative oral food intake, time to first flatus, time to first distension and peristaltic sound recovery time (PSRT). Pain control, adverse events, and acupoint names reported in the included studies were also investigated. Results: Of the 211 reviewed abstracts, 9 studies (702 patients) met eligibility criteria and were included in the present systematic review and meta­analysis. Compared to control groups, acupuncture groups showed a significant reduction in time to postoperative oral food intake [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.18 to -0.35], time to first flatus (SMD=-0.81, 95% CI -1.13 to -0.48), time to first defecation (SMD=-0.91, 95% CI -1.41 to -0.41, PSRT (SMD=-0.92, 95% CI -1.93 to 0.08), and pain intensity (SMD=-0.60, 95% CI -0.83 to -0.37).The Zusanli (ST36) and Shangjuxu (ST37) acupoints were used in eight of the nine included studies. Adverse events related to acupuncture were observed in two studies, and only one case of bruising was reported. Discussion: The present systematic review and meta­analysis suggested that acupuncture significantly improves recovery of gastrointestinal function and pain control in tumor patients receiving the ERAS protocol compared to the control group. Moreover, ST36 and ST37 were the most frequently used acupoints. Although the safety of acupuncture was poorly described in the included studies, the available data suggested that acupuncture is a safe treatment with only mild side effects. These findings provide evidence-based recommendations for the inclusion of acupuncture in the ERAS protocol for tumor patients. Systematic review registration: https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42023430211.

Exploring the Target and Mechanism of Radix Paeoniae Alba on Sjogren's Syndrome.

BACKGROUND: Radix Paeoniae Alba is a traditional Chinese herbal medicine. It can accelerate salivary secretion and alleviate the dry mouth of patients with Sjogren's syndrome (SS). Although it is widely used in clinical treatment, its target and mechanism remain unclear. OBJECTIVE: This study aims to analyze the main components of Radix Paeoniae Alba, explore the target genes, and propose the possible mechanism for Radix Paeoniae Alba's acceleration of salivary secretion. METHODS: The main active components and potential targets of Radix Paeoniae Alba were searched through the TCMSP database. Efforts were made to search for the related genes of Sjogren's syndrome in OMIM and GeneCards databases. Cytoscape v3.8.0 software was used to link target genes of active components and key genes of the disease. The software Autodock vina1.1.2. was adopted to simulate the interaction between active components and target genes. Human submandibular gland (HSG) cells were used in vitro experiments to verify the results of our analysis. RESULTS: ß-Sitosterol, the main component of Radix Paeoniae Alba, may intervene in the disease through CHRM3. Molecular docking shows ß-Sitosterol has a high affinity with CHRM3, and the interaction between CHRM3 and ß-Sitosterol is the basis of biological activity. The in vitro experiments showed that ß-Sitosterol could significantly up-regulate the mRNA and protein expression levels of both CHRM3 and secretion-related genes in HSG cells. CONCLUSION: Our study shows that the chemical components of Radix Paeoniae Alba have a positive effect on the related mechanism of salivary secretion. We found that ß-Sitosterol can promote the expression of CHRM3, stimulate salivary secretion, treat Sjogren's syndrome and potentially improve its prognosis.

A case report: Infection-related glomerulonephritis and mantle cell lymphoma due to mycobacterium avium complex infection.

RATIONALE: Mycobacterium avium complex (MAC) infection is common in lung, liver and skin. However, MAC presenting with peritonitis is uncommon and is particularly rare in immunocompetent patients. We report a case of infection-associated glomerulonephritis and mantle cell lymphoma caused by peritonitis due to MAC. PATIENT CONCERNS: We report a case of a 73-year-old elderly man with fever and abdominal pain for 2 days and gradually developed anuria, ascites, and abdominal lymphadenopathy. DIAGNOSES: The initial diagnosis was peritonitis and acute renal failure. There was no significant relief of symptoms after empirical anti-infective therapy and hemodialysis. infection-associated glomerulonephritis, mantle cell lymphoma, and peritonitis due to MAC were diagnosed by renal biopsy, abdominal lymph node biopsy, and metagenomics next-generation sequencing. INTERVENTIONS: The patient received empirical antibiotic therapy, hemodialysis, and anti-MAC therapy. OUTCOMES: Unfortunately, the patient eventually died of septic shock after the 21st day of admissiom. LESSONS: Early diagnosis of MAC infection is essential. When the cause of fever is unknown, metagenomics next-generation sequencing can be considered.

CDFRegNet: A cross-domain fusion registration network for CT-to-CBCT image registration.

BACKGROUND AND OBJECTIVE: Computer tomography (CT) to cone-beam computed tomography (CBCT) image registration plays an important role in radiotherapy treatment placement, dose verification, and anatomic changes monitoring during radiotherapy. However, fast and accurate CT-to-CBCT image registration is still very challenging due to the intensity differences, the poor image quality of CBCT images, and inconsistent structure information. METHODS: To address these problems, a novel unsupervised network named cross-domain fusion registration network (CDFRegNet) is proposed. First, a novel edge-guided attention module (EGAM) is designed, aiming at capturing edge information based on the gradient prior images and guiding the network to model the spatial correspondence between two image domains. Moreover, a novel cross-domain attention module (CDAM) is proposed to improve the network's ability to guide the network to effectively map and fuse the domain-specific features. RESULTS: Extensive experiments on a real clinical dataset were carried out, and the experimental results verify that the proposed CDFRegNet can register CT to CBCT images effectively and obtain the best performance, while compared with other representative methods, with a mean DSC of 80.01±7.16%, a mean TRE of 2.27±0.62 mm, and a mean MHD of 1.50±0.32 mm. The ablation experiments also proved that our EGAM and CDAM can further improve the accuracy of the registration network and they can generalize well to other registration networks. CONCLUSION: This paper proposed a novel CT-to-CBCT registration method based on EGAM and CDAM, which has the potential to improve the accuracy of multi-domain image registration.

Does application of indocyanine green fluorescence imaging enhance clinical outcomes in liver resection? A meta-analysis.

BACKGROUND: Indocyanine green fluorescence imaging technology has been widely used in liver resection. However, there has been a lack of strong evidence on whether application of indocyanine green fluorescence imaging enhances clinical outcomes in liver resection. This meta-analysis was performed to compare the latest clinical results of indocyanine green fluorescence imaging-guided hepatectomy (FIGH) and conventional hepatectomy (CH) in liver diseases. METHODS: Relevant clinical studies were retrieved from PubMed, Embase, Cochrane Library, Medline and the Web of Science databases until June 21, 2021. Stata14.0 software was adopted in meta-analysis, in which the pooled effect size was calculated by the random-effects model or the fixed-effects model. Meta-regression and subgroup analysis were used to explore sources of heterogeneity. The publication bias was ascertained by egger's test and begg's test. The trim and fill method was used to adjust the occurrence of publication bias. RESULTS: Overall twelve studies comprising 931 patients were included. Compared to the CH group, the FIGH group has lower complications (weighted mean difference [WMD] = 0.5238; 95% CI = 0.351-0.780; P = 0.001), shorter hospital stays (WMD = -1.857; 95% CI = -2.806--0.908; P = 0.000). Six of the studies indicated that no perioperative mortality occurred in either group. In overall analysis, there was no statistical difference in the estimated blood loss between the two groups (WMD = -42.509; 95% CI = -87.842 -2.825; P = 0.066), while in subgroup analysis of only literature from Japan or published between 2018 and 2019 years showed the consistent results above (WMD = 5.613; 95% CI = -45.101-56.328; P = 0.828. WMD = 5.582; 95% CI = -34.597-45.762; P = 0.785). No significant differences were found in operative time, blood transfusion rate, R0 resection, 1-year recurrence rate, 2-year-recurrence rate and the 1-year overall survival rate (P > 0.05). CONCLUSION: This meta-analysis showed that during the liver resection operation, application of indocyanine green fluorescence imaging is a feasible and safe method in the treatment of liver diseases, which enhances some clinical outcomes, such as lower complications and shorter hospital stays.

Unsupervised learning for deformable registration of thoracic CT and cone-beam CT based on multiscale features matching with spatially adaptive weighting.

PURPOSE: Cone-beam computed tomography (CBCT) is a common on-treatment imaging widely used in image-guided radiotherapy. Fast and accurate registration between the on-treatment CBCT and planning CT is significant for and precise adaptive radiotherapy treatment (ART). However, existing CT-CBCT registration methods, which are mostly affine or time-consuming intensity- based deformation registration, still need further study due to the considerable CT-CBCT intensity discrepancy and the artifacts in low-quality CBCT images. In this paper, we propose a deep learning-based CT-CBCT registration model to promote rapid and accurate CT-CBCT registration for radiotherapy. METHODS: The proposed CT-CBCT registration model consists of a registration network and an innovative deep similarity metric network. The registration network is a novel fully convolution network adapted specially for patch-wise CT-CBCT registration. The metric network, going beyond intensity, automatically evaluates the high-dimensional attribute-based dissimilarity between the registered CT and CBCT images. In addition, considering the artifacts in low-quality CBCT images, we add spatial weighting (SW) block to adaptively attach more importance to those informative voxels while inhibit the interference of artifact regions. Such SW-based metric network is expected to extract the most meaningful and discriminative deep features, and form a more reliable CT-CBCT similarity measure to train the registration network. RESULTS: We evaluate the proposed method on clinical thoracic CBCT and CT dataset, and compare the registration results with some other common image similarity metrics and some state-of-the-art registration algorithms. The proposed method provides the highest Structural Similarity index (86.17 ± 5.09), minimum Target Registration Error of landmarks (2.37 ± 0.32 mm), and the best DSC coefficient (78.71 ± 10.95) of tumor volumes. Moreover, our model also obtains comparable distance error of lung surfaces (1.75 ± 0.35 mm). CONCLUSION: The proposed model shows both efficiency and efficacy for reliable thoracic CT-CBCT registration, and can generate the matched CT and CBCT images within few seconds, which is of great significance to clinical radiotherapy.

The effect of total glucoside of paeony on gut microbiota in NOD mice with Sjögren's syndrome based on high-throughput sequencing of 16SrRNA gene.

PURPOSE: To investigate the effect of total glucoside of paeony (TGP) on gut microbiota in NOD mice with Sjögren's syndrome (SS), using high-throughput sequencing of 16SrRNA gene. METHODS: Twenty-four NOD mice were randomly assigned to 4 groups (n = 6 per group): sham group receiving deionized water (0.4 ml), hydroxychloroquin group receiving hydroxychloroquin (0.4 ml), TGP group receiving TGP (0.4 ml), and TGP + hydroxychloroquin group receiving 0.4 ml TGP and 0.4 ml hydroxychloroquin. Balb/c mice (n = 6) receiving 0.4 ml deionized water were used as a control group. After intragastric injection of drugs for 8 weeks, feces were collected for high-throughput sequencing of 16SrRNA gene. RESULTS: The sequencing of 16SrRNA gene resulted in 3686 OTUs, and 10 phyla and 69 genera were identified. Compared with the control group, the indices of Chao, Ace and Shannon in the other 4 groups were significantly lower (P < 0.05), and the Simpson index were significantly higher in the TGP, hydroxychloroquine, and sham groups (P < 0.05). Compared with the sham group, the indices of Chao, Ace and Shannon were significantly higher (P < 0.05), whereas the Simpson index was significantly lower (P < 0.05) in the TGP and TGP + hydroxychloroquine groups. At phylum level, Bacteroidetes was least abundant (36.1%), and Firmicutes was most abundant (56.28%) in the TGP + hydroxychloroquine group. Compared with the other 4 groups, Bacteroidetes was significantly less abundant (P < 0.05) and Firmicutes was significantly more abundant (P < 0.05) in the TGP + hydroxychloroquine group. Verrucomicrobia was most abundant (12.26%) in the hydroxychloroquine, and was significantly more abundant compared with the other 3 groups (P < 0.05). At genus level, compared with the control group, the abundance of Lactobacillus and Incertae of Phylum Firmicutes and Desulfovibrio of Phylum Proteobacteria was significantly increased, and the abundance of Bacteroides and Alloprevotella of Phylum Bacteroidetes and Pseudoflavonifractor of Phylum Firmicutes was significantly decreased in the TGP + hydroxychloroquine group (P < 0.05). Compared with the hydroxychloroquine group, the abundance of Akkermansia of Phylum Verrucomicrobia was significantly decreased in the TGP and TGP + hydroxychloroquine groups (P < 0.05). The abundance of Alistipes of Phylum Bacteroidetes and Desulfovibrio of Phylum Proteobacteria was significantly increased in the TGP + hydroxychloroquine group (P < 0.05). CONCLUSIONS: TGP increases the growth of many key beneficial bacteria, inhibits the growth of dominant pathogenic bacteria, and increases the diversity and abundance of gut microorganisms, especially when combined with hydroxychloroquine. Our findings suggest that TGP may be effective to treat SS by improving the microecological structure of the gut.

Locally Adaptive Total p-Variation Regularization for Non-Rigid Image Registration With Sliding Motion.

Due to the complicated thoracic movements which contain both sliding motion occurring at lung surfaces and smooth motion within individual organs, respiratory estimation is still an intrinsically challenging task. In this paper, we propose a novel regularization term called locally adaptive total p-variation (LaTpV) and embed it into a parametric registration framework to accurately recover lung motion. LaTpV originates from a modified Lp-norm constraint (1 < p < 2), where a prior distribution of p modeled by the Dirac-shaped function is constructed to specifically assign different values to voxels. LaTpV adaptively balances the smoothness and discontinuity of the displacement field to encourage an expected sliding interface. Additionally, we also analytically deduce the gradient of the cost function with respect to transformation parameters. To validate the performance of LaTpV, we not only test it on two mono-modal databases including synthetic images and pulmonary computed tomography (CT) images, but also on a more difficult thoracic CT and positron emission tomography (PET) dataset for the first time. For all experiments, both the quantitative and qualitative results indicate that LaTpV significantly surpasses some existing regularizers such as bending energy and parametric total variation. The proposed LaTpV based registration scheme might be more superior for sliding motion correction and more potential for clinical applications such as the diagnosis of pleural mesothelioma and the adjustment of radiotherapy plans.