[Computer-vision-based artificial intelligence for detection and recognition of instruments and organs during radical laparoscopic gastrectomy for gastric cancer: a multicenter study].

Objective: To investigate the feasibility and accuracy of computer vision-based artificial intelligence technology in detecting and recognizing instruments and organs in the scenario of radical laparoscopic gastrectomy for gastric cancer. Methods: Eight complete laparoscopic distal radical gastrectomy surgery videos were collected from four large tertiary hospitals in China (First Medical Center of Chinese PLA General Hospital [three cases], Liaoning Cancer Hospital [two cases], Liyang Branch of Jiangsu Province People's Hospital [two cases], and Fudan University Shanghai Cancer Center [one case]). PR software was used to extract frames every 5-10 seconds and convert them into image frames. To ensure quality, deduplication was performed manually to remove obvious duplication and blurred image frames. After conversion and deduplication, there were 3369 frame images with a resolution of 1,920×1,080 PPI. LabelMe was used for instance segmentation of the images into the following 23 categories: veins, arteries, sutures, needle holders, ultrasonic knives, suction devices, bleeding, colon, forceps, gallbladder, small gauze, Hem-o-lok, Hem-o-lok appliers, electrocautery hooks, small intestine, hepatogastric ligaments, liver, omentum, pancreas, spleen, surgical staplers, stomach, and trocars. The frame images were randomly allocated to training and validation sets in a 9:1 ratio. The YOLOv8 deep learning framework was used for model training and validation. Precision, recall, average precision (AP), and mean average precision (mAP) were used to evaluate detection and recognition accuracy. Results: The training set contained 3032 frame images comprising 30 895 instance segmentation counts across 23 categories. The validation set contained 337 frame images comprising 3407 instance segmentation counts. The YOLOv8m model was used for training. The loss curve of the training set showed a smooth gradual decrease in loss value as the number of iteration calculations increased. In the training set, the AP values of all 23 categories were above 0.90, with a mAP of 0.99, whereas in the validation set, the mAP of the 23 categories was 0.82. As to individual categories, the AP values for ultrasonic knives, needle holders, forceps, gallbladders, small pieces of gauze, and surgical staplers were 0.96, 0.94, 0.91, 0.91, 0.91, and 0.91, respectively. The model successfully inferred and applied to a 5-minutes video segment of laparoscopic gastroenterostomy suturing. Conclusion: The primary finding of this multicenter study is that computer vision can efficiently, accurately, and in real-time detect organs and instruments in various scenarios of radical laparoscopic gastrectomy for gastric cancer.

[Preliminary experience with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after total laparoscopic proximal gastrectomy for the treatment of adenocarcinoma of esophagogastric junction].

Objective: To explore the feasibility and preliminary technical experience of the double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after total laparoscopic proximal gastrectomy (TLPG) in the treatment of adenocarcinoma of esophagogastric junction (AEG). Methods: A descriptive case series study method was used. Clinical data of 12 AEG patients who underwent the double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after TLPG from January 2021 to June 2021 at the Department of General Surgery, First Medical Center, PLA General Hospital were retrospectively analyzed. Among the 12 patients, the median tumor diameter was 2.0 (1.5-2.9) cm, and the pathological stage was T1-3N0-3aM0. All the patients routinely underwent TLPG and D2 lymph node dissection with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis: (1) Double-tract reconstruction combined with π-shaped esophagojejunal anastomosis: mesentery 25 cm away from the Trevor ligament was treated, and an incision of about 1 cm was made on the mesenteric border of the intestinal wall and the right wall of the esophagus, two arms of the linear cutting closure were inserted, and esophagojejunal side-to-side anastomosis was performed. A linear stapler was used to cut off the lower edge of the anastomosis and close the common opening to complete the esophagojejunal π-shaped anastomosis. (2) Side-to-side gastrojejunostomy anastomosis: an incision of about 1 cm was made at the jejunum to mesenteric border and at the greater curvature of the remnant stomach 15 cm from the esophagojejunostomy, and a linear stapler was inserted to complete the gastrojejunostomy side-to-side anastomosis. (3) Side-to-side jejunojejunal anastomosis: an incision of about 1 cm was made at the proximal and distal jejunum to the mesangial border 40 cm from the esophagojejunostomy, and two arms of the linear stapler were inserted respectively to complete the side-to-side jejunojejunal anastomosis. A midline incision about 4-6 cm in the upper abdomen was conducted to take out the specimen, and an abdominal drainage tube was placed, then layer-by-layer abdominal closure was performed. INDICATIONS: (1) adenocarcinoma of esophagogastric junction (Seiwert type II-III) was diagnosed by endoscopy and pathological examination; (2) ability to preserve at least 1/2 of the distal stomach after R0 resection of proximal stomach was evaluated preoperatively. CONTRAINDICATIONS: (1) evaluation indicated distant metastasis of tumor or invasion of other organs; (2) short abdominal esophagus or existence of diaphragmatic hiatal hernia was assessed during the operation; (3) mesentery was too short or the tension was too high; (4) existence of severe comorbidities before surgery; (5) only palliative surgery was required in preoperative evaluation; (6) poor nutritional status. MAIN OUTCOME MEASURES: operation time, intraoperative blood loss, postoperative complications, time to first flatus and time to start liquid diet, postoperative hospital stay, operation cost, etc. Continuous variables that conformed to normal distribution were presented as mean ± standard deviation, and those that did not conform to normal distribution were presented as median (Q1,Q3). Results: All the patients successfully completed TLPG with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis, and postoperative pathology showed that no cancer cells were found on the upper incision margin. The operation time was (247.9±62.4) minutes, the median intraoperative blood loss was 100.0 (62.5, 100.0) ml, no intraoperative blood transfusion was required, the incision length was (4.9±1.0) cm, and the operation cost was (55.5±0.7) thousand yuan. The median time to start liquid diet was 1.0 (1.0, 2.0) days, and the mean time to flatus was (3.1±0.9) days. All the patients were discharged uneventfully. Only 1 patient developed postoperative paralytic ileus and infectious pneumonia with Clavien-Dindo classification of grade II. The patient recovered after conservative treatment. There was no surgery-related death. The postoperative hospital stay was (8.3±2.1) days. Conclusion: The double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after TLPG is safe and feasible, which can minimize surgical trauma and accelerate postoperative recovery.

Nomogram to predict survival of patients with advanced and metastatic pancreatic Cancer.

BACKGROUND: Nomograms are rarely employed to estimate the survival of patients with advanced and metastatic pancreatic cancer (PC). Herein, we developed a comprehensive approach to using a nomogram to predict survival probability in patients with advanced and metastatic PC. METHODS: A total of 323 patients with advanced and metastatic PC were identified from the Chinese People's Liberation Army (PLA) General Hospital. A baseline nomogram was constructed using baseline variables of 323 patients. Additionally, 233 patients, whose tumors showed initial responses to first-line chemotherapy, were enrolled in the chemotherapy response-based model. 128 patients and 108 patients with advanced and metastatic PC from January 2019 to April 2021 were selected for external validating baseline model and chemotherapy response-based model. The 1-year and 2-year survival probability was evaluated using multivariate COX regression models. The discrimination and calibration capacity of the nomograms were assessed using C-statistic and calibration plots. The predictive accuracy and net benefit of the nomograms were evaluated using ROC curve and DCA, respectively. RESULTS: In the baseline model, six variables (gender, KPS, baseline TB, baseline N, baseline WBC and baseline CA19-9) were used in the final model. In the chemotherapy response-based model, nine variables (KPS, gender, ascites, baseline N, baseline CA 19-9, baseline CEA, change in CA 19-9 level at week, change in CEA level at week and initial response to chemotherapy) were included in the final model. The C-statistics of the baseline nomogram and the chemotherapy response-based nomogram were 0.67 (95% CI, 0.62-0.71) and 0.74 (95% CI, 0.69-0.77), respectively. CONCLUSION: These nomograms were constructed to predict the survival probability of patients of advanced and metastatic PC. The baseline model and chemotherapy response-based model performed well in survival prediction.

Identification of DNA methylation-driven genes and construction of a nomogram to predict overall survival in pancreatic cancer.

BACKGROUND: The incidence and mortality of pancreatic cancer (PC) has gradually increased. The aim of this study was to identify survival-related DNA methylation (DNAm)-driven genes and establish a nomogram to predict outcomes in patients with PC. METHODS: The gene expression, DNA methylation database, and PC clinical samples were downloaded from TCGA. DNAm-driven genes were identified by integrating analyses of gene expression and DNA methylation data. Survival-related DNAm-driven genes were screened via univariate, least absolute shrinkage and selection operator (LASSO), and multivariate Cox regression analyses to develop a risk score model for prognosis. Based on analyses of clinical parameters and risk score, a nomogram was built and validated. The independent cohort from GEO database were used for external validation. RESULTS: A total of 16 differentially expressed methylation-driven genes were identified. Based on LASSO Cox regression and multivariate Cox regression analysis, six genes (FERMT1, LIPH, LAMA3, PPP1R14D, NQO1, VSIG2) were chosen to develop the risk score model. In the Kaplan-Meier analysis, age, T stage, N stage, AJCC stage, radiation therapy history, tumor size, surgery type performed, pathological type, chemotherapy history, and risk score were potential prognostic factors in PC (P < 0.1). In the multivariate analysis, stage, chemotherapy, and risk score were significantly correlated to overall survival (P < 0.05). The nomogram was constructed with the three variables (stage, chemotherapy, and risk score) for predicting the 1-year, 2-year, and 3-year survival rates of PC patients. Nomogram performance was assessed by receiver operating characteristic (ROC) curves and calibration curves. 1-year, 2-year and 3-year AUC of nomogram model was 0.899, 0.765 and 0.776, respectively. CONCLUSIONS: In our study, we successfully identified the six DNAm-driven genes (FERMT1, LIPH, LAMA3, PPP1R14D, NQO1, VSIG2) with a relationship to the outcomes of PC patients. The nomogram including stage, chemotherapy, and risk score could be used to predict survival in PC patients.

Neurotrophin-3 improves fracture healing in rats.

OBJECTIVE: This study aimed at investigating the role of Neurotrophin-3 (NT-3) in the bone fracture healing of rats and to provide a reference for clinical treatment. MATERIALS AND METHODS: 40 Sprague-Dawley (SD) rats were randomly divided into control group and NT-3 group. The tibia fracture model was made in NT-3 group, and the tibia bone mineral density (BMD) was measured before and after the surgery. The biomechanics indexes were inspected after the surgery, including elasticity modulus, max load, and bending rigidity. The levels of bone morphogenetic protein (BMP)-2 and transforming growth factor (TGF)-ß1 in serum were examined by enzyme-linked immunosorbent assay (ELISA). Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the levels of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) mRNA expression in callus tissue. The pathological profile of tibia fracture healing was characterized after the surgery. RESULTS: The levels of BMD in NT-3 group were significantly higher than that in control group after the surgery (p < 0.05). The levels of elasticity modulus, maximum load, stiffness of shinbone, BMP-2 and TGF-ß1 were significantly higher in NT-3 group than those in control group after the surgery (p < 0.05). Compared with the control group, the expression of HIF-1α mRNA was significantly lower and the expression of VEGF mRNA was significantly higher in NT-3 group after the surgery (p < 0.05). Histological study showed that the periosteal reaction, capillary proliferation, cartilage cells production and ossification were happened after treating NT-3 for tibia fracture model rats. CONCLUSIONS: NT-3 can significantly improve fracture healing in rats.

Experimental study on transplantation of autologous minced muscle with human umbilical cord mesenchymal stem cells for urethral reconstruction.

OBJECTIVE: To investigate the feasibility and efficiency of the autologous minced muscle-derived regenerate as a living patch graft for the urethral reconstruction with the assistance of human umbilical cord mesenchymal stem cells (hUC-MSCs) in the rabbit model. MATERIALS AND METHODS: The hUC-MSCs and minced-muscle-derived regenerate tissue was prepared and used as potential autologous patch graft for the reconstruction of the defective rabbit urethra. Animal with autologous free skeletal muscle piece was observed as control. Histopathological and immunohistochemical staining methods were adopted to evaluate the regenerating effect; the reconstructive effects in New Zealand rabbit were observed in both groups by retrograde urethrography and urinary microscopy. RESULTS: The expression of desmin and anti-human specific nuclear antigen (ANA) were positive for co-culture microsomes in vivo and in vitro; after the reconstructive surgery, histopathological studies revealed fibrous connective tissues and abundant muscle fibers constituted the main body of the patch-grafted urethra. Urethrography and urethroscopy showed no urethral obstruction, stenosis, fistula or diverticula anomaly existed in experimental group. CONCLUSIONS: Our preclinical study showed that the hUC-MSCs and minced-muscle-derived regenerate could be used as an autologous pre-vascularized living patch graft for urethral reconstruction.

Whole genome expression profiling of hepatitis B virus-transfected cell line reveals the potential targets of anti-HBV drugs.

Hepatitis B virus (HBV) infection is a major health concern world wide, and few effective treatments have been developed. It has recently been reported that inhibiting host-cell proteins can prevent viral infection. The human genome may contain more genes required for HBV infection and replication than the viral genome. A systematic approach to find these potential antiviral targets is by host gene expression analysis using DNA microarrays. The aim of this study was to identify and validate novel cellular anti-HBV targets. The Human Whole Genome Bioarray was used to analyze differentially expressed genes in HepG2.2.15 cells and HepG2 cells. Altered gene expression in HepG2.2.15 cells was studied following treatment with the anti-HBV drug, lamivudine. Genes that were differentially expressed during HBV infection and reversed with anti-HBV drugs were validated by semiquantitative reverse transcription-PCR. Bioinformatics analysis revealed ABHD2, EREG, ACVR2B, CDC34, KHDRBS3 and RORA as potential cellular anti-HBV targets. Antisense oligodeoxynucleotides were used to test the antiviral activity of these potential targets. Results strongly suggested that inhibition of ABHD2 or EREG significantly blocked HBV propagation in HepG2.2.15 cells. This study demonstrates that ABHD2 and EREG are essential for HBV propagation and provides strong evidence that these proteins could be used as potential targets for anti-HBV drugs.

HBx protein of hepatitis B virus (HBV) can form complex with mitochondrial HSP60 and HSP70.

HBx, a transcriptional transactivating protein of hepatitis B virus (HBV), is required for viral infection and has been implicated in virus-mediated liver oncogenesis. However, the molecular mechanism for its influence on cell remains largely unknown. It was proved that HBx need the help of host cell proteins to exert its function by binding to them. During purifying of GSTX (fusion protein of GST and HBx) expressed in E. coli, we found that it can bind specifically with GrpE (HSP60) and DnaK (HSP70) of E. coli while GST cannot. Using GST pull-down, two-dimensional gel electrophoresis and mass spectrum, we found that GSTX can also bind to human mitochondrial HSP60 and HSP70, which are homologues of GrpE and DnaK. These interactions between HBx and mitochondrial HSP60 and HSP70 are supported by the result of co-immunoprecipitation experiment. It means that HBx can form complex with E. coli and human HSP60 and HSP70. The implication of HBx, HSP60 and HSP70 complex in molecular mechanism of virus infection is discussed.

A novel way to prepare ultra-thin polymer films through surface radical chain-transfer reaction.

Radical chain transfer to bonded thiol groups and surface re-initiated polymerization resulted in ultra-thin polymer films.

Epilepsy as the sole manifestation of brain tumor--report of two cases.

Epilepsy may be the earliest and the sole clinical manifestation of a brain tumor. The existence and the character of the brain tumor cannot be predicted based solely on the severity and pattern of seizure. Epilepsy is common in patients with brain tumors, however, it is less common to find brain tumors in patients with epilepsy. Due to the slow progression of brain tumors and limitations in the use of brain computed tomography (CT), it often takes a long time to diagnose brain tumors in an epileptic child. Relief of epilepsy by surgical removal of the etiologic brain tumor appears to be promising. We report two cases of brain tumors presenting as intractable epilepsy with a discordant neuroimage. Therefore for those children taking long-term anticonvulsants with frequent recurrence, it appears reasonable to perform magnetic resonance imaging (MRI) to enable discovering of any organic lesions.

Effect of concanavalin A on lymph node macrophages: stimulation of endocytic cisternae.

Incubation of isolated lymph node macrophages with concanavalin A (Con A) resulted in a dense and continuous labeling of the plasmalemma and filopodia which were closely adherent to each other and the cell surface. Within a short time period (3-5 min), membranes of the closely apposed filopodia became invaginated into the cytoplasm to form numerous interconnecting cisternae. After 10 min the system of internalized membranes had migrated into the deeper cytoplasm and was closely associated with numerous actin filaments and other components of the cytoskeleton. The internalized plasmalemma remained in the cytoplasm up to 24 hr without fusing with lysosomes. Concomitant with plasmalemmal invagination and the formation of cisternae there were also changes in the Golgi apparatus. These appeared in the form of hypertrophied Golgi saccules and the accumulation of numerous vesicles around the Golgi. Treatment of isolated lymph node macrophages with either succinylated Con A, alpha-methyl-D-mannoside, or ferritin particles alone failed to produce the cisternal structures. The results suggested that the tetravalency of Con A may be responsible for the binding of adjacent Con A-labeled membranes to each other and for maintaining a crosslinking of membranes during invagination and internalization. It is suggested that this process of extensive membrane internalization represents a specialized form of endocytosis. At 24 hr after incubation with Con A, cisternal structures in close proximity to the Golgi vesicles showed signs of degradation. By 48 hr there was a breakdown of cisternal membranes with a release of Con A marker particles into large phagocytic vesicles, which also showed reaction product for acid phosphatase, suggesting a fusion with lysosomes.

Cultivation of human osteosarcoma cell lines in serum-free hormone supplemented medium.

Two human osteosarcoma cell lines (TE-85, LM-1) were adapted to grow in serum-free hydrocortisone supplemented medium. Human osteosarcoma associated antigens were detected both on the cell membrane as well as in the concentrated culture medium. TE-85 cells produced bone specific alkaline phosphatase and LM-1 cells produced both bone specific and placental-like alkaline phosphatases when cultured in this medium. Successful proliferation of human osteosarcoma cell lines in serum-free medium is valuable in human osteosarcoma research.

Concanavalin A receptor sites on lymph node cells in vivo and in vitro.

The distribution and density of receptors for concanavalin A (Con A) on the surfaces of cells of intact and isolated popliteal and axillary lymph nodes were investigated in the rabbit. Intact lymph nodes were perfused via the subcapsular (marginal) sinus with either Con A peroxidase or Con A ferritin, fixed with glutaraldehyde, and processed for electron microscopy. Both Con A peroxidase and Con A ferritin were distributed on the plasmalemma of lymphocytes, macrophages, neutrophils, plasma cells, reticular endothelial cells, and the vascular endothelium. Counts of Con A-conjugated ferritin particles indicated that the density of Con A receptors was generally similar for lymphocytes, macrophages, and neutrophils but lower on plasma cells. When lymph node cells were isolated by mechanical methods and exposed to Con A ferritin, the label was homogenously distributed on the cell surfaces of most cells. However, Con A binding was significantly higher on the surface of isolated cells than in the intact node. It is suggested that the increase in density of Con A binding sites on isolated cells may possibly be due to an unmasking of cell surface moieties in which additional Con A receptor sites become available as a result of the isolation procedure. The density of Con A ferritin binding sites was also significantly lower on the surface of isolated plasma cells than the lymphocyte and macrophage, suggesting that the density distribution of cell surface saccharides is different for various lymphoid cells.

Effect of a new antacid on basal and meal-stimulated gastric secretion.

Our study of the comparative neutralizing effectiveness of four antacids on the acidity and pH of the basal gastric secretion in 32 patients showed that using the conventional doses of two tablets of Rolaids, two tablets of Di-Gel, 15 ml. of Maalox liquid or two tablets of Conquel, they are equal in their acid neutralizing capacity. The duration of action for 45-60 minutes. Conquel, in a dose of two tablets, was a potent buffer for the peptone-meal stimulated secretion. The duration of action lasted for longer than two hours.

Augmented histamine test--diagnostic and prognostic values.

The results of the augmented histamine test in 107 controls, 48 patients with gastric ulcer and 141 patients with duodenal ulcer are presented. The mean basal acid secretion and maximal acid output (MAO) were significantly higher in duodenal ulcer patients than in normal subjects. Ulcers of the body of the stomach were associated with lower than normal levels of secretion, whereas ulcers of the prepyloric region were associated with higher than normal levels. In this study of 141 patients with duodenal ulcer, 101 patients or 72% had an MAO above the upper limit of normal (20.4 mEq./hr.). Conversely, a patient with an MAO of less than 12.4 mEq./hr. is unlikely to have duodenal ulcer disease. The use of the ratio of MAO to actual body weight did not increase the diagnostic discrimination between normal subjects and those with duodenal ulcer. Duodenal ulcer patients with complications had a significantly higher MAO to histamine than those without complication. The finding of an MAO greater than 40 mEq./hr. is highly suggestive of the presence or the imminence of a complication.