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PURPOSE: To confirm if the CYP17A1 gene regulates the ratio of T/E leading to MetS-BPH. METHODS: 824 men, aged 47-88 years, were recruited into this study through consecutive routine physical examination programs and long-term outpatient screening. Several parameters, including SNPs of CYP17A1 gene, total testosterone, estradiol, and the ratio of total testosterone to estradiol (T/E) were obtained for each participant. Based on the diagnosis of BPH, MetS, and MetS-BPH, the participants were divided into BPH and non-BPH groups, MetS and non-MetS groups, and MetS-BPH and non-MetS-BPH groups. Values of the obtained parameters were evaluated using one-way analysis of variance, Student's t-test, Chi-squared test, and logistic regression analysis. RESULTS: SNPs of the CYP17A1 gene, including the rs743572 genotypes (GG, GA, and AA), rs3781287 genotypes (GG, GT, TT), and rs4919686 genotypes (CC, CA, and AA), were present in every group. Only the GG genotype of rs743572 was independently associated with BPH (OR = 5.868, 95% CI: 3.363-7.974, P < 0.001), MetS (OR = 7.228, 95% CI: 3.925-11.331, P < 0.001), and MetS-BPH (OR = 3.417, 95% CI: 1.783-5.266, P < 0.001) after adjusting for age. In the population of genotype GG of rs743572, the decrease in T/E ratio was an independent risk factor for BPH (OR = 839.756, 95% CI: 36.978-1334.263, P = 0.001), MetS (OR = 376.988, 95% CI: 12.980-488.976, P < 0.003), and MetS-BPH (OR = 388.236, 95% CI: 24.869-495.363, P = 0.003). CONCLUSION: The GG genotype of rs743572 in CYP17A1 gene regulating the decrease of T/E ratio can be an independent risk factor for MetS-BPH populations. TRIAL REGISTRATION NUMBER: ChiCTR2200057632 "retrospectively registered". DATE OF REGISTRATION: March 15, 2022 "retrospectively registered".
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Genotipo , Hiperplasia Prostática , Esteroide 17-alfa-Hidroxilasa , Testosterona , Humanos , Esteroide 17-alfa-Hidroxilasa/genética , Masculino , Persona de Mediana Edad , Anciano , Hiperplasia Prostática/genética , Estudios Retrospectivos , Anciano de 80 o más Años , Factores de Riesgo , Testosterona/sangre , Estradiol/sangre , Polimorfismo de Nucleótido Simple , Estudios de CohortesRESUMEN
BACKGROUND: Selective cannulation, which is essential for endoscopic retrograde cholangiopancreatography (ERCP), may be difficult. The aim of this study was to compare transpancreatic sphincterotomy (TPS) and needle-knife precut (NKP) in difficult cannulation during ERCP. METHODS: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for relevant studies from January 1990 to April 2022. A meta-analysis focusing on cannulation success and post-ERCP complications was performed using Review Manager. RESULTS: Seventeen eligible studies involving 2,340 patients were included. Our results showed that the TPS group had a higher cannulation success rate (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.27-0.87, p = 0.02) and less bleeding (OR 1.94, 95% CI: 1.09-3.47, p = 0.03) compared with the NKP group. There was no significant difference between NKP and TPS in the rates of post-ERCP pancreatitis (OR 0.83, 95% CI: 0.59-1.18, p = 0.30), perforation (OR 2.04, 95% CI: 0.69-6.03, p = 0.20), and adverse events (OR 1.29, 95% CI: 0.94-1.77, p = 0.12). CONCLUSION: TPS appears to be associated with a higher cannulation success rate and less bleeding than those with NKP, with equal post-ERCP pancreatitis, perforation, and adverse event rates between TPS and NKP. Further large-scale trials are warranted to support our findings.
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Pancreatitis , Esfinterotomía , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Esfinterotomía Endoscópica/efectos adversos , Resultado del Tratamiento , Cateterismo/efectos adversos , Cateterismo/métodos , Pancreatitis/epidemiología , Pancreatitis/etiología , Esfinterotomía/efectos adversos , Hemorragia/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Hepatic fibrosis is a common consequence of chronic liver diseases without approved antifibrotic therapies. Long noncoding RNAs (lncRNAs) play an important role in various pathophysiological processes. However, the functions of certain lncRNAs involved in mediating the antifibrotic role remain largely unclear. METHODS: The RNA level of lnc-High Expressed in Liver Fibrosis (Helf) was detected in both mouse and human fibrotic livers. Furthermore, lnc-Helf-silenced mice were treated with carbon tetrachloride (CCl4) or bile duct ligation (BDL) to investigate the function of lnc-Helf in liver fibrosis. RESULTS: We found that lnc-Helf has significantly higher expression in human and mouse fibrotic livers as well as M1 polarized hepatic macrophages (HMs) and activated hepatic stellate cells (HSCs). In vivo studies showed that silencing lnc-Helf by AAV8 vector alleviates CCl4- and BDL-induced hepatic inflammation and fibrosis. Furthermore, in vitro experiments revealed that lnc-Helf promotes HSCs activation and proliferation, as well as HMs M1 polarization and proliferation in the absence or presence of cytokine stimulation. Mechanistically, our data illustrated that lnc-Helf interacts with RNA binding protein PTBP1 to promote its interaction with PIK3R5 mRNA, resulting in increased stability and activating the AKT pathway, thus promoting HSCs and HMs activation and proliferation, which augments hepatic inflammation and fibrosis. CONCLUSION: Our results unveil a lnc-Helf/PTBP1/PIK3R5/AKT feedforward, amplifying signaling that exacerbates the process of hepatic inflammation and fibrosis, thus providing a possible therapeutic strategy for hepatic fibrosis.
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Fosfatidilinositol 3-Quinasa , ARN Largo no Codificante , Animales , Humanos , Ratones , Células Cultivadas , Ribonucleoproteínas Nucleares Heterogéneas/genética , Inflamación , Cirrosis Hepática/genética , Cirrosis Hepática/metabolismo , Proteína de Unión al Tracto de Polipirimidina/genética , Proteínas Proto-Oncogénicas c-akt/metabolismo , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , ARN Mensajero/genética , Factores de Transcripción/metabolismo , Fosfatidilinositol 3-Quinasa/metabolismoRESUMEN
BACKGROUND: Long noncoding RNAs (lncRNAs) have emerged as important regulators in a variety of human diseases. The dysregulation of liver sinusoidal endothelial cell (LSEC) phenotype is a critical early event in the fibrotic process. However, the biological function of lncRNAs in LSEC still remains unclear. METHODS: The expression level of lncRNA Airn was evaluated in both human fibrotic livers and serums, as well as mouse fibrotic livers. Gain- and loss-of-function experiments were performed to detect the effect of Airn on LSEC differentiation and hepatic stellate cell (HSC) activation in liver fibrosis. Furthermore, RIP, RNA pull-down-immunoblotting, and ChIP experiments were performed to explore the underlying mechanisms of Airn. RESULTS: We have identified Airn was significantly upregulated in liver tissues and LSEC of carbon tetrachloride (CCl4)-induced liver fibrosis mouse model. Moreover, the expression of AIRN in fibrotic human liver tissues and serums was remarkably increased compared with healthy controls. In vivo studies showed that Airn deficiency aggravated CCl4- and bile duct ligation (BDL)-induced liver fibrosis, while Airn over-expression by AAV8 alleviated CCl4-induced liver fibrosis. Furthermore, we revealed that Airn maintained LSEC differentiation in vivo and in vitro. Additionally, Airn inhibited HSC activation indirectly by regulating LSEC differentiation and promoted hepatocyte (HC) proliferation by increasing paracrine secretion of Wnt2a and HGF from LSEC. Mechanistically, Airn interacted with EZH2 to maintain LSEC differentiation through KLF2-eNOS-sGC pathway, thereby maintaining HSC quiescence and promoting HC proliferation. CONCLUSIONS: Our work identified that Airn is beneficial to liver fibrosis by maintaining LSEC differentiation and might be a serum biomarker for liver fibrogenesis.
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ARN Largo no Codificante , Animales , Biomarcadores/metabolismo , Tetracloruro de Carbono/metabolismo , Tetracloruro de Carbono/farmacología , Células Endoteliales/metabolismo , Humanos , Factores de Transcripción de Tipo Kruppel/genética , Factores de Transcripción de Tipo Kruppel/metabolismo , Factores de Transcripción de Tipo Kruppel/farmacología , Hígado/metabolismo , Hígado/patología , Cirrosis Hepática/patología , Ratones , ARN Largo no Codificante/genéticaRESUMEN
BACKGROUND: The surgical benefits of open distal pancreatectomy (ODP) and laparoscopic distal pancreatectomy (LDP) as a treatment for pancreatic disease in the body or tail were compared. MATERIAL AND METHODS: We searched PubMed, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and Web of Science from 1 August 1990 to 1 July 2019. Studies comparing total LDP and ODP were included. RESULTS: In total, we reviewed 30 studies covering 4040 subjects. The analysis displayed a similar incidence of CR-POPF and POPF between ODP and LDP groups. The findings indicate that LDP correlates with fewer total complications, lower estimated blood loss, shorter length of stay and shorter postoperative hospital stay. There was no significant difference in the operation time, R0 resection, postoperative hemorrhage, number of lymph nodes collected, reoperation, major complications, or mortality. CONCLUSIONS: Application of the International Study Group on Pancreatic Fistula (2017) criteria in this meta-analysis showed that LDP had surgical outcomes comparable with those of ODP. However, LDP has the benefits of causing a relatively lower estimated blood loss, a small number of total complications, and a shorter hospital stay. We, however, note that further high-quality and controlled trials are required to comprehensively compare these treatments.
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Laparoscopía , Neoplasias Pancreáticas , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the potential mechanism of the effect of metabolic syndrome (MetS) on prostate volume (PV) and the risk of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and the relationships of MetS and the major pathogenic factors of MetS with the clinical progression of BPH/LUTS in older Chinese men. SUBJECTS AND METHODS: We analyzed clinical data obtained from 506 ostensibly healthy men who underwent routine health check-ups and recruited 415 subjects from a group of previously studied men after 4 years. We evaluated the associations of major pathological factors of MetS, including insulin resistance, subclinical inflammatory state, and sex hormone changes, with PV, the risk of BPH and the clinical progression of BPH/LUTS by using multiple linear regression and logistic regression. RESULTS: After adjustment for age, insulin, HOMA (homeostatic model assessment) index, leptin, resistin, adiponectin, C-reactive protein, tumor necrosis factor-α (TNF-α), sex hormone-binding globulin, and testosterone levels were significantly associated with PV (all P < .05), and in the age-adjusted logistic regression model, positive associations of resistin and TNF-α with BPH/LUTS were found (OR, 1.662, P = .007 and OR, 1.044, P < .001, respectively). Predictors of BPH/LUTS clinical progression were significantly correlated with MetS and TNF-α. The group with higher TNF-α levels had a higher rate of newly diagnosed BPH (9.5% vs 19.1%, P = .006) and a greater increase in PV levels (0.61 ± 0.08 vs 1.09 ± 0.35 cm3 , P <.001) after 4 years. CONCLUSIONS: MetS and its pathological factors were associated with an increased PV and an increased risk of BPH/LUTS that is more prone to clinical progression. TNF-α may serve as an early biological indicator to identify which patients with BPH/LUTS are at higher risk of unfavorable outcomes.
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Síndrome Metabólico/metabolismo , Síndrome Metabólico/patología , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/patología , Anciano , Presión Sanguínea/fisiología , Humanos , Modelos Logísticos , Masculino , Próstata/metabolismo , Próstata/patología , Circunferencia de la Cintura/fisiologíaRESUMEN
BACKGROUND: We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC). METHODS: We searched PubMed, Embase, Web of Science, the Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials comparing SILC versus MPLC. We evaluated the pooled outcomes for complications, pain scores, and surgery-related events. This study was performed in accordance with PRISMA guidelines. RESULTS: A total of 48 randomized controlled trials involving 2838 patients in the SILC group and 2956 patients in the MPLC group were included in this study. Our results showed that SILC was associated with a higher incidence of incisional hernia (relative risk = 2.51; 95% confidence interval = 1.23-5.12; p = 0.01) and longer operation time (mean difference = 15.27 min; 95% confidence interval = 9.67-20.87; p < 0.00001). There were no significant differences between SILC and MPLC regarding bile duct injury, bile leakage, wound infection, conversion to open surgery, retained common bile duct stones, total complication rate, and estimated blood loss. No difference was observed in postoperative pain assessed by a visual analogue scale between the two groups at four time points (6 h, 8 h, 12 h, and 24 h postprocedure). CONCLUSIONS: Based on the current evidence, SILC did not result in better outcomes compared with MPLC and both were equivalent regarding complications. Considering the additional surgical technology and longer operation time, SILC should be chosen with careful consideration.
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Colecistectomía Laparoscópica , Ensayos Clínicos Controlados Aleatorios como Asunto , Herida Quirúrgica , Bilis , Pérdida de Sangre Quirúrgica , Colecistectomía Laparoscópica/efectos adversos , Conversión a Cirugía Abierta , Femenino , Humanos , Hernia Incisional/etiología , Masculino , Persona de Mediana Edad , Tempo Operativo , Evaluación de Resultado en la Atención de Salud , Dolor Postoperatorio/etiología , Sesgo de Publicación , Riesgo , Infección de la Herida Quirúrgica/etiología , Escala Visual AnalógicaRESUMEN
BACKGROUND: Peritoneal drainage has been used routinely after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). Our objective was to compare patients' outcomes after PD or DP with or without peritoneal drainage. METHODS: We performed a systematic search using the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 June 2019. We included trials comparing no peritoneal drainage versus drainage after PD and/or DP. RESULTS: Ten trials involving 2419 patients were eligible for inclusion. The meta-analysis showed a significantly lower rate of postoperative pancreatic fistula in the no-drain group (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.29-0.51; p < 0.00001). However, there was no significant difference in the analysis of the subgroups, DP and DP + PD peritoneal drainage (p = 0.10, p = 0.19; respectively). The analysis of all studies showed no significant difference between groups regarding clinically related postoperative pancreatic fistula (OR 0.71; 95% CI 0.41-1.24; p = 0.23). Mortality was higher in the drain group in the PD + DP subgroup (OR 0.41; 95% CI 0.27-0.62; p < 0.0001). No significant differences were found regarding intra-abdominal abscess, delayed gastric emptying, biliary fistula, postoperative hemorrhage, or morbidity. CONCLUSION: Our results showed comparable outcomes for PD and DP with or without drainage. However, we can draw no clear conclusions because of the study limitations. Further studies on this topic are recommended.
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Drenaje/métodos , Pancreatectomía/métodos , Fístula Pancreática/cirugía , Pancreaticoduodenectomía/métodos , Anastomosis Quirúrgica/métodos , HumanosRESUMEN
BACKGROUND: Metabolic syndrome (MetS) and serum prostate-specific antigen (PSA) levels are correlated. To investigate the underlying effect of MetS on PSA levels, the relationship between the major pathogenic factors of MetS and serum PSA levels was studied. METHODS: A total of 506 ostensibly healthy men who underwent routine health check-ups were recruited to this study. We evaluated the effect of the major pathogenic factors of MetS, which included insulin resistance, a subclinical inflammatory state and sexual hormone changes, on serum PSA levels by using linear regression analysis and multivariate analysis after adjusting for age, BMI and prostate volume. RESULTS: When simultaneously adjusting for age, BMI, prostate volume and high-density lipoprotein cholesterol, serum insulin levels and SHBG levels were inversely correlated with serum PSA levels (P = 0.049 and P = 0.004, respectively), and testosterone levels were positively correlated with serum PSA levels (P = 0.039). In multivariate regression models, serum insulin levels and serum SHBG levels were significantly associated with serum PSA levels (both P < 0.001). CONCLUSIONS: Among the major pathogenic factors of metabolic syndrome, insulin resistance and sexual hormone changes may be the most significant contributors to the decline in serum PSA levels.
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Síndrome Metabólico/sangre , Síndrome Metabólico/etiología , Antígeno Prostático Específico/sangre , Anciano , Correlación de Datos , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de RiesgoRESUMEN
BACKGROUND: This study was performed to compare the safety and effectiveness of early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC). METHODS: A systematic search was performed of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1 August 1990 to 1 April 2018. Randomized controlled trials comparing ELC versus DLC were included. The primary outcome was bile duct injury (BDI) and bile leakage. The secondary outcomes were wound infection, total complications, conversion to open surgery, operation time, and total hospital stay. The statistical analysis was performed using Review Manager (RevMan) version 5.3 software (Cochrane Informatics and Knowledge Management Department). RESULTS: Fifteen RCTs were included. A meta-analysis showed no significant differences between ELC and DLC in terms of BDI (risk ratio [RR] 0.79; 95% confidence interval [CI] 0.23-2.79; p = 0.72) (in all subgroups of surgery: within 7, 4, and 3 days) (p = 0.22, 0.49, 0.49, respectively) or bile leakage (RR 2.05; 95% CI 0.98-4.31; p = 0.06). No significant differences were found in the rate of wound infection (RR 0.75; 95% CI 0.51-1.11; p = 0.15), total complications (RR 0.90; 95% CI 0.58-1.39; p = 0.63), or conversion to open surgery (RR 0.94; 95% CI 0.74-1.21; p = 0.64). There were no significant differences in the operation time between ELC and DLC (mean difference [MD] = 9.29 min; 95% CI - 0.41 to 18.98; p = 0.06), but ELC was associated with a longer surgery time within 7 days (MD = 16.49 min; 95% CI 2.10-30.88; p = 0.02). The pooled results showed that ELC was associated with a significantly shorter duration of hospital stay (MD = - 3.07 days; 95% CI - 3.98 to - 2.16; p < 0.00001), but with no significantly difference with postoperative hospital stay (MD = 0.45 days; 95% CI - 0.38 to 1.29; p = 0.29). CONCLUSION: ELC appears as safe and effective as DLC for acute cholecystitis within 7 days from presentation and may shorten the total hospital stay.
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Colecistectomía Laparoscópica , Colecistitis Aguda/cirugía , Tiempo de Tratamiento , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
OBJECTIVES: To clarify the lowering effect of metabolic syndrome (MetS) on serum prostate-specific antigen (PSA) levels in a Chinese screened population. SUBJECTS AND METHODS: A total of 45 540 ostensibly healthy men aged 55-69 years who underwent routine health check-ups at Beijing Shijitan Hospital between 2008 and 2015 were included in the study. All the men underwent detailed clinical evaluations. PSA mass density was calculated (serum PSA level × plasma volume ÷ prostate volume) for simultaneously adjusting plasma volume and prostate volume. According to the modified National Cholesterol Education Programme-Adult Treatment Panel (NCEP-ATP) III criteria, patients were dichotomized by the presence of MetS, and differences in PSA density and PSA mass density were compared between groups. Linear regression analysis was used to evaluate the effect of MetS on serum PSA levels. RESULTS: When larger prostate volume in men with MetS was adjusted for, both PSA density and PSA mass density in men with MetS were significantly lower than in men without MetS, and the estimated difference in mean serum PSA level between men with and without MetS was greater than that before adjusting for prostate volume. In the multivariate regression model, the presence of MetS was independently associated with an 11.3% decline in serum PSA levels compared with the absence of MetS. In addition, increasing number of positive MetS components was significantly and linearly associated with decline in serum PSA levels. CONCLUSION: The actual lowering effect of MetS on serum PSA levels was partly concealed by the enlarged prostate in men with MetS, and the presence of MetS was independently associated with lower serum PSA levels. Urologists need to be aware of the effect of MetS on serum PSA levels and should discuss this subject with their patients.
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Síndrome Metabólico/sangre , Síndrome Metabólico/terapia , Antígeno Prostático Específico/sangre , Hiperplasia Prostática/sangre , Neoplasias de la Próstata/sangre , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , China , Colesterol/sangre , Bases de Datos Factuales , Humanos , Masculino , Tamizaje Masivo/métodos , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Obesidad/sangre , Obesidad/epidemiología , Obesidad/fisiopatología , Valor Predictivo de las Pruebas , Hiperplasia Prostática/epidemiología , Hiperplasia Prostática/fisiopatología , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of the present study was to investigate the relationship among serum mean platelet volume (MPV) levels, benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and metabolic syndrome (MetS), and study the potential role of serum MPV levels in BPH/LUTS progression in an indirect manner. METHODS: Five hundred fifty-one men aged 45 or older with moderate to severe LUTS due to benign prostatic enlargement were recruited into this study by consecutive routine physical examination programs. Urologic evaluation included transrectal ultrasound, International Prostate Symptom Score and maximum urinary flow rate (Qmax). Overnight fasting venous blood specimens were collected and serum levels of prostate-specific antigen, fasting blood glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride and C-reactive protein (CRP) were recorded. In addition, MPV were determined by automated hematology analyzer. We divided subjects into 2 groups according to the presence of MetS. We also took the MPV values as a categorical variable and divided subjects into 2 groups (≥11.8 or <11.8 fl) or 4 groups according to the different levels of MPV (9.3-11.0, 11.1-11.5, 11.6-11.9, 12.0-12.5 and ≥12.5 fl). The clinical characteristics and parameters of BPH/LUTS in different groups were measured and compared to identify their relationships. RESULTS: MetS was diagnosed in 37.0% of the subjects. There were significant interactive correlation among the number of positive MetS components, CRP, MPV and parameters of BPH/LUTS. The ratio of PV ≥31 ml and Qmax <10.6 ml/s were positively correlated with the increased level of MPV. Additionally, the OR in relation to PV ≥31 ml and Qmax <10.6 ml/s significantly rose as the level of MPV increased after adjusting for age, suggesting of a threshold effect at 12.0-12.5 fl for PV ≥31 ml (OR 2.678, 95% CI 1.425-5.035) and at >12.5 fl for Qmax <10.6 ml/s (OR 3.190, 95% CI 1.768-5.755). However, only the value of MPV more than 12.5 fl still showed statistically significant effect on Qmax <10.6 ml/s after adjusting for age and the presence of MetS (OR 2.164, 95% CI 1.162-4.032). CONCLUSIONS: Our results add to the evidence that chronic inflammation is a candidate mechanism at the crossroad between MetS and BPH/LUTS, and the presence of elevated MPV may serve as a predictor of MetS-induced inflammation in the progression of BPH/LUTS.
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Síntomas del Sistema Urinario Inferior/sangre , Volúmen Plaquetario Medio , Síndrome Metabólico/sangre , Hiperplasia Prostática/sangre , Anciano , Estudios Transversales , Progresión de la Enfermedad , Humanos , Síntomas del Sistema Urinario Inferior/complicaciones , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Hiperplasia Prostática/complicacionesRESUMEN
OBJECTIVE: To compare the safety and efficiency of preoperative endoscopic sphincterotomy (POES) versus intraoperative endoscopic sphincterotomy (IOES) in patients with gallbladder and common bile duct stones. METHODS: Multiple electronic databases were searched for prospective, randomized, controlled trials on the safety and effectiveness of POES versus IOES. And the outcome parameters of clearance rate, post-procedural complications and hospital stay were analyzed. RESULTS: Five trials with 631 patients (POES, n=318; IOES, n=313) were analyzed. Although the overall rates of common bile duct stone clearance were similar between POES and IOES (RR 0.96, 95% CI: 0.91-1.01; P=0.13), the failure rate of CBD cannulation was significantly higher for IOES (RR 2.54, 95% CI: 1.23-5.26; P=0.01) during endoscopic retrograde cholangiopancreatography (ERCP). The pooled RR after POES for overall complication rates was similar to that for IOES (RR 1.56, 95% CI: 0.94-2.59; P=0.09). However, as compared with IOES, the RR risk of ERCP-related complications was significantly higher for POES (RR 2.27, 95% CI: 1.18-4.40, P=0.01). No significant inter-group differences existed in morbidity after laparoscopic cholecystectomy or subsequent conversion into open surgery. In subgroup analyses, the rates of hemorrhage, perforation, cholangitis, cholecystitis, and gastric ulceration showed no significant inter-group differences. CONCLUSION: With regards to stone clearance and overall complication rate, POES is comparable to IOES in patients with gallbladder and common bile duct stones. However, IOES has a lowered incidence of ERCP-related pancreatitis and a shorter hospital stay.
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Conducto Colédoco , Cálculos Biliares , Esfinterotomía Endoscópica , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Hospitales , Humanos , Tiempo de Internación , Tasa de Depuración Metabólica , Pancreatitis , Estudios Prospectivos , Úlcera GástricaRESUMEN
Mg alloys with excellent high-temperature mechanical properties are urgently desired to meet the design requirements of new-generation aircraft. Herein, novel cast Mg-10Gd-2Y-0.4Zn-0.2Ca-0.5Zr-xAg alloys were designed and prepared according to the advantages of multi-component alloying. The SEM and XRD results revealed that the as-cast microstructures contained α-Mg grains, ß, and Zr-containing phase. As Ag rose from 0 wt.% to 2.0 wt.%, the grain size was refined from 40.7 µm to 33.5 µm, and the ß phase significantly increased. The TEM observations revealed that the nano-scaled γ' phase could be induced to precipitate in the α-Mg matrix by the addition of Ag. The stacking sequence of lamellar γ' phases is ABCA. The multiple strengthening phases, including ß phase, γ' phases, and Zr-containing particles, were effectively tailored through alloying and synergistically enhanced the mechanical properties. The ultimate tensile strength increased from 154.0 ± 3.5 MPa to 231.0 ± 4.0 MPa at 548 K when Ag was added from 0 to 2.0 wt.%. Compared to the Ag-free alloy, the as-cast alloy containing 2.0 wt.% Ag exhibited a minor reduction in ultimate tensile strength (7.0 ± 4.0 MPa) from 498 K to 548 K. The excellent high-temperature performance of the newly developed Mg-RE-Ag alloy has great value in promoting the use of Mg alloys in aviation industries.
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Security printing is of the utmost importance in the information era. However, the excessive use of inks and paper still faces many economic and environmental issues. Thus, developing erasable inkless security printing materials is a remarkable strategy to save resources, protect the environment, and improve information security. To this endeavor, a photoresponsive lanthanide-polyoxometalate-doped gelatin film with high transparency was developed through the solution casting method. Attenuated total reflection Fourier-transform infrared spectroscopy confirmed the electrostatic and hydrogen bond interactions between gelatin and lanthanide-polyoxometalate. Absorption spectra, luminescent spectra, and digital images indicated that the film displayed reversible photochromism behavior and was accompanied by luminescent switching property upon exposure to UV irradiation and oxygen (in the dark) alternately, which allowed its potential application as a reprintable medium for inkless security printing. The printed information can be erased upon exposure to oxygen in the dark, and the film can be reused for printing again. The film exhibited excellent erasability, reprintability, renewability, and low toxicity. In addition, multiple encryption strategies were designed to improve information security. This work offers an attractive alternative strategy for constructing a reprintable film for inkless security printing in terms of simplifying the preparation process, saving resources, and protecting the environment.
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BACKGROUND: This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine. METHODS: A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions-anterior flexion, posterior extension, left-right lateral bending, and left-right rotation-to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments. RESULTS: Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model. CONCLUSION: Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption.
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Discectomía Percutánea , Endoscopía , Análisis de Elementos Finitos , Vértebras Lumbares , Humanos , Vértebras Lumbares/cirugía , Vértebras Lumbares/fisiología , Fenómenos Biomecánicos , Discectomía Percutánea/métodos , Endoscopía/métodos , Foraminotomía/métodos , Modelos Anatómicos , Estrés MecánicoRESUMEN
Strengthening the CoCrFeNi high entropy alloy with a face-center cubic structure has become a research prospect in the last decade. Alloying with double elements, Nb and Mo, is an effective method. In this paper, to further enhance the strength of the Nb and Mo contained high entropy alloy, CoCrFeNiNb0.2Mo0.2 was annealing treated at different temperatures for 24 h. As a result, a new kind of Cr2Nb type nano-scale precipitate with a hexagonal close-packed structure was formed, which is semi-coherent with the matrix. Moreover, by adjusting the annealing temperature, the precipitate was tailored with a considerable quantity and fine size. The best overall mechanical properties were achieved in the alloy annealed at 700 °C. The yield strength, ultimate tensile strength, and elongation are 727 MPa, 1.05 GPa, and 8.38%, respectively. The fracture mode of the annealed alloy is a mixture of cleavage and necking-featured ductile fracture. The approach employed in this study offers a theoretical foundation for enhancing the mechanical properties of face-centered cubic high entropy alloys via annealing treatment.
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Strengthening Mg alloys with rare earth elements has been a research focus for several decades. To minimize the usage of rare earth elements while enhancing mechanical properties, we adopted the strategy of alloying with multiple rare earth elements, namely Gd, Y, Nd, and Sm. Additionally, to promote the precipitation of basal precipitate, Ag and Zn doping was also induced. Thus, we designed a new cast Mg-2Gd-2Y-2Nd-2Sm-1Ag-1Zn-0.5Zr (wt.%) alloy. The microstructure of the alloy and its relevance to mechanical properties in various heat treatment conditions were investigated. After undergoing a heat treatment process, the alloy demonstrated exceptional mechanical properties, with a yield strength of 228 MPa and an ultimate tensile strength of 330 MPa achieved through peak-aging for 72 h at 200 °C. The excellent tensile properties are due to the synergistic effect of basal γⳠprecipitate and prismatic ß' precipitate. In its as-cast state, its primary mode of fracture is inter-granular, whereas in the solid-solution and peak-aging conditions, the predominant mode of fracture is a mixture of trans-granular and inter-granular fractures.
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In order to explore the microstructure evolution of an Mg-RE alloy refined by Al during solution treatment, an Mg-3Y-4Nd-2Al alloy was treated at 545 °C for different time periods. Phase evolution of the alloy was investigated. After solution treatment, the Mg-RE eutectic phase in the Mg-3Y-4Nd-2Al alloy dissolves, the granular Al2RE phase does not change, the acicular Al11RE3 phase breaks into the short rod-like Al2RE phase, and the lamellar Al2RE phase precipitates in the grains. With the extension of solution time, the precipitated phase of the lamellar Al2RE increased at first and then decreased, and its orientation relationship with the matrix is <112>Al2RE//<21¯1¯0>Mg and {111}Al2RE//{0002}Mg. The undissolved granular Al2RE phase can improve the thermal stability of the alloy grain by pinning the grain boundary, and the grain size did not change after solution treatment. Solution treatment significantly improved the plasticity of the alloy. After 48 h of solution treatment, the elongation increased to 17.5% from 8.5% in the as-cast state.
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BACKGROUND: G-protein coupled receptors (GPCRs) are recognized as attractive targets for drug therapy. However, it remains poorly understood how GPCRs, except for a few chemokine receptors, regulate the progression of liver fibrosis. Here, we aimed to reveal the role of GPR65, a proton-sensing receptor, in liver fibrosis and to elucidate the underlying mechanism. METHODS: The expression level of GPR65 was evaluated in both human and mouse fibrotic livers. Furthermore, Gpr65-deficient mice were treated with either bile duct ligation (BDL) for 21 d or carbon tetrachloride (CCl4) for 8 weeks to investigate the role of GPR65 in liver fibrosis. A combination of experimental approaches, including Western blotting, quantitative real-time reverse transcriptionpolymerase chain reaction (qRT-PCR), and enzyme-linked immunosorbent assay (ELISA), confocal microscopy and rescue studies, were used to explore the underlying mechanisms of GPR65's action in liver fibrosis. Additionally, the therapeutic potential of GPR65 inhibitor in the development of liver fibrosis was investigated. RESULTS: We found that hepatic macrophages (HMs)-enriched GPR65 was upregulated in both human and mouse fibrotic livers. Moreover, knockout of Gpr65 significantly alleviated BDL- and CCl4-induced liver inflammation, injury and fibrosis in vivo, and mouse bone marrow transplantation (BMT) experiments further demonstrated that the protective effect of Gpr65 knockout is primarily mediated by bone marrow-derived macrophages (BMMs). Additionally, in vitro data demonstrated that Gpr65 silencing and GPR65 antagonist inhibited, while GPR65 overexpression and application of GPR65 endogenous and exogenous agonists enhanced the expression and release of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and transforming growth factor-ß (TGF-ß), all of which subsequently promoted the activation of hepatic stellate cells (HSCs) and the damage of hepatocytes (HCs). Mechanistically, GPR65 overexpression, the acidic pH and GPR65 exogenous agonist induced up-regulation of TNF-α and IL-6 via the Gαq-Ca2+-JNK/NF-κB pathways, while promoted the expression of TGF-ß through the Gαq-Ca2+-MLK3-MKK7-JNK pathway. Notably, pharmacological GPR65 inhibition retarded the development of inflammation, HCs injury and fibrosis in vivo. CONCLUSIONS: GPR65 is a major regulator that modulates the progression of liver fibrosis. Thus, targeting GPR65 could be an effective therapeutic strategy for the prevention of liver fibrosis.