Deperitoneum biological mesh repair for abdominal wall hernia: a novel wound healing promotion idea.

PURPOSE: Nowadays, biological matrix has become more widely applied than synthetic mesh for the surgical management of ventral hernia. Conventionally, such biodegradable matrix is commonly placed in an intraperitoneal or extraperitoneal position to reinforce the abdominal wall during surgery. Herein, we introduce our novel idea to deliver such biological material. MATERIAL AND METHODS: After contrast-enhanced CT-scan via lateral decubitus confirmed the position of ventral hernias, 11 patients underwent deperitoneum biological mesh repair by open or laparoscopic approach. During surgery, biological material was placed in preperitoneal position with elimination of matrix-covered peritoneum meanwhile. No bridge repair was allowed for this technique. Postoperative complications were prospectively documented. RESULTS: Laparoscopic and open repair were performed in six and five patients, respectively. The mean operative time was 115 min, with no significant difference between the two procedures. All patients had quick recovery and returned to their normal life, with median five days (range, 3-12 days) of hospital stay after surgery. Although wound dehiscence and chronic pain occurred in three (27.3%) patients, no additional surgery was required. No recurrence case was observed within the one-year follow-up period. CONCLUSION: This novel approach could be safely performed in ventral hernia patients. Early evaluation of this surgical technique demonstrates quick recovery and minimal complications.

The CircRNA-ACAP2/Hsa-miR-21-5p/ Tiam1 Regulatory Feedback Circuit Affects the Proliferation, Migration, and Invasion of Colon Cancer SW480 Cells.

BACKGROUND/AIMS: Circular RNAs (circRNAs), a type of RNA that is widely expressed in human cells, have essential roles in the development and progression of cancer. CircRNAs contain microRNA (miRNA) binding sites and can function as miRNA sponges to regulate gene expression by removing the inhibitory effect of an miRNA on its target gene. METHODS: We used the bioinformatics software TargetScan and miRanda to predict circRNA-miRNA and miRNAi-Mrna interactions. Rate of inhibiting of proliferation was measured using a WST-8 cell proliferation assay. Clone formation ability was assessed with a clone formation inhibition test. Cell invasion and migration capacity was evaluated by performing a Transwell assay. Relative gene expression was assessed using quantitative real-time polymerase chain reaction and relative protein expression levels were determined with western blotting. circRNA and miRNA interaction was confirmed by dual-luciferase reporter and RNA-pull down assays. RESULTS: In the present study, the miRNA hsa-miR-21-5p was a target of circRNA-ACAP2, and T lymphoma invasion and metastasis protein 1 (Tiam1) was identified as a target gene of hsa-miR-21-5p. CircRNA-ACAP2 and Tiam1 were shown to be highly expressed in colon cancer tissue and colon cancer SW480 cells, but miR-21-5p was expressed at a low level. SW480 cell proliferation was suppressed when the expression of circRNA-ACAP2 and Tiam1 was decreased and the expression of miR-21-5p was increased in vivo and in vitro. SW480 cell migration and invasion were also inhibited under the same circumstance. The circRNA-ACAP2 interaction regulated the expression of miR-21-5p, and miR-21-5p regulated the expression of Tiam1. Down-regulation of circRNA-ACAP2 promoted miR-21-5p expression, which further suppressed the transcription and translation of Tiam1. CONCLUSION: The present study shows that the circRNA-ACAP2/hsa-miR-21-5p/Tiam1 regulatory feedback circuit could affect the proliferation, migration, and invasion of colon cancer SW480 cells. This was probably due to the fact that circRNA-ACAP2 could act as a miRNA sponge to regulate Tiam1 expression by removing the inhibitory effect of miR-21-5p on Tiam1 expression. The results from this study have revealed new insights into the pathogenicity of colon cancer and may provide novel therapeutic targets for the treatment of colon cancer.

Evaluating the safety and operability of asymmetric trapezoid and near-square side-port incision in cataract surgery.

PURPOSE: To compare the accuracy, safety, and consistency of asymmetric trapezoid and near-square side-port incision in cataract surgery. SETTING: Aier Eye Hospital of Wuhan University, Wuhan, Hubei Province, China. DESIGN: Prospective pilot study. METHODS: This study included patients who underwent phacoemulsification between January 2022 and August 2022. They were divided into Group A and Group B using the random number table method. Group A was given a near-square side-port incision and Group B was given an asymmetric trapezoid side-port incision. We contrasted the differences in incision length, width, and shape; surgical time; and postoperative intraocular pressure (IOP) between the 2 groups. RESULTS: 220 eyes of 220 patients were included. The mean external width of the incision in Group A was much smaller than that in Group B ( P < .01), and the consistency of the incision diameter in Group A was better than that in Group B. There was no statistically significant difference in incision length between the 2 groups ( P = .75). 1 day after surgery, there was no statistically significant difference in incision morphology between the 2 groups ( P = .72). The operating time for Group A was significantly shorter than that of Group B ( P < .01). There was no obvious incision leakage in both groups after surgery, and the IOP was generally elevated after surgery, but there was no significant statistical difference between the 2 groups ( P = .98). CONCLUSIONS: The present study suggests that a near-square side-port results in better consistency of incision width and shorter surgical time.

A precise temperature control during hyperthermic intraperitoneal chemotherapy promises an early return of bowel function.

INTRODUCTION: The hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely applied in clinical practice for peritoneal carcinomatosis (PC). The temperature is one of the important elements affecting the efficacy of HIPEC, and it can become fluctuant by several factors. This study is aimed to explore the role of a stable perfusion temperature in promoting bowel recovery of PC patients due to gastrointestinal malignancies. METHODS: Between January 2012 and July 2013, 59 PC patients undergoing cytoreductive surgery and three-cycle HIPEC were included. Patients having stable perfusion temperature for all cycles were assigned into the study group, with the rest having unstable temperature into the control group. Time of flatus and defecation passage and initiation time of enteral nutrition were compared between both groups to detect the significance in bowel function recovery, with visual analogue scale (VAS) pain intensity and overall survival (OS) compared meanwhile. RESULTS: In sum, 33 (55.9%) patients obtained stable temperature during HIPEC, and the rest of 26 (44.1%) developed fluctuant perfusion temperature. Average time of flatus (2.3 ± 1.2 vs 3.9 ± 2.2 days, P =.002), defecation passage (5.2 ± 2.1 vs 7.1 ± 2.9 days, P =.004) and enteral nutrition initiation (4.3 ± 1.5 vs 6.7 ± 2.3 days, P <.001) were much shorter in the study group than the control group. Additionally, the VAS score (4.5 ± 2.3 vs 6.3 ± 1.3, P <.001) and 5-year OS rate (17.8% vs 11.1%, P=.135) were both improved, with significance observed in postoperative pain control. CONCLUSIONS: During HIPEC, a precise temperature control could promise an early recovery of bowel function and reduce postoperative pain, without survival significance found based on the current cohort.

miR-1-3p suppresses the epithelial-mesenchymal transition property in renal cell cancer by downregulating Fibronectin 1.

PURPOSE: Renal cell cancer (RCC) is one of the primary causes of malignancy deaths all over the world. The most important cause of RCC-related mortality is metastasis. Epithelial-mesenchymal transition (EMT) plays an important role in metastasis of malignant tumors including RCC. miR-1-3p is confirmed to be decreased in many types of cancer. Nevertheless, the function of miR-1-3p in RCC metastasis and EMT process was still unclear. MATERIALS AND METHODS: In this study, information from clinical investigation, in vitro study, and in vivo study discovered miR-1-3p expression character and its status in RCC. The character of miR-1-3p in invasive and metastatic properties in vitro and in vivo was also inspected in RCC cells and xenograft tumor model, and expression levels of EMT markers were evaluated in RCC cells and tissues. RESULTS: miR-1-3p was proved to be decreased in RCC cell lines and tissues compared with normal renal cells and tissues. miR-1-3p expression level in RCC tissues was closely related with capsulation, lymph node metastasis, and vascular invasion. miR-1-3p was found to be able to block the EMT process in A498 and CAKI-1 RCC cells and tumors. Luciferase reporter assay and expression level rescue assays were employed to reveal that miR-1-3p inhibited the invasion and migration property of RCC cells by directly targeting Fibronectin 1. Upregulation of Fibronectin 1 partially reversed the suppressive effect of miR-1-3p on EMT process. CONCLUSION: In brief, this study has verified that miR-1-3p blocked the EMT process of RCC cells by reducing Fibronectin 1 expression. miR-1-3p/Fibronectin 1 axis may be considered as a new target for drug development of RCC.

Two cases of small bowel obstruction due to a shiitake mushroom.

The shiitake mushroom (Lentinula edodes), known as Xiang-gu in China, has been an important component of Asian cuisine for hundreds of years. Although not easily digestible, there are few reports of them causing bowel obstruction. We present two cases of small bowel obstruction due to a shiitake mushroom requiring surgical intervention. Two patients who did not have any teeth and did not use dentures presented with intestinal bowel obstruction and were referred to the Emergency Department of our hospital after eating a meal including shiitake mushrooms without cutting. The first patient underwent an emergency laparotomy and a semental small bowel resection and the other underwent laparoscopic small bowel incision for removal of a foreign body. The causes of the small bowel obstruction for the two patients were uncut shiitake mushrooms in the small bowel. The two patients recovered uneventfully post-operatively.

[Observation of the efficacy of biological patch in hybrid technique for incisional herniorrhaphy: 5-year follow-up results from a single center].

OBJECTIVE: To observe the safety and efficacy of biological patch (Biodesign Surgisis mesh, SIS) in hybrid technique for incisional herniorrhaphy. METHODS: Clinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm. RESULTS: There were four male and tenfemale patients with average age of (67.7±11.6) years and average body mass index(BMI) of (25.5±1.7) kg/m². As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months (median, 8 months). Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra-umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was (202.5±72.9) minutes. The average length and width of hernia ring were (10.9±4.3) cm and (9.3±3.9) cm, respectively. Clean operation was performed in 11 cases, potential contaminative operation in 2 cases and contaminative operation in 1 case. The amount of operative bleeding was (15.0±4.8) ml. The NRS pain scores within 24 hours after the operation, at POD3 and at POD7 were 5.1±0.9, 4.2±0.7 and 3.7±0.9, respectively. The time to flatus after operation was (2.5±0.9) days and the time to liquid diet was (3.8±1.2) days. No patient died during the perioperative period. The average hospitalization time was (21.5±12.0) days. Postoperative complications occurred in 8 cases, including 4 cases of fever, 8 cases of incision complications, 4 cases of abdominal infection, 4 cases of intestinal obstruction, 5 cases of effusion under patch, 2 cases of pneumonia, and 1 case of acute myocardial infarction. According to the Clavien-Dindo classification, 3 cases were grade zero, 3 cases were grade I(, 6 cases were grade II(, 1 case was grade III(, and 1 case was grade IIII(. Thirteen patients received follow-up and the average follow-up time was (33.2±12.3) (18.2-61.0) months. One patient died of cerebral infarction 38 months after operation. The chronic abdominal pain or discomfort was found in 4 cases. The recurrent incisional hernia developed in 5 cases and the average time of recurrence was (11.0±8.3) months. CONCLUSIONS: Biological patch can be used safely and effectively in hybrid technique for incisional herniorrhaphy. However, the morbidity of postoperative complication and the risk of recurrence are high. Terefore, the long-term outcome is still subject to observation.

Intracellular activation of complement C3 in Paneth cells improves repair of intestinal epithelia during acute injury.

AIM: To explore whether Paneth cells (PCs) and complement system collaborate in the repair of enteric epithelia during acute gastrointestinal injury (AGI). METHODS: Wild-type C57BL/6 mice were employed to induce AGI by performing colon ascendens stent surgery, with sham-operated as control. Exogenous C3 treatment was applied at 6-h postsurgery. After 48 h, overall survival, intestinal damage severity, and C3 intracellular activation were assessed in both epithelial cells and PCs. RESULTS: AGI caused a high mortality, while C3 therapy significantly attenuated epithelial damages and improved survival. Besides, exogenous C3 in vitro enhanced the proliferation and activity of PCs. Importantly, intracellular C3 activation was observed inside of PCs under C3 co-stimulation in vitro. CONCLUSION: C3 immunotherapy might play a valuable role in turnover of gut epithelia through intracellular activation in PCs.

Deregulation of MicroRNA-375 Inhibits Proliferation and Migration in Gastric Cancer in Association With Autophagy-Mediated AKT/mTOR Signaling Pathways.

Gastric cancer is a deadly disease. Some microRNAs are involved in tumor invasion and metastasis. Underexpression of miR-375 has been correlated with tumorigenesis, treatment resistance, and poor prognosis. In this study, we first analyzed the profiles and prognostic values of miR-375 expression in gastric cancer tissues from a public database, and the expression level of miR-375 in gastric cancer samples and gastric cancer cell lines was then analyzed by quantitative real- time polymerase chain reaction. Significant underexpression of miR-375 was seen in all the gastric cancer samples compared to paired paracarcinoma tissues, and the expression level of miR-375 in the gastric cancer cell lines was negatively associated with the cell migration ability. A Cell proliferation (CCK-8) assay was performed to examine cell viability. Overexpression of miR-375 suppressed the proliferation of gastric cancer cells. A Western blot analysis was carried out to test protein expression. Overexpression of miR-375 inhibited autophagy through the AKT/ mammalian target of rapamycin signaling pathway. MiR-375 regulated invasion and migration via AKT/ mammalian target of rapamycin pathway-mediated epithelial-to-mesenchymal transition. Wound healing and migration assays were used to determine the motility of gastric cancer cells. A gastric cancer xenograft nude mouse model was used for an in vivo efficacy evaluation. Overexpression of miR-375 significantly suppressed cell proliferation in the established gastric cancer xenograft nude mouse model. Our results demonstrate that increasing the expression level of miR-375 suppresses proliferation in vitro and in vivo, and they provide a mechanistic and applicable rationale for the future clinical evaluation of miR-375 in gastric cancer treatment. Our findings provide not only new information about the molecular mechanism of microRNAs in regulating invasion and migration in gastric cancer but also a theoretical principle for a potential targeted therapy for gastric cancer.

Metastatic tumor of male genital system from gastric cancer: a case report and review of literature.

Spermatic cord (SC) tumor metastatic from gastric cancer (GC) is rare. Here we report a case of left SC metastasis and meanwhile perform a literature review to characterize this rare disease. A 72-year-old male presented with a palpable painful mass in the left groin after one year and a half of remnant GC resection. SC metastasis of signet-ring cell adenocarcinoma was confirmed by trans-inguinal biopsy, and palliative chemoradiotherapy was initiated. The disease remained stable within follow-up 10 months. A total of 27 GC patients with male sex cord metastasis were reviewed according to a literature search from January 1955 to March 2016. In such a cohort, the mean age was 58.3 (range, 23-72) years. The average time interval between primary GC and genital metastasis was 43.2 (range, 2-120) months in 16 (59.3%) metachronous cases, while nine (33.3%) synchronous cases reported. The average size of genital tumor was 3.8 (range, 2.1-9.0) cm in diameter. The major pathological characteristics were signet-ring cell (40.0%, 8/20) and poor differentiation (85.0%, 17/20), with right-side sex cord most commonly involved (48.1%). The incidence of genial metastasis was 74.1% in SC, with 40.7% for epididymis, 33.3% for testis, 14.8% for tunica vaginalis and 3.7% for scrotum. The one-year overall survival rate was 38.7%, with a median survival time of 12 months. Advanced GC metastatic to male sex cord is rare, with poor prognosis. For patients with GC history and groin discomfort or mass, metastatic adenocarcinoma should be suspected, followed by proper diagnosis and treatment.

Cellular immunity following video-assisted thoracoscopic and open resection for non-thymomatous myasthenia gravis.

OBJECTIVES: Myasthenia gravis (MG) is a common chronic disorder of neuromuscular transmission, frequently treated surgically. Little is known about perioperative cellular immune responses following video-assisted thoracoscopic surgery (VATS) when compared with open resection. METHODS: Between January and December 2009, 127 patients with non-thymomatous MG underwent surgery, with 54 undergoing VATS and 73 undergoing conventional trans-sternal extended thymectomy (TS). Operative details, ectopic thymic tissue findings, postoperative concentrations of serum immunoglobulin and complement components as well as T-cell immunity were compared in the VATS and TS groups. RESULTS: There were no between-group differences in patients' age, gender, preoperative duration of MG and operation time. Patients who underwent VATS had a lower rate of postoperative stay in the intensive care unit (P = 0.02), less blood loss (P = 0.01) and a lower probability of ectopic thymic tissue. Prominent cellular immunity difference occurred in serum IgG and C3 concentrations and CD4(+) and CD8(+) T-cell counts between the VATS and TS groups. In VATS patients, serum IgG concentration increased slightly on postoperative days 1 and 3. C3 concentration increased gradually in both groups after surgery, but decreased by postoperative day 7. CD4(+) and CD8(+) T-cell counts were relatively stable postoperatively in the VATS group, but were markedly increased in the TS group on postoperative days 1 and 3, with CD4(+), but not CD8(+), T-cells declining on postoperative day 7. CONCLUSIONS: VATS for non-thymomatous MG has short-term advantages, with less effect on cellular immune responses than open resection.

[Video-assisted thoracoscopic extended thymectomy and transsternal extended thymectomy for treatment of myasthenia gravis: a case-control study].

OBJECTIVE: To compare the therapeutic effects of video-assisted thoracoscopic extended thymectomy (VATET) and transsternal extended thymectomy (TET) for myasthenia gravis (MG). METHOD: This study included 21 patients undergoing VATET through the "three holes" approach on the right chest and 32 undergoing TET with sternum dissection. The thymus was excised and the anterior mediastinum adipose tissue removed in both groups. RESULTS: VATET was associated with reduced intraoperative blood loss and longer operative time without the use of postoperative analgesics; very few patients were admitted into the intensive care unit (ICU), showing significant differences from the TET group (P<0.05). No significant difference was found between the two groups in tracheal tube removal time, length of stay in ICU, closed thoracic drainage removal time, and postoperative hospital stay, total hospital stay, postoperative complications, total hospitalization costs, or the rate of remission and improvement (P>0.05). CONCLUSIONS: Compared with TET, VATET requires only a small incision without leaving metal foreign body in the body, and the patients experience less postoperative pain and rapid recovery, with similar mid- and long-term clinical outcomes.