Preoperative frailty as a key predictor of short- and long-term outcomes among octogenarians undergoing hepatectomy for hepatocellular carcinoma: a multicenter comprehensive analysis.

BACKGROUND: When considering hepatectomy for elderly HCC patients, it's essential to assess surgical safety and survival benefits. This study investigated the impact of preoperative frailty, assessed with the Clinical Frailty Scale (CFS), on outcomes for octogenarians undergoing HCC hepatectomy. METHODS: A retrospective cohort study of octogenarians who had hepatectomy for HCC between 2010 and 2022 at 16 hepatobiliary centers was conducted. Patients were categorized as frail or non-frail based on preoperative CFS, with frailty defined as CFS ≥5. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), with perioperative outcomes as secondary endpoints. RESULTS: Among 240 octogenarians, 105 were characterized as being frail. Frail patients had a higher incidence of postoperative 30-day morbidity and postoperative 30-day and 90-day mortality versus non-frail patients. Meanwhile, 5-year OS, RFS and CSS among frail patients were lower compared with non-frail patients. Univariable and multivariable analysis revealed that preoperative frailty was an independent risk factor of postoperative 30-day morbidity (OR: 2.060), OS (HR: 2.384), RFS (HR: 2.190) and CSS (HR: 2.203). CONCLUSION: Preoperative frailty, as assessed by the CFS, was strongly associated with both short-term outcomes and long-term survival among octogenarians undergoing hepatectomy for HCC. Incorporating frailty assessment into the preoperative evaluation may help optimize patient selection and perioperative care.

Comparison of biliary protein spectrum in gallstone patients with obesity and those with normal body weight.

BACKGROUND: Obesity is a common public health issue and is currently deemed a disease. Research has shown that the risk of gallstones in individuals with obesity is elevated. This study aimed to explore the bile proteomics differences between cholelithiasis patients with obesity and normal body weight. METHODS: Bile samples from 20 patients (10 with obesity and 10 with normal body weight) who underwent laparoscopic cholecystectomy at our center were subjected to tandem mass tag labeling (TMT) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), followed by further bioinformatic analysis. RESULTS: Among the differentially-expressed proteins, 23 were upregulated and 67 were downregulated. Bioinformatic analysis indicated that these differentially-expressed proteins were mainly involved in cell development, inflammatory responses, glycerolipid metabolic processes, and protein activation cascades. In addition, the activity of the peroxisome proliferator-activated receptor (PPAR, a subfamily of nuclear receptors) signaling pathway was decreased in the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Two downregulated proteins in the PPAR signaling pathway, APOA-I and APOA-II, were confirmed using enzyme-linked immunosorbent assay. CONCLUSIONS: The PPAR signaling pathway may play a crucial role in the development of cholelithiasis among patients with obesity. Furthermore, biliary proteomics profiling of gallstones patients with obesity is revealed, providing a reference for future research.

Association of serum bisphenol AF concentration with depressive symptoms in adolescents: A nested case-control study in China.

BACKGROUND: As an important alternative to bisphenol A (BPA), bisphenol AF (BPAF) is widely used and can be detected in multiple human biological samples. However, there are few studies on neurotoxicity of BPAF at present. In particular, no epidemiological studies have investigated BPAF in relation to depressive symptoms in adolescents. Here, our study aimed to evaluate the associations between serum BPAF concentrations and depressive symptoms in adolescents. METHODS: A nested case-control study within an ongoing longitudinal prospective adolescent cohort that was established in Huaibei, China was conducted. A total of 175 participants who had new-onset depressive symptoms (cases) and 175 participants without depressive symptoms (controls) were included. Serum BPAF concentrations was measured using ultra-high-performance liquid chromatography-tandem mass spectrometry. The associations between BPAF exposure and the risk of depressive symptoms in adolescents were assessed using conditional logistic regression. The dose-response relationship between BPAF level and depressive symptoms was estimated using restricted cubic spline analyses. RESULTS: In this study, the detection rate of serum BPAF was 100%, and the median (interquartile range, IQR) serum BPAF concentration was 5.24 (4.41-6.11) pg/mL in the case group and 4.86 (4.02-5.77) pg/mL in the control group (P = 0.009). Serum BPAF exposure was a risk factor for depressive symptoms (odds ratio (OR)= 1.132, 95% confidence interval (CI):1.013-1.264). After adjustment for all for confounders, compared with the low-exposure group, the high-exposure group had a 2.806-fold increased risk of depressive symptoms (OR=2.806, 95% CI: 1.188-6.626). Stratified analysis by sex revealed that males were more vulnerable to BPAF exposure than females. After adjustment for all confounders, compared with the low-exposure group, the relative risk of depressive symptoms in the high-exposure group was 3.858 (95% CI: 1.118-12.535) for males, however, no significant association between BPAF exposure and depressive symptoms was found in females. In addition, there was a marked linear association between BPAF exposure and the risk of depressive symptoms in the total population and in males. CONCLUSIONS: The adolescents in this study were widely exposed to low levels of BPAF. A significant positive association was found between serum BPAF levels and the risk of depressive symptoms. The association was significantly modified by sex, and males were more vulnerable to BPAF exposure than females.

Effect of metformin combined with chemotherapeutic agents on gastric cancer cell line AGS.

To explore the effect of metformin combined with chemotherapeutic agents on gastric cancer cell line AGS, 24 patients with gastric cancer were tracked for treatment. CCK-8, Transwell model and flow cytometry were used to detect the cell proliferation, migration ability and other indexes. The metformin inhibited the AGS cell proliferation in a dose- and time-dependent manner (P<0.05). The application of metformin, cisplatin, adriamycin or paclitaxel alone could effectively lower the migration and invasion ability of AGS cells. The metformin in combination with the three chemotherapeutic agents could effectively promote the apoptosis of AGS cells. The metformin in combination with chemotherapeutic agents can effectively and apparently treat the patients with gastric cancer, more significantly in clinic compared to the traditional administration mode. It can effectively promote the apoptosis of AGS cells, thus, it's worth adopting in clinic.

Littoral cell angioma of the spleen: A study of 10 cases case series and literature review.

BACKGROUND: Current study aimed to investigate the clinical characterization, differential diagnosis, and treatment of splenic littoral cell angioma (LCA). METHODS: A retrospective analysis was performed for 10 LCA cases admitted to Huzhou Central Hospital from 2007 to 2023, for clinical manifestations, hematological tests, imaging features, pathological features, treatment methods, and prognosis along with the relevant literature was also reviewed. RESULTS: During examinations, no specific clinical manifestations and hematological abnormalities were seen in all 10 cases of LCA. Imaging observations depicted single or even multiple spherical lesions in the spleen. Plains shown by computed tomography (CT) were found somewhat equal or slightly lower in density. On the other hand, magnetic resonance imaging (MRI) plain scans viz. T1 weighted image showed equal low and mixed signals while T2-weighted showed high and low mixed signals. Moreover, punctate low signals could be seen in high signals named "freckle sign" in MRI scans. On contrast-enhanced CT scans, the enhancement of the lesions was not obvious in the arterial phase, and some of the lesions showed edged ring-like enhancements and "filling lake" progressive enhancement during the venous phase and delayed phase. In multiple lesions, the number of enhanced scan lesions showed a variable changing pattern "less-more-less." MRI-enhanced scan showed the characteristics of "fast in and slow out." Microscopic examinations identified tumor tissue actually composed of sinus-like lacunae that anastomosed with each other in the form of a network. Furthermore, cystic expansion and pseudopapillary protrusions were also seen in the dilated sinus cavity which was lined with single-layer endothelial cells having conspicuous cytoplasmic hemosiderin. High immunophenotypic expressions of vascular endothelial cell phenotype (CD31, CD34, FVIII) and tissue cell phenotype (CD68) were also seen. Total and partial splenectomy were performed in 8 and 2 patients, respectively, and follow-up examinations showed survival in all patients with no recurrence. CONCLUSION: LCA is a rare splenic benign lesion with atypical clinical manifestations. CT and MRI imaging are important tools in preoperative diagnosis based on pathomorphological and immunohistochemical examinations. Splenectomy is a superior therapeutic choice with significant impacts and prognosis.

Activation of hepatic adenosine A1 receptor ameliorates MASH via inhibiting SREBPs maturation.

Metabolic (dysfunction)-associated steatohepatitis (MASH) is the advanced stage of metabolic (dysfunction)-associated fatty liver disease (MAFLD) lacking approved clinical drugs. Adenosine A1 receptor (A1R), belonging to the G-protein-coupled receptors (GPCRs) superfamily, is mainly distributed in the central nervous system and major peripheral organs with wide-ranging physiological functions; however, the exact role of hepatic A1R in MAFLD remains unclear. Here, we report that liver-specific depletion of A1R aggravates while overexpression attenuates diet-induced metabolic-associated fatty liver (MAFL)/MASH in mice. Mechanistically, activation of hepatic A1R promotes the competitive binding of sterol-regulatory element binding protein (SREBP) cleavage-activating protein (SCAP) to sequestosome 1 (SQSTM1), rather than protein kinase A (PKA) leading to SCAP degradation in lysosomes. Reduced SCAP hinders SREBP1c/2 maturation and thus suppresses de novo lipogenesis and inflammation. Higher hepatic A1R expression is observed in patients with MAFL/MASH and high-fat diet (HFD)-fed mice, which is supposed to be a physiologically adaptive response because A1R agonists attenuate MAFL/MASH in an A1R-dependent manner. These results highlight that hepatic A1R is a potential target for MAFL/MASH therapy.

Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis.

BACKGROUND & AIMS: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. METHODS: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m2), overweight (23.0-27.4 kg/m2) and obese (≥27.5 kg/m2) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. RESULTS: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06-2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17-2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC. CONCLUSIONS: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence.

Stratifying risk of failure to achieve textbook outcomes among patients undergoing hepatectomy for hepatocellular carcinoma: A multicenter score validation study.

BACKGROUND AND AIMS: The concept of textbook outcomes (TOs) has gained increased attention as a critical metric to assess the quality and success of outcomes following complex surgery. A simple yet effective scoring system was developed and validated to predict risk of not achieving textbook outcomes (non-TOs) following hepatectomy for hepatocellular carcinoma (HCC). METHODS: Using a multicenter prospectively collected database, risk factors associated with non-TO among patients who underwent hepatectomy for HCC were identified. A predictive scoring system based on factors identified from multivariate regression analysis was used to risk stratify patients relative to non-TO. The score was developed using 70 % of the overall cohort and validated in the remaining 30 %. RESULTS: Among 3681 patients, 1458 (39.6 %) failied to experience a TO. Based on the derivation cohort, obesity, American Society of Anaesthesiologists score(ASA score), Child-Pugh grade, tumor size, and extent of hepatectomy were identified as independent predictors of non-TO. The scoring system ranged from 0 to 10 points. Patients were categorized into low (0-3 points), intermediate (4-6 points), and high risk (7-10 points) of non-TO. In the validation cohort, the predicted risk of developing non-TOs was 39.0 %, which closely matched the observed risk of 39.9 %. There were no differences among the predicted and observed risks within the different risk categories. CONCLUSIONS: A novel scoring system was able to predict risk of non-TO accurately following hepatectomy for HCC. The score may enable early identification of individuals at risk of adverse outcomes and inform surgical decision-making, and quality improvement initiatives.

A hybrid metal-organic framework nanomedicine-mediated photodynamic therapy and hypoxia-activated cancer chemotherapy.

The hypoxic tumor microenvironment and photodynamic therapy (PDT)-aggravated hypoxia compromise the anticancer efficacy of chemotherapy, immunotherapy, and PDT. Thus, sophisticated nanomedicines that can activate their anticancer capability in situ in response to specific stimuli need to be developed. This study aimed to construct a hybrid nanomedicine that activated chemotherapy by inducing hypoxia, which synergized with PDT to promote antitumor outcomes, contrary to the strategies focusing on reversing tumor hypoxia. The hybridization of a porphyrin metal-organic framework (MOF) and gold nanoparticles (AuNPs) enhanced the stability of the hybrid nanomedicine against the phosphate in blood, thereby preventing the premature drug release during blood circulation. The surface modification with polyethylene glycol (PEG) markedly increased the tumor accumulation of the hybrid MOF nanomedicine, which encapsulated a hypoxia-activated prodrug (tirapazamine, TPZ), by enhancing its colloidal stability and pharmacokinetics. The loaded TPZ was rapidly released from the nanomedicine in response to the concentrated intracellular phosphate after cellular uptake, and was then converted into a potent anticancer drug in a hypoxic microenvironment exacerbated by continuous O2 consumption during PDT. In vitro and in vivo experiments demonstrated that the synergistic PDT and hypoxia-activated chemotherapy exhibited enhanced antitumor therapeutic efficiency and superior antimetastatic effect, and effectively ablated the tumor without recurrence. Therefore, the sophisticated nanomedicine reported here, which eliminated cancer cells by inducing a hypoxic tumor microenvironment, showed translational potential in future therapeutic development.

Circulating MicroRNA Panel as a Diagnostic Marker for Hepatocellular Carcinoma.

BACKGROUND: Current diagnostic markers for hepatocellular carcinoma are compromised and limited by their low sensitivity and speci- ficity. In this study, circulating microRNAs were utilized as a diagnostic tool to segregate hepatocellular carcinoma patients from healthy subjects. METHODS: We analyzed 2 public datasets for differences in plasma microRNA expression profiles of hepatocellular carcinoma patients and healthy controls to identify biomarkers related to hepatocellular carcinoma. Plasma samples from hepatocellular carcinoma patients and control subjects were then collected for next-generation microRNA sequencing analysis. The differential microRNAs obtained from the above 3 parts were intersected to obtain microRNAs that were significantly different between the 2 groups. We then analyzed 58 specimens, which come from hepatocellular carcinoma and the control group, for validation through a quantitative polymerase chain reaction. The diagnostic value of these differentially expressed miRNAs was assessed by receiver operating characteristic curve analysis. RESULTS: The levels of miR-206 and miR-222 were significantly higher (P < .05) and the level of miR-126 was lower (P < .05) in patients with hepatocellular carcinoma than in healthy subjects. Receiver operating characteristic analysis established a powerful diagnostic accuracy when miR-206, miR-222, and miR-126 were combined (area under curve = 0.887), which was similar to that of the markerα-fetoprotein (area under curve = 0.889). When the microRNAs were combined with α-fetoprotein, the accuracy of hepatocellular carci- noma diagnostic potential was further improved (area under curve = 0.989). CONCLUSION: We identified 3 microRNAs significantly altered in the plasma of hepatocellular carcinoma patients and they can screen patients at risk of hepatocellular carcinoma.

The Influence of Alcohol Consumption, Depressive Symptoms and Sleep Duration on Cognition: Results from the China Health and Retirement Longitudinal Study.

AIM: Healthy cognition-related factors include alcohol consumption, depressive symptoms, and sleep duration. However, less is known about the role of these factors in the dyad or tripartite relationships. In this study, we examined whether there were potential mediation effects, moderation effects, and interactions between these factors in the longitudinal study. METHODS: Both cross-sectional data analysis and a longitudinal study were performed using baseline and 2018 data from the China Health and Retirement Longitudinal Study (CHARLS) cohort. CHARLS is a nationwide survey program covering 450 villages and 150 counties in 28 provinces that aims to investigate comprehensive demographic information. After selecting participants from the CHARLS cohort, 15,414 were included in the study. Non-drinkers, those who drink more than once a month, and those who drink less than once a month were defined by their alcohol consumption. Depressive symptoms were defined as nondepressed (less than or equal to 12) and depressed (more than 12). Sleep duration was defined as 7-8 h per night, ≤6 h per night, and ≥9 h per night. The total cognitive scores were calculated from memory, orientation, and executive tests. The PROCESS macro in SPSS was used to analyze all mediations and moderating mediations. RESULTS: Alcohol consumption has a positive correlation with cognition. The global cognition z scores of participants with depressive symptoms were significantly lower than those of the control (all p's < 0.001), in different models. The memory score (ß: -0.148; 95% CI: -0.240 to -0.056; p = 0.002), the executive score (ß: -0.082; 95% CI: -0.157 to -0.006; p = 0.033), and the global cognition score (ß: -0.105; 95% CI: -0.187 to -0.023; p = 0.012) of participants defined as ≤6 h per night were, obviously, less than the control (7-8 h per night). An association between depression and alcohol consumption has been found, and the protective effects have been reversed by depression, which caused the cognition decline. Sleep duration was identified as a moderator, influencing the relationship between depressive symptoms and cognitive function. Besides, there was an interaction causing cognition decline among alcohol consumption, depressive symptoms, and sleep duration. Cognitive function showed a marked downward trend with increasing age. CONCLUSIONS: In this model, depression primarily mediates the relationship between alcohol consumption and cognition, and sleep duration changes the mediation effect. Furthermore, there is a significant interaction between alcohol consumption, depressive symptoms, and sleep duration, which are significantly associated with cognitive function.

Association between serum vitamin D level during pregnancy and recurrent spontaneous abortion: A systematic review and meta-analysis.

PROBLEM: Previous studies had shown that there might be an association between serum vitamin D concentrations and the occurrence of recurrent spontaneous abortion (RSA). However, the conclusions remained controversial. The objective of this study was to systematically review the evidence for an epidemiological association between vitamin D and RSA. METHOD OF STUDY: The literature search was performed in the following databases: PubMed, Web of Science, Embase and Chinese databases. The I2 statistic was used to evaluate heterogeneity. Effect sizes were calculated using fixed or random effects models, including standardized mean difference (SMD), odds ratios (OR) and their 95% confidence intervals (95% CI). Then, we performed subgroup analysis, sensitivity analysis and publication bias analysis. RESULTS: Fourteen studies from five countries were included. Based on the results, patients with RSA had lower vitamin D levels than controls (SMD = -1.48, 95% CI: -2.01, -.94, P < .001), and pregnant women with vitamin D deficiency (VDD) had a higher risk of developing RSA (OR = 4.02, 95% CI: 2.23, 7.25, P < .001). There was remarkable heterogeneity between studies (I2SMD  = 97.3%, P < .001; I2OR  = 82.2%, P < .001). The results of the subgroup analysis suggested that heterogeneity may be caused by the assay method, age and region. Sensitivity analysis showed the analysis results were robust. CONCLUSION: Patients with RSA had lower serum vitamin D levels than normal pregnant women, and pregnant women with VDD might be at higher risk for RSA.

Long-term impact of ambient air pollution on preterm birth in Xuzhou, China: a time series study.

Accumulating evidence witnesses the negative influence of air pollution on human health, but the relationship between air pollution and premature babies has been inconsistent. In this study, the association between weekly average concentration of air pollutants and preterm birth (PTB) was conducted in Xuzhou, a heavy industry city, in China. We constructed a distributed lag non-linear model (DLNM), an ecological study, to access the associations between ambient air pollutants and PTB in this study. Totally, 5408 premature babies were included, and the weekly average levels of PM2.5, PM10, SO2, NO2, O3, and CO were 61.24, 110.21, 22.55, 40.55, 104.45, and 1.04 mg/m3, respectively. We found that PM2.5, PM10, SO2, and NO2 significantly increased the risk of PTB, and the susceptibility windows of these contaminants were the second trimester and third trimester (from 12 to 29 weeks). Every 10 µg/m3 increase of PM2.5, PM10, SO2, and NO2, the greatest relative risk (RR) values and 95% confidence interval (CI) on PTB were 1.0075 [95% CI, 1.0019-1.0131], 1.0053 [95% CI, 1.0014-1.0092], 1.0203 [95% CI, 1.0030-1.0379], and 1.0170 [95% CI, 1.0052-1.0289] in lag 16th, 18th, 19th, and 20th gestational weeks, respectively. No significant influence of O3 and CO were found on preterm birth. Subgroup analysis showed that the risk of premature delivery was higher for younger pregnant women and in warm season. This finding shows that prenatal exposure to ambient air pollutants is associated with preterm birth, and there existed an exposure window period.

Perinatal low-dose bisphenol AF exposure impairs synaptic plasticity and cognitive function of adult offspring in a sex-dependent manner.

Bisphenol AF (BPAF), a kind of the ideal substitutes of Bisphenol A (BPA), has frequently been detected in environmental media and biological samples. Numerous studies have focused on the reproductive toxicity, cardiotoxicity and endocrine disrupting toxicity of BPAF. However, little evidence is available on neurodevelopmental toxicity of BPAF. Here, our study is to evaluate the effect of perinatal BPAF exposure (0, 0.34, 3.4 and 34 mg/kg body weight/day, correspond to Ctrl, low-, medium- and high-dose groups) on the cognitive function of adult mouse offspring. This study firstly found that perinatal BPAF exposure caused cognitive impairments of mouse offspring, in which male offspring was more sensitive than female offspring in low- and medium-dose BPAF groups. Furthermore, the dendritic arborization and complexity of hippocampal CA1 and DG neurons in male offspring were impaired in all BPAF groups, and these effects were only found in high-dose BPAF group for female offspring. The damage of BPAF to dendritic spines, and the structural basis of learning and memory, was found in male offspring but not in females. Correspondingly, perinatal BPAF exposure significantly downregulated the expressions of hippocampal PSD-95 and Synapsin-1 proteins, and male offspring was more vulnerable than female offspring. Meanwhile, we explored the alteration of hippocampal estrogen receptors (ERs) to explain the sex specific impairment of cognitive function in low- and medium-dose BPAF groups. The results showed that perinatal BPAF exposure significantly decreased the expression of ERα in male offspring in a dose-dependent manner, but not in female offspring. In addition, we found that perinatal BPAF exposure can disordered the balance of oxidation and antioxidation in hippocampus of male offspring. In summary, perinatal low-dose bisphenol AF exposure impairs synaptic plasticity and cognitive function of adult offspring in a sex-dependent manner. The present results provide a pierce of potential mechanism of BPAF-caused neurodevelopmental toxicity.

Hidden blood loss and the influencing factors after laparoscopic cholecystectomy.

BACKGROUND: A small amount of bleeding usually occurs during laparoscopic cholecystectomy (LC), but the occurrence of perioperative hidden blood loss (HBL) is ignored. So our objective is to investigate the amount of HBL and find out the influential factors in LC. METHODS: From January 2017 to May 2019, 139 patients scheduled for LC were enrolled in the study. The data of patients' sex, age, height, weight, body mass index (BMI), form of gallbladder bed, gallbladder status, hypertension, diabetes, liver cirrhosis, drainage volume and operation time were recorded. The patients' height, weight and preoperative and postoperative haematocrit and haemoglobin were recorded and applied to the Gross formula to determine the amount of blood loss. The data of sex, age, BMI, hypertension, diabetes, gallbladder status, liver cirrhosis and operation time were analysed by multivariate linear regression analysis. One-way analysis of variance was performed to find out the relative correlation between HBL and the type of gallbladder bed. RESULTS: The HBL was 259.3 ± 188.5 mL. On the basis of multivariate linear regression analysis and analysis of variance, the gallbladder bed, hypertension and the operation time are influential factors of HBL in patients with LC. However, sex, age, BMI, gallbladder status, liver cirrhosis and diabetes are not significantly correlated with HBL. CONCLUSIONS: HBL should not be overlooked during the perioperative period of LC, especially in patients with hypertension, gallbladder bed >50% gallbladder surface or operation time >60 min.

Diverging effects of clean versus dirty money on attitudes, values, and interpersonal behavior.

Does the cue of money lead to selfish, greedy, exploitative behaviors or to fairness, exchange, and reciprocity? We found evidence for both, suggesting that people have both sets of meaningful associations, which can be differentially activated by exposure to clean versus dirty money. In a field experiment at a farmers' market, vendors who handled dirty money subsequently cheated customers, whereas those who handled clean money gave fair value (Experiment 1). In laboratory studies with economic games, participants who had previously handled and counted dirty money tended toward selfish, unfair practices-unlike those who had counted clean money or dirty paper, both of which led to fairness and reciprocity. These patterns were found with the trust game (Experiment 2), the prisoner's dilemma (Experiment 4), the ultimatum game (Experiment 5), and the dictator game (Experiment 6). Cognitive measures indicated that exposure to dirty money lowered moral standards (Experiment 3) and reduced positive attitudes toward fairness and reciprocity (Experiments 6-7), whereas exposure to clean money had the opposite effects. Thus, people apparently have 2 contradictory sets of associations (including behavioral tendencies) to money, which is a complex, powerful, and ubiquitous aspect of human social life and cultural organization.

[Bowel preparation with sodium phosphate versus polyethylene glycol: a prospective, randomized, controlled clinical trial].

OBJECTIVE: To compare the efficacy, tolerance and safety between oral sodium phosphate(NaP) and polyethylene glycol(PEG) on bowel preparation. METHODS: One hundred and fifteen inpatients were randomly divided into NaP group and PEG group. The questionnaire was designed for scoring by patients and doctors regarding to tolerance, taste, side effects and cleaning degree etc. RESULTS: Compared with PEG group, NaP presented better tolerance, lower side effects and higher rate of adequate cleaning quality(P<0.05). NaP could cause electrolytic alterations, such as hyperphosphatemia, hypernatremia, hypocalcemia and hypopotassemia, but these changes were transient and without clinical significance. CONCLUSION: Sodium phosphate is safe and effective for bowel preparation, and is better than polyethylene glycol in tolerance.