Increased difficulty and complications of delayed laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage in acute cholecystitis: a retrospective study.

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is a relatively less invasive alternative treatment to cholecystostomy. However, the influence of the difficulty of delayed laparoscopic cholecystectomy (DLC) after PTGBD on clinical outcomes remains unknown. This study aimed to evaluate the clinical effects of DLC following PTGBD. METHODS: The clinical data of 113 patients diagnosed with moderate (grade II) acute cholecystitis according to the 2018 Tokyo Guidelines in the acute phase and who underwent DLC in our hospital from January 2018 to February 2022 were retrospectively collected and separated into two groups according to whether they received PTGBD treatment in the acute stage. The PTGBD group comprised 27 cases, and the no-PTGBD group included 86 cases. The TG18 difficulty score was used to evaluate every surgical procedure in the cases by reviewing the surgical videos. The clinical baseline characteristics and post-treatment outcomes were also evaluated. RESULTS: Both groups showed significant differences in length of postoperative stay, blood loss, operation time, and difficulty score. The PTGBD group showed a significantly longer postoperative stay and operation time, more blood loss, and a much higher difficulty score than the no-PTGBD group. Conversion rates did not differ. The morbidity rate in the PTGBD group was statistically higher. CONCLUSIONS: PTGBD is an efficient way to relieve the symptoms of acute cholecystitis. However, it may increase the difficulty and complications of DLC.

Can the parkland grading scale predict the difficulty of laparoscopic cholecystectomy? A new approach to validation.

BACKGROUND: The Parkland Grading Scale (PGS) is an intraoperative grading scale to stratify gallbladder disease severity during laparoscopic cholecystectomy (LC). We evaluated the usefulness of the PGS in predicting the difficulty levels of LC procedures using a novel approach. METHODS: A total of 261 patients diagnosed with cholelithiasis and cholecystitis who underwent LC were assessed. The PGS and the surgical difficulty grading system were used to evaluate surgical procedures by reviewing the operation videos. Clinical baseline characteristics and post-treatment outcomes were also recorded. Differences between the five PGS grades in terms of surgical difficulty scores were analyzed using the Jonckheere-Terpstra test. The relationship between PGS grades and surgical difficulty scores was assessed using Spearman's Rank correlation. Finally, the linear trends between morbidity scores and PGS grades were evaluated using the Mantel-Haenszel test. RESULTS: There was a significant difference in the surgical difficulty scores for the five PGS grades (p < 0.001). In pairwise comparison, each grade (1-5) was significantly different from the others (p < 0.05) in terms of surgical difficulty, except Grade 2 vs. 3 (p = 0.07) and Grade 3 vs. 4 (p = 0.08). There was a significant correlation between PGS grades and surgical difficulty scores (rs = 0.681, p < 0.001). There was also a significant linear association between morbidity and PGS grades (p < 0.001). Spearman's R value was 0.176 (p = 0.004). CONCLUSION: The PGS can accurately assess the surgical difficulty level of LC. The precision and conciseness of the PGS make it suitable for use in future research.

Complete colonic duplication presenting as hip fistula in an adult with pelvic malformation: A case report.

BACKGROUND: Alimentary tract duplication (ATD) is a rare congenital anomaly. Thus, a case of ATD with a complete colonic duplication isolated in the abdominal cavity with a fistula and multiple malformations is very distinctive. These characteristics show the variability of this disease and explain why it tends to be challenging to diagnose and treat. CASE SUMMARY: A 25-year-old woman with a history of a fistula opening in her right hip since birth presented with the irregular discharge of foul fluid from the fistula and intermittent abdominal pain. Contrast-enhanced computed tomography and magnetic resonance imaging findings revealed a duplicated tube isolated in her abdominal pelvic cavity along with a pelvic malformation and double ureter. Right foot radiographic examination showed pes cavus. During surgery, the tube appeared to be an almost complete colonic structure and was verified to be connected to the fistula. All of the involved tissue and fistula were removed, and the defect in the pelvic floor was closed by suturing after surgery. After 8 mo, the postoperative follow-up has been uneventful. CONCLUSION: ATD may be a differential diagnosis in sinus tract cases. Laparoscopy combined with open surgery is a viable treatment option.

Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic.

BACKGROUND: Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes. METHODS: Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences. RESULTS: Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED. CONCLUSION: The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.

Understanding the Iron-Cobalt Synergies in ZSM-5: Enhanced Peroxymonosulfate Activation and Organic Pollutant Degradation.

Iron- and cobalt-based heterogeneous catalysts are widely applied for activating peroxymonosulfate (PMS) to degrade organic pollutants. However, few studies have unveiled the clear synergistic mechanism of iron and cobalt in ZSM-5. In this paper, the synergistic mechanism of enhanced PMS activation was revealed by constructing iron and cobalt bimetal modified ZSM-5 zeolite catalysts (FeCo-ZSM-5). The tetracycline hydrochloride (TCH) degradation experiments showed that the catalytic activity of FeCo-ZSM-5-2:3 was much higher than those of Fe-ZSM-5 and Co-ZSM-5. In addition, the influences of catalyst dosage, PMS concentration, reaction temperature, initial pH, and coexisting ions on TCH removal were systematically investigated in this paper. Density functional theory calculations indicated that Co was the main active site for PMS adsorption, and Fe increased the area of Co's positive potential mapped to the electron cloud. The Fe-Co bimetallic doping increased the area of positive potential mapped to the electron cloud and benefited the adsorption of PMS on the catalyst surface, which revealed the synergistic mechanism of bimetals. Electron paramagnetic resonance spectra and quenching experiments showed that sulfate radicals, singlet oxygen, and hydroxyl radicals were involved in the degradation of TCH. Furthermore, liquid chromatography-mass spectrometry was conducted to propose possible degradation pathways. This work provides certain guiding significance in understanding the synergistic effect of heterogeneous catalysts for tetracycline wastewater treatment.

Excessive proliferation and apoptosis of parathyroid cells contribute to primary hyperparathyroidism in rabbit model.

To explore the molecular pathogenesis of primary hyperparathyroidism (PHPT), we investigated the proliferation and apoptosis of parathyroid cells in a rabbit model of diet-induced PHPT. A total of 120 adult Chinese rabbits were randomly divided into normal diet (Ca:P, 1:0.7) group (control group) or a high-phosphate diet (Ca:P, 1:7) group (experimental group). The thyroid and parathyroid complexes were harvested for 1-month interval from month 1 to month 6. The expression of proliferation markers, including proliferating cell nuclear antigen (PCNA) and cyclin-D1, and B cell lymphoma-2 (Bcl-2), were evaluated by immunohistochemistry in thyroid and parathyroid tissues. Apoptosis was quantified by DNA-fragment terminal labeling. Our results demonstrated that parathyroid cells in the experimental group started proliferating from the end of the 2nd month, the expression of PCNA, Bcl-2, and cyclin-D1 were significantly higher in the PHPT group than those of the control group (p<0.05). Furthermore, the apoptosis index (AI) was positively correlated with the glandular cell count and expression of PCNA in the 6th month in the PHPT group. Overall, our results suggested that excessive proliferation and apoptosis of parathyroid cells may contribute to the pathogenesis of PHPT through PCNA-related, Bcl-2-related, and cyclin-D1-related pathways.

Expression of transient receptor potential cation channel subfamily M member 8 in gastric cancer and its clinical significance.

Transient receptor potential cation channel subfamily M member (TRPM8) is abnormally expressed in many malignant tumors, such as breast cancer and pancreatic cancer, but its expression in gastric cancer (GC) has remained unclear. The present study aimed to detect TRPM8 expression and to explore its clinical significance in GC. Western blotting and immunohistochemistry were used to detect the protein expression of TRPM8 in 134 pairs of GC and adjacent healthy tissues. The association of TRMP8 with the 5-year overall survival rate of patients with GC was assessed using a Cox regression model. TRPM8 protein expression was significantly elevated (P<0.05) in gastric tumor cells (SUN-1, AGS, SNU-5 and NCI-N87) and was significantly associated with tumor diameter (P=0.003), Tumor-Node-Metastasis stage (P=0.003), lymph node metastasis (P=0.001) and cancer cell remote metastasis (P=0.010) in patients with GC. The expression of TRPM8 protein was significantly higher in GC patients with a tumor diameter of ≥2.5 cm. Additionally, TRPM8 protein expression in patients with metastases was significantly higher compared with patients without metastasis. Cox regression analysis revealed that TRPM8 protein expression was an independent risk factor for prognosis (odds ratio, 1.625; 95% CI=0.552-3.128) in patients with GC. In addition, the 5-year overall survival rate of patients with high expression of TRPM8 protein (64.44%) in GC was significantly lower compared with patients with low expression (12.36%). TRPM8 was highly expressed in GC tissues and may promote GC cell proliferation and metastasis in vivo.

Aerobic Oil-Phase Cyclic Magnetic Adsorption to Synthesize 1D Fe2O3@TiO2 Nanotube Composites for Enhanced Visible-Light Photocatalytic Degradation.

In this work, Fe2O3@TiO2 nanostructures with staggered band alignment were newly designed by an aerobic oil-phase cyclic magnetic adsorption method. XRD and TEM analyses were performed to verify the uniform deposition of Fe2O3 nanoparticles on the nanotube inner walls of TiO2. The steady-state degradation experiments exhibited that 1FeTi possessed the most superior performance, which might be ascribable to the satisfying dark adsorption capacity, efficient photocatalytic activity, ease of magnetic separation, and economic efficiency. These results indicated that the deposition of Fe2O3 into TiO2 nanotubes significantly enhanced the activity of Fe2O3, which was mainly ascribed to the Fe2O3-induced formation of staggered iron oxides@TiO2 band alignment and thus efficient separation of h+ and e-. Furthermore, the PL intensity and lifetime of the decay curve were considered as key criterions for the activity's evaluation. Finally, the leaching tests and regeneration experiments were also performed, which illustrated the inhibited photodissolution compared with TiO2/Fe3O4 and stable cycling ability, enabling 1FeTi to be a promising magnetic material for photocatalytic water remediation.

Identification of Glypican-3 as a potential metastasis suppressor gene in gastric cancer.

Gastric cancer is a prevalent tumor that is usually detected at an advanced metastatic stage. Currently, standard therapies are mostly ineffective. Here, we report that Glypican-3 (GPC3) is absent in invasive tumors and metastatic lymph nodes, in particular in aggressive and highly disseminated signet ring cell carcinomas. We demonstrate that loss of GPC3 correlates with poor overall survival in patients. Moreover, we show that absence of GPC3 causes up-regulation of MAPK/FoxM1 signaling and that blockade of this pathway alters cellular invasion. An inverse correlation between GPC3 and FoxM1 is also shown in patient samples. These data identify GPC3 as a potential metastasis suppressor gene and suggest its value as a prognostic marker in gastric cancer. Development of therapies targeting signaling downstream of GPC3 are warranted.

Txr1: an important factor in oxaliplatin resistance in gastric cancer.

Oxaliplatin-based chemotherapy is the main treatment regimen for gastric cancer (GC), but can fail because of drug resistance. We investigated the role of a recently identified drug-resistance gene, taxol-resistant gene 1 (Txr1), in oxaliplatin resistance. A retrospective study based on banked tissue was carried out. We collected clinical data from 95 patients with stage II-III GC who were treated with radical D2 surgery and standardized first-line chemotherapy with oxaliplatin; paraffin blocks of their tumor specimens were prepared for a tissue microarray in which Txr1 expression was analyzed immunohistochemically and compared with their clinical data and their 3-year disease-free survival (DFS) rate. The human GC cell line, SGC7901, was developed into the oxaliplatin-resistant cell line, SGC7901/L-OHP, using slowly increased oxaliplatin concentrations over 6 months. The relationship between Txr1 expression and drug-resistance of oxaliplatin in GC was studied with drug intervention, gene silencing technology, real-time PCR and Western blot analysis. Of the 95 patients with GC, those with TXR1(-) GC had longer postoperative 3-year DFS (77.8 %) than those with TXR1(+) GC (52.9 %). In oxaliplatin-resistant SGC7901/L-OHP cells, the main expression location of Txr1 shifted from the nucleus to cytoplasm, and both the mRNA and protein expression of Txr1 were higher than that of the parental cells, whereas expression of thrombospondin-1 (TSP1) decreased. When the Txr1 gene was silenced, TSP1 expression increased and the oxaliplatin resistance was significantly reduced in SGC7901/L-OHP cells. Changed Txr1 expression in GC affects the efficacy of oxaliplatin-based chemotherapy. Increased Txr1 expression decreases TSP1 expression and inhibits apoptosis. Txr1 could be a target in reversing oxaliplatin resistance in GC.

[Changes of serum leptin levels in patients with obstructive sleep apnea-hypopnea syndrome before and after treatment of surgery].

OBJECTIVE: To investigate the change of serum leptin levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after surgery. METHOD: The cases were divided into effective (n=44) and non-effective (n=13) groups according to PSG. The effective cases were divided into decreased (> or = 5%, n=25) and non-decreased(<5%, n=19) BMI. The level of serum leptin was detected by radioimmunoassay. RESULT: The level of serum leptin after treatment (9.1 +/- 2.6 microg/L) was as high as before treatment (9.3 +/- 2.3 microg/L) in 13 non-effective cases. The level of serum leptin after treatment (7.15 +/- 1.23 microg/L) was significantly decreased than before treatment (12.79 +/- 2.98 microg/L) in 25 cases of decreased BMI (> or = 5%). The level of serum leptin after treatment (7.15 +/- 1.23 microg/L) was significantly decreased than before treatment (12.79 +/- 2.98 microg/L) in 19 cases of non-decreased BMI (<5%). Leptin level of all cases showed a positive correlation with AHI (P < 0.01). CONCLUSION: The level of serum leptin in patients with OSAHS are increased. The serum leptin level of effective patients with OSAHS after treatment was significantly decreased. The level of serum leptin reflects the degree of AHI in patients with OSAHS.

Heterogeneous nuclear ribonucleoprotein K (hnRNP K) is a tissue biomarker for detection of early hepatocellular carcinoma in patients with cirrhosis.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors occurring mainly in patients with chronic liver disease. Detection of early HCC is critically important for treatment of these patients. METHODS: We employed a proteomic profiling approach to identify potential biomarker for early HCC detection. Based on Barcelona Clinic Liver Cancer (BCLC) staging classification, 15 early HCC and 25 late HCC tissue samples from post-operative HCC patients and their clinicopathological data were used for the discovery of biomarkers specific for the detection of early HCC. Differential proteins among cirrhotic, early, and late tissue samples were separated by two-dimensional gel electrophoresis (2-DE) and subsequently identified by mass spectrometry (MS). Receiver operating characteristic (ROC) curves analysis were performed to find potential biomarkers associated with early HCC. Diagnosis performance of the biomarker was obtained from diagnosis test. RESULTS: Protein spot SSP2215 was found to be significantly overexpressed in HCC, particularly in early HCC, and identified as heterogeneous nuclear ribonucleoprotein K (hnRNP K) by tandem mass spectrometry (MALDI TOF/TOF). The overexpression in HCC was subsequently validated by western blot and immunohistochemistry. ROC curve analysis showed that hnRNP K intensity could detect early HCC at 66.67 % sensitivity and 84 % specificity, which was superior to serum α-fetoprotein (AFP) in detection of early HCC. Furthermore, the diagnosis test demonstrated, when combined with hnRNP K and serum AFP as biomarker panel to detect early HCC at different cut-off value, the sensitivity and specificity could be enhanced to 93.33 % and 96 %, respectively. CONCLUSIONS: hnRNP K is a potential tissue biomarker, either alone or in combination with serum AFP, for detection of early HCC. High expression of hnRNP K could be helpful to discriminate early HCC from a nonmalignant nodule, especially for patients with liver cirrhosis.