[The incidence and time distribution of early transient intraocular pressure elevation after penetrating canaloplasty].

Objective: To report the incidence and time distribution of early transient intraocular pressure (IOP) elevation after penetrating canaloplasty. Methods: Retrospective case series study. Data of patients treated by penetrating canaloplasty for glaucoma in the Eye Hospital of Wenzhou Medical University from June 2015 to March 2020 were collected. Early transient IOP elevation was defined as an increase of IOP to over 21 mmHg on the first week to the third month after surgery followed by a decrease to 21 mmHg or less within 3 months. Main outcome measures included IOP, quantity of medication use, the occurrence time and duration of IOP elevation. Generalized estimating equations were used for statistical analysis, and measurement data with non-normal distribution was represented as M (Q1, Q3). Results: A total of 277 patients (315 eyes) achieved 360-degree catheterization of the canal successfully, and 299 eyes (94.9%) completed the postoperative 6-month follow-up. Thirty-four eyes (10.8%) had persistently high IOP, so the surgical treatment failed in them. Consequently, 234 patients (265 eyes) were enrolled in the analyses, including 161 males (184 eyes) and 73 females (81 eyes). The median age was 42 (26, 54) years, the mean preoperative IOP was (37.7±11.1) mmHg, and the mean number of drugs used was 3 (2, 4). The incidence of early transient IOP elevation was 43.0% (114/265) in all enrolled eyes, 42.7% (35/82) in eyes with primary open angle glaucoma, 37.8% (17/45) in eyes with primary angle closure glaucoma, 27.7% (13/47) in eyes with congenital glaucoma and 53.8% (49/91) in eyes with secondary glaucoma. The IOP began to increase on the first to fourth week in 91.2% (104/114) of eyes with early transient IOP elevation and reached the peak [21.3 mmHg to 54.8 mmHg; mean, (32.4±8.2) mmHg] in 88.6% (101/114) on the first to fifth week after surgery. The IOP elevation lasted for no more than 4 weeks in 69.3% (79/114) of eyes. Conclusions: Over 40.0% of patients with penetrating canaloplasty may experience postoperative transient IOP elevation. The incidence is relatively high in secondary glaucoma but low in congenital glaucoma. Most of the elevations and peak IOP occur within 1-4 weeks after surgery.

Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach.

BACKGROUND: Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation. METHODS: This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN. RESULTS: Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1-7) and 1 (1-6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths). CONCLUSION: A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.

ANTECEDENTES: Los procedimientos mínimamente invasivos se han convertido en los más frecuentes para el tratamiento de necrosis pancreáticas infectadas. El objetivo de este estudio fue presentar un procedimiento de necrosectomía pancreática retroperitoneal de acceso mínimo (minimal-access retroperitoneal pancreatic necrosectomy, MARPN) modificado y asistido mediante insuflación de gases, así como evaluar su seguridad y eficacia. MÉTODOS: Se realizó un análisis retrospectivo y observacional de los datos de un hospital desde el 1 de enero de 2010 hasta el 31 de diciembre de 2016. Se incluyeron en el análisis todos los pacientes en los que realizó un abordaje por etapas, que consistía en el drenaje percutáneo mediante la colocación de un catéter seguido de un procedimiento MARPN modificado, en los que se dispusiese de un seguimiento postoperatorio mínimo de 1 año. El MARPN en el lado derecho y la necrosectomía realizada a través de más de un acceso se clasificaron como MARPN complejo. Se evaluaron los resultados radiológicos y quirúrgicos. RESULTADOS: De 212 pacientes con necrosis pancreática infectada, en 164 (77,4%) se realizó un abordaje por etapas. La mediana del número de drenajes percutáneos y procedimientos MARPN fue 3 (rango, 1-7) y 1 (rango, 1-6), respectivamente. En 90 pacientes (54,9%) se realizó un MARPN complejo. Para la exéresis de necrosis residual después de un MARPN, en 3 pacientes (1,8%) se realizó mediante gastroscopia y en 11 pacientes (6,7%) con un recambio de drenaje bajo control radiológico. En 13 pacientes (7,9%) fue necesaria la reconversión a cirugía abierta. Hubo complicaciones postoperatorias en 103 pacientes (62,8%). La tasa de mortalidad fue del 6,1% (n = 10). CONCLUSIÓN: El abordaje por etapas con un MARPN modificado es seguro y efectivo en el tratamiento de la necrosis pancreática infectada.

A diagnostic algorithm for assessment of liver fibrosis by liver stiffness measurement in patients with chronic hepatitis B.

Steatosis could affect liver stiffness measurement in patients with nonalcoholic fatty liver disease and chronic hepatitis C. In this study, we aimed to investigate the impact of steatosis on liver stiffness in hepatitis B virus (HBV)-infected patients and develop a diagnostic algorithm for prediction of liver fibrosis by liver stiffness based on the controlled attenuation parameter. A total of 488 HBV-infected patients who underwent clinical examination, Fibroscan and liver biopsy were prospectively enrolled. The best liver stiffness measurement (kPa) cut-offs for significant fibrosis (S≥3) and advanced fibrosis (S≥4) were 8.1 and 10.9, respectively. The best controlled attenuation parameter cut-off for severe steatosis (≥30%) was 287 dB/m. Among patients with low-grade fibrosis (S0-S2/S0-S3), mean liver stiffness values were significantly higher in subjects with severe steatosis or controlled attenuation parameter ≥287 dB/m compared with those without. Moreover, in subjects with low-grade fibrosis, a higher rate of false-positive rate was observed in patients with severe steatosis than those in patients without (F0-F2: 28.2% vs 9.7%; F0-F3: 17.0% vs 5.3%), and in patients with CAP≥287 dB/m compared with their counterpart (F0-F2: 23.7% vs 9.2%; F0-F3: 14.1% vs 4.8%). Low-grade fibrosis was accurately identified by γ-glutamyl transpeptidase-to-platelet ratio (GPR) with a cut-off value of 0.17. In patients with GPR<0.17, similar results were observed. The presence of steatosis may lead to overestimation of fibrosis assessed by liver stiffness measurement in patient with chronic hepatitis B. A diagnostic algorithm for assessing fibrosis using liver stiffness was developed by combining both controlled attenuation parameter and GPR values.

Mitochondrial tRNALeu(CUN) A12307G variant may not be associated pancreatic cancer.

Mitochondrial DNA mutations that lead to mitochondrial dysfunction have long been proposed to play important roles in the development of pancreatic cancer. Of these, alterations to mitochondrial tRNA genes constitute the largest group. Most recently, a variation at position 12307 in the gene encoding tRNA(Leu(CUN)) has been reported to be associated with this disease. However, the molecular mechanism underlying this relationship remains poorly understood. To assess this association, we evaluated this variant by evolutionary conservation analysis, measurements of allelic frequencies among control subjects, and use of several bioinformatic tools to estimate potential structural and functional alterations. We found this residue to have a high conservation index; however, the presence of the A12307G variation in control subjects revealed by a literature search suggested it to be common in human populations. Moreover, RNAfold results showed that this variant did not alter the secondary structure of tRNA(Leu(CUN)). Through the application of a pathogenicity scoring system, this variant was determined to be a "neutral polymorphism," with a score of only 4 points based on current data. Thus, the contribution of the A12307G variant to pancreatic cancer needs to be addressed in further experimental studies.

miR-499A>G rs3746444 and miR-146aG>C expression and hepatocellular carcinoma risk in the Chinese population.

We conducted a case-control study of a possible association of miR-499A>G rs3746444 and miR-146aG>C rs2910164 with risk of hepatocellular carcinoma. Samples from 172 hepatocellular carcinoma patients and 185 cancer-free controls were collected from October 2008 to December 2011. PCR-RFLP analysis was performed to determine the polymorphisms in each individual. The MAFs of miR-146aG>C and miR-499A>G in controls were similar to that known from the SNP database, and frequencies of genotypes in controls were in line with Hardy-Weinberg equilibrium. We found that miR-499 AG was significantly associated with decreased risk for hepatocellular carcinoma when compared with miR-499 AA genotype (adjusted odds ration = 0.74, 95% confidence interval = 0.24-0.96). However, subjects carrying miR-146a GG had a non-significant 0.62-fold decreased risk of hepatocellular carcinoma. We did not find a significant association of miR-146aG>C rs2910164 and miR-499A>G rs3746444 polymorphisms with hepatocellular carcinoma risk in the Chinese population. Further investigations are warranted to clarify the relationship between miRNA polymorphisms and susceptibility to hepatocellular carcinoma risk in various ethnic populations.

The effect of dilution and prolonged injection time on dexamethasone-induced perineal pruritus.

Dexamethasone has been widely used before general anesthesia induction. However, previous studies have found that a pre-induction bolus dose of dexamethasone sometimes causes perineal pruritus. We hypothesized that an appropriate prolongation of the injection time might suppress dexamethasone-induced perineal pruritus. Four hundred patients requiring general anaesthesia were randomly allocated into four groups: group I receiving 2 ml dexamethasone (5 mg/ml); group II receiving 4 ml dexamethasone (2.5mg/ml); group III receiving 10 ml dexamethasone (1 mg/ml); and group IV receiving 20 ml dexamethasone (0.5 mg/ml). Dexamethasone was diluted with 0.9% sodium chloride. The injection time of dexamethasone was 5s in groups I, II and III; while the injection time of dexamethasone was 30s in group IV. Occurrence of perineal pruritus was significantly reduced in Group IV (0% vs 38%, 32% and 12% in Groups I, II and III, respectively, p < 0.05). The incidence was higher in females than in males (p < 0.05). The duration of perineal pruritus was longer in females than in males in groups I, II and III (p < 0.05). We conclude that the dilution of dexamethasone to 0.5 mg/ml with 0.9% sodium chloride combined with prolonged injection time to 30 s eliminates dexamethasone-induced perineal pruritus.

Same pandemic but different studies: an exploration of COVID-19 research at the early stage.

OBJECTIVE: Scientific research is an essential necessity for the prevention and control of COVID-19. Accelerated paper-sharing makes it possible to explore the responses of scientific communities of different countries and their research focus. This is achieved by examining relevant publications during the early stage of the pandemic. This paper explores a timely research assessment on COVID-19 among China, USA, and EU. MATERIALS AND METHODS: Papers indexed in PubMed and published from December 30, 2019, to March 11, 2020, were selected. Papers from China, USA, and EU were assessed by calculating the significance of items in the co-occurrence exported from VOSviewer. RESULTS: The results showed that Chinese studies focus more on clinical manifestations, while USA and EU focus on experimental research. Furthermore, US research is more geared toward detection techniques and mathematical models, China focuses more on monitoring the epidemic situation, and EU engages in both. CONCLUSIONS: This paper argues that the above distinctions are caused by differences in the stages of epidemic development, researchers' experience bases for formulating measures, traditions within the different medical cultures, and the distinction between "information" and "knowledge".

[Effect of traditional Chinese medicine on osseointegration and bone absorption of implants].

Implantation of the base bone in the implant after effective and rapid bone binding and prevention and treatment of bone resorption, to ensure the success of planting surgery is of great significance. This article reviews the mechanism of traditional Chinese medicine promoting bone integration and the etiopathological mechanism of bone resorption, and expounds the influence of traditional Chinese medicine on osseointegration and bone resorption.

Upregulation of the ALDOA/DNA-PK/p53 pathway by dietary restriction suppresses tumor growth.

Dietary restriction (DR) delays the incidence and decreases the growth of various types of tumors; however, the mechanisms responsible for DR-mediated antitumor effects have not been unequivocally identified. Here, we report that DR suppresses xenograft tumor growth by upregulating a novel signaling pathway. DR led to upregulated aldolase A (ALDOA) expression in xenograft tumors. ALDOA physically interacted with the catalytic subunit of DNA-dependent protein kinase (DNA-PK) and promoted DNA-PK activation. Activated DNA-PK phosphorylated p53 and increased its activity. Although ALDOA can function as an oncogene in cultured cells, it can also activate the tumor suppressor p53. Thus, ALDOA overexpression in the presence of p53 suppressed xenograft tumor growth; however, when p53 was suppressed, ALDOA overexpression promoted xenograft tumor growth. Moreover, we demonstrated that p53 suppression inhibited the antitumor effects of DR. Our results indicate that upregulation of the ALDOA/DNA-PK/p53 pathway is a mechanism accounting for the antitumor effects of DR.

A nomogram for predicting prognostic value of inflammatory response biomarkers in decompensated cirrhotic patients without acute-on-chronic liver failure.

BACKGROUND: Inflammation plays a vital role in liver cirrhosis progression and prognosis. AIM: To investigate the prognostic significance of inflammatory response markers in decompensated cirrhotic patients without acute-on-chronic liver failure (ACLF). METHODS: Independent predictors were identified using multivariate Cox model and then assembled into a nomogram to predict survival. Concordance index (C-index) and time-dependent receiver operating characteristics (td-ROC) analysis were adopted to evaluate and compare the performance of nomogram, model for end-stage liver disease (MELD) scores, MELD-Na and Chronic Liver Failure-consortium score for acute decompensated (CLIF-C ADs). RESULTS: A total of 902 decompensated cirrhotic patients with different aetiologies were enrolled, with 6-month, 1-year and 3-year mortality of 18.6%, 24.4% and 34.8%, respectively. The cut-off values for neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) determined by X-tile program were 5.7 and 1.1 respectively. Patients with NLR>5.7 or LMR≤1.1 had significantly higher mortality (P < 0.001). Independent factors derived from multivariable Cox analysis of development cohort to predict mortality were age, NLR and LMR (hazard ratio (HR): 1.064, 95% confidence interval (CI): 1.045-1.084, P < 0.001; HR: 1.124, 95%CI: 1.091-1.158, P < 0.001; HR: 0.794, 95%CI: 0.702-0.898, P < 0.001, respectively). The C-indexes of nomogram were higher than that of MELD score, MELD-Na and CLIF-C ADs for predicting survival. The tdROC and decision curves showed that nomogram was superior to MELD score, MELD-Na and CLIF-C ADs. Similar results were observed in validation cohort. CONCLUSION: The proposed nomogram with neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio resulted in accurate prognostic prediction for decompensated cirrhotic patients without ACLF.