Laparoscopic resection is better than endoscopic dissection for gastric gastrointestinal stromal tumor between 2 and 5 cm in size: a case-matched study in a gastrointestinal center.

BACKGROUND: The feasibility of endoscopic dissection for gastric gastrointestinal stromal tumor (gGIST) between 2 and 5 cm in size has been demonstrated. However, its impact on short-term and long-term outcomes, compared with laparoscopic resection, is unknown. The purpose of this study was to compare short-term and long-term outcomes between laparoscopic resection and endoscopic dissection for 2-5-cm gGIST. METHODS: A case-matched study was performed using the propensity score. To overcome selection bias, we performed a 1:1 match using six covariates, including age, sex, BMI, ASA score, tumor size, and tumor location. Short-term and long-term outcomes between laparoscopic resection and endoscopic dissection were compared. RESULTS: A total of 210 patients with 2-5-cm gGIST were enrolled between 2006 and 2017 in our gastrointestinal center. According to the intention-to-treat approach, 165 patients underwent laparoscopic resection, and 45 patients underwent endoscopic dissection. After the propensity score, 45 pairs were balanced and analyzed. There was no significant difference in the baseline characteristics between the laparoscopic and endoscopic groups after matching. The rate of complications was significantly higher in the endoscopic group compared with the laparoscopic group (P < 0.001). Perforations occurred in 16 patients in the endoscopic group (16/45, 35.6%). The postoperative hospital stay was significantly longer in the endoscopic group compared with the laparoscopic group (P < 0.001). There was no significant difference between the two groups in disease-free survival or overall survival. CONCLUSION: Laparoscopic resection is better than endoscopic dissection for 2-5-cm gGIST because of the lower complication rate and shorter hospital stay.

A case-control study of using carbon nanoparticles to trace decision-making lymph nodes around inferior mesenteric artery in rectal cancer.

BACKGROUND: Accurate identification of lymph nodes localized around inferior mesenteric artery (IMA), with or without metastasis, is of crucial importance for surgeons when dissecting D2 or D3 lymph nodes in patients with rectal cancer (RC). The following study evaluates whether carbon nanoparticles can be used for detection of decision-making lymph nodes (DLNs) in station 253 lymph nodes found around IMA during RC surgery. METHODS: A total of 66 patients with rectal adenocarcinomas were recruited between January 2014 and August 2017. Patients were divided into carbon nanoparticle (CN) group and control (CL) group; for the CN group, 1 ml nanoparticles were endoscopically injected into submucosal layer of primary tumor 1 day before surgery. DLNs were defined as black-dyed nodes in CN group or macroscopic lymph nodes in CL group localized along the IMA, proximal to the origin of the left colic artery. D3 lymph nodes were dissected using laparoscopic radical resection, and then examined using pathological approach. Intra-operative and post-operative data were compared between the two groups. RESULTS: In CN group, black-dyed DLNs were easily found under laparoscopy; the median number of DLNs was 3 (range 1-9). In CL group, the median number of DLNs was 0 (range 0-3). Consistency between intra-operative DLNs and post-operative station 253 nodes were confirmed by pathological examination. Significant higher number of DLNs in station 253 nodes (2.91 ± 2.47 vs 0.58 ± 0.75, p < 0.001), number of station 251 nodes (12.85 ± 8.99 vs 8.09 ± 5.85, p = 0.014), number of station 253 nodes (5.21 ± 5.26 vs 3.15 ± 2.32, p = 0.045), and the number of total lymph nodes (24.06 ± 13.20 vs 16.21 ± 9.09, p = 0.007) were found in the CN group compared to CL group. CONCLUSIONS: Carbon nanoparticles are useful for identifying DLNs in station 253 LNs around IMA in RC. It is not necessary to perform D3 lymph node dissection if there are no intra-operative DLNs metastases in RC.

Real-time in vivo optical biopsy using confocal laser endomicroscopy to evaluate distal margin in situ and determine surgical procedure in low rectal cancer.

BACKGROUND: In low rectal cancer, a negative distal margin (DM) is necessary for R0 radical resection, and therefore, the choice of surgical procedure is dependent on whether the planned transection rectum has residual cancer or not. Currently, surgeons choose surgical procedures according to intraoperative in vitro DM frozen sections. This study aimed to investigate the feasibility of real-time in vivo optical biopsy using confocal laser endomicroscopy (CLE) to evaluate DM in situ and determine the surgical procedure in low rectal cancer. METHODS: Optical biopsy using CLE was performed when the rectum was dissected at the levator ani plane and rectum transection was ready. For negative DM, the surgical procedure of low anterior resection (LAR) was chosen. For positive DM, the surgical procedure of abdominoperineal resection (APR) was chosen. The specimen at the site of the planned transection rectum underwent intraoperative frozen section and routine pathological procedures. RESULTS: Eighteen patients underwent real-time in vivo optical biopsy using CLE in surgery. Eleven patients' CLE images of DM showed a regular, round crypt, and round luminal opening covered by a simple layer of columnar epithelial cells and goblet cells. LAR was then performed. Pathology revealed that the 11 DMs were negative, and the median length of the DMs was 2.0 cm. The remaining seven patients' CLE images of the planned transection rectum showed the loss of crypt architecture and irregular epithelial layer with loss of goblet cells. APR was then performed. Pathology confirmed cancer invasion, and the median distance from tumor to dentate line was 1.0 cm. The sensitivity, specificity, and accuracy of CLE optical biopsy of DM were 85.71%, 100%, and 94.44%, respectively. CONCLUSIONS: It is feasible to perform real-time in vivo optical biopsy using CLE to evaluate DM in situ and determine the surgical procedure in low rectal cancer.

Dysbiosis of Gut Microbiota and Short-Chain Fatty Acids in Acute Ischemic Stroke and the Subsequent Risk for Poor Functional Outcomes.

BACKGROUND: The intestinal microbiota and its metabolites have been reported to play an important role in stroke. Gut microbiota-originating short-chain fatty acids (SCFAs) modulate brain functions directly or indirectly through immune, endocrine, vagal, and other humoral pathways. However, relatively few investigations have evaluated the gut microbiome and SCFAs spectrum or their potential associations with stroke outcomes in acute ischemic stroke (AIS) patients with different stroke severities. METHODS: We used 16S rRNA gene sequencing and gas chromatography to compare the fecal microbial composition and SCFA spectrum between AIS patients (n = 140) and healthy controls (n = 92). Their associations with 90-day poor functional outcomes were evaluated by logistic regression models. RESULTS: We found that the intestinal microbiota distinguished AIS patients from healthy controls. A lack of SCFAs-producing bacteria and a low fecal SCFAs level defined dysbiosis in AIS patients, especially those with increased stroke severity. The SCFAs levels were negatively correlated with stroke severity and prognosis. Reduced SCFAs levels, especially acetate, were associated with an increased risk of 90-day poor functional outcomes even after adjustments. CONCLUSIONS: Dysbiosis of SCFAs-producing bacteria and SCFAs in AIS patients increased the subsequent risk for poor functional outcomes, indicating that SCFAs could be potential prognostic markers and therapeutic targets for stroke.

Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer.

BACKGROUND: Traditional laparoscopic No.12a lymph node dissection in radical gastrectomy for gastric cancer may damage the peripheral blood vessels, and is not conducive to the full exposure of the portal vein and the root ligation of the left gastric vein. We recommend a new surgical procedure, the portal vein approach, to avoid these problems. METHODS: 25 patients with advanced gastric cancer underwent radical laparoscopic gastrectomy and No.12a lymph node were dissected by portal vein approach, including 7 cases with total gastrectomy, 18 cases with distal gastric resection, 14 males and 11 females. Operative time, intraoperative blood loss, time to first flatus, postoperative hospital stay, number of total lymph node dissection and No.12a lymph node dissection, No.12a lymph node metastasis rate and postoperative complications were statistically observed. RESULTS: All the patients were operated successfully and No.12a lymph node were cleaned by portal vein approach. A total of 683 lymph nodes were dissected, with the average number of lymph nodes dissection and positive lymph nodes were (27.3 ± 12.7) and (3.8 ± 5.6) respectively. The average number of No.12a lymph node dissection was (2.4 ± 1.95) and the metastasis rate of No.12a lymph node was 16% (4/25). The average operation time of radical laparoscopic distal and total gastrectomy were (239.2 ± 51.4) min and (295.1 ± 27.7) min respectively. The mean intraoperative blood loss was (134.0 ± 65.7) ml, and postoperative first anal exhaust time was (2.24 ± 0.86) d. The mean time to fluid intake was (4.2 ± 1.7) d, and postoperative hospitalization time was (9.6 ± 5.0) d. Without portal vein injure, anastomotic leakage, gastrointestinal bleeding, intestinal obstruction and other complications were observed in all patient. CONCLUSION: Our results show that the laparoscopic No.12a lymph node dissection by portal vein approach for gastric cancer is safe, feasible and has certain clinical application value.

Dynamic Changes and Prognostic Value of Gut Microbiota-Dependent Trimethylamine-N-Oxide in Acute Ischemic Stroke.

Background: Acute ischemic stroke (AIS) is an atherothrombotic disease. Trimethylamine-N-oxide (TMAO), a gut microbiota-dependent metabolite, has been shown to be proatherogenic and prothrombotic. However, the involvement of TMAO in AIS remains unclear. This study aimed to observe the dynamic changes of TMAO in AIS patients and identify the prognostic value of TMAO for major ischemic events and unfavorable functional outcomes. Methods: This study included 204 AIS patients and 108 healthy controls. Blood samples for TMAO analyses were drawn at admission, 2 and 7 days of admission. Logistic regression models and receiver operating characteristic curves were established to identify associations between TMAO levels and major ischemic events (ischemic stroke, myocardial infarction, or death from an ischemic vascular event), as well as unfavorable functional outcomes (modified Rankin Scale score ≥3), at 90 days and 12 months. Results: TMAO levels showed no significant changes before and within 24 h of AIS treatment (at admission) but decreased significantly thereafter. Elevated log2-transformed baseline TMAO levels were associated with increased risks of 90-day [odds ratio (OR), 2.62; 95% confidence interval (CI), 1.55-4.45; p < 0.001] and 12-month (OR, 3.59; 95% CI, 2.12-6.09; p < 0.001) major ischemic events, as well as 90-day (OR, 2.89; 95% CI, 1.46-5.71; p = 0.002) and 12-month (OR, 2.58; 95% CI, 1.50-4.46; p = 0.001) unfavorable functional outcomes, after adjustments for confounding factors. The areas under curve of baseline TMAO levels for predicting 90-day and 12-month major ischemic events were 0.72 (95% CI, 0.61-0.83; p < 0.001) and 0.76 (95% CI, 0.66-0.85; p < 0.001). Baseline TMAO levels improved the prognostic accuracy of conventional risk factors, National Institutes of Health Stroke Scale (NIHSS) score and N-terminal B-type natriuretic peptide (NT-proBNP) level. Conclusions: TMAO levels decreased with time since stroke onset. Elevated TMAO levels at an earlier period portended poor stroke outcomes, broadening the potential clinical utility of TMAO as an independent prognostic marker and therapeutic target.

Synthesis of heterojunction photocatalysts composed of Ag 2 S quantum dots combined with Bi 4 Ti 3 O 12 nanosheets for the degradation of dyes.

Facilitating the separation of photogenerated electron/hole pairs and widening the light-responsive region are crucial to enhance the overall photocatalytic performance of photocatalysts. To achieve this aim, here we have prepared Ag2S/Bi4Ti3O12 heterojunction composite photocatalysts by assembling Ag2S quantum dots onto the surface of Bi4Ti3O12 nanosheets. Transmission electron microscopy observation demonstrates that two types of Ag2S quantum dots separately with size of 40-70 and 7-17 nm are uniformly assembled onto the surface of large-sized Bi4Ti3O12 thin nanosheets. The as-prepared Ag2S/Bi4Ti3O12 heterojunction composites exhibit much enhanced light absorption (particularly in the visible and near-infrared region) and highly efficient separation of electrons and holes photogenerated in Bi4Ti3O12. Rhodamine B (RhB) aqueous solution was chosen as the target organic pollutant to evaluate the photocatalytic performance of the samples under simulated sunlight irradiation. It is found that the Ag2S/Bi4Ti3O12 heterojunction composites manifest significantly enhanced photocatalytic activity toward the RhB degradaton. In particular, the 15wt% Ag2S/Bi4Ti3O12 composite exhibits the highest photocatalytic activity, which is ca. 2.8 and 4.0 times higher than bare Bi4Ti3O12 and Ag2S, respectively. The enhanced photocatalytic activity of the composites can be explained as a result of the Z-scheme electron transfer from the conduction band of Bi4Ti3O12 to the valence band of Ag2S, and thus more photogenerated holes in the valence band of Bi4Ti3O12 and electrons in the conduction band of Ag2S are able to participate in the photocatalytic reactions. Active species trapping experiments were carried out, from which it is concluded that photogenerated holes and •O2- radicals play the dominant and secondary role in the photocatalysis, respectively.

Growth Process and CQDs-modified Bi4Ti3O12 Square Plates with Enhanced Photocatalytic Performance.

Bi4Ti3O12 square plates were synthesized via a hydrothermal route, and their growth process was systematically investigated. Carbon quantum dots (CQDs) were prepared using glucose as the carbon source, which were then assembled on the surface of Bi4Ti3O12 square plates via a hydrothermal route with the aim of enhancing the photocatalytic performance. XRD (X-ray powder diffraction), SEM (scanning electron microscopy), TEM (transmission electron microscopy), UV-vis DRS (diffuse reflectance spectroscopy), XPS (X-ray photoelectron spectroscopy), FTIR (Fourier transform infrared spectroscopy), PL (photoluminescence) spectroscopy, EIS (electrochemical impedance spectroscopy) and photocurrent spectroscopy were used to systematically characterize the as-prepared samples. It is demonstrated that the decoration of CQDs on Bi4Ti3O12 plates leads to an increased visible light absorption, slightly increased bandgap, increased photocurrent density, decreased charge-transfer resistance, and decreased PL intensity. Simulated sunlight and visible light were separately used as a light source to evaluate the photocatalytic activity of the samples toward the degradation of RhB in aqueous solution. Under both simulated sunlight and visible light irradiation, CQDs@Bi4Ti3O12 composites with an appropriate amount of CQDs exhibit obviously enhanced photocatalytic performance. However, the decoration of excessive CQDs gives rise to a decrease in the photocatalytic activity. The enhanced photocatalytic activity of CQDs-modified Bi4Ti3O12 can be attributed to the following reasons: (1) The electron transfer between Bi4Ti3O12 and CQDs promotes an efficient separation of photogenerated electron/hole pairs in Bi4Ti3O12; (2) the up-conversion photoluminescence emitted from CQDs could induce the generation of additional electron/hole pairs in Bi4Ti3O12; and (3) the photoexcited electrons in CQDs could participate in the photocatalytic reactions.

A novel Bi4Ti3O12/Ag3PO4 heterojunction photocatalyst with enhanced photocatalytic performance.

In this work, we integrated Ag3PO4 with Bi4Ti3O12 to form Bi4Ti3O12/Ag3PO4 heterojunction nanocomposites by an ion-exchange method. The as-prepared Bi4Ti3O12/Ag3PO4 composites were systematically characterized by means of XRD, SEM, TEM, BET, XPS, UV-vis DRS, EIS, PL spectroscopy, and photocurrent response. SEM, TEM, and XPS results demonstrate the creation of Bi4Ti3O12/Ag3PO4 heterojunction with obvious interfacial interaction between Bi4Ti3O12 and Ag3PO4. PL spectra, EIS spectra, and photocurrent responses reveal that the composites display an enhanced separation efficiency of photogenerated electron-hole pairs, which is due to the charge transfer between Bi4Ti3O12 and Ag3PO4. Rhodamine B (RhB) was chosen as the target organic pollutant to evaluate its degradation behavior over Bi4Ti3O12/Ag3PO4 composites under simulated sunlight irradiation. Compared to bare Bi4Ti3O12 and Ag3PO4 nanoparticles, the composites exhibit a significantly enhanced photocatalytic activity. The highest photocatalytic activity is observed for the 10% Bi4Ti3O12/Ag3PO4 composite with 10% Bi4Ti3O12 content, which is about 2.6 times higher than that of bare Ag3PO4. The photocatalytic mechanism involved was investigated and discussed in detail.

Effect of Experimental Parameters on the Hydrothermal Synthesis of Bi2WO6 Nanostructures.

Bi2WO6 nanostructures were synthesized by a hydrothermal route, where the effect of various experimental parameters on the products was investigated. It is demonstrated that the sample morphology and size is highly dependent on the NaOH content (or pH value). At C NaOH = 0-0.0175 mol (pH range of 1-4), the prepared samples present flower-like hierarchical microspheres which are constructed from thin nanosheets via the self-assembly process. The size of the hierarchical microspheres exhibits a decreasing trend with increasing the NaOH content, from 7 µm at C NaOH = 0 mol to 1.5 µm at C NaOH = 0.0175 mol. At C NaOH = 0.03-0.0545 mol (pH: 5-9), the prepared samples exhibit irregular flake-like structures, and their size increases with the increase in NaOH content. At C NaOH = 0.055-0.05525 mol (pH: 10-11), the prepared samples are composed of uniform sphere-like particles with an average size of 85 nm. Compared to the NaOH content, the reaction temperature and time has a relatively small effect on the product morphology and size. The photocatalytic activity of the samples was evaluated by degrading rhodamine B (RhB) under irradiation of simulated sunlight. Among these samples, the samples composed of flower-like hierarchical microspheres have relatively high photocatalytic activity. In particular, the microspheres prepared at C NaOH = 0.01 mol exhibit the highest photocatalytic activity, and the degradation percentage reaches 99 % after 2 h of irradiation.