Cholangiocarcinoma combined with biliary obstruction: an exosomal circRNA signature for diagnosis and early recurrence monitoring.

Cholangiocarcinoma (CCA) is a highly malignant biliary tract cancer with currently suboptimal diagnostic and prognostic approaches. We present a novel system to monitor CCA using exosomal circular RNA (circRNA) via serum and biliary liquid biopsies. A pilot cohort consisting of patients with CCA-induced biliary obstruction (CCA-BO, n = 5) and benign biliary obstruction (BBO, n = 5) was used to identify CCA-derived exosomal circRNAs through microarray analysis. This was followed by a discovery cohort (n = 20) to further reveal a CCA-specific circRNA complex (hsa-circ-0000367, hsa-circ-0021647, and hsa-circ-0000288) in both bile and serum exosomes. In vitro and in vivo studies revealed the three circRNAs as promoters of CCA invasiveness. Diagnostic and prognostic models were established and verified by two independent cohorts (training cohort, n = 184; validation cohort, n = 105). An interpreter-free diagnostic model disclosed the diagnostic power of biliary exosomal circRNA signature (Bile-DS, AUROC = 0.947, RR = 6.05) and serum exosomal circRNA signature (Serum-DS, AUROC = 0.861, RR = 4.04) compared with conventional CA19-9 (AUROC = 0.759, RR = 2.08). A prognostic model of CCA undergoing curative-intent surgery was established by calculating early recurrence score, verified with bile samples (Bile-ERS, C-index=0.783) and serum samples (Serum-ERS, C-index = 0.782). These models, combined with other prognostic factors revealed by COX-PH model, enabled the establishment of nomograms for recurrence monitoring of CCA. Our study demonstrates that the exosomal triple-circRNA panel identified in both bile and serum samples serves as a novel diagnostic and prognostic tool for the clinical management of CCA.

Epidemiology, risk factors, diagnosis, and treatment of intra-abdominal traumatic neuromas - a narrative review.

Traumatic neuroma (TN) is a disorganized proliferation of injured nerves arising from the axons and Schwann cells. Although TN rarely occurs in the abdominal cavity, the incidence of TN may be underestimated because of the large number of asymptomatic patients. TN can cause persistent pain, which seriously affects quality of life. TN of the biliary system can cause bile duct obstruction, leading to acute cholangitis. It is difficult to differentiate TN from malignancies or recurrence of malignancy, which results in a number of patients receiving aggressive treatment. We collected cases reports of intra-abdominal TN over the past 30 years form PubMed and cases diagnosed in our medical center over the past 20 years, which is the largest case series of intra-abdominal TN to the best of our knowledge. In this review, we discuss the epidemiology, pathophysiology, risk factors, classification, diagnosis, and management of intra-abdominal TN.

Risk factors for recurrent common bile duct stones: a systematic review and meta-analysis.

BACKGROUND: Common bile duct stones (CBDS) have a reported recurrence rate of 4%-24% after stone extraction. The most commonly applied stone extraction method is endoscopic cholangiopancreatography (ERCP). We conducted a systematic review and meta-analysis to identify all available risk factors for recurrent CBDS following stone retraction. RESEARCH DESIGN AND METHODS: A literature search of studies with case-control design was performed to identify potential risk factors for recurrent CBDS. The impact of different risk factors on stone recurrence was analyzed. Pooled odds ratios (ORs) with 95% CIs and heterogeneity were calculated. Identified risk factors were graded as 'strong,' 'moderate,' or 'weak' after quality assessment. RESULTS: A total of 46 studies discussing stone recurrence following ERCP treatment were included. CBD diameter≥1.5 cm, sharp CBD angulation, multiple ERCP sessions, postoperative pneumobilia, history of CBD incision, and biliary stent placement were identified as strong risk factors; larger CBD diameter, periampullary diverticulum, mechanical lithotripsy, and history of cholecystectomy were identified as moderate. Other weak risk factors were also listed. CONCLUSIONS: In this comprehensive study, we identified 14 risk/protective factors for recurrent CBDS following ERCP. Pooled odds ratios were calculated and evaluated the quality of evidence. These findings may shed light on the assessment and management of CBDS.

The Relationship between Blood Groups and Aortic Dissection.

BACKGROUND: Plenty of diseases have been found having associations with blood types, especially cardiovascular diseases. The purpose of this study was to clarify whether there is a relationship between blood groups and acute aortic dissection. We also further studied the distribution of blood groups in different types of acute aortic dissection. METHODS: A total of 291 patients diagnosed with acute aortic dissection from 2011 to 2018 were enrolled and analyzed retrospectively in this study. The control group consisted of 582 patients who received plastic surgery at West China hospital from 2011 to 2018. First, we analyzed the distribution of blood groups between the study group and the control group, including the ABO, Rh, O and non-O groups. Then, we further divided the study group into two groups by the type of acute aortic dissection to determine if there was difference in blood groups between the two types of acute aortic dissection. RESULTS: The analysis of the distribution of ABO blood groups (p = 0.302) and Rh blood groups (p = 0.502) did not reveal statistically significant differences. There were no statistically significant differences in the distributions of ABO blood groups and Rh blood groups in different types of acute aortic dissection. CONCLUSIONS: Our study did not prove the incidence of acute aortic dissection, or the type of acute aortic dissection had a relationship with common blood groups.

Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series.

BACKGROUND: Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions. METHODS: In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009 to 2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed. RESULTS: The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1 and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage (HR 6.444 95%CI 1.477-28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409-79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719-19.940 P = 0.005), grade of the adenocarcinoma component (HR 3.876 95%CI 1.451-10.357 P = 0.007) and CD56 positivity (HR 0.265 95%CI 0.100-0.705 P = 0.008) were independent predictors of overall survival. CONCLUSIONS: Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended.

Laparoscopic appendectomy is safe and feasible in pregnant women during second trimester: A retrospective study in a top-level Chinese center.

Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ±â€Š4.3 vs 21.5 ±â€Š2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ±â€Š107 US$ vs 340 ±â€Š115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.

Diagnosis and treatment for pregnancy with aortic dissection / 中国胸心血管外科临床杂志

@#Aortic dissection during pregnancy is rare in clinics. Because the symptoms are lack of specificity, early diagnosis is difficult. However, the progression of aortic dissection is fast, therefore, the mortality of pregnant women and fetuses is high, and half of the death in pregnant women is due to aortic dissection. Although the development of medical condition is rapid, aortic dissection of pregnancy is still a great challenge for patients and clinicians, and is one of the most important diseases in obstetric medical disputes. In this paper, combined with the literatures published in recent years, we summarized the epidemiological characteristics and related treatment suggestions of the aortic dissection in pregnancy.

Designing DNAzyme-Powered Nanomachines Simultaneously Responsive to Multiple MicroRNAs.

Herein, a DNAzyme-powered nanomachine responsive to multiple hepatocellular carcinoma (HCC)-related miRNAs derived from clinical samples was designed. Initially, three types of nanomachines were constructed with dye molecule [(fluorescein (FAM), tetramethylrhodamin (TMR), and Cyanine 5 (Cy5)]-labeled DNA-RNA chimeric substrates and a specific recognized probe for the corresponding miRNAs target. Once the target miRNAs were captured by two recognizing probes, the DNA nanomachine was initiated, leading to the hybridization between the DNAzyme and the substrates. With the help of a cofactor, the automatic operation of the nanomachine was driven by cyclic cleavage of the DNAzyme. Meanwhile, we also explored the recognition behavior between the recognizing probe and the target miRNA. Subsequently, these DNAzyme-powered nanomachines were developed for the homogeneous and simultaneous detection of three target miRNAs at the femtomloar level. Furthermore, the potential in clinical diagnosis was proven by the successful determination of target miRNA in real clinical samples. Thus, this nanomachine-based strategy possesses significant potential to be an innovation in miRNA analysis methodology.