Precut Over a Pancreatic Duct Stent Versus Transpancreatic Precut Sphincterotomy for Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: A Retrospective Cohort Study.

BACKGROUND: Precut over a pancreatic duct stent (PPDS) and transpancreatic precut sphincterotomy (TPS) with immediate pancreatic duct stent placement are techniques employed to promote biliary access during endoscopic retrograde cholangiopancreatography (ERCP) in cases of challenging biliary cannulation. However, limited data are available to compare the efficacy of these two pancreatic stent-assisted precut sphincterotomy techniques. AIMS: The aim of this study was to compare the efficacy of PPDS versus TPS. METHODS: A retrospective analysis was performed on the clinical data of consecutive patients who underwent ERCP between April 1, 2019 and May 31, 2023. According to the selected cannulation approaches, patients were assigned to two groups. In the PPDS group, a pancreatic duct stent was initially placed, followed by needle-knife precut over the stent. In the TPS group, transpancreatic precut sphincterotomy was initially performed, followed by immediate pancreatic stent placement. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) between the two groups were analysed. RESULTS: Among 864 patients who underwent ERCP, 46 patients were equally enrolled in the two groups. Selective bile duct cannulation was successfully achieved in 42 out of 46 (91.3%) cases using the PPDS and in 32 out of 46 (69.6%) cases using TPS technique alone, indicating significantly higher success rate of bile duct cannulation with PPDS compared to TPS (91.3% vs. 69.6%, P = 0.009). The overall success rates for bile duct cannulation were 93.5% and 97.8% in the PPDS and TPS groups, respectively, with no significant difference identified (P = 0.307). PEP occurred in 0 and 4 (8.7%) cases in the PPDS and TPS groups, respectively, with no significant difference between the two groups (8.7% vs. 0%, P = 0.117). There were no cases of bleeding or perforation in either group. CONCLUSIONS: Both PPDS and TPS followed by immediate pancreatic duct stent placement are viable options. TPS stands out for its simplicity and cost-effectiveness, while PPDS is more appropriate for patients who are at a high-risk of developing PEP.

Regulating Astrocytes via Short Fibers for Spinal Cord Repair.

Reactive astrogliosis is the main cause of secondary injury to the central nerves. Biomaterials can effectively suppress astrocyte activation, but the mechanism remains unclear. Herein, Differentially Expressed Genes (DEGs) are identified through whole transcriptome sequencing in a mouse model of spinal cord injury, revealing the VIM gene as a pivotal regulator in the reactive astrocytes. Moreover, DEGs are predominantly concentrated in the extracellular matrix (ECM). Based on these, 3D injectable electrospun short fibers are constructed to inhibit reactive astrogliosis. Histological staining and functional analysis indicated that fibers with unique 3D network spatial structures can effectively constrain the reactive astrocytes. RNA sequencing and single-cell sequencing results reveal that short fibers downregulate the expression of the VIM gene in astrocytes by modulating the "ECM receptor interaction" pathway, inhibiting the transcription of downstream Vimentin protein, and thereby effectively suppressing reactive astrogliosis. Additionally, fibers block the binding of Vimentin protein with inflammation-related proteins, downregulate the NF-κB signaling pathway, inhibit neuron apoptosis, and consequently promote the recovery of spinal cord neural function. Through mechanism elucidation-material design-feedback regulation, this study provides a detailed analysis of the mechanism chain by which short fibers constrain the abnormal spatial expansion of astrocytes and promote spinal cord neural function.

Exploring the effect of different typical plant community on human stress reduction: a field experiment.

Research has demonstrated the positive effect of natural environment on human restoration and well-being. Time spent in nature can often alleviate both physiological and psychological stress. However, few studies have discussed the environmental health effects of the nature's components and characteristics. Sixty volunteers were recruited and one manufactured environment and five different natural environments were randomly assigned to them, including coniferous forests (pure coniferous forest-PC and mixed coniferous forest-MC), broad-leaved forests (pure broad-leaved forest-PB and mixed broad-leaved forest-MB), and mixed forest (mixed coniferous and broad-leaved forest-MCB). Each volunteer sat in a built or natural environment and looked around the environment for 15 min. Physiological (HR, HRV, BP, pulse rate and salivary cortisol) and psychological indicators (POMS and STAI) were used to evaluate the changes in their stress level. Results indicated a strong difference in HR, HRV, POMS and STAI between the built and natural environment, which showed that natural environment can lower the stress level. MC had the best effect on relieving physiological stress, whereas MCB is most successful in improving emotional state and reducing anxiety. Broad-leaved forest and mixed forest significantly affected the DBP and vigor level of the subjects, respectively. While coniferous forest did significantly increase the concentration of salivary cortisol in subjects. The study confirmed that compared to the built environment, the natural environment can relieve the human body's physical and psychological stress and negative emotions, while significantly increasing vitality. And different plant communities also have different effects on the physiological and psychological indicators of the subjects. These results will provide scientific basis for the construction and improvement of urban green space environment.

Effects of horticultural therapy on health in the elderly: A review and meta-analysis.

Aim: Given the current aging population, the demand on medical facilities, facilities for elderly care, and even their high prevalence, it is crucial to investigate the advantages of older people. The purpose of our study was to systematically review the existing literature on the health effects of horticultural therapy as a treatment option for the elderly. Subject and methods: Article searches were conducted through five databases: Web of science, Science Direct, PubMed, EBSCO, and Google Scholar, according to the standard method of systematic evaluation and meta-analysis. Thirty-two published articles were included, and 27 relevant variables were meta-analyzed to assess the benefits of horticultural therapy in terms of physical and psychological functioning in the elderly. Results: Results show that horticultural therapy may be helpful in helping seniors lose weight -0.195 (95% CI -0.507,0.117), reduce their waist circumference -0.327 (95% CI -0.637, -0.017), lower their stress -0.339 (95% CI -0.610, -0.069) and cortisol -0.902 (95% CI -0.728, -0.002) levels, improve their physical flexibility 0.302 (95% CI 0.036, 0.569), social interaction 0.370, (95% CI 0.115, 0.624), and daily vegetables and fruit consumption 0.688 (95% CI: 0.287, 1.089). Conclusion: Horticultural therapy may be a useful tool for enhancing the physical, mental and social aspects of the elderly. However, there is substantial heterogeneity and wide variation in the quality of the included studies. Further high-quality studies, rigorous controls and adjustments for significant confounding variables, and larger populations are needed in the future to further our understanding of the link between horticultural therapy and elder health. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01938-w.

A systematic review of the anxiety-alleviation benefits of exposure to the natural environment.

Research suggests that exposure to natural environments can be beneficial for health, such as reducing physical illness and improving mood and cognitive ability. The potential benefits of nature have come into focus at a time when mental health issues are growing globally. Here, we have selected 24 studies from four databases for meta-analysis to explore the effects of exposure to the natural environment on the anxiety of the human body and summarize the influencing factors on the anxiety relief effect. A random-effect meta-analysis of anxiety state changes before and after exposure to natural environment shows that natural exposure effectively alleviated human anxiety (SMD -1.28, 95% CI: -1.65 to -0.92). The overall quality of the included papers, assessed using the PEDro scale, is considered to vary considerably, but most of the papers are rated between 4 and 7 which is considered fair or good. In addition, we have also investigated the potential moderators of anxiety-relieving effects of the nature. Our results shows that the age and exposure time of the subjects are related to the effect of anxiety relief. The results of the subgroup analysis of moderators prove that compared with the middle-aged people (SMD -0.63, 95% CI: -1.13 to -0.12), young people (SMD -1.50, 95% CI: -1.90 to -1.10) get better anxiety alleviation effect in the natural environment. In terms of exposure time, compared with 0.5-2 h (SMD -0.18, 95% CI: -0.59 to -0.23) and >2 h (SMD -0.84, 95% CI: -1.40 to -0.27) exposure periods, subjects get the maximum anxiety relief benefit when they spent <0.5 h (SMD -1.60, 95% CI: -1.93 to -1.27) in the natural environment. However, the quality of the included studies varies greatly and there is a significant heterogeneity in the meta-analysis. Study location, natural environment type and other moderator factors have no obvious correlation with anxiety-alleviation effect of the nature. A higher quality and more comprehensive study needs to be carried out to find out more moderators about the effects of the natural environment on anxiety alleviation. Further experimental studies should also be conducted to determine the mechanism by which natural exposure reduces anxiety so as to provide strong support for the construction and improvement of healthy natural environment.

Application and prospect of the therapeutic strategy of inhibiting cellular senescence combined with pro-regenerative biomaterials in regenerative medicine.

Complete regeneration of damaged tissues/organs has always been the ultimate challenge in regenerative medicine. Aging has long been considered the basis of age-related diseases, as senescent cells gradually accumulate in tissues with increasing age, tissues exhibit aging and normal physiological functions are inhibited. In recent years, in damaged tissues, scholars have found that the number of cells with features of cellular senescence continues to increase over time. The accumulation of senescent cells severely hinders the healing of damaged tissues. Furthermore, by clearing senescent cells or inhibiting the aging microenvironment, damaged tissues regained their original regenerative and repair capabilities. On the other hand, various biomaterials have been proved to have good biocompatibility and can effectively support cell regeneration after injury. Combining the two solutions, inhibiting the cellular senescence in damaged tissues and establishing a pro-regenerative environment through biomaterial technology gradually reveals a new, unexpected treatment strategy applied to the field of regenerative medicine. In this review, we first elucidate the main characteristics of senescent cells from morphological, functional and molecular levels, and discuss in detail the process of accumulation of senescent cells in tissues. Then, we will explore in depth how the accumulation of senescent cells after damage affects tissue repair and regeneration at different stages. Finally, we will turn to how to promote tissue regeneration and repair in the field of regenerative medicine by inhibiting cellular senescence combined with biomaterial technology. Our goal is to understand the relationship between cellular senescence and tissue regeneration through this new perspective, and provide valuable references for the development of new therapeutic strategies in the future.

Usage behavior and health benefit perception of youth in urban parks: A case study from Qingdao, China.

With the development of the urban park, people's cognition of the relationship between the environment and public health has been improved, and higher requirements for the living environment have been put forward. As an important group of park users, youths often have different needs regarding the health benefits brought by urban parks. To explore the potential relationship among youth's satisfaction with urban parks, their usage behavior, and health benefit perception, this article presents some constructive suggestions for the development of healthy landscapes in urban parks. Researchers have selected five typical urban parks from different areas in Qingdao, China. Furthermore, we have used the survey method by combining the practices of "issuing questionnaires, observing and interviewing" with the goal of collecting data on 500 park visitors in autumn, including information on social demography, the satisfaction of park landscape variables, and usage behavior and health perception. A linear regression model has been used to analyze the correlation among "landscape variables," "usage behavior," and "health benefit perception." Results have shown that urban green landscapes and waterscapes can significantly affect youth's social health perception and static behavior. Moreover, static behaviors such as relaxation have a great impact on mental health perception. The results of this study will be beneficial in understanding youth's needs for landscapes when using urban parks. In addition, it will provide insight for the urban planners and landscape designers to design urban parks from the perspective of youth.

Successful treatment of aortic dissection with pulmonary embolism: A case report.

BACKGROUND: Aortic dissection (AD) and pulmonary embolism (PE) are both life-threatening disorders. Because of their conflicting treatments, treatment becomes difficult when they occur together, and there is no standard treatment protocol. CASE SUMMARY: A 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical examination. Further examination of the head, chest and abdomen by computed tomography revealed a subdural hemorrhage, multiple rib fractures, a hemopneumothorax and a renal hematoma. He was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy, external rib fixation, analgesia and enteral nutrition. The patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 kPa. Computed tomography angiograms confirmed that he had both AD and PE. We subsequently performed only nonsurgical treatment, including nasal high-flow oxygen therapy, nonsteroidal analgesia, amlodipine for blood pressure control, beta-blockers for heart rate control. Eight weeks after admission, the patient improved and was discharged from the hospital. CONCLUSION: Patients with AD should be alerted to the possibility of a combined PE, the development of which may be associated with aortic compression. In patients with type B AD combined with low-risk PE, a nonsurgical, nonanticoagulant treatment regimen may be feasible.

Impact of Exposure to Natural and Built Environments on Positive and Negative Affect: A Systematic Review and Meta-Analysis.

There is increasing evidence that the natural environment provides substantial benefits to human emotional well-being. The current study synthesized this body of research using the meta-analysis and assessed the positive and negative effects of exposure to both the natural and built environments. We searched four databases and 20 studies were included in the review. The meta-analysis results showed the most convincing evidence that exposure to the natural environment could increase positive affect (standardized mean difference, SMD = 0.61, 95% CI 0.41, 0.81) and decreased negative affect (SMD = -0.47, 95% CI -0.71, -0.24). However, there was extreme heterogeneity between the studies, and the risk of bias was high. According to the subgroup analysis, study region, study design, mean age of the sample, sample size, and type of natural and built environment were found to be important factors during exposure to the natural environment. The implications of these findings for the existing theory and research are discussed. These findings will help convince the health professionals and policymakers to encourage the residents to increase their time spent in the natural environment. These findings of this systematic review also suggested that the creation, maintenance, and enhancement of accessible greenspaces or existing natural environments may form part of a multidimensional approach to increasing emotional well-being of the local populations.

Dexmedetomidine inhibits inflammatory response and autophagy through the circLrp1b/miR-27a-3p/Dram2 pathway in a rat model of traumatic brain injury.

Circular RNAs (circRNAs) have a regulatory function on inflammation and autophagy, of which rno-circRNA_010705 (circLrp1b) appears to be significantly up-regulated following traumatic brain injury (TBI). Dexmedetomidine (DEX) shows improvement effects in TBI by inhibiting NLRP3/caspase-1. However, whether circLrp1b plays critical roles in DEX-mediated TBI attenuation and the underlying mechanisms remain unclear. After TBI was established in rats by controlled cortical impact (CCI) to cause brain trauma, they received an intracerebroventricular injection of lentiviral vector, followed by intraperitoneal injection of DEX. Administration of DEX ameliorated autophagy in rats following TBI, accompanied by up-regulated circLrp1b and Dram2 and down-regulated miR-27a-3p. DEX promoted the effects of circLrp1b in attenuating TBI-induced neurologic impairment, autophagy, and inflammation, which was significantly reversed by inhibition of miR-27a-3p or Dram2 overexpression. Mechanistically, northern blot and luciferase reporter assays indicated that circLrp1b up-regulated Dram2 expression by functioning as a sponge for miR-27a-3p to promote autophagy involved in TBI, which was reversed by DEX treatment. Collectively, this study demonstrated that DEX inhibits inflammatory response and autophagy involved in TBI in vivo through inactivation of the circLrp1b/miR-27a-3p/Dram2 signaling pathway.

Astragalus saponins inhibit cell growth, aerobic glycolysis and attenuate the inflammatory response in a DSS-induced colitis model.

Recent studies have reported that Astragalus saponins (AST), extracted from the medicinal plant Astragalus membranaceus, possess anti­tumor and apoptosis­inducing abilities on various types of human cancer in vitro and in vivo. However, limited studies have explored how AST impacts glucose metabolism and growth conditions in vitro. The present study aimed to explore cell growth, proliferation, apoptosis and a series of glycolysis metabolic alterations associated with AST treatment in colorectal cancer (CRC) cells. MTT, a colony formation assay and flow cytometry demonstrated that AST dose­dependently inhibited cell viability and induced apoptosis. Glucose uptake and lactate production measurements revealed that AST could inhibit glycolysis metabolism and lactate production. Reverse transcription­quantitative polymerase chain reaction and western blot analysis identified that the expression levels of glycolytic enzymes were decreased by AST treatment in CRC cells. To uncover the possible impact of AST on inflammation and glucose metabolism in vivo, a dextran sulfate sodium (DSS)­induced colitis mouse model was established. Notably, AST could inhibit growth and glycolysis metabolism in CRC cells in vitro, and attenuate the inflammatory response and tumor­like aerobic glycolysis in the DSS­induced mouse model. The findings indicated that AST may have the capacity to resist tumor­associated inflammation and maintain normal glucose homeostasis, suggesting that AST could be a novel therapeutic strategy in CRC treatment.