Mortality and cardiac arrest rates of emergency surgery in developed and developing countries: a systematic review and meta-analysis.

BACKGROUND: The magnitude of the risk of death and cardiac arrest associated with emergency surgery and anesthesia is not well understood. Our aim was to assess whether the risk of perioperative and anesthesia-related death and cardiac arrest has decreased over the years, and whether the rates of decrease are consistent between developed and developing countries. METHODS: A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s). RESULTS: 35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from - 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134-380) before the 2000s to 46 (16-132) in the 2000-2020 s (p < 0-0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303-395] before the 2000s to 292 [95% CI: 201-423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31-409) before the 2000s to 31 (14-70) in the 2000-2020 s, and also with increasing HDI (68 [95% CI: 29-160] in the low-HDI group to 21 [95% CI: 6-76] in the high-HDI group, P = 0.012). CONCLUSIONS: Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.

Numerical simulation of the fine kinetics of dust reduction using high-speed aerosols.

A numerical model of single-particle fog-dust collision coupling in a high-speed airflow based on three-phase flow theory. The effect of the fog-to-dust particle size ratio, relative velocity between the fog and dust particles, collision angle and contact angle at the wetting humidity function of dust particles is investigated. Different particle size ratios are determined for achieving the optimal wetting humidity for the interaction of high-velocity aerosols with dust particles of different sizes, for differ, that is, kPM2.5 = 2:1, kPM10 = 3.5:1 and kPM20 = 1.5:1. The optimal humidity increases with the relative velocity U between the fog and dust particles in the high-speed airflow. The larger the collision angle is, the lower the wetting rate is.The smaller the contact angle between the solid and liquid is, the better droplet wetting on dust is. The fine kinetic mechanism of single-particle fog-dust collision-coupling in a high-speed airflow is elucidated in this study.

Study on the dust migration law and a spray dust suppression scheme in transportation roadway.

To solve the problem of excessive dust concentration in the belt transportation roadway of the mine. Numerical simulations were used to study the dust migration in the belt transportation roadway under 1.5 m/s ventilation conditions. The simulation results show the process of dust ejection from the inflow chute to contamination of the whole belt transportation roadway, and the spatial distribution of dust velocity. A comprehensive dust reduction scheme of "central suppression and bilateral splitting" was designed according to the dust distribution, with simultaneous control of the infeed chute and the roadway. In practical application, pneumatic spraying greatly reduces the amount of dust in the guide chute. The misting screen has a significant effect on dust collection and segregation. The solution effectively controls the dust in the space of 20 m on both sides of the transfer point, and the dust removal efficiency reaches more than 90%.

Preparation, Characterization and Molecular Dynamics Simulation of Rutin-Cyclodextrin Inclusion Complexes.

Rutin is a natural flavonoid that carries out a variety of biological activities, but its application in medicine and food is limited by its water solubility. One of the classical methods used to enhance drug solubility is encapsulation with cyclodextrins. In this paper, the encapsulation of different cyclodextrins with rutin was investigated using a combination of experimental and simulation methods. Three inclusions of rutin/beta-cyclodextrin (ß-CD), rutin/2-hydroxypropyl beta-cyclodextrin (HP-ß-CD) and rutin/2,6-dimethyl beta-cyclodextrin (DM-ß-CD) were prepared by the freeze-drying method, and the inclusions were analyzed using Fourier infrared spectroscopy (FTIR), X-ray diffraction analysis (XRD), differential scanning calorimetry (DSC) and ultraviolet-visible spectroscopy (UV) to characterize and demonstrate the formation of the inclusion complexes. Phase solubility studies showed that rutin formed a 1:1 stoichiometric inclusion complex and significantly increased its solubility. ß-CD, HP-ß-CD, DM-ß-CD, rutin and the three inclusion complexes were modeled by using MS2018 and AutoDock 4.0, and molecular dynamics simulations were performed to calculate the solubility parameters, binding energies, mean square displacement (MSD), hydrogen bonding and radial distribution functions (RDF) after the equilibration of the systems. The results of simulation and experiment showed that rutin/DM-ß-CD had the best encapsulation effect among the three cyclodextrin inclusion complexes.

Study on coal dust diffusion law and new pneumatic spiral spray dedusting technology at transfer point of mine cross roadway.

In order to solve the problem of coal dust pollution at the transfer point, a three-dimensional numerical model of wind flow-coal dust at the loading point of underground rubber run was established by computational fluid dynamics (CFD) discrete particle model and finite element method and k-ε turbulence model, and the coal dust diffusion pollution phenomenon caused by the coal flow transfer under the intersection of wind flow in the cross tunnel was studied. Based on the simulation results of wind flow velocity contour, pressure contour and isochronous flow vector distribution, the influence mechanism of wind flow and coal dust characteristics on the distribution of wind flow and coal dust diffusion in the roadway is analysed, and a dust control and reduction system and treatment scheme with new pneumatic screw spray technology as the core is proposed to suppress coal dust pollution at the reloading point. The results of the study show that the wind flow distribution is mainly influenced by the intersection of tape traction and cross-roadway wind flow, showing a complex multi-layer distribution along the roadway and in the normal direction; the diffusion of coal dust of different particle sizes is influenced by the roadway wind flow, and coal dust with particle sizes in the range of 10µm~20µm is more easily diffused, and the dust with particle sizes in the range of 20µm~45µm is mainly collected and suspended near the vortex wind flow at the cross-roadway. The coal dust in the range of 20 µm~45 µm is more likely to gather in the vortex; the treatment system effectively controls the coal dust inside the dust cover, and the spiral-shaped transported droplet particle group formed by the pneumatic spiral spray combines with it efficiently, which verifies the dust control and reduction effect of the pneumatic spiral spray system at the transfer point, and the dust removal efficiency reaches 89.35%~93.06%, which provides relevant theoretical support for the treatment of dust pollution at the coal transfer point in underground coal mines It provides the theoretical support and means to control dust pollution at underground coal transfer points.

Structural Model Construction and Optimal Characterization of High-Volatile Bituminous Coal Molecules.

The structural characteristics of coal at the molecular level are important for its efficient use. Bituminous coal from the Baozigou Coal Mine is investigated, using elemental analysis, 13C nuclear magnetic resonance, X-ray photoelectron spectroscopy, and Fourier transform infrared. The molecular structure was determined. The aromatic compounds of bituminous coal molecules are primarily two- and three-ring structures, and the aliphatic structures are primarily in the form of methyl, ethyl side chains, and naphthenic hydrocarbons. The ratio of aromatic bridge carbon to peripheral carbon in the molecular structure is 0.279. Oxygen atoms in the form of carbonyl, phenolic hydroxyl and C-O, and nitrogen atoms in pyrroles. Thus, the average structure model of bituminous coal macromolecules was constructed; the molecular formula was C169H128O10N2S, and the molecular weight was 2378. The aromatic structural units in the macromolecular structure of coal include four naphthalenes, three anthracenes, two tetracenes, and heteroatoms in the form of three carbonyl groups, one phenolic hydroxyl group, one pyrrole, and one pyridine. The structure optimization and annealing kinetic simulation of a single macromolecular structure model were performed. Chemical bonds such as bridge bonds and aliphatic bonds were found to be twisted, and π-π interactions between the aromatic sheets in the molecule produced adjacent aromatic sheets. This arrangement tends to be approximately parallel, and the total energy decreases from 6713.401 to 2667.595 kJ/mol, among which the bond stretching energy and van der Waals energy dominate. We used 20 bituminous coal macromolecular models to construct aggregated structural models. After optimization by molecular dynamics simulation, the macromolecules were constrained by the surrounding molecules, and the sheet-like aromatic carbon structures that were originally approximately parallel were distorted. The macromolecular structure model of bituminous coal constructed in this study provides a theoretical model basis for the optimal surfactant.

A Hypoxia-Sensitive Drug Delivery System Constructed by Nitroimidazole and its Application in the Treatment of Hepatocellular Carcinoma.

Hypoxia is an important pathological phenomenon, and it can induce many tumor microenvironment changes, such as accumulations of intracellular lactic acid, decrease of tumor microenvironment pH value, and regulate a series of physiological and pathological processes such as adhesion, metastasis, and immune escape. Hypoxic tumor cells act as a key target for treating tumor. In this research, we designed and prepared PEG-nitroimidazole grafts, PEG-NI, and FA-PEG-NI. We first explored their physical and chemical properties to serve as a drug carrier. Then, the hypoxia-sensitive properties such as particle size changes and drug release were investigated. Finally, the tumor targeting ability was studied in vitro and in vivo, and anti-tumor capacity was determined. Both grafts showed excellent property as a nanodrug carrier and showed favorable drug encapsulation ability of sorafenib with the help of the hydrophobic chain of 6-(BOC-amino) hexyl bromide. The micelles responded to the hypoxic tumor environment with chemical and spatial structure changes leading to sensitive and fast drug release. With the modification of folic acid, FA-PEG-NI gained tumor targeting ability in vivo. FA-PEG-NI graft proved a potential targeting drug delivery system in the treatment of hypoxic hepatocellular carcinoma.

Oxytocin in Women's Health and Disease.

Oxytocin (OT) is a nonapeptide mainly produced in the supraoptic and paraventricular nuclei. OT in the brain and blood has extensive functions in both mental and physical activities. These functions are mediated by OT receptors (OTRs) that are distributed in a broad spectrum of tissues with dramatic sexual dimorphism. In both sexes, OT generally facilitates social cognition and behaviors, facilitates parental behavior and sexual activity and inhibits feeding and pain perception. However, there are significant differences in OT levels and distribution of OTRs in men from women. Thus, many OT functions in men are different from women, particularly in the reproduction. In men, the reproductive functions are relatively simple. In women, the reproductive functions involve menstrual cycle, pregnancy, parturition, lactation, and menopause. These functions make OT regulation of women's health and disease a unique topic of physiological and pathological studies. In menstruation, pre-ovulatory increase in OT secretion in the hypothalamus and the ovary can promote the secretion of gonadotropin-releasing hormone and facilitate ovulation. During pregnancy, increased OT synthesis and preterm release endow OT system the ability to promote maternal behavior and lactation. In parturition, cervix expansion-elicited pulse OT secretion and uterine OT release accelerate the expelling of fetus and reduce postpartum hemorrhage. During lactation, intermittent pulsatile OT secretion is necessary for the milk-ejection reflex and maternal behavior. Disorders in OT secretion can account for maternal depression and hypogalactia. In menopause, the reduction of OT secretion accounts for many menopausal symptoms and diseases. These issues are reviewed in this work.

Study on dust migration law and spray dedusting technology in parallel double belt transportation.

To effectively solve the problem of dust pollution caused by the parallel double-belt transportation of coal in a coal preparation plant, taking the Huangyuchuan coal preparation plant as an example, a numerical model of the air flow-dust distribution was established by means of simulation. The flow lines between the strips of tape and the tail of the tape machine will gather, and there will be backflow on the right side of the 3001 tape and left side of the 3002 tape. Under the action of wind current, most of the dust particles larger than 10 µm are distributed in the range of 0-5 m on both sides of the tape; dust particles smaller than 10 µm spread to the entire preparation workshop. Combined with field test verification, dust pollution is mainly concentrated at the guide trough, the feed inlet, the rear of the machine, and the joint of the belt corridor. Based on this, a targeted spray dust reduction treatment plan is proposed. By measuring the dust concentration before and after the treatment of dust-polluted areas, it is proven that the dust reduction efficiency of this plan can reach more than 90%.

[The preliminary report of investigation: Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis].

Objective: Observe the increased anatomical dead space of the mask, summarize the law of exercise induced oscillatory breathing (EIOB) in the results of CPET's new 9 figure, and analyze its incidence and age groups that are prone to oscillatory breathing. Methods: After signed the informed consent form by guardian, 501 children from pre-school to middle-school, aged 3~14 year, performed Harbor-UCLA standard protocol CPET with strict quality control in the CPET laboratory of Liaocheng Children's Hospital since 2014. CPET data was interpreted second by second from the breath by breath collection, averaged by 10s and then display by 9 plots. We analyzed the trends, pattern, incidence and age difference for EIOB and gas leakage. Results: The incidence of EIOB was the highest in the 3 to 6-year-old group, which was 42%. The 7 to 10-year-old group was 29.4% and the 11- to 14-year-old group was 29.9%. The three groups were tested by chi-square (x2=7.512), and the difference was statistically significant (P<0.05). 14 out of 508 children had air leakage during CPET, the incidence rate was 2.7%. Conclusion: The phenomenon of oscillatory breathing (OB) in children may be caused by the increased anatomical dead space of the mask, and it is not caused by disease. To improve the quality of CPET and to reduce clinical misdiagnosis, it is recommended to use a mouthpiece to decrease the dead space rather than the musk.

Strategic enhancement of immune checkpoint inhibition in refractory Colorectal Cancer: Trends and future prospective.

Colorectal cancer (CRC), known as a frequently fatal disease, ranking as the third most common malignancy, is the second leading cause of cancer related mortality worldwide. Metastases are common in CRC patients which account for approximately 25% of the patients at diagnosis, 50% of patients during treatment which is associated closely with CRC mortality. Conventional therapies such as surgery, chemotherapy, and radiotherapy are standards of care for the treatment of CRC patients. However, primary tumor recurrence and secondary disease in patients receiving standard of care treatment modalities occur in 50% of patients so that new treatment modalities are needed. Immune checkpoint inhibition (ICI) has transformed the management of patients suffered from metastatic CRC (mCRC) with mismatch repair deficiency (dMMR) and microsatellite instability (MSI) -high (MSI-H) while manifests ineffectiveness in preserved mismatch repair (pMMR) or microsatellite stable (MSS) "cold" tumors which makes up the majority (95%) of mCRC. In this review, we mainly lay emphasis on the development of combinations in therapy strategies with ICIs with other immune based treatment approaches to increase the intra-tumoral immune response and render tumors 'immune-reactive', thereby increasing the efficacy of tumor immunotherapy.

Methionine enkephalin (MENK) suppresses lung cancer by regulating the Bcl-2/Bax/caspase-3 signaling pathway and enhancing natural killer cell-driven tumor immunity.

The aim of this study was to investigate how methionine enkephalin (MENK) regulates the biological behavior of lung cancer cells and to further explore its anti-lung cancer mechanisms in vitro and in vivo. The results showed that MENK enhanced the expression of opioid receptor (OGFr) and induced apoptosis of lung cancer cells by activating the Bcl-1/Bax/caspase-3 signaling pathway in vitro and in vivo. However, the regulatory effects of MENK disappeared after blockade of the OGFr. This confirmed that a prerequisite for the anti-tumor action of MENK is binding to OGFr. Additionally, we observed that MENK treatment enhanced the immunogenicity of lung cancer by enhancing the exposure of calreticulin and high mobility group box 1, and increasing the expression of NKG2D ligands. Further studies showed that MENK treatment increased the expression of natural killer (NK) cell-related cytokines such as granzyme B and interferon-γ and NK cell activation. Thus, we concluded that MENK might inhibit the proliferation of lung cancer cells by activating the Bcl-2/Bax/caspase-3 signaling pathway and enhancing immunogenicity and NK cell-driven tumor immunity.

Reconstruction and seepage simulation of a coal pore-fracture network based on CT technology.

The distribution of multiscale pores and fractures in coal and rock is an important basis for reflecting the capacity of fluid flow in coal seam seepage passages. Accurate extraction and qualitative and quantitative analysis of pore-fracture structures are helpful in revealing the flow characteristics of fluid in seepage channels. The relationship between pore and fracture connectivity can provide a scientific reference for optimizing coal seam water injection parameters. Therefore, to analyse the change in permeability caused by the variability in the coal pore-fracture network structure, a CT scanning technique was used to scan coal samples from the Leijia District, Fuxin. A total of 720 sets of original images were collected, a median filter was used to filter out the noise in the obtained images, and to form the basis of a model, the reconstruction and analysis of the three-dimensional pore-fracture morphology of coal samples were carried out. A pore-fracture network model of the coal body was extracted at different scales. Using the maximum sphere algorithm combined with the coordination number, the effect of different quantitative relationships between pore size and pore throat channel permeability was studied. Avizo software was used to simulate the flow path of fluid in the seepage channels. The change trend of the fluid velocity between different seepage channels was discussed. The results of the pore-fracture network models at different scales show that the pore-fracture structure is nonuniform and vertically connected, and the pores are connected at connecting points. The pore size distribution ranges from 104 µm to 9425 µm. The pore throat channel length distribution ranges from 4206 µm to 48073 µm. The size of the coordination number determines the connectivity and thus the porosity of the coal seam. The more connected pore channels there are, the larger the pore diameters and the stronger the percolation ability. During flow in the seepage channels of the coal, the velocity range is divided into a low-speed region, medium-speed region and high-speed region. The fluid seepage in the coal seam is driven by the following factors: pore connectivity > pore and pore throat dimensions > pore and pore throat structure distribution. Ultimately, the pore radius and pore connectivity directly affect the permeability of the coal seam.

Low-dose naltrexone plays antineoplastic role in cervical cancer progression through suppressing PI3K/AKT/mTOR pathway.

The incidence of cervical cancer is increasing annually worldwide. Low-dose naltrexone (LDN) has been reported to delay tumor progression, but the mechanism remains unclear. Here, we found that low-dose naltrexone could upregulate the expression of OGFr. Additionally, LDN could suppress the abilities of colony formation, migration and invasion in cervical cancer cells. LDN could also inhibit cervical cancer progression in mice model. Moreover, LDN indirectly reduced the expressions of PI3K, pAKT and mTOR in vitro and in vivo. Therefore, LDN may be considered a potential treatment option for cervical cancer.

[Outcomes after Surgical Repair of Thoracoabdominal Aortic Aneurysm with Distal Aortic Dissection:DeBakey Type â versus Type â ¢].

Objective To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. Methods The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, n=47)or type Ⅲ(group Ⅲ, n=83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. Results The 30-day mortality rate was 6.9%(n=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% vs. 4.8%;χ2=0.803, P=0.370).The incidence of major adverse events(38.3% vs. 51.8%;χ2=2.199, P=0.138),5-year actuarial survival rate [(81.7±5.9)% vs.(87.2±4.2)%;χ2=0.483, P=0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% vs.(85.5±4.8)%;χ2=0.010, P=0.920] showed no significant differences between these two groups. Conclusions The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.

Low-dose naltrexone inhibits the epithelial-mesenchymal transition of cervical cancer cells in vitro and effects indirectly on tumor-associated macrophages in vivo.

The metastasis of cervical cancer has always been a clinical challenge. We investigated the effects of low-dose naltrexone (LDN) on the epithelial mesenchymal transition of cervical cancer cells in vitro as well as its influence on macrophage polarization and associated cytokines in vivo. The results suggested that LDN supressed the proliferation, migration and invasion abilities and promote their apoptosis in Hela cells, whereas the opioid growth factor receptor (OGFr) silenced significantly reversed these effects in vitro. Knockdown the expression of OGFr, the inhibitory of LDN on EMT was weakened. LDN could inhibit cervical cancer progression in nude mice. In additon, LDN indirectly reduced the number of tumor-associated macrophages (TAMs), mainly M2 macrophages, and decreased expression of anti-inflammatory factor IL-10 in the serum of nude mice. These findings demonstrate that LDN could be a potential treatment for cervical cancer.

[Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery].

Objective To investigate the risk factors associated with acute renal failure (ARF) after thoracoabdominal aortic aneurysm (TAAA) surgery. Methods A total of 156 patients underwent TAAA repair between January 2009 and December 2017. Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria. The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF. The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis. Results The subjects included 111 males and 45 females aged (40.4±10.9) years (range:19-65 years). The surgical reasons included aortic dissection (n=130,83.3%),aneurysm (n=22,14.1%),and pseudoaneurysm (n=4,2.6%). The degrees of repair included Crawford extent I in 6 patients (3.8%),extent Ⅱ in 128 patients (82.1%),extent Ⅲ in 20 patients (12.8%),and extent Ⅳ in 2 patients(1.3%). There were 3 patients presented with aortic rupture and 6 patients received emergent operations. Nine patients (5.8%) died within 30 days after surgery,and 8 patients (5.1%) suffered from permanent paraplegia. Thirty-six patients (23.1%) had ARF after surgery,and 18 of them needed dialysis. Multivariate logistic analysis showed that smoking (OR =2.637,95%CI=1.113-6.250,P=0.028),packed red blood cell usage in operation (≥6 U) (OR =5.508,95%CI=2.144-11.930,P=0.000),reoperation for bleeding (OR=3.529,95%CI=1.298-9.590,P=0.013) were independent risk factors for ARF after TAAA repair. Conclusion Smoking,packed red blood cell usage in operation (≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.

Preparation and Evaluation of Novel Emodin-loaded Stearic Acid-g-chitosan Oligosaccharide Nanomicelles.

The purpose of this study was to prepare and characterize emodin-loaded stearic acid-g-chitosan oligosaccharide (CSO-SA/EMO) and to evaluate its antitumor activity in vitro. In this study, stearic acid-g-chitosan oligosaccharide was used as a carrier and its physicochemical properties were determined by different methods. Cell uptake behavior was examined using FITC-labeled stearic acid-g-chitosan oligosaccharide. CSO-SA/EMO was prepared using ultrasonication and dialysis. Particle size, surface potential, entrapment efficiency, and drug release behavior were studied in vitro. The effects of CSO-SA/EMO on gastric cancer cells were investigated using MTT assay and flow cytometry. Results showed CSO-SA/EMO particle size was larger and potential was smaller than that of stearic acid-g-chitosan oligosaccharide. The 12 h micellar uptake by MGC803 and BGC823 cells was sufficient, and the micelles were able to abundantly accumulate at lesion sites in mice thus achieving good passive EPR targeting. MTT and cell cycle arrest assays showed CSO-SA/EMO-enhanced antitumor activity significantly towards MGC803 and BGC823 cells compared with that of free emodine. Tumor volume, hematoxylin and eosin staining, and terminal deoxynucleotide transferase dUTP nick-end labeling assay proved CSO-SA/EMO had a significant antitumor effect on tumor tissues in vivo. In conclusion, the ultrasonication-dialysis method provided a simple and effective method for preparing CSO-SA/EMO. The delivery of emodine using a micelle system improved its antitumor effects effectively.

Low-dose naltrexone inhibits colorectal cancer progression and promotes apoptosis by increasing M1-type macrophages and activating the Bax/Bcl-2/caspase-3/PARP pathway.

The incidence of colorectal cancer (CRC) is increasing annually worldwide. However, traditional chemotherapy has obvious side effects. Low-dose naltrexone (LDN) has been reported to delay tumor progression, but the mechanism remains unclear. Therefore, the aim of this study was to explore the mechanisms underlying the inhibitory effect of LDN on CRC progression in vivo and in vitro. We found that expression of macrophage markers (F4/80, CD68) was increased in nude mice treated with LDN compared with the control group (p < 0.05). Additionally, levels of M1 macrophage phenotypic markers (CD80) and cytokines (tumor necrosis factor-α, TNF-α) were higher than in the control group (p < 0.05). LDN was able to upregulate expression of the opioid growth factor receptor (OGFr) and apoptosis-related factors Bax, caspase-9, caspase-3, and PARP and downregulate expression of Bcl-2, Survivin, and Ki67 to promote tumor cell apoptosis. Therefore, we speculate that LDN reduces tumor size by increasing levels of M1-like macrophages and activating the Bax/Bcl-2/caspase-3/PARP signaling pathway to induce apoptosis. We suggest that LDN has potential for the treatment of CRC.

A New Graft for Total Arch Replacement With Frozen Elephant Trunk in Type A Dissection.

In this study, we propose a novel Sutureless Integrated Stented graft, greatly simplifying the distal aortic anastomosis and reducing the deep hypothermic circulatory arrest time in the setting of total arch replacement with frozen elephant trunk for type A aortic dissection.