Exploration of esophagojejunostomy after totally laparoscopic total gastrectomy / 中华胃肠外科杂志

The advantages of lymph node dissection through total laparoscopic total gastrectomy (TLTG) seem to be more and more accepted by the academic community. However, reconstruction of digestive tract is challenging and remains a focus of debate and research. Which way is better for esophagojejunostomy, circular stapler or linear stapler,remains to be answered. The authors believe that, under the conditions of existing anastomosis instruments, using of linear stapler for esophagojejunal side-to-side anastomosis may be the most common choice, but it must be used with strict indications, because there are still many problems to be solved. It is believed that with the breakthrough in the development of the circular stapler suitable for esophagojejunostomy in TLTG, the application of circular stapler for digestive tract reconstruction will become the mainstream again in future. Thus, the current routine clinical practice of TLTG should be cautious and the surgical indications should be strictly evaluated.

Values of ATX in predicting disease progression in patients with PBC and PBC related HCC / 中华肝脏病杂志

Objective: To clarify the values of autotaxin (ATX) in patients with primary biliary cholangitis (PBC) and PBC-related hepatocellular carcinoma (HCC). Methods: 179 patients with PBC were selected from prospective cohorts of autoimmune liver diseases at the time of first diagnosis of PBC in Department of Hepatology, the Fifth Medical Center of PLA General Hospital, from January 2016 to January 2018, all patients with PBC received UDCA therapy, primary endpoint was event of HCC, the follow-up period was censored at the date of HCC. The relationship between level of ATX and clinical features in patients with PBC and its potential value in predicting disease progression and PBC-related HCC were analyzed. Results: The ATX level in the peripheral blood of patients with PBC was significantly higher than that of alcoholic liver cirrhosis(ALC) (t = 3.278, P = 0.001) and healthy controls(HC) (t = 6.594, P < 0.001), however, when comparing PBC to non-PBC related HCC, no significant difference was found between the groups(t=-0.240, P = 0.811). Consistent with peripheral blood levels, histochemical staining indicated that ATX in the liver of patients with PBC was significantly higher than that of HC (Z=-3.633, P < 0.001) and ALC (Z=-3.283, P < 0.001), and the expression of ATX in PBC with advanced histological stage was significantly higher than PBC with early stage (Z=-2.018, P = 0.034). The baseline ATX level in PBC patients without developing to HCC during follow-up had significant difference to patients with developing to HCC (228.451 ± 124.093 ng/ml vs 301.583 ± 100.512 ng/ml, t = 2.339, P = 0.021). The result in multivariate logistic regression analysis showed that ATX were independent predictors of PBC related HCC(OR 1.245, 95%CI 1.097-1.413). The optimal critical value of peripheral blood ATX level at baseline for predicting HCC was 235.254 ng/ml, with the cut-off value of 0.714 in AUC of the ROC (95% CI was 0.597~ 0.857), sensitivity and specificity were 84.6% and 59.0%, respectively. Conclusion: ATX level was significantly higher in PBC patients over controls, and it's concentration was correlated with UDCA efficacy and fibrosis stage. ATX has potential values in predicting disease progression and PBC-related HCC.

Rotational alignment of the tibial component in total knee arthroplasty:a narrative review / 中华外科杂志

Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized "gold standard" is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.

Continuous Glucose Monitoring in the Hospital

Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.

Hyperinsulinemia in Obesity, Inflammation, and Cancer

The relative insufficiency of insulin secretion and/or insulin action causes diabetes. However, obesity and type 2 diabetes mellitus can be associated with an absolute increase in circulating insulin, a state known as hyperinsulinemia. Studies are beginning to elucidate the cause-effect relationships between hyperinsulinemia and numerous consequences of metabolic dysfunctions. Here, we review recent evidence demonstrating that hyperinsulinemia may play a role in inflammation, aging and development of cancers. In this review, we will focus on the consequences and mechanisms of excess insulin production and action, placing recent findings that have challenged dogma in the context of the existing body of literature. Where relevant, we elaborate on the role of specific signal transduction components in the actions of insulin and consequences of chronic hyperinsulinemia. By discussing the involvement of hyperinsulinemia in various metabolic and other chronic diseases, we may identify more effective therapeutics or lifestyle interventions for preventing or treating obesity, diabetes and cancer. We also seek to identify pertinent questions that are ripe for future investigation.

Learning during the pandemic: Perspectives of medical students in Singapore

The COVID-19 pandemic has significantly disrupted medical education, particularly affecting clinical-year students. Educational institutions often had to halt, shorten or impose significant restrictions on their hospital rotations due to strict infection control and social-distancing guidelines implemented in tertiary healthcare institutions, as well as manpower and logistical constraints amid the pandemic. Thus, distance-based learning platforms such as online lectures and case-based teaching were increasingly adopted in place of bedside and face-to-face tutorials. While interactive virtual case-based discussions are generally useful in imparting clinical reasoning skills to medical students, they are unfortunately not able to fully replicate the experience of clerking, examining and managing real patients in the wards, which is a quintessential process towards building clinical acumen and attaining core clinical competencies. Therefore, for final year medical students who are preparing for their Bachelor of Medicine and Bachelor of Surgery (MBBS) examinations, many are naturally concerned by how learning in this "new normal" may affect their ability to make the transition to become competent junior doctors. As such, we seek to share our learning experiences as the first batch of medical students to have completed our entire final year of clinical education amid the COVID-19 pandemic, and offer 4 practical suggestions to future batches of students on how to adapt and optimise clinical learning under these circumstances: actively engaging in virtual learning, making the most of every clinical encounter, learning how to construct peer teaching/practice sessions, and maintaining physical and psychological well-being.

Continuous Glucose Monitoring in the Hospital

Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.

Hyperinsulinemia in Obesity, Inflammation, and Cancer

The relative insufficiency of insulin secretion and/or insulin action causes diabetes. However, obesity and type 2 diabetes mellitus can be associated with an absolute increase in circulating insulin, a state known as hyperinsulinemia. Studies are beginning to elucidate the cause-effect relationships between hyperinsulinemia and numerous consequences of metabolic dysfunctions. Here, we review recent evidence demonstrating that hyperinsulinemia may play a role in inflammation, aging and development of cancers. In this review, we will focus on the consequences and mechanisms of excess insulin production and action, placing recent findings that have challenged dogma in the context of the existing body of literature. Where relevant, we elaborate on the role of specific signal transduction components in the actions of insulin and consequences of chronic hyperinsulinemia. By discussing the involvement of hyperinsulinemia in various metabolic and other chronic diseases, we may identify more effective therapeutics or lifestyle interventions for preventing or treating obesity, diabetes and cancer. We also seek to identify pertinent questions that are ripe for future investigation.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) / 中华烧伤杂志

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) / 中华烧伤杂志

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

roles of cytochrome P450 and P-glycoprotein in the pharmacokinetics of florfenicol in chickens

The effects of three selective oral inhibitors, fluvoxamine [FLU], ketoconazole [KET], and verapamil [VER], on the pharmacokinetics [PK] of florfenicol [FFC] were investigated in chickens. The chickens were administered orally with saline solution [SAL], FLU [60 mg/kg], KET [25 mg/kg], or VER [9 mg/kg] for 7 consecutive days. Florfenicol was given to the chickens at a single dose of 30 mg/kg orally. Blood samples were collected from each chicken at 0 to 12 h post-administration of FFC. The plasma concentration of FFC was analyzed by high-performance liquid chromatography [HPLC]. The AUC of FFC increased and the Cl[s] of FFC decreased with oral co-administration of KET in chickens, and the C[max] of FFC increased with VER. While the AUC, the Cl[s] and the C[max] of FFC were all invariable with FLU. These data suggested that CYP 3A played a key role in the PK of FFC in chickens, however, P-glycoprotein [P-gp] and CYP 1A did not. The results imply that the adverse drug-drug interaction may occur in the use of FFC if the co-administrated drugs are the substrates, inducers or inhibitors of CYP 3A or/and P-gp

Priming of the Cells: Hypoxic Preconditioning for Stem Cell Therapy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Stem cell-based therapies are promising in regenerative medicine for protecting and repairing damaged brain tissues after injury or in the context of chronic diseases. Hypoxia can induce physiological and pathological responses. A hypoxic insult might act as a double-edged sword, it induces cell death and brain damage, but on the other hand, sublethal hypoxia can trigger an adaptation response called hypoxic preconditioning or hypoxic tolerance that is of immense importance for the survival of cells and tissues.</p><p><b>DATA SOURCES</b>This review was based on articles published in PubMed databases up to August 16, 2017, with the following keywords: "stem cells," "hypoxic preconditioning," "ischemic preconditioning," and "cell transplantation."</p><p><b>STUDY SELECTION</b>Original articles and critical reviews on the topics were selected.</p><p><b>RESULTS</b>Hypoxic preconditioning has been investigated as a primary endogenous protective mechanism and possible treatment against ischemic injuries. Many cellular and molecular mechanisms underlying the protective effects of hypoxic preconditioning have been identified.</p><p><b>CONCLUSIONS</b>In cell transplantation therapy, hypoxic pretreatment of stem cells and neural progenitors markedly increases the survival and regenerative capabilities of these cells in the host environment, leading to enhanced therapeutic effects in various disease models. Regenerative treatments can mobilize endogenous stem cells for neurogenesis and angiogenesis in the adult brain. Furthermore, transplantation of stem cells/neural progenitors achieves therapeutic benefits via cell replacement and/or increased trophic support. Combinatorial approaches of cell-based therapy with additional strategies such as neuroprotective protocols, anti-inflammatory treatment, and rehabilitation therapy can significantly improve therapeutic benefits. In this review, we will discuss the recent progress regarding cell types and applications in regenerative medicine as well as future applications.</p>

Effects of low dose radiation on the expression of proteins related to DNA repair requiring caveolin-1 in human mammary epithelial cells

Background: Radiotherapy is an effective and important therapeutic method for breast cancer, but at the same time it has a radiation-induced bystander effect on normal tissue around the tumor. Repair of double-strand breaks [DSBs] by normal cells can reduce the extent of damage caused by this effect. Caveolin-1 [Cav-1] is an important regulatory molecule in cell signal transduction. However, the response of normal human mammary epithelial cells following low dose radiation [LDR]- induced DSBs and the role of Cav-1 in the repair of the DSBs are not clear. The present study examined the DNA damage repair mechanism triggered by LDR in human mammary epithelial cells

Materials and Methods: Human mammary epithelial [MCF10A] and Cav-1 haplo-insufficiency [MCF10A-ST1] cells were irradiated with LDR gamma rays and the effect of this radiation on cell proliferation was determined by cytometric method. Western blot analysis was then used to measure the expression levels of different proteins associated with cell proliferation and DNA repair

Results: LDR enhanced the radiation responsiveness of MCF10A cells in a dose- and time-dependent manner. At a dose of 100 cGy, LDR increased the expression levels of several proteins involved in DNA repair pathways, such as ATM, p53, DNA-PKcs and also activated Cav-1-mediated cell proliferation and survival pathways, such as the MAPK and AKT pathways. The expression of the various DNA repair related proteins was changed after down-regulating the Cav-1 expression

Conclusion: LDR could increase the radiation responsiveness of human mammary epithelial cells through activating the DNA repair pathways, including both HR and NHEJ pathways, as well as triggering the cell proliferation and survival pathways, both of which required Cav-1

Sequence variation and bioinformatics analysis of Toxoplasma gondii GRA16 Gene

Toxoplasmosis is caused by the intracellular protozoan Toxoplasma gondii. It is anopportunistic zoonosis in warm-blooded animals and humans, with a worldwide distribution. Toxoplasma gondii dense granule protein 16 (TgGRA16) can modulate some functions in host cells and is considered a significant virulent factor of the parasite. The present study reports sequence variation in TgGRA16 gene among T. gondii strains from different hosts and geographical locations, and the construction of phylogenetic relationships of these T. gondii strains based on sequences of TgGRA16, and analysis of B cell epitopes in TgGRA16. Our results showed that all TgGRA16 gene sequences were 1518 bp and the C+G contents ranged from 52.17% to 52.59%. Sequence variation in the TgGRA16 gene was 0-1.51%. Phylogenetic analysis revealed that TgGRA16 gene sequence could not be used to differentiate the different T. gondii genotypes. Six B cell epitopes were predicted in TgGRA16. These results indicated that TgGRA16 gene is not an ideal marker for studying genetic relationships of T. gondii isolates, but may represent a good vaccine candidate against toxoplasmosis.

Determination of retardation effect of SOM on aqueous leaching of poly cyclic aromatic hydrocarbons using confocal laser scanning microscope

Influence of soil organic matter [SOM] on the adsorption, desorption and transport of polycyclic aromatic hydrocarbons [PAHs] has already been given full investigation in soils. In this paper, confocal laser scanning microscope [CLSM] was used to elucidate aqueous leaching of PAHs in different types of soil with soil columns, which enhanced understanding on transport of PAHs appreciably. Four typical soils in China including fluvo-aquic soil [FAS], aquic brown soil [ABS], red soil [RS] and black soil [BS] were selected in the experiment. Target pollutants of phenanthrene and pyrene were extracted from the leachate by solid phase extraction [SPE] and then determined by high performance liquid chromatography [HPLC]. The experimental results showed that the retardation ability of pollutants to the four selected types of soil increased in the order: FAS H" ABS < RS < BS. To better expatiate the dissimilar ability of the PAHs transported in the four typical soils, the retardation factor [R], distribution constant [K[d]] and partition coefficient [K[oc] were evaluated based on the observed breakthrough curves [BTCs]. Furthermore, CLSM was used to visualize the effects of SOM on the transport ability of PAHs in different types of soil. All the results provided vivid understanding with mathematical and especially optical measures that SOM was considered the single most important factor limiting the availability and mobility of PAHs in soil over the duration of the experiment

Microbial community changes in contaminated soils in response to phenanthrene amendment

Leachate and reclaimed wastewater have become the important sources of polycyclic aromatic hydrocarbons in soils. However, the information on bioremediation of leachate and reclaimed wastewater-contaminated soils is still lacking. Identification of changes in microbial structure or of enriched genera related to biodegradation could aid identification of particular organisms or consortia capable of degrading polycyclic aromatic hydrocarbons in these contaminated soils. In this study, terminal restriction fragment length polymorphism, coupled with 16S Ribosomal ribonucleic acid clone library analysis, was applied to investigate the composition of bacterial community in leachate-contaminated soil or grassland soil irrigated reclaimed wastewater and the response to phenanthrene amendment. Results showed that phenanthrene amendment had significant but different impacts on microbial community structure, dependent on soil source. Several greatly enriched terminal restriction fragments with phenanthrene biodegradation were identified. Moreover, genus rhizobacteria, possibly linked to phenanthrene biodegradation, was firstly reported in this study. This work might provide some new insights into bioremediation of polycyclic aromatic hydrocarbons-contaminated soils

Waterpipe smoking in Kuwait

A nonrandom sample of 2972 Kuwait is answered a questionnaire about smoking behaviour and beliefs. More than one-third [35%] were nonsmokers, 45% smoked only the waterpipe, 12% only cigarettes and 8% both waterpipe and cigarettes. Compared with cigarette smokers, waterpipe smokers were more likely to be female and to be unskilled manual workers than professionals or students. Waterpipe smokers started the habit at an older age on average than cigarette smokers. Most waterpipe smokers smoked only 1 bowl per day, and smoked mostly at coffee houses. Factor analysis of beliefs about waterpipe smoking resulted in 4 groups of beliefs which explained 50% of the variance. The results are discussed in terms of public health policy and possible risk reduction strategies