Terapia de conversión en cáncer gástrico: experiencia del Instituto Nacional de Cancerología de Colombia / Conversion therapy in gastric cancer: experience at Instituto Nacional de Cancerología de Colombia

RESUMEN Antecedentes: el cáncer gástrico (CG) representa un problema de salud pública en Colombia y el mundo. Dado que la mayoría de los pacientes se encuentran en estadios avanzados en el momento del diagnóstico. desarrollar estrategias de manejo. como la terapia de conversión (TC). es una necesidad cada vez mayor en su tratamiento. Objetivo: estimar los resultados con la TC en el tratamiento de pacientes con CG avanzado en el Instituto Nacional de Cancerología de Colombia (INC). Material y métodos: serie de casos de pacientes con adenocarcinoma gástrico incurable llevados a quimioterapia de inducción y cirugía con intención curativa. entre los años 2010 y 2021. Se revisaron de forma retrospectiva los datos clínico-patológicos y de supervivencia. La supervivencia global (SG) se calculó desde la fecha de la primera quimioterapia hasta la muerte. Las funciones de supervivencia se estimaron con tablas de vida y por el método de Kaplan-Meier y se realizaron curvas de supervivencia a 3 y 5 años. Resultados: se analizaron los datos de 23 pacientes con edad promedio de 56 años. 17 (74%) fueron varones. El criterio de irresecabilidad más frecuente fue un tumor T4b en 13 casos (56.5%). Todos recibieron TC. La mediana de seguimiento fue de 28 meses. Se documentaron 11 recurrencias (52%). La mediana de supervivencia fue de 41.2 meses y la SG a 3 y 5 años de 57.7% y 38.5%. respectivamente. Conclusiones: la TC permitió obtener una SG aceptable de pacientes seleccionados con CG avanzado incurable. Esta estrategia requiere una cuidadosa selección y manejo multidisciplinario en centros oncológicos de referencia.

ABSTRACT Background: Gastric cancer (GC) represents a public health problem in Colombia and worldwide. Since most patients are at advanced stages at the time of diagnosis. it is necessary to develop management strategies as conversion therapy (CT). Objective: The aim of this study was to estimate the results of CT for treating patients with advanced and GC at Instituto Nacional de Cancerología de Colombia (INC). Material and methods: We included patients with incurable gastric cancer who underwent induction chemotherapy and intended curative surgery between 2010 and 2021. The clinical and pathological data and survival of the patients included were retrospectively reviewed. Overall survival (OS) was calculated from the time of initiation of chemotherapy until the date of death. Survival functions were estimated using the life table and Kaplan-Meier methods. and survival curves at 3 and 5 years were constructed. Results: 23 patients were analyzed; mean age was 56 years. and 17 (74%) were men. The most common criterion indicating unresectability was a T4b tumor in 13 cases (56.5%). All the patients underwent CT. Median follow-up was 28 months. Eleven patients developed disease recurrence (52%). Median survival was 41.2 months. and 3- and 5-year OS was 57.7% and 38.5%. respectively. Conclusions: CT provided an acceptable OS rate for selected patients with incurable advanced GC. This strategy requires an adequate selection of patients and multidisciplinary management in reference oncology centers.

Textual Research on Principle of Dose Conversion in Ancient Famous Classical Formulas / 中国实验方剂学杂志

Due to the difference between the system of weights and measures， and the dosage of clinical prescriptions of traditional Chinese medicine in various historical periods， the dosage and conversion standard of prescriptions in past dynasties are different. Therefore， when discounting the dosage of famous classical formulas， the principles of inheriting the essence， making the past serve the present， linking the past and the present， and forming a consensus should be followed， firstly， the dosage of the prescription was converted according to the weights and measures system of the past dynasties. If the converted dosage significantly exceeds the provisions of the 2020 edition of Chinese Pharmacopoeia， then on the premise of ensuring that the proportion of the original prescription drug dosage remains unchanged， the conversion shall be based on expert consensus and drug safety evaluation. For drugs measured in non-standard units， a conversion range is provided based on comprehensive literature analysis and physical measurements. For the conversion of service volume， the original text was used as the basis for the conversion with reference to the measurement standards of different eras. If the original dosage is not clear， the converted dosage will be determined based on the historical evolution of the formula， referring to relevant ancient books， and combining modern applications. Eventually， the converting standard for famous classical formulas was determined as follows：during the Han and Tang dynasties， one Liang（两） was equivalent to 13.8 g and one Sheng（升） was equivalent to 200 mL， in the Tang dynasty， one Fen（分） was equivalent to 3.45 g， during the Song， Jin and Yuan dynasties， one Qian（钱） was equivalent to 4.13 g and one Zhan（盏） was equivalent to 300 mL， during the Ming and Qing dynasties， one Qian（钱） was equivalent to 3.73 g， and one Bei（杯） and one Zhong（盅） were equivalent to 200 mL. For drugs recorded in non-standard units of measurement， it is necessary to conduct actual measurements to determine their conversion standards based on comprehensive analysis to determine their origin. If necessary， different records of the dosage of drugs with the same or similar efficacy and indications in medical books of similar ages can be used to assist in determining the conversion standards. The analysis of the principle of dosage conversion for Chinese medicine is helpful for the clinical application and development of famous classical formulas.

Clinical follow-up study of SARS-CoV-2 Omicron infection / 上海预防医学

ObjectiveTo observe the clinical course and explore the risk factors for SARS-CoV-2 RNA negative conversion duration （NCD） in asymptomatic and mild-symptomatic patients infected with the SARS-CoV-2 Omicron variant. MethodsClinical data were collected from 244 confirmed cases of corona virus disease （COVID-19） with Omicron variant infection admitted to a temporal makeshift hospital in Shanghai from April 9， 2022 to May 20， 2022. Demographic and clinical data were analyzed， with a primary focus on the time of COVID-19 nucleic acid conversion. Univariate and multivariate Cox regression analysis were used to determine identify risk factors associated with NCD. ResultsThe median duration of negative RNA conversion was 9 days （ranged 7‒12 days）. The percentage of patients with positive nucleic acid results on the 5th， 7th， 10th， and 14th days after confirmed infection was 68.4%， 47.1%， 20.1%， and 5.7%， respectively. Kaplan-Meier curves indicated a median nucleic acid conversion time of 12 days （ranged 10‒14 days） for patients with hypertension， 9 days （ranged 7‒11 days） in patients without hypertension， and 11 days （ranged 9‒13 days） for patients aged ≥60 years， and 9 days （ranged 7‒11 days） for patients aged <60 years. Multivariate Cox regression analysis showed that only hypertension was an independent risk factor of NCD （RR=1.60； 95% CI： 1.03‒2.49， P=0.036）. ConclusionIn asymptomatic or mildly symptomatic patients infected with the Omicron variant， 20.1% patients continue to exhibit positive viral nucleic acid on the 10th days of infection. The independent risk factor associated with the conversion of SARS-CoV-2 nucleic acid to negative is hypertension.

Effects of LED Lights on Bulk Fill Resin Polymerization

The present study analyzed the microhardness and degree of conversion of three Bulk Fill resins (M1 - Filtek Bulk Fill; M2 - Tetric N-Ceram Bulk Fill and M3 - Opus Bulk Fill) polymerized by single peak and polywave Light-emitting Diode Curing Lights. A total 90 test specimens (n=10) were obtained using a Teflon matrix for the purpose of testing microhardness; and for degree of conversion: 135 specimens (n=5) by using a 2 x 6 cm matrix. The specimens were light polymerized using 3 light sources (L1 - Optilight Max, L2 - Bluephase, L3 - VALO). They were kept in artificial saliva om an oven at 37±1°C during the experiment. The degree of conversion was measured by FTIR 24 h after obtaining each test specimen. The microhardness readouts were performed with a microdurometer at the time intervals of 48 hours (T0), 7 days (T1), 14 days (T2) and 21 days (T3). M1L3 was found to show the highest microhardness values in T2, and M1 showed the lowest degree of conversion in the deep third with L1. It was concluded that Filtek Bulk Fill resin showed the best results in comparison with the other resins.

El presente estudio analizó la microdureza y el grado de conversión de tres resinas Bulk Fill (M1 - Filtek Bulk Fill; M2 - Tetric N-Ceram Bulk Fill y M3 - Opus Bulk Fill) polimerizadas por lámparas de curado de diodo emisor de luz de pico único y polionda. Se obtuvieron un total de 90 especímenes de prueba (n=10) utilizando una matriz de teflón con el propósito de probar la microdureza; y para grado de conversión: 135 especímenes (n=5) utilizando una matriz de 2 x 6 cm. Las muestras se fotopolimerizaron utilizando 3 fuen- tes de luz (L1 - Optilight Max, L2 - Bluephase, L3 - VALO). Se mantuvieron en saliva artificial en estufa a 37 ±1°C durante el experimento. El grado de conversión se midió por FTIR 24 h después de obtener cada muestra de prueba. Las lecturas de microdureza se realizaron con un microdurómetro en los intervalos de tiempo de 48 horas (T0), 7 días (T1), 14 días (T2) y 21 días (T3). Se encontró que M1L3 mostraba los valores más altos de microdureza en T2, y M1 mostraba el grado más bajo de conversión en el tercio profundo con L1. Se concluyó que la resina Filtek Bulk Fill mostró los mejores resultados en comparación con las demás resinas.

Factores asociados con la conversión a técnica abierta en la colecistectomía laparoscópica / Factors associated with conversion to open technique in laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es el estándar de oro para el manejo de la patología de la vesícula biliar con indicación quirúrgica. Durante su ejecución existe un grupo de pacientes que podrían requerir conversión a técnica abierta. Este estudio evaluó factores perioperatorios asociados a la conversión en la Clínica Central OHL en Montería, Colombia. Métodos. Estudio observacional analítico de casos y controles anidado a una cohorte retrospectiva entre 2018 y 2021, en una relación de 1:3 casos/controles, nivel de confianza 95 % y una potencia del 90 %. Se caracterizó la población de estudio y se evaluaron las asociaciones según la naturaleza de las variables, luego por análisis bivariado y multivariado se estimaron los OR, con sus IC95%, considerando significativo un valor de p<0,05, controlando variables de confusión. Resultados. El estudio incluyó 332 pacientes, 83 casos y 249 controles, mostrando en el modelo multivariado que las variables más fuertemente asociadas con la conversión fueron: la experiencia del cirujano (p=0,001), la obesidad (p=0,036), engrosamiento de la pared de la vesícula biliar en la ecografía (p=0,011) y un mayor puntaje en la clasificación de Parkland (p<0,001). Conclusión. La identificación temprana y análisis individual de los factores perioperatorios de riesgo a conversión en la planeación de la colecistectomía laparoscópica podría definir qué pacientes se encuentran expuestos y cuáles podrían beneficiarse de un abordaje mínimamente invasivo, en búsqueda de toma de decisiones adecuadas, seguras y costo-efectivas

Introduction. Laparoscopic cholecystectomy is the gold standard for the management of gallbladder pathology with surgical indication. During its execution, there is a group of patients who may require conversion to the open technique. This study evaluated perioperative factors associated with conversion at the OHL Central Clinic in Montería, Colombia. Methods. Observational analytical case-control study nested in a retrospective cohort between 2018 and 2021, in a 1:3 case/control ratio, 95% confidence level and 90% power. The study population was characterized and the associations were evaluated according to the nature of the variables, then the OR were estimated by bivariate and multivariate analysis, with their 95% CI, considering a value of p<0.05 significant, controlling for confounding variables. Results. The study included 332 patients, 83 cases and 249 controls, showing in the multivariate model that the variables most strongly associated with conversion were: the surgeon's experience (p=0.001), obesity (p=0.036), gallbladder wall thickening on ultrasonography (p=0.011), and a higher score in the Parkland classification (p<0.001). Conclusions. Early identification and individual analysis of the perioperative risk factors for conversion in the planning of laparoscopic cholecystectomy could define which patients are exposed, and which could benefit from a minimally invasive approach, in search of making safe, cost-effective, and appropriate decisions

DIGITAL SEARCH ADVERTISING – THE ROLE OF POST-CLICK FACTORS IN GENERATING PURCHASE CONVERSIONS

A lot of research is available on the effectiveness of search as an advertising channel. Most of these studies tend to treat a click on a search ad as a binary event. All of them study the events leading to the click. This paper goes beyond this to study the post click actions taken by a user subsequent to clicking on a search ad, and refers to those actions as depth of interaction, and testing the variables that have an effect on the nal outcome. We use a prescriptive research design employing binary logistic regression analysis. Results indicate that the duration of time spent, device used, and recency of visit have a very high positive effect on the nal outcome.

Apendectomía Convencional vs. Laparoscópica en pasantes de cirugía general / Conventional Vs Laparoscopic Appendectomy in General Surgery Interns

La apendicitis aguda (AA) es una de las afecciones más frecuentes para la consulta por el servicio de guardia que requiere tratamiento quirúrgico, con una incidencia estimada de entre 6 y 8%. Métodos: Se crearon dos grupos compuestos por 25 pacientes seleccionados al azar: G1. Apendectomía laparoscópica (AL). G2. Apendectomía convencional (CA). Analizamos variables como sexo, edad, tiempo de operación, dolor postoperatorio, estadía en el hospital y complicaciones postoperatorias. Resultados: el 53.2% de los pacientes eran hombres y el 46.8% restante eran mujeres, con una edad media de 31 años. La serie arrojó una tasa de complicación general del 28% para G1 y 68% para G2. Conclusión: lo que marca la evolución no es solo la capacidad del residente interino, sino también la condición del órgano y los propios factores del paciente

Acute appendicitis (AA) is one of the most frequent conditions for consultation by the on-call service that requires surgical treatment, with an estimated incidence of between 6 and 8%. Methods: Two groups made up of 25 randomly selected patients were created: G1. Laparoscopic appendectomy (AL). G2. Conventional appendectomy (CA). We analyzed variables such as sex, age, operating time, postoperative pain, hospital stay, and postoperative complications. Results: 53.2% of the patients were male and the remaining 46.8% were female, with a mean age of 31 years. The series yielded a general complication rate of 28% for G1 and 68% for G2. Conclusión: What marks the evolution is not only the capacity of the acting resident, but also the condition of the organ and the patient's own factors

Depth of cure, mechanical properties and morphology of dual-cure bulk-Fill composites / Profundidad de curado, propiedades mecánicas y morfología de resinas compuestas duales

This study evaluated selected structural and physical properties, such as degree of conversion (DC), Vickers hardness (VHN), and compression strength (CS), of three new dual-cure bulk-fill resin-based composites (RBCs; ACTIVA, HyperFIL, and Fill-Up) and compared them to those of a conventional RBC (Filtek Z250) at three clinically relevant depths. Samples (n=180) were prepared in three depths (2,4, and 6mm). Fourier-transform infrared spectroscopy (FTIR) analysis and VHN and CS tests were performed. The DC value was calculated by considering the relative change in the aliphatic C=C peaks. The fractured surfaces of representative samples were characterized using scanning electron microscopy (SEM). Data were statistically evaluated using two-way analysis of variance and post hoc Bonferroni tests (p<0.05). According to the VHN results, Filtek Z250 showed the highest bottom/top hardness ratio (97.94±1.01) at 2mm thickness and ACTIVA showed the lowest bottom/top hardness ratio (43.48±5.64) at 6mm thickness (p<0.001). According to the FTIR results, the DC decreased with increasing thickness in all materials (p<0.05). Filtek Z250 showed the highest (301±12.4 MPa) and ACTIVA exhibited the lowest (232±17.2 MPa) CS values at 2mm thickness (p<0.05). The lowest CS values were obtained for ACTIVA, and the highest values were obtained for Filtek Z250 for samples with thicknesses of 4 and 6mm, respectively (p<0.05). The structural features of restorative composites, such as the resin chemistry and filler type and content, and the operational parameters (i.e., material thickness and curing conditions) strongly affect crosslinking reactions and thus the DC, VHN, and CS values.

Este estudio evaluó propiedades físicas y estructurales, como el grado de conversión (DC), la dureza Vickers (VHN) y la resistencia a la compresión (CS), de tres nuevos compósitos a base de resina de curado dual tipo bulk (RBC; ACTIVA , HyperFIL y Fill-Up) y los comparó con los de una resina compuesta convencional (Filtek Z250) en tres profundidades clínicamente relevantes. Se prepararon muestras (n=180) en tres profundidades (2,4 y 6mm). Se realizaron análisis de espectroscopia infrarroja por transformada de Fourier (FTIR) y pruebas VHN y CS. El valor de DC se calculó considerando el cambio relativo en los picos alifáticos C=C. Las superficies fracturadas de muestras representativas se caracterizaron mediante microscopía electrónica de barrido (MEB). Los datos se evaluaron estadísticamente mediante análisis de varianza de dos vías y pruebas post hoc de Bonferroni (p<0,05). De acuerdo con los resultados de VHN, Filtek Z250 mostró la relación de dureza inferior/superior más alta (97,94±1,01) con un espesor de 2mm y ACTIVA mostró la relación de dureza inferior/superior más baja (43,48±5,64) con un espesor de 6mm (p<0,001). De acuerdo con los resultados de FTIR, la DC disminuyó al aumentar el espesor en todos los materiales (p<0,05). Filtek Z250 mostró los valores de CS más altos (301±12,4 MPa) y ACTIVA los más bajos (232±17,2 MPa) a 2mm de espesor (p<0,05). Los valores más bajos de CS se obtuvieron para ACTIVA y los valores más altos para Filtek Z250 para muestras con espesores de 4 y 6mm, respectivamente (p<0,05). Las características estructurales de las resinas compuestas de restauración, como la química; además del tipo y contenido del relleno, y los parámetros operativos (es decir, el espesor del material y las condiciones de curado) afectan en gran medida las reacciones de interacción química y, por lo tanto, los valores de DC, VHN y CS.

No seroconversion among healthcare workers exposed to SARS-CoV-2 during the early phase of the pandemic / Ausencia de seroconversión en trabajadores de la salud expuestos a SARS-CoV-2 durante la primera fase de la pandemia

BACKGROUND: The SARS-CoV-2 pandemic is associated with morbidity, hospitalizations, absenteeism, and mortality among healthcare workers (HCW). AIM: To evaluate the seroconversion rate in HCW exposed to SARS-CoV-2 in the early pandemic phase in 2020 at a regional reference hospital. MATERIAL AND METHODS: One hundred seventy-nine HCW working at a regional hospital were invited to a longitudinal study performed between April-July 2020. A serological analysis by ELISA IgG for viral nucleoprotein and protein S with a secondary analysis by ELISA IgG protein S1/S2 for samples with positive or doubtful result was carried out together with a complementary online survey to inquire about occupational or community exposures to SARS-CoV-2. RESULTS: Two cases with baseline infection were detected (1.1%, one symptomatic and one asymptomatic) and no cases of seroconversion were detected. During the study period, there were 136 patients hospitalized with COVID-19, and regional weekly COVID-19 incidence ranged from 2.7 to 24.4 per 100,000 inhabitants. No SARS-CoV-2 cases were detected by PCR among 27 HCW who consulted for respiratory symptoms in the period. Online surveys confirmed direct care of COVID-19 patients and also detected a high degree of unprotected social interaction at work. CONCLUSIONS: There was no evidence of seroconversion in this group of HCW exposed to the risk of infection by SARS-CoV-2 during the onset of the COVID-19 pandemic. Personal protective equipment and other measures used by the HCW were extremely useful for their protection in the initial phase of the pandemic.

ANTECEDENTES: La pandemia de SARS-CoV-2 está asociada a morbilidad, hospitalizaciones, ausentismo y mortalidad entre el personal de salud (PS). OBJETIVO: Evaluar la tasa de seroconversión en el PS expuesto al SARS-CoV-2 en la fase pandémica inicial el 2020 en un hospital regional de referencia. MATERIAL Y MÉTODOS: Ciento setenta y nueve trabajadores de la salud fueron invitados a un estudio longitudinal realizado entre abril-julio de 2020. Se efectuó un análisis serológico por ELISA IgG para nucleoproteína viral y proteína S con un análisis secundario por ELISA IgG proteína S1 / S2 para muestras con resultado positivo o dudoso junto a encuestas complementarias en línea para preguntar sobre exposiciones ocupacionales o comunitarias al SARS-CoV-2. RESULTADOS: Se detectaron dos casos con infección basal (1,1%, uno sintomático y uno asintomático) sin casos de seroconversión. Durante el período de estudio, hubo 136 pacientes hospitalizados con COVID-19, y la incidencia semanal regional de COVID-19 osciló entre 2,7 y 24,4 por 100.000 habitantes. No se detectaron casos de SARS-CoV-2 por PCR entre los 27 funcionarios que consultaron por síntomas respiratorios en este período. Las encuestas en línea confirmaron la atención directa de los pacientes con COVID-19 y también detectaron un alto grado de interacción social desprotegida en el trabajo. CONCLUSIONES: No hubo evidencia de seroconversión en un grupo de funcionarios expuestos al riesgo de infección por SARS-CoV-2 durante el inicio de la pandemia de COVID-19. Los equipos de protección personal y otras medidas utilizadas por el PS fueron de suma utilidad para su protección en la fase inicial de la pandemia.

Paraplejia funcional que imita una mielopatía aguda durante el embarazo: reporte de un caso

Introducción: Los trastornos funcionales son un reto clínico en la atención de pacientes con déficits neurológicos. Pueden generar manifestaciones clínicas típicas y gran discapacidad. Para su diagnóstico se requiere de una alta sospecha inicial asociado a una batería de examen físico completa. Hallazgos clínicos: Presentamos el caso de una paciente indígena embarazada de 19 años, con pérdida de la fuerza en sus extremidades inferiores, un nivel sensitivo y pérdida del control de los esfínteres. Luego de una evolución estacionaria con estudios imagenológicos e infectocontagiosos dentro de la normalidad. Se sospechó el diagnóstico de un trastorno neurológico funcional por lo que se realizó la prueba del Spinal Injuries Center (SIC) el cual fue positivo. Tratamiento y evolución: Realizamos una intervención multidisciplinar, incluyendo el servicio de rehabilitación, neurología, psiquiatría y psicología. Se utilizaron intervenciones con movimientos articulares, fortalecimiento muscular, estimulación eléctrica y psicoterapia. Posteriormente se obtuvo la recuperación completa de la paciente antes del alta hospitalaria, con la exigencia de seguimiento ambulatorio, además de una inserción satisfactoria en las actividades sociales y familiares. Conclusiones: Este caso refleja la importancia de un análisis neurológico detallado, el conocimiento de diferentes herramientas de semiología y el reto diagnóstico de los trastornos funcionales en neurológicos. La intervención de un equipo multidisciplinar favorece abordajes multidimensionales y resultados clínicos favorables.

Introduction: Functional disorders pose a clinical challenge in the care of patients with neurological deficits. They can generate typical clinical manifestations and great disability. Diagnosis requires a high initial suspicion together with comprehensive physical examination. Clinical Findings: We present the case of a 19-year-old pregnant indigenous patient, with loss of strength in her lower extremities, with a sensitive level and loss of sphincter control. After a stationary evolution with imaging and infectious studies within normal limits, a diagnosis of a functional neurological disorder was suspected; thus, the Spinal Injuries Center (SIC) test was performed, showing positive results. Treatment and evolution: A multidisciplinary intervention was carried out, including the neurology, psychiatry and psychology rehabilitation. Interventions amied towards joint movements, muscle strengthening, electrical stimulation and psychotherapy were used. Eventually, the patient's complete recovery was achieved before hospital discharge, in addition to a satisfactory integration into social and family activities, with a outpatient follow-up requirement. Conclusions: This case reflects the importance of a detailed neurological analysis, knowledge of different semiology tools and the diagnostic challenge of functional neurological disorders. The intervention of a multidisciplinary team favors multidimensional approaches and favorable clinical results.

Laparoscopic appendicectomy: risk factors for conversion to laparotomy / Apendicectomia laparoscópica: fatores de risco de conversão para laparotomia

ABSTRACT BACKGROUND: Laparoscopic appendectomy is the gold standard surgical procedure currently performed for acute appendicitis. The conversion rate is one of the main factors used to measure laparoscopic competence, being important to avoid wasting time in a laparoscopic procedure and proceed directly to open surgery. AIMS: To identify the main preoperative parameters associated with a higher risk of conversion in order to determine the surgical method indicated for each patient. METHODS: Retrospective study of patients admitted with acute appendicitis who underwent laparoscopic appendectomy. A total of 725 patients were included, of which 121 (16.7%) were converted to laparotomy. RESULTS: The significant factors that predicted conversion, identified by univariate and multivariate analysis, were: the presence of comorbidities (OR 3.1; 95%CI; p<0.029), appendicular perforation (OR 5.1; 95%CI; p<0.003), retrocecal appendix (OR 5.0; 95%CI; p<0.004), gangrenous appendix, presence of appendicular abscess (OR 3.6; 95%CI; p<0.023) and the presence of difficult dissection (OR 9.2; 95%CI; p<0.008). CONCLUSIONS: Laparoscopic appendectomy is a safe procedure to treat acute appendicitis. It is a minimally invasive surgery and has many advantages. Preoperatively, it is possible to identify predictive factors for conversion to laparotomy, and the ability to identify these reasons can aid surgeons in selecting patients who would benefit from a primary open appendectomy.

RESUMO RACIONAL: A apendicectomia laparoscópica é o procedimento cirúrgico padrão-ouro realizado atualmente para apendicite aguda. A taxa de conversão é um dos principais fatores utilizados para medir a competência laparoscópica, e importante para evitar perda de tempo em um procedimento laparoscópico e proceder diretamente à cirurgia aberta. OBJETIVO: Identificar os principais parâmetros pré-operatórios associados ao maior risco de conversão para determinar o método cirúrgico indicado para cada paciente. MÉTODOS: Estudo retrospectivo de pacientes admitidos com apendicite aguda, submetidos a apendicectomia laparoscópica. Foram incluídos 725 pacientes, sendo que destes, 121 (16,7%) foram convertidos para laparotomia. RESULTADOS: Os fatores significativos que predizem a conversão, identificados por análise univariada e multivariada, foram: presença de comorbidades (OR 3,1; IC95%; p<0,029), perfuração apendicular (OR 5,1; IC95%; p<0,003), apêndice retrocecal (OR 5,0; IC95%; p<0,004), apêndice gangrenoso, presença de abscesso apendicular (OR 3,6; IC95%; p<0,023) e a presença de dissecção difícil (OR 9,2; IC95%; p<0,008). CONCLUSÕES: A apendicectomia laparoscópica é um procedimento seguro para tratar apendicite aguda. É uma cirurgia minimamente invasiva e tem muitas vantagens. No pré-operatório, é possível identificar os fatores preditores de conversão para laparotomia, e a capacidade de identificar essas razões pode ajudar os cirurgiões na seleção de pacientes que se beneficiariam de uma apendicectomia aberta primária.

Experiencia en bypass gástrico reseccional laparoscópico en pacientes con obesidad mórbida. Primer estudio en Venezuela / Experience in laparoscopic resectional gastric bypass in patients with morbid obesity. First study in Venezuela

El Bypass Gástrico Reseccional, consiste en realizar gastrectomía casi total más anastomosis gastro-yeyunal, con las desventajas de no ser reversible, y disminuir la absorción de los elementos que requieren ácidos gástricos. Objetivo: Describir la experiencia en Bypass Gástrico Reseccional Laparoscópico en pacientes con Obesidad Mórbida, intervenidos en el Centro Quirúrgico Carabobo 200 y en el Instituto Docente de Urología, Carabobo ­ Venezuela, durante el periodo comprendido entre enero ­ diciembre 2.021. Materiales: Investigación descriptiva, retrospectiva, longitudinal y multicéntrica, no probabilístico, comprendiendo 3 pacientes. Se utilizó una ficha de recolección de datos confeccionada para tal fin que incluyó datos clínicos y de laboratorio, previos y posterior a la cirugía, siendo evaluados a los 3, 6 y 12 meses respectivamente. Resultados: Causa más frecuente: presencia de lesiones gástricas benignas en 66.66% de los casos, y falla de técnica bariátrica primaria en 33.33%. Todos los pacientes del estudio presentaban comorbilidades cardiovasculares y metabólicas, siendo las más relevantes; Hipertensión Arterial Sistémica 100%, resistencia a insulina 66.66%, apnea del sueño 66.66% y Diabetes Mellitus tipo 2, en 33.33%. Conclusiones: El Bypass Gástrico Reseccional Laparoscópico tiene buenos resultados en pacientes obesos, con riesgo a desarrollar cáncer gástrico y en fallo de técnica primaria. No hubo complicación transoperatoria. La pérdida de exceso de peso fue exitosa (promedio 85.78% al año). Solo 1 caso presentó complicación postoperatoria tardía de anemia leve con diagnóstico y resolución oportuna. No se evidenciaron otras complicaciones(AU)

The Resectional Gastric Bypass consists of performing almost total gastrectomy plus gastro-jejunal anastomosis, with the disadvantages of not being reversible, and decreasing the absorption of elements that require gastric acids. Objective: To describe the experience in Laparoscopic Resectional Gastric Bypass in patients with Morbid Obesity, operated on at the Carabobo 200 Surgical Center and at the Teaching Institute of Urology, Carabobo - Venezuela, during the period between January - December 2021. Materials: Descriptive, retrospective, longitudinal, and multicenter, non-probabilistic research, involving 3 patients. A data collection sheet prepared for this purpose was drawn up, which included clinical and laboratory data, before and after surgery, being evaluated at 3, 6 and 12 months respectively. Results: Most frequent cause: presence of benign gastric lesions in 66.66% of cases, and primary bariatric technique failure in 33.33%. All the patients in the study presented cardiovascular and metabolic comorbidities, being the most relevant; Systemic Arterial Hypertension 100%, insulin resistance 66.66%, sleep apnea 66.66% and Diabetes Mellitus type 2, in 33.33%. Conclusions: Laparoscopic Resectional Gastric Bypass has good results in obese patients, at risk of developing gastric cancer and in primary technique failure. There were no intraoperative complications. Excess weight loss was successful (average 85.78% per year). Only 1 case presented late postoperative complication of mild anemia with timely diagnosis and resolution. No other complications were found(AU)

Factores predictivos de conversión de colecistectomía laparoscópica. Artículo de Revisión / Predictive factors of laparoscopic cholecystectomy conversion. Review Article

Objetivo: establecer los factores predictivos y causas de conversión de la colecistectomía laparoscópica. Métodos: se trata de un metaanálisis en el que se realizó revisión bibliográfica a través de 8 bases de datos, se incluyeron 14 publicaciones correspondientes al periodo 2019 ­ 2023.Resultados : se encontró que los factores predictivos de conversión de colecistectomía laparoscópica se dividen en: factores propios del paciente: edad, género, índice de masa corporal, comórbidos, antecedente de cirugía abdominal; factores de la enfermedad: forma de ingreso del paciente bien sea electiva o de urgencia, presencia de colecistitis aguda, incremento del grosor de la pared vesicular, presencia de adherencias en el lecho operatorio; y factores del cirujano: que incluyen tanto la experiencia de este como la percepción de colecistectomía difícil.Conclusión : se ha logrado establecer en el presente trabajo que el sexo masculino, la edad avanzada, el mayor grosor de la pared de la vesícula biliar y la presencia de colecistitis aguda, representan factores predictivos de conversión de colecistectomía laparoscópica. Las principales causas de conversión fueron adherencias, dificultad de disección o visualización de las estructuras que componen el triángulo de Calot y hemorragia no controlada(AU)

Objective: to establish the predictive factors and causes of conversion of laparoscopic cholecystectomy. Methods: this is a qualitative research in which a bibliographic review was carried out through 8 databases, 14 publications corresponding to the period 2019 - 2023 were included.Results : it was found that the predictive factors of laparoscopic cholecystectomy conversion were They are divided into: factors specific to the patient: age, gender, body mass index, comorbidities, history of abdominal surgery; disease factors: admission of the patient, whether elective or urgent, presence of acute cholecystitis, increased thickness of the gallbladder wall, presence of adhesions in the surgical bed; and surgeon factors: which include both the surgeon's experience and the perception of difficult cholecystectomy.Conclusion : it has been established in the present work that the male sex, advanced age, greater thickness of the gallbladder wall and the presence of acute cholecystitis represent predictive factors for laparoscopic cholecystectomy conversion. The main causes of conversion were adhesions, difficulty in dissection or visualization of the structures that make up Calot's triangle, and uncontrolled bleeding(AU)

Research progress on mechanism of TLR4 in carcinogenesis of inflammatory bowel disease / 中国药理学通报

Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC) compared with the general population. Currently the molecular mechanism of CRC occurrence in the context of IBD is not clear. The inflammation-atypical hyperplasia-cancer process has been widely accepted. Toll-like receptor 4(TLR4) is a key receptor for pathogen recognition and immune activation, and plays a crucial role in inflammatory and carcinogenic transformation of IBD. Therefore, this paper reviews the epidemiology of colitis-associated colorectal cancer (CAC) and the main mechanisms of TLR4 in the development of IBD to CAC, which will help to further understand the carcinogenesis of IBD, detect and better describe CAC at an earlier stage, and provide more effective prevention and treatment for CAC.

Mechanism of Schisandra Chinensis-mediated microglia phenotypic transformation by regulation of the TLR4 pathway based on miR-124 / 药学学报

To investigate the mechanism by which Schisandra Chinensis mediates the phenotypic transformation of microglia via microRNA-124 (miR-124)-based regulation of the Toll-like receptor 4 (TLR4) pathway, a model was established using lipopolysaccharide (LPS) stimulation of BV2 cells. Cells were treated with different doses of Schisandra Chinensis extract (SCE). MiR-124 inhibitors and negative control sequences (NC inhibitor) were transfected into LPS-induced BV2 cells and treated with SCE. The MTT assay was used for cell activity detection; an NO kit was used to measure NO release; ELISA kits were used to measure the levels of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α). Microglia markers, including ionized calcium binding adapter molecule-1 (IBA-1) and arginase-1 (Arg-1), and the nuclear translocation of nuclear factor-kappa B (NF-κB) were evaluated by immunofluorescent staining. NF-κB p65, IBA-1, Arg-1, TLR4, myeloid differentiation primary factor 88 (MyD88), inhibitor of nuclear factor-kappa B kinases-α (IKK-α), IL-10, TNF-α were detected by immunoblot. SCE at concentrations ranging from 31.25 to 250 μg·mL-1 had no significant effect on cell activity. SCE treatment significantly inhibited NO release induced by LPS (P < 0.001, P < 0.01), increased the level of IL-10 (P < 0.05), and decreased the level of TNF-α (P < 0.001). In addition, SCE significantly reduced the expression of TNF-α, IBA-1, TLR4, and MyD88 (P < 0.01, P < 0.001) and elevated the expression of IL-10, Arg-1, NF-κB P65 and IKK-α (P < 0.001, P < 0.01, P < 0.05). SCE treatment could also promote the expression of miR-124 (P < 0.01). However, transfection with the miR-124 inhibitor increased TNF-α (P < 0.001), decreased the level of IL-10 (P < 0.05), increased the mRNA level and the protein expression of TNF-α and IBA-1 (P < 0.05, P < 0.01, P < 0.001), and decreased the mRNA level and protein expression of IL-10 and Arg-1 (P < 0.001, P < 0.01). In addition, the inhibition of TLR4 and MyD88 was attenuated. In conclusion, SCE appears to inhibit the activation of TLR4 signaling pathway by upregulating miR-124 so as to inhibit microglia M1 polarization and promote microglia M2 polarization.

Influencing factors of conversion from robot-assisted partial nephrectomy to radical nephrectomy / 现代泌尿外科杂志

【Objective】 To explore the influencing factors of planned robot-assisted partial nephrectomy (RAPN) converted to radical nephrectomy (RN). 【Methods】 Clinical data and operation records of 488 patients planned for RAPN in our hospital during 2015 and 2020 were retrospectively collected. The patients were divided into converted and unconverted groups, and relevant clinical data of the two groups were compared. The causes and influencing factors for conversion were analyzed. 【Results】 Among the 488 patients, 14 (2.9%) converted to RN. The causes included: ①complicated tumor anatomy and surgical difficulties; ②local advanced renal tumor suspected during operation; ③severe intraoperative hemorrhage. Univariate analysis showed that R. E. N. A. L score (P<0.001), E value (P<0.001), N value (P<0.001), L value (P<0.001), renal hilum position (P<0.001) and T stage (P=0.002) were influencing factors of conversion. 【Conclusion】 Causes for the conversion of RAPN to RN include complicated tumor anatomy, suspected local advanced renal tumor and severe intraoperative hemorrhage. The R. E. N. A. L score, E value, N value, L value, renal hilum position and T stage are influencing factors.

Optimization of parameters for stir-frying of Kansui Radix with vinegar based on conversion of toxic components / 中国中药杂志

This study aims to optimize the parameters for stir-frying of Kansui Radix with vinegar based on the conversion of representative toxic diterpenes, which is expected to serve as a reference for the standardized production of Kansui Radix stir-fried with vinegar. To be specific, the toxic components [3-O-(2'E,4'Z-decadienoyl)-20-O-acetylingenol(3-O-EZ), kansuiphorin C(KPC)] in Kansui Radix and the products(ingenol, 20-deoxyingenol) after the stir-frying with vinegar were selected. The toxicity to intestine and water-draining activity were evaluated with NCM460(normal human colon mucosal epithelial cell line) and HT-29(a human colorectal adenocarcinoma cell line). An HPLC method was then developed to assess the conversion of toxic components. On this basis, temperature, time, and amount of vinegar for the processing of Kansui Radix were optimized with the Box-Behnken design and the content of ingenol and 20-deoxyingenol as evaluation index. The results showed that after the stir-frying of Kansui Radix with vinegar, 3-O-EZ and KPC were first converted to monoester 3-O-(2'E,4'Z-decadienoyl)ingenol(3-EZ) and 5-O-benzoyl-20-deoxyingenol(5-O-Ben) and finally to almost non-toxic ingenol and 20-deoxyingenol, respectively. Meanwhile, the water-draining activity was retained. Six compounds had a good linear relationship with the peak area in the corresponding concentration ranges(R~2≥0.999 8), and the average recovery fell in the range of 98.20%-102.3%(RSD≤2.4%). The content of representative diterpenes and intermediate products was 14.78%-24.67% lower in the Kansui Radix stir-fried with vinegar than in the Kansui Radix, while the content of the conversed products was 14.37%-71.37% higher. Among the process parameters, temperature had significant influence on the total content of products, followed by time. The optimal parameters were 210 ℃, 15 min, and 30% vinegar. The relative error between the experimental results and the predicted values was 1.68%, indicating that the process was stable and reproducible. The strategy of screening optimal parameters for stir-frying of Kansui Radix with vinegar based on the transformation of toxic components can help improve the production stability, reduce the toxicity, and ensure the efficacy of Kansui Radix stir-fried with vinegar, which can serve as a reference for the process optimization of similar toxic Chinese medicinals.

Modeling human pregastrulation development by 3D culture of blastoids generated from primed-to-naïve transitioning intermediates

Human pluripotent stem cells provide an inexhaustible model to study human embryogenesis in vitro. Recent studies have provided diverse models to generate human blastoids by self-organization of different pluripotent stem cells or somatic reprogramming intermediates. However, whether blastoids can be generated from other cell types or whether they can recapitulate postimplantation development in vitro is unknown. Here, we develop a strategy to generate human blastoids from heterogeneous intermediates with epiblast, trophectoderm, and primitive endoderm signatures of the primed-to-naïve conversion process, which resemble natural blastocysts in morphological architecture, composition of cell lineages, transcriptome, and lineage differentiation potential. In addition, these blastoids reflect many features of human peri-implantation and pregastrulation development when further cultured in an in vitro 3D culture system. In summary, our study provides an alternative strategy to generate human blastoids and offers insights into human early embryogenesis by modeling peri- and postimplantation development in vitro.

Influencing factors of negative conversion time of nucleic acid detection in 228 patients infected with Omicron variant of SARS-CoV-2 in Shanghai / 中国热带医学

@#Abstract: Objective To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods　The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (≤18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results　The mean nucleic acid conversion time of 228 patients was (18.7±12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2±2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8±1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P>0.05); however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P<0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P<0.05). Conclusions The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

Investigation and clarification of traditional measuring units of Tibetan medicine / 中国中药杂志

Quantity is the key factor to ensure the safety and effectiveness of medicines. It is very important to study and determine the traditional measuring units and their quantity values of Tibetan medicine. Based on the literature records of Tibetan medicine and combined with modern experimental verification and investigation research, this study determined the reference, name, and conversion rate of traditional measuring units of Tibetan medicine. Meanwhile, through large sample sampling and repeated quantification of refe-rence of basic units, its weight and volume were clarified. The modern SI volume and weight unit values corresponding to the traditional volume and weight units of Tibetan medicine were deduced, and the correctness, reliability, and practicability of these determination results were demonstrated. This study also put forward some specific suggestions and reference values for formulating the standards of measuring units of weight and volume of Tibetan medicine. It is of great significance in guiding the processing, production, and clinical treatment of Tibetan medicine, and promoting the standardization and standardized development of Tibetan medicine.