Endoscopic retrograde appendicitis treatment for periappendiceal abscess: A case report.

BACKGROUND: Acute appendicitis is the most common abdominal emergency. At present, the main treatments for periappendiceal abscess include antibiotics and surgery. However, the complications and mortality of emergency surgery are high. The preferred therapy is conservative treatment with antibiotics first, ultrasound-guided puncture drainage or surgical treatment is followed when necessary. Endoscopic retrograde appendicitis therapy (ERAT) for acute uncomplicated appendicitis have been proved clinically effective, but it is rarely used in periappendiceal abscess. CASE SUMMARY: We report a patient admitted to hospital because of "right lower abdominal pain for six days". The computerized tomography (CT) of patient showed that appendicitis with fecaliths and abscess in the pelvis. The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths, irrigation and stent placement. CONCLUSION: The patient did not receive surgery because of impoverished family. Abdominal pain did not recur during the follow-up period. This case confirms the value of ERAT in the treatment of periappendiceal abscess.

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report.

BACKGROUND: Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma, iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy. Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography (ERCP) are uncommon and potentially life threatening and should be identified and treated rapidly. CASE SUMMARY: We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP. The patient primary diagnosis was acute biliary pancreatitis with cholangitis, he underwent ERCP on the third day of admission. During ERCP, the left intrahepatic bile duct was cannulated three times. Over the sixth day, Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation. The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically. CONCLUSION: The common complications of ERCP are pancreatitis, bleeding and perforation. False aneurysms occur as a result of damage to the wall of an artery. As far as we know, it is rare complication has been reported following ERCP. We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.

Theoretical Study of Hydrogen Production from Ammonia Borane Catalyzed by Metal and Non-Metal Diatom-Doped Cobalt Phosphide.

The decomposition of ammonia borane (NH3BH3) to produce hydrogen has developed a promising technology to alleviate the energy crisis. In this paper, metal and non-metal diatom-doped CoP as catalyst was applied to study hydrogen evolution from NH3BH3 by density functional theory (DFT) calculations. Herein, five catalysts were investigated in detail: pristine CoP, Ni- and N-doped CoP (CoPNi-N), Ga- and N-doped CoP (CoPGa-N), Ni- and S-doped CoP (CoPNi-S), and Zn- and S-doped CoP (CoPZn-S). Firstly, the stable adsorption structure and adsorption energy of NH3BH3 on each catalytic slab were obtained. Additionally, the charge density differences (CDD) between NH3BH3 and the five different catalysts were calculated, which revealed the interaction between the NH3BH3 and the catalytic slab. Then, four different reaction pathways were designed for the five catalysts to discuss the catalytic mechanism of hydrogen evolution. By calculating the activation energies of the control steps of the four reaction pathways, the optimal reaction pathways of each catalyst were found. For the five catalysts, the optimal reaction pathways and activation energies are different from each other. Compared with undoped CoP, it can be seen that CoPGa-N, CoPNi-S, and CoPZn-S can better contribute hydrogen evolution from NH3BH3. Finally, the band structures and density of states of the five catalysts were obtained, which manifests that CoPGa-N, CoPNi-S, and CoPZn-S have high-achieving catalytic activity and further verifies our conclusions. These results can provide theoretical references for the future study of highly active CoP catalytic materials.

The HBV Specially-Related Long Noncoding RNA HBV-SRL Involved in the Pathogenesis of Hepatocellular Carcinoma.

Hepatitis B virus (HBV) is one of the major risk factors for HCC (hepatocellular carcinoma) occurrence with a diverse role in the pathogenesis of HCC. More works need to be performed to elucidate a more thorough understanding of the molecular mechanisms involving in HBV-induced HCC, although some mechanisms such as genome integration have been reported. In the present study, aberrantly expressed lncRNAs were identified between HCC tumor tissues with or without HBV infection. Among these molecules, HBV specially-related long noncoding RNA (HBV-SRL) was further found to correlate with poor prognosis and a shorter overall survival time in HCC patients with HBV infection. Additionally, HBV-SRL was found function as oncogene by upregulating the NF-κB2 expression. These data suggest that HBV infection altered gene expression pattern in liver cells which contributed to HBV-related HCC development, and HBV-SRL may serve as a new molecular marker or potential therapeutic target of HBV-related HCC.

Impact of metformin use on risk and mortality of hepatocellular carcinoma in diabetes mellitus.

BACKGROUND: The views regarding the associations between metformin use and hepatocellular carcinoma (HCC) among diabetes mellitus (DM) patients are divisive. Thus we summarized all available published studies evaluating the relationship between metformin therapy and HCC survival and risk, and aim to conduct an updated meta-analysis study to more accurately clarify the association. METHODS: We searched for articles regarding impact of metformin use on risk and mortality of HCC in DM and published before April 2021 in databases (PubMed and Web of Science). We used STATA 12.0 software to compute odds ratios (ORs)/relative risks (RRs) or hazard ratios (HRs) and their 95% confidence intervals (CIs) to generate a computed effect size and 95% CI. RESULTS: The present study showed that metformin use was associated with a decreased risk of HCC in DM with a random effects model (OR/RR = 0.59, 95% CI 0.51-0.68, I2 = 96.5%, p < 0.001). In addition, the study indicated that metformin use was associated with a decreased all-cause mortality of HCC in DM with a random effects model (HR = 0.74, 95% CI 0.66-0.83, I2 = 49.6%, p = 0.037). CONCLUSION: In conclusion, our studies support that the use of metformin in DM patients is significantly associated with reduced risk and all-cause mortality of HCC. And more prospective studies focusing on the metformin therapy as a protective factor for HCC are needed to verify the accuracy of the findings.

Clinical recovery after 5 level of posterior decompression spine surgeries in patients with cervical spondylotic myelopathy: A retrospective cohort study.

BACKGROUND/OBJECTIVE: The selection of surgical technique in patients with cervical spondylotic myelopathy relies on the surgeon(s) and patients' conditions. The objectives of the study were to test the hypotheses that French-door laminoplasty recovers faster than laminectomy and has good outcome measures. METHODS: Data regarding surgical, radiological, and clinical outcome measures of 330 patients with cervical spondylotic myelopathy operated under French-door laminoplasty (fdLP group, n = 110), open-door laminoplasty (odLP group, n = 110), or laminectomy (LC group, n = 110) were collected from the records of institute and analyzed. RESULTS: Patients of fdLP group (p < 0.0001, q = 11.65) and odLP group (p < 0.0001, q = 11.27) both had significantly improved modified Rankin scale score than those of LC group. In addition, patients of fdLP group had minimum blood loss during operations and that was maximum for patients of the LC group. Unlike patients of fdLP group (p < 0.0001, q = 80) and LC group (p < 0.0001, q =122), those of odLP group had lost more amount of cervical lordotic after surgery. Open-door laminoplasty had significantly reduced cervical range of motion than laminectomy (p < 0.0001, q = 15.45) and French-door laminoplasty (p < 0.0001, q = 13.45). After 12-months, fdLP group had higher bone union rate than odLP group (p = 0.007, q = 3.395) and LC group (p = 0.007, q = 4.243). French door laminoplasty had a better postoperative quality of life. CONCLUSIONS: Among the posterior decompression spine surgeries, French-door laminoplasty is superior surgical procedure than laminectomy and could be superior surgical technique than open-door laminoplasty.

Diagnosing Perioperative Cardiovascular Risks in Noncardiac Surgery Patients.

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed.

Abnormal expression of long noncoding RNA FGD5-AS1 affects the development of periodontitis through regulating miR-142-3p/SOCS6/NF-κB pathway.

Periodontitis refers to the inflammation of gums and the surrounding structures and caused by a bacterial infection. The infection occurs owing to poor oral hygiene and could destroy the bone and the gum over time if left untreated. The present study identified the involvement of a key long noncoding RNA (lncRNA), i.e. FGD5-AS1, in the pathogenesis of periodontitis by assessing its expression in the gingival tissues of patients diagnosed with chronic periodontitis (CP). Overexpression of FGD5-AS1 in primary human periodontal ligament cells (PDLCs) significantly reduced the lipopolysaccharide (LPS)-induced periodontitis, whereas its suppression aggravated this injury. Moreover, the miR-142-3p was markedly expressed in the gingival samples of patients diagnosed with CP and LPS-induced PDLCs. We found that the FGD5-AS1-mediated reduction in the inflammation was mediated through downside regulation of miR-142-3p, as evident from the upregulation of SOCS6, a target gene of miR-142-3p. Furthermore, the association between FGD5-AS1 and NF-κB pathway was detected. FGD5-AS1 was found to protect against LPS-stimulated PDLC injury through restraining the NF-κB signals. Based on these findings, we conclude that up-regulation of lncRNA FGD5-AS1 could protect against periodontitis via regulating the miR-142-3p/SOCS6/NF-κB signals. Therefore, the FGD5-AS1/miR-142-3p/SOCS6 axis may act as an important indicator in explaining the pathogenesis of periodontitis.

Effect of an Er:YAG laser combined with sodium hypochlorite on the elimination of Enterococcus faecalis in the root canal / 口腔疾病防治

Objective@#To observe the killing and clearance effect of an Er:YAG laser combined with sodium hypochlorite on Enterococcus faecalis at different depths of the root canal in vitro to provide a reference for clinical application.@*Methods @#A total of 75 models of Enterococcus faecalis infection were successfully established and randomly divided into three groups (25 per group). Ten random samples per group underwent no processing. The remaining models in group A were treated with an Er:YAG laser combined with sodium hypochlorite 52.5 g/L. Group B was treated with 52.5 g/L sodium hypochlorite (positive control), and group C was treated with normal saline (negative control). The bacterial reduction rate was calculated for each group. The bactericidal effect on the surface of the root canal wall was observed in 5 samples by scanning electron microscopy.@*Results@#There was no statistically significant difference (P > 0.05) between group A (100.00 ± 0.00) and group B (98.62 ± 2.01) but was a statistically significant difference between group A (100.00 ± 0.00) and group C (64.37 ± 2.45) (P < 0.05). The percentage reduction in bacteria was higher in group A (99.46 ± 2.31) than in groups B (92.89 ± 3.07) and C (56.72 ± 4.96) (P < 0.05). The decrease in bacteria was greater in group A (97.62 ± 3.73) than in groups B (72.49 ± 2.35) and C (44.42 ± 4.78) (P < 0.05). The bacterial reduction rate in group A (95.89 ± 2.46) was higher than that in groups B (63.88 ± 1.08) and C (33.31 ± 5.21) (P < 0.05). There were significant differences at different dentin depths in the bacterial reduction rates among groups A, B and C (P < 0.05). Electron microscopy analysis showed that the Er:YAG laser combined with 52.5 g/L sodium hypochlorite was better than either treatment alone at removing bacteria from the surface of the root canal wall.@*Conclusion@# An Er:YAG laser can effectively enhance the bactericidal effect of sodium hypochlorite on the inner wall of the root canal.

A simple and effective prognostic staging system based on clinicopathologic features of intrahepatic cholangiocarcinoma.

UNLABELLED: Incidence and mortality of intrahepatic cholangiocarcinoma (ICC) are increasing. However, its prognostic predictive system associated with outcome after surgery remains poorly defined. In this study, we conducted retrospective survival analyses in a primary cohort of 370 patients who underwent partial hepatectomy for ICC (2005 and 2009). We found that seven variables were significantly independent predictors for overall survival (OS): serum prealbumin (hazard ratio [HR]: 1.447; p = 0.015), carbohydrate antigen 19-9 (HR: 1.438; p = 0.009), carcinoembryonic antigen (HR: 1.732; p = 0.002), tumor number (HR: 1.781; p < 0.001), vascular invasion (HR: 1.784; p < 0.001), regional lymphatic metastasis (HR: 2.003; p < 0.001) and local extrahepatic metastasis (HR: 1.506; p = 0.008). Using these independent predictors, we created a simple clinicopathologic prognostic staging system for predicting survival of ICC patients after resection. The validity of the prognostic staging system was prospectively assessed in 115 patients who underwent partial hepatectomy between January 2010 and December 2010 at the same institution. The prognostic power was quantified using likelihood ratio test and Akaike information criteria. Compared with the 6(th) and 7(th) AJCC staging systems, the new staging system in the primary cohort had a higher predictive accuracy for OS in terms of homogeneity and discriminatory ability. In the validation cohort, the homogeneity and discrimination of the new staging system were also superior to the two other staging systems. CONCLUSIONS: The new staging system based on clinicopathologic features may provide relatively higher accuracy in prognostic prediction for ICC patients after tumor resection.

Level of hepatitis B surface antigen might serve as a new marker to predict hepatocellular carcinoma recurrence following curative resection in patients with low viral load.

To investigate the association between preoperative HBsAg (hepatitis B surface antigen) level and risk of HCC (hepatocellular carcinoma) recurrence following curative resection, we enrolled 826 HBV-related HCC patients who underwent curative resection and received long-term follow-up at the Eastern Hepatobiliary Surgery Hospital (Shanghai, China). Multivariate analyses showed that serum HBsAg ≥ 2000 S/CO, seropositive hepatitis B e antigen (HBeAg), γ-glutamyl transpeptidase > 61 U/L, prothrombin time > 13 s, multinodularity, lager tumor size, and major portal vein invasion were independently associated with a increased risk of HCC recurrence. Compared with HCC patients with HBsAg level < 2000 S/CO, HCC patients with HBsAg level ≥ 2000 S/CO had a higher prevalence of seropositive HBeAg, antiviral therapy, and cirrhosis; were younger; and had a higher levels of alanine transaminase (ALT), aspartate aminotransferase (AST), and HBV viral load. Multivariable stratified analyses showed HCC patients with HBsAg level < 2000 S/CO tended to have a lower incidence of HCC recurrence in following subgroups of patients, including for noncirrhotic (HR, 0.561; 95% CI, 0.345-0.914), HBV DNA < 2000 IU/mL (HR, 0.604; 95% CI, 0.401-0.912), ALT ≤ 41 U/L (HR, 0.643; 95% CI, 0.440-0.942), AST ≤ 37 U/L (HR, 0.672; 95% CI, 0.459-0.983), and seronegative HBeAg (HR, 0.682; 95% CI, 0.486-0.958). When we evaluated HBeAg-negative patients with HBV DNA < 2000 IU/mL, HBsAg level still determined risk of HCC recurrence (p = 0.014), but not HBV DNA (p = 0.550) and ALT (p = 0.186). These results suggest high levels of HBsAg increase risk of HCC recurrence following curative resection. HBsAg level might serve as a new marker to complement HBV DNA level in predicting HCC recurrence, especially in HBeAg-negative patients with low viral load.

Mutational landscape of intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is a fatal primary liver cancer (PLC) that affects 5-10% of all PLCs. Here we sequence tumour and matching control sample pairs of a large cohort of 103 ICC patients in China, resulting in the identification of an ICC-specific somatic mutational signature that is associated with liver inflammation, fibrosis and cirrhosis. We further uncover 25 significantly mutated genes including eight potential driver genes (TP53, KRAS, IDH1, PTEN, ARID1A, EPPK1, ECE2 and FYN). We find that TP53-defective ICC patients are more likely to be HBsAg-seropositive, whereas mutations in the oncogene KRAS are nearly exclusively found in HBsAg-seronegative ICC patients. Three pathways (Ras/phosphatidylinositol-4,5-bisphosphate 3-kinase signalling, p53/cell cycle signalling and transforming growth factor-ß/Smad signalling), genes important for epigenetic regulation and oxidative phosphorylation are substantially affected in ICC. We reveal mutations in this study that may be valuable for designing further studies, better diagnosis and effective therapies.

Occult hepatitis B virus infection in Chinese cryptogenic intrahepatic cholangiocarcinoma patient population.

BACKGROUND: There is no information available about occult hepatitis B virus (HBV) infection (OBI) in individuals with intrahepatic cholangiocarcinoma (ICC). GOALS: To investigate the correlation between OBI and ICC. STUDY: A retrospective case-control study was conducted. The cases were 183 cryptogenic ICC patients (group I), and the controls were 549 healthy individuals (group II). The cases and controls were matched for age, sex, and inhabitancy. Adjusted odds ratios and 95% confidence intervals were calculated. Intrahepatic total HBV DNA in 63 paraffin-embedded samples was collected from patients in group I (n=44), HBV-associated ICC patients (n=3), and hepatic cavernous hemangioma patients with seronegative HBsAg (hepatitis B S antigen) (group III; n=16). We determined the levels of serum and intrahepatic HBV DNA and compared the level of intrahepatic HBV DNA in 44 cryptogenic patients from group I with the level in the patients from group III. RESULTS: Compared with group II, group I had a lower prevalence of anti-HBs (antibody against HBsAg) and a higher prevalence of anti-HBe (antibody against hepatitis B e antigen) and anti-HBc (antibody against hepatitis B c antigen). Multivariate analysis confirmed that anti-HBe and anti-HBc positivity were associated with ICC. The odds ratios and 95% confidence intervals for anti-HBe and anti-HBc were 2.482 and 1.482-4.158, 4.556 and 2.938-7.066, respectively. Compared with group III, cryptogenic ICC cases showed more frequent detection of intrahepatic total HBV DNA (63.64% vs. 18.75%, P=0.002). CONCLUSIONS: OBI may represent an important risk factor for ICC. HBsAg seroclearance does not signify eradication of HBV and may not entirely prevent the development of ICC.

Fucoidan derived from Undaria pinnatifida induces apoptosis in human hepatocellular carcinoma SMMC-7721 cells via the ROS-mediated mitochondrial pathway.

Fucoidans, fucose-enriched sulfated polysaccharides isolated from brown algae and marine invertebrates, have been shown to exert anticancer activity in several types of human cancer, including leukemia and breast cancer and in lung adenocarcinoma cells. In the present study, the anticancer activity of the fucoidan extracted from the brown seaweed Undaria pinnatifida was investigated in human hepatocellular carcinoma SMMC-7721 cells, and the underlying mechanisms of action were investigated. SMMC-7721 cells exposed to fucoidan displayed growth inhibition and several typical features of apoptotic cells, such as chromatin condensation and marginalization, a decrease in the number of mitochondria, and in mitochondrial swelling and vacuolation. Fucoidan-induced cell death was associated with depletion of reduced glutathione (GSH), accumulation of high intracellular levels of reactive oxygen species (ROS), and accompanied by damage to the mitochondrial ultrastructure, depolarization of the mitochondrial membrane potential (MMP, Δψm) and caspase activation. Moreover, fucoidan led to altered expression of factors related to apoptosis, including downregulating Livin and XIAP mRNA, which are members of the inhibitor of apoptotic protein (IAP) family, and increased the Bax-to-Bcl-2 ratio. These findings suggest that fucoidan isolated from U. pinnatifida induced apoptosis in SMMC-7721 cells via the ROS-mediated mitochondrial pathway.

Fucoidan extract derived from Undaria pinnatifida inhibits angiogenesis by human umbilical vein endothelial cells.

In recent years, anti-angiogenic therapy has become an effective strategy for inhibiting tumor growth. Fucoidan is a class of fucose-enriched sulfated polysaccharides found in brown algae, and it is known to have strong anti-tumor property. Using a human umbilical vein endothelial cells (HUVEC)-based cell culture model, the present study investigated the anti-angiogenic activity of fucoidan extracted from the brown seaweed Undaria pinnatifida. Treatment of HUVECs with various concentrations of fucoidan resulted in significant inhibition of cell proliferation, cell migration, tube formation and vascular network formation. However, significant inhibition of cell proliferation only occurred with longer treatment time (48 h instead of 24h or less). About 40% of cell proliferation and cell migration and 61% of tube formation by HUVECs were inhibited by 400 µg/ml fucoidan, the maximum concentration tested. These results appeared to suggest that modulation of angiogenesis by fucoidan might not occur through growth inhibition and apoptosis. Ex vivo angiogenesis assay demonstrated that at 100 µg/ml, fucoidan caused significant reduction in microvessel outgrowth. Western blot and RT-PCR analyses indicated that at 400 µg/ml, fucoidan significantly reduced the expression of the angiogenesis factor VEGF-A in the suppression of angiogenesis activity. Our results showed that fucoidan isolated from U. pinnatifida may have a new therapeutic potential in the prevention angiogenesis-related diseases.

[The modulating of aloe polysaccharides on the cell cycle and cycle regulating protein expression in X-ray irradiated non-malignant cells].

OBJECTIVE: To study the modulating of Aloe Polysaccharides on the cell cycle and cycle regulating protein expression in X-ray irradiated non-malignant cells. METHODS: The cell cycle was analyzed by flow cytometric analyzed. The levels of cell cycle regulating protein expression were tested by Western blot. RESULTS: A distinct G2/M block happened in 293 and C. Liver cells after irradiation. The pre-treatment of AP in the concentration of 50 microg/ml caused an increasing G0/G1 phase population and decreasing G2/M phase population. Meanwhile, pre-treatment of AP could significantly decrease the high expression of p53 protein caused by irradiation and evidently enhance the expression of P21, Cyclin B1 and pRb protein. Pre-treatment of AP had no evident effect on p27,CDK4 and Cyclin D1 protein. CONCLUSION: There is a radioprotective effect of AP on non-malignant cells. This effect is related to alleviating the cell cycle turbulence. The modulating of Aloe Polysaccharides on the cell cycle regulating protein expression in X-ray irradiated non-malignant cells contributes to its alleviating effect on the cell cycle turbulence.

Protective effects of polydatin against CCl(4)-induced injury to primarily cultured rat hepatocytes.

AIM:To investigate the protective effects of polydatin (PD) against injury to primarily cultured rat hepatocytes induced by CCl(4).METHODS:Rat hepatocytes were separated by methods of liver infusion in vivo and cultured medium (7.5X10(5) cells/mL). Two mL or 0.2mL was added into 24-well or 96-well plates respectively. Twenty-four hours after cell preculture, PD at concentrations of 10(-7) mol/L-10(-4)mol/L was added into each plate. At the same time injury to hepatocytes was induced by adding 10mmol/L CCl(4).Then, 0.1mL or 1mL culture solution was removed from the 96-well or 24-well plates at 6h, 12h, 24h and 48h after CCl14 intoxication respectively for the determination of GPT, GSH and MDA. At 48h, the survivability of rat hepatocytes was assayed by the MTT colormetric method.RESULTS:After CCl(4) challenge, the release of GPT and the formation of MDA in rat hepatocytes markedly increased and maintained at a high level in 48h, whereas PD with different concentrations could markedly inhibit this elevation with 10(-5)mol/L PD having the strongest effects and inhibiting rate was over 50%. PD could also improve the decreased content of GSH caused by CCl(4) in accordance with the doses used. CCl(4) evidently decreased the hepatocyte survivability from 91.0% ± 7.9% to 35.4% ± 3.8%. On the other hand, PD at 10(-7)mol/L-10(-4)mol/L could reverse this change and improve the cell survival rates to 56.1% ± 5.2%, 65.8% ± 5.0%, 88.7% ± 6.8% and 75.2% ± 7.3%, respectively.CONCLUSION: PD at 10(-7)mol/L-10(-4)mol/L could protect primarily cultured rat hepatocytes against CCl(4) induced injury.