HNF1ɑ promotes colorectal cancer progression via HKDC1-mediated activation of AKT/AMPK signaling pathway.

The hepatocyte nuclear factor-1 (HNF1ɑ) is a transcription factor that contributes to several kinds of cancer progression. However, very little is known regarding the mechanisms underlying the activity of HNF1ɑ. We aimed to explore the role of HNF1ɑ in the progress of colorectal cancer (CRC) and elucidate its molecular mechanism. HNF1ɑ expression was upregulated in CRC samples and high expression of HNF1ɑ was associated with poor prognosis of CRC patients. HNF1α knockdown and overexpression inhibited and promoted proliferation, migration and invasion of CRC cells both in vitro and in vivo respectively. Mechanistically, HNF1ɑ increased the transcriptional activity of hexokinase domain component 1（HKDC1）promoter, thus activated AKT/AMPK signaling. Meanwhile, HKDC1 upregulation was important for the proliferation, migration and invasion of CRC cells and knockdown of HKDC1 significantly reversed the proliferation, migration and invasion induced by HNF1α overexpression. Taken together, HNF1ɑ contributes to CRC progression and metastasis through binding to HKDC1 and activating AKT/AMPK signaling. Targeting HNF1ɑ could be a potential therapeutic strategy for CRC patients.

Robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) for the treatment of gastric gastrointestinal stromal tumors in challenging anatomical locations: single-center experience.

Background: Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove. Methods: This study retrospectively analyzed the clinical data of 12 patients with gastric GISTs in challenging anatomical locations who underwent robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) and manual suturing of the gastric wall. Results: This study included 12 patients with a mean age of 56.8 ± 9.8 years and a mean BMI of 23.9 ± 1.9 kg/m2. Tumors were located in the GEJ (n = 3), lesser curvature (n = 3), posterior gastric wall (n = 3) and antrum (n = 3). The cardia and pylorus were successfully preserved in all patients regardless of the tumor location. The mean tumor size was 4.5 ± 1.4 cm. The mitotic-count/50 mm2 was less than 5 in all patients (100%). There was no intraoperative tumor rupture (0%) and no conversion to open surgery (0%). The median operation time was 122 (97-240) min, and the median blood loss volume was 10 (5-30) ml. The median postoperative VAS score was 2 (2-4). The median time to first flatus was 2 (2-3) days. The median time to first fluid intake was 2 (2-3) days. The median time to first ambulation after the operation was 3 (2-4) days. No cases of anastomotic stenosis or leakage were found. The median time to drain removal for 6 patients was 5 (4-7) days. The median time to nasogastric tube removal for all patients was 2 (1-5) days. The median postoperative hospital stay was 5 (4-8) days. One patient (female/41 year) developed moderate anemia (Clavien-Dindo grade II complication). There was no unplanned readmission within 30 days after the operation. The median distance from the tumor to the resection margin was 1 (1-2) cm. R0 resection was achieved in all patients. The median follow-up period was 19 (10-25) months, and all patients survived with no recurrence or metastasis. Conclusions: RALE-PG is a safe, feasible and advantageous technique for treating GISTs in challenging anatomical locations. It can be used to accurately remove the tumor while preserving gastric function to the greatest extent, but long-term oncologic outcomes need to be evaluated in a study with a larger sample size and longer follow-up period.

Full-Spectrum Utilization of ZIF-67/Ag NPs/NaYF4:Yb,Er Photocatalysts for Efficient Degradation of Sulfadiazine: Upconversion Mechanism and DFT Calculation.

In this work, novel ternary composite ZIF-67/Ag NPs/NaYF4:Yb,Er is synthesized by solvothermal method. The photocatalytic activity of the composite is evaluated by sulfadiazine (SDZ) degradation under simulated sunlight. High elimination efficiency of the composite is 95.4% in 180 min with good reusability and stability. The active species (h+, ·O2 - and ·OH) are identified. The attack sites and degradation process of SDZ are deeply investigated based on theoretical calculation and liquid chromatography-mass spectrometry analysis. The upconversion mechanism study shows that favorable photocatalytic effectiveness is attributed to the full utilization of sunlight through the energy transfer upconversion process and fluorescence resonance energy transfer. Additionally, the composite is endowed with outstanding light-absorbing qualities and effective photogenerated electron-hole pair separation thanks to the localized surface plasmon resonance effect of Ag nanoparticles. This work can motivate further design of novel photocatalysts with upconversion luminescence performance, which are applied to the removal of sulphonamide antibiotics in the environment.

A modified chain-based sponge dressing controls junctional hemorrhage in the tactical combat casualty care simulation of pigs.

BACKGROUND: Hemorrhage has always been the focus of battlefield and pre-hospitalization treatment. With the increasing fatality rates associated with junctional bleeding, treatment of bleeding at junctional sites has gradually gained attention in battlefield trauma emergency care. We designed a modified chain-based sponge dressing with a medical polyvinyl alcohol sponge that can be used to treat junctional hemorrhage and tested its hemostatic efficacy and biocompatibility. METHODS: Twenty adult Bama miniature pigs were randomly divided into the modified chain-based sponge dressing (MCSD) and standard gauze (SG) groups. The right femoral artery of the pigs was shot at after anesthesia. The Bama miniature pigs were moved to the safety zone immediately to assess the condition according to the MARCH strategy, which evaluates massive hemorrhaging, airway obstruction, respiratory status, circulatory status, head injury & hypothermia. Hemoglobin and coagulation status were checked during the experiment.Among the pigs in which the inguinal hemorrhagic model based on bullet penetrating wounds was successfully established, those in the MCSD group received a disinfected MCSD for hemostasis, while those in the SG group received standard gauze in an imbricate manner to pack the bullet exit and entrance wounds to stop bleeding until the wound was filled, followed by compression for 3 min at sufficient pressure. CT scanning, transmission electron microscopy, and HE staining were conducted after experiment. RESULTS: The MCSD group showed lower hemostasis time and blood loss than the gauze group. The MCSD group also showed a higher success rate of treatment,more stable vital signs and hemoglobin level. The CT scanning results showed tighter packing without large gaps in the MCSD group. The histopathological assessments and the transmission electron microscopy and HE staining findings indicated good biocompatibility of the polyvinyl alcohol sponge. CONCLUSION: The MCSD met the battlefield's requirements of speedy hemostasis and biosafety for junctional hemorrhage in Bama miniature pigs. Moreover, in comparison with the conventional approach for hemostasis, it showed more stable performance for deep wound hemostasis. These findings provide the theoretical and experimental basis for the application of MCSD in the treatment of hemorrhage in the battlefield in the future.

Ultrasound-assisted carbon nanoparticle labeling of neoadjuvant chemotherapy for breast-conserving surgery in breast cancer.

Background: Neoadjuvant chemotherapy has gradually become an important means of breast cancer treatment; however, tumor regression following chemotherapy remains a concern. This study was conducted to investigate the effect of ultrasound-assisted carbon nanoparticle labeling in neoadjuvant chemotherapy for breast-conserving surgery in breast cancer. Methods: This was a prospective clinical trial study (clinical registration number: ChiCTR-OOC-15006844). Sixty-eight breast cancer patients confirmed by biopsy between July 2015 and January 2017 were randomly selected from the clinical data. Of these, 32 patients were screened for neoadjuvant chemotherapy, forming a consecutive, random series. An ultrasound-guided carbon nanotube was used to mark the original tumor, and sentinel lymph node biopsies were performed. After 4-6 cycles of standard neoadjuvant chemotherapy, 26 patients were selected for breast-conserving surgery. The feasibility and validity of carbon nanoparticle labeling were analyzed through the negative rate of incision margin, the volume of resected tumors, the detection rate of black-stained sentinel lymph nodes, the recurrence rate of ipsilateral breast, and postoperative survival. Results: In all, 32 patients underwent sentinel lymph node biopsy, 29 cases were detected (90.6%), the false-negative rate was 3.8% (1/26), and 0-4 sentinel lymph nodes (mean 1.8±1.1) were detected. A total of 26 patients underwent breast-conserving surgery, 5 underwent secondary excision, and 1 underwent subcutaneous adenectomy due to a positive margin. The minimum margin between the resected site and the infiltrated part was 1.0-2.1 cm (1.3±0.3 cm). The diameter of resected tumors ranged from 2.2 to 4.5 cm (3.1±0.6 cm). No recurrence or distant metastasis of ipsilateral breast tumors was observed during follow-up (the median follow-up time was 9 months). Conclusions: Ultrasound-assisted carbon nanoparticle labeling is effective for sentinel lymph node tracing before neoadjuvant chemotherapy and has a high detection rate for metastatic lymph nodes. During breast-conserving surgery, it can determine the extent of tumor resection to achieve precision surgical treatment.

Application of nano-carbon and titanium clip combined labeling in robot-assisted laparoscopic transverse colon cancer surgery.

BACKGROUND: Robot-assisted laparoscopic transverse colon tumor surgery requires precise tumor localization. The purpose of this study was to evaluate the safety and efficacy of nano-carbon and titanium clip combination labeling methods in robot-assisted transverse colon tumor surgery. METHODS: From January 2018 to January 2019, the clinical data of 16 patients who come from FuZhou, China underwent preoperative nano-carbon and titanium clip combined with robot-assisted laparoscopic transverse colon cancer surgery were retrospectively analyzed. RESULTS: Of the 16 patients, no signs of abdominal pain, fever, or diarrhea were observed after colonoscopy. Two titanium clips were seen on all of the 16 patients' abdominal plain films. Nano-carbon staining sites were observed during the operation, and no staining disappeared or abdominal cavity contamination. All patients underwent R0 resection. The average number of lymph nodes harvsted was 18.23 ± 5.04 (range, 9-32). The average time to locate the lesion under the laparoscopic was 3.03 ± 1.26 min (range, 1-6 min), and the average operation time was 321.43 ± 49.23 min (range, 240-400 min). All were consistent with the surgical plan, and there was no intraoperative change of surgical procedure or conversion to open surgery. CONCLUSION: Preoperative colonoscopy combined with nano-carbon and titanium clip is safe and effective in robot-assisted transverse colon cancer surgery. A At the same time, the labeling method shows potential in shortening the operation time, ensuring sufficient safety margin and reducing complications.

Application of chain-based sponge dressing for gunshot wounds in the groin.

BACKGROUND: With the application of limb tourniquet, junctional hemorrhage has outstripped extremity hemorrhage as the leading cause of death during recent conflicts in Afghanistan and Iraq. We used a gunshot wound femoral artery bleeding model to verify the effect of chain-based sponge dressing (CSD). METHODS: We used a rifle to shoot the femoral artery of female Bama miniature pigs to achieve a gunshot wound model. Pigs were immediately subjected to CSD (n = 4) or standard gauze (SG; n = 4) to achieve hemostasis. We compared outcomes between the CSD and SG groups. RESULTS: There was no significant difference in baseline data between the two groups. The average hemorrhage time was 38.75 ± 9.29 s after CSD and 630.75 ± 169.46 s after SG (p < 0.05). The success rate in the CSD group was 100% (4/4), while the success rate in the SG group was 25% (1/4). The survival time of the CSD group (120 min) was significantly longer compared with the SG group (62.25 min; p < 0.05). There was no statistically significant difference in the average time for removal of the hemostatic material between the two groups. One week after the experiment, animals had a normal diet and were walking. No secondary damage was caused by CSD. CONCLUSION: We used a gun-shot wound model to verify the effectiveness of CSD in the groin area. CSD achieved hemostasis quickly in all animals, and mean arterial pressure remained at normal levels. These findings suggest that CSD may be appropriate for humans with junctional hemorrhage due to bullet wounds, although further research is needed.

Ingested a fish bone-induced ileal perforation: A case report.

INTRODUCTION: Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone. CASE PRESENTATION: A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago. DIAGNOSIS: Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body. INTERVENTIONS: Partial intestinal resection and manual ileum end anastomosis were performed. OUTCOMES: The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain. CONCLUSION: An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.

A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment.

Aim: In this study, we examined the effects of branched silicon tube (BST) and temporary closed circle (TCC) in a Beagle dog model of multiple transection of small intestine and discontinuities suspected intestinal necrosis with hemorrhagic shock. Materials and Methods: Ten male Beagle dogs were randomly divided into two groups. Hemorrhagic shock was induced by bleeding. Intestine was severed. Suspected intestinal necrotic model by ligating the mesenteric vessels was established, with a small tertiary mesenteric vessel reserved. Fracted intestines were ligated (IL group, n = 5) or reconnected with BST (IR group, n = 5). The abdominal cavity was temporarily closed with TCC. Definitive surgery was conducted after 24 h. Results: There was no statistical difference between two groups in the weight of dogs, their blood loss, fluid resuscitation, operation time of early emergency treatment (EET). After definitive surgery, all dogs in IR group and 3 dogs in IL groups were alive. 18 (90%) suspicious necrotic intestinal segments in IL group became necrotic, but 20 (80%) segments in IR group didn't develop obvious changes (p < 0.01). From 2 h after EET, the endotoxin concentration in IL group was significantly higher than that in IR group (133.87 ± 43.73 vs. 56.31 ± 24.70 pg/ml, p < 0.01). Microscopic examination revealed that much more severe damage occurred in the suspicious necrotic intestinal segments in IL group. Conclusion: Both reconnecting intestine with BST and temporary abdominal closure with TCC are viable methods of damage control for multiple discontinuous intestinal injuries.

An expandable one-way-valve device for chest wound treatment: Evaluation of open pneumothorax in a canine model.

BACKGROUND/OBJECTIVE: Thoracic injuries commonly occur after blunt or penetrating trauma, leading to a blowing wound. For thoracic damage control in emergency, we evaluated a novel chest wound treatment device manufactured using expandable material with a one-way valve, and compared it with closed thoracic drainage for first-line treatment of traumatic pneumothorax in a canine model. METHODS: Twenty beagle dogs (10 males and 10 females) were randomly and equally divided into two groups. After arteriovenous catheterization, an open pneumothorax model was established in the beagle dog using a minimally invasive procedure. The experimental group was treated using our test device, while the control group was treated by closed thoracic drainage. Animal survival, oxygen saturation (SO2), oxygen pressure (PO2), and changes in chest radiograph with reference to open pneumothorax before and after intervention were recorded at 30, 60, and 120 min. RESULTS: After a 24-h experimental period, all animals survived. The control group recovered more quickly than the experimental group at 30 min post-trauma. However, the indices were close to normal 120 min after the test device was inserted. During the puncture, chest-wall hemorrhage was stopped by using the device, whereas the control group experienced continual errhysis. The lung had almost re-expanded at the end of the experiment in both groups. The effect of pulmonary re-expansion in the control group was better than that in the experimental group at 120 min. CONCLUSION: The novel expandable one-way valve device is a safe and useful tool for the treatment of open chest trauma in emergency based on our animal experiment.

Duodenum Exclusion Alone Is Sufficient to Improve Glucose Metabolism in STZ-Induced Diabetes Rats.

BACKGROUND: Several studies have found that metabolic surgery can significantly improve glucose homeostasis; however, the intrinsic mechanisms remain unclear. Accumulating evidence suggests that duodenal bypass plays a crucial role in the treatment of type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the effect of duodenal reflux on glucose metabolism in T2DM. METHODS: A high-fat diet and low-dose streptozotocin (STZ) administration were used to induce T2DM in male rats, which were assigned to three experimental groups: sham operation (SO; n = 10), new duodenal-jejunal bypass (NDJB; n = 10), and new duodenal-jejunal bypass with a tube (NDJBT; n = 10). Weight, food intake, oral glucose tolerance test (OGTT) results, glucagon-like peptide 1 (GLP-1) levels, and histopathology were assessed before or after surgery. Plain abdominal radiography was performed 1 week after the operation. RESULTS: Plain abdominal radiography indicated the occurrence of contrast agent reflux into the duodenum. The body weight and food intake in all three groups did not significantly differ before and after surgery. The NDJB and particularly the NDJBT groups exhibited better glucose tolerance, lower fasting blood glucose (FBG) levels, lower area under the curves for OGTT (AUCOGTT) values, and higher GLP-1 levels, as compared with the sham group postoperatively. The villus height and crypt depth were both shorter in the biliopancreatic limb after NDJBT, as compared with those after SO and NDJB. CONCLUSIONS: Thus, exclusion of the duodenum alone and tube placement can effectively prevent duodenal reflux and improve glucose homeostasis, which further suggests that the duodenum plays an important role in T2DM.

Successful diagnosis and treatment of ingested wooden toothpicks: Two case reports.

RATIONALE: Foreign-body ingestion is a common phenomenon and foreign bodies are mostly excreted in stool. Once sharp bodies are ingested without being realized, perforation of intestine is possible and misdiagnosis may be made. We report 2 toothpick ingestion cases that were both diagnosed accurately. PATIENT CONCERNS: We present 2 cases of middle-aged persons who suffered from abdominal pain. They did not realize and provide any information of having the history of swallowing foreign bodies. DIAGNOSES: No serious problem was discovered in the examination and blood test. There were somewhere abnormal in computed tomography (CT) images and ultrasound (US). Then a toothpick was found penetrating the wall of intestine into the adjacent viscera in the laparotomy. INTERVENTIONS: Both patients in the 2 cases were undergone operation to remove the toothpicks. OUTCOMES: The 2 cases' prognoses were good. LESSONS: When accepting patients with abdominal pain, suitable examining means and careful observation should be given to find easily ignored lesions. CT is recommended in the diagnostic process of swallowed foreign mass. When there is a vague place, US can be used for further diagnose.

A novel method for multiple bowel injuries: a pilot canine experiment.

BACKGROUND: Intestinal ligation is the cornerstone for damage control in abdominal emergency, yet it may lead to bowel ischemia. Although intestinal ligation avoids further peritoneal cavity pollution, it may lead to an increased pressure within the bowel segments and rapid bacterial translocation. In this study, we showed that severed intestine could be readily reconnected by using silicon tubes and be secured by using rubber bands in a canine model. METHODS: Adult Beagle dogs, subject to multiple intestinal transections and hemorrhagic shock by exsanguination, randomly received conventional ligation vs. silicon tubes reconnecting (n = 5 per group). Intestinal transections were carried out under general anesthesia after 24-h fasting. The abdomen was opened with a midline incision. The small intestine was severed at 50, 100, and 150 cm below the Treitz ligament. Hemorrhagic shock was established by streaming blood from the left carotid artery until the mean arterial pressure reached 40 mmHg in 20 min. Fluid resuscitation and surgery began 30 min after the establishment of hemorrhagic shock. Severed intestines were ligated or connected with silicon tubes. Definitive repair was conducted in subjects surviving for at least 48 h. RESULTS: Operation time was comparable between the two groups (39.6 ± 8.9 vs. 36.6 ± 7.8 min in ligation and reconnecting groups, respectively; p = 0.56). The time spent in managing each resection was also comparable (4.6 ± 1.1 vs. 3.8 ± 0.84 min; p = 0.24). Blood loss (341.2 ± 28.6 vs. 333.8 ± 34.6 ml; p = 0.48), and fluid resuscitation within the first 24 h (1676 ± 200.6 vs. 1594 ± 156.5 ml; p = 0.46) were similar. One subject in the ligation group was sacrificed at 36-h due to severe vomiting that led to aspiration. Four remaining dogs in the ligation group received definitive surgery, but two out of four had to be sacrificed at 24-h after definitive repair due to imminent death. All five dogs in the reconnecting group survived for at least a week. Radiographic examination confirmed the integrity of the GI tract in the reconnecting group. In both groups, plasma endotoxin concentration increased after damage control surgery, but the increase was much more pronounced in the ligation group. Microscopic examination of the involved segment of the intestine revealed much more severe pathology in the ligation group. CONCLUSION: The current study showed that the reconnecting resected intestine by using silicon tubes is feasible under emergency. Such a method could decrease short-term mortality and minimize endotoxin translocation.

[Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection].

OBJECTIVE: To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection. METHODS: Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection: 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites (upper, lower, left and right) of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized. RESULTS: All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years(range 35-70), completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes(range 5-10). No bleeding, no perforation and no adverse reaction occurred. Four to 21(10±3.5) days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes(range 1-5). All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180(120±30) min, and the blood loss was 50 ~ 200(50±15) ml. There was no intraoperative complications. The first gas passage time was 12 to 48(24±8) h. The postoperative hospital stay was 10 to 3(6.5±2.5) d. There was no postoperative complication and no perioperative mortality. CONCLUSION: Nano carbon tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early colon cancer, and it can improve the safety and precision of surgical procedures, especially for laparoscopic surgery.

Bromodomain protein 4 is a novel predictor of survival for gastric carcinoma.

Expression of bromodomain protein 4 (BRD4) has been reported to predict a worse prognosis in solid tumors. However, its expression profile and prognostic value in gastric carcinoma (GC) remains unknown. Here we investigated BRD4 expression in GC and explored its association with patient survival. Tissue samples were obtained from 95 GC patients who underwent surgical resection to remove the primary tumor from January 2009 to December 2010. Immunohistochemistry was used to detect the expression of BRD4 in GC tissues and adjacent normal tissues. Kaplan-Meier survival curves and Cox proportional hazards regression were used to analyze the data of BRD4 expression profile and clinicopathological characteristics. Immunohistochemical analysis revealed BRD4 was overexpressed in GC tissue compared with adjacent normal tissue. BRD4 expression was significantly associated with TNM stage (p < 0.001), lymphatic permeation (p = 0.011), and vital status at the end of follow-up (p < 0.001). Kaplan-Meier survival curves and the log-rank test demonstrated that higher BRD4 expression was an adverse predictive factor for survival in GC. Multivariate analysis by Cox proportional hazards regression revealed that BRD4 expression was an independent worse prognostic factor in GC. In conclusion, BRD4 could act as a potential biomarker for prognostic assessment of GC.