Safety and effectiveness of totally laparoscopic total gastrectomy vs laparoscopic-assisted total gastrectomy: a meta-analysis.

BACKGROUND: For gastric cancer with total gastrectomy, the usual laparoscopic surgical approaches are totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG). Due to its difficult anastomotic technique, the adoption of TLTG is limited. Therefore, surgeons prefer using LATG, which also led to TLTG being somewhat overlooked, so there is no clear conclusion today as to which surgical procedure is more favorable to the patient's recovery. This article aimed to compare the safety and short-term outcomes of the two surgical approaches. MATERIALS AND METHODS: Studies comparing TLTG and LATG, published up to December 2022, were searched in PubMed, Web of Science, and Embase databases. The study outcomes, including operative time, blood loss, anastomosis time, number of retrieved lymph nodes, proximal and distal resection margins, time to first fluid and soft diet, hospitalization duration, time to first flatus, and postsurgical and anastomotic complications, were compared between these two different surgical procedures. Statistics were analyzed with RevMan 5.4 and Stata 13.1. RESULTS: Fifteen publications were included in this study. The total sample included 3023 cases. The meta-analysis revealed no significant difference in overall postoperative complications between the two surgical approaches ( P >0.05). Compared with LATG, TLTG led to reduced intraoperative blood loss ( P <0.0001), an increased number of lymphatic node dissections ( P <0.0001), and decreased hospitalization duration ( P =0.002). However, operative time, anastomosis time, pulmonary infection, resection margins, time to first fluid and soft diet, time to first flatus and anastomosis-related complications were no significant difference between TLTG and LATG groups ( P >0.05). CONCLUSION: TLTG did not lead to an increase in overall postoperative complications, which is a reliable surgical approach for treatment of gastric cancer. Moreover, it may reduce harm to patients and enable them to obtain better surgical outcomes.

Intravenous dexamethasone administration during anesthesia induction can improve postoperative nutritional tolerance of patients following elective gastrointestinal surgery: A post-hoc analysis.

Aim: To investigate the effect of intravenous dexamethasone administration on postoperative enteral nutrition tolerance in patients following gastrointestinal surgery. Methods: Based on the previous results of a randomized controlled study to explore whether intravenous administration of dexamethasone recovered gastrointestinal function after gastrointestinal surgery, we used the existing research data from 1 to 5 days post operation in patients with enteral nutrition tolerance and nutrition-related analyses of the changes in serum indices, and further analyzed the factors affecting resistance to enteral nutrition. Result: The average daily enteral caloric intake was significantly higher in patients receiving intravenous administration of dexamethasone during anesthesia induction than in controls (8.80 ± 0.92 kcal/kg/d vs. 8.23 ± 1.13 kcal/kg/d, P = 0.002). Additionally, intravenous administration of 8 mg dexamethasone during anesthesia induction can reduce the changes in postoperative day (POD) 3, POD5, and preoperative values of serological indices, including ΔPA, ΔALB, and ΔRBP (P < 0.05). In the subgroup analysis, dexamethasone significantly increased the average daily enteral nutrition caloric intake in patients undergoing enterotomy (8.98 ± 0.87 vs. 8.37 ± 1.17 kcal/kg/d, P = 0.010) or in female patients (8.94 ± 0.98 vs. 8.10 ± 1.24 kcal/kg/d, P = 0.019). The changes of serological indexes (ΔPA, ΔALB, and ΔRBP) in the dexamethasone group were also significantly different on POD3 and POD5 (P < 0.05). In addition, multivariate analysis showed that dexamethasone use, surgical site, and age might influence enteral nutrition caloric tolerance. Conclusion: Postoperative enteral nutrition tolerance was significantly improved in patients receiving intravenous administration of dexamethasone during anesthesia induction, especially in patients following enterotomy surgery, with significant improvements in average daily enteral caloric intake, PA levels, ALB levels, and RBP levels. Clinical trial registration: http://www.chictr.org.cn, identifier: ChiCTR1900024000.

Sulforaphane suppresses skin squamous cell carcinoma cells proliferation through miR-199a-5p/Sirt1/CD44ICD signaling pathway.

BACKGROUND: The present study aimed to explore the impact of sulforaphane on the growth of sSCC cells, and the activation of miR-199a-5p/Sirt1 and CD44ICD signaling pathways. METHODS: Cell viability, count, apoptosis, and invasion assays were performed in the sSCC cell line (SCC-13) in which miR-199a-5p was over-expressed or under-expressed. The expression levels of miR-199a-5p, Sirt1 and CD44ICD mRNA were measured by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Sulforaphane significantly inhibited the cell growth and invasion of SCC-13 cells, and dramatically induced cell apoptosis. Additionally, sulforaphane also greatly increased miR-199a-5p expression and suppressed Sirt1 and CD44ICD mRNA levels. Moreover, miR-199a-5p overexpression considerably down-regulated the expressions of Sirt1 and CD44ICD mRNA, and promoted the ability of sulforaphane to represses cell growth and invasion, and to induce cell apoptosis. However, miR-199a-5p underexpression has the opposite effects. CONCLUSIONS: Sulforaphane appears to inhibit sCC progression by impacting its growth and invasion ability, and regulates miR-199a-5p/Sirt1 and CD44ICD signaling pathways, and may be utilized to develop a curative approach for sSCC.

EyeScreen: Development and Potential of a Novel Machine Learning Application to Detect Leukocoria.

Purpose: Early diagnosis and treatment of retinoblastoma are of paramount importance for a positive clinical outcome. The most common sign of retinoblastoma is leukocoria, or white pupil. Effective, easy-to-perform, community-based screening is needed to improve outcomes in lower-income regions. The EyeScreen (developed by Joshua Meyer from the University of Michigan) Android (Google LLC) smartphone application is an important step toward addressing this need. The purpose of this study was to examine the potential of the novel use of low-cost technologies-a cell phone application and machine learning-to identify leukocoria. Design: A cell phone application was developed and refined with the feedback from on-site, single-population use in Ethiopia. Application performance was evaluated in this technology validation study. Participants: One thousand four hundred fifty-seven participants were recruited from ophthalmology and pediatric clinics in Addis Ababa, Ethiopia. Methods: Photographs obtained with inexpensive Android smartphones running the EyeScreen Application were used to train an ImageNet (ResNet) machine learning model and to measure the performance of the app. Eighty percent of the images were used in training the model, and 20% were reserved for testing. Main Outcome Measures: Performance of the model was measured in terms of sensitivity, specificity, receiver operating characteristic (ROC) curve, and precision-recall curve. Results: Analyses of the participant images resulted in the following at the participant level: sensitivity, 87%; specificity, 73%; area under the ROC curve, 0.93; and area under the precision-recall curve, 0.77. Conclusions: EyeScreen has the potential to serve as an effective screening tool in the areas of the world most affected by delayed retinoblastoma diagnosis. The relatively high initial performance of the machine learning model with small training datasets in this early-phase study can serve as a proof of concept for future use of machine learning and artificial intelligence in ophthalmic applications.

One year of SARS-CoV-2 evolution.

Since the outbreak of SARS-CoV-2, the etiologic agent of the COVID-19 pandemic, the viral genome has acquired numerous mutations with the potential to increase transmission. One year after its emergence, we now further analyze emergent SARS-CoV-2 genome sequences in an effort to understand the evolution of this virus.

SASH1 Suppresses the Proliferation and Invasion of Human Skin Squamous Cell Carcinoma Cells via Inhibiting Akt Cascade.

OBJECTIVE: The SAM- and SH3-domain containing 1 gene (SASH1) has been considered as a tumor suppressor in some cancers. Nevertheless, the effect of SASH1 on the proliferation and invasion of human skin squamous cell carcinoma (cSCC) remains poorly understood. Therefore, the purpose of the present study was to observe the potential role of SASH1 in cSCC and investigate its underlying mechanisms. METHODS: The overexpression of SASH1 was constructed by transfecting the pcDNA3.1/SASH1 vector into SCL-1 and A431 cells, and SASH1 knockdown was generated by transfecting the SASH1 siRNA into cSCC cells. Then, cell proliferation, invasion, apoptosis, and Akt pathway were observed. RESULTS: The expression levels of SASH1 mRNA and protein were greatly reduced in cSCC cells. The overexpression of SASH1 inhibited the viability and invasion of cSCC cells, while its knockdown induced the viability and invasion of cSCC cells. The overexpression of SASH1 also suppressed the expression levels of p-Akt and its target genes, including cyclin D1, Bcl-2, and metal matrix proteinase 2(MMP-2). By contrast, SASH1 knockdown exerted the opposite role. Furthermore, inhibition of Akt obviously decreased the inducible effect of cSCC knockdown on the proliferation and invasion of cSCC cells. CONCLUSION: Overall, these results found that SASH1 inhibits the proliferation and invasion of cSCC cells via suppressing Akt cascade, indicating a tumor inhibitory effect of SASH1 in cSCC cells.

Frequency-modulated continuous-wave generation based on an optically injected semiconductor laser with optical feedback stabilization.

Based on the period-one (P1) dynamics of an optically injected semiconductor laser (SL), a photonic scheme enabling the generation of a tunable high-quality frequency-modulated continuous-wave (FMCW) signal is investigated experimentally. Under a modulated optical injection, the laser is driven into P1 oscillation with a modulated microwave frequency. In this work, optical feedback is also introduced to further reduce the microwave phase noise. The experimental results show that the central frequency of the generated FMCW signal can be widely tuned from 11.41 to 50.05 GHz by simply adjusting injection parameters while the frequency sweep range of the FMCW signal can be controlled by varying the modulation index. Under proper operating parameters, the sweep range and rate of the FMCW signal are 18.42 GHz (13.73 GHz- 32.15 GHz) and 1.14 GHz/ns, respectively. Further, by introducing an optical feedback loop, the frequency comb contrast of the FMCW signal is drastically increased by 27.15 dB when the reciprocal of the feedback delay time matches with the modulation frequency exactly due to the locking effect of the external cavity optical modes.

Effects of the interaction between Na2Wo4-6-benzylaminopurine anionic chelate and rhodamine 6G on the resonance Rayleigh scattering and fluorescence spectra and their analytical applications.

In pH 4.99-6.06 Britton-Robinson (BR) buffer medium, 6-benzylaminopurine (6-BA) reacted with Na2WO4 to form 1:1 anionic chelate (6-BA·WO4)(2-), which further reacted with rhodamine 6G to form ternary ion complexes at room temperature. This resulted in a significant enhancement of resonance Rayleigh scattering (RRS) with a maximum RRS wavelength of 316 nm. Meanwhile, the fluorescence of the solution was quenched and excitation (λ ex) and emission (λ em) wavelengths of the fluorescence were 290 and 559 nm, respectively. Intensities of RRS enhancing (ΔIRRS ) and fluorescence quenching (ΔIF) were directly proportional to concentrations of 6-BA. As a result, RRS and fluorescence quenching for determination of trace amounts of 6-BA were developed. Under optimal conditions, linear ranges and detection limits of the two methods were 0.05-15.00 µg/mL and 8.2 ng/mL (RRS), 0.50-15.00 µg/mL and 17.0 ng/mL, respectively. It was found that the RRS method was superior to fluorescence quenching. The influence of these methods were investigated and results showed that RRS had good selectivity. RRS was applied to determine 6-BA in vegetable samples with satisfactory results. Furthermore, the reaction mechanisms of the ternary ion-association system are discussed. In addition, the polarization experiment revealed that the resonance light scattering (RLS) peak of Na2WO4-6-BA-R6G consisted mainly of depolarized resonance fluorescence and resonance scattering. It was speculated that light emission fluorescence energy (EL) transformed into resonance light scattering energy (ERLS), which was a key reason for enhancement of RRS.

The inhibitory effect of Wnt antagonist Dickkopf-1 (Dkk-1) on transdifferentiation of renal tubular epithelial cells / 解放军医学杂志

Objective To investigate the effects of the Wnt antagonist Dickkopf-1(Dkk-1) on epithelial mesenchymal transdifferentiation in human proximal tubular epithelial cells induced by transforming growth factor-β1 (TGF-β1). Methods Human proximal tubular epithelial cells (HKC) were cultured in vitro and divided into three groups as follows: control group, TGF-β1 group, and TGF-β1+Dkk-1 group. The cells in the control group underwent routine culture with medium containing 10% fetal calf serum. For the TGF-β1 group, TGF-β1 (final concentration 20ng/ml) was added into the routine culture medium. For TGF- β1+Dkk-1 group, TGF-β1 (final concentration 20ng/ml) and Dkk-1(final concentration 100ng/ml) were added at the same time. After cultured for 48h, we performed morphologic observation using an inverted contrast microscope. RT-PCR and Western blotting were adopted to detect the expressions of Wnt4, β-catenin, E-cadherin, and α-SMA mRNA. E-cadherin and α-SMA expressions were detected by cell immunofluorescence. Results Compared with control group, the mRNA expression of Wnt4 and the protein expression of Wnt4 were significantly increased in TGF-β1 and TGF-β1+Dkk-1 groups (P0.05). There was no obvious difference between each group in mRNA expression of β-catenin (P>0.05). The β-catenin protein exhibited low expression in control group, whereas the expression significantly increased in TGF-β1 group. The expression of β-catenin in TGF-β1+Dkk-1 group was lower than that in TGF-β1 group (P0.05). The mRNA and protein expression of E-cadherin were high in control group, but were significantly decreased in TGF-β1 group. Their expressions in the TGF-β1+Dkk-1 group were increased compared with that in TGF-β1 group (P0.05). The mRNA and protein expression of α-SMA were decreased in control and TGF-β1+Dkk-1 groups, compared with TGF-β1 group (P<0.05). Immune fluorescent staining showed that the expression of E-cadherin and α-SMA were consistent with the results of RT-PCR and Western blotting. Conclusion Wnt antagonist Dickkopf-1(Dkk-1) can inhibit epithelial mesenchymal transdifferentiation induced by TGF-β1.

Analysis of mortality rate of stomach cancer and its trend in twenty years in China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze and predict the trend in mortality rate of stomach cancer in twenty years in China.</p><p><b>METHODS</b>Stomach cancer mortality data collected from the China national survey over the period 1970s - 1990s for the cause of death were analyzed.</p><p><b>RESULTS</b>The adjusted mortality rate of stomach cancer in 1990s increased by 11.0% and 6.3% for males and females, respectively. The urban mortality in 1970s was slightly higher than the rural mortality, while in 1990s the rural mortality rate was about 60% higher than the urban mortality. In 1990s, the adjusted urban mortality rate decreased by 22.2% and 26.7% for males and females, respectively. In contrast, the rural mortality rate increased by 26.4% and 22.1% for males and females, respectively. The sex ratio of stomach cancer deaths in 1990s, both in cities and rural areas, was slightly greater than that in 1970s, being more marked in the latter areas. In 1990s, the mortality rate decreased in 12 provinces, accounting for 44% in both sexes (12/27), but the decrease was more marked for females than for males except in Kiangs province. In provinces where the increased rates ranked top six positions, the magnitude of increase in rates was higher in males than in females.</p><p><b>CONCLUSION</b>The overall mortality rates of stomach cancer in the past 20 years in China presented an increasing trend, despite there were upward and downward changes in 27 provinces and decrease in cities while increase in rural areas. Compared with other countries, the world-adjusted mortality rate of stomach cancer for both sexes in China ranks first. The increasing trend in stomach cancer mortality was seen in the older age groups (> 60 years) while a decreasing trend was seen in the younger age groups (30 - 59 years). Aging of the population could be an important factor responsible for the increase in mortality rates of stomach cancer in China.</p>