With the rapid development of science and technology,the minimally invasive surgery(MIS)has become a reality.MIS is associated with less pain,a shorter hospital stay and fewer complications.The higher-quality minimall...With the rapid development of science and technology,the minimally invasive surgery(MIS)has become a reality.MIS is associated with less pain,a shorter hospital stay and fewer complications.The higher-quality minimally invasive instruments allow the surgeons to perform the surgical interventions efficiently without sacrificing patient safety.Therefore,the academic research,technology development,achievement transformation as well as clinical application of minimally invasive devices is extremely important。展开更多
Robotic surgery has a series of advantages,including better flexibility,stability and exposure,minimal trauma and less bleeding,as well as quicker recovery.The da Vinci,the most widely applied surgical robot in China,...Robotic surgery has a series of advantages,including better flexibility,stability and exposure,minimal trauma and less bleeding,as well as quicker recovery.The da Vinci,the most widely applied surgical robot in China,represents the highest level of current surgical robot technology.It was first introduced to Sir Run Run Shaw Hospital,Zhejiang University School of Medicine in 2015.In the past two years,the advantages of robotic surgery have been completely demonstrated.Therefore robotic surgery has gradually become the first choice for patients and surgeons in some disciplines.展开更多
Objective:To assess the analgesic and anti-inflammatory effects of standardized extract of Cotinus coggygria(C.coggygria)in different animal models.Methods:C.coggygria extracts(25,50,and 100 mg/kg)were administered to...Objective:To assess the analgesic and anti-inflammatory effects of standardized extract of Cotinus coggygria(C.coggygria)in different animal models.Methods:C.coggygria extracts(25,50,and 100 mg/kg)were administered to rats and mice(n=6)during hot plate,tail-flick,acetic acid-induced writhing,and formalin tests to determine its analgesic efficacy.The anti-inflammatory activity of C.coggygria extracts was evaluated by histamine and carrageenan-induced paw edema,cotton pellet-induced granuloma,and acetic acid-induced peritoneal capillary dye leakage tests.Results:C.coggygria extracts(50 and 100 mg/kg)significantly alleviated thermal and chemical-induced pain in rodents(P<0.05).It also demonstrated notable anti-inflammatory properties by mitigating histamine and carrageenan-induced paw edema,granuloma deposits,and vascular permeability(P<0.05).Moreover,C.coggygria extracts remarkably reduced TNF-α,IL-1β,IL-6,COX-2,and oxidative stress in rat paws(P<0.05).Carrageenan-induced histological aberrations in hind paw tissues were effectively(P<0.05)mitigated by treatment with C.coggygria extracts.Conclusions:C.coggygria Scop.extracts show analgesic and anti-inflammatory effects via inhibition of COX-2 and inflammatory and oxidative mediators.展开更多
Parkinson’s disease is a common neurodegenerative disorder that is associated with abnormal aggregation and accumulation of neurotoxic proteins,includingα-synuclein,amyloid-β,and tau,in addition to the impaired eli...Parkinson’s disease is a common neurodegenerative disorder that is associated with abnormal aggregation and accumulation of neurotoxic proteins,includingα-synuclein,amyloid-β,and tau,in addition to the impaired elimination of these neurotoxic protein.Atypical parkinsonism,which has the same clinical presentation and neuropathology as Parkinson’s disease,expands the disease landscape within the continuum of Parkinson’s disease and related disorders.The glymphatic system is a waste clearance system in the brain,which is responsible for eliminating the neurotoxic proteins from the interstitial fluid.Impairment of the glymphatic system has been proposed as a significant contributor to the development and progression of neurodegenerative disease,as it exacerbates the aggregation of neurotoxic proteins and deteriorates neuronal damage.Therefore,impairment of the glymphatic system could be considered as the final common pathway to neurodegeneration.Previous evidence has provided initial insights into the potential effect of the impaired glymphatic system on Parkinson’s disease and related disorders;however,many unanswered questions remain.This review aims to provide a comprehensive summary of the growing literature on the glymphatic system in Parkinson’s disease and related disorders.The focus of this review is on identifying the manifestations and mechanisms of interplay between the glymphatic system and neurotoxic proteins,including loss of polarization of aquaporin-4 in astrocytic endfeet,sleep and circadian rhythms,neuroinflammation,astrogliosis,and gliosis.This review further delves into the underlying pathophysiology of the glymphatic system in Parkinson’s disease and related disorders,and the potential implications of targeting the glymphatic system as a novel and promising therapeutic strategy.展开更多
Ingenious design and fabrication of advanced carbon-based sulfur cathodes are extremely important to the development of high-energy lithium-sulfur batteries,which hold promise as the next-generation power source.Herei...Ingenious design and fabrication of advanced carbon-based sulfur cathodes are extremely important to the development of high-energy lithium-sulfur batteries,which hold promise as the next-generation power source.Herein,for the first time,we report a novel versatile hyphae-mediated biological assembly technology to achieve scale production of hyphae carbon fibers(HCFs)derivatives,in which different components including carbon,metal compounds,and semiconductors can be homogeneously assembled with HCFs to form composite networks.The mechanism of biological adsorption assembly is also proposed.As a representative,reduced graphene oxides(rGOs)decorated with hollow carbon spheres(HCSs)successfully co-assemble with HCFs to form HCSs@rGOs/HCFs hosts for sulfur cathodes.In this unique architecture,not only large accommodation space for sulfur but also restrained volume expansion and fast charge transport paths are realized.Meanwhile,multiscale physical barriers plus chemisorption sites are simultaneously established to anchor soluble lithium polysulfides.Accordingly,the designed HCSs@rGOs/HCFs-S cathodes deliver a high capacity(1189 mA h g^(-1)at 0.1 C)and good high-rate capability(686 mA h g^(-1)at 5 C).Our work provides a new approach for the preparation of high-performance carbon-based electrodes for energy storage devices.展开更多
Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used...Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used to repair tympanic membrane(TM)perforation.To obtain good results,appropriate surgical methods and repair materials should be selected.This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa(SIS)during transcanal endoscopic type I tympanoplasty.Method A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Perforation size,tympanic status,pre-and postoperative symptoms,follow-up data,wound healing rates,and hearing improvement were analysed.Results Of the 115 patients included in the study,56 underwent interlayer repair with porcine SIS of the TM,and 59 patients underwent internal repair with tragus cartilage.No significant difference was found between the two groups at baseline in terms of age,sex,disease course,perforation side,tympanic status,underlying disease,or preoperative infection.The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07%(51 patients),and that of internal implantation with tragus cartilage was 88.14%(52 patients).No significant difference was found in terms of the graft success rate between the two surgical methods(p=0.887).Postoperative pure tone auditory(PTA)and air-bone gap(ABG)density significantly increased in both groups compared with before surgery(p<0.05).However,the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups(p>0.05).Compared to those in the internal implantation group,the patients in the interlayer group had a shorter operation duration(51.36±6.76 min vs.59.71±7.45 min,t=6.298,p<0.001)and less blood loss(11.91±2.61 mL vs.15.27±2.57 mL,t=7.019,p<0.001).Conclusions Our study suggests that the porcine SIS,as well as the tragus cartilage,has a high success rate in repairing irreversible TM perforation.Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages,including the absence of donor-site incision and scar formation,and ease of graft modification and manipulation.展开更多
Objective:Magnetically controlled capsule gastroscopy(MCCG)is an effective method for screening gastric diseases;however,its performance may be affected by gastric cleanliness.We aimed to explore the correlation betwe...Objective:Magnetically controlled capsule gastroscopy(MCCG)is an effective method for screening gastric diseases;however,its performance may be affected by gastric cleanliness.We aimed to explore the correlation between Helicobacter pylori infection and the degree of gastric cleanliness in the MCCG.Methods:This retrospective study enrolled 297 participants from October 2020 to April 2024 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Participant characteristics,MCCG examination results,and(13)C-urea breath test(C13-UBT)results were collected.The gastric cleanliness in MCCG examinations was assessed using a gastric cleanliness score.Binary logistic regression was used to analyze the relationships among participant characteristics,H.pylori infection,and gastric cleanliness.Chi-square tests and Fisher's exact tests were used to analyze the relationships among gastric lesions,H.pylori infection,and gastric cleanliness.Results:Among the participants,24.2%had H.pylori infection,and 17.5%had poor gastric cleanliness.Hypertension(odds ratio[OR]:2.63;95%confidence interval[CI]:1.36e5.09;p?0.004)was associated with a greater likelihood of H.pylori infection.H.pylori infection(OR:3.76;95%CI:1.99e7.09;p<0.001)was an independent risk factor for poor gastric cleanliness in the MCCG.A significant disparity was noted in the prevalence of focal erosions(p<0.001),gastric ulcers(p?0.001),and positive gastric lesions(p?0.027)between the 2 groups with and without H.pylori infection.The proportion of positive gastric lesions was not significantly different between the good gastric cleanliness group and the poor gastric cleanliness group(25.7%vs.21.2%;p?0.490).Conclusion:The findings of this study revealed that H.pylori infection was associated with hypertension.H.pylori infection may lead to poor gastric cleanliness.Institutions are advised to perform C13-UBT before MCCG,and participants should be informed of the risk of poor gastric cleanliness if the results are positive.The decision to perform H.pylori eradication before MCCG should take into account patient willingness and the benefit-to-risk ratio.展开更多
Objectives:Anastomotic leakage(AL)stands out as a prevalent and severe complication following gastric cancer surgery.It frequently precipitates additional serious complications,significantly influencing the overall su...Objectives:Anastomotic leakage(AL)stands out as a prevalent and severe complication following gastric cancer surgery.It frequently precipitates additional serious complications,significantly influencing the overall survival time of patients.This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer.Methods:This study included a derivation cohort and validation cohort.The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 1,2015 to December 31,2020.An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions.Based on the questionnaire,inpatient data were collected to form a model-derivation cohort.This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events,and a logistic regression model with stepwise regression was developed.A 5-fold cross-validation ensured model reliability.The validation cohort included patients from August 1,2021 to December 31,2021 at the same hospital.Using the same imputation method,we organized the validation-queue data.We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue.We compared the predictions with the actual occurrence,and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve(AUROC),Brier score,and calibration curve.Results:The derivation cohort included 1377 patients,and the validation cohort included 131 patients.The independent predictors of AL after radical gastrectomy included age65 y,preoperative albumin<35 g/L,resection extent,operative time240 min,and intraoperative blood loss90 mL.The predictive model exhibited a solid AUROC of 0.750(95%CI:0.694e0.806;p<0.001)with a Brier score of 0.049.The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052.External validation showed an AUROC of 0.723(95%CI:0.564e0.882;p?0.006)and a Brier score of 0.055,confirming reliability in different clinical settings.Conclusions:We successfully developed a risk-prediction model for AL following radical gastrectomy.This tool will aid healthcare professionals in anticipating AL,potentially reducing unnecessary interventions.展开更多
Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechan...Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.展开更多
BACKGROUND Genetic screening for breast cancer gene 1(BRCA)1/2 mutations can inform breast/ovarian/pancreatic cancer patients of suitable therapeutic interventions.Four to seven percent of pancreatic cancer patients h...BACKGROUND Genetic screening for breast cancer gene 1(BRCA)1/2 mutations can inform breast/ovarian/pancreatic cancer patients of suitable therapeutic interventions.Four to seven percent of pancreatic cancer patients have germline BRCA mutations.BRCA genes aid in DNA repair,especially homologous recombination,which impacts genomic stability and cancer cell growth.BRCA1 regulates the cell cycle,ubiquitination,and chromatin remodeling,whereas BRCA2 stimulates the immune response.They predict the efficacy of platinum chemotherapy or polymerase(PARP)inhibitors such as olaparib.AIM To determine the trends and future directions in the use of olaparib for pancreatic cancer treatment.METHODS To evaluate the trends in how olaparib works in pancreatic cancer,we performed a bibliometric analysis.One hundred and ninety-six related publications were accessed from the Web of Science Core Collection and were published between 2009 and 2022.The analytic parameters included publications,related citations,productive countries and institutes,influential authors,and keyword development.RESULTS This study visualizes and discusses the current research,including the present global trends and future directions in olaparib and pancreatic cancer.Overall,this study sheds light on optimizing the use of olaparib in pancreatic cancer treatment,Feng X et al.The use of olaparib in pancreatic cancer WJGO https://www.wjgnet.com 4490 November 15,2024 Volume 16 Issue 11 offering valuable guidance for researchers in this field.CONCLUSION Our findings identified trends in olaparib and pancreatic cancer,with China and the USA leading and with global cooperation tightening.O'Reilly EM's team and Memorial Sloan-Kettering had the highest output.The Journal of Clinical Oncology was the most cited journal.More PARP inhibitors are emerging,and combination therapy is suggested for future therapeutic trends.展开更多
BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,whic...BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.展开更多
In the development of colorectal cancer(CRC),cancer-associatedfibroblasts(CAFs)play a pivotal role in establishing tumor-permissive extracellular matrix structures,angiogenesis,and modulating the immune status of the t...In the development of colorectal cancer(CRC),cancer-associatedfibroblasts(CAFs)play a pivotal role in establishing tumor-permissive extracellular matrix structures,angiogenesis,and modulating the immune status of the tumor microenvironment(TME),thereby influencing tumor metastasis and resistance to radiotherapy and chemotherapy.The pleiotropic effects of CAFs in the TME may be attributed to the heterogeneous origin and high plasticity of their population.Given the specificity of CAFs,they provide a variety of potential target molecules for future CRC treatment,which may play an indispensable role in CRC therapeutic strategies.This review summarizes the origin of CAFs and their roles in the CRC tumor microenvironment,including the interaction between exosomes and CAFs in CRC.Additionally,we discuss potential therapeutic strategies targeting CAFs.展开更多
Meiosis is a highly complex process significantly influenced by transcriptional regulation.However,studies on the mechanisms that govern transcriptomic changes during meiosis,especially in prophase I,are limited.Here,...Meiosis is a highly complex process significantly influenced by transcriptional regulation.However,studies on the mechanisms that govern transcriptomic changes during meiosis,especially in prophase I,are limited.Here,we performed single-cell ATAC-seq of human testis tissues and observed reprogramming during the transition from zygotene to pachytene spermatocytes.This event,conserved in mice,involved the deactivation of genes associated with meiosis after reprogramming and the activation of those related to spermatogenesis before their functional onset.Furthermore,we identified 282 transcriptional regulators(TRs)that underwent activation or deactivation subsequent to this process.Evidence suggested that physical contact signals from Sertoli cells may regulate these TRs in spermatocytes,while secreted ENHO signals may alter metabolic patterns in these cells.Our results further indicated that defective transcriptional reprogramming may be associated with non-obstructive azoospermia(NOA).This study revealed the importance of both physical contact and secreted signals between Sertoli cells and germ cells in meiotic progression.展开更多
Laparoscopic,Endoscopic and Robotic Surgery(LERS)could not do its valuable work without the contribution of peer reviewers and authors.In this issue,we recognize our peer reviewers and authors with heartful gratitude....Laparoscopic,Endoscopic and Robotic Surgery(LERS)could not do its valuable work without the contribution of peer reviewers and authors.In this issue,we recognize our peer reviewers and authors with heartful gratitude.Thank you,peer reviewers,for your time and effort!Thank you,authors,for submitting manuscripts to LERS!展开更多
Left atrial appendage aneurysm(LAAA)was first reported in the 1960s.1 LAAA is a rare condition,with just over 100 congenital or acquired cases reported to date.2 LAAA is frequently diagnosed incidentally during echoca...Left atrial appendage aneurysm(LAAA)was first reported in the 1960s.1 LAAA is a rare condition,with just over 100 congenital or acquired cases reported to date.2 LAAA is frequently diagnosed incidentally during echocardiography or computed tomography(CT)scans.Most patients with LAAA are asymptomatic,while a few exhibit nonspecific symptoms,such as dyspnea,palpitation,and chest tightness.Patients with LAAA frequently present with atrial arrhythmias and systemic thromboembolism,such as stroke or multiorgan infarctions,due to the formation of a left atrial appendage thrombus.3 The lesion may be cured using aneurysm resection.Considering it as the potential cause of atrial arrhythmias and thromboembolism,the lesion must be identified on time and cured using a suitable treatment approach.展开更多
Objective:Some patients exhibit septic symptoms following laparoscopic surgery,leading to a poor prognosis.Effective clinical subphenotyping is critical for guiding tailored therapeutic strategies in these cases.By id...Objective:Some patients exhibit septic symptoms following laparoscopic surgery,leading to a poor prognosis.Effective clinical subphenotyping is critical for guiding tailored therapeutic strategies in these cases.By identifying predisposing factors for postoperative sepsis,clinicians can implement targeted interventions,potentially improving outcomes.This study outlines a workflow for the subphenotype methodology in the context of laparoscopic surgery,along with its practical application.Methods:This study utilized data routinely available in clinical case systems,enhancing the applicability of our findings.The data included vital signs,such as respiratory rate,and laboratory measures,such as blood sodium levels.The process of categorizing clinical routine data involved technical complexities.A correlation heatmap was used to visually depict the relationships between variables.Ordering points were used to identify the clustering structure and combined with Consensus K clustering methods to determine the optimal categorization.Results:Our study highlighted the intricacies of identifying clinical subphenotypes following laparoscopic surgery,and could thus serve as a valuable resource for clinicians and researchers seeking to explore disease heterogeneity in clinical settings.By simplifying complex methodologies,we aimed to bridge the gap between technical expertise and clinical application,fostering an environment where professional medical knowledge is effectively utilized in subphenotyping research.Conclusion:This tutorial could primarily serve as a guide for beginners.A variety of clustering approaches were explored,and each step in the process contributed to a comprehensive understanding of clinical subphenotypes.展开更多
BACKGROUND Helicobacter pylori(H.pylori)eradication rates have declined with the rise of antibiotic-resistant strains in recent years.Although highly effective with a low prevalence of resistance,standard dose tetracy...BACKGROUND Helicobacter pylori(H.pylori)eradication rates have declined with the rise of antibiotic-resistant strains in recent years.Although highly effective with a low prevalence of resistance,standard dose tetracycline is associated with frequent adverse events.The efficacy and safety of low-dose tetracycline as part of tetra-cycline and amoxicillin-containing bismuth quadruple therapy are not well described.AIM To compare the efficacy and safety of low-dose compared to standard dose tetracycline with combined amoxicillin-containing bismuth quadruple therapy in patients with H.pylori infection.METHODS Consecutive patients with H.pylori infection receiving tetracycline,amoxicillin,proton pump inhibitor,and bismuth for 14 days at Sir Run Run Shaw Hospital(1/2022-6/2023)were evaluated.The low-dose tetracycline group received tetracycline 500 mg twice daily(bid)while the standard dose group received 750 mg bid or 500 mg three times daily(tid).Primary endpoints were H.pylori eradication rate and treatment-related adverse events.展开更多
In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases.We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of...In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases.We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of cardiac masses.As cardiomyocytes lack the ability to actively divide,primary cardiac tumors are extremely rare across all ethnicities and age groups.Once they occur,these tumors are often associated with genetic mutations and,occasionally,genetic syndromes.This underscores the importance of considering genetic mutations and syndromes when encountering these cases.The more common growths in the heart are thrombi and vegetations,which can mimic tumors,further making the differential diagnosis challenging.Among the imaging techniques,contrast-enhanced cardiac magnetic resonance imaging has the highest sensitivity for differential diagnosis.To aid in the differential diagnosis of cardiac masses,especially thrombi,appropriate utilization of biomarkers(i.e.D-dimer level)may provide pivotal clinical implications.Employing a multidisciplinary approach that integrates personal history,epidemiological insights,imaging findings,genetic markers,and biomarkers is therefore critical in the diagnostic process of cardiac masses.展开更多
Objective:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor survival.Different cell types in the tumor microenvironment participate in the tumorigenesis and progression of HCC.This study aimed to analyz...Objective:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor survival.Different cell types in the tumor microenvironment participate in the tumorigenesis and progression of HCC.This study aimed to analyze the immune microenvironment of HCC and its relationship with clinical outcomes.Methods:We analyzed HCC RNA-seq for cell type identification and prognosis by estimating relative subsets of RNA transcripts using CIBERSORTx.The interaction between B cells and macrophages in HCC was analyzed using a Hepa1-6 orthotopic transplantation mouse model and flow cytometry.The effect of Zinc finger protein 296(ZNF296)on the interaction of B cells and macrophages was verified using human HCC tissues analyzed through western blot,quantitative real-time polymerase chain reaction(qPCR),and multiplex immunofluorescence.A comparative analysis of immune cells associated with HCC prognosis was performed using RNA-seq data from The Cancer Genome Atlas(TCGA),bulk multimodal data,and single-cell transcriptomic data from existing HCC single-cell transcriptomic data employing the Single Cell Inferred Site Specific Omics Resource for Tumor Microenvironments(SCISSOR).Results:Liver hepatocellular carcinoma(LIHC)RNA-seq analysis of TCGA showed that high eosinophil infiltration promoted HCC progression.The proportion of B cells correlated with that of macrophages(r=−0.24)and affected the infiltration and programmed death ligand 1(PD-L1)expression of macrophages in HCC.ZNF296 may participate in the interaction between B cells and macrophages to accelerate the HCC progression by regulating PAFAH1B3 and H2AFX.Moreover,ZNF296 expression positively correlated with LAG3(r=0.27)and CTLA4(r=0.31)expression levels.Among the immune cell phenotypes related to survival and death identified by SCISSOR analysis,T cells correlated with an excellent prognosis of HCC.The normal function of liver and dendritic cells was also associated with a good prognosis in HCC.Conclusions:This study analyzed the interaction of the immune microenvironment with HCC prognosis,identifying ZNF296 as a promising diagnostic and therapeutic target for HCC.展开更多
BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)s...BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)scoring system’s efficacy in predicting postoperative complications following abdominal surgery.METHODS A systematic search of published studies was conducted,yielding 17 studies with pertinent data.Parameters such as preoperative risk score(PRS),surgical stress score(SSS),comprehensive risk score(CRS),postoperative complications,post-operative mortality,and other clinical data were collected for meta-analysis.Forest plots were employed for continuous and binary variables,withχ2 tests assessing heterogeneity(P value).RESULTS Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications[mean difference and 95%confidence interval(CI)of PRS:0.10(0.05-0.15);SSS:0.04(0.001-0.08);CRS:0.19(0.07-0.31)].Following the exclusion of low-quality studies,results remained valid with no discernible heterogeneity.Subgroup analysis indicated that variations in sample size and age may contribute to hetero-geneity in CRS analysis.Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates[odds ratio(OR)(95%CI):3.01(1.83-4.95)],with a significant association observed between high CRS and postoperative mortality[OR(95%CI):15.49(3.75-64.01)].CONCLUSION In summary,postoperative complications in abdominal surgery,as assessed by the E-PASS scoring system,are consistently linked to elevated PRS,SSS,and CRS scores.High CRS scores emerge as risk factors for heightened morbidity and mortality.This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery,underscoring its potential for widespread adoption in effective risk assessment.展开更多
文摘With the rapid development of science and technology,the minimally invasive surgery(MIS)has become a reality.MIS is associated with less pain,a shorter hospital stay and fewer complications.The higher-quality minimally invasive instruments allow the surgeons to perform the surgical interventions efficiently without sacrificing patient safety.Therefore,the academic research,technology development,achievement transformation as well as clinical application of minimally invasive devices is extremely important。
文摘Robotic surgery has a series of advantages,including better flexibility,stability and exposure,minimal trauma and less bleeding,as well as quicker recovery.The da Vinci,the most widely applied surgical robot in China,represents the highest level of current surgical robot technology.It was first introduced to Sir Run Run Shaw Hospital,Zhejiang University School of Medicine in 2015.In the past two years,the advantages of robotic surgery have been completely demonstrated.Therefore robotic surgery has gradually become the first choice for patients and surgeons in some disciplines.
文摘Objective:To assess the analgesic and anti-inflammatory effects of standardized extract of Cotinus coggygria(C.coggygria)in different animal models.Methods:C.coggygria extracts(25,50,and 100 mg/kg)were administered to rats and mice(n=6)during hot plate,tail-flick,acetic acid-induced writhing,and formalin tests to determine its analgesic efficacy.The anti-inflammatory activity of C.coggygria extracts was evaluated by histamine and carrageenan-induced paw edema,cotton pellet-induced granuloma,and acetic acid-induced peritoneal capillary dye leakage tests.Results:C.coggygria extracts(50 and 100 mg/kg)significantly alleviated thermal and chemical-induced pain in rodents(P<0.05).It also demonstrated notable anti-inflammatory properties by mitigating histamine and carrageenan-induced paw edema,granuloma deposits,and vascular permeability(P<0.05).Moreover,C.coggygria extracts remarkably reduced TNF-α,IL-1β,IL-6,COX-2,and oxidative stress in rat paws(P<0.05).Carrageenan-induced histological aberrations in hind paw tissues were effectively(P<0.05)mitigated by treatment with C.coggygria extracts.Conclusions:C.coggygria Scop.extracts show analgesic and anti-inflammatory effects via inhibition of COX-2 and inflammatory and oxidative mediators.
基金supported by the National Key R&D Program of China,No.2021YFF0702203(to HYL)the National Natural Science Foundation of China,No.82101323(to TS)Preferred Foundation of Zhejiang Postdoctors,No.ZJ2021152(to TS).
文摘Parkinson’s disease is a common neurodegenerative disorder that is associated with abnormal aggregation and accumulation of neurotoxic proteins,includingα-synuclein,amyloid-β,and tau,in addition to the impaired elimination of these neurotoxic protein.Atypical parkinsonism,which has the same clinical presentation and neuropathology as Parkinson’s disease,expands the disease landscape within the continuum of Parkinson’s disease and related disorders.The glymphatic system is a waste clearance system in the brain,which is responsible for eliminating the neurotoxic proteins from the interstitial fluid.Impairment of the glymphatic system has been proposed as a significant contributor to the development and progression of neurodegenerative disease,as it exacerbates the aggregation of neurotoxic proteins and deteriorates neuronal damage.Therefore,impairment of the glymphatic system could be considered as the final common pathway to neurodegeneration.Previous evidence has provided initial insights into the potential effect of the impaired glymphatic system on Parkinson’s disease and related disorders;however,many unanswered questions remain.This review aims to provide a comprehensive summary of the growing literature on the glymphatic system in Parkinson’s disease and related disorders.The focus of this review is on identifying the manifestations and mechanisms of interplay between the glymphatic system and neurotoxic proteins,including loss of polarization of aquaporin-4 in astrocytic endfeet,sleep and circadian rhythms,neuroinflammation,astrogliosis,and gliosis.This review further delves into the underlying pathophysiology of the glymphatic system in Parkinson’s disease and related disorders,and the potential implications of targeting the glymphatic system as a novel and promising therapeutic strategy.
基金Natural Science Foundation for Distinguished Young Scholars of Zhejiang Province,Grant/Award Number:LR20E020001Foundation of State Key Laboratory of Coal Conversion,Grant/Award Number:J20-21-909+4 种基金Science and Technology Department of Zhejiang Province,Grant/Award Number:2023C01231National Natural Science Foundation of China,Grant/Award Numbers:52372235,52073252,52002052,22379020,U20A20253,21972127,22279116Open Project Program of the State Key Laboratory of Photocatalysis on Energy and Environment,Grant/Award Number:SKLPEE-KF202206Key Research and Development Project of Science and Technology Department of Sichuan Province,Grant/Award Number:2022YFSY0004Ministry of Education,Grant/Award Number:KFM 202202。
文摘Ingenious design and fabrication of advanced carbon-based sulfur cathodes are extremely important to the development of high-energy lithium-sulfur batteries,which hold promise as the next-generation power source.Herein,for the first time,we report a novel versatile hyphae-mediated biological assembly technology to achieve scale production of hyphae carbon fibers(HCFs)derivatives,in which different components including carbon,metal compounds,and semiconductors can be homogeneously assembled with HCFs to form composite networks.The mechanism of biological adsorption assembly is also proposed.As a representative,reduced graphene oxides(rGOs)decorated with hollow carbon spheres(HCSs)successfully co-assemble with HCFs to form HCSs@rGOs/HCFs hosts for sulfur cathodes.In this unique architecture,not only large accommodation space for sulfur but also restrained volume expansion and fast charge transport paths are realized.Meanwhile,multiscale physical barriers plus chemisorption sites are simultaneously established to anchor soluble lithium polysulfides.Accordingly,the designed HCSs@rGOs/HCFs-S cathodes deliver a high capacity(1189 mA h g^(-1)at 0.1 C)and good high-rate capability(686 mA h g^(-1)at 5 C).Our work provides a new approach for the preparation of high-performance carbon-based electrodes for energy storage devices.
基金approved by the Ethical Committee for Human Subjects at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine(20240276).All participants or their guardians provided written consent for their medical information to be used for publication.
文摘Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used to repair tympanic membrane(TM)perforation.To obtain good results,appropriate surgical methods and repair materials should be selected.This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa(SIS)during transcanal endoscopic type I tympanoplasty.Method A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Perforation size,tympanic status,pre-and postoperative symptoms,follow-up data,wound healing rates,and hearing improvement were analysed.Results Of the 115 patients included in the study,56 underwent interlayer repair with porcine SIS of the TM,and 59 patients underwent internal repair with tragus cartilage.No significant difference was found between the two groups at baseline in terms of age,sex,disease course,perforation side,tympanic status,underlying disease,or preoperative infection.The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07%(51 patients),and that of internal implantation with tragus cartilage was 88.14%(52 patients).No significant difference was found in terms of the graft success rate between the two surgical methods(p=0.887).Postoperative pure tone auditory(PTA)and air-bone gap(ABG)density significantly increased in both groups compared with before surgery(p<0.05).However,the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups(p>0.05).Compared to those in the internal implantation group,the patients in the interlayer group had a shorter operation duration(51.36±6.76 min vs.59.71±7.45 min,t=6.298,p<0.001)and less blood loss(11.91±2.61 mL vs.15.27±2.57 mL,t=7.019,p<0.001).Conclusions Our study suggests that the porcine SIS,as well as the tragus cartilage,has a high success rate in repairing irreversible TM perforation.Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages,including the absence of donor-site incision and scar formation,and ease of graft modification and manipulation.
基金supported by the General Research Project of the Department of Education of Zhejiang Province,China(No.Y202351338)the Soft Science Project of the Department of Science and Technology of Zhejiang Province,China(No.2024C35054).
文摘Objective:Magnetically controlled capsule gastroscopy(MCCG)is an effective method for screening gastric diseases;however,its performance may be affected by gastric cleanliness.We aimed to explore the correlation between Helicobacter pylori infection and the degree of gastric cleanliness in the MCCG.Methods:This retrospective study enrolled 297 participants from October 2020 to April 2024 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Participant characteristics,MCCG examination results,and(13)C-urea breath test(C13-UBT)results were collected.The gastric cleanliness in MCCG examinations was assessed using a gastric cleanliness score.Binary logistic regression was used to analyze the relationships among participant characteristics,H.pylori infection,and gastric cleanliness.Chi-square tests and Fisher's exact tests were used to analyze the relationships among gastric lesions,H.pylori infection,and gastric cleanliness.Results:Among the participants,24.2%had H.pylori infection,and 17.5%had poor gastric cleanliness.Hypertension(odds ratio[OR]:2.63;95%confidence interval[CI]:1.36e5.09;p?0.004)was associated with a greater likelihood of H.pylori infection.H.pylori infection(OR:3.76;95%CI:1.99e7.09;p<0.001)was an independent risk factor for poor gastric cleanliness in the MCCG.A significant disparity was noted in the prevalence of focal erosions(p<0.001),gastric ulcers(p?0.001),and positive gastric lesions(p?0.027)between the 2 groups with and without H.pylori infection.The proportion of positive gastric lesions was not significantly different between the good gastric cleanliness group and the poor gastric cleanliness group(25.7%vs.21.2%;p?0.490).Conclusion:The findings of this study revealed that H.pylori infection was associated with hypertension.H.pylori infection may lead to poor gastric cleanliness.Institutions are advised to perform C13-UBT before MCCG,and participants should be informed of the risk of poor gastric cleanliness if the results are positive.The decision to perform H.pylori eradication before MCCG should take into account patient willingness and the benefit-to-risk ratio.
基金This workwas supported by the Medical and Health Science and Technology Project of Zhejiang Province(No.2021KY180).
文摘Objectives:Anastomotic leakage(AL)stands out as a prevalent and severe complication following gastric cancer surgery.It frequently precipitates additional serious complications,significantly influencing the overall survival time of patients.This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer.Methods:This study included a derivation cohort and validation cohort.The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 1,2015 to December 31,2020.An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions.Based on the questionnaire,inpatient data were collected to form a model-derivation cohort.This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events,and a logistic regression model with stepwise regression was developed.A 5-fold cross-validation ensured model reliability.The validation cohort included patients from August 1,2021 to December 31,2021 at the same hospital.Using the same imputation method,we organized the validation-queue data.We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue.We compared the predictions with the actual occurrence,and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve(AUROC),Brier score,and calibration curve.Results:The derivation cohort included 1377 patients,and the validation cohort included 131 patients.The independent predictors of AL after radical gastrectomy included age65 y,preoperative albumin<35 g/L,resection extent,operative time240 min,and intraoperative blood loss90 mL.The predictive model exhibited a solid AUROC of 0.750(95%CI:0.694e0.806;p<0.001)with a Brier score of 0.049.The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052.External validation showed an AUROC of 0.723(95%CI:0.564e0.882;p?0.006)and a Brier score of 0.055,confirming reliability in different clinical settings.Conclusions:We successfully developed a risk-prediction model for AL following radical gastrectomy.This tool will aid healthcare professionals in anticipating AL,potentially reducing unnecessary interventions.
文摘Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.
基金the Zhejiang Provincial Medical and Health Science and Technology Program,No.2024KY1109.
文摘BACKGROUND Genetic screening for breast cancer gene 1(BRCA)1/2 mutations can inform breast/ovarian/pancreatic cancer patients of suitable therapeutic interventions.Four to seven percent of pancreatic cancer patients have germline BRCA mutations.BRCA genes aid in DNA repair,especially homologous recombination,which impacts genomic stability and cancer cell growth.BRCA1 regulates the cell cycle,ubiquitination,and chromatin remodeling,whereas BRCA2 stimulates the immune response.They predict the efficacy of platinum chemotherapy or polymerase(PARP)inhibitors such as olaparib.AIM To determine the trends and future directions in the use of olaparib for pancreatic cancer treatment.METHODS To evaluate the trends in how olaparib works in pancreatic cancer,we performed a bibliometric analysis.One hundred and ninety-six related publications were accessed from the Web of Science Core Collection and were published between 2009 and 2022.The analytic parameters included publications,related citations,productive countries and institutes,influential authors,and keyword development.RESULTS This study visualizes and discusses the current research,including the present global trends and future directions in olaparib and pancreatic cancer.Overall,this study sheds light on optimizing the use of olaparib in pancreatic cancer treatment,Feng X et al.The use of olaparib in pancreatic cancer WJGO https://www.wjgnet.com 4490 November 15,2024 Volume 16 Issue 11 offering valuable guidance for researchers in this field.CONCLUSION Our findings identified trends in olaparib and pancreatic cancer,with China and the USA leading and with global cooperation tightening.O'Reilly EM's team and Memorial Sloan-Kettering had the highest output.The Journal of Clinical Oncology was the most cited journal.More PARP inhibitors are emerging,and combination therapy is suggested for future therapeutic trends.
基金Supported by The Health Science and Technology Program of Zhejiang Province,No.2022KY836.
文摘BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.
基金supported by grants fromthe National Natural Science Foundation of China (No.30870971)Major Program of NSFC (No. 81090420)National Natural Science Foundation of Zhejiang(LY17H160017, LY12H16027).
文摘In the development of colorectal cancer(CRC),cancer-associatedfibroblasts(CAFs)play a pivotal role in establishing tumor-permissive extracellular matrix structures,angiogenesis,and modulating the immune status of the tumor microenvironment(TME),thereby influencing tumor metastasis and resistance to radiotherapy and chemotherapy.The pleiotropic effects of CAFs in the TME may be attributed to the heterogeneous origin and high plasticity of their population.Given the specificity of CAFs,they provide a variety of potential target molecules for future CRC treatment,which may play an indispensable role in CRC therapeutic strategies.This review summarizes the origin of CAFs and their roles in the CRC tumor microenvironment,including the interaction between exosomes and CAFs in CRC.Additionally,we discuss potential therapeutic strategies targeting CAFs.
基金supported by the National Natural Science Foundation of China(82271645)National Key Research and Development Program of China(2021YFC2700200 to F.S.)。
文摘Meiosis is a highly complex process significantly influenced by transcriptional regulation.However,studies on the mechanisms that govern transcriptomic changes during meiosis,especially in prophase I,are limited.Here,we performed single-cell ATAC-seq of human testis tissues and observed reprogramming during the transition from zygotene to pachytene spermatocytes.This event,conserved in mice,involved the deactivation of genes associated with meiosis after reprogramming and the activation of those related to spermatogenesis before their functional onset.Furthermore,we identified 282 transcriptional regulators(TRs)that underwent activation or deactivation subsequent to this process.Evidence suggested that physical contact signals from Sertoli cells may regulate these TRs in spermatocytes,while secreted ENHO signals may alter metabolic patterns in these cells.Our results further indicated that defective transcriptional reprogramming may be associated with non-obstructive azoospermia(NOA).This study revealed the importance of both physical contact and secreted signals between Sertoli cells and germ cells in meiotic progression.
文摘Laparoscopic,Endoscopic and Robotic Surgery(LERS)could not do its valuable work without the contribution of peer reviewers and authors.In this issue,we recognize our peer reviewers and authors with heartful gratitude.Thank you,peer reviewers,for your time and effort!Thank you,authors,for submitting manuscripts to LERS!
基金The case study was approved by the Ethic Committee of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine(20230767).
文摘Left atrial appendage aneurysm(LAAA)was first reported in the 1960s.1 LAAA is a rare condition,with just over 100 congenital or acquired cases reported to date.2 LAAA is frequently diagnosed incidentally during echocardiography or computed tomography(CT)scans.Most patients with LAAA are asymptomatic,while a few exhibit nonspecific symptoms,such as dyspnea,palpitation,and chest tightness.Patients with LAAA frequently present with atrial arrhythmias and systemic thromboembolism,such as stroke or multiorgan infarctions,due to the formation of a left atrial appendage thrombus.3 The lesion may be cured using aneurysm resection.Considering it as the potential cause of atrial arrhythmias and thromboembolism,the lesion must be identified on time and cured using a suitable treatment approach.
基金The study was funded by the China National Key Research and Development Program(2022YFC2504503,2023YFC3603104)General Health Science and Technology Program of Zhejiang Province(2024KY1099)+2 种基金the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China(LHDMD24H150001)National Natural Science Foundation of China(82272180)the Project of Drug Clinical Evaluate Research of Chinese Pharmaceutical Association(CPA-Z06-ZC-2021e004).
文摘Objective:Some patients exhibit septic symptoms following laparoscopic surgery,leading to a poor prognosis.Effective clinical subphenotyping is critical for guiding tailored therapeutic strategies in these cases.By identifying predisposing factors for postoperative sepsis,clinicians can implement targeted interventions,potentially improving outcomes.This study outlines a workflow for the subphenotype methodology in the context of laparoscopic surgery,along with its practical application.Methods:This study utilized data routinely available in clinical case systems,enhancing the applicability of our findings.The data included vital signs,such as respiratory rate,and laboratory measures,such as blood sodium levels.The process of categorizing clinical routine data involved technical complexities.A correlation heatmap was used to visually depict the relationships between variables.Ordering points were used to identify the clustering structure and combined with Consensus K clustering methods to determine the optimal categorization.Results:Our study highlighted the intricacies of identifying clinical subphenotypes following laparoscopic surgery,and could thus serve as a valuable resource for clinicians and researchers seeking to explore disease heterogeneity in clinical settings.By simplifying complex methodologies,we aimed to bridge the gap between technical expertise and clinical application,fostering an environment where professional medical knowledge is effectively utilized in subphenotyping research.Conclusion:This tutorial could primarily serve as a guide for beginners.A variety of clustering approaches were explored,and each step in the process contributed to a comprehensive understanding of clinical subphenotypes.
文摘BACKGROUND Helicobacter pylori(H.pylori)eradication rates have declined with the rise of antibiotic-resistant strains in recent years.Although highly effective with a low prevalence of resistance,standard dose tetracycline is associated with frequent adverse events.The efficacy and safety of low-dose tetracycline as part of tetra-cycline and amoxicillin-containing bismuth quadruple therapy are not well described.AIM To compare the efficacy and safety of low-dose compared to standard dose tetracycline with combined amoxicillin-containing bismuth quadruple therapy in patients with H.pylori infection.METHODS Consecutive patients with H.pylori infection receiving tetracycline,amoxicillin,proton pump inhibitor,and bismuth for 14 days at Sir Run Run Shaw Hospital(1/2022-6/2023)were evaluated.The low-dose tetracycline group received tetracycline 500 mg twice daily(bid)while the standard dose group received 750 mg bid or 500 mg three times daily(tid).Primary endpoints were H.pylori eradication rate and treatment-related adverse events.
文摘In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases.We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of cardiac masses.As cardiomyocytes lack the ability to actively divide,primary cardiac tumors are extremely rare across all ethnicities and age groups.Once they occur,these tumors are often associated with genetic mutations and,occasionally,genetic syndromes.This underscores the importance of considering genetic mutations and syndromes when encountering these cases.The more common growths in the heart are thrombi and vegetations,which can mimic tumors,further making the differential diagnosis challenging.Among the imaging techniques,contrast-enhanced cardiac magnetic resonance imaging has the highest sensitivity for differential diagnosis.To aid in the differential diagnosis of cardiac masses,especially thrombi,appropriate utilization of biomarkers(i.e.D-dimer level)may provide pivotal clinical implications.Employing a multidisciplinary approach that integrates personal history,epidemiological insights,imaging findings,genetic markers,and biomarkers is therefore critical in the diagnostic process of cardiac masses.
基金the Key Program of the National Natural Science Foundation of China(No.81930016)National Natural Science Foundation of China(No.92159202 and No.82273177)+1 种基金Key Research and Development Plan of Zhejiang Province(No.2021C03118 and No.2022C03108)Zhejiang Provincial Natural Science Foundation of China(No.LQ20H160029).
文摘Objective:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor survival.Different cell types in the tumor microenvironment participate in the tumorigenesis and progression of HCC.This study aimed to analyze the immune microenvironment of HCC and its relationship with clinical outcomes.Methods:We analyzed HCC RNA-seq for cell type identification and prognosis by estimating relative subsets of RNA transcripts using CIBERSORTx.The interaction between B cells and macrophages in HCC was analyzed using a Hepa1-6 orthotopic transplantation mouse model and flow cytometry.The effect of Zinc finger protein 296(ZNF296)on the interaction of B cells and macrophages was verified using human HCC tissues analyzed through western blot,quantitative real-time polymerase chain reaction(qPCR),and multiplex immunofluorescence.A comparative analysis of immune cells associated with HCC prognosis was performed using RNA-seq data from The Cancer Genome Atlas(TCGA),bulk multimodal data,and single-cell transcriptomic data from existing HCC single-cell transcriptomic data employing the Single Cell Inferred Site Specific Omics Resource for Tumor Microenvironments(SCISSOR).Results:Liver hepatocellular carcinoma(LIHC)RNA-seq analysis of TCGA showed that high eosinophil infiltration promoted HCC progression.The proportion of B cells correlated with that of macrophages(r=−0.24)and affected the infiltration and programmed death ligand 1(PD-L1)expression of macrophages in HCC.ZNF296 may participate in the interaction between B cells and macrophages to accelerate the HCC progression by regulating PAFAH1B3 and H2AFX.Moreover,ZNF296 expression positively correlated with LAG3(r=0.27)and CTLA4(r=0.31)expression levels.Among the immune cell phenotypes related to survival and death identified by SCISSOR analysis,T cells correlated with an excellent prognosis of HCC.The normal function of liver and dendritic cells was also associated with a good prognosis in HCC.Conclusions:This study analyzed the interaction of the immune microenvironment with HCC prognosis,identifying ZNF296 as a promising diagnostic and therapeutic target for HCC.
基金Supported by Medical Science and Technology Project of Zhejiang Province of China,No.2020PY053.
文摘BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)scoring system’s efficacy in predicting postoperative complications following abdominal surgery.METHODS A systematic search of published studies was conducted,yielding 17 studies with pertinent data.Parameters such as preoperative risk score(PRS),surgical stress score(SSS),comprehensive risk score(CRS),postoperative complications,post-operative mortality,and other clinical data were collected for meta-analysis.Forest plots were employed for continuous and binary variables,withχ2 tests assessing heterogeneity(P value).RESULTS Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications[mean difference and 95%confidence interval(CI)of PRS:0.10(0.05-0.15);SSS:0.04(0.001-0.08);CRS:0.19(0.07-0.31)].Following the exclusion of low-quality studies,results remained valid with no discernible heterogeneity.Subgroup analysis indicated that variations in sample size and age may contribute to hetero-geneity in CRS analysis.Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates[odds ratio(OR)(95%CI):3.01(1.83-4.95)],with a significant association observed between high CRS and postoperative mortality[OR(95%CI):15.49(3.75-64.01)].CONCLUSION In summary,postoperative complications in abdominal surgery,as assessed by the E-PASS scoring system,are consistently linked to elevated PRS,SSS,and CRS scores.High CRS scores emerge as risk factors for heightened morbidity and mortality.This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery,underscoring its potential for widespread adoption in effective risk assessment.
