G Protein-Coupled Receptor 109A Maintains the Intestinal Integrity and Protects Against ETEC Mucosal Infection by Promoting IgA Secretion

Several studies have reported an intricate link between the G protein-coupled receptor 109A (GPR109A) and intestinal health. Upon activation, induced by butyric acid and β-hydroxybutyric acid, GPR109A regulates the expression of tight junction proteins, exerts anti-inflammatory effects, and maintains the integrity of the intestinal barrier. However, its function and the mechanism of action in combating the infection caused by exogenous pathogenic microorganisms remain unclear. This study established an animal model of infection by oral enterotoxigenic Escherichia coli (ETEC) gavage to examine the underlying mechanism(s) and protective effects of GPR109A on the intestinal tract. Experimental GPR109A^-/-and GPR109A^+/+ mice were orally administered with 1 × 10⁹ colony-forming units (CFUs) of ETEC, and changes in body weight were then observed. The colonization and translocation of ETEC in the intestine were detected by the plate counting method. The expression of tight junction proteins and the levels of inflammatory factors and secretory IgA (SIgA) in the intestine were detected by quantitative real-time polymerase chain reaction (q-PCR), western blotting, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry. The results demonstrated that GPR109A^-/-mice were more susceptible to ETEC infection, showing more severe inflammatory reactions and intestinal damage. Moreover, the secretion of IgA in the intestinal tract of GPR109A^+/+ mice was significantly increased after ETEC infection, whereas the IgA levels in GPR109A^-/-mice did not change significantly. We added 5 g/L sodium butyrate to the drinking water of all mice. The GPR109A^+/+ mice were protected against ETEC infection and no effect was observed in GPR109A^-/-mice. Similarly, sodium butyrate increased the SIgA content in the gut of the GPR109A^+/+ mice and no effect was observed in GPR109A^-/-mice. In conclusion, activated GPR109A is effective against the colonization and translocation of ETEC in the gut and maintains the integrity of the intestinal barrier, possibly by promoting the secretion of intestinal IgA.

Bedaquiline in the treatment of multidrug- and extensively drug-resistant tuberculosis in China

BACKGROUND: Multidrug- and extensively drug-resistant tuberculosis (MDR/XDR-TB) continues to be a challenge in China. Bedaquiline (BDQ) is associated with accelerated sputum culture conversion and favourable treatment outcomes when added to a preferred background regimen. This post-hoc study aimed to assess the outcomes of BDQ treatment in Chinese patients with MDR/XDR-TB.METHODS: Data from 51 Chinese patients who participated in a global Phase 2, open-label, single-arm study (TMC207-C209) were analysed for effectiveness and safety of the BDQ-containing regimen.RESULTS: During the 24-week BDQ treatment, adverse events (AEs) occurred in 48 patients (94.1%), with the most common AE being hyperuricemia. Drug-induced liver injury (DILI) was reported in 13 patients (25.5%); serious DILI was reported in one patient (2.0%). Seven (13.7%) AEs were considered to be possibly related to BDQ by the investigators. Only one Grade 1 QTc prolongation was reported; no QTcF >500 ms was reported. One death occurred after BDQ treatment due to progressive TB. The median time to sputum culture conversion was 85 days based on the 24-week data. The sputum culture conversion rate was 82% at 24 weeks and 78% at 120 weeks; 66% of patients achieved a cure.CONCLUSIONS: BDQ was well-tolerated and effective for treating MDR-TB among Chinese patients.

Structural analysis of pulsed magnets considering interface characteristics

The aim of traditional designs of pulsed magnets is to keep the von-Mises stress on the midplane less than the ultimate tensile strength of materials. However, recently failed high-field experiments showed that some short circuits occurred at the magnet end, which is most possibly caused by the axial displacement of wires. This indicates that the former design is inadequate and accurate axial mechanical analysis of magnets is necessary. In this paper, a finite element model of pulsed magnets considering interface characteristics is proposed. Both the contact status and interfacial friction between the conductor layers and reinforcements can be accounted for Simulations are conducted with a failed 95 T dual-coil prototype, which was originally designed with the self-developed Pulsed Magnet Design Software (PMDS) software. The simulation results show that all the originally expected separations calculated by the PMDS software disappear due to the compression. This makes the calculated maximal von-Mises stress of the inner four reinforcement layers about 600 MPa less than the former designs. The influence of the interfacial friction is also presented. Besides, the simulations show that the maximum axial displacement at the magnet end is up to 8 mm at the designed peak field, which is deadly to the insulations. Hence, we suggest that the axial displacement at the magnet end should also be one design objective of pulsed magnets. At last, the factors affecting the axial displacement are analyzed.

Identification and characterization of long non-coding RNAs as competing endogenous RNAs in the cold stress response of Triticum aestivum

Long non-coding RNAs (lncRNAs) play important roles in plant development and stress responses. MicroRNAs (miRNAs) are involved in transcriptional and post-transcriptional gene regulation. It is not clear how lncRNA-mediated plant responses to cold stress and how lncRNAs, miRNAs and target mRNAs cooperate subject to the competing endogenous RNA (ceRNA). We interpreted the function of lncRNAs in the winter wheat cultivar Dongnongdongmai 1 (Dn1). A total of 9970 putative lncRNAs were initially identified from three Dn1 lncRNA libraries (5 °C, -10 °C and -25 °C) using high-throughput sequencing. Among the 14,626 genes detected via weighted gene co-expression network analysis, 7435 lncRNAs were co-expressed with 7191 mRNAs. We found six modules related to cold resistance in the lncRNA-mRNA weighted co-expression network, and the functions of mRNAs were similar in each module. Antioxidant systems and hormones played important roles in low-temperature responses. RNA sequencing analysis revealed that interactions between the 384 lncRNAs and 70 miRNAs were required for ceRNA activity. According to ceRNA activity, 225 lncRNAs, 60 miRNAs and 621 target mRNAs were involved in the regulatory networks of the cold stress response. Notably, a conserved region was found in the complementary regions of lncRNAs and miR164/408 but had reverse expression trends in the ceRNA network. Our results reveal possible roles of lncRNAs-mRNAs in the regulatory networks associated with tolerance to low temperature and provide useful information for more strategic use of genomic resources in wheat breeding.

The Effects of Dietary Supplementation of Saccharomyces cerevisiae Fermentation Product During Late Pregnancy and Lactation on Sow Productivity, Colostrum and Milk Composition, and Antioxidant Status of Sows in a Subtropical Climate

This study aimed to evaluate the effects of dietary supplementation of Saccharomyces cerevisiae fermentation product (SCFP) during late pregnancy and lactation on sow productivity, colostrum and milk composition, and antioxidant status of sows in a subtropical climate. The study was a 2 × 2 factorial treatment design where the first factor was environmental THI level [Low THI (08:00-19:00: 70.76 ± 0.45, 19:00-08:00: 67.91 ± 0.18, L-THI) or High THI (08:00-19:00: 75.14 ± 0.98, 19:00-08:00: 68.35 ± 0.18, H-THI], and the second factor was dietary treatment (supplemented with or without 3 kg/t SCFP). A total of 120 sows were randomly allotted to the four treatments (n = 30). The feeding trial was conducted from 85-days post-breeding until 21-days post-partum. Compared with L-THI group, sows from H-THI group had lesser individual piglet birth weight, individual piglet weight at weaning, preweaning average daily gain of piglets, average daily feed intake of sows during lactation, and protein percentage in 14-days milk. Additionally, sows from H-THI group had lesser antioxidant status, indicated by lesser serum total antioxidant capacity (T-AOC), and superoxide dismutase (SOD) activity at parturition; lesser serum T-AOC and glutathione peroxidase (GSH-Px) activity at 14-days post-partum, as well as lesser SOD activity in colostrum. Compared with sows fed the control diet, sows fed the SCFP diet had greater number of piglets weaned, litter weight at weaning, and preweaning average daily gain of piglets. Moreover, sows fed the SCFP diet had improved antioxidant status as indicated by higher serum T-AOC at parturition, and lesser malondialdehyde (MDA) content in colostrum and 21-days milk. In conclusion, H-THI negatively affected the productivity, milk composition, antioxidant status, and lactation feed intake of sows. Dietary supplementation of SCFP partially alleviated the adverse effects of H-THI, by improving lactation performance and antioxidant status of sows without influencing reproductive performance and colostrum and milk composition in a subtropical climate.

Copper-catalyzed 1,1-alkynylalkylation of alkynes: access toward conjugated enynes

A copper-catalyzed 1,1-alkynylalkylation of alkynes with α-haloacetamides for the construction of conjugated enynes has been developed.

Are left ventricular muscle area and radiation attenuation associated with overall survival in advanced pancreatic cancer patients treated with chemotherapy?

AIM

To evaluate whether cardiac muscle area and radiation attenuation, determined using pre-chemotherapy computed tomography (CT), are associated with therapeutic response and overall survival (OS) in chemotherapy-treated advanced pancreatic cancer (APC) patients.

MATERIALS AND METHODS

Ninety-eight chemotherapy-treated APC patients who underwent pre-chemotherapy CT between 2009 and 2018 were considered. Left ventricular muscle area (LVMA) and left ventricular muscle radiation attenuation (LVMRA) were measured using pre-chemotherapy arterial-phase CT. OS and progression-free survival (PFS) were analysed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were performed to analyse potential factors affecting OS and PFS.

RESULTS

Patients with low LVMRA, low LVMA at baseline CT, and multiple metastases had a significantly shorter median OS than patients with high LVMRA, high LVMA, and without multiple metastases (8.8 versus 14 months, p=0.017; 12.2 versus 18.1 months, p=0.038; 7.3 versus 13.5 months, p<0.001, respectively). Patients with low LVMRA and distant metastasis had a shorter median PFS than patients with high LVMRA and those without distant metastasis (4.9 versus 8.3 months, p=0.032; 5.4 versus 9.9 months, p=0.002, respectively). Moreover, the mean LVMRA was the highest in the partial response group (p=0.028).

CONCLUSION

LVMRA could well predict PFS and OS in chemotherapy-treated APC patients.

Combined therapy of infusion of DC from rats with higher expression of IDO and CD40L on rejection post heart transplantation

OBJECTIVE

Indoleamine 2, 3-dioxygenase (IDO) can inhibit rejection of graft via inducing T cell apoptosis. CD40L monoclonal antibody (mAb) inhibits T cell activation. However, the effects of the combination of infusion of dendritic cell (DC) from IDO over-expressed donor mice and CD40L mAb on the treatment of graft rejection after heart transplantation have not been reported.

MATERIALS AND METHODS

Allogeneic heart transplantation mouse model was established. Recipient mice were divided into three groups, including control group, IDO group (in which DC donors received adenoviral vector of IDO) and combined therapy group (which received both IDO over-expressed DC infusion and CD40L mAb injection post transplantation). Survival time and cardiac function were observed, with IDO expression being quantified. Flow cytometry (FCM) was used to analyze T cell apoptosis, while enzyme linked immunosorbent assay (ELISA) was adopted to test the levels of interferon-γ (IFN-γ), interleukin-2 (IL-2), interleukin-10 (IL-10) and interleukin-6 (IL-6).

RESULTS

IDO expression was significantly elevated in both IDO and combined therapy groups, with enhanced T cell apoptosis compared to control group (p < 0.05). Both groups had better survival time and cardiac functions compared to control group, along with increased IL-10/IL-6 expression and suppressed INF-γ and IL-2 expression (p < 0.05). However, combined therapy had a better efficiency compared to IDO group (p < 0.05).

CONCLUSIONS

Combined therapy of high IDO expressed mouse DC perfusion with CD40L mAb can elongate the survival time of recipient heart and inhibit rejection reaction via facilitating T cell apoptosis. Meanwhile, combined therapy could also regulate the expression of some immune suppressant factors and mediate the Th1/Th2 cytokine balance.

Notch3 signaling activation in smooth muscle cells promotes extrauterine growth restriction-induced pulmonary hypertension

BACKGROUND AND AIMS

Early postnatal life is a critical developmental period that affects health of the whole life. Extrauterine growth restriction (EUGR) causes cardiovascular development problems and diseases, including pulmonary arterial hypertension (PAH). PAH is characterized by proliferation, migration, and anti-apoptosis of pulmonary artery smooth muscle cells (PASMCs). However, the role of PASMCs in EUGR has not been studied. Thus, we hypothesized that PASMCs dysfunction played a role in EUGR-induced pulmonary hypertension.

METHODS AND RESULTS

Here we identified that postnatal nutritional restriction-induced EUGR rats exhibited an elevated mean pulmonary arterial pressure and vascular remodeling at 12 weeks old. PASMCs of EUGR rats showed increased cell proliferation and migration features. In EUGR-induced PAH rats, Notch3 signaling was activated. Relative mRNA and protein expression levels of Notch3 intracellular domain (Notch3 ICD), and Notch target gene Hey1 in PASMCs were upregulated. We further demonstrated that pharmacological inhibition of Notch3 activity by using a γ-secretase inhibitor DAPT, which blocked the cleavage of Notch proteins to ICD peptides, could effectively inhibit PASMC proliferation. Specifically knocked down of Notch3 in rat PASMCs by shRNA restored the abnormal PASMC phenotype in vitro. We found that administration of Notch signaling inhibitor DAPT could successfully reduce mean pulmonary arterial pressure in EUGR rats.

CONCLUSIONS

The present study demonstrated that upregulation of Notch3 signaling in PASMCs was crucial for the development of EUGR-induced PAH. Blocking Notch3-Hey1 signaling pathway in PASMCs provides a potential therapeutic target for PAH.

Protection of Porcine Intestinal-Epithelial Cells from Deoxynivalenol-Induced Damage by Resveratrol via the Nrf2 Signaling Pathway

Deoxynivalenol (DON), a common mycotoxin, usually induces oxidative stress and affects the intestinal health of humans and animals. This study investigated the protective effect of resveratrol (RES), a natural antioxidant, on alleviating the cytotoxicity induced by DON in the porcine intestinal-epithelial cell line (IPEC-J2). Cells were incubated with RES for 24 h and then exposed to DON for another 24 h. Cell viability, proliferation, apoptosis, and oxidative-stress indicators were determined. In comparison with DON-only-treated cells, pretreatment with RES (15 μM) increased the cell viability (79.74 ± 2.02 vs 90.98 ± 2.66%, P < 0.01), improved proliferation (EdU-positive cells, 26.42 ± 1.12 vs 32.05 ± 0.78%, P < 0.01), decreased accumulation of intracellular reactive oxygen species (ROS, 1.68 ± 0.05 vs 1.29 ± 0.06, P < 0.01), stabilized mitochondrial-membrane potential (MMP, 8.98 ± 1.40 vs 2.29 ± 0.76, P < 0.001), and prevented apoptosis induced by DON (13.91 ± 1.20 vs 6.83 ± 0.52%, P < 0.01). RES activated the Nrf2 signaling pathway, and transfection with Nrf2 siRNA abrogated the protection of RES against DON-induced cytotoxicity, accumulation of intracellular ROS, and mitochondria-dependent apoptosis. Collectively, RES protects IPEC-J2 cells against DON-induced damage at least partly via the Nrf2 signaling pathway.

S-nitrosylation of Src by NR2B-nNOS signal causes Src activation and NR2B tyrosine phosphorylation in levodopa-induced dyskinetic rat model

Abnormality in Src PSD-95 NR2B signaling complex assemble occurs in levodopa-induced dyskinesia (LID). N-methyl-D-aspartate receptor (NMDAR) subunit NR2B tyrosine phosphorylation mediated by Src family protein tyrosine kinases is closely associated with dyskinesia. Src autophosphorylation (p-Src) is an important part of Src-catalyzed phosphorylation of NR2B. In addition, the neuronal nitric oxide synthase (nNOS)-derived NO (nNOS/NO) signal which was also involved in dyskinesia recently was proved to participate in the regulation of Src function. Yet, the detailed signal mechanism about the interactions of NR2B, nNOS, and Src is still unknown. In the present study, we investigated the influences of nNOS on Src activation and NR2B tyrosine phosphorylation in dyskinetic rat model by immunoblotting and immunoprecipitation. The results demonstrated that chronic levodopa treatment resulted in downregulation of p-nNOS-S847, one marker of nNOS overactivation. Coinstantaneously, the S-nitrosylation (SNO-Src) and autophosphorylation (p-Src) of Src and NR2B tyrosine phosphorylation were upregulated in dyskinetic rat model. Conversely, administration of 7-NI, one nNOS inhibitor, reversed all these effects of levodopa treatment. Besides, NR2B-containing NMDAR (NR2B/NMDAR) antagonist CP-101,606 could upregulate p-nNOS-S847 and thus attenuate nNOS activation and simultaneously reduce the SNO-Src, p-Src, and NR2B tyrosine phosphorylation. Taken together, the S-nitrosylation of Src is caused by nNOS/NO signal, which is overactivated via Ca²⁺ influx dependent on NR2B/NMDAR, and subsequently facilitates Src auto-tyrosine phosphorylation and further phosphorylates NR2B. The "NR2B/NMDAR-nNOS/NO-SNO-Src-p-Src-NR2B/NMDAR" signaling cycle may be the molecular basis of NR2B tyrosine phosphorylation upward positive feedback, which demonstrates the possibility as one latent target for dyskinesia therapy.

[The attentional bias of emotion in medical workers of emergency department in one hospital and it's relationship with mood state]

Objective: To study the characteristics of attentional bias to emotional stimulus in medical workers of emergency department and explore the relationship between the emotional Stroop effect and mood states, thus providing a reference to the assessment and intervention of emergency medical workers' mental health. Methods: Two kinds of emotional Stroop tasks with words and pictures and the Profile of Mood States (POMS) were administered to thirty-six medical workers of emergency department and thirty-six medical workers of other departments. Results: The reaction time to negative and positive words and pictures were all higher than the reaction time to neutral stimulus, thus showing the significant Stroop effect in medical workers. The Stroop effect to negative emotional stimulus in medical workers of emergency department was significantly smaller than that in medical workers of other departments, while the difference of Stroop effect to positive stimulus was not significant between the two groups. Correlation analyses revealed that the correlations between Stroop effect size to positive pictures and tension and angry of POMS were all negatively significant (r value was -0.314 and -0.330 respectively) , and the correlation between Stroop effect size to negative pictures and fatigue was negatively significant (r=-0.303) . Conclusions: There is a significant emotional Stroop effect in medical workers. Although the ability of anti-interference to emotional stimulus in medical workers of emergency department was better than medical workers of the other departments, the long-term avoidance to negative emotional stimulus was still has a negative effect on the mood states of individuals.

Expression and significance of peripheral myeloid-derived suppressor cells in chronic hepatitis B patients

BACKGROUND

Myeloid-derived suppressor cells (MDSCs) exert their suppressive effects on multiple immune response and contribute to the development of many diseases. However, limited data is available on the involvement of MDSCs in human chronic HBV infection.

OBJECTIVE

To investigate whether the progression of chronic HBV infection was associated with imbalance of MDSCs.

METHODS

The percentages of MDSCs, regulatory T (Treg), Th1 and Tc1 cells in the peripheral blood from chronic hepatitis B (CHB) patients and healthy controls (HC) were determined by flow cytometry. Plasma levels of IL-10, TGF-β and IFN-γ were measured using enzyme-linked immunosorbent assay. The potential association of the frequencies of MDSCs with clinical parameters was assessed.

RESULTS

The percentages of MDSCs and Treg cells were significantly higher in CHB patients than those in HC. The percentages of MDSCs were negatively correlated with Th1 cells. Increased plasma IL-10 level and decreased IFN-γ level were found in CHB patients compared with HC. Moreover, the frequencies of MDSCs and plasma IL-10 levels were positively correlated with serum HBV DNA loads, as well as liver function impairment.

CONCLUSION

The expanded peripheral MDSCs may contribute to poor viral clearance and disease progression during chronic HBV infection.

Metabolic transition of milk triacylglycerol synthesis in response to varying levels of palmitate in porcine mammary epithelial cells

BACKGROUND

Milk in mammals is a key source of lipids for offspring, providing both critical energy and essential fatty acids. For lactating sows, palmitic acid is one of the most abundant fatty acids in milk, providing 10~12% of the suckling pig total dietary energy supply. However, the effects of exogenous palmitic acid on milk fat synthesis in sow mammary glands are not well-known. In this study, we investigated the effects of palmitic acid on lipogenic genes in porcine mammary epithelial cells (pMECs) to explore the role of exogenous palmitic acid in mediating milk triacylglycerols (TAG) synthesis.

METHODS

Porcine mammary epithelial cells were cultured for 24 h in the presence of different concentrations of palmitate (0, 25, 50, 100, 200, 400, and 600 μM). The effect of palmitate on cell viability was tested via MTT assay. Intracellular lipid accumulation was measured through Oil Red O staining, and TAG levels were quantified by enzymatic colorimetric methods. Expression of genes and proteins involved in milk fat biosynthesis were assayed with quantitative real-time polymerase chain reaction (qPCR) and Western blotting, respectively.

RESULTS

Incubation with palmitate promoted cellular lipid synthesis in a dose-dependent manner, as reflected by the increased TAG content and enhanced formation of cytosolic lipid droplets. The increased lipid synthesis by palmitate was probably attributable to the upregulated mRNA expression of genes associated with milk fat biosynthesis, including long-chain fatty acid uptake (LPL, CD36), intracellular activation and transport (ACSL3, FABP3), TAG synthesis (GPAM, AGPAT6, DGAT1), lipid droplet formation (PLIN2), and regulation of transcription (PPARγ). Western blot analysis of CD36 and DGAT1 proteins confirmed the increased lipid synthesis with increasing incubation of palmitate. However, the genes involved in fatty acid de novo synthesis (ACACA, FASN), fatty acid desaturation (SCD), and regulation of transcription (SREBP1, INSIG1) were inversely affected by incubation with increasing concentrations of palmitate. Western blot analysis of ACACA protein confirmed this decrease associated with increasing levels of palmitate.

CONCLUSIONS

Results from this study suggest that palmitate stimulated the cytosolic TAG accumulation in pMECs, probably by promoting lipogenic genes and proteins that are involved in lipid synthesis. However, addition of palmitate decreased the fatty acid de novo synthesis in pMECs.

GLUT1 and lactose synthetase are critical genes for lactose synthesis in lactating sows

Background

Lactose synthesis rate is an important factor in milk production and quality in mammals. Understanding the lactose synthesis mechanism is crucial for the improvement of milk quantity and quality. However, research on the temporal gene changes regarding lactose synthesis during the whole lactation is still limited. The objective of this study was to determine gene expression profiles related to lactose synthesis in sows during lactation, and further identify the critical steps or key factors in the lactose synthesis pathway.

Methods

To determine the temporal change of factors related to lactose synthesis in sows, milk from eight multiparous Yorkshire sows (parity 3 to 6) was collected at 0 h, 2 h, 6 h, 12 h, 24 h, day 2, 3, 4, 7, 14, and 21 after birth of the first piglet. Lactose content, prolactin and progesterone concentration, and gene or protein expression related to lactose synthesis were measured.

Results

The lactose yield increased gradually from D2 to D21 and reached a maximum at D14 (3-fold from D2) during lactation (P < 0.05). A similar trend was observed in IGF-1 and insulin concentrations in milk, both of which were greatest at D3 with a subsequent decrease during middle to late lactation. Conversely, milk prolactin and progesterone concentrations moderately decreased with the progression of lactation. The mRNA or protein expressions related to glucose transportation (GLUT1), glucose-galactose interconversion (HK1 and UGP2), UDP-galactose transportation (SLC35A2), and lactose synthetase (LALBA and B4GALT1) in the lactose synthesis pathway were significantly upregulated during early to middle lactation and plateaued by late lactation (P < 0.05).

Conclusions

These novel findings suggest that the increased lactose synthesis in lactation was related to the coordinated upregulation of genes or enzymes in the lactose synthesis pathway, and glucose transportation (GLUT1) and lactose synthetase (LALBA and B4GALT1) might be the critical steps in the lactose synthesis pathway of sows during lactation.

An Effective α/β Nucleating Agent Compoundfor the Preparation of Polypropylene

The crystallization behavior and mechanical properties were investigated by mixing the traditional α-form nucleating agent (sodium benzoate, SB) and commercialized β-form nucleating agent (TMB-5) in isotactic polypropylene (iPP). Mechanical properties were evaluated by universal testing machines. X-ray diffraction (XRD) and differential scanning calorimetry (DSC) were conducted to illustrate the crystallization behavior. Polarized optical microscopy (POM) was adopted to observe the crystal morphologies. The experimental results show that the weight ratio of two types of nucleating agents determines the final crystal structure and mechanical properties of iPP. When the weight ratio of [SB] : [TMB-5] is 4 : 1, the impact strength and flexural modulus of iPP reach a maximum value. Compared with the single component β-form nucleating agent, the compound nucleating agent exhibits significant synergistic effect and shows better mechanical properties. It is expected that this new nucleation system will have potential industrial applications.

Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma

BACKGROUND

The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC.

METHODS

Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories.

RESULTS

Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM.

CONCLUSION

The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.