Impact of surgical approach on short-term oncological outcomes and recovery following low anterior resection for rectal cancer

AIM

The aim was to evaluate the influence of operative approach for low anterior resection (LAR) on oncological and postoperative outcomes. Minimally invasive surgical approaches are increasingly used for the treatment of rectal cancer with mixed outcomes.

METHOD

We compared patients undergoing LAR in the National Cancer Database between 2010 and 2015 by surgical approach. Multivariable regression was used to identify risk factors associated with conversion rate, prolonged length of stay (LOS) and 30-day unplanned readmission.

RESULTS

During the study period, 41 282 patients underwent LAR: 6035 robotic-assisted (RLAR) (14.6%), 13 826 laparoscopic (LLAR) (33.5%) and 21 421 open (OLAR) (51.9%). In propensity score matched analysis, RLAR compared to LLAR was associated with shorter LOS (6.3 vs 6.8 days, P < 0.0001), lower risk of prolonged LOS (22.1% vs 25.6%, P < 0.0001) and lower rate of conversion to open (7.5% vs 14.95%, P < 0.0001). Compared to OLAR, RLAR had shorter LOS (6.3 vs 7.8 days, P < 0.0001) and less prolonged LOS (14.1% vs. 20.9%, P < 0.0001). In multivariable analysis, for conversion to open, the laparoscopic approach was one of the risk factors; for prolonged LOS, conversion to open and non-robotic approaches (i.e. LLAR and OLAR) were risk factors; and for unplanned 30-day readmission, conversions and prolonged LOS were risk factors.

CONCLUSIONS

For patients with rectal cancer, RLAR shows recovery benefits over both open and laparoscopic LAR with reduced conversion to open compared with LLAR and less prolonged LOS compared with LLAR and OLAR. RLAR is associated with short-term oncological outcomes comparable to OLAR, supporting its use in minimally invasive surgery for rectal cancer.

Characterisation of spatial variability in water quality in the Great Barrier Reef catchments using multivariate statistical analysis

Water quality monitoring is important to assess changes in inland and coastal water quality. The focus of this study was to improve understanding of the spatial component of spatial-temporal water quality dynamics, particularly the spatial variability in water quality and the association between this spatial variability and catchment characteristics. A dataset of nine water quality constituents collected from 32 monitoring sites over a 11-year period (2006-2016), across the Great Barrier Reef catchments (Queensland, Australia), were evaluated by multivariate techniques. Two clusters were identified, which were strongly associated with catchment characteristics. A two-step Principal Component Analysis/Factor Analysis revealed four groupings of constituents with similar spatial pattern and allowed the key catchment characteristics affecting water quality to be determined. These findings provide a more nuanced view of spatial variations in water quality compared with previous understanding and an improved basis for water quality management to protect nearshore marine ecosystem.

[Eosinophil could predict the prognosis of patients with bloodstream infection: a retrospective analysis of 305 cases]

OBJECTIVE

To investigate the value of peripheral blood for the prognosis of patients with bloodstream infection.

METHODS

A retrospective analysis of patients with bloodstream infection was conducted in the intensive care unit (ICU) of Mianyang Central Hospital of Sichuan from January 2012 to October 2016. According to the 28-day survival, the patients were divided into survival group and death group. The white blood cell (WBC), neutrophils count (NEU), lymphocyte count (LYM), neutrophil/lymphocyte ratio (NLR), monocyte count (MO), eosinophil count (EO), basophil count (BA), hemoglobin (Hb), platelet count (PLT) and procalcitonin (PCT) in peripheral blood were recorded when patients were diagnosed with blood infection. Receiver operating characteristic curve (ROC), Kaplan-Meier survival analysis and Cox regression were used to evaluate the value of these risk factors for predicting the outcome.

RESULTS

305 patients were enrolled. 182 patients survived while 123 patients died during the 28-day period. (1) There was no significant difference in gender, age and comorbidities between the two groups. There was no significant difference in infection rate between the two groups except for fungal infection rate. The fungal infection rate in the death group was significantly higher than that in the survival group (9.8% vs. 3.3%, P = 0.019). (2) The LYM, MO, EO and PLT in the death group were significantly lower than those in the survival group [LYM (×10⁹/L): 0.58 (0.29, 0.93) vs. 0.76 (0.44, 1.23), MO (×10⁹/L): 0.47 (0.19, 0.80) vs. 0.58 (0.30, 0.94), EO (×10⁹/L): 0.00 (0.00, 0.01) vs. 0.03 (0.01, 0.09), PLT (×10¹²/L): 89 (47, 148) vs. 126 (82, 186), all P < 0.05]. The NLR in the death group was significantly higher than that in the survival group [17.09 (7.60, 33.51) vs. 12.86 (6.51, 24.85), P < 0.05]. There was no significant difference in the WBC, NEU, BA, Hb and PCT between the two groups. (3) It was shown by ROC curve analysis that the maximum area under the ROC curve (AUC) of EO was 0.755. When the best cut-off value was 0.015×10⁹/L as a predictor of death in 28 days, the sensitivity was 80.3%, and specificity was 64.7%. (4) It was shown by survival analysis that the 28-day survival rate in the patients with EO < 0.015×10⁹/L was significantly lower than that of patients with EO > 0.015×10⁹/L [38.3% (62/162) vs. 83.9% (120/143), χ ² = 56.999, P = 0.000]. (5) It was shown by Cox regression that EO was the independent factor for 28-day survival (β = 1.466, χ ² = 39.535, P = 0.000). Risk of death was 4.331 times greater in patients with EO < 0.015×10⁹/L than in those with EO > 0.015×10⁹/L [hazard ratio (HR) = 4.331, 95% confidence interval (95%CI) = 2.743-6.840].

CONCLUSIONS

Compared to other parameters in peripheral blood, EO has the best correlation with the prognosis of bloodstream infection. EO is the independent prognostic predictor for 28-day survival.

Increased PD-1 MRNA Expression in Peripheral Blood Cells of ER+ and PR+ Breast Cancer Patients and Its Unfavorable Prognostic Value

Background: The clinical significance of programmed cell death 1 (PD-1) and cytotoxic T lymphocyte-associated protein 4 (CTLA-4) expression on tumor infiltrating lymphocytes in breast cancer patients has been confirmed, while that of peripheral blood cells derived immune molecules remain unclear. Aim: We aimed to investigate the clinical importance of immune molecules, including PD-1 and CTLA-4, expression in peripheral blood cells of breast cancer patients, especially in terms of the relationship between immune molecules and estrogen receptor (ER)/progesterone receptor (PR) status, as well as their prognostic values. Methods: We enrolled 109 breast cancer patients, including 52 cases before surgery and neoadjuvant treatment (PreS group), 18 cases postsurgery and adjuvant chemoradiotherapy (PostS group), 39 metastatic cases presalvage treatment (Met group), and 21 age- and sex-matched healthy volunteers). The mRNA abundance of PD-1, CTLA-4, IL-2 receptor alpha (IL-2Rα), and cluster of differentiation 28 (CD28), forkhead box P3 (FOXP3), transforming growth factor beta (TGF-β), and interleukin-10 (IL-10) in pretreatment peripheral blood were analyzed by quantitative real-time PCR. Results: ER+ breast cancer patients showed significant higher mRNA levels of PD-1, CTLA-4, IL-2Rα, and CD28 with fold changes of 10.8, 2.4, 5.0, and 3.8, respectively ( P < 0.05) than that of ER− cases. Similarly, PR+ patients showed increased levels of PD-1, CTLA-4, and CD28 with fold changes of 6.7, 2.0, and 2.5, respectively ( P < 0.05) comparing to that of PR− cases. Patients in PreS group and Met group showed higher mRNA levels of PD-1, CTLA-4, IL-2Rα, CD28, FOXP3, TGF-β, and IL-10 than PostS group and healthy volunteers. Univariable analysis revealed that high PD-1 expression was associated with poorer progression-free survival (PFS) in metastatic breast cancer patients (5.9 vs 14.6 months, HR: 2.47, 95% CI: 1.22-5.02, P = 0.046). Meanwhile, the prognostic value of PD-1 was remained in multivariate analyses (HR: 2.22, 95% CI: 1.04-4.73, P = 0.039). Conclusion: Increased PD-1, CTLA-4, and CD28 mRNA abundance were showed in breast cancer patients and ER+/PR+ cases, which may provide the rationale for combining checkpoint inhibitors with endocrine therapy for breast cancer treatment. Furthermore, PD-1 is a promising prognostic biomarker for metastatic breast cancer.

[Diagnosis of obstructive sleep apnea using cardiopulmonary coupling analysis]

Objective: To explore the diagnostic value of cardiopulmonary coupling analysis in the screening of obstructive sleep apnea (OSA). Methods: A total of 44 participants with sleep disorders from Sleep Medicine Center of West China Hospital in May 2016 were included in the study. All participants were monitored with cardiopulmonary coupling while undergoing polysomnography (PSG). The sleep parameters detected by cardiopulmonary coupling and PSG were compared and the correlation between respiratory disturbance index (RDI) of cardiopulmonary coupling and sleep parameters of PSG were analyzed. Using PSG as "golden standard" , the sensitivity, specificity, positive predictive value, negative predictive value and the corresponding areas under the receiver operating characteristic (ROC) curves were calculated for cardiopulmonary coupling. Results: There were 44 participants included in the study (37 males and 7 females) with a mean age of (46.3±12.5) years old and a mean body mass index of (25.6±3.7) kg/m(2). And there were 33 subjects diagnosed with OSA. There were no significant difference between respiratory disturbance index (RDI) derived from cardiopulmonary coupling and apnea-hypopnea index (AHI) derived from PSG. Correlation analysis showed that the RDI, low frequency coupling monitored by cardiopulmonary coupling was positively correlated with AHI detected by PSG (r=0.849, 0.850, both P<0.001); and the high frequency coupling was significantly negatively correlated with AHI (r=-0.767, P<0.001). For AHI ≥5/h, ≥10/h, ≥15/h, ≥20/h and ≥30/h respectively according to PSG, sensitivity was 0.82, 0.93, 0.96, 0.96, 0.77, specificity was 0.50, 0.75 0.72, 0.80, 0.86, positive predictive value was 0.85, 0.87, 0.83, 0.85, 0.85, negative predictive value was 0.55, 0.86, 0.93, 0.94, 0.79 for cardiopulmonary coupling. The corresponding areas under the ROC curves were 0.868, 0.892, 0.915, 0.942, 0.921 respectively. In addition, when the RDI derived from CPC was higher than 20.4/h, the patients were more likely suffering from OSA, and the sensitivity was 0.79 and the specificity was 0.91. Conclusions: The results of cardiopulmonary coupling are consistent with simultaneous PSG parameters. Cardiopulmonary coupling has a highly diagnostic value for sleep respiratory disorder.

Randomized clinical trial of autologous skin cell suspension for accelerating re-epithelialization of split-thickness donor sites

BACKGROUND

Split-thickness skin graft (STSG) is used frequently, but may result in complications at the donor site. Rapid healing of donor-site wounds is critical to relieving morbidity. This study investigated whether autologous skin cell suspension could improve healing of STSG donor-site wounds.

METHODS

Between September 2014 and February 2016, patients requiring STSGs were randomized to receive autologous skin cell suspension plus hydrocolloid dressings (experimental group) or hydrocolloid dressings alone (control group) for the donor site. The primary outcome was time to complete re-epithelialization. Secondary outcomes included pain and itching scores measured on a visual analogue scale, and adverse events. Patients were followed for 12 weeks to evaluate quality of healing. Analysis was by intention to treat.

RESULTS

Some 106 patients were included, 53 in each group. Median time to complete re-epithelialization was 9·0 (95 per cent c.i. 8·3 to 9·7) days in the experimental group, compared with 13·0 (12·4 to 13·6) days in the control group (P < 0·001). Overall postoperative pain and itching scores were similar in both groups. No between-group differences in treatment-related complications were observed. Both patients and observers were more satisfied with healing quality after autologous skin cell suspension had been used.

CONCLUSION

The use of autologous skin cell suspension with hydrocolloid dressings accelerated epithelialization and improved healing quality of the donor site compared with hydrocolloid dressings alone. Registration number: UMIN000015000 ( http://www.umin.ac.jp/ctr).

Melatonin protects hepatocytes against bile acid-induced mitochondrial oxidative stress via the AMPK-SIRT3-SOD2 pathway

Mitochondrial oxidative damage is hypothesized to contribute to the pathogenesis of chronic cholestatic liver diseases. Melatonin, an indolamine synthesized in the pineal gland, shows a wide range of physiological functions, and is under clinical investigation for expanded applications. Melatonin has demonstrated efficient protective effects against various types of oxidative damage in the liver system. This study investigates the protective effects of melatonin pretreatment on glycochenodeoxycholic acid (GCDCA)-induced hepatotoxicity and elucidates the potential mechanism of melatonin-mediated protection. Melatonin markedly decreased mitochondrial ROS (mROS) production in L02 cells treated with 100 μM GCDCA, and inhibited GCDCA-stimulated cytotoxicity. Notably, melatonin exerted its hepatoprotective effects by upregulating sirtuin 3 (SIRT3) activity and its expression level, thus regulating superoxide dismutase 2 (SOD2) acetylation and inhibiting the production of mROS induced by GCDCA. Moreover, siRNA targeting SIRT3 blocked the melatonin-mediated elevation in mitochondrial function by inhibiting SIRT3/SOD2 signaling. Importantly, melatonin-activated SIRT3 activity was completely abolished by AMP-activated, alpha 1 catalytic subunit (AMPK) siRNA transfection. Similar results were obtained in rat with bile duct ligation or BDL. In summary, our findings indicate that melatonin is a novel hepatoprotective small molecule that functions by elevating SIRT3, stimulating SOD2 activity, and suppressing mitochondrial oxidative stress at least through AMPK, and that SIRT3 may be of therapeutic value in liver cell protection for GCDCA-induced hepatotoxicity.

Mass spectrometry-based ligand binding assays on adenosine A1 and A2A receptors

Conventional methods to measure ligand-receptor binding parameters typically require radiolabeled ligands as probes. Despite the robustness of radioligand binding assays, they carry inherent disadvantages in terms of safety precautions, expensive synthesis, special lab requirements, and waste disposal. Mass spectrometry (MS) is a method that can selectively detect ligands without the need of a label. The sensitivity of MS equipment increases progressively, and currently, it is possible to detect low ligand quantities that are usually found in ligand binding assays. We developed a label-free MS ligand binding (MS binding) assay on the adenosine A₁ and A_2A receptors (A₁AR and A_2AAR), which are well-characterized members of the class A G protein-coupled receptor (GPCR) family. Radioligand binding assays for both receptors are well established, and ample data is available to compare and evaluate the performance of an MS binding assay. 1,3-Dipropyl-8-cyclopentyl-xanthine (DPCPX) and 4-(2-((7-amino-2-(furan-2-yl)-[1,2,4]triazolo[1,5-a]-[1,3,5]triazin-5-yl)amino)ethyl)phenol (ZM-241,385) are high-affinity ligands selective for the A₁AR and A_2AAR, respectively. To proof the feasibility of MS binding on the A₁AR and A_2AAR, we first developed an MS detection method for unlabeled DPCPX and ZM-241,385. To serve as internal standards, both compounds were also deuterium-labeled. Subsequently, we investigated whether the two unlabeled compounds could substitute for their radiolabeled counterparts as marker ligands in binding experiments, including saturation, displacement, dissociation, and competition association assays. Furthermore, we investigated the accuracy of these assays if the use of internal standards was excluded. The results demonstrate the feasibility of the MS binding assay, even in the absence of a deuterium-labeled internal standard, and provide great promise for the further development of label-free assays based on MS for other GPCRs.

Does live music benefits patients with brain and spinal injury?

OBJECTIVE

The purpose of this study is to examine the feasibility and prospective success associated with implementing and evaluating a six-week live music intervention on an inpatient neurorehabilitation ward.

PATIENTS AND METHODS

In total 26 patients were included in this study. Out of which, 15 were patients and 11 were staff members. Staff participants completed wellbeing measures at before and after music. Patients completed an assortment of validated measures at five consecutive time points from baseline to follow-up. Staff participants experienced a minor decrease in wellbeing over time.

RESULTS

The majority of the data collected from patients illustrated positive trends, with improvements in wellbeing, pain, cognition functioning, independent functioning, and mobility. The feasibility indicates that with modifications that this project is a viable venture.

CONCLUSIONS

We found that live music appears to be promising new addition to neurorehabilitation.

Carposina sasakii (Lepidoptera: Carposinidae) in its Native Range Consists of Two Sympatric Cryptic Lineages as Revealed by Mitochondrial COI Gene Sequences

The genetic differentiation and genetic structure of the peach fruit moth, Carposina sasakii Matsumura (Lepidoptera: Carposinidae), was investigated in China, where the moth is native. The mitochondrial cytochrome c oxidase I (COI) gene of 180 individuals from 16 collections were sequenced and analyzed. The results showed that two sympatric and cryptic mtDNA lineages existed within C. sasakii in China. The genetic differentiation has significant correlation with the geographical distance, but has no evidence for host plant associations. Our results of haplotype distribution suggest that the C. sasakii individuals can naturally move between areas, while the movement of individuals between long-distance locations may be associated with human activities such as the transport of fruit. Finally, an mitochondrial COI gene PCR-RFLP method was developed to differentiate the two cryptic mtDNA lineages within C. sasakii, which provides rapid and reliable tool for the future research of the two lineages.

Randomized clinical trial of autologous skin cell suspension combined with skin grafting for chronic wounds

BACKGROUND

Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates. This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment.

METHODS

This randomized clinical trial enrolled patients with chronic wounds between March 2012 and December 2013. Patients who were assigned randomly to the active treatment received a split-thickness autograft combined with harvested skin cell suspension. Control patients received the split-thickness autograft alone. The primary outcome was the rate of complete wound closure by postoperative day 28. Analysis was by intention to treat. Patients who achieved wound closure were followed up for a minimum of 6 months to evaluate the quality of healing.

RESULTS

A total of 88 patients were included, 44 in each group. More patients achieved complete wound closure in the skin cell group than in the control group (41 versus 34 patients; P = 0·035). Complete wound closure was observed at a median of 14 (95 per cent c.i. 12·0 to 16·0) days in the skin cell group and 20 (15·7 to 24·3) days in the control group (P = 0·001). The skin cell group had significantly fewer complications (4 versus 11 patients; P = 0·047). The autografted sites displayed better physical attributes and a reduced tendency for wound recurrence in the skin cell group.

CONCLUSION

Complementary split-thickness autologous skin grafting with autologous skin cells harvested using ReCell® (Avita Medical, Cambridge, UK) technology improved the healing rate of chronic wounds.

REGISTRATION NUMBER

UMIN000011966 (http://www.umin.ac.jp/ctr).

Effect of heavy-ion on frequency selectivity of semiconducting polymer/electrolyte heterojunction

Long-term bidirectional frequency selectivity has been achieved in MEH-PPV/PEO–Nd³⁺cells, which suggests spike-rate-dependent plasticity learning protocol. It depends on pulse shape due to variation of ionic type.

Cassava (Manihot esculenta Krantz) genome harbors KNOX genes differentially expressed during storage root development

In plants, homeodomain proteins play a critical role in regulating various aspects of plant growth and development. KNOX proteins are members of the homeodomain protein family. The KNOX transcription factors have been reported from Arabidopsis, rice, and other higher plants. The recent publication of the draft genome sequence of cassava (Manihot esculenta Krantz) has allowed a genome-wide search for M. esculenta KNOX (MeKNOX) transcription factors and the comparison of these positively identified proteins with their homologs in model plants. In the present study, we identified 12 MeKNOX genes in the cassava genome and grouped them into two distinct subfamilies based on their domain composition and phylogenetic analysis. Furthermore, semi-quantitative reverse transcription polymerase chain reaction analysis was performed to elucidate the expression profiles of these genes in different tissues and during various stages of root development. The analysis of MeKNOX expression profiles of indicated that 12 MeKNOX genes display differential expressions either in their transcript abundance or expression patterns.