Identification and verification of an exosome-related gene risk model to predict prognosis and evaluate immune infiltration for colorectal cancer

Colorectal cancer (CRC) is a common malignant tumor that severely endangers human health. Exosomes show great potential in tumor immunotherapy. Increasingly studies have shown that exosome-related genes are effective prognostic biomarkers. Clinical information and gene expression data of CRC patients were obtained from gene expression omnibus and the cancer genome atlas. The data were then classified into training and independent validation sets. In the training set, exosome-related genes with a prognostic value were selected by univariate Cox analysis, least absolute shrinkage and selection operator Cox regression model, and stepwise Cox regression analysis. Risk scores were calculated based on the selected genes to stratify patients. The selected exosome-related genes were applied to establish a risk model. Based on 11 exosome-related genes, a prognostic risk model, which could stratify the risk both in the training and validation sets, was established. According to the survival curves, the prognoses of the high- and low-risk groups were significantly different. The AUCs of the risk model for prognostic prediction were 0.735 and 0.784 in the training and validation sets, respectively. A nomogram was constructed to predict the survival of CRC patients. Single-sample gene set enrichment analysis and ESTIMATE algorithms revealed that the risk model was related to immune cell infiltration. The value of the risk model in predicting immunotherapeutic outcomes was also confirmed. An exosome-related gene risk model was constructed to predict prognosis, evaluate microenvironment immune cell infiltration levels and bring a new perspective to CRC patient treatment.

Stereotactic Ablative Radiotherapy Boost to Bladder Tumor for Bladder Preservation in Patients with Muscle-Invasive Bladder Cancer

PURPOSE/OBJECTIVE(S)

Previous studies showed that selective bladder-sparing approach using TMT is an established therapy of MIBC with outcomes that are comparable to those of radical cystectomy. However, it has been shown that the 5-year local recurrence in the bladder is greater than 40% after TMT. One of the possible reasons was that the RT dose to the bladder tumor or tumor bed was insufficient. Thus, we assessed the effectiveness and safety of Stereotactic Ablative Radiotherapy (SABR) boost to bladder tumor or tumor bed for patients with muscle invasive bladder cancer (MIBC).

MATERIALS/METHODS

A total of 59 consecutive patients with cT2-4 bladder cancer underwent transurethral resection of bladder tumor (TURBT). TURBT was visibly complete in 25 cases. Patients received SABR to the tumor or tumor bed in the bladder followed by conventionally fractionated RT (CFRT) to pelvis and total bladder with concomitant weekly radio-sensitizing chemotherapy. During SABR intravesical installation of isovolumetric saline through urinary catheter ensured adequate bladder filling. Response rate was assessed by cystoscopic evaluation and pelvic MRI or CT. Toxicities were reported per the RTOG acute and late Radiation Morbidity Scoring Schema.

RESULTS

The median age of all patients was 76 years (35-90 years). All patients completed SBRT boost and 61% patients received concurrent Gemcitabine chemotherapy. After a median follow-up time of 28 months, the rate of local control (LC) at 3 years was 90.0%. The overall survival (OS) and cancer-specific survival (CSS) rates at 3 years were 61.6% and 77.5%, respectively. Of the surviving patients, 84.4% have a disease-free and functioning bladder. Acute grade 3 gastrointestinal (GI) or genitourinary (GU) toxicities occurred in only 1.7% of the patients. Late grade 3 GU toxicity occurred in 5.1% of the patients. No patients experienced grade 4 GI or GU toxicities.

CONCLUSION

SABR boost followed by chemoradiation to the pelvis was found to be a well-tolerated and effective treatment for MIBC patients who are either not candidates for cystectomy or who desire bladder preservation. Randomized study is required to further evaluate this novel tri-modality treatment paradigm.

Efficacy and Safety of Ciprofol Sedation in ICU Patients Undergoing Mechanical Ventilation: A Multicenter, Single-Blind, Randomized, Noninferiority Trial

OBJECTIVES

To determine the effectiveness and safety of ciprofol for sedating patients in ICUs who required mechanical ventilation (MV).

DESIGN

A multicenter, single-blind, randomized, noninferiority trial.

SETTING

Twenty-one centers across China from December 2020 to June 2021.

PATIENTS

A total of 135 ICU patients 18 to 80 years old with endotracheal intubation and undergoing MV, who were expected to require sedation for 6-24 hours.

INTERVENTIONS

One hundred thirty-five ICU patients were randomly allocated into ciprofol ( n = 90) and propofol ( n = 45) groups in a 2:1 ratio. Ciprofol or propofol were IV infused at loading doses of 0.1 mg/kg or 0.5 mg/kg, respectively, over 4 minutes ± 30 seconds depending on the physical condition of each patient. Ciprofol or propofol were then immediately administered at an initial maintenance dose of 0.3 mg/kg/hr or 1.5 mg/kg/hr, to achieve the target sedation range of Richmond Agitation-Sedation Scale (+1 to -2). Besides, continuous IV remifentanil analgesia was administered (loading dose: 0.5-1 μg/kg, maintenance dose: 0.02-0.15 μg/kg/min).

MEASUREMENTS AND MAIN RESULTS

Of the 135 patients enrolled, 129 completed the study. The primary endpoint-sedation success rates of ciprofol and propofol groups were 97.7% versus 97.8% in the full analysis set (FAS) and were both 100% in per-protocol set (PPS). The noninferiority margin was set as 8% and confirmed with a lower limit of two-sided 95% CI for the inter-group difference of -5.98% and -4.32% in the FAS and PPS groups. Patients who received ciprofol had a longer recovery time ( p = 0.003), but there were no differences in the remaining secondary endpoints (all p > 0.05). The occurrence rates of treatment-emergent adverse events (TEAEs) or drug-related TEAEs were not significantly different between the groups (all p > 0.05).

CONCLUSIONS

Ciprofol was well tolerated, with a noninferior sedation profile to propofol in Chinese ICU patients undergoing MV for a period of 6-24 hours.

Correction to: Improved dynamic functional connectivity estimation with an alternating hidden Markov model

[This corrects the article DOI: 10.1007/s11571-022-09874-3.].

Construction and evaluation of a gated high-resolution neural network for automatic brain metastasis detection and segmentation

OBJECTIVES

To construct and evaluate a gated high-resolution convolutional neural network for detecting and segmenting brain metastasis (BM).

METHODS

This retrospective study included craniocerebral MRI scans of 1392 patients with 14,542 BMs and 200 patients with no BM between January 2012 and April 2022. A primary dataset including 1000 cases with 11,686 BMs was employed to construct the model, while an independent dataset including 100 cases with 1069 BMs from other hospitals was used to examine the generalizability. The potential of the model for clinical use was also evaluated by comparing its performance in BM detection and segmentation to that of radiologists, and comparing radiologists' lesion detecting performances with and without model assistance.

RESULTS

Our model yielded a recall of 0.88, a dice similarity coefficient (DSC) of 0.90, a positive predictive value (PPV) of 0.93 and a false positives per patient (FP) of 1.01 in the test set, and a recall of 0.85, a DSC of 0.89, a PPV of 0.93, and a FP of 1.07 in dataset from other hospitals. With the model's assistance, the BM detection rates of 4 radiologists improved significantly, ranging from 5.2 to 15.1% (all p < 0.001), and also for detecting small BMs with diameter ≤ 5 mm (ranging from 7.2 to 27.0%, all p < 0.001).

CONCLUSIONS

The proposed model enables accurate BM detection and segmentation with higher sensitivity and less time consumption, showing the potential to augment radiologists' performance in detecting BM.

CLINICAL RELEVANCE STATEMENT

This study offers a promising computer-aided tool to assist the brain metastasis detection and segmentation in routine clinical practice for cancer patients.

KEY POINTS

• The GHR-CNN could accurately detect and segment BM on contrast-enhanced 3D-T1W images. • The GHR-CNN improved the BM detection rate of radiologists, including the detection of small lesions. • The GHR-CNN enabled automated segmentation of BM in a very short time.

Hong Kong as a separate customs territory: Past, present and prospect

This article reviews the journey of Hong Kong attaining and retaining the General Agreement on Tariffs and Trade (GATT) and the World Trade Organization (WTO) membership as a separate customs territory, and examines the present challenges for the Hong Kong Special Administrative Region (HKSAR) to maintain its status within the multilateral trade system. By exploring the related facts and laws, the article concludes that Hong Kong has been a separate customs territory member of the GATT and WTO by virtue of the multilateral trade rules, and other countries are not entitled to revoke the HKSAR's separate customs territory status through unilateral measures. Given the past journey and present challenges with the separate customs territory status of Hong Kong, the following prospects can be drawn. The HKSAR remains qualified to possess full autonomy when conducting external commercial relations. A malfunctioning Appellate Body of the Dispute Settlement Body (DSB) may be incapable to safeguard the interests of HKSAR as a separate customs territory.

Regulatory mechanisms of the cAMP-responsive element binding protein 3 (CREB3) family in cancers

The CREB3 family of proteins, encompassing CREB3 and its four homologs (CREB3L1, CREB3L2, CREB3L3, and CREB3L4), exerts pivotal control over cellular protein metabolism in response to unfolded protein reactions. Under conditions of endoplasmic reticulum stress, activation of the CREB3 family occurs through regulated intramembrane proteolysis within the endoplasmic reticulum membrane. Perturbations in the function and expression of the CREB3 family have been closely associated with the development of diverse diseases, with a particular emphasis on cancer. Recent investigations have shed light on the indispensable role played by CREB3 family members in modulating the onset and progression of various human cancers. This comprehensive review endeavors to provide an in-depth examination of the involvement of CREB3 family members in distinct human cancer types, accentuating their significance in the pathogenesis of cancer and the manifestation of malignant phenotypes.

Improved dynamic functional connectivity estimation with an alternating hidden Markov model

Dynamic functional connectivity (DFC) analysis has been widely applied to functional magnetic resonance imaging (fMRI) data to reveal the time-varying functional interactions between brain regions. Although the sliding window (SW) method is popular for DFC analysis, the selection of window length is hard, and the temporal resolution is limited by the window length. The hidden Markov model (HMM) without the limitation of window length has been proven to be able to estimate time-varying brain states from fMRI data. However, HMM tends to be overfitted in DFC analysis of fMRI data because of the high spatial dimension and the limited sample size of fMRI data. In this study, we proposed an alternating HMM (aHMM) method that used the functional connectivity estimation of SW to initialize the covariance matrix of HMM and adopted an alternating HMM procedure to reduce the number of parameters during each optimization. The simulated and real fMRI resting data from the Human Connectome Projects showed that aHMM produced better robustness to noise, parameter number and sample size in DFC estimation than SW and HMM. For the real fMRI resting data of cerebral small vessel disease (CSVD), results of aHMM revealed that amnesia and mild cognitive impairment (aMCI) caused the CSVD with aMCI (CSVD-aMCI) group tended to spend more time on the brain state with overall weak connections and less time on the state with overall strong connections than the CSVD-controls. Moreover, CSVD-aMCI showed significantly lower connectivity amplitude and higher connectivity fluctuation than CSVD-control. In contrast, HMM did not detect intergroup differences of the connectivity amplitude and fluctuations and SW did not detect intergroup differences of connectivity fluctuations and fraction of time. The results further indicated that aHMM outperformed HMM and SW in detecting inter-group differences of temporal properties of DFC and connectivity fluctuations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-022-09874-3.

Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis

Surgery plays a crucial role in the treatment of patients with chronic pulmonary aspergillosis (CPA). However, there is currently limited information available regarding the use of uniportal thoracoscopy (Uni-VATS) in CPA patients. To address this gap, we conducted a retrospective analysis of surgical procedures performed at a single center, aiming to demonstrate the feasibility and safety of Uni-VATS for patients with CPA. We collected basic information and surgical data from patients who underwent surgery for CPA at our hospital between January 2018 and June 2022. All patients received voriconazole antifungal medication for 3-6 months post-surgery and were monitored for a minimum of 6 months. A total of 110 patients, comprising 59 cases in the traditional open chest incision group and 51 cases in the Uni-VATS group, met the inclusion criteria. Among those who underwent surgery, 70% were male (77/110). The median age (IQR) of all enrolled patients was 55 (46-62) years. There were no statistically significant differences in general information, such as age, sex, comorbidities, BMI, FEV1, FVC, clinical symptoms, location of the disease, and duration of voriconazole antifungal medication, between the OS group and the Uni-VATS group (p > 0.05). The postoperative complication rates were 40.7% (24/59) for the traditional open chest incision group and 17.6% (9/51) for the Uni-VATS group. Through univariate analysis, we identified sex and operative approach as risk factors for postoperative complications. Multivariate logistic analysis confirmed that male and OS procedures were the independent risk factors for postoperative complications. There were statistically significant differences in operative time, intraoperative blood loss volume, postoperative drainage volume, pain scores, postoperative drainage tube removal time, postoperative hospital stay time between the OS group and the Uni-VATS group (p < 0.05). Uni-VATS is a feasible and safe surgical procedure for patients with CPA, and we recommend it as a preferred option for selected patients with CPA.

Shared and Disorder-Specific Alterations of Brain Temporal Dynamics in Obsessive-Compulsive Disorder and Schizophrenia

BACKGROUND

Obsessive-compulsive disorder (OCD) and schizophrenia have distinct but also overlapping symptoms. Few studies have examined the shared and disorder-specific disturbances in dynamic brain function in the 2 disorders.

STUDY DESIGN

Resting-state functional magnetic resonance imaging data of 31 patients with OCD and 49 patients with schizophrenia, all untreated, and 45 healthy controls (HCs) were analyzed using spatial group independent component (IC) analysis. Time-varying degree centrality patterns across the whole brain were clustered into 3 reoccurring states, and state transition metrics were obtained. We further explored regional temporal variability of degree centrality for each IC across all time windows.

STUDY RESULTS

Patients with OCD and patients with schizophrenia both showed decreased occurrence of a state having the highest centrality in the sensorimotor and auditory networks. Additionally, patients with OCD and patients with schizophrenia both exhibited reduced dynamics of degree centrality in the superior frontal gyrus than controls, while dynamic degree centrality of the cerebellum was lower in patients with schizophrenia than with OCD and HCs. Altered dynamics of degree centrality nominally correlated with symptom severity in both patient groups.

CONCLUSIONS

Our study provides evidence of transdiagnostic and clinically relevant functional brain abnormalities across OCD and schizophrenia in neocortex, as well as functional dynamic alterations in the cerebellum specific to schizophrenia. These findings add to the recognition of overlap in neocortical alterations in the 2 disorders, and indicate that cerebellar alterations in schizophrenia may be specifically important in schizophrenia pathophysiology via impact on cerebellar thalamocortical circuitry.

Chinese medical staff's knowledge, attitudes and practices towards breast cancer patients' sexual health management: A cross-sectional study

Objective

The objective of this research was to assess the level and determinants of medical personnel's knowledge, attitudes, and practices regarding the management of sexual health in breast cancer survivors residing in western China.

Background

Sexual well-being is a crucial aspect of one's overall satisfaction with life. Once female sexual dysfunction (FSD) occurs, it will affect patients' satisfaction and life quality seriously. In all healthcare settings, the management of sexual health relies heavily on the vital contribution of medical personnel. Nevertheless, the sexual requirements of individuals with breast cancer are still partially unmet.

Design

A web-based questionnaire was used to conduct a multi-centered, cross-sectional study involving medical staff from 26 hospitals in nine cities of Guizhou Province, China.

Methods

Data was gathered from healthcare professionals using a validated tool, the knowledge, attitudes, practices assessment scale for managing the sexual health of breast cancer patients in medical staff. This tool was used to evaluate the knowledge, attitudes, and practices of medical staff regarding sexual health management.

Results

In this study, a grand total of 3181 healthcare professionals took part. The overall KAP scores, including knowledge, attitudes, and practices, were 47.15 ± 11.91, 72.55 ± 12.56, and 58.61 ± 11.45, respectively. Three variables exhibited a strong and favorable correlation. The study identified significant concerns regarding the limited understanding of medical personnel regarding effective strategies for enhancing sexual health function in breast cancer patients, as well as their diminished confidence in addressing FSD. The scores of knowledge, attitudes, and practices related to sexual health management were significantly influenced by whether or not training was received.

Conclusions

The study results emphasize the importance of adopting a holistic approach to enhance the understanding, perspectives, and behaviors of healthcare professionals regarding the management of sexual health. In addition to enhancing the standard of care for individuals with breast cancer.

Wide-temperature-range multispectral camouflage enabled by orientation-gradient co-optimized microwave blackbody metastructure coupled with conformal MXene coating

Cloaking against electromagnetic detection is a well-researched topic; yet achieving multispectral camouflage over a wide temperature range remains challenging. Herein, an orientation-gradient co-optimized graded Gyroid-shellular (GGS) SiOC-based metastructure with a conformal MXene coating (M@SiOC) is proposed to achieve wide-temperature-range microwave/infrared/visible-light-compatible camouflage. Firstly, the combination of coordinate transformation and genetic algorithm endows the GGS architecture with optimal orientation and gradient, allowing superior microwave blackbody-like behavior. Secondly, a microwave-transparent, low-infrared-emissivity MXene metasurface is constructed in situ to permit wide-temperature-range infrared camouflage. Finally, the outstanding spectral selectivity of MXene enables camouflage against 1.06 μm-lidar and visible-light detection. As a result, the as-fabricated [110]-oriented GGS M@SiOC metamaterials exhibit outstanding wide-temperature-range multispectral camouflage: (i) ultrabroadband microwave absorption exceeding 80% in the X-Ku band from room temperature (RT) to 500 °C with absorption above 86.0% (91.4% on average) at 500 °C; (ii) excellent long-wavelength infrared camouflage for object temperatures from RT to 450 °C, reaching an infrared signal intensity of 78.5% for objects at 450 °C; and (iii) camouflage against both 1.06 μm-lidar and dark environment. Compared with traditional hierarchical metamaterials necessitating complex micro/nano-fabrication processes, this work provides a novel pathway toward the realization of structurally integrated multispectral stealth components by combining flexible metastructure design and high-fidelity additive manufacturing.

[Chest hemorrhage after left total pulmonary resection for secondary rifampin-resistant tuberculosis:a case report]

The patient had received five courses of anti-tuberculosis treatment for recurrent tuberculosis. The drug sensitivity test results of the first three courses showed drug-sensitive pulmonary tuberculosis, and the fourth diagnosis was rifampin-resistant tuberculosis (RR-TB), complicated by chronic obstructive pulmonary disease, type Ⅱ respiratory failure, pulmonary heart disease, and heart failure (grade Ⅲ). The patient stopped taking the anti-tuberculosis drugs on his own in the eighth month of receiving the resistant treatment. After admission, the symptoms improved temporarily after receiving oxygen therapy, anti-infection, and anti-tuberculosis treatment. Because of hemoptysis, the patient underwent arterial embolization by catheterization, but a large amount of hemoptysis occurred shortly thereafter. Emergency left total lung resection and gauze packing for hemostasis were performed. After surgery, the patient's vital signs were maintained with mechanical ventilation and vasopressors. Forty-eight hours after surgery, the gauze was removed, and the patient underwent tracheotomy, enteral nutrition, and anti-tuberculosis treatment. After discharge, the patient underwent rehabilitative exercise and anti-resistant tuberculosis therapy. The patient's condition remained stable for more than six months of follow-up.

Hyperkalaemia prevalence and dialysis patterns in Chinese patients on haemodialysis: an interim analysis of a prospective cohort study (PRECEDE-K)

BACKGROUND

Hyperkalaemia is a known risk factor for cardiac arrhythmia and mortality in patients on haemodialysis. Despite standard adequate haemodialysis, hyperkalaemia is common in patients with end-stage renal disease (ESRD) at interdialytic intervals. Data on hyperkalaemia burden and its effects on dialysis patterns and serum potassium (sK) fluctuations in patients on haemodialysis in China remain limited. The prospective, observational cohort study (PRECEDE-K; NCT04799067) investigated the prevalence, recurrence, and treatment patterns of hyperkalaemia in Chinese patients with ESRD on haemodialysis.

METHODS

Six hundred adult patients were consecutively enrolled from 15 secondary and tertiary hospitals in China. In this interim analysis, we report the baseline characteristics of the cohort, the prevalence of predialysis hyperkalaemia (sK > 5.0 mmol/L), and the trends in serum-dialysate potassium gradient and intradialytic sK shift at Visit 1 (following a long interdialytic interval [LIDI]).

RESULTS

At baseline, most patients (85.6%) received three-times weekly dialysis; mean duration was 4.0 h. Mean urea reduction ratio was 68.0% and Kt/V was 1.45; 60.0% of patients had prior hyperkalaemia (previous 6 months). At Visit 1, mean predialysis sK was 4.83 mmol/L, and 39.6% of patients had hyperkalaemia. Most patients (97.7%) received a dialysate potassium concentration of 2.0 mmol/L. The serum-dialysate potassium gradient was greater than 3 mmol/L for over 40% of the cohort (1- < 2, 2- < 3, 3- < 4, and ≥ 4 mmol/L in 13.6%, 45.1%, 35.7%, and 5.2% of patients, respectively; mean: 2.8 mmol/L). The intradialytic sK reduction was 1- < 3 mmol/L for most patients (0- < 1, 1- < 2, 2- < 3, and ≥ 3 mmol/L in 24.2%, 62.2%, 12.8%, and 0.9% of patients, respectively; mean: 1.4 mmol/L).

CONCLUSIONS

Hyperkalaemia after a LIDI was common in this real-world cohort of Chinese patients despite standard adequate haemodialysis, and led to large serum-dialysate potassium gradients and intradialytic sK shifts. Previous studies have shown hyperkalaemia and sK fluctuations are highly correlated with poor prognosis. Effective potassium-lowering treatments should be evaluated for the improvement of long-term prognosis through the control of hyperkalaemia and sK fluctuations.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04799067.

[Effect of sugammadex on postoperative nausea and vomiting after surgery for intracranial aneurysm]

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.

A Foley catheter 'the jack of all trades': a literature review of its common and novel uses

The Foley catheter is one of the most commonly used devices in modern surgical practice. Developed for draining the urinary bladder, this humble catheter has been employed for many other purposes ranging from urine output monitoring to complex urological investigations. Over time, it has evolved into being applied in more complex and innovative ways in various other specialties apart from urology. In this review article, we describe some of the common and novel uses of this deceptively simple device, and discuss the scope of its application in modern medicine.

Safety profile and outcomes of intraoperative ultrasound-guided remnant cholecystectomy

INTRODUCTION

Subtotal cholecystectomy (STC) is a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study evaluates the safety profile and perioperative outcomes of remnant cholecystectomy (RC) performed under intraoperative ultrasound guidance.

METHODS

We retrospectively reviewed the records of all patients that underwent RC under intraoperative ultrasound guidance in 2009 and 2019. Pre-, intra- and postoperative details of patients who underwent RC were obtained from patients' electronic and paper copy records.

RESULTS

Ninety-seven patients underwent STC during the study period. Of this cohort, 16 patients (16.5%) presented with symptomatic gallbladder remnant over a median follow-up period of 14 months (interquartile range [IQR] 2-26). The median age was 64 years (IQR 54-69) with an equal male-to-female distribution. The median body mass index was 31kg/m2 (IQR 28-33). Twelve of 16 patients (75%) then proceeded to elective RC. Intraoperative ultrasound was used in all cases to identify the location of the remnant gallbladder and biliary anatomy. The median operative time was 88min (IQR 80-96), with 67% completed laparoscopically. No patients suffered bile duct injury. The median hospital stay was 3 days (IQR 1-5). During the follow-up period, eight patients (67%) reported symptom resolution.

CONCLUSIONS

RC is a safe operation that can be performed laparoscopically even after previous open subtotal cholecystectomy. We recommend the routine use of intraoperative ultrasound as an adjunct for identifying remnant gallbladder and biliary anatomy in all patients.

Major Active Metabolite Characteristics of Dendrobium officinale Rice Wine Fermented by Saccharomyces cerevisiae and Wickerhamomyces anomalus Cofermentation

Rice, supplemented with Dendrobium officinale, was subjected to cofermentation using Saccharomyces cerevisiae FBKL2.8022 (Sc) and Wickerhamomyces anomalus FBKL2.8023 (Wa). The alcohol content was determined with a biosensor, total sugars with the phenol-sulfuric acid method, reducing sugars with the DNS method, total acids and total phenols with the colorimetric method, and metabolites were analyzed using LC-MS/MS combined with multivariate statistics, while metabolic pathways were constructed using metaboAnalyst 5.0. It was found that the quality of rice wine was higher with the addition of D. officinale. A total of 127 major active substances, mainly phenols, flavonoids, terpenoids, alkaloids, and phenylpropanoids, were identified. Among them, 26 substances might have been mainly metabolized by the mixed-yeasts fermentation itself, and 10 substances might have originated either from D. officinale itself or from microbial metabolism on the newly supplemented substrate. In addition, significant differences in metabolite could be attributed to amino acid metabolic pathways, such as phenylalanine metabolism and alanine, aspartate, and glutamate metabolism. The characteristic microbial metabolism of D. officinale produces metabolites, which are α-dihydroartemisinin, alantolactone, neohesperidin dihydrochalcone, and occidentoside. This study showed that mixed-yeasts cofermentation and fermentation with D. officinale both could increase the content of active substances in rice wine and significantly improve the quality of rice wine. The results of this study provide a reference for the mixed fermentation of brewer's yeast and non-yeast yeasts in rice wine brewing.

Is VATS suitable for lung diseases with hemoptysis? Experience from a hemoptysis treatment center in China

BACKGROUND

Surgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis.

METHODS

We collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022.

RESULTS

Sixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195-665) ml, which was 250 (130-500) ml of the VATS group, significantly less than the 550 (460-820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4-9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6-17) days for all patients, and it was 7 (5-14) days for the VATS group, which was less than 15 (9-20) days for the OS group.

CONCLUSION

VATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.

Homotypic and heterotypic adhesion of cancer cells revealed by force-induced remnant magnetization spectroscopy

Intercellular interaction has tremendous impacts on physiological processes, while unsuccessful cell-cell interaction causes diseases, such as tumorigenesis and metastasis. In-depth investigation of cell-cell adhesions is of great significance to understand the pathological state of cells, and for the rational design of drugs and therapies. Herein, we developed a force-induced remnant magnetization spectroscopy (FIRMS) method to measure cell-cell adhesion in a high throughput way. Our results showed that FIRMS is capable of quantifying and identifying cell-cell adhesion with high detection efficiency. Specifically, we quantified homotypic and heterotypic adhesion forces during tumor metastasis using breast cancer cell lines. We observed that homotypic and heterotypic adhesion forces of cancer cells were associated with degrees of malignancy. In addition, we revealed that CD43-ICAM-1 was a ligand-receptor pair mediating heterotypic adhesion of breast cancer cells to endothelial cells. These findings contribute to advance in-depth understanding of the process of cancer metastasis and provide insight into targeting intercellular adhesion molecules as a potential strategy to inhibit cancer metastasis.

Targeting ESM1/ VEGFα signaling axis: a promising therapeutic avenue for angiogenesis in cervical squamous cell carcinoma

Background: Endothelial-specific molecule 1 (ESM1) dysregulation is widespread in various malignancies. However, the exact significance of ESM1 in cervical squamous cell carcinoma (CSCC) is not yet well understood. Methods: The expression of ESM1 in CSCC was probed by immunohistochemistry (IHC) assay using human specimens and validated and explored ESM1 in CSCC based on TNMplot and TCGA (The Cancer Genome Atlas Program) data repository. Further, the GSEA analysis and in vitro experiments of human CSCC cell lines, including SiHa and ME-180, were performed to investigate the masked molecular mechanisms of ESM1 in CSCC. Results: ESM1 was overexpressed in clinical CSCC tissues compared with paracancer controls, was an independent prognostic factor and was associated with poor prognosis in CSCC patients. These findings were further confirmed in the TNMplot and TCGA datasets. Furthermore, GSEA analysis revealed that the ESM1 high expression group was significantly enriched in carcinoma angiogenesis and the VEGFα signaling pathway. In addition, in vitro assays with human CSCC cell lines, including SiHa and ME-180, demonstrated that knockdown of ESM1 expression inhibited tumor cell proliferation, migration and invasion, resulting in attenuated VEGFα expression and blocked phosphorylation of VEGFR2 and ERK-1/2. Conclusion: In CSCC patients, ESM1 was considerably overexpressed. Upregulation of ESM1 is predictive of poor clinical outcomes in CSCC. Furthermore, ESM1 overexpression promoted carcinoma angiogenesis and CSCC progression through the VEGF/ERK signaling pathway. Hence, ESM1 and associated genes might be useful prognostic biomarkers or therapeutic targets for CSCC individuals.

Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion

BACKGROUND

The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied.

METHODS

In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage.

RESULTS

A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P = 0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group.

CONCLUSIONS

In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban. (Funded by the National Natural Science Foundation of China; RESCUE BT2 Chinese Clinical Trial Registry number, ChiCTR2000029502.).