A multicentre comparative study between laparoscopic and open surgery for intussusception in adults

AIM

Intussusception in adults is rare and requires surgery in most cases. While abdominal laparoscopic surgery (LS) is becoming more popular, there are few reports on the outcomes of adult intussusception treated with LS. This study compared the feasibility of LS vs open surgery (OS) for adult intussusception.

METHOD

We reviewed retrospectively the medical records of adult patients with intussusception from three tertiary hospitals between 2000 and 2016. The patients were divided into LS and OS groups, and their surgical outcomes were compared.

RESULTS

Surgery was indicated in 71 patients with intussusception (41 LS and 30 OS). The median age of the patients was 49.0 and 51.5 years in the LS and OS groups, respectively (P = 0.930). Overall, nine (12.7%) patients had a negative laparotomy or laparoscopy with spontaneous reduction of the intussusception. Conversion to OS from LS was necessary in one patient (2.4%). The operative time and intra-operative and postoperative complication rates were not significantly different. However, there were more serious complications such as bowel perforation and major vessel injury in the LS group. The patients in the LS group had a shorter time to first food intake and hospital stay vs patients in the OS group (4.0 vs 6.0 days, P < 0.001, and 7.0 vs 10.5 days, P < 0.001, respectively).

CONCLUSION

LS may be feasible for adult intussusception; there may be more severe intra-operative complications than in OS.

[Looking for the roots of Wa Na Qi]

Wa Na Qi(), is a traditional-curing male impotence medicinal. We have made several conclusions through a field investigation to Antarctica, material medica literature research, and current market investigation. Throughout history, Wa Na Qi (also known ashaigou shen) was a word of vague connotation which was not the meaning of a specific product. However, the most common meaning of Wa Na Qi was the penises of several different species of seals. The name Wa Na Qi was adapted from a foreign word, and it is believed to sound like walrus, which has also been credited as a source for Wa Na Qi. In Chinese, Wa Na was a reference to the roundness of the walrus but eventually became a general description of heaviness. Later, it became a name for fur seals. The Song Dynasty Materia Medica Bencao Tujing(, Illustration of Materia Medica) and the Ming Dynasty Materia Medica Bencao Pinhui Jingyao(, Collected Essentials of Species of Materia Medica) both had animal illustrations resembling fur seals. The illustrations in the Compendium of Materia Medica, or Bencao Gangmu, Jinling edition also had characteristics of a fur seal. However, in the Buyi Leigong Paozhi Bianlan(, Lei Gong's Guide to Drug Preparation with Addenda) and later materia medica works, the animal illustrations became distorted and almost myth-like. After a field investigation in Antarctica, we learned that historically, name Wa Na Qi probably originated from seals, such as fur seals. This information matches the current medicines available on the market.

Dijet Resonance Search with Weak Supervision Using sqrt[s]=13 TeV pp Collisions in the ATLAS Detector

This Letter describes a search for narrowly resonant new physics using a machine-learning anomaly detection procedure that does not rely on signal simulations for developing the analysis selection. Weakly supervised learning is used to train classifiers directly on data to enhance potential signals. The targeted topology is dijet events and the features used for machine learning are the masses of the two jets. The resulting analysis is essentially a three-dimensional search A→BC, for m_{A}∼O(TeV), m_{B},m_{C}∼O(100  GeV) and B, C are reconstructed as large-radius jets, without paying a penalty associated with a large trials factor in the scan of the masses of the two jets. The full run 2 sqrt[s]=13  TeV pp collision dataset of 139  fb^{-1} recorded by the ATLAS detector at the Large Hadron Collider is used for the search. There is no significant evidence of a localized excess in the dijet invariant mass spectrum between 1.8 and 8.2 TeV. Cross-section limits for narrow-width A, B, and C particles vary with m_{A}, m_{B}, and m_{C}. For example, when m_{A}=3  TeV and m_{B}≳200  GeV, a production cross section between 1 and 5 fb is excluded at 95% confidence level, depending on m_{C}. For certain masses, these limits are up to 10 times more sensitive than those obtained by the inclusive dijet search. These results are complementary to the dedicated searches for the case that B and C are standard model bosons.

[Oncologic outcomes of early stage cervical cancer performed operation by different laparoscopic surgical procedures: analysis of clinical data from mutiple centers]

Objective: To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy. Methods: From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study. Results: There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively (P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions: The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.

[Long-term oncological outcomes of laparoscopic versus abdominal surgery in stage Ⅰa1 （LVSI+）-Ⅰb1 cervical cancer patients with different tumor size: a big database in China]

Objective: To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 （lymph-vascular space invasion-positive, LVSI⁺）- Ⅰb1 cervical cancer patients with different tumor sizes. Methods: Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results: (1) A total of 4 891 patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.367, 95%CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups （94.1% vs 95.4%, P=0.151）. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS (HR=1.420, 95%CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.705, 95%CI: 1.088-2.674, P=0.020). Conclusions: For patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.

CP Properties of Higgs Boson Interactions with Top Quarks in the tt[over ¯]H and tH Processes Using H→γγ with the ATLAS Detector

A study of the charge conjugation and parity (CP) properties of the interaction between the Higgs boson and top quarks is presented. Higgs bosons are identified via the diphoton decay channel (H→γγ), and their production in association with a top quark pair (tt[over ¯]H) or single top quark (tH) is studied. The analysis uses 139  fb^{-1} of proton-proton collision data recorded at a center-of-mass energy of sqrt[s]=13  TeV with the ATLAS detector at the Large Hadron Collider. Assuming a CP-even coupling, the tt[over ¯]H process is observed with a significance of 5.2 standard deviations. The measured cross section times H→γγ branching ratio is 1.64_{-0.36}^{+0.38}(stat)_{-0.14}^{+0.17}(sys)  fb, and the measured rate for tt[over ¯]H is 1.43_{-0.31}^{+0.33}(stat)_{-0.15}^{+0.21}(sys) times the Standard Model expectation. The tH production process is not observed and an upper limit on its rate of 12 times the Standard Model expectation is set. A CP-mixing angle greater (less) than 43 (-43)° is excluded at 95% confidence level.

The expression and significance of lncRNA HOST2 and microRNA let-7b in HPV-positive cervical cancer tissues and cell lines

OBJECTIVE

This study attempted to investigate the expression and significance of lncRNA HOST2 (human ovarian cancer-specific transcript 2) and microRNA let-7b in human papillomavirus (HPV)-positive cervical cancer (CC) tissues and cell lines.

PATIENTS AND METHODS

The expression of levels of HOST2 and let-7b were detected by qRT-PCR in HPV-positive CC tissues and cell lines. The HPV-positive CaSki and HeLa cells were divided into the Blank, NC, pcDNA3.0-HOST2, siHOST2, let-7b mimic, and pcDNA3.0-HOST2+let-7b mimic groups. Dual-luciferase reporter gene assay was employed to verify the targeting relationship between HOST2 and let-7b, MTT and flow cytometry to determinate cell proliferation and apoptosis, and wound-healing and transwell assays to evaluate cell migration and invasion capabilities.

RESULTS

HOST2 was up-regulated but let-7b was down-regulated in HPV-positive CC tissues and cells. Dual-luciferase reporter gene assay confirmed the targeting relationship between HOST2 and let-7b. Over-expressed HOST2 reduced let-7b expression, promoted proliferation migration and invasion and inhibited the apoptosis of CaSki and HeLa cells; however, silencing HOST2 or overexpressing let-7b enhanced the expression of let-7b, inhibited proliferation migration and invasion, and promoted the apoptosis of CaSki and HeLa cells, and let-7b mimic could reverse the promoting effect of HOST2 on the growth of CC cells.

CONCLUSIONS

HOST2 was upregulated in HPV-positive CC tissues and cells, which could promote the proliferation, migration and invasion, but inhibit the apoptosis of HPV-positive CC cells via inhibition of let-7b.

Fermented Platycodon grandiflorum Extracts Relieve Airway Inflammation and Cough Reflex Sensitivity In Vivo

Platycodon grandiflorum (PG) has been extensively utilized as an herb to relieve phlegm. In this study, the effects of PG root extracts on airway inflammation and cough reflex were investigated, especially using fermented PG extracts (FPE) to increase an active compound, platycodin D by fermentation. FPE significantly reduced the numbers of eosinophils and total cells in the bronchoalveolar lavage fluid (BALF) obtained from lipopolysaccharide/ovalbumin (LPS/OVA)-induced asthma mice versus those of vehicle control. Moreover, in the BALF and the serum, FPE significantly reduced the concentration of IL-17E, a proinflammatory cytokine that causes T_H2 immunity, including eosinophil amplification. It was also demonstrated that FPE might relieve inflammations through histological analysis of the lung separated from each mouse. Furthermore, in cough reflex guinea pigs induced by citric acid treatment, FPE treatment significantly reduced the number of coughs versus that of vehicle control, and consequently decreased cough reflex sensitivity. In addition, the total cell number and eosinophils significantly decreased in the BALF obtained from each guinea pig versus that of vehicle control. In in vitro study, pretreatment with FPE in LPS-stimulated RAW264.7 cells significantly reduced the levels of proinflammatory cytokines such as TNF-α, IL-6, and IL-1β, and inducible nitric oxide synthases (iNOS). Therefore, we demonstrated that FPE relieved airway inflammation and cough reflex sensitivity in vivo, and exhibited anti-inflammatory effects through suppression of iNOS and several proinflammatory cytokines. These findings suggest that FPE might have a beneficial effect on respiratory health, and may be useful as a functional food to prevent respiratory diseases.

Search for Heavy Higgs Bosons Decaying into Two Tau Leptons with the ATLAS Detector Using pp Collisions at sqrt[s]=13 TeV

A search for heavy neutral Higgs bosons is performed using the LHC Run 2 data, corresponding to an integrated luminosity of 139  fb^{-1} of proton-proton collisions at sqrt[s]=13  TeV recorded with the ATLAS detector. The search for heavy resonances is performed over the mass range 0.2-2.5 TeV for the τ^{+}τ^{-} decay with at least one τ-lepton decaying into final states with hadrons. The data are in good agreement with the background prediction of the standard model. In the M_{h}^{125} scenario of the minimal supersymmetric standard model, values of tanβ>8 and tanβ>21 are excluded at the 95% confidence level for neutral Higgs boson masses of 1.0 and 1.5 TeV, respectively, where tanβ is the ratio of the vacuum expectation values of the two Higgs doublets.

A predictive survival model for patients with head and neck squamous cell carcinoma treated with immune check point inhibitors

BACKGROUND

ICIs have expanded treatment options for HNSCC. A minority of the patients respond to these expensive treatments.

PATIENTS AND METHODS

This is a single institutional retrospective review on 121 unresectable or metastatic HNSCC patients treated with ICIs. We predicted that inflammatory markers available through routine blood work, in addition to clinical characteristics may divide patients into groups more or less likely to respond to these agents. Here we develop and internally validate our nomogram to predict survival in patients treated with ICIs.

0073 Left Anterior Cingulate Hyperarousal During Sleep Anxiety-Inducing Emotional Tasks Performance in Patients with Insomnia Disorder

Introduction

Patients with insomnia frequently experience sleep/insomnia-related anxiety; this anxiety has been associated with hyperarousal. We investigated the underlying brain function changes in patients with insomnia during emotional task performance that induced sleep/insomnia-related anxiety.

Methods

Functional magnetic resonance imaging (fMRI) was performed during emotional task performance in healthy individuals and patients with insomnia who met the diagnostic criteria of insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and had chronic insomnia for more than 6 months. The participants underwent fMRI scanning during three types of emotional task performance—insomnia-anxiety task, reading sentences that cause insomnia-related anxiety; general-anxiety task, reading sentences that cause anxiety for everyone; and neutral task, reading neutral sentences that do not cause emotional anxiety. The images obtained from fMRI and blood oxygen level-dependent (BOLD) signal changes were compared between patients with insomnia and healthy controls. Interim analysis was performed with the data of 13 patients with insomnia and 9 controls.

Results

The brain activity in the left anterior cingulate was higher during insomnia-anxiety task performance than that during general-anxiety task performance in the insomnia group (voxel-wise uncorrected p &lt; 0.05; cluster size, 100). In the insomnia group, the brain activity during insomnia-anxiety task performance was not lower in any brain area than that during general-anxiety task performance.

Conclusion

We show that patients with chronic insomnia experience sleep anxiety related with hyperarousal in the left anterior cingulate area. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).

Effects of Aster glehni Extract on Serum Uric Acid in Subjects with Mild Hyperuricemia: A Randomized, Placebo-Controlled Trial

Aster glehni extracts (AGE) reduced serum uric acid levels in hyperuricemia rats in several previous studies. However, its efficacy in human has not been yet explored. This study aimed at investigating the efficacy and safety of AGE on the anti-hyperuricemia effect in subjects with slightly high serum uric acid. A randomized, double-blinded, placebo-controlled clinical trial was conducted for 12 weeks. Eligible subjects were randomly assigned to either AGE (480 mg/day) or placebo. The primary endpoint was the change in serum uric acid concentrations from baseline to follow-up time points. The secondary endpoints were the change of serum xanthine oxidase activity, and the levels of C-reactive protein (CRP) and tumor necrosis factor alpha (TNF-α) in the blood from baseline to follow-up time points. Safety was assessed by clinical laboratory parameters and adverse events reported by subjects. Six weeks of AGE supplementation significantly reduced serum uric acid level from baseline (P = .0468) but at the end of the intervention the participants did not show the beneficial effect of AGE supplementation. Also, the serum uric acid level in the AGE group was not significantly different at the follow-up time points, when compared with placebo. The mean changes of secondary endpoints from baseline to each time point did not show significant differences within and between the two groups. There were no adverse events reported by subjects or changes in safety parameters after intervention. In conclusion, AGE supplementation for 12 weeks did not show significant benefits for reducing serum uric acid concentrations in subjects with mild hyperuricemia.

Identifying People with Dementia in Electronic Primary Care Records in the UK

Background

Many epidemiological questions need to be answered regarding dementia, including the causes, prognosis, comorbidities, and treatment of the condition and complications. A routine electronic primary care dataset provides a way of investigating some of the complicated factors with rich information. However, there has been concern regarding whether dementia is recorded well enough.

Methods

This study has therefore explored this by conducting a systematic review to understand how dementia has been identified previously in primary care databases in the UK, and added to this by exploring additional terms and symptoms, and medications that might be helpful in identifying people with dementia. The study estimated the prevalence and incidence rates of dementia in The Health Improvement Network (THIN) database and compared with other longitudinal studies using the comprehensive list of diagnostic codes.

Results

The estimated incidence rates per 1,000 person-years for the 60+ age group who had any of the first diagnosis among the Quality Outcomes Framework (QOF) defined codes, Other diagnoses, Dementia symptoms and Prescribed medications were 2.5, 4.7, and 15.9 in 1995, 2004, and 2015 respectively. The estimated prevalence were 2.8, 3.2, and 10.2 in 1995, 2004, and 2015 respectively.

Conclusions

The codes related to dementia symptoms (represented by mini-mental state examination, the six item cognitive impairment test, referral to memory clinic and behaviour assessment) seem to cover a broad definition of dementia or pre-existing dementia population in the UK primary care records. At least, using of the Other diagnoses (represented by dementia annual review, senile/presenile dementia and dementia monitoring) in addition to the QOF defined codes, and Prescribed medications were evidenced that will not missing out a number of people with dementia.

Key messages

The codes related to dementia symptoms seem to cover a broad definition of dementia or pre-existing dementia population in electronic primary care records in the UK. Nevertheless, the codes about non-specific or temporary symptoms may need to be used carefully as it is possible for memory or cognitive function to be impaired temporarily due to other factors.