[Effects of extramedullary disease on patients with newly diagnosed multiple myeloma]

Objective: To summarize the characteristics of patients with newly diagnosed multiple myeloma (NDMM) admitted at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. We compared the clinical characteristics and prognoses among patients with non-extramedullary disease (EMD), bone-related extramedullary (EM-B) disease, and extraosseous extramedullary (EM-E) disease and further explored the effects of autologous hematopoietic stem cell transplantation (ASCT) for EMD. Methods: From January 2015 to January 2022, data of 114 patients (22%) with EMD out of 515 patients with NDMM were retrospectively analyzed; 91 (18%) and 23 (4%) patients comprised the EM-B and EM-E groups, respectively. The clinical characteristics of patients in all groups were compared with the Chi-square test. Progression-free survival (PFS) and overall survival (OS) of patients were analyzed by the Kaplan-Meier method. Independent prognostic factors were determined using multivariate Cox proportional hazard model. Results: There were no significant differences in age, gender, ISS stage, light chain, creatinine clearance, cytogenetic risk, 17p deletion, ASCT, and induction regimens among the three groups. Overall, 13% of EM-E patients had IgD-type M protein, which was significantly higher than that in EM-B patients (P=0.021). The median PFS of patients in the non-EMD, EM-B, and EM-E groups was 27.4, 23.1, and 14.0 months; the median OS was not reached, 76.8 months, and 25.6 months, respectively. The PFS (vs non-EMD, P=0.004; vs EM-B, P=0.036) and OS (vs non-EMD, P<0.001; vs EM-B, P=0.002) were significantly worse in patients with EM-E, while those were not significantly different between patients with EM-B and those with non-EMD. In the multivariate analysis, EM-E was an independent prognostic factor for OS in patients with NDMM (HR=8.779, P<0.001) and negatively impacted PFS (HR=1.874, P=0.050). In those who did not undergo ASCT, patients with EM-B had significantly worse OS than those with non-EMD (median 76.8 months vs. not reached, P=0.029). However, no significant difference was observed in the PFS and OS of patients with EM-B and those with non-EMD who underwent ASCT. Conclusions: Compared to patients with either non-EMD or EM-B, those with EM-E had the worst prognosis. EM-E was an independent risk factor for OS in patients with NDMM. ASCT can overcome the poor prognosis of EM-B.

A chemometric approach to evaluate the effects of probe-type ultrasonication on the enzyme inactivation and quality attributes of fresh amla juice

The enzymatic browning induced in amla juice due to the high activity of polyphenol oxidase (PPO) and peroxidase (POD) is one of the critical issues faced by the industry. The present study assessed the suitability of non-thermal, high-intensity ultrasound (US) on the inactivation of PPO and POD in fresh Indian Gooseberry juice. Ultrasonic waves, using a 6 mm titanium alloy probe were irradiated in the juice at a maximum power of 455 W and frequency of 20 kHz. The subsequent effects on biochemical attributes were studied using response surface methodology. Inactivation rates of 90.72 % and 73.18 %, respectively, for PPO and POD enzymes, were observed at the highest US intensity and exposure time. Numerical optimisation using the three-factor, three-level Box-Behnken design suggested that an optimum process at 70 % (energy density: 1610 Wcm^-2) pulsed at 5 s on and 5 s off for 7 min 30 s resulted in PPO and POD inactivation of the order of 76.42 % and 64.57 % respectively. At these experimental conditions, the optimized levels of biochemical attributes i.e., ascorbic acid (738.50 mg/100 mL), total phenols (17.10 mg/mL), DPPH antioxidant activity (58.47 %), tannins (7.11 µg/mL), colour change (ΔE = 9.04) and flavonoids (6.14 mg/mL) were achieved. The overall statistical models were significant for all the responses except for reducing sugars. Furthermore, the approximation equations for individual responses indicated that the goodness of fit was adequate (R² > 0.90). The results suggested that ultrasound is a suitable processing technique for amla juice stabilisation compared to thermal treatments that result in the loss of quality.

Pembrolizumab versus cetuximab concurrent with radiotherapy in patients with locally advanced squamous cell carcinoma of head and neck unfit for cisplatin (GORTEC 2015-01 PembroRad): a multicenter, randomized, phase II trial

BACKGROUND

To evaluate potential synergistic effect of pembrolizumab with radiotherapy (RT) compared with a standard-of-care (SOC) cetuximab-RT in patients with locally advanced-squamous cell carcinoma of head and neck (LA-SCCHN).

PATIENTS AND METHODS

Patients with nonoperated stage III-IV SCC of oral cavity, oropharynx, hypopharynx, and larynx and unfit for receiving high-dose cisplatin were enrolled. Patients received once-daily RT up to 69.96 Gy in 33 fractions with weekly cetuximab (cetuximab-RT arm) or 200 mg Q3W pembrolizumab during RT (pembrolizumab-RT arm). The primary endpoint was locoregional control (LRC) rate 15 months after RT. To detect a difference between arms of 60%-80% in 15-month LRC, inclusion of 66 patients per arm was required to achieve a power of at least 0.85 at two-sided significance level of 0.20.

RESULTS

Between May 2016 and October 2017, 133 patients were randomized to cetuximab-RT (n = 66) and pembrolizumab-RT (n = 67). Two patients (one in each arm) were not included in the analysis (a consent withdrawal and a progression before treatment start). The median age was 65 years (interquartile range 60-70 years), 92% were smokers, 60% were oropharynx (46% of oropharynx with p16+) and 75% were stage IV. Median follow-up was 25 months in both arms. The 15-month LRC rate was 59% with cetuximab-RT and 60% with pembrolizumab-RT ]odds ratio 1.05, 95% confidence interval (CI) 0.43-2.59; P = 0.91]. There was no significant difference between arms for progression-free survival (hazard ratio 0.85, 95% CI 0.55-1.32; P = 0.47) and for overall survival (hazard ratio 0.83, 95% CI 0.49-1.40; P = 0.49). Toxicity was lower in the pembrolizumab-RT arm than in the cetuximab-RT arm: 74% versus 92% patients with at least one grade ≥3 adverse events (P = 0.006), mainly due to mucositis, radiodermatitis, and rash.

CONCLUSION

Compared with the SOC cetuximab-RT, pembrolizumab concomitant with RT did not improve the tumor control and survival but appeared less toxic in unfit patients with LA-SCCHN.

Promoting college students' systems thinking in asynchronous discussions: Encouraging students initiating questions

Introduction

Systems thinking is one of the most important thinking skills for medical students. Most of the studies focused on designing technological-rich learning environments which usually take several weeks or months to implement. However, the occurring of COVID-19 health crisis does not allow extensive period of time to implement classroom interventions. How to support students' systems thinking in fully online environments remains an issue. This study examines if encouraging students initiating questions on asynchronous discussion forum supports their systems thinking development.

Methods

Twenty-two junior students participated in this study. We compared if and how students developed systems thinking when they were encouraged asking questions in asynchronous discussion forums in one unit with another unit in which traditional method was used. Multiple analytical methods were applied in this study, including, social network analysis, epistemic network analysis, inferential statistical analysis and qualitative analysis.

Results

Quantitative results showed that all students improved systems thinking compared with traditional teaching unit among which leader students improved most. Further analysis on students' discussion posts suggested leader students asked high systems thinking level questions and provided high level responses. Epistemic network analysis unpacked how leader, regular and peripheral students engaged in initiating questions and providing responses differently.

Discussion

This study provides methodological and practical contributions. Methodologically, this study extends prior methods of applying network analysis beyond its original preservice teacher training contexts; practically, this study provides strategies to practitioners to support students' asynchronous forum discussions.

Visualization of erythrocyte stasis in the living human eye in health and disease

Blood cells trapped in stasis have been reported within the microcirculation, but their relevance to health and disease has not been established. In this study, we introduce an in vivo imaging approach that reveals the presence of a previously-unknown pool of erythrocytes in stasis, located within capillary segments of the CNS, and present in 100% of subjects imaged. These results provide a key insight that blood cells pause as they travel through the choroidal microvasculature, a vascular structure that boasts the highest blood flow of any tissue in the body. Demonstration of clinical utility using deep learning reveals that erythrocyte stasis is altered in glaucoma, indicating the possibility of more widespread changes in choroidal microvascular than previously realized. The ability to monitor the choroidal microvasculature at the single cell level may lead to novel strategies for tracking microvascular health in glaucoma, age-related macular degeneration, and other neurodegenerative diseases.

[Potential application of improved hard tissue section technique in the clinical pathological diagnosis of bone and bone marrow]

Objective: To discuss the application value of hard tissue section in the clinicopathology diagnosis. Methods: From March 2021 to December 2021, bone slices of 19 patients (1 patient with osteochondroma, 2 patients with chondrosarcoma, 4 patients with osteosarcoma, 2 patients with fibrous dysplasia, 2 patients with bone metastasis from thyroid papillary carcinoma, 2 patients with osteomyelitis, 4 patients with giant cell tumor of bone, 2 patients with Ewing sarcoma) and 16 hemopathy patients were collected from the Department of Pathology, Shanghai Sixth People's Hospital. Of the osteopathy patients, there were 14 male and 5 female with a median age of 31 (10-66) years. Meanwhile, there were 7 male and 9 female with a median age of 28 (16-65) years among these hemopathy patients. Thirty-five cases were treated with modified hard tissue slicing technique and paraffin embedding technique, respectively. The advantages and disadvantages of the two methods for clinical diagnosis of bone disease were compared by Hematoxylin-Eosin staining (H&E staining), immunohistochemical staining (IHC), fluorescence in situ hybridization (FISH) and Sanger sequencing. Results: The improved resin-embedded method showed better histological morphology and cell structure. Besides, the expression of Ki67, SATB2, CD34, SMA, CD68,MPO,CD4 and CD33 in immunohistochemical staining in bone tissues which were embedded in resin were more clear in the accurate positive localization than those using paraffin-embedded. MDM2 of FISH exhibited a higher fluorescence intensity and more accurate location. Meanwhile, both methods treated with Sanger sequencing met the requirements of DNA purity and mutation detection. Conclusion: The improved hard tissue section method is simple and short time-consuming, which is suitable for optimizing the clinical bone and bone marrow pathological diagnosis process.

Mechanistic study of the solid-liquid extraction of phenolics from walnut pellicle fibers enhanced by ultrasound, microwave and mechanical agitation forces

The molecular diffusion of phenolics inside walnut pellicle fiber particles under solid-liquid extraction enhanced by ultrasound (US), orbital agitation (OA), impeller agitation (IA), and the combined microwave and impeller agitation (MW-IA) were explored. Numerical modeling considering the temperature-dependent diffusivity revealed that the internal diffusivity of phenolics was the highest under MW-IA and the lowest under OA. At 35 °C, IA (126.246 mg/g, t = 10 min) was more effective to strengthen the phenolic diffusivity than the US-39W (95.538 mg/g, t = 10 min). Due to the simultaneous enhancement of internal diffusivity and external dissolution, the MW-IA extraction reached equilibrium within 16 min, reaching the highest yield among all the treatments (176.944 mg/g). The extraction was then divided into the increasing and falling driving force periods. The comparison of phenolic diffusivity among MW-IA and IA roughly indicated that the proportion of non-thermal effect of microwave at 315 W was 889% higher than 189 W at the extraction equilibrium. Moreover, some soluble polyphenols, i.e. quercitrin and syringic acid, could be adsorbed by the cell wall after equilibrium. The correlations between any two soluble phenolics varied with the phenolic type, deducing that soluble phenolics may interact with each other either positively or negatively. Besides, the mining of phenolic data also indicated that intensive impeller agitation is a good substitution for ultrasonication to extract phenolics effectively.

Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice

Background

Triclosan, an antimicrobial agent in personal care products, could be absorbed into the human body through the digestive tract. This animal experiment aimed to clarify the effects of triclosan exposure on the microbiome and intestinal immune functions in healthy and ulcerative colitis models.

Methods

Balb/c mice were maintained on an AIN-93G diet containing 80ppm triclosan dissolved in polyethylene as vehicle or vehicle alone for 1 week or 4 weeks. In the end, the mice were sacrificed, blood samples and colon tissues were collected for analysis of inflammation, and fecal samples were collected for 16 S rRNA sequencing of gut microbiota. To establish ulcerative colitis mice model, at the beginning of the 4th week, mice maintained on the diet with or without triclosan were treated with 2% Dextran sulfate sodium(DSS) in drinking water for 1 week. Then mice were sacrificed for analysis of colitis and gut microbiota.

Results

Triclosan exposure to common mice enhanced the levels of p-NF-κb and Toll-like receptor 4 (TLR4), and decreased the Occludin in the colon. Triclosan exposure to DSS-induced mice increased the level of inflammatory cytokines, reduced the levels of Occludin, and exacerbated the degree of damage to intestinal mucosa and crypt, infiltration of inflammatory cells and atypia of glandular cells. Low-grade intraepithelial neoplasia appeared. Both in common and DSS-induced mice, triclosan exposure changed the diversity and composition of gut microbiota. Fecal samples showed higher enrichment of sulfate-reducing bacteria and Bacteroides, and less butyrate-producing bacteria.

Conclusion

Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice. And changes in the composition of gut microbiota were characterized by the increase of harmful bacteria, including sulfate-reducing bacteria and Bacteroides, and the reduction of protective probiotics, butyrate-producing bacteria.

Simultaneous extraction and preliminary purification of polyphenols from grape pomace using an aqueous two-phase system exposed to ultrasound irradiation: Process characterization and simulation

In this study, an ultrasound-assisted aqueous two-phase (ATP) extraction method was used for the extraction and purification of phenolic compounds from grape pomace. The effect of acoustic energy densities (AED, 41.1, 63.5, 96.1, 111.2 W/L) and temperatures (20, 30, 40°C) on the yield of phenolics was investigated. An artificial neural network (ANN) was successfully used to correlate the extraction parameters with phenolic yield. Then, a diffusion model based on Fick's second law was used to model the mass transfer process during ultrasound-assisted ATP extraction and evaluate the effective diffusion coefficient of phenolics. The results revealed the increase in AED, and the temperature increased the effective diffusivity of phenolics. The HPLC analysis of anthocyanins and flavonols showed that ultrasound significantly increased the extraction yield of anthocyanins compared with the traditional method. High amounts of rutin and myricetin were recovered using the ATPS systems. Sugars were mainly distributed in the bottom phase, whereas phenolics were located in the top phase. Conclusively, ultrasound-assisted aqueous two-phase (ATP) extraction can be used as an effective method to achieve the simultaneous separation and preliminary purification of phenolics from grape pomace.

Fermentation of ginkgo biloba kernel juice using Lactobacillus plantarum Y2 from the ginkgo peel: Fermentation characteristics and evolution of phenolic profiles, antioxidant activities in vitro, and volatile flavor compounds

In this study, a strain of Lactobacillus plantarum Y2 was isolated from the ginkgo peel, and showed adequate adaptation to the ginkgo biloba kernel juice. After 48 h of fermentation, the number of viable cells in the stable growth phase was remained at 10.0 Log CFU/mL, while the content of total organic acid increased by 5.86%. Phenolic substances were significantly enriched, and the content of total phenolic substances increased by 9.72%, and the content of total flavonoids after fermentation exceeded 55.33 mg/L, which was 3.6 times that of the unfermented ginkgo juice. The total relative content of volatile flavor compounds increased by 125.48%, and 24 new volatile flavor substances were produced. The content of total sugar, total protein, and total free amino acid decreased to 44.85, 67.51, and 6.88%, respectively. Meanwhile, more than 82.25% of 4'-O-methylpyridoxine was degraded by lactic acid fermentation, and the final concentration in ginkgo biloba kernel juice was lower than 41.53 mg/L. In addition, the antioxidant and antibacterial activities of fermented ginkgo biloba kernel juice were significantly enhanced. These results showed that LAB fermentation could effectively improve the nutritional value and safety of ginkgo biloba kernel juice.

Plant foods consumed at the Neolithic site of Qujialing (ca. 5800-4200 BP) in Jianghan Plain of the middle catchment of Yangtze River, China

The site of Qujialing experienced a long, sustained process of the development of Neolithic culture in the Jianghan Plain, with a period of some1600 years. Our previous studies based on macrofossil remains and phytoliths revealed that rice (Oryza sativa) from Qujialing was already domesticated, and millet (Setaria italica and Panicum miliaceum) had also been spread into the site since the Youziling Culture period (5800-5100 BP). Nevertheless, no direct evidence has been provided regarding the daily consumed plant foods, especially plant foods obtained by gathering, throughout the site occupation. This paper thus examines pottery sherds (n=41) associated with culinary practices from Qujialing with starch grain analysis. Apart from starch grains from rice and millet, the results indicate that job's tears (Coix lacryma-jobi), lotus roots (Nelumbo nucifera), tubers possibly from Chinese yam (Dioscorea panthainca), acorns (Quercus sp.), and beans (Vigna sp. or/and Vicia sp.) were consumed by the ancient Qujialing people, within job's tears and lotus roots were not discovered before in the macrofossil remains and phytoliths. Combining the starch data and multiple lines of evidence from macrofossil remains and phytoliths, it is suggested that rice was among the most frequently consumed plant foods since the first occupation phase at Qujialing, while acorns could have been gradually replaced by other agricultural products (i.e., rice) and became less important food ingredients, especially when agriculture was more developed in the last occupation phase at Qujialing. These novel findings not only complement our previous research by providing the first line of evidence of paleodiet in the Jianghan Plain from the perspective of starch grain analysis but also delivers a better understanding of the characterized dietary trends and agricultural development in the research region.

TRPC6 inhibits renal tubular epithelial cell pyroptosis through regulating zinc influx and alleviates renal ischemia-reperfusion injury

Canonical transient receptor potential-6 (TRPC6) has been reported to be involved in cell damage after ischemia/reperfusion (I/R) injury in target organs. While the effect and of TRPC6 on pyroptosis in renal I/R injury remain unclear. In our study, we first established the renal I/R mouse model and oxygen-glucose deprivation and re-oxygenation (OGD/R) cell model, and investigated the impacts of TRPC6 on the pyroptosis-related proteins using CCK-8, western blot, ELISA, and immunofluorescence probes. Besides, we also explored the mechanism of TRPC6 in pyroptosis of renal tubular epithelial cells through A20 knockdown or overexpression and zinc chloride (ZnCl₂ ) or a zinc ion chelator (TPEN) treatment. Our results indicated that I/R injury could cause downregulation of TRPC6 both in vivo and in vitro. In the I/R injury murine model, TRPC6 inhibition exacerbated tissue damage and upregulated NLRP3, ASC, caspase-1, IL-18, and IL-1β, which could be alleviated by the administration of ZnCl₂ . In the OGD/R cell model, inhibitor of TRPC6 (SAR7334) reduced zinc ion influx, aggravated cell death and upregulated pyroptosis-related protein. The pyroptosis phenotype also could be alleviated by ZnCl₂ and intensified by TPEN. Overexpression of A20 reduced the expression of pyroptosis-related protein, increased cell viability in the sh-TRPC6 and TPEN-treated OGD/R cell models, while A20 deficiency impaired the protective effect of zinc ion. Therefore, our results indicate that TRPC6 could promote zinc ion influx in renal tubular epithelial cells, thereby upregulating intracellular A20, inhibiting the activation of inflammasome NLRP3, and ultimately attenuating renal I/R injury.

[Clinical characteristics and prognosis of patients with newly-diagnosed multiple myeloma with t(11;14)]

Objective: To explore the clinical characteristics and prognosis of multiple myeloma (MM) patients with t(11;14). Methods: The clinical data of patients newly diagnosed with MM with t(11;14), which confirmed by fluorescence in situ hybridization (FISH), from January 1, 2016 to May 31, 2021 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine was retrospectively collected. A total of 45 patients were included. Bortezomib based induction therapy were given to 88.9% (40/45) patients, while 11.1% (5/45) received Imids-based therapy. Fourteen patients underwent the autologous hematopoietic stem cell transplantation (AHSCT). The clinical characteristics, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and risk factors affecting survival were analyzed. Results: The average age of patients were (58.8±9.6) years, and 62.2%(28/45)were male. A relatively high incidence of bone lesion 82.2%(37/45)was observed. After 4 cycles induction therapy, the ORR was 66.7% (30/45), and ≥very good partial response (VGPR) was 31.3% (14/45). The rate of ≥VGPR increased to 92.9% (13/14) after AHSCT. The follow-up time [M(Q₁,Q₃)] was 27(20,42)months. The PFS was 34 (95%CI: 23-45) months, the median OS was 44 (95%CI:33-51) months. Median PFS were 48 (only 3 cases of progressive disease, CI not available) months and 24 (95%CI:13-35) months in the transplantation group and non-transplant group respectively (P=0.115). Median OS were 60 (only 1 case of death, CI not available) months and 48 (95%CI:22-74) months in the transplantation group and non-transplantation group, respectively (P=0.238). Cox regression analysis indicated that the number of plasma cell ≥50% in bone marrow and CD20 expression on myeloma cells were the risk factors for PFS[OR=3.272,95%CI:1.167-9.170,P=0.024;OR=3.480,95%CI:1.082-11.234,P=0.036]. No significant effective factor on OS was found. Conclusions: For multiple myeloma patient with t(11;14), the response rate with novel agents induction therapy is not high, but autologous stem cell transplantation can deepen remission. The high burden of bone marrow plasma cells and the expression of CD20 may be associated with the poor prognosis.

Effect of pre-gelatinization on α-amylase-catalyzed hydrolysis of corn starch under moderate electric field

This study aimed to explore the roles of starch structure in α-amylase-catalyzed hydrolysis under moderate electric field (MEF). Corn starch was gelatinized by controlling the temperature procedure of rapid viscos-analysis, and then the pre-gelatinized starch (3.0 g) was treated by MEF (2.5 and 5 V/cm) in the presence of α-amylase (1.5 mL). Only a slight hydrolysis occurred for native starch, showing minor increases in reducing sugar content (RSC, ∼0.19 mg/mL), slight changes in granular and semicrystalline structure, and decreases in thermostability (the maximum decomposition temperature (T_max) decreased from 322 to 300 °C). The densely-packed semicrystalline within starch granules was destroyed by pre-gelatinization, thus enhancing the hydrolysis and further decreasing the thermostability, presenting RSC values of 0.63-0.92 mg/mL and T_max of 291-292 °C. Moreover, some special crystals were formed by IEF-induced orientation of hydrolyzed starch chains. Overall, these results confirmed that the semicrystalline structure of starch dominated in MEF-assisted hydrolysis, which could provide guidance for the application of electro-based techniques in starch modification.

Physiological and biochemical evaluation of high anthocyanin pigmented tea (Camellia sinensis L. O. Kuntze) germplasm for purple tea production

Finding promising purple tea germplasm that would target new tea products for diversification and value addition boost the tea industry’s economic growth. Accordingly, 10 tea germplasm viz. TRA St. 817, TRA St. 293, TRA St. 400, TRA 177/3, TRA 376/2, TRA 376/3, TRA 427/7, TRA P7, TRA P8, and TV1 were evaluated in terms of gas exchange parameters, multiplication performance, and biochemical markers such as chlorophyll, carotenoids, and anthocyanin content, which are related to the purple tea quality. The investigated gas exchange and biochemical parameters revealed significant differences. Germplasm TRA St.817 was physiologically more efficient (24.7 μmol m^–2 s^–1), followed by TRA St. 293, exhibiting the highest net photosynthesis, water use efficiency (19.02 μmol mmol^–1), carboxylation efficiency (0.73), chlorophyll fluorescence or photochemical efficiency of PSII (0.754) and mesophyll efficiency (ci/gs ratio: 2.54). Net photosynthesis was positively correlated with water use efficiency, carboxylation efficiency, mesophyll efficiency, and photochemical efficiency of PSII (r = 0.965^**, 0.937^**, 0.857^**, 0.867^**; P = 0.05), respectively, but negatively correlated with the transpiration ratio (r = −0.878^**; P = 0.05) based on Pearson correlation analysis. The total anthocyanin content (4764.19 μg.g^–1 fresh leaf weight) and carotenoid content (3.825 mg.g^–1 fresh leaf weight) were highest in the TRA St.817 germplasm, followed by germplasm TRA St. 293 (2926.18 μg.g^–1 FW). In contrast, total chlorophyll content was significantly low (1.779 mg.g^–1 fresh weight), which is very suitable for manufacturing purple tea. The highest carotenoid concentration in TRA St. 817 was 3.825 mg.g^–1 FW, followed by TRA P8 (3.475 mg.g^–1 FW), favoring the formation of more volatile flavor constituents. The promising germplasm, TRA St 817, has a multiplication success rate of 91.4% through cleft grafting. The outcome reveals that TRA St.817 is a promising germplasm that can be used to make speciality teas, i.e., purple tea.

Individualized total laparoscopic surgery based on 3D remodeling for portal hypertension: A single surgical team experience

Background and aims

Portal hypertension (PHT) is common in end-stage cirrhosis, and variceal bleeding is the main complication associated with mortality. Surgery is usually performed in patients with PHT with a high risk of variceal bleeding in China. This study aimed to introduce an individualized and precise total laparoscopic surgical procedure based on 3D remodeling for PHT.

Methods

From March 2013 to December 2018, 146 patients with cirrhotic PHT underwent a laparoscopic surgical procedure in our department. An individualized 3D remodeling evaluation was carried out for surgical planning.

Results

The operation time was 319.96 ± 91.53 min. Eight of 146 patients were converted to open surgery. Acute portal vein system thrombosis occurred in 10 patients (6.85%). During the first year, 11 patients (8.15%) experienced rebleeding and two (1.48%) died. 18 patients (13.33%) experienced rebleeding and three died, giving a 3-year mortality rate of 3.66%. Compared with preoperatively, the portal vein showed significant postoperative decreases in diameter, flow velocity, and flow amount, while the hepatic artery showed significant postoperative increases in diameter, flow velocity, and flow amount. A 3D liver volume evaluation found that 19 of 21 patients had a significantly increased liver volume postoperatively, and a significantly decreased MELD score.

Conclusion

This retrospective study introduced a safe, feasible, and effective individualized surgical procedure. Our results show that this surgical treatment may not only act as an effective symptomatic treatment for PHT to prevent esophageal and gastric hemorrhage, but also as an etiological treatment to increase liver function and long-term survival.