The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis

BACKGROUND

Pancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients.

METHODS

The retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed.

RESULTS

Among 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011-4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥4 week: aRR = 0.292, 95% CI 0.100-0.853; P = 0.024) and robotic PD (≤2 week: aRR = 3.058, 95% CI 1.178-7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119-1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004).

CONCLUSION

PBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients' physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.

[Y-box-binding protein 1 mediates sorafenib resistance via the extracellular signal regulated-protein kinase pathway in hepatoma cells]

Objective: To investigate the effect and possible mechanism of Y-box-binding protein 1 (YB-1) on sorafenib resistance in hepatoma cells. Methods: Lentiviral vectors with YB-1 overexpression and knockdown were constructed, respectively, to stimulate human hepatoma cell lines (HepG2 and Huh7) alone or in combination with sorafenib.The overexpression part of the experiment was divided into four groups: overexpression control group (Lv-NC), YB-1 overexpression group (Lv-YB-1), overexpression control combined with sorafenib resistance group (Lv-NC+sorafenib), YB-1 overexpression combined with sorafenib resistance group (Lv-YB-1 + sorafenib). The knockdown part of the experiment was also divided into four groups: knockdown control group (Lv-shNC), YB-1 knockdown group (Lv-shYB-1), knockdown control combined with sorafenib resistance group (Lv-shNC + sorafenib), YB-1 knockdown combined with sorafenib resistance group (Lv-shYB-1 + sorafenib). The occurrence of cell apoptosis was detected by TUNEL. The protein expression levels of phosphorylated (p)-ERK and ERK, key proteins in the extracellular regulatory protein kinase (ERK) signaling pathway, were detected by Western blot and quantified by ImageJ software. Subcutaneous tumorigenesis experiments were performed in nude mice. The effect of YB-1 on the efficacy of sorafenib was verified in vivo. The comparison between the two sets of data was carried out by an independent sample t-test. One-way ANOVA was used for comparisons between the three groups of data above. Results: Sorafenib had accelerated the occurrence of apoptosis in hepatoma cells, while YB-1 overexpression had inhibited cell apoptosis, and at the same time also inhibited the apoptosis-accelerating impact of sorafenib. On the contrary, YB-1 knockdown accelerated cell apoptosis and amplified the induction effect of sorafenib on apoptosis. Furthermore, sorafenib resistance had down-regulated p-ERK levels (HepG2: Lv-NC 0.685 ± 0.143, Lv-NC + sorafenib 0.315 ± 0.168, P < 0.05; Huh7: Lv-NC 0.576 ± 0.078, Lv-NC + sorafenib 0.150 ± 0.131, P < 0.01), whereas YB-1 overexpression had inhibited sorafenib resistance p-ERK reduction (HepG2: Lv-NC + sorafenib 0.315 ± 0.168, Lv-YB-1 + sorafenib 0.688 ± 0.042, P < 0.05; Huh7: Lv-NC + sorafenib 0.150 ± 0.131, Lv-YB-1 + sorafenib 0.553 ± 0.041, P < 0.05). YB-1 knockdown further increased sorafenib-induced p-ERK downregulation (HepG2: Lv-shNC + sorafenib 0.911 ± 0.252, Lv-shYB-1 + sorafenib 0.500 ± 0.201, P < 0.05; Huh7: Lv-shNC + sorafenib 0.577 ± 0.082, Lv-shYB-1 + sorafenib 0.350 ± 0.143, P < 0.05), which was further verified in naked mice (Lv-shNC + sorafenib 0.812 ± 0.279, Lv-shYB-1 + sorafenib 0.352 ± 0.109, P < 0.05). Conclusion: YB-1 mediates the occurrence of sorafenib resistance via the ERK signaling pathway in hepatoma cells.

[QUADAS-C-A tool for assessing risk of bias regarding Quality Assessment of Diagnostic Accuracy Studies-Comparative]

This paper introduced the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C), illustrated the comparison with the QUADAS-2, and using QUADAS-C together with QUADAS-2 to present QUADAS-C results through systematic reviews. Like the domain for QUADAS-2, QUADAS-C retained four domains, including patient selection, index test, reference standard, flow, and timing, and comprised additional questions for each QUADAS-2 part. Unlike the QUADAS-2 tool, the starting question of each domain for QUADAS-C was designed to summarize the risk of biased information captured by QUADAS-2. QUADAS-C only dealt with the risk of bias but did not include the part of concerns regarding applicability. The answers to signaling questions for each domain of QUADAS-C would lead to a 'low''high' or 'unclear' risk of biased judgment for the original study.

[Diagnosis and treatment of two imported cases with schistosomiasis haematobia in Fujian Province]

OBJECTIVE

To analyze the diagnosis and treatment of two imported cases with schistosomiasis haematobia, so as to provide insights into improving the diagnosis and treatment and avoiding misdiagnosis and mistreatment of imported schistosomiasis haematobia.

METHODS

The medical records and epidemiological data pertaining to the two cases were collected. The stool and urine samples were collected for identification of Schistosoma eggs using the Kato-Katz technique and direct smear method after centrifugal precipitation, and blood samples were collected for detection of anti-Schistosoma antibody. Following definitive diagnosis, the patients were given praziquantel therapy.

RESULTS

The patient 1, a Malagasy, was infected in Madagascar and returned to China for delivery. The case presented intermittent painless terminal hematuria symptoms, and showed no remarkable improvements following multiple-round treatments in several hospitals. In January 2017, she was found to be positive for anti-Schistosoma antibody, negative for feces test, and positive for S. haematobium eggs in urine test, and miracidia were hatched from eggs. Then, the case was diagnosed as schistosomiasis haematobia. Patient 2 worked in Republic of Malawi for many years, and presented intermittent painless terminal hematuria since October 2018; however, no definite diagnosis or effective treatment was received after admission to multiple hospitals. In March 2019, pathological examinations showed a number of eggs in the interstitium of the bladder mass, accompanied by a large number of eosinophils, which was consistent with schistosomiasis cystitis. In April 2019, he was tested positive for serum anti-Schistosoma antibody, negative for the fecal test, and had S. haematobium eggs in urine samples, with miracidia hatched from eggs. Then, the case was diagnosed as schistosomiasis haematobia. Following treatment with praziquantel at a dose of 60 mg/kg, all symptoms disappeared.

CONCLUSIONS

Overseas imported schistosomiasis haematobia is likely to be misdiagnosed. The training pertaining to schistosomiasis control knowledge requires to be improved among clinical professionals, in order to avoid misdiagnosis and mistreatment.

Yak milk-derived exosomes alleviate lipopolysaccharide-induced intestinal inflammation by inhibiting PI3K/AKT/C3 pathway activation

Intestinal epithelial cells (IEC) are important parts of the mucosal barrier, whose function can be impaired upon various injury factors such as lipopolysaccharide. Although food-derived exosomes are preventable against intestinal barrier injuries, there have been few studies on the effect of yak milk-derived exosomes and the underlying mechanism that remains poorly understood. This study aimed to characterize the effect of exosomal proteins derived from yak and cow milk on the barrier function of IEC-6 treated with lipopolysaccharide and the relevant mechanism involved. Proteomics study revealed 392 differentially expressed proteins, with 58 higher expressed and 334 lower expressed in yak milk-derived exosomes than those in cow exosomes. Additionally, the top 20 proteins with a relatively consistent higher expression in yak milk exosomes than cow milk exosomes were identified. Protein CD46 was found to be a regulator for alleviating inflammatory injury of IEC-6. In vitro assay of the role of yak milk exosomes on survival of IEC-6 in inflammation by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay confirmed the effectiveness of yak milk exosomes to increase IEC-6 survival up to 18% for 12 h compared with cow milk exosomes (up to 12%), indicating a therapeutic effect of yak milk exosomes in the prevention of intestinal inflammation. Furthermore, yak and cow milk exosomes were shown to activate the PI3K/AKT/C3 signaling pathway, thus promoting IEC-6 survival. Our findings demonstrated an important relationship between yak and cow milk exosomes and intestinal inflammation, facilitating further understanding of the mechanisms of inflammation-driven epithelial homeostasis. Interestingly, compared with cow milk exosomes, yak milk exosomes activated the PI3K/AKT/C3 signaling pathway more to lower the incidence and severity of intestine inflammation, which might represent a potential innovative therapeutic option for intestinal inflammation.

Yak-milk-derived exosomes promote proliferation of intestinal epithelial cells in an hypoxic environment

Intestinal epithelial cells (IEC) are an important part of the intestinal barrier. Barrier function was disrupted under hypoxia, but milk-derived exosomes can regulate the intestinal barrier function. However, the mechanisms underlying the association between yak milk exosomes and hypoxia in IEC remain poorly understood. In this follow-up study, we proposed an effective optimization method for purifying yak-milk-derived exosomes. The Western blot analyses indicated that the expression of the proteins of the endosomal sorting complexes required for transport (TSG101), proteins of the tetraspanin family (CD63), and heat shock protein 70 (Hsp-70) proteins from yak-milk-derived exosomes were significantly higher than those in cow-milk-derived exosomes. Flow cytometry analysis showed that yak milk had 3.7 times the number of exosomes compared with cow milk. Moreover, we explored whether yak milk exosomes could facilitate intestinal cell survival under hypoxic conditions in vitro. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide results showed that yak-milk-derived exosomes significantly increased survival of IEC-6 cells with rates of up to 29% for cells incubated in hypoxic conditions for 12 h, compared with those of cow-milk-derived exosomes posttreatment (rates of up to 22% for cells incubated in hypoxic conditions for 12 h). Confocal microscopy revealed that the IEC-6 cells uptake more yak-milk-derived exosomes than cow milk in hypoxic conditions. Furthermore, the Western blot analyses indicated that yak-milk-derived exosomes significantly promote oxygen-sensitive prolyl hydroxylase (PHD)-1 expression and decrease the expression of hypoxia-inducible factor-α and its downstream target vascular endothelial growth factor (VEGF) in the IEC-6 cells. Further, yak-milk-derived exosomes significantly inhibited p53 levels. In conclusion, our findings demonstrate that yak-milk-derived exosomes more effectively activate the hypoxia-inducible factor signaling pathway, thus promoting IEC-6 cell survival, which may result in higher hypoxia tolerance than cow-milk-derived exosomes.

Hyperbolic lens design of local oscillator optics system for electron cyclotron emission imaging on J-TEXT

An electron cyclotron emission imaging diagnostic system that contains two 16-antenna arrays is being developed on J-TEXT tokamak. In this heterodyne system, the mixers in the front microwave antenna are used to down-convert the electron cyclotron emission to a 2-12 GHz radio frequency. All of the 24 antenna mixers in the individual enclosure box are driven by shining local oscillator (LO) power via launching optics. The previous approach for LO optics was designed with spherical and cylinder lenses, which has limitations such as the inhomogeneity of the energy deposition on different channels and the difficulty of optics alignment. A new generation of LO optics has been designed and applied on J-TEXT with a hyperbolic lens for uniform power deposition across the entire antenna array. The robustness of the optical alignment will be significantly increased with three hyperbolic lenses. Furthermore, the simulation results and robustness analysis of these LO optics are discussed in this paper.

Measurement of electron temperature fluctuations on J-TEXT via correlation ECE

The capabilities of the joint-Texas experimental tokamak correlation electron cyclotron emission (CECE) diagnostic have recently been extended with an upgrade. Four new yttrium iron garnet (YIG) filters from 4 GHz to 18 GHz with a bandwidth of 90 ∼ 230 MHz are added to the previous 4 channels. Optical optimization of the transmission line has improved the poloidal resolution, which allows k _θ < 3.08 cm^-1. The improvement of video amplifiers allows the frequency and amplitude gain to be adjusted discretely from 200 kHz to 1 MHz and from 200 to 1000, respectively, for different situations. A controller is designed to remotely adjust the center frequency of the YIG filters. Based on the CECE, the distribution and the effect of magnetohydrodynamic instabilities on electron temperature fluctuations have been observed. The experiment results show good performance of the upgraded CECE diagnostic.

Cloning and sequence analysis of the Blumea balsamifera DC farnesyl diphosphate synthase gene

Blumea balsamifera DC is a member of the Compositae family and is frequently used as traditional Chinese medicine. Blumea balsamifera is rich in monoterpenes, which possess a variety of pharmacological activities, such as antioxidant, anti-bacteria, and anti-viral activities. Farnesyl diphosphate synthase (FPS) is a key enzyme in the biosynthetic pathway of terpenes, playing an important regulatory role in plant growth, such as resistance and secondary metabolism. Based on the conserved oligo amino acid residues of published FPS genes from other higher plant species, a cDNA sequence, designated BbFPS, was isolated from B. balsamifera DC using polymerase chain reaction. The clones were an average of 1.6 kb and contained an open reading frame that predicted a polypeptide of 342 amino acids with 89.07% identity to FPS from other plants. The deduced amino acid sequence was dominated by hydrophobic regions and contained 2 highly conserved DDxxD motifs that are essential for proper functioning of FPS. Phylogenetic analysis indicated that FPS grouped with other composite families. Prediction of secondary structure and subcellular localization suggested that alpha helices made up 70% of the amino acids of the sequence.

Effect of l-arginine on intestinal mucosal immune barrier function in weaned pigs after Escherichia coli LPS challenge

The effects of l-arginine (Arg) supplementation on intestinal mucosal immune barrier function in weaned pigs after Escherichia coli LPS challenge were evaluated. Twenty-four weaned pigs were allotted to four treatments including: (i) non-challenged control; (ii) LPS-challenged control; (iii) LPS + 0.5% Arg; and (iv) LPS + 1.0% Arg. On d 16, pigs in the LPS, LPS + 0.5% Arg and LPS + 1.0% Arg groups were challenged by injection with 100 µg/kg of body mass LPS, whereas the control group were given sterile saline. At 48 h post-challenge, all pigs were sacrificed for evaluation of small intestinal morphology and mucosal immune barrier function. In the jejunum and ileum, LPS caused villous atrophy and intestinal morphology disruption, whereas 0.5% or 1.0% Arg supplementation mitigated villus atrophy and intestinal morphology impairment caused by LPS challenge. Arg (0.5%) supplementation increased the numbers of IgA-secreting cells, CD8+ and CD4+ T cells in the ileum ( P < 0.05). Arg supplementation prevented the elevation of mast cell numbers induced by LPS challenge ( P < 0.05). Dietary supplementation of Arg caused a decreased lymphocyte apoptosis of Peyer’s patches in pigs challenged by LPS ( P < 0.05). These results indicated that Arg supplementation protects and enhances intestinal mucosal immune barrier function and maintains intestinal integrity in weaned pigs after E. coli LPS challenge.

An alternative cetyltrimethylammonium bromide-based protocol for RNA isolation from blackberry (Rubus L.)

Isolation of high-quality RNA free of contaminants, such as polyphenols, proteins, plant secondary metabolites, and genomic DNA from plant tissues, is usually a challenging but crucial step for molecular analysis. We developed a novel protocol based on the cetyltrimethylammonium bromide method to isolate high-quality RNA from blackberry plant tissues, especially fruits. Most DNA was removed when acetic acid was utilized, before RNA precipitation. Thus, lithium chloride, a reagent widely used for RNA purification, was not needed. The isolation time was shortened to less than 3 h. The RNA was quite pure, with little DNA contamination. The quality of the RNA was assessed by spectrophotometric readings and electrophoresis on agarose gels. It was good enough for downstream enzymatic reactions, such as reverse transcription-PCR, cloning and real-time PCR assay. The method yielded an amount of total RNA comparable to previously described protocols.

Wear performance of ultrahigh molecular weight polyethylene/quartz composites

Ultrahigh molecular weight polyethylene (UHMWPE)/quartz composites were compression molded in the presence of organosiloxane, and then hydrolyzed. The used organosiloxane is vinyl tri-ethyloxyl silane. The gelation, the melting behavior, the crystallinity, the mechanical properties and the wear resistance of UHMWPE/quartz composites were investigated. The results showed that organosiloxane can act as a cross-linking agent for UHMWPE matrix and serve as a coupling agent for improving the bonding between the quartz particles and the UHMWPE matrix. The correlation between the various properties and the morphology of the composites has been discussed. At about 0.5phr organsiloxane while the degree of crystallinity of the composite is at the peak value of 57%, the mechanical properties and the wear resistance of UHMWPE/quartz composites reaches their maximum.

Enhanced wear performance of ultra high molecular weight polyethylene crosslinked by organosilane

Ultra high molecular weight polyethylene (UHMWPE) crosslinked by organosilane was thermal compression molded. The organosilane used was the tri-ethyloxyl vinyl silane. Its gelation, melting behavior, crystallinity, mechanical and wear-resisting properties were systematically investigated. The results showed that the gel ratio of UHMWPE increases with the incorporation of organosilane. At a low content of organosilane, the melting point and crystallinity of the crosslinked UHMWPE increase, and hence the mechanical and wear-resisting properties are improved. However, at a high content of organosilane, these performances of the crosslinked UHMWPE become worse. At 0.4 phr silane, the wear resistance of crosslinked UHMWPE reaches its optimum value.

[The medium optimization of xylitol fermentation based on neural networks and genetic algorithms]

Using genetic algorithms(GA) for medium optimization of xylitol fermentation, and coupling neural networks model for predicting xylitol concentration is introduced. The medium compose determined by GA is as input data of the neural networks, while the output data predicted by neural networks is as suitable value of GA for predicting. The optimum medium is further validated by experimentation. The good result, which save the experimental workload and charge, enhance the level of xylitol fermentation as well as reduced the medium consume is obtained.

Effects of rhynchophylline on motor activity of mice and serotonin and dopamine in rat brain

Rhynchophylline (Rhy) reduced the spontaneous motor activity and enhanced the sedative and hypnotic effects of sodium pentobarbital in mice. The effects of Rhy on serotonin (5-HT) and dopamine (DA) concentrations in rat brain, and the release of 5-HT and DA from the regional brain slices were studied by a fluorescence detector. Rhy increased the 5-HT content in the hypothalamus and cortex, but reduced the DA concentrations in the cortex, amygdala, and spinal cord. Rhy promoted the release of endogenous DA from 4 brain regions. The release of 5-HT was increased in 2 brain regions and decreased in hypothalamus slice. However, Rhy inhibited the release of both 5-HT and DA evoked by high potassium.

[Alcohol injections for the treatment of recurrent intracerebral gliomas]

Seventeen patients with recurrent intracerebral gliomas were given alcohol injection percutaneously guided by ultrasonography. These patients suffered from supratentorial tumors and were operated on previously. The fluid of cystic lesions of 13 patients was aspirated and absolate alcohol was injected for 5-8 times. The cystic cavities soon disappeared followed by symptoms of intracerebral hypertension. Biopsies from different parts of tumor cavity showed that tumor cells were degenerated and necrotized. There was no curable effect on larger solid neoplasm and deep sited solid tumor. We conclude that percutaneous alcohol injection is effective in the treatment of recurrent gliomas.

Protein conformational relaxation following photodissociation of CO from carbonmonoxymyoglobin: picosecond circular dichroism and absorption studies

Picosecond time-resolved polarization spectroscopy is used to study relaxation dynamics in myoglobin following photoelimination of CO from carbonmonoxymyoglobin. Evolution of the transient circular dichroism signal of the N band of myoglobin (probed at 355 nm) to that characteristic of equilibrium myoglobin requires approximately 300 ps. This time scale is significantly longer than that corresponding to the photoinitiated bond cleavage. Transient linear dichroism of the Soret band and picosecond time-resolved magnetic circular dichroism measurements of the Q band demonstrate that the circular dichroism kinetics do not result from either time-dependent changes in the orientation of the transition moments of the heme ring or the doming of the heme that accompanies the out-of-plane motion of the iron. Finally, transient absorption data of the near-IR optical transition of photogenerated myoglobin suggest that the circular dichroism data are not a measure of the tilting of the proximal histidine. The circular dichroism data are discussed in terms of a relaxation in the tertiary structure of the protein following dissociation.

A picosecond circular dichroism study of photosynthetic reaction centers from Rhodobacter sphaeroides

Picosecond transient circular dichroism spectra are reported for the primary intermediates in the photocycle of reaction centers isolated from Rhodobacter sphaeroides. The time-resolved circular dichroism spectra of the two electron transfer intermediates (BChl2) +BPh-LQA and (BChl2) +BPhLQ-A reveal a large, nonconservative, and fairly stationary CD band at 800 nm. These results suggests that mechanisms other than exciton interactions need to be included in order to explain the optical activity of this biological system.

The Drosophila melanogaster z600 gene encodes a chromatin-associated protein synthesized in the syncytial blastoderm

The Drosophila melanogaster z600 gene is zygotically expressed with gene transcripts accumulating transiently during early embryogenesis. Based on nucleotide sequence analysis, z600 is predicted to encode a small, basic, histone-like protein. Antibodies generated against a beta-galactosidase::z600 fusion protein immunoprecipitated the z600 in vitro translation product and detected a z600 protein present predominantly in 2- to 4-h embryos. We localized the z600 protein in whole-amount embryos by indirect immunofluorescence. These studies show that the protein is located in the nucleus and associated with chromatin in the syncytial blastoderm.

cis-acting sequences required for the germ line expression of the Drosophila gonadal gene

We have identified two DNA sequences required for the proper germ line expression of the Drosophila gonadal (gdl) gene. A 53-bp region located from -328 to -276 relative to the gdlM transcription start site was required for the expression of a gdl-lacZ gene fusion in the male germ line. This sequence resides within the upstream z600 gene; however, z600 expression was undetectable in male germ cells. A 30-bp region located from -5 to +25 relative to the gdlF transcription start site was required for the expression of gdl-lacZ gene fusion in the female germ line.

Expression of the Drosophila gonadal gene: alternative promoters control the germ-line expression of monocistronic and bicistronic gene transcripts

The Drosophila gonadal (gdl) gene is differentially expressed in the male and female germ lines. In males, expression in the gdlM mode results in a 1200-/1500-nucleotide RNA pair, whereas in females, expression in the gdlF mode results in a 1000-/1300-nucleotide RNA pair. Since the two expression modes are a result of alternative promoter usage, the sex-specific transcripts differ at their 5′ ends. These sequence differences affect the coding capacity of the gene. A common open reading frame (ORF) of 193 codons (ORF193) is present in all four gdl transcripts; a consequence of the additional sequences at the 5′ end of the gdlM transcripts is the presence of an additional ORF of 39 codons (ORF39). Translation of gdlF and gdlM cRNAs in a reticulocyte lysate reveals that these transcripts can serve as monocistronic and bicistronic mRNAs in vitro. An analysis of germ-line transformants harboring gdl-lacZ gene fusions provides information on gdl gene expression during gametogenesis. The fusion genes are transcribed and translated in the germ line; beta-galactosidase activity is detected in premeiotic and postmeiotic spermatogenic stages in males, and in nurse cells and oocytes of developing egg chambers in females. Both gdlM ORFs are used because transformant lines expressing the lacZ gene, fused in frame with either ORF39 or ORF193, are positive for beta-galactosidase activity in the testes. These studies also reveal that separable transcription control elements are responsible for gdl expression in the male and female germ lines.