Cholecystectomy, hepatectomy, and lymphadenectomy are recommended as the curative treatment for resectable gallbladder cancer (GBC). Textbook outcomes in liver surgery (TOLS) is a novel composite ...measure that has been defined by expert consensus to represent the optimal postoperative course after hepatectomy. This study aimed to determine the incidence of TOLS and the independent predictors associated with TOLS after curative-intent resection in GBC patients.
All consecutive GBC patients who underwent curative-intent resection between 2014 and 2020 were enrolled from a multicenter database from 11 hospitals as the training and the internal testing cohorts, and Southwest Hospital as the external testing cohort. TOLS was defined as no intraoperative grade greater than or equal to 2 incidents, no grade B/C postoperative bile leaks, no postoperative grade B/C liver failure, no 90-day postoperative major morbidity, no 90-day readmission, no 90-day mortality after hospital discharge, and R0 resection. Independent predictors of TOLS were identified using logistic regression and were used to construct the nomogram. The predictive performance was assessed using the area under the curve and calibration curves.
TOLS was achieved in 168 patients (54.4%) and 74 patients (57.8%) from the training and internal testing cohorts, and the external testing cohort, respectively. On multivariate analyses, age less than or equal to 70 years, absence of preoperative jaundice (total bilirubin≤3 mg/dl), T1 stage, N0 stage, wedge hepatectomy, and no neoadjuvant therapy were independently associated with TOLS. The nomogram that incorporated these predictors demonstrated excellent calibration and good performance in both the training and external testing cohorts (area under the curve: 0.741 and 0.726).
TOLS was only achieved in approximately half of GBC patients treated with curative-intent resection, and the constructed nomogram predicted TOLS accurately.
This study is aim to summarize the experience of robotic thyroidectomy via bilateral axillo-breast approach of our center and also to find out the learning curve of this technique.
In total 220 ...initial patients who have undergone robotic thyroidectomy via bilateral axillo-breast approach from May 2015 to September 2017 were involved in this study. The data of operation time, clinical characteristics, surgical outcomes and oncological outcomes were collected. The moving average method is use to explore the learning curve.
All patients had undergone robotic thyroidectomy successfully without conversion to other surgical approaches. The mean age of the enrolled subjects was 34.4 ± 7.8 years old, while the sex ratio (male/female) was 38/182. There were 50 benign tumor cases and 170 malignant tumor cases. The mean total operation time was 105.3 ± 37.6 min. Lymph node metastasis was observed in 61 (35.9%) patients. The mean retrieved lymph node count was 5.1 ± 3.8 while the mean metastatic lymph node count was 0.7 ± 1.5. The operation time decreased significantly after about 30–35 cases and formed the plateau. After 80 cases, the operation time significantly decreased again.
For skilled endocrine surgeons, robotic thyroidectomy has proved to be safe and feasible, which could be applied extensively in patients strictly selected in high-volume centers, with a relatively short learning curve of about 30–35 cases. While the surgeons getting more experienced, this technique would be more efficient.
Many facets of the tumor biology of medulloblastoma (MB) have not been fully elucidated. Collapsin response mediator protein 1 (CRMP1) is a member of cytoplasmic family of proteins that regulate the ...development of central nervous system. Recent studies demonstrated that CRMP1 could function as an invasion suppressor. We reported previously that high mobility group AT-hook 1 (HMGA1) contributed to development of MB and regulated its growth and migration/invasion. Transcriptional profiling and quantitative RT-PCR revealed increased expression of CRMP1 in HMGA1-depleted cells, suggesting that CRMP1 may be a downstream target of HMGA1 in MB. In this study, we showed HMGA1 can bind CRMP1 promoter by chromatin immunoprecipitation (ChIP) assay. Luciferase assay demonstrated a marked enhancement of CRMP1 transcription activity in HMGA1-depleted cells. Furthermore, quantitative RT-PCR revealed a negative correlation between HMGA1 and CRMP1 in 32 MB samples. To investigate the biological roles of CRMP1 in MB pathogenesis, we established MB clones stably expressing CRMP1. Functional analysis revealed that expression of CRMP1 significantly inhibited proliferation, migration, invasion and formation of filopodia and intense stress fiber of MB cells. Our data suggest that HMGA1 regulates CRMP1 expression and CRMP1 is implicated in MB pathogenesis.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Ankle injuries are responsible for more than 5 million emergency department visits each year. The AO and Lauge-Hansen classification systems are widely used in the clinical diagnosis of ankle ...injuries. This study aimed to analyze the intraobserver reliability and interobserver reproducibility of the AO and Lauge-Hansen classification systems. In addition, the authors explored the differences among physicians' classification responses and evaluated the clinical value for diagnosis. Fifty-six patients with an ankle injury with complete clinical and radiologic data were enrolled. The definition of injury type, the index score typing methods, and the specific study criteria were explained in detail. Five observers, who were orthopedic surgeons, determined the classifications according to both the AO and Lauge-Hansen systems. The classification was repeated 1 month later. Cronbach's alpha and Cohen's kappa test were used to determine interobserver reliability and intraobserver reproducibility. The physicians conducted 560 classifications (56 cases × 5 physicians × 2 times per patient). Average inter- and intraobserver kappa values for the AO system were 0.708 and 0.608, respectively. Average inter- and intraobserver kappa values for the Lauge-Hansen system were 0.402 and 0.398, respectively. Cronbach's alpha coefficient was 96.7% for the AO system and 76.0% for the Lauge-Hansen system. The Lauge-Hansen classification system is a comprehensive yet cumbersome system. Comparatively, the AO classification system is easier to understand. This study shows that the AO classification system has more reliability and reproducibility, and thus has more value in clinical practice, than the Lauge-Hansen classification system.
The kinetics and optimization of the decoloration of an active commercial dye, argazol blue BFBR (ABB), by a heterogeneous Fenton-like reaction catalyzed by natural schorl were investigated in this ...study. The kinetic investigations revealed that the first-order kinetic model was more favorable to describe the decoloration of ABB under different reaction conditions than the second-order and Behnajady-Modirshahla-Ghanbery models. The relationship between the reaction rate constant k and reaction temperature T followed the Arrhenius Equation, with an apparent activation energy Ea of 51.31 kJ times mol super(-1). The central composite design under the response surface methodology was employed for the experimental design and optimization of the ABB decoloration process. The significance of a second order polynomial model for predicting the optimal values of ABB decoloration was evaluated by the analysis of variance and 3D response surface plots for the interactions between the two variables were constructed. Then, the optimum conditions were determined.
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•A hierarchical Co3O4@Co3O4/Fe3O4 yolk-shell nanoreactor was designed and prepared.•The confinement effect and bimetallic cycles were integrated in this nanoreactor.•This nanoreactor ...could activate PMS for various organic pollutants degradation.•DFT calculations and MD simulations disclosed the confined reaction mechanisms.
It is still a challenging task to reasonably design an efficient Co3O4-based nanoreactor for persulfate activation and accurately disclose the confined reaction mechanism. Herein, we design and prepare a hierarchical Co3O4@Co3O4/Fe3O4 yolk-shell nanoreactor (CT@CT/MG). In this yolk-shell structured nanoreactor, a Co3O4 solid sphere is the yolk and a flower-like Co3O4 hollow sphere wrapped by Fe3O4 nanoparticles is the shell. The void between them constitutes a confined space. Various instrumental techniques are used to characterize the structure and compositions of this nanoreactor. Degradation experiments show that CT@CT/MG have powerful capability to activate peroxymonosulfate (PMS) for the degradation and mineralization of various organic pollutants and even their mixture. Radical quenching experiments and EPR results confirm that •OH and SO4•− are the dominant reactive oxygen species in the CT@CT/MG-PMS system. Electrochemical measurements indicate that CT@CT/MG have better electron transfer ability and lower charge transfer resistance. In-situ characterization techniques including in-situ FT-IR and in-situ Raman are employed for deep insights into the potential reaction mechanisms. XPS analyses prove that Fe2+ promote the cycling regeneration of the reactive Co2+. MD simulations and DFT calculations disclose the confined reaction mechanisms by the means of comparative investigations in a confined space and under the unrestricted environment.
The dried roots of Berberis heteropoda Schrenk have traditionally been used to treat acute gastroenteritis and dysentery. The aim of this study was to confirm the antibacterial activity of an extract ...of Berberis heteropoda Schrenk rootin vitro and its therapeutic effects on rats with diarrhea-predominant irritable bowel syndrome (D-IBS) in vivo, as well as to identify the related signaling pathways. A water extract of Berberis heteropoda Schrenk root (BHS) inhibited the growth of S. aureus, E. coli, P. aeruginosa and S. faecalis. BHS potentially damaged the structure of the bacterial cell membrane and decreased the activity of some membranous enzymes, eventually killing the S. aureus, E. coli, P. aeruginosa and S. faecalis bacteria. Oral administration of BHS (low, middle and high dose group, L, M and H) significantly alleviated the abdominal pain, diarrhea, and depression-like symptoms of D-IBS rats, and the efficacy index ranged from 30% to 60%, indicating that the BHS treatment was effective. BHS (L, M and H) alleviated the abnormal pathological changes in the brain, as evidenced by HE staining. The expression of CHAT, 5-HT, C-FOS and CGRP was reduced by the BHS treatment (L, M and H). Our findings provide novel insights into the use of the natural product BHS to inhibit pathogenic bacteria by destroying the bacterial structure, indicating that BHS possesses certain biological activities. Furthermore, BHS has the potential to alleviate diarrhea, abdominal pain and depression-like behaviors in D-IBS rats by regulating the brain-gut peptide levels.
Selective tibial neurotomy (STN) was considered as an effective procedure for the treatment of spastic feet. It is also widely used for treating obese calves in some Asian countries. This study aimed ...to provide morphologic measurement data and theoretical support for the operation and intraoperative localization.
Fifty lower legs from 20 embalmed cadavers and 5 fresh corpses were dissected to observe and record the relationship of 4 branches of the tibial nerve, as well as the length, width, and thickness of the triceps surae. An ultrasonic transducer was also used to measure the thickness of muscles of 50 volunteers and acquire the ultrasonic image of muscles and nerve branches.
Anatomic results showed that the tibial nerve gave off 4 branches in a proximal to distal direction: the medial sural cutaneous nerve, the motor branches innervating the medial and lateral gastrocnemius, and the motor branch innervating the soleus. These nerve branches had 8 patterns of origin. A significant finding was that the nerve innervating the soleus consisted of 2 branches. Ultrasonic measurement results showed that the thickness of the gastrocnemius and the soleus were positively related to the circumference of the calf.
The calf circumference was positively related to the thickness of the soleus and the gastrocnemius. Diverging patterns of tibial nerve branches were multiple, and caution should be used to prevent damaging other branches. Tibial nerve, branches, and diverging sites could be seen clearly in the ultrasonic image. A preoperational ultrasonic examination is recommended.
With the development of lightweight vehicles, aluminum alloy sheets are increasingly used in the automotive field. However, the aluminum alloy sheet has poor forming performance at room temperature. ...Therefore, how to improve the sheet metal forming performance of aluminum alloy sheet has become one of the current research hotspots. In this paper, the effects of different lubricants on the deep drawing forming properties of 6061 aluminum alloy sheets were studied by cupping experiments. The effects of lubricants on the deep drawing of sheet metal forming and the wall thickness of cups after deep drawing were explored. The results show that under the condition of drawing speed of 3MPa and 200mm/min, the ultimate drawing ratio of the sheet under oil lubrication is 1.92, and the PTFE film is 2.16. Grease and graphite lubrication are respectively 2.12 and 2.03, using PTFE film lubrication can increase by about 10% contrast with the oil lubrication. The measurement of the wall thickness of the cup under the forming limit state shows that the position with the largest reduction rate appears in the rounded transition zone, and the wall portion of the cylindrical member increases with the height of the wall, and the thickness from the bottom of the cup to the bottom of the cup. The edges all show a trend of decreasing first and then increasing.
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