Background
The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is ...recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings.
Methods
All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute‐and‐chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed.
Results
Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC‐to‐LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (P = .040).
Conclusion
In terms of the clinical course and sequential pathological changes in the gallbladder, a 9‐ to 10‐week interval after PC is the optimal timing for LC.
Highlight
Hung and colleagues performed a retrospective study to determine the optimal timing of laparoscopic cholecystectomy following percutaneous cholecystostomy placement for acute cholecystitis. Based on the sequential pathological changes to the gallbladder and the risk of recurrent biliary events, 9‐10 weeks after percutaneous cholecystostomy was considered the optimal timing.
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•High dosage of SO42− (>10meq/L) stabilized ZnO NPs by inverting surface potential.•The electrolyte-driven aggregation of ZnO NPs was inhibited by 10mg/L SRHA.•ZnO NPs kept stable in ...a wastewater with high TOC and even high ionic strength.•High TOC and low pH compromised high ionic strength on the dissolution of ZnO NPs.
Zinc oxide nanoparticles (ZnO NPs) are widely used nanomaterials and their environmental impacts have received increasing attention. The fate and toxicity of ZnO NPs in the environment are determined by their stability and dissolution. In this study, the influence of water chemistry on aggregation, sedimentation, and dissolution of ZnO NPs was investigated. The stabilized ZnO NPs aggregated and precipitated when the aqueous pH closed to their zero point of charge (pHzpc). Counter-ions neutralized the surface charge of NPs and promoted their destabilization. However, a high concentration of counter-ion (SO42−, >10meq/L) made the NPs more stable because of the inverted surface potential. The stability of ZnO NPs was maintained by high concentration of Suwannee River humic acid (SRHA, 10mg/L) even the concentration of electrolytes was high. The influence of water chemistry on the stability and dissolution of ZnO NPs was further demonstrated in different wastewaters. In one wastewater sample, ZnO NPs was unexpectedly stable and with a high dissolution, which was due to the effects of pH value, organic matter concentration, as well as the concentration of counter ions. Our findings facilitate the predictions of the fate of stabilized ZnO NPs in the environment.
Multidisciplinary care can improve the outcomes of chronic kidney disease (CKD), however the contribution of self-care behavior and knowledge about CKD is unclear. This study enrolled 454 ...participants with CKD stages 1-5 not on dialysis. Structured questionnaires were used to evaluate self-care behavior and kidney disease knowledge. Rapid decline in renal function was defined as the decline in estimated filtration rate > 3 ml/min per 1.73 m
/year within 1-year prior to enrollment. The mean age of all study participants was 65.8 ± 12.1 years and 55.9% were male. The elderly had better self-care behavior while younger participants had better disease knowledge. Both high self-care and high disease knowledge scores were significantly associated with and had a synergistic effect on decreasing the risk of rapid decline in renal function. CKD patients with better self-care behavior and better kidney disease knowledge had lower risk of rapid decline in renal function.
Interfaces play a decisive role in perovskite solar cells’ power conversion efficiency and their long‐term durability. Small‐molecule hole‐transporting materials (HTMs) have grabbed enormous ...attention due to their structural flexibility, material properties, and stabilities, allowing for improved operational durability in perovskite photovoltaics. This study synthesizes and investigates a new class of benzimidazole‐based small molecules, named YJS001 and YJS003, serving as the HTMs to enable high‐efficiency mixed‐cation mixed‐halide perovskite solar cells. The benzimidazole‐based materials are dopant‐free HTMs composed of donor and acceptor building blocks that are designed to engineer the energy level alignment near the HTM/perovskite interface. Mixed‐cation mixed‐halide perovskites can be grown uniformly on both HTMs with large crystalline grains. It is discovered that the donor‐rich YJS003‐based solar cell exhibits a high open‐circuit voltage of 1.09 V with a champion power conversion efficiency of over 20%. Power‐dependent current–voltage characteristics of the solar cells are analyzed, from which the high performance of YJS003's excellent hole mobility and well‐aligned energy level is attributed. This work introduces a new class of benzimidazole‐based small molecules as HTMs, that paves the path for dopant free interface material development for commercialization of perovskite solar cells.
Two new hole‐transporting materials (HTMs) with acceptor‐rich (YJS001) and donor‐rich (YJS003) are synthesized and characterized for hybrid perovskite photovoltaics applications. Under similar conditions, the efficiency of HTM YJS001 and YJS003‐based devices is 17.43% and 20.81%, respectively. The superior performance of YJS003 over YJS001 is attributed to higher open‐circuit voltage and fill factor from good hole transport, lower trap density, and lower electric resistance of cells.
Current therapy does not provide significant benefits for patients with chronic stroke. Pre‐clinical studies suggested that autologous adipose‐derived stem cells have benefits for the treatment of ...chronic stroke. This Phase I open‐label study was conducted to demonstrate the safety and efficacy of autologous adipose‐derived stem cells (GXNPC1) in chronic stroke. Three patients with chronic stroke were treated with stereotactic implantation of autologous adipose‐derived stem cells (1 × 108 cells). The primary endpoints of safety evaluation included adverse events, over a 6 months post‐implantation period. The secondary endpoints included improvements in neurological functions. Evolutional change of brain parenchyma was also followed with magnetic resonance imaging (MRI). All three participants improved significantly at 6 months follow‐up. The extent of improvement from pre‐treatment was: National Institutes of Health Stroke Scale improved 5‐15 points, Barthel Index: 25–50 points, Berg balance scale 0–21 points and Fugl‐Meyer modified sensation 3–28 points. All three patients had signal change along the implantation tract on MRI one month after surgery. There is no related safety issue through 6 months observation. Clinical measures of neurological symptoms of these patients with chronic stroke improved at 6 months without adverse effects after implantation of autologous adipose‐derived stem cells (GXNPC1), which might be correlated with post‐implantation changes on brain MRI.
Clinical Trial Registration‐URL: https://clinicaltrials.gov/ct2/show/NCT02813512?term=ADSC&cond=Stroke&cntry=TW&draw=2&rank=1 Unique identifier: NCT02813512.
Multicolor labeling for monitoring the intracellular localization of the same target type in the native environment using chemical fluorescent dyes is a challenging task. This approach requires both ...bioorthogonal and biocompatible ligations with an excellent fluorescence signal-to-noise ratio. Here, we present a metabolic glycan labeling technique that uses homemade fluorogenic dyes to investigate glycosylation patterns in live cells. These dyes allowed us to demonstrate rapid and efficient simultaneous multilabeling of glycoconjugates with minimum fluorescence noise. Our results demonstrate that this approach is capable of not only probing sialylation and GlcNAcylation in cells but also specifically labeling the cell-surface and intracellular sialylated glycoconjugates in live cells. In particular, we performed site-specific dual-channel fluorescence imaging of extra and intracellular sialylated glycans in HeLa and PC9 cancer cells as well as identified fluorescently labeled sialylated glycoproteins and glycans by a direct enrichment approach combined with an MS-based proteomic analysis in the same experiment. In conclusion, this study provides multilabeling tools in cellular systems for simultaneous site-specific glycan imaging and glycoproteomic analysis to study potential cancer- and disease-associated glycoconjugates.
Submucosal tumors (SMTs) of different etiologies exist from esophagus to rectum. Esophagogastric junction (EGJ) is one of the known difficult locations for tumor resection. Although minimally ...invasive surgery (MIS) is a well-established approach for gastrointestinal surgery, there is no consensus that MIS for resection of SMTs around EGJ is superior to laparotomy. We tried to clarify the factors that determine the surgeons' choices between these two approaches.
From January 2002 to June 2016, 909 patients with SMTs underwent resection in our department. Among them, 119 patients (13%) had SMTs around EGJ were enrolled by retrospective review. The clinicopathological features and tumor-related parameters were reviewed and analyzed.
The cohort was stratified into three groups according to the extent of gastrectomy and surgical approaches. The three groups are as following: major gastrectomy (n = 13), minor gastrectomy by laparotomy (n = 51), and minor gastrectomy with MIS (n = 55). The average tumor size was significantly larger in the major gastrectomy group than in the two minor gastrectomy groups; however, there was no difference between the two minor gastrectomy groups (5.33 cm, 4.07 cm, and 3.69 cm, respectively). The minor gastrectomy with MIS required least hospital stay and operation duration also. We re-stratify the two minor gastrectomy groups (n = 106) according to the orientation of SMTs around the EGJ into 4 zones. Most of SMTs located on the greater curvature side of the EGJ were resected with MIS (82% versus 18%), whereas SMTs in the other zones were resected more often by laparotomy (59% versus 41%). There was no surgical mortality within the cohort, while minor gastrectomy with MIS yielded least number of leakages among the three groups.
For SMTs around the EGJ, larger tumors (diameter of more than 5 cm) are more likely to be resected with major gastrectomy. To resect SMTs around the EGJ in a wedge-like (minor gastrectomy) fashion, tumors located other than the greater curvature side were more often resected by laparotomy. However, MIS yielded acceptable safety and surgical outcomes compared to conventional laparotomy for SMTs around the EGJ of the same size.
Repetitive transcranial magnetic stimulation (rTMS) is an alternative treatment for depression, but the neural correlates of the treatment are currently inconclusive, which might be a limit of ...conventional analytical methods. The present study aimed to investigate the neurophysiological evidence and potential biomarkers for rTMS and intermittent theta burst stimulation (iTBS) treatment. A total of 61 treatment‐resistant depression patients were randomly assigned to receive prolonged iTBS (piTBS; N = 19), 10 Hz rTMS (N = 20), or sham stimulation (N = 22). Each participant went through a treatment phase with resting state electroencephalography (EEG) recordings before and after the treatment phase. The aftereffects of stimulation showed that theta‐alpha amplitude modulation frequency (fam) was associated with piTBS_Responder, which involves repetitive bursts delivered in the theta frequency range, whereas alpha carrier frequency (fc) was related to 10 Hz rTMS, which uses alpha rhythmic stimulation. In addition, theta‐alpha amplitude modulation frequency was positively correlated with piTBS antidepressant efficacy, whereas the alpha frequency was not associated with the 10 Hz rTMS clinical outcome. The present study showed that TMS stimulation effects might be lasting, with changes of brain oscillations associated with the delivered frequency. Additionally, theta‐alpha amplitude modulation frequency may be as a function of the degree of recovery in TRD with piTBS treatment and also a potential EEG‐based predictor of antidepressant efficacy of piTBS in the early treatment stage, that is, first 2 weeks.
The present study, utilizing HHSA to study the nonlinear cross‐frequency modulation, provided evidence of the distinct antidepressant neural correlates of 10 Hz rTMS and piTBS for TRD. The findings suggested that the TMS treatment, whatever protocol was applied, may provide lasting benefits, with the possible entrainment aftereffects seemingly revealed in resulting brain oscillation changes. Furthermore, our findings imply that theta‐alpha amplitude modulation frequency changes may indicate a function of response to piTBS treatment, not for rTMS, which may also indicate a possible predictive biomarker for treatment efficacy of piTBS in the early treatment stage, that is, first 2 weeks.
Background
Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube ...removal before definitive cholecystectomy on surgical outcomes.
Methods
From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography.
Results
The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334–6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182–8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome.
Conclusion
Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
Highlight
Hung and colleagues investigated the impact of percutaneous cholecystostomy tube removal before scheduled laparoscopic cholecystectomy. Removal of the tube was associated with an increased likelihood of emergent cholecystectomy, but not with higher rates of perioperative complications. In addition, routine preoperative cholangiography via a percutaneous cholecystostomy tube may not be necessary.
The prognosis of systemic lupus erythematosus (SLE) is unpredictable. This study aimed to examine the regulatory mechanism of the AHR/TET2/NT5E pathway during SLE progression. The AHR, TET2 and NT5E ...expression levels were examined in T regulatory cells (Tregs) of patients with SLE. The correlation of AHR, TET2 or NT5E expression levels with the immunosuppressive functions of Tregs was analysed. In patients with SLE, the number of CD4+IL2RA−FOXP3+ T cell subset was positively correlated with the SLE disease activity index value and negatively correlated with the AHR and TET2 expression levels in CD4+IL2RA+FOXP3+ Tregs. Transcriptional profiles of 79 patients with SLE obtained from the Gene Expression Omnibus database (GSE61635 dataset) revealed a significant positive correlation between the mRNA expression levels of AHR and TET2. In silico analysis predicted that the TET2 promoter comprises an AHR‐binding site. Kynurenine (KYN) promoted the binding of AHR to the TET2 promoter in Tregs of patients with SLE and Jurkat T cell lines. Furthermore, NT5E expression was significantly downregulated in Tregs of patients with SLE, which can be attributed to the dysregulation of NT5E promoter methylation status induced by downregulated TET2 activity. Furthermore, the Treg immunosuppressive activity, which is mediated through the TET2 and A2AR‐adenosine pathways, in the KYN‐treated group was approximately two‐fold higher than that in the control group. The AHR/TET2/NT5E axis mediates the Treg immunosuppressive activity. These findings provide novel insights for the development of therapeutic approaches for SLE and related autoimmune diseases.
In summary, this study demonstrated that the downregulated expression of AHR in Tregs resulted in impaired Treg function and development in patients with SLE owing to the dysregulation of the AHR/TET2/NT5E signalling pathway.
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