Objectives
To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature.
Materials and Methods
A systematic literature search of the ...PubMed, Embase, Cochrane Library, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Chinese Science and Technology Periodical (VIP) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of associations between the factors and mesh erosion.
Results
In all, 25 studies containing 7 084 patients were included in our systematic review and meta‐analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients (OR 0.96, 95% CI 0.94–0.98), more parities vs less parities (OR 1.27, 95% CI 1.07–1.51), the presence of premenopausal/oestrogen replacement therapy (ERT) (OR 1.36, 95% CI 1.03–1.79), diabetes mellitus (OR 1.87, 95% CI 1.35–2.57), smoking (OR 2.35, 95% CI 1.80–3.08), concomitant pelvic organ prolapse (POP) surgery (OR 0.37, 95% CI 0.16–0.84), concomitant hysterectomy (OR 1.46, 95% CI 1.03–2.07), preservation of the uterus at surgery (OR 0.22, 95% CI 0.08–0.63), and surgery performed by senior vs junior surgeons (OR 0.42, 95% CI 0.30–0.58).
Conclusion
Our study indicates that younger age, more parities, premenopausal/ERT, diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.
Regulatory T (Treg) cell is well known for its anti-inflammatory function in a variety of tissues in health and disease. Accordingly, Treg cells that reside in adipose tissue exhibit specific ...phenotypes. Their numbers are regulated by age, gender and environmental factors, such as diet and cold stimulation. Adipose-resident Treg cells have been suggested to be critical regulators of immune and metabolic microenvironment in adipose tissue, as well as involved in pathogenesis of obesity-related metabolic disorders. This review surveys existing information on adipose-resident Treg cells. We first describe the origin, phenotype and function of adipose-resident Treg cells. We then describe the major regulators of adipose-resident Treg cells, and discuss how the adipose-resident Treg cells are regulated in lean and obese conditions, especially in humans. Finally, we highlight their therapeutic potential in obesity-related disorders.
Metabolic syndrome (MS) is an increasing public health concern because of rapid lifestyle changes. Although there have been previous studies on the prevalence of MS in China, the prevalence may have ...changed with lifestyle changes over the last decade. To update this prevalence, we performed a cross-sectional survey among adults over 18 years old across China from May 2013 to July 2014. Participants underwent questionnaires and provided blood and urine samples for analysis. MS was defined according to the criteria of the China Diabetes Society. A total of 12570 individuals (45.2% men) with an average age of 48.8±15.3 (18-96) years were selected and invited to participate in the study. In total, 9310 (40.7% men) individuals completed the investigation, with a response rate of 74.1%. The prevalence of MS in China was 14.39% 95% confidence interval (CI): -3.75-32.53%, and the age-adjusted prevalence was 9.82% (95% CI: 9.03-10.61%; 7.78% in men and 6.76% in women; 7.39% in rural residents and 6.98% in urban residents). The highest prevalence occurred among adults aged 50-59 years (1.95%, 95% CI: 1.40-2.50%), and the lowest prevalence occurred among adults aged 40-49 years (0.74%, 95% CI: 0.38-1.10%); the prevalence was the highest in the south region and lowest in the east region (4.46% and 1.23%, respectively). The results of logistic regression analyses showed that age, urolithiasis, hyperuricemia, coronary artery disease, thiazide drugs intake, family history of diabetes and hypertension were all significantly associated with an increased risk of metabolic syndrome (OR>1). In addition, education, vitamin D intake and family history of urolithiasis are all protective factors (OR<1). Our results indicate that there was a high prevalence of MS in Chinese adults. Compared to the previous study 10 years ago, some preventive strategies have worked; however, further work on the prevention and treatment of MS remains necessary.
Adipose-resident T cells (ARTs) regulate metabolic and inflammatory responses in obesity, but ART activation signals are poorly understood. Here, we describe class II major histocompatibility complex ...(MHCII) as an important component of high-fat-diet (HFD)-induced obesity. Microarray analysis of primary adipocytes revealed that multiple genes involved in MHCII antigen processing and presentation increased in obese women. In mice, adipocyte MHCII increased within 2 weeks on HFD, paralleling increases in proinflammatory ART markers and decreases in anti-inflammatory ART markers, and preceding adipose tissue macrophage (ATM) accumulation and proinflammatory M1 polarization. Mouse 3T3-L1 and primary adipocytes activated T cells in an antigen-specific, contact-dependent manner, indicating that adipocyte MHCII is functional. HFD-fed MHCII−/− mice developed less adipose inflammation and insulin resistance than did wild-type mice, despite developing similar adiposity. These investigations uncover a mechanism whereby a HFD-induced adipocyte/ART dialog involving MHCII instigates adipose inflammation and, together with ATM MHCII, escalates its progression.
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► Obesity enhances MHCII expression in primary human and mouse adipocytes ► Adipocytes activate CD4+ ARTs via MHCII and leptin to induce adipose inflammation ► Macrophage changes in adipose follow adipocyte and T cell interactions during HFD ► Adaptive immune mechanisms are essential to obesity-induced adipose inflammation
Abstract
Ectopic lipid accumulation and inflammation are the essential signs of NASH. However, the molecular mechanisms of ectopic lipid accumulation and inflammation during NASH progression are not ...fully understood. Here we reported that hepatic Wilms' tumor 1-associating protein (WTAP) is a key integrative regulator of ectopic lipid accumulation and inflammation during NASH progression. Hepatic deletion of
Wtap
leads to NASH due to the increased lipolysis in white adipose tissue, enhanced hepatic free fatty acids uptake and induced inflammation, all of which are mediated by IGFBP1, CD36 and cytochemokines such as CCL2, respectively. WTAP binds to specific DNA motifs which are enriched in the promoters and suppresses gene expression (e.g.,
Igfbp1
,
Cd36
and
Ccl2
) with the involvement of HDAC1. In NASH, WTAP is tranlocated from nucleus to cytosol, which is related to CDK9-mediated phosphorylation. These data uncover a mechanism by which hepatic WTAP regulates ectopic lipid accumulation and inflammation during NASH progression.
Abstract
Obesity leads to a switch in subsets of CD4
+
T cell in adipose tissue, characterized by an increase in IFNγ producing Th1 cells and a decrease in anti-inflammatory regulatory T (Treg) ...cells, which impairs systemic insulin sensitivity. What signals these changes is unknown. Herein we demonstrate that genetic deficiency of adipocyte MHCII decreases adipose IFNγ expression and increases adipose Treg abundance in obese mice, leading to reduced obesity-induced adipose inflammation and reduced insulin resistance without affecting weight gain. The preserved insulin sensitivity of high fat diet (HFD)-fed adipocyte-specific MHCII knockout (aMHCII
−/−
) mice was substantially attenuated by adipose-specific Treg ablation. Adipocytes of aMHCII
−/−
mice exhibit decreased capacity to stimulate IFNγ production in Th1 cells, whereas HFD-fed IFNγR1
−/−
mice were more insulin sensitive and had similarly high levels of Tregs in adipose tissue as aMHCII
−/−
mice. We further show that IFNγ strongly inhibits IL-33 effects to promote adipose Treg proliferation. Our results identify MHCII in adipocyte as a critical determinant of the obesity-induced adipose T cell subset switch and insulin resistance.
To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and open surgery (OS) for surgical treatment of patients with staghorn stones based on published literatures.
A comprehensive ...literature search of Pubmed, Embase, CNKI and Cochrane Library was conducted to identify studies comparing outcomes of PCNL and OS for treating patients with staghorn stones up to Jan 2018.
There was no significant difference in final-SFR between PCNL and OS (odds ratioOR: 1.17; 95% confidence interval CI: 0.64, 2.15; p = 0.61), while PCNL provided a significantly lower immediate-SFR compared with OS (OR: 0.29; 95% CI: 0.16, 0.51; P < 0.0001). PCNL provided significantly lower overall complication rate, shorter operative times, hospitalization times, less blood loss and blood transfusion compared with OS (OR: 0.59; 95% CI: 0.41, 0.84; P = 0.004), (weighted mean difference WMD: -59.01mins; 95% CI: -81.09, -36.93; p < 0.00001), (WMD: -5.77days; 95% CI: -7.80, -3.74; p < 0.00001), (WMD: -138.29ml; 95% CI: -244.98, -31.6; p = 0.01) and (OR: 0.44; 95% CI: 0.29, 0.68; P = 0.00002), respectively. No significant differences were found in minor complications (Clavien I-II) (OR: 0.72; 95% CI: 0.47, 1.09; p = 0.12) and major complications (Clavien III-V) (OR: 0.5; 95% CI: 0.23, 1.08; P = 0.08). In subgroup analysis, there were no significant differences for overall complications and operative times between mini-PCNL and OS. In sensitivity analysis, there was no significant difference for overall complications between PCNL and OS.
Our analysis suggested that standard PCNL turns out to be a safe and feasible alternative for patients with staghorn stones compared to OS or mini-PCNL. Because of the inherent limitations of the included studies, further large sample, prospective, multi-centric and randomized control trials should be undertaken to confirm our findings.
Background
Previous studies have indicated that sarcopenia is associated with poor post‐operative outcomes in liver cancer patients, but the studies are limited by confounding from mixed diseases, ...retrospective data, and non‐standardized measurement methods. At present, there is no research with both muscle mass and strength as predictors for hepatocellular carcinoma (HCC) outcomes. We studied the impact of sarcopenia on post‐operative outcomes in HCC patients in a cohort study designed according to the European Working Group on Sarcopenia in Older People standards.
Methods
A total of 781 consecutive patients admitted to our centre were registered from May 2020 to August 2021. All participants submitted questionnaires and underwent handgrip strength, chair stand test, physical performance, and computed tomographic evaluation. Then, they were divided into three groups according to muscle mass and strength: Group A (reduced muscle mass and strength), Group B (reduced muscle strength or reduced muscle mass), and Group C (normal muscle mass and strength). The baseline data and post‐operative outcomes were compared and analysed. The primary outcome variable in this study was the presence of a major post‐operative complication, and the secondary outcome was the 90‐day re‐admission rate.
Results
A total of 155 patients median age, 60.00 (IQR, 51.00–66.00) years; 20 females (12.90%) were included after strict exclusion. The mean (SD) BMI was 23.37 ± 0.23 kg/m2. The mean (SD) SMI of all participants was 47.05 ± 0.79 cm2/m2, and the mean (SD) handgrip strength was 32.84 ± 0.69 kg. Among them, 77 (49.68%) patients underwent laparoscopic hepatectomy, and 73 (47.10%) patients received major hepatectomy. Regarding the post‐operative results, Group A had a higher rate of major complications 40.91% (9 of 22) vs. 11.94% (8 of 67) in Group B and 6.06 (4 of 66) in Group C; P = 0.001, higher rate of blood transfusion (77.27% vs. 46.27% in Group B and 42.42% in Group C; P = 0.015), higher hospitalization expenses (P = 0.001), and longer hospital stay (P < 0.001). There was no difference in 90‐day re‐admission rates among the three groups. Sarcopenia (hazard ratio, 10.735; 95% CI, 2.547–45.244; P = 0.001) and open surgery (hazard ratio, 4.528; 95% CI, 1.425–14.387; P = 0.010) were independent risk factors associated with major complications.
Conclusions
Sarcopenia is associated with adverse outcomes after liver resection for HCC. It should be evaluated upon admission to classify high‐risk patients and reduce the risk of major complications.
To create an easy risk stratification to recommend the optimal subset of patients with 2–3 cm kidney stones to receive retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy ...(MPCNL). A retrospective patient cohort was reviewed and compared (RIRS,
n
= 147 and MPCNL,
n
= 129). Overall, RIRS group obtained a lower SFR (66% vs. 93.3%,
p
< 0.001) compared to MPCNL group. The RIRS group had more overall complication (12.2% vs. 8.5%) and more urosepsis (2.7% vs. 1.6%) than the MPCNL group, although there was no statistical significance. However, two patients in MPCNL group underwent embolization to treat perioperative bleeding. On multivariate analysis for RIRS group, lower calyx involved OR 2.67, multiple calyces OR 4.49, severe hydronephrosis OR 2.38 were three significant predictors of SFR, which decreased from 88.8%, 70.3%, 52.1% to 25% corresponding to patients with 0, 1, 2, 3 risk predictors, respectively (
p
= 0.008), with a good predictive accuracy (AUC = 0.657;
p
= 0.002). When patients with no risk factor and patients undergoing RIRS had a similar high SFR and no possibility of bleeding, compared to matched patients undergoing MPCNL. Although generally RIRS showed a lower SFR for 2–3 cm stones compared to MPCNL, our easy risk stratification can recommend the optimal subset of patients with 2–3 cm kidney stones to receive RIRS or MPCNL. When these patients with no above-mentioned risk factors, RIRS can be first considered as an alternative to PCNL because it might be potentially less invasive and achieve a similar very high stone-free rate.
BackgroundRecent studies have focused on the correlation between N6-methyladenosine (m6A) modification and specific tumor-infiltrating immune cells. However, the potential roles of m6A modification ...in the tumor immune landscape remain elusive.MethodsWe comprehensively evaluated the m6A modification patterns and tumor immune landscape of 513 clear cell renal cell carcinoma (ccRCC) patients, and correlated the m6A modification patterns with the immune landscape. The m6Ascore was established using principal component analysis. Multivariate Cox regression analysis was performed to evaluate the prognostic value of the m6Ascore.ResultsWe identified three m6Aclusters—characterized by differences in Th17 signature, extent of intratumor heterogeneity, overall cell proliferation, aneuploidy, expression of immunomodulatory genes, overall somatic copy number alterations, and prognosis. The m6Ascore was established to quantify the m6A modification pattern of individual ccRCC patients. Further analyses revealed that the m6Ascore was an independent prognostic factor of ccRCC. Finally, we verified the prognostic value of the m6Ascore in the programmed cell death protein 1 (PD-1) blockade therapy of patients with advanced ccRCC.ConclusionsThis study demonstrated the correlation between m6A modification and the tumor immune landscape in ccRCC. The comprehensive evaluation of m6A modification patterns in individual ccRCC patients enhances our understanding of the tumor immune landscape and provides a new approach toward new and improved immunotherapeutic strategies for ccRCC patients.
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