BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended ...BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended cold ischemia time.However,few studies have been conducted to explore the prognostic effects of shortening the rWIT in transplantations using a liver graft from an extendedcriteria donor(ECD).AIM To investigate whether shortening the rWIT could improve the outcomes of ECD LT.METHODS Rat ECD autologous orthotopic LT were performed with variable rWITs(0,10,20,and 30 minutes).Near-infrared fluorescence imaging(FI)was used for the real-time assessment of liver graft ischemia-reperfusion injury after the anhepatic phase.Survival was assessed,and liver function and histological analyses were performed on the third day after transplantation.RESULTS The FI curve growth rate and postoperative three-day survival rate significantly increased,and the liver function and Suzuki score of the liver grafts significantly improved when the rWIT was≤10 minutes(P<0.05).CONCLUSION The post-transplant outcomes were significantly better with a shorter rWIT(10 minutes or less)than with a longer rWIT,which could be a strategy for expanding the liver donor pool.展开更多
BACKGROUND Clinically,tracheoesophageal fistula(TEF)is lack of effective surgical strategies.One reason is due to the lack of appropriate animal models of acquired TEF,which is usually complex and difficult.Recently,t...BACKGROUND Clinically,tracheoesophageal fistula(TEF)is lack of effective surgical strategies.One reason is due to the lack of appropriate animal models of acquired TEF,which is usually complex and difficult.Recently,the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals.In this study,an animal model of TEF in dogs was developed by using the magnetic compression technique,hoping to provide a new method for mimicking TEF.AIM To establish a TEF model in dogs by using the magnetic compression technique.METHODS Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF.The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea,respectively.The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled.After 4-6 d,the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location,leaving a fistula.Gastroscopy/bronchoscopy,upper gastrointestinal contrast study,and histological analysis were performed.RESULTS The establishment of the TEF model in all six beagles was successful.The average time of magnet placement was 4.33±1.11 min(range,3-7 min).Mean time for the magnets to disengage from the target location was 4.67±0.75 d(range,4-6 d).TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography.The gross anatomical structure of the esophagus and the trachea was in good condition.There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis.CONCLUSION It is simple,feasible,and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.展开更多
BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the inciden...BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.展开更多
BACKGROUND Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral antic...BACKGROUND Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral anticoagulants including aspirin. However, the long-term impact of postoperative aspirin on cirrhotic patients after splenectomy remains unknown. AIM The main purpose of this study was to investigate the effect of postoperative long-term low-dose aspirin administration on the development of HCC and longterm survival of cirrhotic patients after splenectomy. METHODS The clinical data of 264 adult patients with viral hepatitis-related cirrhosis who underwent splenectomy at the First Affiliated Hospital of Xi’an Jiaotong University from January 2000 to December 2014 were analyzed retrospectively. Among these patients, 59 who started taking 100 mg/d aspirin within seven days were enrolled in the aspirin group. The incidence of HCC and overall survival were analyzed.RESULTS During follow-up, 41 (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications. Postoperative longterm low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy (log-rank test, P=0.028). Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy [odds ratio (OR)=6.211, 95% confidence interval (CI): 1.142-27.324, P=0.016] was the only independent risk factor for the development of HCC. Similarly, patients in the aspirin group survived longer than those in the control group (log-rank test, P=0.041). Univariate and multivariate analyses showed that the only factor that independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy [OR = 0.218, 95%CI: 0.049- 0.960, P=0.044]. CONCLUSION In patients with viral hepatitis-related cirrhosis, long-term post-splenectomy administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival.展开更多
BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to...BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.展开更多
BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver d...BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.展开更多
Hypersplenism is a common complication of cirrhosis that is associated with significant impairment to patients'life quality.Splenectomy is often employed in clinical settings as a treatment for hypersplenism.While...Hypersplenism is a common complication of cirrhosis that is associated with significant impairment to patients'life quality.Splenectomy is often employed in clinical settings as a treatment for hypersplenism.While splenectomy is carried out for the purposes of alleviating hypersplenism-related adverse outcomes like thrombocytopenia or anaemia,studies have suggested alterations in the immune status,hemodynamics,and intestinal microbiota of patients following splenectomy,which may potentially influence the onset and progression of hepatocellular carcinoma(HCC).Additionally,patients have been found to face new health risks post-splenectomy,including infections and thrombosis,which could adversely impact their overall health and potentially increase the risk of HCC.Despite these findings,there is currently no consensus on whether splenectomy affects the risk of postoperative HCC in cirrhotic patients.This review synthesizes the pertinent literature on the incidence of HCC following splenectomy,with an emphasis on current evidence related to its physiology,pathophysiology,and epidemiology.Concepts such as immune status,hemodynamics changes,and intestinal microbiota in post-splenectomy patients are explored,in hopes that it can inform more individualized treatment approaches for patients.展开更多
BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival...BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.展开更多
BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver trans...BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.展开更多
Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are well-established therapeutics for gastrointestinal neoplasias,but complications after EMR/ESD,including bleeding and perforation,result in ...Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are well-established therapeutics for gastrointestinal neoplasias,but complications after EMR/ESD,including bleeding and perforation,result in additional treatment morbidity and even threaten the lives of patients.Thus,designing biomaterials to treat gastric bleeding and wound healing after endoscopic treatment is highly desired and remains a challenge.Herein,a series of injectable pH-responsive selfhealing adhesive hydrogels based on acryloyl-6-aminocaproic acid(AA)and AA-g-N-hydroxysuccinimide(AA-NHS)were developed,and their great potential as endoscopic sprayable bioadhesive materials to efficiently stop hemorrhage and promote the wound healing process was further demonstrated in a swine gastric hemorrhage/wound model.The hydrogels showed a suitable gelation time,an autonomous and efficient self-healing capacity,hemostatic properties,and good biocompatibility.With the introduction of AA-NHS as a micro-cross-linker,the hydrogels exhibited enhanced adhesive strength.A swine gastric hemorrhage in vivo model demonstrated that the hydrogels showed good hemostatic performance by stopping acute arterial bleeding and preventing delayed bleeding.A gastric wound model indicated that the hydrogels showed excellent treatment effects with significantly enhanced wound healing with type I collagen deposition,α-SMA expression,and blood vessel formation.These injectable self-healing adhesive hydrogels exhibited great potential to treat gastric wounds after endoscopic treatment.展开更多
BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on....BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on.The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor,and there are too many complications postoperatively.AIM To test MCA technology to reconstruct the esophagus in dogs,prior to studying the feasibility and safety of MCA in humans.METHODS Thirty-six dogs were randomized into either the study or control group(n=18 per group).The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device,while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl.We used interrupted single-layer inverting sutures.The anastomosis time,gross appearance,weight and pathology of the anastomosis were evaluated at one month,three months and six months postoperatively.RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group(7.5±1.0 min vs 12.5±1.8 min,P<0.01).In the MCA group,X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus.In the hand-sewn group,dogs did not undergo X-ray examination.One month after the surgeries,the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group(11.63±0.71 kg vs 12.73±0.80 kg,P<0.05).At 3 mo and 6 mo after the operation,the dogs’weights were similar between the two groups(13.75±0.84 kg vs 14.03±0.82 kg,14.93±0.80 kg vs 15.44±0.47 kg).The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSION MCA is an effective and safe method for esophageal reconstruction.The anastomosis time of the MCA group was less than that of the hand-sewn group.This study shows that MCA technology may be applied to human esophageal reconstruction,provided these favorable results are confirmed by more publications.展开更多
Combined hepatocellular-cholangiocarcinoma(c HCC-CCA)is a rare type of cancer,accounting for 0.4%–14.2%of hepato-carcinoma.Hepatic sarcoma is only less than 2%of primary malignant liver tumors.Thus,sarcomatoid c HCC-...Combined hepatocellular-cholangiocarcinoma(c HCC-CCA)is a rare type of cancer,accounting for 0.4%–14.2%of hepato-carcinoma.Hepatic sarcoma is only less than 2%of primary malignant liver tumors.Thus,sarcomatoid c HCC-CCA is extremely rare.To the best of our knowledge,only twenty-six cases had been reported in the literature[1–19].展开更多
The recent development of tough tissue adhesives has stimulated intense interests among material scientists and medical doctors.However,these adhesives have seldom been tested in clinically demanding surgeries.Here we...The recent development of tough tissue adhesives has stimulated intense interests among material scientists and medical doctors.However,these adhesives have seldom been tested in clinically demanding surgeries.Here we demonstrate adhesive anastomosis in organ transplantation.Anastomosis is commonly conducted by dense sutures and takes a long time,during which all the vessels are occluded.Prolonged occlusion may damage organs and even cause death.We formulate a tough,biocompatible,bioabsorbable adhesive that can sustain tissue tension and pressurized flow.We expose the endothelial surface of vessels onto a gasket,press two endothelial surfaces to the adhesive using a pair of magnetic rings,and reopen the bloodstream immediately.The time for adhesive anastomosis is shortened compared to the time for sutured anastomosis.We have achieved adhesive anastomosis of a great vein in transplanting the liver of a pig.After the surgery,the adhesive is absorbed,the vein heals,and the pig lives for over one month.展开更多
Radium-223(^(223)Ra)is a bone-seeking,alpha-particle-emitting radionuclide that is approved for the treatment of patients with metastatic prostate cancer and is currently being tested in clinical trials for primary an...Radium-223(^(223)Ra)is a bone-seeking,alpha-particle-emitting radionuclide that is approved for the treatment of patients with metastatic prostate cancer and is currently being tested in clinical trials for primary and metastatic cancers to the bone.^(223)Ra accumulates in mineralized bone areas with high bone turnover,where its effects are confined within 100μm of the bone-marrow interface due to the short tissue penetrance of the alpha particles.A recent clinical study has shown a significantly increased fracture rate associated with the administration of^(223)Ra,mostly in tumor-free bones.Importantly,the biological mechanisms underlying this bone fragility remain unclear.In this work,we combined micro-computed tomography and mechanical studies with ex vivo spatial biology analysis based on 3D fluorescence microscopy to clarify the effects of^(223)Ra on bone and key bone stromal cell components.We found that^(223)Ra caused major trabecular bone loss with no detectable impact on cortical bone.In addition,^(223)Ra impaired osteoblast bone-forming activity,which was paralleled by a transient increase in osteoclast number and long-term adipocyte formation.Overall,these results suggest that the impact of^(223)Ra on bone health is orchestrated by multiple bone stromal cell components.^(223)Ra-mediated trabecular bone loss was prevented by administration of zoledronic acid,which should always be combined with^(223)Ra.展开更多
To the Editor:Obesity is becoming a worldwide health issue,and the prevalence of obesity continues to increase.[1,2]Body weight reduction is one of the effective measures to solve this problem;however,only a small num...To the Editor:Obesity is becoming a worldwide health issue,and the prevalence of obesity continues to increase.[1,2]Body weight reduction is one of the effective measures to solve this problem;however,only a small number of obese patients succeed in controlling their body weight without intervention.Sleeve gastrectomy(SG)is widely performed in obese patients for its excellent surgical result and easy surgical procedures.Unfortunately,stomach leakage may cause severe consequences,such as infection and death,although the incidence rate of this complication is 2.4%.展开更多
Postsurgical stricture is the most common cause of esophageal stenosis in children after congenital esophageal atresia repair,^([1,2])followed by congenital esophageal stenosis and chemical corrosion burns.^([3])Endos...Postsurgical stricture is the most common cause of esophageal stenosis in children after congenital esophageal atresia repair,^([1,2])followed by congenital esophageal stenosis and chemical corrosion burns.^([3])Endoscopic or radiologic balloon dilation is the standard method for treatment of esophageal stenosis,but in some complicated cases with severe hyperplasia and severe restenosis and even occlusion,the effect of endoscopic treatment is limited.In 1993,Bulynin et al^([4])reported,for the first time.展开更多
Immunosuppression(IS)is indispensable for liver trans-plant(LTx)patients to control the unwanted alloimmune responses,which are mainly mediated by T cells.However,antigen-independent homeostasis of T cells is vital fo...Immunosuppression(IS)is indispensable for liver trans-plant(LTx)patients to control the unwanted alloimmune responses,which are mainly mediated by T cells.However,antigen-independent homeostasis of T cells is vital for sustaining long-lived T cell-mediated immunity,and excessive IS may increase the risk of opportunistic infections and malignancies.Therefore,IS therapy for LTx patients should be tailored to the immune status of the individual patient.[1]Biliary complications(BC),including biliary strictures with cholangitis,are the most common complications after LTx.However,the immunological characteristics especially T cell-mediated immunity of these patients are unknown yet.展开更多
基金Supported by The Key R&D Plan of Shaanxi Province,No.2021GXLH-Z-047.
文摘BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended cold ischemia time.However,few studies have been conducted to explore the prognostic effects of shortening the rWIT in transplantations using a liver graft from an extendedcriteria donor(ECD).AIM To investigate whether shortening the rWIT could improve the outcomes of ECD LT.METHODS Rat ECD autologous orthotopic LT were performed with variable rWITs(0,10,20,and 30 minutes).Near-infrared fluorescence imaging(FI)was used for the real-time assessment of liver graft ischemia-reperfusion injury after the anhepatic phase.Survival was assessed,and liver function and histological analyses were performed on the third day after transplantation.RESULTS The FI curve growth rate and postoperative three-day survival rate significantly increased,and the liver function and Suzuki score of the liver grafts significantly improved when the rWIT was≤10 minutes(P<0.05).CONCLUSION The post-transplant outcomes were significantly better with a shorter rWIT(10 minutes or less)than with a longer rWIT,which could be a strategy for expanding the liver donor pool.
基金Supported by the National Natural Science Foundation of China,No.81700545the Natural Science Basic Research Plan of Shaanxi Province of China,No.2017JQ8021the Fundamental Research Funds for the Central Universities,No.xjj2018jchz14
文摘BACKGROUND Clinically,tracheoesophageal fistula(TEF)is lack of effective surgical strategies.One reason is due to the lack of appropriate animal models of acquired TEF,which is usually complex and difficult.Recently,the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals.In this study,an animal model of TEF in dogs was developed by using the magnetic compression technique,hoping to provide a new method for mimicking TEF.AIM To establish a TEF model in dogs by using the magnetic compression technique.METHODS Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF.The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea,respectively.The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled.After 4-6 d,the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location,leaving a fistula.Gastroscopy/bronchoscopy,upper gastrointestinal contrast study,and histological analysis were performed.RESULTS The establishment of the TEF model in all six beagles was successful.The average time of magnet placement was 4.33±1.11 min(range,3-7 min).Mean time for the magnets to disengage from the target location was 4.67±0.75 d(range,4-6 d).TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography.The gross anatomical structure of the esophagus and the trachea was in good condition.There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis.CONCLUSION It is simple,feasible,and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.
基金National Natural Science Foundation of China,No.81770491The Innovation Capacity Support Plan of Shaanxi Province,No.2020TD-040.
文摘BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.
基金Supported by the Ministry of Education Innovation Team Development Program of China,No.IRT16R57
文摘BACKGROUND Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral anticoagulants including aspirin. However, the long-term impact of postoperative aspirin on cirrhotic patients after splenectomy remains unknown. AIM The main purpose of this study was to investigate the effect of postoperative long-term low-dose aspirin administration on the development of HCC and longterm survival of cirrhotic patients after splenectomy. METHODS The clinical data of 264 adult patients with viral hepatitis-related cirrhosis who underwent splenectomy at the First Affiliated Hospital of Xi’an Jiaotong University from January 2000 to December 2014 were analyzed retrospectively. Among these patients, 59 who started taking 100 mg/d aspirin within seven days were enrolled in the aspirin group. The incidence of HCC and overall survival were analyzed.RESULTS During follow-up, 41 (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications. Postoperative longterm low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy (log-rank test, P=0.028). Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy [odds ratio (OR)=6.211, 95% confidence interval (CI): 1.142-27.324, P=0.016] was the only independent risk factor for the development of HCC. Similarly, patients in the aspirin group survived longer than those in the control group (log-rank test, P=0.041). Univariate and multivariate analyses showed that the only factor that independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy [OR = 0.218, 95%CI: 0.049- 0.960, P=0.044]. CONCLUSION In patients with viral hepatitis-related cirrhosis, long-term post-splenectomy administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival.
基金the National Natura Science Foundation of ChinaNo. 81770491。
文摘BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.
基金Supported by the National Key Research and Development Program,No.2023YFF0713700 and No.2023YFF0713705Common Technology R&D Platform of Shaanxi Province,No.2023GXJS-01-1-2the Cyrus Tang Foundation Chung Ying Young Scholars Program.
文摘BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.
基金Supported by National Natural Science Foundation of China,No.82200686.
文摘Hypersplenism is a common complication of cirrhosis that is associated with significant impairment to patients'life quality.Splenectomy is often employed in clinical settings as a treatment for hypersplenism.While splenectomy is carried out for the purposes of alleviating hypersplenism-related adverse outcomes like thrombocytopenia or anaemia,studies have suggested alterations in the immune status,hemodynamics,and intestinal microbiota of patients following splenectomy,which may potentially influence the onset and progression of hepatocellular carcinoma(HCC).Additionally,patients have been found to face new health risks post-splenectomy,including infections and thrombosis,which could adversely impact their overall health and potentially increase the risk of HCC.Despite these findings,there is currently no consensus on whether splenectomy affects the risk of postoperative HCC in cirrhotic patients.This review synthesizes the pertinent literature on the incidence of HCC following splenectomy,with an emphasis on current evidence related to its physiology,pathophysiology,and epidemiology.Concepts such as immune status,hemodynamics changes,and intestinal microbiota in post-splenectomy patients are explored,in hopes that it can inform more individualized treatment approaches for patients.
文摘BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.
基金Supported by the Ministry of Education Innovation Team Development Program of China,No.IRT16R57the National Natural Science Foundation of China,No.81470896Research Fund for the Young Talent Recruiting Plans of Xi’an Jiaotong University(RW)
文摘BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.
基金This work was jointly supported by the National Natural Science Foundation of China(grant Nos.:51973172,51673155,81201927,82002957 and 81672460)the National Key Research and Development Plan of China(No.2018YFC0115300)+5 种基金the State Key Laboratory for Mechanical Behavior of Materials,the World-Class Universities(Disciplines)the Characteristic Development Guidance Funds for the Central Universities,the Natural Science Foundation of Shaanxi Province(No.2020JC-03 and 2019TD-020)the Innovation Talent Promotion Plan of Shaanxi(No.2017KJXX-07)the Key Research and Development Program of Shaanxi Province(No.2019SF-012)the Opening Project of Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research,College of Stomatology,Xi’an Jiaotong University(No.2019LHM-KFKT008)Fundamental Research Funds for the Central Universities of China(No.xjj2018090).
文摘Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are well-established therapeutics for gastrointestinal neoplasias,but complications after EMR/ESD,including bleeding and perforation,result in additional treatment morbidity and even threaten the lives of patients.Thus,designing biomaterials to treat gastric bleeding and wound healing after endoscopic treatment is highly desired and remains a challenge.Herein,a series of injectable pH-responsive selfhealing adhesive hydrogels based on acryloyl-6-aminocaproic acid(AA)and AA-g-N-hydroxysuccinimide(AA-NHS)were developed,and their great potential as endoscopic sprayable bioadhesive materials to efficiently stop hemorrhage and promote the wound healing process was further demonstrated in a swine gastric hemorrhage/wound model.The hydrogels showed a suitable gelation time,an autonomous and efficient self-healing capacity,hemostatic properties,and good biocompatibility.With the introduction of AA-NHS as a micro-cross-linker,the hydrogels exhibited enhanced adhesive strength.A swine gastric hemorrhage in vivo model demonstrated that the hydrogels showed good hemostatic performance by stopping acute arterial bleeding and preventing delayed bleeding.A gastric wound model indicated that the hydrogels showed excellent treatment effects with significantly enhanced wound healing with type I collagen deposition,α-SMA expression,and blood vessel formation.These injectable self-healing adhesive hydrogels exhibited great potential to treat gastric wounds after endoscopic treatment.
基金Supported by the National Natural Science Foundation of China,No. 82170676Natural Science Foundation of Shaanxi Provincial Key Industries Innovation Chain (Cluster)-Social Development Project,No. 2020ZDLSF02-03
文摘BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on.The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor,and there are too many complications postoperatively.AIM To test MCA technology to reconstruct the esophagus in dogs,prior to studying the feasibility and safety of MCA in humans.METHODS Thirty-six dogs were randomized into either the study or control group(n=18 per group).The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device,while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl.We used interrupted single-layer inverting sutures.The anastomosis time,gross appearance,weight and pathology of the anastomosis were evaluated at one month,three months and six months postoperatively.RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group(7.5±1.0 min vs 12.5±1.8 min,P<0.01).In the MCA group,X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus.In the hand-sewn group,dogs did not undergo X-ray examination.One month after the surgeries,the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group(11.63±0.71 kg vs 12.73±0.80 kg,P<0.05).At 3 mo and 6 mo after the operation,the dogs’weights were similar between the two groups(13.75±0.84 kg vs 14.03±0.82 kg,14.93±0.80 kg vs 15.44±0.47 kg).The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSION MCA is an effective and safe method for esophageal reconstruction.The anastomosis time of the MCA group was less than that of the hand-sewn group.This study shows that MCA technology may be applied to human esophageal reconstruction,provided these favorable results are confirmed by more publications.
基金supported by a grant from Institution Foundation of the First Affiliated Hospital of Xi’an Jiaotong University(No.2019QN-09)。
文摘Combined hepatocellular-cholangiocarcinoma(c HCC-CCA)is a rare type of cancer,accounting for 0.4%–14.2%of hepato-carcinoma.Hepatic sarcoma is only less than 2%of primary malignant liver tumors.Thus,sarcomatoid c HCC-CCA is extremely rare.To the best of our knowledge,only twenty-six cases had been reported in the literature[1–19].
基金This work was supported by grants from the Key R&D Project of Shaanxi Province(No.2020GXLH-Z-001)the National Key R&D Project of China(No.2018YFC0115300 and No.2018YFC0115305)+1 种基金the National Natural Science Foundation of China(No.81727802,12172272,11702208,11820101001)China Postdoctoral Science Foundation(No.BX201700192,2018M643620).
文摘The recent development of tough tissue adhesives has stimulated intense interests among material scientists and medical doctors.However,these adhesives have seldom been tested in clinically demanding surgeries.Here we demonstrate adhesive anastomosis in organ transplantation.Anastomosis is commonly conducted by dense sutures and takes a long time,during which all the vessels are occluded.Prolonged occlusion may damage organs and even cause death.We formulate a tough,biocompatible,bioabsorbable adhesive that can sustain tissue tension and pressurized flow.We expose the endothelial surface of vessels onto a gasket,press two endothelial surfaces to the adhesive using a pair of magnetic rings,and reopen the bloodstream immediately.The time for adhesive anastomosis is shortened compared to the time for sutured anastomosis.We have achieved adhesive anastomosis of a great vein in transplanting the liver of a pig.After the surgery,the adhesive is absorbed,the vein heals,and the pig lives for over one month.
基金supported by Bayer HealthCare Pharmaceuticals Inc.(57440)Department of Defense,CDMRP-KCRP(KC210132P1,USA)+2 种基金University of Texas MD Anderson Cancer CenterCancer Prevention and Research Institute of Texas(RP230160,USA)National Institutes of Health(P41EB023833,P30CA016672,USA).
文摘Radium-223(^(223)Ra)is a bone-seeking,alpha-particle-emitting radionuclide that is approved for the treatment of patients with metastatic prostate cancer and is currently being tested in clinical trials for primary and metastatic cancers to the bone.^(223)Ra accumulates in mineralized bone areas with high bone turnover,where its effects are confined within 100μm of the bone-marrow interface due to the short tissue penetrance of the alpha particles.A recent clinical study has shown a significantly increased fracture rate associated with the administration of^(223)Ra,mostly in tumor-free bones.Importantly,the biological mechanisms underlying this bone fragility remain unclear.In this work,we combined micro-computed tomography and mechanical studies with ex vivo spatial biology analysis based on 3D fluorescence microscopy to clarify the effects of^(223)Ra on bone and key bone stromal cell components.We found that^(223)Ra caused major trabecular bone loss with no detectable impact on cortical bone.In addition,^(223)Ra impaired osteoblast bone-forming activity,which was paralleled by a transient increase in osteoclast number and long-term adipocyte formation.Overall,these results suggest that the impact of^(223)Ra on bone health is orchestrated by multiple bone stromal cell components.^(223)Ra-mediated trabecular bone loss was prevented by administration of zoledronic acid,which should always be combined with^(223)Ra.
基金This work was supported by grants from the Fundamental Research Funds for the Central Universities(No.xzy022019032)the Fundamental Research Funds for the Central Universities(No.xjj2018104)the Natural Science Basis Research Plan of Shaanxi Province(No.2019JQ-949)。
文摘To the Editor:Obesity is becoming a worldwide health issue,and the prevalence of obesity continues to increase.[1,2]Body weight reduction is one of the effective measures to solve this problem;however,only a small number of obese patients succeed in controlling their body weight without intervention.Sleeve gastrectomy(SG)is widely performed in obese patients for its excellent surgical result and easy surgical procedures.Unfortunately,stomach leakage may cause severe consequences,such as infection and death,although the incidence rate of this complication is 2.4%.
基金National Natural Science Foundation of China(No.82170676)Natural Science Foundation of Shaanxi Provincial Key Industries Innovation Chain(Cluster)-Social Development Project(No.2020ZDLSF02-03)。
文摘Postsurgical stricture is the most common cause of esophageal stenosis in children after congenital esophageal atresia repair,^([1,2])followed by congenital esophageal stenosis and chemical corrosion burns.^([3])Endoscopic or radiologic balloon dilation is the standard method for treatment of esophageal stenosis,but in some complicated cases with severe hyperplasia and severe restenosis and even occlusion,the effect of endoscopic treatment is limited.In 1993,Bulynin et al^([4])reported,for the first time.
基金grants from the Natural Science Basic Research Program of Shaanxi(No.2020JQ-520)China Postdoctoral Science Foundation Grant(No.2019M653663)+1 种基金National Nature Science Foundation of China(Nos.81770491 and 81870445)Key R&D Project of Shaanxi Province(No.2020GXLH-Z-001)。
文摘Immunosuppression(IS)is indispensable for liver trans-plant(LTx)patients to control the unwanted alloimmune responses,which are mainly mediated by T cells.However,antigen-independent homeostasis of T cells is vital for sustaining long-lived T cell-mediated immunity,and excessive IS may increase the risk of opportunistic infections and malignancies.Therefore,IS therapy for LTx patients should be tailored to the immune status of the individual patient.[1]Biliary complications(BC),including biliary strictures with cholangitis,are the most common complications after LTx.However,the immunological characteristics especially T cell-mediated immunity of these patients are unknown yet.
