Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

二甲双胍在结肠癌中通过抑制lncRNA-MALAT1的表达发挥抗肿瘤效应

目的 探讨二甲双胍（MET）对结肠癌细胞的抑制作用及其机制。方法 采用CCK-8、流式细胞术及Transwell检测MET对结肠癌细胞SW480和SW620增殖、凋亡及侵袭的影响,qRT-PCR检测5种lncRNA在结肠癌细胞中的表达,Western blotting检测MET和/或MALAT1基因敲减在体外对PI3K/AKT和ERK通路活性的影响。结果 MET在体外对SW480和SW620细胞具有抑制作用,且呈剂量和时间依赖性（P<0.05）。MET可促进SW480和SW620细胞凋亡（P<0.05）。在5种lncRNA中,lncRNA-MALAT1在SW480和SW620细胞中的表达水平最高（P<0.01）。siRNA可抑制lncRNA-MALAT1表达,并进一步增强MET介导的抗结肠癌作用（P<0.05）。MET可下调结肠癌细胞中lncRNA-MALAT1的表达（P<0.05）,并通过PI3K/AKT和ERK信号通路与lncRNA-MALAT1敲减协同抑制结肠癌细胞的增殖和侵袭,并促进其凋亡（P<0.01）。结论 MET在结肠癌细胞中通过抑制lncRNA-MALAT1的表达发挥抗肿瘤效应。     

Flow diversion within seven days after stroke onset is associated with favorable outcome in anterior circulation stroke

Anterior cerebral artery (ACA) flow diversion (FD), defined as ipsilateral mean velocity (MV) of at least 30% greater than the contralateral artery, could be seen an indirect sign of leptomeningeal collateralization in the setting of middle cerebral artery occlusion. The purpose of the study was to evaluate the association between dynamic FD and functional outcome in acute anterior stroke patients with large artery occlusion. Acute middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive stroke patients within 12 h were recruited. Transcranial Doppler ultrasound was done at baseline, 24 h and 7 d after onset and velocities of MCA and ACA were recorded. FD ratio was calculated by dividing the ipsilateral ACA MV by the contralateral ACA MV. FD was determined positive when FD ratio ≥1.3. Outcome was assessed by 90-day modified Rankin’s Scale (mRS). The association between FD at different time points and functional outcome were analyzed. 16 patients (median age of 67 and 75% were male) were recruited. FD ratio showed a trend of decline but did not reach statistical significance (p = 0.056). The proportion of FD at baseline (p = 0.026), 24 h (p = 0.001) and 7d (p = 0.044) was significantly higher in patients with favorable outcome. Higher FD ratio at baseline (p = 0.02) and 24 h (p = 0.003) were significantly associated with favorable outcome. These results suggested that FD ratio showed a trend of decline after stroke onset. Presence of FD within 7 days was associated with favorable functional outcome in acute MCA/ICA occlusive stroke patients.     

Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology

PurposeTo review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.MethodsA literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.ResultsThe agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.ConclusionsThe current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.     

Corpus callosal lipoma extending as nasal encephalocoel/cranial lipomeningocoel

A hitherto unreported case is presented wherein a 2 year old child had a ‘cranial lipomeningocoel’ or a ‘nasal lipo-encephalocoel’. The child presented with a growing mass in the base of the nose. Investigations revealed that the nasal mass was a lipoma that was an extension of intracranial lipoma. The intracranial component extended up to corpus callosum. Resection of the extracranial extension and basal reconstruction resulted in cosmetic recovery.     

DTI观察乳腺癌化疗前后脑白质微结构与认知功能变化

目的 探讨化疗前后乳腺癌患者脑白质微结构和认知功能变化及其相关性。方法 收集经手术病理证实的21例早期乳腺癌患者,于化疗前和化疗结束后1个月进行神经心理认知测试和全脑DTI,比较化疗前后全脑整体及脑白质区域各向异性分数（FA）和平均弥散率（MD）的差异,并与神经心理认知测试结果进行相关性分析。结果 化疗前后乳腺癌患者Stroop字测试和干扰测试、数字广度倒背测试、数字符号测试、听觉词语学习延迟5 min测试差异有统计学意义（P均<0.05）。化疗前后乳腺癌患者全脑白质整体FA、MD值差异无统计学意义（P均>0.05）;化疗后右侧丘脑后辐射、右侧矢状层、右侧上纵束FA值较化疗前降低（P均<0.05）,右侧内囊豆状核后部、右侧丘脑后辐射、右侧矢状层、双侧扣带束、双侧下额枕束MD值较化疗前升高（P均<0.05）;左侧扣带束MD值与Stroop干扰测试结果呈正相关（r=0.457,P=0.037）。结论 乳腺癌患者化疗后局部白质完整性下降,可能是某一认知领域功能减退的神经解剖学基础。     

Toll样受体2/核转录因子-κB基因表达与小鼠肝癌淋巴道转移关系研究

目的：探讨Toll样受体2（TLR-2）和核转录因子-κB（NF-κB）基因在小鼠肝癌淋巴道转移中的作用。方法：采用实时定量聚合酶链反应（RQ-PCR）方法检测TLR-2和NF-κB基因在淋巴道低转移潜能小鼠肝癌细胞系Hca-P和高转移潜能小鼠肝癌细胞系Hca-F中的表达水平。结果：TLR-2基因在Hca-P和HcaF细胞系基因表达分别为（2.14±0.42）×10-3、（4.31±0.62）×10-3,NF-κB基因在Hca-P和Hca-F细胞系表达分别为（1.41±0.48）×10-3、（2.95±0.22）×10-3,差异有统计学意义（P〈0.01）,随转移潜能的增高,其表达水平增加。结论：TLR2基因和NF-κB基因表达水平增高提示其在肝癌的淋巴道侵袭转移中起作用,TLR2基因和NF-κB基因有可能成为肝癌转移预测指标和潜在治疗靶点。     

Restoration of radiation resistance in ataxia telangiectasia cells by the introduction of normal human chromosome 11

In order to identify the human chromosome which carries a mutated gene in cells from a patient with the hereditary disorder ataxia telangiectasia belonging to complementation group D (AT-D), we performed chromosome transfer experiments via microcell fusion. A single, pSV2neo-tagged chromosome, either 11 or 12, derived from normal human fibroblasts was introduced into AT-D cells by microcell fusion, and clones which were resistant to the antibiotic G418 were isolated. All 3 hybrid clones containing an additional copy number of chromosome 11 showed a restoration of the resistance of wild-type cells to killing by X-irradiation, whereas all 3 hybrid clones containing an additional copy number of chromosome 12 remained hyper-radiosensitive, like the parental AT cells. The results indicate that a defective gene of AT-D cells is also located on chromosome 11, since a genetic linkage analysis has previously suggested that a defective gene of its complementation group A is located on this chromosome.     

Colorectal tumors are enriched with regulatory plasmablasts with capacity in suppressing T cell inflammation

Inflammation plays a critical role in the initiation of colorectal cancer but is also required to mediate antitumor immunity in established tumors. Therefore, identifying the cellular and molecular components in colorectal tumors is necessary for the understanding of tumor progression and the development of novel treatment strategies. In this study, we demonstrated that a specific subtype of regulatory B cells, the CD19^loCD27^hi plasmablasts, was enriched in the colorectal tumor microenvironment. This CD19^loCD27^hi plasmablast subset presented high interleukin 10 (IL-10) expression but not transforming growth factor-β (TGF-β) secretion. Phenotypically, the tumor-infiltrating IL-10⁺ CD19^loCD27^hi plasmablasts presented lower CD24, CD38, and IgA, and higher Tim-1 and IgG expression compared to the IL-10⁻ CD19^loCD27^hi plasmablasts. The tumor-infiltrating IL-10⁺ CD19^loCD27^hi plasmablasts were found to be gut-homing due to their higher expression of α4β7 while peripheral blood B cells did not show the same characteristic. When cocultured with autologous T cells, CD19^loCD27^hi plasmablasts demonstrated potent activity in suppressing interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) expression but did not promote Foxp3 expression. Overall, this study demonstrate that in colorectal cancer, CD19^loCD27^hi plasmablasts make up a large percentage in tumor-infiltrating lymphocytes and possess potent immunoregulatory functions, and thus could be utilized in future therapeutic strategies.     

Chinese expert recommendations on management of hepatocellular carcinoma during COVID-19 pandemic: a nationwide multicenter survey

BackgroundThis study aimed to investigate the work status of clinicians in China and their management strategy alteration for patients with hepatocellular carcinoma (HCC) during the COVID-19 pandemic.MethodsA nationwide online questionnaire survey was conducted in 42 class-A tertiary hospitals across China. Experienced clinicians of HCC-related specialties responded with their work status and management suggestions for HCC patients during the pandemic.Results716 doctors responded effectively with a response rate of 60.1%, and 664 were included in the final analysis. Overall, 51.4% (341/664) of clinicians reported more than a 60% reduction of the regular workload and surgeons declared the highest proportion of workload reduction. 92.5% (614/664) of the respondents have been using online medical consultation to substitute for the “face-to-face” visits. Adaptive adjustment for the treatment strategy for HCC was made, including the recommendations of noninvasive and minimally invasive treatments such as transcatheter arterial chemoembolization for early and intermediate stage. Targeted therapy has been the mainstay for advanced stage and also as a bridge therapy for resectable HCC.DiscussionDuring the COVID-19 pandemic, online medical consultation is recommended to avoid social contact. Targeted therapy as a bridge therapy is recommended for resectable HCC considering the possibility of delayed surgery.