GABARAP suppresses EMT and breast cancer progression via the AKT/mTOR signaling pathway

Few studies have focused on γ-aminobutyric acid type A (GABAA) receptor-associated protein (GABARAP) in tumor progression. We investigated the expression and importance of GABARAP in breast cancer. We analyzed the expression of GABARAP and its relationship with clinicopathological features and prognosis (TCGA). To explain the role and potential mechanism of GABARAP in regulating tumor development, we performed acquisition and loss of function experiments using cell lines and models of mouse xenotransplantation. We found that GABARAP inhibited proliferation, migration and invasion in vitro and in vivo. Notably, low levels of GABARAP induced the epithelial-mesenchymal transition (EMT). Low levels of GABARAP increased p-AKT and p-mTOR levels, and a specific AKT pathway inhibitor reversed the downregulation of GABARAP-induced tumor progression. GABARAP negatively correlated with advanced clinicopathological features in clinical specimens, such as tumor size and TNM stage. Notably, patients with low GABARAP levels had a poor prognosis. Immunohistochemistry (IHC) revealed that GABARAP expression negatively correlated with matrix metalloproteinase (MMP) 2 and MMP14. Conclusively, these data indicate that GABARAP suppresses the malignant behaviors of breast cancer likely via the AKT/mTOR pathway. The targeting of GABARAP may improve the certainty of diagnosis and treatment strategies for breast cancer.

Left atrial function in heart failure with preserved ejection fraction vs. aortic stenosis: evidence for atrial myopathy?

Funding Acknowledgements

Type of funding sources: None.

Background and Aim

Left atrial (LA) enlargement and impaired LA function are frequently found in patients with heart failure with preserved ejection fraction (HFpEF). Whether these structural and functional LA abnormalities are a consequence of increased LA pressure or whether HFpEF patients have an intrinsic LA myopathy is unknown. We compared LA pressure, size and function between patients with HFpEF and aortic stenosis, as a comparator with LA pressure overload, as well as community-dwelling control subjects.

Methods

Extensive echocardiographic assessments were performed in 219 patients with HFpEF (age 68 ± 11, 48% female), 173 patients with moderate to severe AS (age 69 ± 11, 55% female, aortic valve area index 0.55 ± 0.15 cm2/m2), and 219 controls (age 65 ± 9, 48% female, 42.2% hypertensive)

Results

Compared to controls, both patients with HFpEF and AS had larger LV and LA size and worse LV systolic, diastolic and LA function. Compared with AS patients, HFpEF patients had smaller LA volume index (40.2 ± 19.4 vs. 44.5 ± 11.9 ml/m2 p = 0.01) but similar LV filling pressure estimated by E/e’ (13.4 ± 4.8  13.4 ± 4.8 , p = 0.12). Despite smaller LA volume index and similar LV filling pressure, HFpEF patients had remarkably poorer LA function compared to AS [reservoir GLS, 22.6 ± 10% vs 31.4 ± 10.1 (p < 0.001); contractile GLS, 15.8 ± 6.1% vs 17.5 ± 6.9 (p < 0.05); LASrs, 0.92 ± 0.35% vs 1.27 ± 0.41 (p < 0.001); LASre, -1.49 ± 0.65 vs -1.86 ± 0.67 (p < 0.001)]. The differences in  LA reservoir GLS and LASrs remained significant  after adjustment for atrial fibrillation, diabetes, coronary artery disease, LV ejection fraction and LV mass index.

Conclusion

Patients with HFpEF had significantly worse LA function than patients with AS, despite similar LA pressure overload. These findings support the concept of an intrinsic LA myopathy in patients with HFpEF, beyond LA pressure overload.

Abstract Figure.

Dysfunction of Shh signaling activates autophagy to inhibit trophoblast motility in recurrent miscarriage

In early pregnancy, the placenta anchors the conceptus and supports embryonic development and survival. This study aimed to investigate the underlying functions of Shh signaling in recurrent miscarriage (RM), a serious disorder of pregnancy. In the present study, Shh and Gli2 were mainly observed in cytotrophoblasts (CTBs), Ptch was mainly observed in syncytiotrophoblasts (STBs), and Smo and Gli3 were expressed in both CTBs and STBs. Shh signaling was significantly impaired in human placenta tissue from recurrent miscarriage patients compared to that of gestational age-matched normal controls. VEGF-A and CD31 protein levels were also significantly decreased in recurrent miscarriage patients. Furthermore, inhibition of Shh signaling impaired the motility of JAR cells by regulating the expression of Gli2 and Gli3. Intriguingly, inhibition of Shh signaling also triggered autophagy and autolysosome accumulation. Additionally, knockdown of BECN1 reversed Gant61-induced motility inhibition. In conclusion, our results showed that dysfunction of Shh signaling activated autophagy to inhibit trophoblast motility, which suggests the Shh pathway and autophagy as potential targets for RM therapy.

A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies

PURPOSE

To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies.

METHODS

A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome.

RESULTS

There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34 weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34 weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34 weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34 weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34 weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery.

CONCLUSION

The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.

Dual Trigger for Final Follicular Maturation Improves Cumulative Live-Birth Rate in Ovarian Stimulation for Freeze-All In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles

STUDY QUESTION

Does dual trigger in freeze-all in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles improve the cumulative live-birth outcome compared with human chorionic gonadotropin (hCG) trigger?

SUMMARY ANSWER

Dual trigger for final follicular maturation improves the cumulative pregnancy and live-birth rates compared with hCG trigger in freeze-all IVF/ICSI cycles.

WHAT IS KNOWN ALREADY

Dual trigger could increase the numbers of oocytes and mature oocytes and improve pregnancy rates.

STUDY DESIGN SIZE DURATION

This retrospective cohort analysis included data from 4438 freeze-all IVF/ICSI cycles between January 2012 and December 2017.

PARTICIPANTS/MATERIALS SETTING METHODS

Women aged 20-49 years who underwent ovarian stimulation and oocyte retrieval for autologous IVF/ICSI with a freeze-all policy in our centre were enrolled. Data on number of oocytes retrieved, number of mature oocytes, clinical pregnancy rate, live-birth rate, cumulative pregnancy rate, and cumulative live-birth rate (CLBR) were assessed and compared between patients who underwent a dual trigger and hCG trigger. Multivariate logistic regression was performed to identify and adjust for factors known to independently affect the CLBR.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 4438 IVF/ICSI cycles were analyzed, including 1445 cycles with single hCG trigger and 2993 cycles with dual trigger. The cumulative biochemical pregnancy rate (60.8% vs. 68.1%, P<0.001; odds ratio (OR): 0.727; 95% confidence interval (CI): 0.638-0.828), cumulative clinical pregnancy rate (52.9% vs. 58.5%, P<0.001; OR: 0.796; 95%CI: 0.701-0.903), and CLBR (44.3% vs. 50.5%, P<0.001; OR: 0.781; 95%CI: 0.688-10.886) were all significantly lower in the hCG-trigger group compared with the dual-trigger group. The clinical pregnancy rate (48.2% vs. 58.2%, P=0.002; OR: 0.829; 95%CI: 0.737-0.934) and embryo implantation rate (34.4% vs. 38.9%, P<0.001; OR: 0.823; 95%CI: 0.750-0.903) in each transfer cycle were also significantly lower in the hCG-trigger group compared with the dual-trigger group. After controlling for all potential confounding variables, the trigger method was identified as an independent factor affecting the CLBR. The OR and 95%CI for hCG trigger were 0.780 and 0.641-0.949 (P=0.013).

LIMITATIONS REASONS FOR CAUTION

The data used to analyse the effect of dual trigger on cumulative pregnancy and live-birth outcomes were retrospective, and the results may thus have been subject to inherent biases. Further prospective randomized controlled trials are required to verify the beneficial effects of dual trigger.

WIDER IMPLICATIONS OF THE FINDINGS

Dual trigger had a positive effect on CLBRs, suggesting that it could be used as a routine trigger method in freeze-all cycles.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by grants from National Key Research and Development Program of China (2018YFC1004800), the Natural Science Program of Zhejiang (LY19H040009), the National Natural Science Foundation of China (No. 81601236). No authors have competing interests to declare.

Hormone Replacement Therapy Reverses Gut Microbiome and Serum Metabolome Alterations in Premature Ovarian Insufficiency

OBJECTIVE

We explored the gut microbiome and serum metabolome alterations in patients with premature ovarian insufficiency (POI) and the effects of hormone replacement therapy (HRT) with the aim to unravel the pathological mechanism underlying POI.

METHODS

Fecal and serum samples obtained from healthy females (HC, n = 10) and patients with POI treated with (n = 10) or without (n = 10) HRT were analyzed using 16S rRNA gene sequencing and untargeted metabolomics analysis, respectively. Peripheral blood samples were collected to detect serum hormone and cytokine levels. Spearman's rank correlation was used to evaluate correlations between sex hormones and cytokines and between the gut microbiota and serum metabolites. To further confirm the correlation between Eggerthella and ovarian fibrosis, the mice were inoculated with Eggerthella lenta (E. lenta) through oral gavage.

RESULTS

The abundance of genus Eggerthella significantly increased in the fecal samples of patients with POI compared to that observed in the samples of HCs. This increase was reversed in patients with POI treated with HRT. Patients with POI showed significantly altered serum metabolic signatures and increased serum TGF-β1 levels; this increase was reversed by HRT. The abundance of Eggerthella was positively correlated with altered metabolic signatures, which were, in turn, positively correlated with serum TGF-β1 levels in all subjects. Estrogen ameliorated ovarian fibrosis induced by E. lenta in mice.

CONCLUSIONS

The interactions between the gut microbiota, serum metabolites, and serum TGF-β1 in patients with POI may play a critical role in the development of POI. HRT not only closely mimicked normal ovarian hormone production in patients with POI but also attenuated gut microbiota dysbiosis and imbalance in the levels of serum metabolites and TGF-β1, which are reportedly associated with fibrosis. The findings of this study may pave the way for the development of preventive and curative therapies for patients with POI.

Objectively Measured Sleep Characteristics and Incidence of Ischemic Stroke: The Sleep Heart Health Study

OBJECTIVE

Sleep disorders are associated with the prevalence of stroke. However, there is limited evidence regarding the association between objectively measured sleep characteristics and ischemic stroke.

METHODS

Ischemic stroke was assessed during the mean follow-up period of 11 years in the Sleep Heart Health Study. Sleep parameters such as wake after sleep onset (WASO) and sleep efficiency (SE) were objectively measured based on in-home polysomnography records. Multivariable Cox regression analysis was utilized to examine the relationship between objective sleep characteristics and ischemic stroke incidence.

RESULTS

This study involved 4204 participants (1978 males and 2226 females, 63.8±11.1 years). The incidence of ischemic stroke increased in individuals with long WASO, poor SE, and short sleep duration. Multivariable Cox regression analysis showed that WASO within the fourth quartile (hazard ratio [HR] 3.771, 95% confidence interval [CI] 1.805-7.877, P<0.001), third quartile (HR 3.009, 95% CI 1.433-6.317, P=0.004), and second quartile (HR 3.108, 95% CI 1.470-6.568, P=0.003) had a higher incidence of ischemic stroke than WASO within the first quartile. Poor SE (<80.0%) was also found to be a predictor for ischemic stroke (HR 2.220, 95% CI 1.244-3.960, P=0.007). Additionally, a short sleep duration (<6 h) was associated with an increased risk of ischemic stroke (HR 1.725, 95% CI 1.026-2.899, P=0.040).

CONCLUSION

Our results revealed a relationship between WASO, SE, and sleep duration and ischemic stroke. Therefore, these sleep characteristics may be adequate predictors for the incidence of ischemic stroke.

ATG4 promotes cell proliferation, migration and invasion in HCC and predicts a poor prognosis

OBJECTIVE

ATG14, as an autophagy-related protein, has been shown to be implicated in the progression of tumors by modulating cell autophagy. We aimed at exploring ATG14 level in hepatocellular carcinoma (HCC) and its possible molecular mechanism.

PATIENTS AND METHODS

ATG14 levels in HCC tissues and cell lines were examined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR), and the relationship between ATG14 expression and clinical parameters was analyzed through clinical information analysis. The impacts of ATG14 on the proliferation and invasiveness of HCC cells were evaluated by performing Cell Counting Kit-8 (CCK-8) and transwell tests, respectively. We further explored the potential mechanism of ATG14 action using bioinformatics analysis and in vitro cell experiments.

RESULTS

Our data showed that ATG14 levels were abnormally enhanced in HCC tissues and cell lines, which predicted a poor prognosis of HCC patients. Downregulation of ATG14 markedly blunted the proliferation and migratory capacities of HCC cells. Bioinformatics analysis suggested that XIST can regulate ATG14 by binding multiple miRNAs (miR-195-5p, miR-497-5p, miR-424-5p, and miR-16-5p). In addition, XIST promoted cell autophagy by elevating ATG14 expression, thereby providing possible mechanisms by which ATG14 and XIST could modulate the development of HCC.

CONCLUSIONS

In summary, our data preliminary verified ATG14 levels were abnormally enhanced in HCC tissues and cell lines, which predicted a poor prognosis of HCC patients.

Incidence and associated predictors of adverse pregnancy outcomes of maternal syphilis in China, 2016-19: a Cox regression analysis

OBJECTIVE

This study aimed to investigate the incidence and associated predictors of adverse pregnancy outcomes (APOs) among pregnant women infected with syphilis.

DESIGN

Cox regression analysis.

SETTING

China.

POPULATION OR SAMPLE

Pregnant women who were tested for and diagnosed with syphilis during the index pregnancy and delivered at a gestational age ≥28 weeks between 2016 and 2019.

METHODS

Data were extracted from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Descriptive analysis provided profiles and pregnancy outcomes of maternal syphilis, as well as the incidence of APOs. Log-rank tests and Cox proportional hazard models were used to investigate factors influencing APOs in infected mothers with singleton births.

MAIN OUTCOME MEASURES

The incidence of APOs and the hazard ratios of associated predictors using Cox proportional hazard model.

RESULTS

Syphilis treatment data were available from 83.86% of diagnosed women. Including deliveries from the total study population, 13.33% experienced APOs. Cox regression indicated that APOs were more likely in women tested and diagnosed in the late trimester, at delivery or postpartum. Women who accepted non-standardised treatment and who received standardised treatment had less risk of APOs.

CONCLUSIONS

China has made huge progress over the last decades in the prevention of mother-to-child transmission of syphilis, but the incidence of APOs among pregnant women infected with syphilis remains high. It is essential to further strengthen access to early detection and standardised treatment of infected women to reduce the risk of APOs.

TWEETABLE ABSTRACT

Access to early detection and standardised treatment reduces the risk of APOs due to maternal syphilis.

Effect of miR-9 on myocardial fibrosis in rats via TGF-β1/Smads signaling pathway

OBJECTIVE

To observe the effect of micro ribonucleic acid (miR)-9 on the myocardial fibrosis (MF) in rats and explore its mechanism of action.

MATERIALS AND METHODS

A total of 30 rats were selected to prepare the models of MF and randomly divided into Sham group, Model group and MiR-9 group. The rat heart weight (HW)/body weight (BW) and left ventricular weight (LVW)/BW were determined. The content of hydroxyproline (Hyp) in the myocardial tissues of left ventricle was measured using a spectrophotometer. Enzyme-linked immunosorbent assay (ELISA) was performed to determine the levels of type I and type III collagens in myocardial tissues, and the level of miR-9 in myocardial tissues was determined via reverse transcription-polymerase chain reaction (RT-PCR). Finally, Western blotting was conducted to measure the levels of transforming growth factor-β1 (TGF-β1) and Smads2 proteins.

RESULTS

Compared with Sham group, Model group exhibited increased HW/BW and LVW/BW and markedly raised Hyp content and type I collagen, type III collagen, TGF-β1 protein and Smads2 protein levels, but significantly declined miR-9 expression levels in rats. In MiR-9 group, the rats had substantially decreased HW/BW, LVW/BW, Hyp content, and type I and type III collagen levels as well as lowered TGF-β1 protein and Smads2 protein levels.

CONCLUSIONS

MiR-9 can alleviate the MF in rats by inhibiting the TGF-β1/Smads signaling pathway.

Social status and long-term events among acute myocardial infarction patients

Background

Mood disorders, depression, and loneliness are known risk factors for thrombotic occlusions. Social relationships in general, and marital status in particular may play a role in predicting cardiovascular outcomes and survival after ST-segment elevation myocardial infarction (STEMI), but the evidence is inconclusive, especially in Asians. We sought to analyze clinical outcomes following AMI according to insurance type and living type.

Methods

From July 2016 to Sept 2018, the Korean Registry of Regional Cardiocerebrovascular Center for Acute Myocardial Infarction database collected patients over 18 years old who suffered AMI. 3 months and 1-year all-cause death, CVA and re-MI (composite endpoint) were collected by telephone interview.

Results

Overall, the total of 463 all-cause death and 113 re-MI occurred. At 3-months, each group did not any differences in all-cause death and re-MI. At 1-year, however, the single & medical aid patients exhibited significantly higher all-cause death (6.8% vs 18.3%; p=0.000) and composite endpoint (12.5% vs 20.6%; p=0.000) compared to the live together & health insurance.

Conclusion

Social and economic status may be linked to 1-year all-cause death in Korean patients with ST-segment elevation myocardial infarction.

All-cause death and Composite outcomes

Funding Acknowledgement

Type of funding source: None

Permafrost Degradation Leads to Biomass and Species Richness Decreases on the Northeastern Qinghai-Tibet Plateau

Degradation of permafrost with a thin overlying active layer can greatly affect vegetation via changes in the soil water and nutrient regimes within the active layer, while little is known about the presence or absence of such effects in areas with a deep active layer. Here, we selected the northeastern Qinghai-Tibet Plateau as the study area. We examined the vegetation communities and biomass along an active layer thickness (ALT) gradient from 0.6 to 3.5 m. Our results showed that plant cover, below-ground biomass, species richness, and relative sedge cover declined with the deepening active layer, while the evenness, and relative forb cover showed a contrary trend. The vegetation indices and the dissimilarity of vegetation composition exhibited significant changes when the ALT was greater than 2.0 m. The vegetation indices (plant cover, below-ground biomass, evenness index, relative forb cover and relative sedge cover) were closely associated with soil water content, soil pH, texture and nutrient content. Soil water content played a key role in the ALT–vegetation relationship, especially at depths of 30–40 cm. Our results suggest that when the ALT is greater than 2.0 m, the presence of underlying permafrost still benefits vegetation growth via maintaining adequate soil water contents at 30–40 cm depth. Furthermore, the degradation of permafrost may lead to declines of vegetation cover and below-ground biomass with a shift in vegetation species.

Non-aqueous liquid crystals of hydroxyapatite nanorods

Hydroxyapatite (HA) nanorods in the collagen matrix of bone have a macroscopically ordered structure that has many similarities to the ordered structure of anisotropic nano-units in inorganic liquid crystals (LCs). Inspired by these similarities, we conducted the first (to our best knowledge) synthesis of HA LCs in non-polar solvents (such as cyclohexane and toluene), thus expanding the range of applicable monomers and polymers. We synthesized HA nanorods by a simple, effective, and oleic-acid-assisted hydrothermal route. The hydrothermal temperature directly modulates the aspect ratio of the HA nanorods, and indirectly modulates their LC behavior. The LC phase transition has no size limitation. Thus, our approach may be used to develop high solid content, macroscopically assembled, large-scale polymer-based bio(mimetic)-materials.

Association of the duration of post-thaw culture with clinical outcome after vitrified-warmed day 3 embryo transfer in 10,464 cycles: A retrospective cohort study

This study aimed to investigate the effect of the duration of embryo culture on clinical outcome in vitrified-warmed cycles.This retrospective cohort study enrolled 10,464 infertile patients, with a total of 18,843 vitrified-warmed day 3 embryos from 2012 to 2017 at a single center. The patients were divided into 2 groups: 9470 cycles in the short-term culture group (0.5-8 hours of post-thaw culture) and 994 cycles in the 48 to 72 hours culture group. The independent effect of the following variables on clinical outcomes was determined: duration of post-thaw culture, maternal age, transferred embryos, embryo quality, and endometrial thickness.We found that the pregnancy rate was positively associated with the post-thaw culture time. Ordinary least square regression analyses showed that the duration of post-thaw culture was positively associated with implantation and live birth rates overall. However, the implantation and live birth rates were not significantly associated with the post-thaw culture time in the short-term culture group. Additionally, maternal age and the number of transferred embryos were independent predictors of the implantation and live birth rates. Moreover, the duration of post-thaw culture did not affect live birth weight.These results indicated that the pregnancy rate is positively associated with the duration of post-thaw culture. Therefore, under the condition of not affecting work shifts, properly prolonging the duration of post-thaw culture to improve the outcome of frozen-thawed embryo transfer should be considered.

Immunosensor-based rapid quantitative detection of Newcastle disease virus antibodies using innovative gold immunochromatographic assay

AIMS

A novel quantitative method for rapid Newcastle disease virus (NDV) antibody detection was developed based on an innovative gold immunochromatographic assay with a quantitative immunosensor.

METHODS AND RESULTS

NDV antibody-detecting test strips containing a two-reaction system and double-test lines (T1, T2) were prepared. The test results were judged according to the signal ratio between the test and control lines as measured by the quantitative immunosensor. The minimum detection limit of the test strips for NDV antibodies was 2² titres. In addition, the assay was highly specific because only NDV antibodies produced visible test lines on the strip. The clinical application of the strips was tested by detecting NDV antibodies in 506 serum samples collected from chickens. The results showed a coincidence of 92·49% with those of the haemagglutination inhibition assay.

CONCLUSIONS

The strips were successfully prepared and showed high specificity towards NDV, sensitivity and stability.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study describes a new method for detection of NDV antibody and provides a reference basis for rapid and quantitative monitoring of NDV antibodies. This new method overcomes the limitation of the existing colloidal gold immunochromatography, which only produces qualitative or semi-quantitative results.

Function of IL-33 in Wound Age Estimation of Skin Wounds in Mice

Abstract

Objective To explore the application value of interleukin-33 （IL-33） in wound age estimation in forensic practice by observing the sequential changes of IL-33 after skin wound. Methods Skin wound models were generated on the back of mice with a round file of 5 mm in diameter. Skin samples of the same size were taken from the same parts of mice in control group and injury group 1 h, 3 h, 6 h, 12 h, 1 d, 3 d, 5 d, 7 d and 10 d after skin wound. Hematoxylin-eosin （HE） staining method was applied to observe the morphological changes in the recovering process after skin wound. Western blotting, immunohistochemistry staining and double immunofluorescence staining methods were applied to detect the expression changes of IL-33 in the skin wound samples. Results The results of Western blotting showed that the expression of IL-33 protein decreased slightly at 3 h after skin wound, increased gradually at 6 h after skin wound, and reached the peak value at 3 d, then decreased gradually. Immunohistochemistry staining results showed that faint positive expression of IL-33 was observed in epidermis, hair follicles, sebaceous glands and dermal resident cells of the control group skin. The positive cell rate of IL-33 increased at 3 h after skin wound and reached the peak value at 3 d, then decreased gradually. The results of double immunofluorescence staining showed that the majority of IL-33 positive cells from 1 d to 3 d after wound were macrophages, while the majority of IL-33 positive cells from 5 d to 7 d after wound were myofibroblasts. In addition, the results of HE staining showed that the wound healing process of the skin wound model was consistent with the pathological development law of inflammation. Conclusion IL-33 could become a reference index for wound age estimation of skin wound in forensic practice.

[Short-term efficacy of robotic-assisted total mesorectal excision with and without lateral lymph node dissection for mid-low advanced rectal cancer: a propensity score matching analysis]

Objective: To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi'an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups. Results: A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions: Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.