[Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years]

Objective: To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years. Methods: We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M(Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results: Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m²; 37 of the patients having a BMI greater than 40 kg/m². Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m², 28.6±4.3 kg/m², and 26.3±4.4 kg/m², respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion: LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

[Dilemma and breakthrough in the advancement of bariatric and metabolic surgery in China]

China currently has the largest population of overweight and obese individuals globally. Bariatric surgery is by far the most effective approach to address obesity and associated metabolic conditions. To manage the significant growth of obesity, China's bariatric and metabolic surgery has assumed a pivotal role. Despite a delayed start compared to other nations, China has made significant progress in bariatric metabolic surgery over the past two decades. Presently, the annual number of surgeries ranks ahead worldwide. However, the proportion of eligible obese patients undergoing bariatric surgery in China remains lower than global averages. Looking ahead, China's bariatric metabolic surgery field offers ample room for growth and improvement. This paper aims to highlight the achievements in bariatric and metabolic surgery within China while also addressing challenges, such as the high proportion of laparoscopic sleeve gastrectomy, adherence to operation standards and guidelines, postoperative management and loss of follow-up, and quality control of database. By analyzing the current landscape and challenges, it is anticipated that China's bariatric metabolic surgery will continue to make remarkable progress in the future, bolstered by the collective dedication of the medical community.

[The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients]

Objective: To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM). Methods: A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student's t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman's correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results: A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10-3 mm2/s vs. 7.35×10-3 mm2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score (r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score (r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion: IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

[Advances in endoscopic sleeve gastroplasty for the treatment of obesity and metabolic disease]

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.

[Effects of bariatric surgery on sex hormones in male patients with obesity]

Objective: To analyze and evaluate the differences in sex hormones after laparoscopic Roux-en-Y Gastric Bypass Surgery (LRYGB) and laparoscopic sleeve gastrectomy (LSG) in male patients with obesity. Methods: This study was a retrospective cohort study. The inclusion criteria were (1) male patients with obesity who met the surgical indications of the "Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes" (2019 Edition); (2) patients with a body mass index (BMI) of ≥27.5 kg/m2 and obesity-related metabolic diseases, or patients with severe obesity and a BMI of ≥35 kg/m2; and (3) sex hormone levels checked 1 year after surgery. The exclusion criteria included (1) patients with endocrine diseases (thyrotoxicosis, hyperprolactinemia) and hypothalamic-pituitary lesions and (2) those with severe major organ dysfunction who could not tolerate anesthesia or surgery. According to the above criteria, the clinical data of male patients with obesity admitted to the Gastrointestinal Surgery/Bariatric Center of the First Affiliated Hospital of Jinan University from October 2017 to January 2020 were included. A total of 52 male patients with obesity were included in this study. The mean age, body weight, BMI, and total testosterone level were (29.3±10.2) years, (123.6±35.4) kg, (40.1±11.1) kg/m², and 7.6 (5.5, 9.1) nmol/L, respectively. Forty-five patients (86.5%) exhibited testosterone deficiency. Among all the patients, 29 underwent LSG (LSG group) and 23 underwent LRYGB surgery (LRYGB group). The main outcome measure was the change in sex hormone levels before and after bariatric surgery in all the patients. The secondary outcome measures were the comparison of changes in sex hormone levels before and after LSG and LRYGB. Results: Pearson correlation analysis showed that preoperative estradiol was positively correlated with waist circumference (R=0.299, P<0.05), hip circumference (R=0.326, P<0.05), and chest circumference (R=0.388, P<0.05). Testosterone was negatively correlated with BMI (R=-0.563, P<0.01), waist circumference (R=-0.521, P<0.01), hip circumference (R=-0.456, P<0.01), chest circumference (R=-0.600, P<0.01), and neck circumference (R=-0.547, P<0.01). One year following bariatric surgery, the serum testosterone (7.6 [5.5, 9.1] nmol/L vs. 13.6 [10.5, 15.4] nmol/L, Z=-5.910, P<0.001), follicle-stimulating hormone (4.7 [2.7, 5.3] IU/L vs. 6.5 [3.6, 7.8] IU/L, Z=-4.658, P<0.001), and progesterone (1.2 [0.4, 1.5] nmol/L vs. 1.9 [0.8, 1.3] nmol/L, Z=-2.542, P=0.011) levels were significantly higher in all the patients. Both estradiol (172.8 [115.6, 217.5] pmol/L vs. 138.3 [88.4, 168.1] pmol/L, Z=-2.828, P=0.005) and prolactin (11.4 [6.4, 14.6] mIU/L vs. 8.6 [4.8, 7.3] mIU/L, Z=-2.887, P=0.004) levels were decreased. In addition to prolactin levels in the LRYGB group, there were statistically significant differences in the levels of estradiol (P=0.030), follicle-stimulating hormone (P < 0.001), luteinizing hormone (P=0.033), progesterone (P=0.034), and testosterone (P<0.001) compared with their preoperative levels. In the LSG group, there were statistically significant differences in the levels of follicle-stimulating hormone (P=0.011), prolactin (P=0.023), and testosterone (P<0.001) compared with their preoperative levels. Conclusion: The degree of obesity in men was negatively correlated with testosterone levels. Both LRYGB and LSG can significantly improve sex hormone levels in male patients with obesity, and testosterone levels show a significant increase after surgery.

[Application of the concept of precision obesity metabolic surgery in laparoscopic Roux-en-Y gastric bypass]

Due to the complexity and heterogeneity of obesity, the diagnosis and treatment of obesity vary greatly. Five to 10 percent of body weight can be lost through lifestyle modifications, nutritional and behavioral counseling, and the use of approved weight reduction medicines for obesity and diabetes; however, these non-surgical treatments are not effective for all patients. Compared to medical therapy, bariatric surgery is associated with higher rates of type 2 diabetes remission, lower mortality from vascular complications, and long-term, sustained weight loss. With the advent of precision medicine in surgical therapy, bariatric surgeons' fundamental understanding of laparoscopic Roux-en-Y gastric bypass surgery has evolved in recent years. The objective of surgery has shifted from short-term weight loss to the safe and successful long-term management of patient weight and comorbidities. In laparoscopic Roux-en-Y gastric bypass surgery, the concept of precision bariatric and metabolic surgery is mainly reflected in three aspects: accurate preoperative assessment, precise intraoperative operation, and comprehensive postoperative management. A new direction for the future development of precision laparoscopic Roux-en-Y gastric bypass surgery and obesity metabolic surgery is to formulate precise and individualized surgical treatment plans for patients and to use artificial intelligence and big data technology to improve the standardization of specialist data.

[Occurrence of gastric cancer after laparoscopic Roux-en-Y gastric bypass: a systematic review]

Laparoscopic Roux-en-Y gastric bypass (RYGB) is an important obesity surgery. The risk of remnant gastric cancer after RYGB for obesity is gaining growing attention from bariatric surgeons and patients with obesity. This systematic review included articles from major databases internationally and domestically that specifically described the remnant gastric cancer after RYGB intervention, a total of 21 cases was subsequently analyzed. The average median time from post-operative RYGB to diagnosis of gastric cancer was 11 years (1-28 years), the duration of gastric cancer symptoms lasted 7 days to 6 years, abdominal pain is the most common (71.4%), especially in the upper abdomen (33.3%), followed by nausea and vomiting (33.3%), over-weight loss (33.3%), and abdominal bloating (28.6%), etc. Neoplasm location was reported to occur in the antrum or the pre-pyloric region (71.4%), with adenocarcinoma being the most common tumor histology observed (71.4%), tumor stage III-IV as the most diagnosed, 38.1% of tumor were deemed to be unresectable, 52.4% of the patients performed subtotal gastrectomy and lymphadenectomy. In addition, a global article investigating the occurrence of esophageal gastric cancer after RYGB in 64 cases revealed the common preoperative medical history include smoking habits (37.5%), alcohol issues (14.0%), GERD (86.0%), presence with Barret esophagus (10.9%), patients that has other malignant tumor medical history (6.3%), first-degree relatives (6.3%), or other family members with gastric esophagus cancer family history. Although the incidence of gastric cancer after RYGB is rare, the increasing prevalence of gastric cancer development is one of great concern. A rise in clinical cases of patients treated with RYGB presents a target for future studies. Risk of gastric cancer after RYGB should be evaluated and considered in high-risk cases.

[Effect of tourniquet on morphology and stiffness of quadriceps in patients receiving total knee arthroplasty: a randomized controlled trial]

Objective: To evaluate tourniquet effect on the morphology and stiffness of quadriceps in patients receiving total knee arthroplasty (TKA). Methods: Total of 80 patients with primary knee osteoarthritis receiving unilateral primary TKA from August 2020 to June 2021 in Peking University Third Hospital were enrolled in this randomized controlled trial. The patients were randomly divided into tourniquet group and non-tourniquet group (40 cases in each group). The study measured and compared postoperative thickness and stiffness of quadriceps, as well as circumference of the affected thigh in two groups. Results: There were 11 males and 29 females in tourniquet group, 9 males and 31 females in non-tourniquet group, with mean age of (69.1±5.1) years and (67.4±5.3) years, respectively. There was no significant difference in demographic information such as gender, age and BMI (all P<0.05). Postoperative thickness of quadriceps, stiffness of quadriceps and circumference［x¯±s or M （Q₁，Q₃）］of the affected thigh in all patients were (2.76±0.69) cm, 25.20 (17.83, 32.90) m/s, 54.00 (51.13, 56.00) cm. These outcomes in tourniquet and non-tourniquet group［x¯±s or M （Q₁，Q₃）］were (2.78±0.76) cm and (2.73±0.61) cm, 24.00 (17.15, 33.13) m/s and 25.20 (18.68, 32.85) m/s, 54.00 (49.75, 55.00) cm and 54.50 (52.13, 57.53) cm, respectively; no significant deference was found in these indexes between the two groups (all P>0.05). Conclusion: Tourniquet has no significant effect on morphology and stiffness of quadriceps in patients undergoing TKA.

[Whole transcriptome analysis and critical gene regulatory network analysis during Schistosoma japonicum infection and praziquantel treatment in mice]

OBJECTIVE

To investigate long non-coding RNA (lncRNA)-microRNA (miRNA)-messenger RNA (mRNA) interactions and identify the critical gene regulatory network during Schistosoma japonicum infections and praziquantel treatment using whole transcriptome sequencing.

METHODS

A total of 110 male C57BL/6 mice were randomly divided into the control group, the infection group and the treatment group. Mice in the infection treatment and the control group were infected with S. japonicum cercariae via the abdomen, and liver specimens were sampled from 10 mice 3, 6, 8 weeks post-infection. Praziquantel treatment was given to mice in the treatment group 8 weeks post-infection, and liver specimens were sampled from 10 mice 2, 4, 6, 8, 10 weeks post-treatment. Total RNA was isolated from mouse liver specimens, and the transcriptome library was constructed for highthroughput whole transcriptome sequencing. The significant differentially expressed genes were subjected to functional annotations, Gene Ontology (GO) terms enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Correlation analysis of liver specimens was performed using R Corrplot and Himsc functions, and the lncRNAmiRNA-mRNA interaction network analysis was performed using R MixOmics and Himsc functions.

RESULTS

There were 1 176 differentially expressed miRNAs, 5 270 differentially expressed mRNAs, and 2 682 differentially expressed lncRNAs between the infection group and the control group, 1 289 differentially expressed miRNAs, 7 differentially expressed mRNAs, and 69 differentially expressed lncRNAs between the treatment group and the infection group, and 1 210 differentially expressed miRNAs, 4 456 differentially expressed mRNAs, and 2 016 differentially expressed lncRNAs between the treatment group and the control group. Correlation analysis showed a higher correlation of gene expression between the treatment group and the control group. Principal component analysis showed obvious separate clustering between the infection group and the treatment group. The differentially expressed genes with significant relevance were significantly enriched in 24 GO terms, including arachidonic acid metabolic process, xenobiotic catabolic process, unsaturated fatty acid metabolic process, xenobiotic metabolic process, long-chain fatty acid metabolic process, and 8 KEGG metabolic pathways, including cholesterol metabolism, tyrosine metabolism, linoleic acid metabolism, retinol metabolism, and steroid hormone biometabolism.

CONCLUSIONS

There were 23 mRNAs including Cyp2b9 and 14 lncRNAs including Rmrpr in the core position of the gene regulatory network, which may play a critical role in S. japonicum infections and praziquantel treatment, and 9 miRNAs including miR-8105 may serve as potential molecular markers for diagnosis of S. japonicum infections.

[Effect of the acetabular cup positioning and leg length restoration after total hip arthroplasty using robotic-assisted surgery system]

Objective: To assess the improvement of the robotic-assisted total hip arthroplasty (rTHA) regarding the acetabular cup positioning and the leg length restoration. Methods: Clinical data of 246 patients undergoing primary unilateral THA from September 2019 to June 2021 in Peking University Third Hospital were retrospectively reviewed, including patients treated with rTHA (n=113) and conventional THA (cTHA) (n=133). Thirty-seven male patients along with 76 females were enrolled into the rTHA group with a mean age of (62±9) years. In comparison, the average age of cTHA group was (60±12) years with 59 males and 74 females. The postoperative inclination and anteversion of the acetabular cup and the rate of acetabular cup within the Lewinnek and Callanan "safe zone" were documented and analyzed. For the patient with normal or surgically restored contralateral hip, the leg length discrepancy was also measured and compared between the two groups. Results: The overall mean postoperative inclination and anteversion was 39.0°±5.5° and 14.1°±5.1°, respectively. No statistically significant difference was found between the rTHA and cTHA group regarding postoperative inclination (39.3°±2.9° vs 38.7°±7.0°, P=0.383) and anteversion (13.4°±4.3° vs 14.7°±5.6°, P=0.054). In rTHA group, 97.3%(110/113) of the cups were implanted within the Lewinnek"safe zone"(75.9%(101/133) in cTHA group) and 94.7%(107/113) were within the Callanan"safe zone"(66.2%(88/133) in cTHA group), and those were both higher in rTHA group (both P<0.01). There was no significant difference in postoperative leg length discrepancy between the two groups (P=0.445). Meanwhile, 29(23.0%) cases of cTHA group had leg length discrepancy more than 5 mm, and it was 9.7%(9/93) in rTHA group. Conclusion: It indicated the benefit of rTHA in acetabular cup positioning as well as the leg length restoration.

Role of optimization algorithms based fuzzy controller in achieving induction motor performance enhancement

Three-phase induction motors (TIMs) are widely used for machines in industrial operations. As an accurate and robust controller, fuzzy logic controller (FLC) is crucial in designing TIMs control systems. The performance of FLC highly depends on the membership function (MF) variables, which are evaluated by heuristic approaches, leading to a high processing time. To address these issues, optimisation algorithms for TIMs have received increasing interest among researchers and industrialists. Here, we present an advanced and efficient quantum-inspired lightning search algorithm (QLSA) to avoid exhaustive conventional heuristic procedures when obtaining MFs. The accuracy of the QLSA based FLC (QLSAF) speed control is superior to other controllers in terms of transient response, damping capability and minimisation of statistical errors under diverse speeds and loads. The performance of the proposed QLSAF speed controller is validated through experiments. Test results under different conditions show consistent speed responses and stator currents with the simulation results.

Though optimization algorithms for fuzzy logic controller (FIC)-based three-phase induction motor (TIM) systems are attractive for improving efficiency, existing methods have limited search capability. Here, the authors report a quantum-inspired lightning search algorithm with enhanced performance.

[Effects of sleeve gastrectomy base on "membrane anatomy" concept on postoperative nausea and vomiting in patients with obesity or metabolic diseases]

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.

[Concept of membrane anatomy in laparoscopic sleeve gastrectomy procedure]

Membrane anatomy refers to the fascia and/or serosa enveloping the organs and their blood vessels and hanging on the posterior wall of the body cavity, which emphasizes the entirety and integrity of the membrane during operation. The concept can also be applied to most surgical operations. This article mainly expounds the application of the concept of membrane anatomy in the process of laparoscopic sleeve gastrectomy, which is embodied in the key steps of separating the greater omentum, mobilizing the fundus, mobilizing the posterior wall of the stomach, cutting the greater curvature of the stomach, reinforcing the staple line of the stomach, and suturing the greater omentum with staple line, in order to make the laparoscopic sleeve gastrectomy more accurate and precise with less bleeding, fewer complications and faster postoperative recovery.

Clinical and genetic analysis of idiopathic normophosphatemic tumoral calcinosis in 19 patients

PURPOSE

Tumoral calcinosis is a rare clinicopathological entity characterized by ectopic soft-tissue calcification, typically periarticular. Normophosphatemic tumoral calcinosis is seldom reported in East Asian populations, and the preoperative diagnosis is often elusive. This study was performed to characterize the clinical profile of normophosphatemic tumoral calcinosis and investigate the presence of the SAMD9 gene mutation.

METHODS

The clinical features, pathological examination findings, and outcomes of 19 subjects were retrospectively reviewed. All patients were analyzed for SAMD9 gene mutation using paraffin-embedded tumoral calcinosis specimens.

RESULTS

Nineteen subjects were analyzed (7 males, 12 females). Their mean age at surgery, mean age at symptom onset, and median disease duration was 51.9 ± 17.3 (range 7-75) years, 49.1 ± 17.2 (range 7-74) years, and 1.3 (interquartile range 0.5-3.0) years, respectively. Lesions were located in the hand in 8 (42.1%) subjects; wrist in 5 (26.3%); shoulder in 2 (10.5%); and hip, knee, buttock, and scrotum in 1 (5.3%) subject each. The lesions in 17 (89.5%) subjects were located around the joints [small joints (hand and wrist) in 13 (68.4%) and large joints (shoulder, hip, and knee) in 4 (21.1%)]. Lesions occurred in the upper limbs in 15 (78.9%) subjects and in the lower limbs in 2 (10.5%). Multiple-lesion involvement (distal right index finger and middle finger) occurred in one (5.3%) subject. Symptoms included pain in 15 (78.9%) subjects, impaired mobility in 5 (26.3%), swelling in 5 (26.3%), numbness in 2 (10.5%), and an asymptomatic mass in 2 (10.5%). The serum inorganic phosphorus concentration was normal in all 19 subjects (mean 1.17 ± 0.15 mmol/L). The serum calcium concentration was normal in 18 subjects and low in 1. The serum alkaline phosphatase concentration was normal in all 19 subjects. Pathological examination indicated multiple nodules of calcified materials that manifested an amorphous or granular blue-purple crystal and were surrounded by proliferation of mononuclear or multinuclear macrophages, osteoclastic-like giant cells, fibroblasts, and chronic inflammatory cells. Notably, different phases of pathological manifestations were observed in the same microscopic field. During follow-up (0.5-65.0 months), no recurrence of tumoral calcinosis was observed in 18 (94.7%) subjects, but 1 subject developed in situ recurrence of an asymptomatic subcutaneous mass after 6 months postoperatively. Genetic analysis in all 19 subjects revealed no SAMD9 gene mutations.

CONCLUSIONS

Most subjects were females and developed calcinosis in adulthood. Small joints (hand and wrist) and the upper limbs were frequently involved. The presence of different phases of pathological features in the same subject suggests that about half of the study participants had been misdiagnosed with another condition (such as gout, osteoarthritis, etc.). Complete surgical excision led to cure without recurrence during follow-up in majority of the study participants.

HDAC1 is indirectly involved in the epigenetic regulation of p38 MAPK that drive the lung cancer progression

OBJECTIVE

p38 MAPK are a class of protein kinase that may induce or prevent apoptosis in different circumstance. Emerging researches show that it plays a vital role in tumor progression and therefore understanding its dual role in different stages of lung cancer are important to investigate. Also in this study, we planned to understand its upstream target proteins like HDAC1 and uPAR which are responsible for p38 MAPK activation in the pathway.

MATERIALS AND METHODS

We initially develop lung cancer mice model by exposing them to high nicotine content tobacco smoke. The pathological stages of initial and advanced lung cancer are observed and confirmed through histological sectioning. The expression of HDAC1, uPAR and p38 MAPK are observed and analyzed in different stages of lung cancer using immunohistochemistry and Western blotting.

RESULTS

After 4 and 6 months of regular exposure of high nicotine content smoke, the A/J strain mice develop initial and advanced stage of lung cancer. The initial stage cancer develops thick tissue layers with fibrosis whereas advanced stages of lung cancer show more proliferative cells. The expression of HDAC1 and uPAR shows the minimal expression pattern in control and initial stages of lung cancer, but its expression increased in advanced stage of cancer. In case of phospho-p38 MAPK, mild expression was observed almost in every individual cell in the initial stages of cancer, which implies its protective role in preventing advanced stage of cancer. But in advanced stage of lung cancer, we observed dysregulated overexpression of phospho-p38 MAPK.

CONCLUSIONS

The epigenetic regulation of uPAR by HDAC1 confirms its indirect role in regulating p38 MAPK as tumor progress.

LncRNA NNT-AS1 is a major mediator of cisplatin chemoresistance in non-small cell lung cancer through MAPK/Slug pathway

OBJECTIVE

To investigate the role of long non-coding ribonucleic acid (lncRNA) nicotinamide nucleotide transhydrogenase-antisense RNA1 (NNT-AS1) in cisplatin (DDP) resistance in non-small cell lung cancer (NSCLC) and its molecular mechanism.

PATIENTS AND METHODS

Fluorescence quantitative Real-time polymerase chain reaction (qRT-PCR) was used to detect the expression levels of lncRNA NNT-AS1 in NSCLC cell lines (A549 and SPCA-1) and DDP-resistant cell lines (A549/DDP and SPCA-1/DDP). Corresponding plasmids of si-NTT-AS1 and si-NC were conducted. Then, methyl thiazolyl tetrazolium (MTT) assay was applied to detect the changes in half inhibition concentration (IC50) values of DDP in A549/DDP and SPCA-1/DDP cells after interference in lncRNA NNT-AS1 expression. Clone formation assay and flow cytometry were employed to detect the changes in proliferation, cycle and apoptosis of A549/DDP and SPCA-1/DDP cells caused by si-NNT-AS1. Protein expressions of molecular markers in mitogen-activated protein kinase (MAPK)/Slug signaling pathway after interference in lncRNA NNT-AS1 expression was detected by Western blotting. The differential expressions of lncRNA NNT-AS1 in 10 pairs of drug-resistant and non-resistant tissues were detected by qRT-PCR.

RESULTS

QRT-PCR results showed that the expression of lncRNA NNT-AS1 in drug-resistant cells was higher than that in parental cells. The IC50 value of DDP in drug-resistant cells was increased by interfering with the expression of lncRNA NNT-AS1. Clone formation assay and flow cytometry revealed that interfering in the expression of lncRNA NNT-AS1 could inhibit the proliferation, promote the apoptosis and cell cycle arrest of drug-resistant cells. Western blotting assay found that after interfering the expression of lncRNA NNT-AS1, the expressions of molecular markers in MAPK/Slug signaling pathway were downregulated. qRT-PCR assay indicated that there were 9 pairs of drug-resistant tissues with up-regulated lncRNA NNT-AS1 expression in a total of 10 pairs of drug-resistant tissues.

CONCLUSIONS

LncRNA NNT-AS1 is highly expressed in drug-resistant NSCLC tissues and cells, promoting the DDP resistance of NSCLC cells through the MAPK/Slug signaling pathway.

MiR-520b inhibited metastasis and proliferation of non-small cell lung cancer by targeting CHAF1A

OBJECTIVE

To investigate the potential effect of miR-520b on the development of non-small cell lung cancer and to explore the underlying mechanism.

PATIENTS AND METHODS

The expression levels of miR-520b in non-small cell lung cancer (NSCLC) tissues and cells (A549), as well as corresponding adjacent normal tissues and normal human lung epithelial cells (BEAS-2B), were detected by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR), respectively. Luciferase reported gene assay was performed to evaluate the interaction between miR-520b and chromatin assembly factor 1 subunit A (CHAF1A). Meanwhile, the effect of the miR-520b/CHAF1A axis on A549 cells was determined by subsequent experiments, including CHAF1A expression detection, cell proliferation, migration and invasion.

RESULTS

MiR-520b was lowly expressed in NSCLC tissues than that of corresponding adjacent normal tissues. Same results were obtained at the cellular level. To investigate the potential targets of miR-520b, we searched three publicly available algorithms, including TargetScan, miRDB and microRNA. Results indicated that CHAF1A was a direct target of miR-520b. Meanwhile, the luciferase reporter gene assay confirmed our hypothesis. Subsequent experiments demonstrated that decreased expression of CHAF1A resulting from the up-regulation of miR-520b could decelerate the proliferation, invasion and migration of lung cancer cells.

CONCLUSIONS

We discovered the inhibitory function of miR-520b in NSCLC by targeting CHAF1A. Moreover, our study revealed that the miR-520b/CHAF1A axis might be a potential therapeutic target for the treatment of NSCLC.

First Report of Fruit Rot Disease on Pomelo Caused by Lasiodiplodia theobromae in China

Pomelo (Citrus grandis) is widely cultivated in MeiZhou Guangdong Province of China. In 2008, a disease on pomelo fruit caused significant economic losses by affecting fruit quality. Diseased fruit was collected in December 2008 from MeiZhou Guangdong, surface sterilized in 75% ethanol for 1 min and internal necrotic tissue was transferred to potato dextrose agar (PDA) and incubated at 28°C for 5 days. Three single-spore isolates were obtained from different fruit and identified as Lasiodiplodia theobromae (Pat.) Griffon & Maubl. (synonyms Diplodia natalensis Pole-Evans and Botryodiplodia theobromae Pat.; teleomorph Botryosphaeria rhodina (Cooke) Arx) on the basis of morphological and physiological features. The fungus produced dark brown colonies (initially grayish) on PDA. Young hyphae were hyaline and aseptate, whereas mature hyphae were septate with irregular branches. Cultures of L. theobromae produced globular or irregular pycnidia abundantly on PDA (pH 3.5) at 28°C after 1 month. Mature conidia of L. theobromae were 20 to 26 × 12 to 15.5 μm, subovoid to ellipsoid-ovoid, initially hyaline and nonseptate, remaining hyaline for a long time, and finally becoming dark brown and one septate with melanin deposits on the inner surface of the wall arranged longitudinally giving a striate appearance to the conidia. The internal transcribed spacer (ITS) region of the rDNA was amplified from gDNA using primers ITS1 (5'-TCCGATGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') (1). Amplicons were 542 bp long (GenBank Accession No. JF693024) and had 100% nucleotide identity with the corresponding sequence (GenBank Accession No. EU860391) of L. theobromae isolated from a Pinus sp. (2). To satisfy Koch's postulates, six asymptomatic fruit on potted plants were sprayed until runoff with a spore suspension (1 × 10⁶ spores/ml) prepared from 30-day-old cultures of one isolate. Control fruit received water. Plants were covered with sterile wet gauze to maintain high humidity. Fruit spot symptoms similar to those on diseased field fruit appeared after 15 days on all inoculated fruits. L. theobromae was reisolated from all inoculated test fruit. No symptoms were observed on the fruit of control plants. To our knowledge, this is the first report of L. theobromae causing disease on pomelo fruit in China. This pathogen has also been previously reported to be economically important on a number of other hosts by mostly affecting the leaves. References: (1) J. C. Batzer et al. Mycologia 97:1268, 2005. (2) C. A. Pérez et al. Fungal Divers. 41:53,2010.

Extent and pattern of DNA methylation alteration in rice lines derived from introgressive hybridization of rice and Zizania latifolia Griseb

We have reported previously that introgression by Zizania latifolia resulted in extensive DNA methylation changes in the recipient rice genome, as detected by a set of pre-selected DNA segments. In this study, using the methylation-sensitive amplified polymorphism (MSAP) method, we globally assessed the extent and pattern of cytosine methylation alterations in three typical introgression lines relative to their rice parent at approximately 2,700 unbiased genomic loci each representing a recognition site cleaved by one or both of the isoschizomers, HpaII/MspI. Based on differential digestion by the isoschizomers, it is estimated that 15.9% of CCGG sites are either fully methylated at the internal Cs and/or hemi-methylated at the external Cs in the rice parental cultivar Matsumae. In comparison, a statistically significant increase in the overall level of both methylation types was detected in all three studied introgression lines (19.2, 18.6, 19.6%, respectively). Based on comparisons of MSAP profiles between the isoschizomers within the rice parent and between parent and the introgression lines, four major groups of MSAP banding patterns are recognized, which can be further divided into various subgroups as a result of inheritance of, or variation in, parental methylation patterns. The altered methylation patterns include hyper- and hypomethylation changes, as well as inter-conversion of hemi- to full-methylation, or vice versa, at the relevant CCGG site(s). Most alterations revealed by MSAP in low-copy loci can be validated by DNA gel blot analysis. The changed methylation patterns are uniform among randomly selected individuals for a given introgression line within or among selfed generations. Sequencing on 31 isolated fragments that showed different changing patterns in the introgression line(s) allowed their mapping onto variable regions on one or more of the 12 rice chromosomes. These segments include protein-coding genes, transposon/retrotransposons and sequences with no homology. Possible causes for the introgression-induced methylation changes and their implications for genome evolution and crop breeding are discussed.

Improving heterologous gene expression in Aspergillus niger by introducing multiple copies of protein-binding sequence containing CCAAT to the promoter

AIMS

To increase the expression level of heterologous gene in Aspergillus niger.

METHODS AND RESULTS

Inserting multiple copies of an activator protein-binding site originally encoded in the cis-regulatory region of A. niger glucoamylase gene (glaA), CCAAT-containing sequence, into the promoter of an expression plasmid greatly enhanced the production of heterologous protein.

CONCLUSION

The promoter activity was increased by the introduction of the CCAAT-containing sequence resulting in increased gene expression.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides evidence that the CCAAT-containing region of the glaA promoter of A. niger is a binding site for a positive transcriptional factor and demonstrates the possibility for improving the expression of both heterologous and endogenous genes in Aspergillus.

[cDNA cloning, sequence analysis of trehalose-6-phosphate synthase gene from Saccharomyces cerevisiae AS2.1416]

The trehalose-6-phosphate synthase gene tps1 was amplified from yeast S. cerevisiae AS2.1416 cDNA library by polymerase chain reaction. This 1.5 kb fragment was cloned into PstI and BamHI sites of pGEM-T easy vector and the sequence of the gene indicated the cloned tps1 gene contained 1485 nucleotides encoding for 495 amino acid and shared a sequence homology of 99.6% with that from S. cerevisiae S288C.

Low-density lipoprotein receptor-related protein (LRP) gene 766T polymorphism and Parkinson's disease

The C766T polymorphism in exon 3 of the low-density lipoprotein receptor-related protein (LRP) gene is underrepresented in Alzheimer's disease (AD) compared with normal subjects. We examined this polymorphism in 186 patients with Parkinson's disease (PD) and 187 age-matched normal Chinese subjects in addition to 227 newborns representing the general population. The fraction of individuals with 766T was 12.8% in normal subjects and 11.3% in patients with PD, not a significant difference (p = 0.77). The odds ratio was 0.86 with a 95% confidence interval of 0.44-1.69, thus the LRP C766T polymorphism does not play a major role in risk for PD, although the possibility cannot be excluded that it plays a minor role or is a significant risk factor in other ethnic groups.

Low density lipoprotein receptor related protein gene amplification and 766T polymorphism in astrocytomas

Low density lipoprotein receptor related protein (LRP) is a receptor for protease complexes, and may function in cell growth and repair, and in tumor invasiveness. LRP expression increases in glioblastomas compared to lower grade astrocytomas. Two potential mechanisms for this increased expression were investigated. The LRP C766T polymorphism is protective against Alzheimer's disease, perhaps through alteration of LRP expression. The frequency of the polymorphism was measured in astrocytoma patients and controls, but no significant difference was found. Differential PCR revealed LRP gene amplification in four of 25 high-grade gliomas and 0 of 23 other brain tumors. Co-amplification with epidermal growth factor receptor (EGFR) occurred in all four of the LRP-amplified tumors. Thus, LRP amplification may be partly responsible for increased LRP expression in astrocytomas, and may often occur in conjunction with EGFR amplification.

[The experiment research of OB glue used in tracheoanastomosis]

Resect a segment of canine cervical trachea. The length of resected trachea is from 1-4cm and 5-8cm. In the first group, one dog was used for each length and two dogs were used for each length in the second group, therefore twelve were used in the experiment. The upper and lower ends were matched and seved by three stitches, and OB glue was used to coat in the anastomosis crevice, and at last the cre-vice was wrapped with a sheet of loose tracheal sheath. After the operation, irritating cough, barking, swallowing and free movement of neck didn't cause fistula. Nakedeyes and tissue examination showed that the healing of the anastomostic orifice was well and no stenosis was found. The glue membrane was absorbed completely within 1-2 months. Outside body anti-pulling force experiment (for 8 cases) showed that the anastomostic line can hold 100cm H2O stress and 2kg pulling strength if only OB glue was used to connect the resected ends. Hence, this experiment shows that the usage of OB glue for tracheal anastomosis is a safety, simple and convenient method.

In vitro model for intrinsic drug resistance: effects of protein kinase C activators on the chemosensitivity of cultured human colon cancer cells

We investigated the effects that phorbol ester and diacylglycerol protein kinase C (PKC) activators had on the chemosensitivity of the human colon cancer cell line KM12L4a to Adriamycin (ADR), vincristine (VCR), and vinblastine (VLB) and on the intracellular accumulation of those drugs. Exposure of the cells to the PKC activator phorbol-12,13-dibutyrate (PDBu) (15 nM) during a 96-hr in vitro chemosensitivity assay significantly reduced the sensitivity of KM12L4a cells to ADR, VCR, and VLB, but not to 5-fluorouracil. Because a 96-hr treatment with 15 nM PDBu did not down-regulate PKC activity in KM12L4a cells, activation of PKC appeared to be responsible for the observed protection conferred by PDBu. PDBu-induced alterations in drug accumulation may account for its protective effects against these cytotoxic drugs, because both PDBu and the phorbol ester 12-O-tetradecanoyl-phorbol-13-acetate significantly reduced accumulation of [3H] VCR and [14C]ADR in the cultured human colon cancer cells. Unsaturated diacylglycerols are structural and functional analogues of phorbol ester PKC activators that are present in the lumen of the colon. We found that treatment of KM12L4a human colon cancer cells with the diacylglycerol 1-oleoyl-2-acetyl-sn-glycerol (OAG) significantly reduced [14C]ADR and [3H]VCR accumulation in the cells. The effects of OAG were dose dependent at physiological diacylglycerol concentrations and were completely reversed by the protein kinase inhibitor H7. OAG, which is rapidly metabolized in cultured cells, did not protect KM12L4a cells against the cytotoxic drugs in our 96-hr in vitro chemosensitivity assay. However, rapid metabolism of diacylglycerols should not limit their capacity to activate PKC in the colonic epithelium in vivo, because that tissue is chronically exposed to replenished supplies of unsaturated diacylglycerols in the intestinal tract. Our results provide evidence that unsaturated diacylglycerols may be environmental factors that contribute to the intrinsic drug resistance of colon cancer in vivo by reducing drug accumulation in the cancer cells.

Effects of pretreatment with protein kinase C activators on macrophage activation for tumor cytotoxicity, secretion of tumor necrosis factor, and its mRNA expression

The effect of phorbol esters and mezerein pretreatment on macrophage (M phi) activation for tumor cytolysis, tumor necrosis factor (TNF) secretion, and TNF-alpha mRNA expression was investigated. Following pretreatment with various concentrations (0.01 to 10 micrograms/ml) of phorbol 12-myristate 13-acetate (PMA), phorbol-12,13-dibutyrate (PDBu), or mezerein for 16 h, murine peritoneal M phi were activated with M phi-activating factor (MAF) or calcium ionophore A23187 and tested for cytotoxicity in a 24-h cytolysis assay against 125-I-UdR-labeled P815 mastocytoma and NS-1 myeloma target cells. It was found that pretreatment with all three protein kinase C (PKc) activators inhibited M phi activation for cytotoxicity against P815 cells in a dose-dependent manner. Fifty percent inhibition was achieved at concentrations less than 0.1 micrograms/ml. The inhibition was partially reversible. In contrast, the pretreatment did not at all inhibit but significantly enhanced M phi activation for cytolysis against NS-1 cells. Furthermore, exposure to PMA augmented M phi activation by MAF and A23187 for TNF secretion upon stimulation with trace amounts of lipopolysaccharide (LPS). Although the pretreatment neither enhanced nor significantly reduced the synergistic effect of MAF and A23187 on TNF-alpha mRNA expression, it did increase the expression stimulated by LPS alone. Finally, the PKc activity in M phi treated with PMA, PDBu, and mezerein was down-regulated to about 10% of control. Taken together, our results suggest that: 1) PKc plays an important role in the transduction of activating signals for M phi activation by MAF and A23187 to mediate cytotoxicity against some (P815) but not other (NS-1) tumor cells, 2) the induction of TNF-alpha mRNA expression and TNF secretion may be achieved via a PKc-independent pathway, and 3) M phi are equipped with more than one signal transduction pathways for affecting distinct functional activities.