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BackgroundBK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) causes renal allograft dysfunction and graft loss. However, the mechanism of BKPyV replication after kidney transplantation is unclear. Clinical studies have demonstrated that immunosuppressants and renal ischemia–reperfusion injury (IRI) are risk factors for BKPyV infection. Studying the pathogenic mechanism of BKPyV is limited by the inability of BKPyV to infect the animal. Mouse polyomavirus (MPyV) is a close homolog of BKPyV. We used a model of MPyV infection to investigate the core genes and underlying mechanism of IRI and immunosuppressants to promote polyomavirus replication.Materials and MethodsOne-day-old male C57BL/6 mice were intraperitoneally injected with MPyV. At week 9 post-infection, all mice were randomly divided into IRI, immunosuppressant, and control groups and treated accordingly. IRI was established by clamping the left renal pedicle. Subsequently, kidney specimens were collected for detecting MPyV DNA, histopathological observation, and high-throughput RNA sequencing. Weighted gene correlation network analysis (WGCNA), protein–protein interaction network analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were used to screen for core genes and common signaling pathways involved in promoting MPyV replication by IRI and immunosuppressants.ResultsAfter primary infection, MPyV established persistent infection in kidneys and subsequently was significantly increased by IRI or immunosuppressant treatment individually. In the IRI group, viral loads peaked on day 3 in the left kidney, which were significantly higher than those in the right kidney and the control group. In the immunosuppressant group, viral loads in the left kidney were significantly increased on day 3, which were significantly higher than those in the control group. Protein–protein interaction network analysis and WGCNA screened complement C3, epidermal growth factor receptor (EGFR), and FN1 as core genes. Pathway enrichment analysis based on the IRI- or immunosuppressant-related genes selected by WGCNA indicated that the NF-κB signaling pathway was the main pathway involved in promoting MPyV replication. The core genes were further confirmed using published datasets GSE47199 and GSE75693 in human polyomavirus-associated nephropathy.ConclusionsOur study demonstrated that IRI and immunosuppressants promote polyomavirus replication through common molecular mechanisms. In future studies, knockdown or specific inhibition of C3, EGFR, FN1, and NF-κB signaling pathway will further validate their critical roles in promoting polyomavirus replication.

Describe and predict the malignant tumor deaths in Xi'an so as to provide evidence for the government to formulate the prevention and treatment plans.Overall malignant tumor death in Xi'an in the past 16 years was described. The multi-decrease life table was used to calculate cumulative mortality risk by cause and life expectancy reduction years by cause of malignant tumors in 2020. The join point regression models were used to analyze the change trend of standard mortality of malignant tumors in Xi'an from 2005 to 2020. The appropriate gray models were selected to predict the death of malignant tumors in Xi'an in the next decade.The mortality of total malignant tumors in Xi'an showed that men are higher than women and the elderly are higher than other groups. As for 2020, lung cancer had the highest risk of death for both men and women, while leukemia had the highest life expectancy reduction years by cause. From 2005 to 2020, standardized mortality of majority malignant tumors showed downward trends, which were particularly obvious in recent years. The prediction results of several major malignant tumors showed that in the next decade, the mortality of most malignant tumors had downward trends, but combined with the increase of population in the future, the number of malignant tumor deaths in Xi'an will continue to increase.Malignant tumors in Xi'an have decreasing mortality trends in recent years, and effective measures to prevent and treat tumors should be strengthened in the future.

Background The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus. Method A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed. Results All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days. Conclusions The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.

Background Pulse oximetry screening for critical congenital heart disease (CHD) is inapplicable to high altitude due to the variedly decreased arterial saturations and rare complex CHD. We examined the incidence and spectrum of CHD in newborns using echocardiography at high altitude and followed up their outcomes. Methods A total of 1337 babies were studied. Echocardiography was performed in 1002 asymptomatic newborns (3–5 days). In the same period, retrospectively studied 394 newborns (≤2 days) admitted to the NICU where echocardiograph was performed in 335. In both groups, follow-up was made at 1–3, 6 and 12–18 months. Results The incidence of CHD in asymptomatic newborns was 27.8%, consisting secundum atrial septal defect (ASD) [175 (62.7%)], patent ductus arteriosus (PDA) [61 (21.9%)], ventricular septal defect (VSD) [8 (2.9%)] and multiple defects [35 (12.6%)]. And 19.4% in NICU patients with similar spectrum, except for 2 with complex CHD who died before discharge. By 12–18 months of follow-up, 30% of CHD remained open. Thirteen patients developed mild to severe pulmonary arterial hypertension (PAH), and 2 of them died of heart failure. Conclusions The incidence of CHD in newborns at high altitude is about 20 times higher than that at low altitude, consisting mostly of simple forms with left to right shunt, with rare complex CHD. By 12–18 months, the incidence of CHD is still about 10 times higher than that at low altitude. About 8% patients developed PAH or death. Follow-up must be reinforced in order to provide early intervention and prevent from PAH or death.

Orthodenticle homolog 1 (OTX1) has previously been revealed to be tightly associated with the development and progression of several human tumors. However, the functional roles and underlying molecular mechanisms of OTX1 in gastric cancer (GC) remain poorly understood. In the present study, we observed that OTX1 was highly expressed in GC tissues compared with adjacent non‑tumor tissues based on a large cohort of samples from The Cancer Genome Atlas (TCGA) database. An immunohistochemical analysis indicated that OTX1 levels were increased in tumors that became metastatic compared with those in tumors that did not. This finding was significantly associated with patients who had shorter overall survival times. The knockdown of OTX1 significantly inhibited the proliferation, migration and invasion of SGC‑7901 and MGC‑803 cells. Furthermore, the knockdown of OTX1 induced cell cycle arrest in the G0/G1 phase and reduced the expression of cyclin D1. In addition, the inhibition of OTX1 led to increased GC cell apoptosis by upregulating cleaved PARP, cleaved caspase‑3 and Bax. In conclusion, our data indicated that OTX1 functions as a key regulator in tumor growth and metastasis of GC cells. Thus, OTX1 may be a promising novel target for molecular therapy directed toward GC.

Two novel 1α,25-dihydroxyvitamin D

Carboxylesterase (CarE) is a multifunctional superfamily, and it plays important roles in xenobiotic detoxification, pheromone degradation, neurogenesis and regulating development. In this research, firstly, we measured the rutin-induced transcriptional level of BmCarE-10 gene by using real-time quantitative RT-PCR method, and dual spike-in strategy. Several possible physiological functions were certified preliminarily by RNAi experiments in silkworm. Promoter truncation analysis using a dual-luciferase reporter assay in Bombyx mori ovary cells (BmN) showed that the region -705 to -625 for BmCarE-10 gene was essential for basal and rutin-induced transcriptional activity. Sequence analysis of this region revealed several potential transcriptional regulatory elements such as Croc and Dfd. The activities of the BmCarE-10 promoter in various tissues of silkworm were also measured by firefly luciferase activity and normalized by the Renilla luciferase activity. Results showed that the activity of the BmCarE-10 promoter were highest in the Malpighian tubule, followed by fat body, silk gland, midgut, epidermis, and hemocyte. The essential region for basal and rutin-induced transcriptional activity was also -894 to -502 in Malpighian tubule and fat body of silkworm. The potential core promoters of BmCarE-10 gene in B. mori are reported for the first time in this research. Further identification of cis- and trans-elements and their role in upregulation of BmCarE-10 gene may be useful for elucidating the contribution of CarE protein to the response mechanism to rutin.

Hepatocellular carcinoma (HCC) is a common disease and the third leading cause of cancer-related deaths worldwide. Level of the 82-kDa ATP-dependent DNA helicase II (Ku86) increases in some tumors, but its clinical use as a marker for HCC is rare. To examine the relationship between increases in Ku86 and the development of hepatitis B virus (HBV)-related HCC to define the relationship between Ku86 and HCC. Expression of Ku86 in tumor tissue, para-tumor tissue, and normal tissue was examined by immunohistochemistry, and Ku86 antibody titers in patient serum collected pre- and post-operatively were measured by ELISA. Long-term survival of the patients was also monitored. Ku86 staining in tumors was much stronger than in para-tumor and normal tissues. The expression of Ku86 was related to the tumor size, TNM stage, and tumor differentiation but not to gender, age, Child–Pugh score, tumor number, or α-fetoprotein levels. The long-term survival of patients with low Ku86 expression was longer. Patients with HCC had higher pre-operative Ku86 antibody levels. After surgical intervention, Ku86 antibody levels in patients with HCC declined significantly. Survival analysis showed that double-positive patients had the lowest survival rate, double-negative patients had the highest. Receiver operating characteristic curve analysis showed no significant difference between the AFP and Ku86 antibody. Multivariate analysis showed that Ku86 protein and Ku86 antibodies were independent prognostic factors of overall survival. Ku86 and Ku86 antibodies are promising tumor markers for early detection and prognosis prediction of HBV-related HCC.

Ovarian cancer is one of the most common causes of mortality among all cancers in females and is the primary cause of mortality from gynecological malignancies. The objective of the current research work was to evaluate a naturally occurring sesquiterpene-δ-Cadinene for its antiproliferative and apoptotic effects on human ovary cancer (OVCAR-3) cells. We also demonstrated the effect of δ-Cadinene on cell cycle phase distribution, intracellular damage and caspase activation. Sulforhodamine B (SRB) assay was used to evaluate the antiproliferative effect of δ-cadinene on OVCAR-3 cells. Cellular morphology after δ-cadinene treatment was demonstrated by inverted phase contrast microscopy, fluorescence microscopy and transmission electron microscopy. Flow cytometry was used to analyze the effect of δ-cadinene on cell cycle phase distribution and apoptosis using propidium iodide and Annexin V-fluorescein isothiocyanate (FITC)/PI kit. The results revealed that δ-cadinene induced dose-dependent as well as time-dependent growth inhibitory effects on OVACR-3 cell line. δ-cadinene also induced cell shrinkage, chromatin condensation and nuclear membrane rupture which are characteristic of apoptosis. Treatment with different doses of δ-cadinene also led to cell cycle arrest in sub-G1 phase which showed dose-dependence. Western blotting assay revealed that δ-cadinene led to activation of caspases in OVCAR-3 cancer cells. PARP cleavage was noticed at 50 µM dose of δ-cadinene with the advent of the cleaved 85-kDa fragment after exposure to δ-cadinene. At 100 µM, only the cleaved form of PARP was detectable. Pro-caspase-8 expression remained unaltered until 10 µM dose of δ-cadinene. However, at 50 and 100 µM dose, pro-caspase-8 expression was no longer detectable. There was a significant increase in the caspase-9 expression levels after 50 and 100 µM δ-cadinene treatments.

To date, single-port laparoscopic pancreatic surgery has been rarely reported. This study aimed to evaluate the feasibility and safety of single-port retroperitoneoscopic pancreatectomy based on the first 3 cases in a single center. Three patients with suspected lesions in the distal pancreas underwent single-port retroperitoneoscopic pancreatectomy using a conventional retroperitoneoscopic pancreatectomy approach. All operations were successfully completed utilizing a single port. Operating times were 50, 90, and 150 minutes for the 3 cases. There were no complications, and all patients were discharged within 7 days after surgery. In conclusion, for selected patients, single-port retroperitoneoscopy can be safely utilized for pancreatectomy.

Objective This multicenter, randomized, placebo-controlled study evaluated the efficacy and side effects of parecoxib during patient-controlled epidural analgesia (PCEA) after abdominal hysterectomy. Methods A total of 240 patients who were scheduled for elective abdominal hysterectomy under combined spinal-epidural anesthesia received PCEA plus postoperative intravenous parecoxib 40 mg or saline every 12 h for 48 h after an initial preoperative dose of parecoxib 40 mg or saline. An epidural loading dose of a mixture of 6 mL of 0.25% ropivacaine and 2 mg morphine was administered 30 min before the end of surgery, and PCEA was initiated using 1.25 mg/mL ropivacaine and 0.05 mg/mL morphine with a 2-mL/h background infusion and 2-mL bolus with a 15-min lockout. The primary end point of this study was the quantification of the PCEA-sparing effect of parecoxib. Results Demographic data were similar between the two groups. Patients in the parecoxib group received significantly fewer self-administrated boluses (0 (0, 3) vs. 7 (2, 15), P < 0.001) and less epidural morphine (5.01 ± 0.44 vs. 5.95 ± 1.29 mg, P < 0.001) but experienced greater pain relief compared with the control group (P < 0.001). Patient global satisfaction was higher in the parecoxib group than the control group (P < 0.001). Length of hospitalization (9.50 ± 2.1, 95% CI 9.12~9.88 vs. 10.41 ± 2.6, 95% CI 9.95~10.87, P = 0.003) and postoperative vomiting (17% vs. 29%, P < 0.05) were also reduced in the parecoxib group. There were no serious adverse effects in either group. Conclusion Our data suggest that adjunctive parecoxib during PCEA following abdominal hysterectomy is safe and efficacious in reducing pain, requirements of epidural analgesics, and side effects. Trial Registration ClinicalTrials.gov (NCT01566669)

Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.

To summarize the experience with a modeling method for laparoscopic left lateral segment liver resection (LLLR).The surgical procedures of LLLR were carried out with the patient placed in a supine position and 4 trocars placed on the abdomen. After complete dissociation of the left lobe, the segment II and III vascular pedicles were freed with a harmonic scalpel and transected with a linear cutter stapler. The left hepatic vein (LHV) was dissociated with a harmonic scalpel with a slightly left direction of liver dissection, followed by complete resection of the LHV and finally by wound surface management, specimen removal, wound drainage, and abdominal incision closure.Between July, 2003 and August, 2010, this modeling method for LLLR was performed successfully in 48 cases without conversion to laparotomy. The mean operation time was 75∓30.8 min, blood loss was 58∓36.4 ml, and length of postoperative hospital stay was 4.8∓1.5 days. Postoperative complications occurred in 3 cases, including ascites in 2 cases and mild biliary leakage 1 case, all cured conservatively.This modeling method can simplify the surgical procedure of LLLR, reduce blood loss, and avoid air embolism due to vein injury. Being less technically demanding, this method can be safely performed in hospitals at various levels.

To compare the clinical results of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP), confirm the potential advantages of LDP.The medical records of 30 consecutive patients who underwent LDP were reviewed and compared with those of 42 patients who underwent ODP.Operation time was longer for LDP than for ODP [(186.33±58.98 min) vs (149.29±29.00 min), P=0.001], but blood loss [(223.33±143.68 ml) vs(251.19±103.29 ml), P=0.341] and spleen-saving rate(42.3% vs 61.8%, P=0.192) were no significant difference between the 2 groups. Decreased postoperative bowel recovery time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016], oral intake time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016] and length of stay [(7.43±1.57 d) vs (9.67±1.41 d), P=0.000] were seen in LDP group. However, the rate of postoperative pancreatic fistula (16.67% vs 21.43%, P=0.619) was no significant difference between the 2 groups. 3 cases of wound infection and 2 cases of lung related complication were occurred in ODP group, but none in LDP group.LDP is a safe and effective surgical approach, providing the same surgical results comparable to that of ODP, and substantially faster recovery. However, high requirement of laparoscopic technique and equipments limited its further clinical application.

To discuss the localization diagnosis value of laparoscopic ultrasonography in laparoscopic surgery of insulinoma.Retrospectively reviewed the results of laparoscopic ultrasonography in 32 patients from Jan 2007 to Aug 2008 with insulinoma which confirmed after surgery, and analyzed the detection rate of laparoscopic ultrasonography.Insulinoma tumors were success located in 31 patients among 32 patients by laparoscopic ultrasonography. The detection rate was 96.9% and the location accurate rate was 100%. Thirty-seven insulinoma tumors were detected in 31 cases, including 29 solitary insulinoma and 2 multiple insulinomas. One patient did not show a definite tumor in the pancreas and extrapancreatic organ during the laparoscopic ultrasonography examination.Laparoscopic ultrasonography has a high detection rate in localizing diagnosis of insulinoma and can clear display the relationship between tumor and adjacent tissue. It is useful for surgeon to select the suitable operation modality.

To summarize the experiences of laparoscopic pancreatectomy and to discuss its clinical indications and operative techniques.From March 2003 to February 2010, 49 patients with pancreatic diseases, including 18 males and 31 females with a mean age of (42 ± 14) years old (range: 21 - 77), underwent laparoscopy at our department. The preoperative diagnoses included insulinoma (n = 38), cystadenoma (n = 4), cystadenocarcinoma (n = 1), nonfunctional islet cell tumor (n = 5) and solid-pseudopapillary tumor (n = 1).Thirty-nine cases underwent total laparoscopic surgery and 8 cases converted to open surgery. The operative duration was (245 ± 146) minutes (range: 90 - 960). The mean intraoperative blood loss was (191 ± 306) ml (range: 20 - 1500). Secondary operations were needed in 3 cases and pancreatic fistula occurred in 7 cases. The postoperative hospital stay was (10 ± 7) days (range: 4 - 31).Laparoscopic pancreatectomy is safe and feasible in the treatment of most benign pancreatic diseases and some malignant tumors.

To observe the clinical efficacy and complications of intradiscal electrothermal therapy for treatment of discogenic low back pain.Forty patients with discogenic low back pain were treated with intradiscal electrothermal therapy, and the changes in the VAS, functional status and complications after the treatment were analyzed. RESULTS The VAS score was decreased and the functional status improved obviously after the treatment, which caused no severe complications.Intradiscal electrothermal therapy is safe and effective to rapidly achieve pain relief and obviously improve the functional status of patients with discogenic low back pain with few complications.

To investigate the effect of pentoxifylline on one-lung ventilation injury in rabbits.Twenty rabbit models of one-lung ventilation by intrabronchial intubation after tracheotomy were randomly allocated in control group (with one-lung ventilation) and experiment group (with one-lung ventilation and intravenous pentoxifylline administration). One-lung ventilation was maintained for 3 h in both groups using the volume-control mode (tidal volume of 8 ml/kg at the frequency of 30 per min). Arterial blood samples were taken after anesthesia and at 3 h of one-lung ventilation for arterial blood gas analysis to obtain the oxygenation index. At the end of the experiment, the pulmonary wet/dry ratio (W/D), tumor necrosis factor-alpha (TNF-alpha), NO, malondialdehyde (MDA) and superoxide dismutase (SOD) contents in bronchoalveolar lavage fluid (BALF) were measured and the histological appearance of the lung tissue was observed.The oxygenation index was significantly higher (P0.05), W/D ratio lower (P0.05), and contents of TNF-alpha, NO and MAD in the BALF lower in the experimental group than in the control group (P0.05). The activity of SOD increased significantly in the experimental group as compared with the control group (P0.01), and the rabbits in the experimental group showed milder pathological changes.Intravenous pentoxifylline may improve pulmonary ventilation function and alleviate pulmonary injury, thus offering protection against pulmonary injury after one-lung ventilation.

To investigate the association of the left double-lumen endobronchial tube (DLT) and the inner diameter of the left main bronchus.Totally 100 adult patients who required intubation of a left-sided DLT during anesthesia for elective thoracic surgery were randomly enrolled in this study. All the participants underwent a preoperative chest CT scan by a spiral CT scanner. The diameters of the trachea and left main bronchus were measured with three-dimensional image reconstruction technique. All the measurements were performed using the electronic calipers of the spiral CT scanner and the left-sided DLT (Portex SIMS, USA) of the sizes 41Fr, 39Fr, 37Fr, and 35Fr were selected, being predicted according to the inner diameter of the left main bronchus. The placement of DLT was performed after anesthesia induction, and a DLT of a smaller size was selected if the bronchial end of the DLT failed to enter the left main bronchus after two attempts. The trachea and left main bronchus were examined for injury and other complications with postoperative fibreoptic bronchoscopy (FOB).All the 100 patients were intubated with DLT of appropriate sizes and satisfactory lung isolation was achieved. Postoperative complications of the trachea and bronchus were observed in none of the patients with FOB examination. The appropriate size of DLT is correlated with the left main bronchial diameter (correlation coefficient r=0.7346).Clinically, the size of DLT can be determined in accordance with the inner diameter of the left main bronchea.