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Background: Although surgical resection is the main treatment for rectal cancer, the optimal surgical protocol for elderly patients with rectal cancer remains controversial. This study evaluated the feasibility of robot-assisted surgery in elderly patients with rectal cancer., Patients and Methods: This retrospective study enrolled 156 patients aged 28-93 years diagnosed with Stage I-III rectal cancer, who underwent robot-assisted surgery between May 2013 and December 2018 at a single institution., Results: In total, 156 patients with rectal cancer, including 126 non-elderly (aged < 70 years) and 30 elderly (aged ≥70 years) patients, who underwent robot-assisted surgery were recruited. Between the patient groups, the post-operative length of hospital stay did not differ statistically significantly (P = 0.084). The incidence of overall post-operative complications was statistically significantly lower in the elderly group (P = 0.002). The disease-free and overall survival did not differ statistically significantly between the two groups (P = 0.719 and 0.390, respectively)., Conclusions: Robot-assisted surgery for rectal cancer was well tolerated by elderly patients, with similar results to the non-elderly patients. Oncological outcomes and survival did not depend on patient age, suggesting that robot-assisted surgery is a feasible surgical modality for treating operable rectal cancer and leads to age-independent post-operative outcomes in elderly patients., Competing Interests: None

Objectives: Myostatin is a myokine predominantly expressed and secreted in skeletal muscle in response to stimulations, including oxidative stress or inflammation. We investigated a potential association between myostatin levels and endothelial function among kidney transplantation (KT) patients., Materials and Methods: Fasting blood samples were collected from 64 KT patients. The endothelial function that indicated by vascular reactivity index (VRI) was measured by digital thermal monitoring test. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay kit. All patients were categorized into three groups according to their VRI values: poor vascular reactivity was considered if VRI <1.0; 1.0 ≤VRI <2.0 indicated intermediate vascular reactivity, and VRI ≥2.0 was grouped as good vascular reactivity., Results: Seven KT patients (10.9%) were categorized as poor vascular reactivity, 24 KT patients (37.5%) were grouped as intermediate vascular reactivity, and 33 KT patients had good vascular reactivity. Advanced age ( r = -0.372, P = 0.002) and serum alkaline phosphate (ALP) level ( r = -0.341, P = 0.006) were negatively correlated with VRI. However, serum myostatin level ( r = 0.430, P < 0.001) was positively correlated with VRI. In multivariable forward stepwise linear regression analysis, high serum level of myostatin (β = 0.441, adjusted R 2 change = 0.171; P < 0.001), advanced age (β = -0.317, adjusted R 2 change = 0.138; P = 0.003), and serum ALP level (β = -0.270, adjusted R 2 change = 0.060; P = 0.011) were significantly associated with VRI in KT patients., Conclusion: Our study showed that fasting myostatin level was positively associated with VRI and endothelial function among KT patients., Competing Interests: Dr. Bang-Gee Hsu and Dr. Ming-Che Lee, the editorial board members at Tzu Chi Medical Journal, had no roles in the peer review process of or decision to publish this article. The other authors declared that they have no conflicts of interest., (Copyright: © 2021 Tzu Chi Medical Journal.)

Serine incorporator protein 5 (SERINC5) is the host antiretroviral factor that reduces HIV-1 infectivity by incorporating into virions and inhibiting the envelope glycoprotein (Env) mediated virus fusion with target cells. We and others have shown that SERINC5 incorporation into virions alters the Env structure and sensitizes the virus to broadly neutralizing antibodies targeting cryptic Env epitopes. We have also found that SERINC5 accelerates the loss of Env function over time compared to control viruses. However, the exact mechanism by which SERINC5 inhibits HIV-1 fusion is not understood. Here, we utilized 2D and 3D super-resolution microscopy to examine the effect of SERINC5 on the distribution of Env glycoproteins on single HIV-1 particles. We find that, in agreement with a previous report, Env glycoproteins form clusters on the surface of mature virions. Importantly, incorporation of SERINC5, but not SERINC2, which lacks antiviral activity, disrupted Env clusters without affecting the overall Env content. We also show that SERINC5 and SERINC2 also form clusters on single virions. Unexpectedly, Env and SERINC molecules exhibited poor codistribution on virions, as evidenced by much greater Env-SERINC pairwise distances compared to Env-Env distances. This observation is inconsistent with the previously reported interaction between Env and SERINC5 and suggests an indirect effect of SERINC5 on Env cluster formation. Collectively, our results reveal a multifaceted mechanism of SERINC5-mediated restriction of HIV-1 fusion that, aside from the effects on individual Env trimers, involves disruption of Env clusters, which likely serve as sites of viral fusion with target cells.

Anorectal malignant melanoma is a very rare but aggressive cancer which carries poor prognosis. Surgical intervention is the main management but whether wide local excision or abdominoperineal resection has better survival benefit remains controversial. However, robotic-assisted restorative proctectomy with coloanal anastomosis with intersphincteric resection (ISR) has not been reported yet. Hence, we presented a case with anorectal malignant melanoma treated with robotic-assisted ISR with coloanal anastomosis. The patient has satisfied post-operative life quality, and no local recurrence was noted after 3-year follow-up., Competing Interests: None

Ethnopharmacological Relevance: Brown seaweed is a common food for Asians, and the bioactive ingredient fucoxanthin exerts anti-apoptotic activities in several cell types. Renal tubular cell apoptosis is one of the common cellular events leading to renal fibrosis and chronic kidney disease (CKD). However, the influence of fucoxanthin-containing brown seaweed extract on CKD is still unknown. We intended to evaluate the inhibitory effect of fucoxanthin-containing extract from brown seaweed on renal apoptosis under CKD condition and its molecular mechanism., Materials and Methods: The fucoxanthin-containing brown seaweed extract (LJE) was prepared from Laminaria japonica. We investigated how LJE influences on both doxorubicin-treated rat renal tubular cells (NRK-52E) and the renal symptoms of nephrectomy-induced CKD mice., Results: LJE inhibited doxorubicin-induced apoptosis and upregulated Na + /H + exchanger isoform 1 (NHE1) expression in NRK-52E cells, which were blocked by the NHE1 inhibitor cariporide. LJE also upregulated peroxisome proliferator-activated receptor alpha (PPARα). PPARα siRNA transfection inhibited LJE-induced NHE1 expression and anti-apoptotic effect. In CKD mice, LJE increased NHE1 expression in renal tubules and reduced apoptotic renal tubular cells, but not in PPARα knockout mice. The inhibitory effect of LJE on apoptosis also reduced renal tubulointerstitial fibrosis and improved renal function in CKD mice., Conclusion: We demonstrated that LJE inhibits renal apoptosis via NHE1 upregulation. The anti-apoptotic effect of LJE also improves renal function in CKD mice. Therefore, fucoxanthin-containing brown seaweed may have a therapeutic potential for CKD patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Increased circulating leptin, a marker of leptin resistance, is common in patients with obesity and is also an independent factor in prediction of cardiovascular disease. The aim of this study was to evaluate the relationship between fasting serum leptin levels and the aortic augmentation index (AIx) in kidney transplant recipients., Materials and Methods: Fasting blood samples were obtained from 70 kidney transplant recipients. The aortic AIx was measured using a validated tonometry system (SphygmoCor). Plasma leptin levels were measured using a commercial enzyme-linked immunosorbent assay kit., Results: Simple linear analysis of the aortic AIx in kidney transplant recipients showed that body fat mass ( P = 0.002), diastolic blood pressure (DBP) ( P = 0.020), logarithmically transformed triglycerides ( P = 0.035), and leptin ( P < 0.001) were positively correlated, while height ( P = 0.004) and the glomerular filtration rate ( P = 0.022) were negatively correlated with the aortic AIx in kidney transplant recipients. Forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx showed that leptin ( P < 0.001), DBP ( P = 0.014), and body height ( P = 0.036) were independent predictors of the aortic AIx in kidney transplant recipients., Conclusion: These results suggest that the serum fasting leptin level is associated with the aortic AIx in kidney transplant recipients., Competing Interests: There is no conflict of interest.

Introduction: Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy., Case Presentation: A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged., Conclusion: Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.

Adipocyte fatty acid binding protein (A-FABP) is significantly expressed in white and brown adipose tissue, monocytes, and macrophages and is a central regulator of systemic insulin sensitivity. Metabolic syndrome (MetS) is a risk factor for post-transplant diabetes mellitus (PTDM), chronic graft dysfunction, graft loss, and patient death in kidney transplantation (KT) patients. This study was undertaken to evaluate the relationship between MetS and fasting serum A-FABP concentration in KT patients. Fasting blood samples were obtained from 70 KT patients. Serum A-FABP levels were measured using a commercial enzyme-linked immunosorbent assay kit. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation. Twenty-two patients (31.4%) had MetS. KT patients with hypertension ( P = 0.011), diabetes ( P = 0.002), body weight ( P = 0.004), body mass index (BMI, P = 0.001), waist circumference ( P < 0.001), body fat mass ( P < 0.001), systolic blood pressure (SBP, P = 0.017), total cholesterol (TCH, P = 0.028), triglycerides (TG, P = 0.001), blood urea nitrogen (BUN, P = 0.003), insulin ( P < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR, P < 0.001), and A-FABP level ( P < 0.001) were higher, while high-density lipoprotein cholesterol (HDL-C, P = 0.010) was lower in KT patients with MetS. Moreover, SBP (β = 0.347, adjusted R 2 change = 0.108, P = 0.001) and logarithmically transformed triglycerides (log-TG, β = 0.393, adjusted R 2 change = 0.189, P < 0.001) were associated with A-FABP levels in a multivariable forward stepwise linear regression analysis among KT patients. The results of our study showed that the fasting A-FABP level was positively associated with MetS in KT patients. SBP and log-TG were independent predictors of the serum A-FABP level among KT patients., Competing Interests: None., (IJCEP Copyright © 2017.)

Objective: Estrogen interacts with a membrane receptor, G protein-coupled estrogen receptor (GPER). It was reported that 17β-estradiol was able to inhibit contraction of the human colon and cause relaxation of the guinea pig gallbladder, however, the involvement of GPER was not clarified. The aim of the present study was to investigate the effect of estrogen on human gallbladder motility and the possible role of GPER., Materials and Methods: Relaxation of human gallbladder strips were measured using isometric transducers. Expression of GPER was evaluated by reverse transcription polymerase chain reaction (PCR), realtime PCR, and immunohistochemistry., Results: In human gallbladder strips, 17β-estradiol and G-1 elicited marked and rapid relaxation, whereas tamoxifen produced mild concentration-dependent relaxation. The relative efficacies to cause relaxation were as follows: 17β-estradiol = G-1 > tamoxifen. The relaxant response of 17β-estradiol was not attenuated by tetrodotoxin or conotoxin GVIA. This implies that nerve stimulation was not involved in the 17β-estradiol-induced gallbladder relaxation. Analysis by reverse transcription PCR and real-time PCR showed that GPER was expressed in the human gallbladder. Further analysis by immunohisto-chemistry revealed that GPER was expressed in the gallbladder muscle. This suggests that 17β-estradiol relaxes the human gallbladder via GPER., Conclusion: These results demonstrate for the first time that 17β-estradiol and GPER agonist G-1 cause relaxation of the human gallbladder, probably through GPER. Estrogen might play an important role in the control of human gallbladder motility., Competing Interests: Conflicts of interest: none.

Objectives: Arterial stiffness is recognized as an independent risk factor for cardiovascular morbidity and mortality. Recent studies found that osteoprotegerin (OPG) is associated with arterial stiffness and may reflect endothelial dysfunction. The aim of this study was to evaluate the relationship between fasting serum OPG levels and the aortic augmentation index (AIx) in renal transplant recipients., Materials and Methods: Fasting blood samples were obtained from 66 renal transplant recipients. The aortic AIx was measured using a validated tonometry system (SphygmoCor). Serum OPG levels were measured using a commercial enzyme-linked immunosorbent assay kit., Results: Univariate linear analysis of the aortic AIx in renal transplant recipients revealed that body fat mass ( r = 0.377, p = 0.002), aortic diastolic blood pressure (DBP; r = 0.307, p = 0.020), triglycerides ( r = 0.260, p = 0.035), and logarithmically transformed OPG (log-OPG, r = 0.402, p < 0.001) were positively correlated, whereas height ( r = 0.361, p = 0.004) and body weight ( r = 0.212, p = 0.041) were negatively correlated with the aortic AIx in renal transplant recipients. Multivariate forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx showed that log-OPG ( R 2 = 0.213, p < 0.001), height ( R 2 = 0.081, p = 0.009), and aortic DBP ( R 2 = 0.058, p = 0.022) were independent predictors of the aortic AIx in renal transplant recipients., Conclusion: These results suggest that the serum fasting OPG level is associated with the aortic AIx in renal transplant recipients., Competing Interests: Conflicts of interest: none.

Objectives: Peripheral arterial diseases associated with an increased risk of death in kidney transplant patients. Natriuretic peptide has anti-atherosclerotic effects. We sought to evaluate the relation between ankle-brachial index and fasting serum long-acting natriuretic peptide concentrations in kidney transplant patients., Materials and Methods: Fasting blood samples were obtained from 69 kidney transplant patients. Serum long-acting natriuretic peptide concentrations were measured using a commercially available enzyme immunoassay kit. Left or right ankle-brachial index values that were < 0.9 were included in the low ankle-brachial index group., Results: Fifteen patients (21.7%) were enrolled in the low ankle-brachial index group. Increased waist circumference (P = .013), higher serum total cholesterol levels (P = .019), higher triglyceride levels (P = .002), and decreased serum long-acting natriuretic peptide concentrations (P = .006) were noted in the low ankle-brachial index group. Univariate linear regression analysis indicated that the left/right ankle-brachial index values of the subjects were negatively correlated with serum triglycerides (P = .008 or P < .001) and fasting glucose levels (P = .034 or P = .012), but were positively correlated with long-acting natriuretic peptide concentrations (P = .011 or P = .011). Multivariate forward stepwise linear regression analyses of the significant variables revealed that serum triglycerides and long-acting natriuretic peptide levels were independent predictors of the left/right ankle-brachial index values of kidney transplant patients., Conclusions: Serum long-acting natriuretic peptide concentrations correlate positively with ankle-brachial index values among the kidney transplant patients.

Objective: Muscarinic receptors mediate contraction of the human gallbladder through unclear receptor subtypes. The aim of the present study was to characterize muscarinic acetylcholine receptors mediating contraction of the human gallbladder., Materials and Methods: Contraction of human gallbladder muscle strips caused by agonists carbachol and muscarine was measured and the inhibition of carbachol-induced contraction by muscarinic receptor antagonists was evaluated. Reverse transcription polymerase chain reaction was performed to determine the existence of muscarinic receptor subtypes., Results: Carbachol and muscarine caused concentration-dependent contraction of gallbladder strips. Four receptor antagonists, including atropine, 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP), methoctramine, and pirenzepine, inhibited the carbachol-induced contraction. The relative inhibitory potency of these receptor antagonists was atropine > 4-DAMP > methoctramine > pirenzepine. The antagonist affinity estimates (pA(2) values) correlated with the known affinities at M(3), M(4), and M(5) muscarinic receptors. In addition, the M(4)-selective antagonist muscarinic toxin 3 did not inhibit and the M(5)-selective positive allosteric modulator VU0238429 did not potentiate carbachol-induced gallbladder contraction. This suggests that M(3) muscarinic receptors mediate the muscarinic response predominantly. The contractile response of carbachol was attenuated by the voltage-gated Ca(2+) channel inhibitor nifedipine and Rho-kinase inhibitor H-1152, but not affected by protein kinase C inhibitor chelerythrine. This implies the involvement of voltage-gated Ca(2+) channel and Rho kinase but not protein kinase C., Conclusions: These results suggest a major role of M(3) muscarinic receptors mediating the human gallbladder contraction through voltage-gated Ca(2+) channels and Rho kinase. M(3)-selective muscarinic receptor antagonists could be of therapeutic importance in the treatment of biliary motility disorders.

Hypertrophic osteoarthropathy (HOA) is a paraneoplastic syndrome characterized by periosteal formation and arthritis and usually accompanied by clubbing ofthe digits. Many malignancies have been associated with HOA/clubbing, most being lung cancer and lung metastatic cancer. We herein present a 53-year-old man with lung metastasis from renal cell carcinoma (RCC). HOA occurred one year after the metastasis. Reviewing the literature, only five cases of RCC with HOA have been reported. If their clinical history was traceable, they consistently had disease progression. We reviewed the pathogenesis of HOA/clubbing and linked the prognosis of RCC to relevant cytokines. Therefore, HOA not only heralds a progression of disease but suggests a probable therapeutic choice by targeting some cytokines.

Gilbert's syndrome is a benign, often familial condition characterized by asymptomatic jaundice. A patient suffering from Gilbert's syndrome may have hepatic activity of bilirubin-UDP-glucuronosyltransferase decreasing to levels around 30% of the normal. A clinical diagnosis of Gilbert's syndrome is usually followed in case of mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. This article reported a 17-year-old male with only partial indication of indirect hyperbilirubinemia. Rifampicin test and caloric restriction test were applied to assure the patient had Gilbert's syndrome. These two non-invasive diagnostic means, with the benefit of avoiding hazardous liver biopsy, are gaining popularity in our routine Gilbert's syndrome examination.