bluuebunny/crossref_metadata_2025 huggingface dataset:
Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions
Authors: Perini Davina , Martellucci Jacopo
Published: February 2024

Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in the emergency setting. Clinical trials have consistently shown that indocyanine green (ICG)-guided surgery can dramatically reduce the risk of postoperative complications, length of in-hospital stay and total healthcare costs in the elective setting. It is well-known that emergency surgery has a higher complication rate than its elective counterpart, therefore an impelling need for research studies to explore, validate and develop this issue has been highlighted. The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies. Furthermore, we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations. In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases. We then deepened the two most described topics in ICG-guided emergency surgery: Acute cholecystitis and intestinal ischemia, focusing on both the advantages and limitations of green-fluorescence application in these two fields. In emergency situations, ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity, facilitating the detection of intestinal ischemic zones, identifying biliary tree anatomy, reducing post-operative complications, and mitigating high mortality rates. The need to improve its application still exists, therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emergency procedures.
Phospholipase A2 enzymes PLA2G2A and PLA2G12B as potential diagnostic and prognostic biomarkers in cholangiocarcinoma
Authors: Qiu Chen , Xiang Yu-Kai , Da Xuan-Bo , Zhang Hong-Lei , Kong Xiang-Yu , Hou Nian-Zong , Zhang Cheng , Tian Fu-Zhou , Yang Yu-Long
Published: February 2024

BACKGROUND

Phospholipase A2 (PLA2) enzymes are pivotal in various biological processes, such as lipid mediator production, membrane remodeling, bioenergetics, and maintaining the body surface barrier. Notably, these enzymes play a significant role in the development of diverse tumors.

AIM

To systematically and comprehensively explore the expression of the PLA2 family genes and their potential implications in cholangiocarcinoma (CCA).

METHODS

We conducted an analysis of five CCA datasets from The Cancer Genome Atlas and the Gene Expression Omnibus. The study identified differentially expressed genes between tumor tissues and adjacent normal tissues, with a focus on PLA2G2A and PLA2G12B. Gene Set Enrichment Analysis was utilized to pinpoint associated pathways. Moreover, relevant hub genes and microRNAs for PLA2G2A and PLA2G12B were predicted, and their correlation with the prognosis of CCA was evaluated.

RESULTS

PLA2G2A and PLA2G12B were discerned as differentially expressed in CCA, manifesting significant variations in expression levels in urine and serum between CCA patients and healthy individuals. Elevated expression of PLA2G2A was correlated with poorer overall survival in CCA patients. Additionally, the study delineated pathways and miRNAs associated with these genes.

CONCLUSION

Our findings suggest that PLA2G2A and PLA2G12B may serve as novel potential diagnostic and prognostic markers for CCA. The increased levels of these genes in biological fluids could be employed as non-invasive markers for CCA, and their expression levels are indicative of prognosis, underscoring their potential utility in clinical settings.
Influence of donor age on liver transplantation outcomes: A multivariate analysis and comparative study
Authors: Bezjak Miran , Stresec Ivan , Kocman Branislav , Jadrijević Stipislav , Filipec Kanizaj Tajana , Antonijević Miro , Dalbelo Bašić Bojana , Mikulić Danko
Published: February 2024

BACKGROUND

The growing disparity between the rising demand for liver transplantation (LT) and the limited availability of donor organs has prompted a greater reliance on older liver grafts. Traditionally, utilizing livers from elderly donors has been associated with outcomes inferior to those achieved with grafts from younger donors. By accounting for additional risk factors, we hypothesize that the utilization of older liver grafts has a relatively minor impact on both patient survival and graft viability.

AIM

To evaluate the impact of donor age on LT outcomes using multivariate analysis and comparing young and elderly donor groups.

METHODS

In the period from April 2013 to December 2018, 656 adult liver transplants were performed at the University Hospital Merkur. Several multivariate Cox proportional hazards models were developed to independently assess the significance of donor age. Donor age was treated as a continuous variable. The approach involved univariate and multivariate analysis, including variable selection and assessment of interactions and transformations. Additionally, to exemplify the similarity of using young and old donor liver grafts, the group of 87 recipients of elderly donor liver grafts (≥ 75 years) was compared to a group of 124 recipients of young liver grafts (≤ 45 years) from the dataset. Survival rates of the two groups were estimated using the Kaplan-Meier method and the log-rank test was used to test the differences between groups.

RESULTS

Using multivariate Cox analysis, we found no statistical significance in the role of donor age within the constructed models. Even when retained during the entire model development, the donor age's impact on survival remained insignificant and transformations and interactions yielded no substantial effects on survival. Consistent insignificance and low coefficient values suggest that donor age does not impact patient survival in our dataset. Notably, there was no statistical evidence that the five developed models did not adhere to the proportional hazards assumption. When comparing donor age groups, transplantation using elderly grafts showed similar early graft function, similar graft (P = 0.92), and patient survival rates (P = 0.86), and no significant difference in the incidence of postoperative complications.

CONCLUSION

Our center's experience indicates that donor age does not play a significant role in patient survival, with elderly livers performing comparably to younger grafts when accounting for other risk factors.
Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach
Authors: Wang Xing-Ru , Li Xiao-Ju , Wan Dan-Dan , Zhang Qian , Liu Tian-Xi , Shen Zong-Wen , Tong Hong-Xing , Li Yan , Li Jian-Wei
Published: February 2024

BACKGROUND

Advancements in laparoscopic technology and a deeper understanding of intrahepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy (LH) techniques. The indocyanine green (ICG) fluorescence navigation technique has emerged as the most effective method for identifying hepatic regions, potentially overcoming the limitations of LH. While laparoscopic left hemihepatectomy (LLH) is a standardized procedure, there is a need for innovative strategies to enhance its outcomes.

AIM

To investigate a standardized cranial-dorsal strategy for LLH, focusing on important anatomical markers, surgical skills, and ICG staining methods.

METHODS

Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed. The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad, isolating the Arantius ligament , exposing the middle hepatic vein, and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH. The surgical methods, as well as intra- and post-surgical data, were recorded and analyzed. Our hospital’s Medical Ethics Committee approved this study (Ethical review: 2022-019-01).

RESULTS

Intraoperative blood loss during LLH was 335.68 ± 99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5% and 0%, respectively. The overall incidence of complications throughout the follow-up (median of 18 months; range 1-36 months) was 21.6%. No mortality or severe complications (level IV) were reported.

CONCLUSION

LLH has the potential to become a novel, standardized approach that can effectively, safely, and simply expose the middle hepatic vein and meet the requirements of precision surgery.
Hemoglobin loss method calculates blood loss during pancreaticoduodenectomy and predicts bleeding-related risk factors
Authors: Yu Chao , Lin Yi-Min , Xian Guo-Zhe
Published: February 2024

BACKGROUND

The common clinical method to evaluate blood loss during pancreaticoduodenectomy (PD) is visual inspection, but most scholars believe that this method is extremely subjective and inaccurate. Currently, there is no accurate, objective method to evaluate the amount of blood loss in PD patients.

AIM

The hemoglobin (Hb) loss method was used to analyze the amount of blood loss during PD, which was compared with the blood loss estimated by traditional visual methods. The risk factors for bleeding were also predicted at the same time.

METHODS

We retrospectively analyzed the clinical data of 341 patients who underwent PD in Shandong Provincial Hospital from March 2017 to February 2019. According to different surgical methods, they were divided into an open PD (OPD) group and a laparoscopic PD (LPD) group. The differences and correlations between the intraoperative estimation of blood loss (IEBL) obtained by visual inspection and the intraoperative calculation of blood loss (ICBL) obtained using the Hb loss method were analyzed. ICBL, IEBL and perioperative calculation of blood loss (PCBL) were compared between the two groups, and single-factor regression analysis was performed.

RESULTS

There was no statistically significant difference in the preoperative general patient information between the two groups (P > 0.05). PD had an ICBL of 743.2 (393.0, 1173.1) mL and an IEBL of 100.0 (50.0, 300.0) mL (P < 0.001). There was also a certain correlation between the two (r = 0.312, P < 0.001). Single-factor analysis of ICBL showed that a history of diabetes [95% confidence interval (CI): 53.82-549.62; P = 0.017] was an independent risk factor for ICBL. In addition, the single-factor analysis of PCBL showed that body mass index (BMI) (95%CI: 0.62-76.75; P = 0.046) and preoperative total bilirubin > 200 μmol/L (95%CI: 7.09-644.26; P = 0.045) were independent risk factors for PCBL. The ICBLs of the LPD group and OPD group were 767.7 (435.4, 1249.0) mL and 663.8 (347.7, 1138.2) mL, respectively (P > 0.05). The IEBL of the LPD group 200.0 (50.0, 200.0) mL was slightly greater than that of the OPD group 100.0 (50.0, 300.0) mL (P > 0.05). PCBL was greater in the LPD group than the OPD group [1061.6 (612.3, 1632.3) mL vs 806.1 (375.9, 1347.6) mL] (P < 0.05).

CONCLUSION

The ICBL in patients who underwent PD was greater than the IEBL, but there is a certain correlation between the two. The Hb loss method can be used to evaluate intraoperative blood loss. A history of diabetes, preoperative bilirubin > 200 μmol/L and high BMI increase the patient's risk of bleeding.
Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet’s disease
Authors: Park Min Young , Yoon Yong Sik , Park Jae Ha , Lee Jong Lyul , Yu Chang Sik
Published: February 2024

BACKGROUND

Behcet’s disease (BD), a chronic vasculitic disorder affecting multiple organs, is characterized by recurrent oral and genital ulcers, arthritis, vasculitis, and intestinal ulcers. Although intestinal involvement of BD is common in East Asia, the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.

AIM

To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.

METHODS

Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed. Patients’ demographics, clinical features, postoperative course, complications, and follow-up data were evaluated.

RESULTS

We analyzed 39 surgeries in 31 patients. The mean patient age was 45.1 years, and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years (range 1.0-8.0 years). The most common indication for surgery was medical intractability (n = 16, 41.0%), followed by fistula or abscess (n = 11, 28.2%). Laparoscopic approaches were used in 19 patients (48.7%), and 5 patients (12.8%) underwent emergency surgeries. The most common surgical procedure was ileocecal resection (n = 18, 46.2%), followed by right colectomy (n = 11, 28.2%). A diverting stoma was created in only one patient (2.6%). During a mean follow-up period of 45 (range 8-72) months, eight cases (20.5%) of recurrence in five patients required reoperation. The interval between operations was 12.1 months (range 6.3-17.8 mo). Four patients (10.3%) experienced recurrence within 1 year postoperatively, and all eight recurrences occurred within 2 years of the initial surgery. The reoperation rates at 1 and 3 years were 10.3% and 20.5%, respectively. A redo ileocolic anastomosis was performed in all recurrent cases. In multivariate Cox regression analysis, emergency surgery [hazard ratio (HR) 9.357, 95% confidence interval (CI): 1.608-54.453, P = 0.013] and elevated C-reactive protein (CRP) levels (HR 1.154, 95%CI: 1.002–1.328, P = 0.047), but not medication use, were predictors of recurrence.

CONCLUSION

Surgical resection is a feasible treatment option for complicated BD. Reoperation is associated with severe inflammatory conditions, reflected by increased CRP levels and the requirement for emergency surgery.
Preoperative blood markers and intra-abdominal infection after colorectal cancer resection
Authors: Liu Chang-Qing , Yu Zhong-Bei , Gan Jin-Xian , Mei Tian-Ming
Published: February 2024

BACKGROUND

Colorectal cancer (CRC) has one of the highest morbidity and mortality rates among digestive tract tumors. Intra-abdominal infection (IAI) is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process. However, the factors influencing abdominal infection after CRC surgery remain unclear; further, prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.

AIM

To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.

METHODS

The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed. These patients were categorized into IAI (n = 15) and non-IAI groups (n = 65) based on whether IAI occurred. Influencing factors were compared; general data and laboratory indices of both groups were identified. The relationship between the indicators was assessed. Further, a nomogram prediction model was developed and evaluated; its utility and clinical applicability were assessed.

RESULTS

The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and carcinoembryonic antigen (CEA) levels. NLR was correlated with PLR and SII (r = 0.604, 0.925, and 0.305, respectively), while PLR was correlated with SII (r = 0.787). The nomogram prediction model demonstrated an area under the curve of 0.968 [95% confidence interval (CI): 0.948-0.988] in the training set (n = 60) and 0.926 (95%CI: 0.906-0.980) in the validation set (n = 20). The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048, respectively, indicating a good model fit. The decision curve analysis curves demonstrated high net income above the 5% threshold, indicating the clinical practicality of the model.

CONCLUSION

The nomogram model constructed using NLR, PLR, SII, and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC, potentially aiding clinical treatment decision-making.
Immune function status of postoperative patients with colon cancer for predicting liver metastasis
Authors: Xiong Le , Liu Fang-Chen
Published: February 2024

BACKGROUND

Colon cancer (CC) has a high incidence rate. Radical resection is the main treatment method for CC; however, liver metastasis (LM) often occurs post-surgery. The liver contains both innate and adaptive immune cells that monitor and remove abnormal cells and pathogens. Before LM, tumor cells secrete cytokines and exosomes to adjust the immune microenvironment of the liver, thus forming an inhibitory immune microenvironment for colonization by circulating tumor cells. This indicates that the immune state of patients with CC plays a crucial role in the occurrence and progression of LM.

AIM

To observe and analyze the relationship between immune status and expression of tumor factors in patients with LM of CC, and to provide a scientific intervention method for promoting the patient prognosis.

METHODS

A retrospective analysis was performed. The baseline data of 100 patients with CC and 100 patients with CC who suffered from postoperative LM and were admitted to our hospital from May 2021 to May 2023 were included in the non-occurrence and occurrence groups, respectively. The immune status of the patients and the expression of tumor factor-related indicators in the two groups were compared, and the predictive value of the indicators for postoperative LM in patients with CC was analyzed.

RESULTS

Compared with the non-occurrence group, the expression of serum carcinoembryonic antigen (CEA), CA19-9, CA242, CA72-4 and CA50 in patients in the occurrence group were significantly higher, while the expression of CD3+, CD4+, CD8+, natural killer (NK) and CD4+/CD25 in patients in the occurrence group were significantly lower (P < 0.05). No significant difference was observed in other baseline data between groups (P > 0.05). Multivariate logistic regression model analysis revealed that the expressions of CEA, CA19-9, CA242, CA72-4, CA50, CD3+, CD4+, CD8+, NK, and CD4+/CD25 were associated with the LM in patients with CC. High expressions of serum CEA, CA19-9, CA242, CA72-4 and CA50, and low expressions of CD3+, CD4+, CD8+, NK, and CD4+/CD25 in patients with CC were risk factors for LM (OR > 1, P < 0.05). The receiver operating characteristic curve showed that the area under curve for CEA, CA19-9, CA242, CA72-4, CA50, CD3+, CD4+, CD8+, NK, and CD4+/CD25 in the prediction of LM in patients with CC were all > 0.80, with a high predictive value.

CONCLUSION

The expression of tumor factors and immune state-related indices in patients with CC is closely associated with the occurrence of LM.
Biopsy forceps are useful for measuring esophageal varices in vitro
Authors: Duan Zhi-Hui , Zhou Sheng-Yun
Published: February 2024

BACKGROUND

To avoid acute variceal bleeding in cirrhosis, current guidelines recommend screening for high-risk esophageal varices (EVs) by determining variceal size and identifying red wale markings. However, visual measurements of EV during routine endoscopy are often inaccurate.

AIM

To determine whether biopsy forceps (BF) could be used as a reference to improve the accuracy of binary classification of variceal size.

METHODS

An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed. An online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 endoscopists. The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order.

RESULTS

The respondents included 48 academic and four private endoscopists. The accuracy of EV size estimation was low in both the visual (13.81%) and BF-based (20.28%) groups. The use of open forceps improved the ability of the endoscopists to correctly classify the varices by size (small ≤ 5 mm, large > 5 mm) from 71.85% to 82.17% (P < 0.001).

CONCLUSION

BF may improve the accuracy of EV size assessment, and its use in clinical practice should be investigated.
First experience in laparoscopic surgery in low and middle income countries: A systematic review
Authors: Troller Rebekka , Bawa Jasmine , Baker Olivia , Ashcroft James
Published: February 2024

BACKGROUND

Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers.

AIM

To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.

METHODS

MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery.

RESULTS

Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors.

CONCLUSION

Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.
Is tumor necrosis factor-α monoclonal therapy with proactive therapeutic drug monitoring optimized for inflammatory bowel disease? Network meta-analysis
Authors: Zheng Fang-Yuan , Yang Kai-Si , Min Wen-Cheng , Li Xin-Zhu , Xing Yu , Wang Shuai , Zhang Ying-Shi , Zhao Qing-Chun
Published: February 2024

BACKGROUND

The efficacy and safety of anti-tumor necrosis factor-α (TNF-α) monoclonal antibody therapy [adalimumab (ADA) and infliximab (IFX)] with therapeutic drug monitoring (TDM), which has been proposed for inflammatory bowel disease (IBD) patients, are still controversial.

AIM

To determine the efficacy and safety of anti-TNF-α monoclonal antibody therapy with proactive TDM in patients with IBD and to determine which subtype of IBD patients is most suitable for proactive TDM interventions.

METHODS

As of July 2023, we searched for randomized controlled trials (RCTs) and observational studies in PubMed, Embase, and the Cochrane Library to compare anti-TNF-α monoclonal antibody therapy with proactive TDM with therapy with reactive TDM or empiric therapy. Pairwise and network meta-analyses were used to determine the IBD patient subtype that achieved clinical remission and to determine the need for surgery.

RESULTS

This systematic review and meta-analysis yielded 13 studies after exclusion, and the baseline indicators were balanced. We found a significant increase in the number of patients who achieved clinical remission in the ADA [odds ratio (OR) = 1.416, 95% confidence interval (CI): 1.196-1.676] and RCT (OR = 1.393, 95%CI: 1.182-1.641) subgroups and a significant decrease in the number of patients who needed surgery in the proactive vs reactive (OR = 0.237, 95%CI: 0.101-0.558) and IFX + ADA (OR = 0.137, 95%CI: 0.032-0.588) subgroups, and the overall risk of adverse events was reduced (OR = 0.579, 95%CI: 0.391-0.858) according to the pairwise meta-analysis. Moreover, the network meta-analysis results suggested that patients with IBD treated with ADA (OR = 1.39, 95%CI: 1.19-1.63) were more likely to undergo TDM, especially in comparison with patients with reactive TDM (OR = 1.38, 95%CI: 1.07-1.77).

CONCLUSION

Proactive TDM is more suitable for IBD patients treated with ADA and has obvious advantages over reactive TDM. We recommend proactive TDM in IBD patients who are treated with ADA.
Treatment of hemolymphangioma by robotic surgery: A case report
Authors: Li Tian-Ning , Liu Yan-Hong , Zhao Jia , Mu Hong , Cao Lei
Published: February 2024

BACKGROUND

Hemolymphangioma of the jejunum is rare and lacks clinical specificity, and can manifest as gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Computed tomography, magnetic resonance imaging, and other examinations show certain characteristics of the disease, but lack accuracy. Although capsule endoscopy and enteroscopy make up for this deficiency, the diagnosis also still requires pathology.

CASE SUMMARY

A male patient was admitted to the hospital due to abdominal distension and abdominal pain, but a specific diagnosis by computed tomography examination was not obtained. Partial resection of the small intestine was performed by robotic surgery, and postoperative pathological biopsy confirmed the diagnosis of hemolymphangioma. No recurrence in the follow-up examination was observed.

CONCLUSION

Robotic surgery is an effective way to treat hemolymphangioma through minimally invasive techniques under the concept of rapid rehabilitation.
Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report
Authors: Pu Sha-Hong , Bao Wu-Yong-Ga , Jiang Zhen-Peng , Yang Rui , Lu Qiang
Published: February 2024

BACKGROUND

The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma. Consequently, a definitive diagnosis primarily relies on histological results. The ultrasound (US)-guided coaxial core needle biopsy (CNB) not only procures sufficient tissue to help clarify the diagnosis, but reduces the incidence of puncture-related complications.

CASE SUMMARY

A 41-year-old female, with a history of pulmonary tuberculosis, was admitted to our hospital with multiple indeterminate splenic lesions. Gray-scale ultrasonography demonstrated splenomegaly with numerous well-defined hypoechoic masses. Abdominal contrast-enhanced computed tomography (CT) showed an enlarged spleen with multiple irregular-shaped, peripherally enhancing, hypodense lesions. Positron emission CT revealed numerous abnormal hyperglycemia foci. These imaging findings strongly indicated the possibility of infectious disease as the primary concern, with neoplastic lesions requiring exclusion. To obtain the precise pathological diagnosis, the US-guided coaxial CNB of the spleen was carried out. The patient did not express any discomfort during the procedure.

CONCLUSION

Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples, as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and surrounding tissue.
Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report
Authors: Huang Cheng-Ken , Lu Ruey-Hwa , Chen Chien-Cheng , Chen Po-Chun , Hsu Wen-Chang , Tsai Meng-Jui , Ting Chin-Tsung
Published: February 2024

BACKGROUND

Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status. The gallstones may sometime be spilled into the peritoneal cavity, resulting in intra-abdominal abscess if the gallstones were not retrieved. The diagnosis of intra-abdominal abscess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies, such as abdominal ultrasonography or computed tomography (CT). Here we present a case of abscess formation from unretrieved gallstone following laparoscopic cholecystectomy, which mimics the imaging findings of metastatic gallbladder adenocarcinoma.

CASE SUMMARY

This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery. After adjuvant chemotherapy, the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered. Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.

CONCLUSION

Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery. For spilled gall bladder stones, surgeons may consider regular computerized tomography follow-up, and if necessary, laparoscopic examination can be used as a means of confirming the diagnostic and treatment.
Crosstalk between Wnt and bone morphogenetic protein signaling during osteogenic differentiation
Authors: Arya Pakkath Narayanan , Saranya Iyyappan , Selvamurugan Nagarajan
Published: February 2024

Mesenchymal stem cells (MSCs) originate from many sources, including the bone marrow and adipose tissue, and differentiate into various cell types, such as osteoblasts and adipocytes. Recent studies on MSCs have revealed that many transcription factors and signaling pathways control osteogenic development. Osteogenesis is the process by which new bones are formed; it also aids in bone remodeling. Wnt/β-catenin and bone morphogenetic protein (BMP) signaling pathways are involved in many cellular processes and considered to be essential for life. Wnt/β-catenin and BMPs are important for bone formation in mammalian development and various regulatory activities in the body. Recent studies have indicated that these two signaling pathways contribute to osteogenic differentiation. Active Wnt signaling pathway promotes osteogenesis by activating the downstream targets of the BMP signaling pathway. Here, we briefly review the molecular processes underlying the crosstalk between these two pathways and explain their participation in osteogenic differentiation, emphasizing the canonical pathways. This review also discusses the crosstalk mechanisms of Wnt/BMP signaling with Notch- and extracellular-regulated kinases in osteogenic differentiation and bone development.
Advances in the differentiation of pluripotent stem cells into vascular cells
Authors: Jiao Yi-Chang , Wang Ying-Xin , Liu Wen-Zhu , Xu Jing-Wen , Zhao Yu-Ying , Yan Chuan-Zhu , Liu Fu-Chen
Published: February 2024

Blood vessels constitute a closed pipe system distributed throughout the body, transporting blood from the heart to other organs and delivering metabolic waste products back to the lungs and kidneys. Changes in blood vessels are related to many disorders like stroke, myocardial infarction, aneurysm, and diabetes, which are important causes of death worldwide. Translational research for new approaches to disease modeling and effective treatment is needed due to the huge socio-economic burden on healthcare systems. Although mice or rats have been widely used, applying data from animal studies to human-specific vascular physiology and pathology is difficult. The rise of induced pluripotent stem cells (iPSCs) provides a reliable in vitro resource for disease modeling, regenerative medicine, and drug discovery because they carry all human genetic information and have the ability to directionally differentiate into any type of human cells. This review summarizes the latest progress from the establishment of iPSCs, the strategies for differentiating iPSCs into vascular cells, and the in vivo transplantation of these vascular derivatives. It also introduces the application of these technologies in disease modeling, drug screening, and regenerative medicine. Additionally, the application of high-tech tools, such as omics analysis and high-throughput sequencing, in this field is reviewed.
High quality repair of osteochondral defects in rats using the extracellular matrix of antler stem cells
Authors: Wang Yu-Su , Chu Wen-Hui , Zhai Jing-Jie , Wang Wen-Ying , He Zhong-Mei , Zhao Quan-Min , Li Chun-Yi
Published: February 2024

BACKGROUND

Cartilage defects are some of the most common causes of arthritis. Cartilage lesions caused by inflammation, trauma or degenerative disease normally result in osteochondral defects. Previous studies have shown that decellularized extracellular matrix (ECM) derived from autologous, allogenic, or xenogeneic mesenchymal stromal cells (MSCs) can effectively restore osteochondral integrity.

AIM

To determine whether the decellularized ECM of antler reserve mesenchymal cells (RMCs), a xenogeneic material from antler stem cells, is superior to the currently available treatments for osteochondral defects.

METHODS

We isolated the RMCs from a 60-d-old sika deer antler and cultured them in vitro to 70% confluence; 50 mg/mL L-ascorbic acid was then added to the medium to stimulate ECM deposition. Decellularized sheets of adipocyte-derived MSCs (aMSCs) and antlerogenic periosteal cells (another type of antler stem cells) were used as the controls. Three weeks after ascorbic acid stimulation, the ECM sheets were harvested and applied to the osteochondral defects in rat knee joints.

RESULTS

The defects were successfully repaired by applying the ECM-sheets. The highest quality of repair was achieved in the RMC-ECM group both in vitro (including cell attachment and proliferation), and in vivo (including the simultaneous regeneration of well-vascularized subchondral bone and avascular articular hyaline cartilage integrated with surrounding native tissues). Notably, the antler-stem-cell-derived ECM (xenogeneic) performed better than the aMSC-ECM (allogenic), while the ECM of the active antler stem cells was superior to that of the quiescent antler stem cells.

CONCLUSION

Decellularized xenogeneic ECM derived from the antler stem cell, particularly the active form (RMC-ECM), can achieve high quality repair/reconstruction of osteochondral defects, suggesting that selection of decellularized ECM for such repair should be focused more on bioactivity rather than kinship.
Human dental pulp stem/stromal cells in clinical practice
Authors: Grawish Mohammed E
Published: February 2024

Dental pulp stem/stromal cells (DPSCs) are fibroblast-like, neural crest-derived, and multipotent cells that can differentiate into several lineages. They are relatively easy to isolate from healthy and inflamed pulps, with little ethical concerns and can be successfully cryopreserved and thawed. The therapeutic effects of DPSCs derived from animal or human sources have been extensively studied through in-vitro and in-vivo animal experiments and the findings indicated that DPSCs are effective not only for dental diseases but also for systemic diseases. Understanding that translational research is a critical step through which the fundamental scientific discoveries could be translated into applicable diagnostics and therapeutics that directly benefit humans, several clinical studies were carried out to generate evidence for the efficacy and safety of autogenous or allogeneic human DPSCs (hDPSCs) as a treatment modality for use in cell-based therapy, regenerative medicine/dentistry and tissue engineering. In clinical medicine, hDPSCs were effective for treating acute ischemic stroke and human exfoliated deciduous teeth-conditioned medium (SHED-CM) repaired vascular damage of the corpus cavernous, which is the main cause of erectile dysfunction. Whereas in clinical dentistry, autologous SHED was able to regenerate necrotic dental pulp after implantation into injured teeth, and micrografts enriched with autologous hDPSCs and collagen sponge were considered a treatment option for human intrabony defects. In contrast, hDPSCs did not add a significant regenerative effect when they were used for the treatment of post-extraction sockets. Large-scale clinical studies across diverse populations are still lacking to provide robust evidence on the safety and efficacy of hDPSCs as a new treatment option for various human diseases including dental-related problems.
Multiple pretreatments can effectively improve the functionality of mesenchymal stem cells
Authors: Wan Xin-Xing , Hu Xi-Min , Xiong Kun
Published: February 2024

In this editorial, we offer our perspective on the groundbreaking study entitled “Hypoxia and inflammatory factor preconditioning enhances the immunosuppressive properties of human umbilical cord mesenchymal stem cells”, recently published in World Journal of Stem Cells . Despite over three decades of research on the clinical application of mesenchymal stem cells (MSCs), only a few therapeutic products have made it to clinical use, due to multiple preclinical and clinical challenges yet to be addressed. The study proved the hypoxia and inflammatory factor preconditioning led to higher immunosuppressive effects of MSCs without damaging their biological characteristics, which revealed the combination of inflammatory factors and hypoxic preconditioning offers a promising approach to enhance the function of MSCs. As we delve deeper into the intricacies of pretreatment methodologies, we anticipate a transformative shift in the landscape of MSC-based therapies, ultimately contributing to improved patient outcomes and advancing the field as a whole.
Cellular preconditioning and mesenchymal stem cell ferroptosis
Authors: Zineldeen Doaa Hussein , Mushtaq Mazhar , Haider Khawaja Husnain
Published: February 2024

In this editorial, we comment on the article published in the recent issue of the World Journal of Stem Cells . They focus on stem cell preconditioning to prevent ferroptosis by modulating the cystathionine γ-lyase/hydrogen sulfide (H2S) pathway as a novel approach to treat vascular disorders, particularly pulmonary hypertension. Preconditioned stem cells are gaining popularity in regenerative medicine due to their unique ability to survive by resisting the harsh, unfavorable microenvironment of the injured tissue. They also secrete various paracrine factors against apoptosis, necrosis, and ferroptosis to enhance cell survival. Ferroptosis, a regulated form of cell death characterized by iron accumulation and oxidative stress, has been implicated in various pathologies encompassing degenerative disorders to cancer. The lipid peroxidation cascade initiates and sustains ferroptosis, generating many reactive oxygen species that attack and damage multiple cellular structures. Understanding these intertwined mechanisms provides significant insights into developing therapeutic modalities for ferroptosis-related diseases. This editorial primarily discusses stem cell preconditioning in modulating ferroptosis, focusing on the cystathionase gamma/H2S ferroptosis pathway. Ferroptosis presents a significant challenge in mesenchymal stem cell (MSC)-based therapies; hence, the emerging role of H2S/cystathionase gamma/H2S signaling in abrogating ferroptosis provides a novel option for therapeutic intervention. Further research into understanding the precise mechanisms of H2S-mediated cytoprotection against ferroptosis is warranted to enhance the therapeutic potential of MSCs in clinical settings, particularly vascular disorders.
Unmanned Systems (UxS) Control Segment (UCS) Architecture: EA Version of UCS ICD Model
Authors:   AS-4UCS Unmanned Systems Control Segment Architecture
Published: February 2024

This User Guide describes the content of the Enterprise Architect (EA) version of the UCS Architectural Model and how to use this model within the EA modeling tool environment.

The purpose of the EA version of the UCS Architectural Interface Control Document (ICD) model is to provide a working model for Enterprise Architect tool users and to serve as the source model for the Rational Software Architect (RSA) and Rhapsody models (AIR6516 and AIR6517).

The AIR6515 EA Model has been validated to contain the same content as the AS6518 model for:

all UCS ICD interfaces

all UCS ICD messages

all UCS ICD data directly or indirectly referenced by ICD messages and interfaces

the Domain Participant, Information, Service, and Non-Functional Properties Models
Unmanned Systems (UxS) Control Segment (UCS) Architecture: Rhapsody Version of UCS ICD Model
Authors:   AS-4UCS Unmanned Systems Control Segment Architecture
Published: February 2024

This User Guide describes the content of the Rhapsody version of the UCS Architectural Model and how to use this model within the Rhapsody modeling tool environment.

The purpose of the Rhapsody version of the UCS Architectural Interface Control Document (ICD) model is to provide a model for Rhapsody users, derived from the Enterprise Architect (EA) model (AIR6515).

The AIR6515 EA Model, and by derivation, the AIR6517 Rhapsody Model, have been validated to contain the same content as the AS6518 model for:

all UCS ICD interfaces

all UCS ICD messages

all UCS ICD data directly or indirectly referenced by ICD messages and interfaces

the Domain Participant, Information, Service and Non-Functional Properties Models
Titanium Alloy Bars, Forgings and Forging Stock 5Al - 2.5Sn Annealed
Authors:   AMS G Titanium and Refractory Metals Committee
Published: February 2024

This specification covers a titanium alloy in the form of bars up through 4.000 inches (101.60 mm) inclusive, in nominal diameter or least distance between parallel sides, forgings of thickness up through 4.000 inches (101.60 mm), inclusive, and stock for forging of any size.
High-Flow Prescriptive Fueling Protocols for Gaseous Hydrogen Powered Medium and Heavy-Duty Vehicles
Authors:   Fuel Cell Standards Committee
Published: February 2024

This TIR establishes high-flow fueling protocols, including their process limits for fueling of compressed gaseous hydrogen vehicles at peak flow rates from 60 to 300 g/s with compressed hydrogen storage system (CHSS) volume capacities between 248.6 and 7500 L which have been qualified to UN GTR #13. This document is initially being published as a TIR due to limited field testing of the fueling protocols. Once the fueling protocols have been field tested, the SAE Fuel Cell Standards Committee Interface Task Force intends to publish a revision to this document as an SAE Standard.
ChatGPT and ELT: Exploring Teachers’ Voices
Authors: Mabuan Romualdo Atibagos
Published: February 2024

This study investigates the perceptions of English language teachers regarding the use of ChatGPT in English Language Teaching (ELT). The study aims to fill the research gap by exploring teachers' perspectives on the integration of ChatGPT as an instructional tool and its implications for ELT practices. Using a mixed methods approach, the study employed focus group discussions and an online survey to gather insights from a sample of 115 English language teachers in Metro Manila, Philippines. Findings revealed English language teachers’ perspectives on the use of ChatGPT in ELT including potential use of ChatGPT in ELT (e.g., integration for vocabulary expansion and writing practice and enhancing language fluency and communication), potential benefits of ChatGPT to English languge learners (e.g., translation and language comprehension support, conversational practice and language development, access to information and cultural understanding), and potential limitations of using ChatGPT in ELT (e.g., cheating and plagiarism, lack contextual understanding and nuance, reliability and accuracy of information). These findings shed light on teachers' perceptions of ChatGPT as a language teaching tool including ChatGPT’s integration into ELT, use of ChatGPT in writing activities, use of ChatGPT in improving language skills, and other benefits of using ChatGPT, including teachers' concerns regarding the authenticity of AI-generated content and the potential impact on language learning outcomes. The findings of this research contribute to the existing literature on the integration of AI technology in ELT and offer practical recommendations for educators seeking to leverage the potential of ChatGPT in language teaching. By giving voice to teachers' perspectives, this study underscores the importance of considering teachers' perceptions and experiences when incorporating emerging technologies like ChatGPT into the ELT classroom. Ultimately, this research aims to foster a deeper understanding of the complex dynamics between AI technology and language teaching, paving the way for informed decision-making and effective implementation in the field of ELT.
SNSF Datastory - 235 million francs in grants for transitional measures
Authors: Schnyder Daniel , Gorin Simon
Published: February 2024

First preliminary figures: In 2023, the SNSF invested 953 million francs in new projects, fellowships and publications of its regular funding schemes. We awarded a further 235 million for the Horizon Europe transitional measures.
CLINICAL STUDY TO EVALUATE THE EFFICACY OF KAPAL BHATI AND TRIKONASANA IN STHOULYA (OBESITY)
Authors: Buldak Onkar , Kumar Mishra Pramod , Sharma Brahmanand
Published: February 2024

Obesity is the abnormal expansion of adipose tissue brought on by an increase in the number, size, or both of fat cells. This study aims to evaluate the effects of Yoga therapy (Kapal Bhati & Trikonasana) on Sthoulya in Obese patients. Objectives are to bring about a reduction of body weight, reduction of Waistline, and improvement in their quality of life by decreasing stress levels. 40 Obese patients aged 18-45 years, who were willing to partici-pate in the trial were recruited. Those suffering from any medical and Steroid treatment and any other Disorders were excluded. Their body mass index, waist circumference, hip circumference, and blood pressure were meas-ured. Dietary habits and exercise details were recorded. As a part of a clinical trial, they were taught Yoga (Ka-pal Bhati & Trikonasana) for 30-45 minutes. They were instructed to practice twice daily, followed by Shavasa-na for a few minutes with balanced dietary intake and Pathya and Apathya. A baseline assessment of the various parameters was taken. The trial was done for three months. Yoga therapy for three months resulted in a signifi-cant reduction in all body weight measures. Thus, the significant changes observed using different parameters in this study found that yoga therapy has several beneficial effects in reducing body weight.
CONCEPTUAL REVIEW ON ETIOPATHOGENESIS OF VATASHTEELA
Authors: Kiran K , G Bhat Vijayendra , Kamath Shrilatha
Published: February 2024

Vatasteela is one of the Mootraghatas. Vatashteela is named so because of the Vatadushti and formation of a Granthi which is like Ashma (stone like). This Granthi causes obstruction to Mootramarga. Due to the obstruc-tion, it results in clinical features like Basti Adhmana (Distention of Basti), Vedana (Pain) and Mootrasanga (Obstruction to flow of Mootra). The Etiopathogenesis of Vatasteela is understood with the help of general de-scription of Mootraghatas and other related concepts. The treatment consideration for Vatashteela is also same as Mootraghata Chikitsa. Based on the similarity found in the clinical picture, Vatashteela is compared with Be-nign Prostatic Hyperplasia (BPH).