RC Group Research Articles

Remnant cholesterol is superior to other lipid-related parameters for the prediction of cardiometabolic disease risk in individuals with hypertension: The Kailuan study

BackgroundIt is uncertain which lipid-related parameter is most suitable for predicting the risk of cardiometabolic disease (CMD) in individuals with hypertension. AimsTo explore which lipid-related parameter is most suitable for predicting the risk of CMD. Methods and resultsWe studied 30,378 patients with hypertension who completed the 2006–2007 Kailuan health examination and followed up until December 31, 2021. In the constructed model, the utilities of lipid-related parameters for the prediction of CMD were compared using the C-index, NRI, and IDI. The best predictor (remnant cholesterol, RC) was identified and the participants were grouped according to RC quartile. Cox proportional hazard analysis was then used to evaluate the relationship between RC and the risk of CMD. During a median follow-up period of 14.7 years (IQR 5.3–15.1), 9502 (31.27 %) participants with hypertension developed CMD. The C-index, NRI, and IDI values for RC were higher than those for the other lipid parameters. After adjustment for multiple potential confounding factors, compared with the quartile (Q)1 RC group, the adjusted hazard ratios for CMD of the Q2–Q4 groups were 1.09 (1.03–1.16), 1.17 (1.11–1.24), and 1.25 (1.18–1.33) (P < 0.0001). Restrictive cubic spline analysis revealed dose-dependent relationships of lipid parameters with the risk of CMD. ConclusionsRC is superior to other lipid parameters for the prediction of the risk of CMD in individuals with hypertension. As the concentration of RC increases, the risk of CMD in such individuals also increases.

Unraveling the Mfn2-Warburg effect nexus: a therapeutic strategy to combat pulmonary arterial hypertension arising from catch-up growth after IUGR

BackgroundThe interplay between intrauterine and early postnatal environments has been associated with an increased risk of cardiovascular diseases in adulthood, including pulmonary arterial hypertension (PAH). While emerging evidence highlights the crucial role of mitochondrial pathology in PAH, the specific mechanisms driving fetal-originated PAH remain elusive.Methods and resultsTo elucidate the role of mitochondrial dynamics in the pathogenesis of fetal-originated PAH, we established a rat model of postnatal catch-up growth following intrauterine growth restriction (IUGR) to induce pulmonary arterial hypertension (PAH). RNA-seq analysis of pulmonary artery samples from the rats revealed dysregulated mitochondrial metabolic genes and pathways associated with increased pulmonary arterial pressure and pulmonary arterial remodeling in the RC group (postnatal catch-up growth following IUGR). In vitro experiments using pulmonary arterial smooth muscle cells (PASMCs) from the RC group demonstrated elevated proliferation, migration, and impaired mitochondrial functions. Notably, reduced expression of Mitofusion 2 (Mfn2), a mitochondrial outer membrane protein involved in mitochondrial fusion, was observed in the RC group. Reconstitution of Mfn2 resulted in enhanced mitochondrial fusion and improved mitochondrial functions in PASMCs of RC group, effectively reversing the Warburg effect. Importantly, Mfn2 reconstitution alleviated the PAH phenotype in the RC group rats.ConclusionsImbalanced mitochondrial dynamics, characterized by reduced Mfn2 expression, plays a critical role in the development of fetal-originated PAH following postnatal catch-up growth after IUGR. Mfn2 emerges as a promising therapeutic strategy for managing IUGR-catch-up growth induced PAH.

Prospective comparative study of quality of life in patients with bladder cancer undergoing cystectomy with ileal conduit or bladder preservation

ObjectiveTo compare health-related quality of life (HRQOL) in patients undergoing radical cystectomy with ileal conduit (RC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer.Methods and analysisPatients with bladder cancer,...

P-788 Analysis of tissue regeneration after transplantation of bioengineered uterine grafts in a sheep model of uterine injury

Abstract Study question Can we regenerate a damaged uterus using decellularized (further repopulated with stem cells or not) uterine scaffolds in a sheep model? Summary answer Bioengineered uterine grafts can promote the regeneration of a damaged uterus, but this process is highly dependent on the basal immune status of the recipient. What is known already Uterus bioengineering aims to develop scaffolds to repair defective uterine tissue that may cause infertility. The remaining extracellular matrix after uterus decellularization has frequently been used as a scaffold material for preclinical treatment applications. So far, multiple in vivo studies using rodents have shown successful restoration of uterine tissue and even fertility when small grafts were used. Furthermore, this pro-regenerative effect is enhanced when repopulating the scaffolds with mesenchymal stem cells (MSCs). However, studies using larger animal models and larger scaffolds are still missing. Therefore, we investigated the therapeutic potential of transplanting these scaffolds in the sheep model. Study design, size, duration All experiments were performed in university facilities, including the sheep animal work. Uterine scaffold donor sheep (from a local abattoir) and recipient sheep (n = 10) were of the same mixed sheep breed (Swedish fin-ull and Dutch texel mixed breed) and age (8-12 months old). Recipient sheep were transplanted with uterine decellularized (either recellularized or not) grafts that were maintained for 6 weeks. Participants/materials, setting, methods We implemented our previously established decellularization protocol (2% sodium deoxycholate) for sheep uterine scaffold production, generating 3x2cm grafts; half of these were recellularized with sheep MSCs. Decellularized (DC; n = 7) and recellularized (RC; n = 8) grafts were transplanted as replacements for native uterine tissue. After six weeks, histological, immunohistochemistry (CD31, CD45), and gene expression (progesterone/estrogen receptors, HOXA10, VEGF, vWF, TNFA, IFNG) analysis were conducted. Simultaneously, we used cell sorting to monitor the systemic immune response over time. Main results and the role of chance Angiogenesis was increased in the RC group as more new blood vessels (CD31+ cells) were evidenced (P=0.0120). VEGF and vWF gene expression also indicated the presence of blood vessels in the grafts but without differences among the groups. Regarding the immune response, CD45 staining revealed leukocyte recruitment into both transplanted grafts, with an increased significance in the DC group (P=0.0071) compared to the RC (P=0.0181). Furthermore, the pro-inflammatory genes TNFA and IFNG expression remained invariable compared to the native tissue. Finally, hormone receptor gene levels were comparable to those in the native tissue, with HOXA10 presenting higher values in the RC group compared to the DC (P=0.0548). So, the RC group showed signs of better uterine regeneration, probably due to the MSC’s anti-inflammatory action. Still, differences were subtle between groups. So, we blindly analyzed the histology of all grafts and detected substantially but also poorly regenerated grafts in both DC and RC groups. The analysis of the systemic immune response likely answers this, as when segregating individuals in substantially and poorly regenerated grafts, there was a significant difference in the percentage of activated CD4+ T-cells, being higher (P&amp;lt;0.0001) in those with poorly regenerated grafts already at day 0. Limitations, reasons for caution Due to the lack of available sheep antibodies, we did not study specific subtypes of leukocytes by immunohistochemistry as we did for the cell sorting analysis. Also, despite experienced group members performing the blinded histological analysis of the grafts to detect substantially/poorly regenerated grafts, this method requires refinement. Wider implications of the findings Basal immune system status should be considered before transplanting uterine grafts, as inflammation seems crucial in tissue regeneration. Trial registration number Not applicable

#1866 Gender gap in renal transplantation, myth or truth?

Abstract Background and Aims Multiple works show that women are less likely to receive a kidney transplant (Tx) compared to their male counterparts. We aimed to study the sex differences in access to Tx in our waiting list. We also studied the rate of masculine and feminine donors (Do) and their match to same-sex recipients (Rc). Method We included all adult patients active in our transplant waiting list during a 2-year period (from January 1-2021 to December 31-2022). Our center is a medium volume transplant center, and we only perform Tx from deceased donors, and don't perform combined organ transplantation. We analyzed the rate of women vs male, and Rc's and Do's sex, the degree of sex match and mismatch. We evaluated differences in time in waiting list until Tx, re-transplantation, and hyperimmunized patients, between groups. Results 270 individuals were active in our waiting list, 174 (64%) men, and 96 (36%) women. 142 were transplanted during the study period, 92 (65%) were males, and 50 (35%) females. We found no differences in terms of age, BMI, time to Tx, condition of hyperimmunized or re-Tx in the Rc's group and the rate of Tx (p = 0.34) (see Table A). We had 102 donors, ♀ 41 (40%), ♂ 61 (60%), regarding to their features, differences between age and BMI were statistically non-significant, neither in individually nor delta analysis (see Tables B-C, and Figs A-B). Proportionally more male kidneys were transplanted to female Rc's. Conclusion In our sample, we had a 2:1 rate of males to women in our waiting list, and in access to Tx. Relatively more women received a kidney form a male Do (46 vs 31%). Although other studies find a gender gap in access to kidney Tx, this phenomenon was not found in our sample. However, our results may be conditioned by a small sample size. We need to design well powered and multicentric studies, to dilucidate this controversial issue.

Long-Term Effects of Botulinum Toxin A Versus Incisional Surgery for Management of Partially Accommodative Esotropia in Children: Comparison of Three Approaches

Purpose: To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children.Design: Retrospective comparative clinical study.Methods: The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients.Results: There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group [78% (35/45), 84% (38/45)] and the BMR rc group [72% (18/25), 84% (21/25)] (P = 0.042 for near and P=0.006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the three surgical approaches (P=0.656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group [81% (26/32)] and the BMR rc group [88% (14/16)] was higher than that in the BTX-A group [38% (5/13); P=0.004]. There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P>0.05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P=0.017).Conclusions: Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.

Abstract 1057: Association Between Remnant Cholesterol And All-cause Mortality And Cardiovascular Mortality In Young And Middle-aged American Adults: A Retrospective Cohort Study

Background: The association of remnant cholesterol with all-cause mortality and cardiovascular mortality in young, middle-aged American adults remains unclear. The purpose of the study is to explore this relationship. Methods: This retrospective cohort study included 16428 patients aged from 18 to 65 years old from the National Health and Nutrition Examination Survey (1999–2018) with follow-up mortality outcomes records linked to the National Death Index (NDI) until December 31, 2019. Participants were divided into four groups based on the RC quartile: a Q1 group (≤0.359 mmol/L), a Q2 group (0.359–0.517 mmol/L), a Q3 group (0.518–0.768 mmol/L), and a Q4 group (≥0.768 mmol/L). Multivariable Cox proportional hazards models were used to estimate the risk of mortality. Results: During a 123-month follow-up, a total of 931 (5.02%) all-cause deaths and 239 (1.22%) CVD-related deaths were recorded. After adjusting for multiple potential confounding factors and comparing them with the Q1 RC group of the participants, the adjusted hazard ratios for all-cause mortality for the Q2–Q4 groups were 0.98 (0.69, 1.38), 1.02 (0.74, 1.39), and 1.45 (1.09, 1.92) ( P for trend = 0.001), and those for cardiovascular mortality were 1.41 (0.68, 2.94), 1.77 (0.86, 3.62), and 2.98 (1.38, 6.43), respectively ( P for trend =0.001). The restricted cubic splines revealed a non-linear association between the baseline RC and cardiovascular mortality. Interestingly, an interaction effect was found between gender and RC in all-cause mortality. Conclusion: RC was associated with an increased risk of all-cause mortality and cardiovascular mortality in young and middle-aged American populations.

Enhanced Chemoprevention of Prostate Cancer by Combining Arctigenin with Green Tea and Quercetin in Prostate-Specific Phosphatase and Tensin Homolog Knockout Mice.

The low bioavailability of most phytochemicals limits their anticancer effects in humans. The present study was designed to test whether combining arctigenin (Arc), a lignan mainly from the seed of Arctium lappa, with green tea (GT) and quercetin (Q) enhances the chemopreventive effect on prostate cancer. We performed in vitro proliferation studies on different cell lines. We observed a strong synergistic anti-proliferative effect of GT+Q+Arc in exposing androgen-sensitive human prostate cancer LNCaP cells. The pre-malignant WPE1-NA22 cell line was more sensitive to this combination. No cytotoxicity was observed in normal prostate epithelial PrEC cells. For an in vivo study, 3-week-old, prostate-specific PTEN (phosphatase and tensin homolog) knockout mice were treated with GT+Q, Arc, GT+Q+Arc, or the control daily until 16 weeks of age. In vivo imaging using prostate-specific membrane antigen (PSMA) probes demonstrated that the prostate tumorigenesis was significantly inhibited by 40% (GT+Q), 60% (Arc at 30 mg/kg bw), and 90% (GT+Q+Arc) compared to the control. A pathological examination showed that all control mice developed invasive prostate adenocarcinoma. In contrast, the primary lesion in the GT+Q and Arc alone groups was high-grade prostatic intraepithelial neoplasia (PIN), with low-grade PIN in the GT+Q+Arc group. The combined effect of GT+Q+Arc was associated with an increased inhibition of the androgen receptor, the PI3K/Akt pathway, Ki67 expression, and angiogenesis. This study demonstrates that combining Arc with GT and Q was highly effective in prostate cancer chemoprevention. These results warrant clinical trials to confirm the efficacy of this combination in humans.

Prospective assessment of corneal biomechanical properties and intraocular pressure after scleral lens wear: A 12-month follow-up study

PurposeTo investigate the long-term influence of scleral lens (SL) wear on corneal biomechanical properties and intraocular pressure (IOP) in irregular and regular corneas. Secondary goal comprised evaluate the fluid reservoir (FR) thickness overtime and correlate it with the changes in corneal biomechanical parameters and IOP. MethodsSeventy (70) eyes with irregular corneas (IC Group) and 21 eyes with regular corneas (RC Group) were fitted with 16.4 mm SL and wore the lenses for 12 months. Corrected IOP (IOPcc), Goldmann equivalent IOP (IOPg) and corneal biomechanical parameters (Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF)) were measured with Ocular Response Analyzer. Slit lamp images were analyzed with ImageJ software to assess FR thickness overtime. Measurements were taken at lens dispensing visit prior lens wear (LDV1) and after 60 min of lens wear (LDV2) and at 1, 6 and 12-month follow-up visits. Measurements were done immediately after lens removal. ResultsThere were no statistically significant differences on IOPcc, IOPg, CRF and CH over the follow-up visits in both groups. Mean IOPcc and IOPg fluctuations overtime were clinically insignificant and below 1 mmHg in both groups. IOPg, CH and CRF were significantly lower on IC Group (p < 0.001), although no statistically significant differences were found between groups for IOPcc. Regarding FR thickness, statistically significant differences were found over the follow-up on both groups, with a mean decrease of 186.29 µm on IC Group and 175.32 µm on RC Group (p < 0.001). Statistically significant moderate to high negative correlations between FR and IOPg, CRF and CH were found only in the RC Group. ConclusionsLong-term SL wear was not associated to changes in corneal biomechanical parameters neither on IOP as measured after lens removal. Besides IOP measurement without SL removal, more studies are needed to investigate the potential relationship with SL fitting characteristics (namely FR thickness).

Predictive value of low-density lipoprotein cholesterol/remnant cholesterol coordination on cardiovascular and cerebrovascular events in elderly patients with hypertension

Objective: To explore the predictive value of serum low-density lipoprotein cholesterol/residual cholesterol (LDL-C/RC) coordination on major adverse cardiovascular events (MACE) in elderly hypertensive patients. Methods: This is a prospective cohort study. Elderly hypertensive patients hospitalized in Beijing Anzhen Hospital from June 2018 to June 2020 were prospectively enrolled. According to the coordination of baseline LDL-C/RC, patients were divided into four groups: low LDL-C and low RC (LDL-C<2.6 mmol/L, and RC<0.62 mmol/L), low LDL-C and high RC (LDL-C<2.6 mmol/L, and RC≥0.62 mmol/L), high LDL-C and low RC (LDL-C≥2.6 mmol/L, and RC<0.62 mmol/L), and high LDL-C and high RC (LDL-C≥2.6 mmol/L, and RC≥0.62 mmol/L). Patients were followed up until June 2022. The primary outcome was MACE, including non-fatal acute coronary syndrome, non-fatal acute heart failure, non-fatal stroke and death. Kaplan-Meier survival analysis was used to evaluate MACE among the four groups, and Cox regression analysis was performed to evaluate the related factors of MACE. Results: A total of 847 hypertensive patients were enrolled. There were 453 males (53.5%), mean age was (72.4±8.8) years. There were 207, 162, 263, 215 patients in the low LDL-C and low RC, low LDL-C and high RC, high LDL-C and low RC and high LDL-C and high RC group, respectively. During a median follow-up of 37 months, 196 patients (23.1%) had MACE, including 77 cases (9.1%) of ACS, 56 cases (6.6%) of acute heart failure, 34 cases (4.0%)of non-fatal stroke, 29 cases(3.4%) of all-cause mortality, and 16 cases (1.9%) of cardiovascular death. Risk of MACE of the four groups was significantly different (log-rank P<0.001). Compared with low LDL-C and low RC groups, high LDL-C and high RC groups had the highest incidence of MACE (HR=2.237, 95%CI 1.328-3.783, P=0.004), followed by low LDL-C and high RC groups (HR=1.745, 95%CI 1.220-2.527, P=0.003) and high LDL-C and low RC groups (HR=1.393, 95%CI1.048-1.774, P=0.022). In addition, the risk of nonfatal ACS among the four groups was also statistically significant (P=0.037), while the risk of nonfatal acute heart failure, nonfatal stroke, all-cause mortality and cardiovascular death were similar (all P>0.05). Multivariate Cox regression analysis showed that age (HR=1.271), duration of hypertension (HR=1.339), diabetes (HR=1.415), hyperlipidemia (HR=1.348), serum creatinine (HR=1.263), N-terminal pro-B-type natriuretic peptide (HR=1.316), LDL-C (HR=1.205), RC (HR=1.302), low LDL-C and high RC (HR=1.745), high LDL-C and low RC (HR=1.393), high LDL-C and high RC (HR=2.237) were independently associated with the occurrence of MACE. Conclusion: The coordination of LDL-C/RC affects the risk of MACE in elderly hypertensive patients, and the risk of MACE is the highest in patients with high LDL-C and high RC.

Clinical effect of Nobel Biocare angulated screw channel crown compared with cement crown in the aesthetic area: A retrospective cohort study with a mean 32 months follow-up (range 12 to 70 months).

The objective of this study is to compare the clinical efficacy of angulated screw channel abutment applied in the anterior area with regular cemented crowns. Forty-eight patients were included and divided into two groups: the angulated screw channel group (ASC) and regular cemented group (RC) in this retrospective cohort study. The evaluation criteria included implant/restoration survival rate, keratinized mucosa width (KMW), bleeding on probing rate (BOP%), probing depth (PD), pink aesthetic score (PES), mechanical/biological complications, emergence angle (EA), the site of implant axis penetrate (SA), marginal bone loss (MBL), and buccal bone thickness (BBT) at 0 mm, 1 mm, 3 mm, 5 mm below the implant shoulder were evaluated in immediate postoperative (T0) and follow-up period (T1). This retrospective cohort study included a total of 48 patients, with a mean 32 months follow-up period range from 12 months to 70 months. The study did not find any cases of implant failure or restoration failure. EA was significantly wider in the RC group than ASC group (RC: 33.53° ± 8.36° vs ASC: 27.43° ± 8.08°, p = 0.016*). While the BOP% was statistically significant higher in the RC group than ASC group (RC: 28.35% ± 22.92% vs ASC: 13.18% ± 20.00%, p = 0.027*). No significant differences were observed in the other measurements of comparison. Within the limitations of the study, angulated screw channel (Nobel Biocare) crowns might allow the implant axis aim at incisal edge to reduce the emergence angle in the anterior area and benefit the soft-tissue during the 12-70 months follow-up period.

Clinical Practice Patterns and Evidence-Based Medicine in Rhinoplasty: A 10-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery from member surgeons since 2003. These data offer valuable information on national trends in clinical practice. The present study was performed to analyze trends in rhinoplasty over the last decade. Tracer data were compared between two cohorts 2012-2016 (early cohort "EC") and 2017-2021 (recent cohort "RC"). Data included patient demographics and surgical techniques. Results were considered in the context of current EBM-based guidance in the plastic surgery literature. Data from 730 rhinoplasties (270 EC and 460 RC) were analyzed. The median age was 30years, and the most common patient concern was the nasal dorsum (79%). In the RC group, fewer patients voiced concerns about tip projection (58% vs 43%, p = 0.0002) and more complained of functional airway problems (38% vs 49%, p = 0.004). An open approach was most common (83%). Septoplasty (47% vs 52%, p = 0.005), caudal septum repositioning (14% vs 23%, p = 0.002), and tip rotation maneuvers (32% vs 49%, p < 0.0001) became more popular. There was also an increase in the use of spreader grafts (35% vs 45%, p = 0.01) and columellar strut grafts (42% vs 50%, p = 0.04), while there has been a decrease in alar base resection (17% vs 10%, p = 0.007) and non-cartilaginous dorsum/radix augmentation (9% vs 4%, p = 0.02). ABPS tracer data provide an excellent resource for the objective assessment of procedures in plastic surgery. The present study is the first to highlight evolving trends in rhinoplasty over the last 10years. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

FTP5.13 Laparoscopic cholecystectomy is more cost effective than robotic cholecystectomy: a systematic review of published studies

Abstract Objective Robotic cholecystectomy (RC) has been proven safe and postoperative outcomes have also been quoted to be equivalent to conventional laparoscopic cholecystectomy (LC). The objective of this review to evaluate the cost effectiveness of RC compared to LC. Materials and methods All types of comparative studies reporting the cost of RC versus LC were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4. Results Four comparative studies (one randomised trial and 3 retrospective studies) on 817 patients undergoing RC versus LC were found and deemed suitable for analysis. There were 559 patients in the LC group and 258 patients in the RC group. In the random effects model analysis, LC was associated with the reduced cost [standardised mean difference -5.39, 95%, CI (-8.97, -1.81), Z = 2.95, P=0.003] compared to RC. However, there was significant heterogeneity (Tau2 = 13.06; Chi2 = 583.52, df = 3; (p &amp;lt; 0.00001; I2 = 99%) among included studies. Conclusion The LC seems to be more cost effective compared to RC in terms of procedural cost. However, due to statistically significant heterogeneity among included studies and paucity of the randomised, controlled trials, these findings should be taken cautiously. A Major multicentre randomised, controlled trial is needed to validate these findings.

557 Laparoscopic versus robotic cholecystectomy: a meta-analysis to differentiate between postoperative outcomes

Abstract Objective Robotic cholecystectomy (RC) may be an option to replace conventional laparoscopic cholecystectomy (LC) due to several reported advantages. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing RC versus LC. Materials and methods RCTs reporting postoperative outcomes in patients undergoing RC versus LC were selected from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results Two RCTs on 196 (113 patients in RC group and 83 patients in LC group) patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, the duration of operation [standardised mean difference -15.83, 95%, CI (-22.99, -8.67), Z = 4.33, p &amp;lt; 0.0001] was shorter in the LC group. However, the risk of bile leak [standardised mean difference 3.15, 95%, CI (0.69, 14.44), Z = 1.48, p = 0.14] and postoperative complications [standardised mean difference -0.48, 95%, CI (0.10, 2.33), Z =0.91, p = 0.36] were statistically similar between RC and LC groups. There was no heterogeneity (Tau 2 = 0.09; Chi 2 = 1.06, df = 1; (p = 0.30; I 2 = 6 %) between included RCTs. Conclusion RC failed to prove any clinical advantage over LC for postoperative outcomes including longer duration of operation. These findings are insufficient to draw a stronger conclusion due to the paucity of RTCs and a major multicentre RCT is required to strengthen the existing evidence.

Effect of different rice transplanting patterns on microbial community in water, sediment, and Procambarus clarkii intestine in rice-crayfish system.

Although the microbial ecology of integrated rice-crayfish farming systems is receiving increasing attention with the expanding application area in China, the effects of rice transplanting patterns on the microbial community of water, sediment and Procambarus clarkii intestine in rice-crayfish system has yet to be determined. This study explored the microbial community present in water, sediment and intestine samples from three transplant patterns (rice crayfish with wide-narrow row transplanting, rice-crayfish with normal transplanting and pond-crayfish, abbreviated as RC-W, RC, and PC, respectively) using high-throughput sequencing. The results showed that the dominant microbial taxa from sediment, surrounding water, and intestine at phylum level were Proteobacteria, Chloroflexi, Cyanobacteria, Actinobacteria, Bacteroidetes. The patterns of rice transplanting had significant effects on microbial biodiversity and species composition in surrounding water. The OTUs community richness of water under RC group was significantly higher than that of PC group and RC-W group. The OTU relative abundance of top 10 operational taxonomic units had significantly different (p < 0.05) in the water samples from the three groups. The intestinal OTU community richness of Procambarus clarkii in the three groups was positively correlated with the community richness of water. The proximity between intestinal and water samples in PCA diagram indicated that their species composition was more similar. The results also showed that rice transplanting patterns can affect intestinal microbial biodiversity of Procambarus clarkii and the intestinal microbial biodiversity correlated with water bodies. Although the intestinal microbial diversity of crayfish in RC-W group was lower than that in RC group, the relative abundance of potential pathogenic bacteria, such as Vibrio, Aeromonas, in intestine of the crayfish in the RC-W group was significantly decreased under rice wide-narrow row transplanting model. Redundancy analysis revealed that environmental parameters, such as pH, DO, nitrate, which regulate the composition of microbial community structures. This study provides an understanding for microbial response to different rice transplanting pattern in rice-crayfish farming system.

Oncological Outcomes for Patients with European Association of Urology Very High-risk Non–muscle-Invasive Bladder Cancer Treated with Bacillus Calmette-Guérin or Early Radical Cystectomy

BackgroundEuropean Urology Association (EAU) guidelines recommend immediate radical cystectomy (early RC) for patients with very high-risk (VHR) non–muscle invasive bladder cancer (NMIBC), with bacillus Calmette-Guérin (BCG) recommended only for those who refuse or are unfit for RC. ObjectiveTo describe oncological outcomes following BCG or early RC in a contemporary cohort of patients with VHR NMIBC (EAU criteria). Design, setting, and participantsPatients diagnosed with VHR NMIBC between 2000 and 2020 were identified from our institutional NMIBC registry. Outcome measurements and statistical analysisThe primary outcomes were overall survival (OS) and cancer-specific mortality (CSM). Secondary outcomes were the progression rate and high-grade recurrence (HGR) rate for patients receiving BCG. Results and limitationsWe identified 235 patients with VHR NMIBC, of whom 157 (67%) received BCG and 78 (33%) underwent early RC. The median follow-up was 52.8 mo. OS and CSM rates were 80.2% and 5.3% in the BCG group, and 88.1% and 4.9% in the early RC group, respectively with no significant difference in OS (p = 0.6) or CSM (p = 0.8) between the two groups. Among the patients treated with BCG, 5-yr HGR and progression rates were 41.9% and 17.4%, respectively; 39 patients (25%) underwent delayed RC after BCG. No significant difference in CSM emerged when comparing patients treated with delayed RC (after BCG) with those undergoing early RC (p = 0.86). ConclusionsOur findings suggest that intravesical BCG can be offered to patients as a resonable alternative to early RC for selected patients with VHR NMIBC. Patient summaryWe evaluated outcomes for patients with very high-risk non–muscle-invasive bladder cancer (NMIBC) treated with BCG (bacillus Calmette-Guérin) versus early surgical removal of the bladder and found no differences in survival. We conclude that BCG could be offered to selected patients with this type of bladder cancer as a reasonable alternative to early bladder removal.

TIPS-05 ADJUVANT TEMOZOLOMIDE CHEMOTHERAPY FOLLOWING RADIOTHERAPY IN NEWLY DIAGNOSED LOW-GRADE GLIOMA PATIENT WITH RESIDUE TUMORS: A MULTICENTER, OPEN LABEL, RANDOMIZED TRIAL

Abstract Low-grade glioma (LGG) with infiltrative nature and frequent growth in eloquent area in brain often makes total resection impossible. Although post-radiation adjuvant temozolomide (TMZ) is the standard of care for high-grade gliomas, and radiotherapy and/or TMZ are recommended for the treatment of residue low-grade gliomas, the efficacy of combined radiotherapy with adjuvant TMZ for residue LGG remains to be defined. We have initiated a randomized clinical trial in 2012 to test whether radiotherapy with subsequent TMZ chemotherapy will improve survival of patients with residue LGG compared to radiotherapy alone. This study was approved by the Ethics Committee of the Sun Yat-sen University Cancer Center, Guangzhou, China (approval No. 5010-2012-03) and was registered with ClinicalTrials.gov (NCT01649830). Inclusion Criteria: Patients age of 18 years to 60 years, with incompletely resected supratentorial WHO grade 2 astrocytoma, oligodendroglioma or oligodendroastrocytoma. Enrolled patients were randomized into: radiation therapy alone (RT) or radiotherapy with subsequent TMZ chemotherapy (RC) group. Start Date: July 2012, Estimated Primary Completion Date:August 2025. Radiation therapy will start within 8 weeks after neurosurgical procedures, with a total dose of 54.0 Gy in 27 - 30 fractions over 6 - 7 weeks. Four weeks after radiotherapy, patients in RC group will receive 6 cycle of TMZ dosed at 200 mg/m2 daily for 5 consecutive days, repeated every 28 days. We have completed enrollment on December 2018 with valid cases of 248 patients. Up to last follow-up date of Feb. 2023, 204 cases were analyzed (see table). There is no significant difference between RT group and RC group on both PFS and OS (5-year PFS 68.9% vs 75.2%, p=0.680; 5-year OS 92.0% vs 86.0%, p=0.400). Longer follow-up and molecular subgroup analysis are currently on the way, which could show benefit in special molecular subgroup.

Stocking-only versus additional eccentric compression after below-the-knee truncal vein sclerotherapy: A SOVAECS prospective randomized within-person trial

ObjectiveAfter foam sclerotherapy in the truncal saphenous vein, the clinical effects of additional eccentric compression has not yet been explored. MethodsBetween April 2020 and February 2021, we enrolled 42 patients (84 limbs) who underwent bilateral endovenous combined therapy for great saphenous vein (GSV) reflux. Each patient received the same type of endovenous ablation in both above-the-knee GSVs (laser, radiofrequency, cyanoacrylate glue), and combined foam sclerotherapy was performed on both below-the-knee GSVs. Subsequently, we conducted a prospective randomized, single-blind, within-person study in which each patient's bilateral truncal saphenous vein of the calves underwent two different compression therapies: wearing of a regular class II compression stocking on one side (RC group) and additional eccentric compression on the other side (AC group). The primary end point was the occlusion range (score, 0-10) of the below-the-knee truncal GSV after foam sclerotherapy. The secondary outcomes were the pain score (visual analog scale score range, 0-10) of the paired limb, the required number of additional foam sclerotherapy sessions, compliance with compression therapy, and procedure-related complications. ResultsFor the above-the-knee GSV, endovenous laser treatment (n = 44), endovenous radiofrequency ablation (n = 14), and endovenous cyanoacrylate glue ablation (n = 26) were performed. The mean subcompression pressure of the medial calf in the supine and standing positions were 16.7 ± 2.34 mm Hg and 24.5 ± 6.6 mm Hg in the RC group and 38.5 ± 5.5 mm Hg and 45.3 ± 8.2 mm Hg in the AC group, respectively (P = .000). The secondary outcomes of pain score, number of additional foam sclerotherapy sessions, and pigmentation were not significantly different statistically between the two groups. The patient-reported satisfaction scores (range, 0-10) on compression at 24 hours postoperatively were 8.03 ± 1.9 for the AC group and 7.98 ± 1.9 for the RC group (P = .317; Wilcoxon signed ranks test). In both groups, the closure rate of the above-the-knee GSV at 1 month postoperatively was 100%. No procedure-related complications were identified within 1 month postoperatively, including no deep vein thrombosis, numbness, or skin necrosis requiring additional medical attention. ConclusionsThe 24 hours of additional eccentric compression on the truncal GSV compared with the use of a conventional knee-level stocking only did not yield any clinical advantages in terms of the occlusion range, postoperative pain, need for additional sclerotherapy, or skin pigmentation after foam sclerotherapy. The decision on which type of compression therapy to perform after foam sclerotherapy in the truncal vein should be comprehensively determined.

Comparison of the nutrient value, nonspecific immunity, and intestinal microflora of red swamp crayfish (Procambarus clarkii) in different culture modes

This study aimed to compare the nutritional composition, digestive enzyme activity, nonspecific immunity, and intestinal microflora of Procambarus clarkii under different culture modes: crayfish and crab coculture, pond intensive farmed culture (PF), rice and crayfish coculture (RC), cement pond culture (CP), and wild-caught. The muscle, hepatopancreas, and intestine of crayfish with a mean weight of 25.35 ± 4.23 g were collected and examined. The results showed that the nutritive value of amino acids and fatty acids in the muscle was higher in the RC group than in the other groups. Moreover, muscle crude protein contents were the highest in the CP group. Trypsin activities in the intestines were significantly higher in the PF and CP groups than in the other groups (P < 0.05). The alkaline phosphatase (AKP) and acid phosphatase (ACP) activities of the PF group were the lowest, whereas the CP group showed high AKP and ACP activities and low malondialdehyde levels. The dominant bacterial communities in the intestine of P. clarkii included Proteobacteria, Bacteroidetes, Firmicutes, RsaHF231, Tenericutes, and Planctomycetes at the phylum level and ZOR0006, Candidatus Bacilloplasma, and Aeromonas at the genus level. These results suggested that the dominant bacterial community phyla and genera in the intestine varied greatly between the culture modes. The results of principal coordinate analysis based on the operational taxonomic unit level showed that the bacterial community distribution in the CP group was quite different from that in the other groups, indicating dramatic variations in species diversity. Our current findings will provide a theoretical foundation for understanding the association between the culture modes of P. clarkii and nutrition, immunity, and intestinal microflora.

Incidence and Mechanism of Refractory Postoperative Cholangitis After Hepatectomy with Hepaticojejunostomy

IntroductionMalignant tumors, such as hilar cholangiocarcinoma, have shown improved long-term outcomes, and measures to prevent late postoperative complications are important. Postoperative cholangitis after hepatectomy with hepaticojejunostomy (HHJ) may occur and can significantly decrease the quality of life. However, there are few reports on the incidence and pathogenesis of postoperative cholangitis after HHJ. MethodsWe retrospectively reviewed 71 cases post HHJ at Tokyo Medical and Dental University Hospital from January 2010 to December 2021. Cholangitis was diagnosed using the Tokyo Guideline 2018. Cases due to tumor recurrence around the hepaticojejunostomy (HJ) were excluded. Patients with three or more episodes of cholangitis were classified as the “refractory cholangitis group” (RC group). RC group patients were divided into a “stenosis group” and “non-stenosis group” according to intrahepatic bile duct dilatation at the onset of cholangitis. Their clinical characteristics and risk factors were analyzed. ResultsCholangitis occurred in 20 patients (28.1%), with 17 (23.9%) in the RC group. Most patients in the RC group developed their first episode within the first postoperative year. The stenosis group consisted of 6 patients, and their cholangitis was treated with repeated anastomotic dilatation and stent replacement. In the non-stenosis group, cholangitis was relatively mild and treated with antibiotics. Hepatobiliary scintigraphy for these cases showed bile congestion in the jejunum near the site of the hepaticojejunostomy. ConclusionThere are two types of postoperative cholangitis, each with different pathogenesis and treatment. It is essential to assess anastomotic stenosis early and provide the necessary treatment.