RESUMEN

Based on the previous research results that the addition of sucrose in the medium improved the biofilm formation of Tetragenococcus halophilus, the influence of sucrose on biofilm formation was explored. Moreover, the influence of exogenous expression of related genes sacA and galE from T. halophilus on the biofilm formation of L. lactis NZ9000 was investigated. The results showed that the addition of sucrose in the medium improved the biofilm formation, the resistance of biofilm cells to freeze-drying stress, and the contents of exopolysaccharides (EPS) and eDNA in the T. halophilus biofilms. Meanwhile, the addition of sucrose in the medium changed the monosaccharide composition of EPS and increased the proportion of glucose and galactose in the monosaccharide composition. Under 2.5% (m/v) salt stress condition, the expression of gene sacA promoted the biofilm formation and the EPS production of L. lactis NZ9000 with the sucrose addition in the medium and changed the EPS monosaccharide composition. The expression of gene galE up-regulated the proportion of rhamnose, galactose, and arabinose in the monosaccharide composition of EPS, and down-regulated the proportion of glucose and mannose. This study will provide a theoretical basis for regulating the biofilm formation of T. halophilus, and provide a reference for the subsequent research on lactic acid bacteria biofilms.

Asunto(s)

Biopelículas , Sacarosa , Biopelículas/crecimiento & desarrollo , Sacarosa/metabolismo , Polisacáridos Bacterianos/metabolismo , Enterococcaceae/genética , Enterococcaceae/metabolismo , Enterococcaceae/fisiología , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Monosacáridos/metabolismo , Regulación Bacteriana de la Expresión Génica , Liofilización

RESUMEN

BACKGROUND: Surgical resection is a curative therapy for early-stage hepatocellular carcinoma (HCC) patients meeting the Milan criteria as well as a widely used therapy in intermediate-stage HCC. However, intermediate-stage HCC encompasses a wide spectrum of disease and there is a lack of good predictive models for the long-term clinical outcome of HCC patients currently. Here, we adopt Mazzaferro's Metroticket 2.0 to create a robust survival prediction model for intermediate-stage HCC patients undergoing surgical resection. Our algorithm considers age, AFP levels, ALBI score, and nodule size/number to generate survival estimates in an accessible graph format. Importantly, our model surpasses the American Joint Committee on Cancer staging model and was validated with independent US patient data. METHODS: We conducted a retrospective analysis of OS and RFS in early- and intermediate-stage HCC patients treated with liver resection, including a training cohort in Singapore and a validation cohort in North Carolina, USA. RESULTS: We recorded 278 deaths (35.0%) and 428 patients (53.9%) in the first 5-years after surgical resection; higher ALBI score, higher lnAFP, more advanced age and higher tumour burden index were identified as significant parameters. The overall predictive capability of our model, with the inclusion of AFP, is reflected with a UNO's C-statistic of 0.655, which is 1.11 times better than the 0.5895 C-statistic of the 8th AJCC TNM Staging model. CONCLUSIONS: Our modified Metroticket model allows for more granular and better-informed prognostication. This will help surgeons and patients make accurate comparisons between the clinical outcomes of surgical resection and other non-surgical treatments.

RESUMEN

BACKGROUND: Traditional surgical education often lacks targeted preparation for the interactive components of examinations, such as viva voce and objective structured clinical examination (OSCE) assessments. We present our approach and explore the efficacy of a near-peer tutoring program aimed at enhancing final-year students' readiness for such assessments. METHODS: Project SEPFYR (surgical exam prep for final year exam readiness) was conducted within a near-peer tutoring framework and comprised interactive discussions of selected case scenarios focusing on viva voce techniques and OSCE responses. Pre- and postprogram anonymized web-based surveys were employed to assess perceived self-efficacy among participants, while the Stanford Faculty Development Program-26 (SFDP-26) tool was used to evaluate the performance of tutors. RESULTS: Near-peer tutoring intervention resulted in improvements in perceived self-efficacy scores among final-year students. Additionally, tutors demonstrated high-quality facilitation skills as evaluated by the SFDP-26. CONCLUSIONS: Near-peer tutoring is a promising approach to enhance surgical examination readiness, particularly in addressing interactive assessment components. This model fosters a supportive learning environment while leveraging the expertise and relatability of near-peer tutors.

RESUMEN

The abuse of antibiotics has seriously threatened human health and living environment. Nevertheless, the detection of quinolones is currently mainly performed by high-cost and cumbersome means, such as High-Performance Liquid Chromatography (HPLC). Herein, we reported a novel method based on copper-doped MoOx nanoparticles (Cu-MoOx NPs) with peroxidase-like enhancement activity for the easy preparation, sensitive and rapid visualization of quinolone detection. Cu-MoOx NPs can make the chromogenic substrate 3,3',5,5'-Tetramethylbenzidine (TMB) change from colorless to blue. Moreover, the addition of quantitative quinolone antibiotics can significantly accelerate the TMB oxidation reaction. Based on this phenomenon, a colorimetric method for detecting quinolone antibiotics was established with a good linear relationship ranging from 1 × 10-6 M to 1.3 × 10-4 M, and the detection limit was 0.310 µM for ciprofloxacin (CIP) and 0.520 µM for levofloxacin (LVFX). Furthermore, the mechanism was also explored, and the results showed that the peroxidase-like activity of Cu-MoOx NPs was probably derived from the generated OH, 1O2, oxygen vacancies and partially reduced Cu+, and on the other hand was derived from quinolone antibiotics and nanozymes electrostatic interaction between them.

RESUMEN

A novel reaction of cyclic and acyclic secondary amines with in situ-generated allene intermediate species from nitro-substituted donor-acceptor cyclopropanes is reported. In the presence of a simple inorganic base, NaOH, tetrasubstituted enamine derivatives can be obtained in moderate to excellent yields. The reaction is operationally easy, features mild reaction conditions and simple inorganic bases, and is free of transition metals.

RESUMEN

Roasted-rice leachate fermentation, a distinctive local tobacco fermentation method in Sichuan, imparts a mellow flavor and glossy texture to tobacco leaves, along with a roasted rice aroma. In order to find out the impact of roasted-rice leachate on cigar tobacco leaves, the physicochemical properties, volatile flavor profile, and microbial community were investigated. The content of protein significantly decreased after fermentation. The volatile flavor compounds increased following roasted-rice leachate fermentation, including aldehydes, alcohols, acids, and esters. High-throughput sequencing identified Staphylococcus, Pseudomonas, Pantoea, Oceanobacillus, Delftia, Corynebacterium, Sphingomonas, Aspergillus, Weissella, and Debaryomyces as the primary genera. Network and correlation analysis showed Debaryomyces played a crucial role in roasted-rice leachate fermentation, due to its numerous connections with other microbes and positive relationships with linoelaidic acid, aromandendrene, and benzaldehyde. This study is useful for gaining insight into the relationship between flavor compounds and microorganisms and provides references regarding the effect of extra nutrients on traditional fermentation products. KEY POINTS: • Volatile flavor compounds increased following roasted-rice leachate fermentation • Staphylococcus was the primary genera in fermented cigar • Debaryomyces may improve the quality of tobacco leaves.

Asunto(s)

Bacterias , Fermentación , Aromatizantes , Oryza , Compuestos Orgánicos Volátiles , Compuestos Orgánicos Volátiles/metabolismo , Compuestos Orgánicos Volátiles/análisis , Aromatizantes/metabolismo , Oryza/microbiología , Bacterias/metabolismo , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Hojas de la Planta/microbiología , Productos de Tabaco , Gusto , Nicotiana/microbiología , Microbiota , Odorantes/análisis

RESUMEN

This paper introduces a novel digital triangular-trapezoidal double-channel shaping algorithm to enhance the counting rate of resistive anode detectors. The algorithm is based on the trapezoidal shaping algorithm and improves it. At the extreme counting rate, the trapezoidal shaping algorithm cannot alleviate the pulse pileup, so the counting rate cannot meet the requirements of a high performance detector. The triangular-trapezoidal double-channel shaping algorithm is introduced in the resistance anode detector, which can replace the trapezoidal shaping filtering algorithm to process the output signal of the resistance anode detector and obtain the single photon position information. This improvement improves the counting rate of the resistor anode detector and reduces the resolution degradation caused by pulse pileup. The algorithm is simulated by System Generator software and implemented on FPGA (field programmable gate array). The triangular-trapezoidal double-channel shaping algorithm presented in this paper plays an important role in reducing electronic noise and pulse pileup. The algorithm is subjected to simulation testing, and it can recognize signals with a minimum pulse interval of 1 µs and counting rate up to 1000 kcps.

RESUMEN

Many 3D mesh processing tasks revolve around generating and manipulating curves on surface meshes. While it is intuitive to explicitly model these curves using mesh edges or parametric curves in the ambient space, these methods often suffer from numerical instability or inaccuracy due to the projection operation. Another natural strategy is to adapt spline based tools, these methods are quite fast but are hard to be extended to more versatile constraints and need heavy manual interactions. In this paper, we present an efficient and versatile approach to curve design based on an implicit representation known as the level set. While previous works have explored the use of the level set to generate curves with minimal length, they typically have limitations in accommodating additional conditions for rich and robust control. To address these challenges, we formulate curve editing with constraints like smoothness, interpolation, tangent control, etc., via a level set based variational problem by constraining the values or derivatives of the level set function. However, the widely used gradient flow strategy converges very slowly for this complicated variational problem compared to the classical geodesic one. Thus, we propose to solve it via Newton's method enhanced by local Hessian correction and a trust-region strategy. As a result, our method not only enables versatile control, but also excels in terms of performance due to nearly quadratic convergence and almost linear complexity in each iteration via narrow band acceleration. In practice, these advantages effectively benefit various applications, such as interactive curve manipulation, boundary smoothing for surface segmentation and path planning with obstacles as demonstrated.

RESUMEN

Prolyl 4-hydroxylase beta subunit (P4HB) plays a vital role in bone formation. This study intends to clarify the role of P4HB in the therapeutic effect of Icariin (ICA) on osteoporosis. Herein, in vivo and in vitro models were constructed by performing ovariectomy (OVX) in rats and inducing osteogenic differentiation in bone marrow stem cells (BMSCs), respectively. Hematoxylin and eosin staining and micro-computed tomography analysis were performed to evaluate osteoporosis in OVX rats. Alizarin Red staining, alkaline phosphatase staining, and the ALP activity test were employed to assess osteogenesis. m6A dot blotting and methylated RNA immunoprecipitation were used to determine m6A modification. We found that P4HB was downregulated in bone tissues of patients with osteoporosis and OVX rats. P4HB facilitated osteogenic differentiation of BMSCs. What's more, ICA upregulated P4HB expression, promoted osteogenic differentiation of BMSCs, and alleviated osteoporosis in OVX rats, which were reversed by knocking down P4HB. ICA enhanced the stability and m6A modification of P4HB. METTL14 mediated m6A modification of P4HB mRNA. In addition, METTL14 knockdown overturned the promotive effects of ICA on P4HB m6A level and BMSC osteogenic differentiation. To sum up, ICA elevated the METTL14-mediated m6A modification of P4HB to facilitate BMSC osteogenic differentiation.

Asunto(s)

Diferenciación Celular , Flavonoides , Metiltransferasas , Osteogénesis , Ratas Sprague-Dawley , Animales , Osteogénesis/efectos de los fármacos , Diferenciación Celular/efectos de los fármacos , Ratas , Femenino , Flavonoides/farmacología , Metiltransferasas/metabolismo , Metiltransferasas/genética , Humanos , Osteoporosis/patología , Osteoporosis/metabolismo , Osteoporosis/genética , Células Madre Mesenquimatosas/metabolismo , Células Madre Mesenquimatosas/efectos de los fármacos , Ovariectomía , Regulación hacia Arriba/efectos de los fármacos , Procolágeno-Prolina Dioxigenasa/metabolismo , Procolágeno-Prolina Dioxigenasa/genética , Células de la Médula Ósea/metabolismo , Células de la Médula Ósea/efectos de los fármacos , Células Cultivadas , Adenosina/análogos & derivados , Adenosina/metabolismo

RESUMEN

The greater geometrical design freedom offered by additive manufacturing (AM) as compared to the conventional manufacturing method has attracted increasing interest in AM to develop innovative and complex designs for enhanced performance. However, the difference in material composition and surface properties from conventional alloys has made surface micro-/nanostructuring of AM metals challenging. Frost accretion is a safety hazard in numerous engineering applications. To expand the application of AM, this study experimentally investigates the antifrosting performance of superhydrophobic and slippery lubricant-infused porous surfaces (SLIPSs) generated on AM alloy, AlSi10Mg. By strategically utilizing the subgrain structure in the metallography of the AM alloy, the functionalized superhydrophobic AM surface featuring hierarchical structures was shown to greatly reduce frost formation as compared to functionalized single-tier structured surfaces, hierarchical structures formed on conventional aluminum alloy surfaces, and SLIPSs. Optical observation of frost propagation demonstrated that the mechanism of frost delay is governed by the inhibition of spontaneous droplet freezing through exceptional Cassie state stability during condensation frosting. The Cassie stability results from the unique AM structure morphology, which creates a higher structural energy barrier to prevent condensate from infiltrating the cavities. This phenomenon also enables the formation of a high surface-to-droplet thermal resistance, which eliminates spontaneous droplet freezing down to a -15 °C surface temperature. Our work demonstrates a scalable structuring method for AM metals, which can result in delayed frost formation, and it also provides guidelines for the development of engineered surfaces requiring the antifrosting function for several industries.

RESUMEN

BACKGROUND: Metabolic syndrome (MetS), characterized by obesity, hyperglycemia, and abnormal blood lipid levels, is the pathological basis of many cardiovascular diseases. Gualou-Xiebai-Banxia-Tang decoction (GT) was first described in the Synopsis of the Golden Chamber, the earliest traditional Chinese medicine (TCM) monograph on diagnosis and treatment of miscellaneous diseases in China. According to TCM precepts, based on its ability to activate yang to release stagnation, activate qi to reduce depression, remove phlegm, and broaden the chest, GT has been used for more than 2,000 years to treat cardiovascular ailments. However, the molecular bases of its therapeutic mechanisms remain unclear. PURPOSE: The aim of this study was to identify lipid- and glucose-related hepatic genes differentially regulated by GT, and to assess GT impact on gut microbiota composition, in mice with high-fat diet (HFD)-induced MetS. STUDY DESIGN AND METHODS: ApoE-/- mice were fed with an HFD for 24 weeks, with or without concurrent GT supplementation, to induce MetS. At the study's end, body weight, visceral fat weight, blood lipid levels, and insulin sensitivity were measured, and histopathological staining was used to evaluate hepatosteatosis and intestinal barrier integrity. Liver transcriptomics was used for analysis of differentially expressed genes in liver and prediction of relevant regulatory pathways. Hepatic lipid/glucose metabolism-related genes and proteins were detected by RT-qPCR and western blotting. Gut microbial composition was determined by 16S rRNA gene sequencing. RESULTS: GT administration reduced MetS-related liver steatosis and weight gain, promoted insulin sensitivity and lipid metabolism, and beneficially modulated gut microbiota composition by decreasing the relative abundance of g_Lachnospiraceae_NK4A136_group and increasing the relative abundance of g_Alistipes. Liver transcriptomics revealed that GT regulated the expression of genes related to lipid and glucose metabolism (Pparγ, Igf1, Gpnmb, and Trem2) and of genes encoding chemokines/chemokine receptors (e.g. Cxcl9 and Cx3cr1). Significant, positive correlations were found for Ccr2, Ccl4, Ccr1, and Cx3cr1 and the g_Lachnospiraceae_NK4A136_group, and between Cxcl9, Ccr2, Ccl4, and Cx3cr1 and g_Desulfovibrio. GT treatment downregulated the protein expressions of SCD1 and CX3CR1 and upregulated the expression of PCK1 protein. CONCLUSION: GT supplementation alleviates HFD-induced MetS in mice by improving hepatic lipid and glucose metabolism. The anti-metabolic syndrome effects of GT may be related to the regulation of the gut-liver axis.

Asunto(s)

Dieta Alta en Grasa , Medicamentos Herbarios Chinos , Microbioma Gastrointestinal , Hígado , Síndrome Metabólico , Animales , Medicamentos Herbarios Chinos/farmacología , Hígado/efectos de los fármacos , Hígado/metabolismo , Microbioma Gastrointestinal/efectos de los fármacos , Síndrome Metabólico/tratamiento farmacológico , Masculino , Ratones , Metabolismo de los Lípidos/efectos de los fármacos , Ratones Endogámicos C57BL

RESUMEN

The placenta links feto-maternal circulation for exchanges of nutrients, gases, and metabolic wastes between the fetus and mother, being essential for pregnancy process and maintenance. The allantois and mesodermal components of amnion, chorion, and yolk sac are derived from extraembryonic mesoderm (Ex-Mes), however, the mechanisms contributing to distinct components of the placenta and regulation the interactions between allantois and epithelium during chorioallantoic fusion and labyrinth formation remains unclear. Isl1 is expressed in progenitors of the Ex-Mes and allantois the Isl1 mut mouse line is analyzed to investigate contribution of Isl1+ Ex-Mes / allantoic progenitors to cells of the allantois and placenta. This study shows that Isl1 identifies the Ex-Mes progenitors for endothelial and vascular smooth muscle cells, and most of the mesenchymal cells of the placenta and umbilical cord. Deletion of Isl1 causes defects in allantois growth, chorioallantoic fusion, and placenta vessel morphogenesis. RNA-seq and CUT&Tag analyses revealed that Isl1 promotes allantoic endothelial, inhibits mesenchymal cell differentiation, and allantoic signals regulated by Isl1 mediating the inductive interactions between the allantois and chorion critical for chorionic epithelium differentiation, villous formation, and labyrinth angiogenesis. This study above reveals that Isl1 plays roles in regulating multiple genetic and epigenetic pathways of vascular morphogenesis, provides the insight into the mechanisms for placental formation, highlighting the necessity of Isl1 for placenta formation/pregnant maintenance.

Asunto(s)

Alantoides , Proteínas con Homeodominio LIM , Mesodermo , Placenta , Factores de Transcripción , Animales , Embarazo , Ratones , Femenino , Proteínas con Homeodominio LIM/metabolismo , Proteínas con Homeodominio LIM/genética , Alantoides/metabolismo , Placenta/metabolismo , Placenta/irrigación sanguínea , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Mesodermo/metabolismo , Mesodermo/embriología , Morfogénesis/genética , Morfogénesis/fisiología , Placentación/genética , Placentación/fisiología

RESUMEN

After RNAi was first discovered over 20 years ago, siRNA-based therapeutics are finally becoming reality. However, the delivery of siRNA has remained a challenge. In our previous research, we found that spermine-based poly(ß-amino ester)s are very promising for siRNA delivery. However, the role of hydrophobic modification in siRNA delivery of spermine-based poly(ß-amino ester)s is not fully understood yet. In the current work, we synthesized spermine-based poly(ß-amino ester)s with different percentages of oleylamine side chains, named P(SpOABAE). The chemical structures of the polymers were characterized by 1H NMR. The polymers showed efficient siRNA encapsulation determined by SYBR Gold assays. The hydrodynamic diameters of the P(SpOABAE) polyplexes from charge ratio N/P 1 to 20 were 30-100 nm except for aggregation phenomena observed at N/P 3. Morphology of the polyplexes was visualized by atomic force microscopy, and cellular uptake was determined by flow cytometry in H1299 cells, where all the polyplexes showed significantly higher cellular uptake than hyperbranched polyethylenimine (25 kDa). The most hydrophobic P(SpOABAE) polyplexes were able to achieve more than 90% GFP knockdown in H1299/eGFP cells. The fact that gene silencing efficacy increased with hydrophobicity but cellular uptake was affected by both charge and hydrophobic interactions highlights the importance of endosomal escape. For pulmonary administration and improved storage stability, the polyplexes were spray-dried. Results confirmed the maintained siRNA activity after storage for 3 months at room temperature, indicating potential for dry powder inhalation.

Asunto(s)

Interacciones Hidrofóbicas e Hidrofílicas , ARN Interferente Pequeño , Espermina , ARN Interferente Pequeño/química , ARN Interferente Pequeño/administración & dosificación , ARN Interferente Pequeño/farmacología , Espermina/química , Humanos , Administración por Inhalación , Polímeros/química , Polvos/química , Línea Celular Tumoral

RESUMEN

In order to improve the flavor profiles, food security, probiotic effects and shorten the fermentation period of traditional fermented foods, lactic acid bacteria (LAB) were often considered as the ideal candidate to participate in the fermentation process. In general, LAB strains possessed the ability to develop flavor compounds via carbohydrate metabolism, protein hydrolysis and amino acid metabolism, lipid hydrolysis and fatty acid metabolism. Based on the functional properties to inhibit spoilage microbes, foodborne pathogens and fungi, those species could improve the safety properties and prolong the shelf life of fermented products. Meanwhile, influence of LAB on texture and functionality of fermented food were also involved in this review. As for the adverse effect carried by environmental challenges during fermentation process, engineering strategies based on exogenous addition, cross protection, and metabolic engineering to improve the robustness and of LAB were also discussed in this review. Besides, this review also summarized the potential strategies including microbial co-culture and metabolic engineering for improvement of fermentation performance in LAB strains. The authors hope this review could contribute to provide an understanding and insight into improving the industrial functionalities of LAB.

Asunto(s)

Fermentación , Microbiología de Alimentos , Lactobacillales , Ingeniería Metabólica , Ingeniería Metabólica/métodos , Lactobacillales/metabolismo , Probióticos/metabolismo , Alimentos Fermentados/microbiología

RESUMEN

Objectives: The aim of this study is to estimate the excess mortality burden of influenza virus infection in China from 2012 to 2021, with a concurrent analysis of its associated disease manifestations. Methods: Laboratory surveillance data on influenza, relevant population demographics, and mortality records, including cause of death data in China, spanning the years 2012 to 2021, were incorporated into a comprehensive analysis. A negative binomial regression model was utilized to calculate the excess mortality rate associated with influenza, taking into consideration factors such as year, subtype, and cause of death. Results: There was no evidence to indicate a correlation between malignant neoplasms and any subtype of influenza, despite the examination of the effect of influenza on the mortality burden of eight diseases. A total of 327,520 samples testing positive for influenza virus were isolated between 2012 and 2021, with a significant decrease in the positivity rate observed during the periods of 2012-2013 and 2019-2020. China experienced an average annual influenza-associated excess deaths of 201721.78 and an average annual excess mortality rate of 14.53 per 100,000 people during the research period. Among the causes of mortality that were examined, respiratory and circulatory diseases (R&C) accounted for the most significant proportion (58.50%). Fatalities attributed to respiratory and circulatory diseases exhibited discernible temporal patterns, whereas deaths attributable to other causes were dispersed over the course of the year. Conclusion: Theoretically, the contribution of these disease types to excess influenza-related fatalities can serve as a foundation for early warning and targeted influenza surveillance. Additionally, it is possible to assess the costs of prevention and control measures and the public health repercussions of epidemics with greater precision.

Asunto(s)

Causas de Muerte , Gripe Humana , Humanos , Gripe Humana/mortalidad , Gripe Humana/epidemiología , China/epidemiología , Adulto , Persona de Mediana Edad , Masculino , Femenino , Preescolar , Adolescente , Niño , Lactante , Anciano , Adulto Joven , Vigilancia de la Población

RESUMEN

PURPOSE: This study evaluated the accuracy of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculator in predicting outcomes after hepatectomy for colorectal cancer (CRC) liver metastasis in a Southeast Asian population. METHODS: Predicted and actual outcomes were compared for 166 patients undergoing hepatectomy for CRC liver metastasis identified between 2017 and 2022, using receiver operating characteristic curves with area under the curve (AUC) and Brier score. RESULTS: The ACS-NSQIP calculator accurately predicted most postoperative complications (AUC > 0.70), except for surgical site infection (AUC = 0.678, Brier score = 0.045). It also exhibited satisfactory performance for readmission (AUC = 0.818, Brier score = 0.011), reoperation (AUC = 0.945, Brier score = 0.002), and length of stay (LOS, AUC = 0.909). The predicted LOS was close to the actual LOS (5.9 vs. 5.0 days, P = 0.985). CONCLUSION: The ACS-NSQIP calculator demonstrated generally accurate predictions for 30-day postoperative outcomes after hepatectomy for CRC liver metastasis in our patient population.

Asunto(s)

Neoplasias Colorrectales , Hepatectomía , Neoplasias Hepáticas , Complicaciones Posoperatorias , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asia Sudoriental , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Tiempo de Internación , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/secundario , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Pueblos del Sudeste Asiático

RESUMEN

BACKGROUND: This study evaluated the cost-effectiveness of open, laparoscopic, and robotic liver resection. METHODS: A comprehensive literature review and Bayesian network meta-analysis were conducted. Surface under cumulative ranking area values, mean difference, odds ratio, and 95% credible intervals were calculated for all outcomes. Cluster analysis was performed to determine the most cost-effective clustering approach. Costs-morbidity, costs-mortality, and costs-efficacy were the primary outcomes assessed, with postoperative overall morbidity, mortality, and length of stay associated with total costs for open, laparoscopic, and robotic liver resection. RESULTS: Laparoscopic liver resection incurred the lowest total costs (laparoscopic liver resection versus open liver resection: mean difference -2,529.84, 95% credible intervals -4,192.69 to -884.83; laparoscopic liver resection versus robotic liver resection: mean difference -3,363.37, 95% credible intervals -5,629.24 to -1,119.38). Open liver resection had the lowest procedural costs but incurred the highest hospitalization costs compared to laparoscopic liver resection and robotic liver resection. Conversely, robotic liver resection had the highest total and procedural costs but the lowest hospitalization costs. Robotic liver resection and laparoscopic liver resection had a significantly reduced length of stay than open liver resection and showed less postoperative morbidity. Laparoscopic liver resection resulted in the lowest readmission and liver-specific complication rates. Laparoscopic liver resection and robotic liver resection demonstrated advantages in costs-morbidity efficiency. While robotic liver resection offered notable benefits in mortality and length of stay, these were balanced against its highest total costs, presenting a nuanced trade-off in the costs-mortality and costs-efficacy analyses. CONCLUSION: Laparoscopic liver resection represents a more cost-effective option for hepatectomy with superior postoperative outcomes and shorter length of stay than open liver resection. Robotic liver resection, though costlier than laparoscopic liver resection, along with laparoscopic liver resection, consistently exceeds open liver resection in surgical performance.

Asunto(s)

Hepatectomía , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Humanos , Análisis Costo-Beneficio , Hepatectomía/economía , Hepatectomía/métodos , Hepatectomía/efectos adversos , Laparoscopía/economía , Laparoscopía/métodos , Laparoscopía/efectos adversos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Metaanálisis en Red , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Robotizados/economía , Procedimientos Quirúrgicos Robotizados/efectos adversos

RESUMEN

Minimally invasive abdominal surgery (MAS) can exert a physical cost. Surgical trainees spend years assisting minimally-invasive surgeries, increasing the risk of workplace injury. This prospective questionnaire-based cohort study was conducted amongst general surgery residents in Singapore. Residents assisting major MAS surgery were invited to complete anonymous online survey forms after surgery. The Phase 1 survey assessed physical discomfort scores and risk factors. Intraoperative measures to improve ergonomics were administered and evaluated in Phase 2. During Phase 1 (October 2021 to April 2022), physical discomfort was reported in at least one body part in 82.6% (n = 38) of respondents. Over a third of respondents reported severe discomfort in at least one body part (n = 17, 37.0%). Extremes of height, training seniority, longer surgical duration and operative complexity were significant risk factors for greater physical discomfort. In Phase 2 (October 2022 to February 2023), the overall rate of physical symptoms and severe discomfort improved to 81.3% (n = 52) and 34.4% (n = 22) respectively. The ergonomic measure most found useful was having separate television monitors for the primary surgeon and assistants, followed by intraoperative feedback on television monitor angle or position. Close to 20% of survey respondents felt that surgeon education was likely to improve physical discomfort.

Asunto(s)

Abdomen , Ergonomía , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Femenino , Masculino , Adulto , Estudios Prospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/educación , Abdomen/cirugía , Encuestas y Cuestionarios , Internado y Residencia , Cirujanos/educación , Singapur , Factores de Riesgo

RESUMEN

Objective: To evaluate the efficacy of combining polyene phosphatidylcholine (PPC) with liraglutide in the treatment of nonalcoholic fatty liver disease (NAFLD) and investigate its impact on adipokine expression, specifically omentin-1 and vaspin. Methods: One hundred twenty NAFLD patients were randomly assigned to either the observation group (n = 60) or the control group (n = 60). The control group received single-dose PPC treatment, while the observation group received a combination of PPC and liraglutide for 12 weeks. Clinical efficacy, adipose-related factors (omentin-1, vaspin, serum fibroblast growth factor 21 (FGF21)), liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT)), and adverse reaction rates were compared between the two groups before and after treatment. Results: In the observation group, the clinical effectiveness rate (95.00%) was significantly higher than that in the control group (83.33%) (P < .05). Before treatment, there were no significant differences in omentin-1, vaspin, FGF21, ALT, AST, and GGT between the two groups (P > .05). After treatment, both groups showed decreased levels of vaspin, FGF21, ALT, AST, and GGT, along with increased omentin-1 levels. However, levels of vaspin, FGF21, ALT, AST, and GGT were lower in the observation group compared to the control group, while omentin-1 levels were higher (P < .05). Adverse reaction rates did not significantly differ between the two groups (10.00% vs. 6.67%) (P > .05). Conclusions: The combination therapy of PPC and liraglutide demonstrates efficacy in treating NAFLD, improving adipose-related factors, and reducing liver enzyme activity with high safety. This approach warrants broader clinical implementation.