Gallbladder cancer (GBC) is a malignant digestive system tumor, and patients are often only diagnosed at an advanced stage, resulting in high mortality and poor prognosis. Insufficiently specific and sensitive biomarkers impede early screening and diagnosis, highlighting the need to improve early diagnostic capabilities and identify reliable molecular biomarkers. Two GBC datasets and 3,252 acetylation-related genes were compiled from GeneCards and PubMed. Key genes were then identified using four machine learning algorithms, and their diagnostic performance and correlations with immune cell infiltration were evaluated. There were 848 identified differentially expressed genes (DEGs), of which 203 were acetylation-related DEGs. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis revealed associations with biological processes. Machine learning approaches identified seven key genes that were used to develop a diagnostic model. The model’s performance was assessed using receiver operating characteristic curves and decision curve analysis. Immune infiltration analysis revealed links between the principal genes and immune cell populations, with NCOA1 showing the strongest positive correlation with activated natural killer cells. This study systematically characterizes acetylation-related genes in GBC, develops a high-accuracy diagnostic model, and provides preliminary insights into potential links between epigenetic regulation and the immune microenvironment.

Neuroendocrine neoplasms (NENs) of the gallbladder (GB) are rare, accounting for approximately 0.5

Background T-tube cholangiography and choledochoscopy are commonly employed techniques for assessing residual bile duct stones following biliary surgery. Further investigation is warranted to determine the utility of routine cholangiography prior to T-tube removal. It is imperative to explore the diagnostic efficacy of various examination methods for detecting residual calculi post-biliary surgery. Methods The clinical data of 287 patients who underwent T-tube angiography and choledochoscopy following choledochotomy and subsequent T-tube drainage at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from 2017 to 2022 were retrospectively analyzed. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage surgery. The results of T-tube cholangiography and choledochoscopy for each patient were recorded, followed by analysis and comparison. Results Among the cohort of 287 patients, T-tube cholangiography revealed 38 cases of residual stones, which were subsequently confirmed by choledochoscopy in 29 cases. Conversely, among the remaining 249 patients who exhibited no evidence of residual stones on T-tube angiography, a single patient was later verified to have retained stones through choledochoscopy. The results of T-tube cholangiography and choledochoscopy showed no significant difference (P = 0.82), indicating a high level of agreement between the two methods (Kappa value: 0.70). Conclusion The simultaneous performance of T-tube cholangiography and choledochoscopy after biliary surgery is recommended to enhance the diagnostic accuracy of residual stones and reduce the incidence of bile duct stone remnants.

Hepatocellular carcinoma (HCC) is a malignancy associated with high morbidity and mortality rates. Conversion therapy provides patients with unresectable HCC (uHCC) the opportunity to undergo radical treatment and achieve long-term survival. Despite accumulating evidence regarding the efficacy of conversion therapy, the optimal treatment approach for such therapy remains uncertain. Lenvatinib (LEN) has shown efficacy and tolerable rates of adverse events (AEs) when applied in combination with immune checkpoint inhibitors (ICIs) or locoregional therapy (LRT) over the past decade. Therefore, the present meta-analysis was performed to systematically assess the safety and efficacy of LEN-based treatment regimens in conversion therapies for uHCC. Data on outcomes, including the conversion rate, objective response rate (ORR), disease control rate (DCR) and AE incidence in patients with uHCC, were collected. A systematic literature search was performed using MEDLINE, Embase, Web of Science and Cochrane Library databases, up to the date of September 1, 2023. In total, 16 studies, encompassing a total of 1,650 cases of uHCC, were included in the final meta-analysis. The pooled conversion rates for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were calculated to be 0.04 (95% CI, 0.00-0.07; I2=77%), 0.23 (95% CI, 0.16-0.30; I2=66%), 0.14 (95% CI, 0.10-0.18; I2=0%) and 0.35 (95% CI, 0.23-0.47; I2=88%), respectively. The pooled ORRs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were found to be 0.45 (95% CI, 0.23-0.67; I2=96%), 0.49 (95% CI, 0.39-0.60; I2=78%), 0.43 (95% CI, 0.24-0.62; I2=88%) and 0.69 (95% CI, 0.56-0.82; I2=92%), respectively. The pooled DCRs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were observed to be 0.77 (95% CI, 0.73-0.81; I2=23%), 0.82 (95% CI, 0.69-0.95; I2=90%), 0.67 (95% CI, 0.39-0.94; I2=94%) and 0.87 (95% CI, 0.82-0.93; I2=67%), respectively. The pooled grade >= 3 AEs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were 0.25 (95% CI, 0.14-0.36; I2=89%), 0.43 (95% CI, 0.34-0.53; I2=23%), 0.42 (95% CI, 0.19-0.66; I2=81%) and 0.35 (95% CI, 0.17-0.54; I2=94%), respectively. These findings suggested that LEN-based combination strategies may confer efficacy and acceptable tolerability for patients with uHCC. In particular, LEN + ICI, with or without LRT, appears to represent a highly effective conversion regimen, with an acceptable conversion rate and well-characterized safety profile.

文化自信是一个国家、一个民族发展中最基本、最深沉、最持久的力量.向上、向善的文化是一个国家、一个民族休戚与共、血脉相连的重要纽带.如何将医学人文素养与新时代医院基层党建工作有效融合,以医院基层党建工作为抓手,进而提升医务工作者的医学人文素养成为新时期创新基层党建工作中面临的一个重要课题.本文阐述了文化自信的精神内核,以科研型党支部为例,通过提升医学人文素养的"自主性""引导性""包容性""创新性"的四维特性;以文化铸魂,通过"理论+实践"巧塑党员价值核心;以"党建 + 业务"为动力,推动医院科研事业高质量发展;以"服务 + 需求"创新党建工作的深度和广度,在文化自信视域下全方位多角度提升医院基层党支部党员的医学人文素养,扎实推进党建服务医院发展工作,奋力开创基层支部建设新局面,为高质量医院发展作出新的贡献.

IntroductionNon-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disorder over the last four decades, more evidence shows a high prevalence of sarcopenia in NAFLD that may influence disease severity. This meta-analysis aims to determine the association of sarcopenia with liver fibrosis and steatohepatitis in NAFLD.Methods and analysisWe will conduct the literature search using Medline (via PubMed), Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews (from the date of inception to 1 May 2022). There will be no restriction to the publication year. Two reviewers will independently screen the articles and abstract key study characteristics. The outcome of this meta-analysis is the strength of association of sarcopenia with liver fibrosis and steatohepatitis in NAFLD. The STATA (V.14, StataCorp, 2015) will be used to carry out the statistical analysis. Comprehensive evaluation of bias risk and heterogeneity will be performed before data synthesis. Also, consistency and evidence quality will be assessed.Ethics and disseminationThere will be no need of ethics approval as this systematic review is summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal.PROSPERO registration numberCRD42022322685.

Objective:To observe the effects of exosomes derived from human umbilical cord mesenchymal stem cells on the proliferation and invasion of pancreatic cancer cells, and to analyze the contents of exosomes and explore the mechanisms affecting pancreatic cancer cells.Methods:Exosomes extracted from human umbilical cord mesenchymal stem cells were added to pancreatic cancer cells BxPC3, Panc-1 and mouse models of pancreatic cancer, respectively. The proliferative activity and invasion abilities of BxPC3 and Panc-1 cells were measured by cell counting kit-8 (CCK-8) and Transwell assays. The expressions of miRNAs in exosomes were detected by high-throughput sequencing. GO and KEGG were used to analyze the related functions and the main metabolic pathways of target genes with high expressions of miRNAs.Results:The results of CCK-8 cell proliferation assay showed that the absorbance of BxPC3 and Panc-1 cells in the hucMSCs-exo group was significantly higher than that in the control group [(4.68±0.09) vs. (3.68±0.01), P<0.05; (5.20±0.20) vs. (3.45±0.17), P<0.05]. Transwell test results showed that the number of invasion cells of BxPC3 and Panc-1 in hucMSCs-exo group was significantly higher than that in the control group (129.40±6.02) vs. (89.40±4.39), P<0.05; (134.40±7.02) vs. (97.00±6.08), P<0.05. In vivo experimental results showed that the tumor volume and weight in the exosomes derived from human umbilical cord mesenchymal stem cells (hucMSCs-exo) group were significantly greater than that in the control group [(884.57±59.70) mm 3 vs. (695.09±57.81) mm 3, P<0.05; (0.94±0.21) g vs. (0.60±0.13) g, P<0.05]. High-throughput sequencing results showed that miR-148a-3p, miR-100-5p, miR-143-3p, miR-21-5p and miR-92a-3p were highly expressed. GO and KEGG analysis showed that the target genes of these miRNAs were mainly involved in the regulation of glucosaldehylation, and the main metabolic pathways were ascorbic acid and aldehyde acid metabolism, which were closely related to the development of pancreatic cancer. Conclusion:Exosomes derived from human umbilical cord mesenchymal stem cells can promote the growth of pancreatic cancer cells and the mechanism is related to miRNAs that are highly expressed in exosomes.

Objective:To analyze the preliminary explorations and practical effects of strengthening the process management of nursing special projects in a tertiary general hospital, so as to explore the refined management strategy of hospital projects and provide reference for improving the management level of the research project.Methods:This article takes a series of refined measures taken by the hospital in the process management of nursing special projects from August 2016 to August 2021 as the research example, including setting up subject directions around key disciplines, setting application conditions at different levels, standardizing selection procedures, strengthening mid-term assessments, strictly controlling final acceptance, establishing integrity files, and promoting the transformation of scientific achievements, etc. and these measures are deeply analyzed and discussed.Results:Through a series of measures, the hospital nursing team has significantly improved in terms of research paper publication, patent authorization, approval of projects above the bureau level, and nursing specialties ranking of Chinese hospital Science and Technology Evaluation Metrics (STEM) in the past six years.Conclusions:By strengthening the process management of nursing special research project, the construction level of nursing disciplines has been significantly improved, and the development of nursing disciplines has been greatly promoted.

医学生担负着国家医疗卫生事业的未来,是健康中国战略成功施行的中流砥柱.临床实习期是医学生向临床医生角色转变的重要阶段,加强临床实习期课程思政教育,是培养医学生救死扶伤、敬业奉献、勇于担当等职业素养的根本保障.提高临床教师对课程思政探索和实践的能力、将课程思政贯穿于临床教学中的言传身教、灵活运用多种教学方法、培养学生积极实践和自我反思的能力等措施是提升医学生临床实习期课程思政教育成效的有效路径.

目的 探索肝胆外科临床实习教学活动中,网络辅助临床案例问题为导向(CBL-PBL)的教学模式提高临床思维能力的教学效果.方法 选取2020年9月至2021年4月在首都医科大学宣武医院肝胆外科病区实习的临床医学系5年级医学生50名作为研究对象,使用随机数字表法将其分为研究组和对照组,每组各25名.研究组采用网络辅助CBL-PBL教学模式,包括网络化的组织管理、CBL为基础的教案设计、PBL为中心的教学实施和网络化课后管理.对照组采用传统教学模式.比较两组学生对临床思维能力学习的满意度.使用临床思维能力教学评估量通用量表评分评估临床思维教学效果.结果 研究组学生对临床思维能力教学满意度高于对照组(P<0.05).研究组学生批评思维、系统思维、循证思维及临床思维能力及总分高于对照组(P<0.01).结论 应用网络辅助CBL-PBL教学模式,在临床医学生肝胆外科的实习中,可以提高学生满意度,改善临床思维能力教学效果,值得深入研究、完善和推广.

Pancreatic beta cells are insulin-producing cells that are structurally and functionally polarized in the islets of Langerhans. The organization and position of the Golgi complex play a key role in maintaining a polarized cell state, but the factors and molecular mechanisms determining the Golgi polarization of pancreatic beta cells are still unknown. In the current study, using pancreatic beta cell-specific Atg5 knockout mice, we found that Atg5, an essential gene for autophagy, plays a pivotal role in regulating Golgi integrity and polarization by affecting the expression of genes involved in vesicle transport. Deletion of Atg5 led to endoplasmic reticulum (ER) stress and impaired the distribution of proinsulin and insulin secretion of pancreatic beta cells, which further exacerbates diabetes. These results contribute to a comprehensive understanding of autophagy-mediated Golgi polarization and its regulation of the function of pancreatic beta cells.

目的 根据公立医院高质量发展要求,探索基于双因素理论下的医学青年创新激励路径,为推动公立医院高质量发展提供参考与借鉴.方法 使用文献分析法对双因素理论、医院科研奖励机制和青年人才科研奖励机制进行调研;同时结合双因素理论与实践经验,分析公立医院在青年医学人才创新激励政策中存在的问题,提出相应对策,以构建双因素理论下青年医学人才创新激励路径.结果 管理者应在青年医学人才需求特征分析的基础上,区分保健因素和激励因素,从两方面入手实施激励.利用提高个人成就感、创造个人成长环境、晋升职称等手段提供激励因素,激发青年人才的创新动力;从工作条件、物质利益、薪酬水平等方面入手,落实保健因素.结论 高质量发展作为一种新的发展理念,不仅体现在以科技创新驱动的高质量发展上,更体现于管理机制的创新,让制度创新先行成为高质量发展的动力源.

Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

BackgroundIntraoperative blood salvage autotransfusion(IBSA) has been widely used in a variety of surgeries, but the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. Numerous studies have reported that IBSA used during LT for HCC is not associated with adverse oncologic outcomes. This systematic review and meta-analysis aims to estimate the clinical prognosis of IBSA for patients with H+CC undergoing LT.MethodsMEDLINE, Embase, Web of Science, and Cochrane Library were searched for articles describing IBSA in HCC patients undergoing LT from the date of inception until May 1, 2022, and a meta-analysis was performed. Study heterogeneity was assessed by I2 test. Publication bias was evaluated by funnel plots, Egger’s and Begg’s test.Results12 studies enrolling a total of 2253 cases (1374 IBSA and 879 non-IBSA cases) are included in this meta-analysis. The recurrence rate(RR) at 5-year(OR=0.75; 95%CI, 0.59-0.95; P=0.02) and 7-year(OR=0.65; 95%CI, 0.55-0.97; P=0.03) in the IBSA group is slightly lower than non-IBSA group. There are no significant differences in the 1-year RR(OR=0.77; 95% CI, 0.56-1.06; P=0.10), 3-years RR (OR=0.79; 95% CI, 0.62-1.01; P=0.06),1-year overall survival outcome(OS) (OR=0.90; 95% CI, 0.63-1.28; P=0.57), 3-year OS(OR=1.16; 95% CI, 0.83-1.62; P=0.38), 5-year OS(OR=1.04; 95% CI, 0.76-1.40; P=0.82),1-year disease-free survival rate(DFS) (OR=0.80; 95%CI, 0.49-1.30; P=0.36), 3-year DFS(OR=0.99; 95%CI, 0.64-1.55; P=0.98), and 5-year DFS(OR=0.88; 95%CI, 0.60-1.28; P=0.50). Subgroup analysis shows a difference in the use of leukocyte depletion filters group of 5-year RR(OR=0.73; 95%CI, 0.55-0.96; P=0.03). No significant differences are found in other subgroups.ConclusionsIBSA provides comparable survival outcomes relative to allogeneic blood transfusion and does not increase the tumor recurrence for HCC patients after LT.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022295479.

A 64-year-old man was admitted with intermittent abdominal pain caused by cholecystolithiasis and chronic cholecystitis. He had no previous liver operations or diseases. In the course of diagnosis and treatment, abdominal computed tomography (CT) showed that segments II, III and IV of the liver, the lateral and medial segments of the left lobe, were missing. Segment I, the caudate lobe, could still be seen. The left hepatic vein, left hepatic artery, and left portal vein were all absent, while the main portal vein and its right branch were visible (Fig. 1a,b, Videos S1 and S2). Magnetic resonance cholangiopancreatography (MRCP) examination showed an overall irregular shape of the liver with cluster tortuous dilatation of the intrahepatic bile ducts at the left margin of the liver. No substantial change in the right lobe of the liver was found (Fig. 1c). The gallbladder is in its normal position with a normal shape of size (70 mm 30 mm 20 mm), and multiple small round high signal intensity were observed inside it (Video S3). The patient had no history of liver surgery or liver disease. Physical examination showed that except for slight tenderness in the right upper abdomen, there were no obvious signs in the abdomen. The liver function indexes of the patients were all in the normal range before operation. Laparoscopic cholecystectomy was performed after the diagnosis of gallbladder stones with chronic cholecystitis was confirmed. During the laparoscopic surgery, the shape of the liver was found to be approximately round. In the original position of the left lobe, there was an obvious abnormal structure shown as atrophic, flattened and tortuous, with several small hepatic cysts (2 ~ 4 mm) on the surface (Fig. 2a,b). There was no obvious anatomical abnormality in the gallbladder triangle structure, except a long mesocyst was found (Fig. 2c). The postoperative pathology of the specimen reported chronic cholecystitis with cholecystolithiasis. The patient was discharged 1 day

Impaired insulin release is a hallmark of type 2 diabetes and is closely related to chronically elevated glucose concentrations, known as “glucotoxicity.” However, the molecular mechanisms by which glucotoxicity impairs insulin secretion remain poorly understood. In addition to known kiss-and-run and kiss-and-stay fusion events in INS-1 cells, ultrafast Hessian structured illumination microscopy (Hessian SIM) enables full fusion to be categorized according to the newly identified structures, such as ring fusion (those with enlarged pores) or dot fusion (those without apparent pores). In addition, we identified four fusion intermediates during insulin exocytosis: initial pore opening, vesicle collapse, enlarged pore formation, and final pore dilation. Long-term incubation in supraphysiological doses of glucose reduced exocytosis in general and increased the occurrence of kiss-and-run events at the expense of reduced full fusion. In addition, hyperglycemia delayed pore opening, vesicle collapse, and enlarged pore formation in full fusion events. It also reduced the size of apparently enlarged pores, all of which contributed to the compromised insulin secretion. These phenotypes were mostly due to the hyperglycemia-induced reduction in syntaxin-1A (Stx-1A) and SNAP-25 protein, since they could be recapitulated by the knockdown of endogenous Stx-1A and SNAP-25. These findings suggest essential roles for the vesicle fusion type and intermediates in regulating insulin secretion from pancreatic beta cells in normal and disease conditions.

The anatomical location of the pancreas and the sparse distribution of islets limit the study of islets in vivo, while the unique physiological structure of the anterior chamber of the eye provides a new technical method for long-term, non-invasive, real-time and in vivo physiological study of transplanted islets. In recent years, through the experimental study of rodents and non-human primates, great progress has been made in the survival, functional regulation and pathophysiological changes of islets after transplantation. This article will focus on the current research progress of islet transplantation in the anterior chamber of the eye, and the advantages and disadvantages of this technical method are introduced as well.

Purpose: Although human umbilical cord mesenchymal stem cells (hucMSCs) can contribute to the growth of tumors, including pancreatic ductal adenocarcinoma (PDAC), however, little is known about the exact mechanisms by which the exosomes secreted from hucMSCs (hucMSCs-exo) have an oncogenic effect on the physiopathology of PDAC. The effects of hucMSCs on tumor development are attributed to hucMSCs-exo, which deliver unique proteins and miRNAs to cancer cells. Methods: HucMSCs and exosomes were isolated and confirmed via transmission electron microscopy, nanoparticle tracking analysis and western blot. The nude mice were inoculated subcutaneously on both flanks with human pancreatic cancer Panc-1 cells (1 x 106), and hucMSCs-exo were directly administered via intratumoral injection once a day for three days each week. Cell proliferation assays were performed using a Cell Counting Kit8 assay and the cell invasion assay was performed using Transwell assay. The miRNA data were predicted and analyzed by miRanda software. The analysis of the target genes of the miRNAs was proformed with the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. Results: Firstly, we observed that hucMSCs-exo promoted Panc-1 and BxPC3 cell growth by increasing proliferation and migration in vitro. Secondly, in a xenograft tumor model, hucMSCs-exo increased the growth of Panc-1 cells. Thirdly, high-throughput sequencing of hucMSCs-exo showed that hsa-miR-148a-3p, hsa-miR-100-5p, hsamiR-143-3p, hsa-miR-21-5p and hsa-miR-92a-3p were highly expressed. For the five identified miRNAs, 1308 target genes were predicted by miRanda software. From the GO and KEGG analyses of the target genes of the identified miRNAs, it was found that the main GO function was the regulation of cellular glucuronidation, and the main KEGG metabolic pathway involved the metabolism of ascorbic acid and aldehyde acid. These processes are related to the occurrence and development of pancreatic cancer. Finally, we observed that miR-100-5p promoted Panc-1 and BxPC3 cell growth in vitro and in vivo. Conclusion: Here, by utilizing exosomes secreted from hucMSCs, we systematically investigated the effects of hucMSCs-exo on PDAC growth in vitro and in vivo for the first time. Building on these results, we provided new insights into the role of hucMSCs-exo in the PDAC growth and revealed the attractive communication between hucMSCs and PDAC cells that occurs through MSCs-exosomes-miRNAs.

脾脏窦岸细胞血管瘤是一种少见的脾脏血管源性肿瘤,无明显特异性临床表现,常伴恶性肿瘤及免疫性疾病.多因偶然原因发现,其主要依靠影像学检查和病理学检查确定诊断.该肿瘤性质大多数呈良性发展,极少数存在恶性倾向.目前治疗主要为手术切除,可获得治愈,但也有肿瘤复发转移的报道.该疾病在临床上较为罕见,临床医生往往缺乏认识,容易漏诊、误诊.现就该疾病的诊断治疗现状进行综述,旨在为临床诊治提供参考.

Comprehensive reviews and large population-based cohort studies have played an important role in the diagnosis and treatment of pancreatitis and its sequelae. The incidence and mortality of pancreatitis have been reduced significantly due to substantial advancements in the pathophysiological mechanisms and clinically effective treatments. The study of extracellular vesicles (EVs) has the potential to identify cell-to-cell communication in diseases such as pancreatitis. Exosomes are a subset of EVs with an average diameter of 50~150 nm. Their diverse and unique constituents include nucleic acids, proteins, and lipids, which can be transferred to trigger phenotypic changes of recipient cells. In recent years, many reports have indicated the role of EVs in pancreatitis, including acute pancreatitis, chronic pancreatitis and autoimmune pancreatitis, suggesting their potential influence on the development and progression of pancreatitis. Plasma exosomes of acute pancreatitis can effectively reach the alveolar cavity and activate alveolar macrophages to cause acute lung injury. Furthermore, upregulated exosomal miRNAs can be used as biomarkers for acute pancreatitis. Here, we summarized the current understanding of EVs in pancreatitis with an emphasis on their biological roles and their potential use as diagnostic biomarkers and therapeutic agents for this disease.