Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This...Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’recovery.Methods:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before ERCP.All ERCP procedures were performed using deep sedation with intravenous propofol.The investigators were blinded but not the patients.The primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic indicators.The outcomes were analyzed according to a modified intention-to-treat principle.Results:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),respectively.The 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD group.The CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable models.Conclusion:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,abdominal pain,and cholangitis during展开更多
Cholangiocarcinoma(CCA)is a bile duct malignancy with a dismal prognosis.This study systematically investigated the role of the ribosomal protein S6(RPS6)gene,which is dependent in CCA.We found that RPS6 upregulation ...Cholangiocarcinoma(CCA)is a bile duct malignancy with a dismal prognosis.This study systematically investigated the role of the ribosomal protein S6(RPS6)gene,which is dependent in CCA.We found that RPS6 upregulation in CCA tissues was correlated with a poor prognosis.Functional investigations have shown that alterations in RPS6 expression,both gain-and loss-of function could affect the proliferation of CCA cells.In xenograft tumor models,RPS6 overexpression enhances tumorigenicity,whereas RPS6 silencing reduces it.Integration analysis using RNA-seq and proteomics elucidated downstream signaling pathways of RPS6 depletion by affecting the cell cycle,especially DNA replication.Immunoprecipitation followed by mass spectrometry has identified numerous spliceosome complex proteins associated with RPS6.Transcriptomic profiling revealed that RPS6 affects numerous alternative splicing(AS)events,and combined with RNA immunoprecipitation sequencing,revealed that minichromosome maintenance complex component 7(MCM7)binds to RPS6,which regulates its AS and increases oncogenic activity in CCA.Targeting RPS6 with vivo phosphorodiamidate morpholino oligomer(V-PMO)significantly inhibited the growth of CCA cells,patient-derived organoids,and subcutaneous xenograft tumor.Taken together,the data demonstrate that RPS6 is an oncogenic regulator in CCA and that RPS6-V-PMO could be repositioned as a promising strategy for treating CCA.展开更多
Delayed response behaviour commonly occurs in conjunction with changes in riverbed scouring and sediment deposition and is a key component in understanding the intrinsic behaviour of reservoir siltation.Due to the com...Delayed response behaviour commonly occurs in conjunction with changes in riverbed scouring and sediment deposition and is a key component in understanding the intrinsic behaviour of reservoir siltation.Due to the complexity of the riverbed siltation process,the variability in the factors that influence siltation and the limitations of available research methods,the understanding of the delayed response behaviour of the sedimentation process in the Three Gorges Reservoir(TGR)is currently merely qualitative,and there is a lack of quantitative in-depth understanding.In addition,the effects of changes in water and sediment conditions on sedimentation in the TGR before and after cascade reservoir impoundment have not been quantified,so further studies are needed to provide a reference for better understanding the intrinsic behaviour of sedimentation in the TGR and the implications for the long-term use of the reservoir.Based on measured water and sediment data from 2003 to 2020 and topographic data from 2003 to 2018,a delayed response model for sedimentation in the TGR is constructed and combined with theoretical derivation to analyse the changes in the delayed response behaviour of the TGR before and after the impoundment of the cascade reservoirs and the associated causes.Then,the influence of changes in water and sediment conditions in previous years on sedimentation in the reservoir area is determined.The results show that(1)the improved delayed response model of sedimentation,which considers variations in external water and sediment conditions,reservoir scheduling,and riverbed adjustment rates,can effectively reflect the sedimentation process in the TGR,especially after the impoundment of the cascade reservoirs.Additionally,the typical section elevation delayed response model can simulate the section elevation adjustment process.(2)After the impoundment of the cascade reservoirs,the decreased variation in incoming water and sediment and more concentrated incoming sediment in the flood season increased the adjust展开更多
目的:观察关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位的临床疗效。方法:2015年4月至2018年4月,采用关节镜下Bankart损伤修复术联合Remplissage术治疗复发性肩关节前脱位患者18例。男13例,...目的:观察关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位的临床疗效。方法:2015年4月至2018年4月,采用关节镜下Bankart损伤修复术联合Remplissage术治疗复发性肩关节前脱位患者18例。男13例,女5例。年龄18~43岁,中位数31岁。均合并Hill-Sachs损伤,骨缺损体积均小于肱骨头体积的20%。合并肩胛骨关节盂骨缺损14例,骨缺损直径均小于关节盂直径的20%;合并肱二头肌肌腱炎4例、上盂唇损伤3例;均不合并盂肱韧带肱骨侧撕脱损伤、肱骨大小结节骨折及肩袖损伤。采用美国肩肘关节外科医师协会(American Shoulder and Elbow Surgeons,ASES)评分标准、美国加州大学洛杉矶分校(the University of California at LosAngeles,UCLA)肩关节评分标准评价临床疗效,记录手术前后肩关节屈曲活动度、外旋活动度。结果:所有患者均获随访,随访时间12~17个月,中位数15个月。ASES评分,术前(84.4±4.7)分,术后12个月(97.4±6.3)分;UCLA评分,术前(21.8±4.4)分,术后12个月(28.9±3.1)分;肩关节屈曲活动度,术前168.1°±2.7°,术后167.8°±2.9°;外旋活动度,术前71.0°±9.4°,术后72.7°±8.7°。末次随访时,所有患者均未发生肩关节再脱位。结论:关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位,有利于改善肩关节功能、维持肩关节正常活动,避免肩关节再脱位。展开更多
文摘Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’recovery.Methods:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before ERCP.All ERCP procedures were performed using deep sedation with intravenous propofol.The investigators were blinded but not the patients.The primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic indicators.The outcomes were analyzed according to a modified intention-to-treat principle.Results:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),respectively.The 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD group.The CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable models.Conclusion:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,abdominal pain,and cholangitis during
基金the National Key Research and Development Program of China(2022YFC2407405)National Natural Science Foundation of China(82060551,32160230)+2 种基金Natural Science foundation of Gansu Province(22JR5RA891,China)Gansu Provincial Health Industry Research Program(GSWSQH2021-001,China)Science and Technology Bureau Talent Innovation Program of Chengguan District(2019RCCX0038,China).
文摘Cholangiocarcinoma(CCA)is a bile duct malignancy with a dismal prognosis.This study systematically investigated the role of the ribosomal protein S6(RPS6)gene,which is dependent in CCA.We found that RPS6 upregulation in CCA tissues was correlated with a poor prognosis.Functional investigations have shown that alterations in RPS6 expression,both gain-and loss-of function could affect the proliferation of CCA cells.In xenograft tumor models,RPS6 overexpression enhances tumorigenicity,whereas RPS6 silencing reduces it.Integration analysis using RNA-seq and proteomics elucidated downstream signaling pathways of RPS6 depletion by affecting the cell cycle,especially DNA replication.Immunoprecipitation followed by mass spectrometry has identified numerous spliceosome complex proteins associated with RPS6.Transcriptomic profiling revealed that RPS6 affects numerous alternative splicing(AS)events,and combined with RNA immunoprecipitation sequencing,revealed that minichromosome maintenance complex component 7(MCM7)binds to RPS6,which regulates its AS and increases oncogenic activity in CCA.Targeting RPS6 with vivo phosphorodiamidate morpholino oligomer(V-PMO)significantly inhibited the growth of CCA cells,patient-derived organoids,and subcutaneous xenograft tumor.Taken together,the data demonstrate that RPS6 is an oncogenic regulator in CCA and that RPS6-V-PMO could be repositioned as a promising strategy for treating CCA.
基金National Key R&D Program of China,No.2017YFC0405202National Natural Science Foundation of China,No.U2040218。
文摘Delayed response behaviour commonly occurs in conjunction with changes in riverbed scouring and sediment deposition and is a key component in understanding the intrinsic behaviour of reservoir siltation.Due to the complexity of the riverbed siltation process,the variability in the factors that influence siltation and the limitations of available research methods,the understanding of the delayed response behaviour of the sedimentation process in the Three Gorges Reservoir(TGR)is currently merely qualitative,and there is a lack of quantitative in-depth understanding.In addition,the effects of changes in water and sediment conditions on sedimentation in the TGR before and after cascade reservoir impoundment have not been quantified,so further studies are needed to provide a reference for better understanding the intrinsic behaviour of sedimentation in the TGR and the implications for the long-term use of the reservoir.Based on measured water and sediment data from 2003 to 2020 and topographic data from 2003 to 2018,a delayed response model for sedimentation in the TGR is constructed and combined with theoretical derivation to analyse the changes in the delayed response behaviour of the TGR before and after the impoundment of the cascade reservoirs and the associated causes.Then,the influence of changes in water and sediment conditions in previous years on sedimentation in the reservoir area is determined.The results show that(1)the improved delayed response model of sedimentation,which considers variations in external water and sediment conditions,reservoir scheduling,and riverbed adjustment rates,can effectively reflect the sedimentation process in the TGR,especially after the impoundment of the cascade reservoirs.Additionally,the typical section elevation delayed response model can simulate the section elevation adjustment process.(2)After the impoundment of the cascade reservoirs,the decreased variation in incoming water and sediment and more concentrated incoming sediment in the flood season increased the adjust
文摘目的:观察关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位的临床疗效。方法:2015年4月至2018年4月,采用关节镜下Bankart损伤修复术联合Remplissage术治疗复发性肩关节前脱位患者18例。男13例,女5例。年龄18~43岁,中位数31岁。均合并Hill-Sachs损伤,骨缺损体积均小于肱骨头体积的20%。合并肩胛骨关节盂骨缺损14例,骨缺损直径均小于关节盂直径的20%;合并肱二头肌肌腱炎4例、上盂唇损伤3例;均不合并盂肱韧带肱骨侧撕脱损伤、肱骨大小结节骨折及肩袖损伤。采用美国肩肘关节外科医师协会(American Shoulder and Elbow Surgeons,ASES)评分标准、美国加州大学洛杉矶分校(the University of California at LosAngeles,UCLA)肩关节评分标准评价临床疗效,记录手术前后肩关节屈曲活动度、外旋活动度。结果:所有患者均获随访,随访时间12~17个月,中位数15个月。ASES评分,术前(84.4±4.7)分,术后12个月(97.4±6.3)分;UCLA评分,术前(21.8±4.4)分,术后12个月(28.9±3.1)分;肩关节屈曲活动度,术前168.1°±2.7°,术后167.8°±2.9°;外旋活动度,术前71.0°±9.4°,术后72.7°±8.7°。末次随访时,所有患者均未发生肩关节再脱位。结论:关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位,有利于改善肩关节功能、维持肩关节正常活动,避免肩关节再脱位。
