Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective To investigate the effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR)on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases)according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group[(193.98±12.31)min]was lower than that of the NOSES group[(203.54±15.02)min]and the ISR group[(199.85±11.98)min](P＜0.05),operation time of NOSES group and ISR group was no difference(P＞0.05).The first exhaust time[(60.21±10.05)h],the first time of getting out of bed[(37.52±6.21)h],and the length of postoperative hospital stay[(12.51±1.47)d]in the traditional laparoscopic group were all higher than those in the NOSES group[(51.06±8.67)h,(30.13±4.92)h,and(11.27±)1.23)d]and ISR group[(53.19±9.24)h,(28.97±4.71)h,(11.73±1.35)d](P＜0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P＞0.05).There was no statistically significant difference in the Visual Analogue Scale(VAS)scores for pain at 4 hours,24 hours,and 48 hours after surgery among the three groups(P＞0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery,and the difference was statistically significant(P＜0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery,and the difference was statistically significant(P＜0.05).The NOSES group's Wexner score[(4.93±0.76)points]at 3 months after surgery and Wexner score[(3.21±0.42)points]at 6 months after surgery were lower than those of the ISR group[(6.32±0.93)points,(4.48±0.54)points]and the traditional laparoscopic group[(5.93±0.81)points,(4.01±0.53)points](P＜0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P＜0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was(74.82±4.01)points,and that at 6 months was(85.49±4.93)points,which were higher than those of the ISR group[(67.05±5.03)points and(71.64±4.21)points]and the traditional laparoscopic group[(70.42±3.92)points,(76.28±4.48)points](P＜0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group,and the difference was statistically significant(P＜0.05).The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P＜0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P＜0.05).There was no significant difference in the incidence of total complications among the three groups(P＞0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective To investigate the effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR)on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases)according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group[(193.98±12.31)min]was lower than that of the NOSES group[(203.54±15.02)min]and the ISR group[(199.85±11.98)min](P＜0.05),operation time of NOSES group and ISR group was no difference(P＞0.05).The first exhaust time[(60.21±10.05)h],the first time of getting out of bed[(37.52±6.21)h],and the length of postoperative hospital stay[(12.51±1.47)d]in the traditional laparoscopic group were all higher than those in the NOSES group[(51.06±8.67)h,(30.13±4.92)h,and(11.27±)1.23)d]and ISR group[(53.19±9.24)h,(28.97±4.71)h,(11.73±1.35)d](P＜0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P＞0.05).There was no statistically significant difference in the Visual Analogue Scale(VAS)scores for pain at 4 hours,24 hours,and 48 hours after surgery among the three groups(P＞0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery,and the difference was statistically significant(P＜0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery,and the difference was statistically significant(P＜0.05).The NOSES group's Wexner score[(4.93±0.76)points]at 3 months after surgery and Wexner score[(3.21±0.42)points]at 6 months after surgery were lower than those of the ISR group[(6.32±0.93)points,(4.48±0.54)points]and the traditional laparoscopic group[(5.93±0.81)points,(4.01±0.53)points](P＜0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P＜0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was(74.82±4.01)points,and that at 6 months was(85.49±4.93)points,which were higher than those of the ISR group[(67.05±5.03)points and(71.64±4.21)points]and the traditional laparoscopic group[(70.42±3.92)points,(76.28±4.48)points](P＜0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group,and the difference was statistically significant(P＜0.05).The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P＜0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P＜0.05).There was no significant difference in the incidence of total complications among the three groups(P＞0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.

Purpose/Significance To alleviate digital health technology anxiety in elderly patients with chronic diseases.Method/Process A convenience sampling method is used to survey 1 222 elderly patients with chronic diseases in tertiary,secondary,and commu-nity hospitals in Shanghai,China,with respect to demographic information,the level of anxiety about digital health technologies,and the conditions of individual use of digital health technologies.Logistic regression analyse is used to investigate the factors influencing anxiety in the use of digital health technologies among elderly patients with chronic diseases.Result/Conclusion Elderly patients with chronic diseases as a whole have low moderate levels of anxiety about digital health technologies.Educational level,per capita monthly income,experience of using digital health technologies,and learning ability are independent factors affecting anxiety about digital health technolo-gies among elderly patients with chronic diseases.Aging-friendly design,assistance and support,improved facility accessibility,and precise training should be implemented so as to increase the acceptance and use of digital health technologies among elderly chronic dis-ease patients.

Objective:To study the expression of miR-496 in gastric cancer cells, and explore its role and mechanism in the proliferation and apoptosis of gastric cancer cells. Methods:Real-time fluorescence quantitative PCR (qPCR) was used to detect the expression of miR-496 in normal gastric epithelial cell lines and gastric cancer cell lines AGS and MKN45. miR-496 was knocked down in AGS cells with the lowest expression level, and a negative control group and a blank control group were set up. Cell proliferation and apoptosis were detected by CCK8 assay and flow cytometry. LYN, the target gene of miR-496, was screened using bioinformatics software, and the effect of transfection of miR-496 on LYN expression was detected by qPCR. Subsequently, rescure experiment was conducted to further study the mechanism of miR-496 on gastric cancer cells through regulation of LYN. Data were analyzed by GraphPad Prism 9 software. Measurement data were presented as mean ± standard deviation, and the comparison between the two groups was performed by t test. Results:The expression of miR-496 in AGS and MKN45 was significantly lower than that in normal gastric epithelial cells ( P<0.05). After overexpression of miR-496, the proliferation of AGS cells could be inhibited and the apoptosis ratio of AGS cells could be significantly increased ( P<0.05). QPCR results showed that miR-496 overexpression group could inhibit the expression of LYN ( P<0.05). Bioinformatics analysis showed that miR-496 binds to LYN kinase ( LYN) 3 ′UTR region, and overexpression of miR-496 can inhibit the expression of LYN in AGS cells, while CCK8 rescue experiment showed that overexpression of LYN could remove the inhibitory effect of miR-496 on cell proliferation. Flow cytometry showed that LYN expression could cancel the promoting effect of miR-496 on apoptosis ( P<0.05). Conclusion:miR-496 is low expressed in gastric cancer cells, and it inhibits the proliferation and promotes apoptosis of gastric cancer cells by targeting the expression of LYN in gastric cancer cells.

Objective : To investigate the effect of glycyrrhizin on the fibrosis of silica⁃treated mice. Methods : C57BL/6 male mice were randomly divided into control group , silicosis model group and glycyrrhizin treatment group ,with 6 mice in each group. The pathological changes of lung tissues were observed by HE and Sirius red stai⁃ ning. Lung function indexes were detected by respiratory function instrument. The content of hydroxyproline in the lung tissues was detected by corresponding kit. The mRNA levels of monocyte chemotactic protein 1 (MCP⁃1) , fibronectin (FN) and alpha⁃smooth muscle actin ( α ⁃SMΑ) were detected by real⁃time fluorescent quantitative PCR. The number of leukocytes in the bronchoalveolar lavage fluid (BALF) was counted and the secretion of transforming growth factor⁃β1 (TGF⁃ β1) in BALF was detected by ELISA. Results : HE and Sirius red staining showed that the inflammatory cells and the collagen were accumulated in the lung tissue of mice in silicosis model group. After treatment with glycyrrhizin , the accumulation of inflammatory cells and the collagen was ameliorated. Compared with the control group , pause (PAU) and enhanced pause (Penh) increased in the model group (P < 0. 05) . Glycyrrhizin treatment improved the respiratory function in mice. Furthermore , glycyrrhizin also effectively reduced the increase in the content of hydroxyproline , the expression of MCP⁃1 , FN and α ⁃SMΑ mRNA , the number of leukocytes and the secretion of TGF⁃ β1 induced by silica treatment in mice (P < 0. 05) . Conclusion Glycyrrhizin can improve the pulmonary function and alleviate the fibrosis in mice with silicosis.

Objective:To investigate the role of stress-inducible protein Sestrin2 (Sesn2) in the improvement of insulin resistance in rat L6 skeletal muscle cells treated with liraglutide.Methods:The establishment of insulin resistance model of rat L6 skeletal muscle cells was induced by palmitate. The experimental cells were divided into control group(Con group), palmitate 0.6 mmol/L treatment group(PA group), palmitate 0.6 mmol/L+ liraglutide 10 nmol/L treatment group(PA+ Lir10 group), palmitate 0.6 mmol/L+ liraglutide 100 nmol/L treatment group(PA+ Lir100 group), and palmitate 0.6 mmol/L+ liraglutide 1 000 nmol/L treatment group(PA+ Lir1000 group). The cell counting kit 8(CCK8) method was used to detect the cell activity in each group. Western blotting was used to detect the expression levels of glucose transporter 4(GLUT4), protein kinase B(Akt), phosphorylated protein kinase B(p-Akt), and Sesn2 protein in L6 cells. L6 cells were transfected with siRNA to inhibit the expression of Sesn2. The cells were treated with palmitate and liraglutide. Western blotting was used to detect the expression levels of Sesn2, Akt, p-Akt, and GLUT4 protein in L6 cells.Results:Compared with Con group, the cell survival rate, p-Akt/Akt ratio, Sesn2, and GLUT4 protein expression in PA group decreased significantly( P<0.05). After liraglutide intervention, the cell activity, p-Akt/Akt ratio, Sesn2, and GLUT4 protein expression of PA+ Lir100 and PA+ Lir1000 groups was increased( P<0.05). After inhibiting the expression of Sesn2, p-Akt/Akt ratio and GLUT4 protein in transfected si-Sesn2 and treated with 0.6 mmol/L palmitate group(PA+ si-Sesn2 group) and transfected si-Sesn2 and treated with 0.6 mmol/L palmitate+ liraglutide 100 nmol/L group (Lir100+ PA+ si-Sesn2 group) were significantly lower than those in transfection negative group (si-Con group; P<0.05). Even after liraglutide intervention, compared with PA+ si-Sesn2 group, p-Akt/Akt ratio and GLUT4 protein expression level were not significantly increased in Lir100+ PA+ si-Sesn2 group ( P>0.05). Conclusions:Palmitate could induce the decrease of p-Akt/Akt ratio and GLUT4 protein expression in L6 cells. Liraglutide upregulates the expression of Sesn2, which leads to the increase of p-Akt/Akt ratio and GLUT4 protein expression and contributes to the improvement of insulin resistance.

Objective:To study the effect and mechanism of Rab4A knockout expression on proliferation, migration and invasion of gastric cancer cells. Methods:The expression of Rab4A in four human gastric cancer cell lines MGC-803, SGC-790, MKN45 and AGS was detected by Western blot. Rab4A was knocked out in AGS cells with the highest expression level, and untransfected gastric cancer cells were used as control group. Cell proliferation, migration and invasion were detected by CCK8 and Transwell assay, respectively. Western blot analysis was used to investigate the expression changes of epidermal growth factor receptor (EGFR), downstream pathway proteins AKT and β-catenin induced by Rab4A knockout. The interaction between Rab4A and MiR- 496 was detected by dual luciferase reporter gene, and the effect of MiR- 496 transfection on Rab4A expression was detected by qPCR and Western blot. GraphPad Prism 9 software was used for data analysis, t-test was used for comparison between the two groups, and normal distribution measurement data were expressed as mean ± standard deviation ( ± s). Results:The expression of Rab4A was the highest in AGS cells, and the knockdown of Rab4A inhibited the proliferation, migration and invasion of AGS cells ( P<0.05). In Rab4A knockout gastric cancer cells, the surface expression of epidermal growth factor receptor (EGFR) was significantly decreased, and the expression of downstream pathway proteins p-AKT and β-catenin was also inhibited ( P<0.05). The luciferase reporter showed that MiR- 496 could bind the 3′UTR of Rab4A. In addition, MiR- 496 down-regulated the expression of Rab4A in AGS cells( P<0.05). Conclusion:The expression of Rab4A is inhibited by MiR- 496, and the proliferation, migration and invasion of gastric cancer cells can be inhibited by down-regulating the surface expression of EGFR after inhibiting Rab4A expression.

Objective:To observe chicken typeⅡcollagen-induced arthritis( CIA) in serum of mice with the dynamic changes of IL-27,IL-17,IL-10. Methods: 54 DBA1/J mice were randomly divided into control group(n=6) and model group(n=12), according to the progress of CIA mouse course early,middle and late(7,14,and 35 days after booster immunization) ,taking the eyeball for blood and separating the serum under sterile condition. The dynamic levels of cytokines IL-27,IL-17,IL-10 were detected by flow cy-tometry. Results:The level of IL-27 in the model group was significantly declined in the the progress of CIA mouse course early and middle(P<0. 05,P<0. 01) compared with the control group,but there was no significant difference between late disease and control group(P> 0. 05);the level of IL-17 in the disease early and late was no significant difference(P> 0. 05) compared with the control group,while in the mid course significantly higher than control group(P<0. 05) during the course of disease. The level of IL-10 showed no difference from the experiment beginning(P> 0. 05). Conclusion: IL-27,IL-17,IL-10 paticipate in the pathogenesis of CIA and their alterations at different stages of the disease have a relation to the development of arthritis.