Incidental gallbladder cancer (iGBC) diagnosed post-histopathological examination of gallbladders removed assuming benign gallstone disease constitutes a significant proportion of GBC patients. Most iGBC patients present with early-stage disease. The standard care for localized (non-metastatic) iGBC includes a reoperation for complete extended (radical) cholecystectomy involving liver resection and lymphadenectomy, followed by postoperative adjuvant systemic therapy. However, a major drawback of this approach is the high recurrence rate within six months post-radical surgery, which undermines the benefits of the extensive procedure; notably, most recurrences are distant, highlighting the efficacy of systemic therapy. Similar to other gastrointestinal cancers, there appears to be a potential for neoadjuvant systemic therapy (chemotherapy) before reoperative surgery in iGBC cases. The premise that neoadjuvant systemic therapy aids in selecting diseases with more favorable biological characteristics and addresses micro-metastatic disease appears applicable to iGBC as well. This systematic review examines the current evidence supporting or refuting neoadjuvant therapy and discusses criteria for selecting patients who would derive significant benefit, along with proposing an optimal chemotherapy regimen for iGBC patients. Improved outcomes have been reported in patients undergoing reoperation after 4 to 14 weeks following the initial cholecystectomy compared to immediate reoperation. Limited, yet promising, evidence supports the use of 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy prior to reoperative surgery in select high-risk iGBC cases.

Incidental gallbladder cancer (iGBC) diagnosed post-histopathological examination of gallbladders removed assuming benign gallstone disease constitutes a significant proportion of GBC patients. Most iGBC patients present with early-stage disease. The standard care for localized (non-metastatic) iGBC includes a reoperation for complete extended (radical) cholecystectomy involving liver resection and lymphadenectomy, followed by postoperative adjuvant systemic therapy. However, a major drawback of this approach is the high recurrence rate within six months post-radical surgery, which undermines the benefits of the extensive procedure; notably, most recurrences are distant, highlighting the efficacy of systemic therapy. Similar to other gastrointestinal cancers, there appears to be a potential for neoadjuvant systemic therapy (chemotherapy) before reoperative surgery in iGBC cases. The premise that neoadjuvant systemic therapy aids in selecting diseases with more favorable biological characteristics and addresses micro-metastatic disease appears applicable to iGBC as well. This systematic review examines the current evidence supporting or refuting neoadjuvant therapy and discusses criteria for selecting patients who would derive significant benefit, along with proposing an optimal chemotherapy regimen for iGBC patients. Improved outcomes have been reported in patients undergoing reoperation after 4 to 14 weeks following the initial cholecystectomy compared to immediate reoperation. Limited, yet promising, evidence supports the use of 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy prior to reoperative surgery in select high-risk iGBC cases.

Incidental gallbladder cancer (iGBC) diagnosed post-histopathological examination of gallbladders removed assuming benign gallstone disease constitutes a significant proportion of GBC patients. Most iGBC patients present with early-stage disease. The standard care for localized (non-metastatic) iGBC includes a reoperation for complete extended (radical) cholecystectomy involving liver resection and lymphadenectomy, followed by postoperative adjuvant systemic therapy. However, a major drawback of this approach is the high recurrence rate within six months post-radical surgery, which undermines the benefits of the extensive procedure; notably, most recurrences are distant, highlighting the efficacy of systemic therapy. Similar to other gastrointestinal cancers, there appears to be a potential for neoadjuvant systemic therapy (chemotherapy) before reoperative surgery in iGBC cases. The premise that neoadjuvant systemic therapy aids in selecting diseases with more favorable biological characteristics and addresses micro-metastatic disease appears applicable to iGBC as well. This systematic review examines the current evidence supporting or refuting neoadjuvant therapy and discusses criteria for selecting patients who would derive significant benefit, along with proposing an optimal chemotherapy regimen for iGBC patients. Improved outcomes have been reported in patients undergoing reoperation after 4 to 14 weeks following the initial cholecystectomy compared to immediate reoperation. Limited, yet promising, evidence supports the use of 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy prior to reoperative surgery in select high-risk iGBC cases.

Objective:To describe the current status and trends in the outcomes and care practices of extremely preterm infants at 22-25 weeks′ gestation age from the Chinese Neonatal Network (CHNN) from 2019 to 2021.Methods:This cross-sectional study used data from the CHNN cohort of very preterm infants. All 963 extremely preterm infants with gestational age between 22-25 weeks who were admitted to neonatal intensive care units (NICU) of the CHNN from 2019 to 2021 were included. Infants admitted after 24 hours of life or transferred to non-CHNN hospitals were excluded. Perinatal care practices, survival rates, incidences of major morbidities, and NICU treatments were described according to different gestational age groups and admission years. Comparison among gestational age groups was conducted using χ2 and Kruskal-Wallis tests. Trends by year were evaluated by Cochran-Armitage and Jonckheere-Terpstra tests for trend. Results:Of the 963 extremely preterm infants enrolled, 588 extremely preterm infants (61.1%) were male. The gestational age was 25.0 (24.4, 25.6) weeks, with 29 extremely preterm infants (3.0%), 88 extremely preterm infants (9.1%), 264 extremely preterm infants (27.4%), and 582 extremely preterm infants (60.4%) at 22, 23, 24, and 25 weeks of gestation age, respectively. The birth weight was 770 (680, 840) g. From 2019 to 2021, the number of extremely preterm infants increased each year (285, 312, and 366 extremely preterm infants, respectively). Antenatal steroids and magnesium sulfate were administered to 67.7% (615/908) and 51.1% (453/886) mothers of extremely preterm infants. In the delivery room, 20.8% (200/963) and 69.5% (669/963) extremely preterm infants received noninvasive positive end-expiratory pressure support and endotracheal intubation. Delayed cord clamping and cord milking were performed in 19.0% (149/784) and 30.4% (241/794) extremely preterm infants. From 2019 to 2021, there were significant increases in the usage of antenatal steroids, antenatal magnesium sulfate, and delivery room noninvasive positive-end expiratory pressure support (all P<0.05). Overall, 349 extremely preterm infants (36.2%) did not receive complete care, 392 extremely preterm infants (40.7%) received complete care and survived to discharge, and 222 extremely preterm infants (23.1%) received complete care but died in hospital. The survival rates for extremely preterm infants at 22, 23, 24 and 25 weeks of gestation age were 10.3% (3/29), 23.9% (21/88), 33.0% (87/264) and 48.3% (281/582), respectively. From 2019 to 2021, there were no statistically significant trends in complete care, survival, and mortality rates (all P>0.05). Only 11.5% (45/392) extremely preterm infants survived without major morbidities. Moderate to severe bronchopulmonary dysplasia (67.3% (264/392)) and severe retinopathy of prematurity (61.5% (241/392)) were the most common morbidities among survivors. The incidences of severe intraventricular hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, and sepsis were 15.3% (60/392), 5.9% (23/392) and 19.1% (75/392), respectively. Overall, 83.7% (328/392) survivors received invasive ventilation during hospitalization, with a duration of 22 (10, 42) days. The hospital stay for survivors was 97 (86, 116) days. Conclusions:With the increasing number of extremely preterm infants at 22-25 weeks′ gestation admitted to CHNN NICU, the survival rate remained low, especially the rate of survival without major morbidities. Further quality improvement initiatives are needed to facilitate the implementation of evidence-based care practices.

Objective:To investigate the current status, trends, and differences among institutions in the application of delivery room continuous positive airway pressure (DRCPAP) for very preterm infants treated in the institutions in the Chinese Neonatal Network (CHNN). Also, to explore the impact of DRCPAP on the outcomes of very preterm infants in China.Methods:A retrospective cohort study was conducted. Based on the CHNN very preterm infant cohort, very preterm infants (gestational ages ranging from 25 weeks +0 to 31 weeks +6) born in-hospital and treated in 79 tertiary neonatal intensive care units (NICUs) participating in the CHNN from 2019 to 2021 were included. The usage rates of DRCPAP in different hospitals, as well as gestational ages and years, were described. Data were analyzed using the Chi-square test (or Fisher's exact test) or t-test. A multivariate logistic regression model was established to explore the correlation between DRCPAP and clinical outcomes. Results:(1) A total of 18 048 very preterm infants were included. Among them, 3 666 (20.3%) received DRCPAP, and 14 382 (79.7%) did not. (2) The usage rate of DRCPAP for very preterm infants among different institutions is from 0.0% to 94.5%. Fourteen institutions did not use DRCPAP, and 55 institutions had a usage rate below 30%. The usage rate of DRCPAP in very preterm infants increased annually, from 13.8% (818/5 916) in 2019 to 26.0% (1 583/6 097) in 2021 ( χ2trend=122.00, P<0.001). (3) The DRCPAP group had higher rates of maternal assisted reproductive technology pregnancy, chorioamnionitis, a full course of antenatal corticosteroids, gestational diabetes, fetal distress, antenatal magnesium sulfate use, and cesarean delivery compared to the non-DRCPAP group [20.3% (744/3 665) vs. 17.6% (2 529/14 369), χ2=14.45; 23.0% (695/3 021) vs. 16.4% (1 956/11 926), χ2=72.57; 57.1% (2 090/3 660) vs. 54.3% (7 766/14 302), χ2=9.55; 23.0% (844/3 669) vs. 20.7% (2 969/14 342), χ2=9.77; 8.7% (319/3 666) vs. 7.0% (1 006/14 371), χ2=12.51; 87.1% (3 186/3 657) vs. 82.0% (11 736/14 312), χ2=81.38; 63.5% (2 327/3 664) vs. 60.7% (8 722/14 369), χ2=9.59; all P<0.05]. While the incidence of hypertensive disorders of pregnancy and the proportion of infants not using antenatal corticosteroids were lower in the non-DRCPAP group [17.1% (626/3 660) vs. 22.6% (3 183/14 084), χ2=44.70; 14.2% (520/3 661) vs. 19.7% (2 814/14 284), χ2=57.34; all P<0.05]. The DRCPAP group had lower birth weight and gestational age, higher 1 min and 5 min Apgar scores, and lower neonatal transport stabilization index scores [(1 308±314) g vs. (1 325±315) g, t=2.90; (29.5±1.7) weeks vs. (29.7±1.6) weeks, t=3.96; (7.9±1.8) scores vs. (7.6±1.9) scores, t=－9.80; (9.0±1.1) scores vs. (8.7±1.3) scores, t=－13.01; (11.0±9.4) scores vs. (13.1±9.8) scores, t=11.31; all P<0.05]. The incidence of early-onset sepsis was higher in the DRCPAP group than in the non-DRCPAP group [1.8% (68/3 578) vs. 1.3% (193/14 296), adjusted OR (95% CI): 1.417 (1.028-1.955)], while the rates of tracheal intubation within 72 hours, PS use, invasive mechanical ventilation, mortality, admission hypothermia, grade Ⅲ-Ⅳ intracranial hemorrhage, and stage≥3 ROP were all lower in the DRCPAP group compared to the non-DRCPAP group [22.6% (830/3 666) vs. 36.9% (5 310/14 374), adjusted OR (95% CI): 0.499 (0.448-0.555); 53.1% (1 947/3 666) vs. 58.3% (8 388/14 377), adjusted OR (95% CI): 0.764 (0.697-0.836); 30.1% (1 104/3 662) vs. 43.9% (6 307/14 366), adjusted OR (95% CI): 0.539 (0.487-0.595); 7.4% (274/3 666) vs. 10.6% (1 526/14 342), adjusted OR (95% CI): 0.709 (0.601-0.836); 57.5% (2 103/3 657) vs. 66.5% (9 501/14 287), adjusted OR (95% CI): 0.722 (0.661-0.788); 3.0% (101/3 366) vs. 5.9% (763/12 932)], adjusted OR (95% CI): 0.525 (0.412-0.669); 2.2% (65/2 954) vs. 3.3% (367/11 121), adjusted OR (95% CI): 0.692 (0.505-0.947); all P<0.05]. There were no statistically significant differences between the two groups in the incidence rates of BPD at a corrected gestational age of 36 weeks, patent ductus arteriosus ligation, spontaneous intestinal perforation, and pneumothorax. Conclusions:Domestically, the application of DRCPAP might be related to a decrease in the demand for invasive ventilation, the use of surfactants, and mortality, but it might not reduce the occurrence of bronchopulmonary dysplasia, at a corrected gestational age of 36 weeks. In recent years, the use of DRCPAP in very premature infants in China has increased, but the overall usage rate is still low, and there are significant differences between units, requiring continuous quality improvement.

Objective:To investigate the current status, trends, and differences among institutions in the application of delivery room continuous positive airway pressure (DRCPAP) for very preterm infants treated in the institutions in the Chinese Neonatal Network (CHNN). Also, to explore the impact of DRCPAP on the outcomes of very preterm infants in China.Methods:A retrospective cohort study was conducted. Based on the CHNN very preterm infant cohort, very preterm infants (gestational ages ranging from 25 weeks +0 to 31 weeks +6) born in-hospital and treated in 79 tertiary neonatal intensive care units (NICUs) participating in the CHNN from 2019 to 2021 were included. The usage rates of DRCPAP in different hospitals, as well as gestational ages and years, were described. Data were analyzed using the Chi-square test (or Fisher's exact test) or t-test. A multivariate logistic regression model was established to explore the correlation between DRCPAP and clinical outcomes. Results:(1) A total of 18 048 very preterm infants were included. Among them, 3 666 (20.3%) received DRCPAP, and 14 382 (79.7%) did not. (2) The usage rate of DRCPAP for very preterm infants among different institutions is from 0.0% to 94.5%. Fourteen institutions did not use DRCPAP, and 55 institutions had a usage rate below 30%. The usage rate of DRCPAP in very preterm infants increased annually, from 13.8% (818/5 916) in 2019 to 26.0% (1 583/6 097) in 2021 ( χ2trend=122.00, P<0.001). (3) The DRCPAP group had higher rates of maternal assisted reproductive technology pregnancy, chorioamnionitis, a full course of antenatal corticosteroids, gestational diabetes, fetal distress, antenatal magnesium sulfate use, and cesarean delivery compared to the non-DRCPAP group [20.3% (744/3 665) vs. 17.6% (2 529/14 369), χ2=14.45; 23.0% (695/3 021) vs. 16.4% (1 956/11 926), χ2=72.57; 57.1% (2 090/3 660) vs. 54.3% (7 766/14 302), χ2=9.55; 23.0% (844/3 669) vs. 20.7% (2 969/14 342), χ2=9.77; 8.7% (319/3 666) vs. 7.0% (1 006/14 371), χ2=12.51; 87.1% (3 186/3 657) vs. 82.0% (11 736/14 312), χ2=81.38; 63.5% (2 327/3 664) vs. 60.7% (8 722/14 369), χ2=9.59; all P<0.05]. While the incidence of hypertensive disorders of pregnancy and the proportion of infants not using antenatal corticosteroids were lower in the non-DRCPAP group [17.1% (626/3 660) vs. 22.6% (3 183/14 084), χ2=44.70; 14.2% (520/3 661) vs. 19.7% (2 814/14 284), χ2=57.34; all P<0.05]. The DRCPAP group had lower birth weight and gestational age, higher 1 min and 5 min Apgar scores, and lower neonatal transport stabilization index scores [(1 308±314) g vs. (1 325±315) g, t=2.90; (29.5±1.7) weeks vs. (29.7±1.6) weeks, t=3.96; (7.9±1.8) scores vs. (7.6±1.9) scores, t=－9.80; (9.0±1.1) scores vs. (8.7±1.3) scores, t=－13.01; (11.0±9.4) scores vs. (13.1±9.8) scores, t=11.31; all P<0.05]. The incidence of early-onset sepsis was higher in the DRCPAP group than in the non-DRCPAP group [1.8% (68/3 578) vs. 1.3% (193/14 296), adjusted OR (95% CI): 1.417 (1.028-1.955)], while the rates of tracheal intubation within 72 hours, PS use, invasive mechanical ventilation, mortality, admission hypothermia, grade Ⅲ-Ⅳ intracranial hemorrhage, and stage≥3 ROP were all lower in the DRCPAP group compared to the non-DRCPAP group [22.6% (830/3 666) vs. 36.9% (5 310/14 374), adjusted OR (95% CI): 0.499 (0.448-0.555); 53.1% (1 947/3 666) vs. 58.3% (8 388/14 377), adjusted OR (95% CI): 0.764 (0.697-0.836); 30.1% (1 104/3 662) vs. 43.9% (6 307/14 366), adjusted OR (95% CI): 0.539 (0.487-0.595); 7.4% (274/3 666) vs. 10.6% (1 526/14 342), adjusted OR (95% CI): 0.709 (0.601-0.836); 57.5% (2 103/3 657) vs. 66.5% (9 501/14 287), adjusted OR (95% CI): 0.722 (0.661-0.788); 3.0% (101/3 366) vs. 5.9% (763/12 932)], adjusted OR (95% CI): 0.525 (0.412-0.669); 2.2% (65/2 954) vs. 3.3% (367/11 121), adjusted OR (95% CI): 0.692 (0.505-0.947); all P<0.05]. There were no statistically significant differences between the two groups in the incidence rates of BPD at a corrected gestational age of 36 weeks, patent ductus arteriosus ligation, spontaneous intestinal perforation, and pneumothorax. Conclusions:Domestically, the application of DRCPAP might be related to a decrease in the demand for invasive ventilation, the use of surfactants, and mortality, but it might not reduce the occurrence of bronchopulmonary dysplasia, at a corrected gestational age of 36 weeks. In recent years, the use of DRCPAP in very premature infants in China has increased, but the overall usage rate is still low, and there are significant differences between units, requiring continuous quality improvement.

BACKGROUND: Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China. METHODS: This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage. RESULTS: A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS. CONCLUSIONS The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
Humans ; Infant, Newborn ; Infant ; Pregnancy ; Female ; Gestational Age ; Infant, Premature ; Intensive Care Units, Neonatal ; Cross-Sectional Studies ; Adrenal Cortex Hormones/therapeutic use*

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.
Humans ; Quality of Life ; Self Expandable Metallic Stents/adverse effects* ; Colonic Neoplasms/surgery* ; Stents/adverse effects* ; Intestinal Obstruction/surgery* ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Retrospective Studies

The Chinese Neonatal Network(CHNN) was established in 2018 with the mission of establishing a national collaboration platform, conducting high-quality and collaborative research, and ultimately improving the quality of neonatal-perinatal care and health in China.At present, 112 hospitals across the country have joined CHNN.CHNN has established a national standardized cohort of very premature infants/very low birth weight infants with >10 000 enrollments each year, has been leading data-driven collaborative quality improvement initiatives, conducting multicenter clinical studies, and performing multi-level training programs.Guided by the principles of collaboration and sharing, data-driven, continuous improvement, and international integration, CHNN has become an important platform for clinical and research collaboration in neonatal medicine in China.

Sex difference has shown in the arthritis diseases in human population and animal models. We investigate how the sex and symmetry vary among mouse models with different genomic backgrounds. Disease data of sex and limbs accumulated in the past more than two decades from four unique populations of murine arthritis models were analyzed. They are (1) interleukin-1 receptor antagonist (IL-1ra) deficient mice under Balb/c background (Balb/c KO); (2) Mice with collagen II induced arthritis under DBA/1 background; (3) Mice with collagen II induced arthritis under C57BL/6 (B6) background and (4) A F2 generation population created by Balb/c KO X DBA/1 KO.Our data shows that there is a great variation in sexual dimorphism for arthritis incidence and severity of arthritis in mice harboring specific genetic modifications. For a F2 population, the incidence of arthritis was 57.1% in female mice and 75.6% in male mice. There was a difference in severity related to sex in two populations: B6.DR1/ B6.DR4 (P < 0.001) and F2 (P = 0.023) There was no difference Balb/c parental strain or in collagen-induced arthritis (CIA) in DBA/1 mice. Among these populations, the right hindlimbs are significantly higher than the scores for the left hindlimbs in males (P < 0.05). However, when examining disease expression using the collagen induced arthritis model with DBA/1 mice, sex-dimorphism did not reach statistical significance, while left hindlimbs showed a tendency toward greater disease expression over the right. Sexual dimorphism in disease expression in mouse models is strain and genomic background dependent. It sets an alarm that potential variation in sexual dimorphism among different racial and ethnic groups in human populations may exist. It is important to not only include both sexes and but also pay attention to possible variations caused by disease expression and response to treatment in all the studies of arthritis in animal models and human populations.