Background Lipid metabolism in liver shows circadian-dependent profiles. The hepatotoxicity of environmental chemicals is dependent on circadian time. Objective To observe the effects of bisphenol A (BPA) exposure at different zeitgeber time (ZT) on hepatic and blood lipid metabolism and decipher the underlying mechanisms related to circadian rhythm in mice. Methods Thirty-five female C57BL/6J mice were sacrificed every 4 h in a light-dark cycle (12 h/12 h). The liver tissues were collected to describe the circadian profiles of hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels within 24 h. Thirty female mice were divided into 6 groups by the timing (ZT3 represents the 3 h after light on, ZT15 represents the 3 h after light off) and dose (50 or 500 μg·kg⁻¹·d⁻¹) of BPA exposure to observe hepatotoxicity. Mice were gavaged with designed doses of BPA once per day for 4 weeks. Mice were maintained with ad libitum access to food and water and measured body weight weekly. After the experiment, mice were euthanatized and liver tissues were separated to determine the biochemical indicators of lipid metabolism and lipid metabolism- and circadian-related gene mRNA expressions. Results Hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels were rhythmic during a 24 h period in mice. At ZT3 and ZT15, BPA did not alter body weight, plasma glucose, plasma total cholesterol, plasma low density lipoprotein cholesterol, and plasma triglycerides (P>0.05). The plasma high density lipoprotein cholesterol decreased in the 50 μg·kg⁻¹·d⁻¹ BPA group at ZT3 by 14.56% compared with the control group (P<0.05). The liver triglycerides increased in the 50 μg·kg⁻¹·d⁻¹ BPA group at ZT15 by 115.20% compared with the control group (P<0.05). BPA decreased Srebp1c mRNA expression level when dosing at ZT3 and increased Chrebp, Srebp1c, and Acc1 mRNA expression levels when dosing at ZT15 compared with the control group (P<0.05). BPA increased Bmal1 mRNA expression level and decreased Rev-erbα mRNA expression level at ZT3 exposure and decreased Bmal1 and increased Rev-erbα mRNA expression level at ZT15 exposure (P<0.05). Conclusion BPA exposure at light or dark period has different effects on hepatic lipid metabolism in mice. Hepatic lipid deposit appears when BPA is dosed at dark period. Rev-erbα-Bmal1 regulation circuits and the subsequent upregulation of Srebp1c and Chrebp and the target gene Acc1 may be involved.

Objective:To explore the value of laparoscopic and endoscopic cooperative surgery with the patient lying on supine position under general anesthesia in the operation of type I Mirizzi syndrome with choledocholithiasis.Methods:From Jan 2018 to Jan 2020, 53 cases of Mirizzi syndrome with choledocholithiasis undergoing laparoscopic and endoscopic cooperative surgery (preLC+ ERCP+ EST) at the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.Results:53 patients successfully underwent LC without conversion to open surgery, and 2 patients failed in ERCP + EST attempt, with a success rate of 96.2%. One patient developed pancreas pseudocyst as a result of post-operative hemorrhagic necrotizing pancreatitis. Two patients suffered from chronic pancreatitis. Three patients complaining postoperative upper abdominal discomfort were finally diagnosed as stump cystic duct inflammation by MRCP, and no abnormalities were found in the follow-up of the remaining cases.Conclusion:Laparoscopic and endoscopic cooperative surgery in the treatment of patients with type I Mirizzi syndrome combined with choledocholithiasis is minimally invasive and effective.

Objective    To summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor. Methods    A retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed. Results    All the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489 (26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000). Conclusion    Compared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.

BACKGROUND: Thoracoscopic safe and effective hemostasis is an important condition for rapid rehabilitation of thoracic surgery. Placing hemostatic materials during surgery is a commonly used method in lung cancer laparoscopic surgery. Among them, resorbable oxidized cellulose is a commonly used hemostatic material. This research aims to observe the hemostatic effect of resorbable oxidized cellulose in lung cancer surgery. METHODS: A retrospective analysis of 42 patients with thoracoscopic lung cancer undergoing radical surgery in the Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University School of Medicine from July 1, 2018 to December 1, 2018, and intraoperative use of regenerative oxidized cellulose to stop bleeding The clinical and pathological data were selected and the perioperative indicators were selected as the outcome events for statistical analysis. RESULTS: The mean operative time was (120.5±57.3) min. The mean intraoperative blood loss was (26.8±21.6) mL. The average postoperative drainage volume was (513.6±359.5) mL. The average postoperative chest tube indwelling time was (2.6±1.2) d. CONCLUSIONS The use of absorbable regenerated oxidized cellulose in the radical operation of thoracoscopic lung cancer has a good hemostasis effect, and is suitable for hemostasis of wounds after lymph node dissection.

BACKGROUND: To investigate the diagnostic significance of percutaneous lung puncture for solid pulmonary nodules (diameter ≤15 mm). METHODS: This study retrospectively included 20 patients with solid pulmonary nodules who underwent percutaneous puncture from January 2014 to December 2018, including 11 males and 9 females. The diameter of the lesion is between 0.5 cm-1.5 cm, excluding severe organ dysfunction, and patients with coagulopathy. RESULTS: All 20 patients were successfully selected, and 19 patients were diagnosed with pathological diagnosis. Among them, 11 patients found malignant tumor cells, which were clearly malignant tumors of the lungs, 5 cases of chronic inflammation of the lungs, 2 cases of fibrous tissue hyperplasia, and 1 case of lung cartilage tissue, no tumor cells were found in 1 case. One patient with a small amount of pneumothorax after puncture and one patient with a small amount of pleural effusion on the puncturesite. CONCLUSIONS Percutaneous lung puncture has a high effectiveness and safety for the diagnosis of solid pulmonary nodules.

The technical combination of artificial intelligence (AI) and thoracic surgery is increasingly close, especially in the field of image recognition and pathology diagnosis. Additionally, robotic surgery, as a representative of high-end technology in minimally invasive surgery is flourishing. What progress has been or will be made in robotic surgery in the era of AI? This article aims to summarize the application status of AI in thoracic surgery and progress in robotic surgery, and looks ahead the future.

Objective To investigate the diagnostic value of multiparametric MRI in early prostate cancer(PCa) based on PI-RADS version 2.Methods 27 surgically-proved early PCa patients were collected in this retrospective study.T2WI,DWI and DCE were evaluated by two blinded radiologists.By 12 sub-region classification method the possibility of the presence of cancer at each sub-region was scored according to the PI-RADS V2.The receiver operating characteristic (ROC) curve was used to analyze the diagnosic efficacy of the following 4 protocols:T2WI alone(protocol 1),T2WI+DWI(protocol 2),T2WI+DCE(protocol 3),T2WI+DWI+DCE(protocol 4).The sensitivity,specificity and accuracy for each protocol were calculated.The average scores of cancerous sub-regions and non-cancerous sub-regions were calculated and the independent sample t test was used to compare the four protocols.Results 324 sub-regions were analyzed in 27 early PCa patients and then divided into 119 cancerous sub-regions and 205 non-cancerous sub-regions,including 64 peripheral zone cancerous sub-regions and transition zone cancerous sub-regions.In protocol 1-4, the average scores of cancerous sub-regions in orderwere 3.13±1.19,3.27±1.15,3.28±1.23, 3.33±1.16,respectively.Non-cancerous sub-regions's scores in order were 1.98±0.90,1.91±0.91, 2.03±0.99,1.94±0.96 respectively and there were significant differences among each protocol (P<0.05).The area under the ROC curve of the 4 protocols for region-based analysis were displayed in descending order: protocol 4 (0.819), protocol 2 (0.810), protocol 3 (0.772), protocol 1 (0.765) and there were no significant differences between any two protocols (P>0.05).In four protocols, the sensitivity in order were 45.40%, 56.30%, 59.70%, 61.34%, while the specificity in order were 95.10%, 96.10%, 89.80%, 96.60%, and the accuracy in order were 76.85%, 81.48%, 78.70%, 83.65%.Conclusion Multiparametric MRI can improve the diagnostic accuracy for the detection of early PCa, and T2WI+DWI+DCE is with the highest value.The PI-RADS V2 system is a better semi quantitative method for evaluation of early PCa.

BACKGROUND: Mechanisms related to bone fracture and nonunion have been clarified, but the healing time and treatment strategy of delayed union remain controversial. OBJECTIVE: To establish a reliable model of femoral delayed union using external fixation in the New Zealand white rabbit. METHODS: Seventy-two New Zealand white rabbits were randomized to three groups. After removal of 10-mm femoral middle bone cortex with internal and external periosteum and bone marrow, a uniplanar external fixator was used. There was a 1 mm gap between broken ends (group A), and the broken ends were sealed by bone wax (group B). For controls, only bone cortex was cut and then fixed to contact the broken ends. The gross, radiological and histological observations were performed to observe the bone healing at 4, 8 and 12 weeks after modeling. RESULTS AND CONCLUSION: The control group achieved bone healing at the 4th week, which was considered as the normal time of bone healing. The groups A and B achieved healing at the 12th week, which was remarkably longer than that in the control group. The rabbit femoral delayed union model showed the typical X-ray imaging and pathological features of delayed union. Our results suggest that the model is reasonable and reliable, which can provide reference for clinical research.

Objective To explore the effect and mechanism of fragile site WWOX gene on regulating proliferation of gallbladder cancer cells in vitro. Methods The pcDNA3.0 - WWOX recombinant plasmid which was previous successfully built was transfected to GBC-SD cells and empty carrier by liposome medium. Liposome and GBC-SD were served as the negative control and the blank control,respectively. After 48 hours transfection, inverted microscope was used to observe the changes of gallbladder cancer cells' morphology,MTT and BrdU were used to detect the proliferation level of gallbladder cancer cells,and flow cytometry instrument was used to detect the change of the cell proliferation cycle. Results The results of inverted microscope shown: the number of GBC-SD cells in pcDNA3.0-WWOX group decreased significantly,the suspension cells and cell debris increased,while cells in the vector control,NC and Mock groups were in normal proliferation state. MTT test showed the proliferation levels of GBC-SD cells in pcDNA3.0-WWOX group was lower than those in the control group in 24 h,48 h,72 h,96 h and 120 h,and the differences were statistically significant(P < 0.05). The cell proliferation activity in the pcDNA3.0-WWOX group was obviously inhibited over time. BrdU detection results showed the cell proliferation rate of pcDNA3.0 - WWOX group was(0.44±0.03),while that in the three control groups was(0.78±0.02), (0.81±0.01)and(0.85±0.01),respectively. It showed that cell proliferation activity in pcDNA3.0-WWOX group was lower than the control groups,and the difference was statistically significant(P < 0.05). Cell cycle detection showed the cells increased in G0/G1 phase and decreased in G2/M and S phases of pcDNA3.0-WWOX group. The cell apoptosis rate was significantly higher and the proliferation index was significantly lower than those of the control groups(P < 0.05). However,there were no significant differences among the three control groups(P > 0.05). Conclusion The overexpression of WWOX gene in vitro could effectively inhibit the proliferation activity of gallbladder cancer cells. WWOX might participate in the development of the malignant biological behavior of gallbladder cancer cells. It is expected to become a new potential target for the gene therapy to gallbladder cancer.

Objective To evaluate the advantages of minimally invasive technique for treatment of progressive hemothorax.Methods The study enrolled 62 patients with progressive hemothorax treated by minimally invasive surgery between October 2009 and March 2012.According to the treatment methods,the patients were classified to thoracoscope group (n =47) and urethral catheter balloon blockage group (n =15).Postoperative drainage volume and recovery were detected in both groups.Results All patients in thoracoscope group were healed with the mean operation time of 54 minutes (range,30-120 minutes).Mean effusion removed within thoracic cavity was 1 260 ml (range,700-2 000 ml).Postoperative bedside chest radiography revealed good pulmonary reexpansion without effusion or pneumatosis within thoracic cavity.All patients in urethral catheter balloon blockage group were healed.Chest drainage within postoperative 3 hours was mean 260 ml of fresh blood (range,100-500 ml) and thereafter no more massive bloody fluid discharge occurred.Meanwhile,chest CT reexamination revealed no increase of chest effusion.Conclusion Minimally invasive technique in treatment of progressive hemothorax patients with moderate or less effusion provides accurate effect,minor trauma,rapid recovery,and few complications and hence deserves clinical application.