Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective: The aim of this study was to investigate differentially expressed genes and their functions in the hippocampus and striatum after heroin administration in cynomolgus macaques of different ages. Methods: Cynomolgus monkeys were divided by age as follows: 1 year (A1, n = 2); 3 to 4 years (A2, n = 2); 6 to 8 years (A3, n = 2); and older than 11 years (A4, n = 2). After heroin was injected intramuscularly into the monkeys (0.6 mg/kg), we performed large-scale transcriptome profiling in the hippocampus (H) and striatum (S) using RNA sequencing technology. Some genes were validated with real-time quantitative PCR. Results: In the hippocampus, the gene expression of A1H was similar to that of A4H, while the gene expression of A2H was similar to that of A3H. Genes associated with the mitogen-activated protein kinase signaling pathway (STMN1, FGF14, and MAPT) and -aminobutyric acid-ergic synapses (GABBR2 and GAD1) were differentially expressed among control and heroin-treated animals. Differential gene expression between A1S and A4S was the least significant, while differential gene expression between A3S and A2S was the most significant. Genes associated with the neurotrophin signaling pathway (NTRK1 and NGFR), autophagy (ATG5), and dopaminergic synapses (AKT1) in the striatum were differentially expressed among control and heroin-treated animals. Conclusion These results suggest that even a single heroin exposure can cause differential gene expression in the hippocampus and striatum of nonhuman primates at different ages.

BACKGROUND/AIMS: Renal aging-related changes are characterized by oxidative stress. SIRT1 regulates cellular conditions by activating Nrf2. The present study investigated the processes of renal changes by antioxidant enzymes and the relationship between SIRT1 and Nrf2. METHODS: We used male 2-, 12-, and 24-month-old C57BL/6 mice. We measured renal function, histological changes, oxidative stress, and expression of SIRT1–Nrf2 signaling in the kidneys. RESULTS: 24-month-old mice exhibited increased albuminuria and serum creatinine. Creatinine clearance was decreased in 24-month-old mice compared with 12-month-old mice. There were increases in mesangial volume and tubulointerstitial fibrosis in 24-month-old mice. Moreover, oxidative stress marker, 3-Nitrotyrosine, expression and apoptosis were increased in 24-month-old mice. The 24 h urinary 8-isoprostane and 8-hydroxy-deoxyguanosine excretion increased with aging. The levels of expression of SIRT1 and nuclear Nrf2 were decreased in 24-month-old mice. The antioxidant enzymes HO-1 and NQO-1 were down-regulated in 24-month-old mice. Another antioxidant enzyme, SOD2, was decreased in 24-month-old mice. CONCLUSIONS: Our results demonstrated that SIRT1 was down-regulated with aging, and this may be related to changes in the expression of target molecules including Nrf2. As a result, oxidative stress was induced. The pharmacological targeting of these signaling molecules may reduce the pathological changes associated with aging in the kidney.
Aging ; Albuminuria ; Animals ; Apoptosis ; Child, Preschool ; Creatinine ; Fibrosis ; Humans ; Infant ; Kidney* ; Male ; Mice ; NF-E2-Related Factor 2 ; Oxidative Stress ; Sirtuin 1

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Kidney*

BACKGROUND/OBJECTIVES: A high-fat diet (HFD) induces obesity, which is a major risk factor for cardiovascular disease and cancer, while a calorie-restricted diet can extend life span by reducing the risk of these diseases. It is known that health effects of diet are partially conveyed through epigenetic mechanism including DNA methylation. In this study, we investigated the genome-wide hepatic DNA methylation to identify the epigenetic effects of HFD-induced obesity. MATERIALS AND METHODS: Seven-week-old male C57BL/6 mice were fed control diet (CD), calorie-restricted control diet (CRCD), or HFD for 16 weeks (after one week of acclimation to the control diet). Food intake, body weight, and liver weight were measured. Hepatic triacylglycerol and cholesterol levels were determined using enzymatic colorimetric methods. Changes in genome-wide DNA methylation were determined by a DNA methylation microarray method combined with methylated DNA immunoprecipitation. The level of transcription of individual genes was measured by real-time PCR. RESULTS: The DNA methylation statuses of genes in biological networks related to lipid metabolism and hepatic steatosis were influenced by HFD-induced obesity. In HFD group, a proinflammatory Casp1 (Caspase 1) gene had hypomethylated CpG sites at the 1.5-kb upstream region of its transcription start site (TSS), and its mRNA level was higher compared with that in CD group. Additionally, an energy metabolism-associated gene Ndufb9 (NADH dehydrogenase 1 beta subcomplex 9) in HFD group had hypermethylated CpG sites at the 2.6-kb downstream region of its TSS, and its mRNA level was lower compared with that in CRCD group. CONCLUSIONS: HFD alters DNA methylation profiles in genes associated with liver lipid metabolism and hepatic steatosis. The methylation statuses of Casp1 and Ndufb9 were particularly influenced by the HFD. The expression of these genes in HFD differed significantly compared with CD and CRCD, respectively, suggesting that the expressions of Casp1 and Ndufb9 in liver were regulated by their methylation statuses.
Acclimatization ; Animals ; Body Weight ; Cardiovascular Diseases ; Caspase 1 ; Cholesterol ; Diet ; Diet, High-Fat ; DNA Methylation* ; DNA* ; Eating ; Epigenomics ; Humans ; Immunoprecipitation ; Lipid Metabolism ; Liver ; Male ; Methods ; Methylation ; Mice ; Mice, Obese* ; NADH Dehydrogenase ; Obesity ; Oxidoreductases ; Real-Time Polymerase Chain Reaction ; Risk Factors ; RNA, Messenger ; Transcription Initiation Site ; Triglycerides

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
Body Temperature ; Child ; Coronavirus Infections* ; Disease Outbreaks ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Humans ; Information Systems ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Overall

OBJECTIVES: This study was conducted in order to investigate the influence of sexual trauma on the psychopathology and quality of life of children and adolescents in Korea. METHODS: Twenty-seven children and adolescents and their caretakers who visited the Kangwon Sunflower Center participated in a cross-sectional study. Participants completed the Korean version of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Child Behavior Checklist (CBCL), and Child Health Questionnaire-Parent Form-50 (CHQ-PF-50). Their scores were compared with those of a age and sex-matched control group of 27 healthy children and adolescents. RESULTS: Victims of sexual violence showed higher t score in Withdrawn, Social problems, Delinquent behavior, Externalizing problems, and Total problems in CBCL, compared with control group. In CHQ-PF-50, there were lower scores on Bodily pain/discomfort, Behavior, Mental health, Time impact in parents, and Family activities subscales in victims of sexual violence. While Behavior and Family activities subscale showed negative correlations with Delinquent behavior, Externalizing problems, and Total problems in CBCL. Mental health subscale showed negative correlations with Social problems, Delinquent behavior, Externalizing problems, and Total problems. In addition, Time impact on parent subscale showed a negative association with Delinquent behavior in CBCL. CONCLUSION: The current study provided evidence suggesting that victims of sexual violence had a higher level of psychopathology and lower level of quality of life.
Adolescent* ; Checklist ; Child Behavior ; Child Health ; Child* ; Cross-Sectional Studies ; Gangwon-do ; Helianthus ; Humans ; Korea ; Mental Health ; Mood Disorders ; Parents ; Psychopathology* ; Quality of Life* ; Sex Offenses* ; Social Problems ; Surveys and Questionnaires

Obesity has been reported to be associated with low grade inflammatory status. In this study, we investigated the inflammatory response as well as associated signaling molecules in immune cells from diet-induced obese mice. Four-week-old C57BL mice were fed diets containing 5% fat (control) or 20% fat and 1% cholesterol (HFD) for 24 weeks. Splenocytes (1 x 10(7) cells) were stimulated with 10 microg/mL of lipopolysaccharide (LPS) for 6 or 24 hrs. Production of interleukin (IL)-1beta, IL-6, and TNF-alpha as well as protein expression levels of nucleotide-binding oligomerization domain (NOD)2, signal transducer and activator of transcription (STAT)3, and pSTAT3 were determined. Mice fed HFD gained significantly more body weight compared to mice fed control diet (28.2 +/- 0.6 g in HFD and 15.4 +/- 0.8 g in control). After stimulation with LPS for 6 hrs, production of IL-1beta was significantly higher (P = 0.001) and production of tumor necrosis factor (TNF)-alpha tended to be higher (P < 0.064) in the HFD group. After 24 hrs of LPS stimulation, splenocytes from the HFD group produced significantly higher levels of IL-6 (10.02 +/- 0.66 ng/mL in HFD and 7.33 +/- 0.56 ng/mL in control, P = 0.005) and IL-1beta (121.34 +/- 12.72 pg/mL in HFD and 49.74 +/- 6.58 pg/mL in control, P < 0.001). There were no significant differences in the expression levels of STAT3 and pSTAT3 between the HFD and the control groups. However, the expression level of NOD2 protein as determined by Western blot analysis was 60% higher in the HFD group compared with the control group. NOD2 contributes to the induction of inflammation by activation of nuclear factor kappaB. These findings suggest that diet-induced obesity is associated with increased inflammatory response of immune cells, and higher expression of NOD2 may contribute to these changes.
Animals ; Blotting, Western ; Body Weight ; Cholesterol ; Diet ; Diet, High-Fat ; Inflammation ; Interleukin-6 ; Interleukins ; Mice ; Mice, Inbred C57BL ; Mice, Obese ; Obesity ; Staphylococcal Protein A ; Transducers ; Tumor Necrosis Factor-alpha

OBJECTIVETo investigate the application of the retroperitoneal approach in aortic surgery.

METHODSWe collected and analyzed data of 7 patients in Macau who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion.

RESULTSNo operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation.

CONCLUSIONRetroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.

Aged ; Aorta ; surgery ; Humans ; Myocardial Revascularization ; methods ; Peritoneal Cavity ; Treatment Outcome ; Vascular Surgical Procedures ; methods

OBJECTIVETo investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.

METHODSTwenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.

RESULTSThe surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.

CONCLUSIONSThe use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; pathology ; surgery ; Humans ; Iliac Artery ; pathology ; surgery ; Male ; Middle Aged ; Neovascularization, Physiologic ; Saphenous Vein ; surgery ; Substance Abuse, Intravenous ; complications ; Vascular Surgical Procedures ; methods ; Young Adult