Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction

BackgroundStoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction.MethodsA single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 1st July 2022 to 31st December 2022. The stoma pressure was measured by TISM at different time points.ResultsThe mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmH2O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH2O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function) (10.23 vs. 6.04 cmH2O, p<0.001) and the postoperative hospital stay (10 vs. 8.49 days, p=0.028) showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) (4 vs. 4.49 cmH2O, p=0.585), the second time point (the day of return of gut function) (6.8 vs. 5.62 cmH2O, p=0.123), and the fourth time point (discharge day) (5.88 vs. 5.9 cmH2O, p=0.933) showed no significant difference in both groups.ConclusionTISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS

Analysis of Driver Brake Operation In Near-Crash Situation Using Naturalistic Driving Data

A large scale of field-test investigation was conducted in Beijing using Video Drive Recorder (VDR) which could record image in front of the vehicle. Fifty taxis equipped with VDR were used to collect data in real traffic environments for a whole year and a large volume of naturalistic driving data including crashes and near-crashes was collected. This paper analyzed the pre-event maneuvers of drivers and studied the characteristics of braking operations of Conflict-prone drivers. Then an evaluation method was proposed to rate a driver's accidents avoidance ability, and to evaluate the relationships between driver's brake behaviors and accident rates. The results showed that most evasive maneuvers were within 2s before the most dangerous state. By comparing the near-crashes with crashes recorded by the VDR regarding traffic accidents in Beijing, great similarities were found in accident type and occurrence time between them. According to 100 rear-end near-crashes, if the braking time of drivers were delayed by 0.2s, 17% of near-crashes would have been crashes; and if the braking forces were decreased by 0.1g, 33% of near-crashes would have been crashes

A Higher Frequency of CD14+ CD169+ Monocytes/Macrophages in Patients with Colorectal Cancer.

Monocytes and macrophages can infiltrate into tumor microenvironment and regulate the progression of tumors. This study aimed at determining the frequency of different subsets of circulating monocytes and tumor infiltrating macrophages (TIMs) in patients with colorectal cancer (CRC).The frequency of different subsets of circulating monocytes was characterized in 46 CRC patients and 22 healthy controls (HC) by flow cytometry. The frequency of different subsets of macrophages was analyzed in TIMs from 30 tumor tissues and in lamina propria mononuclear cells (LPMCs) from 12 non-tumor tissues. The concentrations of plasma cytokines and carcinoembryonic antigen (CEA) were determined. The potential association of these measures with the values of clinical parameters was analyzed.In comparison with that in the HC, the percentages of circulating CD14+ CD169+, CD14+ CD169+ CD163+ and CD14+ CD169+ CD206+ monocytes and TIMs CD14+ CD169+ as well as IL-10+ CD14+ CD169+, but not IL-12+ CD14+ CD169+ macrophages were significantly increased, accompanied by higher levels of plasma IL-10 in the CRC patients. The percentages of CD14+ CD169+ circulating monocytes and TIM macrophages were associated with the stage of disease and correlated positively with the levels of plasma IL-10 and CEA in CRC patients.Our data suggest that an increase in the frequency of CD14+ CD169+ cells may be associated with the development and progression of CRC and is concomitant rise of both, pro-tumor (M2-like, IL-10 producing) and anti-tumor (M1-like, IL-12 producing) monocytes and infiltrating macrophages. The frequency of CD14+ CD169+ circulating monocytes and infiltrating macrophages may serve as a biomarker for evaluating the pathogenic degrees of CRC

Conjunctival Fluid Secretion Impairment via CaCC-CFTR Dysfunction Is the Key Mechanism in Environmental Dry Eye

Dry eye disease (DED) is a multifactorial disease with an incidence of approximately 50% worldwide. DED seriously affects quality of life and work. The prevalence of environmental DED (eDED) ranges from 35 to 48%. Conjunctival fluid secretion dysfunction may be one of the major causes of DED. Notably, the Cl– flux corresponds to the conjunctival fluid secretion and could be affected by ATP. Both the cystic fibrosis transmembrane conductance regulator (CFTR) and the Ca2+-activated Cl– channel (CaCC) are Cl– channels involved in epithelial fluid secretion. Conjunctival fluid secretion could be increased by activating P2Y2R (an ATP receptor) in DED. However, the role of the CaCC and CFTR channels regulated by P2Y2R in eDED remains unclear. In this study, we established a rabbit eDED model using a controlled drying system. A Ussing chamber was used to perform a conjunctival short-circuit current induced by ATP to evaluate the reactivity of the ion channels to the ATP. Our results revealed that eDED accompanied by conjunctival fluid secretion impairment was caused by a P2Y2R dysfunction, which is related to CaCC-CFTR signaling in the conjunctiva epithelium. Notably, the coupling effect of the ATP-induced CaCC-CFTR activation and intracellular Ca2+ may represent a promising therapeutic target for treating eDED

Characterization of CD14⁺CD169⁺IL-10⁺ M2 cells in CRC patients.

<p>PBMCs and TIMs were isolated from individual subjects and stimulated with LPS and PMA/ionomycin. The cells were stained with anti-CD169 and anti-CD14 for 30 min, fixed, and permeabilized, followed by intracellular staining with anti-IL-10 or anti-IL-12. The cells were first gated on CD14⁺CD169⁺ cells and the percentages of CD14⁺CD169⁺IL-12⁺ M1 and CD14⁺CD169⁺IL-10⁺ M2 cells in PBMCs or TIMs from individual subjects were determined by flow cytometry. The levels of plasma IL-10 and IL-12 in individual subjects were determined by ELISA. Data are representative charts or expressed as the values of individual patients. The horizontal lines indicate the median for individual groups. (A) Flow cytometry analysis. (B) The percentages of CD14⁺CD169⁺IL-10⁺ M2 cells. (C) The percentages of CD14⁺CD169⁺IL-12⁺ M1 cells. The horizontal lines indicate the median values. (D) The potential association between the percentages of circulating CD14⁺CD169⁺IL-10⁺ cells and CD14⁺CD169⁺ cells in CRC patients. (E) The potential association between the percentages of TIMs CD14⁺CD169⁺IL-10⁺ cells and CD14⁺CD169⁺cells in the CRC tissues. (F) The levels of plasma IL-10. (G) The levels of plasma IL-12. (H) The correlation of plasma IL-10 levels with the percentages of CD14⁺CD169⁺ IL-10⁺ monocytes in PBMCs from CRC patients. (I) The correlation between the levels of plasma IL-10 and CEA in CRC patients.</p

Stratification analysis of the percentages of CD14⁺CD169⁺ circulating monocytes and tumor infiltrating macrophages in CRC patients.

<p>The CRC patients were stratified as early (I/II, n = 21) or advanced stage (III/IV, n = 25) and the percentages of CD14⁺CD169⁺ circulating monocytes and TIMs in individual patients were analyzed. Furthermore, the potential association between the percentages of CD14⁺CD169⁺ circulating monocytes or TIMs and the levels of plasma CEA in individual groups of patients were analyzed. Data are the mean of individual subjects. (A) Percentages of CD14⁺CD169⁺ monocytes in PBMCs (n = 21 for early stage, n = 25 for advanced stage of CRC patients) and the percentages of CD14⁺CD169⁺ macrophages in TIMs from early (n = 14) or advanced (n = 16) stage of CRC patients. The horizontal lines indicate the median for individual groups. (B) The correlation between the percentages of CD14⁺CD169⁺ circulating monocytes and TIMs in early stage of CRC patients. (C) The correlation between the percentages of CD14⁺CD169⁺ circulating monocytes and TIMs in advanced stage of CRC patients. (D) The correlation between the levels of plasma CEA and the percentages of CD14⁺CD169⁺ circulating monocytes in the CRC patients. (E) The correlation between the levels of plasma CEA and the percentages of CD14⁺CD169⁺ TIMs in the CRC patients.</p

Characterization of CD14⁺CD169⁺ macrophages in the colorectal tissues.

<p>A total of 30 fresh surgical CRC tumor tissues were digested for characterization of tumor infiltrating macrophages (TIMs). In addition, 12 lamina propria tissues from non-tumor patients were digested for characterization of macrophages in total lamina propria mononuclear cells (LPMCs). Subsequently, the cells were stained with anti-CD14, CD169 and CD163 or CD206. The frequency of CD14⁺CD169⁺, CD14⁺CD169⁺CD163⁺ and CD14⁺CD169⁺CD206⁺ macrophages in LPMCs and TIMs was determined by flow cytometry. Data are representative charts or expressed as the values of individual subjects. The horizontal lines indicate the median for individual groups. (A) Flow cytometry analysis of CD14⁺CD169⁺ in LPMCs and TIMs. (B) The percentages of CD14⁺CD169⁺ macrophages in LPMCs and TIMs. (C) Flow cytometry analysis of CD14⁺CD169⁺CD163⁺ and CD14⁺CD169⁺CD206⁺ macrophages in total CD14⁺CD169⁺ LPMCs and TIMs macrophages. (D) The frequency of CD14⁺CD169⁺CD163⁺ macrophages in LPMCs and TIMs. (E) The frequency of CD14⁺CD169⁺CD206⁺ macrophages in LPMCs and TIMs.</p

Characterization of circulating CD14⁺CD169⁺ monocytes in CRC patients.

<p>Peripheral blood mononuclear cells (PBMCs) were obtained from individual subjects and stained with anti-CD14 and anti-CD169. The frequency of circulating CD14⁺CD169⁺ monocytes was characterized by flow cytometry. The cells were gated initially on mononuclear cells and then on CD14⁺ cells. Subsequently, the percentages of CD14⁺CD169⁺ monocytes were determined. To characterize different subsets of CD14⁺CD169⁺ monocytes, PBMCs were stained with fluorescent antibodies against CD14, CD169 and CD163, CD206 or MAC387. The cells were gated on CD14⁺CD169⁺ monocytes and the percentages of CD14⁺CD169⁺CD163⁺, CD14⁺CD169⁺CD206⁺ and CD14⁺CD169⁺MAC387⁺ macrophages were determined. Data are representative charts of flow cytometry and expressed as the values of individual subjects. The horizontal lines indicate the median for individual groups. (A) Flow cytometry analysis of CD14⁺CD169⁺ monocytes/macrophages. (B) Flow cytometry analysis of different subsets of circulating CD14⁺CD169⁺ monocytes/macrophages. (C) The percentages of CD14⁺CD169⁺ monocytes. (D) The frequency of CD14⁺CD169⁺CD163⁺ macrophages. (E) The frequency of CD14⁺CD169⁺CD206⁺ macrophages. (F) The frequency of CD14⁺CD169⁺MAC387⁺ macrophages.</p