Supplementary Material for: Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis

<b><i>Objective:</i></b> To clarify the efficacy and side effects of mechanical bowel preparation (MBP) before gynecologic surgery. <b><i>Methods:</i></b> A systematic review was conducted. Embase, PubMed, the Cochrane Central Register of Controlled Trials in the Cochrane Library and China National Knowledge Infrastructure were searched. Randomized controlled trials on MBP prior to gynecologic surgery were included. The software package Revman 5.3 was used for statistical analysis. Odds ratio (OR) and standard mean deviation were calculated for dichotomous and continuous variable, respectively. <b><i>Results:</i></b> The quality of the included studies was moderate to good. MBP prior to laparoscopic gynecologic benign surgery or vaginal prolapse surgery has not been proven to be valuable for surgical performance, mainly involving visualization of the surgical field (OR 1.52, 95% confidence interval [CI] 1 to 2.32; Z = 1.95, p = 0.05), bowel handling (OR 2.21, 95% CI 0.83 to 5.84; Z = 1.59, p = 0.11), surgical complications (OR 1.3, 95% CI 0.46 to 3.67; Z = 0.5, p = 0.62) and bowel preparation. The discomfort due to oral catharsis is severer than no bowel preparation and enema, however without any difference between enema and no bowel preparation. <b><i>Conclusion:</i></b> The routine practice of MBP before gynecologic surgery needs to be reconsidered. This traditional clinical behavior has to be abandoned before benign laparoscopic surgery. Studies on the role of MBP for gynecologic laparotomy and gynecologic cancer are urgent

Supplementary Material for: High Serum Ferritin Levels Increase the Risk of Hyperuricemia: A Cross-Sectional and Longitudinal Study

<b><i>Background/Aims:</i></b> To examine the cross-sectional and longitudinal associations of serum ferritin levels with hyperuricemia. <b><i>Methods:</i></b> A cross-sectional and subsequently prospective study was performed among the employees of Zhenhai Refining and Chemical Company, Ningbo, China. In a cross-sectional study, the association between serum ferritin levels and the prevalence of hyperuricemia was analyzed. Subjects who were free of hyperuricemia at baseline were followed up annually to explore the prospective association between serum ferritin levels and hyperuricemia incidence. <b><i>Results:</i></b> Of the 10,074 subjects enrolled at baseline, 1,731 (17.18%) fulfilled the diagnostic criteria of hyperuricemia. Subjects with hyperuricemia presented significantly higher serum ferritin levels, and the levels were positively correlated with the prevalence of hyperuricemia. During a total of 22,367 person-years of follow-up, 502 subjects developed hyperuricemia. The overall incidence of hyperuricemia for 1,000 person-years of follow-up was 22.4, ranging from 17.6 in subjects with baseline serum ferritin levels in the first quintile to 19.2, 21.7, 23.9, and 30.7 in subjects in quintiles 2, 3, 4, and 5, respectively (p for trend < 0.001). Cox regression analyses showed that serum ferritin levels were positively associated with the risk of incident hyperuricemia. <b><i>Conclusions:</i></b> Our cross-sectional and longitudinal results indicate that high serum ferritin levels increase the risk of hyperuricemia

Supplementary Material for: Resveratrol Inhibits Proliferation and Induces Apoptosis through the Hedgehog Signaling Pathway in Pancreatic Cancer Cell

<p><i>Purpose:</i> To investigate the effect and possible mechanisms of resveratrol on pancreatic cancer cells in vitro. <i>Methods:</i> After being treated with resveratrol, cell viability, cell cycle phase distribution and apoptosis rate of pancreatic cancer cells were measured by CCK-8 assay and flow cytometer, respectively. The effects of resveratrol on the Hedgehog pathway were studied by real-time RT-PCR and Western blotting. By interfering Gli1 expression in PANC-1 cells and overexpressing Gli1 in BxPC-3 cells, we detected the expressions of Gli1-targeted genes, such as Ptc1, CCND1 and BCL-2, compared with resveratrol experimental group. We further used the luciferase reporter assay to explore the correlation between resveratrol and Gli1. <i>Results:</i> Resveratrol inhibited the growth of pancreatic cancer cells in a dose- and time-dependent manner. Compared with control group, the cells in the G0/G1 phase and the apoptosis rate were significantly increased. Low concentration of resveratrol decreased the expression of the Hedgehog pathway members including Gli1, Ptc1 and Smo. The expression of downstream target genes of the Hedgehog pathway such as Gli1, Ptc1, CCND1 and BCL-2 were significantly decreased after 12.5 µ<i>M</i> resveratrol treatment, which demonstrated a similar change of gene expression when Gli1 was knocked down by the RNAi technique in PANC-1 cells. Resveratrol also downregulated the expression of Gli1, Ptc1, CCND1 and BCL-2 in Gli1-overexpressed BxPC-3 cells. Results of the luciferase assay showed that resveratrol did not act on the Gli1 promoter directly. <i>Conclusion:</i> Resveratrol can inhibit pancreatic cancer cell survival and its mechanisms might be partly via the Hedgehog signaling pathway.</p

Supplementary Material for: General Anesthesia may have Similar Outcomes with Conscious Sedation in Thrombectomy Patients with Acute Ischemic Stroke: A Real-World Registry in China

<b><i>Background and Purpose:</i></b> Clinical trials showed that anesthesia may not influence the functional outcome in stroke patients with endovascular therapy; however, data are lacking in China. Using real-world registry data, our study aims to compare the effects of general anesthesia or conscious sedation on functional outcomes in stroke patients treated with thrombectomy in China. <b><i>Methods:</i></b> Consecutive patients with acute anterior circulation stroke receiving thrombectomy in 21 stroke centers between January 2014 and June 2016 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with general anesthesia and the conscious sedation. The 90-day modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH), and death were compared between groups. <b><i>Results:</i></b> Of the 698 patients undergoing endovascular treatment, 138 were treated with general anesthesia and 560 with conscious sedation. After propensity score matching, 114 general anesthesia and 114 conscious sedation patients were matched. The proportions of patients with 90-day mRS 0–2 were not significantly different between general anesthesia and conscious sedation groups (41.2% [47/114] vs. 46.5% [53/114], <i>p</i> = 0.470), nor were the rates of sICH (21.9% [25/114] vs. 12.3% [14/114], <i>p</i> = 0.072) and 90-day mortality (31.6% [36/114] vs. 21.9% [25/114], <i>p</i> = 0.145). <b><i>Conclusion:</i></b> Anesthesia patterns may have no significant impacts on clinical outcomes in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in the real-world practice in China

Supplementary Material for: Mild renal function impairment and long-term outcomes in patients with three-vessel coronary artery disease: a cohort study

Background: Limited data are available on the long-term impact of mild renal dysfunction (eGFR 60-89 ml/min/1.73m2) in patients with three-vessel coronary disease (3VD). Methods: A total of 5,272 patients with 3VD undergoing revascularization were included and were categorized into 3 groups: normal renal function (eGFR ≥90 ml/min/1.73m2, n=2352), mild renal dysfunction (eGFR 60-89, n=2501) and moderate renal dysfunction (eGFR 30-59, n=419). Primary endpoint was all-cause death. Secondary endpoints included cardiac death and major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction and stroke. Results During the median 7.6-year follow-up period, 555 (10.5%) deaths occurred. After multivariable adjustment, patients with mild and moderate renal dysfunction had significantly higher risks of all-cause death (adjusted HR: 1.36, 95% CI 1.07-1.70; adjusted HR 2.06, 95% CI 1.53-2.78, respectively) compared with patients with normal renal function. patients after coronary artery bypass grafting (CABG) had a lower rate of all-cause death and MACCE than those undergoing percutaneous coronary intervention (PCI) in the normal and mild renal dysfunction group, but not in the moderate renal dysfunction group. Results were similar after propensity score matching. Conclusions In patients with 3VD, even mild renal impairment was significantly associated with a higher risk of all-cause death. The superiority of CABG over PCI diminished in those with moderate renal dysfunction. Our study alerts clinicians to the early screening of mild renal impairment in patients with 3VD and provides real-world evidence on the optimal revascularization strategy in patients with renal impairment