AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI). METHODS:A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted. RESULTS:Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal i n t u s s u s c e p t i o n s . 6 5 . 9 % o f i n t u s s u s c e p t i o n s were diagnosed preoperatively using a computed tomography (CT ) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo.Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion. CONCLUSION:CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided.

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circular RNAs (circRNAs) serve important roles in cardiovascular diseases, including myocardial infarction. However, the mechanisms underlying the roles of circRNAs in cardiomyocyte death induced by anoxia/reoxygenation (A/R) are not fully understood. In the present study, the roles of circRNA_101237 and let-7a-5p in cardiomyocyte death induced by A/R injury were investigated. It was identified that circRNA_101237 was induced by A/R injury in a time-dependent manner and that circRNA_101237 knockdown protected cardiomyocytes from A/R-mediated apoptosis. Additional mechanistic studies revealed that circRNA_101237 served as a sponge for let-7a-5p, subsequently regulating insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3)-dependent autophagy. IGF2BP3 downregulation decreased the levels of apoptosis and inhibited autophagy induced by A/R challenge in primary cardiomyocytes. These results identified circRNA_101237 as a novel circRNA that regulates cardiomyocyte death and autophagy, and demonstrated that the circRNA-101237/let-7a-5p/IGF2BP3 axis, which serves as a regulator of cardiomyocyte death, may be a potential therapeutic target for the management of cardiovascular diseases.

BackgroundPrior authorization, audit and feedback, and pay for performance are the three core “active” strategies of antimicrobial stewardship program (ASP), yet little is known about the individual or combined benefits of such programs, particularly in a pediatric setting.ObjectivesThe aim of this study was to compare these core ASP strategies and determine the incremental effect of financially punished audit and feedback.MethodsDuring the journey to the Joint Commission International accreditation, a tertiary pediatric medical center performed two different hospital-wide stewardship interventions in succession. The first stage without formalized ASPs served as pre-intervention period, January 2011 to April 2011. The ASP used prior authorization alone during the first-intervention period, May 2011 to September 2011. In October 2011, financially punished audit and feedback was introduced, marking the start of the second-intervention period, October 2011 to November 2012. We compared the differences of the change in monthly average use of antibiotics and expenditure on antibiotics before and after the ASP changes by using interrupted time series via dynamic regression. The main end points included the proportions of antibiotic prescriptions and expenditure on antibacterial relative to all medications.ResultsBefore the second-intervention period, neither the proportion of antibiotic prescriptions nor the proportion of expenditure on antibiotics declined significantly in both ambulatory and inpatient settings. However, after the introduction of financially punished audit and feedback, the proportion of both antibiotic prescriptions (β = −6.269, P < 0.001, and reduction = 59.4% for outpatients; β = −1.235, P < 0.001, and reduction = 19.8% for inpatients) and expenditure on antibiotics (β = −7.777, P < 0.001, and reduction = 46.7% for outpatients; β = −4.933, P = 0.001, and reduction = 16.3% for inpatients) dropped immediately.ConclusionThe combination of more than one core strategies (prior authorization, audit and feedback, and pay for performance) will be more effective than one strategy alone.

Vascular calcification (VC) is a significant risk factor for cardiovascular morbidity and mortality. We recently reported that apocynin had benefits for preventing cardiovascular diseases. However, whether apocynin could attenuate VC is unknown. Here, we investigated the role of apocynin in VC and its underlying mechanisms. 163 participants with high or normal ankle–brachial index (ABI) were enrolled in this study for analyzing the demographic and biochemical data. In vitro, vascular smooth muscle cells (VSMCs) were exposed to calcification medium containing b-glycerophosphate and angiotensin II (Ang II) for 24 hours. The results showed that serum level of Ang II was significantly increased in patients with high ABI (P<0.05). In cultured VSMCs, Ang II significantly exacerbated osteogenic switching. The expression of osteogenic phenotype markers, including bone morphogenetic protein 2 (BMP2), runt-related transcription factor 2 (Runx2) and osteopontin (OPN), were significantly upregulated, whereas contractile markers expression, including alpha smooth muscle actin (a-SMA) and smooth muscle 22 alpha (SM22a) were simultaneously downregulated. However, these effects were greatly attenuated by apocynin. Apocynin enhanced expression of a-SMA by 5.3%, and reduced expression of BMP2, Runx2, OPN by 3.37%, 0.61% and 3.07%, respectively. Furthermore, extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation was upregulated by Ang II, and this effect was also reversed by apocynin. Intriguingly, pretreatment with U0126, an inhibitor of ERK1/2, had similar effects with apocynin. Apocynin may act as a novel molecular candidate to protect against VSMCs osteogenic switching through suppressing ERK1/2 pathway.