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关键词： Robotic   Biliary surgery   Hepaticojejunostomy   Bilio-enteric anastomosis   Cholecystectomy   Choledochal cyst  

摘要： BackgroundPresently, experience with laparoscopic and robotic bilio-enteric anastomosis (BEA) has been increasing world-wide although widespread adoption remains limited. In this study, we report our initial experience with both these *** retrospective cross-sectional review of a single center prospective database of 130 consecutive laparoscopically and robotically constructed BEAs in hepatopancreatobiliary surgeries performed between 2013 and 2022 was conducted. A propensity-scored match analysis comparing results between both groups was *** were 55 patients in the laparoscopic cohort and 75 patients in the robotic cohort. There were no significant differences in the demographic data between both groups. Operative time was longer in the robotic group, but with less blood loss. There were no differences between the groups with regards to length of stay, number and grade of complications, reoperation and mortality rates. After propensity-score matching, there remained statistically significant differences in median operative time (robotic 650 min, 550-720 min;laparoscopic 550 min, 485-590 min) and median blood loss (robotic 200mls, 100-300;laparoscopic 300mls, 200-500mls). There remained no differences between the groups with regards to length of stay, number and grade of complications, reoperation and mortality rates between both groups after propensity-score matching. The overall biliary anastomotic leak rate was 4.6% (6/130). The anastomotic leak rate for L-HJ was 9.1% (5/55) versus 1.3% (1/75) for R-HJ, P = 0.08).ConclusionLaparoscopic and robotically constructed bilio-enteric anastomosis can be adopted safely with a low anastomotic complication rate.

摘要： It is likely that in the near future many practices and practice-based veterinarians will be directly involved in the workplace-based core clinical training of veterinary students. An understanding of what is involved is important so that informed decisions regarding participation can be made. This article - the first in a two-part series - describes the advantages of workplace-based clinical training and the operational infrastructure and processes required to build a practice network and support the delivery of a workplace-based clinical model of clinical training.

关键词： cancer   carcinogen   exposure   occupational cancer   occupational exposure  

摘要： Objectives The Korean CARcinogen EXposure (K-CAREX) project previously assessed occupational exposure to 20 International Agency for Research on Cancer (IARC) Group 1 carcinogens in 2010. This study updated K-CAREX to reflect exposure data from *** We selected 20 IARC Group 1 carcinogens for this update. Reference exposure prevalence estimates were calculated using 3 nationwide occupational databases: the Work Environment Measurement Database (WEMD), the Special Health Examination Database (SHED), and the Work Environment Condition Survey (WECS). Among 37 industrial hygienists from the previous study, 26 participated again, providing exposure estimates after reviewing reference estimates from the 3 data sources. The median of their estimates was used as the final exposure prevalence. The number of exposed workers was calculated by multiplying the final exposure prevalence by the 2020 national census data for each carcinogen and industry. Exposure intensity ratings were also estimated using the *** Exposure prevalence and the number of exposed workers were estimated for 20 carcinogens across 232 industries. For example, in the "manufacture of basic chemicals" industry, benzene exposure prevalence was estimated at 9%, with 3,833 workers exposed and an exposure intensity rating of 2. The largest exposed population was to welding fumes (266,965 workers), followed by crystalline silica (246,807 workers), nickel (191,258 workers), and mineral oil mist (179,305 workers).Conclusions This updated data offers valuable insights into occupational carcinogen exposure, supporting cancer prevention efforts and future epidemiological studies.

关键词： GLP-1RA   obesity   safety   semaglutide   type 1 diabetes   weight loss  

关键词： Immunotherapy   Cancer   Regulatory t cell   Gut microbiome   CD8(+) t cells   Immune checkpoint inhibitor   Kampo medicine   Juzentaihoto  

摘要： Immune checkpoint blockade (ICB) therapy has been extensively employed across various cancer types. However, unresponsiveness to ICB remains a major obstacle;therefore, novel strategies to improve its efficacy are required. Juzentaihoto (JTT) is a Japanese Kampo medicine widely used in clinical practice as supportive care to improve the overall condition of cancer patients, particularly those with compromised immune function. Although the immunomodulatory effects of JTT have been suggested, it remains unclear whether JTT can enhance the efficacy of ICB. In this study, we demonstrated that JTT enhances the anti-tumor efficacy of anti-PD-1 antibody therapy in a B16-OVA model, accompanied by modulation of gut bacterial composition and the production of their metabolites in tumor-bearing mice. In line with these changes in gut microbiota and metabolite production, the combination of JTT and anti-PD-1 antibody therapy inhibited Treg expansion in tumor-draining lymph nodes and enhanced the activation of tumor-infiltrating CD8(+) T cells, resulting in greater diversity of the TCR repertoire. These results suggest that the immunomodulatory mechanism of JTT may involve alterations in the gut microbiome and the immunological tumor microenvironment. [GRAPHICS] .