Lack of gamma delta T cells ameliorates inflammatory response after acute intestinal ischemia reperfusion in mice.

T-cells have been demonstrated to modulate ischemia-reperfusion injury (IRI) in the kidney, lung, liver, and intestine. Whereas most T-cell subpopulations contribute primarily to the antigen-specific effector and memory phases of immunity, γδ-T-cells combine adaptive features with rapid, innate-like responses that can place them in the initiation phase of immune reactions. Therefore, we aimed to clarify the role of γδ-T-cells in intestinal IRI. Adult wild-type (WT) and γδ-T-cell-deficient mice were subjected to acute intestinal IRI. Gene expression of pro-inflammatory cytokines and influx of leukocyte subpopulations in the gut were assessed by qPCR and flow cytometry. Serum transaminases were measured as an indicator of distant organ IRI. Intestinal IRI led to increased influx of neutrophils, pro-inflammatory cytokine expression and LDH/ALT/AST elevation. Selective deficiency of γδ-T-cells significantly decreased pro-inflammatory cytokine levels and neutrophil infiltration in the gut following IRI compared to controls. Furthermore, γδ-T-cell deficiency resulted in decreased LDH and transaminases levels in sera, indicating amelioration of distant organ injury. Increasing evidence demonstrates a key role of T-cell subpopulations in IRI. We demonstrate that γδ-T-cell deficiency ameliorated pro-inflammatory cytokine production, neutrophil recruitment and distant organ injury. Thus, γδ-T-cells may be considered as mediators contributing to the inflammatory response in the acute phase of intestinal IRI.

Conventional alpha beta (αß) T cells do not contribute to acute intestinal ischemia-reperfusion injury in mice.

PURPOSE: Ischemia-reperfusion injury (IRI) is associated with significant patient mortality and morbidity. The complex cascade of IRI is incompletely understood, but inflammation is known to be a key mediator. In addition to the predominant innate immune responses, previous research has also indicated that αß T cells contribute to IRI in various organ models. The aim of this study was to clarify the role αß T cells play in IRI to the gut. METHODS: Adult wild-type (WT) and αß T cell-deficient mice were subjected to acute intestinal IRI with 30min ischemia followed by 4h reperfusion. The gene expression of pro-inflammatory cytokines was measured by qPCR, and the influx of leukocyte subpopulations in the gut was assessed via flow cytometry and histology. Pro-inflammatory cytokines in the serum were measured, and transaminases were assessed as an indicator of distant organ IRI. RESULTS: Intestinal IRI led to an increased expression of pro-inflammatory cytokines in the gut tissue and an influx of leukocytes that predominantly consisted of neutrophils and macrophages. Furthermore, intestinal IRI increased serum IL-6, TNF-α, and ALT/AST levels. The αß T cell-deficient mice did not exhibit a more significant increase in pro-inflammatory cytokines in the gut or serum following IR than the WT mice. There was also no difference between WT- and αß T cell-deficient mice in terms of neutrophil infiltration or macrophage activation. Furthermore, the increase in transaminases was equal in both groups indicating that the level of distant organ injury was comparable. CONCLUSION: An increasing body of evidence demonstrates that αß T cells play a key role in IRI. In the gut, however, αß T cells are not pivotal in the first hours following acute IRI as deficiency does not impact cytokine production, neutrophil recruitment, macrophage activation, or distant organ injury. Thus, αß T cells may be considered innocent bystanders during the acute phase of intestinal IRI.

Comparison of Cleaning up Eyelids after Taking off False Eyelashes between Eye Makeup Remover Alone and Eye Makeup Remover with Ocusoft®.

Background: Hirschsprung's disease (HD) is the most common intestinal obstruction in newborn. The Transanal Endorectal Pull -Through (TERPT) is a new surgical procedure that has rapidly replaced traditional ones. Objective: We have reviewed early post-operative complications after TERPT of childhood HD in Thailand. Material and Method: The clinical course and a 1 year outcome of all pediatric HD undergoing TERPT from 5 pediatric surgical centers in Thailand between 2008 and 2011 were reviewed. Results: Seventy-six patients (66 males and 10 females) of HD were included. The average age of diagnosis and surgery are 199 (0-4,015) and 297 (9-4,075) days, respectively, where ages and classification of HD are not related. The associated conditions are Down syndrome (DS) 6.6% and congenital heart disease (CHD) 5.3%. The most common presented symptom was intestinal obstruction. Other symptoms were Hirschsprung, which are associated with enterocolitis (HAEC) 13.1% and intestinal perforation 2.6%. The patients were diagnosed by barium enema (BE) 93.4%, rectal biopsy (RB) 6.6% and anorectal manometry (ARM) 6.6%. HAEC is the most common both pre- and post-operative complications (23.7% and 22.4%). Other post-operative complications are incontinence 13.2%, perianal excoriation 9.2%, anastomosis stricture 7.9%, anastomosis leakage 2.6%, retained aganglionic segment 2.6%, anastomosis volvulus 1.3% and anovaginal fistula 1.3%. One patient died due to anastomosis leakage (1.3%). Five patients were associated with DS, 3 patients (60%) were incontinent, 1 patient had anastomosis stricture (20%) and 2 patients (40%) was HAEC. Conclusion: Most of HD were diagnosed and treated in the newborn period. TERPT is safe and also feasible in all pediatric age groups. The associated DS are related to have more morbidity. HAEC is the most common complication. Even though there are limitations in the diagnostic investigation those did not achieve the standard diagnosis of HD in this study; but the outcomes are not different from the reviews. The improvement in laboratories and pathological investigation services will reflect the surgical service and outcome of pediatric HD in this region. The awareness of post-operative complications will lead to the prevention and early management in the postoperative period.

Three-Dimensional Versus Two-Dimensional Imaging in Adult Versus Pediatric Laparoscopy: A Simulator Box Study.

AIM: Three-dimensional (3D) imaging has been shown to enhance depth perception and facilitate operations in training box studies and in adult laparoscopy. However, there are no data on 3D vision in small working spaces, which are common pediatric surgery. Therefore, this study examined the impact of monoscopic versus stereoscopic visualization in large versus small working spaces in individuals with varying surgical expertise. MATERIALS AND METHODS: Twenty-four individuals with varying surgical expertise (experts, surgical residents, and surgical novices) were involved in the study. Participants were asked to perform four tasks in large (24- × 30- × 50-cm) and small (9- × 11- × 18-cm) training boxes, using two-dimensional and 3D imaging. Sixteen standardized procedures were performed by each participant. Primary outcome measure was performance time. Secondary outcome parameters included the number of errors and subjective depth perception. RESULTS: Surgical novices showed a shorter performance time and lesser total number of errors in large and small training boxes using 3D imaging. Residents achieved a significantly shorter performance time in the large and lesser number of errors in the small box. With 3D vision experts performed laparoscopic suturing in the small box and target touching in both boxes significantly faster. The overall performance time and total number of errors of experts were not different in the two boxes. Subjective depth perception with 3D vision in the small box in all groups and in the small box in surgical novices was significantly better. CONCLUSIONS: We identified several advantages of 3D vision in individuals with varying surgical expertise. However, the benefits were rather experienced by surgical novices and residents than by experts. Differences in performance time and number of errors were similar in the large and small simulator boxes.

3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon.

BACKGROUND AND PURPOSE: Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been postulated to enhance depth perception and facilitate operations. However, it has never been evaluated in conditions where the focus is close to the optical system. Thus, it is unclear whether 3D cameras can improve laparoscopic surgical performance in neonates and infants. We tested 3D versus two-dimensional (2D) vision during laparoscopic surgery in rabbits, mimicking the size of a neonatal patient. MATERIALS AND METHODS: Cadaver New Zealand white rabbits (mean weight 2,755 g) were operated by two surgeons experienced in 2D laparoscopic surgery and two surgical residents (with basic skills in 2D laparoscopy). All surgeons had never performed 3D laparoscopic surgery. Animals underwent six operations: Nissen fundoplication, small bowel anastomosis, and closure of a diaphragmatic defect using either 2D or 3D. Primary endpoint was cumulative operating time and operating time of each operation. Secondary endpoints included the hemodynamic response and psychomental stress level of the surgeons. Finally, subjective data on depth perception were assessed by questionnaires. RESULTS: Cumulative operating time of all three types of operations was significantly shorter with 3D laparoscopy in experts (3D: 23.01 ± 5.65 min vs 2D: 29.51 ± 7.51 min, p < 0.01) and residents (3D: 27.95 ± 3.69 min vs 2D: 33.95 ± 6.21 min, p < 0.05). This effect could be shown for each operation in the expert group and the Nissen fundoplication in the resident group. There were no differences in the hemodynamic response as well as the psychomental stress level between 2D and 3D imaging. 3D provided better depth perception. CONCLUSION: 3D laparoscopy in small spaces is associated with a significant shorter operating time. It induces no additional physical or psychomental stress in surgeons naive to 3D imaging. 3D may therefore facilitate minimal invasive surgery in neonates and infants.

Resection for primary liver tumors in children: an experience of 52 cases at one institution.

OBJECTIVE: To review the authors' experiences of liver resection for primary tumors in children. MATERIAL AND METHOD: The children who had undergone liver resection for any masses between January 1996 and December 2005 were studied. Their clinical data and pathological reports were reviewed for descriptive study. Surgical data including the extent of lesions, type of resection, and post-operative complications within 60 days after surgery were analyzed. Data are expressed as mean and standard deviation (SD). RESULTS: Fifty-two children, with a male to female sex ratio of 28:24, underwent resection for primary liver tumors. Their average age was 36.64 +/- 4.05 months and average weight was 12.02 +/- 6.76 Kg. Asymptomatic mass was the main complaint. Ultrasonography was the initial investigation and CT scan was performed later in all patients with suspected liver mass to confirm the diagnosis and to assess the resectability. CT scan was also useful for the diagnosis of liver tumor in six cases which ultrasonography could not differentiate from other abdominal tumors. The tumors were assessed to be unresectable in 28 of 52 (53.8%) patients who had preoperative chemotherapy and became resectable later. Surgical procedures were as follows: 39 hepatic lobectomies, six extended hepatic lobectomies, and seven segmentectomies. Mean operative time was 251.04 +/- 89.22 min. Mean ICU stay was 2.8 +/- 3.2 days. Pathology revealed 38 hepatoblastomas, five hemangioendotheliomas, four hepatomas, two harmatomas, and three other lesions. Post-operative complications occurred in 15 children (29%) including intra-abdominal bleeding (3), subphrenic collection (1), acute liver failure (3), wound infection (2), and atelectasis (6). No mortality within 60 days after surgery occurred. Most of the patients were discharged within 10 days after surgery. CONCLUSION: With the advancement of preoperative evaluation, more accurate diagnosis of liver tumors, and the extent of lesions has led to the proper more effective surgical resection and further treatment, then led to zero mortality rate related to liver resection for primary tumors in the present series. Although there were significant complications, mostly minor problems and all both minor and major complications were manageable; their fatal potentials should not be underestimated.

Overexpression of hepatic inducible nitric oxide synthase in biliary atresia.

AIMS: Biliary atresia (BA) is a rare and serious liver disease in infants characterized by progressive inflammatory cholangiopathy. The aims of this study were to investigate hepatic expression of inducible nitric oxide synthase (iNOS) in BA and to associate the iNOS expression with their early therapeutic outcome. METHODS: Hepatic iNOS expression was determined using immunohistochemistry from liver biopsies of 24 BA patients, and 16 non-BA patients whose liver tissues were needed in the treatment process. Six months after surgery, the BA patients were categorized into two groups;good and poor outcome. The iNOS expression of hepatocyte areas was evaluated based on its intensity using ImageJ software. Unpaired t-tests were used for the comparisons of iNOS expression between groups. RESULTS: Hepatic iNOS expression of BA patients was significantly stronger than that of non-BA patients (P < 0.0001). The largest area of hepatic iNOS expression was the area of hepatocytes. Subgroup analysis of BA patients at 6 months post-op revealed that there was no difference in iNOS expression between the patients with good outcome and those with poor outcome (P = 0.732). CONCLUSIONS: Overexpression of hepatic iNOS in BA patients was demonstrated. Within liver tissues, hepatocytes were the major source of hepatic iNOS production. However, the expression was not associated with the early therapeutic outcome. These results suggest that iNOS plays a role in the liver pathology of BA but its expression cannot be used as a predictor for therapeutic outcome.