Abdominal Actinomycotic Abscess after Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Report.

Actinomycosis is a rare, chronic, suppurative, and granulomatous bacterial disease. The Actinomyces species exist as normal flora in the oropharynx, gastrointestinal tract, and the female genital tract. They are incapable of penetrating the normal mucous membranes and become pathogenic only when this barrier has been destroyed by trauma, surgery, immunosuppression, or after viscus perforation. We report the first case of an actinomycotic abscess after laparoscopic sleeve gastrectomy. A 29-year-old man underwent a laparoscopic sleeve gastrectomy with no intra-operative complications. On postoperative day 3, the patient had a fever with elevated inflammatory markers. Abdominal computerized tomography (CT) with oral water-soluble contrast media showed no extra-luminal leakage and no fluid collection adjacent to the resected stomach, other than the fluid collection in the right subhepatic space. Percutaneous drainage was attempted, but the procedure failed due to the patient's thick abdominal wall. After two weeks of weight loss of about 12 kg, percutaneous drainage was successfully performed, and A. odontolyticus was identified through pus culture. After effective abscess drainage and high-dose antibiotics, the patient's symptoms improved and the abscess pocket disappeared. We reported Actinomyces infection after gastric sleeve surgery. In the case of abscess formation after gastric sleeve surgery caused by actinomycete infection, antibiotic treatment and percutaneous drainage are effective together.

Repeatability of feed efficiency and its relationship with carcass traits in Hanwoo steers during their entire growing and fattening period.

Objective: This study investigated the repeatability of feed efficiency and its association with carcass traits in Hanwoo steers during the entire growing and fattening periods. Methods: The growth and intake of thirty-six Hanwoo steers (259 ± 19.7 kg; nine months) were monitored throughout five periods, including two growing periods (GP) and three fattening periods (FP). The steers were fed two types of concentrate mixes with varying nutrient compositions until they reached a target weight of 800 kg for slaughter. For each period, steers were categorized into three classes based on their feed efficiency rankings using residual feed intake (RFI) and feed conversion ratio (FCR). Feed efficiency repeatability was assessed using the Spearman correlation coefficient, decomposition of random errors, and the Theil segregation index (TSI). The Pearson correlation coefficient was used to examine the relationship between feed efficiency and carcass traits. Results: The results demonstrated a significant and high correlation with RFI, but not FCR, during the growing or fattening stages (r > 0.5; P < 0.01). When steers were classified according to their feed efficiency rankings, 58% of the animals in the high RFI class (low efficient) initially (GP 1) remained in the same class by the last period (FP 3), whereas steers were randomly distributed based on FCR. The repeatability, assessed by the decomposition of random errors, was higher for RFI (0.61) than for FCR (0.15). The TSI also indicated that RFI rankings, rather than FCR rankings, are more likely to be maintained. Moreover, a weak association was observed between feed efficiency and carcass traits. Conclusion: In conclusion, RFI repeatability throughout the growing and fattening periods surpassed that of the FCR, with steers classified as high RFI during the GP more likely to remain in the same class during the FP. Feed efficiency was weakly correlated with carcass traits.

Practice guidelines for managing extrahepatic biliary tract cancers.

Backgrounds/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions: The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Effect of the Meal Interval Setting of an Automated Concentrate Feeding System on Feed Intake and Feeding Behavior in Fattening Hanwoo Steers.

An automatic concentrate feeding system (ACFS) divides the day into several intervals, allowing cattle to consume a predetermined amount of concentrate mix per interval. This study investigated the impact of changing these intervals (four vs. six) in an ACFS on its precision in monitoring the feed intake and feeding behavior of fattening Hanwoo steers. The experiment, involving 29 fattening Hanwoo steers (688 ± 43.3 kg of body weight, 24 months old), employed a switchback design with two interval settings: four and six per day. Both individual forage and concentrate intakes and feeding behaviors were automatically recorded; however, the ACFS measured feed supply, not actual intake. The precision of the ACFS's intake recordings was tested by manually assessing feed residuals per visit using video recordings. Although no difference was observed in the concentrate intake (p > 0.05), the six-interval setting reduced concentrate residuals by 0.2 kg per visit (p < 0.05). The increased interval setting also resulted in fewer visits for forage consumption and decreased forage and total dry matter intakes (p < 0.05). In conclusion, the increased interval setting for the ACFS reduced the visit frequency for forage consumption and actual forage consumption while improving the precision of the ACFS's intake recordings.

Carcinosarcoma of the gallbladder: report of two cases.

Adenocarcinoma is the predominant histological type of carcinoma of the gallbladder, accounting for more than 80% of all gallbladder carcinomas. In contrast, carcinosarcoma of the gallbladder is an extremely atypical subset of gallbladder malignancies. It is characterized by the presence of both epithelial and mesenchymal components. Currently, fewer than 100 cases have been reported in the English literature. Therefore, knowledge and experience regarding this disease are limited. Recently, we experienced two cases of gallbladder carcinosarcoma, which were diagnosed as gallbladder carcinoma based on the preoperative clinical and radiological examinations. Cholecystectomies were performed in both cases, and the malignant tumor cells included carcinomatous and sarcomatous components histologically. The final pathological diagnoses were carcinosarcoma of the gallbladder. We herein report these two cases of gallbladder carcinosarcoma and review the previous pertinent literature.

Primary extragastrointestinal stromal tumor arising in the pancreas: report of a case.

Primary extragastrointestinal stromal tumors (EGISTs) arising in the pancreas are extremely rare, with only ten cases documented to our knowledge. We report a further case of EGIST of the pancreas. The patient was a 55-year-old man who presented with postprandial abdominal discomfort. Abdominal computed tomography and magnetic resonance imaging showed a lobulated heterogenous enhancing mass, 11 cm in diameter, in the abdominal cavity. No regional lymphadenopathy, ascites, or metastasis was seen radiologically. There was no obvious lesion in the stomach or small intestine. The initial diagnosis was a solid pseudopapillary tumor or serous cystic neoplasm. The patient underwent distal pancreatectomy with splenectomy. Microscopically, the tumor consisted of spindle cells arranged in short fascicles. Mitotic figures were seen in 7/50 high-power fields. Immunohistochemical examination revealed strongly positive staining for CD117. Based on these findings, the final pathologic diagnosis was a primary EGIST of the pancreas. This case consolidates the possibility that this rare tumor can involve the pancreas as a primary site and should be included in the differential diagnosis of cystic lesions in this site.

Analysis of the Factors Influencing Body Weight Variation in Hanwoo Steers Using an Automated Weighing System.

This study aimed to determine the factors affecting the body weight (BW) of Hanwoo steers by collecting a large number of BW measurements using an automated weighing system (AWS). The BW of 12 Hanwoo steers was measured automatically using an AWS for seven days each month over three months. On the fourth day of the BW measurement each month, an additional BW measurement was conducted manually. After removing the outliers of BW records, the deviations between the AWS records (a) and manual weighing records (b) were analyzed. BW measurement deviations (a - b) were significantly (p < 0.05) affected by month, day and the time within a day as well as the individual animal factor; however, unexplained random variations had the greatest impact (70.4%). Excluding unexplained random variations, the difference between individual steers was the most influential (80.1%). During the day, the BW of Hanwoo steers increased before feed offerings and significantly decreased immediately after (p < 0.05), despite the constant availability of feeds in the feed bunk. These results suggest that there is a need to develop pattern recognition algorithms that consider variations in individual animals and their feeding patterns for the analysis of BW changes in animals.

Comparison of laparoscopic versus open distal pancreatectomy for benign, pre-malignant, and low grade malignant pancreatic tumors.

BACKGROUNDS/AIMS: The purpose of this study is to demonstrate that laparoscopic distal pancreatectomy in benign disease is is safer and more favorable to patients than open distal pancreatectomy. METHODS: We retrospectively reviewed data of 150 patients who underwent laparoscopic (n=69) or open (=81) distal pancreatectomy at a double institutes from 2008 to 2018. We reviewed each patient's history for age, sex, pathologic diagnosis. Specific outcomes that were included hospital stay, operative time (in minutes), operative blood loss (in milliliters), 30-daymajormorbidity and mortality (Clavian-Dindo classification), pancreatic leak rate (grade of leak A, B, or C), pancreatic hemorrhage. RESULTS: From 2008 to 2018, there were 150 patients underwent distal pancreatectomy with or without splenectomy for benign pancreatic disease. 81 patients underwent open and 69 patients underwent laparoscopic distal pancreatectomy (LDP) Intra-operative estimated blood loss was significantly lower in the LDP group than in the OPD group (200 vs. 400 ml p<0.01). There was no difference in blood transfusion between the two groups. There was a significant difference in the resection method between the two groups (p<0.01) and there was a significant difference in the use of mesh for prevention of postoperative pancreatic fistula (POPF) (53 vs. 34 p<0.01). There was no significant difference in incidence of POPF (15.9% in LDP vs 7.4% in ODP, p=0.235) between the two groups, morbidity rate between the two groups (18 vs. 30 p=0.152), post - pancreatectomy hemorrhage, wound infection, hospital stay and readmission. CONCLUSIONS: LDP showed there was no difference in the occurrence of POPF, complication and hospital stay. In contrast, intra-operative blood loss was significantly lower in the LDP group than in the ODP group, and LDP was also significantly better in the view point of the feeding advance. In other words, LDP is safer and more favorable to patients than ODP.

Natural course of tonsillectomy pain: A prospective patient cohort study.

OBJECTIVE: The aim of this study was to determine the natural course of pain after tonsillectomy. METHODS: This study included 119 patients that underwent tonsillectomy between November 2013 and November 2015. After undergoing tonsillectomy, patients scored their pain using the visual analogue scale three times daily (morning, midday, and evening) for 2 weeks. A linear mixed model was used for statistical analyses. RESULTS: Increasing postoperative days was negatively associated with pain following tonsillectomy surgery (estimated value [EV] of visual analogue score [VAS]/day=-0.42, 95% confidence interval [CI]=-0.43 to -0.41, P<0.001); the post-tonsillectomy pain curve illustrated this negative correlation. Postoperative pain was less in children and adolescents (≤18years old) than in adults (>18 years old) (EV=-0.81, 95% CI=-1.56 to -0.08, P=0.031). Mean tonsillectomy-associated pain on postoperative day 1 was 6.4 VAS. It decreased slightly to 5.3 VAS until postoperative day 7, after which it reduced sharply to 3.7 VAS within 3 days; on postoperative day 14 it had decreased to 1.6 VAS. Pain assessments were higher in the morning (EV=0.59, 95% CI=0.50 to 0.69, P<0.001) compared with assessments conducted in the evening. CONCLUSION: The natural course of postoperative tonsillectomy pain follows a gradual decline for 1 week after surgery, but decreases more rapidly after this period.

Severe hearing impairment and risk of depression: A national cohort study.

OBJECTIVE: Hearing impairment is suggested to be associated with depression in the elderly. The present study evaluated the risk of depression after hearing impairment in all age groups matched by age, sex, income, and region of residence. METHODS: The Korean Health Insurance Review and Assessment Service-National Patient Samples were collected for a period from 2002 to 2013. Hearing impairment was defined as a hearing threshold ≥ 60 dB in both ears or as ≥ 80 dB in one ear and ≥ 40 dB in one ear. Hearing-impaired participants performed a pure tone audiometry test 3 times and an auditory brainstem response threshold test once. The 6,136 hearing-impaired participants were matched 1:4 with 24,544 controls with no reported hearing impairment for age, sex, income, and region of residence. Depression was investigated based on the International Classification of Disease-10 codes F31 (bipolar affective disorder) through F39 (unspecified mood disorder) by a psychiatrist from 2002 through 2013. The crude (simple) and adjusted (age, sex, income, region of residence, dementia, hypertension, diabetes, and dyslipidemia) hazard ratio (HR) of hearing impairment on depression were analyzed using Cox-proportional hazard model. RESULTS: The rate of depression was significantly higher in the severe hearing-impaired group than in the control group (7.9% vs. 5.7%, P < 0.001). Severe hearing impairment increased the risk of depression (adjusted HR = 1.37, 95% confidence interval [CI] = 1.24-1.52, P < 0.001). In a subgroup analysis, young (0-29 years old), middle-aged (30-59 years old), and old (≥ 60 years old) severe hearing-impaired groups showed significantly increased risk of depression compared to controls with no reported hearing impairment. In accordance with income level, severe hearing impairment elevated depression in the low and high income groups, but not in the middle income group. CONCLUSION: Severe hearing impairment increased the risk of depression independently of age, sex, region, past medical histories, and income (in low and high income persons but not in middle income persons).

A biologically active angiogenesis inhibitor, human serum albumin-TIMP-2 fusion protein, secreted from Saccharomyces cerevisiae.

Tissue inhibitor of metalloproteinase-2 (TIMP-2) is an endogenous and bi-functional inhibitor of angiogenesis. TIMP-2 is expressed in an insoluble form in Escherichia coli and secreted at a very low level from yeast. Here, we report on a high level of secretion of TIMP-2 fused with human serum albumin (HSA) from the yeast Saccharomyces cerevisiae. The secreted HSA-TIMP-2 fusion protein (87kDa) was purified to greater than 95% homogeneity. The HSA-TIMP-2 protein inhibited approximately 81% of tube formation of human umbilical vein endothelial cells (HUVECs) when studied at a concentration of 187microM. The systemic administration of HSA-TIMP-2 at 40mg/kg to the C57B1/6 mouse inhibited the growth of B16BL6 tumors. Furthermore, a combination treatment of HSA-TIMP-2 with 5-fluorouracil (50mg/kg) showed significant effects on tumor growth in this model. The high level of secretion of the biologically active angiogenesis inhibitor from S. cerevisiae should facilitate fundamental research and application studies of HSA-TIMP-2, as an attractive candidate for therapeutic agents treating angiogenesis-related diseases.