Postoperative oral nutritional supplementation after major gastrointestinal surgery: a randomized controlled clinical trial.

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the efficacy of post-operative oral nutrition supplementation after major gastrointestinal surgery. METHODS AND STUDY DESIGN: A prospective randomized controlled trial was conducted to evaluate 174 subjects who were discharged within 2 weeks after major gastrointestinal surgery. The subjects in the study group were prescribed 400 ml/day of Encover® from the day of discharge for 8 weeks, but no supplementation was allowed in the control group. The primary endpoint was the weight loss rate at 8 weeks after discharge compared with the pre-operative weight, and the secondary endpoints included changes in body weight, body mass index, Patient-Generated Subjective Global Assessment score/grade, hematological/ biochemical parameters, and adverse events evaluated at 2, 4, and 8 weeks after discharge. RESULTS: The weight loss rate at 8 weeks after discharge did not differ between two groups (4.23±5.49% vs 4.80±4.84%, p=0.481). The total lymphocyte count, the level of total cholesterol, total protein, and albumin were significantly higher in the study group after discharge. Diarrhea was the most frequent adverse event, and the incidence of adverse events with a severity score of >=3 did not differ between groups (2.3% vs 1.2%). CONCLUSIONS: The utility of routine oral nutritional support after major gastrointestinal surgery was not proven in terms of weight loss at 8 weeks after discharge. However, it can be beneficial for early recovery of biochemical parameters.

Synergistic effect of fucoidan with antibiotics against oral pathogenic bacteria.

BACKGROUND: Fucoidan is a sulphated polysaccharide that is primarily extracted from brown seaweeds; it has been broadly studied in recent years due to its numerous biological properties, including anticoagulant, antithrombotic, antitumour and antiviral activities. OBJECTIVE AND DESIGN: In this study, fucoidan was evaluated against oral bacteria, either alone or with antibiotics, via the broth dilution method and chequerboard and time-kill assay. RESULTS: Minimum inhibitory concentration/minimum bactericidal concentration (MIC/MBC) values for the fucoidan against all the tested bacteria ranged between 0.125 and 0.50/0.25 and 1.00mgml(-1), for ampicillin 0.125 and 64/0.5 and 64µgml(-1) and for gentamicin 2 and 256/4 and 512µgml(-1), respectively. Furthermore, the MIC and MBC were reduced to one half-eighth as a result of the combination of the fucoidan with antibiotics. One to 3h of treatment with MIC50 of fucoidan with MIC50 of antibiotics resulted from an increase of the rate of killing in colony forming units (CFUs) ml(-1) to a greater degree than was observed with alone. CONCLUSION: These results suggest that fucoidan is important in the antibacterial actions of the agents.

Preventive effect of Korean red ginseng for acute respiratory illness: a randomized and double-blind clinical trial.

Korean Red Ginseng (KRG) is a functional food and has been well known for keeping good health due to its anti-fatigue and immunomodulating activities. However, there is no data on Korean red ginseng for its preventive activity against acute respiratory illness (ARI). The study was conducted in a randomized, double-blinded, placebo-controlled trial in healthy volunteers (Clinical Trial Number: NCT01478009). Our primary efficacy end point was the number of ARI reported and secondary efficacy end point was severity of symptoms, number of symptoms, and duration of ARI. A total of 100 volunteers were enrolled in the study. Fewer subjects in the KRG group reported contracting at least 1 ARI than in the placebo group (12 [24.5%] vs 22 [44.9%], P = 0.034), the difference was statistically significant between the two groups. The symptom duration of the subjects who experienced the ARI, was similar between the two groups (KRG vs placebo; 5.2 ± 2.3 vs 6.3 ± 5.0, P = 0.475). The symptom scores were low tendency in KRG group (KRG vs placebo; 9.5 ± 4.5 vs 17.6 ± 23.1, P = 0.241). The study suggests that KRG may be effective in protecting subjects from contracting ARI, and may have the tendency to decrease the duration and scores of ARI symptoms.

Heterogeneous nuclear ribonucleoprotein C1/C2 controls the metastatic potential of glioblastoma by regulating PDCD4.

MicroRNAs (miRNAs) have been implicated in the pathogenesis and progression of brain tumors. miR-21 is one of the most highly overexpressed miRNAs in glioblastoma multiforme (GBM), and its level of expression correlates with the tumor grade. Programmed cell death 4 (PDCD4) is a well-known miR-21 target and is frequently downregulated in glioblastomas in accordance with increased miR-21 expression. Downregulation of miR-21 or overexpression of PDCD4 can inhibit metastasis. Here, we investigate the role of heterogeneous nuclear ribonucleoprotein C1/C2 (hnRNPC) in the metastatic potential of the glioblastoma cell line T98G. hnRNPC bound directly to primary miR-21 (pri-miR-21) and promoted miR-21 expression in T98G cells. Silencing of hnRNPC lowered miR-21 levels, in turn increasing the expression of PDCD4, suppressing Akt and p70S6K activation, and inhibiting migratory and invasive activities. Silencing of hnRNPC reduced cell proliferation and enhanced etoposide-induced apoptosis. In support of a role for hnRNPC in the invasiveness of GBM, highly aggressive U87MG cells showed higher hnRNPC expression levels and hnRNPC abundance in tissue arrays and also showed elevated levels as a function of brain tumor grade. Taken together, our data indicate that hnRNPC controls the aggressiveness of GBM cells through the regulation of PDCD4, underscoring the potential usefulness of hnRNPC as a prognostic and therapeutic marker of GBM.

Feasibility study of early oral intake after gastrectomy for gastric carcinoma.

PURPOSE: Despite the compelling scientific and clinical data supporting the use of early oral nutrition after major gastrointestinal surgery, traditional bowel rest and intravenous nutrition for several postoperative days is still being used widely after gastric cancer surgery. MATERIALS AND METHODS: A phase II study was carried out to evaluate the feasibility and safety of postoperative early oral intake (water intake on postoperative days (POD) 1-2, and soft diet on POD 3) after a gastrectomy. The primary outcome was morbidity within 30 postoperative days, which was targeted at <25% based on pilot study data. RESULTS: The study subjects were 90 males and 42 females with a mean age 61.5 years. One hundred and four (79%) and 28 (21%) patients underwent a distal and total gastrectomy, respectively. The postoperative morbidity rate was within the targeted range (15.2%, 95% CI, 10.0~22.3%), and there was no hospital mortality. Of the 132 patients, 117 (89%) successfully completed a postoperative early oral intake regimen without deviation; deviation in 10 (8%) due to gastrointestinal symptoms and in five (4%) due to the management of postoperative complications. The mean times to water intake and a soft diet were 1.0±0.2 and 3.2±0.7 days, respectively, and the mean hospital stay was 10.0±6.1 days. CONCLUSIONS: Postoperative early oral intake after a gastrectomy is feasible and safe, and can be adopted as a standard perioperative care after a gastrectomy. Nevertheless, further clinical trials will be needed to evaluate the benefits of early oral nutrition after upper gastrointestinal surgery.

Accuracy of macroscopic intraoperative diagnosis of serosal invasion and risk of over- and underestimation in gastric carcinoma.

BACKGROUND: Accurate intraoperative diagnosis of serosal invasion is a prerequisite for proper application of invasive procedures, such as intraperitoneal chemohyperthermia, for serosa positive gastric carcinomas. METHODS: We reviewed the prospectively constructed data of 1,265 gastric cancer patients who underwent surgery between 2007 and 2009. Accuracies of macroscopic diagnoses of serosal invasion were determined by comparing with pathological findings. The risk factors of over- and underestimation of serosal invasion were analyzed in the univariate and multivariate model. RESULTS: The accuracy of macroscopic intraoperative diagnosis of serosal invasion was 88%. Serosal invasion was underestimated in 34 of 187 serosa positive patients and overestimated in 117 of 1,078 serosa negative patients; a sensitivity and specificity of 82 and 89%, respectively. When pT1 tumors were excluded, the accuracy, sensitivity, and specificity of macroscopic diagnosis of serosal invasion were 71.5, 81.8, and 65.3%, respectively. Univariate and multivariate analysis revealed that a tumor size of >4 cm and preoperative CT finding of serosa positive were independent risk factors for macroscopic overestimation as serosal invasion in pT2 gastric cancer. Meanwhile, Borrmann type 1, preoperative CT finding of serosa negative, lesser/posterior surface location, and tumor size of <4 cm were independent risk factors for underestimation of serosal invasion in pT3 gastric carcinoma. CONCLUSIONS: The macroscopic diagnosis of serosal invasion is largely consistent with pathological findings. However, great care should be taken with regard to the risk of over- and underestimation of serosal invasion when making a decision for invasive treatments based on macroscopic findings of serosal invasion.

Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma.

PURPOSE: To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery. METHODS: Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008. RESULTS: Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (± 20) days. CONCLUSIONS: Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.

MAPK activation is necessary to the apoptotic death of KB cells induced by the essential oil isolated from Artemisia iwayomogi.

AIM OF THE STUDY: Artemisia iwayomogi is a perennial small herbal plant that has long been used as a chemopreventive agent in traditional Korean medicine. Previously, the purified essential oil was isolated from Artemisia iwayomogi, herein named AIEO, and found to contain the active components responsible for the chemopreventive potential of the herb. MATERIALS AND METHODS: This study examined whether or not AIEO has potential chemopreventative effects against cancer using the human oral epidermoid carcinoma cell line, KB cells. The possible mechanism of AIEO-induced apoptosis was also examined. RESULTS: The results showed that AIEO induces the apoptotic death of KB cells, which is mediated by mitogen-activated protein kinases (MAPKs). In addition, AIEO not only induced an imbalance between the mitochondrial Bcl-2 and Bax levels with the concomitant release of Cytochrome c into the cytosol but also induced the activation of caspases and the cleavage of PARP. This induction was significantly suppressed by MAPK inhibitors. Moreover, pretreating the cells with each of the caspase or MAPK-specific inhibitors apparently inhibited AIEO-induced cytotoxicity of KB cells. CONCLUSIONS: These results strongly suggest that AIEO might have cancer chemopreventive and therapeutic potential, which is closely related to its ability to activate the MAPK-mediated signaling pathways with the subsequent induction of a mitochondria- and caspase-dependent mechanism.

Essential Oil Prepared from Cymbopogon citrates Exerted an Antimicrobial Activity Against Plant Pathogenic and Medical Microorganisms.

Essential oils are mixtures of volatile, lipophilic compounds originating from plants. Some essential oils have useful biological activities including antimicrobial, spasmolytic, antiplasmodial, and insect-repelling activities. In this study, we tested the antimicrobial activity of essential oil prepared from the aromatic plant, Cymbopogon citrates, against three important plant pathogenic and medical microorganisms, Pectobacterium carotovorum, Colletotrichum gloeosporioides, and Aspergillus niger. It effectively inhibited the growth of the bacterium, Pectobacterium carotovorum, in a dose-dependent fashion, and 0.5% of the oil inhibited the growth of bacteria completely. Similarly, the essential oil inhibited the growth of plant pathogenic fungus, Colletotrichum gloeosporioides, and the addition of 1% of essential oil completely inhibited the growth of fungus even after 5 days of culture. Finally, it effectively inhibited the growth of the medically and industrially important fungal species, Aspergillus spp. These results suggest that the essential oil from Cymbopogon citrates may be an environmentally safe alternative to inhibit antimicrobial agents for various uses.

Antibacterial activity of sophoraflavanone G isolated from the roots of Sophora flavescens.

This study investigated the antibacterial activities of sophoraflavanone G from Sophora flavescens in combination with two antimicrobial agents against oral bacteria. The combined effect of sophoraflavanone G and the antimicrobial agents was evaluated using the checkerboard method to obtain a fractional inhibitory concentration (FIC) index. The sophoraflavanone G+ampicillin (AM) combination was found to have a synergistic effect against S. mutans, S. sanguinis, S. sobrinus, S. gordonii, A. actinomycetemcomitans, F. nucleatum, P. intermedia, and P. gingivalis, whereas the sophoraflavanone G+gentamicin (GM) combination had a synergistic effect against S. sanguinis, S. criceti, S. anginosus, A. actinomycetemcomitans, F. nucleatum, P. intermedia, and P. gingivalis. Neither combination exhibited any antagonistic interactions (FIC index >4). In particular, the MICs/MBCs for all the bacteria were reduced to one-half - one-sixteenth as a result of the drug combinations. A synergistic interaction was also confirmed by time-kill studies for nine bacteria where the checkerboard suggested synergy. Thus, a strong bactericidal effect was exerted through the drug combinations, plus in vitro data suggested that sophoraflavanone G combined with other antibiotics may be microbiologically beneficial rather than antagonistic.

Chemical composition and antimicrobial activity of the essential oil of Cryptomeria japonica.

The composition and the antibacterial activity of the essential oil obtained from Cryptomeria japonica D. Don on oral bacteria were studied. The chemical composition of the essential oil was analysed by GC and GC-MS. Sixty-eight compounds accounting for 95.82% of the oil were identified. The main compounds in the oil were alpha-pinene (6.07%), sabinene (8.86%), terpinen-4-ol (9.77%), alpha-terpineol (6.13%), elemol (11.17%) and 10(15)-cadinen-4-ol (7.16%). The essential oil and some of its major compounds were tested for antimicrobial activity against 15 different genera of oral bacteria. The essential oil of C. japonica exhibited considerable inhibitory effects against all bacteria tested (MICs, 0.025-0.05 mg/mL; MBCs, 0.025-0.1 mg/mL), while its major compounds demonstrated various degrees of growth inhibition.

Chemical composition and antimicrobial activity of the essential oil of Artemisia lavandulaefolia.

The chemical components of the essential oil obtained from Artemisia lavandulaefolia DC. were analyzed by GC-MS. Ninety-nine compounds accounting for 94.9 % of the essential oil were identified. The major compounds in the essential oil were beta-caryophyllene (16.1 %), cis-chrysanthenol (7.0 %), 1,8-cineole (5.6 %), borneol (5.3 %), trans-beta-farnesene (5.1 %), camphor (4.9 %), yomogi alcohol (4.5 %), alpha-terpineol (3.9 %), and alpha-humulene oxide (3.3 %). The essential oil and some of its major compounds were tested for antimicrobial activity against 15 different genera of oral bacteria. The essential oil of A. lavandulaefolia exhibited considerable inhibitory effects against all obligate anaerobic bacteria (MIC values, 0.025 to 0.05 mg/mL; MBC values, 0.025 to 0.1 mg/mL) tested, while its major compounds demonstrated different degrees of growth inhibition.

Chemical composition and antimicrobial activity of the essential oils of Artemisia scoparia and A. capillaris.

The chemical composition of the essential oils obtained from Artemisia scoparia Waldst. et Kitamura and Artemisia capillaris Thunb. was analyzed by GC/MS. The essential oil of A. scoparia was rich in camphor (11.0 %), 1,8-cineole (21.5 %), and beta-caryophyllene (6.8 %) as the major compounds, whereas A. capillaris oil was rich in beta-pinene (9.4 %), beta-caryophyllene (11.1 %), and capillene (32.7 %). The essential oils and some of their major compounds were tested for their antimicrobial activity against 15 different genera of oral bacteria. The essential oils of A. scoparia and A. capillaris exhibited considerable inhibitory effects against all oral bacteria tested, while their major components demonstrated various degrees of growth inhibition.