A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study.

BACKGROUND: Dense inflammation obscuring the hepatocystic anatomy can hinder the ability to perform a safe standard laparoscopic cholecystectomy in severe cholecystitis, requiring use of a bailout procedure. We compared clinical outcomes of laparoscopic and open subtotal cholecystectomy against the traditional standard of open total cholecystectomy to identify the optimal bailout strategy for the difficult gallbladder. METHODS: A multicenter, multinational retrospective cohort study of patients who underwent bailout procedures for severe cholecystitis. Procedures were compared using one-way analysis of variance/Kruskal-Wallis tests and χ2 tests with multiple pairwise comparisons, maintaining a family-wise error rate at 0.05. Multiple multivariate linear/logistical regression models were created. RESULTS: In 11 centers, 727 bailout procedures were conducted: 317 laparoscopic subtotal cholecystectomies, 172 open subtotal cholecystectomies, and 238 open cholecystectomies. Baseline characteristics were similar among subgroups. Bile leak was common in laparoscopic and open fenestrating subtotal cholecystectomies, with increased intraoperative drain placements and postoperative endoscopic retrograde cholangiopancreatography(P < .05). In contrast, intraoperative bleeding (odds ratio = 3.71 [1.9, 7.22]), surgical site infection (odds ratio = 2.41 [1.09, 5.3]), intensive care unit admission (odds ratio = 2.65 [1.51, 4.63]), and length of stay (Δ = 2 days, P < .001) were higher in open procedures. Reoperation rates were higher for open reconstituting subtotal cholecystectomies (odds ratio = 3.43 [1.03, 11.44]) than other subtypes. The overall rate of bile duct injury was 1.1% and was not statistically different between groups. Laparoscopic subtotal cholecystectomy had a bile duct injury rate of 0.63%. CONCLUSION: Laparoscopic subtotal cholecystectomy is a feasible surgical bailout procedure in cases of severe cholecystitis where standard laparoscopic cholecystectomy may carry undue risk of bile duct injury. Open cholecystectomy remains a reasonable option.

Combined CD25, CD64, and CD69 Biomarker in 3D-Printed Multizone Millifluidic Device for Sepsis Detection in Clinical Samples.

Sepsis is a serious medical condition that arises from a runaway response to an infection, which triggers the immune system to release chemicals into the bloodstream. This immune response can result in widespread inflammation throughout the body, which may cause harm to vital organs and, in more severe cases, lead to organ failure and death. Timely and accurate diagnosis of sepsis remains a challenge in analytical diagnostics. In this work, we have developed and validated a sepsis detection device, utilizing 3D printing technology, which incorporates multiple affinity separation zones. Our device requires minimal operator intervention and utilizes CD64, CD69, and CD25 as the biomarker targets for detecting sepsis in liquid biopsies. We assessed the effectiveness of our 3D-printed multizone cell separation device by testing it on clinical samples obtained from both septic patients (n = 35) and healthy volunteers (n = 8) and validated its performance accordingly. Unlike previous devices using poly(dimethyl siloxane), the 3D-printed device had reduced nonspecific binding for anti-CD25 capture, allowing this biomarker to be assayed for the first time in cell separations. Our results showed a statistically significant difference in cell capture between septic and healthy samples (with p values of 0.0001 for CD64, CD69, and CD25), suggesting that 3D-printed multizone cell capture is a reliable method for distinguishing sepsis. A receiver operator characteristic (ROC) analysis was performed to determine the accuracy of the captured cell counts for each antigen in detecting sepsis. The ROC area under the curve (AUC) values for on-chip detection of CD64+, CD69+, and CD25+ leukocytes were 0.96, 0.92, and 0.88, respectively, indicating our diagnostic test matches clinical outcomes. When combined for sepsis diagnosis, the AUC value for CD64, CD69, and CD25 was 0.99, indicating an improved diagnostic performance due to the use of multiple biomarkers.

Methane emissions and 13C composition from beef steers consuming binary C3-C4 diets.

Improvements in forage nutritive value can reduce methane emission intensity in grazing ruminants. This study was designed to evaluate how the legume rhizoma peanut (Arachis glabrata; RP) inclusion into bahiagrass (Paspalum notatum) hay diets would affect intake and CH4 production in beef steers. We also assessed the potential to estimate the proportion of RP contribution to CH4 emissions using δ13C from enteric CH4. Twenty-five Angus-crossbred steers were randomly allocated to one of five treatments (five steers per treatment blocked by bodyweight): 1) 100% bahiagrass hay (0%RP); 2) 25% RP hay + 75% bahiagrass hay (25%RP); 3) 50% RP hay + 50% bahiagrass hay (50%RP); 4) 75% RP hay + 25% bahiagrass hay (75%RP); 5) 100% RP hay (100%RP). The study was laid out using a randomized complete block design, and the statistical model included fixed effect of treatment, and random effect of block. Methane emissions were collected using sulfur hexafluoride (SF6) technique, and apparent total tract digestibility was estimated utilizing indigestible neutral detergent fiber as an internal marker. A two-pool mixing model was used to predict diet source utilizing CH4 δ13C. Inclusion of RP did not affect intake or CH4 production (P > 0.05). Methane production per animal averaged 250 g CH4/d and 33 g CH4/kg dry matter intake, across treatments. The CH4 δ13C were -55.5, -60.3, -63.25, -63.35, and -68.7 for 0%RP, 25%RP, 50%RP, 75%RP, and 100%RP, respectively, falling within the reported ranges for C3 or C4 forage diets. Moreover, there was a quadratic effect (P = 0.04) on the CH4 δ13C, becoming more depleted (e.g., more negative) as the diet proportion of RP hay increased, appearing to plateau at 75%RP. Regression between predicted and observed proportions of RP in bahiagrass hay diets based on δ13C from CH4 indicate δ13C to be useful (Adj. R2 = 0.89) for predicting the contribution of RP in C3-C4 binary diets. Data from this study indicate that, while CH4 production may not always be reduced with legume inclusion into C4 hay diets, the δ13C technique is indeed useful for tracking the effect of dietary sources on CH4 emissions.

Investigating methods for reducing enteric methane emissions from ruminant livestock are important to reduce environmental impacts and improving production efficiency through reduced energy losses. This experiment evaluated the effects of increasing proportion of rhizoma peanut hay (a C3 legume) into bahiagrass hay (a C4 grass) on intake and methane production in beef steers. In addition, carbon stable isotopes (13C) of the methane emitted were used to back-calculate the diet components consumed. Angus-crossbred steers were randomly allocated to one of five hay diets (treatments): 1) 100% bahiagrass; 2) 25% rhizoma peanut + 75% bahiagrass; 3) 50% rhizoma peanut + 50% bahiagrass; 4) 75% rhizoma peanut + 25% bahiagrass; 5) 100% rhizoma peanut. Inclusion of rhizoma peanut did not affect intake or methane production, but apparent total tract digestibility increased as proportion of rhizoma peanut increased in the diet. The carbon stable isotope composition observed from enteric methane production was within the expected ranges for C3­C4 forage diets. Furthermore, the carbon stable isotope composition from enteric methane production was useful in predicting contributions from each diet source in C3­C4 binary diets.

Stable isotopes of C and N differ in their ability to reconstruct diets of cattle fed C3-C4 forage diets.

Stable isotopes are useful for estimating livestock diet selection. The objective was to compare δ13C and δ15N to estimate diet proportion of C3-C4 forages when steers (Bos spp.) were fed quantities of rhizoma peanut (Arachis glabrata; RP; C3) and bahiagrass (Paspalum notatum; C4).Treatments were proportions of RP with bahiagrass hay: 100% bahiagrass (0%RP); 25% RP + 75% bahiagrass (25%RP); 50% RP + 50% bahiagrass (50%RP); 75% RP + 25% bahiagrass (75%RP); and 100% RP (100% RP). Feces, plasma, red blood cell (RBC), and hair were collected at 8-days intervals, for 32 days. Two-pool mixing model was utilized to back-calculate the proportion of RP based on the sample and forage δ13C or δ15N. Feces showed changes using δ13C by 8 days, and adj. R2 between predicted and observed RP proportion was 0.81 by 8 days. Plasma, hair, and RBC required beyond 32-days to reach equilibrium, therefore were not useful predictors of diet composition during the study. Diets were best represented using fecal δ13C at both 8-days and 32-days. By 32-days, fecal δ15N showed promise (R2 = 0.71) for predicting diet composition in C3-C4 diets. Further studies are warranted to further corroborate fecal δ15N as a predictor of diet composition in cattle.

Inclusion of a tannin-rich legume in the diet of beef steers reduces greenhouse gas emissions from their excreta.

The objectives of this study were to determine the emission of nitrous oxide (N2O), methane (CH4), and carbon dioxide (CO2), as well as the isotopic composition of N2O from excreta of beef steers fed 'AU Grazer' sericea lespedeza hay [SL; Lespedeza cuneata (Dum. Cours.) G. Don]. Fifteen Brahman × Angus crossbred steers were fed one of three experimental diets: 0, 50, or 100% inclusion of SL into 'Tifton 85' bermudagrass hay (Cynodon spp.). Gas sampling occurred on days 0, 1, 3, 5, 7, 14, 18, 25, and 32 after urine or feces application to static chambers for two experimental periods. Effect of the day after feces application (P < 0.001), while day × inclusion of SL interaction was observed in urine (P < 0.001) for all greenhouse gases (GHG) analyzed. Peaks of emission of all GHG in urine and feces occurred in the first days (P < 0.001), with days 3 and 5 being most depleted in 15N-N2O in feces, and days 3, 5, and 7, in urine (P < 0.001). Feeding SL to beef steers was effective in mitigating the emission of GHG from the excreta, but further research is necessary to investigate the mechanisms behind the reductions.

Composition and decomposition of rhizoma peanut (Arachis glabrata Benth.) belowground biomass.

Roots and rhizomes can play an important role in nutrient cycling, however, few studies have investigated how their decomposition pattern is affected by defoliation and time of the year. This 2-year study evaluated root-rhizome composition and decomposition of a warm-season rhizomatous perennial legume [rhizoma peanut (RP; Arachis glabrata Benth.)] under continuous stocking or when defoliated by clipping every 56 days. A 168-days incubation trial was performed to determine disappearance of biomass and N and changes in acid detergent fiber (ADF), acid detergent insoluble N (ADIN), and C:N ratio. Additionally, three 56-days incubations were performed each year to evaluate the disappearance coefficient (B0) and relative decay rate (k). There were no treatment differences in any response for the 168-days incubation. After 168 days, 21 and 60% of initial biomass and initial N remained, respectively. Relative decay rate for OM and N were 0.0088 and 0.0035 g g-1 day-1, respectively. Carbon-to-N ratio decreased from 29 at day 0 to 17 at day 168. Concentration of ADIN increased from 6.9 to 19.3 g kg-1, plateauing at day 79. The B0 and k for remaining OM and N were greater in late than early season and could be explained by greater N concentration and lesser C:N ratio. Rapid decomposition, difference in C:N ratio from day 0 to 168, and the increase in ADIN concentration during incubation indicate large amounts of root-rhizome-soluble C at initiation of incubation. These data indicate that RP root-rhizome turnover is more responsive to season than defoliation frequency.

Autologous Cell Harvesting System as Adjunct for Soft-tissue Reconstruction of Necrotizing Soft Tissue Infection.

Necrotizing soft tissue infections (NSTIs) cause rapidly progressing destruction of skin and soft tissue, leaving large soft tissue defects and necessitating complex reconstruction. RECELL, an autologous cell harvesting device, provides a regenerative epidermal suspension (RES) from a small split-thickness skin biopsy for the substitution of (or in addition to) split-thickness skin grafting (STSG). We present a case of a 56-year-old man with extensive NSTI managed by serial debridement, leading to a degloving injury to the right upper extremity, axilla, flank and back, which was later reconstructed using RES application in conjunction with STSG and Integra placement. At his 2-week hospital follow-up, the patient was healing well with limited right upper extremity range of motion, but continued improvement seen with physical and occupational therapy. Due to the patient's significant soft tissue defect, a unique reconstructive plan was required using both Integra and RECELL in conjunction with STSG. RECELL, in conjunction with STSG, should be considered for the treatment of significant soft tissue defects such as those found in NSTI.