c-Met activation promotes extravasation of hepatocellular carcinoma cells into 3D-cultured hepatocyte cells in lab-on-a-chip device.

Activation of c-Met signaling is associated with an aggressive phenotype and poor prognosis in hepatocellular carcinoma (HCC); however, its contribution to organ preference in metastasis remains unclear. In this study, using a Lab on a Chip device, we defined the role of aberrant c-Met activation in regulating the extravasation and homing capacity of HCC cells. Our studies showed that (i) c-Met overexpression and activation direct HCC cells preferentially towards the hepatocytes-enriched microenvironment, and (ii) blockage of c-Met phosphorylation by a small molecule inhibitor attenuated extravasation and homing capacity of HCC cells. These results, thus, demonstrate the role of c-Met signaling in regulating the colonization of HCC cells preferentially in the liver.

Climate-ecosystem modelling made easy: The Land Sites Platform.

Dynamic Global Vegetation Models (DGVMs) provide a state-of-the-art process-based approach to study the complex interplay between vegetation and its physical environment. For example, they help to predict how terrestrial plants interact with climate, soils, disturbance and competition for resources. We argue that there is untapped potential for the use of DGVMs in ecological and ecophysiological research. One fundamental barrier to realize this potential is that many researchers with relevant expertize (ecology, plant physiology, soil science, etc.) lack access to the technical resources or awareness of the research potential of DGVMs. Here we present the Land Sites Platform (LSP): new software that facilitates single-site simulations with the Functionally Assembled Terrestrial Ecosystem Simulator, an advanced DGVM coupled with the Community Land Model. The LSP includes a Graphical User Interface and an Application Programming Interface, which improve the user experience and lower the technical thresholds for installing these model architectures and setting up model experiments. The software is distributed via version-controlled containers; researchers and students can run simulations directly on their personal computers or servers, with relatively low hardware requirements, and on different operating systems. Version 1.0 of the LSP supports site-level simulations. We provide input data for 20 established geo-ecological observation sites in Norway and workflows to add generic sites from public global datasets. The LSP makes standard model experiments with default data easily achievable (e.g., for educational or introductory purposes) while retaining flexibility for more advanced scientific uses. We further provide tools to visualize the model input and output, including simple examples to relate predictions to local observations. The LSP improves access to land surface and DGVM modelling as a building block of community cyberinfrastructure that may inspire new avenues for mechanistic ecosystem research across disciplines.

Role of Biobanks for Cancer Research and Precision Medicine in Hepatocellular Carcinoma.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a highly complex and deadly cancer. There is an urgent need for new and effective treatment modalities. Since the primary goal in the management of cancer is to cure and improve survival, personalized therapy can increase survival, reduce mortality rates, and improve quality of life. Biobanks hold potential in leading to breakthroughs in biomedical research and precision medicine (PM). They serve as a biorepository, collecting, processing, storing, and supplying specimens and relevant data for basic, translational, and clinical research. OBJECTIVE: We aimed to highlight the fundamental role of biobanks, harboring high quality, sustainable collections of patient samples in adequate size and variability, for developing diagnostic, prognostic, and predictive biomarkers to develop and PM approaches in the management of HCC. METHOD: We obtained information from previously published articles and BBMRI directory. RESULTS AND CONCLUSION: Biobanking of high-quality biospecimens along with patient clinical information provides a fundamental scientific infrastructure for basic, translational, and clinical research. Biobanks that control and eliminate pre-analytical variability of biospecimens, provide a platform to identify reliable biomarkers for the application of PM. We believe, establishing HCC biobanks will empower to underpin molecular mechanisms of HCC and generate strategies for PM. Thus, first, we will review current therapy approaches in HCC care. Then, we will summarize challenges in HCC management. Lastly, we will focus on the best practices for establishing HCC biobanking to support research, translational medicine in the light of new experimental research conducted with the aim of delivering PM for HCC patients.

High glucose induced c-Met activation promotes aggressive phenotype and regulates expression of glucose metabolism genes in HCC cells.

Hepatocellular carcinoma (HCC) is strongly associated with metabolic dysregulations/deregulations and hyperglycemia is a common metabolic disturbance in metabolic diseases. Hyperglycemia is defined to promote epithelial to mesenchymal transition (EMT) of cancer cells in various cancers but its molecular contribution to HCC progression and aggressiveness is relatively unclear. In this study, we analyzed the molecular mechanisms behind the hyperglycemia-induced EMT in HCC cell lines. Here, we report that high glucose promotes EMT through activating c-Met receptor tyrosine kinase via promoting its ligand-independent homodimerization. c-Met activation is critical for high glucose induced acquisition of mesenchymal phenotype, survival under high glucose stress and reprogramming of cellular metabolism by modulating glucose metabolism gene expression to promote aggressiveness in HCC cells. The crucial role of c-Met in high glucose induced EMT and aggressiveness may be the potential link between metabolic syndrome-related hepatocarcinogenesis and/or HCC progression. Considering c-Met inhibition in hyperglycemic patients would be an important complementary strategy for therapy that favors sensitization of HCC cells to therapeutics.

The factors that affect the mortality of emergency operated ASA 3 colon cancer patients.

INTRODUCTION: colorectal cancers take third place among cancer-related deaths and 10-28% of these patients are admitted with the necessity of emergency surgical intervention. The main propose of this study was to investigate the factors affecting mortality in ASA 3 colorectal cancer patients who undergo emergency surgery. METHODS: between 2010 and 2017 ASA 3 patients who underwent emergency colon cancer surgery were included in the study. All of the study group was evaluated within the first 30-day time-frame. The results were obtained by a statistical comparison of the data of patients with and without mortality. RESULTS: one hundred and twenty eight patients included in the study. There was no statistical difference in the demographic data of the groups and the indications of the operation. The differences and durations of surgery also did not make any statistical difference. The complication rate was the same according to the Clavien-Dindo classification. CONCLUSION: despite the screening programs applied in colorectal cancers, applications to emergency services and procedures performed under emergency conditions are still at high levels. Surgical operations, which have to be performed in patients with impaired metabolic status, carry major risks for patients, but their outcomes are also satisfactory for them.

Can Magnetic Resonance Imaging Replace Mammography and Ultrasonography for the Detection of Breast Lesions?

Objective We aimed to evaluate the role of magnetic resonance imaging (MRI) in the visualization of breast lesions and to estimate whether MRI can be a reliable alternative to mammography (MG) and ultrasonography (USG) for this purpose. Materials and methods In this retrospective, single-center study, an analysis of medical files of 260 patients with breast masses as breast imaging reports and data system (BI-RADS) 4 and 5 at MRI was performed. The features of the breast lump, such as the side, location, multi foci or multicentricity, histopathological diagnosis, contrast-enhancement characteristics, radiological, and pathological axillary involvement, were noted. Consistency between MRI-BIRADS and MG+USG-BIRADS, as well as the association between lesion characteristics, was sought. Results The agreement ratio between the BI-RADS categories of MRI and MG+USG was 0.654 while consistency between histopathological diagnosis and MRI BI-RADS category was 0.838. The agreement between the BI-RADS category of MG+USG and histopathological diagnosis was 0.819. The consistency between MRI BI-RADS and MG+USG BI-RADS increased remarkably with the advancement of age. Similarly, the consistency between MRI BI-RADS and histopathological diagnosis tends to increase with the advancement of age. Nonmass contrast enhancement yielded the highest agreement ratios between MRI BI-RADS and MG+USG BI-RADS, histopathological diagnosis and MRI BI-RADS, and histopathological diagnosis and MG+USG BI-RADS. Conclusion Dynamic MRI is a useful and reliable method for imaging breast neoplasms. However, it is not devoid of disadvantages such as cost, attainability, and contrast use and it should be reserved as a problem-solving technique to be used in conjunction with conventional methods including MG and USG.

Effects of hyperbaric oxygen and iloprost on intestinal ischemia-reperfusion induced acute lung injury.

PURPOSE: To research the effects of iloprost (IL) and hyperbaric oxygen (HBO) combination treatment on lung injury and on tumor necrosis factor alpha (TNF-α), myeloperoxidase (MPO), malondialdehyde (MDA), and soluble intercellular adhesion molecule-1 (sICAM-1) levels after tissue or organ ischemia-reperfusion, and on ischemia-reperfusion induced lung neutrophil sequestration. METHODS: Forty white New Zealand rabbits were assigned randomly into 5 groups: HBO, IL, HBO+IL, control, and sham groups. TNF-α values were checked before ischemia, in the 1st hour of ischemia and in the 1st and 4th hours of reperfusion, also at the end of reperfusion period, plasma and tissue MPO values, MDA values, and sICAM-1 levels were detected. After sacrifice, the degree of lung injury was determined by histopathological examination. RESULTS: Compared to the control group all therapy groups showed a drastically meaningful reduction in TNF-α increase in 1, 2, and 4 hours. Plasma and lung MDA, MPO, and sICAM-1 levels were significantly lower in IL, HBO, HBO+IL, and sham groups compared with the control group. IL and/or HBO suppressed MDA and MPO increase in the lung tissue and in plasma. Additionally, histopathological score was significantly lower in HBO, IL, HBO+IL, and sham groups than that of the control group. CONCLUSION: Both HBO and IL therapy have a beneficial effect by causing a meaningful reduction in TNF-α production, MPO, MDA, sICAM-1 levels and pulmonary neutrophil sequestration; which play a role, especially, in ischemia reperfusion induced lung damage.

Arteriovenous fistulas ipsilateral to internal jugular catheters for hemodialysis have decreased patency rates.

PURPOSE: This study aimed to evaluate the effects of hemodialysis catheters on the survival of subsequent arteriovenous fistulas, according to the relative localization to the catheters. METHODS: A total of 201 patients who initiated dialysis therapy using a hemodialysis catheter were eligible for this retrospective study. Arteriovenous fistulas were created on the nondominant upper extremity after the placement of hemodialysis catheters. The catheters were removed after four consecutive successful dialyses via arteriovenous fistulas. The effective factors on arteriovenous fistula failure were determined in and the prognostic factors for survival were modeled by regression analysis. RESULTS: The relative placement of catheters as ipsi- or contralateral was found to significantly affect the survival of the arteriovenous fistulas. The overall survival was significantly longer in the contralateral arteriovenous fistula group (778.7 ± 28.8 vs. 247.3 ± 26.1 days; p < 0.001). The independent predictors of arteriovenous fistula survival were found to be relative side of arteriovenous fistula and hemodialysis catheter, age, and the presence of hypertension in multivariate analyses. CONCLUSION: This study showed that ipsilateral localization of the catheters and arteriovenous fistulas negatively affect the cumulative arteriovenous fistula survival. Therefore, to improve vascular access survival, side of catheters or arteriovenous fistulas should always be considered.

Pleiotropic Effects of Heparins: From Clinical Applications to Molecular Mechanisms in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is a major health problem worldwide and most cases are incurable because of late presentation. It is the most common primary neoplasm of the liver and often arises in the context of a chronic liver disease that impairs coagulation. Portal vein thrombosis (PVT) is a common complication of HCC that is associated with a poor prognosis. Heparin derivatives are widely used in the management of venous thromboembolism (VTE). Among them low molecular weight heparin (LMWH) favorably influences the survival in patients with advanced cancer, including HCC. Due to their pleiotropic function, heparins affect tumorigenesis in many ways and may promote or hamper tumorigenic transformation depending on the cancer type and cancer stage along with their structural properties and concentration. Thus, their application as an antithrombotic along with the conventional therapy regime should be carefully planned to develop the best management strategies. In this review, we first will briefly review clinical applications of heparin derivatives in the management of cancer with a particular focus on HCC. We then summarize the state of knowledge whereby heparin can crosstalk with molecules playing a role in hepatocarcinogenesis. Lastly, we highlight new experimental and clinical research conducted with the aim of moving towards personalized therapy in cancer patients at risk of thromboembolism.

A Comparison of the Effectiveness of Silibinin and Resveratrol in Preventing Alpha-Amanitin-Induced Hepatotoxicity.

Amanita phalloides species mushrooms containing alpha-amanitin (α-AMA) are responsible for the majority of fatal mushroom intoxications and can lead to severe poisonings resulting in hepatotoxicity and acute hepatic failure. Existing antidotes, such as silibinin, are not sufficiently effective in the prevention and/or resolution of α-AMA-induced hepatotoxicity. We investigated the effects of resveratrol on α-AMA-induced hepatotoxicity and compared with silibinin, a known antidote using in vivo and in vitro toxicity models. In the in vivo protocol, resveratrol (30 mg/kg) was given simultaneously with α-AMA (α-AMA + SR) or 12 (α-AMA + 12R) or 24 (α-AMA + 24R) hr after α-AMA administration. Silibinin (5 mg/kg) (α-AMA + Sil) and normal saline (α-AMA + NS) were given simultaneously with α-AMA. We found that liver transaminase levels in α-AMA + SR and α-AMA + 12R groups and histomorphologic injury score in the α-AMA + SR, α-AMA + 12R, α-AMA + 24R and α-AMA + Sil groups were significantly lower than that of the α-AMA + NS group. Resveratrol decreased mononuclear cell infiltration, necrosis and active caspase-3 immunopositivity in the liver. In the in vitro protocol, the effects of resveratrol and silibinin were evaluated in a reduction in cell viability induced by α-AMA in THLE-2 and THLE-3 hepatocytes. Neither resveratrol nor silibinin was found to be effective in increasing cell viability decreased by α-AMA + NS. As a conclusion, resveratrol was found to be effective in α-AMA-induced hepatotoxicity with its anti-inflammatory properties in in vivo conditions. It is a promising compound with the potential for use in the treatment of hepatotoxicity associated with Amanita phalloides type mushroom poisonings.

The regulatory role of heparin on c-Met signaling in hepatocellular carcinoma cells.

The role of heparin as an anticoagulant is well defined; however, its role in tumorigenesis and tumor progression is not clear yet. Some studies have shown that anticoagulant treatment in cancer patients improve overall survival, however, recent clinical trials have not shown a survival benefit in cancer patients receiving heparin treatment. In our previous studies we have shown the inhibitory effects of heparin on Hepatocyte Growth Factor (HGF)-induced invasion and migration in hepatocellular carcinoma (HCC) cells. In this study, we showed the differential effects of heparin on the behaviors of HCC cells based on the presence or absence of HGF. In the absence of HGF, heparin activated HGF/c-Met signaling and promoted motility and invasion in HCC cells. Heparin treatment led to c-Met receptor dimerization and activated c-Met signaling in an HGF independent manner. Heparin-induced c-Met activation increased migration and invasion through ERK1/2, early growth response factor 1 (EGR1) and Matrix Metalloproteinases (MMP) axis. Interestingly, heparin modestly decreased the proliferation of HCC cells by inhibiting activatory phosphorylation of Akt. The inhibition of c-Met signaling reversed heparin-induced increase in motility and invasion and, proliferation inhibition. Our study provides a new perspective into the role of heparin on c-Met signaling in HCC.

The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism.

AIM: To investigate the effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism. MATERIAL AND METHODS: This controlled, randomized, prospective cohort was carried out on 40 patients who admitted for surgery due to hyperthyroidism. Cases were randomly assigned to receive either preoperative treatment with Lugol solution (Group 1) or no preoperative treatment with Lugol solution (Group 2). Group 3 (n = 10) consisted of healthy adults with no known history and signs of hyperthyroidism. Blood flow through the thyroid arteries of patients was measured by color flow Doppler ultrasonography. Free T3, free T4, TSH, thyroid volume and the resistance index of the four main thyroid arteries were measured in all patients. RESULTS: There was not a significant difference between gender, preoperative serum thyroid hormone levels, or thyroid gland volumes between groups 1 and 2. The mean blood flow of the patients in Group 1 was significantly lower than values in Group 2. When age, gender, thyroid hormone, TSH, thyroid volume, blood flow, and Lugol solution treatment were included as independent variables, Lugol solution treatment (OR, 7.40; 95% CI, 1.02-58.46; p = 0.001) was found to be the only significant independent determinant of intraoperative blood loss. Lugol solution treatment resulted in a 7.40-fold decrease in the rate of intraoperative blood loss. CONCLUSION: Preoperative Lugol solution treatment was found to be a significant independent determinant of intraoperative blood loss. Moreover, preoperative Lugol solution treatment decreased the rate of blood flow, and intraoperative blood loss during thyroidectomy.

Assessing the effects of melatonin and N-acetylcysteine on the McFarlane flap using a rat model.

OBJECTIVE: To determine the effects of N-acetylcysteine (NAC) and melatonin, alone and in combination, on McFarlane flap viability in a rat model. METHODS: Forty Wistar rats were divided into four groups and received daily intraperitoneal injections for one week before surgery: control (sham [n=10]); melatonin (n=10); NAC (n=10); and NAC+melatonin (n=10). One week after surgery, the experiment was terminated and photographs were taken for topographic studies. A transillumination study was performed to observe vascularization in the flaps and biopsies were obtained for histopathological studies. RESULTS: Flap viability was significantly greater in the antioxidant- (ie, NAC and melatonin) treated groups compared with the control group; however, there were no significant differences among the groups that received antioxidants. CONCLUSIONS: Melatonin and NAC are important antioxidants that can be used alone or in combination to increase flap viability and prevent distal necrosis in rats.

OBJECTIF: Déterminer les effets de la N-acétylcystéine (NAC) et de la mélatonine, seules ou ensemble, sur la viabilité d'un lambeau de type McFarlane dans un modèle de rat. MÉTHODOLOGIE: Les chercheurs ont réparti 40 rats Wistar en quatre groupes à qui ils ont administré des injections intrapéritonéales quotidiennes pendant une semaine avant l'opération: sujets témoins (n=10), mélatonine (n=10), NAC (n=10) et NAC+mélatonine (n=10). Une semaine après l'opération, ils ont mis fin à l'expérience et pris des photos en vue d'études topographiques. Ils ont réalisé une étude de transillumination pour observer la vascularisation des lambeaux et effectué des biopsies pour mener des études histologiques. RÉSULTATS: La viabilité des lambeaux était beaucoup plus importante dans les groupes traités aux antioxydants (NAC et mélatonine) que dans le groupe témoin. Cependant, les différences n'étaient pas significatives entre les divers groupes qui avaient reçu des antioxydants. CONCLUSIONS: La mélatonine et la NAC sont d'importants antioxydants qu'on peut utiliser seuls ou ensemble pour accroître la viabilité des lambeaux et prévenir la nécrose distale chez les rats.

Laparoscopic cholecystectomy in patients aged 80 years and older: an analysis of 111 patients.

INTRODUCTION: The incidence of cholelithiasis increases with age. More octogenarian (≥80 y) patients are undergoing laparoscopic cholecystectomy (LC) operation throughout the world. PATIENTS AND METHODS: A retrospective study was conducted on patients older than 80 years (group 1: 111 patients) and those in the 18 to 79 years age group (group 2: 185 patients), who underwent LC between July 2005 and October 2009. The variables analyzed were the presentation, demographics, comorbid illnesses, American Society of Anaesthesiology (ASA) scores, history of previous abdominal surgery, the operative time, postoperative morbidity and mortality, and the length of hospital stay. A comparison was made between the two groups. Data was evaluated by using the χ and the Fisher exact test. P<0.005 was considered significant. RESULTS: The difference in both groups in the mean age and ASA scores were significant. The indication for LC was gallstone disease in 87 (78.4%) patients, acute cholecystitis in 16 (14.4%), and gallstone pancreatitis in 8 (7.2%) of group 1 patients. The conversion rate was not statistically significant. The mean operative time was 77 minutes in group 1 patients, and this was significantly longer than that of group 2 patients. The postoperative oral intake within 24 hours of surgery was significantly earlier in group 2 patients. Other parameters were not significantly different between the 2 groups. CONCLUSIONS: LC in octogenarians is a relatively safe procedure that can be performed with low morbidity and mortality rates. The comorbidities and higher ASA scale are major risk factors for postoperative complications in this age group of patients.

Investigation of the direct hepatic effects of intramuscular interleukin-8 injection in an experimental rabbit model.

BACKGROUND: The aim of this study was to investigate the effects of intramuscular IL-8 injection on hepatic tissues using an in vivo histopathological animal model. MATERIAL AND METHODS: Twelve New Zealand white rabbits were used for this randomized, controlled, single-blinded interventional study. For 6 days, 1 gluteus maximus muscle was injected daily with 1 mcg/kg of IL-8 in 6 rabbits (Group A). The remaining 6 rabbits (to determine to normal porto-hepatic morphology of the rabbit genus) were in the sham group (Group B). At the end of the 7th day, all rabbits were killed and livers were meticulously harvested. Microscopically, regional tissues were scored according to portal inflammation, focal necrosis, piecemeal necrosis, and total impact. RESULTS: Total impact score, portal inflammation, focal necrosis, and piecemeal necrosis were the histopathologic changes present in a higher incidence in the IL-8 group compared with the control group. The differences were significant when the groups were compared according to total impact score, portal inflammation, focal necrosis, and piecemeal necrosis according to Pearson's correlation (p<0.05). The most significant differences were detected at the total impact scores (p=0.002) and the portal inflammation scores (p=0.008). CONCLUSIONS: Our results showed that IL-8 may damage hepatocytes. This can be the determined target for new therapeutic strategies. Further trials should be designed to obtain definitive results.

Isolated lingual dystonia induced by speaking: a rare form of focal dystonia.

Focal lingual dystonia is a rare condition that can be misdiagnosed as a psychogenic problem because it may interfere with chewing, swallowing, and speaking. We present a patient with an uncommon type of dystonia (speech-induced primary lingual dystonia), that responded well to botulinum toxin injection.

Rupture of liver hydatid cysts into the peritoneal cavity. A challenge in endemic regions.

OBJECTIVE: To evaluate the clinical presentation and early and long-term outcomes of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. METHODS: The medical records of 21 patients with rupture of hydatid cysts were evaluated retrospectively between January 2000 and April 2009 at Izmir Ataturk Training and Research Hospital, Izmir, Turkey, as were the records of 368 patients with hydatid cysts. Age, gender, symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality, and recurrence were evaluated. RESULTS: Sixteen of these patients (76.2%) were women. The mean age was 43.8 years. Cysts were single in 16 cases (76.2%). In 14 cases (66.7%) cysts were localized only in the right lobe. There was also a cyst in the spleen in 4 patients (19%). Simple falls or direct abdominal minor trauma was responsible in 8 patients (38.1%), and pedestrian mishaps in 4 (19%). Nine (42.8%) patients experienced spontaneous rupture. External drainage was performed in 12 (57.1%) patients and omentoplasty in 9 patients (42.8%) to manage the cyst cavity. A total of 11 morbidities developed in 9 patients (42.8%). There was no postoperative mortality. The mean hospital stay was 11.37.4 days, and mean follow-up was 63.131.3 months. The recurrence rate was 23.8%. CONCLUSION: The morbidity and recurrence rates of surgical interventions for ruptured hydatid cysts are high. This pathology, although rare, should be included in the differential diagnosis of an acute abdomen in endemic areas.

Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery.

BACKGROUND: An occult cysto-biliary communication in liver hydatid disease is still a major problem in surgical practice. Radiologic and intraoperative findings may not be helpful to detect cysto-biliary communications in some asymptomatic patients with liver hydatid disease. Biliary leakage is a troubling complication that arises after conservative surgery in patients who have occult "insidious" cysto-biliary communications. We aimed to identify the factors which are associated with the risk of occult insidious cysto-biliary communications in patients preoperatively who developed biliary leakage after surgery. PATIENTS AND METHODS: We investigated the records of 183 asymptomatic patients treated for liver hydatid cyst and analyzed potential predictors of occult insidious cysto-biliary communication, retrospectively. RESULTS: There were 115 female and 68 male patients; the mean age was 42.3 years. Occult insidious cysto-biliary communications which presented as postoperative biliary leakage found in 24 (13.1%). Independent clinical predictors were alkaline phosphatase >133 U/L, total bilirubin levels >1.2 mg/dL, white blood cell count >10,000/mm(3) and cyst diameter >10 cm on multivariate analysis. Seventeen of 24 were low output biliary fistula which resolved spontaneously within 9.2 days. The remaining 7 were high output biliary fistula for which endoscopic sphincterotomy was performed in all patients, fistulas resolved within 22.6 days. Average interval between endoscopic sphincterotomy and fistula closure was 10.3 days. Mean hospital stay was longer in patients with biliary leakage than in those without (9.8 vs. 4.2 day p<0.001). There was no hospital mortality. CONCLUSION: The predictors demonstrated in this study should allow the likelihood of occult insidious cysto-biliary communication to be determined and, thus, indicate the need for additional procedures during operations to prevent the complications of biliary leakage.