Naked-eye detection of specific DNA sequences amplified by the polymerase chain reaction with nanocomposite beads.

We developed a novel nanocomposite bead system for detection by the naked eye of specific DNA sequences amplified by the polymerase chain reaction (PCR). The DNA probes, which were complementary to the target DNA, are conjugated with the nanocomposite beads. If the amplified products contained sequences complementary to the probes, the beads aggregated through sandwich hybridization. The aggregation was detectable as precipitation of the nanocomposite beads. The results were determined visually and did not require instrumental detection. The assay was sensitive enough to detect PCR products with a detection limit of 10 copies/tube for DNA templates. This technique is that all needed components are included within the initial cap, so that the risk of carryover contamination is very low. The nanocomposite bead system has broad application prospects for the detection of specific DNA sequences in biological and biomedical research.

Optimal Lymphadenectomy of the Mesopancreas Based on Fluorescence Imaging During Pancreaticoduodenectomy.

BACKGROUND: Excision of the mesopancreas with lymphadenectomy is an important component of pancreatoduodenectomy. However, the optimal extent of lymphadenectomy remains unclear. Furthermore, accurate description of the mesopancreatic lymphatic pathways is difficult, probably because of the complex anatomy. Intestinal derotation simplifies the anatomy and facilitates both examination of lymphatic flow and the surgical procedure. The aim of this study was to evaluate lymphatic flow in the mesopancreas using indocyanine green fluorescence imaging with an intestinal derotation technique, and to clarify the optimal extent of mesopancreas excision and lymphadenectomy in pancreatoduodenectomy. METHODS: Indocyanine green solution (2.5 × 10-3 mg) was injected into the pancreatic head parenchyma. After intestinal derotation, the spread of indocyanine green was observed using near-infrared imaging. RESULTS: Participants comprised 10 patients who underwent pancreatoduodenectomy for periampullary neoplasms. With indocyanine green fluorescence imaging, 9 of the 10 patients showed lymphatic flow from the pancreatic head to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery (but not via the second and more distant arteries), with eventual drainage into the paraaortic region. CONCLUSIONS: Lymphatic pathways from the pancreatic head were connected to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery. Excision of the mesopancreas with the inferior pancreaticoduodenal artery and first jejunal artery while preserving the second or more distant arteries appears optimal in pancreatoduodenectomy for periampullary malignancies.

Vascular Anatomy of Mesopancreas in Pancreatoduodenectomy Using an Intestinal Derotation Procedure.

BACKGROUND: Mesopancreas excision in pancreatoduodenectomy is technically complicated because of the anatomical complexity of the mesopancreas with the inferior peripancreatic blood vessels which is caused by intestinal rotation in fetal life. We have developed a novel artery-first approach (the intestinal derotation procedure) for facilitating mesopancreas excision. The aim of this study was to clarify the vascular anatomy of the mesopancreas after derotation. METHODS: The right-sided colon and small intestine are mobilized from the retroperitoneum, and the intestinal loop is then derotated. In 136 cases of pancreatoduodenectomy employing the derotation procedure, we analyzed the vascular anatomy of the mesopancreas. RESULTS: After derotation, the anatomy was simplified. The mesopancreas extended from the right aspect of the superior mesenteric artery (SMA), forming a horizontal plane. The first jejunal trunk (FJT) was situated in parallel with the second jejunal artery and was anterior (91%) or posterior (9%) to the SMA. The inferior pancreaticoduodenal vein (IPDV) entered the right side of the FJT (83%) or the superior mesenteric vein (17%). Besides the IPDV, 1-4 tributaries entered the right wall of the FJT, in 89% of cases. The inferior pancreaticoduodenal artery was observed to originate from the right wall of the SMA, sharing a common stem with the first jejunal artery (70%) or branching directly from the SMA (29%). CONCLUSIONS: Intestinal derotation simplifies the mesopancreas anatomy and reveals the anatomical details of the inferior peripancreatic blood vessels in pancreatoduodenectomy.

MicroRNA biomarkers for chemical hazard screening identified by RNA deep sequencing analysis in mouse embryonic stem cells.

We investigated the responses of microRNAs (miRNAs) using mouse embryonic stem cells (mESCs) exposed to nine chemicals (bis(2-ethylhexyl)phthalate, p-cresol, p-dichlorobenzene, phenol, pyrocatecol, chloroform, tri-n-butyl phosphate, trichloroethylene, and benzene), which are listed as "Class I Designated Chemical Substances" from the Japan Pollutant Release and Transfer Register. Using deep sequencing analysis (RNA-seq), several miRNAs were identified that show a substantial response to general chemical toxicity (i.e., to these nine chemicals considered as a group) and several miRNA biomarkers that show a substantial and specific response to benzene. The functions of the identified miRNAs were investigated in accordance with Gene Ontology terms of their predicted target genes, indicating regulation of cellular processes. We compared the results with those for the long non-coding RNAs (ncRNAs) and mRNAs reported in our previous studies in addition to previously identified miRNAs that are either up- or down-regulated in response to the benzene as stimuli. We also observed that the changes in expression of miRNAs were smaller than those for long ncRNAs and mRNAs. Taken together the current and previous results revealed that toxic chemical stimuli regulate the expression of miRNAs. We believe that the use of miRNAs, including the thus identified miRNAs, as biomarkers contribute to predicting the potential toxicity of particular chemicals or identifying human individuals that have been exposed to chemical hazards.

Restrictive ventilatory impairment and thrombosis due to a giant liver cyst.

Most patients with liver cysts are asymptomatic and require no treatment. In this patient with symptoms and restrictive ventilatory impairment, percutaneous needle aspiration with injection of minocycline hydrochloride was effective.

Improving attainment of the critical view of safety during laparoscopic cholecystectomy.

INTRODUCTION: We hypothesized that practicing surgeons would successfully achieve a better and more frequent Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) after participation in a structured Safe CVS Curriculum. METHODS: All surgeons performing LC at a regional health system had four LC cases recorded: twice before and twice after a curriculum focused on the CVS, which was led by a member of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Safe LC Task Force. Videos were then de-identified and randomly ordered for grading on a 6-point CVS assessment tool by two expert surgeons, who were blinded to the operator and whether the surgeries were performed before or after the curriculum. Confidence surveys and performance on a CVS identification video quiz were also compared pre- and post-curriculum. RESULTS: Twelve surgeons (five general, four acute care, and three minimally invasive) with an average experience of 17.9 ± 6.3 years participated in the study. After the curriculum, surgeons achieved all three CVS criteria in more cases (1/24 (4%) versus 10/24 (42%), p < 0.004). There was also significant improvement in correctly identifying whether the CVS was achieved in 10 video clips from the Internet (7.9 ± 1.5 vs. 9.3 ± 0.8, p = 0.006) and increased confidence on a 5-point Likert scale in accurately identifying the CVS (4.5 ± 0.5 vs. 4.9 ± 0.3, p = 0.017). CONCLUSION: A structured curriculum on achieving a quality CVS for practicing, experienced surgeons improved their confidence and frequency of obtaining the Critical View of Safety during LC. We recommend that the Safe CVS Curriculum be considered for widespread use in order to increase the quality and frequency of attaining the Critical View of Safety.

A 1-day simulation-based boot camp for incoming general surgery residents improves confidence and technical skills.

BACKGROUND: For surgery residents, opportunities to systematically learn about surgical equipment are limited. Our facility holds a simulation-based boot camp for incoming, first-year general surgery residents. The aim of this study was to assess the effectiveness of this boot camp at increasing resident confidence and improving technical skills. METHODS: Boot camp for incoming surgery residents is held annually and provides hands-on simulation relating to endoscopy, laparoscopy, bronchoscopy, and abdominal access. Before the boot camp, participants completed a pretest, which includes self-confidence, experience, and a skills-assessment. Identical assessments of self-confidence and skills were completed after the boot camp as a posttest. Data was accrued from 2016 to 2018. RESULTS: A total of 26, first-year, general surgery residents participated in the boot camp. Most participants had never used an endoscopic simulator (61.5%), handled a colonoscope (57.7%), a gastroscope (80.8%), or gained operative access to the abdomen (76.9%). The assessments of self-confidence and skills demonstrated a mean increase in all 4 topics. All differentials demonstrated statistical significance (P <. 001). CONCLUSION: A 1-day, simulation-based boot camp for incoming surgery residents with a focus on endoscopy, laparoscopy, and abdominal access increases resident confidence as well as several basic aspects of technical skill.

384-Channel electrochemical sensor array chips based on hybridization-triggered switching for simultaneous oligonucleotide detection.

We investigated the feasibility of simultaneous detection of multiple environmentally- and biomedically-relevant RNA biomarker target sequences on a single newly fabricated 384-ch sensor array chip aiming at practical application. The individual sensor is composed of a photolithographically-fabricated Au/Cr-based electrode modified with peptide nucleic acid (PNA) probes. The sensor array chips showed sequence-specific responses upon hybridization of the probes with target sequences complementary to the probes in contrast to mismatch versions. The target oligonucleotides have 15-22 mer sequences from messenger RNAs for estrogen-responsive genes and microRNAs for lung cancer biomarkers. The dependence on target concentrations of sensor responses was observed by using a single chip on which experiments for detection of several target concentrations proceeded simultaneously, with the detection limit of 7.33 × 10-8 M. As more realistic samples, oligonucleotide samples amplified by PCR from a synthesized template sequence were applied to the chip. They showed sequence-specific responses, revealing the potential for fabricated sensor array chips to be utilized to analyze PCR samples. Unlike complicated and expensive chips that require nanofabrication, our sensor array chips based on glass coated with gold thin films are simple and can be fabricated from inexpensive and readily available materials.

Impact of metabolic surgery on health-related quality of life and quality of alimentation.

BACKGROUND: Bariatric surgery for morbidly obese patients has been shown to ameliorate their quality of life (QOL). Little data are available in mildly obese patients undergoing metabolic surgery. OBJECTIVES: To investigate the impact of metabolic surgery for diabetic patients with body mass index <35 kg/m2 on health-related QOL (HR-QOL), food tolerance, and food satisfaction in a single institution. SETTING: Private practice, Japan. METHODS: Fifty-one consecutive mildly obese, diabetic patients underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass were initially enrolled. Only 46 returned for follow-up and were eventually included in the final population. Preoperatively, the mean weight and body mass index were 89.1 ± 11.9 kg and 31.7 ± 2.2 kg/m2, respectively. The mean fasting plasma glucose and glycated hemoglobin were 196 ± 69 mg/dL and 9.0 ± 1.5%, respectively. The mean duration of diabetes was 9.0 ± 6.1 years. Before surgery, 40 patients (78.4%) were treated with oral hypoglycemic agents and 28 patients (54.9%) were treated with subcutaneous insulin. The 36-item Short Form Survey was used to gauge HR-QOL at the preoperative phase and at 1 year after surgery. Questionnaires regarding food tolerance, food satisfaction, and dietary intake were also distributed to the enrolled patients. RESULTS: The follow-up rate at 1 year was 90.2%. At this point, there was a decrease in mean weight and body mass index were 67.5 ± 11.6 kg and 23.9 ± 2.8 kg/m2, respectively (P < .001). This accounted for the mean percent total weight loss of 24.4 ± 8.3%. The mean fasting plasma glucose and glycated hemoglobin were 114 ± 35 mg/dL and 6.5 ± 1.1%, respectively (P < .001). Remission of diabetes was seen in 52.2% of the patients. With regard to the HR-QOL, significant improvements were observed in the aspects of physical functioning, bodily pain, general health, vitality, and mental health. Dietary intake significantly decreased from 2679 ± 952 kcal/d at baseline to 1346 ± 483 kcal/d at 1 year (P < .001). Food tolerance score significantly decreased from 21.6 ± .6 to 18.7 ± 3.9 (P < .001). By contrast, food satisfaction score significantly increased from 3.0 ± 1.1 to 3.5 ± 1.1 (P = .015). CONCLUSIONS: In mildly obese patients associated with severe diabetes who underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass, marked amelioration in glycemic control was observed and, although the amount of food intake and food tolerance were affected, the overall HR-QOL as well as food satisfaction improved significantly.

Identification of RNA biomarkers for chemical safety screening in neural cells derived from mouse embryonic stem cells using RNA deep sequencing analysis.

Chemical safety screening requires the development of more efficient assays that do not involve testing in animals. In vitro cell-based assays are among the most appropriate alternatives to animal testing for screening of chemical toxicity. Most studies performed to date made use of mRNAs as biomarkers. Recent studies have however indicated the presence of many unannotated non-coding RNAs (ncRNAs) in the transcriptome that do appear to encode proteins. In the present study, we performed whole-transcriptome sequencing analysis (RNA-Seq) to identify novel RNA biomarkers, including ncRNAs, which showed marked responses to the toxicity of nine chemicals. Chemical safety screening was performed in cell-based assays using mouse embryonic stem cell (mESC)-derived neural cells. Marked responses in the expression of some ncRNAs to the chemical compounds were observed. The results of the present study suggested that ncRNAs may be useful in chemical safety screening as novel RNA biomarkers.

Short-lived long noncoding RNAs as surrogate indicators for chemical stress in HepG2 cells and their degradation by nuclear RNases.

Long noncoding RNAs (lncRNAs) are non-protein-coding transcripts >200 nucleotides in length that have been shown to play important roles in various biological processes. The mechanisms underlying the induction of lncRNA expression by chemical exposure remain to be determined. We identified a novel class of short-lived lncRNAs with half-lives (t1/2) ≤4 hours in human HeLa Tet-off cells, which have been suggested to express many lncRNAs with regulatory functions. As they may affect various human biological processes, short-lived lncRNAs may be useful indicators of the degree of stress on chemical exposure. In the present study, we identified four short-lived lncRNAs, designated as OIP5-AS1, FLJ46906, LINC01137, and GABPB1-AS1, which showed significantly upregulated expression following exposure to hydrogen peroxide (oxidative stress), mercury II chloride (heavy metal stress), and etoposide (DNA damage stress) in human HepG2 cells. These lncRNAs may be useful indicators of chemical stress responses. The levels of these lncRNAs in the cells were increased because of chemical stress-induced prolongation of their decay. These lncRNAs were degraded by nuclear RNases, which are components of the exosome and XRN2, and chemical exposure inhibited the RNase activities within the cells.

A Robust Method for the Determination of Cr(VI) and Cr(III) in Industrial Wastewaters by Liquid Chromatography-Inductively Coupled Plasma Mass Spectrometry Combined with a Chelating Pretreatment with 2,6-Pyridinedicarboxylic Acid.

We have developed a method for the determination of Cr(VI) and Cr(III) in industrial wastewater by liquid chromatography-inductively coupled plasma mass spectrometry (LC-ICP-MS) combined with a chelating pretreatment with 2,6-pyridinedicarboxylic acid (PDCA). The PDCA unified the chemical forms of the Cr(III) species in water samples by the formation of a stable Cr(III)-PDCA complex, which was then separated by a LC column. The chromatographic mobile phase at neutral pH and the column of a mixed-bed of anion and cation exchangers successfully separated not only the chromium species without any redox conversion, but also chloride, which interfered with ICP-MS detection. The method detection limits measured at m/z 53 were 0.66 µg of Cr L-1 for Cr(III) and 0.74 µg L-1 for Cr(VI) with a sample injection volume of 20 µL under a no gas mode. The recoveries of spiked Cr(VI) at 50 and 500 g L-1 into the fifteen kinds of industrial wastewater samples were satisfactory (>90%). The proposed method for the determination of Cr(VI) was also validated by comparing with a colorimetric method using 1,5-diphenylcarbazide prescribed by the ISO 11083 and the JIS K0102.

Effect of Reprimo Down-regulation on Malignant Transformation of Intraductal Papillary Mucinous Neoplasm.

OBJECTIVES: Reprimo gene is a cytoplasmic protein belonging to a family of molecules controlled by p53 that inhibits cell cycle progression. Ectopic expression of Reprimo results in cell cycle arrest at the G2 phase. The aim of this study was to investigate the impact of Reprimo expression on tumorigenesis of intraductal papillary mucinous neoplasm (IPMN). METHODS: Thirty-seven surgical cases of IPMN were collected retrospectively. Twenty-eight patients had benign IPMNs (low-grade dysplasia, n = 18; intermediate-grade dysplasia, n = 10), and the remaining 9 had malignant IPMNs (high-grade dysplasia, n = 4; invasive carcinoma, n = 5). DNA from tumor samples was extracted. DNA methylation patterns of Reprimo were determined by the methods of methylation-specific polymerase chain reaction and immunohistochemistry. The methylation status of Reprimo was compared between benign IPMNs and malignant IPMNs. RESULTS: The incidence of aberrant DNA methylation of Reprimo was significantly higher in malignant IPMNs than in benign IPMNs (78% vs 32%, P = 0.016). Furthermore, the incidence of immunohistochemical Reprimo expression was significantly lower in malignant IPMNs than in benign IPMNs (22% vs 82%, P = 0.002). CONCLUSIONS: Reprimo methylation was found more frequently in malignant IPMNs. Reprimo methylation is involved in malignant transformation of IPMNs.

A Simple and Robust Method for Determination of Alkylmercury in Seawater and Industrial Wastewater by Phenylation Pretreatment Combined with GC-MS.

For determination of methylmercury (MeHg) and ethylmercury (EtHg) in seawater and industrial wastewater, a simple and robust analytical method was developed based on phenylation and solvent extraction followed by GC-MS measurement. Alkylmercury compounds were directly phenylated with sodium tetraphenylborate in water and extracted into toluene. The method detection limits obtained for MeHg and EtHg in pure water were 53.3 and 33.5 ng Hg L-1, respectively, which are almost 10 times lower than the environmental quality standards for water pollution in Japan (EQSJ): 0.5 µg Hg L-1. The recoveries of alkylmercury compounds from seawater and four kinds of industrial wastewater except for EtHg from treated wastewater of an optic lens factory were satisfactory (>90%) at 1- or 4-fold concentrations of the EQSJ. Contrarily, the low recovery of EtHg from the treated wastewater (75.4 ± 4.7%) was found to be caused by the rapid decomposition of EtHg into inorganic mercury.

Relation of dietary inorganic arsenic exposure and urinary inorganic arsenic metabolites excretion in Japanese subjects.

Inorganic arsenic (InAs) is a ubiquitous metalloid that has been shown to exert multiple adverse health outcomes. Urinary InAs and its metabolite concentration has been used as a biomarker of arsenic (As) exposure in some epidemiological studies, however, quantitative relationship between daily InAs exposure and urinary InAs metabolites concentration has not been well characterized. We collected a set of 24-h duplicated diet and spot urine sample of the next morning of diet sampling from 20 male and 19 female subjects in Japan from August 2011 to October 2012. Concentrations of As species in duplicated diet and urine samples were determined by using liquid chromatography-ICP mass spectrometry with a hydride generation system. Sum of the concentrations of urinary InAs and methylarsonic acid (MMA) was used as a measure of InAs exposure. Daily dietary InAs exposure was estimated to be 0.087 µg kg-1 day-1 (Geometric mean, GM), and GM of urinary InAs+MMA concentrations was 3.5 ng mL-1. Analysis of covariance did not find gender-difference in regression coefficients as significant (P > 0.05). Regression equation Log 10 [urinary InAs+MMA concentration] = 0.570× Log 10 [dietary InAs exposure level per body weight] + 1.15 was obtained for whole data set. This equation would be valuable in converting urinary InAs concentration to daily InAs exposure, which will be important information in risk assessment.

Pancreatic Duct Holder and Mucosa Squeeze-out Technique for Duct-to-Mucosa Pancreatojejunostomy After Pancreatoduodenectomy: Propensity Score Matching Analysis.

BACKGROUND: Duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy can be technically difficult, particularly in cases with a non-dilated pancreatic duct. We devised a novel procedure employing a pancreatic duct holder and mucosa squeeze-out technique facilitating duct-to-mucosa anastomosis. We compared the perioperative outcomes of pancreatoduodenectomy with duct-to-mucosa pancreatojejunostomy between the novel and conventional procedures. METHODS: Our pancreatic holder has a cone-shaped tip with a slit. The holder can expand the pancreatic duct and provides a good surgical field for anastomosis. A small incision for anastomosis is made on the jejunum, while the jejunum is grasped around the incision. Then, the jejunal mucosa becomes squeezed-out and everted. This mucosa squeeze-out technique facilitates suturing the full thickness of the jejunum. Propensity score matching yielded 113 cases each undergoing the novel and the conventional procedure, among 308 cases receiving pancreatoduodenectomy with duct-to-mucosa pancreatojejunostomy. RESULTS: The overall morbidity rate was significantly lower in the novel procedure group. The pancreatic fistula (ISGPF grade B/C) rate was significantly lower in the novel (5 %) than in the conventional (13 %) procedure group. For cases with a non-dilated pancreatic duct (≤3 mm), the rate was significantly lower in the novel (10 %) than in the conventional procedure group (24 %). Multivariate analysis identified a non-dilated pancreatic duct, soft pancreas, and the conventional procedure as factors independently predicting the complication of pancreatic fistula formation. CONCLUSIONS: Our novel procedure facilitates duct-to-mucosa pancreatojejunostomy and decreases the pancreatic fistula rate. This procedure is simple, rational, and useful for achieving anastomosis, particularly in cases with a non-dilated pancreatic duct.

Development and Potential Utility of a New Scoring Formula for Prediction of Malignant Intraductal Papillary Mucinous Neoplasm of the Pancreas.

OBJECTIVE: A simple system is needed to determine whether surgery is indicated in cases of intraductal papillary mucinous neoplasm (IPMN). METHODS: We conducted a retrospective study to identify factors predictive of malignant IPMN and thus simplify the treatment decision-making process. Ninety-six consecutive patients treated surgically for IPMN at Kyorin University Hospital (Tokyo, Japan) between 1994 and 2014 were included. Univariate and multivariate analyses were used to identify preoperative factors predictive of malignancy. A simple scoring formula was derived from the regression equation. RESULTS: Twenty-two (23%) of the IPMNs were malignant, and 74 (77%) were benign. Pancreatic head tumor, cyst diameter of 47 mm or greater, and mural nodule diameter of 9 mm or greater were identified as significant predictors of malignant IPMN. The following scoring formula was developed: 4 × tumor location (pancreatic head, 1; pancreatic body or tail, 0) + 3 × cyst diameter (≥47 mm, 1; <47 mm, 0) + 6 × mural nodule diameter (≥9 mm, 1; <9 mm, 0); the area under the receiver operating characteristic curve was 0.970. At a cutoff of 8 points, the diagnostic accuracy was excellent (sensitivity, 90.9%; specificity, 95.9%; accuracy, 94.8%). CONCLUSIONS: Our scoring system has potential as a simple screening tool for the identification of malignant IPMN.

Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome.

OBJECTIVE: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS. METHODS: (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-ß4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features. RESULTS: (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRß4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-ß4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates. CONCLUSION: The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.

Intestinal derotation procedure for facilitating pancreatoduodenectomy.

BACKGROUND: In pancreatoduodenectomy (PD), mesopancreas excision with division of the inferior pancreatoduodenal artery (IPDA) is technically difficult because of the complex anatomy resulting from intestinal rotation occurring during embryological development. We have developed an intestinal derotation procedure for facilitating mesopancreas excision. The perioperative factors of PD were retrospectively compared between our derotation and the conventional procedure. METHODS: The entire small intestine and right colon are mobilized from the retroperitoneum, and intestinal rotation is reduced. This procedure simplifies the anatomic situation, in which (1) the mesopancreas stretches from the right side of the superior mesenteric artery (SMA) in a horizontal plane, (2) the IPDA arises from the right wall of the SMA, and (3) the SMA is situated at the right-posterior side of the superior mesenteric vein. In 232 cases undergoing PD, perioperative factors were compared retrospectively between the derotation (n = 117) and conventional (n = 115) procedure groups. RESULTS: The derotation procedure significantly decreased operative time (434 vs 516 minutes) and blood loss (521 vs 908 mL), and tended to increase the rate of R0 resection (90% vs 78%), compared with the conventional procedure. The derotation group had a significantly higher incidence of early, that is, before division of the drainage vein, IPDA division. Postoperative complication rates did not differ, between the 2 groups. CONCLUSION: The derotation procedure is a simple but useful technique that facilitates mesopancreas excision and early IPDA division during PD.