Investigating the Pharmacological Mechanisms of Total Flavonoids from Eucommia ulmoides Oliver Leaves for Ischemic Stroke Protection.

The aim of this study was to explore how the total flavonoids from Eucommia ulmoides leaves (EULs) regulate ischemia-induced nerve damage, as well as the protective effects mediated by oxidative stress. The cell survival rate was significantly improved compared to the ischemic group (p < 0.05) after treatment with the total flavonoids of EULs. The levels of reactive oxygen species (ROS), lactate dehydrogenase (LDH), and malondialdehyde (MDA) decreased, while catalase (CAT) and glutathione (GSH) increased, indicating that the total flavonoids of EULs can significantly alleviate neurological damage caused by ischemic stroke by inhibiting oxidative stress (p < 0.01). The mRNA expression level of VEGF increased (p < 0.01), which was consistent with the protein expression results. Meanwhile, the protein expression of ERK and CCND1 increased (p < 0.01), suggesting that the total flavonoids of EULs could protect PC12 cells from ischemic injury via VEGF-related pathways. MCAO rat models indicated that the total flavonoids of EULs could reduce brain ischemia-reperfusion injury. In conclusion, this study demonstrates the potential mechanisms of the total flavonoids of EULs in treating ischemic stroke and their potential therapeutic effects in reducing ischemic injury, which provides useful information for ischemic stroke drug discovery.

A facile and efficient synthesis approach of salidroside esters by whole-cell biocatalysts in organic solvents.

Salidroside, the main bioactive compound isolated from the plant source of Rhodiola rosea L, possesses broad-spectrum pharmacological activities, but suffers from the low cell membranes permeability and alimentary absorption due to its high polarity. Therefore, a whole-cell catalytic strategy for the synthesis of salidroside esters was explored to improve its lipophilicity. The results showed that Aspergillus oryzae demonstrated the highest biocatalytic activity among the microbial strains tested. For the synthesis of salidroside caprylate, the optimum conditions of reaction medium, Aspergillus oryzae amount, molar ratio of vinyl caprylate to salidroside and reaction temperature were acetone, 30 mg/ml, 10°C and 40°C, respectively. Under these conditions, the initial reaction rate was 15.36 mM/h, and substrate conversion and regioselectivity all reached 99%. Moreover, the results indicated that although various 6'-monoesters derivatives of salidroside were exclusively obtained with excellent conversions (96%-99%), the reaction rate varied greatly with different chain-length acyl donors. This study details an efficient and cost-effective biocatalytic approach for the synthesis of salidroside esters by using Aspergillus oryzae as a catalyst for the first time. Considering the whole cell catalytic efficiency and operational stability, this strategy may provide a new opportunity to develop green industrial processes production for ester derivatives of salidroside and its analogues.

Identification of Key Biological Processes, Pathways, Networks, and Genes with Potential Prognostic Values in Hepatocellular Carcinoma Using a Bioinformatics Approach.

Aim: Hepatocellular carcinoma (HCC), as one primary liver cancer type, accounts for 75%-85% of liver cancer cases. HCC is the second leading cause of cancer death in East Asia and sub-Saharan Africa and the sixth most common in Western countries. Identification of key genes would facilitate the development of therapies and improve the prognosis outcomes of HCC patients. This study was to identify the key biological processes, pathways, and key genes in HCC. Methods: Data were downloaded from Broad GDAC. Differentially expressed genes (DEGs) and weighted gene coexpression network (WGCNA) were analyzed by DESeq2 and WGCNA, respectively. Gene ontology (GO) and KEGG enrichment analyses were performed on all DEGs and the coexpressed genes in two significant modules. Kaplan-Meier plotter online database was used to identify the potential prognostic genes in HCC. Finally, GEO database was used to validate the analysis of gene expression of Broad GDAC data. Results: The authors identified the dark gray and red modules as the significant modules in HCC based on WGCNA. GO and KEGG enrichment of the two significant modules identified the mitochondrion-mediated metabolic processes and pathways, and the cell cycle as the key biological processes and pathways in HCC. Subsequently, 28 hub genes were screened out by constructing protein-protein interaction network using Metascape. Finally, three genes (NDUFAF6, CKAP5, and DSN1 genes) were identified to be potential prognostic and key genes in HCC based on Kaplan-Meier survival analysis, GEO dataset validation, and literature review. Conclusions: The authors found that mitochondrion-mediated metabolic processes and the cell cycle were the key biological processes and pathways in HCC. NDUFAF6, CKAP5, and DSN1 genes were valuable genes with the potential to be prognosis biomarkers and targeted therapies in HCC.

Remediation of PBDEs-metal co-contaminated soil by the combination of metal stabilization, persulfate oxidation and bioremediation.

Laboratory experiments were performed to investigate the efficiency of a simultaneous metal stabilization, persulfate oxidation and bioremediation for decontaminating polybrominated diphenyl ethers (PBDEs) and toxic metals from an actual soil polluted by the recycling activity of electronic waste. Biochar and bentonite were applied to the soil for immobilizing heavy metals (Cu, Pb, Zn and Ni). It was found that the toxicity level declined most significantly in the case of 20 g/kg biochar +20 g/kg bentonite. A low dose of persulfate (20 mmol/kg soil) was found to be suitable for oxidizing soil PBDEs and enhancing the bioavailability of PBDEs residue. Persulfate oxidation reduced the soil organic matter content, and caused dramatic decrease of bacterial density. Nevertheless, microbial activity and number recovered on the whole during 90 days of bioremediation. Finally, a degradation efficiency of 94.6% and a mineralization efficiency of 60.3% were obtained by the hybrid treatment scheme. The pyrosequencing analysis indicates that soil bacterial community changed obviously during the treatments, and there was an enrichment of PBDE-degrading populations during bioremediation relative to that of oxidized soil.

Remediation of resins-contaminated soil by the combination of electrokinetic and bioremediation processes.

In this work, soil contaminated by petroleum resins was remediated by electrokinetic-bioremediation (EK-BIO) technology for 60 days. A microbial consortium, comprising Rhizobium sp., Arthrobacter globiformis, Clavibacter xyli, Curtobacterium flaccumfaciens, Bacillus subtilis, Pseudomonas aeruginosa and Bacillus sp., was used to enhance the treatment performance. The results indicate that resin removal and phytotoxicity reduction were highest in the inoculated EK process, wherein 23.6% resins was removed from the soil and wheat seed germination ratio was increased from 47% to around 90% after treatment. The microbial counts, soil basal respiration and dehydrogenase activity were positively related to resins degradation, and they could be enhanced by direct current electric field. After remediation, the C/H ratio of resins decreased from 8.03 to 6.47. Furthermore, the structure of resins was analyzed by Fourier-transform infrared spectroscopy, elemental analysis, and 1H nuclear magnetic resonance (1H NMR) before and after treatment. It was found that the changes of the structure of resins took place during EK-BIO treatment and finally led to the reduction of aromaticity, aromaticity condensation and phytotoxicity.

How Abusive Supervision Affects Employees' Unethical Behaviors: A Moderated Mediation Examination of Turnover Intentions and Caring Climate.

Drawing on psychological contract theory, this research contributes to the unethical behavior literature by exploring employees' turnover intentions as a mediator of the relationship between abusive supervision and employees' unethical behavior and the moderating role of the caring climate in the relationship between turnover intentions and unethical behavior. The results from a sample of 679 reveal that turnover intentions mediate relationship between abusive supervision and subordinates' unethical behavior, and caring climate moderates the positive relationship between turnover intentions and subordinates' unethical behavior. We also find that the indirect effect is moderated by the caring climate. The theoretical and practical implications are discussed.

Interactions between decabromodiphenyl ether and lead in soil-plant system.

Pot experiments were conducted under abiotic conditions to investigate the interactive influence of decabromodiphenyl ether (BDE-209) and lead (Pb) on the seed germination, germ length, root exudation and physiological characteristics of tall fescue (Festuca arundinaceae), and the uptake, accumulation of Pb and BDE-209 in the plant tissues. Results show that seed germination and germ length were impacted by Pb but less influenced by BDE-209. BDE-209 spiking (10 and 50 mg/L) could alleviate the toxicity of high Pb concentration on seed germination and growth. The chlorophyll content was significantly increased at 500 mg/kg Pb but declined at 2000 mg/kg Pb. Low-level Pb contamination (500 mg/kg) activated antioxidase activity; however, 2000 mg/kg Pb significantly reduced the antioxidase activity. Plant biomass slightly decreased at 500 mg/kg Pb but significantly declined at 2000 mg/kg Pb. The addition of a moderate dosage of BDE-209 (10-50 mg/kg) lessened Pb phytotoxicity, leading to improved plant growth relative to the case of Pb spiking alone. The exudate secretion was significantly enhanced by Pb addition, but BDE-209 spiking only caused slightly increased secretion. Pb could interfere with BDE-209 adsorption and translocation of tall fescue by affecting physiological behavior of the plant, but BDE-209 exhibited little influence on the Pb fate in the plant. Overall, BDE-209 had slight interference on the impact of Pb towards tall fescue. The results demonstrate the complex interactive effects of organic pollutants and heavy metals in the soil-plant system.

Treatment of chlorpyrifos manufacturing wastewater by peroxide promoted-catalytic wet air oxidation, struvite precipitation, and biological aerated biofilter.

Chlorpyrifos manufacturing wastewater (CMW) is characterized by complex composition, high chemical oxygen demand (COD) concentration, and toxicity. An integrated process comprising of peroxide (H2O2) promoted-catalytic wet air oxidation (PP-CWAO), struvite precipitation, and biological aerated filters (BAF) was constructed to treat CMW at a starting COD of 34000-35000 mg/L, total phosphorus (TP) of 5550-5620 mg/L, and total organophosphorus (TOP) of 4700-4840 mg/L. Firstly, PP-CWAO was used to decompose high concentrations of organic components and convert concentrated and recalcitrant TOP to inorganic phosphate. Copper citrate and ferrous citrate were used as the catalysts of PP-CWAO. Under the optimized conditions, 100% TOP was converted to inorganic phosphate with 95.6% COD removal. Then, the PP-CWAO effluent was subjected to struvite precipitation process for recovering phosphorus. At a molar ratio of Mg2+:NH4+:PO43- = 1.1:1.0:1.0, phosphate removal and recovery reached 97.2%. The effluent of struvite precipitation was further treated by the BAF system. Total removals of 99.0%, 95.2%, 97.3%, 100%, and 98.3% were obtained for COD, total suspended solids, TP, TOP, and chroma, respectively. This hybrid process has proved to be an efficient approach for organophosphate pesticide wastewater treatment and phosphorus reclamation.

Bioremediation of petroleum-contaminated soil enhanced by aged refuse.

In this study, the effect of aged refuse on biodegradation of total petroleum hydrocarbons (TPH), microbial counts, soil ecotoxicity, dehydrogenase activity and microbial community compositions were investigated in solid phase reactors during a 30-week period. The results demonstrate that the removal efficiency of TPH was significantly higher in the soil supplemented with aged refuse than in the soil without aged refuse. After 30 weeks, the removal efficiencies of TPH in soils were 29.3%, 82.1%, 63.7% and 90.2% in the cases of natural attenuation, nutrient addition (with NH4NO3 and K2HPO4), supplement with 20% (w/w, dry weight basis) of aged refuse and the combination of nutrient and aged refuse. Nutrient plus aged refuse made the TPH concentration decrease to below the threshold level of commercial use required for Chinese soil quality for TPH (<3000 mg/kg) in 30 weeks. It was also found that dehydrogenase activity, bacterial counts and degrader abundance in the soil were remarkably enhanced by the addition of aged refuse (20%,w/w). Total organic carbon analysis demonstrates that large amounts of hydrocarbon intermediates occurred in the soil after bioremediation.

Acute Hypervolemic Infusion Can Improve Splanchnic Perfusion in Elderly Patients During Laparoscopic Colorectal Surgery.

BACKGROUND There is no adequate evidence on how the long duration of laparoscopic surgery affects splanchnic perfusion in elderly patients or the efficacy of acute hypervolemic fluid infusion (AHFI) during the induction of anesthesia. Our aim was to observe the effects of AHFI during the induction of general anesthesia on splanchnic perfusion. MATERIAL AND METHODS Seventy elderly patients receiving laparoscopic colorectal surgery were randomly divided into three groups: lactated Ringer's solution group (group R), succinylated gelatin group (group G), and hypertonic sodium chloride hydroxyethyl starch 40 injection group (group H). Thirty minutes after the induction of general anesthesia, patients received an infusion of target dose of these three solutions. Corresponding hemodynamic parameters, arterial blood gas analysis, and gastric mucosal carbon dioxide tension were monitored in sequences. RESULTS In all three groups, gastric-arterial partial CO2 pressure gaps (Pg-aCO2) were decreased at several beginning stages and then gradually increased, Pg-aCO2 also varied between groups due to certain time points. The pH values of gastric mucosa (pHi) decreased gradually after the induction of pneumoperitoneum in the three groups. CONCLUSIONS The AHFI of succinylated gelatin (12 ml/kg) during the induction of anesthesia can improve splanchnic perfusion in elderly patients undergoing laparoscopic surgery for colorectal cancer and maintain good splanchnic perfusion even after a long period of pneumoperitoneum (60 minutes). AHFI can improve splanchnic perfusion in elderly patients undergoing laparoscopic colorectal surgery.

Different doses of sevoflurane facilitate and impair learning and memory function through activation of the ERK pathway and synthesis of ARC protein in the rat hippocampus.

BACKGROUND: Sevoflurane has been shown to stimulate or depress memory in adult rats; however, the cellular mechanism of this bidirectional effect has not been fully investigated. METHODS: We used an intra-hippocampal microinfusion of U0126 to suppress ERK activation. Male SD rats were randomly assigned to four groups: Sham, 0.11%SEV, 0.3%SEV and 0.3%+U0126. They received bilateral injections of U0126 or saline. Rats were anesthetized, and Inhibitory Avoidance (IA) training was performed immediately after anesthesia. The memory retention latency was observed 24 h later. In another experiment, the hippocampus was removed 45 min after IA training to assess ARC expression, the synapsin 1 protein levels and the phosphorylation level of ERK. RESULTS: Treatment with 0.11%SEV led to rapid phosphorylation of ERK, while 0.3%SEV inhibited phosphorylation; the latter change was reversed by the microinfusion of U0126 in the hippocampus. The memory latency result had similar tendencies. The local infusion of U0126 abolished the 0.3%SEV-induced memory impairment and ERK inhibition. Selective upregulations of ARC and synapsin 1 proteins were observed in the 0.3%SEV group compared with the 0.11%SEV group. CONCLUSIONS: The results indicate that different doses of sevoflurane trigger synaptic plasticity-related cytoskeleton proteins through the ERK signaling pathway. This novel modulation by inhalational agents may help to reduce their side-effects on memory function.

Short-term effects of CO2 leakage on the soil bacterial community in a simulated gas leakage scenario.

The technology of carbon dioxide (CO2) capture and storage (CCS) has provided a new option for mitigating global anthropogenic emissions with unique advantages. However, the potential risk of gas leakage from CO2 sequestration and utilization processes has attracted considerable attention. Moreover, leakage might threaten soil ecosystems and thus cannot be ignored. In this study, a simulation experiment of leakage from CO2 geological storage was designed to investigate the short-term effects of different CO2 leakage concentration (from 400 g m-2 day-1 to 2,000 g m-2 day-1) on soil bacterial communities. A shunt device and adjustable flow meter were used to control the amount of CO2 injected into the soil. Comparisons were made between soil physicochemical properties, soil enzyme activities, and microbial community diversity before and after injecting different CO2 concentrations. Increasing CO2 concentration decreased the soil pH, and the largest variation ranged from 8.15 to 7.29 (p < 0.05). Nitrate nitrogen content varied from 1.01 to 4.03 mg/Kg, while Olsen-phosphorus and total phosphorus demonstrated less regular downtrends. The fluorescein diacetate (FDA) hydrolytic enzyme activity was inhibited by the increasing CO2 flux, with the average content varying from 22.69 to 11.25 mg/(Kg h) (p < 0.05). However, the increasing activity amplitude of the polyphenol oxidase enzyme approached 230%, while the urease activity presented a similar rising trend. Alpha diversity results showed that the Shannon index decreased from 7.66 ± 0.13 to 5.23 ± 0.35 as the soil CO2 concentration increased. The dominant phylum in the soil samples was Proteobacteria, whose proportion rose rapidly from 28.85% to 67.93%. In addition, the proportion of Acidobacteria decreased from 19.64% to 9.29% (p < 0.01). Moreover, the abundances of genera Methylophilus, Methylobacillus, and Methylovorus increased, while GP4, GP6 and GP7 decreased. Canonical correlation analysis results suggested that there was a correlation between the abundance variation of Proteobacteria, Acidobacteria, and the increasing nitrate nitrogen, urease and polyphenol oxidase enzyme activities, as well as the decreasing FDA hydrolytic enzyme activity, Olsen-phosphorus and total phosphorus contents. These results might be useful for evaluating the risk of potential CO2 leakages on soil ecosystems.

The effects of hypervolemic infusion on microcirculation perfusion of patients during laparoscopic colorectal surgery.

The aim of this study is to assess the effects of hypervolemic infusion with different solutions on microcirculation perfusion during laparoscopic colorectal surgery.Thirty-six patients were randomly divided into Ringer lactate solution [RL] group, succinylated gelatin injection [Gel] group, and hypertonic saline hydroxyethyl starch 40 injection [HS] group. Hypervolemic infusion was performed during the induction period of general anesthesia. Arterial blood-gas parameters, noninvasive hemodynamics, gastric tonometry values, and central venous pressure (CVP) were compared at baseline (T1); the end of hypervolemic infusion (T2); 5 min (T3), 15 min (T4), 30 min (T5), and 60 min (T6) during pneumoperitoneum; 5 min (T7), 15 min (T8), and 25 min (T9) after pneumoperitoneum. Patients were also grouped by age for further comparisons.The hematocrit levels of all groups after T2 decreased. The gastric mucosal-arterial carbon dioxide partial pressure (Pg-aCO2) started to decrease after T2 and rebounded after T5. There was no difference in the gastric mucosal perfusion when compared between 3 groups. The blood Na of HS group increased significantly after T2, then gradually restored and returned to baseline by T8. The plasma bicarbonate (HCO3) levels of RL and Gel groups elevated from T2 to T7, after which they started to decrease, but this phenomenon was not significant in HS group. In both RL and Gel groups, blood pressure has a significant fluctuation in elder patients.Hypervolemic infusion of these solutions during the induction of anesthesia can improve gastric mucosal perfusion. HS can maintain a more stable hemodynamic effect when used with caution in patients with preoperative hypernatremia.

Extra-cellular signal-regulated kinase (ERK) is inactivated associating hippocampal ARC protein up-regulation in sevoflurane induced bidirectional regulation of memory.

Low dose sevoflurane is demonstrated to have neuronal excitatory effects in the central nervous system. Activity-regulated cytoskeleton protein (Arc) can be rapidly expressed in the hippocampus for the modulation of synaptic plasticity. The extracellular signal-regulated kinase (ERK) pathway is also involved in learning and memory by mediating signals and modifications. This study aims at exploring the mechanism of sevoflurane on memory by connecting the ERK pathway, Arc and inhibitory avoidance (IA) behavioral training. SD rats were randomly assigned to three groups (sham, 0.11 and 0.3 % SEV). Anesthesia was given by target dose of sevoflurane for 45 min and IA (0.4 mA, 2 s) was conducted on every subject immediately after inhalation. The memory retention latency was observed 24 h after. Another serial of rats were sacrificed for Western-blot and polymerase chain reaction (PCR) examination of hippocampal tissue after first IA. 24 h IA performance was compared among groups. The 0.11 % SEV group displayed an elevation of memory retention, while the 0.3 % SEV group had decreased memory retention, both showed statistical differences from the sham (air) group. PCR analysis of Arc mRNA levels showed that subanesthetic doses of sevoflurane did not change Arc transcription levels between groups. However, 0.11 % sevoflurane significantly increased Arc protein in the hippocampus, while 0.3 % sevoflurane reversed this (*P < 0.05, compared with the sham group). There was no difference in total ERK between groups. Expression of phosphorylated ERK was significantly increased upon exposure to sevoflurane in a does dependent manner. ERK was down-regulated with hippocampal ARC expression in sevoflurane induced bidirectional regulation of memory, potentially at a translational level of modification.

Polo-like kinase 1 is overexpressed in colorectal cancer and participates in the migration and invasion of colorectal cancer cells.

BACKGROUND: Polo-like kinase 1 (PLK1) is an important molecule in proliferation of many human cancers. The aim of study is to clarify the expression patterns and potential function of PLK1 in colorectal cancers. MATERIAL/METHODS: Fifty-six colorectal cancers samples were collected and arranged onto a tissue array and the expression of PLK1 were detected by immunohistochemistry and correlated with clinico-pathological characteristics and expression of PCNA. Expression of PLK1 in 9 colorectal cancer cells lines was investigated by RT-PCR and Western blot, then SW1116 cells lines were treated with PLK1 siRNA and the efficiency was examined by Western blot. Transwell test was applied to detect the migration and invasion capability of cancer cells by counting the number of cells passing through the membranes. Cell proliferation and apoptosis were examined by Cell Counting Kit-8 (CCK-8) and Annexin-V Kit. RESULTS: PLK1 was positively expressed in 73.2% (41/56) of colorectal cancers tissues, but in only 3.6% (2/56) of normal tissues, and was associated with Duke's stage (P<0.01), tumor size (P<0.01), invasion extent (P<0.05) and lymphatic metastasis (P<0.01). The expression of PLK1 was correlated with expression of PCNA (R=0.553, P<0.01). PLK1 was inhibited in SW1116 cells by treating with PLK1 siRNA oligos, which resulted in a decreased number of cells passing through the membrane as compared with control groups (P<0.01) at 24 hours after transfection. Cell proliferation was inhibited from 48 hours after transfection, while cells apoptosis was induced from 72 hours after transfection. CONCLUSIONS: PLK1 could be a progression marker for colorectal cancer patients and PLK1 depletion can inhibit migration and invasion capability of colorectal cancer cells SW1116, suggesting that PLK1 might be involved in metastasis and invasion of colorectal cancer. Therapeutic strategies targeting PLK1 may be a new approach to colorectal cancer.

Direct and indirect costs and long-term survival of laparoscopic anterior resection for rectal cancer.

BACKGROUND: Few studies evaluate the cost-effectiveness issues of laparoscopic anterior resection (LAR) for rectal cancer. This study evaluates direct and indirect costs of LAR and its long-term survival rate in rectal cancer patients. MATERIAL/METHODS: This prospective nonrandomized controlled trial included 2 endpoints (direct and indirect costs, and disease-free survival). From January 2003 to May 2005, rectal cancer patients admitted to our center were assigned to 2 groups: 87 patients underwent LAR (LAP), while 86 cases received open anterior resection (OPEN). The direct costs were prospectively evaluated. Main indirect cost is productivity loss. The data of direct costs, indirect costs, and the total costs were collected for the minimal cost analysis. RESULTS: Disease-free survival at 65 months in the LAP group and the OPEN group was 78.2% and 74.7%; there was no significant difference between the groups. Median direct costs were not significantly different between the LAP and the OPEN groups. Indirect costs of the LAP group were significantly lower than those of the OPEN group, while total costs were not significantly different. Cost percentage for operations, medications, and hospitalization were 75.90%, 11.28%, and 2.18% in the LAP group; while in the operation group, they were 54.50%, 29.09%, and 3.35%. CONCLUSIONS: Total economic budget for a patient receiving LAR was not significantly increased compared with the conservative method owing to its technical predominance, oncologic safety, as well as frequent bed turnover.

Laparoscopic low anterior resection for rectal carcinoma: complications and management in 132 consecutive patients.

AIM: To analyze the clinical manifestations and risk factors of complications in laparoscopic low anterior resection (LAR) for rectal cancer patients. METHODS: A series of 132 consecutive patients who received laparoscopic LAR for rectal cancer in our center were included. The etiology, diagnosis, treatment and prevention of rectal cancer were studied among the patients with surgery-related complications using both univariate and multivariate regression analysis. RESULTS: No conversion to open surgery was observed and 5 cases converted to hand-assisted laparoscopic operation. The overall morbidity rate was 20.5%. Complications occurred during the operation in 7 patients (5.3%), within 30 postoperative days in 24 patients (18.2%), and within 3 mo in 2 patients (1.5%). The most significant complications were anastomotic leakage (9.1%) and anastomotic hemorrhage (5.3%). Size and location of tumor, pathological staging and preoperative nutrition were significant factors associated with LAR complications, while gender, age and pathological type showed no relevance. Binary logistics regression showed that the size and location of tumor, and pathological staging were independent factors of laparoscopic LAR. All the complications were treated during their onset of clinical manifestations by interventional or conservative therapy. CONCLUSION: Anastomotic leakage is a major complication in laparoscopic LAR. The complications may be associated with tumor size and site, and pathological stage. Interventional therapies are of value in the management of laparoscopic LAR complications.

The safety of CO2 pneumoperitoneum for elderly patients during laparoscopic colorectal surgery.

OBJECTIVE: The aim of this study was to compare the anesthetic outcomes of elderly and younger patients perioperatively, and to evaluate the safety of this procedure in elderly. METHODS: A total of 25 patients undergoing elective laparoscopic colorectal surgery were enrolled in this study prospectively. Ten patients were more than or equal to 70 years (Group E) and 15 patients were less than or equal to 69 years (Group Y). The parameters between groups for perioperative hemodynamics, arterial blood chemistry, and perfusion of intraabdominal organs were recorded and compared periodically from before induction of anesthesia till after the operation. RESULTS: Group E had a higher ASA degree (P<0.01) than group Y. During the operation, the HCO3 and PaCO2 value increased whereas the pH value decreased significantly. All these parameters recovered gradually at the end of the surgery; some serum electrolytes decreased, especially K and Ca. The central venous pressure increased after volume expansion and the beginning of operation, and then decreased postoperatively. Mean arterial pressure had a marked change during volume expansion period and early after the induction of anesthesia. pHi decreased when the operation began. PgCO2 increased significantly at the end of the surgery. Central venous pressure of group E was higher than that of group Y at 5 minutes during operation, whereas mean arterial pressure of elder group was lower than that of younger group at 15 minutes after the end of operation. Other hemodynamic parameters did not differ significantly from the results. CONCLUSION: There is no significantly adverse effect for elderly patients during perioperative period. Adequate intraoperative administration and monitoring are beneficial for maintaining a safe anesthesia.

Effects of persistent CO(2) insufflation during different laparoscopic inguinal hernioplasty: a prospective, randomized, controlled study.

OBJECTIVE: The aims of this study were to investigate the effects of carbon-dioxide (CO(2)) insufflation on hemodynamic and respiratory function during laparoscopic inguinal hernioplasty and to evaluate the safety of transabdominal preperitoneal hernia repair (TAPP) and extraperitoneal hernia repair (TEP). MATERIALS AND METHODS: Forty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair in our study. The patients were randomly assigned to undergo TAPP (TAPP group, n = 20) or TEP (TEP group, n = 20). Hemodynamic and respiratory parameters, including heart rate, blood pressure, end-tidal CO(2) (EtCO(2)), and blood-gas parameters, were observed and compared between the two groups. RESULTS: There was no significant difference between the two groups in terms of sex, age, American Society of Anesthesiology degree, body-mass index, type of hernia, operation time, hospital stay, and postoperative pain score. In both groups, 5 minutes into the operation, blood pressure, EtCO(2), PaCO(2), and HCO(3)(-) increased significantly, whereas heart rate and pH decreased significantly (P < 0.05). The above tendency became significant with the operation prolonged. All parameters recovered to normal levels at the end of surgery. No significant difference was found between the TAPP and TEP groups. CONCLUSIONS: Both TAPP and TEP procedures can result in CO(2) accumulation, acidosis, increased blood pressure, and decreased heart rate. But, these effects were transient and could be well controlled by appropriate treatments during the operation. The laparoscopic TAPP and TEP techniques are safe for patients by proper perioperative management.

Duodenal perforations after endoscopic retrograde cholangiopancreatography: experience and management.

OBJECTIVE: The aim of this study was to summary the experiences and lessons from periduodenal perforations related to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). METHODS: A retrospective review from 2004 to 2007 identified 9 patients (0.37%) of periduodenal perforation related to ERCP/EST. Charts were reviewed for the following parameters: clinical presentation of patients, ERCP findings, diagnostic methods, treatment (surgical or conservative procedures), complications, and outcome. RESULTS: Nine patients who had periampullary perforations received ERCP/EST for common bile duct stones. Cannulation was considered difficult in 7 of 9 patients, and the precut technique was used. The diagnosis was made due to subcutaneous emphysema or peritonitis, and 3 patients received emergent operations (e.g., external biliary or retroperitoneal drainage), and 1 patient had a reoperation for a retroperitoneal sealed abscess. Their median length of hospital stay was 50 days. The other 6 were treated conservatively with nasal-duodenal and nasal-biliary drainage. Their median length of hospital stay was 13 days. There was no mortality. CONCLUSIONS: The precut technical may be a risk factor of duodenal perforation. Early diagnosis of duodenal perforation is essential for an optimum outcome, and subcutaneous emphysema may be a sensitive sign. Although the management of perforation after ERCP/EST is still controversial, a selective management is proposed, based on the features of classification type. Nevertheless, duodenal and biliary drainage is essential in both surgical and conservative therapy.