The influence of nutritional assessment on the outcome of ostomy takedown.

PURPOSE: Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition. METHODS: A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010. RESULTS: Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications. CONCLUSION: A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.

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

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

Frequent mutations of human Mad2, but not Bub1, in gastric cancers cause defective mitotic spindle checkpoint.

Since the underlying mechanism for the high incidence of aneuploidy in gastric cancer has not clarified, we screened 49 gastric cancers and five gastric cancer cell lines for mutations in the mitotic spindle checkpoint genes, Bub1 and Mad2, and we analyzed the functional consequences of these mutations. The presence of mutations in Bub1 and Mad2 coding sequences was primarily detected by RT-PCR-SSCP and subsequently confirmed by automatic sequencing of either the RT-PCR products and/or the PCR products from genomic DNA. Mad2 was mutated in 44.9% of gastric cancer tissues and one gastric cancer cell line, N87, but not Bub1. Of these, three mutational hotspots at codons 156, 165 and 182 were identified. Mutations at codons 165 and 182 led to amino acid substitutions, whereas the mutation at codon 156 was a silent one. Overexpression of mutant Mad2 in HeLa cells led to the appearance of aneuploid cells in the presence of nocodazole, and this indicated that these mutations caused a defect in MAD2 protein. Wild type and mutant MAD2 protein displayed distinct mobility on two-dimensional gel electrophoresis. Novel mutational hotspots in human Mad2 genes were discovered for the gastric cancers and these mutations caused the functional defects in the spindle checkpoint suggesting that these mutations might be involved in the development and progression of gastric cancer.

Analysis of protein adsorption characteristics to nano-pore silica particles by using confocal laser scanning microscopy.

The effect of average pore size of nano-pore silica particles on protein adsorption characteristics was determined experimentally by the dissociation constant and the adsorption capacity determined from the Langmuir equation. As the average pore size was increased from 2.2 to 45 nm, the BSA adsorption capacity increased from 16.8 to 84.3 mg/g-silica so as the equilibrium constant (from 2.6 to 9.4 mg/ml). Using confocal microscopy with fluorescence labeling, we could visualize the protein adsorption in situ and determine the minimum pore size required for efficient intraparticle adsorption. The confocal microscopy analysis revealed that BSA was adsorbed mainly on the surface of the particles with a smaller pore size, but diffused further into the interstitial surface when it was sufficiently large. It was concluded that for BSA whose Stoke's diameter is ca. 3.55 nm the minimum pore size of about 45 nm or larger was required for a sufficient adsorption capacity.