Wedge resection versus segment IVb and V resection of the liver for T2 gallbladder cancer: a systematic review and meta-analysis.

Objectives: Although guidelines recommend extended cholecystectomy for T2 gallbladder cancer (GBC), the optimal hepatectomy strategy remains controversial. The study aims to compare the prognosis of T2 GBC patients who underwent wedge resection (WR) versus segment IVb and V resection (SR) of the liver. Methods: A specific search of online databases was performed from May 2001 to February 2023. The postoperative efficacy outcomes were synthesized and meta-analyses were conducted. Results: A total of 9 studies involving 2,086 (SR = 627, WR = 1,459) patients were included in the study. The primary outcomes included disease-free survival (DFS) and overall survival (OS). For DFS, the 1-year DFS was statistically higher in patients undergoing SR than WR [risk ratio (RR) = 1.07, 95% confidence interval (CI) = 1.02-1.13, P = 0.007]. The 3-year DFS (P = 0.95), 5-year DFS (P = 0.77), and hazard ratio (HR) of DFS (P = 0.72) were similar between the two groups. However, the 3-year OS was significantly lower in patients who underwent SR than WR [RR = 0.90, 95% CI = 0.82-0.99, P = 0.03]. Moreover, SR had a higher hazard HR of OS [HR = 1.33, 95% CI = 1.01-1.75, P = 0.04]. No significant difference was found in 1-year (P = 0.32) and 5-year (P = 0.9) OS. For secondary outcomes, patients who received SR tended to develop postoperative complications (POC) [RR = 1.90, 95% CI = 1.00-3.60, P = 0.05]. In addition, no significant differences in intrahepatic recurrence (P = 0.12) were observed. Conclusions: In conclusion, SR can improve the prognosis of T2 GBC patients in DFS. In contrast to WR, the high HR and complications associated with SR cannot be neglected. Therefore, surgeons should evaluate the condition of the patients and take their surgical skills into account when selecting SR. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier, CRD42022362974.

The Vibrio cholerae var regulon encodes a metallo-ß-lactamase and an antibiotic efflux pump, which are regulated by VarR, a LysR-type transcription factor.

The genome sequence of V. cholerae O1 Biovar Eltor strain N16961 has revealed a putative antibiotic resistance (var) regulon that is predicted to encode a transcriptional activator (VarR), which is divergently transcribed relative to the putative resistance genes for both a metallo-ß-lactamase (VarG) and an antibiotic efflux-pump (VarABCDEF). We sought to test whether these genes could confer antibiotic resistance and are organised as a regulon under the control of VarR. VarG was overexpressed and purified and shown to have ß-lactamase activity against penicillins, cephalosporins and carbapenems, having the highest activity against meropenem. The expression of VarABCDEF in the Escherichia coli (ΔacrAB) strain KAM3 conferred resistance to a range of drugs, but most significant resistance was to the macrolide spiramycin. A gel-shift analysis was used to determine if VarR bound to the promoter regions of the resistance genes. Consistent with the regulation of these resistance genes, VarR binds to three distinct intergenic regions, varRG, varGA and varBC located upstream and adjacent to varG, varA and varC, respectively. VarR can act as a repressor at the varRG promoter region; whilst this repression was relieved upon addition of ß-lactams, these did not dissociate the VarR/varRG-DNA complex, indicating that the de-repression of varR by ß-lactams is indirect. Considering that the genomic arrangement of VarR-VarG is strikingly similar to that of AmpR-AmpC system, it is possible that V. cholerae has evolved a system for resistance to the newer ß-lactams that would prove more beneficial to the bacterium in light of current selective pressures.

Cognitive testing and revision of the pain quality assessment scale.

OBJECTIVE: To revise the Pain Quality Assessment Scale (PQAS) using feedback from patients to further increase its validity. METHODS: This project involved 3 cognitive interviewing studies. In Study 1, a group of patients with chronic pain (N=20) were asked a series of questions regarding the PQAS's understandability, and invited to make suggestions regarding how the measure could be improved. In Study 2, a second group of patients (N=21) responded to questions about a modified version of the PQAS. The PQAS was further modified on the basis of the findings of Study 2, and in Study 3 the participants were asked to indicate whether the changes made improved the understandability of the PQAS further. RESULTS: The participants in Studies 1 and 2 identified portions of the PQAS instructions and some of the PQAS items that could be modified to increase their understandability. Modifications resulted in a revised PQAS that was deemed by patients with chronic pain to be more understandable than the original PQAS by the majority of participants. DISCUSSION: testing can be used to improve the understandability of pain measures. The results of cognitive testing with the PQAS indicated that much of the content of the original instructions and items were understandable as written, but that minor changes could be made to make them even clearer to patients with chronic pain. The changes made resulted in a revised PQAS that is more understandable and may therefore be even more useful than with the original PQAS.

Frequency of chronic pain descriptors: implications for assessment of pain quality.

The current study interviewed patients with chronic pain to: (1) identify the most common words used by patients in the samples to describe the "quality" of their pain (i.e. sharp, dull) and (2) evaluate the validity of existing pain quality measures. Two-hundred and thirteen individuals with pain associated with spinal cord injury (SCI) or multiple sclerosis (MS) were asked to describe their pain. Consistent with previous research that has shown that patients with different types of pain problems describe their pain using different pain quality descriptors, there was variability in the frequency of pain descriptors used by the study participants. For example, patients with SCI and below injury level pain used "burning" more often than patients with SCI and shoulder, arm, or neck pain or patients with MS. Regarding the validity of existing pain measures, only one pain quality measure assessed all 14 of the most common pain descriptors volunteered by the sample. Also, although a number of pain quality measures have been developed to discriminate neuropathic from nociceptive pain, there was surprisingly little overlap in descriptors between these measures. The results of the current study and other studies using similar procedures would be useful for evaluating and developing existing and future pain quality measures.