Soy protein retards the progression of non-alcoholic steatohepatitis via improvement of insulin resistance and steatosis.

OBJECTIVE: Non-alcoholic steatohepatitis (NASH) is a common cause of liver disease, and it may progress to fibrosis or cirrhosis. The aim of this study was to investigate the effects of soy protein on hepatic steatosis and insulin resistance in NASH. METHODS: Forty male Sprague-Dawley rats were fed a high-fat diet for 4 wk to induce NASH and then were allocated to one of four diets: a NASH-inducing diet, a standard diet, a NASH-inducing diet plus soy protein, and a standard diet plus soy protein. RESULTS: After the 10-wk experimental period, the results showed that soy protein significantly lowered plasma cholesterol concentrations and body fat accumulation. Soy protein intake also decreased the hepatic lipid depots of triacylglycerols and cholesterol and decreased the concentrations of lipid peroxides. In an analysis of antioxidative status, rats fed the soy protein diet showed improved antioxidative potential due to increases in superoxide dismutase and catalase activities and a decrease in the protein expression of cytochrome P450 2E1. CONCLUSION: Soy protein may improve the liver function in patients with NASH by lowering lipid levels in the blood and liver, increasing the antioxidative capacity, and improving insulin resistance.

Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials.

BACKGROUND: Staple fixation of mesh during laparoscopic total extraperitoneal (TEP) inguinal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase surgical complications and pain. Therefore, a meta-analysis of randomized controlled trials (RCTs) was conducted to compare the outcomes of nonfixation with fixation of mesh by metal tacks during TEP inguinal hernia repair. METHODS: The meta-analysis was conducted according to the Quality of Reporting of Meta-analyses (QUOROM) standards. The inclusion criteria were RCTs comparing stapled with unstapled mesh in TEP inguinal hernia repair. The primary outcome was incidence of recurrence, secondary outcomes were operative duration, postoperative pain score, number of analgesics consumed, in-hospital stay, time to return to normal activity, cost, and complications. RESULTS: Six trials were included with a total number of 932 patients (1086 hernias): the mesh was fixed in 463 (540 hernias) patients and not fixed in 469 (546 hernias). We found no difference between groups in the incidence of recurrence (OR = 2.01, 95% CI: 0.37-11.02), complications (OR = 0.73, 95% CI: 0.51-1.05), postoperative pain score [day 1 (p = 0.19), day 7 (p = 0.18) and month 1 (p = 0.47)] and number of analgesics consumed (WMD of -1.20, 95% CI: -3.08 to 0.68). The mean operative time (WMD of -3.86, 95% CI: -7.45 to -0.26) and hospital stay (WMD of -0.34, 95% CI: -0.50 to -0.18) were significantly higher in the mesh fixation group. Moreover, a net cost savings was realized for each hernia repair performed without stapled mesh. CONCLUSIONS: Elimination of tack fixation of mesh in TEP inguinal hernia repair is associated with decreased operative cost and significantly reduce operative time and in-hospital stay, but no difference in the risk of hernia recurrence, complications, and postoperative pain. For more detailed evaluation, further well-structured trials with improved standardization of hernia type, operative technique, and surgeon experience are necessary.

Association of increasing surgeon age with decreasing in-hospital mortality after coronary artery bypass graft surgery.

BACKGROUND: The aim of this study was to investigate the relation between surgeon age and in-hospital mortality for patients who underwent a coronary artery bypass graft (CABG) using a nationwide population-based data set. METHODS: This study used data from the 2004 Taiwan National Health Insurance Research Database. The study sample comprised 3766 patients hospitalized for CABG surgery and was divided into three equal-sized surgeon age groups: <40, 40 to 45, and >45 years. A conditional (fixed-effect) logistic regression was performed to examine the relation between surgeon age and in-hospital mortality after adjusting for surgeon CABG caseload and characteristics of patients and surgeons as well as the clustering effect among surgeons. RESULTS: Patients who underwent CABG performed by surgeons in the <40 years age group had significantly higher in-hospital mortality rates (5.4%) than those operated on by surgeons in the 40- to 45-year age group (3.5%) and surgeons in the >45-year age group (2.6%). Regression shows that the adjusted odds ratio of in-hospital mortality for patients operated on by surgeons in the <40-year age group was 1.47 (p < 0.05) times that for surgeons in the 40- to 45-year age group and 1.82 (p < 0.05) times that for surgeons in the >45-year age group. CONCLUSION: We conclude that older surgeons are more likely to achieve better clinical performance with CABG surgery because of their greater clinical experience.

Pyogenic liver abscess complicating early bile duct carcinoma in the middle bile duct: a rare presentation.

We describe an 83-year-old woman who developed a pyogenic liver abscess complicated with early bile duct carcinoma. After percutaneous abscess drainage, endoscopic retrograde cholangiography revealed a filling defect in the extrahepatic bile duct suggestive of a bile duct tumor. Resection of the extrahepatic bile duct with regional lymph node dissection was carried out. The resected specimen showed a polypoid tumor in the middle bile duct and histologic examination revealed well-differentiated tubular adenocarcinoma limited to the mucosal layer. These findings suggest that careful investigation of the biliary tract is necessary in patients with pyogenic liver abscess, because of the possible association of bile duct cancer.

Thyroid metastasis in a patient with hepatocellular carcinoma: case report and review of literature.

BACKGROUND: Despite the apparent low incidence of cancer metastatic to the thyroid, autopsy and clinical series suggest it is more common than generally. Although lung, renal, and breast cancer are probably the most common primary sites, a number of cancers have been reported to metastasize to the thyroid synchronously with diagnosis of primary tumor or years after apparently curative treatment. CASE PRESENTATION: We report a rare case of a hepatocellular carcinoma metasatic to the thyroid. The patient presented seven months after original diagnosis and treatment with hepatic lobectomy with multiple neck lesions producing a mass effect on the trachea and bilateral lymphadenopathy. Fine-needle aspiration revealed highly anaplastic carcinoma, and immunohistochemistry confirmed hepatocellular carcinoma. The patient received total thyroidectomy as palliative therapy because of the presence of multiple recurrent lesions in the liver. CONCLUSION: Clinicians should consider the possibility of metastatic cancer in each patient who presents with a new thyroid mass, especially those with a history of cancer, however remote. In cases where cytology or histology is not diagnostic, immunohistochemistry may be definitive in making the diagnosis.

Application of laparoscopic techniques for resection of individual gastric submucosal tumors.

Large gastric submucosal tumors should be excised to prevent ischemic mucosal ulceration of the overlying surface and central necrosis of the neoplasm, which may in turn lead to massive hemorrhage. Large tumors near the esophagocardiac junction or on the posterior wall are usually resected by an open procedure. We describe 2 cases of upper gastrointestinal tract bleeding owing to huge submucosal tumors in the posterior gastric high body treated by laparoscopic resection of the gastric tumors. These 2 patients recovered smoothly without major or minor complications. We emphasize that design of specific strategies for individual tumors is essential for the successful laparoscopic resection of tumors adjacent to the esophagocardiac junction and large tumors on the posterior wall.

Jejunal and multiple mesenteric calcifying fibrous pseudotumor induced jejunojejunal intussusception.

We describe here a patient with an unusual presentation--mesenteric calcifying fibrous pseudotumor in association with jejunojejunal intussusception. This 25-year-old woman came to our emergency department with severe abdominal distension and intermittent epigastric cramping pain. She was found to have rebound tenderness and an ill-defined mass palpable in her lower abdomen. Abdominal computed tomography revealed an inhomogeneous soft tissue mass with target sign and intussusception of small intestine was suspected. Emergency laparotomy showed jejunojejunal intussusception involving ~30cm of jejunum with multiple tumors on the mesentery surface extending over the whole bowel mesenteric and peritoneal surfaces. One of the mesenteric tumors formed the leading point of the intussusception. Segmental resection of jejunum with primary anastomosis was done. Some larger tumors were resected but most of the other tumors were left in place because they were small and numerous and total resection was impossible. Pathology confirmed that the lesions were benign mesenteric calcifying fibrous pseudotumors. In such patients, surgery might be curative. If a large segment of the bowel is affected by calcifying fibrous pseudotumor, smaller pseudotumors might be left in place because these tend to be asymptomatic. But they might become the leading points of recurrent intussusception.

Tubulozole-induced G2/M cell cycle arrest in human colon cancer cells through formation of microtubule polymerization mediated by ERK1/2 and Chk1 kinase activation.

Our studies demonstrated that human colon cancer cells (COLO 205), with higher expression level of check point kinase 1 (Chk1), were more sensitive to microtubule damage agent Tubulozole (TUBU) induced G2/M phase arrest than normal human colon epithelial (CRL) cells. TUBU (10 microM, for 3h) treatment resulted in rapid and sustained phosphorylation of Cdc25C (Ser-216) leading to increased 14-3-3beta binding. This resulted in increased nuclear translocation. In addition, TUBU induced phosphorylation of the Cdc25C (Ser-216) and Bad (Ser-155) proteins were blocked by Chk1 SiRNA-transfection. Surprisingly, cellular apotosis was observed in cells treated with TUBU after Chk1 SiRNA inhibition. We further demonstrated that extracellular signal-regulated kinase (ERK) activation by TUBU was needed for Chk1 kinase activation and microtubule formation as shown by the attenuation of these responses by the ERK1/2 specific inhibitor PD98059. However, TUBU induced ERK1/2 phosphorylation was not blocked in the Chk1 SiRNA-transfected COLO 205 cells. These results imply that ERK1/2 mediated Chk1 activation may be play an important role in determining TUBU induced G2/M arrest or apoptosis in COLO 205 cells.

Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country.

BACKGROUND: Using 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections. METHODS: The study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was in-hospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality. RESULTS: The adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in very-high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality. CONCLUSIONS: After adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with higher-volume hospitals.