Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma: Risk score and significance of future liver remnant volume-to-body weight ratio.

BACKGROUND: Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume-to-body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). METHODS: This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008-2015 at a single center in Korea and they were retrospectively analyzed. RESULTS: Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume (P = .803) or indocyanine green clearance of the future liver remnant (P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF (P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802-0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. CONCLUSIONS: FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.

Sympatholytic Effect of the High Thoracic Erector Spinae Plane Block.

BACKGROUND: The erector spinae plane block (ESPB), which was introduced for the management of thoracic pain, is a technically easy and relatively noninvasive ultrasound (ULSD)-guided technique. Although the ESPB is used widely in variable clinical situations, its sympatholytic effect has never been studied. OBJECTIVES: The purpose of this study is to demonstrate the sympatholytic effect of the high thoracic ESPB by comparing the blocked and unblocked sides of patients' upper extremities, using the changes in the perfusion index (PI). STUDY DESIGN: Prospective, single-group, and open-label study. SETTING: The study was carried out in the pain clinic of a tertiary university hospital. METHODS: This study included 47 patients with upper extremity pain and various diseases who received T2 or T3 ESPBs using 20 mL of 0.2% ropivacaine. For the evaluation of the sympatholytic effect, measurements were taken on the numeric rating scale (NRS), the neck disability index (NDI), and the PI. RESULTS: The PIs of the blocked sides demonstrated significant increases at 10, 20, and 30 minutes compared to the PIs of the baseline and unblocked sides (P < 0.001). The PI ratio at 10 minutes was 2.74 ± 1.65, which was the highest value during the measurement period. Until 30 minutes after the ESPB, the PI ratio was significantly higher in the blocked side than in the unblocked side. During the study period, significant reductions in NRS and NDI scores were found irrespective of disease entity. LIMITATION: The period of PI measurement was only 30 minutes, so we could not determine the time point when the PI returned to the baseline value. CONCLUSION: The high thoracic ESPB was effective in relieving upper extremity pain in diverse disease entities, and the PIs of patients' blocked sides demonstrated significant increases over the baseline value and contralateral unblocked sides.

Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience.

BACKGROUND: Few reports describe the use of laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) in centers with experience using this technique. In addition, the clinical outcomes of this procedure remain undetermined. METHODS: In the current study, 100 patients with benign or malignant lesions in the pancreatic head underwent LPPPD between May 2007 and December 2011. The overall clinical outcomes and changes in these outcomes during the surgeon learning period were analyzed to assess the feasibility and safety of this procedure. RESULTS: Pathologic examination of the pancreas confirmed intraductal papillary mucinous neoplasms in 37 patients, solid pseudopapillary tumors in 17 patients, neuroendocrine tumors in 15 patients, serous cystic neoplasms in seven patients, pancreatic ductal adenocarcinomas in seven patients, ampulla of Vater tumors and duodenal gastrointestinal stromal tumors in five patients, and other disease in seven patients. The median operative time was 7.9 h, which decreased with accumulating experience of the surgeon using this procedure, from 9.8 h for the first 33 cases to 6.6 h for the last 34 cases. Complications developed in 25% of the patients, including six cases (6%) with significant pancreatic fistula [International Study Group on Pancreatic Fistula (ISGPF) grade B]. The complication rate decreased from 33.3% for the first 33 cases to 17.6% for the last 34 cases. The mean hospital stay was 14 days, which also decreased from 20.4 days for the first 33 cases to 11.5 days for the last 34 cases. For the 12 patients in the study cohort with invasive malignant disease, the median tumor size was 2.8 cm, and the median number of lymph nodes harvested was 13. All the patients had margin-negative R0 resections. CONCLUSION: The LPPPD procedure is technically safe and feasible, with an acceptable rate of morbidity and other clinical outcomes for benign and malignant diseases. Clinical outcomes can be improved once a learning curve has been overcome.

Effect of an intravenous infusion of lidocaine on cisatracurium-induced neuromuscular block duration: a randomized-controlled trial.

BACKGROUND: Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking agents. We hypothesized that intravenous lidocaine would prolong the time to recovery of neuromuscular function after cisatracurium. METHODS: Forty-two patients were enrolled in this randomized, double-blind, placebo-controlled study. Before induction, patients were administered either a 1.5 mg/kg bolus of intravenous lidocaine followed by a 2 mg/kg/h infusion or an equal volume of saline. Anaesthesia was induced and maintained using propofol and remifentanil infusions. After loss of consciousness, a 0.15 mg/kg bolus of cisatracurium was administered. No additional cisatracurium injection was allowed. Neuromuscular function was assessed every 20 s using kinemyography. The primary endpoint was the time to spontaneous recovery of a train-of-four (TOF) ratio ≥ 0.9. RESULTS: The time to spontaneous recovery of a TOF ratio ≥ 0.9 was 94 ± 15 min in the control group and 98 ± 16 min in the lidocaine group (P=0.27). CONCLUSIONS: No significant prolongation of spontaneous recovery of a TOF ratio ≥ 0.9 after cisatracurium was found in patients receiving intravenous lidocaine.

BPC 157 Rescued NSAID-cytotoxicity Via Stabilizing Intestinal Permeability and Enhancing Cytoprotection.

The stable gastric pentadecapeptide BPC 157 protects stomach cells, maintains gastric integrity against various noxious agents such as alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs), and exerts cytoprotection/ adaptive cytoprotection/organoprotection in other epithelia, that is, skin, liver, pancreas, heart, and brain. Especially BPC 157 counteracts gastric endothelial injury that precedes and induces damage to the gastric epithelium and generalizes "gastric endothelial protection" to protection of the endothelium of other vessels including thrombosis, prolonged bleeding, and thrombocytopenia. In this background, we put the importance of BPC 157 as a possible way of securing GI safety against NSAIDs-induced gastroenteropathy since still unmet medical needs to mitigate NSAIDs-induced cytotoxicity are urgent. Furthermore, gastrointestinal irritants such as physical or mental stress, NSAIDs administration, surfactants destroyer such as bile acids, alcohol can lead to leaky gut syndrome through increasing epithelial permeability. In this review article, we described the potential rescuing actions of BPC 157 against leaky gut syndrome after NSAIDs administration for the first time.

Enhancement of Low pH Stress Tolerance in Anthocyanin-Enriched Transgenic Petunia Overexpressing RsMYB1 Gene.

We investigated whether the presence of anthocyanins in plants could contribute to low pH stress tolerance using anthocyanin-enriched transgenic petunia lines (PM2, PM6, and PM8) expressing RsMYB1 and wild-type (WT) plants. We examined several physiological and biochemical factors and the transcript levels of genes involved in abiotic stress tolerance. A reduction in plant growth, including plant height and fresh weight, was observed when plants (PM2, PM6, PM8, and WT) were exposed to low pH (pH 3.0) conditions compared to growth under normal (pH 5.8) conditions. A small reduction in the growth of PM6 was observed, followed by that in PM2, PM8, and WT, reflecting the anthocyanin levels in the plants (PM6 > PM2 and PM8 > WT). An analysis of physiological and biochemical factors also supports the degree of low pH tolerance in the plants (PM6 > PM2 and PM8 > WT). In addition, an enhanced expression of the genes [superoxide dismutase (SOD), catalase (CAT), peroxidase (POX), osmotin, and vacuolar H+-ATPase (V-ATPase)] was observed in the transgenic lines (PM2, PM6, and PM8). The resultant of the enhanced transcript levels of the genes could promote antioxidant activities, proline content, and pH homeostasis involved in the mechanisms underlying abiotic stress tolerance in plants. These results suggest that anthocyanin-enriched plants overexpressing RsMYB1 enhances low pH stress tolerance by elevating the transcript levels of the relevant genes.

Overexpression of Rosea1 From Snapdragon Enhances Anthocyanin Accumulation and Abiotic Stress Tolerance in Transgenic Tobacco.

The co-expression of Rosea1 (Ros1) and Delila (Del) regulates anthocyanin levels in snapdragon flowers, as well as in tomato, petunia, and tobacco. However, there is little information on how Ros1 expression alone controls anthocyanin regulation and whether it is involved in the mechanism that leads to abiotic stress tolerance. In the present study, tobacco (Nicotiana tabacum 'Xanthi') transgenic plants overexpressing Ros1 (T2-Ros1-1, T2-Ros1-2, T2-Ros1-3, and T2-Ros1-4) promoted accumulation of anthocyanin in leaves and flowers by elevating the transcription of all key genes involved in the biosynthesis of this pigment. This promotion largely occurred through the upregulation of dihydroflavonol 4-reductase (DFR), and anthocyanidin synthase genes in leaves and upregulation of DFR in flowers. Under normal conditions, the transgenic lines and wild type (WT) plants showed well-developed broad leaves and regular roots, whereas a reduction in plant growth was observed under cold and drought stresses. However, the transgenic T2-Ros1 lines were able to tolerate the stresses better than the WT line by inducing reactive oxygen species scavenging activities, and the expression of antioxidant-related and stress-responsive genes. In addition, phylogenetic analysis clustered Ros1 with many transcription factors (TFs) that confer tolerance to different abiotic stresses. Overall, the results obtained here suggest that Ros1 overexpression upregulates anthocyanin biosynthetic, antioxidant-related, and stress-responsive genes thereby enhancing anthocyanin accumulation and abiotic stress tolerance.

Role of Nano-silver and the Bacterial Strain Enterobacter cloacae in Increasing Vase Life of Cut Carnation 'Omea'.

We investigated the role of nano-silver (NAg) and the bacterial strain Enterobacter cloacae in increasing the vase life of cut carnation flowers 'Omea.' NAg treatment extended vase life of the flowers by increasing relative fresh weight, antioxidant activities, and expression level of the cysteine proteinase inhibitor gene (DcCPi), and by suppressing bacterial blockage in stem segments, ethylene production and expression of ethylene biosynthesis genes and DcCP1 gene, compared with the control. Out of all the treatments, administration of 25 mg L-1 NAg gave the best results for all the analyzed parameters. Interestingly, application of E. cloacae also extended the vase life of cut flowers by 3 days in comparison with control flowers, and overall, showed better results than the control for all the analyzed parameters. Taken together, these results demonstrate the positive role of NAg and E. cloacae in increasing the longevity of cut carnation flowers, and indicate that this effect is brought about through multiple modes of action.

Microbiological characteristics of community-acquired peritonitis at Souro Sanou Teaching Hospital of Bobo Dioulasso.

The purpose of this study was to describe the microbiological characteristics of community-acquired peritonitis at the Souro Sanou teaching hospital of Bobo Dioulasso, Burkina Faso. This 10-month prospective study, from July 2012 through May 2013 included all cases of community-acquired peritonitis who underwent surgery at our hospital and had a pus sample taken at that time. Bacteriological analyses were performed according to the hospital laboratory's protocol. The study included 72 patients (45 men and 27 women with a sex-ratio of 1.6). Their mean age was 27.3 years (range: 14 months to 67 years). The analysis of 72 samples of pus enabled confirmation of 39 cases and led to the identification of 53 bacterial strains. The most common families were enterobacteriaceae in 58% and Gram-positive cocci in 36%. The most common enterobacteria species was Escherichia coli (47%) followed by Streptococcus species (22%). The microbiological confirmation of peritonitis was most frequent in the 20-30 year-old age group. These bacteria appeared most susceptible to gentamycin, ceftriaxone, and ciprofloxacin, while we observed resistance to amoxicillin and the combination of clavulanic acid-amoxicillin. These findings suggest that the best probabilistic antibiotic treatment for the peritonitis in our context would combine a third-generation cephalosporin with aminoglycosides, with imidazole to cover potential anaerobic bacteria.

Isolation of cDNA clones differentially accumulated in the placenta of pungent pepper by suppression subtractive hybridization.

Capsaicinoids responsible for pungency of chili pepper are synthesized exclusively in the placenta tissue of the fruit. As an elementary step in the molecular genetics study of capsaicinoid biosynthesis, a cDNA library was constructed from the placenta of a highly pungent pepper, Capsicum chinense cv. Habanero using the suppression subtractive hybridization (SSH). Thirty-nine cDNA clones from about 400 subtracted clones were selected through dot blot analysis and according to their nucleotides sequence. Sequence information of the chosen clones was evaluated by comparing it with DNA and protein databases. Results showed that the cDNA clones could be divided into 4 groups; cDNAs with similarities in genes encoding metabolic enzymes including acyl transferase and fatty acid alcohol oxidase (Group I), putative cell wall proteins (Group II), biotic and abiotic stress-inducible proteins (Group III), and lastly, cDNAs with no similarity (Group IV). Northern blot analysis was performed to confirm that these clones are differentially expressed in pungent pepper. The results revealed that all cDNA clones were differentially expressed in pungent pepper. In addition, the cDNA clones of Groups I and IV were differentially or preferentially expressed in the placenta of pungent pepper.