Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child–Pugh grade A cirrhosis

Background

Patients with Child–Pugh grade A cirrhosis and clinical evidence of portal hypertension are likely to develop posthepatectomy liver failure (PHLF). Whether such patients are suitable candidates for partial hepatectomy is controversial. This study explored the impact of portal venous pressure (PVP) on PHLF and the possibility of stratifying patients with Child–Pugh grade A cirrhosis for risk of PHLF using clinical data alone.

Methods

Between April 2009 and May 2011, consecutive patients who underwent partial hepatectomy for hepatocellular carcinoma and intraoperative measurement of PVP were included in this prospective study. Using signs of clinically significant portal hypertension (CSPH), patients with Child–Pugh grade A cirrhosis were subclassified into three groups: no, mild and severe CSPH. Risk factors for PHLF were subjected to univariable and multivariable analysis, and receiver operating characteristic (ROC) curve analysis.

Results

Sixty-seven (35·3 per cent) of 190 patients developed PHLF, which was persistent in 12 patients (6·3 per cent). Four patients (2·1 per cent) died from PHLF within 3 months of surgery. Multivariable analysis showed both PVP and CSPH to be independent predictors of PHLF (P < 0·001). PVP values, incidence of PHLF and persistent PHLF were significantly higher in the severe CSPH group than in the other two groups (P < 0·001). Severe CSPH (odds ratio 27·68, P = 0·005) and a preoperative neutrophil : lymphocyte ratio (NLR) of 2·8 or above (odds ratio 49·75, P = 0·002) were independent factors affecting the incidence of persistent PHLF.

Conclusion

The severity of CSPH, corresponding to different PVP levels, could be used to stratify patients with Child-Pugh grade A cirrhosis and to predict the incidence of PHLF. Patients with severe CSPH or a NLR of 2·8 or above were more likely to develop persistent PHLF after partial hepatectomy.

Impact of glucagon-like peptide-1 (7-36) amide, isosteviol and 5-aminoimidazole-4-carboxamide 1-β-d-ribofuranoside on leucine-mediated α-cell dysfunction

AIM

To investigate the acute and chronic effects of l-leucine on pancreatic α-cell function in vitro. Furthermore, we wanted to explore if glucagon-like peptide-1 (GLP-1), isosteviol (ISV) and 5-aminoimidazole-4-carboxamide 1-β-d-ribofuranoside (AICAR) counteract changes in α-cell function induced by chronic exposure to leucine.

METHODS

Isolated mice islets were incubated with 10 mM leucine for 2 or 72 h. We investigated glucagon and insulin secretion at 2 mM and 16.7 mM glucose. In addition, we cultured clonal α-TC1-6 cells with 5 mM leucine, 5 mM leucine plus GLP-1 (10(-6) M), or ISV (10(-6) M) or AICAR (10(-5) M) at high glucose for 72 h. We measured the glucagon secretion, cholesterol (CHO) and triglyceride (TG) content, cell proliferation as well as gene expression.

RESULTS

Ten millimolar of leucine for 2 h significantly stimulated glucagon and insulin secretion both at 2 and 16.7 mM glucose in mice islets. After 72 h incubation with 10 mM leucine the glucagon secretion was enhanced at both 2 and 16.7 mM glucose, whereas the glucose-stimulated insulin secretion (16.7 mM glucose) was inhibited. Chronic exposure to 5 mM leucine increased glucagon secretion, CHO and TG content, cell proliferation and Pcsk2 (p < 0.001), MafB (p < 0.05), Gcg (p < 0.001), Prkaa1 (p < 0.01), Hmgcr (p < 0.001), Srebf2 (p < 0.001), Acaca (p < 0.001), Mtor (p < 0.05) mRNA expression in clonal α-TC1-6 cells. While GLP-1 was cable of reducing glucagon hypersecretion and Pcsk2 (p < 0.05) mRNA expression. ISV and AICAR had no effect on leucine-induced glucagon hypersecretion.

CONCLUSIONS

Long-term exposure to leucine induces hypersecretion of glucagon secretion, that is, aminoacidotoxicity and influences some key genes of pancreatic α-cells. Interestingly, GLP-1 counteracts the leucine-induced α-cell dysfunction.

Managing chronic inflammation in the aging diabetic patient with CKD by diet or sevelamer carbonate: a modern paradigm shift

The maintenance of normal metabolism and body defenses depends on the balance between cellular antioxidant and anti-inflammatory factors. This balance can be disrupted by agents/mechanisms in the extracellular milieu that induce excess reactive oxygen species (ROS) and inflammation. Cytopathic advanced glycation endproducts, present in ever increasing amounts in the modern diet, are one of the major environmental factors that cause excess ROS and/or inflammation at all ages and induce complications in aging, such as chronic kidney disease (CKD) and type 2 diabetes. Increased ROS and/or inflammation are present in both aging and CKD, and are associated with reduced cellular defenses against ROS and/or inflammation. Affected individuals have reduced defenses against further stress and are predisposed to organ failure, now a well-known phenomenon in aging. Thus, new methods are urgently needed to safely reduce ROS and/or inflammation in the aging type 2 diabetes patient with CKD. Studies of both normal aging and diabetic patients with kidney disease underline the fact that increased ROS and/or inflammation can be managed in these conditions by economical, safe, and effective interventions that reduce the uptake of advanced glycation endproducts by either modifying preparation of food or an oral drug. This communication reviews these data and adds new information on the efficacy of a drug, sevelamer carbonate, required to reduce ROS and/or inflammation in the aging type 2 diabetes patient complicated by CKD. If larger and longer studies confirm the hypothesis that one or both of these interventions reduce progression of CKD, it could represent a new paradigm in the management of complications in the type 2 diabetes patient with CKD.

A novel cytotoxic T lymphocyte epitope analogue with enhanced activity derived from cyclooxygenase-2

Cyclooxygenase-2 is a promising target for cancer immunotherapy. Here, we designed the analogues p321-9L and p321-1Y9L (YLIGETIKL) from cyclooxygenase-2-derived native peptide p321. Then, we tested the binding affinity and stability of the analogues and their ability to elicit specific immune response both in vitro (from PBMCs of HLA-A*02⁺ healthy donors) and in vivo (from HLA-A2.1/K(b) transgenic mice). Our results indicated that the activity of cytotoxic T lymphocytes induced by p321-9L and p321-1Y9L was more potent than that of p321. In conclusion, the epitope analogue, especially p321-1Y9L, may be a good candidate which could be used to the immunotherapy of patients with tumours expressing cyclooxygenase-2.

Isolation and identification of the immune-relevant ribosomal protein L10 (RPL10/QM-like gene) from the large yellow croaker Pseudosciaena crocea (Pisces: Sciaenidae)

In order to investigate the immune role of ribosomal protein L10 (RPL10/QM-like gene) in marine fish, we challenged the large yellow croaker Pseudosciaena (= Larimichthys) crocea, the most important marine fish culture species in China, by injection with a mixture of the bacteria Vibrio harveyi and V. parahaemolyticus (3:1 in volume). Microarray analysis and real-time PCR were performed 24 and 48 h post-challenge to isolate and identify the QM-like gene from the gill P. crocea (designated PcQM). The expression level of the PcQM gene did not changed significantly at 24 h post-challenge, but was significantly downregulated at 48 h post-challenge, suggesting that the gene had an immune-modulatory effect in P. crocea. Full-length PcQM cDNA and genomic sequences were obtained by rapid amplification of cDNA ends (RACE)-PCR. The sequence of the PcQM gene clustered together with those of other QM-like genes from other aquatic organisms, indicating that the QM-like gene is highly conserved in teleosts.

Effect of three polyether ionophores on pharmacokinetics of florfenicol in male broilers

Drug-drug interactions (DDIs) may adversely affect the prevention and cure of diseases. The effects of three polyether ionophore antibiotics, salinomycin (SAL), monensin (MON), and maduramycin (MAD) on the pharmacokinetics of florfenicol (FFC) were investigated in broilers. The chickens were fed rations with or without SAL (60 mg/kg feeds), MON (120 mg/kg feeds), or MAD (5 mg/kg feeds) for 14 consecutive days. FFC was given to the chickens either intravenously (i.v.) or orally (p.o.) at a single dose of 30 mg/kg body weight. Blood samples were taken from each chicken at 0-24 h postadministration of FFC. The plasma concentration of FFC was detected by high-performance liquid chromatography. The plasma concentration of FFC decreased with i.v. or p.o. co-administration of SAL, MON, or MAD in broilers, implying occurrence of DDIs during the co-administration of FFC with these ionophores. Our findings suggest that more attention should be given to the use of FFC to treat bacterial infections in chickens supplemented with polyether ionophore antibiotics.

Further studies on the use of a polymerase chain reaction test for the diagnosis of infectious coryza

Further information is reported on the use of a polymerase chain reaction (PCR) test for the diagnosis of infectious coryza in China. The majority of sinus swabs taken from artificially infected chickens and stored in glycerol-enriched phosphate-buffered saline were still positive by PCR after storage for 180 days at either 4 degrees C or - 20 degrees C. Storage of swabs in either saline or nutrient broth was not as effective. Traditional culture failed to detect H. paragallinarum after storage for 3 days, regardless of storage medium or storage temperature. With dry swabs, the PCR could detect H. paragallinarum after storage for 7 days or longer at either 4 degrees C or - 20 degrees C, while traditional culture could not. In PCR tests on 64 artificially-challenged chickens, all were positive by PCR at the six sampling dates up to 18 days post-challenge. Traditional culture gave a similar result. Both PCR and culture detected 50% or less of chickens as positive at 21 and 24 days post challenge. Antibiotic treatment reduced the ability of both culture and the PCR test to detect H. paragallinarum. The value of the PCR test and its superiority over traditional culture for the diagnosis of infectious coryza has been confirmed in these experiments.

[Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer]

BACKGROUND

To summarize the results of extended resection of the heart, great vessels, or both in the treatment of 349 patients with locally advanced lung cancer.

METHODS

From February , 1983 to December, 2000, lobectomy or pneumonectomy combined with extended resection of the heart, great vessels or both were carried out in 349 patients with locally advanced lung cancer. The operations included bronchoplastic procedures and pulmonary artery reconstruction in 205 cases, extended resection of left atrium in 75 cases, superior vena cava resection and reconstruction in 65 cases ( 3 patients had carina resection and reconstruction simultaneously) , and aorta resection and reconstruction in 4 cases respectively.

RESULTS

There were two operative death. The operative mortality was 0. 6% in the series. Fifty-three patients had operative complications. The 1, 3, 5 and 10-year survival rates were 79. 36%, 59. 93%, 33. 14% and 23. 56% respectively.

CONCLUSIONS

Extended resection of the heart, great vessels or both can remarkably increase the long-term survival and improve the prognosis in patients with locally advanced lung cancer. Lobectomy or pneumonectomy combined with extended resection of the heart, great vessels in the treatment of locally advanced lung cancer.

Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration

Autonomic sympathetic activation, for instance following noxious stimuli, decreases the size and flattens the shape of the photoplethysmographic peripheral pulse waveform. We report a simple measure of the waveform shape, the ratio of mean-to-peak wave amplitude, for measuring nociception level during general anaesthesia. Fifty participants, anaesthetised with propofol and remifentanil, were randomly allocated to one of three different remifentanil effect-site concentrations (1, 3 and 5 ng.ml(-1) ). Tracheal intubation increased the mean (SD) plethysmographic ratio from 0.38 (0.06) to 0.48 (0.04), p = 2.6 × 10(-16) . The mean (SD) ratios following intubation at remifentanil effect-site concentrations of 1 ng.ml(-1) , 3 ng.ml(-1) and 5 ng.ml(-1) , were 0.49 (0.03), 0.48 (0.03) and 0.45 (0.04), respectively. Remifentanil therefore suppressed changes in the mean-to-peak ratio caused by tracheal intubation (p = 0.006). The ratio of the mean-to-peak plethysmographic amplitude may represent a simple measure of the balance of autonomic sympathetic and parasympathetic activity under general anaesthesia, and its performance following intubation was significantly different from peak amplitude (p = 0.046).

Effect of muscle type, packaging, and irradiation on lipid oxidation, volatile production, and color in raw pork patties

Effects of packaging and irradiation combinations on lipid oxidation, off-flavor, and color changes of raw patties prepared from three pork muscles were studied. Patties were prepared from each of the ground L. dorsi (L. thoracis and lumborum), psoas, and R. femoris muscles of pig, packaged either in oxygen permeable polyethylene bags or impermeable nylon/polyethylene bags, irradiated with an electron beam at 0 or 4.5 kGy dose, and then stored up to two weeks at 4 °C. Lipid 8 oxidation and color of the patties were determined after 0, 3, 7, and 14 days of storage, and volatiles 24 hr after irradiation. Irradiation and high fat content accelerated the lipid oxidation in raw meat during storage. Oxygen availability during storage, however, was more important than irradiation on the lipid oxidation and color values of raw patties. Irradiated meat produced more volatiles than nonirradiated patties, and the proportion of volatiles varied by the packaging-irradiation conditions of patties. Irradiation produced many unidentified volatiles that could be responsible for the off-odor in irradiated raw meat. No single volatile components but total volatiles, however, could be used to predict lipid oxidation status of raw meat.

Evaluation of a PCR test for the detection of Haemophilus paragallinarum in China

The application of a recently described PCR test for the detection of Haemophilus paragallinarum in China is described. The test was used to examine a total of 127 chickens sourced from a challenge trial (38 chickens), a respiratory disease-free experimental chicken farm (50 chickens) and eight farms with suspect infectious coryza (IC) outbreaks (39 chickens). The PCR results were compared with traditional culture. The PCR detected 14/14 infected birds in the challenge trial as compared with 13/14 for culture. The 50 chickens from the disease-free experimental farm were all negative by both PCR and culture. PCR yielded 15/39 birds and 6/8 commercial farms positive as compared with 8/39 birds and 4/8 farms positive by culture. All farms positive by PCR had chickens showing the typical clinical signs of IC, indicating that culture failed to confirm coryza on two farms that had the typical clinical signs of the disease. Although chickens on two commercial farms were thought initially to be suffering from coryza, detailed clinical examination yielded no birds with typical clinical signs. The 12 chickens examined from these two farms were negative by both PCR and culture. The results suggest that the PCR test for H. paragallinarum is a suitable alternative to culture even under the typical field and laboratory conditions that operate in China.

The use of cell culture for subchromosomal introgressions of barley yellow dwarf virus resistance from Thinopyrum intermedium to wheat

Barley yellow dwarf virus (BYDV) resistance has been transferred to wheat from a group 7 chromosome of Thinopyrum (Agropyron) intermedium. The source of the resistance gene was the L1 disomic addition line, which carries the 7Ai-1 chromosome. The resistance locus is on the long arm of this chromosome. BYDV resistant recombinant lines were identified after three or more generations of selection against a group 7 Th. intermedium short arm marker (red coleoptile) and selection for the presence of BYDV resistance. One recombinant line produced by ph. mutant induced homoeologous pairing and 14 recombinant lines induced by cell culture have been identified. Resistance in seven of the cell culture induced recombinants has been inherited via pollen according to Mendelian segregation ratios for up to eight generations. Meiotic analysis of heterozygotes indicates that the alien chromatin in the cell culture induced recombinants is small enough to allow regular meiotic behaviour. The ph-induced recombinant was less regular in meiosis. A probe, pEleAcc2, originally isolated from Th. elongatum and that hybridizes to dispersed repeated DNA sequences, was utilised to detect Th. intermedium chromatin, which confers resistance to BYDV, in wheat backgrounds. Quantification of these hybridization signals indicated that the translocations involved a portion of alien chromatin that was smaller than the complete long arm of 7Ai-1. Restriction fragment length polymorphism analysis confirmed the loss of the short arm of 7Ai-1 and indicated the retention of segments of the long arm of 7Ai-1. Two 7Ai-1L DNA markers always assorted with the BYDV resistance. A third 7Ai-IL DNA marker was also present in seven of eight recombinants. In all recombinants except TC7, the 7Ai-1L markers replaced the 7DL markers. None of the wheat group 7 markers was missing from TC7. It is concluded that all the resistant lines are the result of recombination with wheat chromosome 7D, except line TC7, which is the result of recombination with an unidentified nongroup 7 chromosome.

Yes-Associated Protein 1 Promotes Adenocarcinoma Growth and Metastasis through Activation of the Receptor Tyrosine Kinase Axl

Yes-associated protein 1 (YAP1), a nuclear effector of the Hippo pathway, plays an important role in tumorigenesis and progression of multiple cancers. The present study aimed to investigate the clinical significance of YAP1 and receptor tyrosine kinase Axl expression in human lung adenocarcinomas (LAC). We further explored possible molecular mechanisms mediated by YAP1 in LAC and gastric adenocarcinoma (GAC) cells. Forty-nine cases of human LAC and normal lung tissue (NLT) were collected. The expression of YAP1 and Axl was assessed by immunohistochemical assay through tissue microarray procedure and the clinicopathologic characteristics of all patients were analyzed. Using a loss of function approach, we investigated the effects of small hairpin RNA (shRNA)-mediated knockdown of YAP1 on the expression of Axl, proliferating cell nuclear antigen (PCNA) and matrix metalloproteinase-9 (MMP-9), and the proliferative activities and invasive potential in LAC A549 and GAC SGC-7901 cell lines. As a result, the expression of YAP1 and Axl was found in LAC tissues with higher strong reactivity rate compared to the NLT (87.8% vs.60.8%, p=0.000;77.6% vs 0.0%, P=0.000), but they did not associate with the age, gender, tumor size, TNM staging or lymph node metastases of LAC patients (each p>0.05). Spearman rank correlation analysis showed a positive correlation between YAP1 and Axl expression. Furthermore, knockdown of YAP in vitro markedly down-regulated the expression of Axl, PCNA and MMP-9, and inhibited the proliferation and invasion of LAC and GAC cells. Taken together, YAP1 and Axl are highly expressed in LAC compared to the NLT, and knockdown of YAP1 may inhibit the proliferation and invasion of adenocarcinoma cells through downregulation of the Axl pathway, representing a potential therapeutic target for the treatment of cancer.

Near midplane scintillator-based fast ion loss detector on DIII-D

A new scintillator-based fast-ion loss detector (FILD) installed near the outer midplane of the plasma has been commissioned on DIII-D. This detector successfully measures coherent fast ion losses produced by fast-ion driven instabilities (≤500 kHz). Combined with the first FILD at ∼45° below the outer midplane [R. K. Fisher, et al., Rev. Sci. Instrum. 81, 10D307 (2010)], the two-detector system measures poloidal variation of losses. The phase space sensitivity of the new detector (gyroradius r(L) ∼ [1.5-8] cm and pitch angle α ∼ [35°-85°]) is calibrated using neutral beam first orbit loss measurements. Since fast ion losses are localized poloidally, having two FILDs at different poloidal locations allows for the study of losses over a wider range of plasma shapes and types of loss orbits.