Indocyanine green retention test avoiding liver failure after hepatectomy for hepatolithiasis

BACKGROUND/AIMS

To investigate the role of indocyanine green (ICG) retention test in avoiding postoperative liver failure after hepatectomy for primary hepatolithiasis.

METHODOLOGY

Between January, 2004 and December, 2010, 144 patients with primary hepatolithiasis undergoing hepatectomy were retrospectively selected for the study. Eighty-two of those (Group CP) were preoperatively evaluated only by Child-Pugh (CP) scoring to select candidates for hepatectomy before September, 2008. Since then ICG15 retention test was accepted for the same purpose in the remaining 62 cases (Group ICG).

RESULTS

The immediate stone clearance rates were 79.27% and 80.65%, with final stone clearance rates 93.9% and 93.55% in the CP and ICG groups, respectively. Liver failure was observed significantly more in the CP (12.2%) than that in the ICG group (1.61%), (p<0.05). More hospital deaths occurred in the CP (4.88%) than in the ICG group (1.61%), although no significant difference was observed (p=0.548). The complication rate of the CP group (37.80%) was significantly higher than that of ICG group (17.74%), (p<0.05).

CONCLUSIONS

ICG15 retention test is more effective to predict and avoid liver failure for patients with hepatolithiasis after hepatectomy than CP scoring system. It may also decrease the morbidity and mortality rate through strict selection, thus increasing operative safety.

Isoform-specific palmitoylation of JNK regulates axonal development

The c-jun N-terminal kinase (JNK) proteins are encoded by three genes (Jnk1-3), giving rise to 10 isoforms in the mammalian brain. The differential roles of JNK isoforms in neuronal cell death and development have been noticed in several pathological and physiological contexts. However, the mechanisms underlying the regulation of different JNK isoforms to fulfill their specific roles are poorly understood. Here, we report an isoform-specific regulation of JNK3 by palmitoylation, a posttranslational modification, and the involvement of JNK3 palmitoylation in axonal development and morphogenesis. Two cysteine residues at the COOH-terminus of JNK3 are required for dynamic palmitoylation, which regulates JNK3's distribution on the actin cytoskeleton. Expression of palmitoylation-deficient JNK3 increases axonal branching and the motility of axonal filopodia in cultured hippocampal neurons. The Wnt family member Wnt7a, a known modulator of axonal branching and remodelling, regulates the palmitoylation and distribution of JNK3. Palmitoylation-deficient JNK3 mimics the effect of Wnt7a application on axonal branching, whereas constitutively palmitoylated JNK3 results in reduced axonal branches and blocked Wnt7a induction. Our results demonstrate that protein palmitoylation is a novel mechanism for isoform-specific regulation of JNK3 and suggests a potential role of JNK3 palmitoylation in modulating axonal branching.

A case of severe acute pancreatitis and cholangitis presenting as initial complaints of hepatocellular carcinoma

Jaundice occurs in 19%-40% of the hepatocellular carcinoma (HCC) patients. HCC associated jaundice may be divided into hepatocellular and icteric types in terms of its underlying pathophysiology. The jaundice of icteric type is caused by obstruction of the bile duct through cancer embolus, blood clot, biliary sludge, tumor compression or infiltration. Jaundice and epigastric discomforts are the main clinical manifestations. In the present case, severe acute pancreatitis and acute cholangitis presenting as initial complaints of icteric type HCC were quite rare. A tumor located at the central lobe of the liver and a cancer embolus at the lower part of the common bile duct (CBD) were detected by CT scan. Curative resection of HCC with CBD exploration eradicated both the tumor and the embolus, and no recurrence was found after a 36 month follow-up.

Serum γ-glutamyltransferase and associated damage among a She Chinese population

OBJECTIVE

It has been suggested that serum γ-glutamyltransferase is independently associated with cardiovascular mortality and atherosclerosis. The present study is to investigate the relationship between serum γ-glutamyltransferase and potential associated damage in an adult She Chinese population.

METHOD

A multistage, stratified, cluster, random sampling method was used to select an ethnically representative group of individuals aged 20-80 years in the general population. Brachial-ankle pulse-wave velocity was used to assess arterial stiffness in the general population and the Toronto Clinical Neuropathy Scoring System was used to detect diabetic peripheral polyneuropathy among populations with diabetes.

RESULTS

A total of 5385 subjects were entered into the analysis. Serum γ-glutamyltransferase levels were classified into four groups using the 25th, 50th and 75th percentiles as cut points (males: < 20, 20-29, 29-52 and > 52 U/l; females: < 13, 13-18, 18-25 and > 25 U/l). As compared with the first quartile, the relative risks of arterial stiffness were 1.418, 1.667 and 2.394 in the other three categories, respectively (test for trend P < 0.05). After adjustment in five models, serum γ-glutamyltransferase was still a risk factor of arterial stiffness. We found inverted U-shape curves in both genders and the third quartile (male: 29 52 U/l; female: 18-25 U/l) had the highest odds ratios of 1.640 and 1.529, respectively.

CONCLUSIONS

We demonstrated that high serum γ-glutamyltransferase concentrations were directly associated with the increased risk of arterial stiffness, in general, and with peripheral polyneuropathy in subjects with diabetes in an ethnic She Chinese population. Alcohol use, gender, BMI and blood pressure were related to serum γ-glutamyltransferase and were involved in the relationship between serum γ-glutamyltransferase and brachial-ankle pulse-wave velocity.

Curing Efficiency of Three Different Curing Modes at Different Distances for Four Composites

Doubling the exposure time of a high-intensity light-emitting diode curing light with a turbo tip and autofocus capability does not predictably compensate for distance in deep cavities.

NEL-like molecule-1-modified bone marrow mesenchymal stem cells/poly lactic-co-glycolic acid composite improves repair of large osteochondral defects in mandibular condyle

OBJECTIVE

Articular cartilage of the mandibular condyle has limited ability to regenerate itself after injury. This study was to investigate whether osteochondral defects in mandibular condyle could be repaired by NELL-1(NEL-like molecule-1)-modified autogenous bone marrow mesenchymal stem cells (BMMSCs) and poly lactic-co-glycolic acid (PLGA) composite.

METHODS

Osteochondral defects of 3mm-diameter × 5mm-depth were created unilaterally in the central part of the condyle in 50 adult goats. The injury sites were treated with NELL-1-modified BMMSCs/PLGA, BMMSCs/PLGA, PLGA alone, or left empty. The defect area was monitored using gross examination, histology, immunohistochemistry, and micro-computed tomography (μ-CT). Implanted BMMSCs were tracked using Adeno-LacZ labeling.

RESULTS

The NELL-1-modified BMMSCs/PLGA group showed vigorous and rapid repair leading to regeneration of fibrocartilage at 6 weeks and to complete repair of native articular cartilage and subchondral bone at 24 weeks. The BMMSCs/PLGA group also completely repaired the defect with fibrocartilage at 24 weeks, but the cartilage in the BMMSCs/PLGA group was less well-organized than the NELL-1-modified BMMSCs/PLGA. The osteochondral defects in the PLGA and empty defect groups were poorly repaired, and no cartilage in the empty defect group or only small portion of cartilage in the PLGA group was found. In vivo viability of implanted cells was demonstrated by the retention for 6 weeks in the defects.

CONCLUSION

These findings demonstrated that NELL-1-modified BMMSCs/PLGA composite can rapidly repair large osteochondral defect in the mandibular condyle with regeneration of native fibrocartilage and subchondral bone.

Cesium Ion Implantation in Single Crystal Yttria-Stabilized Zirconia (YSZ) and Polycrystalline MgAl2O4-YSZ

YSZ and MgAl2O4-YSZ composite are two promising materials as in the inert matrix nuclear fuel for the incineration of plutonium. In this study, 400 keV Cs ions were implanted to a fluence of 1×1017 ions/m2 in both materials in order to investigate the retention behavior of fission product at elevated temperature. The implantations were completed at room temperature for the YSZ and 973 K for MgAl2O4-YSZ, respectively. Subsequent annealing at 1273 K was performed after a room temperature implantation of YSZ. After annealing, a high density of gas bubbles formed with diameter from 3 to 40 nm from the surface to a depth of 150 nm in the YSZ matrix. The swelling due to bubbles formation was estimated to be 2.5%. In situ TEM was employed during high temperature ion implantation of the MgAl2O4-YSZ composite. A high density of small bubbles with 5 nm in diameter formed in the MgAl2O4 and YSZ grains after an ion dose of 1×1017 ions/cm2. There was no preferential precipitation along grain boundaries. Electron Paramagnetic resonance (EPR) spectroscopy was used to investigate the type of defects that formed in the YSZ matrix.

Morphology and Microstructure of (111) Crystalline CeO2 Films Grown on Amorphous SiO2 Substrates by Pulsed-Laser Ablation

The surface morphology and microstructure of (lll)-oriented CeO2 thin films, grown on amorphous fused silica (S1O2) substrates by low-energy-ion-beam assisted pulsed laser ablation, have been studied by atomic force microscopy (AFM) and x-ray diffraction (XRD). These CeO2 films are aligned with respect to a single in-plane axis despite being deposited on an amorphous substrate. There is a honeycomb-like growth morphology to the films and island-growth can be observed in thicker films. These islands, inside of which are high density of honeycomb-like clusters, are separated by a void network with ∼700nm width. However, on the surface of the thinnest film (∼3nm), only very small clusters (diameter <60nm) appear, and the boundaries of the void network are undefined, which implies that the film is just beginning to coalesce into clusters (grains). The combined AFM images and XRD pattern suggest these clusters probably are the initial seeds for the subsequent island growth. Based on these results, the growth mechanism of oriented CeO2 films on amorphous fused silica substrates is discussed.

Obesity and non-fatal motor vehicle crash injuries: sex difference effects

Background

Obesity and motor vehicle crash (MVC) injuries are two parallel epidemics in the United States. An important unanswered question is if there are sex differences in the associations between the presence of obesity and non-fatal MVC injuries.

Objectives

To further understand the association between obesity and non-fatal motor vehicle crash injuries, particularly the sex differences in these relations.

Methods

We examined this question by analyzing data from the 2003 to 2007 National Automotive Sampling System Crashworthiness Data System (NASS CDS). A total of 10, 962 drivers who were aged 18 years or older and who survived frontal collision crashes were eligible for study.

Results

Male drivers experienced a lower rate of overall non-fatal MVC injuries than did female drivers (38.1% vs. 52.2%) but a higher rate of severe injuries (0.7% vs. 0.2%). After adjusting for change in velocity (ΔV) during the crashes, obese male drivers showed a much higher risk [logistic coefficients of BMI for moderate, serious, and severe injury are 0.0766, 0.1470, and 0.1792, respectively; all p<0.05] of non-fatal injuries than did non-obese male drivers and these risks increased with injury severity. Non-fatal injury risks were not found to be increased in obese female drivers. The association between obesity and risk of non-fatal injury was much stronger for male drivers than for female drivers.

Conclusion

The higher risk of non-fatal MVC injuries in obese male drivers might result from their different body shape and fat distribution compared with obese female drivers. Our findings should be considered for obesity reduction, traffic safety evaluation and vehicle design for obese male drivers and provide testable hypotheses for future studies.

Associations of fat mass and fat distribution with bone mineral density in pre- and postmenopausal Chinese women

Fat mass (FM) is closely related to bone mineral density (BMD). However, the associations of FM and fat distribution with BMD in pre- and postmenopausal women are still poorly understood. The present study showed android fat mass accumulation after menopause had a negative association with BMD.

INTRODUCTION

FM is closely related to BMD. However, it is unknown whether FM and central fat distribution have different associations with BMD in pre- and postmenopausal women. The study aims to investigate the associations of FM and fat distribution with BMD in pre- and postmenopausal Chinese women.

METHODS

Two hundred sixty premenopausal and 267 postmenopausal women aged 18 to 79 years were analyzed. Lean mass (LM), FM, percent body fat (%BF), android FM, gynoid FM, and total and regional BMD were measured using dual-energy X-ray absorptiometry. Fat distribution was assessed by android to gynoid FM ratio (AOI). Multiple regression analysis was performed to examine the associations of BMD with FM, LM, and AOI.

RESULTS

FM, %BF, android FM, and AOI were significantly higher, whereas total and regional BMD were significantly lower in postmenopausal women (all р < 0.01). In premenopausal women, FM was positively associated with total and regional BMD (all р < 0.05). AOI had no significant association with BMD. In postmenopausal women, FM was significantly associated with total and regional BMD even additionally adjusting for LM (all р < 0.01). AOI had significantly negative association with total, head, arm, and leg BMD (all р < 0.05). The results remained unchanged when replacing FM with %BF.

CONCLUSIONS

There were different associations of FM and fat distribution with BMD in pre- and postmenopausal Chinese women. Increased central body fat had a negative association with BMD. Our findings may have significant implications in the prevention of menopause-related osteoporosis through reducing centralized fat deposition.