Amaranth squalene reduces serum and liver lipid levels in rats fed a cholesterol diet

In this study, the hypocholesterolaemic effect of amaranth grain, oil and squalene are examined. In experiment 1, rats are given a semi-purified diet containing 1% (w/w) cholesterol for four weeks and either amaranth grain (AG; 300 g/kg) or amaranth oil (AO; 90 g/kg) substituted in experimental groups. Both AG and AO lowered serum and hepatic cholesterol and triglyceride levels. Faecal excretion of cholesterol and bile acid in the AO group increased, while AG affected only bile acid excretion. In experiment 2, rats were fed the cholesterol diet for four weeks and injected (i.p.) with saline (control), amaranth squalene (AS) or shark liver squalene (SS, 200 mg/kg) for seven days. The hypolipidaemic effects of AS were evident in both serum and liver. In addition, AS markedly increased faecal excretions of cholesterol and bile acid, and slightly inhibited 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activity. In contrast, none of these effects were observed in the SS group. This preliminary study suggests that the cholesterol-lowering effect of AS may be mediated by increased faecal elimination of steroids through interference with cholesterol absorption, and that different sources of squalene (plant versus animal) may affect cholesterol metabolism differently.

Simultaneous Stabilization and Multimerization of a Peptide α-Helix by Stapling Polymerization

Maintaining specific conformations of peptide ligands is crucial for improving the efficacy of biological interactions. Here, a one-pot polymerization strategy for stabilizing the α-helical conformation of peptides while simultaneously constructing multimeric ligands is presented. The new method, termed stapling polymerization, uses radical polymerization between acryloylated peptide side chains and vinylic monomers. Studies with model peptides indicate that i, i+7 crosslinking is effective for the helix stabilization, whereas i, i+4 crosslinking is not. The stapling polymerization results in the formation of peptide-polyacrylamide conjugates that include ≈3-16 peptides in a single conjugate. This stapling polymerization provides a simple but powerful methodology to fabricate multimeric α-helices that can further be developed to modulate multivalent biomacromolecular interactions.

Changes in the types of liver diseases requiring hepatic resection: a single-institution experience of 9016 cases over a 10-year period

Backgrounds/Aims

To understand the changing demands for hepatic resection (HR), we collected data regarding HR performed in a tertiary centre over a period of 10 years.

Methods

We carried out extensive search of institutional databases to identify HR cases performed between January 2005 and December 2014. A study cohort of 9,016 patients were divided into 5 disease categories, namely hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), intrahepatic duct stone disease (IHDS), colorectal cancer liver metastasis (CRLM), and uncommon/rare diseases (URD).

Results

There were 5,661 (62.8%) HCC cases, followed by 1441 (16.0%) CRLM, 942 (10.5%) ICC, 638 (7.1%) IHDS and 334 (3.7%) URD. The number of annual HR cases gradually increased from 443 in 2005 to 1,260 in 2015. Annual HCC cases also gradually increased, but the annual proportion of HCC cases fluctuated narrowly between 58.3% and 70.2%. Annual CRLM cases increased rapidly, and their proportion increased progressively from 4.7% to 20.5%. Annual ICC cases increased slowly, and their annual proportion fluctuated between 7.2% and 15.6%. Annual IHDS cases decreased slowly, and their annual proportion decreased progressively from 17.2% to 3.4%, while annual URD cases fluctuated, with annual proportions varying between 2.3% and 5.6%.

Conclusions

Annual cases of HR increased over the last 10 years in a tertiary center probably due to a center-specific centralization effect. The number of CRLM cases increased rapidly; those of HCC and ICC increased gradually, and those of IHDS declined gradually. We believe that these results reflect real changes in the types of liver disease requiring HR.

A phase 3b study of sofosbuvir plus ribavirin in treatment-naive and treatment-experienced Korean patients chronically infected with genotype 2 hepatitis C virus

In Korea, patients with chronic hepatitis C virus (HCV) infection are typically treated with pegylated interferon-alpha plus ribavirin, but interferons are contraindicated in many patients and are often poorly tolerated, particularly by the elderly and those with advanced liver disease. No interferon-free treatment regimens are approved in Korea. Sofosbuvir is an oral nucleotide analog inhibitor of the HCV nonstructural 5B RNA polymerase. It is approved in the USA, European Union and Japan for treating a number of HCV genotypes, including genotype 2. Genotype 2 has a seroprevalence of 38-46% in Korea. This single-arm, phase 3b study (NCT02021643) examined the efficacy and safety of sofosbuvir plus ribavirin (12-week duration) in chronic genotype 2 HCV-infected treatment-naive and treatment-experienced Korean patients with and without cirrhosis. The proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12) was 97% (125/129), with 96% (101/105) of treatment-naive and 100% (24/24) of treatment-experienced patients achieving SVR12. Two patients experienced virologic failure (n = 1, on-treatment failure; n = 1, relapse). No patient discontinued study treatment due to an adverse event (AE). The most common treatment-emergent AEs were headache (18%, 23/129) and pruritus (15%, 19/129). Few patients had grade 3 AEs (5%, 6/129) or grade 3 laboratory abnormalities (12%, 15/129). No grade 4 AE was reported. These data suggest that 12 weeks of treatment with the all-oral, interferon-free regimen of sofosbuvir plus ribavirin is effective and well tolerated in Korean patients with chronic genotype 2 HCV infection.

A quasi-steady aerodynamic model for flapping flight with improved adaptability

An improved quasi-steady aerodynamic model for flapping wings in hover has been developed. The purpose of this model is to yield rapid predictions of lift generation and efficiency during the design phase of flapping wing micro air vehicles. While most existing models are tailored for a specific flow condition, the present model is applicable over a wider range of Reynolds number and Rossby number. The effects of wing aspect ratio and taper ratio are also considered. The model was validated by comparing against numerical simulations and experimental measurements. Wings with different geometries undergoing distinct kinematics at varying flow conditions were tested during validation. Generally, model predictions of mean force coefficients were within 10% of numerical simulation results, while the deviations in power coefficients could be up to 15%. The deviation is partly due to the model not taking into consideration the initial shedding of the leading-edge vortex and wing-wake interaction which are difficult to account under quasi-steady assumption. The accuracy of this model is comparable to other models in literature, which had to be specifically designed or tuned to a narrow range of operation. In contrast, the present model has the advantage of being applicable over a wider range of flow conditions without prior tuning or calibration, which makes it a useful tool for preliminary performance evaluations.

Improved survival after palliative resection of unsuspected stage IV pancreatic ductal adenocarcinoma

BACKGROUND

Palliative resection of stage IV pancreatic ductal adenocarcinoma (PDAC) has not shown its benefit until now. In our retrospective review, we compared the results of palliative resection to non-resection.

METHODS

Between 2000 and 2009, metastasis of PDAC was confirmed in the operating room in 150 patients. 35 underwent palliative resection (resection group; R) and 115 did bypass or biopsy. 35 patients (biopsy or bypass group: NR) in the 115 patients were matched with the patients undergoing resection for tumor size and the metastasis of peritoneal seeding. Demographic, clinical, operative data and survival were analyzed.

RESULTS

There was no significant difference of major complication (Clavien-Dindo classification 3-5) between two groups. There was no 30-day mortality in either group. More patients in R received postoperative chemotherapy (82.9% vs. 57.1%; P = 0.019). Multivariate analysis showed resection and postoperative chemotherapy as independent factor related to survival (hazard ratio, 0.44; 95% CI, 0.25-0.76; P = 0.003). Patients in R showed better survival rates compared to those in NR (P < 0.001).

CONCLUSION

Our study suggests resection for stage IV PDAC can be associated with increased survival. In patients of stage IV PDAC, palliative resection with chemotherapy could have some benefit in selected patients.

Methyl syringate, a TRPA1 agonist represses hypoxia-induced cyclooxygenase-2 in lung cancer cells

BACKGROUND

We have previously found that methyl syringate is a specific and selective agonist of the human transient receptor potential channel ankyrin 1 (TRPA1) and suppresses food intake and gastric emptying in imprinting control region mice. Because TRPA1 has been implicated in inflammatory responses, and inflammation and tumorigenesis are stimulated by the cyclooxygenase-2 (COX-2)/prostaglandin E2 pathway in hypoxic cancer cells.

PURPOSE

This study examined the effects of methyl syringate on hypoxia-induced COX-2 in human distal lung epithelial A549 cells.

STUDY DESIGN

The effect of the methyl syringate on suppression of hypoxia-induced COX-2 in A549 cells were determined by Western blot and/or quantitative real-time polymerase chain reaction. The anti-invasive effect of methyl syringate was evaluated on A549 cells using matrigel invasion assay.

RESULTS

Methyl syringate suppressed hypoxia-induced COX-2 protein and mRNA expression and promoter activity and reduced hypoxia-induced cell migration and invasion and secretion of vascular endothelial growth factor. These effects were antagonized by a TRPA1 antagonist, implying their mediation by the TRPA1 pathway.

CONCLUSION

Together, these results indicate that methyl syringate inhibits the hypoxic induction of COX-2 expression and cell invasion through TRPA1 activation. These findings suggest that methyl syringate could be effective to suppress hypoxia-induced inflammation and indicate an additional functional effect of methyl syringate.

SHM-Based Probabilistic Fatigue Life Prediction for Bridges Based on FE Model Updating

Fatigue life prediction for a bridge should be based on the current condition of the bridge, and various sources of uncertainty, such as material properties, anticipated vehicle loads and environmental conditions, make the prediction very challenging. This paper presents a new approach for probabilistic fatigue life prediction for bridges using finite element (FE) model updating based on structural health monitoring (SHM) data. Recently, various types of SHM systems have been used to monitor and evaluate the long-term structural performance of bridges. For example, SHM data can be used to estimate the degradation of an in-service bridge, which makes it possible to update the initial FE model. The proposed method consists of three steps: (1) identifying the modal properties of a bridge, such as mode shapes and natural frequencies, based on the ambient vibration under passing vehicles; (2) updating the structural parameters of an initial FE model using the identified modal properties; and (3) predicting the probabilistic fatigue life using the updated FE model. The proposed method is demonstrated by application to a numerical model of a bridge, and the impact of FE model updating on the bridge fatigue life is discussed.

Cutaneous involvement of disseminated adenovirus infection in an allogeneic stem cell transplant recipient

Infection by human adenoviruses can lead to significant morbidity and mortality in immunocompromised hosts, such as allogeneic stem cell transplant (SCT) recipients, with limited effective treatment options. Specific cutaneous manifestations of disseminated adenovirus infection are not well described. We report a woman in her twenties who received an allogeneic T-cell-depleted peripheral blood SCT for the treatment of severe aplastic anaemia and, 5 months post-transplant, was hospitalized for severe systemic adenovirus infection with progressive involvement of the colon, liver and lungs. Despite therapy with intravenous cidofovir, oral brincidofovir and intravenous immunoglobulin, she had progression of adenoviraemia and dissemination of adenoviral disease. The patient developed a progressive rash characterized by keratotic papules that began on the palms and soles and spread to the entire body. Histopathological examination of skin biopsies of individual skin lesions from the palm and abdomen showed focal acantholytic dyskeratosis and keratinocytes with hyperchromatic nuclei. Several keratinocyte nuclei were immunoreactive for adenovirus. The patient was further treated with ribavirin and adenovirus-specific cytotoxic T lymphocytes but experienced multisystem progression of adenovirus infection culminating in death.

A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients

Background

Preservation of the spleen in distal pancreatectomy has recently attracted considerable attention. Our current study aimed in the first instance to define the safety of lap-WT in relation to the capacity of this technique to achieve preservation of the spleen and secondly to investigate the effectiveness of a planned lap-WT procedure or early conversion to lap-WT in selected patients with a large tumor attached to the splenic vessels.

Methods

Among 1056 patients who underwent a laparoscopic distal pancreatectomy between January 2005 and December 2014 at our hospital, 122 (24.6 %) underwent lap-WT which were analyzed. The 122 patients were categorized into two groups chronologically (early group: 2005–2012, late group: 2013–2014).

Results

The median follow-up was 35 months, and the median operation time was 181 min. The median postoperative hospital stay was 7 days, and the median estimated blood loss was 316 ml. Postoperative complications occurred in 9 patients (7.3 %), including 4 patients (3.2 %) with major pancreatic fistula (ISGPF grade B, C). A reoperation to address postoperative bleeding was needed in one patient. During a median follow-up of 35 months, there were no clinical significant splenic infarctions or gastric varices in any case. All patients were observed conservatively. In patients in the late group who underwent the lap-WT, the mean operating time (171 vs. 205 min, p = 0.001) and mean estimated blood loss (232.1 vs. 370.0 ml, p = 0.017) were significantly less than the early group cases who received lap-WT.

Conclusions

A lap-WT is a safe treatment strategy in select cases when used as a way of preserving the spleen. When splenic vessel preservation is technically challenging, for example when the tumor is enlarged or is attached to the splenic vessels, planned lap-WT or early conversion to lap-WT may be a feasible option.

Incarceration of gravid uterus by growing subserosal myoma: case report

Incarceration of gravid uterus is a rare condition, occurring in one in 3,000 to 10,000 pregnancies during second trimester. Incarceration of uterus can cause several complications, such as uterine rupture, labor dystocia, and uncontrollable postpartum hemorrhage. Early diagnosis is important to prevent these complications, but there are no standard treatments of incarceration of gravid uterus. The authors present a case report of incarceration of gravid uterus caused by growing subserosal myoma, which was treated with myomectomy during second trimester.

Comparison of Inner Ear Contrast Enhancement among Patients with Unilateral Inner Ear Symptoms in MR Images Obtained 10 Minutes and 4 Hours after Gadolinium Injection

BACKGROUND AND PURPOSE

Recently 4-hour delayed-enhanced 3D-FLAIR MR imaging has been used in pathophysiologic analysis of the inner ear in many auditory diseases, including sudden sensorineural hearing loss, but comparison among different time points is not clear in patients with unilateral inner ear symptoms. We compared the signal-intensity ratios of the inner ears in patients with unilateral inner ear symptoms on 10-minute delayed-enhanced and 4-hour delayed-enhanced 3D-FLAIR MR images after IV gadolinium injection.

MATERIALS AND METHODS

The 10-minute delayed-enhanced and 4-hour delayed-enhanced 3D-FLAIR MR images were retrospectively analyzed. Signal-intensity ratios between the cerebellum and inner ear structures, such as the cochleae, vestibules, and vestibulocochlear nerve were assessed. Multiple comparisons were performed.

RESULTS

Signal-intensity ratios of the affected cochleae, vestibules, and vestibulocochlear nerve were higher than those of unaffected sides in both 10-minute delayed-enhanced and 4-hour delayed-enhanced images. At the affected side, signal-intensity ratios of the vestibulocochlear nerve were higher in patients with nonsudden sensorineural hearing loss than in those with sudden sensorineural hearing loss on both 10-minute delayed-enhanced and 4-hour delayed-enhanced images. The signal-intensity ratios of some affected inner ear structures were higher than those of the unaffected sides in a group of 30 patients with sudden sensorineural hearing loss and 20 patients with nonsudden sensorineural hearing loss on 10-minute delayed-enhanced and 4-hour delayed-enhanced images.

CONCLUSIONS

Signal-intensity ratios of the inner ear show statistically significant increases in many diseases, especially neuritis, in 10-minute delayed-enhanced and 4-hour delayed-enhanced images. The 4-hour delayed-enhanced images may be superior in neural inflammatory-dominant conditions, while 10-minute delayed-enhanced images may be superior in neural noninflammatory-dominant conditions.

Perioral soft tissue evaluation of skeletal Class II Division 1: A lateral cephalometric study

INTRODUCTION

To obtain the balance and harmony of the soft tissue facial profile in orthodontic treatment, it is necessary to identify the characteristics of overlying soft tissues according to the horizontal and vertical skeletal patterns. The aim of this study was to evaluate the perioral soft tissue characteristics of skeletal Class II Division 1 subjects (group II) with various vertical patterns compared with skeletal Class I subjects (group I).

METHODS

Lateral cephalograms of 99 Korean adults (44 women, 45 men; mean age, 23.4 years) were divided into 4 groups based on horizontal and vertical skeletal pattern (SN-MP angle): group I, 22 subjects; group II-low angle (<27°), 14 subjects; group II-normal angle (27°-36°), 33 subjects; and group II-high angle (>37°), 30 subjects. The correlations and multiple linear regression tests were used to determine the skeletal and dental variables influencing soft tissue characteristics.

RESULTS

Group II-high angle showed significantly greater values than did group II-low angle for basic lower lip thickness and lower lip length. The perioral soft tissue measurements of group II were correlated with the inclination and anteroposterior position of the maxillary and mandibular incisors along with facial depth (N-Go) and facial length (S-Gn). Upper lip strain of group II was not influenced by any skeletal variables but only by the inclination and anteroposterior position of the maxillary incisors.

CONCLUSIONS

Clinicians need to evaluate lip strain and lip thickness based on the skeletal pattern as well as dental inclination to obtain balance in the perioral muscle activity.

The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM®) analysis

We evaluated changes in rotational thromboelastometry (ROTEM(®) ) parameters and clinical outcomes in patients undergoing total hip replacement arthroplasty, with concomitant infusions of tranexamic acid and of 6% hydroxyethyl starch 130/0.4. Fifty-five patients were randomly assigned to either the tranexamic acid (n = 29) or the control (n = 26) group. Hydroxyethyl starch was administered in the range of 10-15 ml.kg(-1) during the operation in both groups. In the control group, the clot formation time and maximum clot firmness of APTEM showed significant differences when compared with those of EXTEM at one hour postoperatively, suggestive of fibrinolysis. In the tranexamic acid group, there was no significant difference between each postoperative EXTEM and APTEM parameter. In the tranexamic acid and control group, postoperative blood loss was 308 ml (210-420 [106-745]) and 488 ml (375-620 [170-910], p = 0.002), respectively, and total blood loss was 1168 ml (922-1470 [663-2107]) and 1563 ml (1276-1708 [887-1494], p = 0.003). Haemoglobin concentration was higher in the tranexamic acid group on the second postoperative day (10.5 (9.4-12.1 [7.9-14.0]) vs. 9.6 (8.9-10.5[7.3-16.0]) g.dl(-1) , p = 0.027). In patients undergoing total hip replacement arthroplasty, postoperative fibrinolysis aggravated by hydroxyethyl starch was attenuated by co-administration of 10 mg.kg(-1) tranexamic acid, which may have led to less postoperative blood loss.

Initial human experience of endoscopic ultrasound-guided photodynamic therapy with a novel photosensitizer and a flexible laser-light catheter

BACKGROUND AND STUDY AIMS

New methods for the endoscopic selective ablation of locally advanced pancreaticobiliary malignancies as a minimally invasive approach are needed. Our aim was to examine the feasibility and safety of endoscopic ultrasonography (EUS)-guided photodynamic therapy (PDT) for local tumor control in patients with locally advanced pancreaticobiliary malignancies.

PATIENTS AND METHODS

A chlorin e6 derivative and a flexible laser-light catheter were used to perform EUS-guided PDT in four patients with locally advanced pancreaticobiliary malignancies.

RESULTS

EUS-guided PDT was technically feasible in all four patients with locally advanced pancreaticobiliary malignancies (two in the caudate lobe of the liver, one in the far distal bile duct, and one in the tail of the pancreas). No treatment-related complications occurred. The median volume of necrosis produced by PDT was 4.0 cm(3) (range 0.7 - 11.3). Disease remained stable in all four patients during a median follow-up of 5 months (range 3 - 7).

CONCLUSION

These preliminary data suggest that EUS-guided PDT with a second-generation photosensitizer and a flexible laser probe is feasible and safe.

The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents

BACKGROUND/OBJECTIVES

The use of dietary supplements (DSs) by children and adolescents is increasing. The aim of this study was to identify the characteristics of DS users and examine the nutritional contributions of DSs to total nutrient intakes in children and adolescents, using data obtained from a national survey.

SUBJECTS/METHODS

In total, 3134 subjects aged 9-18 years who participated in the 4th Korea National Health and Nutrition Examination Survey (2007-2009) were selected; the survey included 24-h recall questions on food intake and questions on DS use over the past year. Nutrient intakes from DSs were calculated using the aid of a label-based database on such supplements, and individual total nutrient intakes were derived by combining information on the foods and DSs consumed by each subject.

RESULTS

There were 895 DS users (28.5%), 85.2% of whom (n=577) had complete DS nutrient information and were therefore defined as identified-DS users. Identified-DS users were slightly younger and had a greater household income and better nutritional knowledge than did non-users. The most frequently consumed type of supplement was a 'multivitamin and minerals' complex. For total nutrient intake, identified-DS users had a significantly higher intake of most of the nutrients, except for macronutrient and sodium than non-users. In all identified-DS users, the contribution of vitamins and minerals from DSs to total nutrient intake was higher than energy and macronutrients.

CONCLUSIONS

DS use by children and adolescents can improve micronutrient status, but it also increases the risk of excessive intake of certain vitamins and minerals.

Branch duct intraductal papillary mucinous neoplasm of the pancreas: single-center experience with 324 patients who underwent surgical resection

Backgrounds/Aims

International treatment guidelines for branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas have been proposed, for features associated with malignancy and invasiveness. We investigated the clinicopathological characteristics that are predictive of malignancy or invasiveness and disease recurrence.

Methods

A review of 324 patients with resected and pathologically confirmed BD-IPMN, between March 1997 and December 2013, was conducted.

Results

There were 144 (44.4%) low grade dysplasia (LGD), 138 (42.6%) intermediate grade dysplasia (IMGD), 17 (5.3%) high grade dysplasia (HGD), and 25 (7.7%) invasive carcinoma (invIPMC) cases. The 5-year survival rates were 98.1% for LGD, 95.3% for IMGD, 100% for HGD, and 71.8% for invIPMC. Through a univariate analysis, the male sex was associated with malignancy, and CA19-9 was related to both malignant and invasive IPMN. The high risk or worrisome features of the international guidelines were associated with both malignant and invasive IPMN: the total bilirubin of the head/uncinate lesion, tumor size, mural nodule, and the size of the main pancreatic duct (MPD). Through a multivariate analysis, the male sex, elevated CA19-9, mural nodule, and dilated MPD diameter were independently correlated with the malignant IPMN. The elevated CA19-9 and dilated MPD diameter were also correlated with invasive carcinoma. The patient age and the initial pathological diagnosis were strongly associated with disease recurrence following surgical resection.

Conclusions

The high risk or worrisome features in the current treatment guidelines for BD-IPMN are confined to the morphological characteristics of the disease. Patient factors and biological features should also be considered in order to develop optimal therapeutic or surveillance strategies.