Circulating chemerin levels are increased in first-degree relatives of type 2 diabetic patients

BACKGROUND

Chemerin is an important risk factor of insulin resistance and metabolic syndrome. The aim of this study was to explore the potential role of chemerin in the early stage of diabetes development.

METHODS

63 control subjects without any family history of diabetes and with normal glucose tolerance (NGT) and 74 healthy, first-degree relatives (FDRs) of type 2 diabetic patients were recruited in the study. All subjects underwent a 75 g oral glucose tolerance (OGTT) test after having fasted overnight. Plasma glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, chemerin, and adiponectin were measured.

RESULTS

FDR subjects had higher BMI, WHR, waist, fasting plasma glucose, fasting insulin, TG, UA, HOMA-IR, LDL-C, and lower HDL- C levels than control subjects (p < 0.05). The FDRs group had significantly lower adiponectin levels while chemerin was higher. Plasma chemerin levels were independently correlated with HOMA-IR, FINS, TG, FPG, and adiponectin level. Multiple stepwise regression analysis showed that HOMA-IR and TG were independent risk factors that influenced circulating chemerin levels.

CONCLUSIONS

These findings showed a significant increase of chemerin levels in FDR subjects which suggested that chemerin may be involved in the development and progression of insulin resistance.

The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program

OBJECTIVE

To compare the efficacy of non-nutritive sweetened beverages (NNS) or water for weight loss during a 12-week behavioral weight loss treatment program.

METHODS

An equivalence trial design with water or NNS beverages as the main factor in a prospective randomized trial among 303 men and women was employed. All participants participated in a behavioral weight loss treatment program. The results of the weight loss phase (12 weeks) of an ongoing trial (1 year) that is also evaluating the effects of these two treatments on weight loss maintenance were reported.

RESULTS

The two treatments were not equivalent with the NNS beverage treatment group losing significantly more weight compared to the water group (5.95 kg versus 4.09 kg; P < 0.0001) after 12 weeks. Participants in the NNS beverage group reported significantly greater reductions in subjective feelings of hunger than those in the water group during 12 weeks.

CONCLUSION

These results show that water is not superior to NNS beverages for weight loss during a comprehensive behavioral weight loss program.

Interactions during feeding with mothers and their infants with symptoms of gastroesophageal reflux

OBJECTIVES

To examine whether maternal-child interaction during feedings was suboptimal in dyads in which the infant had gastroesophageal reflux disease (GERD) and to compare massage therapy to a nonmassage therapy sham treatment in improving the mother-child interaction in these dyads.

DESIGN

In this randomized, controlled pilot study, infants received massage therapy (n=18) or a nonmassage touch/holding sham treatment (n=18). Mothers, data collectors, and the investigator who scored the feeding observations were blinded to group assignment.

SETTINGS/LOCATION

Dyads were recruited from pediatric care providers in the Denver metropolitan area and online advertisements at the University of Colorado. Treatments were given in the home of the dyad.

PARTICIPANTS

Healthy infants, born at 38-42 weeks gestational age, were 5-10 weeks of age at enrollment; had a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised; and were diagnosed with GERD by their pediatric provider. Mothers were English speaking and at least 18 years of age.

INTERVENTIONS

Treatments were given for 30 minutes twice weekly for 6 weeks. A certified infant massage therapist administered massage, and a registered nurse or physical therapist experienced with infants administered the control treatment.

OUTCOME MEASURES

Maternal and infant scores on the Nursing Child Assessment of Feeding Scale (NCAFS).

RESULTS

NCAFS scores were significantly lower than national norms. Small to moderately sized effects showing improvement in the massage group relative to the nonmassage group were seen for Sensitivity to Cues, Social-Emotional Growth Fostering, Cognitive Growth Fostering, and Clarity of Cues (Cohen d) and ranged from 0.24 to 0.56.

CONCLUSIONS

Mothers and infants with GERD experience significantly worse interactions than those without GERD. Massage given twice weekly by a professional trended toward improved interaction during feeding. Daily maternal administration of massage may have a positive effect on the relationship.

Obstructive sleep apnea and hypoxemia are associated with advanced liver histology in pediatric nonalcoholic fatty liver disease

OBJECTIVE

To determine whether obstructive sleep apnea (OSA) and/or nocturnal hypoxemia are associated with the severity of liver injury in patients with pediatric nonalcoholic fatty liver disease (NAFLD).

STUDY DESIGN

Obese children aged 10-18 years with liver biopsy-proven NAFLD were enrolled. Demographic, clinical, and laboratory data were collected, polysomnography was performed, and liver histology was scored. Subjects were divided into those with OSA/hypoxemia and those without OSA/hypoxemia for analysis.

RESULTS

Of 25 subjects with NAFLD, OSA/hypoxemia was present in 15 (60%) (mean age, 12.8 ± 1.9 years; 68% male; 88% Hispanic; mean body mass index z-score, 2.3 ± 0.3). Subjects with and without OSA/hypoxemia had similar levels of serum aminotransferases, serum lipids, and inflammatory and insulin resistance markers. Although there were no differences between groups in the histological severity of steatosis, inflammation, ballooning degeneration, NAFLD activity score, or histological grade, subjects with OSA/hypoxemia had significantly more severe hepatic fibrosis. Moreover, oxygen saturation nadir during polysomnography was related to hepatic fibrosis stage (r = -0.49; P = .01) and aspartate aminotransferase level (r = 0.42; P < .05). Increasing percentage of time with oxygen saturation ≤90% was related to NAFLD inflammation grade (r = 0.44; P = .03), degree of hepatic steatosis (r = -0.50; P = .01), NAFLD activity score (r = 0.42; P = .04), aspartate aminotransferase level (r = 0.56; P = .004), and alanine aminotransferase level (r = 0.44; P = .03).

CONCLUSION

Moderate OSA/hypoxemia is common in pediatric patients with biopsy-proven NAFLD. OSA and the severity/duration of hypoxemia are associated with biochemical and histological measures of NAFLD severity.

Benefits of massage therapy for infants with symptoms of gastroesophageal reflux disease

OBJECTIVES

This randomized controlled pilot trial was conducted to evaluate the clinical efficacy of massage therapy (MT) for relief of symptoms of gastroesophageal reflux disease (GERD). The hypothesis was that, when compared to infants who received nonmassage therapy, infants who received MT would display fewer GERD symptoms, greater weight gain, greater amount of sleep, lower cortisol levels before and after treatment, and lower daily (area under the curve [AUC]) cortisol secretion.

METHODS

Participants were 36 infants born at term, 4-10 weeks of age at enrollment, healthy except for a diagnosis of GERD by their pediatrician, and with a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R). Infants were randomized to receive either MT or a nonmassage sham treatment in their homes for 30 min twice a week for 6 weeks. Data collectors and parents were blind to study condition.

RESULTS

GERD symptoms decreased in both groups and weight increased. Pretreatment salivary cortisol levels decreased significantly over time in the massage group while increasing in the nonmassage group. Daily cortisol level also decreased in the massage group and increased in the nonmassage group, but the difference was not significant.

CONCLUSIONS

MT administered by a professional therapist did not affect symptoms of GERD differently than a sham treatment but did decrease infant stress as measured by cortisol. Research focusing on stress reduction in infants with GERD and multimodal treatments addressing GERD symptoms may yield the most effective treatment.

Laryngeal view and temperature measurements while using the perilaryngeal airway (Cobra-PLUS™) in children

INTRODUCTION

The Cobra-PLUS™ perilaryngeal airway (CP) is a modification of the Cobra perilaryngeal airway. It has a distal curve for easier placement and a thermistor on the pharyngeal cuff. We assessed the orientation of the larynx to the CP and compared temperatures measured using CP to temporal arterial (TA) and infrared tympanic (T) thermometers.

METHODOLOGY

American Society of Anesthesiologists (ASA) physical status 1 and 2 children 0-18 years old undergoing general anesthesia using CP were grouped into different weight cohorts. A fiberoptic scope was inserted through the CP, and laryngeal views were recorded and graded off line. Temperatures were measured from the CP, TA, and T at 15-min intervals for four readings or until the end of surgery. The CP was removed, while the patient was deeply anesthetized.

RESULTS

Eighty subjects were analyzed. 87.5% (cohort range 75-95%) had an unobstructed view of the larynx. No serious adverse effects noted. Three hundred and sixteen temperature data points were recorded for each measured site. CP temperatures were consistently lower than TA and T with a bias of 0.9 and 0.6°C, respectively. Using temperatures measured at time 0 and 15 min, CP was associated with a larger intraclass correlation coefficient and smaller repeatability coefficient when compared to TA or T (ICC 0.65, 0.46. 0.44 and RC 0.78, 1, 1.36, respectively), indicating it had a better measure and remeasure reliability.

CONCLUSION

The CP has a better orientation to the larynx compared with its previous version. It may be used to reliably trend intraoperative temperatures.

The oesophageal string test: a novel, minimally invasive method measures mucosal inflammation in eosinophilic oesophagitis

OBJECTIVE

Eosinophil predominant inflammation characterises histological features of eosinophilic oesophagitis (EoE). Endoscopy with biopsy is currently the only method to assess oesophageal mucosal inflammation in EoE. We hypothesised that measurements of luminal eosinophil-derived proteins would correlate with oesophageal mucosal inflammation in children with EoE.

DESIGN

The Enterotest diagnostic device was used to develop an oesophageal string test (EST) as a minimally invasive clinical device. EST samples and oesophageal mucosal biopsies were obtained from children undergoing upper endoscopy for clinically defined indications. Eosinophil-derived proteins including eosinophil secondary granule proteins (major basic protein-1, eosinophil-derived neurotoxin, eosinophil cationic protein, eosinophil peroxidase) and Charcot-Leyden crystal protein/galectin-10 were measured by ELISA in luminal effluents eluted from ESTs and extracts of mucosal biopsies.

RESULTS

ESTs were performed in 41 children with active EoE (n=14), EoE in remission (n=8), gastro-oesophageal reflux disease (n=4) and controls with normal oesophagus (n=15). EST measurement of eosinophil-derived protein biomarkers significantly distinguished between children with active EoE, treated EoE in remission, gastro-oesophageal reflux disease and normal oesophagus. Levels of luminal eosinophil-derived proteins in EST samples significantly correlated with peak and mean oesophageal eosinophils/high power field (HPF), eosinophil peroxidase indices and levels of the same eosinophil-derived proteins in extracts of oesophageal biopsies.

CONCLUSIONS

The presence of eosinophil-derived proteins in luminal secretions is reflective of mucosal inflammation in children with EoE. The EST is a novel, minimally invasive device for measuring oesophageal eosinophilic inflammation in children with EoE.

The hemodynamic response to dexmedetomidine loading dose in children with and without pulmonary hypertension

BACKGROUND

Dexmedetomidine, an α-2 receptor agonist, is widely used in children with cardiac disease. Significant hemodynamic responses, including systemic and pulmonary vasoconstriction, have been reported after dexmedetomidine administration. Our primary goal of this prospective, observational study was to quantify the effects of dexmedetomidine initial loading doses on mean pulmonary artery pressure (PAP) in children with and without pulmonary hypertension.

METHODS

Subjects were children undergoing cardiac catheterization for either routine surveillance after cardiac transplantation (n = 21) or pulmonary hypertension studies (n = 21). After anesthetic induction with sevoflurane and tracheal intubation, sevoflurane was discontinued and anesthesia was maintained with midazolam 0.1 mg/kg i.v. (or 0.5 mg/kg orally preoperatively) and remifentanil i.v. infusion 0.5 to 0.8 μg/kg/min. Ventilation was mechanically controlled to maintain PCO2 35 to 40 mm Hg. When end-tidal sevoflurane was 0% and fraction of inspired oxygen (FIO2) was 0.21, baseline heart rate, mean arterial blood pressure, PAP, right atrial pressure, pulmonary artery occlusion pressure, right ventricular end-diastolic pressure, cardiac output, and arterial blood gases were measured, and indexed systemic vascular resistance, indexed pulmonary vascular resistance, and cardiac index were calculated. Each subject then received a 10-minute infusion of dexmedetomidine of 1 μg/kg, 0.75 μg/kg, or 0.5 μg/kg. Measurements and calculations were repeated at the conclusion of the infusion.

RESULTS

Most hemodynamic responses were similar in children with and without pulmonary hypertension. Heart rate decreased significantly, and mean arterial blood pressure and indexed systemic vascular resistance increased significantly. Cardiac index did not change. A small, statistically significant increase in PAP was observed in transplant patients but not in subjects with pulmonary hypertension. Changes in indexed pulmonary vascular resistance were not significant.

CONCLUSION

Dexmedetomidine initial loading doses were associated with significant systemic vasoconstriction and hypertension, but a similar response was not observed in the pulmonary vasculature, even in children with pulmonary hypertension. Dexmedetomidine does not appear to be contraindicated in children with pulmonary hypertension.

Results of treatment of femoroacetabular impingement in adolescents with a surgical hip dislocation approach

BACKGROUND

The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress.

QUESTIONS

We assessed (1) how validated measures of patient-oriented assessment of hip function and quality of life change after surgical hip dislocation; (2) whether any patient-related or technique variables correlated with changes in the outcome scores; and (3) what the complications of treatment are and how many reoperations we performed on these patients.

METHODS

We retrospectively reviewed a consecutive series of 71 hips in adolescents younger than 21 years who underwent surgical hip dislocation for FAI. The final cohort consisted of 44 patients (52 hips) with a mean age of 16 years. We analyzed changes in outcome variables after surgical hip dislocation and recorded reoperations during the study period.

RESULTS

The minimum followup was 12 months (average, 27 months; range, 12-60 months). Modified Harris hip scores increased from a mean of 57.7 preoperatively to a mean of 85.8 postoperatively. Mean SF-12 scores increased from 42.3 to 50.6. Mean preoperative hip flexion increased from 97.5° to 106.2°. Mean internal rotation of the affected hip at 90° flexion increased from 18.19° to 34°.

CONCLUSIONS

Early results revealed improvements in hip function, patient quality of life, and ROM after surgical hip dislocation for the majority of this group of adolescents with FAI. However, 10% of the patients did not improve, and an additional 15% improved but still did not consider their hips good or excellent. This points toward the need for further studies in this population of patients.

The Crystallinity of PVC and its Effect on Physical Properties**

Differential scanning calorimetry (DSC) was used to investigate the crystallinity of crude PVC powders and annealed PVC compounds. Crude PVC powder exhibited a broad crystallite fusion endotherm ranged from 110°C to 220°C. High degree of polymerization of PVC showed high degree of crystallinity both for powder and annealed sample under the same annealing conditions. Annealing conditions (time and temperature) had large effects on recrystallization behavior of PVC. The crystallinity of PVC decreased with increasing of DOP plasticizer content in PVC compounds, and lead to decrease of modulus and increase of average molecular weight between physical crosslinks.

Intrahepatic fat is increased in the neonatal offspring of obese women with gestational diabetes

OBJECTIVES

To assess precision magnetic resonance imaging in the neonate and determine whether there is an early maternal influence on the pattern of neonatal fat deposition in the offspring of mothers with gestational diabetes mellitus (GDM) and obesity compared with the offspring of normal-weight women.

STUDY DESIGN

A total of 25 neonates born to normal weight mothers (n = 13) and to obese mothers with GDM (n = 12) underwent magnetic resonance imaging for the measurement of subcutaneous and intra-abdominal fat and magnetic resonance spectroscopy for the measurement of intrahepatocellular lipid (IHCL) fat at 1-3 weeks of age.

RESULTS

Infants born to obese/GDM mothers had a mean 68% increase in IHCL compared with infants born to normal-weight mothers. For all infants, IHCL correlated with maternal prepregnancy body mass index but not with subcutaneous adiposity.

CONCLUSION

Deposition of liver fat in the neonate correlates highly with maternal body mass index. This finding may have implications for understanding the developmental origins of childhood nonalcoholic fatty liver disease.

Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females

There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.

Identification of the antibiotic ionomycin as an unexpected peroxisome proliferator-activated receptor γ (PPARγ) ligand with a unique binding mode and effective glucose-lowering activity in a mouse model of diabetes

AIMS/HYPOTHESIS

Existing thiazolidinedione (TZD) drugs for diabetes have severe side effects. The aim of this study is to develop alternative peroxisome proliferator-activated receptor γ (PPARγ) ligands that retain the benefits in improving insulin resistance but with reduced side effects.

METHODS

We used AlphaScreen assay to screen for new PPARγ ligands from compound libraries. In vitro biochemical binding affinity assay and in vivo cell-based reporter assay were used to validate ionomycin as a partial ligand of PPARγ. A mouse model of diabetes was used to assess the effects of ionomycin in improving insulin sensitivity. Crystal structure of PPARγ complexed with ionomycin revealed the unique binding mode of ionomycin, which elucidated the molecular mechanisms allowing the discrimination of ionomycin from TZDs.

RESULTS

We found that the antibiotic ionomycin is a novel modulating ligand for PPARγ. Both the transactivation and binding activity of PPARγ by ionomycin can be blocked by PPARγ specific antagonist GW9662. Ionomycin interacts with the PPARγ ligand-binding domain in a unique binding mode with properties and epitopes distinct from those of TZD drugs. Ionomycin treatment effectively improved hyperglycaemia and insulin resistance, but had reduced side effects compared with TZDs in the mouse model of diabetes. In addition, ionomycin effectively blocked the phosphorylation of PPARγ at Ser273 by cyclin-dependent kinase 5 both in vitro and in vivo.

CONCLUSIONS/INTERPRETATION

Our studies suggest that ionomycin may represent a unique template for designing novel PPARγ ligands with advantages over current TZD drugs.

NORM situation in non-uranium mining in China

The Ministry of Environmental Protection in China is responsible for regulatory control on radiation protection from naturally occurring radioactive material (NORM). The natural radiation caused by human activities is a major contributor to public and occupational exposure in China. This paper introduces the first national census on pollution sources (target year 2007) in China, and describes NORM sites in Baotou, Inner Mongolia, one of the largest rare earth deposits in China. The ores are rich in radioactive elements, with a concentration of ThO(2) of 0.01-0.05% and concentration of U(3)O(8) of 0.0005-0.002%. The large amount of NORM residues is regulated and controlled. After treatment of the waste water, it is discharged into tailing ponds and then pumped directly to milling plants for re-use. The waste gas after off-dust cleaning is discharged into the environment. A substantial amount of blast furnace iron slag from the waste treatment is transformed into cement, concrete, and bricks, or used directly for highway construction. This raises a serious environmental concern. As a result, environmental radiation monitoring and assessment have been introduced recently. Regulatory control of NORM is very important in order to take effective measures to lower the dose.

The efficacy of intra-articular injections for pain control following the closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures: a randomized controlled trial

BACKGROUND

The purpose of this single-blinded, randomized, controlled trial was to compare the analgesic efficacy of intra-articular injections of bupivacaine or ropivacaine with that of no injection for postoperative pain control after the operative treatment of supracondylar humeral fractures in a pediatric population.

METHODS

Subjects (n=124) were randomized to treatment with 0.25% bupivacaine (Group B) (n=42), 0.20% ropivacaine (Group R) (n=39), or no injection (Group C) (n=43). The opioid doses and the times of administration as well as child-reported pain severity (Faces Pain Scale-Revised) and parent-reported pain severity (Total Quality Pain Management survey) were recorded.

RESULTS

The proportion of subjects who required morphine and/or fentanyl injections was significantly (p=0.004) lower in Group B (10%) as compared with Group R (36%) and Group C (44%). On the basis of the log-rank test, the opioid-free survival rates were significantly greater in Group B as compared to Groups C and R. Total opioid consumption (morphine equivalent mg/kg) in the first seventy-two hours postoperatively was significantly less in Group B as compared with Group C (mean difference, 0.225; [95% confidence interval (CI), 0.0152 to 0.435]; p=0.036). Parent-reported pain scores were also significantly lower in Group B as compared with both Group C (mean difference, 1.81 [95% CI, 0.38 to 3.25]; p=0.014) and Group R (mean difference, 1.66; 95% CI, 0.20 to 3.12; p=0.027). There were no significant differences across the three groups in terms of self-reported pain. Differences between Groups R and C were not significant for any of the outcome variables.

CONCLUSIONS

The intra-articular injection of 0.25% bupivacaine significantly improves postoperative pain control following the closed reduction and percutaneous pinning of supracondylar humeral fractures in pediatric patients.

Screening by pulse CO-oximetry for environmental tobacco smoke exposure in preanesthetic children

OBJECTIVE

The purpose of this study was to evaluate the ability of multiple wavelength pulse CO-oximetry (SpCO) to screen for environmental tobacco smoke (ETS) exposure in children.

BACKGROUND

Exposure to ETS is associated with an increased risk of perioperative respiratory complications in children. It is often difficult to obtain an accurate history for ETS exposure, so a preoperative screening tool is desirable. Carbon monoxide is a measurable product of tobacco combustion. Multiple wavelength pulse CO-oximetry is a recently developed point-of-care monitor.

METHODS

Following IRB approval and parental consent, 220 children aged 1-16 years having outpatient surgical procedures were enrolled. SpCO was measured preoperatively three times with the Radical-7 Rainbow SET CO-oximeter (Masimo, Irvine, CA, USA). Immediately following induction of anesthesia, a blood sample for laboratory measurement of carboxyhemoglobin (COHb) and serum cotinine was obtained. Regression analysis determined the correlation of SpCO with serum cotinine values. Receiver operator characteristic (ROC) curves analyzed the discriminating ability of SpCO or COHb to predict ETS exposure based on cotinine cutoff values known to be present in children exposed to ETS. Agreement of SpCO and COHb values was assessed using Bland-Altman plots.

RESULTS

SpCO did not correlate with cotinine (R(2) = 0.005). Both SpCO and COHb had poor discriminating ability for ETS exposure (area under the ROC curve = 0.606 and 0.562, respectively). SpCO values had poor agreement with COHb values.

CONCLUSIONS

The point-of-care multiple wavelength pulse CO-oximeter does not appear to be a useful preoperative screening tool for ETS exposure in children.

Selective hepatic vascular exclusion versus Pringle manoeuvre in liver resection for tumours encroaching on major hepatic veins

Background

Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins.

Methods

All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed.

Results

From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; P = 0·007) and transfusion requirements (mean(s.d.) 1·3(0·6) versus 2·9(1·4) units; P = 0·008) were significantly less in the SHVE group. In the Pringle group, hepatic vein injury resulted in major intraoperative bleeding of over 1000 ml in 65 patients (7·5 per cent) and air embolism in 14 (1·6 per cent), and three patients (0·3 per cent) died during surgery, whereas there was no major bleeding, air embolism or intraoperative death in the SHVE group. Postoperative liver failure, multiple organ failure and in-hospital death were significantly more common in the Pringle group (P = 0·019, P = 0·032 and P = 0·004 respectively).

Conclusion

SHVE was more efficacious than the Pringle manoeuvre in minimizing intraoperative bleeding and air embolism during partial hepatectomy for tumours encroaching on major hepatic veins, and decreased the postoperative liver failure rate.

Effect of Streptococcus sanguinis/Porphyromonas gingivalis single and combined biofilms upon platelet aggregation

OBJECTIVE

To assess the effect of two oral bacteria Streptococcus sanguinis and Porphyromonas gingivalis upon platelet aggregation.

MATERIALS AND METHODS

Streptococcus sanguinis, P. gingivalis, S. sanguniis+P. gingivalis were added to platelet-rich plasma and platelet aggregation measured using a platelet aggregometer. Platelets were passed through a flow chamber with S. sanguinis, P. gingivalis or a biofilm of S. sanguinis and P. gingivalis coated with saliva. Platelet adhesion to the chamber was observed under a fluorescence microscope for 15min. The positive control was platelets treated with adrenaline; the negative control was platelets treated with phosphate-buffered saline.

RESULTS

The mean (± s.e.) aggregation magnitude of S. sanguinis and P. gingivalis was 77.7±7.4% and 79.3±9.9%, respectively. The aggregation magnitude of S. sanguinis+P. gingivalis was 51.3±12.9%, which was significantly lower than that for S. sanguinis/P. gingivalis (P<0.05). In the flow chamber system, platelets adhered to S. sanguinis/P.gingivalis respectively within 3min, and reached a plateau at 5-15min. Under the condition of the S. sanguinis- and P. gingivalis-saliva biofilm, platelet adhesion to the biofilm was significantly reduced at 5-15min (P<0.05).

CONCLUSIONS

In the static or dynamic flow system, platelets adhered to S. sanguinis or P. gingivalis. However, if S. sanguinis was mixed with P. gingivalis, the aggregation magnitude (%) was significantly reduced.

Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation

The objective of this study was to determine the impact of parenteral nutrition (PN) on the outcomes of biliary atresia (BA) patients listed for liver transplantation (LT). We retrospectively reviewed the charts of all BA patients at our institution who underwent hepatoportoenterostomy and were listed for LT before the age of 36 months between 1990 and 2010. The initiation of PN was based on clinical indications. Twenty-five PN subjects and 22 non-PN subjects (74% female) were studied. The median PN initiation age was 7.7 months, the mean duration was 86 days, and the mean amount of energy supplied by PN was 77 kcal/kg/day. Before PN, the triceps skinfold thickness (TSF) and the mid-arm circumference (MAC) z scores were decreasing. After PN, TSF (P < 0.001) and MAC (P < 0.001) improved significantly. The PN group had lower MAC and TSF scores than the non-PN group at the time of LT listing. Between listing and LT, MAC and TSF improved in the PN group and worsened in the non-PN groups; as a result, the 2 groups had the same z scores at LT. The PN group had a higher incidence of gastrointestinal bleeding and ascites before LT, but there were no differences in the rates of pre-LT bacteremia, days in the intensive care unit after LT, or patient or graft survival. In conclusion, PN improves the nutritional status of malnourished BA patients awaiting LT, and this is associated with post-LT outcomes comparable to those of patients not requiring PN.