The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year

Purpose Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up. Methods This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively. Results Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001). Conclusion The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment

Value of virtual monochromatic spectral image of dual-layer spectral detector CT with noise reduction algorithm for image quality improvement in obese simulated body phantom

Background Dual-layer spectral detector CT (SDCT) may provide several theoretical advantages over pre-existing DECT approaches in terms of adjustment-free sampling number and dose modulation, beam hardening correction, and production spectral images by post-processing. In addition, by adopting noise reduction algorithm, high contrast resolution was expected even in low keV level. We surmised that this improvement would be beneficial to obese people. Therefore, our aim of study is to compare image quality of virtual monochromatic spectral images (VMI) and polychromatic images reconstructed from SDCT with different body size and radiation dose using anthropomorphic liver phantom. Methods One small and one large size of body phantoms, each containing eight (four high- and four low-contrast) simulated focal liver lesions (FLLs) were scanned by SDCT (at 120 kVp) using different Dose Right Indexes (DRIs). VMI were reconstructed from spectral base images from 40 keV to 200 keV. Hybrid iterative reconstruction (iDose4) was used for polychromatic image reconstruction. Image noise and contrast to noise ratio (CNR) were compared. Five radiologists independently rated lesion conspicuity, diagnostic acceptability and subjective noise level in every image sets, and determined optimal keV level in VMI. Results Compare with conventional polychromatic images, VMI showed superior CNR at low keV level regardless of phantom size at every examined DRIs (Ps < 0.05). As body size increased, VMI had more gradual CNR decrease and noise increase than conventional polychromatic images. For low contrast FLLs in large phantom, lesion conspicuities at low radiation dose levels (DRI 16 and 19) were significantly increased in VMI (Ps < 0.05). Subjective image noise and diagnostic acceptabilities were significantly improved at VMI in both phantom size. Conclusions VMI of dual-layer spectral detector CT with noise reduction algorithm provides improved CNR, noise reduction, and better subjective image quality in imaging of obese simulated liver phantom compared with polychromatic images. This may hold promise for improving detection of liver lesions and improved imaging of obese patients.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Induction of transforming growth factor-beta 1 by androgen is mediated by reactive oxygen species in hair follicle dermal papilla cells

The progression of androgenetic alopecia is closely related toandrogen-inducible transforming growth factor (TGF)-β1 secretionby hair follicle dermal papilla cells (DPCs) in bald scalp.Physiological levels of androgen exposure were reported toincrease reactive oxygen species (ROS) generation. In thisstudy, rat vibrissae dermal papilla cells (DP-6) transfected withandrogen receptor showed increased ROS production followingandrogen treatment. We confirmed that TGF-β1 secretion isincreased by androgen treatment in DP-6, whereas androgeninducibleTGF-β1 was significantly suppressed by the ROSscavenger,N-acetyl cysteine. Therefore, we suggest that inductionof TGF-β1 by androgen is mediated by ROS in hair follicleDPCs.This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant No. A103017) and partially by a research agreement with AmorePacific Corporation, Republic of Korea.OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000045457/8SEQ:8PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000045457ADJUST_YN:NEMP_ID:A079130DEPT_CD:801CITE_RATE:1.634FILENAME:(460-464)bmb 12-228.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

A pathogen-derived metabolite induces microglial activation via odorant receptors

Microglia (MG), the principal neuroimmune sentinels in the brain, continuously sense changes in their environment and respond to invading pathogens, toxins, and cellular debris, thereby affecting neuroinflammation. Microbial pathogens produce small metabolites that influence neuroinflammation, but the molecular mechanisms that determine whether pathogen-derived small metabolites affect microglial activation of neuroinflammation remain to be elucidated. We hypothesized that odorant receptors (ORs), the largest subfamily of G protein-coupled receptors, are involved in microglial activation by pathogen-derived small metabolites. We found that MG express high levels of two mouse ORs, Olfr110 and Olfr111, which recognize a pathogenic metabolite, 2-pentylfuran, secreted by Streptococcus pneumoniae. These interactions activate MG to engage in chemotaxis, cytokine production, phagocytosis, and reactive oxygen species generation. These effects were mediated through the G(alpha s)-cyclic adenosine monophosphate-protein kinase A-extracellular signal-regulated kinase and G(beta gamma)-phospholipase C-Ca2+ pathways. Taken together, our results reveal a novel interplay between the pathogen-derived metabolite and ORs, which has major implications for our understanding of microglial activation by pathogen recognition. Database Model data are available in the PMDB database under the accession number PM0082389.N

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prohexadione-Calcium Application during Vegetative Growth Affects Growth of Mother Plants, Runners, and Runner Plants of Maehyang Strawberry

Strawberry (Fragaria &#215; ananassa Duch.) is an important horticultural crop that is vegetatively propagated using runner plants. To achieve massive production of runner plants, it is important to transfer the assimilation products of the mother plant to the runner plants, and not to the runner itself. Application of prohexadione&#8211;calcium (Pro&#8211;Ca), a plant growth retardant with few side effects, to strawberry is effective in inhibiting transport of assimilates to runners. This study aimed to determine the optimum application method and concentration of Pro&#8211;Ca on the growth characteristics of mother plants, runners, and runner plants for the propagation of strawberry in nurseries. Pro&#8211;Ca was applied at the rate of 0, 50, 100, 150, or 200 mg&#183;L&#8722;1 (35 mL per plant) to plants via foliar spray or drenching under greenhouse conditions at 30 days after transplantation. Petiole lengths of mother plants were measured 15 weeks after treatment; growth was suppressed at the higher concentrations of Pro&#8211;Ca regardless of the application method. However, the crown diameter was not significantly affected by the application method or Pro&#8211;Ca concentration. The number of runners was 7.0 to 8.2, with no significant difference across treatments. Runner length was shorter at higher concentrations of Pro&#8211;Ca, especially in the 200 mg&#183;L&#8722;1 drench treatment. However, fresh weight (FW) and dry weights (DW) of runners in the 50 mg&#183;L&#8722;1 Pro&#8211;Ca drench treatments were higher than controls. Foliar spray and drench treatments were more effective for runner plant production than the control; a greater number of runner plants were produced with the 100 and 150 mg&#183;L&#8722;1 Pro&#8211;Ca foliar spray treatment and the 50 and 100 mg&#183;L&#8722;1 drench treatment. The FW and DW of the first runner plant was not significantly different in all treatments, but DW of the second runner plant, and FW and DW of the third runner plant were greatest in the 50 mg&#183;L&#8722;1 Pro&#8211;Ca drench treatment. These results suggested that growth and production of runner plants of Maehyang strawberry were greatest under the 50 mg&#183;L&#8722;1 Pro&#8211;Ca drench treatment

Reappraisal of the Lymphatic Drainage System of the Distal Rectum: Functional Lymphatic Flow into the Presacral Space and Its Clinical Implication in Rectal Cancer Treatment

Understanding the source and route of pelvic metastasis is essential to developing an optimal strategy for controlling local and systemic diseases of rectal cancer. This study aims to delineate the distribution of lymphatic channels and flow from the distal rectum. In fresh-frozen cadaveric hemipelvis specimens, the ligamentous attachment of the distal rectum to the pelvic floor muscles and the presacral fascia were evaluated. Using indocyanine green (ICG) fluorescence imaging, we simultaneously evaluated the gross anatomy of the lymphatic communication of the distal rectum. We also investigated the lymphatic flow in the pelvic cavity intraoperatively in rectal cancer patients who underwent radical rectal resection with total mesorectal excision (TME). In fresh cadavers, multiple small perforating lymphovascular branches exist in the retrorectal space, posteriorly connecting the mesorectum to the presacral fascia. The lymphatic flow from the distal rectum drains directly into the presacral space through the branches. In patients who underwent TME for rectal cancer, intraoperative ICG fluorescence signals were seen in the pelvic sidewalls and the presacral space. This anatomical study demonstrated that the lymphatic flow from the distal rectum runs directly to the pelvic lateral sidewalls and the presacral space, suggesting a possible route of metastasis in distal rectal cancer

Assessment of Colorectal Anastomosis with Intraoperative Colonoscopy: Its Role in Reducing Anastomotic Complications

The use of intraoperative colonoscopy (IOC) to evaluate the integrity of newly created anastomosis has been advocated by some surgeons. However, whether direct visualization of fresh anastomosis can help reduce anastomotic problems is still unclear. This study investigates the impact of immediate endoscopic assessment of colorectal anastomosis on anastomotic problems. This is a retrospective study conducted at a single center. Among six hundred forty-nine patients who underwent stapled anastomosis for left-sided colorectal cancer, the anastomotic complications were compared between patients who underwent IOC and those who did not. Additionally, patients with subsequent intervention after the IOC were compared to those without the intervention. Twenty-seven patients (5.0%) developed anastomotic leakage, and six (1.1%) experienced anastomotic bleeding postoperatively. Of the patients with IOC, 70 patients received reinforcement sutures to secure anastomotic stability. Of 70 patients, 39 patients showed abnormal findings in IOC. Thirty-seven patients (94.9%) who underwent reinforcement sutures did not develop postoperative anastomotic problems. This study demonstrates that IOC assessment with reinforcement sutures does not imminently reduce the rate of anastomotic complications. However, its use may play a role in detecting early technical failure and preventing postoperative anastomotic complications

Reappraisal of the Lymphatic Drainage System of the Distal Rectum: Functional Lymphatic Flow into the Presacral Space and Its Clinical Implication in Rectal Cancer Treatment

Understanding the source and route of pelvic metastasis is essential to developing an optimal strategy for controlling local and systemic diseases of rectal cancer. This study aims to delineate the distribution of lymphatic channels and flow from the distal rectum. In fresh-frozen cadaveric hemipelvis specimens, the ligamentous attachment of the distal rectum to the pelvic floor muscles and the presacral fascia were evaluated. Using indocyanine green (ICG) fluorescence imaging, we simultaneously evaluated the gross anatomy of the lymphatic communication of the distal rectum. We also investigated the lymphatic flow in the pelvic cavity intraoperatively in rectal cancer patients who underwent radical rectal resection with total mesorectal excision (TME). In fresh cadavers, multiple small perforating lymphovascular branches exist in the retrorectal space, posteriorly connecting the mesorectum to the presacral fascia. The lymphatic flow from the distal rectum drains directly into the presacral space through the branches. In patients who underwent TME for rectal cancer, intraoperative ICG fluorescence signals were seen in the pelvic sidewalls and the presacral space. This anatomical study demonstrated that the lymphatic flow from the distal rectum runs directly to the pelvic lateral sidewalls and the presacral space, suggesting a possible route of metastasis in distal rectal cancer

Using Light Quality for Growth Control of Cucumber Seedlings in Closed-Type Plant Production System

During seedling production, growth control of seedlings is an important problem because the overgrowth of seedlings causes a decrease of seedling quality and has disadvantages after transplanting. In this study, we aim to evaluate the possibility of replacing chemical plant growth regulators using light quality in a closed-type plant production system (CPPS) for cucumber seedling production. We used various light treatments, such as monochromatic or combined red (R) and blue (B), and combined R and B with UV-A or Far-red (Fr) light, to compare with a chemical plant growth regulator conventionally using in nursery farms. The combined R and B treatment decreased stem elongation and increased dry matter and compactness. UV-A treatment increased compactness but did not significantly affect the stem elongation or dry matter. Fr increased stem elongation and stem diameter and decreased compactness and dry matter. In leaf growth, combined R and B treatments and UV-A treatments increased leaf area, specific leaf weight, and SPAD value, and decreased leaf shape index. Fr treatments increased leaf area and leaf shape index and decreased specific leaf weight (SLW) and SPAD values. Cucumber seedlings have many different morphological changes, and R5B5 light quality was more effective in growth control due to higher compactness than chemical plant growth regulators. Also, R5B5 light quality has increased seedling quality, such as dry matter and SLW compared with fluorescent lamps. Thus, the use of light quality is a possible alternative to a chemical plant growth regulator