Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Drains' role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of "standard" and "draining-tract-targeted" management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF)

Mesenteric-Portal Vein Resection during Pancreatectomy for Pancreatic Cancer

The aim of the present study was to determine the outcome of patients undergoing pancreatic resection with (VR+) or without (VR 12) mesenteric-portal vein resection for pancreatic carcinoma. Between January 1998 and December 2012, 241 patients with pancreatic cancer underwent pancreatic resection: in 64 patients, surgery included venous resection for macroscopic invasion of mesenteric-portal vein axis. Morbidity and mortality did not differ between the two groups (VR+: 29% and 3%; VR 12: 30% and 4.0%, resp.). Radical resection was achieved in 55/64 (78%) in the VR+ group and in 126/177 (71%) in the VR 12 group. Vascular invasion was histologically proven in 44 (69%) of the VR+ group. Survival curves were not statistically different between the two groups. Mean and median survival time were 26 and 15 months, respectively, in VR 12 versus 20 and 14 months, respectively, in VR+ group . In the VR+ group, only histologically proven vascular invasion significantly impacted survival , while, in the VR 12 group, R0 resection and tumor\u2019s grading significantly influenced long-term survival. Vascular resection during pancreatectomy can be performed safely, with acceptable morbidity and mortality. Long-term survival was the same, with or without venous resection. Survival was worse for patients with histologically confirmed vascular infiltration

An Easier Technique for End to End Pancreatlcojejunostomy

Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains the most common and troublesome complication

Do Caucasian and Asian clocks tick differently?

The Period 3 and Clock genes are important components of the mammalian molecular circadian system. Studies have shown association between polymorphisms in these clock genes and circadian phenotypes in different populations. Nevertheless, differences in the pattern of allele frequency and genotyping distribution are systematically observed in studies with different ethnic groups. To investigate and compare the pattern of distribution in a sample of Asian and Caucasian populations living in Brazil, we evaluated two well-studied polymorphisms in the clock genes: a variable number of tandem repeats (VNTR) in PER3 and a single nucleotide polymorphism (SNP) in CLOCK. The aim of this investigation was to search for clues about human evolutionary processes related to circadian rhythms. We selected 109 Asian and 135 Caucasian descendants. The frequencies of the shorter allele (4 repeats) in the PER3 gene and the T allele in the CLOCK gene among Asians (0.86 and 0.84, respectively) were significantly higher than among Caucasians (0.69 and 0.71, respectively). Our results directly confirmed the different distribution of these polymorphisms between the Asian and Caucasian ethnic groups. Given the genetic differences found between groups, two points became evident: first, ethnic variations may have implications for the interpretation of results in circadian rhythm association studies, and second, the question may be raised about which evolutionary conditions shaped these genetic clock variations.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Associação Fundo de Incentivo à Pesquisa (AFIP)Universidade Federal de São Paulo (UNIFESP) Instituto do Sono Departamento de PsicobiologiaUniversidade de São Paulo Escola de Artes, Ciências e Humanidades Curso de GerontologiaUNIFESP, Instituto do Sono Depto. de PsicobiologiaFAPESP: 98/14303-

New symptoms in Castanea sativa stands in Italy: chestnut mosaic virus and nutrient deficiency

The European chestnut characterizes both the landscape and economy of mountainous Italian areas. In recent years, new canopy disorders have been reported: “chestnut yellows”, often ascribed to phytoplasma and/or nutrient deficiency, and “chestnut mosaic”, associated with a virus (ChMV). Therefore, research was carried out in four Italian regions to describe the two symptomatic frames and assess their etiology. Surveys were conducted on 101 chestnut trees (23 with mosaic, 38 with yellowing, and 40 without symptoms). The phytosanitary status was monitored, and the new canopy disorders were detected, distinguishing between yellowing and mosaic. Moreover, leaf samples were collected for molecular and nutrient analyses. No phytoplasma infection was recorded, while ChMV was detected in 91.3% of samples with mosaic symptoms, 31.6% of yellowing samples, and 30.0% of asymptomatic samples. Yellowing was associated with Mn deficiency. On the other hand, ChMV-infected and healthy leaves had similar mineral contents, showing that mosaic symptoms are induced by the virus. Both disorders negatively affected photosynthesis efficiency. These phytosanitary problems are present in Italian chestnut woods and cause local effects, and a relationship with other biotic and abiotic factors can be hypothesized. Considering the increase in new records, these symptoms represent an emerging issue whose impact and spread need to be further monitore

A simple method for the determination of lipid composition of human bile

The Entero-Test, a device for easy sampling of gastrointestinal contents, including bile, has been used for determination of biliary lipid composition. The device consists of a weighted gelatin capsule containing 140 cm of a highly absorbent nylon line. The capsule is swallowed while one end of the string is taped to the face. After 3.5 h, when the line has reached the duodenum, gallbladder contraction is stimulated by intramuscular administration of ceruletide. The line is pulled out, and the last 15 cm are eluted four times in methanol. Total bile acids (by 3 alpha-hydroxysteroid-dehydrogenase assay), individual bile acids (by high performance liquid chromatography), phospholipids (by assay of lipid-soluble phosphorus), and cholesterol (by gas-liquid chromatography) are determined in the eluate. Tests in vitro demonstrated no preferential binding and a good recovery of biliary lipids from the thread. Similar values of biliary cholesterol saturation were obtained by means of duodenal intubation and of the Entero-Test in a series of 12 subjects (r = 0.952). In 5 subjects, individual bile acids were also measured and were found to be similar with both techniques (r = 0.948). When the test was repeated over 3 days in a series of 7 subjects, biliary cholesterol saturation was found to be remarkably reproducible (CV = 7.6%). Thus, the Entero-Test is a convenient technique for the determination of biliary lipid composition, which can be particularly useful in longitudinal studies

Simple Detection of Large InDeLS by DHPLC: The ACE Gene as a Model

Insertion-deletion polymorphism (InDeL) is the second most frequent type of genetic variation in the human genome. For the detection of large InDeLs, researchers usually resort to either PCR gel analysis or RFLP, but these are time consuming and dependent on human interpretation. Therefore, a more efficient method for genotyping this kind of genetic variation is needed. In this report, we describe a method that can detect large InDeLs by DHPLC (denaturating high-performance liquid chromatography) using the angiotensin-converting enzyme (ACE) gene I/D polymorphism as a model. The InDeL targeted in this study is characterized by a 288 bp Alu element insertion (I). We used DHPLC at nondenaturating conditions to analyze the PCR product with a flow through the chromatographic column under two different gradients based on the differences between D and I sequences. The analysis described is quick and easy, making this technique a suitable and efficient means for DHPLC users to screen InDeLs in genetic epidemiological studies

SMAD4 loss enables EGF, TGF\u3b21 and S100A8/A9 induced activation of critical pathways to invasion in human pancreatic adenocarcinoma cells

Epidermal Growth Factor (EGF) receptor overexpression, KRAS, TP53, CDKN2A and SMAD4 mutations characterize pancreatic ductal adenocarcinoma. This mutational landscape might influence cancer cells response to EGF, Transforming Growth Factor \u3b21 (TGF\u3b21) and stromal inflammatory calcium binding proteins S100A8/A9. We investigated whether chronic exposure to EGF modifies in a SMAD4-dependent manner pancreatic cancer cell signalling, proliferation and invasion in response to EGF, TGF\u3b21 and S100A8/A9. BxPC3, homozigously deleted (HD) for SMAD4, and BxPC3-SMAD4+ cells were or not stimulated with EGF (100 ng/mL) for three days. EGF pre-treated and non pretreated cells were stimulated with a single dose of EGF (100 ng/mL), TGF\u3b21 (0,02 ng/mL), S100A8/A9 (10 nM). Signalling pathways (Reverse Phase Protein Array and western blot), cell migration (Matrigel) and cell proliferation (XTT) were evaluated. SMAD4 HD constitutively activated ERK and Wnt/\u3b2-catenin, while inhibiting PI3K/AKT pathways. These effects were antagonized by chronic EGF, which increased p-BAD (anti-apoptotic) in response to combined TGF\u3b21 and S100A8/A9 stimulation. SMAD4 HD underlied the inhibition of NF-\u3baB and PI3K/AKT in response to TGF\u3b21 and S100A8/A9, which also induced cell migration. Chronic EGF exposure enhanced cell migration of both BxPC3 and BxPC3-SMAD4+, rendering the cells less sensitive to the other inflammatory stimuli. In conclusion, SMAD4 HD is associated with the constitutive activation of the ERK and Wnt/\u3b2-catenin signalling pathways, and favors the EGF-induced activation of multiple signalling pathways critical to cancer proliferation and invasion. TGF\u3b21 and S100A8/A9 mainly inhibit NF-\u3baB and PI3K/AKT pathways and, when combined, sinergize with EGF in enhancing anti-apoptotic p-BAD in a SMAD4-dependent manner

Polimorfismos em receptores hipocretinérgicos e insônia

Hypocretin system has been described as one of the most important neurotransmission systems involved in the waking process. The system’s lack of function, caused by mutation or neuron death, leads to sharp sleepiness in mammals. It has been proposed that a hyperactive hypocretin system can result in hyperarousal episodes and insomnia. Hypocretins 1 and 2 are bind to two known receptors that are widely distributed in the brain. The current study sought to analyze if either polymorphism in hypocretin receptor 1 or in hypocretin receptor 2 are associated to insomnia. We enrolled 83 insomnia patients, confirmed their clinical insomnia symptoms by means of polysomnographic recordings, comparing single nucleotide polymorphism frequencies in both hypocretin receptors and to those from healthy control patients who had no sleep disorders as confirmed by two nights of sleeping records. Our results show no association to either receptor polymorphism or insomniaO sistema de neurotransmissão hipocretinérgico tem sido descrito como um dos mais importantes envolvidos no processo de manutenção do alerta. A ausência da função neste sistema, por mutação ou morte neuronal, leva à sonolência excessiva em mamíferos. Tem sido proposto que um sistema hipocretinérgico hiperativo pode resultar em episódios de alerta e insônia. As hipocretinas 1 e 2 se ligam a dois receptores conhecidos e amplamente distribuídos no cérebro. No presente estudo, buscamos investigar se existe associação entre variações genéticas nos receptores das hipocretinas e a insônia. Foram incluídos 83 pacientes insones, com sintomas clínicos confirmados por registro polissonográfico e investigadas as frequências de polimorfismos em ambos os receptores de hipocretina comparados com uma amostra controle sem distúrbios de sono. Nossos resultados não mostraram associação entre polimorfismos nestes nos dois receptores com insôniaFAPESP 05/58077-2CEPID 98/14303-3AFI