Expression of HTRA Genes and Its Association with Microsatellite Instability and Survival of Patients with Colorectal Cancer

HtrA proteases regulate cellular homeostasis and cell death. Their dysfunctions have been correlated with oncogenesis and response to therapeutic treatment. We investigated the relation between HtrA1-3 expression and clinicopathological, and survival data, as well as the microsatellite status of tumors. Sixty-five colorectal cancer patients were included in the study. The expression of HTRA1-3 was estimated at the mRNA and protein levels by quantitative PCR and immunoblotting. Microsatellite status was determined by high-resolution-melting PCR. We found that the HTRA1 mRNA level was higher in colorectal cancer tissue as compared to the unchanged mucosa, specifically in primary lesions of metastasizing cancer. The levels of HtrA1 and HtrA2 proteins were reduced in tumor tissue when compared to unchanged mucosa, specifically in primary lesions of metastasizing disease. Moreover, a decrease in HTRA1 and HTRA2 transcripts' levels in cancers with a high level of microsatellite instability compared to microsatellite stable ones has been observed. A low level of HtrA1 or/and HtrA2 in cancer tissue correlated with poorer patient survival. The expression of HTRA1 and HTRA2 changes during colorectal carcinogenesis and microsatellite instability may be, at least partially, associated with these changes. The alterations in the HTRA1/2 genes' expression are connected with metastatic potential of colorectal cancer and may affect patient survival.

FasR and FasL in colorectal cancer

Colorectal cancer (CRC) is one of the most common solid organ cancers prevalent worldwide causing, in spite of advancing therapeutic methodology, high rate of patient mortality, especially due to metastasis development. The cancer stem cell (CSC) theory of tumor growth indicates that CSCs within the tumor mass have great capacity to initiate and sustain tumor growth. Following the suggestion that Fas signaling can be engaged in apoptosis, tumor maintenance, senescence or DICE (death induced by CD95 or CD95L elimination), the attempts to broaden the knowledge concerning the relationships between CSCs features and FasR/FasL appeared to be necessary. The most important advantage of our study was the simultaneously analysis of CSCs from commonly used CRC lines (HCT116 and HT29) and tumor fragments collected from CRC patients. Moreover, the sphere-promoting expansion of CRC lines brought a specific three-dimensional specific environment for CSC exploration. We further investigated the function of Fas signaling in CRC lines depending on the culture mode as we incubated HCT116 and HT29 cells with anti-FasR agonistic antibodies. It appeared to act in a line-dependent and culture mode-dependent manner and influenced some particular features of CSCs such as spherogenicity, proliferation and phenotype. Additionally, the analysis of mRNA level showed that disease progression is associated with significantly increased expression of FasR and/or FasL. In conclusion, our observation seems to confirm that spherical model of cancer lines is more reliable for some sophisticated analysis because of their greater resemblance to the CSCs from human CRC samples in comparison to commonly used adherent cells, at least according to aspects of their biology analyzed in this study. That can be extended to the resemblance of in vitro sphere forming conditions to the in vivo environment. However, the greatest difference concerns the level of apoptosis, thus, this issue require further experiments.

Changes in expression of human serine protease HtrA1, HtrA2 and HtrA3 genes in benign and malignant thyroid tumors

Human HtrA proteins are serine proteases involved in essential physiological processes. HtrA1 and HtrA3 function as tumor suppressors and inhibitors of the TGF-β signaling pathway. HtrA2 regulates mitochondrial homeostasis and plays a pivotal role in the induction of apoptosis. The aim of the study was to determine whether the HtrA proteins are involved in thyroid carcinogenesis. We used the immunoblotting technique to estimate protein levels of HtrA1, HtrA2, long and short variants of HtrA3 (HtrA3-L and HtrA3-S) and TGF-β1 in tissues of benign and malignant thyroid lesions, and control groups. We found that the levels of HtrA2 and HtrA3-S were higher in thyroid malignant tumors compared to normal tissues and benign tumors. The HtrA3-L level was increased in malignant tumor tissues compared to benign tumor tissues and control tissues from patients with benign lesions, and elevated in normal tissues from patients with thyroid carcinoma compared to normal tissues from patients with benign lesions. We also compared levels of HtrA proteins in follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) and found that these types of carcinoma differed in the expression of HtrA3-S and HtrA1. These results indicate the implication of HtrA proteins in thyroid carcinogenesis suggest that HtrA3 variants may play different roles in cancer development, and that the increased HtrA3-L levels in thyroid tissue could be correlated with the development of malignant lesions. The TGF-β1 levels in tumor tissues were not significantly altered compared to control tissues.

Does antioxidant therapy influence every aspect of quality of life?

To present problems that might severely impact the conclusions drawn by the authors of an article on antioxidant treatment in chronic pancreatitis (World J Gastroenterol 2010; 16: 4066-4071). We analyzed and discussed this paper by Shah et al, and found that promising as it is, this study has some methodological shortcomings, such as: cross-sectional nature of the study, lack of initial evaluations of quality of life and regular follow-ups to determine the dynamics and real directions of changes in quality of life. We therefore concluded that the results of the study by Shah et al are biased and, although very promising, should not be considered as scientifically relevant.

Decreased serum betaine concentrations in patients after bariatric surgery

Bariatric surgery significantly reduces the risk of cardiovascular diseases but has no effects on hyperhomocysteinemia, the risk factor for atherogenesis. We hypothesize that the decrease in serum betaine (involved in homocysteine metabolism) concentrations, after bariatric surgery, impairs conversion of homocysteine to methionine, leading to hyperhomocysteinemia. If this is true, it may be desirable to supply patients after bariatric surgery with betaine. Serum betaine and homocysteine concentrations were measured by liquid chromatography/mass spectrometry, in 16 obese patients, before and 6 months after bariatric surgery. Ten healthy individuals with normal body mass index served as controls. Serum betaine concentrations decreased to the values lower than in controls after bariatric surgery, whereas serum homocysteine concentrations remained elevated. In patients supplemented with B(12) and folate, no effect of bariatric surgery on serum concentrations of vitamins involved in homocysteine metabolism was observed. These results suggest that betaine deficit could be responsible for maintenance of hyperhomocysteinemia after bariatric surgery. We postulate that supplementation with betaine could be of therapeutic value for the treatment of hyperhomocysteinemia after bariatric surgery.

Surgical morphology of the pancreatic isthmus

BACKGROUND

Pancreatic isthmus method anastomosis following pancreatic resection is an important factor of postoperative fistula formation. While the anatomy and vascular supply of the pancreatic head have been studied in detail, little is known about the morphology of the pancreatic isthmus. The authors determine the anatomy and morphology of the pancreatic isthmus.

METHODS

99 consecutive cadaveric pancreatic specimens were taken during standard autopsy. Organs were transected at the isthmus and pancreatograms and microscopic specimens of the transection plane were analyzed.

RESULTS

The mean size of the Wirsung duct at the isthmus was 2.89 mm (+/-0.87 mm, from 1.4 to 6 mm). The main pancreatic duct was located approximately in the middle of the pancreatic cross-section plane in almost all specimens. The total number of second-degree pancreatic ducts visible on pancreatograms within the isthmus was 1.77 (+/-1.00, from 0 to 4) and 1.83 (+/-1.4, from 0 to 5) on microscopic analysis.

CONCLUSIONS

The presence of second-degree pancreatic ducts at the transection site might favor the use of a pancreaticoenteric anastomosis with stump invagination to reduce the risk of anastomotic leakage. and IAP.

Postoperative PTH measurement as a predictor of hypocalcaemia after thyroidectomy

BACKGROUND

Hypocalcaemia after thyroidectomy is the most common postoperative complication, with a reported incidence from 0.5% to even 50% of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for the prediction of the incidence of hypocalcaemia. The most effective of them are the peri-operative and intra-operative measurements of the parathyroid hormone (PTH) level.

METHODS

A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2008. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before as well as 1 hour and 24 hours after the surgery.

THE AIM

The goal of the study was to assess the potential correlation between the iPTH levels after the operation and the development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be assessed.

RESULTS

We have presented a significant correlation between early iPTH measurement and the risk of hypocalcaemia. Moreover, a significant correlation between the iPTH level one hour after operation with the calcium level 24 hours after the operation was demonstrated.

CONCLUSION

Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to the avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcaemia.

Quality of life after surgical treatment of pancreatic cancer

BACKGROUND

This study was designed to assess postoperative changes in the quality of life (QoL) of patients after surgical treatment for pancreatic cancer.

MATERIAL AND METHODS

QoL was analyzed in a prospective single-centre study that included 54 patients with pancreatic cancer. Patients with potentially resectable tumours underwent pancreaticoduodenectomy (PD) (n = 26), a double-bypass procedure (DBP) (n = 17) or laparotomy (L) (n = 11). They were asked to complete a questionnaire before and at 1, 2, 3 and 6 months after surgery. QoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-PAN26 questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and PAN26).

RESULTS

The patients did not demonstrate significant differences in the assessment of their global health status. Although, after resection, patients gave a positive assessment of most parameters in question, after DBP they reported some aggravation of most of the symptoms. The majority of patients did not have aggravated symptoms after laparotomy.

CONCLUSIONS

The study has shown the value of conducting both curative and palliative resection for QoL. Bypass procedures should be performed in cases of non-resectable pancreatic cancer with accompanying jaundice and/or gastric outlet obstruction in patients with a life expectancy of at least 6 months.

Dynamics of oxidative damage at early stages of estrogen-dependant carcinogenesis

The objective of this study was to assess the dynamics of oxidative damage to cellular macromolecules such as proteins, lipids, and DNA under conditions of oxidative stress triggering early stages of estrogen-dependent carcinogenesis. A rodent model of carcinogenesis was used. Syrian hamsters were sacrificed after 1, 3, 5 h and 1 month from the initial implantation of 17beta-estradiol (E2). Matching control groups were used. Kidneys as target organs for E2-mediated oxidative stress were excised and homogenized for biochemical assays. Subcellular fractions were isolated. Carbonyl groups (as a marker of protein oxidation) and lipid hydroxyperoxides were assessed. DNA was isolated and 8-oxodGuo was assessed. Electron paramagnetic resonance spectroscopy was used to confirm the results for lipid peroxidation. Exposition to E2 in rodent model leads to a damage of macromolecules of the cell, including proteins and DNA, but not lipids. Proteins appear to be primary target of the damage but are shortly followed by DNA. It has previously been speculated that protein peroxides can increase DNA modifications. This time sequence was observed in our study. Nevertheless, direct relation between protein and DNA damage still remains unsolved.

NOTES--third generation surgery. Vain hopes or the reality of tomorrow?

BACKGROUND

Laparoscopic approach has made many procedures less invasive; however, it seems like this is not enough. The newest challenge for the medical environment is applying the scarless surgery in humans. In this article, we review the origin, current state of art, and future of natural orifice transluminal endoscopic surgery (NOTES). The registered base of research in humans is yet scarce; however, the porcine model experimental studies hold a great promise. In NOTES, peritoneal cavity can be easily achieved, and some procedures are feasible through the natural orifices like digestive tract, vagina, or urinary bladder. If safety and advantages of these approaches will be proven beyond question, NOTES procedures are likely to be adapted in humans after overcoming the critical obstacles, like reliable closure methods, indispensable equipment invention, the multidisciplinary specialists training, etc. The aim of this article was to review available literature to provide current state of art in NOTES surgery.

MATERIALS AND METHODS

Medical databases were searched for animal and human experience with NOTES to give an overview of history, current state of art, and future of this technique.

RESULTS

NOTES is currently the subject of the intensive research. It seems like this is only the matter of time when a transluminal access to the abdominal or even thoracic cavity will become the reality. Moreover, this will enable the management of some diseases in a possibly minimally invasive pattern, nearly painless and leaving no scar at all.

Fibrogenesis in fatty liver associated with obesity and diabetes mellitus type 2

Fatty liver in obese patients is emerging as one of the most common causes of chronic liver disease. Obese patients are at risk of developing type 2 diabetes mellitus (DM), and aggravating non-alcoholic fatty liver disease (NAFLD), developing into steatohepatitis (NASH) and hepatic fibrosis. Little is known of the possible impact on liver fibrogenesis of diabetes type 2 associated with obesity and NAFLD. Fifty-two morbidly obese patients were evaluated with complete clinical and laboratory medical assessment. Liver biopsy material was fixed in formalin, routinely processed to paraffin blocks, cut into 4-microm sections, stained with HE, PAS, Masson's trichrome and reticulin. Immunohistochemical stains included collagen IV, SMA and laminin. Within the initial group of 52, 25 patients had DM type 2, mean age 45.8 years. Patients with diabetes were older; had higher BMI, liver enzyme tests, glucose, cholesterol, and triglycerides; and lower albumin concentration. Livers of diabetics had significantly more severe steatosis and rich perisinusoidal collagen IV, laminin and SMA accumulation without histologically detectable NASH and irrespective of the degree of steatosis. Obese patients with type 2 DM and insulin resistance develop more severe NAFLD and early sinusoidal fibrosclerosis.

Dynamics of estrogen-induced oxidative stress

The objective of this study was to assess the dynamics of oxidative damage to cellular macromolecules such as proteins, lipids and DNA under conditions of oxidative stress triggering early stages of estrogen-dependent carcinogenesis. A rodent model of carcinogenesis was used. Syrian hamsters were sacrificed after 1, 3, 5 h and one month from the initial implantation of estradiol. Matching control groups were used. Kidneys as target organs for estradiol-mediated oxidative stress were excised and homogenized for biochemical assays. Subcellular fractions were isolated. Carbonyl groups (as a marker of protein oxidation) and lipid hydroxyperoxides were assessed. DNA was isolated and 8-oxodGuo was assessed. Electron paramagnetic resonance spectroscopy was used to confirm the results for lipid peroxidation. Exposition to estradiol in the rodent model leads to damage of macromolecules of the cell, including proteins and DNA, but not lipids. Proteins appear to be the primary target of the damage but are closely followed by DNA. It has previously been speculated that protein peroxides can increase DNA modifications. This time sequence was observed in our study. Nevertheless, the direct relation between protein and DNA damage still remains unsolved.

Wernicke’s Syndrome after Sleeve Gastrectomy

We report a case of Wernicke's encephalopathy after sleeve gastrectomy, which had been complicated by stomach wall edema and aggravated by dietary non-compliance. Despite intense parenteral nutrition, thiamine deficiency became clinically evident. It suggests that nutritional preparations used were unable to cover the increased thiamine requirement. After intense thiamine supplementation, gradual improvement occurred during the 6 months after the diagnosis, without permanent cognitive impairment. Clinicians involved in postoperative management of bariatric surgery patients must consider Wernicke's syndrome in hyper-emetic patients, who show unclear neurological deterioration. Early diagnosis and treatment can instantly improve the patient's condition without permanent sequelae.

Pancreatic cross-section: an elliptical model

BACKGROUND

Pancreatic surgery has developed over the last 60 years. A pancreaticoduodenectomy of the pancreatic head and duodenal papilla is the most common procedure. The most popular pancreatic cross-section site of a pancreaticoduodenectomy is the isthmus of the gland. The pancreatic isthmus anatomical configuration is still being considered.

STUDY DESIGN

The authors propose a new parametric descriptive system of pancreatic cross-section based on an elliptical model.

RESULTS

The pancreatic cross-section was evaluated as a geometric ellipse and the location of the pancreatic duct was based on coordinates. When analyzing the cross-section plane of the pancreatic isthmus, the mean size of the pancreatic isthmus cross-section was 10.46+/-2.34 mm in width (mean+/-SD) and 25.55+/-4.56 mm in length. The mean vertical/horizontal distance ratio was 0.42+/-0.12. The mean size of the main pancreatic duct was 1.02x2.46 mm. The mean distribution coordinates of the main pancreatic duct were: X 51.23; Y 50.60.

CONCLUSIONS

A proportional model of pancreatic isthmus cross-section analysis is easy and effective, and could become a valuable tool in future anatomical studies. The system described allows us to analyze data acquired from several investigators.

Dynamics of estrogen-induced oxidative stress

The objective of this study was to assess the dynamics of oxidative damage to cellular macromolecules such as proteins, lipids and DNA under conditions of oxidative stress triggering early stages of estrogen-dependent carcinogenesis. A rodent model of carcinogenesis was used. Syrian hamsters were sacrificed after 1, 3, 5 h and one month from the initial implantation of estradiol. Matching control groups were used. Kidneys as target organs for estradiol-mediated oxidative stress were excised and homogenized for biochemical assays. Subcellular fractions were isolated. Carbonyl groups (as a marker of protein oxidation) and lipid hydroxyperoxides were assessed. DNA was isolated and 8-oxodGuo was assessed. Electron paramagnetic resonance spectroscopy was used to confirm the results for lipid peroxidation. Exposition to estradiol in the rodent model leads to damage of macromolecules of the cell, including proteins and DNA, but not lipids. Proteins appear to be the primary target of the damage but are closely followed by DNA. It has previously been speculated that protein peroxides can increase DNA modifications. This time sequence was observed in our study. Nevertheless, the direct relation between protein and DNA damage still remains unsolved.

Assessment of cadaveric livers discarded from transplantation. A correlation between clinical and histological parameters

BACKGROUND

We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology.

MATERIAL/METHODS

Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation.

RESULTS

In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation.

CONCLUSIONS

Results of biopsies suggested that approximately in one third of livers discarded from transplantation due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".

Does the Septic Shock Interfere Experimental Acute Pancreatitis in Rats?

INTRODUCTION

Acute pancreatitis is a disease involving pro-inflammatory mediators. Two complex and multifactorial pathogenetic ways lead to edematous or necrotizing pancreatitis. The course of the disease is thought to be the consequence of an acute inflammatory response.

AIM

The authors examined the impact of Escherichia coli LPS on the acute cerulein pancreatitis in rats.

METHODS

The study was performed on rats using the ceruleine pancreatitis model. The activation status of polymorphonuclear cells, blood IL-6 concentration, oxidative stress parameters, pancreatic enzymes concentration and microscopic alterations were determined at 5th and 9th h observations.

RESULTS

In acute pancreatitis and acute pancreatitis with LPS groups, the peripheral polymorphonuclear cells activity was lower than in control one. Authors noticed the same neutrophil activation in acute pancreatitis after lipopolysaccharide administration although the peripheral blood polymorphonuclear cells count was significantly higher at the 9th h observation. LPS neither changed the oxidative stress within pancreatic gland, nor amylase or serum lipase activity. LPS given to acute pancreatitis animals resulted in significant increase of serum IL-6 concentration at 5th observation turning normal after 9th h.

CONCLUSIONS

Collected data supports thesis of early polymorphonuclear cells involvement in acute pancreatitis and oxidative stress evidence in pancreatic parenchyma. However, results did not reveal that administration of LPS amplified inflammatory response during the course of acute pancreatitis.

New prognostic scales LAST-1 and LAST-2: supporting prediction and staging of thyroid cancer

INTRODUCTION

Epidemiologically, thyroid gland tumors are lesions of the highest importance among endocrine tumors in humans. Although the results of surgical treatment of the highly differentiated (follicular and papillary) tumors seem to be satisfactory, treatment of the poorly differentiated (medullary and anaplastic) tumor still demands clinical and basic investigations. In this study the authors sought to evaluate clinical and molecular factors that could contribute to preoperative detection of more advanced thyroid cancers (i.e., those that exhibit extrathyroid spread and lymph node invasion).

METHODS

A total of 27 patients operated on for thyroid cancer were evaluated according to age, sex, time from the onset of the disease, cytogenetic changes, and loss of heterozygosity (LOH) in 14 microsatellite markers. The output variables were defined according to postoperative findings and the TNM 2002 score. The T1-2 N0 M0 cases were defined as local malignancy (LM); and T3-4 any N any M, any T N1 any M, or any T any N M1 were considered advanced malignancy (AM). The control groups consisted of 25 patients with multinodular goiter (MNG) and 32 patients with follicular adenoma (FA). In all cases, clinical and molecular data similar to those listed above were collected, excluding staging and follow-up information.

RESULTS

There was no predominant specific type of chromosomal aberration observed and no marker lost in more than five patients (18%). The logistic regression identified three input variables as contributing significantly to the dichotomized outcome measure (LM vs. AM): LOH in any of the examined loci, age of the patient at the presentation, and the sex of the patient. Furthermore, discriminant analysis revealed four input variables differentiating among TC, FA, and MNG patients. Based on the multivariate analysis results, two numeric prognostic scales were fashioned: LAST-1, a scale applicable to differentiation of thyroid cancers at different degrees of clinical advancement; and LAST-2, a scale applicable to differentiation of any thyroid lumps.

CONCLUSIONS

It was concluded that LOH and the age and sex of the patients can provide sufficient data to predict thyroid cancer with a high degree of clinical advancement. LAST-1 scale is a reliable tool for identifying these patients. The LAST-2 scale gives supportive information about the character of thyroid lumps, distinguishing TC from MNG and FA.

Pancreatic islet transplantation, what has been achieved since Edmonton break-through

It has been 6 years since the Edmonton group published their outstanding results with pancreatic islet transplantation patients, demonstrating one-year insulin independence of 100% with type I diabetics. In order to assess what has been achieved for past six years we analyzed the actual state of islet transplantation, based on the updated summary of results from Edmonton and compare this experience with combined results from 19 institutions in North America as reported to the Collaborative Islet Transplant Registry (CITR). CITR data have largely substantiated the reproducibility of the Edmonton procedure. Complete insulin-independence was achieved in more then 55% of patients 1 year after transplant, but this state has not been sustained permanently. Although only 10% of patients remained insulin-free after 5 years, more then 80% of them had still detectable levels of C peptide and substantially improved glycemic control without episodes of hypoglycemia. Even though currently, the islet graft is still not a remedy for every brittle diabetic, islet transplantation has already obtained "nonresearch" status in Canada and is close to having a biological license status approved by the FDA in the United States that would further stimulate progress in the field.

A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy

BACKGROUND AND AIMS

Pancreatic cancer is characterized by a constant deterioration in quality of life, excruciating pain and progressive cachexia. The aim of this study was to compare the effectiveness of two invasive methods of pain treatment in these patients: neurolytic coeliac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) to a conservatively treated control group concerning pain, quality of life and opiates' consumption.

PATIENTS AND METHODS

Fifty nine patients suffering from pain due to inoperable pancreatic cancer were treated invasively with NCPB (N=35) or VSPL (N=24) in two non-randomised, prospective, case-controlled protocols. Intensity of pain (VAS-pain), quality of life (FACIT and QLQ C30) and opioid intake were compared between the groups and to a control group of patients treated conservatively before the procedure and after 2 and 8 weeks of follow-up. The analysis was performed retrospectively using meta-analysis statistics.

RESULTS

Both methods of invasive pain treatment resulted in significant reduction of pain (VSPL effect size=11.27, NCPB effect size=7.29) and fatigue (effect sizes, respectively, 1.23 and 3.37). NCPB improved also significantly physical, emotional and social well-being (effect sizes, respectively, 2.37, 4.13 and 7.51) which was not observed after VSPL. No influence on ailments characteristic for the disease was demonstrated. Mean daily opioid consumption was significantly decreased after both procedures. There was no perioperative mortality and no major morbidity.

CONCLUSION

Both NCPB and VSPL provide significant reduction of pain and improvement of quality of life in inoperable pancreatic cancer patients. They present rather similar efficacy, but lower invasiveness of NCPB, in combination with its more positive effect on quality of life, pre-disposes it as being the preferred method.

Serum hepatocyte growth factor concentration in obese women decreases after vertical banded gastroplasty

BACKGROUND

Human obesity is associated with increased serum hepatocyte growth factor (HGF) concentration. This study examines whether reduced body fat mass after vertical banded gastroplasty (VBG) is associated with a decrease in serum HGF concentration.

METHODS

Serum HGF concentration and body weight, BMI, body fat mass, blood pressure, serum leptin, insulin, triacylglycerol, and cholesterol concentrations were studied in 10 obese women before and 1 year after VBG. 10 lean, healthy women were used as controls.

RESULTS

Obese women showed significantly higher serum HGF concentration than control (lean, healthy) subjects. The mean serum HGF concentration decreased significantly 1 year after VBG, but did not reach the value observed in lean women. After VBG, BMI, body fat mass and serum HGF had similar patterns of decrease. Moreover, serum HGF concentration was positively correlated with both BMI (r=0.6, P<0.01) and body fat mass (r=0.6, P<0.01). Before surgery in obese women, elevated blood pressure was observed, which decreased after VBG. Linear regression analysis between blood pressure and serum HGF concentration using all subjects, showed no correlation between either systolic blood pressure and serum HGF concentration (r=.15, P=NS) or between diastolic blood pressure and serum HGF concentration (r=0.1, P=NS). Insulin resistance index (HOMA score), serum leptin, insulin and triacylglycerol concentrations decreased 1 year after VBG. However, serum cholesterol concentration did not change significantly.

CONCLUSIONS

These results indicate that VBG results in a reduction in circulating HGF concentration. The reduced body fat mass may contribute in part to the decrease of serum HGF concentration after VBG. Because elevated serum HGF concentration may contribute to the progression of atherosclerosis, the decrease in serum HGF concentration after VBG may be beneficial for obese subjects.

Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients

AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.

METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL. Although both questionnaires covered similar problems, they could not be compared directly one with another. Therefore, the studies were compared by meta-analysis methodology.

RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients, and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.

CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.

Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients

AIM

To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.

METHODS

Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL. Although both questionnaires covered similar problems, they could not be compared directly one with another. Therefore, the studies were compared by meta-analysis methodology.

RESULTS

Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients, and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.

CONCLUSION

Both invasive pain treatment methods are effective in CP patients with chronic pain.

Does resveratrol prevent free radical-induced acute pancreatitis?

OBJECTIVE

The purpose of this study was to examine protective and antioxidative effect of stilbene derivatives, resveratrol and diethylstilbestrol, in experimental acute pancreatitis (EAP).

METHODS

EAP was induced in male Wistar rats by retrograde injection of tert-butyl hydroperoxide (ButOOH) solution, a well-known prooxidant agent, into the common bile pancreatic duct. After a 3-hour observation, the animals were killed. Blood samples were collected. Each pancreas was removed and weighed. Tissue samples were taken for microscopic studies. The carbonyl and sulfhydryl (SH) group levels were estimated in the homogenate.

RESULTS

Examination using light microscopy revealed morphologic changes in pancreata removed from EAP rats, namely focal edema, acinar cell vacuolization, and focal necrosis of pancreatic acini. The electron microscopic analysis also showed changes in their subcellular structures: dilated cisternae of the rough endoplasmic reticulum, swollen mitochondria, and "debris" of mitochondrial cristae. These changes corresponded with higher activities of serum amylase and tissue carbonyl groups levels and decreased SH group level compared with controls. Changes in pancreata were much less pronounced in the rats that received resveratrol or diethylstilbestrol for 8 days prior to ButOOH injection.

CONCLUSION

Stilbene derivatives prevent pancreatic cells from structural changes during ButOOH-induced acute pancreatitis.

Enhanced citrate synthase activity in human pancreatic cancer

OBJECTIVES

Assuming that a high flux of carbohydrate is strictly connected with lipid synthesis in neoplastic cells, one can hypothesize that the activity of citrate synthase, which plays an important role in glucose to lipid conversion, is enhanced in pancreatic cancer. The aim of the present study was to verify this hypothesis.

METHODS

The activity of citrate synthase (as well as lactate and glucose 6-phosphate dehydrogenases) was measured using tissue extract prepared from specimens (pancreatic cancer and control specimens taken from the adjacent pancreatic normal tissue) obtained from 24 patients with ductal carcinoma who underwent pancreatoduodenectomy or total pancreatomy.

RESULTS

The average of citrate synthase activity in human pancreatic ductal carcinoma is significantly higher comparing with adjacent nonneoplastic tissue: 40.2 +/- 27.2 and 18.3 +/- 13.6 nmole/min/mg protein, respectively (P = 0.001). The lactate dehydrogenase and glucose 6-phosphate dehydrogenase activity in human pancreatic ductal carcinoma were also higher than in adjacent nonneoplastic tissues.

CONCLUSION

It is likely that enhanced citrate synthase activity contributes to the conversion of glucose to lipids in pancreatic cancer providing substrate for membrane lipids synthesis.

Comparative immunologic and kinetic evaluation of AMP-deaminase isolated from normal human liver and hepatocellular carcinoma (HCC)

In the present paper physico-chemical properties of AMP-deaminase purified from human liver neoplasm-hepatocellular carcinoma (HCC) were investigated and compared with these obtained for the enzyme from normal, unaffected tissue.

Factors influencing surgeons’ choice of method for hernia repair technique

Tension-free hernioplasty is performed using prosthetic material in one-half of hernia repair procedures in Poland but in 85% of those in the region of Pomerania. This questionnaire study of surgeons in Pomerania examined their sources of knowledge about and the factors influencing their choice of groin hernia surgery. The questionnaire was sent to surgeons from 19 hospitals and was answered by 109 (83% of hernia surgeons in the region). We analyzed their reported knowledge of particular operative techniques, factors important in selecting the technique (personal experience, trends in surgical center), and the available sources of information (e.g., medical literature, internet, information from teachers, sales representatives). All respondents reported being familiar with and able to perform tension-free techniques, but only 44% are influenced by their individual professional skills in selecting the technique. Another 44% base their decision on trends in their hospital, and only 22% consider the patient's preferences. The most frequently quoted sources of scientific information are articles in the medical literature and conference reports (90%). Only 8% of the respondents are governed in their professional work by information from pharmaceutical company representatives. Most surgeons (70%) would prefer to make a decision about using a new surgical technique after practical training sessions or workshops led by experienced colleagues. In contrast to common opinion, the information from sales representatives are of only minor importance compared to that of evidence-based data and attendance at workshops and courses.

Enhanced glycerol 3-phosphate dehydrogenase activity in adipose tissue of obese humans

The primary purpose of this investigation was to determine whether adipose tissue glycerol 3-phosphate dehydrogenase activity is associated with human obesity. The data presented in this paper indicate that the glycerol 3-phosphate dehydrogenase activity in adipose tissue from morbidly obese subjects is approximately 2-fold higher than from lean individuals. Moreover, positive correlation between adipose tissue glycerol 3-phosphate dehydrogenase activity and body mass index (BMI) (r = 0.5; p < 0.01) was found. In contrast, the adipose tissue fatty acid synthase (FAS) and ATP-citrate lyase (ACL) activities in morbidly obese patients are significantly lower than in lean subjects. Furthermore, negative correlation between adipose tissue FAS activity and BMI (r = -0.3; p < 0.05) as well as between ACL activity and BMI (r = -0.3; p < 0.05) was found. These data indicate that elevated glycerol 3-phosphate dehydrogenase might contribute to the increase of triacylglycerol (TAG) synthesis in obese subjects, however, fatty acids necessary for glycerol 3-phosphate esterification must be derived (because of lower FAS and ACL activities) mainly from TAG in circulating lipoproteins formed in liver (VLDL), and/or from the intake with food (chylomicrons). The conclusion is, that the enhanced activity of glycerol 3-phosphate dehydrogenase, and hence the generation of more glycerol 3-phosphate in adipose tissue offers a novel explanation for increased TAG production in adipose tissue of obese subjects.

BMI is the main determinant of the circulating leptin in women after vertical banded gastroplasty

OBJECTIVE

To assess the main determinant of serum leptin concentration changes in morbidly obese patients treated by banded vertical gastroplasty.

RESEARCH METHODS AND PROCEDURES

Serum leptin and insulin concentrations, insulin resistance, BMI, body weight, and body fat mass in 18 obese women and 8 obese men treated by vertical banded gastroplasty were studied. Lean women and men subjects were used as controls.

RESULTS

Before surgery, serum leptin and insulin concentrations and insulin resistance index were significantly higher in morbidly obese patients than in control subjects. BMI, body fat mass, and serum triacylglycerol concentrations were also significantly higher in obese than in lean subjects. All of these parameters gradually decreased during 50 weeks after surgery. Univariate regression analysis displayed significant correlations between the following: serum leptin concentration and BMI (and body fat mass), serum leptin concentration and serum insulin concentration, and serum leptin concentration and insulin resistance index. Multivariate regression analysis indicated that only BMI was independently correlated with the decrease in serum leptin concentration.

DISCUSSION

Obtained data suggest the following: 1) vertical banded gastroplasty causes reduction of body weight, serum leptin and insulin concentration, insulin resistance, and serum triacylglycerol concentration; and 2) BMI is the main determinant of the circulating leptin concentration in morbidly obese women after anti-obesity surgery.

Psychological factors influencing results of cholecystectomy

BACKGROUND

Cholecystectomy is a surgical gold-standard procedure for gallbladder diseases, among which gallstones are the most frequent. Despite the introduction of minimally invasive surgery and broad access to ultrasound examination there is a group of patients in whom the surgery ailments persist. Those vague ailments can be perceived from a psychological point of view as somatization or even somatoform disorders.

METHODS

The aim of the study, designed as a case-control study, was to evaluate psychological characteristics that may accompany the incidence of so-called post-cholecystectomy pain syndrome (PCPS). The study focused on 367 patients treated for gallstones in the Dept. of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdańsk, Poland. At about a year after the operation, the patients received a questionnaire that included a structured interview and psychological assessment of social support and rumination. Those who revealed symptoms of PCPS were invited to the department for further medical and psychological evaluations. Psychosocial scores of PCPS and non-PCPS patients were compared.

RESULTS

The PCPS patients did not present any dysfunction at the physical examination or in gastroduodenoscopy or sonography. However, they differed from the remaining. asymptomatic group in terms of lacking social support, as well as increased rumination.

CONCLUSION

It is concluded that psychological variables may play an important role in the onset of subjective symptoms in at least a subgroup of the PCPS patients as a form of somatization. Psychological supportive and explanatory activities (cognitive and behavioural approach) may provide sufficient help.

Immunocytes and activated stellate cells in pancreatic fibrogenesis

INTRODUCTION AND AIMS

Chronic pancreatitis is a progressive chronic inflammatory disease characterized by irreversible destruction of exocrine pancreatic tissue and extensive fibrosis. Excessive alcohol consumption has been identified as the main etiologic factor of this disease in the Western world. Idiopathic pancreatitis accounts for approximately 30% of cases. An autoimmune mechanism may be involved in some patients, but this concept has not been generally accepted as a new clinical entity. The purpose of this work was to investigate the pathogenesis of pancreatic fibrosis and to establish the role of immunocytes and activated stellate cells in chronic pancreatitis, which was categorized into three groups: chronic alcoholic pancreatitis (AP), chronic idiopathic pancreatitis (IP), and chronic pancreatitis in the presence of pancreatic cancer (CA).

METHODOLOGY

Fifty-one pancreatic tissue samples were studied histopathologically and immunohistochemically (AP, 16 samples; IP, 12; CA, 12; and samples of tissue with apparently normal pancreatic histology, 11). The following immunohistochemical stains were used: alpha-smooth muscle antibody, desmin, and synaptophysin, as markers of activated stellate cells; and laminin, fibronectin, and collagen IV, as markers of extracellular matrix (ECM) proteins. Immunocytes were stained with antibody to LCA, CD68 antibody (macrophages), and CD8 antibody (natural killer T cell subset), and mast cells were examined using the Giemsa method. Positively stained macrophages, lymphocytes, and mast cells were counted in three high-power fields of a light microscope. The immunoreactivity of activated stellate cells and ECM proteins was assessed by a semiquantitative method (0, lack of positive staining; 5, numerous cells with strong positive immunostaining). Results were assessed statistically.

RESULTS

We found no statistical differences between cases of AP, IP, and CA in terms of total lymphocyte count (mean numbers: 416, 418, and 407 per three high-power fields, respectively). The percentage of CD8+ T cells in IP was statistically higher than that in AP. The macrophage count was significantly higher in the IP group than in the AP and CA groups. The mast cell count was markedly higher in the IP group than in the other groups. The stellate cell markers alpha-smooth muscle antibody and desmin showed slightly higher immunoreactivity in IP. The immunopositivity for synaptophysin was also higher in the IP group. There was a positive correlation between alpha-smooth muscle antibody, desmin, and synaptophysin expression and the degree of fibrosis. ECM protein markers showed no statistically significant differences between the three groups.

CONCLUSION

Results of this work show that a significant number of IP cases might have an autoimmune etiology. There was a positive correlation between activated stellate cell marker expression and the degree of fibrosis.

Small intestine perforation because of capacitive coupling as a cause of abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy

The authors present a case report regarding abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. Capacitive coupling was considered to be the most probable cause of small intestine perforation and further complications. Despite intensive treatment, the 69-year-old patient died.

Comparative study of the lipogenic potential of human and rat adipose tissue

The reported low activity of lipogenic enzymes (especially adenosine triphosphate [ATP]-citrate lyase) in human adipose tissue led to the general conclusion that in humans lipogenesis occurs primarily in the liver. However, recent studies indicate that the liver plays a minor role in de novo lipogenesis and suggest that adipose tissue may be the principal lipogenic human tissue. In an attempt to resolve these contradictions we reinvestigated the lipogenic potential of human adipose tissue and compared with adipose tissue of rats fed a high-fat diet for 2 weeks and fasted overnight before death. These conditions mimic the nutritional state of patients at the moment of tissue sampling. We found that overnight fasting of the rats maintained previously for 12 days on a high-fat diet caused a decrease of ATP-citrate lyase of about 7-fold. Thus, in human adipose tissue, the mean activity of ATP-citrate lyase was approximately 8 times lower than in rats fed a high-fat diet and fasted overnight, and about 50 times lower than in rats maintained on normal laboratory diet. Unlike ATP-citrate lyase, fatty acid synthase (FAS) activity was only slightly lower in human adipose tissue than in rats maintained on a normal laboratory diet. Comparable FAS activity was found when rats were fed a high-fat diet and fasted overnight. The average activities of human adipose tissue acetyl-coenzyme A carboxylase, malic enzyme, and glucose-6-phosphate dehydrogenase were approximately 3-, 4-, and 6-fold lower than in adipose tissue from rats fed a high-fat diet and fasted overnight before tissue sampling, while the activity of 6-phosphogluconate dehydrogenase in humans was higher than in rat adipose tissue. No significant differences in lipogenic enzyme activities were found between male and female and between lean and obese patients. The rate of fatty acid synthesis in intact pieces of human adipose tissue was approximately 5 times lower than in adipose tissue pieces of rats fed a high-fat diet and fasted overnight before tissue samples were taken. The comparison of the lipogenic potential of humans and rats (maintained on the diet to mimic the nutritional state of patients at the time of tissue sampling) suggests that human adipose tissue is an important site of fatty acid synthesis.

Beneficial effect of therapeutic infusion of nafamostat mesilate (FUT-175) on hemodynamics in experimental acute pancreatitis

Acute pancreatitis was induced in 13 anesthetized dogs by retrograde injection of bile mixed with trypsin into the pancreatic duct. Six animals were treated with intravenous infusion of new synthetic antiprotease. Nafamostat Mesilate, at a dose of 1 mg/kg/h. Four out of seven untreated animals died during the experiment. All the treated dogs survived. Hemodynamic data were regularly monitored during a ten-hour observation period. Cardiac output, mean arterial pressure and left ventricular stroke volume decreased rapidly in the untreated animals. An increase in systemic vascular resistance and pulmonary vascular resistance was observed in dogs without treatment. Nafamostat Mesilate given as therapy significantly improved the hemodynamic parameters, and prevented the animals from developing shock. The study demonstrates an advantageous influence of synthetic antiprotease Nafamostat Mesilate on the course of acute experimental pancreatitis.