Impact of vascular abnormality on contrast-enhanced CT and high C-reactive protein levels on postoperative pancreatic hemorrhage after pancreaticoduodenectomy: A multi-institutional,retrospective analysis of 590 consecutive cases

Background/Objectives: This study aimed to elucidate the efficacy of CT findings and perioperative characteristics to predict post-pancreatectomy hemorrhage (PPH): a critical complication after pancreaticoduodenectomy.MethodsThe records of 590 consecutive patients who underwent pancreaticoduodenectomy at three institutes between 2012 and 2018 were included. The presence of a vascular wall abnormality or ascites with high density (vascular abnormality) on postoperative day (POD) 5–10 contrast-enhanced CT (early CT), perioperative characteristics, and any PPH or pseudoaneurysm formation (PPH events) were analyzed through a multivariate analysis.ResultsPPH events occurred in 48 out of 590 patients (8%). The vascular abnormality on early CT and the C-reactive protein (CRP) value on POD 3 were independent risk factors for PPH events after POD5 (vascular abnormality: odds ratio 6.42, p = 0.001; CRP on POD 3: odds ratio 1.17, p = 0.016). The sensitivity of vascular abnormality for PPH events was 24% (7/29), and the positive predictive value was 30% (7/23). The combination of vascular abnormality and a high CRP value (≥15.5 mg/dL) on postoperative day 3 had a higher positive predictive value of 64% (7/11) than the vascular abnormality alone. None of the seven PPH events that occurred more than one month after surgery were foreseen via early CT.ConclusionThe combination of vascular abnormality and high CRP value was associated with increasing risk of PPH events after pancreaticoduodenectomy, but the low sensitivity of early CT must be noted as an important shortcoming. The normal findings on early CT could not eliminate the risk of late PPH.     

Changing Blue Fluorescent Protein to Green Fluorescent Protein Using Chemical RNA Editing as a Novel Strategy in Genetic Restoration

Using the transition from cytosine of BFP (blue fluorescent protein) gene to uridine of GFP (green fluorescent protein) gene at position 199 as a model, we successfully controlled photochemical RNA editing to effect site‐directed deamination of cytidine (C) to uridine (U). Oligodeoxynucleotides (ODNs) containing 5′‐carboxyvinyl‐2′‐deoxyuridine (^CVU) were used for reversible photoligation, and single‐stranded 100‐nt BFP DNA and in vitro‐transcribed full‐length BFP mRNA were the targets. Photo‐cross‐linking with the responsive ODNs was performed using UV (366 nm) irradiation, which was followed by heat treatment, and the cross‐linked nucleotide was cleaved through photosplitting (UV, 312 nm). The products were analyzed using restriction fragment length polymorphism (RFLP) and fluorescence measurements. Western blotting and fluorescence‐analysis results revealed that in vitro‐translated proteins were synthesized from mRNAs after site‐directed RNA editing. We detected substantial amounts of the target‐base‐substituted fragment using RFLP and observed highly reproducible spectra of the transition‐GFP signal using fluorescence spectroscopy, which indicated protein stability. ODNc restored approximately 10% of the C‐to‐U transition. Thus, we successfully used non‐enzymatic site‐directed deamination for genetic restoration in vitro. In the near future, in vivo studies that include cultured cells and model animals will be conducted to treat genetic disorders.     

Reversal of ischemia-induced mitochondrial dysfunction after coronary reperfusion

This study was designed to clarify the mechanism of the reversal of ischemia-induced mitochondrial dysfunction after a reperfusion of the myocardium in dogs. The occlusion of the left anterior descending coronary artery for 30 min led to the significant increase of acyl-CoA level in ischemic mitochondria and the ischemic mitochondrial function was disturbed. Pre-infusion of 1 ml/kg of lipid before occlusion further increased the acyl-CoA accumulation in ischemic mitochondria, and concomitantly, the mitochondrial dysfunction was extended much more. On the other hand, 40 min of reperfusion following 30 min of occlusion diminished the accumulation of acyl-CoA in the reperfused mitochondria and restored the mitochondrial function. However, when lipid was pre-infused, acyl-CoA level in the reperfused mitochondria was still high and mitochondrial dysfunction was observed. Administration of carnitine prior to reperfusion not only suppressed the accumulation of acyl-CoA in the reperfused mitochondria but also preserved the mitochondrial function, despite the pre-infusion of lipid. There was a clear reciprocal correlation (r = ?0.97) between acyl-CoA level and mitochondrial function. These results suggest that acyl-CoA accumulation is one of the important factors in ischemia-induced mitochondrial dysfunction, and that reversal of the dysfunction after reperfusion is closely dependent upon the lowering of the acyl-CoA accumulation.     

Transpyloric prolapse of a pedunculated polypoid gastric carcinoma

A patient with transpyloric prolapse of a pedunculated polypoid gastric carcinoma is reported. Only three previous cases have been reported in the international literatures. However, in Japan, 33 cases of prolapsed gastric carcinoma have been reported during the past 30 years. Prolapsed gastric carcinoma should be included in the differential diagnosis of localized intraluminal filling defects in the duodenal bulb. Endoscopy and biopsy are essential for correct diagnosis.