Comparative Study Between Laparoscopic Adjustable Gastric Banded Plication and Sleeve Gastrectomy in Moderate Obesity—2 Year Results

Background

The traditional bariatric surgery guidelines issued by the National Institute of Health in 1991 did not include moderate obesity as an indication for bariatric surgery. These patients also develop risk of significant comorbidity and mortality. Nonsurgical treatment for them is not generally effective. This study compared the results of patients undergoing laparoscopic adjustable gastric banded plication (LAGBP) with laparoscopic sleeve gastrectomy (LSG) in patients with BMI between 30 and 35.

Methods

A review of data was done for patients who underwent either LAGBP or LSG in our hospital from February 2007 to October 2012. The inclusion criterion for both groups was BMI between 30 and 35 with or without comorbidity.

Results

One hundred thirty-nine patients were included in the study out of which 42 underwent LAGBP and 97 LSG. The operating time for LAGBP was significantly longer: 105.39?±?39 vs. 59?±?29.56 min. The postoperative hospital stay was not statistically different between the two procedures. The mean percent excess weight loss (%EWL) was significantly lower for LAGBP at 1 year but became insignificant at 2 years. Both groups had two postoperative complications, but the rate was not statistically different. The comorbidity resolution data did not show any significant difference between the two groups.

Conclusion

In the present study, both LAGBP and LSG seemed to be safe and effective bariatric procedures in moderate obesity with 2-year results. But the long-term results are still awaited.

     

Expression and prognostic significance of gastric-specific annexin A10 in diffuse- and intestinal-type gastric carcinoma

Background and Aims: Annexin A10 (ANXA10) and its liver‐specific short isoform (ANXA10S) had tissue‐restricted expression. The downregulation of ANXA10S is correlated with tumor progression and poor prognosis in hepatocellular carcinoma. The aim of the present study was to validate the tissue distribution and explore the role of the ANXA10 protein expression in gastric carcinoma. Methods: We examined the ANXA10 protein expression in human and animal tissues and 356 resected primary gastric carcinomas, using specific mouse and rabbit polyclonal antibodies, by immunohistochemical staining. Results: The ANXA10 protein is a nuclear protein specifically expressed in fetal and adult gastric mucosa and Brunner's gland across species, including humans, minipigs, woodchucks, and mice, and is commonly lost in gastric mucosa with intestinal metaplasia. The ANXA10 protein was expressed in 43.5% (155 cases) of gastric carcinomas; 74.2% (98/132) in the diffuse‐type gastric carcinoma (DGC), 73.7% (28/38) in the mixed‐type gastric carcinoma, and significantly lower in the intestinal‐type gastric carcinoma (IGC) and indeterminate groups, 16.8% (28/167) and 5.3% (1/19), respectively (P < 1 × 10^?8). IGC with ANXA10 expression was correlated with a higher stage (P = 0.049), particularly higher in stage IIIA/IIIB/IV IGC than lower‐stage (IA/IB/II) tumors (P = 0.005), but was not correlated with age, sex, and nodal status. In contrast, DGC with ANXA10 expression was associated with younger age, female patients, and importantly, lower tumor stage and lymph node metastasis (P = 0.007, P = 0.065, P = 0.024, and P = 0.0014, respectively). Moreover, DGC with ANXA10 expression had a better 5‐year patient survival (P = 0.0048), whereas IGC with ANXA10 expression had a lower 5‐year survival (P = 0.034). Conclusions: The ANXA10 protein expression is a novel marker of gastric differentiation, and is differentially expressed in IGC and DGC, with opposite prognostic significance.     

A controller for a miniature intra-aortic ventricular assist device

Two control algorithms have been developed for a minimally invasive axial-flow ventricular assist device (VAD) for placement in the descending aorta. The purpose of the device is to offload the left ventricle and to augment lower body perfusion in patients with moderate congestive heart failure. The VAD consists of an intra-aortic impeller with a built-in permanent magnet rotor and an extra-aortic stator. The control algorithms, which use pressure readings upstream and downstream of the VAD to determine the pump status, have been tested in a mock circulatory system under two conditions, namely with or without afterload sensitivity. The results give an insight into controller design for an intra-aortic blood pump working in series with the heart.     

Down-regulation of annexin A10 in hepatocellular carcinoma is associated with vascular invasion,early recurrence,and poor prognosis in synergy with p53 mutation

Annexins (ANXs) are a large group of calcium-binding proteins participating in diverse important biological processes. ANXA10 is the least expressed new member of unknown function. We showed that ANXA10 mRNA was expressed in adult liver and hepatocellular carcinoma (HCC), but not in multiple adult and fetal tissues, cholangiocarcinoma, and several other common carcinomas. Of 182 unifocal primary HCCs, ANXA10 mRNA was dramatically reduced in 121 (66%), and the down-regulation correlated with p53 mutation (P = 0.024), early intrahepatic tumor recurrence (P = 0.0007), and lower 4-year survival (P = 0.0014). Down-regulation of ANXA10 was twofold more frequent in large than small HCCs (P = 0.0012), in grade II to III than grade I HCC (P < 0.00001), and in stage IIIA to IV than stage I to II HCC (P < 0.00001). Moreover, ANXA10 down-regulation and p53 mutation acted synergistically toward high-grade (P < 0.00001), high-stage HCC (P < 0.00001), and poorer prognosis (P = 0.0025). Our results indicate that the expression of the tissue- and tumor-restricted ANXA10 is a marker of liver cell differentiation and growth arrest, and its down-regulation associated with malignant phenotype of hepatocytes, vascular invasion, and progression of HCC, leading to poor prognosis. Thus, ANXA10 might serve as a new potential target of gene therapy for HCC.     

Anti-ageing effects of alpha-naphthoflavone on normal and UVB-irradiated human skin fibroblasts

Ageing is a complex and multifactorial process resulting in several functional and aesthetic changes to the skin. We found that α-Naphthoflavone (α-NF) concentration-dependently induced pro-collagen type I protein expression and inhibited MMP-1 protein expression, in both normal and UVB-irradiated cells. SB431542 and SIS3 - inhibitors of TGF-β and Smad3, respectively - significantly alleviate α-NF-caused response of MMP-1 and pro-collagen. LY294002 (PI3K inhibitor) can reverse α-NF-induced ERK, Akt, Smad-3 activation, pro-collagen synthesis and α-NF-suppressed AP-1 activation. PD (ERK inhibitor) was not involved in pro-collagen generation and MMP-1 inhibition. We concluded that α-NF promotes pro-collagen production and inhibits MMP-1 expression via the activation of a PI3K/Akt/Smad-3 pathway in normal and UVB-irradiated human skin fibroblasts, while TGF-β may play an important role in transducing this pathway. These results suggest that α-NF, a natural plant product, has the potential to become a novel anti-ageing skin application.     

Isolinderanolide B, a butanolide extracted from the stems of Cinnamomum subavenium, inhibits proliferation of T24 human bladder cancer cells by blocking cell cycle progression and inducing apoptosis

Isolinderanolide B (IOB), a butanolide extracted from the stems of Cinnamomum subavenium, was investigated for its antiproliferative activity in T24 human bladder cancer cells. To identity the anticancer mechanism of IOB, its effect on apoptosis, cell cycle distribution, and levels of p53, p21 Waf1/Cip1, Fas/APO-1 receptor, and Fas ligand was assayed. Enzyme-linked immunosorbent assay showed that the G0/G1 phase arrest is because of increase in the expression of p21 Waf1/Cip1. An enhancement in Fas/APO-1 and membrane-bound Fas ligand (mFasL) might be responsible for the apoptotic effect induced by IOB. This study reports the novel finding that the induction of p21 Waf1/Cip1 and activity of the Fas/mFas ligand apoptotic system may participate in the antiproliferative activity of IOB in T24 cells.     

Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

Purpose

The purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.

Materials and Methods

The patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.

Results

A total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.

Conclusions

Increased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.

Level of Evidence

III.

     

Long-term establishment, characterization and manipulation of cell lines from mouse basal cell carcinoma tumors

There have been few reports of successful long-term culture of cells established from cutaneous basal cell carcinoma (BCC) tumors. Here, we describe techniques that have enabled us to establish three long-term cultures of BCC cells isolated from BCC tumors that arose in irradiated Patched 1 (Ptch1)(+/-) mice. All three cell lines showed cellular morphology similar to that of BCC tumors and could be propagated for at least 20 passages. In addition, similar to BCC tumors, all cell lines had lost the wildtype Ptch1 allele, expressed BCC molecular markers, and responded similarly to cyclopamine, a small molecule inhibitor of Hedgehog signaling. Finally, we describe an efficient electroporation technique for DNA transfection into the BCC cell lines and show that they have activated Hedgehog signaling activity, albeit at a level lower than that of murine BCCs in vivo. These data indicate that the cell lines are bona fide long-term cultures of BCC cells and that DNA plasmids can be introduced into the BCC cell lines with relatively high transfection efficiency using a modified electroporation technique.