Role of adjuvant chemoradiotherapy and chemotherapy in patients with resected gallbladder carcinoma: a multi-institutional analysis (KROG 19-04)

Objective:The effectiveness of adjuvant treatments for resected gallbladder carcinoma (GBC) has remained unclear due to lack of randomized controlled trials; thus, the aim of present study was to evaluate the role of adjuvant treatments, including chemoradiotherapy (CRT) and/or chemotherapy (CTx), in patients with resected GBC.Methods:A total of 733 GBC patients who received curative-intent surgical resection were identified in a multi-institutional database. Of 733 patients, 372 (50.8%) did not receive adjuvant treatment, whereas 215 (29.3%) and 146 (19.9%) received adjuvant CTx and CRT, respectively. The locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS), and overall survival (OS) of the adjuvant treatment groups were compared according to tumor stage (stage II vs. stage III–IV).Results:In stage II disease (n = 381), the 5-year LRFS, RFS, and OS were not significantly different among the no-adjuvant therapy, CTx, and CRT groups, and positive resection margin, presence of perineural invasion, and Nx classification were consistently associated with worse LRFS, RFS, and OS in the multivariate analysis (P < 0.05). For stage III–IV (n = 352), the CRT group had significantly higher 5-year LRFS, RFS, and OS than the no-adjuvant therapy and CTx groups (67.8%, 45.2%, and 56.9%; 37.9%, 28.8%, and 35.4%; and 45.0%, 30.0%, and 45.7%, respectively) (P < 0.05).Conclusions:CRT has value as adjuvant treatment for resected GBC with stage III–IV disease. Further study is needed for stage II disease with high-risk features.     

Lead-Free BiFeO3-Based Piezoelectrics: A Review of Controversial Issues and Current Research State

Lead-free electroceramics represent an emerging area of research that has the potential to enable new green advances in electronics. Research has mainly focused on the development of new piezoelectric materials for replacing lead containing oxides exhibiting superior electromechanical behavior. Lead-free BiFeO₃-based materials are not only the promising candidates to replace lead-based materials but also show intriguing properties which may inspire innovative material design for the next generation of lead-free piezoceramics. This review aims to highlight the current state of research and overlooked aspects in lead-free BiFeO₃-based ceramics, which could be insightful in elucidating certain controversial issues. Current strategies to reduce high conductivity, influence of chemical heterogeneity on both functional properties and crystal structure, effective heat treatment procedures, and the role of pseudo-cubic structures on the enhancement of piezoelectric properties are subjects of highlighted within this review as they have a significant impact on the quality of BiFeO₃-based lead-free piezoelectrics (but are often disregarded).     

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer: A case report

Rationale:Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality.Patient concerns:A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation.Diagnosis:Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel.Interventions:Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally.Outcomes:The patient experienced no postoperative complications and remained disease-free for 9months postoperatively.Lessons:Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.     

Clinical Impact of Empirical Antibiotic Therapy in Patients With Coronavirus Disease 2019 Requiring Oxygen Therapy

Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.     

Phloroglucinol (PG) purified from Ecklonia cava attenuates radiation-induced apoptosis in blood lymphocytes and splenocytes

Phloroglucinol (PG), a polyphenol compound of Eckloniacava known as brown algae abundant in Jeju island, has been proposed to exert the antioxidative and cytoprotective effects against oxidative stress. In this study, we confirmed that PG protected mice from damages caused by ionizing radiation and investigated its protection mechanism in detail. The result showed that PG increased the viability of splenocytes without cytotoxicity. Also, PG significantly enhanced the proliferation of splenocytes by limiting the increment of sub-G₁ DNA contents via the inhibition of reactive oxygen species production in 2 Gy-irradiated splenocytes. In addition, PG significantly decreased DNA damage and the number of apoptotic fragments in lymphocytes against oxidative stress. Also, PG increased the counts of endogenous spleen CFUs, compared with only ionizing radiation-irradiated mice. These results demonstrate the multi-faceted protection mechanisms of PG in mice against oxidative stress caused by ionizing radiation, providing the benefit of inhibiting apoptosis and strengthening hematopoiesis.     

A lignan fromRubia akane

A lignan, (+)-isolariciresinol, was isolated fromRubia akane Nakai. This is the first reporting from Rubiaceae.     

Beta-carboline alkaloids from a Korean tunicate Eudistoma sp

Seven new beta-carboline-based metabolites, designated as eudistomins Y1-Y7 ( 1- 7), were isolated from a tunicate of the genus Eudistoma collected near Tong-Yeong City, South Sea, Korea. These new metabolites differ from previously isolated marine metabolites due to the presence of a benzoyl group attached to the beta-carboline nucleus at C-1. Eudistomins Y 1-Y 7 were evaluated for their antibacterial activity, and eudistomin Y6 exhibited moderate antibacterial activity against Gram-positive bacteria Staphylococcus epidermis and Bacillus subtilis without cytotoxicity in the MTT assay at 100 microM.     

Anti-atherogenic effects of the aqueous extract of rhubarb in rats fed an atherogenic diet

The present study was designed to investigate whether the aqueous extract of rhubarb (AR) could prevent the development of atherosclerosis through regulating vascular inflammatory processes in rats fed with an atherogenic diet. AR significantly reduced plasma low-density lipoprotein-cholesterol, and increased plasma high-density lipoprotein-cholesterol in rats fed with an atherogenic diet. AR inhibited vascular expressions of endothelin-1 (ET-1) and endothelin-converting enzyme (ECE) induced in rats with an atherogenic diet. On the other hand, AR augmented the vascular expression of endothelial nitric oxide synthase (ecNOS) and restored vascular nitric oxide (NO) production. Furthermore, AR suppressed the elevated expression of vascular nuclear factor-kappaB (NF-kappaB) p65 as well as adhesion molecules, including intracellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin in rats fed with an atherogenic diet. Also, AR decreased endothelial expression of ICAM-1 and ET-1 in aorta. These results suggest that AR suppresses the development of atherosclerosis in the atherogenic-diet rat model through inhibiting vascular expressions of proinflammatory and adhesion molecules via the regulation of nitric oxide and endothelin system.     

Elaeocarpus sylvestris modulates gamma-ray-induced immunosuppression in mice: implications in radioprotection

The study investigated the potential of Elaeocarpus sylvestris var. ellipticus (E.S.), which contains 1,2,3,4,6-penta-O-galloyl-beta-D-glucose (PGG), to protect mice from radiation injury by single whole-body irradiation (WBI) in vivo. The results from the present study demonstrate that the E.S. extract significantly improved the rate and duration of survival beyond that of untreated, irradiated control mice. The counts of endogenous colony forming units (CFU) increased in E.S.-treated mice, indicating that E.S. induced the regeneration of hematopoietic cells. E.S. treatment also accelerated the proliferation and recovery of lymphocytes and granulocytes, compared with those levels in untreated, irradiated controls. These results suggest that E.S. extract increases the survival time of mammals exposed to ionizing radiation by intensifying the victims' hematopoietic repair capacities. Therefore, it is concluded that the E.S. extract may be an effective agent of protection from radiation-induced injuries.