Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases

Background  Robotic surgery was invented to overcome the demerits of laparoscopic surgery. However, the role of robotic surgery in gastrectomy has rarely been reported. This study aimed to evaluate the use of robot-assisted distal subtotal gastrectomy to facilitate surgical training for gastric cancer. Methods  Twenty gastric cancer patients who underwent robotic gastrectomy from July 2005 to November 2006 were compared with 20 initial patients who underwent laparoscopic subtotal gastrectomy from May 2003 to August 2003 and 20 recent patients who underwent laparoscopic subtotal gastrectomy during the same period as the 20 robotic gastrectomy procedures by the same surgeon. Result  All 60 patients underwent subtotal gastrectomies with gastroduodenostomy without open or laparoscopic conversion. Operation time for robotic gastrectomy, initial laparoscopic gastrectomy, and recent laparoscopic gastrectomy was 230 min (range 171–312 min), 289.5 min (range 190–450 min), and 134.1 min (range 90–260 min). The number of retrieved lymph nodes was 35.3 ± 10.5, 31.5 ± 17.1, and 42.7 ± 14.9, respectively. Hospital stay was 5.7, 7.7, and 6.2 days, respectively. Postoperative complication occurred in two patients in recent laparoscopic gastrectomy and one patient each in robotic and initial laparoscopic gastrectomy. Conclusion  In this context, it could be assumed that experienced laparoscopic surgeons could perform robotic gastrectomy with a certain level of skill, even in initial series.     

Fontan conversion with arrhythmia surgery.

OBJECTIVE: Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with Fontan conversion and concomitant arrhythmia surgery. METHODS: Between January 1996 and February 2004, 16 patients underwent Fontan conversion and arrhythmia surgery. Mean age at the initial Fontan operation was 5.1+/-3.5 (range: 2-15) years and mean age at Fontan conversion was 17.0+/-5.8 (range: 6-30). The initial Fontan operations were atriopulmonary connections in 14 patients, extracardiac lateral tunnel in 1, and intracardiac lateral tunnel in 1. The types of arrhythmia included atrial flutter in 10 patients and atrial fibrillation in 3. Fontan conversion operation was performed with intracardiac lateral tunnel in 5 patients and extracardiac conduit in 11. Arrhythmia surgery included isthmus cryoablation in 10 patients and right-sided maze in 3. RESULTS: There has been no mortality. At Fontan conversion operation, 7 patients required permanent pacemaker. All patients have improved to New York Heart Association class I or II. With a mean follow-up of 26.9+/-30.6 (range:1-87) months, 16 patients had sinus rhythm, 2 patients had transient atrial flutter which was well controlled, and 2 patients required permanent pacemaker during follow-up. CONCLUSIONS: Fontan conversion with concomitant arrhythmia surgery and permanent pacemaker placement is safe, improves New York Heart Association functional class, and has a low incidence of recurrent arrhythmias. In most patients, concomitant permanent pacemakers are needed.     

Validation of a Korean version of the Child Oral Health Impact Profile (COHIP) among 8- to 15-year-old school children

International Journal of Paediatric Dentistry 2012; 22: 292–301 Objectives. The purpose of this study was to assess reliability, discriminant validity, and convergent validity of the Oral Health Impact Profile (COHIP) Korean version in a representative community sample of 8‐ to 15‐year‐old Korean children. Methods. A Korean version of COHIP was developed according to the standard procedure of cross‐cultural adaptation of self‐reported instruments. A representative community sample of 2236 schoolchildren was selected by cluster sampling method. Results. Mean age of the participants was 11.8 years. Mean and median of the overall COHIP score were 103.3 (SD 13.3) and 106, respectively. Internal reliability and retest reliability were excellent with Chronbach’s alpha 0.88 and intraclass correlation coefficient 0.88. Face validity was confirmed with 98% of participants reporting the COHIP questionnaire was easy to answer. Nonclinical factors such as self‐rated oral health or satisfaction with oral health were significantly related with overall COHIP score and five subscale scores (P < 0.001) in a consistent manner. Children with carious permanent teeth and with orthodontic treatment need had highly significantly lower overall COHIP score (P < 0.01). Conclusion. The Korean version of the COHIP was successfully developed. The internal reliability, retest reliability, face validity, discriminant validity, and convergent validity of the COHIP Korean version were confirmed.     

Preferential occupancy of Eu3+ and energy transfer in Eu3+ doped Sr2V2O7, Sr9Gd(VO4)7 and Sr2V2O7/Sr9Gd(VO4)7 phosphors

The vanadate-based phosphors Sr₂V₂O₇:Eu³⁺ (SV:Eu³⁺), Sr₉Gd(VO₄)₇:Eu³⁺ (SGV:Eu³⁺) and Sr₉Gd(VO₄)₇/Sr₂V₂O₇:Eu³⁺ (SGV/SV:Eu³⁺) were obtained by solid-state reaction. The bond-energy method was used to investigate the site occupancy preference of Eu³⁺ based on the bond valence model. By comparing the change of bond energy when the Eu³⁺ ions are incorporated into the different Sr, V or Gd sites, we observed that Eu³⁺ doped in SV, SGV or SV/SGV would preferentially occupy the smaller energy variation sites, i.e., Sr4, Gd and Gd sites, respectively. The crystal structures of SGV and SV, the photoluminescence properties of SGV:Eu³⁺, SV, SGV/SV and SGV/SV:Eu, as well as their possible energy transfer mechanisms are proposed. Interesting tunable colours (including warm-white emission) of SGV/SV:Eu³⁺ can be obtained through changing the concentration of Eu³⁺ or changing the relative quantities of SGV to SV by increasing the calcination temperature. Its excitation bands consist of two types of O²⁻ → V⁵⁺ charge transfer (CT) bands with the peaks at about 325 and 350 nm respectively, as well as f–f transitions of Eu³⁺. The obtained warm-white emission consists of a broad photoluminescence band centred at about 530 nm, which originates from the O²⁻ → V⁵⁺ CT of SV, and a sharp characteristic spectrum (⁵D₀–⁷F₂) at about 615 and 621 nm.

The vanadate-based phosphors Sr₂V₂O₇:Eu³⁺ (SV:Eu³⁺), Sr₉Gd(VO₄)₇:Eu³⁺ (SGV:Eu³⁺) and Sr₉Gd(VO₄)₇/Sr₂V₂O₇:Eu³⁺ (SGV/SV:Eu³⁺) were obtained by solid-state reaction.     

Erythrophagocytosis of Lead-Exposed Erythrocytes by Renal Tubular Cells: Possible Role in Lead-Induced Nephrotoxicity

Background: Nephrotoxicity associated with lead poisoning has been frequently reported in epidemiological studies, but the underlying mechanisms have not been fully described.Objectives: We examined the role of erythrocytes, one of the major lead reservoirs, in lead-associated nephrotoxicity.Methods and results: Co-incubation of lead-exposed human erythrocytes with HK-2 human renal proximal tubular cells resulted in renal tubular cytotoxicity, suggesting a role of erythrocytes in lead-induced nephrotoxicity. Morphological and flow cytometric analyses revealed that HK-2 cells actively phagocytized lead-exposed erythrocytes, which was associated with phosphatidylserine (PS) externalization on the erythrocyte membrane and generation of PS-bearing microvesicles. Increased oxidative stress and up-regulation of nephrotoxic biomarkers, such as NGAL, were observed in HK-2 cells undergoing erythrophagocytosis. Moreover, TGF-β, a marker of fibrosis, was also significantly up-regulated. We examined the significance of erythrophagocytosis in lead-induced nephrotoxicity in rats exposed to lead via drinking water for 12 weeks. We observed iron deposition and generation of oxidative stress in renal tissues of lead-exposed rats, as well as the histopathological alterations such as tubulointerstitial lesions, fibrosis, and up-regulation of KIM-1, NGAL, and TGF-β.Conclusions: Our data strongly suggest that erythrophagocytosis and subsequent iron deposition in renal tubular cells could significantly enhance nephrotoxicity following lead exposure, providing insight on lead-associated kidney damages.Citation: Kwon SY, Bae ON, Noh JY, Kim K, Kang S, Shin YJ, Lim KM, Chung JH. 2015. Erythrophagocytosis of lead-exposed erythrocytes by renal tubular cells: possible role in lead-induced nephrotoxicity. Environ Health Perspect 123:120–127; http://dx.doi.org/10.1289/ehp.1408094     

Adeno-associated virus mediated endostatin gene therapy in combination with topoisomerase inhibitor effectively controls liver tumor in mouse model

AIM: rAAV mediated endostatin gene therapy has been examined as a new method for treating cancer. However, a sustained and high protein delivery is required to achieve the desired therapeutic effects. We evaluated the impact of topoisomerase inhibitors in rAAV delivered endostatin gene therapy in a liver tumor model. METHODS: rAAV containing endostatin expression cassettes were transduced into hepatoma cell lines. To test whether the topoisomerase inhibitor pretreatment increased the expression of endostatin, Western blotting and ELISA were performed. The biologic activity of endostatin was confirmed by endothelial cell proliferation and tube formation assays. The anti-tumor effects of the rAAV-endostatin vector combined with a topoisomerase inhibitor, etoposide, were evaluated in a mouse liver tumor model. RESULTS: Topoisomerase inhibitors, including camptothecin and etoposide, were found to increase the endostatin expression level in vitro. The over-expressed endostatin, as a result of pretreatment with a topoisomerase inhibitor, was also biologically active. In animal experiments, the combined therapy of topoisomerase inhibitor, etoposide with the rAAV-endostatin vector had the best tumor-suppressive effect and tumor foci were barely observed in livers of the treated mice. Pretreatment with an etoposide increased the level of endostatin in the liver and serum of rAAV-endostatin treated mice. Finally, the mice treated with rAAV-endostatin in combination with etoposide showed the longest survival among the experimental models. CONCLUSION: rAAV delivered endostatin gene therapy in combination with a topoisomerase inhibitor pretreatment is an effective modality for anticancer gene therapy.     

Anomalous subaortic position of the brachiocephalic vein (innominate vein): an echocardiographic study

In 24 (0.98%) of 2457 patients with congenital heart disease the brachiocephalic vein was in an anomalous position below the aortic arch. This is a much higher proportion of such cases than reported so far. This high frequency may arise from differences in the study population and the method of diagnosis. This venous anomaly was more common in patients with tetralogy of Fallot or ventricular septal defect with pulmonary atresia. Patients with the venous anomaly were more likely to have a right aortic arch. The anomalous course of the brachiocephalic vein from the neck to the junction of the superior vena cava was shown by cross sectional echocardiography. In doubtful cases, Doppler study usually clarified the anatomical arrangement.     

Composite neuroendocrine and adenocarcinoma of the common bile duct associated with Clonorchis sinensis: a case report

The biliary tract has neuroendocrine cells of endoderm origin similar to the gastrointestinal tract, however neuroendocrine tumors of the biliary tract are rare. We report a composite glandular-endocrine cell carcinoma of the common bile duct in a 64-year-old Korean man which was associated with Clonorchis sinensis. The patient complained of right upper quadrant abdominal pain. Several parasites of Clonorchis sinensis were removed during the percutaneous transbiliary drainage. Endoscopic retrograde cholangiopancreatography revealed a polypoid mass (3 x 3 cm) with central ulceration in the common bile duct. Pancreaticoduodenectomy was performed. Microscopic examination of the tumor revealed a composite small cell neuroendocrine carcinoma and adenocarcinoma. The small cell carcinoma component showed positive reaction to chromogranin A and neuron-specific enolase and it was located mainly in the deeper portion of the mass. The well-differentiated adenocarcinoma component showed a positive reaction to carcinoembryonic antigen and it was situated in the superficial portion of the mass. Exclusively, the small cell component metastasized to the lymph node. It is suggested that this tumor could arise from a multipotential stem cell and showed neuroendocrine and glandular differentiation and that Clonorchis sinensis could be a predisposing factor, as in cholangiocarcinoma.