High-fat diet (HFD) induces low-grade chronic inflammation and insulin resistance. However, little is known about the mechanism underlying HFD-induced chronic inflammation in peripheral ...insulin-responsive tissues. Here, we show that colonic pro-inflammatory macrophages regulate insulin sensitivity under HFD conditions. To investigate the pathophysiological role of colonic macrophages, we generated macrophage-specific chemokine (C-C Motif) receptor 2 (Ccr2) knockout (M-Ccr2KO) and intestinal epithelial cell-specific tamoxifen-inducible Ccl2 knockout (Vil-Ccl2KO) mice. Both strains exhibited similar body weight to control under HFD. However, they exhibited decreased infiltration of colonic pro-inflammatory macrophages, decreased intestinal permeability, and inactivation of the colonic inflammasome. Interestingly, they showed significantly improved glucose tolerance and insulin sensitivity with decreased chronic inflammation of adipose tissue. Therefore, inhibition of pro-inflammatory macrophage infiltration prevents HFD-induced insulin resistance and could be a novel therapeutic approach for type 2 diabetes.
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•HFD-induced inflammatory changes occur earlier in the colon than adipose tissues•Colonic inflammatory macrophages increase intestinal permeability•HFD induces inflammasome activation in colonic macrophages•Inhibition of colonic macrophage recruitment prevents insulin resistance
Kawano et al. reveal that the colon is the first tissue to respond to high-fat diet, with increased Ccl2 expression in intestinal epithelial cells leading to the recruitment of pro-inflammatory macrophages, increased gut permeability, and inflammasome activation, ultimately resulting in inflammation and insulin resistance in adipose tissue.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
OBJECTIVE:To evaluate the impact of complications on long-term survival in patients with perihilar cholangiocarcinoma.
BACKGROUND:Surgical resection for perihilar cholangiocarcinoma is vulnerable to ...postoperative complications. The prognostic impact of complications in patients with this disease is unknown.
METHODS:The medical records of patients who underwent curative-intent hepatectomy for perihilar cholangiocarcinoma between 2010 and 2017 were reviewed retrospectively. The comprehensive complication index (CCI) was calculated based on all postoperative complications, which were graded by the Clavien-Dindo classification (CDC). Patients were divided into high and low CCI groups by the median score, and survival was compared between the two groups.
RESULTS:Excluding 8 patients who died in hospital, 369 patients were analyzed. The CDC grade was I in 20 (5.4%), II in 108 (29.3%), III in 224 (60.7%), and IV in 17 (4.6%) patients. The CCI increased with increasing CDC grade; the median was 42.9 (range, 15.0–98.9). Overall survival (OS) differed significantly between the high (n = 187) and low (n = 182) CCI groups (41.2% versus 47.9% at 5 years; p = 0.041). However, multivariable analyses demonstrated that traditional clinicopathological factors were independent predictors of survival and that the dichotomized CCI was not. In addition, the CCI score as a continuous variable was not an independent prognostic factor for OS in the multivariable analyses (hazard ratio per 1 CCI score1.00, 95% confidence interval0.99–1.01, p = 0.775).
CONCLUSION:Cumulative postoperative complications after resection of perihilar cholangiocarcinoma only moderately deteriorate long-term survival, and should not be an argument to deny surgery in this high risk population.
Probe diffusion in a gelation process provides unique information such as local viscosity and sol/gel fraction that general scattering and rheological measurements do not provide. In this study, we ...revisited a gelation process of radical copolymerization of monomers and cross-linkers by conducting a series of probe diffusion experiments with dynamic light scattering (DLS). By using an isorefractive solvent to the gel system, we exclusively monitored the dynamics of gold nanoparticles during its real-time gelation process at multiscattering angles. The obtained time-correlation functions (g 2(τ) – 1) were analyzed by fitting with empirical stretched exponential functions. The ratio of mobile particles to the total particles, the relaxation time of mobile particles, and the heterogeneity of their dynamics were obtained as the fitting parameters. With those fitting parameters, the gel point, heterogeneity of local environment, and the local viscosity were evaluated. In addition, a unique up-and-down transition was found in the relaxation time, suggesting the local viscosity that the particles feel changes drastically around the gel point. This transition point in the relaxation time matches the gel point for homogeneous gels but showed a systematic deviation in heterogeneous gels by changing q –1 and the size of probe particles.
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IJS, KILJ, NUK, PNG, UL, UM
The sol–gel transition of tetrafunctional polymers with mutual reactive end-groups was investigated by analyzing the dynamics of probe particles via dynamic light scattering. The dynamics of probe ...particles was exclusively observed by matching the refractive index of the solvent and the polymers. The sol–gel transition point, decreasing of sol fraction and increasing of gel fraction with the reaction, the onset of formation of closed structure inside branched polymer clusters, and a piece of evidence for the decrease of the local viscosity in postgel regime were observed via the dynamics of probe particles. In addition, a scaling relationship ηeff ∼ ε–1.13±0.06 was found in a wide range of cross-linking conversion (p) before the gel point, where ηeff is the effective viscosity estimated from probe particles’ dynamics and ε ≡ |p – p c|/p c is the relative distance from the sol–gel transition point (p c is the cross-linking conversion at gel point).
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IJS, KILJ, NUK, PNG, UL, UM
Background
Although there are many studies on technical outcomes of endoscopic nasobiliary drainage (ENBD), no authors reported on preoperative course of patients undergoing ENBD. The aim of this ...study was to investigate the course of patients with ENBD during the waiting period.
Methods
Patients who underwent resection of perihilar cholangiocarcinoma (PHCC) between January 2013 and September 2017 were retrospectively reviewed.
Results
During the study period, 191 consecutive patients underwent surgical resection of PHCC after ENBD. Of the study patients, 154 (80.6%) patients were discharged, returned to their home, then re‐admitted for surgery. The remaining 37 patients were continuously hospitalized. The number of cholangitis events during the waiting period was 0 in 120 patients, 1 in 59 patients, 2 ≤ in 12 patients. Endoscopic re‐intervention was needed in 52 patients. The median length between the first admission and surgery was 37 days (range 12–197 days) in the entire cohort; it was longer in patients with portal vein embolization than in those without (43 vs. 27 days, P < 0.001).
Conclusions
In patients undergoing resection of PHCC, ENBD is widely tolerable with relatively low incidence of cholangitis and thus recommended for preoperative biliary drainage.
Highlight
Maeda and colleagues reported that preoperative endoscopic nasobiliary drainage in patients with perihilar cholangiocarcinoma was well tolerated, despite its patient‐unfriendly nature due to nasopharyngeal irritation, and was associated with a relatively low incidence of cholangitis. They concluded that the drainage method is safe and thus recommended for preoperative biliary drainage.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
We aimed to assess the utility of a clinician-reported outcome (the Japanese Orthopedic Association JOA hip score) as evaluated by clinicians and physiotherapists. This assessment was made by ...comparing these scores to those of the JOA hip disease evaluation questionnaire (JHEQ), which is a measurement of patient-reported outcomes after total hip arthroplasty.
In this retrospective case-control study, 52 hips that underwent primary total hip arthroplasty were included in the analyses. The mean age of the participants was 66.8 years (sex, seven male and 45 female participants). The JOA hip score included four categories: pain, range of motion, ability to walk, and active daily living. The JHEQ included three categories: pain, movement, and mental health. These scores were evaluated preoperatively and postoperatively by clinicians or physiotherapists. Pearson's correlation coefficients were utilized to analyze the association of the JOA hip scores to those of the JHEQ.
The JOA hip scores were determined by clinicians and physiotherapists (scores of 46.8 and 57.3, respectively) preoperatively and at 24 months (scores of 94.4 and 91.7, respectively) postoperatively. The JHEQ points were 28.8 and 66.2 preoperatively and at 24 months postoperatively, respectively. The correlation coefficients between the JOA hip and JHEQ scores were .66 and .69 preoperatively and .57 and .76 at 24 months postoperatively, as evaluated by clinicians and physiotherapists, respectively.
Although the JHEQ scores were positively correlated to the JOA hip scores by clinicians and physiotherapists preoperatively and postoperatively, this study implies that clinicians may interpret the results in a way that might have been beneficial to them. To comprehend a patients' health status, we should inclusively understand the varying range of information among different evaluators.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
The efficacy of adjuvant chemotherapy for biliary cancers remains controversial because of conflicting results from previous phase 3 studies that used different key drugs and enrolled ...patients with heterogeneous tumor sites and disease stages. Fluoropyrimidine seems more beneficial than gemcitabine (GEM) combination regimens in the adjuvant setting; however, data comparing the survival benefit between GEM‐ and fluoropyrimidine‐based regimens are lacking.
Methods
Patients who underwent resection for node‐positive perihilar cholangiocarcinoma were included. The patients who underwent adjuvant chemotherapy were divided into the S‐1 and GEM groups according to the regimen. The recurrence‐free survival (RFS) and the overall survival (OS) were compared between the groups and adjusted with propensity scores generated from 14 potentially confounding clinicopathological factors.
Results
In total, 186 patients (Surgery alone, n = 71; S‐1, n = 60; GEM, n = 55) were included. The S‐1 and GEM completion rates were 75% and 65%, respectively. Among the patients who underwent adjuvant therapy, the RFS was longer in the S‐1 group patients than the GEM group patients (median, 24.4 months vs 14.9 months; P = .044) whereas the OS was not significantly different between the groups (median, 48.5 months vs 35.0 months; P = .324). After propensity score adjustment, the differences in RFS and OS between the groups were more evident (HR: 2.696, 95% CI: 1.739‐4.180 P < .001; HR: 1.988, 95% CI: 1.221‐3.238, P < .001, respectively).
Conclusions
Compared with adjuvant GEM monotherapy, adjuvant S‐1 monotherapy may improve survival in node‐positive perihilar cholangiocarcinoma patients.
Highlight
Takahashi and colleagues evaluated the survival benefit of adjuvant S‐1 monotherapy over gemcitabine monotherapy for biliary tract cancer in patients after hepatectomy for node‐positive perihilar cholangiocarcinoma, a group with relatively homogenous tumor subtype and stage. S‐1 monotherapy was associated with longer recurrence‐free and overall survival on multivariable and propensity‐score adjusted analysis.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose The purpose of the present study was to determine whether panoramic radiographs could predict physical contact between the mandibular third molar and the mandibular canal on limited cone-beam ...computed tomography, known as dental 3D-CT (3-dimensional computed tomography 3D-CT). Patients and Methods The association of images between the panoramic radiograph and the dental 3D-CT was investigated in a cross-sectional study. Seventy-three lower third molars in 65 patients were examined. Findings of absence or presence of the white line of the mandibular canal wall on panoramic radiographs and contact or separation between the tooth and the mandibular canal on dental 3D-CT were compared. Results Absence of a superior white line on panoramic radiography was associated with an increased risk of contact between the third molar and the mandibular canal on dental 3D-CT, even when the effects of tooth position, age, and gender were taken into account. The multivariate adjusted odds ratio was 10.79. Women were more likely to have contact between the 2 structures on dental 3D-CT when their panoramic radiograph showed absence of the white line. Conclusions Panoramic radiography is useful for predicting to a limited extent physical contact between the mandibular third molar and the mandibular canal on dental 3D-CT.
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GEOZS, NUK, OILJ, SBCE, UL
•3D print model for glioma surgery involved plural structures with material adjustment.•Useful simulation of insertion of fence-post and resection of tumor.•Understanding relationship between tumor ...and fiber being not visible perioperatively.
Although the three-dimensional (3D) printing technology has spread in the field of neurosurgery, the use of 3D print models concerning glioma surgery has rarely reported. For glioma surgery, some preoperative and intraoperative assistive methods have been developed to avoid injury to the cortex and fiber that are related to the neurological function. Furthermore, in order to perform preoperative simulation of glioma surgery, we created a 3D print model using a multi-material 3D printer that provided the flexibility of adjusting the color, hardness, and translucency of each structure arbitrarily. The use of 3D print model was demonstrated in one case involving an intramedullary tumor in the right temporal lobe. The tumor, optic radiation, brain parenchyma, tentorium, ventricle, and sinus were constructed in a single model in one printing process. Design of the degree of resection, insertion of the fence-post, and tumor resection paying attention to the optic radiation were simulated preoperatively using this model. The surgery was performed generally as the simulation and gross total removal of the tumor was achieved. This model was useful for understanding the degree of resection, adequate insertion of the fence-post, and the relationship of the tumor with other important structures. A variety of printing materials contributed to make the model realistic and to understand anatomical relationship. In conclusion, the 3D print model can supplement an image of some portions that are not visible perioperatively and serve as a preoperative assistant modality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purposes
This study sought to define the impact of skeletal muscle mass and quality on postoperative outcomes in patients with perihilar cholangiocarcinoma.
Methods
Patients who underwent major ...hepatectomy for perihilar cholangiocarcinoma were included. The normalized total psoas area (TPA) (psoas muscle index PMI) and average Hounsfield units of the TPA (psoas muscle density PMD) were measured using preoperative computed tomography images. The cohort was dichotomized using the following indices: sex‐specific lowest tertile (low PMI and low PMD) and other (normal PMI and normal PMD). Intraoperative and postoperative outcomes were compared, focusing on PMI and PMD.
Results
A total of 456 patients were analyzed. The intraoperative blood loss (IBL) was 21.3 ml/kg in the low PMI group and 17.2 ml/kg in the normal PMI group (P = .008). Patients in the low PMI or PMD group experienced postoperative infectious complications more frequently than those in the other groups. The median survival time was 37.8 months in the low PMI group and 54.2 months in the normal PMI group (P = .027).
Conclusions
PMI and PMD were closely associated with IBL and postoperative infectious complications. Additionally, PMI impacted long‐term survival. These results suggest an importance of improving muscle mass and quality before surgery.
Asai and colleagues analyzed 456 patients with perihilar cholangiocarcinoma to define the impact of skeletal muscle mass and quality on postoperative outcomes. The psoas muscle index and psoas muscle density were closely associated with intraoperative blood loss and postoperative infectious complications. Additionally, the psoas muscle index impacted long‐term survival.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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