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The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes. This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed. The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hypertension, and 170 did not. After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay. Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies. [ABSTRACT FROM AUTHOR]

Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies. This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized. A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most perioperative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P <.001), longer operation time (320 vs 305 vs 300 and 266 minutes, P <.001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P =.022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P =.009) in obese, overweight, normal weight, and underweight patients, respectively (P <.001). However, postoperative major morbidity demonstrated a "U"-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients. Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures. [ABSTRACT FROM AUTHOR]

Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the peri-operative outcomes following laparoscopic left lateral sectionectomy (L-LLS). A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines. A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5–36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03–1.25), operative time (MD 11 min, 95% CI 6–16), use of Pringles maneuver (RR 1.15, 95% CI 1.06–1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to −0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a "U" shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients. Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections. [ABSTRACT FROM AUTHOR]

Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [ 4-8] vs. 6 [ 5-9] days, p-value = 0.043) were found in the NAT-group. The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM. Abbreviated abstract: The impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive major liver resections (MLRs) remains poorly investigated. NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for colorectal liver metastases. [ABSTRACT FROM AUTHOR]

Determination of vessel resection in patients with pancreatectomy after neo-adjuvant chemotherapy remains controversial. The recently introduced computed tomography-based vascular burden index presents a potential solution to this challenge. This study aimed to evaluate the model performance for the prediction of vascular resection and pathological invasion. Patients who underwent surgery after neo-adjuvant chemotherapy were included. Two independent reviewers measured the vascular tumour burden index around the adjacent artery (AVBI), and vein (VVBI). The area under the curve was compared to assess the predictive capacity of vascular burden index values and their changes for vascular resection and pathological vascular invasion. Among 252 patients, 179 and 73 had borderline resectable and locally advanced pancreatic cancer, respectively. Concurrent vessel resection and pathological vascular invasion were observed in 121 (48.0 %) and 42 (16.6 %) patients, respectively. In all patients, the VVBI (area under the curve: 0.872) and AVBI (0.911) after neo-adjuvant therapy significantly predicted vessel resection. In patients with vascular resection, the VVBI after neo-adjuvant chemotherapy (0.752) and delta value of the AVBI (0.706) demonstrated better performance for predicting pathological invasion of the resected vein. The regression of the AVBI and VVBI was an independent prognostic factor for survival (hazard ratio: 0.54, 95 % confidence interval: 0.34–0.85; P = 0.009) Regressed VVBI on serial computed tomography scans is useful for predicting vein resection and pathological venous invasion before surgery. The delta value of the AVBI may therefore be helpful for predicting pathological arterial invasion after neo-adjuvant chemotherapy. • Adjacent vessels were resected in 50 % of patients after neo-adjuvant chemotherapy, and pathological invasion of resected vessels occurred in approximately 30 % of cases. • A regressed VVBI or VVBI score <6 was associated with a reduced likelihood of venous invasion based on pathological reports. • Patients with regressed AVBI and VVBI could achieve longer survival. [ABSTRACT FROM AUTHOR]

Guyon canal (GC) syndrome is a rare peripheral neuropathy involving the distal part of the ulnar nerve. Several causes are associated with GC syndrome, including anatomic variations, space-occupying tumors, and trauma. Because of disease rarity, the only reported studies of GC syndrome are case series with small sample size. We conducted a multicenter study to identify the basic characteristics of patients with surgically treated GC syndrome and the risk factors for the disease. This retrospective multicenter study was conducted between January 2001 and December 2020. We screened 70 patients who underwent GC release surgery by seven hand surgeons at six institutes. A total of 56 patients were included in this study, including 38 patients (67.9%) who underwent isolated GC decompression and 18 (32.1%) who underwent combined peripheral nerve decompression. The mean patient age was 48.4 years (range: 20–89 years), and 40 patients (71.4%) were male. The average preoperative symptom duration was 18.5 months, and most patients were office workers. Ultrasound was positive for GC syndrome in 7/10 patients evaluated, CT in 2/5, MRI in 17/23, and electrodiagnostic studies in 35/44. The most common cause of GC syndrome was tumor (n = 23), followed by idiopathic (n = 17), trauma (n = 12), anatomic variants (n = 3), and inflammation (n = 3). In conclusion, most patients with GC syndrome in this study were male and had symptoms in one wrist. The most common cause of GC syndrome in this study was a tumor, including a ganglion cyst. Level of Evidence: Level IV case series [ABSTRACT FROM AUTHOR]

Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes. This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases. The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P =.011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P =.009), and larger tumor size (50 mm vs 32 mm, P <.001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach. Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases. [ABSTRACT FROM AUTHOR]

EUS-guided transluminal drainage (EUS-TD) is increasingly used for the treatment of postoperative pancreatic fluid collections (POPFCs). A novel lumen-apposing metal stent (LAMS) was recently developed and used for the drainage of POPFCs. This study aimed to evaluate the efficacy and safety of a novel LAMS in patients with POPFCs. Forty-seven patients with symptomatic POPFCs who underwent EUS-TD with a novel LAMS (Niti-S SPAXUS; Taewoong Medical Co, Ltd, Ilsan, South Korea) between April 2019 and July 2020 were included in this study. Clinical outcomes, including technical success, clinical success, and adverse events, were retrospectively evaluated. EUS-TD was technically successful in 41 of 47 patients (87.2%). Clinical success was achieved in 37 of 41 patients (90.2%). The mean procedure time was 13.7 ± 3.5 minutes. The mean POPFC size was 59 ± 18.9 mm. The mean time interval from surgery to EUS-TD was 24.2 ± 37.6 days. Five patients experienced 6 procedural adverse events (12.8%): 4 (8.5%) POPFC infections and 2 (4.3%) distal stent migrations. The 4 patients with POPFC infection underwent additional endoscopic interventions. Of the 2 patients with stent migration, 1 underwent laparoscopic exploration and surgical extraction of the stent and 1 (2.1%) experienced POPFC recurrence, which was managed with percutaneous drainage. EUS-TD for symptomatic POPFCs with a novel LAMS is technically feasible and effective, with an acceptable adverse event rate. Further larger-scale prospective studies are required to confirm the findings of this study. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Dynamic changes in electrocardiographic findings between initial and follow-up electrocardiograms (ECGs) have rarely been studied for disease severity and differential diagnosis in non-ST elevation acute coronary syndrome. We aimed to determine whether the changes in staple variables on ECG can assist in distinguishing between neuropsychiatric or gastrointestinal disorders (mild non-ischemic disorders), heart failure, and NSTE-ACS (non-ST elevation acute coronary syndrome).Methods: This retrospective study enrolled 1279 patients who presented with ischemic symptoms; were diagnosed with NSTE-ACS, acute heart failure, and mild disorders; and underwent echocardiography and coronary angiography. After performing propensity matching of the ECG follow-up interval, 184 patients with symptom onset within 48 h were included and analyzed.Results: As a discriminator for NSTE-ACS, the maximum change in the T/QRS ratio in two contiguous leads was superior to the maximum change in ST segment depression, T wave inversion, and ST/T ratio. ECGs of patients with NSTE-ACS and heart failure showed a tendency to increase and decrease the T/QRS ratio change, respectively. Compared with regional wall motion abnormality, the change in troponin I/h and the maximum change in ST segment depression and T-wave inversion, the most deviated T/QRS ratio change from 1 (>1.5 or < 0.5) in two contiguous leads was the most significant discriminator for disease severity and differential diagnosis (standardized β = 0.545, p < 0.001).Conclusion: The maximum changes in the T/QRS ratio in two contiguous leads can assist in distinguishing disease severity and acute mimicking disease such as acute heart failure in patients with suspected ACS. [ABSTRACT FROM AUTHOR]

In the last three decades, minimally invasive liver resection has been replacing conventional open approach in liver surgery. More recently, developments in neoadjuvant chemotherapy have led to increased multidisciplinary management of colorectal liver metastases with both medical and surgical treatment modalities. However, the impact of neoadjuvant chemotherapy on the surgical outcomes of minimally invasive liver resections remains poorly understood. A multicenter, international, database of 4998 minimally invasive minor hepatectomy for colorectal liver metastases was used to compare surgical outcomes in patients who received neoadjuvant chemotherapy with surgery alone. To correct for baseline imbalance, propensity score matching, coarsened exact matching and inverse probability treatment weighting were performed. 2546 patients met the inclusion criteria. After propensity score matching there were 759 patients in both groups and 383 patients in both groups after coarsened exact matching. Baseline characteristics were equal after both matching strategies. Neoadjuvant chemotherapy was not associated with statistically significant worse surgical outcomes of minimally invasive minor hepatectomy. Neoadjuvant chemotherapy had no statistically significant impact on short-term surgical outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases. [ABSTRACT FROM AUTHOR]

Although different body composition including fat adiposity has known to be associated with survival in patients with colorectal cancer (CRC), the clinical significance was inconsistent. We investigated prognostic impact of visceral and subcutaneous fat adiposity in patients with CRC after surgical resection. This retrospective single center study included 987 stage I−III CRC patients (583 males, and 404 females) who underwent surgical resection between March 2005 and April 2014. Preoperative diagnostic computed tomography images were used to quantify visceral fat area (VFA) and subcutaneous fat area (SFA). The sex-specific optimal cut-off value for body fat composition was defined using the X-tile program. The Cox proportional hazards model was used to determine the correlation fat composition and disease-free survival (DFS). Harrell's concordance index (C-index) and integrated area under curve (iAUC) were used to evaluate the predictive ability of cut-derived stratification. In univariate analysis, high SFA (≥141.73 cm2 in males and ≥168.71 cm2 in females) and high VFA (≥174.38 cm2 in male and ≥83.65 cm2 in female) were identified as significant prognostic factors for better DFS (p =.001 and p =.003 respectively). However, multivariate analysis revealed that high SFA independently predicted longer DFS (HR 0.505; 95% CI 0.266–0.957; p =.036) whereas, high VFA did not (HR 0.656; 95% CI 0.402–1.071; p =.092). Combining stage and SFA-cutoff showed better discriminatory performance than the model using stage solitary with respect to C-index (0.667; 95% CI 0.623–6.711; p =.0098) and iAUC (0.601; 95% CI 0.556–0.620). High SFA was correlated with better DFS in patients with CRC. Subcutaneous fat can have additive predictive capability when incorporated into clinical decision-making [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of lignin characteristics (mainly molecular weight, functional groups, and internal linkages) on nanoparticle formation. First, five different lignin fractions (M w 1460–12,900) were obtained from commercial kraft lignin (KL) by sequential solvent extraction. Functional groups and internal linkages were determined in lignin fractions, each fraction consisting of different levels and ratios. Second, spherical lignin nanoparticles (i.d. 193–1039 nm) were synthesized by nanoprecipitation at different pre-dialysis concentrations (1, 2, 4, and 6 mg mL−1 THF) with the different fractions (F1, F2, F3, F4, and F5). The study revealed that larger particles consisted of lignin fractions of lower molecular weight and higher phenolic group content (KL-F1 and F2), while smaller but non-uniform particles were produced from fractions of higher molecular weight and lower phenolic group content (KLF4 and F5). Every zeta potential value of the particle exceeded −35 mV. The nanoparticles from raw kraft lignin exhibited no significant cytotoxicity, hemotoxicity, and hypersensitivity. This study revealed that molecular weight and hydroxyl group content in the lignin highly correlated with nanoparticle properties. The present kraft lignin nanoparticles have potential for use in various polymer-based nanotechnology. • Lignin nanoparticle was successfully formed by using five lignin fractions with different structural features • Nanoparticle size was influenced by pre-dialysis lignin concentration, molecular weight, and hydroxyl group content • Lignin nanoparticle showed good size and distribution, colloidal stability, and biocompatibility [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the clinical outcomes of A1 pulley release with ulnar superficialis slip resection (group A) and simple A1 pulley release (group B) in trigger finger with flexion contracture of the proximal interphalangeal (PIP) joint. From January 2016 to December 2019, the 2 surgical procedures were performed alternately every year for trigger fingers with preoperative PIP joint flexion contractures of ≥10°. Twenty-six fingers in group A and 29 fingers in group B that were followed up for >1 year were reviewed in this retrospective study. The visual analog scale (VAS) score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of PIP joint flexion contracture; grip strength; and pinch strength were measured after surgery and compared. The differences in postoperative PIP joint flexion contracture between groups were <4° at 2 and 6 weeks, and there were no clinically relevant differences at 6 weeks and 12 months. At the final follow-up, PIP joint flexion contractures of 5° were observed in 2 fingers in each group. The difference in VAS scores between groups was less than half of a point until 3 months, and there were no clinically relevant differences at 6 weeks and 12 months. The DASH score did not show any difference between groups at the final follow-up. There were clinically relevant differences in the grip and pinch strengths between groups at 6 weeks. However, there were no clinically relevant differences at the final follow-up. Proximal interphalangeal joint flexion contracture measurements and clinical scores did not differ between groups at the final follow-up. Therefore, we recommend use of a simple A1 pulley release, which is simpler than an A1 pulley release with ulnar superficialis slip resection, in cases of trigger finger with PIP joint flexion contracture. Therapeutic IV. [ABSTRACT FROM AUTHOR]

We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies. This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021. 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025). The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR. [ABSTRACT FROM AUTHOR]

Background: Changes in the electrocardiographic findings, namely the ratio T sum to QRS sum (T/QRS ratio), between the initial electrocardiogram (ECG) and the baseline ECG have rarely been investigated in patients with non-ST elevation myocardial infarction (NSTEMI). Thus, we aimed to determine whether changes in various parameters on ECG, including T/QRS ratio, can assist in distinguishing between coronary artery disease (CAD) and NSTEMI without CAD with low to moderate risk.Methods: This retrospective study enrolled 2572 patients who presented ischemic symptoms, who were diagnosed with NSTEMI, and who underwent coronary angiography. Overall, 388 patients had prior ECG and echocardiography data available; 110 patients were included after excluding patients with other cardiac diseases except CAD. The population divided into two groups: a coronary stenosis group (n = 78); normal coronary group (n = 32) were analyzed.Results: We found that acute dynamic change in the most deviated T/QRS ratio in each region of leads of initial ECG from those of remote/recent ECG was an extremely strong predictor of acute CAD (odds ratio, 110; p < .001) compared to that of initial serum troponin I levels, new-onset regional wall motion abnormalities, and new-onset T inversion or ST depression. T/QRS ratio change > 1.5 or <0.5 times in injured regional leads was a significant predictor of CAD.Conclusion: Change in the most deviated T/QRS ratio in the regional leads on initial ECG from the T/QRS ratio in the same lead on remote ECG can assist in predicting CAD risk between patients with CAD and patients with no CAD in NSTEMI. [ABSTRACT FROM AUTHOR]

Crude bio-oil produced from fast pyrolysis of woody biomass was subjected to catalytic hydrodeoxygenation reaction with various metal catalysts (Ni/C, Ni/SBA-15, Ni/Al-SBA-15, NiMn/SBA-15, Pt/C) using for continuous-flow reaction system at 300 °C under H 2 pressure. Gas, immiscible liquid phases (light oil and heavy oil), and char was obtained as the primary products. Heavy oil yield was in the range 27.9–42.3 wt%, while char production was 2.3–11.0 wt%, both less than the corresponding figures for batch processing. Hydrodeoxygenation enhanced the fuel properties of bio-oil, yielding higher HHV (32.8–38.0 MJ/kg) than bio-oil (15.7 MJ/kg) and heavy oil produced in a batch type reactor (24.4–34.5 MJ/kg). Additionally, Miscibility of crude bio-oil and upgraded heavy oils with gasoline and diesel were also evaluated with three emulsifiers (Span60, Brij58, or IGEPAL CO-520). Crude bio-oil was hardly emulsified, whereas upgraded heavy oil was well emulsified with Span60. Increasing Span60 concentration also enhance the miscibility of heavy oil and diesel. An emulsion of heavy oil and diesel was stable for 6 months, suggesting that the heavy oil produced might have potential use in blends with diesel. • HDO reaction of crude bio-oil was performed in continuous flow reactor with 5 different metal catalysts. • Heavy oil properties, especially HHV, improved compared with that from batch type reactor. • Continuous reactor yielded lower char, thereby decreasing the rate of catalyst deactivation. • Miscibility with petroleum (gasoline and diesel) was obviously improved after HDO reaction. [ABSTRACT FROM AUTHOR]

Background: A reduced-port approach including single-site surgery has been used for distal pancreatectomy. However, triangulation is difficult in reduced-port laparoscopic distal pancreatectomy, and instrument crowding, and collision may occur, so this approach has not been widely used. Recently, an innovative technique for distal pancreatectomy using a robotic single-site surgical system was introduced. Herein, we evaluate the safety and feasibility of this technique.Methods: Twenty-seven patients with a pancreatic tail mass underwent robotic single-site plus one-port distal pancreatectomy at six centers. We collected clinicopathologic data and evaluated the short-term perioperative outcomes of robotic single-site plus one-port distal pancreatectomy.Results: We evaluated 26 patients who underwent robotic single-site plus one-port distal pancreatectomy excluding one patient who needed more ports because of fatty abdomen. The mean age and body mass index were 47.3 years (range 21-74) and 22.6 kg/m2 (range 15.8-28.8), respectively. The most common pathologic diagnosis was solid papillary neoplasm followed by a neuroendocrine tumor. The mean operating time was 201 min. The mean length of hospital stay after surgery was 7 days (range 4-10). The rate of spleen preservation was 34.6% (9/26). Six patients had postoperative pancreatic fistula (POPF) grade A, and no patients had POPF grade B or C. Only one patient had class II morbidity.Conclusion: Robotic single-site plus one-port distal pancreatectomy is safe and feasible in terms of short-term outcomes. This technique could be performed in select cases to expand the surgical boundaries of the robotic single-site platform. Further studies are needed with more cases to investigate long-term outcomes. [ABSTRACT FROM AUTHOR]

Three Ni-based bimetallic catalysts were prepared on hexagonally structured mesoporous SBA-15 supports(NiCu/SBA-15, NiMn/SBA-15, NiZn/SBA-15). Hydrodeoxygenation (HDO) of biooil was performed at 250–350 °C for 45 min with 3 MPa H 2 pressure in the presence of the three catalysts. HDO reaction yielded a primary products of gas, two immiscible liquids (light oil and heavy oil) and char. High catalyst surface area resulted in a high heavy oil yield (40.8–60.6 wt%). Bimetallic catalysts decreased yield of light oil (3.6–11.7 wt%), while increased the gas fraction (16.3–43.7 wt%) compared with the data from the monometallic Ni/SBA-15 catalyst (20.3–30.4 and 6.6–26.2 wt% yields, respectively). Use of bimetallic catalysts instead of monometallic catalyst enhanced fuel properties of heavy oil; such as moisture content (from 11.4 to 2.0–8.8 wt%), acidity (from 62.2 to 49.2–59.8 mg KOH/g oil), viscosity (from 7.1 to 3.2–4.3 cSt) and oxygen content (from 32.2 to 26.2–34.6 wt%). Cyclohexanone, 4-ethylphenol, and methyl-cyclopentenone, which were lack in the bio-oil, were detected after HDO reaction and these components could be produced via demethoxylation, hydrogenation, dehydration, and dehydroxylation under the presence of bimetallic catalysts, thereby improving the fuel properties of the heavy oil. • Bimetallic catalysts on SBA-15 was prepared to enhance the activity of Ni/SBA-15. • Heavy oil yield and properties improved compared with monometallic Ni catalyst. • NiCu/SBA-15 effectively catalyzed dehydration, resulted in low water content in heavy oil. • NiZn/SBA-15 produced high HHV of heavy oil, through its high deoxygenation activity. • At the high temperature, NiMn/SBA-15 could conduct the most efficient process. [ABSTRACT FROM AUTHOR]

[Display omitted] • Nut oils increased the TEER value in TNF-α/IFN-γ-damaged Caco-2 cells. • Nut oils reduce FITC-dextran permeability in TNF-α/IFN-γ-damaged Caco-2 cells. • Nut oils reduced IL-6 production in TNF-α/IFN-γ-damaged Caco-2 cells. • Walnut oil improved TJ protein expression in TNF-α/IFN-γ-damaged Caco-2 cells. Damage to the intestinal barrier causes intestinal inflammation, which could lead to the development of gastrointestinal diseases. Nut oils contain an abundance of unsaturated fatty acids, which are responsible for most of the bioactivities of nut oils. Here, the protective effect of four nut oils on the intestinal epithelial barrier was confirmed using Caco-2 cells damaged by tumor necrosis factor-α/interferon-γ treatment. Nut oils effectively increased transepithelial electronic resistance and lowered paracellular fluorescein isothiocyanate-dextran permeability in damaged Caco-2 cells. Furthermore, the nut oils inhibited the pro-inflammatory cytokine production of interleukin-6, which was induced by the inflammatory response. In particular, walnut oil effectively improved tight junction protein (occludin and zonula occludens-1) expression and distribution in damaged Caco-2 cells. In conclusion, our findings suggest that nut oils are promising candidates for impaired intestinal barrier protection. [ABSTRACT FROM AUTHOR]

To assess the impact of cirrhosis and portal hypertension (PHT) on technical difficulty and outcomes of minimally invasive liver resection (MILR) in the posterosuperior segments. This is a post-hoc analysis of patients with primary malignancy who underwent laparoscopic and robotic wedge resection and segmentectomy in the posterosuperior segments between 2004 and 2019 in 60 centers. Surrogates of difficulty (i.e, open conversion rate, operation time, blood loss, blood transfusion, and use of the Pringle maneuver) and outcomes were compared before and after propensity-score matching (PSM) and coarsened exact matching (CEM). Of the 1954 patients studied, 1290 (66%) had cirrhosis. Among the cirrhotic patients, 310 (24%) had PHT. After PSM, patients with cirrhosis had higher intraoperative blood transfusion (14% vs. 9.3%; p = 0.027) and overall morbidity rates (20% vs. 14.5%; p = 0.023) than those without cirrhosis. After coarsened exact matching (CEM), patients with cirrhosis tended to have higher intraoperative blood transfusion rate (12.1% vs. 6.7%; p = 0.059) and have higher overall morbidity rate (22.8% vs. 12.5%; p = 0.007) than those without cirrhosis. After PSM, Pringle maneuver was more frequently applied in cirrhotic patients with PHT (62.2% vs. 52.4%; p = 0.045) than those without PHT. MILR in the posterosuperior segments in cirrhotic patients is associated with higher intraoperative blood transfusion and postoperative morbidity. This parameter should be utilized in the difficulty assessment of MILR. [ABSTRACT FROM AUTHOR]

Backgrounds: A two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP), followed by cholecystectomy, is one of the primary treatments of concomitant gallstones and choledocholithiasis. However, negative findings on ERCP and migrating gallstones after cholecystectomy are major concerns. This study aimed to identify the prevalence of unnecessary ERCP and to develop and validate a predictive nomogram using preoperative factors in patients who underwent a two-stage procedure.Methods: Consecutive 931 patients were treated with the two-stage procedure for evident gallstones and suspected choledocholithiasis. After the cholecystectomy, a cholangiogram was performed to confirm the absence of the migrating gallstones. The patients were divided into derivation (n = 652) and validation (n = 279) cohorts.Results: A total of 26.5% (247/931) patients had unnecessary ERCP (negative choledocholithiasis, 14.6%; migrating gallstones, 11.9%). No stones on images (P < 0.001), total bilirubin < 1.2 mg/dL (P = 0.006), and common bile duct diameter < 8.0 mm (P = 0.004) were independent factors associated with negative finding on ERCP with a validated nomogram area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.64-0.80). For migrating gallstones after cholecystectomy, radiolucent gallstones (P < 0.001), gallstone size ≤ 6.4 mm (P = 0.001), cystic duct stones (P < 0.001), gallbladder wall thickness ≥ 3.2 mm (P = 0.003), and low-lying cystic duct (P < 0.001) were independent factors with a validated nomogram AUC of 0.77 (95% CI 0.68-0.87).Conclusions: About one fourth of the patients may have unnecessary ERCP in the two-stage procedure. Based on our nomogram using preoperative factors, high-risk patients who are more likely to perform unnecessary ERCP could be considered for the one-stage procedure. [ABSTRACT FROM AUTHOR]

Background: Increasing the size of the central veins is required to increase the success rate of central line placement and decrease complication risk. Right-sided approach for the central veins, Valsalva maneuver, and Trendelenburg position have been recommended, but these may not be available for some cases. This study aimed to determine a more convenient patient position that can result in the largest central vein diameter.Methods: Recruited subjects were placed in 60° and 30° upper body elevation, supine position, and 30° and 60° lower body elevation, and lumbar elevation (LE) was consecutively performed, with one position maintained for 10 min. Diameters of the subclavian vein (SCV) and internal jugular vein (IJV) were measured using high-resolution two-dimensional ultrasonography at each position.Results: The most suitable position on the ordinary bed for increasing central vein diameter was LE. The maximum and minimum SCV and IJV diameters in LE were significantly larger than those in the supine position (SCV: coefficients -0.633 and -0.863, p = 0.08 and 0.011, respectively; IJV: coefficients -1.09 and -1.15, p < 0.001 and = 0.001, respectively). Leg elevation for 10 min failed to dilate the central vein diameter.Conclusion: The LE without leg elevation produced a greater and more significant increase in central vein diameter than the supine position and may be useful for central line placement. [ABSTRACT FROM AUTHOR]

Background: The clinicopathologic characteristics of duodenal gastrointestinal stromal tumor (GIST) were unclear and the optimal surgical procedure for duodenal GIST remains poorly defined. We aimed to analyze clinicopathological characteristics, survival outcomes based on the surgical procedure, and recommend optimal surgical treatment for duodenal GIST.Methods: From July 2000 to April 2017, 118 patients with localized duodenal GIST underwent curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes.Results: The 5-year overall survival (OS) and disease-free survival (DFS) rates were 94.9 and 79.2%, respectively. On multivariate analysis, the mitotic count was a statistically significant prognostic factor for DFS. Limited resection (LR) was performed in 20 patients with GIST in the first or fourth portion of the duodenum. Both LR and pancreaticoduodenectomy (PD) were performed in 98 patients with GIST in second or third portion of the duodenum. The patients in the LR group had less late complications than in the PD group and no postoperative newly developed diabetes mellitus. The minimally invasive LR (MI-LR) group had a shorter duration of surgery and shorter length of postoperative hospital stay.Conclusion: LR is a feasible and effective surgical treatment for patients with small-sized and antimesenteric-sided duodenal GIST in terms of late complications and postoperative diabetic complications. MI-LR has better perioperative outcomes than open LR. Therefore, we should consider MI-LR as an optimal surgical treatment for selected patients with duodenal GIST. [ABSTRACT FROM AUTHOR]