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Background Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institution, characterized by a trauma surgery–liver surgery collaborative approach to trauma care.Methods This was an observational cohort study of adult patients (age ≥16) with HGLI (The American Association for Surgery of Trauma (AAST) grades IV and V) admitted to an urban level I trauma center from January 2010 to November 2021. Data were obtained from the electronic medical record and state trauma registry. Patients were categorized by management strategy: immediate OM or planned NOM. The primary outcome was 30-day mortality.Results Our institution treated 179 patients with HGLI (78% blunt, 22% penetrating); 122 grade IV (68%) and 57 grade V (32%) injuries. All abdominal gunshot wounds and 49% of blunt injuries underwent initial OM; 51% of blunt injuries were managed initially by NOM. Procedures at the initial operation included hepatorrhaphy±packing (66.4%), nonanatomic resection (5.6%), segmentectomy (9.3%), and hepatic lobectomy (7.5%). Thirty-day mortality in the OM group was substantially lower than prior reports (23.4%). Operative mortality attributable to the liver injury was 15.7%. 19.4% of patients failed NOM with one death (1.4%).Conclusion We report an operative mortality of 23.4% for HGLI in a trauma care system characterized by a collaborative approach by trauma surgeons and liver surgeons.Level of evidence III

Introduction Advanced radiation therapy delivery techniques require greater understanding of various planning sequences and methods. The aim of this study is to determine a class solution that finds the best possible technique to deliver for stereotactic radiosurgery between dynamic conformal arc (DCA) techniques using various options such as DCA, DCA + SSO (segment shape optimization), and DCA + SSO + VDR (variable dose rate) using noncoplanar beam arrangement and volumetric modulated arc therapy (VMAT) using coplanar beams. Materials and Methods In this dosimetric study, 11 brain cases were retrospectively planned for various techniques and analyzed for the Paddick conformity index (CI), Radiation Therapy Oncology Group homogeneity index (HI), Paddick gradient index (GI), treatment time in terms of monitor units (MU) and normal brain dose (V12Gy). The paired t-test was performed to know the statistical significance between the techniques. Results In terms of CI, GI, and control of the normal brain dose, the VMAT plan was superior to other techniques. But, HI was found to be better with DCA. Above all, VMAT delivered higher MU than any other technique. The p-values between DCA + SSO and DCA, DCA + SSO + VDR and DCA + SSO, and VMAT and DCA + SSO + VDR are as follows: CI: 0.0004, 0.015, and 0.03; GI: 0.03, 0.33, and 0.29; HI: 0.008, 0.04, and 0.06; V12 Gy of normal brain: 0.1, 0.01, 0.38. VMAT requires approximately 41 ± 17% more MU than DCA + SSO + VDR. Conclusion VMAT using coplanar beams is preferable among all the techniques, considering the dosimetric parameters studied. If VMAT is not available in the facility, DCA + SSO + VDR technique using non coplanar beams can be used to deliver SRS treatment.

BACKGROUND:Pancreatic fistula remains a morbid complication after pancreatectomy. Since the proposed mechanism of pancreatic fistula is different between pancreaticoduodenectomy and distal pancreatectomy, we hypothesized that pancreatic gland texture and duct size are not associated with pancreatic fistula after distal pancreatectomy. METHODS:All patients ≥18 years in the 2014-15 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset were linked with the ACS NSQIP Public Use File (PUF). Pancreatic duct size (6 mm) and pancreatic gland texture (hard, intermediate, soft) were categorized. Separate multivariable analyses were performed to evaluate associations between pancreatic duct size and gland texture after pancreaticoduodenectomy and distal pancreatectomy. RESULTS:A total of 9366 patients underwent pancreaticoduodenectomy or distal pancreatectomy during the study period. Proportion of pancreatic fistula was similar after distal pancreatectomy (606 of 3132, 19.4%) and pancreaticoduodenectomy (1163 of 6335, 18.4%, p = 0.245). Both pancreatic gland texture and duct size were significantly associated with pancreatic fistula after pancreaticoduodenectomy (p

Hepatitis C is a chronic liver disease that contributes to progressive metabolic dysfunction. Infection of hepatocytes by hepatitis C virus (HCV) results in reprogramming of hepatic and serum lipids. However, the specific contribution of these distinct pools of lipids to HCV infection remains ill defined. In this study, we investigated the role of hepatic lipogenesis in HCV infection by targeting the rate-limiting step in this pathway, which is catalyzed by the acetyl-CoA carboxylase (ACC) enzymes. Using two structurally unrelated ACC inhibitors, we determined that blockade of lipogenesis resulted in reduced viral replication, assembly, and release. Supplementing exogenous lipids to cells treated with ACC inhibitors rescued HCV assembly with no effect on viral replication and release. Intriguingly, loss of viral RNA was not recapitulated at the protein level and addition of 2-bromopalmitate, a competitive inhibitor of protein palmitoylation, mirrored the effects of ACC inhibitors on reduced viral RNA without a concurrent loss in protein expression. These correlative results suggest that newly synthesized lipids may have a role in protein palmitoylation during HCV infection.

Introduction: 3D-Conformal Radiation Therapy(3D-CRT) is the standard of care for Carcinoma of esophagus cases. This treatment modality involves initial AP-PA field arrangement followed by 3-field technique (AP-RPO-LPO) for the boost volume. In this technique, PTV coverage is generally sub-optimal owing to the requirement of maintaining the spinal cord dose to its tolerance level. Intensity Modulated Radiation Therapy (IMRT) improves the coverage and reduces the Organ at Risk doses. With the continued advancement in Radiotherapy, Volume Modulated Arc Therapy (VMAT) came into existence. While both IMRT and VMAT tend to deliver large volume of low dose regions, VMAT has the advantage of delivering the plan with lesser MU as compared to IMRT. In order to have balance between various aspects of Dose Volume considerations, we intend to introduce Hybrid technique (combination of 3D-CRT and VMAT) and compare the results with other treatment techniques, such as 3D-CRT and VMAT. Objective: The purpose of this study is to carry out planning study on the potential benefit of Hybrid technique (3D CRT combined with VMAT concurrently) against full course of 3D-CRT & VMAT technique in the treatment of mid thoracic esophageal cancer patient. Materials and Methods In this planning study, 10 patients was planned for these three techniques. Mean target volume was 220cc (range 109-301 cc). Patients were simulated with appropriate immobilization devices. CT image of 2.5 mm acquired. All treatment plans were generated in TPS (Eclipse; v11.1; Varian Medical Systems, USA), to a prescribed dose of 5040 cGy in 28 fractions with 5 fractions/week. The calculation algorithm used for calculation for all the technique is Anisotropic Analytic Algorithm(AAA). In 3D-CRT plan, the first phase contained AP-PA (3600cGy in 20 fr) followed by boost (1440cGy in 8 fr) through 3-field technique. In VMAT plan, full dose was planned using single arc. In HYBRID plan, the dose is concurrently split as AP-PA (55% of the dose) and VMAT (45% of the dose). Quantitative and qualitative analysis were carried out using various dosimetric parameters for both target volume and OARs. Result & Discussion The Conformity Indices (CI) & Homogeneity Indices (HI) for Hybrid plan are comparable to VMAT plan and better than 3D-CRT plan. Total lung dose (V5%, V10% and V20%) in Hybrid plan is less as compared to both VMAT and 3D-CRT plans. The max. dose of spinal cord in Hybrid plan was higher than VMAT plan and smaller than 3D-CRT plan. For region of heart, the dose evaluation (V40%) for hybrid plan, are comparable to VMAT plan and better than 3D CRT plan. VMAT alone plan results in higher integral dose since this technique has larger beam entry and exit points for the full therapeutic dose as compared to 3D-CRT and Hybrid techniques. Conclusion Given the clear dosimetric advantages, Hybrid technique can improve the target coverage while reducing the volume of the lung and healthy tissue during radiotherapy of mid thoracic esophageal cancer. Hence Hybrid Technique could be a treatment of choice in ultra modern radiotherapy. Conflict of Interest: NIL. [ABSTRACT FROM AUTHOR]

An addition to the article which discusses transcriptional regulation of interferon for hepatocytes infected with hepatitis C virus is presented.