Lower air humidity reduced both the plant growth and activities of photosystems I and II under prolonged heat stress.

The warming is global problem. In natural environments, heat stress is usually accompanied by drought. Under drought conditions, water content decreases in both soil and air; yet,the effect of lower air humidity remains obscure. We supplied maize and barley plants with an unlimited source of water for the root uptake and studied the effect of relative air humidity under heat stress. Young plants were subjected for 48 h to several degrees of heat stress: moderate (37 °C), genuine (42 °C), and nearly lethal (46 °C). The conditions of lower air humidity decreased the photochemical activities of photosystem I and photosystem II. The small effect was revealed in the control (24 °C). Elevating temperature to 37 °C and 42 °C increased the relative activities of both photosystems; the photosystem II was activated more. Probably, this is why the effect of air humidity disappeared at 37 °C; the small inhibiting effect was observed at 42 °C. At 46 °C, lower air humidity substantially magnified the inhibitory effect of heat. As a result, the maximal and relative activities of both photosystems decreased in maize and barley; the photosystem II was inhibited more. Under the conditions of 46 °C at lower air humidity, the plant growth was greatly reduced. Maize plants increased water uptake by roots and survived; barley plants were unable to increase water uptake and died. Therefore, air humidity is an important component of environmental heat stress influencing activities of photosystem I and photosystem II and thereby plant growth and viability under severe stress conditions.

Liver venous deprivation for resection of advanced hilar cholangiocarcinoma-a case report and review of the literature.

Hilar cholangiocarcinoma is a rare primary malignancy associated with a dismal prognosis. Currently, complete extended right or left-sided hepatectomy is the primary curative therapy. Achieving a negative resection margin is associated with long-term survival and better quality of life, while post-hepatectomy liver failure (PHLF) due to insufficient liver remnant remains the most dreaded complication with a negative effect on overall survival. Precise preoperative management with sufficient future remnant liver (FRL) volume is the key to achieving good results in the treatment of bile duct carcinoma. To present a case report and a literature review for preoperative FRL optimization prior to major hepatectomies for hilar cholangiocarcinoma. Improvement of postoperative outcomes after extended liver resections in the case of hilar cholangiocarcinoma. A 62-year-old Caucasian woman with Lynch syndrome presented to our department with a hilar cholangiocarcinoma Bismuth type IIIa. The patient had an insufficient future liver volume for extended liver resection. She underwent preoperative preconditioning using a liver venous deprivation (LVD) and underwent two weeks later a right trisectorectomy without any interventional complications. Liver function remained stable postoperatively. The patient was discharged on the 20th postoperative day without major surgical post-operative complications or the need for readmission. LVD is a technically feasible, safe, and effective procedure to increase the FRL in a short period of time with low intra and post-operative complications and therefore improving the survival of patients with hilar cholangiocarcinoma.

Minimally Invasive Approach for Complicated Choledocholithiasis in an Elderly Patient After Roux-Y Gastric Bypass.

Gallstone disease after bariatric surgery is a common condition due to the obesity and rapid weight loss. Because of increasing obesity amongst the population, and the gastric bypass having been established as the standard treatment for morbid obesity, the occurrence of bile duct stones after this kind of surgery remains a therapeutic dilemma. We present a case of obstructed choledocholithiasis with shrinking of the gallbladder and consequent cholangitis in a 69-year-old Caucasian male patient after a laparoscopic Roux-and-Y gastric bypass (LRYGB), who underwent a successful laparoscopic single-stage bile stone removal of the choledochal duct using intraoperative ultrasound and choledochoscopy. There are several techniques to manage choledocholithiasis after LRYGB. Laparoscopic choledochoscopy with concomitant cholecystectomy after bariatric surgery can be a safe procedure even for elderly patients.

IgG4 induces tolerogenic M2-like macrophages and correlates with disease progression in colon cancer.

IgG4 subclass antibodies are expressed in alternative Th2 environments featuring high IL-10 expression, including several solid tumors such as melanoma. To induce tolerance, allergen immunotherapy mediates antibody class switching from pro-inflammatory IgE to anti-inflammatory IgG4. We previously reported that IgG4 drives allergic M2 macrophages toward tolerogenic states. Here we assessed the roles of IgG4 and macrophage activation in colorectal cancer (CRC). In this observer-blinded, case-control study, we analyzed total circulating serum IgE, IgG1 and IgG4 levels in CRC (n = 38) patients with (n = 13, TxNxM1) or without (n = 25, TxNxM0) metastasis, and in healthy donors (n = 21). Primary cultures of circulating monocyte-derived macrophages from healthy controls and CRC patients were further evaluated in their responses to stimulation with IgG1 or IgG4. We found higher absolute serum levels of IgG4 in patients with CRC. IgG4 enabled polarization of macrophages derived from CRC patients and healthy controls into alternatively-activated tolerogenic M2b phenotypes. IgG4-stimulated M2 macrophages were characterized by lower surface CD206, CD163, CD14, and CD11b expression and higher CCL-1, IL-10, and IL-6 production. IgG4 was less potent that IgG1 in triggering antibody-dependent cell-mediated phagocytosis (ADCP) of cancer cells. Further, higher z-normalized IgG4/-IgE sera level ratios correlated with the presence of metastasis (p = .0247 and p = .0009, respectively) in CRC patients. High IgG4 in CRC synergizes with macrophages in shaping an immunosuppressive microenvironment and impairs anti-cancer effector cell functions. The shift of serum IgG4/IgE ratios toward enhanced tolerance induction in metastatic disease indicates a role for high IgG4 in disease progression and poor prognostic outcome.

Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation.

Various inflammatory abnormalities of the pancreas can mimic pancreatic ductal adenocarcinoma (PDAC) at cross-sectional imaging. Misdiagnosis of PDAC at imaging may lead to unnecessary surgery. On the other hand, chronic pancreatitis (CP) bears a greater risk of developing PDAC during the course of the disease. Thus, differentiation between mass-forming chronic pancreatitis (MFCP) and PDAC is important to avoid unnecessary surgery and not to delay surgery of synchronous PDAC in CP.Imaging features such as the morphology of the mass including displacement of calcifications, presence of duct penetrating, sign appearance of duct stricturing, presence or absence of vessel encasement, apparent diffusion coefficient (ADC) value and intravoxel incoherent motion (IVIM) at diffusion-weighted imaging (DWI), fluorodeoxyglucose (FDG) uptake in PET/CT, and mass perfusion parameters can help to differentiate between PDAC and MFCP. Correct interpretation of imaging features can appropriately guide biopsy and surgery, if necessary. This review summarizes the relevant computed tomography (CT) and magnetic resonance imaging (MRI) features that can help the radiologist to come to a confident diagnosis and to guide further management in equivocal cases.

Ramucirumab plus paclitaxel or FOLFIRI in platinum-refractory advanced or metastatic gastric or gastroesophageal junction adenocarcinoma-experience at two centres.

BACKGROUND: Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in patients with pretreated metastatic gastric/gastrooesophageal junction (GEJ) adenocarcinoma. We present data from patients treated with ramucirumab and paclitaxel or FOLFIRI after failure of at least one platinum- and 5-FU-containing chemotherapy (CHT) regimen. METHODS: In this retrospective two-center study, 56 patients with metastatic gastric cancer (47%) or adenocarcinoma of the GEJ (53%) were treated with paclitaxel and ramucirumab (n=38) as second-line (75%) or beyond second-line (25%) therapy. FOLFIRI-ramucirumab (FOLFIRI-R) (n=16) was given to patients with a short interval between taxane-based perioperative CHT and occurrence of metastatic disease or to those ineligible for paclitaxel. RESULTS: The median progression-free survival (PFS) and OS for patients treated with paclitaxel-ramucirumab (pacl-R) were 2.9 (95% CI: 2.3-3.6) and 4.4 (4.1-4.7) months, respectively, and those for patients treated with FOLFIRI-R were 5.9 (95% CI: 0.35-11.4) and 8.3 (6.6-10) months, respectively (P=0.05). We observed a trend towards prolonged PFS after perioperative taxane-based FLOT CHT (n=12) with FOLFIRI-R compared with pacl-R. Adverse events were manageable, with neutropenia and polyneuropathy (PNP) being the most common events. More than two treatment lines were given to 48.2% of patients. CONCLUSIONS: The use of ramucirumab in combination with FOLFIRI showed favourable PFS and OS in patients with prior treatments with platinum and/or taxane-based agents and allows further treatment lines after progression. In patients with taxane pretreatment or persistent high-grade PNP, the combination of FOLFIRI-R might be a promising combination.

Specificity of Cd, Cu, and Fe effects on barley growth, metal contents in leaves and chloroplasts, and activities of photosystem I and photosystem II.

Cd, Cu, and Fe were used to reveal the specificity of their toxic actions. We studied the effects of heavy metals on the growth of barley seedlings, contents of cations in leaves and chloroplasts, induced chlorophyll fluorescence and P700 light absorption. Differences were found at each level of research. We measured the contents of Cd, Cu, Fe, Mn, Zn, Ca, Mg, and K. The proportion of cations in leaves targeted to chloroplasts varied from 0.1% (K) to >90% (Fe). Their levels changed in different ways. We found no correlation between changes in cation contents in leaves and chloroplasts. Treatment with Cd, Cu, and Fe increased the contents of some cations. The extra portions were targeted primarily out of chloroplasts, which was most noticeable in the case of Cu and Fe. Cd treatment decreased non-photochemical quenching with concomitant increases in closed photosystem II. We introduced new coefficients qC for closed photosystem II and X(II) to compare the yields of photosystem II and photosystem I. Cd likely decreased both PSI content in leaves and its quantum yield. In control plants, the quantum yield ratio of PSI/PSII increased gradually from 1.25 under low light to 4 under high light. Cd treatment prevented the increase under moderate light; under high light the ratio reached 2. Cu treatment increased the acceptor side limitation of photosystem I under low light; components of the Calvin cycle likely demand more light for activation in Cu-treated plants.

Nab-paclitaxel and gemcitabine or FOLFIRINOX as first-line treatment in patients with unresectable adenocarcinoma of the pancreas: does sequence matter?

BACKGROUND: Locally advanced or metastatic adenocarcinoma of the pancreas remains - despite the implementation of new chemotherapy protocols - a disease with short overall survival (OS). METHODS: Eighty-three patients were treated with locally advanced or metastatic adenocarcinoma of the pancreas with either FOLFIRINOX or nab-Paclitxel and Gemcitabine (nabPGem) as first- or second line therapy. We analysed the outcome for OS and progression-free survival (PFS) in terms of treatment regimen and sequence. RESULTS: The majority of patients presented in good performance status (PS) with a median age of 68 years. Fourty-two patients received FOLFIRINOX as first-line therapy, 41 patients were treated with nabPGem as first line therapy. Forty-eight patients received both treatments. The OS of all 83 patients was 12.6 months (95% CI: 10.7-14.6), resulting in a 1-year OS of 54%. Forty-eight patients received FOLFIRINOX followed by nabPGem or vice versa. There was no significant difference in OS or PFS for either of the two sequences (p = 0.9). The OS for FOLFIRINOX followed by nabPGem or nabPGem followed by FOLFIRINOX was 13.7 months (95% CI: 12.6-14.7) and 13.8 months (95% CI: 8.6-19), respectively. CONCLUSIONS: The sequence FOLFIRINOX followed by nab-Paclitaxel and Gemcitabine or vice versa lead to an equal OS outcome.

Distribution of Cd and other cations between the stroma and thylakoids: a quantitative approach to the search for Cd targets in chloroplasts.

Plant growth and photosynthetic activity are usually inhibited due to the overall action of Cd on a whole organism, though few cadmium cations can invade chloroplasts in vivo. We found that in vivo, the major portion of Cd in barley chloroplasts is located in the thylakoids (80%), and the minor portion is in the stroma (20%). Therefore, the electron-transport chain in the thylakoids would be the likely target for direct Cd action in vivo. In vitro, we found the distribution of Cd to be shifted to the stroma (40-60%). In barley chloroplasts, the major portions of Mg, Fe, Mn, and Cu were found to be located in the thylakoids, and most Ca, Zn, and K in the stroma. This finding was true for both control and Cu- or Fe-treated plants. Treatment with Cd affected the contents of all cations, and the largest portions of Ca and Zn were in the thylakoids. Alterations of the K and Mn contents were caused by Cd, Cu, or Fe treatment; the levels of other cations in chloroplasts were changed specifically by Cd treatment. The quantity of Cd in chloroplasts was small in comparison to that of Mg, Ca, and Fe. In thylakoids, the amount of Cd was similar to that of Cu and comparable to the levels of Zn and Mn. Accordingly, the possible targets for direct Cd action in thylakoids are the Mn cluster, plastocyanin, carbonic anhydrase, or FtsH protease. The quantity of Cd in thylakoids is sufficient to replace a cation nearly completely at one of these sites or partially (20-30%) at many of these sites.

Modification and Cross-Linking of Proteins by Glycolaldehyde and Glyoxal: A Model System.

Highly reactive intermediates of the Maillard reaction, such as glycolaldehyde and glyoxal, are precursors in the modification and cross-linking of proteins. Therefore, we investigated ribonuclease A modified by glycolaldehyde and glyoxal, separately. For the first time, various protein species derived by these aldehydes were successfully separated by ion-exchange chromatography and gel permeation chromatography. Highly cross-linked ribonuclease A was obtained in glycolaldehyde incubations. In contrast, glyoxal predominantly led to modified monomeric protein species. These results were verified by sodium dodecyl sulfate polyacrylamide gel electrophoresis and isoelectric focusing. Quantitation of mono- and bivalent protein modifications of the isolated protein species led to a positive correlation between the degree of protein modification and the change of the isoelectric point and molecular weight, respectively. Glycolaldehyde is easily oxidized to glyoxal. However, significantly lower levels of bivalent glyoxal modifications were detected in glycolaldehyde versus glyoxal incubations (glyoxal-lysine dimer, 1.58 ± 0.02 versus 2.86 ± 0.04 mmol/mol of phenylalanine; glyoxal-lysine amide, 2.7 ± 0.1 versus 5.6 ± 0.1 mmol/mol of phenylalanine). In addition, a novel glycolaldehyde-specific lysine-lysine cross-link was identified and putatively assigned as 1-(5-amino-5-carboxypentyl)-4-(5-amino-5-carboxypentyl-amino)pyridinium salt.

Influence of Transketolase-Catalyzed Reactions on the Formation of Glycolaldehyde and Glyoxal Specific Posttranslational Modifications under Physiological Conditions.

In the present study, we investigated the role of transketolase (TK) in the modulation of glycolaldehyde driven Maillard reactions. In vitro experiments with recombinant human TK reduced glycolaldehyde and glyoxal induced carbonyl stress and thereby suppressed the formation of advanced glycation endproducts up to 70% due to the enzyme-catalyzed conversion of glycolaldehyde to erythrulose. This was further substantiated by the use of 13C-labeled compounds. For the first time, glycolaldehyde and other sugars involved in the TK reaction were quantified in vivo and compared to nondiabetic uremic patients undergoing hemodialysis. Quantitation revealed amounts of glycolaldehyde up to 2 µM and highlighted its crucial role in the formation of AGEs in vivo. In this context, a LC-MS2 method for the comprehensive detection of sedoheptulose-7-phosphate, fructose-6-phosphate, ribose-5-phosphate, erythrose-4-phosphate, erythrulose, and glycolaldehyde in whole blood, plasma, and red blood cells was established and validated based on derivatization with 1-naphthylamine and sodium cyanoborohydride.

Transketolase A from E. coli Significantly Suppresses Protein Glycation by Glycolaldehyde and Glyoxal in Vitro.

Short-chained carbonyl species such as glycolaldehyde and its oxidized pendant glyoxal are highly reactive Maillard agents, leading to the formation of protein modifications. These advanced glycation endproducts have gained considerable interest as they have been linked to various pathologies in vivo. The ability of transketolase to use glycolaldehyde as a substrate suggested the possibility to modulate carbonyl-driven Maillard reactions. Model incubations with recombinant transketolase A from Escherichia coli in the presence of bovine serum albumin and glycolaldehyde indeed led to a decrease in glycolaldehyde concentrations paralleled by the enzymatic conversion to erythrulose. As a result, reversibly protein-bound glycolaldehyde and the major final endproduct N6-carboxymethyl lysine were significantly reduced by approximately 50%, respectively. Glycolaldehyde is easily oxidized to glyoxal in the presence of amines and oxygen. In the presence of transketolase, the lower amounts of glycolaldehyde therefore also strongly suppressed the formation of glyoxal specific arginine modifications, measured as 5-(2-imino-5-oxo-1-imidazolidinyl)norvaline after acid hydrolysis.

Emotion regulation and mental well-being before and six months after bariatric surgery.

PURPOSE: According to the current state of research, mental health improves due to bariatric surgery. However, improvements in weight and psychosocial aspects often show a gradual decline with time. As emotion regulation (ER) appears to be a key variable in the successful outcome of weight loss treatments, the present study aimed at investigating ER-strategies applied by bariatric surgery candidates pre- and post-surgery and examining interactions between ER, depressive symptoms, health-related quality of life (HrQoL), and post-surgical weight loss. METHODS: Prior to and 6 months after bariatric surgery, 45 patients (76% women) completed self-report questionnaires assessing depressive symptoms (Beck Depression Inventory-II), HrQoL (Short Form-36 Health Survey), and ER-strategies (Emotion Regulation Inventory for Negative Emotions). RESULTS: Six months post-surgery, the patients reported significant improvements in depressive symptomatology, HrQoL, and satisfaction with ER compared to pre-surgery. Groups differing in their course of ER-satisfaction also differed in psychosocial dimensions pre- to post-surgery, increased satisfaction being related to less impairment and enhanced communication of negative emotions as a form of an adaptive regulation. Patients with higher weight loss applied the strategy of controlled expression more frequently post-surgery than pre-surgery and compared to patients with lower weight loss. CONCLUSIONS: Postoperative weight loss leads to improvements in ER-satisfaction and mental well-being. As satisfaction with ER seems to be associated with less impaired mental well-being among bariatric surgery candidates, presumably even more positive psychosocial outcomes could be obtained post-surgery by implementing trainings explicitly encouraging the use of adaptive ER-strategies.

Cadmium accumulation in chloroplasts and its impact on chloroplastic processes in barley and maize.

Data on cadmium accumulation in chloroplasts of terrestrial plants are scarce and contradictory. We introduced CdSO4 in hydroponic media to the final concentrations 80 and 250 µM and studied the accumulation of Cd in chloroplasts of Hordeum vulgare and Zea mays. Barley accumulated more Cd in the chloroplasts as compared to maize, whereas in the leaves cadmium accumulation was higher in maize. The cadmium content in the chloroplasts of two species varied from 49 to 171 ng Cd/mg chlorophyll, which corresponds to one Cd atom per 728-2,540 chlorophyll molecules. Therefore, Mg(2+) can be substituted by Cd(2+) in a negligible amount of antenna chlorophylls only. The percentage of chloroplastic cadmium can be estimated as 0.21-1.32 % of all the Cd in a leaf. Photochemistry (F v/F m, ΦPSII, qP) was not influenced by Cd. Non-photochemical quenching of chlorophyll-excited state (NPQ) was greatly reduced in barley but not in maize. The decrease in NPQ was due to its fast relaxing component; the slow relaxing component rose slightly. In chloroplasts, Cd did not affect mRNA levels, but content of some photosynthetic proteins was reduced: slightly in the leaves of barley and heavily in the leaves of maize. In all analyzed C3-species, the effect of Cd on the content of photosynthetic proteins was mild or absent. This is most likely the first evidence of severe reduction of photosynthetic proteins in leaves of a Cd-treated C4-plant.

Investigations on the Maillard reaction of dextrins during aging of Pilsner type beer.

Although Maillard reaction plays a pivotal role during preparation of food, only few investigations concerning the role of carbohydrate degradation in beer aging have been carried out. The formation of Maillard specific precursor structures and their follow-up products during degradation of low molecular carbohydrate dextrins in the presence of proline and lysine was studied in model incubations and in beer. Twenty-one α-dicarbonyl compounds were identified and quantitated as reactive intermediates. The oxidative formation of 3-deoxypentosone as the precursor of furfural from oligosaccharides was verified. N-Carboxymethylproline and N-formylproline were established as novel proline derived Maillard advanced glycation end products. Formation of N-carboxymethylproline and furfural responded considerably to the presence of oxygen and was positively correlated to aging of Pilsner type beer. The present study delivers an in-depth view on the mechanisms behind the formation of beer relevant aging parameters.

Laparoscopic liver packing to protect surrounding organs during thermal ablation.

PURPOSE: To evaluate the feasibility of liver packing for the prevention of injury to adjacent organs during thermal ablation of liver tumors. MATERIAL AND METHODS: Between January 2005 and March 2010, 47 (52 sessions) patients with non-resectable liver tumors were treated and their tumors (55 primary carcinomas and 65 metastases, 1-12) were isolated from adjacent organs by laparoscopic liver mobilization and packing. Stereotactic radiofrequency ablation (SRFA) comprised body fixation, contrast-enhanced CT, 3-D planning, navigation, needle placement, control CT of needle positions (with image fusion), thermal ablation and control CT (with image fusion). Liver packing was removed laparoscopically thereafter. Complications, primary success and local recurrence rates were analyzed. RESULTS: A total of 120 liver lesions with a median size of 2.4 cm (range 1-15 cm) were treated. Laparoscopic packing could be performed in all patients. The primary success rate of ablation was 91.6% (110/120) and the local recurrence rate was 4.5% (5/110). There was one perioperative death (1.9%). All remaining complications could be managed by radiological interventions. Despite broad surface contact thermal injury of surrounding organs could be prevented in all patients. CONCLUSION: Liver packing presents a viable and safe option for RFA of tumors with broad surface contact to surrounding organs with excellent local tumor control.

Stereotactic radiofrequency ablation of unresectable intrahepatic cholangiocarcinomas: a retrospective study.

PURPOSE: To evaluate treatment effects, complications, and outcome of percutaneous stereotactic radiofrequency ablation (SRFA) of intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS: Eleven consecutive patients (nine men and two women) with a total of 36 inoperable ICCs (18 initial lesions, 16 lesions newly detected during follow-up, and two local recurrences) underwent SRFA between December 2004 and June 2010. Two different radiofrequency ablation (RFA) devices with internally cooled electrodes were used. Tumor diameters ranged from 0.5 to 10 cm (median 3.0 cm). A total of 23 SRFA sessions were performed. The efficacy of SRFA was evaluated by contrast-enhanced computed tomography or magnetic resonance imaging 1 month after treatment and then every 3 months. RESULTS: Primary technical effectiveness rate was 92%. Further follow-up every 3 months revealed three local recurrences (8%), two of which were successfully retreated, resulting in a secondary technical effectiveness rate of 98%. After a total of 23 RFA sessions, three major complications occurred (13%) that could be managed interventionally. Mean follow-up time was 35 months (range 12-81 months). One- and 3-year overall survival rates were 91 and 71%, respectively. The median overall survival was 60 months (according to the life table method). Eight (73%) of 11 patients were still alive at the end of follow-up. CONCLUSION: SRFA is effective in the treatment of unresectable ICC even if the tumor is large and located close to major vessels. SRFA shows a survival benefit compared to other palliative treatment options and may also be considered as the first-line local treatment of ICCs in selected patients.

Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases.

OBJECTIVES: To evaluate the outcome of patients with colorectal liver metastasis (CRLM) treated with stereotactic radiofrequency ablation (SRFA). METHODS: Following IRB approval, a retrospective evaluation of 98 SRFA treatment sessions of 189 CRLMs in 63 consecutive patients was performed. Local recurrence rate (LR), overall survival (OS) and disease-free survival (DFS) were analysed. RESULTS: LR was identified in 16% of the tumours (31/189), with no significant differences (P = 0.635) when comparing tumour sizes <3 cm (17.7%), 3-5 cm (11.1%) and >5 cm (17.4%). The median OS from SRFA treatment was 33.2 months after a mean follow-up of 25 months (range 2-66); the corresponding 1-, 3- and 5- year survival rates were 87%, 44% and 27%. The median OS was significantly different when comparing unresectable and resectable patients (27 vs. 58 months, P = 0.002) with OS rates of 92%, 66% and 48% at 1, 3 and 5 years in resectable patients. Tumour size did not affect OS and DFS. CONCLUSION: Due to the favourable outcome, SRFA challenges resection as first-line local treatment of patients with CRLM. As long as randomised studies are pending, we recommend entering an individual decision-making process with every patient. KEY POINTS: Large colorectal liver metastases can be effectively treated by stereotactic radiofrequency ablation (SRFA). Using SRFA the overall survival is not affected by tumour size. SRFA achieves similar overall and disease-free survival rates as surgical resection. SRFA challenges surgical resection as the first-line treatment for colorectal liver metastases.

Effect of weight loss on serum pigment epithelium-derived factor levels.

BACKGROUND: Cumulating evidence suggests that the broadly acting neurotrophic pigment epithelium-derived factor is associated with visceral adiposity, the metabolic syndrome, diabetes and exerts beneficial effects on atherosclerosis. To further elucidate the relationship between pigment epithelium-derived factor and metabolic perturbations characteristic of obesity, we examined the effect of pronounced weight loss on serum levels of pigment epithelium-derived factor. MATERIALS AND METHODS: Thirty-six severely obese adults were examined before and 18 months after bariatric surgery. Abdominal fat distribution was determined by ultrasound, metabolic parameters by standard methods, pro-inflammatory biomarkers and serum pigment epithelium-derived factor levels by enzyme-linked immunosorbent assay. RESULTS: Bariatric surgery resulted in a mean body mass index (BMI) reduction of 9·0 ± 5·0 kg m(-2) and concomitant improvements in glucose homoeostasis and lipid profile. Pigment epithelium-derived factor serum levels decreased from a median 11·0 µg mL(-1) (interquartile range: 3·8) to 9·2 µg mL(-1) (interquartile range: 4·5) (P < 0·0001). In univariate analysis, relative change in pigment epithelium-derived factor levels was significantly associated with change in weight, BMI, fat mass, visceral fat diameter, insulin, homoeostasis model for insulin resistance, triglyceride and leptin levels (all r > 0·370, P < 0·05). No associations were observed for C-reactive protein, interleukin-6 or tumour necrosis factor alpha. After adjustment for age, sex and smoking status, associations remained significant. CONCLUSIONS: The beneficial effects of bariatric surgery-induced pronounced weight loss on glucose homoeostasis may partially be attributable to visceral adipose tissue reduction and concomitantly decreasing pigment epithelium-derived factor concentrations.