Surgical and survival outcomes after robotic and open pancreaticoduodenectomy with positive margins.

BACKGROUND: Though nowadays a palliative pancreaticoduodenectomy (PD) can be performed safely with relatively low mortality and acceptable morbidity rates in experienced centers, there have been no studies on the routine use of a palliative PD or on the advantages of performing surgical resection as a debulking procedure. Furthermore, the impact of resection margins on survival outcomes has been a matter of controversy. Therefore, this study aimed to clarify the role of robotic PD (RPD) in pancreatic and periampullary adenocarcinomas with positive resection margins. METHODS: Patients undergoing RPDs and open PDs (OPDs) were included in this study. Based on the resection margins, the patients were divided into the R0, R1, and R2 PD groups. Surgical risks and survival outcomes were analyzed. RESULTS: There were 348 PDs, including 29 (8.3%) palliative and 319 (91.7%) curative. Primary tumor origin, tumor sizes, perineural invasions, and abnormal serum carcinoembryonic antigen (CEA) levels were factors leading to palliative resection. The multivariate analysis showed that only pancreatic head adenocarcinomas and abnormal serum CEA levels (>5 ng/mL) were independent predictors. The surgical risks between curative and palliative PD were similar. There were no significant differences in the surgical risks and other surgical parameters between palliative RPDs and OPDs. For curative resection, RPDs resulted in less blood loss, greater harvested lymph nodes yield, less postoperative complications, less delayed gastric emptying, and shorter hospital stays than OPDs. The survival outcome was significantly better following R0 resection in overall periampullary adenocarcinomas, whereas a significant survival difference was shown only between the R0 and R2 resections for pancreatic head adenocarcinomas. CONCLUSION: Compared with R0 PDs, palliative R1 PDs could benefit patients with pancreatic head adenocarcinomas when considering survival outcomes without increasing surgical risks. RPD can be considered for curative purposes and as an alternative for palliative management.

Aspirin Attenuates Hyperoxia-Induced Acute Respiratory Distress Syndrome (ARDS) by Suppressing Pulmonary Inflammation via the NF-κB Signaling Pathway.

Acute respiratory distress syndrome (ARDS) is a common destructive syndrome with high morbidity and mortality rates. Currently, few effective therapeutic interventions for ARDS are available. Clinical trials have shown that the effectiveness of aspirin is inconsistent. The contribution of platelets to the inflammatory response leading to the development of ARDS is increasingly recognized. The antiplatelet agent aspirin reportedly exerts a protective effect on acid- and hyperoxia-induced lung injury in murine models. Our previous study showed that pretreatment with aspirin exerts protective effects on hyperoxia-induced lung injury in mice. However, the mechanisms and therapeutic efficacy of aspirin in the posttreatment of hyperoxia-induced acute lung injury (ALI) remain unclear. In this study, we used a homozygous NF-κB-luciferase+/+ transgenic mouse model and treated mice with low-dose (25 µg/g) or high-dose (50 µg/g) aspirin at 0, 24, and 48 h after exposure to hyperoxia (inspired oxygen fraction (FiO2) > 95%). Hyperoxia-induced lung injury significantly increased the activation of NF-κB in the lung and increased the levels of macrophages infiltrating the lung and reactive oxygen species (ROS), increased the HO-1, NF-κB, TNF-α, IL-1ß, and IL-4 protein levels, and reduced the CC10, SPC, eNOS, Nrp-1, and IκBα protein levels in the lung tissue. Pulmonary edema and alveolar infiltration of neutrophils were also observed in the lung tissue of mice exposed to hyperoxia. However, in vivo imaging revealed that posttreatment with aspirin reduced luciferase expression, suggesting that aspirin might reduce NF-κB activation. Posttreatment with aspirin also reduced hyperoxia-induced increases in the numbers of lung macrophages, intracellular ROS levels, and the expression of TNF-α, IL-1ß, and IL-4; it also increased CC10, SPC and Nrp-1 levels compared with hyperoxia exposure alone. Lung histopathology also indicated that the aspirin posttreatment significantly reduced neutrophil infiltration and lung edema compared with hyperoxia exposure alone. Aspirin effectively induces an anti-inflammatory response in a model of hyperoxia-induced lung injury. Thus, aspirin may have potential as a novel treatment for hyperoxia-induced ALI.

Anti-Inflammatory and Reactive Oxygen Species Suppression through Aspirin Pretreatment to Treat Hyperoxia-Induced Acute Lung Injury in NF-κB-Luciferase Inducible Transgenic Mice.

: Acute lung injury (ALI), a common cause of morbidity and mortality in intensive care units, results from either direct intra-alveolar injury or indirect injury following systemic inflammation and oxidative stress. Adequate tissue oxygenation often requires additional supplemental oxygen. However, hyperoxia causes lung injury and pathological changes. Notably, preclinical data suggest that aspirin modulates numerous platelet-mediated processes involved in ALI development and resolution. Our previous study suggested that prehospital aspirin use reduced the risk of ALI in critically ill patients. This research uses an in vivo imaging system (IVIS) to investigate the mechanisms of aspirin's anti-inflammatory and antioxidant effects on hyperoxia-induced ALI in nuclear factor κB (NF-κB)-luciferase transgenic mice. To define mechanisms through which NF-κB causes disease, we developed transgenic mice that express luciferase under the control of NF-κB, enabling real-time in vivo imaging of NF-κB activity in intact animals. An NF-κB-dependent bioluminescent signal was used in transgenic mice carrying the luciferase genes to monitor the anti-inflammatory effects of aspirin. These results demonstrated that pretreatment with aspirin reduced luciferase expression, indicating that aspirin reduces NF-κB activation. In addition, aspirin reduced reactive oxygen species expression, the number of macrophages, neutrophil infiltration and lung edema compared with treatment with only hyperoxia treatment. In addition, we demonstrated that pretreatment with aspirin significantly reduced the protein levels of phosphorylated protein kinase B, NF-κB and tumor necrosis factor α in NF-κB-luciferase+/+ transgenic mice. Thus, the effects of aspirin on the anti-inflammatory response and reactive oxygen species suppressive are hypothesized to occur through the NF-κB signaling pathway. This study demonstrated that aspirin exerts a protective effect for hyperoxia-induced lung injury and thus is currently the drug conventionally used for hyperoxia-induced lung injury.

Combination Therapy of Acarbose and Cyclosporine a Ameliorates Imiquimod-Induced Psoriasis-Like Dermatitis in Mice.

Moderate to severe psoriasis, an immune-mediated inflammatory disease, adversely affects patients' lives. Cyclosporin A (CsA), an effective immunomodulator, is used to treat psoriasis. CsA is ineffective at low doses and toxic at high doses. Acarbose (Acar), a common antidiabetic drug with anti-inflammatory and immunomodulatory effects, reduces imiquimod (IMQ)-induced psoriasis severity. Combinations of systemic drugs are generally more efficacious and safer than higher doses of single drugs. We observed that mice treated with a combination of Acar (250 mg/kg) and low-dose CsA (10 or 20 mg/kg) exhibited significantly milder IMQ-induced psoriasis-like dermatitis and smoother back skin than those treated with Acar (250 mg/kg), low-dose CsA (10 or 20 mg/kg), or IMQ alone. The combination therapy significantly reduced serum and skin levels of Th17-related cytokines (interleukin (IL)-17A, IL-22, and IL-23) and the Th1-related cytokine tumor necrosis factor-α (TNF-α) compared with Acar, low-dose CsA, and IMQ alone. Additionally, the combination therapy significantly reduced the percentages of IL-17- and IL-22-producing CD4+ T-cells (Th17 and Th22 cells, respectively) and increased that of Treg cells. Our data suggested that Acar and low-dose CsA in combination alleviates psoriatic skin lesions by inhibiting inflammation. The findings provide new insights into the effects of immunomodulatory drugs in psoriasis treatment.

Sleep deprivation reduces the recovery of muscle injury induced by high-intensity exercise in a mouse model.

Sleep is crucial to improve athlete performance and their circadian rhythm, but sleep patterns may be disturbed because athletes participate in several competitions. In addition, intensive training programs can cause muscle pain and psychological stress in athletes, resulting in a lack of sleep. Sleep also plays a critical role in the recovery of muscle injury induced by exercise. The current study evaluated the effect of sleep deprivation on the recovery of muscle injury induced by high-intensity exercise in a mouse model. In this study, 28 mice were randomly assigned to four groups (N = 7): control (Control), exercise (EX), sleep deprivation (SD), and sleep deprivation with exercise (EX+SD). The mice from the EX and EX+SD groups were subjected to high-intensity swimming. The results showed that 72-h sleep deprivation increased food intake and reduced body weight. However, the manipulation of 8-week exercise and/or 72-h sleep deprivation did not have any effect in the elevated plus maze task and tail suspension test. Interestingly, the EX+SD group exhibited improved memory performance in the Morris water maze and impaired motor activity in the open field test. According to the TNF-α level and aspartate aminotransferase (AST), and creatine phosphokinase (CK) activities, only the EX+SD group exhibited muscle impairment. Overall, high-intensity exercise may cause muscle injury, and adequate sleep can recover muscle damage. However, sleep deprivation reduces protein synthesis, which decreases the ability to restore muscle damage and aggravates the harmful effect of high-intensity exercise.

Two Transcutaneous Stimulation Techniques in Shoulder Pain: Transcutaneous Pulsed Radiofrequency (TPRF) versus Transcutaneous Electrical Nerve Stimulation (TENS): A Comparative Pilot Study.

Objective: To compare the safety and efficacy of 2 transcutaneous stimulation techniques, transcutaneous pulsed radiofrequency (TPRF) versus transcutaneous electrical nerve stimulation (TENS), in chronic shoulder tendonitis. Design: A prospective, randomized, and double-blind clinical trial. Setting: Academic pain service of a city hospital. Subjects: Fifty patients with sonography-confirmed shoulder tendonitis. Methods: Fifty patients were randomly allocated into two groups for electrical stimulation treatment with 3-month follow-ups: Group 1 (n=25), TENS and Group 2 (n=25), TPRF. Both groups underwent either treatment for 15 minutes every other day, three times total. Our primary goals were to find any treatment comfort level, adverse event, and changes in Constant-Murley shoulder (CMS) scores. The secondary goals were finding the changes in pain, enjoyment of life, and general activity (PEG) scores. Results: For primary goals, no adverse events were noted throughout this study. No differences were found between groups for treatment tolerability (3.20 + 0.87 vs. 2.16 + 0.75). Statistically significant lower PEG scores were noticeable with the TPRF group after the course (12.73 + 5.79 vs. 24.53 + 10.21, p=0.013). Their statistical significance lasted for 3 months although the difference gap diminished after 1 month. CMS scores were significantly higher in the TPRF group (70.84 + 6.74 vs. 59.56 + 9.49, p=0.007) right after treatment course but the significance did not last. Conclusions: In treating chronic shoulder tendinitis using two transcutaneous stimulation techniques, both TPRF and TENS are safe and effective. TPRF is superior to TENS.

Cross-wire technique for difficult contralateral limb cannulation during endovascular abdominal aneurysm repair for tortuous proximal aortic neck.

In selected cases of endovascular aortic repair (EVAR) of an abdominal aortic aneurysm, such as patients with tortuous proximal aortic neck, achieving a successful cannulation can sometimes be difficult. Herein, we described a novel cross-wire technique to help overcome such anatomical variations. During the EVAR procedure among our 5 cases, the main body of the Gore Excluder Stent Graft was deployed through an ipsilateral guidewire. Because of a large angle between the contralateral guidewire and the contralateral short limb of the main body, a successful traditional cannulation was unfeasible. Therefore, the contralateral guidewire was cannulated into the ipsilateral long limb, and the ipsilateral guidewire was cannulated into the contralateral short limb. The contralateral and ipsilateral iliac limb components of the stent graft were deployed through the ipsilateral and contralateral guidewires, respectively. All 5 patients receiving this technique during EVAR of an abdominal aortic aneurysm were free of mortality or any kind of complication at the 1-year follow-up. In conclusion, the cross-wire technique might be safe and effective for EVAR of an abdominal aortic aneurysm when a traditional cannulation is unachievable in selected cases without creating additional percutaneous access or using extra devices.

Applications of Electrochromic Copolymers Based on Tris(4-carbazoyl-9-ylphenyl)amine and Bithiophene Derivatives in Electrochromic Devices.

Four copolymers (P(tCz (tris(4-carbazoyl-9-ylphenyl)amine)-co-bTP (2,2'-bithiophene)), P(tCz-co-CPDT (4H-cyclopenta[2,1-b:3,4-b']dithiophene)), P(tCz-co-DTC (3,6-di(2-thienyl)carbazole)), and P(tCz-co-CPDTK (cyclopentadithiophene ketone))) are deposited on indium tin oxide (ITO) surfaces using electrochemical polymerization. Spectroelectrochemical properties of copolymer electrodes reveal that the colors of P(tCz-co-bTP) film are pinkish-orange, light olive green, light grayish blue, and dark blue at 0.0, 0.8, 1.2, and 1.6 V, respectively, whereas the color variations of P(tCz-co-CPDTK) film are light yellow, yellow, and blue at 0.0 V, 0.8 V, and 1.5 V, respectively. The ΔT of P(tCz-co-bTP), P(tCz-co-CPDT), P(tCz-co-DTC), and P(tCz-co-CPDTK) films are estimated to be 43.0% at 967 nm, 28.7% at 864 nm, 43.6% at 870 nm, and 24.5% at 984 nm, respectively. Five electrochromic devices (ECDs) are assembled using the tCz-based homopolymer and copolymers as coloring electrodes, and poly(2,2-dimethyl-3,4-propylenedioxythiophene) (PProDOT-Me2) as the complementary electrode. P(tCz-co-DTC)/PProDOT-Me2 ECD reveals high transmittance change (45.9% at 624 nm), P(tCz-co-CPDTK)/PProDOT-Me2 ECD shows high η (513.0 cm² C-1 at 582 nm), and P(tCz-co-bTP)/PProDOT-Me2 ECD presents short switching time (less than 0.4 s) at 628 nm. Moreover, these ECDs show satisfactory redox stability and open circuit stability.

Electrosynthesis of Copolymers Based on 1,3,5-Tris(N-Carbazolyl)Benzene and 2,2'-Bithiophene and Their Applications in Electrochromic Devices.

Poly(1,3,5-tris(N-carbazolyl)benzene) (PtnCz) and three copolymers based on 1,3,5-tris(N-carbazolyl)benzene (tnCz) and 2,2'-bithiophene (bTp) were electrochemically synthesized. The anodic P(tnCz1-bTp2) film with a tnCz/bTp feed molar ratio of 1/2 showed four colors (light orange at 0.0 V, yellowish-orange at 0.7 V, yellowish-green at 0.8 V, and blue at 1.1 V) from the neutral state to oxidized states. The optical contrast (∆T%) and coloration efficiency (η) of the P(tnCz1-bTp2) film were measured as 48% and 112 cm²âˆ™C-¹, respectively, at 696 nm. Electrochromic devices (ECDs) based on PtnCz, P(tnCz1-bTp1), P(tnCz1-bTp2), P(tnCz1-bTp4), and PbTp films as anodic polymer layers and poly(3,4-dihydro-3,3-dimethyl-2H-thieno[3,4-b-1,4]dioxepin) (PProDOT-Me2) as cathodic polymer layers were assembled. P(tnCz1-bTp2)/PProDOT-Me2 ECD showed three various colors (saffron yellow, yellowish-blue, and dark blue) at potentials ranging from -0.3 to 1.5 V. In addition, P(tnCz1-bTp2)/PProDOT-Me2 ECD showed a high ∆T% value (40% at 630 nm) and a high coloration efficiency (519 cm²âˆ™C-¹ at 630 nm).

Poly(tris(4-carbazoyl-9-ylphenyl)amine)/Three Poly(3,4-ethylenedioxythiophene) Derivatives in Complementary High-Contrast Electrochromic Devices.

A carbazole-based polymer (poly(tris(4-carbazoyl-9-ylphenyl)amine) (PtCz)) is electrosynthesized on an indium tin oxide (ITO) electrode. PtCz film displays light yellow at 0.0 V, earthy yellow at 1.3 V, grey at 1.5 V, and dark grey at 1.8 V in 0.2 M LiClO4/ACN/DCM (ACN/DCM = 1:3, by volume) solution. The ΔT and coloration efficiency (η) of PtCz film are 30.5% and 54.8 cm²âˆ™C-1, respectively, in a solution state. Three dual-type electrochromic devices (ECDs) are fabricated using the PtCz as the anodic layer, poly(3,4-ethylenedioxythiophene) (PEDOT), poly(3,3-dimethyl-3,4-dihydro-thieno[3,4-b][1,4]dioxepine) (PProDOT-Me2), and poly(3,4-(2,2-diethylpropylenedioxy)thiophene) (PProDOT-Et2) as the cathodic layers. PtCz/PProDOT-Me2 ECD shows high ΔTmax (36%), high ηmax (343.4 cm²·C-1), and fast switching speed (0.2 s) at 572 nm. In addition, PtCz/PEDOT, PtCz/PProDOT-Me2, and PtCz/PProDOT-Et2 ECDs show satisfactory open circuit memory and long-term stability.

Active Component of Danshen (Salvia miltiorrhiza Bunge), Tanshinone I, Attenuates Lung Tumorigenesis via Inhibitions of VEGF, Cyclin A, and Cyclin B Expressions.

Tanshinone I (T1) and tanshinone II (T2) are the major diterpenes isolated from Danshen (Salvia miltiorrhiza Bunge). Three human lung adenocarcinoma cell lines, A549, CL1-0, and CL1-5, were treated with T1 and T2 for the in vitro antitumor test. Results showed that T1 was more effective than T2 in inhibiting the growth of lung cancer cells via suppressing the expression of VEGF, Cyclin A, and Cyclin B proteins in a dose-dependent manner. Moreover, a transgenic mice model of the human vascular endothelial growth factor-A165 (hVEGF-A 165) gene-induced pulmonary tumor was further treated with T1 for the in vivo lung cancer therapy test. T1 significantly attenuated hVEGF-A165 overexpression to normal levels of the transgenic mice (Tg) that were pretreated with human monocytic leukemia THP-1 cell-derived conditioned medium (CM). It also suppressed the formation of lung adenocarcinoma tumors (16.7%) compared with two placebo groups (50% for Tg/Placebo and 83.3% for Tg/CM/Placebo; P < 0.01). This antitumor effect is likely to slow the progression of cells through the S and G2/M phases of the cell cycle. Blocking of the tumor-activated cell cycle pathway may be a critical mechanism for the observed antitumorigenic effects of T1 treatment on vasculogenesis and angiogenesis.

Bovine lactoferrin inhibits lung cancer growth through suppression of both inflammation and expression of vascular endothelial growth factor.

Lung cancers are among the most common cancers in the world, and the search for effective and safe drugs for the chemoprevention and therapy of pulmonary cancer has become important. In this study, bovine lactoferrin (bLF) was used in both in vitro and in vivo approaches to investigate its activity against lung cancer. A human lung cancer cell line, A549, which expresses a high level of vascular endothelial growth factor (VEGF) under hypoxia, was used as an in vitro system for bLF treatment. A strain of transgenic mice carrying the human VEGF-A165 (hVEGF-A165) gene, which induces pulmonary tumors, was used as an in vivo lung cancer therapy model. We found that bLF significantly decreased proliferation of A549 cells by decreasing the expression of VEGF protein in a dose-dependent manner. Furthermore, oral administration of bLF at 300 mg/kg of body weight 3 times a week for 1.5 mo to the transgenic mice overexpressing hVEGF-A165 significantly eliminated expression of hVEGF-A165 and suppressed the formation of tumors. Additionally, treatment with bLF significantly decreased the levels of proinflammatory cytokines, such as tumor necrosis factor-α, and antiinflammatory cytokines, such as IL-4 and IL-10. Levels of IL-6, which is both a proinflammatory and an antiinflammatory cytokine, were also reduced. Treatment with bLF decreased levels of tumor necrosis factor-α, IL-4, IL-6, and IL-10 cytokines, resulting in limited inflammation, which then restricted growth of the lung cancer. Our results revealed that bLF is an inhibitor of angiogenesis and blocks lung cell inflammation; as such, it has considerable potential for therapeutic use in the treatment of lung cancer.