[Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database].

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

Computed Tomography of the Mandibles of a Stranded Offshore Killer Whale (Orcinus orca).

A mature, adult female, offshore killer whale (Orcinus orca) was stranded deceased in Portage Bay, Alaska, in October 2015. Full necropsy examination with histopathology was performed. Consistent with previous studies of offshore killer whales, and thought to be a result of their unique elasmobranch diet, all the teeth were significantly abraded and almost flush with the gingival margin. Age was estimated at 30-35 years based on annuli and growth arrest lines in a remaining tooth. The dentate portion of the mandibles were excised en bloc and frozen until imaging could be completed. Radiography and computed tomography revealed lesions consistent with severe abrasion, pulp exposure and evidence of endodontic and/or periodontal disease in nine of the 15 mandibular teeth present (60.0%). Only five (33.3%) teeth were suspected to have been vital at the time of death based on imaging. Lesions were more severe rostrally, with the caudal teeth less affected. Autolysis precluded gingival histopathology and no teeth were analyzed histologically. Necropsy examination revealed a likely multifactorial cause of death, with most significant lesions including the severe chronic periodontal/endodontic disease with abrasion, inanition and emaciation with possible cardiovascular disease. This case highlights the importance of imaging in evaluating periodontal and endodontic status, especially post mortem when other tissues are no longer available, and demonstrates that periodontal and endodontic disease occur naturally in this species and can be a significant cause of morbidity in mature free-ranging killer whales of the offshore ecotype.

Parathyroid hormone-related peptide and hypercalcaemia in a dog with functional keratinizing ameloblastoma.

This case report describes a 6-year-old dog with oral ameloblastoma and hypercalcaemia. Serum parathyroid hormone-related peptide (PTH-rp) levels were high. No other cause for hypercalcaemia was found. The hypercalcaemia resolved after hemimandibulectomy. We are not aware of the previous description of canine oral ameloblastoma and hypercalcaemia mediated by PTH-rp. This case report suggests that PTH-rp stimulation of the PTH receptor may result in hypercalcaemia in dogs with oral ameloblastoma or other odontogenic neoplasms.

Protection of pigs by vaccination of pregnant sows against eastern equine encephalomyelitis virus.

Serum-virus neutralizing antibodies were detected in serum and colostrum of sows vaccinated during pregnancy with commercially available vaccines against eastern equine encephalomyelitis virus (EEEV), and antibodies were detected in serum from nearly all pigs from vaccinated sows following colostrum uptake. Serum-virus neutralizing antibody (SVN) test titers were measured in colostrum and pigs at the next farrowing, and additional vaccination of sows prior to the third farrowing led to elevated SVN titers in serum, colostrum and all pigs. Six pigs from vaccinated sows challenged at 8 to 9 days of age with 1 x 10(6) TCID50 EEEV did not develop the high temperatures or signs of central nervous system disease that 6 pigs from non-vaccinated sows developed. Virus was isolate from blood and oropharyngeal swabs from all pigs from non-vaccinated sows with blood virus titers as high as 9.3 x 10(4) TCID50, while only low levels of virus were detected in blood and oropharyngeal swabs from pigs from vaccinated sows. Virus was also isolated from tonsils collected at necropsy from 3 pigs from non-vaccinated and 1 pig from vaccinated sows. Vaccination of pregnant sows leads to development of maternal antibodies that are transmitted via colostrum to pigs and are protective against clinical EEEV related disease after experimental challenge with EEEV. In addition, vaccination prevents amplification of virus in infected pigs and could result in protection of animals and farm labor in the environment of infected pigs.

Disseminated adenovirus infection associated with cutaneous and visceral hemorrhages in a nursing piglet.

An unusual adenovirus infection in a conventionally raised nursing pig was characterized clinically by hemorrhagic diathesis of the skin and microscopically by disseminated viral inclusions in the endothelial, interstitial, and epithelial cells of the skin, kidney, spleen, liver, heart, and small and large intestines. This disease was confirmed ultrastructurally by demonstration of typical adenoviral particles in the nuclei of endothelial cells in the myocardium and of interstitial cells in the small intestine. This is the first report of disseminated adenovirus infection in a nursing pig in North America.

Eastern equine encephalomyelitis virus infection in swine.

In 1 of 2 outbreaks of eastern equine encephalomyelitis virus (EEEV) infection in swine, 280 of 350 pigs died. Histopathologic findings in the brain were typical of EEEV infection. In addition, multifocal necrosis and inflammation were seen in the myocardium. Follow-up investigation in 1 of the herds revealed antibody response to EEEV in surviving pigs and in adult swine. Growth retardation was noticed in surviving pigs. Histologic examination revealed mild lesions in the brain of the survivors.

Leukocyte changes associated with acute inflammation in chickens.

Leukocyte changes in chickens with turpentine-induced inflammation were investigated sequentially at 0, 6, 12, and 24 hours and at 2, 3, 4, 7, and 14 days. During acute inflammation, significant leukocytosis and heterophilia developed by 6 hours and persisted through 7 days. The peak mean heterophil and leukocyte counts occurred at 12 hours and 3 days, respectively. Left shifts were present at 12 and 24 hours as detected by 100-cell leukocyte differential counts. Heterophil mean nuclear scores documented nuclear hyposegmentation (left shift) during early inflammation and nuclear hypersegmentation (right shift) during convalescence. Mean monocyte and lymphocyte counts peaked at 2 and 3 days, respectively. Basophil and eosinophil counts were erratic. Toxic changes of heterophils were most apparent during intense left shifts and consisted of cell swelling, degranulation, cytoplasmic vacuolation, and cytoplasmic basophilia. Cytoplasmic basophilia was the last aspect of toxic change to resolve. Ultrastructurally, toxic heterophils had intracellular edema, dissolution of granules, retention of ribosomes, nuclear membrane blebs, and decreased heterochromatin density. All inflammation-associated alterations in cell counts and morphology returned to baseline values and appearance by 14 days after turpentine administration.

Comparative study of the pathogenicity of avian reoviruses.

Reovirus strains CO8 and 81-5, isolated from chickens with malabsorption syndrome, and reovirus strain 176, isolated from chickens with tenosynovitis, were each individually inoculated into 1-day-old specific-pathogen-free chicks. Strain CO8 caused tenosynovitis and pericarditis following footpad inoculation, but it was of low pathogenicity when given by either oral or subcutaneous route. In contrast, strains 81-5 and 176 were highly pathogenic and caused severe mortality following subcutaneous inoculation. Lesions included hepatic necrosis, bursal atrophy, thymitis, and splenic hyperplasia; strain 81-5 also caused pericarditis and myocarditis. Although strain 176 caused higher mortality than strain 81-5, these two strains differed little in the severity and distribution of the lesions they caused. No signs or lesions of typical malabsorption syndrome were observed.

The effect on newborn chicks of oral inoculation of reovirus isolated from chickens with tenosynovitis.

Reovirus strain 176, isolated from chickens with tenosynovitis, was highly pathogenic following oral inoculation of 1-day-old specific-pathogen-free chicks. Disseminated lesions including hepatic necrosis, splenic lymphostromal cell hyperplasia, and bursal atrophy occurred on day 3 postinoculation (PI), followed by myocarditis on day 6 PI and by pericarditis and tenosynovitis on day 9 PI. Reovirus was isolated from the liver as early as day 1 PI, whereas significant neutralizing antibody was detected on day 13 PI. Mortality occurred from day 4 to day 7 PI, and the death of birds was associated with the severity of hepatic necrosis. The occurrence of tenosynovitis in virus-inoculated birds was subclinical.

Application of the avidin-biotin-peroxidase complex (ABC) technique for detecting avian reovirus in chickens.

An immunoperoxidase technique, avidin-biotin-peroxidase complex (ABC), was used for detecting avian reovirus in glutaraldehyde-formalin-fixed, paraffin-embedded tissues. A peroxidase-positive reaction, characterized by the presence of dark brown granules in the cytoplasm of affected cells, was found in the liver (Kupffer cells, macrophages, and hepatocytes) and bursa of Fabricius (epithelial cells, stromal cells, and/or macrophages). The early presence of peroxidase activity in the bursa of Fabricius supports our previous idea that the bursa of Fabricius may serve as a primary site of replication for natural reovirus infection.

Vitamin A toxicity: comparative changes in bone of the broiler and leghorn chicks.

Severe skeletal lesions were produced in both broilers and leghorns orally administered toxic levels of vitamin A (330 or 660 IU vit. A/g body weight X day) for 21 consecutive days. Hypervitaminosis A in broilers produced an osteodystrophy characterized by abnormal thickening of the proliferative-maturation zone, metaphyseal sclerosis, hyperosteoidosis, decreased number of osteoclasts, and parathyroid gland hyperplasia. In leghorns, the osteodystrophic lesions were characterized by a thin proliferative-maturation zone, a relatively thickened hypertrophy zone, flattened spindle-shaped osteoblasts, and osteoporosis. In both broilers and leghorns given excessive vitamin A, the osteogenic layer of periosteum in all bones was thin.