Survival following lung volume reduction procedures: results from the UK Lung Volume Reduction (UKLVR) registry.

INTRODUCTION: Lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement can produce substantial benefits in appropriately selected people with emphysema. The UK Lung Volume Reduction (UKLVR) registry is a national multicentre observational study set up to support quality standards and assess outcomes from LVR procedures at specialist centres across the UK. METHODS: Data were analysed for all patients undergoing an LVR procedure (LVRS/EBV) who were recruited into the study at participating centres between January 2017 and June 2022, including; disease severity and risk assessment, compliance with guidelines for selection, procedural complications and survival to February 2023. RESULTS: Data on 541 patients from 14 participating centres were analysed. Baseline disease severity was similar in patients who had surgery n=244 (44.9%), or EBV placement n=219 (40.9%), for example, forced expiratory volume in 1 s (FEV1) 32.1 (12.1)% vs 31.2 (11.6)%. 89% of cases had discussion at a multidisciplinary meeting recorded. Median (IQR) length of stay postprocedure for LVRS and EBVs was 12 (13) vs 4 (4) days(p=0.01). Increasing age, male gender and lower FEV1%predicted were associated with mortality risk, but survival did not differ between the two procedures, with 50 (10.8%) deaths during follow-up in the LVRS group vs 45 (9.7%) following EBVs (adjusted HR 1.10 (95% CI 0.72 to 1.67) p=0.661) CONCLUSION: Based on data entered in the UKLVR registry, LVRS and EBV procedures for emphysema are being performed in people with similar disease severity and long-term survival is similar in both groups.

Protein digestion and absorption after massive small bowel resection.

The digestion, absorption, and intestinal propulsion of a 14C-labeled protein meal were examined in rats with a 70% proximal small bowel resection at one and at six weeks after surgery. In addition, rats were studied one week after 70% small bowel resection plus ileocecal valve bypass. Comparison with sham-operated controls showed no significant impairment of digestion or absorption of the protein meal in both groups of resected rats. Intestinal transit was measured by a nonabsorbable marker 51CrCl3, and there was no evidence of early appearance of the meal in the colon even in resected animals with ileocecal valve bypass. We conclude that, as early as one week after massive proximal small bowel resection, significant compensatory adaptative and motility changes have occurred, allowing protein digestive and absorptive function to be maintained.

Protein digestion and absorption in the blind loop syndrome.

Protein digestion and absorption was studied in rats with 6-week-old surgically constructed self-filling intestinal blind loops and steatorrhea, ie, blind-loop animals and controls were fed a 14C-labeled protein meal containing a nonabsorbable marker, 51CrCl3, and sacrificed 1 or 2 hr later. Intestinal contents were analyzed for 14C, 51Cr, protein, trypsin, and the products of digestion. At 1 hr, 14C absorption was greater in controls, but at 2 hr there was no difference in absorption between the two groups. Marker studies showed that blind-loop filling resulted in a delay of the progression of intestinal contents distally. Intraluminal trypsin and porteolysis were similar in the two groups. Endogenous protein was greater in the blind-loop animals. The early stages of the blind-loop syndrome may be characterized by delayed protein absorption secondary to blind-loop filling, which is compensated for by the distal gut resulting in an absence of overall protein malabsorption.

Protein digestion and absorption in rats with pancreatic duct occlusion.

The effects of pancreatic duct ligation on the digestion and absorption of a randomly 14C-labeled protein meal has been investigated in the rat. Although there was a significant reduction in luminal digestion and absorption of the protein meal in the pancreatic duct-ligated animals compared with controls, 37% of administered protein was absorbed despite absence of luminal pancreatic proteolytic enzyme activity. To characterize further the digestive and absorptive processes that occur in the absence of luminal pancreatic proteolytic enzyme activity, whole protein meal (untreated) and protein preincubated with (1) pepsin and HCl, and (2) HCl alone (treated), was instilled into isolated loops of rat intestine containing no demonstrable pancreatic proteolytic enzyme activity. Thirty per cent absorption of the untreated protein meal occurred in 4 hr; significantly greater amounts of both treated forms of meal were absorbed. It is concluded that the small bowel has the capacity to hydrolyze and absorb nutritionally significant amounts of dietary large molecular weight protein in the absence of luminal pancreatic enzyme activity. Furthermore, this process may be enhanced by prior denaturation and proteolysis in the stomach.

Protein digestion and absorption in the rat.

1. A randomly labelled 14C protein was synthesized in order to investigate the site and rate of digestion and absorption of dietary protein in the rat. 2. A liquid test meal consisting of protein and a non-absorbable marker, 51CrCl3, was administered to rats which were then sacrificed at intervals up to 4 hr after ingestion of the meal. Analysis of intestinal contents showed that as gastric emptying proceeded, the meal moved rapidly to the distal two thirds of the small intestine. 3. Protein digestion and absorption occurred predominantly in this area over a period of 1-2 hr. 4. Amounts of endogenous protein present in the small intestine never exceeded amounts of exogenous protein during maximum absorption of exogenous protein (0-1 hr). At later time periods (2-4 hr), however, more endogenous than exogenous protein was detected in the intestinal lumen. 5. It is concluded that the digestion and absorption of dietary protein is a rapid process, taking place in the distal two-thirds of the small intestine. Endogenous protein levels do not exceed exogenous protein levels until after the bulk of exogeneous protein is absorbed.

Glycosyltransferases in human blood. II. Study of serum galactosyltransferase and N-acetylgalactosaminyltransferase in patients with liver diseases.

Serum galactosyltransferase activity was found to be elevated in patients with alcoholic and other liver disorders but remained at a normal level in patients with a variety of nonhepatic diseases. The properties of the galactosyltransferase in patients with liver disease were compared with those of the enzyme in the serum of normal subjects. The possible presence of inhibitors or activators in the serum was examined. Results indicated that in patients with liver disease, the rise in the serum galactosyltransferase was due to an increase in the level of the enzyme present in normal serum and not due to the appearance of a new enzyme. In the cases examined, the level of the enzyme increased with the deterioration of liver function and declined in a patient recovering from acute alcoholic hepatitis. Another glycosyltransferase, an N-acetylgalactosaminyltransferase, was not elevated in the serum of liver disease patients and, unlike the galactosyltransferase, was not detected in normal liver. The results suggest that the serum galactosyltransferase originates from the liver and that an abnormal rise in the level of this enzyme in serum is due to hepatocellular damage.