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Minimally invasive approaches to major liver resection have been limited by presumed difficulty of the operation. While some concerns arise from mastering the techniques, factors such as tumor size and liver parenchymal features have anecdotally been described as surrogates for operative difficulty. These factors have not been systematically studied for minimally invasive right hepatectomy (MIRH).

Seventy-five patients who underwent MIRH during 2007-2016 by the senior author were evaluated; these were compared to control group of open right hepatectomy. Demographics, operative, and post-operative variables were collected. Operative times and estimated blood loss, two objective parameters of operative difficulty were correlated to volume of hepatic resection, parenchymal transection diameter and liver parenchymal features using regression analysis.

Thirty-eight (50.6%) resections were performed for malignant indications. Average tumor size was 5.7cm (±3.6), mean operative time was 196min (±74), and mean EBL was 220mL (±170). Average transection diameter was 10.1cm (±1.7). There was no correlation between operative difficulty with parenchymal transection diameter or presence of steatosis. Blood loss was higher with increased right hepatic lobe volume and body mass index.

This analysis of a very defined anatomical resection suggests that the often quoted radiographic and pathologic features indicative of a challenging procedure were not significant in determining operative difficulty.

This analysis of a very defined anatomical resection suggests that the often quoted radiographic and pathologic features indicative of a challenging procedure were not significant in determining operative difficulty.

The place of surgery and interventional radiology in the management of delayed (> 24h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.

Between 2005 and 2019, 57 patients (median age 64years) experienced 86 DHR episodes after pancreatic resection (n = 26), liver transplantation (n = 24) and other (n = 7). Z-VAD-FMK mouse Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.

Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p = 0.14). Recurrence was similar after stenting and embolization (n = 4/18, 22% vs n = 8/26, 31%, p = 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n = 2/10, 20% vs. n = 11/16, 69%, p = 0.042).

IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.

IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.

Spontaneous lienorenal shunts (SLS) siphon blood away from the portal circulation and may compromise portal inflow in liver transplantation (LT). Performing a left renal vein ligation (LRVL) is a relatively easy and efficacious method of overcoming this portal 'steal'. However, given the delicate state of renal function in these patients, its short and long term effects remain undefined. The aim of this study was to evaluate the efficacy of LRVL in augmenting portal flow and safety with regards to renal function.

A prospectively collected database of 1638 consecutive LT recipients between January 2010 and August 2020 was reviewed. Twenty-eight patients who underwent LRVL were identified. There were six paediatric recipients, who were analysed separately. Data with regards to imaging, renal function, intraoperative portal hemodynamics, and renal morbidity were analysed.

Of the 22 adults, 21 underwent live donor LT. 22.5% had a pre-transplant history of acute kidney injury (AKI). Pre-operative CT demonstrated portal vein thrombosis and SLS in 63.6% and 92.9% of patients respectively. LRVL resulted in a significant augmentation of portal hemodynamics in both the adult and paediatric recipients. Postoperatively, 14.3% and 35.7% of patients developed chylous drain output and AKI respectively. Of 13 patients who underwent CT at various timeframes, 5 patients had a partial re-canalisation of LRV at 6months.

From renal and portal standpoints, LRVL is a safe and effective technique of augmenting portal inflow. link2 Further large-scale multicentre studies and consensus will help define an objective algorithmic approach to LT recipients with SLS.

From renal and portal standpoints, LRVL is a safe and effective technique of augmenting portal inflow. Further large-scale multicentre studies and consensus will help define an objective algorithmic approach to LT recipients with SLS.

There are controversies about the ability of neutrophil to lymphocyte ratio to predict the recurrence and survival in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation. The objective of this study is to investigate the prognostic potential of combined lymphocyte count (LC) and neutrophil count (NC) in LARC patients treated with chemoradiotherapy (CRT) followed by curative surgery.

Patients with LARC who underwent surgical resection between January 2010 and December 2017 were reviewed retrospectively. We divided the patients into three groups high LC and low NC, low LC and high NC, and the remaining patients. The cut-off values of LC and NC were determined by receiver operating characteristic curve analysis and log-rank test statistics. We compared the disease-free survival (DFS) rate between the groups.

A total of 176 consecutive patients were included in this study. The 5year DFS rate was significantly different among the three groups in pathologic node (pN)+ patients (73.2% vs. link3 61.9% vs. 14.2%; P = 0.025). Cox multivariate analysis for pN+ patients demonstrated that combination of low LC and high NC (hazard ratio, 3.630; 95% confidence interval [CI], 1.306-10.093; P = 0.013) was significantly correlated with decreased DFS.

This study showed that the combination of LC and NC is a powerful predictive factor for disease recurrence in pN+ LARC patients who underwent CRT.

This study showed that the combination of LC and NC is a powerful predictive factor for disease recurrence in pN+ LARC patients who underwent CRT.

This study aimed to explore the protective effect of broccoli microgreens juice (BMJ) during C57BL/6J mice obesity development.

The obese model mice, induced by feeding high-fat diet (HFD), were treated with BMJ by gavage for 10weeks. Melbine was gavaged at 300mg/(kg bw)/d, as a positive control group.

BMJ supplementation significantly reduced white adipose tissues (WAT) mass, the body weight and adipocyte size, and increased water intake in HFD-fed mice. Moreover, it improved glucose tolerance, reduced insulin level and HOMA-IR value, and alleviated insulin resistance. Compared with the HFD group, BMJ supplementation significantly increased the relative abundance of Bacteroidetes and decreased the ratio of Firmicutes to Bacteroidetes at the phylum level, and enriched Bacteroides_acidifaciens at the species level. These changes in the composition of gut microbiota are associated with the production of short-chain fatty acids (SCFAs), and reduced LPS levels, and had an obvious anti-inflammatory effect.

These findings suggested that the protective effects of BMJ on diet-induced obesity may be involved in gut microbiota-SCFAs-LPS-inflammatory axis. In addition, BMJ can enhance liver antioxidant capacity and reduce liver fat accumulation. Consequently, these results sustain BMJ as a novel functional food for obesity, on the basis of its opposing effects on HFD-induced obesity in mice.

These findings suggested that the protective effects of BMJ on diet-induced obesity may be involved in gut microbiota-SCFAs-LPS-inflammatory axis. In addition, BMJ can enhance liver antioxidant capacity and reduce liver fat accumulation. Consequently, these results sustain BMJ as a novel functional food for obesity, on the basis of its opposing effects on HFD-induced obesity in mice.Fluorotelomer alcohols (FTOHs) are widely used as industrial raw materials due to their unique hydrophobic and oleophobic properties. However, because of accidental exposure to products containing FTOHs or with the widespread use of FTOHs, they tend to contaminate the water and the soil. There are reports demonstrating that FTOHs can cause various harmful effects in animals and humans (for example, neurotoxicity, hepatotoxicity, nephrotoxicity, immunotoxicity, endocrine-disrupting activity, and developmental and reproductive toxicities). Oxidative stress is related to a variety of toxic effects induced by FTOHs. To date, few reviews have addressed the relationship between the toxicity of FTOHs and oxidative stress. This article summarises research demonstrating that the toxicity induced by FTOHs correlates with oxidative stress and metabolism. Furthermore, during the metabolic process of FTOHs, a number of cytochrome P450 enzymes (CYP450) are involved and many metabolites are produced by these enzymes, which can induce oxidative stress. This is also reviewed.Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e. (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.