CLF Group Research Articles

A Physiologically Relevant Dose of 50% Egg-Phosphatidylcholine Is Sufficient in Improving Gut Permeability while Attenuating Immune Cell Dysfunction Induced by a High-Fat Diet in Male Wistar Rats

BackgroundObesity is associated with increased intestinal permeability and a diminished immune response. Phosphatidylcholine (PC), a form of choline found in eggs, has been shown to beneficially modulate T-cell response in the context of obesity when provided as the sole form of choline in the diet. ObjectiveThis study aimed to determine the impact of varying doses of PC as part of a high-fat diet (HFD) on immune cell function and intestinal permeability. MethodsMale Wistar rats 4 wk of age were randomly assigned to consume 1 of 6 diets for 12 wk containing the same amount of total choline but differing in the forms of choline: 1—control low-fat (CLF, 20% fat, 100% free choline [FC]); 2—control high-fat (CHF, 50% fat, 100% FC); 3—100% PC (100PC, 50% fat, 100% egg-PC); 4—75% PC (75PC, 50% fat, 75% egg-PC+25% FC); 5—50% PC (50PC, 50% fat, 50% egg-PC+50% FC); and 6—25% PC (25PC; 50% fat, 25% egg-PC+75% FC). Intestinal permeability was measured by fluorescein isothiocyanate–dextran. Immune function was assessed by ex vivo cytokine production of splenocytes and cells isolated from the mesenteric lymph node (MLN) after stimulation with different mitogens. ResultsFeeding the CHF diet increased intestinal permeability compared with the CLF diet, and doses of PC 50% or greater returned permeability to levels similar to that of the CLF diet. Feeding the CHF diet lowered splenocyte production of interleukin (IL)-1β, IL-2, IL-10, and tumor necrosis factor-alpha, and MLN production of IL-2 compared with the CLF group. The 50PC diet most consistently significantly improved cytokine levels (IL-2, IL-10, tumor necrosis factor-alpha) compared with the CHF diet. ConclusionsOur results show that a dose of 50% of total choline derived from egg-PC can ameliorate HFD-induced intestinal permeability and immune cell dysfunction.

Efficacy of inguinal buffered lidocaine and intranasal flunixin meglumine on mitigating physiological and behavioral responses to pain in castrated piglets.

Managing castration pain on US sow farms is hindered by the lack of Food and Drug Administration (FDA) approved products for mitigating pain. Previous work assessing flunixin meglumine (FM) efficacy in mitigating castration pain has shown the drug to be effective in pigs, meanwhile, results from previous work evaluating lidocaine efficacy are contradictory. Therefore, the objectives of this study were to determine the efficacy of inguinal buffered lidocaine (BL) and FM in mitigating castration pain in piglets. This study was divided into Part I (physiological response) and Part II (behavioral response). For part I piglets were randomly assigned to the following treatments: T1: (C) Castration plus physiological saline; T2: (S) Sham plus physiological saline; T3: (CL) Castration plus BL; T4: (SL) Sham plus BL; T5: (CF) Castration plus FM; T6: (SF) Sham plus FM; T7: (CLF) Castration plus BL and FM; T8: (SLF) Sham plus BL and FM. Blood was collected 24 h prior to castration, 1 h, and 24 h post castration for cortisol quantification. For Part II another cohort of piglets was enrolled and randomly assign to the following treatments: T1: (C) Castration plus physiological saline and T7: (CLF) Castration plus BL and FM. Behavior scoring was obtained in real-time by observing each piglet for 4-min continuously using Unesp-Botucatu pig acute pain scale (UPAPS) at the following timepoints: 1 h before castration (-1 h), immediately post-castration (0 h), and 3 h post-castration (+3 h). Average cortisol concentrations did not differ at -24 h (P > 0.05) or at 24 h post-castration (P > 0.05) between treatments. At 1 h post-castration, castrated piglets (C and CL) demonstrated greater cortisol concentrations (P < 0.05). Castrated piglets in the CF and CLF group had lower cortisol concentrations compared to C and CL-treated pigs (P < 0.05). For behavioral response, there were no differences between treatments on total UPAPS scores (C and CLF, P > 0.05). Intranasal FM was able to effectively reduce the physiological piglet's response immediately post-castration. Inguinal buffered lidocaine had no effect on the either physiological or behavioral response to pain. Long-term research should focus on refining injection techniques for inguinal BL and consider administration frequency and dosing of intranasal FM to control pain for a longer period post-castration.

Selection of embryo recipients, a real challenge in cows embryo transfer programs

This article comes as a response to a clinical situation that the members of our team found at an embryo transfer program. At the moment of insemination, day 7 after estrus period, a high number of untransferable recipients was found after ovaries ultrasonography. From 54 animals synchronized, just in 5 (9.25 %) cases was performed the embryo insemination. The embryo transfer was performed in cases where a corpus luteum (CL group) higher than 17 mm was found on the ovary, corpus luteum with a cavity of a maximum 10 mm and without a follicle higher than 10 mm on the ovary with the corpus luteum or on the other ovary. The rest of heifers were classified into the next groups: Hollow corpus luteum (HCL Group), 11 cases (20.37%), Lutheal cyst (LC Group), 5 cases (9.25%), No corpus luteum (NCL Group), 4 cases (7.40%), Corpus luteum and follicle (CLF Group), Small corpus luteum (SCL Group). Cystic corpus luteum seems to be a good variant for performing the Embryo Transfer. Even if the level of P4 concentrations in the case of a luteal cyst is highest, the embryo transfer in these cases is with a high level of risk and should be avoided.

Egg-Phosphatidylcholine Attenuates T-Cell Dysfunction in High-Fat Diet Fed Male Wistar Rats.

Obesity is associated with immune dysfunction including an impaired T-cell function characterized by a lower IL-2 (proliferation marker) production after stimulation. Phosphatidylcholine (PC), a form of choline mostly found in eggs, has been shown to beneficially modulate T-cell responses during the lactation period by increasing the production of IL-2. To determine the impact of egg-PC as part of a high-fat diet on immune function we randomly fed male Wistar rats one of three diets containing the same amount of total choline but differing in the form of choline: 1—Control low fat [CLF, 10% wt/wt fat, 100% free choline (FC)]; 2— Control high-fat (CHF, 25% wt/wt fat, 100% FC); 3— PC high-fat (PCHF, 25% wt/wt, 100% PC). After 9 weeks of feeding, rats were euthanized. Cell phenotypes and ex vivo cytokine production by splenocytes stimulated with phorbol 12-myristate 13-acetate plus ionomycin (PMA+I), lipopolysaccharide (LPS) and pokeweed (PWM) were measured by flow cytometry and ELISA, respectively. Rats fed the PCHF diet had a lower proportion of CD3+ cells when compared to both the CLF and the CHF. Following PMA+I stimulation, splenocytes from the CHF group produced less IL-2 and TNF-α compared to CLF and PCHF groups. No significant differences in cytokine production were found among groups after LPS and PWM stimulation. Our results show that feeding a high-fat diet impairs T-cell responses, as measured by ex vivo cytokine production, which can be attenuated by providing egg-PC.

A High-Fat Diet Containing 50% Egg-Phosphatidylcholine Increased the Proportion of T Cells Expressing a Memory Marker in Male Wistar Rats

ObjectivesStudies have suggested that high-fat (HF) diets are associated with immune dysfunction, which results in a lower production of IL-2 and a lower proportion of helper T cells. Providing a diet containing 100% phosphatidylcholine (PC), a form of choline mainly found in eggs, has been shown to increase IL-2 production early in life. However, this is of no relevance for human consumption since no human diet will contain 100% PC. Therefore, the objective of this study was to determine the dose effect of egg-PC added to a high fat diet compared to a control high fat and low fat diets on T cell function in male Wistar rats. MethodsAt four weeks of age, male Wistar rats were randomized to consume one of 6 diets: 1- Control low fat (CLF, 10%wt/wt fat, 100% free choline (FC), n = 10); 2- Control high fat (CHF, 25% wt/wt fat, 100% FC, n = 10); 3- 100% PCHF (100PCHF, 25% wt/wt fat, 100% PC, n = 10); 4- 75% PCHF (75PCHF, 25% wt/wt fat, 75% PC, 25% FC, n = 10); 5- 50% PCHF (50PCHF, 25% wt/wt fat, 50% PC, 50% FC, n = 10); 6- 25% PCHF (25PCHF; 25% wt/wt fat, 25% PC, 75% FC, n = 10). Fatty acid composition was closely matched in all of the diets. Anthropometric data was collected through the duration of the study (12 weeks). At the end of the study, splenocytes phenotypes were measured by flow cytometry. ResultsFrom week 1 to week 10 there was no difference in body weight between the diets. Starting from week 2 the CLF group had a higher food intake compared to the other groups. The 50PCHF diet had a higher proportion of helper T cells (CD4+) compared to the CLF and CHF diets. In addition, 50PCHF had a higher proportion of helper T cells expressing IL-2 receptors (CD4+CD25+) compared to 25PCHF (P < 0.05). 50PCHF also had a higher proportion of T cells expressing a memory marker (CD3+CD27+) compared with all HF diets (all P < 0.05) but not the CLF diet. ConclusionsOur results suggest that a diet providing 50% of total choline in the form of egg-PC normalizes the proportion of T cells expressing CD27 in the context of a HF diet which may lead to a better immune response if a second exposure to a pathogen occurs. Whether the higher proportion of helper T cells expressing the IL-2 receptor in the 50PCHF group is associated with better T cell response upon challenge remains to be investigated. Funding SourcesEgg farmers of Canada, NSERC.

Behavioral effects of chronic stress in Carioca High- and Low-Conditioned Freezing rats

Chronic unpredictable mild stress (CUMS) is a widely used model to study stress-coping strategies in rodents. Different factors have been shown to influence whether animals adopt passive or active coping responses to CUMS. Individual adaptation and susceptibility to the environment seem to play a critical role in this process. To further investigate this relationship, we examined the effects of CUMS on Carioca high- and low-conditioned freezing rats (CHF and CLF, respectively), bidirectional lines of animals selected for high and low freezing in response to contextual cues that were previously associated with footshocks. For this purpose, the behavior of CHF and CLF animals was evaluated in the contextual fear conditioning, open field, elevated T maze, and forced swimming tests before and after 21 days of CUMS. Animals kept under standard housing conditions were used as controls. For all tests, CHF rats were more susceptible to the effects of CUMS compared to CLF and control groups. CHF animals exposed to CUMS displayed a reduction in freezing behavior, decreased number of entries and time spent in the center of the open field, greater latencies to become immobile, and increased avoidance and escaping behaviors in the elevated T maze. Overall, these findings support the hypothesis that a heightened susceptibility to the environment exerts a strong influence on coping responses to chronic stress.

The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial

BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches.&#x0D; METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year.&#x0D; RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p &lt; 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p &lt; 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p &lt; 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p &lt; 0.05).&#x0D; CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.

21. The safety and efficacy of cervical laminectomy and fusion vs cervical laminoplasty surgery in degenerative cervical myelopathy: a prospective randomized trial

BACKGROUND CONTEXT There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated via cervical laminoplasty or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. PURPOSE We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. STUDY DESIGN/SETTING In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). PATIENT SAMPLE A total of 39 patients (mean age, 55.7±5.5 years, 69.2% men) underwent prospective randomization. OUTCOME MEASURES The primary outcome measures were the change in the visual analog scale (VAS), Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. METHODS In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). The primary outcome measures were the change in the visual analogue scale (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. The follow-up period was at least one year. RESULTS There was a significantly greater improvement in the NDI and VAS in the CLF group at one year (p CONCLUSIONS Among patients with multilevel DCM, the CLF approach was significantly better regarding the postoperative pain, NDI, and one-year Cobb's angle improvement, while the posterior approach was significantly better in terms of shorter hospital stay and operative time. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

High- and Low-conditioned Behavioral effects of midazolam in Carioca high- and low-conditioned freezing rats in an ethologically based test

The selective breeding of laboratory rodents with different anxiety-related traits is the subject of growing interest. The present study compared the effects of the benzodiazepine midazolam in the elevated plus maze (EPM) test of anxiety in two lines of Wistar rats that were selectively bred in our laboratory for either high or low anxiety-like traits based on a contextual freezing conditioning paradigm. After phenotyping anxiety-like traits (i.e., conditioned freezing behavior), Carioca High-Freezing [CHF], Carioca Low-Freezing [CLF]) and control rats were intraperitoneally injected (1.0 ml/kg) with .9 % saline or midazolam (.25, .5, .75, and 1.0 mg/kg) and subjected to the EPM 30 min later. After the saline injection, the CHF and CLF groups exhibited lower and higher open-arm exploration in the EPM, respectively, compared with control rats. These results indicate that anxiety-related traits previously selected from an associative learning paradigm can also be phenotypically expressed in an ethologically based animal model of anxiety. All midazolam doses significantly increased open-arm exploration in both CHF and control animals, but this anxiolytic-like effect in CLF rats was only observed at the lowest dose tested (.25 mg/kg). The present findings indicate that these two breeding lines of rats are a useful model for studying anxiety, and the anxiolytic effect of midazolam depends on genetic variability that is associated with basal reactions to threatening situations.

Behavioral alterations are independent of previous generalized anxiety in experimental sepsis

BackgroundMany sepsis survivor patients develop psychological problems and cognitive impairment. We hypothesize that previous stress exacerbate the cognitive impairment and anxiety in sepsis survivors. To test our hyphothesis, experimental animals that were selectively bred for high and low contextual fear conditioning were subjected to sepsis to evaluate long-term behavior changes. MethodsAdult male Albino Wistar rats selectively bred for high (Carioca high-conditioned freezing - CHF) levels or low (Carioca low-conditioned freezing - CLF) levels of emotionality were subject to sepsis by the cecal ligation and perforation (CLP) or sham operated (no-CLP) as a control group. Elevated plus-maze and inhibitory avoidance tasks were performed 10 days after CLP and non-CLP surgeries. ResultsThe sepsis survivor rats (wild-type, CHF, and CLF groups) and sham (CHF and CLF groups) presented anxious-like behavior evaluated by elevated plus-maze task. However, only sepsis groups presented aversive memory impairment evaluated by inhibitory avoidance task at 10 days after CLP surgery. The CLF or CHF did not interefere in the long-term impairment triggered by sepsis. ConclusionOur data suggest that previous stress did not interfere in the long-term cognitive impairment and anxious-like behavior observed in septic survivor rats.

Outcomes of multisegmental transforaminal enlarged decompression plus posterior pedicle screw fixation for multilevel lumbar spinal canal stenosis associated with lumbar instability

PurposeThe aim of this study was to evaluate the clinical and radiologic results of multisegmental transforaminal enlarged decompression (TED) plus posterior pedicle screw fixation in the treatment of multilevel lumbar spinal canal stenosis (LSCS) with lumbar instability (MLSCSI). Methods113 patients with MLSCSI underwent surgery were recruited in this study. All patients were suffering from symptoms typical of degenerative LSCS and treated with either TED plus fusion (TEDF group) or conventional laminectomy plus fusion (CLF group). Clinical and radiologic parameters were evaluated. The clinical data, including Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), operative time, intraoperative blood loss, postoperative drainage, hospital stay, and the rate of postoperative complications, were assessed. With respect to radiologic parameters, mean disc height (MDH) and lumbar lordotic angle (LLA) were measured using plain radiographs. Patient satisfaction was evaluated according to the North American Spine Society (NASS) Outcome Questionnaire. ResultsNo serious complications occurred during the follow-up. The operative time was significantly shorter for TEDF group than for CLF group, and similar results were found with regard to the blood loss and postoperative drainage (p < .05). The improvements in ODI, leg and back VAS scores were observed in both groups after surgery and follow-up (P < .05). In the last follow-up, ODI and back VAS scores in TEDF group were significantly higher than those in CLF group (P < .05). Regarding radiologic variants, MDH and LLA were improved after operation for 3 months (P > .05) and were all well maintained in the final follow-up in both groups. Patients in TEDF group were more satisfied than patients in the CLF group (85.2% vs 76.9%, p = .092). ConclusionsSatisfactory clinical and radiological outcomes can be achieved with the use of multisegmental TED plus lumbar fusion for the treatment of MLSCSI. This technique can reduce surgically induced instability and obviously improve the symptoms and signs of the patients, suggesting a safe and effective therapeutic procedure for MLSCSI.

Effect of a probiotic beverage consumption (Enterococcus faecium CRL 183 and Bifidobacterium longum ATCC 15707) in rats with chemically induced colitis.

BackgroundSome probiotic strains have the potential to assist in relieving the symptoms of inflammatory bowel disease. The impact of daily ingestion of a soy-based product fermented by Enterococcus faecium CRL 183 and Lactobacillus helveticus 416 with the addition of Bifidobacterium longum ATCC 15707 on chemically induced colitis has been investigated thereof within a period of 30 days.MethodsColitis was induced by dextran sulfate sodium. The animals were randomly assigned into five groups: Group C: negative control; Group CL: positive control; Group CLF: DSS with the fermented product; Group CLP: DSS with the non-fermented product (placebo); Group CLS: DSS with sulfasalazine. The following parameters were monitored: disease activity index, fecal microbial analyses, gastrointestinal survival of probiotic microorganisms and short-chain fatty acids concentration in the feces. At the end of the protocol the animals’ colons were removed so as to conduct a macroscopical and histopathological analysis, cytokines and nitrite quantification.ResultsAnimals belonging to the CLF group showed fewer symptoms of colitis during the induction period and a lower degree of inflammation and ulceration in their colon compared to the CL, CLS and CLP groups (p<0.05). The colon of the animals in groups CL and CLS presented severe crypt damage, which was absent in CLF and CLP groups. A significant increase in the population of Lactobacillus spp. and Bifidobacterium spp. at the end of the protocol was verified only in the CLF animals (p<0.05). This group also showed an increase in short-chain fatty acids (propionate and acetate). Furthermore, the intestinal survival of E. faecium CRL 183 and B. longum ATCC 15707 in the CLF group has been confirmed by biochemical and molecular analyzes.ConclusionsThe obtained results suggest that a regular intake of the probiotic product, and placebo to a lesser extent, can reduce the severity of DSS-induced colitis on rats.

IMPACT OF LOW FLOW ON SURVIVAL AFTER AORTIC VALVE REPLACEMENT FOR SEVERE AORTIC STENOSIS

Low LV outflow can occur both in patients with reduced or preserved LV ejection fraction (LVEF) (i.e. classical low-flow: CLF or paradoxical low-flow: PLF). Several studies have reported that patients with CLF have higher operative risk when undergoing aortic valve replacement (AVR). However, the outcome of PLF patients following AVR remains unknown. The aim of this study was to compare the short- and long-term outcomes of PLF, CLF and normal flow (NF) patients after AVR. Among 1213 consecutive patients with severe AS who underwent AVR ±coronary bypass grafting, 216 (18%) were in CLF as defined by LVEF35ml/m2. Compared to the 2 other groups CLF patients had a more comorbidities and higher operative risk as documented by higher Parsonnet risk score (CLF: 8.5±10 vs. PLF: 4.5±4.2 and NF: 3.7±3.5 in, p<0.0001), while comorbidities were grossly equivalent between PLF and NF (Parsonnet p=0.15). AS severity appeared to be worse in low flow groups as documented by aortic valve area (CLF: 0.72±0.22; PLF: 0.66±0.24 and NF: 0.80±0.21cm2; all p<0.001). 30-Day mortality was higher (p<0.0001) in CLF and PLF groups compared to NF group (6.0 and 6.4 vs. 1.6%; respectively). PLF group or alternatively lower SVi were independent predictors of operative mortality (OR: 3.36; p=0.001 and 1.23 (by 5ml/m2 decrease); p=0.03; respectively), while CLF group or low LVEF were not. At 5 years post AVR, overall survival was 73±4% in the CLF group, 81±3% in the PLF group and 85±2% in the NF group (p<0.0001). After adjustment for age, sex, NYHA III-IV, diabetes, atrial fibrillation, chronic kidney failure, chronic obstructive pulmonary disease, coronary artery disease, LV mass index and mean gradient, CLF (p=0.03) or lower LVEF (p=0.03) were independent predictor of mortality while PLF (p=0.33) or lower SVi (p=0.44) were not. As patients with CLF, patients with PLF are at higher risk for operative mortality. However, the traditional pre-operative risk scores do not appear to adequately capture the increased operative risk associated with the PLF entity. To overcome this limitation, the SVi should be systematically integrated in the preoperative risk stratification of patients with AS. In the longer-term, patients with PLF have similar prognosis as those with NF and only patients with CLF have continued increased risk of mortality.

Serum 1H-NMR Metabolomic Fingerprints of Acute-On-Chronic Liver Failure in Intensive Care Unit Patients with Alcoholic Cirrhosis

IntroductionAcute-on-chronic liver failure is characterized by acute deterioration of liver function in patients with compensated or decompensated, but stable, cirrhosis. However, there is no accurate definition of acute-on-chronic liver failure and physicians often use this term to describe different clinical entities. Metabolomics investigates metabolic changes in biological systems and identifies the biomarkers or metabolic profiles. Our study assessed the metabolomic profile of serum using proton nuclear magnetic resonance (1H-NMR) spectroscopy to identify metabolic changes related to acute-on-chronic liver failure.PatientsNinety-three patients with compensated or decompensated cirrhosis (CLF group) but stable liver function and 30 patients with cirrhosis and hospitalized for the management of an acute event who may be responsible of acute-on-chronic liver failure (ACLF group), were fully analyzed. Blood samples were drawn at admission, and sera were separated and stored at –80°C until 1H-NMR spectral analysis. Using orthogonal projection to latent-structure discriminant analyses, various metabolites contribute to the complete separation between these both groups.ResultsThe predictability of the model was 0.73 (Q2 Y) and the explained variance was 0.63 (R2 Y). The main metabolites that had increased signals related to acute-on-chronic liver failure were lactate, pyruvate, ketone bodies, glutamine, phenylalanine, tyrosine, and creatinine. High-density lipids were lower in the ALCF group than in CLF group.ConclusionA serum metabolite fingerprint for acute-on-chronic liver failure, obtained with 1H-NMR, was identified. Metabolomic profiling may aid clinical evaluation of patients with cirrhosis admitted into intensive care units with acute-on-chronic liver failure, and provide new insights into the metabolic processes involved in acute impairment of hepatic function.

Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up.

This study compares the outcome 3 years after treatment of varicose veins by endovenous laser ablation (EVLA), radiofrequency ablation, ultrasound-guided foam sclerotherapy (UGFS), or surgery by assessing recurrence, Venous Clinical Severity Score (VCSS), and quality of life (QOL). A total of 500 patients (580 legs) were randomized to one of the three endovenous treatments or high ligation and stripping of the great saphenous vein (GSV). Follow-up included clinical and duplex ultrasound examinations and VCSS and QOL questionnaires. Kaplan-Meier (KM) life-table analysis was used. P values below .05 were considered statistically significant. At 3 years, eight (KM estimate, 7%), eight (KM estimate, 6.8%), 31 (KM estimate, 26.4%), and eight (KM estimate, 6.5%) of GSVs recanalized or had a failed stripping procedure (more than 10 cm open refluxing part of the treated GSV; CLF, EVLA, UGFS, and stripping, respectively; P<.01). Seventeen (KM estimate, 14.9%), 24 (KM estimate, 20%), 20 (KM estimate, 19.1%), and 22 (KM estimate, 20.2%) legs developed recurrent varicose veins (P= NS). The patterns of reflux and location ofrecurrent varicose veins were not different between the groups. Within 3 years after treatment, 12 (KM estimate, 11.1%), 14 (KMestimate, 12.5%), 37 (KM estimate, 31.6%), and 18 (KM estimate, 15.5%) legs were retreated in the CLF, EVLA,UGFS, and stripping groups, respectively (P< .01). VCSS, SF-36, and Aberdeen QOL scores improved significantly in all the groups with no difference between the groups. All treatment modalities were efficacious and resulted in a similar improvement in VCSS and QOL. However,more recanalization and reoperations were seen after UGFS.

The balance between intrahepatic IL-17+ T cells and Foxp3+ regulatory T cells plays an important role in HBV-related end-stage liver disease

BackgroudIL-17+ T helper cells and Foxp3+ regulatory T cells are CD4+ T helper cells with reciprocally regulated differentiation and function. Their frequency and function vary in patients with chronic hepatitis B. In this study, we investigated the balance between IL-17+ T cells and Foxp3+ regulatory T cells and illustrated their function in the aggravation of chronic hepatitis B (CHB).ResultsTwenty-six patients with chronic HBV -related liver failure (CLF), thirty-one patients with acute on chronic HBV-related liver failure (ACLF) and twelve normal controls were enrolled in our study. The expressions of IL-17, Foxp3, CD4, CD8 and perforin in liver tissue were measured by immunochemistry for the evaluation of liver-infiltrating lymphocytes. The frequency of liver IL-17+ T cells on liver inflammatory cells and their proportion in the total CD4+ T cell population increased markedly in the ACLF group, while the frquency of Foxp3+ T cells and their proportion in the total CD4+ T cell population did not show a significant difference in the two HBV infection groups. In addition, the ACLF group showed a dramatically higher IL-17+ /Foxp3+ ratio than the CLF group. CD4+ T cells increased significantly in the liver of patients with ACLF, compared with those in the liver of patients with CLF.ConclusionsOur findings suggest that intrahepatic IL-17+ T cells play an important role in the development of chronic HBV and that the imbalance between IL-17+ and Foxp3+ T cells in the liver may lead to progression of the disease but the mechanism should be further explored.

Comparison of the classic limberg flap and modified limberg flap in the treatment of pilonidal sinus disease: A retrospective analysis of 416 patients

Pilonidal sinus disease (PSD) is usually seen on the sacrococcygeal region in adolescent patients. The current study analyzed the outcome of the rhomboid excision and the Limberg flap procedure (cLF) in comparison to the modified Limberg flap procedure (mlF) for PSD. Four hundred and sixteen patients with PSD were operated on under spinal or general anesthesia by cLF and mlF. The patients were divided into two groups. In Group 1, cLF was performed on 211 patients. In Group 2, mlF was performed on 205 patients. No significant difference was detected between Groups 1 and 2 in terms of sex, age, preoperative disease period, follow-up time, the mean hospital stay, and hypoesthesia. The mlF group had better clinical results than the cLF group. The recurrence rate was statistically higher in the cLF group 1 than in the mlF group (P = 0.036). The time to return to work, time to walk without pain, and time to be able to sit on the toilet without pain were longer in the cLF group (P = 0.001). The maceration and wound infection rate were statistically higher in the cLF group than in the mlF group (P = 0.020 and P = 0.019, respectively). The mlF is a more effective treatment than cLF for the surgical management of PSD.

Effect of thermocycling on the bond strength between dual-cured resin cements and zirconium-oxide ceramics

The present study evaluated the durability of bond strength between zirconia and 3 different resin cements. Thirty stabilized tetragonal zirconium-dioxide blocks were duplicated in dual-curing resin core build-up material specimens. Resin blocks were randomly luted to zirconium surfaces using 1) Clearfil Esthetic Cement (CLF), 2) RelyX Unicem Aplicap (RELX), or 3) Multilink Automix (MLA). After 24 h, half of the specimens from each of the 3 groups were loaded in tension until fracture (0.5 mm/min). The remaining half were tested after 6,000 thermal cycles (5 to 55°C). Data were analyzed using 2-way ANOVA and the Tukey test (α = 0.05). Fractographic analysis was performed using a stereomicroscope. Tensile bond strength values were significantly affected by the luting agent system employed and by thermal aging (P < 0.001). The highest tensile bond strength values in non-thermal-aged groups were observed for specimens from the RELX and CLF groups. In contrast, in the thermal-aged groups, the highest tensile bond strength values were for the MLA and RELX groups. Moreover, while thermocycling significantly affected bond strengths in the RELX and CLF groups, the mean strength of the MLA group did not significantly change after aging. There was little difference in the distribution of failure modes in any group.

β-Carotene 15,15′-Dioxygenase Activity and Cellular Retinol-Binding Protein Type II Level Are Enhanced by Dietary Unsaturated Triacylglycerols in Rat Intestines

The purpose of this study was to examine effects of dietary triacylglycerols on β-carotene 15,15′-dioxygenase (EC 1.13.11.21) activity and cellular retinol-binding protein [CRBP (II)] in rats. Six groups of eight rats (7-wk old) were fed one of the following diets: standard (STD; 2.5% soybean oil), saturated (SFA; 15% hydrogenated soybean oil), monounsaturated (MUFA; 15% olive oil), polyunsaturated (PUFA; 15% soybean oil) or clofibrate (CLF; 2.5% soybean oil + 0.2% clofibrate) for 3 wk. The dioxygenase specific activities of the intestinal homogenates in the MUFA and PUFA groups fed the high fat diets were 2.4 times that of the STD group fed a low fat diet (P < 0.01), whereas the activities of the SFA and CLF groups were not significantly different from that of the STD group. The level of CRBP (II) in the intestine of the PUFA group was 1.3-fold that of the STD group (P < 0.05), whereas there were no significant differences among the other groups. In a second experiment, the dioxygenase activity of rat intestine was followed over 3 wk of feeding the STD and PUFA diets. After the PUFA diet was consumed for 1 d, the activity was enhanced to 2.7 times the baseline level and remained thereafter at that high level, whereas the activity of the STD group remained at the low baseline level. Thus, dietary polyunsaturated triacylglycerols enhanced both β-carotene 15,15′-dioxygenase activity and CRBP (II) level in rat intestine. These results suggest that the dioxygenase and CRBP (II) are regulated by the same mechanism involving long-chain fatty acids and their metabolites.