Se-Young Kim

The safety of a “fast-track” program after laparoscopic colorectal surgery is comparable in older patients as in younger patients

IntroductionFast-track protocols, introduced in the late 1990s, have been applied in several surgical fields, particularly for colorectal surgery. However, currently many surgical patients are elderly, and discussion about the application of such programs for elderly patients is lacking. The present study was designed to assess the safety of application of a fast-track program after laparoscopic colorectal surgery in elderly patients.MethodsFrom August 2009 to January 2011, we prospectively collected data from patients who underwent laparoscopic colorectal surgery with a perioperative fast-track program. The data of patients older and younger than 70xa0years were compared.ResultsOf a total of 337 patients, the group of patients older than 70xa0years (OG) totaled 87 (25.8xa0%) and the younger group (YG) totaled 250 (74.2xa0%). Ten patients (11.5xa0%) were excluded in the OG and 24 (9.6xa0%) in the YG. There were no differences in gender, history of previous surgeries, body mass index, type of operation, operative time, or blood loss between groups. Age (74.8 vs. 56.7xa0years, pxa0<xa00.001), presence of comorbidities (70.1 vs. 44.7xa0%, pxa0<xa00.001), and ASA score (I:II:III, 33.8:57.1:9.1 vs. 60.6:33.2:6.2xa0%, pxa0<xa00.001) were significantly different between the two groups. Postoperative course did not show differences, including return of flatus, stool passage, advancement of diet, removal of urinary catheter, length of usage of IV antibiotics, complications, and length of postoperative stay. Emergency department visits or readmission within a month after discharge were more frequent in the OG (11.7xa0%) than the YG (4xa0%; pxa0=xa00.013).ConclusionsFast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70xa0years. Physicians should keep in mind complications that may present after discharge and should actively educate patients about them.

Ursolic acid improves lipid and glucose metabolism in high‐fat‐fed C57BL/6J mice by activating peroxisome proliferator‐activated receptor alpha and hepatic autophagy

SCOPEnThis study investigated metabolic effects of ursolic acid (UA), a peroxisome proliferation-activated receptor (PPAR)-α activator, in vivo.nnnMETHODS AND RESULTSnHigh-fat diet (HFD)-fed C57BL/6J mice were orally administered UA (50 or 200 mg/kg body weight) for 8 wk. UA reduced liver and adipose tissue mass, adipocyte size, and plasma leptin concentrations, plasma triglyceride and low-density-lipoprotein cholesterol concentrations, while it elevated the high-density-lipoprotein cholesterol and adiponectin concentrations significantly compared with controls. UA induced the expression of PPARα and its responsive genes involved in fatty acid uptake and β-oxidation in the livers, whereas genes involved in lipogenesis, including sterol regulatory element-binding proteins-1c, were downregulated. UA administration improved glucose tolerance and insulin sensitivity significantly compared with the HFD-fed control livers. UA administration also activated hepatic autophagy as assessed by the expression of microtubule-associated protein 1A/1B-light chain 3 (LC3)-II and other key proteins in the autophagy pathway.nnnCONCLUSIONnOur findings suggest that UA ameliorates lipid and glucose metabolism in HFD-fed mice primarily by the activation of PPARα and induction of the hepatic autophagy pathway. Thus, intake of UA in the diet or in an isolated form may ameliorate lipid and glucose metabolism.

Requirement of Zinc Transporter SLC39A7/ZIP7 for Dermal Development to Fine-Tune Endoplasmic Reticulum Function by Regulating Protein Disulfide Isomerase

Skin is the first area that manifests zinc deficiency. However, the molecular mechanisms by which zinc homeostasis affects skin development remain largely unknown. Here, we show that zinc-regulation transporter-/iron-regulation transporter-like protein 7 (ZIP7) localized to the endoplasmic reticulum plays critical roles in connective tissue development. Mice lacking the Slc39a7/Zip7 gene in collagen 1-expressing tissue exhibited dermal dysplasia. Ablation of ZIP7 in mesenchymal stem cells inhibited cell proliferation thereby preventing proper dermis formation, indicating that ZIP7 is required for dermal development. We also found that mesenchymal stem cells lacking ZIP7 accumulated zinc in the endoplasmic reticulum, which triggered zinc-dependent aggregation and inhibition of protein disulfide isomerase, leading to endoplasmic reticulum dysfunction. These results suggest that ZIP7 is necessary for endoplasmic reticulum function in mesenchymal stem cells and, as such, is essential for dermal development.

Emerging role of the robot in rectal cancer surgery

the European Society of Gastroenterology formed the Euro-NOTES Clinical and the New European Surgical Academy founded the Natural Orifice Surgery working group and the German NOTES registry. There is also an international multicentre trial on clinical natural orifice surgery – NOTES IMTN study group based in Brazil which published preliminary results of 362 patients in 2010. NOTES has not delivered the paradigm shift it potentially promised and this may be due to several issues; namely technical, lack of recognized training and patient education. Technological advances in endoscope and platform design along with instrument modification may overcome some of the technical difficulties. However, the biggest need is to form a world expert committee with continental and country advisory boards to oversee surgical training and provide robust evidence of the potential advantages of NOTES.

Removal of Hazardous Surgical Smoke Using a Built-in-Filter Trocar: A Study in Laparoscopic Rectal Resection

Background: Surgical smoke containing potentially carcinogenic and harmful materials is an inevitable consequence of surgical energy devices, and constitutes a substantial occupational hazard in the operating room. This study aimed to evaluate the efficacy of a built-in-filter trocar in eliminating hazardous surgical smoke during laparoscopic and robotic rectal surgery. Methods: Ten patients who underwent rectal cancer resection were enrolled. Five patients underwent surgery utilizing a nonfiltered trocar, and the remaining 5 utilized a built-in-filter trocar. Gas samples were aspirated from the peritoneal cavity over 30 minutes of electrocauterization and collected in a Tedlar bag. Concentrations of surgical smoke were measured using ultraperformance liquid chromatography and gas chromatography. Results: Eleven hazardous chemical compounds (benzene, toluene, ethylbenzene, xylene, styrene, formaldehyde, acetaldehyde, propionaldehyde, butyraldehyde, isovaleraldehyde, and valeraldehyde) were identified in the surgical smoke. With the built-in-filter trocar, removal rates of 69% for benzene (P=0.028), 72% for toluene (P=0.009), 67% for butyraldehyde (P=0.047), 46% for ethylbenzene (P=0.092), 44% for xylene (P=0.086), 35% for styrene (P=0.106), 39% for formaldehyde (P=0.346), and 33% for propionaldehyde (P=0.316) were achieved. Conclusions: This study confirmed the presence of harmful materials in surgical smoke. Evacuation of surgical smoke through a disposable built-in-filter trocar is a simple and effective way in reducing volatile organic compounds concentrations.

The Hypolipidemic and Hypoglycemic Activities of Fermented Brown RiceFibers by Regulating PPARα and ChREBP in the Livers of C57BL/6J Mice

The fermentation of brown rice produces black vinegar that has been suggested with beneficial metabolic effects; however, the mechanisms of actions of fermented brown rice have not been studied. We found that fermented brown rice extracts, especially a fraction of fermented brown rice fibers (FBRF), exhibited hypolipidemic and hypoglycemic activities in vivo. The oral administration of FBRF to C57BL/6J mice reduced plasma cholesterol, triglycerides, lowdensity- lipoprotein cholesterol levels, hepatic lipid accumulation and adipocyte size. The activation and induction of hepatic PPARα and subsequent regulation of its target gene expressions in fatty acid uptake and oxidation were the major mechanism for reducing plasma and hepatic triglyceride concentrations. In addition, FBRF improved glucose tolerance and insulin sensitivity. FBRF feeding reduced the expressions of hepatic ChREBP, a key transcription factor in gluconeogenesis, and pro-inflammatory cytokines, thus improved insulin resistance. These results demonstrated that FBR, especially FBRF, shows potent hypolipidemic and anti-diabetic activities through regulating the expression of genes associated with lipid, glucose metabolism and inflammatory cytokines.