Explore the vast range of titles available.

Under environmental stress, plants are believed to actively repress their growth to save resource and alter its allocation to acquire tolerance against the stress. Although a lot of studies have uncovered precise mechanisms for responding to stress and acquiring tolerance, the mechanisms for regulating growth repression under stress are not as well understood. It is especially unclear which particular genes related to cell cycle control are involved in active growth repression. Here, we showed that decreased growth in plants exposed to moderate salt stress is mediated by MYB3R transcription factors that have been known to positively and negatively regulate the transcription of G2/M-specific genes. Our genome-wide gene expression analysis revealed occurrences of general downregulation of G2/M-specific genes in Arabidopsis under salt stress. Importantly, this downregulation is significantly and universally mitigated by the loss of MYB3R repressors by mutations. Accordingly, the growth performance of Arabidopsis plants under salt stress is significantly recovered in mutants lacking MYB3R repressors. This growth recovery involves improved cell proliferation that is possibly due to prolonging and accelerating cell proliferation, which were partly suggested by enlarged root meristem and increased number of cells positive for CYCB1;1-GUS. Our ploidy analysis further suggested that cell cycle progression at the G2 phase was delayed under salt stress, and this delay was recovered by loss of MYB3R repressors. Under salt stress, the changes in expression of MYB3R activators and repressors at both the mRNA and protein levels were not significant. This observation suggests novel mechanisms underlying MYB3R-mediated growth repression under salt stress that are different from the mechanisms operating under other stress conditions such as DNA damage and high temperature.

Background Accurate estimation of the hepatic functional reserve before liver resection is important to avoid post-hepatectomy liver failure (PHLF). The aim of the present study was to evaluate the association of indocyanine green retention test with portal pressure by the cause of cirrhosis (non-viral vs. viral) and assessed postoperative outcomes including incidence of PHLF in patients with viral and non-viral cirrhosis. Methods The cohort includes 50 consecutive patients with liver cirrhosis scheduled for liver resection for primary liver tumors at the Lausanne University Hospital between 2009 and 2018. Results There were 31 patients with non-viral liver cirrhosis (Non-virus group) and 19 with viral liver cirrhosis (virus group). The indocyanine green retention rate at 15 min (ICG-R15) ( p  = 0.276), Hepatic Venous Portal Gradient (HVPG; p  = 0.301), and postoperative outcomes did not differ between the non-virus group and viral group. ICG-R15 and HVPG showed a significant linear correlation in all patients (Spearman’s rank correlation coefficient, ρ  = 0.599, p  < 0.001), the non-virus group ( ρ  = 0.555, p  = 0.026), and the virus group ( ρ  = 0.534, p  = 0.007). A receiver operating characteristic curve analysis showed that ICG-R15 was a predictor for presence of portal hypertension (PH; HVPG ≥ 12 mmHg) (area under the curve [AUC] = 0.780). The cut-off value of ICG-R15 for predicting the presence of PH was 16.0% with 72.3% of sensitivity and 79.0% of specificity. Conclusions The ICG-R15 level was associated with portal pressure in both patients with non-virus cirrhosis and patients with virus cirrhosis and predicts the incidence of PH with relatively good discriminatory ability. Clinical trial number https://clinicalTrials.gov(ID:NCT00827723) Local ethics committee number CER-VD 251.08

INTRODUCTION: Anatomical anomalies, such as branches of the celiac artery and superior mesenteric artery (SMA), and pancreatic malformations, including the annular pancreas, are important during pancreaticoduodenectomy (PD). Here, we report a case of an anomaly of the artery and main pancreatic duct (MPD) in which the pancreatic parenchyma surrounded the replaced common hepatic artery (rCHA), and the meandering main pancreatic duct (MMPD) ran behind the rCHA.CASE PRESENTATION: A 71-year-old woman was diagnosed with intraductal papillary mucinous neoplasm (IPMN) of pancreatic body and the dilation of MPD to 13 mm, which was a factor of high-risk stigmata. Preoperative computed tomography (CT) showed that the rCHA branched from the superior mesenteric artery (SMA) and the pancreatic parenchyma surrounded the rCHA. Moreover, the MPD meandered and ran behind the rCHA. PD was performed. At the time of dissection between the rCHA and pancreatic parenchyma, we had to divide not only the cranial part of the pancreatic parenchyma along the rCHA but also the MPD. The postoperative course was uneventful.CONCLUSION: This is the first report of the rCHA surrounded by pancreatic parenchyma and MMPD running behind the rCHA and in front of the portal vein.

Introduction Large cell neuroendocrine carcinoma (LCNEC) of the bladder is rare and aggressive. Reports of metastasectomy for single distant metastases are even rarer. Case Presentation A 49‐year‐old man was admitted to our hospital with gross hematuria. Cystoscopy, magnetic resonance imaging, and computed tomography revealed invasive bladder cancer without metastasis. He underwent transurethral resection of the bladder tumor, and histopathological examination confirmed LCNEC. The patient received neoadjuvant chemotherapy followed by partial cystectomy. Nineteen months postoperatively, a solitary metastasis was detected in the right axillary lymph node, and at 44 months, another solitary metastasis appeared in the subcutaneous tissue outside the right scapula. Both metastases were surgically resected, and no additional treatment was administered. At the time of this writing, there had been no recurrence or metastasis for 42 months following the second metastasectomy. Conclusion Metastasectomy may be an effective treatment option for solitary metastasis of LCNEC of the bladder.

Background Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions  These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

PurposeAmong the variations of the right hepatic artery (RHA), the identification of an aberrant RHA arising from the gastroduodenal artery (GDA) is vital for avoiding damage to the RHA during surgery, since ligation of the GDA is necessary during pancreaticoduodenectomy (PD). However, this variation is not frequently reported. The purpose of this study was to focus on an aberrant RHA arising from the GDA, which was not noted in the classifications reported by Michels and Hiatt.MethodsA total of 574 patients undergoing a PD between Jan 2001 and Dec 2015 at a tertiary care hospital in Switzerland (n = 366) and between Jan 2009 and May 2015 at a hospital in Japan (n = 208) were included in the analysis. Of these, preoperative CT angiography or/and MRI angiography findings were available for 532 patients. We retrospectively analyzed the hepatic artery variations, patient demographics, and surgical outcomes.ResultsAmong the 532 patients who received a PD, an RHA originating from the GDA was observed in 19 cases (3.5%). Eleven patients (2.1%) had both an aberrant RHA and an aberrant left hepatic artery (LHA) (Hiatt Type 4). Six patients (1.2%) had a replaced CHA arising from the SMA (Hiatt Type 5). We could, therefore, correctly identify the aberration in all cases.ConclusionsWe observed rarely reported but important aberrant RHA variations arising from the GDA. To prevent injury during PD in patients with this type of aberrant RHA, intensive preparations using CT and/or MRI imaging before surgery and intraoperative liver Doppler ultrasonography are considered to be essential.

INTRODUCTION: Colorectal cancer (CRC) can metastasize to various sites, including the liver, lungs, ovaries, adrenal glands, and lymph nodes. Approximately 1%–2% of patients with CRC develop para-aortic lymph node metastases. Herein, we report a case of surgical resection of an isolated, metachronous, retrocaval lymph node recurrence of rectal cancer above the renal vein.CASE PRESENTATION: A 77-year-old woman was diagnosed with a solitary metachronous retrocaval lymph node metastasis from rectal cancer. The patient underwent robot-assisted laparoscopic abdominoperineal resection. The pathological status was T3, N0, M0, or Stage IIA. No recurrence was observed for 13 months after the initial surgery. CT revealed a 24-mm tumor on the dorsal side of the inferior vena cava (IVC). Tumor resection was performed, including right adrenalectomy, Spiegel lobectomy, and partial resection of the IVC. Pathological findings revealed adenocarcinoma metastasis to a solitary lymph node, which invaded the IVC and Spiegel lobe.CONCLUSIONS: This is the first report of a surgical resection of a retrocaval lymph node metastasis from CRC that invaded both the IVC wall and the liver.

Aims The incidence of postoperative chronic liver failure (PCLF) after major hepatectomy for perihilar cholangiocarcinoma is relatively low, but it warrants careful attention. This study aimed to analyze the risk factors for PCLF, with a specific focus on the correlation with postoperative changes in liver and spleen volumes. Methods A total of 172 patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2006 and 2021 were included in the study. PCLF is defined as the presence of liver failure, such as ascites, esophageal varices, encephalopathy, and jaundice at 3 mo postoperatively. Risk factors, including chronological changes in liver volume, spleen volume, and hepatospleno volume ratio for PCLF, were evaluated by univariate and multivariate analyses. Results PCLF occurred in 8 of the 172 patients. On univariate analysis, multiple factors including preoperative prealbumin levels, indocyanine green retention test, and future remnant liver volume were identified as risk factors for PCLF. On multivariate analysis, the hepatospleno volume ratio (p = 0.033) and prealbumin level (p = 0.015) 3 mo after surgery were significantly associated with PCLF. The cutoff value for the hepatospleno volume ratio was 3.0 (area under the curve [AUC]: 0.881, sensitivity: 91.7%, specificity: 66.7%) and that for prealbumin level was 10 mg/dL (AUC: 0.894, sensitivity: 83.3%, specificity: 88.9%). Conclusion Hepatospleno volume ratio <3.0 and prealbumin level <10 mg/dL 3 mo after surgery were identified as risk factors for PCLF, implying the importance of postoperative nutritional guidance to preserve the remnant liver function for patients with these risk factors. The hepatospleno volume ratio and prealbumin levels 3 mo after major hepatectomy for perihilar cholangiocarcinoma are significant predictors of postoperative chronic liver failure (PCLF). The importance of this finding is that it emphasizes the need for targeted postoperative nutritional support and regular screening endoscopy to mitigate the risk of PCLF in vulnerable patients.

Background Secondary postpartum hemorrhage (PPH), which occurs between 24 h and 12 weeks postpartum, is a rare but potentially severe complication. The primary causes include retained products of conception (RPOC), subinvolution of the placental site (SIPS), and endometritis. SIPS, historically diagnosed histopathologically, is increasingly being identified using ultrasonography and angiography. However, this condition remains underrecognized in Japan. Uterine artery embolization (UAE) is an effective and minimally invasive treatment for PPH. This study aimed to evaluate the increasing incidence of secondary PPH, particularly due to SIPS, and the effectiveness of UAE. Methods In this retrospective review, we analyzed cases of PPH requiring blood transfusion or embolization at a regional perinatal medical center between December 2014 and November 2024. Patients with placenta previa or accreta were excluded. Maternal characteristics, use of assisted reproductive technology, delivery mode, bleeding onset, hemostatic intervention, and transfusion status were evaluated. Imaging diagnoses were confirmed by radiologists and interventional radiology‐certified emergency physicians. Results Among the 8107 deliveries, 37 cases (0.46%) of PPH were identified. 10 patients had secondary PPH. UAE was performed in 9 of the 10 cases (90%), with a 100% success rate. SIPS was the most common cause of secondary PPH (70%). Major complications were not observed. Conclusion The incidence of secondary PPH, particularly due to SIPS, has been increasing. UAE is considered a safe and effective intervention. Strategies for improved recognition and further research on PPH are needed to optimize the diagnosis and management of PPH due to SIPS in Japan. The incidence of secondary postpartum hemorrhage (PPH) due to subinvolution of the placental site (SIPS) is rising. This study highlights the effectiveness and safety of uterine artery embolization (UAE) as a minimally invasive treatment, emphasizing the need for improved recognition and management of SIPS in Japan.

INTRODUCTION: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication following pancreaticoduodenectomy, requiring prompt and accurate diagnostic and therapeutic measures to ensure patient survival.CASE PRESENTATION: A 79-year-old man underwent robot-assisted pancreaticoduodenectomy for suspected intraductal papillary mucinous carcinoma. Postoperatively, he developed a pancreatic fistula and major bile leak, leading to a hemorrhagic event on postoperative day 6. Initial stabilization was achieved with intravenous fluids and blood transfusions, followed by emergent angiography, which identified bleeding from the gastroduodenal artery (GDA) stump. Due to the short length of the remaining GDA, simple embolization of the GDA stump was considered inadequate. Given the anatomy of the short proper hepatic artery (PHA) and its immediate bifurcation into the left and right hepatic arteries, coil embolization was feared to cause infarction of the entire liver, and even with stenting, the left hepatic artery (LHA) would have to be sacrificed. Temporary balloon occlusion of the common hepatic artery (CHA) was used to stabilize the hemodynamics, serving as a bridge to surgical intervention to maintain hepatic blood flow. Although it was an emergency laparotomy, intraoperative CHA balloon occlusion created a controlled environment, allowing for precise localization and effective management of the hemorrhage. The root of the GDA was ligated, and hepatic blood flow was preserved. The choledochojejunostomy leak was repaired by re-anastomosis. The patient was discharged following successful conservative management of the pancreatic fistula. Eight months post-intervention, follow-up imaging confirmed preserved hepatic arterial flow.CONCLUSION: This case underscores the efficacy of a multidisciplinary approach in managing delayed PPH in hemodynamically stable patients. Comprehensive angiographic assessment, combined with temporary CHA balloon occlusion for bleeding control and meticulous surgical hemostasis, offers a viable strategy ensuring immediate and mid-term patient well-being.