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Background Preoperative biliary drainage (PBD) has been advocated to address the plethora of physiologic derangements associated with cholestasis. However, available literature reports mixed outcomes and is based on largely outdated and/or single-institution studies. Methods Patients undergoing PBD prior to pancreaticoduodenectomy (PD) for periampullary malignancy between 2014-2018 were identified in the ACS-NSQIP pancreatectomy dataset. Patients with PBD were propensity-score-matched to those without PBD and 30-day outcomes compared. Results 8,970 patients met our inclusion criteria. 4,473 with obstruction and PBD were matched to 829 with no preoperative drainage procedure. In the non-jaundiced cohort, 711 stented patients were matched to 2,957 without prior intervention. PBD did not influence 30-day mortality (2.2% versus 2.4%) or major morbidity (19.8% versus 20%) in patients with obstructive jaundice. Superficial surgical site infections (SSIs) were more common with PBD (6.8% versus 9.2%), however, no differences in deep or organ-space SSIs were found. Patients without obstruction prior to PBD exhibited a 3-fold increase in wound dehiscence (0.5% versus 1.5%) additionally to increased superficial SSIs. Conclusion PBD was not associated with an increase in 30-day mortality or major morbidity but increased superficial SSIs. PBD should be limited to symptomatic, profoundly jaundiced patients or those with a delay prior to PD.

Treatment for diverticular disease has evolved over time. In the United States, there has been a trend towards minimally invasive surgical approaches and fewer postoperative complications, but no study has investigated this subject in the Veterans Health Administration.This retrospective review identified patients undergoing elective surgery for diverticular disease from 2004 to 2018. Demographics, comorbidities, operative approach, rates of ostomy creation, and 30-day outcomes were compared. The 15-year time period was divided into 3-year increments to assess changes over time.4198 patients were identified. Complication rate decreased significantly over time (28.1%-15.7%, p 0.001), as did infectious complications (21.5-6.3%, p 0.001). Median hospital length-of-stay decreased from 7 to 5 days (p 0.001). Rates of laparoscopic surgery increased over time (17.7%-48.1%, p 0.001).Increased utilization of laparoscopy in veterans undergoing elective surgery for diverticular disease coincided with fewer complications and a shorter length-of-stay. These trends mirror outcomes reported in non-veterans.

The adverse effects of tobacco use on postoperative outcomes are well documented. While smoking cessation is associated with overall improvement in long-term survival for lung cancer patients, the effects of cessation shortly before lung surgery are unclear. This study compares thirty-day outcomes after lobectomy between active smokers, recent quitters, and non-smokers. Patients who underwent lobectomy for cancer at national Veterans Affairs medical centers from 2012-2018 were retrospectively identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. The sample was stratified into three groups: smokers within two weeks of surgery ("active smokers"), those who quit between two weeks and three months prior to surgery ("recent quitters"), and "non-smokers". Propensity score matching was performed to compare groups. Of 5,715 patients who met inclusion criteria, 2,696 were non-smokers, 774 were recent quitters, and 2,245 were active smokers. After propensity matching, 572 patients comprised each group. Compared to recent quitters, active smokers had 48% higher odds of suffering a pulmonary complication (95% confidence interval (CI): 1.03-2.14; p=0.035) and 72% higher odds of suffering multiple complications (CI: 1.07-2.76; p=0.026). Relative to non-smokers, active smokers had 81% higher odds of pulmonary complications (CI: 1.34-2.65; p=0.003). No differences were detected in outcomes comparing recent quitters to non-smokers. Veterans undergoing lobectomy for cancer who quit 2 weeks before surgery had less pulmonary complications than active smokers. Recent quitters have similar outcomes to non-smokers. Surgeons should therefore encourage patients to quit smoking, including just prior to lung surgery.

Background A lateral pancreaticojejunostomy, or a Puestow procedure, is used in chronic pancreatitis with ductal dilation and pain. The current literature on the Puestow is sparse. This study examines outcomes of Puestow procedures nationwide. Methods Using ACS-NSQIP database, patients who underwent a Puestow procedure from 2010 to 2016 were identified. Univariate analysis and multivariable regression models were used to identify predictors of mortality and morbidities. Covariates included in the regression models were chosen based on clinical significance. Results The cohort included 524 patients. The 30-day mortality rate was 1.2%(n = 6). At least one major complication occurred in 19.1% of patients including death (1.2%), major organ dysfunction (8.2%), pulmonary embolism (1.3%), and surgical site infections (13.0%). Diabetes, COPD, and transfusions were the strongest predictors of complications. Conclusions The Puestow procedure is an acceptable treatment modality with low rates of morbidity and mortality. Minimizing transfusions and optimizing pulmonary status may improve 30-day outcomes.

The pigment lead white ((PbCO3)2·Pb(OH)2) was analyzed by LDI-MS/MS and LDI-Orbitrap-MS/MS for the first time. The elucidation of formulae from a suite of isotopically complex cluster ions was obtained from low- and high-resolution full- and tandem-mass spectra in concert with both deductive and inductive reasoning. The unique isotopic pattern of lead was used both to delineate the full-scan spectrum into superclusters and to identify the monoisotopic mass of each cluster, from which a lead-limited, accurate formula could be derived. Chemical formulae for the clusters of lead white followed the form PbxOyHz. Also, the in situ detection of lead white by LDI-MS was achieved for cross sections of painted works of art.

The peculiar ionization of anthraquinones, including the artistic dyes alizarin and purpurin, is examined. When alizarin (MW = 240) is ionized by either LDI or MALDI it exhibits a dominant ion of m / z 242 [M + 2H] + with a far greater abundance than expected from the 13 C isotopic contribution from the [M + H] + ion at m / z 241. For the first time, MS/MS analysis of these anomalous [M + 2H] + ions is presented, which indicates that they arise from a laser-induced photoreduction of one of the anthraquinone’s carbonyl groups. MS/MS daughter ions produced from neutral losses of either water or ammonia from the [M + 2H] + ions exhibit different relative abundances, depending upon their respective functional groups’ proximity to the reduced carbonyl. LDI-MS/MS was used for the in situ detection of alizarin in a painting cross section and a swatch of dyed silk.

A 9-week feeding trial was conducted with juvenile red drum, Sciaenops ocellatus, to evaluate the use of soy oil as a fish oil replacement. Three primary protein sources (fishmeal - FM, soybean meal - SBM, and soy protein concentrate - SPC) were utilized with 100% fish oil (FM, SBM, SPC), 75% fish oil (SBM, SPC), or 50% fish oil (FM, SBM, SPC) as the lipid source. Traditional growth and performance metrics (specific growth rate, feed consumption, feed conversion ratio) were tracked and tissue samples (liver, muscle, plasma, adipose, and brain) were collected for gas chromatography-based fatty acid profiling. Ten lipid metabolism related genes were analyzed for potential expression differences between dietary treatments in liver and muscle tissues and whole body and fillet tissues were sampled for proximate composition analyses. Forty- four fatty acids were measured by gas chromatography-flame ionization detector (GC-FID) and evaluated with principle component analysis and ANOVA to understand the dietary influence on lipid metabolism and health. Significant differences in growth rate were observed with the SBM 50% fish oil diet outperforming the FM 100% fish oil reference diet. All other soy protein-based diets performed statistically equivalent to both FM reference diets (100% and 50% fish oil) in regard to growth, however all soy protein-based formulations had significantly lower feed conversion ratios than the fishmeal-based references (p < .001). Gene expression differences were not significant in most cases, however often trended similarly as the observed performance. Fatty acid profiles differed as a function of oil source, with no apparent influence by protein source, with C18:2n-6 (linoleic acid) being-the primary differentiator. Overall, the six soy protein, fishmeal-free formulations performed equivalently or better than the fishmeal references with up to 50% of fish oil replaced by soybean oil.

The evolutionary histories of mobile and integrative genetic elements (MIGEs), key factors in the emergence of pathogenic bacteria, remain obscure due to their widespread distribution and diversity in gene content. Pathogenicity islands (PAIs) are large chromosomal regions that encode bacterial virulence factors present in pathogenic isolates and absent from non-pathogenic isolates. We examined the utility of PAI-encoded integrases as a marker to determine PAI phylogeny and evolutionary relationships to other MIGEs particularly bacteriophages. We examined 68 tyrosine recombinase (TR) integrases from 27 PAIs and 39 phages from five fully sequenced pathogenic Escherichia coli strains in the database. In general, all PAI regions identified were integrated adjacent to tRNA loci and had a percent GC content that differed from the host chromosome, which was not the case for most phages examined. Our phylogenetic analysis demonstrated that PAI-encoded integrases clustered within a distinct lineage, separate from phage-encoded integrases, which suggested a discrete evolutionary history. The tree branch lengths among PAI integrases were shorter than those among phage integrases suggesting that PAIs may be a more recent addition to E. coli. Further phylogenetic comparisons of these 68 integrases with 53 TR integrases from other characterized MIGEs also demonstrated that PAI-encode integrases form a distinct lineage, suggesting that these PAIs in E. coli are not remnants of other MIGEs. We identified recombination directionality factors/excisionases in the proximity of many of the E. coli PAI integrases, factors that were previously not shown to be present in E. coli PAIs. Overall this work is the first to demonstrate a dichotomy in the evolution of integrases encoded on PAIs and phages from pathogenic E. coli suggesting that PAIs are an evolutionary distinct genetic element.

Quantitation of cellular adenylate levels (i.e., ATP, ADP, AMP) has widespread applications in physiological, metabolic and energetic studies. We have compared classical adenylate extraction procedures (i.e., perchloric acid, boiling) with a previously unreported proteinase K-based extraction technique. Our results suggest that all three techniques are comparable in soft animal tissue, but proteinase K-based extractions consistently generated higher adenylate yields from a broad range of organisms, particularly those containing a cell wall (e.g., alga, bacteria, fungi, plant).

The ice worm, Mesenchytraeus solifugus , is among a few metazoan species that survive exclusively in glacier ice/snow. In this study, we demonstrate that ice worm adenylate levels [i.e. adenosine 5′-triphosphate (ATP), ADP and AMP] are maintained at levels well above their mesophilic counterparts, and that their response to temperature change is distinctly opposite, namely, ice worms increase energy levels as temperatures fall. Initially, this response is characterized by a sharp spike in [ATP] and the adenylate energy charge (even at sub-zero temperatures), which is followed by corresponding increases in [ADP] and [AMP] within a few days. These results suggest that ice worms have evolved a compensatory mechanism by which gains in adenylate nucleotides off-set, at least in part, the inherent lethargy and death usually associated with cold temperature.