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This study aimed to evaluate the efficacy of stereotactic body radiotherapy (SBRT) compared with three-dimensional conformal radiotherapy (3DCRT). Forty-three patients with portal vein tumor thrombosis (PVTT)/inferior vena cava tumor thrombosis (IVCTT) treated with SBRT (27 with CyberKnife (CK) and 16 with TrueBeam (TB)) from April 2013 to December 2014, and 54 treated with 3DCRT from June 2008 to March 2013 were evaluated. Dosimetric parameters, response to radiotherapy (RT) and survival outcomes were compared in total SBRT vs. 3DCRT, CK vs. 3DCRT and TB vs. 3DCRT, respectively. The median biologically effective dose 10 (BED10) values in total SBRT, CK, TB and 3DCRT were 73.4 Gy10, 75.0 Gy10, 60.5 Gy10 and 58.5 Gy10, respectively (P < 0.001 in total SBRT vs. 3DCRT, P < 0.001 in CK vs. 3DCRT, P = 0.004 in TB vs. 3DCRT). The tumor response rates were 67%, 70%, 62% and 46%, respectively (P = 0.04, P = 0.04, P = 0.25). The 1-year overall survival rates were 49.3%, 56.7%, 38.1% and 29.3%, respectively (P = 0.02, P = 0.02, P = 0.30), and the 1-year local progression rates were 20.4%, 21.9%, 18.8% and 43.6%, respectively (P = 0.01, P = 0.04, P = 0.10). The use of SBRT made it possible to achieve a higher BED10 compared with the use of 3DCRT. Improvements in local control and survival were achieved in the CK group and the total SBRT group. Our results suggest that SBRT may have the potential to be the standard RT technique for the treatment of PVTT/IVCTT.

Background Compromised patients subjected to major digestive surgery frequently develop infective complications caused by methicillin-resistant Staphylococcus aureus (MRSA), which may have dangerous consequences. This was a prospective randomized study to determine whether intranasal mupirocin could reduce postoperative infective complications in patients having digestive surgery. Methods A total of 395 patients who underwent abdominal digestive surgery were assigned randomly into two groups: a treated group (193 patients) and controls (202). Patients in the treated group were given 30 mg mupirocin calcium hydrate ointment topically to each nostril three times a day on each of the 3 days before operation. The untreated group received no mupirocin treatment. Results Most infections were due to Gram-negative bacteria in both groups. There were 21 Gram-positive infections detected at the surgical site, ten in the treated group and 11 in control patients. The incidence of pneumonia was significantly different between the groups (none in the treated group and five in control patients; P = 0·028). Four of five patients with pneumonia had a sputum culture containing MRSA. Conclusion Intranasal mupirocin treatment had no significant impact on surgical-site infection after digestive surgery.

Background Intestinal ischaemia–reperfusion (IR) injury frequently occurs in abdominal surgery. Perfluorochemical (PFC) can be used to oxygenate intestinal organs directly and allows adenosine 5′-triphosphate (ATP) production within the submerged organs during ischaemia. This study was designed to evaluate the protective effect of PFC in IR injury, focusing on cytokine production in rat small intestine. Methods The superior mesenteric artery was occluded in rats for 60 min and the small bowel placed in an intestinal bag containing either normal saline (group 1), oxygenated saline (group 2) or oxygenated PFC (group 3). The arterial clip was subsequently removed, allowing reperfusion. The number of rats that survived for 7 days, tissue ATP levels, biochemical variables, tissue lipid peroxidation (LPO), bacterial cultures and histological changes were examined after reperfusion. Results The use of oxygenated PFC in group 3 improved survival compared with the other groups. Serum creatine phosphokinase and lactate dehydrogenase levels in groups 1 and 2 reflected small intestinal damage, and plasma levels of tumour necrosis factor α and interleukin 6 were raised. In contrast, oxygenated PFC decreased these levels, and reduced LPO, bacterial translocation and augmented apoptosis of the small intestine after reperfusion. Conclusion An intestinal bag containing oxygenated PFC showed protective effects during bowel ischaemia.

Background Liver resection of segments VII and/or VIII sometimes requires segmental resection of the right hepatic vein in patients with liver tumours invading or located close to the hepatic vein. In this situation, hepatic vein reconstruction is thought to have an important role in the postoperative function of segment VI. This study investigated whether preoperative embolization of the major hepatic vein could obviate the need for hepatic vein reconstruction after cranial partial resection of the liver including the major hepatic vein trunk in a preclinical model. Methods Sixteen beagles were divided into two groups of eight: control group (hepatectomy alone) and hepatic venous embolization (HVE) group (hepatectomy after HVE). HVE was performed 2 weeks before hepatectomy. All dogs underwent resection of the cranial third of the left lateral liver lobe together with the major trunk of the left hepatic vein. Following hepatectomy, survival, histological features, portal venous pressure and serum aspartate aminotransferase (AST) levels were determined. Results Six control animals and seven in the HVE group were alive 1 week after hepatectomy. Immediately after hepatectomy, portal venous pressure was significantly higher in the control group compared with the HVE group (mean(s.d.) 14·0(1·1) versus 8·1(1·0) mmHg; P < 0·01). Histological examination of the remnant left lateral lobe demonstrated patchy parenchymal haemorrhage in the control group and normal parenchymal architecture in the HVE group. Peak AST levels were observed on day 1 in both groups and were significantly higher in the control group (mean(s.d.) 182(42) versus 67(40) units/l; P < 0·01). Conclusion In this model, preoperative HVE facilitated interlobar venous collateral formation and minimized the untoward effects of segmental hepatic vein resection. This procedure may obviate the need for hepatic vein reconstruction after cranial partial liver resection including the major hepatic vein.

Although muscle glycogen phosphorylase kinase reacts preferentially with an inactive form of phosphorylase, the enzyme is able to phosphorylate in vitro multiple species of unidentified endogenous proteins in mammalian tissues such as liver. The reactions absolutely require Ca2+. Phosphate acceptor proteins are most abundant in the soluble and microsomal fractions. Sodium lauryl sulfate-slab gel electrophoresis analysis has revealed that the spectrum of phosphate acceptor proteins entirely differs from that for cyclic AMP-dependent protein kinase, although the biological significance of these reactions is unclear. Nevertheless, it is suggested that the enzyme is potentially multifunctional and plays roles in controlling some of the Ca2+-dependent processes. In contrast, myosin light chain kinase which is another species of calmodulin-dependent protein kinase seems to be strictly specific for this particular protein, and does not utilize any other endogenous protein so far tested.