Introduction: Obesity is associated with an increased risk of fatty liver disease, predisposing to liver fibrosis and cirrhosis, as well as increased occurrence of hepatocellular carcinoma. Obesity is intuitively cons...Introduction: Obesity is associated with an increased risk of fatty liver disease, predisposing to liver fibrosis and cirrhosis, as well as increased occurrence of hepatocellular carcinoma. Obesity is intuitively considered a risk factor for increased post-hepatectomy morbidity and mortality. Nevertheless, peer-reviewed literature reveals significant heterogeneity between different cohorts contributing to varying conclusions. Outcomes in this cohort for Laparoscopic Liver Resection (LLR), especially in non-academic settings remain under-evaluated. The current study evaluated outcomes of LLR in obese patients, in a community health system. Methods: A retrospective analysis of all patients undergoing LLR at the flagship hospital in the community health system, between 2013 and 2020, was performed. Classified into two groups based on Body Mass Index (BMI): obese (BMI > 30 kg/m<sup>2</sup>) vs non-obese (BMI Results: 90 patients underwent LLR during the 7-year period;obese = 38 and non-obese = 52. No statistically significant differences were noted between obese and non-obese cohorts, in baseline characteristics including age (53.1 ± 15.1 vs 56.8 ± 11.6 years), female gender (60.5% vs 53.8%), and ASA grade (3.13 ± 0.53 vs 3.02 ± 0.54) (all p > 0.05). Univariate analysis showed no statistically significant differences between obese and non-obese groups, comparing estimated blood loss [300 (100 - 500) vs. 200 (100 - 462.5) cc], operative time [177 (125 - 215) vs. 150.9 (111 - 207) minutes], bile leak (2.6% vs. 4.1%), post-operative bleeding (2.6% vs. 4.1%), infection (0% vs. 4.1%), cardiorespiratory complication (10.5% vs 12.2%), conversion rate (5.3% vs 5.8%), length of stay [4 (3 - 5) vs. 4 (2 - 5) days], 90-day reoperation (0% vs. 2%) and 90-day readmission (2.6% vs. 4.1%) (p > 0.05). Multivariate analysis showed no association between obesity and composite complication rate (p = 0.97), after adjusting for alcohol abuse, neoadjuvant therapy, and prior liver surgery. Conclusion: LLR is a key technique that can be replicated in the community setting to improve outcomes in obese patients requiring liver resection. Larger prospective multicenter studies are warranted to externally validate these findings.展开更多
Lupinus is known to form endophytic associations with both nodulating and non-nodulating bacteria. In this study, multilocus sequence analysis (MLSA) was used to analyze phylogenetic relationships among root nodule ba...Lupinus is known to form endophytic associations with both nodulating and non-nodulating bacteria. In this study, multilocus sequence analysis (MLSA) was used to analyze phylogenetic relationships among root nodule bacteria associated with Lupinus and soybean. Out of 17 bacterial strains analyzed, 13 strains isolated from root nodules of Lupinus spp. were obtained from the National Rhizobium Germplasm Resource Collection, USDA. Additionally, two strains of root-nodule bacteria isolated each from native lupinus and domestic soybean were examined. Sequences of the 16S rRNA gene and three house-keeping genes (atpD, dnaK and glnII) were used. All the reference genes were retrieved from the existing complete genome sequences only. The clustering of 12 of the strains was consistent among single and concatenated gene trees, but not USDA strains 3044, 3048, 3504, 3715, and 3060. According to the concatenated phylogeny, we suggest that USDA 3040, 3042, 3044, 3048, 3051, 3060, 3504, 3709 and 3715 are Bradyrhizobium, USDA 3063 and 3717 are Mesorhizobium, USDA 3043 is Burkholderia and USDA 3057a is Microvirga. The two strains isolated from native lupines in this study are Burkholderia and Rhizobium, whereas the two from domestic soybean are Bradyrhizobium. This study emphasizes the robustness of MLSA, the diversity of bacterial species that are capable of nodulating lupine and the substantial capability of Burkholderia spp. to colonize lupine root nodules.展开更多
文摘Introduction: Obesity is associated with an increased risk of fatty liver disease, predisposing to liver fibrosis and cirrhosis, as well as increased occurrence of hepatocellular carcinoma. Obesity is intuitively considered a risk factor for increased post-hepatectomy morbidity and mortality. Nevertheless, peer-reviewed literature reveals significant heterogeneity between different cohorts contributing to varying conclusions. Outcomes in this cohort for Laparoscopic Liver Resection (LLR), especially in non-academic settings remain under-evaluated. The current study evaluated outcomes of LLR in obese patients, in a community health system. Methods: A retrospective analysis of all patients undergoing LLR at the flagship hospital in the community health system, between 2013 and 2020, was performed. Classified into two groups based on Body Mass Index (BMI): obese (BMI > 30 kg/m<sup>2</sup>) vs non-obese (BMI Results: 90 patients underwent LLR during the 7-year period;obese = 38 and non-obese = 52. No statistically significant differences were noted between obese and non-obese cohorts, in baseline characteristics including age (53.1 ± 15.1 vs 56.8 ± 11.6 years), female gender (60.5% vs 53.8%), and ASA grade (3.13 ± 0.53 vs 3.02 ± 0.54) (all p > 0.05). Univariate analysis showed no statistically significant differences between obese and non-obese groups, comparing estimated blood loss [300 (100 - 500) vs. 200 (100 - 462.5) cc], operative time [177 (125 - 215) vs. 150.9 (111 - 207) minutes], bile leak (2.6% vs. 4.1%), post-operative bleeding (2.6% vs. 4.1%), infection (0% vs. 4.1%), cardiorespiratory complication (10.5% vs 12.2%), conversion rate (5.3% vs 5.8%), length of stay [4 (3 - 5) vs. 4 (2 - 5) days], 90-day reoperation (0% vs. 2%) and 90-day readmission (2.6% vs. 4.1%) (p > 0.05). Multivariate analysis showed no association between obesity and composite complication rate (p = 0.97), after adjusting for alcohol abuse, neoadjuvant therapy, and prior liver surgery. Conclusion: LLR is a key technique that can be replicated in the community setting to improve outcomes in obese patients requiring liver resection. Larger prospective multicenter studies are warranted to externally validate these findings.
文摘Lupinus is known to form endophytic associations with both nodulating and non-nodulating bacteria. In this study, multilocus sequence analysis (MLSA) was used to analyze phylogenetic relationships among root nodule bacteria associated with Lupinus and soybean. Out of 17 bacterial strains analyzed, 13 strains isolated from root nodules of Lupinus spp. were obtained from the National Rhizobium Germplasm Resource Collection, USDA. Additionally, two strains of root-nodule bacteria isolated each from native lupinus and domestic soybean were examined. Sequences of the 16S rRNA gene and three house-keeping genes (atpD, dnaK and glnII) were used. All the reference genes were retrieved from the existing complete genome sequences only. The clustering of 12 of the strains was consistent among single and concatenated gene trees, but not USDA strains 3044, 3048, 3504, 3715, and 3060. According to the concatenated phylogeny, we suggest that USDA 3040, 3042, 3044, 3048, 3051, 3060, 3504, 3709 and 3715 are Bradyrhizobium, USDA 3063 and 3717 are Mesorhizobium, USDA 3043 is Burkholderia and USDA 3057a is Microvirga. The two strains isolated from native lupines in this study are Burkholderia and Rhizobium, whereas the two from domestic soybean are Bradyrhizobium. This study emphasizes the robustness of MLSA, the diversity of bacterial species that are capable of nodulating lupine and the substantial capability of Burkholderia spp. to colonize lupine root nodules.
