Background: Liver resection being the only potentially curative treatment for patients with liver metastasis, it is critical to select the appropriate preoperative imaging modality. The aim of this study was to assess the impact of preoperative gadoxetic acid-enhanced MRI compared to a conventional extracellular gadolinium-enhanced MRI on the surgical management of colorectal and neuroendocrine liver metastasis.Methods: We included 110 patients who underwent both a gadoxetic acid-enhanced MRI (hepatospecific contrast) and conventional extracellular gadolinium for the evaluation of colorectal or neuroendocrine liver metastases, from January 2012 to December 2015 at the CHU de Québec -Université Laval. When the number of lesions differed, a hepatobiliary surgeon evaluated if the gadoxetic acidenhanced MRI modified the surgical management.Results: Gadoxetic acid-enhanced MRI found new lesions in 25 patients (22.7%), excluded lesions in 18 patients (16.4%) and identified the same number in 67 patients (60.9%). The addition of the gadoxetic acid-enhanced MRI directly altered the surgical management in 19 patients overall (17.3% (95% CI [10.73-25.65])). Conclusion:Despite the additional cost associated with gadoxetic acid-enhanced MRI compared to conventional extracellular gadolinium-enhanced MRI, the use of this contrast agent has a significant impact on the surgical management of patients with liver metastases.

At least 28 plasmid-mediated j-lactamases have been described in gram-negative bacteria. To assess the relationship among these enzymes, we produced and characterized 28 murine monoclonal antibodies to the TEM-1 plasmid-mediated ,i-lactamase. Radial immunodiffusion identified 3 monoclonal antibodies as immunoglobulin M (IgM), 18 as subclass IgGl, 2 as IgG2a, and 5 as IgG2b. Using a newly described enzyme immunoassay, cross-reactivity of 16 of these monoclonal antibodies was tested against 24 plasmid-determined ,-lactamases. The 16 monoclonal antibodies cross-reacted with TEM-2 and TLE-1 and, to a certain extent, SHV-1. Different levels of cross-reactivity were also observed with OXA-3 (11 of 16), OXA-7 (8 of 16), OXA-1 (2 of 16), OXA-6 (2 of 16), and AER-1 (2 of 16). Six monoclonal antibodies demonstrated partial neutralization of I8-lactamase activity. This study suggests that common epitopes are shared by nine biochemically distinct plasmid-mediated I-lactamases. On the basis of cross-reactivities with these monoclonal antibodies, we identified four epitopes on TEM-1, TEM-2, TLE-1, and SHV-1 P-lactamases.Four mechanisms of bacterial resistance to ,-lactam antibiotics have been described in gram-negative bacteria (13): (i) modification of cell-wall permeability (46), (ii) modification of penicillin-binding proteins (54), (iii) tolerance to the antibiotic (58), and (iv) enzymatic modification of the drug (34). Among these, the most frequent mechanism is the production of P-lactamases (EC 3.5.2.6) which hydrolyze the antibiotic, rendering it inactive (34). These enzymes are produced by almost all bacterial species and differ from each other in their enzymological and physicochemical properties. Although three classifications have been proposed (1, 42, 56), we tend to refer to ,B-lactamases as plasmid-mediated or chromosomal enzymes. At least 28 plasmid-mediated ,-lactamases are known (5,15,19,24,26,30,31,36,38,45,53), including the newly described BRO-1 (11), NPS-1 (25), OHIO-1 (51), and SAR-1 (39). Of all these enzymes, the most widely distributed is the TEM-1 P-lactamase (26,44,52).Three techniques are available to identify plasmidmediated P-lactamases precisely: analytical isoelectric focusing (27), DNA hybridization (23), and immunological assays (40,41). Several studies have reported immunological comparisons between plasmid-mediated P-lactamases using polyclonal antisera directed against TEM

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Background We sought to determine if lumpectomy patients who received perioperative opioid-sparing multimodal analgesia reported less pain when compared with those who received traditional opioid-based care. Study Design A prospective cohort of patients undergoing lumpectomy who received an opioid-sparing multimodal analgesia protocol [no opioids group (NOP)] was compared with a large cohort of patients who received traditional care [opioids group (OG)]. In-hospital and discharge opioids were compared using oral morphine equivalents (OMEs). Postoperative day one and week one pain scores were compared using the Kruskal–Wallis test. Results Overall, 1153 patients underwent lumpectomy: 634 patients received the protocol (NOP), and 519 patients did not (OG). Median pain scores were significantly lower in the NOP cohort when compared with the OG cohort the day after surgery (2 vs. 0, p < 0.001) and the week after surgery (1 vs. 0, p < 0.001). NOP patients were significantly less likely to report severe pain (7–10 on a 10-point scale) the day after surgery compared with OG patients (15.7% vs. 6.9%, p = 0.004). Patients in the NOP cohort were discharged with a median of zero OMEs (range 0–150), while patients in the OG were discharged with a median of 90 OMEs (range 0–360; p < 0.001). Conclusion Implementation of an opioid-sparing multimodal analgesia protocol for lumpectomy patients resulted in superior pain control without a routine opioid prescription. Surgeons can improve their own patients’ outcomes while addressing the larger societal issue of the opioid crisis by adopting similar protocols that decrease the quantity of opioids available for diversion.