INTRODUCTION:Previously, in a murine model of blunt thoracic trauma, we provided evidence of primary pulmonary thrombosis associated with increased expression of the cell adhesion molecule, P-selectin. In this study, mice are treated with P-selectin blocking antibody after injury to investigate the clinical viability of this antibody for the prevention of pulmonary thrombosis. In addition, viscoelastic testing is performed to investigate if P-selectin inhibition has a detrimental impact on normal hemostasis. METHODS:A murine model of thoracic trauma was used. Mice were divided into sham control and experimental injury groups. Thirty minutes after trauma, mice were treated with the following: P-selectin blocking antibody, isotype control antibody, low-dose heparin, high-dose heparin, or normal saline. At 90 minutes, whole blood was collected for characterization of coagulation by viscoelastic coagulation monitor (VCM Vet; Entegrion, Durham, NC). Mean clotting time, clot formation time, clot kinetics (α angle), and maximum clot firmness were compared between each treatment group. RESULTS:Mice that received P-selectin antibody 30 minutes after blunt thoracic trauma had four-to fivefold less (p < 0.001) arterial fibrin accumulation than those that received the isotype control. In both sham and trauma groups, compared with vehicle (normal saline) alone, no statistical difference was noted in any coagulation parameters after injection with P-selectin antibody, isotype control, or low-dose heparin. In addition, blinded histopathological evaluation yielded no difference in hemorrhage scores between injured mice treated with P-selectin blocking antibody and those treated with isotype antibody control. CONCLUSION:This study supports the clinical use of P-selectin blocking antibody for the prevention of pulmonary thrombosis by confirming its efficacy when given after a blunt thoracic trauma. In addition, we demonstrated that the administration of P-selectin antibody does not adversely affect systemic coagulation as measured by viscoelastic testing, suggesting that P-selectin antibody can be safely given during the acute posttraumatic period.

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resection using ESD knives and post-resection closure with OTSC(Group 1), the other was closure with OTSC and secondary EFTR with snare(Group 2). Results Of 11 patients, 6 cases were in Group 1 and 5 cases in Group 2. The mean time of EFTR procedure was 76.83 ± 34.97 minutes in Group 1 which is significantly longer than that of Group 2 (P=0.0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rate of Group 1 and Group 2 were 83.3% and 100%(P=0.338).VAS scores of Group 1 after operation and 24 hours are significantly higher than those of Group 2(P=0.047 and P=0.009, respectively). In Group 1, One patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain.No complications associated with endoscopic procedure was observed in Group 2. Conclusions EFTR of pre-resection closure is potentially faster and safer compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.

Invasive mucormycosis is an opportunistic fungal infection that commonly involves the rhinocerebral and pulmonary system. We are presenting a rare case of small intestine invasive mucormycosis causing multiple perforations and gangrene in the small intestine. Mucormycosis infection occurred after traumatic perforation peritonitis. Mucormycosis usually occurs in the presence of predisposing conditions like uncontrolled diabetes mellitus, neutropenia, underlying malignancy, or those receiving immunosuppressive agents. Gastrointestinal mucormycosis is uncommon and seldom diagnosed in living patients. In these cases, diagnosis is delayed and the mortality rate is high.

minimally invasive (laparoscopic and robotassisted) resection with regional lymphadenectomy D2 were performed. Mann-Whitney U-test was used for statistical analysis. Result: Three patients were treated for benign strictures (PHCC was not confirmed on pathology). Further, only patients with PHCC were included analyzed. Demographic and perioperative data: female/male ratio 51/ 46; mean age 60 (35-80) year; ASA 4 (2-5); acute cholangitis after biliary drainage 56 (58%); portal vein embolization 22 (23%); vascular reconstruction 32 (33%); blood loss 505 (50-2500) mL; operation time 567 (290-985) min. PHLF took place in 19 (20%) of patients, including 11 and 8 cases of grade B and C (ISGLS), respectively. The whole mortality was 16 (16%); mortality in PHLF group was 5 (31%). Severe morbidity (>II Clavien-Dindo) was registered in 77 (79%) patients. R0 resection rate was 85%; hospital stay 24 (3-73) day. Portal vein embolization (PVE) was performed in 24 patients (25%). The influence of 22 factors on the risk of PHLF was analyzed. PHLF significantly dependent on blood loss (p=0,033), blood transfusion (p=0,017), resection of >3 liver segments (p=0,045). PHLF did not significantly increase the hospital stay. Conclusion:The high risk of PHLF should be considered after major liver resection and large blood loss. PVE in case of small future liver remnant and effective treatment of preoperative cholangitis are necessary to reduce the risk of PHLF.