The RCD technique is a safe and viable option for the surgical resection of CBTs. In our experience, this approach was associated with a significant decrease in procedural time and hospital stay.

Palliative care of malignant gastric outlet obstruction symptoms is critical for improved quality of life. We reviewed 66 consecutive patients with malignant gastric outlet obstruction who underwent palliative gastrointestinal bypass. The objective was to analyze morbidity and mortality-associated factors of this surgical procedure. Surgical morbidity and mortality were 39 per cent and 31 per cent, respectively. Reintervention was necessary in 16.6 per cent of cases. The only variable associated with surgical mortality was a Karnofsky score less than 80 (P = 0.02). Median survival of patients was 4 months (range, 2.11–5.9 months). Variables associated with shorter survival rates were an advanced stage of the disease and a Karnofsky score less than 80. Nine of 45 (20%) patients who survived after the gastrointestinal bypass surgery were unable to tolerate a normal diet. Palliative gastrojejunostomy in patients with malignant gastric outlet obstruction is associated with high morbidity and mortality; it is necessary to improve nonsurgical options such as endoscopic stenting.

Introduction: Melatonin the main product secreted by the pineal gland has been shown to increase neurite formation in N1E-115 cells through microtubule enlargement elicited by calmodulin antagonism and vimentin intermediate filament reorganization caused by protein kinase C (PKC) stimulation. Besides microtubule and intermediate filament reorganization, neurite formation involves microfilament rearrangements in microspikes, lamellipodia and filopodia to form growth cones in the neurite growing tips. In this work, we studied the effect of melatonin on growth cone formation and the possible participation of Rho associated kinase (ROCK) a downstream kinase in the PKC signaling pathway.Methods: N1E-115 cells were incubated for 6 h with either the vehicle, 1 nM melatonin, 2 nM of the PKC activator phorbol-12-myristate-13acetate (PMA), or with melatonin or PMA in the presence of the PKC Inhibitor, bisindolylmaleimide (5 M), the Rho inhibitor C3 (100 ng/ml) or the ROCK inhibitor, Y27632 (10 M) and melatonin or PMA. Microfilaments organized in growth cones were stained with rhodamine-phalloidin and observed by fluorescence microscopy. ROCK activity was determined in cells cultured and in whole cell extracts with the mentioned compounds by using the ROCK substrate long S6 peptide.Results: The results showed that melatonin caused an increase in the number of cells with growth cones. Similar results were obtained with the PKC activator PMA. While, the PKC inhibitor bisindolylmaleimide, Rho inhibitor C3, or the ROCK inhibitorY27632, abolished the microfilament reorganizations elicited by either melatonin or PMA. Both ROCK and PKC activity measured in whole cell extracts and in N1E-115 cells were increased in the presence of melatonin and PMA.Discussion: The results indicate that ROCK activity is stimulated by melatonin downstream the PKC pathway in N1E-115 cells and in whole cell extracts. Also, data suggest that melatonin induces activation of PKC which in turn activates RHO/ROCK pathway increasing growth cone formation that precludes neurite enlargement elicited by melatonin. Acknowledgement

ClinicalTrials.gov NCT02264509.

vein compression is related with DVT. On the other hand, it may prevent the thrombus from migrating into the pulmonary circulation. The aim of this study was to evaluate the anatomic and clinical risk factors of PE in patients with DVT of the lower extremity (LE).Methods: In the setting of a referral hospital, the patients with DVT underwent duplex ultrasound (DUS) and/or computed tomography (CT) of the LE. PE was evaluated with chest CT. The patients were classified as group 1 (DVT without PE) and group 2 (DVT with PE). We analyzed the anatomic and clinical risk factors associated with PE in patients with DVT. As the anatomic factor, the shortest length between the common iliac artery (CIA) and spinal body (SB) was measured. In statistical analysis, we used independent t-test and multivariable logistic regression model.Results: We examined 114 patients (41.7% men, age 62.76 16.9 years) with DVT with/without PE. The prevalence of concurrent DVT/PE was 52.6%. Neither the risk factors nor blood tests differed significantly between two groups. Of all the assessed patient characteristics (age and sex, body mass index, diabetes, hypertension, history of varicose vein, previous DVT, history of surgery, infection, pneumonia, coronary artery disease, chronic renal failure, and paralysis), the only one factor, infection, was significantly and independently associated with PE (P ¼ .04). The lengths between CIA and SB were 6.7 6 3.5 mm in group 1 and 11.3 6 3.7 mm in group 2, respectively (P < .0001). With receiver operating characteristic curve analysis, 7.6 mm was the cutoff value for the risk of PE in patients with LE DVT.Conclusions: Infection was significantly and independently associated with concurrent DVT/PE. The shorter length between CIA and SB (<7.6 mm) may prevent the PE in patients with DVT. Our results should be further investigated in a larger prospective study.