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Three copies of the beta subunit must be modified to achieve complete inactivation of the bovine mitochondrial F1-ATPase by 5'-p-fluorosulfonylbenzoyladenosine.

The modification of both beta-Tyr-368 and beta-His-427 can be correlated with the loss of activity observed when the bovine mitochondrial F1-ATPase is inactivated with 5'-p-fluorosulfonylbenzoyl[3H]adenosine ([3H]FSBA). At pH 8.0, where the rate of inactivation is fast, beta-Tyr-368 is modified predominantly, while at pH 6.0, where the rate of inactivation is slow, beta-His-427 is modified predominantly. At pH 7.0, the 2 residues are modified with about equal efficiency. When the F1-ATPase was inactivated by 80% at pH 6.5, 7.0, and 7.5, the sum of radioactivity incorporated into beta-Tyr-368 and beta-His-427 was 1.99, 1.87, and 1.82 mol of label incorporated per mol of enzyme, respectively. Examination of the rate of inactivation of the enzyme by FSBA as a function of pH revealed two pKa values, one of about 7.6 associated with the modification of beta-Tyr-368 and the other of about 5.8 associated with the modification of beta-His-427. The inactivation of the F1-ATPase by FSBA exhibited an initial fast rate followed by a slower rate in triethanolamine-HCl, pH 7.0. In contrast, only a single rate, equivalent to the fast phase of inactivation in the absence of phosphate, was observed in 0.2 M phosphate, pH 7.0. The dependence of this stimulation on phosphate concentration is sigmoidal with half-maximal stimulation occurring at approximately 160 mM. The ratio of 3H incorporated into beta-Tyr-368 to that incorporated into beta-His-427 was approximately the same during the fast and slow phases of inactivation in triethanolamine-HCl, pH 7.0. Approximately the same ratio was observed when the enzyme was modified during the single phase of inactivation exhibited in the presence of 0.2 M phosphate, pH 7.0. The sum of the 3H incorporated into beta-Tyr-368 and beta-His-427 during inactivation of the F1-ATPase from bovine heart mitochondria by [3H]FSBA in the presence and absence of phosphate was linear and extrapolated to a value of about 2.6 residues modified on complete inactivation of the enzyme. From these data, it is concluded that FSBA binds to a single binding site on the beta subunits of the enzyme where it reacts with either beta-Tyr-368 or beta-His-427 in mutually exclusive reactions. All three beta subunits must be modified in this manner for complete inactivation to be observed.

Adenosine↗

Cell-mediated lympholysis (CML) to allogeneic and trinitrophenyl (TNP)-modified cells: re-evaluation of the role of the thymus in CML.

The role of the thymus in cell-mediated lympholysis (CML) to allogeneic and trinitrophenyl (TNP)-modified cells was re-evaluated using adult thymectomized (ATx) and neonatal thymectomized (NTx) mice. CML to TNP-modified cells was used as the model of the major histocompatibility complex (MHC)-restricted CML. CML to TNP-modified cells, but not to allogeneic cells was reduced at late stages after ATx and remained low even in NTx-11 (thymectomy at 11 days of age) mice. Interleukin-2 (IL-2) producing activity in such mice was lower than that in the normal controls, while allogeneic CML was maintained at the same level as seen in the controls. The addition of exogenous IL-2 to in vitro culture led to a restoration of the generation of CML to TNP-modified cells, in neonatal thymectomized mice. These results suggested that thymus-dependency differs in the 2 forms of CML and that the CML to TNP-modified cells showed a higher thymus-dependency than did the allogeneic CML. Moreover, the activity of helper T cells may exert a direct influence on CML to TNP-modified cells, as compared to allogeneic cells.

Animals↗

Response of three enzymes to oleic acid, trypsin, and calmodulin chemically modified with a reactive phenothiazine.

Calmodulin was covalently modified with 10-(1-propionyloxysuccinimide)-2-trifluoromethylphenothiazine++ + to stoichiometries between 0 and 2 mol/mol in the presence of Ca2+. The modified calmodulins, oleic acid, and trypsin were assayed for their ability to activate pea plant NAD kinase, bovine brain 3',5'-cAMP phosphodiesterase, and human erythrocyte Ca2+-ATPase. All modified calmodulins activated both phosphodiesterase and Ca2+-ATPase; at the highest concentration assayed, calmodulin modified with 2 mol of reagent/mol activated phosphodiesterase and Ca2+-ATPase to 53% and 100%, respectively, of the activation obtained with unmodified calmodulin. However, higher concentrations of the modified calmodulins were required to observe the same activation; at least 900-fold and 100-fold higher concentrations were required for the two enzymes, respectively. NAD kinase was not activated by any calmodulin labeled to a stoichiometry greater than 1 mol/mol even when a concentration equal to 17,000 times the apparent dissociation constant of calmodulin for NAD kinase was assayed. Therefore, the modified protein (and not some fraction resistant to labeling) is active toward the mammalian enzymes but inactive toward plant NAD kinase. The different response of the three enzymes to the chemical modification suggests that the enzymes may utilize different binding domains on calmodulin. NAD kinase also was not activated by other known activators of the two mammalian enzymes, namely lipids and limited proteolysis. In parallel experiments using the same agents on each enzyme, NAD kinase was the only enzyme of the three that was not activated by oleic acid and several other lipids or by limited trypsin digestion. These results show that NAD kinase possesses several attributes which would not be predicted by current models of the mechanism of activation of enzymes by calmodulin.

3',5'-Cyclic-AMP Phosphodiesterases↗

[A study of functional recovery of urination and defecation by modified sero-muscular ileal flap fixation to the bladder in patients with neurogenic bladder].

Between 1978 and 1985, 72 patients with urinary and defecatory dysfunction due to neurogenic bladder associated with myelodysplasia (57), spinal cord injury (11), and other causes (4) were treated with modified sero-muscular ileal flap fixation to the bladder (modified IFFB). They were followed from 1 to 88 months (mean: 36.3 months). This operative procedure was attempted to recover urinary and defecatory function. Sixty-four patients underwent urodynamic studies before and after the modified IFFB. On urodynamic evaluation, bladder capacity was not decreased, voiding time was diminished, and average urine flow rate was significantly improved after the modified IFFB. Patients who were followed at least 6 months after the modified IFFB showed the following results. Urinary substitute sensation appeared in 57 out of 59 patients (96.6%) and fecal substitute sensation in 34 (57.6%). Urinary incontinence improved in 38 out of 42 patients (90.5%), disappearing completely in 19 (45.2%). Constipation improved in 26 of 59 patients (44.1%). The upper urinary tract improved in 22 renal units, remained unchanged in 90 renal units, and deteriorated in 6 of the 118 renal units. Operative complications were encountered in 6 out of 72 patients (8.3%). The modified IFFB procedure does not appear to be suitable for the low compliance bladders with high grade VUR or for young women who desire pregnancy in the future.

Adult↗

The use of a clonal assay for cytotoxic T lymphocytes to determine the Ly phenotypes of the cytotoxic precursor and effector cells to alloantigens and trinitrophenyl-modified self antigens.

Considerable controversy has arisen regarding the Ly phenotypes of cytotoxic T lymphocytes (CTL) and their precursors (CLP) to alloantigens and modified-self antigens. Although there is general agreement that all CTL and their pregenitors express the Ly2 alloantigen, the presence of the LY1 alloantigen on either CTL or CLP is debated. Clonal assays for CLP, capable of detecting single CLP in the absence of accessory cells, have recently been developed. This assay system provides a sensitive means of determining the Ly phenotypes of CLP to alloantigens or trinitrophenyl- (TNP) modified self antigens. Lymph node cells from C57BL/6 (Ly-1.2, 2.2, 3.2) or CBA (Ly-1.1, 2.1, 3.2) mice were treated with anti-Ly serum and complement (C), and the frequencies of CLP of the treated populations to alloantigens or TNP-modified self antigens were determined. We found that the number of CLP reactive to alloantigens or TNP-modified self antigens were greatly reduced after treatment with either anti-Ly-1 or anti-Ly-2 serum and C in both C57BL/6 and CBA mice. In other words, the CLP to alloantigens or TNP-modified self antigens in these 2 strains of mice are Ly 1+2+. We also found that the CTL derived from the Ly1+2+ CLP were also Ly1+2+. The significance of this finding with respect to the cytotoxic repertoire for alloantigens and modified self antigens is discussed.

Animals↗

[Antiviral activity of modified RNAses].

Antiviral activity of pancreatic RNase and RNase from Act.rimosus modified by various dextran derivatives was studied with respect to aphthosa and Ayzeku disease viruses. Antiviral activity of pancreatic RNase modified by dextran m-aminobenzylhydroxymethyl ether was lower than biological activity of RNase from Act.rimosus modified by the same dextran. Antiviral activity of pancreatic enzyme modified by dialdehyde dextran also changed insignificantly. Modification by dextran hydroxyethylsulfonylanisole ether, dextran m-aminobenzylhydroxymethyl ether in the presence of pyridine or dextran sulfate resulted in a more pronounced increase in antiviral activity of pancreatic enzyme. Therefore, biological activity of the modified nucleases depended on the nature of the enzyme and dextran modifying it.

Animals↗

Comparison of standard and modified enzyme immunoassay of phenytoin.

A modified method for the enzyme immunoassay (EMIT, Syva Company) of phenytoin is presented and compared with the standard method. Serum samples from 14 patients were analyzed for phenytoin content using both methods. All assays were performed by the same individual. Within-day and between-day variations of the modified method were determined. A carry-over study was done to determine if a sample with a high phenytoin concentration might contaminate subsequent samples with lower concentrations or whether samples with low concentrations could dilute subsequent samples with higher concentrations. Within-day and between-day variations of the modified method were 7.5% and 9.9%, respectively. These values are less than the 10% coefficient of variation limit claimed by the manufacturer of the standard method. The carry-over study revealed no significant carry-over with the modified method. An excellent correlation was observed between the values obtained from the two methods. The modified method can reduce assay costs by up to 40%. The modified method was found to provide accuracy and precision equivalent to the standard EMIT method at a substantial cost savings.

Costs and Cost Analysis↗

Immunological and pharmacological characterization of poly-DL-alanyl-modified Erwinia carotovora L-asparaginase.

The covalent attachment of poly-DL-alanine peptides to lysyl residues on the surface of Erwinia carotovora L-asparaginase has produced a modified enzyme which is much less immunogenic in mice and demonstrates 100-fold longer plasma half-life in the rhesus monkey. Immunogenic responses towards both the immunoglobulin G (IgG) and immunoglobulin E (IgE) antibody subclasses were evaluated in C57BL x DBA/2 F1 mice exposed to 250 rads of whole-body irradiation 4 hr prior to immunization with 5-diazo-4-oxynorvaline-inactivated native and modified L-asparaginase in complete Freund's adjuvant. Under these immunologically stressful conditions, the native enzyme evoked an IgE and IgG response which could be further amplified by a secondary immunization, whereas the modified enzyme evoked no IgE or IgG response even after a tertiary immunization. In experiments mimicking an intensive therapeutic schedule, whereby two groups of mice were given weekly injections of 5 to 10 units of either native or modified asparaginase for up to 14 weeks, neither enzyme form evoked a significant IgE response, and only the mice given injections of the native enzyme produced an IgG response. In a preliminary patient study, skin testing of a child who had shown an allergic reaction to the native enzyme resulted in a negative response after an intradermal injection of the modified enzyme, whereas a wheal and flare reaction was observed to both the native enzyme and a histamine control. All of these results suggest that the modified enzyme should show a definite reduction in immunological reactions associated with L-asparaginase treatment of childhood leukemia.

Allergens↗

[Tetracycline penetration into tissue by modified electro- and phonophoretic methods].

A total of 451 experiments (130 with the method of electrophoresis and 321 with the method of phonophoresis) were performed on healthy rabbits of the same species, age, weight and sex with the use of the galvanization apparatus "Potok-1" and ultrasound therapeutic apparatus "VTP-1". The penetration levels of tetracycline into the tissues after its administration with the modified methods of electro- and phonophoresis were determined. The dependence of the process on the current density, ultrasound intensity, time and antibiotic concentration was studied. The efficacy of the routine electro- and phonophoresis methods was compared with that of the modified ones. It was found that the tissue levels of tetracycline administered with the modified methods of electro- and phonophoresis increased with an increase in the current density or ultrasound intensity, the procedure time and antibiotic concentration. When tetracycline was administered with the modified method of electrophoresis its levels were highest in the skin, lower in the muscles and minimum in the bones. With the use of the modified method of phonophoresis the highest levels were in the skin, the lowest in the bones and the minimum in the muscles. The tissue levels of tetracycline administered with the modified methods of electro- and phonophoresis were higher than those obtained with the routine methods of electro- and phonophoresis.

Animals↗

Antibodies from alcoholics, ethanol-fed rats and a rabbit immunised with proteins modified by acetaldehyde in vitro react with liver cytosolic proteins from ethanol-fed rats.

In previous studies we have shown that ethanol-fed rats generate antibodies reactive with proteins modified by acetaldehyde in vitro and that their livers contain proteins modified by acetaldehyde. In this study we demonstrate that the antibodies from these animals react with the modified proteins found in their livers. Furthermore, when the antibodies reactive with specific proteins were isolated, they were found to react with all of the modified proteins detected by the whole serum. This suggests that all of the proteins modified by acetaldehyde in vivo carry the same or similar epitope(s). In addition, antibodies from alcoholics and a rabbit immunised with proteins modified by acetaldehyde in vitro also reacted with the liver cytosolic proteins from ethanol-fed rats. Therefore it appears that similar epitopes are generated in alcoholics as a result of ethanol misuse, in rat liver due to prolonged ethanol feeding and by the in vitro modification procedure used to produce the immunogen for the rabbit.

Acetaldehyde↗

Novel pharmacological properties of transient potassium currents in central neurons revealed by N-bromoacetamide and other chemical modifiers.

The chemical modifiers N-bromoacetamide (NBA), N-bromosuccinimide (NBS), and chloramine-T (ChT) are commonly used to remove fast inactivation of sodium currents and transient potassium currents (IA). In the present study, I examined the effects of these chemical modifiers as well as of others on IA in neurons dissociated from several brain regions. External application of NBA irreversibly inhibited IA, with higher NBA concentrations increasing the rate of inhibition. The current kinetics, however, were not altered by external NBA at any concentration. IA was also inhibited by internal NBA but only at high concentrations, and the rate of inhibition was much slower. The current kinetics were not altered by internal NBA at any concentration. NBA is a nonspecific chemical reagent that can modify a protein at several target amino acids. The NBA-induced irreversible inhibition of IA was reproduced by external diethylpyrocarbonate, a reagent that specifically modifies histidine residues, and by ChT and cyanogen bromide, reagents that modify methionine residues through distinct mechanisms. However, NBS, a reagent that cleaves the peptide bond at tryptophan residues, had no effect on IA, nor did chemical modifiers specific for cysteine and tyrosine residues. Taken together, these results suggest that the conserved, functionally important methionine and/or histidine residues are the likely targets for NBA modifications. These novel pharmacological properties are in sharp contrast to those known previously, despite their similarity in both kinetics and 4-AP sensitivities. Therefore, the pharmacological treatments presented in the present study should be useful for characterizing other IA.

Acetamides↗

[Modified surgical technique for the reduction of bone marrow spilling in knee endoprosthesis].

In the literature 20 cases of fat embolism syndrome (FES) after total knee replacement (TKR) are reported; 16 cases had cemented hinged TKR and 4 resurfacing TKR. Initially, it was believed that the bone cement was responsible for the FES. Since then, however, Fahmy et al. have published extraordinary data, demonstrating the causal relationship between increased intramedullary pressure (IMP) during the insertion of the intramedullary rod (IR) and cardiorespiratory deterioration. The industry responded by developing a fluted IR, disregarding the overdrilling in the distal femur required by Fahmy. In the first part of this paper clinically manifest FES cases after resurfacing TKR are reported. In the second part of the study the conventional surgical technique is compared with a modified technique, which focuses on a reduction of bone-marrow release into the circulation. In the conventional and the modified group, IRs with and without flutes were compared. It was shown that only the opening of the intramedullary canal and insertion of the IR generated relevant IMP peaks during implantation of resurfacing TKR. When compared with the conventional surgical technique, the modified technique revealed significantly lower IMPs, and in neither group was a difference demonstrated between the IR with or without flutes. In 4 patients (2 conventional, 2 modified) transesophageal echocardiography (TEE) was performed for detection of bone-marrow release into the circulation. In the two patients operated on conventionally, TEE showed a markedly higher bone-marrow release than in the patients with modified operations. In conclusion, we recommend the presented modified surgical technique in order to reduce bone-marrow release into the circulation.

Aged↗

Characterization of modified and normal deoxyoligonucleotides by MALDI, time-of-flight mass spectrometry.

A commercially available, matrix-assisted, laser desorption/ionization (MALDI), time-of-flight mass spectrometer has been used for the successful characterization of picomole quantities of modified deoxyoligonucleotides. The procedure was found to be applicable to the analysis of a variety of modified synthetic structures that included oligos with an intact dimethoxytrityl-blocking group, with omega-aminohexyl- and omega-hexyl-modified bases and with alterations to the normal phosphate backbone: 2'-5' and phosphorothioate linkages. Use of an alpha-cyano-4-hydroxycinnamic acid/ammonium formate based matrix gave sharp peaks, sensitivity to 1 pmol, accuracy to 0.06% on average and avoided the necessity for cryogenic technique and/or specialized equipment. Mixtures of normal and modified oligonucleotides worked well without any special precautions as long as the modified oligonucleotides contained a polyanionic backbone. Modified oligonucleotides that contained an amide linkage in place of the usual phosphate ester link required a sinapinic acid- or esculetin-based matrix with no ammonium formate. Crude oligonucleotides could be rapidly analyzed as a quality-control measure using from 10 to 20 pmol of a typical 0.2-mumol scale synthesis.

Base Sequence↗

The value of a negative antepartum test: contraction stress test and modified biophysical profile.

OBJECTIVE: To examine the outcome of pregnancies in high-risk patients whose last antepartum fetal assessment was a negative contraction stress test (CST) or a negative modified biophysical profile. METHODS: Twenty-nine hundred ninety-four women who received modified biophysical profiles were compared with 2450 who had CSTs during the preceding 3 years. Pregnancy outcomes were evaluated in patients whose last test was negative. RESULTS: Seventeen hundred fifty-three patients had negative modified biophysical profiles as the last test before delivery, and 1337 had negative CSTs as the last test before delivery. Adverse perinatal outcomes included perinatal death or death before nursery discharge, cesarean delivery for fetal distress within the first 2 hours of labor, 5-minute Apgar score less than 7, neonatal seizures, or grade III or grade IV central nervous system hemorrhage. Adverse outcomes occurred in 90 patients (5.1%) whose last test before delivery was a negative modified biophysical profile and in 93 patients (7.0%) whose last test was a negative CST (P = .04, odds ratio 1.38, 95% confidence interval 1.01-1.88). Overall, there were 11 perinatal deaths, nine of which resulted from lethal congenital abnormalities. CONCLUSIONS: In this population, the frequency of adverse perinatal outcome following a negative modified biophysical profile was no greater than that following a negative CST. Further, the incidence of potentially preventable perinatal death following a negative modified biophysical profile or CST was less than one per 1000 tested high-risk pregnancies.

Adult↗

Biochemical characterization of P22 phage-modified Escherichia coli RecBCD enzyme.

The biochemical properties of phage P22 Abc-modified RecBCD enzyme from Escherichia coli have been examined. RecBCD purified from a cell that expresses Abc (anti-RecBCD) contains all three RecBCD subunits and the 11.6-kDa Abc protein in equal stoichiometric amounts. Abc depresses the rate of RecBCD double-stranded DNA exonuclease, helicase, and ATPase activities about 3-4-fold, yet it has no effect on the rate of the single-stranded DNA exonuclease activity. Abc induces a slight increase in the ATP-independent single-stranded DNA endonuclease activity and does not induce dimerization of the RecBCD trimer. Abc-modified RecBCD helicase activity possesses reduced but significant processivity (10 kilobase pairs) relative to the native enzyme (30 kilobase pairs). In the absence of ATP, Abc-modified RecBCD shows a 2-4-fold higher affinity for double-stranded DNA ends. The RecBCD-binding Gam protein from bacteriophage lambda inhibits binding of both native and Abc-modified RecBCD to double-stranded DNA ends. Finally, unlike the native enzyme, the nonspecific nuclease activity of Abc-modified RecBCD is not suppressed by Chi sites in vitro. These findings are discussed in terms of the recombination-deficient phenotype of cells expressing Abc in vivo and the relationship between Abc-modified RecBCD and two mutant RecBCD's previously characterized: the RecBCD-K117Q and RecB2109CD mutant enzymes.

Bacteriophage P22↗

Distribution and turnover of acetaldehyde-modified proteins in liver and blood of ethanol-fed rats.

Previous studies have shown that acetaldehyde (AcH)-modified proteins are formed in the liver and blood of rats fed ethanol-containing diets. In this study we report the application of ELISA techniques to study the subcellular distribution and turnover of AcH-modified proteins in ethanol-fed and control rats. Modified proteins were found in liver mitochondrial, crude membrane and cytosolic fractions, as well as in plasma from ethanol-fed rats. No adducts were detected by our assay in haemolysates from the same animals. The rate of decline of AcH-modified proteins after cessation of ethanol feeding was also examined. Modified liver cytosolic proteins were shown to decline with a half-life of 2.3 weeks, whereas modified plasma adducts declined with a half-life of 4.8 weeks.

Acetaldehyde↗

Perinatal outcome with the modified biophysical profile.

OBJECTIVE: Our purpose was to evaluate perinatal outcomes in high-risk pregnancies monitored with a modified biophysical profile. STUDY DESIGN: All non-insulin-dependent patients referred for antepartum fetal surveillance received a modified biophysical profile biweekly. A modified biophysical profile is a combination of a nonstress test and an amniotic fluid index. Patients with a singleton gestation and intact membranes were entered into a protocol of randomized backup testing for an abnormal modified biophysical profile. Those patients having a nonreactive fetal heart rate, significant variable decelerations, late decelerations, or an amniotic fluid index < or = 5.0 cm received either a contraction stress test or a biophysical profile immediately. Once randomized, a patient received the same backup test, when indicated, with subsequent testing. RESULTS: A total of 2774 patients had 17,429 tests with an uncorrected perinatal mortality rate of 2.9 per 1000. The overall incidence of an adverse perinatal outcome (i.e., perinatal death or nursery death before infant hospital discharge, cesarean delivery for fetal distress within the first 2 hours of labor, 5-minute Apgar score < 7, neonatal seizures or grade III or IV central nervous system hemorrhage) was 7.0%. When compared with patients having persistently normal modified biophysical profile, patients requiring a backup test had a significantly greater incidence of adverse perinatal outcome (9.3% vs 4.9%, p < 0.001, odds ratio 2.0, 95% confidence interval 1.5 to 2.7) and small-for-gestational-age infants (5.2% vs 2.4%, p < 0.001, odds ratio 2.2, 95% confidence interval 1.5 to 3.5). No differences in outcomes between patients randomized to a contraction stress test versus a biophysical profile could be identified either overall or in limiting the analysis to outcome after a negative last test. However, patients having contraction stress test as a backup test had a significantly higher rate of intervention for an abnormal test result than did those having a biophysical profile backup test (23.7% vs 16.6%, p < 0.002, odds ratio 1.6, 95% confidence interval 1.2 to 2.1). CONCLUSION: The modified biophysical profile is an excellent means of fetal surveillance and identifies a group of patients at increased risk for adverse perinatal outcome and small-for-gestational-age infants. There does not appear to be a significant benefit with the contraction stress test compared with the biophysical profile as a backup test. Further, the contraction stress test is associated with a higher rate of intervention for an abnormal test than is the biophysical profile.

Adult↗

[The effectiveness of preservation of hepatic arterial blood flow by modified Appleby procedure with reconstruction of the hepatic artery--serial changes in postoperative liver function].

We investigated whether modified Appleby procedure with reconstruction of the hepatic artery can avoid complications due to a decrease in heptic arterial flow which has been comprehended in conventional Appleby's operation. The postoperative liver function of 17 patients undergoing modified Appleby's procedure was compared with that of 16 patients undergoing total gastrectomy and distal pancreato-splenectomy (control group). (1) Anticoagulant therapy was not required during and after operation. The common hepatic arterial flow after vascular anastomosis was 396 +/- 101 ml/min. Postoperative celiac arteriography revealed good patency of anastomosis. (2) There were no significant differences between the modified Appleby group and the control group in any of the blood levels of GOT, GPT total bilirubin and alkaline phosphatase at any point until the fourth postoperative week. In none of the patients in the modified Appleby group, the blood levels of GOT and GPT exceeded 250 IU/l. (3) In the modified Appleby group, ICG-R15 was 4 +/- 1% before operation and 6 +/- 3% at the first postoperative month. These results suggested that modified Appleby procedure enabled us to perform resection according to Appleby's operation safely, without need for preoperative or intraoperative examination about the retrograde blood flow mediated by the gastrodudenal artery.

Adult↗