Objective of present study was to prepare and characterize self-nanoemulsifying drug delivery system (SNEDDS) of lutein and to evaluate its effect on bioavailability of warfarin. The SNEDDS was prepared using an oil, a surfactant, and co-surfactants with optimal composition based on pseudo-ternary phase diagram. Effect of the SNEDDS on the bioavailability of warfarin was performed using Sprague Dawley rats. Lutein was successfully formulated as SNEDDS for immediate self-emulsification and dissolution by using combination of Peceol as oil, Labrasol as surfactant, and Transcutol-HP or Lutrol-E400 as co-surfactant. Almost complete dissolution was achieved after 15 min while lutein was not detectable from the lutein powder or intra-capsule content of a commercial formulation. SNEDDS formulation of lutein affected bioavailability of warfarin, showing about 10% increase in Cmax and AUC of the drug in rats while lutein as non-SNEDDS did not alter these parameters. Although exact mechanism is not yet elucidated, it appears that surfactant and co-surfactant used for SNEDDS formulation caused disturbance in the anatomy of small intestinal microvilli, leading to permeability change of the mucosal membrane. Based on this finding, it is suggested that drugs with narrow therapeutic range such as warfarin be administered with caution to avoid undesirable drug interaction due to large amount of surfactants contained in SNEDDS.
Animals ; Area Under Curve ; Biological Availability* ; Drug Delivery Systems* ; Drug Interactions ; Lutein* ; Membranes ; Microvilli ; Permeability ; Rats ; Rats, Sprague-Dawley ; Surface-Active Agents ; Warfarin*

PURPOSE: Minimally invasive central pancreatectomy has rarely performed because of its technical difficulty. Robot system enhances surgical dexterity to perform such complex procedures. METHODS: A 29-year-old woman was admitted with acute cholecystitis and an 1.4 cm enhancing mass was incidentally found at the pancreatic proximal body on computed tomography. Preoperative image studies suggested a neuroendocrine tumor or solid pseudopapillary neoplasm. The patient underwent robotic cholecystectomy and central pancreatectomy with pancreaticojejunostomy. RESULTS: The total operation time was 280 minutes and the estimated amount of intraoperative bleeding was 100 ml. The postoperative recovery was uneventful and she was discharged on the 7(th) postoperative day. Pathologic examination reported a solid pseudopapillary neoplasm. CONCLUSION: The technical difficulties associated with the procedure can be overcome with the help of the wrist-like movement of the robotic instruments, especially for the preservation of splenic vessels and for creating precise anastomoses in narrow spaces.
Adult ; Cholecystectomy ; Cholecystitis, Acute ; Female ; Hemorrhage ; Humans ; Neuroendocrine Tumors ; Pancreatectomy* ; Pancreatic Neoplasms ; Pancreaticojejunostomy* ; Robotic Surgical Procedures

BACKGROUND: Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM. METHODS: We searched the PubMed database for studies on the association between Se and DM from inception to June 2018. RESULTS: Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found (I2 =82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I2 =77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I2 =0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I2 =0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I2 =91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias. CONCLUSION: This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.
Antioxidants ; Diabetes Mellitus ; Diet ; Epidemiologic Studies ; Odds Ratio ; Population Characteristics ; Prospective Studies ; Publication Bias ; Selenium ; Trace Elements