A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid (ALA) in liver transplantation (LT). The grafts were randomized to receive ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with the ALA-perfused graft received 600 mg of intravenous ALA, while patients with the nonperfused graft received the placebo just before graft reperfusion. Hepatic biopsy was performed 2 h postreperfusion. Blood samples were collected before, during and 1 and 2 days after reperfusion. Quantitative polymerase chain reaction (qPCR) analysis was performed on biopsies to assess genes involved in the response to hypoxia, apoptosis, cell growth, survival and proliferation, cytokine production and tissue damage protection. Nine of 40 patients developed postreperfusion syndrome (PRS), but seven of them belonged to the control group. There was a decrease in PHD2 and an increase in alpha subunit of hypoxia-inducible factor-1 (HIF-1α) and baculoviral IAP repeat containing 2 (Birc2) transcript levels in the biopsies from the ALA-treated versus the control group of patients. Additionally, plasma levels of alarmins were lower in ALA-treated patients than control patients, which suggests that ALA-treated grafts are less inflammatory than untreated grafts. These results showed that ALA is safe for use in LT, induces gene changes that protect against hypoxia and oxidative stress and reduces the appearance of PRS.

included the term "IPMN" (intraductal papillary mucinous neoplasm) from November 2017-June 2018. 57 cases were identified for preliminary review. Cyst characterization was defined by size, nodule, associated main pancreatic duct dilatation, symptoms, type of cross-sectional imaging, and specialty of ordering physician. Results: Of the 57 cases, 26 were female and 31 were male. Cyst size ranged from 0.2 cm to 4.1 cm, evenly distributed throughout the pancreas and multiple in 27%. 22 of 57 (38.5%) were detected incidentally with computed tomography (CT) scan, (72%). The majority of the scans were ordered by primary care physicians, emergency department, and other specialists unrelated to surgery or gastroenterology. When AGA guidelines were applied, 6/ 57 (11%) patients had worrisome features such as a dilated pancreatic duct, jaundice, size >3 cm, or associated mass necessitating further intervention such as endoscopic ultrasound and fine needle aspiration (FNA). Conclusion:The majority of pancreatic cystic neoplasms can be safely observed over time. Current AGA guidelines suggest the need for surveillance to reduce the risk of pancreatic adenocarcinoma related mortality. The role for a cyst surveillance program was demonstrated by our preliminary review of incidentally discovered cysts

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