Liver Transplantation for Hepatocarcinoma: Results over Two Decades of a Transplantation Programme and Analysis of Factors Associated with Recurrence.

BACKGROUND: In recent years, many studies have attempted to develop models to predict the recurrence of hepatocarcinoma after liver transplantation. METHOD: A single-centre, retrospective cohort study analysed patients receiving transplants due to hepatocarcinoma during the 20 years of the transplant programme. We analysed patient survival, hepatocarcinoma recurrence and the influence of the different factors described in the literature as related to hepatocarcinoma recurrence. We compared the results of previous items between the first and second decades of the transplantation programme (1995-2010 and 2010-2020). RESULTS: Of 265 patients, the patient survival rate was 68% at 5 years, 58% at 10 years, 45% at 15 years and 34% at 20 years. The overall recurrence rate of hepatocarcinoma was 14.5%, without differences between periods. Of these, 54% of recurrences occurred early, in the first two years after transplantation. Of the parameters analysed, an alpha-fetoprotein level of >16 ng/mL, the type of immunosuppression used and the characteristics of the pathological anatomy of the explant were significant. A trend towards statistical significance was identified for the number of nodules and the size of the largest nodule. Logistic regression analysis was used to develop a model with a sensitivity of 85.7% and a specificity of 35.7% to predict recurrences in our cohort. Regarding the comparison between periods, the survival and recurrence rates of hepatocarcinoma were similar. The impact of the factors analysed in both decades was similar. CONCLUSIONS: Most recurrences occur during the first two years post-transplantation, so closer follow-ups should be performed during this period, especially in those patients where the model predicts a high risk of recurrence. The detection of patients at higher risk of recurrence allows for closer follow-up and may, in the future, make them candidates for adjuvant or neoadjuvant systemic therapies to transplantation.

T3-T4 index as a prognostic marker of response to biological treatments in elderly patients with inflammatory bowel disease.

Following the growing trend of trying to individualise treatment in inflammatory bowel disease and in view of the challenge posed by elderly patients requiring biologic treatments, we have conducted a study in our centre to assess the T3/T4 index as a predictor of response to biologic treatments in elderly patients.

Comprehensive insight into the alterations in the gut microbiome and the intestinal barrier as a consequence of iron deficiency anaemia.

BACKGROUND: Iron deficiency is the top leading cause of anaemia, whose treatment has been shown to deteriorate gut health. However, a comprehensive analysis of the intestinal barrier and the gut microbiome during IDA have not been performed to date. This study aims to delve further into the analysis of these two aspects, which will mean a step forward minimising the negative impact of iron supplements on intestinal health. METHODS: IDA was experimentally induced in an animal model. Shotgun sequencing was used to analyse the gut microbiome in the colonic region, while the intestinal barrier was studied through histological analyses, mRNA sequencing (RNA-Seq), qPCR and immunofluorescence. Determinations of lipopolysaccharide (LPS) and bacteria-specific immunoglobulins were performed to assess microbial translocation. RESULTS: Microbial metabolism in the colon shifted towards an increased production of certain amino acids, short chain fatty acids and nucleotides, with Clostridium species being enriched during IDA. Structural alterations of the colonic epithelium were shown by histological analysis. RNA-Seq revealed a downregulation of extracellular matrix-associated genes and proteins and an overall underdeveloped epithelium. Increased levels of serum LPS and an increased immune response against dysbiotic bacteria support an impairment in the integrity of the gut barrier during IDA. CONCLUSIONS: IDA negatively impacts the gut microbiome and the intestinal barrier, triggering an increased microbial translocation. This study emphasizes the deterioration of gut health during IDA and the fact that it should be addressed when treating the disease.

Fermented Goat's Milk Contributes to the Recovery of Iron Deficiency Anemia via Modulation of the Gut Microbiome.

Iron deficiency anemia (IDA) is a global public health concern affecting 1.6 billion people worldwide. The administration of iron supplements during the treatment of IDA adversely affects the intestinal barrier function and the composition and functionality of the intestinal microbiome, both of which are already altered during IDA. For this reason, it is of great interest to develop nutritional strategies aimed at alleviating these gut alterations associated with IDA and its treatment. In this sense, fermented goat's milk (FGM) was studied due to its nutritional quality. Our findings showed that in anemic animals the consumption of a FGM-based diet, compared to a standard diet, had positive modulatory effects on the intestinal microbiome. FGM-based diet restored intestinal dysbiosis, the intestinal barrier functionality, and bacterial translocation, contributing to a more efficient recovery of IDA. Therefore, FGM is a useful nutritional tool to ease intestinal alterations occurring during IDA and during its treatment.

The mechanism for polar localization of the type IVa pilus machine in Myxococcus xanthus.

IMPORTANCE: Type IVa pili (T4aP) are widespread bacterial cell surface structures with important functions in motility, surface adhesion, biofilm formation, and virulence. Different bacteria have adapted different piliation patterns. To address how these patterns are established, we focused on the bipolar localization of the T4aP machine in the model organism Myxococcus xanthus by studying the localization of the PilQ secretin, the first component of this machine that assembles at the poles. Based on experiments using a combination of fluorescence microscopy, biochemistry, and computational structural analysis, we propose that PilQ, and specifically its AMIN domains, binds septal and polar peptidoglycan, thereby enabling polar Tgl localization, which then stimulates PilQ multimerization in the outer membrane. We also propose that the presence and absence of AMIN domains in T4aP secretins contribute to the different piliation patterns across bacteria.

BODY COMPOSITION ASSESSED BY DUAL-ENERGY X-RAY ABSORPTIOMETRY ON METABOLIC PROFILE AND CARDIOVASCULAR RISK IN OBESE PATIENTS PRIOR TO BARIATRIC SURGERY.

BACKGROUND: Fat, muscle, and bone are endocrine organs capable of affecting the metabolic profile and cardiovascular risk. Relating these components is important to the establishment of early intervention strategies for overweight patients. AIMS: This study aimed to evaluate the influence of body mass components on the metabolic profile and cardiovascular risk in the preoperative period of bariatric surgery. METHODS: A cross-sectional study was conducted with patients admitted for bariatric surgery at a university hospital in the city of Recife, Brazil, between 2018 and 2019. Body composition was determined using dual-energy x-ray absorptiometry. Cardiovascular risk was assessed using the Framingham risk score. Data were collected on anthropometric, clinical, and lifestyle characteristics. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), blood glucose, and vitamin D were determined using the standard methods of the hospital laboratory. RESULTS: A total of 60 patients were analyzed, 86.7% of whom had comorbidities, 33.3% had moderate/high cardiovascular risk, and 71.4% had vitamin D insufficiency/deficiency. Lower lean body mass (adjusted PR 3.24; 95%CI 1.19-5.77) was independently associated with the severity of obesity. The body mass index and waist circumference were negatively correlated with lean body mass (r=-0.52; p<0.01)/r=-0.36; p<0.01). Lean body mass was negatively correlated with fat mass (r=-0.26; p<0.05), trunk fat (r=-0.29; p<0.05), fasting glucose (r=-0.26; p<0.05), and bone mineral density (r=-0.26; p<0.05). A total of 84.2% of individuals with less trunk fat tended to have low cardiovascular risk (p=0.05). However, physical inactivity (adjusted PR 2.14; 95%CI 1.19-5.54) and the risk of alcohol dependence (adjusted PR 2.41; 95%CI 1.76-4.15) were the only variables independently associated with cardiovascular risk. CONCLUSION: Obese patients in the preoperative period of bariatric surgery with less trunk fat tended to have low cardiovascular risk. However, the other components of body mass were also not associated with cardiovascular risk.

Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Effect of High Hydrostatic Pressure Processing on the Microbiological Quality and Bacterial Diversity of Sous-Vide-Cooked Cod.

High hydrostatic pressure (HP) is a promising method to improve the microbiological quality of sous-vide foods. Monitoring the composition and behavior of the microbial communities in foods is of most importance for the production of high-quality and safe products. High-throughput sequencing (HTS) provides advanced approaches to determine food's microbial community composition and structure. The aim of the present study was to determine the impact of different HP treatments on the microbial load and bacterial diversity of sous-vide Atlantic cod. Sous-vide cooking at 57.1 °C for 30 min followed by HP treatment at 500 MPa for 8 min reduced viable cell counts (total aerobic mesophiles) in the cod samples below detectable levels for 45 days of storage under refrigeration. In a second trial with cod cooked sous-vide at 52 °C for 20 min followed by HP treatments at 300 or 600 MPa (with HP treatment temperatures of 22 °C or 50 °C for 4 or 8 min, depending on treatment), only the treatments at 600 MPa delayed bacterial growth for at least 30 days under refrigeration. The optimal HP conditions to improve the microbiological quality of sous-vide cod cooked at low temperatures were obtained at 600 MPa for 4 min at a pressurization temperature of 50 °C. Bacterial diversity was studied in cod cooked sous-vide at 52 °C for 20 min by HTS. In the absence of HP treatment, Proteobacteria was the main bacterial group. A succession of Pseudomonadaceae (Pseudomonas) and Enterobacteriaceae was observed during storage. Firmicutes had low relative abundances and were represented mainly by Anoxybacillus (early storage) and Carnobacterium (late storage). The HP-treated sous-vide cod showed the greatest differences from controls during late storage, with Aerococcus and Enterococcus as predominant groups (depending on the HP conditions). The application of HTS provided new insights on the diversity and dynamics of the bacterial communities of sous-vide cod, revealing the presence of bacterial genera not previously described in this food, such as Anoxybacillus. The significance of Anoxybacillus as a contaminant of seafoods should be further investigated.

Impact of HCV Treatment on Recurrence of Hepatocarcinoma After Liver Transplantation.

The treatment of hepatitis C virus (HCV) has been a revolution in hepatology. Since the beginning of transplantation, liver cirrhosis and hepatocarcinoma on HCV cirrhosis has been the main etiology of liver transplantation. We set out to analyze the impact that C virus treatment has had on liver transplantation. To do so, we divided our cohort into 2 periods, one before virus treatment (from 2000-2014) and one after the onset of treatment (2014-2020). Taking into account this differentiation, we analyzed the percentage of patients transplanted for hepatocarcinoma over cirrhotic liver by HCV in both groups. Among the patients transplanted for HCV, we analyzed whether there were differences in hepatocarcinoma recurrences according to their serologic status at the time of transplantation.

Draft Genome Sequence of a Putatively Antibiotic-Resistant Escherichia coli Strain Isolated from Calf Intestine in Boyacá, Colombia.

A draft genome of the putatively antibiotic-resistant Escherichia coli strain ANGUJ1, which was isolated from calf intestine from Boyacá, Colombia, is reported. The genome possessed genetic determinants for antibiotic resistance and multicompound resistance efflux pumps. In silico prediction analysis suggests phenotypic resistance to six classes of antibiotics plus aldehyde and peroxide.

Body composition assessed by dual-energy x-ray absorptiometry on metabolic profile and cardiovascular risk in obese patients prior to bariatric surgery / Composição corporal avaliada pela absortometria radiológica de dupla energia sobre o perfil metabólico e o risco cardiovascular em obesos antes da cirurgia bariátrica

ABSTRACT BACKGROUND: Fat, muscle, and bone are endocrine organs capable of affecting the metabolic profile and cardiovascular risk. Relating these components is important to the establishment of early intervention strategies for overweight patients. AIMS: This study aimed to evaluate the influence of body mass components on the metabolic profile and cardiovascular risk in the preoperative period of bariatric surgery. METHODS: A cross-sectional study was conducted with patients admitted for bariatric surgery at a university hospital in the city of Recife, Brazil, between 2018 and 2019. Body composition was determined using dual-energy x-ray absorptiometry. Cardiovascular risk was assessed using the Framingham risk score. Data were collected on anthropometric, clinical, and lifestyle characteristics. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), blood glucose, and vitamin D were determined using the standard methods of the hospital laboratory. RESULTS: A total of 60 patients were analyzed, 86.7% of whom had comorbidities, 33.3% had moderate/high cardiovascular risk, and 71.4% had vitamin D insufficiency/deficiency. Lower lean body mass (adjusted PR 3.24; 95%CI 1.19-5.77) was independently associated with the severity of obesity. The body mass index and waist circumference were negatively correlated with lean body mass (r=-0.52; p<0.01)/r=-0.36; p<0.01). Lean body mass was negatively correlated with fat mass (r=-0.26; p<0.05), trunk fat (r=-0.29; p<0.05), fasting glucose (r=-0.26; p<0.05), and bone mineral density (r=-0.26; p<0.05). A total of 84.2% of individuals with less trunk fat tended to have low cardiovascular risk (p=0.05). However, physical inactivity (adjusted PR 2.14; 95%CI 1.19-5.54) and the risk of alcohol dependence (adjusted PR 2.41; 95%CI 1.76-4.15) were the only variables independently associated with cardiovascular risk. CONCLUSION: Obese patients in the preoperative period of bariatric surgery with less trunk fat tended to have low cardiovascular risk. However, the other components of body mass were also not associated with cardiovascular risk.

RESUMO RACIONAL: O tecido adiposo, músculos e ossos representam órgãos endócrinos, capazes de interferir no perfil metabólico e risco cardiovascular. Relacionar esses componentes será importante para estratégias de intervenção precoce, em obesos. OBJETIVOS: Avaliar a influência dos compartimentos da massa corporal, sobre o perfil metabólico e risco cardiovascular, no pré-operatório de cirurgia bariátrica. MÉTODOS: Estudo transversal, com pacientes admitidos para cirurgia bariátrica, em hospital universitário. A composição corporal foi avaliada pela absortometria radiológica de dupla energia e o risco cardiovascular pelo escore de risco de Framingham. Foram analisadas variáveis antropométricas, clínicas e de estilo de vida. Foi avaliado perfil lipídico (colesterol total, HDL-c, LDL-c, triglicerídeos), glicemia e vitamina D, utilizando a metodologia padrão. RESULTADOS: Foram analisados 60 pacientes, 86,7% apresentavam comorbidades, 33,3% risco cardiovascular moderado/elevado e 71,4% insuficiência/deficiência de vitamina D. Menor massa corporal magra associou-se à gravidade da obesidade. O índice de massa corpórea e a circunferência da cintura correlacionaram-se negativamente com a massa corporal magra (r=-0,52; p<0,01)/r=-0,36; p<0,01). A massa corporal magra correlacionou-se negativamente com a massa gorda (r=-0,26; p<0,05), gordura troncular (r=-0,29; p<0,05), glicemia de jejum (r=-0,26; p<0,05) e densidade mineral óssea (r=-0,26; p<0,05). Ao todo, 84,2% dos indivíduos com menos gordura troncular apresentaram tendência a baixo risco cardiovascular (p=0,05). Contudo, inatividade física (razão de prevalência ajustada 2,14; IC95% 1,19-5,54) e risco de dependência alcoólica foram as únicas variáveis independentemente associadas ao risco cardiovascular. CONCLUSÕES: Os pacientes obesos em pré-operatório de cirurgia bariátrica com menos gordura troncular, apresentaram tendência a baixo risco cadiovascular. Contudo, o risco cardiovascular também não foi associado aos demais componentes da massa corporal.

Dietary patterns among adolescent freshmen attending a public university / Padrões alimentares de adolescentes recém-ingressos em uma universidade pública

ABSTRACT Objective To identify the association between dietary patterns and nutritional status in adolescent freshmen at a public university in Northeastern Brazil. Methods In this cross-sectional study anthropometric variables, body composition and food intake were collected and assessed using the food frequency questionnaire. Dietary patterns were evaluated through factor analysis using the principal component extraction method. Results Two dietary patterns were identified: "Western" pattern, consisting of foods with high energy density and low nutritional value, and the "traditional Brazilian" pattern, with foods from Brazilian cuisine such as rice, beans, corn, roots and tubers, fruits, greens and vegetables. The multiple regression analysis revealed a negative association between the "traditional Brazilian" pattern and both excess weight and body fat in females. Conclusion A healthy dietary pattern with typical local cuisine foods can offer protection to health and should be encouraged.

RESUMO Objetivo Identificar a associação entre padrões alimentares e estado nutricional em adolescentes recém-ingressos em uma universidade pública do Nordeste brasileiro. Métodos Neste estudo transversal foram coletados dados antropométricos, composição corporal e consumo alimentar, verificado pelo questionário de frequência alimentar. Os padrões alimentares foram derivados através da análise fatorial pelo método de extração de componentes principais. Resultados Dois padrões alimentares foram identificados: o padrão "Ocidental", composto por alimentos de elevada densidade energética e de baixo valor nutricional, e o padrão "tradicional brasileiro", contendo alimentos da culinária brasileira como arroz, feijão, milho, raízes e tubérculos, frutas, verduras e legumes. A análise de regressão múltipla mostrou associação negativa entre o excesso de peso e de gordura corporal e o padrão alimentar "tradicional brasileiro" no sexo feminino. Conclusão Um padrão alimentar saudável e com alimentos típicos da culinária local pode conferir proteção à saúde, devendo ser incentivado.

Biohazard Accidents, Harmful Elements to the Wellness of Healthcare Workers, and Their Risk Factors.

BACKGROUND: For healthcare personnel, biohazard accidents pose a significant risk to their health. These exposures can enable the transmission of pathogens such as Hepatitis B, Hepatitis C, and human immunodeficiency virus (HIV). OBJECTIVE: To indicate and quantify the risk associated with higher threatening situations, such as biohazard accidents on repeated occasions or incorrect notifications to injured healthcare professionals. METHODS: A cross-sectional study was conducted at the Poniente Hospital in Almeria (Spain). In total, 592 participants reported 1062 accidents and their characteristics and notifications were analyzed. RESULTS: It was found that women (OR = 1.29) working in the surgical area (OR = 2.92), those on indefinite contracts (OR = 1.67), and those with high work experience (OR = 1.14) were the main risk factors for multiple biohazard accidents. Concerning the incorrect notification of these accidents, the main risk factors were work performance during the afternoon shift (OR = 1.72) and the fact that the accident was caused by the injured worker himself (OR = 1.53). CONCLUSIONS: This study outlined the main factors that can contribute to healthcare professionals suffering these accidents. As a result, corrective measures must be taken against these risk factors to improve safety for healthcare workers in the future.

Antimicrobial Resistance, Biocide Tolerance, and Bacterial Diversity of a Dressing Made from Coriander and Parsley after Application of Treatments Using High Hydrostatic Pressure Alone or in Combination with Moderate Heat.

The effects of high-hydrostatic pressure (HP) treatments (450 and 600 megapascals, MPa, for 5 min at temperatures of 22 °C and 50 °C) on the microbiota of a coriander and parsley dressing was studied via culture-dependent and culture-independent approaches. Samples were refrigerated for 20 days, with periodic counts of the culture media supplemented with, or without, antimicrobials. HP-treated samples showed significantly lower viable cell counts compared to untreated controls. Only the control samples yielded bacterial growth on media with antimicrobials (imipenem, cefotaxime, benzalkonium chloride), including mostly Pseudomonas and Lactobacillus. Bacillus and Paenibacillus were identified from pressurized samples. Few isolates showed higher tolerance to some of the biocides tested. Pseudomonads showed outstanding resistance to meropenem and ceftazidime. According to high-throughput sequencing analysis, the microbiota of the dressing control samples changes during storage, with a reduction in the relative abundance of Proteobacteria and an increase in Firmicutes. The composition of the residual microbiota detected during storage was highly dependent on the pressure applied, and not on the treatment temperature.

Eating disorders in the preoperative phase of bariatric surgery / Transtornos alimentares durante o pré-operatório de cirurgia bariátrica

Introduction: Bariatric surgery is considered the most effective obesity treatment. Obese patients have a high prevalence of eating disorders. Objectives: Evaluate the occurrence of eating disorders and eating patterns in candidates for bariatric surgery and associate eating disorders with sociodemographic and clinical characteristics. Methods: A retrospective study was conducted using electronic charts of candidates for bariatric surgery. Data were collected on sex, age, marital status, schooling, occupation, non-communicable diseases, body mass index (BMI), eating disorders, and eating patterns. Results: Among the 281 patients evaluated, eating disorders were detected in 26.7%; 10.3% had binge eating disorder, 6.6% had bulimia nervosa, and 5.3% had the night-eating syndrome. The specific eating patterns were overeating (46.6%), binge eating during periods of stress (9.3%), eating sweets (4%), and snaking (1.3%). BMI ranged from 35.38 to 59.03 kg/m² (mean: 44.37 ± 5.89). All individuals (100%) had systemic arterial hypertension, and 23.3% had type 2 diabetes mellitus or dyslipidemia. Conclusions: The frequency of eating disorders was low in the sample studied, the most common of which was binge eating disorder. Non-communicable diseases were associated with eating disorders. Among the eating patterns observed, the most frequent was overeating (AU)

Introdução: A cirurgia bariátrica é considerada o tratamento mais eficaz para a obesidade. Pacientes obesos possuem elevada prevalência de transtornos alimentares. Objetivos: Avaliar a presença de transtornos alimentares e padrões alimentares em candidatos à cirurgia bariátrica, associando os transtornos alimentares aos dados sociodemográficos e clínicos. Métodos: Estudo retrospectivo de cunho documental, com base em prontuários eletrônicos de pacientes candidatos à cirurgia bariátrica. Foram obtidas variáveis como sexo, idade, estado civil, nível de escolaridade, ocupação, doenças crônicas não transmissíveis, índice de massa corporal (IMC), transtorno e padrão alimentar. Resultados: Dos 281 pacientes avaliados, foi detectado 26,7% de transtornos alimentares, sendo 10,3% transtorno de compulsão alimentar periódica, 6,6% de bulimia nervosa e 5,3% de síndrome do comer noturno. Os padrões alimentares específicos encontrados foram: glutões (46,6%), compulsivos alimentares em períodos de estresse (9,3%), comedores de doces (4%) e beliscadores (1,3%). O IMC variou de 35,38 a 59,03 kg/m² (44,37±5,89), com 100% do grupo apresentando Hipertensão Arterial Sistêmica e 23,3% com Diabetes Mellitus tipo 2 ou dislipidemia. Conclusões: Constatou-se baixa frequência de transtornos alimentares na amostra estudada, sendo o transtorno de compulsão alimentar periódica o mais observado. Doenças crônicas não transmissíveis foram associadas com a presença de transtornos alimentares. Dentre os padrões alimentares observados, os glutões foram os mais frequentes (AU)

Evidence for a Widespread Third System for Bacterial Polysaccharide Export across the Outer Membrane Comprising a Composite OPX/ß-Barrel Translocon.

In Gram-negative bacteria, secreted polysaccharides have multiple critical functions. In Wzx/Wzy- and ABC transporter-dependent pathways, an outer membrane (OM) polysaccharide export (OPX) type translocon exports the polysaccharide across the OM. The paradigm OPX protein Wza of Escherichia coli is an octamer in which the eight C-terminal domains form an α-helical OM pore and the eight copies of the three N-terminal domains (D1 to D3) form a periplasmic cavity. In synthase-dependent pathways, the OM translocon is a 16- to 18-stranded ß-barrel protein. In Myxococcus xanthus, the secreted polysaccharide EPS (exopolysaccharide) is synthesized in a Wzx/Wzy-dependent pathway. Here, using experiments, phylogenomics, and computational structural biology, we identify and characterize EpsX as an OM 18-stranded ß-barrel protein important for EPS synthesis and identify AlgE, a ß-barrel translocon of a synthase-dependent pathway, as its closest structural homolog. We also find that EpsY, the OPX protein of the EPS pathway, consists only of the periplasmic D1 and D2 domains and completely lacks the domain for spanning the OM (herein termed a D1D2OPX protein). In vivo, EpsX and EpsY mutually stabilize each other and interact in in vivo pulldown experiments supporting their direct interaction. Based on these observations, we propose that EpsY and EpsX make up and represent a third type of translocon for polysaccharide export across the OM. Specifically, in this composite translocon, EpsX functions as the OM-spanning ß-barrel translocon together with the periplasmic D1D2OPX protein EpsY. Based on computational genomics, similar composite systems are widespread in Gram-negative bacteria. IMPORTANCE Bacteria secrete a wide variety of polysaccharides that have critical functions in, e.g., fitness, surface colonization, and biofilm formation and in beneficial and pathogenic human-, animal-, and plant-microbe interactions. In Gram-negative bacteria, export of these chemically diverse polysaccharides across the outer membrane depends on two known translocons, i.e., an outer membrane OPX protein in Wzx/Wzy- and ABC transporter-dependent pathways and an outer membrane 16- to 18-stranded ß-barrel protein in synthase-dependent pathways. Here, using a combination of experiments in Myxococcus xanthus, phylogenomics, and computational structural biology, we provide evidence supporting that a third type of translocon can export polysaccharides across the outer membrane. Specifically, in this translocon, an outer membrane-spanning ß-barrel protein functions together with an entirely periplasmic OPX protein that completely lacks the domain for spanning the OM. Computational genomics support that similar composite systems are widespread in Gram-negative bacteria.

Experience in the treatment of esophageal anastomosis dehiscence using self-expanding metallic prosthesis

Introduction: esophageal anastomosis dehiscence is a serious complication after esophageal cancer surgery with high mortality risk. One of the treatment options is self-expanding esophageal prostheses. Our aim was to evaluate the outcome of esophageal prostheses in the management of suture dehiscences after oncologic surgery.Material and methods: we performed a descriptive and retrospective study with patients diagnosed with esophageal anastomosis fistula or dehiscence treated by esophageal prosthesis between the years 2015 and 2021. We considered technical success as the correct positioning of the prosthesis with visualization of anastomotic leak closure after release of the prosthesis during endoscopy, and clinical success the resolution of dehiscence after removal of the prosthesis 8 weeks after positioning.Results: technical success was 95% and clinical success 89%.Conclusion: in our center, esophageal prostheses are a treatment option for fistulas and anastomotic dehiscence after surgery with a high success rate and few complications. (AU)

Experience in the treatment of obstructive colorectal cancer with self-expandable colon prosthesis in a tertiary hospital.

Colorectal cancer is one of the most frequent neoplasms, with an increasing incidence in recent years. Intestinal obstruction is present at the time of diagnosis in 10-30% of patients. The aim of our study is to describe our experience in the use of colonic SEMS in the treatment of colonic stenosing neoplasia. For this purpose, we retrospectively evaluated the 92 patients treated with self-expandable metallic prostheses in our hospital between 2016 and 2021. In 66.3% of patients the prosthesis placement was bridge to curative surgery and in 33.7% with palliative attitude. The stenosis location was differentiated: rectum (2.1%), rectosigmoid junction (20.7%), sigma (58.7%), left colon (8.7%), splenic angle (8.7%) and transverse colon (1.1%); being the size of the self-expandable metallic prostheses used 60x25 mm, 90x25 mm and 120x25 mm. The procedure was technically effective in 92.4% of the cases and clinically effective in 89.1%, with post-procedural perforations being detected in 9 patients (9.8%). Survival 30 days after prosthesis placement was 91.3%. No mortality directly related to the procedure was detected. In our experience, placement of self-expandable metallic prostheses is a safe and effective option in the initial management of neoplastic colon stenosis.