Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery-a multicentre observational study.

Background: Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery is based on conflicting evidence. This study explores the relationship between CPET and postoperative outcomes, specifically for patients undergoing neoadjuvant treatment. Methods: Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO2 peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses. Results: Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO2 peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (P=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; P<0.001) and Clavien-Dindo ≥3a (P<0.001) were associated with 1-yr and 3-yr survival. On subgroup analyses, pre-neoadjuvant treatment CPET; anaerobic threshold (absolute; P=0.024, relative to ideal body weight; P=0.001, body surface area; P=0.009) and VE/VCO2 at anaerobic threshold (P=0.026) were associated with 3-yr survival. No other CPET variables (pre- or post-neoadjuvant treatment) were associated with survival. Conclusions: VO2 peak was not associated with 1-yr survival after oesophagogastric cancer resection. Tumour characteristics and major complications were associated with survival; however, only some selected pre-neoadjuvant treatment CPET variables were associated with 3-yr survival. CPET in this cohort of patients demonstrates limited outcome predictive precision. Clinical trial registration: NCT03637647.

Antiplatelet, cytotoxic activities and characterization of green-synthesized zinc oxide nanoparticles using aqueous extract of Nephrolepis exaltata.

The goal of the current study was to synthesize zinc oxide nanoparticles (ZnO-NPs) using ZnCl2.2H2O salt precursor and an aqueous extract of Nephrolepis exaltata (N. exaltata), which act as a capping and reducing agent. N. exaltata plant extract-mediated ZnO-NPs were further characterized by various techniques, such as X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier transforms infrared spectroscopy (FT-IR), UV-visible (UV-Vis), and energy-dispersive X-ray (EDX) analysis. The nanoscale crystalline phase of ZnO-NPs was analyzed by the XRD patterns. The FT-IR analysis revealed different functional groups of biomolecules involved in the reduction and stabilization of the ZnO-NPs. The light absorption and optical properties of ZnO-NPs were examined by UV-Vis spectroscopy at a wavelength of 380 nm. The spherical shape morphology of ZnO-NPs with mean particle size ranges between 60 and 80 nm was confirmed by SEM images. While the EDX analysis was used to identify the elemental composition of ZnO-NPs. Furthermore, the synthesized ZnO-NPs demonstrate potential antiplatelet activity by inhibiting the platelet aggregation induced by platelet activation factor (PAF) and arachidonic acid (AA). The results showed that synthesized ZnO-NPs were more effective in inhibiting platelet aggregation induced by AA with IC50 (56% and 10 µg/mL) and PAF (63% and 10 µg/mL), respectively. However, the biocompatibility of ZnO-NPs was assessed in human lung cancer cell line (A549) under in vitro conditions. The cytotoxicity of synthesized nanoparticles revealed that cell viability decreased and the IC50 was found to be 46.7% at a concentration of 75 µg/mL. The present work concluded the green synthesis of ZnO-NPs that was achieved by N. exaltata plant extract and showed good antiplatelet and cytotoxic activity, which demonstrates the lack of harmful effects making them more effective for use in pharmaceutical and medical fields to treat thrombotic disorders.

Affective Antidepressant, Cytotoxic Activities, and Characterization of Phyto-Assisted Zinc Oxide Nanoparticles Synthesized Using Sanvitalia procumbens Aqueous Extract.

Green synthesis of nanoparticles has emerged as an effective and environmentally friendly method. Therefore, the current investigation is based on the green synthesis of zinc oxide nanoparticles (ZnO-NPs) using plant extract of Sanvitalia procumbens (S. procumbens) that act as a capping and reducing agent. S. procumbens is a fast-growing shrub and densely available plant and may have potential to synthesize ZnO-NPs. The synthesized ZnO-NPs were characterized by different techniques, including Fourier transform infrared spectroscopy (FT-IR), UV-visible (UV-Vis), energy-dispersive X-ray (EDX), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The UV-Vis spectrum at 350 nm revealed an absorption peak for the synthesis of ZnO-NPs. In addition, photoactive biomolecules of the prepared ZnO-NPs were identified by using FT-IR spectroscopy. Furthermore, the spherical geometry of ZnO-NPs was evaluated by SEM images. The synthesized ZnO-NPs were also used to enhance the antidepressant activity and exhibited a remarkable reduction in the time of immobility in tail suspension tests (TST) and forced swim tests (FST), as well as increased the BDNF levels in the brain and plasma. ZnO-NPs have a low risk of biocompatibility (cell visibility) at a concentration of 7 g/mL or below. The nanoparticles were biologically compatible when the concentrations were increased up to 11 µg/mL. It was concluded that ZnO-NPs were investigated as a possible carrier for antidepressant drug delivery into the brain, and their excellent cytotoxic activity was evaluated by using the MTT assay to determine their biocompatibility.

Clinico-radiological Results of Distal Chevron Osteotomy without Lateral Soft Tissue Release in Mild to Moderate Hallux Valgus Deformity.

BACKGROUND: The study was done to evaluate short term clinico-radiological results of distal chevron oste-otomy without lateral soft tissue release in mild to moderate hallux valgus. MATERIALS AND METHODS: This was a prospective study consisting of a total of 35 cases with mild to moderate hallux valgus deformity. All these patients were treated by distal chevron osteotomy without lateral soft tissue release. RESULTS: In our study, the average value of hallux angle preoperatively was 32° (range, 24°-40°) and at final follow-up it was 14° (range, 8°-31°). The average reduction was 18°. The average intermetatarsal angle showed mean reduction of 5.3° at the final follow-up. Average range of motion of the first metatarsophalyngeal joint preoperatively and at final follow-up showed a small reduction of 5 degrees. The average preoperative AOFAS score was 49, which improved by 35 points to 84 at the final follow-up. 11.42% of the patients in the study group had a recurrence. CONCLUSIONS: 1. Based on our experience with distal chevron osteotomy without lateral soft tissue release, we found the procedure easy to perform with good procedural outcomes. 2. The possible complications of lateral soft tissue release are avoided.

Thermal and Structural Characterization of Geopolymer-Coated Polyurethane Foam-Phase Change Material Capsules/Geopolymer Concrete Composites.

The thermal and structural performance of geopolymer-coated polyurethane foam⁻phase change material capsules/geopolymer concrete composites was investigated. Three groups of concrete composites were prepared. The first was pure geopolymer (GP, control sample), the second was a GP/polyurethane foam (F) concrete composite, and the third was GP-coated polyurethane foam-phase change material capsules (GP-F-PCM)/GP concrete composites. Three different percentages of foam and GP-F-PCM capsules (25%, 50%, and 75%) were used in the composites. Thermal and U-value tests were conducted for all composites to characterize their peak temperature damping and insulation performances. The addition of 75% foam has been noticed to increase the back-surface temperature by 5.9 °C compared to the control sample. This may be attributed to the degradation of foam into low molecular constituents in the presence of a strong alkali. However, a temperature drop of 12.5 °C was achieved by incorporating 75% of GP-F-PCM capsules. The addition of 50% foam as a sandwich layer between two halves of a geopolymer concrete cube is also investigated. It was found that inserting a foam layer reduced the back-surface temperature by 3.3 °C, which is still less than the reduction in the case of GP-F-PCM capsules. The compressive strength was tested to check the integrity of the prepared concrete. At 28 days of aging, the compressive strength dropped from 65.2 MPa to 9.9 MPa with the addition of 75% GP-F-PCM capsules, which is still acceptable for certain building elements (e.g., nonloadbearing exterior walls). Generally, the best results were for the GP-F-PCM composite capsules as a heat insulator.

Preparation and Characterization of Expanded Clay-Paraffin Wax-Geo-Polymer Composite Material.

Paraffin-based phase change material (PCM) is impregnated into the pores of lightweight expanded clay aggregate (LECA) through vacuum impregnation to develop PCM containing macro-capsules of LECA. Three different grades of LECA varying in size and morphology are investigated to host the PCM to determine the impregnation effectiveness, viability for coating, and its stability. The produced LECA-PCM is coated with geopolymer paste (GP) to provide leak proofing during the phase change. The PCM is thermophysically characterized by employing differential scanning calorimetry (DSC) and the temperature history method (THM) to determine the phase transition and the latent heat. The stability of the macro-capsules is determined by weight loss through rapid thermal cycling (RTC) at elevated temperatures. Leakage of the PCM is tested using the diffusion-oozing circle test (DOCT). The results show that the GP coated LECA-PCM macro-capsules achieved 87 wt % impregnation efficiencies and no noticeable loss of PCM, which indicates leak proofing of the developed capsules up to 1000 RTC.