Surgical Outcomes of Laparoscopic-assisted Distal Gastrectomy Versus Totally Laparoscopic Distal Gastrectomy Billroth I for Gastric Cancer.

OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.

Progression of diabetic nephropathy and vitamin D serum levels: A pooled analysis of 7722 patients.

BACKGROUND AND AIM: Low serum Vitamin D levels have been associated with diabetic nephropathy (DN). Our study aimed to analyse the serum levels of vitamin D in patients suffering from DN and the subsequent changes in serum vitamin D levels as the disease progresses. METHODS: PubMed, Embase, SCOPUS and Web of Science were searched using keywords such as '25 hydroxyvitamin D' and 'diabetic nephropathy'. We included observational studies that reported the association between the serum 25 hydroxy vitamin D levels and diabetic nephropathy without restriction to age, gender, and location. R Version 4.1.2 was used to perform the meta-analysis. The continuous outcomes were represented as mean difference (MD) and standard deviation (SD) and dichotomous outcomes as risk ratios (RR) with their 95% confidence interval (CI). RESULTS: Twenty-three studies were included in our analysis with 7722 patients. Our analysis revealed that vitamin D was significantly lower in diabetic patients with nephropathy than those without nephropathy (MD: -4.32, 95% CI: 7.91-0.74, p-value = .0228). On comparing diabetic patients suffering from normoalbuminuria, microalbuminuria, or macroalbuminuria, we found a significant difference in serum vitamin D levels across different groups. Normoalbuminuria versus microalbuminuria showed a MD of -1.69 (95% CI: -2.28 to -1.10, p-value = .0002), while microalbuminuria versus macroalbuminuria showed a MD of (3.75, 95% CI: 1.43-6.06, p-value = .0058), proving that serum vitamin D levels keep declining as the disease progresses. Notwithstanding, we detected an insignificant association between Grade 4 and Grade 5 DN (MD: 2.29, 95% CI: -2.69-7.28, p-value = .1862). CONCLUSION: Serum Vitamin D levels are lower among DN patients and keep declining as the disease progresses, suggesting its potential benefit as a prognostic marker. However, on reaching the macroalbuminuria stage (Grades 4 and 5), vitamin D is no longer a discriminating factor.

Novel strategies of essential oils, chitosan, and nano- chitosan for inhibition of multi-drug resistant: E. coli O157:H7 and Listeria monocytogenes.

Despite the wide range of available antibiotics, food borne bacteria demonstrate a huge spectrum of resistance. The current study aims to use natural components such as essential oils (EOs), chitosan, and nano-chitosan that have very influential antibacterial properties with novel technologies like chitosan solution/film loaded with EOs against multi-drug resistant bacteria. Two strains of Escherichia coli O157:H7 and three strains of Listeria monocytogenes were used to estimate antibiotics resistance. Ten EOs and their mixture, chitosan, nano-chitosan, chitosan plus EO solutions, and biodegradable chitosan film enriched with EOs were tested as antibacterial agents against pathogenic bacterial strains. Results showed that E. coli O157:H7 51,659 and L. monocytogenes 19,116 relatively exhibited considerable resistance to more than one single antibiotic. Turmeric, cumin, pepper black, and marjoram did not show any inhibition zone against L. monocytogenes; Whereas, clove, thyme, cinnamon, and garlic EOs exhibited high antibacterial activity against L. monocytogenes with minimum inhibitory concentration (MIC) of 250-400 µl 100-1 ml and against E. coli O157:H7 with an MIC of 350-500 µl 100-1 ml, respectively. Among combinations, clove, and thyme EOs showed the highest antibacterial activity against E. coli O157:H7 with MIC of 170 µl 100-1 ml, and the combination of cinnamon and clove EOs showed the strongest antibacterial activity against L. monocytogenes with an MIC of 120 µl 100-1 ml. Both chitosan and nano-chitosan showed a promising potential as an antibacterial agent against pathogenic bacteria as their MICs were relatively lower against L. monocytogenes than for E. coli O157:H7. Chitosan combined with each of cinnamon, clove, and thyme oil have a more effective antibacterial activity against L. monocytogenes and E. coli O157:H7 than the mixture of oils alone. Furthermore, the use of either chitosan solution or biodegradable chitosan film loaded with a combination of clove and thyme EOs had the strongest antibacterial activity against L. monocytogenes and E. coli O157:H7. However, chitosan film without EOs did not exhibit an inhibition zone against the tested bacterial strains.

Wild Strawberry-like Flavor Produced by the Fungus Wolfiporia cocos─Identification of Character Impact Compounds by Aroma Dilution Analysis after Dynamic Headspace Extraction.

Brown-rot fungi are particularly suitable for the sustainable and cost-efficient biotechnological production of natural flavors. In this study, Wolfiporia cocos was employed for the fermentation of European black currant pomace supplemented with aspartate in surface cultures to produce a flavor reminiscent of wild strawberries. Aroma dilution analysis (ADA) by means of dynamic headspace extraction was developed as a suitable technique for solid samples. The character impact compounds were quantified by stable isotope dilution analysis and standard addition and validated by recombination experiments. (R)-Linalool (1879 µg kg-1, ADA 211), methyl anthranilate (2206 µg kg-1, 210), 2-aminobenzaldehyde (771 µg kg-1, 25), and geraniol (138 µg kg-1, 25) were identified as key aroma compounds. Recombination experiments demonstrated that the combination of the four analyzed compounds was responsible for the odor impression reminiscent of wild strawberries.

Relationship of Physical Activity at Older Age with Biomarkers of Oxidative Stress: A Large, Population-based Cohort Study.

INTRODUCTION: No population-based cohort study on the associations of physical activity with biomarkers of oxidative stress has been performed so far. METHODS: The total thiol groups of serum proteins (TTP), which can be considered as a proxy biomarker for the antioxidant defense capacity of cells and the derivatives of reactive oxygen metabolites (D-ROM) serum concentration, which is mainly a biomarker of lipid peroxidation, were measured in 2572 participants of a population-based cohort study of older adults (age range, 57-83 yr), of whom 2068 had repeated measurements 3 yr later. Physical activity was assessed by a questionnaire specifically designed for the elderly. RESULTS: In multivariable linear regression models, total physical activity was statistically significantly, inversely associated with both D-ROM concentrations measured at baseline and their 3-yr change. With respect to TTP, a nonsignificant, positive association with total physical activity was observed in the cross-sectional analysis, which was statistically significant in obese study participants, and a statistically significant interaction between physical activity and obesity was detected. However, no longitudinal association between total physical activity and changes in TTP levels was observed. The type of physical activity (sports, leisure time, or household activity) did not have a strong effect on the results. CONCLUSIONS: This first population-based cohort study suggests that regular physical activity at older age could reduce oxidative stress. With the multifold potential adverse health consequences of chronically increased, systemic oxidative stress in mind, physical activity should be intensively promoted for all older adults as a measure to prevent age-related diseases.

Surgery for Locally Advanced GIT Cancers Has Potentially Good Postoperative Outcomes in a Tertiary Hospital.

BACKGROUND: Adhesions and infiltration into adjacent tissues are present in about 12% of gastrointestinal (GIT) cancers. These adhesions have high potential risk of malignancy. Free resection margin is a predictor of good survival in such patients. This study aims at evaluating the post-operative outcomes after multi-visceral resection of locally advanced gastrointestinal cancers. PATIENTS AND METHODS: Ninety patients who underwent extended and multi-visceral resection for GIT cancers invading or adhering to adjacent organs have been included. RESULTS: For gastric cancer, distal gastrectomy was performed for 12% of the cases and total gastrectomy in 20%. For recto-sigmoid cancer, anterior resection was performed in 18% and abdomino-perineal resection in 7%. Partial colectomy was performed for colonic cancer in 43% of the cases. One organ was excised with GIT tumor in 60 cases (67%). The other 30 cases (33%) required excision of more than one organ. Pathological invasion of adjacent organs was confirmed in 42% of cases. Free margins were obtained in 87% of patients. Morbidity rate was 51%. The most frequent complications were wound infection (17%), anastomotic leak (10%), and chest infection (10%). In this study, 19% required surgical re-intervention. Positive margin and positive lymph nodes (LNs) as well as mucoid adenocarcinoma were associated with a higher recurrence rate. CONCLUSION: Achieving free resection margins could be a safe and feasible procedure and may offer good prognosis when followed by adjuvant therapy for patients with locally advanced GIT cancer if patients were precisely selected to have procedure done in a high volume center.

Use of plant growth promoting Rhizobacteria (PGPR) and mycorrhizae to improve the growth and nutrient utilization of common bean in a soil infected with white rot fungi.

Extensive use of fertilizers and pesticides led to dangerous ecological effects and therefore the biological approaches have been widely recommended to prevent further deterioration for the environment. The current study was conducted to explore the potentiality of using single or combined inoculations by mycorrhizae, Bacillus subtilis and Pseudomonas fluorescence for controlling the infection of common bean plants with Sclerotium rolfsii on one hand and as bio-fertilizers for improving plants nutritional status on the other hand. The soil of study was mildly infected with S. rolfsii and contained high total-P content. Thus, minimal P inputs were added to the inoculated soil in the form of rock phosphate. Activities of plant defense enzymes i.e. chitinase, peroxidase and polyphenol oxidase were determined under the greenhouse conditions and the results obtained herein indicated that activities of such enzymes increased significantly owing to bio-agent inoculations. In this concern, combined treatments resulted in further significant increases over the single ones. A field study was then conducted for two successive years and the results reveal that single inoculations increased straw and green pod yields as well as the uptake of P and Fe by plants as compared with the non-inoculated treatment. Combined inoculants recorded further significant increases in these parameters even when compared with the fungicide treated plants. Generally, straw and pod yields obtained from the second growing season were significantly higher than those attained in the first growing one. Our study confirms the success of the used bio-treatments in minimizing soil pollution through fertilizer and/or pesticide inputs.

Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy.

BACKGROUND: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. MATERIALS AND METHODS: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. RESULTS: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival. CONCLUSIONS: PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

Breast cancer: surgery at the South egypt cancer institute.

Breast cancer is the most frequent malignant tumor in women worldwide. In Egypt, it is the most common cancer among women, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer Institute's (NCI) series of 10,556 patients during the year 2001, with an age-adjusted rate of 49.6 per 100,000 people. In this study, the data of all breast cancer patients presented to the surgical department of the South Egypt cancer Institute (SECI) hospital during the period from Janurary 2001 to December 2008 were reviewed .We report the progress of the availability of breast cancer management and evaluation of the quality of care delivered to breast cancer patients. The total number of patients with a breast lump presented to the SECI during the study period was 1,463 patients (32 males and 1431 females); 616 patients from the total number were admitted at the surgical department .There was a decline in advanced cases. Since 2001, facilities for all lines of comprehensive management have been made accessible for all patients. We found that better management could lead to earlier presentation, and better overall outcome in breast cancer patients.The incidence is steadily increasing with a tendency for breast cancer to occur in younger age groups and with advanced stages.

Simultaneous treatment of unresectable hepatocelluar carcinoma and hepatic artery aneurysm, case report.

INTRODUCTION: Hepatic artery aneurysm is uncommon with an estimated incidence of less than 0.25%. Because most patients are asymptomatic, the diagnosis is usually made as an incidental finding on imaging studies performed for other reasons. Because of their propensity to rupture with potential catastrophic intraperitoneal hemorrhage, early diagnosis is important. Herein, relatively asymptomatic aneurysm of the common hepatic artery mostly of atherosclerotic etiology is presented. The importance of imaging findings in the diagnosis of this condition is discussed and relevant literature is reviewed (1, 2). Hepatocellular carcinoma (HCC) ranks among the most common malignancies worldwide, and the prognosis for patients with HCC is typically poor. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Transcatheter arterial chemoembolization is intended to deliver a highly concentrated dose of chemotherapy to tumor cells, prolong the contact time between the chemotherapeutic agents and the cancer cells, and minimize systemic toxicity. Ideally, achieving these goals will result in a tumor shrinkage, symptomatic relief, improved quality of life, and increased patient survival (3). METHODS: We will present a case of male patient, 72 years old, who was referred for transcatheter arterial chemoembolization for unresectable hepatocelluar carcinoma. RESULTS: Helical CT scan showed right lobe mass infiltrating the peritoneum with enhancement in the early arterial phase together with hepatic artery aneurysm that was successfully treated at the same time using emulsion of N-butyl cyanoacylate and lipodol with a concentration of 1:1. CONCLUSION: Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Early diagnosis is essential because the natural tendency of the lesion is to rupture into peritoneal cavity or surrounding organs. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Our case is notable, because atherosclerotic aneurysms of the hepatic artery are extremely rare with very few cases reported so far and to diagnose a hepatic artery aneurysm and to treat it in one setting with chemoembolization of unresectable HCC without rupture of the aneurysm is also unusual.

Pancreatic endocrine neoplasm can mimic serous cystadenoma.

A 57-yr-old female patient was referred to our hospital with a cystic lesion of the head of the pancreas that had been noted on abdominal computed tomography (CT). Endoscopic ultrasonography (EUS) showed a 3.0 cm rounded mass in the head of the pancreas. EUS images showed that the tumor had a solid component consisting of multiple microcysts separated by septae and a cystic component consisting of a macrocystic lesion. Thus, the tumor was suspected of being a serous cystadenoma (SCA). However, the histopathological diagnosis based on endoscopic ultrasound- guided fine-needle-aspiration biopsy (EUS-FNAB) was that of a pancreatic endocrine neoplasm (PEN). Surgical resection was performed. Despite having very similar macroscopic findings to SCA, microscopic examination revealed that the patient's tumor was definitely a PEN. This case suggests that it is very difficult to distinguish PENs from SCAs based solely on imaging methods. EUS-FNAB is essential for determining the appropriate therapeutic strategy, as it provides the histopathological diagnosis.