Bowel recovery after intra- vs extra-corporeal anastomosis for oncologic laparoscopic right hemicolectomy within an ERAS protocol: a retrospective study.

OBJECTIVE: Restoring bowel continuity after laparoscopic right hemicolectomy with an intra-corporeal (IC) rather than an extra-corporeal (EC) ileocolic anastomosis may offer advantages in post-operative recovery. The aim of this study was to compare bowel function recovery between these two techniques, in a context of complete mesocolic excision within an enhanced recovery after surgery (ERAS) protocol. METHODS: All consecutive patients who underwent oncologic laparoscopic right hemicolectomy from January 2012 to February 2021 in our institution were included in the study. Data were gathered from the prospectively maintained official ERAS (EIAS) database and completed through our institution's electronic health records. The primary endpoint was prolonged post-operative ileus (PPOI), defined as the need to insert a nasogastric tube, or refractory nausea VAS > 4, on or after the third post-operative day. Secondary endpoints were post-operative pain, morbidity and length of hospital stay (LoS). Groups were compared before and after propensity score matching based on age, gender, ASA score, use of epidural analgesia and post-operative complications. RESULTS: A total of 108 patients met the inclusion criteria, 36 (30%) had IC and 72 (70%) EC anastomosis. In the unmatched population, baseline characteristics were similar except for more frequent use of epidural analgesia in the EC group (62 (72.9%) vs. 17 (47.2), p = 0.007). PSM analysis was carried out. Operative time was longer in the IC group (197 min (176-223) vs. 160 (140-189), p < 0.001). The rate of PPOI was similar (2 (5.6%) patients in the IC group vs. 10 (11.6%) in the EC group (p = 0.306)), but time to frist passage of flatus and stool was shorter in the IC group. There was no difference in morbidity but patients after IC anastomosis had lower pain VAS scores at 24 h (p = 0.004) and a trend for a shorter LoS (6 (5-8) days vs 7 (5-10) in the EC group, p = 0.054). After PSM, there were 36 patients in each group. PPOI, time to first flatus and stool, morbidity and LoS were not significantly different although there was a trend for better recovery outcomes in the IC group. Patients in the IC group had significantly longer operative times but less pain at 24 h. CONCLUSIONS: Although IC anastomosis was not significantly associated to lower rates of PPOI, it showed trends of faster recovery and significantly less post-operative pain at the expense of longer operating times.

Effect of the pressureless post-sintering on the hot isostatic pressed Al2O3 prepared from the oxidized AlN powder.

The effect of the pressureless post-sintering in hydrogen on the structural and mechanical properties of the hot isostatic pressed Al2O3 prepared by oxidized AlN powder has been studied. The micrometer size AlN powder has been oxidized in air at 900° C and sintered by hot isostatic pressing (HIP) at 1700 °C, 20 MPa nitrogen atmosphere for 5 h. Pressureless sintering (PS) has been applied for all HIP sintered samples in H2 gas at 1800° C for 10 h. It has been shown that the oxidation caused a core-shell AlN/Al2O3 structure and the amount of Al2O3 increased with increasing of the oxidation time of the AlN powder. For the first time, the green samples obtained from oxidized AlN powder have been successfully sintered first by HIP followed by post-sintering by PS under hydrogen without adding any sintering additives. All post-sintered samples exhibited the main α-Al2O3 phase. Sintering in H2 caused the full transformation of AlN to α-Al2O3 phase and their better densification. Therefore, the hardness values of post-sintered samples have been increased to 17-18 GPa having apparent densities between 3.11 and 3.39 g/cm3.

Validation of a food quantification picture book and portion sizes estimation applying perception and memory methods.

We tested the applicability of EPIC-SOFT food picture series used in the context of a Hungarian food consumption survey gathering data for exposure assessment, and investigated errors in food portion estimation resulted from the visual perception and conceptualisation-memory. Sixty-two participants in three age groups (10 to <74 years) were presented with three different portion sizes of five foods. The results were considered acceptable if the relative difference between average estimated and actual weight obtained through the perception method was ≤25%, and the relative standard deviation of the individual weight estimates was <30% after compensating the effect of potential outliers with winsorisation. Picture series for all five food items were rated acceptable. Small portion sizes were tended to be overestimated, large ones were tended to be underestimated. Portions of boiled potato and creamed spinach were all over- and underestimated, respectively. Recalling the portion sizes resulted in overestimation with larger differences (up to 60.7%).

Moderate red wine consumption improves hemorheological parameters in healthy volunteers.

Pieces of epidemiological evidence have supported that moderate red wine consumption reduces the risk of cardiovascular diseases (French-paradox). Our previous in vitro experiment has demonstrated favourable hemorheological effects of red wine, alcohol-free red wine extract and ethanol. Thirty-nine healthy, non-smoking male volunteers between 18-40 years were assigned into two groups: control group had drunk water, while red wine group had consumed 2 dl of red wine each day at dinner for 3 weeks. No alcohol had been drunk for one week prior to the study. Blood was obtained in the morning of the first and last day. Hematocrit (Hct), plasma (PV) and whole blood viscosity (WBV) (Hevimet 40 capillary viscometer), red blood cell (RBC) aggregation (Myrenne and LORCA aggregometer) and deformability (LORCA ektacytometer) were measured and Hct/WBV ratio was calculated to determine oxygen carrying capacity. Hct was adjusted to 40%. Hct and PV were not affected. WBV remained unchanged in controls, but it considerably decreased in the red wine group compared to the 3-week control group, while Hct/WBV ratio became significantly higher in the red wine group compared to the control (p < 0.05). RBC aggregation significantly decreased in the red wine group and became significantly lower compared to the 3-week controls (p < 0.05). Red wine significantly increased RBC deformability (p < 0.05) at high shear stress. Our results show that moderate red wine consumption has beneficial effects on hemorheological parameters which may contribute to the French-paradox.

Glioblastoma multiforme with an unusual location and clinical course.

We present a unique case of a brain tumor patient with atypical location and progression. He was initially presented with mood and anxiety type symptoms together with aphasia and left-sided paraesthesias. Magnetic resonance imaging and CSF were negative and the patient was diagnosed with PTSD as he recently experienced a small motor vehicle accident. Two months after the first presentation, MRI revealed multifocal juxtacortical, leptomeningeal hyperdensities in the bilateral frontal lobes. MRI-guided frameless stereotactic biopsy defined a diagnosis of GBM 1 week prior to death which occurred within 4 months. Postmortally, formalin-fixed brain demonstrated that the main tumor mass was located in the fornix, infiltrating the ventricular system and disseminating over the cortex, cerebellum and spinal cord. The authors recommend closer scrutiny of psychiatric patients presenting CNS symptomatology, negative MRI, CT and CSF.