Crystal structure and Hirshfeld surface analysis of dimethyl 2-oxo-4-(pyridin-2-yl)-6-(thio-phen-2-yl)cyclo-hex-3-ene-1,3-di-carboxyl-ate.

In the title compound, C19H17NO5S, the cyclo-hexene ring adopts nearly an envelope conformation. In the crystal, mol-ecules are linked by C-H⋯O hydrogen bonds, forming a three-dimensional network. In addition, C-H⋯π inter-actions connect the mol-ecules by forming layers parallel to the (010) plane. According to the Hirshfeld surface analysis, H⋯H (36.9%), O⋯H/H⋯O (31.0%), C⋯H/H⋯C (18.9%) and S⋯H/H⋯S (7.9%) inter-actions are the most significant contributors to the crystal packing.

Crystal structure and Hirshfeld surface analysis of 1-(2-amino-4-methyl-1,3-thia-zol-5-yl)ethan-1-one.

In the title compound, C6H8N2OS, all atoms except for the methyl H atoms are coplanar, with a maximum deviation of 0.026 (4) Å. In the crystal, pairs of mol-ecules are linked by N-H⋯N hydrogen bonds, forming R 2 2(8) ring motifs. Dimers are connected by N-H⋯O hydrogen bonds, forming layers parallel to the (102) plane. Consolidating the mol-ecular packing, these layers are connected by C-H⋯π inter-actions between the center of the 1,3-thia-zole ring and the H atom of the methyl group attached to it, as well as C=O⋯π inter-actions between the center of the 1,3-thia-zole ring and the O atom of the carboxyl group. According to a Hirshfeld surface study, H⋯H (37.6%), O⋯H/H⋯O (16.8%), S⋯H/H⋯S (15.4%), N⋯H/H⋯N (13.0%) and C⋯H/H⋯C (7.6%) inter-actions are the most significant contributors to the crystal packing.

Crystal structure and Hirshfeld surface analysis of 2-amino-5-{(1E)-1-[(carbamo-thioyl-amino)-imino]eth-yl}-4-methyl-1,3-thia-zol-3-ium chloride monohydrate.

In the hydrated title salt, C7H12N5S2 +·Cl-·H2O, the asymmetric unit comprises one 2-amino-5-{(1E)-1-[(carbamo-thioyl-amino)-imino]-eth-yl}-4-methyl-1,3-thia-zol-3-ium cation, one chloride anion and one water mol-ecule of crystallization. The cation is nearly flat (r.m.s. deviation of non-H atoms is 0.0814 Å), with the largest deviation of 0.1484 (14) Šobserved for one of the methyl C atoms. In the crystal, the cations are linked by O-H⋯Cl, N-H⋯Cl, N-H⋯O, N-H⋯S and C-H⋯S hydrogen bonds, forming a tri-periodic network. The most important contributions to the crystal packing are from H⋯H (35.4%), S⋯H/H⋯S (24.4%), N⋯H/H⋯N (8.7%), Cl⋯H/H⋯Cl (8.2%) and C⋯H/H⋯C (7.7%) inter-actions.

Bile Leakage From the Luschka Duct After Laparoscopic Sleeve Gastrectomy and Cholecystectomy: A Case Report.

Bile leakage may develop as a result of traumatic or iatrogenic injuries of bile ducts during laparoscopic cholecystectomy (LC). The frequency of Luschka duct injuries during LC is extremely rare. In this case, we present a case of bile leakage due to Luschka duct injury during sleeve gastrectomy (SG) and LC. The leakage was not noticed during the surgery, and on postoperative day 2, bilious drainage was seen from the drain. Magnetic resonance imaging (MRI) was helpful to determine Luschka duct injury. Biliary leakage resolved after endoscopic retrograde cholangiopancreatography (ERCP) with stent placement.

Robotic male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal cancer share similar specimen quality, complication rates and long-term oncological outcomes.

The aim of this study was to compare perioperative and long-term oncological outcomes between laparoscopic sphincter-preserving total mesorectal excision in female patients (F-Lap-TME) and robotic sphincter-preserving total mesorectal excision in male patients (M-Rob-TME) with mid-low rectal cancer (RC). A retrospective analysis of a prospectively maintained database was performed. 170 cases (F-Lap-TME: 60 patients; M-Rob-TME: 110 patients) were performed by a single surgeon (January 2011-January 2020). Clinical characteristics did not differ significantly between the two groups. Operating time was longer in M-Rob-TME than in F-Lap-TME group (185.3 ± 28.4 vs 124.5 ± 35.8 min, p < 0.001). There was no conversion to open surgery in both groups. Quality of mesorectum was complete/near-complete in 58 (96.7%) and 107 (97.3%) patients of F-Lap-TME and M-Rob-TME (p = 0.508), respectively. Circumferential radial margin involvement was observed in 2 (3.3%) and 3 (2.9%) in F-Lap-TME and M-Rob-TME patients (p = 0.210), respectively. Median length of follow-up was 62 (24-108) months in the F-Lap-TME and 64 (24-108) months in the M-Rob-TME group. Five-year overall survival rates were 90.5% in the F-Lap-TME and 89.6% in the M-Rob-TME groups (p = 0.120). Disease-free survival rates in F-Lap-TME and M-Rob-TME groups were 87.5% and 86.5% (p = 0.145), respectively. Local recurrence rates were 5% (n = 3) and 5.5% (n = 6) (p = 0.210), in the F-Lap-TME and M-Rob-TME groups, respectively. The robotic technique can potentially overcome some technical challenges related to the pelvic anatomical difference between sex compared to laparoscopy. Laparoscopic and robotic approach, respectively in female and male patients provide similar surgical specimen quality, perioperative outcomes, and long-term oncological results.

Laparoscopic Sleeve Gastrectomy in Monozygotic Twins: Report of the First Case.

Obesity is an epidemic disease that is believed to link to other pathologies as well as life-threatening cardiovascular pathology. Here we report a case of monozygotic twins who successfully lost weight following laparoscopic sleeve gastrectomy at the end of the 18-month follow-up period. We aimed to determine the factors affecting the weight loss outcome after sleeve gastrectomy in monozygotic twins. The twins' initial BMIs were 37.1 kg/m2 and 40.2 kg/m2, respectively. Twin A's excess weight loss was 48.4%, 61.3%, 80.6%, 96.8%, and 112.9% at three, six, nine, 12 and 18 months, while Twin B's in the third, sixth, ninth, 12th and 18th months was 23.1%, 41%, 51.3%, 61.5% and 71.8%. On the third, sixth, ninth, 12th, and 18th months of Twin A, the total weight loss was 15.8%, 20%, 26.3%, 31.6%, and 36.8%. In Twin B in the third, sixth, ninth, 12th, and 18th months, it was 8.7%, 15.5%, 19.4%, 23.3%, and 27.2%. When the twins were compared in terms of excess weight loss and total weight loss at 18 months, Twin A was more successful than Twin B. Especially at this point, Twin B's having a child (three years old) at a young age, her low compliance with the recommendations in the post-operative period and her difficulty in changing her lifestyle, environmental factors are as important as hereditary factors in achieving weight loss and a healthy body mass index (BMI) range.

Crystal structure and Hirshfeld surface analysis of 2-amino-4-(4-meth-oxy-phen-yl)-6-oxo-1-phenyl-1,4,5,6-tetra-hydro-pyridine-3-carbo-nitrile.

The central tetra-hydro-pyridine ring of the title compound, C19H17N3O2, adopts a screw-boat conformation. In the crystal, strong C-H⋯O and N-H⋯N hydrogen bonds form dimers with R 2 2(14) and R 2 2(12) ring motifs, respectively, between consecutive mol-ecules along the c-axis direction. Inter-molecular N-H⋯O and C-H⋯O hydrogen bonds connect these dimers, forming a three-dimensional network. C-H⋯π inter-actions and π-π stacking inter-actions contribute to the stabilization of the mol-ecular packing. A Hirshfeld surface analysis indicates that the contributions from the most prevalent inter-actions are H⋯H (47.1%), C⋯H/H⋯C (20.9%), O⋯H/H⋯O (15.3%) and N⋯H/H⋯N (11.4%).

Crystal structure and Hirshfeld surface analysis of 3-cyano-4-hy-droxy-2-(4-methyl-phen-yl)-6-oxo-N-phenyl-4-(thio-phen-2-yl)cyclo-hexane-1-carbox-amide 0.04-hydrate.

In the title compound, C25H22N2O3S·0.04H2O, the central cyclo-hexane ring adopts a chair conformation. In the crystal, mol-ecules are linked by N-H⋯O, C-H⋯O, and C-H⋯N hydrogen bonds, forming the mol-ecular layers parallel to the bc plane, which inter-act by the van der Waals forces between them. A Hirshfeld surface analysis indicates that the contributions from the most prevalent inter-actions are H⋯H (41.2%), C⋯H/H⋯C (20.3%), O⋯H/H⋯O (17.8%) and N⋯H/H⋯N (10.6%).

Ethyl 4-(5-bromo-2-hy-droxy-phen-yl)-2,7,7-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

In the title compound, C21H24BrNO4, the dihedral angle between the heterocyclic ring and the pendant aromatic ring is 80.20 (13)°. The hexahydroquinone [i.e. the one with the C=O group] ring adopts a sofa conformation. An intra-molecular O-H⋯O hydrogen bond generates an S(6) ring motif. The ethyl group is disordered over two sets of sites with a refined site occupancy ratio of 0.633 (10):0.366 (10). In the crystal, mol-ecules are linked by N-H⋯O inter-actions, forming chains parallel to [101]. There are no significant C-H⋯π or π-π inter-actions in the crystal structure.

Ethyl 2,7,7-trimethyl-5-oxo-4-phenyl-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

In the title compound, C(21)H(25)NO(3), the hydro-pyridine ring that constitutes a part of the hexa-hydro-quinoline fused-ring system adopts a sofa conformation; the methine C atom deviates from the least-squares plane defined by the remaining five non-H atoms (r.m.s. deviation = 0.088 Å) by 0.454 (3) Å. The phenyl ring is aligned at 85.5 (1)° with respect to this mean plane. In the crystal, adjacent molecules are linked via an N-H⋯O hydrogen bond, involving the amino group and the carbonyl O atom of the fused-ring system, forming chains running along [100]. The ethyl group is disordered over two positions in a 0.609 (6):0.391 (6) ratio.