Vagal sparing gastrectomy: A systematic review and meta-analysis.

Radical gastrectomy is associated with significant functional complications. In appropriate patients may be amenable to less invasive resection aimed at preserving the vagal trunks. The aim of this systematic review and meta-analysis is to assess the functional consequences and oncological safety of vagal sparing gastrectomy (VSG) compared to conventional non-vagal sparing gastrectomy (CG). A systematic review of four databases was undertaken for studies published between 1/11990 and 15/122021, comparing patients who underwent VSG to CG. We meta-analysed the following outcomes: operative time, blood loss, nodal yield, days to flatus, body weight changes, as well as the incidence of post-operative cholelithiasis, diarrhoea, delayed gastric emptying, and dumping syndrome. Thirty studies were included in the meta-analysis with a selection of studies qualitatively analysed. VSG was associated with a lower rate of cholelithiasis (OR 0.25, 95% CI 0.15-0.41, p<0.010) and early dumping syndrome (OR 0.42, 95% CI 0.21 - 0.86; p=0.02), less blood loss (MD -51 ml, 95% CI -89.11 to -12.81 ml, p=0.009), less long term weight loss (MD 2.03%, 95% CI 0.31-3.76%, p=0.02) and a faster time to flatus (MD -0.42 days, 95% CI -0.48 - 0.36, p<0.001). There was no significant difference in nodal harvest, overall survival, and all other endpoints. VSG significantly reduces the incidence of post-operative cholelithiasis and dumping syndrome, decreases weight loss and facilitates an earlier return of gut motility. Although technically more challenging, VSG should be considered for prophylactic surgery.

Understanding Potentially Preventable Mortality Following Oesophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality.

INTRODUCTION: At a national level, understanding preventable mortality after oesophago-gastric cancer surgery can direct quality-improvement efforts. Accordingly, utilizing the Australian and New Zealand Audit of Surgical Mortality (ANZASM), we aimed to: (1) determine the causes of death following oesophago-gastric cancer resections in Australia, (2) quantify the proportion of potentially preventable deaths, and (3) identify clinical management issues contributing to preventable mortality. METHODS: All in-hospital mortalities following oesophago-gastric cancer surgery from 1 January 2010 to 31 December 2020 were analysed using ANZASM data. Potentially preventable and non-preventable cases were compared. Thematic analysis with a data-driven approach was used to classify clinical management issues. RESULTS: Overall, 636 complications and 123 clinical management issues were identified in 105 mortalities. The most common causes of death were cardio-respiratory in aetiology. Forty-nine (46.7%) deaths were potentially preventable. These cases were characterized by higher rates of sepsis (59.2% vs 33.9%, p = 0.011), multiorgan dysfunction syndrome (40.8% vs 25.0%, p = 0.042), re-operation (63.3% vs 41.1%, p = 0.031) and other complications compared with non-preventable mortality. Potentially preventable mortalities also had more clinical management issues per patient [median (IQR): 2 (1-3) vs 0 (0-1), p < 0.001), which adversely impacted preoperative (30.6% vs 7.1%, p = 0.002), intraoperative (18.4% vs 5.4%, p = 0.037) and postoperative (51.0% vs 17.9%, p < 0.001) care. Thematic analysis highlighted recurrent areas of deficiency with preoperative, intraoperative and postoperative patient management. CONCLUSIONS: Almost 50% of deaths following oesophago-gastric cancer resections were potentially preventable. These were characterized by higher complication rates and clinical management issues. We highlight recurrent themes in patient management to improve future quality of care.

Para-conduit diaphragmatic hernia following esophagectomy-the new price of minimally invasive surgery?

Esophageal Cancer is the seventh commonest cancer worldwide with poor overall survival. Significant morbidity related to open esophagectomy has driven practice toward hybrid, totally minimally invasive and robotic procedures. With the increase in minimally invasive approaches, it has been suggested that there might be an increased incidence of subsequent para-conduit diaphragmatic hernia. To assess the incidence, modifiable risk factors and association with operative approach of this emerging complication, we evaluated outcomes following esophagectomy from two Australian Centers. Prospectively collected databases were examined to identify patients who developed versus did not develop a para-conduit hernia. Patient characteristics, disease factors, treatment factors, operative and post-operative factors were compared for these two groups. A total of 24 of 297 patients who underwent esophagectomy were diagnosed with a symptomatic para-conduit diaphragmatic hernia (8.1%). The significant risk factor for hernia was a minimally invasive abdominal approach (70.8% vs. 35.5%; P = 0.004, odds ratio = 12.876, 95% CI 2.214-74.89). Minimally invasive thoracic approaches were not associated with increased risk. Minimally invasive abdominal approaches to esophagectomy doubled the risk of developing a para-conduit diaphragmatic hernia. Effective operative solutions to address this complication are required.

Use of regression models for development of a simple and effective biogas decision-support tool.

Anaerobic digestion (AD) is an alternative way to treat manure while producing biogas as a renewable fuel. To increase the efficiency of AD performance, accurate prediction of biogas yield in different working conditions is necessary. In this study, regression models were developed to estimate biogas production from co-digesting swine manure (SM) and waste kitchen oil (WKO) at mesophilic temperatures. A dataset was collected from the semi-continuous AD studies across nine treatments of SM and WKO, evaluated at 30, 35 and 40 °C. Application of polynomial regression models and variable interactions with the selected data resulted in an adjusted R2 value of 0.9656, much higher than the simple linear regression model (R2 = 0.7167). The significance of the model was observed with the mean absolute percentage error score of 4.16%. Biogas estimation using the final model resulted in a difference between predicted and actual values from 0.2 to 6.7%, except for one treatment which was 9.8% different than observed. A spreadsheet was created to estimate biogas production and other operational factors using substrate loading rates and temperature settings. This user-friendly program could be used as a decision-support tool to provide recommendations for some working conditions and estimation of the biogas yield under different scenarios.

Exploration of SARS-CoV-2 Mpro Noncovalent Natural Inhibitors Using Structure-Based Approaches.

With the emergence of antibody-evasive omicron subvariants (BA.2.12.1, BA.4, and BA.5), which can compromise the efficacy of vaccination, it is of utmost importance to widen the finite therapeutic options for COVID-19. Although more than 600 co-crystal complexes of Mpro with inhibitors have been revealed, utilizing them to search for novel Mpro inhibitors remains limited. Although there were two major groups of Mpro inhibitors, covalent and noncovalent inhibitors, noncovalent inhibitors were our main focus due to the safety concerns with their covalent counterparts. Hence, this study aimed to explore Mpro noncovalent inhibition ability of phytochemicals extracted from Vietnamese herbals by combining multiple structure-based approaches. By closely inspecting 223 complexes of Mpro with noncovalent inhibitors, a 3D-pharmacophore model representing typical chemical features of Mpro noncovalent inhibitors was generated with good validation scores (sensitivity = 92.11%, specificity = 90.42%, accuracy = 90.65%, and goodness-of-hit score = 0.61). Afterward, the pharmacophore model was applied to explore the potential Mpro inhibitors from our in-house Vietnamese phytochemical database, revealing 18 substances, 5 of which were in vitro assayed. The remaining 13 substances were then examined by induced-fit molecular docking, revealing 12 suitable compounds. A machine-learning activity prediction model was developed to rank the hit, suggesting nigracin and calycosin-7-O-ß-glucopyranoside as promising Mpro natural noncovalent inhibitors.

In silico approach to identify novel allosteric intracellular antagonist for blocking the interleukin-8/CXCR2 receptor signaling pathway.

The role of interleukin-8 (IL-8) and its receptor CXCR2 in inflammatory responses and tumor development and progression has been well documented. Our study aims to discover novel compounds as CXCR2 antagonists to block the IL-8 signaling pathway using an in silico drug design. Herein, a structure-based pharmacophore model was developed based on the crystal structure of inactive CXCR2 in a complex with an allosteric inhibitor. This model was validated and refined, followed by virtual screening with the ZINC15 database. Subsequent molecular docking allows for predicting the best pose of a ligand inside a receptor binding site. We found that the 35 top-ranked hits exhibited docking scores from -30.81 to -25.28 kJ/mol and better interaction potential comparing the reference inhibitor. Analysis of ADME and toxicity properties revealed the efficacy and safety of the selected seven compounds. To validate the stability of the protein-ligand complex structure MD simulations approach has also been performed and confirmed via the critical parameters. The MD results explained that the CXCR2 receptor bound with two best-proposed molecules, including ZINC77105530 and ZINC93176465, was quite stable states as observed from low RMSD, RMSF, Rg, SASA values, and high occupancy of the interaction types. Finally, our data identified that these compounds play as potential inhibitors of IL-8 signaling pathways with the MM/GBSA binding free energies of -41.77 ± 6.45 kcal/mol and -38.84 ± 6.16 kcal/mol, respectively.Communicated by Ramaswamy H. Sarma.

Tumor-Infiltrating Neutrophils after Neoadjuvant Therapy are Associated with Poor Prognosis in Esophageal Cancer.

BACKGROUND: In esophageal cancer (EC), there is a paucity of knowledge regarding the interplay between the tumor immune microenvironment and response to neoadjuvant treatment and, therefore, which factors may influence outcomes. Thus, our goal was to investigate the changes in the immune microenvironment with neoadjuvant treatment in EC by assessing the expression of immune related genes and their association with prognosis. METHODS: We examined the transcriptome of paired pre- and post-neoadjuvant treated EC specimens. Based on these findings, we validated the presence of tumor-infiltrating neutrophils using CD15+ immunohistochemistry in a discovery cohort of patients with residual pathologic disease. We developed a nomogram as a predictor of progression-free survival (PFS) incorporating the variables CD15+ cell count, tumor regression grade, and tumor grade. RESULTS: After neoadjuvant treatment, there was an increase in genes related to myeloid cell differentiation and a poor prognosis associated with high neutrophil (CD15+) counts. Our nomogram incorporating CD15+ cell count was predictive of PFS with a C-index of 0.80 (95% confidence interval [CI] 0.68-0.9) and a concordance probability estimate (CPE) of 0.77 (95% CI 0.69-0.86), which indicates high prognostic ability. The C-index and CPE of the validation cohort were 0.81 (95% CI 0.69-0.91) and 0.78 (95% CI 0.7-0.86), respectively. CONCLUSIONS: Our nomogram incorporating CD15+ cell count can potentially be used to identify patients at high risk of recurrent disease and thus stratify patients who will benefit most from adjuvant treatment.

Invasion Pattern of Aedes aegypti in the Native Range of Ae. albopictus in Vietnam Revealed by Biogeographic and Population Genetic Analysis.

Since its introduction to Asia, Aedes aegypti has coexisted with the native species Ae. albopictus and has been reported to transmit several infectious diseases. However, the development of efficient disease prevention and vector control is hindered by the relatively poor understanding of the biogeography and the genetic diversity of Ae. aegypti in the region. This study aimed to determine the invasion patterns of Ae. aegypti by evaluating the distribution and abundance of Ae. aegypti and Ae. albopictus in different climatic regions (northern temperate and southern tropical regions) and habitats (domestic, peri-domestic, and natural). We further analyzed the genetic diversity and phylogenetic relationships of Ae. aegypti populations in Vietnam using mitochondrial COI gene sequences. Both Aedes species were observed at most of the study sites, but only Ae. albopictus thrived in northern mountainous areas. In sympatric ranges, the individual abundance of the species was influenced by regional climate and habitats. The tropical climate and availability of domestic containers facilitated the dominance of Ae. aegypti, whereas temperate climates and natural breeding sites facilitated that of Ae. albopictus. In addition, many genetic polymorphisms were detected in the Ae. aegypti populations, which formed two distinct genetic groups; however, this genetic diversity is unlikely to be relevant to the invasive success of Ae. aegypti. These findings provide insights into the mechanisms and patterns of Ae. Aegypti invasion, which depend on the climate and reproductive strategies in the native range of Ae. albopictus in Asia.

Optimization and microbial diversity of anaerobic co-digestion of swine manure with waste kitchen oil at high organic loading rates.

Anaerobic co-digestion of swine manure (SM) and waste kitchen oil (WKO) was conducted to evaluate the effect of high organic loading rates (OLRs) on biogas production efficiency and microbial changes. Combinations of different loading rates of SM and WKO, with total OLRs from 2 to 8 g VS (volatile solid)/L/d, were evaluated in a laboratory-scale study. While feeding more than 4 g VSSM/L/d did not result in higher biogas production in both mono- and co-digestion scenarios, the addition of WKO increased the total OLR up to 6 g VS/L/d without significant reduction of system productivity. Biogas yields of M2O1 (2 g VSSM/L/d + 1 g VSWKO/L/d) and M4O2 were 910 ± 35 and 849 ± 85 mL/g VSfed which were 25.2 % and 16.9 % higher than the mono-digestion of M2, respectively. A significant increase of bacterial alpha-diversity (Shannon index) was observed in M2O1, at 233.0 ± 3.6 compared with 218.7 ± 5.1 of M2 (p < 0.05). Less bacterial alpha-diversity and accumulation of volatile fatty acids were observed in M4O1 and M4O2, suggesting their potential instability. When digesters were fed with M2, the introduction of 1.4 g VSWKO/L/d or more did not increase biogas yield and could cause system imbalance. The study suggests the limit of WKO could be increased when higher OLRs of SM were applied but should not be more than 4 g VSSM/L/d, and ratio between SM and WKO should be considered to avoid failure. Some of the system disturbances took up to three months to show.

Role of the predaceous mosquito Toxorhynchites christophi (Diptera: Culicidae) in treehole ecosystems in a Korean forest.

Toxorhynchites mosquitoes have been studied as potential biological mosquito control agents because they consume other mosquito larvae. As a top predator, Toxorhynchites species are also considered keystone predators in phytotelmata. However, limited information is available regarding Toxorhynchites christophi, which is found in northeast Asia. The present study investigated whether Tx. christophi could reduce mosquito populations and increase species diversity by functioning as a mosquito control agent and keystone predator, respectively. During the study, aquatic insects were collected every three weeks (May-October, 2018) from tire habitats, which resemble treehole ecosystems, at the Korean National Arboretum in the central region of the Korean Peninsula. The samples were separated into the surface- and the substrate-groups based on their behavior, and the communities were compared based on the density of Tx. christophi. As a result, the communities with a higher density of the predators showed a higher diversity and evenness, and the communities also had a lower mosquito ratio, dominance, and density of the surface-group. The results of both non-metric multi-dimensional scaling and one-way analysis of similarities also indicated that the communities were affected by the density of Tx. christophi larvae. Similarity percentage analysis results revealed the effects of this predator on the communities could mainly be attributed to reductions in the densities of the three dominant mosquito species (Aedes koreicus, Ae. flavopictus, and Tripteroides bambusa). Thus, Tx. christophi may be valuable as both a biological mosquito control agent and keystone species of treehole ecosystems by reducing dominant mosquito species and improving species diversity.

Potential Clinical Utility of a Targeted Circulating Tumor DNA Assay in Esophageal Adenocarcinoma.

OBJECTIVE: To explore the clinical utility of circulating tumor DNA (ctDNA) in esophageal adenocarcinoma (EAC) by developing a cost-effective and rapid technique utilising targeted amplicon sequencing. SUMMARY OF BACKGROUND DATA: Emerging evidence suggests that levels of ctDNA in the blood can be used to monitor treatment response and in the detection of disease recurrence in various cancer types. Current staging modalities for EAC such as computerised tomography of the chest/abdomen/pelvis (CT) and positron emission tomography (PET) do not reliably detect occult micro-metastatic disease, the presence of which signifies a poor prognosis. After curative-intent treatment, some patients are still at high risk of recurrent disease, and there is no widely accepted optimal surveillance tool for patients with EAC. METHODS: Sixty-two patients with EAC were investigated for the presence of ctDNA using a tumor-informed approach. We designed a custom targeted amplicon sequencing panel of target specific primers covering mutational foci in 9 of the most commonly mutated genes in EAC. Serial blood samples were taken before and after neoadjuvant treatment (NAT), and during surveillance. RESULTS: Somatic mutations were detected in pre-treatment biopsy samples of 55 out of 62 (89%) EAC patients. Mutations in TP53 (80%) were the most common. Out of these 55 patients, 20 (36%) had detectable ctDNA at baseline. The majority (90%) of patients with detectable ctDNA had either locally advanced tumors, nodal involvement or metastatic disease. In patients with locally advanced tumors, disease free survival (DFS) was more accurately stratified using pre-treatment ctDNA status [HR 4.34 (95% CI 0.93-20.21); P = 0.05] compared to nodal status on PET-CT. In an exploratory subgroup analysis, patients who are node negative but ctDNA positive have inferior DFS [HR 11.71 (95% CI 1.16-118.80) P = 0.04]. In blood samples taken before and following NAT, clearance of ctDNA after NAT was associated with a favourable response to treatment. Furthermore, patients who are ctDNA positive during post-treatment surveillance are at high risk of relapse. CONCLUSIONS: Our study shows that ctDNA has potential to provide additional prognostication over conventional staging investigation such as CT and PET. It may also have clinical utility in the assessment of response to NAT and as a biomarker for the surveillance of recurrent disease.

Increased risk of diaphragmatic herniation following esophagectomy with a minimally invasive abdominal approach.

OBJECTIVE: Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. METHODS: A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. RESULTS: This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. CONCLUSIONS: In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.

Two siblings with non-classic P450scc deficiency resulted from a novel mutation in CYP11A1 gene misdiagnosed as familial glucocorticoid deficiency.

P450scc deficiency due to CYP11A1 gene mutations is a rare cause of primary adrenal insufficiency (PAI) in children. We reported two young siblings with PAI presented with hyperpigmentation. They were referred to our clinic with a diagnosis of familial glucocorticoid deficiency (FGD), another rare cause of PAI. However, further hormonal evaluation revealed increased plasma renin activity, which was not congruent with the diagnosis of FGD. Genetic analysis showed the compound heterozygous mutations in exon 8 of the CYP11A1 gene, including a missense mutation, R466W (c1396C>T), and a nonsense mutation, R439X (c1315C>T). A case responded well to hydrocortisone, while another case received prednisolone due to her unresponsiveness to hydrocortisone. To correctly diagnose P450scc deficiency, physicians should be alerted with the similarity between this disease and FGD because of their predominant glucocorticoid deficiency. Long-acting glucocorticoids may be used with caution to reach treatment goals.

Genetic Diversity and Population Structure of the Asian Tiger Mosquito (Aedes albopictus) in Vietnam: Evidence for Genetic Differentiation by Climate Region.

Aedes albopictus is a native mosquito to Southeast Asia with a high potential for disease transmission. Understanding how Ae. albopictus populations that develop in the species' native range is useful for planning future control strategies and for identifying the sources of invasive ranges. The present study aims to investigate the genetic diversity and population structure of Ae. albopictus across various climatic regions of Vietnam. We analyzed mitochondrial cytochrome oxidase I (COI) gene sequences from specimens collected from 16 localities, and we used distance-based redundancy analysis to evaluate the amount of variation in the genetic distance that could be explained by both geographic distance and climatic factors. High levels of genetic polymorphism were detected, and the haplotypes were similar to those sequences from both temperate and tropical regions worldwide. Of note, these haplotype groups were geographically distributed, resulting in a distinct population structure in which northeastern populations and the remaining populations were genetically differentiated. Notably, genetic variation among the Ae. albopictus populations was driven primarily by climatic factors (64.55%) and to a lesser extent was also influenced by geographic distance (33.73%). These findings fill important gaps in the current understanding of the population genetics of Ae. albopictus in Vietnam, especially with respect to providing data to track the origin of the invaded regions worldwide.

Atypical gnathostomiasis-confirmed cutaneous larva migrans, Vietnam.

We reported a case of gnathostomiasis in a 42-year-old woman with an unclear history of eating high-risk foods and had a non-migratory skin lesion, negative serological testing and normal blood eosinophil counts. A diagnosis of gnathostomiasis was based on a live, third-stage Gnathostoma spinigerum larva that was randomly taken from the patient's skin lesion by herself. The presenting case report demonstrates challenges in correctly diagnose cutaneous gnathostomiasis even in endemic countries due to atypical skin lesions, negative serology testing and the absence of eosinophilia and thus, the widely used classic triad of suggestive evidence of gnathostomiasis is not fulfilled.