Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy.

The hemidouble stapler technique (HDST) in laparoscopic intracorporeal esophagojejunostomy has aspects that pose risks to the safety of the anastomosis. We developed a new esophagojejunostomy technique that converts a double-stapled anastomosis to a single-stapled anastomosis in laparoscopic total gastrectomy (LTG). The aim of this study is to compare the results of two techniques. Patients who underwent LTG for gastric cancer in our hospital between October 2016 and May 2022 were included in the study. Patients were retrospectively reviewed in two groups: those who underwent HDST and the ghosting double stapling technique (GDST). Both groups were analysed in terms of demographics, perioperative findings, and postoperative outcomes. The GDST was used in 14 patients. The HDST was used on 16 patients. Two patients in the HDST group whose esophagojejunal anastomosis was not assessed on endoscopic imaging were excluded. The mean total operative times were 292.6 ± 43.7 and 224.3 ± 36.1 min (p < 0.001). The mean times for esophagojejunostomy were 38.6 ± 4.3 and 26.8 ± 6.4 min (p < 0.001). One case of anastomotic stenosis was observed in the HDST group. Anastomotic leakage was not observed in both groups. However, there was no significant difference in overall morbidity between the groups (p > 0.05). Both HDST and GDST can be safely performed in the esophagojejunostomy for LTG.

One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass: A Randomized Prospective Trial.

Background and Objectives: One anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) surgeries are effective methods used in bariatric surgery. There are limited randomized studies comparing these procedures over more than 2 years. Here, we aimed to compare the 3-year results of two bariatric procedures. Materials and Methods: Patients included in this randomized prospective study were compared in OAGB and RYGB groups. A total of 55 patients, aged between 18 and 65, were eligible for the study. Thirteen patients who did not accept randomization were excluded. Patients were evaluated at 6, 12, 24, and 36 months postoperatively. Results: Three patients were excluded from the study due to loss of communication during the clinical follow-up and one due to death by amyotrophic lateral sclerosis, which started in the eighth month after surgery. The study was completed with a total of 38 patients (OAGB; n = 20, RYGB; n = 18). Patients in the two groups were similar in terms of age, gender, body mass index (BMI), and obesity-related comorbidities. At the end of 3-year follow-up, BMI in the OAGB and RYGB groups was 28.80 ± 4.53 kg/m2 and 29.17 ± 5.36 kg/m2, respectively (p = 0.822). Percentage total weight loss (TWL%) was similar. No significant differences were found between the groups regarding percentage excess weight loss (EWL%). Remission of comorbidities was similar. De novo refluxes developed in four OAGB patients; there were no occurrences of these in RYGB patients (p = 0.066). Conclusions: Both OAGB and RYGB are effective in the treatment of morbid obesity. The two procedures are similarly successful in terms of obesity-related comorbidities.

The Effects of Nasocomial SARS-CoV-2 Infection after Elective Gastrointestinal Oncologic Procedures: Single Center 30-day Follow-up Results.

Although there is extensive debate for the best treatment strategies, limited studies, which reflect the effects of postoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on mortality and hospital stay after elective gastrointestinal oncologic procedures were published. In order to contribute to the existing literature, a single-center, retrospective, cross-sectional study, including 301 patients who underwent elective gastrointestinal oncological procedures was planned. Patients' data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and SARS-CoV-2 preoperative screening tests were recorded. Four of them were postponed due to positive preoperative screening for SARS-CoV-2. 395 procedures were performed due to cancer originating from colon (105), rectum (91), stomach (74), periampullar region (16), distal pancreas (4), esophagus (3), retroperitoneum (2), ovary (2), endometrium (1), spleen (1) and small bowel (2). Laparoscopy was the approach of choice for 44 patients (14.7% vs. 85.3%). In the postoperative period, two patients were infected with SARS-CoV-2 and one of them died in the intensive care unit (n=1/2, 50% mortality). Two patients died due to surgical complications unrelated to SARS-CoV-2 (n=2/299, 0.67% mortality) (p<0.01). The mean hospital stay was longer in patients with SARS-CoV-2 infection (21.5 ± 9.1 - 8.2 ± 5.2 days, respectively, p<0.01). 298 patients were safely discharged (99%). During the pandemic elective gastrointestinal oncologic procedures may be safely performed; however, preoperative testing, precautions to minimize contamination should be performed strictly to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high and hospital stay is also significantly increased.

A novel stent fixation method for anastomotic leaks after gastrectomy: anchoring of the distal flare to the jejunum by using through-the-scope endoclips.

Introduction: An anastomotic leak is a life-threatening complication after gastrectomy. A fully covered, self-expandable, metal stent (FC-SEMS) can be used as an alternative to traditional surgical re-intervention. However, stent migration can be worrisome. Aim: To evaluate the feasibility and effectiveness of anchoring of the distal flare of the FC-SEMS to the jejunum by using through-the-scope (TTS) endoclips to prevent stent migration. Material and methods: Patients, who received a FC-SEMS capable of being fixed to the jejunum by using TTS endoclips due to an anastomotic leak after gastrectomy, were reviewed retrospectively. Demographic and clinical characteristics, the properties of the deployed stents, and outcomes were evaluated. Results: A total of 7 patients underwent FC-SEMS placement. The mean age was 59 ±13.8 years, and the mean body mass index was 29.8 ±8.4 kg/m2. All patients' American Society of Anesthesiologists scores were between II and IV. The mean time between gastrectomy and stent insertion was 6.7 ±6.1 days. Technical success was achieved in all patients. Stent migration was not observed in any of the patients. All but one were removed between 4 and 6 weeks after placement. The mean stent removal time was 37 ±4.6 days. Complete resolution of the leak was achieved in 6 patients. Conclusions: Anchoring of the distal flare of the FC-SEMS to the jejunum with TTS endoclips is feasible and may reduce the risk of migration. This inexpensive and safe technique may be proposed to patients with factors predictive of FC-SEMS migration.

Timing of laparoscopic cholecystectomy in patients with non-severe biliary pancreatitis.

Introduction: In patients with acute biliary pancreatitis (ABP), cholecystectomy is mandatory to prevent further biliary events, but the precise timing of laparoscopic cholecystectomy (LC) for non-severe disease remain a subject of ongoing debate. Aim: To prove which method - early or delayed LC - is the method of choice in the non-severe disease by examining rates of gallstone-related complications, dissection difficulty, conversion rate, morbidity, mortality, and length of hospital stay. Material and methods: We retrospectively analysed the data of patients diagnosed with non-severe ABP, who were followed and underwent LC in our department. Patients who met the inclusion criteria were divided in to the early (< 2 weeks) and the delayed groups (> 2 weeks). Results: The patients in the early and delayed groups (n = 43/39) were similar in terms of demographic characteristics, comorbidities, and severity of biliary pancreatitis. The mean time to surgery was 1.7 vs. 6.5 weeks in the early and late groups, respectively. Patients in the delayed group had a 17.9% readmission rate. The causes were acute pancreatitis (10.2%), cholangitis, and cholecystitis. The conversion and the difficult dissection rates were 11.6% vs. 12.8% and 13.95% vs. 20.51% in the early and delayed groups, respectively. Mortality was not observed in the groups. Morbidity rates were 4.6% vs. 5%, and mean length of hospital stay was 10 vs. 17 days in the early and delayed groups, respectively. Conclusions: Delayed LC increases the rate of biliary events and early LC does not increase the operative difficulty or morbidity in patients with ABP.

An ethnobotanical study in Midyat (Turkey), a city on the silk road where cultures meet.

BACKGROUND: Studies of ethnobotanical usages in south-eastern Turkey are rare. To widen this field of knowledge, we conducted an ethnobotanical study in Midyat (Mardin Province), Turkey. METHODS: The field study was completed during three years (2007-2010). Our aim was to document the ethnobotanical uses of local plants and to make an ethnobotanical inventory of uncommon plants using qualitative interviews. RESULTS: During field studies, 368 voucher specimens were collected in the investigated area. Ninety-two traditionally used plant species were reported from Midyat and surrounding vicinities in Turkey. Among the 92 taxa (129 usages), 35% were used for medical purposes, 22% for food, 13% for animal fodder, 7% as ornamental plants and dyes, 6% as brooms, 4% for latex and as fragrance, 4% for herbal tea, molasses and wine preparation, 3% for agricultural purposes, and 6% for other purposes. Comparative assessment showed that Teucrium polium (0.51), Matricaria aurea (0.26), Alcea setosa (0.21), and Malva neglecta (0.21) have the highest recorded UVs, and the following taxa had UVs between 0.10-0.20: Anthemis cotula (0.12), Allium cepa (0.13), Alcea striata subsp. striata (0.14), Crupina crupinastrum (0.12), Papaver rhoeas (0.13), Salvia multicaulis (0.14), Thymbra spicata (0.11), and Vicia pannonica subsp. striata (0.15). We reported the ethnobotanical usages of 21 taxa for the first time, in addition to indicating usages previously recorded in the literature. We also recorded four endemic plant usages in the area: Alkanna trichophila var. mardinensis, Centaurea kurdica, Centaurea stapfiana, and Sideritis libanotica subsp. linearis. They have variable leaf and flower morphology that are used traditionally. They are present as well-developed populations and thus their conservation status is not compromised. Additionally, Thymbra sintenisii is a recorded species that is classified as a rare and extensively used species in the region. CONCLUSIONS: These results contribute to the fundamental knowledge of ethnobotanical usages in Midyat. To date, ethnobotanical studies have not been carried out in this region. This investigation uncovered usages of endemic medicinal plant species and traditional knowledge of Midyat communities living in a mixed culture. The people of Midyat, Batman, and Sirnak are Turkish citizens from various ethnic backgrounds, such as Kurdish, Arabic, and Syriac. We compared our data with results from other studies conducted in Turkey, particularly in south-eastern and eastern regions, as well as with studies from bordering countries, Iraq, Jordan, Syria, and Iran. Nonetheless, more work needs to be conducted to extend the present knowledge for locals to contribute to and evaluate economic potential in the region.

Cycloartane and oleanane-type glycosides from Astragalus pennatulus.

Four new cycloartane and one new oleanane-type glycosides were isolated from Astragalus pennatulus along with five known cycloartane-type glycosides. The structures of the new compounds were established as 3-O-ß-D-xylopyranosyl-6-O-ß-D-glucopyranosyl-3ß,6α,16ß-trihydroxy-24-oxo-20(R),25-epoxycycloartane (1), 3-O-[ß-D-glucuronopyranosyl-(1 → 2)-ß-D-xylopyranosyl]-3ß,16ß,24α-trihydroxy-20(R),25-epoxycycloartane (2), 3-O-[ß-D-glucuronopyranosyl-(1 → 2)-ß-D-xylopyranosyl]-3ß,16ß,25-trihydroxy-20(R),24(S)-epoxycycloartane (3), 3,25-di-O-ß-D-glucopyranosyl-6-O-ß-D-xylopyranosyl-3ß,6α,16ß,25-tetrahydroxy-20(R),24(S)-epoxycycloartane (4), 29-O-α-L-rhamnopyranosyl-abrisapogenol B (5) by 1D and 2D-NMR experiments along with ESIMS and HRMS analyses. The aglycone of compound 1, 3ß,6α,16ß-trihydroxy-24-oxo-20(R),25-epoxycycloartane, is reported for the first time. The cytotoxic activity of the isolated compounds was evaluated against three cancer cell lines including A549 (human lung adenocarcinoma), A375 (human melanoma) and DeFew (human B lymphoma) cells. None of the tested compounds caused a significant reduction of the cell number.

Revision of the species of the Merodon nanus group (Diptera: Syrphidae) including three new species.

The nanus group of the genus Merodon Meigen (Diptera, Syrphidae) is revised, yielding an illustrated key, a discussion of taxonomic characters and morphological diagnosis for the five species of this group. Three new cryptic species are described, Merodon kopensis Vujic et Hayat sp. n., M. neonanus Vujic et Taylor sp. n. and M. rasicus Vujic et Radenkovic sp. n. New diagnostic characters are given for M. nanus Sack and M. telmateia Hurkmans. In addition, environmental profiles for each investigated species have been defined and compared, and maps of distribution and richness created. Niche dissimilarity was found for each species. Eastern Anatolia and the southern Aegean region of Turkey are reported as the most species rich regions for the nanus group.

Monoterpenoid glucoindole alkaloids and iridoids from Pterocephalus pinardii.

A new secondary metabolite, pterocephaline, along with the known cantleyoside, 7alpha-morroniside, 3beta,5alpha-tetrahydrodesoxycordifoline lactam, 5S-5-carboxyvincoside, sweroside, and loganin have been isolated from the aerial parts of P. pinardii (Dipsacaceae). Moreover, cantleyoside-methyl-hemiacetal and cantleyoside-dimethyl-acetal were obtained as seco-iridoid artifacts. The structures were elucidated by extensive spectroscopic methods including 1D-((1)H, (13)C and TOCSY) and 2D-NMR (DQF-COSY, HSQC and HMBC). Monoterpenoid glucoindole alkaloids were encountered for the first time in Dipsacaceae family.

Triterpene glycosides from the roots of Astragalus flavescens.

Six new triterpene saponins, 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-21-epi-kudzusapogenol A (1), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-21-epi-kudzusapogenol A (2), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-22-O-beta-D-glucopyranosyl-21-epi-kudzusapogenol A (3), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-22-O-beta-D-glucopyranosyl-21-epi-kudzusapogenol A (4), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-22-O-alpha-L-arabinopyranosyl-21-epi-kudzusapogenol A (5), and 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl-(1-->2)-beta-D-glucuronopyranosyl-22-O-alpha-L-arabinopyranosyl-21-epi-kudzusapogenol A (6), were isolated from the roots of Astragalus flavescens, together with the known trajanoside B, azukisaponin V, and astragalosides IV, VII, and VIII. Their structures were established mainly by 2D NMR techniques and mass spectrometry.

Chionaeosides A-D, triterpene saponins from Paronychia chionaea.

Four new triterpenoid saponins, chionaeosides A-D (1-4) were isolated from the roots of Paronychia chionaea. On the basis of their spectroscopic data, the structures of the new saponins were established as 3-O-alpha-L-arabinopyranosylgypsogenic acid 28-O-beta-D-glucopyranosyl-(1-->3)-beta-D-glucopyranosyl-(1-->6)-beta-D-glucopyranoside (1), 3-O-alpha-L-arabinopyranosylgypsogenic acid 28-O-beta-D-glucopyranosyl-(1-->6)-beta-D-glucopyranoside (2), 3-O-alpha-L-arabinopyranosylgypsogenic acid 28-O-beta-D-glucopyranoside (3), and 3-O-alpha-L-arabinopyranosylgypsogenic acid (4).

Determination of naphthazarin derivatives in endemic Turkish Alkanna species by reversed phase high performance liquid chromatography.

The quantification of free and total alkannins in 13 endemic Anatolian Alkanna species is described for the first time. Extraction of the samples was performed by sonication with hexane, followed by hydrolysis in 1 N NaOH. For analysis, a new HPLC method, utilizing reversed phase material (Synergi Max RP), was developed and successfully validated. The obtained data confirmed that the assay is sensitive (LOD of 13 ng on-column for alkannin), accurate (the recovery rate was 92.3%) and precise (RSD