Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Traditional teaching has been to place patients in the left lateral decubitus starting position for colonoscopies. Recent randomized controlled trials (RCTs) have compared left lateral decubitus starting position to other approaches. The aim of this systematic review and meta-analysis was to compare different starting positions for colonoscopies and their effect on cecal intubation. METHODS: MEDLINE, Embase, and CENTRAL were searched from inception to July 2023. Articles were eligible for inclusion if they were RCTs comparing at least two different starting positions for adults undergoing colonoscopy. The main outcome was cecal intubation time. Meta-analysis used an inverse variance random effects model. Risk of bias was assessed with the Cochrane Tool for RCTs 2.0. RESULTS: After screening 1523 citations, 14 RCTs were included. Four studies compared left lateral decubitus to right lateral decubitus, four studies compared left lateral decubitus to left lateral tilt-down, three studies compared left lateral decubitus to prone, and three studies compared left lateral decubitus to supine. There were no statistically significant differences in cecal intubation time in seconds across all comparisons: left lateral decubitus vs. right lateral decubitus (MD 14.9, 95% CI - 111.8 to 141.6, p = 0.82, I2 = 85%); left lateral decubitus vs. left lateral tilt-down (MD - 31.3, 95% CI - 70.8 to 8.3, p = 0.12, I2 = 82%); left lateral decubitus vs. prone (MD 17.2, 95% CI - 174.9 to 209.4, p = 0.86, I2 = 94%); left lateral decubitus vs. supine (MD - 149.9, 95% CI - 443.6 to 143.9, p = 0.32, I2 = 89%). CONCLUSION: The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study.

OBJECTIVE: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. SUMMARY BACKGROUND DATA: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. METHODS: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. RESULTS: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. CONCLUSION: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

Modes of Action of a Bi-domain Plant Defensin MtDef5 Against a Bacterial Pathogen Xanthomonas campestris.

Defensins are small cysteine-rich endogenous host defense peptides expressed in all higher plants. They are thought to be important players in the defense arsenal of plants against fungal and oomycete pathogens. However, little is known regarding the antibacterial activity of these peptides. The genome of the model legume Medicago truncatula contains 63 genes each encoding a defensin with a tetradisulfide array. A unique bi-domain defensin, designated MtDef5, was recently characterized for its potent broad-spectrum antifungal activity. This 107-amino acid defensin contains two domains, 50 amino acids each, linked by a short peptide APKKVEP. Here, we characterize antibacterial activity of this defensin and its two domains, MtDef5A and MtDef5B, against two economically important plant bacterial pathogens, Gram-negative Xanthomonas campestris and Gram-positive Clavibacter michiganensis. MtDef5 inhibits the growth of X. campestris, but not C. michiganensis, at micromolar concentrations. MtDef5B, but not MtDef5A, exhibits more potent antibacterial activity than its parent MtDef5. MtDef5 and each of its two domains induce distinct morphological changes and cell death in X. campestris. They permeabilize the bacterial plasma membrane and translocate across membranes to the cytoplasm. They bind to negatively charged DNA indicating these peptides may kill bacterial cells by inhibiting DNA synthesis and/or transcription. The cationic amino acids present in the two γ-core motifs of MtDef5 that were previously shown to be important for its antifungal activity are also important for its antibacterial activity. MtDef5 and its more potent single domain MtDef5B have the potential to be deployed as antibacterial agents for control of a Xanthomonas wilt disease in transgenic crops.

A novel bi-domain plant defensin MtDef5 with potent broad-spectrum antifungal activity binds to multiple phospholipids and forms oligomers.

Defensins are cysteine-rich cationic antimicrobial peptides contributing to the innate immunity in plants. A unique gene encoding a highly cationic bi-domain defensin MtDef5 has been identified in a model legume Medicago truncatula. MtDef5 consists of two defensin domains of 50 amino acids each linked by a 7-amino acid peptide. It exhibits broad-spectrum antifungal activity against filamentous fungi at submicromolar concentrations. It rapidly permeabilizes the plasma membrane of the ascomycete fungi Fusarium graminearum and Neurospora crassa and induces accumulation of reactive oxygen species. It is internalized by these fungi, but uses spatially distinct modes of entry into these fungi. It co-localizes with cellular membranes, travels to nucleus and becomes dispersed in other subcellular locations. It binds to several membrane-resident phospholipids with preference for phosphatidylinositol monophosphates and forms oligomers. Mutations of the cationic amino acids present in the two γ-core motifs of this defensin that eliminate oligomerization also knockout its ability to induce membrane permeabilization and fungal growth arrest. MtDef5 is the first bi-domain plant defensin that exhibits potent broad-spectrum antifungal activity, recruits multiple membrane phospholipids and forms oligomers in their presence. These findings raise the possibility that MtDef5 might be useful as a novel antifungal agent in transgenic crops.

Live-cell Imaging of Fungal Cells to Investigate Modes of Entry and Subcellular Localization of Antifungal Plant Defensins.

Small cysteine-rich defensins are one of the largest groups of host defense peptides present in all plants. Many plant defensins exhibit potent in vitro antifungal activity against a broad-spectrum of fungal pathogens and therefore have the potential to be used as antifungal agents in transgenic crops. In order to harness the full potential of plant defensins for diseases control, it is crucial to elucidate their mechanisms of action (MOA). With the advent of advanced microscopy techniques, live-cell imaging has become a powerful tool for understanding the dynamics of the antifungal MOA of plant defensins. Here, a confocal microscopy based live-cell imaging method is described using two fluorescently labeled plant defensins (MtDef4 and MtDef5) in combination with vital fluorescent dyes. This technique enables real-time visualization and analysis of the dynamic events of MtDef4 and MtDef5 internalization into fungal cells. Importantly, this assay generates a wealth of information including internalization kinetics, mode of entry and subcellular localization of these peptides. Along with other cell biological tools, these methods have provided critical insights into the dynamics and complexity of the MOA of these peptides. These tools can also be used to compare the MOA of these peptides against different fungi.

Assessment of toxic elements in the samples of different cigarettes and their effect on the essential elemental status in the biological samples of Irish hypertensive consumers.

Cigarette smoking causes an acute increase in blood pressure and heart rate and has been found to be associated with malignant hypertension (HT). A significant flux of toxic metals among other toxins reaches the lungs through smoking. In the present study, the relationship between essential (zinc and selenium) and toxic element (TE; cadmium and mercury) and HT incidence in smoker and nonsmoker population living in Dublin, Ireland was investigated. The zinc (Zn), selenium (Se), cadmium (Cd) and mercury (Hg) were determined in biological (scalp hair and blood) samples of smoker and nonsmoker hypertensive patients. For comparison purposes, healthy age- and sex-matched subjects as referents residing in the same city were also selected. The different brands of cigarette consumed by the studied population were also analyzed for Cd and Hg. The concentrations of essential trace and TEs in all studied samples were measured by inductively coupled plasma atomic emission spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology was checked using certified reference materials (CRMs). The recovery of all the studied elements was found to be in the range of 96.4-99.7% of certified values of CRMs. The filler tobacco of different branded cigarettes contains Hg and Cd concentrations in the range of 9.55-12.4 ng and 1.70-2.12 µg per cigarette, respectively. The results of this study showed that the mean values of Cd and Hg were significantly higher in scalp hair and blood samples of hypertensive patients as compared with healthy controls, whereas Zn and Se concentrations were found to be lower in hypertensive patients, the difference was significant in the case of smoker patients (P < 0.001). The levels of both TEs were 2-3-folds higher in scalp hair and blood samples of nonhypertensive smoker subjects as compared with nonsmoker controls. It was observed that exposure of TEs via cigarette smoking may be synergistic with other risk factors associated with HT.

Multivariate optimization of cloud point extraction procedure for zinc determination in aqueous extracts of medicinal plants by flame atomic absorption spectrometry.

Cloud point extraction method has been developed for preconcentration of trace quantities of zinc (Zn) in aqueous extract of medicinal plants and blood samples of liver cancer patients using flame atomic absorption spectrometry. The Zn in aqueous extracts of medicinal plants (MPs) was complexed with 2-methyl-8-hydroxyquinoline (quinaldine) and 1-(2-pyridylazo)-2-naphthol (PAN) separately and entrapped in a non-ionic surfactant Triton X-114. After centrifugation, the surfactant-rich phase was diluted with 0.25mL acidic ethyl alcohol. The multivariate strategy was applied to estimate the optimum values of experimental variables (pH, time temperature, ligands and surfactant concentrations). Interactions between analytical factors and their optimal levels were investigated by two level factorial designs. Student's t-test on the results of factorial design with 16 runs for Zn extraction, demonstrated that the factors, ligands concentrations, pH and temperature were statistically significant. The accuracy was assessed by analysis of certified reference materials, namely, BCR 101 (spruce needles), Clincheck control-lyophilized human whole blood. Enhancement factor of 30 and 26 were achieved for the preconcentration of Zn by 2-methyl-8-hydroxyquinoline (L1) and 1-(2-pyridylazo)-2-naphthol (L2), respectively. The relative standard deviation for six replicate determinations of Zn at 10µg/L level using 2-methyl-8-hydroxyquinoline (L1) and 1-(2-pyridylazo)-2-naphthol (L2) were <4% and >5%, respectively.

Determination of selenium content in aqueous extract of medicinal plants used as herbal supplement for cancer patients.

The chemical constituents in medicinal plants (MPs), including elements, are partially responsible for their medicinal and nutritional properties as well as toxic effects. This research aimed to monitor selenium (Se) contents in aqueous extract of MPs used for treatment of cancer and different diseases. In present work the Se in MPs was extracted in aqueous media by microwave-assisted (ME) and conventional extraction (CE) methods. The total and residual Se in MPs were determined, prior to microwave-assisted acid digestion. The Se in aqueous extracts and digests were analysed by electrothermal atomic absorption spectrometry. The optimum extractable Se in MPs were obtained by ME and CE, required 2 and 40 min, respectively. Precision and accuracy of the methodologies were checked by standard addition method. The Se contents in aqueous extract of MPs were found in the range of 1.09-2.23 µg/g corresponding to 21-33% of total Se contents. The daily intake of Se from aqueous extract of MPs as recommended by herbalist (10 g of plant material) was found in the range of 20-40% of daily requirement.

Evaluation of cadmium, lead, nickel and zinc status in biological samples of smokers and nonsmokers hypertensive patients.

The objective of this study was to evaluate the association between trace and toxic elements zinc (Zn), cadmium (Cd), nickel (Ni) and lead (Pb) in biological samples (scalp hair, blood and urine) of smoker and nonsmoker hypertensive patients (n=457), residents of Hyderabad, Pakistan. For the purpose of comparison, the biological samples of age-matched healthy controls were selected as referents. The concentrations of trace and toxic elements were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference materials and by the conventional wet acid digestion method on the same certified reference materials and real samples. The recovery of all the studied elements was found to be in the range of 97.8-99.3% in certified reference materials. The results of this study showed that the mean values of Cd, Ni and Pb were significantly higher in scalp hair, blood and urine samples of both smoker and nonsmoker patients than in referents (P<0.001), whereas the concentration of Zn was lower in the scalp hair and blood, but higher in the urine samples of hypertensive patients. The deficiency of Zn and the high exposure of toxic metals as a result of tobacco smoking may be synergistic with risk factors associated with hypertension.

Evaluation of arsenic, cobalt, copper and manganese in biological Samples of Steel mill workers by electrothermal atomic absorption Spectrometry.

The determination of trace and toxic elements in biological samples (blood, urine and scalp hair samples) of human beings is an important clinical test. The aim of our present study was to determine the concentration of arsenic (As), copper (Cu), cobalt (Co) and manganese (Mn), in biological samples of male production workers (PW) and quality control workers (QW) of steel mill, with aged 25-55 years, to assess the possible influence of environmental exposure. For comparison purpose, the same biological samples of unexposed healthy males of same age group were collected as control subjects. The determination of all elements in biological samples was carried out by electrothermal atomic absorption spectrometry, prior to microwave assisted acid digestion. The accuracy of the As, Cu, Co and Mn measurements was tested by simultaneously analyzing certified reference materials (CRMs) and for comparative purposes conventional wet acid digestion method was used on the same CRMs. No significant differences were observed between the analytical results and the certified values, using both methods (paired t-test at P > 0.05). The results indicate that concentrations of As, Cu, Co and Mn in all three biological samples of the exposed workers (QW and PW) were significantly higher than those of the controls. The possible correlation of these elements with the etiology of different physiological disorders is discussed. The results were also demonstrated the need of attention for improvements in workplace, ventilation and industrial hygiene practices.

Toxic metals distribution in different components of Pakistani and imported cigarettes by electrothermal atomic absorption spectrometer.

It was extensively investigated that a significant flux of toxic metals, along with other toxins, reaches the lungs through smoking. In present study toxic metals (TMs) (Al, Cd, Ni and Pb) were determined in different components of Pakistani local branded and imported cigarettes, including filler tobacco (FT), filter (before and after normal smoking by a single volunteer) and ash by electrothermal atomic absorption spectrometer (ETAAS). Microwave-assisted digestion method was employed. The validity and accuracy of methodology were checked by using certified sample of Virginia tobacco leaves (ICHTJ-cta-VTL-2). The percentages (%) of TMs in different components of cigarette were calculated with respect to their total contents in FT of all branded cigarettes before smoking, while smoke concentration has been calculated by subtracting the filter and ash contents from the filler tobacco content of each branded cigarette. The highest percentage (%) of Al was observed in ash of all cigarettes, with range 97.3-99.0%, while in the case of Cd, a reverse behaviour was observed, as a range of 15.0-31.3% of total contents were left in the ash of all branded cigarettes understudy.

Determination of cadmium in whole blood and scalp hair samples of Pakistani male lung cancer patients by electrothermal atomic absorption spectrometer.

A large number of epidemiologic studies have been undertaken to identify potential risk factors for cancer, amongst which the association with cadmium has received considerable attention. There is compelling evidence in support of positive associations between cadmium and risk of lung cancer. In present study we measured the concentration of Cd in whole blood and scalp hair samples of 120 male lung cancer patients (smokers) and 150 controls or referents (smokers and nonsmokers) from different cities of Pakistan. Both referents and patients were of same age group (ranged 40-70 years), socio-economic status, localities and dietary habits. The scalp hair and whole blood samples were oxidized by 65% nitric acid: 30% hydrogen peroxide (2:1) ratio in microwave oven. To check the validity of the proposed method, a conventional wet acid digestion method was used to obtain total Cd concentration in certified samples of human hair BCR 397 and Clincheck control-lyophilized human whole blood. All digests were analyzed for Cd concentration by electrothermal atomic absorption spectrometer (ETAAS). The results of this study showed that the average Cd concentration was higher in the blood and scalp hair of lung cancer patients at different stages as compared to controls (p<001). The smoker referents have high level of Cd in both biological samples as compared to nonsmoker subjects. These results illustrate that the patients who continued smoking after confirmed diagnosis of lung cancer have 34.2-67.26 and 22.4-57.3% more Cd in blood samples and scalp hair than lung cancer patients who cease smoking. This study is compelling evidence in support of positive associations between cadmium, cigarette smoking and lung cancer risk.

Malignant schwannoma of facial nerve.

The occurrence of malignant schwannoma in children is rare. A search of English language literature did not reveal involvement of cranial nerve among children.