Food applications of bioactive biomaterials based on gelatin and chitosan.

Food packaging must guarantee the products' quality during the different operations including packing and maintenance throughout transportation and storage until to consumption. Thus, it should satisfy, both, food freshness and quality preservation and consumers health safety. Natural bio-sourced polymers have been explored as safe edible materials for several packaging applications, being interestingly carrier of bioactive substances, once added to improve films' properties. Gelatin and chitosan are among the most studied biomaterials for the preparation of edible packaging films due to their excellent characteristics including biodegradability, compatibility and film-forming property. These polymers could be used alone or in combination with other polymers to produce composite films with the desired physicochemical and mechanical properties. When incorporated with bioactive substances (natural extracts, polyphenolic compounds, essential oils), chitosan/gelatin-based films acquired various biological properties, including antioxidant and antimicrobial activities. The emerging bioactive composite films with excellent physical attributes represent excellent packaging alternative to preserve different types of foodstuffs (fruits, meat, fish, dairy products, …) and have shown great achievements. This chapter provides the main techniques used to prepare gelatin- and chitosan- based films, showing some examples of bioactive compounds incorporated into the films' matrix. Also, it illustrates the outstanding advantages given by these biomaterials for food preservation, when used as coating and wrapping agents.

Utilizing adaptive deformable convolution and position embedding for colon polyp segmentation with a visual transformer.

Polyp detection is a challenging task in the diagnosis of Colorectal Cancer (CRC), and it demands clinical expertise due to the diverse nature of polyps. The recent years have witnessed the development of automated polyp detection systems to assist the experts in early diagnosis, considerably reducing the time consumption and diagnostic errors. In automated CRC diagnosis, polyp segmentation is an important step which is carried out with deep learning segmentation models. Recently, Vision Transformers (ViT) are slowly replacing these models due to their ability to capture long range dependencies among image patches. However, the existing ViTs for polyp do not harness the inherent self-attention abilities and incorporate complex attention mechanisms. This paper presents Polyp-Vision Transformer (Polyp-ViT), a novel Transformer model based on the conventional Transformer architecture, which is enhanced with adaptive mechanisms for feature extraction and positional embedding. Polyp-ViT is tested on the Kvasir-seg and CVC-Clinic DB Datasets achieving segmentation accuracies of 0.9891 ± 0.01 and 0.9875 ± 0.71 respectively, outperforming state-of-the-art models. Polyp-ViT is a prospective tool for polyp segmentation which can be adapted to other medical image segmentation tasks as well due to its ability to generalize well.

Impact of Helicobacter pylori Status on Postoperative Morbidities After Laparoscopic Sleeve Gastrectomy in an Endemic Region (a Retrospective Multicentric Study).

PURPOSE: Studies are still ongoing to determine whether Helicobacter pylori (HP) may affect the results of laparoscopic sleeve gastrectomy (LSG). The main research objectives were HP prevalence in patients with severe obesity and the effects of HP status on outcomes. PATIENTS AND METHODS: This multicenter retrospective study included patients with severe obesity who had LSG. The patients were grouped into three groups based on the HP status of preoperative endoscopic biopsies and postoperative specimen results: group I (negative HP), group II (eradicated HP), and group III (positive HP). The primary outcome was the overall postoperative morbidities. RESULTS: One thousand six hundred fifteen patients who underwent LSG for severe obesity were included in this study. Seven hundred fifty (46.4%) patients had negative HP, and 637 (39.4%) patients had eradicated HP, whereas 228 (14.1%) patients had positive HP. The antral and gastric body wall thickness was significantly noticed with positive HP. The groups had no significant differences regarding postoperative complication frequency, severity, and hospital mortality. The rates of gastric leakage in the three groups do not differ significantly. BMI > 50, gastropexy, gastric thickness, and antral resection were found to be independent risk factors for the occurrence of postoperative complications after LSG. There was no statistical significance as regards postoperative %TWL and %EWL among the three groups. CONCLUSION: The early results of LSG do not appear to be impacted by HP's status. The early postoperative course is unaffected by HP eradication anymore. Therefore, routine preoperative HP testing may not be as necessary, and management can be finished after LSG.

Prevalence, Risk Factors, and Management of Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy (a Retrospective Multicentric Study).

PURPOSE: Postoperative nausea and vomiting (PONV) is a frequent unappealing laparoscopic sleeve gastrectomy (LSG) sequel. The study's purpose was to determine the prevalence, risk factors of PONV, and management of PONV after LSG. PATIENTS AND METHODS: This multicenter retrospective study included patients with morbid obesity who had LSG between January 2022 and April 2023. The age range for LSG was 16 to 65 years, and the eligibility requirements included morbid obesity according to international guidelines. RESULTS: PONV was experienced by 74.6% of patients who underwent LSG at 6 h postoperative. Multivariate analysis revealed that female gender, smokers, preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were found to be independent protective variables against the development of PONV. Combined intravenous ondansetron and metoclopramide improved 92.6% of patients who developed PONV. Dexamethasone and antihistamines drugs are given for 42 cases with persistent PONV after using intravenous ondansetron and metoclopramide. Pain management postoperatively by opioid-free analgesia managed PONV. Helicobacter pylori status has no role in the development of PONV after LSG. CONCLUSION: Female gender, smoking, presence of preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were observed to be independent protective factors against the occurrence of PONV. Combined intravenous ondansetron and metoclopramide improved PONV. Dexamethasone and antihistamines drugs are given for persistent PONV.

Amino acids and protein profiles of defatted camel and cow milk fractions: correlation with their in vitro antioxidant and antidiabetic activities.

Introduction: This work presents proteins, amino acids profiles and antioxidant and properties of camel and cow milk fractions produced using an integrated coagulation-centrifugation process. Methods: Antioxidant activity using DPPH radical scavenging assay; and antidiabetic activity antidiabetic activity using in vitro α-amylase inhibitory activity were assessed on defatted milk fractions and their extracts using water/ethanol or HCl/ethanol solvents. Protein profiles and amino acids composition were analyzed by high-performance liquid chromatography. Results and discussions: The predominant protein found in cow and camel milk was ß-casein in sodium caseinate, ß-lactoglobulin was found in the whey of cow milk, whereas α-lactalbumin was detected in the whey fractions of camel. The primary amino acids (comprising 1% to 5.2%) in skim milk and sweet whey milk were leucine, proline, and lysine. However, acid whey, casein fractions (sodium caseinate, and ß-casein) from both camel and cow milk exhibited elevated concentrations of histidine, leucine, lysine and proline (1.12 - 6.62%). Camel milk and its different protein fractions showed an interesting in vitro α-amylase inhibitory activity varying, according to different milk fractions and extraction methods, from 19.10 ± 1.40 to 97.40 ± 1.50%. Whatever the used method, the whey fractions from camel milk, both acid and sweet, displayed ed the highest antioxidant activity. Principal components analysis showed a positive correlation between the total phenols content, antioxidant (DPPH assay) and antidiabetic (α amylase inhibition test) activities within the milk fractions. Sweet and acid cow milk fractions seem to be the most promising for deeper exploration of in vivo biological activities and are promising milk derivatives for specific nutritional diet and/or functional food formulation.

Integrative Systems Biology Approaches to Identify Potential Biomarkers and Pathways of Cervical Cancer.

Nowadays, cervical cancer (CC) is treated as the leading cancer among women throughout the world. Despite effective vaccination and improved surgery and treatment, CC retains its fatality rate of about half of the infected population globally. The major screening biomarkers and therapeutic target identification have now become a global concern. In the present study, we have employed systems biology approaches to retrieve the potential biomarkers and pathways from transcriptomic profiling. Initially, we have identified 76 of each up-regulated and down-regulated gene from a total of 4643 differentially expressed genes. The up-regulatory genes mainly concentrate on immune-inflammatory responses, and the down-regulatory genes are on receptor binding and gamma-glutamyltransferase. The involved pathways associated with these genes were also assessed through pathway enrichment, and we mainly focused on different cancer pathways, immunoresponse, and cell cycle pathways. After the subsequent enrichment of these genes, we have identified 12 hub genes, which play a crucial role in CC and are verified by expression profile analysis. From our study, we have found that genes LILRB2 and CYBB play crucial roles in CC, as reported here for the first time. Furthermore, the survivability of the hub genes was also assessed, and among them, finally, CXCR4 has been identified as one of the most potential differentially expressed genes that might play a vital role in the survival of CC patients. Thus, CXCR4 could be used as a prognostic and/or diagnostic biomarker and a drug target for CC.

Early and intermediate term outcomes after laparoscopic one-anastomosis gastric bypass for morbidly obese patients: a single center experience.

Objectives: To evaluate our outcomes of laparoscopic one-anastomosis gastric bypass (LOAGB) as a primary weight loss procedure. We evaluated the impact of biliary reflux by combination of upper endoscopy (UGIE), ambulatory pH metry, and ambulatory biliary reflux monitoring. Material and Methods: We reviewed the data of patients who underwent LOAGB during the period between July 2015 till August 2018. Results: Forty consecutive patients were included in the study. Thirty-seven patients (92.5%) had obesity related comorbidities. The median follow-up duration was 18 months (6-36 months). The 1-, 2-, and 3-years excess weight loss percentages were 53.1%, 60.4%, and 62.3%. At three years follow-up, complete remission of diabetes mellitus occurred in 7/7 patients (100%) and of hypertension in 4/7 patients (57.1%). Eighteen patients (45%) accepted to undergo UGIE with routine biopsies and evaluation of acidic and biliary reflux. All examined patients had negative acid reflux results according to ambulatory PH metry with median DeMeester score of 2 (0.3-8.7). According to ambulatory biliary reflux monitoring, 17/18 patients (94.1%) had posi- tive result. Only 6/18 patients (33.3%) had symptoms of biliary reflux and had positive symptom index on bilimetric study. Regarding UGIE, all patients had just gastritis and reflux esophagitis with no evidence of gross mucosal changes. Pathological examination of all routine biopsies did not show any sign of faveolar hyperplasia, atypia or malignancy. Conclusion: LOAGB is a safe and efficient bariatric procedure with acceptable morbidity rate. LOAGB is not associated with significant biliary reflux or pathological changes in the esophagogastric mucosa.

Arsenic and lead in the indoor residential settings of different socio-economic status; assessment of human health risk via dust exposure.

In the present study, occurrence of arsenic (As) and lead (Pb) is reported in rural and urban household dust (floor and AC filter dust) of the Kingdom of Saudi Arabia (KSA). Several studies have found concerning concentrations of these toxic metals in indoor dust from different countries, but data from this region is missing. The association between studied toxic metals and different socioeconomic parameters was investigated. Furthermore, health risk associated with these toxic metals via dust exposure was evaluated for the Saudi population. Mean concentration of Pb was several times higher than As in both types of dust samples. AC filter dust was more contaminated with these metals than floor dust. Levels of Pb were up to 775 ppm in AC filter dust from urban areas, while 167 ppm in rural AC filter dust. Different socioeconomic parameters did not influence much on the presence of studied metals in both AC and floor dust. To estimate health risk from contaminated dust hazardous index (HI), hazardous quotient (HQ), and incremental lifetime cancer risk (ILCR) via dust ingestion, inhalation, and dermal contact was calculate using USEPA equations. The ILCR range for both toxic metals was within the tolerable range of reference values of USEPA (1 × 10-5 to 5 × 10-7). Nonetheless, HI was close to 1 for Pb via dust exposure for young urban children, which signifies the risk of non-carcinogenic health problems in studied area. Graphical abstract.

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh.

As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform.A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 AM to 3:59 PM, 4 PM to 11:59 PM, and midnight to 7:59 AM.Participants' mean age was 31.4 (standard deviation ±â€Š13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P-value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries.This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.

Trace metals in different socioeconomic indoor residential settings, implications for human health via dust exposure.

In this study a number of heavy metals namely chromium (Cr), cadmium (Cd), zinc (Zn), barium (Ba), copper (Cu), manganese (Mn), cobalt (Co), rubidium (Rb), selenium (Se) are studied in the floor and air condition (AC) filter dust collected from urban and rural households of Saudi Arabia. To the best of our knowledge, many of these heavy metals are reported for the very first time in the indoor dust of Saudi Arabia. Studied metals were higher in urban dust than rural except Mn and Rb which were significantly higher (P < 0.05) in rural dust. All metals, except Cd, Zn, and Ba in urban settings, were detected at higher (P < 0.05) levels in AC filter dust than household floor dust from both rural and urban residential settings. Levels of the two dominant metals i.e., Zn and Mn were up to 1600 and 700 µg/g, respectively in studied dust samples. Also associations between heavy metals and a number of different socio-economic parameters were studied which was significant for some trace metals. In literature exposure to many of trace metals are associated with various health problems, therefore health risk assessment for the Saudi population was calculated by incremental lifetime cancer risk (ILCR) and hazardous index (HI) via dust ingestion, inhalation, and dermal contact. The ILCR for all metals was within the tolerable range of reference values of USEPA (1 × 10- 11 to 1 × 10- 4). However, calculated HI for Mn, Cu, Ni, and Zn was more than 1 via dust exposure, which signifies the non-carcinogenic risk. The study highlights the occurrence of toxic metals in the indoor environments of Saudi Arabia and provides baseline data for future studies on these toxic metals in the region.

Disruption of MAPK1 expression in the ERK signalling pathway and the RUNX1­RUNX1T1 fusion gene attenuate the differentiation and proliferation and induces the growth arrest in t(8;21) leukaemia cells.

The t(8;21) translocation is one of the most frequent chromosome abnormalities associated with acute myeloid leukaemia (AML). This abberation deregulates numerous molecular pathways including the ERK signalling pathway among others. Therefore, the aim of the present study was to investigate the gene expression patterns following siRNA­mediated suppression of RUNX1­RUNX1T1 and MAPK1 in Kasumi­1 and SKNO­1 cells and to determine the differentially expressed genes in enriched biological pathways. BeadChip microarray and gene ontology analysis revealed that RUNX1­RUNX1T1 and MAPK1 suppression reduced the proliferation rate of the t(8;21) cells with deregulated expression of several classical positive regulator genes that are otherwise known to enhance cell proliferation. RUNX1­RUNX1T1 suppression exerted an anti­apoptotic effect through the overexpression of BCL2, BIRC3 and CFLAR genes, while MAPK1 suppression induced apopotosis in t(8;21) cells by the apoptotic mitochondrial changes stimulated by the activity of upregulated TP53 and TNFSF10, and downregulated JUN gene. RUNX1­RUNX1T1 suppression supported myeloid differentiation by the differential expression of CEBPA, CEBPE, ID2, JMJD6, IKZF1, CBFB, KIT and CDK6, while MAPK1 depletion inhibited the differentiation of t(8;21) cells by elevated expression of ADA and downregulation of JUN. RUNX1­RUNX1T1 and MAPK1 depletion induced cell cycle arrest at the G0/G1 phase. Accumulation of cells in the G1 phase was largely the result of downregulated expression of TBRG4, CCNE2, FOXO4, CDK6, ING4, IL8, MAD2L1 and CCNG2 in the case of RUNX1­RUNX1T1 depletion and increased expression of RASSF1, FBXO6, DADD45A and P53 in the case of MAPK1 depletion. Taken together, the current results demonstrate that MAPK1 promotes myeloid cell proliferation and differentiation simultaneously by cell cycle progression while suppresing apoptosis.

Currently used organophosphate flame retardants determined in the settled dust of masjids and hotels of Saudi Arabia, a new insight into human health implications of dust exposure.

Indoor settled dust particles are considered as an important source of human exposure to chemicals such as organophosphate flame retardants (PFRs). In recent decades the Kingdom of Saudi Arabia (KSA) has experienced tremendous growth in population, as a result the number of masjids has also increased significantly to provide sufficient space for the public to offer prayers. The hospitality industry in KSA is also expanding to cater for the ever-increasing number of pilgrims visiting the two holy cities of the kingdom. However, limited data are available on the indoor pollution of masjids and hotels. In this study, PFRs were analyzed in the settled dust collected from various hotels and masjids of Jeddah, KSA. Tris(1,3-dichloro-2-propyl) phosphate (TDCPP) and tris(1-chloro-2-propyl) phosphate (TCPP) were the major PFRs in masjid (median = 2490 and 2055 ngg-1) and hotel (median = 2360 and 3315 ngg-1) dust, respectively. A public health risk assessment was carried out by determining the incremental lifetime cancer risk (ILCR), and daily exposure via dust ingestion, inhalation, and dermal contact of PFRs. The calculated daily exposure via dust ingestion was well below the reference dose (RfD) values, and also the calculated hazardous quotient (HQ) and carcinogenic risk were well below the risk mark. However, the ILCR for PFRs was below the reference values of USEPA, which suggested that long-term exposure to these chemicals has a limited cause for concern. The study showed that the general public is exposed to PFRs in the studied microenvironments and the major exposure routes are dermal contact and ingestion.

Phthalates and polycyclic aromatic hydrocarbons (PAHs) in the indoor settled carpet dust of mosques, health risk assessment for public.

A number of studies have reported the occurrence of phthalates and polycyclic aromatic hydrocarbons (PAHs) in indoor settled dust from different occupational and residential settings around the world but limited studies are available from public and religious places. In recent decades Kingdom of Saudi Arabia (KSA) has experienced tremendous industrial growth especially in the petroleum industries, and as result environmental issues related with such industries have also increased but scientific data is still scarce to understand the impact on public health. Therefore, the main objective of this study was to report the phthalates and PAHs profile in the settled dust collected from various mosques of Jeddah, an important part of people living in the region, and to evaluate the health risk associated with these chemicals via dust ingestion, inhalation and dermal contact for the general public who attend mosques for prayers. Phenanthrene (500-3000 ng/g), pyrene (40-1220 ng/g), and chrysene (95-4590 ng/g) were the major PAHs and ∑12PAHs concentrations ranged from 2550 to 9150 ng/g. Whereas, DEHP (

Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: A case-control study.

BACKGROUND/OBJECTIVE: The potential benefit of preoperative biliary drainage (PBD) on postoperative outcomes remains controversial. The aim of this study was to elucidate surgical outcomes of pancreaticoduodenectomy (PD) in patients with PBD and to show the impact of bilirubin level. METHODS: We retrospectively studied all patients who underwent PD in our center between January 2003 and June 2015. Patients were divided into: Group A (PBD) and Group B (no PBD). The primary outcome was the rate of postoperative complication. RESULTS: A total of 588 cases underwent PD. Group A included 314 (53.4%) patients while Group B included 274 (46.6%) patients. The overall incidence of complications and its severity were higher in Group A (p = 0.03 and p = 0.02). There was significant difference in the incidence of postoperative pancreatic fistula (p = 0.002), delayed gastric emptying (p = 0.005), biliary leakage (p = 0.04), abdominal collection (p = 0.04), and wound infection (p = 0.04) in Group A. The mean length of hospital stay was significantly longer in Group A than in Group B (12.86 ± 7.65 days vs. 11.05 ± 7.98 days, p = 0.01). No significant impact of preoperative bilirubin level on surgical outcome was detected. CONCLUSION: PBD before PD was associated with major postoperative complications and stent-related complications.

Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases.

BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula (POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of reconstruction. This study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group (absent risk factor), moderate-risk group (presence of one risk factor) and high-risk group (presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m2, cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF developed in 128 (14.3%) patients. Delayed gastric emptying occurred in 164 (18.4%) patients, biliary leakage developed in 65 (7.3%) and pancreatitis presented in 20 (2.2%). POPF in low-, moderate- and high-risk groups were 26 (8.3%), 65 (15.7%) and 37 (22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy (PG) in high-risk group, while pancreaticojejunostomy (PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in low- and moderate-risk groups.

Surgical outcomes of pancreaticoduodenectomy in young patients: A case series.

BACKGROUND: Pancreaticoduodenectomy (PD) is a complex procedure for management periampullary neoplasms The aim of our work is to report the surgical outcomes after PD in young adult (YA) (<35 years) and to compare it to a adult patients who underwent PD. METHODS: We retrospectively analyzed the data of all patients who underwent PD in the period from January 1993 to December 2016. The primary outcome was the rate of total postoperative complications. Secondary outcomes included postoperative pathology, exocrine and endocrine function and survival rate. RESULTS: 58/975 patients (5.9%) were YA and the majority of them were females. The incidence of post-operative complications in the YA was comparable to that in the adult group. Delayed gastric emptying developed significantly in adult group than YA group (0.008). The overall survival was significantly higher in the YA (P = 0.0001). The most common pathology in the YA was adenocarcinoma (41.4%) and solid pseudopapillary tumor (SPT) (29.3%). No significant difference as regards postoperative pancreatic exocrine and endocrine function in both groups. CONCLUSION: PD in YA when performed in tertiary centers with good surgical experience is safe. The most common pathological diagnosis in the YA was adenocarcinoma followed by SPT.

Superior mesenteric artery syndrome: A diagnosis to be kept in mind (Case report and literature review).

INTRODUCTION: Superior mesenteric artery (SMA) syndrome or what is called Wiklie's syndrome is one of the rare causes of small bowel obstruction. Its exact incidence is not known. It is due to decrease in Aortomesenteric angle. CASE PRESENTATION: A thirty-Four-year old male patient presented to our accident and emergency (department) with 3days history of epigastric pain, which was not radiating anywhere. It had no aggravating or relieving factors. Patient complained of repeated attack of vomiting as well. Contrast enhanced Computed tomography (CT) showed duodenal obstruction caused by superior mesenteric artery compression on 3rd part of duodenum. DISCUSSION: Superior mesenteric artery syndrome (SMA) is one of the rare causes of small bowel obstruction. Incidence of superior mesenteric artery syndrome reported in literature is ranging from 0.1 to 0.3%. The most common cause is significant weight loss which leads to loss of retroperitoneal fat. Treatment usually is conservative but surgical intervention should be considered if that failed. CONCLUSION: Superior mesenteric artery syndrome is a rare cause of intestinal obstruction but should be kept in mind. Persistent vomiting after history of weight loss should raise the suspicion of this diagnosis. Upper GI endoscopy may be necessary to exclude mechanical causes of duodenal obstruction. Contrast enhanced CT scan is useful in the diagnosis of superior mesenteric artery syndrome and can provide diagnostic information.

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome.

BACKGROUND/AIMS: Cystobiliary communication (CBF) with hepatic hydatid disease is responsible for postoperative bile leakage after surgical management. This study aims to detect various predictors of CBF and its outcome after surgical management. MATERIALS AND METHODS: This is a retrospective, cohort study of all patients who underwent surgical management for hydatid disease of the liver. Patient data were recorded on an internal web-based registry system supplemented by paper records. Patients were classified into two groups according to the presence of CBF: group (A) patients with CBF and group (B) patients without CBF. RESULTS: There were 123 patients with a hepatic hydatid cyst with a mean age of 39.92±14.59 years. Patients were classified into group (A), 26 patients (21.1%) with CBF, and group (B), 97 patients (78.9%) without CBF. The age group (p=0.04), presence of jaundice (p=0.001), serum glutamic-pyruvic transaminase (SGPT) (p=0.001), cyst size (p=0.0001), and cyst size group (>10 cm) (p=0.0001) were associated with CBF. That cyst size was the only independent predictor of the occurrence of CBF. Intraoperative suturing and the T tube led to complete healing of CBF, and postoperative endoscopic retrograde cholangio-pancreatography (ERCP) and tubal drainage led to a rapid reduction in the bile output and the healing of the fistulas after 9±2.6 days. CONCLUSION: That cyst size was the only independent predictor for the occurrence of CBF. Management is related to the size of the fistula, the site of the cyst, and the experience of the hepatobiliary surgeon. ERCP is an important option for the management of CBF.

Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left Ventricular Function and Predicts Outcomes After Cardiac Surgery.

BACKGROUND: Echocardiography-based speckle-tracking strain imaging is an emerging modality to assess left ventricular function. The aim of this study was to investigate the change in left ventricular systolic function after cardiac surgery with 3-dimensional (3D) speckle-tracking strain imaging and to determine whether preoperative 3D strain is an independent predictor of acute and long-term clinical outcomes after aortic valve, mitral valve, and coronary artery bypass grafting operations. METHODS: In total, 163 adult patients undergoing aortic valve, mitral valve, and coronary artery bypass surgeries were enrolled prospectively and had complete data sets. Demographic, operative, and outcome data were collected. 3D transthoracic echocardiograms were preformed preoperatively and on second to fourth postoperative day. Blinded off-line analysis was performed for left ventricular 2-dimensional (2D) ejection fraction (EF2D) and 3D ejection fraction (EF3D) and global peak systolic area, longitudinal, circumferential, and radial strain. RESULTS: 3D global strain correlated well with EF3D. Ventricular function as measured by strain imaging decreased significantly after all types of cardiac surgery. When preoperative EF3D was used, receiver operating characteristic curves identified reference values for 3D global strain corresponding to normal, mildly reduced, and severely reduced ventricular function. Normal ventricular function (EF3D ≥ 50%) corresponded to 3D global area strain -25%, with area under curve = 0.86 (0.81-0.89). Patients with reduced preoperative 3D global area strain had worse postoperative outcomes, including length of intensive care unit stay (4 vs 3 days, P = .001), major adverse events (27% vs 11%, P = .03), and decreased 1-year event-free survival (69% vs 88%, P = .005). After we controlled for baseline preoperative risk models including European System for Cardiac Operative Risk Evaluation score and surgery type, preoperative strain was an independent predictor of both short- and long-term outcomes, including length of intensive care unit stay, postoperative inotrope score, and 1-year event-free survival. CONCLUSIONS: This study shows that cardiac surgery was associated with an acute reduction in postoperative left ventricular function, when evaluated with 3D strain imaging. In addition, preoperative 3D strain was demonstrated to be an independent predictor of acute and long-term clinical outcomes after cardiac surgery. The use of noninvasive 3D transthoracic echocardiogram strain imaging before cardiac surgery may provide added information to aid in perioperative risk stratification and management for these high-risk patients.

Outcomes of pancreaticoduodenectomy in elderly patients.

BACKGROUND: Although the mortality and morbidity of pancreaticoduodenectomy (PD) have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients. METHODS: We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I (patients aged <60 years), group II (those aged 60 to 69 years) and group III (those aged ≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate. RESULTS: A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579 (69.9%) patients in group I, 201 (24.3%) in group II, and 48 (5.8%) in group III. The overall incidence of complications was higher in elderly patients (25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006). There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality. CONCLUSIONS: PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.