Influence of temperature on the population size of Aceria litchii (Acari: Eriophyidae) and the development of its galls.

The lychee erinose mite, Aceria litchii (Keifer), is a tiny eriophyid mite known to induce the formation of open galls (erinea) on lychee plants, Litchi chinensis Sonn. In lychee infested by A. litchii, four stages of erineum are observed, based on erineum color: hyaline, white, amber and dark brown. The cause of the color change in erinea is unknown, but it might be linked to the extent of A. litchii infestation. Artificially infested lychee seedlings were used to determine the developmental time, trichome density, and mite population size in each of the four erineum stages. The effect of temperature (15, 25, and 35 °C) on A. litchii population size and erineum developmental time was also investigated. Overall, each erineum stage lasted approximately 50 days and the population size of A. litchii increased gradually through the hyaline, white and amber stages, and a strong decline was observed in dark brown erinea. Visual comparisons of the low-temperature scanning electron microscope (LT-SEM) images revealed that the trichome density was lower in the hyaline stage than in the other stages. Temperature influenced mite population size and amber erinea developmental time. Mite population was lower at 35 °C than at 15 and 25 °C, suggesting that high temperatures promote detrimental effects on A. litchii. Amber erinea developed slower at 15 °C than at 25 and 35 °C. Possible effects of the temperature on A. litchii population in lychee plants are discussed.

Formulation and evaluation of anion transporters in nanostructured lipid carriers.

Six novel click-tambjamines (1-6) bearing an alkyl chain of varying length linked to the imine moiety have been formulated in nanostructured lipid carriers (NLCs) to evaluate their transmembrane anion transport activity both when free (i.e., not encapsulated) and nanoformulated. Nanostructured lipid carriers (NLCs) are an example of drug delivery systems (DDSs) that stand out because of their versatility. In this work we show that NLCs can be used to efficiently formulate highly lipophilic anionophores and experiments conducted in model liposomes reveal that these formulations are adequate to deliver anionophores without compromising their transport activity. This result paves the way to facilitate the study of highly lipophilic anionophores and their potential use as future drugs.

E-cigarette exposure with or without heating the e-liquid induces differential remodeling in the lungs and right heart of mice.

Various cardiopulmonary pathologies associated with electronic cigarette (EC) vaping have been reported. This study investigated the differential adverse effects of heating-associated by-products versus the intact components of EC aerosol to the lungs and heart of mice. We further dissected the roles of caspase recruitment domain-containing protein 9 (CARD9)-associated innate immune response and NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome in EC exposure-induced cardiopulmonary injury. C57BL/6 wild type (WT), CARD9-/-, and NLRP3-/- mice were exposed to EC aerosol 3 h/day, 5 days/week for 6 month with or without heating the e-liquid with exposure to ambient air as the control. In WT mice, EC exposure with heating (EwH) significantly increased right ventricle (RV) free wall thickness at systole and diastole. However, EC exposure without heating (EwoH) caused a significant decrease in the wall thickness at systole. RV fractional shortening was also markedly reduced following EwH in WT and NLRP3-/- mice. Further, EwH activated NF-κB and p38 MAPK inflammatory signaling in the lungs, but not in the RV, in a CARD9- and NLRP3-dependent manner. Levels of circulatory inflammatory mediators were also elevated following EwH, indicating systemic inflammation. Moreover, EwoH activated TGF-ß1/SMAD2/3/α-SMA fibrosis signaling in the lungs but not the RV of WT mice. In conclusion, EC aerosol exposure following EwH or EwoH induced differential cardiopulmonary remodeling and CARD9 innate immune response and NLRP3 inflammasome contributed to the adverse effects.

Dysregulated lipolysis and lipophagy in lipid droplets of macrophages from high fat diet-fed obese mice.

Obesity is associated with lipid droplet (LD) accumulation, dysregulated lipolysis and chronic inflammation. Previously, the caspase recruitment domain-containing protein 9 (CARD9) has been identified as a potential contributor to obesity-associated abnormalities including cardiac dysfunction. In the current study, we explored a positive feedback signalling cycle of dysregulated lipolysis, CARD9-associated inflammation, impaired lipophagy and excessive LD accumulation in sustaining the chronic inflammation associated with obesity. C57BL/6 WT and CARD9-/- mice were fed with normal diet (ND, 12% fat) or a high fat diet (HFD, 45% fat) for 5 months. Staining of LDs from peritoneal macrophages (PMs) revealed a significant increase in the number of cells with LD and the number of LD per cell in the HFD-fed WT but not CARD9-/- obese mice. Rather, CARD9 KO significantly increased the mean LD size. WT obese mice showed down regulation of lipolytic proteins with increased diacylglycerol (DAG) content, and CARD9 KO normalized DAG with restored lipolytic protein expression. The build-up of DAG in the WT obese mice is further associated with activation of PKCδ, NF-κB and p38 MAPK inflammatory signalling in a CARDD9-dependent manner. Inhibition of adipose triglyceride lipase (ATGL) by Atglistatin (Atg) resulted in similar effects as in CARD9-/- mice. Interestingly, CARD9 KO and Atg treatment enhanced lipophagy. In conclusion, HFD feeding likely initiated a positive feedback signalling loop from dysregulated lipolysis, CARD9-dependent inflammation, impaired lipophagy, to excessive LD accumulation and sustained inflammation. CARD9 KO and Atg treatment protected against the chronic inflammation by interrupting this feedforward cycle.

Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis (with video).

BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) is used for refractory gastroparesis (RG) with good early-term but variable mid- and long-term outcomes. Limited data exist about candidates and long-term clinical and predictive factors. Our aim was to evaluate the 4-year follow-up efficacy and predictive factors in patients with RG. METHODS: Confirmed RG patients were included and evaluated between April 2017 and December 2021. Gastroparesis Cardinal Symptom Index (GCSI) score, retention percentage at 4 hours (RP4H), mean half-emptying time (MHET), and the 36-item short-form survey (SF-36) were performed at 1, 6, 12, 18, 24, 30, 36, 42, and 48 months. RESULTS: After G-POEM, 374 patients with RG were included: 141 patients (37.7%) had diabetic gastroparesis (DG), 115 (30.7%) had idiopathic gastroparesis (IG), 102 (27.3%) had postsurgical gastroparesis (PSG), and 16 (4.3%) had other etiologies. After the 48-month evaluation, 102 patients completed follow-up (DG, 58; IG, 22; PSG, 18; other, 4). Before G-POEM, GCSI score, RP4H, and MHET were 3.84 ± .53, 44% (interquartile range [IQR], 11-68), and 246 minutes (IQR, 150-368), respectively, and after the 48-month evaluation improved to 2.1 ± .70 (P < .001), 15.5% (IQR, 0-36; P = .021), and 135 minutes (IQR, 67-290; P = .045), respectively. At the 48-month evaluation, clinical success was 77.5%. DG showed the best outcomes (DG vs IG vs PSG vs other: 86.5% vs 72.5% [P = .001] vs 72.1% [P = .003] vs 68.8% [P < .001]). Long-term success predictors were DG (odds ratio [OR], 5.113; 95% confidence interval [CI], 1.643-5.981; P = .035), early diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P = .042), nausea/vomiting (OR, 3.541; 95% CI, 1.881-5.511; P = .012), GCSI score at 6 months (1.5-2) (OR, 3.612; 95% CI, 2.122-5.317; P = .022), and RP4H <10% at 6 months (OR, 2.188; 95% CI, 1.435-4.233; P = .039). CONCLUSIONS: G-POEM is an effective 4-year treatment in patients with RG, especially in DG, establishing a potential first-line therapy in these patients. However, randomized controlled clinical trials are needed to confirm these results. (Clinical trial registration number: NTC03126513.).

The role of indolyl substituents in squaramide-based anionophores.

A new family of squaramide-based anionophores (L1-L8) have been synthesised and fully characterised with the aim to investigate the effect of indolyl substituents on their anion binding and transmembrane transport properties. L1, L2, L6, and L8, bearing a 7-indolyl/indol-7-yl moiety as the substituent, were found to be the most efficient of the series in binding chloride with high stability constants. L1, L6, and L8 were also found to be the most potent anionophores of the series, able to mediate transmembrane anion transport. In particular, L6 bearing the 3,5-bis(trifluoromethyl)phenyl group was found to be the most active transporter, and its efficiency as an anionophore/anion transporter was favourably compared with that of their symmetrically-substituted squaramide analogues L9 and L10, previously reported in the literature.

[Results of the application of the Protocol for Improved Recovery in Surgery (PREMEC) in the surgical treatment of colorectal cancer at the Edgardo Rebagliati National Hospital â€" EsSalud]. / Resultados de la aplicación del Protocolo de Recuperación Mejorada en Cirugía (PREMEC) en el tratamiento quirúrgico del cáncer colorrectal en el Hospital Nacional Edgardo Rebagliati â€" EsSalud.

INTRODUCTION: Improvement in health care is reflected in achieving better results in quality indicators. For quite some time several programs have pursued a reduction of complications and length of stay. A program called Protocol for Improved Recovery in Surgery (PREMEC) has been implemeted at the colorectal surgery service. OBJECTIVE: The objective of this study is to show results of the implementation of PREMEC. MATERIALS AND METHODS: This is an observational study of two cohorts, 516 patients were included. One is a historic cohort (before the protocol) comprised by patients who underwent resective colonic and rectal surgery through an open approach from January 2017 to November 2018. The other prospective cohort includes patients treated under the PREMEC program from December 2018 through to March 2020. This cohort was divided into two groups according to the surgical approach, open and laparoscopic. All groups were compared regarding postoperative length of stay, complications, mortality and readmissions. RESULTS: Groups were similar in age, sex, cancer staging and type of surgery. Length of stay was 13.86 days (SD 7.86 days) for the pre-PREMEC group, 10.62 days (SD 5.4 days) for the PREMEC open group and 6.86 days (SD 2.7 days) for the PREMEC laparoscopic group. As for complications the PREMEC group showed a decrease in anastomotic leaks, Surgical Site Infection (SSI) and postoperative ileus. No differences were found regarding mortality, reoperations and readmissions. CONCLUSION: Implementation of the PREMEC program attained a decrease in length of stay, anastomotic leaks, SSI and postoperative ileus with no increase in mortality, reoperations or readmissions.

Members of the Euwallacea fornicatus species complex exhibit promiscuous mutualism with ambrosia fungi in Taiwan.

Carrillo, J.D., Rugman-Jones, PF., Husein, D., Stajich, J.E., Kasson, M.T., Carrillo, D., Stouthamer, R., and Eskalen, A. 2019. Members of the Euwallacea fornicatus species complex exhibit promiscuous mutualism with ambrosia fungi in Taiwan. A number of ambrosia beetles have come to prominence in recent years because of the damage they inflict on a variety of trees within invaded habitats across the globe. Ambrosia beetles rely on symbiotic microorganisms, mainly fungi, as a dedicated food source and carry those microorganisms around with them within specialized organs termed mycangia. Investigation of members of the Euwallacea fornicatus species complex and their fungal symbionts in Taiwan revealed promiscuous symbioses with ambrosial Fusaria clade (AFC) members, Graphium spp., and Paracremonium spp. based on co-phylogenetic analyses. For AFC members, a novel diagnostic PCR assay targeting mating type genes MAT1-1-1 and MAT1-2-1 was developed and validated by amplicon size and sequencing. Mating type screening of AFC members revealed the isolates screened are all heterothallic (self-sterile), with both MAT types represented and recovered from fungi vectored by E. fornicatus (tea shot hole borer), E. kuroshio (Kuroshio shot hole borer), and E. whitfordiodendrus (polyphagous shot hole borer) in Taiwan. Members of the Euwallacea fornicatus species complex and the variety of ambrosia fungi they utilize further confirms that their relationship with these fungi are more likely promiscuous in native areas, as opposed to strictly obligate to a specific combination of fungi as observed in invaded areas.

MetaMass, a tool for meta-analysis of subcellular proteomics data.

We report a tool for the analysis of subcellular proteomics data, called MetaMass, based on the use of standardized lists of subcellular markers. We analyzed data from 11 studies using MetaMass, mapping the subcellular location of 5,970 proteins. Our analysis revealed large variations in the performance of subcellular fractionation protocols as well as systematic biases in protein annotation databases. The Excel and R versions of MetaMass should enhance transparency and reproducibility in subcellular proteomics.

Xyleborus volvulus (Coleoptera: Curculionidae): Biology and Fungal Associates.

The ambrosia beetle Xyleborus volvulus Fabricius has been reported as a potential vector of the plant pathogen Raffaelea lauricola T.C. Harr., Fraedrich & Aghayeva that is affecting avocado orchards in South Florida. In this study, we examined its life cycle, process of gallery formation, gallery structure, and fungal associates by rearing one generation on avocado sawdust medium under control conditions. The adult foundress excavated a vertical tunnel that constituted the main gallery with a length of 2.5 cm, followed by the construction of up to six secondary galleries with a total length of 4.4 cm. The time period for one generation (egg to adult) was 28 days. Teneral males emerged 3 days after the emergence of the first females. The F1 generation did not significantly contribute to gallery expansion. Four species of Raffaelea and nine yeast species were recovered from galleries and beetles. Raffaelea arxii and Candida berthetii were the most frequent symbionts recovered from new adults and galleries. Candida berthetii dominated during the early stages of the gallery development, whereas R. arxii was most frequent in later stages. Other Raffaelea species were inconsistently isolated from galleries, which suggests a strong association between Xyleborus volvulus and both R. arxii and C. berthetii These results suggest that R. arxii is the primary nutritional symbiont of X. volvulus and that yeast species may be pioneer colonizers that assist with the growth of fungal symbionts.IMPORTANCE Ambrosia beetles cultivate fungi in tunnels bored into weakened host trees. This obligate interaction is required for their survival as beetles feed on these symbiotic fungi, and the fungi benefit from transportation by the beetles. Xyleborus volvulus carries many nonpathogenic symbionts; however, recently the acquisition of Raffaelea lauricola (the causal agent of a lethal vascular disease of lauraceous trees) by this beetle has altered its status from wood degrader to potential pest in avocado. We conducted a study to understand the relationship of this beetle and its fungal associates. Our results show that X. volvulus has a multipartite flexible association with different Raffaelea species. The lack of fidelity in the mutualistic association may explain the acquisition of R. lauricola Knowing the beetle biology and its mutualistic interactions furthers an understanding of the beetle's role as a potential vector and in disease transmission.

Identification of the Achilles heels of the laurel wilt pathogen and its beetle vector.

Ambrosia beetles harbor fungal symbionts that serve as food sources for larvae and adults. These beetles lay their eggs along tunnels in xylem sapwood, which is the substrate for fungal growth. Symbiotic fungi of the genus Raffaelea found in invasive and indigenous ambrosia beetles include the highly virulent plant pathogen Raffaelea lauricola affecting members of the Lauraceae family. R. lauricola is responsible for the deaths of > 500 million trees since 2005. Infection by as few as 100 spores can kill a healthy tree within months. Our data show that R. lauricola is cold-adapted with optimal growth between 16 and 26 °C, with little to no growth at temperatures ≥ 30 °C. The fungus is halophilic and shows a dramatic decrease in growth at pH ≥ 6.8. Fungicide resistance profiling revealed sensitivity of R. lauricola to prochloraz, dichlorofluanid, most conazoles, dithiocarbamates, and zineb (zinc fungicide), whereas the related species Raffaelea arxii showed more limited fungicide sensitivity. Entomopathogenic fungi potentially useful for beetle control were generally highly resistant to most fungicides tested. Coupling pH decreased the concentration for 95% inhibition of fungal growth (IC95) of the most potent R. lauricola fungicides by 3-4-fold. Use of avocado bark plug insect bioassays revealed that commercially available Beauveria bassiana can be used as a biological control agent capable of effectively killing the beetle vectors. These data provide simple and practical recommendations to specifically target R. lauricola while having minimal effects on other symbiotic and entomopathogenic fungi, the latter of which can be used to manage the beetle vectors.

Aggressive melanoma in an infant with congenital melanocytic nevus syndrome and multiple, NRAS and BRAF mutation-negative nodules.

We report the case of a newborn boy with multinodular NRAS and BRAF mutation-negative congenital melanocytic nevi and cerebral lesions compatible with congenital intraparenchymal melanosis. Histopathology from skin lesions showed atypical nodular melanocytic proliferation with marked melanocytic atypia and a large number of mitoses and apoptosis, indicating aggressive proliferation. The child developed several new subcutaneous tumors and multiple internal lesions, which were confirmed to be metastases, and died at 5 months of age. This case may represent an infantile melanoma developing from a giant congenital melanocytic nevus or a congenital melanoma.

Responses of Anastrepha suspensa, Diachasmimorpha longicaudata, and Sensitivity of Guava Production to Heterorhabditis bacteriophora in Fruit Fly Integrated Pest Management.

Caribbean fruit fly, also known as Caribfly or Anastrepha suspensa , is a major tephritid pest of guavas. A virulent entomopathogenic nematode (EPN) species was investigated to suppress the fruit-to-soil stages of Caribflies, which are also attacked by the koinobiont parasitoid Diachasmimorpha longicaudata in south Florida. The main objective was to develop a feasible and cost-effective EPN-application method for integrated pest management (IPM) of Caribfly to improve guava production. Naturally infested guavas were treated with increasing Heterorhabditis bacteriophora infective juvenile (IJ) concentration or rate (0, 25, 50, …, 1,600 IJs cm -2 ) in field trials to measure the optimum IJ rate and then examine sensitivity of producing guavas to inclusion of Heterorhabditis bacteriophora in Caribfly IPM plans. Relative survival of Caribfly in treatments significantly decreased with increasing IJ rate from 0 to 100 IJs cm -2 . Similarly, probability of observing large numbers of parasitoid wasps ( Diachasmimorpha longicaudata ) in EPN treatments significantly declined with increasing IJ rate (0-100 IJs cm -2 ), even though the non-target effects of Heterorhabditis bacteriophora on relative survival of Diachasmimorpha longicaudata could not be determined because of few emerging parasitoid wasps. Optimum suppression (⩾ 60%) of Caribfly was consistently achieved at 100 IJs cm -2 or 17,500 IJs fruit -1 . Profitability analysis showed that Heterorhabditis bacteriophora can be included in Caribfly IPM tactics to produce guavas. Costs of EPNs in Caribfly IPM are minimized if Heterorhabditis bacteriophora is strategically applied by spot treatment of fruit. Repayment of costs of EPN-augmentation by spot treatments appears achievable by recovering 5.71% of the annual yield losses (⩾1,963 kg ha -1 ≈ US$ 8,650 ha -1 ), which are largely due to Caribfly infestation. Hectare-wide EPN-augmentation (or broadcasting) method requires more fruit recovery than the total annual yield losses to repay its high costs. Profitability of guava production in south Florida will not be very sensitive to marginal costs of the spot treatment method, when compared to the field-wide broadcasting of Heterorhabditis bacteriophora .

Discordant phylogenies suggest repeated host shifts in the Fusarium-Euwallacea ambrosia beetle mutualism.

The mutualism between xyleborine beetles in the genus Euwallacea (Coleoptera: Curculionidae: Scolytinae) and members of the Ambrosia Fusarium Clade (AFC) represents one of 11 known evolutionary origins of fungiculture by ambrosia beetles. Female Euwallacea beetles transport fusarial symbionts in paired mandibular mycangia from their natal gallery to woody hosts where they are cultivated in galleries as a source of food. Native to Asia, several exotic Euwallacea species were introduced into the United States and Israel within the past two decades and they now threaten urban landscapes, forests and avocado production. To assess species limits and to date the evolutionary diversification of the mutualists, we reconstructed the evolutionary histories of key representatives of the Fusarium and Euwallacea clades using maximum parsimony and maximum likelihood methods. Twelve species-level lineages, termed AF 1-12, were identified within the monophyletic AFC and seven among the Fusarium-farming Euwallacea. Bayesian diversification-time estimates placed the origin of the Euwallacea-Fusarium mutualism near the Oligocene-Miocene boundary ∼19-24 Mya. Most Euwallacea spp. appear to be associated with one species of Fusarium, but two species farmed two closely related fusaria. Euwallacea sp. #2 in Miami-Dade County, Florida cultivated Fusarium spp. AF-6 and AF-8 on avocado, and Euwallacea sp. #4 farmed Fusarium ambrosium AF-1 and Fusarium sp. AF-11 on Chinese tea in Sri Lanka. Cophylogenetic analyses indicated that the Euwallacea and Fusarium phylogenies were largely incongruent, apparently due to the beetles switching fusarial symbionts (i.e., host shifts) at least five times during the evolution of this mutualism. Three cospeciation events between Euwallacea and their AFC symbionts were detected, but randomization tests failed to reject the null hypothesis that the putative parallel cladogenesis is a stochastic pattern. Lastly, two collections of Euwallacea sp. #2 from Miami-Dade County, Florida shared an identical cytochrome oxidase subunit 1 (CO1) allele with Euwallacea validus, suggesting introgressive hybridization between these species and/or pseudogenous nature of this marker. Results of the present study highlight the importance of understanding the potential for and frequency of host-switching between Euwallacea and members of the AFC, and that these shifts may bring together more aggressive and virulent combinations of these invasive mutualists.

MagicFinger: 3D Magnetic Fingerprints for Indoor Location.

Given the indispensable role of mobile phones in everyday life, phone-centric sensing systems are ideal candidates for ubiquitous observation purposes. This paper presents a novel approach for mobile phone-centric observation applied to indoor location. The approach involves a location fingerprinting methodology that takes advantage of the presence of magnetic field anomalies inside buildings. Unlike existing work on the subject, which uses the intensity of magnetic field for fingerprinting, our approach uses all three components of the measured magnetic field vectors to improve accuracy. By using adequate soft computing techniques, it is possible to adequately balance the constraints of common solutions. The resulting system does not rely on any infrastructure devices and therefore is easy to manage and deploy. The proposed system consists of two phases: the offline phase and the online phase. In the offline phase, magnetic field measurements are taken throughout the building, and 3D maps are generated. Then, during the online phase, the user's location is estimated through the best estimator for each zone of the building. Experimental evaluations carried out in two different buildings confirm the satisfactory performance of indoor location based on magnetic field vectors. These evaluations provided an error of (11.34 m, 4.78 m) in the (x; y) components of the estimated positions in the first building where the experiments were carried out, with a standard deviation of (3.41 m, 4.68 m); and in the second building, an error of (4 m, 2.98 m) with a deviation of (2.64 m, 2.33 m).

Catalytic amyloids for nucleotide hydrolysis.

The design of small peptides that assemble into catalytically active intermolecular structures has proven to be a successful strategy towards developing minimalistic catalysts that exhibit some of the unique functional features of enzymes. Among these, catalytic amyloids have emerged as a fruitful source to unravel many different activities. These assemblies can potentially have broad applications that range from biotechnology to prebiotic chemistry. Although many peptides that assemble into catalytic amyloids have been developed in recent years, the elucidation of convergent mechanistic aspects of the catalysis and the structure/function relationship is still a challenge. Novel catalytic activities are necessary to better address these issues and expand the current repertoire of applicability. In this chapter, we described a methodology to produce catalytic amyloids that are specifically active towards the hydrolysis of phosphoanhydride bonds of nucleotides. The design of potentially active amyloid-prone peptide sequences is explored using as template the active site of enzymes with nucleotidyltransferase activity. The procedures include an approach for sequence design, in vitro aggregation assays, morphological characterization of the amyloid state and a comprehensive methodology to measure activity in vitro using nucleoside and deoxynucleosides triphosphates as model substrates. The proposed strategy can also be implemented to explore different types of activities for the design of future catalytic amyloids.

Elucidating jejunal diverticulosis: Diagnostic and treatment insights from a perforated case study.

INTRODUCTION AND IMPORTANCE: Diverticula are sac-shaped formations resulting from the inward folding of the intestinal wall's lining. While they predominantly occur in the colon, they can manifest in other parts of the gastrointestinal tract, with jejunal diverticulum being the most prevalent. Symptoms are infrequent in most cases, and when they do occur, intestinal perforation is the most severe complication. In such instances, prompt surgical intervention is imperative, typically entailing the excision of the affected intestinal segment, followed by a end-to-end anastomosis. CASE PRESENTATION: A 75-year-old female patient presented at the emergency department with sharp abdominal pain. Imaging revealed the presence of perforated jejunal diverticula. Diagnostic laparoscopy confirmed a perforated jejunal diverticulum along with generalized peritonitis and multiple diverticula in the same region. Consequently, we performed a segmental intestinal resection and anastomosis. CLINICAL DISCUSSION: Jejunal diverticulosis, a rare condition primarily affecting the elderly, is found in 0.5-2.3 % of imaging studies. Although its exact cause remains elusive, potential contributing factors include abnormal intestinal movements and elevated gut pressure. Symptoms are generally vague, such as abdominal discomfort. Diagnosis often occurs incidentally during imaging, leading to a high mortality rate when complications occurs. While computed tomography (CT) scans are useful for detecting intestinal wall protrusions, definitive diagnosis typically requires laparoscopy or laparotomy. Treatment varies based on symptoms and complications, with surgery often necessary for perforations or when medical treatment fails. CONCLUSION: Jejunal diverticulosis is often asymptomatic or displays non-specific symptoms. Timely diagnosis and prompt surgical intervention in case of perforation is crucial.

Video assisted retroperitoneal debridement for infected pancreatic necrosis: A two port approach for difficult access.

INTRODUCTION AND IMPORTANCE: The incidence of acute pancreatitis varies globally, and its rates are increasing. Timely intervention in cases of infected necrosis is crucial to effective management. The landscape of acute pancreatitis management has undergone transformation through adopting a "step-up" strategy, accentuating the shift towards minimally invasive techniques. CASE PRESENTATION: A 63-year-old patient with acute pancreatitis and infected pancreatic necrosis underwent a challenging yet successful treatment using video-assisted retroperitoneal debridement employing a two-port approach facilitated access for an intricate area. The procedure, performed 45 days after admission, effectively reduced peripancreatic collections, demonstrating the efficacy of this approach in managing complex cases of infected pancreatic necrosis. CLINICAL DISCUSSION: The management of acute pancreatitis has evolved towards a comprehensive strategy involving early hydration, nutritional support, effective pain management, and interventions. Infected pancreatic necrosis poses a serious complication, with minimally invasive techniques such as video-assisted retroperitoneal debridement (VARD) emerging as preferred options. The efficacy and safety of VARD in complex cases are highlighted, although challenges persist, especially in extensive necrosis. CONCLUSION: The VARD procedure, a key component of the step-up approach, exhibits a remarkable safety profile, substantially reducing postoperative complications and mortality compared to open surgical counterparts. However, challenges persist in managing cases of infected Walled-Off Necrosis with deep extension, necessitating carefully considering a minimal-access approach. We report our experience using the VARD in a two-port approach.

Anal involvement in patient with pemphigus vulgaris: Case report.

INTRODUCTION AND IMPORTANCE: Pemphigus Vulgaris (PV) is a low incidence autoimmune mucocutaneous bullous disease, in which pathogenic antibodies are directed against the keratinocyte cell surface. Although anal involvement is unusual, correlations between its appearance and disease severity have been recently reported. CASE PRESENTATION: A 42-year-old male presented with an anal fissure and a year of recurrent oral and pharyngeal aphtha. A chemical sphincterotomy with botulinum toxin plus fissurectomy was performed. 3 years later an upper eyelid injury raised suspicion of pemphigus vulgaris (PV), tested negative for specific antibodies. A couple years later, an anal fissure, and suspected Crohn's disease, led to a second intervention. Surgical analysis unveiled characteristics indicative of a vegetating variant of PV. CLINICAL DISCUSSION: Anal involvement in PV varies in prevalence, with studies reporting rates between 2 % and 27.98 %. This manifestation often accompanies late disease stages and may indicate severity, notably in association with oral lesions. Patients might not readily discuss anal symptoms, leading to potential underreporting. Anal PV is linked to other lesions (ocular, nasal, genital) and the severity of oral PV. Even when other sites are in remission, anal recurrence can occur. Early recognition and follow-up are crucial, highlighting the need for routine anal examination and confirmatory diagnostics. CONCLUSION: PV lesions can present on the skin or mucosa, although oral lesions are the most common site of initial presentation. Anal PV is a diagnostic challenge, and this case illustrates the importance of a careful evaluation.