Conventional surgery in colon cancer with comparison to complete mesocolic excision and central vascular ligation: initial experience in a tertiary centre.

INTRODUCTION: The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the affected portion of the colon and surrounding lymph nodes with an improved method of controlling the vascular supply to the tumour. MATERIALS AND METHODS: A retrospective study of patients with colon cancer underwent right hemicolectomy (either CME and CVL or conventional method) were operated by colorectal surgeons in a tertiary centre in Kuala Lumpur from 2018 to 2020. We review the data to compare the oncological, pathological and surgical outcomes of both techniques. Categorical variables were presented as frequencies and percentages. Continuous variables were compared using an independent t-test or Mann-Whitney Rank U test. The chi-square test was used to determine the association between categorical variables and mortality. Statistical analysis was conducted with IBM SPSS Statistics 25.0, and statistical significance was set at p<0.05. RESULTS: A total of 30 patients (CME and CVL=15 or conventional colectomies=15) were included in this study with mean age of 65 years. There was no statistical difference between the mean age of the two groups (p=0.355). Most of the patients were Malays (46.7%) followed by Chinese (43.3 %) and Indians (10.0%). The mean (SD) = 19 (9) number of lymph nodes harvested is more in CME and CVL groups which however is not statistically significant compared to the mean (SD) = 16 (9), number of lymph nodes in conventional colectomies. The duration of surgery is longer in CME and CVL groups (214 minutes) compared to conventional colectomies (188 minutes) but with no significant statistical difference. Most of the perioperative complications were similar in both groups with no significant statistical differences. CONCLUSION: CME and CVL are not inferior to conventional surgery in colon surgery in a tertiary centre. It should be considered since the advantages such as lymph node yield and median recurrence free survival are better with similar perioperative morbidity.

Links between socio-demographic characteristics and body mass index to colorectal cancer in North Borneo, Malaysia: A case-control study.

INTRODUCTION: The fourth leading cause of cancer-related mortality and morbidity worldwide is colorectal cancer (CRC). Numerous reasons have contributed to the massive rise in CRC cases, for which Asian nations differ significantly in terms of risk incidence rates. The objectives of this study were to, first, identify the socio-demographic characteristics of those of North Borneo ethnicity and body mass index (BMI) and, second, determine the association of these factors with CRC. This research will contribute to preventing this form of cancer. MATERIALS AND METHODS: This study is an analysis of a matched case-control study with a ratio of 1:2. The case group contained 206 respondents, and the control group contained 412. All CRC cases were confirmed with the histological results. The control group was matched for links between age, sex and ethnicity with CRC. The Statistical Package for Social Sciences Statistics (SPSS) IBM version 28.0 was used to conduct descriptive analysis using chi-squared testing and simple logistic regression. The statistical significance was P < 0.05. RESULT: Overall, 618 respondents took part in this survey, of which 256 (41.4%) were female and 362 (58.6%) were male. The maximum age was 76, with a mean age ± SD of 53.17 ± 11.4. Those of Bajau ethnicity comprised 24.6% (152) of the population, followed by Dusun with 22.8% (141), Kadazan with 17.6% (109%), other North Borneo ethnic groups with 15.5% (96), Bugis with 9.7% (60), Brunei with 4.4% (27) and other predominant races with 5.3% (33). Regression analyses revealed that the incidence of CRC in North Borneo, Malaysia, was substantially correlated with income, occupation, other linked diseases and BMI. CONCLUSION: Various risk factors are linked to CRC, based on the findings related to socio-demographic characteristics and BMI. Therefore, to lower the nationwide prevalence of CRC, national public health campaigns should include collaboration with the regional authorities to highlight the incidence and risk factors of CRC based on ethnicity.

Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain.

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews.

Wandering spleen: a unique cause of acute abdomen.

We present the case of a 16-year-old boy presented with 2-week episode of wor-sening lower abdominal pain. Clinically, there was a tender palpable mass on the suprapubic region. Ultrasonography showed an absent spleen at its usual area, instead suprapubic mass suggestive of ectopic spleen was identified. An emer-gency laparotomy revealed a congested spleen in the pelvic cavity. Splenectomy was undertaken as it was non-viable. The patient was discharged uneventfully with triple vaccinations. We describe this unique entity with its literature review. (Folia Morphol 2018; 77, 2: 400-402).

An Obstructed Malignant Inflammatory Myofibroblastic Tumour of the Rectum.

Inflammatory myofibroblastic tumour is rare but more common in children. It shows an immunophenotypic features of myofibroblastic differentiation, hence bearing neoplastic potential. The diagnosis is challenging especially if it involves rectum. Surgical resection is the mainstay of treatment if clinically obstructed. A 65-year-old gentleman presented with intestinal obstruction, which then followed by a hartmann's procedure. Final diagnosis is a rare case of inflammatory myofibroblastic tumour of the rectum. We discuss its genetic involvement with a literature review.

Allele-specific PCR for a cost-effective & time-efficient diagnostic screening of spinal muscular atrophy.

BACKGROUND & OBJECTIVES: Genetic diagnosis of spinal muscular atrophy (SMA) is complicated by the presence of SMN2 gene as majority of SMA patients show absence or deletion of SMN1 gene. PCR may amplify both the genes non selectively in presence of high amount of DNA. We evaluated whether allele-specific PCR for diagnostic screening of SMA is reliable in the presence of high amount of genomic DNA, which is commonly used when performing diagnostic screening using restriction enzymes. METHODS: A total of 126 blood DNA samples were tested in amounts ranging 80-200 ng, referred for the genetic diagnosis of SMA using both conventional PCR-RFLP and allele-specific PCR. RESULTS: The results from both methods showed agreement. Further, allele-specific PCR was found to be a time-efficient and cost-effective method. INTERPRETATION & CONCLUSIONS: Our study demonstrated the accuracy of our allele-specific PCR and the results were comparable compatible with that of PCR-RFLP, indicating its practical application in SMA diagnostic screening.

Partial Purification of Bacteriocin from Lactobacillus pentosus Strain 124-2 Isolated from "Dadih".

<b>Background and Objective:</b> Preservation using antimicrobials has been observed to inhibit the growth of pathogenic bacteria in food. Nowadays many people choose food preservatives that are safe for health and natural. Bacteriocins as food preservatives are safe because antimicrobials from the antimicrobial peptide group include GRAS (Generally Recognized As Safe). Bacteriocin-producing LAB can be found in various fermented foods, one of which is "Dadih". Bacteriocins are expected to inhibit the growth of pathogenic bacteria so that they can be developed as an alternative to food preservatives. <b>Materials and Methods:</b> In this study, all experiments were performed with two replicates and the results were expressed as Mean±Standard Deviation (SD). <b>Results:</b> Screening results showed that the DK8 isolate had the highest antimicrobial activity. The DK8 isolate was identified molecularly using 16s RNA sequencing, showing that the DK8 isolate had the highest similarity to <i>Lactobacillus pentosus</i> strain 124-2. Bacteriocins from DK8 isolate and partially purified using ammonium sulfate precipitation at concentrations of 50, 60 and 70%. The addition of ammonium sulfate with a concentration of 50% showed the highest antimicrobial activity against <i>Salmonella</i> sp. (12.63 mm) and <i>Escherichia coli</i> (11.33 mm) while the highest antimicrobial activity against <i>Staphylococcus aureus</i> was the addition of 60% ammonium sulfate (8.13 mm). <b>Conclusion:</b> Lactic acid bacteria isolate was identified to have the highest similarity with <i>Lactobacillus pentosus</i> strain 124-2 and precipitation using 50% ammonium sulfate showed the highest antimicrobial activity.

Bespoke magnetic field design for a magnetically shielded cold atom interferometer.

Quantum sensors based on cold atoms are being developed which produce measurements of unprecedented accuracy. Due to shifts in atomic energy levels, quantum sensors often have stringent requirements on their internal magnetic field environment. Typically, background magnetic fields are attenuated using high permeability magnetic shielding, with the cancelling of residual and introduction of quantisation fields implemented with coils inside the shield. The high permeability shield, however, distorts all magnetic fields, including those generated inside the sensor. Here, we demonstrate a solution by designing multiple coils overlaid on a 3D-printed former to generate three uniform and three constant linear gradient magnetic fields inside the capped cylindrical magnetic shield of a cold atom interferometer. The fields are characterised in-situ and match their desired forms to high accuracy. For example, the uniform transverse field, Bx, deviates by less than 0.2% over more than 40% of the length of the shield. We also map the field directly using the cold atoms and investigate the potential of the coil system to reduce bias from the quadratic Zeeman effect. This coil design technology enables targeted field compensation over large spatial volumes and has the potential to reduce systematic shifts and noise in numerous cold atom systems.

Indigenous Bacteriocin of Lactic Acid Bacteria from "Dadih" a Fermented Buffalo Milk from West Sumatra, Indonesia as Chicken Meat Preservative.

BACKGROUND AND OBJECTIVE: The bacteriocin isolated from fermented buffalo milk from West Sumatra-Indonesia, called Dadih, can be considered as a natural and safe antimicrobial compound for food products. The objective of this research was to evaluate the antimicrobial activity of bacteriocin from Dadih and its effectiveness as a preservative in chicken meat. MATERIALS AND METHODS: This study used experimental method followed by statistical analysis using 3 experiments with duplication including experiment of meat samples (0 and 10% bacteriocin), storage temperatures (7 and 26°C) and storage duration (0, 1, 2, 3, 4, 5, 6 days and 0, 6, 12 hrs). Each experiment consists of a bacteriocin test, antimicrobial activity assay, physicochemical measurement and storability. RESULTS: From 10 LAB isolates successfully obtained from Dadih, two isolates with D7 code and D10 code had the highest antimicrobial activity, reaching 11.75 mm and 12 mm, respectively. The meat treated by 10% of bacteriocin gave the lower total microbial (3rd and 5th day) and total E. coli (5th day) at 7 and 26°C. The pH and water activity (aw) values of chicken meat with 10% of bacteriocin showed lower values at 7 and 26°C. The application of bacteriocin to chicken meat was able to inhibit the microbial growth that was still below standard for 3 days at 7°C and 6 hrs at 26°C. CONCLUSION: Based on research, lactic acid bacteria isolated from buffalo milk curd produced bacteriocin compound which has antimicrobial properties. This bacteriocin showed potential as a natural preservative for chicken meat by inhibiting the growth of pathogen microorganisms.

An artificial biofilm induced secondary caries model for in vitro studies.

BACKGROUND: The aim of this study was to establish a new in vitro model for biofilm induced secondary caries studies using an oral biofilm reactor. METHODS: An approximately 2 × 3 × 2 mm(3) sized dentino-enamel Class I cavity was prepared in the middle of a square-shaped specimen from the mid-labial portion of bovine incisors. The cavities were partially filled with either Clearfil AP-X with SE-Bond or Clearfil AP-X without any bond. Artificial biofilms were then formed on the resin composite filled surfaces using three species of oral bacteria in an oral biofilm reactor for 20 hours followed by 7- or 30-day incubation periods. RESULTS: The lesions were clearly visible on fluorescence microscopy and by scanning electron microscopy in the enamel at the interface of resin restorations in all samples. The data from image analysis showed that the lesion size was largest in the No-bond samples with statistically significant differences (p < 0.05). Demineralization along the cavity wall extended deeper in No-bond compared to SE-Bond samples and penetration was significantly deeper in No-bond 30-day samples. CONCLUSIONS: A primary artificial secondary caries model was established using biofilms for in vitro studies and the significance of using a bonding system could also be verified.

Half-Saline versus Combined Normal Saline and 1/3-2/3 Intravenous Fluid Therapy in Kidney Transplantation.

BACKGROUND: Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of fluid therapy post-operatively. We compared half-saline vs. normal saline and 1/3-2/3 intravenous fluid replacement after renal transplantation. METHODS: We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients (Case) received half saline, and group B patients (Control) received normal saline and 1/3-2/3 intravenous fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day. RESULTS: There were 34 and 36 eligible patients in the case and control groups, respectively. The mean±SD 6-hour urine output in the first 5 days after surgery was 2586±725 mL in the control group and 2764±758 mL in the case group (p=0.31). The mean±SD serum creatinine level at the end of the 5th post-operative day was 1.3±0.5 and 1.4±0.7 mg/dL in the case and control groups, respectively (p=0.56). Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day (p=0.558). The mean±SD time to creatinine level <1.5 mg/dL was 1.3±1 days in the control group and 1.7±0.8 days in the case group (p=0.635). Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group (p=0.318). The incidence of hyponatremia in the control group was 11% (4 of 36 patients) vs no patients in the case group (p=0.115). CONCLUSION: Either half-saline or normal saline and 1/3-2/3 intravenous solution can be safely used as fluid replacement therapy after kidney transplantation.

Peak expiratory flow rate control chart in asthma care: chart construction and use in asthma care.

BACKGROUND: The home monitoring of peak expiratory flow rate (PEFR), although recommended in current asthma guidelines, remains seriously underutilized by both patients and physicians. Our assessment is that this is more a statement regarding the inability of current charting methods to fulfill the promises made for PEFR monitoring, rather than a commentary regarding the usefulness of peak expiratory flow rate monitoring per se. We have adapted the theory and charting tool of the discipline of statistical process control to the daily monitoring of PEFR in the care of patients with asthma. Statistical process control charts integrate the actual PEFR values and their day-to-day variation in a manner that permits more informed decision-making. This article introduces our adaptation of statistical process control theory and charts via three case presentations. OBJECTIVE: Report our experience in the use of statistical process control theory and charting to the monitoring of peak expiratory flow in the care of patients with asthma. METHODS: Discussion of methodology and case reports. CONCLUSION: This is the first report of the application of statistical process control (SPC) theory and charting to the home monitoring of peak expiratory flow rate and the clinical decision-making processes involved in the day-to-day care of patients with asthma. SPC charts integrate knowledge of actual serial PEFR measurements with knowledge of their associated serial variation. Our adaptation of this theory and its charting methodology results in a tool that loses nothing provided by the charting methods suggested in current guidelines and, at the same time, provides patient specific, statistically driven signals of significant change; facilitates identification of the reason(s) for the change in PEFR; predicts the range in which future function will occur; permits decision-making and care to be provided in an anticipatory manner; and, importantly, permits the early identification of the functionally at-risk patient. This report demonstrates that home monitoring of peak expiratory flow is a robust tool whose usefulness in the care of patients with asthma has been limited more by the paradigm in which we have required it be used than by any of the limitations of the measurement per se.

Using statistical process control charts for the continual improvement of asthma care.

BACKGROUND: Home monitoring of lung function using simple, inexpensive tools to measure peak expiratory flow rate (PEFR) has been possible since the 1970s. Yet although current national and international guidelines recommend monitoring of PEFRs via traditional run charts, their use by both patients and physicians remains low. The role of statistical process control (SPC) theory and charts in the serial monitoring of lung function at home were explored and applied to the direct care of patients with asthma. The method represents an integration of collective professional and improvement knowledge with the related disciplines of continual improvement, SPC, system thinking/system dynamics, paradigms, and the learning community/organization. CASE STUDIES: Use of PEFR control charts for four patients cared for at the Asthma-Allergy Clinic and Research Center (Shreveport, La) is described. The key to good asthma control is the ability to optimize lung function by reducing the variation between serial lung function measurements and thereby generate a safe range of function. Knowledge of the type of variation (special cause or common cause) in the system helps in focusing clinical decision making. Case 4, an 11-year-old boy, for example, shows how control charts were used to learn the effects of a new inhaled corticosteroid. Comparison of the last 14 days of baseline and the last 14 days of open label use of the inhaled corticosteroid showed an obvious improvement in actual PEFR values--which a run chart or comparison of means would have easily demonstrated. The control chart showed that this child's care process at baseline was functionally at risk for severe asthma (46% personal best) and that the effect of the new medication not only elevated the mean function but shifted the range of function from 46%-72% personal best to 78%-102% personal best. At this new range of function the patient's system of care was not capable of delivering values that are at risk for severe asthma. Unless the range of function the change in care is capable of producing is specifically quantitated, misinterpretation of improvement data can occur. DISCUSSION: Developing the concept of the PEFR control chart involved examining and challenging traditional mental models for monitoring PEFR at home in the care of asthma, acquiring a better understanding of the workings of dynamic systems and with system thinking, and sharing what was learned with patients and seeking their input. CONCLUSIONS: The PEFR control chart employs an interesting statistical platform that enables the integration of knowledge of serial measurements and knowledge of the variation between those measurements into a tool with which to better assess the asthma care process being followed. This tool provides clinical insights, practical knowledge, and opportunities unavailable to patients and physicians via traditional PEFR charting.