Billroth-II modified with hinged anti-peristaltic afferent loop versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A propensity-score match analysis.

BACKGROUND: This study aimed to evaluate the effectiveness of modified Billroth-II with a hinged anti-peristaltic afferent loop by comparing it with the Roux-en-Y method. METHODS: We retrospectively analyzed 344 patients with gastric cancer who underwent distal gastrectomy between 2016 and 2021. Propensity score matching was conducted to balance baseline characteristics. RESULTS: After propensity score matching, there were 117 patients in each group. The Billroth-II group was significantly better regarding operating time (184.7 vs 225.3 minutes), postoperative hospital stays (7.9 vs 9.2 days), and time to semi-solid diet tolerance (2.8 vs 3.8 days). The Billroth-II group demonstrated comparable results with the Roux-en-Y group in weight loss, hemoglobin changes, reflux esophagitis, food residue, and gastritis severity. Presentation of bile in gastric remnant was significantly higher in the Billroth-II group (42.9% vs 10.3%). CONCLUSION: There were no significant differences in functional outcomes between Billroth-II and Roux-en-Y reconstructions. The Billroth-II was superior to Roux-en-Y in operating time, hospital stays, and time to semi-solid diet tolerance. The Billroth-II could be considered an acceptable alternative reconstruction after distal gastrectomy.

Improved synthesis, molecular modeling and anti-inflammatory activity of new fluorinated dihydrofurano-naphthoquinone compounds.

A series of new fluorinated dihydrofurano-napthoquinone compounds were sucessfully synthesized in good yields using microwave-assisted multi-component reactions of 2-hydroxy-1,4-naphthoquinone, fluorinated aromatic aldehydes, and pyridinium bromide. The products were fully characterized using spectroscopic techniques and evaluated for their anti-inflammatory activity using lipopolysaccharide (LPS)-stimulated RAW264.7 macrophage cells. Among 12 new compounds, compounds 8b, 8d, and 8e showed high potent NO inhibitory activity in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophage cells with IC50 values ranging from 1.54 to 3.92 µM. The levels of pro-inflammatory cytokines IL-1ß and IL-6 in LPS-stimulated RAW264.7 macrophages were remarkably decreased after the application of 8b, 8d, 8e and 8k. Molecular docking simulations revealed structure-activity relationships of 8b, 8d, and 8e toward NO synthase, cyclooxygenase (COX-2 over COX-1), and prostaglandin E synthase-1 (mPGES-1). Further physicochemical and pharmacokinetic computations also demonstrated the drug-like characteristics of synthesized compounds. These findings demonstrated the importance of fluorinated dihydrofurano-napthoquinone moieties in the development of potential anti-inflammatory agents.

Synthesis, in vitro Α-Glucosidase, and acetylcholinesterase inhibitory activities of novel Indol-Fused Pyrano[2,3-D]Pyrimidine compounds.

In this study, new indol-fused pyrano[2,3-d]pyrimidines were designed and synthesized. These products were obtained in moderate to good yields and their structures were assigned by NMR, MS, and IR analysis. Afterwards, the biological important of the products was highlighted by evaluating in vitro for α-glucosidase inhibitory activity as well as acetylcholinesterase (AChE) inhibitory activity. Eleven products revealed substantial inhibitory activity against α-glucosidase enzyme, among which, two most potent products 11d,e were approximately 93-fold more potent than acarbose as a standard antidiabetic drug. Besides that, product 11k exhibited good AChE inhibition. The substituents on the 5-phenyl ring, attached to the pyran ring, played a critical role in inhibitory activities. The biological potencies have provided an opportunity to further investigations of indol-fused pyrano[2,3-d]pyrimidines as potential anti-diabetic agents.

Long-term Results of Totally Laparoscopic Near-total Gastrectomy for Middle-third Gastric Cancer.

PURPOSE: In recent years, laparoscopic near-total gastrectomy (LnTG) has emerged as a surgical option for gastric cancer in the middle-third of the stomach. However, its application in locally advanced stages presents technical challenges. This study aims to provide a detailed analysis of the operative outcomes and long-term functional and oncological results of totally LnTG in combination with D2 lymphadenectomy for middle-third gastric cancer. PATIENTS AND METHOD: A prospective study was conducted on 79 patients who underwent totally LnTG and D2 lymphadenectomy for middle-third gastric cancer between January 2017 and December 2021. Short-term outcomes included operative characteristics, and the evaluation of gastroesophageal reflux and gastric remnant condition using endoscopy based on the Los Angeles (LA) and Residue-Gastritis-Bile classifications. Long-term oncological outcomes included overall survival and disease-free survival. RESULTS: Totally LnTG was successfully performed in 98.7% of patients without intraoperative complications or conversions to laparotomy. The mean operation time was 202.2±43.0 min, and the median blood loss was 50 (50;100) mL. The overall incidence of postoperative morbidities was 16.5%, with one patient experiencing a narrowing of the gastrojejunostomy, successfully treated by endoscopic balloon dilation. All patients had tumor-free resection margins, and there were no mortalities. The 5-year overall survival and disease-free survival rates were 80% and 55%, respectively. CONCLUSIONS: Totally LnTG is an effective and feasible approach for gastric cancer in the middle-third of the stomach, yielding favorable short-term outcomes and acceptable long-term results. Routine application of totally LnTG for middle-third gastric cancer is practical and promising.

Regional Lymph Node Metastasis Distribution in Resectable Middle-Third Gastric Cancer: A Cross-Sectional Study.

Introduction Lymph node (LN) metastasis happens even in early gastric cancer (GC) even in LN stations that are not adjacent to the primary tumor. Total or subtotal gastrectomy (TG or sTG) can be performed in the middle third of the GC if the negative proximal margin is maintained. These procedures differed in the extent of LN dissection; therefore, oncology considerations must be taken into consideration when selecting the appropriate procedure. Methods This was a cross-sectional study involving 98 patients suffering from middle-third GC. The metastatic lymph nodes (mLN) ratio was calculated in each case by the ratio between the number of mLN and the number of total LNs retrieved. We compare the difference in the total LN retrieved, number of mLN, and rate of positive LN (N+) between the two groups TG and sTG. Results The majority of patients had advanced GC (82.7% pT2-4). About 65.3% of patients had metastasis LN. The events of LN metastasis and skipped LN metastasis happened even in tumors contained in the submucosal layer. The metastasis rates in each LN station were also increasing in correlation with the depth of tumor invasion. For LN station No. 2, 4sa, 10, 11d (which are not mandatory) in sTG, the rate of mLN was 0% for the pT1-3 tumor, regardless of tumor longitudinal location. The rate of mLN for each station was higher in adjacent stations of the tumor (No. 1-3-5-7 in lesser curvature, No. 4sb-4d-6 in greater curvature, No.1-3-4sb in the anterior wall, No. 3-7-12a in the posterior wall). The total LN retrieved, number of mLN, and rate of positive LN were statistically higher in the TG group compared to the sTG group. However, the mean mLN ratios between the two groups were comparable (p = 0.116). Conclusion In accordance with the macroscopic and microscopic characteristics, we observed a stratified distribution of mLN in the middle third of the GC. With these early results, sTG combined with standard lymphadenectomy was an acceptable treatment for T1-T3 middle-third GC in terms of mLN distribution. Total No. 4sb LN dissection might also be reserved in gastrectomy for T1-T3 GC.

Three-year prospective outcomes of laparoscopic intraperitoneal on-lay mesh repair of abdominal incisional hernia.

BACKGROUND: Incisional hernia (IH) can be treated with an intraperitoneal on-lay mesh (IPOM). This study aimed to evaluate the surgical outcomes, recurrence rates, and chronic pain after laparoscopic IH repair. METHOD: The data of 50 patients who underwent laparoscopic IPOM repair between March 2018 and May 2021 were prospectively collected. RESULTS: The standard IPOM technique was used on 41 patients (82%), whereas the IPOM-plus technique was used on nine patients (18%). There was a history of IH repair for 12 patients (24%), and two of them recurrent hernias. The average body mass index was 24.7, and the average defect size was 17.6 cm2 . The mean operative time was 145.7 minutes, and the mean hospital stay was 3.5 days. There were minor complications in nine patients (18%), a case of bowel injury (2%), and a case of bladder injury (2%). Recurrent hernias were observed in three patients (6%) over a mean follow-up period of 17.9 months (4-36 months). One patient had postoperative chronic pain lasting 3 months. The width and size of the hernia were risk factors for recurrence. CONCLUSION: Laparoscopic IPOM repair was a safe and effective method of treating IH, with a low incidence of postoperative complications, chronic pain, and recurrence.

A new triterpenoid from the stems of Kadsura coccinea with antiproliferative activity.

A series of schiartane C29 nortriterpenoids with 5/5/7/6/5 membered consecutive rings (1‒5) with an unique schinortriterpenoid skeleton including a new, kadcoccilactone V (1), together with four known ones (2‒5) and three known triterpenoids (6‒8) were identified from stems of Kadsura coccinea (Lem.) A. C. Smith. The structures of 1 and known compounds were elucidated by interpretation of 1D and 2D NMR, and HR-ESI-MS data as well as comparing those data in the literature. All the isolated compounds were examined for cytotoxic effects against six human cancer cell lines [(HCT-15 (colon), NUGC-3 (stomach), NCI-H23 (lung), ACHN (renal), PC-3 (prostate), and MDA-MB-231 (breast)]. Among them, compound 6 showed potent cytotoxicity against NCI-H23 (GI50 1.28 µM) and NUGC-3 (GI50 1.28 µM), and significantly inhibited on PC-3, MDA-MB-231, ACHN, HCT-15 with GI50 values around 2.33 to 2.67 µM.

Biomechanical considerations for uprighting impacted mandibular molars / 대한치과교정학회지

This case report demonstrates two different uprighting mechanics separately applied to mesially tipped mandibular first and second molars. The biomechanical considerations for application of these mechanisms are also discussed. For repositioning of the first molar, which was severely tipped and deeply impacted, a novel cantilever mechanics was used. The molar tube was bonded in the buccolingual direction to facilitate insertion of a cantilever from the buccal side. By twisting the distal end of the cantilever, sufficient uprighting moment was generated. The mesial end of the cantilever was hooked over the miniscrew placed between the canine and first premolar, which could prevent exertion of an intrusive force to the anterior portion of the dentition as a side effect. For repositioning of the second molar, an uprighting mechanics using a compression force with two step bends incorporated into a nickel-titanium archwire was employed. This generated an uprighting moment as well as a distal force acting on the tipped second molar to regain the lost space for the first molar and bring it into its normal position. This epoch-making uprighting mechanics could also minimize the extrusion of the molar, thereby preventing occlusal interference by increasing interocclusal clearance between the inferiorly placed two step bends and the antagonist tooth. Consequently, the two step bends could help prevent occlusal interference. After 2 years and 11 months of active treatment, a desirable Class I occlusion was successfully achieved without permanent tooth extraction.

Comparison of Novel, Bach Mai Boston Tool (BBT) and the Patient-Generated Subjective Global Assessment (PG-SGA) for Oncology Inpatients.

Oncology inpatients are at high risk of malnutrition. Identification of at risk patients by nutrition screening requires a practical and easy to use tool. The aim of this study was to determine the validity of the Bach Mai Boston Tool (BBT) compared to a 'gold standard' full nutrition assessment using the Patient-Generated Subjective Global Assessment (PG-SGA). A cross-sectional study was conducted on 270 oncology inpatients from January to December 2016. Cohen's Kappa, sensitivity, specificity and ROC analyses were performed. 270 inpatients were included in this study with a mean age of 56.3 ± 12.1 years old. Of these patients, 51.8% were male, and 74.1% had gastrointestinal cancer. The mean body mass index of patients was 20.6 ± 3.0 kg/m2. The PG-SGA tool identified 146 (54.1%) malnourished patients, while the BBT identified 105 (39.9%) malnourished patients. The BBT had a medium consistency, with a Kappa value of 0.6. Using a cut-off point of ≥ 4, the BBT had a sensitivity of 87.7% and a specificity of 72.6%. On the other hand, a BBT with a cut-off point ≥ 5 resulted in a sensitivity of 67.1%, a specificity of 94.4%, and an AUC of 0.81. The BBT is a practical, informative and valid tool for detecting malnutrition in hospitalized oncology patients. We recommend using a cut-off point of 4 for screening the risk of malnutrition for oncology inpatients.

High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use

@#Abstract Objective: The World Health Organization’s guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. Methods: We surveyed 1886 women aged ≥ 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. Results: Across these provinces, high prevalence of HCV exposure (8.8–30.4%) and active infection (3.6–22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8–37.9), injection drug use (aOR = 23.3; 95% CI: 13.1–41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4–4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2–3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8–39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8–5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2–4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3–3.7) were independently associated with HCV exposure. Discussion: FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.

Pilot scale degradation of mono and multi volatile organic compounds by surface discharge plasma/TiO2 reactor: Investigation of competition and synergism.

This paper mainly deals with the isovaleraldehyde degradation with the help of a nonthermal plasma surface discharge (NPSD) coupled with photocatalysis. The efficiency of NPSD reactor, for gas treatment, was studied for different binary mixtures: (1) mixture of aldehydes (Isovaleraldehyde and Butyraldehyde) and (2) mixture of aldehyde and amine (Isovaleraldehyde and Trimethylamine). A planar continuous reactor is used to investigate the effect of addition of another pollutant on the performance of oxidation process. A synergetic effect was observed by combining NPSD and photocatalysis for the degradation of mixture of pollutants. In addition, combined NPSD/photocatalysis has significantly enhanced the CO2 selectivity, as compared to NPSD alone. This is attributed to the formation of more reactive species due to the presence of TiO2 in the plasma discharge zone. Moreover, ozone and UV light on TiO2, produced by plasma, have activated the surface leading to enhanced mineralization. In addition, the byproducts of each binary mixture were identified and evaluated.

Molecular epidemiology and antimicrobial resistance phenotypes of Acinetobacter baumannii isolated from patients in three hospitals in southern Vietnam.

Multidrug resistance in the nosocomial pathogen Acinetobacter baumannii limits therapeutic options and impacts on clinical care. Resistance against carbapenems, a group of last-resort antimicrobials for treating multidrug-resistant (MDR) A. baumannii infections, is associated with the expression (and over-expression) of carbapenemases encoded by the blaOXA genes. The aim of this study was to determine the prevalence of antimicrobial-resistant A. baumannii associated with infection in three hospitals in southern Vietnam and to characterize the genetic determinants associated with resistance against carbapenems. We recovered a total of 160 A. baumannii isolates from clinical samples collected in three hospitals in southern Vietnam from 2012 to 2014. Antimicrobial resistance was common; 119/160 (74 %) of isolates were both MDR and extensively drug resistant (XDR). High-level imipenem resistance (>32 µg ml-1) was determined for 109/117 (91.6 %) of the XDR imipenem-nonsusceptible organisms, of which the majority (86.7 %) harboured the blaOXA-51 and blaOXA-23 genes associated with an ISAba1 element. Multiple-locus variable number tandem repeat analysis segregated the 160 A. baumannii into 107 different multiple-locus variable number tandem repeat analysis types, which described five major clusters. The biggest cluster was a clonal complex composed mainly of imipenem-resistant organisms that were isolated from all three of the study hospitals. Our study indicates a very high prevalence of MDR/XDR A. baumannii causing clinically significant infections in hospitals in southern Vietnam. These organisms commonly harboured the blaOXA-23 gene with ISAba1 and were carbapenem resistant; this resistance phenotype may explain their continued selection and ongoing transmission within the Vietnamese healthcare system.

Esophago-intestinal anastomotic leakage after total gastrectomy in gastric cancer

149 patients with gastric epithelioma indicated the total gastrectomy in the army central hospital 108 during 1994-2000. The esophago-intestinal anastomotic leakage, a severe complication occurred in 2 patients among group received the esophago-intestinal anastomosis as method of omega. There was no this complication in group received the operation as method of lygidakis (making the false stomach). This study indicated that technique of anastomosis played an important role in the esophago-intestinal anastomotic leakage.

Situation of hepatitis B infection during 1992-1996 the results of project "radioimmunological diagnosis of hepatitis B (RAS/6/018)

The results of project "RAS/6/018" have shown that the rate of HBsAg carriers among normal people was 10.6-15.1%. The rate of HBsAg among blood donors was 1.3%, lower 10 times than this of general population. Frequency of HBV infection, HBV and HIV infection was high among patients with chronic hepatitis. There were markers of HBsAg and HBeAg of transmission from mother to her children among chronic viral hepatitis B carriers due to the uncompleted immunological structure and function.

The esophageal mucosal lesion after total gastrectomy, recovering the digestive function as type omega and corrective lygidakis

119 patient with the peptic cancer received the total gastrectomy, participated to a study after 6-12 months of operation, were recovered the digestive functions as 2 different methods. The results of esophageal endoscopy and biosy only allowed to determine the levels of lesion but not allow affirm that these lesions due to reflu. However, there were the close relation between the general picture according to the description of boyce and microscopic picture according to the description of Beigi I with the clinical symptoms of the reflux esophagitis. Therefore, they also can be used as a standard of diagnosis. The method of the digestive functional recovering by making the distribution bag DD type Lygidakis showed the obvious efficacy in the limitation of the esophageal mucosal lesion due to the postoperative reflux

The surgical accident and complication of the total gastrectomy to treat the gastric cancer

149 patients with gastric epithelioglandular cancer were operated for the total gastrectomy in the Army Central Hospital No 108 from 1/1994 to 1/200 (male: 86; female: 63), average ages: 50, divided 2 groups according to the 2 methods of the different digestive circulation recovering. The results have shown that the rate of the tumors in the determined positions as vertical axis and perimeter of stomach the average size of the tumor, the average duration of operation and the rate of accidents were not different between two groups. The average rate of accident during operation was 6,7%, the rate of surgical complication was 18,1%.There was no death.

The results of long-term monitoring 149 patients with gastric cancer received the radical total gastrectomy

Studying was performed on the 149 patients with gastric epithelia glandular cancer received a radical total gastrectomy in the Army Central Hospital No 108 during 1/1/1994 - 1/1/2000. The results has shown that the survival rate within 1,2,3,4,5 years from operations for group connected with omega were 76,36%; 60%; 40%; 27,27%; 25,45%, 53,7% and 46%, respectively. There is a significant different between the survival rates of patients with the tumors T3 and T4. There is no different of the survival rate between levels of the glandular metastasis N2 and N3 and between the third phase and the fourth phase.

Study on the gastric emptying times in patients with total gastrectomy by CT scanner

CT scanner with marking 99m Tc-DTPA, with semi-solid meal can study completely the movement of food in the gastric region in the physiological condition and determine the gastric emptying times. The ability of rapid movement of the food from omega loop (t50% = 25.42 minutes) and the time of retention of the food in the false stomach in patients with total gastrectomy were the same as this in persons with the normal stomach (t50%=49.23 minutes). This accounted for the better living condition and less disorder in patients with gastric replacement by false stomach as type of Lygidakis total gastrectomy.

Evaluation of esophagoduodenal reflux in total gastroresected patients by image

A study was carried out 50 patients with stomach cancer received total gastrectomy after 6-12 months of operation, recovered the digestive functions by 2 methods. The evaluation of the esophagoduodenal reflux by scintigraphy. Used 99m Tc-HIDA and gamma-camera found that as a simple, physiological acceptable method and could be used for quantitative analysis. The method of the esophago-intestinal anastomosis type omega after the total gastrectomy can remainly cause the reflux. The method of making the pseudo stomach type lygidakis with distance of 40 cm from the anastomosis stoma Roux -en-Y to the anastomosis stoma of the esophagointestine found that it can prevent the esophagoduodenal reflux. The reflux found that did not occure in all 31 patients who evaluted by scintigraphy.

Investigation of the hepatitis B viral infection by the radio immunological technique

53,010 tests of RIA implemented during 1/1992- 10/1996 including 45,210 tests of HBsAg, 4,764 anti-HBs, 1,119 HBeAg, 1325 anti-HBe and 1,358 anti HBc to evaluate the frequent of HBsAg, double infection of HBV and HCV in the chronic hepatitis and the changes of markers of hepatitis B in persons carrying the chronic HBsAg. The results have shown that the frequent of the hepatitis B viral infection was very high and the double infection of HBV and HCV was common in patients with the chronic hepatitis