Pathological, microscopic, and molecular diagnosis of paratuberculosis/John's disease in naturally infected dromedary camel (Camelus dromedarius).

Background and Aim: Paratuberculosis (PTB) or John's disease is a chronic disease of ruminants impeding the reproduction and productivity of the livestock sector worldwide. Since there is a lack of pathological studies explaining the nature and development of the disease in camels, this study aimed to highlight the anatomopathological changes of PTB in camels, which may help in verifying and validating some diagnostic tests used to detect the etiology of the disease in camel tissues. Materials and Methods: In August 2017, at Alselaa border's Veterinary Clinic of Al Dhafra Region, Western Abu Dhabi, UAE, one imported culled she-camel of 2 years old was subjected to clinical, microscopic, and anatomopathological investigations along with real-time quantitative polymerase chain reaction (q-PCR) to confirm the infection and correlate between clinical signs and pathological lesions of the PTB in dromedary camels. Results: Clinically, typical clinical signs compliant with the pathognomonic gross and histologic lesions of PTB were seen in naturally infected dromedary camel. As presumptive diagnosis microscopically, acid-fast coccobacillus bacterium clumps were demonstrated in direct fecal smears as well as in scraped mucosal and crushed mesenteric lymph node films, and in histopathological sections prepared from a necropsied animal and stained by Ziehl-Neelsen stain. Free and intracellular acid-fast clump phagosomes were further confirmed as Mycobacterium avium subsp. paratuberculosis by q-PCR. Conclusion: Clinical signs and pathological lesions of paratuberculosis in a dromedary camel were found to be similar to those of the other susceptible hosts.

Economizing on a 12 mm port incision site: modification of robotic bowel stapling technique in Da Vinci X/Xi left colonic resections-the modified Norfolk and Norwich robotic stapling technique.

The modified Norfolk and Norwich technique allows to replace a 12 mm port incision site by an 8 mm one, therefore reducing potential postoperative complications linked to 12 mm incisions by robotically stapling through the routinely placed suprapubic Alexis port.

Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta-analysis.

AIM: Complete mesocolic excision (CME) lacks consistent data advocating operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analysis, analysing population characteristics and perioperative, pathological and oncological outcomes. METHODS: D3 extended lymphadenectomy dissection was considered comparable to CME, and D2 and D1 dissection to be comparable to conventional surgery. Outcomes reviewed included lymph node yield, R1 resection, overall complications, overall survival and disease-free survival. RESULTS: In all, 3039 citations were identified; 148 studies underwent full-text reviews and 31 matched inclusion criteria: total cohort 26 640 patients (13 830 CME/D3 vs. 12 810 conventional). Overall 3- and 5-year survival was higher in the CME/D3 group compared with conventional surgery: relative risk (RR) 0.69 (95% CI 0.51-0.93, P = 0.016) and RR 0.78 (95% CI 0.64-0.95, P = 0.011) respectively. Five-year disease-free survival also demonstrated CME/D3 superiority (RR 0.67, 95% CI 0.52-0.86, P < 0.001), with similar findings at 1 and 3 years. There were no statistically significant differences between the CME/D3 and conventional group in overall complications (RR 1.06, 95% CI 0.97-1.14, P = 0.483) or anastomotic leak (RR 1.02, 95% CI 0.81-1.29, P = 0.647). CONCLUSIONS: Meta-analysis suggests CME/D3 may have a better overall and disease-free survival compared to conventional surgery, with no difference in perioperative complications. Quality of evidence regarding survival is low, and randomized control trials are required to strengthen the evidence base.

The New Generation from Biomembrane with Green Technologies for Wastewater Treatment.

A biopolymer of polylactic acid (PLLA)/polypropylene carbonate (PPC)/poly (3-hydroxybutrate) (PHB)/triethyl citrate (TEC) blends was prepared by the solution-casting method at different proportions. The thermal characteristics were studied by differential scanning calorimetry (DSC) and thermogravimetry (TG). PHB and TEC were added to improve the interfacial adhesion, crystallization behavior, and mechanical properties of the immiscible blend from PLLA and PPC (20%). The addition of more than 20% of PPC as an amorphous part hindered the crystallization of PLLA. PPC, PHB, and TEC also interacted with the PLLA matrix, which reduced the glass transition temperature (Tg), the cold crystallization temperature (Tcc), and the melting point (Tm) to about 53, 57 and 15 °C, respectively. The Tg shifted from 60 to 7 °C; therefore, the elongation at break improved from 6% (pure PLLA) to 285% (PLLA blends). In this article, biomembranes of PLLA with additives were developed and made by an electrospinning process. The new generation from biopolymer membranes can be used to absorb suspended pollutants in the water, which helps in the purification of drinking water in the household.

The Routine Use of Cholangiography for Laparoscopic Cholecystectomy in the Modern Era.

BACKGROUND AND OBJECTIVES: The use of routine versus selective intra-operative cholangiogram (IOC) for laparoscopic cholecystectomy (LC) remains an area of debate. In this study, we investigated the routine use of IOC in a single center, to determine whether it confers a reduced risk of common bile duct (CBD) injury and improved patient outcomes. We also identified several preoperative predictive factors for CBD stone detection on IOC to investigate the feasibility of a predictive model. METHODS: We identified 1005 LCs with routine IOC over a 2-year period at the Norfolk and Norwich University Hospital from October 1, 2013, to September 30, 2015. Outcomes measured included CBD stone detection on IOC, CBD injury, complication rates, readmission rate, and mortality. We also calculated sensitivity, specificity, and likelihood ratios for detection of CBD stones on IOC from preoperative biochemistry and radiological investigations. RESULTS: We identified a CBD stone detection rate of 10.1% and a readmission rate of 0.03%, with no reported CBD injuries and 1 reported mortality. Of the preoperative predictive factors investigated, the most specific for CBD stone detection on IOC was bilirubin at 89%. The most sensitive was preoperative MRCP at 77%. DISCUSSION: This study demonstrates that routine IOC is an effective method of detecting CBD stones and CBD injuries, resulting in improved patient outcomes and economic benefits for health services. We have also identified several predictive factors for CBD stones on IOC.

Increase the elongation at break of poly (lactic acid) composites for use in food packaging films.

Poly (3-hydroxy butyrate) (PHB), cellulose nano crystal (CNC) and a plasticizer (TBC) are mixed together with PLLA with the aim to increase the elongation at break for use in the food packing sector. Spherical (CNC) and fibril nano crystal (CNF) were prepared by hydrolysis of microcrystalline cellulose (MCC) in distilled water, and then stirred using a magnetic stirrer for 15 days and ultrasonic treatment without using any acids as green method. The morphology, thermal, and mechanical properties were studied using POM, DSC, WAXD, SEM and tensile testing, respectively. DSC demonstrated that the addition of PHB, CNC and TBC to PLLA matrix lead to reduce Tg, TCC and Tm than pure PLLA. FT-IR verified that the carbonyl group C=O appeared broad and some peaks in the PLLA composites 5, 6 and 7 shifted from 3.98 × 108 to 4.07 × 108 Hz, at 3.54 × 108 to 3.44 × 108 Hz, at 3.19 × 108 to 3.13 × 108 Hz. Mechanical testing shows that pure PLLA is brittle, and the elongation at break of PLLA composites reaches up to 205%, making it suitable to use in food packaging.

Influence of Electrospinning Parameters on Fiber Diameter and Mechanical Properties of Poly(3-Hydroxybutyrate) (PHB) and Polyanilines (PANI) Blends.

Random and oriented fibers of poly (3-hydroxybutyrate) (PHB) and their blends were manufactured using electrospinning using a co-solvent. The kind and the concentration of the co-solvent affected the diameter of electrospun fibers. The morphology, thermal analysis, and crystalline structure of electrospun fibers was studied using polarized optical microscop (POM), Differential scanning colametry (DSC), Scanning Electron Microscopy (SEM), Wide angle X-ray diffraction (WAXD), and FT-IR analysis. The diameter of the electrospun fibers decreases with increasing collector speed for the blends compared to pure PHB, which are about 6 µm in diameter. The fibers obtained from blends reduce to 2 µm. The aligned electrospun fiber mats obtained from pure PHB showed no signs of necking at different take-up speeds, but the blends show multiple necking. It was found by FT-IR that the peak intensity at 1379 cm-1 was lower by take up speed than in casting films; this peak is sensitive to crystallinity of PHB. The addition of polyanilines (PANIs) to (PHB) with a plasticizer decreases the diameter of the electrospun fiber.

Canonical Wnt signals combined with suppressed TGFß/BMP pathways promote renewal of the native human colonic epithelium.

BACKGROUND: A defining characteristic of the human intestinal epithelium is that it is the most rapidly renewing tissue in the body. However, the processes underlying tissue renewal and the mechanisms that govern their coordination have proved difficult to study in the human gut. OBJECTIVE: To investigate the regulation of stem cell-driven tissue renewal by canonical Wnt and TGFß/bone morphogenetic protein (BMP) pathways in the native human colonic epithelium. DESIGN: Intact human colonic crypts were isolated from mucosal tissue samples and placed into 3D culture conditions optimised for steady-state tissue renewal. High affinity mRNA in situ hybridisation and immunohistochemistry were complemented by functional genomic and bioimaging techniques. The effects of signalling pathway modulators on the status of intestinal stem cell biology, crypt cell proliferation, migration, differentiation and shedding were determined. RESULTS: Native human colonic crypts exhibited distinct activation profiles for canonical Wnt, TGFß and BMP pathways. A population of intestinal LGR5/OLFM4-positive stem/progenitor cells were interspersed between goblet-like cells within the crypt-base. Exogenous and crypt cell-autonomous canonical Wnt signals supported homeostatic intestinal stem/progenitor cell proliferation and were antagonised by TGFß or BMP pathway activation. Reduced Wnt stimulation impeded crypt cell proliferation, but crypt cell migration and shedding from the crypt surface were unaffected and resulted in diminished crypts. CONCLUSIONS: Steady-state tissue renewal in the native human colonic epithelium is dependent on canonical Wnt signals combined with suppressed TGFß/BMP pathways. Stem/progenitor cell proliferation is uncoupled from crypt cell migration and shedding, and is required to constantly replenish the crypt cell population.

Human epidermal growth factor receptor-2 in oesophageal cancers: an observational study.

AIM: To determine the incidence of human epidermal growth factor receptor 2 (HER2) over expression in oesophageal cancers. METHODS: A retrospective study, of one hundred consecutive cases of endoscopic histological samples of oesophageal cancers from a single British cancer network were included. Cancer cases were diagnosed between April 2007 and June 2010. HER2 over expression was assessed using immunohistochemistry, those that scored "0" and "+1" were considered "negative" for HER2; those that scored "+3" were considered "Positive". Cases that were scored "+2" on immunohistochemistry further went on to have HER2 gene analysis using the Ventana HER brightfield dual-colour in situ hybridisations (HER B DISH) assay and either came back to be positive or negative for HER2 over expression. Overall survival was measured from date of histological diagnosis until date of death. 93% of the cases were followed up till five years or death, and all were followed up till two years. Cases of gastro-oesophageal junctional tumours were excluded. RESULTS: The median age of our sample was 66 years (range: 38-91 years). Eighty one were male and 19 female. Ninety-one of the cases were adenocarcinoma of the oesophagus and the rest were cases of squamous cell carcinoma. The anatomical distribution of the tumours was; upper oesophagus 2, middle oesophagus 11, and 87 were in the lower oesophagus. Operative resection was completed in 15 cases; seven cases had attempted surgical resections, i.e., open and close, 33 patients received definitive chemo-radiation and 52 had palliative treatment. Twenty-five of the cancers showed evidence of HER2 over expression, all were adenocarcinomas. Of the 25 cases that showed evidence of HER2 over expression, 21 (84%) were located in the lower third of the oesophagus. On staging, 24 out of the 25 HER2 positive cases were at stage 3 or more (13 at stage 3 and 11 at stage 4), For HER2 negative cases 37 were at stage 3 and 32 were staged as stage 4. Seventeen out of twenty five cases (68%) with HER2 over expression received palliative therapy, in comparison to thirty five out of seventy five (46.7%) in tumours not expressing HER2. No significant difference in overall survival was demonstrated between patients whose cancers showed evidence of HER2 over expression and those who did not; median overall survival for HER2 positive tumours was 15 mo (95%CI, 11-19 mo) compared to 13 mo (95%CI, 9-17 mo) for HER2 negative ones. Two years cumulative survival for cases with HER2 over expression was 33.7% compared to 31.6% in cases without HER2 over expression (P = 0.576). Only cancer's stage significantly affected overall survival on both univariant and multivariable analysis (P = 0.034 and P = 0.009 respectively). None of the patients included in this study received Trastuzumab. CONCLUSION: Twenty-seven point five percent of oesophageal adenocarcinomas showed evidence of HER2 over expression. Routine testing for human HER2 in oesophageal adenocarcinomas can have significant implication on treatments offered to patients that may potentially affect their prognosis.

Stomach torsion in pregnancy as a complication of laparoscopic adjustable gastric banding.

Laparoscopic Adjustable Gastric Banding (LAGB) was done for the first time in Belgium in 1993. Gastric torsion after band slippage is extremely rare. Literature review of gastric banding and complications in pregnancy did not reveal any case of gastric torsion. Hence, we report this rare case of gastric torsion in a pregnant lady following gastric banding.

An effect of letrozole on gastric cancer?

Letrozole is a drug used in the treatment of postmenopausal women with breast and ovarian tumours. There is no evidence in the literature indicating its use in treating gastric cancer. We present a 68 year old lady admitted from the emergency department with weight loss, malaise and anaemia. Investigations confirmed the presence of two different primary tumours in the left breast and the stomach. Following that this patient with oestrogen receptor positive breast cancer and oestrogen receptor negative gastric cancer was treated with letrozole for her breast cancer followed by a gastric resection. Independent histology by two pathologists pre-operatively diagnosed gastric adenocarcinoma. Post-operatively, independent analysis of the resected stomach, omentum and lymph nodes revealed no evidence of gastric cancer. Therefore we conclude that there is a possibility of letrozole having an effect on gastric cancer. Further studies are needed.