Sleeve Gastrectomy and Cholecystectomy are Safe in Obese Patients with Asymptomatic Cholelithiasis. A Multicenter Randomized Trial.

BACKGROUND: Obesity is a severe health problem. Gallstones may symptomatize after sleeve gastrectomy (SG). Concomitant laparoscopic cholecystectomy (LC) with SG is controversial. The effects of SG and LC versus delayed LC following SG in obese patients with asymptomatic gallbladder stones were evaluated. METHODS: A randomized trial of 222 morbidly obese patients with gallbladder stones divided them into two equal groups: SG + LC and SG-only. This multicenter study conducted from January 2016 to January 2019. RESULTS: Except for operative time and postoperative hospital stay, there was no statistically significant difference between LSG + LC group and SG group (P < 0.001). In SG + LC group, LC added 40.7 min to SG, three patients (3%) required conversion, early postoperative complications occurred in 9 cases (9/111, 9%), three cases required re-intervention (3%). In SG group, the complicated cases required LC were 61 cases (61/111, 55%). Acute cholecystitis (26/61, 42.7%) was the most common gallstone symptoms. Most complicated cases occurred in the first-year follow-up (52/61, 85%). In the delayed LC group (61 patients), operative time was 50.13 ± 1.99 min, open conversion occurred in 2 cases (2/61, 3.2%), early postoperative complications occurred in four patients (4/61, 6.4%) and postoperative re-intervention were due to bile leaks and cystic artery bleeding (2/61, 3.2%). CONCLUSIONS: SG with LC prolongs the operative time and hospital stay, but the perioperative complications are the same as delayed LC; LC with SG minimizes the need for a second surgery. Concomitant LC with SG is safe.

Factors Influencing Decolourization and Detoxification of Remazol Brilliant Blue R Dye by Aspergillus flavus.

<b>Background and Objectives:</b> Anthraquinone synthetic dyes are widely used in textile, dyeing and paper painting. The discharge of these dyes into the environment causes detriment. The removal of physiochemical dyes is sometimes unsuccessful and expensive. Biological removal is inexpensive, eco-friendly and may break down organic contaminants. In the current work, a fungal technique was applied to decolorize and detoxify dye. <b>Materials and Methods:</b> Dye decolorizing fungi isolation, selection and identification of the most effective isolate and dye decolorization optimization based on carbon and nitrogen sources. In addition, the product's cytotoxicity and metabolites were tested. The enzyme activities were measured to determine dye decolorization. <b>Results:</b> Decolorization of reactive blue 19 dye by the most effective fungal strain isolate (5BF) isolated from industrial effluents were studied. This isolate was identified as <i>Aspergillus flavus</i> based on phenotypic characteristics and confirmed using 18S rRNA gene sequencing. Thin-layer chromatography indicated that this strain is aflatoxins free. Furthermore, metabolites produced from dye treatment with <i>A. flavus</i> were assessed using gas chromatography-mass spectrometry. Toxicity data revealed that <i>A. flavus</i> metabolites were not toxic to plants. Using a one-factor-at-a-time optimization technique, a maximum decolorization percentage (99%) was obtained after 72 hrs in the presence of mannitol and NH₄NO₃ or NH₄Cl as carbon and nitrogen sources. Two enzymes (laccase and manganese peroxidase) were shown to be active during dye decolorization by <i>A. flavus</i>. <b>Conclusion:</b> The <i>A. flavus</i> strain was shown to be safe when it came to removing dye from a synthetic medium with high efficiency and their metabolites had no negative influence on the environment. As a result, this strain will be used in the future for dye wastewater bioremediation.