Comparison of short-term outcomes of video-assisted thoracoscopic (VATS) plication of diaphragmatic eventration - a six-year prospective cohort study.

Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10-stapled resection, 9-suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other.

Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Systematic Review of Bariatric and Metabolic Surgery.

In recent years, combined restrictive and hypo-absorptive procedures have gained widespread acceptance. The rationale of this systematic review is to compare the safety and efficacy between Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Eighteen eligible studies were finalized for this review. Weight loss outcomes were greater with SADI-S (5 years) and OAGB (10 years). SADI-S offered better resolution of diabetes whereas hypertension and dyslipidaemia resolution were better with OAGB. Although early complications and mortality were higher with SADI-S, late complications were more frequent with RYGB. Both SADI-S and OAGB are as effective as RYGB for weight loss, but OAGB offers lesser complications. However, more data is imperative to determine the next gold standard procedure.

Endoscopic Thyroidectomy: A 6-Year Experience from a Tertiary Care Teaching Hospital in Western India.

Background: Minimally invasive and endoscopic surgical techniques have surpassed the conventional open thyroidectomy for the treatment of thyroid nodules. Trans-axillary, Unilateral Axillo-Breast Approach (UABA), Bilateral Axillo-Breast Approach, and Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) are the most common endoscopic procedures performed currently. This article highlights our experiences with UABA and TOETVA over a period of 6 years. Materials and Methods: Between January 2015 and December 2020, we retrospectively analyzed our experience in Endoscopic thyroidectomy with 119 patients using UABA (n = 72) and TOETVA (n = 47) in our tertiary care teaching hospital. Both approaches used the standard three-port technique. Real time angiography was performed intraoperatively using Indocyanine Green dye to delineate the vessels in all patients. Results: The mean operative time for UABA and TOETVA was 90 and 110 minutes, respectively. Estimated blood loss was 18 mL in the former and 20 mL in the latter. Temporary Recurrent Laryngeal Nerve palsy and Hypoparathyroidism were minimal with TOETVA (5 patients versus 4 patients and 7 patients versus 2 patients). Shorter duration of hospital stay was observed with UABA (3 days versus 5 days). Cosmetic satisfaction was better with TOETVA. Conclusion: Based on our 6-year experience, we propose "JJ Hospital Criteria," which we currently follow to decide which surgical approach will yield best results. UABA and TOETVA are safe, feasible, and give exceptional cosmetic satisfaction. Both approaches should be seen as complementary rather than competitive.

Endoscopic sistrunk using bilateral axillo-breast approach - A minimal access technique for thyroglossal duct cysts.

Sistrunk procedure for thyroglossal duct cyst (TGDC) includes removal of the thyroglossal cyst, middle portion of the hyoid bone and the tract towards the foramen caecum. Endoscopic approaches have surpassed the traditional open approaches for the treatment of benign thyroid swellings and TGDCs. Endoscopic Sistrunk procedure using bilateral axillo-breast approach is a safe and better alternative for the successful treatment of TGDC and provides excellent cosmetic results.

Coplanarity driven fluorescence turn-on sensor for chromium(iii) and its application for bio-imaging.

New benzimidazole and benzothiazole derivatives (S1-S3) derived from thiophene-2,5-dicarboxaldehyde and 5,5'-bipyridyldicarboxaldehyde with NSN/SSS/NN binding sites were tested against various cations and anions. S3 showed selectivity toward copper(ii) ions among other cations under consideration with the colour change to pale yellow from colourless under aqueous medium. In the cases of S1 and S2, no colour change was observed. S1 alone showed selective fluorescence turn on for Cr(iii) ions among other cations. S1 showed sensitivity towards Cr(iii) with fluorescence change with bathochromic shift. The prominent fluorescence change of S1 with Cr(iii) ions was applied to live cell imaging of HeLa cells.

Connecting science, policy, and implementation for landscape-scale habitat connectivity.

We examined the links between the science and policy of habitat corridors to better understand how corridors can be implemented effectively. As a case study, we focused on a suite of landscape-scale connectivity plans in tropical and subtropical Asia (Malaysia, Singapore, and Bhutan). The process of corridor designation may be more efficient if the scientific determination of optimal corridor locations and arrangement is synchronized in time with political buy-in and establishment of policies to create corridors. Land tenure and the intactness of existing habitat in the region are also important to consider because optimal connectivity strategies may be very different if there are few, versus many, political jurisdictions (including commercial and traditional land tenures) and intact versus degraded habitat between patches. Novel financing mechanisms for corridors include bed taxes, payments for ecosystem services, and strategic forest certifications. Gaps in knowledge of effective corridor design include an understanding of how corridors, particularly those managed by local communities, can be protected from degradation and unsustainable hunting. There is a critical need for quantitative, data-driven models that can be used to prioritize potential corridors or multicorridor networks based on their relative contributions to long-term metacommunity persistence.

Effect of Erythrina variegata seed extract on hyperlipidemia elicited by high-fat diet in wistar rats.

OBJECTIVE: To investigate the effect of the methanolic extract of Erythrina variegata (Linn.) var Orientalis (Fabaceae) seeds (MEEV) in reducing the cholesterol levels and as well as antioxidant in experimentally induced hyperlipidemic rats. MATERIALS AND METHODS: Doses of 200 and 400 mg/kg of the extract were evaluated for its effect on lipid profile, HMG-CoA reductase, and on antioxidant enzymes in high-fat diet (HFD) induced hyperlipidemia. RESULTS AND CONCLUSION: The elevated levels of total cholesterol, triglycerides, low-density lipoprotein, and very low density lipoprotein due to HFD was reduced by concurrent treatment with MEEV (200 and 400 mg/kg) significantly (P<0.001). A significant reduction (P<0.001) in high-density lipoprotein was noticed in HFD fed groups; however, a nonsignificant increment was produced by the administration of MEEV (200 and 400 mg/kg). The HMG-CoA reductase activity was increased in HFD fed animals significantly (P<0.001) and was reduced by MEEV 400 mg/kg significantly (P<0.001). There was a noticed increase in the body weight and mesenteric fat pad weight in HFD fed group (P<0.001), which was reduced by the administration of MEEV (200 and 400 mg/kg). The antioxidant enzymes such as superoxide dismutase and catalase were reduced significantly in the HFD fed group, whose levels were increased significantly (P<0.001) by the administration of MEEV (200 and 400 mg/kg). Lipid peroxidation was increased in HFD fed animals, which was reduced significantly (P<0.001) by the treatment with MEEV (200 and 400 mg/kg).

Protective effect of Morinda citrifolia fruits on beta-amyloid (25-35) induced cognitive dysfunction in mice: an experimental and biochemical study.

The neuroprotective effect of an ethyl acetate extract of Morinda citrifolia (Rubiaceae) Linn. fruits (EMC, ethyl acetate extract of Morinda citrifolia) at doses of 200 and 400 mg/kg, p.o. was studied on beta-amyloid (25-35) peptide induced cognitive dysfunction in mice. In the step-down inhibitory avoidance, EMC exhibited a significant increase in short-term memory and long-term memory (p < 0.05). A significant decrease (p < 0.01) in escape latency was noticed in the animals in the water maze. A significant increase (p < 0.01) in alteration of behavior was exhibited upon administration of EMC 200 and 400 mg/kg on the Y maze. Exploratory parameters such as line crossings, head dipping and rearing were increased significantly in EMC treated groups in a dose-dependent manner (p < 0.05 and p < 0.01). A significant reduction (p < 0.05) in acetyl cholinesterase activity was noticed in the EMC 200 and 400 mg/kg treated groups. The level of monoamine oxidase-A was decreased by the administration of EMC 200 and 400 mg/kg (p < 0.05 and p < 0.01, respectively). EMC at a dose of 400 mg/kg exhibited a significant increase (p < 0.01) in the levels of serotonin and dopamine. Antioxidant enzymes such as superoxide dismutase, glutathione reductase, glutathione peroxidase and ascorbic acid were decreased significantly in the b-amyloid peptide injected group, whose levels were restored significantly (p < 0.01) by the administration of EMC (400 mg/kg).

Trichosporon loubieri infection in a patient with adult polycystic kidney disease.

A 45-year-old man from Nepal with a 13-year history of polycystic kidney disease was diagnosed as suffering from chronic renal failure with end-stage renal disease. After receiving empirical antituberculosis treatment, he was treated with broad-spectrum antibiotics. A left nephrectomy was performed, and after 4 months, he received a kidney transplant. The left kidney was grossly enlarged, with multiple cystic spaces filled with blackish material. Histologic examination of the excised left kidney tissue stained with hematoxylin and eosin and Gomori's methenamine silver stains showed numerous hyaline, septate, fungal hyphae of various lengths, many broken into rectangular arthroconidia in the cystic spaces. Culture of the kidney tissue yielded white, glabrous, yeast-like colonies. Based on its micromorphology, growth at 42 degrees C, and ribosomal DNA (rDNA) sequence analysis, and also sequence analysis of the internal-transcribed-spacer and D1/D2 rDNA regions, the yeast was identified as Trichosporon loubieri. Postsurgically, the patient was treated with amphotericin B and oral itraconazole, followed by maintenance therapy with fluconazole. He remained afebrile and asymptomatic. At the final follow-up, all parameters were found normal and the patient was doing well, with normal renal function reports. This paper presents the first known case of human infection caused by T. loubieri.

The role of extreme events in the impacts of selective tropical forestry on erosion during harvesting and recovery phases at Danum Valley, Sabah.

Ten years' hydrological investigations at Danum have provided strong evidence of the effects of extremes of drought, as in the April 1992 El Niño southern oscillation event, and flood, as in January 1996. The 1.5 km2 undisturbed forest control catchment experienced a complete drying out of the stream for the whole 1.5 km of defined channel above the gauging station in 1992, but concentrated surface flow along every declivity from within a few metres of the catchment divide after the exceptional rains of 19 January 1996. Under these natural conditions, erosion is episodic. Sediment is discharged in pulses caused by storm events, collapse of debris dams and occasional landslips. Disturbance by logging accentuates this irregular regime. In the first few months following disturbance, a wave of sediment is moved by each storm, but over subsequent years, rare events scour sediment from bare areas, gullies and channel deposits. The spatial distribution of sediment sources changes with time after logging, as bare areas on slopes are revegetated and small gullies are filled with debris. Extreme storm events, as in January 1996, cause logging roads to collapse, with landslides leading to surges of sediment into channels, reactivating the pulsed sediment delivery by every storm that happened immediately after logging. These effects are not dampened out with increasing catchment scale. Even the 721 km2 Sungai Segama has a sediment yield regime dominated by extreme events, the sediment yield in that single day on 19 January 1996 exceeding the annual sediment load in several previous years. In a large disturbed catchment, such road failures and logging-activity-induced mass movements increase the mud and silt in floodwaters affecting settlements downstream. Management systems require long-term sediment reduction strategies. This implies careful road design and good water movement regulation and erosion control throughout the logging process.