Vaginal Evisceration After Abdominal Hysterectomy: A Case Report.

Vaginal cuff dehiscence (VCD) is an extremely rare complication after a hysterectomy, with possible life-threatening consequences. Multiple cases of pelvic organ evisceration through the vaginal cuff have been reported, most frequently precipitated by sexual intercourse. Surgeons should be suspicious of clinical signs of VCD postoperatively, as any intervention should be prompt. Patients at high-risk patients of developing vaginal cuff dehiscence should be advised to refrain from straining exercises for longer periods of time. Herein, we present the case of a 46-year-old with this complication.

Development of a Circular Oriented Bioprocess for Microbial Oil Production Using Diversified Mixed Confectionery Side-Streams.

Diversified mixed confectionery waste streams were utilized in a two-stage bioprocess to formulate a nutrient-rich fermentation media for microbial oil production. Solid-state fermentation was conducted for the production of crude enzyme consortia to be subsequently applied in hydrolytic reactions to break down starch, disaccharides, and proteins into monosaccharides, amino acids, and peptides. Crude hydrolysates were evaluated in bioconversion processes using the red yeast Rhodosporidium toruloides DSM 4444 both in batch and fed-batch mode. Under nitrogen-limiting conditions, during fed-batch cultures, the concentration of microbial lipids reached 16.6-17 g·L-1 with the intracellular content being more than 40% (w/w) in both hydrolysates applied. R. toruloides was able to metabolize mixed carbon sources without catabolite repression. The fatty acid profile of the produced lipids was altered based on the substrate employed in the bioconversion process. Microbial lipids were rich in polyunsaturated fatty acids, with oleic acid being the major fatty acid (61.7%, w/w). This study showed that mixed food side-streams could be valorized for the production of microbial oil with high unsaturation degree, pointing towards the potential to produce tailor-made lipids for specific food applications. Likewise, the proposed process conforms unequivocally to the principles of the circular economy, as the entire quantity of confectionery by-products are implemented to generate added-value compounds that will find applications in the same original industry, thus closing the loop.

Unusual case of intraluminal cecal recurrence of a low grade appendiceal mucinous neoplasm (LAMN)-Case report and brief literature review.

INTRODUCTION: Appendiceal mucinous neoplasms exhibit a wide spectrum of clinical behavior, ranging from neoplasms which are relatively slow-growing but with considerable risk for recurrence and eventual death and those neoplasms that are highly aggressive with increased likelihood of early death. Clinical behavior depend mainly on mucinous neoplasms grading and staging. PRESENTATION OF CASE: We present the incidental finding of a mucinous appendiceal neoplasm in a 52 years old woman during her follow up for an operated breast carcinoma. The patient underwent appendectomy and a low grade appendiceal mucinous neoplasm (LAMN) confined into the appendiceal wall was diagnosed. Resection margin showed fibrous replacement of the appendiceal wall and some acellular intraluminal mucin. Three months later the tumor recurred inside the cecal lumen and a right hemicolectomy was performed showing again a LAMN confined into the bowel wall. DISCUSSION: According to the latest AJCC eighth edition patients with pTis LAMN, as in our case, (LAMN confined to the muscularis propria after histologic examination of the entire appendix) have essentially no risk of recurrence. Moreover, some authors suggest follow up for LAMN confined into the appendix even with a positive surgical margin. CONCLUSION: Rarely, LAMN may recur in the form of a polypoid protrusion into the cecal lumen and this recurrence may originate from the buried stump of the appendix, especially when the surgical margin is positive.

Valorisation of side streams from wheat milling and confectionery industries for consolidated production and extraction of microbial lipids.

Crude enzymes produced via solid state fermentation (SSF) using wheat milling by-products have been employed for both fermentation media production using flour-rich waste (FRW) streams and lysis of Rhodosporidium toruloides yeast cells. Filter sterilization of crude hydrolysates was more beneficial than heat sterilization regarding yeast growth and microbial oil production. The initial carbon to free amino nitrogen ratio of crude hydrolysates was optimised (80.2g/g) in fed-batch cultures of R. toruloides leading to a total dry weight of 61.2g/L with microbial oil content of 61.8% (w/w). Employing a feeding strategy where the glucose concentration was maintained in the range of 12.2-17.6g/L led to the highest productivity (0.32 g/L·h). The crude enzymes produced by SSF were utilised for yeast cell treatment leading to simultaneous release of around 80% of total lipids in the broth and production of a hydrolysate suitable as yeast extract replacement.

Formulation of fermentation media from flour-rich waste streams for microbial lipid production by Lipomyces starkeyi.

Flour-rich waste (FRW) and by-product streams generated by bakery, confectionery and wheat milling plants could be employed as the sole raw materials for generic fermentation media production, suitable for microbial oil synthesis. Wheat milling by-products were used in solid state fermentations (SSF) of Aspergillus awamori for the production of crude enzymes, mainly glucoamylase and protease. Enzyme-rich SSF solids were subsequently employed for hydrolysis of FRW streams into nutrient-rich fermentation media. Batch hydrolytic experiments using FRW concentrations up to 205 g/L resulted in higher than 90% (w/w) starch to glucose conversion yields and 40% (w/w) total Kjeldahl nitrogen to free amino nitrogen conversion yields. Starch to glucose conversion yields of 98.2, 86.1 and 73.4% (w/w) were achieved when initial FRW concentrations of 235, 300 and 350 g/L were employed in fed-batch hydrolytic experiments, respectively. Crude hydrolysates were used as fermentation media in shake flask cultures with the oleaginous yeast Lipomyces starkeyi DSM 70296 reaching a total dry weight of 30.5 g/L with a microbial oil content of 40.4% (w/w), higher than that achieved in synthetic media. Fed-batch bioreactor cultures led to a total dry weight of 109.8 g/L with a microbial oil content of 57.8% (w/w) and productivity of 0.4 g/L/h.