Evidence comparing conventional minimally invasive esophagectomy (CMIE) via laparoscopy and thoracoscopy with robot-assisted minimally invasive esophagectomy (RAMIE) is scarce. The aim of this ...meta-analysis was to compare surgical outcomes after CMIE and RAMIE with an intrathoracic anastomosis.
A systematic literature search was performed to identify original articles analyzing outcomes after CMIE and RAMIE. Main surgical outcomes included operative time, intraoperative blood loss, anastomotic leak rates, pneumonia, overall morbidity, length of stay (LOS), and 30-day mortality. Oncologic outcomes included lymph node yield and R0 resections rates. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes.
A total of 6,249 patients were included for analysis; 5,275 (84%) underwent CMIE and 974 (16%) RAMIE. Robotic esophagectomy had longer operative time and less intraoperative blood loss. Anastomotic leakage rates were similar with both approaches. Patients undergoing RAMIE had significantly lower rates of postoperative pneumonia (OR 0.46, 95% CI 0.35–0.61, P < .0001) and overall morbidity (OR 0.67, 95% CI 0.58–0.79, P < .0001). Median LOS was similar in both procedures (RAMIE: 12.1 versus CMIE: 11.9 days, P = .64). Similar mortality rates were found after RAMIE and CMIE (OR 0.69, 95% CI 0.34–1.38, P = .29). Lymph node yield was similar in both procedures, but RAMIE was associated with higher rates of R0 resection (OR 2.84, 95% CI 1.53–5.26, P < .001).
Patients undergoing robotic esophagectomy have less intraoperative blood loss, lower rates of postoperative pneumonia, reduced overall morbidity, and higher rates of R0 resections, as compared with those undergoing a laparoscopic-thoracoscopic esophageal resection.
Hybrid and minimally invasive approaches have emerged as less invasive alternatives to open Ivor Lewis esophagectomy. The aim of this study was to compare surgical outcomes between open (OE), hybrid ...(HE), and totally minimally invasive esophagectomy (TMIE).
A systematic literature search was performed to analyze outcomes after OE, HE, and TMIE with intrathoracic anastomosis. Main outcomes included anastomotic leak rate, overall morbidity, and 30-day mortality. A meta-analysis of proportions was used to assess the effect of each approach on different outcomes.
A total of 130 studies comprising 16,053 patients were included for analysis; 8081 (50.3%) underwent OE, 1524 (9.5%) HE, and 6448 (40.2%) TMIE. The risk of anastomotic leak was lower after OE (odds ratio OR, 0.71; 95% CI, 0.62-0.81; P < .0001). Overall morbidity rate was 45% (95% CI, 38%-52%) after OE, 40% (95% CI, 25%-59%) after HE, and 37% (95% CI, 32%-43%) after TMIE. Risk estimation showed higher odds of postoperative mortality after OE (OR, 2.22; 95% CI, 1.76-2.81; P < .0001) and HE (OR, 1.93; 95% CI, 1.32-2.81; P < .001), compared with TMIE. Median length of hospital stay (LOS) was 14.1 (range, 8-28), 12.5 (range, 8-18), and 11.9 (range, 7-30) days after OE, HE and TMIE, respectively (P = .003).
HE and TMIE are associated with lower rates of overall morbidity, reduced postoperative mortality, and shorter LOS, compared with OE. TMIE is associated with lower mortality rates and shorter LOS than HE. Further efforts are needed to widely embrace TMIE in a safe manner.
Main findings of the study. Display omitted
The interest in seaweeds for cosmetic, cosmeceutics, and nutricosmetics is increasing based on the demand for natural ingredients. Seaweeds offer advantages in relation to their renewable character, ...wide distribution, and the richness and versatility of their valuable bioactive compounds, which can be used as ingredients, as additives, and as active agents in the formulation of skin care products. Bioactive compounds, such as polyphenols, polysaccharides, proteins, peptides, amino acids, lipids, vitamins, and minerals, are responsible for the biological properties associated with seaweeds. Seaweed fractions can also offer technical features, such as thickening, gelling, emulsifying, texturizing, or moistening to develop cohesive matrices. Furthermore, the possibility of valorizing industrial waste streams and algal blooms makes them an attractive, low cost, raw and renewable material. This review presents an updated summary of the activities of different seaweed compounds and fractions based on scientific and patent literature.
Flavonoids accumulate in plant vacuoles usually as O-glycosylated derivatives, but several species can also synthesize flavonoid C-glycosides. Recently, we demonstrated that a flavanone 2-hydroxylase ...(ZmF2H1, CYP93G5) converts flavanones to the corresponding 2-hydroxy derivatives, which are expected to serve as substrates for C-glycosylation. Here, we isolated a cDNA encoding a UDP-dependent glycosyltransferase (UGT708A6), and its activity was characterized by in vitro and in vivo bioconversion assays. In vitro assays using 2-hydroxyflavanones as substrates and in vivo activity assays in yeast co-expressing ZmF2H1 and UGT708A6 show the formation of the flavones C-glycosides. UGT708A6 can also O-glycosylate flavanones in bioconversion assays in Escherichia coli as well as by in vitro assays with the purified recombinant protein. Thus, UGT708A6 is a bifunctional glycosyltransferase that can produce both C- and O-glycosidated flavonoids, a property not previously described for any other glycosyltransferase.
Background: Plant UDP-glycosyltransferases add sugars to acceptors like flavonoids either via hydroxyls (O-linkage) or carbons (C-linkage).
Results: A maize glycosyltransferase produces both flavonoid C-glycosides and O-glycosides.
Conclusion: This is the first description of a bifunctional C-/O-glycosyltransferase with a dual role in nature.
Significance: This enzyme might be involved both in the biosynthesis of the natural insecticide maysin and in the formation of O-glycosides.
Background
Laparoscopic appendectomy (LA) has become the standard of care for the management of acute appendicitis in adult patients. Despite the increasing experience in laparoscopy, conversion to ...open surgery might still occur. We aimed to identify preoperative and intraoperative risk factors for conversion and determine surgical outcomes in this population.
Methods
We performed a retrospective analysis of a consecutive series of patients undergoing LA during the period 2006–2020. The cohort was divided into two groups: patients who underwent a fully laparoscopic appendectomy (FLA) and patients who were converted to open appendectomy (CA). Demographics, perioperative variables and postoperative outcomes were compared between both groups. Independent risk factors for conversion were determined by logistic regression analysis.
Results
A total of 2193 patients were included for analysis; 2141 (98%) underwent FLA and 52 (2%) CA. Conversion rates decreased significantly over time (
p
= 0.006). Patients with CA had significantly higher overall postoperative morbidity rates (FLA 14.9% vs. CA 48.0%,
p
< 0.0001) and longer mean length of hospital stay (FLA 1.7 vs. CA 5 days). In the multivariate analysis, obesity (
p
< 0.001), previous abdominal operations (
p
= 0.013), peritonitis (
p
= 0.003) and complicated appendicitis (
p
< 0.001) were independent risk factor for conversion.
Conclusions
Although conversion from laparoscopic to open appendectomy is infrequent and has decreased over time, it is associated with significantly higher postoperative morbidity. Patients with previous abdominal operations, obesity and complicated appendicitis should be thoroughly advised about the higher risk of conversion.
Novel nanocomposites were prepared by blending linear or cyclic poly(ε-caprolactones) with two types of chemically modified carbon nanotubes (CNTs). The low-polydispersity cyclic PCL samples (C-PCLs) ...were synthesized by click chemistry with a number-average molecular weight (M n) of 22 kg/mol. Linear analogues (L-PCLs) with the same M n value were also prepared. Two types of CNTs were employed (with 1% w/w content): single wall CNTs functionalized with octadecylamine (SWNT-ODA) and multiwall carbon nanotubes grafted with linear PCL chains (i.e., MWNT-g-PCL prepared by ring-opening polymerization on previously functionalized MWNTs with a composition of 10% MWNT and 90% L-PCL). The nanocomposites were characterized by transmission electron microscopy (TEM), polarized light optical microscopy (PLOM), and differential scanning calorimetry (DSC). A nucleating effect was detected in both PCLs when SWNT-ODAs were employed. However, in the case of MWNT-g-PCL, the nanofiller nucleated L-PCL but caused an unexpected antinucleation effect on C-PCL. Another interesting behavior displayed by this novel C-PCL/MWNT-g-PCL nanocomposite (composed of 90% C-PCL, 9% L-PCL, and 1% MWNTs) was not only a reduction in nucleation density and in T c temperatures during cooling from the melt, as expected for an antinucleating agent, but also a decrease in spherulitic growth rate and in overall isothermal crystallization kinetics as compared to C-PCL. The results were explained by realizing that new topological effects were created upon mixing the grafted L-PCL chains within MWNT-g-PCL with C-PCL molecules. When these linear chains come into contact with cyclic PCL chains, a threading effect is produced that dramatically affects chain dynamics by forming a transient entanglement network. As a consequence, cyclic molecules relax and diffuse more slowly than anticipated, decreasing both nucleation and growth kinetics. Results on linear and cyclic PCL blends are also presented here, and they support our explanation of the unexpected antinucleation effect reported for C-PCL/MWNT-g-PCL nanocomposites.
A transthoracic esophagectomy is associated with high rates of morbidity. Minimally invasive esophagectomy has emerged to decrease such morbidity. The aim of this study was to accurately determine ...surgical outcomes after totally minimally invasive Ivor-Lewis Esophagectomy (TMIE).
A systematic literature search was performed to identify original articles analyzing patients who underwent TMIE. Main outcomes included overall morbidity, major morbidity, pneumonia, arrhythmia, anastomotic leak, chyle leak, and mortality. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for each analyzed outcome.
A total of 5619 patients were included for analysis; 4781 (85.1%) underwent a laparoscopic/thoracoscopic esophagectomy and 838 (14.9%) a robotic-assisted esophagectomy. Mean age of patients was 63.5 (55–67) years and 75.8% were male. Overall morbidity and major morbidity rates were 39% (95% CI, 33%–45%) and 20% (95% CI, 13%–28%), respectively. Postoperative pneumonia and arrhythmia rates were 10% (95% CI, 8%–13%) and 12% (95% CI, 8%–17%), respectively. Anastomotic leak rate across studies was 8% (95% CI, 6%–10%). Chyle leak rate was 3% (95% CI, 2%–5%). Mortality rate was 2% (95% CI, 2%–2%). Median ICU stay and length of hospital stay were 2 (1–4) and 11.2 (7–20) days, respectively.
Totally minimally invasive Ivor-Lewis esophagectomy is a challenging procedure with high morbidity rates. Strategies to enhance postoperative outcomes after this operation are still needed.
The century-old maize (Zea mays) salmon silks mutation has been linked to the absence of maysin. Maysin is a C-glycosyl flavone that, when present in silks, confers natural resistance to the maize ...earworm (Helicoverpa zea), which is one of the most damaging pests of maize in America. Previous genetic analyses predicted Pericarp Color1 (P1; R2R3-MYB transcription factor) to be epistatic to the sm mutation. Subsequent studies identified two loci as being capable of conferring salmon silks phenotypes, salmon silks1 (sm1) and sm2. Benefitting from available sm1 and sm2 mapping information and from knowledge of the genes regulated by P1, we describe here the molecular identification of the Sm1 and Sm2 gene products. Sm2 encodes a rhamnosyl transferase (UGT91L1) that uses isoorientin and UDP-rhamnose as substrates and converts them to rhamnosylisoorientin. Sm1 encodes a multidomain UDP-rhamnose synthase (RHS1) that converts UDP-glucose into UDP-l-rhamnose. Here, we demonstrate that RHS1 shows unexpected substrate plasticity in converting the glucose moiety in rhamnosylisoorientin to 4-keto-6-deoxy glucose, resulting in maysin. Both Sm1 and Sm2 are direct targets of P1, as demonstrated by chromatin immunoprecipitation experiments. The molecular characterization of Sm1 and Sm2 described here completes the maysin biosynthetic pathway, providing powerful tools for engineering tolerance to maize earworm in maize and other plants.
The entry into force of the Protocol on Amendments to the Protocol on the Statute of the African Court of Justice and Human Rights (hereinafter the Malabo Protocol) will imply the activation of the ...International Criminal Law Section of the African Court of Justice and Human and Peoples’ Rights, along with the new crimes there included — among them, the crime of unconstitutional change of government. While the African Union (AU)’s concern over these changes of government is understandable, the criminalization of them raises several doubts. First, the lack of precision in the wording makes it difficult for both judges and individuals to know what is prohibited and what is not. This, along with the AU’s approach to popular uprisings, entails a serious risk for the Criminal Section of the Court to be used in accordance with political considerations of the regional organization. Finally, the combination of the crime with the immunity clause, also contained in the Protocol, greatly impedes the achievement of the criminalization’s goal.
Despite laparoscopy is considered an adequate tool for the diagnosis and management of postoperative surgical complications, its role after laparoscopic appendectomy (LA) remains uncertain. The aim ...of this study was to evaluate whether laparoscopy is useful for treating complications after laparoscopic appendectomy. A retrospective analysis of a prospectively collected database of patients undergoing LA, who needed a reoperation for postoperative complications during the period 2006–2020, was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A total of 2019 LA were performed, and 41 patients (2%) underwent a RL for post appendectomy complications. Twenty-three patients (56%) were male. The mean age was 32 years old (16–92 years). The majority of patients (75%) had a complicated acute appendicitis in the first operation. The most common findings at RL were generalized peritonitis (36.4%) and intraabdominal abscesses (26.8%). Five patients (12.1%) developed stump appendicitis, all of them as a late complication. The procedures were completed laparoscopically in 85% and 6 patients (15%) required conversion to an open approach. Three patients (7.3%) required a percutaneous drainage and two patients (4.9%) needed an additional surgery (laparotomy) after RL, all of them presenting with generalized peritonitis at the RL. No mortality was registered. Re-laparoscopy is feasible, safe, and highly effective for the diagnosis and treatment of post appendectomy complications. RL should be encouraged to avoid more aggressive procedures.
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