Helicobacter pylori strains from different geographic areas exhibit clear phylogeographical differentiation; therefore, the genotypes of H. pylori strains can serve as markers for the migration of ...human populations. Currently, the genotypes of two virulence factors of H. pylori, cagA and vacA, and multilocus sequence typing (MLST) are widely used markers for genomic diversity within H. pylori populations. There are two types of cagA: the East Asian type and the Western type. In addition, the right end of the cag pathogenicity island is divided into five subtypes and there are distinct mosaic structures at the signal region and the middle region of vacA. Using combinations of the cagA, cag right end junction, and vacA genotypes, five major groups (East Asia type, South/Central Asia type, Iberian/Africa type and Europe type) have been defined according to geographical associations. MLST has revealed seven modern population types and six ancestral population types of H. pylori, and is a useful tool for mapping human migration patterns. Serial studies of large numbers of H. pylori strains, including strains isolated from aboriginal populations, show that MLST analysis provides more detailed information on human migration than does the analysis of human genetics. H. pylori infection is rapidly declining as a result of improvements in personal hygiene and quality of life. The molecular epidemiology of H. pylori infection has much to tell us and should be studied before it disappears entirely.
In the populations of Western countries, particular genotypes of the vacuolating cytotoxin gene, vacA (vacA s, signal region variants; vacA m, middle region variants) of Helicobacter pylori are ...believed to be risk factors for the development of peptic ulcers and gastric cancer. However, it was unclear whether these vacA gene variants are associated with the development of gastrointestinal diseases in developing nations. The relationship between vacA genotypes and H. pylori-related disease development in Latin American and African populations was investigated using meta-analysis of 2612 patients from Latin America (2285 strains) and 520 patients from Africa (434 strains). The frequencies of vacA s and m genotypes differed between strains from Latin America (77.2% for s1 and 68.1% for m1) and Africa (83.9% for s1 and 56.7% for m1). Latin American strains with s1 and m1 genotypes increased the risk of gastric cancer (OR 4.17, 95% CI 2.49–6.98 for s1, and 3.59, 2.27–5.68 for m1) and peptic ulcers (e.g. 1.73, 1.37–2.20 for s1). African strains with the s1 or m1 genotypes also increased the risk of peptic ulcers (8.69, 1.16–64.75 for s1) and gastric cancer (10.18, 2.36–43.84 for m1). The cagA-positive genotype frequently coincided with s1 and m1 genotypes in both populations. Overall, the vacA s and m genotypes were related to gastric cancer and peptic ulcer development and might be useful markers of risk factors for gastrointestinal disease, especially in Latin America. Further studies will be required to evaluate the effects of vacA genotypes in African populations because of the small sample number currently available.
A study of metal‐organic chemical vapor deposition (MOCVD) grown AlN nucleation layer (NL) on breakdown characteristics for GaN‐on‐Si is presented. It is widely believed that AlN NL can act as an ...insulator because of its large band gap ∼6.2 eV. On contrary, this study of AlN NL/Si reveals conductive nature and shows high vertical leakage. The structural examinations along with electrical characterization show AlN NL/Si quality depends on the growth temperature. The surface morphology and presence of unintentional oxygen impurities govern the vertical leakage of AlN NL/Si. Interestingly, the AlN NL influences the growth of subsequent epitaxial layers as well as their vertical breakdown voltages (BVs). Further, it is found that AlGaN intermediate layer and multipairs of AlGaN/AlN strained layer superlattice (SLS) grown over AlN NL with better surface properties enhances the vertical BV. A high BV of 1.3 kV is achieved for SLS multipairs with a total thickness of 4.4 μm and the translated breakdown field strength is 2.8 MV cm−1 for MOCVD grown GaN‐on‐Si.
•Outcome measurements varied among studies, with few interventional studies.•All-aim dissatisfaction was compounded by unmet health needs and social isolation.•Studies with a comprehensive outcome ...evaluation are lacking.•Participants in some studies had no intellectual disability.
Today, most individuals with cerebral palsy are adults who need a paediatric-to-adult health care transition. However, many remain in paediatric care for treatment of adult-onset health issues. Therefore, a systematic review based on the ‘Triple Aim’ framework was performed to determine the status of paediatric-to-adult health care transition for people with cerebral palsy. A comprehensive evaluation of transitional care was proposed for using this framework. It consists of ‘experience of care’, meaning satisfaction with the care, ‘population health’, meaning the well-being of patients, and ‘cost’, meaning cost-effectiveness.
Electronic database (PubMed) searches were performed. The inclusion criteria were original articles published between 1990 and 2020. The search terms used in this study were (‘cerebral palsy’ AND ‘transition to adult health care’) OR (‘cerebral palsy’ AND ‘transition’). The study type had to be epidemiological, case report, case-control, and cross-sectional, but not qualitative. The outcomes of the studies were categorised into ‘care experience’, ‘population health’, and ‘cost’, according to the Triple Aim framework.
Thirteen articles met the abovementioned inclusion criteria. Few studies have examined the effect of the intervention of transition for young adults with cerebral palsy. Participants in some studies had no intellectual disability. Young adults were dissatisfied with the ‘care experience’, ‘population health’, and ‘cost’ and had unmet health needs and inadequate social participation.
Further transition intervention studies with a comprehensive assessment and proactive involvement of individuals are warranted. The presence of an intellectual disability should be considered.
Background and aims: A number of Helicobacter pylori outer membrane proteins (OMPs) undergo phase variations. This study examined the relation between OMP phase variations and clinical outcome. ...Methods: Expression of H pylori BabA, BabB, SabA, and OipA proteins was determined by immunoblot. Multiple regression analysis was performed to determine the relation among OMP expression, clinical outcome, and mucosal histology. Results:H pylori were cultured from 200 patients (80 with gastritis, 80 with duodenal ulcer (DU), and 40 with gastric cancer). The most reliable results were obtained using cultures from single colonies of low passage number. Stability of expression with passage varied with OipA > BabA > BabB > SabA. OipA positive status was significantly associated with the presence of DU and gastric cancer, high H pylori density, and severe neutrophil infiltration. SabA positive status was associated with gastric cancer, intestinal metaplasia, and corpus atrophy, and negatively associated with DU and neutrophil infiltration. The Sydney system underestimated the prevalence of intestinal metaplasia/atrophy compared with systems using proximal and distal corpus biopsies. SabA expression dramatically decreased following exposure of H pylori to pH 5.0 for two hours. Conclusions: SabA expression frequently switched on or off, suggesting that SabA expression can rapidly respond to changing conditions in the stomach or in different regions of the stomach. SabA positive status was inversely related to the ability of the stomach to secrete acid, suggesting that its expression may be regulated by changes in acid secretion and/or in antigens expressed by the atrophic mucosa.
The variations in the three regions of the Helicobacter pylori vacA gene, the signal (s1 and s2), intermediate (i1 and i2) and middle regions (m1 and m2), are known to cause the differences in ...vacuolating activities. However, it was unclear whether these vacA genotypes are associated with the development of gastric cancer and peptic ulcer in the Middle East. The aim was to identify the prevalence of vacA genotypes in the Middle East and the association with gastroduodenal diseases. We investigated the relationship of vacA genotypes to H. pylori-related disease development by meta-analysis using previous reports of 1,646 patients from the Middle East. The frequency of the vacA s1, m1 and i1 genotypes in the Middle Eastern strains was 71.5% (1,007/1,409), 32.8% (427/1,300) and 40.7% (59/145), respectively. Importantly, the frequency of vacA s- and m-region genotypes significantly differed between the north and south parts of the Middle East countries (P < 0.001). The vacA genotypes significantly increased the risk of gastric cancer (odds ratio OR: 4.02, 95% confidence interval CI: 1.98-8.14 for the s1 genotype; 2.50, 1.62-3.85 for m1; 5.27, 1.97-14.1 for s1m1; 15.03, 4.69-48.17 for i1) and peptic ulcers (OR: 3.07, 95% CI: 2.08-4.52 for s1; 1.81, 1.36-2.42 for m1). The cagA-positive genotype frequently coincided with the s1, m1 and i1 genotypes. The vacA s- and m-region genotypes may be useful risk factors for gastrointestinal diseases in the Middle East, similar to European and American countries. Further studies will be required to evaluate the effects of the i-region genotype.
Background
Perineal hernia (PH) is a late complication of abdominoperineal resection (APR) that may compromise a patient’s quality of life. The frequency and risk factors for PH after robotic APR ...adopting recent rectal cancer treatment strategies remain unclear.
Methods
Patients who underwent robotic APR for rectal cancer between December 2011 and June 2022 were retrospectively examined. From July 2020, pelvic reinforcement procedures, such as robotic closure of the pelvic peritoneum and levator ani muscles, were performed as prophylactic procedures for PH whenever feasible. PH was diagnosed in patients with or without symptoms using computed tomography 1 year after surgery. We examined the frequency of PH, compared characteristics between patients with PH (PH+) and without PH (PH-), and identified risk factors for PH.
Results
We evaluated 142 patients, including 53 PH+ (37.3%) and 89 PH− (62.6%). PH+ had a significantly higher rate of preoperative chemoradiotherapy (26.4% versus 10.1%,
p
= 0.017) and a significantly lower rate of undergoing pelvic reinforcement procedures (1.9% versus 14.0%,
p
= 0.017). PH+ had a lower rate of lateral lymph node dissection (47.2% versus 61.8%,
p
= 0.115) and a shorter operative time (340 min versus 394 min,
p
= 0.110). According to multivariate analysis, the independent risk factors for PH were preoperative chemoradiotherapy, not undergoing lateral lymph node dissection, and not undergoing a pelvic reinforcement procedure.
Conclusions
PH after robotic APR for rectal cancer is not a rare complication under the recent treatment strategies for rectal cancer, and performing prophylactic procedures for PH should be considered.
Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of ...the arterial anatomy and the relationships of feeders in these lesions.
This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder.
We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder.
Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.
Asian soybean rust (ASR), caused by Phakopsora pachyrhizi, is one of the most serious diseases of soybean. The soybean landraces PI 594767A, PI 587905 and PI 416764 previously showed high levels of ...resistance to a wide range of ASR fungus, while the genetic basis of the resistance has yet to be understood. In this study, the ASR resistance loci were mapped using three independent mapping populations, POP‐1, POP‐2 and POP‐3 derived from crosses BRS184 × PI 594767A, BRS184 × PI 587905 and BRS184 × PI 416764, respectively. In each population, the resistance to ASR segregated as a single gene, but the resistance was dominant in PI 594767A and PI 587905 and incompletely dominant in PI 416764. The resistance genes from both PI 594767A and PI 587905 were mapped on chromosome 18 corresponding to the same location as known resistance locus Rpp1. Quantitative trait locus (QTL) analysis performed on POP‐3 identified the putative ASR resistance locus in PI 416764 on the defined region of chromosome 6 where Rpp3 was located. The QTLs detected by the mapping explained about 67–72% of the phenotypic variation in POP‐3. Cluster analysis based on disease reactions to 64 ASR populations demonstrated the presence of at least two types of functional resistant Rpp1 alleles: strong and weak allele(s), e.g. soybean accession PI 594767A and PI 587905 carry the strong resistant Rpp1 allele(s). Introducing or pyramiding strong Rpp1 allele(s) in elite soybean cultivars is expected to be useful against the South American rust population.
Background
The safety and feasibility of robotic-assisted multivisceral resection for locally advanced rectal cancer remain unclear. The aim of this study was to assess the short-term outcomes of ...this procedure at our institution.
Methods
From December 2011 to December 2016, patients who underwent robotic-assisted multivisceral resection for rectal cancer were investigated. Patient demographics, treatment characteristics, perioperative outcomes, and pathological results were evaluated retrospectively.
Results
There were 31 patients; 17 men (54.8%) and 14 women (45.2%), with a median age of 65 years (range 40–82 years). Twenty-one patients (67.7%) had a cT4 tumor, 9 patients (29.0%) had a pT4b tumor, and all patients except one (96.8%) underwent complete resection of the primary tumor with negative resection margins. Eleven patients (35.5%) received neoadjuvant chemoradiation. The most commonly resected organ was the vaginal wall (
n
= 12, 38.7%), followed by the prostate (
n
= 10, 32.3%). Lateral lymph node dissection was performed in 20 patients (64.5%). The median operative time was 394 min (range 189–549 min), and the median blood loss was 41 mL (range 0–502 mL). None of the patients received intraoperative blood transfusions or required conversion to open. Overall, postoperative complications occurred in 11 patients (35.5%). The most frequent complication was urinary retention (
n
= 5, 16.1%), and none of the patients developed serious complications classified as Clavien–Dindo grades III–V.
Conclusions
Robotic-assisted multivisceral resection for rectal cancer is safe and technically feasible.
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