Unexpectedly ease surgery for a worrisome abdominal mass: Pedunculated GISTs

AbstractINTRODUCTIONDiscovery of abdominal masses often poses significant diagnostic difficulties. GISTs are mesenchymal masses, with specific histological features. Dimensions may vary from millimeters to giant tumours. We would like to present our case, which had an unexpectedly easy operative course which was easily handled with a simple surgical excision with a short operative duration.PRESENTATION OF CASEA 38 years old female patient was diagnosed to have an abdominal heterogen mass of 15cm×12cm×10cm in dimension. Abdominal computed tomography revealed the solid mass between the stomach and pancreas corpus and tail, possibly orginating from the pancreas. With the preoperative diagnosis of locally invasive distal pancreas cancer the patient underwent laparotomy, following the dissection, the mass was observed to be originating from the posterior gastric Wall, extending exophytically with a peduncle of 5cm in width, without any visual evidence for peritoneal invasion and metastasis. The tumour and the peduncle was resected with stapler device. Total operation time was 30min. Postoperative course was uneventful. Pathologic diagnosis was gastrointestinal stromal tumour (GIST).DISCUSSIONPedunculated large GISTs are not frequent and they can enlarge as 15cm in diameter and compress the neighbouring organs. When they were huge, it is difficult to differentiate the origin of the masses. GISTs should be considered in differential diagnosis of giant abdominal masses.CONCLUSIONWhen GISTs are huge and pedunculated, it can be difficult to differentiate the origin of the masses. This case report presents unexpectedly ease surgery for a worrysome abdominal mass

Fetal Tracheal Occlusion Increases Lung Basal Cells via Increased Yap Signaling

Basal cell; Fetal tracheal occlusion; MechanotransductionCélula basal; Oclusión traqueal fetal; MecanotransducciónCèl·lula basal; Oclusió traqueal fetal; MecanotransduccióFetal endoscopic tracheal occlusion (FETO) is an emerging surgical therapy for congenital diaphragmatic hernia (CDH). Ovine and rabbit data suggested altered lung epithelial cell populations after tracheal occlusion (TO) with transcriptomic signatures implicating basal cells. To test this hypothesis, we deconvolved mRNA sequencing (mRNA-seq) data and used quantitative image analysis in fetal rabbit lung TO, which had increased basal cells and reduced ciliated cells after TO. In a fetal mouse TO model, flow cytometry showed increased basal cells, and immunohistochemistry demonstrated basal cell extension to subpleural airways. Nuclear Yap, a known regulator of basal cell fate, was increased in TO lung, and Yap ablation on the lung epithelium abrogated TO-mediated basal cell expansion. mRNA-seq of TO lung showed increased activity of downstream Yap genes. Human lung specimens with congenital and fetal tracheal occlusion had clusters of subpleural basal cells that were not present in the control. TO increases lung epithelial cell nuclear Yap, leading to basal cell expansion.Funding was obtained from NIH/NHLBI R01HL141229 (to BV)

USING SOME POME FRUIT TREES IN LANDSCAPE DESIGNS

Landscape; when viewed from a point of view, natural and cultural beings that are able to enter into the frame of view are brought together to form a fountain. The materials that make up the live decor of the areas consist of especially the large trees of the plant kingdom, shrubs, undergrowths, ivies, single annual, biennial or perennial herbaceous plants, that is, roots consist of onion, lumpy or rhizomaceous herbaceous plants, grass plants and water plants which can be kept on the ground continuously. Among these, wild and cultured forms of soft-seeded fruits constitute an important place. In this study, the functional and visual use of wild plants such as wild pear, pear, apple, quince and their wild forms in different landscape designs have been investigated. In plantation studies, plants can be used in esthetic, functional or both ways to be more effective. It can also be growth for economic reasons. Economically cultivated species are particularly high economic values. However, they are often used for esthetic purposes outside of commercial assets, such as in other fruit trees. For this reason, the most common uses are to take advantage of both fruit and to benefit from the visual effect of flowers and fruit

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Is There a Causal Relationship between Intussusception and Food Allergy?

Although intussusception and food allergy are common health problems in childhood, the relation between these two diseases remain obscure. The aim of this study is to investigate the relationship between food allergy and intussusception, and the factors associated with both. Patients diagnosed with intussusception by the Brighton Collaboration Intussusception Working Group criteria were prospectively investigated for food allergy per the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Guideline. They were analyzed per demographic features, clinical, physical and laboratory findings. There were eight (38.1%) patients diagnosed with food allergy, while 13 (61.9%) patients were non-allergic. The mean number of days of presenting symptoms was 1.13 days in the allergy group and 7.85 days in the non-allergy group. The mean number of intussusception attacks was 1.63 in the allergy group while 1 in the non-allergy group (p &lt; 0.05, relative risk (RR) = 2.6). In the allergy group, one (13%) patient was followed up, six (75%) patients were reduced with pneumatic and one (13%) patient reduced manually. In the non-allergy group, four (31%) patients were followed up, six (46%) patients were reduced with pneumotic, one (7%) patient was reduced manually, and resection anastomosis was performed in two (15%) patients. Food allergy is an unrecognized associated factor for intussusception patients, which increases the risk for recurrence. Due to the small patient population, these results should be interpreted with caution

Allylimidazole containing OSTE based photocured materials for selective and efficient removal of gold from aqueous media

Off-Stoichiometry Thiol-Ene (OSTE) photopolymerization technique provides an innovative platform for the development of materials with tunable mechanical and surface properties. In this work, this technique was used to prepare polymeric materials that can effectively and selectively adsorb Au(III) from aqueous solutions. The use of OSTE technique brought simplicity and speed. OSTE based photocured discs were prepared from commercial monomers (trimethylolpropane tris(3-mercaptopropionate) and 1,3,5-triallyl-1,3,5-triazine-2,4,6(1H,3H,5H)-trione) by UV curing and 1-allyimidazole was also introduced to incorporate imidazole functionality. Then disc shaped photocured resins were used for the recovery studies. The effects of pH, imidazole group, contact time were investigated to determine the optimal conditions. The optimal contact time was found as 5 h while the optimum pH was determined as 1.5. The adsorption profile of the OSTE based discs was well fitted to Langmuir adsorption isotherm model (??R-2: 0.997, chi(2): 1.455). In the presence of different metal cations such as Cu (II), Cd (II) and Pb (II) imidazole containing photocured discs showed high selectivity towards Au (III). It was also found that the photocured resins could be regenerated and reused for successfully for five times. The OSTE based photocured adsorbent resins were also tested to remove Au (III) ions from a gold ore and river water samples and the resin exhibited over 90% Au (III) ions recovery in all samples

Imidazole modified acrylate-containing photocured hydrogels for the efficient removal of malachite green dye from aqueous solutions

In this work, we aimed to prepare a simple and an efficient adsorbent for the removal of toxic, cationic dye; malachite green (MG). We reviewed many previous studies and designed our adsorbent based on the rationale that (1) acidic groups containing monomers which are capable of making hydrogen bonds (or electrostatic interactions) with MG are very effective in adsorption and (2) pi-pi stacking enhances the adsorption capacity. We first synthesized an imidazole-acrylate adduct and used it for the preparation of photocured hydrogels. The imidazole-acrylate adduct was characterized by H NMR and FTIR spectroscopy. The effect of experimental conditions on the MG adsorption properties of the hydrogels such as the effect of pH, time and MG concentration were also investigated. Under the optimum conditions (pH = 6 and 220 min contact time) at room temperature, the maximum adsorption capacity was found as high as 714.28 mg/g. The results showed that the adsorption process of the optimum hydrogel, which can be used 4 times without a significant loss in its adsorption capacity, fits the Langmuir isotherm model. The hydrogel adsorbent displayed good selectivity and reusability