Short-term pre-operative protein caloric restriction in elective vascular surgery patients: a randomized clinical trial

(1) Background: Vascular surgery operations are hampered by high failure rates and frequent occurrence of peri-operative cardiovascular complications. In pre-clinical studies, pre-operative restriction of proteins and/or calories (PCR) has been shown to limit ischemia-reperfusion damage, slow intimal hyperplasia, and improve metabolic fitness. However, whether these dietary regimens are feasible and safe in the vascular surgery patient population remains unknown. (2) Methods: We performed a randomized controlled trial in patients scheduled for any elective open vascular procedure. Participants were randomized in a 3:2 ratio to either four days of outpatient pre-operative PCR (30% calorie, 70% protein restriction) or their regular ad-libitum diet. Blood was drawn at baseline, pre-operative, and post-operative day 1 timepoints. A leukocyte subset flow cytometry panel was performed at these timepoints. Subcutaneous/perivascular adipose tissue was sampled and analyzed. Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of whom 11 completed the study. No diet-related reasons for non-completion were reported, and there was no intervention group crossover. The PCR diet induced weight loss and BMI decrease without malnutrition. Insulin sensitivity was improved after four days of PCR (p = 0.05). Between diet groups, there were similar rates of re-intervention, wound infection, and cardiovascular complications. Leukocyte populations were maintained after four days of PCR. (4) Conclusions: Pre-operative PCR is safe and feasible in elective vascular surgery patients.Vascular Surger

Plasmopara viticola infection process and accumulation of important stilbenes in some grapevine varieties grown in Turkey and in individuals for brined leaves

The detached leaves of three Turkish grapevine varieties (cv. Karasakız, cv. Müşküle and cv. Tekirdağ Sultani) and three hybrid individuals for brined leaves (119, 154, 200) with different resistance levels to downy mildew (Plasmopara viticola) based on sporulation area (mm2) were examined for sporangia number at 7 days, progress of the pathogen and stilbene production at different times after inoculation. A significant positive correlation was determined between number of sporangia on the lesion and sporulation area. The lowest number of stomata infected by the pathogen at 48 h after inoculation (hpi) was determined in extremely resistant 200, followed by highly resistant cv. Müşküle and 154. Vesicles of the pathogen were observed in leaves of all tested plants at 15 hpi; however, in 200 the vesicle primary hypha, which developed at 72 hpi, did not elongate into intercellular spaces of the mesophyll after that time. Elongation occurred in 119 (resistant) at 48 hpi and in cv. Müşküle and 154 at 72 hpi, but development of the pathogen was restricted to 72 hpi. Pathogen mycelia covered the intercostal fields in sensitive (cv. Karasakız) and highly sensitive (cv. Tekirdağ Sultani) varieties at 72 hpi. The amount of resveratrol was found to be high in resistant types, while the highest amount of ?-viniferin was determined in 200 at 72 hpi. Cv. Müşküle and 154 contained higher amounts of pterostilbene than 119. These new results underline the role of ?-viniferin in 200 and pterostilbene in cv. Müşküle and 154 in high resistance toward P. viticola and the importance of these grapevine types in downy mildew management. © 2021, The Author(s) under exclusive licence to Deutsche Phytomedizinische Gesellschaft.NKUBAP.03; 1180226; Central Research Laboratory, CRLThe authors acknowledge the Research Fund of Namık Kemal University (Project Number NKUBAP.03.YL.19.224) for their support, the Turkish Scientific and Technical Research Council (TUBİTAK) (Project No.: 1180226) for obtaining the individuals for brined leaves and Central Research Laboratory (NABILTEM-NKU) for using HPLC. The authors are also grateful to Martha Rowe (University of Nebraska–Lincoln) for improving the language and for useful remarks

Risk for Malignant and Borderline Ovarian Neoplasms Following Basic Preoperative Evaluation by Ultrasonography, Ca125 Level and Age

Objective: To verify the basic preoperative evaluation in the discrimination between benign and malignant adnexal masses in our clinical practice. Materials and Methods: Data were collected on the records of 636 women with adnexal masses who had undergone surgery either by open or endoscopic approaches. Those with obvious signs of malignancy, any history of cancer, emergency surgeries without basic evaluation were excluded. The preoperative features by age, ultrasound and serum Ca125 level were compared with final histopathological diagnosis at the four departments of the institution. These are the general gynecology (Group 1:exploratory laparotomy), the gynecologic endoscopy (Group 2: laparoscopy and adnexectomy), the gynecological oncology (Group 3:staging laparotomy) and the gynecologic endocrinology and infertility (Group 4: laparoscopy and cystectomy). Results: There were simple and complex cyst rates of 22.3% and 77.2%, respectively. There were 86.3% benign, 4.1% (n:20) borderline ovarian tumor (BOT) and 6.4% (n:48) malignant lesions. There were 3 BOT and 9 ovarian cancers in Group 1 and one BOT and two ovarian cancer in the Group 2. During the surgery, 15 BOT (75%) and 37 ovarian cancer (77%) were detected in the Group 3, only one BOT was encountered in the Group 4. The risk of rate of unsuspected borderline or focally invasive ovarian cancer significantly increased by age, size, complex morphology and Ca125 (95% CI, OR=2.72, OR=6.60, OR=6.66 and OR=4.69, respectively). Conclusions: Basic preoperative evaluation by comprehensive ultrasound imaging combined with age and Ca125 level has proved highly accurate for prediction of unexpected malignancies. Neither novel markers nor new imaging techniques provide better information that allow clinicians to assess the feasibility of the planned surgery; consequently, the risk of inadvertent cyst rupture during laparoscopy may be significantly decreased in selected cases

Perturbation of sectorial projections of elliptic pseudo-differential operators

Over a closed manifold, we consider the sectorial projection of an elliptic pseudo-differential operator A of positive order with two rays of minimal growth. We show that it depends continuously on A when the space of pseudo-differential operators is equipped with a certain topology which we explicitly describe. Our main application deals with a continuous curve of arbitrary first order linear elliptic differential operators over a compact manifold with boundary. Under the additional assumption of the weak inner unique continuation property, we derive the continuity of a related curve of Calderon projections and hence of the Cauchy data spaces of the original operator curve. In the Appendix, we describe a topological obstruction against a verbatim use of R. Seeley's original argument for the complex powers, which was seemingly overlooked in previous studies of the sectorial projection.Comment: 30 pages, 2 figures; v3: major revision, shortened, several references added, some material moved into an appendix; v4: final version, accepted for publication in Journal of Pseudo-Differential Operators and Application