Minimally invasive approach to colorectal tumors - 3 years of experience in a private hospital

Spitalul Privat ”Sanador”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Abordul minim invaziv al tumorilor colo-rectale reprezintă o preocupare a colectivului Spitalului privat Sanador, în pofida adresabilității crescute a cancerelor în stadii avansate, procentul acestora din totalul intervențiilor chirurgicale pentru această patologie rămânând constant, printr-o atentă selecție a pacienților, care sa beneficieze de avantajele laparoscopiei. Material și metode: Studiul prezent analizează intervențiile chirurgicale pentru tumori colo-rectale efectuate între anii 2016-2018 în Spitalul Sanador București. Din totalul de 214 intervenții chirurgicale pentru patologia colo-rectală, 41 au fost prin abord minim invaziv, reprezentând procentual 20% din totalul intervențiilor pentru această patologie, procentul fiind constant în fiecare din acești ani: 2016 – 13 intervenții prin abord minim invaziv din totalul de 68 (19.11%); 2017 – 17 intervenții prin abord minim invaziv din totalul de 79 (21.5%); 2018 – 11 intervenții chirurgicale prin abord minim invaziv dintr-un total de 57 (19.3%). Rezultate: Cele mai frecvente localizări ale tumorilor pentru care indicația a fost de abord minim invaziv, au fost cele recto-sigmoidiene (28). Selecția pacienților s-a facut după stadializarea preoperatorie, admitându-se ca și abord laparoscopic tumori T1, T2, T3, în rare cazuri T4. În cazul tumorilor avansate, substadializate preoperator, s-a tentat efectuarea a cât mai multor timpi din cadrul rezecției, prin abord minim invaziv, iar cazurile in care anastomozele au fost efectuate extracorporeal nu au fost interpretate ca și conversie. Concluzii: Rezultatele bune se înscriu în rândul celor ale centrelor cu volum și experiența mari în abordarea minim invazivă a tumorilor colo-rectale și constituie premize pentru creșterea procentului de astfel de intervenții în clinica noastră.Introduction: The minimally invasive approach of colorectal tumors is a concern of the Sanador private hospital team, despite the increased addressability of cancers in advanced stages, their percentage of total surgical interventions for this pathology remaining constantly through a careful selection of patients who benefit from the advantages of laparoscopy. Material and methods: The present study examines surgical interventions for colorectal tumors performed between 2016-2018 at Sanador Hospital Bucharest. Of the total of 214 surgical procedures for rectal pathology, 41 were by minimally invasive approach, accounting for 20% of all interventions for this pathology, the percentage being constant in each of these years: 2016-13 interventions through the minimally invasive approach of the total of 68 (19.11%); 2017 - 17 interventions through minimally invasive approach from the total of 79 (21.5%); 2018 - 11 minimally invasive surgical interventions from a total of 57 (19.3%). Results: The most common tumor localizations for which the indication was minimally invasive were the recto-sigmoid (28). Selection of patients was made after preoperative staging, admitting as a laparoscopic approach T1, T2, T3 tumors, in rare cases T4. In the case of advanced tumors, pre-operative substations, it was tempting to perform as many times as possible in the resection through a minimally invasive approach, and the cases in which the anastomoses were performed extracorporeally were not interpreted as conversion. Conclusions: Good results are among those with large volume centers and great experience in the minimally invasive approach of colorectal tumors and are prerequisites for increasing the percentage of such interventions in our clinic

Characterization of n-Hexane sub-fraction of Bridelia micrantha (Berth) and its antimycobacterium activity

<p>Abstract</p> <p>Background</p> <p>Tuberculosis, caused by <it>Mycobacterium tuberculosis </it>(MTB), is the most notified disease in the world. Development of resistance to first line drugs by MTB is a public health concern. As a result, there is the search for new and novel sources of antimycobacterial drugs for example from medicinal plants. In this study we determined the <it>in vitro </it>antimycobacterial activity of <it>n</it>-Hexane sub-fraction from <it>Bridelia micrantha </it>(Berth) against MTB H₃₇Ra and a clinical isolate resistant to all five first-line antituberculosis drugs.</p> <p>Methods</p> <p>The antimycobacterial activity of the <it>n</it>-Hexane sub-fraction of ethyl acetate fractions from acetone extracts of <it>B. micrantha </it>barks was evaluated using the resazurin microplate assay against two MTB isolates. Bioassay-guided fractionation of the ethyl acetate fraction was performed using 100% <it>n</it>-Hexane and Chloroform/Methanol (99:1) as solvents in order of increasing polarity by column chromatography and Resazurin microtiter plate assay for susceptibility tests.</p> <p>Results</p> <p>The <it>n</it>-Hexane fraction showed 20% inhibition of MTB H₃₇Ra and almost 35% inhibition of an MTB isolate resistant to all first-line drugs at 10 μg/mL. GC/MS analysis of the fraction resulted in the identification of twenty-four constituents representing 60.5% of the fraction. Some of the 24 compounds detected included Benzene, 1.3-bis (3-phenoxyphenoxy (13.51%), 2-pinen-4-one (10.03%), N(b)-benzyl-14-(carboxymethyl) (6.35%) and the least detected compound was linalool (0.2%).</p> <p>Conclusions</p> <p>The results show that the <it>n-</it>Hexane fraction of <it>B. micrantha </it>has antimycobacterial activity.</p

Antimicrobial and Efflux Pump Inhibitory Activity of Caffeoylquinic Acids from Artemisia absinthium against Gram-Positive Pathogenic Bacteria

Background: Traditional antibiotics are increasingly suffering from the emergence of multidrug resistance amongst pathogenic bacteria leading to a range of novel approaches to control microbial infections being investigated as potential alternative treatments. One plausible antimicrobial alternative could be the combination of conventional antimicrobial agents/antibiotics with small molecules which block multidrug efflux systems known as efflux pump inhibitors. Bioassay-driven purification and structural determination of compounds from plant sources have yielded a number of pump inhibitors which acted against gram positive bacteria. Methodology/Principal Findings: In this study we report the identification and characterization of 4′,5′-O-dicaffeoylquinic acid (4′,5′-ODCQA) from Artemisia absinthium as a pump inhibitor with a potential of targeting efflux systems in a wide panel of Gram-positive human pathogenic bacteria. Separation and identification of phenolic compounds (chlorogenic acid, 3′,5′-ODCQA, 4′,5′-ODCQA) was based on hyphenated chromatographic techniques such as liquid chromatography with post column solid-phase extraction coupled with nuclear magnetic resonance spectroscopy and mass spectroscopy. Microbial susceptibility testing and potentiation of well know pump substrates revealed at least two active compounds; chlorogenic acid with weak antimicrobial activity and 4′,5′-ODCQA with pump inhibitory activity whereas 3′,5′-ODCQA was ineffective. These intitial findings were further validated with checkerboard, berberine accumulation efflux assays using efflux-related phenotypes and clinical isolates as well as molecular modeling methodology. Conclusions/Significance: These techniques facilitated the direct analysis of the active components from plant extracts, as well as dramatically reduced the time needed to analyze the compounds, without the need for prior isolation. The calculated energetics of the docking poses supported the biological information for the inhibitory capabilities of 4′,5′-ODCQA and furthermore contributed evidence that CQAs show a preferential binding to Major Facilitator Super family efflux systems, a key multidrug resistance determinant in gram-positive bacteria.National Institutes of Health (U.S.) (grant R01GM59903)National Institutes of Health (U.S.) (grant R01AI050875)Netherlands Organization for Scientific Research (VICI grant 700.56.442)Massachusetts Technology Transfer Center (MTTC)National Institutes of Health (U.S.) (grant 5U54MH084690-02

An antibacterial hydroxy fusidic acid analogue from Acremonium crotocinigenum

A fusidane triterpene, 16-deacetoxy-7-β-hydroxy-fusidic acid (1), was isolated from a fermentation of the mitosporic fungus Acremonium crotocinigenum. Full unambiguous assignment of all 1H and 13C data of 1 was carried out by extensive one- and two-dimensional NMR studies employing HMQC and HMBC spectra. Compound 1 was tested against a panel of multidrug-resistant (MDR) and methicillin-resistant Staphylococcus aureus (MRSA) strains and showed minimum inhibitory concentration values of 16 μg/ml

Late-Night Overeating or Low-Quality Food Choices Late at Night Are Associated with Subclinical Vascular Damage in Patients at Increased Cardiovascular Risk

Late-night overeating (LNO) is associated with several cardiovascular disease (CVD) risk factors. Limited data exist regarding the association between late-night (LN) systematic food consumption, LNO, and LN poor food quality with subclinical vascular damage (SVD) which precedes the onset of CVD. This study aimed to investigate the above associations with SVD in a large sample of adults, free of established CVD, with one or more CVD risk factors. In total, 901 adults (45.2% males) underwent anthropometric, dietary (through two 24 h dietary recalls) and vascular assessment. LN systematic eating was defined as consumption of food after 19:00 h in both dietary recalls and LNO was defined as systematic consumption of >40% of daily total energy intake (dTEI) after 19:00 h. Systematic LN food consumption was inversely associated with diastolic blood pressure (DBP) (−1.44 95% C.I. (−2.76, −0.12)) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, smoking, BMI and dTEI. LNO was positively associated with existence of carotid plaques (1.70 95% C.I. (1.07, 2.68)), while LN increased consumption of red meat, refined grains and wine and low consumption of whole wheat grains was positively associated with Aix (Augmentation Index) (0.84 95% C.I. (0.09, 1.59)), after adjusting for all the mentioned confounders. Systematic LN eating is associated with lower DBP while systematic LNO and consumption of poor-quality food late at night, is associated with SVD. Further research is needed to define more accurately the impact of LN eating habits on vascular health