OR Group Research Articles

Therapeutic Effects of Heterotrigona itama (Stingless Bee) Bee Bread in Improving Hepatic Lipid Metabolism through theActivation of the Keap1/Nrf2 Signaling Pathway in an Obese Rat Model.

Bee bread (BB) has traditionally been used as a dietary supplement to treat liver problems. This study evaluated the therapeutic effects of Heterotrigona itama BB from Malaysia on obesity-induced hepatic lipid metabolism disorder via the regulation of the Keap1/Nrf2 pathway. Male Sprague Dawley rats were fed with either a normal diet or high-fat diet (HFD) for 6 weeks to induce obesity. Following 6 weeks, obese rats were treated either with distilled water (OB group), BB (0.5 g/kg body weight/day) (OB + BB group) or orlistat (10 mg/kg body weight/day) (OB + OR group) concurrent with HFD for another 6 weeks. BB treatment suppressed Keap1 and promoted Nrf2 cytoplasmic and nuclear translocations, leading to a reduction in oxidative stress, and promoted antioxidant enzyme activities in the liver. Furthermore, BB down-regulated lipid synthesis and its regulator levels (SIRT1, AMPK), and up-regulated fatty acid β-oxidation in the liver of obese rats, being consistent with alleviated lipid levels, improved hepatic histopathological changes (steatosis, hepatocellular hypertrophy, inflammation and glycogen expression) and prevented progression to non-alcoholic steatohepatitis. These results showed the therapeutic potentials of H. itama BB against oxidative stress and improved lipid metabolism in the liver of obese rats possibly by targeting the Keap1/Nrf2 pathway, hence proposing its role as a natural supplement capable of treating obesity-induced fatty liver disease.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial.

Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents. A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n=288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n=147) or oral counselling (OR; n=141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n=66/OR without App; n=71/VD + App; n=63/VD without App; n=63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests. In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p=0.039) and GBI (p=0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p=0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p=0.007). This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

Orlistat Mitigates Oxidative Stress-Linked Myocardial Damage via NF-κβ- and Caspase-Dependent Activities in Obese Rats.

Oxidative stress contributes to major complications of obesity. This study intended to identify whether orlistat could mitigate myocardial damage in obese animal models. The tested rats were divided into two groups and fed either with normal chow (n = 6 per group) or with a high-fat diet (HFD) for 6 weeks to induce obesity (n = 12 per group). Obese rats were further subjected to treatment either with distilled water (OB group) or orlistat 10 mg/kg/day (OB + OR group). Key indices of oxidative stress, inflammation, and apoptosis were assessed using an immunohistochemical-based technique and real-time PCR. The OB group showed significant increases of oxidative stress markers (TBARs and PCO), with significant decreases of anti-oxidant markers (Nrf2, SOD, CAT, and GPx). Furthermore, mRNA expression of pro-inflammatory markers (TNF-α and NF-κβ) and pro-apoptosis markers (Bax, Caspase-3, Caspase-8, and Caspase-9) were significantly upregulated in the OB group. Obese rats developed pathological changes of myocardial damages as evidenced by the presence of myocardial hypertrophy and inflammatory cells infiltration. Orlistat dampened the progression of myocardial damage in obese rats by ameliorating the oxidative stress, and by inhibiting NF-κβ pathway and caspase-dependent cell apoptosis. Our study proposed that orlistat could potentially mitigate oxidative stress-linked myocardial damage by mitigating inflammation and apoptosis, thus rationalizing its medical usage.

Association between tumor response to systemic therapy and patient-reported disease symptoms.

The association of treatment-induced tumor shrinkage with symptom palliation for patients with lung cancer remains unknown. We investigated this correlation using the Edmonton Symptom Assessment System-Revised. Using the in-hospital cancer registry, we identified patients receiving chemotherapy and/or immunotherapy for newly diagnosed advanced or metastatic lung cancer. Tumor response and post-treatment Edmonton Symptom Assessment System-Revised were obtained after 2-3 treatment cycles. Patients were divided into groups with or without >30% unidirectional tumor shrinkage (objective response [OR] or non-OR [N-OR] groups, respectively). They were further classified as good-objective response (>50% unidirectional tumor shrinkage), moderate-objective response (30-50% shrinkage), progressive disease (>20% tumor growth or new lesion) or stable disease (SD; N-objective response and non-progressive disease). The primary endpoint was change in the total Edmonton Symptom Assessment System-Revised score from baseline. The Mann-Whitney U test was used for analysis. In total, 113 patients were enrolled. The total Edmonton Symptom Assessment System-Revised score was significantly more improved in the OR group versus the N-OR group (median: 5 vs. 2, respectively; P=0.013). This association was more prominent in patients with small-cell lung cancer and large-cell neuroendocrine tumor than those with other histology. Sensitivity analyses showed that the total Edmonton Symptom Assessment System-Revised score was more improved in the OR group versus the SD group (median: 5 vs. 3, respectively; P=0.029) and in the 'good-OR' group versus the 'moderate-OR and SD' group (median: 7.5 vs. 2, respectively; P=0.003), suggesting that greater tumor shrinkage led to more symptom amelioration. Tumor shrinkage was associated with Edmonton Symptom Assessment System-Revised score improvement in patients with lung cancer receiving systemic therapy.

117 Comparative Study Between Laparoscopic and Open Rectosigmoid Cancer Resection in Two Laparoscopic Naïve Centers in a Middle-Income Country

Abstract Aim The aim was to compare the short-term, oncologic, outcomes of laparoscopic and open resection for recto-sigmoid /upper rectal cancer in two centers with relatively newly adopted laparoscopic techniques in cancer. Method Our patients were recruited from two centers in Damietta, Egypt; one of them is a laparoscopic naïve center which has not introduced MIS surgery until recently and the other has the main laparoscopic experience reserved primarily for benign Upper GI and Bariatric work. 50 patients with recto- sigmoid and upper rectal cancer diseases in the period between December 2016 and December 2018 were included. Patients were randomly divided into two groups: (LR Group: “25 patients”) subjected to laparoscopic interventions, and (OR Group: “25 patients)” subjected to open surgery. Data were collected and Short-term outcomes were analyzed. Results The mean operative time was significantly increased in the LR group than OR group (LR 198.88± 18.7, OR 183.4± 20.5 minutes, p =0.01) as well as the hospital stay (LR 8.8± 2, OR 7.4± 2.9 days, p =0.013). However, LR group was quicker to recover in term of mobilizing early, recovery of bowel function, and early toleration of diet and fluid and this difference was only statistically significant for oral fluid but not for diet (p= 0.078; 0.17 respectively). There was no significant difference between both groups in tumor characteristics as locations, gross tumor morphology, staging, and distance to the distal margin. Also, both groups had comparable intraoperative and post-operative adverse events. Conclusion Laparoscopic technique represents a feasible and sound oncological approach and should be considered as standard in low resource setting.

537-P: Timing of Moderate-to-Vigorous Physical Activity Is Associated with Improvements in Glycemic Control in Type 2 Diabetes in the Look AHEAD Study

Background: We examined the association of time-of-day bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic measures and use of antidiabetic medications in adults with type 2 diabetes. Methods: Look AHEAD participants were randomly assigned to a lifestyle intervention or a control group, in which the most intensive intervention occurred in Year 1. Among 1755 participants (age, mean ± SD 60 ± 7 years; 57% women) with 7-day waist-worn accelerometry data at Year 1, we grouped them by the timing of bMVPA (≥3 METs in ≥min bouts) : ≥50% of bMVPA during the same time period (Morning, Midday, Afternoon, or Evening; N=191-258) , <50% of bMVPA in any time period (Mixed; N=379) , and ≤1 day with bMVPA per week (Inactive; N=485) . Analyses were adjusted for covariates including socio-demographic factors, randomization arm, and clinics; then further adjusted for weekly bMVPA volume and intensity. Findings: Timing of bMVPA was associated with changes in HbA1c across Year 1 (P=0.01) , independent of weekly bMVPA volume and intensity. Participants in the afternoon group as compared to the inactive group had a greater HbA1c reduction (mean: -0.16%; 95%CI: -0.33% to 0%) . Among non-insulin users the odds of discontinuation vs. maintaining or initiating antidiabetic medications across Year 1 trended to differ between the bMVPA timing groups (P=0.09) , with the afternoon group having the highest odds of discontinuation (OR vs. inactive group: 1.86; 1.14 to 3.02) . Interpretation: Timing of bMVPA may be linked with improvements in glycemic control in adults with type 2 diabetes. While regular physical activity remains to be the cornerstone for blood glucose management in diabetes, our findings suggested that exercise interventions aimed to increase glycemic control in patients with diabetes can be enhanced by engaging in physical activity at specific times of the day. Experimental protocols are needed to test the causality. Disclosure J.Qian: None. R.Middelbeek: Research Support; Novo Nordisk. Q.Xiao: None. M.P.Walkup: None. M.Coday: None. M.Erickson: None. J.L.Unick: None. J.M.Jakicic: Advisory Panel; Spark360, Wondr Health, WW International, Inc. K.Hu: None. F.A.Scheer: None. Funding National Institutes of Health (K99HL148500, DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, R01HL140574, RF1AG059867, RF1AG064312)

Cost-analysis of in-office versus operating room sialendoscopy: Comparison of cost burden and outcomes

PurposeOffice-based procedures in otolaryngology are increasingly utilized to increase efficiency, reduce cost, and eliminate risks associated with surgery. Gland-preserving surgical management of sialadenitis and sialolithiasis are often performed in the operating room, although many surgeons are moving this practice to clinic. We aim to determine the difference in patient charges and perioperative outcomes for salivary gland procedures performed in the clinic versus the OR. MethodsRetrospective series of patients presenting with sialolithiasis, acute or chronic sialadenitis, and stricture between 2010 and 2019. Demographics, perioperative variables, setting, and charge data were collected. Results528 patients underwent operative intervention (n = 427 office, n = 101 OR). Cohort demographics were comparable. Sialolithiasis was the most common presenting diagnosis in both cohorts. Both cohorts had similar rates of complete (p = 0.09) and partial (p = 0.97) response to treatment. A higher percentage of patients in the OR group reported no improvement (21.4 vs 12.2%, p = 0.034). Overall complications were similar (p = 0.582). Mean charges were statistically greater in the OR ($5560.35 OR vs $1298.33 office, p < 0.001). Operative time was significantly reduced in the office group (21.8 min vs 60.85 min, p < 0.001). ConclusionsAppropriately selected patients can be successfully treated in outpatient clinic without compromising patient safety or quality while significantly reducing the financial burden to patients and the healthcare system.

Effect of side-group structure and temperature on chain transfer to polymer and branching in acrylate homopolymerizations

The paper reports studies of the effects of ester side-group size and structure on chain transfer to polymer (CTP) and mol% branches (%br) in the final polymers from monomer-starved semi-batch emulsion homopolymerizations of a series of alkyl acrylates with different numbers of ester OR side-group carbon atoms (NsgC) in the range 1–10. Although the high instantaneous conversions and high gel contents in the final polymers show that intermolecular CTP is significant, the kinetics have been analysed principally in terms of intramolecular CTP (intraCTP) because this is expected to be numerically the dominant CTP process. For linear OR side groups, there is a small, continuous increase in %br (from ~ 3.4 to ~ 5.0 mol%) as NsgC increases from 1 to 8, which arises predominantly from the acrylate molar mass (Macrylate) reducing the molar monomer concentration and from the small increase in rate coefficient for propagation (kp) as NsgC increases; no discernible effects of NsgC on the rate coefficient for intraCTP ({k}_{mathrm{trP}}^{mathrm{intra}}) are evident. For isomeric butyl acrylates, there is no measurable effect of isomer structure on %br (4.3–4.4 mol%), indicating that butyl groups are too small for changes in side-group bulkiness to influence {k}_{mathrm{trP}}^{mathrm{intra}} and kp. A similar observation was made for n-hexyl acrylate (nHA) and 2-ethylbutyl acrylate (%br 4.7–4.8 mol%). However, cyclohexyl acrylate (cHA) gives a much higher %br (~ 7.2 mol%), which has been assigned to steric effects increasing {k}_{mathrm{trP}}^{mathrm{intra}} because kp values for nHA and cHA are very similar. For OR side-groups with NsgC of 8 and10, there is a strong effect of side-group non-linearity (2-ethylhexyl, iso-octyl and iso-decyl) increasing %br, with polymers from n-alkyl acrylates having much lower %br (~ 4.5–5.0 mol%) than those from the equivalent non-linear acrylates (~ 6.7–7.1 mol%); since the kp values are expected to be similar for these acrylates, it is evident that the much bulkier non-linear OR groups cause a significant increase in {k}_{mathrm{trP}}^{mathrm{intra}} compared to the linear equivalents. Tentative hypotheses for these steric effects have been postulated. Studies of the effect of temperature (0–80 °C) on CTP and %br for methyl acrylate solution homopolymerization (in which intraCTP should be completely dominant) show the expected reduction in %br as temperature reduces, such that CTP is negligible at 0 °C; Arrhenius analysis gives an activation energy of 40.7 kJ mol−1 for intraCTP, which is within the range of values reported for n-butyl acrylate.

The use of preoperative planning to decrease costs and increase efficiency in the OR.

BackgroundShoulder arthroplasty (SA) incurs up to $1.8B per year in societal costs. With the increasing demand for SA and the steady decrease of annual reimbursements for orthopedic procedures, it has become crucial to control costs. In SA, there has been an interest in using preoperative planning software to improve accuracy in positioning and implant selection, ultimately optimizing outcomes. However, the use of preoperative planning to increase efficiency has not been studied. The purpose of this study was to determine if preoperative planning could increase efficiency and decrease costs in the operating room.MethodsThis retrospective review included 94 patients who underwent shoulder arthroplasty and had a CT scan with a preoperative plan by a single orthopedic surgeon between 2017 and 2020. The patients were divided based on the use of the preoperative plan during surgery. Group 1 included 65 patients with a preoperative plan used during surgery, and group 2 included 29 patients without a preoperative plan utilized during surgery. Average preparation time, surgical time, time in the operating room, the number of trays sterilized, and postoperative outcomes were analyzed between the two groups. Subanalysis was done to find a statistical difference in the cost of sterilization for both groups.ResultsThe cohort had 55% males, with an average age of 71 years and an average BMI of 29.9. There were no significant differences between the groups for age, BMI, or ASA class. There was no significant difference between groups in preparation time (group 1: 53.3 min, group 2: 53.1 min P = .924), surgical time (group 1: 119.7 min, group 2: 111.9 min; P = .25), or time in the OR (group 1: 183.2 min, group 2: 173.2 min; P = .156). There was a statistical difference in the number of trays (5 vs. 8; P < .01) and cost of sterilization between groups ($487.30 vs. $842.86; P < .01). No correlation between the number of trays and preparation time (group 1: −0.05, group 2: −0.28) or trays and surgical time was found for either group (group 1: r = −0.31, group 2: r = −0.22). There were no significant differences in postoperative outcomes between the groups.ConclusionWhile preoperative planning did not reduce time in the OR for shoulder arthroplasty, it was correlated to a significant reduction in the number and cost of sterilized trays with comparable postoperative outcomes.

Biomolecules, Fatty Acids, Meat Quality, and Growth Performance of Slow-Growing Chickens in an Organic Raising System.

Simple SummaryThe increasing demand for nutritionally rich quality products by health-conscious consumers has raised the need to explore alternative farming systems such as organic farming. In this study, we report the efficiency of Korat chickens grown in organic farm conditions. The study demonstrates not only that the slow-growing Korat chicken is suitable for organic farming, but also that the organic raising system improves its growth performance and meat quality. Furthermore, the study unveils a set of biochemical traits using synchrotron radiation-based Fourier transform infrared that show significant differences between the meat quality of chickens raised under conventional and organic raising systems, suggesting their potential use as markers to monitor the meat quality. The findings of this study provide evidence for the potential of organic raising systems for commercial adoption in tropical areas such as Southeast Asia.This study was to determine the effect of the organic raising system (OR) on growth performance, meat quality, and physicochemical properties of slow-growing chickens. Three hundred and sixty (one-day-old) Korat chickens (KRC) were randomly assigned to control (CO) and OR groups. The groups comprised six replicates of thirty chickens each. The chickens were housed in indoor pens (5 birds/m2), wherein those in OR had free access to Ruzi pasture (1 bird/4 m2) from d 21 to d 84 of age. In the CO group, chickens were fed with a mixed feed derived from commercial feedstuffs, while those in the OR group were fed with mixed feed derived from organic feedstuffs. The results revealed a lower feed intake (p < 0.0001) and feed conversion ratio (p = 0.004) in the OR. The OR increased total collagen, protein, shear force, color of skin and meat, and decreased abdominal fat (p < 0.05). The OR improved fatty acid with increased DHA, n-3 PUFA, and decreased the ratio of n-6 to n-3 PUFA in KRC meat (p < 0.05). The synchrotron radiation-based Fourier transform infrared spectroscopy and correlation loading analyses confirmed these results. In conclusion, our results proved that OR could improve growth performance and meat quality and suggested the raising system be adopted commercially. In addition, the observed differences in biochemical molecules could also serve as markers for monitoring meat quality.

Anti-Obesity Effects of Polymethoxyflavone-Rich Fraction from Jinkyool (Citrus sunki Hort. ex Tanaka) Leaf on Obese Mice Induced by High-Fat Diet.

Polymethoxyflavones (PMFs) are flavonoids exclusively found in certain citrus fruits and have been reported to be beneficial to human health. Most studies have been conducted with PMFs isolated from citrus peels, while there is no study on PMFs isolated from leaves. In this study, we prepared a PMF-rich fraction (PRF) from the leaves of Citrus sunki Hort ex. Tanaka (Jinkyool) and investigated whether the PRF could improve metabolic decline in obese mice induced by a high-fat diet (HFD) for 5 weeks. The HFD-induced obese mice were assigned into HFD, OR (HFD + orlistat at 15.6 mg/kg of body weight/day), and PRF (HFD + 50, 100, and 200 mg/kg of body weight/day) groups. Orlistat and PRF were orally administered for 5 weeks. At the end of the experiment, the serum biochemical parameters, histology, and gene expression profiles in the tissues of each group were analyzed. The body weight gain of the obese mice was significantly reduced after orlistat and PRF administration for 5 weeks. PRF effectively improved HFD-induced insulin resistance and dyslipidemia. Histological analysis in the liver demonstrated that PRF decreased adipocyte size and potentially improved the liver function, as it inhibited the incidence of fatty liver. PRF activated AMP-activated protein kinase (AMPK), acetyl-CoA carboxylase (ACC), and hormone-sensitive lipase (HSL) in HFD-induced obese mice. Moreover, liver transcriptome analysis revealed that PRF administration enriched genes mainly related to fatty-acid metabolism and immune responses. Overall, these results suggest that the PRF exerted an anti-obesity effect via the modulation of lipid metabolism.

Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron alone or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholycystectomy

Post-operative nausea and vomiting (PONV) is highly distressing and unpleasant symptom. Palonosetron and dexamethasone are effective antiemetics with minimal side effect profile. This study compared the efficacy of palonosetron dexamethasone combination with palonosetron alone and dexamethasone alone for prevention of PONV after laparoscopic cholecystectomy.This prospective, randomised, double-blind study was done on 150 adults, American Society of Anesthesiologists Grade I and II patients, aged 18-60 years undergoing laparoscopic cholecystectomy. They were allocated to three groups which were to receive either of the three treatment regimens: Group A, (n = 50) Dexamethasone 8 mg plus Palonosetron 0.075 mg OR GroupB (n = 50) Palonosetron 0.075 mg Alone OR Group C (n = 50) Dexamethasone 8 mg Alone. The primary outcome was incidence of PONV in 24 h and the secondary outcome was a number of rescue antiemetic required. One-way ANOVA test was used to compare the means amongst three groups. To compare the proportions in the groups, Chi-square test/Fisher's exact test/Two proportions Z-test was applied as appropriate.Overall incidences of PONV in the study 24 h postoperatively were 22% in group A, 42% in group B and 86% in group C in 24 h postoperatively (P &amp;#60; 0.001). Requirement of rescue antiemetic was more in dexamethasone group than other two groups.Palonosetron alone and palonosetron-dexamethasone combination were equally effective in the prevention of PONV. Dexamethasone alone was least effective amongst the three groups. There is no difference between palonosetron and palonosetron-dexamethasone for PONV prevention.

Early versus Delayed Implant Exchange after Periprosthetic Breast Infection: A Single Center Study.

Background:Breast implant infections are challenging problems for both plastic surgeons and patients. They may require readmissions, re-operations, and have the potential to compromise the final result. Our goal was to determine whether early operative intervention (return to the operating room <72 h after diagnosis of infection) or intravenous antibiotics with later operative intervention increased long-term retention of a prosthesis.Methods:A retrospective review was conducted of patients who were hospitalized or underwent reoperation for an infection from 2006 through 2016. The length of hospitalization, length of IV antibiotic use, and retention of the breast prosthesis at 3-months after reoperation were recorded for each patient.Results:A total of 43 patients were included in our study. Of these, 33 patients underwent early intervention, and 10 patients underwent delayed intervention. The average length of stay was significantly shorter in the early versus delayed return to OR group (4.1 versus 6.4 days; P = 0.008). The average duration of antibiotics was shorter in the early intervention group than the delayed group (5.1 versus 6.4 days; P = 0.28). At 3-months postoperatively, a greater proportion of patients in the early intervention group compared with the delayed group retained their breast prostheses (87.5% versus 60%; P = 0.25).Conclusions:The results of this study demonstrate that breast implants may be salvaged after early (<72 hours) or delayed (>72 hours) operative intervention; however, early intervention is associated with a significantly shorter length of stay, and trends toward a shorter antibiotic course and higher rate of implant retention at 3 months.

Evaluation the Effect of Occlusal Reduction on Postoperative Pain in Teeth with Irreversible Pulpitis and Mild Tenderness to Percussion.

Pain control management after root canal treatment is a very important in clinical practice. The purpose of this study was to evaluate the effect of occlusal reduction on postoperative pain following root canal instrumentation in teeth with irreversible pulpitis and mild tenderness to percussion.Methods: Forty premolar vital teeth with sensitivity to percussion requiring endodontic treatment were included in this study. After administration of local anesthesia, the root canals were instrumented using WaveOne single file technique. The patients were randomly divided into 2 groups of 20 each. In group I (OR group) the occlusal surface was reduced, whereas in the other group II (NOR group), the occlusal surface was not modified (no occlusal reduction) and all teeth were instrumented with WaveOne single file technique. Each patient was asked to record their postoperative pain on a verbal rating scale with 4 categories at 12 hours, 24 hours and 48 hours. Data were analyzed by Mann-Whtney tests.Results: Forty patients returned the verbal rating scale forms. There was no significant difference in postoperative pain between the 2 groups (P &gt; .05) after root canal preparation.Conclusions: Occlusal surface reduction did not provide any further reduction in postoperative pain for teeth with irreversible pulpitis and mild tenderness to percussion compared with no occlusal

THE COMPARATIVE STUDY BETWEEN OPEN TECHNIQUES VERSUS LIMBERG FLAP TECHNIQUE IN MANAGEMENT OF SACROCOCCYGEAL PILONIDAL SINUS

Background: Comparative study of laparoscopic and open surgical method in management of peptic ulcer perforation&#x0D; Methods: The present study was conducted in patients presented with perforation peritonitis to the emergency department in G.G.S medical college and hospital, a tertiary care hospital in Faridkot, Punjab in which comparison of the clinical outcome between laparoscopic and open surgical methods for treatment of Gastro duodenal perforation was study.&#x0D; Results: Mean operative time of laparoscopic repair group was higher (158.2±0.64 min) in comparison to open repair group (70.8±0.42 min). In the present study post-operative pain score was assessed in each and every patient using Visual analogue scale. On post-operative day 1, mean VAS for OR Group was significantly higher in comparison to LR Group. Later on postoperative day 3, Majority of patients of in LR group had a highest score of 1-4 while in OR group was score 5-7.Nexton postoperative day 5, again mean VAS for LR patients was less in comparison to OR Group.&#x0D; Conclusion: As this is the first kind of study in our geographical area in which role of alcohol proved to be an important risk factor. Laparoscopic approach for repair of perforated peptic ulcer may offer significant advantage over open repair approach with lesser post-operative pain, lsser postoperative complications like wound infections, comparable reperforation rates and&#x0D; lesser duration of hospital stay.&#x0D; Keywords: Laparoscopic, Open, Repair

COMPARATIVE STUDY OF LAPAROSCOPIC AND OPEN SURGICAL METHOD IN MANAGEMENT OF PEPTIC ULCER PERFORATION

Background: Comparative study of laparoscopic and open surgical method in management of peptic ulcer perforation&#x0D; Methods: The present study was conducted in patients presented with perforation peritonitis to the emergency department in G.G.S medical college and hospital, a tertiary care hospital in Faridkot, Punjab in which comparison of the clinical outcome between laparoscopic and open surgical methods for treatment of Gastro duodenal perforation was study.&#x0D; Results: Mean operative time of laparoscopic repair group was higher (158.2±0.64 min) in comparison to open repair group (70.8±0.42 min). In the present study post-operative pain score was assessed in each and every patient using Visual analogue scale. On post-operative day 1, mean VAS for OR Group was significantly higher in comparison to LR Group. Later on postoperative day 3, Majority of patients of in LR group had a highest score of 1-4 while in OR group was score 5-7.Nexton postoperative day 5, again mean VAS for LR patients was less in comparison to OR Group.&#x0D; Conclusion: As this is the first kind of study in our geographical area in which role of alcohol proved to be an important risk factor. Laparoscopic approach for repair of perforated peptic ulcer may offer significant advantage over open repair approach with lesser post-operative pain, lsser postoperative complications like wound infections, comparable reperforation rates and&#x0D; lesser duration of hospital stay.&#x0D; Keywords: Laparoscopic, Open, Repair

Titanium-Oxo Clusters with Bi- and Tridentate Organic Ligands: Gradual Evolution of the Structures from Small to Big.

Homometallic titanium oxo clusters are one of the most important groups of metal oxo clusters, with more than 300 examples characterized by X‐ray structure analyses. Most of them are uncharged and are obtained by partial hydrolysis and condensation of titanium alkoxo derivatives. The cluster cores, ranging from 3 to >50 titanium atoms, are stabilized by organic ligands. Apart from residual OR groups, carboxylato and phosphonato ligands are most frequent. The article critically reviews and categorizes the known structures and works out basic construction principles by comparing the different cluster types.

Nebulized dexamethasone sodium phosphate in the treatment of horses with severe asthma.

BackgroundA study reported low systemic availability of injectable dexamethasone nebulized to healthy horses using the Flexineb mask. When used in horses with severe asthma and a different nebulizer, lack of efficacy and cortisol suppression were observed.HypothesisNebulized dexamethasone is as effective as PO administration for the treatment of severe asthma in horses.AnimalsTwelve horses with severe asthma from a research herd.MethodsRandomized clinical trial. Horses were divided into 2 groups and received 5 mg of dexamethasone sodium phosphate by nebulization using a Flexineb mask (NE, n = 6) or PO (OR, n = 6) q24h for 7 days. Lung function and serum cortisol concentrations were evaluated at baseline, after 4 days of treatment (D4) and 1 day after the last treatment (D8). Data were analyzed using linear mixed models with Benjamini‐Hochberg adjustments.ResultsLung resistance significantly improved at D4 (mean decrease ± SD, −1.5 ± 0.45 cm H₂O/L/s; 95% confidence interval [CI], −2; −0.6) and D8 (−1.4 ± 0.45 cm H₂O/L/s; 95% CI, −2.4; −0.5) compared to baseline in the OR group only (P = .004 and .01, respectively). Serum cortisol concentration was significantly decreased at D4 and D8 for both groups (maximum decrease, −1.2 ± 0.3 μg/dL; 95% CI, −1.9; −0.6 at D4 for NE group and −2.2 ± 0.3 μg/dL; 95% CI, −2.8; −1.6 at D8 for OR group; P < .001).Conclusions and Clinical ImportanceOral, but not nebulized dexamethasone is an effective therapy for horses with severe asthma and both treatment modalities inhibit the hypothalamic‐pituitary‐adrenal axis.

Evaluating Individual Radiosensitivity for the Prediction of Acute Toxicities of Chemoradiotherapy in Esophageal Cancer Patients.

In this work, individual radiosensitivity was evaluated using DNA damage response and chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) for the prediction of acute toxicities of chemoradiotherapy (CRT) in esophageal cancer patients. Eighteen patients with esophageal cancer were enrolled in this prospective study. Prescribed doses were 60 Gy in 11 patients and 50 Gy in seven patients. Patients received 2 Gy radiotherapy five days a week. PBLs were obtained during treatment just before and 15 min after 2 Gy radiation therapy on the days when the cumulative dose reached 2, 20, 40 Gy and 50 or 60 Gy. PBLs were also obtained four weeks and six months after radiotherapy in all and 13 patients, respectively. Dicentric and ring chromosomes in PBLs were counted to evaluate the number of CAs. Gamma-H2AX foci per cell were scored to assess DNA double-strand breaks. We analyzed the association between these factors and adverse events. The number of γ-H2AX foci before radiotherapy showed no significant increase during CRT, while their increment was significantly reduced with the accumulation of radiation dose. The mean number of CAs increased during CRT up to 1.04 per metaphase, and gradually decreased to approximately 60% six months after CRT. Five patients showed grade 3 toxicities during or after CRT (overreactors: OR), while 13 had grade 2 or less toxicities (non-overreactors: NOR). The number of CAs was significantly higher in the OR group than in the NOR group at a cumulative dose of 20 Gy (mean value: 0.63 vs. 0.34, P = 0.02), 40 Gy (mean value: 0.90 vs. 0.52, P = 0.04), and the final day of radiotherapy (mean value: 1.49 vs. 0.84, P = 0.005). These findings suggest that number of CAs could be an index for predicting acute toxicities of CRT for esophageal cancer.

A pilot study of the enhanced recovery after surgery protocol in aortic surgery

ObjectiveWe tested the outcomes with the use of the enhanced recovery after surgery protocol in patients who had undergone open abdominal aortic aneurysm (AAA) repair (enhanced recovery after vascular surgery [ERAVS] protocol). We compared them with those obtained for patients who had undergone endovascular aneurysm repair (EVAR) and for a historical control group of standard open AAA repair in a prospective, single-center pilot study. MethodsFrom June to December 2019, all patients who were candidates for open AAA repair at our department were enrolled in the ERAVS protocol (ERAVS group; 17 patients). During the same period, 18 patients had undergone EVAR (EVAR group). The historical control group of standard open AAA repair included 32 patients who had undergone surgery during the 6 months before the study period (standard protocol open repair [OR] group). The three groups were compared on an “on-treatment” basis (prospectively for the ERAVS and EVAR groups and retrospectively for the OR group) in terms of the time to discharge (TTD), interval to the resumption of oral intake, time to ambulation, resumption of bowel function, and postoperative pain. Comparisons were performed using the one-way analysis of variance test, Tukey post hoc test for quantitative data, and χ2 test for qualitative data. ResultsThe ERAVS protocol was successfully applied for all but one patient (feasibility rate, 94%). The mean TTD was 5.1 days in the ERAVS group, 3.5 days in the EVAR group, and 8.4 days in the OR group [P < .001; F(2,64) = 11.3], with a significant difference between the OR and ERAVS and EVAR groups (P = .1 and P < .001, respectively) but not between the EVAR and ERAVS groups (P = .4). The ERAVS group had intervals to the resumption of oral intake and ambulation similar to those of the EVAR group. In contrast, these were significantly longer for the OR group. The mean time to the resumption of bowel function was similar in the ERAVS and OR groups (2.6 and 2.9 days, respectively; P = .6). In the ERAVS group, the mean value of the maximum referred pain using the numeric rating scale was 3.75 (range, 1-6). The corresponding values for the EVAR and OR groups were 2.6 (range, 0-6) and 4.9 [range, 1-8; F(2,62) = 15.4; P < .001]. The post hoc test showed a significant difference between the OR group and the ERAVS and EVAR group (P = .01 and P < .001, respectively) but not between the ERAVS and EVAR groups (P = .07). ConclusionsIn our early experience, the ERAVS protocol appeared to be effective in reducing the TTD and improving the postoperative outcomes compared with the OR group, without significant differences compared with the EVAR group.