Transtumoral endoprothesis in surgery of colorectal cancer, complicated with colonic obstruction: advantages and disadvantages. A review of the literature

A multifactorial analysis of the literature data on the treatment of acute tumor colonic obstruction using minimally invasive endoscopic surgical technology was carried out. On the basis of the analysis of special publications, the effectiveness of stenting of the large intestine, as a minimally invasive endoscopic method of decompression, is presented. Indications and contraindications for colorectal stenting, advantages and disadvantages, possibilities and prospects of endoscopic decompression of the colon are described in detail. It is postulated that stenting, used in acute tumor obstruction of the colon as a «bridge to surgery», being a worthy alternative to classical colostomy, allows an effective antegrade decompression of the colon and prepares the patient to surgical treatment with the performance of oncological justified primary radical and one-stage restorative operations in more optimal conditions with minimal risk. It is shown that in the late stages of the malignant process and in the presence of neresect-leucorrhoea colorectal cancer, as well as in the presence of absolute contraindications to a radical surgeon Colon stenting can serve as the final treatment for inoperable patients.

High Participant Satisfaction Achieved Using Cryolipolysis for Fat Reduction of the Abdomen and Flanks

Background Patient-reported outcome (PRO) data evaluating the physical and psychosocial impact of Cryolipolysis (CoolSculpting) treatment are limited. Objectives Assess multidimensional aspects of satisfaction following cryolipolysis treatment of the flanks and abdomen using a combination of PRO instruments. Methods This was a multi-national, prospective, single cohort, interventional study. The primary endpoint was the proportion of Satisfied or Very Satisfied participants with treatment at 12 weeks post final treatment. Secondary endpoints included satisfaction categorized by treatment area, total number of treatment cycles, baseline body mass index (BMI), and fat volume reduction measured by 3D photography at 12 weeks post final treatment. Exploratory endpoints assessed the physical and psychosocial impacts of treatment. Safety was monitored throughout the study. Results Of 112 participants who were treated, 74.1% were female. The mean age and BMI were 42.5 years and 24.9 kg/mg 2, respectively. Of the 106 evaluable participants, 89.6% were Satisfied or Very Satisfied with treatment results. Satisfaction was high regardless of body area(s), total number of treatment cycles, or baseline BMI. Mean (SD) fat volume reduction was 264.8 mL (411.4). Overall, 90.6% reported Noticeable or Very Noticeable fat reduction, 89.6% were Likely or Very Likely to treat additional areas, and 93.4% would recommend cryolipolysis to a friend. 24 (21.4%) participants reported treatment-emergent adverse events (AEs); 23 (20.5%) reported these as Adverse Device Effects (ADE). No serious device-related or unanticipated adverse effects occurred. Conclusions Cryolipolysis (CoolSculpting) for fat reduction of the flanks and/or abdomen was well-tolerated and associated with high levels of satisfaction across multidimensional PROs.

Failures of the Fontan System in Univentricular Hearts and Mortality Risk in Heart Transplantation: A Systematic Review and Meta-Analysis

The Fontan procedure (FP) is the standard surgical treatment for Univentricular heart diseases. Over time, the Fontan system fails, leading to pathologies such as protein-losing enteropathy (PLE), plastic bronchitis (PB), and heart failure (HF). FP should be considered as a transitional step to the final treatment: heart transplantation (HT). This systematic review and meta-analysis aims to establish the risk of death following HT according to the presence of FP complications. There was a total of 691 transplanted patients in the 18 articles, immediate survival 88% (n = 448), survival from 1 to 5 years of 78% (n = 427) and survival from 5.1 to 10 years of 69% (n = 208), >10 years 61% (n = 109). The relative risk (RR) was 1.12 for PLE (95% confidence interval [CI] = 0.89–1.40, p = 0.34), 1.03 for HF (0.7–1.51, p = 0.88), 0.70 for Arrhythmias (0.39–1.24, p= 0.22%), 0.46 for PB (0.08–2.72, p = 0.39), and 5.81 for CKD (1.70–19.88, p = 0.005). In patients with two or more failures, the RR was 1.94 (0.99–3.81, p = 0.05). After FP, the risk of death after HT is associated with CKD and with the presence of two or more failures.

Racemic ketamine as an alternative to electroconvulsive therapy for unipolar depression. A randomized, open-label, non-inferiority trial. (KetECT)

BACKGROUND Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared to electroconvulsive therapy (ECT), the most effective therapy for depression. METHODS Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT, in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale [MADRS] score ≤10). Secondary outcomes included adverse events (AEs), time to remission and relapse. Treatment sessions (maximum of twelve) were administered until remission or maximal effect was achieved. Remitters were followed for twelve months after the final treatment session. RESULTS 186 inpatients were included and received treatment. Among patients receiving ECT 63% remitted, compared to 46% receiving ketamine infusions (p=0.026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of six treatment sessions to induce remission. Distinct adverse events (2015) were associated with each treatment. Serious and long-lasting AE, including cases of persisting amnesia, were more common with ECT, while treatment emergent AE led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within twelve months in the ketamine and ECT group respectively (p=0.52). CONCLUSION Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.

Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature

Background Appendix’ anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment. Case presentation We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery. Therapeutic decisions were extremely challenging due to clinical deterioration and an uncertain etiology. Only the histopathology report revealed the presence of a complete subserosal appendix which was responsible for the entire symptomatology. Here, we review all case reports regarding intramural, intracecal or subserosal appendixes. A discussion of the general approach to this specific case and the importance of consensual diagnostic criteria for these specimens are also presented. At last, an incidental finding is exposed and final treatment options are discussed given the overall presentation. Conclusions Considering these variants would guide physicians towards a more accurate approach to similar clinical pictures and hence an improved long-term prognosis.

Sustainable Manufacturing Process in the Context of Wood Processing by Sanding

The aim of this paper is the issue of a sustainable manufacturing process in the context of woodworking by sanding, as one of the most important technological operations before its final treatment, focusing on a selected pillar of sustainable manufacturing process, waste management. The first step of the experiment was to optimize the pressures of the sanding means on the surface. The optimal pressure of 1.04 N·cm−2 was chosen. The second level was to obtain the wear curves of the abrasive means with grain size 80 (evaluated by wood removal) and the optimal pressure in dependence on the sanding direction (along and perpendicular to the wood fibres and in the direction of 60° to the wood fibres) and different types of woods (beech, oak, alder, pine). The set parameters were suitable for beech and were not suitable for alder and pine. By extending the operating life of the sanding belts via appropriate choice of input factor settings it can be influenced metrics of pillar waste management-savings of material and waste minimization.

Low- and High-Pressure Membrane Separation in the Production of Process Water for Coke Quenching

Although the time for operating mines and coking plants in many countries is coming to an end due to climate change, we must still ensure that the pollution generated by this source of the economy is minimized. Despite the several stages of treatment of the coke-oven effluent, completed with nitrification and denitrification processes preceding final sedimentation, the stream obtained does not meet the requirements of water for coke quenching. That is why the stream after biodegradation and sedimentation was treated on membrane units to ensure water reusing in the coking plant. As the subjected stream contained both solid and dissolved pollutants, a two-stage system was proposed: low- and high-pressure membrane filtration. Industrial modules were tested on pilot units operating under industrial plant conditions. In the case of the ultrafiltration process, all the tested ultrafiltration modules fulfilled the primary task. All of them separated almost completely the turbidities present in the stream, which would have disturbed the operation of the high-pressure plant. Considering the decrease in permeate flux and the possibility of cleaning, a PCI membrane made of PVDF tubes with a diameter of 12.5 mm and pore size of 20 μm was selected. Regarding the high-pressure membrane filtration, the reverse osmosis membrane was significantly better in the removal efficiency of both organic and inorganic dissolved substances. An operating pressure of 3 MPa was chosen for the system. Hence, membrane processes, which are not used as stand-alone treatment units for coke-oven effluents, function well as a final treatment stage.

Maxillary Occlusion Rehabilitation of Multiple Anterior Teeth Agenesis Followed by Tooth Wear: A Case Report

A 19-year-old female patient came with the chief complaint that the upper anterior teeth looked small and with many spaces. The patient claimed that the tooth had never been replaced since birth. The patient wanted to improve the aesthetics of the tooth. Treatment, in this case, was made using a fixed prosthetic to aesthetically rehabilitate through prosthodontic treatment in the anterior teeth agenesis followed by attrition. It can be concluded that fixed prosthodontic treatment using a splint bridge is one treatment option that can be used in multiple anterior teeth agenesis followed by tooth wear. An appropriate material selection increases the aesthetics and functional aspects of the final treatment.

Lactobacillus Paracasei BEJ01 Protects Against Fumonisin B1-Induced Intestinal Toxicity in Balb/c Mice

Fumonisin B1 (FB1) is a carcinogenic (Class 2B) mycotoxin produced by Fusarium fungi and is responsible for several types of mycotoxicoses in animals and humans. Lactobacillus paracasei (LP), as a probiotic, is known to impart a wide range of advantageous effects on host health. The objective of the current study was to evaluate if LP (type BEJ01) isolated from Tunisian artisanal butter, could potentially help protect a host against intestinal alterations caused by exposure to FB1. Here, adult male Balb/c mice were randomly assigned to four groups, i.e., control (vehicle only), treated with FB1 (100 µg/kg BW), LP (2 × 109 CFU/ml [≈ 2 mg/kg BW]) and FB1 (100 µg/kg BW) + LP (2 × 109 CFU/ml) and treated per os daily for 10 days. At 24 hr after the final treatment, mice were euthanized and their jejunum harvested for examination of intestinal alterations induced by the FB1. The data showed that a variety of negative effects in jejunal tissue were induced by the FB1, including DNA fragmentation, oxidative stress, apoptotic cell death, and histopathological alterations. The results also showed that co-treatment of LP with FB1 was able to mitigate the harmful FB1 effects. LP alone imparted no damage to jejunal tissues. These results show that apart from potential use as a bio-preservative for extending the shelf-life of food and feeds, LP may also provide a benefit of helping prevent untoward effects from a potent mycotoxin like FB1.