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Background: Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in laparoscopic procedures. Nevertheless, available evidenced-based data comparing their operative results still are scarce. This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative blood losses in laparoscopic colorectal surgery.Methods: The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference in operating time and blood loss between instruments.Results: Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p < 0.05).Conclusions: The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number of patients are required to confirm the results of this metaanalysis. [ABSTRACT FROM AUTHOR]

Background: Bariatric and metabolic surgery tourism (BMT) is becoming an increasingly popular route to treatment for patients living with obesity. Recent reports have highlighted that some patients travelling abroad for bariatric surgery have received inadequate care, fraudulent care, and, tragically, some cases have resulted in death. This study aimed to define consensus in Europe regarding safe practices concerning BMT., Materials and Methods: IFSO-EC, EASO and ECPO initiated a task force to delineate safe practices in BMT. Two expert European panels were convened, one comprised of healthcare professionals (identified from EASO and IFSO-EC) and the other of patient representatives (identified from ECPO). The study utilised a modified Delphi consensus methodology, and 135 questions were administered. Surveys were conducted anonymously online, and consensus was defined as 70% agreement. Themes analysed regarding BMT included regulation, pre-operative evaluation, operative care, post-operative care, advertising and online information., Results: One hundred and nineteen healthcare professionals and 88 patient representatives participated from 26 countries. The healthcare professional panel included 66 bariatric surgeons, 28 endocrinologists, 18 dietitians, three nurses, two psychologists, one general practitioner and one gastroenterologist. Three questionnaire rounds were conducted for the healthcare professional panel, and two were performed for the patient representative panel. Consensus recommendations were given across all themes relevant to BMT. These included evaluating and managing psychological health, sleep apnoea, cardiovascular disease, liver health and dietetic assessment. The recommendations covered the requirements for regulatory standards, including surgeon accreditation and procedural volume. They also included recommendations regarding patient education, standardised operative care, online information provision, and follow-up., Conclusions: Through collaboration with healthcare professionals and patients living with obesity, we provide European recommendations regarding safe practices concerning BMT. Further evaluation is required regarding outcomes following BMT. These data, alongside the Delphi consensus recommendations, will inform BMT clinical guideline development., (Copyright © 2024. Published by Wolters Kluwer Health, Inc.)

Background: Coffee roasting is one of the crucial steps in obtaining a high-quality product as it forms the product's color and flavor characteristics. Roast control is made by visual inspection or traditional instruments such as the Agtron spectrophotometer, which can have high implementation costs. Therefore, the present study evaluated colorimetric approaches (a bench colorimeter, smartphone digital images, and a colorimetric sensor) to predict the Agtron roasting degrees of whole and ground coffee. Two calibration approaches were assessed, that is, multiple linear regression and least-squares support vector machine. For that, 70 samples of whole and ground roasted coffees comprising the Agtron roasting range were prepared., Results: The results showed that all three colorimetric acquisition types were efficient for the model building, but the bench colorimeter and the smartphone digital images generally performed with good determination coefficients and low errors as measured by external validation. For the whole bean coffee, the best model presented a determination coefficient (R 2 ) of 0.99 and a root-mean-squared error (RMSE) of 1.91%, while R 2 of 0.99 and RMSE of 0.87% was obtained for ground coffee, both using the colorimeter., Conclusion: The obtained models presented good prediction capability, as assessed by external validation and randomization tests. The obtained findings point to an alternative for coffee roasting monitoring that can lead to higher digitalization and local control of the process, even for smaller producers, due to its lower costs. © 2024 Society of Chemical Industry., (© 2024 Society of Chemical Industry.)

Background/aim: In the context of surgical de-escalation in early breast cancer (EBC), this study aimed to evaluate the contrast enhancement ultrasound (CEUS) sentinel lymph node (SLN) procedure as a non-invasive axillary staging procedure in EBC in comparison with standard SLN biopsy (SLNB)., Patients and Methods: A subanalysis of the AX-CES study, a prospective single-arm, monocentric phase 3 study was performed (EudraCT: 2020-000393-20). The study included patients with EBC undergoing upfront surgery and SLN resection, with no prior history of locoregional treatment, and weighing between 40-85 kg. All patients underwent the CEUS SLN procedure as a non-invasive axillary staging procedure, with CEUS SLN accumulation marked using blue dye. After the CEUS SLN procedure, all patients underwent the standard mapping procedure. Data on success rate, systemic reactions, mean procedure time, mean surgical procedure, mean procedure without axillary staging, CEUS SLN appearance (normal/pathological), SLN number, and concordance with standard mapping procedure were collected., Results: After the CEUS SLN procedure, 29 LNs among 16 patients were identified and marked. In all cases, CEUS SLN revealed at least one LN enhancement. Six (37.50%) LNs were defined as pathological after the CEUS SLN procedure. Definitive staining of CEUS SLN pathology revealed metastatic involvement in four (66.67%) of the cases. Two SLNs were identified during the CEUS SLN procedure; however, owing to the low disease burden, no change in the surgical plan was reported., Conclusion: The CEUS SLN procedure shows promise as a technique for non-invasive assessment of the axilla, potentially enabling safe axillary de-escalation in EBC by estimating the axillary disease burden., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

This proof-of-concept study explored the use of an RGB colour sensor to identify different blends of vegetable oils in avocado oil. The main aim of this work was to distinguish avocado oil from its blends with canola, sunflower, corn, olive, and soybean oils. The study involved RGB measurements conducted using two different light sources: UV (395 nm) and white light. Classification methods, such as Linear Discriminant Analysis (LDA) and Least Squares Support Vector Machine (LS-SVM), were employed for detecting the blends. The LS-SVM model exhibited superior classification performance under white light, with an accuracy exceeding 90%, thus demonstrating a robust prediction capability without evidence of random adjustments. A quantitative approach was followed as well, employing Multiple Linear Regression (MLR) and LS-SVM, for the quantification of each vegetable oil in the blends. The LS-SVM model consistently achieved good performance ( R 2 > 0.9) in all examined cases, both for internal and external validation. Additionally, under white light, LS-SVM models yielded root mean square errors (RMSE) between 1.17-3.07%, indicating a high accuracy in blend prediction. The method proved to be rapid and cost-effective, without the necessity of any sample pretreatment. These findings highlight the feasibility of a cost-effective colour sensor in identifying avocado oil blended with other oils, such as canola, sunflower, corn, olive, and soybean oils, suggesting its potential as a low-cost and efficient alternative for on-site oil analysis.

Colorectal medullary carcinoma (CMC) is a rare subset of minimally differentiated carcinomas. CMC tend to be right-sided and present at an advanced stage. Despite this, distant metastases are rare at presentation. The liver and the regional lymph nodes represent the most common sites of metastases. Most of the time, CMCs exhibit mismatch repair deficiency and a strong association with high-level microsatellite instability. There is no conspicuous data regarding treatment strategies and short-term outcomes. CMC is supposed to be related to better prognosis compared to poorly-differentiated and undifferentiated colonic adenocarcinomas, but reports are controversial.This lesion, with heterogeneous presentations and unclear prognostic significance, may be unfamiliar to histopathologists and can lead to diagnostic uncertainty and overtreatments.Our aim is to renew the attention to this rare histological subtype through the report of two cases.

The aim of this study was to investigate the attributes of the pulp and nut oils from Terminalia catappa fruits obtained by supercritical fluid extraction (SFE) with pressurized CO 2 . The yield, physico-chemical characterization and fatty acid profiles of both oils were assessed based on their acidity and peroxide indices, thermogravimetric behavior, infrared spectroscopic and gas chromatographic analyses. The extraction yields were 7.4% and 61.5% for the pulp and nut from T. catappa, respectively. The pulp and nut oils exhibited low levels of acidity, 3.3 and 1.9 mg KOH g -1 , and peroxides, 3.8 and 1.7 mEq kg -1 , respectively. These values are lower than the maximum recommended levels given by the Codex Alimentarius for virgin oils (4.0 mg KOH g -1 and 15 mEq Kg -1 , respectively). Unsaturated fatty acids were a major constituent of the oils (58%), of which omegas 3 and 6 were predominant. The infrared spectroscopy of the nut oil showed high intensity bands between 2912 and 716 cm -1 , representative of chemical groups commonly present in unsaturated fatty acids. The pulp oil displayed higher thermal stability than the nut oil, whereby the initial degradation temperatures (T onset ) were 280 °C and 230 °C, respectively. This difference may be related to a greater amount of saturated fatty acids in the pulp oil compared to the nut oil. Thus, both pulp and nut oils displayed good physicochemical properties, which are desirable in diverse industrial sectors., (Copyright © 2020. Published by Elsevier Ltd.)

Purpose: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL)., Methods: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL., Results: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20-35 kg/m2 ). The median tumor distance from the anal verge was 8 cm (range, 4-12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation., Conclusion: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose Methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight Heparin and gastroprotected medication. Complete transection of the spinal cord and an anterior haematoma from T11 to T12 were confirmed on X rays, CT's and MRI scans. Posterior surgical stabilisation was performed using Isola instrumentation, starting 8 h post injury. Her post surgical period was uneventful except for some episodes of low blood pressure (85/60 mmHg) from which she had no symptoms. On the 12th post operative day, while in the physiotherapy department, she complained of right scapular pain. This occurred every time she was sat up and was associated with paraesthesia of both upper limbs. Two days later she deteriorated neurologically and her level ascended initially to T8 and then to T3. MRI of the spine with and without gadolinium showed spinal cord oedema between C3 and T1. There was no evidence of haemorrhage or syringomyelia. The authors discussed this case making different hypotheses. They are mainly the following: (1) Gradually ascending ischaemia due to a vascular disorder; (2) Double spinal trauma; (3) Ischaemia related to repeated hypotensive episodes; (4) Low grade intramedullary tumour; and (5) Thrombus of the Radicularis Magna artery. The case has been recognised as being very rare and interesting. In the conclusions, the presenting author stresses the importance of adopting MRI-compatible instrumentation for the surgical stabilisation of the spine, and careful monitoring of blood pressure during the acute phase of spinal cord injury. Dr Aito agrees with Mr El Masry about the opportunity of forming a group of clinicians in order to discuss protocols to cope with this devastating complication.

Seventy-eight cases of late cerebral radionecrosis gathered from the literature are reviewed and three personal cases reported. The difficulties in making pre-and intra-operative diagnoses, the efficacy of surgical treatment in cases of circumscribed lesions, and the very poor prognosis of diffuse lesions are emphasized.