Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy:A retrospective case-series study

AIM:To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy(LTG).METHODS:Between July 2010 and December 2012,58 consecutive patients with early gastric cancer underwent LTG were enrolled.We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients.Then patients’characteristics,perioperative outcome and histopathologic data were analyzed retrospectively.RESULTS:The mean age and body mass index were59.3±9.7 years and 22.7±2.6 kg/m2.The mean operation,reconstruction and anvil insertion times(from gastric incision to linear stapling)were 251.8±57.0,43.1±2.8 and 4.2±1.9 min,respectively.Intraoperative blood loss was 204.6±156.3 m L and there was no open conversion.The postoperative complications were in 8 cases(delayed gastric emptying in 4 cases,pulmonary complication in 2cases,pancreatitis in 1 case,anastomotic stricture in 1case).Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention.The patients were discharged at a mean of 9.6±2.0 d after surgery.Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively.The mean proximal margin of specimen was 2.7±2.8 cm CONCLUSION:Roux-en Y esophagojejunostomy usingthe double stapling technique is simple and rapid,and it may offer a solid,alternative reconstruction method for LTG or proximal gastrectomy.

Anesthetic management of the SRS^(TM) endoscopic stapling system for gastro-esophageal reflux disease

The SRS TM Endoscopic Stapling System(Medigus,Tel Aviv,Israel) is a new tool capable of creating a totally endoscopic fundoplication,combined with an endoscope,endoscopic ultrasound and a surgical stapler.SRS TM endoscopic stapling for gastro-esophageal reflux disease is a minimally invasive,outpatient procedure,which requires general anesthesia with positive-pressure ventilation.Keeping the patient on positive endexpiratory pressure(PEEP) may minimize the pressure gradient between the esophagus and the mediastinum,as well as help to prevent air from leaking around the screws and causing pneumomediastinum.In addition,in patients with hiatal hernia,higher PEEP levels may be required to increase intra-thoracic pressure and to force the stomach to slide into the abdomen for ease of endoscopy.We advise smoother emergence from anesthesia,taking precautions for retching,postoperative nausea and vomiting(PONV),while coughing and gagging during extubation and PONV may affect the success of the procedure.Total intravenous anesthesia with propofol and remifentanil seems to be a good choice for these reasons.

Incidence of anastomotic stricture after Ivor-Lewis oesophagectomy using a circular stapling device

BACKGROUND Benign oesophageal strictures carry a significant level of morbidity,causing burdensome symptoms impacting on quality of life.Post-oesophagectomy anastomotic stricture rates as high as 41%have been reported in the literature.These can require endoscopic dilatation,often multiple times to relieve dysphagia.The aim of the present study was to determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.AIM To determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.METHODS We performed a retrospective analysis of a prospectively collected database of Ivor-Lewis oesophagectomy performed from 2004-2018 to determine the stricture rate.The database comprised a single-surgeon series of open,two-stage oesophagectomies with a circular stapled intra-thoracic anastomosis.Tumour location,histology,neoadjuvant chemotherapy,stapler size,T-stage and R-status were analysed to see if they could predict stricture formation.Stricture was defined as dysphagia requiring endoscopic dilatation.Patients with anastomotic leaks were excluded on the basis they would develop an anastomotic stricture.RESULTS One hundred and seventy patients were collected in the database.Nineteen were excluded on the basis of anastomotic leak,perioperative death and early recurrence.One hundred and fifty-four patients(119 males,35 females)with a mean age of 64±10 years were eligible for analysis.A total of 15 patients developed strictures a median of 99 d(interquartile range:84-133)after surgery,giving a Kaplan-Meier estimated stricture rate of 10%at one year.None of the factors considered were found to be significantly associated with strictures.CONCLUSION In this study the stricture rate was 10%,with the majority occurring in the first 100 d after surgery.No significant independent factors were found in the development of strictures.

Different stapling-based peptide drug design:Mimicking α-helix as inhibitors of protein-protein interaction

Peptide stapling strategy has been proven a promising solution in addressing two major pharmacological hurdles, proteolytic stability and membrane permeability, for small peptides as therapeutics. This stapling peptides feature a covalent cross-link of side chains, thus effectively mimicking α-helix as inhibitors of protein-protein interactions. In this review, we category and analyze key examples of various peptide stapling strategies based on different cross-links aligned on the side chain of peptides mainly in the last three years.

Cleavable Cys labeling directed Lys site-selective stapling and single-site modification

Site-selective modification of peptide/protein is a vital approach to disclose post-translational modifications(PTMs) and plays a crucial role in chemical biology, as well as drug development. Compared with synthetic and chemical biology methods, chemical modification of native peptide/protein provides a more versatile approach to achieve late-stage diversification for functional studies. Lysine featured high nucleophilicity, frequency, and solvent accessibility, making its site-selective modification important but elusive. Herein, we reported a visible-light-driven and Cys-directed Lys site-selective stapling approach for peptide/protein. By cleavable Cys anchoring, site-selective Lys single-site modification was achieved, and this method could be applied to multi-functionalization.

Simulation and Experimental Study of Staple Line Reinforcement Surgery

The aim of this study was to evaluate the effectiveness of BM (basement membrane) and SIS (small intestine submucosa) composite extracellular matrix staple line reinforcement in surgical procedures through finite element modelling simulations and leak-proof performance experiments. The mechanical analyses of soft tissues with and without staple line reinforcement were performed by establishing finite element models of three tissues, namely, stomach, intestine and lungs, under the use scenarios of different anastomosis staple models;and the leak-proof performance of the staple line reinforcement was evaluated by simulating leak-proof experiments of gastric incision margins, intestinal sections, and lung incision margins in vitro. The results showed that the equivalent average stresses of the staple line reinforcement were increased by 20 kPa-68 kPa in gastric and intestinal tissues, and 8 kPa-22 kPa in lung tissues. and that the BM and SIS composite extracellular matrix staple line reinforcement could strengthen the anastomotic structure, and at the same time disperse the high stresses of the anastomosed tissues, which could effectively reduce the postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis. It can effectively reduce postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis.

Peptide stapling with the retention of double native side-chains

All-hydrocarbon stapling strategy has been widely applied for enhancing the proteolytic stability of peptides. However, two major technical hurdles to some extent limit the development of stapled peptides for therapeutic usage: rational selection of the stapling sites and the corresponding deletion of the native side chains. Previously we described the development of the olefin-terminated amino acids with the retention of native side chains and successfully applied them in the synthesis of hydrocarbon stapled peptides with single side-chain retention. Here, we explored the feasibility and effectiveness of hydrocarbon stapling strategy characterized as double side-chains retention. Modeled after a lengthy human immunodeficiency virus-1(HIV-1) fusion inhibitor SC34 EK, Leu^(i), Ser^(i+4)and Lys^(i), Leu^(i+4)stapled peptides with the retention of double side-chains were effectively obtained. Our complementary study provided a convenient alternative to address where to install the staple in sequence for conventional all-hydrocarbon peptide stapling. Furthermore, this method not only conferred conformational reinforcement for SC34 EK with high α-helicity and protease resistance, but also preserved the structural characteristic(key peripheral residues, charge and solubility) of the linear peptide to the maximum, which are crucial for anti-HIV-1 activity.

Cysteine-Specific Bioconjugation and Stapling of Unprotected Peptides by Chlorooximes

Cyclic peptides have found applications in fields ranging from drug discovery to nanomaterials.Peptide stapling reagents crosslink two or more residues in peptides to generate macrocycles of diverse topology and introduce linker units that might directly impact the properties and biological functions of cyclic peptides.Herein,we demonstrate that chlorooxime derivatives are cysteine-specific peptide bioconjugation and stapling reagents that generate stable thiohydroximate linkages.

Magnetic resonance imaging-based deep learning model to predict multiple firings in double-stapled colorectal anastomosis

BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.

Gastroenteroanastomosis Techniques for Laparoscopic Gastric Bypass: Linear vs Circular Stapler

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE leak, surgical site infection, and stapling malfunction. This study evaluated the efficiency of weight loss and the incidence of short- and mid-term postoperative complications in patients undergoing LRYGB in which anastomosis was performed using a linear stapler (LSA) or a circular stapler (CSA). Methods: Prospective observational study conducted between April 2016 and March 2019. The data were extracted from a hospital database that includes patients undergoing LRYGB in two different GE techniques, assessing postoperative complications and excess body weight loss. Results: Data from 457 patients were analyzed, of which 216 were in the LSA group and 241 were in the CSA group. There were four cases (1.7%) of GE stenosis in the CSA group and only one (0.5%) in the LSA group. Stapler malfunction occurred in both groups: CSA (0.4%) and LSA (0.5%), and a GE leak developed only in the CSA group (0.4%). Surgical site infection was found in five patients in the CSA group (2.1%) and two in the LSA group (0.9%). No statistical difference was found between the two groups in any of the variables analyzed (p > 0.05). Conclusions: Both stapling techniques resulted in a similar loss of excess body weight during the follow-up period. Although the LSA group had fewer total complications, these were not statistically significant, which substantiates the fact that both techniques are safe and feasible, provided they are performed by a surgeon with a long learning curve in laparoscopic bariatric surgery.

一种基于AR的配电柜辅助检修跟踪注册方法

针对装备体型较大、结构较为复杂,当发生遮挡时跟踪注册出现模型漂移、注册效率低的问题,提出一种基于特征互补算法和卡尔曼滤波融合的跟踪注册方法。首先,使用基于空间可靠性的二进制掩码增强模板像素级融合跟踪算法(sum of template and pixel-wise learners,Staple)的颜色特征中的目标信息,从而提高算法在复杂场景中的跟踪精度;其次,当目标跟踪失败时,在重新检测前使用卡尔曼滤波器预测当前帧中目标的位置;接着,提出一种改进的ORB(oriented FAST and rotated BRIEF)算法,该算法采用Hessian矩阵和灰度质心法给出特征点的尺度和方向信息,并在此基础上,采用汉明距离对特征点进行匹配,并采用渐进式采样一致性算法进一步优化匹配结果;最后,对经过优化的特征点求解位姿矩阵,对其叠加虚拟信息以便增强真实世界特征。仿真实验结果表明:改进的Staple跟踪算法相比原始算法在目标跟踪的精确度上提高了5.6%,运算速度达到72.2帧/s。此外,所提算法在配电柜上的跟踪注册结果,进一步证实了该算法在实际场景中的有效性。

Assessing genetic variation in Gossypium barbadense L.germplasm based on fibre characters

Background Gossypium barbadense L.has specific fibre in terms of its length,strength,and fineness,and known as extra-long staple(ELS) cotton,Sea–Island cotton,or Egyptian cotton.Narrow genetic base with less genetic variability is observed in G.barbadense germplasm.Hence,this study was aimed to evaluate the genetic variability present in 108 germplasm accessions of G.barbadense and to identify the superior genotypes based on the fibre traits.Results We evaluated 108 accessions for five fibre quality traits along with three checks in augmented block design.All fibre traits showed significant differences among genotypes,indicating that there is genetic potential for improvement.Fibre strength and micronaire(MIC) showed high phenotypic and genotypic coefficients of variation.High heritability combined with high genetic advance as percentage of mean(GAM) was recorded for fibre length,strength,and micronaire.Fibre strength and fibre length were significantly correlated with each other,while both showed negative correlation with micronaire.Principal component analysis and Biplot analysis showed that uniformity index discriminated all the genotypes in higher level,while fibre length and strength were medium in discrimination power.Biplot revealed genotypes DB 16,EC959191,GSB 39,ARBB 20,5746U,EA 203,and EA 201 were genetically diverse.Hierarchal cluster analysis based on unweighted paired group method using arithmetic average(UPGMA) grouped the genotypes into four clusters,with each cluster consisting of 4,18,48,and 38 genotypes,respectively.Conclusion Among the genotypes,34 for fibre length(> 35 mm),18 for fibre strength(> 40.4 g·tex^(-1)) and 66 for micronaire(3.7-4.2,A grade) were identified as potential accessions based on their superiority.The superior fibre genotypes identified in this study are potential lines for the ELS cotton breeding program.

Primary Characterization of a Novel Soymilk-Cashew Fermented with an Improving of Its Antioxidant and Anti-Inflammatory Contents

Cashew nut (Anacardium occidental) milk was included as a functional ingredient in soybean (Glycine max L.) milk at 20/80% and was fermented comparatively to commercial yogurt starters by two strains TC6 and A4 (recently isolated from two Ivorian highly flavored neglected traditional staple foods (beer and garlic)) identified as Weissella paramesenteroides and Enterococcus faecalis, after the screening of their probiotic, antioxydant and anti-inflammatory potentialities, respectively. The primary characterization of these plant-milks showed a strong improvement in their sensory, antioxidant and anti-inflammatory abilities. While TC6 from traditional beer Tchapalo increases anti-inflammatory activity by almost eighteen times, A4 isolated from garlic increases antioxidant activity by two times. Due to their aromatic and organosensory potentialities certainly, milks L138, L180 and 130 fermented respectively by the combination of TC6 and A4, TC4 alone and A4 alone were the most appreciated than the plant-milk fermented by the two strains of commercial yogurt. These probiotics, anti-oxidant and anti-inflammatory plant-milks should be further characterized in terms of their biological activities and tested in animal models to confirm their nutrition-health claims.

Using shape-memory alloy staples to treat comminuted manubrium sterni fractures: A case report

BACKGROUND Comminuted manubrium sterni fractures are rare,and internal fixation methods are limited.This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures.CASE SUMMARY A 17-year-old female was injured in a car accident for which she underwent debridement and suturing of her head and anterior chest wounds in another hospital.Eight days later,the patient was transferred to our hospital for surgical treatment.The manubrium sterni was found intraoperatively to be split into three irregular fragments with obvious overlap and separation displacement.Meanwhile,a manubriosternal joint dislocation and left first rib cartilage fracture were observed.The retraction force of the shape-memory alloy staples was used to pull the fracture fragments together.Two more titanium locking plates were then used to fix the manubrium sterni and corpus sterni longitudinally,and the left first rib cartilage fracture was repositioned and fixed with a titanium locking plate.A postoperative computed tomography scan showed reduced and rigid fixation of the comminuted manubrium sterni fractures.The patient recovered well with no significant complaints of discomfort.The patient was discharged 10 days postoperatively after the stitches had been removed.CONCLUSION Shape-memory alloy staples had the advantage of being safe and effective during the repositioning and internal fixation of comminuted manubrium sterni fractures.Therefore,they provided a new surgical option for comminuted manubrium sterni fractures.

Potential Probiotic Tiger Nut-Cashew Nut-Milk Production by Fermentation with Two Lactic Bacteria Isolated from Ivorian Staple Foods

Probiotification of plant milk can improve its sensory and health-promoting properties. As traditional fermented foods where lactic acid bacteria (LAB) are present have been associated with beneficial effects on human health, the beneficial effects of two LAB recently isolated from two current Ivorian staple foods (a pepper and a traditional beer) were screened. These two strains LAC 1 (Lactobacillus plantarum) and LAC 2 (Pediococcus acidilactici) which presented probiotic, exopolysaccharides, inflammatory and anti-oxidant activities, were used to ferment a composite plant milk of tiger-nut and cashew (80/20) compared to two starters of a commercial yogourt. The obtained plant milks SCT 2 and SCT 3 with a significant increase in their antioxidant and/or anti-inflammatory activities and lactic bacteria contents were more preferred by consumers than SCT 1 obtained by fermentation of the commercial yogourt starters. The mixing of LAC 1 and LAC 2 was not beneficial. SCT 2 (with an anti-inflammatory activity of 31.38% and an anti-oxidant activity of 17.30%) and SCT 3 (with an anti-oxidant activity of 22.28) could be further tested in animal models to verify their nutrition-health claims.

The Advantages and Disadvantages of Skin Staple Suture Compared with Traditional Suture in Brain Surgery in Primary Hospital:A Randomized Controlled Study

Objective:This paper aims to compare the effect of skin staple suture and traditional silk suture in scalp suture surgery.Methods:A total of 80 craniocerebral surgery patients were included in this study,and the patients were randomly divided into observation group and control group,with 40 cases in each group.The observation group used disposable skin stapler to suture the scalp incision,and the control group used conventional silk suture to suture the incision.Statistical analysis was carried out on 6 indicators including suturing speed,healing under-scab,incision necrosis,incision cerebrospinal fluid(CSF)leakage,incision infection,and postoperative“centipede-shaped”scar incidence rate of the two suture methods.Results:There was no significant difference between the groups in terms of postoperative healing under-scab,incision necrosis,incision CSF leakage,and intracranial infection(P>0.05).The suturing speed in the observation group was 15.2±0.7 cm/min,which was significantly faster than 7.4±0.3 cm/min in the control group(P<0.05).The incidence of“centipede-shaped”scars in the observation group was significantly lower than that in the control group at 1 to 6 months after operation(P<0.05).Conclusion:Compared with traditional silk suture,skin staple suture has obvious advantages in suture speed and cosmetic effect.

红外图像实时在线离线跟踪算法研究

大多数基于目标检测的红外图像目标跟踪算法采取基于时空一致性在线模型更新策略。然而,当所跟踪的目标发生形变、快速运动和受到遮挡时,在线模型更新过程会受到不同程度的干扰而导致目标跟踪失败。基于孪生网络的离线模型跟踪策略则能够在目标发生扰动的情况下保持其外观模型的不变性。然而,在跟踪速度上与在线模型更新策略差距较大。提出了目标跟踪过程中的跟踪错误检测方法将在线和离线目标模型更新方法相结合,该检测方法通过基于联合响应图的离散度测量来联合2类模型更新方法,并能根据当前目标跟踪状态自动在2种模型更新方法中切换,有效地解决了跟踪算法实时性与鲁棒性的平衡问题。所提出算法在VOT-TIR-2015数据库的实验结果显示相比原有算法Staple和Siam FC在跟踪成功率上分别提高3.3%和3.6%,在跟踪精度上分别提高3.8%和5%,同时保证跟踪的实时性。

Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.

Superiority of laparoscopic rectal surgery:Towards a new era

While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.

Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy

AIM: To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve.METHODS: Laparoscopic sleeve gastrectomy is a com-mon bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbid-ities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test. RESULTS: We observed progressive weight regain after sleeve in 11 of the 201 patients(5.4%) who had a mean follow-up of 21.1 ± 9.7 mo(range 6-57 mo). Three patients started to regain weight after 6 mo fol-lowing Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant(P < 0.05) mean body mass index reduction(-6.6 ± 2.7 kg/m2) and mean % ex-cess weight loss(%EWL) increase(+31.0% ± 15.8%). An important reduction of antihypertensive drugs and hypoglycemic agents was observed after re-sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients.CONCLUSION: Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve.