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IntroductionCytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei (PMP) from perforated low-grade appendiceal mucinous neoplasms (LAMN II). In a selected group of LAMN II patients without established PMP, CRS/HIPEC can be performed laparoscopically (L-CRS/HIPEC); however the short-term benefits and safety of this approach have yet to be determined. This study aims to determine the short-term outcomes from a series of L-CRS/HIPEC LAMN II patients compared to those who have undergone a similar open operation (O-CRS/HIPEC) for low-volume PMP.MethodsLAMN II patients undergoing L-CRS/HIPEC at a UK national peritoneal tumour centre were compared to O-CRS/HIPEC patients (peritoneal cancer index ≤ 7). Outcomes of interest included Clavien–Dindo complication grade, operative time, blood transfusions, high dependency unit (HDU) admission, length of hospital stay, and histopathological findings.Results55 L-CRS/HIPEC were compared to 29 O-CRS/HIPEC patients (2003–2017). Groups were matched for age, sex, and procedures. Median operative time was 8.8 (IQR 8.1–9.5) h for L-CRS/HIPEC versus 7.3 (IQR 6.7–8) h for O-CRS/HIPEC (Mann–Whitney test p < 0.001). Post-operative HDU admission was 56% versus 97% (OR 0.04 95% CI 0.01–0.34) and median length of stay = 6 (IQR 5–8) versus 10 (IQR 8–11) days (p < 0.001) for L- versus O-CRS/HIPEC. Despite a normal pre-operative CT scan, 13/55 (23.6%) L-CRS/HIPEC patients had acellular mucin and 2/55 (3.5%) had mucin with epithelium present in their specimens. Residual appendix tumour was identified in 2/55 patients (3.6%). Clavien–Dindo Grade 1–4 complications were similar in both groups with no mortality.ConclusionL-CRS/HIPEC for LAMN II takes longer; however patients have significantly reduced length of HDU and overall stay, without increased post-operative complications. A significant proportion of LAMN II patients undergoing L-CRS/HIPEC have extra-appendiceal acellular mucin with some cases demonstrating residual cellular epithelium from the LAMN II. The risk of these patients developing PMP without surgery is under current review.

Need to search for edible plants with antimicrobial and nutraceutical properties is increasing due to reduced efficacy, high cost and increased resistance of conventional medicine and for food quality and safety applications. This study analysed proximate, amino acids, minerals, secondary metabolites, and phytochemical composition of Moringa oleifera from two geographical locations in India and there was wide variation between two regions. Proximate composition revealed high protein, fibre and less fat content of leaves. Glutamate, arginine and isoleucine were the major amino acids. Calcium and potassium was found to be high in leaves and copper was high in seeds. Leaves and seeds had high vitamin E and C. Gas Chromatography-Mass Spectrometry (GC-MS) analysis revealed 185 compounds from seeds and 50 compounds from leaves. 1,30-triacontanediol, octacosane, Z-14-nonacosane were found to be major compounds of leaves from Madurai and nonacosane, .gamma.-sitosterol were found to be major compounds of leaves from Chennai. 6-octadecenoic acid, n-hexadecanoic acid, oleic acid were found to be major compounds of seeds from Madurai and 13-docosenamide, (Z)-, propionamide, ethyl oleate were found to be major compounds of seeds from Chennai. Leaves had high total polyphenols and antioxidant activity. High antimicrobial activity against dysentery causing entero-pathogens was found in leaves and seeds from Madurai.

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are an established treatment for pseudomyxoma peritonei (PMP), but it is a major surgical procedure and may be associated with long-term morbidity. To date, health-related quality-of-life (HRQL) data among survivors are lacking.MethodsA two-period qualitative study investigated patients undergoing CRS-HIPEC for PMP at a national peritoneal tumor center between 2003 and 2011. First, the European Organization for Research and Treatment (EORTC)-QLQ C30 HRQL questionnaire was used longitudinally preoperatively and at postoperative months 3, 6, 9, 12, 18, and 24, then yearly thereafter. Second, it was updated in 2016 as a cross-sectional study. Both studies were compared with age- and sex-matched reference populations (one-way t tests).ResultsA total of 553 longitudinal HRQL questionnaires were completed for 137 patients, truncated at 60 months. In the 2016 update, 85 responses were received from 103 survivors (mean follow-up period, 8.11 years). Patients’ physical, role, and social function scores were impaired until 12 months postoperatively, after which the scores did not differ significantly from those of with reference populations. Similarly, fatigue, appetite loss, insomnia, and financial difficulties worsened significantly compared with reference populations in the first 12-months and then normalized. In contrast, impaired cognitive function (82.3 vs 88.5; P = 0.017), constipation (13.7 vs 7.3; P = 0.032), and diarrheal symptoms (15.1 vs 4.9; P = 0.0006) persisted through both periods. Global health scores did not differ significantly from those of the reference population.ConclusionsBeyond 12 months postoperatively, CRS-HIPEC for PMP is associated with a good quality of life except for some cognitive functional impairment and bowel disturbances.

Introduction Many patients in Greater Manchester underwent emergency/urgent surgery, but limited data are available about managing these patients and their outcomes. We aimed to study the clinico-demographic profile, management trends, and outcomes of the patients presenting to the ED in the real world. Methods All patients with lower GI cancer (known or newly diagnosed on the present visit) in the ED requiring admission under surgeons for treatment were identified prospectively over six months and were included in the study. Results Nineteen patients were admitted (13 (69%) colon, 5 (26%) rectum, 1 (5%) anal cancer), with a median age of 67 years, and 10 (52.6%) were female. Ten (53%) patients were on the two-week wait pathway, and 14 (73.6%) patients presented with obstruction symptoms. Only 3 (15.7%) patients had received neoadjuvant therapy. Most had moderately differentiated adenocarcinoma. All had CT of the abdomen on admission, with 9 (52.6%) having CT of the thorax. All had locally advanced or metastatic cancers. Twelve (63%) patients underwent surgery (6 (50%) definitive, 6 (50%) diversion stoma). Nine (75%) patients had early postoperative complications, and 6 (50%) required ICU admission. The median postoperative stay was 9.5 days, with a 30-day mortality rate of 25%. Conclusion This study provides a snapshot of the management and outcomes of patients presenting in emergencies. A further study at the regional/national level is needed to investigate the increasing emergency presentations of colorectal cancer (CRC) despite an established screening program.

The use of natural coagulant protein in drinking water treatment has been discussed for a long time, though the method is still not in practice, probably due to limited knowledge and availability of material. In the present work, different Mustard varieties were tested for the presence of coagulant protein compared with Moringa seed extract and their potential application in water treatment. The coagulation activity of the protein extract was measured using synthetic clay solution as well as water from pond. The protein content was determined by Bradford method, molecular mass determined by Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and peptide sequence was analyzed by Mass spectrometry. Extract of Mustard (large) and Moringa seed showed coagulation activity of ≅70 and ≅85 % after 90 min, respectively. Interestingly, seed extracts from other Mustard varieties had coagulation activity after heat activation at 95 °C for 5 h. However, the coagulation activity of Mustard seed extract against turbid pond water was higher (≅60 %) compared to Moringa seed extract (≅50 %). The peptide sequence analysis of 6.5 and 9 kDa proteins was found to be homologous to Moringa coagulant protein and napin3, respectively. To our knowledge, this could be the first report on Mustard seed having coagulant protein. The coagulation activity of Mustard (large) against highly turbid pond water suggested that it could be a potential natural coagulant for water treatment.

Among several traditional foods of India, idli is one of the most popular and commonly consumed steamed products. A new method of adding Murraya koenigii (curry leaves) to idli batter as a vehicle for fortification and extension of shelf-life has been developed. Dried curry leaves powder was incorporated with other ingredients like rice and dehusked black gram in different proportions to optimize the most palatable formulation. Rate of fermentation and microbial changes in the batter; nutritional qualities, texture and sensory properties of the prepared product were assessed. Incorporation of curry leaves powder (5 %) in idli batter increased the shelf-life and also increased the flavour, texture and appearance of the idli . The calcium content of the prepared idli was 10 times more than that of the control idli , while dietary fiber content increased by 18.6 %. Anti-microbial activity of the curry leaves in idli batter extended the shelf-life from 2 to 5 days when stored at 30 °C.

There are several public cloud service providers (CSPs) across the globe supplying a variety of application, platform, middleware, database, and infrastructure services. The brewing challenge before any cloud user is how to be sure about the trustworthiness of a service being offered by various CSPs. With the overwhelming usage of cloud services by individuals and organizations, this problem has acquired a lot of attention these days. Precisely arriving and articulating that this particular service from a specific cloud CSP is trustworthy is becoming complicated because of many moving variables in this whole phenomenon. There are varying parameters and indicators for decisively proving that a particular service is trustworthy or not. In order to meet up this crucial challenge and concern being widely expressed by cloud customers, researchers and cloud professionals across the world have unearthed a few viable mechanisms. There are fresh algorithms, techniques, and tools to enable cloud users towards easily and quickly selecting trustworthy services. This paper digs deeper and dwells at length about the intrinsic challenges being associated with the provenance of the trustworthiness factor. The paper also presents a machine learning approach to compute the trust factor of CSPs and it is found that the methodology gains advantage when compared to similar works.

Hepatocellular carcinoma (HCC) is the commonest primary malignant neoplasm of the liver in most countries with a notoriously poor prognosis. Variation in global incidence is well-recognized and the occurrence of HCC is linked to several established environmental, dietary, and lifestyle factors. HCC demonstrates morphological heterogeneity both within the same tumor and from patient to patient. Differing architectural patterns and cytological variants may be seen. Inclusion bodies are believed to represent organized structures of proteins which contribute to their pathogenesis and share several constituents like chaperones, p62, ubiquitin, and Valosin containing protein. The various hepatocyte cytoplasmic inclusions described in HCC include Mallory-Denk bodies (MDBs), hyaline bodies (HBs), glycogen, fat, fibrinogen, alpha 1 antitrypsin (AAT), and ground glass. MDBs are the most common inclusions seen in hepatocellular carcinomas. The two cases shared intracytoplasmic inclusions which are characterized by larger sizes and present in every section examined. These exhibited features of MDBs and HBs present in most tumor cells, further supporting close relationship.