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Background Corydalis DC., the largest genus in the family Papaveraceae, comprises > 465 species. Complete plastid genomes (plastomes) of  Corydalis  show evolutionary changes, including syntenic arrangements, gene losses and duplications, and IR boundary shifts. However, little is known about the evolution of the mitochondrial genome (mitogenome) in Corydalis . Both the organelle genomes and transcriptomes are needed to better understand the relationships between the patterns of evolution in mitochondrial and plastid genomes. Results We obtained complete plastid and mitochondrial genomes from  Corydalis pauciovulata  using a hybrid assembly of Illumina and Oxford Nanopore Technologies reads to assess the evolutionary parallels between the organelle genomes. The mitogenome and plastome of  C. pauciovulata  had sizes of 675,483 bp and 185,814 bp, respectively. Three ancestral gene clusters were missing from the mitogenome, and expanded IR (46,060 bp) and miniaturized SSC (202 bp) regions were identified in the plastome. The mitogenome and plastome of  C. pauciovulata  contained 41 and 67 protein-coding genes, respectively; the loss of genes was a plastid-specific event. We also generated a draft genome and transcriptome for C. pauciovulata . A combination of genomic and transcriptomic data supported the functional replacement of acetyl-CoA carboxylase subunit β ( accD ) by intracellular transfer to the nucleus in  C. pauciovulata . In contrast, our analyses suggested a concurrent loss of the NADH-plastoquinone oxidoreductase ( ndh ) complex in both the nuclear and plastid genomes. Finally, we performed genomic and transcriptomic analyses to characterize DNA replication, recombination, and repair (DNA-RRR) genes in  C. pauciovulata as well as the transcriptomes of  Liriodendron tulipifera and Nelumbo nuicifera . We obtained 25 DNA-RRR genes and identified their structure in C. pauciovulata . Pairwise comparisons of nonsynonymous ( d N ) and synonymous ( d S ) substitution rates revealed that several DNA-RRR genes in C. pauciovulata have higher d N and d S values than those in N . nuicifera. Conclusions The C. pauciovulata genomic data generated here provide a valuable resource for understanding the evolution of Corydalis organelle genomes. The first mitogenome of Papaveraceae provides an example that can be explored by other researchers sequencing the mitogenomes of related plants. Our results also provide fundamental information about DNA-RRR genes in Corydalis and their related rate variation, which elucidates the relationships between DNA-RRR genes and organelle genome stability.

A single-institution prospective study was conducted to evaluate hearing loss rate after intensity modulated radiotherapy with concomitant cisplatin-based chemotherapy (CRT) for locally advanced head and neck cancer and identify cochlear dosimetric parameters associated with hearing loss risk. Hearing assessment, patients' characteristics, tumor-related variables, and cochlear quantitative dosimetric factors for adults with locally advanced head and neck cancer treated with CRT were prospectively collected. Each patient repeated audiometry at baseline (pre-CRT), 1 month after CRT, and then every 3 to 6 months. For each cochlea minimum dose (D ), mean dose (D ), and maximum dose (D ) were extracted from treatment plans. Logistic analysis was used for multivariate modeling. The relation between cochlear dosimetric factors and significant hearing loss was also analyzed with receiver operating characteristic (ROC) curves. Between January 2016 and December 2018, 35 patients (70 cochleae) were included. Most patients (n=29; 82.9%) had primary cancer in a low-risk region (oral cavity, oropharynx, larynx). All patients completed the programmed CRT. During follow-up, significant hearing loss was recorded in 13 cases (37.1%). The ROC areas for significant hearing loss in relation to D , D , and D were 0.70, 0.66, and 0.66, respectively. A dose-dependent relationship was noted between cochlear D and significant hearing loss. D <14.4 Gy is associated with reduced rates of significant hearing loss after concomitant cisplatin-based CRT in patients with locally advanced head and neck cancer.

Imagine a surgeon's critical decision: Should the gallbladder be removed now, along with the planned bariatric surgery, or risk the complication and necessity of a second surgery later? This clinical dilemma is central to treating morbidly obese patients, who face a high prevalence of gallstone disease exacerbated by rapid postoperative weight loss. The best approach to managing existing gallstones in bariatric candidates remains debated, with debate focusing on whether combining laparoscopic cholecystectomy (LC) with bariatric surgery is both safe and advantageous. In this pilot study, we provide randomized evidence to guide this decision. In this prospective randomized controlled pilot study, 58 morbidly obese patients with ultrasound-confirmed gallstones were randomly assigned to two groups: Group I (  = 30) received bariatric surgery and LC; Group II (  = 28) had bariatric surgery only, with LC delayed for symptoms. The primary outcomes were clearly defined as operative time, intraoperative complications, and postoperative morbidity, providing a focused measure of safety and efficacy. Secondary outcomes included hospital stay, pain, and follow-up gallstone symptoms. Baseline demographics and comorbidities were similar across groups. Operative time was longer in Group I (98.93 ± 11.58 min) than in Group II (75.18 ± 11.26 min, < 0.001). An extra port was used in 20% of Group I patients, compared with none in Group II ( = 0.012). No significant differences were observed in bleeding, bile leakage, postoperative complications, or hospital stay. Group I reported higher pain scores ( < 0.001). During follow-up, 79.3% of Group II developed symptomatic gallstones, requiring later cholecystectomy. Concomitant LC during bariatric surgery in morbidly obese patients with pre-existing gallstones is demonstrated to be safe and feasible, with acceptable increases in operative time and postoperative pain. The high rate (79.3%) of symptomatic gallstone development in patients who did not undergo concomitant cholecystectomy supports adopting routine concomitant LC to prevent future morbidity, thereby influencing clinical decision-making and standard practice. ClinicalTrials.gov: NCT04567890.

BackgroundObesity is a predisponing factor for gallstone formation with a prevalence > 10% in patients undergoing gastric bypass procedure. Although there is a strong recommendation for concomitant cholecystectomy in patients with symptomatic gallstones, the evidence level for patients with asymptomatic gallstones is weak. According to recent literature, up to 21% of asymptomatic gallstones become symptomatic after bariatric surgery. Secondary prophylaxis with ursodeoxycholic acid (UDCA), which is altering the composition and excretion of the bile acid pool, was the objective of this study.MethodsRetrospective analysis of the patient records of all patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SGx) at our center between January 2007 and October 2017.ResultsWe enrolled a total of 704 patients with routine preoperative ultrasound. In 61 patients, asymptomatic gallstones were detected and these patients were treated with UDCA for 6 months after bariatric surgery. One patient developed a single episode of symptoms 3 months after SGx, which did not require surgery. One patient developed chronic cholecystitis and underwent cholecystectomy 6 months after SGx. All other patients (n = 59; 96.8%) remained asymptomatic under UDCA therapy.ConclusionUDCA for 6 months after bariatric surgery seems to reduce the incidence of gallstone-associated morbidity when compared to the current literature. Thus, our results call the concept of prophylactic concomitant cholecystectomy in patients with asymptomatic gallstones into question while at the same time paving the way for a future clinical trial.

Background Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution. Methods Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes. Results A total of 159 patients underwent concomitant VHR during the study period at the time of BS. One hundred and one (64 %) patients were female; median age was 53 years (IQR 45.0–60.3) and median BMI was 48.2 kg/m 2 (IQR 41.6–54.1). Comorbidities included: hypertension ( n  = 124, 78 %), type 2 diabetes ( n  = 103, 65 %), hyperlipidemia ( n  = 100, 63 %), obstructive sleep apnea ( n  = 98, 62 %) and reflux disease ( n  = 54, 34 %). Out of 159 patients, 41 patients (26 %) had a prior VHR. Out of 103 patients, 69 patients (67 %) had a previous abdominal surgery. Of the concomitant VHR, 144 (91 %) were completed laparoscopically, 12 (7 %) patients were converted to open surgery and 3 (2 %) patients underwent primary open procedures. Technique included primary suture closure in 115 (72 %) and mesh repair in 44. Early postoperative complications (<30 days) were reported in 16 (10 %) patients, with superficial wound infection ( n  = 9), bowel obstruction ( n  = 2), marginal ulcer ( n  = 2), DVT ( n  = 1) and pneumonia ( n  = 1). Hernia recurrence was reported in 3 patients (2 %) in the early post-op period and in 40 patients (25 %) as a late (>30 days) complication. Surgery for recurrent hernia was performed in 31/42 patients during follow-up. At 12-month follow-up, median BMI and % excess weight loss were 34.2 kg/m 2 (IQR 29.5–40.9) and 59.6 % (IQR 44.9–74.8 %), respectively. Conclusion Ventral hernia is a common finding in patients undergoing BS. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and perioperative complications.

Maintaining mitochondrial proteome integrity is especially important under stress conditions to ensure a continued ATP supply for protection and adaptation responses in plants. Deg/HtrA proteases are important factors in the cellular protein quality control system, but little is known about their function in mitochondria. Here we analyzed the expression pattern and physiological function of Arabidopsis thaliana DEG10, which has homologs in all photosynthetic eukaryotes. Both expression of DEG10:GFP fusion proteins and immunoblotting after cell fractionation showed an unambiguous subcellular localization exclusively in mitochondria. DEG10 promoter:GUS fusion constructs showed that DEG10 is expressed in trichomes but also in the vascular tissue of roots and aboveground organs. DEG10 loss-of-function mutants were impaired in root elongation, especially at elevated temperature. Quantitative proteome analysis revealed concomitant changes in the abundance of mitochondrial respiratory chain components and assembly factors, which partially appeared to depend on altered mitochondrial retrograde signaling. Under field conditions, lack of DEG10 caused a decrease in seed production. Taken together, our findings demonstrate that DEG10 affects mitochondrial proteostasis, is required for optimal root development and seed set under challenging environmental conditions, and thus contributes to stress tolerance of plants.

Candidates of metabolic and bariatric surgery (MBS) are prone for gallstone formation. Concomitant cholecystectomy (CC) during MBS is controversial. This study is first to examine the safety of CC during one anastomosis gastric bypass (OAGB), compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Single-center retrospective comparative study of CC (2012–2021) during OAGB, to SG and RYGB. CC was performed in 115 patients during OAGB ( n  = 50), SG ( n  = 39), and RYGB ( n  = 26). All procedures were completed laparoscopically. Baseline characteristics were similar except age, body mass index, gastroesophageal reflux disease, obstructive sleep apnea, and previous MBS ( p  < 0.05). Intraoperative complications occurred in one OAGB patient (2% vs. 0%, 0%; p  = 0.52), which was not cholecystectomy related. There were no differences in total (6% vs. 2.6%, 15.4%; p  = 0.13) and major (2% vs. 0%, 3.8; p  = 0.50) early-complication rates. Of them, cholecystectomy-related complications occurred in one OAGB, compared with none of SG and one RYGB (2% vs. 0%, 3.8%; p  = 0.50). The former was major, and the latter was minor complication. None of the OAGB patients needed re-admission (0% vs. 0%, 11.5; p  = 0.04). All CC outcome parameters were similar between asymptomatic and symptomatic gallstones. Previous bariatric procedures were found to be a significant risk for major complications and readmissions (OR = 16.87, p  = 0.019). CC during OAGB for gallstones seems safe, as in SG and RYGB. No cholecystectomy-related intraoperative complications occurred, and postoperative complication rates were low and acceptable. Outcomes for asymptomatic gallstones were similar to symptomatic ones, and we cautiously support CC in the presence of gallstones.

Background: Androgenetic alopecia (AGA) is the most common form of hair loss in men and in women. Currently, minoxidil and finasteride are the treatments with the highest levels of medical evidence, but patients who exhibit intolerance or poor response to these treatments are in need of additional treatment modalities. Objective: The aim was to evaluate the efficacy and safety of low-level laser therapy (LLLT) for AGA, either as monotherapy or as concomitant therapy with minoxidil or finasteride, in an office-based setting. Materials and Methods: Retrospective observational study of male and female patients with AGA, treated with the 655 nm-HairMax Laser Comb ® , in an office-based setting. Efficacy was assessed with global photographic imaging. Results: Of 32 patients (21 female, 11 male), 8 showed significant, 20 moderate, and 4 no improvement. Improvement was seen both with monotherapy and with concomitant therapy. Improvement was observed as early as 3 months and was sustained up to a maximum observation time of 24 months. No adverse reactions were reported. Conclusions: LLLT represents a potentially effective treatment for both male and female AGA, either as monotherapy or concomitant therapy. Combination treatments with minoxidil, finasteride, and LLLT may act synergistic to enhance hair growth.

Background Laparoscopic adjustable gastric banding (LAGB) has a significant incidence of long-term failure, which may require an alternative revisional bariatric procedure to remediate. Unfortunately, there is few data pinpointing which specific revisional procedure most effectively addresses failed gastric banding. Recently, it has been observed that laparoscopic sleeve gastrectomy (LSG) is a promising primary bariatric procedure; however, its use as a revisional procedure has been limited. This study aims to evaluate the safety and efficacy of LSG performed concomitantly with removal of a poor-outcome LAGB. Methods A retrospective review was performed on patients who underwent LAGB removal with concomitant LSG at King Saud University in Saudi Arabia between September 2007 and April 2012. Patient body mass index (BMI), percentage of excess weight loss (%EWL), duration of operation, length of hospital stay, complications after LSG, and indications for revisional surgery were all reviewed and compared to those of patients who underwent LSG as a primary procedure. Results Fifty-six patients (70 % female) underwent conversion of LAGB to LSG concomitantly, and 128 (66 % female) patients underwent primary LSG surgery. The revisional and primary LSG patients had similar preoperative ages (mean age 33.5 ± 10.7 vs. 33.6 ± 9.0 years, respectively; p  = 0.43). However, revisional patients had a significantly lower BMI at the time of surgery (44.4 ± 7.0 kg/m 2 vs. 47.9 ± 8.2; p  < 0.01). Absolute BMI postoperative reduction at 24 months was 14.33 points in the revision group and 18.98 points in the primary LSG group; similar %EWL was achieved by both groups at 24 months postoperatively (80.1 vs. 84.6 %). Complications appeared in two (5.5 %) revisional patients and in nine (7.0 %) primary LSG patients. No mortalities occurred in either group. Conclusions Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone.

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.