The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.
One of the factors that contribute to the development of gastric cancer is the host immune response. Extensive immunophenotype of gastric cancer can be identified by using antibody microarray technique that profiles more than 100 cluster of differentiation (CD) antigens in parallel. In this study, we used DotScanTM antibody microarray to profile CD antigen expression in patients with distinct digestive diseases for surface antigen disease-signatures. Patients’ blood samples with gastric disorders and healthy controls were taken and processed for leukocytes isolation using Histopaque density gradient centrifugation. Leukocytes were captured onto DotScanTM slides and cell binding densities were analyzed using DotReaderTM. Different groups of gastric diseases were found to be characterized by differentially expressed distinct CD antigens. Compared to normal healthy controls, 17, two and four highly expressed CD antigens were identified in gastritis, gastric ulcer and gastric cancer patients, respectively. The 17 CD antigens that show differential expression in gastritis were CD15, CD16, CD20, CD23, CD24, CD25, CD28, CD34, CD37, CD77, CD102, CD103, CD122, CD128, CD10, CD183, and CD184. High expression of CD64 and CD69 were found in gastric ulcer, whereas CD52, CD126, CD135, and CD121a were highly expressed in gastric cancer. CD antigens involve in T-cell functions had reduced expression in gastric cancer, while proinflammatory cytokines shows increased expression. These results demonstrate specific immunophenotype of CD antigens in patients with various gastric diseases and identification of differential expressed surface antigens may have clinical significance for diagnostic and therapeutic purposes.
Abstract Background Malaysia is a unique Asian country with multiracial, multicultural and multi-religion society. It is divided into six regions geographically and each region has different population distribution and socioeconomic status. Urbanization occurs more rapidly in the central region with higher population density and household income. We would like to compare the epidemiology of esophageal cancer between Northern and Central Malaysia. Methods A review of esophageal cancer from two regional tertiary referral centers in Northern and Central Malaysia in 2014–2017. Results A total of 143 esophageal cancers were detected during the study period, 60 cases from northern region and 83 cases from central region. In both regions, the mean age of diagnosis was similar (63.3 vs 62.0). More male patients were noted in Central Malaysia (71% vs 62%). Esophageal cancer was commonest in the Chinese ethnicity in both regions. Cardioesophageal junction was the commonest location of cancer and majority of patients presented with dysphagia in both regions. For tumour histology, squamous cell carcinoma (SCC) was the commonest (49.4%) in the Central as compared to adenocarcinoma in the North (47.5%). The incidence of SCC was highest among the Indian population in both regions while adenocarcinoma was the commonest tumour in other ethnicity. Most of the patients in both regions presented with advanced disease and the incidence of stage 4 disease was higher in the North (65% vs 48%). Hence, there were more patients who underwent curative intend surgery in the central region (58% vs 28.5%). Conclusion The epidemiology of esophageal cancer is similar in both regions in Malaysia. Esophageal cancer is commonest among the Chinese. Further studies are needed to explore the tumour biology, host genetic factors and sociocultural practice for better understanding of esophageal cancer among the multiracial population in Malaysia. Disclosure All authors have declared no conflicts of interest.
Introduction: Ki-67 antigen was originally defined by the prototype monoclonal antibody Ki-67 detected by immunizing mice with nuclei of the Hodgkin lymphoma cell line L-428. 2 The name derived from Kiel (city of origin) and the number of the original clone in the 96-well plate.Ki-67 has been thoroughly investigated in cases of both benign and malignant thyroid nodules.However, few previous studies have focused on a potential link between prognostic factors of papillary thyroid carcinoma (PTC) and the Ki-67 proliferative index.The objective of this study was to determine the prognostic significance of Ki-67 levels and PTC.We compared Ki-67 levels against the metastasis, age, completeness of resection, invasion, and size (MACIS) tumor scoring system.By correlating Ki-67 with poor prognostic features of thyroid carcinoma, we aimed to predict tumor recurrence in PTC.Materials and methods: A total of 46 PTC patients who had underwent surgery from 2006 to 2012 were involved in this study.All of the surgical specimens were analyzed for Ki-67 through immunohistochemistry (IHC), and two independent pathologists evaluated the Ki-67 staining results.We compared Ki-67 levels with various prognostic factors for PTC.Results: There was no significant relationship between the Ki-67 index and age, tumor size, cervical lymph nodes involvement, or complete tumor removal during initial surgery (p value > 0.05).However, there were significant links between Ki-67 levels and extrathyroidal extension (p value = 0.006), vascular invasion (p value = 0.006), and distant metastasis (p value = 0.005).Ki-67 was significantly reduced among the lowrisk group for recurrent PTC (p value = 0.007).Tumor recurrence at 3 years was significantly correlated with high Ki-67 levels (p value = 0.01).
Long urethral strictures are often treated with autologous genital skin and buccal mucosa grafts; however, risk of hair ingrowth and donor site morbidity, restrict their application. To overcome this, we introduced a tissue-engineered human urethra comprising adipose-derived stem cell (ASC)-based self-assembled scaffold, human urothelial cells (UCs) and smooth muscle cells (SMCs). ASCs were cultured with ascorbic acid to stimulate extracellular matrix (ECM) production. The scaffold (ECM) was stained with collagen type-I antibody and the thickness was measured under a confocal microscope. Results showed that the thickest scaffold (28.06 ± 0.59 μm) was achieved with 3 × 104 cells/cm2 seeding density, 100 μg/mL ascorbic acid concentration under hypoxic and dynamic culture condition. The biocompatibility assessment showed that UCs and SMCs seeded on the scaffold could proliferate and maintain the expression of their markers (CK7, CK20, UPIa, and UPII) and (α-SMA, MHC and Smootheline), respectively, after 14 days of in vitro culture. ECM gene expression analysis showed that the ASC and dermal fibroblast-based scaffolds (control) were comparable. The ASC-based scaffold can be handled and removed from the plate. This suggests that multiple layers of scaffold can be stacked to form the urothelium (seeded with UCs), submucosal layer (ASCs only), and smooth muscle layer (seeded with SMCs) and has the potential to be developed into a fully functional human urethra for urethral reconstructive surgeries.
Abstract Background Esophageal cancer is one of the deadliest cancer in Malaysia. However, neither the incidence nor prevalence has been recorded nationally. We report our experience in dealing with esophageal cancer in Penang Hospital (PH) and Universiti Kebangsaan Malaysia Medical Center (UKMMC), two tertiary hospitals in Northern and Central region of Malaysia, respectively. Methods A review of 143 esophageal cancer that were diagnosed in PH and UKMMC in year 2014–2017. Results Among the 143 esophageal cancers, 60 cases were from HPP and 83 from UKMMC. The mean age at diagnosis was 62.5 ± 14.2. 67.4% were male patients. Esophageal cancer was commonest in Chinese ethnicity (41%), followed by Malay (29.9%), Indian (17.4%) and others (11.8%). Dysphagia was the commonest presenting symptom (84.6%) and the mean duration of symptoms were 14 weeks. Majority of the cancers were located at the cardioesophageal junction (38.6%), followed by lower third of esophagus (32.1%), mid esophagus (23%), upper third of esophagus (11.5%) and cervical esophagus (5.7%). More than 90% of patients presented with advanced disease, 35% and 55% of patients with stage 3 and stage 4 disease, respectively. Squamous cell carcinoma (45.8%) was the commonest histology type, slightly more than adenocarcinoma (45.1%). The rest were neuroendocrine tumour, gastrointestinal tumour and lymphoma. To date, surgery with curative intend were done in 44.1% of patients while the rest were managed with palliative treatment. Conclusion It is striking that majority of patients presented with late disease. Disease awareness campaign, early detection and multimodality treatment are crucial to improve outcomes of patients. Disclosure All authors have declared no conflicts of interest.
Kanser gaster merupakan salah satu kanser utama yang paling banyak menyebabkan kematian di seluruh dunia. Diagnosis dan prognosis kanser gaster adalah sukar untuk dibuat dan kebanyakan pesakit didiagnos dengan kanser ini pada peringkat yang teruk. Prognosis kanser gaster adalah berlainan berdasarkan kepada subjenis kanser gaster dan jangkitan Helicobacter pylori. Antigen kluster pembezaan (CD) boleh digunakan sebagai biopenanda untuk diagnosis dan prognosis penyakit kronik kerana pengekspresannya yang berubah mengikut tahap penyakit. Objektif kajian ini adalahuntuk membuat perbandingan pengekspresan antigen CD dalam sel darah periferi dan sel adenokarsinoma pesakit kanser gaster dan menentukan peranan CD55 dalam rembesan interleukin-8 (IL-8) oleh sel selanjar. Sampel darah periferi dan tumor telah diambil daripada pesakit kanser gaster. Sampel kemudian diproses untuk mendapatkan ampaian sel tunggal. Imunofenotip antigen CD telah dijalankan menggunakan slaid mikroatur DotScanTM. Penyenyapan CD55 telah dibuat menggunakan RNA pengganggu kecil (siRNA). Sembilan belas antigen CD, kebanyakan daripadanya adalah penanda untuk sel B, diekspres secara lebih tinggi dalam tumor subjenis kardia berbanding subjenis bukan kardia. CD182 dan CD125 merupakan reseptor interleukin yang penting, diekspres lebih tinggi dalam subjenis bukan kardia daripada subjenis kardia. Pengekspresan 32 antigen CD yang lebih tinggi dapat diperhatikan dalam tumor subjenis difus berbanding subjenis usus. CD29 dan CD73 diekspres dengan tinggi dalam sarkoma gastrointestinal. Perbandingan pengekspresan antigen CD menunjukkan CD11a dan CD49d diekspres sama tinggi dalam darah dan tumor. Penyenyapan CD55 mengawal pengeluaran IL-8 dalam sel yang dijangkiti oleh H. pylori secara bergantung kepada kehadiran gen berkaitan sitotoksin (cagA). Kajian ini menunjukkan perbezaan pengekspresan antigen CD dalam pelbagai subjenis kanser gaster dan berpotensi dijadikan biopenanda untuk diagnosis kanser gaster secara tidak invasif.
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