Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients

Objective

Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients.

Materials and Methods

A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption.

Results

Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures.

Conclusion

TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

Atractylodes macrocephala Koidz's rhizomes contain anti-inflammatory sesquiterpenes

Two new compounds, named eudesm-4(15),7-diene-3α,9β,11-triol (1) and eudesm-4(15),7-diene-1β,3α,9β,11-tetraol (2) together with three known sesquiterpene lactones (1S,5R,7R,10R)-secoatractylolactone (3), (1S,5R,7R,10R)-secoatractylolactone-11-O-β-D-glucopyranoside (4) atractylenolide III (5) were isolated from the rhizomes of Atractylodes macrocephala. Their structures were elucidated by using 1D and 2D-NMR spectra and HRESIMS data. Compound 5 exhibited the most active anti-inflammatory activity with IC₅₀ values of 27.5 μM in inhibiting of nitric oxide production. Compounds 1, 2, and 3 showed moderate effects while compound 4 was inactive.

Alpha-Glucosidase Inhibitory Activity of Saponins Isolated from Vernonia gratiosa Hance

Species belonging to the Vernonia (Asteraceae), the largest genus in the tribe Vernonieae (consisting of about 1,000 species), are widely used in food and medicine. These plants are rich sources of bioactive sesquiterpene lactones and steroid saponins, likely including many as yet undiscovered chemical components. A phytochemical investigation resulted in the separation of three new stigmastane-type steroidal saponins (1 - 3), designated as vernogratiosides A-C, from whole plants of V. gratiosa. Their structures were elucidated based on infrared spectroscopy  (IR), one-dimensional (1D) and two-dimensional nuclear magnetic resonance (2D NMR), high-resolution electrospray ionization mass spectrometry (HR-ESI-MS), and electronic circular dichroism analyses (ECD), as well as chemical reactivity. Molecular docking analysis of representative saponins with αglucosidase inhibitory activity was performed. Additionally, the intended substances were tested for their ability to inhibit α-glucosidase activity in a laboratory setting. The results suggested that stigmastane-type steroidal saponins from V. gratiosa are promising candidate antidiabetic agents.

Feruloylmonotropeins: promising natural antioxidants in Paederia scandens

Paederia scandens (Lour.) is a widely used medicinal herb in Vietnam, China, India, and Japan for the treatment of a variety of conditions, including toothache, chest pains, piles, and spleen inflammation. There is broad interest in identifying the composition of its extracts and confirming their numerous biological activities, including anti-nociceptive, antiviral, and anticancer properties. Two iridoid glucosides obtained from the MeOH extract of P. scandens, 6'-O-E-feruloylmonotropein (6-FMT) and 10'-O-E-feruloylmonotropein (10-FMT), are potential antioxidants based on their structure. In this study, the hydroperoxyl scavenging activity of 6-FMT and 10-FMT was examined in silico by using density functional theory. These FMTs are predicted to be weak antioxidants in non-polar environments, whereas a good HOO˙ scavenging activity is expected in polar environments (pH = 7.4) with k _overall = 3.66 × 10⁷ M^-1 s^-1 and 9.45 × 10⁶ M^-1 s^-1, respectively. This activity is better than many common antioxidants such as trolox and nearly equivalent to ascorbic acid and resveratrol. The hydroperoxyl scavenging activity was exerted mainly by the di-anion form of FMTs in water at physiological pH following the single electron transfer mechanism. The results suggest that FMTs are promising natural antioxidants in aqueous physiological environments.

Dammarane-type triterpenoid saponins from the flower buds of Panax pseudoginseng with cytotoxic activity

Phytochemical investigation of a methanol extract of Panax pseudoginseng flower buds resulted in the isolation of 22 dammarane-type triterpenoid saponins, including three new compounds, pseudoginsenosides A-C (1-3), and 19 known analogs. Their chemical structures were identified by the comprehensive spectroscopic methods, including 1 D and 2 D NMR and mass spectra. In addition, their cytotoxic effects toward three human carcinoma cell lines, including liver (HepG2), breast (MCF7), and lung (A549) were also evaluated.

Calculating bond dissociation energies of X-H (X=C, N, O, S) bonds of aromatic systems via density functional theory: a detailed comparison of methods

In this study, the performance of 17 different density functional theory functionals was compared for the calculation of the bond dissociation energy (BDE) values of X-H (X=C, N, O, S) bonds of aromatic compounds. The effect of the size of the basis set (expansions of 6-31(G)) was also assessed for the initial geometry and zero-point energy calculations, followed by the single-point BDE calculations with different model chemistries with the 6-311 + (3df,2p) basis set. It was found that the size of the basis set for geometry optimization has a much smaller effect on the accuracy of BDE than the choice of functional for the following single-point calculations. The M06-2X, M05-2X and M08-HX functionals yielded highly accurate BDE values compared to experimental data (with the average mean unsigned error MUE = 1.2-1.5 kcal mol^-1), performing better than any of the other functionals. The results suggest that geometry optimization may be performed with B3LYP functional and a small basis set, whereas the M06-2X, M05-2X and M08-HX density functionals with a suitably large basis set offer the best method for calculating BDEs of ArX-H (X=C, N, O, S) bonds.

Mutations in the HBV PreS/S gene related to hepatocellular carcinoma in Vietnamese chronic HBV-infected patients

Background

Chronic hepatitis B virus (CHB) infection is a major health problem and leading cause of hepatocellular carcinoma (HCC) worldwide. Several point and deletion mutations on the PreS/S gene have been intensively considered associated with HCC. This study aimed to describe the characteristics of HBV PreS/S mutations in Vietnamese CHB-infected patients and their association with HCC.

Methods

This cross-sectional study was conducted from 02/2020 to 03/2021, recruited Vietnamese CHB-infected patients with HBV-DNA >3 log₁₀-copies/mL and successful PreS/S gene sequencing. Mutations were detected by direct Sanger sequencing.

Results

247 CHB-infected patients were recruited, characterized by 68.8% males, 54.7% HBV genotype B, 57.5% HBeAg positive, 23.1% fibrosis score ≥F3 and 19.8% HCC. 61.8% amino acid replacements were detected throughout the PreS1/PreS2/S genes. The most common point-mutations included N/H51Y/T/S/Q/P (30.4%), V68T/S/I (44.9%), T/N87S/T/P (46.2%) on PreS1 gene; T125S/N/P (30.8%), I150T (42.5%) on PreS2 gene; S53L (37.7%), A184V/G (39.3%), S210K/N/R/S (39.3%) on S gene. The rates of case(s) with any point-mutation on the Major Hydrophylic Region (MHR) and the "a" determinant region were 63.6% and 39.7%, respectively. Most of S point-mutations were presented with low rates such as T47A/E/V/K (9.3%), P120S/T (8.5%), G145R (2%). On multivariable analysis, males (OR = 4.51, 95%CI 1.78–11.4, p = 0.001), age≥40 (OR = 5.5, 95%CI 2.06–14.68, p = 0.001), W4P/R/Y on PreS1 (OR = 11.56, 95%CI 1.99–67.05, p = 0.006) and 4 S point-mutations as: T47A/E/V/K (OR = 3.67, 95%CI 1.19–11.29, p = 0.023), P120S/T (OR = 3.38, 95%CI 1.09–10.49, p = 0.035), S174N (OR = 29.73, 95%CI 2.12–417.07, p = 0.012), P203R (OR = 8.45, 95%CI 1.43–50.06, p = 0.019) were associated with HCC.

Conclusions

We detected 61% amino acid changes on PreS/S regions in Vietnamese CHB patients. One point-mutation at amino acid 4 on PreS1 gene and 4 point-mutations at amino acids 47, 120, 174, and 203 on S gene were associated with HCC. Further investigations are recommended to further clarify the relationship and interaction between mutations in HBV genome and HCC progression.

Oxoberberine: a promising natural antioxidant in physiological environments

Oxoberberine (OB, 2,10-dihydroxy-3,9-dimethoxy-8-oxo-protoberberine, artathomsonine), which was isolated from Artabotrys thomsonii, was shown to exhibit potent antioxidant activity in vitro, however that is the only reported evidence of the radical scavenging activity of this compound thus far. In the present study, thermodynamic and kinetic calculations were used to determine the free radical scavenging activity of OB against a range of biologically important species, under physiological conditions. In the first part the activity is calculated against the HOO˙ radical that is both biologically important and a reference radical for comparison. It was found that OB has high antiradical capacity against HOO˙ in both lipid medium and water at physiological pH with k _overall = 1.33 × 10⁵ and 1.73 × 10⁶ M^-1 s^-1, respectively. The formal hydrogen transfer mechanism defined the activity in nonpolar environments, whereas in the aqueous solution the single electron transfer competes with the hydrogen transfer pathway. The results showed that, in lipid medium, the HOO˙ trapping capability of OB is better than typical antioxidants such as Trolox, BHT, resveratrol and ascorbic acid. Similarly, the activity of OB in water at pH 7.4 is roughly 19 and 7 times faster than those of Trolox and BHT, respectively, but slightly lower than the activities of resveratrol or ascorbic acid. In the second part, it was found that OB also exhibits high activity against other typical free radicals such as CH₃O˙, CH₃OO˙, CCl₃OO˙, NO₂, SO₄˙^-, DPPH and ABTS˙⁺ with k _f ranging from 2.03 × 10⁵ to 5.74 × 10⁷ M^-1 s^-1. Hence, it is concluded that OB is a promising radical scavenger in the physiological environment.

Genetic variants in NKG2D axis and susceptibility to Epstein-Barr virus-induced nasopharyngeal carcinoma

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a rare epithelial carcinoma arising from the nasopharyngeal region. The pathogenesis of NPC is linked to Epstein-Barr virus (EBV) infection, although genetics and lifestyle factors appears to be also implicated. NKG2D is an immunoreceptor expressed by NK and T-cell subsets that recognizes MICA protein and other ligands on tumor cells. NKG2D interaction with MICA plays a role in the immunosurveillance to viruses and cancer.

METHODS

We investigated potential associations between functional polymorphisms in NKG2D and MICA genes with NPC susceptibility. We conducted a case-control study including 255 Vietnamese patients with EBV + non-differentiated NPC and 220 healthy controls.

RESULTS

We observed a significant association between the LNK/LNK genotype of rs1049174 (a variant associated with lower NKG2D receptor expression and reduced NK cell cytotoxicity) and increased susceptibility to NPC (adjusted OR = 1.66, 95% CI 1.07-2.59; p = 0.024). Similarly, the AA genotype of MICA rs2596542 was significantly associated with NPC (adjusted OR = 2.12; 95% CI 1.22-3.81; p = 0.009). In addition, tumor specimens of NPC patients with the AA genotype displayed a higher expression level of MICA proteins and showed higher EBV titers compared with tumor tissues from patients with the GG or GA genotypes. Higher EBV copy numbers were also observed in tumors with the A allele of MICA rs1051792 (also known as MICA-129 Met/Val) compared with those with the G allele; however, MICA rs1051792 variants were not associated with NPC susceptibility. These results suggest that genetic variants in components of the NKG2D axis may influence the individual susceptibility to EBV-induced NPC.

A new triterpenoid and other compounds from lichens Cryptothecia faveomaculata Makhija & Patw

Ten compounds (1-10) were purified from the extract of lichens C. faveomaculata, and among these one new triterpenoid, cryptothecin A (1) was characterized through mass spectrometric and 2D NMR spectroscopic analyses. Some of the isolated compounds were assessed for their antimicrobial (1, 6, and 8) and cytotoxic activity (1, 4-5, and 7-9), but only weak inhibitory effects were observed.

Triterpenoids and steroids from the fruiting bodies of Hexagonia tenuis and their cytotoxicity

One new triterpenoid, hexagonin F (1) was characterized from the fruiting bodies of Hexagonia tenuis with the assistance of spectroscopic and spectrometric analytical methods. In addition, two triterpenoids and two steroids were also identified by comparison of their physical and spectroscopic data with those reported. The purified compounds were examined for their cytotoxicity against five tumor cell lines, however, only weak cytotoxicity was demonstrated.

Quassinoids and Alkaloids From the Roots of Eurycoma longifolia

Five quassinoids and 2 alkaloids were isolated from the roots of Eurycoma longifolia. The structures of 3 new quassinoids, eurycomalide F, G, and H (1-3), were elucidated using a variety of spectroscopic methods. The known compounds were identified as eurycomalide A (4), laurycolactone B (5), 5-methoxycanthin-6-one (6), and canthin-6-one (7). Among the isolated compounds, canthin-6-one (7) exhibited the strongest inhibitory effect on nitric oxide production (IC50 = 16.9 μM). 5-Methoxycanthin-6-one (6) and eurycomalide F (1) exhibited weak inhibition with IC50 values of 23.4 and 32.7 μM, respectively.

Characterization of Cytochalasins and Steroids From the Ascomycete Daldinia concentrica and Their Cytotoxicity

One new cytochalasin daldinin (1), 2 known cytochalasins 2 and 3, along with 2 steroids 4 and 5, were characterized from the methanol extracts of the fruiting bodies of Daldinia concentrica. The structure of new compound 1 was elucidated using a combination of 1- and 2-dimensional nuclear magnetic resonance spectroscopic and high-resolution electrospray ionization mass spectrometric analyses. In addition, the isolated compounds were examined for their cytotoxicity against several tumor cell lines and the tested compounds demonstrated moderate-to-weak cytotoxicity.

Two new guaiane sesquiterpene lactones from the aerial parts of Artemisia vulgaris

Two new guaiane sesquiterpene lactones, vulgarolides A and B (1 and 2), were isolated from Artemisia vulgaris aerial parts using various chromatographic separations. The structure elucidation was performed by combination of spectroscopic experiments including 1D and 2D NMR, HR ESI MS, and CD. Their in vitro cytotoxic activities against five human cancer cell lines were also evaluated using SRB method.

Field Survey and Comparative Study of Pteris Vittata and Pityrogramma Calomelanos Grown on Arsenic Contaminated Lands with Different Soil pH

In field survey, Pteris vittata and Pityrogramma calomelanos were only found in arsenic (As) contaminated areas with soil pH 7.2-8.8 and 2.3-4.2, respectively. In the first pot experiment, two fern species were grown on the soil amended with 300 mg kg^-1 As at soil pH of 5.1, 7.2 and 9. P. calomelanos survived all pH treatments, and had the highest frond As concentration and soil As removal efficiency at soil pH 5.1. All P. vittata plants were dead at soil pH 5.1. P. vittata had higher frond As concentration, biomass and the amount of As removed from the soil than those of P. calomelanos at soil pH of 7.2 and 9. In the second pot experiment, P. vittata was demonstrated to have greater life time, biomass, As tolerance and accumulation than those of P. calomelanos as planted on alkaline soil (pH 7.8) spiked with various concentrations of As.

Increase in ozone due to the use of biodiesel fuel rather than diesel fuel

The consumption of fuel by vehicles emits nitrogen oxides (NOx) and non-methane hydrocarbons (NMHCs) into the atmosphere, which are important ozone precursors. Ozone is formed as a secondary pollutant via photochemical processes and is not emitted directly into the atmosphere. In this paper, the ozone increase resulting from the use of biodiesel and diesel fuels was investigated, and the different ozone formation trends were experimentally evaluated. Known amounts of exhaust gas from a power generator operated using biodiesel and diesel fuels were added to ambient air. The quality of the ambient air, such as the initial NMHC and NOx concentrations, and the irradiation intensity have an effect on the ozone levels. When 30 cm(3) of biodiesel fuel exhaust gas (BFEG) or diesel fuel exhausted gas (DFEG) was added to 18 dm(3) of ambient air, the highest ratios of ozone increase from BFEG compared with DFEG in Japan and Vietnam were 31.2 and 42.8%, respectively, and the maximum ozone increases resulting from DFEG and BFEG compared with the ambient air in Japan were 17.4 and 26.4 ppb, respectively. The ozone increase resulting from the use of BFEG was large and significant compared to that from DFEG under all experimental conditions. The ozone concentration increased as the amount of added exhaust gas increased. The ozone increase from the Jatropha-BFEG was slightly higher than that from waste cooking oil-BFEG.

Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

OBJECTIVE

To evaluate the effect of combined iron-zinc supplementation on micronutrient status, growth and morbidity.

DESIGN

Randomized, double-masked, placebo-controlled supplementation trial.

SETTING

Rural district of Que Vo, in the Red River Delta in Vietnam.

SUBJECTS

A total of 915 breast-fed infants aged 4-7 months were included and 784 completed the study.

INTERVENTIONS

The Fe-group received daily and for a 6-month period 10 mg of iron, the Zn-group 10 mg zinc, the Fe-Zn group 10 mg iron+10 mg zinc and the placebo group a placebo. Hemoglobin (Hb), serum ferritin (SF) and zinc (SZn), and anthropometry were measured before and at the end of the intervention. Morbidity was recorded daily.

RESULTS

Changes of Hb and SF were higher in both Fe and Fe+Zn groups (respectively 22.6 and 20.6 g/l for Hb; 36.0 and 24.8 microg/l for SF) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: -18.2 and -16.9 microg/l, P<0.0001). SZn increased more in Zn group (10.3 micromol/l) than in Fe+Zn group (8.0 micromol/l, P=0.03) and more in these groups compared to Fe and placebo groups (1.6 and 1.2 micromol/l, P<0.0001). Weight gain was higher in the Zn group. No significant effects of supplementations on growth in length or morbidity.

CONCLUSIONS

Combined iron-zinc supplementation had a positive effect on iron and zinc status in infants. However, the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements.

SPONSORSHIP

UNICEF New York.