Laparoscopic total pancreatectomy (LTP) is technically challenging and infrequently documented in the literature. In this paper, we present a new approach for performing fully LTP, a pancreatic tail-first approach with a counterclockwise technique, to accomplish total mesopancreas dissection and standard lymphadenectomy en bloc. Firstly, the tail and body of the pancreas without the spleen were dissected retrogradely, starting from the lower border of the body of pancreas and then from left to right. After that, a counterclockwise dissection of the tail and body of the pancreas was performed. The splenic artery and vein were divided at the terminal end of the pancreatic tail. The spleen was preserved. The entire body and tail of the pancreas were then pulled to the right side. This maneuver facilitated the isolation and dissection of arteries in the retropancreatic region more easily via laparoscopy, including the splenic artery, gastroduodenal artery, and supporting superior mesenteric artery first-approach. It also enabled total mesopancreas dissection.The inferior pancreaticoduodenal artery was resected last during this phase. The remainder of the dissection was like that of a laparoscopic pancreaticoduodenectomy with total mesopancreas dissection, involving two laparoscopic manual anastomoses. The operative time was 490 minutes and the total blood loss was 100 mL. Pathology revealed a low-grade intraductal papillary mucinous neoplasm extending from the head to the tail of the pancreas.

Laparoscopic total pancreatectomy (LTP) is technically challenging and infrequently documented in the literature. In this paper, we present a new approach for performing fully LTP, a pancreatic tail-first approach with a counterclockwise technique, to accomplish total mesopancreas dissection and standard lymphadenectomy en bloc. Firstly, the tail and body of the pancreas without the spleen were dissected retrogradely, starting from the lower border of the body of pancreas and then from left to right. After that, a counterclockwise dissection of the tail and body of the pancreas was performed. The splenic artery and vein were divided at the terminal end of the pancreatic tail. The spleen was preserved. The entire body and tail of the pancreas were then pulled to the right side. This maneuver facilitated the isolation and dissection of arteries in the retropancreatic region more easily via laparoscopy, including the splenic artery, gastroduodenal artery, and supporting superior mesenteric artery first-approach. It also enabled total mesopancreas dissection.The inferior pancreaticoduodenal artery was resected last during this phase. The remainder of the dissection was like that of a laparoscopic pancreaticoduodenectomy with total mesopancreas dissection, involving two laparoscopic manual anastomoses. The operative time was 490 minutes and the total blood loss was 100 mL. Pathology revealed a low-grade intraductal papillary mucinous neoplasm extending from the head to the tail of the pancreas.

Laparoscopic total pancreatectomy (LTP) is technically challenging and infrequently documented in the literature. In this paper, we present a new approach for performing fully LTP, a pancreatic tail-first approach with a counterclockwise technique, to accomplish total mesopancreas dissection and standard lymphadenectomy en bloc. Firstly, the tail and body of the pancreas without the spleen were dissected retrogradely, starting from the lower border of the body of pancreas and then from left to right. After that, a counterclockwise dissection of the tail and body of the pancreas was performed. The splenic artery and vein were divided at the terminal end of the pancreatic tail. The spleen was preserved. The entire body and tail of the pancreas were then pulled to the right side. This maneuver facilitated the isolation and dissection of arteries in the retropancreatic region more easily via laparoscopy, including the splenic artery, gastroduodenal artery, and supporting superior mesenteric artery first-approach. It also enabled total mesopancreas dissection.The inferior pancreaticoduodenal artery was resected last during this phase. The remainder of the dissection was like that of a laparoscopic pancreaticoduodenectomy with total mesopancreas dissection, involving two laparoscopic manual anastomoses. The operative time was 490 minutes and the total blood loss was 100 mL. Pathology revealed a low-grade intraductal papillary mucinous neoplasm extending from the head to the tail of the pancreas.

Novel antimicrobial agents are continually developed to address the global threat of multidrug-resistant Neisseria gonorrhoeae. Promising candidates include zoliflodacin and, possibly, solithromycin. We evaluated their in-vitro activities against gonococcal isolates collected in Korea. In total, 250 N. gonorrhoeae isolates obtained across Korea between 2016 and 2018 were used to determine the minimum inhibitory concentrations (MICs) of 10 therapeutic agents using the CLSI agar dilution method. Most isolates (94.8%, 237/250) demonstrated non-susceptibility to penicillin G, tetracycline, and ciprofloxacin, and susceptibility to ceftriaxone and spectinomycin was substantially high. The half-maximal IC (MIC50) and 90% IC (MIC90) values for zoliflodacin were 0.03 and 0.06 µg/mL, respectively; 0.06 and 0.12 µg/mL, respectively, for solithromycin; and 0.03 and 0.12 µg/mL, respectively, for ceftriaxone. Notably, no cross-resistance was observed between zoliflodacin and ciprofloxacin, despite both targeting DNA topoisomerase II enzymes. Zoliflodacin and solithromycin demonstrated significant in-vitro activity against multidrug-resistant N.gonorrhoeae isolates, and zoliflodacin has shown non-inferiority to ceftriaxone/azithromycin dual therapy in a clinical phase 3 trial. Collectively, our findings highlight the potential of zoliflodacin as a novel therapeutic agent for gonococcal infections, particularly in the context of rising multidrug resistance, and highlight the need for continued surveillance and development of alternative antimicrobial strategies.

Objective: In Viet Nam, tuberculosis (TB) prevalence surveys revealed that approximately 98% of individuals with pulmonary TB have TB-presumptive abnormalities on chest radiographs, while 32% have no TB symptoms. This prompted the adoption of the “Double X” strategy, which combines chest radiographs and computer-aided detection with GeneXpert testing to screen for and diagnose TB among vulnerable populations. The aim of this study was to describe demographic, clinical and radiographic characteristics of symptomatic and asymptomatic Double X participants and to assess multilabel radiographic abnormalities on chest radiographs, interpreted by computer-aided detection software, as a possible tool for detecting TB-presumptive abnormalities, particularly for subclinical TB. Methods: Double X participants with TB-presumptive chest radiographs and/or TB symptoms and known risks were referred for confirmatory GeneXpert testing. The demographic and clinical characteristics of all Double X participants and the subset with confirmed TB were summarized. Univariate and multivariable logistic regression modelling was used to evaluate associations between participant characteristics and subclinical TB and between computer-aided detection multilabel radiographic abnormalities and TB. Results: From 2020 to 2022, 96 631 participants received chest radiographs, with 67 881 (70.2%) reporting no TB symptoms. Among 1144 individuals with Xpert-confirmed TB, 51.0% were subclinical. Subclinical TB prevalence was higher in older age groups, non-smokers, those previously treated for TB and the northern region. Among 11 computer-aided detection multilabel radiographic abnormalities, fibrosis was associated with higher odds of subclinical TB. Discussion: In Viet Nam, Double X community case finding detected pulmonary TB, including subclinical TB. Computer-aided detection software may have the potential to identify subclinical TB on chest radiographs by classifying multilabel radiographic abnormalities, but further research is needed.

Purpose: Endosseous titanium dental implants are widely regarded as the gold standard for replacing missing teeth. Despite the proven osseointegration of titanium implants, particularly those with enhanced surface modifications, concerns remain regarding esthetics, the risk of peri-implantitis, and potential hypersensitivity. Consequently, alternative materials, such as zirconia, have received increasing attention in recent years. This study evaluated the osseointegration parameters of zirconia implants placed in the mandibles of beagle dogs, as a preliminary in vivo evaluation of zirconia dental implants in South Korea. Materials and Methods: Seven 8-month-old beagle dogs underwent premolar extraction followed by placement of implants in the healed mandibular ridges. The following implants were used in this study: six turned-surface titanium implants, six rough-surface titanium implants, and six zirconia implants, following which the implants and surrounding tissues were harvested en bloc for histological analyses. Bone-to-implant contact (BIC) and new bone area (BA) percentages (%) were calculated and compared between the groups. Statistical analyses were conducted using ANOVA, with the significance level set at p < .05. Results: Histological analysis revealed no statistically significant difference in BIC between the rough-surface titanium and zirconia implants, although the turned-surface titanium implants exhibited significantly lower BIC than the other two groups (p < .05). No significant differences were found among the three groups in terms of BA. Conclusion The results of this study demonstrate that zirconia implants achieve BIC comparable to that of rough-surface titanium implants, suggestive of their potential clinical application.

Purpose: Endosseous titanium dental implants are widely regarded as the gold standard for replacing missing teeth. Despite the proven osseointegration of titanium implants, particularly those with enhanced surface modifications, concerns remain regarding esthetics, the risk of peri-implantitis, and potential hypersensitivity. Consequently, alternative materials, such as zirconia, have received increasing attention in recent years. This study evaluated the osseointegration parameters of zirconia implants placed in the mandibles of beagle dogs, as a preliminary in vivo evaluation of zirconia dental implants in South Korea. Materials and Methods: Seven 8-month-old beagle dogs underwent premolar extraction followed by placement of implants in the healed mandibular ridges. The following implants were used in this study: six turned-surface titanium implants, six rough-surface titanium implants, and six zirconia implants, following which the implants and surrounding tissues were harvested en bloc for histological analyses. Bone-to-implant contact (BIC) and new bone area (BA) percentages (%) were calculated and compared between the groups. Statistical analyses were conducted using ANOVA, with the significance level set at p < .05. Results: Histological analysis revealed no statistically significant difference in BIC between the rough-surface titanium and zirconia implants, although the turned-surface titanium implants exhibited significantly lower BIC than the other two groups (p < .05). No significant differences were found among the three groups in terms of BA. Conclusion The results of this study demonstrate that zirconia implants achieve BIC comparable to that of rough-surface titanium implants, suggestive of their potential clinical application.

Purpose: Endosseous titanium dental implants are widely regarded as the gold standard for replacing missing teeth. Despite the proven osseointegration of titanium implants, particularly those with enhanced surface modifications, concerns remain regarding esthetics, the risk of peri-implantitis, and potential hypersensitivity. Consequently, alternative materials, such as zirconia, have received increasing attention in recent years. This study evaluated the osseointegration parameters of zirconia implants placed in the mandibles of beagle dogs, as a preliminary in vivo evaluation of zirconia dental implants in South Korea. Materials and Methods: Seven 8-month-old beagle dogs underwent premolar extraction followed by placement of implants in the healed mandibular ridges. The following implants were used in this study: six turned-surface titanium implants, six rough-surface titanium implants, and six zirconia implants, following which the implants and surrounding tissues were harvested en bloc for histological analyses. Bone-to-implant contact (BIC) and new bone area (BA) percentages (%) were calculated and compared between the groups. Statistical analyses were conducted using ANOVA, with the significance level set at p < .05. Results: Histological analysis revealed no statistically significant difference in BIC between the rough-surface titanium and zirconia implants, although the turned-surface titanium implants exhibited significantly lower BIC than the other two groups (p < .05). No significant differences were found among the three groups in terms of BA. Conclusion The results of this study demonstrate that zirconia implants achieve BIC comparable to that of rough-surface titanium implants, suggestive of their potential clinical application.

Background: s/Aims: Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results.There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape. Methods: We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated. Results: The median operative time was 289.6 min (178−540 min), the median intraoperative blood loss was 209 mL (30−1,600 mL).Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%. Conclusions The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.

Background: s/Aims: Parenchymal-sparing anatomical hepatectomy (Ps–AH) based on portal ramification of the right anterior section (RAS) is a new technique to avoid unnecessarily transecting too much liver parenchyma, especially in cases of major anatomical hepatectomy. Methods: We prospectively assessed 26 patients with primary hepatic malignancies having undergone major Ps–AH based on portal ramification of the RAS from August 2018 to August 2022 (48 months). The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: Among the 26 patients analyzed, there was just one case that had intrahepatic cholangiocarcinoma The preoperative level of α– Fetoprotein was 25.2 ng/mL. All cases (100%) had Child–Pugh A liver function preoperatively. The ventral/dorsal RAS was preserved in 19 and 7 patients, respectively. The mean surgical margin was 6.2 mm. The mean surgical time was 228.5 minutes, while the mean blood loss was 255 mL. In pathology, 5 cases (19.2%) had microvascular invasion, and in the group of HCC patients, 92% of all cases had moderate or poor tumor differentiation. Six cases (23.1%) of postoperative complications were graded over III according to the Clavien–Dindo system, including in three patients resistant ascites or intra-abdominal abscess that required intervention. Conclusions Parenchymal-sparing anatomical hepatectomy based on portal ramification of the RAS to achieve R0-resection was safe and effective, with favorable short-term outcomes. This technique can be used widely in clinical practice.