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Understanding HIV-1 replication and latency in different reservoirs is an ongoing challenge in the care of patients with HIV/AIDS. A mathematical model was created to describe and predict the viral dynamics of HIV-1 and SIV infection within the brain during effective combination antiretroviral therapy (cART). The mathematical model was formulated based on the biology of lentiviral infection of brain macrophages and used to describe the dynamics of transmission and progression of lentiviral infection in brain. Based on previous reports quantifying total viral DNA levels in brain from HIV-1 and SIV infections, estimates of integrated proviral DNA burden were made, which were used to calibrate the mathematical model predicting viral accrual in brain macrophages from primary infection. The annual rate at which susceptible brain macrophages become HIV-1 infected was estimated to be 2.90×10-4.87×10 per year for cART-treated HIV/AIDS patients without comorbid neurological disorders. The transmission rate for SIV infection among untreated macaques was estimated to be 5.30×10-1.37×10 per year. An improvement in cART effectiveness (1.6-48%) would suppress HIV-1 infection in patients without neurological disorders. Among patients with advanced disease, a substantial improvement in cART effectiveness (70%) would eradicate HIV-1 provirus from the brain within 3-32 (interquartile range 3-9) years in patients without neurological disorders, whereas 4-51 (interquartile range 4-16) years of efficacious cART would be required for HIV/AIDS patients with comorbid neurological disorders. HIV-1 and SIV provirus burdens in the brain increase over time. A moderately efficacious antiretroviral therapy regimen could eradicate HIV-1 infection in the brain that was dependent on brain macrophage lifespan and the presence of neurological comorbidity. [ABSTRACT FROM AUTHOR]

Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation. [ABSTRACT FROM AUTHOR]

Abstract: Anti-retroviral treatments (ART) such as HAART have been used to control the replication of HIV virus in HIV-positive patients. In this paper, we study an in-host model of HIV infection with ART and carry out mathematical analysis of the global dynamics and bifurcations of the model in different parameter regimes. Among our discoveries is a parameter region for which backward bifurcation can occur. Biologically, the catastrophic behaviors associated with backward bifurcations may explain the sudden rebound of HIV viral load when ART is stopped, and possibly provide an explanation for the viral blips during ART suppression of HIV. [Copyright &y& Elsevier]

Aortoenteric fistula ( AEF) is an uncommon condition, but carries high mortality, with increasing incidence. Conventional treatment of AEF by open debridement and bypass grafting has high mortality and morbidity rates. In the present study, we report on a patient with a history of open repair of impending ruptured abdominal aortic aneurysm, who presented with aortoduodenal fistula 9 years after the index operation. The patient was treated with endovascular stenting and recovered well afterwards. We also reviewed previous reports on the use of endovascular stents for the treatment of secondary AEF. [ABSTRACT FROM AUTHOR]

• A proportion of those with oropharyngeal cancer (OPC) are positive for ERα. • ERα positivity has been associated with improved survival in OPC. • The role of ERα in OPC pathogenesis is unclear. • Further work is needed to validate ERα as a biomarker and therapeutic target. [ABSTRACT FROM AUTHOR]

Introduction The two current standard laparoscopic approaches for inguinal hernia repair are transabdominal preperiotneal and totally extraperitoneal. Single-incision repairs have been explored in an effort to further reduce the invasiveness of the surgery. However, with single incision, surgeons need to possess special skills and require special instruments. Needlescopic inguinal hernia repair could represent a more attractive alternative. Using a transumbilical incision, an almost scarless transabdominal preperiotneal can be achieved. In the present study, we report our experience of scarless needlescopic transabdominal preperiotneal inguinal hernia repair. Patients and Methods This is a prospective analysis of a cohort of patients with inguinal hernia who underwent elective scarless needlescopic transabdominal preperiotneal repair. Patient demographic data, type of hernia, operative time, perioperative and postoperative course, pain score and final patient satisfaction score were all recorded for analysis. Results In March 2011, four patients received scarless needlescopic transabdominal preperiotneal for inguinal hernia repair. Their average age was 57.25 years. The mean operative time was 79.5 min. The patients were discharged on the same day. There were no postoperative complications. Conclusion Scarless needlescopic transabdominal preperiotneal inguinal hernia repair is feasible and safe, and is well accepted by patients. Further studies will be conducted to evaluate its full potential. [ABSTRACT FROM AUTHOR]

Abstract: We consider a mathematical model for HIV/AIDS that incorporates staged progression and amelioration. Amelioration as a result of HAART treatment is allowed to occur across any number of stages. The global dynamics are completely determined by the basic reproduction number . If , then the disease-free equilibrium (DFE) is globally asymptotically stable and the disease always dies out. If , DFE is unstable and a unique endemic equilibrium (EE) is globally asymptotically stable, and the disease persists at the endemic equilibrium. The proof of global stability utilizes a global Lyapunov function. [Copyright &y& Elsevier]

Abstract: Introduction: Laparoscopic liver resection can either be total laparoscopic or hand-assisted laparoscopic approach. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was developed to overcome the disadvantages of conventional laparoscopic surgery. The role of robotic system in laparoscopic surgery was not well evaluated yet. The aim of this cohort study was to evaluate the outcome of multimodality approach of laparoscopic liver resection for hepatic malignancy Methods: From January 1998 to August 2010, all patients with hepatic malignancy underwent laparoscopic liver resection were included. A prospectively collected data was analyzed retrospectively. Results: During the study period, a total of 56 patients with hepatic malignancies (hepatocellular carcinoma, HCC, n = 42; colorectal liver metastases, CLM, n = 14) underwent laparoscopic liver resection in our surgical unit. The majority of cases were performed by hand-assisted laparoscopic approach, n = 31 (55.3%) and the remainder were with total laparoscopic approach, n = 10 (17.9%) and robot-assisted laparoscopic approach, n = 15 (26.8%). The median operation time was 150 min (range, 75–307 min). The median blood loss during surgery was 175 ml (range, 5–2000 ml). Two patients (3.6%) needed open conversion and one patient (1.8%) needed to be converted to hand-assisted laparoscopic approach. The morbidity rate was 14.3%. There was no procedure-related death. 89.3% of patients had R0 resection and 10.7% of patients had R1 resection. The median hospital stay was 6.5 days (range, 2–13 days). The 1-year, 3-year, and 5-year disease-free survival rates for HCC were 85%, 47%, and 38%, respectively. The 1-year, 3-year, and 5-year overall survival rates for HCC were 96%, 67%, and 52%, respectively. The 1-year, and 3-year disease-free survival rates for CLM were 92% and 72%. The 1-year, and 3-year overall survival rates for CLM were 100% and 88%, respectively. Conclusions: Multimodality approach of laparoscopic liver resection of hepatic malignancy was feasible, and safe in selected patients. It was associated with a low complications rate. The mid-term and long-term survival outcome was favorable also. [Copyright &y& Elsevier]

Aim: The present article aims to review the results of the use of the self-expanding metallic stent (SEMS) in our institution for distal colorectal tumours, defined as tumours distal to the splenic flexure. Patients and methods: SEMS was selectively offered to the following patients with distal colorectal tumours: (i) patients with clinically obstructed tumours; (ii) patients undergoing palliative treatment; and (iii) patients planned for neoadjuvant chemotherapy. All data, including outcomes and complications, were entered prospectively into a database. A review was carried out for those patients who underwent endoluminal stenting between February 2002 and August 2008. Results: Sixty-eight patients were evaluated with a median age of 68 years (range 39–91). The median follow up was 11 months. Of these, 53 patients received emergency stenting for acute intestinal obstruction, 12 had palliative stenting for endoscopically obstructive cancer and three had pre-emptive stenting of locally advanced, stenotic rectal cancer before neoadjuvant chemo-irradiation. The overall technical success and clinical success rates were 81% and 65%, respectively. Complications included four stent-related perforations (5.9%) and seven distal migrations (10.3%). Twenty-seven patients from the intestinal obstruction group and the three patients from the neoadjuvant chemo-irradiation group subsequently underwent laparoscopic tumour resection with success. Conclusion: In conclusion, our experience showed that SEMS is a useful adjunct in the management of distal colorectal cancer. Apart from being an alternative measure for palliation, SEMS is an effective and non-invasive way for relieving obstruction in patients with obstructed tumours, allowing them to undergo subsequent one-stage laparoscopic tumour resection. It is also useful in patients with locally advanced rectal cancer, in whom neoadjuvant chemo-irradiation is planned. [ABSTRACT FROM AUTHOR]

Aim Paraoesophageal hernia warrants surgical repair when it becomes symptomatic. Complex definitive surgical repair carries a high risk of complication and morbidity. Patients and Methods We present a case of paraoesophageal hernia in an elderly woman managed by minimally-invasive method with laparoscopic-assisted endoscopic reduction and gastropexy. Results The operation was done under general anaesthesia. The intrathoracic oesophagus and stomach were reduced with laparoscopic assistance, and the adhesion with the hernia sac was removed. Gastropexy was performed with two percutaneous endoscopic gastrostomies (PEG), and a feeding jejunostomy was placed via one of the PEG. The patient was initially started on jejunosotmy feeding, and oral feeding was gradually resumed. She was then discharged on postoperative day 20. Conclusion In patients who are considered high risk for definitive surgical repair or invasive procedure involving hiatal dissection, endoscopic reduction and fixation with laparoscopic assistance are an acceptable alternative. [ABSTRACT FROM AUTHOR]

Imatinib mesylate is the treatment of choice for metastatic and unresectable gastrointestinal stromal tumour. With evidence showing overall excellent response rates, its potential role in the neoadjuvant setting is currently being explored. In addition to improving resectability of advanced tumours, the downstaging effect may also have potential functional advantages. We herein report a successful case of sphincter-preserving resection of a low rectal gastrointestinal stromal tumour following neoadjuvant therapy with imatinib. [ABSTRACT FROM AUTHOR]

The article discusses the used of the technique for rectal adenoma called transanal endoscopic operation (TEO). It mentions that a TEO device was used on the patient in the lithotomy position during the operation. It adds that the TEO technique was already used in 11 patients since 2008, however, two patients developed recurrent adenoma and were successfully removed by colonoscopic polypectomy. Furthermore, it suggests TEO to patients with large mid or upper rectal polyps.