Modulation of the gait pattern during split-belt locomotion after lateral spinal cord hemisection in adult cats

Most previous studies investigated the recovery of locomotion in animals and people with incomplete spinal cord injury (SCI) during relatively simple tasks (e.g., walking in a straight line on a horizontal surface or a treadmill). We know less about the recovery of locomotion after incomplete SCI in left-right asymmetric conditions, such as turning or stepping along circular trajectories. To investigate this, we collected kinematic and electromyography data during split-belt locomotion at different left-right speed differences before and after a right thoracic lateral spinal cord hemisection in nine adult cats. After hemisection, although cats still performed split-belt locomotion, we observed several changes in the gait pattern compared with the intact state at early (1-2 wk) and late (7-8 wk) time points. Cats with larger lesions showed new coordination patterns between the fore- and hindlimbs, with the forelimbs taking more steps. Despite this change in fore-hind coordination, cats maintained consistent phasing between the fore- and hindlimbs. Adjustments in cycle and phase (stance and swing) durations between the slow and fast sides allowed animals to maintain 1:1 left-right coordination. Periods of triple support involving the right (ipsilesional) hindlimb decreased in favor of quad support and triple support involving the other limbs. Step and stride lengths decreased with concurrent changes in the right fore- and hindlimbs, possibly to avoid interference. The above adjustments in the gait pattern allowed cats to retain the ability to locomote in asymmetric conditions after incomplete SCI. We discuss potential plastic neuromechanical mechanisms involved in locomotor recovery in these conditions.NEW & NOTEWORTHY Everyday locomotion often involves left-right asymmetries, when turning, walking along circular paths, stepping on uneven terrains, etc. To show how incomplete spinal cord injury affects locomotor control in asymmetric conditions, we collected data before and after a thoracic lateral spinal hemisection on a split-belt treadmill with one side stepping faster than the other. We show that adjustments in kinematics and muscle activity allowed cats to retain the ability to perform asymmetric locomotion after hemisection.

O-012 Biosimilar recombinant human FSH (Follitropin alpha) for controlled ovarian stimulation in ovulatory women undergone IVF/ICSI cycles? A systematic review and meta-analysis

Study question

Is biosimilar Follitropin alpha preparations for controlled ovarian stimulation in ovulatory women undergoing IVF, is effective as as compared to the originator

Summary answer

Biosimilar preparations of Follitropin alpha are probably associated with lower clinical pregnancy and ongoing pregnancy rates than the originator.

What is known already

As the patent expired for the originator, there was increasing interest in developing biosimilar follitropin alpha. Biosimilar medicinal product is a biological product developed to be highly similar to the already approved biological medicine (reference medicine) (EMA 2017). Biosimilar recombinant FSH preparations are manufactured in Chinese hamster ovary cells with a fully human glycosylation – which may differ slightly between products – and represent products with demonstrated similarity in physicochemical characteristics, efficacy, and safety to those of Gonal-F® (European Medicines Agency 2013; Weise et al 2011; Lammerich et al 2015 a, b; Wolzt et al., 2016; Abd-Elaziz et al., 2017).

Study design, size, duration

Systematic review and meta-analysis of randomized controlled trials (RCTs).

Participants/materials, setting, methods

 

Partticipants

Infertile women undergoing in vitro fertilization (IVF).

Setting

Not applicable.

Methods

Five databases were searched through Jan.2022 for RCTs comparing the biosimilar Follitropin alpha to the originator for controlled ovarian stimulation and reporting clinical IVF outcomes, not restricted by language. We used the The Cochrane Risk of Bias 2 tool was used to assess the quality of the included studies.

Main Outcome Measure

clinical pregnancy rate and the number of retrieved oocytes.

Main results and the role of chance

The search retrieved 111 records. Six studies met the eligibility criteria and were included in the qualitative synthesis and the meta-analysis. Compared to the originator Follitropin alpha, biosimilars are probably associated with lower clinical pregnancy rates (RR 0.81, 95% CI 0.69 to 0.94, I2 = 0%, 6 RCTs, 1453 participants, moderate-quality evidence), but there was no evidence of a difference in the number of retrieved oocytes (MD 0.69, 95% CI -0.09 to 1.46, I2 = 0%, 6 RCTs, 1353 participants, moderate-quality evidence). We are uncertain of the effect of biosimilar preparations on live birth which may indicate no difference or serious harm (RR 0.86, 95% CI 0.71 to 1.05, I2 = 0%, 5 RCTs, 978 participants, low-quality evidence). Both preparations were similar in terms of OHSS (RR 1.25, 95% CI 0.89 to 1.76, 5 RCTs, 1353 participants, moderate-quality evidence) and adverse events (RR 1.09, 95% CI 0.92 to 1.30, 4RCTs, 981 participants, moderate-quality evidence).

Limitations, reasons for caution

Since it is based on a small number of RCTs and patients, therefore the findings in terms of pregnancy rates, number of oocytes and OHSS are derived from 6 RCTs . Thus, these low numbers limit the validity of the findings and indicate that more high-quality studies are needed.

Wider implications of the findings

Couples should be counseled for the possible inferiority of these preparations compared to the originator. More RCTs are required to confirm these results, and these RCTs should consider the cost-effectiveness outcomes in their designs and analyses.

Trial registration number

CRD42020124121

QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection

BACKGROUND

Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population.

METHODS

We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms).

RESULTS

Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation (P = .004 for the likelihood-ratio test).

CONCLUSION

The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.

Sex-Specific Retinal Anomalies Induced by Chronic Social Defeat Stress in Mice

Major depressive disorder (MDD) is one of the most common consequences of chronic stress. Still, there is currently no reliable biomarker to detect individuals at risk to develop the disease. Recently, the retina emerged as an effective way to investigate psychiatric disorders using the electroretinogram (ERG). In this study, cone and rod ERGs were performed in male and female C57BL/6 mice before and after chronic social defeat stress (CSDS). Mice were then divided as susceptible or resilient to stress. Our results suggest that CSDS reduces the amplitude of both oscillatory potentials and a-waves in the rods of resilient but not susceptible males. Similar effects were revealed following the analysis of the cone b-waves, which were faster after CSDS in resilient mice specifically. In females, rod ERGs revealed age-related changes with no change in cone ERGs. Finally, our analysis suggests that baseline ERG can predict with an efficacy up to 71% the expression of susceptibility and resilience before stress exposition in males and females. Overall, our findings suggest that retinal activity is a valid biomarker of stress response that could potentially serve as a tool to predict whether males and females will become susceptible or resilient when facing CSDS.

Regulation of impulsive and aggressive behaviours by a novel lncRNA

High impulsive and aggressive traits associate with poor behavioural self-control. Despite their importance in predicting behavioural negative outcomes including suicide, the molecular mechanisms underlying the expression of impulsive and aggressive traits remain poorly understood. Here, we identified and characterized a novel long noncoding RNA (lncRNA), acting as a regulator of the monoamine oxidase A (MAOA) gene in the brain, and named it MAOA-associated lncRNA (MAALIN). Our results show that in the brain of suicide completers, MAALIN is regulated by a combination of epigenetic mechanisms including DNA methylation and chromatin modifications. Elevated MAALIN in the dentate gyrus of impulsive-aggressive suicides was associated with lower MAOA expression. Viral overexpression of MAALIN in neuroprogenitor cells decreased MAOA expression while CRISPR-mediated knock out resulted in elevated MAOA expression. Using viral-mediated gene transfer, we confirmed that MAALIN in the hippocampus significantly decreases MAOA expression and exacerbates the expression of impulsive-aggressive behavioural traits in CD1 aggressive mice. Overall, our findings suggest that variations in DNA methylation mediate the differential expression of a novel lncRNA that acts on MAOA expression to regulate impulsive-aggressive behaviours.

Convalescent Plasma Efficacy in Life-Threatening COVID-19 Patients Admitted to the ICU: A Retrospective Cohort Study

(1) Background: There are limited data regarding the efficacy of convalescent plasma (CP) in critically ill patients admitted to the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). We aimed to determine whether CP is associated with better clinical outcome among these patients. (2) Methods: A retrospective single-center study including adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to the ICU for acute respiratory failure. The primary outcome was time to clinical improvement, within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale. (3) Results: Overall, 110 COVID-19 patients were admitted. Thirty-two patients (29%) received CP; among them, 62.5% received at least one CP with high neutralizing antibody titers (≥1:160). Clinical improvement occurred within 28 days in 14 patients (43.7%) of the CP group vs. 48 patients (61.5%) in the non-CP group (hazard ratio (HR): 0.75 (95% CI: 0.41-1.37), p = 0.35). After adjusting for potential confounding factors, CP was not independently associated with time to clinical improvement (HR: 0.53 (95% CI: 0.23-1.22), p = 0.14). Additionally, the average treatment effects of CP, calculated using the inverse probability weights (IPW), was not associated with the primary outcome (-0.14 days (95% CI: -3.19-2.91 days), p = 0.93). Hospital mortality did not differ between CP and non-CP groups (31.2% vs. 19.2%, p = 0.17, respectively). Comparing CP with high neutralizing antibody titers to the other group yielded the same findings. (4) Conclusions: In this study of life-threatening COVID-19 patients, CP was not associated with time to clinical improvement within 28 days, or hospital mortality.

Insights on toxin genotyping, virulence, antibiogram profiling, biofilm formation and efficacy of disinfectants on biofilms of Clostridium perfringens isolated from poultry, animals and humans

AIMS

This study aimed to determine the toxin genotypes, virulence determinants and antibiogram of Clostridium perfringens isolated from poultry, animals and humans. Biofilm formation and the efficacy of disinfectants on C. perfringens biofilms were studied.

METHODS AND RESULTS

Thirty C. perfringens isolates (20 clinical and 10 from chicken carcasses) were genotyped by PCR and all isolates were genotype A (cpa+). The overall prevalence of cpe, cpb2, netB and tpeL virulence genes was 6·7, 56·7, 56·7 and 36·7% respectively. Twenty-one isolates (70%) were multidrug-resistant, 8 (26·7%) were extensive drug-resistant and one isolate (3·3%) was pan drug-resistant. The average multiple antibiotic resistance index was 0·7. Biofilms were produced by 63·3% of C. perfringens isolates and categorized as weak (36·7%), moderate (16·7%) and strong (10%). Sodium hypochlorite caused significant reduction in C. perfringens biofilms (P < 0·0001).

CONCLUSIONS

All C. perfringens strains in this study were type A, resistant to multiple antibiotics and most of them were biofilm producers. Sodium hypochlorite showed higher efficacy in reducing C. perfringens biofilms.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study reported the efficacy of disinfectants in reducing C. perfringens biofilms of economic and public health concern and recommends application on surfaces in farms, food processing plants and slaughterhouses.

Alleviating pain with delta opioid receptor agonists: evidence from experimental models

The use of opioids for the relief of pain and headache disorders has been studied for years. Nowadays, particularly because of its ability to produce analgesia in various pain models, delta opioid receptor (DOPr) emerges as a promising target for the development of new pain therapies. Indeed, their potential to avoid the unwanted effects commonly observed with clinically used opioids acting at the mu opioid receptor (MOPr) suggests that DOPr agonists could be a therapeutic option. In this review, we discuss the use of opioids in the management of pain in addition to describing the evidence of the analgesic potency of DOPr agonists in animal models.

Contrasted resistance and resilience of two mangrove forests after exposure to long-term and short-term anthropic disturbances

Mangroves, coastal forests under the influence of tides, are known to be very resilient when they face natural disturbances such as storms or tsunami. While they provide several ecological services, they are threatened by many anthropic pressures. The aim of this study was to assess and to compare the stability of two mangrove fringes defined by contrasted set of natural constraints and exposed to pretreated domestic wastewaters discharges. The in situ experimental system set up in Mayotte Island (Indian Ocean) allowed us to determine both the short-term (2 years) and the long-term (9 years) resistance and the resilience. We focused on vegetation and crabs, an essential component of mangroves fauna. Wastewater discharges induced increases in tree coverage, leaves productivity and pigment content, and a decrease in crab diversity and density. Within 2 years after the release of the disturbance, several parameters reach back control values indicating fast resilience. Our results notably emphasized the high stability of the mangrove fringe dominated by Rhizophora mucronata trees, which was both more resistant and more resilient. This makes this fringe more suitable for application purposes, such as outfall for domestic wastewaters treatment plants.

Dithallium(III)-Containing 30-Tungsto-4-phosphate, [Tl2Na2(H2O)2(P2W15O56)2]16-: Synthesis, Structural Characterization, and Biological Studies

Here we report on the synthesis and structural characterization of the dithallium(III)-containing 30-tungsto -4-phosphate [Tl₂Na₂(H₂O)₂{P₂W₁₅O₅₆}₂]^16- (1) by a multitude of solid-state and solution techniques. Polyanion 1 comprises two octahedrally coordinated Tl³⁺ ions sandwiched between two trilacunary {P₂W₁₅} Wells-Dawson fragments and represents only the second structurally characterized, discrete thallium-containing polyoxometalate to date. The two outer positions of the central rhombus are occupied by sodium ions. The title polyanion is solution-stable as shown by ³¹P and ^203/205Tl NMR. This was also supported by Tl NMR spectra simulations including several spin systems of isotopologues with half-spin nuclei (²⁰³Tl, ²⁰⁵Tl, ³¹P, ¹⁸³W). ²³Na NMR showed a time-averaged signal of the Na⁺ counter cations and the structurally bonded Na⁺ ions. ^203/205Tl NMR spectra also showed a minor signal tentatively attributed to the trithallium-containing derivative [Tl₃Na(H₂O)₂(P₂W₁₅O₅₆)₂]^14-, which could also be identified in the solid state by single-crystal X-ray diffraction. The bioactivity of polyanion 1 was also tested against bacteria and Leishmania.

Adeno-associated virus 2/9 delivery of Cre recombinase in mouse primary afferents

Genetically-modified animal models have significantly increased our understanding of the complex central nervous system circuits. Among these models, inducible transgenic mice whose specific gene expression can be modulated through a Cre recombinase/LoxP system are useful to study the role of specific peptides and proteins in a given population of cells. In the present study, we describe an efficient approach to selectively deliver a Cre-GFP to dorsal root ganglia (DRG) neurons. First, mice of different ages were injected in both hindpaws with a recombinant adeno-associated virus (rAAV2/9-CBA-Cre-GFP). Using this route of injection in mice at 5 days of age, we report that approximately 20% of all DRG neurons express GFP, 6 to 8 weeks after the infection. The level of infection was reduced by 50% when the virus was administered at 2 weeks of age. Additionally, the virus-mediated delivery of the Cre-GFP was also investigated via the intrathecal route. When injected intrathecally, the rAAV2/9-CBA-Cre-GFP virus infected a much higher proportion of DRG neurons than the intraplantar injection, with up to 51.6% of infected lumbar DRG neurons. Noteworthy, both routes of injection predominantly transduced DRG neurons over spinal and brain neurons.

Limited impact of several years of pretreated wastewater discharge on fauna and vegetation in a mangrove ecosystem

It was hypothesized that mangroves, tropical wetlands, could be used for the finishing treatment of domestic wastewaters. Our aim was to determine if a nutrient-stressed mangrove could tolerate long-term discharges of pretreated wastewater (PW). Since 2008, in an in situ experimental system set up in Mayotte Island (Indian Ocean), domestic PW are discharged into two impacted areas (675 m²) dominated by different species of mangrove trees. Anthropogenic inputs during > 4.5 years led to an increase in vegetation growth associated with an increase in leaf pigment content, leaf surface and tree productivity. A marked increase in tree mortality was observed. There was no effect on crabs and meiofauna densities, but significant modifications of community structures. These effects may be directly linked to PW inputs, or indirectly to the modifications of the environment associated with higher tree growth. However, our results indicate that there was no major dysfunction the ecosystem.

The Delta Opioid Receptor in Pain Control

Nowadays, the delta opioid receptor (DOPr) represents a promising target for the treatment of chronic pain and emotional disorders. Despite the fact that they produce limited antinociceptive effects in healthy animals and in most acute pain models, DOPr agonists have shown efficacy in various chronic pain models. In this chapter, we review the progresses that have been made over the last decades in understanding the role played by DOPr in the control of pain. More specifically, the distribution of DOPr within the central nervous system and along pain pathways is presented. We also summarize the literature supporting a role for DOPr in acute, tonic, and chronic pain models, as well as the mechanisms regulating its activity under specific conditions. Finally, novel compounds that have make their way to clinical trials are discussed.

Delta opioid receptors recycle to the membrane after sorting to the degradation path

Soon after internalization delta opioid receptors (DOPrs) are committed to the degradation path by G protein-coupled receptor (GPCR)-associated binding protein. Here we provide evidence that this classical post-endocytic itinerary may be rectified by downstream sorting decisions which allow DOPrs to regain to the membrane after having reached late endosomes (LE). The LE sorting mechanism involved ESCRT accessory protein Alix and the TIP47/Rab9 retrieval complex which supported translocation of the receptor to the TGN, from where it subsequently regained the cell membrane. Preventing DOPrs from completing this itinerary precipitated acute analgesic tolerance to the agonist DPDPE, supporting the relevance of this recycling path in maintaining the analgesic response by this receptor. Taken together, these findings reveal a post-endocytic itinerary where GPCRs that have been sorted for degradation can still recycle to the membrane.

Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group

Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs' therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy.

The bacteriophage-derived transcriptional regulator, LscR, activates the expression of levansucrase genes in Pseudomonas syringae

Synthesis of the exopolysaccharide levan occurs in the bacterial blight pathogen of soybean, Pseudomonas syringae pv. glycinea PG4180, when this bacterium encounters moderate to high concentrations of sucrose inside its host plant. The process is mediated by the temperature-dependent expression and secretion of two levansucrases, LscB and LscC. Previous studies showed the importance of a prophage-associated promoter element in driving the expression of levansucrase genes. Herein, heterologous screening for transcriptional activators revealed that the prophage-borne transcriptional regulator, LscR, from P. syringae mediates expression of levansucrase. A lscR-deficient mutant was generated and exhibited a levan-negative phenotype when grown on a sucrose-rich medium. This phenotype was confirmed by zymographic analysis and Western blots which demonstrated absence of levansucrase in the supernatant and total cell lysates. Transcriptional analysis showed a down-regulation of expression levels of levansucrase and glycosyl hydrolase genes in the lscR-deficient mutant. Ultimately, a direct binding of LscR to the promoter region of levansucrase was demonstrated using electrophoretic mobility shift assays allowing to conclude that a bacteriophage-derived regulator dictates expression of bacterial genes involved in in planta fitness.

Expression of extra-cellular levansucrase in Pseudomonas syringae is controlled by the in planta fitness-promoting metabolic repressor HexR

BACKGROUND

Pseudomonas syringae pv. glycinea PG4180 causes bacterial blight on soybean plants and enters the leaf tissue through stomata or open wounds, where it encounters a sucrose-rich milieu. Sucrose is utilized by invading bacteria via the secreted enzyme, levansucrase (Lsc), liberating glucose and forming the polyfructan levan. P. syringae PG4180 possesses two functional lsc alleles transcribed at virulence-promoting low temperatures.

RESULTS

We hypothesized that transcription of lsc is controlled by the hexose metabolism repressor, HexR, since potential HexR binding sites were identified upstream of both lsc genes. A hexR mutant of PG4180 was significantly growth-impaired when incubated with sucrose or glucose as sole carbon source, but exhibited wild type growth when arabinose was provided. Analyses of lsc expression resulted in higher transcript and protein levels in the hexR mutant as compared to the wild type. The hexR mutant's ability to multiply in planta was reduced. HexR did not seem to impact hrp gene expression as evidenced by the hexR mutant's unaltered hypersensitive response in tobacco and its unmodified protein secretion pattern as compared to the wild type under hrp-inducing conditions.

CONCLUSIONS

Our data suggested a co-regulation of genes involved in extra-cellular sugar acquisition with those involved in intra-cellular energy-providing metabolic pathways in P. syringae.

Bilateral descending hypothalamic projections to the spinal trigeminal nucleus caudalis in rats

Several lines of evidence suggest that the hypothalamus is involved in trigeminal pain processing. However, the organization of descending hypothalamic projections to the spinal trigeminal nucleus caudalis (Sp5C) remains poorly understood. Microinjections of the retrograde tracer, fluorogold (FG), into the Sp5C, in rats, reveal that five hypothalamic nuclei project to the Sp5C: the paraventricular nucleus, the lateral hypothalamic area, the perifornical hypothalamic area, the A11 nucleus and the retrochiasmatic area. Descending hypothalamic projections to the Sp5C are bilateral, except those from the paraventricular nucleus which exhibit a clear ipsilateral predominance. Moreover, the density of retrogradely FG-labeled neurons in the hypothalamus varies according to the dorso-ventral localization of the Sp5C injection site. There are much more labeled neurons after injections into the ventrolateral part of the Sp5C (where ophthalmic afferents project) than after injections into its dorsomedial or intermediate parts (where mandibular and maxillary afferents, respectively, project). These results demonstrate that the organization of descending hypothalamic projections to the spinal dorsal horn and Sp5C are different. Whereas the former are ipsilateral, the latter are bilateral. Moreover, hypothalamic projections to the Sp5C display somatotopy, suggesting that these projections are preferentially involved in the processing of meningeal and cutaneous inputs from the ophthalmic branch of the trigeminal nerve in rats. Therefore, our results suggest that the control of trigeminal and spinal dorsal horn processing of nociceptive information by hypothalamic neurons is different and raise the question of the role of bilateral, rather than unilateral, hypothalamic control.

Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: a randomised controlled trial

OBJECTIVE

To assess the efficacy of electrosurgical bipolar vessel sealing using the LigaSure system during vaginal hysterectomy in comparison with conventional suture ligation method.

STUDY DESIGN

103 patients undergoing vaginal hysterectomy for benign conditions were randomised to either LigaSure or Suture groups. Each group was divided into two subgroups according to the degree of surgical difficulty.

RESULTS

Participants in the LigaSure had shorter procedure time (52.5 min vs. 90 min; p<0.001) and less blood loss (230 ml vs. 360 ml; p<0.001). Complication rates were not statistically different between the two groups. The advantage of the LigaSure system in reducing the operative blood loss was more pronounced in the more difficult procedures.

CONCLUSION

The LigaSure system reduces the operating time (by reducing pedicle-securing time) and blood loss without increasing the post-operative complication rates of vaginal hysterectomy. This beneficial effect was found to be more pronounced in difficult procedures.

CT-guided percutaneous cryotherapy of renal masses

PURPOSE

To assess the results of initial and current techniques for percutaneous renal cryotherapy, including long-term imaging outcomes.

MATERIALS AND METHODS

Computed tomography (CT)-guided percutaneous cryotherapy was performed on 49 masses in 48 outpatients and procedure comfort noted for each. These 49 masses included 36 primary renal cell carcinomas (RCCs), 3 oncocytomas, 1 angiomyolipoma, 6 renal inflammatory lesions, 2 benign parenchymal changes, and 1 colon cancer metastasis. All complications were graded according to standardized criteria.

RESULTS

Patients received only local anesthesia and moderate sedation during the procedure and were discharged with minimal discomfort within 4-6 hours. All cryotherapy zones were well defined by CT during ablation as hypodense ice with an average diameter of 5.3 cm, covering an average tumor size of 3.3 cm. Average ablation zone diameters showed significant reduction over time (P < .001), becoming significantly less than the original tumor size by 12 months (P < .05). Major and minor complications were seen in 3 (6%) and 11 (22%) procedures, respectively. At a mean follow-up of 1.6 years (range, 1 week to 3.8 years) for primary RCC patients, four failures (11.1%) by imaging criteria were noted, but one proved to be inflammatory tissue at re-biopsy (estimated neoplastic failure rate = 3/36 = 8.3%).

CONCLUSIONS

Percutaneous renal cryotherapy is a well-tolerated outpatient procedure that allows safe, CT monitoring of ice formation beyond visible tumor margins. With appropriate cryoprobe placements, a low failure rate appears less dependent on tumor size or location. Ablation volume involution was >80% after 6 months.

Weaning from mechanical ventilation: an open issue

Weaning from mechanical ventilation represents one of the main challenges facing ICU physicians. Difficult weaning affects about 25% of critical patients undergoing mechanical ventilation. Its duration correlates on one hand with pathophysiological aspects of the underlying disease and, on the other hand, with other factors such as the development of neuromyopathy of the critically ill patient, prolonged use of sedative-hypnotic drugs and, most of all, physicians' reluctance to identify the correct timing of therapeutic steps for weaning and subsequent extubation. The goal of adopting weaning protocols is to overcome problems due to an exclusively clinical opinion. Protocols have to be used together with daily clinical evaluation of the patient and the procedure must be carried out by an ICU team of both medical and nursing staff. Attempts to wean a patient from a ventilator and extubate him should be made through a spontaneous breathing trial (SBT) with T-tube or pressure support ventilation (PSV) with pressure support of 7-8 cmH(2)O +/- PEEP =/> 4 cmH(2)O. Proper recourse to non invasive mechanical ventilation (NIMV) and an accurate timing for tracheostomy are effective tools which can be used by physicians to facilitate weaning and to improve patient outcomes.

Modified Burch colposuspension: laparoscopy versus laparotomy

STUDY OBJECTIVE

To compare results of laparoscopic Burch colposuspension with those of classic Burch colposuspension, and to assess complications, results, and morbidity associated with each procedure.

DESIGN

Prospective, randomized study (Canadian Task Force classification I).

SETTING

Minimal access surgery unit.

PATIENTS

Seventy-four women with genuine stress incontinence.

INTERVENTION

Laparoscopic and classic Burch colposuspensions. MEASUREMENTS AND MEAN RESULTS: Mean operating times for laparoscopic and open surgery were 70.18 +/- 16.54 and 53+/- 10.05 minutes, respectively (p <0.001). Mean blood loss was 42.75 +/- 7.2 and 240.5 +/- 35.5 ml, respectively (p <0.001). Postoperative analgesia requirement was significantly less with laparoscopy (p <0.001). Mean postoperative hospital stay was 36 +/- 6.3 hours for the laparoscopic group and 76+/- 10.4 hours for the open group p<0.001). Average time to return to light work was 8.5 and 31.5 days, respectively. Success rates were 90.9% at 6 months and 87.9% at 18 months in the laparoscopic group, compared with 90% and 85%, respectively, in the open group.

CONCLUSION

Given equal efficacy of the two procedures, we prefer the laparoscopic approach since it is associated with lower morbidity, shorter hospital stay, and fewer complications. (J Am Assoc Gynecol Laparosc 8(1):99-106, 2001)

Role of passive T-cell death in chronic experimental autoimmune encephalomyelitis

The mechanisms of chronic disease and recovery from relapses in experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis, are unknown. Deletion of myelin-specific lymphocytes by apoptosis may play a role in termination of the inflammatory response. One pathway of apoptosis is the passive cell death or "cell death by neglect" pathway, which is under the control of the Bcl family of genes. To investigate the role of passive cell death pathway in EAE, we used mice with transgenic expression of the long form of the bcl-x gene (Bcl-x(L)) targeted to the T-cell lineage. We found that mice transgenic for Bcl-x(L) have an earlier onset and a more chronic form of EAE induced by myelin oligodendrocyte glycoprotein (MOG) peptide 35-55 compared with wild-type littermate mice. This was not due to an expanded autoreactive cell repertoire. Primed peripheral lymphocytes from Bcl-x(L) transgenic mice showed increased proliferation and cytokine production to MOG peptide in vitro compared with lymphocytes from wild-type animals. Immunohistologic studies demonstrated increased cellular infiltrates, immunoglobulin precipitation, and demyelination in the Bcl-x(L) transgenic central nervous system (CNS) compared with controls. There was also a decreased number of apoptotic cells in the CNS of Bcl-x(L) transgenic mice when compared with littermates at all time points tested. This is the first report of an autoimmune disease model in Bcl-x(L) transgenic mice. Our data indicate that the passive cell death pathway is important in the pathogenesis of chronic EAE. These findings have implications for understanding the pathogenesis of multiple sclerosis and other autoimmune diseases.

Evaluation of the impact of oral rehydration therapy on the outcome of diarrheal disease in a large community

Diarrheal diseases are a serious public health problem in the Gaza Strip, being the most important cause of hospitalization in infants and responsible for about half of postneonatal deaths, Oral rehydration therapy using oral rehydration solution (ORS), a formula recommended by WHO, has been proven effective in the treatment of dehydration in acute childhood diarrhea. The availability of a well-organized health service in Gaza provided an excellent opportunity to institute a large-scale project to evaluate the effectiveness of early ORS therapy in reducing diarrhea-related hospital admissions, mortality and malnutrition. A 3-year program was started in 1979, encompassing all community health centers and including intensive community education in the use of ORS. Compared with the prestudy year 1977, diarrhea-related hospital admissions were reduced by 35.3% in 1980 and 42.0% in 1981; hospital deaths from diarrheal diseases were reduced 34.4 and 37.4% in 1980 and 1981, respectively. Total deaths in the 0- to 3-year age-group were reduced by 28.7% in 1980 and by 41.7% in 1981. Diarrheal mortality was reduced by 35.6% in 1980 and 53.2% in 1981. This study succeeded in establishing active community and family participation.