Drainless robot-assisted minimally invasive oesophagectomy-randomized controlled trial (RESPECT)

BACKGROUND

The purpose of this randomized trial is to evaluate the early removal of postoperative drains after robot-assisted minimally invasive oesophagectomy (RAMIE). Evidence is lacking about feasibility, associated pain, recovery, and morbidity.

METHODS/DESIGN

This is a randomized controlled multicentric trial involving 72 patients undergoing RAMIE. Patients will be allocated into two groups. The "intervention" group consists of 36 patients. In this group, abdominal and chest drains are removed 3 h after the end of surgery in the absence of contraindications. The control group consists of 36 patients with conventional chest drain management. These drains are removed during the further postoperative course according to a standard algorithm. The primary objective is to investigate whether postoperative pain measured by NRS on the second postoperative day can be significantly reduced in the intervention group. Secondary endpoints are the intensity of pain during the first week, analgesic use, number of postoperative chest X-ray and CT scans, interventions, postoperative mobilization (steps per day as measured with an activity tracker), postoperative morbidity and mortality.

DISCUSSION

Until now, there have been no trials investigating different intraoperative chest drain strategies in patients undergoing RAMIE for oesophageal cancer with regard to perioperative complications until discharge. Minimally invasive approaches combined with enhanced recovery after surgery (ERAS) protocols lower morbidity but still include the insertion of chest drains. Reduction and early removal have been proposed after pulmonary surgery but not after RAMIE. The study concept is based on our own experience and the promising current results of the RAMIE procedure. Therefore, the presented randomized controlled trial will provide statistical evidence of the effectiveness and feasibility of the "drainless" RAMIE.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05553795. Registered on 23 September 2022.

Concurrent assessment of hepatic and intestinal cytochrome P450 3A activities using deuterated alfentanil

Alfentanil (ALF) is a validated probe for hepatic, first-pass, and intestinal cytochrome P450 (CYP) 3A activity, using plasma clearances, single-point concentrations, and noninvasive pupil diameter change (miosis). Assessing intravenous (i.v.) and oral drug disposition typically requires separate dosing. This investigation evaluated concurrent administration of oral deuterated and i.v. unlabeled ALF to assess both intestinal and hepatic CYP3A, and compare sequential and simultaneous dosing. ALF disposition was evaluated after strong hepatic and/or intestinal CYP3A induction and inhibition by rifampin, ketoconazole, and grapefruit juice. Using plasma ALF concentrations and area under the curve (AUC), clearance, or single-point concentrations, both simultaneous and sequential dosing provided equivalent results and detected hepatic and intestinal CYP3A induction and inhibition. Miosis better detected CYP3A modulation with sequential vs. simultaneous dosing. These results show that concurrent administration of oral deuterated and i.v. ALF, either sequentially or simultaneously, is an efficient and effective approach to assessing hepatic and intestinal CYP3A activity.

Psychopatholgy, fundamental assumptions and CD4 T lymphocyte counts in HIV-positive patients

OBJECTIVE

We investigated whether psychopathology in HIV-positive patients was associated with more negative fundamental assumptions than in healthy controls. In addition, we explored whether psychopathology and negative fundamental assumptions in HIV-positive patients were associated with lower CD4 T-lymphocyte counts.

METHOD

Self-rating questionnaires to assess depressive symptoms, posttraumatic stress symptoms, alcohol abuse, general psychopathology and fundamental assumptions, were completed by 123 HIV-positive patients and 84 uninfected clinic attendees at three primary health care clinics in the Western Cape, South Africa. CD4 T-lymphocyte counts were obtained from chart records.

RESULTS

HIV-positive patients reported more depressive and posttraumatic symptoms than uninfected individuals. However when controlling for socio-economic status, the number of traumatic events experienced and other potential confounds, no differences remained. Fundamental assumptions (FA) were mainly positive in both HIV-positive patients and controls and no correlations were found between fundamental assumptions, psychiatric symptoms and CD4 levels. However, in infected patients FA and psychopathology were negatively associated with all participants scoring in the positive range of the FA scale.

CONCLUSION

The positive scores on the FA scale indicate that positive assumptions are related to less psychopathology. Longitudinal studies investigating the association between the valence of fundamental assumptions and HIV morbidity are needed.

Expression of insulin pathway genes during the period of caste determination in the honey bee, Apis mellifera

Female honeybees have two castes, queens and workers. Developmental fate is determined by larval diet. Coding sequences made available through the Honey Bee Genome Sequencing Consortium allow for a pathway-based approach to understanding caste determination. We examined the expression of several genes of the insulin signalling pathway, which is central to regulation of growth based on nutrition. We found one insulin-like peptide expressed at very high levels in queen but not worker larvae. Also, the gene for an insulin receptor was expressed at higher levels in queen larvae during the 2nd larval instar. These results demonstrate that the insulin pathway is a compelling candidate for pursing the relationship between diet and downstream signals involved in caste determination and differentiation.

Beef cattle productivity under traditional and improved management in Botswana

A comparison of productivity over a 4-year period from indigenous type beef cattle under two production systems in Botswana is reported. The two systems are: the traditional system on unenclosed communal grazing (cattle post) and ranching within fenced paddocks. Calving percentages, 7-month old calf weight, calf mortality and post-weaning growth to 18 months of age under cattle post conditions were 46.4 per cent, 122.5 kg, 10.2 percent and 88.5 kg respectively. Corresponding figures for cattle on the fenced ranches were 74.0 per cent, 177.4 kg, 8.5 per cent and 105.8 kg. These results indicate overall productivity estimates of 51 and 120 kg of weaner calf per cow per year and 86 and 188 kg of 18-month old calf per cow per year for the cattle post and fenced ranch respectively.