Single-port hysterectomy with pelvic lymph node dissection in the porcine model: feasibility and validation of a novel robotic lightweight endoscope positioner

The purpose of this study was to evaluate the feasibility and validity of a modified single-port robotic lightweight endoscope in the performance of single-port hysterectomy with pelvic lymph node dissection in the porcine model. Task completion times were recorded for each component of the procedure: port placement, docking of the surgical robot, operative time for the procedures. For each task, linear regression modeling was performed using SPSS to determine whether a correlation existed between task completion time and increasing surgeon experience. All robotic-assisted LESS procedures were performed successfully without the addition of laparoscopic ports or open conversion. Regression analysis demonstrated a strong correlation between the number of procedures and task completion time for robot docking and pelvic lymph node dissection, correlation coefficients 0.74 and 0.77, p = 0.001, respectively. This study demonstrated the feasibility and effectiveness of a new, compact single-port robotic voice-activated endoscope at improving laparoscope guidance during the performance of single-port hysterectomy with pelvic lymph node dissection in the porcine model. Further work is needed to better define the ideal operative procedure for single-site surgery in oncology and integration of new single-port robotic platforms into clinical practice.     

Coexistencia de hipertensión intracraneal idiopática y drusas del nervio óptico en una paciente latinoamericana: reporte de caso

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optic nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare optic nerve drusen and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient.We present a case of a 34-year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and orbits. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound.To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension.     

Intracerebroventricular Administration of Streptozotocin as an Experimental Approach to Depression: Evidence for the Involvement of Proinflammatory Cytokines and Indoleamine-2,3-Dioxygenase

There is a lack of information about the molecular events underlying the depressive-like effect of an intracerebroventricular injection of streptozotocin (ICV-STZ) in mice. Elevated activity of the tryptophan-degrading enzyme indoleamine-2,3-dioxygenase (IDO) has been proposed to mediate depression in inflammatory disorders. In this study, we report that ICV-STZ activates IDO in the hippocampus of mice and culminates in depressive-like behaviors, measured by an increased duration in immobility time in the forced swimming test and decreased total time of grooming in the splash test. Indirect blockade of IDO activation with the cytokine inhibitor minocycline prevents the development of depressive-like behaviors and attenuates STZ-induced upregulation of proinflammatory cytokines in the hippocampus. Minocycline abrogates the increase in tryptophan and kynurenine levels as well as prevents serotonin dysfunction in the hippocampus of STZ-injected mice. These results suggest that hippocampal IDO activation in STZ-associated depressive-like behavior is mediated by proinflammatory cytokine-dependent mechanisms. Our study not only extends the evidence that IDO has a critical role in mediating inflammation-induced depression but also supports the notion that neuroinflammation and the kynurenine pathway are important targets of novel therapeutic drugs for depression. In addition, our study provides new insights into the neurobiological mechanisms underlying ICV-STZ and indicates that this model could be employed in the preclinical research of depression.     

Pregestational obesity,maternal morbidity and risk of caesarean delivery in a country in an advanced stage of obstetric transition

ObjectiveTo evaluate whether pregestational obesity is associated with the risk of caesarean section in pregnant women living in a country in an advanced stage of the obstetric transition.MethodsRetrospective cohort study. Data were collected from prenatal and hospital records. Pregestational obesity was defined as: body mass index, [weight(k)/height (m²)] ≥30, and caesarean sections were categorized as elective, emergency, or non-emergency/medically necessary. Biodemographic and sociodemographic characteristics, obstetric and perinatal pathologies, and maternal anthropometric variables were assessed. Chi-square and t-tests were used to compare qualitative and quantitative variables, respectively. Simple and adjusted generalized linear models were used to evaluate the association between pregestational obesity and caesarean delivery. Finally, population attributable risk was calculated. Data analysis was performed using STATA.v.14.0.Participants2309 pregnant women with a singleton pregnancy who gave birth at a public hospital in the Metropolitan Region of Santiago, Chile in 2015.ResultsThe prevalence of pregestational obesity was 21.4%, and the incidence of caesarean deliveries was 34.8% (33% of which corresponded to elective, 46% to emergency, and 21% to non-emergency/medically necessary caesarean deliveries). Pregestational obesity increased the risk of caesarean delivery (aRR = 1.46; 95%CI. [1.19–1.79] as well as the risk of elective (aRR = 1.74; 95%CI. [1.23–2.45]) and emergency caesarean delivery (aRR = 1.44; 95%CI. [1.03–2.00]). The population attributable risk of pregestational obesity for caesarean section was 32%.ConclusionGiven the significant association between pregestational obesity and caesarean delivery, it is necessary to develop strategies to decrease obesity among women of childbearing age in order to decrease obstetric intervention.     

Eucalypt plantation forestry in Chile

Eucalypt planting has increased rapidly in Chile in the last two decades, from 753 ha in 1974 to about 45 000 ha in 1992; there were an estimated 170 000 ha of plantations by 1992. The most widely planted species is Eucalyptus globulus, planted in the centre and south; E. nitens is planted in colder areas and E camaldulensis in the drier north-central zone. E. cladocalyx and E. sideroxylon have shown promise in arid zones, and E. regnans, E. fastigata and E. delegatensis in the south. About 60% of the plants produced in 1992 were raised in containers, and most big companies prefer containerized plants even though bare-root seedlings are cheaper to produce. Large companies invest in intensive establishment and management techniques (site preparation, fertilization and weed control) which are often mechanized. The most damaging pathogen in nurseries is Botrytis cinerea, while plantations on droughty sites are prone to attack by the stem-boring insect Phoracantha semipunctata. It is estimated that E. globulus and E. nitens can grow at 40 m³/ha/year on some sites such as the coast of the VIIIth region. Rotations of 8 to 10 years are envisaged for pulpwood production and up to 25 years for solidwood production. The main goal is the production of pulpwood, with a short-fibre mill of 235 000 tons annual capacity commissioned in 1991. Eucalypt pulp is used in another mill as a supplement to radiata pine fibre. Sawn timber, plywood, veneer, built-up board, fuelwood and essential oils are also obtained from eucalypt plantations. An equilibrium level of 300 000 ha of eucalypt plantations, a production of 600 000 tons of pulp and the export of 5 million tons of chips have been predicted for the year 2000. Some concerns have been raised about possible negative impacts of the dramatic increase in the area planted with eucalypts. Several genetic improvement programmes are under way. with the first clonal orchard of E. globulus planted in 1991 and several more being established. A major research effort on the clonal propagation of eucalypts will begin in 1993.     

Practice Patterns for Prevention of Chemotherapy-Induced Nausea and Vomiting and Antiemetic Guideline Adherence Based on Real-World Prescribing Data

BackgroundGuideline‐recommended antiemetic prophylaxis improves nausea and vomiting control in most patients undergoing chemotherapy. Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) antiemetic guidelines recommend prophylaxis with a neurokinin‐1 receptor antagonist (NK₁RA), a 5‐hydroxytryptamine‐3 receptor antagonist (5‐HT₃RA), and dexamethasone for patients receiving highly emetogenic chemotherapy (HEC), including anthracycline‐cyclophosphamide (AC)‐ and carboplatin (considered moderately emetogenic chemotherapy)‐based chemotherapy. Here, we analyze the use of NK₁RA–5‐HT₃RA–dexamethasone for antiemetic prophylaxis associated with HEC and carboplatin.MethodsThe data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and the U.K. were screened for treatment involvement and number of patients treated per month. Patients’ data from January to December 2018 were collected from medical charts and extrapolated on the basis of the total number of physicians who prescribe chemotherapy. The emetic risk of chemotherapy was classified per MASCC/ESMO guidelines.ResultsData from 45,324 chemotherapy‐treated patients were collected, representing a total extrapolated prevalence of 1,394,848 chemotherapy treatments included in the analysis. NK₁RAs were used in 45%, 42%, and 19% of patients receiving cisplatin‐, AC‐, and carboplatin‐based chemotherapy, respectively; 18%, 24%, and 7% received the guideline‐recommended NK₁RA–5‐HT₃RA–dexamethasone combination; no antiemetics were prescribed for 12% of the treatments. Often, physicians’ perception of the emetic risk of chemotherapy did not follow MASCC/ESMO guideline classification.ConclusionLow adherence to antiemetic guidelines was revealed in clinical practice in five European countries, with 15% of all HEC‐/carboplatin‐based treatments receiving guideline‐recommended NK₁RA–5‐HT₃RA–dexamethasone prophylaxis and 12% of them receiving no antiemetics. New strategies for improving guideline adherence are urgently needed.Implications for PracticeDespite recent advances in antiemetic therapy, a substantial proportion of patients experience nausea and vomiting associated with chemotherapy in daily clinical practice. Antiemetic guidelines aim at prevention of chemotherapy‐induced nausea and vomiting (CINV), and guideline‐consistent antiemetic therapy can effectively prevent vomiting and, to a lesser extent, nausea in most patients with cancer. This study reports low adherence to antiemetic guidelines in the highly emetogenic chemotherapy setting in daily clinical practice across five European countries. Opportunity exists to increase adherence to antiemetic guideline recommendations. Implementation of strategies to facilitate guideline adherence can potentially improve CINV control.     

Enfermedad de Von Hippel Lindau: estudio familiar

Case reportThe case of 5 members of a family who suffer from Von Hippel-Lindau disease (VHL) is presented. It is shown that retinal capillary hemangioma was the main ophthalmic symptom, with hemovitreous and tractional retinal detachment as the main complications.DiscussionVHL disease is rare, but very serious, even fatal, thus it is important to obtain an early diagnosis by ophthalmoscopy, in order to change the visual prognosis and life expectancy, not only for the patient, but also for the family.