Skilled reaching training promotes astroglial changes and facilitated sensorimotor recovery after collagenase-induced intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is the most devastating type of stroke and a leading cause of disability and mortality worldwide. Although rehabilitation improves recovery after ICH the cellular mechanisms involved are poorly understood. We decided to examine if skilled (SK) and unskilled (US) training after sham or intracerebral hemorrhage (ICH) surgeries would induce GFAP+ astrocytic changes and whether these modifications can be associated with functional improvement. A 4-week course of motor training, involving either skilled and unskilled training began seven days after surgery; sensorimotor recovery was evaluated using Staircase, ladder walk and cylinder tests. Histological and morphometric analyses were used to assess GFAP+ cell bilaterally in forelimb sensorimotor cortex and dorsolateral striatum. All behavioral tests showed that ICH-SK rats experienced a greater degree of recovery when compared to ICH no task or ICH-US groups; no behavioral differences were found among all sham groups. Astrocytic density was increased in all analyzed structures for ICH no task, ICH-SK and ICH-US rats. Morphological analysis revealed an increased number of primary processes in ipsilateral (to lesion) sensorimotor cortex for all ICH groups. Present results also revealed that both ICH and SK induced an increased length of GFAP+ primary process; there was a further increase in length processes for ICH-SK group in sensorimotor cortex and ipsilateral striatum. We suggest that skilled reaching is an effective intervention to promote astrocytic plasticity and recovery after ICH.     

Production of Belite Based Clinker from Ornamental Stone Processing Sludge and Calcium Carbonate Sludge with Lower CO2 Emissions

Environmental concerns have come to the forefront due to the substantial role of the cement industry in the extraction and expenditure of natural resources. Additionally, industrial processes generate a considerable amount of waste, which is frequently disposed of inadequately. The objective of this study was to evaluate the simultaneous use of ornamental rock processing sludge and calcium carbonate sludge generated from the kraft process in the production of belitic clinker. These waste materials would be used in total or partial substitution of natural raw materials, namely, limestone and clay. Several formulations were produced and sintered at 1100 and 1200 °C. The raw materials were characterized physico-chemically and thermogravimetrically, with subsequent evaluation of the resulting dosed raw mixes. Mineral analyses determined that the mixtures with limestone and clay in substitution ratios of 95% and 100%, respectively, and sintered at 1100 °C have the potential to produce belite-rich clinkers. This temperature is considerably lower than those reported in reference studies. Additionally, full limestone and clay substitution could result in a 23.92% reduction in carbon dioxide in clinker production. The results confirmed the potential use of ornamental rock processing sludge and calcium carbonate sludge as viable alternative materials for cement production and, consequently, could contribute to a reduction in the negative environmental impacts of this industry.     

Transperitoneal robotic-assisted laparoscopic radical prostatectomy and inguinal herniorrhaphy

Patients undergoing radical prostatectomy are at increased risk of development of post-operative inguinal hernias (IH). We present the largest series of transperitoneal combined robotic-assisted laparoscopic prostatectomy (RALP) and IH. After IRB approval, data from patients undergoing RALP at two centers were prospectively entered into a database and analyzed. IH were repaired robotically via a transperitoneal route with mesh. Between June 2002 and May 2007, 837 RALPs were performed, 80 of which included combined IH repair (9.6%), by two surgeons, T.A. and D.S. Forty-two patients (52.5%) had IH on pre-operative exam. Twenty-four hernias were left, 32 right, and 24 bilateral. Twenty-two patients had prior ipsilateral or contralateral herniorrhaphy. After dissection of the hernia sac, a swatch of flat Marlex mesh (n = 22), a polypropylene mesh plug (n = 19), an Ultrapro hernia system (n = 7), a Proceed coated mesh (n = 19), a 3D-Max (n = 37), a combination of both umbrella and flat mesh (n = 3), or suture alone (n = 2) was used. Inguinal herniorrhaphy added approximately 15 min of operative time in all cases. There was one hernia recurrence over an average follow-up period of 12.5 months (0.2–52 months). There was one complication attributable to IH repair—a urine leak which was attributed to anastomotic stretch due to reperitonealization. Urological surgeons should perform a thorough inguinal exam during preoperative evaluation and intraoperatively to detect subclinical inguinal hernias. Inguinal herniorrhaphy at the time of RALP is safe and should be routinely performed.     

Spread of thermal energy and heat sinks: implications for nerve-sparing robotic prostatectomy

BACKGROUND AND PURPOSE: During nerve-sparing robot-assisted laparoscopic prostatectomy, nerve injury caused by thermal energy is a concern. Using a porcine model, we studied thermal spread and queried whether vessels such as the prostatic pedicle may act as a heat sink, reducing the spread of thermal energy. MATERIALS AND METHODS: Monopolar (MP) and bipolar (BP) cautery was applied laparoscopically on the anterior abdominal wall surface of six pigs with the da Vinci robot. Using fiberoptic thermometry (Luxtron Inc. Santa Clara, CA), temperatures were recorded with and without the interposed inferior epigastric vessels to evaluate the heat sink effect. RESULTS: Interposition of the inferior epigastric vessels definitively demonstrated a heat sink phenomenon: at 7 mm from the MP/BP energy source, temperatures rose 10.7 degrees C to 13.8 degrees C without interposed vessels versus only 1.9 degrees C to 2.5 degrees C when vessels were interposed (P < 0.001). CONCLUSION: The heat sink phenomenon suggests that the prostatic vascular pedicle should be protective of the neurovascular bundle during transection of the bladder neck during laparoscopic prostatectomy.     

Chronic brain hypoperfusion causes early glial activation and neuronal death, and subsequent long-term memory impairment

Reduction of cerebral blood flow is an important risk factor for dementia states and other brain dysfunctions. In present study, the effects of permanent occlusion of common carotid arteries (2VO), a well established experimental model of brain ischemia, on memory function were investigated, as assessed by reference and working spatial memory protocols and the object recognition task; cell damage to the hippocampus, as measured through changes in immunoreactivity for GFAP and the neuronal marker NeuN was also studied. The working hypothesis is that metabolic impairment following hypoperfusion will affect neuron and glial function and result in functional damage. Adult male Wistar rats were submitted to the modified 2VO method, with the right common carotid artery being occluded first and the left one week later, and tested seven days, three and six months after the ischemic event. A significant cognitive deficit was found in both reference and working spatial memory, as well as in the object recognition task, three and six months after surgery. Neuronal death and reactive astrogliosis were already present at 7 days and continued for up to 3 months after the occlusion; interestingly, there was no significant reduction in hippocampal volume. Present data suggests that cognitive impairment caused by brain hypoperfusion is long - lasting and persists beyond the time point of recovery from glial activation and neuronal loss.