Cutaneous perforators of the peroneal artery: Cadaveric study with implications in the design of the osteocutaneous free fibular flap

Bilateral dissection of 15 formalin embalmed cadaver legs was performed in order to study the anatomic pattern of the peroneal artery (PA) and its cutaneous perforating vessels (CB). The total number of CB from the PA was 125 or an average of 4.17 branches per leg. CB were distributed in the superoinferior axis between 18.25 and 84.25% of the length of the fibula and their average length was 5 ± 1.8 cm. 86/125 (68.8%) of the CB were classified as myocutaneous branches (MC) that penetrated muscle before reaching the skin, whereas 39/125 (31.2%) were septocutaneous branches (SC) that passed through the intermuscular septum. The mean distance between the posterior border of the fibula and the site where the perforators emerged was 1.88 ± 0.79 cm for the SC and 1.21 ± 0.87 cm for the MC. These anatomic findings should encourage the surgeon to design the skin paddle in the boundary between the middle and the distal third of the fibular length about 2 cm behind the posterior fibular border on the posterolateral leg, where the number of CB is maximal. Clin. Anat. 22:826–833, 2009. © 2009 Wiley‐Liss, Inc.     

Gut microbiome: Linking together obesity,bariatric surgery and associated clinical outcomes under a single focus

Obesity is increasingly prevalent in the post-industrial era, with increased mortality rates. The gut microbiota has a central role in immunological, nutritional and metabolism mediated functions, and due to its multiplexity, it is considered an independent organ. Modern high-throughput sequencing techniques have allowed phylogenetic exploration and quantitative analyses of gut microbiome and improved our current understanding of the gut microbiota in health and disease. Its role in obesity and its changes following bariatric surgery have been highlighted in several studies. According to current literature, obesity is linked to a particular microbiota profile that grants the host an augmented potential for calorie release, while limited diversity of gut microbiome has also been observed. Moreover, bariatric surgery procedures represent effective interventions for sustained weight loss and restore a healthier microbiota, contributing to the observed fat mass reduction and lean mass increase. However, newer evidence has shown that gut microbiota is only partially recovered following bariatric surgery. Moreover, several targets including FGF15/19 (a gut-derived peptide), could be responsible for the favorable metabolic changes of bariatric surgery. More randomized controlled trials and larger prospective studies that include well-defined cohorts are required to better identify associations between gut microbiota, obesity, and bariatric surgery.     

The effect of intense passive apnea in the acid-base balance and electrolytes

The aim of this study was to investigate the disturbances of the acid-base balance and electrolyte disorders in healthy individuals in the greatest passive apnea (prior to apnea and prior to first inhalation). The changes of the acid-base balance, the serum potassium and calcium levels as well as the disturbances of the cardiac rhythm were studied in a group of 15 healthy males aged 18 to 41 years old. Seven individuals part of the original group participated in a second trial. Following the initial apnea trial the individuals were allowed to 2-3 free inhalations and a second passive apnea effort was performed. The same parameters were measured in the second effort. In the primary effort the apnea duration was 170 +/- 53 s (mean +/- SD). The results received prior to the effort and immediately before the end of the apnea (paired t-test), showed no significant changes in the blood pH. The PaCO2 increased significantly, the PaO2 decreased significantly, blood bicarbonate increased significantly, the hemoglobin oxygen saturation decreased significantly. In addition the serum potassium and calcium levels decreased significantly. In the subgroup (7 individuals) the second effort of apnea lasted 50-70 s and showed no significant changes in the blood pH. The same changes concerning PaCO2 and blood bicarbonate were observed in the first and second effort of passive apnea. The serum potassium and calcium levels as well as the hemoglobin oxygen saturation showed no significant changes. During the initial effort of apnea all men presented bradycardia, which was followed by tachycardia immediately after the end of the effort. One individual, whose effort lasted 290s suffered intense tachycardia, cyanosis, convulsions, and loss of consciousness. It is concluded that during an intense effort of passive apnea: (a) the blood PaCO2 is significantly increased, as well as the blood bicarbonates, (b) the PaO2, the hemoglobin oxygen saturation and the serum potassium and calcium levels are significantly decreased, (c) the cardiac rate is significantly decreased, and (d) the second effort of apnea, following immediately the initial one, is sorter in duration and produces similar or milder changes of the above parameters.     

Pelvic pain in urogynecology. Part II: treatment options in patients with lower urinary tract symptoms

Therapeutic options for chronic pelvic pain in women offer only a limited symptom relief. Especially in the patient with lower urinary tract symptoms (LUTS), where overlap of pain, storage and voiding symptoms is common, data on the efficacy of treatment of pain are limited. We conducted a literature review to detect articles which pertained to female patients with LUTS and pelvic pain and we included articles which evaluated the efficacy of the treatment of pelvic pain. Forty-one articles were detected, which included nerve stimulation (sacral and pudendal), intravesical instillations and injections, oral pharmacological treatments, periurethral injections as well as physical and manual therapy as treatment options. Only five controlled trials were found, which did not show superiority of the active treatment versus placebo. Although some treatment options show promising results in the treatment of pelvic pain in patients with LUTS, more randomised controlled trials are needed to confirm these results.     

Investigation of a Novel Multicomponent Mycotoxin Detoxifying Agent in Amelioration of Mycotoxicosis Induced by Aflatoxin-B1 and Ochratoxin A in Broiler Chicks

The present study was designed to determine the efficacy of a novel multicomponent mycotoxin detoxifying agent (MMDA) containing modified zeolite (Clinoptilolite), Bacillus subtilis, B. licheniformis, Saccharomyces cerevisiae cell walls and silymarin against the deleterious effects of Aflatoxin B₁ (AFB₁) and Ochratoxin A (OTA) in broiler chicks. A total of 160 one-day-old Ross 308^® broiler chicks were randomly allocated in four treatment groups, with four replicates, according to the following experimental design for 42 days. Group A received a basal diet; Group B received a basal diet contaminated with AFB₁ and OTA at 0.1 mg/kg and 1 mg/kg, respectively; Group C received a basal diet contaminated with AFB₁ and OTA and MMDA at 1 g/kg feed, and Group D received a basal diet contaminated with AFB₁ and OTA and MMDA at 3 g/kg feed. Results showed that ingested mycotoxins led to significant (p ≤ 0.05) reduction in body weight and feed conversion from 25 days of age, induced histopathological changes, increased the pH of the intestinal content, and altered the biochemical profile of birds with significantly (p ≤ 0.05) increased aspartate aminotransferase (AST) values (p ≤ 0.05). On the other hand, the supplementation of MMDA significantly (p ≤ 0.05) improved the feed conversion ratio (FCR) during the second part of the study, diminished biochemical alterations, reduced pH in jejunal and ileal content, and E. coli counts in the caeca of birds (p ≤ 0.05). It may be concluded that the dietary supplementation of the MMDA partially ameliorated the adverse effects of AFB₁ and OTA in broilers and could be an efficient tool in a mycotoxin control program.     

Perioperative adverse events associated with pelvic organ prolapse repair by nerve-preserving sacropexy: an analysis of 768 cases over a 10-year period

Purpose

Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS? in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term.

Methods

This prospective longitudinal study included women with twin (n = 27) or singleton pregnancies (n = 62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24–36 and 48–72 h postpartum.

Results

By 24–36 h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P < 0.0001), after which it abruptly began to decline until reaching a nadir 24–36 h after delivery (P < 0.0001), while it remained steady throughout the CS and then dropped until 24–36 h after delivery in the twin group (P < 0.05). None of the studied parameters differed significantly between the groups for the 24–36 and 48–72 h postpartum measurements.

Conclusions

Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS? in assessing cardiovascular-related pregnancy complications are warranted.

     

Role of exercise in preventing and restoring gut dysbiosis in patients with inflammatory bowel diseases: A review

Inflammatory bowel diseases (IBD) include a spectrum of chronic inflammatory disorders of the gastrointestinal tract whose pathogenesis is yet to be elucidated. The intestinal microbiome has been studied as a causal component, with certain microbiotic alterations having been observed in subtypes of IBD. Physical exercise is a modulator of the intestinal microbiome, causing shifts in its composition that are partially corrective of those observed in IBD; furthermore, physical exercise may be beneficial in patients with certain IBD subtypes. This review studies the effects of physical exercise on the human gut microbiome while investigating pathophysiologic mechanisms that could explain physical activity’s clinical effects on patients with IBD.