L’assistance robotisée en chirurgie oncogynécologique: revue

The laparoscopic approach, over the past 20 years, has become, in Gyn Oncologic Surgery, a gold standard for several teams. Introduced 10 years ago, robot-assisted laparoscopy is increasingly used in the gynecologic surgical field. For the surgeon, the advantages of this intuitive robotic surgery are the three-dimensional approach, the precision of the dissection with robotic instrument articulation, and a shorter learning curve compared to conventional laparoscopy. For the patients, a quicker postoperative recovery, less postoperative pain, and lower blood loss compared to laparoscopy seems to emerge. This review summarizes all the published results of robotic assistance applied to cervical and endometrial cancer surgical management.     

Two-photon interactions at single fluorescent molecule level

Single-molecule spectroscopy and single-molecule detection are emerging areas that have many applications when combined with scanning, imaging, and spectroscopy techniques. We have combined a commercial confocal scanning head, to a Ti:sapphire laser and to an inverted microscope, for the detection of single molecule fluorescence of varies dyes by two-photon excitation. We collected spot images of fluorescent molecules that have been deposited on a substrate considering both blinking and photobleaching behavior of fluorescent spots. Here, we report data related to two-photon interactions that occur with the following fluorescent molecules: Indo-1, Rhodamine 6G, Fluorescein, and Pyrene. The choice of these specific dyes is based upon their wide use in biological and medical applications together with the varying complexity of their chemical structure that increases from Pyrene to Indo-1. Moreover, we report some data about single molecule studies related to denaturation of an enhanced green fluorescent protein, GFPmut2, under one photon excitation regime, that show a very similar trend to that observed for the already mentioned fluorescent molecules.     

Group I intron lateral transfer between red and brown algal ribosomal RNA

How group I introns originate in nuclear ribosomal (r)RNA genes is an important question in evolutionary biology. Central to this issue is the multitude of group I introns present in evolutionarily distantly related plant, fungal, and protist lineages, together with an understanding of their origin and lateral transfer from one exon to another, between cell organelles, and between cells. These introns vary considerably in primary and secondary structure; and their provenance from a few or perhaps many mobile elements that have spread in rRNAs is unknown. Here we show that a novel lineage of group IC1 introns inserted at position 516 (Escherichia coli gene numbering) in the small subunit rRNA in bangiophyte red algae and a brown alga (Aureoumbra lagunensis) are specifically related, although their host cells are not. These bangiophyte and Aureoumbra introns are the only known cases that have a helical insertion in the P5b helix. The highly conserved primary and secondary structure of the extra P5b helix suggests that it is important, although its specific function is unknown. Our study attempts to understand the origin and movement of these IC1 introns.     

Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience

Objective

The objective of this study is to demonstrate the feasibility of robotically assisted laparoscopy paraaortic lymphadenectomy (PAL), isolated or combined with another procedure using different surgical approaches.

Methods

From February 2007 to December 2010, 53 patients underwent paraaortic lymphadenectomy up to the left renal vein. We used three different approaches with three different positions for the robot in relation to the surgical procedure (isolated transperitoneal PAL, isolated extraperitoneal PAL, or transperitoneal PAL combined with another procedure). Thirty-nine patients underwent isolated lomboaortic lymphadenectomy and 14 a combined procedure. Information concerning installation time, operative time, peri- and postoperative complications, blood loss, lymph node count, and conversion rate was recorded.

Results

For the whole population, mean installation time was 33?±?18?min, mean operative time was 197?±?81?min, and mean hospital stay was 3.9?±?2.8?days. We observed 15.1% lymph node involvement at definitive pathology. Between isolated trans- and extraperitoneal PAL, only body mass index (BMI, 27.4 versus 22?kg/m²) was significantly different. No difference was observed concerning mean number of lymph nodes or hospital stay. We observed statistical difference between combined and isolated PAL concerning mean operative time (256 versus 160?min), mean number of lymph nodes (7.8 versus 14.6), and hospital stay (5.9 versus 2.9?days).

Conclusions

Although laparoscopic robotic-assisted PAL is a safe and feasible procedure, lymph node staging seems to be better if the procedure is isolated. In case of combined procedures, the surgical approach should be modified regarding patient BMI and the associated procedure, to increase lymph node count.     

Structural nucleotide analogs are potent activators/inhibitors of pancreatic β cell KATP channels: an emerging mechanism supporting their use as antidiabetic drugs

The 2H-1,4-benzoxazine derivatives are novel drugs structurally similar to nucleotides; however, their actions on the pancreatic β cell ATP-sensitive K+ (KATP) channel and on glucose disposal are unknown. Therefore, the effects of the linear/branched alkyl substituents and the aliphatic/aromatic rings at position 2 of the 2H-1,4-benzoxazine nucleus on the activity of these molecules against the pancreatic β cell KATP channel and the Kir6.2ΔC36 subunit were investigated using a patch-clamp technique. The effects of these compounds on glucose disposal that followed glucose loading by intraperitoneal glucose tolerance test and on fasting glycemia were investigated in normal mice. The 2-n-hexyl analog blocked the KATP (IC?? = 10.1 × 10?? M) and Kir6.2ΔC36 (IC?? = 9.6 × 10?? M) channels, which induced depolarization. In contrast, the 2-phenyl analog was a potent opener (drug concentration needed to enhance the current by 50% = 0.04 × 10?? M), which induced hyperpolarization. The ranked order of the potency/efficacy of the analog openers was 2-phenyl > 2-benzyl > 2-cyclohexylmethyl. The 2-phenylethyl and 2-isopropyl analogs were not effective as blockers/openers. The 2-n-hexyl (2-10 mg/kg) and 2-phenyl analogs (2-30 mg/kg) reduced and enhanced the glucose areas under the curves, respectively, after glucose loading in mice. These compounds did not affect the fasting glycemia as is observed with glibenclamide. The linear alkyl chain and the aromatic ring at position 2 of the 1,4-benzoxazine nucleus are the determinants, which confer the KATP channel blocking action with glucose-lowering effects and the opening action with increased glucose levels, respectively. The opening/blocking actions of these compounds mimic those that were observed with ATP and ADP. The results support the use of these compounds as novel antidiabetic drugs.     

Evidence of autonomic dysregulation in otherwise healthy cancer caregivers: a possible link with health hazard

Caregiving, an important component of cancer patient treatment, may set forth a cascade of stress responses such as sympatho-adrenal activation, immuno-humoral changes and an unhealthy lifestyle, which could be hazardous to caregivers' health. In this observational study, we addressed whether autonomic nervous system (ANS) regulation and perception of stress would be altered in a group of 58 health cancer caregivers as compared to 60 controls. We employed non invasive autoregressive spectral analysis of cardiovascular variabilities and ad hoc questionnaires. Caregivers show, in addition to signs of psychological involvement, a clear autonomic imbalance, suggestive of sympathetic predominance at rest and of a reduction of vagal cardiac regulation (overall gain of baroreflex -index alpha- was respectively of 17.5+/-1.5 versus 25.1+/-1.8 msec/mmHg, p<0.02). These data suggest possible preventive strategies, based on tailored treatments aiming at a betterment of individual autonomic profile.     

FokI Polymorphism of the Vitamin D Receptor Gene Correlates with Parameters of Bone Mass and Turnover in a Female Population of the Italian Island of Lampedusa

One of the most promising genetic approaches to dissecting a multifactorial disease is represented by genetically isolated population studies. We studied a genetic marker in a cohort of women living on the Mediterranean island of Lampedusa, a geographically isolated population. Lampedusa, located between the African coast and Sicily, consists of a young genetic isolate (<20 generations) with an exponential growth in the last generations. We analyzed the association between the FokI vitamin D receptor (VDR) gene polymorphism, previously proposed as a predictor of bone mass, with parameters of bone mass and turnover in a cohort of pre- and postmenopausal women living on Lampedusa. In 424 women (277 postmenopausal and 147 premenopausal), allelic frequencies were 49% for the F allele and 51% for the f allele. Using analysis of covariance, we found that subjects with ff genotype exhibited a significantly (P < 0.001) lower lumbar spine bone mass, by dual-energy X-ray absorptiometry, and lower values of bone ultrasonographic parameters (speed of sound and broadband ultrasound attenuation) relative to those with Ff and FF genotypes. Conversely, osteocalcin and serum cross-laps were significantly higher in ff and Ff compared to FF genotype. Our data suggest that FokI VDR polymorphism may contribute to the determination of bone mass and turnover in both pre- and postmenopausal women in this geographically isolated population.     

Erythema nodosum: etiological factors and relapses in a retrospective cohort study

Erythema nodosum (EN) is a septal panniculitis which may be associated with a wide variety of factors and disorders. In some patients it is?recurrent, but few studies have considered recurrent EN. Our aim was to describe the causes of and diseases associated with EN and relapsing EN. Patients diagnosed with EN from 1997 to 2007 were included. EN was defined as post-infective, based on temporal, clinical, laboratory and microbiological criteria. Diagnosis of drug-induced EN was based on a temporal correlation, on the relapse of EN after drug re-introduction and on the absence of relapsing EN with a continuous treatment with the imputed drug. When the above criteria were excluded and EN was not associated with an underlying systemic disease or pregnancy, it was considered idiopathic.124?patients (mean age 39.5 years; median 37?years; range 4-90 years) were visited and re-evaluated after one to ten years (mean ± SD follow up time 5 ± 4 years). In 73 (58.8%) patients an aetiology of the first manifestation of EN was attributed to infections (25.8% of the total number; 32% of those with an attributed aetiology), drugs (mostly sex hormones; 15.3%; 26%), systemic diseases (11.2%; 19.2%) and pregnancy (6.5%; 10.9%). EN relapsed in 33 (26.6%) patients and was mostly attributed to infections and drugs. Factors responsible for the first manifestation of EN frequently differed from those causing relapses in the same patients, with the exception of drug-induced EN. We conclude that drug-induced EN can recur after re-exposure to the same drug, and the recurrence can be predicted.