Global projections of the soil microbiome in the Anthropocene.

AIM: Soil microbes are essential for maintenance of life-supporting ecosystem services, but projections of how these microbes will be affected by global change scenarios are lacking. Therefore, our aim was to provide projections of future soil microbial distribution using several scenarios of global change. LOCATION: Global. TIME PERIOD: 1950-2090. MAJOR TAXA STUDIED: Bacteria and fungi. METHODS: We used a global database of soil microbial communities across six continents to estimate past and future trends of the soil microbiome. To do so, we used structural equation models to include the direct and indirect effects of changes in climate and land use in our predictions, using current climate (temperature and precipitation) and land-use projections between 1950 and 2090. RESULTS: Local bacterial richness will increase in all scenarios of change in climate and land use considered, although this increase will be followed by a generalized community homogenization process affecting > 85% of terrestrial ecosystems. Changes in the relative abundance of functional genes associated with the increases in bacterial richness are also expected. Based on an ecological cluster analysis, our results suggest that phylotypes such as Geodermatophilus spp. (typical desert bacteria), Mycobacterium sp. (which are known to include important human pathogens), Streptomyces mirabilis (major producers of antibiotic resistance genes) or potential fungal soil-borne plant pathogens belonging to Ascomycota fungi (Venturia spp., Devriesia spp.) will become more abundant in their communities. MAIN CONCLUSIONS: Our results provide evidence that climate change has a stronger influence on soil microbial communities than change in land use (often including deforestation and agricultural expansion), although most of the effects of climate are indirect, through other environmental variables (e.g., changes in soil pH). The same was found for microbial functions such as the prevalence of phosphate transport genes. We provide reliable predictions about the changes in the global distribution of microbial communities, showing an increase in alpha diversity and a homogenization of soil microbial communities in the Anthropocene.

Colpocleisis para el tratamiento del prolapso de cúpula vaginal grave / Colpocleisis for the treatment ofadvanced vaginal vault prolapse

INTRODUCCIÓN: El prolapso de los órganos pélvicos (POP) es una condición cuya prevalencia aumenta con la edad. Es necesario que los cirujanos comprendan las indicaciones, riesgos, limitaciones y resultados de las varias técnicas quirúrgicas disponibles. En este artículo se aborda el tratamiento quirúrgico obliterativo del POP (colpocleisis y colpectomia) en base a la revisión de estudios. TÉCNICA: En la literatura son descritas muchas variaciones de las técnicas obliterativas. Con el objetivo de reglamentar la técnica para futuros estudios, describimos la técnica de LeFort modificada, realizada por los autores. Los métodos obliterativos tienen un tiempo operatório, morbilidad perioperatoria reducida y una tasa baja de recurrencia del prolapso. El índice de calidad de vida y satisfacción de la paciente son altos. CONCLUSIÓN: La literatura existente respecto a la colpocleisis es limitada por la calidad metodológica. Por tanto, no hay nivel de evidencia I o II, en lo que se refiere a la colpocleisis. Sin embargo, esta técnica debe hacer parte del arsenal terapéutico del cirujano en el abordaje de los prolapsos severos en mujeres mayores.

INTRODUCTION. The pelvic organ prolapse (POP) is a condition whose prevalence increases with age. Surgeons need to understand the indications, risks, constraints and results of various surgical techniques. This article is about obliterative surgical treatment of POP (colpocleisis and colpectomia) and it is based on the review of studies is discussed. TECHNICAL. In the literature are many variations of the techniques obliterative. In order to regulate the art for future study, we describe the technique of LeFort modified by the authors. The obliterative methods have operatory time, reduced perioperative morbidity and a low rate of recurrence of prolapse. The index ofquality oflife and patient satisfaction are high. CONCLUSION. The literature regarding the colpocleisis is limited by methodological quality. Therefore no evidence level I or II, in what concerns the colpocleisis. However, this technique should be part of the armamentarium of the surgeon in addressing severe prolapse in elderly women.

Tela de polipropileno versus correção sítio-especifica no tratamento do prolapso de parede vaginal anterior: resultados preliminares de ensaio clínico randômico / Polypropylene mesh vs. Site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial

OBJETIVO: Comparar o uso de tela de polipropileno e correção sitio-específica no tratamento cirúrgico do prolapso vaginal anterior. MÉTODOS: Estudo prospectivo randômico comparativo em que foram operadas 32 pacientes com idades entre 50 e 75 anos, que apresentavam prolapso vaginal anterior estádio III ou IV, ou recidivado. A estática pélvica foi avaliada segundo as recomendações da International Continence Society (ICS), o sistema POP-Q e pelo Índice de Quantificação de Prolapso (POP-Q-I) Absoluto e Relativo. Para o rastreamento da incontinência urinária de esforço oculta todas as pacientes, sintomáticas ou não, foram submetidas a estudo urodinâmico em posição semi-ginecológica e semi-sentada, com redução do prolapso com pinça de Cheron. Registrou-se o tempo cirúrgico, o volume de sangramento intra-operatório e as complicações intra e pós-operatórias. O tempo de seguimento médio do estudo foi de 8,5 meses. RESULTADOS: Em relação aos resultados anatômicos ocorreu melhores resultados com a utilização de tela de polipropileno sobre o reparo sitio-específico. Em relação à morbidade cirúrgica, observou-se menor tempo cirúrgico no grupo em que utilizou-se tela. CONCLUSÃO: Houve superioridade dos resultados anatômicos obtidos com a utilização de tela de polipropileno sobre o reparo sitio-específico.

OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11 percent risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29 percent chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.

Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina / A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: histeropexy versus histerectomy

OBJETIVO: Comparar os resultados anatômicos pós-operatórios de pacientes portadoras de prolapso uterino tratadas utilizando tela de polipropileno para correção dos defeitos do assoalho pélvico, comparando histerectomia vaginal com a preservação do útero. MÉTODO: Estudo randomizado com 31 mulheres portadoras de prolapso uterino estádio III ou IV (POP-Q) divididas em dois grupos: Grupo HV- 15 mulheres submetidas à histerectomia vaginal e reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) e Grupo HP- 16 mulheres mulheres submetidas à reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) preservando o útero. Raça, urgência miccional, constipação intestinal, dor sacral, sangramento e tempo de operação foram os parâmetros analisados. RESULTADOS: O tempo de seguimento médio foi de nove meses. Não se observou diferença entre os grupos nas complicações funcionais. O tempo cirúrgico foi 120 minutos para grupo HV versus 58.9 minutos para grupo HP ( p < 0.001 ) e o volume de perda sanguínea intraoperatória foi 120 mL no grupo HV versus 20 mL para grupo HP ( p < 0.001*). A taxa de sucesso objetivo foi 86.67 por cento para grupo HV e 75 por cento para grupo HP (p = 0,667). A taxa de erosão de tela foi 20 por cento (3/15) de extrusão no grupo HV versus 18,75 por cento (3/16) no grupo HP (p = 1,000). CONCLUSÃO: A correção cirúrgica do assoalho pélvico com telas nas portadoras de prolapso uterino apresentaram similaridade quer sendo ela feita com histeropexia quer com histerectomia. Contudo, o tempo cirúrgico e o volume da perda sanguínea foram significantemente maiores no grupo com histerectromia (HV). Operações vaginais com telas são procedimentos efetivos para a correção do prolapso.

OBJECTIVES: To compare surgical morbidity and time, as well as anatomical outcomes between vaginal histerectomy and uterine preservation in the treatment of uterine prolapse using a mesh kit (Nazca ®). METHODS: Randomized controled trial with 31 women with uterine prolapse POP-Q stage 3 or 4 pelvic organ prolapse who underwent vaginal surgery using tipe I polypropilene mesh (Nazca ®). They were randomized in two groups: group HV: hysterectomy and pelvic reconstruction floor with mesh (n=15); group HP: hysteropexy and pelvic reconstruction floor with mesh (n=16). Race, miccional urgency, intestinal constipation, sacral pain were assessed as well as the amount of bleeding and time of operation. RESULTS: Median follow-up was nine months on both groups. No difference was observed on complication rates and functional outcomes. Operation time was 120 minutes on group HV, versus 58.9 minutes on group HP (X² = 17.613*, p < 0.001 ) and intraoperative blood loss was 120 mL on group HV versus 20 mL on group HP (X² = 19.425*; p < 0.001). There was no differences in relationship to anatomical cure rates. Objective success rate was 86.67 percent to group HV and 75 percent to group HP (p=0,667) at nine months of follow-up. The anatomical results were similar between the two groups. CONCLUSION: The anatomic results between histeropexy and hysterectomy were similar. However, surgical time and blood loss were greater in group with histerectomies. The erosion rate were also similar. Vaginal surgery using mesh is an effective procedure for pelvic organ prolapse.

[A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: hysteropexy versus hysterectomy]. / Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina.

OBJECTIVES: To compare surgical morbidity and time, as well as anatomical outcomes between vaginal histerectomy and uterine preservation in the treatment of uterine prolapse using a mesh kit (Nazca). METHODS: Randomized controled trial with 31 women with uterine prolapse POP-Q stage 3 or 4 pelvic organ prolapse who underwent vaginal surgery using tipe I polypropilene mesh (Nazca). They were randomized in two groups: group HV: hysterectomy and pelvic reconstruction floor with mesh (n=15); group HP: hysteropexy and pelvic reconstruction floor with mesh (n=16). Race, miccional urgency, intestinal constipation, sacral pain were assessed as well as the amount of bleeding and time of operation. RESULTS: Median follow-up was nine months on both groups. No difference was observed on complication rates and functional outcomes. Operation time was 120 minutes on group HV, versus 58.9 minutes on group HP (X(2) = 17.613*, p < 0.001 ) and intraoperative blood loss was 120 mL on group HV versus 20 mL on group HP (X(2) = 19.425*; p < 0.001). There was no differences in relationship to anatomical cure rates. Objective success rate was 86.67% to group HV and 75% to group HP (p=0,667) at nine months of follow-up. The anatomical results were similar between the two groups. CONCLUSION: The anatomic results between histeropexy and hysterectomy were similar. However, surgical time and blood loss were greater in group with histerectomies. The erosion rate were also similar. Vaginal surgery using mesh is an effective procedure for pelvic organ prolapse.

Polypropylene mesh vs. site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial.

OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11% risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29% chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.

Infección intrahospitalaria por rotavirus en lactantes / Cross infection by rotavirus in infants

Con el objeto de estudiar la frecuencia y las características de la infección ent+érica intrahospitalaria, con especial referencia a rotavirus (RV), se hizo un seguimiento de tres salas con 7 camas cada una, de un sector del Hospital Roberto del río destinado a lactantes menores de 2 años con diarrea aguda. Al ingreso se tomó muestra de deposiciones para investigar Shigella, Salmonella y RV y de suero para medir anticuerpos antirotavirus. Durante trece meses se recolectó muestra de heces día por medio a todos los lactantes, estudiando RV mediante electroforesis del ARN viral. Durante seis meses se sacaron los enfermos RV (+) de una sala, para dejarla limpia de RV; en los meses siguientes se usó técnica de aislamiento individual, sin sacarlos de la sala. Se detectó 21,4 por ciento (105/491) de casos con RV al ingreso y 18,5 por ciento (90/491) de infección intrahospitalaria (IIH) por este virus. Hubo 3,5 por ciento de ingresos con Shigella y 1,4 por ciento de infección nosocomial poe este agente. La diarrea intrahospitalaria se observó en el 12,5 por ciento de los casos. No hubo influencia de las diferentes técnicas de aislamiento para prevenir la IIH por rotavirus. Esta fue mas frecuente durante la primera semana de hospitalización en menores de 6 meses y se presentó como casos esporádicos o como brotes epidémicos en la sala. El rotavirus subgrupo II predominó (85 por ciento) tanto en los ingresos como en los casos nosocomiales. El 72 por ciento de la IIH por RV fue subclínica. Se concluye que las medidas de aislamiento son adecuadas para controlar las infecciones por Shigella, pero no por Rotavirus. La alta contagiosidad de los RV podría deberse a que tengan una dosis infectiva muy baja y a que tal vez se trasmitan por vía aérea, además de la vía fecal-oral

Infección intrahospitalaria por rotavirus en lactantes, Santiago, Chile / Hospital rotavirus infection in infants, Santiago, Chile

En Santiago, Chile, entre 1979 y 1984 se investigó, mediante la técnica de electroforesis del ARN vírico, la infección por rotavirus en 1 033 niños menores de dos años hospitalizados por diarrea en el servicio de pediatría del Hospital Roberto del Río. La aparición frecuente de diarrea intrahospitalaria causada por rotavirus fue motivo de un estudio adicional de seguimiento en 139 niños hospitalizados entre septiembre y diciembre de 1983. En total, el 26,8% de los 1 033 ingresos fue positivo para rotavirus con porcentajes más altos entre los niños de 6 a 23 meses de edad y significativamente menores en los lactantes de 0 a 5 meses. Si bien los casos de diarrea aguda aumentaron en las épocas calurosas, los rotavirus se detectaron durante todo el año, con mayor frecuencia en otoño y predominio del subgrupo II. Un estudio preliminar de seguimiento intrahospitalario indicó que el 11,5% de los 139 lactantes hospitalizados presentó diarrea nosocomial causada en el 75% de los casos por rotavirus. Se concluye que estos resultados justifican investigaciones más profundas sobre la frecuencia de infecciones intrahospitalarias por rotavirus