Fatty Acid Incorporation in the Muscle, Oxidative Markers, Lipid Peroxidation and PPAR-α and SREBP-2 Expression of Zebrafish Fed Linseed Oil and Clove Leaf Essential Oil.

The objective of this study is to assess, in zebrafish, the effects of combining linseed oil (LO) and clove leaf essential oil (CLEO) on the incorporation of fatty acids in the muscle, oxidative markers, lipid peroxidation and expression of the PPAR-α (Peroxisome Proliferator-Activated Receptor-α) and the SREBP-2 (Sterol Regulatory Element Binding Protein-2) genes. Six diets were prepared, containing combinations of LO (3, 6 and 9%) and CLEO (0.5 and 1%): 3% LO + 0.5% CLEO; 3% LO + 1% CLEO; 6% LO + 0.5% CLEO; 6% LO + 1% CLEO; 9% LO + 0.5% CLEO; 9% LO + 1% CLEO. Results showed increase in the incorporation of n-3 fatty acids in the muscle concomitantly with the addition of LO and CLEO. The activities of superoxide dismutase and catalase were reduced and the glutathione content had increased. Lipid peroxidation was lower in the treatment with 1% CLEO, regardless of LO content. The expression of the PPAR-α and the SREBP-2 genes was higher in animals fed 9% LO + 0.5% CLEO. Therefore, for a greater incorporation and protection against the oxidative damages of n-3 fatty acids, a combined use of 9% LO with 0.5% CLEO is recommended for zebrafish.

The use of self-assembling peptides (PuraStat) for hemostasis in cervical endocrine surgery. A real-life case series of 353 patients.

INTRODUCTION: Cervical endocrine surgery is frequent and carries the risk of rare but potentially life-threatening bleeding complications. Energy-based devices for stopping bleeding are not always usable in contact with nerves or parathyroid glands. Topical hemostatic agents may be an additional resource. PuraStat™, made of the self-assembling peptide RADA16, forms a new category of topical hemostatic agents. OBJECTIVE: To assess the performance and safety of PuraStat to achieve hemostasis in cervical endocrine surgery. METHODS: A retrospective chart review over four years was performed on 353 patients undergoing thyroidectomy and/or parathyroidectomy by a single senior surgeon, using PuraStat at the end of surgery in contact with recurrent nerves and parathyroid glands. RESULTS: 353 patients (79.06% female, mean age 54 years) underwent surgery with six weeks follow-up visit. Three patients had revision surgery for hematoma within the first 4 h (0.84%), which is within the low ranges reported in the literature. There was no delayed bleeding after 24 h, and dysphonia was observed in 15 patients, more severe for 2 patients (one unilateral and one bilateral palsy), and transient for the other 13 patients suggesting no product-related damage to the recurrent nerves. Hypocalcemia with clinical signs were reported in 8 cases. There were no unexpected adverse events. CONCLUSION: This is the first report of the use of PuraStat in patients undergoing cervical endocrine surgery, showing high performance and safety in achieving hemostasis and in preventing delayed bleeding without damage to the recurrent nerves. Further randomized controlled studies are needed to confirm the results.

Post-operative benefits of Tisseel(®)/Tissucol (®) for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial.

PURPOSE: The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate-severe complications of pain 12 months post-operatively compared with sutures. Further analyses may assist surgeons by investigating predictors of post-surgical complications and identifying patients that may benefit from Tisseel/Tissucol intervention. METHODS: Univariate and multivariate analyses identified risk factors for combined pain, numbness and groin discomfort (PND) visual analogue scale (VAS) score 12 months post-operatively. Variables tested were: fixation method, age, employment status, physical activity, nerve handling, PND VAS score at pre-operative visit and 1 week post-operatively. The effect of fixation technique on separate PND outcomes 12 months post-surgery was also assessed. Analyses included the intention-to-treat (ITT) population and a subpopulation with pre-operative PND VAS > 30 mm. RESULTS: 316 patients were included in the ITT, with 130 patients in the subpopulation with pre-operative PND VAS > 30. Multivariate analysis identified mesh fixation with sutures, worsening pre-operative PND and worsening PND 1 week post-surgery as significant predictors of 12-month PND in the ITT population; mesh fixation with sutures was a significant predictor of 12-month PND in the pre-operative PND VAS > 30 subpopulation (p < 0.05). Mesh fixation with Tisseel/Tissucol resulted in significantly less numbness and a lower intensity of groin discomfort compared with sutures at 12 months; there was no difference in pain between the treatment groups. CONCLUSIONS: Pre-operative discomfort may be an important predictor of post-operative pain, numbness and discomfort. Tisseel/Tissucol may improve long-term morbidity over conventional sutures in these patients.

An animal model to train Lichtenstein inguinal hernia repair.

PURPOSE: Inguinal hernia repair is a common surgical procedure, and the majority of operations worldwide are performed ad modum Lichtenstein (open tension-free mesh repair). Until now, no suitable surgical training model has been available for this procedure. We propose an experimental surgical training model for Lichtenstein's procedure on the male and female pig. METHODS: In the pig, an incision is made 1 cm cranially to the inguinal sulcus where a string of subcutaneous lymph nodes is located and extends toward the pubic tubercle. The spermatic cord is located in a narrow sulcus in the pig, thus complicating the procedure if operation should be done in the inguinal canal. The chain of lymph nodes resembles the human spermatic cord and can be used to perform Lichtenstein's hernia repair. RESULTS: This experimental surgical model has been tested on two adult male pigs and three adult female pigs, and a total of 55 surgeons have been educated to perform Lichtenstein's hernia repair in these animals. CONCLUSIONS: This new experimental surgical model for training Lichtenstein's hernia repair mimics the human inguinal anatomy enough to make it suitable as a training model. The operation facilitates the training in the positioning and fixation of the mesh and can be performed numerous times on the same pig. It is therefore a useful training method for inexperienced surgeons to obtain experience in aspects of the Lichtenstein procedure.

Production of L1 protein from different types of HPV in Pichia pastoris using an integrative vector.

Human papillomavirus (HPV) infection is the most common sexually transmitted disease in the world and is related to the etiology of cervical cancer. The most common high-risk HPV types are 16 and 18; however, the second most prevalent type in the Midwestern region of Brazil is HPV-33. New vaccine strategies against HPV have shown that virus-like particles (VLP) of the major capsid protein (L1) induce efficient production of antibodies, which confer protection against the same viral type. The methylotrophic yeast Pichia pastoris is an efficient and inexpensive expression system for the production of high levels of heterologous proteins stably using a wild-type gene in combination with an integrative vector. It was recently demonstrated that P. pastoris can produce the HPV-16 L1 protein by using an episomal vector associated with the optimized L1 gene. However, the use of an episomal vector is not appropriate for protein production on an industrial scale. In the present study, the vectors were integrated into the Pichia genome and the results were positive for L1 gene transcription and protein production, both intracellularly and in the extracellular environment. Despite the great potential for expression by the P. pastoris system, our results suggest a low yield of L1 recombinant protein, which, however, does not make this system unworkable. The achievement of stable clones containing the expression cassettes integrated in the genome may permit optimizations that could enable the establishment of a platform for the production of VLP-based vaccines.

Fibrin sealant in inguinal hernioplasty: an observational multicentre study in 1,201 patients.

PURPOSE: A prospective, multicentre, observational study was undertaken to assess Tisseel fibrin sealant for atraumatic mesh fixation in inguinal hernia repair throughout France. METHODS: Surgeons recorded data on patients undergoing tension-free inguinal hernioplasty with mesh fixation with Tisseel, regardless of the hernioplasty technique used. Assessments were made at 2 days and 1 month after surgery. Data on local complications, operation times and ease of product use were collected. RESULTS: In total, 1,201 patients were recruited (90% men, mean age 57 years), among which 526 procedures were performed using open techniques and 675 using laparoscopic repairs. Local complications occurred in 4.7% of patients: 3.0% haematoma, 1.4% seroma, 0.3% recurrence. The mean visual analogue scale (VAS)-rated pain scores were 3.2 pre-operatively, 2.3 immediately after surgery and 1.8 at 1 month. Surgeons rated the product as very easy to use. CONCLUSIONS: Tisseel fibrin sealant appears to be a well-tolerated and easy-to-use alternative to traditional, tissue-penetrating devices for mesh fixation in hernia repair techniques.

Micro macroporous biphasic ceramics and fibrin sealant as a moldable material for bone reconstruction in chronic otitis media surgery. A 15 years experience.

Bone reconstruction is still a matter of concern in middle ear surgery despite the large number of surgical techniques proposed. Combination of biphasic calcium phosphate bioceramics with human fibrin sealant forms a moldable material easy to apply for bone reconstruction. Since 1986, we have been using this composite for reconstruction of mastoid cavities during chronic otitis media surgery. Granules of ceramic provide immediate mechanical stability and later on, promote osseoinduction when fibrin sealant forms a strong bond between granules enhancing the wound healing process. After checking feasibility, efficacy and tolerance through a controlled study on dogs by filling mastoid cavities, we started a clinical series comprising yet 66 mastoid reconstructions. A retrospective data analysis on 63 patients with an average follow up of 42 months including 12 histological controls confirms the stability of bone reconstruction with a remarkable tolerance of the skin in contact. Biopsies confirmed progressive replacement of material by lamellar newly formed bone. Mastoid cavities have a randomed shape making complex bone reconstruction procedure and their filling by the composite constitutes an easy way and represents a highly satisfactory procedure. The authors considered that this should be explored in other indications of bone surgery.

[The otolaryngologist and Creutzfeldt-Jakob disease]. / L'oto-rhino-laryngologiste et la maladie de Creutzfeldt Jakob.

Is the ENT surgeon guilty of being a vector in Creutzfeldt-Jakob disease (CJD) in the past, present and future, with possible medico-legal implications, by virtue of his use of biomaterials and of his failure to sterilise surgical instruments adequately? Once the disease has been diagnosed, are there any implications for ENT? CJD is the most frequent clinical manifestation of the infectious subacute spongiform encephalopathies. It is invariably fatal within a few months, and at present there is no known treatment. Currently the diagnosis can be confirmed only by brain biopsy, but diagnostic tests are being developed. The causative agent belongs to the group of non-conventional transmissible agents, or prions, which are resistant to all conventional sterilisation methods. The illness has a long incubation period extending to several years, during which the abnormal prion protein (PPr), derived from a protein which is normally present, accumulates in the central nervous system. CJD is a rare condition, affecting less than one in a million of the population, and manifests itself in one of three distinct ways: sporadic, in 90% of cases, possibly due to a natural mutation of the gene responsible for formation of the protein, hereditary familial (5 to 10% of cases); and iatrogenic, transmitted by the implantation of biomaterials of human origin, which are the cases for which the ENT surgeon could be responsible, and which may affect any age group. The possible modes of ENT transmission have been identified. These could be the use of surgical material contaminated by a patient suffering from CJD, the use of human biomaterials whether dural homografts, ossicular homografts taken together with the donor dura, the use of blood products, or the use of biomaterials of bovine origin. Such materials have been used widely in the past without any observed increase in new CJD cases, but the incubation period of this disease is not well understood. A knowledge of the possible alternatives and of the new relations on the subject should allow us to improve the epidemiology of the condition, help the surgeon in his choice of materials, help in the diagnosis of the condition, and in avoiding its transmission by heeding new advice on sterilisation.

Macroporous biphasic calcium phosphate efficiency in mastoid cavity obliteration: experimental and clinical findings.

Following our previous experimental studies on the performance of macroporous biphasic calcium phosphate (MBCP) in canine mastoid cavities, we used this material in patients requiring surgical intervention. Twenty-two cases were selected, and in eight specific cases a biopsy specimen was taken. Histologic, ultrastructural, and microanalysis studies were performed. This study demonstrates the effectiveness of MBCP implants as bone graft substitutes for mastoid cavity obliteration. Clinical evaluation of the series and histologic and ultrastructural results demonstrated the bioactivity and osteo-conduction of this material, with partial transformation of MBCP granules into lamellar bone after several months.

Surtos familiares de gastroenterite aguda associados a rotavírus em Belém, Pará / Self-limited outbreak fo acute diarrhoea affecting three families in Belem, Para

Durante os microssurtos ocorridos em Belém, Pará, abril de 1986, foram estudadas 26 pessoas, distribuídas em 3 famílias residentes no bairro da Pedreira. Exames com vistas à detecçäo de bactérias, parasitos e agentes viróticos foram realizados nos espécimes fecais dos indivíduos envolvidos no surto, encontrando-se como único patógeno os rotavirus. Quatro amostras positivas para rotavírus foram detectadas pelo método imunoenzimático ("ELISA"), sendo esses vírus classificados como pertencentes ao subgrupo exhibirám os mesmos perfis eletroforéticos. A pesquisa de anticorpos grupo-específicos para rotavírus, através do método de "ELISA", revelou 3 soroconversöes, e que 84.2% dos adultos apresentaram níveis estacionários

Reinfecçöes por rotavírus em crianças de Belém, Pará, Brasil / Reinfections due to rotavirus in children of Belém, Pará, Brazil

Reinfecçöes por rotavírus foram detectadas em 7 (9,2%) de 76 crianças habitantes da periferia de Belém, Pará, Brasil, no decurso de seus primeiros 20 meses de vida. A presença de rotavírus classificados no subgrupo II ("long pattern") foi assinalada, tanta na primeira como segunda infecçöes, em cinco desses indivíduos. Em duas situaçöes, a primeira infecçäo foi causada por rotavírus subgrupo II e, a reinfecçäo, por rotavírus de subgrupo näo claramente caracterizado. Seis diferentes padröes foram observados, näo ocorrendo casos em que, numa única criança, se tenham assinalado perfis homólogos. O maior intervalo de tempo registrado entre duas infecçöes no mesmo indivíduo foi de 19 meses, enquanto que o menor, de 6. Formas sintomáticas em ambos os processos infecciosos se apresentaram em cinco crianças; em duas, os primeiros episódios revelaram-se assintomáticos, sucedendo-se quadros diarréicos. Em seis dos sete indivíduos, observaram-se soroconversöes para rotavírus durante a segunda infecçäo; durante a primeira, entretanto, a elevaçäo significativa nos níveis de anticorpos grupo-específicos se registrou em apenas um caso (Paciente F)