Laparoscopic management of colovesical fistula in different clinical scenarios.

INTRODUCTION: Colovesical fistula (CVF) is a condition with various aetiologies and presentations. Surgical treatment is necessary in most cases. Due to its complexity, open approach is preferred. However, laparoscopic approach is reported in the management of CVF due to diverticular disease. The aim of this study was to analyse the management and outcome of patients with CVF of different aetiologies treated with laparoscopic approach. PATIENTS AND METHODS: This was a retrospective study. We retrospectively reviewed all patients undergoing elective laparoscopic management of CVF from March 2015 to December 2019. STATISTICAL ANALYSIS USED: None. RESULTS: Nine patients underwent laparoscopic management of CVF. There were no intraoperative complications or conversions to open surgery. A sigmoidectomy was performed in eight cases. In one patient, a fistulectomy with sigmoid and bladder defect closure was performed. In two cases of locally advanced colorectal cancer with bladder invasion, a multi-stage procedure with temporary colostomy was chosen. In three cases, with no intraoperative leakage, we did not perform bladder suture. Four Clavien I-II complications were recorded. Two fragile patients died in the post-operative period. No patients required re-operation. At a median follow-up of 21 months (interquartile range: 6-47), none of the patients had recurrence of fistula. CONCLUSIONS: CVF can be managed with laparoscopic approach by skilled laparoscopic surgeons in different clinical scenarios. Bladder suture is not necessary if leakage is absent. Informed counselling to the patient must be guaranteed concerning the risk of major complications and mortality in case of CVF due to malignant disease.

"What Is the Benefit?": Perceptions and Preferences for Long-Acting Injectable Antiretroviral Therapy Among People Living With HIV.

Long-acting injectable antiretroviral therapy (LA-ART) expands treatment options for people living with HIV (PLWH). This qualitative study characterizes LA-ART awareness, perceptions, and preferences among PLWH engaged in HIV care. From 2019 through 2021, we conducted semistructured in-depth interviews with 71 PLWH sampled from three clinics in three U.S. settings (North Carolina, Washington, DC, Massachusetts). Transcripts were analyzed using narrative and thematic techniques. Participant mean age was 46 years (range 24-72); most were cisgender men (55%) and virally suppressed (73%). Most participants had not heard of LA-ART and reacted with a mix of excitement and cautiousness. Potential LA-ART benefits included easier adherence, privacy, and effectiveness; concerns included effectiveness, side effects, costs, and increased clinic visits. Participants appreciated that LA-ART could support achieving and sustaining viral suppression. To inform their decision, participants wanted more information and convenient access and administration. Findings indicated that a shared decision-making approach and economic and logistical support for PLWH could facilitate LA-ART uptake.

Láser de baja frecuencia para aftas mayores recurrentes. Caso Clínico / Low frequency laser for major recurrent aphthous stomatitis. Clinical case

La estomatitis aftosa recurrente (menor, mayor o herpética) es una de las enfermedades bucodentales más frecuentes, de etiología multifactorial y con predisposición genética. Para esta patología su diagnóstico es clínico, y tomando como base la historia clínica se puede discriminar con otras patologías ulcerativas. La terapia con láser de baja potencia (LLLT) se propone como un tratamiento no invasivo, actuando como un fotomodulador celular, por lo que reduce el dolor, la inflamación, y estimula la regeneración tisular, previniendo daños. En el presente artículo se reporta a un niño de 11 años con una herida dolorosa de 4 meses en el borde posterior de la lengua que apareció tras una mordedura, en el que a la exploración clínica se encontró una lesión amarillenta con zonas enrojecidas, rodeada de un halo blanquecino de bordes redondeados. Para el tratamiento se utilizó LLLT, luego de una semana disminuyó el dolor, el paciente comenzó a comer correctamente, a los 15 días se observó una reducción de los bordes rojizos de la lesión, pasado el mes la lesión había remitido casi por completo. La LLLT se describe como un tratamiento eficaz, no invasivo, reduciendo los síntomas, y mejorando la calidad de vida del paciente al promover la curación de las lesiones.

Recurrent aphthous stomatitis (minor, major or herpetic) is one of the most frequent bucodental diseases, of multifactorial etiology and with genetic predisposition. The diagnosis of this pathology is clinical, and based on the clinical history it can be discriminated with other ulcerative pathologies. Low power laser therapy (LLLT) is proposed as a non-invasive treatment, acting as a cellular photo modulator, which reduces pain, inflammation, and stimulating tissue regeneration, preventing damage. This article reports an 11-year-old boy with a 4-month-old painful wound on the posterior edge of the tongue that appeared after a bite, in which clinical examination revealed a yellowish lesion with reddened areas, surrounded by a whitish halo with rounded edges. LLLT was used for the treatment, after one week the pain decreased, the patient started to eat properly, after 15 days a reduction of the reddish edges of the lesion was observed, after one month the lesion had almost completely remitted. LLLT is described as an effective, non-invasive treatment, which reduces symptoms and improves the patient's quality of life promoting the healing of the lesions.

A Comparison of Lymphoid and Myeloid Cells Derived from Human Hematopoietic Stem Cells Xenografted into NOD-Derived Mouse Strains.

Humanized mice are an invaluable tool for investigating human diseases such as cancer, infectious diseases, and graft-versus-host disease (GvHD). However, it is crucial to understand the strengths and limitations of humanized mice and select the most appropriate model. In this study, we describe the development of the human lymphoid and myeloid lineages using a flow cytometric analysis in four humanized mouse models derived from NOD mice xenotransplanted with CD34+ fetal cord blood from a single donor. Our results showed that all murine strains sustained human immune cells within a proinflammatory environment induced by GvHD. However, the Hu-SGM3 model consistently generated higher numbers of human T cells, monocytes, dendritic cells, mast cells, and megakaryocytes, and a low number of circulating platelets showing an activated profile when compared with the other murine strains. The hu-NOG-EXL model had a similar cell development profile but a higher number of circulating platelets with an inactivated state, and the hu-NSG and hu-NCG developed low frequencies of immune cells compared with the other models. Interestingly, only the hu-SGM3 and hu-EXL models developed mast cells. In conclusion, our findings highlight the importance of selecting the appropriate humanized mouse model for specific research questions, considering the strengths and limitations of each model and the immune cell populations of interest.

Revegetación natural de áreas afectadas por minería de oro en la selva pluvial tropical del Chocó, Colombia / Natural revegetation of areas impacted by gold mining in the tropical rain forest of Chocó, Colombia

Introducción: La minería de oro a cielo abierto ocasiona impactos drásticos sobre los bosques naturales en regiones tropicales de alta biodiversidad, y la eficiencia de "revegetación", un proceso de resembrar y reconstruir el suelo, continúa siendo poco estudiado. Objetivo: Evaluar el efecto del tiempo sucesional y la distancia al bosque de referencia sobre la estructura biológica y composición de especies en minas de oro revegetadas. Métodos: Realizamos inventarios de vegetación en minas abandonadas en el bosque tropical lluvioso de Chocó, Colombia. Las minas contaban con 6, 10, 15, 19 y 24 años de sucesión natural. En cada escenario, establecimos cuatro parcelas de 2×50 m: a 50 m y 100 m de distancia desde el borde bosque-mina (ecotono). Resultados: Se identificaron 300 especies (193 géneros y 75 familias). La riqueza, diversidad y equitatividad cambian poco con el tiempo sucesional en las minas, pero alcanzan valores superiores en el bosque de referencia. La composición de especies es similar entre las minas con distinto tiempo sucesional, pero difiere ampliamente del bosque de referencia (solo 7 % de semejanza). La calidad del sustrato y las estrategias reproductivas de plantas herbáceas (principalmente Cyperaceae y Melastomataceae) y arbóreas (Cespedesia spathulata y Miconia reducens) que crecen espontáneamente en las minas, juegan un papel importante en la revegetación natural temprana. Conclusiones: 24 años de sucesión natural es poco tiempo para apreciar una recuperación sustancial de la vegetación en las minas si se compara con el bosque, y la distancia desde el ecotono parece no tener efecto significativo; sin embargo, la calidad de sustrato y estrategias reproductivas de plantas herbáceas son importantes en la etapa temprana de recuperación de las áreas impactadas por la minería de oro en Chocó.

Introduction: Open pit gold mining causes drastic impacts on natural forests in tropical regions of high biodiversity, and the efficacy of "revegetation", a process of replanting and rebuilding the soil, is still poorly studied. Objective: To evaluate the effect of successional time, and distance to the reference forest, on the biological structure and species composition of revegetated gold mines. Methods: We inventoried the adjacent forest and abandoned gold mines in the tropical rain forest of Chocó, Colombia. The mines had 6, 10, 15, 19 and 24 years of natural succession. In each scenario, we set four 2 × 50 m plots: two 50 m and two 100 m from the forest-mine edge (ecotone). Results: We identified 300 plant species (193 genera, 75 families). The richness, diversity and evenness changed little with successional time in the mines but reached higher values in the forest. The species composition was similar between the mines with different successional times but differed widely from the forest (only 7 % similarity). The substrate quality and reproductive strategies of herbaceous plants (mainly Cyperaceae and Melastomataceae) and trees (Cespedesia spathulata and Miconia reducens) that grow spontaneously in the mines, play an important role on the early natural revegetation. Conclusions: The 24 years of natural succession have been insufficient to reach a community of a complexity similar to that of the forest, and distance from the ecotone has no significant effect; however, the substrate quality and reproductive strategies of herbaceous plants are important in the early stages of mine recovery in the Chocó.

Methylotrophs and Hydrocarbon-Degrading Bacteria Are Key Players in the Microbial Community of an Abandoned Century-Old Oil Exploration Well.

In this work, we studied the microbial community and the physicochemical conditions prevailing in an exploratory oil well, abandoned a century ago, located in the Cahuita National Park (Costa Rica). According to our analysis, Cahuita well is characterized by a continuous efflux of methane and the presence of a mixture of hydrocarbons including phenanthrene/anthracene, fluoranthene, pyrene, dibenzothiophene, tricyclic terpanes, pyrene, sesquiterpenes, sterane, and n-alkanes. Based on the analysis of 16S rRNA gene amplicons, we detected a significant abundance of methylotrophic bacteria such as Methylobacillus (6.3-26.0% of total reads) and Methylococcus (4.1-30.6%) and the presence of common genera associated with hydrocarbon degradation, such as Comamonas (0.8-4.6%), Hydrogenophaga (1.5-3.3%) Rhodobacter (1.0-4.9%), and Flavobacterium (1.1-6.5%). The importance of C1 metabolism in this niche was confirmed by amplifying the methane monooxygenase (MMO)-encoding gene (pmo) from environmental DNA and the isolation of two strains closely related to Methylorubrum rhodesianum and Paracoccus communis with the ability to growth using methanol and formate as sole carbon source respectively. In addition, we were able to isolated 20 bacterial strains from the genera Pseudomonas, Acinetobacter, and Microbacterium which showed the capability to grow using the hydrocarbons detected in the oil well as sole carbon source. This work describes the physicochemical properties and microbiota of an environment exposed to hydrocarbons for 100 years, and it not only represents a contribution to the understanding of microbial communities in environments with permanently high concentrations of these compounds but also has biotechnological implications for bioremediation of petroleum-polluted sites.

Management of colovesical fistula: a systematic review.

INTRODUCTION: Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. EVIDENCE ACQUISITION: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. EVIDENCE SYNTHESIS: The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. Four percent anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68-month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8-49%, 0-63% and 1.2%, respectively. CONCLUSIONS: CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and reanastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.

Influencia de un panel molecular de reacción de polimerasa en cadena múltiple en el diagnóstico o descarte de neumonía asociada a ventilación mecánica en una cohorte chilena de pacientes críticos con COVID-19

Resumen Introducción: La neumonía asociada a ventilación mecánica (NAVM) es frecuente en pacientes críticos con COVID-19. Su diagnóstico precoz es fundamental para su pronóstico. Objetivo: Demostrar la utilidad del panel FilmArray Pneumo (PFA-P) en la confirmación o descarte de NAVM en estos pacientes. Métodos: Estudio retrospectivo de 71 pacientes críticos con COVID-19 con sospecha de NAVM en quienes se realizó cultivos y PFA-P para confirmación diagnóstica. Se describen las características clínicas, microbiología y mortalidad. Se define la validez y seguridad de PFA-P. Resultados: El uso de FAP-P y cultivos descartó NAVM en 29 pacientes (40,8%). En 41 pacientes se confirmó NAVM y la mortalidad a 30 días fue 48,8%. Se estudiaron 48 muestras, los cultivos fueron positivos en 30 (62,5%) y se detectaron 33 bacterias, PFA-P detectó 32 de estas 33 bacterias; 37 bacterias fueron detectadas exclusivamente por PFA-P. Las bacterias prevalentes fueron Klebsiella pneumoniae (31,4%) Pseudomonas aeruginosa (21,4%) y Acinetobacter calcoaceticusbaumannii (14,2%). La sensibilidad, especificidad, valor predictor positivo y valor predictor negativo de PFA-P con respecto a cultivos fue 96,9%, 92,5%, 46,4% y 99,8, respectivamente. Un paciente tuvo NAVM por Burkholderia cepacia bacteria no detectada por FAP-P. Conclusiones: La FAP-P es una técnica molecular eficaz para descartar y diagnosticar la NAVM permitiendo una suspensión rápida de los antimicrobianos o un tratamiento dirigido temprano.

Abstract Background: Ventilator-associated pneumonia (VAP) is frequent in critical COVID-19 patients. Its early diagnosis is essential for its prognosis. Aim: To demonstrate the usefulness of the FilmArray Pneumo panel (FAP-P) in confirming or ruling out VAP in these patients. Methods: Retrospective study of 71 critical COVID-19 patients with suspected VAP in whom cultures and FAP-P were performed for diagnostic confirmation. Clinical characteristics, microbiology and mortality are described. The validity and safety of FAP-P is defined. Results: The use of FAP-P and cultures ruled out VAP in 29 patients (40.8%). In 41 patients, VAP was confirmed and the 30-day mortality was 48.8%. Forty-eight samples were studied, the cultures were positive in 30 (62.5%) and 33 bacteria were detected, FAP-P detected 32 of these 33 bacteria; 37 bacteria were exclusively detected by PFA-P. The most prevalent bacteria were Klebsiella pneumoniae (31.4%), Pseudomonas aeruginosa (21.4%) and Acinetobacter calcoaceticus-baumannii (14.2%). The sensitivity, specificity, positive predictive value and negative predictive value of FAP-P with respect to cultures were 96.9%, 92.5%, 46.4% and 99.8%, respectively. One patient had VAP due to Burkholderia cepacia bacteria not detected by FAP-P. Conclusions: FAP-P is an effective molecular technique to rule out and diagnose VAP, allowing rapid suspension of antibiotics or early targeted treatment.

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 2: Clinic-Pathologic Correlations.

Many studies have investigated the potential prognostic and predictive role of PD-L1 in prostatic carcinoma (PC). We performed a systematic literature review (PRISMA guidelines) to critically evaluate human tissue-based studies (immunohistochemistry, molecular analysis, etc.), experimental research (cell lines, mouse models), and clinical trials. Despite some controversial results and study limitations, PD-L1 expression by tumor cells may be related to clinic-pathologic features of adverse outcome, including advanced tumor stage (high pT, presence of lymph node, and distant metastases), positivity of surgical margins, high Grade Group, and castration resistance. Different PD-L1 positivity rates may be observed in matched primary PCs and various metastatic sites of the same patients. Over-fixation, type/duration of decalcification, and PD-L1 antibody clone may influence the immunohistochemical analysis of PD-L1 on bone metastases. PD-L1 seemed expressed more frequently by castration-resistant PCs (49%) as compared to hormone-sensitive PCs (17%). Some series found that PD-L1 positivity was associated with decreased time to castration resistance. Treatment with ipilimumab, cyclophosphamide/GVAX/degarelix, or degarelix alone may increase PD-L1 expression. Correlation of PD-L1 positivity with overall survival and outcomes related to tumor recurrence were rarely investigated; the few analyzed series produced conflicting results and sometimes showed limitations. Further studies are required. The testing and scoring of PD-L1 should be standardized.

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 1: Focus on Immunohistochemical Results with Discussion of Pre-Analytical and Interpretation Variables.

Immunotherapy targeting the PD-1-PD-L1 axis yielded good results in treating different immunologically ''hot'' tumors. A phase II study revealed good therapeutic activity of pembrolizumab in selected prostatic carcinoma (PC)-patients. We performed a systematic literature review (PRISMA guidelines), which analyzes the immunohistochemical expression of PD-L1 in human PC samples and highlights the pre-analytical and interpretation variables. Interestingly, 29% acinar PCs, 7% ductal PCs, and 46% neuroendocrine carcinomas/tumors were PD-L1+ on immunohistochemistry. Different scoring methods or cut-off criteria were applied on variable specimen-types, evaluating tumors showing different clinic-pathologic features. The positivity rate of different PD-L1 antibody clones in tumor cells ranged from 3% (SP142) to 50% (ABM4E54), excluding the single case tested for RM-320. The most tested clone was E1L3N, followed by 22C3 (most used for pembrolizumab eligibility), SP263, SP142, and 28-8, which gave the positivity rates of 35%, 11-41% (depending on different scoring systems), 6%, 3%, and 15%, respectively. Other clones were tested in <200 cases. The PD-L1 positivity rate was usually higher in tumors than benign tissues. It was higher in non-tissue microarray specimens (41-50% vs. 15%), as PC cells frequently showed heterogenous or focal PD-L1-staining. PD-L1 was expressed by immune or stromal cells in 12% and 69% cases, respectively. Tumor heterogeneity, inter-institutional preanalytics, and inter-observer interpretation variability may account for result biases.

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 4: Experimental Treatments in Pre-Clinical Studies (Cell Lines and Mouse Models).

In prostate cancer (PC), the PD-1/PD-L1 axis regulates various signaling pathways and it is influenced by extracellular factors. Pre-clinical experimental studies investigating the effects of various treatments (alone or combined) may discover how to overcome the immunotherapy-resistance in PC-patients. We performed a systematic literature review (PRISMA guidelines) to delineate the landscape of pre-clinical studies (including cell lines and mouse models) that tested treatments with effects on PD-L1 signaling in PC. NF-kB, MEK, JAK, or STAT inhibitors on human/mouse, primary/metastatic PC-cell lines variably down-modulated PD-L1-expression, reducing chemoresistance and tumor cell migration. If PC-cells were co-cultured with NK, CD8+ T-cells or CAR-T cells, the immune cell cytotoxicity increased when PD-L1 was downregulated (opposite effects for PD-L1 upregulation). In mouse models, radiotherapy, CDK4/6-inhibitors, and RB deletion induced PD-L1-upregulation, causing PC-immune-evasion. Epigenetic drugs may reduce PD-L1 expression. In some PC experimental models, blocking only the PD-1/PD-L1 pathway had limited efficacy in reducing the tumor growth. Anti-tumor effects could be increased by combining the PD-1/PD-L1 blockade with other approaches (inhibitors of tyrosine kinase, PI3K/mTOR or JAK/STAT3 pathways, p300/CBP; anti-RANKL and/or anti-CTLA-4 antibodies; cytokines; nitroxoline; DNA/cell vaccines; radiotherapy/Radium-223).

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 5: Epigenetic Regulation of PD-L1.

Epigenetic alterations (including DNA methylation or miRNAs) influence oncogene/oncosuppressor gene expression without changing the DNA sequence. Prostate cancer (PC) displays a complex genetic and epigenetic regulation of cell-growth pathways and tumor progression. We performed a systematic literature review (following PRISMA guidelines) focused on the epigenetic regulation of PD-L1 expression in PC. In PC cell lines, CpG island methylation of the CD274 promoter negatively regulated PD-L1 expression. Histone modifiers also influence the PD-L1 transcription rate: the deletion or silencing of the histone modifiers MLL3/MML1 can positively regulate PD-L1 expression. Epigenetic drugs (EDs) may be promising in reprogramming tumor cells, reversing epigenetic modifications, and cancer immune evasion. EDs promoting a chromatin-inactive transcriptional state (such as bromodomain or p300/CBP inhibitors) downregulated PD-L1, while EDs favoring a chromatin-active state (i.e., histone deacetylase inhibitors) increased PD-L1 expression. miRNAs can regulate PD-L1 at a post-transcriptional level. miR-195/miR-16 were negatively associated with PD-L1 expression and positively correlated to longer biochemical recurrence-free survival; they also enhanced the radiotherapy efficacy in PC cell lines. miR-197 and miR-200a-c positively correlated to PD-L1 mRNA levels and inversely correlated to the methylation of PD-L1 promoter in a large series. miR-570, miR-34a and miR-513 may also be involved in epigenetic regulation.

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 3: PD-L1, Intracellular Signaling Pathways and Tumor Microenvironment.

The tumor microenvironment (TME) includes immune (T, B, NK, dendritic), stromal, mesenchymal, endothelial, adipocytic cells, extracellular matrix, and cytokines/chemokines/soluble factors regulating various intracellular signaling pathways (ISP) in tumor cells. TME influences the survival/progression of prostate cancer (PC), enabling tumor cell immune-evasion also through the activation of the PD-1/PD-L1 axis. We have performed a systematic literature review according to the PRISMA guidelines, to investigate how the PD-1/PD-L1 pathway is influenced by TME and ISPs. Tumor immune-escape mechanisms include suppression/exhaustion of tumor infiltrating cytotoxic T lymphocytes, inhibition of tumor suppressive NK cells, increase in immune-suppressive immune cells (regulatory T, M2 macrophagic, myeloid-derived suppressor, dendritic, stromal, and adipocytic cells). IFN-γ (the most investigated factor), TGF-ß, TNF-α, IL-6, IL-17, IL-15, IL-27, complement factor C5a, and other soluble molecules secreted by TME components (and sometimes increased in patients' serum), as well as and hypoxia, influenced the regulation of PD-L1. Experimental studies using human and mouse PC cell lines (derived from either androgen-sensitive or androgen-resistant tumors) revealed that the intracellular ERK/MEK, Akt-mTOR, NF-kB, WNT and JAK/STAT pathways were involved in PD-L1 upregulation in PC. Blocking the PD-1/PD-L1 signaling by using immunotherapy drugs can prevent tumor immune-escape, increasing the anti-tumor activity of immune cells.

Toxoplasma cyst detection in Piringer-Kuchinka lymphadenitis. Report of two cases and literature review.

The diagnosis of acute toxoplasmic lymphadenitis is traditionally based on the combination of lymph node excisional biopsy with specific tests. The classic triad (marked follicular hyperplasia, small irregular clusters of epithelioid histiocytes in germinal centers, and sinusoidal distension by monocytoid B lymphocytes) is considered diagnostic of the so-called Piringer-Kuchinka lymphadenitis. Toxoplasma gondii organisms have been exceptionally disclosed in such histopathological setting, establishing the diagnosis of toxoplasmic lymphadenitis. Two cases of Piringer-Kuchinka lymphadenitis with toxoplasma cyst demonstration are reported, along with a complete review of the literature.

Gene expression and morphological responses of Lolium perenne L. exposed to cadmium (Cd2+) and mercury (Hg2+).

Soil contamination with heavy metals is a major problem worldwide, due to the increasing impact mainly caused by anthropogenic activities. This research evaluated the phytoremediation capacity of, Lolium perenne for heavy metals such as cadmium (Cd2+) and mercury (Hg2+), and the effects of these metals on morphology, biomass production, and the changes on gene expression. Seeds of L. perenne were exposed to six concentrations of Cd2+ and Hg2+ in the range of 0 to 25 mg L-1, and two mixtures of Cd2+-Hg2. The Non-Observed Effect Level (NOEL) was established with dose response curves and the expression of specific genes was evaluated applying a commercially available quantitative reverse transcription (RT-qPCR) assay. There was no significant effect when exposing the seeds to Hg2+, for Cd2+ the maximum concentration was established in 0.1 mg L-1, and for the two concentrations of mixtures, there was a negative effect. An increase of expression of genes that regulate antioxidant activity and stress was found when the plant was exposed to heavy metals. Given the high tolerance to metals analyzed that was reflected both, the development of the plant and in its molecular response, these results highlight that L. perenne is a plant with phytoremediator potential.

Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases.

Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.