Transanal endoscopic surgery with a 3D printed device.

BACKGROUND: The aim of this study was to investigate the effectiveness of devices manufactured with 3D printing for performing transanal endoscopic procedures without pneumorectum. METHODS: Functional devices were designed in the Polytechnic School of Engineering of Gijón from 2016 to 2018 using three-dimensional (3D) solid modelling software (Solid-Works®), that allows customization of the device (diameter and length). The devices were made in acrylonitrile butadiene styrene (ABS) by additive manufacturing using an HP Designjet 3D Printer, with fused deposition modelling (FDM) technology. Tests were carried out on mixed simulators (with viscera) and cadavers with a prototype in the form of an open cylindrical base ellipsoid spindle with two bars. In this paper, we present the information of the first series of patients in which this device has been used to perform a full-thikness endoscopic resection of the rectal wall without pneumorectum. The characteristics of the patients, size, and location of the lesion, the type of anesthesia used, the duration of the procedure, hospital stay, complications, and pathology were analyzed. An endoscopic follow-up was also carried out for at least 2 years. RESULTS: Seven interventions were carried out in six patients. The lesions were located at a mean distance of 5 cm from the anal verge and an average area of 11.8 cm2. Four of the procedures were performed with general anesthesia and 3 with spinal anesthesia. Histopathology examination identified 3 adenomas, 3 pT1 and 1 pT2 adenocarcinomas. All excisions were full thickness. En bloc excision was possible in all cases. In only one case of a benign polyp there was a positive lateral margin. As regards complications, there was one case of postoperative rectal bleeding without the need for transfusions. There were no readmissions and no postoperative mortality. CONCLUSIONS: An innovative device made with a 3D printer can be used successfully in transanal endoscopic resections of the rectal wall, with spinal anaesthesia and avoiding the need for pneumorectum.

Short-day photoperiod increases milk yield in cows with a reduced dry period length.

Exposure of cows to a short-day photoperiod (SDPP; 8 h light:16 h dark) during a 60-d dry period increases milk yield in the subsequent lactation compared with cows exposed to a long-day photoperiod (LDPP; 16 h light:8 h dark). Whereas the traditional recommendation for dry period length is 60 d, recent studies indicate that the dry period length can be reduced without depressing the yield in the next lactation. However, the optimal duration of the dry period appears to be between 40 and 60 d, because fewer than 30 d could result in a significant loss of milk production. Our main objective was to determine whether treatment with SDPP combined with a reduced dry period length of 42 d would increase milk yield in the next lactation relative to treatment with LDPP, even though SDPP exposure was limited to 42 d. Multiparous Holstein cows (n = 40) were randomly assigned to 1 of 2 treatments during the dry period: LDPP or SDPP. Each treatment group (n = 20) was balanced according to the previous 305-d mature equivalent milk yield. To quantify plasma prolactin (PRL) concentration, blood samples were collected weekly during the dry period. Dry matter intake (DMI) was recorded during the dry period. Health was monitored weekly during the dry period and at calving. During lactation, milk yield and DMI were recorded for 120 and 42 d, respectively. Cows exposed to SDPP calved 4.8 d earlier than cows exposed to LDPP and days dry averaged 37 and 42 d for cows exposed to SDPP and LDPP, respectively. Cows on SDPP consumed more dry matter (17.0 +/- 1.1 kg/d) during the dry period than did cows on LDPP (15.9 +/- 1.1 kg/d), but DMI after parturition did not differ. In the first 42 d of lactation, cows exposed to SDPP and LDPP consumed 18.0 and 17.7 +/- 1.4 kg/d, respectively. The periparturient PRL surge was greater in cows exposed to LDPP (22.6 +/- 3.2 ng/mL) than in those exposed to SDPP (17.1 +/- 4.1 ng/mL). Milk yield was inversely related to the magnitude of the periparturient PRL surge, but was directly related to the expression of PRL-receptor mRNA in lymphocytes during the dry period. Through 120 d of lactation, cows exposed to SDPP when dry produced more milk (40.4 +/- 1.1 kg/d) than cows exposed to LDPP (36.8 +/- 1.1 kg/d). These results support the concept that SDPP, combined with a targeted 42-d dry period, increases milk yield in the subsequent lactation, relative to a 42-d dry period combined with LDPP, and that exposure to 42 d of SDPP in the dry period is sufficient to increase milk yield in the next lactation.

Complete Genome Sequences of Zika Virus Strains Isolated from the Blood of Patients in Thailand in 2014 and the Philippines in 2012.

Here, we present the complete genome sequences of two Zika virus (ZIKV) strains, Zika virus/Homo sapiens-tc/THA/2014/SV0127-14 and Zika virus/H. sapiens-tc/PHL/2012/CPC-0740, isolated from the blood of patients collected in Thailand, 2014, and the Philippines, 2012, respectively. Sequencing and phylogenetic analysis showed that both strains belong to the Asian lineage.

Voltage-activation of high-conductance K+ channel in the insulin-secreting cell line RINm5F is dependent on local extracellular Ca2+ concentration.

Patch-clamp single-channel current recording experiments have been carried out on intact insulin-secreting RINm5F cells. Voltage-activation of high-conductance K+ channels were studied by selectively depolarizing the electrically isolated patch membrane under conditions with normal Ca2+ concentration in the bath solution but with or without Ca2+ in the patch pipette solution. When Ca2+ was present in the pipette, 40 mV to 120 mV depolarizing pulses (100 ms) from the normal resting potential (-70 mV) regularly evoked tetraethylammonium-sensitive large outward single-channel currents and the average open state probability during the pulses varied from about 0.015 (40 mV pulses) to 0.1 (120 mV pulses). In the absence of Ca2+ in the pipette solution the same protocol resulted in fewer and shorter K+ channel openings and the open-state probability varied from about 0.0015 (40 mV pulses) to about 0.03 (120 mV pulses). It is concluded that Ca2+ entering voltage-gated channels raises [Ca2+]i locally and thereby markedly enhances the open-state probability of tetraethylammonium-sensitive voltage-gated high-conductance K+ channels.

Single-channel Ba2+ currents in insulin-secreting cells are activated by glyceraldehyde stimulation.

Single-channel Ba2+ current recordings have been made from the insulin-secreting cell line RINm5F with the patch-clamp technique. Depolarization evokes opening of Ca2+ (Ba2+) channels with a relatively high conductance (30 pS) and during the 200 ms depolarizing pulses there is no inactivation. The threshold is high as 50 mV depolarization from the resting membrane potential of -70 mV is required for any channel opening to occur. Glyceraldehyde, a substance evoking insulin secretion from the RINm5F cells, enhances the voltage-activated Ca2+ channel opening by increasing the mean open time and decreasing the longer of the two mean shut times and also decreases the voltage threshold for channel opening.

Distribution of catecholaminergic afferent fibres in the rat globus pallidus and their relations with cholinergic neurons.

The topographical distribution of catecholaminergic nerve fibres and their anatomical relationship to cholinergic elements in the rat globus pallidus were studied. Peroxidase-antiperoxidase and two-colour immunoperoxidase staining procedures were used to demonstrate tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), phenylethanolamine N-methyltransferase (PNMT) and choline acetyltransferase (ChAT) immunoreactivities, combined with acetylcholinesterase (AChE) pharmacohistochemistry. TH immunoreactive nerve fibres were seen to enter the globus pallidus from the medial forebrain bundle. The greatest density of such fibres was found in the ventral region of the globus pallidus, which was also characterized by the greatest density of ChAT immunoreactive neurons. TH immunoreactive nerve fibres showed varicose arborizations and sparse boutons, which were occasionally seen in close opposition to cholinergic structures. In all regions of the globus pallidus, there were also larger, smooth TH immunoreactive nerve fibres of passage to the caudate putamen. A smaller number of DBH immunoreactive nerve fibres and terminal arborizations were found in the substantia innominata, internal capsule and in the globus pallidus bordering these structures. A few PNMT immunoreactive nerve fibres in the substantia innominata and internal capsule did not enter the globus pallidus. Electron microscopy revealed TH immunoreactive synaptic profiles in the ventromedial area of the globus pallidus corresponding to the nucleus basalis magnocellularis of Meynert (nBM). These made mainly symmetrical and only a few asymmetrical synaptic contacts with dendrites containing AChE reaction product. The results indicate that cholinergic structures in the nBM are innervated by dopaminergic fibres and terminals, with only a very small input from noradrenergic fibres.

Predicting the biologic behavior of ductal carcinoma in situ: an analysis of molecular markers.

BACKGROUND: Ductal carcinoma in situ (DCIS) of the breast encompasses a heterogeneous group of noninvasive cancers that now represents 19% of new breast cancer cases. Optimal treatment remains controversial. We undertook this study to characterize the relationship between angiogenic markers and the biologic behavior of various DCIS phenotypes. METHODS: We performed histopathologic review and immunohistochemistry for p53, vascular endothelial growth factor (VEGF), and factor VIII-related antigen on 103 specimens of pure DCIS. RESULTS: VEGF expression was seen in 89 tumors (86%) and correlated with microvessel density (MVD). Among VEGF-negative tumors, mean MVD (number of microvessels per square millimeter) was 48 +/- 19, versus 117 +/- 7 for tumors expressing VEGF (P =.001). Strong p53 expression was observed in 28 tumors (27%) and was associated with comedo histology, high tumor grade, necrosis, high MVD, and ipsilateral tumor recurrence (all P < or =.03). Among 8 patients with ipsilateral recurrence, 5 (63%) had tumors with strong p53 expression, whereas only 24% of patients without recurrence had tumors with strong p53 expression (P =.03). Although 7 of 8 patients with ipsilateral recurrence had tumors with VEGF and high MVD, neither parameter achieved statistical significance. CONCLUSIONS: These data suggest that molecular alterations may help predict the biologic aggressiveness of DCIS. Mutant p53 expression predisposes the patient toward ipsilateral recurrence, perhaps by promoting angiogenesis. Further investigation may identify clinically useful markers and novel treatment strategies.

A prospective analysis of office-based breast ultrasound.

OBJECTIVE: To determine the usefulness of office-based breast ultrasound. DESIGN: Prospective, nonrandomized study. SETTING: Academic-affiliated community teaching hospital. PATIENTS: Among 653 consecutive patients seen in our office during a 30-month period, we performed 660 ultrasound examinations. The presenting complaint included a palpable mass in 53%, abnormal mammogram in 39%, and nipple discharge or retraction in 3%. INTERVENTION: Ultrasound examination was performed using a handheld 7.5-MHz linear array transducer. Findings and pertinent clinicopathologic data were recorded prospectively in our Breast Ultrasound Registry. MAIN OUTCOME MEASURE: Contribution of breast ultrasound to diagnosis and treatment. RESULTS: The sonogram was normal in 201 cases (30%), showed duct ectasia in 20 cases (3%), a simple cyst or seroma in 101 cases (15%), and a focal complex or solid abnormality in 338 cases (51%). Among the last group, 114 (97%) of 118 lesions thought to be benign on ultrasonography proved to be benign, whereas 13 (12%) of 111 indeterminate and 72 (75%) of 96 sonographically suspicious lesions proved to be cancer (including 13 cases with normal mammograms). Ultrasonographic features of malignancy included an anteroposterior-to-lateral dimension ratio of 1 or greater, heterogeneous hypoechoicity, irregular shadowing, and fuzzy and/or jagged margins. Ultrasound-guided needle biopsy accurately diagnosed 46 benign nonpalpable lesions and 20 malignant nonpalpable lesions. CONCLUSIONS: These data suggest that ultrasonography is a useful adjunct to clinical and mammographic evaluation of breast disease. Breast ultrasound identifies cysts, aids in differentiating benign from malignant lesions, and facilitates office needle biopsy of nonpalpable abnormalities, permitting timely and cost-effective patient care.

Detection of pancreatic tumors by ultrasound during surgery.

Real-time B-mode ultrasonic scanning was performed during 14 operations for pancreatic tumors. All operations were for adenocarcinoma, except in one patient with a Zollinger-Ellison tumor. The ultrasonic tissue appearance of pancreatic carcinoma was not specific. However, ultrasonic signs of pancreatic duct dilation, striction or invasion of the superior mesenteric veins, and common bile duct involvement may help to establish the diagnosis of malignancy. A triad of ultrasound signs indicative of malignant obstruction of the common bile duct consisted of (1) dilation, (2) absence of biliary stones, and (3) a distinctive termination pattern of the duct. Operative ultrasound was used to guide a biopsy needle to obtain pancreatic tissue samples. The Zollinger-Ellison tumor of the pancreas produced a sonolucent appearance that clearly distinguished it from the surrounding tissue.

Medialis dorsalis thalamic unitary response to tooth pulp stimulation and its conditioning by brainstem and limbic activation.

In nembutalized cats tooth pulp stimulation (TPS) was effective in exciting 18% of medialis dorsalis (MD) thalamic units. Facilitation of spontaneous MD unitary discharge followed high frequency stimulation of the lateral amygdala (25%), dorsal hippocampus (22%), mesencephalic reticular formation (20%) and septal nuclei (17%). Conditioning high-frequency stimulation of limbic and reticular structures, strongly facilitated the MD unitary responses to TPS. None of the thalamic neurons involved in nociception seems to project to the cerebral cortex. The conditioning effect on MD response of limbic and reticular stimulation suggests that these central structures may be involved in the modulation of the nociceptive input.

Correlating sonography, mammography, and pathology in the assessment of breast cancer size.

BACKGROUND: With the increasing use of neoadjuvant and minimally invasive therapy, the accuracy of preoperative determination of breast tumor size becomes important. Therefore, we undertook this study to compare mammography and ultrasonography (US). METHODS: A total of 180 invasive breast cancer patients were prospectively examined by mammography and US; 146 eligible patients had tumors visualized by both modalities. RESULTS: In 69% of cases, US was better than or equivalent to mammography in determining tumor size. Both underestimated tumor size; mean (median) underestimation was 3.8 +/- 0.7 mm (1.7 mm) by US and 3.5 +/- 0.9 mm (2 mm) by mammogram. Maximal tumor dimension was accurate within 5 mm in 65% of cases by mammography and 75% of cases by US. For mammographically determined size (versus pathologic size) correlation, r, was 0.4 and for US it was 0.63 and improved for only T1 and T2 tumors. CONCLUSIONS: These data suggest that US is more accurate than mammography in assessing breast cancer size.

Laparoscopic ultrasound enhances diagnostic laparoscopy in the staging of intra-abdominal neoplasms.

Routine laparoscopy and laparoscopic ultrasound (LUS) for staging intra-abdominal malignancies remains controversial. Thus, we undertook a prospective study to assess the value of preoperative laparoscopy with LUS for patients with intra-abdominal tumors judged resectable by preoperative studies. Laparoscopy was successfully performed in 76 of 77 patients, and 60 underwent LUS. Of 33 patients with presumed pancreatic cancer, laparoscopic findings changed the operative management of 11 patients, and LUS altered the management of an additional 6 patients. Laparotomy was avoided in 9 patients (27%). Among 14 patients with hepatobiliary tumors, laparotomy was avoided in 9 patients in whom laparoscopy and/or LUS revealed either benign or advanced disease. Operative management was altered in 4 of 18 patients with gastric or esophageal cancer by laparoscopic findings. LUS did not add to the management of these patients. Of 12 patients with presumed intra-abdominal lymphoma, 9 were diagnosed with lymphoma and 3 with benign disease, without laparotomy in all but 1 case. Laparoscopy and LUS are valuable tools for evaluating the resectability of pancreatic and hepatobiliary tumors. Laparoscopy, and to a lesser degree LUS, greatly facilitates diagnosing patients with intra-abdominal lymphomas and spares an occasional patient with esophagogastric carcinoma from undergoing laparotomy.

Use of ultrasound-guided fine needle aspiration biopsy in the management of thyroid disease.

Fine-needle aspiration biopsy (FNAB) of thyroid nodules has resulted in fewer patients needing thyroidectomy. Nondiagnostic FNAB specimens may require surgery for diagnosis. Ultrasound can help decrease nondiagnostic biopsies by visualizing lesions and guiding biopsy needles. Between 1996 and 1997, 76 patients had ultrasound-guided needle biopsies of thyroid nodules. Sixteen patients had clearly palpable nodules, whereas 19 were described as difficult to palpate. There were 32 patients who presented with either prominent thyroids or enlarged lobes. Six patients presented only with nonspecific symptoms, and 3 had nodules discovered incidentally on imaging studies. Biopsies were diagnostic in 73 of 76 (96%) patients. This varied with the size of the nodule, with the rate of nondiagnostic biopsies being 13 per cent in lesions <1.0 cm and 3 per cent in lesions >2.0 cm. Fifteen patients had surgery based on the FNAB, with a surgical yield of malignancy of 47 per cent. Ultrasound-guided FNAB is extremely useful in evaluating thyroid lesions that are difficult to palpate or nonpalpable, as well as the remainder of the gland and surrounding structures. The use of ultrasound guidance in performing FNAB results in a low rate of nondiagnostic biopsies, which may decrease the number of unnecessary thyroidectomies performed to rule out malignancy.

Laparoscopic herniorrhaphy in the geriatric population.

Laparoscopy has brought controversy to herniorrhaphy, particularly in the elderly. We reviewed our experience with this technique in patients older than 65 years at a single teaching institution. Data include demographics, American Society of Anesthesiologists (ASA) class, operative time, hernia type, type of repair, hospital stay, and complications. A telephone questionnaire was used to assess return to normal activity, recurrence, and reason for choosing the laparoscopic approach. From March 1992 through March 1996, 110 of 328 patients were eligible. Mean age was 73 +/- 5.6 years; 34 patients had bilateral and 20 had recurrent hernias; 73 patients (66.4%) were ASA-2, and 22 (20%) were ASA-3. The extra-abdominal and transabdominal preperitoneal approaches were used in 64 and 46 patients, respectively; mean operative time was 87.9 +/- 34 minutes. The overall complication rate was 15 per cent, with 71 per cent of these being urinary retention. Patients were discharged the same day (59%) and at 1 day (33%). Follow-up was available in 84.5 per cent. Recurrence rate was 9.7 per cent, which was not significantly influenced by complication rate, hernia repair type, or ASA class. Median return to normal activity was 7 days. ASA classification correlated with hospital stay (P = .02), but not with complications, recurrence, or return to normal activities (P = not significant). Laparoscopic herniorrhaphy appears safe in the elderly.

[Abscessed brucellar prostatitis. An infrequent location]. / Prostatitis brucelar abscesificada. Una localización poco frecuente.

Explanation of one case of abscessified brucellar prostatitis in a 44-year old patient. The emphasis is placed on the high incidence of brucellosis in the province of Soria and the rarity of the prostatic location of this condition. Also, a revision is made of the diagnostic methodology and current therapeutical approaches. The crucial role of the endocavitary ultrasound techniques both for diagnosis as well as treatment and case follow-up is highlighted.

[Renal brucelloma. A rare possible diagnosis]. / Bruceloma renal. Una rara posibilidad diagnóstica.

Presentation of one case of renal Brucelloma in a 61-year old patient. The emphasis is placed in the pathophysiology of the condition and the extraordinary rarity of its renal location. Also an explanation is proposed for the diagnostic methodology and the dissociation, typical in chronic brucellosis, of the different serologic testing. Finally, the increased incidence experimented by this condition in our environment, which involves the reappearance of clinical pictures today thought eradicated, is pointed out.

[Brucellar orchitis. Report of a series of 16 cases]. / Orquitis brucelar. Aportación de una serie de 16 casos.

A retrospective study of orchiepididymitis, diagnosed and admitted to our Unit over the 1989-94 period was conducted. there were 125 orchiepididymitis, of which 16 (12.8%) had a brucellar etiology, and three had simultaneously become abscessified (18.75%). Considering that our working area is located within an endemic region, and even more, our province has the country's highest incidence rate (112.8/100000 inh.), this prompted us to study the conditions' morbidity in the testicular location, while we make a superficial revision of this disease. Brucellar orchitis is a diagnostic option to be taken into account in endemic regions, and the clinical picture associated to the orchiepididymal process should make us suspect its diagnosis and trigger follow-up of these patients.

Correlation of rectal temperature and peripheral temperature from implantable radio-frequency microchips in Holstein steers challenged with lipopolysaccharide under thermoneutral and high ambient temperatures.

Early detection of disease can speed treatment, slow spread of disease in a herd, and improve health status of animals. Immune stimulation increases rectal temperature (RT). Injectable radio-frequency implants (RFI) can provide temperature at the site of implantation. The fidelity of peripheral site temperature, determined by RFI, relative to RT is unknown in cattle. We hypothesized that during lipopolysaccharide (LPS) challenge, temperature at 3 peripheral sites would be similar to RT in steers (n = 4; BW 77 ± 2.1 kg). The 3 sites were 1) subcutaneous (SC) at the base of the ear (ET); 2) SC posterior to the poll (PT); and 3) SC beneath the umbilical fold (UT). Steers were housed in controlled temperature (CT) rooms (between 18 and 21°C; n = 2/room). Rectal temperature, ET, PT, and UT were recorded every 8 h daily. On d 7, 21, 22, 36, and 37, RT and RFI were taken every 5 min for 6 h, every 15 min for 3 h, and every 30 min for 15 h. To test RFI during a simulated immune challenge, LPS (E. coli 055:B5) was injected intravenously (i.v.) at 1000 h on d 22 and 37. Basal temperatures (°C) were RT (38.7 ± 0.20), ET (37.1 ± 0.86), PT (36.7 ± 0.57), and UT (36.3 ± 0.97). Rectal temperature increased to 39.9 ± 0.30°C after LPS, but ET, PT, and UT decreased. Heat stress also increases RT, which makes it difficult to identify sick animals using RT. The second hypothesis tested was that ET positively correlates to RT and negatively correlates to RT during LPS under heat stress. Four steers (127 ± 7.3 kg) were housed in CT chambers (n = 2/chamber), implanted with a RFI, and allowed 2 wk to acclimate. One chamber remained at 20°C, the other was increased to 34°C starting at 0800 h for a period of 48 h. The LPS was administered i.v. to all steers at 1000 h on d 2. After a 2-wk recovery at 20°C, the temperature was increased in the other chamber, resulting in a crossover design with each steer serving as its own control. Pearson's correlation coefficients for ET and RT were 0.30 (P < 0.01) during heat stress, 0.20 (P < 0.05) during heat stress with LPS challenge, 0.34 (P < 0.01) during thermoneutrality, and -0.42 (P < 0.01) during thermoneutrality with LPS. These data refute the hypothesis that RT and peripheral temperature move in synchrony after LPS challenge. These data suggest that individual response be considered when identifying models for use of ET, but these RFI have potential for use in the early detection of diseases that alter basal temperature.