Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Extraction and Concentration of Spirulina Water-Soluble Metabolites by Ultrafiltration.

Spirulina (Arthospira platensis) is known for its rich content of natural compounds like phycocyanin, chlorophylls, carotenoids, and high protein levels, making it a nutrient-dense food. Over the past decade, research has aimed to optimize the extraction, separation, and purification of these valuable metabolites, focusing on technologies such as high-pressure processing, ultrasound-assisted extraction, and microwave-assisted extraction as well as enzymatic treatments, chromatographic precipitation, and membrane separation. In this study, various extraction methods (conventional vs. ultrasound-assisted), solvents (water vs. phosphate buffer), solvent-to-biomass ratios (1:5 vs. 1:10), and ultrafiltration (PES membrane of MWCO 3 kDa, 2 bar) were evaluated. The quantities of total protein, phycocyanin (PC), chlorophyll a (Cla), and total carotenoids (TCC) were measured. The results showed that ultrasound-assisted extraction (UAE) with phosphate buffer at a 1:10 ratio yielded a metabolite-rich retentate (MRR) with 37.0 ± 1.9 mg/g of PC, 617 ± 15 mg/g of protein, 0.4 ± 0.2 mg/g of Cla, and 0.15 ± 0.14 mg/g of TCC. Water extraction in the concentration process achieved the highest concentrations in MRR, with approximately 76% PC, 92% total protein, 62% Cla, and 41% TCC. These findings highlight the effective extraction and concentration processes to obtain a metabolite-rich retentate from Spirulina biomass, reducing the volume tenfold and showing potential as a functional ingredient for the food, cosmetic, and pharmaceutical industries.

Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male: A case report.

BACKGROUND: Esophagopericardial fistula (EPF) is a rare, life-threatening condition with limited scientific literature and no established management guidelines. This case report highlights a successful multidisciplinary approach and the innovative use of endoscopic vacuum assisted closure (endoVAC) therapy in treating this complex condition. CASE SUMMARY: A 16-year-old male with a history of esophageal atresia and colon interposition presented with progressive chest pain, fever, and dyspnea. Imaging revealed an EPF with associated pleural and pericardial effusions. Initial management with an esophageal stent failed, prompting the use of an endoVAC system. The patient underwent multiple endoVAC device changes and received broad-spectrum antibiotics and nutritional support. The fistula successfully closed, and the patient recovered, demonstrating no new symptoms at a 6-month follow-up. CONCLUSION: EndoVAC therapy can effectively manage EPF, providing a minimally invasive treatment option.

Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis.

Objective: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection: Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect: We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO: CRD42023449655.

Association between ovarian tumors and exposure to assisted reproductive technologies and ovarian stimulation: a systematic review and meta-analysis.

INTRODUCTION:  The question of whether assisted reproductive technologies (ART) and ovulation induction are related to a higher incidence of ovarian tumors (OTs) is still controversial in the literature. METHODS: We performed a comprehensive search of PubMed, Embase, and Web of Science databases for case-control and cohort studies that investigated ART and ovulation induction exposure as risk factors for OT in infertile women. Odds ratios (OR) with 95% confidence intervals (CI) were employed for all endpoints. RESULTS: A total of nine case-control and twelve cohort studies were included, encompassing 439,477 women. ART was not associated with a higher risk of OTs (OR 1.05; 95% CI 0.86-1.29; p = 0.64; I2 = 36%), nor when considering only borderline OTs (OR 1.13; 95% CI 0.84-1.51; p = 0.42; I2 = 31%). In a subgroup analysis by study type, the risk difference of OTs remained non-significant for case-control (OR 1.12; 95% CI 0.70-1.78; p = 0.65; I2 = 60%) and cohort studies (OR 1.05; 95% CI 0.87-1.27; p = 0.60; I2 = 1%). For borderline OTs, the difference between groups was also non-significant for case-control studies (OR 1.44; 95% CI 0.73-2.87; p = 0.30; I2 = 40%) and cohort studies (OR 1.00; 95% CI 0.75-1.34; p = 0.99; I2 = 24%). CONCLUSION: In this systematic review and meta-analysis, ART exposure in infertile women was not associated with a higher risk of OTs in general or borderline tumors, even when accounting for study type differences.

Serum progesterone measurement on the day of fresh embryo transfer and its correlation with pregnancy success rates: A prospective analysis.

Studies regarding serum Progesterone (P4) concentration and Clinical Pregnancy Rates (CPR) in fresh Embryo Transfer (ET) after Controlled Ovarian Stimulation Cycles (COS) remain inconclusive. To find a P4 cutoff point on fresh ET day associated with higher CPR, and to identify predictive factors of CPR and P4, the authors conducted a prospective cohort of 106 patients who underwent COS at a public IVF center. The luteal phase was supported with vaginal micronized progesterone (200 mg, 8/8h), beginning on oocyte retrieval day. The primary outcome was CPR beyond the 8th week of pregnancy. A ROC curve was constructed to identify the best cutoff point correlated with higher CPR. Multivariate analysis evaluated predictive variables of CPR and P4 concentration. P4 levels showed no significant differences between pregnant and non-pregnant patients (67.12 ± 31.1 ng/mL vs. 64.17 ± 61.76, p = 0.7465). The cutoff point correlated with higher CPR was P4 ≥ 28.9 ng/mL (AUC 0.5654). Women's age (OR = 0.878; 95 % CI 0.774-0.995) and top-quality embryo transfer (OR = 2.89; 95 % CI 1.148-7.316) were associated with CPR. Women's age ≥ 40 years (OR = 0.0956; 95 % CI 0.0156-0.5851), poor response to COS (OR = 0.0964; 95 % CI 0.0155-0.5966), and follicles ≥ 10 mm (OR = 1.465; 95 % CI 1.013-2.117) were associated with the cutoff point. As the ROC curve was unsatisfactory, P4 ≥ 28.9 ng/mL should not be used to infer gestational success. In fresh ET, P4 concentration may merely reflect a woman's age and individual response to COS rather than being a reliable CPR predictor.

Microwave-Assisted vs. Conventional Extraction of Moringa oleifera Seed Oil: Process Optimization and Efficiency Comparison.

This study aims to evaluate the effectiveness of microwave-assisted and conventional extraction using ethanol, hexane, and petroleum ether as solvents, and to optimize the process for extracting oil from Moringa oleifera Lam. seeds, with a focus on improving food-grade oil production. Response surface methodology (RSM) was applied to enhance the extraction process of the oil. Central composite rotational design (CCRD) was used to analyze the impact of solid-liquid ratio (x1), power (x2), and temperature (x3) on oil yield. The optimization identified the optimal conditions as a solid/liquid ratio of 1:38, power of 175 W, and temperature of 50 °C, achieving a 42% oil yield. Notably, the microwave-assisted extraction reduced the processing time from 8 h (using conventional Soxhlet extraction) to just 1 h. Conventional extraction with hexane and petroleum ether was also performed for comparison, resulting in similar oil content and fatty acid profiles, predominantly, oleic acid. FTIR analysis confirmed that the microwave-extracted oil contained fatty acids and had similar characteristics to the conventionally extracted oil. Thus, the use of ethanol as a green solvent in the microwave has shown significant improvement in terms of time and energy savings compared to the Soxhlet method with toxic solvents. This study concludes that microwave-assisted extraction with ethanol provides a more energy efficient, environmentally friendly, and time-saving alternative for food-grade oil production, aligning with advancements in food engineering and production.

Ultrasound-Assisted Liposuction for Top Surgery in Transgender Men: Clinical Experience and Evaluation of Satisfaction and Quality of Life with TRANS-Q and BREAST-Q.

BACKGROUND: During the last decade, the demand for top surgery in female-to-male transgender (FMT) has increased worldwide. This study aims to present our initial experience with the novel use of ultrasound-assisted liposuction (UAL) in top surgery. Additionally, we evaluate the satisfaction and quality of life with TRANS-Q and BREAST-Q. METHODS: We conducted a retrospective study analyzing FMT undergoing UAL in top surgery from 2019 to 2021 at a single institution. We analyzed demographic variables, comorbidities, surgical techniques, operative time, complications, and follow-up time. We used TRANS-Q and BREAST-Q to evaluate patient-reported outcomes. A p value < 0.05 was considered significant. RESULTS: We performed 34 UAL combined subcutaneous mastectomies in 17 patients. Twelve patients (70.6%) underwent mastectomy double incision with free nipple grafting (DIFNG), and 29.4% underwent concentric circular mastectomy. In the DIFNG group, BMI (p < 0.02), the weight of each mammary gland (p < 0.001), and use of chest binder (p < 0.03) were significantly higher. The mean operative time was 115 min. The complication rate was 11.7% (one hematoma and three hypertrophic scars). The mean follow-up was 29.4 months, and no aesthetic revision surgeries was reported. The response rate for TRANS-Q and BREAST-Q was 76.5%, and high satisfaction with the results and significant improvement in quality of life were reported. CONCLUSIONS: We present the first cohort of transgender men who underwent UAL in top surgery. With proper training, the use of UAL could be a feasible and safe technique, offering good long-term esthetic results. Additionally, TRANS-Q and BREAST-Q demonstrated improved satisfaction and quality of life. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Determining Absolute Configuration of Small Molecules by Diffusion NMR Experiments.

Enantiomers are ubiquitous in many areas of science, such as pharmaceuticals, agriculture, and food. Nuclear magnetic resonance (NMR) alone is not able to differentiate enantiomers as their spectra are identical. However, these can be distinguished using chiral auxiliaries (such as chiral complexing agents) that form diastereomeric complexes, but absolute identification is still troublesome, usually requiring a chemical reaction with a chiral derivatizing agent. Here, we propose a new method that uses a hybrid mixture of solvating agents in a simple comparison of diffusion NMR experiments, which can discriminate enantiomers in both frequency and diffusion domains, dubbed CHIMERA (CHIral Micelle Enantiomer Resolving Agent). The new method was assessed for twenty-three small chiral molecules using a combination of BINOL and (-)-DMEB, a chiral surfactant, and initial results indicate that absolute configuration can be obtained from a simple experiment.

Video-assisted retroperitoneal debridement for necrotizing pancreatitis: a single center experience in Colombia.

INTRODUCTION: Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10-20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up. METHODS: A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described. RESULTS: A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5 cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up. CONCLUSION: According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.

First Rib Resection Using Videothoracoscopy in Patients With Vascular Thoracic Outlet Syndrome.

Objective: Thoracic outlet syndrome (TOS) comprises a series of signs and symptoms produced by compression of neurovascular structures in any of the anatomical spaces of the thoracic outlet. First rib resection is a therapeutic alternative to decompress the structures of the thoracic outlet at the costoclavicular space. Traditional surgical approaches include transaxillary, supraclavicular, and infraclavicular access. The objective was to describe the surgical experience and follow up results of first rib resection using video assisted thoracoscopic surgery (VATS) in patients with vascular TOS. Methods: Observational descriptive study based on a retrospective single centre analysis of a prospective database. Patients diagnosed with vascular TOS who underwent VATS first rib resection from January 2017 to December 2023 were included. The diagnosis for each subtype was based on the criteria defined in the standards of the American Society for Vascular Surgery in TOS. Among other things, the response to initial anticoagulation, peri-operative data, complications, symptom improvement, duration of post-operative anticoagulation, and symptom recurrence were investigated. Results: Twenty nine patients diagnosed with vascular TOS who underwent VATS first rib resection, three of whom had bilateral procedures, were included. The total number of costal rib resections performed was 32 (31 venous TOS and one arterial TOS). The mean age was 29.1 ± 10.4 years and mean hospital stay was 2.7 ± 1.2 days. There were neither conversions to open surgery nor intra-operative complications, but there were two major post-operative complications (6.25%). No recurrences were detected during midterm follow up (median of 17.9 months, interquartile range 7.3, 45). Conclusion: VATS first rib resection is a safe and feasible procedure. Unlike traditional approaches, this procedure allows physicians to make the resection under complete vision of the anatomical structures of the thoracic outlet reducing intra-operative complications and, if necessary, entire rib resection can be performed.

Nanoparticles based on biopolymers improved antioxidant activity of phenolic compounds from jambolan (Syzygium cumini (L.) skeels).

Jambolan (Syzygium cumini L.) is an underutilized fruit rich in bioactive phenolic compounds, specially anthocyanins, but the low stability of these substances and interaction with other compounds in the food matrix limit their application as food additives; nanoencapsulation is the best strategy to overcome these limitations. This study aimed to nanoencapsulate a phenolic-rich jambolan extract using whey proteins and pectin by nanoprecipitation in different antisolvent compositions. Two formulations were synthesized (7.33 % extract, 1.67 % pectin, and 5 % concentrated or isolated whey protein) precipitated in different acetone concentrations (50, 70, and 100 % v/v). SEM showed particles with spherical shape and smooth surface. DLS pointed diameters between 82 nm and 116 nm. FTIR indicated chemical interactions between the materials. Encapsulation efficiency showed high phenolic compounds entrapment in all systems [73.81-84.65 %, p > 0.05]. However, particles precipitated in 50 and 100 % acetone (v/v) showed greater anthocyanins retention [56.89-35.24 %, p < 0.05]. Nanoencapsulation potentiated the antioxidant activity up to 110 % more than the crude extract (p < 0.05). These results show the potential of nanoprecipitation as an effective encapsulation process and the biopolymers combination to produce nanoparticles containing jambolan phenolic compounds to promote their application in foods and health products.

40 'wild' years: the current reality and future potential of assisted reproductive technologies in wildlife species.

Over the past 40 years, assisted reproductive technologies (ARTs) have grown significantly in scale and innovation, from the bovine embryo industry's shift from in vivo derived to in vitro produced embryos and the development of somatic cell-based approaches for embryo production. Domestic animal models have been instrumental in the development of ARTs for wildlife species in support of the One Plan Approach to species conservation that integrates in situ and ex situ population management strategies. While ARTs are not the sole solution to the biodiversity crisis, they can offer opportunities to maintain, and even improve, the genetic composition of the captive and wild gene pools over time. This review focuses on the application of sperm and embryo technologies (artificial insemination and multiple ovulation/in vitro produced embryo transfer, respectively) in wildlife species, highlighting impactful cases in which significant progress or innovation has transpired. One of the key messages following decades of efforts in this field is the importance of collaboration between researchers and practitioners from zoological, academic, governmental, and private sectors.

40 years of AETE: the contribution of scientists and practitioners to the progress of reproductive biotechnologies in Europe.

This conference celebrates the 40th anniversary of AETE. Over the past 40 years, AETE has served as a forum for scientists, practitioners, and students working in assisted animal reproduction in livestock species. AETE conferences have reflected developments in the field, from basic to applied science, as well as regulatory changes in assisted animal reproduction practices. Europe has led the way in these developments for many years, progressing from artificial insemination, embryo transfer, and cryopreservation to semen sexing, in vitro production of embryos, cloning by nuclear transfer, genomic selection, and the rescue of highly endangered species. These significant contributions were made possible by the support of funding agencies, both at the national and European levels, promoting cooperation between scientists and practitioners. Assisted reproduction, and animal breeding more generally, face opposition from various groups, including animal rights activists, vegetarians, proponents of organic farming, environmentalists, certain political parties, and increasing regulatory burdens. These challenges seriously affect funding for scientific research, the work of practitioners, and the breeding industry as a whole. It is crucial to invest time and resources in communication to remind the public, politicians, and regulators of the achievements in this field and the contributions made to the food supply chain and the care of the rural and natural environment.

Intercostal Lung Hernias Presenting After Minimally Invasive Cardiac Surgery.

INTRODUCTION: With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS: We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS: From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION: Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.

Equine-assisted therapy in quality of life and functioning of people with active epilepsy: A feasibility study.

People with active epilepsy, which is often associated with specific neurological conditions, endure significant impairments in quality of life (QoL) and functioning, particularly those in middle-income countries. Physical intervention plays an essential role in addressing these challenges. This study investigated the impact of equine-assisted therapy (EAT) on QoL, functional independence, sleep quality, antiseizure medications, and frequency of seizures among people with epilepsy (PWE), with or without additional neurological conditions. Fourteen participants aged 4-34 years old diagnosed with focal epilepsy participated in a structured EAT program. The EAT program consisted of 36 sessions, each lasting 30 min and conducted weekly. Data were collected at four different times: baseline (T1), after 12 sessions (T2), after 24 sessions (T3), and after 36 sessions (T4). The assessments included the Quality of Life in Epilepsy (QOLIE-31), Functional Independence Measure (FIM), Pittsburgh Sleep Quality Index (PSQI), and Liverpool Adverse Event Profile (LAEP) scores. Seizure frequency was monitored continuously. Horse welfare was evaluated using the Horse Welfare Assessment Protocol (HWAP). After the EAT intervention, significant improvements were observed in the QoL scores (from 62.18 [57.88 - 70.25] to 80.18 [65.30 - 86.78]) and in FIM values (from 70.00 [36.50 - 97.75] to 70.00 [51.75 - 116.75]), particularly in the self-care and social cognition domains. Additionally, there was also a decrease in seizure frequency, adverse effects of antiseizure medications, and sleep quality. The HWAP indicated satisfactory welfare conditions for the horses. These findings indicate that EAT holds promise as a therapeutic intervention for improving the QoL and functioning of PWE. Tailored interventions are essential to address the diverse challenges faced by PWE, emphasizing the need for further research on effective therapeutic approaches.

Advanced Extraction Techniques Combined with Natural Deep Eutectic Solvents for Extracting Phenolic Compounds from Pomegranate (Punica granatum L.) Peels.

Pomegranate (Punica granatum L.) peel is a potential source of bioactive phenolic compounds such as ellagic acid and α- and ß-punicalagin. This work explores the efficiency of natural deep eutectic solvents combined with ultrasound-assisted extraction (UAE) and pressurized liquid extraction (PLE) for their extraction. Five NaDESs were evaluated by employing UAE (25 °C, for 50 min) to determine their total phenolic content (Folin-Ciocalteu assay) and ellagic acid and α- and ß-punicalagin contents (high-performance liquid chromatography (HPLC-DAD)). The NaDES composed of choline chloride (ChCl) and glycerol (Gly) (1:2, molar ratio) was the most efficient in the UAE when compared with the rest of the NaDESs and water extracts. Therefore, ChCl:Gly was further evaluated using PLE at different temperatures (40, 80, 120 and 160 °C). The PLE-NaDES extract obtained at 80 °C for 20 min at 1500 psi exhibited the highest contents of ellagic acid and α- and ß-punicalagin compared to the rest of the temperatures and PLE-water extracts obtained under the same extraction conditions. Combining UAE or PLE with a NaDES emerges as a sustainable alternative for extracting ellagic acid and α- and ß-punicalagin from pomegranate peel.

Robot-assisted versus laparoscopic ileal ureteral replacement: systematic review and meta-analysis.

Introduction: Robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (LS) are the main options for ileal ureteral replacement (IUR). It is not clear which option is superior. The purpose of this study is to compare RALS and LS for IUR. Material and methods: We searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Central, and Google Scholar for studies comparing RALS and LS for IUR. The outcomes of interest are operative time, blood loss, postoperative stay, and Clavien-Dindo complications. Meta-analysis was performed with Rev Man version 5.4. Results: We included 36 patients from 3 studies. The mean age was 44 years, with 53% male patients. Blood loss (MD -89.13 cc, CI -129.03 to -49.22, I2 = 0%) was significantly lower in patients undergoing RALS when comparing with LS. No differences were observed when comparing operative time (MD -10.99 minutes, CI -85.66 to 63.59, p = 0.77, I2 = 64%), postoperative stay (MD -2.56 days, CI -8.24 to 3.13, p = 0.38, I2 = 30%), and postoperative complications (OR 1.63, CI 0.27 to 10.02, p = 0.60, I2 = 0%). Conclusions: Overall, we conclude that the robot-assisted technique showed less bleeding compared to the laparoscopic technique.

Genome-Wide Association Studies and QTL Mapping Reveal a New Locus Associated with Resistance to Bacterial Pustule Caused by Xanthomonas citri pv. glycines in Soybean.

Bacterial pustule (BP), caused by Xanthomonas citri pv. glycines, is an important disease that, under favorable conditions, can drastically affect soybean production. We performed a genome-wide association study (GWAS) with a panel containing Brazilian and American cultivars, which were screened qualitatively and quantitatively against two Brazilian X. citri isolates (IBS 333 and IBS 327). The panel was genotyped using a genotyping by sequencing (GBS) approach, and we identified two main new regions in soybeans associated with X. citri resistance on chromosomes 6 (IBS 333) and 18 (IBS 327), different from the traditional rxp gene located on chromosome 17. The region on chromosome 6 was also detected by QTL mapping using a biparental cross between Williams 82 (R) and PI 416937 (S), showing that Williams 82 has another recessive resistance gene besides rxp, which was also detected in nine BP-resistant ancestors of the Brazilian cultivars (including CNS, S-100), based on haplotype analysis. Furthermore, we identified additional SNPs in strong LD (0.8) with peak SNPs by exploring variation available in WGS (whole genome sequencing) data among 31 soybean accessions. In these regions in strong LD, two candidate resistance genes were identified (Glyma.06g311000 and Glyma.18g025100) for chromosomes 6 and 18, respectively. Therefore, our results allowed the identification of new chromosomal regions in soybeans associated with BP disease, which could be useful for marker-assisted selection and will enable a reduction in time and cost for the development of resistant cultivars.

Primary LYmphedema Multidisciplinary Approach in Patients Affected by Primary Lower Extremity Lymphedema.

Background: Primary lymphedema is a chronic condition caused by a developmental abnormality of the lymphatic system, leading to its malfunction. Various surgical options, including physiologic and excisional procedures, have been proposed. The aim of this study was to present a comprehensive algorithm for the treatment of primary lower extremity lymphedema: the Primary LYmphedema Multidisciplinary Approach (P-LYMA). Methods: Nineteen patients were treated following the P-LYMA protocol. Patients underwent pre- and postoperative complex decongestive therapy (CDT). A variety of physiologic and excisional procedures were performed, either independently or in combination. The primary outcome was to assess the circumferential reduction rate (CRR). The Lymphedema Quality of Life Score (LeQOLiS), reduction in the number of cellulitis episodes, and complications were recorded. Results: The mean CRR was 73 ± 20% at twelve months postoperatively. The frequency of cellulitis episodes per year decreased from a mean of 1.9 ± 0.8 preoperatively to 0.4 ± 0.6 during follow-up. Two patients experienced minor complications. The mean hospitalization time was 5 days. Patients' quality of life, as measured by the LeQOLiS, significantly improved from 70.4 ± 12 preoperatively to 24 ± 14 at twelve months postoperatively. Conclusions: The P-LYMA algorithm maximizes surgical outcomes and improves the quality of life in patients with primary lymphedema. CDT is essential for optimizing results.