Robot-assisted partial nephrectomy using the novel Hugo™ RAS system: Feasibility, setting and perioperative outcomes of the first off-clamp series.

INTRODUCTION: Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System. METHODS: Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration. RESULTS: Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4-8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68-115 min). Median estimated blood loss were 200 ml (IQR, 50-400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days. CONCLUSIONS: We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.

Pediculosis capitis risk factors in schoolchildren: hair thickness and hair length.

The human head lice is a cosmopolitan ectoparasite that causes pediculosis. The main way of spreading lice is through direct head-to-head contact. It is popular knowledge that some individuals are more susceptible to contracting head lice than others. Reports of individuals who have never been affected by the disease are common, even living in the same environment and under the same conditions as people who regularly have lice infestations. Previous research has been carried out on the risk of this infection associated with different human factors like gender or age. However, studies on the influence of the individual hair characteristics are scarce. The objective of the study was to analyze the pediculosis risk using geographical location, gender, age and individual hair characteristics as variables. Pediculosis was diagnosed through the detection of living lice in the hair. This cross-sectional school-based epidemiological study was conducted in 310 schoolchildren aged 1 to 13 years of schools in 4 municipalities situated in the State of Paraná, Brazil. The prevalence of head louse infection in primary school students was 49.35 %. The Odds Ratio of presence of pediculosis (OR) was estimated using multivariate logistic regression analysis. The results obtained indicate that hair length and thickness increase the risk of infection. Furthermore, the inclusion of hair color, hair shape, kind of hair-scale as covariates increases the risk of pediculosis, indicating that these variables partly explain this susceptibility and that pediculosis is independent of gender. A smaller hair diameter may favor insect fixation to the hair in the nymphal phases. These results may explain why girls are a greater risk as they let their hair grow for cultural reasons, i.e., being of female gender is an agglutinating variable. The conclusions drawn may explain the discrepancies obtained in previous analyses.

An integrative approach to explore species limits in Laelaps mazzai Fonseca, 1939 (Mesostigmata, Laelapidae), a South American widespread mite parasitizing the cricetid Calomys Waterhouse, 1837.

Laelaps mazzai Fonseca, 1939 (Mesostigmata, Laelapidae) parasitizes several species of the widespread South American rodent genus Calomys Waterhouse, 1837. Morphological variation has been noticed within this laelapid but has yet to be analyzed. Since several other species of laelapids that initially were considered generalists have resulted in host-specific species, after further analyses, herein we explored, through morphology and genetics, the variation of this parasite across six species of Calomys, trying to establish if it constitutes a polymorphic species or a complex of cryptic host specific-species. An integrative approach was applied, including principal component and discriminant analyses of females and males and DNA sequences (nuclear region ITS and the COI gene). The obtained results indicate that female mites tend to differentiate only the sizes of their dorsal shield among host species but with extensive overlapping. At the same time the males lack metrical differentiation, and the genetic evidence failed to resolve specific-species clades. We conclude that L. mazzai is a single widespread mite with little genetic and phenotypic differentiation.

Variability of Calodium hepaticum eggs from sigmodontine host species through geometric morphometric analysis.

Calodium hepaticum is a zoonotic nematode with a worldwide distribution. Although the host range of C. hepaticum includes a wide spectrum of mammals (including humans), this parasite is predominantly associated with the families Muridae and Cricetidae. Several Sigmodontinae species from Argentina were found to be infected by C. hepaticum, with a high prevalence in Akodon azarae. The present study focuses on C. hepaticum eggs from natural infection of three species of sigmodontine rodents from Argentina. Eggs were genetically characterized (intergenic 18S rRNA region). The objectives of this work are: (i) to propose a new analytical methodology; and (ii) to morphologically characterize C. hepaticum eggs, from three Sigmodontinae species (A. azarae, Calomys callidus and Oligoryzomys flavescens). Analyses were made by the Computer Image Analysis System based on the new standardized measurements and geometric morphometric tools. The resulting factor maps clearly illustrate global size differences in the parasite eggs from the three Sigmodontinae species analysed. The degree of similarity between egg populations was assessed through pairwise Mahalanobis distances, showing that the largest distances were detected between parasite eggs from C. callidus and O. flavescens. Herein, the phenotypical plasticity of C. hepaticum eggs is shown. Significant positive correlations were obtained between each egg parasite principal component 1 and rodent corporal characteristics: weight; liver weight; rodent length; and rodent body condition. The usefulness of the geometric morphometric analysis in studies of the relationship between C. hepaticum and its host must be highlighted. The high prevalence observed in A. azarae, associated with the wide size range of the parasite eggs evidenced by principal component analysis, suggests A. azarae to be the Sigmodontinae host species that plays the most important role as reservoir host for C. hepaticum in the New World.

Effects of host factors on the dynamics of fleas (Siphonaptera) in Sigmodontinae rodents (Cricetidae) from El Espinal Ecoregion, Argentina.

We investigated the patterns of flea infestation in wild populations of eight Sigmodontinae rodent species: Akodon azarae, Calomys callidus, Calomys venustus, Holochilus chacarius, Necromys lasiurus, Oligoryzomys flavescens, Oligoryzomys nigripes and Oxymycterus rufus. Rodents were captured in systematic trapping sessions carried out along 2 years at two localities from El Espinal Ecoregion, Argentina. Mean flea intensity, occurrence (presence/absence) of flea infestation, richness and diversity were compared for different ages, body condition, sex and rodent tribes (Akodontini, Oryzomyini and Phyllotini). A total of 376 fleas of the following species and subspecies were collected: Craneopsylla minerva wolffhuegeli, Polygenis (Neopolygenis) pradoi, Polygenis (Polygenis) axius axius, and Polygenis (Polygenis) byturus. The most important factor driving flea infestation was the rodent tribe, with Phyllotini showing the highest values of occurrence, abundance and species richness. Only C. m. wolffhuegeli was affected by the sex of the host. Age and body condition of the hosts did not affect flea infestation. Our results contribute to knowledge of the ecology of fleas on rodent hosts in El Espinal Ecoregion. The relevance of host taxonomy as driver of flea dynamics highlight the importance of considering host community structures at the time of studying the ecology of parasites.

Calodium hepaticum (Trichuroidea: Capillariidae) Infection In Akodon azarae: First Description of Histopathological Lesions In Sigmodontinae.

Calodium hepaticum (Trichinellida: Capillaridae) is a parasitic nematode of mammals distributed worldwide. Although this parasite can infect the liver of a wide diversity of mammals (including humans), it is mostly associated with Muroidea hosts. Sigmodontinae rodents were recently recognized as important hosts of this parasite in Argentina, but the impact of this parasitism on these hosts has not been established. Here we report results of histopathological analyses of 40 livers of Akodon azarae infected with C. hepaticum. Lesions were classified into 4 categories: level 0, absence of lesions; level 1, with focal granulomatous hepatitis; level 2, presence of multifocal granulomatous hepatitis, fibrosis and focal necrosis with neutrophils, and level 3, absence of intact adult parasites, diffuse distribution, necrosis, and fibrosis. Most samples presented lesions of level 2 (55%), but all categories of lesions were found. This is the first study to describe the lesions caused by C. hepaticum in the liver of Sigmodontinae rodents, and the results suggest that infection by this parasite is costly to A. azarae populations.

Heart rate variability at bedtime predicts subsequent sleep features.

Getting enough sleep during the night is important for preventing adverse short- and long-term health outcomes. The sympathetic-parasympathetic autonomic balance, characteristics of the pre-bed time resting period, correlates with sleep efficiency. We investigated in healthy subjects whether Low/High Frequencies (LF/HF) and other Heart Rate Variability (HRV) metrics, extracted in the period immediately before sleep onset, are able to predict quality/architecture sleep parameters in the sample group and in the Evening-Intermediate- chronotype subgroups. Linear correlations were found between HRV metrics and the investigated quality/architecture sleep parameters. The possibility to predict sleep parameters from the HRV metrics while falling asleep might pave the way to behavioral interventions during the bedtime period to increase the quality of sleep.

Liver fluke (Fasciola hepatica) naturally infecting introduced European brown hare (Lepus europaeus) in northern Patagonia: phenotype, prevalence and potential risk.

Fascioliasis has recently been included in the WHO list of Neglected Zoonotic Diseases. Besides being a major veterinary health problem, fascioliasis has large underdeveloping effects on the human communities affected. Though scarcely considered in fascioliasis epidemiology, it is well recognized that both native and introduced wildlife species may play a significant role as reservoirs of the disease. The objectives are to study the morphological characteristics of Fasciola hepatica adults and eggs in a population of Lepus europaeus, to assess liver fluke prevalence, and to analyze the potential reservoir role of the European brown hare in northern Patagonia, Argentina, where fascioliasis is endemic. Measures of F. hepatica found in L. europaeus from northern Patagonia demonstrate that the liver fluke is able to fully develop in wild hares and to shed normal eggs through their faeces. Egg shedding to the environment is close to the lower limit obtained for pigs, a domestic animal whose epidemiological importance in endemic areas has already been highlighted. The former, combined with the high prevalence found (14.28%), suggest an even more important role in the transmission cycle than previously considered. The results obtained do not only remark the extraordinary plasticity and adaptability of this trematode species to different host species, but also highlight the role of the European brown hare, and other NIS, as reservoirs capable for parasite spillback to domestic and native cycle, representing a potentially important, but hitherto neglected, cause of disease emergence.

Trigeminocardiac reflex by mandibular extension on rat pial microcirculation: role of nitric oxide.

In the present study we have extended our previous findings about the effects of 10 minutes of passive mandibular extension in anesthetized Wistar rats. By prolonging the observation time to 3 hours, we showed that 10 minutes mandibular extension caused a significant reduction of the mean arterial blood pressure and heart rate respect to baseline values, which persisted up to 160 minutes after mandibular extension. These effects were accompanied by a characteristic biphasic response of pial arterioles: during mandibular extension, pial arterioles constricted and after mandibular extension dilated for the whole observation period. Interestingly, the administration of the opioid receptor antagonist naloxone abolished the vasoconstriction observed during mandibular extension, while the administration of Nω-Nitro-L-arginine methyl ester, a nitric oxide synthase inhibitor, abolished the vasodilation observed after mandibular extension. Either drug did not affect the reduction of mean arterial blood pressure and heart rate induced by mandibular extension. By qRT-PCR, we also showed that neuronal nitric oxide synthase gene expression was significantly increased compared with baseline conditions during and after mandibular extension and endothelial nitric oxide synthase gene expression markedly increased at 2 hours after mandibular extension. Finally, western blotting detected a significant increase in neuronal and endothelial nitric oxide synthase protein expression. In conclusion mandibular extension caused complex effects on pial microcirculation involving opioid receptor activation and nitric oxide release by both neurons and endothelial vascular cells at different times.

Analysis of climate and extrinsic incubation of Dirofilaria immitis in southern South America.

Dirofilariosis, caused by Dirofilaria immitis and D. repens, is spreading in several geographic regions. The development of infective larvae in the mosquito vector (extrinsic incubation) needs an accumulated total of 130 degree-days above the 14 °C threshold, normally expressed as heartworm development units (HDUs). Based on this information, temperature- based models have been developed and applied to evaluate the distribution and spread of Dirofilaria infections in various countries and continents. Despite the confirmed presence of D. immitis in most South American countries, the available information about its epidemiology remains scarce. We analysed the temporal and spatial extrinsic incubation of this parasite in Argentina, Chile and Uruguay, taking into account daily temperatures from 49 meteorological stations during a 30-year period (1982-2012). The theoretically possible number of D. immitis generations was calculated based on the number of meteorological stations that reached the 130-HDUs threshold. The resulting information was spatially interpolated using the inverse weighted distance (IWD) model to produce thematic maps. The model shows that 41 of the meteorological stations reach the threshold needed and that D. immitis transmission is markedly seasonal with a peak in late spring (December), stable during summer (January to March) and declining in the autumn (April and May). Suitable temperatures exist in Uruguay and most of Argentina, whereas D. immitis transmission in Chile is only possible in the north and in the central inlands. The results suggest that the climatic impact on D. immitis transmission must have been minimal in the countries investigated since the annual meteorological records did not change much during the 30-year period analysed.

Field monitoring and evaluation of innovative solutions for cleaning storm water runoff.

Urbanization increases the variety and amount of pollutants transported to receiving waters. Sediment from development and new construction; oil, grease, and toxic chemicals from automobiles; nutrients and pesticides from turf management and gardening; viruses and bacteria from failing septic systems; road salts; and heavy metals are examples of pollutants generated in urban areas. Sediments and solids constitute the largest volume of pollutant loads to receiving waters in urban areas. When runoff enters storm drains, it carries many of these pollutants with it. In older cities, this polluted runoff is often released directly into open waterways without any treatment. Increased pollutant loads can harm fish and wildlife populations, kill native vegetation, foul drinking water supplies, and make recreational areas unsafe. The objective of the study, performed by University of Pavia (Italy), University of Brescia (Italy) and GreenTechTexas International (US), reported herein is to evaluate the use of an innovative stormwater technology (EcoDräin) to reduce pollution due to urban runoff in existing urban areas. The paper describes the methodology and the results achieved with tests conducted in laboratory in Pavia University in Italy and in two pilot areas in Italy and in Australia to investigate the EcoDräin's effectiveness for oil and heavy metals retention and sediment trapping. In the tests performed in a marina near Sydney in Australia a reduction has been achieved in oil and grease concentration higher than 95% and a reduction in metal concentration (particularly Copper, Lead and Zinc) close to 98%. The paper also describes the methodology of the analysis on the absorbing material after its use and the consequent determination of the most efficient and environmentally safe way to dispose of consummated absorbent.

[The variation of the vestibular response vs. the variations of the auditory threshold after administration of glycerol in patients with Meniere's disease]. / Variazione della risposta vestibolare versus variazioni di soglia tonale dopo somministrazione di glicerolo in pazienti menierici.

Vestibular and auditory functions after glycerol intake were assessed correlated in twenty-eight patients diagnosed as menieric according to AAOO criteria. All patients had unilateral Ménière's disease confirmed by monolateral hypoacusia and labyrinthine hypofunction. Hearing thresholds were tested by tone-audiometry, according to the standard glycerol test. Variation in vestibular response were assessed comparing the VOR during the rotatory sinusoidal test as well as the caloric test, before glycerol intake and 2 hours after drug administration. Slow phase angolar velocity, directional preponderance percentile and percentile variation between basic and control observation were calculated. The audiometric glycerol test was positive in 58% of the cases. The vestibular glycerol test was positive in 30% of the cases and no correlation between and individual results hearing threshold result was found. The findings reported by other Authors regarding auditory and vestibular responses to glycerol intake were verified. Possible reasons which may account for variation with regard to reaction patterns in the acoustic and non acoustic labyrinth after glycerin administration are discussed. In the Authors' view, incoherence between vestibular and cochlear response might be linked to differences in the physiology of the fluid in the two labyrinths. In the vestibular district, glycerol might induce an early depletive effect and a later paradoxal effects due to mechanical modification of the ampulla function.