Case report: Minimally invasive primary debulking surgery for advanced stage epithelial ovarian cancer.

The surgical management of advanced ovarian cancer has historically emphasized an open technique, but advances in minimally invasive surgery (MIS) have led to its increasing use in ovarian cancer. Most research has focused on the utility of MIS in the interval debulking setting. Here, we present a case of a 38-year-old patient with incidentally diagnosed advanced stage ovarian cancer. We describe the robotic surgery techniques used to achieve complete primary cytoreduction, including resection of disease on the diaphragm. The patient has completed standard adjuvant chemotherapy and maintenance treatment and remains without evidence of disease for more than 2 years. This case details the techniques utilized to achieve complete cytoreduction including trocar placement, robotic instrument preference, and rotation of the robotic boom. This patient has had successful perioperative and oncologic outcomes, and her case highlights the role for minimally invasive primary debulking surgery for select patients with advanced ovarian cancer.

Endometrial carcinoma: association between mutational status, sites of metastasis, recurrence, and correlation with overall survival.

PURPOSE: To investigate the association between sites of endometrial carcinoma (EC) recurrence and metastases, mutational status, race, and overall survival (OS). METHODS: This single-center retrospective study evaluated patients with biopsy-proven EC that underwent genomic molecular testing between January 2015 and July 2021. Association between genomic profile and sites of metastases or recurrence was performed using Pearson's chi-squared or Fisher exact test. Survival curves for ethnicity and race, mutations, sites of metastases or recurrence were estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard regression models were used. RESULTS: The study included 133 women [median age 64 years (IQR 57-69)]. The most common mutation was TP53 (65/105 patients, 62%). The most common site of metastasis was the peritoneum (35/43, 81%). The most common recurrence was in lymph nodes (34/75, 45%). Mutations of TP53 and PTEN were significantly associated with Black women (p = 0.048, p = 0.004, respectively). In the univariable Cox regression analyses, TP53 mutation and presence of recurrence or metastases to the peritoneum were associated with lower OS (HR 2.1; 95% CI 1.1, 4.3; p = 0.03/ HR 2.9; 95% CI 1.6, 5.4; p = 0.0004; respectively). On multivariable Cox proportional hazards model ER expression (HR 0.4; 95% CI 0.22, 0.91; p = 0.03), peritoneal recurrence or metastases (HR 3.55; 95% CI 1.67, 7.57; p = 0.001), and Black race (HR 2.2; 95% CI 1.1, 4.6; p = 0.03) were significant independent predictors of OS. CONCLUSIONS: The integration of EC mutational status and clinicopathological risk assessment demonstrated potential implications on the patterns of metastasis, recurrence, and OS.

Uterine serous carcinoma: assessing association between genomics and patterns of metastasis.

Background: Uterine serous carcinoma (USC) is an aggressive subtype of endometrial carcinoma which has been increasing at alarming rates, particularly among Asian, Hispanic and Black women. USC has not been well characterized in terms of mutational status, pattern of metastases and survival. Objective: To investigate the association between sites of recurrence and metastases of USC, mutational status, race, and overall survival (OS). Methods: This single-center retrospective study evaluated patients with biopsy-proven USC that underwent genomic testing between January 2015 and July 2021. Association between genomic profile and sites of metastases or recurrence was performed using χ2 or Fisher's exact test. Survival curves for ethnicity and race, mutations, sites of metastasis/recurrence were estimated using the Kaplan-Meier method and compared with log-rank test. Cox proportional hazard regression models were used to examine the association between OS with age, race, ethnicity, mutational status, and sites of metastasis/recurrence. Statistical analyses were performed using SAS Software Version 9.4. Results: The study included 67 women (mean age 65.8 years, range 44-82) with 52 non-Hispanic women (78%) and 33 Black women (49%). The most common mutation was TP53 (55/58 women, 95%). The peritoneum was the most common site of metastasis (29/33, 88%) and recurrence (8/27, 30%). PR expression was more common in women with nodal metastases (p=0.02) and non-Hispanic women (p=0.01). ERBB2 alterations were more common in women with vaginal cuff recurrence (p=0.02), while PIK3CA mutation was more common in women with liver metastases (p=0.048). ARID1A mutation and presence of recurrence or metastases to the liver were associated with lower OS (Hazard Ratio (HR): 31.87; 95%CI: 3.21, 316.9; p<0.001 and HR: 5.66; 95%CI: 1.2, 26.79; p=0.01, respectively). In the bivariable Cox model, the presence of metastasis/recurrence to the liver and/or the peritoneum were both independent significant predictors of OS (HR: 9.8; 95%CI: 1.85-52.7; p=0.007 and HR: 2.7; 95%CI: 1.02-7.1; p=0.04, respectively). Conclusions: TP53 is often mutated in USC, which most commonly metastasize and recur in the peritoneum. OS was shorter in women with ARID1A mutations and with metastasis/recurrence to the liver. The presence of metastasis/recurrence to liver and/or peritoneum were independently associated with shorter OS.

Pandemia do Coronavírus e Ensino Remoto Emergencial: Percepção do Impacto no Bem Estar de Universitários

Resumo: Jovens em ensino superior são mais vulneráveis ao aparecimento de sintomas psicológicos diante do contexto de COVID-19. Não só a pandemia, como a adaptação à realidade do ensino remoto e demais dificuldades podem afetar o bem estar dos universitários. Por isso, esse estudo buscou investigar a percepção de bem-estar e saúde mental de universitários que realizaram ensino remoto durante a quarentena. Trata-se de um estudo transversal, exploratório e descritivo. Utilizou-se o instrumento "Questionário sobre percepção do isolamento social por universitários durante quarentena da COVID-19". Por meio da técnica por amostragem de referência os universitários divulgaram o link de acesso ao questionário online a seus pares. Participaram 497 estudantes, a maioria mulheres (74,69%) com média de idade 21,71 (DP=2.85), matriculados em Instituição de Ensino Superior pública (IES) (72.89%). Encontrou-se correlação positiva e significante (p<0.0001) para prejuízo no desempenho acadêmico pela adesão ao Ensino Remoto Emergencial e a percepção negativa na saúde mental e no bem-estar. Nos dados qualitativos, foram identificados percepção de maior ansiedade (15.35%), estresse (7.3%) e alteração do sono (7.67%) nos participantes. Cerca de 91.96% dos participantes estão engajados em práticas de auto cuidado e gerenciamento emocional. Portanto, os resultados convergem com a literatura e implicam que o ensino remoto pode impactar negativamente sobre o bem-estar e gerar insegurança quanto à qualidade e solidez da formação acadêmica. Os dados desse estudo sugerem que as instituições implementem atividades preventivas em relação à saúde mental dos estudantes e adequem o ensino remoto a fim de reduzir o sofrimento identificado.

Abstract: Young people in higher education are more vulnerable to the appearance of psychological symptoms in the context of COVID-19. Also, the adaptation to remote education and other difficulties can affect the well-being of university students. Therefore, this study sought to investigate the perception of well-being and mental health of university students who underwent remote education during quarantine. This is a cross-sectional, exploratory, and descriptive study. The instrument used was "Questionnaire on the perception of social isolation by university students during quarantine of COVID-19". Using the reference sampling technique, university students released the link to access the online questionnaire to their peers. 497 students participated, most of them women (74.69%), with mean age of 21.71 (SD = 2.85), enrolled in a public higher education institution (HEI) (72.89%). A positive and significant correlation was found (p <0.0001) for academic performance impaired by the adhesion of Emergency Remote Education and the negative perception of mental health and well-being. In the qualitative part, participants noticed anxiety (15.35%), stress (7.3%) and altered sleep (7.67%). About 91.96% of the participants are engaged in self-care and emotional management practices. Therefore, the results converge with the literature and imply that online education can impact well-being and generate insecurity regarding the quality and solidity of academic training. Data from this study suggest that institutions should implement preventive activities regarding students' mental health and adapt remote learning in order to reduce student's distress.

Resumen: Los jóvenes en educación superior son más vulnerables a la aparición de síntomas psicológicos en el contexto de COVID-19. La pandemia, la adaptación a la educación a distancia y otras dificultades afectan el bienestar de los estudiantes universitarios. Este estudio buscó investigar la percepción de bienestar y salud mental de los que realizaron educación remota durante la cuarentena. Esto es un estudio transversal, exploratorio y descriptivo. El instrumento utilizado fue "Cuestionario sobre la percepción de aislamiento social de estudiantes universitarios durante la cuarentena de COVID-19". Utilizando la técnica de muestreo de referencia, los estudiantes lanzaron el enlace para acceder al cuestionario en línea a sus compañeros. Participaron 497 estudiantes, la mayoría mujeres (74,69%) con una media de edad de 21,71 (DE = 2,85) matriculados en una institución pública de educación superior (72,89%). Se encontró una correlación positiva y significativa (p<0,0001) para el rendimiento académico deteriorado por este modelo de enseñanza y la percepción negativa de salud y bienestar mental. En el resultado cualitativo se identificaron percepcíon de mayor ansiedad (15,35%), estrés (7,3%) y alteración del sueño (7,67%). Aproximadamente el 91,96% realiza prácticas de autocuidado y manejo emocional. Por tanto, los resultados convergen con la literatura e implican que la educación remota puede impactar el bienestar y generar inseguridad en cuanto a la calidad y solidez de la formación académica. Los datos de este estudio sugieren que las instituciones deben implementar actividades preventivas relacionadas con la salud mental de los estudiantes y adaptar el aprendizaje a distancia para reducir la angustia de los universitarios.

Zygocotyle lunata as a model for in vivo screening of anthelmintic activity against paramphistomes: Evaluation of efficacy of praziquantel, albendazole and closantel in experimentally infected mice.

Paramphistomes are important parasites in veterinary medicine. There are few anthelmintic drugs available against them. The development of new drugs is urgently needed and this process can be accelerated through the development of rodent models for in vivo testing. Among the few paramphistomes that develop in rodents is the caecal fluke Zygocotyle lunata, a species with which several biological studies have been performed over several decades. Nevertheless, its use as a model for evaluation of anthelmintic drugs had not yet been evaluated. In the present study, we evaluated the efficacy of praziquantel (PZQ 300 mg/kg 5x), albendazole (ABZ 200 mg/kg 5x) and closantel (CLO 50 mg/kg single dose, 50 mg/kg 3x and 25 mg/kg 3x) for treatment of mice experimentally infected with Z. lunata. The animals were infected with 20 metacercariae of the parasite and were treated 30 days post-infection. Untreated groups were maintained as controls. Seven days after the treatments, the animals were euthanized for recovery and counting of parasites. We found that PZQ and ABZ, at the dosages and therapeutic schedule employed here, did not cause significant alterations in worm burden [worm counts 16.0 ±â€¯2.8 (13-19), 17.6 ±â€¯2.1 (14-19) and 16.2 ±â€¯1.9 (13-18) (p = 0.51) in PZQ, ALB and control, respectively]. CLO 50 mg/kg in a single dose caused significant reduction in the number of parasites [treated: 1.8 ±â€¯0.9 (1-3); control: 15.6 ±â€¯2.5 (12-19)], although it did not result in complete elimination of the parasites in any animal. Despite the fact that three doses of CLO 50 mg/kg or CLO 25 mg/kg caused complete elimination of the parasites in most surviving animals, there was significant host mortality. In general, results here obtained are concordant with those of studies performed on ruminant paramphistomes. Given that Z. lunata can be maintained in laboratory rodents, it is a suitable model for screening anthelmintic drugs against paramphistomes.

The life cycle of a zoonotic parasite reassessed: Experimental infection of Melanoides tuberculata (Mollusca: Thiaridae) with Centrocestus formosanus (Trematoda: Heterophyidae).

Centrocestus formosanus is a foodborne intestinal trematode that is native to Asia and has been introduced into the Americas and Europe. Although there are several studies of C. formosanus in definitive vertebrate hosts (birds and mammals, including humans), and in intermediate vertebrate hosts (fish and amphibians), there is little published information regarding interaction with its transmitting mollusc. In this study we studied the miracidial development of C. formosanus using a mouse as a source of eggs. Adult parasites were maintained in water in order to develop miracidia in intrauterine eggs. Miracidia appeared at 12 days of incubation, with no hatching observed for up to 40 days. Subsequently, we placed dead C. formosanus containing eggs with miracidia individually in contact with 48 specimens of Melanoides tuberculata, and observed the absence of the parasites after 1h of exposure, suggesting that they were ingested by the snails. Of the 33 experimentally-infected snails that were alive after 84-89 days post-infection (DPI), seven (21%) shed cercariae. We detected young C. formosanus rediae in 21/33 (64%) M. tuberculata at 90 DPI. To our knowledge, this report is the first to show that, in the life cycle of C. formosanus, infection of molluscs occurs passively by ingestion of eggs, followed by a long intramolluscan phase. We compare these data with those described for other Heterophyidae, and discuss on the phylogenetic background of the pattern of miracidial development verified in these parasites.

Improvement of heart rate variability after exercise training and its predictors in COPD.

BACKGROUND: Current literature lacks solid evidence on the improvement of heart rate variability (HRV) after exercise training in patients with COPD. OBJECTIVES: We aimed to investigate changes in HRV after two exercise training programs in patients with COPD and to investigate the determinants of these eventual changes. METHODS: Forty patients with COPD (FEV(1) 39 ± 13%pred) were randomized into high (n = 20) or low (n = 20) intensity exercise training (3-month duration), and had their HRV assessed by the head-up tilt test before and after either protocols. Baseline spirometry, level of daily physical activity, exercise capacity, body composition, functional status, health-related quality of life and muscle force were also assessed to investigate the determinants of improvement in HRV after the training program. RESULTS: There was a significant improvement in HRV only after the high-intensity protocol (pre versus post; SDNN 29 ± 15 ms versus 36 ± 19 ms; rMSSD 22 ± 14 ms versus 28 ± 22 ms; p < 0.05 for both). Higher values of biceps brachialis strength, time spent walking in daily life and SDNN at baseline were determinants of improvement in HRV after the training program. CONCLUSIONS: High-intensity exercise training improves HRV at rest and during orthostatic stimulus in patients with COPD. Better baseline total HRV, muscle force and daily physical activity level are predictors of HRV improvements after the training program.