Robotic intracorporeal urinary diversion: practical review of current surgical techniques

In this practical review, we discuss current surgical techniques reported in the literature to perform Intracorporeal Urinary Diversion (ICUD) after Robotic Radical Cystectomy (RARC), emphasizing criticisms of single approaches and making comparisons with Extracorporeal Urinary Diversion (ECUD). Although almost 97% of all RARCs use an ECUD, ICUD is gaining in popularity, in view of its potential benefits (i.e., decreased bowel exposure, etc.), although there are a few studies comparing ICUD and ECUD. Analysing single experiences and the data from recent metanalyses, we emphasize the current critiques to ICUD, stressing particular technical details which could reduce operative time, lowering the postoperative complications rate, and improving functional outcomes. Only analysis of long-term follow-up data from large-scale homogeneous series can ascertain whether robotic intracorporeal urinary diversion is superior to other approaches

Application of an acoustofluidic perfusion bioreactor for cartilage tissue engineering

Cartilage grafts generated using conventional static tissue engineering strategies are characterised by low cell viability, suboptimal hyaline cartilage formation and, critically, inferior mechanical competency, which limit their application for resurfacing articular cartilage defects. To address the limitations of conventional static cartilage bioengineering strategies and generate robust, scaffold-free neocartilage grafts of human articular chondrocytes, the present study utilised custom-built microfluidic perfusion bioreactors with integrated ultrasound standing wave traps. The system employed sweeping acoustic drive frequencies over the range of 890 to 910 kHz and continuous perfusion of the chondrogenic culture medium at a low-shear flow rate to promote the generation of three-dimensional agglomerates of human articular chondrocytes, and enhance cartilage formation by cells of the agglomerates via improved mechanical stimulation and mass transfer rates. Histological examination and assessment of micromechanical properties using indentation-type atomic force microscopy confirmed that the neocartilage grafts were analogous to native hyaline cartilage. Furthermore, in the ex vivo organ culture partial thickness cartilage defect model, implantation of the neocartilage grafts into defects for 16 weeks resulted in the formation of hyaline cartilage-like repair tissue that adhered to the host cartilage and contributed to significant improvements to the tissue architecture within the defects, compared to the empty defects. The study has demonstrated the first successful application of the acoustofluidic perfusion bioreactors to bioengineer scaffold-free neocartilage grafts of human articular chondrocytes that have the potential for subsequent use in second generation autologous chondrocyte implantation procedures for the repair of partial thickness cartilage defects

Acoustic force mapping in a hybrid acousticoptical micromanipulation device supporting high resolution optical imaging

Many applications in the life-sciences demand non-contact manipulation tools for forceful but nevertheless delicate handling of various types of sample. Moreover, the system should support high-resolution optical imaging. Here we present a hybrid acoustic/optical manipulation system which utilizes a transparent transducer, making it compatible with high-NA imaging in a microfluidic environment. The powerful acoustic trapping within a layered resonator, which is suitable for highly parallel particle handling, is complemented by the flexibility and selectivity of holographic optical tweezers, with the specimens being under high quality optical monitoring at all times. The dual acoustic/optical nature of the system lends itself to optically measure the exact acoustic force map, by means of direct force measurements on an optically trapped particle. For applications with (ultra-)high demand on the precision of the force measurements, the position of the objective used for the high-NA imaging may have significant influence on the acoustic force map in the probe chamber. We have characterized this influence experimentally and the findings were confirmed by model simulations. We show that it is possible to design the chamber and to choose the operating point in such a way as to avoid perturbations due to the objective lens. Moreover, we found that measuring the electrical impedance of the transducer provides an easy indicator for the acoustic resonances

Cardiac output affects the response to pulsed inhaled nitric oxide in mechanically ventilated anesthetized ponies determined by CT angiography of the lung

OBJECTIVE To measure changes in regional lung perfusion using CT angiography in mechanically ventilated, anesthetized ponies administered pulsed inhaled nitric oxide (PiNO) during hypotension and normotension.ANIMALS 6 ponies for anesthetic 1 and 5 ponies for anesthetic 2.PROCEDURES Ponies were anesthetized on 2 separate occasions, mechanically ventilated, and placed in dorsal recumbency within the CT gantry. Pulmonary arterial, right atrial, and facial arterial catheters were placed. During both anesthet-ics, PiNO was delivered for 60 minutes and then discontinued. Anesthetic 1: hypotension (mean arterial pressure < 70 mmHg) was treated using dobutamine after 30 minutes of PiNO delivery. Following the discontinuation of PiNO, dobutamine administration was discontinued in 3 ponies and was continued in 3 ponies. The lung was imaged at 30, 60, and 105 minutes. Anesthetic 2: hypotension persisted throughout anesthesia. The lung was imaged at 30, 60, and 90 minutes. At all time points, arterial and mixed venous blood samples were analyzed and cardiac output (Qt) was measured. Pulmonary perfusion was calculated from CT image analysis.RESULTS During PiNO delivery, perfusion to well-ventilated lungs increased if ponies were normotensive, leading to increased arterial oxygenation, reduced alveolar dead space, and reduced alveolar to arterial oxygen tension gradient. When PiNO was stopped and dobutamine administration continued, alveolar dead space and venous admixture increased, in contrast to when dobutamine and PiNO were both discontinued.CLINICAL RELEVANCE If PiNO is administered to mechanically ventilated, anesthetized ponies with concurrent hypotension and low Qt, this must be supported to achieve favorable redistribution of pulmonary perfusion to improve pulmonary gas exchange

Effects of early castration on carcass composition, yield and quality characteristics of meat from young reindeer (Rangifer tarandus tarandus) bulls and steers

Thirty male reindeer; n=16 bulls (control treatment) and n=14 steers (castrated males) were used to evaluate the effects of early castration on carcass yield and meat quality attributes. The reindeer were castrated at 2 and 13 months of age, and then slaughtered at 2 and 3 years of age. Live weights and carcass weights were significantly highest in the 3 year old bulls and steers. Dressing percentage did not differ between the 2 and 3 year old reindeer steers castrated at 2 months; however these values were higher than for 2 year old steers castrated at 13 months. Meat ultimate pH values (measured in the striploin; LD) were significantly highest in 2 year old steers castrated at 13 months and their corresponding control group of 2 year old bulls, indicating low muscle glycogen stores at slaughter. Castration had an effect on fat content with 3 year old steers having a higher fat content than bulls. No significant differences were found in any sensory attribute when the trained panel compared the meat from 2 year old reindeer bulls and steers. Abstract in Swedish / Sammanfattning:Effekter av tidig kastrering p&aring; slaktkroppssammans&auml;ttning, styckningsutbyte och k&ouml;ttkvalitet hos unga renarTrettio hanrenar; n=16 tjurar (kontrolldjur) och n=14 kastrater (h&auml;rkar) ingick i denna studie f&ouml;r att utv&auml;rdera effekterna av tidig kastrering p&aring; slaktkroppssammans&auml;ttning och k&ouml;ttkvalitetsparametrar. Renarna kastrerades vid 2 respektive 13 m&aring;naders &aring;lder och slaktades sedan n&auml;r de var antingen 2 eller 3 &aring;r gamla. Levandevikt och slaktkroppsvikt var h&ouml;gst f&ouml;r 3 &aring;r gamla tjurar och h&auml;rkar. Slaktutbytet skiljde sig inte mellan 2 och 3 &aring;r gamla h&auml;rkar som kastrerats vid 2 m&aring;naders &aring;lder, men deras slaktutbyte var h&ouml;gre &auml;n f&ouml;r de 2-&aring;riga h&auml;rkarna som kastrerats vid 13 m&aring;naders &aring;lder. K&ouml;ttets pH-v&auml;rde (m&auml;tt i ytterfil&eacute;n) var signifikant h&ouml;gst hos de 2-&aring;riga h&auml;rkarna som kastrerats vid 13 m&aring;naders &aring;lder och deras tillh&ouml;rande kontrollgrupp av 2-&aring;riga tjurar, vilket tydde p&aring; l&aring;ga niv&aring;er av muskelglykogen vid slakt. Kastrering hade en signifikant effekt p&aring; fettinneh&aring;llet i slaktkropparna hos de 3-&aring;riga renarna, med de h&ouml;gsta fetthalterna hos h&auml;rkarna. Inga skillnader i &auml;tkvalitet rapporterades n&auml;r k&ouml;tt fr&aring;n 2-&aring;riga rentjurar och h&auml;rkar j&auml;mf&ouml;rdes

A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea

Background: Irritable bowel syndrome with diarrhoea (IBS-D) is particularly debilitating due to urgency and episodic incontinence. Some 5-hydroxytryptamine 3 (5-HT3) receptor antagonists (5-HT3RAs) have proven effective but have serious side effects. Ondansetron, also a 5-HT3RA, has been widely used as an antiemetic with an excellent safety record for over two decades. Our aim was to assess its effectiveness in IBS-D. Methods: 120 patients meeting Rome III criteria for IBS-D entered a randomised, double-blind, placebo-controlled crossover study of 5 weeks of ondansetron 4 mg versus placebo with dose titration allowed, up to two tablets three times daily in the first 3 weeks. Patients completed daily diaries documenting stool consistency using the Bristol Stool Form score. Gut transit was measured in the last week of each treatment. The primary endpoint was average stool consistency in the last 2 weeks of treatment. Results: Ondansetron significantly improved stool consistency (mean difference in stool form between ondansetron and placebo −0.9, 95% CI −1.1 to −0.6, p<0.001). Compared with placebo, patients on ondansetron experienced fewer days with urgency (p<0.001), lower urgency scores (p<0.001), reduced frequency of defaecation (p=0.002) and less bloating (p=0.002), although pain scores did not change significantly. IBS symptom severity score fell more with ondansetron than placebo (83±9.8 vs 37±9.7, p=0.001). 65% reported adequate relief with ondansetron but not placebo compared with 14% reporting relief with placebo but not ondansetron, relative risk 4.7, 95% CI 2.6 to 8.5, p<0.001. Conclusions: Ondansetron relieves some of the most intrusive symptoms of IBS-D, namely loose stools, frequency and urgency

Functional loss of IKBE leads to NF-KB deregulation in aggressive chronic lymphocytic leukemia

NF-?B is constitutively activated in chronic lymphocytic leukemia (CLL); however, the implicated molecular mechanisms remain largely unknown. Thus, we performed targeted deep sequencing of 18 core complex genes within the NF-?B pathway in a discovery and validation CLL cohort totaling 315 cases. The most frequently mutated gene was NFKBIE (21/315 cases; 7%), which encodes I?B?, a negative regulator of NF-?B in normal B cells. Strikingly, 13 of these cases carried an identical 4-bp frameshift deletion, resulting in a truncated protein. Screening of an additional 377 CLL cases revealed that NFKBIE aberrations predominated in poor-prognostic patients and were associated with inferior outcome. Minor subclones and/or clonal evolution were also observed, thus potentially linking this recurrent event to disease progression. Compared with wild-type patients, NFKBIE-deleted cases showed reduced I?B? protein levels and decreased p65 inhibition, along with increased phosphorylation and nuclear translocation of p65. Considering the central role of B cell receptor (BcR) signaling in CLL pathobiology, it is notable that I?B? loss was enriched in aggressive cases with distinctive stereotyped BcR, likely contributing to their poor prognosis, and leading to an altered response to BcR inhibitors. Because NFKBIE deletions were observed in several other B cell lymphomas, our findings suggest a novel common mechanism of NF-?B deregulation during lymphomagenesis. <br/

Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery : the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)

Non-cardiac surgery; Pre-operative cardiac risk assessment; Pre-operative cardiac testing; Pre-operative coronary artery revascularization; Perioperative cardiac management; Renal disease; Pulmonary disease; Neurological disease; Anaesthesiology; Post-operative cardiac surveillanc