Surgical management of abdominal and retroperitoneal Castleman's disease

BACKGROUND: Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form. METHODS: The authors report two cases of localized Castleman's disease in the retroperitoneal space and review the current and recent progress in the knowledge of this atypical disease. CASES PRESENTATION: The two patients were young healthy women presenting with a hyper vascular peri-renal mass suggestive of malignant tumor. Both have been resected in-toto. One of them had an extensive resection with nephrectomy, while the second had a kidney preserving surgery. Pathological examination revealed localized Castleman's disease and surgical margins were free of disease. Postoperative course was uneventful, and after more than 5-years of follow-up no recurrences have been observed. CONCLUSION: Localized Castleman's disease should be considered when facing a solid hypervascular abdominal or retroperitoneal mass. A better knowledge of this disorder and its characteristic would help surgeon to avoid unnecessarily extensive resection for this benign disorder when dealing with abdominal or retroperitoneal tumors. Surgical resection is curative for the localized form, when complete, while splenectomy could be indicated for the systemic form

Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass

Background: Robotic surgery is a complex technology offering technical advantages over conventional methods. Still, clinical outcomes and financial issues have been subjects of debate. Several studies have demonstrated higher costs for robotic surgery when compared to laparoscopy or open surgery. However, other studies showed fewer costly anastomotic complications after robotic Roux-en-Y gastric bypass (RYGBP) when compared to laparoscopy. Methods: We collected data for our gastric bypass patients who underwent open, laparoscopic, or robotic surgery from June 1997 to July 2010. Demographic data, BMI, complications, mortality, intensive care unit stay, hospitalization, and operating room (OR) costs were analyzed and a cost projection completed. Sensitivity analyses were performed for varied leak rates during laparoscopy, number of robotic cases per month, number of additional staplers during robotic surgery, and varied OR times for robotic cases. Results: Nine-hundred ninety patients underwent gastric bypass surgery at the University Hospital Geneva from June 1997 to July 2010. There were 524 open, 323 laparoscopic, and 143 robotic cases. Significantly fewer anastomotic complications occurred after open and robotic RYGBP when compared to laparoscopy. OR material costs were slightly less for robotic surgery (USD 5,427) than for laparoscopy (USD 5,494), but more than for the open procedure (USD 2,251). Overall, robotic gastric bypass (USD 19,363) was cheaper when compared to laparoscopy (USD 21,697) and open surgery (USD 23,000). Conclusions: Robotic RYGBP can be cost effective due to balancing greater robotic overhead costs with the savings associated with avoiding stapler use and costly anastomotic complication

Differences in soil moisture, nutrients and the microbial community between forests on the upper Pacific and Caribbean slopes at Monteverde, Cordillera de Tilaran: Implications for responses to climate change

Abstract: A study was conducted to identify soil ecosystem metrics for use in monitoring soil ecosystem health in tropical montane cloud forest habitats, and to establish a baseline of soil community characteristics. This work was performed in six unique forested habitats on the Caribbean and Pacific slopes of the Monteverde Reserve in Costa Rica. Comparisons were made of the soil moisture, nitrogen fixation activity, microbial biomass, fungal and bacterial abundance and diversity, and the abundance of key functional genes laccase (for lignin degradation by basidiomycete fungi) and nifH (for bacterial N-fixation). Differences were found in these metrics between habitats, which were correlated with soil moisture. The results of this work show that these metrics can be used as part of a program to monitor the soil ecosystems for early indicators of shifts in conditions in response to environmental change within this part of a fragile ecosystem. Resumen: Se realizó un estudio para identificar las métricas del ecosistema edáfico que pueden usarse en el monitoreo de la salud de este ecosistema en hábitats de bosque nublado montano y para establecer información de línea base de las características de la comunidad del suelo. Este trabajo se llevó a cabo en hábitats forestales únicos en las laderas del Caribe y del Pacífico de la Reserva Monteverde, Costa Rica. Se hicieron comparaciones de la humedad del suelo, la actividad de fijación de nitrógeno, la biomasa microbiana, la abundancia y la diversidad de hongos y bacterias, y la abundancia de los genes funcionales clave de la lacasa (para la degradación de la lignina por hongos basidiomicetos) y nifH (para la fijación bacteriana de N). Se encontraron diferencias para estas métricas entre hábitats, las cuales estuvieron correlacionadas con la humedad del suelo. Los resultados de este trabajo muestran que estas métricas pueden usarse en programas de monitoreo de ecosistemas edáficos como indicadores tempranos de modificaciones en las condiciones como respuesta al cambio ambiental en este componente de un ecosistema frágil. Resumo: Este estudo foi conduzido para identificar as métricas do ecossistema do solo para uso na monitorização da saúde do ecossistema em habitats florestais tropicais montanos de nevoeiros, e estabelecer uma linha básica quanto às características da comunidade do solo. Este trabalho foi efectuado em seis habitats florestados únicos nas vertentes das Caraíbas e d

Differences in soil moisture, nutrients and the microbial community between forests on the upper Pacific and Caribbean slopes at Monteverde, Cordillera de Tilaran: Implications for responses to climate change

Abstract: A study was conducted to identify soil ecosystem metrics for use in monitoring soil ecosystem health in tropical montane cloud forest habitats, and to establish a baseline of soil community characteristics. This work was performed in six unique forested habitats on the Caribbean and Pacific slopes of the Monteverde Reserve in Costa Rica. Comparisons were made of the soil moisture, nitrogen fixation activity, microbial biomass, fungal and bacterial abundance and diversity, and the abundance of key functional genes laccase (for lignin degradation by basidiomycete fungi) and nifH (for bacterial N-fixation). Differences were found in these metrics between habitats, which were correlated with soil moisture. The results of this work show that these metrics can be used as part of a program to monitor the soil ecosystems for early indicators of shifts in conditions in response to environmental change within this part of a fragile ecosystem. Resumen: Se realizó un estudio para identificar las métricas del ecosistema edáfico que pueden usarse en el monitoreo de la salud de este ecosistema en hábitats de bosque nublado montano y para establecer información de línea base de las características de la comunidad del suelo. Este trabajo se llevó a cabo en hábitats forestales únicos en las laderas del Caribe y del Pacífico de la Reserva Monteverde, Costa Rica. Se hicieron comparaciones de la humedad del suelo, la actividad de fijación de nitrógeno, la biomasa microbiana, la abundancia y la diversidad de hongos y bacterias, y la abundancia de los genes funcionales clave de la lacasa (para la degradación de la lignina por hongos basidiomicetos) y nifH (para la fijación bacteriana de N). Se encontraron diferencias para estas métricas entre hábitats, las cuales estuvieron correlacionadas con la humedad del suelo. Los resultados de este trabajo muestran que estas métricas pueden usarse en programas de monitoreo de ecosistemas edáficos como indicadores tempranos de modificaciones en las condiciones como respuesta al cambio ambiental en este componente de un ecosistema frágil. Resumo: Este estudo foi conduzido para identificar as métricas do ecossistema do solo para uso na monitorização da saúde do ecossistema em habitats florestais tropicais montanos de nevoeiros, e estabelecer uma linha básica quanto às características da comunidade do solo. Este trabalho foi efectuado em seis habitats florestados únicos nas vertentes das Caraíbas e d

Lapa verde estable pero inestable

No disponible/Not availabl

Green Macao, victim of unsustainable forest management

No disponible/Not availabl

Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass (RYGB) and to compare outcomes with the laparoscopic approach. Methods: From January 2003 to September 2013, 777 consecutive minimally invasive RYGB have been performed in our institution: 389 laparoscopically (50.1%) and 388 robotically (49.9%). During the study period, all the data regarding these consecutive RYGB has been prospectively collected in a dedicated database. Results: While longer in duration compared to laparoscopy (+30min; p = 0.0001), the robotic approach had a lower conversion rate (0.8 vs. 4.9%; p = 0.0007), and less complications (11.6% vs. 16.7%; p = 0.05), in particular, less gastrointestinal leaks (0.3 vs. 3.6%; p = 0.0009). There were also less early reoperations (1 vs. 3.3%; p = 0.05) and a shorter hospital stay in the robotic group (6.2 vs. 10.4days; p = 0.0001). There were no statistical differences between the early and the current robotic experience, except in operative time and hospital stay, which were shorter for the last 100 cases. Finally, the BMI loss was significantly higher in the laparoscopic group starting at the first post-operative year. Conclusions: Robotic RYGB is not only safe and feasible, but also a valid option in comparison to laparoscopy. At the cost of a longer operative time, we observed better short-term outcomes with the robotic approach

A Permeable Cuticle Is Associated with the Release of Reactive Oxygen Species and Induction of Innate Immunity

Wounded leaves of Arabidopsis thaliana show transient immunity to Botrytis cinerea, the causal agent of grey mould. Using a fluorescent probe, histological staining and a luminol assay, we now show that reactive oxygen species (ROS), including H2O2 and O2−, are produced within minutes after wounding. ROS are formed in the absence of the enzymes Atrboh D and F and can be prevented by diphenylene iodonium (DPI) or catalase. H2O2 was shown to protect plants upon exogenous application. ROS accumulation and resistance to B. cinerea were abolished when wounded leaves were incubated under dry conditions, an effect that was found to depend on abscisic acid (ABA). Accordingly, ABA biosynthesis mutants (aba2 and aba3) were still fully resistant under dry conditions even without wounding. Under dry conditions, wounded plants contained higher ABA levels and displayed enhanced expression of ABA-dependent and ABA-reporter genes. Mutants impaired in cutin synthesis such as bdg and lacs2.3 are already known to display a high level of resistance to B. cinerea and were found to produce ROS even when leaves were not wounded. An increased permeability of the cuticle and enhanced ROS production were detected in aba2 and aba3 mutants as described for bdg and lacs2.3. Moreover, leaf surfaces treated with cutinase produced ROS and became more protected to B. cinerea. Thus, increased permeability of the cuticle is strongly linked with ROS formation and resistance to B. cinerea. The amount of oxalic acid, an inhibitor of ROS secreted by B. cinerea could be reduced using plants over expressing a fungal oxalate decarboxylase of Trametes versicolor. Infection of such plants resulted in a faster ROS accumulation and resistance to B. cinerea than that observed in untransformed controls, demonstrating the importance of fungal suppression of ROS formation by oxalic acid. Thus, changes in the diffusive properties of the cuticle are linked with the induction ROS and attending innate defenses

Dynamic biogeochemical provinces in the global ocean

In recent decades, it has been found useful to partition the pelagic environment using the concept of biogeochemical provinces, or BGCPs, within each of which it is assumed that environmental conditions are distinguishable and unique at global scale. The boundaries between provinces respond to features of physical oceanography and, ideally, should follow seasonal and interannual changes in ocean dynamics. But this ideal has not been fulfilled except for small regions of the oceans. Moreover, BGCPs have been used only as static entities having boundaries that were originally established to compute global primary production. In the present study, a new statistical methodology based on non-parametric procedures is implemented to capture the environmental characteristics within 56 BGCPs. Four main environmental parameters (bathymetry, chlorophyll a concentration, surface temperature, and salinity) are used to infer the spatial distribution of each BGCP over 1997–2007. The resulting dynamic partition allows us to integrate changes in the distribution of BGCPs at seasonal and interannual timescales, and so introduces the possibility of detecting spatial shifts in environmental conditions

A first update on mapping the human genetic architecture of COVID-19

peer reviewe