Cost-benefit in laparoscopic colorectal procedures: comparative analysis with conventional approach

A cirurgia colorretal por vídeo representa procedimento avançado, geralmente associado a custos elevados. No entanto, vantagens observadas na evolução dos pacientes operados por esta via permitem recuperação mais precoce com menor tempo de hospitalização. Uma questão relevante relacionada a este tema diz respeito à dúvida se essas vantagens da cirurgia colorretal por vídeo podem compensar os maiores custos associados a este método. O objetivo deste trabalho foi fazer uma análise crítica dos diversos aspectos envolvidos na relação custo-benefício desta via de acesso em operações colorretais, com base em uma revisão da literatura sobre essa questão.Laparoscopic colorectal surgery is now considered an advanced procedure often associated with great costs. However, the observed advantages in patient's outcome that are operated through this approach include faster recovery and less hospital stay. One important question regarding this issue is: is the laparoscopic colorectal surgery cost effective when compared to the conventional access? The scope of this paper was to make a critical analysis about the aspects that are involved in cost-effectiveness related to laparoscopic colorectal procedures, through a literature review

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

OBJECTIVES: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer. METHODS: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155. RESULTS: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement. CONCLUSIONS: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes

Effects of prolonged administration of the anabolic-androgenic steroid nandrolone decanoate in emotional behaviors and serotonergic system related genes expression in several brain areas of mice

O decanoato de nandrolona é um esteróide anabólico-androgênico (EAA), derivado da testosterona, utilizado de maneira abusiva por indivíduos procurando ganho de força física ou apenas efeitos estéticos. Doses suprafisiológicas desses compostos têm sido associadas a efeitos psiquiátricos adversos, especialmente episódios de impulsividade e aumento no comportamento agressivo. Considerando o desconhecimento dos mecanismos neurais envolvidos nessa desinibição comportamental, nós investigamos a integridade da transcrição de componentes do sistema serotoninérgico (intimamente relacionados à expressão de comportamentos emocionais) em diversas áreas cerebrais de camundongos sob a administração prolongada de nandrolona. Camundongos machos adultos da linhagem C57Bl/6J receberam uma injeção subcutânea diária de 15 mg/kg de decanoato de nandrolona durante 28 dias. Diferentes grupos de animais foram utilizados para a análise de comportamentos emocionais e para a quantificação da expressão de genes relacionados à serotonina (5-HT), utilizando a transcrição reversa do RNA associada à técnica de PCR em tempo-real. Os camundongos tratados apresentaram um aumento na massa corporal, hiperatividade motora e aumento de comportamentos relacionados à ansiedade em ambientes novos. A imobilidade avaliada no teste de nado forçado apresentou-se reduzida. Os animais que receberam a nandrolona se mostraram mais agressivos e impulsivos para iniciar o ataque aos camundongos oponentes, no modelo de residenteintruso. O EAA induziu uma redução significante na quantidade de transcritos da maioria dos receptores pós-sinápticos de 5-HT investigados na amígdala e no córtex pré-frontal. A expressão do gene do receptor 5-HT1B (reconhecidamente envolvido com as alterações comportamentais observadas) estava também reduzida no hipocampo e hipotálamo. No mesencéfalo, região onde se encontram os corpos neuronais dos neurônios serotoninérgicos que inervam o sistema límbico e demais áreas cerebrais, não se observou nenhuma alteração na expressão dos genes relacionados aos receptores serotoninérgicos pré-sinápticos. Os transcritos do transportador e da enzima de síntese de 5-HT, indicadores da integridade serotoninérgica pré-sináptica, também não se apresentaram alterados. Dessa maneira, concluímos que o efeito de altas doses do EAA decanoato de nandrolona em camundongos confirma os dados encontrados em literatura quanto à desinibição comportamental observada em usuários abusivos humanos. Nosso modelo também foi eficiente em mostrar pela primeira vez alterações moleculares induzidas por este EAA. A redução generalizada na expressão dos genes de receptores de 5-HT na amígdala e córtex pré-frontal sugere essas áreas, pós-sinápticas ao sistema serotoninérgico, como críticas nos efeitos induzidos pelo EAA. Nosso trabalho também sugere um papel importante para o receptor 5-HT1B na desinibição comportamental observadaNandrolone decanoate is a highly abused anabolic-androgenic steroid (AAS) by individuals looking for gains in physical strength or body appearance. Supraphysiological doses of this testosterone synthetic derivative have been associated with many physical and psychiatric adverse effects, especially reported episodes of impulsiveness and overt aggressive behavior. Since the neural mechanisms underlying AAS-induced behavioral disinhibition are unknown, we investigated the integrity of serotonergic system transcription in several brain areas of mice under prolonged nandrolone administration. Male C57Bl/6J mice received 15 mg/kg of nandrolone decanoate subcutaneously once daily for 28 days, and different sets of animals were used to investigate motor and emotion-related behaviors or 5-HT-related gene expression by qRT-PCR. AAS-injected mice had increased body weight, were hyperactive and displayed more anxious-like behaviors in novel environments. They exhibited reduced immobility in the forced swim test, higher probability of being aggressive and elevated impulsivity to attack the opponent. AAS induced substantial reduction in the transcription of most postsynaptic 5-HT receptors investigated in the amygdala and prefrontal cortex. Interestingly, 5-HT1B mRNA was further reduced in the hippocampus and hypothalamus. At the midbrain level, there was no alteration in 5- HT receptors, transporter or synthetic enzyme gene transcription. In conclusion, high doses of AAS nandrolone in male mice recapitulate the behavioral disinhibition observed in abusers. Furthermore, they are associated with overall decrease in 5-HT receptor gene expression in the amygdala and prefrontal cortex, implicating these areas as critical sites for AASinduced effects and indicating a role for the 5-HT1B receptor in this behavioral disinhibitio

Effects of prolonged administration of the anabolic-androgenic steroid nandrolone decanoate in emotional behaviors and serotonergic system related genes expression in several brain areas of mice

O decanoato de nandrolona é um esteróide anabólico-androgênico (EAA), derivado da testosterona, utilizado de maneira abusiva por indivíduos procurando ganho de força física ou apenas efeitos estéticos. Doses suprafisiológicas desses compostos têm sido associadas a efeitos psiquiátricos adversos, especialmente episódios de impulsividade e aumento no comportamento agressivo. Considerando o desconhecimento dos mecanismos neurais envolvidos nessa desinibição comportamental, nós investigamos a integridade da transcrição de componentes do sistema serotoninérgico (intimamente relacionados à expressão de comportamentos emocionais) em diversas áreas cerebrais de camundongos sob a administração prolongada de nandrolona. Camundongos machos adultos da linhagem C57Bl/6J receberam uma injeção subcutânea diária de 15 mg/kg de decanoato de nandrolona durante 28 dias. Diferentes grupos de animais foram utilizados para a análise de comportamentos emocionais e para a quantificação da expressão de genes relacionados à serotonina (5-HT), utilizando a transcrição reversa do RNA associada à técnica de PCR em tempo-real. Os camundongos tratados apresentaram um aumento na massa corporal, hiperatividade motora e aumento de comportamentos relacionados à ansiedade em ambientes novos. A imobilidade avaliada no teste de nado forçado apresentou-se reduzida. Os animais que receberam a nandrolona se mostraram mais agressivos e impulsivos para iniciar o ataque aos camundongos oponentes, no modelo de residenteintruso. O EAA induziu uma redução significante na quantidade de transcritos da maioria dos receptores pós-sinápticos de 5-HT investigados na amígdala e no córtex pré-frontal. A expressão do gene do receptor 5-HT1B (reconhecidamente envolvido com as alterações comportamentais observadas) estava também reduzida no hipocampo e hipotálamo. No mesencéfalo, região onde se encontram os corpos neuronais dos neurônios serotoninérgicos que inervam o sistema límbico e demais áreas cerebrais, não se observou nenhuma alteração na expressão dos genes relacionados aos receptores serotoninérgicos pré-sinápticos. Os transcritos do transportador e da enzima de síntese de 5-HT, indicadores da integridade serotoninérgica pré-sináptica, também não se apresentaram alterados. Dessa maneira, concluímos que o efeito de altas doses do EAA decanoato de nandrolona em camundongos confirma os dados encontrados em literatura quanto à desinibição comportamental observada em usuários abusivos humanos. Nosso modelo também foi eficiente em mostrar pela primeira vez alterações moleculares induzidas por este EAA. A redução generalizada na expressão dos genes de receptores de 5-HT na amígdala e córtex pré-frontal sugere essas áreas, pós-sinápticas ao sistema serotoninérgico, como críticas nos efeitos induzidos pelo EAA. Nosso trabalho também sugere um papel importante para o receptor 5-HT1B na desinibição comportamental observadaNandrolone decanoate is a highly abused anabolic-androgenic steroid (AAS) by individuals looking for gains in physical strength or body appearance. Supraphysiological doses of this testosterone synthetic derivative have been associated with many physical and psychiatric adverse effects, especially reported episodes of impulsiveness and overt aggressive behavior. Since the neural mechanisms underlying AAS-induced behavioral disinhibition are unknown, we investigated the integrity of serotonergic system transcription in several brain areas of mice under prolonged nandrolone administration. Male C57Bl/6J mice received 15 mg/kg of nandrolone decanoate subcutaneously once daily for 28 days, and different sets of animals were used to investigate motor and emotion-related behaviors or 5-HT-related gene expression by qRT-PCR. AAS-injected mice had increased body weight, were hyperactive and displayed more anxious-like behaviors in novel environments. They exhibited reduced immobility in the forced swim test, higher probability of being aggressive and elevated impulsivity to attack the opponent. AAS induced substantial reduction in the transcription of most postsynaptic 5-HT receptors investigated in the amygdala and prefrontal cortex. Interestingly, 5-HT1B mRNA was further reduced in the hippocampus and hypothalamus. At the midbrain level, there was no alteration in 5- HT receptors, transporter or synthetic enzyme gene transcription. In conclusion, high doses of AAS nandrolone in male mice recapitulate the behavioral disinhibition observed in abusers. Furthermore, they are associated with overall decrease in 5-HT receptor gene expression in the amygdala and prefrontal cortex, implicating these areas as critical sites for AASinduced effects and indicating a role for the 5-HT1B receptor in this behavioral disinhibitio

Genetic diversity of bats coronaviruses in the Atlantic Forest hotspot biome, Brazil

Bats are notorious reservoirs of genetically-diverse and high-profile pathogens, and are playing crucial roles in the emergence and re-emergence of viruses, both in human and in animals. In this report, we identified and characterized previously unknown and diverse genetic clusters of bat coronaviruses in the Atlantic Forest Biome, Brazil. These results highlight the virus richness of bats and their possible roles in the public health

Identification and frequency of transposable elements in Eucalyptus

Transposable elements (TE) are major components of eukaryotic genomes and involved in cell regulation and organism evolution. We have analyzed 123,889 expressed sequence tags of the Eucalyptus Genome Project database and found 124 sequences representing 76 TE in 9 groups, of which copia, MuDR and FAR1 groups were the most abundant. The low amount of sequences of TE may reflect the high efficiency of repression of these elements, a process that is called TE silencing. Frequency of groups of TE in Eucalyptus libraries which were prepared with different tissues or physiologic conditions from seedlings or adult plants indicated that developing plants experience the expression of a much wider spectrum of TE groups than that seen in adult plants. These are preliminary results that identify the most relevant TE groups involved with Eucalyptus development, which is important for industrial wood production

Genetic diversity of bats coronaviruses in the Atlantic Forest hotspot biome, Brazil

Bats are notorious reservoirs of genetically-diverse and high-profile pathogens, and are playing crucial roles in the emergence and re-emergence of viruses, both in human and in animals. In this report, we identified and characterized previously unknown and diverse genetic clusters of bat coronaviruses in the Atlantic Forest Biome, Brazil. These results highlight the virus richness of bats and their possible roles in the public health

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

OBJECTIVES: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer. METHODS: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155. RESULTS: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement. CONCLUSIONS: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes