axillary lymphadenectomy for breast cancer a randomized controlled trial comparing a bipolar vessel sealing system to the conventional technique

Abstract Aim To compare safety and efficacy of a bipolar vessel sealing system (BVSS) to the conventional technique in axillary node dissection. Methods 116 women with breast cancer were randomized to conventional node dissection surgical technique (control; n = 58) by scalpel and monopolar cautery or using an electrothermal BVSS (study group; n = 58). Results The median (range) total volume of fluid collected by drain and aspirations was 305 (30–1420) mL in the study group and 335 (80–1070) mL in the control group ( p = 0.325). The median (range) total volume of lymph collected by percutaneous aspirations was 207.5 (40–1050) mL in the study group and 505 (270–705) mL in the control group ( p = 0.010). The incidence of seroma was similar in both groups ( p = 0.845). The axillary drain was removed earlier in the study group than in controls ( p = 0.046). Conclusion The use of a BVSS offers marginal advantages when compared to the conventional technique

Cerros lindos. De la cadena de valor del patrimonio cultural al patrimonio como innovación social

This text contextualises the issue of the Cerritos de Indios (earthen mounds) in the framework of Uruguayan heritage policy. A brief outline is provided of a project to manage heritage responsibly, as the foundation for social development, which was carried out on a set of cerritos in India Muerta (Rocha, Uruguay) between 2016 and 2021. The subsequent section characterises the classical concept of “the cultural heritage value chain” and advocates for its renovation. Based on the experience of this project in Uruguay, a theoretical and methodological reflection is made oriented towards this renovation. The necessity of rethinking the ontological bases of landscape and heritage management is presented, along with the need for a greater and more relativised role for science (specifically archaeology) within the framework of the ‘heritagization’ process, in which various dimensions should be taken into account. This renovation implies moving from a perspective of heritage taken as an object or set of objects to be evaluated toward a model which functions as a means for social transformation and innovation.En este texto se parte de una contextualización de la problemática de los cerritos de indios en el marco de las políticas patrimoniales en Uruguay. A continuación, se describe someramente un proyecto de gestión patrimonial y producción responsable como bases para el desarrollo social, llevado a cabo en un conjunto de cerritos de India Muerta (Rocha, Uruguay), entre 2016 y 2021. En la parte subsiguiente se caracteriza el concepto clásico de “cadena de valor del patrimonio cultural”, y se argumenta la necesidad de una actualización del mismo. A partir de la experiencia del proyecto en Uruguay, se realiza una reflexión teórico-metodológica orientada a dicha actualización. Se pone de manifiesto la necesidad de un replanteamiento de las bases ontológicas de la gestión del paisaje y el patrimonio, así como una ampliación y relativización del rol de la ciencia (en concreto, de la arqueología), en el marco de un proceso de patrimonialización en el que diversas dimensiones valorativas deben ser tenidas en cuenta. Esta actualización implica el paso de un patrimonio entendido como objeto o conjunto de objetos a valorizar, a un patrimonio que funciona como medio para la transformación e innovación social

Fatty Liver Is Associated with Transcriptional Downregulation of Stearoyl-CoA Desaturase and Impaired Protein Dimerization

AIMS AND METHODS: We evaluated the modulation of liver stearoyl-CoA desaturase-1 (Scd1) by dietary factors and insulin resistance (IR) in two experimental models of high-fat diet (HFD)-induced nonalcoholic fatty liver disease (NAFLD). The first model included Sprague Dawley (SD) rats that developed NAFLD without IR, and the second one included a rat model of genetic IR and cardiovascular disease, the spontaneously hypertensive rats (SHR) and its normotensive, insulin-sensitive control Wistar-Kyoto (WKY). The adult rats were given standard chow diet (CD) or HFD for 10 weeks. In all the animals, we explored the hepatic Scd1 transcriptional activity and protein levels. RESULTS: HFD-fed rats of both strains developed severe NAFLD. Liver abundance of Scd1 mRNA was significantly decreased in HFD-fed rats regardless of the strain; SD-CD: 235±195 vs. SD-HFD 4.5±2.9, p<0.0004, and SHR-CD: 75.6±10.8 vs. SHR-HFD: 4.48±17.4, and WKY-CD: 168.7±17.4 vs. WKY-HFD: 12.9±17.4, p<0.000001 (mean±SE, ANCOVA adjusted by HOMA). Analysis of liver Scd1 protein expression showed a particular pattern in the HFD groups, characterized by the presence of high levels of a monomeric protein band (32.2-36.6 Kda, p<0.003) and decreased levels of a dimeric protein band (61.9-66.1 Kda, p<0.02) regardless of the rat strain. Pharmacologic intervention with the peroxisome proliferator-activated receptor α agonist clofibrate reverted the liver phenotype and significantly modified the hepatic Scd1 transcriptional activity and protein expression. CONCLUSION: Diet-induced fatty liver is associated with the downregulation of hepatic Scd1 transcript and de-dimerization of the protein, and these changes were not much affected by the status of peripheral IR.Fil: Fernandez Gianotti T.Fil: Burgueño A.Fil: Gonzales Mansilla Nl.Fil: Pirola Cj.Fil: Sookoian S

The path of dishonesty: identification of mental processes with electrical neuroimaging.

Much research finds that lying takes longer than truth-telling. Yet, the source of this response time difference remains elusive. Here, we assessed the spatiotemporal evolution of electrical brain activity during honesty and dishonesty in 150 participants using a sophisticated electrical neuroimaging approach-the microstate approach. This uniquely positioned us to identify and contrast the entire chain of mental processes involved during honesty and dishonesty. Specifically, we find that the response time difference is the result of an additional late-occurring mental process, unique to dishonest decisions, interrupting the antecedent mental processing. We suggest that this process inhibits the activation of the truth, thus permitting the execution of the lie. These results advance our understanding of dishonesty and clarify existing theories about the role of increased cognitive load. More broadly, we demonstrate the vast potential of our approach to illuminate the temporal organization of mental processes involved in decision-making

Maternal amoxicillin affects piglets colon microbiota: microbial ecology and metabolomics in a gut model

The first weeks of life represent a crucial stage for microbial colonization of the piglets’ gastrointestinal tract. Newborns’ microbiota is unstable and easily subject to changes under stimuli or insults. Nonetheless, the administration of antibiotics to the sow is still considered as common practice in intensive farming for pathological conditions in the postpartum. Therefore, transfer of antibiotic residues through milk may occurs, affecting the piglets’ colon microbiota. In this study, we aimed to extend the knowledge on antibiotic transfer through milk, employing an in vitro dedicated piglet colon model (MICODE— Multi Unit In vitro Colon Model). The authors’ focus was set on the shifts of the piglets’ microbiota composition microbiom- ics (16S r-DNA MiSeq and qPCR—quantitative polymerase chain reaction) and on the production of microbial metabolites (SPME GC/MS—solid phase micro-extraction gas chromatography/mass spectrometry) in response to milk with different concentrations of amoxicillin. The results showed an effective influence of amoxicillin in piglets’ microbiota and metabolites production; however, without altering the overall biodiversity. The scenario is that of a limitation of pathogens and opportun- istic taxa, e.g., Staphylococcaceae and Enterobacteriaceae, but also a limitation of commensal dominant Lactobacillaceae, a reduction in commensal Ruminococcaceae and a depletion in beneficial Bifidobactericeae. Lastly, an incremental growth of resistant species, such as Enterococcaceae or Clostridiaceae, was observed. To the authors’ knowledge, this study is the first evaluating the impact of antibiotic residues towards the piglets’ colon microbiota in an in vitro model, opening the way to include such approach in a pipeline of experiments where a reduced number of animals for testing is employed

In Vivo Effects of Einkorn Wheat (Triticum monococcum) Bread on the Intestinal Microbiota, Metabolome, and on the Glycemic and Insulinemic Response in the Pig Model

Einkorn wheat (Triticum monococcum) is characterized by high content of proteins, bioactive compounds, such as polyunsaturated fatty acids, fructans, tocols, carotenoids, alkylresorcinols, and phytosterols, and lower α-, β-amylase and lipoxygenase activities compared to polyploid wheat. These features make einkorn flour a good candidate to provide healthier foods. In the present study, we investigated the effects of einkorn bread (EB) on the intestinal physiology and metabolism of the pig model by characterizing the glycemic and insulinemic response, and the microbiota and metabolome profiles. Sixteen commercial hybrid pigs were enrolled in the study; four pigs were used to characterize postprandial glycemic and insulinemic responses and twelve pigs underwent a 30-day dietary intervention to assess microbiota and metabolome changes after EB or standard wheat bread (WB) consumption. The postprandial insulin rise after an EB meal was characterized by a lower absolute level, and, as also observed for glucose, by a biphasic shape in contrast to that in response to a WB meal. The consumption of EB led to enrichment in short-chain fatty acid producers (e.g., Blautia, Faecalibacterium, and Oscillospira) in the gut microbiota and to higher metabolic diversity with lower content of succinate, probably related to improved absorption and therefore promoting intestinal gluconeogenesis. The observed changes, at both a compositional and metabolic scale, strongly suggest that EB consumption may support a health-promoting configuration of the intestinal ecosystem

Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis

Background and aims: Body composition parameters and immunonutritional indexes provide useful information on the nutritional and inflammatory status of patients. We sought to investigate whether they predict the postoperative outcome in patients with pancreatic cancer (PC) who received neoadjuvant therapy (NAT) and then pancreaticoduodenectomy. Methods: Data from locally advanced PC patients who underwent NAT followed by pancreaticoduodenectomy between January 2012 and December 2019 in four high-volume institutions were collected retrospectively. Only patients with two available CT scans (before and after NAT) and immunonutritional indexes (before surgery) available were included. Body composition was assessed and immunonutritional indexes collected were: VAT, SAT, SMI, SMA, PLR, NLR, LMR, and PNI. The postoperative outcomes evaluated were overall morbidity (any complication occurring), major complications (Clavien-Dindo ≥ 3), and length of stay. Results: One hundred twenty-one patients met the inclusion criteria and constituted the study population. The median age at the diagnosis was 64 years (IQR16), and the median BMI was 24 kg/m2 (IQR 4.1). The median time between the two CT-scan examined was 188 days (IQR 48). Skeletal muscle index (SMI) decreased after NAT, with a median delta of −7.8 cm2/m2 (p &lt; 0.05). Major complications occurred more frequently in patients with a lower pre-NAT SMI (p = 0.035) and in those who gained in subcutaneous adipose tissue (SAT) compartment during NAT (p = 0.043). Patients with a gain in SMI experienced fewer major postoperative complications (p = 0.002). The presence of Low muscle mass after NAT was associated with a longer hospital stay [Beta 5.1, 95%CI (1.5, 8.7), p = 0.006]. An increase in SMI from 35 to 40 cm2/m2 was a protective factor with respect to overall postoperative complications [OR 0.43, 95% (CI 0.21, 0.86), p &lt; 0.001]. None of the immunonutritional indexes investigated predicted the postoperative outcome. Conclusion: Body composition changes during NAT are associated with surgical outcome in PC patients who receive pancreaticoduodenectomy after NAT. An increase in SMI during NAT should be favored to ameliorate the postoperative outcome. Immunonutritional indexes did not show to be capable of predicting the surgical outcome

Increasing incidence and prevalence of metabolic syndrome in people living with HIV during the COVID-19 pandemic

IntroductionThe aim of this study was to analyze the impact of COVID-19 pandemic restrictions on the prevalence and incidence of metabolic syndrome (MS), and to identify predictors of new MS cases in people living with HIV (PLWH).MethodsThis cohort study included PLWH followed at the IRCCS San Raffaele, Milan, Italy, with at least one body mass index (BMI) determination during the pre-pandemic period (1 December 2018 to 29 February 2020) and the pandemic period (1 March 2020 to 31 May 2021). MS diagnosis was based on NCEP ATP III 2005 criteria. Univariable Poisson regression model was used to compare MS incidence rates. Univariable mixed linear models estimated the crude mean change in metabolic parameters during each time period. Multivariable Cox proportional hazards model was used to assess risk factors for MS.ResultsThis study included 1,564 PLWH, of whom 460 and 1,104 were with and without a diagnosis of MS, respectively, at the beginning of the pre-pandemic period, with an overall prevalence of MS of 29.4%. During the pre-pandemic period, 528/1,564 PLWH had MS, with a prevalence of 33.8% (95%CI = 31.5%–36.1%), while during the pandemic period, the number of PLWH with a diagnosis of MS increased to 628/1,564, with a prevalence of 40.2% (95%CI 37.8%–42.6%; McNemar’s test: p &lt; 0.0001). Similarly, the MS incidence rate increased from 13.7/100 person-years of follow-up (PYFU; 95%CI = 11.7–16.0) in the pre-pandemic period to 18.5/100 PYFU (95%CI = 16.2–21.1) in the pandemic period (p = 0.004), with 201 subjects developing MS during the pandemic period. In addition, we observed a significant increase in the crude mean change during the pandemic period compared with the pre-pandemic period for: total cholesterol, LDL cholesterol, plasma glucose, blood pressure, and atherosclerotic cardiovascular disease (ASCVD) risk score. Finally, after adjustment for HIV risk factors, HBV, HCV, ART duration, duration of virologic suppression and use of INSTIs, age [adjusted hazard ratio (AHR) per 3 years older = 1.12 (95%CI = 1.08–1.17)], sex [AHR female vs. male = 0.62 (95%CI = 0.44–0.87)] and CD4+ cell count [AHR per 100 cells/μL higher = 1.05 (95%CI = 1.01–1.09)] were associated with the risk of MS.ConclusionThe COVID-19 pandemic affected the metabolic profile of PLWH and increased the prevalence and incidence of MS