Description and Executability of a Novel Pre-tied Mini Ligature (Miniloop) in Laparocopic Ovariectomy in Cats

Background: Ovariectomy(OVE) and ovariohysterectomy (OVH) are the most performed surgical procedures in Veterinary Medicine. In videosurgery, both in stray animals at sterilization campaigns and in the increasing demand of tutors to perform the technique. Laparoscopy results in reduced tissue damage, due to minimal organ manipulation and surgical access hemostasis can be performed by several methods, such as electro-coagulation, clips, and intra and extracorporeal ligatures. A pre-tied ligature system, or endoloop, is a haemostatic technique comprised of a slipknot and knot pusher, which is inserted into the abdominal cavity through one of the laparoscopic ports. The aim of this study was to describe a novel OVE technique in cats, in which haemostasis was performed using miniloop, aimed at reducing the number of ports needed for knot tying.Material, Methods & Results: Ten healthy not spayed female cats, aged 6 months to 5 years, were selected for this study. They were submitted to an OVE using miniloop as haemostasis method. Access to the peritoneal cavity was through two 5 mm ports on the midline of the ventral abdomen, 5 cm apart, with one immediately caudal to the umbilical scar and the other in between the last pair of teats. The first trocar was inserted at the caudal incision using the Hasson technique and a 5 mm zero-degree optics attached to a camera was introduced through it. The placement of the second access port was video assisted. For ovary exposure, the patients were positioned in lateral recumbency on the contralateral side to the ovary being removed. The miniloop was composed of a 2 mm diameter minitrocar, a 1.8 mm knot pusher, and a pre-tied slipknot. It was introduced percutaneously at the lateral abdominal wall. It was inserted attached to a pre-tied loop ligature. A Babcock forceps was used to guide the slipknot until it enveloped the ovarian vessels and the proximal part of the uterine horn. Subsequently, the knot was tightened with the aid of the knot pusher. A second miniligature was applied. The forceps was removed and a Metzenbaum scissors inserted to cut between the ligatures, releasing the ovary with the nylon ligature but keeping the PDS knot. It was performed at both ovary. Mean (±SD) surgical time was 44.8 min (± 13.4) and varied significantly (P = 0.0006) between animals, with the shortest time being 29 min and the longest 66 min. Positioning of the patients in lateral decubitus allowed for good ovarian exposure, without the need for excessive manipulation of the intestinal loops or other abdominal organs. Rupture of the suture thread was the only trans-operative complication observed and occurred in two animals. A second ligature (miniloop) was needed to ensure haemostasis. One cat showed eventration at the site of the caudal port on the second day post-operative.Discussion: The mean surgical time in the present study was lower than reported by some authors, but longer than anothers. Furthermore, the surgical time from this study is similar to that of other studies in cats in which haemostasis of the OAVC was achieved using bipolar electrocoagulation. Surgical team expertise is of outmost importance in minimizing complications and overcoming problems during videosurgical procedures in order to reduce surgical time, such as gas leakage, extensive incision, and difficulty in manipulating surgical instruments

Síncope de Causa Indefinida e Seus Desafios Diagnósticos

A síncope, caracterizada pela perda súbita e transitória da consciência, apresenta-se como um desafio diagnóstico, especialmente quando sua origem permanece indefinida. Este estudo abordou uma paciente idosa que experimentou síncope sem causa definida, destacando a complexidade do fenômeno. A literatura médica reconhece a diversidade de etiologias possíveis, desde distúrbios cardíacos até condições neurológicas e metabólicas, acrescentando uma camada de complexidade ao diagnóstico. A metodologia adotada foi qualitativa, concentrando-se na avaliação de uma paciente hospitalizada por meio de parâmetros observacionais e exames de imagem. A paciente, R.C.D, de 65 anos, apresentou síncope súbita após cirurgia de catarata, sendo diagnosticada com hemorragia subaracnóidea traumática e fratura cervical C5. Após imobilização e monitoramento, a paciente apresentou recuperação favorável, mas surgiram queixas de tontura e problemas de memória anterógrada. A investigação revelou inconsistências nos resultados dos exames, atribuídas à agitação psicomotora durante a captura de imagens. O envelhecimento foi destacado como fator contribuinte, impactando a resposta cardiovascular ao ortostatismo e tornando os idosos mais suscetíveis a eventos sincopais. As considerações finais enfatizam a necessidade de uma investigação detalhada e contínua para determinar as causas subjacentes da síncope em idosos, especialmente diante da complexidade do caso apresentado. A correlação entre eventos e sintomas prévios, juntamente com uma interpretação clínica cautelosa, foi ressaltada como crucial. A inconsistência nos resultados sublinha a importância de uma abordagem sistêmica e destaca a necessidade de intervenções futuras orientadas pelos achados da investigação

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost