Laparoscopic hiatal hernia repair: personal experience

Catedra chirurgie nr.5, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Militar Central, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Herniile hiatale (HH) simptomatice reprezintă o patologie frecventă, care este supusă tratamentului structurat în etape. HH paraesofagiene şi HH asociate BRGE severă necesită tratament chirurgical. Materiale şi metode: În clinica au fost supuşi tratamentului chirurgical prin abord laparoscopic 167 pacienţi cu HH simptomatice (aa. 2011-2019). Repartiţia HH conform SAGES (2013): tip I (n=135); tip II (n=6); tip III (n=23); tip IV, “upside-down” (n=3). Pacienţii cu HH asociate cu BRGE au fost selectaţi pentru cura chirurgicală în baza criteriilor ghidului SAGES (2010): tratamentul medicamentos ineficient (n=78); alternativa tratamentului medicamentos (n=48); manifestări extra-esofagiene (n=38); BRGE agravată (n=3). Intervenţia a inclus reducerea herniei, identificarea pilierilor şi joncţiunii eso-gastrice, recalibrarea hiatusului esofagian prin crurorafia posterioară şi realizarea valvei anti-reflux. În 141 cazuri a fost realizată fundoplicatura Nissen-Rossetti ”short-floppy”, la 19 pacienţiprocedeul Toupet şi la 7 pacienţi- procedeul Dor. Rezultate: Incidente intraoperatorii rezolvate laparoscopic au inclus: leziuni hepatice (n=4), hemoragie din vasele scurte (n=3), capnotorax (n=3). Leziunea esofagiană (n=1) a servit indicaţie către conversie. Perioada medie a spitalizării a constituit 4 zile. Peste 3 luni după intervenţie rezultatul excelent (scorul modificat Visick) a fost realizat la 11% pacienţi; bun- 70%; sătisfăcător – 16%, nesătisfăcător -3%. 36 pacienţi nu au fost evaluaţi. Disfagie persistentă postoperator la 16 pacienţi a necesitat dilatare endoscopică. Recurenţă semnelor de HH confirmată radiologic a fost constatată în 6 cazuri (3,5%). Concluzii: Avantajele tehnicii chirurgicale laparoscopice sunt evidente în perioada postoperatorie: reducerea sindromului algic, spitalizarea redusă, recuperarea rapidă şi rezultate funcţionale sătisfăcătoare. Abordul laparoscopic al HH voluminoase reprezintă o intervenţie laborioasă, şi necesită experienţă în posedarea tehnicilor laparoscopice avansate.Background: Hiatal hernia (HH) is the common benign medical condition of the stomach and esophagus which needs step-by-step treatment approach. For patients that experience life-limiting symptoms of gastroesophageal reflux disease (GERD) despite medical therapy and those diagnosed with paraesophageal hernia, surgical approach should be considered. Materials and methods: The group of 167 patients underwent laparoscopic hiatal hernia repair for the period 2011-2019. Patients who have a HH associated with GERD were selected for interventional procedures based on SAGES guidelines (2010) criteria: medical management failure (n=78); desire for surgery due to quality of life considerations (n=48); presence of extra-esophageal manifestations (n=38) and complicated GERD (n=3). The procedure included reduction of the hernia sac, identification of both crura and the eso-gastric junction, obtaining at least 4 cm of intra-abdominal esophageal length, hiatal closure and laparoscopic antireflux procedure (LARP). LARP was performed as follows: 141 cases according to Nissen- Rossetti ”short-floppy”, 19 according to Toupet, and 7 according to Dor. Results: The majority of intraoperative incidents (bleeding from liver (n=4) and short gastric vessels (n=3), capnotorax (n=3)) were solved laparoscopically without sequelae. The esophageal lesion (n=1) served as an indication to open antireflux procedure. The average length of hospital stay was 4 days. Follow up data were analyzed, based on modified Visick scale, 3 month after surgery: excellent result was obtained for 11% of the patients, good - 70%, satisfactory- 16%, and unsatisfactory – 3 %. 36 individuals have not been evaluated. We observed the persistent dysphagia postfundoplication in 16 patients, these cases underwent the endoscopic dilation of the eso-gastric junction. The HH recurrence developed in 6 patients (3,5%). Conclusions: The advantages of laparoscopic HH repair include less postoperative pain, short length of hospital stay, fast return to normal activities and satisfactory functional results. Although technically challenging, laparoscopic repair of giant HH is a viable alternative to "open" surgical approaches

Diurnal Rhythms in Neurexins Transcripts and Inhibitory/Excitatory Synapse Scaffold Proteins in the Biological Clock

The neurexin genes (NRXN1/2/3) encode two families (α and β) of highly polymorphic presynaptic proteins that are involved in excitatory/inhibitory synaptic balance. Recent studies indicate that neuronal activation and memory formation affect NRXN1/2/3α expression and alternative splicing at splice sites 3 and 4 (SS#3/SS#4). Neurons in the biological clock residing in the suprachiasmatic nuclei of the hypothalamus (SCN) act as self-sustained oscillators, generating rhythms in gene expression and electrical activity, to entrain circadian bodily rhythms to the 24 hours day/night cycles. Cell autonomous oscillations in NRXN1/2/3α expression and SS#3/SS#4 exons splicing and their links to rhythms in excitatory/inhibitory synaptic balance in the circadian clock were explored. NRXN1/2/3α expression and SS#3/SS#4 splicing, levels of neurexin-2α and the synaptic scaffolding proteins PSD-95 and gephyrin (representing excitatory and inhibitory synapses, respectively) were studied in mRNA and protein extracts obtained from SCN of C3H/J mice at different times of the 24 hours day/night cycle. Further studies explored the circadian oscillations in these components and causality relationships in immortalized rat SCN2.2 cells. Diurnal rhythms in mNRXN1α and mNRXN2α transcription, SS#3/SS#4 exon-inclusion and PSD-95 gephyrin and neurexin-2α levels were found in the SCN in vivo. No such rhythms were found with mNRXN3α. SCN2.2 cells also exhibited autonomous circadian rhythms in rNRXN1/2 expression SS#3/SS#4 exon inclusion and PSD-95, gephyrin and neurexin-2α levels. rNRXN3α and rNRXN1/2β were not expressed. Causal relationships were demonstrated, by use of specific siRNAs, between rNRXN2α SS#3 exon included transcripts and gephyrin levels in the SCN2.2 cells. These results show for the first time dynamic, cell autonomous, diurnal rhythms in expression and splicing of NRXN1/2 and subsequent effects on the expression of neurexin-2α and postsynaptic scaffolding proteins in SCN across the 24-h cycle. NRXNs gene transcripts may have a role in coupling the circadian clock to diurnal rhythms in excitatory/inhibitory synaptic balance

Expression of the vesicular GABA transporter within neuromedin S+ neurons sustains behavioral circadian rhythms

The suprachiasmatic nucleus (SCN) of the hypothalamus is the site of a central circadian clock that orchestrates overt rhythms of physiology and behavior. Circadian timekeeping requires intercellular communication among SCN neurons, and multiple signaling pathways contribute to SCN network coupling. Gamma-aminobutyric acid (GABA) is produced by virtually all SCN neurons, and previous work demonstrates that this transmitter regulates coupling in the adult SCN but is not essential for the nucleus to sustain overt circadian rhythms. Here, we show that the deletion of the gene that codes for the GABA vesicular transporter Vgat from neuromedin-S (NMS)+ neurons-a subset of neurons critical for SCN function-causes arrhythmia of locomotor activity and sleep. Further, NMS-Vgat deletion impairs intrinsic clock gene rhythms in SCN explants cultured ex vivo. Although vasoactive intestinal polypeptide (VIP) is critical for SCN function, Vgat deletion from VIP-expressing neurons did not lead to circadian arrhythmia in locomotor activity rhythms. Likewise, adult SCN-specific deletion of Vgat led to mild impairment of behavioral rhythms. Our results suggest that while the removal of GABA release from the adult SCN does not affect the pacemaker's ability to sustain overt circadian rhythms, its removal from a critical subset of neurons within the SCN throughout development removes the nucleus ability to sustain circadian rhythms. Our findings support a model in which SCN GABA release is critical for the developmental establishment of intercellular network properties that define the SCN as a central pacemaker.Fil: Bussi, Ivana Leda. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. University of Washington; Estados UnidosFil: Neitz, Alexandra F.. University of Washington; Estados UnidosFil: Sanchez, Raymond E A. University of Washington; Estados UnidosFil: Casiraghi, Leandro Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés. Escuela de Educación; Argentina. University of Washington; Estados UnidosFil: Moldavan, Michael. Oregon Health And Science University; Estados UnidosFil: Kunda, Divya. University of Washington; Estados UnidosFil: Allen, Charles N.. Oregon Health And Science University; Estados UnidosFil: Evans, Jennifer A.. Marquette University; Estados UnidosFil: de la Iglesia, Horacio Oscar. University of Washington; Estados Unido

Surface charge and interface state density on Silicon substrates after Ozone based wet chemical oxidation and Hydrogen termination

Textured Si solar cell substrates, as well as flat Si 100 and Si 111 reference wafers were prepared in DIW O3 at room temperature RT with increasing ozone dose Dozone . The influence of both O3 content and oxidation time on the efficiency and stability of interface conditioning was investigated. Additionally, hydrophobic, H terminated Si surfaces were prepared by the subsequent removal of the wet chemical oxides by applying HF 1 solution. Correlations were established between morphological structure of the silicon sur face and DIW O3 preparation conditions, and the resulting surface charge, density and energetic distribu tion of rechargeable states Dit E . The results of these investigations were correlated to previously reported findings obtained on RCA treated interface and atomically flat, H terminated Si 111 sur faces which were prepared by different wet chemical oxidation and oxide removal processes. On H terminated substrate prepared this way H terminated substrates low values of Dit E could be achieved, comparable to values obtained on similar substrates by the RCA process followed by HF dip. On the oxidized hydrophilic surface a homogenous oxide layer can be applied to improve the wettability for subsequent processes on textured solar substrate

Improving the Quality of Inclusive Education in Institutions of Physical Culture and Sports

The article describes the experience of study Russian sign language by healthy students in order to create an inclusive environment for stu-dents with hearing disabilities. The implementation of this project at the Kuban State University of Physical Culture, Sports and Tourism is described. Through a survey, a group of people wishing to learn Russian sign language was formed, training was conducted, the first results were obtained, acquired skills were successfully applied to a group of students of the Department of adaptive physical culture.В статье описывается опыт изучения русского жестового языка здоровыми студентами с целью создания инклюзивной среды для студентов с нарушением слуха. Описана реализация данного проекта в Кубанском государственном университете физической культуры, спорта и туризма. Путем опроса была сформирована группа желающих изучать русский жестовый язык, проведено обучение, получены первые результаты, освоенные навыки успешно применяются на группе студентов кафедры адаптивной физической культуры