Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users.

Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion. We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons' characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis. The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy. Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit

TARAPACÁ EN ATACAMA: ARTE RUPESTRE Y RELACIONES INTERSOCIETALES ENTRE EL 900 Y 1450 DC TARAPACA IN ATACAMA: ROCK ART AND INTERSOCIETAi RELATIONSHIPS BETWEEN AD 900 AND 1450

En este artículo se explora la presencia tarapaqueña en Atacama durante el Período Intermedio Tardío, sistematizando la información procedente de cementerios y asentamientos e integrándola con el registro de representaciones rupestres de figuras antropomorfas con vestimenta trapezoidal como indicador de dicha presencia. Tomando como marco la teoría social, se discuten los tipos de ocupación que mantuvo Tarapacá en Atacama, así como la naturaleza de estas relaciones intersocietales en el área del Loa.This paper explores the Tarapacan presence in Atacama during the Late Intermediate Period, relying on systematized evidence from cemeteries and settlements, and a registry of anthropomorphic rock art figures depicted with the culture's characteristic trapezoidal apparel. In the framework of the social theory, the authors discuss the types of occupation that Tarapacá had in Atacama, and the nature of the group's intersocietal relationships in the Loa River area

Evaluación y manejo psicológico del paciente candidato a cirugía metabólica

Psychological factors can play a role in the onset, course and the way a patient copes with diabetes; therefore the mental health approach is gaining increasing relevance in the management of the disease. With the advent of metabolic surgery as a new treatment alternative, assessment of psychosocial variables and pre and postoperative psychological support acquire a significant role in the short and long term outcomes. The objective of this article is to highlight the importance of a proper assessment and treatment of behaviors and mental disorders that can interfere the adherence to post operatory directions, which is fundamental given the high prevalence of psychopathology in this population. The main psychological problems associated with this disease are presented, as well as psychosocial and behavioral domains assessed pre and post operatively. Patients must have realistic expectations regarding the surgery and be aware of their responsibility in the outcomes, committing themselves to change their lifestyle and self-care. Continuous follow up that includes psychological support and treatment if necessary is required

Circulating leptin, resistin, adiponectin, visfatin, adipsin and ghrelin levels and insulin resistance in postmenopausal women with and without the metabolic syndrome.

To measure serum levels of adipsin, leptin, resistin, adiponectin, visfatin, ghrelin and insulin in postmenopausal women screened for the metabolic syndrome (METS).Serum of 100 postmenopausal women was analyzed using multiplex technology for the mentioned analytes. In addition, values for the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. Comparisons were performed in accordance to the presence or not of the METS and each of its components. Criteria of the American Heart Association were used to define the METS.Age and time since menopause onset were similar in women with the METS (n=57) as compared to those without the syndrome (n=43). METS women displayed significantly higher levels of adipsin, leptin, resistin, insulin and HOMA-IR values and lower adiponectin levels. These differences were mainly observed among women with abdominal obesity, independent of fulfilling METS criteria or not. In this same sense, lower adiponectin levels significantly related to low HDL-C and high triglyceride levels; and higher insulin and HOMA-IR values related to high triglyceride and glucose levels, respectively.In this sample, postmenopausal women with the METS displayed higher insulin and adipokine levels. These were mainly related to abdominal obesity and metabolic and lipid abnormalities. More research is warranted in this regard