Subject(s)
Humans , Male , Aged, 80 and over , Carcinoma, Medullary , Hepatitis C , Sofosbuvir , Anemia, Iron-Deficiency , Gastroscopy , BiopsyABSTRACT
Choroid plexus homogenates from 27 cases with Alzheimer disease-related pathology (AD), stages I/0 (n = 5), III-IV/0-B (n = 15) and V-VI/B-C (n = 7) and 3 age-matched controls (no clinical symptoms, no neuropathological lesions) were processed for gel electrophoresis and western blotting for oxidation markers carboxymethyl-lysine (CML) and N-carboxyethyl-lysine (CEL). Increased CEL and CML expression was seen in AD cases stages IVB, and V-VI/B-C when compared to controls and cases with AD-related pathology classified as I/0 and III/0. Variable stress damage was seen in stage III/B. Although lower stages of AD did not show beta-amyloid deposition in the choroid plexus, the amount of beta-amyloid was very variable at stages V/VI as revealed by western blotting, suggesting that other factors in addition to local fibrillar beta-amyloid were associated with oxidative damage in the choroid plexus. Two-dimensional gel electrophoresis and western blotting to CEL and CML in combination with mass spectrometry disclosed increased intensity of variable spots in AD cases leading to the identification of tyrosine 3/tryptophan 5-monooxygenase activation protein, zeta polypeptide, tropomyosin 3 isoform, and apolipoprotein A-II (ApoA-II) as targets of increased oxidative damage in AD. Oxidation of these proteins may result in impaired protein interactions, protein folding and protein kinase activity; abnormal function of endothelial and vascular smooth muscle cells; and impaired HDL-cholesterol metabolism in the choroid plexus in advanced stages of AD.
Subject(s)
Alzheimer Disease/pathology , Choroid Plexus/pathology , Oxidative Stress , Proteins/metabolism , Aged , Aged, 80 and over , Alzheimer Disease/metabolism , Amyloid beta-Peptides/metabolism , Blotting, Western , Choroid Plexus/metabolism , Electrophoresis, Gel, Two-Dimensional , Female , Humans , Male , Mass Spectrometry , Middle Aged , Neurons/metabolism , Neurons/pathologyABSTRACT
HYPOTHESIS: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional open or laparoscopic surgery. However, most information is fragmented and comes from specific or selective indications. To assess the current situation of HALS, a general overview of the fields of application, results, and quality of the evidence of these results is necessary. DATA SOURCES: Current English-language literature review. STUDY SELECTION: Case reports, series, and opinion articles on HALS. DATA EXTRACTION AND SYNTHESIS: Evaluation of the type of study and results. Most of the articles are short case series. Only a few comparative or randomized comparative trials on HALS for splenectomy and colectomy have been published. CONCLUSIONS: Hand-assisted laparoscopic surgery seems to be a promising technique that has been applied with success in a wide range of digestive tract-related surgical procedures. The main role is to help in difficult cases before conversion is necessary or for training unskilled surgeons, and not as an alternative to pure laparoscopic surgery. However, not enough evidence-based data are available to know exactly the final outcome of this technique in general surgery. Prospective randomized trials with established open or laparoscopic procedures are lacking, and these trials are needed to support the final role of HALS.
Subject(s)
Laparoscopy , Colectomy/methods , Digestive System Surgical Procedures/methods , Humans , Laparoscopy/methods , Nephrectomy/methods , Splenectomy/methodsABSTRACT
Introducción. El principal inconveniente de la cirugía laparoscópica convencional es la pérdida de la sensación táctil. En los últimos meses se han desarrollado diversos dispositivos que han permitido reconsiderar el concepto de cirugía laparoscópica asistida con la mano (CLAM), que constituye un tipo híbrido de cirugía que mantiene las características de la CL (mejor visión y más detallada) con la recuperación del tacto. Objetivo. Revisión del estado de conocimiento actual de la CLAM. Resultados. La CLAM ha sido utilizada para efectuar la mayoría de las intervenciones laparoscópicas digestivas, así como urológicas, ginecológicas y vasculares, con buenos resultados iniciales, aunque en la mayoría de los casos no existen datos comparativos basados en evidencias con la cirugía abierta convencional o la laparoscópica pura. Conclusión. La cirugía laparoscópica asistida con la mano puede ser una interesante alternativa a la CL convencional o a la cirugía abierta, facilitando la realización de intervenciones complejas a cirujanos expertos o la iniciación en CL avanzada de los cirujanos menos entrenados. Se requieren estudios comparativos con las técnicas laparoscópicas bien establecidas para definir sus ventajas definitivas, pero puede ser un recurso antes de la conversión a cirugía abierta, ante la evidencia inicial de que mantiene las ventajas de la CL. (AU)
