Clinical and pathophysiological outcomes of the robotic-assisted Heller-Dor myotomy for achalasia: a single-center experience.

Laparoscopic Heller myotomy and Dor fundoplication is considered a safe and effective treatment for achalasia. Robotic-assisted Heller-Dor procedure (RAHD) has emerged as an alternative approach due to improved visualization and fine motor control. The aim of this prospective study was to evaluate clinical, and functional results of RAHD. We evaluated a group of 66 patients with achalasia that underwent robotic-assisted Heller-Dor operation. Before treatment all patients underwent a diagnostic work-up such as upper endoscopy, esophageal barium swallow and high resolution manometry. The presence of postoperative gastroesophageal reflux disease was diagnosed by impedance and pH monitoring (MII-pH). Dysphagia improved in 92.4% of patients after treatment. Barium swallow series showed esophageal emptying in 100% of patients and a significant reduction of the esophageal diameter (p = 0.00235). Forty-five of 66 patients (68.2%) underwent upper endoscopy and 35 of 66 (53%) underwent MII-pH. Esophageal erosions were found in 4/45 (8,8%) and MII-pH showed abnormal results in 3/35 patients (8.6%). RAHD ensures a meticulous esophageal and gastric myotomy, allowing to visualize and divide each muscle fibers with a low rate of intraoperative and postoperative complications. resulting in turn in good clinical outcomes, radiological findings and functional results even if robotic tecnique definitely increases the surgical cost in the treatment of these functional esophageal disorders.

AMH: An ovarian reserve biomarker in assisted reproduction.

Ovarian reserve tests provide knowledge of a possible response to controlled ovarian hyperstimulation in patients undergoing assisted reproduction treatment, allowing management and alteration of treatment protocol with the appropriate dose of gonadotrophin. Several parameters have been used as predictors of ovarian response. The basal FSH serum level on the third day of the menstrual cycle seemed to be the best predictor, but with significant intraindividual variability from one cycle to another. Thus, the anti-Müllerian hormone (AMH) emerges as a new ovarian test marker. AMH is produced exclusively in the gonads, by the granulosa cells, and plays an important role in folliculogenesis, acting on the modulation of follicular recruitment in the granulosa cells in order to limit the number of recruited oocytes and to regulate the number of growing follicles and their selection for ovulation. It has been suggested that AMH is strongly associated with oocyte yield after ovarian stimulation and could therefore be capable of predicting the ovarian response and the quality of oocytes and embryos. In this review, we discuss the role of AMH in assisted reproduction outcomes.

Hepatocyte growth factor disrupts cell contact and stimulates an increase in type 3 inositol triphosphate receptor expression, intracellular calcium levels, and apoptosis of rat ovarian surface epithelial cells.

The present studies revealed that hepatocyte growth factor (HGF) disrupts cell contact, increases both type 3 IP3 receptor and intracellular calcium ([Ca2+]i) levels and induces apoptosis of rat ovarian surface epithelial cells (ROSE-179 cells). Type 3 IP3 receptor was only increased in cells that lost cell contact. Disrupting cell contact by depleting extracellular calcium (Ca2+) also resulted in an increase in [Ca2+]i levels and an increase in apoptosis. These responses were prevented by the addition of 0.7 mM Ca2+. Actinomycin D and cycloheximide prevented apoptosis that resulted from Ca2+ removal. In situ hybridization studies revealed that type 3 IP3 receptor was expressed at relatively low levels by ROSE-179 cells cultured with Ca2+ but at high levels in the absence of Ca2+. ROSE-179 cells cultured in Ca2+-free medium with type 3 IP3 receptor antisense oligonucleotide lost cell contact but did not show an increase in either type 3 IP3 receptor protein, [Ca2+]i, or apoptosis. The nonsense oligonucleotide did not alter these responses to Ca2+ removal. Thus, the disruption of cell contact by either HGF or Ca2+ depletion increases the expression of type 3 IP3 receptor, which causes an increase in [Ca2+]i and the apoptotic death of ROSE-179 cells.

Cyclic expression of endothelin-converting enzyme-1 mediates the functional regulation of seminiferous tubule contraction.

The potent smooth muscle agonist endothelin-1 (ET-1) is involved in the local control of seminiferous tubule contractility, which results in the forward propulsion of tubular fluid and spermatozoa, through its action on peritubular myoid cells. ET-1, known to be produced in the seminiferous epithelium by Sertoli cells, is derived from the inactive intermediate big endothelin-1 (big ET-1) through a specific cleavage operated by the endothelin-converting enzyme (ECE), a membrane-bound metalloprotease with ectoenzymatic activity. The data presented suggest that the timing of seminiferous tubule contractility is controlled locally by the cyclic interplay between different cell types. We have studied the expression of ECE by Sertoli cells and used myoid cell cultures and seminiferous tubule explants to monitor the biological activity of the enzymatic reaction product. Northern blot analysis showed that ECE-1 (and not ECE-2) is specifically expressed in Sertoli cells; competitive enzyme immunoassay of ET production showed that Sertoli cell monolayers are capable of cleaving big ET-1, an activity inhibited by the ECE inhibitor phosphoramidon. Microfluorimetric analysis of intracellular calcium mobilization in single cells showed that myoid cells do not respond to big endothelin, nor to Sertoli cell plain medium, but to the medium conditioned by Sertoli cells in the presence of big ET-1, resulting in cell contraction and desensitization to further ET-1 stimulation; in situ hybridization analysis shows regional differences in ECE expression, suggesting that pulsatile production of endothelin by Sertoli cells (at specific "stages" of the seminiferous epithelium) may regulate the cyclicity of tubular contraction; when viewed in a scanning electron microscope, segments of seminiferous tubules containing the specific stages characterized by high expression of ECE were observed to contract in response to big ET-1, whereas stages with low ECE expression remained virtually unaffected. These data indicate that endothelin-mediated spatiotemporal control of rhythmic tubular contractility might be operated by Sertoli cells through the cyclic expression of ECE-1, which is, in turn, dependent upon the timing of spermatogenesis.

In vitro susceptibility of chromoblastomycosis and phaeohyphomycosis agents to antifungal drugs.

The in vitro susceptibility of chromoblastomycosis and phaeohyphomycosis agents to antifungal drugs was appraised using the reference macrodilution method proposed by the National Committee for Clinical Laboratory Standards (NCCLS) for yeasts modified for filamentous fungi. The antifungal drugs amphotericin B, 5-fluorocytosine, itraconazole and fluconazole were tested against one environmental and 18 clinical isolates. This work amended the macrodilution methods proposed by NCCLS and suggests that a conidial suspension free of hyphae leads to a more reliable assay and provides for better reproducibility. The macrodilution method was performed with 10(4) conidia ml-1. The MIC values ranged from 1.0 to 16.0 micrograms ml-1 for amphotericin B and 3.12 to 25.0 micrograms ml-1 for 5-fluorocytosine. A MIC range of 0.06 to 1.95 micrograms ml-1 was determined for itraconazole while 2.0 to 64.0 micrograms ml-1 was detected for fluconazole.

Funçäo encefálica residual: problema para a confirmaçäo de morte encefálica em doadores potenciais de tecidos / Residual encephalic function: a problem to confirm the brain death in potential tissue donors patients

Os autores revisam os critérios clínicos e os exames complementares necessários para o diagnóstico de morte encefálica, assim como aspectos éticos, legais e morais ligados à questäo. Ressaltam que a avaliaçäo de um doador potencial objetiva o diagnóstico de morte encefálica em determinado momento, näo julgando seu prognóstico. Sugerem que cada centro médico envolvido com transplantes de tecidos desenvolva protocolo e crie arquivo de dados próprios

Effect of monensin on the invasiveness and multiplication of Legionella pneumophila.

The polyether antibiotic monensin exhibited bacteriostatic activity against a clinical isolate of Legionella pneumophila in vitro. Experiments designed to test the effect of the compound on the invasiveness and multiplication of L. pneumophila in HeLa cells showed that, in the presence of the antibiotic, legionellas that penetrated the cells did not multiply. However, monensin did not alter the characteristics of phagosomes that contained ingested legionellas. In the presence of monensin, infected cells exhibited extensive vacuolation and a noticeable reduction in the number of intracellular micro-organisms was evident a few hours after infection.

Role of phospholipids in BK virus infection and haemagglutination.

The role of phospholipids in BK virus infection and haemagglutination was studied by competition binding experiments and by treatment of susceptible cells with phospholipases. Phospholipids extracted from Vero cells and some commercial phospholipids showed an inhibiting activity on both BK virus infectivity and haemagglutination. The treatment of Vero cells with phospholipases affected the binding of BK virus, but the addition of phospholipids to enzyme-treated cells restored their susceptibility to both viral infectivity and haemagglutination.

Arginine thiazolidinecarboxylate in the treatment of chronic active hepatitis: double-blind comparison with placebo.

Forty-four patients with chronic active hepatitis were given arginine thiazolidinecarboxylate (800 mg/day per os for 40 days) or placebo in a randomized, double-blind trial. The most important liver function parameters were measured in each patient at the beginning of the trial, after 20 days, and at the end of the trial. The active drug lessened the parameters of necrosis and cholestasis while protein synthesis improved in liver cells. The differences between ATCA and placebo groups were highly significant. No treatment-related side-effects were reported.