Septal Lesions Research Articles

Selective Medial Septum Lesions in Healthy Rats Induce Longitudinal Changes in Microstructure of Limbic Regions, Behavioral Alterations, and Increased Susceptibility to Status Epilepticus

Septo-hippocampal pathway, crucial for physiological functions and involved in epilepsy. Clinical monitoring during epileptogenesis is complicated. We aim to evaluate tissue changes after lesioning the medial septum (MS) of normal rats and assess how the depletion of specific neuronal populations alters the animals’ behavior and susceptibility to establishing a pilocarpine-induced status epilepticus. Male Sprague–Dawley rats were injected into the MS with vehicle or saporins (to deplete GABAergic or cholinergic neurons; n = 16 per group). Thirty-two animals were used for diffusion tensor imaging (DTI); scanned before surgery and 14 and 49 days post-injection. Fractional anisotropy and apparent diffusion coefficient were evaluated in the fimbria, dorsal hippocampus, ventral hippocampus, dorso-medial thalamus, and amygdala. Between scans 2 and 3, animals were submitted to diverse behavioral tasks. Stainings were used to analyze tissue alterations. Twenty-four different animals received pilocarpine to evaluate the latency and severity of the status epilepticus 2 weeks after surgery. Additionally, eight different animals were only used to evaluate the neuronal damage inflicted on the MS 1 week after the molecular surgery. Progressive changes in DTI parameters in both white and gray matter structures of the four evaluated groups were observed. Behaviorally, the GAT1-saporin injection impacted spatial memory formation, while 192-IgG-saporin triggered anxiety-like behaviors. Histologically, the GABAergic toxin also induced aberrant mossy fiber sprouting, tissue damage, and neuronal death. Regarding the pilocarpine-induced status epilepticus, this agent provoked an increased mortality rate. Selective septo-hippocampal modulation impacts the integrity of limbic regions crucial for certain behavioral skills and could represent a precursor for epilepsy development.

Bubble CPAP as first ventilatory choice in extremely premature infants: Relation to outcomes and bronchopulmonary dysplasia

PurposePropose an admission strategy of very PTNB, for quality improvement and prevent adverse events, and risk of developing bronchopulmonary dysplasia-BPD, vascular, and neurological outcomes. Methodsobservational prospective cohort study, from 2020 to 2021. All preterms younger than 32 weeks of gestational age were admitted to bCPAP, recorded failure and main outcomes. Results26 very PTNB (30 weeks+2 days), 6 presented bCPAP failure and intubated. Outcomes: 1 nasal bleeding, 2 septal hyperemia, 1 septal lesion and 1 pneumomediastinum, 5 peri-intraventricular hemorrhages, negative retinopathy of prematurity in those who underwent the examination, 1 death and 2 had a diagnosis of BPD. A positive association was identified with the need for FIO2 greater than 21% and BPD. Conclusionsvery PTNB can be safely admitted to bCPAP with the implementation of the proposed protocol, provided that the multidisciplinary team is prepared with periodic training. Attention should be given to the proper positioning of the interface and the baby in the bed, in addition to constant monitoring of ventilatory parameters and air temperature. Supplemental oxygen is associated with an increased risk of developing BPD.

Correlation between dorsal capsulo-scapholunate septum (DCSS) lesion and predynamic scapholunate instability

ObjectiveScapholunate instability is the most common ligament injury of the wrist. In case of predynamic instability, diagnosis can be difficult, even under arthroscopy. Scapholunate instability is not the result of an isolated injury to the scapholunate interosseous ligament. Scapholunate stability is dependent not only on the scapholunate ligament, but on a complex that is comprising intrinsic and extrinsic ligaments. The dorsal capsule-scapholunate septum (DCSS) is one of the secondary stabilizers of the scapholunate complex. The objective of the present study was to investigate the correlation between DCSS lesion and predynamic scapholunate instability. MethodA prospective multicenter study included patients who underwent wrist arthroscopy for traumatic wrist. Arthroscopic DCSS lesion stage and instability according to European Wrist Arthroscopy Society stage were assessed. ResultsTwenty-seven subjects were included. We found a significant correlation between pathological DCSS and predynamic scapholunate instability and a correlation between DCSS lesion severity and instability level. ConclusionIsolated DCSS lesion should be considered a predictive factor for predynamic instability.

P-wave morphology variants in patients with interatrial block visualized using CineECG: A new classification approach

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

The CineECG in repolarization abnormalities due to myocardial ischemia

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

CineECG for visualization of changes in ventricular activation and repolarization during ischemia

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

Neurobehavioral basis of Maier 3-table and other matching-to-place tasks.

The Maier 3-table task comprises three phases conducted each day. During the exploration phase, rats explore the entire apparatus. During the information phase, the rats are placed on one of the three tables where food is found. During the test phase, the animals are placed at the starting point on one of the two remaining tables and must enter the goal table where they previously ate. The acquisition of the Maier 3-table task was slowed down after lesions of the septum, fornix, hippocampus, medial prefrontal cortex, or posterior parietal cortex. Because of its time-consuming nature, the Maier 3-table task has more recently been superseded by appetitive matching-to-place in Y- or T-mazes or the circular water maze, because experimenters skip over the exploration phase. Nevertheless, like the Maier 3-table task, the acquisition of the Y- or T-maze matching-to-place task was retarded after lesions of the medial septum or medial prefrontal cortex, more particularly its prelimbic-infralimbic part. Like the previous task, the water-maze version is sensitive to lesions of the medial septum or retrosplenial cortex. Despite methodological differences between the three procedures, these results indicate common neurobiological bases of matching-to-place learning.

Comparison of left atrial lesion size and troponin release of two novel single shot devices for pulmonary vein isolation: pulsed field ablation vs. multi-electrode radiofrequency balloon

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pulsed-field ablation (PFA) and the multi-electrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent. Purpose We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low-voltage area in high-density maps and the release of biomolecules reflecting cardiac injury. Methods PVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multi-electrode radiofrequency balloon (HELIOSTAR). Before and after PVI high-density mapping with CARTO3 was performed. In addition, blood samples were taken before transseptal puncture and after post-PVI remapping. Serum concentrations of high-sensitive Troponin I (hsTropI) were quantified by Immunoassay. Results 50 patients undergoing PVI by PFA (n=26, age 71±10 y, 58% males, 58% persistent AF) or RFB (n=24; age 64±13 y, 54% males, 25% persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses were n=34±5 and mean number RFB applications were n=8±3. Total posterior ablation area was bigger in PFA (19.0±6.2 cm²) than in RFB (9.0±2.2 cm²; p<0.001). The posterior distance between septal and lateral lesions was shorter in PFA (23.7±10.5 mm) than in RFB (30.0±7.3 mm; p=0.021). In a total of 38 patients increase of hsTropI was higher after PFA (625±138 pg/ml, n=28) vs. RFB (148±36 pg/ml; n=10; p=0.049) supporting the evidence of larger lesion extent by PFA. Conclusion Pulse-field ablation delivers larger acute lesion areas and higher troponin release upon successful pulmonary vein isolation than multi-electrode array balloon-based pulmonary vein isolation in this single-center series.

Post-infarction ventricular septal rupture.

Coronary reperfusion therapies have led to a reduction in the incidence of mechanical complications of acute myocardial infarction (AMI), but the associated mortality of these complications has remained high. Ventricular septal rupture is the most common mechanical complication after myocardial infarction and occurs in approximately 0.21% with ST-segment elevation myocardial infarction and in 0.04% with non-ST-segment elevation myocardial infarction. Surgery is the only definitive treatment but it is associated with high operative mortality and morbidity and, in some centers, alternative treatment with mechanical support of circulation and trans-catheter closure of the defect is being used. We continue to believe that immediate surgery offers the best opportunity for long-term survival. Patients should be taken directly to the operating room or via the heart catheterization laboratory if the coronary artery anatomy is unknown. This should be done as soon as the diagnosis is made, as acute rupture of the interventricular septum is a surgical emergency. The operative technique of infarct exclusion has been our preferred method and when performed in hemodynamically stable patients, the operative mortality is around 10%, although much higher in patients in cardiogenic shock. Patch dehiscence and persistent shunts are uncommon after closure of the defect using this technique. Delaying operative intervention in hemodynamically stable patients frequently leads to cardiogenic shock and multi-organ failure. Transcatheter closure of these acute septal lesions is complex, not necessarily feasible in all patients, and there is no evidence that the results are superior to surgery.

MRI – advantages and limitations in the diagnosis and treatment of endometriosis

Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infertility. It may occur as invasive peritoneal fibrotic nodules and adhesions or as ovarian cysts with hemorrhagic content. Although the findings at the physical examination may be suggestive, imaging is ne­ces­sary for the definitive diagnosis, patient counseling and treatment planning. The imaging techniques that are most useful for preoperative disease mapping are trans­va­gi­nal ultrasonography (US) after bowel preparation and mag­ne­tic resonance imaging (MRI). Materials and method. In our retrospective study, associations of MRI diagnoses ver­sus intraoperative diagnoses are statistically significant, with high specificity on rectal lesions (96.8%), respectively 96.2% on sigmoid lesions, then parametrial lesions and rec­to­va­gi­nal septum lesions. The dimensions of the rectal no­dules had a nonparametric distribution (p<0.05) and the dimensions of the sigmoid nodules had a normal dis­tri­bu­tion (p>0.05) according to the Shapiro-Wilk test. Despite some limitations, magnetic resonance imaging is able to direct­ly demonstrate deep pelvic endometriosis. The MRI feat­ures depend on the type of lesions: infiltrating small im­plants, solid deep lesions mainly located in the posterior cul-de-sac and involving the uterosacral ligaments and torus uterinus, or visceral endometriosis involving the blad­der and rectal wall.

High-intensity ultrasound catheter ablation achieves deep mid-myocardial lesions in vivo

Radiofrequency ablation of epicardial and mid-myocardial ventricular arrhythmias is limited by lesion depth. The purpose of this study was to generate deep mid-interventricular septal (IVS) lesions using high-intensity ultrasound (US) from an endocardial catheter-based approach. Irrigated US catheters (12 F) were fabricated with 3 × 5 mm transducers of 5.0, 6.5, and 8.0 MHz frequencies and compared in an exvivo perfused myocardial ablation model. Invivo septal ablation in swine (n = 12) was performed via femoral venous access to the right ventricle. Lesions were characterized by echocardiography, cardiac magnetic resonance imaging, and electroanatomic voltage mapping pre- and post-ablation, and at 30 days. Four animals were euthanized immediately post-ablation to compare acute and chronic lesion histology and gross pathology. In exvivo models, maximal lesion depth and volume was achieved by 6.5 MHz catheters, which were used invivo. Lesion depth by gross pathology was similar post-ablation (10.8 mm; 95% confidence interval [CI] 9.9-12.4 mm) and at 30 days (11.2 mm; 95% CI 10.6-12.4 mm) (P = .56). Lesion volume decreased post-ablation to 30 days (from 255 [95% CI 198-440] to 162 [95% CI 133-234] mm3; P = .05), yet transmurality increased from 58% (95% CI 50%-76%) to 81% (95% CI 74%-93%), attributable to a reduction in IVS thickness (from 16.0 ± 1.7 to 10.6 ± 2.4 mm; P = .007). Magnetic resonance imaging confirmed dense septal ablation by delayed enhancement, with increased T1 time post-ablation and at 30 days and increased T2 time only post-ablation. Voltage mapping of both sides of IVS demonstrated reduced unipolar (but not bipolar) voltage along the IVS. High-intensity US catheter ablation may be an effective treatment of mid-myocardial or epicardial ventricular arrhythmias from an endocardial approach.

Hyperdipsia in sheep bearing lesions in the medial septal nucleus

Previous experiments in rodents showed that ablation of the septal brain region caused hyperdipsia. We investigated which part of the septal region needs ablation to produce hyperdipsia in sheep, and whether increased drinking was a primary hyperdipsia. Following ablation of the medial septal region (n = 5), but not parts of the lateral septal region (n = 4), daily water intake increased from ~2.5–5 L/day up to 10 L/day for up to 3 months post-lesion. In hyperdipsic sheep, plasma osmolality increased on the first day post-lesion and body weight fell, suggesting that initial hyperdipsia was secondary to fluid loss. However hyperosmolality was not sustained long-term and plasma hypo-osmolality persisted from 0.5 to 3 months post-lesion. Acute dipsogenic responses to intravenous hypertonic saline, intravenous or intracerebroventricular angiotensin II, water deprivation for 2 days, or feeding over 5 h were not potentiated by medial septal lesions, showing that the rapid pre-systemic inhibitory influences that cause satiation of thirst upon the act of drinking were intact. However, hyperdipsic sheep continued to ingest water when hyponatremic (plasma [Na] was 127–132 mmol/l) and plasma osmolality was 262–268 mosmol/kg due to retention of ingested fluid resulting from intravenous infusion of vasopressin administered to maintain a basal blood level of antidiuretic hormone. The results show that septal lesion-induced hyperdipsia is not due to disruption of acute pre-systemic influences associated with drinking water that initiates rapid satiation of thirst. Rather, inhibitory influences of hyponatremia, hypo-osmolality or hypervolemia on drinking appear to be disrupted by medial septal lesions.

The effect of septal lesion on sexual behavior, sperm count and testicular activity in Young male albino rats

The effect of septal lesion on sexual behavior, sperm count and testicular activity in Young male albino rats - IJCAP- Print ISSN No: - 2394-2118 Online ISSN No:- 2394-2126 Article DOI No:- 10.18231/2394-2126.2018.0015, Indian Journal of Clinical Anatomy and Physiology-Indian J Clin Anat Physiol

The role of right ventricular late gadolinium enhancement scoring by cardiac magnetic resonance imaging in cardiac sarcoidosis

Abstract Background The right ventricular (RV) function is a significant predictor of the prognosis and exercises tolerance in patients with left ventricular dysfunction. The previous study reported that RV late gadolinium enhancements (LGE) as assessed by cardiac magnetic resonance (CMR) imaging were present in 16% of pulmonary sarcoidosis. Although RV LGE is associated with a poor prognosis, a semi-quantitative assessment of RV LGE was not been established so far. Moreover, the frequency of RV dysfunction (RVD) in cardiac sarcoidosis (CS) and predictors of RVD are unclear. Purpose Our aim of this study is to establish RV LGE semi-quantitative scores and to clarify the rate and predictors of RVD in CS. Methods Forty-four consecutive patients with CS who underwent CMR imaging (median age, 63 [IQR 54–71] years old; 10 males) were studied. They were diagnosed as definitive based on the Heart Rhythm Society expert consensus statement. Two patients were excluded due to no long axial view. Thus, a total of 42 patients were included in this study. RV LGE was semi-quantitatively evaluated using the original score developed by ours. RV was classified into RV outflow tract (OT), basal, middle and apex. RVOT and apex are assigned 1 segment for each, and basal and middle are assigned 4 segments include anterior, septal, inferior and lateral (Figure1). In total, 10 segments were evaluated. RV LGE scores were analysed independently by the two operators. The RV ejection fraction was assessed in a long axial view without an RVOT (20 phases, 12 slices). We divided the cohort into the non-RVD group (RVEF ≥45%) and the RVD group (RVEF &amp;lt;45%) and compared the RV scores between the two groups. Results The RVD was present in 31% of the entire cohort. The presence of RV LGE was significantly higher in the RVD group than the non-RVD group (83% vs. 43%, p=0.037). RV LGE score in the RVD group was significantly higher than that in the non-RVD group (2.83±1.95 vs. 0.83±1.21, p=0.001). The septal lesions in basal and middle levels accounted for 54% in all segments. RVEF showed a significant inverse correlation with RV LGE score (r=−0.57, p&amp;lt;0.0001). In the ROC curve for RVD, the RV LGE score of more than 2 and equal could discriminate RVD from non-RVD with AUC of 0.813 (Sensitivity = 0.77, Specificity = 0.76, p=0.003). Conclusion RVD was observed in 31% of patients with definitive CS. The septal lesions were the most frequent in the RV LGE site, which suggests that the longitudinal abnormal motion of RV is a significant predictor of the RVD in patients with CS. RV LGE score is a valuable method to assess RVD. RV LGE score Funding Acknowledgement Type of funding source: None

The lateral septum mediates kinship behavior in the rat

Evolutionary theory and behavioral biology suggest that kinship is an organizing principle of social behavior. The neural mechanisms that mediate kinship behavior are, however, not known. Experiments confirm a sibling-approach preference in young rat pups and a sibling-avoidance-preference in older pups. Lesions of the lateral septum eliminate such kin preferences. In vivo juxta-cellular and whole-cell patch-clamp recordings in the lateral septum show multisensory neuronal responses to kin and non-kin stimuli. Non-kin odor-responsive neurons are located dorsally and kin-odor responsive neurons are located ventrally in the lateral septum. With development, the fraction of kin-responsive lateral septal neurons decrease and ongoing firing rates increase. Lesion effects, developmental changes and the ordered representation of response preferences according to kinship—an organization we refer to as nepotopy—point to a key role of the lateral septum in organizing mammalian kinship behavior.

A paediatric patient with nasal septal perforation – symptoms, diagnosis and treatment options

Introduction. Nasal septum is an anatomical structure which not only separates both nasal cavities, but is also a supporting element for the external nose, and has an impact on its physiology. Structural abnormalities of the nasal septum, such as deviations and defects, affect the airflow in the nasal cavities. Nasal septal perforation is one of the factors that impair nasal patency due to secondary pathological changes. There are various treatment options, depending on the symptoms reported and the stage of septal lesions. Treatment strategy is selected individually for each patient. Aim. The aim of this paper was to discuss the symptoms, diagnostic methods and treatment options in children with nasal septal perforation. Patients of the Department of Paediatric Otolaryngology, Medical University of Warsaw, were included in the analysis. Material and methods. We present cases of 18 patients aged between 3 and 17 years, admitted to the Outpatient ENT Clinic at the Department of Paediatric Otolaryngology, Medical University of Warsaw. Results. A total of 18 patients aged between 3 and 17 years (mean age 12.83 years, SD = 4.34) reported to our clinic. In most cases, nasal septal perforation developed as a complication of septoplasty (4) or nasal trauma. Nasal bleeding and crusting were the most commonly reported symptoms. Perforation was accompanied by external nasal deformity in about 1/3 of patients. Conclusions. Only few reports on paediatric patients with nasal septal perforation may be found in literature. All data obtained was analysed based on reports describing adult and paediatric patients. The severity of symptoms varied depending on the aetiology.

Kinesio Taping® as an innovative therapeutic tool to prevent nasal septal lesions in newborns: a case study

Abstract Introduction: The immaturity of the integumentary system in premature newborns (PTNB), associated with ventilatory support, contributes to the higher occurrence of nasal trauma. Objective: This article reports on the case of a newborn submitted to Kinesio® Taping as an innovative prophylactic therapy for nasal trauma. Method: We report on Kinesio® Taping, a material frequently used to treat pain in athletes, as an innovative therapeutic tool to prevent nasal septal lesions in a PTNB undergoing noninvasive mechanical ventilation (NIMV), who, after 13 days on NIMV, presented with nasal septal lesions. Results: The Kinesio® Taping, was positioned to protect the nasal septum from friction caused by direct contact of the nasal prong, maintained NIMV pressure, adapted well to the shape of the nose and improved nasal trauma after 3 days of use. Conclusion: Given that breathing in this period of life occurs predominantly through the nose and maintaining the integrity of this mucosa reduces not only respiratory discomfort, but also deformities and the risk of infections. The present study presents KT as an innovative protective tool against nasal injury in premature newborns submitted to positive pressure ventilation using nasal prongs. Despite describing a single case, the results obtained were promising. However, studies with a larger sample and different groups are needed, primarily to compare with existing methods.

ORAL MANIFESTATIONS OF MUCOCUTANEOUS LEISHMANIASIS: A 4-CASE SERIES

Mucosal leishmaniosis (ML) is a chronic infection that affects the upper respiratory tract or oral mucosa, caused by Leishmania protozoan parasites. Four male patients between the ages of 60 and 94 years presented with oral lesions of ML. All of them presented with destruction of the nasal septum and infiltrative lesions in the soft palate, with a granulomatous and erythematous base. One of the patients presented with edema and erythema in the nose and middle face. The histopathologic exam was performed in all the cases, but, polymerase chain reaction (PCR) was necessary in 2 cases to confirm the diagnosis. The older patient received treatment with liposomal amphotericin B but then died due to generalized infection. The other 3 patients were treated with meglumine antimoniate. In 2 cases, the lesions healed and we have no data regarding to third patient. One patient died due to complications of the treatment. Support: FAPEMIG

Mechanisms of Convergent Egg Provisioning in Poison Frogs.

Parental provisioning of offspring with physiological products (nursing) occurs in many animals, yet little is known about the neuroendocrine basis of nursing in non-mammalian species. Within amphibians, maternal provisioning has evolved multiple times, with mothers of some species feeding unfertilized eggs to their developing offspring until tadpoles complete metamorphosis [1-3]. We conducted field studies in Ecuador and Madagascar to ask whether convergence at the behavioral level provides similar benefits to offspring and relies on shared neural mechanisms in dendrobatid and mantellid poison frogs. At an ecological level, we found that nursing allows poison frogs to provide chemical defenses to their tadpoles in both species. At the neural level, nursing was associated with increased activity in the lateral septum and preoptic area, demonstrating recruitment of shared brain regions in the convergent evolution of nursing within frogs and across vertebrates [4]. In contrast, only mantellids showed increased oxytocin neuron activity akin to that in nursing mammals [5], suggesting evolutionary versatility in molecular mechanisms. Our findings demonstrate that maternal provisioning provides similar potential benefits to offspring and relies on similar brain regions in poison frog species with convergently evolved toxicity and maternal care. VIDEO ABSTRACT.

The Role of Shaving Technique in the Treatment of Recto-Vaginal Endometriosis

Video Objective To demonstrate the rational use of shaving technique in the approach of endometriotic lesions of the recto-vaginal septum in selected cases. Setting Botucatu Medical School, Sao Paulo State University - FMB/UNESP. Tertiary public hospital, university teaching center. Interventions The procedure begins by characterizing the endometriotic lesion, by recognition of the pelvic anatomical structures and their relations with the disease. The physiological adherence of the sigmoid to the left pelvic wall is dissected, followed by identification of the ureters. Anatomic markers are used to guide dissection avoiding complications and inadvertent injury of noble structures. The retroperitoneal dissection begins on both sides from healthy tissue laterally towards the medial retro-uterine portion until it reaches the central portion of the lesion in the insertion of uterosacral ligaments. From this point on, the lesion is confined to the posterior portion of the uterus and anterior wall of the rectum. The endometriotic lesion is then isolated in the rectal wall using the reverse shaving technique. With the aid of a rectal probe, superficial resection of the endometriotic lesion is started, taking care not to deepen its dissection beyond the superficial sero-muscular layer. Finally, rigorous hemostasis is performed. When resection is very deep or very extensive it is advisable to check the integrity of the rectum-sigmoid wall with the aid of safety maneuvers. The vaginal touch is repeated at the end of the procedure to confirm that the entire initial lesion has been removed. Conclusion Despite its indication only for cases of superficial lesions the shaving technique presents as advantages: autonomy for the gynecologist, less tissue damage with preservation of the neuronal activity of the intestine, rapid recovery with early return of the daily life activity to the patient, being a great option for the treatment of rectum-vaginal endometriosis in duly selected cases.