Transection Procedure Research Articles

Comparative Efficacy of Algan Hemostatic Agent Powder and Liquid Forms in Rat Tail Transection Model: A Controlled Experimental Study

Objective: The Algan Hemostatic Agent (AHA) is a bioabsorbable, multi-herbal medical agent formulated to manage bleeding from surgical procedures and traumatic wounds. It is designed to be used when conventional hemostatic methods, such as compression or ligation, fail to adequately control capillary, venous, or arterial bleeding. This study aims to assess the hemostatic efficacy of AHA in two formulations—powder and liquid—using a rat tail transection model. Materials and Methods: This study included 24 Wistar Albino rats aged 10–12 weeks and weighing 250–280 g, which were randomly divided into three experimental groups (n = 8/group): 1) AHA powder, 2) AHA liquid-impregnated gauze-sponge, and 3) control (treated with a physiological saline-soaked sponge). A standardized tail transection procedure was performed on each rat to induce bleeding. Immediately following the transection, the designated treatment for each group was applied directly to the hemorrhage site. Bleeding cessation was assessed at 20-second intervals, and if bleeding persisted, the application was repeated for up to two additional attempts. Hemostasis was considered unsuccessful if bleeding continued after three consecutive applications of the assigned treatment. Results: Significantly shorter bleeding times were observed in both AHA-treated groups compared to the control group. None of the rats in the control group achieved hemostasis following three applications of the physiological saline-soaked sponge. In the AHA powder group, all 8 rats (100%) achieved hemostasis within the first 20 seconds of the initial application. In the AHA liquid-impregnated gauze-sponge group, 6 out of 8 rats (75%) achieved hemostasis after the first application, while the remaining 2 rats (25%) stopped bleeding after the second application. Statistical analysis revealed a significant difference between the control group and the two AHA-treated groups (p < 0.0001). Conclusions: These findings demonstrate the potential of AHA as a reliable hemostatic agent in both surgical settings and emergency situations where traditional methods are insufficient to control bleeding effectively. The rapid hemostasis achieved with AHA treatments suggests their utility in improving patient outcomes and minimizing blood loss in critical scenarios.

Species Diversity And Pollination Ecology Of Bagale Hills Forest Reserve, Girei Local Government Area, Adamawa State - Nigeria

Background: This study assessed the pollination ecology and diversity of the Bagale Hills Forest Reserve (BHFR) in Adamawa State. The aim of the study was to understand if biodiversity conservation of the reserve, as planned by the government, is achieved. The objectives were to: assess angiosperm diversity; determine pollinator diversity; evaluate the interaction between angiosperms-pollinators and assess the period of flowering of angiosperms in the transects of the study area. Materials and Methods: The study adopted the systematic line transect procedure in laying out transects. Four transects of 1 km were laid and four sampled plots of 50 m x 50 m size was alternately laid along each of the transect. Three angiosperms were selected at random for data collection on phenology and the diversity of both plants and its associated pollinators. The studied reserve was traversed on foot for three months and the appearance of flower buds and the presence of pollinators on targeted tree species was observed. Data were analyzed and presented using the Descriptive statistics and the Shannon-Wiener diversity index was used for the determination of biodiversity. Results: The result of the Shannon-Wiener Diversity Index indicated pollinator species diversity of 2.686 and angiosperms diversity index of 2.761591 that indicated a very high biodiversity for both the pollinators and its associated plant species in the study area. The phenology result indicated that the pollinators observed were invertebrates that were not evenly distributed and that only about 3.25 % of the tree species were flowering during the wet season. It was also observed that all sampled tree species were generalist in nature. Conclusion: It was concluded that conservation education must be prioritized for the communities surrounding the study area.

Establishment of a Posttraumatic Osteoarthritis Model in Mice Induced by Noninvasive Anterior Cruciate Ligament Tear

Background: Animal models that use open surgical transection of the anterior cruciate ligament (ACL) do not accurately simulate the clinical condition regarding the pivot-shift mechanism and the associated inflammatory response that occurs before reconstruction. Purpose/Hypothesis: The purpose was to characterize a reproducible manual, nonsurgical method to mimic an isolated ACL tear in a clinically relevant model and to evaluate the development of progressive posttraumatic osteoarthritis due to ACL injury. It was hypothesized that the ACL could be reproducibly torn with minimal damage to other ligaments and that there would be progressive development of degenerative joint disease after ACL injury. Study Design: Controlled laboratory study. Methods: A total of 37 mice (strain C57BL/6) were used to compare the manual procedure with sham surgery (sham group; n = 10) and with the established surgical ACL transection (ACLT) procedure (surgical group; n = 27). In the sham group, a closed manual procedure was performed on the right knee and sham surgery on the left knee. In the surgical group, the closed manual procedure was performed on the right knee and surgical ACLT on the left knee. Dissection using India ink, histological assessment with safranin O and hematoxylin-eosin staining, radiological evaluation through radiographs and microfocus computed tomography scans, and gait analyses were performed to assess cartilage/ligament status. Osteoarthritis Research Society International (OARSI) and synovitis scores, anterior tibial translation, range of motion, bone microstructure, osteophyte volume, and pain were assessed at 2, 4, and 8 weeks postoperatively. Results: The manual procedure successfully resulted in an ACL rupture and associated meniscal injury. The posterior cruciate, lateral collateral, and medial collateral ligaments were intact in all dissected knees. Two weeks after ACL tear, the surgical group showed a significantly higher synovitis score, whereas 8 weeks after ACL tear, the manual group showed a significantly higher volume of osteophytes. No significant differences were found between the groups in terms of OARSI score, anterior tibial translation, range of motion, bone microstructure computed tomography values, and stride distance/irregularity. Conclusion: This procedure can be used to create an ACL tear model without causing grossly evident injuries to other ligaments and avoiding the risk of cartilage damage from surgical instruments. Clinical Relevance: This procedure offers a more clinically relevant ACL tear model and facilitates simple, inexpensive, and reproducible development of posttraumatic osteoarthritis.

Dietary fiber may benefit chondrocyte activity maintenance.

The understanding of the link between the gut-bone axis is growing yearly, but the mechanisms involved are not yet clear. Our study analyzed the role of Sestrin2 (SESN2)pathway in the gut-bone axis. We established an osteoarthritis (OA) model in Sprague-Dawley (SD) rats using the anterior cruciate ligament transection (ACLT) procedure, followed by a dietary intervention with varying levels of dietary fiber content for 8 weeks. By 16S rRNA sequencing of the gut microbiota, we found that high dietary fiber (HDF) intake could significantly increase the Bacillota-dominant gut microbiota. Meanwhile, enzyme linked immunosorbent assay (ELISA) and histological analysis showed that intervention with HDF could reduce the degree of bone and joint lesions and inflammation. We hypothesize that HDF increased the dominant flora of Bacillota, up-regulated the expression of SESN2 in knee joint, and reduced gut permeability, thereby reducing systemic inflammatory response and the degree of bone and joint lesions. Therefore, the present study confirms that changes in gut microbiota induced by increased dietary fiber intake delayed the onset of OA by promoting up-regulation of SESN2 expression at the knee joint to maintain chondrocyte activity and reduce synovial inflammation.

MiR-148b-3p suppresses the proliferation and migration of Schwann cells by targeting USP6 following sciatic nerve injury

ABSTRACT Background Peripheral nerve injury is a common disorder associated with damaged axons and distal myelin sheath degeneration, and Schwann cells play a paramount role in peripheral nerve regeneration. This study aims to explore the role of microRNA miR-148b-3p on Schwann cells after peripheral nerve injury. Methods Sciatic nerve transection was conducted in rat as the model of peripheral nerve injury. The expression level of miR-148b-3p and Ubiquitin Specific Peptidase 6 (USP6) was detected by qRT-PCR and Western blot at diverse time points after nerve transection. Cell migration and proliferation were determined in primary Schwann cells isolated from rat. The functional interaction of miR-148b-3p and USP6 mRNA was validated by dual-luciferase reporter assay. Results In the animal model of sciatic nerve injury, miR-148b-3p expression level in the proximal nerve stump showed downregulation after nerve transection procedure, while USP6 expression level was elevated. The overexpression of miR-148b-3p inhibited the proliferation and migration of primary Schwann cells, while suppressing miR-148b-3p showed the opposite effect. USP6 mRNA was identified as a target of miR-148b-3p, which was found to mediate the effect of miR-148b-3p. USP6 silencing suppressed the migration and proliferation in primary Schwann cells. Conclusion Our data demonstrated the functional role of miR-148b-3p/USP6 axis in regulating the migration and proliferation of Schwann cells following peripheral nerve injury. miR-148b-3p showed downregulation and its target USP6 was upregulated after nerve transection procedure. Targeting miR-148b-3p/USP6 axis may provide a novel opportunity for peripheral nerve repair.

Application of self-pulling and latter transection in totally laparoscopic total gastrectomy.

Recent years have seen an increase in gastric cancer incidence. The most effective method of treating gastric cancer is still surgical resection. Over the past few decades, minimally invasive surgery has rapidly developed, reducing post-operative complications and speeding up recovery. However, the technical difficulties, especially during anastomosis, hinder the widespread use of this advanced surgery. The aim of this study was to investigate the safety and efficacy of self-pulling and latter transection in totally laparoscopic total gastrectomy (SPLT-TLTG). A retrospective study compared the outcomes of laparoscopic-assisted total gastrectomy (LATG) and SPLT-TLTG in patients with gastric cancer. Eighty patients who underwent either LATG or SPLT-TLTG between January 2016 and June 2018 were included in the study. Clinical information was used to compare patients who underwent these surgeries. Compared to LATG, patients who received SPLT-TLTG surgery recovered faster than those who received LATG time (operation and digestive tract reconstruction), blood loss, rehabilitation, first flatus, oral food intake, average pain score and hospital stay were significantly shorter in the SPLT-TLTG group than in the LATG group (P < 0.05). However, the two groups had no significant differences in LNs and baseline characteristics. The findings of this study provide significant evidence in support of the use of self-pulling and the latter transection procedures in total laparoscopic gastrectomy.

Diagnosis and treatment of meralgia paresthetica between 2005 and 2018: a national cohort study

The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. Since guidelines and large-scale studies are lacking, there are substantial regional differences in diagnostics and management in MP care. Our study aims to report on current diagnostic and therapeutic strategies as well as time trends in clinical MP management in Germany. Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with MP as their primary diagnosis were identified using the International Classification of Disease (ICD-10) code G57.1 and standardized operations and procedures codes (OPS). A total of 5828 patients with MP were included. The rate of imaging studies increased from 44% in 2005 to 79% in 2018 (p < 0.001) and that of non-imaging diagnostic studies from 70 to 93% (p < 0.001). Among non-imaging diagnostics, the rates of evoked potentials and neurography increased from 20%/16% in 2005 to 36%/23% in 2018 (p < 0.001, respectively). Rates of surgical procedures for MP decreased from 53 to 37% (p < 0.001), while rates of non-surgical procedures increased from 23 to 30% (p < 0.001). The most frequent surgical interventions were decompressive procedures at a mean annual rate of 29% (± 5) throughout the study period, compared to a mean annual rate of 5% (± 2) for nerve transection procedures. Between 2005 and 2018, in-hospital MP care in Germany underwent significant changes. The rates of imaging, evoked potentials, neurography, and non-surgical management increased. The decompression of the LFCN was substantially more frequent than that of the LFCN transection, yet both types of intervention showed a substantial decrease in in-hospital prevalence over time.

A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study.

IntroductionPrevious studies have shown that, thread carpal tunnel release (TCTR), an ultrasound-guided transverse carpal ligament (TCL) transection procedure through needle and thread, to be a safe and effective technique for carpal tunnel release, compared to an open and endoscopic technique. We developed a newly improved thread (Smartwire-01, 0.27mm in diameter, Korea). This pilot study was performed to propose the effectiveness of TCTR with Smartwire-01 compared to the commercial thread in clinical settings.MethodsA total of 22 TCTR procedures have been performed on 19 patients by one physiatrist during a 42-month period. The diagnosis of carpal tunnel syndrome was based on standard clinical criteria including electromyography (EMG). Patients were divided into two groups, one dissected with commercial thread and the other with Smartwire-01. The technique was standardized by keeping the entry point at the middle of the palm and the exit point at just medial to the palmaris longus tendon. The Numeric Rating Scale and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were used to assess monthly outcomes for 6 months following the procedure. The Wilcoxon signed rank test and the Mann-Whitney-U test were performed to analyze the above variables in the two groups.ResultsThere was no definite evidence that the two groups have significant differences for any of the surveyed variables. The TCTR procedure with our newly developed thread also had significant improvements for all variables, showing its effectiveness in both pain and functional ability. The NRS and BCTQ severity and functional scales showed significant decreases just after the dissection and progressive improvement during each monthly follow-up of our study until the last assessment at 6 months.ConclusionThe study suggests that, our newly developed thread is as safe and effective as the commercial thread in TCTR, we therefore recommend a randomize controlled trial with above methodology.

Synovial fluid proteome profile of surgical versus chemical induced osteoarthritis in rabbits.

BackgroundAnimal models are significant for understanding human osteoarthritis (OA). This study compared the synovial fluid proteomics changes in surgical and chemical induced OA models.MethodsThirty rabbits either had anterior cruciate ligament transection (ACLT) procedure or injected intra-articularly with monosodium iodoacetate (MIA, 8 mg) into the right knee. The joints were anatomically assessed, and the synovial fluid proteins analyzed using two-dimensional polyacrylamide gel electrophoresis (2DGE) and MALDI TOF/TOF mass spectrometry analysis at 4, 8 and 12 weeks. The proteins’ upregulation and downregulation were compared with control healthy knees.ResultsSeven proteins (histidine-rich glycoprotein, beta-actin-like protein 2 isoform X1, retinol-binding protein-4, alpha-1-antiproteinase, gelsolin isoform, serotransferrin, immunoglobulin kappa-b4 chain-C-region) were significantly expressed by the surgical induction. They characterized cellular process (27%), organization of cellular components or biogenesis (27%), localization (27%) and biological regulation (18%), which related to synovitis, increased cellularity, and subsequently cartilage damage. Three proteins (apolipoprotein I-IV precursor, serpin peptidase inhibitor and haptoglobin precursor) were significantly modified by the chemical induction. They characterized stimulus responses (23%), immune responses (15%), biological regulations (15%), metabolism (15%), organization of cellular components or biogenesis (8%), cellular process (8%), biological adhesions (8%) and localization (8%), which related to chondrocytes glycolysis/death, neovascularization, subchondral bone necrosis/collapse and inflammation.ConclusionsThe surgical induced OA model showed a wider range of protein changes, which were most upregulated at week 12. The biological process proteins expressions showed the chemical induced joints had slower OA progression compared to surgical induced joints. The chemical induced OA joints showed early inflammatory changes, which later decreased.

Comparison of bone and articular cartilage changes in osteoarthritis: a micro-computed tomography and histological study of surgically and chemically induced osteoarthritic rabbit models

BackgroundOsteoarthritis (OA) is a multifaceted condition that affects both the subchondral bones and the articular cartilage. Animal models are widely used as an effective supplement and simulation for human OA studies in investigating disease mechanisms and pathophysiology. This study is aimed to evaluate the temporal changes of bone and cartilage in surgically and chemically induced osteoarthritis using micro-computed tomography and histology.MethodsThirty rabbits underwent either anterior cruciate ligament transection (ACLT) procedure or injected intraarticularly with monosodium iodoacetate (MIA, 8 mg) at the right knee joint. The subchondral bones were scanned via micro-CT, and articular cartilage was assessed histologically at 4-, 8- and 12-week post-induction.ResultsBased on bone micro-architecture parameters, the surgically induced group revealed bone remodelling processes, indicated by increase bone volume, thickening of trabeculae, reduced trabecular separation and reduced porosity. On the other hand, the chemically induced group showed active bone resorption processes depicted by decrease bone volume, thinning of trabeculae, increased separation of trabecular and increased porosity consistently until week 12. Histologically, the chemically induced group showed more severe articular cartilage damage compared to the surgically induced group.ConclusionsIt can be concluded that in the ACLT group, subchondral bone remodelling precedes articular cartilage damage and vice versa in the MIA group. The findings revealed distinct pathogenic pathways for both induction methods, providing insight into tailored therapeutic strategies, as well as disease progression and treatment outcomes monitoring.

Superior laryngeal nerve transection for neuropathic cough: A pilot study

ObjectiveTo describe a novel surgical therapy for the treatment of medically refractory neuropathic cough, in which carefully selected subjects undergo surgical transection of the internal branch of the superior laryngeal nerve (iSLN). MethodsSubjects with a diagnosis of neuropathic cough, who were not improved after two medication trials, underwent iSLN block with local anesthetic in the office. While anesthetized, they underwent provocative testing to determine whether the nerve block improved their symptoms; if so, a modified barium swallow study (MBSS) was performed to determine whether they still swallowed safely without supraglottic sensation. Those who passed this screening were offered operative iSLN transection. We retrospectively reviewed our results to date. ResultsSix subjects (5 females, ages 46–71), with neuropathic cough symptoms for 2–15 years, passed the screening and underwent iSLN transection procedures. At a mean follow-up of 8.2 months, significant symptomatic relief was experienced by 5/6 subjects, with Cough Severity Index (CSI) scores averaging 34.83 ± 6.94 pre-op (range 36–40) and 15.5 ± 11.81 post-op (range 0–29) (p = 0.043). Operative time averaged 49 min (range 30–64). There were no major complications. No subjects experienced post-op aspiration problems. ConclusionThis preliminary data supports iSLN transection as a viable option for subjects with refractory neuropathic cough. Our screening algorithm identifies subjects that would be expected to improve with this procedure and confirms a safe swallow.

Acute molecular biological responses during spontaneous anterior cruciate ligament healing in a rat model

Anterior cruciate ligament (ACL) injury is one of the most common injuries of the knee joint and is becoming more prevalent. While ACL reconstruction is considered the “gold standard” of treatment, some studies have demonstrated natural spontaneous healing of the ACL in humans, rabbits, and rats. At this time, the mechanism of ACL healing is poorly understood. The purpose of this study was to determine the process of ACL healing by examining the molecular and histological changes in the acute phases, using an ACL-Transection model and a spontaneous ACL healing model. Sixty adult male Wistar rats were randomly assigned to two groups: the ACL transection (ACLT) group and the controlled abnormal movement (CAM) group. Thirty rats were randomly assigned to three groups (day 1, day 3, and day 5). Then, all rats underwent an ACL transection procedure. The CAM group rats underwent controlled abnormal extra-articular tibial translation. Samples were harvested from rats and used for histological and biochemical analyses. Both, the ACLT and the CAM groups exhibited ruptured ACLs. However, in the CAM group, the ends of the proximal remnants were not retracted. Expressions of MMP-3 and PDGF-α increased, and expression of TGF-β1 decreased in the CAM group on day 5 (p < 0.01); PDGF-β expression in the CAM group increased significantly at each time point (p < 0.01). Our results suggested that controlling abnormal movements changed intra-articular responses positively during the acute phase both histologically and biochemically.

Laparoscopic right hepatectomy with an anterior approach for large hepatocellular carcinoma using a right para caval liver hanging maneuver

Introduction: Laparoscopic right hepatectomy (LRH) for large hepatocellular carcinoma (HCC) with an anterior approach is a complicated procedure. We gradually introduce a modified liver hanging maneuver (LHM) through the retrohepatic tunnel on the right side of the inferior vena cava with the assistant of a Goldfinger Dissector. Method: Between January 2012 and June 2018, 39 patients with large HCC underwent LRH were enrolled in this study. The first 27 patients did not apply the LHM technique (the non-LHM group); the following 12 patients implemented the LHM technique (the LHM group). Perioperative and survival outcomes were compared. Result: The preoperative variables were almost comparable between the two groups. The median tumor size was 12.0 (IQR 10.0-13.0) cm in the LHM group and 12.6 (IQR 9.9-15.0) cm in the non-LHM group (P=0.541). Ten patients (83.3%) in the LHM group and 20 (74.1%) in the non-LHM group had tumor size >10 cm (P=0.693). The median duration of retrohepatic dissection is 14.5 (IQR 12-16) minutes. Total blood loss was significantly greater in the non-LHM group than that in the LHM group (460 vs. 200 ml, P<0.001), especially during the procedure of hepatic parenchyma transection (300 vs. 100 ml, P<0.001). As a result, the operative time was longer (415 vs. 312 min, P<0.001), and intraoperative transfusion rate was higher (55.6% vs. 16.7%) in the non-LHM group than that in the LHM group. Two cases (7.4%) converted to an open approach in the non-LHM group, while no patients experience conversion in the LHM group (P=1.000). However, postoperative complications and long-term survival were comparable between the two groups. Conclusion: The LHM can be quickly established in the laparoscopic approach with the assistant a Goldfinger dissector through the retrohepatic tunnel on the right side of the inferior vena cava. Application of the LHM can increase the safety of LRH for large HCC.

Microscopic observation of a rat spontaneous anterior cruciate ligament healing

Controlling abnormal joint movement immediately after anterior cruciate ligament (ACL) injury could prevent destruction of intra-articular tissues and lead to spontaneous ACL healing. In a previous study, healing tissue was observed between the remnant gaps in the process of spontaneous ACL healing. The purpose of this study was to evaluate the healing tissue as observed in the process of spontaneous ACL healing by histological analysis. A total of 30 adult male Wistar rats were randomly assigned to three groups: Sham, ACL transection (ACLT), and Controlled abnormal movement (CAM). The ACLT group and the CAM group underwent an ACL transection procedure, and the CAM group underwent extra-articular braking to control for abnormal tibial translation. Samples of the knee joints were harvested at 1 and 2 weeks postoperatively, and stained by Hematoxylin-Eosin (HE), Aldehyde Fuchsin-Masson Goldner (AF-MG), and anti-CD68 antibody. HE staining showed that ACL healing was not observed in the ACLT group, while spontaneous ACL healing was observed at 2 weeks postoperatively in the CAM group. AF-MG stains showed that the healing area consists of collagen. CD68 positive cells were mainly located at the superficial layer and the fibrous layer in all groups. Furthermore, in the CAM group, CD68 positive cells were located at the remnant at 1 week postoperatively and at the healing area at 2 weeks postoperatively. This study indicates that correcting abnormal kinetics during the early stages of ACL injury is critical for spontaneous ACL healing, and the healing tissue observed in the healing area contains collagen and type A synoviocytes.

A novel approach to lower rectal anastomosis: technique innovation and the preliminary report of twenty cases

Background and aimsTo describe a practical technique innovation (transanal ‘Pull-through’ approach) as a feasible, safe and effective alternative to the conventional transabdominal stapler low rectal anastomosis in lesions of minimal anatomical distinction from the adjacent intact mucosa. Material and methodsProspective case-series of patients with low rectal cancers, familial adenomatous polyposis (FAP) and ulcerative colitis undergoing Pull-through transection and very low rectal anastomosis using linear TA-90 noncutting stapler and circular stapler-cutter. ResultsIn this series, twenty patients (11 men and 9 women) underwent proctectomy by the transanal Pull-through technique. Barring one of the patients that developed a pelvic abscess in the immediate postop follow-up, surgical procedure and the long-term follow-up period was uncomplicated with no critical findings of leakage, stenosis and bleeding. The postop rate of infection and fecal incontinence was not significantly different between genders and different age groups of the study. The mean operative time was calculated 169.9±11.1minutes. ConclusionPull-through transection procedure using the TA-90 non-cutting stapler is a safe, efficient and economically sound technique implicated in low-lying rectal lesions. The transanal ‘Pull-through’ approach is particularly helpful in situations where the direct visualization of lower rectal mucosa changes the prognosis through determining the marginal extent of intact/involved mucosa (e.g., FAP, villous adenomas, rectal polyps and post-neoadjuvant chemoradiotherapy tumors).

The processus vaginalis transection method is superior to the simple prophylactic procedure for prevention of inguinal hernia after radical prostatectomy.

We compared retrospectively the efficacy of two methods for prevention of post-radical prostatectomy inguinal hernia: blunt dissection of the peritoneum at the internal inguinal ring, and isolation of the spermatic cord from the peritoneum (simple prophylactic procedure) and transection of the processus vaginalis. Of the 367 patients who underwent open radical retropubic prostatectomy for clinically localized prostate cancer between February 2005 and March 2012 at Saitama Cancer Center Hospital, 344 patients whose follow-up period was more than 2 years were enrolled in this study. Of these patients, 178 patients received the simple prophylactic procedure and 57 underwent processus vaginalis transection. We evaluated the risk factors for inguinal hernia (age; anastomotic stricture post radical prostatectomy; prophylactic procedures for inguinal hernia; previous history of abdominal surgery; previous inguinal hernia surgery; body mass index) using univariate and multivariate analysis. The effects of the two prophylactic procedures on incidence of inguinal hernia were analyzed using Kaplan-Meier plots. The incidence of inguinal hernia was 24.8 % in those not undergoing the prophylactic procedure; 18.5 % in those undergoing the simple prophylactic procedure; and 0.00 % in those undergoing the processus vaginalis transection procedure (p < 0.001). In univariate and multivariate analysis, undergoing the processus vaginalis transection procedure and high body mass index were significant predictors for hernia-free survival after radical prostatectomy. Our data suggest that the processus vaginalis transection procedure is superior to the simple prophylactic procedure for the prevention of inguinal hernia after radical prostatectomy.

Complete rat spinal cord transection as a faithful model of spinal cord injury for translational cell transplantation.

Spinal cord injury (SCI) results in neural loss and consequently motor and sensory impairment below the injury. There are currently no effective therapies for the treatment of traumatic SCI in humans. Various animal models have been developed to mimic human SCI. Widely used animal models of SCI are complete or partial transection or experimental contusion and compression, with both bearing controversy as to which one more appropriately reproduces the human SCI functional consequences. Here we present in details the widely used procedure of complete spinal cord transection as a faithful animal model to investigate neural and functional repair of the damaged tissue by exogenous human transplanted cells. This injury model offers the advantage of complete damage to a spinal cord at a defined place and time, is relatively simple to standardize and is highly reproducible.

Inferior mesenteric vein serves as an alternative guide for transection of the pancreatic body during pancreaticoduodenectomy with concomitant vascular resection: a comparative study evaluating perioperative outcomes.

BackgroundTumors of the pancreatic head often involve the superior mesenteric and portal veins. The purpose of this study was to assess perioperative outcomes after pancreaticoduodenectomy (PD) with concomitant vascular resection using the inferior mesenteric vein (IMV) as a guide for transection of the pancreatic body (Whipple at IMV, WATIMV).MethodsOne hundred thirty-seven patients had segmental vein resection during PD between January 2006 and June 2013. Depending on whether the standard approach of creating a tunnel anterior to the mesenterico-portal vein (MPV) axis was achieved for pancreatic transection, patients were subjected to a standard PD with vein resection procedure (s-PD + VR, n = 75) or a modified procedure (m-PD + VR, n = 62). Within the m-PD + VR group, 28 patients underwent the WATIMV procedure, while 34 patients underwent the usual procedure of transection, or ‘central pancreatectomy’ (c-PD + VR).ResultsThe volume of intraoperative blood loss and the blood transfusion requirements were significantly greater, and the venous wall invasion and neural invasion frequency were significantly higher in the m-PD + VR group compared with the s-PD + VR group. There were no significant differences in the length of hospitalization, postoperative morbidity, and grades of complications between the two groups. Multivariate logistic regression identified intraoperative blood transfusion (P = 0.004) and vascular invasion (P = 0.008) as the predictors of postoperative morbidity. Further stratification of the entire cohort of 62 (45%) patients who underwent m-PD + VR showed a higher rate of negative resection margins (96.4%) in the WATIMV group compared with the c-PD + VR group (76.5%) (P = 0.06). The volume of intraoperative blood loss (P = 0.013), and intraoperative blood transfusion requirements (P = 0.07) were significantly greater in the c-PD + VR group compared with the WATIMV group. Furthermore, high intraoperative blood loss and tumor stage were predictive of a positive resection margin.Conclusions‘Whipple at the IMV (WATIMV)’ has comparable postoperative morbidity with standard PD + VR. If IMV runs into the splenic vein, it could serve as an alternative guide for transection of the pancreatic body during PD + VR.

Long‐term Results of the Paraesophagogastric Devascularization with or without Esophageal Transection: Which Is More Suitable for Variceal Bleeding?

It has been reported that the paraesophagogastric devascularization with esophageal transection procedure, also known as the modified Sugiura procedure, was effective in the treatment of variceal bleeding. However, it was not widely accepted by other surgeons because of the high rate of rebleeding, complications, and mortality. To discover the effects of the paraesophagogastric devascularization procedure and the modified Sugiura procedure, we retrospectively analyzed the outcomes of these two procedures. During January 1990 and December 2009, 278 patients with variceal bleeding underwent devascularization after failed pharmacotherapy and endotherapy. In these 278 patients, 180 underwent paraesophagogastric devascularization without esophageal transection (group I), and the other 98 patients were subjected to the modified Sugiura procedure (group II). Postoperative mortality was 7.2% in group I, and 9.2% in group II (P = 0.563). The postoperative rebleeding rate in the two groups was 2.2 and 3.1%, respectively (P = 0.474). After a mean follow-up of 67.9 ± 37.3 months and 67.4 ± 44.6 months, respectively, esophageal transaction-related morbidity (leak, bleeding, and stricture) was 8.2% (8/98) in group II and 0% (0/180) in group I (P < 0.001). The overall rebleeding rate was 27% (41/152) in group I, and 27.2% (22/81) in group II (P = 0.976). The overall mortality was 28.3% (43/152) in group I, and 28.4% (23/81) in group II (P = 0.986). In the management of variceal bleeding, paraesophagogastric devascularization without esophageal transection is as effective and safe as devascularization with esophageal transaction, but with less esophageal transection-related morbidity.

Population parameters of the endangered titi monkey, Callicebus coimbrai Kobayashi and Langguth, 1999, in the fragmented landscape of southern Sergipe, Brazil

The recently-discovered titi, Callicebus coimbrai, is endemic to the coastal Brazilian Atlantic Forest south of the São Francisco River, a region with a long tradition of deforestation. While a number of C. coimbrai populations have now been identified, little is known about basic population parameters. Considering the importance of this information for conservation planning, the population of a site in southern Sergipe (with a total area of forest of approximately 500 ha) was surveyed between April and October 2008. Standard line transect procedures were used in the four largest fragments, and additional monitoring included the use of playback broadcasts for the observation of titi groups. The presence of titis was confirmed in all the forest fragments at the site, including one of only five hectares. Two other primates - Callithrix jacchus and Cebus xanthosternos - were also recorded at the site, but were less abundant than titis. A total transect walk of 476 km provided 164 sightings of primates, the majority of which (104) were of Callicebus coimbrai. Titi groups ranged in size between two and five individuals. The most reliable estimate of overall population density, derived from the combined data set, was 12.6 individuals per km²;, although density was much higher in smaller (more disturbed) fragments. The total population of Callicebus coimbrai at the site was estimated to be at least 50 individuals, which may represent a considerable proportion of the population of the species remaining in the wild. In addition to its apparent tolerance of habitat fragmentation, densities of C. coimbrai recorded at the site compare favourably with those of other Atlantic Forest titi species.