Adoption of Single-Port Robotic Prostatectomy: Two Alternative Strategies
JOURNAL OF ENDOUROLOGY
Authors: Abaza, Ronney; Martinez, Oscar; Murphy, Christopher; Urkmez, Ahmet; Davis, John
Abstract
Objective:To demonstrate two distinct methods for adopting the single-port (SP) robotic surgery system for robotic-assisted laparoscopic prostatectomy (RALP) by two experienced robotic surgeons (J.D. and R.A.) and evaluate early outcomes with each strategy. Methods:The initial RALP procedures using the SP robot by two surgeons were reviewed from prospective data collection at two institutions, MD Anderson Cancer Center (MDA) and OhioHealth Dublin Methodist Hospital (DMH). Both teams adopted different strategies regarding patient selection criteria, surgical approach, use of assistant ports, performance of lymphadenectomy, postoperative discharge criteria, and having a backup robot on standby. Results:The initial 74 consecutive patients who underwent SP-RALP at MDA and DMH (n = 34 andn = 40, respectively) were reviewed. All DMH and 24 MDA patients underwent a transperitoneal (TP) approach, whereas 10 MDA patients underwent an extraperitoneal (EP) approach. Mean operative time was similar for MDA and DMH, although it was shorter in TP patients. All MDA patients underwent nerve-sparing procedures and 12% underwent pelvic lymph node dissection (PLND); however, at DMH, all patients had PLND and 55% had nerve sparing. Mean estimated blood loss was not clinically significant for either group. Length of stay was 1.1 days (range, 1-2 days) for MDA and 0.12 days (range, 0--1 day) for DMH. No major complications occurred in either group other than two lymphoceles requiring percutaneous drainage in the EP SP-RALP group. Conclusion:Two significantly different strategies for SP robot adoption allowed immediately safe and equally efficacious outcomes in the initial patients treated.
Collagen Nanoparticle-Mediated Brain Silymarin Delivery: An Approach for Treating Cerebral Ischemia and Reperfusion-Induced Brain Injury
FRONTIERS IN NEUROSCIENCE
Authors: Rathore, Pankaj; Arora, Indu; Rastogi, Shweta; Akhtar, Mohd; Singh, Shruti; Samim, Mohammed
Abstract
Silymarin is a bioactive constituent isolated from milk thistle (Silybum marinum). Since its discovery, silymarin has been considered a gold standard drug in treating ailments related to the liver, resulting from alcohol consumption and viral hepatitis. This hepatoprotective nature of silymarin arises out of antioxidative and tissue-regenerating properties of silymarin. However, several recent studies have established the neuroprotective link of silymarin, too. Thus, the current investigation was aimed at exploring the neuroprotective effect of nanosilymarin (silymarin encapsulated inside collagen-based polymeric nanoparticulate drug delivery system). The study aimed at bringing out the role of nanoparticles in enhancing the therapeutic effect of silymarin against neuronal injury, originating out of oxidative-stress-related brain damages in focal cerebral ischemia. Collagen-based micellar nanoparticles were prepared and stabilized using 3-ethyl carbodiimide-hydrochloride (EDC-Hcl) and malondialdehyde (MDA) as crosslinkers. Nanoparticles were characterized using dynamic light scattering (DLS), transmission electron microscopy (TEM), and Fourier transform infrared (FT-IR) spectroscopy techniques, and the size of nanoparticles was found to be around 48 nm. Male albino Wistar rats were pretreated with three different doses of nanosilymarin of 10, 100, and 1,000 mu g/kg b.wt and a dose of free silymarin of 100 mg/kg b.wt intraperitoneally (i.p.) for 7 days. Focal cerebral ischemia was induced using the middle cerebral artery occlusion (MCAO) model on the eighth day for 1 h followed by 24 h reperfusion. The animals were then evaluated for neurobehavioral, infarct analysis, biochemical, histopathological, and immunohistochemical studies. All the above parameters showed remarkable improvement in nanosilymarin-treated groups in comparison to the silymarin-treated group. Nanoparticle encapsulation of drug enhanced neuroprotection by increasing drug bioavailability and targeting. Thus, the present study concluded with satisfactory results, showing the critical role played by nanoparticles in improving the neuroprotection at very low drug doses.