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Autophagy is a process through which damaged cytoplasmic structures are recycled and degraded within the cell. Aging can affect autophagy regulation in different steps and lead to the accumulation of altered proteins, leading to cell damage and death. Motor neuron (MN) loss is an important contributor to sarcopenia age-dependent motor dysfunction. Understanding the regulatory mechanisms of autophagy can help elucidate the motor dysfunction that occurs with aging and provide a target for developing future therapeutic agents. Previous immunofluorescence imaging studies in phrenic MNs showed an age-dependent increase in key autophagy proteins LC3 and p62, reflecting autophagosome accumulation and autophagy impairment. Accordingly, we hypothesized that aging in lumbar MNs leads to autophagy impairment reflected in regulatory protein expression. The current study assessed autophagy in choline acetyltransferase-positive MNs from spinal levels L1-L6, focused on crural muscles (extensor digitorum longus and soleus), using confocal immunofluorescence imaging. Expression of LC3 and p62 proteins in MNs were determined in male and female C57BL/6 mice at 6-, 18- and 24- months of age. Increased expression of LC3 in lumbar MNs was observed with aging across all three age groups and p62 expression in lumbar MNs was significantly increased by 24- and 18-months compared to 6-months (p Supported by NIH R01 AG057052. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

BACKGROUND The standard surgical treatment for low rectal cancer is abdominoperineal resection (APR). Comparing to primary closure, immediate flap reconstruction has shown to have good outcomes. We aimed to assess the inferior rectus abdominis muscle flap complications after APR surgery, a new method of reconstruction. METHODS This study was conducted from 2014 to 2016 in a single center in Firoozgar Hospital, Tehran, Iran. Eighteen patients who underwent pelvic floor closure with inferior part of abdominis rectus musculofascial flap were included enrolled. The sampling method used in this study was census. All patients had distal rectoanal malignancies. A checklist including age, gender, tumor location, complications after surgery, tumor type, length of hospital stay, length of operation, neoadjuvant chemotherapy and neoadjuvant radiotherapy history was filled for all patients. RESULTS Among 18 participants, 27.8% were female. The mean age of participants was 58.28 ± 17.86 yr (minimum of 19 and the maximum of 89 yr). The pathology of the tumor in all but one of the cases was adenocarcinoma (94.4%). The overall complication rate after surgery was 27.8%. In total, 80% received neoadjuvant chemoradiotherapy. In 12 months follow-up 2 patients needed reoperation. CONCLUSION Inferior part of rectus abdominis muscle flap was a reliable and comparable means of reconstruction after APR surgery with low rate of complications and mortality.

Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr.We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores.Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively).Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.

Rapid recovery after minimally invasive mitral valve (MV) repair has been demonstrated in many studies, but the issue of postoperative pain has not been fully elucidated. We evaluated pain scores and medication use in patients undergoing MV repair by minimally invasive surgery (MIS) and open sternotomy (OS).Between 2008 and 2019, 1332 patients underwent isolated MV repair by OS, and 913 underwent minimally invasive MV repair. After 1:1 propensity score matching, the study included 709 patients in each group. Opioid use was quantified as oral morphine equivalents in milligrams for each hospital day. The highest pain scores were collected from a visual analogue scale at 6-hour intervals. Predictive modeling was employed to compare pain medications and pain scores between the groups.The postoperative median length of stay was 3 (3-4) and 5 (4-5) days for the MIS and OS groups, respectively (P.001). The predicted geometric mean oral morphine equivalents demonstrated lower opioid use for the MIS group compared with the OS group for the first 4 days. However, the predicted mean pain score was higher in the first 24 hours for the MIS group compared with the OS group (4.7 [4.5-4.8] vs 4.4 [4.3-4.5], respectively, on a visual analogue scale of 0 to 10).MV repair by MIS methods was associated with decreased opioid use but not with decreased postoperative pain scores. Possible explanations include the difference in incision site pain and subjective differences in postoperative pain expectations.

Background: Primary dysmenorrhea is one of the most common gynecological complaints that can affect the quality of life. The exact pathophysiology of dysmenorrhea is not yet fully understood. However, some studies have suggested an association between anthropometric indices and dysmenorrhea. Objectives: We aimed to evaluated the association between anthropometric indices and dysmenorrhea. Methods: In this cross-sectional study conducted in Qazvin, Iran, during 2016, 400 high school students aged between 14 and 18 years old were enrolled based on the inclusion criteria. The relevant information and anthropometric indices were collected using a checklist. The data were analyzed by SPSS version 17. Results: Among 400 students, the prevalence of dysmenorrhea was 82.5%. There were significant differences in cycle length (29.15 ± 2.69 vs. 27.57 ± 2.38; P = 0.001), duration of menstruation (6.03 ± 1.11 vs. 5.65 ± 1.20; P = 0.011), hip circumference (93.13 ± 9.25 vs. 90.14 ± 12.15; P = 0.021), height (162.62 ± 5.47 vs. 160.72 ± 5.92; P = 0.01), and waist to hip ratio (WHR) (0.78 ± 0.06 vs. 0.81 ± 0.09; P = 0.001) between the groups with dysmenorrhea and without dysmenorrhea. Based on a logistic regression model, only WHR was a predictive protective factor for dysmenorrhea (OR = 0.896, CI95% = 0.821 - 0.971, P = 0.012) and height (OR = 1.057, CI95% = 1.006 - 1.111, P < 0.001), cycle length (OR = 1.238, CI95% = 1.117 - 1.372, P = 0.028), and menstruation length (OR = 1.269, CI95% = 1.002 - 1.608, P = 0.048) were risk factors. Conclusions: WHR and height were noted to be associated with dysmenorrhea. In addition, WHR was found to be a protective factor and height to be a risk factor.

Surgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. Although the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution.From 2008 to 2019, 843 patients underwent robotic MV repair at Mayo Clinic in Rochester, Minnesota. Repeated measures generalized least squares (GLS) modeling was used to assess the echocardiographic changes over time.The median age was 58 years (interquartile range, 50.8, 65.5 years), and 591 were male (70.1%). The mechanism of mitral regurgitation was posterior leaflet prolapse in 479 (56.8%) patients, bileaflet prolapse in 325 (38.6%), and anterior leaflet prolapse in 36 (4.3%). There were 3 early deaths (0.4%) and 24 early reoperations (2.8%). Echocardiographic follow-up demonstrated left ventricular end-systolic and end-diastolic dimensions, left atrial volume index, and pulmonary pressure all continuously improved up to 2 years postoperatively. Ejection fraction immediately declined postoperatively but then gradually improved to near normal over 2 years. Survival and freedom from reoperation at 10 years were 93% and 92.6%, respectively. When patients were surveyed after dismissal, 93.4% reported their activity level at or above their peers, and 93.3% reported no activity limitation from cardiac symptoms.Robotic MV repair is safe and effective with excellent long-term results, including echocardiographic data that demonstrated early improvement in cardiac chamber size and maintenance of postoperative cardiac function. Exceedingly low mortality rates and freedom from reoperation are comparable to those of the standard open repair.

Obstructive defecation syndrome (ODS) affects quality of life of patients to a great extent by disturbing defecation. Laparoscopic ventral mesh rectopexy (LVMR) has gained much attention in the recent years. Common synthetic used meshes have a risk of erosion for adjacent pelvic organs leading to some complications. The aim of this study was to assess the outcomes of LVMR using polyvinylidene fluoride (PVDF) mesh in patients with ODS for the first time.Of 156 patients, 155 had a 12-month complete follow-up. Thirty-nine (25.2%) were male and 116 (74.8%) female. Mean ± SD age of participants was 45.61 ± 14.02 years. The overall complication rate was 3.87%. No major mesh-related complications were recorded. Four cases (2.58%) of trocar site hernia were reported. Also, two cases (1.29%) of postoperative bleeding occurred. CSS before the operation and 1, 3, and 12 months after it were 11.04 ± 5.93, 7.98 ± 4.85, 5.46 ± 3.70 and 4.09 ± 2.98, respectively (Synthetic meshes might cause severe erosion in pelvic organs. However, at least in short-term follow-up, PVDF mesh seems to be safe and effective in LVMR, with the advantage of being cheaper.

As the challenge for finding the best abdominal incision closure technique continues, surgeons are aiming to minimize postoperative wound complications such as wound dehiscence and hernia as an acute or late manifestation. In order to achieve this goal, several abdominal opening and closure techniques have been tried. In this article, we describe a method in which we used a nasogastric tube (NGT) in mass closure for patients with fascial dehiscence. In this case-series study, a total number of 25 patients participated. All of the patients had abdominal dehiscence after a surgery and had to undergo for another. An NGT was used for abdominal closure. The patients were followed for a month and were examined for any signs and symptoms of fever, infection, pain, material expenses, closing time, and laboratory data. The data were analyzed using SPSS software V.22. Mean ± SD and frequencies were used for describing the variables. The mean NGT mass closure material expenses for each patient were 8400.00 ± 0.00 IRR (around 0.25 US dollars). The mean closure time after the operation was 13.08 ± 3.09 min. There was no evidence of infection among the patients as well as no other complications after the surgery in the 1-month study period. Abdominal mass closure with NG tube suturing technique is associated with reduced time required for closure of the incision, incidence of wound dehiscence, and the incidence of incisional hernia as well as infection, with a considerable low cost.