Hernia Diafragmatica Izquierda. Reporte de un caso / Left Diaphragmatic Hernia: A case report

Se presenta un caso clínico de diagnóstico ecográfico de hernia diafragmática realizado a partir de signos de sospecha. La paciente se presenta a control prenatal cursando 18 semanas de gestación, donde se visualiza alteración de la posición de la silueta cardiaca y cambios en la ecogenicidad en el campo pulmonar izquierdo. Se evalúan los signos pronósticos de las hernias diafragmáticas como la presencia de estómago e hígado en tórax y se calcula el índice pulmóncabeza ( LHR). En el presente caso el LHR arrojo un valor de 2,3 %, lo cual indica un buen pronóstico ya que el LHR mayor a 1,4 % se asocia a 93 % de posibilidades de sobrevivir

A clinical case of ultrasound diagnosis of diaphragmatic hernia performed from signs of suspicion is presented. The patient is presented to prenatal control studying 18 weeks gestation, where alteration of the position of the cardiac silhouette and changes in ecogenicity in the left pulmonary field is displayed. The prognostic signs of diaphragmatic hernias such as the presence of stomach and thorax liver and the lung-headed index (LHR) are evaluated. In the present case, the LHR shows a value of 2.3 %, which indicates a good prognosis since the LHR greater than 1.4 % is associated with 93 % possibilities to survive

Polimorfismos del gen del receptor para la hormona luteinizante (LHR - LHGCR) en folículos ováricos de vacas Romosinuano y Brahman ciclando / Luteinizing hormone choriogonadotropin receptor (LHGCR) gene polymorphism in ovarian follicles from cycling Romosinuano and Brahman cows / Polimorfismos do gene receptor para o hormônio luteinizante (LHR - LHGCR) em folículos ováricos de vacas Romosinuano e Brahman no ciclo

Resumen El gen del receptor para la hormona luteinizante (LHR-LHCGR) es un gen altamente conservado y su mRNA origina diferentes variantes por corte y empalme alternativo (splicing alternativo). En bovinos se han reportado variantes que traducen en proteína pero ésta no atraviesa la membrana celular; en humanos ante una deleción del exón 10 no hay respuesta a la acción de la LH, por lo tanto, es razonable asumir que las diferencias en la respuesta a la LH estén relacionadas con la expresión de los LHR. El objetivo de este trabajo fue comparar entre la raza criolla Colombiana Romosinuano y la raza Brahman los posibles polimorfismos del ARNm del gen como potenciales indicadores de fertilidad. Se tomaron 5 vacas ciclando de cada raza se extirpó el ovario que contenía un folículo preovulatorio, se retiró la pared folicular, se extrajo el RNA total y se sintetizó, amplificó, secuenció y comparó el ADNc contra secuencias ya reportadas, presentando una alta similitud. Se concluye que en estas razas la ausencia de variantes en la expresión del gen, estaría asociada a buen desempeño reproductivo.

Abstract The luteinizing hormone (LH) choriogonadotropin receptor (LHCGR) gene is highly conserved and its mRNA causes variants by alternative splicing. Variants have been reported in cattle that translate into protein; however, this does not cross the cell membrane. Exon 10 deletion in humans does not trigger a response to the action of LH; it is therefore reasonable to assume that differences regarding response to LH are related to LHR expression. This work was aimed at comparing the Colombian creole Romosinuano breed to the Brahman breed regarding possible HCGR gene mRNA polymorphisms as potential fertility indicators. Five cycling cows were taken from each breed and the ovaries containing pre-ovulatory follicles were excised, the follicular wall was removed and total RNA extracted. The cDNA was synthesised, amplified, sequenced and compared to already reported sequences, great similarity being observed. It was concluded that the lack of variants regarding gene expression in these breeds would be associated with good reproductive performance.

Resumo O gene do receptor para o hormônio luteinizante (LHR-LHCGR) é altamente conservado e seu mRNA origina diferentes variantes por splicing alternativo. Em bovinos, foram registradas variantes que se traduzem em proteína, mas esta não atravessa a membrana celular; em humanos quando há uma deleção do exon 10 não há nenhuma resposta à ação do LH, portanto, é possível que as diferenças na resposta ao LH estão relacionados à expressão do LHR. O objetivo deste estudo foi comparar os polimorfismos do mRNA do gene entre a raça crioula colombiana Romosinuano e a raça Brahman, como potenciais indicadores de fertilidade. Foram avaliadas cinco fêmeas de cada raça, retirou-se o ovário que continha um folículo pré-ovulatório, retirou-se a parede folicular, o RNA total foi extraído. Se sintetizou, amplificou, sequenciou e comparou o cDNA com sequencias já descritas, a qual presentou alta semelhança.

Resultados en ciclos de FIV-ICSI adicionando hormona luteinizante recombinante a la hormona folículo estimulante recombinante con menotropinas durante la estimulación ovárica en pacientes mayores de 35 años / Results in IVF-ICSI cycles adding luteinizing hormone recombinant to follicle stimulating hormone recombinant with menotropins during ovarian stimulation in patients over 35 years-old

Resumen OBJETIVO Evaluar los resultados en ciclos de FIV-ICSI de dos protocolos de estimulación ovárica en mujeres mayores de 35 años e investigar si agregar hormona luteinizante recombinante a FSH-r en un protocolo de estimulación mejora la respuesta ovárica y, en consecuencia, las tasas de embarazo en este grupo poblacional. MATERIALES Y MÉTODOS Estudio longitudinal, observacional y retrospectivo efectuado en pacientes de la Clínica de Reproducción Hisparep del Hospital Español con diagnóstico de infertilidad, mayores de 35 años, que recibieron un ciclo de hiperestimulación ovárica controlada con FIV-ICSI durante el periodo 2014-2016. El análisis estadístico se efectuó con la prueba de t de Student para muestras independientes. Los estudios se analizaron con el paquete estadístico SPSS IBM, versión 22. RESULTADOS Se analizaron 201 mujeres con infertilidad, mayores de 35 años. El grupo 1 (n = 101) de FIV-ICSI recibió estimulación con hormona folículo estimulante recombinante y hormona luteinizante recombinante 2:1 con menotropinas (Pergoveris® y Merapur®) a partir del segundo día del ciclo. El grupo 2 (n = 100) recibió hormona folículo estimulante recombinante y menotropinas (Gonal F® y Merapur®); en ambos esquemas se utilizó antagonista de GnRH a partir del día 7 del ciclo. La media de ovocitos aspirados fue de 7.5 en el grupo 1 y 9.1 en el grupo 2 (p = 0.058). La media de ovocitos maduros fue 6.2 en el Grupo 1 vs 7.4 en el grupo 2 (p = 0.085). La tasa de fecundación en el grupo 1 fue de 57 vs 67% en el grupo 2 (p = 0.045). En el grupo 1 la tasa de implantación por embrión transferido en fresco fue 24.1 vs 10.3% en el Grupo 2 (p = 0.40), la tasa de recién nacido vivo fue de 30% en el Grupo 1 vs 20.6% en el Grupo 2. La media de embriones vitrificados en el Grupo 1 fue 1.47 vs 1.38 en el Grupo 2. CONCLUSIONES La probable ventaja de la complementación con hormona folículo estimulante recombinante durante la estimulación ovárica en mujeres mayores de 35 años es de interés y se requiere su evaluación en estudios posteriores.

Abstract OBJECTIVE To evaluate the reproductive effects when recombinant luteinizing hormone is added and to compare two stimulation schemes by number of aspirated oocytes, mature oocytes, fertilization and implantation rates, live newborn and number of vitrified embryos. MATERIALS AND METHODS Longitudinal, observational and retrospective study carried out in patients of the Hisparep Reproduction Clinic of the Spanish Hospital with diagnosis of infertility, over 35 years old, who received a controlled ovarian hyperstimulation cycle with IVF-ICSI during the period 2014-2016. The statistical analysis was carried out with the Student t test for independent samples. The studies were analyzed with the IBM SPSS statistical package, version 22. RESULTS We analyzed 201 women with infertility, over 35 years of age. Group 1 (n = 101) of IVF-ICSI received stimulation with recombinant follicle-stimulating hormone and recombinant luteinizing hormone 2: 1 with menotropins (Pergoveris® and Merapur®) from the second day of the cycle. Group 2 (n = 100) received recombinant follicle stimulating hormone and menotropins (Gonal F® and Merapur®); in both schemes, GnRH antagonist was used from day 7 of the cycle. The average number of aspirated oocytes was 7.5 in Group 1 and 9.1 in Group 2 (p = 0.058). Mean mature oocytes were 6.2 in Group 1 vs 7.4 in Group 2 (p = 0.085). The fertilization rate in group 1 was 57 vs. 67% in Group 2 (p = 0.045). In Group 1 the implantation rate per embryo transferred fresh was 24.1 vs 10.3% in Group 2 (p = 0.40), the live newborn rate was 30% in Group 1 vs 20.6% in Group 2. The mean number of vitrified embryos in Group 1 was 1.47 vs 1.38 in Group 2. CONCLUSIONS The probable advantage of supplementation with recombinant follicle-stimulating hormone during ovarian stimulation in women over 35 years of age is of interest and its evaluation is required in subsequent studies.

Utilidad de factores pronósticos antenatales en pacientes con hernia diafragmática congénita aislada / Usefulness of antenatal prognostic factors in patients with hernia congenital diaphragmatic isolated

La Hernia Diafragmática Congénita (HDC) corresponde a una malformación del diafragma por la cual los órganos abdominales protruyen hacia la cavidad torácica durante el desarrollo intrauterino. Los recién nacidos afectados presentan grados variables de insuficiencia respiratoria e hipertensión pulmonar, asociándose a una alta morbilidad y mortalidad. Materiales y métodos: Se revisaron los casos de HDC controlados en los períodos pre y post-natal en el Hospital Clínico UC durante el período 2012-2016. Se analizaron los resultados perinatales según distintos factores pronósticos. Resultados: Fueron analizadas 26 embarazadas con diagnóstico de HDC. La sobrevida global fue de un 77% (20/26). La mortalidad global de las pacientes con herniación hepática fue de un 45% (5/11) versus 7% (1/15) en los fetos con hígado no herniado. La mortalidad neonatal fue de un 14% (3/21) en las pacientes con la relación pulmón cabeza (LHR), (observado/ esperado) o/e ≥ a 45% y 60% (3/5) cuando el LHR o/e es < 45%. De las pacientes con LHR o/e ≥ 45%, la necesidad de ECMO fue de un 33% (8/21) mientras que un LHR o/e < 45% fue de un 20% (1/5). Conclusión: La obtención antenatal de un LHR o/e ≥ 45% y ausencia de herniación hepática, son buenos predictores de sobrevida neonatal. La medición de LHR o/e no es capaz de discriminar que pacientes desarrollarán morbilidad respiratoria grave, por lo que debemos buscar nuevos y mejores modelos que permitan seleccionar que pacientes requerirán nacer en un centro con disponibilidad de terapias de soporte vital avanzado como el ECMO neonatal. (AU)

Congenital Diaphragmatic Hernia (CDH) is a malformation of the diaphragm muscle in which the abdominal organs protrude into the thoracic cavity during intrauterine development. Affected newborns have varying degrees of respiratory failure and pulmonary hypertension, associated with high morbidity and mortality. Materials and methods: Controlled HDC cases were reviewed in the pre and post-natal periods at the Clinical Hospital UC during the period 2012-2016. Perinatal results were analyzed according to different prognostic factors. Results: During the 2012-2016 period, 26 pregnant women with a diagnosis of CDH were monitored. The overall mortality of patients with hepatic herniation was 45% (5/11) versus 7% (1/15) in fetuses with a non-herniated liver. Neonatal mortality was 14% (3/21) in patients with o/e (observed/expected) LHR ≥ 45% and 60% (3/5) when the o/e LHR <45%. Of the patients with o/e LHR ≥ 45%, the need for ECMO was 33% (8/21), while a LHR o/e <45% was 20% (1/5). Conclusion: An o/e LHR ≥ 45% and absence of hepatic herniation are good predictors of neonatal survival. The o/e LHR measurement is not capable of identifying which patients will develop severe respiratory morbidity, so we must explore new and better models that allow us to select patients who need to give birth in centers with available advanced life support therapies, such as neonatal ECMO. (AU)

Regulation of luteinizing hormone receptor in hippocampal neurons following different long-lasting treatments of castrated adult rats.

The aim of this study was to investigate the effects of different Luteinizing hormone (LH) and steroid hormones levels on LH receptor (LHR) expression in the hippocampal cells. Rats (24 males and 24 females) were assigned to four groups: one control and three experimental [gonadectomy (GDX), gonadectomy + gonadotropin releasing hormone analogue (GDX+GnRHa) and GDX+GnRHa+estradiol (E2) or testosterone (T)] independently for each gender. All experimental rats were gonadectomized; then GnRHa was administrated to GDX+GnRHa group, and GnRHa plus steroid hormone to GDX+GnRHa+E2 or T group in both genders for four-month. LHR mRNA expression and its protein level in hippocampal cells were measured using QRT-PCR and Western blotting. Quantification of mRNA revealed a decrease in LHR transcripts level in GDX+GnRHa group of females. A significant change was observed between GDX groups and GDX+GnRHa+E2 or T versus GDX+GnRHa group in females. High levels of LH decreased significantly the immature isoform of LHR in GDX group compared to control group in both genders, but low LH concentrations in GDX+GnRHa group induced immature LHR isoform production only in females. Therefore increased LH concentration induces production of incomplete LHR transcripts in hippocampal cells and decreases immature LHR at the protein level. This implies that LH decreases the efficiency of translation through either producing non-functional LHR molecules or preventing their translation.

Effects of dietary energy level on ovarian expression of mRNA s for luteinizing hormone receptor and follicle-stimulatiing hormone receptor in prepubertal gilts / 中国兽医学报

To explore the effects of long-term treatment of different dietary energy levels on ovarian expression of mRNAs for LHR and FSHR,the present study was performed in nine growth-matched littermate crossbred (Land-race×Large White X Duroc) prepubertal gilts. At approximately 30 kg of body weight and 50 day of age,gilts were housed with individual feeding stalls and placed on a normal level of feeding for 90 days (dl-90) with free ac-cess to water and food throughout the whole research. From d91 ,littermates were divided and randomly assigned to one of the following three treatment lines for 3 weeks till d112:Group H,Group M, and Group L, fed the high energy level diet (n = 3, digestible energy 14.87 MJ/kg), moderate energy level diet (n = 3, digestible energy 12.39 MJ/ kg), and low energy level diet (n = 3, digestible energy 9.98 MJ/kg), respectively. When gilts were slaughtered on d112 after 3 weeks energy treatment, both ovaries of every gilts were collected,snap frozen in liquid nitrogen and re-tained at -80℃ for use to determine and analysis the relative amount of ovarian LHR and FSHR mRNAs using semi-quantitative RT-PCR. Results showed that the effect of dietary energy treatment was notable: the ovarian ex-pression of mRNAs for LHR and FSHR was significantly higher (P<0.05) in gilts treated with high energy diet compared to gilts treated with moderate and low energy diets, while gilts treated with low energy diet had a signifi-cantly lower (P<0.05) ovarian LHR and FSHR expression compared with gilts treated with moderate and high en-ergy diets. These results revealed that ovarian expression of I.HR and FSHR in prepubertal gilts increased as the lev-el of dietary energy intake elevated,i, e. , high energy diet can markedly enhance ovarian expression of mRNAs for LHR and FSHR,whereas energy deficit markedly suppress the expression.

The effect of LH Receptor in the Pregnancy of Poor Responders / 대한불임학회지

OBJECTIVES: To investigate the effect of LH receptor in folliculogenesis, we confirm the expression level of LH receptor (LH-R) mRNA in human granulosa cells (GCs) and its expression levels were analyzed by comparison to embryo developmental rate and pregnancy rate. MATERIALS AND METHODS: GCs were obtained at the time of oocyte retrieval from the patients undergoing IVF-ET program. The patients were divided into two groups: Group I (n=20) is poor responder (retrieved oocyte(s)3ea). After the extraction of total RNA, semiquantitative RT-PCR was performed and the expression level of LH-R mRNA was normalized by beta-actin. Statistical analysis was performed by using Chi(2) test, Student's t-test and Pearson correlation. RESULTS: In Group II, the relative values of LH-R mRNA (0.680 vs. 0.463, p<0.005) and pregnancy rate (54.7% vs. 23.1%, p<0.05) were significantly higher than in Group I. Number of retrieved oocyte(s) was gradually increased when the expression of LH-R mRNA was increased (p<0.05). But the quality of retrieved oocyte and transferred embryo were not related with the expression of LH-R mRNA. When the pregnancy rate was compared with FSH only group and FSH combined with hMG group in the ovarian stimulation protocol, FSH combined with hMG group was significantly higher than FSH only group in Group I (37.5% vs. 0%), and the expression of LH-R mRNA was significantly higher in hMG combined group than FSH only group (p<0.05). CONCLUSION: Expression level of LH-R mRNA has important role in ovarian function related with the response to gonadotrophin in human folliculogenesis. Furthermore these data might provide the evidence that additional use of hMG is helpful to poor responders.