GnRH antagonist administration to postpone a weekend intrauterine insemination: a large cohort study from a public center.

BACKGROUND: In Spanish public hospital Reproduction Units it is very problematic to perform programmed intrauterine insemination (IUI) on weekends, if indicated. Small previous pilot studies suggest that using a GnRH antagonist to avoid an LH weekend surge would allow to perform IUI on the following Monday, not impairing the expected pregnancy rate. METHODS: Between 1st January 2007 and 31st December 2015, 4.782 intrauterine inseminations were performed at Valladolid University Clinic, Spain, corresponding to 1.650 women. Of them, 911, corresponding to 695 women, should ideally have been performed during the weekend. If it happened that a member of the Reproduction Unit was on duty during that particular weekend, the standard protocol was not interrupted, and the IUI performed as planned (control group, 685 IUIs). If the former was not the case, the weekend gap was bridged by administering 0.25 mg GnRH antagonist (GnRHa). Ovulation was induced by means of 250 ug recombinant HCG (rHCG) 36 h prior to IUI on the following Monday (study group, 226 IUIs). RESULTS: There were no differences in the clinical pregnancy rate (13.7 cc vs. 16.2 %, p = 0.371) or in the ongoing pregnancy rate between groups (11.9 % vs. 14.9 %, p = 0.271). The multiple pregnancy rate was also comparable in both groups (14.7 % vs. 18.5 %, p = 0.77). CONCLUSIONS: Women with a planned IUI which cannot be performed at the ideal date can be offered postponement for two days with the support of GnRHa treatment, with results that are not inferior to those expected applying the regular protocol.

A randomized intervention trial to reduce mechanical exposures in the Colombian flower industry.

BACKGROUND: Evidence on effectiveness of ergonomic interventions to reduce mechanical demands of the upper extremity is scarce in agriculture. OBJECTIVE: To conduct an ergonomic intervention to reduce mechanical exposures on workers during manual flower cutting, while emphasizing postural education and reduction of force requirements. PARTICIPANTS: Seventy seven workers (20 to 55 years old; 80% women) from six companies that cultivate roses participated in this study. METHODS: Participants from three companies were randomly assigned to control and intervention groups. A postural education program and a maintenance program was designed and implemented in the intervention group aiming to achieve more neutral postures of the wrist and forearm and to reduce force requirements during rose cutting. Changes in self-reported effort and upper extremity postures, kinematics and muscular activity between baseline and follow-up assessments were evaluated. RESULTS: Most of the observed changes in the evaluated mechanical exposures were moderate for both groups. The intervention group showed differential improvements compared to the control group for 95th percentile forearm pronation (intervention group went from 50.6 to 35.6°; control group went from 18.4 to 34.7°); and to some degree for the maximum wrist radial deviation (the intervention group went from 17° to 7.6°; control group went from 10.1° to 7.8°). Also, the mean elbow flexion for the control group was reduced from 62.3 to 48.4°, whereas it increased from 52.2 to 57.3° in the intervention group. No differential changes between the intervention and control groups were observed for the kinematic variables, except for an unexpected reduction in the 95th percentile velocity of wrist flexion-extension in the control group, which was not observed in the intervention group. Lastly, although observed changes in muscular activity were not statistically significant, improvements were observed for the intervention group for the flexor and extensor carpi radialis and the flexor carpi ulnaris; although the opposite was true for the extensor carpi ulnaris. CONCLUSIONS: Important although sometimes mixed results were achieved with this field intervention, focusing on postural and force requirement demands. The positive results are encouraging considering the presence of typical limitations observed in field intervention studies.

Physical workloads of the upper-extremity among workers of the Colombian flower industry.

BACKGROUND: We report the prevalence of symptoms of common upper-limb disorders and describe comprehensively mechanical workloads in a sample of workers of the Colombian flower industry. METHODS: One hundred fifty eight workers from eight flower manufacturers were assessed. Assessments included Borg self-reported exertion and working practices, medical examinations, video-based observations and kinematic and surface muscular activity assessments of upper-limb. RESULTS: Point prevalence of signs and symptoms of CTS, epicondylitis, and De Quervain's disease was 32.9%, 15.2%, and 13.3%, respectively. All tasks are executed on average in wrist extension, ulnar deviation, and high elbow flexion. Average median muscle activity across tasks ranged between 3.6% and 27.3%. Forearm muscles were mainly active. CONCLUSIONS: The occurrence of signs and symptoms of upper-extremity musculoskeletal disorders was high among the sample. The classification and cutting task showed the highest mechanical demands. Interventions in this working population are required and should be directed to allow for muscular rest on regular basis.

A randomized intervention trial to reduce mechanical exposures in the Colombian flower industry.

Evidence on the effectiveness of ergonomic interventions to reduce mechanical demands and upper-extremity MSDs is scarce in agriculture. We conducted an intervention to reduce mechanical exposures during manual flower cutting through job rotation, education and reduction of force requirements. One-hundred and twenty workers (20 to 60 years old; 89% women) from six companies that cultivate roses participated in this study. Three companies were randomly assigned to control and intervention groups. We studied changes between baseline and follow-up in self-reported effort and upper-extremity postures, kinematics and muscular activity. Most of the observed changes were moderate for both groups. The intervention group showed differential improvements compared to the control group for the maximum wrist radial deviation and forearm pronation, and acceleration of the forearm supination-pronation and elbow flexion-extension; and the muscular activity of the flexor and extensor carpi radialis and the flexor carpi ulnaris. However, we also observed that the maximum ulnar deviation, velocity of the wrist flexion-extension and muscular activity of the extensor carpi ulnaris improved more in the control group. These mixed results may be related to limited time for intervention adjustment, and uncontrolled task changes in the control group. Future research should address these issues and test other solutions.

A field experiment comparing mechanical demands of two pruners for flower cutting.

Manual flower cutting requires repetitive forceful movements that may explain the high incidence of upper-extremity MSDs among workers of the Colombian flower industry. Force demands may be caused by the use of pruners that have not been designed for Colombian workers. We conducted a repeated measures field experimental study (n=16, 69% women, 20 to 60 years old) to compare the mechanical demands during rose cutting of two different pruners (Traditional vs. alternative pruner) at two different cutting heights (elbow vs. over-shoulder). Demands included the perceived comfort, perceived effort and upper limb's muscular activity and posture. Workers perceived their traditional pruner as more comfortable but requiring more effort than the prototype tool. No benefits were observed regarding ulnar deviation with the alternative pruner. The wrist extension and related muscular activity of the wrist extensors were higher with the prototype pruner. The prototype pruner resulted in reduced muscular load of the wrist flexors; the biceps when working at the elbow height; and the deltoids when working at the shoulder height. However, Moderate results may be explained by the lack of time for workers' adaptation to the alternative tool. New design developments must focus on reducing extension and ulnar deviation of the wrist.

Work pattern causes bias in self-reported activity duration: a randomised study of mechanisms and implications for exposure assessment and epidemiology.

BACKGROUND: Self-reported activity duration is used to estimate cumulative exposures in epidemiological research. OBJECTIVE: The effects of work pattern, self-reported task dullness (a measure of cognitive task demand), and heart rate ratio and perceived physical exertion (measures of physical task demands) on error in task duration estimation were investigated. METHODS: 24 participants (23-54 years old, 12 males) were randomly assigned to execute three tasks in either a continuous (three periods of 40 continuous minutes, one for each task) or a discontinuous work pattern (40 min tasks each divided into four periods of 4, 8, 12 and 16 min). Heart rate was measured during tasks. After completing the 2 h work session, subjects reported the perceived duration, dullness and physical exertion for each of the three tasks. Multivariate models were fitted to analyse errors and their absolute value to assess the accuracy in task duration estimation and the mediating role of task demands on the observed results. RESULTS: Participants overestimated the time spent shelving boxes (up to 38%) and filing journals (up to 9%), and underestimated the time typing articles (up to -22%). Over- and underestimates and absolute errors were greater in the discontinuous work pattern group. Only the self-reported task dullness mediated the differences in task duration estimation accuracy between work patterns. CONCLUSIONS: Task-related factors can affect self-reported activity duration. Exposure assessment strategies requiring workers to allocate work time to different tasks could result in biased measures of association depending on the demands of the tasks during which the exposure of interest occurs.

Quiste de retención prostético: una causa rara de retención aguda de orina / Prostatic cyst causing urinary obstruction: report of one case

Las lesiones quísticas localizadas en la línea media de la glándula prostética presentan una incidencia difícil de estimar, debido a que la mayoría son asintomáticas y suelen ser un hallazgo casual durante el estudio de otra patología urológica. Presentamos el caso de un varón de 85 años que en el transcurso de un episodio de retención aguda de orina es diagnosticado de un quiste de retención prostético, y realizamos una revisión de la literatura.

The incidence of medial prostatic cysts is unknown, since most of them are asymptomatic, and usually appear as an incidental finding during the study of other urological disease. We report an 85 years oíd man with a urinary obstruction. Rectal palpation disclosed a mass that was adjacent to the prostate. Magnetic resonance showed a cystic lesión of the right seminal vesicle. The cyst was drained, obtaining 250 mi of fluid and urinary obstruction subsided. After three months of follow up, the patient remains asymptomatic.

Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work.

The distance of the keyboard from the edge of a work surface has been associated with hand and arm pain; however, the variation in postural and muscular effects with the horizontal position have not been explicitly explored in previous studies. It was hypothesized that the wrist approaches more of a neutral posture as the keyboard distance from the edge of table increases. In a laboratory setting, 20 adults completed computer tasks using four workstation configurations: with the keyboard at the edge of the work surface (NEAR), 8 cm from the edge and 15 cm from the edge, the latter condition also with a pad that raised the work surface proximal to the keyboard (FWP). Electrogoniometers and an electromagnetic motion analysis system measured wrist and upper arm postures and surface electromyography measured muscle activity of two forearm and two shoulder muscles. Wrist ulnar deviation decreased by 50% (4 degrees ) as the keyboard position moved away from the user. Without a pad, wrist extension increased by 20% (4 degrees ) as the keyboard moved away but when the pad was added, wrist extension did not differ from that in the NEAR configuration. Median values of wrist extensor muscle activity decreased by 4% maximum voluntary contraction for the farthest position with a pad (FWP). The upper arm followed suit: flexion increased while abduction and internal rotation decreased as the keyboard was positioned further away from the edge of the table. In order to achieve neutral postures of the upper extremity, the keyboard position in the horizontal plane has an important role and needs to be considered within the context of workstation designs and interventions.

Polihidramnios secundario a corioangioma placentario / Polyhydramnios due to placental chorioangioma

El corioangioma es el tumor placentario mas frecuente, se presenta en aproximadamente un 1% de las gestaciones. Es un tumor vascular benigno formado por vasos fetales unidos mediante tejido conjuntivo, que se localiza habitualmente en contacto con la placa coriónica o en sus cercanías. El tamaño es muy variable, lo más frecuente es que tengan un diámetro 5 cm. Éstos presentan, en ocasiones, zonas de infarto o trombosis y están asociados con más frecuencia a complicaciones de la gestación como hidramnios, amenaza de parto prematuro o insuficiencia cardíaca fetal. El diagnóstico del corioangioma se realiza fundamentalmente en el segundo o tercer trimestre y se basa en el estudio ecográfico. Se observan imágenes nodulares en la cara fetal de la placenta o en su interior. El estudio Doppler pone de manifiesto la presencia de vascularización en el interior de la masa o en su periferia, aunque este hallazgo no esté siempre presente. El tratamiento de este tumor va desde la simple observación de la evolución hasta las actuaciones más invasivas, como la alcoholización del tumor o la coagulación con láser (AU)

Chorioangioma is the most common tumor of the placenta, occurring in approximately 1% of pregnancies. This entity is a benign vascular tumor composed of fetal vascular elements joined by connective tissue and is usually found in contact with the chorionic plate or surrounding areas. Size is highly variable but chorioangiomas usually have a diameter of less than 4 cm. Larger chorangiomas (5 cm or more) can occur in areas of infarction or thrombosis and are more frequently associated with complications such as polyhydramnios, preterm labor, and fetal congestive heart failure. Diagnosis of chorioangioma is made in the second or third trimester by ultrasound, which shows nodular images in the fetal side of the placenta or the inner placenta. Doppler studies reveal the presence of vascularization inside or on the periphery of the mass, although this finding is not always present. The management of this tumor ranges from close surveillance of the pregnancy to more invasive procedures such as chemosclerosis with absolute alcohol or laser devascularization. We report a case of large chorioangioma with polyhydramnios, diagnosed at 33 weeks of gestation (AU)

Developmental characterization of the fasciated locus and mapping of Arabidopsis candidate genes involved in the control of floral meristem size and carpel number in tomato.

Mutation at the fasciated locus was a key step in the production of extreme fruit size during tomato domestication. To shed light on the nature of these changes, near-isogenic lines were used for a comparative developmental study of fasciated and wild-type tomato plants. The fasciated gene directly affects floral meristem size and is expressed before the earliest stages of flower organogenesis. As a result, mature fruit of fasciated mutants have more carpels (locules) and greater fruit diameter and mass. The discovery that fasciated affects floral meristem size led to a search for candidate genes from Arabidopsis known to be involved in floral meristem development. Putative homologs were identified in a large tomato EST database, verified through phylogenetic analyses, and mapped in tomato; none mapped to the fasciated locus; however, putative homologs of WUS and WIG mapped to the locule number locus on chromosome 2, the second major transition to large tomato fruit, with WUS showing the highest association. In other cases, minor QTLs for floral organ number (lcn2.2) and (stn11.2) co-localized with a CLV1 paralog and with the syntenic region containing the CLV3 gene in Arabidopsis, respectively.

Endometriosis parietal recidivante / Recurring parietal endometriosis

Se presenta el caso de una paciente con antecedente de 2 laparotomías, que presenta a lo largo de varios meses 3 episodios de nódulo doloroso en la pared abdominal, identificados histológicamente tras su exéresis como sucesivas recidivas de una endometriosis parietal. El interés del caso radica en la excepcionalidad de la endometriosis parietal iterativa (AU)

We present the case of a patient with a history of 2 previous laparotomies and 3 episodes of painful nodules on the abdominal wall. Histological identification following their removal was recurrence of parietal endometriosis. The main interest of this case is the extremely low incidence of iterative parietal endometriosis (AU)

Evaluating the genetic basis of multiple-locule fruit in a broad cross section of tomato cultivars.

Lycopersicon esculentum accessions bearing fasciated (multiloculed) fruit were characterized based on their flower organ and locule number phenotypes. Greenhouse and field evaluations indicate that increases in locule number are associated with increases in the number of other floral organs (e.g., sepals, petals, stamens) in all stocks. F1 complementation, F2 segregation analysis, and genetic mapping indicate that at least four loci account for increases in the number of carpels/locules in these stocks. The most significant of these map to the bottoms of chromosomes 2 and 11 and correspond to the locule number and fasciated loci. All stocks tested were fixed for mutations at the fasciated locus, which maps to the 0.5-cM interval between the markers T302 and cLET24J2A and occurs in at least three allelic forms (wild type and two mutants). One of the fasciated mutant alleles is associated with nonfused carpels and repressed recombination and may be due to a small inversion or deletion. The other two loci controlling locule number correspond to the lcn1.1 and lcn2.2 loci located on chromosomes 1 and 2, respectively.