Can the microcystic, elongated and fragmented pattern of invasion influence the evaluation of the depth of myometrial invasion in low-grade endometrioid endometrial cancer using imaging techniques?

Objectives: The microcystic, elongated and fragmented pattern of invasion can be associated with an underestimation of the depth of myometrial invasion by imaging techniques. We aimed to evaluate the influence of microcystic, elongated and fragmented pattern of invasion in the diagnostic performance of transvaginal ultrasound scan and magnetic resonance imaging for the prediction of the depth of myometrial invasion in low-grade endometrioid endometrial carcinomas. Methods: Prospective and consecutive study including all low-grade (G1-G2) endometrioid endometrial carcinomas diagnosed between October 2013 and July 2018 in a tertiary hospital. Preoperative staging was performed with transvaginal ultrasound scan and/or magnetic resonance imaging followed by surgical staging. Final histology was considered as the reference standard. Sensitivity, specificity and diagnostic accuracy for the prediction of depth of myometrial invasion was calculated for both imaging techniques. The STARD 2015 guidelines were used. Results: A total of 136 patients were consecutively included. Transvaginal ultrasound scan was performed in 132 patients and magnetic resonance imaging in 119 patients. The diagnostic accuracy of transvaginal ultrasound scan for the prediction of depth of myometrial invasion in the microcystic, elongated and fragmented negative group (82% (95% confidence interval = 73-88)) was higher compared to the microcystic, elongated and fragmented positive group (61% (95% confidence interval = 36-83)). The diagnostic accuracy of magnetic resonance imaging was also higher in the microcystic, elongated and fragmented negative group (80% (95% confidence interval = 71-87)) compared to the microcystic, elongated and fragmented positive (47% (95% confidence interval = 21-73)). Conclusions: In low-grade endometrioid endometrial carcinomas with a positive microcystic, elongated and fragmented pattern of invasion, the evaluation of the depth of myometrial invasion using transvaginal ultrasound scan and magnetic resonance imaging may be underestimated.

The effects of obesity on longitudinal ventricular and atrial strain in a rural population of Spanish children and adolescents, evaluated by a new strain software.

BACKGROUND AND OBJECTIVES: Research on the relationship between body mass index (BMI) and strain values in children and adolescents is limited. Our aim was to analyse the relationship between BMI and strain values of both ventricles and left atrium in children and adolescents. METHODS: Both ventricles and left atrial strain values were compared among different BMI categories in children and adolescents from a town in the South of Spain. RESULTS: Of the 198 subjects, aged 6-17 years, 53% were of normal weight, 26% were overweight and 21% had obesity. Lower absolute values of left ventricular global longitudinal strain (25.9 ± 2.0% vs. 26.9 ± 2.2%, p = 0.002) and right ventricular free wall longitudinal strain (29.5 ± 4.2% vs. 30.8 ± 4.5%, p = 0.04) were found in subjects with obesity and overweight versus subjects with normal weight. A lower right ventricular four-chamber longitudinal strain was also observed in males with obesity and overweight (24.8 ± 3.3% vs. 26.4 ± 3.6%, p = 0.03). Statistically significant negative correlations of BMI were found for all ventricular, but not atrial, strain values in univariate analysis. This association turned non-significant for right ventricular four-chamber longitudinal strain in multivariate analysis. CONCLUSIONS: Utilizing this new strain software, children and adolescents with high BMI were associated with significantly lower values for left and right ventricular free wall longitudinal strain, without impact in left atrial strain.

Preimplantation Developmental Competence of Bovine and Porcine Oocytes Activated by Zinc Chelation.

After sperm-oocyte fusion, intracytoplasmic rises of calcium (Ca) induce the release of zinc (Zn) out of the oocyte (Zn sparks). Both phenomena are known to play an essential role in the oocyte activation process. Our work aimed to explore different protocols for activating bovine and porcine oocytes using the novel zinc chelator 1,10-phenanthroline (PHEN) and to compare developmental rates and quality to bovine IVF and parthenogenetic ionomycin-induced embryos in both species. Different incubation conditions for the zinc chelator were tested, including its combination with ionomycin. Embryo quality was assessed by immunofluorescence of SOX2, SOX17, OCT4, and CDX2 and total cell number at the blastocyst stage. Even though blastocyst development was achieved using a zinc chelator in bovine, bypassing calcium oscillations, developmental rates, and blastocyst quality were compromised compared to embryos generated with sperm-induced or ionomycin calcium rise. On the contrary, zinc chelation is sufficient to trigger oocyte activation in porcine. Additionally, we determined the optimal exposure to PHEN for this species. Zinc chelation and artificial induction of calcium rise combined did not improve developmental competence. Our results contribute to understanding the role of zinc during oocyte activation and preimplantation embryo development across different mammalian species.

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis.

BACKGROUND: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. METHODS: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. RESULTS: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.

Role of obesity and blood pressure in epicardial adipose tissue thickness in children.

BACKGROUND: Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children. METHODS: A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography. RESULTS: EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001). CONCLUSIONS: This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events. IMPACT: Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

Relationship between overweight and obesity and cardiac dimensions and function in a paediatric population.

Obesity in adults is associated with left ventricular hypertrophy, dilatation, and myocardial fibrosis, as well as heart failure and coronary heart disease. These associations have been studied to a lesser extent in the paediatric population. This study aims to investigate the relationship between obesity and cardiac structure and function in the paediatric population. In a southern Spanish village, we selected all inhabitants aged 6-17 years stratifying by age, gender, and educational centres. We performed a complete transthoracic echocardiogram evaluating all the cardiac morphological and functional parameters commonly measured in an echocardiographic study. There were 212 children and adolescents included. Of them, 48.1% were males. The mean age was 10.9 ± 3.0 years. A total of 106 (50%) were normal weight, 57 (26.9%) overweight, and 49 (23.1%) obese. Sex and age were similar in all three groups. Overweight and obesity were associated with larger left ventricular end-diastolic and end-systolic volumes (p < 0.0005), greater left ventricular mass (p < 0.0005), and smaller ejection fraction (p < 0.0005). They were also associated with larger atrial, aortic, and right ventricular size. Lateral and mean E/e' ratios were higher (p = 0.007 and p = 0.01 respectively). Body mass index was independently associated with all cavity size variables as well as left ventricular ejection fraction. CONCLUSION: Childhood obesity is independently associated with larger heart chambers, greater left ventricle mass, and smaller left ventricle ejection fraction. WHAT IS KNOWN: • Childhood obesity is related to the development of cardiovascular risk factors and is considered an epidemic of the twenty-first century; its prevalence is rising. WHAT IS NEW: • Childhood overweight and obesity lead to changes in cardiac structure and function which, although not considered clinically pathological, are significant and a result of obesity, and which behave as unfavourable incipient alterations at an early age.

Preoperative treatment with botulinum toxin A: a tool for giant groin hernia repair? Case report.

<b>Introduction:</b> Giant groin hernia is an unusual disease nowadays and its management can be a challenge for surgeons. The application of botulinum toxin A as a preoperative therapy could decrease the thickness of the lateral wall muscles, increase their length and increase the volume of the abdominal cavity facilitating the surgical repair. Morbidity and mortality due to high intra-abdominal pressure would decrease, allowing a minimal tension closure after reduction of the herniated viscera. <br><b>Case report:</b> We present the repair of two cases of massive inguinal hernia with loss of domain using preoperative abdominal wall injection of botulinum toxin.

Metástasis cerebral de cáncer epitelial de ovario: estudio de un caso / Cerebral metastasis of ovarian epithelial cancer: case study

Caso: mujer de 50 años de edad, diagnosticada y tratada de un carcinoma epitelial de ovario en 1996. Se realizó cirugía citorreductora óptima y quimioterapia adyuvante. Nueve años más tarde, desarrolló una lesión metastásica cerebral tratada con cirugía y radioterapia holocraneal. Cuatro años después del tratamiento sigue sin evidencia de enfermedad. Conclusión: estas pacientes tienen un pronóstico pobre, con estudios que reportan una supervivencia media de 12 meses. Sin embargo, nuestra paciente se mantiene libre de la enfermedad, por lo que en pacientes con metástasis única, la cirugia y la radioterapia son la mejor opción de tratamiento (AU)

Case: 50-year-old woman diagnosed and treated for primary ovarian cancer in 1996. She underwent optimal cytoreductive surgery and adjuvant chemotherapy. Nine years later, she developed brain metastatic lesion, and was treated with both surgery and whole-brain radiotherapy. She is currently 4 years post-treatment of her brain metastases without evidence of disease-free. Conclusion: These patients have a poor prognosis, with studies reporting a mean survival of 12 months. However, the patient in this report remains disease-free since her treatment for metastatic disease. Aggressive surgical and radiation treatment for patients with isolated central nervous system metastases can be a reasonable option in selected patients (AU)

Efecto protector de los análogos de la GnRH sobre la capacidad reproductiva de las mujeres en edad fértil con neoplasia o enfermedad autoinmunitaria tratadas con fármacos citotóxicos. Resultado final de un ensayo clínico fase II / Protective effect of GnRH analogues on the reproductive capacity of women with neoplasia or autoimmune disease who require chemotherapy. Final results of a phase ii clinical trial

Fundamento y objetivo: Para evitar el efecto tóxico quimioterápico se ha propuesto la utilización de análogos agonistas de la GnRH (aGnRH) para inhibir la depleción de folículos ováricos. Existen controversias sobre su eficacia, por lo que se ha realizado un ensayo clínico para valorar el efecto protector de los análogos de la GnRH en mujeres afectadas de cáncer y enfermedades autoinmunitarias tratadas con fármacos citotóxicos. Pacientes y métodos: Ensayo clínico, de fase ii, unicéntrico y abierto. Durante el tratamiento quimioterápico se administraron 5 dosis de análogo antagonista de la GnRH en intervalos de 3 días y/o una dosis mensual de aGnRH. Se realizaron determinaciones hormonales previamente al inicio del tratamiento quimioterápico y al finalizar este. Resultados: La inclusión de las pacientes se concluyó precozmente al introducir como parámetro de evaluación de la reserva ovárica la determinación de hormona antimulleriana (HAM). De las 38 pacientes seguidas, 23 (60,5%, IC95% 43,4-76,0) presentaron valores de AMH por debajo de la normalidad tras la conclusión del tratamiento. Se realizó un análisis intermedio en el que se observó que el 86,6% (IC95% 71,9-95,6) de las pacientes recuperaban el ciclo menstrual, pero estas presentaban una reducción de los niveles de HAM. Conclusión: Aunque la mayoría de las pacientes presentaron recuperación de los ciclos menstruales, la reserva ovárica disminuyó en la mayoría de ellas, por lo que podemos concluir que la administración concomitante al tratamiento quimioterápico de análogos de la GnRH no preserva de la pérdida de la población folicular ovárica (AU)

Background and objective: In order to avoid the toxic effect of chemotherapy, it has been proposed to use GnRH agonist analogues (GnRHa) to inhibit the depletion of ovarian follicles. Nevertheless, there is controversy about its effectiveness. This clinical trial has been conducted with the aim to assess the protective effect of GnRH analogues on the reproductive capacity of women with malignancies or autoimmune diseases, which require chemotherapy. Patients and methods: Open phase ii single-center clinical trial. During chemotherapy, a total of 5 doses of GnRH antagonist analogue at a dose interval of 3 days and/or a monthly dose of GnRHa were administered. Hormonal determinations prior to the start of the CT treatment were conducted during treatment and at the end of it. Results: The inclusion of patients was prematurely concluded when incorporating the determination of anti-Müllerian hormone (AMH) as a parameter for assessing the ovarian reserve. Out of 38 patients, 23 (60.5%, 95%CI 43.4-76.0) had AMH values below normal following completion of treatment. An intermediate analysis was carried out observing that while most patients were recovering the menstrual cycle (86.6% 95%CI 71.9-95.6), they had reduced levels of AMH. Conclusion: Although most patients recovered their menstrual cycles, the ovarian reserve, assessed by the concentration of AMH, decreased in many patients. Therefore, we can conclude that the concomitant treatment of chemotherapy and GnRH analogues does not preserve the loss of follicular ovarian reserve (AU)

[Protective effect of GnRH analogues on the reproductive capacity of women with neoplasia or autoimmune disease who require chemotherapy. Final results of a phase ii clinical trial]. / Efecto protector de los análogos de la GnRH sobre la capacidad reproductiva de las mujeres en edad fértil con neoplasia o enfermedad autoinmunitaria tratadas con fármacos citotóxicos. Resultado final de un ensayo clínico fase II.

BACKGROUND AND OBJECTIVE: In order to avoid the toxic effect of chemotherapy, it has been proposed to use GnRH agonist analogues (GnRHa) to inhibit the depletion of ovarian follicles. Nevertheless, there is controversy about its effectiveness. This clinical trial has been conducted with the aim to assess the protective effect of GnRH analogues on the reproductive capacity of women with malignancies or autoimmune diseases, which require chemotherapy. PATIENTS AND METHODS: Open phase ii single-center clinical trial. During chemotherapy, a total of 5 doses of GnRH antagonist analogue at a dose interval of 3 days and/or a monthly dose of GnRHa were administered. Hormonal determinations prior to the start of the CT treatment were conducted during treatment and at the end of it. RESULTS: The inclusion of patients was prematurely concluded when incorporating the determination of anti-Müllerian hormone (AMH) as a parameter for assessing the ovarian reserve. Out of 38 patients, 23 (60.5%, 95%CI 43.4-76.0) had AMH values below normal following completion of treatment. An intermediate analysis was carried out observing that while most patients were recovering the menstrual cycle (86.6% 95%CI 71.9-95.6), they had reduced levels of AMH. CONCLUSION: Although most patients recovered their menstrual cycles, the ovarian reserve, assessed by the concentration of AMH, decreased in many patients. Therefore, we can conclude that the concomitant treatment of chemotherapy and GnRH analogues does not preserve the loss of follicular ovarian reserve.

Transtelephonic electrocardiography for managing out-of-hospital chest pain emergencies.

BACKGROUND: Some healthcare facilities lack professionals qualified to interpret electrocardiograms. We aimed to assess the usefulness of transtelephonic electrocardiography in combination with patients' clinical histories in the diagnosis and management of patients with acute chest pain in out-of-hospital healthcare facilities with personnel without expertise in cardiology or electrocardiography. METHODS: Data from 506 consecutive patients (53.9 ± 16.2 years old) referred from 55 healthcare facilities without professionals specialized in cardiology or electrocardiography form the basis of analysis. Patients were classified into 2 groups according to the results of transtelephonic electrocardiography: (A) patients without electrocardiographic abnormalities (n = 445) and (B) patients who presented abnormalities suggesting a cardiac origin (n = 61) of the chest pain. The presence of risk factors was evaluated by multivariate analysis. RESULTS: The following risk factors were independent predictors of electrocardiographic abnormalities: male gender (P = .006), diabetes mellitus (P = .0001), and dyslipidemia (P = .001). The multivariate analysis yielded a high degree of specificity (99.6%). Follow-up visits confirmed the noncardiac origin of pain in 432 patients (97%) in group A and the cardiac origin of pain in 59 patients (97%) in group B. CONCLUSIONS: Transtelephonic electrocardiography combined with awareness of the risk factors of patients presenting with chest pain is useful for the diagnostic management of these patients in health care facilities without the means to interpret electrocardiograms.

Prophylactic closure of trocar orifices with an intraperitoneal mesh (ventralex) in laparoscopic bariatric surgery.

Laparoscopic surgery reduces, but not eliminates, the rate of incisional hernia. It is accepted that large trocar orifices should be sutured, in order to prevent future herniation. In morbidly obese patients, the closure of the anterior fascia is a very difficult job, and it does not prevent from preperitoneal herniation. Ventralex composite mesh is a very easy-to-place device, which closes satisfactorily both the peritoneal opening and the subcutaneous trocar pathway. We recommend its use for large diameter orifices and Hasson orifices in bariatric patients.

Melatonin modulates the effects of gastric injury in rats: role of prostaglandins and nitric oxide.

Experimental evidence has been presented connecting melatonin with the prevention or treatment of gastrointestinal disorders either by the scavenging properties of active oxygen or by receptor-mediated stimulation of gene expression of neutralizing enzymes. Prostaglandins and nitric oxide are important neuroimmunomodulators in digestive physiology and different studies have indicated that the protective properties of melatonin may be explained by prostaglandin and/or nitric oxide mechanisms. The aim of the present study was to examine the effect of intraperitoneal administration of melatonin on in vivo changes in PGE(2), generated in gastric mucosal lesions by ischemia-reperfusion. Cyclic GMP nucleotide was also studied as an index of the principal enzymatic activity involved in the metabolism of nitric oxide, the nitric oxide synthase. The different immunological tests showed that the intraperitoneal administration of melatonin prevents the postischemic decrease in prostaglandins. The concentration of this eicosanoid in the rat mucosa treated with 20 mg.kg(-1) of melatonin was significantly higher (p < 0.05) than that in the control rats. The amount of cyclic GMP in the stomach decreased because of ischemia-reperfusion. In treated animals however, a marked increase occurred in concentrations of GMP, but the difference was not statistically significant. The results suggest that the mechanism of protection afforded by melatonin against lesions induced by gastric ischemia-reperfusion may be due to stimulation of the synthesis of eicosanoid protectors during the ischemic process.

Evolución de la hipertensión de bata blanca a hipertensión mantenida. Seguimiento durante un año mediante monitorización ambulatoria de la presión arterial / Evolution of white coat hypertension to sustained hypertension. One year follow-up by ambulatory blood pressure monitoring

FUNDAMENTO: Analizar la evolución de la hipertensión de bata blanca (HBB) a hipertensión mantenida mediante monitorización ambulatoria de la presión arterial (MAPA) durante el primer año tras su diagnóstico. SUJETOS Y MÉTODO: Se diseñó un estudio prospectivo de cohortes en el centro de salud La Orden de Huelva. Se seleccionaron 86 individuos divididos en dos grupos: a) grupo de no expuestos (GNE), compuesto por 43 normotensos voluntarios, y b) grupos expuestos (GE): 43 individuos con HBB, definidos ambos grupos por presiones arteriales clínicas inferiores o superiores, respectivamente, a 140 y/o 90 mmHg y cifras de presión arterial ambulatoria diurna inferiores a 135 y 85 mmHg en ambos casos. Se realizó una MAPA (Spacelabs 90207) al inicio del estudio, a los 6 meses y al año. Se compararon entre ambos grupos las presiones arteriales clínicas y ambulatorias, así como la incidencia de hipertension arterial mantenida por MAPA. Se consideró hipertensión mantenida cuando las cifras diurnas fueron superiores a 135 y/o 85 mmHg para la presión arterial sistólica y diastólica, respectivamente. RESULTADOS: Finalizaron el estudio 82 individuos. La incidencia de hipertensión arterial a los 6 meses de seguimiento fue del 4,76 por ciento (intervalo de confianza [IC]: 0-26,9) en GNE y del 19,04 por ciento (IC, 0-42,6) en el GE (riesgo relativo [RR]: 3,8; IC, 0,86-16,9) (p = 0,052). Al año de seguimiento, la incidencia de hipertensión arterial en el GNE fue del 9,8 por ciento (IC, 0-31,1) frente al 46,3 por ciento (IC, 20,5-72,1) en el GE (RR: 4,63; IC, 1,7-12,4) (p = 0,001). CONCLUSIONES: Los individuos con HBB presentan una incidencia de hipertensión arterial superior a los normotensos al año de seguimiento (AU)