Management and outcomes of obturator hernias: a systematic review and meta-analysis.

PURPOSE: Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. METHODS: PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS: One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. CONCLUSION: Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.

Hyperphosphatemia is associated with cardiac valve calcification in chronic hypoparathyroidism.

PURPOSE: To evaluate the association between metabolic abnormalities and cardiovascular risk factors in patients with chronic hypoparathyroidism (HPP). PATIENTS AND METHODS: Patients 18 years and older, glomerular filtration > 30 mL/min/1.73 m2 and no documented coronary artery disease were selected. Serum calcium, phosphorus, glucose, lipids, PTH, 25(OH)D and FGF23 were measured. Cardiovascular risk was estimated by the European Society of Cardiology (ESC) calculator. Transthoracic echocardiogram and carotid ultrasound were performed to detect carotid plaques (CP), carotid intima-media thickness (IMT), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH). RESULTS: Thirty-seven patients (94.6% female), aged 56.0 ± 13.5 years and HPP duration 7.0 (4.0; 11.3) years, were included. Fifteen were classified as low cardiovascular risk, 9 as intermediate risk, 9 as high risk and none as very high risk. The prevalence of CP, CVC and LVH was 24.3%, 24.3% and 13.5%, respectively. IMT values were within normal ranges in all cohort. FGF23 were not associated with CP, IMT, CVC or LVH. After logistic regression, phosphorus was the only significant metabolic variable impacting CVC in univariate analysis (OR 2.795; 95% CI 1.132-6.905; p = 0.026), as well as in the multivariate analysis (OR 3.572; 95% CI 1.094-11.665; p = 0.035). Analysis by ROC curve showed serum phosphorus > 5.05 mg/dL (AUC 0.748; CI 0.584-0.877; p = 0.05) as the best cutoff point associated with valve heart calcification (sensitivity 78%; negative predictive value 91.3%). CONCLUSION: Hyperphosphatemia was associated with CVC in HPP patients. Further studies are needed to investigate whether the control of hyperphosphatemia may reduce cardiovascular risk in this population.

Prevalence and factors associated with erectile dysfunction in patients with chronic kidney disease on conservative treatment.

Population with chronic kidney disease (CKD) has had many problems, and some of these have arisen from sexual disorders. The present study intends to determine the prevalence and the associated factors with erectile dysfunction (ED) among patients with CKD on conservative treatment (CKDCT). This transversal study was conducted from May 2013 to December 2015. The tools used were: medical records and the International Index of Erectile Function. Data were analyzed by univariate and multivariate logistic regression analysis. Among 245 patients that have participated of this study, ED was present in 71.02% and it was severe in 36.73%. Age greater than 50 years, body mass index lower than 25, diabetes mellitus, stages IV/V of CKD, cardiac conduction disturbances, benign prostatic hyperplasia, smoking, alcohol use, albumin <3.5 g per 100 ml and creatinine clearance between 15 and 29 ml min-1 per 1.73 m2 were associated with ED. Time of CKD was the only variable associated with ED independent of the presence of other factors. ED prevalence in patients with CKDCT is high and it is severe in more than half of them. Several factors are associated with ED in this population but the principal one is the time of CKD.

Exercise training at MLSS decreases weight gain and increases aerobic capacity in obese Zucker rats.

This study aimed to identify the aerobic capacity enhancement and subsequent body weight (BW) status of obese Zucker rats (OZRs) after 4 weeks of treadmill running exercise at the maximal lactate steady state (MLSS). In addition to obese Zucker rats (OZRs), lean Wistar Kyoto rats (WKYs) were used, and both species were divided into control and exercise groups as follows: obese exercise (OZR-EX, n=5), obese control (OZR-CON, n=5), lean exercise (WKY-EX, n=5) and lean control (WKY-CON, n=5). The OZR and WKY exercise groups trained 5 days per week at 12.5 m.min-1 and 20 m.min-1, respectively. After 4 weeks of training, MLSS was ascertained to evaluate the animals' aerobic capacity using 3 different velocities (12.5, 15 and 17.5 m.min-1 for OZRs and 25, 30 and 35 m.min-1 for WKYs). The MLSS of OZR-EX was identified at the velocity of 15 m.min-1, representing a 20% increase in aerobic capacity after the exercise program. The MLSS of WKY-EX was identified at 30 m.min-1 with a 50% increase of in aerobic capacity. Obese animals that exercised showed reduced weight gain compared to the non-exercise obese control group (p <0.05). Our results thus show that exercise training at MLSS intensity increased the aerobic capacity in both obese and non-obese animals and also reduced BW gain.

Identification of a novel subtype of feline immunodeficiency virus in a population of naturally infected felines in the Brazilian Federal District.

The feline immunodeficiency virus (FIV) is a retrovirus that is found worldwide, and it can be assigned to six subtypes (A, B, C, D, E, and a putative subtype F) based on sequencing analysis of the env and gag genes. Subtypes A and B are the most common worldwide. In Brazil, several authors have isolated only subtype B, and its prevalence differs markedly among investigated populations. Blood samples from 200 domestic felines from the Federal District in Brazil were analyzed by PCR. Samples that tested positive for FIV were then cloned, sequenced, and analyzed phylogenetically and statistically. The results represent the first description of FIV infection in the Central Region of Brazil and suggest that only 2 % of felines in this region are positive for the virus. In addition, the analysis showed that one out of the four positive samples that we detected could not be assigned to any of the six classical subtypes. This sample was taken as a putative novel subtype of the FIV virus. The remaining three positive samples were assigned to subtype B, with differences existing among these samples.

Determination of the maximal lactate steady state in obese Zucker rats.

This study aims to identify the maximum lactate steady state (MLSS) in obese rats in order to provide a more effective tool in the exercise training prescription for this important animal model. To make such determination, obese (Zucker, n=5) (390.0±18.8 g) and lean (Wistar, n=5) (227.3±26.2 g) rats were studied. After adaptation of animals to treadmill, the MLSS was determined by using 3 different velocities (10 m.min⁻¹, 12.5 m.min⁻¹ and 15 m.min⁻¹ for Zucker and 15 m.min⁻¹, 20 m.min⁻¹ and 25 m.min⁻¹ for Wistar). The MLSS was defined as the highest blood lactate concentration that increased up to 1 mmol.L⁻¹ during constant exercise. In obese rats, the MLSS was found in a velocity considerably lower than in lean controls (12.5 m.min⁻¹ and 20 m.min⁻¹), respectively (p<0.05). Therefore, the identification of MLSS in obese Zucker rats is an important tool for exercise prescription and evaluation in obese rat models.

Crosstalk between the signaling pathways triggered by angiotensin II and adenosine in the renal proximal tubules: implications for modulation of Na(+)-ATPase activity.

We have previously demonstrated that adenosine (Ado) reverses the stimulatory effect of angiotensin II (Ang II) on Na(+)-ATPase activity via the A(2A) receptor. In this work, the molecular mechanism involved in Ado-induced shutdown in the signaling pathway triggered by 10(-8)M Ang II was investigated. It was observed that: (1) both 10(-12)M PMA (a PKC activator) and 5x10(-8)M U73122 (an inhibitor of PI-PLCbeta) prevent the reversion effect induced by 10(-6)M Ado (only observed in the presence of 10(-6)M DPCPX (an A(1) receptor antagonist)) on Ang II-stimulated Na(+)-ATPase and PKC activities; (2) Ang II-stimulated PKC activity was reversed by 10(-6)M forskolin (an adenylyl cyclase activator) or 10(-8)M PKA inhibitory peptide and 10(-8)M DMPX (an A(2) receptor-selective antagonist). Considering that PMA prevents the inhibitory effect of Ado on Ang II-stimulated Na(+)-ATPase and PKC activities, it is likely that the PMA-induced effect, i.e. PKC activation, is downstream of the target for Ado-induced reversion of Ang II stimulation of Na(+)-ATPase activity. We investigated the hypothesis that PI-PLCbeta could be the target for Ado-induced PKA activation. Our data demonstrate that Ang II-stimulated PI-PLCbeta activity was reversed by Ado or 10(-7)M cAMP; the reversibility of the Ado-induced effect was prevented by either DMPX or PKA inhibitory peptide. These data demonstrate that Ado-induced PKA activation reduces Ang II-induced stimulation of PI-PLCbeta.

PTEN and p53 expression in primary ovarian carcinomas: immunohistochemical study and discussion of pathogenetic mechanisms.

Proapoptotic molecules have been studied in epithelial ovarian neoplasms as possible indicators of the pathogenetic pathways, as targets for new therapeutic approaches, and as prognostic markers. PTEN and p53 are proteins that have many different regulatory functions, including apoptosis. We have studied their immunohistochemical expression in 70 cases of primary ovarian carcinomas (26 serous, 27 endometrioid, and 17 mucinous) and compared the results with morphologic parameters (histologic grade, subtype) and clinical data (age, stage, tumor size). Statistical analyses showed a significantly higher expression of p53 in histologically high-grade tumors (grades 2 and 3), mainly of the serous subtype. A statistical tendency of higher expression of p53 in older patients (P= 0.08) was also observed. The loss of expression of PTEN was significantly more frequent in grade 1 endometrioid adenocarcinomas. These markers did not show association with volume or stage of the tumor. p53 is associated with serous carcinoma, loss of differentiation, and older patients, whereas PTEN inactivation is an early event in carcinogenesis of the endometrioid subtype, as observed in type I endometrial carcinoma. Our results are in keeping with different pathogenetic pathways in subtypes of ovarian carcinoma, prompting the search for new strategies of prevention and treatment.

Adenosine reverses the stimulatory effect of angiotensin II on the renal Na+-ATPase activity through the A2 receptor.

In the present paper, we report the modulation of the Angiotensin II (Ang II)-stimulated Na+-ATPase activity of the proximal tubule basolateral membrane by adenosine (Ado). Preincubation of isolated basolateral membrane with 10(-8)M Ang II increases the Na+-ATPase activity from 7.5+/-0.3 (control) to 14.6+/-0.9 nmol Pi x mg(-1)x min(-1)nmol Pi x mg(-1) x min(-1) (p<0.05). Incubation of Ang II-stimulated enzyme with 10(-6)M Ado, in the presence of the A1 receptor antagonist DPCPX (10(-6)M), completely reverses the Ang II-induced effect bringing the Na+-ATPase activity to the basal level. The following evidences demonstrate involvement of the A2 receptor/Gs protein/adenylyl cyclase/PKA signaling pathway in the inhibitory effect induced by Ado on the Ang II-stimulated Na+-ATPase activity in the presence of the DPCPX: 1) the inhibitory effect of Ado is abolished by the A2 receptor selective antagonist DMPX (10(-8)M); 2) the effect induced by Ado is blocked by 10(-8)M GDPbetaS and mimicked by 10(-9)M cholera toxin and 10(-8)M GTPgammaS; 3) the stimulatory effect of Ang II is reduced by 10(-6)M forskolin, an activator of adenylyl cyclase, or 10(-6)M cAMP; 4) Ado stimulates PKA activity; 5) the inhibitory effect induced by this nucleoside is reversed by the PKA inhibitor peptide.

Expression of p53, c-erbB-2, Ki-67, and CD34 in granulosa cell tumor of the ovary.

The purpose of this study is to investigate the expression of p53, c-erbB-2, Ki-67, and angiogenic activity and their correlation with the clinicopathologic characteristics in a series of granulosa cell tumors of the ovary (GCTO). Eighteen GCTO cases assisted at the Department of Obstetrics and Gynecology, School of Medical Science, UNICAMP, after diagnostic confirmation by three pathologists, were submitted to immunohistochemistry for assessment of p53, c-erbB-2, Ki-67, and CD34 expressions. The mean tumor size was 13 cm (range: 4-30 cm). Six (33%) cases presented with extraovarian disease. Thirteen (72%) cases presented some solid diffuse or sarcomatoid pattern and six (33%) moderate or strong atypia. Fourteen cases presented