Clinical Conundrum: Spontaneous Paravaginal Venous Plexus Thrombosis Presenting as Acute Lower Pelvic Pain.

Acute pelvic pain due to venous thrombosis can be encountered in the context of pelvic congestion syndrome. Some vascular anomalies such as nutcracker syndrome or May-Thurner syndrome may cause left ovarian vein or left iliofemoral vein thrombosis. Smaller parametrial or paravaginal vein thrombi have rarely been reported as aetiologies of acute pelvic pain. We present a case of spontaneous paravaginal venous plexus thrombosis presenting as acute lower pelvic pain in which thrombophilia was diagnosed. Small vein thrombosis or an unusual location of thrombus should prompt vascular studies and a thrombophilia work-up.

Epigenetic modulation of Nrf2 and Ogg1 gene expression in testicular germ cells by methyl parathion exposure.

Methyl parathion (Me-Pa) is an oxidizing organophosphate (OP) pesticide that generates reactive oxygen species (ROS) through its biotransformation. Some studies have also suggested that OP pesticides have the capacity to alkylate biomolecules, including DNA. In general, DNA methylation in gene promoters represses transcription. NRF2 is a key transcription factor that regulates the expression of antioxidant, metabolic and detoxifying genes through the antioxidant response element (ARE) situated in promoters of regulated genes. Furthermore, DNA repair genes, including 8-oxoguanine DNA glycosidase (OGG1), have been proposed as NRF2 target genes. Me-Pa exposure produces poor semen quality, genetic and oxidative damage in sperm cells, and reduced fertility. However, the Me-Pa effects on the methylation status and the expression of antioxidant (Nrf2) or DNA repair (Ogg1) genes in male germ cells have not been investigated. Therefore, mice were exposed to Me-Pa to evaluate the global (%5-mC) and specific methylation of Nrf2 and Ogg1 genes using pyrosequencing, gene expression, and total protein carbonylation in male germ cells. The results showed that Me-Pa significantly decreased the global DNA methylation pattern and significantly increased the methylation of two CpG sites within Ogg1 promoter and one CpG site within Nrf2 promoter. In addition, Ogg1 or Nrf2 expression did not change after Me-Pa exposure despite the oxidative damage produced. Altogether, our data suggest that Me-Pa toxicity alters Ogg1 and Nrf2 promoter methylation in male germ cells that may be modulating their gene expression.

3D-printed silicate porous bioceramics using a non-sacrificial preceramic polymer binder.

Silicate bioceramics possess an excellent bioactivity; however, shaping them into complex geometries is still challenging. Therefore, this paper aims to present a new strategy for the shaping of a bioglass-ceramic with controlled geometry and properties starting from a glass powder combined with a preceramic polymer, i.e. a silicon resin, and reactive fillers. The powder-based three-dimensional (3D)-printing of wollastonite (CaSiO3)-based silicate bioceramic parts was demonstrated in this work. The resin plays a dual role, as it not only acts as a non-sacrificial binder for the filler powders in the printing process but it also reacts with the fillers to generate the desired bioceramic phases. The mechanical and physical properties, i.e. ball-on-three-balls test, density, porosity and morphology, were evaluated in 3D-printed discs. These samples possessed a total porosity around 64 vol% and a biaxial flexural strength around 6 MPa. The raw materials used in this work also enabled the 3D-printing of scaffolds possessing a designed multi-scale porosity, suitable bioceramic phase assemblage and a compressive strength of 1 MPa (for cylindrical scaffolds with total porosity ~80 vol%). Solubility in TRIS/HCl and in vitro assays, i.e. viability, cytotoxicity and apoptosis assays, were also performed. In vitro tests indicated good cell viability and no cytotoxicity effect on the cells.

Tumor de Krukenberg del ovario asociado a teratoma maduro / Krukenberg tumor of the ovary associated with mature teratoma

Se reporta un caso excepcional de tumor de Krukenberg ovárico bilateral asociado a teratoma maduro encontrado en una mujer de 54 años. La ecografía mostró al lado derecho tumor ovárico sólido de 55 mm y al lado izquierdo tumor quístico de 125 mm. Se realizó histerectomía total, salpingooforectomía bilateral, resección del epiplón mayor y muestras peritoneales. Al tercer día postcirugía, la paciente presentó signos de tromboembolismo pulmonar masivo y aunque recibió terapia anticoagulante falleció al quinto día postoperatorio. El estudio histológico mostró infiltración masiva de carcinoma de células en anillo positivas para citoqueratina en ambos ovarios. El ovario derecho mostró la forma sólida clásica del tumor de Krukenberg mientras que el ovario izquierdo correspondió a un quiste dermoide con infiltración tumoral de carcinoma de células en anillo en la pared.

An exceptional case of bilateral Krukenberg tumor of the ovary associated with mature teratoma presented in a 54 years old patient is reported. The ultrasound showed a 55 mm solid right ovarian tumor and a 125 mm left cystic ovarian tumor. Hysterectomy and bilateral salpingoophorectomy was performed including omental resection and peritoneal biopsies. Massive pulmonary embolism was detected in the third day after the surgery. Even anticoagulant therapy was established the patient died in the fifth postoperative day. The histological study revealed massive infiltration of signet ring cell carcinoma with positive expression for cytokeratin in both ovaries. The right ovary showed the classical solid form of the tumor. The left ovary was a dermoid cyst with signet ring cell carcinoma infiltrating the cystic wall.

Methamidophos alters sperm function and DNA at different stages of spermatogenesis in mice.

Methamidophos (MET) is a highly toxic organophosphate (OP) pesticide that is widely used in developing countries. MET has male reproductive effects, including decreased fertility. We evaluated MET effects on sperm quality, fertilization and DNA integrity, exploring the sensitivity of different stages of spermatogenesis. Adult male mice received MET (3.75 or 5mg/kg-bw/ip/day/4 days) and were euthanized 1, 28 or 45 days post-treatment (dpt) to evaluate MET's effects on epididymal maturation, meiosis or mitosis, respectively. Spermatozoa were obtained from the cauda epididymis-vas deferens and were evaluated for sperm quality, acrosome reaction (AR; Coomassie staining), mitochondrial membrane potential (by JC-1), DNA damage (comet assay), oxidative damage (malondialdehyde (MDA) production), in vitro fertilization and protein phosphorylation (immunodetection), and erythrocyte acetylcholinesterase (AChE) activity. At 1-dpt, MET inhibited AChE (43-57%) and increased abnormal cells (6%). While at 28- and 45-dpt, sperm motility and viability were significantly reduced with an increasing MET dose, and abnormal morphology increased at 5mg/kg/day/4 days. MDA and mitochondrial activity were not affected at any dose or time. DNA damage (OTM and %DNA) was observed at 5mg/kg/day/4 days in a time-dependent manner, whereas both parameters were altered in cells from mice exposed to 3.75 mg/kg/day/4 days only at 28-dpt. Depending on the time of collection, initial-, spontaneous- and induced-AR were altered at 5mg/kg/day/4 days, and the fertilization capacity also decreased. Sperm phosphorylation (at serine and tyrosine residues) was observed at all time points. Data suggest that meiosis and mitosis are the more sensitive stages of spermatogenesis for MET reproductive toxicity compared to epididymal maturation.

Longitudinal evaluation using FP-CIT in patients with parkinsonism.

OBJECTIVE: To assess a group of patients with parkinsonism using serial studies with FP-CIT, basically the initial false negative results. METHODS: Restrospective study of 92 patients (55 men and 37 women) who had undergone 2 different FP-CIT studies because of discrepancies between study results and clinical progression. The mean elapsed time between the studies was 26 months (SD: 6). We performed a semi-quantitative study using the patient's clinical history and the available literature to analyse discrepant cases with a normal initial study and subsequent pathological findings. RESULTS: A total of 184 studies were completed for 92 patients; 11 of those 92 showed discrepancies between initial and subsequent studies. Among the 11 discrepant cases, 7 showed a normal initial study and pathological findings at a later date. Analysis of the predominant clinical features that might explain this behaviour revealed that 4 of these 7 subjects presented tremor-dominant parkinsonism. Regarding the rest, 1 presented early stage parkinsonism and was treated with antidopaminergic agents; 1 was classified as probable multisystem atrophy type C, and the third showed clinical signs of atypical parkinsonism without any causes of those signs being identified. CONCLUSIONS: Serial FP-CIT studies are unnecessary in the large majority of cases, but they may be justifiable in certain clinical situations.

Quality of life and predictive factors in patients undergoing assisted reproduction techniques.

OBJECTIVES: To evaluate the quality of life (QOL) of a cohort of women undergoing assisted reproduction techniques (ART), to compare two QOL questionnaires [Short Form 36 (SF36) and FertiQoL], and to identify the predictive factors related to QOL. STUDY DESIGN: Women who received infertility medication from a hospital pharmacist during a one-year period were included in this study. Two standardized validated questionnaires - FertiQoL and SF36 - were used. Multivariate analyses were used to assess predictive factors for QOL. RESULTS: Sixty-one women participated in this study. Median QOL scores ranged from 58 to 100. Comparisons between the two questionnaires revealed lower QOL scores when using FertiQoL. Most correlations between the questionnaires were positive, and significant for the majority of SF36 mental dimensions. The major predictors of QOL were: accompanied to the pharmacist's visit by partner, nationality, ART (in vitro fertilization or artificial insemination), employment status (employed or unemployed), tobacco consumption, age, number of cycles, infertility factor and treatment results (pregnancy, no pregnancy or treatment cancellation). CONCLUSIONS: FertiQoL examines dimensions such as partner and social relationships. As such, it is recommended that FertiQoL should be used together with a short version of SF36 to investigate QOL among patients undergoing ART.

Bulk physicochemical, interconnectivity, and mechanical properties of calcium phosphate cements-fibrin glue composites for bone substitute applications.

Calcium phosphate cements (CPCs) and fibrin glue (FG) are used for surgical applications. Their combination is promising to create bone substitutes able to promote cell attachment and bone remodeling. This study proposes a novel approach to create CPC-FG composites by simultaneous CPC setting and FG fibrinogenesis. CPC-FG composites were obtained by mixing CPC powders, i.e. α-tricalcium phosphate, dicalcium phosphate anhydrous and precipitated hydroxyapatite, with FG powder components, i.e. fibrinogen and thrombin, and a 2% Na(2) HPO(4) solution. To study the effect of FG quantity and fibrinogenesis kinetics, long and fast setting FGs were evaluated in amounts of 0.125, 0.250, and 0.500 mL on CPC-FG composites. Physicochemical, interconnectivity, and mechanical properties were measured. Scanning electron microscopy, Micro-computed tomography (µ-CT), X-ray diffraction, and Fourier transform Infrared spectroscopy (FTIR) analyzed morphology, structure, crystallographic, and chemical composition, respectively. FG fibrinogenesis was performed within the CPC. FTIR confirmed this and its interfacial bonding with CPC. µ-CT confirmed a good FG distribution. FG addition affected the CPC when compared with pristine CPC. Adding FG to CPC changed their morphology, density, porosity, setting, cohesion, injectability, interconnectivity, crystallographic and chemical composition and mechanical properties. Moreover, 0.500 mL of long setting FG modified the observed fracture behavior of the CPC-FG.

Metástasis de carcinoma de células en anillo de sello al cuello uterino / Metastasis of signet-ring cell carcinoma of the cervix

Las metástasis de carcinomas extragenitales al útero es rara y el compromiso al cuello uterino es excepcional, especialmente del tipo histológico de carcinoma de células en anillo de sello. Se presentan tres casos encontrados en 240 adenocarcinomas cervicales (1,25 por ciento) diagnosticados entre 1979-2012. Dos casos se presentaron en pacientes de 48 y 56 años originados en carcinomas lobulillares infiltrantes de la mama diagnosticados previamente. La primera paciente está viva a 19 meses del diagnóstico ginecológico y la segunda falleció a los 14 meses, siendo en ambas un hallazgo histológico incidental en cirugías realizadas por patología ginecológica benigna. El tercer caso se presentó en una paciente de 43 años que debutó por metrorragia y tumor cervical y fue originado en un carcinoma gástrico infiltrante difuso, encontrado en forma sincrónica y fallece a los 2 meses del diagnóstico. Se revisan los criterios diagnósticos entre metástasis y carcinoma primario de células en anillo de sello del cuello uterino y el aporte al diagnóstico de la histología convencional, la inmunohistoquímica y la tipificación molecular de HPV. Conclusión: Se concluye que la metástasis de carcinoma de células en anillo al cuello uterino es rara y el pronóstico es malo. La citoreducción y la quimioterapia podría tener un rol para casos seleccionados de carcinomas metastásicos de origen mamario y que estos casos no deberían ser considerados un evento preterminal.

The uterine metastatic involving of extragenital carcinomas is rare, especially the signetring cell type. Three of such a cases were found in 240 cases of adenocarcinomas of uterine cervix (1.25 percent) diagnosed between 1979-2012. Two of these cases occurred in patients aged 48 and 56 years with infiltrating lobular carcinomas arising in the breast previously diagnosed. The first patient is alive at 19 months after diagnosis and the second is deceased at 14 months after diagnosis. In both cases, the metastasis to the cervix was an incidental histological finding in surgeries performed by benign gynecological pathology. The third case was identified in a 43-years old patient who debuted with metrorrhagia and cervical tumor which was originated in a diffuse infiltrating gastric carcinoma that was found synchronously and she is dead at 2 months after diagnosis. The diagnostic criteria between metastases and primary cervix carcinoma of signet ring cells and the contribution to the diagnosis of conventional histology, immunohistochemistry and molecular typing of HPV are reviewed. The metastasis of signet ring cell carcinoma to the uterine cervix is rare and the survival is poor. Conclusion: The role of cytoreduction and chemotherapy for selected cases of metastasis from breast carcinomas should be considered and in such a case the gynecological involvement should not be considered a preterminal event.

Hipoacusia en el diabético: prevalencia y correlación con daño de otros órganos blanco / Hearing impairment in diabetes

INTRODUCCIÓN Se desconoce la prevalencia de la hipoacusia en los pacientes diabéticos. OBJETIVOS Describir la prevalencia de hipoacusia en pacientes con diabetes tipo 2 y correlacionar el hallazgo con otros marcadores de daño de órgano blanco (microangiopatía renal y retiniana). MÉTODOS Se realizó un estudio observacional. Se incluyó a pacientes menores de 60 años con diabetes tipo 2 de más de 5 años de diagnóstico. A todos los pacientes se les realizó un test audiométrico y una logoaudiometría. Además, se evaluó por laboratorio hemograma, glucemia, HbA1c, creatinina, aclaramiento de creatinina según fórmula MDRD, proteinuria y perfil lipídico. Se midió presión arterial, cintura e índice de masa corporal. A todos los participantes se les realizó un fondo de ojo. RESULTADOS Se incluyó a 52 pacientes. La edad promedio fue 52,6±7,8 años con 10,1±5,3 años de enfermedad diabética. Un solo paciente tuvo audiometría normal. Del resto, el 60% presentó hipoacusia para tonos agudos, y un 30% para todos los tonos. No hubo diferencias significativas al comparar los distintos tipos de hipoacusia con años de diabetes, valor de colesterol, presión arterial, edad, IT/B, IMC, ni grado de control de la diabetes. La correlación entre retinopatía-hipoacusia y nefropatía- hipoacusia fue escasa. DISCUSIÓN La hipoacusia en el diabético es una patología frecuente y está subdiagnosticada. En este estudio se encontraron audiometrías alteradas en el 96% de los pacientes y, aunque no hubo diferencias significativas con los datos basales, se halló una escasa correlación con nefropatía y retinopatía diabética. En vista de estos hallazgos, puede observarse que la hipoacusia en el paciente diabético es frecuente y que su daño podría producirse de manera precoz, si se compara con otro tipo de daño microvascular.

Bulk properties and bioactivity assessment of porous polymethylmethacrylate cement loaded with calcium phosphates under simulated physiological conditions.

Polymethylmethacrylate (PMMA) cements are widely used in spinal surgery. Nevertheless, these types of cements present some documented drawbacks. Therefore, efforts have been made to improve the properties and biological performance of solid PMMA. A porous structure would seem to be advantageous for anchoring purposes. This work studied the bulk physicochemical, mechanical and interconnectivity properties of porous PMMA cements loaded with various amounts of calcium phosphate (CaP). As a measure of bioactivity, changes of PMMA cements under simulated physiological conditions were studied in a calcium phosphate solution for 0, 3, 7, 14, 21 and 28 days. Scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), micro-computed tomography (µ-CT) and mechanical compression tests were performed to characterize the morphology, crystallographic and chemical composition, interconnectivity and mechanical properties, respectively. SEM allowed observing the result of loading CaP into the porous PMMA, which was corroborated by XRD, FTIR and µ-CT. No interference of the CaP with the PMMA was detected. µ-CT described similar interconnectivity and pore distribution for all CaP percentages. Mechanical properties were not significantly altered by the CaP percentages or the immersion time. Hence, porous PMMA was effectively loaded with CaP, which provided the material with properties for potential osteoconductivity.

Citrus Responses to Xylella fastidiosa Infection.

The xylem-limited bacterium Xylella fastidosa causes the widely disseminated citrus variegated chlorosis disease (CVC). In Brazil, CVC has been known for more than 20 years and affects only sweet orange. Lime and mandarin have remained free of symptoms despite the high inoculum pressure. Knowing the mechanisms underlying this apparent resistance is important to devise new disease control strategies. The reaction of commercial sweet orange ('Caipira', 'Natal', 'Pêra', and 'Valencia'), lime (Mexican and Persian), mandarin ('Cleopatra', 'Cravo', 'Ponkan', and 'Sunki'), and the acid citrus species Rangpur to X. fastidiosa was compared in artificially inoculated seedlings, which were assessed for symptom expression, pathogen isolation, and the amount of apparently occluded xylem vessels in cross-sectioned leaf petioles. Only the sweet orange expressed typical CVC symptoms, varying from 53.8% in Valencia to 63.0% in Caipira. Average percentages of positive isolations (pi) and occluded vessels (ov) were higher in sweet orange (pi= 59.2 to 75.0; ov = 10.7 to 25.8) than mandarin (pi = 2.3 to 16.3; ov = 1.4 to 4.0), lime (pi = 0 to 5.4; ov = 0 to 2.1), or Rangpur (pi = 1,9; ov = 1.1). There were no obvious differences in xylem anatomy among all citrus varieties, suggesting that the mechanisms of resistance to CVC are not related to any physical variation in xylem structure.

El trasplante de astrocitos encapsulados mejoran el déficit motor en la habilidad manual producido por la lesión de la corteza frontal en ratas adultas / Transplant of encapsulated astrocyte ameliorate lesion-induced motor deficits in adults rats with frontal cortex injury

Objetivo: Investigar la capacidad de trasplantes de astrocitos encapsulados en esferas de alginato de recuperar el déficit en la habilidad manual producida por la lesión de la corteza frontal, en ratas adultas. Material y metodología: Se utilizaron ratas Wistar, y se emplearon pruebas conductuales, cultivos celulares, técnica de encapsulación de células y trasplantes. Los animales se condicionaron en un test de habilidad motora fina y se determinó su mano preferente. Se lesionó la corteza frontal contralateral a la mano preferente y se evaluó la efectividad de la lesión mediante el test de conducta. En un grupo de animales lesionados se trasplantó astrocitos encapsulados en esferas de alginato en la cavidad producida por la lesión; en un segundo grupo, se trasplantó tejido cortical fetal; y en un tercer grupo, se implantó esferas de alginato sin células. Resultados: A los tres meses post-trasplante, tanto los animales con trasplantes de astrocitos encapsulados como con trasplantes de tejido cortical mejoraron el déficit motor inducido por la lesión. Los animales con trasplantes de esferas de alginato vacías no experimentaron mejoría. Conclusión: Los trasplantes de astrocitos encapsulados mejoran, a largo plazo, el deficit motor. El alginato indujo efectos secundarios en el huésped (AU)

Objetive: To investigate whether transplants of encapsulated astrocytes in alginate spheres were able to recover the deficit in motor skills produced by frontal cortex lesion, in adult rats. Material and method: Male Wistar rats were used. Behavioral test, tissue culture, astrocyte transplants and immunocytochemical and histological techniques were applied. Animals were conditioned in a paw reaching for food task and the preferred paw determine. Lesion was produced in the frontal cortex contralateral to the preferred paw and the effectiveness of the lesion tested. In one group of lesion animals, encapsulated astrocytes in alginate spheres were implanted in the lesion cavity; in a second group, fetal cortical tissue was used as donor material; while in a third group empty alginate spheres were implanted. Results: Three months after grafting, the rats with encapsulated astrocyte or with fetal cortical tissue transplants ameliorated the lesion-induced motor deficit.The rats with implant of empty alginate spheres showed no improvement. Conclusion: Transplants of encapsulated astrocytes in alginate spheres induce a long- term improvement of motor lesion deficits. The alginate induced long-term side effects on the host (AU)

Sí­ndrome de cabeza cada asociado a distonía craneofacial / Dropped head syndrome associated to craniofacial dystonia

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The effect of ball milling grinding pathways on the bulk and reactivity properties of calcium phosphate cements.

Calcium phosphate cements (CPCs) are significant alternatives to autologous bone grafting. CPCs can be composed of biphasic or multiphase calcium phosphate (CaP) compounds. A common way to process CPCs is by ball milling. Ball milling can be used for grinding or mechanosynthesis. The aim of this study was to determine the effect of well-defined ball milling grinding parameters, applied via different milling pathways, on the properties of CPCs. Starting CaP compounds used included α-tricalcium phosphate, dicalcium phosphate anhydrous and precipitated hydroxyapatite. Scanning electron microscopy showed changes in the powder morphology, which were related to the behavior of the starting CaP materials. Specific surface area (SSA) and particle size (PS) measurements exposed the effect of ball milling on the CaP compounds and CPC powders. X-ray diffraction revealed no effect of ball milling pathways or milling time on the composition of CPCs or the starting materials, but affected their crystallographic properties. No contamination of the milling media or transformation into an amorphous calcium phosphate compound was found. The milling pathways affected setting and cohesion. Fourier transform infrared spectroscopy (FTIR) revealed differences on the CPC v4-PO4³â» bands according to the interaction, created between the CaP compounds by the milling pathways. FTIR confirmed that the milling pathways changed the crystallographic properties. This study demonstrates that the pathways used for milling grinding modify the PS, SSA, and crystallographic properties of the powders, without affecting their composition. These modifications affected the bulk and reactivity properties of the CPCs by creating different setting and cohesion behaviors.