Although it induces synchronized ovulation, hCG reduces the fertility of Santa Ines ewes submitted to TAI / Embora induza a ovulação sincronizada, hCG reduz a fertilidade de ovelhas Santa Inês submetidas à IATF

The aim of this study was to evaluate hCG treatment on ovarian response and on pregnancy rate using a 9-day oestrus synchronization protocol in Santa Ines ewes. On a random oestrus cycle day, ewes received an intravaginal progesterone device (Primer-PR®, Tecnopec, Brazil). Nine days later (Day 9), 30µg of d-cloprostenol (Prolise®, Syntex, Argentina) and 250IU of eCG (Folligon®, Intervet, Brazil) were administered and the progesterone device was removed. This moment, the ewes were randomly assigned on two groups: Control Group and hCG Group. In the hCG Group, the ewes received 500IU of hCG (Vetecor®, Hertape-Calier, Spain) 24h after device removal. In the Control Group, the ewes did not receive any ovulation inductor. Control and hCG Groups ewes were inseminated 60h and 48h after device removal, respectively. There was no difference between the groups regarding the first ovulatory follicle diameter and the second ovulatory follicle. hCG Group ewes had shorter interval between device removal and ovulation (Control: 79.9±15.4h and hCG: 54.7±4.9h; P=0.001) and more synchronized ovulations. However, the treatment with hCG decreased the pregnancy rate after TAI (P=0,009). In conclusion, hCG administration improves ovulatory synchronisation, but causes a decrease in the pregnancy rate.(AU)

Avaliou-se o tratamento com hCG na resposta ovariana e na taxa de prenhez utilizando protocolo de sincronização do estro de nove dias em ovelhas Santa Inês. As ovelhas receberam um dispositivo intravaginal de progesterona em fase aleatória do ciclo (dia zero= D0). No momento da remoção do dispositivo (D9), as fêmeas receberam 30µg de d-cloprostenol (Prolise®, Syntex, Argentina) e 250UI de eCG (Folligon®, Intervet, Brasil). Nesse momento, as ovelhas foram aleatoriamente distribuídas em dois grupos de tratamento: controle sem indução de ovulação e tratamento com 500UI hCG para indução de ovulação. As ovelhas dos grupos controle e hCG foram inseminadas 60h e 48h após a remoção do dispositivo, respectivamente. Não houve diferença entre os grupos para o diâmetro do primeiro e do segundo folículo pré-ovulatório. As avelhas do grupo hCG apresentaram menor intervalo entre a remoção do dispositivo e a ovulação (grupo controle: 79.9±15.4h e grupo hCG: 54.7±4.9h; P=0.001) e maior sincronização das ovulações. No entanto, o tratamento com hCG diminuiu a taxa de prenhez após a IATF (P=0,009). Conclui-se que, apesar de a administração de hCG aumentar a sincronização da ovulação, reduz a taxa de prenhez.(AU)

Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT): A review of 47 cases.

OBJECTIVE: Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare disease with a poor prognosis. SCCOHT has recently been shown to be associated with SMARCA4 gene mutations as well as molecular and genetic similarities to malignant rhabdoid tumors (MRT). The objective of our study is to describe the clinical characteristics, treatment modalities and outcomes of 47 patients with SCCOHT. METHODS: We performed a retrospective analysis of 47 patients with SCCOHT evaluated at MD Anderson Cancer Center between 1990 and 2014. Medical records were reviewed for demographic information, pathologic findings, treatment regimens and outcomes. RESULTS: Median age at diagnosis was 30 years (range 5-46). All patients underwent surgery with unilateral salpingo-oophorectomy (USO) performed in 26 patients (55%), and hysterectomy with bilateral salpingooophorectomy (BSO) in 21 patients (45%). Sixteen patients (34.0%) had stage I disease, six (12.8%) stage II, 23 (48.9%) stage III, and two patients (4.3%) had stage IV disease. Information on adjuvant treatment was available for 43 patients: 83.3% received chemotherapy alone, 9.5% chemotherapy followed by radiotherapy, 2.4% chemoradiation, and 4.8% did not receive any adjuvant therapy. Median follow-up was 13.2 months (range, 0.1 to 210.7) with a median overall survival of 14.9 months. Multi-agent chemotherapy and radiotherapy were associated with a better prognosis. CONCLUSION: Our findings suggest that aggressive therapy including multi-agent chemotherapy and possibly radiotherapy may extend survival. Further study is needed to improve outcomes in these patients including the adoption of systemic therapies used in MRT as well as the development of novel agents targeting specific mutations.

Context-specific selection of algorithms for recursive feature tracking in endoscopic image using a new methodology.

In minimally invasive surgery, the tracking of deformable tissue is a critical component for image-guided applications. Deformation of the tissue can be recovered by tracking features using tissue surface information (texture, color,...). Recent work in this field has shown success in acquiring tissue motion. However, the performance evaluation of detection and tracking algorithms on such images are still difficult and are not standardized. This is mainly due to the lack of ground truth data on real data. Moreover, in order to avoid supplementary techniques to remove outliers, no quantitative work has been undertaken to evaluate the benefit of a pre-process based on image filtering, which can improve feature tracking robustness. In this paper, we propose a methodology to validate detection and feature tracking algorithms, using a trick based on forward-backward tracking that provides an artificial ground truth data. We describe a clear and complete methodology to evaluate and compare different detection and tracking algorithms. In addition, we extend our framework to propose a strategy to identify the best combinations from a set of detector, tracker and pre-process algorithms, according to the live intra-operative data. Experimental results have been performed on in vivo datasets and show that pre-process can have a strong influence on tracking performance and that our strategy to find the best combinations is relevant for a reasonable computation cost.

Psychosis Incident Cohort Outcome Study (PICOS). A multisite study of clinical, social and biological characteristics, patterns of care and predictors of outcome in first-episode psychosis. Background, methodology and overview of the patient sample.

AIMS: This paper aims at providing an overview of the background, design and initial findings of Psychosis Incident Cohort Outcome Study (PICOS). METHODS: PICOS is a large multi-site population-based study on first-episode psychosis (FEP) patients attending public mental health services in the Veneto region (Italy) over a 3-year period. PICOS has a naturalistic longitudinal design and it includes three different modules addressing, respectively, clinical and social variables, genetics and brain imaging. Its primary aims are to characterize FEP patients in terms of clinical, psychological and social presentation, and to investigate the relative weight of clinical, environmental and biological factors (i.e. genetics and brain structure/functioning) in predicting the outcome of FEP. RESULTS: An in-depth description of the research methodology is given first. Details on recruitment phase and baseline and follow-up evaluations are then provided. Initial findings relating to patients' baseline assessments are also presented. Future planned analyses are outlined. CONCLUSIONS: Both strengths and limitations of PICOS are discussed in the light of issues not addressed in the current literature on FEP. This study aims at making a substantial contribution to research on FEP patients. It is hoped that the research strategies adopted in PICOS will enhance the convergence of methodologies in ongoing and future studies on FEP.

Simulation of pneumoperitoneum for laparoscopic surgery planning.

Laparoscopic surgery planning is usually realized on a preoperative image that does not correspond to the operating room conditions. Indeed, the patient undergoes gas insufflation (pneumoperitoneum) to allow instrument manipulation inside the abdomen. This insufflation moves the skin and the viscera so that their positions do no longer correspond to the preoperative image, reducing the benefit of surgical planning, more particularly for the trocar positioning step. A simulation of the pneumoperitoneum influence would thus improve the realism and the quality of the surgical planning. We present in this paper a method to simulate the movement of skin and viscera due to the pneumoperitoneum. Our method requires a segmented preoperative 3D medical image associated to realistic biomechanical parameters only. The simulation is performed using the SOFA simulation engine. The results were evaluated using computed tomography [CT] images of two pigs, before and after pneumoperitoneum. Results show that our method provides a very realistic estimation of skin, viscera and artery positions with an average error within 1 cm.

Quality characteristics and fertilizing ability of ram sperm subpopulations separated by partition in an aqueous two-phase system.

Centrifugal countercurrent distribution (CCCD) in an aqueous two-phase system (TPS) is a resolute technique revealing sperm heterogeneity and for the estimation of the fertilizing potential of a given semen sample. However, separated sperm subpopulations have never been tested for their fertilizing ability yet. Here, we have compared sperm quality parameters and the fertilizing ability of sperm subpopulations separated by the CCCD process from ram semen samples maintained at 20°C or cooled down to 5°C. Total and progressive sperm motility was evaluated by computer-assisted analysis using a CASA system and membrane integrity was evaluated by flow cytometry by staining with CFDA/PI. The capacitation state, staining with chlortetracycline, and apoptosis-related markers, such as phosphatidylserine (PS) translocation detected with Annexin V, and DNA damage detected by the TUNEL assay, were determined by fluorescence microscopy. Additionally, the fertilizing ability of the fractionated subpopulations was comparative assessed by zona binding assay (ZBA). CCCD analysis revealed that the number of spermatozoa displaying membrane and DNA alterations was higher in samples chilled at 5°C than at 20°C, which can be reflected in the displacement to the left of the CCCD profiles. The spermatozoa located in the central and right chambers (more hydrophobic) presented higher values (P<0.01) of membrane integrity, lower PS translocation (P<0.05) and DNA damage (P<0.001) than those in the left part of the profile, where apoptotic markers were significantly increased and the proportion of viable non-capacitated sperm was reduced. We have developed a new protocol to recover spermatozoa from the CCCD fractions and we proved that these differences were related with the fertilizing ability determined by ZBA, because we found that the number of spermatozoa attached per oocyte was significantly higher for spermatozoa recovered from the central and right chambers, in both types of samples. This is the first time, to our knowledge that sperm recovered from a two-phase partition procedure are used for fertilization assays. These results open up new possibilities for using specific subpopulations of sperm for artificial insemination or in vitro fertilization, not only regarding better sperm quality but also certain characteristics such as subpopulations enriched in spermatozoa bearing X or Y chromosome that we have already isolated or any other feature.

A cost effective simulator for education of ultrasound image interpretation and probe manipulation.

Ultrasonography is the lowest cost no risk medical imaging technique. However, reading an ultrasonographic (US) image as well as performing a good US probe positioning remain difficult tasks. Education in this domain is today performed on patients, thus limiting it to the most common cases. In this paper, we present a cost effective simulator that allows US image practice and realistic probe manipulation from CT data. More precisely, we tackle the issue of providing a realistic interface for the probe manipulation with a basic haptic feedback.

A real-time predictive simulation of abdominal viscera positions during quiet free breathing.

Prediction of abdominal viscera and tumour positions during free breathing is a major challenge from which several medical applications could benefit. For instance, in radiotherapy it would reduce the healthy tissue irradiation. In this paper, we present a new approach to predict real-time abdominal viscera positions during free breathing. Our method needs an abdo-thoracic 3D preoperative CT or MR image, a second one limited to the diaphragmatic area, and a tracking of the patient's skin position. First, a physical analysis of the breathing motion shows it is possible to predict accurately abdominal viscera positions from the skin position and a modelling of the diaphragm motion. Secondly, a quantitative analysis of the skin and organ motion allows us to define the demands our real-time simulation has to fulfill. Then, we present in detail all the necessary steps of our original method to compute a deformation field from data extracted in both 3D preoperative image and skin surface tracking. Finally, experiments carried out with two human data show that our simulation model predicts abdominal viscera positions, such as liver, kidneys or spleen, at 50 Hz with an accuracy within 2-3 mm.

An augmented reality system for liver thermal ablation: design and evaluation on clinical cases.

We present in this paper an augmented reality guidance system for liver thermal ablation in interventional radiology. To show the relevance of our methodology, the system is incrementally evaluated on an abdominal phantom and then on patients in the operating room. The system registers in a common coordinate system a preoperative image of the patient and the position of the needle that the practitioner manipulates. The breathing motion uncertainty is taken into account with a respiratory gating technique: the preoperative image and the guidance step are synchronized on expiratory phases. In order to fulfil the real-time constraints, we have developed and validated algorithms that automatically process and extract feature points. Since the guidance interface is also a major component of the system effectiveness, we validate the overall targeting accuracy on an abdominal phantom. This experiment showed that a practitioner can reach a predefined target with an accuracy of 2mm with an insertion time below one minute. Finally, we propose a passive evaluation protocol of the overall system in the operating room during five interventions on patients. These experiments show that the system can provide a guidance information during expiratory phases with an error below 5mm.

Clinical evaluation of a respiratory gated guidance system for liver punctures.

We have previously proposed a computer guidance system for liver punctures designed for intubated (free breathing) patients. The lack of accuracy reported (1 cm) was mostly due to the breathing motion that was not taken into account. In this paper we modify our system to synchronise the guidance information on the expiratory phases of the patient and present an evaluation on 6 patients of our respiratory gated system. Firstly, we show how a specific choice of patient allows us to rigorously and passively evaluate the system accuracy. Secondly, we demonstrate that our system can provide a guidance information with an error below 5 mm during expiratory phases.

Sentinel lymph node in endometrial cancer.

The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.

Progesterone receptor (PROGINS) polymorphism and the risk of endometrial cancer development.

The progesterone receptor gene (PROGINS) has been identified as a risk modifier for benign and malignant gynecological diseases. The present case-control study is to evaluate the role of the PROGINS polymorphisms, as risk factor, for endometrial cancer development and to investigate the association between these genetics variants and clinical/pathologic variables of endometrial cancer. PROGINS polymorphism was examined in a total of 121 patients with endometrial cancer and 282 population-based control subjects, all located at the same area in São Paulo, SP, Brazil. The genotyping of PROGINS polymorphism was determined by polymerase chain reaction. The frequencies of PROGINS polymorphism T1/T1, T1/T2, and T2/T2 were 82.6%, 14.9%, and 2.5% in the endometrial cancer patients and 78.4%, 21.6%, and 0% in the controls, respectively. The chi(2) test showed a higher incidence of the T2/T2 genotype in the endometrial cancer group subjects, these results were statistically different (P= 0.012). However, due to the fact that there were no women in the control group showing homozygosis for the allele T2, the correct evaluation of odds ratio could not be properly calculated. Regarding the clinical and pathologic findings observed within the group of patients with endometrial cancer, there was significant correlation between T1/T2 genotype and the presence of myoma (P= 0.048). No correlations were observed among the other variables. These data suggest that the PROGINS polymorphism T2/T2 genotype might be associated with an increased risk of endometrial cancer.

Differential gene expression profile reveals overexpression of MAP3K8 in invasive endometrioid carcinoma.

Gene microarray technology is highly effective in screening for differential gene expression and has hence become a popular tool in the molecular investigation of cancer. In the present study, cDNA microarrays containing 2,000 different genes were used to analyze gene expression profiles in ten human postmenopausal endometrioid-paired carcinoma specimens versus corresponding adjacent normal tissue to identify differentially expressed genes. In our study several genes were found differentially expressed. One of them was the MAP3K8, a gene that has never been described to be overexpressed in this kind of malignancy. To validate the differential expression of this gene as well as the membrane array, we performed semiquantitative reverse transcription-PCR analysis. MAP3K8 was found overexpressed in 30% of the endometrial carcinoma samples. To the best of our knowledge this is the first report showing the MAP3K8 oncogene linked to human endometrial carcinoma suggesting that it may be another molecule involved in human endometrial cancer.

A complete augmented reality guidance system for liver punctures: first clinical evaluation.

We provided in an augmented reality guidance system for liver punctures, which has been validated on a static abdominal phantom. In this paper, we report the first in vivo experiments. We developed a strictly passive protocol to directly evaluate our system on patients. We show that the system algorithms work efficiently and we highlight the clinical constraints that we had to overcome (small operative field, weight and sterility of the tracked marker attached to the needle...). Finally, we investigate to what extent breathing motion can be neglected for free breathing patient. Results show that the guiding accuracy, close to 1 cm, is sufficient for large targets only (above 3 cm of diameter) when the breathing motion is neglected. In the near future, we aim at validating our system on smaller targets using a respiratory gating technique.

Histologic studies of the effects of circulating hot saline on the uterus before hysterectomy.

STUDY OBJECTIVE: To evaluate a new device for endometrial ablation. DESIGN: (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: Thirty-two women scheduled for hysterectomy. INTERVENTIONS: Endometrial ablation and hysterectomy. MEASUREMENTS AND MAIN RESULTS: The new device for endometrial ablation was evaluated by studying depth of necrosis after staining for the oxidative enzyme NADH. Uniform endomyometrial necrosis was achieved at a depth of 2 to 4 mm with 90 degrees C saline circulated for 10 minutes. CONCLUSION: The procedure was successful in all patients, and there were no adverse clinical sequelae. (J Am Assoc Gynecol Laparosc 6(3):269-273, 1999)

Evaluation of Hydro ThermAblator for endometrial destruction in patients with menorrhagia.

OBJECTIVE: To describe endometrial destruction with the Hydro ThermAblator. DESIGN: (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: Twenty-six women with uncontrolled menorrhagia. INTERVENTION: Endometrial ablation with saline heated to 90 degrees C and circulated in the uterine cavity for 10 minutes under hysteroscopic control. MEASUREMENTS AND MAIN RESULTS: All patients tolerated the procedure well, all but one was satisfied with the results, and there were no significant side effects or complications. Seventy-seven percent of women were either amenorrheic or hypomenorrheic after 6 months, and 88% were amenorrheic or hypomenorrheic after 1 year, including one patient who was treated a second time; 87.5% were amenorrheic or hypomenorrheic at 18 months. One woman had persistent menorrhagia and was treated by hysterectomy. CONCLUSION: In this study, endometrial ablation was performed successfully with the Hydro ThermAblator in 25 of 26 women. (J Am Assoc Gynecol Laparosc 6(3):275-278, 1999)

Importance of peniscopy, oncologic cytology and histopathology in the diagnosis of penile infection by human papillomavirus.

INTRODUCTION: Male genital infection by human papillomavirus is of particular importance since it is often asymptomatic. The patient generally presents no clinical lesion. Therefore, men represent an important reservoir of virus, playing a special role in the transmission and perpetuation of the disease. PATIENTS AND METHODS: In the present prospective clinical trial study, 190 sex partners of women with genital infection by human papillomavirus, associated or not with cervical intraepithelial neoplasia, were investigated. All patients were unaware of or denied the presence of a genital lesion. RESULTS: Cytologic examination revealed koilocytosis in 9 cases (4.7%) in the urethra and in 3 cases (1.6%) in the corona of the glans and the distal prepuce. Peniscopy with the previous use of 5% acetic acid revealed white lesions in 97.9% of the patients. Toluidine blue stained most of the lesions. At least one fragment revealed koilocytosis in the histopathologic study of 97 cases (51.05%). CONCLUSION: The three methods complement one another, allowing a more precise diagnosis of the infection in men.

[The diagnosis and surgical treatment in the case of 2 rare sites of hydatid cyst in children]. / Diagnostic si tratament chirurgical în cazul a 2 localizari rare de chist hidatic la copil.

In the Clinic of Paediatric surgery of the Hospital "Gr. Alexandrescu" there have been hospitalized and operated 2 cases of hydatic cyst within 1990-1993. The both patients had tumoural structures, one of them being placed on left axillary area (S.E.--11 years old) and the other on the left thigh (M.S.--5 years old). The both patients have been surgically operated, the said tumoural structures being eradicated. The anatomic-pathological examination attested that for the both patients the diagnosis was the hydatic cysts are localized on pulmonary, hepatic or splenic areas, we considered to be interesting to inform you about details of two rare localization of this disease.

Ultra-sonografia seriada do endométrio e da endocérvice durante o ciclo menstrual normal da mulher / Serial ultrasonography of the endometrium and endocervix during the normal menstrual cycle of women

Os relatos ultra-sonográficos do endométrio humano säo, em sua maior parte, obtidos de pacientes com esterilidade conjugal, nulíparas, fazendo uso de drogas indutoras da ovulaçäo. Essas pesquisas, geralmente, näo se acompanham do estudo histológico da cavidade uterina e preocupam-se, sobretudo, com o período ovulatório. Há, contudo, controvérsias na interpretaçäo das imagens. OBJETIVO. Estudas a ultra-sonografia do endométrio, no decorrer do ciclo menstrual normal. MÉTODOS. Os autores selecionaram 15 mulheres, eumenorréicas, multíparas, que näo faziam uso de drogas indutoras da ovulaçäo, DIU ou contra-conceptivos hormonais. todas foram examinadas no primeiro, no sétimo, no décimo-quarto eno vigésimo-primeiro dia do ciclo menstrual. Confrontaram-se os achados ecográficos com os resultados histológicos. RESULTADOS. Avaliaram a imagem ultra-sonográfica do endométrio em 66.66 por cento das mulheres no primeiro dia do ciclo. Em todas elas, no sétimo, décimo-quarto e vigésimo-primeiro dia essa imagem também pôde ser identificada e apreciada. Verificaram, durante o ciclo, aumento progressivo da espessura da imagem endometrial, de forma linear. O halo hipoecóico teveincidência progressiva, atingindo 93,33 por cento no vigésimo-primeiro dia do ciclo. CONCLUSÄO. As alteraçöes cíclicas do endométrio foram demonstradas pela ultra-sonografia. As modificaçöes endocervicais também foram detectadas. Todavia, säo menos exuberantes do que as observadas no endométrio

[Serial ultrasonography of the endometrium and endocervix during the normal menstrual cycle in women]. / Ultra-sonografia seriada do endométrio e da endocérvice durante o ciclo menstrual normal da mulher.

Articles on ultrasound of the human endometrium are in the majority of the cases based on studies of patients who have infertility and are taking drugs to induce ovulation. Such investigations do not include histological study of the endometrium and have focused on the ovulatory period. There is controversy in the interpretation of the images. PURPOSE--To evaluate the sonographic appearance of the endometrium during the normal menstrual cycle. METHODS--We studied 15 multiparous women with normal cycles, and who were not under drugs for ovulation induction, had neither IUD, nor were having oral hormonal contraceptives. They were seen on the first, seventh, fourteenth, and twentieth-first days of the menstrual cycle. The sonographic aspects were compared with the histological findings. RESULTS--We could see the images of the endometrium on the first day of the cycle in 66.66% of the patients. On the other visits we could study properly its features very well in all the patients. The endometrial image thickness increased in a linear pattern and the hypoechogenic halo was seen in 93.33% of the patients on the twentieth-first day of the menstrual cycle. CONCLUSION--The cyclic changes of the endometrium were shown with the sonography. The cyclic changes of the endocervix were evaluated too with the sonogram although they are not as remarkable as the endometrial ones.