Intracellular pH differentially regulates transcription of metabolic and signaling pathways in normal epithelial cells.

Intracellular pH (pHi) dynamics regulate normal cell function, and dysregulated pHi dynamics is an emerging hallmark of cancer (constitutively increased pHi) and neurodegeneration (constitutively decreased pHi). However, the molecular mechanisms by which pHi dynamics regulate cell biology are poorly understood. Here, we discovered that altering pHi in normal human breast epithelial cells triggers global transcriptional changes. We identified 176 genes differentially regulated by pHi, with pHi-dependent genes clustering in signaling and glycolytic pathways. Using various normal epithelial cell models, we showed pH-dependent Notch1 expression, with increased protein abundance at high pHi. This resulted in pH-dependent downstream signaling, with increased Notch1 signaling at high pHi. We also found that high pHi increased the expression of glycolytic enzymes and regulators of pyruvate fate, including lactate dehydrogenase and pyruvate dehydrogenase kinase. These transcriptional changes were sufficient to alter lactate production, with high pHi shifting these normal epithelial cells toward a glycolytic metabolism and increasing lactate production. Thus, pHi dynamics transcriptionally regulate signaling and metabolic pathways in normal epithelial cells. Our data reveal new molecular regulators of pHi-dependent biology and a role for increased pHi in driving the acquisition of cancer-associated signaling and metabolic changes in normal human epithelial cells.

Nonylphenol releases arachidonic acid in rat Sertoli cells via activation of PKA and PLA2.

In brief: The endocrine disruptor, nonylphenol (NP) increases 20:4n-6 release in Sertoli cells via PKA/cPLA2 activation. Our data show that lipid metabolism could be a target of NP-induced abnormal reproductive outcomes. Abstract: Nonylphenol (NP), an endocrine-disrupting chemical, is an environmental contaminant, and many notorious effects on male fertility have been reported in animal models and wild-type species. Here, we evaluated the effects of NP in follicle-stimulating hormone (FSH) signal transduction pathways and lipid metabolism using an in vitro model of rat Sertoli cell (SC) primary culture. Results show that an acute (1 h) SC exposure to NP (10 µM) increased the intra- and extra-cellular concentrations of free fatty acids (FFAs), mainly arachidonic acid (20:4n-6). Phosphatidylinositol seemed to be the major phospholipid source of this 20:4n-6 release by activation of the protein kinase A (PKA)/cytoplasmic phospholipase A2 (cPLA2) pathway. NP also increased diacylglycerols (DAG) levels and the expression (mRNA) of cyclooxygenase 2 (Cox2) and prostaglandin E2 (PGE2) levels. It is noteworthy that accumulation of lipid droplets took place after 24 h NP exposition, which was prevented by both a PKA inhibitor and a PLA2 inhibitor. Like FSH, NP triggers the release of 20:4n-6, which is a substrate for PGE2 synthesis via PKA/PLA2 activation. In addition, NP induces the formation of DAG, which could be required as a cofactor of the PKC-mediated activation of the COX2 inflammatory pathway. Our findings suggest that NP alters lipid homeostasis in SCs by inducing the activation of pro-inflammatory pathways that may trigger adverse effects in testis physiology over time. Concomitantly, the SC enhances the acylation of surplus FFAs (including 20:4n-6) in neutral lipids as a protective mechanism to shield itself from lipotoxicity and pro-inflammatory signals.

Hypothalamic-pituitary-gonadal axis response to photoperiod changes in female guanacos (Lama guanicoe).

The guanaco, a wild South American camelid, is renowned for its remarkable resilience to extreme conditions. Despite this, little is known about how reproductive hormones in female camelids are influenced during their seasonal breeding period, which occurs during long photoperiod. To explore this, the study investigated the response of the hypothalamic-pituitary-gonadal axis in female guanacos during short days (10L:14D; July) and long days (16L:8D; December) in the Mediterranean ecosystem (33°38'28″S, 70°34'27″W). Blood samples from 14 adult animals were collected, and measurements of melatonin, 17ß-estradiol, FSH, and LH concentrations were taken. The results showed that melatonin concentration was lower (P < 0.05) during long days than short days, whereas 17ß-estradiol, FSH, and LH concentrations were higher (P < 0.05) during long days compared to short days. Furthermore, the study detected the expression of the melatonin receptor 1A and kisspeptin in the hypothalamus and pituitary, suggesting that the pineal gland of female guanacos is sensitive to seasonal changes in day length. These findings also indicate a seasonal variation in the concentration of reproductive hormones, likely linked to the distinct modulation of the hypothalamic-pituitary-gonadal axis of female guanacos during short and long days.

Robotic approach to remove four tailgut cyst cases in Brazil: a case series.

Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial.

Importance: General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective: To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants: This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France. Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions: Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures: The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results: Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, -2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance: In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications. Trial Registration: ClinicalTrials.gov Identifier: NCT03229148.

Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry.

BACKGROUND: Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone. METHODS: We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients. RESULTS: Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004). CONCLUSIONS: In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.

Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey.

BACKGROUND: Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS: In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS: All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION: This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.

Histomorphological changes between short and long days in ovary guanacos (Lama guanicoe).

This is the first morpho-histological comparison of guanaco ovaries between reproductive (long-days) and non-reproductive (short-days) seasons, and oestrogen receptor-alpha (ERα) and beta (ERß) detection. Different stages of follicle development were found in the cortical area, but no corpus luteum was detected. The size and frequency of antral follicles and large atretic follicles were higher in long-day ovaries than short-days, consistent with ovarian activity in this season. Differential expression of ERα and ERß was observed in follicles at different stages of development between short and long days. These data reveal histological and molecular differences between reproductive and non-reproductive seasons of guanaco ovaries.

Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results.

BACKGROUND: Patients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice. METHODS: The Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up. RESULTS: Among the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0-2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158). CONCLUSIONS: In tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.

Robotic approach to remove four tailgut cyst cases in Brazil: a case series

ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

Hipoacusia como primera manifestación de granulomatosis con poliangeítis

Introducción: Las vasculitis asociadas a anticuerpos anti citoplasma de neutrófilos (ANCA) son entidades clínicas poco frecuentes con manifestaciones amplias que se asocian a retos diagnósticos. El tratamiento oportuno se asocia a mejoría pronóstica significativa. Caso clínico: Femenina de 45 años que acude con síntomas constitucionales de 2 meses de evolución, asociado en las últimas 2 semanas a hipoacusia progresiva. Se evidencia lesión renal aguda asociada a datos de sedimento urinario activo. El perfil inmune solicitado resultó positivo para ANCA PR-3, y la biopsia renal confirma el diagnóstico de Granulomatosis con Poliangeitis. Se inicia tratamiento inmunosupresor con ciclofosfamida, con poca mejoría de la función renal y requerimiento de hemodiálisis crónica.  La amplia variedad de manifestaciones clínicas asociadas a las vasculitis ANCA conducen a la incapacidad de diagnosticarlas tempranamente y la hipoacusia, aunque descrita, es una manifestación inicial poco frecuente. Conclusión: Las VAA son entidades clínicas poco frecuentes y cuando se presentan con manifestaciones atípicas, suelen ser un reto diagnóstico. Resulta imperativo considerarla en casos de síntomas constitucionales, asociados a manifestaciones renales, otorrinolaringológicas y pulmonares. (provisto por Infomedic International)

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides are rare clinical entities with broad manifestations that are associated with diagnostic challenges. Prompt treatment is associated with significant prognostic improvement. Case report: 45-year-old female presenting with constitutional symptoms of 2 months of evolution, associated in the last 2 weeks with progressive hypoacusis. Acute renal lesion associated with active urinary sediment data was evidenced. The requested immune profile was positive for ANCA PR-3, and the renal biopsy confirmed the diagnosis of Granulomatosis with Polyangiitis. Immunosuppressive treatment with cyclophosphamide was started, with little improvement in renal function and requiring chronic hemodialysis. The wide variety of clinical manifestations associated with ANCA vasculitis lead to the inability to diagnose them early and hypoacusis, although described, is a rare initial manifestation. Conclusion: AAV are rare clinical entities and when they present with atypical manifestations, they are often a diagnostic challenge. It is imperative to consider it in cases of constitutional symptoms, associated with renal, otorhinolaryngologic and pulmonary manifestations. (provided by Infomedic International)

Distractibility, anxiety, irritability, and agitation symptoms are associated with the severity of depressive and manic symptoms in mixed depression

Objective: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. Methods: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. Results: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. Conclusion: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression. Clinical trial registration: ClinicalTrials.gov (NCT04123301).

INCISIONAL HERNIA AFTER BARIATRIC SURGERY: ONLY THE PHYSICAL EXAMINATION IS ENOUGH?

BACKGROUND: Incisional hernia is characterized by a bulging of the abdominal wall caused by the prolapse of intracavitary structures, such as a segment of the small intestine, through the trocar orifice. Ultrasonography and physical examination are used in the diagnosis of incisional hernia. AIMS: This study aimed to evaluate the difference between physical examination and abdominal ultrasonography at the diagnosis of incisional hernia in patients who underwent laparoscopic bariatric surgery. METHODS: A total of 123 patients who underwent Roux-en-Y gastric bypass type bariatric surgery performed by laparoscopy were analyzed for the presence or absence of hernia by physical and ultrasonography examination at each trocar incision site. RESULTS: In our results, a total of 7 hernias were detected by physical examination, while ultrasonography detected a total of 56 hernias in at least one of the incision sites. Lin's concordance analysis showed that the tests are not concordant. The association between body mass index and hernia detection (p=0.04 for physical examination and p=0.052 for ultrasonography) was observed. Ultrasonography detected more incisional hernias in 10-mm or larger trocars than in 5-mm trocars (p<0.0001, p<0.05). No differences were noted among the trocar types that were used. CONCLUSIONS: Abdominal ultrasonography showed to have a higher accuracy than physical examination, resulting in a substantial increase in incisional hernia detection at the trocar sites.

Desempeño del método de suma de discos comparado con el método bidimensional en la estimación cuantitativa del derrame pericárdico / Performance of the method of disks compared to the bidimensional method in the quantitative estimation of pericardial effusion

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

Incisional hernia after bariatric surgery: only the physical examination is enough? / Hérnia incisional após a cirurgia bariátrica: apenas o exame físico é suficiente?

ABSTRACT BACKGROUND: Incisional hernia is characterized by a bulging of the abdominal wall caused by the prolapse of intracavitary structures, such as a segment of the small intestine, through the trocar orifice. Ultrasonography and physical examination are used in the diagnosis of incisional hernia. AIMS: This study aimed to evaluate the difference between physical examination and abdominal ultrasonography at the diagnosis of incisional hernia in patients who underwent laparoscopic bariatric surgery. METHODS: A total of 123 patients who underwent Roux-en-Y gastric bypass type bariatric surgery performed by laparoscopy were analyzed for the presence or absence of hernia by physical and ultrasonography examination at each trocar incision site. RESULTS: In our results, a total of 7 hernias were detected by physical examination, while ultrasonography detected a total of 56 hernias in at least one of the incision sites. Lin's concordance analysis showed that the tests are not concordant. The association between body mass index and hernia detection (p=0.04 for physical examination and p=0.052 for ultrasonography) was observed. Ultrasonography detected more incisional hernias in 10-mm or larger trocars than in 5-mm trocars (p<0.0001, p<0.05). No differences were noted among the trocar types that were used. CONCLUSIONS: Abdominal ultrasonography showed to have a higher accuracy than physical examination, resulting in a substantial increase in incisional hernia detection at the trocar sites.

RESUMO RACIONAL: A hérnia incisional é caracterizada por um abaulamento da parede abdominal causada por um prolapso das estruturas intracavitárias, como um segmento do intestino delgado, através de um orifício de trocarte. A ultrassonografia e o exame físico são usados no diagnóstico da hérnia incisional. OBJETIVOS: Avaliar a diferença entre o exame físico e a ultrassonografia abdominal no diagnóstico da hérnia incisional em pacientes submetidos a cirurgia bariátrica por videolaparoscopia. MÉTODOS: O total de 123 pacientes submetidos à cirurgia bariátrica, tipo derivação gástrica em Y de Roux, foram avaliados para a presença ou ausência de hérnia incisional por exame físico e ultrassonografia, nos sítios incisionais de cada trocarte. RESULTADOS: O total de sete hérnias foram detectados por exame físico, enquanto a ultrassonografia detectou um total de 56 hérnias em pelo menos um sítio incisional. A análise de concordância de Lin mostrou que os testes empregados não são concordantes. A associação entre o Índice de Massa Corpórea e a detecção de hérnia foi observada (p=0.04, para exame físico, p=0.052 para ultrassonografia). A ultrassonografia detectou mais hérnias incisionais em trocartes de 10 mm ou mais do que em trocartes de 5 mm (p<0,0001, p<0.05). Não foi observada diferença entre os tipos de trocartes empregados. CONCLUSÕES: A ultrassonografia abdominal demonstrou ter acurácia mais elevada que o exame físico, resultando em um aumento substancial na detecção de hérnia incisional nos locais de inserção dos trocartes.

De la resistencia a la transformación: una revisión de la resiliencia en el deporte / From Resistance to Transformation: A Review of Resilience in Sports

Resumen Se realizó una revisión de literatura acerca de los aportes investigativos de la resiliencia en el deporte entre los años de 2010 y 2020 en una muestra de 239 artículos que respondieron a criterios de inclusión como: artículos originales, de revisión de literatura, estudios cualitativos, cuantitativos o mixtos publicados; tesis o trabajos de grado y capítulos de libro. La búsqueda se realizó en las bases de datos de PubMed, Ebsco Host, Science Direct, Scopus, PsyINFO. Se encontró que la investigación y aportes de la resiliencia en el deporte son numerosos y aplicados a una gran diversidad de modalidades deportivas y a nivel de actividad física, deporte formativo y competitivo. Se encontraron predominantemente estudios cuantitativo-descriptivos; sin embargo se destacan diversos enfoques metodológicos. Se observó además que los estudios se orientaron hacia las poblaciones de adultos y adolescentes, y un tercer foco de interés son las revisiones de literatura. Los campos en los que se exploró la resiliencia en el deporte se asociaron al desempeño en competencia, afrontamiento de la adversidad, situaciones estresantes, o de burn out, como dimensión motivacional. Se concluye con la necesidad de realizar estudios específicos por práctica deportiva, tipos de deporte y fenómenos psico-sociales relacionados como la influencia de la recuperación de lesiones, estados anímicos y situaciones adversas extradeportivas y extra-competición.

Abstract A literature review was conducted on the research contributions on resilience in sports between 2010 and 2020 in a sample of 239 articles, which responded to inclusion criteria such as original articles; literature reviews; qualitative, quantitative, or mixed published studies; thesis or degree works; and book chapters. The search was carried out in PubMed, Ebsco Host, Science Direct, Scopus, and PsycINFO databases. It was found that research and contributions on resilience in sports are numerous and applied to a great diversity of sports modalities and at the level of physical activity and formative and competitive sports. Quantitative-descriptive studies were predominantly found; however, different methodological approaches are highlighted. It was also observed that the studies were oriented towards adult and adolescent populations, and a third focus of interest is literature reviews. The fields in which resilience in sports was explored were associated with performance in competition, coping with adversity, stressful situations, or burnout, as a motivational dimension. It is concluded that it is necessary to carry out specific studies by sports practice and types of sports, and the related psycho-social phenomena, such as the influence of injury recovery, moods, and adverse extra-sports and extra-competition situations.

Cardiomiopatía hipertrófica apical: revisión de la literatura y presentación de caso / Apical hypertrophic cardiomyopathy: literature review and presentation of case

Resumen La cardiomiopatía hipertrófica apical es una forma poco común de cardiomiopatía hipertrófica que se caracteriza por un compromiso, casi exclusivo, del ápice ventricular izquierdo, y se distingue por la morfología de as de picas en la ventriculografía. La heterogeneidad y la variabilidad en la presentación de esta patología y de su curso clínico hacen que sea un diagnóstico fácilmente omitido. Describimos el caso clínico de un paciente con cardiomiopatía hipertrófica apical que debutó con dolor precordial típico y síncope de origen cardiogénico. El propósito de este reporte es revisar las características principales de una afección poco frecuente, incluyendo su epidemiologia, diagnóstico, pronóstico y tratamiento, y así facilitar al personal médico el momento en que se enfrente a ella en la práctica clínica.

Abstract Apical hypertrophic cardiomyopathy is an uncommon form of hypertrophic cardiomyopathy characterized by a compromise of the left ventricular apex and is distinguished by the ace morphology in the ventriculography. The heterogeneity and variability in the presentation of this pathology and the clinical course, make a diagnosis easily omitted. We describe a clinical case of a patient with apical hypertrophic cardiomyopathy that debuted with precordial pain and syncope of cardiogenic origin. The purpose of this report is to review the main characteristics of a rare pathology, epidemiology, diagnosis, prognosis and treatment and thus, to provide medical personnel with the approach of this pathology in clinical practice.

The effect of marrow secretome and culture environment on the rate of metastatic breast cancer cell migration in two and three dimensions.

Metastasis is responsible for over 90% of cancer-related deaths, and bone is the most common site for breast cancer metastasis. Metastatic breast cancer cells home to trabecular bone, which contains hematopoietic and stromal lineage cells in the marrow. As such, it is crucial to understand whether bone or marrow cells enhance breast cancer cell migration toward the tissue. To this end, we quantified the migration of MDA-MB-231 cells toward human bone in two- and three-dimensional (3D) environments. First, we found that the cancer cells cultured on tissue culture plastic migrated toward intact trabecular bone explants at a higher rate than toward marrow-deficient bone or devitalized bone. Leptin was more abundant in conditioned media from the cocultures with intact explants, while higher levels of IL-1ß, IL-6, and TNFα were detected in cultures with both intact bone and cancer cells. We further verified that the cancer cells migrated into bone marrow using a bioreactor culture system. Finally, we studied migration toward bone in 3D gelatin. Migration speed did not depend on stiffness of this homogeneous gel, but many more dendritic-shaped cancer cells oriented and migrated toward bone in stiffer gels than softer gels, suggesting a coupling between matrix mechanics and chemotactic signals.

Cancer and pH Dynamics: Transcriptional Regulation, Proteostasis, and the Need for New Molecular Tools.

An emerging hallmark of cancer cells is dysregulated pH dynamics. Recent work has suggested that dysregulated intracellular pH (pHi) dynamics enable diverse cancer cellular behaviors at the population level, including cell proliferation, cell migration and metastasis, evasion of apoptosis, and metabolic adaptation. However, the molecular mechanisms driving pH-dependent cancer-associated cell behaviors are largely unknown. In this review article, we explore recent literature suggesting pHi dynamics may play a causative role in regulating or reinforcing tumorigenic transcriptional and proteostatic changes at the molecular level, and discuss outcomes on tumorigenesis and tumor heterogeneity. Most of the data we discuss are population-level analyses; lack of single-cell data is driven by a lack of tools to experimentally change pHi with spatiotemporal control. Data is also sparse on how pHi dynamics play out in complex in vivo microenvironments. To address this need, at the end of this review, we cover recent advances for live-cell pHi measurement at single-cell resolution. We also discuss the essential role for tool development in revealing mechanisms by which pHi dynamics drive tumor initiation, progression, and metastasis.