A meta-analysis on uterine transplantation: Redefining the limits of reproductive surgery.

In September 2014, the first baby grown in a transplanted uterus was born, which represented an astonishing scientific progress that will mark the history of human reproduction. The recipient was a 32-year-old woman with Rokytanski syndrome who became pregnant after a successful embryo transfer and had an uneventful pregnancy, giving birth to a healthy newborn and marking the beginning of a new era. Patients who do not have a uterus or have a dysfunctional uterus now have the chance of dreaming with pregnancy and motherhood. Combining principles of solid organ transplantation and techniques of human reproduction, uterus transplantation is the first ephemeral transplant performed in order to promote reproductive potential of women and may be removed after successful pregnancy. Worldwide, 11 uterine transplantations were performed in patients. Of these, seven maintained their reproductive potential, with viable transplanted uteri and regular menstrual cycles.

Selective late sodium current blockade with GS-458967 markedly reduces ischemia-induced atrial and ventricular repolarization alternans and ECG heterogeneity.

BACKGROUND: Ischemic heart disease is associated with dual risk for atrial and ventricular arrhythmias. OBJECTIVE: We examined whether selectively targeting late sodium channel current (INa) with GS-458967 (hereafter GS967) can reduce cardiac electrical instability and compared its effects to a clinically relevant dose of flecainide. METHODS: Electrode catheters were positioned on the left atrial appendage and left ventricle of anesthetized pigs to monitor repolarization alternans and electrocardiographic heterogeneity before and during left circumflex coronary artery stenosis (75% flow reduction) before and after GS967 (0.4 mg/kg, intravenously [IV]) or flecainide (1 mg/kg, IV, bolus over 2 minutes followed by 1 mg/(kg·h), IV, for 1 hour) administration. RESULTS: Left circumflex coronary artery stenosis increased atrial repolarization alternans by 520% (from 9.4 ± 1.2 to 58.3 ± 11.3 µV; P = .029) and T-wave alternans by 1038% (from 30.7 ± 8.2 to 349.3 ± 103.8 µV; P = .049). GS967 prevented ischemia-induced increases in alternans in the left atrium (19.3 ± 5.6 µV vs 58.3 ± 11.3 µV; P = .023) and left ventricle (217.9 ± 95.8 µV vs 349.3 ± 103.8 µV; P < .001) (n = 7). GS967 reduced ischemia-induced increases in depolarization heterogeneity (atrium: from 45% to 28%; ventricle: from 92% to 51%) and repolarization heterogeneity (atrium: 43% to 23%; ventricle: 137% to 91%). GS967 did not alter heart rate, arterial blood pressure, PR and QT intervals, or QRS duration, but it mildly decreased contractility (left ventricular dP/dt) during ischemia, which was consistent with late INa inhibition. Flecainide (n = 7) amplified ischemia-induced increase in atrial and ventricular repolarization alternans, electrocardiographic heterogeneity, and ventricular fibrillation incidence. CONCLUSION: Selective late INa inhibition with GS967 exerts potent protective effects against ischemia-induced depolarization and repolarization abnormalities in both atria and ventricles.

A meta-analysis on uterine transplantation: Redefining the limits of reproductive surgery / Uma metanálise sobre o transplante de útero: redefinindo os limites da cirurgia reprodutiva

SUMMARY In September 2014, the first baby grown in a transplanted uterus was born, which represented an astonishing scientific progress that will mark the history of human reproduction. The recipient was a 32-year-old woman with Rokytanski syndrome who became pregnant after a successful embryo transfer and had an uneventful pregnancy, giving birth to a healthy newborn and marking the beginning of a new era. Patients who do not have a uterus or have a dysfunctional uterus now have the chance of dreaming with pregnancy and motherhood. Combining principles of solid organ transplantation and techniques of human reproduction, uterus transplantation is the first ephemeral transplant performed in order to promote reproductive potential of women and may be removed after successful pregnancy. Worldwide, 11 uterine transplantations were performed in patients. Of these, seven maintained their reproductive potential, with viable transplanted uteri and regular menstrual cycles.

RESUMO Em 2014, nasce o primeiro bebê oriundo de um útero transplantado, um avanço científico que ficará marcado na história da reprodução humana. A paciente, portadora da síndrome de Rokytanski, engravidou após transplante de útero e transferência de embrião. Teve uma gestação sem complicações e deu à luz um recém-nascido saudável, marcando o início de uma nova realidade. Pacientes que não possuem útero ou possuem útero disfuncional agora podem sonhar em ser mães e gestar um filho. Combinando princípios de transplante de órgão sólido e técnicas de reprodução humana, o transplante de útero consiste no primeiro transplante efêmero realizado com o intuito de promover potencial reprodutivo à mulher, podendo ser removido após gestação bem-sucedida. Mundialmente, 11 transplantes de útero foram realizados em humanos. Dentre os casos, sete mantêm potencial reprodutivo, com úteros viáveis e ciclos menstruais regulares.

Aspectos epidemiológicos da fibrilação atrial / Epidemiological aspects of atrial fibrillation

Fibrilação atrial (FA), a arritmia cardíaca mais comum com relevância clínica, é estudada no presente trabalho segundo aspectos epidemiológicos. Foram revisados artigos de 1947 a abril de 2013, buscando “fibrilação atrial” e “epidemiologia”, “rastreamento”, “mortalidade”, “morbidade”, “fatores de risco”, entre outros em base de dados internacional, considerando fator de impacto e língua inglesa. Os resultados foram apresentados em: Perfil Epidemiológico, com prevalência, incidência, fatores de risco e etiologia; Perfil de Morbimortalidade, com comorbidades associadas mais prevalentes e causas e taxas de óbitos e; Perfil de Hospitalização, com características e tempo de internação dos indivíduos portadores da arritmia. Assim, observou-se que: 1. O aumento da expectativa de vida vem acompanhado por maior incidência de FA, com prevalência maior em grupos de idade avançada e em homens; 2. Doenças cardiovasculares são condições associadas que agravam o quadro da arritmia e as taxas de óbito; 3. Houve aumento nos gastos hospitalares e nas internações atribuídos à FA, em discordância com a redução no número total de internações.

Atrial fibrillation (AF) is the most common cardiac arrhythmia clinically relevant. In this project we studied the disease based on epidemiological characteristics. Articles from 1947 to April of 2013 were reviewed, matching “atrial fibrillation” and “epidemiology”, “screening”, “mortality”, “morbidity”, “risk factors” among others in an international database, taking into consideration impact factor and English language. Results are presented as following: Epidemiological Profile, that analyses prevalence and incidence of AF regarding to age, gender, risk factors and etiology; Morbimortality Profile, that investigates the most commonly associated diseases and their multivariate mortality rates; and Hospitalization Profile, that shows hospitalized AF patients’ characteristics and length of stay. Thus, it has been shown that: 1. The increase in life expectancy is accompanied by an increase in AF incidence. The prevalence is significantly higher in men and in older people; 2. Cardiovascular diseases are associated conditions that worsen the AF’ severity and mortality rates; 3. There was an increase in hospital expenses and in hospitalizations assigned to AF, in spite of a decrease in hospitalizations in general.