Author Correction: Low-molecular-weight-heparin increases Th1- and Th17-associated chemokine levels during pregnancy in women with unexplained recurrent pregnancy loss: a randomised controlled trial.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Low-molecular-weight-heparin increases Th1- and Th17-associated chemokine levels during pregnancy in women with unexplained recurrent pregnancy loss: a randomised controlled trial.

Low-molecular-weight heparin (LMWH) is widely used to treat recurrent pregnancy loss (RPL) because of its anti-coagulant effects. Although in vitro studies have suggested additional immunological effects, these are debated. We therefore investigated whether LMWH could modulate immune responses in vivo during pregnancy of women with unexplained RPL. A Swedish open multi-centre randomised controlled trial included 45 women treated with tinzaparin and 42 untreated women. Longitudinally collected plasma samples were obtained at gestational weeks (gw) 6, 18, 28 and 34 and analysed by multiplex bead technology for levels of 11 cytokines and chemokines, chosen to represent inflammation and T-helper subset-associated immunity. Mixed linear models test on LMWH-treated and untreated women showed differences during pregnancy of the Th1-associated chemokines CXCL10 (p = 0.01), CXCL11 (p < 0.001) and the Th17-associated chemokine CCL20 (p = 0.04), while CCL2, CCL17, CCL22, CXCL1, CXCL8, CXCL12, CXCL13 and IL-6 did not differ. Subsequent Student's t-test showed significantly higher plasma levels of CXCL10 and CXCL11 in treated than untreated women at gw 28 and 34. The consistent increase in the two Th1-associated chemokines suggests a potential proinflammatory and unfavourable effect of LMWH treatment during later stages of pregnancy, when Th1 immunity is known to disrupt immunological tolerance.

The ubiquitous hyaluronan: Functionally implicated in the oviduct?

Hyaluronan (hyaluronic acid) is a simple, nonantigenic, nonsulfated glycosaminoglycan present everywhere in the extracellular compartments of the body. Noteworthy, it is highly conserved phylogenetically, from sauropsida to mammals; and plays a plethora of roles from embryonic/fetal development to adult physiological and pathological events, including tumor development. In reproduction, hyaluronan has proven related to initial events as sperm survival, buildup of the sperm reservoir in the oviduct, regulation of sperm capacitation, and prefertilization to later participate in embryo, fetal, and placental development. Synthesis, binding (via the CD44 membrane receptor), and degradation of hyaluronan occur in male and female genital organs, the oviduct being no exception. This review discusses our current knowledge on roles of this ubiquitous glycosaminoglycan on the survival of immunologically foreign spermatozoa in the pig oviduct, a relevant event for fertility. During preovulatory storage in the functional tubal sperm reservoir, spermatozoa are entrapped in a mucus-like tubal fluid. This fluid contains fluctuating levels of hyaluronan, which is synthesized by the lining epithelium by hyaluronan synthase 3. Both hyaluronan and its CD44 receptor are particularly evident in the deep mucosal furrows of the sperm reservoir, in which most spermatozoa are embedded in; kept alive, uncapacitated but also undetected by the immune system of the female. Hyaluronan is also present in the seminal plasma, and evidence points toward an involvement of hyaluronan and its receptor in the local (tubal and possibly uterine) production of antiinflammatory cytokines, such as interleukin-10, pertaining maternal immune tolerance of these foreign cells.

Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis.

Appendicitis is one of the most common and costly acute abdominal states of illnesses. Previous studies suggest two types of appendicitis which may be different entities, one which may resolve spontaneously and another that progresses to gangrene and perforation. Gangrenous appendicitis has a positive association to states of Th1 mediated immunity whereas Th2 associated immune states are associated with lower risk of appendicitis. This study investigated the inflammatory response pattern in patients previously appendicectomized for gangrenous (n = 7), or phlegmonous appendicitis (n = 8) and those with a non-inflamed appendix (n = 5). Peripheral blood mononuclear cells were analysed with ELISPOT analysis for number of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-4, IL-10 and IL-12 secreting cells or with ELISA for concentration of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-5 and IL-10. Spontaneously IL-10 secreting cells/100,000 lymphocytes were increased in the gangrenous group compared to the phlegmonous group (P = 0.015). The median concentration of IL-10 secreted after Tetanus toxoid (TT)-stimulation were higher in the gangrenous group and the control group, than the phlegmonous group (P = 0.048 and P = 0.027, respectively). The median concentration of TT induced IFN-gamma secretion was higher for the gangrenous group compared to both the phlegmonous group and the control group (P = 0.037 and P = 0.003). Individuals with a history of gangrenous appendicitis demonstrated ability to increased IL-10 and IFN-gamma production. The increased IFN-gamma may support the notion of gangrenous appendicitis as an uncontrolled Th1 mediated inflammatory response and increased IL-10 may speculatively indicate the involvement of cytotoxic cells in the progression to perforation.

Trabajo de investigación en psicoprofilaxis quirúrgica pediátrica. Primera experiencia nacional / Research on preoperative pediatric surgical psychoprophylasis. First national experience

Introducción: las ideas que las personas tienen de la cirugía están impregnadas de fantasías con una excesiva carga de ansiedad que impiden un control emocional y recuperación adecuados. La hipótesis del presente trabajo es demostrar que la psicoprofilaxis quirúrgica permite poner en funcionamiento mecanismos defensivos que amortiguan el impacto que implica la cirugía. Objetivo: demostrar el beneficio de la psicoprofilaxis quirúrgica en niños de edad escolar enfrentados a una cirugía de coordinación. Material y métodos: se estudiaron 30 pacientes del Centro Hospitalario Pereira Rossell (CHPR) con edades entre 5 y 12 años divididos en dos grupos de 15 niños: un grupo testigo, que recibió información básica, sin intervención psicológica; y un grupo muestra, que recibió información detallada, con intervención psicológica. El estudio comparativo entre ambos grupos se realizó a través de la valoración psicológica y de la variación de parámetros biológicos. Resultados y conclusiones: la psicoprofilaxis quirúrgica facilitó en este grupo de niños la creación de defensas eficaces permitiendo una conducta adaptativa con un monto de ansiedad que el Yo pudo controlar, disminuyendo el potencial efecto traumático de la vivencia, demostrando ser efectiva para disminuir el impacto psicobiológico y sus efectos deletéreos en la etapa de superación postoperatoria inmediata.

Colestasis neonatal: evolución de los pacientes diagnosticados entre 1983-2000 en dos servicios gastroenterológicos de referencia de Montevideo / Neonatal cholestasis: course of patients diagnosed between 1983 and 2000 in two referential departments of Gastroenterology in Montevideo

Con el objetivo de conocer la evolución de los pacientes con colestasis neonatal en relación a las diferentes etiologías y compararla con la de otros centros, se realizó un estudio descriptivo de los 51 niños con colestasis neonatal diagnosticados en los Servicios de Gastroenterología del Departamento de Especialidades Médico-Quirúrgicas (DEMEQUI) y del Centro Hospitalario Pereira Rossell (CHPR) en el período comprendido entre 1983 y 2000 inclusive. Los resultados pretenden ser un aporte a la planificación de acciones futuras que mejoren la asistencia de estos niños. Los datos se extrajeron de fichas precodificadas, que se habían completado al asistir a los pacientes por primera vez, y de las historias clínicas. En el 2001 los niños fueron citados para una entrevista en la que se realizó anamnesis, examen físico y estudios paraclínicos, registrando los datos en fichas codificadas que se analizaron con Epi Info 6. Se analizaron y describieron las etiologías encontradas así como la evolución clínica y paraclínica. La evolución de los pacientes fue similar a la descrita en otras series excepto en el caso de los niños trasplantados que tuvieron peor evolución y en los casos de hepatitis neonatal que presentaron todos buena evolución, probablemente porque varios fueron hepatitis neonatales transitorias. Se destaca la derivación tardía al tercer nivel de atención. Se propone trabajar este tema en desarrollo profesional médico continuo, lograr mejor seguimiento y apoyo nutricional de los pacientes y conseguir los recursos para organizar un equipo de especialistas pediátricos que asuma el seguimiento de los niños trasplantados, en forma centralizada, en el país, trabajando en coordinación con el equipo del centro de trasplante del exterior mientras esta técnica no se realice en el Uruguay.

Automputación de ovario / Autoamputation of the ovary

La autoamputación de ovario es una patología poco frecuente, cuya etiología habitual, es la torsión intrauterina de la gónada. Se analizara aquí esta patología a propósito de su hallazgo en una niña de 11 años y se discutirá su real incidencia, su génesis y su tratamiento