Prostate cancer brachytherapy: SFRO guidelines 2021.

Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

Maternal melatonin effects on clock gene expression in a nonhuman primate fetus.

In the adult mammal the circadian system, which allows predictive adaptation to daily environmental changes, comprises peripheral oscillators in most tissues, commanded by the suprachiasmatic nucleus (SCN) of the hypothalamus. The external environment of the fetus is provided by its mother. In primates, maternal melatonin is a candidate to entrain fetal circadian rhythms, including the SCN rhythms of metabolic activity. We found in the 90% of gestation capuchin monkey fetus expression of the clock genes Bmal-1, Per-2, Cry-2, and Clock in the SCN, adrenal, pituitary, brown fat, and pineal. Bmal-1, Per-2, and the melatonin 1 receptor (MT1) showed a robust oscillatory expression in SCN and adrenal gland, whereas a circadian rhythm of dehydroepiandrosterone sulphate was found in plasma. Maternal melatonin suppression changed the expression of Bmal-1, Per-2, and MT1 in the fetal SCN. These effects were reversed by maternal melatonin replacement. In contrast, neither maternal melatonin suppression nor its replacement had effects on the expression of Per-2 and Bmal-1 or MT1 in the fetal adrenal gland or the circadian rhythm of fetal plasma dehydroepiandrosterone sulphate. Our data suggest that maternal melatonin is a Zeitgeber for the fetal SCN but probably not for the adrenal gland.

Arousal and differential Fos expression in histaminergic neurons of the ascending arousal system during a feeding-related motivated behaviour.

Arousal depends on the concerted activity of the ascending arousal system (AAS) but specific stimuli may primarily activate some nuclei of this system. Motivated behaviours are characterized by behavioural arousal, although it is not known which AAS nuclei are active during a motivated behaviour. To address this issue, rats were rendered motivated for food by fasting them for 1 day and then were enticed with food that they could not obtain for varying periods of time. We studied the level of arousal by polysomnography or radiotelemetry, and Fos-ir in the AAS, during food enticing. We found a strong arousal and an early increase in Fos-ir in the histaminergic neurons from the tuberomammillary nucleus, after 30 min of enticing, followed by increased Fos-ir in the whole AAS if food enticing was prolonged to 1 or 2 hours. In contrast, food presentation to non-motivated rats did not increase arousal or Fos-ir in the tuberomammillary nucleus. As opposed to the active arousal of the motivated rats, passive arousal induced by sensory stimulation was associated with increased Fos-ir in the locus coeruleus and the orexin neurons, but not with increased Fos-ir in the tuberomammillary nucleus or in the other nuclei of the AAS. We conclude that the arousal during feeding-related motivated behaviour is associated primarily with the activation of the tuberomammillary nucleus, while the other arousal-related nuclei become active later on.

[Screening for glaucoma in diabetic patients by using the Schiörtz tonometer]. / Cribado del glaucoma en pacientes diabéticos mediante el tonómetro de Schiörtz.

OBJECTIVES: To assess the usefulness of measuring in primary care the intraocular pressure (IOP) of diabetics as a glaucoma screening test, validating the Schiörtz tonometer for this end. To analyse the prevalence of glaucoma and associated risk factors in our diabetic population. DESIGN: An observational crossover study. SETTING: Primary Care. Concentaina Health Centre. PATIENTS: 144 patients in our centre's diabetes mellitus health programme. MEASUREMENTS AND MAIN RESULTS: There were 31 cases of IOP over 20 mmHg measured with the Schiörtz tonometer, on whom the ophthalmologist repeated the measurement with the Perkins tonometer, i.e. viewing the back of the eye to confirm the existence of papillary cupping consistent with the presence of Glaucoma. We chose a group with normal IOP, homogeneous with the group with high IOP to validate the Schiörtz tonometer, using as confirmation the results obtained by the ophthalmologist with the Perkins tonometer; and as confirmation in the detection of glaucoma, finding papillary excavation in the binocular ophthalmoscopy. Prevalence of glaucoma was 11%, which was 75% in the newly diagnosed cases. The positive predictive value of the Schiörtz tonometer in detecting increases in IOP was 87.1%, and with respect to the detection of glaucoma, it was 35.5%. CONCLUSIONS: The high prevalence of glaucoma in diabetic patients justifies the systematic study of this risk factor. The Schiörtz tonometer is a useful and valid method, that can be used in primary care for glaucoma screening in this population group.

Neuroendocrine mechanisms of lactational infertility in women.

The current knowledge on the mechanisms of lactational infertility, discussed during a symposium of investigators in this subject, is reviewed. Three periods of lactation are examined: the first weeks postpartum, the period of extended lactational amenorrhea and the recovery of ovarian function. In the first postpartum weeks the inhibition of ovarian function is accounted by diminished pituitary response to GnRH, since exogenous GnRH fails to elicit a LH increase. Suckling can extend the period of ovarian inhibition for weeks, months or years, although it does not fully suppress pulsatile secretion of LH beyond the first weeks. Extended lactational amenorrhea is associated with low LH plasma levels, a great PRL increase in response to suckling, low basal E2 levels and a suppression of estrogen positive feedback. Decreased immunoreactive LH levels may result from partial suppression of the LH pulse generator and a smaller mass of GnRH released in each burst. The role of neurotransmitters, PRL and ovarian factors is discussed. After the recovery of ovulatory cycles suckling still has a residual infertility effect, associated to inadequate luteal function. The sources of variation among women and populations were recognized. Areas in which research is needed to improve the understanding of the mechanisms that sustain lactational amenorrhea are suggested.

Neuroendocrine mechanisms of lactational infertility in women

The current knowledge on the mechanisms of lactational infertility, discussed during a symposium of investigators in this subject, is reviewed. Three periods of lactation are examined: the first weeks postpartum, the period of extended lactational amenorrhea and the recovery of ovarian function. In the first postpartum weeks the inhibition of ovarian function is accounted by diminished pituitary response to GnRH, since exogenous GnRH fails to elicit a LH increase. Suckling can extend the period of ovarian inhibition for weeks, months or years, although it does not fully suppress pulsatile secretion of LH beyond the first weeks. Extended lactational amenorrhea is associated with low LH plasma levels, a great PRL increase in response to suckling, low basal E2 levels and a suppression of estrogen positive feedback. Decreased immunoreactive LH levels may result from partial suppression of the LH pulse generator and a smaller mass of GnRH released in each burst. The role of neurotransmitters, PRL and ovarian factors is discussed. After the recovery of ovulatory cycles suckling still has a residual infertility effect, associated to inadequate luteal function. The sources of variation among women and populations were recognized. Areas in which research is needed to improve the understanding of the mechanisms that sustain lactational amenorrhea are suggested

Prenatal development of the retinohypothalamic pathway and the suprachiasmatic nucleus in the sheep.

Circadian rhythms are present during fetal life in several mammalian species. To characterize the ontogeny of the neural mechanisms that account for circadian rhythmicity in a precocious species, we studied the prenatal development of the retinohypothalamic pathway in lambs (gestation period of 147 days), using horseradish peroxidase and wheat germ agglutinin as anterograde tracers. The suprachiasmatic nucleus was present as early as embryonic day 52 (E52). After E58, the suprachiasmatic nucleus reached its full number of neurons, estimated by the disector method in about 160,000 cells per nucleus at E62. The retinohypothalamic axons invaded the suprachiasmatic nucleus from E58, while neuroblasts were still migrating to the nucleus. At E62, there was a strong retinal projection that evolved until E121, when the retinal afferents established their definitive pattern of distribution in the ventral and central regions of the suprachiasmatic nucleus, and adjacent hypothalamic structures. The development of the retinohypothalamic pathway was delayed by about a week relative to the innervation of other subcortical visual centers. The present findings demonstrated an early prenatal development of the visual pathways in lambs, including the retinohypothalamic pathway, suggesting that the mechanisms for the visual entrainment of circadian rhythms in lambs may be functioning several weeks before birth.

The retino-hypothalamic tract is involved in prolactin regulation in fetal sheep.

To investigate the role of the retino-hypothalamic tract on fetal prolactin regulation, we examined the effect of ocular enucleation on fetal plasma prolactin. Eleven fetuses of Suffolk ewes were chronically catheterized during fall, and six of them were subjected to bilateral ocular enucleation. All ewes were kept at 12h:12h light:dark cycle (lights on at 0800 and off at 2000). The experiments were performed 5-9 days after surgery (GA control fetuses 125 +/- 1.5, optical enucleation 121.3 +/- 1.5 days). Blood samples were taken from fetuses hourly around the clock, and plasma prolactin and cortisol were measured by radioimmunoassay (RIA). Luteinizing hormone (LH) and Growth hormone (GH) were measured in pooled plasma samples from control and enucleated fetuses by RIA. Average plasma prolactin was 5-fold lower in enucleated than in control fetuses (9.6 +/- 0.5 and 54.2 +/- 3.3 ng/ml, SEM; P < 0.005). Both control and enucleated fetuses presented circadian rhythm of prolactin with acrophase between 1400 and 1830 h. An enucleated fetus was tested for response of prolactin to TRH. Prolactin increased as described in the literature. There was no change in plasma concentration of cortisol, LH or GH after ocular enucleation. Our data indicate that the optical pathway participates in prolactin regulation in the fetal sheep.

[Modular enteral nutrition in pediatrics]. / Nutrición enteral modular en pediatría.

INTRODUCTION: Modular Enteral Nutrition may be a substitute for Parenteral Nutrition in children with different pathologies. MATERIAL AND METHODS: Study of 4 children with different pathologies selected from a group of 40 admitted to the Maternal-Childrens Hospital "Valle de Hebrón" in Barcelona, who received modular enteral nutrition. They were monitored on a daily basis by the Dietician Service. Modular enteral nutrition consists of modules of proteins, peptides, lipids, glucids and mineral salts-vitamins. RESULTS: 1.--Craneo-encephalic traumatisms with loss of consciousness, Feeding with a combination of parenteral nutrition and modular enteral nutrition for 7 days. In view of the tolerance and good results of the modular enteral nutrition, the parenteral nutrition was suspended and modular enteral nutrition alone used up to a total of 43 days. 2.--55% burns with 36 days of hyperproteic modular enteral nutrition together with normal feeding. A more rapid recovery was achieved with an increase in total proteins and albumin. 3.--Persistent diarrhoea with 31 days of modular enteral nutrition, 5 days on parenteral nutrition alone and 8 days on combined parenteral nutrition and modular enteral nutrition. In view of the tolerance and good results of the modular enteral nutrition, the parenteral nutrition was suspended. 4.--Mucoviscidosis with a total of 19 days on modular enteral nutrition, 12 of which were exclusively on modular enteral nutrition and 7 as a night supplement to normal feeding. DISCUSSION: We administered proteic intakes of up to 20% of the total calorific intake and in concentrations of up to 1.2 calories/ml of the final preparation, always with a good tolerance. CONCLUSIONS: Modular enteral nutrition can and should be used as a substitute for parenteral nutrition in children with different pathologies, thus preventing the complications inherent in parenteral nutrition.