Ultrasound appearance of decidualized non-ovarian endometriotic lesions during pregnancy and after delivery.

OBJECTIVE: To evaluate the changes in the ultrasound characteristics of decidualized non-ovarian endometriotic lesions that occur during pregnancy and after delivery. METHODS: This was a prospective observational cohort study carried out at a single tertiary center between December 2018 and October 2021. Pregnant women with endometriosis underwent a standardized transvaginal ultrasound examination with color Doppler imaging once in every trimester and after delivery. Non-ovarian endometriotic lesions were measured and evaluated by subjective semiquantitative assessment of blood flow. Lesions with moderate-to-marked blood flow were considered decidualized. The size and vascularization of decidualized and non-decidualized lesions were compared between the gravid state and after delivery. Only patients with non-ovarian endometriotic lesion(s) who underwent postpartum examination were included in the final analysis. RESULTS: Overall, 26 pregnant women with a surgical or sonographic diagnosis of endometriosis made prior to conception were invited to participate in the study, of whom 24 were recruited. Of those, 13 women with non-ovarian endometriosis who attended the postpartum examination were included. In 7/13 (54%) cases, the lesion(s) were decidualized. In 4/7 (57%) women with decidualized lesion(s), the size of the largest lesion increased during pregnancy, while in 3/7 (43%), the size was unchanged. The size of non-decidualized lesions did not change during pregnancy. On postpartum examination, only seven lesions were observed, of which three were formerly decidualized and four were formerly non-decidualized. Lesions that were detected after delivery appeared as typical endometriotic nodules and were smaller compared with during pregnancy. The difference in maximum diameter between the gravid and postpartum states was statistically significant in decidualized lesions (P < 0.01), but not in non-decidualized lesions (P = 0.09). The reduction in mean diameter was greater in decidualized compared with non-decidualized lesions (P = 0.03). CONCLUSIONS: Decidualization was observed in 54% of women with non-ovarian endometriotic lesion(s) and resolved after delivery. Our findings suggest that the sonographic features of decidualization, which might mimic malignancy, are pregnancy-related and that expectant management and careful monitoring should be applied in these cases. Clinicians should be aware of the changes observed during pregnancy to avoid misdiagnosing decidualized lesions as malignancy and performing unnecessary surgery. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prospective observational study investigating the predictive validity of the STarT Back tool and the clinical effectiveness of stratified care in an emergency department setting.

PURPOSE: To determine the predictive validity of the STarT Back tool (SBT) undertaken at baseline and 6 weeks to classify Emergency Department (ED) patients with LBP into groups at low, medium or high risk of persistent disability at 3 months. A secondary aim was to evaluate the clinical effectiveness of pragmatic risk-matched treatment in an ED cohort at 3 months. METHODS: A prospective observational multi-centre study took place in the physiotherapy services linked to the ED in four teaching hospitals in Dublin, Ireland. Patients were stratified into low, medium and high-risk groups at their baseline assessment. Participants received stratified care, where the content of their treatment was matched to their risk profile. Outcomes completed at baseline and 3 months included pain and disability. Linear regression analyses assessed if baseline or 6-week SBT score were predictive of disability at 3 months. Changes in the primary outcome of disability were dichotomised into those who achieved/ did not achieve a 30% improvement in their RMDQ at 6 weeks and 3 months. RESULTS: The study enrolled 118 patients with a primary complaint of LBP ± leg pain with 67 (56.7%) completing their 6-week and 3-month follow-up. Baseline RMDQ and being in medium or high risk SBT group at 6 weeks were predictive of persistent disability at 3 months. A total of 54 (80.6%) participants reported a > 30% improvement at 3 months. CONCLUSION: Disability at baseline and SBT administered at 6 weeks more accurately predicted disability at 3 months than SBT at baseline in an ED population.

Contribution of polymorphisms in the LEP, LEPR and RETN genes on serum leptin and resistin levels in young adults from Mexico.

Polymorphisms in the LEP (G-2548A and A19G), LEPR (A326G, A668G and G3057A) and RETN (C-420G and G+62A) genes were documented according to their association with alterations in biochemical parameters such as glucose, insulin and lipid profiles, along with serum leptin and resistin concentrations. The aim of the study was to establish any contribution of the G-2548A and A19G polymorphisms of the LEP gene, the A326G, A668G and G3057A polymorphisms of the LEPR gene, and the C-420G and G+62A polymorphisms of the RETN gene to serum leptin and resistin levels in Mexican young adults. Clinical and biochemical variables, serum leptin and resistin levels, and genotype profiles were analysed in 66 Mexican young adults. Seven polymorphisms in the LEP, LEPR and RETN genes were genotyped using polymerase chain reaction-restriction fragment length polymorphisms analysis. Individuals carrying allele 3057A of the G3057A polymorphism in the LEPR gene showed significantly higher leptin concentrations than those bearing the genotype G/G (43.78 ± 39.11 vs 28.20 ± 14.12 ng/mL; p = 0.021). There were no associations of serum leptin or resistin levels according to the genotype of the other six analysed polymorphisms. Our results suggest that the allele 3057A of the LEPR G3057A polymorphism contributes to increased serum leptin levels in Mexican young adults.

[The effects of the social environment on the brain]. / Efectos cerebrales del medio ambiente social.

AIMS: This work analyses the main studies dealing with the mechanisms by which the brain is altered by chronic stress and the impact of social stimuli on the activation of these mechanisms, which can lead to behavioural disorders and cognitive impairment in communities of mammals. DEVELOPMENT: The physiological and hormonal responses triggered as a response to stress are linked to alterations in certain areas of the brain and more particularly in the hippocampus. These mechanisms include hyperactivity of the hypothalamus-pituitary-adrenal axis, raised levels of corticosteroids and excitatory amino acids, neurotoxicity due to intracellular accumulation of calcium, apoptosis and a number of factors having to do with the immunological system. Most of these studies have involved the exogenous application of supraphysiological levels of corticosteroids or challenging the individual with stimuli that do not properly belong to their natural surroundings. Nevertheless, it is also possible that these mechanisms are triggered by aversive social stimuli from the natural environment, such as confrontation, establishing hierarchies, neglect and social evaluation. It has been proved that social stress has important effects on conduct and health, especially with regard to the structural and functional integrity of the brain. CONCLUSIONS: Social stress can trigger important alterations in the nervous system of individuals exposed to it and these changes can manifest themselves as varying types of disorders affecting conduct and the cognitive skills. Nevertheless, not all natural surroundings give rise to these adverse effects, as balanced communities offer their members support, protection and a series of other advantages.

Efectos cerebrales del medio ambiente social / The effects of the social environment on the brain

Objetivo. El presente trabajo analiza los principales estudios sobre los mecanismos de alteración cerebral resultantes del estrés crónico y el impacto de los estímulos de tipo social sobre la activación de estos mecanismos, de lo que pueden resultar alteraciones conductuales y déficit cognitivos en las comunidades de mamíferos. Desarrollo. Las respuestas hormonal y fisiológica frente al estrés están vinculadas con alteraciones de algunas áreas cerebrales, especialmente el hipocampo. Entre estos mecanismos están: hiperactividad del eje hipotálamo-hipófisis-adrenal, elevación de la concentración de los corticosteroides y los aminoácidos excitatorios, neurotoxicidad por acumulación intracelular de calcio, apoptosis y algunos factores del sistema inmunológico. La mayoría de estos estudios han utilizado la aplicación exógena de concentraciones suprafisiológicas de corticosteroides o la confrontación del individuo con estímulos ajenos a su ambiente natural. Sin embargo, posiblemente, esos mecanismos también pueden activarse por la estimulación social aversiva del medio natural, como confrontación, establecimiento de jerarquías, abandono y evaluación social. Se ha demostrado que el estrés social tiene efectos importantes sobre el comportamiento y la salud, especialmente sobre la integridad estructural y funcional cerebral. Conclusiones. El estrés social provoca alteraciones importantes en el sistema nervioso de los individuos expuestos y estos cambios pueden manifestarse por trastornos variables del comportamiento y las habilidades cognitivas; sin embargo, no siempre resultan efectos adversos de todos los ambientes naturales, ya que las comunidades equilibradas brindan apoyo, protección y numerosas ventajas a los individuos (AU)

Aims. This work analyses the main studies dealing with the mechanisms by which the brain is altered by chronic stress and the impact of social stimuli on the activation of these mechanisms, which can lead to behavioural disorders and cognitive impairment in communities of mammals. Development. The physiological and hormonal responses triggered as a response to stress are linked to alterations in certain areas of the brain and more particularly in the hippocampus. These mechanisms include hyperactivity of the hypothalamus-pituitary-adrenal axis, raised levels of corticosteroids and excitatory amino acids, neurotoxicity due to intracellular accumulation of calcium, apoptosis and a number of factors having to do with the immunological system. Most of these studies have involved the exogenous application of supraphysiological levels of corticosteroids or challenging the individual with stimuli that do not properly belong to their natural surroundings. Nevertheless, it is also possible that these mechanisms are triggered by aversive social stimuli from the natural environment, such as confrontation, establishing hierarchies, neglect and social evaluation. It has been proved that social stress has important effects on conduct and health, especially with regard to the structural and functional integrity of the brain. Conclusions. Social stress can trigger important alterations in the nervous system of individuals exposed to it and these changes can manifest themselves as varying types of disorders affecting conduct and the cognitive skills. Nevertheless, not all natural surroundings give rise to these adverse effects, as balanced communities offer their members support, protection and a series of other advantages (AU)

Induction of the apoptosis-promoting protein Bak by perillyl alcohol in pancreatic ductal adenocarcinoma relative to untransformed ductal epithelial cells.

Perillyl alcohol has antitumor activity toward pancreas and other cancers with low toxicity. Here, we have investigated the mechanism of action responsible for the differential sensitivity of malignant versus non-malignant pancreatic cells to the drug. We report that the rate of apoptosis is over 6-fold higher in perillyl alcohol-treated pancreatic adenocarcinoma cells than in untreated cells, and that the effect of perillyl alcohol on pancreatic tumor cells is significantly greater than its effect on non-malignant pancreatic ductal cells. Moreover, the perillyl alcohol-induced increase in apoptosis in all of the pancreatic tumor cells is associated with a 2- to 8-fold increase in the expression of the proapoptotic protein Bak, but Bak expression is not affected by perillyl alcohol in non-malignant cells. Thus, the antitumor activity of perillyl alcohol toward pancreatic cancers may be due to preferential stimulation of Bak-induced apoptosis in malignant versus normal cells. Bak may, therefore, be a useful biomarker for the chemopreventive and therapeutic effects of perillyl alcohol.

Inhibition of pancreatic cancer growth by the dietary isoprenoids farnesol and geraniol.

Fruits and vegetables have protective effects against many human cancers, including pancreatic cancer. Isoprenoids are one class of phytochemicals which have antitumor activity, but little is known about their effects on cancer of the pancreas. We tested the hypothesis that isoprenoids would inhibit the growth of pancreatic tumor cells. Significant (60-90%) inhibition of the anchorage-independent growth of human MIA PaCa2 pancreatic tumor cells was attained with 25 microM farnesol, 25 microM geranylgeraniol, 100 microM perillyl amine, 100 microM geraniol, or 300 microM perillyl alcohol. We then tested the relative in vivo antitumor activities of dietary farnesol, geraniol, and perillyl alcohol against transplanted PC-1 hamster pancreatic adenocarcinomas. Syrian Golden hamsters fed geraniol or farnesol at 20 g/kg diet exhibited complete inhibition of PC-1 pancreatic tumor growth. Both farnesol and geraniol were more potent than perillyl alcohol, which inhibited tumor growth by 50% at 40 g/kg diet. Neither body weights nor plasma cholesterol levels of animals consuming isoprenoid diets were significantly different from those of pair-fed controls. Thus, farnesol, geraniol, and perillyl alcohol suppress pancreatic tumor growth without significantly affecting blood cholesterol levels. These dietary isoprenoids warrant further investigation for pancreatic cancer prevention and treatment.

Prenylation of oncogenic human PTP(CAAX) protein tyrosine phosphatases.

Many isoprenylated proteins are known to participate in signal transduction, but not all have been identified. Using an in vitro prenylation screen, two human cDNAs (PTP(CAAXI) and PTP(CAAX2)) homologous to the rat PRL-1 and human OV-1 protein tyrosine phosphatase genes were identified. PTP(CAAXI) and PTP(CAAX2) were farnesylated in vitro by mammalian farnesyl:protein transferase, and epitope-tagged PTP(CAAX2) was prenylated in epithelial cells. Overexpression of PTP(CAAXI) and PTP(CAAX2) in epithelial cells caused a transformed phenotype in culture and tumor growth in nude mice. Thus, PTP(CAAXI) and PTP(CAAX2) represent a novel class of isoprenylated, oncogenic protein tyrosine phosphatases.

Antitumorigenic effects of limonene and perillyl alcohol against pancreatic and breast cancer.

Perillyl alcohol is a natural product from cherries and other edible plants. Perillyl alcohol and d-limonene, a closely related dietary monoterpene, have chemotherapeutic activity against pancreatic, mammary, and prostatic tumors. In addition, perillyl alcohol, limonene, and other dietary monoterpenes have chemopreventive activity. Several mechanisms may account for the antitumorigenic effects of monoterpenes. For example, many monoterpenes inhibit the post-translational isoprenylation of cell growth-regulatory proteins such as Ras. Perillyl alcohol induces apoptosis without affecting the rate of DNA synthesis in both liver and pancreatic tumor cells. In addition, monoterpene-treated, regressing rat mammary tumors exhibit increased expression of transforming growth factor beta concomitant with tumor remodeling/redifferentiation to a more benign phenotype. Monoterpenes are effective, nontoxic dietary antitumor agents which act through a variety of mechanisms of action and hold promise as a novel class of antitumor drugs for human cancer.

Chemotherapy of pancreatic cancer with the monoterpene perillyl alcohol.

Perillyl alcohol has antitumor activity against rat mammary and liver cancer. Here, we report the chemotherapeutic effects of perillyl alcohol on pancreatic cancer. Perillyl alcohol reduced the growth of hamster pancreatic tumors to less than half that of controls (P < 0.025). Moreover, 16% of perillyl alcohol-treated pancreatic tumors completely regressed whereas no control tumors regressed (P < 0.05). Perillyl alcohol induced contact inhibition in cultured human pancreatic carcinoma cells and inhibited their anchorage-independent growth (P < 0.001). Thus, perillyl alcohol has antitumor activity against pancreatic carcinomas at non-toxic doses, and may be an effective chemotherapeutic agent for human pancreatic cancer.

Preclinical pharmacology of Ro 31-6930, a new potassium channel opener.

The present study compares the effects of Ro 31-6930, a novel potassium channel opener, with those of cromakalim and nitrendipine on blood pressure and other haemodynamic parameters. In conscious, spontaneously hypertensive rats (SHR) the oral dose of Ro 31-6930 for lowering blood pressure was 10 times lower than that of cromakalim and some 100 times lower than that of nitrendipine. In addition, the duration of antihypertensive activity of Ro 31-6930 was longer than that of cromakalim or nitrendipine. The tachycardia evoked by Ro 31-6930 and cromakalim was of shorter duration than the antihypertensive effect of either agent. In a repeat, once daily dosing experiment no tolerance was observed to the antihypertensive effect of Ro 31-6930 over a 22-day period. In conscious normotensive cats Ro 31-6930 was 10 times more potent than cromakalim and 1,000 times more potent than nitrendipine in reducing blood pressure. The duration of hypotensive activity was in excess of 5 h for each agent. In anaesthetised dogs all three agents reduced mean arterial pressure (MAP) and total peripheral resistance (TPR), while increasing cardiac output (CO) via a rise in stroke volume (SV). Both Ro 31-6930 and cromakalim significantly reduced femoral (FVR) and mesenteric vascular resistances (MVR), while only cromakalim reduced renal vascular resistance (RVR). Ro 31-6930 is a potent new antihypertensive agent that compares favourably with cromakalim and nitrendipine.

Minority admissions to medical schools: problems and opportunities.

The Congress and the Association of American Medical Colleges have the common objective of ensuring that all Americans will enjoy a high level of medical care. In furtherance of that objective, an AAMC task force in 1970 recommended that representation of minority groups in M.D. programs be increased from 2.8 percent (the level at that time) to 12 percent by 1975--76. While the goal was not realized, substantial progress has been made. Yet formidable barriers remain for many minority students who want to enter the health professions. Perhaps the greatest barrier consists of the subtle discriminatory pressures that manifest themselves in all institutions of the country. Today the phrase "reverse discrimination" poses a new political obstacle to the elimination of such pressures. And a series of court decisions has begun to erode the special admissions programs that are attempting to open up professional schools to members of minority groups.