Systematic review and network meta-analysis of hydrosalpinx treatment before in vitro fertilization.

OBJECTIVES: To compare different methods to treat hydrosalpinx, based on both ablative and non-ablative approaches, in infertile patients before undergoing IVF-ET. METHODS: Systematic review and network meta-analysis (NMA) of comparisons between different treatments of hydrosalpinx in infertile patients undergoing IVF. DATA SOURCES: structured searches in common citation databases. Study inclusion criteria: peer-reviewed randomized trials (RCT) or cohort studies comparing effects of salpingectomy, laparoscopic proximal tubal occlusion (LTO), insertion of intratubal device (ITD), sclerotherapy, ultrasound-guided aspiration and no treatment, on live birth, ongoing pregnancy, clinical pregnancy as main outcomes, considering also miscarriage, ectopic pregnancy and complications as secondary outcomes. Principal NMA included RCT, and aggregated NMA of RCT and observational studies was carried out. Pooled effects have been estimated by Odds Ratio (OR) and its 95% confidence interval (CI) for direct and indirect-mixed comparisons, derived from random-effects models. Imprecision and heterogeneity of NMA estimations was assessed by comparison of its 95% CI with predefined intervals for clinically relevant size of effect (OR <0.9 or >1.1). Surface under the cumulative ranking curve (SUCRA) were used to predict treatment rankings for each outcome. RESULTS: Nine RCT were included in main analysis, plus 17 additional observational studies in additional analysis. NMA of RCT did not identify significant differences in the effect of compared treatments on live birth rate, and LTO was the option with the highest value of SUCRA (0.92, mean rank: 1.2). Salpingectomy and US-aspiration associated to a significant increase of ongoing pregnancy rate compared to no treatment, according to NMA results (NMA OR: 4.35; 95% CI: 1.7, 11.14 and 2.8; 95% CI: 1.03, 7.58 respectively). Salpingectomy had the highest SUCRA value (0.88, mean rank: 1.4). NMA estimated significant increase of clinical pregnancy rate for salpingectomy compared with no treatment (NMA OR: 2.24; 95% CI: 1.3, 3.86) as well as for LTO versus no treatment (NMA OR: 2.55; 95% CI: 1.2, 5.41). Both comparisons were affected by a high grade of heterogeneity. For clinical pregnancy, LTO was the intervention with highest SUCRA (0.85; mean rank: 1.6). Regarding secondary outcomes, feasible NMA estimates did not support significant differences between treatments effects. According to aggregated NMA including randomized and observational studies, sclerotherapy showed significant beneficial effects on live birth rate compared to no treatment (NMA (OR: 4.6; 95% CI: 1.21, 17.46). Compared with untreated patients, the aggregated NMA estimates a higher ongoing pregnancy rate in patients treated with salpingectomy (NMA OR: 3.35; 95% CI: 2.12, 5.12), US-aspiration (NMA OR: 2.16; 95% CI: 1.28, 3.65) and LTO (NMA OR: 2.46; 95% CI: 1.11, 5.43). Salpingectomy and LTO produced a higher beneficial effect compared to ITD, based on both direct and indirect comparisons. Salpingectomy obtained the highest SUCRA value in rank of effects on ongoing pregnancy (0.94; mean rank: 1.2). NMA found significant effects on clinical pregnancy for comparisons between the different active management procedures compared with no treatments, with the exception of ITD insertion. LTO had more increasing effect on clinical pregnancy rate compared with US-aspiration (NMA OR: 2.04; 95% CI: 1.05, 3.97), while for the rest of the comparisons between procedures no significant differences were identified. NMA ranked LTO as the treatment with a highest SUCRA value (0.91; mean rank: 1.5). NMA prediction models identified LTO as best intervention to reduce miscarriage (SUCRA value: 0.84; mean rank: 1.8), as sclerotherapy as safer option in terms of ovarian response to IVF stimulation. CONCLUSIONS: The present NMA fails to support the effectiveness of any option to treat hydrosalpinx before IVF in order to improve live birth rates, although the beneficial effect of salpingectomy and US aspirations on ongoing pregnancy rates and of both salpingectomy and LTO on clinical pregnancy rates emerges from our analysis, which reinforces current recommendations. Based on the aggregated analyses, sclerotherapy could be a promising alternative to conventional laparoscopic techniques, combined with a favorable safety profile. This article is protected by copyright. All rights reserved.

Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis.

Background: Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events. Objective: To assess the impact of CUA on reproductive outcomes in pregnancies conceived spontaneously or after assisted reproduction. Materials and Methods: Systematic review and meta-analysis of cohort studies comparing patients with CUA versus women with normal uterus. A structured literature search was performed in leading scientific databases to identify prospective and retrospective studies. The Newcastle-Ottawa scale, adapted to AHRQ standards, was used to assess the risk of bias. Pooled odds ratios (OR) were calculated. Publication bias and statistical heterogeneity were assessed, and meta-regression was used to analyse the heterogeneity. Main outcome measures: Miscarriage, ectopic pregnancy, placental abruption, term, and premature rupture of membranes (PROM), malpresentation at delivery, preterm delivery prior to 37, 34 and 32 weeks, caesarean delivery, intrauterine growth restriction/small for gestational age, foetal mortality and perinatal mortality. Results: 32 studies were included. CUAs increased significantly the risk of first/second trimester miscarriage (OR:1.54;95%CI:1.14-2.07), placental abruption (OR:5.04;3.60-7.04), PROM (OR:1.71;1.34-2.18), foetal malpresentation at delivery (OR:21.04;10.95-40.44), preterm birth (adjusted OR:4.34;3.59-5.21), a caesarean delivery (adjusted OR:7.69;4.17-14.29), intrauterine growth restriction/small for gestational age (adjusted OR:50;6.11-424), foetal mortality (OR:2.07;1.56-2.73) and perinatal mortality (OR:3.28;2.01-5.36). Conclusions: CUA increases the risk of complications during pregnancy, delivery, and postpartum. Complications most frequent in CUA patients were preterm delivery, foetal malpresentation, and caesarean delivery. What is new?: Bicornuate uterus was associated with the highest number of adverse outcomes, followed by didelphys, subseptate and septate uterus.

Effects of direct-fed microbial supplementation on performance and immune parameters of lactating dairy cows.

We evaluated the effects of supplementing bacterial direct-fed microbial (DFM) on performance, apparent total-tract digestibility, rumen fermentation, and immune parameters of lactating dairy cows. One hundred fourteen multiparous Holstein cows (41 ± 7 DIM) were used in a randomized complete block design with an experiment comprising 14 d of a covariate (pre-experimental sample and data collection) and 91 d of an experimental period. Cows were blocked based on energy-corrected milk (ECM) yield during the covariate period and the following treatments were randomly assigned within each block: (1) control (CON), corn silage-based total mixed ration without DFM; (2) PRO-A, basal diet top-dressed with a mixture of Lactobacillus animalis and Propionibacterium freudenreichii at 3 × 109 cfu/d; and 3) PRO-B, basal diet top-dressed with a mixture of L. animalis, P. freudenreichii, Bacillus subtilis, and Bacillus licheniformis at 11.8 × 109 cfu/d. Milk yield, dry matter intake (DMI), and body weight were measured daily, while milk samples for component analysis were taken on 2 consecutive days of each week of data collection. Feces, urine, rumen, and blood samples were taken during the covariate period, wk 4, 7, 10, and 13 for estimation of digestibility, N-partitioning, rumen fermentation, plasma nutrient status and immune parameters. Treatments had no effect on DMI and milk yield. Fat-corrected milk (3.5% FCM) and milk fat yield were improved with PRO-B, while milk fat percent and feed efficiency (ECM/DMI) tended to increase with PRO-B compared with PRO-A and CON. Crude fat digestibility was greater with PRO-B compared with CON. Feeding CON and PRO-A resulted in higher total volatile fatty acid concentration relative to PRO-B. Percentage of neutrophils tended to be reduced with PRO-A compared with CON and PRO-B. The mean fluorescence intensity (MFI) of anti-CD44 antibody on granulocytes tended to be higher in PRO-B compared with CON. The MFI of anti-CD62L antibody on CD8+ T cells was lower in PRO-A than PRO-B, with PRO-A also showing a tendency to be lower than CON. This study indicates the potential of DFM to improve fat digestibility with consequential improvement in fat corrected milk yield, feed efficiency and milk fat yield by lactating dairy cows. The study findings also indicate that dietary supplementation with DFM may augment immune parameters or activation of immune cells, including granulocytes and T cells; however, the overall effects on immune parameters are inconclusive.

Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis.

The purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can be diagnosed on two-dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high-quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost-effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high-quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first-line approach as long as the residual myometrial thickness is at least 2.5-3.0 mm. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Epithelial downgrowth leading to graft rejection after penetrating keratoplasty.

PURPOSE: To report a case of epithelial downgrowth after penetrating keratoplasty. CASE DESCRIPTION: A 58-year-old man presented with graft rejection in his three-month-old, repeat penetrating keratoplasty. Examination revealed centripetal opacification of the posterior cornea due to deep epithelization. He had new retro-corneal membranes and anterior uveitis. Specular microscopy and anterior segment optical coherence tomography were performed, and a clinical diagnosis of epithelial downgrowth was made. The patient had intracameral injections with 5-fluorouracil (5FU) and achieved resolution of intraocular findings after treatment. CONCLUSIONS: Epithelial downgrowth is an uncommon complication of penetrating keratoplasty. It affects the patients' visual acuity and graft survival. Clinical observation is preferred in severe cases due to the high risk of intraocular damage; intracameral 5FU promises to be a good option in these cases.

Endometrial biopsy under direct hysteroscopic visualisation versus blind endometrial sampling for the diagnosis of endometrial hyperplasia and cancer: Systematic review and meta-analysis.

Background: Endometrial cancer is the most common gynaecological neoplasia in western countries. Diagnosis of endometrial cancer requires an endometrial biopsy. A good quality endometrial biopsy allows not only the identification of the pathology, but also preoperative histologic subtype classification. Endometrial biopsy can be performed under direct hysteroscopic visualisation, but also using blind sampling techniques. Objectives: To compare endometrial biopsy performed under direct hysteroscopic visualisation versus blind sampling for the diagnosis of endometrial hyperplasia and cancer. Materials and Methods: Systematic review and meta-analysis. Electronic databases were searched from their inception until March 2022.We included all studies comparing endometrial biopsy performed under direct hysteroscopic visualisation versus blind endometrial sampling. Main outcome measures: Sample adequacy, failure rate to detect endometrial cancer or endometrial hyperplasia, and rate of detection of endometrial cancer. The summary measures were reported as relative risk (RR) with 95% of confidence interval (CI). Results: Four studies with a total of 1,295 patients were included. Endometrial biopsy under direct hysteroscopic visualisation was associated with a significantly higher rate of sample adequacy (RR 1.13, 95% CI 1.10 to 1.17), and significantly lower risk of failure to detect endometrial cancer or endometrial hyperplasia (RR 0.16, 95% CI 0.03 to 0.92) compared to blind endometrial sampling. However, there was no significant difference between endometrial biopsies taken under direct hysteroscopic visualisation or blindly, with or without a preceding diagnostic hysteroscopy, in the rate of detection of endometrial cancer (RR 0.18, 95% CI 0.03 to 1.06). Conclusion: Hysteroscopic endometrial biopsy under direct visualisation is associated with significantly higher rate of sample adequacy and is comparable to blind endometrial sampling for the diagnosis of endometrial cancer and precancer. What is new?: Hysteroscopic endometrial biopsy under direct visualisation would be expected to reduce diagnostic failure for endometrial cancer compared to blind endometrial sampling.

A compact x-ray diffraction system for dynamic compression experiments on pulsed-power generators.

Pulsed-power generators can produce well-controlled continuous ramp compression of condensed matter for high-pressure equation-of-state studies using the magnetic loading technique. X-ray diffraction (XRD) data from dynamically compressed samples provide direct measurements of the elastic compression of the crystal lattice, onset of plastic flow, strength-strain rate dependence, structural phase transitions, and density of crystal defects, such as dislocations. Here, we present a cost-effective, compact, pulsed x-ray source for XRD measurements on pulsed-power-driven ramp-loaded samples. This combination of magnetically driven ramp compression of materials with a single, short-pulse XRD diagnostic will be a powerful capability for the dynamic materials' community to investigate in situ dynamic phase transitions critical to equation of states. We present results using this new diagnostic to evaluate lattice compression in Zr and Al and to capture signatures of phase transitions in CdS.

Gene expression analysis during the fruit development in dehiscent and indehiscent Bixa orellana L. accessions.

Fruit morphology and dehiscence-related genes were analyzed in dehiscent N4P and dehiscent P12 Bixa orellana accessions. Fruit architecture (exocarp and pericarp cells, trichomes, vascular bundles, vesicles, and bixin cells) documented by Scanning electron microscopy (SEM) morphology, blue toluidine stain, and phloroglucinol and hydrochloric acid (PHCL) stain was similar in both accessions. Although, the dehiscent zone (DZ) was higher in the indehiscent P12 B. orellana accession, lignification values, obtained by phloroglucinol and hydrochloric acid stain, within the DZ remain was similar in both variants being lower at 34 days after floral anthesis in the dehiscent N4P B. orellana accession. Dehiscence-related genes APETALA (AP2), SHATTERPROOF (SHP), and SPATULA (SPT) were identified on the reported B. orellana transcriptome (SRX1117606). Real-time quantitative polymerase chain reaction primers build by using these genes allow observing a differential expression during six fruit development stages. In both B. orellana accessions, the AP2 transcripts have a reduced expression, whereas the SHP transcripts were significantly higher during the first two days and ten days of development. SPT transcripts show an expression differential between both accessions being significantly higher in the dehiscent N4P, peaking with 9.66% at 42 days after floral anthesis (DAFA) of development. SPT transcription profile suggested that this gene has an important role during the fruit opening in the dehiscent N4P B. orellana accession. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-022-01180-w.

Opuntia ficus-indica Extract and Isorhamnetin-3-O-Glucosyl-Rhamnoside Diminish Tumor Growth of Colon Cancer Cells Xenografted in Immune-Suppressed Mice through the Activation of Apoptosis Intrinsic Pathway.

This study aimed to evaluate the effects of Opuntia ficus-indica extract (OFI-E) and its glycoside isorhamnetin-3-O-glucosyl-rhamnoside (IGR) on the growth of human colorectal adenocarcinoma cells and in a xenografted-immunosuppressed mice model. The IC50 values of OFI-E and IGR on colon cancer cells (HT-29 RFP) were determinate, as well as their effects on the cell cycle and apoptosis induction. OFI-E and IGR produced an increased in apoptosis induction, ROS production and a G0/G1 cell cycle arrest. In xenografted-inmunosupressed mice, OFI-E and IGR reduced the tumor growth rate, myeloperoxidase activity and total cholesterol levels. OFI-E and IGR reduced the tumor growth through the overexpression of cleaved Caspase-9, Hdac11, and Bai1 proteins. OFI-E reduced the expression of bcl-2. Results demonstrated the chemopreventive effects of OFI-E, and its purified compound IGR, showing their potential as an alternative in the treatment of colorectal cancer.

Trace metals and metalloids in Andean flamingos (Phoenicoparrus andinus) and Puna flamingos (P. jamesi) at two wetlands with different risk of exposure in the Bolivian Altiplano.

Birds are widely used as bioindicators in monitoring programs in wetlands. We compare concentrations of seven trace metals and metalloids (TMM) As, Cd, Cu, Fe, Hg, Pb, Znin both feathers and blood in two flamingo species in two high-altitude wetlands in Bolivia, with different levels of anthropogenic point source pollution. Lake Uru Uru (LUU) receives discharges from mining operations, and also effluents from the nearby city of Oruro, while Laguna Colorada (LCo) does not receive contaminants from anthropogenic sources. We sampled water and sediments at each site, as well as flamingos in three age classes in an effort to establish a benchmark for long-term monitoring. Metal concentrations in water did not differ between sites, whereas Zn and Pb concentrations of TMM in sediments were higher at LUU, and Hg higher at LCo. TMM concentrations were highly specific for all separate elements, but results point to differences between Andean flamingo (Phoenicoparrus andinus) chicks and the rest of the classes considered. As flamingo chicks did not molt before sampling, we pose that TMM concentrations in their blood and feathers may respond mainly to local conditions. Eggshells provide additional information, since adults transfer some TMM during egg development. Long-term monitoring in these species should include different age classes and sample both feathers and eggshells to monitor the environmental conditions and bioaccumulation of TMM in these species. Future studies should include sites devoid of natural sources of TMM to help distinguish sources of contamination, since some TMM (As and Pb) may be naturally in high concentrations in remote areas, like Laguna Colorada.

Chemical characterization and antimicrobial activity of Campomanesia aurea against three strains of Listeria monocytogenes / Caracterização química e atividade antimicrobiana de Campomanesia aurea contra três cepas de Listeria monocytogenes

Abstract The essential oil (EO) composition of leaves of Campomanesia aurea was analyzed by GC-MS. The plant was collected in April (EOA) and October (EOO) in São Francisco de Assis/RS. The essential oils were obtained by hydrodistillation in a modified Clevenger apparatus. The yields were 4.44% in April, and 6.15%, in October. Thirty-one compounds were identified in EOA, accounting for 96.87% of the total, and twenty-eight compounds were identified in EOO, accounting for 99.46% of the total. For EOA, the major identified monoterpene was p-cymene (8.33%) and the major identified sesquiterpene was α-cadinol (10.72%), while regarding EOO the major identified monoterpene was repeatedly Terpinolene (3.43%), whereas the major identified sesquiterpene was α-cadinol (12.79%). The antibacterial activity of the essential oil was evaluated against the three Listeria monocytogenes from the American Type Culture Collection (strains ATCC 7644, 19114 and 13932). The essential oil showed a MIC of 10 mg/mL against the strains ATCC 7644 and 19114, with bacteriostatic effect of 20 mg/mL and a MIC of 20 mg/mL for ATCC 13932. Regarding the antibiofilm activity, o EOO showed the best results with an inhibition of 90% in the sessile growth with an applied concentration of 4.0 mg/mL.

Resumo O óleo essencial (EO) das folhas de Campomanesia aurea foi analisado por CG-EM. O A planta foi coletada em abril (OEA) e outubro (OEO) em São Francisco de Assis/RS. Os óleos essenciais foram obtidos por hidrodestilação em aparelho Clevenger modificado. Os rendimentos foram de 4,44% em abril e 6,15% em outubro. Trinta e um compostos foram identificados no EOA, representando 96,87% do total, e vinte e oito compostos foram identificados no EOO, representando 99,46% do total. Para EOA, o principal monoterpeno identificado foi o p-cimeno (8,33%) e o principal sesquiterpeno identificado foi o α-candinol (10,72%), enquanto o EOO o maior monoterpeno identificado foi repetidamente Terpinolene (3,43%), enquanto o sesquiterpeno principal identificado foi α-cadinol (12,79%). A atividade antibacteriana do óleo essencial foi avaliada contra as três cepas de Listeria monocytogenes obtidas a partir da American Type Culture Collection (isolados ATCC 7644, 19114 and 13932). O óleo essencial apresentou uma CIM de 10 mg/mL contra as cepas ATCC 7644. e 19114, com efeito bacteriostático de 20 mg/mL e MIC de 20 mg/mL para ATCC 13932. Quanto à atividade antibiofilme, o EOO apresentou os melhores resultados com uma inibição de 90% no crescimento séssil com uma concentração aplicada de 4,0 mg/mL.

Chemical characterization and antimicrobial activity of Campomanesia aurea against three strains of Listeria monocytogenes.

The essential oil (EO) composition of leaves of Campomanesia aurea was analyzed by GC-MS. The plant was collected in April (EOA) and October (EOO) in São Francisco de Assis/RS. The essential oils were obtained by hydrodistillation in a modified Clevenger apparatus. The yields were 4.44% in April, and 6.15%, in October. Thirty-one compounds were identified in EOA, accounting for 96.87% of the total, and twenty-eight compounds were identified in EOO, accounting for 99.46% of the total. For EOA, the major identified monoterpene was p-cymene (8.33%) and the major identified sesquiterpene was α-cadinol (10.72%), while regarding EOO the major identified monoterpene was repeatedly Terpinolene (3.43%), whereas the major identified sesquiterpene was α-cadinol (12.79%). The antibacterial activity of the essential oil was evaluated against the three Listeria monocytogenes from the American Type Culture Collection (strains ATCC 7644, 19114 and 13932). The essential oil showed a MIC of 10 mg/mL against the strains ATCC 7644 and 19114, with bacteriostatic effect of 20 mg/mL and a MIC of 20 mg/mL for ATCC 13932. Regarding the antibiofilm activity, o EOO showed the best results with an inhibition of 90% in the sessile growth with an applied concentration of 4.0 mg/mL.

Stable isotopes to study sulfur amino acid utilization in broilers.

Nutritionists have been discussing whether the dietary supplementation of cyst(e)ine is required as a part of the dietary methionine (Met) in the total sulfur amino acid (TSAA) requirement to achieve optimum performance in broilers. Part of Met is converted to cysteine (Cys) to meet the Cys requirement, especially for feather growth. The TSAA requirement has been determined by using graded levels of free Met in the diet, without supplementation of free cyst(e)ine. It has also been argued that the Met to Cys ratio (Met : Cys) changes with age and even with different Met sources. The objective of this study was to evaluate the two sources of Met, while determining the proportion of Met and Cys in total dietary TSAA that optimize the performance of broilers. A performance assay was carried out in a factorial arrangement (5 × 2) using 1080 broilers from 42 to 56 days of age fed diets having different dietary proportions of Met and Cys (44 : 56, 46 : 54, 48 : 52, 50 : 50 or 52 : 48) while maintaining the same dietary TSAA in the diets. Two synthetic Met sources (dl-Met or l-Met) were used for each of the diets with different dietary Met : Cys ratios. Twenty-one broilers of the same age were fed the diets 44 : 56, 48 : 52 and 52 : 48 by supplementing the diet with L-(15N) Met or L-(15N2) Cystine to study the metabolism of TSAA. No differences were observed between Met sources for feed intake, BW gain and feed conversion ratio (FCR; P > 0.05); however, FCR was numerically improved at 50 : 50 Met : Cys. Regarding TSAA utilization, the conversion of Met to Cys increased with increase in Met : Cys ratios, but the concentration of Met intermediates decreased. Broiler chickens responded to different dietary proportions of sulfur amino acids by altering their sulfur amino acid metabolism, and diets containing 50 : 50 Met : Cys is recommended for broilers of age 42 to 56 days.

[Beliefs, perceptions and experiences in sexuality of Chilean adolescents with HIV acquired by vertical transmission]. / Creencias, percepciones y experiencias en sexualidad de adolescentes chilenos con infección por VIH adquirida por transmisión vertical.

BACKGROUND: Since the incorporation of antiretroviral therapy (ART) HIV has become a chronic condition, improving survival and allowing children with the virus to come in better conditions to adolescence, where they are faced with a series of changes, among them, to sexual awakening. AIM: To explore the main beliefs, perceptions and experiences in sexuality of a group of adolescents with HIV infection acquired through vertical transmission. METHODS: A qualitative research was carried out with exploratory and descriptive scope. Semi-structured interviews were applied to 28 adolescents, under control in hospitals in Santiago and Valparaíso, with HIV infection. The analysis was carried out according to the Grounded Theory. RESULTS: There was a lack of sexual education and a vision that focuses on risks, such as sexually transmissible infections or teenage pregnancy. There are fears about the possibility of rejection by others and of transmitting the virus to the couple or the children and they are invaded by feelings of shame and anger. CONCLUSION: It is important to train health professionals who work with this group, because they are identified as a reliable source of information and education.

The relationship between the number of consecutive days with heat stress and milk production of Holstein dairy cows raised in a humid continental climate.

Heat stress is known to affect performance of dairy cows experiencing prolonged periods of high temperature and relative humidity. Less is known about its effects in cooler climates. The goals of the present study were to determine the prevalence of days susceptible to cause mild heat stress in dairy cows living in a humid continental climate and to investigate the relationship between the number of consecutive days of mild heat stress and milk, fat, protein, and lactose production. A 6-yr data set (2010-2015) containing 606,031 milk analysis records for 34,360 Holstein dairy cows at different parities was matched with the corresponding daily maximum temperature-humidity index. Exposure to heat stress conditions was divided into 5 categories corresponding to 0, 1 to 2, 3 to 4, 5 to 6, and 7 to 8 consecutive days before milk test date. On average, cows were exposed to heat stress conditions for 135.8 ± 5.9 d/yr in Southwest Quebec and 95.3 ± 10.2 d/yr in Eastern Quebec. Cows experiencing heat stress conditions produced on average less fat, protein, and energy-corrected milk and lower fat and protein concentrations. The decrease in milk fat reached 6% for category 7 to 8 exposure of cows in parity 3 or more. The association between exposure category and milk yield and lactose yield and concentration was weak. Heat stress lowered milk fat and protein production but had little effect on milk volume output. Further research is necessary to better understand the mechanism underlying the effects of sporadic low- to medium-intensity heat stress on dairy productivity.

Left Hepatic Lobectomy in the Living Donor-Comparison Between Open vs Laparoscopic Surgery.

Laparoscopic hepatic surgery dramatically changed surgical practice in the last decades, improving outcomes in correctly selected patients. The reduction of postoperative pain, lower rate of complication, early return to work activities, and better esthetic result have been well described in several studies. The success of these procedures would inevitably clash in the more complex and delicate field of hepatectomy in the living donor. The 2nd International Consensus of the Conference on Laparoscopic Liver Surgery considers laparoscopic hepatectomy in the donor as an ideal procedure. The aim of this study is to compare the results between conventional and laparoscopic surgery; prospective data and retrospective analysis of 55 cases of live liver donor lobectomy were collected between January 2013 and June 2018. The mean age was 30.4 years in the video laparoscopic technique and 32.1 years in conventional surgery; the majority of donors were male in both groups. The mean time of ischemia was 70.2 minutes (range, 50-120 minutes) in laparoscopic surgery and 80.2 minutes (range, 50-165 minutes) in conventional surgery. The surgical time ranged from 270 to 800 minutes (mean, 452 minutes) in laparoscopic surgery and ranged from 300 to 600 minutes (mean, 424 minutes) in conventional surgery. The mean length of hospital stay was 2.2 days in laparoscopy and 3.97 days in conventional surgery. Laparoscopic left liver lobectomy in the living donor is safe and feasible. There was no significant difference in surgical time; however, the time of hospitalization was lower in patients submitted to laparoscopic technique.

Liver Transplantation for Acute Liver Failure due to Yellow Fever: A Case Report.

Yellow fever is a noncontagious disease caused by an arbovirus in the Flaviviridae family. It is an endemic disease in the tropical forests of Africa and South America, with the mosquito as a vector. Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms. The lethality of the severe form reaches up to 70%. The objective of this study was to report on the case of a patient who was transferred to the hepatobiliary unit of our service due to acute liver failure due to yellow fever. He was treated with liver transplantation. The patient progressed satisfactorily, being discharged from the intensive care unit in 10 days and discharged from the hospital within 19 days after transplantation. Despite the encouraging result of our team, this has not been applied to other centers that have also performed this modality of treatment; therefore, the question remains as to whether and when to recommend liver transplantation for treatment of severe yellow fever.

Creencias, percepciones y experiencias en sexualidad de adolescentes chilenos con infección por VIH adquirida por transmisión vertical / Beliefs, perceptions and experiences in sexuality of Chilean adolescents with HIV acquired by vertical transmission

Resumen Introducción: Desde la incorporación de la terapia anti-retroviral (TAR) la infección por VIH ha pasado a ser una condición crónica, mejorando la sobrevida y permitiendo que los niños que han sido infectados con el virus lleguen en mejores condiciones a la adolescencia, donde se ven enfrentados a una serie de cambios, entre ellos, al despertar sexual. Objetivo: Explorar las principales creencias, percepciones y experiencias en sexualidad de un grupo de adolescentes con infección por VIH adquirida por transmisión vertical. Pacientes y Métodos: Se realizó una investigación cualitativa con alcance exploratorio y descriptivo. Se aplicaron entrevistas semiestructuradas a 28 adolescentes, bajo control en hospitales de Santiago y Región de Valparaíso, con infección por VIH. El análisis se realizó de acuerdo a la Teoría Fundamentada. Resultados: Se observó falta de educación sexual y una visión que se centra en los riesgos, tales como contagio de infecciones de transmisión sexual o embarazo adolescente. Existen temores frente a la posibilidad de rechazo de los otros y a transmitir el virus a la pareja o a los hijos y los invaden sentimientos de vergüenza y rabia. Conclusión: Es importante capacitar a los profesionales de salud que trabajan con este grupo, pues son identificados como fuente confiable de información y educación.

Background: Since the incorporation of antiretroviral therapy (ART) HIV has become a chronic condition, improving survival and allowing children with the virus to come in better conditions to adolescence, where they are faced with a series of changes, among them, to sexual awakening. Aim: To explore the main beliefs, perceptions and experiences in sexuality of a group of adolescents with HIV infection acquired through vertical transmission. Methods: A qualitative research was carried out with exploratory and descriptive scope. Semi-structured interviews were applied to 28 adolescents, under control in hospitals in Santiago and Valparaíso, with HIV infection. The analysis was carried out according to the Grounded Theory. Results: There was a lack of sexual education and a vision that focuses on risks, such as sexually transmissible infections or teenage pregnancy. There are fears about the possibility of rejection by others and of transmitting the virus to the couple or the children and they are invaded by feelings of shame and anger. Conclusion: It is important to train health professionals who work with this group, because they are identified as a reliable source of information and education.