Modulation of in vitro osteoclast activity mediated by different doses of parathyroid hormone / Modulación in vitro de la actividad osteoclástica mediada por diferentes dosis de hormona paratiroidea

Bone remodeling is a process regulated by the interaction between cells and various molecules such as parathyroid hormone (PTH). The aim of the study was to evaluate the effect of different doses of PTH on osteoclast activity in a culture model of bone organs. Six-day-old male C57BL/6 mice (n=14) were euthanized and the calvariae were dissected and sectioned in the middle, keeping the periosteal and endosteal. The bone fragments were divided into three groups: Group I (control - without adding PTH), Group II (addition of 3 nM PTH) and Group III (30 nM PTH), all cultured in aMEM for up to 72 h osteoclast activity was evaluated by biochemical quantification of calcium released in the culture medium at intervals of 24, 48, and 72 h and by histomorphometric analysis of bone resorption lacunae at 72 h our results show that group II exhibited significantly higher values of calcium levels in the medium compared to group I (p<0.05) in all intervals, also being higher for group III at 24 hours (p<0.05). Group II promoted a greater demineralization area (22068 ± 2193 mm2) than those found in group I (2084 ± 38 mm2) and group III (8952 ± 246 mm2), with statistically significant difference (p<0.001) among all groups. We concluded that in culture model of bone organs PTH promotes higher bone resorption when administered in lower doses.

La remodelación ósea es un proceso regulado por la interacción entre las células y varias moléculas como la hormona paratiroidea (PTH). El objetivo de este estudio fue evaluar el efecto de diferentes dosis de PTH sobre la actividad de los osteoclastos en un modelo de cultivo de órganos óseos. Se sacrificaron ratones C57BL/6 machos, de 6 días de edad (n = 14), y se disecaron y seccionaron las calvarias, manteniendo el periostio y endostio. Los fragmentos óseos se dividieron en tres grupos: Grupo I (control - sin adición de PTH), Grupo II (adición de 3 mM de PTH) y Grupo III (30 nM de PTH), todos cultivados en aMEM hasta 72 horas. La actividad de los osteoclastos se evaluó mediante la cuantificación bioquímica de calcio liberado en medio de cultivo, a intervalos de 24, 48 y 72 horas, y por análisis histomorfométrico de las lagunas de resorción ósea a las 72 horas. Nuestros resultados muestran que el grupo II exhibió valores significativamente más altos de calcio en el medio, comparado con el grupo I (p <0.05) en todos los intervalos, siendo también más alto para el grupo III a las 24 horas (p <0.05). El grupo II promovió una mayor área de desmineralización (22068 ± 2193 mm2) que los encontrados en el grupo I (2084 ± 38 mm2) y en el grupo III (8952 ± 246 mm2), con diferencia estadísticamente significativa (p <0,001) entre todos los grupos. Concluimos que en el modelo de cultivo de órganos óseos la PTH promueve una mayor resorción ósea cuando se administra en dosis más bajas.

Effect of low-level laser therapy on mesenchymal stem cell proliferation: a systematic review.

Low-level laser therapy (LLLT) has been used in several in vitro experiments in order to stimulate cell proliferation. Cells such as fibroblasts, keratinocytes, lymphocytes, and osteoblasts have shown increased proliferation when submitted to laser irradiation, although little is known about the effects of LLLT on stem cells. This study aims to assess, through a systematic literature review, the effects of LLLT on the in vitro proliferation of mesenchymal stem cells. Using six different terms, we conducted an electronic search in PubMed/Medline database for articles published in the last twelve years. From 463 references obtained, only 19 papers met the search criteria and were included in this review. The analysis of the papers showed a concentration of experiments using LLLT on stem cells derived from bone marrow, dental pulp, periodontal ligament, and adipose tissue. Several protocols were used to irradiate the cells, with variations on wavelength, power density, radiation time, and state of light polarization. Most studies demonstrated an increase in the proliferation rate of the irradiated cells. It can be concluded that the laser therapy positively influences the in vitro proliferation of stem cells studied, being necessary to carry out further experiments on other cell types and to uniform the methodological designs.

Problemas sexuales derivados de la histerectomía / Sexual problems due to hysterectomy

Introducción: La histerectomía constituye la segunda cirugía que más se aplica en mujeres en edad reproductora. En ocasiones este tipo de procedimiento quirúrgico puede acarrear consecuencias físicas y de tipo psicológico, lo que puede alterar el funcionamiento sexual de estas mujeres. Por ello, el objetivo de este estudio es realizar una revisión bibliográfica sobre los posibles problemas sexuales derivados de los diferentes tipos de histerectomía. Material y métodos: Se llevó a cabo una revisión bibliográfica en las bases de datos de Medline, Cinahl y Scopus y en ella se exploraron 111 artículos, de los cuales, solo 12 cumplieron los criterios de inclusión: 9 eran estudios prospectivos y 3 eran retrospectivos y se realizaron en mujeres de cualquier edad operadas de histerectomía, ya fuera por causas benignas o malignas. Se trata de artículos publicados entre el 2007 y el 2013, en inglés, español o portugués con las palabras clave "hysterectomy" y "sexuality". Resultados: Los 12 estudios analizados incluyeron los 3 tipos de histerectomía: subtotal, total o radical ya fuera por vía abdominal, vaginal o laparoscópica. En ellos se determinaron cuáles fueron los problemas sexuales que más afectan a las mujeres que sufren histerectomía, sea cual sea su causa. Conclusión: Los problemas sexuales son frecuentes tras la histerectomía, siendo la histerectomía vaginal la que mayores disfunciones provoca. Factores como la edad o la existencia de un trastorno depresivo también contribuyen a la aparición de las disfunciones

Introduction: Hysterectomy is the second most widely performed surgical procedure in women of reproductive age and sometimes has physical and psychological effects that affect sexual functioning. The aim of this study was to review the literature on possible sexual problems after different types of hysterectomy. Material and methods: We conducted a literature search in the databases Medline, CINAHL and Scopus and obtained 111 articles, of which only 12 met the inclusion criteria. Nine studies were prospective and 3 were retrospective, performed in women of any age who had undergone hysterectomy whether for benign or malignant causes. The articles were published between 2007 and 2013 in English, Spanish or Portuguese with the keywords 'hysterectomy' and 'sexuality'. Results: The 12 studies analyzed included 3 types of hysterectomies: subtotal, total, or radical, either abdominal, vaginal or laparoscopic. These studies identified the sexual problems most affecting women who had undergone a hysterectomy, irrespective of cause. Conclusion: Sexual problems are common after hysterectomy. The greatest dysfunction is caused by vaginal hysterectomy. Factors such as age and the existence of a depressive disorder also contribute to dysfunction

Influência do envelhecimento no rendimento in vitro de células-tronco mesenquimais da medula óssea de camundongos / Influence of aging on the in vitro yield of mice bone marrow mesenchymal stem cells

Objetivo - Avaliar a influência do processo de envelhecimento sobre a capacidade de adesão e proliferação das células mesenquimais da medula óssea de camundongos, comparando-se dois grupos de animais: jovens (30 dias de idade) e senis (18 meses de idade). Métodos - Extratos de medula óssea foram coletados do canal medular de tíbia e fêmur de camundongos jovens (n=5) e senis (n=5) e as células mesenquimais foram cultivadas em meio de cultura alfa-MEM nos intervalos de 24, 48 e 72 horas. Resultados - Observou-se uma curva crescente de proliferação celular nos animais jovens, enquanto nos animais senis houve uma grande redução no número de células no intervalo de 72 horas.Conclusão - A idade do animal é um fator importante no rendimento in vitro de células mesenquimais da medula óssea nos períodos iniciais do cultivo, o que pode influenciar no resultado dos experimentos com este tipo celular.

Objective - To evaluate the influence of aging on the adhesion and proliferation of mesenchymal cells from mice bone marrow, comparing two groups: young (30 days old) and senile (18 months old) animals. Methods - Extracts of bone marrow were collected from the marrow cavity of the tibia and femur of young (n=5) and senile (n=5) mice and the mesenchymal cells were cultured in MEM for intervals of 24, 48 and 72 hours. Results - It was found an increased curve of cell proliferation in young animals while in senile animals there was a large reduction in cell number in the 72 hours period. Conclusion - The animal's age is an important factor in the in vitro yield of from bone marrow mesenchymal cells in the early periods of culture, which may influence the results of experiments with this cell population.

[Laparoscopy as diagnostic-therapeutic method in abdominal traumatism in the pediatric age]. / Laparoscopia como método diagnóstico-terapéutico en el traumatismo abdominal en la edad pediátrica.

The management of blunt abdominal traumatism with a moderate amount of free peritoneal fluid and without solid organ injury as well as the one of minimal penetrating trauma is controversial. We present three cases of blunt abdominal trauma and two of penetrating trauma that underwent diagnostic laparoscopy in our department. We found a small bowel perforation in one of the cases of blunt trauma that was repaired by externalization of the jejuna loop by one of the ports. In the other two cases we found intestinal and mesenteric contusions and free fluid that were treated by peritoneal drainage. One of the cases of penetrating trauma presented omentum evisceration with no other injuries and the second presented a gastric perforation that needed reconversion to laparotomy. In our experience and according to literature, laparoscopy should be taken into account as a diagnostic procedure and sometimes also therapeutic in selected cases of both blunt and penetrating abdominal trauma in pediatric population.

Laparoscopia como método diagnóstico-terapéuticoen el traumatismo abdominal en la edad pediátrica / Laparoscopy as diagnostic-therapeutic method in abdominal traumatism in the pediatric age

El trauma abdominal cerrado con líquido libre sin evidencia de lesión de víscera sólida, así como el penetrante con dudosa afectación peritoneal suponen un reto diagnóstico y terapéutico. Presentamos tres casos de traumatismo abdominal cerrado y dos penetrante que fueron sometidos en nuestro centro a laparoscopia diagnóstica. Los cinco pacientes se encontraban hemodinámicamente estables. De los traumatismos cerrados, en uno se evidenció una perforación a nivel de íleondistal que fue reparada. Los otros dos casos presentaban distensión de asas y líquido que se drenó sin evidenciar otras lesiones. De los dos casos de traumatismo penetrante en uno de ellos se redujo el epiplón eviscerado por la herida sin evidenciar otras lesiones y en el otro se diagnosticó una perforación a nivel gástrico que se reparó mediante laparotomía La laparoscopia, por tanto, puede tener un papel diagnóstico y en ocasiones también terapéutico en casos seleccionados de traumatismo abdominal tanto penetrante como cerrado (AU)

The management of blunt abdominal traumatism with a moderate amount of free peritoneal fluid and without solid organ injury as wellas the one of minimal penetrating trauma is controversial. We present three cases of blunt abdominal trauma and two of penetrating trauma that underwent diagnostic laparoscopy in our department. We found as mall bowel perforation in one of the cases of blunt trauma that was repaired by externalization of the jejuna loop by one of the ports. In the other two cases we found intestinal and mesenteric contusions and free fluid that were treated by peritoneal drainage. One of the cases of penetrating trauma presented omentum evisceration with no other injuries and the second presented a gastric perforation that needed reconversion to laparotomy. In our experience and according to literature, laparoscopy should be taken into account as a diagnostic procedure and sometimes also therapeutic in selected cases of both blunt and penetrating abdominal trauma in pediatric population (AU)

Cirugía laparoscópica en pacientes con válvula de derivación ventrículo-peritoneal / Minimally invasive surgery in pediatric patients with ventriculo-peritoneal shunts

Clásicamente ha existido controversia en cuanto a la realización de intervenciones laparoscópicas en los pacientes portadores de válvulas de derivación ventrículo-peritoneales (VDVP), por la posibilidad de desarrollo de hipertensión intracraneal durante la cirugía, el riesgo deinfecciones del sistema de derivación o la presencia de adherencias peritoneales. Presentamos los resultados de los pacientes de estas características tratados en nuestro centro. Se han realizado 16 intervenciones laparoscópicas en pacientes portadores de VDVP. El procedimiento más frecuente fue la cirugía antirreflujo. Durante las intervenciones no se evidenciaron episodios de hipertensión intracraneal. Durante 2 de las cirugías programadas la presencia de adherencias y líquido tabicado aumentó la complejidad del procedimiento. No hubo complicaciones intraoperatorias. En los seis meses siguientes sólo fue preciso recambiar una de las válvulas en los casos de cirugía limpia y limpia-contaminada. Según nuestra experiencia, por tanto, la laparoscopia en portadoresde VDVP es factible, puede resultar más compleja pero no parece aumentar la tasa de infecciones del sistema. Estos niños pueden por consiguiente beneficiarse de las ventajas de la laparoscopia y sus indicaciones (AU)

The use of laparoscopy in patients with ventriculo-peritoneals hunts has been controversial. There is concern about the risk malfunction or infection of the shunt as well as about the possibility of adhesions that could make the surgical procedures too difficult to be undertaken by minimally invasive surgery. We present our results inpediatric patients with ventriculoperitoneal shunts that have undergonel aparoscopic procedures in our department. We have performed16 surgical procedures. The most frequent indication was fundoplication. During surgery there were no complications or intracranial hypertension episodes. Two of the procedures were considered by the surgeons more difficult and longer than usual. None of them required conversion to open technique. One shunt had to be replaced after surgery because of infection. According to our experience minimallyinvasive surgery is feasible and safe in pediatric patients with ventriculo-peritoneal shunts (AU)

[Minimally invasive surgery in pediatric patients with ventriculo-peritoneal shunts]. / Cirugía laparoscópica en pacientes con válvula de derivación ventrículo-peritoneal.

The use of laparoscopy in patients with ventriculo-peritoneal shunts has been controversial. There is concern about the risk malfunction or infection of the shunt as well as about the possibility of adhesions that could make the surgical procedures too difficult to be undertaken by minimally invasive surgery. We present our results in pediatric patients with ventriculoperitoneal shunts that have undergone laparoscopic procedures in our department. We have performed 16 surgical procedures. The most frequent indication was fundoplication. During surgery there were no complications or intracranial hypertension episodes. Two of the procedures were considered by the surgeons more difficult and longer than usual. None of them required conversion to open technique. One shunt had to be replaced after surgery because of infection. According to our experience minimally invasive surgery is feasible and safe in pediatric patients with ventriculo-peritoneal shunts.

Birth weight variation according to maternal characteristics and gestational weight gain in Brazilian women.

OBJECTIVES: This study aims to identify birth weight variation according to maternal characteristics and gestational weight gain. METHODS: It is a cross-sectional descriptive study with 433 puerperal women (> or = 20 years old) who attended a public maternity hospital in Rio de Janeiro. The data were collected through interviews with the women and access to their medical records. Several models were tested using linear regression, using the stepwise method to identify the predictive variables of birth weight. RESULTS: The mean maternal age and gestational age at the end of pregnancy were 27 years old (+/- 5.09 years) and 39 weeks (+ 1.68 weeks), respectively. The data shows that the mean number of prenatal and nutritional prenatal care appointments were 8.24 (+/- 2.98) and 2.26 (+/- 2.33), respectively. Among the predictor variables of birth weight, total gestational weight gain (beta = 25.29; p = 0.000), pre-gestational BMI (beta =13.02; p = 0.037), and the number of pre-natal care appointments (beta = 28.21; p = 0.007) were highlighted. The association of weight gain in the three trimesters was also verified. CONCLUSIONS: This study confirms the interface between adequacy of the pre-gestational and gestational nutritional status and some maternal characteristics with birth weight. Nutritional care should be recognised as part of the actions during pre-natal assistance.

Birth weight variation according to maternal characteristics and gestational weight gain in Brazilian women / Variación del peso corporal en función de las características maternas y la ganancia de peso gestacional en mujeres brasileñas

Objective: This study aims to identify birth weight variation according to maternal characteristics and gestational weight gain. Methods: It is a cross-sectional descriptive study with 433 puerperal women (beta 20 years old) who attended a public maternity hospital in Rio de Janeiro. The data were collected through interviews with the women and access to their medical records. Several models were tested using linear regression, using the stepwise method to identify the predictive variables of birth weight. Results: The mean maternal age and gestational age at the end of pregnancy were 27 years old (± 5.09 years) and39 weeks (+ 1.68 weeks), respectively. The data shows that the mean number of prenatal and nutritional prenatal care appointments were 8.24 (± 2.98) and 2.26 (± 2.33), respectively. Among the predictor variables of birthweight, total gestational weight gain (beta= 25.29; p = 0.000), pre-gestational BMI (beta=13.02; p = 0.037), and the number of pre-natal care appointments (beta= 28.21; p = 0.007)were highlighted. The association of weight gain in the three trimesters was also verified. Conclusions: This study confirms the interface between adequacy of the pre-gestational and gestational nutritional status and some maternal characteristics with birth weight. Nutritional care should be recognised as part of the actions during pre-natal assistance (AU)

Objetivo: Este estudio tiene por objeto identificar la variación de peso al nacimiento en función de las características maternas y la ganancia de peso gestacional. Métodos: Se trata de un estudio transversal y descriptivo con 433 mujeres puérperas (beta 20 años de edad) que acudieron a un hospital maternal de Río de Janeiro. Se recogieron los datos mediante entrevistas con las mujeres y acceso a sus historiales clínicos. Se ensayaron diversos modelos utilizando la regresión linear y el método por pasos para identificar las variables predictivas del peso al nacimiento. Resultados: La edad media materna y la edad gestacional al final del embarazo fueron 27 años (± 5,09 años) y 39semanas (± 1,68 semanas), respectivamente. Los datos muestran que el número medio de visitas prenatales y de educación nutricional prenatal fue de 8,24 (± 2,98) y 2,26 (± 2,33), respectivamente. Entre las variables predictivas del peso al nacimiento, destacaban la ganancia total de peso gestacional (beta= 25,29; p = 0.000), el IMC pre-gestacional(beta= 13,02; p = 0,037) y el número de visitas prenatales (beta= 28,21; p = 0,007). También se verificó la asociación de ganancia de peso en los tres trimestres del embarazo. Conclusiones: Este estudio confirma la interrelación entre un estado nutricional pre-gestacional y gestacional adecuado y algunas características maternas con el peso al nacimiento. Debería reconocerse la atención nutricional como parte de las acciones de la asistencia prenatal (AU)

[Rectocolonic plasty using mechanical stapler as a surgical solution in complications of megacolon]. / Rectocoloplastia con sutura mecánica como solución quirúrgica en las complicaciones del megacolon.

Hirschsprung's disease surgically treated with Duhamel's technique in which no mechanical suture has been used, usually presents, as main complication, cronic constipation, due to fecalomas in the rectal pouch. In our experience (30 cases plus four patients sent to our hospital for reintervention), this complication is not present when mechanical suture is introduced to the Duhamel's Technique. This allows us to assure that perineal rectocoloplasty, with auto-suture material is a precise optional treatment, with excellent results and allows the chance of not going through laparotomy in those cases that require reintervention.

[Intestinal anastomosis by biodegradable rings]. / Anastomosis intestinal mediante anillos biofragmentables.

During an 9-month period (March to November 1992), six children underwent an intestinal anastomosis by means of a biofragmentable ring (BAR). Patients ages ranged from 5 to 16 years old. There were no mayor complications at surgery. The main technical problems was the difference of size between BAR and intestinal lumen. No patients in which BAR was used have presented fistulae, dehiscence or anastomotical stenosis.