Initial needle tracking with the first standalone combined infrared camera - CT system for brachytherapy-analysis of tracking accuracy and uncertainties.

PURPOSE: A prototype infrared camera - cone-beam computed tomography (CBCT) system for tracking in brachytherapy has recently been developed. We evaluated for the first time the corresponding tracking accuracy and uncertainties, and implemented a tracking-based prediction of needles on CBCT scans. METHODS: A marker tool rigidly attached to needles was 3D printed. The precision and accuracy of tool tracking was then evaluated for both static and dynamic scenarios. Euclidean distances between the tracked and CBCT-derived markers were assessed as well. To implement needle tracking, ground truth models of the tool attached to 200 mm and 160 mm needles were matched to the tracked positions in order to project the needles into CBCT scans. Deviations between projected and actual needle tips were measured. Finally, we put our results into perspective with simulations of the system's tracking uncertainties. RESULTS: For the stationary scenario and dynamic movements, we achieved tool-tracking precision and accuracy of 0.04 ± 0.06 mm and 0.16 ± 0.18 mm, respectively. The tracked marker positions differed by 0.52 ± 0.18 mm from the positions determined via CBCT. In addition, the predicted needle tips in air deviated from the actual tip positions by only 1.62 ± 0.68 mm (200 mm needle) and 1.49 ± 0.62 mm (160 mm needle). The simulated tracking uncertainties resulted in tip variations of 1.58 ± 0.91 mm and 1.31 ± 0.69 mm for the 200 mm and 160 mm needles, respectively. CONCLUSION: With the innovative system it was possible to achieve a high tracking and prediction accuracy of marker tool and needles. The system shows high potential for applicator tracking in brachytherapy.

Paravalvular leak closure after TAVI with plugs: A literature review with a specific focus on arterio-arterial loop.

More than mild paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) is associated with a twofold increase in all-cause mortality, heart failure hospitalizations, and the need for reintervention. Successfully addressing PVL in TAVIs is more challenging than in surgical valves. The arterial-arterial (A-A) rail technique emerges as a valuable strategy for post-TAVI PVL closure, enhancing success rates by enabling the effective use of lower-profile vascular plug devices. When standard approach is ineffective, generating an A-A loop for post-TAVI PVL closure is probably the most recommended strategy to ensure procedural success.

Association between Myometrial Thickness and Assisted Reproductive Technologies Outcomes: A Prospective Cohort Study.

BACKGROUND: Myometrial thickness has been expected to be a prognosticator for lower uterine segment function. An abnormal function of the uterine muscle layer can cause common and important reproductive problems. This study aimed to evaluate the relationship between baseline myometrial thickness and assisted reproductive technologies (ART) outcomes. MATERIALS AND METHODS: In this prospective cohort study, 453 infertile women undergoing ART cycles without any obvious uterine pathology, participated in this prospective cohort study from February 2013 to May 2015. In order to measure the myometrial thickness in the anterior and posterior of the uterine, trans-vaginal ultrasounds were conducted on days 2-4 of the cycle (menstrual phase) preceding ovarian stimulation and the day of human chorionic gonadotropin (hCG) injection. We defined three groups based on the baseline myometrial thickness in the anterior and posterior, including (A) <25 mm, (B) 25-29.9 mm and (C) ≥30 mm. Ovarian stimulation, oocyte retrieval and luteal phase support were performed in accordance with the standard long protocol. Two weeks after embryo transfer, the patients underwent a pregnancy test by checking their serum ß-hCG levels. The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were, implantation rate, abortion rate and live birth rate. RESULTS: The clinical pregnancy (P=0.013) and implantation (P=0.003) rates were significantly lower in group A than in two other groups. Although the live birth rate was lower in group A than two other groups, this decrease was not statistically significant (P=0.058). CONCLUSION: The findings may be a way for clinicians to draw focus on providing therapeutic strategies and a specific supportive care for women with a baseline myometrial thickness <25 mm in order to improve the reproductive outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI).

Non-monotonic effects of Bisphenol A Dimethacrylate on male mouse reproductive system and fertility leads to impaired conceptive performance.

As an estrogenic agent, Bisphenol A Dimethacrylate (Bis-DMA) may incite alterations in both the reproductive tract and the neuroendocrine axis, and thus have the potential to affect the proper development, maturity and conceptive performance in animals. We investigated the consequences of 14 weeks of exposure to different concentrations of Bis-DMA on male mouse conceptive performance. Male mice were exposed to Bis-DMA (0, 0.1 mg/L, 1.0 mg/L or 10 mg/L) via drinking water, and the effects on fertility, reproductive organ weights, reproductive hormone levels, sperm counts and testicular histology were assessed. We clearly demonstrate that prolonged exposure of male mice to Bis-DMA negatively affects fertility and reproduction causing significant reductions in sperm counts, non-monotonic effects on serum LH and testosterone levels, increased seminal vesicle weights, lower number of embryonic implantations and viable fetuses, as well as, increased embryonal resorptions in females mated by Bis-DMA treated males. Furthermore, Bis-DMA caused abnormalities in testicular infrastructure with atrophic seminiferous tubules exhibiting intraepithelial vacuolization and disorganization, loss and shedding of germ cells into the lumen, and presence of apoptotic cells. Our data collectively suggest that Bis-DMA adversely affects male fertility and reproduction by interference with normal hormone signaling in the testis, inducing changes in testicular infrastructure and ultimately leading to impaired reproductive function and fertility.

Clinical and Anatomic Outcomes of 3-Piece Poly(methyl methacrylate) Intraocular Lens Rescue and Needle-Assisted Transconjunctival Intrascleral Lens Fixation.

Purpose: To report the clinical and anatomic outcomes of a single-stage rescue and sutureless 30-gauge needle-assisted transconjunctival intrascleral fixation of dislocated 3-piece rigid poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs). Methods: This retrospective noncomparative single-surgeon interventional study comprised eyes that had concurrent 23- or 25-gauge pars plana vitrectomy and IOL rescue with sutureless transconjunctival needle-assisted flanged haptic intrascleral fixation. Lamellar scleral dissection for haptic fixation was performed 3 mm posterior to the surgical limbus with 30-gauge needles. Primary endpoints included visual acuity (VA), IOL tilt measured with ultrasound biomicroscopy (UBM), and postoperative complications. Results: The study evaluated 25 eyes of 24 patients. The IOL was successfully refixated in 24 of the 25 eyes. The mean preoperative logMAR VA of 1.21 ± 0.79 SD (median 1.3; Snellen equivalent 20/400) improved to 0.28 ± 0.35 (median 0.14; Snellen equivalent 20/30) postoperatively (P < .0001). The mean IOL tilt measured by UBM (n = 7) was 3.79 ± 3.60 degrees. The mean postoperative follow-up was 348 ± 284 days (range, 7-979 days). Postoperative complications included self-clearing vitreous hemorrhage (n = 9), retinal detachment (RD) (n = 1), cystoid macular edema (n = 3), and corneal edema (n = 3). Three eyes (13%) required additional surgery, 1 for RD and 2 for delayed haptic slippage and secondary IOL tilt causing irregular astigmatism. Conclusions: Intrascleral needle-assisted fixation of dislocated or mobile 3-piece PMMA IOLs is an effective, safe method to restore VA.

Influence of Prosthodontic Rehabilitation Using Zygomatic Implants in Covid 19 Related Mucormycosis (Rhino-Orbital-Cerebral) Maxillectomy Patients Upon Post-Operative Stress, Anxiety and Functional Impairment: A Prospective Cohort Study.

Purpose: To determine the influence of prosthodontic rehabilitation using zygomatic implants in partial maxillectomy upon post-operative stress, anxiety and functional impairment, due to covid 19 associated rhino-orbital-cerebral mucormycosis (ROCM). Patients and Methods: Twenty maxillectomy patients fulfilling study criterion, received zygomatic implants (ZI) (quad zygoma) (ZDI Simpladent, Switzerland) retained/supported complete maxillary denture. Assessment of stress, anxiety, masticatory performance and speech were determined using diurnal salivary cortisol level, Appearance Anxiety Inventory, multiple sieve technique and auditory perception analysis, respectively. Data were recorded at 6 different stages of rehabilitation (after maxillectomy, implant placement, and after prosthesis delivery (1 week, 1 month, 6 months and 1 year)). Demographic data were expressed as frequency distribution, while mean values were used to find differences between various rehabilitation stages using Friedman and chi-square test with statistical significance value at p < 0.05. Results: Average daily salivary cortisol levels declined from post maxillectomy (22.80 ± 0.902) to 1 year after prosthesis wearing (8.65 ± 0.985), indicating stress reduction after ZI rehabilitation. Mean scores for appearance anxiety reduced from pre-prosthetic rehabilitation (27.350 ± 3.030) to 1 year (8.950 ± 0.887) following prosthesis wearing. Functional parameters for mastication and speech also improved significantly during the course of rehabilitation. All differences between pre-prosthetic to 1-year stage after prosthesis wearing were found to be statistically significant at p < 0.05. Conclusion: Post ROCM maxillectomy cases after prosthetic rehabilitation using zygomatic implants showed significant improvement in the psychological (stress and anxiety) as well as function (mastication and speech) characteristics. Rehabilitation post ROCM maxillectomy with the present approach of fixed prosthesis using zygomatic implants mitigates deficient mastication and speech. It also impacts positively on patient psychology by decreasing stress and anxiety.

Prosthetic Mitral Valve Endocarditis Complicated by Left Ventricular Pseudoaneurysm.

Left ventricular pseudoaneurysm is a rare complication that can result from mitral valve replacement. Proper follow-up imaging can help to detect this potentially fatal complication and identify areas of concern. Infective endocarditis following mitral valve replacement can occur and further lead to the development of a pseudoaneurysm. We describe a case of left ventricular aneurysm in the setting of infective endocarditis following mitral valve replacement and present radiologic images from various modalities detailing the major findings.

PEGylated Manganese-Zinc Ferrite Nanocrystals Combined with Intratumoral Implantation of Micromagnets Enabled Synergetic Prostate Cancer Therapy via Ferroptotic and Immunogenic Cell Death.

Therapeutic efficacy for prostate cancer is highly restricted by insufficient drug accumulation and the resistance to apoptosis and immunogenic cell death (ICD). Although enhanced permeability and retention (EPR) effect of magnetic nanomaterials could benefit from external magnetic field, it falls off rapidly with increased distance from magnet surface. Considering the deep location of prostate in pelvis, the improvement of EPR effect by external magnetic field is limited. In addition, apoptosis resistance and cGAS-STING pathway inhibition-related immunotherapy resistance are major obstacles to conventional therapy. Herein, the magnetic PEGylated manganese-zinc ferrite nanocrystals (PMZFNs) are designed. Instead of providing external magnet, micromagnets into tumor tissues are intratumorally implanted to actively attract and retain intravenously-injected PMZFNs. As a result, PMZFNs accumulate in prostate cancer with high efficacy, depending on the established internal magnetic field, which subsequently elicit potent ferroptosis and the activation of cGAS-STING pathway. Ferroptosis not only directly suppresses prostate cancer but also triggers burst release of cancer-associated antigens and consequently initiates ICD against prostate cancer, where activated cGAS-STING pathway further amplifies the efficacy of ICD by generating interferon-ß. Collectively, the intratumorally implanted micromagnets confer a durable EPR effect of PMZFNs, which eventually achieve the synergetic tumoricidal efficacy with negligible systemic toxicity.

The economics of TAVI: A systematic review.

Objective: The scope of this systematic review is to update the existing body of evidence regarding the cost-effectiveness of transcatheter aortic valve implantation, stratified across all risk categories, and to assess their methodological quality. Methods: A systematic review was performed including published cost-effectiveness analyses of heart valve implantations. The quality was assessed with the Quality of Health Economics Tool. Results: We identified 33 economic evaluations of transcatheter aortic heart valve implantations. Results were not consistent, ranging from dominant to dominating. Moreover, the models were sensitive to an array of variables. The methodological quality of the studies was good. Conclusion: This systematic review led to inconclusive and inconsistent results pertinent to the economic profile of TAVI technology. It also highlighted areas which merit further research regarding the pillars of cost-effectiveness analysis such as modeling, the extrapolation of available data and the uncertainty of the evidence. A thorough assessment of the patient should proceed any decision-making.

Radical cystectomy and orthotopic neobladder in a patient with a preexisting three-components inflatable penile prosthesis.

INTRODUCTION AND OBJECTIVES: As erectile dysfunction is more commonly being diagnosed and treated with a preexisting inflatable penile prosthesis (IPP) insertion at younger ages, surgeons will increasingly encounter pre-placed abdominal reservoirs when performing pelvic surgery. MATERIALS AND METHODS: A 69-year-old Caucasian man with BCG refractory carcinoma-in-situ (CIS) and past history of non-invasive high-grade urothelial carcinoma of the bladder was a candidate for a radical cystectomy and an ileal-neobladder diversion. He had a three-components IPP inserted for the treatment of Peyronie disease and organic erectile dysfunction (ED). During the radical cystectomy the reservoir was encapsulated on the left lateral pelvic wall over the external iliac vessels. It was isolated and IPP was inflated to reduce the reservoir size. After accurate disinfection, the reservoir was removed from Retzius space without disconnecting it from the pump. Then, the radical cystectomy was carried out without any intraoperative complications and Studer ileal orthotopic neobladder was performed. At the end of the surgery, the reservoir was disinfected with the Mulcahy protocol and then placed in the same position. RESULTS: A week after catheter removal the IPP was successfully activated. The patient's postoperative recovery was uneventful and no postoperative complication occurred. Definitive histological examination described a multifocal urothelial carcinoma of the bladder: pG3Tis N0 R0. The patient reports excellent functionality of the penile prosthesis and is currently using it. CONCLUSIONS: Sexual functionality preservation in oncologic patients should be pursued when possible. In this report, the functionality of the IPP was preserved, while still performing oncologically radical procedures. A multicenter study is needed to assure more solid recommendations on this rare procedure that is surely burdened by a lot of risks.

Intraocular lens power calculation formulas: a scientometric analysis.

Background: The most accurate method of intraocular lens (IOL) power calculation in cataract surgery has not been determined, and further studies are needed to reach a consensus. The aim of this study was to assess publications related to IOL power calculation formulas, mapping their yearly trends, most productive authors, top publishing countries and institutions, and areas of specialization for IOL power formulas. Methods: We conducted a comprehensive analysis of research articles published on the topic of IOL power calculation formulas. Using PubMed, we employed appropriate search terms and filtered the results for the period of January 1, 1946, to June 28, 2023. Data were analyzed using CiteSpace, VOSviewer, and Microsoft Excel programs. The visual representations of the collected data through the use of figures was provided to demonstrate the aspects of IOL power calculation research. Results: We retrieved 5475 documents in the initial search. Analysis of these documents revealed an increase in the number of publications, from one publication in 1946 to 201 publications in 2023. The top three countries contributing to these publications were the United States, China, and Japan, collectively accounting for over 27% of the total articles. However, the two institutions with the highest contributions were located in the United Kingdom and Hungary, neither of which was among the top 10 countries in overall contributions. Overall 15 326 authors contributed to publications pertaining to IOL power calculation formulas. Among these authors, the most prolific contributors included Achim Langenbucher from Saarland University (Germany), Giacomo Savini from G.B. Bietti Foundation I.R.C.C.S. (Italy), and Kenneth J Hoffer from the University of California (United States). Saarland University emerged as the most productive institution, contributing equally to two distinct departments: the Dr. Rolf M. Schwiete Center for Limbal Stem Cell Research and Congenital Aniridia, as well as the Department of Experimental Ophthalmology. The School of Physical Science at the Open University in the United Kingdom engaged in partnership with various institutions including Eye & Laser Clinic Castrop Rauxel in Germany and Johannes Kepler University Linz in Austria. Among the top 10 keywords found in the publications were "cataract", "cataract surgery", and "intraocular lens". Conclusions: This study represents the first scientometric analysis of publications related to IOL power calculation formulas. The study offers valuable insights into the geographic distribution, contributing authors, and emphasis of research on the IOL power calculation formulas. Further cooperation is essential to pinpoint the most suitable formula and to address gaps in our current understanding.

Impact of the extension of the anterior-posterior spread on quality of life and satisfaction of patients treated with implant-retained mandibular overdentures - a randomized clinical trial.

OBJECTIVES: To compare the degree of satisfaction (SD) and the impact on oral health-related quality of life (OHRQoL) of edentulous patients treated with conventional complete dentures (CCDs) and mandibular overdentures (IODs) with a short anteroposterior spread (S-APS) or a large antero-posterior spread (L-APS). MATERIALS AND METHODS: Edentulous patients were treated with CCDs and subsequently randomly allocated to receive a bar clip mandibular overdenture retained by 2 interforaminal implants (Control) or 4 (Test: 2 additional implants distal to the mental foramen). The Oral Health Impact Profile Edent questionnaire (OHIP-20E) and the Visual Analogue Scale (VAS) were applied at a mean follow-up of 38.5 months to assess the impact on OHRQoL and DS, respectively. Comparisons between the type of prosthesis and the extension of the AP spread were made with Student's t test for paired samples and for independent samples, respectively, at a significance level of 5%. RESULTS: The IODs had significantly lower OHRQoL values ​​in the dimensions "functional limitation" (p=0.03), "physical pain" (p=0.02), "psychological discomfort" (p<0.01), "disability physical" (p<0.01) and "general score" (p<0.01) (n=20 patients). The IODs presented DS values ​​significantly for "aesthetics" (p=0.04), "stability" (p=0.03), "masticatory capacity" (p<0.01), "function" (p<0.01) and "oral condition" (p=0.03). The S-APS group (control) resulted in significantly lower values ​​in the dimensions "physical pain" (p<0.01) and "general score" (p<0.01) and no domain with statistical difference in the VAS scale. CONCLUSIONS: IODs significantly improved OHRQoL and DS. The increase in AP spread did not result in benefits for the patient's OHRQOL and DS in this clinical study. (Study Protocol Number: 1.452.492) CLINICAL SIGNIFICANCE: Implantology has experienced in the last 20 years a permanent evolution that aim at increasing predictability and improving long-term clinical performance. Placement of short implants distally to the mental foramen, for instance, and the resulting increase of the anterior-posterior spread, is a promising approach and is worthy of investigation.

Ultrastretchable Organogel/Silicone Fiber-Helical Sensors for Self-Powered Implantable Ligament Strain Monitoring.

Implantable sensors with the abilities of real-time healthcare monitoring and auxiliary training are important for exercise-induced or disease-induced muscle and ligament injuries. However, some of these implantable sensors have some shortcomings, such as requiring an external power supply or poor flexibility and stability. Herein, an organogel/silicone fiber-helical sensor based on a triboelectric nanogenerator (OFS-TENG) is developed for power-free and sutureable implantation ligament strain monitoring. The OFS-TENG with high stability and ultrastretchability is composed of an organogel fiber and a silicone fiber intertwined with a double helix structure. The organogel fiber possesses the merits of rapid preparation (15 s), good transparency (>95%), high stretchability (600%), and favorable stability (over 6 months). The OFS-TENG is successfully implanted on the patellar ligament of the rabbit knee for the real-time monitoring of knee ligament stretch and muscle stress, which is expected to provide a solution for real-time diagnosis of muscle and ligament injuries. The prepared self-powered OFS-TENG can monitor data on human muscles and ligaments in real-time.

Biomedical IoT: Enabling Technologies, Architectural Elements, Challenges, and Future Directions.

This paper provides a comprehensive literature review of various technologies and protocols used for medical Internet of Things (IoT) with a thorough examination of current enabling technologies, use cases, applications, and challenges. Despite recent advances, medical IoT is still not considered a routine practice. Due to regulation, ethical, and technological challenges of biomedical hardware, the growth of medical IoT is inhibited. Medical IoT continues to advance in terms of biomedical hardware, and monitoring figures like vital signs, temperature, electrical signals, oxygen levels, cancer indicators, glucose levels, and other bodily levels. In the upcoming years, medical IoT is expected replace old healthcare systems. In comparison to other survey papers on this topic, our paper provides a thorough summary of the most relevant protocols and technologies specifically for medical IoT as well as the challenges. Our paper also contains several proposed frameworks and use cases of medical IoT in hospital settings as well as a comprehensive overview of previous architectures of IoT regarding the strengths and weaknesses. We hope to enable researchers of multiple disciplines, developers, and biomedical engineers to quickly become knowledgeable on how various technologies cooperate and how current frameworks can be modified for new use cases, thus inspiring more growth in medical IoT.

Maternal serum leptin in the pregnant rat: fetal-placental implantation number and progesterone.

PURPOSE: This study was designed to determine whether there is a role of the placenta in the regulation of maternal serum leptin levels in the pregnant rat. METHODS: We have adjusted the number of fetal-placental implants on day 9 in the pregnant rat by aspirating fetal-placental units to adjust the number to 1-2, 4-5 per rat or >10 in controls. Serum levels of leptin and progesterone were determined by radioimmunoassay. A separate group of pregnant rats were ovariectomized and maintained with progesterone silastic capsules (10, 20 or 40 mm). RESULTS: In the pregnant rats with varied fetal-placental implant numbers, the maternal serum leptin were greatest in the group with the smallest number (1-2) of implants; intermediate in the midgroup (4-5 implants); and lowest in the group with a full complement of implantations (>10) (p < 0.001). Serum progesterone levels are lowest in the 1-2 implantation group. In the ovariectomized rats there was a stepwise decline in serum leptin (p < 0.05) as the dose of progesterone increased (p < 0.01). Both of these studies suggest that progesterone suppressed maternal serum leptin levels. CONCLUSIONS: Increasing placental mass is not associated with increasing maternal serum leptin levels in the pregnant rat; the contrary condition is observed with the least placental implants having the highest leptin levels. Progesterone seems to suppress serum leptin levels in several physiological models.

A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots.

The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.

Selection of the optimal first ear for sequential bilateral cochlear implantation in children.

OBJECTIVES: When there is a difference in hearing on both ears, where to perform the first cochlear implantation (CI) becomes an important issue. The purpose of the study was to evaluate which ear should be chosen for the first implantation in sequential bilateral CI with a long inter-implant period. METHODS: The study population consisted of 34 severe-to-profound sensorineural hearing loss pediatrics with the inter-implant period of ≥3 years between the first CI (CI-1) and the second CI (CI-2) before the age of 19 (mean of inter-implant period: 7.1-year). The patients were classified into Group A (CI-1 was performed on the ear with better hearing), Group B (CI-1 on the ear with worse hearing), or Group C (symmetrical hearing in both ears). Speech intelligibility test results were compared between the groups. RESULTS: The monosyllabic word scores of CI-1 were excellent in Groups A (91.7±7.9%) and B (92.5±3.6%) but slightly lower in Group C (85.7±14.9%) before the second implantation (P = .487). At 3 years after the second implantation, all groups demonstrated excellent scores in the bilateral CI condition (95.9±3.0% in Group A; 99.1±.8% in Group B; 97.5±2.9% in Group C, P = .600). However, when the patients were tested in using CI-2 only in Groups A and B after using bilateral CI for 3 years, the scores were inconsistent in Group A (79.6±23.9%; range: 22.2-94.4%), while those were higher and more constant in Group B (92.9±4.8%; 86.8-100.0%). CONCLUSIONS: The first CI is strongly recommended to perform on a worse hearing ear if they had different hearing levels between ears. Even with the first CI on a worse hearing ear, its performance never deteriorates. In addition, if they receive the second CI several years later, it will be likely that the second one functions better.

Tercer episodio de doble contractura capsular unilateral posterior a mamoplastia de aumento / Third episode of unilateral double capsular contracture after breast augmentation

Resumen La mamoplastia de aumento consiste en insertar una prótesis dentro del tejido mamario con el fin de alterar su tamaño y forma. Actualmente, se utilizan varios tipos de implantes según su forma, tamaño y material, así como diferentes variaciones en la técnica quirúrgica. Se han descrito complicaciones asociadas por ser considerados cuerpos extraños y la más común es la contractura capsular. Se presenta el caso de una paciente de 41 años a quien se le realizó mamoplastia de aumento con implantes de silicona y de forma atípica presentó un episodio de doble contractura capsular que requirió dos intervenciones adicionales por asimetría y dolor cambiando el implante y nuevamente presentando el mismo fenómeno de manera unilateral en la mama izquierda.

Abstract Augmentation mammoplasty consists of inserting a prosthesis into the breast tissue in order to alter its size and shape. Currently, several types of implants are used according to their shape, size and material, as well as different variations in the surgical technique. Associated complications have been described because they are considered foreign bodies and the most common is capsular contracture. We present the case of a 41 year old patient who underwent augmentation mammoplasty with silicone implants and atypically presented an episode of double capsular contracture that required two additional interventions due to asymmetry and pain by changing the implant and again presenting the same phenomenon unilaterally in the left breast.

Insulin signaling is an essential regulator of endometrial proliferation and implantation in mice.

Insulin signaling is critical for the development of preovulatory follicles and progression through the antral stage. Using a conditional knockout model that escapes this blockage, we recently described the role of insulin signaling in granulosa cells during the periovulatory window in mice lacking Insr and Igf1r driven by Pgr-Cre. These mice were infertile, exhibiting defects in ovulation, luteinization, steroidogenesis, and early embryo development. Herein, we demonstrate that while these mice exhibit normal uterine receptivity, uterine cell proliferation and decidualization are compromised resulting in complete absence of embryo implantation in uteri lacking both receptors. While the histological organization of double knockout mice appeared normal, the thickness of their endometrium was significantly reduced. This was supported by the reduced proliferation of both epithelial and stromal cells during the preimplantation stages of pregnancy. Expression and localization of the main drivers of uterine proliferation, ESR1 and PGR, was normal in knockouts, suggesting that insulin signaling acts downstream of these two receptors. While AKT/PI3K signaling was unaffected by insulin receptor ablation, activation of p44/42 MAPK was significantly reduced in both single and double knockout uteri at 3.5 dpc. Overall, we conclude that both INSR and IGF1R are necessary for optimal endometrial proliferation and implantation.

Cochlear implant in patients with autistic spectrum disorder-a systematic review.

INTRODUCTION: In cases of autism spectrum disorders with severe to profound hearing loss, cochlear implant is a therapeutic option. OBJECTIVE: To identify evidence in the scientific literature that the cochlear implant brings benefits to people with autism spectrum disorders with associated hearing loss. METHODS: Systematic review of the literature based on the criteria recommended by PRISMA. The population, intervention, comparison, outcomes, study design, PICOS strategy, was used to define the eligibility criteria. The studies that met the inclusion criteria for this second stage were included in a qualitative synthesis. Each type of study was analyzed according to the Joanna Briggs Institute's risk of bias assessment through the critical checklist for cohort studies, prevalence studies and critical criteria and case reports. RESULTS: Four hundred and eighty-four articles were found in eight databases and 100 in the gray literature, mentioning the relationship between cochlear implants in patients with autism spectrum disorder and hearing loss. Twelve articles were read in full and 7 were selected for qualitative analysis in this systematic review. All seven articles were analyzed on the critical evaluation checklist. Four articles had a low risk of bias and three articles had a moderate risk of bias. In this study, were included 66 patients with autism spectrum disorder and hearing loss who received cochlear implant. CONCLUSION: This systematic review indicates that a cochlear implant can bring benefits to autism spectrum disorder patients with associated deafness.