Tooth avulsion accidents due to urgent and emergency orotracheal intubation.

BACKGROUND: Intubation is necessary during critical situations to reduce the risk of death. In Brazil, a need exists to determine the prevalence of tooth avulsions in emergency and urgent care. The objective of this study was to identify the causes of orotracheal intubation (OTI), the number of tooth avulsions, and the avulsed teeth that result from urgent and emergency intubation. MATERIAL AND METHODS: The sample consisted of 116 patients (total group) in intensive care units (ICUs) distributed across Group 1 (G1), which was composed of 71 patients from an urgent-care hospital, and Group 2 (G2), which was composed of 45 patients from an emergency hospital. Clinical examinations showed dental alveolus with signs of recent exodontia in the upper and lower anterior regions. Sociodemographic data and the reason for intubation were evaluated. The Shapiro-Wilk normality test, chi-square test, Fisher's exact test, Mann-Whitney U test, and univariate logistic regression were performed with a significance level of 5%. RESULTS: The avulsion prevalence was 4.3%, with more cases receiving emergency intubation (n=4). All avulsions occurred in adults, and a significant difference (p=0.011) was observed with regard to the elderly. A 1-year reduction in age increased the chance of tooth avulsion during intubation by 1.09 times; being female increased the chance by 2.88 times. CONCLUSION: Pulmonary problems were the major causes of intubation, with the highest tooth avulsion prevalence observed during emergency intubation. The avulsed teeth were 11, 12, 13, 22, 32, and 33 across all cases.

Do we need to measure progesterone in oocyte donation cycles? A retrospective analysis evaluating cumulative live birth rates and embryo quality.

STUDY QUESTION: Does late follicular-phase elevated serum progesterone (LFEP) during ovarian stimulation for oocyte donation have an impact on embryo quality (EQ) and cumulative live birth rate (CLBR)? SUMMARY ANSWER: LFEP does not have an influence on EQ nor CLBR in oocyte donation cycles. WHAT IS KNOWN ALREADY: Ovarian stimulation promotes the production of progesterone (P) which, when elevated during the follicular phase, has been demonstrated to have a deleterious effect in autologous fresh IVF outcomes. While there is robust evidence that this elevation results in impaired endometrial receptivity, the impact on EQ remains a matter of debate. The oocyte donation model is an excellent tool to assess the effects of LFEP on EQ from those on endometrium receptivity separately. Previous studies in oocyte donation cycles investigating the influence of elevated P on pregnancy outcomes in oocyte recipients showed conflicting results. STUDY DESIGN, SIZE, DURATION: This is a retrospective analysis including all GnRH antagonist down-regulated cycles for fresh oocyte donation taking place in a tertiary referral university hospital between 2010 and 2017. A total of 397 fresh donor-recipient cycles were included. Each donor was included only once in the analysis and could be associated to a single recipient. PARTICIPANTS/MATERIALS, SETTING, METHODS: The sample was stratified according to serum P levels of ≤1.5 and >1.5 ng/mL on the day of ovulation triggering. The primary endpoint of the study was the top-quality embryo rate on Day 3, and the secondary outcome measure was CLBR defined as a live-born delivery beyond 24 weeks. MAIN RESULTS AND THE ROLE OF CHANCE: Three hundred ninety-seven fresh oocyte donation cycles were included in the analysis, of which 314 (79%) had a serum P ≤ 1.5 ng/mL and 83 (20.9%) had a serum P > 1.5 ng/mL. The average age of the oocyte donors was 31.4 ± 4.7 and 29.9 ± 4.5 years, respectively, for normal and elevated P (P = 0.017). The mean number of oocytes retrieved was significantly higher in the elevated P group with 16.6 ± 10.6 vs 11.5 ± 6.9 in the P ≤ 1.5 group (P < 0.001).In parallel, the total number of embryos on Day 3, as well as the number of good-quality embryos at this stage, was significantly higher in the elevated P group (6.6 ± 5.6 vs 4.15 ± 3.5 and 8.7 ± 6.3 vs 6.1 ± 4.4; respectively, P < 0.001). However, maturation and fertilization rates did not vary significantly between the two study groups and neither did the top- and good-quality embryo rate and the embryo utilization rate, all evaluated on Day 3 (P = 0.384, P = 0.405 and P = 0.645, respectively). A multivariable regression analysis accounting for P groups, age of the donor, number of retrieved oocytes and top-quality embryo rate as potential confounders showed that LFEP negatively influenced neither the top-quality embryo rate nor the CLBR. LIMITATIONS, REASONS FOR CAUTION: This is an observational study based on a retrospective data analysis. Better extrapolation of the results could be validated by performing a prospective trial. Furthermore, this study was focused on oocyte donation cycles and hence the results cannot be generalized to the entire infertile population. WIDER IMPLICATIONS OF THE FINDINGS: This is the first study providing evidence that LFEP does not influence CLBR and is adding strong evidence to the existing literature that LFEP does not harm EQ in oocyte donation programs. STUDY FUNDING/COMPETING INTERESTS: Not applicable.

No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study.

PURPOSE: Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes. MATERIALS AND METHODS: In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°). RESULTS: The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5-11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes. CONCLUSION: The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon. LEVEL OF EVIDENCE: Prospective randomized study, level I.

In vitro maturation (IVM) of oocytes in patients with resistant ovary syndrome and in patients with repeated deficient oocyte maturation.

PURPOSE: To assess the efficiency of IVM in patients with repeated ART failure due to resistant ovary syndrome or due to deficient oocyte maturation. METHODS: Clinical and laboratory data were obtained retrospectively from 28 patients who underwent 49 cycles of IVM between 2010 and 2017; nine patients had resistant ovary syndrome and 19 patients had repeated deficient oocyte maturation. RESULTS: Nine patients with resistant ovary syndrome underwent 24 IVM cycles. In those, an average of 11.5 ± 10.4 cumulus-oocyte complexes (COC) was retrieved, and IVM resulted in 3.4 ± 3.1 mature oocytes. After ICSI and transfer of 23 cleavage-stage embryos, eight pregnancies were obtained, resulting in five healthy live births. The live birth rate was 16.7% per started cycle and 33.3% per patient. Nineteen patients with a history of deficient oocyte maturation underwent 25 IVM cycles. An average of 10.6 ± 9.2 COC was retrieved, and after IVM, 1.3 ± 2.1 oocytes were mature. No mature oocytes were obtained in 11 cycles. In ten cycles with mature oocytes, none of them fertilized after ICSI. Out of four cycles with fertilized oocytes, only one good-quality embryo was obtained. No live births were obtained after IVM in patients with a history of deficient oocyte maturation. CONCLUSIONS: Based on our experience, IVM is a valuable approach in patients with resistant ovary syndrome, but should not be recommended for patients with deficient oocyte maturation.

Ovarian steroids, oxytocin, and tumor necrosis factor modulate equine oviduct function.

The oviduct plays important roles in the early reproductive process. The aim of this study was to evaluate gene transcription and protein expression of progesterone receptor (PGR), estrogen receptors 1 (ESR1) and 2 (ESR2); oxytocin receptor (OXTR); prostaglandin F2α synthase (AKR1C3), and prostaglandin E2 synthase (Ptges) in mare oviduct in different estrous cycle stages. Estradiol (E2), progesterone (P4), oxytocin (OXT), and tumor necrosis factor α (TNF) effect on in vitro PGE2 and prostaglandin F2α (PGF2α) secretion by equine oviduct explants or by oviductal epithelial cells (OECs) were also assessed. During the breeding season, oviduct tissue was obtained post mortem from cyclic mares. Protein of ESR1, ESR2, PGR, AKR1C3, and Ptges was present in OECs, whereas OXTR was shown in oviduct stroma. In follicular phase, protein expression of ESR1, ESR2, PGR, and OXTR increased in oviduct explants (P < 0.05), whereas no estrous cycle effect was noted for AKR1C3 or Ptges. In follicular phase, mRNA transcription was upregulated for Pgr but downregulated for Oxtr, Ptges, and Akr1c3 (P < 0.05). Nevertheless, Esr1 and Esr2 mRNA levels did not change with the estrous cycle. In the ampulla, Esr1, Esr2, and Oxtr mRNA transcription increased, but not for Pgr or Ptges. In contrast, Akr1c3 mRNA level was upregulated in the infundibulum (P < 0.05). In follicular phase, E2, P4, and OXT downregulated PGE2 production by OEC (P < 0.05), but no difference was observed in mid-luteal phase. Explants production of PGE2 rose when treated with OXT in follicular phase; with TNF or OXT in early luteal phase; or with TNF, OXT, or P4 in mid-luteal phase. PGF2α production by OEC was downregulated by all treatments in follicular phase but upregulated in mid-luteal phase (P < 0.05). Oviduct explants PGF2α production was stimulated by TNF or OXT in all estrous cycle phases. In conclusion, this work has shown that ESR1, ESR2, OXTR, Ptges, and AKRLC3 gene transcription and/or translation is estrous cycle dependent and varies with oviduct portion (infundibulum vs ampulla) and cell type. Ovarian steroid hormones, OXT and TNF stimulation of PGF2α and/or PGE2 production is also estrous cycle dependent and varies in the different portions of mare oviduct. Differential transcription level and protein localization in various portions of the oviduct throughout the estrous cycle, as well as PG production, suggest coordinated physiologic actions and mechanisms of steroid hormones, OXT, and TNF in the equine oviduct.

Early Rehospitalization Post-Kidney Transplant Due to Infectious Complications: Can We Predict the Patients at Risk?

INTRODUCTION: Rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney transplantation. METHODS: We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters. RESULTS: We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications. CONCLUSION: There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series.

Nephrotic Range Proteinuria in Renal Transplantation: Clinical and Histologic Correlates in a 10-year Retrospective Study.

INTRODUCTION: There is a high incidence of nephrotic proteinuria in renal transplant recipients, which is an accurate predictor of graft loss. Despite this, its histologic correlates and prognostic implications are still not well characterized. We assessed the clinical and histological correlates of kidney transplantation patients with nephrotic range proteinuria. METHODS: We have retrospectively analyzed clinical and histological data from 50 kidney transplantation biopsy specimens from 44 renal transplant recipients with nephrotic range proteinuria between 2006 and 2015. The median follow-up time was 93 months (range, 14 months to 190 months). RESULTS: The mean age of the patients was 45.2 ± 13.7 years and our cohort included 86% recipients of deceased-donor grafts. The maintenance immunosuppressive regimen included calcineurin inhibitors in 68% and mammalian target of rapamycin inhibitors in 32% of patients. The average proteinuria was 6.9 ± 3.8 g/d and 52% of patients presented with nephrotic syndrome. The main histological findings were transplant glomerulopathy (22%), de novo glomerular disease (22%), and recurrence of primary disease (22%). Tubular atrophy and interstitial fibrosis was present in 78% of the biopsy specimens. Thirty-one patients (62%) lost the graft at follow-up. There was no statistically significant difference between the histologic diagnosis nor the proteinuria levels and the outcome of the graft. CONCLUSIONS: The main causes of nephrotic range proteinuria in patients undergoing biopsy were transplant glomerulopathy, recurrence of the underlying disease, and de novo glomerulonephritis. Nephrotic range proteinuria was related to a high rate of graft loss.

Selection of experimental strawberry (Fragaria x ananassa) hybrids based on selection indices.

The strawberry (Fragaria x ananassa Dutch.), is the only vegetable belonging to the rosacea family. All strawberry species have now emerged from wild species and belong to the genus Fragaria, being that this genus presents more than 45 described species, and only 11 are considered natural species. Due to the octoploid nature of strawberry and its variability after hybridization, selecting one or more characters may result in unfavorable genotypes and even the exclusion of promising ones, because negative genetic correlations have been observed among them that cause inefficient selection. Therefore, the objective of this study was to verify the efficiency of selection indices in selecting experimental strawberry hybrids for in natura consumption and processing. Seven commercial cultivars and 103 hybrids were used, which were obtained from populations derived from their crossings. The experiment was conducted in augmented blocks, in which four agronomical traits (total mass, amount of commercial fruit, amount of noncommercial fruit, and average fruit mass) and seven physical-chemical traits (soluble solids, soluble solids:titratable acidity ratio, total sugars, total pectin, vigor, and internal and external coloration) were evaluated. For hybrid selection, the following indices were used: Mulamba and Mock (1978), Smith (1936), Hazel (1943), and genotype-ideotype, which selected 20% of the genotypes evaluated. The three indices selected about 9% of the hybrids. The selection of two experimental hybrids (89 and 495) and the use of selection indices resulted in larger estimates of selection gains. The Mulamba and Mock (1978), Smith (1936), and Hazel (1943) indices had the highest percentage of gains on selection, and are therefore recommended for the selection of strawberry clones.

Mini-laparoscopic hysterectomy for adenocarcinoma in situ of the uterine cervix using interchangeable 5-mm end effectors: a way to cross the line of minimally invasive surgery in gynaecologic oncology.

The incidence of adenocarcinoma of the uterine cervix is increasing. It poses the affected women in risk and the definitive treatment requires hysterectomy. Here we describe a case of adenocarcinoma in situ of the uterine cervix successfully managed by minilaparoscopic hysterectomy using interchangeable 5-mm end effectors.

Potential for CSO treatment with horizontal flow constructed wetlands: influence of hydraulic load, plant presence and loading frequency.

This study aimed at analysing the performance of horizontal subsurface flow constructed wetlands (CWs) to treat combined sewer overflow (CSO). Four horizontal subsurface flow CWs, organized in two groups (A and B) each with a planted (Phragmites australis) and a non-planted bed, were loaded with simulated CSO, with group B receiving twice the hydraulic load of group A. Beds were monitored for pH, dissolved oxygen, conductivity, redox potential, chemical oxygen demand (COD), total suspended solids (TSS) and enterococci. Porosity variations were also estimated. Monitoring was conducted during spring and wintertime, with regular and irregular loading frequencies. Results showed an average treatment efficiency of 90-100 % for TSS, 60-90 % for COD and 2-6 log for enterococci. Removal rates were especially relevant in the first 24 h for COD and TSS. TSS and enterococci removal did not exhibit the influence of macrophytes or the applied hydraulic load while COD's removal efficiency was lower in the higher load group and in planted beds.

Topographic and biometric study of radial nerve branches to the muscles of the anterior compartment of the arm / Estudio topográfico y biométrico de los ramos del nervio radial para los músculos del compartimiento anterior del brazo

The radial nerve is a terminal branch of the brachial plexus that innervates the entire posterior compartment of the upper limb. Researches have shown that the branches can contribute to innervation of the muscles from the anterior compartment of the arm. This study sought to identify branches of radial nerve for brachialis and coracobrachialis muscles and its clinical value during surgery. Dissection was performed in 60 arms, from 30 corpses selected from the Human Anatomy Laboratories of Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL). In each arm, three segments of the same proportion were considered (proximal, middle and distal) in order to observe the number of radial nerve branches to brachialis and coracobrachialis muscles. Branches were identified in 4 of the 60 upper limb (6.66%) with the following distribution: nerve with 1 branch to the brachialis muscle in the distal third (1.66%); with 1 branch to the middle third of the coracobrachialis (1.66%) and 5 branches to the coracobrachialis muscle in the proximal third; 1 branch being found in an upper limb (1.66 %) and 4 branches in the other upper limb (1.66 %). The event was not bilaterally in the same body, and in four cases there was no branching, but only communication with other terminal nerves of the brachial plexus. In conclusion, although most authors do not describe the possibility of the occurrence of radial nerve branches to the muscles of the anterior compartment of the arm, this condition exists as an anatomical variation.

El nervio radial es un ramo terminal del plexo braquial que inerva el compartimiento posterior del miembro superior. Diversos estudios han mostrado que sus ramos pueden contribuir a la inervación de los músculos del compartimiento anterior del brazo. El presente estudio tuvo como objetivo identificar ramos del nervio radial dirigidos a los músculos braquial y coracobraquial y su importancia clínica durante las cirugías. Para ello, se disecaron 60 brazos de 30 cuerpos formolizados en los Laboratorios de Anatomía Humana de la Universidad Estadual de Ciencias de la Salud de Alagoas, Brasil (UNCISAL). En cada brazo, se consideraron tres partes de similares proporciones (proximal, medio y distal) para localizar los ramos dirigidos a los músculos mencionados. En 4 de los 60 brazos (6,66%) se identificaron ramos con la siguiente distribución: un ramo para el músculo braquial en el tercio distal (1,66%); un ramo para el tercio medio del músculo coracobraquial (1,66%) y cinco ramos para este mismo músculo en su tercio proximal; en otro miembro (1,66%)se encontró solo un ramo y en la otra muestra (1,66%) se encontraron cuatro ramos. Ninguno de los casos fue bilateral y en los cuatro casos no había ninguna ramificación. No hubo comunicación con el nervio musculocutáneo pero si con otros ramos del plexo braquial. Aunque la mayoría de los autores no describe la posibilidad de que el nervio radial inerve a los músculos anteriores del brazo, esta disposición existe como una variación anatómica.

Lipopolysaccharides, cytokines, and nitric oxide affect secretion of prostaglandins and leukotrienes by bovine mammary gland during experimentally induced mastitis in vivo and in vitro.

The aim of the study was to determine the effects of lipopolysaccharide (LPS), tumor necrosis factor alpha (TNF), interleukin-1-alpha (IL-1α), and nitric oxide donor (NONOate) on both in vivo and in vitro secretion of prostaglandin (PG)E2, PGF2α, leukotriene (LT)B4, and LTC4 by the bovine mammary gland. In the first experiment, tissues isolated from the teat cavity and lactiferous sinus were treated in vitro with LPS (10 ng/mL), TNF (10 ng/mL), IL-1α (10 ng/mL), NONOate (10(-4) M), and the combination of TNF + IL-1α + NONOate for 4 or 8 h. PGE2 or PGF2α secretion was stimulated by all treatments (P < 0.05) excepting NONOate alone, which did not stimulate PGF2α secretion. Moreover, all factors increased LTB4 and LTC4 secretion (P < 0.05). In the second experiment, mastitis was experimentally mimicked in vivo by repeated (12 h apart) intramammary infusions (5 mL) of (1) sterile saline; (2) 250-µg LPS; (3) 1-µg/mL TNF; (4) 1-µg/mL IL-1α; (5) 12.8-µg/mL NONOate; and (6) TNF + IL-1α + NONOate into 2 udder quarters. All infused factors changed PGE2, 13,14-dihydro,15-keto-PGF2α, and LT concentrations in blood plasma collected from the caudal vena cava, the caudal superficial epigastric (milk) vein, the jugular vein, and the abdominal aorta (P < 0.05). In summary, LPS and other inflammatory mastitis mediators modulate PG and LT secretion by bovine mammary gland in both in vivo and in vitro studies.

Loading and composite restoration assessment of various non-carious cervical lesions morphologies - 3D finite element analysis.

BACKGROUND: The present study analysed the effects of different occlusal loading on premolars displaying various non-carious cervical lesions morphologies, restored (or not) with composites, by 3D finite element analysis. METHODS: A three-dimensional digital model of a maxillary premolar was generated using CAD software. Three non-carious cervical lesions morphological types were simulated: wedged-shaped, saucer and mixed. All virtual models underwent three loading types (100 N): vertical, buccal and palatal loading. The simulated non-carious cervical lesions morphologies were analysed with and without restorations to consider specific regions, such as the occlusal and gingival walls as well as the depth of the lesions. Data summarizing the stress distribution were obtained in MPa using Maximum Principal Stress. RESULTS: Palatal loads were responsible for providing the highest values of accumulated tensile stress on the buccal wall; 27.66 MPa and 25.76 MPa for mixed and wedged-shaped morphologies, respectively. The highest tensile values found on non-carious cervical lesions morphologies restored with composite resin were 5.9 MPa in the mixed morphology, similar to those found on sound models despite their morphologies and occlusal loading. CONCLUSIONS: The various non-carious cervical lesions morphologies had little effect on stress distribution patterns, whereas the loading type and presence of composite restorations influenced the biomechanical behaviour of the maxillary premolars.

Physiopathologic mechanisms involved in mare endometrosis.

Endometrosis is a degenerative chronic process, characterized by paramount fibrosis development in mare endometrium. This condition is one of the major causes of subfertility/infertility in mares. As in other organs, fibrosis might be a pathologic sequel of many chronic inflammatory diseases. However, aetiology and physiopathologic mechanisms involved in endometrial fibrosis are still controversial. This review presents new hypotheses based on our newest data. As the first line of innate immune defence, systemic neutrophils arrive in the uterus at mating or in the presence of pathogens. A novel paradigm is that neutrophils cast out their DNA in response to infectious stimuli and form neutrophil extracellular traps (NETs). We have shown that bacterial strains of Streptococcus zooepidemicus, Escherichia coli or Staphylococcus capitis, known to cause endometritis in mares were able to induce NETs release in vitro by equine PMN to different extents. An intriguing dilemma is the dual action of NETs. While NETs play a desirable role fighting micro-organisms in mare uterus, they may also contribute to endometrial fibrosis. A long-term in vitro exposure of mare endometrium explants to NETs components (myeloperoxidase, elastase and cathepsin G) up-regulated fibrosis markers TGFß and Tissue inhibitor of metalloproteinase (TIMP-1). Also, pro-fibrotic cytokines regulated collagen deposition and fibrosis. Changes in expression of connective tissue growth factor (CTGF), interleukins (IL)1-α, IL-1ß, IL-6 and receptors in endometrium with different degrees of fibrosis and/or inflammation were observed. A putative role of CTGF, IL and NETs components in endometrosis development should be considered. Additionally, we speculate that in sustained endometritis in mares, prostaglandins may not only cause early luteolysis or early pregnancy loss, but may also be related to endometrial fibrosis pathogenesis by stimulating collagen deposition.

Neutrophil extracellular traps formation by bacteria causing endometritis in the mare.

Besides the classical functions, neutrophils (PMNs) are able to release DNA in response to infectious stimuli, forming neutrophil extracellular traps (NETs) and killing pathogens. The pathogenesis of endometritis in the mare is not completely understood. The aim was to evaluate the in vitro capacity of equine PMNs to secrete NETs by chemical activation, or stimulated with Streptococcus equi subspecies zooepidemicus (Szoo), Escherichia coli (Ecoli) or Staphylococcus capitis (Scap) strains obtained from mares with endometritis. Ex vivo endometrial mucus from mares with bacterial endometritis were evaluated for the presence of NETs. Equine blood PMNs were used either without or with stimulation by phorbol-myristate-acetate (PMA), a strong inducer of NETs, for 1-3h. To evaluate PMN ability to produce NETs when phagocytosis was impaired, the phagocytosis inhibitor cytochalasin (Cyt) was added after PMA. After the addition of bacteria, a subsequent 1-h incubation was carried out in seven groups. NETs were visualized by 4',6-diamidino-2-phenylindole (DAPI) and anti-histone. Ex vivo samples were immunostained for myeloperoxidase and neutrophil elastase. A 3-h incubation period of PMN + PMA increased NETs (p < 0.05). Bacteria + 25 nM PMA and bacteria + PMA + Cyt increased NETs (p<0.05). Szoo induced fewer NETs than Ecoli or Scap (p < 0.05). Ex vivo NETs were present in mares with endometritis. Scanning electron microscopy showed the spread of NETs formed by smooth fibers and globules that can be aggregated in thick bundles. Formation of NETs and the subsequent entanglement of bacteria suggest that equine NETs might be a complementary mechanism in fighting some of the bacteria causing endometritis in the mare.

Cor triatriatum sinister e hipertensão arterial pulmonar secundária em cão / Cor triatriatum sinister and secondary pulmonary arterial hypertension in a dog

This paper describes the occurrence of cor triatriatum sinister, a rare cardiac malformation in dogs, associated with pulmonary edema and pulmonary hypertension in a 5-year-old Poodle female with history of acute dyspnea and cyanosis. The animal presented acute respiratory failure, heart failure with low cardiac output, progressing to acute tubular necrosis and death. The diagnosis was made posmortem due to the clinical instability of the dog. This malformation was diagnosed by the subdivision of the left atrium into two compartments separated by an abnormal fibromuscular membrane, absence of structural abnormalities of the mitral valve and thickening of pulmonary artery tunica media associated with renal tubular degeneration. The occurrence of cor triatriatum in dogs is most common in the right atrium, defined as cor triatriatum dexter. Additionally, pulmonary arterial hypertension associated with this malformation is described only in humans with this heart defect.

Growth and regression in bovine corpora lutea: regulation by local survival and death pathways.

The bovine corpus luteum (CL) is a transient gland with a life span of only 18 days in the cyclic cow. Mechanisms controlling CL development and secretory function may involve factors produced both within and outside this gland. Although luteinizing hormone (LH) surge is the main trigger of ovulation and granulosa cells luteinization, many locally produced agents such as arachidonic acid (AA) metabolites, growth factors and cytokines were shown to complement gonadotropins action in the process of CL development. Bovine CL is a highly vascular gland, where the very rapid angiogenesis rate (until Day 5 of the cycle) results in the development of a capillary network, endowing this gland with one of the highest blood flow rate per unit mass in the body. Angiogenesis in the developing CL is later followed by either controlled regression of the microvascular tree in the non-fertile cycle or maintenance and stabilization of the blood vessels, as seen during pregnancy. Different luteal cell types (both steroidogenic and accessory luteal cells: immune cells, endothelial cells, pericytes and fibroblasts) are involved in the pro- and/or anti-angiogenic responses. The balance between pro- and anti-angiogenic responses to the main luteolysin - prostaglandin F2α (PGF2α) could be decisive in whether or not PGF2α induces CL regression. Fibroblast growth factor-2 (FGF2) may be one of the factors that modulate the angiogenic response to PGF2α. Manipulation of local production and action of FGF2 will provide new tools for reproductive management of dairy cattle. Luteolysis is characterized by a rapid decrease in progesterone production, followed by structural regression. Factors like endothelin-1, cytokines (tumour necrosis factorα, interferons) and nitric oxide were all shown to play critical roles in functional and structural regression of the CL by inhibiting steroidogenesis and inducting apoptosis.

Role of tumor necrosis factor-α, interferon-γ and Fas-ligand on in vitro nitric oxide activity in the corpus luteum.

Normal reproductive function involves the expression of inflammatory mediators. Regarding the corpus luteum (CL), cytokines promote the cross-talk between immune, vascular and steroidogenic cells, among others. Moreover, TNF, IFNG and FASL were shown to regulate equine CL establishment and regression. We hypothesized that cytokines action on equine CL may be mediated by nitric oxide (NO), through the regulation of endothelial NO synthase (eNOS) expression. TNF increased eNOS mRNA level and NO metabolite (nitrite) production during CL growth. Cytokines combined action (TNF+IFNG+FASL) promoted eNOS protein upregulation in mid-CL and nitrite production in mid and late-CL. However, in late-CL, TNF alone decreased nitrite secretion. These results indicate that in equine CL, cytokines TNF, IFNG and FASL regulate NO activity, via eNOS expression modulation.

Coumestrol and its metabolite in mares' plasma after ingestion of phytoestrogen-rich plants: potent endocrine disruptors inducing infertility.

Phytoestrogens exist in plants that are present in forages fed to horses. They may compete with 17-ß estradiol and influence the estrous cycle. Therefore, the objective was to determine whether coumestrol from clover-mixed pastures is present in mare's plasma after their ingestion (experiment I), and when this phytoestrogen was present in mare's plasma after ingestion (experiment II). The effect of a long-term ingestion of phytoestrogens on estrous cycle disruption was assessed (experiment III; clinical case). Experiment I was carried out in nonpregnant anestrous and cyclic Lusitano mares (n = 14) kept on clover and grass-mixed pastures, and supplemented with concentrate and hay or cereal straw. Blood and feedstuff were obtained from November to March. In experiment II, stabled cyclic Lusitano mares (n = 6) were fed for 14 days with increasing amounts of alfalfa pellets (250 g to 1 kg/day). Sequential blood samples were obtained for 8 hours after feed intake on Day 0 (control) and on Days 13 and 14 (1 kg/day alfalfa pellets). Experiment III mares were fed with a mixture of alfalfa and clover haylage for 5 months (group 1; n = 4) or for 9 months (group 2; n = 12). Estrous cycle was determined on the basis of plasma estradiol (E2), progesterone (P4), and ultrasound (experiment III). Concentrations of phytoestrogen coumestrol and its metabolite methoxycoumestrol were determined by high-performance liquid chromatography coupled with mass spectrometry. Phytoestrogens decreased in pasture from November until March (P < 0.01) (experiment I), but were always detected in mares' plasma. In experiment II, plasma-conjugated forms of coumestrol and methoxycoumestrol were higher on Days 13 and 14 than in control (P < 0.05). The highest concentrations of conjugated form of coumestrol were at 1.5 and 4 hours (P < 0.001), whereas its free forms peaked at 1 and at 3.5 hours after ingestion (P < 0.05). Methoxycoumestrol-conjugated form concentration was the highest at 1.5 and 5 hours (P < 0.001), whereas its free form peaked at 1 hour (P < 0.05) and at 1.5 hours (P < 0.001). Long-term intake of coumestrol caused lack of ovulation, uterine edema, and uterine fluid accumulation (experiment III). Coumestrol and methoxycoumestrol in both forms were higher in group 2 (while still ingesting haylage) than in group 1, after haylage withdrawal (P < 0.001). These data show that in the mare, coumestrol and its metabolite increase in blood after ingestion of estrogenic plants and can influence reproduction in mares as potent endocrine disruptors.