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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shifts in the ecological niche of Lutzomyia peruensis under climate change scenarios in Peru.

The Peruvian Andes presents a climate suitable for many species of sandfly that are known vectors of leishmaniasis or bartonellosis, including Lutzomyia peruensis (Diptera: Psychodidae), among others. In the present study, occurrences data for Lu. peruensis were compiled from several items in the scientific literature from Peru published between 1927 and 2015. Based on these data, ecological niche models were constructed to predict spatial distributions using three algorithms [Support vector machine (SVM), the Genetic Algorithm for Rule-set Prediction (GARP) and Maximum Entropy (MaxEnt)]. In addition, the environmental requirements of Lu. peruensis and three niche characteristics were modelled in the context of future climate change scenarios: (a) potential changes in niche breadth; (b) shifts in the direction and magnitude of niche centroids, and (c) shifts in elevation range. The model identified areas that included environments suitable for Lu. peruensis in most regions of Peru (45.77%) and an average altitude of 3289 m a.s.l. Under climate change scenarios, a decrease in the distribution areas of Lu. peruensis was observed for all representative concentration pathways. However, the centroid of the species' ecological niche showed a northwest direction in all climate change scenarios. The information generated in this study may help health authorities responsible for the supervision of strategies to control leishmaniasis to coordinate, plan and implement appropriate strategies for each area of risk, taking into account the geographic distribution and potential dispersal of Lu. peruensis.

Economic effect of reducing nitrogen and phosphorus mass balance on Wisconsin and Québec dairy farms.

Our objective was to explore the trade-offs between economic performance (farm net income, FNI) and environmental outcomes (whole-farm P and N balances) of dairy farms in Wisconsin (WI; United States) and Québec (QC; Canada). An Excel-based linear program model (N-CyCLES; nutrient cycling: crops, livestock, environment, and soil) was developed to optimize feeding, cropping, and manure management as a single unit of management. In addition to FNI, P and N balances model outputs included (1) the mix of up to 9 home-grown and 17 purchased feeds for up to 5 animal groups, (2) the mix of up to 5 crop rotations in up to 5 land units and c) the mix of up to 7 fertilizers (solid and liquid manure and 5 commercial fertilizers) to allocate in each land unit. The model was parameterized with NRC nutritional guidelines and regional nutrient management planning rules. Simulations were conducted on a typical WI farm of 107 cows and 151 ha of cropland and, a Southern QC farm of 87 cows and 142 ha of cropland and all results were expressed per kg of fat- and protein-corrected milk (FPCM). In absence of constraints on P and N balances, maximum FNI was 0.12 and 0.11 $/kg of FPCM for WI and QC, respectively, with P and N balances of 1.05 and 14.29 g/kg of FPCM in WI but 0.60 and 15.70 g/kg of FPCM in QC. The achievable reduction (balance at maximum FNI minus balance when the simulation objective was to minimize P or N balance) was 0.31 and 0.54 g of P/kg of FPCM (29 and 89% reduction), but 2.37 and 3.31 g of N/kg of FPCM (17 and 24% reduction) in WI and QC, respectively. Among other factors, differences in animal unit per hectare and reliance on biological N fixation may have contributed to lower achievable reductions of whole-farm balances in WI compared with QC. Subsequent simulations to maximize FNI under increasing constraints on nutrient balances revealed that it was possible to reduce P balance, N balance, and both together by up to 33% without a substantial effect on FNI. Partial reduction in P balance reduced N balance (synergetic effect) in WI, but increased N balance (antagonistic effect) in QC. In contrast, reducing N balance increased P balance in both regions, albeit in different magnitudes. The regional comparison highlighted the importance of site-specific conditions on modeling outcomes. This study demonstrated that even when recommended guidelines are followed for herd nutrition and crop fertilization, the optimization of herd feeding, cropping, and manure spreading as a single unit of management may help identify management options that preserve FNI, while substantially reducing whole-farm nutrient balance.

Nitrogen efficiency of eastern Canadian dairy herds: Effect on production performance and farm profitability.

Nitrogen efficiency (milk N/dietary N; NE) can be used as a tool for the nutritional, economic, and environmental management of dairy farms. The aim of this study was to identify the characteristics of herds with varying NE and assess the effect on farm profitability. One hundred dairy herds located in Québec, Canada, comprising on average 42 ± 18 cows in lactation were visited from October 2014 to June 2015. Feed intake was measured over 24 h. Samples of each feedstuff were taken and sent to a commercial laboratory for analysis of chemical composition. Feeding management and feed prices were recorded. Milk yield was recorded and milk samples were collected over 2 consecutive milkings. Fat, protein, and milk urea N were analyzed. Balances of metabolizable protein (MP; MP supply - MP requirements) and rumen degradable protein (RDP; RDP supply - RDP requirement) were calculated. A hierarchical cluster analysis was conducted and allowed grouping the farms by their NE. Four clusters were identified with an average NE of 22.1 (NE22), 26.9 (NE27), 30.0 (NE30), and 35.8% (NE36). Herds in clusters NE30 and NE36 were fed diets with greater concentrations of starch, net energy for lactation, and nonfiber carbohydrates than those in the other 2 clusters. Moreover, the average proportion of corn silage was lower for herds in cluster NE22 compared with NE30 and NE36 (8.23 vs. 31.8 and 31.3% of total forages, respectively). In addition, crude protein of the diets declined from an average of 16.0 to 14.9% with increasing NE among clusters. Average dry matter intake declined from 26.1 to 22.5 kg/d as NE of clusters increased. Herds in cluster NE22 had lower yields of milk (28.7 vs. 31.8 kg/d), fat (1.15 vs. 1.29 kg/d), and protein (0.94 vs. 1.05 kg/d) than the other clusters. Also, milk urea N was greater for farms in cluster NE22 (13.2 mg/dL) than for farms in the other clusters (11.4 mg/dL). Furthermore, MP and RDP balances decreased from 263.2 to -153.7 g/d and from 594.7 to 486.9 g/d, respectively, with increasing NE among clusters. Income over feed cost increased from $14.3 to $17.3/cow per day (Can$) as NE among clusters augmented. Results from this study showed that some farms were able to achieve high NE by using lower levels of dietary N and having cows with lower DMI while maintaining milk performance. These farms had a potentially lower environmental impact, and they were more profitable.

A basic intervention improves CPAP adherence in sleep apnoea patients: a controlled trial.

BACKGROUND: The treatment of choice for sleep apnoea-hypopnoea syndrome (SAHS) is continuous positive airway pressure (CPAP). However, CPAP effectiveness strongly depends on patient adherence to treatment. The aim of this study was to determine the effectiveness of a low-cost, basic intervention on improving CPAP adherence. METHODS: A controlled parallel-group trial. Participants were SAHS patients for whom CPAP treatment was indicated. Those in the intervention group were shown the results of their sleep test and were told the importance of treatment adherence; the control group received neither. Outcomes for both groups were compared at 6 months. The primary outcome assessed was CPAP usage. RESULTS: One hundred fifty-four patients were included in the intervention group and 167 in the control group. At 6 months, the intervention group had 10% more participants with CPAP usage ≥4 h, significantly higher adherence as compared to controls (5 ± 1.8 h vs 4.3 ± 1.7, p = 0.031), mean: 0.7 h/day and fewer discontinuations of CPAP. A multiple linear regression model showed that intervention group and daytime sleepiness were variables independently associated with treatment adherence. CONCLUSIONS: An inexpensive basic intervention involving communication of sleep test results and the importance of CPAP adherence improves adherence to CPAP therapy. In addition, greater daytime sleepiness is associated with higher CPAP adherence.

Reconsidering the switch from low-molecular-weight heparin to unfractionated heparin during pregnancy.

Venous thromboembolic disease accounts for 9% of all maternal deaths in the United States. In patients at risk for thrombosis, common practice is to start prophylactic doses of low-molecular-weight heparin and transition to unfractionated heparin during the third trimester, with the perception that administration of neuraxial anesthesia will be safer while on unfractionated heparin, as spinal/epidural hematomas have been associated with recent use of low-molecular-weight heparin. In patients receiving prophylactic doses of unfractionated heparin, neuraxial anesthesia may be placed, provided the dose used is 5,000 units twice a day. The American Society of Regional Anesthesia and Pain Medicine guidelines recognize that the safety of neuraxial anesthesia in patients receiving more than 10,000 units per day or more than 2 doses per day is unknown, limiting the theoretical benefit of unfractionated heparin at doses higher than 5,000 units twice a day.

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

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

Radioactive synovectomy with (90) yttrium and (153) samarium hydroxyapatite in haemophilic joints: preliminary study on radiation safety.

Most countries still do not achieve 1 IU of factor VIII/capita sufficient for survival. Although primary prophylaxis prevents synovitis, is not universally used. Chronic synovitis is treated with arthroscopy at expense of considerable amount of coagulation factors, and specialized surgeons. Radioactive synovectomy (RS) is a minimally invasive and cost effective alternative to arthroscopy, often considered first the option for persistent synovitis. Even without established causation with cancer, RS is avoided by some, due to this concern. We aim contributing to the understanding of RS safety regarding malignancy, presenting a large number of treated patients, and a single case of cancer. Three centres in Brazil applied RS with (90) Yttrium Citrate, (90) Yttrium hydroxyapatite or (153) Samarium hydroxyapatite in haemophilic joints and performed a survey addressing cancer in these patients. Four hundred and eighty eight patients (ages 3-51) received 1-3 RS (total 842) and follow-up was 6 months to 9 years. One patient aged 14 years presented Ewing sarcoma, 11 months after RS. The tumour was treated successfully with surgery and chemotherapy. Causality of cancer by RS is improbable in this case. Accordingly, latency here is far below minimum 5-10 years for radio-induction of solid tumours. Moreover, ES is not a typically radio-induced tumour, even at high doses. In agreement with others, though recognizing limitations, this study suggests RS is safe regarding cancer induction. Synovitis is a known burden for patients. The decision of making reasonable usage of RS should be outweighed with the risks of leaving synovitis untreated.

Differential immune response in mice immunized with the A, R or C domain from TcSP protein of Trypanosoma cruzi or with the coding DNAs.

In a murine model of experimental Trypanosoma cruzi (H8 strain) infection, we investigated the induction of protective immunity against the domains [amino (A), repeats (R) and carboxyl (C)] of the surface protein (SP), a member of the trans-sialidase (TS) superfamily. Recombinant proteins and plasmid DNA coding for the respective proteins were used to immunize BALB/c mice, and the humoral response and cytokine levels were analysed. Immunization with the recombinant proteins induced higher levels of anti-TcSP antibodies than immunization with the corresponding DNAs, and analysis of serum cytokines showed that immunization with both recombinant proteins and naked DNA resulted in a Th1-Th2 mixed T-cell response. Mice immunized with either recombinant proteins or plasmid DNA were infected with blood trypomastigotes. The recombinant protein-immunized mice showed a variable reduction in peak parasitemia, and most died by day 60. Only the pBKTcSPR-immunized mice exhibited a significant reduction in peak parasitemia and survived the lethal challenge. DNA-based immunization with DNA coding for the repeats domain of TcSP is a good candidate for the development of a vaccine against experimental T. cruzi infection.

Epithelial downgrowth leading to graft rejection after penetrating keratoplasty.

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

Multilocus sequence types of invasive Corynebacterium diphtheriae isolated in the Rio de Janeiro urban area, Brazil.

Invasive infections caused by Corynebacterium diphtheriae in vaccinated and non-vaccinated individuals have been reported increasingly. In this study we used multilocus sequence typing (MLST) to study genetic relationships between six invasive strains of this bacterium isolated solely in the urban area of Rio de Janeiro, Brazil, during a 10-year period. Of note, all the strains rendered negative results in PCR reactions for the tox gene, and four strains presented an atypical sucrose-fermenting ability. Five strains represented new sequence types. MLST results did not support the hypothesis that invasive (sucrose-positive) strains of C. diphtheriae are part of a single clonal complex. Instead, one of the main findings of the study was that such strains can be normally found in clonal complexes with strains related to non-invasive disease. Comparative analyses with C. diphtheriae isolated in different countries provided further information on the geographical circulation of some sequence types.

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

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

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

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