Diagnosis of Developmental Dysplasia of the Hip Using Sound Transmission in Neonates

The developmental dysplasia of the hip disease is in 1% of newborns, and it is a risk factor for dislocation of the hip;only 1 from 7000 newborns develops dislocation of the hip. Newborns were selected from public and private hospitals in Celaya, Guanajuato. Parents were asked to sign informed consent. Clinical maneuvers were applied for diagnosis of developmental dysplasia of the hip, on three consecutive occasions, two by the same investigator and the third by a different observer: Ortolani, Barlow, Piston, Galeazzi, Peter Baden, the comparative sound transmission test, and comparative sound transmission with extension/flexion test were applied. The diagnosis was confirmed with ultrasound of hip, technique Graf, I healthy hip, II functionally immature, III subluxation, and IV dislocation. Sample size was 8 affected hips and 56 healthy hips. Kappa for intra observer and inter observer reliability were measured;the validity was measured by sensitivity, specificity, positive and negative predictive values, using the ultrasound diagnosis as the gold standard. The sample consisted of 78 neonates hips with female’s predominance. With comparative sound transmission test was obtained Kappa intra observer 0.80, Kappa inter observer 0.93, sensitivity 45.45%, specificity 96.27%, positive predictive value 66.67% and negative predictive value 91.49%;with comparative sound transmission with extension/flexion, was 0.83, 0.92, 72.73%, 95.52%, 72.73%, and 95.52%, respectively. The tests compared the sound transmission help better diagnose developmental dysplasia disease of the hip.

The adenoviral E1A protein relieves gene repression by receptors in v/vo displaces corepressors and unliganded thyroid hormone

The human adenovirus type 5 early region 1A （E1A） is one of two oncogenes present in the adenovirus genome and functions by interfering with the activities of cellular regulatory proteins. The E1A gene is alternatively spliced to yield five products. Earlier studies have revealed that E1A can regulate the function of thyroid hormone （T3） receptors （TRs）. However, analysis in yeast compared with transfection studies in mammalian cell cultures yields surprisingly different effects. Here, we have examined the effect of E1A on TR function by using the frog oocyte in vivo system, where the effects of E1A can be studied in the context of chromatin. We demonstrate that different isoforms of E1A have distinct effects on TR function. The two longest forms inhibit both the repression by unliganded TR and activation by T3-bound TR. We further show that E1A binds to unliganded TR to displace the endogenous corepressor nuclear receptor corepressor, thus relieving the repression by unliganded TR. On the other hand, in the presence of T3, E1A inhibits gene activation by T3-bound TR indirectly, through a mechanism that requires its binding domain for the general coactivator p300. Taken together, our results thus indicate that E1A affects TR function through distinct mechanisms that are dependent upon the presence or absence of T3.

Prospects of diagnostic and prognostic biomarkers of pyometra in canine

Pyometra is one of the most common uterine pathologies of intact bitch at middle to advanced age. In the early stages, the disease shows subtle changes, making diagnosis a challenge. In contrast, at later stages, it manifests as potentially life-threatening systemic inflammatory response syndrome. Ultrasonographic examination of the uterus aids in the diagnosis, although it has limitation in ascertaining the clinical severity of pyometra. Moreover, differentiation of cystic endometrial hyperplasia from pyometra could not be discerned with greater accuracy. Therefore, false negative diagnosis of pyometra patients leads to development of systemic inflammatory response, which delays administration of therapies and results in deaths during early course of treatment. Further, indiscriminate use of broad-spectrum antimicrobials at higher dose in false positive cases considerably contributes to the rising pool of drug resistant pathogens, thereby increasing the risk of case fatality due to sepsis in a long-term. Monitoring the circulating pro-inflammatory cytokines, acute phase proteins, endotoxin, growth factors and inflammatory mediators is the current trend in pyometra research, especially for developing diagnostic and prognostic biomarkers. The present review deals with the prospects of developing diagnostic and prognostic biomarkers in the canine pyometra.

Accessory Breast Tissue in Pregnancy

Accessory breast tissue development frequently occurs in addition to physiologic breast development and is a common congenital condition with an occurrence of 0.4% to 6% in women and 1% - 3% in men. A 31-year-old G1P0 female presented to our triage at 20 + 4 weeks gestation with a one-week history of painful bilateral axillary lumps. Her last menstrual period was consistent with an estimated gestational age of 39 + 3 weeks by LMP. She had emigrated from Bengal three years earlier with no other gynecological complaints and knew of no abnormalities on physical exam. The painful axillary lumps were found to be accessory breast tissue. This entity is presented as a palpable thickening that is most prevalent along the milk line in the region immediately below the breasts, along the abdomen, in the axilla and in the groin region adjacent to the vulva. Affected individuals may undergo premenstrual changes such as tenderness, swelling, and difficulty with shoulder range of motion and irritation. The onset of pregnancy stimulates the tissue and makes it more evident as it did with our patient.

Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Validity and Reliability of a Measuring Device Based on Sound Transmission for Diagnosis of Hip Dysplasia in Newborns

Sound transmission has been used for diagnosis of hip dysplasia in newborns and infants with tunning fork and sthetoscope. The study aims to identify the validity of a device based on sound transmission. Male and female newborns from Celaya, Gto, ranging from 4 to 28-day-old were selected for the study. The sound transmission device was used both, in bilateral assessment (compared sound transmission) and on each hip separately (sound transmission with extension/flexion). In the first application if the sound is lower by a digit, there is a hip unhealthy. In the second application if the sound is increased by a digit, there is also an alteration of the hip. A hip ultrasound was applied using the Graf technique as a gold standard. Sensitivity, specificity and predictive values were calculated to identify validity. The intra-observer and inter-observer Kappa Test was applied to identify reliability. The hips of 103 newborns were assessed, obtaining a sensitivity of 60.9%, and a specificity of 92%;it should be a positive predictive value of 51.9% and a negative predictive value of 95% for the compared sound transmission test. In the sound transmission test with extension/flexion, the values were 82.6%, 96.2%, 73.1% and 97.8% for sensitivity, specificity, positive predictive value and negative predictive value, respectively. The result of the intra-observer kappa was 0.80 and the inter-observer was 0.70 for the compared sound transmission. The intra-observer Kappa was 0.88 and the inter-observer was 0.78 for the compared sound transmission test with extension/flexion. The device for sound transmission is valid and reliable for the diagnosis of dysplastic development hip disease in newborns.

阴道-肛周与阴道-直肠培养物鉴定B族链球菌的比较

OBJECTIVE: To estimate whether the rates of recovery of group B streptococci from combined vaginal and perianal cultures and combined vaginal and rectal cultures are equivalent. METHODS: We performed a prospective cohort study of vaginal-perianal versus vaginal-rectal culture for group B streptococci. Two hundred pregnant women in the third trimester were enrolled. Three specimens were collected from each patient in the following order: lower third of the vagina, perianal skin, and rectum. Each specimen was cultured serially in selective broth media, then on sheep’s blood agar. Suspicious colonies were confirmed by latex agglutination. Culture positivity rates from the combined sites of vagina and perianal skin were compared with vagina and rectum. Laboratory personnel were blinded to the collection site of each individual swab. RESULTS: Of the 200 subjects, 71 (36%) had a positive culture from at least 1 site. Vaginal culture was positive in 55 patients (28%), compared with 48 patients (24%) with positive perianal cultures and 50 patients (25%) with positive rectal cultures. Results of combined vaginal and perianal cultures were positive in 68 patients (34%); results of combined vaginal and rectal cultures were positive in 67 patients (34%) (P =1.0). CONCLUSION: The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen.

Role of epithelial-mesenchymal transition factor SNAI1 and its targets in ovarian cancer aggressiveness

Ovarian cancer remains the most lethal gynecologic malignancy in the USA.For over twenty years,epithelial-mesenchymal transition(EMT)has been characterized extensively in development and disease.The dysregulation of this process in cancer has been identified as a mechanism by which epithelial tumors become more aggressive,allowing them to survive and invade distant tissues.This occurs in part due to the increased expression of the EMT transcription factor,SNAI1(Snail).In the case of epithelial ovarian cancer,Snail has been shown to contribute to cancer invasion,stemness,chemoresistance,and metabolic changes.Thus,in this review,we focus on summarizing current findings on the role of EMT(specifically,factors downstream of Snail)in determining ovarian cancer aggressiveness.

An imbalance between innate and adaptive immune cells at the maternal-fetal interface occurs prior to endotoxin-induced preterm birth

Preterm birth （PTB） is the leading cause of neonatal morbidity and mortality worldwide. A transition from an anti-inflammatory state to a pro-inflammatory state in the mother and at the maternal-fetal interface has been implicated in the pathophysiology of microbial-induced preterm labor. However, it is unclear which immune cells mediate this transition. We hypothesized that an imbalance between innate and adaptive immune cells at the maternal-fetal interface will occur prior to microbial-induced preterm labor. Using an established murine model of endotoxin-induced PTB, our results demonstrate that prior to delivery there is a reduction of CD4 ＋ regulatory T cells （Tregs） in the uterine tissues. This reduction is neither linked to a diminished number of Tregs in the spleen, nor to an impaired production of ILIO, CCL17, or CCL22 by the uterine tissues. Endotoxin administration to pregnant mice does not alter effector CD4＋ T cells at the maternal-fetal interface. However, it causes an imbalance between Tregs （CD4＋ and CD8＋）, effector CD8＋ T cells, and Th17 cells in the spleen. In addition, endotoxin administration to pregnant mice leads to an excessive production of CCL2, CCL3, CCL17, and CCL22 by the uterine tissues as well as abundant neutrophils. This imbalance in the uterine microenvironment is accompanied by scarce APC-like cells such as macrophages and MHC II ＋ neutrophils. Collectively, these results demonstrate that endotoxin administration to pregnant mice causes an imbalance between innate and adaptive immune cells at the maternal-fetal interface.

Endometriosis Pathoetiology: The Role of MicroRNAs in the Dysregulation of Endometrial Functions

Endometriosis is a common gynecological disorder characterized by pelvic pain,heavy menstruation,and infertility.The clinical diagnosis of endometriosis is often delayed 8-10 years after the onset of symptoms due to the lack of an effective and reliable noninvasive diagnostic method.In recent years,a number of research studies have reported using microRNAs(miRNAs)as potential noninvasive biomarkers for diagnosing endometriosis.Because miRNAs regulate gene expression,the differential expression of miRNAs in endometriosis patients also provides insight on dysregulated gene expressions in the pathogenesis of endometriosis.In this review,a number of global profiling studies(published through July 2019)that investigated the differential expression of miRNAs in endometriosis were identified.Based on these findings,the role of miRNAs in the pathogenesis of endometriosis,particularly with regard to the dysregulation of endometrial functions,cell cycle regulation,proliferation of endometrial stromal cells,and angiogenesis,was discussed.The potential of these miRNAs as noninvasive diagnostic biomarkers of endometriosis was also discussed.

Twin Anemia Polycythemia Sequence: Knowledge and Insights After 15 Years of Research

Twin anemia polycythemia sequence (TAPS) is a chronic form of unbalanced feto-fetal transfusion through minuscule placental anastomoses in monochorionic twin pregnancies, leading to anemia in the donor twin and polycythemia in the recipient twin. TAPS can occur spontaneously in up to 5% of monochorionic twins or can arise in 2%-16% of cases after incomplete laser surgery for twin-twin transfusion syndrome. TAPS can develop across the entire second and third trimester. Antenatal diagnosis for TAPS is reached via Doppler measurement of the fetal middle cerebral artery peak systolic velocity, showing an increased velocity in the donor, combined with a decreased velocity in the recipient. Treatment options for TAPS include expectant management, preterm delivery, intrauterine blood transfusion with or without a partial exchange transfusion, fetoscopic laser surgery and selective feticide. The best treatment option is unclear and is currently being investigated in an international multicenter randomized trial (the TAPS trial). Spontaneous fetal demise occurs in 5%-11% of TAPS twins, more often in donors (8%-18%) than in recipients (2%-5%). Severe long-term neurodevelopmental impairment is seen in 9% of TAPS twins, with donors having an increased risk for cognitive impairment and hearing problems (15%).

Neurodevelopmental Outcome After Fetoscopic Laser Surgery for Twin-twin Transfusion Syndrome:A Systematic Review of Follow-up Studies from the Last Decade

Objective:To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome(TTTS).Methods:A literature search in PubMed,Embase,Emcare,Web of Science,Cochrane library,and Academic Search Premier was performed.Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams.Exclusion criteria were non-English articles and reviews,case reports,letters,and guidelines.Results:Nineteen articles were included.Long-term severe neurodevelopmental impairment(NDI)was reported by seven and ranged from 4.0%to 18.0%with a mean of 9.7%(95%confidence interval(CI):7.8-11.5).The prevalence of cerebral palsy ranged from 1.6%to 18.2%,with a mean of 5.1%(95%CI:4.1-6.2).The mean prevalence of minor impairment was 13.7%(95%CI:11.4-16.0).However,only 78.9%(15/19)studies used a validated neurodevelopmental test.As studies lack uniform definitions of primary outcome,timing of follow-up,inclusion criteria,and methods,adequate comparison is hampered.Conclusion:The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7%and 5.1%,respectively.International agreements on primary outcomes,methods,and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.