Assessment of satisfaction in patients after hysterectomy by myomatous uterus

Objetivo: el objetivo de este estudio es evaluar los resultados, en cuanto a calidad de vida, de aquellas pacientes que han sido sometidas a una histerectomía por útero miomatoso. Material y métodos: se realiza una encuesta sobre calidad de vida a todas las pacientes sometidas a histerectomía con indicación de útero miomatoso, en un hospital de tercer nivel dentro de la red de hospitales del servicio de salud de la Comunidad de Madrid, en el año 2010. Resultados: Se identificaron un total de 152 pacientes a las que se les había realizado una histerectomía por útero miomatoso, de las cuales contestaron la encuesta un total de 112 (74%) pacientes. Cuando se les preguntó a las pacientes si había mejorado su calidad de vida tras la realización de la histerectomía, un 78’6% (88/112) respondió afirmativamente, un 17% (19/112) refirió tener la misma calidad de vida, y un 4’4% (5/112) respondió que su calidad de vida había empeorado tras la intervención. Conclusiones: las pacientes sometidas a una histerectomía por útero miomatoso presentan un alto grado de satisfacción tras la cirugía, comunicando en su mayoría una mejora en cuanto al dolor pélvico previo a la cirugía, y una mejor calidad de vida tras la intervenciónObjective: the objective of this study is to evaluate the results, in terms of quality of life of those patients who have undergone hysterectomy for fibroid uterus. Material and methods: we performed a survey on quality of life for all patients undergoing hysterectomy with uterine fibroid indication in a tertiary care hospital within the hospital network of the health service of the Community of Madrid, in the year 2010. Results: a total of 152 patients which had undergone a hysterectomy for uterine myoma, which answered the survey a total of 112 (74%) patients. When asked patients if they had improved their quality of life after performing a hysterectomy, a 78’6% (88/112) responded affirmatively, 17% (19/112) reported having the same quality of life, and 4.4% (5/112) responded that their quality of life had worsened after surgery. Conclusions: patients undergoing a hysterectomy for uterine fibroids have a high degree of satisfaction after the surgery, communicating mostly an improvement in pelvic pain prior to surgery, and improved quality of life after surger

Protandric Transcriptomes to Uncover Parts of the Crustacean Sex-Differentiation Puzzle

Hermaphrodite systems offer unique opportunities to study sexual differentiation, due to their high degree of sexual plasticity and to the fact that, unlike gonochoristic systems, the process is not confined to an early developmental stage. In protandric shrimp species, such as Hippolyte inermis and Pandalus platyceros, male differentiation is followed by transformation to femaleness during adulthood. The mechanisms controlling sexual differentiation have not been fully elucidated in crustaceans, but a key role has been attributed to the insulin-like hormone (IAG) produced by the androgenic gland (AG), a crustacean masculine endocrine organ. To uncover further transcriptomic toolkit elements affecting the sexual differentiation of H. inermis, we constructed eye and whole body RNA libraries of four representative stages during its protandric life cycle (immature, male, young female and mature female). The body libraries contained transcripts related to the reproductive system, among others, while the eye libraries contained transcripts related to the X-organ-sinus gland, a central endocrine complex that regulates crustacean reproduction. Binary pattern analysis, performed to mine for genes expressed differentially between the different life stages, yielded 19,605 and 6,175 transcripts with a specific expression pattern in the eye and body, respectively. Prominent sexually biased transcriptomic patterns were recorded for the IAG and vitellogenin genes, representing, respectively, a key factor within the masculine IAG-switch, and a precursor of the yolk protein, typical of feminine reproductive states. These patterns enabled the discovery of novel putative protein-coding transcripts exhibiting sexually biased expression in the H. inermis body and eye transcriptomes of males and females. Homologs to the above novel genes have been found in other decapod crustaceans, and a comparative study, using previously constructed transcriptomic libraries of another protandric shrimp, P. platyceros, showed similar sexually biased results, supporting the notion that such genes, mined from the H. inermis transcriptome, may be universal factors related to reproduction and sexual differentiation and their control in other crustaceans. This study thus demonstrates the potential of transcriptomic studies in protandric species to uncover unexplored layers of the complex crustacean sex-differentiation puzzle

Placenta percreta, experiencia en 20 años del Hospital Universitario La Paz, Madrid, España

La placenta percreta es una rara enfermedad placentaria, con una incidencia muy baja y un muy difícil diagnóstico prenatal. Se presentan tres casos clínicos de placenta percreta recogidos en nuestro centro en los últimos 20 años. Se realiza una exposición detallada de cada uno de ellos, atendiendo fundamentalmente a la secuencia de acontecimientos quirúrgicos que tienen lugar tras el diagnóstico de esta grave entidad. La dificultad en el diagnóstico prenatal, así como la imperiosidad de las medidas terapéuticas, convierten a la placenta percreta en una enfermedad con una elevada morbilidad y mortalidad materna. El tratamiento quirúrgico así como la prevención y el tratamiento de la hemorragia posparto son las armas fundamentales para controlar esta gravísima complicación obstétrica.<br>The placenta percreta is a rare placental disease with a very low incidence and prenatal diagnosis difficult. We present three cases of placenta percreta observed in our hospital over the past 20 years. We present a detailed discussion of each of them, fundamentally to the sequence of surgical events that occur after the diagnosis of this serious entity. The difficulty of prenatal diagnosis, as well as the urgent therapeutic measures, make the placenta percreta in a disease with high morbidity and mortality. The surgical treatment and the prevention of postpartum hemorrhage are essential weapons to control this serious obstetric complication

Binary Gene Expression Patterning of the Molt Cycle: The Case of Chitin Metabolism

<div><p>In crustaceans, like all arthropods, growth is accompanied by a molting cycle. This cycle comprises major physiological events in which mineralized chitinous structures are built and degraded. These events are in turn governed by genes whose patterns of expression are presumably linked to the molting cycle. To study these genes we performed next generation sequencing and constructed a molt-related transcriptomic library from two exoskeletal-forming tissues of the crayfish <i>Cherax quadricarinatus</i>, namely the gastrolith and the mandible cuticle-forming epithelium. To simplify the study of such a complex process as molting, a novel approach, binary patterning of gene expression, was employed. This approach revealed that key genes involved in the synthesis and breakdown of chitin exhibit a molt-related pattern in the gastrolith-forming epithelium. On the other hand, the same genes in the mandible cuticle-forming epithelium showed a molt-independent pattern of expression. Genes related to the metabolism of glucosamine-6-phosphate, a chitin precursor synthesized from simple sugars, showed a molt-related pattern of expression in both tissues. The binary patterning approach unfolds typical patterns of gene expression during the molt cycle of a crustacean. The use of such a simplifying integrative tool for assessing gene patterning seems appropriate for the study of complex biological processes.</p></div

A Novel Chitin Binding Crayfish Molar Tooth Protein with Elasticity Properties

<div><p>The molar tooth of the crayfish <i>Cherax quadricarinatus</i> is part of the mandible, and is covered by a layer of apatite (calcium phosphate). This tooth sheds and is regenerated during each molting cycle together with the rest of the exoskeleton. We discovered that molar calcification occurs at the pre-molt stage, unlike calcification of the rest of the new exoskeleton. We further identified a novel molar protein from <i>C</i>. <i>quadricarinatus</i> and cloned its transcript from the molar-forming epithelium. We termed this protein Cq-M13. The temporal level of transcription of <i>Cq-M13</i> in an NGS library of molar-forming epithelium at different molt stages coincides with the assembly and mineralization pattern of the molar tooth. The predicted protein was found to be related to the pro-resilin family of cuticular proteins. Functionally, <i>in vivo</i> silencing of the transcript caused molt cycle delay and a recombinant version of the protein was found to bind chitin and exhibited elastic properties.</p></div

Chitin-binding ability of rCq-M13.

<p>Following incubation with chitin powder, equal amounts of Negative control—BSA (top), Positive control—GAP 65 (middle, using gastrolith protein extract with known chitin binding abilities [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127871#pone.0127871.ref002" target="_blank">2</a>], and rCq-M13 (bottom) underwent three consecutive washes prior to SDS-PAGE. Lane 1 represent the first wash with DDW, lane 2 represent the second wash with NaCl (0.2 M) and lane 3 represent the third wash with denaturation buffer (DB, containing SDS and 2-mercaptoethanol).</p

Normalized read count of key chitin metabolism-related genes transcripts.

<p>Read count of key chitin metabolism-related genes transcripts from the gastrolith-forming epithelium (left) and the mandible cuticle-forming epithelium (right). Numbers on the X axis represent the four molt stages, 1 inter-molt (pool of animals, n = 1), 2 early pre-molt (pool of animals, n = 1), 3 late pre-molt (two single animals and one pool, n = 3) and 4 post-molt (all single animals, n = 2). Presented transcripts are (a) chitin synthase, (b) chitinase, (c) chitin deacetylase, (d) GlcN-6P synthase and (e) GlcN-6P deaminase. Letters represent statistical groups which are significantly different (<i>p</i>-value <0.05), error bars represent standard error.</p

Duplicates of the amino sugar metabolism pathway, modified from KEGG.

<p>The upper panel shows gene expression patterns in the gastrolith-forming epithelium, while the lower panel shows gene expression patterns in the mandible cuticle-forming epithelium. Enzymes that were found in the transcriptomic library are highlighted in blue for pattern 1111, red for pattern 0110, orange for pattern 1001, green for pattern 0111 and grey for enzymes that did not show any pattern. Enzymes discussed in the text are marked as I for chitin synthase, II for uridylyltransferase, III for chitinase, IV for chitin deacetylase, V for GlcN-6P synthase and VI for GlcN-6P deaminase.</p

Development of a new molar tooth during an induced molt cycle in an ecdysone-injected male <i>C</i>. <i>quadricarinatus</i> and spatial and temporal expression patterns of the <i>Cq-M13</i> transcript <i>in vitro</i> and <i>in silico</i>.

<p><b>A</b>. Changes in molt mineralization index (MMI) during the induced molt cycle following repetitive injections of ecdysone. The x axis is normalized to days from ecdysis. A dashed line on an isolated mandible represents a cut through which a transverse plane is visible (A-top). <b>B</b>. Visualization of the new molar tooth assembly process in the crayfish mandible on days -9, -8, -7, -4, -3 and 0, following ecdysone injection by <i>ex vivo</i> micro-computed tomography. The top and bottom series of images show a view of the transverse and posterior planes of the mandibles correspondingly. White arrows point to the newly formed molar tooth. <b>C</b>. <i>In silico</i> transcriptomic analysis of <i>Cq-M13</i> read counts from four different molt stages. Different letters above columns represent statistically significant differences (p < 0.05 ± SE). <b>D</b>. Agarose gels showing RT-PCR products demonstrating spatial and temporal expression patterns of the <i>Cq-M13</i> transcript in cuticle-, molar-, basal segment (B.S.)-, maxillae- and gastrolith-forming tissues, as well as in hepatopancreas (Hepato) and testis.</p