Massa vulvar – a ponta do iceberg

Uterine fibroids are benign monoclonal tumors that originates from the smooth muscle cells of the myometrium and are the most common solid pelvic tumors in women. In the differential diagnosis of vulvar masses we should considered Bartholin's cysts or abscesses, Bartholin's tumors, fibroids (usually fibroids of the round ligament), subcutaneous lipomas, inguinal hernia or adenomegaly. With this images we present a case of a vulvar mass caused by a fibroid, probably from the round ligament, which was a tip of the iceberg of an extensive pelvic leiomyomatosis.info:eu-repo/semantics/publishedVersio

THE IMPORTANCE OF CONSISTENT KINEMATIC DATA IN THE INVERSEDYNAMIC ANALYSIS OF BIOMECHANICAL MODELS

INTRODUCTION: The evaluation of the muscular actions and internal forces of human articular joints is of major importance in different areas of medicine, sports, physical rehabilitation or biomedical engineering. There is no experimental methodology that can directly measure these forces. Among the numerical procedures that can be applied, inverse dynamics based methods are still the most commonly used numerical tools. Their use requires that the kinematics of human motion, i.e., the positions, velocities and accelerations of the anatomical points, be known in advance. This is obtained by standard reconstruction methods based on the DLT technique (Aziz and Karara, 1971). Moreover, the equations of motion for the system must be associated to a biomechanical model (Celigueta, 1996; Silva et al., 1997). The muscle action may be obtained by having each particular group of muscles, defined as those with similar functions and common anatomical insertions, modeled independently and included in the biomechanical model (An et al., 1995). This leads to an indeterminate problem, in terms of the unknown forces, that can be solved using the optimization theory (Pedotti et al., 1978). Alternatively, the actions of the different muscle groups can be lumped as moments about anatomical joints leading to a determinate inverse dynamics problem (Winter, 1991). Regardless of the biomechanical model used or of the way the muscle actions are described, the results obtained from the inverse dynamic analysis are related to the quality of the kinematic data supplied. The problem of the consistency of this kinematic data with respect to the biomechanical model used is addressed in this work, it being shown that the quality of the inverse dynamics analysis results is highly dependent on the data kinematic consistency

Sexualidade no Terceiro Trimestre de Gravidez

Objectivos: Descrever a experiência sexual feminina no terceiro trimestre de gravidez. Tipo de estudo: Estudo descritivo transversal. Local: Consulta de Referência da Maternidade Dr. Alfredo da Costa – Lisboa, Portugal. População: Amostra de conveniência de cem mulheres com gravidez de baixo risco, que não tinham restrições médicas na sua actividade sexual. Métodos: As participantes completaram voluntariamente e em anonimato um questionário elaborado pelos autores respeitante a dados demográficos, história obstétrica, relacionamento sexual e esclarecimento/mitos sobre a sexualidade durante o último mês de gravidez. Resultados: A maioria das grávidas refere diminuição da actividade sexual após engravidar, embora mantenha relações sexuais uma ou mais vezes por semana e coito vaginal no terceiro trimestre, sem mudanças significativas para outros tipos de comportamento. Os factores que influenciam a redução da actividade sexual no terceiro trimestre são a diminuição do desejo, dispareunia e cansaço físico. Os mitos, crenças religiosas, nível de educação e dificuldade na informação sentida também parecem contribuir para a redução da actividade sexual. Frequentemente as grávidas indicam que o parceiro tem medo de prejudicar o bebé. Poucas mulheres obtiveram informação através dos profissionais de saúde sobre este tópico e consideram que gostariam de ter sido mais bem esclarecidas pelos mesmos. Conclusões: Os autores acreditam que na maioria dos casos a gravidez não provoca uma ruptura na sexualidade de um casal se esta era previamente satisfatória. No entanto, consideram importante a abordagem deste tema com a grávida por parte dos profissionais de saúde

Congenital Malformations of the Female Genital Tract: a Review of Available Classification Systems

Congenital malformations of the female genital tract are being diagnosed more frequently due to advances in imaging techniques. A broad international consensus on their classification is still lacking. This paper aimed to comparatively summarize the most frequently and widely used, as well as the most recently developed classification systems of congenital female genital malformations. A non-systematic review was done through a search on major databases with the medical subject heading (MeSH) term ‘‘congenital abnormalities” in combination with ‘‘classification” and ‘‘female genitalia”. All available systems, including, among others, the American Fertility Society Classification (1988), the Acien and Acien classification (1992, 2004), the VCUAM system (2005), the European Society for Human Reproduction and Embryology - European Society for Gynecological Endoscopy classification (2013), the Congenital Uterine Malformation Experts (CUME) group recommendations, and the American Society for Reproductive Medicine Classification (2021) possess the advantages and disadvantages listed in this article. Regarding the most common situations, the criteria for differentiating physiologic arcuate and discrete partial septate uteri vary widely between classifications, while difficulties also persist with the rarer complex abnormalities that cannot be easily classified, contributing to a gap in clinical and research protocols. The main factor compromising any attempt to reach an ideal classification system is the lack of evidence-based data, justifying the need for comparative multicenter international randomized control trials in this field. Pending new research data and a broad international consensus, it seems essential for adequate patient orientation to describe each detected malformation in detail and to correlate it with the clinical presentation, regardless the type of classification used.info:eu-repo/semantics/publishedVersio

Lupus and Pregnancy. 15 Years of Experience in a Tertiary Center

This retrospective study was designed to evaluate the outcome of pregnancies in women diagnosed with systemic lupus erythematosus (SLE) followed in a tertiary fetal–maternal center. Data were collected from clinical charts between January 1993 and December 2007, with a total of 136 pregnancies (107 patients). Mean maternal age was 29 years, with the vast majority of patients being Caucasian. Most patients were in remission 6 months prior to pregnancy (93%) and the most frequently affected organs were the skin and joints. Renal lupus accounted for 14% of all cases. Twenty-nine percent of patients were positive for at least one antiphospholid antibody (aPL) and nearly 50% had positive SSa/SSb antibodies. All patients with positive aPL received low-dosage aspirin and low molecular- weight heparin (LMWH). There were no pregnancy complications in more than 50% of cases and hypertensive disease and intrauterine growth restriction were the most common adverse events. There were 125 live births, one neonatal death, eight miscarriages, and three medical terminations of pregnancy. Preterm delivery occurred in 25% of pregnancies. Our results are probably the conjoined result of a multidisciplinary approach together with a systematic management of SLE pregnancies, with most patients keeping their prior SLE medication combined with low-dosage aspirin and LMWH in the presence of aPL

Influence of the contact–impact force model on the dynamic response of multi-body systems

This work deals with contact–impact force models for both spherical and cylindrical contact surfaces. The incorporation of the friction phenomenon, based on the Coulomb friction law, is also discussed together with an effective computational strategy, which includes the automatic step size selection procedure. Impacts within a revolute clearance joint in a basic slider–crank mechanism are used as an example to compare the different contact force models. The collision is a prominent phenomenon in manymulti-body systems such as mechanisms with intermittent motion, kinematic discontinuities, and clearance joints. As a result of an impact, the values of the system state variables change very fast, eventually looking like discontinuities in the system velocities and accelerations. The impact is characterized by large forces that are applied and removed in a short time period. The knowledge of the peak forces developed in the impact process is very important for the dynamic analysis of multibody systems and it has consequences in the design process. The model for the contact–impact force must consider the material and geometric properties of the colliding surfaces, consider information on the impact velocity, contribute to an efficient integration, and account for some level of energy dissipation. These characteristics are ensured with a continuous contact force model, in which the deformation and contact forces are considered as continuous functions.FEDER - Project POCTI/2001/EME/38281.Fundação para a Ciência e a Tecnologia (FCT)

Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: a Prospective Multicenter Portuguese Study

This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.info:eu-repo/semantics/publishedVersio

Corneal Biomechanics in Ectatic Diseases: Refractive Surgery Implications.

BACKGROUND: Ectasia development occurs due to a chronic corneal biomechanical decompensation or weakness, resulting in stromal thinning and corneal protrusion. This leads to corneal steepening, increase in astigmatism, and irregularity. In corneal refractive surgery, the detection of mild forms of ectasia pre-operatively is essential to avoid post-operative progressive ectasia, which also depends on the impact of the procedure on the cornea. METHOD: The advent of 3D tomography is proven as a significant advancement to further characterize corneal shape beyond front surface topography, which is still relevant. While screening tests for ectasia had been limited to corneal shape (geometry) assessment, clinical biomechanical assessment has been possible since the introduction of the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, USA) in 2005 and the Corvis ST (Oculus Optikgerate GmbH, Wetzlar, Germany) in 2010. Direct clinical biomechanical evaluation is recognized as paramount, especially in detection of mild ectatic cases and characterization of the susceptibility for ectasia progression for any cornea. CONCLUSIONS: The purpose of this review is to describe the current state of clinical evaluation of corneal biomechanics, focusing on the most recent advances of commercially available instruments and also on future developments, such as Brillouin microscopy.(undefined)info:eu-repo/semantics/publishedVersio

Lubricated revolute joints in rigid multibody systems

The main purpose of this work is to present a general methodology for modeling lubricated revolute joints in constrained rigid multibody systems. In the dynamic analysis of journal-bearings, the hydrodynamic forces, which include both squeeze and wedge effects, generated by the lubricant fluid, oppose the journal motion. The hydrodynamic forces are obtained by integrating the pressure distribution evaluated with the aid of Reynolds’ equation, written for the dynamic regime. The hydrodynamic forces built up by the lubricant fluid are evaluated from the system state variables and included into the equations of motion of the multibody system. Numerical examples are presented in order to demonstrate the use of the methodologies and procedures described in this work.Fundação para a Ciência e a Tecnologia (FCT

Differential contribution of the guanylyl cyclase-cyclic GMP-protein kinase g pathway to the proliferation of neural stem cells stimulated by nitric oxide

Nitric oxide (NO) is an important inflammatory mediator involved in the initial boost in the proliferation of neural stem cells following brain injury. However, the mechanisms underlying the proliferative effect of NO are still unclear. The aim of this work was to investigate whether cyclic GMP (cGMP) and the cGMP-dependent kinase (PKG) are involved in the proliferative effect triggered by NO in neural stem cells. For this purpose, cultures of neural stem cells isolated from the mouse subventricular zone (SVZ) were used. We observed that long-term exposure to the NO donor (24 h), NOC-18, increased the proliferation of SVZ cells in a cGMP-dependent manner, since the guanylate cyclase inhibitor, ODQ, prevented cell proliferation. Similarly to NOC-18, the cGMP analogue, 8-Br-cGMP, also increased cell proliferation. Interestingly, shorter exposures to NO (6 h) increased cell proliferation in a cGMP-independent manner via the ERK/MAP kinase pathway. The selective inhibitor of PKG, KT5823, prevented the proliferative effect induced by NO at 24 h but not at 6 h. In conclusion, the proliferative effect of NO is initially mediated by the ERK/MAPK pathway, and at later stages by the GC/cGMP/PKG pathway. Thus, our work shows that NO induces neural stem cell proliferation by targeting these two pathways in a biphasic manner. Copyright (C) 2012 S. Karger AG, BaselCalouste Gulbenkian Foundation; L'Oreal; UNESCO; Foundation for Science and Technology (FCT, Portugal) [SFRH/BPD/78901/2011, SFRH/BD/23754/2005, SFRH/BD/38127/2007]; COMPETE; FEDER [PTDC/SAU-NEU/102612/2008]info:eu-repo/semantics/publishedVersio