A Rare Obstetric Outcome in Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis

Background: The unique clinical syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal anomaly is very rare and can be quite difficult to recognize because of the enormous heterogeneity in its clinical presentation. There are few long-term reports of the reproductive performance of women with this syndrome following treatment, or about the location of subsequent pregnancies. Case: A case in which two spontaneous pregnancies occurred alternatively in both hemiuteri: one despite a previous ipsilateral large hematometra and hematocolpos and the other, 8 years after, simultaneously with contralateral hematometra and hematocolpos(because of vaginal restenosis), is reported. Drainage of hematocolpos was performed at 14 weeks of pregnancy with immediate pain relief. Results: Pregnancy proceeded without complications. Eight month after delivery, a vaginoplasty was performed by excising the longitudinal vaginal septum, and marsupializing the vaginal cuff. Conclusions: This case highlights the importance of a correct and early diagnosis of developmental anomalies of the urogenital tract, as well as how a conservative approach in a Mullerian anomaly with unilateral obstruction led to two successful pregnancies occurring alternatively in the unaffected and in the previously blocked side. This is additional information supporting that every effort should be made to preserve the obstructed uterus

The prevalence of retinopathy of prematurity in very low birth weight newborn infants

OBJECTIVE: To evaluate the prevalence of retinopathy of prematurity and the risk factors affecting very low birth weight infants at a neonatal intensive care unit. METHODS: A cross-sectional study investigating all newborn infants with birth weights > 1,500 g and/or gestational ages > 32 weeks, admitted to the Neonatal ICU at the Hospital de Clínicas de Porto Alegre, from October 2002 to March 2004. Patients underwent indirect binocular ophthalmoscopy of the fundus at six weeks postpartum. Infants who progressed to threshold disease were given laser therapy. RESULTS: One hundred and fourteen newborn infants were studied. Eighty-three patients were not diagnosed with retinopathy of prematurity, 18 had stage I retinopathy of prematurity, seven stage II retinopathy of prematurity and six patients had threshold retinopathy of prematurity. The prevalence of retinopathy of prematurity was 27.2% (95% CI: 19.28-36.32) affecting 31 newborn infants, and the prevalence of retinopathy of prematurity progressing to threshold disease was 5.26% (95% CI: 1.96-11.10), affecting six patients. Retinopathy of prematurity was confirmed in 50% of the patients with weights below 1,000 g and 71.5% of newborn infants born at gestational ages of less than 28 weeks. Gestational age and birth weight were significantly lower among patients with retinopathy of prematurity than among those without. CONCLUSIONS: Although the results of this study demonstrate that the observed prevalence was similar to that described in literature, this ROP frequency remains elevated among very low birth weight infants. The development of retinopathy of prematurity was inversely proportional to weight and gestational age at birth.OBJETIVO: Avaliar a prevalência de retinopatia da prematuridade e os fatores de risco em recém-nascidos de muito baixo peso internados em uma unidade de tratamento intensivo neonatal. MÉTODOS: Estudo transversal incluindo todos os recém-nascidos com peso ao nascimento > 1.500 g e/ou idade gestacional > 32 semanas, admitidos na unidade de tratamento intensivo neonatal do Hospital de Clínicas de Porto Alegre, entre outubro de 2002 e março de 2004. Os pacientes foram submetidos a exame de fundo de olho sob oftalmoscopia binocular indireta na sexta semana de vida. Foi realizado tratamento a laser nos que atingiram a doença limiar RESULTADOS: Foram estudados 114 recém-nascidos. Em 83 pacientes, não se diagnosticou retinopatia da prematuridade; 18 apresentaram retinopatia da prematuridade 1; sete, retinopatia da prematuridade 2; seis, retinopatia da prematuridade em doença. A prevalência de retinopatia da prematuridade foi de 27,2% (IC 95%: 19,28-36,32), afetando 31 recém-nascidos, e a prevalência de retinopatia da prematuridade que atingiu doença limiar foi de 5,26% (IC 95%: 1,96-11,10), afetando seis pacientes. Verificou-se retinopatia da prematuridade em 50% dos pacientes com peso inferior a 1.000 g e em 71,5% dos recém-nascidos com idade gestacional inferior a 28 semanas. A idade gestacional e o peso de nascimento foram significativamente menores nos pacientes com retinopatia da prematuridade em comparação aos normais. CONCLUSÕES:Embora os resultados deste estudo mostrem que a prevalência encontrada foi semelhante à encontrada na literatura, a ocorrência de retinopatia da prematuridade ainda é alta nos recém-nascidos de muito baixo peso. O desenvolvimento da retinopatia da prematuridade foi inversamente proporcional ao peso e à idade gestacional ao nascimento.Universidade Federal do Rio Grande do SulUniversidade Federal de São Paulo (UNIFESP)Hospital de Clínicas de Porto Alegre Setor de Retinopatia da PrematuridadeHCPA Serviço de NeonatologiaUNIFESPSciEL

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

Transobturator tapes for stress urinary incontinence treatment: middle-term results

INTRODUCTION Minimal invasive surgical treatment of female stress urinary incontinence with suburethral transobturator tapes is completely accepted nowadays. The purpose of this study is to evaluate the efficacy and security of these suburethral tapes, comparing the outside-in to the inside-out approach. MATERIAL AND METHODS We performed a retrospective study of 298 patients with stress urinary incontinence diagnosis that were submitted to transobturator surgery between 2003 and 2006. From these patients 113 women underwent outside-in approach and 185 patients had inside-out approach. RESULTS The mean-age of the patients was 57.2 +/- 10.3 years-old and 69.1% were in the post-menopausal period. Mean parity was 2.2 +/- 1.1. The outside-in approach was performed more frequently in association with other(s) pelvic floor surgery(ies) (83.2% versus 37.8% for the inside-out technique). The mean follow-up duration was of 14.35 +/- 13.75 months in those patients who had a transobturator outside-in technique and of 11.79 +/- 10.39 months in the inside-out group. In respect to the efficacy, results were identical in the two groups with cure and cure or improvement rates respectively of 76.9% and 92.9% in the outside-in group and of 82.7% and 93.5% in the inside-out group (differences not significative). Regarding mean procedure duration, when it was performed isolated, we had a significant lower duration in patients submitted to inside-out technique (14.77 +/- 5.37 minutes versus 21.21 +/- 7.48 minutes, p < 0.05). The post-operative rates of de novo urge incontinence and mesh erosions were identical in the two groups, however microporous tapes had more erosions than macroporous ones (p < 0.05). DISCUSSION AND CONCLUSIONS The transobturator suburethral tapes are effective and safe for the stress urinary incontinence treatment. We had elevated cure and improvement rates with no significant differences in regard to performed procedure. The inside-out technique is significantly associated to a lower operative duration.publishersversionpublishe

Phonon confinement and substitutional disorder in Cd1-xZnxS Nanocrystals

1LO optical phonons in free-standing mixed Cd1-xZnxS nanocrystals, synthesized using chemical precipitation, are investigated using Raman spectroscopy. As expected for the nanocrystals, the 1-LO modes are found to appear at slightly lower wavenumbers than those in the bulk mixed crystals and exhibit one mode behavior. On the other hand, the line broadening is found to be much more than that can be accounted on the basis of phonon confinement. From the detailed line shape analysis it turns out that the substitutional disorder in the mixed crystals contributes much more to the line broadening than the phonon confinement. The linewidth arising from these mechanisms are also extracted from the analysis.Comment: 15 Pages,8 Figures, Accepted in J. Raman Spectroscop

Researching interactions between humans and machines: methodological challenges

Communication scholars are increasingly concerned with interactions between humans and communicative agents. These agents, however, are considerably different from digital or social media: They are designed and perceived as life-like communication partners (i.e., as “communicative subjects”), which in turn poses distinct challenges for their empirical study. Hence, in this paper, we document, discuss, and evaluate potentials and pitfalls that typically arise for communication scholars when investigating simulated or non-simulated interactions between humans and chatbots, voice assistants, or social robots. In this paper, we focus on experiments (including pre-recorded stimuli, vignettes and the “Wizard of Oz”-technique) and field studies. Overall, this paper aims to provide guidance and support for communication scholars who want to empirically study human-machine communication. To this end, we not only compile potential challenges, but also recommend specific strategies and approaches. In addition, our reflections on current methodological challenges serve as a starting point for discussions in communication science on how meaning-making between humans and machines can be investigated in the best way possible, as illustrated in the concluding section

PREVALÊNCIA DA RETINOPATIA DA PREMATURIDADE NO CENTRO DE NEONATOLOGIA DO HOSPITAL DE CLÍNICAS DE PORTO ALEGRE

Objetivo: Estudar a prevalência da retinopatia da prematuridade em recém-nascidos prematuros, nascidos no Hospital de Clínicas de Porto Alegre entre outubro de 2002 e agosto de 2005. Métodos: Estudo transversal de 220 crianças prematuras nascidas com peso igual ou inferior a 1.500 gramas e/ou com idade gestacional igual ou menor do que 32 semanas, examinadas no centro de neonatologia, após dilatação das pupilas, sempre a partir da sextasemana de vida. Resultados: A retinopatia da prematuridade ocorreu em 61 (61/220) prematuros, em um percentual de 27,73%. A doença atingiu estadiamento 1 em 12,73% dos casos (28/220), estadiamento 2 em 9,55% dos casos (21/220) e estadiamento 3 em 5% dos casos (11/220). Apenas uma das crianças atingiu o estadiamento 5 da doença, em 0,45% dos casos (1/220).Conclusões: O percentual de 27,73% de retinopatia encontrado foi similar ao de outros trabalhos internacionais com o mesmo delineamento, assim como o percentual de 5% de retinopatia no estágio 3. Apenas um dos prematuros desenvolveu a doença até o estágio mais grave (5), havendo 0,45% de cegueira pela retinopatia da prematuridade no Hospital de Clínicas de Porto Alegre.Unitermos: Retinopatia da prematuridade, prevalência, cegueira, prevenção

Secreted aspartic protease 2 of Candida albicans inactivates factor H and the macrophage factor H-receptors CR3 (CD11b/CD18) and CR4 (CD11c/CD18).

The opportunistic pathogenic yeast Candida albicans employs several mechanisms to interfere with the human complement system. This includes the acquisition of host complement regulators, the release of molecules that scavenge complement proteins or block cellular receptors, and the secretion of proteases that inactivate complement components. Secreted aspartic protease 2 (Sap2) was previously shown to cleave C3b, C4b and C5. C. albicans also recruits the complement inhibitor factor H (FH), but yeast-bound FH can enhance the antifungal activity of human neutrophils via binding to complement receptor type 3 (CR3). In this study, we characterized FH binding to human monocyte-derived macrophages. Inhibition studies with antibodies and siRNA targeting CR3 (CD11b/CD18) and CR4 (CD11c/CD18), as well as analysis of colocalization of FH with these integrins indicated that both function as FH receptors on macrophages. Preincubation of C. albicans yeast cells with FH induced increased production of IL-1beta and IL-6 in macrophages. Furthermore, FH enhanced zymosan-induced production of these cytokines. C. albicans Sap2 cleaved FH, diminishing its complement regulatory activity, and Sap2-treatment resulted in less detectable CR3 and CR4 on macrophages. These data show that FH enhances the activation of human macrophages when bound on C. albicans. However, the fungus can inactivate both FH and its receptors on macrophages by secreting Sap2, which may represent an additional means for C. albicans to evade the host innate immune system