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

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

Diabetes changes ionotropic glutamate receptor subunit expression level in the human retina

Early diabetic retinopathy is characterized by changes in subtle visual functions such as contrast sensitivity and dark adaptation. The outcome of several studies suggests that glutamate is involved in retinal neurodegeneration during diabetes. We hypothesized that the protein levels of ionotropic glutamate receptor subunits are altered in the retina during diabetes. Therefore, we investigated whether human diabetic patients have altered immunoreactivity of ionotropic glutamate receptor subunits in the retina.http://www.sciencedirect.com/science/article/B6SYR-4RS9SS1-1/1/232d6ae7147919a2286326863ee69f1

Reductive decarboxylation of bicyclic prolinic systems: a new approach to the enantioselective synthesis of the Geissman-Waiss lactone. X-ray structure determination of a key lactone intermediate

Two concise and enantioselective syntheses of the necine base precursors (1R,5R)-N-Cbz and N-Boc-2-oxa-6-azabicyclo[3.3.0]octan-3-ones (Geissman-Waiss lactones) were carried out from two enantiomerically pure endocyclic five-membered enecarbamates with overall yields of 23% and 26%, respectively. The synthetic strategy made use of a highly effective and stereoselective [2+2]cycloaddition of enantiomerically pure endocyclic enecarbamates with dichloroketene, as well as an efficient decarboxylation step of a bicyclic alpha-amino acid employing Boger's acyl selenide protocol employing tributyltin hydride. Interesting aspects concerning the regiochemical outcome of Baeyer-Villiger oxidations of bicyclic cyclobutanones are also reported, in which the usual stereoelectronic bias of Baeyer-Villiger oxidation seems to be counterbalanced by steric effects on the putative Criegee intermediate.Duas sínteses do conhecido precursor de bases necínicas, (1R,5R)-N-Cbz e N-Boc 2-oxa-6-azabiciclo[3.3.0]octan-3-onas (lactonas de Geissman-Waiss) foram realizadas com rendimentos globais de 23% e 26%, em seis e cinco etapas respectivamente, a partir de enecarbamatos endocíclicos de cinco membros enantiomericamente puros. A estratégia sintética adotada está fundamentada em uma reação de cicloadição [2+2] eficiente e altamente estereosseletiva de enecarbamatos de cinco membros com diclorocetenos, assim como em uma eficaz descarboxilação de alfa-amino ácidos bicíclicos pelo método de Boger, que utiliza a redução de selenetos de acila por hidretos de estanho. Aspectos relativos a regiosseletividade da reação de oxidação de azabiciclo ciclobutanonas pelo método de Baeyer-Villiger são também descritos, com destaque para um potencial controle regioquímico advindo de aspectos estéreos em contraposição a aspectos estereoeletrônicos.2738Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

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

High glucose and diabetes increase the release of [3H]-D-aspartate in retinal cell cultures and in rat retinas

Several evidences suggest that glutamate may be involved in retinal neurodegeneration in diabetic retinopathy (DR). For that reason, we investigated whether high glucose or diabetes affect the accumulation and the release of [3H]-D-aspartate, which was used as a marker of the glutamate transmitter pool. The accumulation of [3H]-D-aspartate did not change in cultured retinal neural cells treated with high glucose (30 mM) for 7 days. However, the release of [3H]-D-aspartate, evoked by 50 mM KCl, significantly increased in retinal cells exposed to high glucose. Mannitol, which was used as an osmotic control, did not cause any significant changes in both accumulation and release of [3H]-D-aspartate. In the retinas, 1 week after the onset of diabetes, both the accumulation and release of [3H]-D-aspartate were unchanged comparing to the retinas of agematched controls. However, after 4 weeks of diabetes, the accumulation of [3H]-D-aspartate in diabetic retinas decreased and the release of [3H]-Daspartate increased, compared to age-matched control retinas. These results suggest that high glucose and diabetes increase the evoked release of D-aspartate in the retina, which may be correlated with the hypothesis of glutamate-induced retinal neurodegeneration in DR

Modified gauge unfixing formalism and gauge symmetries in the non-commutative chiral bosons theory

We use the gauge unfixing (GU) formalism framework in a two dimensional noncommutative chiral bosons (NCCB) model to disclose new hidden symmetries. That amounts to converting a second-class system to a first-class one without adding any extra degrees of freedom in phase space. The NCCB model has two second-class constraints -- one of them turns out as a gauge symmetry generator while the other one, considered as a gauge-fixing condition, is disregarded in the converted gauge-invariant system. We show that it is possible to apply a conversion technique based on the GU formalism direct to the second-class variables present in the NCCB model, constructing deformed gauge-invariant GU variables, a procedure which we name here as modified GU formalism. For the canonical analysis in noncommutative phase space, we compute the deformed Dirac brackets between all original phase space variables. We obtain two different gauge invariant versions for the NCCB system and, in each case, a GU Hamiltonian is derived satisfying a corresponding first-class algebra. Finally, the phase space partition function is presented for each case allowing for a consistent functional quantization for the obtained gauge-invariant NCCB.Comment: 13 page

Prevalence of iron deficiency anemia and iron deficiency in a pediatric population with inflammatory bowel disease

OBJECTIVES: Iron deficiency is the most common cause of anemia in children with inflammatory bowel disease, although the real prevalence is unknown. Intravenous iron is suggested as the first line treatment. This study aims to determine the prevalence of iron deficiency anemia in children with inflammatory bowel disease followed in a Pediatric Gastroenterology Unit of a tertiary center and to evaluate this unit's experience with intravenous iron. MATERIALS AND METHODS: A retrospective cohort study was designed involving children with inflammatory bowel disease followed in that unit between January 2001 and April 2016. Laboratory results were collected at the moment of diagnosis, after one-year follow-up and prior each IV iron administration performed during the study period. Anemia was defined according to World Health Organization criteria and the iron deficiency was defined using recent guidelines. RESULTS: Were studied 69 patients 71% had CD and 29% UC. 50.7% were female. Mean patient age at diagnosis was 13.3 years (range 1--17 years). Prevalence of ID and IDA at diagnosis was 76.8% and 43.5%, respectively. After one year follow-up, those values decreased to 68.1% (p=.182) and 21.7% (p=.002), respectively. Hemoglobin significantly increased (p<.001). Intravenous iron was administered to 92.8% of patients. No adverse reactions were reported. CONCLUSIONS: Intravenous iron is the first line in the treatment of Iron deficiency anemia in Inflammatory Bowel disease and it is safe and effective. Persistent anemia and iron deficiency are common.info:eu-repo/semantics/publishedVersio

Elevated glucose changes the expression of ionotropic glutamate receptor subunits and impairs calcium homeostasis in retinal neural cells

PURPOSE. Altered glutamatergic neurotransmission and calcium homeostasis may contribute to retinal neural cell dysfunction and apoptosis in diabetic retinopathy (DR). The purpose of this study was to determine the effect of high glucose on the protein content of -amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) and kainate glutamate receptor subunits, particularly the GluR2 subunit, because it controls Ca2 permeability of AMPA receptor-associated channels. The effect of high glucose on the concentration of cytosolic free calcium ([Ca2 ]i) was also investigated. METHODS. The protein content of GluR1, GluR2, GluR6/7, and KA2 subunits was assessed by Western blot. Cobalt staining was used to identify cells containing calcium/cobalt-permeable AMPA receptors. The [Ca2 ]i changes evoked by KCl or kainate were recorded by live-cell confocal microscopy in R28 cells and in primary cultures of rat retina, loaded with fluo-4. RESULTS. In primary cultures, high glucose significantly decreased the protein content of GluR1 and GluR6/7 subunits and increased the protein content of GluR2 and KA2 subunits. High glucose decreased the number of cobalt-positive cells, suggesting a decrease in calcium permeability through AMPA receptor-associated channels. In high-glucose–treated cells, changes in [Ca2 ]i were greater than in control cells, and the recovery to basal levels was delayed. However, in the absence of Na , to prevent the activation of voltage-sensitive calcium channels, the [Ca2 ]i changes evoked by kainate in the presence of cyclothiazide, which inhibits AMPA receptor desensitization, were significantly lower in high-glucose–treated cells than in control cultures, further indicating that AMPA receptors were less permeable to calcium. Mannitol, used as an osmotic control, did not cause significant changes compared with the control. CONCLUSIONS. The results suggest that elevated glucose may alter glutamate neurotransmission and calcium homeostasis in the retina, which may have implications for the mechanisms of vision loss in DR.Foundation for Science and Technology, Portugal and FEDER (Grant POCTI/CBO/38545/01), The Juvenile Diabetes Research Foundation, The American Diabetes Association and the Pennsylvania Lions Sight Conservation and Eye Eye Research Foundation

Patterns of cell proliferation and apoptosis by topographic region in normal Bos taurus vs. Bos indicus crossbreeds bovine placentae during pregnancy

Abstract Background Placental and fetal growth requires high rates of cellular turnover and differentiation, which contributes to conceptus development. The trophoblast has unique properties and a wide range of metabolic, endocrine and angiogenic functions, but the proliferative profile of the bovine placenta characterized by flow cytometry analysis and its role in fetal development are currently uncharacterized. Complete understanding of placental apoptotic and proliferative rates may be relevant to development, especially if related to the pathogenesis of pregnancy losses and placental abnormalities. Methods In this study, the proliferation activity and apoptosis in different regions of normal bovine placenta (central and boundary regions of placentomes, placentomal fusion, microplacentomes, and interplacentomal regions), from distinct gestation periods (Days 70 to 290 of pregnancy), were analyzed by flow cytometry. Results Our results indicated that microplacentomes presented a lower number of apoptotic cells throughout pregnancy, with a higher proliferative activity by the end of gestation, suggesting that such structures do not contribute significantly to normal of placental functions and conceptus development during pregnancy. The placentome edges revealed a higher number of apoptotic cells from Day 170 on, which suggests that placentome detachment may well initiate in this region. Conclusion Variations involving proliferation and apoptotic rates may influence placental maturation and detachment, compromising placental functions and leading to fetal stress, abnormalities in development and abortion, as frequently seen in bovine pregnancies from in vitro fertilization and cloning procedures. Our findings describing the pattern of cell proliferation and apoptosis in normal bovine pregnancies may be useful for unraveling some of the developmental deviations seen in nature and after in vitro embryo manipulations