Molecular and Clinical Insights on the Complex Interaction between Oxidative Stress, Apoptosis, and Endobiota in the Pathogenesis of Endometriosis

Endometriosis (EMS) remains, to date, an intriguing and debilitating gynecological disorder that possesses a multifactorial substrate. Recent studies with the objective of elucidating its etiology highlighted the antagonistic effect of EMS on a multiple of processes involved in homeostasis. Although the current oxidative biomarkers clearly reveal the consequences induced by EMS, its implication in the associated inflammatory reactions could be much more complex. Besides the overproduction of reactive oxygen species (ROS) that leads to an exacerbated oxidative response, it also changes the normal expression of several pro-inflammatory modulators, reflected by the fluctuating activity of several pro- and anti-apoptotic mediators whose expression is impaired. In light of this topic, several studies elucidate the involvement of apoptosis in EMS, being brought controversial findings, even reports with no significant change. Further, some authors reported an abnormal expression of multiple genes that are crucial for the overall functionality of the female reproductive system. Cumulatively, it seems that the subsequent oxidative imbalance and apoptosis process impairment could further disrupt the normal removal of unnecessary biological products. Based on all gathered evidence, we could argue that the related stress state could determine human endobiota impairment, which could further participate in the inflammatory and main antioxidant enzyme changes occurring in EMS. Moreover, a correlation between endobiota integrity, inflammation, and oxidative stress (OS) was suggested in relation to the possible predisposition to pathogen determined infections.

The complex relationship between infertility and psychological distress (Review)

Infertility is defined as the inability to procreate, or carry or deliver a baby naturally. The majority of specialists describe infertility as being unable to get pregnant after having tried for at least one year. The relationship between infertility and psychological stress is complex. On the one hand, infertile couples are subject to greater stress and have a greater risk of developing psychological disorders compared with normal, healthy couples. On the other hand, high levels of psychological distress have been indicated to increase infertility. Therefore, in the present review, the main factors that may lead to increased stress in couples who try to conceive, psychological stress as the reason for infertility, and the therapies that can help decrease psychological distress and increase chances of pregnancy are underlined. In addition to the psychological side effects that may occur from infertility itself, a range of other side effects can be caused by hormones and drugs used to treat infertility. Additionally, problem during erection and ejaculation can cause of psychological distress, which can lead to infertility among men. Psychotherapy is the main intervention recommended for couples who suffer from any form of infertility. Ideally, counselling should begin before patients start any medical intervention to help with their infertility.

Importance of studying primitive neuroectodermal tumors and extraosseous Ewings sarcoma of the vagina and vulva

Primitive neuroectodermal tumor (PNT) and Ewing's sarcoma are rare, round-cell tumors, characterized by the presence of the t(11; 22)(q24; q12) chromosomal translocation. A review of the literature revealed only 38 previously reported cases of vulvar PNT and Ewing's sarcoma and 15 vaginal PNT and Ewing's sarcoma. Although rare, these types of tumors should be taken into consideration when making a differential diagnosis for vulvar or vaginal tumors. The currently available data is limited, and therefore, case reports are essential for improving knowledge and management of these types of extremely rare tumors. However, further molecular and histopathological studies are essential for an improved understanding of these conditions and for an early, correct diagnosis. Although the gathered and presented data from the present review are limited, the literature demonstrates that the outcome of these types of cancer are more favorable compared with outcomes observed for carcinomas in more typical locations.

Mini-Review on the Possible Interconnections between the Gut-Brain Axis and the Infertility-Related Neuropsychiatric Comorbidities

Both the gut-brain axis (GBA) and the hypothalamic–pituitary–adrenal (HPA) axis remain an intriguing yet obscure network with a strong influence over other systems of organs. Recent reports have sought to describe the multitude of harmful stressors that may impact the HPA axis along with the interconnections between these. This has improved our knowledge of how the underlying mechanisms working to establish homeostasis are affected. A disruption to the HPA axis can amplify the chances of gastrointestinal deficiencies, whilst also increasing the risk of a wide spectrum of neuropsychiatric disorders. Thus, the influence of microorganisms found throughout the digestive tract possess the ability to affect both physiology and behaviour by triggering responses, which may be unfavourable. This is sometimes the case in of infertility. Numerous supplements have been formulated with the intention of rebalancing the gut microflora. Accordingly, the gut flora may alter the pharmacokinetics of drugs used as part of fertility treatments, potentially exacerbating the predisposition for various neurological disorders, regardless of the age and gender.

A case report of placental mesenchymal dysplasia: A rare case of a genetically normal fetus with severe intrauterine growth restriction

RATIONALE

We report a rare case of a pregnant woman with placental mesenchymal dysplasia (PMD) and intrauterine growth restriction (IUGR) with a genetically normal fetus.

PATIENT CONCERNS

A 42-year-old woman Gravida I, Para I with pre-existent uncontrolled hypertension and uterine polyfibromatosis present at 30 weeks of gestation for diminished fetal activity during the last 2 days.

DIAGNOSIS

Placental mesenchymal dysplasia associated with intrauterine growth restriction, hypertension, and uterine polyfibromatosis.

INTERVENTION

A live male infant was delivered by emergency caesarean section.

OUTCOMES

The infant, weighing 700 g, died 4 days after birth due to a massive intracerebral hemorrhage.

LESSONS

A careful examination should be done at every ultrasound in case of a fetus with IUGR to exclude some rare cases of placental pathologies. PMD can be a rare cause of IUGR with a genetically normal fetus.

Präoperative Dignitätsbeurteilung asymptomatischer Adnextumoren mittels Positronen-Emissions-Tomographie und F-18-FluordeoxygIukose

Ziel: Es wurde untersucht, ob die FDG-PET zu einer Verbesserung der Dignitätsbeurteilung asymptomatischer, sonographisch malignomsuspekter Ovarialtumoren beitragen kann. Methode: 85 Patientinnen mit malignomsuspekten, asymptomatischen Adnextumoren unterzogen sich einer FDG-PET Untersuchung. Emissionsaufnahmen des Abdomens wurden ca. 1 h nach i. v. Injektion von 222-555 MBq F-18-FDG angefertigt (Exact HR+ bzw. ECAT 931). Die Bildrekonstruktion erfolgte iterativ. Die PET-Aufnahmen wurden visuell ausgewertet, zum einen ohne andere bildgebende Verfahren, zum anderen zusammen mit der Kernspintomographie. Die Validierung erfolgte mittels Histologie. Ergebnisse: Histologisch fanden sich 8 Malignome, von denen 4 mittels FDGPET als richtig positiv erkannt wurden. Falsch negative Resultate ergaben sich bei 2 Adenokarzinomen im Stadium pT1a und bei 2 Borderline-Tumoren. Bei 60 der 77 benignen Ovarialtumoren konnte das Vorliegen von Malignität mittels PET ausgeschlossen werden. Falsch positive Ergebnisse lagen bei 3 akut entzündlichen Veränderungen, 1 Teratom, 1 benignen Schwannom, 1 Dermoidzyste, 1 benignen Thekom, 1 serösen Zyste, 1 serösen Zystadenom, 2 muzinösen Zystadenomen, 2 Corpusluteum-Zysten, 3 Endometriosezysten und 1 Sactosalpinx vor, wobei in mindestens 6 Fällen der falsch positive FDG-Uptake einer Fehlinterpretation von physiologischer Darmaktivität zuzuschreiben war. Die Sensitivität und Spezifität der FDG-PET betrugen 50% und 78%. Die retrospektive Befundung zusammen mit der Kernspintomographie steigerte die Spezifität auf 86% (bei gleichbleibender Sensitivität). Schlußfolgerung: Die Sensitivität der FDG-PET bezüglich der Detektion von Borderline-Tumoren und Frühkarzinomen des Ovars ist deutlich eingeschränkt. Die sich aus der geringen Inzidenz maligner Ovarialtumoren ergebende Anforderung höchster Spezifität an ein Verfahren zur Dignitätsdiagnostik wird von der FDG-PET auch unter Einbeziehung kernspintomographischer Informationen nicht erfüllt. Die FDG-PET ist somit in der klinischen Situation der präoperativen Dignitätsbeurteilung suspekter, asymptomatischer Ovarialtumoren nicht empfehlenswert.

Effect of Histophilus somni on Heart and Brain Microvascular Endothelial Cells

Histophilus somni is a pathogenic gram-negative bacterium responsible for pneumonia and septicemia in cattle. Sequelae include infectious thrombotic meningoencephalitis (ITME), myocarditis, arthritis, and abortion. These syndromes are associated with widespread vasculitis and thrombosis, implicating a role for endothelium in pathogenesis. Histopathologic and immunohistochemical investigation of 10 natural cases of bovine H. somni myocarditis and 1 case of ITME revealed intravascular H. somni in large biofilm-like aggregates adherent to the luminal surface of microvascular endothelium. Ultrastructurally, bacterial communities were extracellular and closely associated with degenerating or contracted endothelial cells. Histophilus somni was identified by bacterial culture and/or immunohistochemistry. Western blots of the bacterial isolates revealed that they expressed the immunodominant protective 40 kDa OMP and immunoglobulin-binding protein A (IbpA) antigens. The latter is a large surface antigen and shed fibrillar antigen with multiple domains. The cytotoxic DR2Fic domain of IbpA was conserved as demonstrated by polymerase chain reaction. Treatment of endothelial cells in vitro with IbpA in crude culture supernatants or purified recombinant GST-IbpA DR2Fic (rDR2) cytotoxin induced retraction of cultured bovine brain microvascular endothelial cells. By contrast, no retraction of bovine endothelium was induced by mutant rDR2H/A with an inactive Fic motif or by a GST control, indicating that the cytotoxic DR2Fic motif plays an important role in endothelial cell retraction in vasculitis. The formation of biofilm-like aggregates by H. somni on bovine microvascular endothelium may be fundamental to its pathogenesis in heart and brain.

Pericardial Teratoma: Prenatal Diagnosis and Course

We report on a case of primary pericardial teratoma detected in a 29-week-old fetus. Due to cardiac decompensation, pericardiocentesis was performed at 33 weeks of gestation, and surgical excision of the tumor was indicated shortly after birth. The present report draws attention to the impact of fetal echocardiography on perinatal management.

European experience with a novel noninvasive sensor for intra-amniotic or extra-amniotic evaluation of fetal oxygen saturation

OBJECTIVE

We evaluated the feasibility of a new instrument for continuous fetal pulse oximetry during labor. The measuring sensor can be placed on the fetal back before or after rupture of membranes.

METHODS

One hundred adult women who had completed 32 weeks of gestation and had an anticipated duration of labor greater than 30 minutes were included in the study. Patients with premature rupture of membranes for 24 hours or more, low placental localization, placenta previa or abruption, vaginal bleeding, acute infection, polyhydramnios, oligohydramnios, or uterine or congenital abnormalities were excluded.

RESULTS

All sensors were placed successfully. The mean continuous recording time was 276 minutes. Peripheral oxygen saturation as measured by pulse oximeter values were obtained during a median of 64.05% of the recording time. No chorioamnionitis or endometritis was noted.

CONCLUSION

The new sensor instrumentation was safe for mother and fetus and was well accepted by parents and physicians.

Endoscopic axillary surgery in breast cancer

Background

The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer.

Methods

Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed.

Results

The operating time ranged from 60 to 150 min. A mean 17 (range 10–28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility.

Conclusion

Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.

Prediction of fetal anemia with Doppler measurement of the middle cerebral artery peak systolic velocity in pregnancies complicated by maternal blood group alloimmunization or parvovirus B19 infection

OBJECTIVES

To confirm the relationship between the middle cerebral artery peak systolic velocity (MCA PSV) and hemoglobin values in fetuses at risk for anemia (due to maternal blood group alloimmunization or parvovirus B19 infection) and to investigate the clinical value of this method in the management of these pregnancies regardless of previous transfusions.

SUBJECTS AND METHODS

Forty singleton pregnancies, 30 affected by alloimmunization and 10 by intrauterine parvovirus B19 infection, were referred to our tertiary center between 1998 and 2000. All cases underwent Doppler measurement of the MCA PSV immediately before fetal blood sampling and just before and after intrauterine transfusion. Hemoglobin determination was always performed after diagnostic cordocentesis, before starting and after terminating fetal transfusion.

RESULTS

Overall, we performed 165 fetal blood samplings (hemoglobin values) and obtained 165 corresponding MCA PSV values, 140 in pregnancies complicated by red-cell alloimmunization and 25 by parvovirus B19 infection. In order to adjust for the effect of gestational age on the measurements, the data were expressed in multiples of the median (MoM). We found a good correlation between MCA PSV MoM and Hb MoM in both groups (alloimmunization, r2 = 0.6; y = 2.21 - 1.41 x + 0.24 x 2; parvovirus infection, r2 = 0.68; y = 2.09 - 0.58 x - 0.16 x 2). The reduction of post-transfusion MCA PSV values was statistically significant ( P < 0.0001). Using a threshold of 1.29 for MoM PSV, the sensitivity and the specificity of MCA pulsatility indices on pretransfusion values in predicting any degree of fetal anemia (Hb < or = 0.84 MoM) were 73.1% and 81.5% in the alloimmunization group and 100% and 100% in the parvovirus infection group, respectively.

CONCLUSION

We can confirm the presence of an inverse correlation between MCA PSV measurements and hemoglobin values in fetuses at risk for anemia due to maternal blood group alloimmunization and fetal parvovirus B19 infection. The MCA PSV is a reliable method for the prediction of anemia not only in fetuses before the first intrauterine transfusion, but also in those which have undergone one or more transfusions, with good sensitivity and specificity in both groups of fetuses at risk.