Painless cervical dilation with "hourglass membranes". Conservative management: our experience

BACKGROUND

Cervical competence is currently conceived as a continuous biological process with progressive degrees of insufficiency, this substituting the traditional vision of cervical competence as being present or absent. The most extreme expression of cervical insufficiency is known as "hourglass membranes". Currently no consensus exists regarding the treatment of pregnancies complicated by the protrusion of amniotic membranes; however, the majority of authors agree on recommending bed rest and performing cervical cerclage, known as "emergent cerclage".

METHODS

We describe a series of clinical cases corresponding to second-trimester pregnancies with cervical dilation and prolapsed amniotic membranes that were admitted to our hospital,managed with conservative treatment. All patients received the same basic treatment: intravenous fluid therapy for hydration, a single-oral-dose of azithromycin and intravenous antibiotic therapy for 7 days, vaginal micronized progesterone and indomethacin administrated orally.

RESULTS

Mean gestational age at diagnosis was 22,5 weeks with an extension of pregnancy between 2.1 and 16 weeks, with eight patients (72.72%) who extended their pregnancy for more than 8 weeks. In all cases, live fetuses were obtained, with favourable evolution.

CONCLUSIONS

Despite our limited experience, resulting from the low number of cases presenting, our results encourage us to propose conservative management in pregnancies complicated with a dilated cervix and membranes protruding into the vagina, as a reasonable alternative to surgical emergency cervical cerclage, which is currently considered the therapy of choice when extreme cervical shortening occurs in the second trimester of pregnancy.

Tar Spot: An Understudied Disease Threatening Corn Production in the Americas

Tar spot of corn has been a major foliar disease in several Latin American countries since 1904. In 2015, tar spot was first documented in the United States and has led to significant yield losses of approximately 4.5 million t. Tar spot is caused by an obligate pathogen, Phyllachora maydis, and thus requires a living host to grow and reproduce. Due to its obligate nature, biological and epidemiological studies are limited and impact of disease in corn production has been understudied. Here we present the current literature and gaps in knowledge of tar spot of corn in the Americas, its etiology, distribution, impact and known management strategies as a resource for understanding the pathosystem. This will in tern guide current and future research and aid in the development of effective management strategies for this disease.

Temporal Dynamics of Wheat Blast Epidemics and Disease Measurements Using Multispectral Imagery

Wheat blast is a devastating disease caused by the Triticum pathotype of Magnaporthe oryzae. M. oryzae Triticum is capable of infecting leaves and spikes of wheat. Although symptoms of wheat spike blast (W_SB) are quite distinct in the field, symptoms on leaves (W_LB) are rarely reported because they are usually inconspicuos. Two field experiments were conducted in Bolivia to characterize the change in W_LB and W_SB intensity over time and determine whether multispectral imagery can be used to accurately assess W_SB. Disease progress curves (DPCs) were plotted from W_LB and W_SB data, and regression models were fitted to describe the nature of W_SB epidemics. W_LB incidence and severity changed over time; however, the mean W_LB severity was inconspicuous before wheat began spike emergence. Overall, both Gompertz and logistic models helped to describe W_SB intensity DPCs fitting classic sigmoidal shape curves. Lin's concordance correlation coefficients were estimated to measure agreement between visual estimates and digital measurements of W_SB intensity and to estimate accuracy and precision. Our findings suggest that the change of wheat blast intensity in a susceptible host population over time does not follow a pattern of a monocyclic epidemic. We have also demonstrated that W_SB severity can be quantified using a digital approach based on nongreen pixels. Quantification was precise (0.96 < r> 0.83) and accurate (0.92 < ρ > 0.69) at moderately low to high visual W_SB severity levels. Additional sensor-based methods must be explored to determine their potential for detection of W_LB and W_SB at earlier stages.

Detection of the level of estrogen receptor and functional variants in human breast cancers by novel assays

The level of estrogen receptor (ER) is a key determinant for the management of ER-positive [ER(+)] breast cancer patients. Growth of many human breast cancers is regulated by estrogen (E2) and progesterone (Pr). Generally, the ER in ER(+) breast cancer patients is targeted for therapy with antihormones. However 40% of ER(+) patients do not respond to antihormone therapy. Thus, the identification of antihormone resistant ER(+) breast cancers is essential for therapeutic predictions. Although 3H-E2 binding and immunodetection can identify ER, these procedures do not assess the functional state of the receptor molecule. In this study we describe a novel and rapid assay for the detection of ER and its functional state on the basis of the downstream interaction with its response element (ERE) based on the preferential binding of DNA-protein complex (ERE-ER) to a nitrocellulose membrane (NMBA). This method permits measurement of both the total and the functional fraction of ER. The ER status was examined in breast cancer cell lines and in breast cancer biopsy specimens by (i) 3H-E2 binding assay, (ii) immunodetection assays and (iii) by its interaction with 32P-ERE. The sensitive NMBA assay was validated with well-characterized ER(+) breast cancer cell lines and also identified functional variants of ER among breast tumor biopsy specimens.

Epidermal growth factor-induced nuclear factor kappa B activation: A major pathway of cell-cycle progression in estrogen-receptor negative breast cancer cells

The epidermal growth factor (EGF) family of receptors (EGFR) is overproduced in estrogen receptor (ER) negative (-) breast cancer cells. An inverse correlation of the level of EGFR and ER is observed between ER- and ER positive (+) breast cancer cells. A comparative study with EGFR-overproducing ER- and low-level producing ER+ breast cancer cells suggests that EGF is a major growth-stimulating factor for ER- cells. An outline of the pathway for the EGF-induced enhanced proliferation of ER- human breast cancer cells is proposed. The transmission of mitogenic signal induced by EGF-EGFR interaction is mediated via activation of nuclear factor kappaB (NF-kappaB). The basal level of active NF-kappaB in ER- cells is elevated by EGF and inhibited by anti-EGFR antibody (EGFR-Ab), thus qualifying EGF as a NF-kappaB activation factor. NF-kappaB transactivates the cell-cycle regulatory protein, cyclin D1, which causes increased phosphorylation of retinoblastoma protein, more strongly in ER- cells. An inhibitor of phosphatidylinositol 3 kinase, Ly294-002, blocked this event, suggesting a role of the former in the activation of NF-kappaB by EGF. Go6976, a well-characterized NF-kappaB inhibitor, blocked EGF-induced NF-kappaB activation and up-regulation of cell-cycle regulatory proteins. This low molecular weight compound also caused apoptotic death, predominantly more in ER- cells. Thus Go6976 and similar NF-kappaB inhibitors are potentially novel low molecular weight therapeutic agents for treatment of ER- breast cancer patients.

Ethopharmacological analysis of 5-HT ligands on the rat elevated plus-maze

The present study investigated the behavioral effects of five 5-HT agonists and antagonists in the rat elevated-plus-maze using conventional and ethologically derived measures. An anxiolytic effect of the 5-HT1A agonist ipsapirone (0.25, 0.75, and 2.25 mg/kg) was detected by risk-assessment and scanning but not by percentage of open-arm entries and time spent on open arms. Anxiogenic effects of the 5-HT2C agonist TFMPP (0.1, 0.2, and 0.4 mg/kg) and 5-HT2A antagonist SR 46349B (1, 3, and 10 mg/kg) were detected by percentage of open-arm entries, time spent on open arms, scanning, end exploring, but not by risk assessment. Finally, the effects of the 5-HT3 antagonist BRL 46470 A (0.001, 0.01, and 0.1 mg/kg) and 5-HT(2A/C) antagonist RP 62203 (0.25, 1, and 4 mg/kg) were scarce in both conventional and ethologically derived measures. These results are indicative that ethological measures may sometimes be more sensitive than the standard ones, and should be used together with them when assessing serotonergic or any other novel drugs in the elevated plus-maze.

Ethopharmacological analysis of rat behavior on the elevated plus-maze

Behavioral categories were measured in rats left on an elevated plus-maze for 5 min, in addition to the traditional measures. Four independent factors emerged from a factor analysis. The variables that loaded highly and positively on Factor 1, seemingly related with anxiety, were: number of entries onto open arms, time spent on open arms, percentage of open/total arm entries, percentage of time on open arms, scanning over the edge of an open arm, and open arm end-exploring. The time spent on enclosed arms loaded highly, but negatively on the same factor. Risk-assessment from an enclosed arm also loaded negatively on Factor 1. Number of enclosed arm entries, total number of arm entries and rearing loaded highly on Factor 2, probably related to motor activity. However, the total number of entries also loaded on Factor 1, being thus a mixed index. Similarly, the number of open arm entries loaded on both Factors 1 and 2. As expected, the variables having high loads on Factor 1 were changed to one direction by administration of two anxiolytics (nitrazepam and midazolam) and to the opposite direction by two anxiogenic drugs (pentylenetetrazol and FG 7142). Such pattern of drug effects was not observed with the remaining variables.

Influence of stimulus preexposure and of context familiarity on conditioned freezing behavior

1. This paper reports an experiment examining the influence of context on latent inhibition using conditioned freezing behavior as an index. 2. Two groups of 8 Wistar rats (290-320 g) were placed in one chamber (Context 2) and either exposed 7 times or not to a sound stimulus (68 dB, 90 s). Two additional groups of 8 rats received the same stimulation in a different environment (Context 1). Next, each rat was required to form a sound-shock (0.2 mA, 1.5 s) association (20 trials) in Context 2. Freezing behavior was measured both during sound (CS) presentation and during an equal period of time immediately preceding the CS. 3. When the test environment was familiar, the conditioning of fear was greater in the non-preexposed than in the CS-preexposed group. Acquisition of conditioned freezing was intermediate when the test environment was unfamiliar, irrespective of CS preexposure. 4. These results further support the context specificity of latent inhibition. In addition, they suggest that novelty interferes with sound-shock associations.