Estradiol stimulates progenitor cell division in the ventricular and subventricular zones of the embryonic neocortex

Two distinct populations of cerebral cortical progenitor cells that generate neurons during embryogenesis have been identified: radial glial cells and intermediate progenitor cells. Despite advances in our understanding of progenitor cell populations, we know relatively little about factors that regulate their proliferative behaviour. 17-beta-Estradiol (E2) is present in the adult and developing mammalian brain, and plays an important role in central nervous system processes such as neuronal differentiation, survival and plasticity. E2 also stimulates neurogenesis in the adult dentate gyrus. We examined the role of E2 during embryonic cortical neurogenesis through immunohistochemistry, in situ hybridization, functional enzyme assay, organotypic culture and in utero administration of estradiol-blocking agents in mice. We show that aromatase, the E2 synthesizing enzyme, is present in the embryonic neocortex, that estrogen receptor-alpha is present in progenitor cells during cortical neurogenesis, that in vitro E2 administration rapidly promotes proliferation, and that in utero blockade of estrogen receptors decreases proliferation of embryonic cortical progenitor cells. Furthermore, the E2 inhibitor alpha-fetoprotein is expressed at high levels by radial glial cells but at lower levels by intermediate progenitor cells, suggesting that E2 differentially influences the proliferation of these cortical progenitor cell types. These findings demonstrate a new functional role for E2 as a proliferative agent during critical stages of cerebral cortex development.     

Chronic scapholunate dissociation: ligament reconstruction combining a new extensor carpi radialis longus tenodesis and a dorsal intercarpal ligament capsulodesis

Scapholunate dissociation (SLD) is the commonest cause of carpal instability and wrist osteoarthrosis. The value of early diagnosis and treatment of this injury is well established in the literature. When a partial or total rupture of the scapholunate ligament is treated with early anatomic reduction and repair, functional results may be good to excellent. However, if this ligament is not addressed acutely then an overall carpal malalignment may seem progressively as a result of failure of the secondary scaphoid stabilizers. Chronic SLD will lead to scapholunate advanced collapse and progressive painful arthritis of the wrist. Although most surgeons agree that operative intervention is indicated, no clear consensus exists on the best treatment for patients with chronic SLD. Several procedures have been described that include some sort of partial fusion, capsulodesis, tenodesis, or bone-ligament-bone graft. If there is no evidence for arthrosis, soft-tissue procedures using either capsulodesis or tenodesis may be carried out in an attempt to preserve radiocarpal and intercarpal motion whereas avoiding fusion. This article describes a scapholunate ligament reconstruction combining a new dorsal extensor carpi radialis longus tenodesis and a dorsal capsulodesis for the treatment of chronic SLD.     

Round ligament cyst, a rare condition simulating inguinal hernia. Case report

Cysts of the inguinal cord are disorders that simulate inguinal hernias and manifest as inguinal masses and, in some cases, are accompanied by pain that can simulate a complicated inguinal hernia. We report the third case of a round ligament cyst in a 21-year-old female with a mass in the right inguinal area with intermittent pain. The patient was subjected to surgical exploration of the right inguinal area where a round ligament cyst was found. The ligament was resected and reported as a serous cyst. The patient's outcome was excellent and she was discharged 24 h after surgery. She has been followed up for 3 months without recurrence. Round ligament cysts are very rare disorders, and the diagnosis is perioperative. Resection of the round ligament causes complete symptom relief, and every case requires inguinal hernioraphy.     

Preoperative Education in Cholecystectomy in the Context of a Multimodal Protocol of Perioperative Care: A Randomized, Controlled Trial

Background

Preoperative education is a key point in multimodal protocols of perioperative care. We investigated whether preoperative education for patients undergoing open cholecystectomy would reduce the incidence of perioperative symptoms.

Methods

This was a randomized, single-blinded, clinical trial that included adult (18–65 years old) candidates for elective open cholecystectomy. All patients took part in the ERAS/ACERTO protocol of perioperative care except that only the intervention group received preoperative education. The main endpoints of the study were the presence and intensity of postoperative symptoms (e.g., nausea, vomiting, pain) measured by a visual analogue scale, 24 h after the operation.

Results

A total of 74 patients (34 in the intervention group, 40 in the control group) completed the study. The intervention group had significantly lower median (interquartile range) scores for nausea [0 (4) vs. 2.5 (5.8), p = 0.04] and pain [0.2 (2.3) vs. 3.1 (3.45), p < 0.01] than the controls. High well-being (score ≥6) was reported by 79.4 % (27 patients) of the intervention group in contrast to 57.5 % (23 patients) of the controls (p = 0.04).

Conclusions

Preoperative education is highly effective in the context of a multimodal protocol for enhancing the recovery of patients submitted to open cholecystectomy.     

Postimplant Behavior of Lightweight Polypropylene Meshes in an Experimental Model of Abdominal Hernia

Background. Over the years, reticular prostheses have undergone changes in their structure and composition to give rise to today's partially absorbable lightweight meshes. This study was designed to assess the biological and biomechanical behavior of these prostheses to establish whether they offer any advantages over nonabsorbable lightweight polypropylene prostheses. Materials and Methods. 7 × 5 cm defects were created in the anterior abdominal wall of New Zealand White rabbits and repaired by securing different prostheses to the edges of the defect with a running 4/0 polypropylene suture. The lightweight biomaterials compared were two nonabsorbable meshes: Parietene® and Optilene elastic®, and two partially absorbable prostheses: Vypro II® and Ultrapro®. At 14 and 90 days postimplant, tissue/prosthesis specimens were subjected to histological, immunohistochemical, shrinkage, and biomechanical analyses. Results. Adhesion formation on the peritoneum-facing surface of the meshes was significantly less extensive in the meshes with absorbable components at 90 days postimplant. The newly formed tissue around the prosthetic filaments was comprised of collagen fibers, fibroblasts, blood vessels, and macrophages. The partially absorbable meshes showed higher macrophage proportions (due to remnants of absorbable material and their structure) than the nonabsorbable meshes at 90 days, although differences were not significant. At 90 days postimplant, similar tensile strengths were recorded for all the implants. Conclusions. All the prosthetic materials induced good host tissue ingrowth, with no significant differences in tensile strength observed. Our findings suggest that partially absorbable lightweight prostheses could offer advantages over nonabsorbable lightweight meshes since less foreign material persists in the recipient, improving abdominal wall compliance.     

Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas

IntroductionDespite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies.ObjectivesThe aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model.Material and methodsSix male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17β-estradiol and 5α-androstene 3α 17β-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates.ResultsAll animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia.ConclusionsThe administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..     

Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting

Dialectical behavior therapy (DBT) has been shown to be successful in the treatment of borderline personality disorder and eating disorders separately. The present study compares Standard Dialectical Behavior Therapy with a Treatment as Usual Cognitive Behavior Therapy (TAU CBT) for the treatment of borderline personality disorder and eating disorders comorbid features. A total of 118 women diagnosed with borderline personality disorders and eating disorders were assigned to one of two treatment groups in a naturalistic setting (DBT?=?71; TAU CBT?=?47). DBT showed a greater decrease in dysfunctional behaviors used to regulate emotions and related to borderline personality disorder (i.e. substance abuse, impulsive money spending, unprotected sex, etc.), non-suicidal self-injuries, and depressive symptoms, as well as an increase in cognitive reappraisal and global functioning. DBT and TAU CBT showed similar improvements in suicide attempts, dysfunctional eating behaviors (i.e. binge eating, purgative behaviors, and restriction), hospitalizations, negative and positive affect, and expressive suppression. Results of this study support the utility and effectiveness of standard DBT for comorbid borderline personality disorder and eating disorders in naturalistic settings. Replications of this study and randomized controlled trials are needed.     

Positional accommodative intraocular lens power error induced by the estimation of the corneal power and the effective lens position

Purpose:

To evaluate the predictability of the refractive correction achieved with a positional accommodating intraocular lenses (IOL) and to develop a potential optimization of it by minimizing the error associated with the keratometric estimation of the corneal power and by developing a predictive formula for the effective lens position (ELP).

Materials and Methods:

Clinical data from 25 eyes of 14 patients (age range, 52–77 years) and undergoing cataract surgery with implantation of the accommodating IOL Crystalens HD (Bausch and Lomb) were retrospectively reviewed. In all cases, the calculation of an adjusted IOL power (P_IOLadj) based on Gaussian optics considering the residual refractive error was done using a variable keratometric index value (n_kadj) for corneal power estimation with and without using an estimation algorithm for ELP obtained by multiple regression analysis (ELP_adj). P_IOLadj was compared to the real IOL power implanted (P_IOLReal, calculated with the SRK-T formula) and also to the values estimated by the Haigis, HofferQ, and Holladay I formulas.

Results:

No statistically significant differences were found between P_IOLReal and P_IOLadj when ELP_adj was used (P = 0.10), with a range of agreement between calculations of 1.23 D. In contrast, P_IOLReal was significantly higher when compared to P_IOLadj without using ELP_adj and also compared to the values estimated by the other formulas.

Conclusions:

Predictable refractive outcomes can be obtained with the accommodating IOL Crystalens HD using a variable keratometric index for corneal power estimation and by estimating ELP with an algorithm dependent on anatomical factors and age.