Diffuse cutaneous leishmaniasis (DCL) is a rare clinical manifestation of tegumentary leishmaniasis. The molecular mechanisms underlying DCL pathogenesis remain unclear, and there is no efficient treatment available. This study investigated the systemic and in situ expression of the inflammatory response that might contribute to suppression in DCL. The plasma levels of arginase I, ornithine decarboxylase (ODC), transforming growth factor β (TGF-β), and prostaglandin E2 (PGE2) were higher in patients with DCL, compared with patients with localized cutaneous leishmaniasis (LCL) or with controls from an area of endemicity. In situ transcriptomic analyses reinforced the association between arginase I expression and enzymes involved in prostaglandin and polyamine synthesis. Immunohistochemistry confirmed that arginase I, ODC, and cyclooxygenase2 expression was higher in lesion biopsy specimens from patients with DCL than in those from patients with LCL. Inhibition of arginase I or ODC abrogates L. amazonensis replication in infected human macrophages. Our data implicate arginase I, ODC, PGE2, and TGF-β in the failure to mount an efficient immune response and suggest perspectives in the development of new strategies for therapeutic intervention for patients with DCL.
Objetivo. Avaliar o impacto do índice de massa corpórea das pacientes submetidas a fertilização in vitro sobre as taxas de gravidez e de abortamento, em um centro privado de reprodução assistida em Brasília-DF, Brasil, no período de janeiro de 2014 a dezembro de 2016. Método. Estudo retrospectivo em que foram analisados os resultados das transferências de embriões a fresco em pacientes submetidas a fertilização in vitro. Para análise estatística foi utilizado o teste exato de Fisher. Resultados. Foram avaliados 567 ciclos de fertilização in vitro com transferências de embrião a fresco. A média do índice de massa corpórea foi 23,4. O total de 410 pacientes obtiveram índices de massa corpórea abaixo de 25 (grupo A), 135 apresentaram índice de 25 a 29,99 (grupo B) e 22 tiveram índice igual ou acima de 30 (grupo C). As taxas de gestação de cada grupo foram, respectivamente, para os grupos A, B e C, 54,8% (225 de 410), 45,9% (62 de135) e 40,9% (9 de 22), e as de abortamento foram as seguintes, nesta ordem: 13,8% (31 de 225), 17,8% (11 de 62) e 66,6% (6 de 9). As taxas de gestação em curso foram de 47,3% para o grupo A, 37,7% para o B e 13,6% para o C. O teste exato de Fisher resultou em diferenças significativas nas taxas de gestação evolutiva entre os grupos A e C (p < 0,001) e entre B e C (p < 0,005). Conclusão. Demonstrou-se que a obesidade feminina afeta negativamente a taxa de gestação e eleva as taxas de abortamento em pacientes submetidas a fertilização in vitro. Palavras-chave. Obesidade; peso corporal; fertilização in vitro; taxa de gestação; taxa de abortamento ABSTRACT Objective. To evaluate the impact of the body mass index on pregnancy and miscarriage rates of patients undergoing in vitro fertilization in a private assisted reproduction center in Brazil from January 2014 to December 2016. Method. Retrospective single institution study which analysed the results of fresh embryo transfer in patients undergoing in vitro fertilization at an assisted reproduction center in Brasília-DF. Statistical analysis was performed by using Fisher's exact test. Units of measurement for body mass index are kg/m 2. Results. There were 567 in vitro fertilization cycles with Vinicius Medina Lopes-médico, ginecologista e obstetra, mestre pela
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