Is it possible to detect associated deep infiltrating endometriosis (DIE) before surgery for patients operated on for endometriomas using a preoperative clinical symptoms questionnaire?
A diagnostic ...score of DIE associated with endometriomas using four clinical symptoms defined a high-risk group where the probability of DIE was 88% and a low-risk group with a 10% probability of DIE.
Many clinical symptoms are already known to be associated with DIE but they have not yet been used to build a clinical prediction model.
We built a diagnostic score of DIE based on a case control study of 326 consecutive patients operated on for an endometrioma between January 2005 and October 2011: 164 had associated DIE (DIE+) and 162 had no DIE (DIE-). We derived the score on a training sample obtained from a random selection of 2/3 of the population (211 patients, 101 DIE+, 110 DIE-), and validated the results on the remaining third (115 patients, 63 DIE+, 52 DIE-). The gold standard for the diagnosis of DIE was based on surgical exploration and histological diagnosis.
Participants were consecutive patients aged 18-42 years who underwent surgery for an endometrioma with histological confirmation and complete treatment of their endometriotic lesions: data for these women were extracted from a prospective database including a standardized preoperative questionnaire. On the training dataset, variables associated with DIE in a univariate analysis were introduced in a multiple logistic regression and selected by a backward stepwise procedure and a Jackknife procedure. A diagnostic score of DIE was built with the scaled/rounded coefficients of the multiple regression. Two cut-off values delimitated a high and a low risk group, and their diagnostic accuracy was tested on the validation dataset.
Four variables were independently associated with DIE: visual analogue scale of gastro-intestinal symptoms ≥5 or of deep dyspareunia >5 (adjusted diagnostic odds ratio (aDOR) = 6.0, 95% confidence interval (CI) 2.9-12.1), duration of pain greater than 24 months (aDOR = 3.8, 95% CI 1.9-7.7), severe dysmenorrhoea (defined as the prescription of the oral contraceptive pill for the treatment of a primary dysmenorrhoea or the worsening of a secondary dysmenorrhoea) (aDOR = 3.8, 95% CI 1.9-7.6) and primary or secondary infertility (aDOR = 2.5, 95% CI 1.2-4.9). The sum of these variables weighted by their rounded/scaled coefficients constituted the score ranging from 0 to 53. A score <13 defined a low-risk group where the probability of DIE was 10% (95% CI 7-15 with a sensitivity of 95% (95% CI 89-98) and a negative likelihood ratio of 0.1 (95% CI 0.0-0.3). A score ≥35 defined a high-risk group where the probability of DIE was 88% (95% CI 83-92%), with a specificity of 94% (95% CI 87-97), and a positive likelihood ratio of 8.1 (95% CI 3.9-17.0). The performance of the score was confirmed on the validation dataset with 11% of DIE+ patients having a score <13 (sensibility: 95%) and 90% of DIE+ patients having a score ≥35 (specificity: 94%).
This study was performed in a department specialized in DIE management. Score accuracy could be different in less specialized centres.
This score could have a major clinical impact on the time of diagnosis, the management of DIE and could reduce the cost of investigations by helping to identify high-risk patients, while preserving the quality of care.
The authors have no competing interests to declare. No grant supported the study.
The New Magnetar SGR J1830−0645 in Outburst Zelati, F. Coti; Borghese, A.; Israel, G. L. ...
Astrophysical journal. Letters,
02/2021, Letnik:
907, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Abstract
The detection of a short hard X-ray burst and an associated bright soft X-ray source by the Swift satellite in 2020 October heralded a new magnetar in outburst, SGR J1830−0645. Pulsations at ...a period of ∼10.4 s were detected in prompt follow-up X-ray observations. We present here the analysis of the Swift/Burst Alert Telescope burst, of XMM-Newton and the Nuclear Spectroscopic Telescope Array observations performed at the outburst peak, and of a Swift/X-ray Telescope monitoring campaign over the subsequent month. The burst was single-peaked, lasted ∼6 ms, and released a fluence of ≈5 × 10
−9
erg cm
−2
(15–50 keV). The spectrum of the X-ray source at the outburst peak was well described by an absorbed double-blackbody model plus a power-law component detectable up to ∼25 keV. The unabsorbed X-ray flux decreased from ∼5 × 10
−11
to ∼2.5 × 10
−11
erg cm
−2
s
−1
one month later (0.3–10 keV). Based on our timing analysis, we estimate a dipolar magnetic field ≈5.5 × 10
14
G at pole, a spin-down luminosity ≈2.4 × 10
32
erg s
−1
, and a characteristic age ≈24 kyr. The spin modulation pattern appears highly pulsed in the soft X-ray band, and becomes smoother at higher energies. Several short X-ray bursts were detected during our campaign. No evidence for periodic or single-pulse emission was found at radio frequencies in observations performed with the Sardinia Radio Telescope and Parkes. According to magneto-thermal evolutionary models, the real age of SGR J1830−0645 is close to the characteristic age, and the dipolar magnetic field at birth was slightly larger, ∼10
15
G.
Abstract
Swift J1818.0−1607 is a radio-loud magnetar with a spin period of 1.36 s and a dipolar magnetic field strength of
B
∼ 3 × 10
14
G, which is very young compared to the Galactic pulsar ...population. We report here on the long-term X-ray monitoring campaign of this young magnetar using XMM-Newton, NuSTAR, and Swift from the activation of its first outburst in 2020 March until 2021 October, as well as INTEGRAL upper limits on its hard X-ray emission. The 1–10 keV magnetar spectrum is well modeled by an absorbed blackbody with a temperature of
kT
BB
∼ 1.1 keV and apparent reduction in the radius of the emitting region from ∼0.6 to ∼0.2 km. We also confirm the bright diffuse X-ray emission around the source extending between ∼50″ and ∼110″. A timing analysis revealed large torque variability, with an average spin-down rate
ν
̇
∼
−2.3 × 10
−11
Hz
2
that appears to decrease in magnitude over time. We also observed Swift J1818.0−1607 with the Karl G. Jansky Very Large Array on 2021 March 22. We detected the radio counterpart to Swift J1818 measuring a flux density of
S
v
= 4.38 ± 0.05 mJy at 3 GHz and a half-ringlike structure of bright diffuse radio emission located at ∼90″ to the west of the magnetar. We tentatively suggest that the diffuse X-ray emission is due to a dust-scattering halo and that the radio structure may be associated with the supernova remnant of this young pulsar, based on its morphology.
Animals that wield toxins face self-intoxication. Poison frogs have a diverse arsenal of defensive alkaloids that target the nervous system. Among them is epibatidine, a nicotinic acetylcholine ...receptor (nAChR) agonist that is lethal at microgram doses. Epibatidine shares a highly conserved binding site with acetylcholine, making it difficult to evolve resistance yet maintain nAChR function. Electrophysiological assays of human and frog nAChR revealed that one amino acid replacement, which evolved three times in poison frogs, decreased epibatidine sensitivity but at a cost of acetylcholine sensitivity. However, receptor functionality was rescued by additional amino acid replacements that differed among poison frog lineages. Our results demonstrate how resistance to agonist toxins can evolve and that such genetic changes propel organisms toward an adaptive peak of chemical defense.
Weinvestigated whether observation of actions reproduced in three-dimensional virtual reality would engage perceptual and visuomotor brain processes different from those induced by the observation of ...real hand actions. Participants were asked to passively observe grasping actions of geometrical objects made by a real hand or by hand reconstructions of different quality in 3D virtual reality as well as on a 2D TV screen. We found that only real actions in natural environment activated a visuospatial network including the right posterior parietal cortex. Observation of virtual-reality hand actions engaged prevalent visual perceptual processes within lateral and mesial occipital regions. Thus, only perception of actions in reality maps onto existing action representations, whereas virtual-reality conditions do not access the full motor knowledge available to the central nervous system.
Descriptive data on active transportation in children focuses on the trip to school and has relied on subjective reports. The purpose of this study was to use objective measures to describe total ...active transportation and active transportation to common destinations within children.
This was a descriptive study of 388 children aged 10-13 years from Kingston, Ontario, Canada. Participants wore a Garmin GPS watch during waking hours for seven days. Personal Activity Measurement Location System software used the GPS data to identify trips, time spent in each trip and the trip modality (walking, bicycle or vehicle). Google Maps software was used to identify trip destinations.
A total of 8875 trips were identified. Most (69%) trips were made by vehicle; 25% were made by walking and 6% by bicycle. Mean time spent in active transportation was 10.3 min/day (95% CI: 7.4, 14.5). Time spent in active transportation was higher for boys (12.1 min/day 95% CI: 8.8, 17.0) than for girls (8.5 min/day 95% CI: 6.1, 12.0) and increased from 7.7 min/day (95% CI: 5.5, 11.1) at age 10 to 14.3 min/day (95% CI: 10.3, 19.9) at age 13. Time spent in active transportation was lower in the winter by comparison to the other seasons. The four most common active transportation destinations were the participant's home, school, other people's homes, and parks or greenspace with 69%, 39%, 37% and 32% of participants walking or bicycling to these destinations at least once over the 7-day measurement period.
Over 65% of trips made and time spent travelling occurred in a vehicle. When active transportation was used, the most common destinations were home, school, other people's homes, and parks.
Abstract
We observed the periodic radio transient GLEAM-X J162759.5-523504.3 (GLEAM-X J1627) using the Chandra X-ray Observatory for about 30 ks on 2022 January 22–23, simultaneously with radio ...observations from the Murchison Widefield Array, MeerKAT, and the Australia Telescope Compact Array. Its radio emission and 18 min periodicity led the source to be tentatively interpreted as an extreme magnetar or a peculiar highly magnetic white dwarf. The source was not detected in the 0.3–8 keV energy range with a 3
σ
upper limit on the count rate of 3 × 10
−4
counts s
−1
. No radio emission was detected during our X-ray observations either. Furthermore, we studied the field around GLEAM-X J1627 using archival European Southern Observatory and DECam Plane Survey data, as well as recent Southern African Large Telescope observations. Many sources are present close to the position of GLEAM-X J1627, but only two within the 2″ radio position uncertainty. Depending on the assumed spectral distribution, the upper limits converted to an X-ray luminosity of
L
X
< 6.5 × 10
29
erg s
−1
for a blackbody with temperature
kT
= 0.3 keV, or
L
X
< 9 × 10
29
erg s
−1
for a power law with photon index Γ = 2 (assuming a 1.3 kpc distance). Furthermore, we performed magneto-thermal simulations for neutron stars considering crust- and core-dominated field configurations. Based on our multiband limits, we conclude that (i) in the magnetar scenario, the X-ray upper limits suggest that GLEAM-X J1627 should be older than ∼1 Myr, unless it has a core-dominated magnetic field or has experienced fast cooling; (ii) in the white dwarf scenario, we can rule out most binary systems, a hot sub-dwarf, and a hot magnetic isolated white dwarf (
T
≳ 10.000 K), while a cold isolated white dwarf is still compatible with our limits.
The aim of this study was to evaluate whether L-Arginine (L-Arg) supplementation modifies nitric oxide (NO) system and consequently aquaporin-2 (AQP2) expression in the renal outer medulla of ...streptozotocin-diabetic rats at an early time point after induction of diabetes. Male Wistar rats were divided in four groups: Control, Diabetic, Diabetic treated with L-Arginine and Control treated with L-Arginine. Nitric oxide synthase (NOS) activity was estimated by 14C L-citrulline production in homogenates of the renal outer medulla and by NADPH-diaphorase staining in renal outer medullary tubules. Western blot was used to detect the expression of AQP2 and NOS types I and III; real time PCR was used to quantify AQP2 mRNA. The expression of both NOS isoforms, NOS I and NOS III, was decreased in the renal outer medulla of diabetic rats and L-Arg failed to prevent these decreases. However, L-Arg improved NO production, NADPH-diaphorase activity in collecting ducts and other tubular structures, and NOS activity in renal homogenates from diabetic rats. AQP2 protein and mRNA were decreased in the renal outer medulla of diabetic rats and L-Arg administration prevented these decreases. These results suggest that the decreased NOS activity in collecting ducts of the renal outer medulla may cause, at least in part, the decreased expression of AQP2 in this model of diabetes and constitute additional evidence supporting a role for NO in contributing to renal water reabsorption through the modulation of AQP2 expression in this pathological condition. However, we cannot discard that another pathway different from NOS also exists that links L-Arg to AQP2 expression.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
STUDY QUESTION
Is there an association between the endometriosis phenotype and presentation with infertility?
SUMMARY ANSWER
In a population of operated patients with histologically proven ...endometriosis, ovarian endometrioma (OMA) per se is not associated with an increased risk of presentation with infertility, while previous surgery for endometriosis was identified as a risk factor for infertility.
WHAT IS KNOWN ALREADY
The increased prevalence of endometriosis among subfertile women indicates that endometriosis impairs reproduction for reasons that are not completely understood.
STUDY DESIGN, SIZE, DURATION
This was an observational, cross-sectional study using data prospectively collected in all non-pregnant patients aged between 18 and 42 years, who were surgically explored for benign gynaecological conditions at our institution between January 2004 and March 2013. For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding surgery.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Surgery was performed in 2208 patients, of which 2066 signed their informed consent. Of the 1059 women with a visual diagnosis of endometriosis, 870 had histologically proven endometriosis and complete treatment for their endometriotic lesions, including 307 who presented with infertility. Univariate analysis and multiple logistic regression analysis were performed to determine factors associated with infertility.
MAIN RESULTS AND THE ROLE OF CHANCE
The following variables were identified as risk factors for endometriosis-related infertility: age >32 years (odds ratio OR = 1.9; 95% confidence interval CI: 1.4–2.4), previous surgery for endometriosis (OR = 1.9; 95% CI: 1.3–2.2), as well as peritoneal superficial endometriosis (OR = 3.1; 95% CI: 1.9–4.9); Conversely, previous pregnancy was associated with a lower rate of infertility (OR = 0.7; 95% CI: 0.6–0.9 and OR = 0.6; 95% CI: 0.4–0.9, respectively). OMA is not selected as a significant risk factor for infertility.
LIMITATIONS, REASON FOR CAUTION
The selection of our study population was based on a surgical diagnosis. We cannot exclude that infertile women with OMA associated with a diminished ovarian reserve, as assessed during their infertility work-up, were referred less frequently to surgery and might therefore be underrepresented. In addition we cannot exclude that our group of infertile women present associated other causes of infertility.
WIDER IMPLICATIONS OF THE FINDINGS
Identification of risk and preventive factors of endometriosis-related infertility can help improve clinical and surgical management of endometriosis in the setting of infertility.
STUDY FUNDING/COMPETING INTEREST(S)
None.
TRIAL REGISTRATION NUMBER
None.
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