Several studies, although with conflicting results, have sought to determine the concentration of soluble CTLA4 antigens in peripheral blood plasma and peritoneal fluid in patients with ...endometriosis-related infertility. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a search of the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database and Web of Science, and Clinical Trials research register. We included observational or prospective human and animal studies with any features related to endometriosis and/or infertility studies involving CTLA4-related pathogenesis published in English. The results of studies in which the size and characteristics of the observed groups were not stated were excluded. From the initial pool of 73 publications identified and screened, we finally included 5 articles to summarize the most recent knowledge about CTLA4-linked autoimmunity in the pathogenesis of endometriosis and related infertility. Evidence from clinical studies shows that CTLA4-based autoimmunity is involved in the maintenance of chronic inflammation in the peritoneal environment, with pre-clinical evidence of anti-CTLA antibodies as a potential novel target therapy for endometriosis. However, CTLA4 gene analyses do not support findings of CTLA4-linked autoimmunity as a primary determinant of the pathogenesis of endometriosis. These findings underlie the role of complex interactions within the family of immune checkpoint molecules involved. Further studies are needed to investigate the clinical relevance of anti-CTLA target therapy, taking into account the potential adverse events and repercussions of novel immunologic therapy modalities. However, with the general scarcity of studies investigating this topic, the clinical importance of CTLA4 autoimmunity still remains unclear.
Introduction and hypothesis
Despite the widespread use of UDI-6 and ICIQ-UI SF in Croatia, it remains unknown whether a realiable and valid measure for the population of interest is used. Thus, the ...aim of this study was to translate, adapt and validate the UDI-6 and the ICIQ-UI SF in Croatia.
Methods
The study included a total of 232 consecutive patients with urinary incontinence symptoms. The translation to Croatian followed standardized procedure. All participants underwent urodynamic assesment and completed UDI-6 and ICIQ-UI SF questionnaires at inclusion and 2 weeks after to assess test-retest reliability. Cronbach α coefficient was calculated in order to assess internal consistency.
Results
Both questionnaires had high internal consistency (Cronbach α for UDI-6 and ICIQ-UI SF was .83 and .85, respectively) and high test-retest reliability (intraclass correlation coefficient .99 for instruments). Strong correlation was found between urodynamic findings and total scores in UDI-6 and ICIQ-UI SF (ρ = 0.88 and 0.89, respectively). Women with stress urinary incontinence (SUI) and detrusor overactivity (DOA) group had significantly higher scores on UDI-6 (Mdn = 33.33 and Mdn = 50, respectively) compared to women with no urodynamic abnormality (Mdn = 0;
p
< 0.001). Women with no urodynamic abnormality scored significantly lower on ICIQ-UI SF (Mdn = 0; p < 0.001) compared to women with SUI (Mdn = 14) and DOA (Mdn = 16). Women with DOA scored worse on Irritative and Obstructive symptoms when comparing with two other groups (
p
< 0.001), while women with SUI had significantly worse score on Stress symptoms subscale (p < 0.001).
Conclusions
The UDI-6 and ICIQ-UI SF have very good psychometric characteristics and can be used in Croatian urogynecology practice.
Monitoring of the gas and leachate parameters in a closed landfill is a long-term activity defined by national legislative worldwide. Serbian Waste Disposal Law defines the monitoring of a landfill ...at least 30 years after its closing, but the definition of the monitoring extent (number and type of parameters) is incomplete. In order to define and clear all the uncertainties, this research focuses on process of monitoring optimization, using the closed landfill in Zrenjanin, Serbia, as the experimental model.
The aim of optimization was to find representative parameters which would define the physical, chemical and biological processes in the closed methanogenic landfill and to make this process less expensive. Research included development of the five monitoring models with different number of gas and leachate parameters and each model has been processed in open source software GeoGebra which is often used for solving optimization problems. The results of optimization process identified the most favorable monitoring model which fulfills all the defined criteria not only from the point of view of mathematical analyses, but also from the point of view of environment protection. The final outcome of this research - the minimal required parameters which should be included in the landfill monitoring are precisely defined.
•Model of optimization of landfill gas and leachate in closed landfill is proposed.•Model of optimization is based on linear programming method.•Models and submodels are developed by open source software GeoGebra.•Landfill gas and leachate parameters for monitoring are proposed.
Purpose
To describe a case series of patients with malignant ovarian germ cell tumors (MOGCT) treated exclusively with fertility-sparing surgery (FSS) with or without adjuvant chemotherapy.
Methods
...We retrospectively reviewed the records of 27 patients with MOGCT treated in the Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Croatia, between January 2009 and July 2019.
Results
The median age at diagnosis was 22 years, and the main symptom was abdominal distension (57.0%). The most prevalent histological subtype was immature teratoma (
n
= 13, 48.1%). Twenty-three patients (85.2%) had laparotomy and 4 (14.8%) had laparoscopy, without conversions. Lymphadenectomy was performed in 16 (59.3%) patients, with 184 removed lymph nodes, and omentectomy was performed in 19 (70.4%) patients. The rate of chemotherapy administration was 81.5%. The follow-up length ranged between 6.30 and 115.1 months (median: 49.60 months). No patient experienced tumor recurrence. The rate of complete gross resection was 100%. At the time of analysis, all patients were alive and disease free. Fifty percent of patients who actively tried to conceive after FSS became pregnant, with 12 deliveries.
Conclusion
This study suggests that FSS is a safe treatment option for MOGCT, regardless of tumor stage and histological type.
Abstract
Objective
Desmoplastic small round cell tumor (DSRCT) is a rare intraabdominal neoplasm that grows along serosal surfaces and is primarily found in young men. To date, only 16 cases of ...ovarian DSRCT have been previously reported in women in the English literature, and no large population-based studies on this topic exist.
Case Report
We report the case of a 19-year-old virgo with unremarkable past medical history, initially presented with abdominal fullness. After being treated with the optimal treatment modality (primary and secondary surgical debulking, unique chemotherapy, protocol and adjuvant radiotherapy), the patient has remained without tumor disease for 40 months.
Conclusion
Although the best therapy for patients with DSRCT has yet to be determined, combining complete surgical resection, adjuvant chemotherapy, and radiotherapy is required to prolong survival and to achieve proper quality of life.
Common practice in Southeast Europe (SEE) countries is that mostly low skilled workers work in waste management sector. In SEE countries there are no institutions specialized for educational training ...concerning safety of the employees who work in solid waste management system. It should be emphasized, that this specific type of profession, which is dealing with the high occupational health risks, needs legal basis for proper education and training, like it is defined for numerous professions in public sectors. Evidently, companies that provide the education and training for their employees will have direct benefits. The main focus of professional education is on workers on landfill, as this is the working place with the highest risk, but at the same time very important for operational practice and sustainability of a landfill. For these workers, there are following focus points: Professional training; Health and Safety protection; Fire protection; Landfill gas management; Leachate management. Well defined educational programmes for H&S, emphasizing safety precautions in handling with hazardous materials and fire protection, are good way to reduce injuries and to improve efficiency of employees as well.
This paper explores the impact of concentrate recirculation, as a product of leachate treated by reverse osmosis plant, on the production of landfill gas at the real-scale landfill for municipal ...solid waste. In an effort to come up with results experimental measurements were carried out at the landfill in Bijeljina. All measurements performed, were divided into 3 groups. The aims of two groups of measurement were to determine landfill gas and methane yield from concentrate and leachate in laboratory conditions (1st group) and to find out concentrations of oxidizing matters (COD and BOD5) present in leachate and concentrate at different points of treatment as well as its variability over the time (2nd group) which could be used to calculate the potential of landfill gas and methane generation from concentrate by recirculation, theoretically. 3rd group of measurements, carried out in parallel, have goal to determine the quality and quantity of the collected landfill gas at wells throughout the landfill. The results of analysis carried out in this experimental research show the clear evidence of concentrate recirculation impact on methane production by increasing the landfill gas flow, as well as its concentration within the landfill gas composition, at the nearby well. Although results indicated relatively high impact of concentrate recirculation on landfill gas production, comparing to its theoretical potential, the influence on the landfill at whole, is negligible, due to relatively low volumes in recirculation with respect to its size and objectively low potential given by organic matter present in concentrate.
The purpose of this review is to analyze current medical strategies in the prevention
of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitro fertilization.
Owing to ...contemporary preventive measures of OHSS, the incidence of moderate and severe
forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is
completely effective, there is high-quality evidence that replacing human chorionic gonadotropin
(hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-
quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce
the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and
leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded
as the best tool for OHSS prevention, intensive luteal support with exogenous administration
of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH
agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently
available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common
drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols
offer attractive option in OHSS prevention with satisfactory pregnancy rates.
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