Introduction
This study presents a unifying concept of the pathophysiology of endometriosis and adenomyosis. In particular, a physiological model is proposed that provides a comprehensive explanation ...of the local production of estrogen at the level of ectopic endometrial lesions and the endometrium of women affected with the disease.
Methods
In women suffering from endometriosis and adenomyosis and in normal controls, a critical analysis of uterine morphology and function was performed using immunohistochemistry, MRI, hysterosalpingoscintigraphy, videohysterosonography, molecular biology as well as clinical aspects. The relevant molecular biologic aspects were compared to those of tissue injury and repair (TIAR) mechanisms reported in literature.
Results and conclusions
Circumstantial evidence suggests that endometriosis and adenomyosis are caused by trauma. In the spontaneously developing disease, chronic uterine peristaltic activity or phases of hyperperistalsis induce, at the endometrial–myometrial interface near the fundo-cornual raphe, microtraumatizations with the activation of the mechanism of ‘tissue injury and repair’ (TIAR). This results in the local production of estrogen. With ongoing peristaltic activity, such sites might increase and the increasingly produced estrogens interfere in a paracrine fashion with the ovarian control over uterine peristaltic activity, resulting in permanent hyperperistalsis and a self-perpetuation of the disease process. Overt auto-traumatization of the uterus with dislocation of fragments of basal endometrium into the peritoneal cavity and infiltration of basal endometrium into the depth of the myometrial wall ensues. In most cases of endometriosis/adenomyosis, a causal event early in the reproductive period of life must be postulated leading rapidly to uterine hyperperistalsis. In late premenopausal adenomyosis, such an event might not have occurred. However, as indicated by the high prevalence of the disease, it appears to be unavoidable that, with time, chronic normoperistalsis throughout the reproductive period of life leads to the same extent of microtraumatization. With the activation of the TIAR mechanism followed by infiltrative growth and chronic inflammation, endometriosis/adenomyosis of the younger woman and premenopausal adenomyosis share in principle the same pathophysiology. In conclusion, endometriosis and adenomyosis result from the physiological mechanism of ‘tissue injury and repair’ (TIAR) involving local estrogen production in an estrogen-sensitive environment normally controlled by the ovary.
Purpose
In a series of publications, we had developed the concept that uterine adenomyosis and pelvic endometriosis as well as endometriotic lesions at distant sites of the body share a common ...pathophysiology with endometriosis constituting a secondary phenomenon. Uterine auto-traumatization and the initiation of the mechanism of tissue injury and repair (TIAR) were considered the primary events in the disease process. The present MRI study was undertaken (1) to corroborate this concept by re-visiting, in view of discrepant results in the literature, the association of adenomyosis with endometriosis and (2) to extend our views concerning the mechanisms of uterine auto-traumatization.
Patients and methods
MRI was performed in 143 women attending our center, in whom, on the basis of transvaginal sonography (TVS) and historical data, such as documented endometriosis and dysmenorrhea of various degrees of severity, the presence of uterine adenomyosis was suspected. In addition to the measurement of the diameter of junctional zone (JZ) of the anterior and posterior walls in the mid-sagittal plane, the diagnosis of adenomyosis was based on visualization, in that all planes were analyzed with scrutiny. By this method of “visualization” all transient enlargement of the JZ, such as peristaltic waves of the archimyometrium and sporadic neometral contractions that might mimic adenomyotic lesions could be excluded. At the same time, this method allowed to lower the limit of detection in terms of thickness of the JZ for assured diagnosis of adenomyosis. Furthermore, the localizations of the individual lesions, their shapes and patterns were described.
Results
With the method of ‘visualization’, the diagnosis of uterine adenomyosis could be verified in 127 of the 143 patients studied. The prevalence of endometriosis in adenomyosis was 80.6 % and the prevalence of adenomyosis in endometriosis was 91.1 %. As concluded from their localization within the uterine wall, the adenomyotic lesions predominantly developed in the median region of the upper two-thirds of the uterine wall. Cystic cornual angle adenomyosis was a distinct phenomenon that was only observed in patients suffering from extreme primary dysmenorrhea. Aside from this, the majority of the patients complained of primary dysmenorrhea (80 %). On the basis of these findings and the fact that particularly extreme primary dysmenorrhea is associated with high intrauterine pressure, menstrual ‘archimetral compression by neometral contraction’ has to be considered as an important cause of uterine auto-traumatization in addition to uterine peristalsis and hyperperistalsis. Both mechanical functions of the non-pregnant uterus exert their strongest power in the upper region of the uterus, which is compatible with the predominant localization of the adenomyotic lesions.
Conclusions
The data confirm our previous results of a high association of adenomyosis with endometriosis and vice versa. Our view of the mechanism of uterine auto-traumatization by mechanical functions of the non-pregnant uterus has to be extended, in that ‘archimetral compression by neometral contractions’ could be realized as the predominant cause of mechanical strain to the non-pregnant uterus. The data of this study confirm our concept of the etiology and pathophysiology of adenomyosis and endometriosis in that the process of chronic proliferation and inflammation is induced at the level of the archimetra by chronic uterine auto-traumatization. Furthermore, with respect to the diagnosis of uterine adenomyosis (and consequently endometriosis) this study shows a high degree of accordance between the findings in real-time TVS and MRI.
ABSTRACT
In this work, we study variations in the parabolic scintillation arcs of the binary millisecond pulsar PSR J1643−1224 over five years using the Large European Array for Pulsars (LEAP). The ...two-dimensional (2D) power spectrum of scintillation, called the secondary spectrum, often shows a parabolic distribution of power, where the arc curvature encodes the relative velocities and distances of the pulsar, ionized interstellar medium, and Earth. We observe a clear parabolic scintillation arc, which varies in curvature throughout the year. The distribution of power in the secondary spectra is inconsistent with a single scattering screen, which is fully 1D or entirely isotropic. We fit the observed arc curvature variations with two models: an isotropic scattering screen and a model with two independent 1D screens. We measure the distance to the scattering screen to be in the range 114–223 pc, depending on the model, consistent with the known distance of the foreground large-diameter H ii region Sh 2-27 (112 ± 17 pc), suggesting that it is the dominant source of scattering. We obtain only weak constraints on the pulsar’s orbital inclination and longitude of ascending node, since the scintillation pattern is not very sensitive to the pulsar’s motion and the screen is much closer to the Earth than the pulsar. More measurements of this kind – where scattering screens can be associated with foreground objects – will help to inform the origins and distribution of scattering screens within our galaxy.
BACKGROUND: The hypothesis is tested that both adenomyotic and endometriotic lesions are derived from basal endometrium. METHODS: Normal uteri and uteri with adenomyosis obtained by hysterectomy, ...excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. Estrogen receptor (ER), progesterone receptor (PR), progesterone receptor B isoform (PRB) and P450 aromatase (P450A) immunohistochemistry was performed with the use of specific monoclonal antibodies. RESULTS: With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium. The endometrium of endometriotic and adenomyotic lesions mimicked the cyclical pattern of the basalis. The peristromal muscular tissue of endometriotic and adenomyotic lesions displayed the same cyclical pattern of ER and PR expression as the archimyometrium. There was a significantly higher prevalence of fragments of shed basalis in menstrual blood of women with endometriosis than in healthy controls. CONCLUSIONS: These data suggest that ectopic endometrial lesions result from dislocation of basal endometrium. Dislocated basal endometrium has stem cell character resulting in the ectopic formation of all archimetrial components such as epithelial and stromal endometrium as well as peristromal muscular tissue.
ABSTRACT
Using data from the Large European Array for Pulsars, and the Effelsberg telescope, we study the scintillation parameters of the millisecond pulsar PSR J0613−0200 over a 7 yr timespan. The ...‘secondary spectrum’ – the 2D power spectrum of scintillation – presents the scattered power as a function of time delay, and contains the relative velocities of the pulsar, observer, and scattering material. We detect a persistent parabolic scintillation arc, suggesting scattering is dominated by a thin, anisotropic region. The scattering is poorly described by a simple exponential tail, with excess power at high delays; we measure significant, detectable scattered power at times out to ${\sim}5 \, \mu {\rm s}$, and measure the bulk scattering delay to be between 50 to 200 ns with particularly strong scattering throughout 2013. These delays are too small to detect a change of the pulse profile shape, yet they would change the times of arrival as measured through pulsar timing. The arc curvature varies annually, and is well fitted by a one-dimensional scattering screen ${\sim}40{{\ \rm per\ cent}}$ of the way towards the pulsar, with a changing orientation during the increased scattering in 2013. Effects of uncorrected scattering will introduce time delays correlated over time in individual pulsars, and may need to be considered in gravitational wave analyses. Pulsar timing programmes would benefit from simultaneously recording in a way that scintillation can be resolved, in order to monitor the variable time delays caused by multipath propagation.
Slip and tilt: modeling falls over railings Muggenthaler, H.; Hubig, M.; Meierhofer, A. ...
International journal of legal medicine,
01/2021, Volume:
135, Issue:
1
Journal Article
Peer reviewed
Open access
Falls over railings are frequent case scenarios forensic experts are confronted with. An important issue is the differentiation of accidental and non-accidental falling scenarios. From a ...biomechanical point of view, this is a challenging task and should be addressed in a multifactorial approach. This work presents a simplified mechanical model in terms of a cranked rod that can be used in cases without relevant dynamic components in terms of pushing or jumping. If the anti-slip and the anti-tilt condition are violated, the possibility for a person to get over a railing should be assumed and investigated in more detail. Because our approach also involves uncertainties, the formulae should be understood to be part of a multifactorial approach. Numerical simulation, experimental reconstruction, injury pattern, and trace analysis can yield additional substantial connecting facts.
Rectal temperature measurement (RTM) from crime scenes is an important parameter for temperature-based time of death estimation (TDE). Various influential variables exist in TDE methods like the ...uncertainty in thermal and environmental parameters. Although RTM depends in particular on the location of measurement position, this relationship has never been investigated separately. The presented study fills this gap using Finite Element (FE) simulations of body cooling. A manually meshed coarse human FE model and an FE geometry model developed from the CT scan of a male corpse are used for TDE sensitivity analysis. The coarse model is considered with and without a support structure of moist soil. As there is no clear definition of ideal rectal temperature measurement location for TDE, possible variations in RTM location (RTML) are considered based on anatomy and forensic practice. The maximum variation of TDE caused by RTML changes is investigated via FE simulation. Moreover, the influence of ambient temperature, of FE model change and of the models positioning on a wet soil underground are also discussed. As a general outcome, we notice that maximum TDE deviations of up to ca. 2–3 h due to RTML deviations have to be expected. The direction of maximum influence of RTML change on TDE generally was on the line caudal to cranial.
• Injuries caused by strikes with a rubber mallet.• Acceleration measurements using animal heads.• Short contact times comparable to strikes with steel hammer.• Contact forces between 3.0kN and ...4.7kN.
Acts of violence often result in blunt force trauma. On behalf of the court, forensic experts not only have to assess injuries in terms of morphology or severity, but they also have to give statements regarding the risk of potential fatal injuries. We describe a case of domestic violence where a man hit the head of his wife using a rubber mallet. His wife sustained extensive and multiple parietal scalp lacerations and avulsions with exposure of the cranial bone. A CCT revealed neither skull fractures nor intracranial injuries. Biomechanical measurements were performed using a bowling ball and an animal head representing head surrogates. In comparison to steel hammer impacts we hypothesized longer contact durations and lower maximum contact forces in blows with a rubber mallet. However, contact durations in the magnitude of 3ms do not confirm our hypothesis. The contact forces calculated based on mallet and animal head accelerations were between 2.97kN and 4.68kN. These force values are rather below the parietal fracture thresholds, explaining the absence of parietal skull fractures in the case presented. Moreover, the relatively low Young’s modulus comes along with a deformation of the rubber mallet and a decrease in contact pressure. In summary, contact times could be reliably estimated, while contact forces remained largely uncertain.
ABSTRACT
We present the first large sample of scintillation arcs in millisecond pulsars (MSPs), analysing 12 sources observed with the Large European Array for Pulsars (LEAP), and the Effelsberg ...100-m telescope. We estimate the delays from multipath propagation, measuring significant correlated changes in scattering time-scales over a 10 yr time span. Many sources show compact concentrations of power in the secondary spectrum, which in PSRs J0613−0200 and J1600−3053 can be tracked between observations, and are consistent with compact scattering at fixed angular positions. Other sources such as PSRs J1643−1224 and J0621+1002 show diffuse, asymmetric arcs which are likely related to phase-gradients across the scattering screen. PSR B1937+21 shows at least three distinct screens which dominate at different times and evidence of varying screen axes or multiscreen interactions. We model annual and orbital arc curvature variations in PSR J0613−0200, providing a measurement of the longitude of ascending node, resolving the sense of the orbital inclination, where our best-fit model is of a screen with variable axis of anisotropy over time, corresponding to changes in the scattering of the source. Unmodelled variations of the screen’s axis of anisotropy are likely to be a limiting factor in determining orbital parameters with scintillation, requiring careful consideration of variable screen properties, or independent very long baseline interferometry (VLBI) measurements. Long-term scintillation studies such as this serve as a complementary tool to pulsar timing, to measure a source of correlated noise for pulsar timing arrays, solve pulsar orbits, and to understand the astrophysical origin of scattering screens.
•In homicide cases used: stomach content death time estimation (Tröger, Baur, Spann) (SCE).•SCE gives confidence intervals for its estimator TEE of time between last meal and death.•We show that TEE ...is not optimal in the sense of maximum probability estimation (MPE).•The article gives update formulae and diagrams to change TEE to an MPE.•It is shown that: (1) TEE>MPE; (2) (TEE−MPE)>0.15×TEE; (3) (TEE−MPE) can be 1h.
Stomach content based death time estimation (SCE), is a well-known technique in forensic sciences. Among more qualitatively oriented approaches the content percentage based method SCE by Tröger, Baur and Spann yields quantitative results and gives stochastic error measures for its outputs. This is possible since the methods estimator, which we call transformed expectation estimator (TEE) as well as the probability distribution of the time between last meal and death are determined numerically, though in SCE the estimator and confidence intervals are presented graphically only.
Our articles outcomes are:
-Explicit formulae of the TE estimator for SCE and of its probability distribution-Introduction of the maximum probability estimation (MPE) concept as well as of a MP estimator formula for SCE-Evidence that TEE>MPE, that the difference is more than ca.15% of the TEE and the difference can rise up to ca. 1h-Evidence that MPE is more relevant in forensic contexts than TEE
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