Hysteroscopic Myomectomy: the Guidelines of the International Society for Gynecologic Endoscopy (ISGE)

Objective: With this publication, the International Society for Gynecologic Endoscopy (ISGE) aims to provide the clinicians with the recommendations arising from the best evidence currently available on hysteroscopic myomectomy (HM). Study design: The ISGE Task Force for HM defined key clinical questions, which led the search of Medline/PubMed and the Cochrane Database. We selected and analyzed relevant English-language articles, published from January 2005 to June 2021, including original works, reviews and the guidelines previously published by the European Society for Gynecological Endoscopy (ESGE) and the American Association of Gynecologic Laparoscopists (AAGL), in which bibliographies were also checked in order to identify additional references, using the medical subject heading (MeSH) term "Uterine Myomectomy" (MeSH Unique ID: D063186) in combination with ''Myoma" (MeSH Unique ID: D009214) and ''Hysteroscopy" (MeSH Unique ID: D015907). We developed the recommendations through multiple cycles of literature analysis and expert discussion. Results: The ISGE Task Force did develop 10 grade 1A-C and 4 grade 2A-C recommendations. For planning HM, evaluation of the uterus with saline infusion sonohysterography (SIS) or combined assessment by transvaginal ultrasound (TVUS) and diagnostic hysteroscopy is recommended (Grade 1A). The use of STEPW (Size, Topography, Extension of the base, Penetration and lateral Wall position) classification system of submucosal leiomyoma (LM) is recommended to predict the complex surgeries, incomplete removal of the LM, long operative time, fluid overload and other major complications (grade 1B). For type 0 LMs, in addition to resectoscopy (slicing technique), morcellation is recommended, being faster and having a shorter learning curve with respect to resectoscopy (grade 1C). For type 1-2 LMs, slicing technique is currently recommended (grade 1C). A fluid deficit of 1000 mL also in case of bipolar myomectomy with saline solution, in healthy women of reproductive age, contains low risk for major complications. Lower thresholds (750 mL) for fluid deficit should be considered in the elderly and in women with cardiovascular, renal or other co-morbidities (Grade 1B). Conclusion: HM is the most effective conservative minimally invasive gynecologic intervention for submucous LM. The set of 14 ISGE recommendations can significantly contribute to the success of HM and the safety of patients for whom the choice of appropriate surgical technique, as well as the surgeon's awareness and measures to prevent complications are of the utmost importance.info:eu-repo/semantics/publishedVersio

Congenital Malformations of the Female Genital Tract: a Review of Available Classification Systems

Congenital malformations of the female genital tract are being diagnosed more frequently due to advances in imaging techniques. A broad international consensus on their classification is still lacking. This paper aimed to comparatively summarize the most frequently and widely used, as well as the most recently developed classification systems of congenital female genital malformations. A non-systematic review was done through a search on major databases with the medical subject heading (MeSH) term ‘‘congenital abnormalities” in combination with ‘‘classification” and ‘‘female genitalia”. All available systems, including, among others, the American Fertility Society Classification (1988), the Acien and Acien classification (1992, 2004), the VCUAM system (2005), the European Society for Human Reproduction and Embryology - European Society for Gynecological Endoscopy classification (2013), the Congenital Uterine Malformation Experts (CUME) group recommendations, and the American Society for Reproductive Medicine Classification (2021) possess the advantages and disadvantages listed in this article. Regarding the most common situations, the criteria for differentiating physiologic arcuate and discrete partial septate uteri vary widely between classifications, while difficulties also persist with the rarer complex abnormalities that cannot be easily classified, contributing to a gap in clinical and research protocols. The main factor compromising any attempt to reach an ideal classification system is the lack of evidence-based data, justifying the need for comparative multicenter international randomized control trials in this field. Pending new research data and a broad international consensus, it seems essential for adequate patient orientation to describe each detected malformation in detail and to correlate it with the clinical presentation, regardless the type of classification used.info:eu-repo/semantics/publishedVersio

Relationship Between Endocrine Profile, Energy Balance and Milk Yield in Dairy Cows During Lactation

The objective of the present study was to investigate relationship between endocrine profile with energy balance (EB) and milk yield (MY) in Simmental dairy cows during lactation. Fifteen late pregnant cows, 15 early lactation cows and 15 mid lactation cows were chosen for the analysis. Blood samples were collected to measure growth hormone (GH), insulin, triiodothyronine (T3) and thyroxine (T4). Early lactation cows were found to have higher blood serum concentrations of GH (p0.05), T3 (p0.05) compared to dry and mid lactation cows. Insulin and thyroid hormones were in positive correlation with EB (p<0.05), and in negative correlation with MY (nonsignificant). GH was in positive correlation with MY (p<0.05), but in negative correlation with EB (nonsignificant). Relationship between hormones showed significant positive correlation between insulin and thyroid hormones. These relations are not principaly determinated by EB or MY. Negative correlations between insulin or thyroid hormones with GH were observed. These relations are principaly determinated by EB or MY

Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: a Prospective Multicenter Portuguese Study

This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.info:eu-repo/semantics/publishedVersio

A matrix pencil approach to the existence of compactly supported reconstruction functions in average sampling

The aim of this work is to solve a question raised for average sampling in shift-invariant spaces by using the well-known matrix pencil theory. In many common situations in sampling theory, the available data are samples of some convolution operator acting on the function itself: this leads to the problem of average sampling, also known as generalized sampling. In this paper we deal with the existence of a sampling formula involving these samples and having reconstruction functions with compact support. Thus, low computational complexity is involved and truncation errors are avoided. In practice, it is accomplished by means of a FIR filter bank. An answer is given in the light of the generalized sampling theory by using the oversampling technique: more samples than strictly necessary are used. The original problem reduces to finding a polynomial left inverse of a polynomial matrix intimately related to the sampling problem which, for a suitable choice of the sampling period, becomes a matrix pencil. This matrix pencil approach allows us to obtain a practical method for computing the compactly supported reconstruction functions for the important case where the oversampling rate is minimum. Moreover, the optimality of the obtained solution is established

Baryonic Generating Functions

We show how it is possible to use the plethystic program in order to compute baryonic generating functions that count BPS operators in the chiral ring of quiver gauge theories living on the world volume of D branes probing a non compact CY manifold. Special attention is given to the conifold theory and the orbifold C^2/Z_2 times C, where exact expressions for generating functions are given in detail. This paper solves a long standing problem for the combinatorics of quiver gauge theories with baryonic moduli spaces. It opens the way to a statistical analysis of quiver theories on baryonic branches. Surprisingly, the baryonic charge turns out to be the quantized Kahler modulus of the geometry.Comment: 44 pages, 7 figures; fonts change

SQCD: A Geometric Apercu

We take new algebraic and geometric perspectives on the old subject of SQCD. We count chiral gauge invariant operators using generating functions, or Hilbert series, derived from the plethystic programme and the Molien-Weyl formula. Using the character expansion technique, we also see how the global symmetries are encoded in the generating functions. Equipped with these methods and techniques of algorithmic algebraic geometry, we obtain the character expansions for theories with arbitrary numbers of colours and flavours. Moreover, computational algebraic geometry allows us to systematically study the classical vacuum moduli space of SQCD and investigate such structures as its irreducible components, degree and syzygies. We find the vacuum manifolds of SQCD to be affine Calabi-Yau cones over weighted projective varieties.Comment: 49 pages, 1 figur

Generating Geodesic Flows and Supergravity Solutions

We consider the geodesic motion on the symmetric moduli spaces that arise after timelike and spacelike reductions of supergravity theories. The geodesics correspond to timelike respectively spacelike $p$-brane solutions when they are lifted over a $p$-dimensional flat space. In particular, we consider the problem of constructing \emph{the minimal generating solution}: A geodesic with the minimal number of free parameters such that all other geodesics are generated through isometries. We give an intrinsic characterization of this solution in a wide class of orbits for various supergravities in different dimensions. We apply our method to three cases: (i) Einstein vacuum solutions, (ii) extreme and non-extreme D=4 black holes in N=8 supergravity and their relation to N=2 STU black holes and (iii) Euclidean wormholes in $D\geq 3$. In case (iii) we present an easy and general criterium for the existence of regular wormholes for a given scalar coset.Comment: Fixed a typo in table 3, page 27, results unchange