Multicenter evaluation of blood-based biomarkers for the detection of endometriosis and adenomyosis: A prospective non-interventional study.

OBJECTIVE To evaluate blood-based biomarkers to detect endometriosis and/or adenomyosis across nine European centers (June 2014-April 2018). METHODS This prospective, non-interventional study assessed the diagnostic accuracy of 54 blood-based biomarker immunoassays in samples from 919 women (aged 18-45 years) with suspicion of endometriosis and/or adenomyosis versus symptomatic controls. Endometriosis was stratified by revised American Society for Reproductive Medicine stage. Symptomatic controls were "pathologic symptomatic controls" or "pathology-free symptomatic controls". The main outcome measure was receiver operating characteristic-area under the curve (ROC-AUC) and Wilcoxon P values corrected for multiple testing (q values). RESULTS CA-125 performed best in "all endometriosis cases" versus "all symptomatic controls" (AUC 0.645, 95% confidence interval [CI] 0.600-0.690, q < 0.001) and increased (P < 0.001) with disease stage. In "all endometriosis cases" versus "pathology-free symptomatic controls", S100-A12 performed best (AUC 0.692, 95% CI 0.614-0.769, q = 0.001) followed by CA-125 (AUC 0.649, 95% CI 0.569-0.729, q = 0.021). In "adenomyosis only cases" versus "symptomatic controls" or "pathology-free symptomatic controls", respectively, the top-performing biomarkers were sFRP-4 (AUC 0.615, 95% CI 0.551-0.678, q = 0.045) and S100-A12 (AUC 0.701, 95% CI 0.611-0.792, q = 0.004). CONCLUSION This study concluded that no biomarkers tested could diagnose or rule out endometriosis/adenomyosis with high certainty

Risk for pelvic metastasis and role of pelvic lymphadenectomy in node-positive vulvar cancer - results from the AGO-VOP.2 QS vulva study

Simple Summary In node-positive vulvar squamous cell cancer, questions of when and how to perform pelvic lymphadenectomy (LAE) as well as the optimal extent of pelvic treatment in general have been surrounded by considerable controversy. In Germany, systematic pelvic LAE is currently recommended as a staging procedure in patients at risk for pelvic nodal involvement in order to prevent morbidity caused by pelvic radiotherapy (RT) in patients without histologically-confirmed pelvic involvement. However, the population at risk for pelvic metastases remains insufficiently described, resulting in the potential overtreatment of a considerable proportion of patients with groin-positive disease. This applies to the indication to perform surgical staging but also to adjuvant RT of the pelvis without previous pelvic staging. Our study aims to describe the risk for pelvic lymph node metastasis with regard to positive groin nodes and to clarify the indication criteria for pelvic treatment in node-positive vulvar cancer. Abstract The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Vision und Wirklichkeit des globalen Bodenschutzes: effizienzorientierte institutionelle Ansaetze auf marktwirtschaftskonformem Boden

Available from Bibliothek des Instituts fuer Weltwirtschaft, ZBW, Duesternbrook Weg 120, D-24105 Kiel W 276 (25) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Institutional learning within the WTO regime: an evolutionary perspective on the trade—environment dispute

The assessment of interactions between trade and the environment is dominated by intensive ideological and scientific controversies. These controversies also influence the development of international rules for trade within the GATT/WTO regime. Despite recognition of the need for accepted institutional rules, only slow institutional changes can be observed. The connection of environmental protection with protectionist measures favouring old industrial and agricultural sectors makes it especially difficult to define accepted and objectiflable criteria for justifiable trade interventions. This paper analyses the incentives within the GATT/WTO regime to use institutional experiences for learning processes and institutional reforms. By using an interdisciplinary methodology of evolutionary economics and political science, new procedural criteria to identify learning efforts are developed. These criteria offer opportunities to show the reform potential within and outside the international trade system to overcome common misunderstandings and controversies.global environmental institutions; greening the GATT/WTO; institutional learning processes; trade and the environment.

Vorrichtung zur zerstoerungsfreien Werkstoffpruefung

DE 2814125 C UPAB: 19930901 A clock pulse generator coupled to a multiplexer, produces one or more DC voltages to control a v.c.i. This oscillator has a variable amplitude sine wave output which is fed to a number of eddy current probe coils for workpiece testing. Currents are induced in pick-up coils and fed to multiplier circuits, which are also supplied with constant amplitude sine and cosine outputs from the oscillator, to generate real and imaginary current components. The instantaneous measured impedances are stored in a memory circuit to provide a correction factor for subsequent measurements

Wirbelstromverfahren zur Untersuchung der Spannungsrisskorrosion in austenitischen Bauteilen sowie Vorrichtung zur Durchfuehrung des Verfahrens

Bei einem Wirbelstromverfahren zur Untersuchung der Korrosionstiefe bei Spannungsrisskorrosion in austenitischen Bauteilen wird die Impedanzveraenderung einer flachen Abtastspule sowohl bei einer ersten niedrigen Frequenz im Bereich von weniger als 30 kHz als auch einer zweiten wesentlich hoeheren Frequenz im Bereich von 2 MHz ausgewertet. Es werden jeweils kompensierte Summensignale erzeugt, wobei das niederfrequente Summensignal phasenunabhaengig gleichgerichtet wird, um ein Signal zu erzeugen, das der Summe der tatsaechlichen Spulenabhebung und der Korrosionstiefe entspricht. Das hochfrequente Summensignal wird mit Hilfe eines Phasengleichrichters so gleichgerichtet, dass das in ihm enthaltene Korrosionssignal unterdrueckt wird und ein Abhebungssignal erzeugt wird, das der tatsaechlichen Spulenabhebung zugeordnet ist. Durch eine Subtraktion des zweiten Signals vom ersten Signal wird die Korrosionstiefe ermittelt