Atypical polypoid adenomyoma follow-up and management: Systematic review of case reports and series and meta-analysis

BACKGROUND: Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. METHODS: This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. RESULTS: We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P\u200a<\u200a.05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. CONCLUSION: This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies

A Case of Advanced Tubal Ectopic Pregnancy after Emergency Contraception

Ectopic pregnancy is a relatively common condition and an important cause of morbidity in women of childbearing age. The most frequent implantation site is the fallopian tube. Most cases are diagnosed in an early gestational period. Patients come to the attention of clinicians for pelvic pain and vaginal blood loss, and consequent diagnosis is made through clinical presentation, laboratory tests, and ultrasound. Other rarer implantation sites such as the abdominal cavity give space for ectopic pregnancy to grow until later gestational ages, delaying diagnosis. This is a rare case of a healthy 41-year-old woman with an advanced ectopic pregnancy after emergency contraception with Ulipristal Acetate. The patient went to visit for amenorrhea after taking a contraceptive. Evaluation with ultrasound demonstrated a 10 + 4 weeks’ unruptured tubal pregnancy with fetal heart rate. The patient underwent laparoscopic salpingectomy without complication. This is the first case of such an advanced ectopic pregnancy in a woman who performed emergency contraception with Ulipristal Acetate

A breach in plant defences: Pseudomonas syringae pv. actinidiae targets ethylene signalling to overcome Actinidia chinensis pathogen responses

8openInternationalBothEthylene interacts with other plant hormones to modulate many aspects of plant metabolism, including defence and stomata regulation. Therefore, its manipulation may allow plant pathogens to overcome the host’s immune responses. This work investigates the role of ethylene as a virulence factor for Pseudomonas syringae pv. actinidiae (Psa), the aetiological agent of the bacterial canker of kiwifruit. The pandemic, highly virulent biovar of this pathogen produces ethylene, whereas the biovars isolated in Japan and Korea do not. Ethylene production is modulated in planta by light/dark cycle. Exogenous ethylene application stimulates bacterial virulence, and restricts or increases host colonisation if performed before or after inoculation, respectively. The deletion of a gene, unrelated to known bacterial biosynthetic pathways and putatively encoding for an oxidoreductase, abolishes ethylene production and reduces the pathogen growth rate in planta. Ethylene production by Psa may be a recently and independently evolved virulence trait in the arms race against the host. Plant- and pathogen-derived ethylene may concur in the activation/suppression of immune responses, in the chemotaxis toward a suitable entry point, or in the endophytic colonisationopenCellini, Antonio; Donati, Irene; Farneti, Brian; Khomenko, Iuliia; Buriani, Giampaolo; Biasioli, Franco; Cristescu, Simona M.; Spinelli, Francesco;Cellini, A.; Donati, I.; Farneti, B.; Khomenko, I.; Buriani, G.; Biasioli, F.; Cristescu, S.M.; Spinelli, F

On-line tracking of the human gut microbial metabolism: high-throughput screening during colonic in-vitro fermentation

The human gut encloses a large community of bacteria producing a wide range of volatile organic compounds (VOCs) when fermenting undigestible substrates. This study aims to provide a high throughput method to study in real-time the gut microbial volatilome when the microbiota process undigestible dietary substrates. Background: Small metabolites from the human gut microbiota are recognized as the intermediates of the microbiome-host cross-talk [1]. The research on the human gut metabolome is mainly based on discrete sampling representing discontinuous ‘snapshot’ of these complex biological systems [2]. The aim of this research work is to enhance the current understanding of the dynamics of the gut microbiota by integrating non-invasive and continuous analytical methods with in-vitro gut simulators, to monitor in real-time, the progression of small molecules released into the headspace [2,3] Methodology: Automated Head space-Solid Phase Micro Extraction coupled with Gas Chromatography-Mass Spectrometry (HS-SPME-GC-MS) and Static Headspace- Proton Transfer Reaction-Time of Flight-Mass Spectrometry (SHS-PTR-ToF-MS) are used for the purpose of this investigation. The objective is to screen and monitor a specific set of masses of interest, to gain system level mechanistic insights on primary metabolism of the gut microbial consortia. Results: This methodology enabled the continuous monitoring of multiple metabolites in time, including short-chain fatty acids (SCFAs) and medium-chain fatty acids (MCFAs) derived from 24h oat bran fermentation. A mixture of -odd and -even chain acids were co-released into the culture headspace after 4 hours of fermentation and their relative abundance increased in time over 24 hours. The production of multiple MCFAs from the substrate is most likely a community optimization strategy to maximize ATP production from oat degradation by means of reverse beta-oxidation which involves the utilization of fermentation intermediates, such as propanol and acetate. Furthermore, the untargeted screening allowed the detection of low abundant sulfur metabolites, thiophenes, which, to our knowledge, were never investigated before as gut microbial metabolites (GMMs). Conclusion: By integrating non-invasive and continuous analytical methods with an in-vitro gut simulator, it was possible to monitor in real-time the progression of two important class of small molecules released by the microbial consortia into the headspace. The collected information can be jointly integrated to shed light on the dynamics of bacterial foraging of complex undigestible substrates (e.g. bran from cereals). Overall, these results confirm the idea to consider the bacterial headspace as a highly dynamic chemical system that contains information on microbial community behavio

A breach in plant defences: Pseudomonas syringae pv. actinidiae targets ethylene signalling to overcome Actinidia chinensis pathogen responses

Ethylene interacts with other plant hormones to modulate many aspects of plant metabolism, including defence and stomata regulation. Therefore, its manipulation may allow plant pathogens to overcome the host’s immune responses. This work investigates the role of ethylene as a virulence factor for Pseudomonas syringae pv. actinidiae (Psa), the aetiological agent of the bacterial canker of kiwifruit. The pandemic, highly virulent biovar of this pathogen produces ethylene, whereas the biovars isolated in Japan and Korea do not. Ethylene production is modulated in planta by light/dark cycle. Exogenous ethylene application stimulates bacterial virulence, and restricts or increases host colonisation if performed before or after inoculation, respectively. The deletion of a gene, unrelated to known bacterial biosynthetic pathways and putatively encoding for an oxidoreductase, abolishes ethylene production and reduces the pathogen growth rate in planta. Ethylene production by Psa may be a recently and independently evolved virulence trait in the arms race against the host. Plantand pathogen-derived ethylene may concur in the activation/suppression of immune responses, in the chemotaxis toward a suitable entry point, or in the endophytic colonisation

Variability in concentrations of potentially toxic elements in urban parks from six European cities

Use of a harmonised sampling regime has allowed comparison of concentrations of copper, chromium, nickel, lead and zinc in six urban parks located in different European cities differing markedly in their climate and industrial history. Wide concentrations ranges were found for copper, lead and zinc at most sites, but for chromium and nickel a wide range was only seen in the Italian park, where levels were also considerably greater than in other soils. As might be expected, the soils from older cities with a legacy of heavy manufacturing industry (Glasgow, Torino) were richest in potentially toxic elements (PTEs); soils from Ljubljana, Sevilla and Uppsala had intermediate metal contents, and soils from the most recently established park, in the least industrialised city (Aveiro), displayed lowest concentrations. When principal component analysis was applied to the data, associations were revealed between pH and organic carbon content; and between all five PTEs. When pH and organic carbon content were excluded from the PCA, a distinction became clear between copper, lead and zinc (the "urban" metals) on the one hand, and chromium and nickel on the other. Similar results were obtained for the surface (0-10 cm depth) and sub-surface (10-20 cm depth) samples. Comparisons with target or limit concentrations were limited by the existence of different legislation in different countries and the fact that few guidelines deal specifically with public-access urban soils intended for recreational use

Optimization of gas sensors measurements by dynamic headspace analysis supported by simultaneous direct injection mass spectrometry

Dynamic headspace extraction is frequently used in gas sensors measurements. The procedure may introduce artefacts but its influence in sensor signals interpretation is rarely considered. In this paper, taking advantage of the on-line combination of a quartz microbalance gas sensor array with a proton transfer reaction mass spectrometer, we have been able to track the evolution of the concentration of volatile compounds along 75 s of extraction of the headspace of differently treated tomato pastes. Proton transfer reaction mass spectrometer signals show that VOCs are characterized by a large diversity of the evolution of the concentration. VOCs kinetics has been described by an electric equivalent circuit model. On the other hand, sensor signals continuously grow approaching a steady value. The contrasting behaviour between sensors signals and the concentration of most of VOCs is explained considering that water is the dominant component in the tomato paste sample and that water is one of those compounds whose concentration in the sensor cell steadily grows. Analysis of variance show that sensors signals achieve the largest separation between classes when the concentration of VOCs in the sensor cell reached its peak. Thus, although the sensor signals continue to rise their information content decays. This finding suggests that measurement protocols need to be adjusted according to the properties of the sample and that the actual measurement times could be much shorter than those predicted from the behaviour of sensor signal