Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal

BACKGROUND: The prevalence of congenital uterine anomalies in women with reproductive failure remains unclear, largely due to methodological bias. The aim of this review is to assess the diagnostic accuracy of different methodologies and estimate the prevalence of congenital uterine anomalies in women with infertility and recurrent miscarriage (RM). METHODS: Studies from 1950-2007 were identified through a computer MEDLINE search; all relevant references were further reviewed. RESULTS: The most accurate diagnostic procedures are combined hysteroscopy and laparoscopy, sonohysterography (SHG) and possibly three-dimensional ultrasound (3D US). Two-dimensional ultrasound (2D US) and hysterosalpingography (HSG) are less accurate and are thus inadequate for diagnostic purposes. Preliminary studies (n=24) suggest MRI is a relatively sensitive tool. A critical analysis of studies suggests that the prevalence of congenital uterine anomalies is ~6.7% [confidence interval (CI) 95%, 6.0 – 7.4] in the general population, ~7.3% (CI 95%, 6.7 – 7.9) in the infertile population and ~16.7% (CI 95%, 14.8 – 18.6) in the recurrent miscarriage (RM) population. The arcuate uterus is the commonest anomaly in the general and RM population. In contrast, the septate uterus is the commonest anomaly in the infertile population, suggesting a possible association. CONCLUSION: Women with RM have a high prevalence of congenital uterine anomalies and should be thoroughly investigated. HSG and/or 2D US can be used as an initial screening tool. Combined hysteroscopy and laparoscopy, SHG and 3D US can be used for a definitive diagnosis. The accuracy and practicality of magnetic resonance imaging (MRI) remains unclear

Poaching and Human-elephant Conflict: A Destructive Duo. How Poaching May Alter Male Elephant Society and Indirectly Influence Human-elephant Conflict

The uncertain future of African elephants (Loxodonta africana) is currently a popular issue in conservation circles, largely due to the ongoing poaching crisis. Compounding the threat of illegal offtake are the added pressures of habitat loss and human-elephant conflict (HEC). HEC specifically is a complex challenge to conservation and a major threat to elephants across their entire range, leading not only to retaliation killings but the erosion of local support for conservation. While the issues of poaching and human-elephant conflict have been considered separate issues, an examination of elephant behaviour and HEC under a political ecology framework highlights the possibility that these processes are becoming increasingly interconnected. Elephant bull society, specifically the influence of mature males, aids not only in proper social development of adolescents but controls musth in younger males. As older males have the largest and thus most desirable tusks, the ivory trade presents a unique challenge to bull society by removing the positive influence of older conspecifics. This stifles the ability of young males to learn proper foraging and leads to early musth. As pre-musth males must forage heavily, and foraging behaviour is learnt by association with older males, the ivory trade may lead to heavy crop raiding by young males and thus exacerbate HEC. When we consider that the social and economic situations that are thought to drive poaching activity are the same as those that both put people at higher risk of HEC and drive retaliation killings, it is likely that poaching influences levels of HEC

Factors influencing dietary nitrate metabolism in humans

Dietary nitrate supplementation, with nitrate-rich beetroot juice (BR), increases nitric oxide (NO) bioavailability by the stepwise reduction of nitrate to nitrite and NO. This has been associated with a number of beneficial physiological and exercise performance effects, but understanding of nitrate metabolism is incomplete. The purpose of this thesis was to investigate some of the factors purported to influence dietary nitrate metabolism in humans. Specifically, the influence of oral cavity temperature and pH on dietary nitrate metabolism, and the influence of muscle oxygenation on exercise economy and tolerance were investigated following BR supplementation. Chapter 3: Salivary and plasma [nitrate] and [nitrite] were assessed at a neutral oral pH with a low (TempLo-pHNorm), intermediate (TempMid-pHNorm) and high (TempHi-pHNorm) oral temperature, and at an alkaline oral pH with a low (TempLo-pHHi), intermediate (TempMid-pHHi) and high (TempHi-pHHi) oral temperature. Compared to the TempMid-pHNorm trial (976 ± 388 µM), mean salivary [nitrite] over the protocol was higher in the TempMid-pHHi (1855 ± 423 µM), TempHi-pHNorm (1371 ± 653 µM), TempHi-pHHi (1792 ± 741 µM), TempLo-pHNorm (1495 ± 502 µM) and TempLo-pHHi (2013 ± 662 µM) conditions, with salivary [nitrite] also higher at a given oral temperature when oral pH was increased (P0.05). BR consumption increased peak oxygen uptake in hypoxia (P0.05). Collectively, these findings improve our understanding of dietary nitrate metabolism and might help guide future studies assessing the efficacy of dietary nitrate supplementation on human health and performance

Humber Bridge: suppressing main cable corrosion by means of dehumidification

The Humber Bridge officially opened in 1981 and carries 4 lanes of traffic across the Humber Estuary between Barton and Hessle to the west of Kingston-upon-Hull in East Yorkshire, England. When opened, it was the longest span suspension bridge in the world with a main span of 1410m but it currently ranks as the fifth longest span in the world. Humber Bridge Board (HBB) commissioned an internal inspection of the main cables following the discovery of extensive corrosion and broken wires in the main cables of two older suspension bridges in the UK. The main cable inspections revealed widespread, if generally light corrosion with localised pitting and a very small number of broken wires. Dehumidification of suspension bridge main cables is becoming standard practice not only in the UK but worldwide. This paper examines the installation of the Humber Bridge system, discusses the mechanics of atmospheric steel corrosion and explains how the cable dehumidification system will suppress future corrosion

Does free androgen index predict subsequent pregnancy outcome in women with recurrent miscarriage?

BACKGROUND: Several studies have investigated plasma androgen levels in women with recurrent miscarriage (RM) with conflicting results on whether an association between hyperandrogenaemia and RM exists. However, none of these studies included sensitive androgen measurements using a large data set. We therefore investigated the free androgen index (FAI) in a large number of women with RM in order to ascertain whether hyperandrogenaemia is a predictor of subsequent pregnancy outcome. METHODS: We studied 571 women who attended the Recurrent Miscarriage Clinic in Sheffield and presented with !3 consecutive miscarriages. Serum levels of total testosterone and sex hormone-binding globulin were measured in the early follicular phase and FAI was then deduced. RESULTS: The prevalence of hyperandrogenaemia in RM was 11% and in a subsequent pregnancy, the miscarriage rate was significantly higher in the raised FAI group (miscarriage rates of 68% and 40% for FAI > 5 and FAI 5 respectively, P 5 0.002). CONCLUSIONS: An elevated FAI appears to be a prognostic factor for a subsequent miscarriage in women with RM and is a more significant predictor of subsequent miscarriage than an advanced maternal age (!40 years) or a high number (!6) of previous miscarriages in this study

Local radio to promote mental health awareness: a public health initiative.

BACKGROUND: Public health strategies have focused largely on physical health. However, there is increasing recognition that raising mental health awareness and tackling stigma is crucial to reduce disease burden. National campaigns have had some success but tackling issues locally is particularly important. AIMS: To assess the public's awareness and perception of the monthly BBC Cornwall mental health phone-in programmes that have run for 8.5 years in Cornwall, UK (population 530 000). METHOD: A consultation, review and feedback process involving a multiagency forum of mental and public health professionals, people with lived experience and local National Health Service trust's media team was used to develop a brief questionnaire. This was offered to all attendees at two local pharmacies covering populations of 27 000 over a 2-week period. RESULTS: In total, 14% (95% CI 11.9-16.5) were aware of the radio show, 11% (95% CI 9.0-13.1) have listened and the majority (76%) of those who listened did so more than once. The estimated reach is 70 000 people in the local population, of whom approximately 60 000 listen regularly. The show is highly valued among respondents with modal and median scores of 4 out of 5. CONCLUSIONS: Local radio is a successful, cost-effective and impactful way to reach a significant proportion of the population and likely to raise awareness, reduce stigma and be well received. The format has been adopted in other regions thus demonstrating easy transferability. It could form an essential part of a public health strategy to improve a population's mental well-being. DECLARATION OF INTEREST: W.H. received support from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula UK. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. L.R. and D.S. were involved in delivering the programmes but had no role in their evaluation

The effect of dietary phytochemicals on nuclear factor erythroid 2-related factor 2 (Nrf2) activation: a systematic review of human intervention trials

We conducted a systematic review of human trials examining the effects of dietary phytochemicals on Nrf2 activation. In accordance with the PRISMA guidelines, Medline, Embase and CAB abstracts were searched for articles from inception until March 2020. Studies in adult humans that measured Nrf2 activation (gene or protein expression changes) following ingestion of a phytochemical, either alone or in combination were included. The study was pre-registered on the Prospero database (Registration Number: CRD42020176121). Twenty-nine full-texts were retrieved and reviewed for analysis; of these, eighteen were included in the systematic review. Most of the included participants were healthy, obese or type 2 diabetics. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Twelve different compounds were examined in the included studies: curcumin, resveratrol and sulforaphane were the most common (n = 3 each). Approximately half of the studies reported increases in Nrf2 activation (n = 10); however, many were of poor quality and had an unclear or high risk of bias. There is currently limited evidence that phytochemicals activate Nrf2 in humans. Well controlled human intervention trials are needed to corroborate the findings from in vitro and animal studies

Influence of muscle oxygenation and nitrate-rich beetroot juice supplementation on o2 uptake kinetics and exercise tolerance

We tested the hypothesis that acute supplementation with nitrate (NO3-)-rich beetroot juice (BR) would improve quadriceps muscle oxygenation, pulmonary oxygen uptake (VO2) kinetics and exercise tolerance (Tlim) in normoxia and that these improvements would be augmented in hypoxia and attenuated in hyperoxia. In a randomized, doubleblind, cross-over study, ten healthy males completed two-step cycle tests to Tlim following acute consumption of 210 mL BR (18.6 mmol NO3-) or NO3--depleted beetroot juice placebo (PL; 0.12 mmol NO3-). These tests were completed in normobaric normoxia [fraction of inspired oxygen content (FIO2): 21%], hypoxia (FIO2: 15%) and hyperoxia (FIO2: 40%). Pulmonary VO2 and quadriceps tissue oxygenation index (TOI), derived from multi-channel near-infrared spectroscopy, were measured during all trials. Plasma [nitrite] was higher in all BR compared to all PL trials (P0.05). These findings indicate that BR supplementation is more likely to improve Tlim and peak VO2 in situations when skeletal muscle is more hypoxic.</div