Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study

OBJECTIVE: To determine the diagnostic value of transvaginal ultrasonography and hysteroscopy in patients with postmenopausal bleeding. MATERIAL AND METHODS: Between January 1, 1998 and June 30, 1999, 88 outpatient women with postmenopausal bleeding were enrolled in a prospective study. They underwent transvaginal ultrasonography and hysteroscopy, and were submitted to directed biopsy during hysteroscopy. Findings were classified as normal endometrium, suggestive of atrophy, focal abnormality (benign or suspicious), and diffuse thickness (benign or suspicious). Data was compared with the final diagnosis, established by histological examination, as atrophy, benign pathology, atypical hyperplasia and endometrial carcinoma. RESULTS: Among 88 women enrolled, 15 were excluded because hysteroscopy was impossible, and four had abandoned the study. The histological findings were scanty material in 12 (17.4%), atrophy in 24 (34.8%), cystic atrophy in one (1.4%), normal endometrium in five (7.2%), tuberculous endometritis in one (1.4%), polyps in 12 (17.4%), leiomyoma in one (1.4%), non-atypical hyperplasia in three (4.3%), atypical hyperplasia in one (1.4%) and endometrial carcinoma in nine cases (13.0%). For the assessment of endometrial carcinoma, ultrasonography revealed sensitivity 77.8%, specificity 93.3%, positive predictive value 63.6%, negative predictive value 96.6%; and hysteroscopy revealed sensitivity of 88.9%, specificity 98.3%, positive predictive value 88.9%, negative predictive value 98.3%. The combined use of both methods revealed sensitivity 100%, specificity 91.7%, positive predictive value 64.3%, negative predictive value 100%. CONCLUSIONS: Both imagiological methods were found to be useful screening tests for endometrial carcinoma. Hysteroscopy was a superior diagnostic procedure

GLUT1-mediated glucose uptake plays a crucial role during Plasmodium hepatic infection.

Intracellular pathogens have evolved mechanisms to ensure their survival and development inside their host cells. Here, we show that glucose is a pivotal modulator of hepatic infection by the rodent malaria parasite Plasmodium berghei and that glucose uptake via the GLUT1 transporter is specifically enhanced in P. berghei-infected cells. We further show that ATP levels of cells containing developing parasites are decreased, which is known to enhance membrane GLUT1 activity. In addition, GLUT1 molecules are translocated to the membrane of the hepatic cell, increasing glucose uptake at later stages of infection. Chemical inhibition of GLUT1 activity leads to a decrease in glucose uptake and the consequent impairment of hepatic infection, both in vitro and in vivo. Our results reveal that changes in GLUT1 conformation and cellular localization seem to be part of an adaptive host response to maintain adequate cellular nutrition and energy levels, ensuring host cell survival and supporting P. berghei hepatic development

Axion Protection from Flavor

The QCD axion fails to solve the strong CP problem unless all explicit PQ violating, Planck-suppressed, dimension n<10 operators are forbidden or have exponentially small coefficients. We show that all theories with a QCD axion contain an irreducible source of explicit PQ violation which is proportional to the determinant of the Yukawa interaction matrix of colored fermions. Generically, this contribution is of low operator dimension and will drastically destabilize the axion potential, so its suppression is a necessary condition for solving the strong CP problem. We propose a mechanism whereby the PQ symmetry is kept exact up to n=12 with the help of the very same flavor symmetries which generate the hierarchical quark masses and mixings of the SM. This "axion flavor protection" is straightforwardly realized in theories which employ radiative fermion mass generation and grand unification. A universal feature of this construction is that the heavy quark Yukawa couplings are generated at the PQ breaking scale.Comment: 16 pages, 2 figure

The anomalous U(1) global symmetry and flavors from an SU(5) x SU(5)′' GUT in Z12−IZ_{12-I} orbifold compactification

In string compactifications, frequently there appears the anomalous U(1) gauge symmetry which belonged to E8$\times$E8 of the heterotic string. This anomalous U(1) gauge boson obtains mass at the compactification scale, just below $10^{18\,}$GeV, by absorbing one pseudoscalar (corresponding to the model-independent axion) from the second rank anti-symmetric tensor field $B_{MN}$. Below the compactification scale, there results a global symmetry U(1)$_{\rm anom}$ whose charge $Q_{\rm anom}$ is the original gauge U(1) charge. This is the most natural global symmetry, realizing the "invisible" axion. This global symmetry U(1)$_{\rm anom}$ is suitable for a flavor symmetry. In the simplest compactification model with the flipped SU(5) grand unification, we calculate all the low energy parameters in terms of the vacuum expectation values of the standard model singlets.Comment: 18 pages, 4 figur

Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study

BACKGROUND AND PURPOSE: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. METHODS: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. RESULTS: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52–2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13–2.15]) than patients without stroke. CONCLUSIONS: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation

Application of an indoor air pollution metamodel to a spatially-distributed housing stock

Estimates of population air pollution exposure typically rely on the outdoor component only, and rarely account for populations spending the majority of their time indoors. Housing is an important modifier of air pollution exposure due to outdoor pollution infiltrating indoors, and the removal of indoor-sourced pollution through active or passive ventilation. Here, we describe the application of an indoor air pollution modelling tool to a spatially distributed housing stock model for England and Wales, developed from Energy Performance Certificate (EPC) data and containing information for approximately 11.5 million dwellings. First, we estimate indoor/outdoor (I/O) ratios and total indoor concentrations of outdoor air pollution for PM2.5 and NO2 for all EPC dwellings in London. The potential to estimate concentration from both indoor and outdoor sources is then demonstrated by modelling indoor background CO levels for England and Wales pre- and post-energy efficient adaptation, including heating, cooking, and smoking as internal sources. In London, we predict a median I/O ratio of 0.60 (99% CIs; 0.53–0.73) for outdoor PM2.5 and 0.41 (99%CIs; 0.34–0.59) for outdoor NO2; Pearson correlation analysis indicates a greater spatial modification of PM2.5 exposure by housing (ρ = 0.81) than NO2 (ρ = 0.88). For the demonstrative CO model, concentrations ranged from 0.4–9.9 ppm (99%CIs)(median = 3.0 ppm) in kitchens and 0.3–25.6 ppm (median = 6.4 ppm) in living rooms. Clusters of elevated indoor concentration are found in urban areas due to higher outdoor concentrations and smaller dwellings with reduced ventilation potential, with an estimated 17.6% increase in the number of living rooms and 63% increase in the number of kitchens exceeding recommended exposure levels following retrofit without additional ventilation. The model has the potential to rapidly calculate indoor pollution exposure across large housing stocks and estimate changes to exposure under different pollution or housing policy scenarios

Prevalência e fatores associados aos comportamentos sedentários em adolescentes

OBJETIVO Analisar a prevalência e fatores associados aos comportamentos sedentários em adolescentes. MÉTODOS Estudo transversal com adolescentes de 10 a 17 anos de idade, de ambos os sexos, pertencentes a uma coorte de nascimentos entre 1994-1999 na cidade de Cuiabá, Mato Grosso, Brasil. Para o levantamento dos dados, foi utilizado um questionário contendo informações sociodemográficas, econômicas e de estilo de vida e aferição de dados antropométricos. Determinou-se como comportamento sedentário o uso de televisão e/ou computador/vídeo games por um tempo igual ou superior a 4 horas/dia. Avaliou-se a associação de comportamentos sedentários com o índice de massa corporal, tanto na infância quanto na adolescência, e com variáveis sociodemográficas e comportamentais por meio de regressão logística hierarquizada. RESULTADOS A prevalência global de comportamentos sedentários foi de 58,1%. Dos 1.716 adolescentes estudados, 50,7% (n = 870) eram do sexo masculino. Na análise multivariada, após ajuste para fatores de confusão, as variáveis que permaneceram associadas com os comportamentos sedentários foram: idade (14 anos ou mais) (OR = 3,51; IC95% 2,19;5,60); classe econômica elevada (OR = 3,83; IC95% 2,10;7,01); maior nível de escolaridade da mãe (OR = 1,81; IC95% 1,09;3,01); residir no interior (OR = 0,49; IC95% 0,30;0,81); atividade física insuficiente (OR = 1,25; IC95% 1,02;1,53); experimentação de bebidas alcoólicas (OR = 1,34; IC95% 1,08;1,66) e excesso de peso na adolescência (OR = 1,33; IC95% 1,06;1,68). CONCLUSÕES A elevada proporção de adolescentes em atividades sedentárias e a não associação dessas atividades na adolescência com o excesso de peso na infância indicam a necessidade de intervenções para redução de vários comportamentos de risco. O incentivo à prática de atividade física como forma de reduzir os comportamentos sedentários e consequentemente o excesso de peso entre os jovens torna-se fundamental