Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions

STUDY QUESTION: What is the interobserver and intraobserver reproducibility of pelvic ultrasound for the detection of endometriotic lesions? SUMMARY ANSWER: Pelvic ultrasound is highly reproducible for the detection of pelvic endometriotic lesions. WHAT IS KNOWN ALREADY: Transvaginal ultrasound (TVS) has been widely adopted as the first-line assessment for the diagnosis and assessment of pelvic endometriosis. Severity of endometriosis as assessed by ultrasound has been shown to have good concordance with laparoscopy (kappa 0.79). The reproducibility of TVS for assessment of ovarian mobility and pouch of Douglas obliteration using the 'sliding sign' has already been described in the literature. However, there is no available data in the literature to demonstrate the intraobserver repeatability of measurements for endometriotic cysts and nodules. STUDY DESIGN SIZE DURATION: This was a prospective observational cross-sectional study conducted over a period of 12 months. We included 50 consecutive women who were all examined by two operators (A and B) during their clinic attendance. PARTICIPANTS/MATERIALS SETTING METHODS: The study was carried out in a specialist endometriosis centre. We included all consecutive women who had ultrasound scans performed independently by two experienced operators during the same visit to the clinic. The outcomes of interest were the inter- and intraobserver reproducibility for the detection of endometriotic lesions. We also assessed repeatability of the measurements of lesion size. MAIN RESULTS AND THE ROLE OF CHANCE: There was a good level of agreement between operator A and operator B in detecting the presence of pelvic endometriotic lesions (k = 0.72). There was a very good level of agreement between operators in identifying endometriotic cysts (k = 0.88) and a good level of agreement in identifying endometriotic nodules (k = 0.61). The inter- and intraobserver repeatability of measuring endometriotic cysts was excellent (intra-class correlation (ICC) ≥ 0.98). There was good interobserver measurement repeatability for bowel nodules (ICC 0.88), but the results for nodules in the posterior compartment were poor (ICC 0.41). The intraobserver repeatability for nodule size measurements was good for both operators (ICC ≥0.86). LIMITATIONS REASONS FOR CAUTION: Within this cohort, there was insufficient data to perform a separate analysis for nodule size in the anterior compartment. All examinations were performed within a specialised unit with a high prevalence of deep endometriosis. Our findings may not apply to operators without intensive ultrasound training in the diagnosis of pelvic endometriosis. WIDER IMPLICATIONS OF THE FINDINGS: These findings are important because ultrasound has been widely accepted as the first-line investigation for the diagnosis of pelvic endometriosis, which often determines the need for future investigations and treatment. The detection and measurement of bowel nodules is essential for anticipation of surgical risk and planning surgical excision. STUDY FUNDING/COMPETING INTERESTS: The authors have no conflict of interest. No funding was obtained for this work

Impact of Brown Midrib Trait on the Decomposition Rate of Sorghum-Sudangrass Residue in Pastures

Sorghum-sudangrass (Sorghum bicolor var. bicolor x bicolor var. sudanense) can provide high quality summer grazing. Some varieties possess the brown midrib (BMR) trait which results in reduced lignin resulting in higher digestibility and animal performance. If microbes in the rumen can digest BMR sorghum-sudangrass more completely, then soil macro/micro flora and fauna may do so as well. This could result in nutrients being returned to the soil faster from plants containing the BMR trait. The objective of this study was to determine the decomposition rate of BMR and non-BMR sorghumsudangrass. The experimental design was a random complete with four replications. Sorghum-sudangrass with and without the BMR trait was placed in litter decomposition bags as whole plants or divided into leaves and stems. A composite sample was taken when bags were loaded to determine initial dry matter. Loaded bags were then placed on the soil surface in a pasture and collected at 1, 2, 3, 4, 6, 8, 10, 12, 14, or 16 weeks after placement. Upon collection plant material was dried for 3-days at 55°C in a forced air oven. Dry weights at each collection date were subtracted from the initial dry weight to determine total DM loss. The BMR trait did not impact dry matter loss in the leaves. Stems possessing the BMR trait lost dry matter at a greater rate resulting in dry matter losses at 14 weeks of 78 and 68% and 59 and 47% for the BMR and non-BMR varieties in trials 1 and 2, respectively. Whole plants showed limited differences in dry matter loss at 14 weeks after placement

The availability and geographic location of open-source food composition data used to estimate micronutrient intakes in sub-Saharan Africa: A scoping review

Background Estimates of dietary micronutrient intakes rely on food composition data. The nutrient composition of foods varies spatially with potentially large effects on dietary micronutrient intakes. This review assessed the availability and geographic origin of five minerals (calcium, iron, iodine, selenium and zinc) in publicly available food composition tables/databases (FCTs) for use in sub-Saharan Africa (SSA). Methods A scoping review was conducted following PRISMA guidelines, in which four databases (MEDLINE, Embase, Global Health and Africa Wide Information) and four online resources were searched to identify published FCTs for use in SSA. Metadata were reviewed to identify the geographic origin of composition values for selected foods. Results Nineteen publicly available FCTs were identified, with the highest geographic coverage in Eastern Africa (45% of countries) and lowest coverage in Central Africa (12% of countries). Iodine and selenium were reported in four and six FCTs, respectively, while iron and calcium were included in ≥ 18 FCTs. More than 60% of nutrient values were borrowed from other FCTs. The geographic origin of 22% of mineral values were documented. Conclusions Limited local food composition analytical data is available, for estimating mineral intakes of SSA populations, with poor documentation of the data sources and the geographic origins of samples. New data structures and improved metadata are required to capture and report geographic information in publicly available FCTs, and to accommodate a new generation of spatially-resolved food composition data

Loss of constitutional heterozygosity on chromosomes 5 and 17 in cholangiocarcinoma.

It has been established that loss of tumour suppressor genes is crucial in carcinogenesis. There has been no reported study on searching for tumour suppressor genes in cholangiocarcinomas as yet. In order to investigate the loss of heterozygosity (LOH), which may represent such gene loss, in cholangiocarcinoma, we studied 14 patients with this tumour using restriction fragment length polymorphism analysis. Twenty-two probes assigned to chromosomes 1, 5, 7, 9, 11, 12, 13, 14, 16, 17 and 18 were used. Allelic losses were found in chromosomal regions 5q35-qter and 17p13. Loss of genetic material in these regions in cholangiocarcinoma was shared with hepatocellular carcinoma. Probes for other chromosomes have as yet shown no consistent LOH. In conclusion, this study for the first time showed LOH on chromosomes 5 and 17 in cholangiocarcinoma

Infrequent chromosome allele loss in fibrolamellar carcinoma.

As yet, there is no reported study of chromosome allele loss in fibrolamellar carcinoma (FLC), a distinct, rare variant of hepatocellular carcinoma (HCC). We searched for evidence of allele loss in FLC using 18 DNA probes for 10 chromosomes and compared the pattern of loss with our series of HCC. Two of the probes, lambda MS32 (1q42-43) and cMS621 (5p) showed allele losses in one tumour, while other probes showed no loss. The frequency of allele loss in FLC was much lower than in HCC, which may be associated with their different prognoses

GEO 600 and the GEO-HF upgrade program: successes and challenges

The German-British laser-interferometric gravitational wave detector GEO 600 is in its 14th year of operation since its first lock in 2001. After GEO 600 participated in science runs with other first-generation detectors, a program known as GEO-HF began in 2009. The goal was to improve the detector sensitivity at high frequencies, around 1 kHz and above, with technologically advanced yet minimally invasive upgrades. Simultaneously, the detector would record science quality data in between commissioning activities. As of early 2014, all of the planned upgrades have been carried out and sensitivity improvements of up to a factor of four at the high-frequency end of the observation band have been achieved. Besides science data collection, an experimental program is ongoing with the goal to further improve the sensitivity and evaluate future detector technologies. We summarize the results of the GEO-HF program to date and discuss its successes and challenges

Gupta-Bleuler quantization for minimally coupled scalar fields in de Sitter space

We present in this paper a fully covariant quantization of the minimally-coupled massless field on de Sitter space. We thus obtain a formalism free of any infrared (e.g logarithmic) divergence. Our method is based on a rigorous group theoretical approach combined with a suitable adaptation (Krein spaces) of the Wightman-G\"{a}rding axiomatic for massless fields (Gupta-Bleuler scheme). We make explicit the correspondence between unitary irreducible representations of the de Sitter group and the field theory on de Sitter space-time. The minimally-coupled massless field is associated with a representation which is the lowest term of the discrete series of unitary representations of the de Sitter group. In spite of the presence of negative norm modes in the theory, no negative energy can be measured: expressions as \le n_{k_1}n_{k_2}...|T_{00}|n_{k_1}n_{k_2}...\re are always positive.Comment: 20 pages, appear in class. quantum gra