Poster 156 Musculoskeletal Injuries in Dancers

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147106/1/pmr2s223.pd

Poster 312 Efficacy of Combined Intra‐articular Facet Joint and Transforaminal Epidural Steroid Injection in the Management of Symptomatic Lumbosacral Lateral Recess Stenosis: A Retrospective Analysis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147060/1/pmr2s280a.pd

Approach to the Patient:Diagnostic Challenges in the Workup for Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) affects 10% to 13% of women globally. It is a condition with metabolic, reproductive, and psychological features, with health impacts across the lifespan. The etiology of PCOS is complex, with an interplay of several factors, including genetic and epigenetic susceptibility, androgen exposure in early life and adiposity-related dysfunction leading to hypothalamic-ovarian disturbance. Diagnosis is recommended based on the International PCOS Guideline criteria, with diagnosis confirmed in adults when 2 of out the following 3 criteria are met: (i) hyperandrogenism (clinical or biochemical); (ii) irregular cycles; and (iii) polycystic ovary morphology or elevated anti-Müllerian hormone (AMH) levels. With its clinical heterogeneity, distinct phenotypes, variation across the lifespan and ethnic variation, PCOS diagnosis can present significant diagnostic challenges to clinicians.</p

The additional value of ultrasound markers in the diagnosis of polycystic ovary syndrome

Objective: To study the value of current definitions for follicle number per ovary and ovarian volume in the diagnosis of polycystic ovary syndrome (PCOS). Design: Cross-sectional study. Subjects: Women diagnosed with PCOS after standardized screening were eligible for inclusion in the PCOS group. Women without PCOS who underwent the same screening, had regular menstrual cycles, normal hormonal values, and no other endocrine pathology were eligible for inclusion. Exposure: Not applicable. Main Outcome Measure(s): Follicle number per ovary and ovarian volume in women with PCOS, stratified by age. Linear regression models to investigate the influence of body mass index (BMI) on follicle number per ovary and ovarian volume. Differences in follicle number per ovary and ovarian volume between the PCOS phenotypes and the additional value of ovarian volume compared with follicle number per ovary. Result(s): A total of 2,492 women (16–50 years) with PCOS and 152 women without PCOS were included. Most women with PCOS up to age of 35 exhibit a follicle number per ovary ≥20 (87.8%–100%) (using an ultrasound transducer ≥8 MHz) or ≥12 (95.1%–98.6%) (using a transducer &lt;8 MHz), followed by a decline in follicle number per ovary &gt;35 years. Median ovarian volume was below the 10 mL cutoff in every age group, for both ultrasound transducers. Follicle number per ovary and ovarian volume were higher in women with PCOS compared with women without PCOS in every age category. In our cohort, 13/2,297 women with PCOS (0.6%) would not have received the diagnosis if ovarian volume was not considered a marker for polycystic ovarian morphology. For both ultrasound transducers, women with phenotype A (ovulatory dysfunction + hyperandrogenism + polycystic ovarian morphology) exhibited the highest follicle number per ovary and ovarian volume, followed by phenotype D (ovulatory dysfunction + polycystic ovarian morphology), then phenotype C (hyperandrogenism + polycystic ovarian morphology), and then phenotype B (ovulatory dysfunction + hyperandrogenism). No clinically significant correlation between BMI and follicle number per ovary or ovarian volume was observed. Conclusion(s): Criteria to define follicle number per ovary should be established per age category, as follicle number per ovary decreases with age. Ovarian volume shows a less clear decline with age and has a lower discriminative power, and therefore could be excluded from the diagnostic criteria. Follicle number per ovary does not need to be stratified by BMI.</p

Polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.Robert J Norman, Ruijin Wu and Marcin T Stankiewic

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Bone morphogenetic proteins and the polycystic ovary syndrome

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is defined by two out of the following three criteria being met: oligo- or anovulation, hyperandrogenism, and polycystic ovaries. Affected women are often obese and insulin resistant. Although the etiology is still unknown, members of the Transforming Growth Factor β (TGFβ) family, including Bone Morphogenetic Proteins (BMPs) and anti-Müllerian hormone (AMH), have been implicated to play a role. In this pilot study we aimed to measure serum BMP levels in PCOS patients. METHODS: Twenty patients, fulfilling the definition of PCOS according to the Rotterdam Criteria, were randomly selected. Serum BMP2, -4, -6 and −7 levels were measured using commercially available BMP2, BMP4, BMP6 and BMP7 immunoassays. RESULTS: Serum BMP2, serum BMP4 and serum BMP6 levels were undetectable. Three patients had detectable serum BMP7 levels, albeit at the lower limit of the standard curve. CONCLUSIONS: BMP levels were undetectable in almost all patients. This suggests that with the current sensitivity of the BMP assays, measurement of serum BMP levels is not suitable as a diagnostic tool for PCOS

European Consensus Statement on Expert Colposcopy

Peer reviewedPublisher PD

Investigation of Metallized and Nonmetallized Hydroxyl Terminated Polybutadiene/Hydrogen Peroxide Hybrid Rockets

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/77070/1/AIAA-22091-612.pd