The management of menopause in women with a history of endometriosis: a systematic review

BACKGROUND Endometriosis is typically regarded as a premenopausal disease, resolving after natural or iatrogenic menopause due to declining oestrogen levels. Nonetheless, case reports over the years have highlighted the incidence of recurrent postmenopausal endometriosis. It is now clear that both recurrence and malignant transformation of endometriotic foci can occur in the postmenopausal period. Postmenopausal women are commonly treated with hormone replacement therapy (HRT) to treat climacteric symptoms and prevent bone loss; however, HRT may reactivate endometriosis and stimulate malignant transformation in women with a history of endometriosis. Given the uncertain risks of initiating HRT, it is difficult to determine the best menopausal management for this group of women. OBJECTIVE AND RATIONAL The aim of this study was to systematically review the existing literature on management of menopausal symptoms in women with a history of endometriosis. We also aimed to evaluate the published literature on the risks associated with HRT in these women, and details regarding optimal formulations and timing (i.e. initiation and duration) of HRT. SEARCH METHODS Four electronic databases (MEDLINE via OVID, Embase via OVID, PsycINFO via OVID and CINAHL via EbscoHost) were searched from database inception until June 2016, using a combination of relevant controlled vocabulary terms and free-text terms related to ‘menopause’ and ‘endometriosis’. Inclusion criteria were: menopausal women with a history of endometriosis and menopausal treatment including HRT or other preparations. Case reports/series, observational studies and clinical trials were included. Narrative review articles, organizational guidelines and conference abstracts were excluded, as were studies that did not report on any form of menopausal management. Articles were assessed for risk of bias and quality using GRADE criteria. OUTCOMES We present a synthesis of the existing case reports of endometriosis recurrence or malignant transformation in women undergoing treatment for menopausal symptoms. We highlight common presenting symptoms, potential risk factors and outcomes amongst the studies. Sparse high-quality evidence was identified, with few observational studies and only two randomized controlled trials. Given this paucity of data, no definitive conclusions can be drawn concerning risk. WIDER IMPLICATIONS Due to the lack of high-quality studies, it remains unclear how to advise women with a history of endometriosis regarding the management of menopausal symptoms. The absolute risk of disease recurrence and malignant transformation cannot be quantified, and the impact of HRT use on these outcomes is not known. Multicentre randomized trials or large observational studies are urgently needed to inform clinicians and patients alike

Is the time right for a new initiative in mathematical modeling of the lower urinary tract? ICI-RS 2023.

INTRODUCTION A session at the 2023 International Consultation on Incontinence - Research Society (ICI-RS) held in Bristol, UK, focused on the question: Is the time right for a new initiative in mathematical modeling of the lower urinary tract (LUT)? The LUT is a complex system, comprising various synergetic components (i.e., bladder, urethra, neural control), each with its own dynamic functioning and high interindividual variability. This has led to a variety of different types of models for different purposes, each with advantages and disadvantages. METHODS When addressing the LUT, the modeling approach should be selected and sized according to the specific purpose, the targeted level of detail, and the available computational resources. Four areas were selected as examples to discuss: utility of nomograms in clinical use, value of fluid mechanical modeling, applications of models to simplify urodynamics, and utility of statistical models. RESULTS A brief literature review is provided along with discussion of the merits of different types of models for different applications. Remaining research questions are provided. CONCLUSIONS Inadequacies in current (outdated) models of the LUT as well as recent advances in computing power (e.g., quantum computing) and methods (e.g., artificial intelligence/machine learning), would dictate that the answer is an emphatic "Yes, the time is right for a new initiative in mathematical modeling of the LUT.

Laws of war and military criminal law: from ancient greek world to the contemporary military criminal code

The research for the existence of the rules that restrain the violence of war within the framework of daily life in the ancient Greek world – connected more specifically with the military preparation and the martial activity of the citizen-warriors (hoplites) of the ancient Greek city-state – is the basic subject of this paper, in which is attempted a total recording of the evolution that led to the development of the rules which are related to the military criminal law, and generally the law of armed conflicts, with focus mainly on the years of classical antiquity. Methodologically a historical review of the institutions of Greek world precedes, from the beginning of historical time, with focus on the information relative to the military organization and martial customs of ancient Greek societies, which quotes many examples from ancient Greek sources. Then the related contemporary rules of international humanitarian law and military criminal law are mentioned, as well as the view related to the topic of intellectuals of Greece, such as historians, poets and philosophers. In conclusion, it is recorded that written laws had been established for the regulation of military obligations of the Greek hoplites. However, these laws were not extended to the regulation of behavior of belligerents at the duration of hostilities. Despite of that, the Greeks had accomplished in placing restrictions on the violence of war, which received concrete form in the framework of common laws of Greeks, in other words their customary law, that law was shaped from their martial traditions, from time immemorial, that found their first written expression in Homeric epics which constituted the more basic tool of education of young men in the entire ancient Greek world, thus achieving the shaping of a common martial culture among Greek and crystallizing the prevailed opinions of the Greeks about the vital subjects of war and peace.Η διερεύνηση ύπαρξης κανόνων περιοριστικών της βίας του πολέμου, εντός των πλαισίων ρύθμισης της καθημερινής ζωής την αρχαία Ελλάδα, της συνδεόμενης. Ειδικότερα με τη στρατιωτική προετοιμασία και την πολεμική δραστηριότητα των πολιτών-οπλιτών τη αρχαιοελληνικής πόλης-κράτους, αποτελεί το βασικό αντικείμενο της διατριβής, στην οποία επιχειρείται μια συνολική καταγραφή της εξελικτικής διαδρομής που οδήγησε στη διαμόρφωση κανόνων δικαίου σχετιζόμενων με το στρατιωτικό ποινικό δίκαιο και το δίκαιο των ένοπλων συγκρούσεων γενικότερα, με εστίαση κυρίως στα χρόνια της κλασικής αρχαιότητας. Μεθοδολογικά, προηγείται μια ιστορική κατά βάσιν επισκόπηση των θεσμών του ελληνικού κόσμου, από τις απαρχές του ιστορικού χρόνου, με ιδιαίτερη έμφαση στις πληροφορίες τις σχετικές με τη στρατιωτική οργάνωση και τα πολεμικά ήθη των εξεταζόμενων αρχαιοελληνικών κοινωνιών, με παράθεση πλήθους παραδειγμάτων από τις πηγές. Στη συνέχεια παρατίθενται οι σύγχρονοι σχετικοί κανόνες του διεθνούς ανθρωπιστικού δικαίου των ένοπλων συγκρούσεων και του στρατιωτικού ποινικού δικαίου, ενώ έγινε επίσης προσπάθεια να εξεταστούν οι σχετικές με το ζήτημα θέσεις των πνευματικών ανθρώπων της Ελλάδας, ποιητές, ιστορικούς και φιλοσόφους. Συμπερασματικά καταγράφεται ότι γραπτοί νόμοι είχαν θεσπιστεί για τη ρύθμιση των στρατιωτικών υποχρεώσεων των πολιτών-οπλιτών, οι οποίοι δεν επεκτείνονταν στην ρύθμιση τα συμπεριφοράς των εμπόλεμων κατά τη διάρκεια των εχθροπραξιών, αφού η τελευταία ρυθμιζόταν από του «κοινούς νόμους των Ελλήνων», το εθιμικό δηλαδή, δίκαιο, το διαμορφωμένο από τις προαιώνιες πολεμικές παραδόσεις, οι οποίες βρήκαν την πρώτη γραπτή τους έκφραση στα ομηρικά έπη τα οποία επέτυχαν τη διαμόρφωση μιας κοινής πολεμικής κουλτούρας μεταξύ των Ελλήνων, απεικονίζοντας το ήθος του Έλληνα πολεμιστή και αποκρυσταλλώνοντας τις επικρατούσες αρχαιοελληνικές απόψεις γύρω από τα σημαντικά θέματα του πολέμου και της ειρήνης