A polymorphism in a let-7 microRNA binding site of KRAS in women with endometriosis.

Endometriosis is found in 5-15% of women of reproductive age and is more frequent in relatives of women with the disease. Activation of KRAS results in de novo endometriosis in mice, however, activating KRAS mutations have not been identified in women. We screened 150 women with endometriosis for a polymorphism in a let-7 microRNA (miRNA) binding site in the 3'-UTR of KRAS and detected a KRAS variant allele in 31% of women with endometriosis as opposed to 5% of a large diverse control population. KRAS mRNA and protein expression were increased in cultured endometrial stromal cells of women with the KRAS variant. Increased KRAS protein was due to altered miRNA binding as demonstrated in reporter assays. Endometrial stromal cells from women with the KRAS variant showed increased proliferation and invasion. In a murine model, endometrial xenografts containing the KRAS variant demonstrated increased proliferation and decreased progesterone receptor levels. These findings suggest that an inherited polymorphism of a let-7 miRNA binding site in KRAS leads to abnormal endometrial growth and endometriosis. The LCS6 polymorphism is the first described genetic marker of endometriosis risk

Efficiency of developing renewable energy market in Russia

The goal of this study is to systematize and provide a quantitative and qualitative assessment of potential positive economic and non-economic effects of the implementation of a new mechanism for supporting renewable energy in Russia. It should result in achieving the national medium-term objective to increase the share of renewable energy in the wholesale electricity and capacity market to 2.5 % by 2024. The introduction examines the mechanism for supporting the generators of renewable energy by capacity charge in the wholesale electricity and capacity market. It is assumed that the main positive effects from implementing this mechanism will be the replacement of hydrocarbon fuels burned for generating the electricity in traditional coal or gas power plants; improvement in the trade balance; multiplier effects from the development of RES in related industrial sectors, new value added and jobs in the sectors producing the generating and auxiliary equipment for generators; reduction of carbon dioxide emissions; decrease in average prices in the wholesale electricity market; reduction of expenditure on environmental activities and measures to protect the health in the territories with traditional power plants; additional scal charges. As a result, the quantification of these effects amounts to 47.77 billion rubles in 2024. The authors rely on the experience of foreign countries, expert estimates, forecasts by the Russian Ministry of Energy and the Ministry of Economic Development, research by the Russian Energy Agency, International Energy Agency, International Renewable Energy Agency, Community for Renewable Energy Policy in the 21st Century (REN21), statistics of Russian Federal State Statistics Service

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Cesarean Scar Pregnancy: A Three-Year Experience at Yale-New Haven Hospital [2N]

INTRODUCTION:The incidence of cesarean scar pregnancy (CSP) is rising along with the cesarean delivery rate. Data on the optimal management of the CSP are limited. METHODS:This is a series of all CSP cases diagnosed over the period 5/2013–8/2016 at Yale-New Haven Hospital. Data were collected retrospectively and prospectively from electronic medical records with approval from the Institutional Review Board. RESULTS:Sixteen cases of CSP were diagnosed in 14 patients, including 2 recurrences. Median number of prior cesarean deliveries was 3 (SD 0.98). Median gestational age at time of diagnosis was 45.5 days (6+3/7 weeks) (SD 11). Fetal cardiac activity was detected in 10 cases. Three patients had spontaneous demise of the CSP and were managed expectantly. Others opted for termination via systemic methotrexate alone (n=4); combined systemic/local methotrexate (n=5); systemic/local methotrexate with bilateral uterine artery embolization (n=1); systemic/local methotrexate with intra-sac KCl injection (n=2); and KCl injection with laparotomy and wedge resection (n=1). Three patients who underwent expectant management or methotrexate therapy had retained products of conception diagnosed 48, 61 and 82 days after initial diagnosis that required hysteroscopy and curettage. One patient opted for hysterectomy after curettage for definitive management. Three patients spontaneously conceived after resolution of CSP. Two patients had recurrences that were managed with methotrexate therapy. One patient has an ongoing viable intrauterine gestation. CONCLUSION:This case series highlights the risk of complications associated with expectant management and methotrexate therapy, and demonstrates the potential for spontaneous conception following CSP

Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman

Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike

Endometrial Carcinoma in a 26-Year-Old Patient with Bardet-Biedl Syndrome

Background. Bardet-Biedl Syndrome (BBS) is a rare genetic condition characterized by cognitive impairment, dysmorphism, central obesity, and diabetes mellitus, among other abnormalities. Although some of these characteristics are known independent risk factors for endometrial cancer and its precursors, the association between BBS and endometrial cancer is underreported. Case. We present the case of a 26-year-old patient with BBS and clinical signs of hyperestrogenism who presented with abnormal uterine bleeding and was diagnosed with endometrioid adenocarcinoma. She ultimately underwent definitive surgical treatment with hysterectomy and bilateral salpingectomy. Conclusions. This is one of only a few reports in the literature describing the association of BBS and endometrioid endometrial adenocarcinoma. Given the association of BBS with risk factors for hyperestrogenism such as truncal obesity, hyperinsulinemia, and ovulatory dysfunction, providers should have increased suspicion for endometrial cancer in young patients with BBS and abnormal uterine bleeding