Transvaginal-laparoscopic anterior rectum resection in a hysterectomized woman with deep-infiltrating endometriosis: Description of a gynecologic natural orifice transendoluminal surgery approach

Deep-infiltrating endometriosis may affect the vagina, the rectum, and the cervicoisthmic part of the uterus, resulting in severe pain, particularly dyschezia, dysmenorrhea, dyspareunia, and diminished quality of life. Advanced surgical techniques, such as laparoscopic-assisted anterior rectum resection, are recognized as safe and effective therapeutic approaches. In some cases, a laparotomy or minilaparotomy has to be performed for technical reasons. This can be avoided in some cases by transvaginal-laparoscopic low anterior rectum resection. The technique is a 4-step procedure, which can be described as follows: step 1 (vaginal) - rectovaginal examination, preparation of the rectovaginal septum, opening of the pouch of Douglas, mobilization of the endometriotic nodule and the rectum, temporary vaginal closure; step 2 (laparoscopic) - removal of additional endometriotic lesions, adhesiolysis, final mobilization of the rectum, mobilization of the rectosigmoid, endoscopic resection using an endoscopic stapler step 3 (vaginal) - transvaginal resection of the lesion, preparation of the oral anvil, closure of the vagina; and step 4 (laparoscopic) - endoscopic transanal stapler anastomosis and underwater rectoscopy, prophylaxis of adhesions, drainage. We used this procedure to treat a 46-year-old woman (gravida 2, para 2) who was admitted to our hospital for severe lower abdominal pain, constipation, dyspareunia, dyschezia, and cyclic rectal bleedings. The symptoms were caused by an endometriotic nodule accompanied by a palpable rectum stenosis. In addition, she reported a past abdominal hysterectomy with complications caused by symptomatic myomatous uterus. As a gynecologic natural orifice surgery approach, the transvaginal-laparoscopic anterior rectum resection may be an additional useful surgical technique that could be offered by surgical gynecologists to some women with deep-infiltrating endometriosis

The Relationship Between Galaxies and Low Redshift Weak Lyman alpha Absorbers in the Directions of H1821+643 and PG1116+215

To study the nature of low z Lya absorbers in the spectra of QSOs, we have obtained high signal-to-noise UV spectra of H 1821+643 (z = 0.297) and PG 1116+215 (z = 0.177) with the GHRS on the HST. The spectra have minimum S/N of 70-100 and 3 sigma limiting equivalent widths of 50-75 mA. We detect 26 Lya lines with Wr > 50 mA toward H1821+643 and 13 toward PG1116+215, which implies a density of 102+/-16 lines per unit redshift. The two-point correlation function shows marginal evidence of clustering on ~500 km/s scales, but only if the weakest lines are excluded. We have also used the WIYN Observatory to measure galaxy redshifts in the ~1 degree fields centered on each QSO. We find 17 galaxy-absorber pairs within projected distances of 1 Mpc with velocity separations of 350 km/s or less. Monte Carlo simulations show that if the Lya lines are randomly distributed, the probability of observing this many close pairs is 3.6e-5. We find that all galaxies with projected distances of 600 kpc or less have associated Lya absorbers within 1000 km/s, and the majority of these galaxies have absorbers within 350 km/s. We also find that the Lya equivalent width is anticorrelated with the projected distance of the nearest galaxy out to at least 600 kpc, but this should be interpreted cautiously because there are potential selection biases. Statistical tests using the entire sample also indicate that the absorbers are not randomly distributed. We discuss the nature of the Lya absorbers in light of the new data.Comment: Accepted for publication in ApJ. 17 pages plus 11 tables and 17 figure

The Low Redshift Lyman Alpha Forest in Cold Dark Matter Cosmologies

We study the physical origin of the low-redshift Lyman alpha forest in hydrodynamic simulations of four CDM cosmologies. Our main conclusions are insensitive to the cosmological model but depend on our assumption that the UV background declines at low redshift. We find that the expansion of the universe drives rapid evolution of dN/dz (the number of absorbers per unit z) at z > 1.7, but that at lower redshift the fading of the UV background counters the influence of expansion, leading to slow evolution. At every redshift, weaker lines come primarily from moderate fluctuations of the diffuse, unshocked IGM, and stronger lines originate in shocked or radiatively cooled gas of higher overdensity. However, the neutral hydrogen column density associated with structures of fixed overdensity drops as the universe expands, so an absorber at z = 0 is dynamically analogous to an absorber with neutral hydrogen column density 10 to 50 times higher at z = 2-3. We find no clear distinction between lines arising in "galaxy halos" and lines arising in larger scale structures; however, galaxies tend to lie near the dense regions of the IGM that produce strong Lyman alpha lines. The simulations provide a unified physical picture that accounts for the most distinctive observed properties of the low redshift Lyman alpha forest: (1) a sharp transition in the evolution of dN/dz at z ~ 1.7, (2) stronger evolution for absorbers of higher equivalent width, (3) a correlation of increasing Lyman alpha equivalent width with decreasing galaxy impact parameter, and (4) a tendency for stronger lines to arise in close proximity to galaxies while weaker lines trace more diffuse large scale structure. (Abridged)Comment: 57 pages, 18 figures, submitted to Ap

Cognitive conflicts in major depression : Between desired change and personal coherence

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposesThe notion of intrapsychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma (ID), and on a new way of identifying these conflicts by means of the Repertory Grid Technique. Our aim was to explore the relevance of cognitive conflicts among depressive patientsPeer reviewedFinal Published versio

Semi analytic approach to understanding the distribution of neutral hydrogen in the universe: Comparison of simulations with observations

Following Bi & Davidsen (1997), we perform one dimensional semi analytic simulations along the lines of sight to model the intergalactic medium (IGM). Since this procedure is computationally efficient in probing the parameter space -- and reasonably accurate -- we use it to recover the values of various parameters related to the IGM (for a fixed background cosmology) by comparing the model predictions with different observations. For the currently favoured LCDM model (\Omega_m=0.4, \Omega_{\Lambda}=0.6 and h=0.65), we obtain, using statistics obtained from the transmitted flux, constraints on (i) the combination f=(\Omega_B h^2)^2/J_{-12}, where \Omega_B is the baryonic density parameter and J_{-12} is the total photoionisation rate in units of 10^{-12} s^{-1}, (ii) temperature T_0 corresponding to the mean density and (iii) the slope \gamma of the effective equation of state of the IGM at a mean redshift z \simeq 2.5. We find that 0.8 <(T_0/10^4 K)< 2.5 and 1.3<\gamma<2.3. while the constraint obtained on f is 0.020^2<f<0.032^2. A reliable lower bound on J_{-12} can be used to put a lower bound on \Omega_B h^2, which can be compared with similar constraints obtained from Big Bang Nucleosynthesis (BBN) and CMBR studies. We find that if J_{-12}>1.2, the lower bound on \Omega_B h^2 is in violation of the BBN value.Comment: Revised version; accepted for publication in Ap

Large-scale structure in the Lyman-alpha forest II: analysis of a group of ten QSOs

The spatial distribution of Ly-alpha forest absorption systems towards ten QSOs has been analysed to search for large-scale structure over the redshift range 2.2 < z < 3.4. The QSOs form a closely spaced group on the sky and are concentrated within a 1 deg^2 field. We have employed a technique based on the first and second moments of the transmission probability density function which is capable of identifying and assessing the significance of regions of over- or underdense Ly-alpha absorption. We find evidence for large-scale structure in the distribution of Ly-alpha forest absorption at the > 99 per cent confidence level. In individual spectra we find overdense Ly-alpha absorption on scales of up to 1200 km s^-1. There is also strong evidence for correlated absorption across line of sight pairs separated by < 3 h^-1 proper Mpc (q_0 = 0.5). For larger separations the cross-correlation signal becomes progressively less significant.Comment: 15 pages, LaTeX, 6 Postscript figures, accepted for publication in MNRA

Leptin and Amylin Act in an Additive Manner to Activate Overlapping Signaling Pathways in Peripheral Tissues: In vitro and ex vivo studies in humans

OBJECTIVE: Amylin interacts with leptin to alter metabolism. We evaluated, for the first time, amylin- and/or leptin-activated signaling pathways in human peripheral tissues (hPTs). RESEARCH DESIGN AND METHODS: Leptin and amylin signaling studies were performed in vitro in human primary adipocytes (hPAs) and human peripheral blood mononuclear cells (hPBMCs) and ex vivo in human adipose tissue (hAT) from male versus female subjects, obese versus lean subjects, and subjects with subcutaneous versus omental adipose tissue. RESULTS: The long form of leptin receptor was expressed in human tissues and cells studied in ex vivo and in vitro, respectively. Leptin and amylin alone and in combination activate signal transducer and activator of transcription 3 (STAT3), AMP-activated protein kinase, Akt, and extracellular signal-regulated kinase signaling pathways in hAT ex vivo and hPAs and hPBMCs in vitro; all phosphorylation events were saturable at leptin and amylin concentrations of ∼50 and ∼20 ng/ml, respectively. The effects of leptin and amylin on STAT3 phosphorylation in hPAs and hPBMCs in vitro were totally abolished under endoplasmic reticulum stress and/or in the presence of a STAT3 inhibitor. Results similar to those in the in vitro studies were observed in hAT studied ex vivo. CONCLUSIONS: Leptin and amylin activate overlapping intracellular signaling pathways in humans and have additive, but not synergistic, effects in signaling pathways studied in hPTs in vitro and ex vivo

Δ-6 desaturase substrate competition : dietary linoleic acid (18∶2n-6) has only trivial effects on α-linolenic acid (18∶3n-3) bioconversion in the teleost rainbow trout

It is generally accepted that, in vertebrates, omega-3 (n-3) and omega-6 (n-6) poly-unsaturated fatty acids (PUFA) compete for ?-6 desaturase enzyme in order to be bioconverted into long-chain PUFA (LC-PUFA). However, recent studies into teleost fatty acid metabolism suggest that these metabolic processes may not conform entirely to what has been previously observed in mammals and other animal models. Recent work on rainbow trout has led us to question specifically if linoleic acid (LA, 18:2n-6) and ?-linolenic acid (ALA, 18:3n-3) (?-6 desaturase substrates) are in direct competition for access to ?-6 desaturase. Two experimental diets were formulated with fixed levels of ALA, while LA levels were varied (high and low) to examine if increased availability of LA would result in decreased bioconversion of ALA to its LC-PUFA products through substrate competition. No significant difference in ALA metabolism towards n-3 LC-PUFA was exhibited between diets while significant differences were observed in LA metabolism towards n-6 LC-PUFA. These results are evidence for minor if any competition between substrates for ?-6 desaturase, suggesting that, paradoxically, the activity of ?-6 desaturase on n-3 and n-6 substrates is independent. These results call for a paradigm shift in the way we approach teleost fatty acid metabolism. The findings are also important with regard to diet formulation in the aquaculture industry as they indicate that there should be no concern for possible substrate competition between 18:3n-3 and 18:2n-6, when aiming at increased n-3 LC-PUFA bioconversion in vivo