Pregnancy incidence and outcome before and after cervical intraepithelial neoplasia: a retrospective cohort study

We performed a retrospective cohort study of 3530 women treated for cervical intraepithelial neoplasia (CIN) in Helsinki University Central Hospital, Finland, to investigate whether CIN treatment itself affects pregnancy incidence and outcome. We estimated the incidence of live births, miscarriages, extrauterine pregnancies, molar pregnancies, and termination of pregnancies (TOPs) before and after CIN treatment using nationwide registers. Women were followed up until death, emigration, sterilization, or the end of 2004. The comparison of incidence of pregnancy outcomes before and after the treatment was estimated by calculating hazard ratios (HRs) with conditional Poisson regression. After 76,162 woman-years of follow-up, the incidence of any pregnancy remained constant over CIN-treatment, HR 1.02 and 95% confidence interval (CI) 0.97-1.08, but the incidence of the first pregnancy was significantly elevated after treatment, HR 1.13, and 95% CI 1.03-1.23. The incidence of live births was significantly elevated after treatment, HR 1.08 and 95% CI 1.01-1.15. Incidence of miscarriages, TOPs, extrauterine pregnancies, and molar pregnancies was not elevated. TOPs was significantly increased in the first pregnancy, HR 1.40, 95% CI 1.15-1.72 and after treatment by the loop electrosurgical excision procedure (LEEP), HR 1.36, 95% CI 1.15-1.60. CIN treatment did not reduce pregnancy incidence and women had more live births after than before CIN treatment. TOPs was more common in the first pregnancy or after treatment by LEEP. We encourage research on the psychosocial consequences of CIN treatment also in other countries and settings

Low anti-Müllerian hormone level is not a risk factor for early pregnancy loss in IVF/ICSI treatment

STUDY QUESTION: Is a low ( SUMMARY ANSWER: A low or moderately low serum AMH level does not associate with miscarriage, non-visualized pregnancy loss or overall early pregnancy loss rate in the IVF/ICSI treatment. WHAT IS KNOWN ALREADY: Low AMH predicts poor ovarian response and small oocyte yield in IVF/ICSI treatment, but its value in the evaluation of live birth rate (LBR) is modest Little is known about the risk of early pregnancy loss in ART among women with low AMH. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study on 1383 women undergoing their first oocyte retrieval for IVF/ICSI in Helsinki University Hospital in Helsinki, Finland, between 2012 and 2016, with all associated fresh (n = 1315) and frozen-thawed (n = 1418) ET cycles finished by August 2018. AMH was measured within 12 months before the IVF/ICSI stimulation. PARTICIPANTS/MATERIALS, SETTING, METHODS: Of all the women, 235 (17.0%) had low (= 2.0 mu g/L) AMH. The primary outcomes were miscarriage, non-visualized pregnancy loss and early pregnancy loss (miscarriage and non-visualized pregnancy loss combined) after fresh or frozen-thawed ET. The impact of AMH on these outcomes was calculated in three populations: among all women who became pregnant, among women with AMH MAIN RESULTS AND THE ROLE OF CHANCE: Of 1123 pregnancies, 285 (25.4%) ended in non-visualized pregnancy loss and 143 (12.7%) in miscarriage. The LBR was 24.6% per ET (673/2733). Low or moderately low AMH, compared with normal AMH, did not associate with miscarriage or non-visualized pregnancy loss in analyses among all women who became pregnant (adjusted relative risk (RR) for miscarriage vs live birth, 0.70 and 95% CI 0.42-1.17 in low AMH and adjusted RR, 1.00 and 95% CI, 0.68-1.49 in moderately low AMH; adjusted RR for non-visualized pregnancy loss vs live birth, 0.90 and 95% CI, 0.65-1.23 in low AMH and adjusted RR, 1.09 and 95% CI 0.85-1.41 in moderately low AMH), nor did low or moderately low AMH associate with the overall early pregnancy loss rate (adjusted RR for early pregnancy loss vs live birth, 0.86 and 95% CI, 0.68-1.10 in low AMH and adjusted RR, 1.01 and 95% CI, 0.86-1.27 in moderately low AMH). Results remained similar after restricting the analysis to women with AMH LIMITATIONS, REASONS FOR CAUTION: The number of miscarriages in women with low AMH was moderately small, limiting the power of the study. The real-world clinical setting of the study restricted the ability to control for all factors causing selection bias. WIDER IMPLICATIONS OF THE FINDINGS: The cLBR was higher among women with normal AMH than among women with low or moderately low AMH in their first IVF/ICSI treatment because these women had more oocytes and embryos. Women with low or moderately low AMH did not have an increased risk for early pregnancy loss. This information is reassuring for couples and useful in counseling. These results are also valuable when assessing the overall effectiveness of IVF/ICSI treatment.Peer reviewe

The Emotional and Political Power of Images of Suffering: Discursive Psychology and the Study of Visual Rhetoric

Drawing on insights from discursive and rhetorical approaches in psychology, the chapter examines responses to the publication of the photographs of the body of Alan Kurdi, the three-year-old Syrian refugee who drowned off the coast of Turkey in 2015. The chapter considers how and why the images were constructed as inherently ‘moving’, and as possessing the power to elicit emotions, and affect the audience on a ‘visceral’ level. It also looks at how accounts of (and for) emotional reactions to the images were deployed rhetorically to manage accountability associated with viewing, and sharing, images of a dead child. Through the examination of the Kurdi images the chapter also considers the possibility of a psychologically-informed approach to visual rhetoric, one that offers a better understanding of how and why certain images (but not others) are constituted as topics of humanitarian concern, and a source of emotional and political investment

Stromal Fibroblasts in Digestive Cancer

The normal gastrointestinal stroma consists of extra-cellular matrix and a community of stromal cells including fibroblasts, myofibroblasts, smooth muscle cells, pericytes, endothelium and inflammatory cells. α-smooth muscle actin (α-SMA) positive stromal fibroblasts, often referred to as myofibroblasts or activated fibroblasts, are critical in the development of digestive cancer and help to create an environment that is permissive of tumor growth, angiogenesis and invasion. This review focusses on the contribution of activated fibroblasts in carcinogenesis and where possible directly applies this to, and draws on examples from, gastrointestinal cancer. In particular, the review expands on the definition, types and origins of activated fibroblasts. It examines the molecular biology of stromal fibroblasts and their contribution to the peritumoral microenvironment and concludes by exploring some of the potential clinical applications of this exciting branch of cancer research. Understanding the origin and biology of activated fibroblasts will help in the development of an integrated epithelial-stromal sequence to cancer that will ultimately inform cancer pathogenesis, natural history and future therapeutics

Bem-morar em São Paulo, 1880-1910: Ramos de Azevedo e os modelos europeus

Domestic architecture achieves a great impulse in the second half of XIXth-century. From Europe to the whole world, models are conformed to the new social order and spread as industrialization takes command. Dwelling becomes the main concern among architects. New concepts are developed for the ideal house for 011 social strata: working class, middle-class, bourgeoisie. This essay traces the introduction in São Paulo of European formal patterns and principies Ihygiene, salubrity, comfort, social and domestic rites, social visibility) through the activity of F. P. Ramos de Azevedo! 1851-19281. The main projects he conceived for the local bourgeoisie are analysed.A arquitetura doméstica tem um grande impulso no século XIX. Da Europa são difundidos, para todo mundo, os modelos conformados à nova ordem social e à industrialização. A residência se transforma numa preocupação central dos arquitetos. Desenvolvem-se novos conceitos para casa ideal para todas as camadas sociais: operários, classe média, burguesia. Este artigo retrata, em São Paulo, a introdução de padrões formais e princípios (de higiene, salubridade, conforto, ritos sociais e domésticos, as aparências). a partir da atividade de F. P. Ramos de Azevedo (1851-19201. Analisam-se os principais projetos que ele desenvolveu para a burguesia local

A Synthesis of Tagging Studies Examining the Behaviour and Survival of Anadromous Salmonids in Marine Environments

This paper synthesizes tagging studies to highlight the current state of knowledge concerning the behaviour and survival of anadromous salmonids in the marine environment. Scientific literature was reviewed to quantify the number and type of studies that have investigated behaviour and survival of anadromous forms of Pacific salmon (Oncorhynchus spp.), Atlantic salmon (Salmo salar), brown trout (Salmo trutta), steelhead (Oncorhynchus mykiss), and cutthroat trout (Oncorhynchus clarkii). We examined three categories of tags including electronic (e.g. acoustic, radio, archival), passive (e.g. external marks, Carlin, coded wire, passive integrated transponder [PIT]), and biological (e.g. otolith, genetic, scale, parasites). Based on 207 papers, survival rates and behaviour in marine environments were found to be extremely variable spatially and temporally, with some of the most influential factors being temperature, population, physiological state, and fish size. Salmonids at all life stages were consistently found to swim at an average speed of approximately one body length per second, which likely corresponds with the speed at which transport costs are minimal. We found that there is relatively little research conducted on open-ocean migrating salmonids, and some species (e.g. masu [O. masou] and amago [O. rhodurus]) are underrepresented in the literature. The most common forms of tagging used across life stages were various forms of external tags, coded wire tags, and acoustic tags, however, the majority of studies did not measure tagging/handling effects on the fish, tag loss/failure, or tag detection probabilities when estimating survival. Through the interdisciplinary application of existing and novel technologies, future research examining the behaviour and survival of anadromous salmonids could incorporate important drivers such as oceanography, tagging/handling effects, predation, and physiology

From the geopolitics of oil and gas to the geopolitics of the energy transition: Is there a role for European supermajors?

The energy transition is changing the corporate positioning of European international oil companies (IOCs). Developments such as Russia's invasion of Ukraine in 2022 and the gas market volatility of 2021 have brought energy geopolitics to the fore and further complicated the landscape in which these companies operate. By combining data from literature and semi-structured interviews with key experts, this work explores how the influence of the European IOCs on the geopolitics of oil, gas, and renewable energy sources might evolve in the transition. We find that European IOCs continue to have geopolitical influence, but it has been diminished by the rise of national oil companies. If fossil fuels are phased down globally, the reduction in oil activities of these companies is likely to further reduce their geopolitical power. While European IOCs may continue to be active in the gas market, this is unlikely to render them significant geopolitical influence given that they may become common rather than dominant market players. The same is true for the IOCs' role in renewable energy markets, although here European IOCs may seek to gain more influence by becoming significant intermediaries and global experts. As the energy transition progresses, many experts expect the political and market landscape around energy to become more fragmented, reducing the overall geopolitical influence of IOCs. Recent events such as the war in Ukraine do not change the overall conclusions, although it remains to be seen whether they will slow down or speed up the IOCs' involvement in the energy transition