277 research outputs found
Advantages of Laparoscopy Versus Laparotomy in Extremely Obese Women (BMI>35) with Early-stage Endometrial Cancer: A Multicenter Study.
Influence of body lesion severity on oxidative status and gut microbiota of weaned pigs
Body lesions in pigs are a common welfare concern, particularly during the weaning period. These lesions can lead to pain, infection, and impaired mobility, resulting in reduced growth performance and increased mortality. Moreover, weaning stress can affect gut microbiota, immune response and increase the oxidative stress of piglets during this transition period. It has been hypothesised that social stress and body lesions could contribute to affect the gut microbiota, physiological and immune response of piglets. The study aims to evaluate the impact of the body lesions due to social stress on microbial profile, immune response, and oxidative status of weaned piglets. Lesion score (LS) on skin, tail, ear, neck, middle trunk, and hind quarters was measured 1 week (28 days of age, T1) and 7 weeks postweaning (T2) on 45 tail-docked pigs according to the method suggested from the Walfer QualityÂź (2009) on a scale from 0 to 2. Based on the LS, at T1, piglets were classified as High LS (n = 16), when LS was >1 in at least two of the areas considered, or Low LS (n = 29). At T2, based on the same scoring system and to the LS observed at T1, piglets were divided into four groups: High to Low LS (H-L, n = 11), High to High LS (H-H, n = 5), Low to Low LS (L-L, n = 21) and Low to High LS (L-H, n = 8). Blood and faecal samples were collected at T1 and T2. At T1, pigs with a high LS had a lower biological antioxidant potential compared with the L group (P < 0.02). At T2, the L-H group had a lower Reactive Oxygen Metabolites concentration compared with the H-H group (P = 0.03) while the L-L group had a lower concentration of Immunoglobulin A compared with H-H and L-H groups (P = 0.02 and P = 0.04, respectively). At T1, piglets with high LS had a different microbiota compared to piglets with low LS (R2 = 0.04, P < 0.01). Low LS pigs were characterised by a higher abundance of Firmicutes, Blautia, Eubacterium coprostanoligenes, Faecalibacterium, Megasphaera, Subdoligranulum (P.adj < 0.05), while pigs with high LS were characterised by higher abundance of Bacteroidota, Rikenellaceae RC9, Prevotellaceae UCG-003, uncultured-Lachnospiraceae and uncultured-Oscillospiraceae (P.adj < 0.05). At T2, the H-H group were characterised by Oscillospirales-UCG-010, H-L by Agatobachter and L-L by Alloprevotella (P.adj < 0.05). Overall, this study provides valuable insights into the relationship between body lesions, oxidative stress, and gut microbiota in weaned pigs
Contemporary surgical practice in the management of anal fistula: results from an international survey
Background Management of anal fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons. Methods An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques. Results In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), ageââ„â40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeonsâ experience. Only 1â4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohnâs disease. Conclusions Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers
Pituitary block with gonadotrophin-releasing hormone antagonist during intrauterine insemination cycles: a systematic review and meta-analysis of randomised controlled trials
BACKGROUND:
Several randomised controlled trials (RCTs) have investigated the usefulness of pituitary block with gonadotrophin-releasing hormone (GnRH) antagonists during intrauterine insemination (IUI) cycles, with conflicting results.
OBJECTIVE:
The aim of the present systematic review and meta-analysis of RCTs was to evaluate the effectiveness of GnRH antagonist administration as an intervention to improve the success of IUI cycles.
SEARCH STRATEGY:
Electronic databases (MEDLINE, Scopus, EMBASE, Sciencedirect) and clinical registers were searched from their inception until October 2017.
SELECTION CRITERIA:
Randomised controlled trials of infertile women undergoing one or more IUI stimulated cycles with GnRH antagonists compared with a control group.
DATA COLLECTION AND ANALYSIS:
The primary outcomes were ongoing pregnancy/live birth rate (OPR/LBR) and clinical pregnancy rate (CPR). Pooled results were expressed as odds ratio (OR) or mean differences with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. The body of evidence was rated using GRADE methodology. Publication bias was assessed with funnel plot, Begg's and Egger's tests.
MAIN RESULTS:
Fifteen RCTs were included (3253 IUI cycles, 2345 participants). No differences in OPR/LBR (OR 1.14, 95% CI 0.82-1.57, P = 0.44) and CPR (OR 1.28, 95% CI 0.97-1.69, P = 0.08) were found. Sensitivity and subgroup analyses did not provide statistical changes in pooled results. The body of evidence was rated as low (GRADE 2/4). No publication bias was detected.
CONCLUSION:
Pituitary block with GnRH antagonists does not improve OPR/LBR and CPR in women undergoing IUI cycles.
TWEETABLE ABSTRACT:
Pituitary block with GnRH antagonists does not improve the success of IUI cycles
Atomic-layer deposited thulium oxide as a passivation layer on germanium
A comprehensive study of atomic-layer deposited thulium oxide (Tm2O3) on germanium has been conducted using x-ray photoelectron spectroscopy (XPS), vacuum ultra-violet variable angle spectroscopic ellipsometry, high-resolution transmission electron microscopy (HRTEM), and electron energy-loss spectroscopy. The valence band offset is found to be 3.05â±â0.2âeV for Tm2O3/p-Ge from the Tm 4d centroid and Ge 3p3/2 charge-corrected XPS core-level spectra taken at different sputtering times of a single bulk thulium oxide sample. A negligible downward band bending of âŒ0.12âeV is observed during progressive differential charging of Tm 4d peaks. The optical band gap is estimated from the absorption edge and found to be 5.77âeV with an apparent Urbach tail signifying band gap tailing at âŒ5.3âeV. The latter has been correlated to HRTEM and electron diffraction results corroborating the polycrystalline nature of the Tm2O3 films. The Tm2O3/Ge interface is found to be rather atomically abrupt with sub-nanometer thickness. In addition, the band line-up of reference GeO2/n-Ge stacks obtained by thermal oxidation has been discussed and derived. The observed low reactivity of thulium oxide on germanium as well as the high effective barriers for holes (âŒ3âeV) and electrons (âŒ2âeV) identify Tm2O3 as a strong contender for interfacial layer engineering in future generations of scaled high-Îș gate stacks on Ge
Interface Engineering Routes for a Future CMOS Ge-based Technology
We present an overview study of two germanium interface engineering routes, firstly a germanate formation via La2O3 and Y2O3, and secondly a barrier layer approach using Al2O3 and Tm2O3. The interfacial composition, uniformity, thickness, band gap, crystallinity, absorption features and valence band offset are determined using X-ray photoelectron spectroscopy, ultra violet variable angle spectroscopic ellipsometry, and high resolution transmission electron microscopy. The correlation of these results with electrical characterization data make a case for Ge interface engineering with rare-earth inclusion as a viable route to achieve high performance Ge CMOS.</jats:p
Clinical implementation of the hysteroscopic morcellator for removal of intrauterine myomas and polyps. A retrospective descriptive study
The aim of this study is to report our experience with a novel technique, the hysteroscopic morcellator (HM), for removal of intrauterine myomas and polyps. We performed a retrospective study on 315 women undergoing operative hysteroscopy with the HM in our university-affiliated teaching hospital. We collected data on installation and operating times, fluid deficit, peri- and postoperative complications. In 37 patients undergoing myomectomy with the HM, mean installation time was 8.7 min, mean operating time, 18.2 min, and median fluid deficit, 440 mL. Three out of 37 HM procedures were converted to resectoscopy, related to a type 2 myoma. In 278 patients, mean installation and operating times for polypectomy with the HM were 7.3 min and 6.6 min, respectively. All procedures were uneventful. Implementation of the HM for removal of type 0 and 1 myomas â€3 cm, and removal of polyps appears safe and effective
CYBRD1 as a modifier gene that modulates iron phenotype in HFE p.C282Y homozygous patients
Background. Most patients with Hereditary Hemochromatosis are homozygous for the p.C282Y mutation in the HFE gene in Caucasian population. Penetrance and expression of Hemochromatosis largely differ in p.C282Y homozygous cases. Besides environmental factors, genetic factors might be implicated.
Design and Methods. In the present study, we analysed 50 candidate genes involved in iron metabolism and evaluated the association between 214 single nucleotide polymorphisms in these genes and three phenotypic outcomes of iron overload (serum ferritin, iron removed and transferrin saturation) in a large group of 296 Italian p.C282Y homozygous cases. Polymorphisms were tested for genetic association with each single outcome using linear regression models adjusted for age, sex and alcohol consumption.
Results. We found a series of 17 genetic variants located in different genes with possible additive effect on the studied outcomes. In order to evaluate if the selected polymorphisms could provide a predictive signature for adverse phenotype, we re-evaluated data by dividing patients in two extreme phenotype classes based on the three phenotypic outcomes. We found that only a small improvement in prediction can be achieved adding genetic information to clinical data. Among the selected polymorphisms, a significant association between rs3806562, located in the 5\u2019UTR of CYBRD1, and transferrin saturation was observed. This variant belongs to the same haplotype block which contains the CYBRD1 polymorphism rs884409, found to be associated with serum ferritin in another population of p.C282Y homozygotes, and able to modulate promoter activity. Luciferase assay indicates that rs3806562 has not a significant functional role, suggesting that it is a genetic marker linked to the putative genetic modifier rs884409.
Conclusions. While our results support the hypothesis that polymorphisms in genes regulating iron metabolism may modulate penetrance of HFE-HH, with emphasis on CYBRD1, they strengthen the notion that none of these polymorphisms alone is a major modifier of HH phenotype
Current practice in the removal of benign endometrial polyps: a Dutch survey
The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) pâ<â0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), pâ<â0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), pâ<â0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), pâ<â0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands
- âŠ