Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women

<p>Abstract</p> <p>Background</p> <p>In 2009 the Uterine Bleeding and Pain Women's Research Study (UBP-WRS) was conducted interviewing 21,479 women across 8 countries in order to gain patient-based prevalence data on uterine pain and bleeding indications and investigate uterine symptoms and women's treatment experiences. This article shows relevant results of the study for the indication uterine fibroids providing data on self-reported prevalence, symptomatology and management of uterine fibroids.</p> <p>Methods</p> <p>2,500 women (USA: 4,500 women) in each country (Brazil, Canada, France, Germany, Italy, South Korea, the UK, the USA) completed an online survey. Women included were in their reproductive age (age group 15-49 years; USA: 18-49 years) and had ever experienced menstrual bleedings. Quotas were applied for age, region, level of education and household income of respondents. Variables have been analyzed descriptively and exploratory statistical tests have been performed.</p> <p>Results</p> <p>The self-reported prevalence of uterine fibroids ranged from 4.5% (UK) to 9.8% (Italy), reaching 9.4% (UK) to 17.8% (Italy) in the age group of 40-49 years. Women with a diagnosis of uterine fibroids reported significantly more often about bleeding symptoms than women without a diagnosis: heavy bleedings (59.8% vs. 37.4%), prolonged bleedings (37.3% vs. 15.6%), bleeding between periods (33.3% vs. 13.5%), frequent periods (28.4% vs. 15.2%), irregular and predictable periods (36.3% vs. 23.9%). Furthermore women with diagnosed uterine fibroids reported significantly more often about the following pain symptoms: pressure on the bladder (32.6% vs. 15.0%), chronic pelvic pain (14.5% vs. 2.9%), painful sexual intercourse (23.5% vs. 9.1%) and pain occurring mid-cycle, after and during menstrual bleeding (31.3%, 16.7%, 59.7%, vs. 17.1%, 6.4%, 52.0%). 53.7% of women reported that their symptoms had a negative impact on their life in the last 12 month, influencing their sexual life (42.9%), performance at work (27.7%) and relationship & family (27.2%).</p> <p>Conclusions</p> <p>Uterine fibroid is a common concern in women at fertile age causing multiple bleeding and pain symptoms which can have a negative impact on different aspects in women's life.</p

Нормалізація крововтрати у жінок з інтенсивними менструальними кровотечами, які отримували оральні контрацептиви, що містять естрадіолу валерат/дієногест

The study was conducted to assess the efficacy of estradiol valerate/dienogest (E₂V/DNG) administered using an estrogen step-down and progestogen stepup approach in a 28-day regimen in the treatment of heavy menstrual bleeding (HMB) using clinical end points allowing E₂V/DNG to be compared with other available medical therapies. This was a pooled analysis of data from two identically designed randomized, placebo-controlled, multiple center studies conducted in Europe, Australia and North America that assessed the effectiveness of E₂V/DNG in reducing menstrual blood loss (MBL) in women with HMB. Women aged ≥ 18 years with objectively confirmed HMB were randomized to E₂V/DNG (n=220) or placebo (n = 135) for seven treatment cycles. Outcomes analyzed included absolute reduction in MBL from baseline, proportion of women successfully treated (defined as MBL below 80 mL and ≥ 50% reduction in MBL), proportion with MBL below 80 mL and proportion with ≥ 50% reduction in MBL from baseline. At study end, 63.6% and 11.9% of patients were successfully treated with E₂V/DNG and placebo, respectively, with 68.2% and 15.6% of women with MBL below 80 mL, and 70.0% and 17.0% with MBL reduction ≥ 50% (all p&lt;.001). Conclusion: E₂V/DNG is highly effective for the treatment of HMB and is associated with a high rate of treatment success.Дослідження проведене з метою оцінки клінічної ефективності естрадіолу валерату/дієногесту (Е2В/ДН Г ), який приймався в режимі доз естрогенів, що знижуються, і доз прогестагену, що підвищуються, в 28-денному режимі для лікування інтенсивних менструальних кровотеч, в порівнянні з іншими доступними методами лікування. Дослідження являло собою об’єднаний аналіз даних з двох ідентичних за дизайном рандомізованих плацебо-контрольованих багатоцентрових досліджень, проведених в Європі, Австралії та Північній Америці, в яких оцінювалася ефективність Е2В/ДН Г відносно зниження менструальної крововтрати (МК) у жінок з інтенсивними менструальними кровотечами. Жінки ≥ 18 років з підтвердженими інтенсивними менструальними кровотечами рандомізовані для прийому Е2В/ДН Г (n = 220) або плацебо (n = 135) протягом 7 лікувальних циклів. Проаналізовані результати включали абсолютне зниження МК порівняно з початковим, співвідношення з позитивним результатом (визначеним як МК менше 80 мл і ≥ 50-відсоткове зниження МК), співвідношення зниження МК менше 80 мл і ≥ 50-відсоткового зниження порівняно з вихідним значенням. Наприкінці дослідження відповідно 63,6 і 11,9% пацієнток мали позитивний результат від прийому Е2В/ДН Г і плацебо, у 68,2 і 15,6% жінок МК булла меншою за 80 мл, і у 70,0 і 17,0% відзначалося зниження МК ≥ 50% (р &lt; 0,001 для всіх випадків). Було зроблено висновок, що Е2В/ДН Г високоефективний для лікування інтенсивних менструальних кровотеч.Дослідження проведене з метою оцінки клінічної ефективності естрадіолу валерату/дієногесту (Е2В/ДН Г ), який приймався в режимі доз естрогенів, що знижуються, і доз прогестагену, що підвищуються, в 28-денному режимі для лікування інтенсивних менструальних кровотеч, в порівнянні з іншими доступними методами лікування. Дослідження являло собою об’єднаний аналіз даних з двох ідентичних за дизайном рандомізованих плацебо-контрольованих багатоцентрових досліджень, проведених в Європі, Австралії та Північній Америці, в яких оцінювалася ефективність Е2В/ДН Г відносно зниження менструальної крововтрати (МК) у жінок з інтенсивними менструальними кровотечами. Жінки ≥ 18 років з підтвердженими інтенсивними менструальними кровотечами рандомізовані для прийому Е2В/ДН Г (n = 220) або плацебо (n = 135) протягом 7 лікувальних циклів. Проаналізовані результати включали абсолютне зниження МК порівняно з початковим, співвідношення з позитивним результатом (визначеним як МК менше 80 мл і ≥ 50-відсоткове зниження МК), співвідношення зниження МК менше 80 мл і ≥ 50-відсоткового зниження порівняно з вихідним значенням. Наприкінці дослідження відповідно 63,6 і 11,9% пацієнток мали позитивний результат від прийому Е2В/ДН Г і плацебо, у 68,2 і 15,6% жінок МК булла меншою за 80 мл, і у 70,0 і 17,0% відзначалося зниження МК ≥ 50% (р &lt; 0,001 для всіх випадків). Було зроблено висновок, що Е2В/ДН Г високоефективний для лікування інтенсивних менструальних кровотеч

Occurrence and severity of non-occlusive mesenteric ischemia (NOMI) after cardiovascular surgery correlate with preoperatively assessed FGF-23 levels.

To evaluate the value of preoperatively assessed fibroblast growth factor 23 (FGF-23) levels and to correlate FGF-23 with angiographic findings in non-occlusive mesenteric (NOMI) ischemia using a standardized scoring system.Between 2/2011 and 3/2012 a total of 865 patients (median age: 67 years) underwent cardiovascular surgery during this ethics committee approved, prospective study. 65 of these patients had clinical suspicion of NOMI and consequently underwent catheter angiography of the superior mesenteric artery. Images were assessed using a standardized reporting system (Homburg-NOMI-Score). These data were correlated to following preoperative parameters of kidney function: cystatin C, creatinine, FGF-23 and estimated glomerular filtration rate (eGFR), and outcome data (death, acute renal failure) using linear and logistic regressions, as well as nonparametric tests.Significant correlations were found between FGF-23 and the angiographic appearance of NOMI (p = 0.03). Linear regression analysis showed no significant correlation to the severity of NOMI with creatinine (p = 0.273), cystatin C (p = 0.484), cystatin C eGFR (p = 0.914) and creatinine eGFR (p = 0.380). Logistic regression revealed a significant correlation between death and the Homburg-NOMI-Score (p<0.001), but not between development of NOMI and acute renal failure (p = 0.122). The ROC Analysis yielded an area under the curve of 0.695 (95% CI: 0.627-0.763) with a sensitivity of 0.672 and specificity of 0.658.FGF-23 significantly correlates with the severity of NOMI, which is in contrast to other renal function parameters. The applied scoring system allows to predict mortality in NOMI patients

Use of argatroban: Experiences in continuous renal replacement therapy in critically ill patients after cardiac surgery

ObjectivesAcute kidney injury requiring renal replacement therapy (RRT) is a common complication after cardiac surgery, complicated by suspected or proven heparin-induced thrombocytopenia (type II). The present study evaluated the use of argatroban as an anticoagulant during continuous RRT in the early period after cardiac surgery. Argatroban was compared with unfractionated heparin (UH) with respect to bleeding complications and the effectiveness of anticoagulation.MethodsPatients requiring RRT after cardiac surgery from March 2007 to June 2009 were identified. The effectiveness of anticoagulation was measured indirectly by the duration of dialysis filter use. Bleeding was defined as clinical signs of blood loss or the need for transfusion.ResultsOf 94 patients, 41 received argatroban, 27 UH, and 26 required conversion from UH to argatroban. In all 3 subgroups, RRT was begun within a median postoperative period of 2.0 days. Similar levels of anticoagulation were achieved with the duration of the circuit and filter changed an average of 1.1 times daily during RRT. Liver function was comparable in all patients. Neither clinically relevant signs of bleeding nor significant differences in the hemoglobin levels or a requirement for transfusion were noted. However, the Simplified Acute Physiology Score II values during dialysis and mortality were significantly greater in the patients initially receiving argatroban compared with those who received UH alone (54 ± 2 vs 43 ± 3, P < .001; 71% vs 44%, P = .04).ConclusionsArgatroban can provide effective anticoagulation in postoperative cardiac patients receiving continuous RRT. Close monitoring and dose titration resulted in a comparable risk of bleeding for anticoagulation with both argatroban and heparin, regardless of the disease severity or impaired hepatic function

Development and validation of a tissue-equivalent test environment for detection of malfunctions in active medical implants caused by ionizing radiation

Many patients in radiotherapy carry active implantable medical devices (AIMDs) such as pacemakers or cardioverter defibrillators (ICDs). The influence of the ionizing radiation can lead to failures in the device function. This study presents a tissue-equivalent test environment to investigate the influence of ionizing radiation on AIMDs. The in-vitro test environment is designed to simulate a human torso. Structures such as the heart, lungs, ribs, spinal column and soft tissue are replicated from tissue-equivalent materials to allow realistic treatment planning and to simulate the effect of ionizing radiation on active implants. CT measurements and Monte-Carlo validations have shown that Polytetrafluorethylen (bone), carrageenan (heart), Styrodur (lung) and Biresin® G27 (soft tissue) fulfill all requirements for suitable tissue surrogates. A plug-in unit integrated in the test environment has been designed specifically to allow the placement AIMDs in the phantom at typical positions for implant placement in humans. The dosimetry validation showed that the test environment is applicable in the full treatment planning process

Absence of telomerase reverse transcriptase promoter mutations in neuroblastoma

Maintenance of telomere length is a critical hallmark of malignant transformation. While silenced in somatic cells, telomerase reverse transcriptase (TERT), the catalytic subunit of telomerase, is frequently overexpressed in malignant cells thereby maintaining their telomere length. Specific point mutations in the TERT promoter region have recently been identified in melanoma and other tumor entities resulting in high TERT expression. Neuroblastoma is the most common extracranial tumor of childhood, arising from neural-crest progenitor cells. TERT overexpression has been observed in the majority of neuroblastoma. Taking into consideration that TERT promoter mutations are frequently described in neural-crest-derived tumors such as melanoma, as well as a variety of other neuronal tumors, the present study analyzed the frequency of TERT promoter mutations in primary neuroblastoma and neuroblastoma cell lines. In 131 neuroblastoma primary tumors representing the whole spectrum of neuroblastoma, no TERT promoter mutations were detected. However, in 3 out of 19 neuroblastoma cell lines the previously described C228T TERT promoter mutation was present. In conclusion, the TERT promoter mutations are not a frequent mechanism of TERT overexpression in neuroblastoma

Myocardial-Perfusion-SPECT Update S1-Guideline

The S1 guideline for myocardial perfusion SPECT has been published by the Association of the Scientific Medical Societies in Germany (AWMF) and is valid until 2/2022. This paper is a short summary with comments on all chapters and subchapters wich were modified and amended

A single preoperative FGF23 measurement is a strong predictor of outcome in patients undergoing elective cardiac surgery: a prospective observational study

Abstract Introduction Several scoring systems have been developed to predict postoperative mortality and complications in patients undergoing cardiac surgery. However, these computer-based calculations are time- and cost-intensive. A simple but highly predictive test for postoperative risk would be of clinical benefit with respect to increasingly scarce hospital resources. We therefore assessed the predictive power of fibroblast growth factor 23 (FGF23) measurement compared with an established scoring system. Methods We conducted a prospective interdisciplinary observational study at the Saarland University Medical Centre that included 859 patients undergoing elective cardiac surgery between January 2010 and March 2011 with a median follow-up after discharge of 822 days. We compared a single preoperative measurement of FGF23 as a prognostic tool with the 18 parameters comprising EuroSCORE II with respect to postoperative mortality, acute kidney injury, non-occlusive mesenteric ischemia, clinical course and long-term outcome. Results Preoperative FGF23 levels were highly predictive of postoperative outcome and complications. The predictive value of FGF23 for mortality in the receiver operating characteristic curve was greater than the EuroSCORE II (area under the curve: 0.800 versus 0.725). Moreover, preoperative FGF23 independently predicted postoperative acute kidney injury and non-occlusive mesenteric ischemia comparably to the EuroSCORE II. Finally, FGF23 was found to be an independent predictor of clinical course parameters, including duration of surgery, ventilation time and length of stay. Conclusions In patients undergoing elective cardiac surgery, a simple preoperative FGF23 measurement is a powerful indicator of surgical mortality, postoperative complications and long-term outcome. Its utility compares to the widely used EuroSCORE II. </jats:sec