The Incidence of Malignancy and the Preoperative Assessment of Women Undergoing Hysterectomy with Morcellation for Benign Indications

Background: The use of power morcellation in gynecologic surgery has come under scrutiny secondary to concerns for occult malignancy dissemination. The incidence of undiagnosed gynecologic malignancy when hysterectomy performed for benign indications is not definitive but has been quoted as high as 2.7% (1:37). There is not a standard recommended preoperative evaluation, and variation is anticipated by preoperative complaint or diagnosis. Objectives: To quantify the malignancy incidence in women undergoing hysterectomy for benign indications and to compare the preoperative evaluation of patients undergoing hysterectomy with and without morcellation. Methods: Retrospective cohort of women undergoing hysterectomies between October 2007 and June 2014 was identified by procedural codes through the hospital billing system. Exclusions included hysterectomies performed by gynecologic oncologists or non-gynecologic surgeons and surgeries performed outside the UMass healthcare system. Chart abstraction included demographics; pre-hysterectomy evaluation, including current cervical cytology, pathologic endometrial assessment (biopsy, dilation and curettage), and imaging (ultrasound, MRI, CT scan, sonohysterogram, or hysteroscopy); intraoperative factors; and final diagnosis. Results: Analytic cohort included 2,332 women undergoing hysterectomy with 396 (17.0%) including use of morcellation. The malignancy incidence on final pathology was 2.1% and was different between non-morcellated versus morcellated specimens (2.5% vs. 0.3%, p Conclusion: The incidence of malignancy at time ofhysterectomy performed by non­-oncology trained gynecologists was 2.1% overall, and 0.3% in morcellated cases. The pre-operative evaluation of patients undergoing hysterectomy with morcellation is similar to those without morcellation, except for lower rates of pathologic endometrial assessment. An argument could be made that a pathology assessment is indicated in this group due to risk of dissemination in the case of occult malignancy. The risk of occult malignancy is rare, but this should be discussed with patients and taken into account during the pre-operative evaluation

Current commands for high-efficiency torque control of DC shunt motor

The current commands for a high-efficiency torque control of a DC shunt motor are described. In the proposed control method, the effect of a magnetic saturation and an armature reaction are taken into account by representing the coefficients of an electromotive force and a torque as a function of the field current, the armature current and the revolving speed. The current commands at which the loss of the motor drive system becomes a minimum are calculated as an optimal problem. The proposed control technique of a motor is implemented on the microprocessor-based control system. The effect of the consideration of the magnetic saturation and the armature reaction on the produced torque and the minimisation of the loss are discussed analytically and experimentally </p

Crisis in the laws of war? Beyond compliance and effectiveness

How can we tell what state the laws of war are in today, and whether they face exceptional pressures? Standard accounts of the condition of this body of law focus on problems of compliance and effectiveness. In particular, there is a dominant international legal diagnosis that most non-compliance is accounted for by the prevalence of non-state belligerents in irregular or asymmetric conflicts. We propose that any such diagnosis is partial at best. A focus on compliance and effectiveness tells us nothing about the reasons for actor behaviour, or about its impact on the regime. We advance a different conceptual framework, exploring the complex connections between compliance, effectiveness and legitimacy. We propose an alternative diagnostic model that places legitimacy at the heart of the analysis, treating it as causal, not simply symptomatic. This highlights when violations result in legitimacy costs for the individual actor, as opposed to reaching a tipping point when violations cumulatively impose legitimacy costs on the regime itself. We argue for the need to move beyond discussions framed by compliance and effectiveness, and towards the forms, reasons and reception of non-compliant behaviour, as this provides a truly social measure of the state of the law. In order to illustrate this, we examine three distinct types of challengers — Islamic State of Iraq and the Levant, the US and Russia — and present them as, respectively, revisionist, rejectionist and denialist threats to the regime. Unusually, the laws of war today face challenges on all three fronts simultaneously

How to Inhibit Nuclear Factor-Kappa B Signaling: Lessons from Poxviruses

The Nuclear Factor-kappa B (NF-&kappa;B) family of transcription factors regulates key host inflammatory and antiviral gene expression programs, and thus, is often activated during viral infection through the action of pattern-recognition receptors and cytokine&ndash;receptor interactions. In turn, many viral pathogens encode strategies to manipulate and/or inhibit NF-&kappa;B signaling. This is particularly exemplified by vaccinia virus (VV), the prototypic poxvirus, which encodes at least 18 different inhibitors of NF-&kappa;B signaling. While many of these poxviral NF-&kappa;B inhibitors are not required for VV replication in cell culture, they virtually all modulate VV virulence in animal models, underscoring the important influence of poxvirus&ndash;NF-&kappa;B pathway interactions on viral pathogenesis. Here, we review the diversity of mechanisms through which VV-encoded antagonists inhibit initial NF-&kappa;B pathway activation and NF-&kappa;B signaling intermediates, as well as the activation and function of NF-&kappa;B transcription factor complexes

Evaluating the association between genetically proxied ACE inhibition and dementias

Introduction: Angiotensin-converting enzyme (ACE) has been implicated in the metabolism of amyloid beta; however, the causal effect of ACE inhibition on risk of Alzheimer's disease (AD) dementia and other common dementias is largely unknown. Methods: We examined the causal association of genetically proxied ACE inhibition with four types of dementias using a two-sample Mendelian randomization (MR) approach. Results: Genetically proxied ACE inhibition was associated with increased risk of AD dementia (odds ratio per one standard deviation reduction in serum ACE [95% confidence interval]; 1.07 [1.04–1.10], P = 5 × 10−07) and frontotemporal dementia (1.16 [1.04–1.29], P = 0.01) but not with Lewy body dementia or vascular dementia (P > 0.05). These findings were independently replicated and remained consistent in sensitivity analyses. Discussion: This comprehensive MR study provided genetic evidence for an association between ACE inhibition and the risk for AD and frontotemporal dementias. These results should encourage further studies of the neurocognitive effects of ACE inhibition. Highlights: This study evaluated genetically proxied angiotensin-converting enzyme (ACE) inhibition association with dementias. The results suggest an association between ACE inhibition and Alzheimer's disease. The results suggest an association between ACE inhibition and frontotemporal dementia. Those associations can be interpreted as potentially causal

Juicy Fruit in the Harem: Pomological Symbolism in some Paintings by John Frederick Lewis

International audienc