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

Correlation between the Mean Matter Density and the Width of the Saturated Lyman Alpha Absorption

We report a scaling of the mean matter density with the width of the saturated Lyman alpha absorptions. This property is established using the ``pseudo-hydro'' technique (Croft et al. 1998). It provides a constraint for the inversion of the Lyman alpha forest, which encounters difficulty in the saturated region. With a Gaussian density profile and the scaling relation, a simple inversion of the simulated Lyman alpha forests shows that the one-dimensional mass power spectrum is well recovered on scales above 2 Mpc/h, or roughly k < 0.03 s/km, at z=3. The recovery underestimates the power on small scales, but improvement is possible with a more sophisticated algorithm.Comment: 7 pages, 9 figures, accepted for publication in MNRAS, replaced by the version after proo

Prevalence, risk factors and awareness of albuminuria on a Canadian First Nation: A community-based screening study

BACKGROUND: Both diabetic and non-diabetic end stage renal disease (ESRD) are more common among Canadian First Nations people than among the general Canadian population. The purpose of this research was to determine the prevalence of and risk factors for albuminuria in a Canadian First Nation population at high risk for ESRD and dialysis. METHODS: Data from a community-based screening study of 483 residents of a Plains Ojibway First Nation in Manitoba was used. Participants provided random urine samples. Proteinuria was defined as any dipstick positive for protein (≥1 g/L) or those with ACR in the macroalbuminuric range (≥30 mg/mmol) on at least one sample. Microalbuminuria was defined as ACR ≥2 mg/mmol for males and ≥2.8 mg/mmol for females. Other measures included fasting glucose, haemoglobin A(1c), triglycerides, cholesterol, blood pressure, height, weight and waist and hip circumferences. RESULTS: Twenty percent of study participants had albuminuria, (5% proteinuria and 15% microalbuminuria). Of participants with diabetes, 42% (56/132) had albuminuria compared to 26% (7/27) among those with impaired fasting glucose and 10% (30/303) among those with normal glucose tolerance. Only 5.3% of those with albuminuria were aware of any degree of renal disease. In a multivariate logistic regression, independent associations with albuminuria were male gender [p = 0.002], increasing fasting glucose [p <0.0001], years diagnosed with diabetes [p = 0.03], increasing systolic blood pressure [p = 0.009], and increasing body mass index (BMI) [p = 0.04]. CONCLUSIONS: The independent association between BMI and albuminuria has not been previously reported among indigenous populations. There is a high prevalence of albuminuria in this Canadian First Nation population; the high proportion of patients with diabetes and undiagnosed kidney disease demonstrates the need for screening, education and intervention to halt the progression and development of albuminuria and ultimately ESRD and CVD

Discovery of a z=4.93, X-ray selected quasar by the Chandra Multiwavelength Project (ChamP)

We present X-ray and optical observations of CXOMP J213945.0-234655, a high redshift (z=4.93) quasar discovered through the Chandra Multiwavelength Project (ChaMP). This object is the most distant X-ray selected quasar published, with an X-ray luminosity of L(X)=5.9x10^44 erg/s (measured in the 0.3-2.5 keV band and corrected for Galactic absorption). CXOMP J213945.0-234655 is a g' dropout object (>26.2), with r'=22.87 and i'=21.36. The rest-frame X-ray to optical flux ratio is similar to quasars at lower redshifts and slightly X-ray bright relative to z>4 optically-selected quasars observed with Chandra. The ChaMP is beginning to acquire significant numbers of high redshift quasars to investigate the unobscured X-ray luminosity function out to z~5.Comment: Published in ApJ Letters; 4 pages; 3 figures; http://hea-www.harvard.edu/CHAMP

Development of requirements for performance analysis

В работе рассмотрена разработка требований к проведению анализа несоответствий. С использованием методов статистического анализа, был проведен анализ несоответствий для конкретной организации, на основе результатов которого составлен алгоритм анализа несоответствий, который носит рекомендательный характер. The paper considers the development of requirements for the analysis of nonconformities. Using the methods of statistical analysis, an analysis of nonconformities was conducted for a specific organization, based on the results of which an algorithm for analyzing nonconformities was compiled, which is advisory in nature

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

On the Possible Sources of D/H Dispersion at High Redshift

Recent observations suggest the existence of a white dwarf population in the Galactic halo, while others suggest that deuterium has been astrated in systems at high redshift and low metallicity. We propose that these observations could be signatures of an early population of intermediate-mass stars. Such a population requires a Population III initial mass function different from that of the solar neighborhood, as perhaps also suggested by the observed cosmic infrared background. Also, to avoid overproduction of C and N, it is required that the Z=0 yields of these stars have low ($\sim 10^{-3}$ solar) abundances as suggested by some recent calculations. Under these assumptions, we present a model which reproduces the observed D vs Si trend, and predicts a high cosmic Type Ia supernova rate, while producing a white dwarf population that accounts for only $\sim$ 1.5% of the dark halo. This scenario can be tested by observations of the cosmic supernova rate, and by confirmation and further studies of the putative white dwarf halo population.Comment: AASTeX, 17 pages, 3 embedded eps fig

Corneal Replication Is an Interferon Response-Independent Bottleneck for Virulence of Herpes Simplex Virus 1 in the Absence of Virion Host Shutoff

Herpes simplex viruses lacking the virion host shutoff function (Δvhs) are avirulent and hypersensitive to type I and type II interferon (IFN). In this study, we demonstrate that even in the absence of IFN responses in AG129 (IFN-αβγR−/−) mice, Δvhs remains highly attenuated via corneal infection but is fully virulent via intracranial infection. The data demonstrate that the interferon-independent inherent replication defect of Δvhs has a significant impact upon peripheral replication and neuroinvasion