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

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

Nutrition challenges ahead

The breakout session ‘Nutrition challenges ahead’ was held at the EFSA 2nd Scientific Conference ‘Shaping the Future of Food Safety, Together’ (Milan, Italy, 14–16 October 2015) to address the main problems in the area of nutrition to be faced in the 21st Century, both at a global and individual level. The nutrition challenges ahead are diverse and depend on agricultural, socioeconomic and individual factors. At a global level, food security, food sustainability and decreasing the impact of food production on climate change are of paramount importance. Decreasing the prevalence of obesity and related disorders, which may coexist with selected micronutrient deficiencies, is a major challenge for wealthy countries; for developing countries and rural food systems, fighting protein–energy malnutrition and micronutrient deficiencies is a priority. Diets based on a wide variety of nutrient-rich local plant foods (e.g. fruits, vegetables, whole grain cereals, vegetable oils, nuts) that contain moderate amounts of animal protein (preferably in the form of fish) and are low in saturated and trans-fatty acids, added sugars and sodium, are healthy, nutritious, sustainable and climate friendly. Creating an environment where such diets are also economically advantageous and convenient may be a part of a global solution to these nutritional challenges. Individuals, however, are unique regarding their genetic background, gut microbiota and health status. In addition, nutrition may already play a role in the development (and prevention) of disease very early in life. Thus, additional health benefits could be achieved by tailoring nutritional strategies to particular population subgroups or even individuals on the basis of current and future knowledge about the relationship between nutrients, genes, the microbiome and health. New technologies and food innovation may help in finding novel foods fit for purpose

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

Semi analytic approach to understanding the distribution of neutral hydrogen in the universe: Comparison of simulations with observations

Following Bi & Davidsen (1997), we perform one dimensional semi analytic simulations along the lines of sight to model the intergalactic medium (IGM). Since this procedure is computationally efficient in probing the parameter space -- and reasonably accurate -- we use it to recover the values of various parameters related to the IGM (for a fixed background cosmology) by comparing the model predictions with different observations. For the currently favoured LCDM model (\Omega_m=0.4, \Omega_{\Lambda}=0.6 and h=0.65), we obtain, using statistics obtained from the transmitted flux, constraints on (i) the combination f=(\Omega_B h^2)^2/J_{-12}, where \Omega_B is the baryonic density parameter and J_{-12} is the total photoionisation rate in units of 10^{-12} s^{-1}, (ii) temperature T_0 corresponding to the mean density and (iii) the slope \gamma of the effective equation of state of the IGM at a mean redshift z \simeq 2.5. We find that 0.8 <(T_0/10^4 K)< 2.5 and 1.3<\gamma<2.3. while the constraint obtained on f is 0.020^2<f<0.032^2. A reliable lower bound on J_{-12} can be used to put a lower bound on \Omega_B h^2, which can be compared with similar constraints obtained from Big Bang Nucleosynthesis (BBN) and CMBR studies. We find that if J_{-12}>1.2, the lower bound on \Omega_B h^2 is in violation of the BBN value.Comment: Revised version; accepted for publication in Ap

Large-scale structure in the Lyman-alpha forest II: analysis of a group of ten QSOs

The spatial distribution of Ly-alpha forest absorption systems towards ten QSOs has been analysed to search for large-scale structure over the redshift range 2.2 < z < 3.4. The QSOs form a closely spaced group on the sky and are concentrated within a 1 deg^2 field. We have employed a technique based on the first and second moments of the transmission probability density function which is capable of identifying and assessing the significance of regions of over- or underdense Ly-alpha absorption. We find evidence for large-scale structure in the distribution of Ly-alpha forest absorption at the > 99 per cent confidence level. In individual spectra we find overdense Ly-alpha absorption on scales of up to 1200 km s^-1. There is also strong evidence for correlated absorption across line of sight pairs separated by < 3 h^-1 proper Mpc (q_0 = 0.5). For larger separations the cross-correlation signal becomes progressively less significant.Comment: 15 pages, LaTeX, 6 Postscript figures, accepted for publication in MNRA

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