Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women.

OBJECTIVES: Our primary aim was to assess how patients characteristics, bleeding pattern, sonographic endometrial thickness (ET) and additional features at unenhanced ultrasound examination (UTVS) and at fluid instillation sonography (FIS) contribute to the diagnosis of intracavitary uterine pathology in women presenting with abnormal uterine bleeding (AUB). We further aimed to report the prevalence of pathology in women presenting with AUB. METHODS: 1220 consecutive women presenting with AUB underwent UTVS, colour Doppler imaging (CDI) and FIS. Most women (n = 1042) had histological diagnosis. RESULTS: Mean age was 50 years and 37% were postmenopausal. Of 1220 women 54% were normal, polyps were diagnosed in 26%, intracavitary fibroids in 11%, hyperplasia without atypia in 4% and cancer in 3%. All cancers were diagnosed in postmenopausal (7%) or perimenopausal (1%) women. ET had a low predictive value in premenopausal women (LR+ and LR- of 1.34 and 0.74, respectively), while FIS had a LR+ and LR- of 6.20 and 0.24, respectively. After menopause, ET outperformed all patient characteristics for the prediction of endometrial pathology (LR+ and LR- of 3.13 and 0.24). The corresponding LR+ and LR- were 10.85 and 0.71 for CDI and 8.23 and 0.26 for FIS. CONCLUSION: About half of the women presenting to a bleeding clinic will have pathology. In premenopausal women, benign lesions are often the cause of AUB. For the prediction of intracavitary pathology ET is of little value in premenopausal women. CDI and FIS substantially improve the diagnostic accuracy

Dynamics and microscopic origin of fast 1.5 μm emission in Er-doped SiO<inf>2</inf> sensitized with Si nanocrystals

We investigate the origin of fast 1.5 μm photoluminescence from Er-doped SiO2 sensitized with silicon nanocrystals, which appears and decays within the first microsecond after a short laser excitation pulse. Time-resolved and temperature-dependent measurements on the 1.5 μm emission from Er-doped and Er-free samples reveal that the major part of this emission is Er related. A possible contribution from other photoluminescence bands, specifically of the defect-related band centered around 1.3 μm, has also been considered. All the results obtained indicate the dominant contribution of Er3+ ions to the fast 1.5 μm emission in the investigated materials. We propose two possible mechanisms behind the fast excitation and quenching of Er3+ 1.5 μm emission, which are both facilitated by Er-related trap centers with ionization energy of EA ∼60 meV. © 2011 American Physical Society

Energy transfer processes in Er-doped SiO2 sensitized with Si nanocrystals

We present a high-resolution photoluminescence study of Er-doped SiO2 sensitized with Si nanocrystals (Si NCs). Emission bands originating from recombination of excitons confined in Si NCs and of internal transitions within the 4f-electron core of Er3+ ions, and a band centered at lambda = 1200nm have been identified. Their kinetics have been investigated in detail. Based on these measurements, we present a comprehensive model for energy transfer mechanisms responsible for light generation in this system. A unique picture of energy flow between subsystems of Er3+ and Si NCs is developed, yielding truly microscopic information on the sensitization effect and its limitations. In particular, we show that most of the Er3+ ions available in the system are participating in the energy exchange. The long standing problem of apparent loss of optical activity of majority of Er dopants upon sensitization with Si NCs is clarified and assigned to appearance of a very efficient energy exchange mechanism between Si NCs and Er3+ ions. Application potential of SiO2:Er sensitized by Si NCs is discussed in view of the newly acquired microscopic insight.Comment: 30 pages 13 figure

Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors.

All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice

Model fit after pairwise maximum likelihood

Maximum likelihood factor analysis of discrete data within the structural equation modeling framework rests on the assumption that the observed discrete responses are manifestations of underlying continuous scores that are normally distributed. As maximizing the likelihood of multivariate response patterns is computationally very intensive, the sum of the log--likelihoods of the bivariate response patterns is maximized instead. Little is yet known about how to assess model fit when the analysis is based on such a pairwise maximum likelihood (PML) of two--way contingency tables. We propose new fit criteria for the PML method and conduct a simulation study to evaluate their performance in model selection. With large sample sizes (500 or more), PML performs as well the robust weighted least squares analysis of polychoric correlations

Electric Dipole Radiation from Spinning Dust Grains

We discuss the rotational excitation of small interstellar grains and the resulting electric dipole radiation from spinning dust. Attention is given to excitation and damping of rotation by: collisions with neutrals; collisions with ions; plasma drag; emission of infrared radiation; emission of microwave radiation; photoelectric emission; and formation of H_2 on the grain surface. We introduce dimensionless functions F and G which allow direct comparison of the contributions of different mechanisms to rotational drag and excitation. Emissivities are estimated for dust in different phases of the interstellar medium, including diffuse HI, warm HI, low-density photoionized gas, and cold molecular gas. Spinning dust grains can explain much, and perhaps all, of the 14-50 GHz background component recently observed in CBR studies. It should be possible to detect rotational emission from small grains by ground-based observations of molecular clouds.Comment: 59 pages, 19 eps figures, uses aaspp4.sty . Submitted to Ap.