326 research outputs found
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
The Low Redshift Lyman Alpha Forest in Cold Dark Matter Cosmologies
We study the physical origin of the low-redshift Lyman alpha forest in
hydrodynamic simulations of four CDM cosmologies. Our main conclusions are
insensitive to the cosmological model but depend on our assumption that the UV
background declines at low redshift. We find that the expansion of the universe
drives rapid evolution of dN/dz (the number of absorbers per unit z) at z >
1.7, but that at lower redshift the fading of the UV background counters the
influence of expansion, leading to slow evolution. At every redshift, weaker
lines come primarily from moderate fluctuations of the diffuse, unshocked IGM,
and stronger lines originate in shocked or radiatively cooled gas of higher
overdensity. However, the neutral hydrogen column density associated with
structures of fixed overdensity drops as the universe expands, so an absorber
at z = 0 is dynamically analogous to an absorber with neutral hydrogen column
density 10 to 50 times higher at z = 2-3. We find no clear distinction between
lines arising in "galaxy halos" and lines arising in larger scale structures;
however, galaxies tend to lie near the dense regions of the IGM that produce
strong Lyman alpha lines. The simulations provide a unified physical picture
that accounts for the most distinctive observed properties of the low redshift
Lyman alpha forest: (1) a sharp transition in the evolution of dN/dz at z ~
1.7, (2) stronger evolution for absorbers of higher equivalent width, (3) a
correlation of increasing Lyman alpha equivalent width with decreasing galaxy
impact parameter, and (4) a tendency for stronger lines to arise in close
proximity to galaxies while weaker lines trace more diffuse large scale
structure. (Abridged)Comment: 57 pages, 18 figures, submitted to Ap
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
Prostate cancer detection through unbiased capture of methylated cell-free DNA
Funding: Cancer Research UK, CRUK Career Development Fellowship, University of Cambridge W.D. Armstrong Trust Fund, John Black Prostate Cancer Foundation Young Investigator Award. This research was also supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).Prostate cancer screening using prostate-specific antigen (PSA) has been shown to reduce mortality but with substantial overdiagnosis, leading to unnecessary biopsies. The identification of a highly specific biomarker using liquid biopsies, represents an unmet need in the diagnostic pathway for prostate cancer. In this study, we employed a method that enriches for methylated cell-free DNA fragments coupled with a machine learning algorithm which enabled the detection of metastatic and localized cancers with AUCs of 0.96 and 0.74, respectively. The model also detected 51.8% (14/27) of localized and 88.7% (79/89) of patients with metastatic cancer in an external dataset. Furthermore, we show that the differentially methylated regions reflect epigenetic and transcriptomic changes at the tissue level. Notably, these regions are significantly enriched for biologically relevant pathways associated with the regulation of cellular proliferation and TGF-beta signaling. This demonstrates the potential of circulating tumor DNA methylation for prostate cancer detection and prognostication.Peer reviewe
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
Leptin and Amylin Act in an Additive Manner to Activate Overlapping Signaling Pathways in Peripheral Tissues: In vitro and ex vivo studies in humans
OBJECTIVE: Amylin interacts with leptin to alter metabolism. We evaluated, for the first time, amylin- and/or leptin-activated signaling pathways in human peripheral tissues (hPTs). RESEARCH DESIGN AND METHODS: Leptin and amylin signaling studies were performed in vitro in human primary adipocytes (hPAs) and human peripheral blood mononuclear cells (hPBMCs) and ex vivo in human adipose tissue (hAT) from male versus female subjects, obese versus lean subjects, and subjects with subcutaneous versus omental adipose tissue. RESULTS: The long form of leptin receptor was expressed in human tissues and cells studied in ex vivo and in vitro, respectively. Leptin and amylin alone and in combination activate signal transducer and activator of transcription 3 (STAT3), AMP-activated protein kinase, Akt, and extracellular signal-regulated kinase signaling pathways in hAT ex vivo and hPAs and hPBMCs in vitro; all phosphorylation events were saturable at leptin and amylin concentrations of ∼50 and ∼20 ng/ml, respectively. The effects of leptin and amylin on STAT3 phosphorylation in hPAs and hPBMCs in vitro were totally abolished under endoplasmic reticulum stress and/or in the presence of a STAT3 inhibitor. Results similar to those in the in vitro studies were observed in hAT studied ex vivo. CONCLUSIONS: Leptin and amylin activate overlapping intracellular signaling pathways in humans and have additive, but not synergistic, effects in signaling pathways studied in hPTs in vitro and ex vivo
- …