Reference ranges for uterine vein dimensions in non-pregnant women with normal pelvic organs

OBJECTIVE

To establish reference ranges for uterine vein (UtV) diameters in non-pregnant women with normal pelvic organs.

METHODS

This was a prospective study of all women attending the general gynecological clinic of a university teaching hospital in the UK, between August 2015 and December 2016. All women aged ≥ 18 years underwent a transvaginal ultrasound examination in accordance with the study protocol. In women with normal pelvic organs, the largest trunk of the uterine venous plexus was identified in the transverse plane on each side. The maximum anteroposterior vessel diameter was measured by placing the calipers on the inner walls of the vein, and the mean of three measurements was used as the representative value. Inter- and intraobserver variability was assessed in a subgroup of 30 women. Maximum UtV diameter was compared between right and left UtVs and between pre- and postmenopausal women. Factors associated with UtV diameter were assessed and reference ranges were constructed.

RESULTS

Of 1500 women examined, 486 (32%) had normal pelvic organs on ultrasound scan and were included in the final analysis. In all women, the uterine venous trunk was clearly visualized and there was no significant difference between the maximum median left and right UtV diameters (P = 0.37). UtV diameters were generally lower in postmenopausal, compared with premenopausal, women, with the difference being statistically significant for the right UtV and the average of left and right UtVs. There was a gradual increase in UtV diameter with advancing age, with a peak observed in women aged 41-50 years and decreasing values in older age groups. Univariable analysis showed that parity, menopausal status and age were associated significantly with UtV diameters (P < 0.01). On multivariable analysis, only higher parity was significantly associated with increasing venous size in both pre- and postmenopausal women. Reference ranges were constructed separately for nulliparous and parous premenopausal women aged between 18 and 45 years.

CONCLUSION

UtVs can be identified and measured consistently in all women with normal pelvic organs using transvaginal ultrasound. Parity was the main factor influencing the maximum mean UtV diameter, which had to be taken into account when constructing reference ranges. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Hemoperitoneum as a precursor of deep pelvic endometriosis: prospective cohort study

OBJECTIVE

To determine whether significant hemoperitoneum could be a precursor of deep pelvic endometriosis in non-pregnant premenopausal women presenting with severe acute lower abdominal pain.

METHODS

This was a prospective observational cohort study carried out at a dedicated gynecological diagnostic unit over a period of 18 months. We included consecutive non-pregnant, premenopausal women who attended with severe acute lower abdominal pain and underwent a pelvic ultrasound examination. Women were triaged for surgical or conservative management depending on the cause of pain and severity of their symptoms. Those who were selected for conservative management were invited for follow-up ultrasound scans. The main outcome measure was evidence of newly developed deep endometriosis at follow-up examination.

RESULTS

Of 118 non-pregnant women who attended our unit with severe acute lower abdominal pain, 20 underwent emergency surgery and 17 had a history of endometriosis, or evidence of endometriosis on the initial scan, and were excluded from the study. Therefore, conservative management was employed in 81 women, eight of whom had evidence of significant hemoperitoneum at presentation. A total of 35 women attended for all follow-up ultrasound scans. At the completion of follow-up, four of six (67% (95% CI, 22-96%)) women who presented initially with significant intra-abdominal bleeding had developed new evidence of deep endometriosis, compared with one of 29 (3% (95% CI, 0-18%)) of those without hemoperitoneum (relative risk, 19.3 (95% CI, 3-144); P < 0.001).

CONCLUSION

In some women, the presence of significant hemoperitoneum that is managed conservatively precedes the development of deep endometriosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Impact of Puberty and Age on Adolescent Inhibition Over Time

Objective

We measured how puberty impacted inhibition over three years. We hypothesized that age and puberty development would predict inhibition at each time point. Results revealed differential effects of puberty and age over time.

Method

Participants from Southern Idaho were 245 adolescents at Time 1 (T1) (M = 10.4, SD = 1.5, 50% female, 64% Caucasian), 196 adolescents at Time 2 (T2) (M = 11.8, SD = 1.5, 50% female, 81% Caucasian), and 87 adolescents at Time 3 (T3) (M = 13, SD = 1.5, 56% female, 82% Caucasian). Participants completed a physical exam with a registered nurse, which included the Tanner Scale (Apter & Hermanson, 2002; Tinggaard et. al., 2012) and the Puberty Development Scale (Petersen et al., 1988). Inhibition was assessed using stop-signal reaction time (SSRT) within the Stop-it Task (Logan, Cowan, & Davis, 1984).

Results

Using structural equation modeling, for T1, the overall model demonstrated a good fit, χ2(3) = 1.23, p = .75, RMSEA = .00, CFI = 1.00, TLI = 1.04. Puberty significantly predicted inhibition (β = -.21, p < .05), i.e., higher puberty scores predicted stronger inhibition. However, age was not a significant predictor. At T2, the model demonstrated a good fit, χ2(7) = 7.77, p = .35, RMSEA = .03, CFI = 1.00, TLI = .99. Age significantly predicted inhibition (β=-.39, p < .001). However, puberty was not a significant predictor. In T3, neither age nor puberty predicted inhibition.

Conclusions

Our results indicate that early adolescent increases in inhibition may be due to puberty development rather than age. As one ages, puberty has less effect, and chronological age becomes more significant. Finally, in mid-adolescence, neither age nor puberty significantly affects inhibition. These findings highlight the changing effects of age and puberty on inhibitory control across adolescence.

Pattern of failure in anaplastic glioma patients with an IDH1/2 mutation

PURPOSE

The current study aimed to assess patterns of failure (PoF) in anaplastic glioma (AG) patients managed with intensity-modulated radiation therapy (IMRT) and their relationship to molecular subtype.

METHODS

The outcomes of AG patients managed between 2008 and 2014 and entered into a prospective database were assessed, including PoF. AG was initially defined using the WHO 2007 classification, but for analysis, patients were subsequently recategorised based on WHO 2016 as anaplastic oligodendroglioma (AOD), astrocytoma isocitrate dehydrogenase (IDH) mutant (AAmut) or astrocytoma IDH wildtype (AAwt). Management involved IMRT and temozolomide (TMZ), including from 2011 patients with an IDH mutation (IDHmut) planned with 18F-fluoroethyltyrosine (FET) and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET). PoF was local, marginal or distant in relation to the IMRT volume. Relapse-free survival (RFS) was calculated from the start of IMRT.

RESULTS

A total of 156 patients were assessed, with median follow-up of 5.1 years. Of these patients, 75% were IDHmut, 44% were managed at first or later relapse and 73% received TMZ. Relapse occurred in 68 patients, with 6‑year RFS of 75.0, 48.8 and 2.5% for AOD, AAmut and AAwt, respectively (p < 0.001). There was a component of local relapse in 63%, of marginal relapse in 19% and of distant relapse in 37% of relapses. Isolated local, marginal and distant relapse was evident in 51, 9 and 22%, respectively. A distant relapse pattern was more frequent in IDHmut compared to IDHwt patients (26% vs. 45%, p = 0.005), especially within the first 2 years post-IMRT. In multivariate analysis, distant relapse remained associated with AAmut (p < 0.002) and delayed IMRT until the second relapse (p < 0.001).

CONCLUSION

Although patients with IDH-mutated AG have improved outcomes, there was a higher proportion of distant relapses occurring during the 2 years after IMRT.

Validation study of the Brief Medication Adherence Scale (BMAS) in patients with schizophrenia and related disorders in Hong Kong

The purpose of this study was to develop and test an original self-rating instrument known as Brief Medication Adherence Scale (BMAS) to assess antipsychotic adherence level of Hong Kong Chinese patients with schizophrenia. On the interview day, BMAS and three other validated rating scales were given to local patients with schizophrenia and related disorders for completion. BMAS was required to fill in a second time after two weeks for the study of test-retest reliability. Results of BMAS were matched with those of other scales and blood level of prescribed mood stabilizers to test for construct validity. Data analysis was performed for 84 patients. Median BMAS scores recorded at both times were identical at 89/100, and a cutoff score of 70 was considered medication adherent with a sensitivity of 98.61% (CI 92.50%-99.96%). BMAS was positively and significantly correlated with the established Medication Adherence Rating Scale -Taiwanese (Spearman's ρ = 0.56, p < 0.05) and with variation in serum mood stabilizer level (Pearson's r = 0.55, p < 0.05). On the other hand, correlations with scales measuring mental condition and medication side effects were weak. Principal component analysis found two components (i.e. medication taking behaviors and attitudes) for the 10-question BMAS. Test-retest BMAS total scores were significantly correlated (intraclass correlation alpha = 0.87, p < 0.05), and Cronbach's alpha measuring internal consistency was 0.68. The current study confirms that BMAS is a valid and reliable scale that assesses medication adherence in patients with schizophrenia.

Remarkable fly (Diptera) diversity in a patch of Costa Rican cloud forest: Why inventory is a vital science

Study of all flies (Diptera) collected for one year from a four-hectare (150 x 266 meter) patch of cloud forest at 1,600 meters above sea level at Zurquí de Moravia, San José Province, Costa Rica (hereafter referred to as Zurquí), revealed an astounding 4,332 species. This amounts to more than half the number of named species of flies for all of Central America. Specimens were collected with two Malaise traps running continuously and with a wide array of supplementary collecting methods for three days of each month. All morphospecies from all 73 families recorded were fully curated by technicians before submission to an international team of 59 taxonomic experts for identification.        Overall, a Malaise trap on the forest edge captured 1,988 species or 51% of all collected dipteran taxa (other than of Phoridae, subsampled only from this and one other Malaise trap). A Malaise trap in the forest sampled 906 species. Of other sampling methods, the combination of four other Malaise traps and an intercept trap, aerial/hand collecting, 10 emergence traps, and four CDC light traps added the greatest number of species to our inventory. This complement of sampling methods was an effective combination for retrieving substantial numbers of species of Diptera. Comparison of select sampling methods (considering 3,487 species of non-phorid Diptera) provided further details regarding how many species were sampled by various methods.        Comparison of species numbers from each of two permanent Malaise traps from Zurquí with those of single Malaise traps at each of Tapantí and Las Alturas, 40 and 180 km distant from Zurquí respectively, suggested significant species turnover. Comparison of the greater number of species collected in all traps from Zurquí did not markedly change the degree of similarity between the three sites, although the actual number of species shared did increase.        Comparisons of the total number of named and unnamed species of Diptera from four hectares at Zurquí is equivalent to 51% of all flies named from Central America, greater than all the named fly fauna of Colombia, equivalent to 14% of named Neotropical species and equal to about 2.7% of all named Diptera worldwide. Clearly the number of species of Diptera in tropical regions has been severely underestimated and the actual number may surpass the number of species of Coleoptera.        Various published extrapolations from limited data to estimate total numbers of species of larger taxonomic categories (e.g., Hexapoda, Arthropoda, Eukaryota, etc.) are highly questionable, and certainly will remain uncertain until we have more exhaustive surveys of all and diverse taxa (like Diptera) from multiple tropical sites.        Morphological characterization of species in inventories provides identifications placed in the context of taxonomy, phylogeny, form, and ecology. DNA barcoding species is a valuable tool to estimate species numbers but used alone fails to provide a broader context for the species identified.

Comprehensive inventory of true flies (Diptera) at a tropical site

Estimations of tropical insect diversity generally suffer from lack of known groups or faunas against which extrapolations can be made, and have seriously underestimated the diversity of some taxa. Here we report the intensive inventory of a four-hectare tropical cloud forest in Costa Rica for one year, which yielded 4332 species of Diptera, providing the first verifiable basis for diversity of a major group of insects at a single site in the tropics. In total 73 families were present, all of which were studied to the species level, providing potentially complete coverage of all families of the order likely to be present at the site. Even so, extrapolations based on our data indicate that with further sampling, the actual total for the site could be closer to 8000 species. Efforts to completely sample a site, although resource-intensive and time-consuming, are needed to better ground estimations of world biodiversity based on limited sampling.