Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy

The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.     

Determination of intracellular pH and compartmentation using diffusion-weighted NMR spectroscopy with pH-sensitive indicators.

The intracellular pH (pHi) of a series of cancer cell lines was determined using the pH-sensitive indicators imidazole (Im) or histidine (His) and diffusion-weighted (DW) proton NMR spectroscopy. The DW method allows the observation at high magnetic field gradient values of only the slow-moving (intracellular) components, thus ensuring complete separation between intra- and extracellular components. Using the chemical shift difference (deltadelta) between the imidazole ring C2-H and C4(5)-H peaks, we were able to measure the pHi independently of chemical shift standardization. With His, the cell lines gave pHi values of approximately 6.5-7.0, whereas with Im, a second, more acidic compartment (pHi = 5.5-5.8) was also observed. An inverse correlation was also found between pHi and the intracellular lactate concentration. This method may be applicable to in vivo pH determinations.     

Genetically determined heterogeneity in hemoglobin scavenging and susceptibility to diabetic cardiovascular disease

A major function of haptoglobin (Hp) is to bind hemoglobin (Hb) to form a stable Hp-Hb complex and thereby prevent Hb-induced oxidative tissue damage. Clearance of the Hp-Hb complex can be mediated by the monocyte/macrophage scavenger receptor CD163. We recently demonstrated that diabetic individuals homozygous for the Hp 2 allele (Hp 2-2) were at 500% greater risk of cardiovascular disease (CVD) compared with diabetic individuals homozygous for the Hp 1 allele (Hp 1-1). No differences in risk by Hp type were seen in individuals without diabetes. To understand the relationship between the Hp polymorphism and diabetic CVD, we sought to identify differences in antioxidant and scavenging functions between the Hp types and to determine how these functions were modified in diabetes. The scavenging function of Hp was assessed using rhodamine-tagged and 125I-Hp in cell lines stably transfected with CD163 and in macrophages expressing endogenous CD163. We found that the rate of clearance of Hp 1-1-Hb by CD163 is markedly greater than that of Hp 2-2-Hb. Diabetes is associated with an increase in the nonenzymatic glycosylation of serum proteins, including Hb. The antioxidant function of Hp was assessed with glycosylated and nonglycosylated Hb. We identified a severe impairment in the ability of Hp to prevent oxidation mediated by glycosylated Hb. We propose that the specific interaction between diabetes, CVD, and Hp genotype is the result of the heightened urgency of rapidly clearing glycosylated Hb-Hp complexes from the subendothelial space before they can oxidatively modify low-density lipoprotein to atherogenic oxidized low-density lipoprotein.     

Autobiographical memory, interpersonal problem solving, and suicidal behavior in adolescent inpatients

OBJECTIVE: The aim of the study was to test Williams' (Williams JMG. Depression and the specificity of autobiographical memory. In: Rubin D, ed. Remembering Our Past: Studies in Autobiographical Memory. London: Cambridge University Press; 1996:244-267.) theory of suicidal behavior in adolescents and young adults by examining the relationship among suicidal behaviors, defective ability to retrieve specific autobiographical memories, impaired interpersonal problem solving, negative life events, repression, and hopelessness. METHODS: Twenty-five suicidal adolescent and young adult inpatients (16.5 y +/- 2.5) were compared with 25 nonsuicidal adolescent and young adult inpatients (16.5 y +/- 2.5) and 25 healthy controls. Autobiographical memory was tested by a word association test; problem solving by the means-ends problem solving technique; negative life events by the Coddington scale; repression by the Life Style Index; hopelessness by the Beck scale; suicidal risk by the Plutchik scale, and suicide attempt by clinical history. RESULTS: Impairment in the ability to produce specific autobiographical memories, difficulties with interpersonal problem solving, negative life events, and repression were all associated with hopelessness and suicidal behavior. There were significant correlations among all the variables except for repression and negative life events. CONCLUSIONS: These findings support Williams' notion that generalized autobiographical memory is associated with deficits in interpersonal problem solving, negative life events, hopelessness, and suicidal behavior. The finding that defects in autobiographical memory are associated with suicidal behavior in adolescents and young adults may lead to improvements in the techniques of cognitive behavioral therapy in this age group.     

Establishment of immune competence in the avian GALT during the immediate post-hatch period

Population dynamics of intestinal lymphocytes and the temporal development of lymphocyte functions were studied in broiler chicks during the first 2 weeks post-hatch. This period is of major immunological importance as the chick is immediately exposed to environmental antigens and pathogens. We show that the gut-associated lymphoid tissue contains functionally immature T and B lymphocytes at hatch, and that function is attained during the first 2 weeks of life as demonstrated by mRNA expression of both ChIL-2 and ChIFNgamma. Functional maturation occurred in two stages: the first-during the first week post-hatch, and the second during the second week, which was also accompanied by an increase in lymphocyte population, as determined by expression of antigen receptor genes. Evidence is presented to show that in the intestinal milieu cellular immune responses mature earlier, and are a prerequisite for humoral responses. Hence, the lack of antibody response in young chicks is primarily due to immaturity of T lymphocytes.     

Role of goblet cells and mucin layer in protecting maternal IgA in precocious birds

Immune protection of the gut in early life depends on provision of maternal antibodies, particularly that of IgA. In precocial birds (in this study Gallus gallus domesticus) the egg provides the only source of maternal antibodies, IgA inclusive. The gut-life of IgA in hatchlings is expected to be brief due to antigen binding and intestinal washout, and maternal IgA is likely to be depleted prior to immune independence at 7–10 days of age in the domestic fowl. We followed the track of maternal IgA in mucosal surfaces of the fowl and describe for the first time a mechanism that might provide the means to extend the active period of maternal IgA in the gut. Maternal IgA was located in the gut, lung, and cloacal bursa in embryos and hatchlings prior to the appearance of endogenic IgA positive plasma cells (D3 in the bursa or D7 in the gut and lung); the source of IgA was most probably the yolk, as the plasma was devoid of IgA till D7 post-hatch. The levels of maternal IgA decreased with time, but were still easily determined at the onset of endogenous IgA production following maturation of the adaptive immune system. Persistence of maternal IgA in the gut was enabled by goblet cell up-take by a yet un-described mechanism, and its consequent release in a mucin-like layer on enterocyte apical surfaces.     

Self-Reported Type 2 Diabetes and Diabetes-Related Eye Disease in Jews and Arabs in Israel

Prevalence rates of diabetes and its complications may be higher in minorities. We assessed these rates in Jews and Arabs living in Israel. Data were pooled from the first and second Israeli national health interview surveys. 9625 Jews and 2401 Arabs participated in the analysis. The age adjusted rate of self-reported diabetes was 10.7 % among Arabs and 5.7 % among Jews [odds ratio (OR) 2.14, 95 % confidence interval 1.77–2.60]. After adjustment for risk factors the OR decreased to 1.28 (95 % CI 1.04–1.59). The rate of self-reported diabetes-related eye disease was 37.6 % among Arabs with diabetes and 18.3 % among Jews (OR 2.69, 95 % CI 1.84–3.93). After adjustment the odds among Arabs were still double that of Jews (OR 2.26, 95 % CI 1.44–3.56). Self-reported type 2 diabetes and diabetes-related eye disease were higher among Arabs. Multi-disciplinary and cultural sensitive approach is required in order to improve diabetes care among the Arab population.     

Modification of deeply buried hydrophobic interfaces by ionic surfactants

Hydrophobicity, the spontaneous segregation of oil and water, can be modified by surfactants. The way this modification occurs is studied at the oil-water interface for a range of alkanes and two ionic surfactants. A liquid interfacial monolayer, consisting of a mixture of alkane molecules and surfactant tails, is found. Upon cooling, it freezes at T(s), well above the alkane's bulk freezing temperature, T(b). The monolayer's phase diagram, derived by surface tensiometry, is accounted for by a mixtures-based theory. The monolayer's structure is measured by high-energy X-ray reflectivity above and below T(s). A solid-solid transition in the frozen monolayer, occurring approximately 3 °C below T(s), is discovered and tentatively suggested to be a rotator-to-crystal transition.     

Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy

OBJECTIVE: To compare the outcome of pregnancy after operative laparoscopy or laparotomy for the management of adnexal pathology during pregnancy. DESIGN: Retrospective comparative study. SETTING: University tertiary care referral center for endoscopic surgery. PATIENT(S): Eighty-eight pregnant women who underwent 93 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 39 patients. The remaining 54 patients underwent laparotomy, 25 during the first trimester and 29 during the second trimester. INTERVENTION(S): Laparoscopy or laparotomy for the management of adnexal masses during pregnancy. MAIN OUTCOME MEASURE(S): Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. RESULT(S): No operative or postoperative maternal complications occurred in the pregnant women who underwent laparoscopic surgery. In this group of 39 women, 5 women had a first-trimester miscarriage and 2 newborns had congenital malformations (hypospadias and cleft lip and palate). Two miscarriages occurred in the first-trimester laparotomy group, and 1 congenital malformation (transposition of the great vessels) was diagnosed in the second-trimester laparotomy group. CONCLUSION(S): Laparoscopic gynecologic surgery appears to be safe during pregnancy, although prospective controlled studies and national registries encompassing larger numbers of cases are needed.