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Objective: To establish a normal reference interval for amniotic sac diameter (ASD) between 7 + 0 and 9 + 6 weeks' gestation and its relative size in relation to gestational sac diameter (GSD) and the embryo crown–rump length (CRL). Methods: This was a prospective, cross‐sectional study of consecutive women presenting to the Early Pregnancy Unit, University College Hospital, London, UK, between August 2022 and June 2023. We included live, normally sited, singleton pregnancies with a normal 20‐week anomaly scan. We collected 120 cases per gestational week, from 7 + 0 to 9 + 6 weeks' gestation, totaling 360 cases. We performed an inter‐ and intraobserver variability assessment in the measurement of mean ASD in 30 patients. Regression analyses were used to establish reference intervals for GSD and CRL, ASD and CRL, GSD and ASD, and GSD/ASD ratio and CRL. A fitted regression line was calculated, along with a 90% prediction interval and R2 value. Results: There was good interobserver agreement (mean ± SD difference, 0.007 ± 1.105 mm (95% limits of agreement (LoA), −2.160 to 2.174 mm)) and good intraobserver agreement for Observer A (mean ± SD difference, −0.080 ± 0.741 mm (95% LoA, −1.532 to 1.372 mm)) and Observer B (mean ± SD difference, −0.014 ± 0.919 mm (95% LoA, −1.814 to 1.786 mm)) in the measurement of mean ASD. Regression analyses showed a statistically significant association between each pair of values (P < 0.001 for all). There was a significant quadratic association between mean GSD and CRL (R2 = 56%), mean GSD and ASD (R2 = 60%) and GSD/ASD ratio and CRL (R2 = 68%), and a significant cubic association between mean ASD and CRL (R2 = 90%). The regression equations were used to quantify the values of ASD and GSD/ASD ratios for a range of CRL values and gestational ages. Conclusion: Our study has produced comprehensive reference intervals for amniotic sac size in early pregnancy, which could be used in routine clinical practice. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To report the outcome of cesarean scar pregnancy (CSP) undergoing treatment. Methods: MEDLINE, Embase and CINAHL databases were searched. Inclusion criteria were women with CSP undergoing treatment. The primary outcome was successful treatment for CSP, defined as no need for additional medical or surgical strategies. Secondary outcomes were the type of additional treatment (surgical or medical), need for blood transfusion, emergency laparotomy, hysterectomy, post-treatment complications. All these outcomes were explored in women undergoing single and compound treatments for CSP. Furthermore, we performed a separate sub-group analysis only including studies which reported on the outcomes of elective treatments. Random effects meta-analyses were used to analyze the data and results reported as pooled proportions or odd ratio (OR). Results: 176 studies (13431 women with CSP undergoing treatment) were included. Successful treatment after primary intervention was achieved in 86.2% (95% CI 82.3–89.7) of women with CSP undergoing treatment with ultrasound guided suction curettage, 72.4% (95% CI 64.8-79.3) with systemic MTX, 81.6% (95% CI 72.3–89.3) with local MTX, 83.9% (95% CI 66.7–95.6) with interventional radiology, 90.42% (95% CI 82.9–96.0) with hysteroscopy, 96.1% (95% CI (92.3–98.6) with laparoscopy and 92.6 with high intensity focused ultrasound (95% CI 78.2–99.6). Post-treatments complications were reported in 3.5% (95% CI 1.7–6.0) of women treated with systemic MTX, 5.9% (95% CI 0.8–15.1) with local MTX or KCl, 1.2% (95% CI 0.1–3.5) with interventional radiology, 1.4% (95% CI 0.4–2.9) with hysteroscopy, 5.5% (95% CI 0.4–25.7) with high intensity focused ultrasound and in none of the cases treated with ultrasound guided suction curettage. When considering compound treatments, successful resolution of CSP was achieved in 91.9% (95% CI 88.0–95.10) of women treated with interventional radiology followed by curettage, 83.3% (95% CI 68.8–93.8) with systemic MTX and curettage, 79.4% (95% CI 56.3–95.2) with local MTX and curettage, 96.2% (95% CI 92.3–98.7) with curettage followed by single or double balloon insertion in the uterine cavity, 98.3% (95% CI 95.9–99.7) with high intensity focused ultrasound followed by curettage, 91.1% (95% CI 3.4–97.0) with interventional radiology followed by removal of CSP with hysteroscopy, 64.3% (95% CI 13.8–99.2) with interventional radiology and systemic MTX and in 95.5% (95% CI 92.9–97.5) with curettage and hysteroscopy. When considering studies reporting a comparison between different treatments, there was no difference between systemic vs local MTX in the primary outcome. Curettage was associated with a higher chance of achieving a successful treatment. Conclusions: A multitude of treatments for CSP have been reported in the published literature. All treatments described for CSP are apparently equally effective in treating this condition. The findings from this systematic review highlight the need for adopting a common definition and outcome reporting of CSP to better elucidate its natural history, estimate the magnitude of maternal complication after treatment and design appropriately powered RCT to elucidate the optimal treatment of CSP according to its ultrasound phenotype and gestational age at treatment, in terms of effective resolution of the condition and risk of post-intervention complications. [ABSTRACT FROM AUTHOR]

Background: Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown. Objectives: The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality. Search Strategy: We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms 'caesarean scar ectopic pregnancy and caesarean scar pregnancy'. Selection Criteria: We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English. Data Collection and Analysis: Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models. Main Results: A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3–4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503). Conclusions: This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high‐quality research that is both useful and relevant to patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the natural progression of ovarian endometrioma in women who are managed expectantly. Methods: This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. Results: A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26–51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49–71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1–5) and the median follow‐up time was 634 (range, 187–2984) days. A total of 39/83 (47% (95% CI, 36–58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13–32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22–42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was −2.7 (range, −57.7 to 39.3) mm, with a median annual regression rate of −1.7 (range, −24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow‐up (median diameter, 22.3 (range, 6.7–77.0) mm vs 18.5 (range, 5.0–72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. Conclusions: In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is acute haemoperitoneum that is managed conservatively a precursor of deep endometriosis? SUMMARY ANSWER Our study provides evidence to suggest that acute haemoperitoneum may lead to the development of deep endometriosis in a significant proportion of cases. WHAT IS KNOWN ALREADY A recent pilot study was the first to suggest that acute haemoperitoneum could be a precursor of deep endometriosis. However, the sample size was small, and the follow-up was not standardized owing to unknown rates of clot absorption and development of endometriosis. STUDY DESIGN, SIZE, DURATION This was a prospective observational cohort study conducted at a single centre over a 31-month period. A required sample size of 30 was calculated using results from a previous study, with a minimum of 15 women each in the groups with and without significant haemoperitoneum (study and control groups, respectively). A total of 59 women were recruited to the study and eight were lost to follow-up. The final sample comprised 51 women, 15 in the study group and 36 in the control group. PARTICIPANTS/MATERIALS, SETTING, METHODS All non-pregnant, premenopausal women aged 18–50 years who consecutively presented to our dedicated gynaecological diagnostic unit with severe acute lower abdominal pain were eligible for this study. We only included women who were clinically stable and were suitable for conservative management. Those with prior history or evidence of endometriosis on their initial ultrasound scan, previous hysterectomy, or bilateral oophorectomy were excluded. Participants had standardized follow-up visits for 6 months, with pelvic ultrasound scans and the British Society of Gynaecological Endoscopy pelvic pain questionnaires completed at each visit. The primary outcome was the sonographically confirmed presence of newly formed endometriosis. Secondary outcomes were the presence and change of pelvic pain symptoms and health-related quality of life (HR-QOL). MAIN RESULTS AND THE ROLE OF CHANCE After completion of follow-up, 7/15 (47%; 95% CI 21.3–71.4%) women presenting with acute haemoperitoneum (study group) developed sonographic evidence of deep endometriosis, compared to 0/36 (0%; 97.5% CI 0.0–9.7%) women in the control group. A ruptured functional haemorrhagic cyst was the most common cause of haemoperitoneum, occurring in 13/15 cases (87%). The time from the initial event to sonographic evidence of endometriosis varied from 2 to 6 months. The EuroQol visual analogue scores were not significantly different at baseline between the groups that developed and did not develop endometriosis [28 (interquartile range (IQR) 15–40, n = 6) vs 56 (IQR 35–75, n = 44), P  =   0.09], while the EuroQol-5D values were lower in the endometriosis group [−0.01 (IQR −0.07 to 0.19, n = 6) vs 0.62 (IQR 0.24–0.73, n = 44), P  =   0.002]. At 6 months, the EuroQol-5D scores were improved in both groups, but remained significantly lower in the endometriosis group compared to the no endometriosis group [0.69 (IQR 0.66–0.80, n = 6) vs 0.85 (IQR 0.76–1.00, n = 44), P  =   0.03]. There was no clinically relevant difference in the pelvic pain scores at either time point. LIMITATIONS, REASONS FOR CAUTION It remains uncertain whether minimal, superficial endometriosis existed at commencement of the study and had a role in the development of deep endometriosis. Although the ultrasound findings were in keeping with deep endometriosis, this was not confirmed histologically. The pelvic pain and HR-QOL findings could have been influenced by the baseline scores being taken when the patient was admitted with acute pain. Also, the sample size was too small to draw reliable conclusions regarding the impact of newly developed endometriosis on QoL. WIDER IMPLICATIONS OF THE FINDINGS Our study provides further evidence showing that significant haemoperitoneum may be a precursor of deep endometriosis. Haemodynamically stable women presenting with acute pelvic pain and significant haemoperitoneum should be counselled about the risk of developing deep endometriosis. Interventional studies should be carried out in the future to see whether laparoscopy and pelvic washout could prevent development of deep endometriosis. Preventative strategies, including treatment to suppress ovulation and formation of functional cysts, should be further investigated. This includes the combined and progesterone-only contraceptive pills. Larger future studies are also required to assess women over a longer period of time, with adjustment for confounding factors, to evaluate a possible effect on HR-QOL and pain symptoms. STUDY FUNDING/COMPETING INTEREST(S) Funding was obtained from The Gynaecology Ultrasound Centre, London, UK. TT received personal fees from GE, Samsung, Medtronic, and Merck for lectures on ultrasound. TT also received a postdoctoral grant from the South-Eastern Norwegian Health Authority (grant number 2020083). TRIAL REGISTRATION NUMBER researchregistry6472. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy (OEP) with those of tubal ectopic pregnancy (TEP). Methods: This was a retrospective case–control study of women with OEP and those with TEP seen at a single center between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, if a corpus luteum was present within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes, such as blood loss at surgery, need for blood transfusion, length of hospital stay, follow‐up and future pregnancy outcome, between cases of OEP and TEP. Results: Overall, 20 women with OEP were identified and compared to 100 women with TEP. A total of 15/20 (75%) OEPs were diagnosed correctly on the first ultrasound scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared with TEP, OEP was more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%); odds ratio (OR), 10.0 (95% CI, 3.45–29.20); P < 0.01), contain an embryo with cardiac activity (3/20 (15%) vs 2/100 (2%); OR, 8.7 (95% CI, 1.34–55.65); P = 0.02) and have severe hemoperitoneum on ultrasound (9/20 (45%) vs 8/100 (8%); OR, 9.4 (95% CI, 3.01–29.40); P < 0.01), and had a higher volume of blood loss at surgery (median, 700 mL vs 100 mL; P < 0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, one wedge resection) with preservation of the ovary. Only one (5%) case of OEP required a blood transfusion. Conclusions: OEP is more likely than TEP to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting, the majority of OEPs were detected on an ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusion and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. Material and methods: A retrospective single‐center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown‐rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Results: Median CRL of the 17 patients included was 54.1 mm (range: 40.0–85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6–15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250–2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Conclusions: Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs. [ABSTRACT FROM AUTHOR]

Understanding the complex network of protein–protein interactions (PPI) that govern cellular functions is essential for unraveling the molecular basis of biological processes and diseases. Mass spectrometry (MS) has emerged as a powerful tool for studying protein dynamics, enabling comprehensive analysis of protein function, structure, post-translational modifications, interactions, and localization. This article provides an overview of MS techniques and their applications in proteomics studies, with a focus on the replication fork proteome. The replication fork is a multi-protein assembly involved in DNA replication, and its proper functioning is crucial for maintaining genomic integrity. By combining quantitative MS labeling techniques with various data acquisition methods, researchers have made significant strides in elucidating the complex processes and molecular mechanisms at the replication fork. Overall, MS has revolutionized our understanding of protein dynamics, offering valuable insights into cellular processes and potential targets for therapeutic interventions. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? SUMMARY ANSWER The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. WHAT IS KNOWN ALREADY In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. STUDY DESIGN, SIZE, DURATION This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. PARTICIPANTS/MATERIALS, SETTING, METHODS We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. MAIN RESULTS AND THE ROLE OF CHANCE A total of 30/210 (14.0%, 95% CI 9.9–19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P  = 0.003), with an odds ratio of 3.65 (95% CI 1.49–8.89, P  = 0.004). A hCG/C <4.0 was associated with a 1.9% risk of intervention, which accounted for 25.7% of the study population. A similar result was obtained by substituting hCG/C <4.0 with an initial hCG level <100 IU/l, which was associated with 2.0% risk of intervention, and accounted for 23.8% of the study population (P  > 0.05) LIMITATIONS, REASONS FOR CAUTION A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. WIDER IMPLICATIONS OF THE FINDINGS A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. STUDY FUNDING/COMPETING INTEREST(S) No external funding was required for this study. No conflicts of interest are required to be declared. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

The deep drawing process of thick sheet metal for vessel production is carried out by applying a tractrix die with the absence of a blank holder, which has economic benefits for industrial production. The main aim of the paper is the development of a reliable numerical thermo-mechanical model of a silicon brass vessel manufactured by a deep drawing process in a tractrix die and a subsequent ironing process, which includes the previous assembly of the dies with reinforcing rings that creates the required prestresses. The testing of the mechanical properties of silicon brass CuZn24Si was carried out by a standard uniaxial tensile test, thus a flow curve was determined to describe the material behaviour. The initial temperatures of the environment, blank and tools were measured with an infrared thermal imager. A comprehensive finite element stress analysis of the deformable tools was carried out for the assembly phase of the dies, and for workpiece and tools in the deep drawing and ironing processes. The comparison of measured and numerically estimated temperatures had a good agreement, so the developed numerical model was confirmed and validated. This research study demonstrates how different process parameters can be investigated through a reliable and precise numerical model with complementary experimental research for the optimization of industrial technology. [ABSTRACT FROM AUTHOR]

Background: Biological studies suggested that the COVID-19 outbreak in France occurred before the first official diagnosis on January 24, 2020. We investigated this controversial topic using a large collection of chest CTs performed throughout French emergency departments within 6 months before the 1st lockdown. Results: Overall, 49,311 consecutive patients (median age: 60 years, 23,636/49,311 [47.9%] women) with available chest CT images and reports from 61 emergency departments between September 1, 2020, and March 16, 2020 (day before the 1st French lockdown), were retrospectively included in this multicentre study. In the macroscopic analysis of reports automatically (labelled for presence of ground glass opacities [GGOs], reticulations, and bilateral and subpleural abnormalities), we found a significant breakpoint on February 17, 2020, for the weekly time series with 1, 2 and ≥ 3 of these 4 radiological features, with 146/49,311 (0.3%) patients showing bilateral abnormalities and ground glass opacities (GGOs) from that day. According to radiologists, 22/146 (15.1%) CT images showed typical characteristics of COVID-19, including 4/146 (2.7%) before February 2020. According to hospital records, one patient remained without microbial diagnosis, two patients had proven influenza A and one patient had concomitant influenza A and mycoplasma infection. Conclusion: These results suggest that SARS-CoV-2 was not circulating in the areas covered by the 61 emergency departments involved in our study before the official beginning of the COVID-19 outbreak in France. In emergency patients, the strong resemblance among mycoplasma, influenza A and SARS-CoV-2 lung infections on chest CT and the nonspecificity of CT patterns in low prevalence periods is stressed. Critical relevance statement: We proposed here an innovative approach to revisit a controversial 'real' start of the COVID-19 pandemic in France based on (1) a population-level approach combining text mining, time series analysis and an epidemiological dataset and (2) a patient-level approach with careful retrospective reading of chest CT scans complemented by analysis of samples performed contemporarily to the chest CT. We showed no evidence that SARS-CoV-2 was actively circulating in France before February 2020. Key points: 1. Emergency teleradiology databases enable both population-level and patient-level analyses and facilitate revisiting the beginning of the COVID-19 pandemic. 2. The rates of typical COVID-19 chest CTs did not increase before February 2020. 3. Typical COVID-19 chest CTs before February 2020 were diagnosed as influenza A and mycoplasma pneumonia. [ABSTRACT FROM AUTHOR]

Background: Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment. Objectives: To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta‐analysis. Search Strategy: MEDLINE, EMBASE, and CENTRAL from inception till September 2022. Selection Criteria: Randomised trials that evaluated any treatment option for woman with a TEP. Data Collection and Analysis: We performed pairwise and network meta‐analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence‐intervals (CI). Main Results: We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta‐analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta‐analysis showed similar effect‐size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra‐sac instillation vs. expectant RR 0.84, 95% CI 0.63–1.12; methotrexate intra‐sac instillation vs. expectant RR 0.91, 95% CI 0.75–1.10; multi‐dose methotrexate vs. expectant RR 1.00, 95% CI 0.88–1.15; prostaglandin intra‐sac instillation vs. expectant RR 0.75, 95% CI 0.53–1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84–1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85–1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89–1.33). All treatment options showed a higher risk of failure compared to salpingectomy. Conclusions: There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management. [ABSTRACT FROM AUTHOR]

This study aims to develop a comprehensive HEI choice intention (CI) model to understand how social influence (SI), brand equity (BE), and HEI factors influence attitude toward HEI (HEIA) as well as how the HEI attitude is a mediator of the relationship of these variables with the HEI CI. Data collected from 1633 high school seniors via online questionnaires was analyzed using structural equation modelling. The findings show that HEI attitude fully mediates the relationship between SI and HEI fully on CI while partially mediating BE's relationship with CI. This study contributes to the theory by providing a model to measure HEI CI that reflects the important role of attitude during HEI choice. Findings also provide guidance to the practitioners in terms of suggesting marketing strategies to be competitive, especially in the new education outlook emerging from COVID19 experiences. [ABSTRACT FROM AUTHOR]

Objective: To develop core outcome sets (COS) for miscarriage management and prevention. Design: Modified Delphi survey combined with a consensus development meeting. Setting: International. Population: Stakeholder groups included healthcare providers, international experts, researchers, charities and couples with lived experience of miscarriage from 15 countries: 129 stakeholders for miscarriage management and 437 for miscarriage prevention. Methods: Modified Delphi method and modified nominal group technique. Results: The final COS for miscarriage management comprises six outcomes: efficacy of treatment, heavy vaginal bleeding, pelvic infection, maternal death, treatment or procedure‐related complications, and patient satisfaction. The final COS for miscarriage prevention comprises 12 outcomes: pregnancy loss <24 weeks' gestation, live birth, gestation at birth, pre‐term birth, congenital abnormalities, fetal growth restriction, maternal (antenatal) complications, compliance with intervention, patient satisfaction, maternal hospitalisation, neonatal or infant hospitalisation, and neonatal or infant death. Other outcomes identified as important were mental health‐related outcomes, future fertility and health economic outcomes. Conclusions: This study has developed two core outcome sets, through robust methodology, that should be implemented across future randomised trials and systematic reviews in miscarriage management and prevention. This work will help to standardise outcome selection, collection and reporting, and improve the quality and safety of future studies in miscarriage. [ABSTRACT FROM AUTHOR]

Objective: To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. Methods: This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Results: Sixty‐five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23–44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in‐vitro fertilization. There were 10/65 (15% (95% CI, 7–24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31–55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30–54%)) had both. Of the women with ovarian endometrioma who underwent follow‐up, 29/34 (85% (95% CI, 73–97%)) experienced cyst regression, 2/34 (6% (95% CI, 0–14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0–18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14–45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow‐up, 43/51 (84% (95% CI, 74–94%)) experienced nodule regression, 2/51 (4% (95% CI, 0–9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3–21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0–15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3–25%)) women who attended postnatal follow‐up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14–45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39–67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33–67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35–63%)) women with nodules, most commonly in the second trimester. Conclusions: For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion‐to‐anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra‐ and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra‐ and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. Material and methods: This prospective observational cross‐sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter‐rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion‐to‐anal‐verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland–Altman limits of agreement were used to assess the reproducibility of the parameters. Results: The inter‐rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion‐to‐anal‐verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter‐rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra‐rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter‐rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland–Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. Conclusions: This study demonstrated a high intra‐ and inter‐rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components. [ABSTRACT FROM AUTHOR]

Introduction: The natural history of endometriosis is poorly understood, and despite numerous studies, the rate of the disease progression and optimal treatment planning in women who are asymptomatic or experience mild symptoms not requiring treatment are unknown. The aim of this study was to assess the behavior of deep endometriosis in women who are managed expectantly without any medical or surgical intervention. Material and methods: A retrospective cohort study of women diagnosed with deep endometriosis on transvaginal ultrasound scan at the Department of Gynecology, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK, from April 2007 to April 2022. All women attended for at least two ultrasound scans which were carried out by a single expert ultrasound examiner and at least 6 months apart. The number and position of endometriotic nodules were recorded, and the mean diameter of each nodule was calculated from measurements taken in three orthogonal planes. Results: During the study period, 1922 women were found to have moderate or severe deep endometriosis on pelvic ultrasound examination. A total of 135 premenopausal women who were managed expectantly fitted the inclusion criteria. The median number of endometriotic nodules per woman at the initial visit was 2 (range: 0–7), and the median follow‐up time was 666 days (181–2984). In the follow‐up period, 50/135 women (37%, 95% CI: 29–46) developed additional nodules or experienced an increase in nodule size, and 17/135 women (13%, 95% CI: 8–19) had a regression in the number or size of the nodules. In the remaining 68/135 women (50%, 95% CI: 42–59) the disease remained static during the follow‐up. The median change in mean diameter of nodules during the study period per woman was +0.13 mm (−11.67 − +5.83), with an annual growth rate of +0.09 mm/year (−6.65 − +6.45). Conclusions: In our study we found evidence of deep endometriosis progression in just over a third of women. In view of this, asymptomatic or mildly symptomatic women diagnosed with deep endometriosis could be reassured that their disease is unlikely to worsen with time. [ABSTRACT FROM AUTHOR]

The graphic edition of Snyder's On Tyranny (2021) states "truth dies in four modes," which is a contemporary synthesis connected to Klemperer's Language of the Third Reich (1957). The researchers connected these four modes to information literacy (IL) instruction--but would others? The researchers surveyed academic librarians engaged in IL instruction on whether they felt they addressed any of the modes in their work. The researchers also asked whether they believe the ACRL Framework for Information Literacy for Higher Education works to circumvent any of the four modes. Nearly 150 librarians responded and, while most respondents were unfamiliar with the two texts referenced and their thoughts were mixed, many saw their work and the Framework as antagonistically related to Mode 1 (Open Hostility to Verifiable Reality). This paper discusses survey results and their implications for better understanding of how academic librarians engaged in IL instruction view their work in a socio-political context. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy is an important health condition which affects up to 1 in 100 women. Women who present with mild symptoms and low serum human chorionic gonadotrophin (hCG) are often treated with methotrexate (MTX), but expectant management with close monitoring is a feasible alternative. Studies comparing the two treatments have not shown a statistically significant difference in uneventful resolution of ectopic pregnancy, but these studies were too small to define whether certain subgroups could benefit more from either treatment. Material and methods: We performed a systematic review and individual participant data meta‐analysis (IPD‐MA) of randomized controlled trials comparing systemic MTX and expectant management in women with tubal ectopic pregnancy and low hCG (<2000 IU/L). A one‐stage IPD‐MA was performed to assess overall treatment effects of MTX and expectant management to generate a pooled intervention effect. Subgroup analyses and exploratory multivariable analyses were undertaken according to baseline serum hCG and progesterone levels. Primary outcome was treatment success, defined as resolution of clinical symptoms and decline in level of serum hCG to <20 IU/L, or a negative urine pregnancy test by the initial intervention strategy, without any additional treatment. Secondary outcomes were need for blood transfusion, surgical intervention, additional MTX side‐effects and hCG resolution times. Trial registration number: PROSPERO: CRD42021214093. Results: 1547 studies reviewed and 821 remained after duplicates removed. Five studies screened for eligibility and three IPD requested. Two randomized controlled trials supplied IPD, leading to 153 participants for analysis. Treatment success rate was 65/82 (79.3%) after MTX and 48/70 (68.6%) after expectant management (IPD risk ratio [RR] 1.16, 95% confidence interval [CI] 0.95–1.40). Surgical intervention rates were not significantly different: 8/82 (9.8%) vs 13/70 (18.6%) (RR 0.65, 95% CI 0.23–1.14). Mean time to success was 19.7 days (95% CI 17.4–22.3) after MTX and 21.2 days (95% CI 17.8–25.2) after expectant management (P = 0.25). MTX specific side‐effects were reported in 33 MTX compared to four in the expectant group. Conclusions: Our IPD‐MA showed no statistically significant difference in treatment efficacy between MTX and expectant management in women with tubal ectopic pregnancy with low hCG. Initial expectant management could be the preferred strategy due to fewer side‐effects. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical and sonographic characteristics of intramural pregnancy, as well as the available management options and treatment outcomes. Methods: This was a retrospective single‐center study of consecutive patients with a sonographic diagnosis of intramural pregnancy between November 2008 and November 2022. An intramural pregnancy was diagnosed on ultrasound when a pregnancy was implanted within the uterine corpus, above the level of the internal cervical os and separate from the interstitial section of the Fallopian tube, and extended beyond the decidual–myometrial junction. Clinical, ultrasound, relevant surgical and histological information and outcomes were retrieved from each patient's record and analyzed. Results: Eighteen patients were diagnosed with an intramural pregnancy during the study period. Their median age was 35 (range, 28–43) years and the median gestational age at diagnosis was 8 + 1 (range, 5 + 5 to 12 + 0) weeks. Vaginal bleeding with or without abdominal pain was the most common presenting symptom, recorded in eight patients. Nine (50%) patients had a partial and nine (50%) had a complete intramural pregnancy. Embryonic cardiac activity was present in eight (44%) pregnancies. The majority of pregnancies (n = 10 (56%)) were initially managed conservatively, including expectant management in eight (44%) cases, local injection of methotrexate in one (6%) and embryocide in one (6%). Conservative management was successful in nine of the 10 (90%) pregnancies, with a median time to serum human chorionic gonadotropin resolution of 71 (range, 35–143) days. One patient with an ongoing live pregnancy had an emergency hysterectomy for a major vaginal bleed at 20 weeks' gestation. No other patient managed conservatively experienced any significant complication. The remaining eight (44%) patients had primary surgical treatment, comprising transcervical suction curettage in seven (88%) of these cases, while one patient presented with uterine rupture and underwent emergency laparoscopy and repair. Conclusions: We describe the ultrasound features of partial and complete intramural pregnancy, demonstrating key diagnostic features. Our series suggests that, when intramural pregnancy is diagnosed before 12 weeks' gestation, it can be managed either conservatively or by surgery, with preservation of reproductive function in most women. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Free movement inside the internet universe and the ability to adapt to almost every culture they encounter enable monster creations to develop through this process of exploring cultures other than theirs. Perhaps this is one of the qualities that contemporary monster creations need to have in order to become and stay alive. In this article, I argue that the Slender Man myth seems to have adapted in terms of monstrosity in many cultures of the world, where its digital quality is its greatest strength and at the same time its greatest weakness in cultures that do not have the capacity or interest to create an equivalent to it. Instead, the lack of a digital aspect makes the folklore of these countries like the Balkan ones more significant, which sabotages the adaptation of digital monsters into a non-digital monster culture that prides itself on its traditional folk stories and legends, like the rich Balkan culture. These digital products in return end up lost within certain cultures, as they do not have the means or the capacity to develop and adapt because of the clash of the digital and the traditional. [ABSTRACT FROM AUTHOR]

Objectives: To assess using transvaginal ultrasound the prevalence of deep and ovarian endometriosis in premenopausal women attending a general gynecology clinic. We also investigated whether the presence of endometriosis was associated with various demographic factors and other pelvic abnormalities. Methods: This was a prospective observational cohort study carried out between February 2019 and October 2020. Consecutive premenopausal women who attended our general gynecology clinic underwent pelvic ultrasound examination, performed by a single experienced operator. Pregnant women and those with a history of hysterectomy or oophorectomy were excluded. The primary outcome was the prevalence of deep and/or ovarian endometriosis. Secondary outcomes were the anatomical distribution of endometriotic lesions and the association of endometriosis with demographic characteristics and various pelvic abnormalities, which were analyzed using logistic regression and multivariable analysis. Results: A total of 1026 women were included in the final study sample, of whom 194 (18.9% (95% CI, 16.6–21.4%)) had sonographic evidence of deep and/or ovarian endometriosis. Of the 194 women diagnosed with endometriosis, 106 (54.6% (95% CI, 47.4–61.8%)) were diagnosed with endometriotic nodules only, 26 (13.4% (95% CI, 9.0–19.0%)) with ovarian endometriomas only, and 62 (32.0% (95% CI, 25.5–39.0%)) women had evidence of both. There was a total of 348 endometriotic nodules in 168 women, located most frequently in the retrocervical area (166/348; 47.7% (95% CI, 42.4–53.1%)), uterosacral ligaments (96/348; 27.6% (95% CI, 23.0–32.6%)) and bowel (40/348; 11.5% (95% CI, 8.3–15.3%)). Multivariable analysis found significant positive associations between endometriosis and both adenomyosis (odds ratio (OR), 1.72 (95% CI, 1.10–2.69); P = 0.02) and pelvic adhesions (OR, 25.7 (95% CI, 16.7–39.3); P < 0.001), whilst higher parity (OR, 0.44 (95% CI, 0.24–0.81); P = 0.03) and history of Cesarean section (OR, 0.18 (95% CI, 0.06–0.52); P = 0.002) were associated with a lower occurrence of endometriosis. A total of 75/1026 women (7.3% (95% CI, 5.8–9.1%)) underwent laparoscopy within 6 months of pelvic ultrasound examination. There was very good agreement between ultrasound and surgical findings, with a kappa value of 0.84 (95% CI, 0.69–0.99). Conclusions: Deep and/or ovarian endometriosis was present in nearly one in five women attending a general gynecology clinic. There were significant positive associations with adenomyosis and pelvic adhesions and negative associations with higher parity and previous Cesarean section. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, titled "Development of deep endometriosis following acute hemoperitoneum: a prospective ultrasound study," presents the findings of a single-center observational cohort study conducted between August 2019 and March 2022. The study aimed to determine if acute hemoperitoneum, managed conservatively, is a precursor of deep endometriosis. The results showed that 47% of women with acute hemoperitoneum developed sonographic evidence of deep endometriosis, compared to 0% of women without hemoperitoneum. The study suggests that endometrial cells trapped under blood clots may play a role in the development of deep endometriosis. Further research is needed to investigate preventative treatments and assess women's symptoms and quality of life over a longer period. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, explores the clinical significance of left to right uterine venous shunting. The study involved 216 premenopausal patients without gynecological pathology who underwent routine transvaginal ultrasound (TVUS) to assess uterine venous circulation. The researchers found that uterine venous shunting was observed in 20.4% of the patients, and it was significantly associated with a lower BMI and the presence of a dilated left uterine vein. The combination of non-cyclical pelvic pain and dilated uterine veins was also significantly associated with shunting. The findings suggest that left to right uterine shunting may be a causative factor in pelvic congestion syndrome and further investigation is warranted. [Extracted from the article]

This article, titled "OC21.02: Endometrial assessment on ultrasound: why transvaginal scan alone is not good enough?" discusses the effectiveness of a multimodal (MM) sonographic approach compared to transvaginal ultrasound (TVS) alone in assessing endometrial thickness (ET) in women with abnormal uterine bleeding (AUB). The study found that TVS alone resulted in suboptimal ET assessment in 37% of cases, with the most common reasons being adenomyosis, suboptimal angle, and submucosal fibroids. The MM approach was more likely to achieve optimal ET assessment and resulted in significantly lower ET measurements. This could potentially reduce the need for invasive interventions such as hysteroscopy or endometrial biopsy. [Extracted from the article]

A study published in the journal Ultrasound in Obstetrics & Gynecology aimed to validate the accuracy of the "amniotic sac sign" in diagnosing early miscarriage. The study involved 1897 pregnancies from 1890 women across five centers. The results showed that the presence of an amniotic sac without a live embryo had 100% specificity for the diagnosis of miscarriage. Implementing this sign could potentially reduce the number of follow-up visits for pregnancies of uncertain viability by 10%, providing benefits in terms of patient anxiety and financial costs. [Extracted from the article]

This article, titled "Correlation between pelvic pain symptoms and the presence of deep or ovarian endometriosis: a prospective ultrasound study," examines whether women with deep or ovarian endometriosis are more likely to experience pelvic pain symptoms and a lower quality of life compared to women without this condition. The study involved 514 women, 28.4% of whom were diagnosed with endometriosis. The results showed that menstrual dyschezia and difficulty emptying the bladder occurred significantly more frequently in women with endometriosis. However, most pelvic pain symptoms were comparable between the groups with and without endometriosis, suggesting that endometriosis may not always be the source of pain. The study emphasizes the importance of investigating other causes of pain in symptomatic patients before considering high-risk procedures and providing appropriate patient counseling. [Extracted from the article]

Background: Genotype-phenotype analyses of rare diseases often suffer from a lack of power, due to small sample size, which makes identifying significant associations difficult. Sinusoidal obstruction syndrome (SOS) of the liver is a rare but life-threatening complication of hematopoietic stem cell transplantation (HSCT). The alkylating agent busulfan is commonly used in HSCT and known to trigger SOS. We developed a novel pipeline to identify genetic determinants in rare diseases by combining in vitro information with clinical whole-exome sequencing (WES) data and applied it in SOS patients and controls. Methods: First, we analysed differential gene expression in six lymphoblastoid cell lines (LCLs) before and after incubation with busulfan. Second, we used WES data from 87 HSCT patients and estimated the association with SOS at the SNP and the gene levels. We then combined the results of the expression and the association analyses into an association statistic at the gene level. We used an over-representation analysis to functionally characterize the genes that were associated with a significant combined test statistic. Results: After treatment of LCLs with busulfan, 1708 genes were significantly up-, and 1385 down-regulated. The combination of the expression experiment and the association analysis of WES data into a single test statistic revealed 35 genes associated with the outcome. These genes are involved in various biological functions and processes, such as "Cell growth and death", "Signalling molecules and interaction", "Cancer", and "Infectious disease". Conclusions: This novel data analysis pipeline integrates two independent omics datasets and increases statistical power for identifying genotype-phenotype associations. The analysis of the transcriptomics profile of cell lines treated with busulfan and WES data from HSCT patients allowed us to identify potential genetic contributors to SOS. Our pipeline could be useful for identifying genetic contributors to other rare diseases where limited power renders genome-wide analyses unpromising. Trial registration: For the clinical dataset: Clinicaltrials.gov: NCT01257854. https://clinicaltrials.gov/ct2/history/NCT01257854. [ABSTRACT FROM AUTHOR]

Objective: To investigate a possible association between increased uterine venous plexus diameter and chronic pelvic pain in women attending the gynecology clinic.Methods: This was a retrospective study conducted in a tertiary university hospital in London, U.K. Women presenting to the gynecology clinic undergoing transvaginal ultrasound examinations were recruited into the study. The largest trunk of the uterine venous plexus was measured on each side. Blood flow within the uterine veins was categorized into continuous or interrupted flow and evaluated using color and spectral Doppler during normal respiration and Valsalva to demonstrate the presence of reflux. The larger uterine vein diameter and its corresponding blood flow were used for the analysis. The main outcome measures were chronic pelvic pain, uterine venous diameters and type of blood flow.Results: We included 1500 women into the study, 584 [38.9% (95% CI 36.5% to 41.5%)] of whom reported chronic pelvic pain. Dysmenorrhea was the most common type of pelvic pain. Age (p < 0.001), menopausal status (p = 0.02), varicose veins (p = 0.01), adenomyosis (p < 0.001) and endometriosis (p < 0.001) were found to be independently associated with the occurrence of pain. There was no difference in uterine venous diameters between women with and without pain (p = 0.10). Neither vessel diameter (p = 0.47) or type of blood flow (p = 0.07) were significantly associated with the occurrence of pelvic pain.Conclusion: Our findings show that uterine venous diameter alone is not associated with pelvic pain. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

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Virtual Reality (VR) technology is gaining in popularity as a research tool for studying human behavior. However, the use of VR technology for remote testing is still an emerging field. This study aimed to evaluate the feasibility of conducting remote VR behavioral experiments that require millisecond timing. Participants were recruited via an online crowdsourcing platform and accessed a task on the classic cognitive phenomenon "Inhibition of Return" through a web browser using their own VR headset or desktop computer (68 participants in each group). The results confirm previous research that remote participants using desktop computers can be used effectively for conducting time-critical cognitive experiments. However, inhibition of return was only partially replicated for the VR headset group. Exploratory analyses revealed that technical factors, such as headset type, were likely to significantly impact variability and must be mitigated to obtain accurate results. This study demonstrates the potential for remote VR testing to broaden the research scope and reach a larger participant population. Crowdsourcing services appear to be an efficient and effective way to recruit participants for remote behavioral testing using high-end VR headsets. [ABSTRACT FROM AUTHOR]

Objectives: To study the reproductive outcomes of women with a unicornuate uterus and compare them to those of women with no congenital uterine anomaly. Methods: This was a single‐center, retrospective cohort study. Cases were women aged at least 16 years who were diagnosed with a unicornuate uterus on transvaginal/transrectal ultrasound between January 2008 and September 2021. Controls were women with no congenital uterine anomaly matched 1:1 by age and body mass index. The primary outcome was live‐birth rate. Secondary outcomes were pregnancy loss (miscarriage, ectopic pregnancy, termination of pregnancy), preterm delivery, mode of delivery and concomitant gynecological abnormalities (endometriosis, adenomyosis, fibroids). Results: Included in the study were 326 cases and 326 controls. Women with a unicornuate uterus had a significantly lower live‐birth rate (184/388 (47.4%) vs 229/396 (57.8%); P = 0.004) and higher rates of overall miscarriage (178/424 (42.0%) vs 155/465 (33.3%); adjusted odds ratio (aOR), 2.21 (95% CI, 1.42–3.42), P < 0.001), ectopic pregnancy (26/424 (6.1%) vs 11/465 (2.4%); aOR, 2.52 (95% CI, 1.22–5.22), P = 0.01), preterm delivery (45/184 (24.5%) vs 17/229 (7.4%); aOR, 3.04 (95% CI, 1.52–5.97), P = 0.001) and Cesarean delivery (116/184 (63.0%) vs 70/229 (30.6%); aOR, 2.54 (95% CI, 1.67–3.88), P < 0.001). Rudimentary‐horn pregnancies accounted for 7/26 (26.9%) ectopic pregnancies in the study group. Women with a unicornuate uterus were more likely to have endometriosis (17.5% vs 10.7%; P = 0.018) and adenomyosis (26.7% vs 15.6%; P = 0.001), but were not more likely to have fibroids compared with controls. Women with a functional rudimentary horn were more likely to have pelvic endometriosis compared to those without (odds ratio, 2.4 (95% CI, 1.4–4.1), P = 0.002). Conclusions: Pregnant women with a unicornuate uterus should be classified as high risk. Removal of a functional rudimentary horn should be discussed with the patient to prevent a rudimentary‐horn ectopic pregnancy. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

FoxL1+telocytes (TCFoxL1+) are novel gastrointestinal subepithelial cells that form a communication axis between the mesenchyme and epithelium. TCFoxL1+ are strategically positioned to be key contributors to the microenvironment through production and secretion of growth factors and extracellular matrix (ECM) proteins. In recent years, the alteration of the bone morphogenetic protein (BMP) signaling in TCFoxL1+ was demonstrated to trigger a toxic microenvironment with ECM remodeling that leads to the development of pre-neoplastic gastric lesions. However, a comprehensive analysis of variations in the ECM composition and its associated proteins in gastric neoplasia linked to TCFoxL1+ dysregulation has never been performed. This study provides a better understanding of how TCFoxL1+ defective BMP signaling participates in the gastric pre-neoplastic microenvironment. Using a proteomic approach, we determined the changes in the complete matrisome of BmpR1a△FoxL1+ and control mice, both in total antrum as well as in isolated mesenchyme-enriched antrum fractions. Comparative proteomic analysis revealed that the deconstruction of the gastric antrum led to a more comprehensive analysis of the ECM fraction of gastric tissues microenvironment. These results show that TCFoxL1+ are key members of the mesenchymal cell population and actively participate in the establishment of the matrisomic fraction of the microenvironment, thus influencing epithelial cell behavior. [ABSTRACT FROM AUTHOR]

We present the results of the analysis of Type II and anomalous Cepheids using the data from the Kepler K2 mission. The precise light curves of these pulsating variable stars are the key to study the details of their pulsation, such as the period-doubling effect or the presence of additional modes. We applied the Automated Extended Aperture Photometry (autoEAP) to obtain the light curves of the targeted variable stars which were observed. The light curves were Fourier analysed. We investigated 12 stars observed by the K2 mission, seven Type II, and five anomalous Cepheids. Among the Type II Cepheids, EPIC 210622262 shows period-doubling, and four stars have modulation present in their light curves which are different from the period-doubling effect. We calculated the high-order Fourier parameters for the short-period Cepheids. We also determined physical parameters by fitting model atmospheres to the spectral energy distributions. The determined distances using the parallaxes measured by the Gaia space telescope have limited precision below 16 mag for these types of pulsating stars, regardless if the inverse method is used or the statistical method to calculate the distances. The BaSTI evolutionary models were compared to the luminosities and effective temperatures. Most of the Type II Cepheids are modelled with low metallicity models, but for a few of them solar-like metallicity ([Fe/H] = 0.06) model is required. The anomalous Cepheids are compared to low-metallicity single stellar models. We do not see signs of binarity among our sample stars. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What outcomes should be reported in all studies investigating uterus-sparing interventions for treating uterine adenomyosis? SUMMARY ANSWER We identified 24 specific and 26 generic core outcomes in nine domains. WHAT IS KNOWN ALREADY Research reporting adenomyosis treatment is not patient-centred and shows wide variation in outcome selection, definition, reporting and measurement of quality. STUDY DESIGN, SIZE, DURATION An international consensus development process was performed between March and December 2021. Participants in round one were 150 healthcare professionals, 17 researchers and 334 individuals or partners with lived experience of adenomyosis from 48 high-, middle- and low-income countries. There were 291 participants in the second round. PARTICIPANTS/MATERIALS, SETTING, METHODS Stakeholders included active researchers in the field, healthcare professionals involved in diagnosis and treatment, and people and their partners with lived experience of adenomyosis. The core component of the process was a 2-step modified Delphi electronic survey. The Steering Committee analysed the results and created the final core outcome set (COS) in a semi-structured meeting. MAIN RESULTS AND THE ROLE OF CHANCE A total of 241 outcomes was identified and distilled into a 'long list' of 71 potential outcomes. The final COS comprises 24 specific and 26 generic core outcomes across nine domains, including pain, uterine bleeding, reproductive outcomes, haematology, urinary system, life impact, delivery of care, adverse events and reporting items, all with definitions provided by the Steering Committee. Nineteen of these outcomes will apply only to certain study types. Although not included in the COS, the Steering Committee recommended that three health economic outcomes should be recorded. LIMITATIONS, REASONS FOR CAUTION Patients from continents other than Europe were under-represented in this survey. A lack of translation of the survey might have limited the active participation of people in non-English speaking countries. Only 58% of participants returned to round two, but analysis did not indicate attrition bias. There is a significant lack of scientific evidence regarding which symptoms are caused by adenomyosis and when they are related to other co-existent disorders such as endometriosis. As future research provides more clarity, the appropriate review and revision of the COS will be necessary. WIDER IMPLICATIONS OF THE FINDINGS Implementing this COS in future studies on the treatment of adenomyosis will improve the quality of reporting and aid evidence synthesis. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received for this work. T.T. received a grant (grant number 2020083) from the South Eastern Norwegian Health Authority during the course of this work. T.T. receives personal fees from General Electrics and Medtronic for lectures on ultrasound. E.R.L. is the chairman of the Norwegian Endometriosis Association. M.G.M. is a consultant for Abbvie Inc and Myovant, receives research funding from AbbVie and is Chair of the Women's Health Research Collaborative. S.-W.G. is a board member of the Asian Society of Endometriosis and Adenomyosis, on the scientific advisory board of the endometriosis foundation of America, previous congress chair for the World Endometriosis Society, for none of which he received personal fees. E.S. received outside of this work grants for two multicentre trials on endometriosis from the National Institute for Health Research UK, the Rosetrees Trust, and the Barts and the London Charity, he is a member of the Medicines and Healthcare Products Regulatory Agency (MHRA), Medicines for Women's Health Expert Advisory Group, he is an ambassador for the World Endometriosis Society, and he received personal fees for lectures from Hologic, Olympus, Medtronic, Johnson & Johnson, Intuitive and Karl Storz. M.H. is member of the British Society for Gynaecological Endoscopy subcommittee. No other conflict of interest was declared. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objective: To assess the reproducibility of a standardized method of measuring the Cesarean section (CS) scar, CS scar niche and their position relative to the internal os of the uterine cervix by transvaginal ultrasound in pregnant women with a previous full-dilatation CS.Methods: This was a prospective, single-center reproducibility study on women with a singleton pregnancy and a previous full-dilatation CS who underwent transvaginal ultrasound assessment of cervical length and CS scar characteristics at 14-24 weeks' gestation. The CS scar was identified as a hypoechogenic linear discontinuity of the myometrium at the anterior wall of the lower uterine segment or cervix. The CS scar niche was identified as an indentation at the site of the scar with a depth of at least 2 mm. The CS scar position was evaluated by measuring the distance to the internal cervical os. CS scar niche parameters, including its length, depth, width, and residual and adjacent myometrial thickness, were assessed in the sagittal and transverse planes. Qualitative reproducibility was assessed by agreement regarding visibility of the CS scar and niche. Quantitative reproducibility of CS scar measurements was assessed using three sets of images: (1) real-time two-dimensional (2D) images (real-time acquisition and caliper placement on 2D images by two operators), (2) offline 2D still images (offline caliper placement by two operators on stored 2D images acquired by one operator) and (3) three-dimensional (3D) volume images (volume manipulation and caliper placement on 2D images extracted by two operators). Agreement on CS scar visibility and the presence of a niche was analyzed using kappa coefficients. Intraobserver and interobserver reproducibility of quantitative measurements was assessed using Bland-Altman plots.Results: To achieve the desired statistical power, 72 women were recruited. The CS scar was visualized in > 80% of images. Interobserver agreement for scar visualization and presence of a niche in real-time 2D images was excellent (kappa coefficients of 0.84 and 0.85, respectively). Overall, reproducibility was higher for real-time 2D and offline 2D still images than for 3D volume images. The 95% limits of agreement (LOA) for intraobserver reproducibility were between ± 1.1 and ± 3.6 mm for all sets of images; the 95% LOA for interobserver reproducibility were between ± 2.0 and ± 6.3 mm. Measurement of the distance from the CS scar to the internal cervical os was the most reproducible 2D measurement (intraobserver and interobserver 95% LOA within ± 1.6 and ± 2.7 mm, respectively). Overall, niche measurements were the least reproducible measurements (intraobserver 95% LOA between ± 1.6 and ± 3.6 mm; interobserver 95% LOA between ± 3.1 and ± 6.3 mm). There was no consistent difference between measurements obtained by reacquisition of 2D images (planes obtained twice and caliper placed), caliper placement on 2D stored images or volume manipulation (planes obtained twice and caliper placed).Conclusions: The CS scar position and scar niche in pregnant women with a previous full-dilatation CS can be assessed in the second trimester of a subsequent pregnancy using either 2D or 3D volume ultrasound imaging with a high level of reproducibility. Overall, the most reproducible CS scar parameter is the distance from the CS scar to the internal cervical os. The method proposed in this study should enable clinicians to assess the CS scar reliably and may help predict pregnancy outcome. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the acceptance and efficacy of transrectal ultrasound (TRS) in assessing the endometrium in postmenopausal women with an axial uterus.Methods: This was a prospective cross-sectional study conducted between October 2015 and October 2018 of consecutive postmenopausal women with an axial uterus on transvaginal ultrasound (TVS). Women with a known diagnosis of gynecological malignancy were excluded. TRS was offered immediately after TVS without prior bowel preparation. A single operator determined subjectively whether the endometrium was visualized satisfactorily on TVS and TRS. In women with postmenopausal bleeding (PMB), endometrial thickness (ET) was measured and endometrial morphology was categorized as atrophic, uniformly thickened, benign endometrial polyp or endometrial cancer, based on subjective pattern recognition. All women with PMB and a non-atrophic endometrium underwent outpatient endometrial biopsy, hysteroscopy or hysterectomy. The success rate of TRS in assessing satisfactorily the endometrium was compared with that of TVS. In patients with PMB, ET measurements and subjective diagnosis of endometrial cancer on TVS vs TRS were compared.Results: Of the 1553 women who underwent TVS examination, 103 (6.6%) had an axial uterus, of whom 76 (73.8%) presented with PMB. TRS was accepted by 66/103 (64.1%) women with an axial uterus. TRS assessed satisfactorily a significantly higher proportion of endometria compared with TVS (90.9% vs 62.1%; χ2  = 14.1, P < 0.001). In 50 women with PMB and an axial uterus who underwent both TVS and TRS, TVS failed to visualize the endometrium satisfactorily in 15 (30.0%) women, whilst TRS provided satisfactory images in all cases. Among the 35 women with PMB and a satisfactory endometrial assessment on TVS and TRS, measurements of ET on TRS were significantly lower compared to those on TVS (median difference, -1.2 (interquartile range, -3.0 to -0.4) mm). The overall agreement of TVS and TRS on the presence or absence of endometrial cancer using subjective pattern recognition was 30/35 (85.7%; 95% CI, 74.1-97.3%). While all seven cases of histologically confirmed endometrial cancer were diagnosed correctly on TRS, four were misdiagnosed on TVS as benign polyps or uniformly thickened endometrium.Conclusions: TRS is an acceptable and effective way to assess the endometrium in postmenopausal women with an axial uterus. Among women presenting additionally with PMB, TRS is associated with a higher proportion of satisfactory endometrial assessments and fewer misdiagnoses of endometrial cancer by subjective pattern recognition compared with TVS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Study Question: What outcomes should be reported in all studies investigating uterus-sparing interventions for treating uterine adenomyosis?Summary Answer: We identified 24 specific and 26 generic core outcomes in nine domains.What Is Known Already: Research reporting adenomyosis treatment is not patient-centred and shows wide variation in outcome selection, definition, reporting and measurement of quality.Study Design, Size, Duration: An international consensus development process was performed between March and December 2021. Participants in round one were 150 healthcare professionals, 17 researchers and 334 individuals or partners with lived experience of adenomyosis from 48 high-, middle- and low-income countries. There were 291 participants in the second round.Participants/materials, Setting, Methods: Stakeholders included active researchers in the field, healthcare professionals involved in diagnosis and treatment, and people and their partners with lived experience of adenomyosis. The core component of the process was a 2-step modified Delphi electronic survey. The Steering Committee analysed the results and created the final core outcome set (COS) in a semi-structured meeting.Main Results and the Role Of Chance: A total of 241 outcomes was identified and distilled into a 'long list' of 71 potential outcomes. The final COS comprises 24 specific and 26 generic core outcomes across nine domains, including pain, uterine bleeding, reproductive outcomes, haematology, urinary system, life impact, delivery of care, adverse events and reporting items, all with definitions provided by the Steering Committee. Nineteen of these outcomes will apply only to certain study types. Although not included in the COS, the Steering Committee recommended that three health economic outcomes should be recorded.Limitations, Reasons For Caution: Patients from continents other than Europe were under-represented in this survey. A lack of translation of the survey might have limited the active participation of people in non-English speaking countries. Only 58% of participants returned to round two, but analysis did not indicate attrition bias. There is a significant lack of scientific evidence regarding which symptoms are caused by adenomyosis and when they are related to other co-existent disorders such as endometriosis. As future research provides more clarity, the appropriate review and revision of the COS will be necessary.Wider Implications Of the Findings: Implementing this COS in future studies on the treatment of adenomyosis will improve the quality of reporting and aid evidence synthesis.Study Funding/competing Interest(s): No specific funding was received for this work. T.T. received a grant (grant number 2020083) from the South Eastern Norwegian Health Authority during the course of this work. T.T. receives personal fees from General Electrics and Medtronic for lectures on ultrasound. E.R.L. is the chairman of the Norwegian Endometriosis Association. M.G.M. is a consultant for Abbvie Inc and Myovant, receives research funding from AbbVie and is Chair of the Women's Health Research Collaborative. S.-W.G. is a board member of the Asian Society of Endometriosis and Adenomyosis, on the scientific advisory board of the endometriosis foundation of America, previous congress chair for the World Endometriosis Society, for none of which he received personal fees. E.S. received outside of this work grants for two multicentre trials on endometriosis from the National Institute for Health Research UK, the Rosetrees Trust, and the Barts and the London Charity, he is a member of the Medicines and Healthcare Products Regulatory Agency (MHRA), Medicines for Women's Health Expert Advisory Group, he is an ambassador for the World Endometriosis Society, and he received personal fees for lectures from Hologic, Olympus, Medtronic, Johnson & Johnson, Intuitive and Karl Storz. M.H. is member of the British Society for Gynaecological Endoscopy subcommittee. No other conflict of interest was declared.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

This article, titled "EP16.26: Outcome of expectantly managed CSP continued to viability: data from the international Caesarean scar pregnancy registry," examines the outcomes of women with a viable Caesarean scar pregnancy (CSP) who continued their pregnancy to at least 23 weeks. The study compares the outcomes between women who had third-trimester ultrasound signs of placenta accreta spectrum (PAS) and those who did not. The results show that women with a viable CSP have a high risk of requiring a peripartum hysterectomy, even if they do not have signs of PAS. The study suggests that women continuing their CSP should deliver in a tertiary obstetric center with a dedicated PAS service. [Extracted from the article]

This article discusses a study conducted at University College London Hospital to evaluate the use of 3D ultrasound scar features in predicting spontaneous preterm birth (SPTB) in women with previous advanced labor Caesarean delivery. The study analyzed cervical length and Caesarean scar characteristics in pregnant women using transvaginal ultrasound. The results showed that the addition of 3D scar features did not significantly improve the prediction of SPTB or the development of short cervical length. The study suggests that clinical information combined with scar ultrasound features can be used to predict SPTB and short cervical length in pregnant women who have had a previous Caesarean delivery. [Extracted from the article]

This article discusses a study that aimed to explore the relationship between maternal and peripartum factors and the appearance of Caesarean scars on ultrasound within the first year postpartum. The study found that scars located at or below the internal cervical os were significantly more likely to have poor healing compared to lower segment scars. Factors such as uterine hypoperfusion, birthweight over 4000g, and scar position were associated with an increased risk of niche development and reduced healing ratio. The findings suggest that poor healing of Caesarean scars in these locations may potentially affect cervical support in subsequent pregnancies and lead to spontaneous preterm birth. [Extracted from the article]

This article, titled "Intramural ectopic pregnancy: emerging from obscurity – an extended series," presents a retrospective cohort study on intramural pregnancy (IMP). The study analyzed the clinical and sonographic characteristics of IMP, as well as treatment outcomes. The results showed that out of the 21 patients included in the study, 43% had partial IMP and 57% had complete IMP. The majority of patients had previous uterine surgery or concomitant uterine pathology as risk factors. Conservative management was successful in most cases, but it was associated with prolonged resolution times. The article concludes that early diagnosis is crucial for good clinical outcomes, and the management approach depends on factors such as gestation, site, and clinical presentation. [Extracted from the article]

This article discusses the efficacy of systemic methotrexate (MTX) treatment in patients with Caesarean scar pregnancy (CSP), a condition where a blastocyst implants in a uterine scar from a previous Caesarean section. The study analyzed data from 69 patients who received systemic MTX as a first-line treatment. The results showed that secondary treatment was required in 65.2% of patients, and the overall success rate of single-line systemic MTX treatment was 34.8%. Factors such as peak beta-hCG levels, Crown-rump length (CRL), and the presence of a fetal heartbeat were found to be significant predictors of treatment efficacy. The study suggests that alternative methods such as suction evacuation, surgical excision, or balloon treatment should be considered as first-line treatment for CSP. [Extracted from the article]

Transcriptional silencing of 35S rDNA loci inherited from one parental species is occurring relatively frequently in allopolyploids. However, molecular mechanisms by which it is selected for transcriptional silencing remain unclear. We applied NGS, silver staining and bisulfite sequencing to study the structure, expression and methylation landscape of 35S rDNA in two allopolyploids of common origin, allotetraploid Anemone multifida (2n = 4x = 32, genome composition BBDD) and allohexaploid A. baldensis (2n = 6x = 48, AABBDD), and their genome donors, A. sylvestris (2n = 16, AA), A. cylindrica (2n = 16, BB) and A. parviflora (2n = 16, DD). The size of the recovered 35S rDNA units varied from 10,489 bp in A. cylindrica to 12,084 bp in A. sylvestris. Anemone showed an organization typical of most ribosomal 35S rDNA composed of NTS, ETS, rRNA genes, TTS and TIS with structural features of plant IGS sequences and all functional elements needed for rRNA gene activity. The NTS was more variable than the ETS and consisted of SRs which are highly variable among Anemone. Five to six CpGrich islands were found within the ETS. CpG island located adjacent to the transcription initiation site (TIS) was highly variable regarding the sequence size and methylation level and exhibited in most of the species lower levels of methylation than CpG islands located adjacent to the 18S rRNA gene. Our results uncover hypomethylation of A. sylvestrisand A. parviflora-derived 35S rDNA units in allopolyploids A. multifida and A. baldensis. Hypomethylation of A. parviflora-derived 35S rDNA was more prominent in A. baldensis than in A. multifida. We showed that A. baldensis underwent coupled A. sylvestrisderived 35S rDNA array expansion and A. parviflora-derived 35S rDNA copy number decrease that was accompanied by lower methylation level of A. sylvestris-derived 35S rDNA units in comparison to A. parviflora-derived 35S rDNA units. These observations suggest that in A. baldensis nucleolar dominance is directed toward A. sylvestris-derived chromosomes. This work broadens our current knowledge of the 35S rDNA organization in Anemone and provides evidence of the progenitor-specific 35S rDNA methylation in nucleolar dominance [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.Methods: A modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two-dimensional (2D) video recordings (four recordings also included three-dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.Results: Of 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan-shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.Conclusion: Consensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

To evaluate the impact of different ultrasound signs in the management and the role of ultrasound guidance in the surgical evacuation of partial placental tissue retention. This is an observational cohort study and retrospective case assessment of 82 patients with clinical symptoms of partial placental retention following a third trimester singleton livebirth between January 2013 and May 2019. The ultrasound signs were recorded using a standardized protocol and the outcome of the management strategy and the use of ultrasound guidance during any surgical procedure was evaluated. Out of the 64 patients who had a vaginal birth, 25 (39.1%) had a manual removal of the placenta at delivery. Fifteen patients were confirmed as not having retained placental tissue and did not require further treatment. Four patients were referred after failed surgical management and four after failed conservative management. All surgical procedures were vacuum aspiration and forceps removal under continuous ultrasound guidance. A significantly lower gestational age at delivery (p <.05), shorter interval between delivery and ultrasound diagnosis (p <.05) and lower number of patients presenting with heavy bleeding was found in the conservative compared to the surgical management subgroups (p <.05). The incidence of feeding vessels was significantly (p <.05) higher in the surgical than in the conservative management subgroups and associated with increased myometrial vascularity. Six patients developed intra-uterine adhesions. In four of these cases, ultrasound examination showed a hyperechoic mass surrounded by normal myometrial vascularity and no feeding vessel. Ultrasound imaging accurately differentiated between patient with and without partial placental retention after third trimester livebirth. Ultrasound-guided vacuum aspiration is safe and efficient in these cases. [ABSTRACT FROM AUTHOR]