The public-sector family planning program impact scores in association with long-acting reversible contraceptive use among young women in 22 Sub-Saharan African countries: A pooled multi-level analysis.

OBJECTIVE: The objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15 to 24. STUDY DESIGN: We conducted this research using a large population database covering several decades' worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants. RESULTS: We found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43-1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70-0.81). CONCLUSIONS: Findings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa IMPLICATIONS: For young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.

Effects of different carbon supplements on phosphorus removal in low C/P ratio industrial wastewater.

This study focuses on the effects of different carbon supplements on biological phosphorus removal in the optonics and semiconductor industrial wastewater treatment. Experimental results demonstrate that the addition of a carbon source (glucose, acetate, and digester supernatant) improved phosphorus removal effectively. When the COD/P ratios were controlled in the range of 18-20 (using glucose and supernatant as supplement), the acclimated sludge showed more than 98% removal of phosphorus. In addition, different organic carbons induce dissimilar behavior in anaerobic release and aerobic uptake of phosphorus. The glucose supplement induces significant phosphorus release in anaerobic phase and then an increased phosphorus uptake in aerobic phase. The released phosphorus descended in anaerobic phase when acetate and supernatant were added. There was a good linear relationship of first order reaction between initial COD concentration and specific substrate utilization rate in anaerobic phase.

Transvaginal sonographic criteria for the diagnosis of adenomyosis based on histopathologic correlation.

OBJECTIVE: To evaluate the accuracy of different transvaginal sonographic criteria in the diagnosis of adenomyosis, and to determine the most useful sonographic feature by comparison with histopathologic results. MATERIALS AND METHODS: A total of 213 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography in this retrospective study. The diagnosis of adenomyosis was made if one or more of the following sonographic findings were present: (1) a globular uterine configuration; (2) poor definition of the endometrial-myometrial interface; (3) sub-endometrial echogenic linear striations; (4) myometrial anterior-posterior asymmetry; (5) myometrial cysts; and (6) a heterogeneous myometrial echotexture. These sonographic findings were then compared with the histopathologic findings. RESULTS: The prevalence of adenomyosis was 39.9%. The sensitivity, specificity, positive and negative predictive values, and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 87.1, 60.1, 59.2, 87.5 and 70.9%, respectively. We found that subendometrial echogenic linear striations, a heterogeneous myometrial echotexture, and myometrial anterior-posterior asymmetry showed greater accuracy for the diagnosis of adenomyosis. Further evaluation of these findings showed that subendometrial echogenic linear striations had the best sensitivity, and positive and negative predictive values for the diagnosis of uterine adenomyosis (91.8, 67.8 and 92.9%, respectively). The presence of a globular uterine configuration was the most specific sonographic feature (78.1%), but showed poor specificity (50.6%). CONCLUSION: The presence of subendometrial echogenic linear striations, a heterogeneous myometrial echotexture, and myometrial anterior-posterior asymmetry on transvaginal ultrasonography supports the diagnosis of adenomyosis. Among the transvaginal ultrasonographic findings consistent with the diagnosis of adenomyosis, subendometrial linear striations had the highest diagnostic accuracy.

A new quantitative method to evaluate adnexal tumors.

OBJECTIVE: The purpose of this study was to assess endometriomas and follicular cysts using a new quantitative method provided by the picture archiving and communication system. MATERIALS AND METHODS: We reviewed our computer ultrasound database of endometriomas and follicular cysts between November 2003 and July 2007. A total of 123 consecutive women diagnosed with an endometrioma or follicular cyst on two-dimensional sonography were re-evaluated using new parameters with the picture archiving and communication system. We chose quantitative tumor density and standard deviation on sonographic images as the new diagnostic parameters. Analysis of variance and Scheffé post hoc test were analyzed to compare the mean tumor density of the endometriomas and follicular cysts. The receiver operating characteristic curve was plotted to choose the cutoff value of the endometrioma tumor density with the best sensitivity and specificity. RESULTS: There was a significant difference when the tumor density of the follicular cyst and endometrioma groups was compared using the vaginal, abdominal or endovaginal approach (p < 0.001). Based on the results of the receiver operating characteristic curve, endovaginal ultrasonography is an excellent diagnostic tool with which to evaluate endometriomas. With endovaginal ultrasonography examination, the best cutoff value of tumor density is 28 and the sensitivity and specificity are 64% and 100%, respectively. CONCLUSION: The use of quantitative tumor density and standard deviation on sonographic images is a potential new diagnostic tool in the assessment of endometriomas and follicular cysts.

Age and prevalence of cervical carcinoma in subsequent hysterectomy following a conization procedure.

OBJECTIVE: To determine the prevalence and age of patients with cervical carcinoma missed by a loop electrosurgical excision procedure. MATERIALS AND METHODS: A total of 253 women with cervical dysplasia who underwent conization and 248 women who later underwent hysterectomy were retrospectively reviewed. The age and prevalence of those with cervical carcinoma diagnosed and missed by conization were determined. RESULTS: Of the 248 patients, 11 cases (4.4%) of cervical carcinoma were missed by cervical conization. The age of those with cervical carcinoma missed by conization was significantly greater than those whose diagnosis was not missed (p < 0.05). CONCLUSION: Women with severe cervical dysplasia who no longer wish to preserve fertility should be advised to undergo hysterectomy if the conization margins are not free of disease. Older women with incomplete resection margins tend to have undiagnosed hidden cervical carcinoma after cervical conization.

Adjuvant concurrent chemoradiotherapy with intensity-modulated pelvic radiotherapy after surgery for high-risk, early stage cervical cancer patients.

PURPOSE: This study was undertaken to assess local control and toxicity with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy (CCRT) for early stage cervical cancer. PATIENTS AND METHODS: Between June 2004 and February 2007, 54 patients with early stage cervical cancer (stage IB-IIA) with high-risk factors for treatment failure after surgery were treated with adjuvant pelvic IMRT and CCRT. Adjuvant chemotherapy consisted of cisplatin (50 mg/m2) weekly for 4 to 6 courses. All the patients received 50.4 Gy of external beam radiotherapy with IMRT in 28 fractions and 6 Gy of high-dose rate vaginal cuff brachytherapy in 3 insertions. RESULTS: Adjuvant CCRT with IMRT provided good local tumor control in posthysterectomy cervical cancer patients with high-risk pathologic features. The 3-year locoregional control and disease-free survival were 93% and 78%, respectively. Histology and lymph node metastasis were indicators for disease-free survival. Low acute and chronic treatment-related toxicities were noted with IMRT. All the patients completed the radiotherapy treatment without any major toxicity. In terms of chronic toxicity, only 1 patient had grade 3 genitourinary toxicity and none had grade 3 gastrointestinal toxicity. CONCLUSION: Our results indicate that adjuvant CCRT with IMRT technique for adjuvant treatment of early stage cervical cancer is associated with excellent local control and low toxicity.

Simvastatin alleviates diabetes-induced VEGF-mediated nephropathy via the modulation of Ras signaling pathway.

AIMS: The activation of Ras signaling and vascular endothelial growth factor (VEGF) expression in mesangial cells is a pathogenic consequence of diabetic nephropathy. We examined the role of simvastatin in modulating Ras signaling and the expression of VEGF in mesangial cells stressed with high doses of glucose in vitro and in vivo. METHODS: For the in vitro studies, we cultured mesangial cells, with or without simvastatin or manumycin A pretreatment, in 35 mM glucose and assayed VEGF activity. For the in vivo studies, we administered simvastatin or manumycin A to streptozocin-induced diabetic rats for 28 days and dissected renal tissues for an immunohistological assessment of Ras and VEGF expression in glomerular cells. RESULTS: We showed that high glucose significantly increased VEGF gene expression and Ras activation. The pretreatment with 10 microM simvastatin and inhibition of Ras activity by manumycin A significantly reversed high glucose promotion of VEGF mRNA expression. Pretreatment with simvastatin and manumycin A clearly affected the activation of Ras promoted by high glucose. Tube-like formations were abundant in high glucose-treated mesangial cells co-cultured with HUVEC. However, the simvastatin and manumycin A treatment group's down-regulated tube formation was comparable to the mesangial cells treated only with high glucose. Exogenous simvastatin and manumycin A treatment alleviated urinary albumin secretion and attenuated Ras activation and VEGF protein expression in the kidneys of diabetic rats. CONCLUSIONS: Ras protein activation is a key mediator of VEGF-induced diabetic nephropathy. By inhibiting Ras activation, simvastatin modulates the high glucose-induced VEGF-mediated signaling pathway in vitro and in vivo.

Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy.

PURPOSE: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. METHODS AND MATERIALS: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m(2)) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. RESULTS: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). CONCLUSION: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT.