Ovulation induction in polycystic ovary syndrome.

The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested. Additional first-line medical alternatives include insulin sensitizers, selective estrogen receptor modulators, and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second-line treatments are ovarian electrocautery and low-dose follicle-stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option as it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS.

Mapping policies for surface water protection zones on forest land in the Nordic-Baltic region: Large differences in prescriptiveness and zone width.

The forest landscape across the Nordic and Baltic regions hosts numerous lakes and watercourses, which must be included in forest management. In this study, national policy designs regarding protection zones for surface waters on forest land were reviewed and compared for the Nordic countries, Estonia and Latvia. The focus was how each country regulates protection zones, whether they are voluntary or mandatory, and the rationale behind adopting a low or high degree of prescriptiveness. Iceland and Denmark had a low degree of policy prescriptiveness, whereas Norway, Estonia and Latvia had a high degree of prescriptiveness. Sweden and Finland relied to a large extent on voluntary commitments. The prescribed zone widths within the region ranged from 1 m to 5 km. The results indicated that land-use distribution, forest ownership structure and historical and political legacies have influenced the varying degrees of prescriptiveness in the region.

Nitrogen dynamics in managed boreal forests: Recent advances and future research directions.

Nitrogen (N) availability plays multiple roles in the boreal landscape, as a limiting nutrient to forest growth, determinant of terrestrial biodiversity, and agent of eutrophication in aquatic ecosystems. We review existing research on forest N dynamics in northern landscapes and address the effects of management and environmental change on internal cycling and export. Current research foci include resolving the nutritional importance of different N forms to trees and establishing how tree-mycorrhizal relationships influence N limitation. In addition, understanding how forest responses to external N inputs are mediated by above- and belowground ecosystem compartments remains an important challenge. Finally, forestry generates a mosaic of successional patches in managed forest landscapes, with differing levels of N input, biological demand, and hydrological loss. The balance among these processes influences the temporal patterns of stream water chemistry and the long-term viability of forest growth. Ultimately, managing forests to keep pace with increasing demands for biomass production, while minimizing environmental degradation, will require multi-scale and interdisciplinary perspectives on landscape N dynamics.

Is the water footprint an appropriate tool for forestry and forest products: the Fennoscandian case.

The water footprint by the Water Footprint Network (WF) is an ambitious tool for measuring human appropriation and promoting sustainable use of fresh water. Using recent case studies and examples from water-abundant Fennoscandia, we consider whether it is an appropriate tool for evaluating the water use of forestry and forest-based products. We show that aggregating catchment level water consumption over a product life cycle does not consider fresh water as a renewable resource and is inconsistent with the principles of the hydrologic cycle. Currently, the WF assumes that all evapotranspiration (ET) from forests is a human appropriation of water although ET from managed forests in Fennoscandia is indistinguishable from that of unmanaged forests. We suggest that ET should not be included in the water footprint of rain-fed forestry and forest-based products. Tools for sustainable water management should always contextualize water use and water impacts with local water availability and environmental sensitivity.

Volumetric ablation of uterine fibroids using Sonalleve high-intensity focused ultrasound in a 3 Tesla scanner--first clinical assessment.

INTRODUCTION: The purpose of this study was to evaluate the feasibility and safety of the Sonalleve high-intensity focused ultrasound (HIFU; Philips Healthcare, Vantaa, Finland) system in ablating uterine fibroids in a 3T magnet. MATERIAL AND METHODS: Seven women were included in this study. Treatment was performed according to the manufacturer's recommendation. Technical data describing the HIFU procedures were collected. On MR images at baseline, immediately and 30 days after ablation, we evaluated the volumes of the uterus, the dominant fibroid and the ablation zone. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire was used to assess potential clinical response. RESULTS: The procedure was technically feasible in all patients. The median number of sonications performed during each procedure was 20 (range 2-27) per patient, the maximum temperature in all sonication cells was about 68°C. The median procedure time was 156 minutes (range 95-164). The non-perfused volume after treatment ranged from 1 to 27 ml and was unchanged or decreased in all but one patient at 30 days follow-up. There were no major adverse events. DISCUSSION: In our 3T magnet the system was able to heat tissue and induce areas of non-enhancement within uterine fibroids without major complications. Clinical benefit remains to be proven.

Improved infarction rates in fibroids after the introduction of contrast-enhanced ultrasound during uterine artery embolization.

BACKGROUND: In order to achieve sustained symptom control and minimize the risk of recurrence, uterine artery embolization (UAE) should aim at complete infarction of all fibroids. PURPOSE: To retrospectively evaluate the infarction rate of uterine fibroids in patients that had undergone uterine artery embolization (UAE) after the introduction of contrast-enhanced ultrasound (CEUS) during UAE procedures at our institution. MATERIAL AND METHODS: Thirty patients treated with UAE between February 2006 and August 2009 were included. MR images obtained before, at 3 months, and 12 months after the procedure were reviewed. We evaluated volume changes in dominant fibroids as well as the infarction rate of all fibroids in each patient. Clinical results were evaluated by reviewing the medical records. The study was approved by the institutional review board. RESULTS: CEUS was technically successfully performed during the UAE procedure in all patients. In five cases the endpoint of embolization was adjusted based on findings at CEUS. The mean volume shrinkage of dominant fibroids was 39.8% after 3 months and 59.8% after 12 months. There was complete infarction of all fibroid tissue in 97% of patients at 3 months and 96% at 12 months. No major complications were observed. CONCLUSION: After the introduction of CEUS during UAE procedures in our institution, high infarction rates were achieved.

Environmental services provided from riparian forests in the Nordic countries.

Riparian forests (RF) growing along streams, rivers and lakes comprise more than 2% of the forest area in the Nordic countries (considering a 10 m wide zone from the water body). They have special ecological functions in the landscape. They receive water and nutrients from the upslope areas, are important habitats for biodiversity, have large soil carbon stores, but may emit more greenhouse gases (GHG) than the uplands. In this article, we present a review of the environmental services related to water protection, terrestrial biodiversity, carbon storage and greenhouse gas dynamics provided by RF in the Nordic countries. We discuss the benefits and trade-offs when leaving the RF as a buffer against the impacts from upland forest management, in particular the impacts of clear cutting. Forest buffers are effective in protecting water quality and aquatic life, and have positive effects on terrestrial biodiversity, particularly when broader than 40 m, whereas the effect on the greenhouse gas exchange is unclear.

Short-term effects of clear-cutting on the water chemistry of two boreal streams in northern Sweden: a paired catchment study.

The effects of clear-cutting on stream-water chemistry in northern Sweden remain largely unexplored. Here we report data collected during a reference period and the first two years after logging in two typical partially harvested northern catchments; the objective was to compare water chemistry along the stream with and without a forest buffer. Two typical uncut reference catchments are included for comparison. Runoff was measured at the outlet of each catchment, and water samples were generally taken every second week and analyzed for 20 constituents. Logging resulted in increased runoff and increased concentrations of sodium, potassium, chloride, total nitrogen, total phosphorus, and suspended material from both catchments. Nitrate (NO3-) leaching increased only from the catchment without a forest buffer. It has not yet been possible to evaluate fully the effects of the forest buffer on the NO3- leaching because the uphill clear-cut area leached minimal amounts of NO3-.

Forest harvest increases runoff most during low flows in two boreal streams.

To understand how forest harvest influences the aquatic environment, it is essential to determine the changes in the flow regime. This paper presents changes in the hydrological regime during the first 2 y after harvest in two catchments of the Balsjö Catchment Study in Sweden. The changes were judged relative to a reference catchment, calibrated during an 18-mo pretreatment period starting in September 2004. From August 2006 through March 2008, there was an average of 35% more runoff from the harvested catchments relative to the reference. The flow increased most during the growing seasons and at base flows (<1 mm d(-1); 58-99% increase), followed by dormant season and intermediate flows (30-43%). No significant changes were observed during the highest flows (over 5 mm d(-1)), except for the spring flood a few weeks after harvest, which was delayed and attenuated. Large relative changes in low flow may influence the ecosystem by altering the aquatic habitat.