Laparoscopic Ovarian Transposition and Ovariopexy for Fertility Preservation in Patients Treated with Pelvic Radiotherapy with or without Chemotherapy.

BACKGROUND: Preservation of fertility in cancer patients of reproductive age is a concern for both the patient and the clinician. In this study, we aimed to study the effectiveness of laparoscopic ovarian transposition or ovariopexy in preserving ovarian function in women undergoing pelvic radiotherapy with or without chemotherapy for pelvic tumours. METHODS: The records of patients who underwent laparoscopic ovarian transposition or ovariopexy prior to pelvic radiation therapy between 2002 and 2018 were reviewed retrospectively. RESULTS: Thirty-nine women or adolescent girls with a diagnosis of cervical cancer (n=15), Hodgkin's lymphoma (n=6) or other types of pelvic tumours (n=18) were included in the study. The majority of patients had bilateral (n=25) or unilateral (n=8) ovarian transposition prior to radiotherapy. Nine out of 10 (90%) patients with soft tissue tumors, Ewing sarcoma or ependymoma, five out of seven (71.4%) patients with Hodgkin's lymphoma, two patients (100%) with rectal and anal cancer, and six out of 15 (40%) with cervical cancer retained ovarian function. Patients with cervical cancer, those who received concomitant chemotherapy and those older than 30 years were more likely to experience ovarian failure. Five patients conceived spontaneously and two women had four live births. CONCLUSION: Laparoscopic repositioning of the ovaries out of the radiation field in order to protect ovarian function in patients receiving radiotherapy appears to be effective in the majority of patients. The procedure seems safe and should be considered either as a sole procedure or in association with other fertility preservation methods prior to pelvic radiotherapy.

Causative Genes in Amyotrophic Lateral Sclerosis and Protein Degradation Pathways: a Link to Neurodegeneration.

Amyotrophic lateral sclerosis (ALS) is a disease caused by the degeneration of motor neurons (MNs) leading to progressive muscle weakness and atrophy. Several molecular pathways have been implicated, such as glutamate-mediated excitotoxicity, defects in cytoskeletal dynamics and axonal transport, disruption of RNA metabolism, and impairments in proteostasis. ALS is associated with protein accumulation in the cytoplasm of cells undergoing neurodegeneration, which is a hallmark of the disease. In this review, we focus on mechanisms of proteostasis, particularly protein degradation, and discuss how they are related to the genetics of ALS. Indeed, the genetic bases of the disease with the implication of more than 30 genes associated with familial ALS to date, together with the important increase in understanding of endoplasmic reticulum (ER) stress, proteasomal degradation, and autophagy, allow researchers to better understand the mechanisms underlying the selective death of motor neurons in ALS. It is clear that defects in proteostasis are involved in this type of cellular degeneration, but whether or not these mechanisms are primary causes or merely consequential remains to be clearly demonstrated. Novel cellular and animal models allowing chronic expression of mutant proteins, for example, are required. Further studies linking genetic discoveries in ALS to mechanisms of protein clearance will certainly be crucial in order to accelerate translational and clinical research towards new therapeutic targets and strategies.

Belatacept Combined With Transient Calcineurin Inhibitor Therapy Prevents Rejection and Promotes Improved Long-Term Renal Allograft Function.

Belatacept, a T cell costimulation blocker, demonstrated superior renal function, lower cardiovascular risk, and improved graft and patient survival in renal transplant recipients. Despite the potential benefits, adoption of belatacept has been limited in part due to concerns regarding higher rates and grades of acute rejection in clinical trials. Since July 2011, we have utilized belatacept-based immunosuppression regimens in clinical practice. In this retrospective analysis of 745 patients undergoing renal transplantation at our center, we compared patients treated with belatacept (n = 535) with a historical cohort receiving a tacrolimus-based protocol (n = 205). Patient and graft survival were equivalent for all groups. An increased rate of acute rejection was observed in an initial cohort treated with a protocol similar to the low-intensity regimen from the BENEFIT trial versus the historical tacrolimus group (50.5% vs. 20.5%). The addition of a transient course of tacrolimus reduced rejection rates to acceptable levels (16%). Treatment with belatacept was associated with superior estimated GFR (belatacept 63.8 mL/min vs. tacrolimus 46.2 mL/min at 4 years, p < 0.0001). There were no differences in serious infections including rates of cytomegalovirus or BK viremia. We describe the development of a costimulatory blockade-based strategy that ultimately allows renal transplant recipients to achieve calcineurin inhibitor-free immunosuppression.

Pain Clinic Referral to Psychological Services Best Addressed with Collaboration.

A case study of a middle aged female with severe musculoskeletal medical conditions causing severe pain is presented. The referral for psychological services was conducted in concordance with the medical treatments. In this case, the complex nature of the severe musculoskeletal medical conditions necessitated intensive care and the collaborative communications provided this to the patient. A tabulation of representative treatments is provided with an explanation of the nature of the collaboration. Outcome data in terms of patient self-reported pain ratings and sleep logging provided evidence of a mild improvement and stability where more negative findings, given the complexity of the medical conditions was expected.

Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon.

OBJECTIVE: This study aims at examining the patterns of 'substance' use in Lebanon among an 'at risk' population, the university students. METHOD: A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered. RESULTS: The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%. CONCLUSION: University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.

[Predictive factors of the delivery method in women with cesarean section scars]. / Facteurs prédictifs de la voie d'accouchement des femmes ayant un utérus cicatriciel.

OBJECTIVE: To determine the independent effect of clinical and non clinical factors on the mode of delivery after previous cesarean section. METHODS: We performed a retrospective multicenter study of 579 women who had previously undergone a cesarean section and who delivered between January 1995 and June 1997. Maternal and perinatal morbidity associated with trial of labor and elective repeat cesarean was assessed. Multiple logistic regression was used to identify prognostic factors for the outcome of a trial of labor. The odds ratios provided indicate the risk of cesarean section when the factor is present. RESULTS: The rate of successful trial of labor was 74.5%. Overall morbidity was not increased in the trial of labor group. The variables of significant predictive value were the Bishop's score (OR = 15.2 for a score < 3; 95% CI: 5.54 to 41.9), an anomaly of the pelvis (OR = 5.89; 95% CI: 2.37 to 14.7), a previous vaginal delivery (OR = 0.27; 95% CI: 0.12 to 0.60), a fetal distress (OR = 4.11; 95% CI: 2.01 to 8.43), the weight gain during pregnancy (OR = 2.01; 95% CI: 1.10 to 3.68), a delivery between 11 p.m. and 7 a.m. (OR = 0.29; 95% CI: 0.13 to 0.66), a hypertension (OR = 3.10; 95% CI: 1.09 to 8.80) and the use of an intra-uterine pressure catheter (OR = 0.26; 95% CI: 0.11 to 0.57). CONCLUSION: A trial of labor should be allowed in most of the women with previous cesarean section. The Bishop's score is the best predictor of the mode of delivery. Induction of labor and a first cesarean for dystocia do not affect the chances of vaginal birth.

Effects of inbreeding on reproduction, weights and survival of Sardi and Beni Guil sheep.

SUMMARY: This study was based on the data of 2943 and 3032 Sardi ewes and lambs and 2737 and 2961 Beni Guil ewes and lambs, collected over 12 years in Kra Kra Station and 19 years in Oued Isly Station, respectively. The effects of inbreeding on performance were examined by using the regression models, in which inbreeding coefficients for the individual and dam were fitted as covariates to models that included other environmental and genetic sources of variation and various performance traits as dependent variables. For Beni Guil lambs, inbreeding of the individual had a negative effect on weight at birth, 30 days and 90 days. The estimates of the effect of a 1% increase in inbreeding were -0.0053, -0.0274, and -0.0469 kg, respectively. Inbreeding of the dam had a significant negative effect on lamb weights in the two breeds, except for the weight at 90 days of Beni Guil lambs. The effects of individual and dam inbreeding did not differ significantly from zero for lamb survival to 90 days. However, litter size at birth and 90 days, as well as litter weight at 90 days, were not affected significantly by either lamb (fetus) or ewe inbreeding. The only exception was the litter weight at 90 days of Beni Guil ewes, which was depressed by 0.0832 for each 1% increase in lamb inbreeding. It was concluded that inbreeding depression is unimportant in open flocks with a low level of inbreeding. RÉSUMÉ: Effets de la consanguinité sur la reproduction, les poids et la viabilité des ovins de races Sardi et Beni Guil L'étude a porté sur 2943 et 3032 performances des brebis et des agneaux de race Sardi collectées sur 12 années à la Ferme de Sélection de Kra Kra, et sur 2737 et 2961 performances des brebis et des agneaux de race Beni Guil enregistrées pendant 19 années à la Ferme de Sélection de Oued Isly. Les effects de la consanguinité sur les performances ont été examinés en utilisant la méthode de régression, par l'introduction des coefficients de consanguinité de l'individu et de la mère comme covariables dans les modèles incluant les autres sources de variation environnementales et génétiques et les différents caractères comme variables dépendantes. La consanguinité de l'agneau a un effet négatif sur les poids à la naissance, 30 j et 90 j des agneaux Beni Guil. Les estimations sont respectivement de -0,0053, -0,0274 et -0,0469 kg pour 1% d'augmentation de la consanguinité. La consanguinité de la mére a un effet négatif sur les poids des agneaux des deux races. Les effets de la consanguinité de l'agneau et de la mère sur la viabilité à 90 j ne sont pas significativement différents de zero. D'un autre cǒté, les tailles de la portée à la naissance et à 90 j, ainsi que le poids de la portée à 90 j ne sont affectés ni par la consanguinité de la brebis ni par celle du foetus, sauf le poids de la portée à 90 j des brebis Beni Guil, qui a été diminué de 0,0832 kg pour chaque 1% d'augmentation de la consanguinité de l'agneau. Il a été conclu que la dépression de consanguinité est sans grande importance dans les troupeaux ouverts ayant des taux de consanguinité faibles.

PTSD: how frequently should the symptoms occur? The effect on epidemiologic research.

The definition of posttraumatic stress disorder (PTSD), like most other psychiatric disorders, relies on descriptive methodology; the formulation of the criteria needed to establish a diagnosis is based on clinical and research findings. We used our data from a community study in Beirut, Lebanon to look at the effect that the frequency of occurrence of individual PTSD symptoms might have on the total PTSD prevalence. We found that the prevalence of PTSD decreased by half if symptoms were required to have occurred at least twice per week. This phenomenon was true whether we considered war or nonwar traumata and was true for the DSM-III-R and the DSM-IV definitions of PTSD.