Surgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: A Multicentric Cohort Study.

STUDY OBJECTIVE: To investigate the postoperative morbidity of laparoscopic hysterectomy (LH) for endometriosis/adenomyosis in terms of operative outcomes and complications. DESIGN: Retrospective multicentric cohort study. SETTING: Eight European minimally invasive referral centers. PATIENTS: Data from 995 patients with pathologically confirmed endometriosis and/or adenomyosis who underwent LH without concomitant urological and/or gastroenterological procedures from January 2010 to December 2020. INTERVENTIONS: Total LH. MEASUREMENTS AND MAIN RESULTS: Demographic patients' characteristics, surgical outcomes, and intraoperative and postoperative complications were evaluated. We considered major postoperative surgical-related complications, any grade 2 or more events (Clavien-Dindo score) that occurred within 30 days from surgery. Univariate analysis and multivariable models fit with logistic regression were used to estimate the adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) for major complications. Median age at surgery was 44 years (28-54), and about half of them (505, 50.7%) were on medical treatment (estro-progestins, progestin, or Gonadotropin hormone-releasing hormone-analogues) at the time of surgery. In association with LH, posterior adhesiolysis was performed in 387 (38.9%) cases and deep nodule resection in 302 (30.0%). Intraoperative complications occurred in 3% of the patients, and major postoperative complications were registered in 93 (9.3%). The multivariable analysis showed an inverse correlation between the occurrence of Clavien-Dindo >2 complications and age (OR 0.94, 95% CI 0.90-0.99), while previous surgery for endometriosis (OR 1.62, 95% CI 1.01-2.60) and intraoperative complications (OR 6.49, 95% CI 2.65-16.87) were found as predictors of major events. Medical treatment at the time of surgery has emerged as a protective factor (OR 0.50, 95% CI 0.31-0.81). CONCLUSION: LH for endometriosis/adenomyosis is associated with non-negligible morbidity. Knowing the factors associated with higher risks of complications might be used for risk stratification and could help clinicians during preoperative counseling. The administration of estro-progestin or progesterone preoperatively might reduce the risks of postoperative complications following surgery.

Dataset on the global distribution of shallow groundwater.

Shallow groundwater (GW), defined as the water table of unconfined or perched aquifers that is near enough to the land surface to influence the vadose zone and the surface soil moisture, impacts land surface water, energy, and carbon cycles by providing additional moisture to the root zone via capillary fluxes. Although the interactions of shallow GW and the terrestrial land surface are widely recognized, incorporating shallow GW into the land surface, climate, and agroecosystem models is not yet possible due to the lack of groundwater data. Groundwater systems are affected by various factors, including climate, land use/land cover, ecosystems, GW extractions, and lithology. Although GW wells are the most direct and accurate way of monitoring water table depths at point scales, upscaling GW levels from point scale to areal or regional scale poses significant challenges. Here, we provide high spatiotemporal resolution global maps of the terrestrial land surface areas influenced by shallow GW from mid-2015 to 2021 (a separate NetCDF file for each year) in a 9 km spatial and daily temporal resolution. We derived this data from NASA's Soil Moisture Active Passive (SMAP) mission spaceborne soil moisture observations with a temporal resolution of 3 days and approximately 9 km grid resolution. This spatial scale corresponds to SMAP's "Equal Area Scalable Earth" (EASE) grids. The central assumption is that the monthly moving average of soil moisture observations and their coefficient of variation are sensitive to shallow GW regardless of the prevailing climate. We process the Level-2 enhanced passive soil moisture SMAP (SPL2SMP_E) product to detect shallow GW signals. The presence of shallow GW data is calculated by an ensemble machine learning model, which is trained using simulations from a variably saturated soil moisture flow model (Hydrus-1D). The simulations span various climates, soil textures, and lower boundary conditions. The spatiotemporal distribution of shallow GW data based on SMAP soil moisture observations is provided for the first time with this dataset. The data are of value in a wide variety of applications. The most direct use is in climate and land surface models as lower boundary conditions or as a diagnostic tool to verify model results. Some other applications may include flood risk analyses and regulation, identifying geotechnical issues such as shallow GW-triggered liquefaction, global food security, ecosystem services, watershed management, crop yield, vegetation health, water storage trends, and tracking mosquito-borne diseases by identifying wetlands, among other applications.

Fallopian tube tumour presenting as supraclavicular lymph node metastasis.

A 72-year-old woman noted a lump in her left supraclavicular fossa with no other symptoms or other signs on physical exam. A cervical biopsy indicated metastatic carcinoma. On the diagnostic workup: thoracic-abdominal-pelvic CT revealed augmented lymph nodes (LNs) in the retroperitoneum; Positron Emission Tomography-CT showed uptake in the LNs described and in two small areas in the pelvis; blood tests showed elevated CA125 and CA72.4. Another biopsy, considering a para-aortic LN, proved to be metastasis of a high-grade serous carcinoma (HGSC). Gynaecological exam and pelvic imaging were innocent. Diagnostic laparoscopy, including hysterectomy and bilateral adnexectomy, was performed and anatomopathological examination confirmed a HGSC in the fallopian tube (FT), in a tiny focus of 1.5 mm. The patient continued treatment with adjuvant chemotherapy. Literature review indicates that supraclavicular LN as first manifestation of FT carcinoma is not usual, and widespread lymphadenopathies with no macroscopic pelvic disease at diagnosis are even rarer.

Fetal Splenomegaly: A Review.

Enlargement of the fetal spleen is usually found secondary to systemic diseases and is frequently associated with hepatomegaly. By far, the most common causes of fetal splenomegaly are infectious. Other etiologies responsible for this sign are hemolytic anemia, congestive cardiac failure, metabolic disorders, and rarely, leukemia, lymphoma, and histiocytosis.We report a case of prenatal splenomegaly diagnosed at 35 weeks, confirmed in the postnatal period. The postnatal workup showed the newborn had a familial type 3 form of hemophagocytic lymphohistiocytosis (HLH).Hemophagocytic lymphohistiocytosis is an aggressive and life-threatening syndrome of excessive immune activation. The genes implicated in the hereditary forms of the disease act in an autosomal recessive fashion.

Adnexal Torsion in the First Trimester of Pregnancy: Diagnosis, Laparoscopic Management, and Review of the Literature.

We report a case of an adnexal torsion in a 27-year-old woman in her 12th week of gestation. She presented with hypogastric and lumbar pain with biliary vomiting and nausea. Upon physical examination, tenderness in the right lower quadrant with rebound tenderness was apparent, and gynecological examination revealed right adnexal tenderness with absence of abnormal cervical discharge. The transvaginal ultrasonography demonstrated an enlarged cystic right ovary with no flow detected on color and power Doppler mode. We performed a laparoscopy and the diagnosis of adnexal torsion was confirmed. Detorsion of the right adnexa and cystectomy of the ovary was achieved without surgical or anesthetic complications. The patient was supplemented with progesterone during pregnancy and gave birth to a healthy child at term. Adnexal torsion is an unusual cause of abdominal pain in gestation with an incidence of 1-5:10.000, and it is more often observed during the first and early second trimesters of gestation. The clinical signs are often unspecific, and an ultrasound is the most commonly used imaging method for this diagnosis. The laparoscopy is the preferred method of diagnosis and treatment can be safely used in pregnancy if the guidelines are respected.

The fate of Amazonian ecosystems over the coming century arising from changes in climate, atmospheric CO2, and land use.

There is considerable interest in understanding the fate of the Amazon over the coming century in the face of climate change, rising atmospheric CO2 levels, ongoing land transformation, and changing fire regimes within the region. In this analysis, we explore the fate of Amazonian ecosystems under the combined impact of these four environmental forcings using three terrestrial biosphere models (ED2, IBIS, and JULES) forced by three bias-corrected IPCC AR4 climate projections (PCM1, CCSM3, and HadCM3) under two land-use change scenarios. We assess the relative roles of climate change, CO2 fertilization, land-use change, and fire in driving the projected changes in Amazonian biomass and forest extent. Our results indicate that the impacts of climate change are primarily determined by the direction and severity of projected changes in regional precipitation: under the driest climate projection, climate change alone is predicted to reduce Amazonian forest cover by an average of 14%. However, the models predict that CO2 fertilization will enhance vegetation productivity and alleviate climate-induced increases in plant water stress, and, as a result, sustain high biomass forests, even under the driest climate scenario. Land-use change and climate-driven changes in fire frequency are predicted to cause additional aboveground biomass loss and reductions in forest extent. The relative impact of land use and fire dynamics compared to climate and CO2 impacts varies considerably, depending on both the climate and land-use scenario, and on the terrestrial biosphere model used, highlighting the importance of improved quantitative understanding of all four factors - climate change, CO2 fertilization effects, fire, and land use - to the fate of the Amazon over the coming century.

Maximum entropy distributions of scale-invariant processes.

Organizations of many variables in nature such as soil moisture and topography exhibit patterns with no dominant scales. The maximum entropy (ME) principle is proposed to show how these variables can be statistically described using their scale-invariant properties and geometric mean. The ME principle predicts with great simplicity the probability distribution of a scale-invariant process in terms of macroscopic observables. The ME principle offers a universal and unified framework for characterizing such multiscaling processes.

Impact of deforestation in the Amazon basin on cloud climatology.

Shallow clouds are prone to appear over deforested surfaces whereas deep clouds, much less frequent than shallow clouds, favor forested surfaces. Simultaneous atmospheric soundings at forest and pasture sites during the Rondonian Boundary Layer Experiment (RBLE-3) elucidate the physical mechanisms responsible for the observed correlation between clouds and land cover. We demonstrate that the atmospheric boundary layer over the forested areas is more unstable and characterized by larger values of the convective available potential energy (CAPE) due to greater humidity than that which is found over the deforested area. The shallow convection over the deforested areas is relatively more active than the deep convection over the forested areas. This greater activity results from a stronger lifting mechanism caused by mesoscale circulations driven by deforestation-induced heterogeneities in land cover.

Magnetic resonance imaging of self-assembled biomaterial scaffolds.

Current interest in biomaterials for tissue engineering and drug delivery applications have spurred research into self-assembling peptide amphiphiles (PAs). Nanofiber networks formed from self-assembling PAs can be used as biomaterial scaffolds with the advantage of specificity by the incorporation of peptide-epitopes. Imaging the materials noninvasively will give information as to their fate in vivo. We report here the synthesis and in vitro MR images of self-assembling peptide amphiphile contrast agents (PACAs) that form nanofibers. At 400 MHz using a 0.1 mM Gd(III) conjugate of the PA we observed a T(1) three times that of a control gel. The PA derivative was doped into various epitope bearing PA solutions and upon gelling resulted in a homogeneous biomaterial as imaged by MRI.

Self-assembled peptide amphiphile nanofibers conjugated to MRI contrast agents.

Self-assembled peptide amphiphile nanofibers have been investigated for their potential use as in vivo scaffolds for tissue engineering and drug delivery applications. We report here the synthesis of magnetic resonance (MR) active peptide amphiphile molecules that self-assemble into spherical and fiber-like nanostructures, enhancing T(1) relaxation time. This new class of MR contrast agents can potentially be used to combine high-resolution three-dimensional MR fate mapping of tissue-engineered scaffolds with targeting of specific cellular receptors.