External Validation of the "2021 AAGL Endometriosis Classification": A Retrospective Cohort Study.

STUDY OBJECTIVE: Externally validate the American Association of Gynecologic Laparoscopists (AAGL) staging system against surgical complexity and compare diagnostic accuracy with revised American Society for Reproductive Medicine (rASRM) stage, as was done in original publication. DESIGN: Retrospective, diagnostic accuracy study. SETTING: Multicenter (Sydney, Australia). PATIENTS: A total of 317 patients (January 2016-October 2021) were used in the final analysis. INTERVENTIONS: A database of patients with coded surgical data was analyzed. MEASUREMENTS AND MAIN RESULTS: Three independent observers assigned an AAGL surgical stage (1-4) as the index test and surgical complexity level (A-D) as the reference standard. Results from the most accurate of the 3 observers were used in the final analysis. The weighted kappa score for the overall performance of AAGL stage and rASRM to predict AAGL level was 0.48 and 0.48, respectively (no difference). This represents weaker agreement with AAGL level than was observed in the reference paper, which reported a weighted kappa of 0.62. Diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) for stage 1 to predict level A was 98.5%, 64.3%, 66.3%, and 98.3%; stage 2 to predict level B 31.2%, 90.5%, 27.0%, and 92.1 %; stage 3 to predict level C 12.3%, 94.1%, 59.3%, and 60.7%; stage 4 to predict level D 95.65%, 88.10%, 38.60%, and 99.62%. Area under the receiver operating characteristic curve for A vs B/C/D (cut point 9) was 0.87, A/B vs C/D (cut point 16) was 0.78, and A/B/C vs D (cut point 22) was 0.94. CONCLUSION: There was weak to moderate agreement between AAGL stage and AAGL surgical complexity level. Across all key indicators, the AAGL system did not perform as well in this external validation, nor did it outperform rASRM as it did in the reference paper. Results suggest the system is not generalizable.

Maternal Perfluoroalkyl Substances, Thyroid Hormones, and DIO Genes: A Spanish Cross-sectional Study.

Results of studies on perfluoroalkyl substances (PFASs) and thyroid hormones (THs) are heterogeneous, and the mechanisms underlying the action of PFASs to target THs have not been fully characterized. We examined the relation between first-trimester maternal PFAS and TH levels and the role played by polymorphisms in the iodothyronine deiodinase 1 (DIO1) and 2 (DIO2) genes in this association. Our sample comprised 919 pregnant Spanish women (recruitment = 2003-2008) with measurements of perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), and free thyroxine (FT4), and we genotyped for single-nucleotide polymorphisms in the DIO1 (rs2235544) and DIO2 (rs12885300) genes. We performed multivariate regression analyses between PFASs and THs and included the interaction term PFAS-genotypes in the models. PFHxS was associated with an increase in TSH (% change in outcome [95% CI] per 2-fold PFAS increase = 6.09 [-0.71, 13.4]), and PFOA and PFNA were associated with a decrease in TT3 (-7.17 [-13.5, -0.39] and -6.28 [-12.3, 0.12], respectively). We found stronger associations between PFOA, PFNA, and TT3 for DIO1-CC and DIO2-CT genotypes, although interaction p-values were not significant. In conclusion, this study found evidence of an inverse association between PFOA and TT3 levels. No clear effect modification by DIO enzyme genes was observed.

A Multicenter International Temporal and External Validation Study of the Ultrasound-based Endometriosis Staging System.

STUDY OBJECTIVE: The aim of this study was to validate temporally and externally the ultrasound-based endometriosis staging system (UBESS) to predict the level of complexity of laparoscopic surgery for endometriosis. DESIGN: A multicenter, international, retrospective, diagnostic accuracy study was carried out between January 2016 and April 2018 on women with suspected pelvic endometriosis. SETTING: Four different centers with advanced ultrasound and laparoscopic services were recruited (1 for temporal validation and 3 for external validation). PATIENTS: Women with pelvic pain and suspected endometriosis. INTERVENTIONS: All women underwent a systematic transvaginal ultrasound and were staged according to the UBESS system, followed by classification of laparoscopic level of complexity according to the Royal College of Obstetricians and Gynaecologists (RCOG) levels 1 to 3. MEASUREMENTS AND MAIN RESULTS: UBESS I, II, and III were then correlated with RCOG levels 1, 2, and 3, respectively. A comparison between temporal and external sites (skipping "A") and between each site was performed in terms of the diagnostic accuracy of UBESS to predict RCOG laparoscopic skill level. A total of 317 consecutive women who underwent laparoscopy with suspected endometriosis were included. Complete transvaginal ultrasound and laparoscopic surgical outcomes were available for 293/317 (92.4%). At the temporal site, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of UBESS I to predict RCOG level 1 were 80.0%,73.8%, 94.9%, 97.2%, 60.2%, 14.5%, and 0.3%, respectively; of UBESS II to predict RCOG level 2 were 81.0%, 70.6%, 82.0%, 26.7%, 96.8%, 3.9%, and 0.3%, respectively; of UBESS III to predict RCOG level 3 were 91.0%, 85.7%, 92.4%, 75.0%, 96.1%, 11.3%, and 0.2%, respectively. At the external sites, the results of UBESS I to predict RCOG level 1 were 90.3%, 92.0%, 88.4%, 90.2%, 90.5%, 7.9%, and 0.1% respectively; UBESS II to predict RCOG level 2 were 89.2%, 100.0%, 88.5%, 37.5%, 100.0%, 8.7%, and 0.0%, respectively; and UBESS III to predict RCOG level 3 were 86.0%, 67.6%, 98.2%, 96.2%, 82.1%, 37.8%, and 0.3%, respectively. When patients requiring ureterolysis (i.e., RCOG level 3) in the absence of bowel endometriosis were excluded (n = 54), the sensitivity of UBESS III to correctly classify RCOG level 3 increased from 85.7% to 96.7% at the temporal site (n = 42) and from 67.6% to 96.0% at the external sites (n = 12) (p <.005). CONCLUSION: The results from this external validation study suggest that UBESS in its current form is not generalizable unless there is either or both bowel deep endometriosis and cul-de-sac obliteration present. The major limitation appears to be the misclassification of women who require surgical ureterolysis in the absence of bowel endometriosis.

Evolución del estado de nutrición de yodo en gestantes del area sanitaria de Pamplona / Change over time in the iodine nutritional status of pregnant women from the Pamplona healthcare region

INTRODUCCIÓN: La ingesta adecuada de yodo es esencial durante el embarazo. Sin embargo, una parte de la población gestante de nuestro país persiste en una situación de yododeficiencia. Un estudio previo realizado en embarazadas del área sanitaria de Pamplona mostró una yoduria insuficiente (125 mcg/l) y un bajo consumo de sal yodada. El objetivo del presente trabajo es conocer la ingesta de yodo y analizar la evolución del estado de yodación en gestantes de nuestro medio en los últimos años. MÉTODOS: Estudio observacional de 400 gestantes de primer trimestre sin antecedentes conocidos de enfermedad tiroidea. Se cumplimentó un cuestionario de consumo de yodo. Como marcadores del estado de yodación se analizaron la yoduria en una muestra simple de orina y la tiroglobulina sérica, y se calculó el volumen tiroideo mediante ecografía cervical. RESULTADOS: El 70,5% de las participantes consumía sal yodada (55,3% pregestacional) y el 98,5% suplementos farmacológicos con yodo (dosis 202,6±30,1 mcg/día). La mediana de la yoduria fue 242 mcg/l (138,5-415,5 mcg/l) y de la tiroglobulina 12,3 mcg/l (8,39 mcg/l). El consumo de sal yodada se asoció a mayor yoduria y a un menor volumen tiroideo. No se encontraron diferencias en los parámetros estudiados en función del consumo de lácteos, pescado o huevos. CONCLUSIONES: La ingesta de yodo en gestantes de Pamplona ha aumentado, tanto a expensas del empleo de sal yodada como de la dosis de la suplementación farmacológica. Esto ha permitido alcanzar un estado de yodación adecuado

INTRODUCTION: Adequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. METHODS: An observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. RESULTS: Iodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. CONCLUSIONS: Iodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment.

We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.

Contenido de yodo de la leche convencional ultrapasteurizada (UHT) de vaca: Variaciones a lo largo del año y diferencias regionales. Implicaciones para los estudios epidemiológicos sobre el estado de nutrición de yodo / Iodine contents in conventional ultra-high temperature (UHT) processed cow milk: Changes over the year and regional differences. Implications for epidemiological studies on iodine nutritional status

ANTECEDENTES Y OBJETIVOS: La leche ultrapasteurizada (leche UHT) de vaca es la más consumida en el suroeste europeo. Los objetivos del estudio fueron: 1) describir el patrón que sigue la concentración de yodo (CY) en la leche convencional UHT de vaca a lo largo del año y 2) averiguar si existen diferencias en la CY en este tipo de leche según su procedencia geográfica. MATERIAL Y MÉTODOS: Se compraron briks de leche convencional UHT de vaca de marcas comerciales disponibles en los grandes establecimientos de alimentación de Vitoria-Gasteiz (Araba/Álava) durante 12 meses consecutivos y se determinó su CY mediante cromatografía líquida de alta resolución. RESULTADOS: La mediana (P25-P75) de la CY en la leche (n = 489) fue de 190 (159-235) μg/L. La CY experimentó grandes variaciones a lo largo del año, alcanzando valores máximos entre enero y mayo, 241 (201-272) μg/L, y mínimos entre julio y noviembre, 162 (134-185) μg/L (p < 0,0001). La CY de la leche envasada en Alemania fue significativamente menor que la de las leches envasadas en España y en Francia, 119 (106-156) μg/L frente a 189 (159-229) μg/L y 205 (176-243) μg/L respectivamente (p < 0,0001). CONCLUSIONES: La leche convencional UHT de vaca es una fuente alimentaria muy importante de yodo, pero su CY es altamente variable. Conocer el patrón que sigue la CY en la leche a lo largo del año tiene mucho interés para la planificación de los estudios epidemiológicos sobre el estado de nutrición de yodo en escolares y para la interpretación de los resultados

BACKGROUND AND OBJECTIVES: Ultra-high temperature (UHT) processed cow milk is the milk most commonly consumed in Southwest Europe. The study objectives were: 1) to describe the pattern followed by iodine concentration (IC) in conventional UHT milk over the year, and 2) to find out any differences in IC in this type of milk depending on its geographical origin. MATERIAL AND METHODS: Bricks of conventional UHT cow milk of commercial brands available in food stores in Vitoria-Gasteiz (Araba/Álava), Basque Country (Spain) were bought for 12 consecutive months, and their ICs were measured using high performance liquid chromatography. RESULTS: Median (P25-P75) IC in UHT milk (n = 489) was 190 (159-235) μg/L. IC in milk showed great changes over the year, reaching peak values between January and May (241 [201-272] μg/L), and minimal levels between July and November (162 [134-185] μg/L) (P < .0001). The IC of milk packed in Germany was significantly lower than that of milks packed in Spain and France, 119 (106-156) μg/L versus 189 (159-229) μ g/L and 205 (176-243) μg/L respectively (P < .0001). CONCLUSIONS: Conventional UHT cow milk is a very important nutritional source of iodine, but its IC is highly variable. Knowledge of the pattern followed by IC in milk over the year is of great interest for planning epidemiological studies on iodine nutritional status in schoolchildren and for interpretation of their results

One-Size-Fits-All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills.

OBJECTIVES: To evaluate whether gynecologic surgical trainees (fellows) can become competent in the real-time classification of the pouch of Douglas (POD) obliteration state and direct visualization of bowel deep endometriosis (DE) during a program with a prespecified number of transvaginal ultrasound (TVUS) examinations. METHODS: We performed a prospective study between December 2017 and December 2018. Three fellows (F1-F3) performed 50 scans each, which were all supervised by an expert sonologist, who performed the reference standard TVUS examination. The fellows performed a focused TVUS examination to assess the bowel and POD state, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's official classifications. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. RESULTS: A total of 150 examinations were performed on 145 patients. Twenty-six (17.9%) patients had a diagnosis of bowel DE, and 34 (23.4%) were classified as having a negative sliding sign by the reference standard. The overall accuracy of the presence/absence of bowel DE was 90% (range, 82%-94%). The overall accuracy of POD state classification was 93% (range, 90%-96%). The cumulative summation test for the learning curve for bowel DE showed that F1 did not reach competency by 50 scans, whereas F2 and F3 required 21 and 25 scans, respectively. For POD obliteration, F2 did not reach competency, whereas F1 and F3 required 40 and 22 scans. CONCLUSIONS: Not all trainees can reach competency for TVUS evaluations of POD obliteration and bowel DE in a predefined number of scans.

Ureter Visualization With Transvaginal Ultrasound: A Learning Curve Study.

OBJECTIVES: To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. METHODS: We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. RESULTS: A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. CONCLUSIONS: Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.

Change over time in the iodine nutritional status of pregnant women from the Pamplona healthcare region. / Evolución del estado de nutrición de yodo en gestantes del area sanitaria de Pamplona.

INTRODUCTION: Adequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. METHODS: An observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. RESULTS: Iodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. CONCLUSIONS: Iodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade.

Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy.

STUDY OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasound in predicting a laparoscopic, surgically assigned, revised American Society of Reproductive Medicine (ASRM) endometriosis stage. DESIGN: A multicenter, retrospective, diagnostic accuracy study. SETTING: The patients visited 1 of 2 academic gynecologic ultrasound units and underwent laparoscopy led by 1 of 6 surgeons in metropolitan Sydney, Australia, between 2016 and 2018. PATIENTS: Patients with suspected endometriosis (n = 204). INTERVENTIONS: Ultrasound followed by laparoscopy. MEASUREMENTS AND MAIN RESULTS: Surgical cases were identified. The preoperative ultrasound report and surgical operative notes were each used to retrospectively assign an ASRM score and stage. The breakdown of surgical findings was as follows: ASRM 0 (i.e., no endometriosis), 24/204 (11.8%); ASRM 1, 110/204 (53.9%); ASRM 2, 22/204 (10.8%); ASRM 3, 16/204 (7.8%); ASRM 4, 32 204 (15.7%). The overall accuracy of ultrasound in predicting the surgical ASRM stage was as follows: ASRM 1, 53.4%; ASRM 2, 93.8%; ASRM 3, 89.7%; ASRM 4, 93.1%; grouped ASRM 0, 1, and 2, 94.6%; and grouped ASRM 3 and 4 of 94.6%. Ultrasound had better test performance in higher disease stages. When the ASRM stages were dichotomized, ultrasound had sensitivity and specificity of 94.9% and 93.8%, respectively, for ASRM 0, 1, and 2 and of 93.8% and 94.9%, respectively, for ASRM 3 and 4. CONCLUSION: Ultrasound has high accuracy in predicting the mild, moderate, and severe ASRM stages of endometriosis and can accurately differentiate between stages when ASRM stages are dichotomized (nil/minimal/mild vs moderate/severe). This can have major positive implications on patient triaging at centers of excellence in minimally invasive gynecology for advanced-stage endometriosis.

The Use of Ultrasound in Detecting Endometriosis: Endometriotic Nodule Detected on Ultrasound but not Visualized on Laparoscopy.

The gold standard for diagnosis of endometriosis remains direct visualization at laparoscopy and histological confirmation. However, ultrasound is emerging as a key modality in detecting endometriosis. This case demonstrates how ultrasound has the ability to detect lesions that may not be visible on laparoscopy. A left uterosacral ligament (LUSL) deep endometriosis (DE) nodule was detected on preoperative ultrasound. During laparoscopy, no abnormalities were visualized at that site. Given ultrasound's high specificity for DE, the LUSL was resected; histopathology confirmed DE. This case demonstrates the utility of ultrasound and its ability to detect lesions that may not be visible to a surgeon's eye at laparoscopy. Laparoscopy may fail to identify not only sites of endometriosis but also the extent of infiltration of the disease. The utility of ultrasound for pre-operative mapping can guide surgeons in targeted excision of all lesions at the time of surgery, potentially leading to lower rates of suboptimal resection and residual disease. Interestingly, this case may support the theory of müllerianosis, whereby, during fetal organogenesis, misplaced endometrial tissue develops into endometriosis, allowing it to potentially later manifest as DE.

La nutrición de yodo en España. Necesidades para el futuro / Iodine nutrition status in Spain Needs for the future

Aunque la nutrición de yodo en España ha mejorado en los últimos años, el problema no está resuelto del todo. Es preciso que las Instituciones sanitarias establezcan medidas para garantizar que la nutrición de yodo de toda la población sea la adecuada, especialmente entre los colectivos de mayor riesgo (niños y adolescentes, mujeres en edad fértil, mujeres embarazadas y madres lactantes). Debe aconsejarse un bajo consumo de sal, pero que esta sea yodada. También es imprescindible que las agencias de control alimentario establezcan un control efectivo sobre una adecuada yodación de la sal. En las futuras encuestas de salud debería incluirse indicadores sobre la nutrición de yodo. El estudio EUthyroid y la Declaración de Cracovia sobre la nutrición de yodo brindan una oportunidad para establecer un plan paneuropeo para la prevención de la deficiencia de yodo que debería ser considerada y aprovechada por las autoridades sanitarias

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities

Iodine nutrition status in Spain Needs for the future. / La nutrición de yodo en España. Necesidades para el futuro.

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.

Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts.

PURPOSE: As a component of thyroid hormones, adequate iodine intake is essential during pregnancy for fetal neurodevelopment. Across Europe, iodine deficiency is common in pregnancy, but data are lacking on the predictors of iodine status at this life stage. We, therefore, aimed to explore determinants of iodine status during pregnancy in three European populations of differing iodine status. METHODS: Data were from 6566 pregnant women from three prospective population-based birth cohorts from the United Kingdom (ALSPAC, n = 2852), Spain (INMA, n = 1460), and The Netherlands (Generation R, n = 2254). Urinary iodine-to-creatinine ratio (UI/Creat, µg/g) was measured in spot-urine samples in pregnancy (≤ 18-weeks gestation). Maternal dietary intake, categorised by food groups (g/day), was estimated from food-frequency questionnaires (FFQs). Multivariable regression models used dietary variables (energy-adjusted) and maternal characteristics as predictors of iodine status. RESULTS: Median UI/Creat in pregnant women of ALSPAC, INMA, and Generation R was 121, 151, and 210 µg/g, respectively. Maternal age was positively associated with UI/Creat in all cohorts (P < 0.001), while UI/Creat varied by ethnicity only in Generation R (P < 0.05). Of the dietary predictors, intake of milk and dairy products (per 100 g/day) was positively associated with UI/Creat in all cohorts [ALSPAC (B = 3.73, P < 0.0001); INMA (B = 6.92, P = 0.002); Generation R (B = 2.34, P = 0.001)]. Cohort-specific dietary determinants positively associated with UI/Creat included fish and shellfish in ALSPAC and INMA, and eggs and cereal/cereal products in Generation R. CONCLUSIONS: The cohort-specific dietary determinants probably reflect not only dietary habits but iodine-fortification policies; hence, public-health interventions to improve iodine intake in pregnancy need to be country-specific.

Iodine contents in conventional ultra-high temperature (UHT) processed cow milk: Changes over the year and regional differences. Implications for epidemiological studies on iodine nutritional status. / Contenido de yodo de la leche convencional ultrapasteurizada (UHT) de vaca: Variaciones a lo largo del año y diferencias regionales. Implicaciones para los estudios epidemiológicos sobre el estado de nutrición de yodo.

BACKGROUND AND OBJECTIVES: Ultra-high temperature (UHT) processed cow milk is the milk most commonly consumed in Southwest Europe. The study objectives were: 1) to describe the pattern followed by iodine concentration (IC) in conventional UHT milk over the year, and 2) to find out any differences in IC in this type of milk depending on its geographical origin. MATERIAL AND METHODS: Bricks of conventional UHT cow milk of commercial brands available in food stores in Vitoria-Gasteiz (Araba/Álava), Basque Country (Spain) were bought for 12 consecutive months, and their ICs were measured using high performance liquid chromatography. RESULTS: Median (P25-P75) IC in UHT milk (n=489) was 190 (159-235)µg/L. IC in milk showed great changes over the year, reaching peak values between January and May (241 [201-272]µg/L), and minimal levels between July and November (162 [134-185]µg/L) (P<.0001). The IC of milk packed in Germany was significantly lower than that of milks packed in Spain and France, 119 (106-156)µg/L versus 189 (159-229)µg/L and 205 (176-243)µg/L respectively (P<.0001). CONCLUSIONS: Conventional UHT cow milk is a very important nutritional source of iodine, but its IC is highly variable. Knowledge of the pattern followed by IC in milk over the year is of great interest for planning epidemiological studies on iodine nutritional status in schoolchildren and for interpretation of their results.

A Novel Ultrasound Technique Called Saline Infusion SonoPODography to Visualize and Understand the Pouch of Douglas and Posterior Compartment Contents: A Feasibility Study.

Women with infertility are often investigated with saline-infusion sonohysterography and hysterosalpingo-contrast-sonography. The high prevalence of endometriosis in this population also warrants an evaluation with transvaginal ultrasound for deep endometriosis. To minimize investigations, we prospectively evaluated the feasibility of a novel combined ultrasound technique called saline-infusion sonoPODography. In most patients, the fluid infused to assess the cavity and tubal patency spilled through patent tubes and filled the pouch of Douglas, yielding a "standoff" view of posterior compartment structures, including uterosacral ligaments, rectovaginal septum, and the pouch of Douglas. We believe this improved our ability to evaluate this space.

Optimización del seguimiento de gestantes con enfermedad tiroidea autoinmune / Optimization of the follow-up of pregnant women with autoimmune thyroid disease

Objetivo: Determinar el riesgo de hipotiroidismo en gestantes con enfermedad tiroidea autoinmune y tirotropina (TSH) < 2,5 mUI/l al inicio del embarazo. Métodos: Estudio prospectivo longitudinal en gestantes de primer trimestre sin antecedentes de patología tiroidea y con TSH en primer trimestre < 2,5 mUI/l. Se determinaron TSH, tiroxina libre (T4l) y anticuerpos antiperoxidasa (TPO) y antitiroglobulina en los 3 trimestres. Se comparó la evolución de la función tiroidea y la aparición de hipotiroidismo gestacional (TSH > 4 mUI/l), entre las gestantes con autoinmunidad positiva y autoinmunidad negativa. Resultados: Se incluyeron 300 gestantes con TSH basal 1,3 ± 0,6 mUI/l (semana gestacional 9). El 17,7% (n = 53) tenían autoinmunidad positiva en el primer trimestre. Los títulos de anticuerpos TPO y antitiroglobulina disminuyeron entre el primer y el tercer trimestre un 76,8% y un 80,7% respectivamente. La evolución de la función tiroidea fue similar en el grupo con autoinmunidad positiva y el grupo con autoinmunidad negativa, y la aparición de hipotiroidismo fue del 1,9% (1/53) y del 2% (5/247) respectivamente. Las gestantes en las que la TSH aumentó por encima de 4 mUI/l (n = 6) tenían cifras superiores de TSH basal en comparación con las que mantuvieron TSH≤4 mUI/l a lo largo del embarazo (1,8 vs. 1,3 mUI/l; p = 0,047). Conclusión: En nuestra población, las mujeres con TSH < 2,5 mUI/l al inicio del embarazo tienen un riesgo mínimo de desarrollar hipotiroidismo durante la gestación, independientemente de la autoinmunidad tiroidea

Objective: To determine the risk of hypothyroidism in pregnant women with autoimmune thyroid disease and thyrotropin (TSH) < 2,5 mIU/l at the beginning of pregnancy. Methods: Prospective longitudinal study of pregnant women with no personal history of thyroid disease, and with TSH < 2.5 mIU/l in the first trimester. TSH, free thyroxine (FT4), anti peroxidase (TPO) and anti thyroglobulin antibodies were measured in the 3 trimesters of pregnancy. We compared thyroid function throughout pregnancy, and the development of gestational hypothyroidism (TSH >4 mIU/l) among pregnant women with positive thyroid autoimmunity and those with negative autoimmunity. Results: We included 300 pregnant women with mean baseline TSH 1.3 ± 0.6 mIU/l (9th gestational week). Positive thyroid autoinmunity was detected in 17.7% of women (n = 53) at the first trimester. Between the first and the third trimesters, TPO and anti thyroglobulin antibodies titers decreased 76.8% and 80.7% respectively. Thyroid function during pregnancy was similar among the group with positive autoimmunity and the group with negative autoimmunity, and the development of hypothyroidism was 1.9% (1/53) and 2% (5/247) respectively. Pregnant women in whom TSH increased above 4 mIU/l (n = 6), had higher baseline TSH levels compared to those who maintained TSH ≤4 mIU/l during pregnancy (1.8 vs. 1.3 mIU/l; p=.047). Conclusion: In our population, women with TSH levels <2.5 mIU/l at the beginning of pregnancy have a minimal risk of developing gestational hypothyroidism regardless of thyroid autoimmunity