Post-menopausal metrorrhagia - an ovarian thecoma presentation

Os tecomas são tumores raros do ovário, do grupo dos tumores dos cordões sexuais, de natureza sólida e frequentemente unilaterais. Têm maior incidência no período pósmenopausa e normalmente são silenciosos. Quando sintomáticos traduzem-se por dor pélvica e metrorragia (condicionada pela habitual natureza produtora de estrogénios do tumor). Podem ser concomitantes a síndrome de Meigs e/ou de Golin-Goltz e associaremse a transformação benigna ou maligna do endométrio. Embora a ecografia possa ser inespecífica neste contexto, uma avaliação multiparamétrica abrangente em ressonância magnética, incluindo por estudo dinâmico e com ponderação em difusão, permite frequentemente orientar de modo favorável a marcha diagnóstica. Apresentamos um caso raro de tecoma do ovário, com espessamento associado do endométrio, avaliado por ecografia ginecológica por vias supra-púbica e transvaginal bem como tomografia computorizada e ressonância magnética, confirmado cirurgicamente. Tratou-se de uma examinada caucasiana de 61 anos de idade, apresentando-se com metrorragia pósmenopáusica, sem outros sintomas nem contexto familiar relevante. Procedeu-se, a este propósito, a uma revisão da literatura focada no diagnóstico multimodal diferencial, apresentação clínica, tratamento e prognóstico destes tumores.

Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature

We present a case of a postmenopausal woman diagnosed with an ovarian mass containing thyroid follicles and foci of papillary thyroid carcinoma during pathological examination. This patient referred having had a metachronous thyroid malignancy 10 years before. The differential diagnosis between a thyroid malignancy arising from a struma ovarii and a metastatic ovarian tumor originating from thyroid-cancer is challenging. Struma ovarii should be considered when thyroid components are the predominant element or when thyroid malignant tissue is identified within an ovarian lesion. Thyroid carcinoma arising from a struma ovarii is reported to occur in a minority of cases. Of these, papillary carcinoma is the most frequent subtype encountered. Regarding primary thyroid carcinomas, papillary carcinomas have a lower metastatic potential when compared to follicular carcinomas, and most of the metastases occur in the cervical lymph nodes. Ovarian metastases are exceedingly rare and generally associated with widespread disease. However, they must be considered in the presence of previous history of malignant thyroid carcinoma. The authors review the main clinical, imaging and therapeutic aspects of both these entities and present the most likely diagnosis.

Hydration status using free water reserve in Portuguese adolescents

Introduction: Few data is available about the hydration status of active adolescents in free living conditions. Cell dehydration may be prevalent in healthy, free-living children at school and they could be in a state of chronic voluntary dehydration. Objective: This study aims to describe hydration status assessed by Free Water Reserve (FWR) in adolescents. Method: Two hundred participants (118 girls), aged 13-18 years completed the study. Urinary volume (ml/d) and urinary osmolality (mosm/kg) were measured by one 24h urinary collection, and coefficient of creatinine was used to validate completeness of urine collections. FWR (measured urine volume minus the obligatory urine volume) was used for characterization of hydration status. Positive values of FWR indicate euhydration, negative values the risk of hypo-hydration. Results: Median urinary volume excretion was 1100.0 ml/d for boys and 1025.0 ml/d for girls (p=0.923). Mean urinary osmolality was 715.7±172.3 mosm/kg for boys and 597.42±193.1 mosm/kg for girls (p=0.247). Median FWR (ml/24h) was positive in both sex groups (173.2 ml/d in boys and 373.2 ml/d in girls); however, 40.2% of boys and 31.4% of girls (p=0.195) were at risk of hypo-hydration status. Conclusions: In this sample of adolescents approximately one third was classified as at risk of hypo-hydration status. Preventive measures to increase the level of total water intake should be considered.

Association of follicle stimulating hormone receptor promoter with ovarian response in IVF-ET patients

Background: Poor ovarian response phenomenon has been observed in some of the in vitro fertilization-embryo transfer patients. Some investigations found that follicle stimulating hormone receptor (FSHR) gene plays a role in the process, but no direct evidence shows the correlation between genotypes of FSHR and ovarian response. Objective: Exploring the molecular mechanism behind the mutation of FSHR promoter association with ovarian granulosa cells and poor ovarian response. Materials and Methods: This cross sectional study was performed using 158 women undergoing the controlled short program ovarian stimulation for IVF treatment. The 263 bp DNA fragments before the follicle stimulating hormone (FSH) receptor 5' initiation site were sequenced in the patients under IVF cycle, 70 of which had poor ovarian response and 88 showed normal ovarian responses. Results: With a mutation rate of 40%, 63 in 158 cases showed a 29th site G→A point mutation; among the mutated cases, the mutation rate of the poor ovarian responders was significantly higher than the normal group (60% versus 23.9%; χ2=21.450, p<0.001). Besides, the variability was also obvious in antral follicle count, and ovum pick-ups. The estradiol peak values and the number of mature eggs between the two groups had significant difference. However, there was no obvious variability (t=0.457, p=0.324) in the basic FSH values between the two groups (normal group, 7.2±2.3 U/L; mutation group, 7.1±2.0 U/L). Conclusion: The activity of FSHR promoter is significantly affected by the 29th site G→A mutation that will weaken promoter activity and result in poor response to FSH.

No relationship between most polymorphisms of steroidogenic acute regulatory (StAR) gene with polycystic ovarian syndrome

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine women’s disorders in reproductive age. Hyperandrogenism has a critical role in the etiology of PCOS and it can cause fault in Steroidogenesis process. During steroidogenesis, steroidogenic acute regulatory protein (StAR) seems to increase the delivery of cholesterol through mitochondrial membrane. Therefore, polymorphisms of StAR might effect on this protein and play a role in the etiology of PCOS. Objective: The aim of this study was to investigate the association between StAR SNPs with PCOS. Thus, seven polymorphisms in this gene: rs104894086, rs104894089, rs104894090, rs137852689, rs10489487, rs104894085 were detected. Materials and Methods: In this case control study, 45 PCOS women, 40 male factor/unexplained infertile women, and 40 fertile women as two control groups were participated from 2008-2012. Polymorphisms were detected using restriction fragment length polymorphism (PCR-RFLP) method. Results: Heterozygote genotyping for rs137852689 SNP (amino acid 218 C > T) was only seen in seven PCOS patients, one in normal ovulatory women, and five in male factor/unexplained infertile women (15.5%, 2.5%, 12.5%, respectively) (p= 0.12). While, it has shown no association between other SNPS with PCOs. Conclusion: The RFLP results for seven chosen SNPs, which located in exon 5 and 7 showed normal status in three groups, it means no heterozygous or homozygous forms of selected SNPs were observed. So, it seems evaluation of the active amino acid sites should be investigated and also the study population should be increased.

Effects of aqueous extract from Asparagus officinalis L. roots on hypothalamic-pituitary-gonadal axis hormone levels and the number of ovarian follicles in adult rats

Background: Asparagus is a plant with high nutritional, pharmaceutical, and industrial values. Objective: The present study aimed to evaluate the effect of aqueous extract of asparagus roots on the hypothalamic-pituitary-gonadal axis hormones and oogenesis in female rats. Materials and Methods: In this experimental study, 40 adult female Wistar rats were divided into five groups, which consist 8 rats. Groups included control, sham and three experimental groups receiving different doses (100, 200, 400 mg/kg/bw) of aqueous extract of asparagus roots. All dosages were administered orally for 28 days. Blood samples were taken from rats to evaluate serum levels of Gonadotropin releasing hormone (GnRH), follicular stimulating hormone (FSH), Luteinal hormone (LH), estrogen, and progesterone hormones. The ovaries were removed, weighted, sectioned, and studied by light microscope. Results: Dose-dependent aqueous extract of asparagus roots significantly increased serum levels of GnRH, FSH, LH, estrogen, and progestin hormones compared to control and sham groups. Increase in number of ovarian follicles and corpus luteum in groups treated with asparagus root extract was also observed (p<0.05). Conclusion: Asparagus roots extract stimulates secretion of hypothalamic- pituitary- gonadal axis hormones. This also positively affects oogenesis in female rats.

3D Block Modeling and Reserve Estimation of a Garnet Deposit

The purpose of this project is to develop a three-dimensional block model for a garnet deposit in the Alder Gulch, Madison County, Montana. Garnets occur in pre-Cambrian metamorphic Red Wash gneiss and similar rocks in the vicinity. This project seeks to model the percentage of garnet in a deposit called the Section 25 deposit using the Surpac software. Data available for this work are drillhole, trench and grab sample data obtained from previous exploration of the deposit. The creation of the block model involves validating the data, creating composites of assayed garnet percentages and conducting basic statistics on composites using Surpac statistical tools. Variogram analysis will be conducted on composites to quantify the continuity of the garnet mineralization. A three-dimensional block model will be created and filled with estimates of garnet percentage using different methods of reserve estimation and the results compared.

Tourism environmental attitudes in Berlengas Biosphere Reserve, Portugal

O potencial conflito entre o paradigma de conservação da natureza e o desenvolvimento de atividades de turismo em áreas protegidas exige uma gestão rigorosa. Em alguns casos, o controlo da visitação é uma estratégia para a preservação dos recursos naturais assim como outras ferramentas de gestão tais como a capacidade de carga turística e/ou zonamento, com a definição de áreas de acesso restrito a visitas. A fim de promover a harmonização entre essas duas forças opostas (preservação vs. visitação) algumas áreas protegidas têm mudado o turismo de natureza para o ecoturismo. Isto implica que as atividades turísticas deverão ser focadas numa viagem responsável a áreas naturais, e, ao mesmo tempo, na promoção da conservação do meio ambiente, na interpretação e na educação. No nosso estudo analisamos o potencial do Ecoturismo na Reserva Natural das Berlengas, uma área protegida em Portugal. Foram analisados o perfil, as motivações e o comportamento ambiental dos turistas que visitam as Berlengas. Um questionário bilingue foi elaborado e os dados foram recolhidos a partir de 304 turistas que visitaram as Berlengas, durante os meses de julho e agosto de 2014, o s quais concordaram em colaborar neste estudo. A análise dos nossos resultados permitiu-nos inferir que, de facto, o turista visita a ilha da Berlenga devido ao ambiente natural e à vida selvagem, a visita também está relacionada com as atividades de natureza, tais como, visitar as cavernas de barco, observação da vida selvagem, caminhadas e praia. No entanto, pelo facto dos turistas estarem motivados a visitarem a ilha para se envolverem na natureza não significa que eles tenham consciência pró-ambiental. Encontramos 53,2%/ medio-ecológicos e apenas 37,9% dos turistas pró-ecológico; 8,9% são mesmo anti-ecológicos. Os nossos resultados sugerem que a natureza e a vida selvagem são motivações que não parecem ser suficientes para as pessoas apoiarem verdadeiramente a conservação da natureza e desenvolver comportamentos pró-ambientais. Mas, também verificámos que os turistas com um maior nível de instrução têm uma maior consciência ecológica. Assim, os turistas com maior nível de instrução tendem a ter menos impacto sobre o destino turístico. De acordo com nossos resultados, são apresentadas várias recomendações para a implementação do ecoturismo nas Berlengas.

Novel resistance training-specific rating of perceived exertion scale measuring repetitions in reserve

The primary aim of this study was to compare rating of perceived exertion (RPE) values measuring repetitions in reserve (RIR) at particular intensities of 1 repetition maximum (RM) in experienced (ES) and novice squatters (NS). Furthermore, this investigation compared average velocity between ES and NS at the same intensities. Twenty-nine individuals (24.0 ± 3.4 years) performed a 1RM squat followed by a single repetition with loads corresponding to 60, 75, and 90% of 1RM and an 8-repetition set at 70% 1RM. Average velocity was recorded at 60, 75, and 90% 1RM and on the first and last repetitions of the 8-repetition set. Subjects reported an RPE value that corresponded to an RIR value (RPE-10 = 0-RIR, RPE-9 = 1-RIR, and so forth). Subjects were assigned to one of the 2 groups: (a) ES (n = 15, training age: 5.2 ± 3.5 years) and (b) NS (n = 14, training age: 0.4 ± 0.6 years). The mean of the average velocities for ES was slower (p ≤ 0.05) than NS at 100% and 90% 1RM. However, there were no differences (p > 0.05) between groups at 60, 75%, or for the first and eighth repetitions at 70% 1RM. In addition, ES recorded greater RPE at 1RM than NS (p = 0.023). In ES, there was a strong inverse relationship between average velocity and RPE at all percentages (r = −0.88, p < 0.001), and a strong inverse correlation in NS between average velocity and RPE at all intensities (r = −0.77, p = 0.001). Our findings demonstrate an inverse relationship between average velocity and RPE/RIR. Experienced squatter group exhibited slower average velocity and higher RPE at 1RM than NS, signaling greater efficiency at high intensities. The RIR-based RPE scale is a practical method to regulate daily training load and provide feedback during a 1RM test.

Ace's activity book : fun and facts relating to the ACE Basin Reserve

This activity book is a fun way to reinforce and enrich every student’s ACE Basin experience ... to instill a stronger awareness and respect for environmentalism and conservation, to broaden their knowledge of this area where they co-exist with a diversity of other life forms, and to encourage them to enjoy the adventure and discovery within Coastal South Carolina. These pages can also be used as coloring pages.

Early reserve effects linked to small home ranges of a commercial fish, Diplodus sargus, Sparidae

Studies that combine both the ecological responses of marine species and protection measures with movement patterns and habitat use are of major importance in order to better understand the performance of marine protected areas (MPA) and how species respond to their implementation. However, few studies have assessed MPA performance by relating local individual movement patterns and the observed reserve effects. In this study, we combined acoustic telemetry with abundance estimates to study the early effects of a recently established small coastal MPA on the local populations of white seabream. The results show that even small, recently established coastal MPAs can increase the abundance and biomass of commercial fish species, provided that target species have small home ranges and exhibit high site fidelity.

'Reserve effect' within a temperate marine protected area in the north-eastern Atlantic (Arrabida Marine Park, Portugal)

Benefits of marine protected areas depend on local ecological and socio-cultural aspects which are critical to the success of the protection measures. In particular, before-after comparisons are indispensable to disentangle the effects of protection from those of different physical and ecological characteristics among areas. Using underwater visual surveys, we assessed whether biomass and abundance of temperate reef fish assemblages and target invertebrates increased inside a no-take area in the Arrabida Marine Park (Portugal) 3 to 4 yr after its establishment. Data were compared to a previous study, conducted 10 yr before protection was effective. Control-effect comparisons after reserve establishment showed a positive response of legal-size demersal fish and below legal-size target invertebrates. The first evidence of protection was found in biomass but not in numbers. Non-target groups and below legal-size demersal fish had a significant interaction among reserve and habitat complexity indices for either density or biomass, suggesting a lack of a reserve effect. Before-after comparisons revealed non-significant patterns of increase in numbers of target species compared to non-target ones. The most important commercial species showed the largest increase in density after protection was established. Significantly higher abundances and proportionally heavier individuals of these species were also found inside the reserve in the control-effect comparisons. These findings are reinforced by an increasing trend in landings which are consistent with the early detection of a reserve effect.

Utility and safety of invasive (fractional flow reserve) and non-invasive (cardiac magnetic resonance imaging) diagnostic tests in patients with NSTEMI

A prospective randomised controlled clinical trial of treatment decisions informed by invasive functional testing of coronary artery disease severity compared with standard angiography-guided management was implemented in 350 patients with a recent non-ST elevation myocardial infarction (NSTEMI) admitted to 6 hospitals in the National Health Service. The main aims of this study were to examine the utility of both invasive fractional flow reserve (FFR) and non-invasive cardiac magnetic resonance imaging (MRI) amongst patients with a recent diagnosis of NSTEMI. In summary, the findings of this thesis are: (1) the use of FFR combined with intravenous adenosine was feasible and safe amongst patients with NSTEMI and has clinical utility; (2) there was discordance between the visual, angiographic estimation of lesion significance and FFR; (3). The use of FFR led to changes in treatment strategy and an increase in prescription of medical therapy in the short term compared with an angiographically guided strategy; (4) in the incidence of major adverse cardiac events (MACE) at 12 months follow up was similar in the two groups. Cardiac MRI was used in a subset of patients enrolled in two hospitals in the West of Scotland. T1 and T2 mapping methods were used to delineate territories of acute myocardial injury. T1 and T2 mapping were superior when compared with conventional T2-weighted dark blood imaging for estimation of the ischaemic area-at-risk (AAR) with less artifact in NSTEMI. There was poor correlation between the angiographic AAR and MRI methods of AAR estimation in patients with NSTEMI. FFR had a high accuracy at predicting inducible perfusion defects demonstrated on stress perfusion MRI. This thesis describes the largest randomized trial published to date specifically looking at the clinical utility of FFR in the NSTEMI population. We have provided evidence of the diagnostic and clinical utility of FFR in this group of patients and provide evidence to inform larger studies. This thesis also describes the largest ever MRI cohort, including with myocardial stress perfusion assessments, specifically looking at the NSTEMI population. We have demonstrated the diagnostic accuracy of FFR to predict reversible ischaemia as referenced to a non-invasive gold standard with MRI. This thesis has also shown the futility of using dark blood oedema imaging amongst all comer NSTEMI patients when compared to novel T1 and T2 mapping methods.