Attitudes and perceptions of affected women towards endocrine endometriosis therapy: an international survey based on free-word association networks.

STUDY QUESTION: What are the attitudes and perceptions towards endocrine endometriosis therapy? SUMMARY ANSWER: Among the study population, endocrine endometriosis therapies are associated with negative mental images and emotions and there seems to be a pre-therapeutic information deficit on the part of physicians. WHAT IS KNOWN ALREADY: Endocrine therapies, as the current standard of conservative endometriosis treatment, have good efficacy and improve symptoms and quality of life in most patients. Nevertheless, clinical practice repeatedly shows rejection on the part of patients, which may result in reduced compliance and discontinuation of therapy. STUDY DESIGN, SIZE, DURATION: Cross-sectional study among endometriosis patients using a multilingual questionnaire distributed via the most popular social media channels between November 2020 and February 2021. A total of 3348 women participated in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Based on a pilot phase, an international, multilingual online survey was conducted among women affected by endometriosis. The questionnaire included free-word associations and questions about personal medical history, source of information, and demographic data. Mental representations were detected based on modules of the co-occurrence network of associations. MAIN RESULTS AND THE ROLE OF CHANCE: Six modules with different dominant emotional labels emerged from the confluence of associations to endocrine endometriosis therapy mentioned by participants. Five modules reflected negative mental associations, with the most frequently mentioned words being 'side effects', 'pain', 'ineffective', 'depression', and 'uncertainty'. Of the 12 most frequently selected emotions, only 'optimistic' was positive. Side effects affecting mental health are the most important reason for deciding against endocrine therapy in our survey population. Twenty-seven percent of respondents reported knowing little about endocrine therapies for endometriosis. Social media are the most frequently used sources of information and were rated as the most useful. LIMITATIONS, REASONS FOR CAUTION: By translating the questionnaire, questions might have been understood differently depending on the language. By using social media channels for distribution, digitally literate patients were targeted. The survey population might not be representative as patients who are critical/unhappy with therapy are more likely to seek advice from peer groups. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study replicate the findings of a recent survey in three European countries. Given the prevalence of endometriosis and the few emerging pharmaceutical alternatives, these data point to a growing need for further research and development of non-hormonal drugs for treating endometriosis. Most endometriosis patients are young and digitally literate, and much information is obtained from alternative sources, such as social media. Careful education before starting therapy should be taken seriously, and patients' concerns should be addressed individually by health care providers. This could help reduce misunderstanding and misinformation and improve treatment adherence and satisfaction. STUDY FUNDING/COMPETING INTEREST(S): There is no funding or conflict of interest to declare. TRIAL REGISTRATION NUMBER: The trial is not registered at any trial registry.

Ski- and snowboard related open peroneal nerve injury: A 20-year retrospective case series study.

INTRODUCTION: Traumatic peroneal nerve injury (PNI) caused by ski or snowboard edges is a severe but scarcely reported accident. METHODS: In a 20-year retrospective study, all skiers and snowboarders with this injury treated surgically at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Innsbruck, Austria, were included, covering a period from 1999/2000 to 2018/2019. RESULTS: In total, 34 patients were included in this study (30 males (88.2%) and 4 (11.8%) females). Of these 34 injured skiers or snowboarders, 33 (97.1%) were recreational athletes and Non-Austrian citizens, and 21 (61.8%) patients sustained accidental injuries without collision. All of the injuries under investigation, i.e., open lacerations, most often with complete transection, were the patients' main injuries. Surgery was performed with direct coaptation in 24 patients (70.6%), and with a suralis nerve graft in the other 10 patients (29.4%). CONCLUSION: Traumatic laceration of the peroneal nerve at the knee level by sharp ski or snowboard edges is a rare but severe injury. Causes for this injury may be multifactorial. Recommendations to reduce the risk of such an injury may follow general instructions and warnings to skiers and snowboarders regarding equipment, familiarity with the region, as well as appropriate skills and training.

CYP2E1 activity in patients with alcoholic liver disease.

BACKGROUND/AIMS: In addition to the possible toxicological impact of cytochrome P4502E1 (CYP2E1) in alcohol-induced liver damage, its activity can be regarded as a variable for drug action in patients with alcoholic liver disease as CYP2E1 is involved in the metabolism of several drugs, for example, paracetamol and halogenated anesthetics. The purpose of our study was to acquire detailed knowledge of CYP2E1 activity in patients with progressingly severe manifestations of alcoholic liver disease. METHODS: The concentration ratio of 6-hydroxy-chlorzoxazone/chlorzoxazone in plasma 2 h after ingestion of 500 mg chlorzoxazone (so-called metabolic ratio) has been shown to reflect CYP2E1 activity in vivo. We examined CYP2E1 activity in 56 Caucasian inpatients with minor (n=20), more pronounced (n=14) and severe alcoholic liver disease (n=22). Alcohol abusers were compared to healthy teetotallers (n=14). RESULTS: Metabolic ratios were increased 3-fold in actively drinking (ethanol-induced) compared to abstaining (non-induced) patients with alcoholic liver disease (1.19+/-0.84 vs. 0.44+/-0.45, mean+/-SD, (p<0.0001). CYP2E1 activity was significantly lower in non-induced patients with severe alcoholic liver disease (0.19+/-0.10) than in healthy controls (0.50+/-0.28, p<0.01), abstaining alcohol abusers with minor (0.67+/-0.60, p<0.01) and more pronounced alcoholic liver disease (0.53+/-0.31, p<0.01). When non-induced patients with alcoholic liver disease were arranged in progressing order of liver damage (minor, more pronounced, severe alcoholic liver disease), there was a significant decline in CYP2E1 activity (p=0.0008). CONCLUSIONS: In non-induced patients, CYP2E1 activity decreases in line with severity of alcoholic liver disease. CYP2E1-mediated drug metabolism is significantly impaired in severe alcoholic liver disease.

Evaluation of relative fertility of cryopreserved goat sperm.

This study was designed to compare differences in the in vivo fertility of cryopreserved goat semen assessed by heterospermic insemination with differences in in vitro analyses. Five groups of does were inseminated with mixed frozen-thawed semen from different pairs of bucks. The percentage of offspring sired by each buck in the pair was compared with the relative ability of spermatozoa from that frozen-thawed ejaculate to penetrate zona-free hamster ova, relative post-thaw acrosomal integrity, ability to undergo an acrosome reaction during in vitro capacitation, and assessments of sperm motility. In 4 of the 5 different insemination pairs, the ratio of offspring born was other than 1:1. Acrosomal integrity, ability of spermatozoa to undergo an acrosome reaction, and parameters of sperm motility were not correlated with differences in relative fertility in this experiment using ejaculates from fertile bucks. The ability of spermatozoa to fuse with the oocyte plasma membrane was highly correlated with relative in vivo fertility (R2=0.78, P=0.04). This suggests that fusion with the oocyte plasma membrane is an event in the fertilization process in which significant variation exists among fertile bucks. Assessment of ability of spermatozoa to fuse with zona-free hamster ova may contribute to analysis of post-thaw fertility of frozen-thawed buck semen.

In vitro inhibition of mammary cell growth by lactoferrin: a comparative study.

The effect of lactoferrin (Lf) on mammary epithelial cell growth in culture was tested in a comparative study of bovine and human Lf. Bovine Lf was inhibitory to growth of a bovine mammary epithelial cell line, both in the presence and absence of fetal bovine serum in the medium. The growth inhibition activity of bovine Lf was not affected by iron-saturation status of the protein. In contrast with bovine Lf, human Lf had minimal inhibitory activity on bovine cell growth in the presence of serum, and cell growth was stimulated by human Lf in the absence of serum. In the latter case, human Lf may have acted as an iron-transport protein for the cells. Bovine Lf and human Lf had no effect on growth of MCF-7 human breast tumor cells and only minimal inhibitory activity toward the MDA-MB 231 human breast tumor cell line. The effect of bovine Lf on bovine mammary epithelial cells could be prevented by immunoneutralization of the Lf. These results indicate that Lf can be inhibitory to growth of mammary epithelial cells in culture, but this response to specific for the species origin of the Lf and of the mammary cell.

Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism.

Fifty-eight consecutive patients with clinical symptoms of pulmonary embolism/infarction were examined by ultrasound as the first imaging modality. The diagnosis was confirmed in 35 patients by ventilation-perfusion scintigraphy; 13 underwent pulmonary angiography for verification of clinical diagnosis. Seven patients died, necropsy was performed and the diagnosis of pulmonary embolism was confirmed in six cases; three patients were submitted to transthoracic lung biopsy. Intercostal space and an additional small pleural effusion in 48% of the examined patients served as a sonic window for the 5 MHz sector scanner. In 42 of the 54 cases with a final diagnosis of pulmonary embolism/infarction a total of 69, hypoechoic, lesions with a pleural basis were detected. These were conspicuous, predominantly triangular, of a mean size 4.6 x 3.7 cm (range 9 x 8 to 2 x 1.5). A hyperechoic structure with reverberation artefacts suggestive of air was frequently visible in the centre: a sign of segmental involvement. The ultrasound examination yielded a true positive result in 41 cases. The overall sensitivity was 98% and the specificity 66%. The prevalence of pulmonary embolism was 83% and the diagnostic accuracy 90%. This suggests that chest sonography can be an efficient technique in the detection of pulmonary infarction.

[Sonography in salmonella enterocolitis]. / Sonographie bei Salmonellen-Enterokolitis.

27 patients suffering from salmonella enterocolitis--24 proven by stool cultures, 3 confirmed serologically--were examined for ultrasound findings. In 81% the left side gut wall was concentrically thickened up to 7 mm (5-11). Further sonographic findings were: Less demarcated gut wall layers in 33%, hypoechoic gut wall in 48%, polypoid mucosa thickening in 33%. In individual cases enlarged mesenteric lymph nodes, splenomegaly, and ascites were seen. Sonographic changes correlated well with clinical results in respect of the intensity of the illness.

MRI evaluation of amyloid myopathy.

Amyloid myopathy is a rare complication of primary amyloidosis. The magnetic resonance imaging (MRI) features of two patients with amyloid myopathy were studied. Slight prolongation of muscle T1 and T2 relaxation times was evident but the striking abnormality was marked reticulation of the subcutaneous fat. The clinical findings of indurated extremities far exceeds the minimal signal intensity alteration seen in the muscles. The MR appearance of amyloid myopathy differs from that of other neuromuscular conditions in the minimal changes found in muscle, but the striking abnormality seen in subcutaneous fat makes it distinct from many neuromuscular conditions.

Skeletal muscle lymphoma: MRI evaluation.

The magnetic resonance imaging (MRI) features of two cases of malignant lymphoproliferative disease involving skeletal muscle are presented. In both cases involved muscles were quantitatively and subjectively hypointense to fat on T1-weighted spin echo images, hypointense or isointense on T2-weighted spin echo images, and hyperintense on short tau inversion recovery (STIR) images. The findings suggest that lymphoproliferative disease should be considered as an etiology of a skeletal muscle lesion that is hypointense or isointense to fat on T2-weighted spin echo magnetic resonance images.

Epibulbar squamous cell carcinomas in brothers with Xeroderma pigmentosa.

We report two brothers aged 6.6 and 5 years old with the De Sanctis-Cacchione variant of Xeroderma Pigmentosa. They had typically severe skin, and ocular and neurologic involvement. Both had epibulbar squamous cell carcinomas. The oldest presented with a large, invasive, epibulbar mass of the left eye which required enucleation. He also had an invasive squamous cell carcinoma of the right lower lid. The younger brother presented with a smaller papillomatous lesion at the medial limbus of the right eye. After removal, this was found to be squamous cell carcinoma in-situ. Flow cytometry done on the tumors revealed diploidy. The case descriptions, histopathology, and discussion of ocular manifestations are presented.

[Lung infarcts detected with ultrasonography]. / Lungeninfarkte sind sonographisch zu entdecken.

33 patients with clinical signs of pulmonary infarction were investigated by intercostal chest sonography. 40 preponderant triangular sharply outlined echo-poor lesions were detected with an airdense reflex in the centre of the area as a sign of segmental involvement. Sonomorphology of pulmonary infarction is compared to pneumonias (n = 22) and carcinomas (n = 20). The sensitivity of chest sonography in pulmonary infarction is 96%, whereas the diagnostic accuracy is 82%.

Evaluation of a latex agglutination test for the detection of Salmonella and Shigella spp. by using broth enrichment.

We evaluated the Bactigen Salmonella-Shigella Latex Agglutination Slide Test (Wampole Laboratories, Div. Carter-Wallace, Inc., Cranbury, N.J.) for detection of Salmonella and Shigella spp. in enrichment broth cultures (gram-negative broth incubated for 24 h) as part of the routine testing of stool samples. A total of 1,128 stool samples were screened by using this test. Of 29 samples culture positive for Salmonella spp., 25 were positive with the Salmonella test (sensitivity, 86.2%; specificity, 96.2%). Of four stool samples culture positive for Shigella spp., two were detected with the Shigella latex reagent. Overall, the Shigella test had a specificity of 99.2%. Testing of enrichment broth cultures after 24 h of incubation was more sensitive than was testing after 6 h of incubation. When used for direct culture identification, both reagents had a specificity of greater than 98.0%. We conclude that the Salmonella test may be useful as an enrichment broth screening test to detect Salmonella spp.; however, we cannot make any conclusions about the Shigella test because of the low number of culture-positive specimens in this study.

Sexual behavior of male dairy goats: effects of deafferentation of the genitalia.

The following study examines the effects of deafferentation of the penis, scrotum, prepuce and adjacent cutaneous surfaces on the development of mounting behavior in male dairy goats. Ten males underwent surgical deafferentations and 10 males received sham operations at 8 to 12 weeks of age. Mounting and other sexual behaviors were monitored while subjects were cohabiting with male and female penmates and when individually exposed to estrous females. Denervated males mounted penmates less frequently than sham controls and lacked vigorous thrusting behavior. When exposed to estrous females denervated goats did not exhibit the normal progression from shallow to deep thrusting with successive mounts and failed to attain intromissions and ejaculations. However, frequency of mounting was similar to that of controls when the latter were prevented from attaining intromissions. It was concluded that sensory feedback from the genitalia and surrounding cutaneous areas is not required for the initiation of leg-kicking behavior in male dairy goats but plays an important role in the development and maintenance of normal patterns of thrusting behavior. Because it was not possible to determine the rate at which reinnervation occurred, the extent to which mounting behavior depends on sensory feedback could not be determined.

Effects of lung inflation on the excitability of dorsal respiratory group neurons.

The effect of lung inflation on the excitability of inspiratory neurons of the dorsal respiratory group was studied in decerebrate, paralyzed, artificially ventilated cats. Variations in the antidromic latency (AL) were used as a measure of the changes in excitability. The antidromic responses of single cells were recorded extracellularly during electrical stimulation (20 Hz) of their spinal axons. Single-breath test inflations were delivered at the onset of inspiration (I) or expiration (E), and then maintained for the duration of that respiratory phase. In the absence of inflation during E, most of the inspiratory cells underwent progressive lengthening of the AL, indicating inhibition or disfacilitation. This effect was stronger in I beta than in I alpha cells but there was considerable overlap. In every cell (21 I alpha, 17 I beta), inflation during E caused a prompt AL shortening (excitation or disinhibition) that was evident in single tests. On average, I beta neurons were more strongly excited by the test inflation during E, but again there was considerable overlap. The excitation was maintained for the duration of the inflation, indicating that pulmonary stretch receptor afferents (PSR) were involved. The response to slow inflations (that preferentially excite PSR) was a progressive shortening of the AL that mirrored the increase in lung volume. The results emphasize the qualitative similarity in the responses of I alpha and I beta neurons to lung inflation and in their excitability changes during normal respiratory cycles.