Evolving the narrative for protecting a rapidly changing ocean, post-COVID-19.

The ocean is the linchpin supporting life on Earth, but it is in declining health due to an increasing footprint of human use and climate change. Despite notable successes in helping to protect the ocean, the scale of actions is simply not now meeting the overriding scale and nature of the ocean's problems that confront us.Moving into a post-COVID-19 world, new policy decisions will need to be made. Some, especially those developed prior to the pandemic, will require changes to their trajectories; others will emerge as a response to this global event. Reconnecting with nature, and specifically with the ocean, will take more than good intent and wishful thinking. Words, and how we express our connection to the ocean, clearly matter now more than ever before.The evolution of the ocean narrative, aimed at preserving and expanding options and opportunities for future generations and a healthier planet, is articulated around six themes: (1) all life is dependent on the ocean; (2) by harming the ocean, we harm ourselves; (3) by protecting the ocean, we protect ourselves; (4) humans, the ocean, biodiversity, and climate are inextricably linked; (5) ocean and climate action must be undertaken together; and (6) reversing ocean change needs action now.This narrative adopts a 'One Health' approach to protecting the ocean, addressing the whole Earth ocean system for better and more equitable social, cultural, economic, and environmental outcomes at its core. Speaking with one voice through a narrative that captures the latest science, concerns, and linkages to humanity is a precondition to action, by elevating humankind's understanding of our relationship with 'planet Ocean' and why it needs to become a central theme to everyone's lives. We have only one ocean, we must protect it, now. There is no 'Ocean B'.

Psychological distress associated with colposcopy: patients' perception.

OBJECTIVE: Cervical screening and colposcopy are associated with varying degrees of anxiety in women. Interventions are in place to reduce anxiety but the effectiveness of these needs examination. Our objective was to develop an understanding of factors associated with anxiety in relation to colposcopy and to seek women's opinion on interventions designed to reduce anxiety. STUDY DESIGN: Prospective, anonymised survey. Determination of anxiety level and effectiveness of interventions within the colposcopy experience, i.e. information leaflet, video-screen display, nursing and medical intervention and exploration of medical terms, i.e. 'CIN'. RESULTS: Prior to attendance 36% of patients felt they were very worried, 54% slightly worried and 10% not worried. All patients found the standardised NHS information leaflet helpful to a variable degree. During colposcopy 30% of patients found watching on a video-screen display very helpful, whilst a significant number (18%) found it increased their worry. Stratification of results showed that women with pre-existing high level of anxiety were least satisfied with indices examined. CONCLUSION: Our results indicate that the higher the index level of anxiety regarding colposcopy, the less likely women were to find either the leaflet or the video-screen display helpful. Research should focus on the 'very anxious' women, as they are least satisfied with existing measures in place to reduce anxiety. However, evidence is presented to imply this may not be possible.

Short-term complications of the trans-obturator foramen procedure for urinary stress incontinence.

This paper reports the efficacy and complications of the trans-obturator foramen procedure (TOT). The effect of TOT on co-existing urgency and urge incontinence and voiding difficulty were also noted. It reports on patients (31) undergoing TOT (Obtape) from April 2005 to April 2006, who were sent a questionnaire. The mean age was 53 years, mean parity 2.3, mean duration of incontinence 6.2 years and the mean duration of follow-up was 9 months. All patients had significant stress incontinence. Co-existing urge incontinence was present in 70%; no intraoperative complications. One patient had a urinary tract infection (UTI) and one, catheterisation for 5 days. A total of 16.6% of patients developed sling erosion. There was a 93% response rate to the postal survey, indicating a 31% complete cure of urinary incontinence; 65% a significant improvement and 3.5% failure. Urge incontinence disappeared in 66%, no de-novo urgency and 8% reported slower voiding. Satisfaction was 8.9 on a 1 - 10 Scale. The success rate of the TOT procedure was high, helping both stress and concomitant urge incontinence, but due to an unacceptably high erosion rate, Obtape was discontinued.

Assessment of menorrhagia by total menstrual fluid loss.

Half of the women presenting with heavy periods do not have objective menorrhagia. In the normal woman, blood is a minority component of total menstrual volume. This paper was designed to examine the hypothesis that the volume of total menstrual fluid loss (TMFL) could be more important than blood loss. A total of 115 women complaining of menorrhagia performed a menstrual collection from which TMFL and menstrual blood loss (MBL) was derived. In women complaining of menorrhagia, mean total menstrual fluid loss is 183.5 ml, with a corresponding menstrual blood loss of 110.3 ml. There is a significant correlation between TMFL and MBL (r = 0.82 (95% CI 0.75 - 0.87), p < 0.001). Blood loss accounts for an average of 60.5% of the total menstrual fluid loss with a wide range of 20 - 99.8%. A change in the proportion of TMFL loss that is blood may well be part of the complex reasons why women present.

Adenovirus expressing an NPC1-GFP fusion gene corrects neuronal and nonneuronal defects associated with Niemann pick type C disease.

Niemann Pick type C (NPC) disease is an autosomal recessive disorder characterized by abnormal cholesterol metabolism and accumulation in lysosomal and endosomal compartments. Although peripheral organs are affected, the progressive neurodegeneration in the brain is typically most deleterious, leading to dystonia, ataxia, seizures, and premature death. Although the two genes underlying this disorder in humans and mouse models of the disease have been identified (NPC1 in 95% and NPC2/HE1 in 5% of human cases), their cellular roles have not Been fully defined, and there is currently no effective treatment for this disorder. To help address these issues, we constructed a recombinant adenovirus, Ad(NPC1-GFP), which contains a cDNA encoding a mouse NPC1 protein with a green fluorescent protein (GFP) fused to its C-terminus. Fluorescence microscopy and cholesterol trafficking assays demonstrate that the GFP-tagged NPC1 protein is functional and detectable in cells from different species (hamster, mouse, human) and of different types (ovary-derived cells, fibroblasts, astrocytes, neurons from peripheral and central nervous systems) in vitro. Combined with results from time-lapse microscopy and in vivo brain injections, our findings suggest that this adenovirus offers advantages for expressing NPC1 and analyzing its cellular localization, movement, functional properties, and beneficial effects in vitro and in vivo.

Assessment of menstrual blood loss using a pictorial chart: a validation study.

OBJECTIVE: To assess the accuracy of a pictorial blood loss assessment chart (PBAC) as a method for estimating menstrual blood loss in women complaining of heavy periods. DESIGN: A prospective analysis of 103 consecutive women complaining of excessive menstrual blood loss. POPULATION: Women recruited into an on-going study of menstrual blood loss in a large district general hospital. MAIN OUTCOME MEASURES: Correlation between pictorial assessment of blood loss and actual measured menstrual blood loss. RESULTS: There was poor correlation between observed PBAC score and menstrual blood loss. CONCLUSION: We have not been able to validate previously published work. The pictorial assessment chart offers no significant improvement in the quality of objective diagnosis in women complaining of menorrhagia.

Penetrating trauma to the head.

Penetrating trauma to the brain is not as common as blunt trauma; however, the incidence is becoming a frequent occurrence in our society. Rapid transport to trauma centers where definitive care can be rendered is essential. Outcome depends on the site of the missile tract, the presenting neurologic status, and the extent of neurologic tissue destruction. Neurologic deterioration occurs rapidly, and outcome results seem to depend on the patient's neurologic status at the time of surgery. CT scanning is the diagnostic procedure of choice and should be performed if the patient's condition is stable (see Fig. 3). Aggressive removal of missile and bone fragments needs to be balanced by the knowledge that it is preferable to leave behind a few hard-to-reach fragments than to increase the patient's neurologic deficit. CT scanning in the postoperative period is very helpful in identifying abscess formation as well as new or recurrent hematomas, edema, and areas of tissue injury not evident at the time of initial scanning. Antibiotic therapy should be initiated preoperatively. Control of elevated ICP plays a significant role in decreasing mortality and morbidity. Judicious debridement of injured brain combined with medical management of increased ICP will maximize the quality of recovery and increase survivability. Although great strides have been made in reducing mortality and morbidity for trauma patients, the sad issue is that the majority of traumas are preventable. Until society is willing to understand that it needs to make firearm safety a priority, there will always be patients to care for who have sustained a penetrating injury.

Nd:YAG laser endometrial ablation: histological aspects of uterine healing.

Laser ablation of the endometrium performed under hysteroscopic control is a novel procedure for the conservative management of menorrhagia in cases of dysfunctional uterine bleeding. The effect this has on the uterine cavity and the mechanism of reepithelialisation and endometrial regeneration have been examined by means of histological examination of endometrial biopsies and four hysterectomy specimens obtained for various indications at varying time intervals after laser endometrial ablation. During the first 3 months, fragments of necrotic and granulation tissue are found surrounded by a limited polymorph response. By 3 months, the uterine cavity appears to be completely reepithelialised. After 6 months, areas of normal-appearing endometrium may persist, but in other areas there is an attenuated cuboidal surface epithelium closely applied, to the underlying myometrium. Stromal fibrosis reminiscent of Asherman syndrome is also apparent.

In-vivo studies of uterine electrosurgery.

OBJECTIVE: To study the effects of electrosurgery on the living human uterus. DESIGN: Prospective observational study. SUBJECTS: Nine women with recurrent refractory dysfunctional uterine bleeding, listed for hysterectomy. INTERVENTION: Experimental endometrial resection on patients immediately prior to hysterectomy. MAIN OUTCOME MEASURES: The influence of power output, duration of exposure and repetition of consecutive surgical applications on the size of the zone of thermal necrosis in uterine tissue. RESULTS: Resection of the endometrium was associated with a narrow zone of thermal necrosis of between 0.69 and 0.76 mm which was not dependent on power output. Duration of exposure, however, was directly related to tissue necrosis (1.44 vs 1.88 mm for 1s and 5s, respectively). Coagulation by pin-point desiccation caused a zone of thermal necrosis of 3.30-3.77 mm that was independent of either power or duration of exposure to electrical energy. Thermal transmission through the uterus in situ, during electrosurgery was minimal, the maximum recorded rise in temperature from the baseline was 0.4 degrees C. The differences between the in vitro and in vivo effects of electrosurgery are highlighted and the possible reasons for these differences explored. CONCLUSIONS: The potential for unwanted thermally-induced damage to the uterus is small.

Ethanol labeling: detection of early fluid absorption in endometrial resection.

A study is presented of ethanol labeling of irrigation fluid in endometrial resection. The introduction of ethanol labeling and intraoperative breath ethanol analysis provided an inexpensive and potentially useful means of detecting early fluid absorption during uterine surgery. The breath ethanol analyzer used was a hand-held meter; the irrigant solution was 5% dextrose with 1% ethanol. Simultaneous breath and venous samples were taken from women undergoing endometrial resection. An increase in breath ethanol was positively correlated with fluid absorption, blood ethanol, and serum glucose. This technique may prove valuable in preventing fluid overload during endometrial resection.

Artificial sapphire contact probes in Nd:YAG endometrial ablation: a quantitative in vitro and in vivo study.

Artificial sapphire contact probes offer theoretical advantages in Nd:YAG endometrial ablation. To examine this, an in vitro and in vivo study of laser-tissue interaction was performed. In vitro, a linear correlation was found between applied energy and total depth of effect, that is, photovaporization and photocoagulation. Using a Round (MTR 1.5) contact probe, an applied energy of 30 joules gave a depth of myometrial effect of 3.3 mm. In vivo, there was a significant reduction in tissue effect (p less than 0.001) compared to in vitro. Difficulty of manipulation of the contact laser probe within the uterus also caused a significant reduction (p less than 0.001) in depth of tissue ablation achieved on the posterior uterine wall compared with that achievable at the uterine fundus, but this may be counteracted by increasing applied energy.

In vitro studies of uterine electrosurgery.

This study investigated electrosurgical techniques in vitro with emphasis on the tissue effects and heat transfer through full-thickness blocks of excised uterine tissue. Uterine morphometry was also examined. The 7-mm cutting resection loop was associated with a surrounding zone of thermal necrosis between 1.07-1.40 mm. There was no variation in this zone when power was altered, but a statistically significant increase was demonstrated with duration of exposure. A depth of destruction of 3.24-3.49 mm was possible with the desiccating coagulation technique, but fulguration achieved a depth of only 1.70-1.78 mm. A greater tissue effect was demonstrated as time intervals were increased. There was a fall-off in the measured rise in temperature with distance; at 4 mm from the active electrode, a mean rise of 4.5C was noted, whereas at 12 mm the mean temperature rise was 3.9C. There was a statistically significant increase in the mean temperature as power output in the cutting mode was increased. At 180 W, the mean rise was 2.0C but by 260 W, it was 3.9C. When the time interval was increased and the power held constant (220 W), a mean rise of 2.5C was recorded at 1 second, compared with 4.6C at 5 seconds, achieving statistical significance. Power increments in the coagulating mode did not alter the temperature profile, but increasing duration of exposure was associated with a significant rise in mean temperature (from 0.8 to 4.6C). A stepwise increase in the baseline temperature was noted with repetitive insults. The mean myometrial thickness of the anterior and posterior walls measured 1.8 and 1.9 cm, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of presentation of insulin with surface I-Ad and A alpha and A beta mRNA expression by cloned B lymphoma hybridoma variants.

We investigated the relationship between Ia expression and antigen presentation in cloned B cells, using variants of TA3 antigen presenting cells. Two TA3 subclones were selected as high presenters and 5 as low presenters of insulin to pork insulin/I-Ad restricted T cells. All TA3 subclones express the surface I-Ak, I-Ek, I-Ad and I-Ed Ia antigens characteristic of the parental cell line. However, surface I-Ad levels correlated best with the ability to present insulin, since high presenters express 2- to 4-fold more I-Ad than low presenters. High presenters possess 2- to 4-times more A alpha and A beta Ia mRNA than low presenters and also transcribe these mRNAs 2- to 5-fold faster than most low presenters. Thus, the correlation noted between I-Ad surface density and capacity to present insulin by our panel of TA3 variants is regulated at the level of transcription and not translation of I-Ad specific mRNAs.