Impact of COVID-19 lockdown on mental health in Germany: longitudinal observation of different mental health trajectories and protective factors.

The COVID-19 pandemic and resulting measures can be regarded as a global stressor. Cross-sectional studies showed rather negative impacts on people's mental health, while longitudinal studies considering pre-lockdown data are still scarce. The present study investigated the impact of COVID-19 related lockdown measures in a longitudinal German sample, assessed since 2017. During lockdown, 523 participants completed additional weekly online questionnaires on e.g., mental health, COVID-19-related and general stressor exposure. Predictors for and distinct trajectories of mental health outcomes were determined, using multilevel models and latent growth mixture models, respectively. Positive pandemic appraisal, social support, and adaptive cognitive emotion regulation were positively, whereas perceived stress, daily hassles, and feeling lonely negatively related to mental health outcomes in the entire sample. Three subgroups ("recovered," 9.0%; "resilient," 82.6%; "delayed dysfunction," 8.4%) with different mental health responses to initial lockdown measures were identified. Subgroups differed in perceived stress and COVID-19-specific positive appraisal. Although most participants remained mentally healthy, as observed in the resilient group, we also observed inter-individual differences. Participants' psychological state deteriorated over time in the delayed dysfunction group, putting them at risk for mental disorder development. Consequently, health services should especially identify and allocate resources to vulnerable individuals.

Comparison of transvaginal ultrasound, hysteroscopy, and dilatation and curettage in the diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women.

STUDY OBJECTIVE: To compare transvaginal ultrasound, hysteroscopy, and dilation and curettage (D&C) in the evaluation of women with perimenopausal and postmenopausal bleeding. DESIGN: Descriptive study (Canadian Task Force classification II-1). SETTING: Seven outpatient clinics. PATIENTS: One thousand two hundred eighty-six women. INTERVENTION: Transvaginal ultrasound, hysteroscopy, and D&C. MEASUREMENTS AND MAIN RESULTS: Of our patient population, 29 (2.26%) had a histologic diagnosis of endometrial carcinoma; in 2 of them (7.14%) endometrial thickness was 5 mm or less. In 10 women (34.5%), endometrial carcinoma was missed by hysteroscopy (sensitivity 65.52%, specificity 99.92%). Complication rate of D&C was 1.4%. CONCLUSION: In women with perimenopausal and postmenopausal bleeding neither transvaginal ultrasound nor hysteroscopy as a single diagnostic tool is suitable to rule out endometrial cancer.

[Laparoscopy in the day clinic--a prospective multicenter study for evaluating complications]. / Laparoskopien in der Tagesklinik--Eine prospektive Multizenterstudie zur Komplikationserfassung.

In a six centre prospective study complications after outpatient laparoscopies were registered. Within a four month period 1474 patients have been interviewed after one and four weeks. Surgical complications and conversions to laparotomy 0%, wound infections 2.9%, febrile course 2.4%. 3.7% of the patients were hospitalized > 24 hours. No readmissions occurred. Factors influencing the quality of results are discussed.

Immunoscintigraphy using CA 125 antibodies in the management of ovarian cancer.

Radioimmundetection (RID) using anti-CA 125 antibodies proved to be a valuable tool in the follow-up of metastasizing ovarian cancer. Sensitivity, specificity, and accuracy were high. RID had no clinical side effects. But some patients formed antibodies which interfered a) with the evaluation of the scintigram and b) with further measurement of CA 125 levels. We found 2 cm diameter metastases that were not detected by computed tomography. However, the heterogeneity of tumor metastases limits the sensitivity of this method. CA 125 serum levels, immunohistochemistry, and immunoscintigraphy did not always correlate. Monitoring serum levels of CA 125 was most valuable in clinical management of tumor spread and in the optimal use of RID.

[Functional morphology of the fallopian tube]. / Funktionelle Morphologie des Eileiters.

Human fallopian tubes were examined after injection with epoxy rems, after formation of tissue blocks, and after sectioning the blocks with a diamond saw. Calibers of arteries and veins were measured in these transparent sections. Fallopian cubes of women in the reproductive phase of life receive their blood mainly from the ovarian artery, while those of postmenopausal women predominantly get their blood from the uterine artery. There are special arterial cushions around the intramural part of the tube, around the abdominal os of the tube, and within the mucosal folds of the ampulla. The hypothesis is advanced that the cushions may play a role as sphincters, and in the case of the mucosal folds as an arterial, pulse-triggered pump for egg transport. The ovarian fimbria contains muscle bundles which may be important for the capture of the egg.

[Chemotherapy of dysgerminoma]. / Chemotherapie des Dysgerminoms.

Two patients with metastases after primary surgery to remove a dysgerminoma were successfully treated by chemotherapy. One received monotherapy with chlorambucil, the other vinblastine, bleomycin and cisplatin followed by irradiation. Both survived 5 years without evidence of disease. Dysgerminomas are highly sensitive not only to irradiation but also to chemotherapy. It is suggested that in younger women, in order to preserve fertility, chemotherapy should be used after primary conservative surgery, and irradiation only as a third-line remedy.

[Induction of secondary labor in triplet pregnancy]. / Induktion einer zweizeitigen Geburt bei Drillingen.

After premature birth of the first triplet we successfully delayed the delivery of the remaining triplets for 21 days until the 29th week of gestation. The 36 year-old patient from Africa (Uganda) was suffering secondary sterility due to bilateral salpingectomy. After transfer of four in-vitro fertilised eggs, triplets were diagnosed ultrasonographically in the 7th week of gestation. In the 26th week, despite tocolysis, premature labour led to the delivery of a 740 g female foetus who died 2 days later. Immediately after delivery cerclage was performed under halothane anaesthesia. Further treatment consisted of tocolytics, antiseptics locally, antibiotics systemically, and rest in bed. In the 29th week a caesarean section had to be performed because of uncontrollable contractions and threatening asphyxia of the second triplet. Both infants, 1100 and 1150 g, were female, both survived without handicaps.

[How much labor assistance should the emergency physician render?]. / Wieviel Geburtshilfe soll ein Notarzt leisten?

Seven case reports of emergency obstetrics serve to demonstrate to what extent an emergency physician can be of help and where the limits of his field of activities are. The article describes the emergency physician's tasks in general as well as the education and training which may reasonably be expected in young physicians. It is concluded, among other things, that it is not one of the tasks of an emergency physician to supervise or initiate parturition since that is no longer part of the physician's training in the FRG.

Studies on the development of cell contacts and of the intercellular matrix during decidualization in the rat.

Cell contacts between developing decidual cells were examined in thin sections and in replicas of freeze-cleaved tissue of rat uterus. At the time of implantation only puncta adhaerentia were found between stromal cells. Gap junctions appeared 24 h after decidualization and thereafter increased in number and extent. Thus, there is little morphological evidence for a propagation of the initial stimulus for decidualization via gap junctions. An increase in amorphous, extracellular material is noted after decidualization with a concomitant decrease of collagen fibers. This amorphous material probably represents fibrinoid.

[Biochemical and morphological changes in the uterus after the use of estradiol]. / Biochemische und morphologische Veränderungen im Uterus nach Ostradiol-Gabe.

A review is given of data concerning changes in the uterus after estradiol administration. It is concluded that the time intervals between hormone administration and appearance of cellular changes cannot always be compared as they depend upon many variables, e.g. species, dose of hormone, route of application, age of animals, and time elapsed after ovariectomy. Several hypotheses on the mechanism of estrogen action are discussed.

On the fine structure of polyribosomes.

The ultrastructural morphology of ribosomes was studied in tissue sections of rat uterus using defferent fixatives (acrolein formaldehyde, acetic acid, methanol-acetic acid, OsO4) after various pre-incubations in solutions of different osmolarity, electrolyte content, and pH. In addition, whole-mount ribosomes of spread cytoplasm of epithelial cells were examined. The results indicate: Ribosomes are "thickenings" in the course of a cytoplasmic RNP-network which extends in three dimensions between nucleus and plasma membranes. This network consists of fibrils which vary in width depending on intrinsic and extrinsic factors. Often the fibril width is approx. 100 A. In places where the fibril is folded up into ribosomal "granules" and strands the width may be 300 A. Each fibril seems to be composed of two elementary filaments, 10 A up to 40 A thick. Estimation of filament length within a ribosomal "granule" allowed the conclusion that only a fraction of a 45 S-RNA filament is folded up into a "ribosome" in cytological preparations. No morphological evidence was found for clefts within ribosomes or single messenger RNA filaments "piercing" ribosomes. Filaments of membrane-bound ribosomes appearently show continuities with fibrils within the cytoplasmic matrix on the one side and with filaments within the cisternae of the endoplasmic reticulum on the other. Ribosomal filaments of stromal cells also seen to have filamentous continuities with extracellular fibrils. This morphological evidence opens new perspectives concerning the role of RNA filaments in protein synthesis.

Changes in the morphology of ribosomes in uterine epithelial cells under various hormonal conditions.

The ultrastructural morphology of "free" cytoplasmic ribosomes of rat uterine epithelial cells was studied during diestrus, estrus, after ovariectomy, and after estradiol-17 beta administration to rats that were ovariectomized 1 to 25 weeks before hormone treatment. A change in size and contrast of ribosomes was observed concomitant with a transition from pre-existing monosomes to polysomes depending on the dose of estradiol and its route of application. In 3 weeks ovariectomized rats these changes in ribosomal granules take place at approximately the same time (30-45 min) when synthesis of "induced protein" was described biochemically. The morphological events after estradiol administration are discussed with respect to a primary site of estrogen action.