The WOEST 2 registry : A prospective registry on antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention.

BACKGROUND: Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain insight into antithrombotic management over time. METHODS: A prospective cohort study of patients on OACs for atrial fibrillation or a mechanical heart valve undergoing PCI was performed. Thrombotic outcomes were myocardial infarction, stroke, target-vessel revascularisation and all-cause mortality. Bleeding outcome was any bleeding. We report the 30-day outcome. RESULTS: The mean age of the 758 patients was 73.5 ± 8.2 years. The CHA2DS2-VASc score was ≥ 3 in 82% and the HAS-BLED score ≥ 3 in 44%. At discharge, 47% were on vitamin K antagonists (VKAs), 52% on NOACs, 43% on triple therapy and 54% on dual therapy. Treatment with a NOAC plus clopidogrel increased from 14% in 2014 to 67% in 2019. The rate of thrombotic (4.5% vs 2.0%, p = 0.06) and bleeding (17% vs. 14%, p = 0.42) events was not significantly different in patients on VKAs versus NOACs. Also, the rate of thrombotic (2.9% vs 3.4%, p = 0.83) and bleeding (18% vs 14%, p = 0.26) events did not differ significantly between patients on triple versus dual therapy. CONCLUSIONS: Patients on combined oral anticoagulation and antiplatelet therapy undergoing PCI are elderly and have both a high bleeding and ischaemic risk. Over time, a NOAC plus clopidogrel became the preferred treatment. The rate of thrombotic and bleeding events was not significantly different between patients on triple or dual therapy or between those on VKAs versus NOACs.

COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction.

BACKGROUND: The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate. METHODS: Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019. RESULTS: A total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797). CONCLUSIONS: During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations.

Biotechnological applications of nanostructured hybrids of polyamine carbon quantum dots and iron oxide nanoparticles.

The combination of different nanomaterials has been investigated during the past few decades and represents an exciting challenge for the unexpected emerging properties of the resulting nano-hybrids. Spermidine (Spd), a biogenic polyamine, has emerged as a useful functional monomer for the development of carbon quantum dots (CQDs). Herein, an electrostatically stabilized ternary hybrid, constituted of iron oxide-DNA (the core) and spermidine carbon quantum dots (CQDSpds, the shell), was self-assembled and fully characterized. The as-obtained nano-hybrid was tested on HeLa cells to evaluate its biocompatibility as well as cellular uptake. Most importantly, besides being endowed by the magnetic features of the core, it displayed drastically enhanced fluorescence properties in comparison with parent CQDSpds and it is efficiently internalized by HeLa cells. This novel ternary nano-hybrid with multifaceted properties, ranging from fluorescence to superparamagnetism, represents an interesting option for cell tracking.

The situation of vaccines for the prevention of infections in adults: An opinion paper on the situation in Spain.

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.

Integrable Coupled σ Models.

A systematic procedure for constructing classical integrable field theories with arbitrarily many free parameters is outlined. It is based on the recent interpretation of integrable field theories as realizations of affine Gaudin models. In this language, one can associate integrable field theories with affine Gaudin models having arbitrarily many sites. We present the result of applying this general procedure to couple together an arbitrary number of principal chiral model fields on the same Lie group, each with a Wess-Zumino term.

Incidencia y evolución de la miocardiopatía séptica en una cohorte de pacientes con sepsis y shock séptico / Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock

OBJETIVO: El objetivo de este estudio fue determinar la incidencia de miocardiopatía séptica (MS) en pacientes con sepsis y shock séptico, describir sus características y comprobar su evolución. DISEÑO: Estudio prospectivo sobre una cohorte. PARTICIPANTES: Se incluyeron 57 pacientes consecutivos ingresados en Unidad de Cuidados Intensivos, con criterios de sepsis y shock séptico. Variables de interés principales: Se analizaron variables clínicas y bioquímicas. Se realizó un ecocardiograma en las primeras 24h de ingreso, determinando parámetros de función cardiaca, y si los pacientes presentaban una fracción de eyección de ventrículo izquierdo (FEVI)<50%, se realizó un ecocardiograma evolutivo. Ámbito: Servicio de Medicina Intensiva médico-quirúrgico de adultos en Hospital Universitario. RESULTADOS: La edad media de los pacientes fue de 62,1±16,3 años, el 58% fueron varones. El 22,8% presentaron disfunción de ventrículo izquierdo. La FEVI media en los pacientes con MS fue inferior respecto a los que no la tenían (34,1±10,6 vs. 60,7±6,94%; p < 0,001), con recuperación completa de la misma, en los supervivientes, tras el evento agudo (FEVI al alta 56,1±6,3%; p = 0,04). Los pacientes con MS, presentaban mayores niveles de procalcitonina (47,1±35,4 vs. 18,9±24,5; p = 0,02) y puntuación en la escala Sequential Organ Failure Assessment (SOFA) (9,91±3,82 vs. 7,47±3,41; p = 0,037). La mortalidad no fue significativamente diferente entre ambos grupos (4 [30,8%] vs. 4 [9,1%]; p = 0,07). CONCLUSIONES: La MS no es infrecuente, se relaciona con mayor puntuación en las escalas de gravedad. En los supervivientes, la FEVI se normalizó tras la recuperación del evento agudo

OBJECTIVE: The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN: Prospective cohort study. PARTICIPANTS: We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. Principal variables of interest: Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. Ambit: Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS: The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS: SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event

Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock. / Incidencia y evolución de la miocardiopatía séptica en una cohorte de pacientes con sepsis y shock séptico.

OBJETIVE: The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN: Prospective cohort study. PARTICIPANTS: We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. PRINCIPAL VARIABLES OF INTEREST: Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. AMBIT: Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS: The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS: SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event.

[Blood pressure values in adolescents in the Community of Madrid: Tables based on the MEPAFAC Study]. / Valores de presión arterial obtenidos en población adolescente de la Comunidad de Madrid: Tablas basadas en el estudio MEPAFAC.

INTRODUCTION: High blood pressure (HBP) is a modifiable cardiovascular risk factor and its detection at early ages may allow strategies to be designed to reduce cardiovascular risk in adulthood. OBJECTIVES: To provide blood pressure (BP) values in a sample of adolescents using an electronic oscillometric device. MATERIAL AND METHODS: BP was measured according the European Society of Hypertension guidelines using an oscillometric device. Height and weight were also measured. Four height groups were used in order to associate the 90, 95, and 99 percentiles with systolic BP (pSBP) and diastolic BP percentiles (pDBP) for sex and age: H150 (≤ 150cm), H160(151-160cm), H170(161-170cm), and H180(≥171cm). RESULTS: Data from 2,758 students aged 12-17 years were included in the analysis. BP increases with age, with differences of up to 11mmHg in boys vs. 3mmHg in girls for SBP and 3mmHg vs. 1mmHg for DBP. In high SBP, for the younger adolescents, the difference related to height was 15mmHg in boys vs. 8mmHg in girls, with no significant increase in the older ones in either gender. The high BDP varied depending on the height, 10mmHg in younger boys and 3mmHg in older ones, while in girls the variation was 3mmHg for all ages. CONCLUSIONS: SBP/DBP in adolescents increases with age and also with height, giving similar figures in the taller ones, regardless of age.

Electrostatically stabilized hybrids of carbon and maghemite nanoparticles: electrochemical study and application.

Binary hybrids have been investigated for the past few decades due to the emerging properties of nanoparticle composites. Electrostatically stabilized core-shell nanostructures composed of surface active magnetic nanoparticles (SAMNs) and differently charged carbon nanomaterials display specific electrochemical properties. In this work, a set of binary hybrids that include a new class of magnetic nanoparticles is presented and the electrochemical features of the hybrids are reported. Gallic acid derived carbon dots (GA-CDs), PEG derived graphene dots (PEG-GDs), and quaternized carbon dots (Q-CDs) characterized by different charged groups were used for the preparation of different complexes with SAMNs. Thus, a set of six binary nanomaterials was obtained, and characterized by electrochemical impedance spectroscopy, cyclic voltammetry and chronoamperometry, demonstrating significant differences in the charge transfer resistance, capacitive current, electrochemical performance, and reversibility with respect to the isolated subunits. Among them, the combination of Q-CDs with an excess of SAMNs led to a Q-CD@SAMN hybrid, which displayed peculiar electrocatalytic properties attributable to the influence of the strong electrostatic interactions exerted by Q-CDs on the SAMN surface. Notwithstanding their small fraction (around 1% w/w), Q-CDs oriented the electrocatalysis of SAMNs toward the selective electro-oxidation of polyphenols at low applied potentials (+0.1 V vs. SCE). Finally, the Q-CD@SAMN hybrid was used for the development of a coulometric sensor for polyphenols, composed of a simple carbon paste electrode in a small volume electrochemical flow cell (1 µL), and used for the complete direct electro-oxidation of polyphenols from plant extracts.

[Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update]. / Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017.

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding anti-pneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved.

Effectiveness of several solutions to prevent the formation of precipitate due to the interaction between sodium hypochlorite and chlorhexidine and its effect on bond strength of an epoxy-based sealer.

AIM: To evaluate the effectiveness of isopropyl alcohol, saline or distilled water to prevent the precipitate formed between sodium hypochlorite (NaOCl) and chlorhexidine (CHX) and its effect on the bond strength of an epoxy-based sealer in radicular dentine. METHODOLOGY: The root canals of 50 extracted human canines (n = 10) were instrumented. In G1, root canals were irrigated with 17% EDTA and 2.5% NaOCl; G2, as G1, except that 2% CHX was used as the final irrigant. In the other groups, intermediate flushes with isopropyl alcohol (G3), saline (G4) or distilled water (G5) were used between NaOCl and CHX. The specimens were submitted to SEM analysis to evaluate the presence of debris and smear layer, in the apical and cervical segments. In sequence, fifty extracted human canines were distributed into five groups (n = 10), similar to the SEM study. After root filling, the roots were sectioned transversally to obtain dentine slices, in the cervical, middle and apical thirds. The root filling was submitted to a push-out bond strength test using an electromechanical testing machine. Statistical analysis was performed using Kruskal-Wallis and Dunn's tests (α = 5%). RESULTS: All groups had similar amounts of residue precipitated on the canal walls (P > 0.05). The push-out bond strength values were similar for all groups, independently of the root third evaluated (P > 0.05). CONCLUSIONS: Isopropyl alcohol, saline and distilled water failed to prevent the precipitation of residues on canal walls following the use of NaOCl and CHX. The residues did not interfere with the push-out bond strength of the root filling.

Integrable deformation of the AdS5×S5 superstring action.

An integrable deformation of the type IIB AdS5×S5 superstring action is presented. The deformed field equations, Lax connection, and κ-symmetry transformations are given. The original psu(2,2|4) symmetry is expected to become q deformed.

[Equity and nutritional inequalityin two school centers in Madrid (Spain)]. / Equidad y desigualdad nutricional en dos centros escolares de la ciudad de Madrid (España).

INTRODUCTION: Health inequality is the difference in incidence, prevalence, mortality, volume of diseases and other adverse sanitary conditions that exist between groups of specific populations. OBJECTIVES: To analyze the possible nutritional inequalities between two educational centers of Madrid to promote healthy habits, to anticipate the obesity and the diseases associated in the children population. METHODS: Observational and transverse study on a sample of 118 students (14 years old/3ºESO) of two educational centers of different socioeconomic level. They underwent a survey on lifestyle, anthropometric examinations and measurement of blood pressure and physical activity. RESULTS: In both centers normal weight prevails in both sexes without differences as for the percentage of pupils that are overweight. Major obesity is registered in the public school more than in the private school. The correlation stands out between the percentiles body mass index (BMI) and the blood pressure (BP) (to major BMI, major B.P). The food pattern is similarly independent from the socioeconomic stratum. The fifth part of the pupils (principally women) does not practice any type of physical activity in their free time and they dedicate almost 2 daily hours to sedentary activities. CONCLUSIONS: As a whole, the two educational centers are in the average weight range, even though a tendency has been found in the public school that there is double the rate of obesity. These results can be attributed to the small sample size or that the sociocultural inequality to nutritional level is not so accentuated in the city of Madrid. Prevention and promotion of healthy habits is the way of combating against overweight, juvenile obesity, cardiovascular risk factors and cardiovascular diseases in the adult age.

Equidad y desigualdad nutricional en dos centros escolares de la ciudad de Madrid (España) / Equity and nutritional inequality in two school centers in Madrid (Spain)

Introducción: La inequidad en salud es la diferencia en incidencia, prevalencia, mortalidad, volumen de enfermedades y otras condiciones adversas sanitarias que existen entre grupos de poblaciones específicas. Objetivo: Identificar y analizar las posibles desigualdades nutricionales entre dos centros educativos de dos distritos municipales de la ciudad de Madrid, para promover hábitos saludables, prevenir la obesidad y las enfermedades asociadas en la población infantil. Métodos: Estudio observacional, transversal en 118 estudiantes de 3o Educación Secundaria Obligatoria (14 años) de dos centros escolares de diferente nivel socioeconómico. Realización de un cuestionario general de salud validado, medidas antropométricas, presión arterial y actividad física. Resultados: En los dos centros prevalece el normopeso en ambos sexos sin diferencias en cuanto al porcentaje de alumnos con sobrepeso, registrándose un mayor grado de obesidad en el centro público que en el centro privado. Destaca la correlación entre el índice de masa corporal (IMC) percentilado y la presión arterial (PA) (a mayor IMC, mayor PA). Los patrones alimentarios son similares e independientes del estrato socioeconómico. La quinta parte de los alumnos (principalmente mujeres) no realiza ningún tipo de actividad física en su tiempo libre y dedican casi dos horas diarias a acciones sedentarias. Conclusiones: En su conjunto los dos centros educativos se encuentran en normopeso, aunque se observa una tendencia a la obesidad en el centro público frente al centro privado. Estos resultados pueden atribuirse al pequeño tamaño de la muestra o que la inequidad sociocultural a nivel nutricional no se encuentra tan acentuada en la ciudad de Madrid. La prevención y promoción de hábitos saludables es la forma de enfrentarse al sobrepeso, la obesidad juvenil, los factores de riesgo cardiovascular y las enfermedades cardiovasculares en la edad adulta (AU)

Introduction: Health inequality is the difference in incidence, prevalence, mortality, volume of diseases and other adverse sanitary conditions that exist between groups of specific populations. Objectives: To analyze the possible nutritional inequalities between two educational centers of Madrid to promote healthy habits, to anticipate the obesity and the diseases associated in the children population. Methods: Observational and transverse study on a sample of 118 students (14 years old/3oESO) of two educational centers of different socioeconomic level. They underwent a survey on lifestyle, anthropometric examinations and measurement of blood pressure and physical activity. Results: In both centers normal weight prevails in both sexes without differences as for the percentage of pupils that are overweight. Major obesity is registered in the public school more than in the private school. The correlation stands out between the percentiles body mass index (BMI) and the blood pressure (BP) (to major BMI, major B.P). The food pattern is similarly independent from the socioeconomic stratum. The fifth part of the pupils (principally women) does not practice any type of physical activity in their free time and they dedicate almost 2 daily hours to sedentary activities. Conclusions: As a whole, the two educational centers are in the average weight range, even though a tendency has been found in the public school that there is double the rate of obesity. These results can be attributed to the small sample size or that the sociocultural inequality to nutritional level is not so accentuated in the city of Madrid. Prevention and promotion of healthy habits is the way of combating against overweight, juvenile obesity, cardiovascular risk factors and cardiovascular diseases in the adult age (AU)

Long-term outcome of the unrestricted use of everolimus-eluting stents compared to sirolimus-eluting stents and paclitaxel-eluting stents in diabetic patients: the Bern-Rotterdam diabetes cohort study.

BACKGROUND: Newer generation everolimus-eluting stents (EES) improve clinical outcome compared to early generation sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). We investigated whether the advantage in safety and efficacy also holds among the high-risk population of diabetic patients during long-term follow-up. METHODS: Between 2002 and 2009, a total of 1963 consecutive diabetic patients treated with the unrestricted use of EES (n=804), SES (n=612) and PES (n=547) were followed throughout three years for the occurrence of cardiac events at two academic institutions. The primary end point was the occurrence of definite stent thrombosis. RESULTS: The primary outcome occurred in 1.0% of EES, 3.7% of SES and 3.8% of PES treated patients ([EES vs. SES] adjusted HR=0.58, 95% CI 0.39-0.88; [EES vs. PES] adjusted HR=0.29, 95% CI 0.13-0.67). Similarly, patients treated with EES had a lower risk of target-lesion revascularization (TLR) compared to patients treated with SES and PES ([EES vs. SES], 5.6% vs. 11.5%, adjusted HR=0.68, 95% CI: 0.55-0.83; [EES vs. PES], 5.6% vs. 11.3%, adjusted HR=0.51, 95% CI: 0.33-0.77). There were no differences in other safety end points, such as all-cause mortality, cardiac mortality, myocardial infarction (MI) and MACE. CONCLUSION: In diabetic patients, the unrestricted use of EES appears to be associated with improved outcomes, specifically a significant decrease in the need for TLR and ST compared to early generation SES and PES throughout 3-year follow-up.

Laparoscopic treatment of endometriosis.

Endometriosis can be considered as a chronic disease which is characterized by the presence of ectopic endometrium outside the endometrial cavity and which is associated with symptoms as pelvic pain and infertility. Medical treatment is often not sufficient in patients with moderate to severe endometriosis and deep infiltrative endometriosis (DIE), therefore requiring surgical intervention. Over the past 15 years, we have built a multidisciplinary surgical team to perform a radical but fertility preserving resection of extensive endometriosis with involvement of surrounding organ systems, realizing a good clinical outcome with low complication and recurrence rate, a very good improvement of QOL and a high pregnancy rate. However, for future research evaluating surgical treatment of extensive endometriosis, it is important to reach agreement on study design and on reporting clinical outcome data. A multicenter study with clear patient identification and well defined outcome parameters needs to be set up. Moreover, prevention of DIE with colorectal extension is important, ideally by early identification and management of girls and women at risk. Years of pain and disability as well as a lot of money could be saved when patients, at risk of developing extensive forms of endometriosis could be diagnosed during adolescence.