The use of hysteroscopy in endometrial cancer: old questions and novel challenges.

Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.

Effectiveness of different methods for polypectomy in the menopause: a retrospective study.

Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.

Minute ventilation stabilization during all pressure-control / support mechanical ventilation modes.

The main goal of our prospective randomized study was comparing compare the effectiveness of ventilation control method "Automatic proportional minute ventilation (APMV) "versus manually set pressure control ventilation modes in relationship to lung mechanics and gas exchange. 80 patients undergoing coronary artery bypass grafting (CABG) were randomized into 2 groups. 40 patients in the first group No.1 (APMV group) were ventilated with pressure control (PCV) or pressure support ventilation (PSV) mode with APMV control. The other 40 patients (control group No.2) were ventilated with synchronized intermittent mandatory ventilation (SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control with APMV was able to maintain minute ventilation more precisely in comparison with manual control (p<0.01), similarly deviations of ETCO(2) were significantly lower (p<0.01). The number of manual corrections of ventilation settings was significantly lower when APMV was used (p<0.01). The differences in lung mechanics and hemodynamics were not statistically significant. Ventilation using APMV is more precise in maintaining minute ventilation and gas exchange compared with manual settings. It required less staff intervention, while respiratory system mechanics and hemodynamics are comparable. APMV showed as effective and safe method applicable on top of all pressure control ventilation modes.

Both trait-neutrality and filtering effects are validated by the vegetation patterns detected in the functional recovery of sand grasslands.

Neutral theory of species assembly means that species assembly is governed by stochastic dispersal processes and fluctuations in established populations. An alternative theory suggests that assembly is strongly determined by functional trait filtering governed by abiotic and biotic filtering selecting species from the local species pool. To test these assumptions, in the current paper we analysed vegetation changes in the first 12 years of succession after heavy goose grazing on acidic sand. With trait-based analyses using permanent plots we addressed the following hypotheses: (i) High fluctuations in the trait values are typical in the first years; later a temporally divergent change in the trait patterns of sites with different vertical position became characteristic. (ii) In the functional diversity of regenerative and vegetative traits we expected different temporal patterns. We confirmed the first hypothesis, as in the first few years most traits displayed high fluctuations with no clear patterns. Our findings weakly supported the second hypothesis; while there were distinct patterns detected in the functional richness of traits, functional divergence and evenness displayed no clear distinctive patterns. We can conclude that both trait neutrality and filtering effects operate in the vegetation changes of the first period of secondary succession.

Relationship between dynamic expiratory time constant tau(edyn) and parameters of breathing cycle in pressure support ventilation mode.

Study of the relationship between ventilation parameters: monitored expiratory time constant - tau(edyn) and breathing - trigger frequency (f(trig)) and time of breathing cycle (T(cy)) are main goals of this article. Parameters were analyzed during last 4+/-2 h before weaning from ventilation in 66 patients ventilated in pressure support mode (PSV). We have found out, that there exist mathematical relationships, observed during adequate gas exchange, yet not described. Monitored parameters are represented by tau(edyn), f(trig) and T(cy). The analysis showed close negative correlation between T(cy) and f(trig) (R(2)=0.903). This implies that each increasing of tau(edyn) causes decreasing of f(trig) and vice versa. The calculation of regression equation between tau(edyn) and T(cy) outlined that T(cy) = 5.2625 * tau(edyn) + 0.1242 (R(2)=0.85). Regulation of respiratory cycles by the respiratory center in the brain is probably based on evaluation of tau(edyn) as the tau(edyn) probably represents a regulatory element and T(cy) regulated element. It can be assumed, that respiratory center can optimize the work of breathing in order to minimize energy in system patient + ventilator. The unique relationship, described above could be useful in clinical practice for development of new ventilation modes.

Comparison of different theories for focusing through a plane interface: reply.

The correction pointed out by Kim et al. [J. Opt. Soc. Am. A35, 591 (2018)JOAOD60740-323210.1364/JOSAA.35.000591] to our paper [J. Opt. Soc. Am. A14, 1482 (1997)JOAOD60740-323210.1364/JOSAA.14.001482] is welcome. A few additional remarks are included in this reply.

Probing the internal micromechanical properties of Pseudomonas aeruginosa biofilms by Brillouin imaging.

Biofilms are organised aggregates of bacteria that adhere to each other or surfaces. The matrix of extracellular polymeric substances that holds the cells together provides the mechanical stability of the biofilm. In this study, we have applied Brillouin microscopy, a technique that is capable of measuring mechanical properties of specimens on a micrometre scale based on the shift in frequency of light incident upon a sample due to thermal fluctuations, to investigate the micromechanical properties of an active, live Pseudomonas aeruginosa biofilm. Using this non-contact and label-free technique, we have extracted information about the internal stiffness of biofilms under continuous flow. No correlation with colony size was found when comparing the averages of Brillouin shifts of two-dimensional cross-sections of randomly selected colonies. However, when focusing on single colonies, we observed two distinct spatial patterns: in smaller colonies, stiffness increased towards their interior, indicating a more compact structure of the centre of the colony, whereas, larger (over 45 µm) colonies were found to have less stiff interiors.

Polarization-multiplexed encoding at nanometer scales.

Optical data storage was developed using binary encoding primarily due to signal to noise ratio considerations. We report on a multiplexing method that allows a seven fold storage increase, per storage layer, per side, and propose one that can yield theoretically a 20+ fold increase. Multiplexing is achieved by encoding information in polarization via appropriately oriented nanostructures that emit strongly polarized light when excited by unpolarized light. The storage increase is possible due to the significantly reduced crosstalk that results form using unpolarized light.

Aortic valve-sparing operation versus Bentall and mechanical aortic valve replacement--midterm results.

OBJECTIVES: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. METHODS: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. RESULTS: Analyzed parameters were divided into two parts as function of time. In the first part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. CONCLUSION: Based on our first experience, we believe that in spite of higher technical difficulty, the aortic valve-sparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

Confocal polarization imaging in high-numerical-aperture space.

In this work we describe theoretical and experimental physical aspects of high-resolution imaging polarimetry and its application to polarization-multiplexed encoding. We theoretically demonstrate that it is possible to resolve the orientation of two fixed dipole-like emitters placed significantly below the resolution limit if their emission is uncorrelated. Furthermore, we experimentally demonstrate this phenomenon by illuminating closely spaced asymmetric nanopits with unpolarized light and subsequently determining their individual orientation and position from the measured spatial distributions of the azimuth angle of the polarization and degree of polarization, respectively. Reduction of the optical resolution of the imaging system is also shown to only weakly affect resolution obtainable via polarization measurements.

Phase-retrieved pupil function and coherent transfer function in confocal microscopy.

This work reports on the retrieval of the pupil function and coherent transfer function of a coherent reflection type confocal microscope from simulated measurements of the intensity point spread function. Two phase retrieval algorithms are presented in this vein, which incorporate the multiple pupil dependence of image formation in confocal microscopy. Verification of the algorithms follows by numerical simulations.

[Is there a relationship between inflammatory markers, oxidative stress and postoperative atrial fibrillation?]. / Existuje vztah medzi zápalovými markermi, oxidacným stresom a pooperacnou fibriláciou predsiení?

INTRODUCTION: Atrial fibrillation (AF) is one of the most common complications following heart surgery. The aim of this work was to verify the relationship between inflammatory markers, oxidative stress and postoperative arrhythmia. METHODS: 45 patients with ischemic heart disease (12 women and 33 men, mean age 62.3 ± 9.4 years) underwent surgical myocardial revascularization. The extracorporeal circulation (ECC) was used in 30 patients, without ECC was 15 patients. During the first 3 postoperative days was determining the incidence and duration of the AF, laboratory markers of inflammation (CRP, leukocytes, TNFα), malondialdehyde (MDA). RESULTS: Demographic data and associated disease were in this patients similar. The incidence of AF we documented in 30 patients (66.7%). In patients with postoperative AF were significantly higher levels of inflammatory markers (leukocytes 13.6 ± 3.6 vs 11.3 ± 3.6; 14.7 ± 3.9 vs 12.5 ± 2.9; 13.7 ± 4.1 vs 11.4 ± 13.7; p 0.05; CRP 138.1 ± 41.1 vs 69.9 ± 25.8; p 0.001; TNFα 11.3 ± 14.3 vs 8.7 ± 3.6; 12.1 ± 14.5 vs 8.7 ± 3.1; p 0.05) compared with patients who were free from AF. Values of MDA were not significantly different. CONCLUSION: Patients with post-operative atrial fibrillation were higher levels of inflammatory markers compared with patients with sinus rhythm but no significant differences in the levels of oxidative stress.

Synthesis of structured partially spatially coherent beams.

We report on the generation and rapid characterization of structured beams of arbitrary spatial coherence. An experimental setup is introduced capable of generating partially coherent fields by incoherently superposing fully coherent fields. The characterization is performed using the spectral information in the interferogram produced when using a two-dimensional nonredundant array of pinholes. An example of a partially coherent "doughnut" beam is given and proved to be partially coherent.

[Why there is atrial fibrillation after cardiac operations?]. / Preco vzniká fibrilácia predsiení po kardiochirurgických operáciách?

Atrial fibrillation (AF) is the most frequent arrhythmias after cardiac operations. Its incidence ranges from 10-65%. Often there is a patient discomfort, prolongs hospitalization, increases costs of operation and may be permanent or recurrent course. The cause of postoperative AF is multifactorial. The prevention of non-pharmacological and pharmacological interventions. The conventional treatment strategies include monitoring ventricular rate, restoration of sinus rhythm and prevention of thromboembolic events. The development of effective therapies designed to decrease the high incidence of postoperative AF may be important in the future.

Spatial and temporal variations in vector fields.

We introduce a new metric to characterise spatial variations occurring in a time varying vector field, and we derive a rotationally invariant formula that quantifies temporal fluctuations within a consistent framework. So as to highlight the physics behind these metrics, both are derived from a well-known experiment in polarimetry. The derivation yields a set of expressions in a two-dimensional space, which is subsequently expanded to n-dimensions for special cases. The resulting expressions of the temporal and spatial metrics are incorporated into the electromagnetic theory of coherence and polarisation. Examples are given in the context of single molecule detection when measuring asymmetrically and radially polarised beams.

The role of seed bank in the dynamics of understorey in an oak forest in Hungary.

We studied the potential role of seed bank in the dynamics of the understorey in a turkey oak-sessile oak forest (Querceteum petraeae-cerris) in Hungary. We used long-term records of the herb layer (1973-2006) and the seed bank composition of 2006 to assess the role of seed bank in the regeneration of herb layer. The total cover of herb layer decreased from 22% (1973) to 6% (1988), and remained low (<10%) till 2006; coinciding with the increasing cover of secondary canopy dominated by Acer campestre. We found a low density seed bank (ca. 1300 seeds/m2). Altogether 33 species were germinated from the soil samples. A few generalist weed species composed the majority of seed bank. It was possible to assign a seed bank type for 19 species; 14 species out of 19 was long-term persistent. We found that the characteristic perennial forest herbs and grasses had only sparse seed bank. The Jaccard similarity between vegetation and seed bank was low (<30%). Our results suggest that the continuous establishment of forest herbs are not based on local persistent seed bank; it should be based on vegetative spreading and/or seed rain.

Early vegetation development after grassland restoration by sowing low-diversity seed mixtures in former sunflower and cereal fields.

We studied the early vegetation dynamics in former croplands (sunflower and cereal fields) sown with a low-diversity seed mixture (composed of 2 native grass species) in Egyek-Pusztakócs, Hortobágy National Park, East-Hungary. The percentage cover of vascular plants was recorded in 4 permanent plots per field on 7 restored fields between 2006 and 2009. Ten aboveground biomass samples per field were also collected in June in each year. We addressed two questions: (i) How do seed sowing and annual mowing affect the species richness, biomass and cover of weeds? (ii) How fast does the cover of sown grasses develop after seed sowing? Weedy species were characteristic in the first year after sowing. In the second and third year their cover and species richness decreased. From the second year onwards the cover of perennial grasses increased. Spontaneously immigrating species characteristic to the reference grasslands were also detected with low cover scores. Short-lived weeds were suppressed as their cover and biomass significantly decreased during the study. The amount of litter and sown grass biomass increased progressively. However, perennial weed cover, especially the cover of Cirsium arvense increased substantially. Our results suggest that grassland vegetation can be recovered by sowing low diversity mixtures followed up by yearly mowing. Suppression of perennial weed cover needs more frequent mowing (multiple times a year) or grazing.

Properties of high-numerical-aperture Mueller-matrix polarimeters.

To our knowledge there has been very little work done to establish the theoretical basis of high-NA Mueller matrix polarimetry. We consider how high-NA polarimetry differs from traditional wide-field polarimetry. We show that confocal polarimetry leads to an averaging of the sample Jones matrices, each of which is associated with one of the incident plane waves comprising the incident focused field and that a conventional polarimeter leads to an averaging of sample Mueller matrices. We conclude with an example.

High numerical aperture vectorial imaging in coherent optical microscopes.

Imaging systems are typically partitioned into three components: focusing of incident light, scattering of incident light by an object and imaging of scattered light. We present a model of high Numerical Aperture (NA) imaging systems which differs from prior models as it treats each of the three components of the imaging system rigorously. It is well known that when high NA lenses are used the imaging system must be treated with vectorial analysis. This in turn requires that the scattering of light by the object be calculated rigorously according to Maxwell's equations. Maxwell's equations are solvable analytically for only a small class of scattering objects necessitating the use of rigorous numerical methods for the general case. Finally, rigorous vectorial diffraction theory and focusing theory are combined to calculate the image of the scattered light. We demonstrate the usefulness of the model through examples.

Calculation of the image of an arbitrary vectorial electromagnetic field.

In order to rigorously calculate the image of a scattered field, it must be propagated into the far-field before vectorial focusing theory is applied. This approach may become difficult when, for example, the scattering object is embedded in a stratified medium, requiring calculation of the appropriate Green's tensor. We present a method for calculating the image of an arbitrary vectorial field by decomposing the field into a superposition of magnetic-dipole waves. We show that this technique can significantly simplify the calculation of the image of arbitrary vectorial fields even when the field is known within a stratified medium. The technique is more computationally efficient than existing methods however we also show that the method retains accuracy.