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PurposeAdenomyosis is a poorly understood entity with no unified treatment protocol. It has been thought to only affect the quality of life of older women, but growing evidence is highlighting the increased frequency of adenomyosis in younger patients and its possible effects on fertility outcomes. This can have a great impact on how clinicians screen, diagnose, and treat this condition. The aim of this review is to explore the relationship between adenomyosis and infertility.MethodsA literature search of the keywords “adenomyosis”, “infertility”, “pregnancy” and “fertility” was conducted using the PubMed and Medline search engines. The articles selected were observational, systematic reviews, meta-analyses, and randomized controlled trials. The search was limited to English, abstracts were screened, and articles were selected.ResultsThe literature reports lower clinical pregnancy rates, lower live birth rates, higher miscarriage rates, and higher odds of adverse obstetric outcomes in patients with adenomyosis. Treatment seems to be associated with higher pregnancy rates and live births rates.ConclusionAn association between adenomyosis and infertility seems to exist, and treatment could lead to improved fertility outcomes.

[...]the value of ICPM in OAs remains poorly understood. [...]the authors attempt to create comparable groups through propensity matching based on demographics, injury characteristics, and trauma center level. [...]the study classifies both discharge to skilled nursing facility (SNF) and discharge to hospice as “unfavorable”.

Abstract PurposeThe use of platelet-rich plasma is being investigated in reproductive medicine and clinically promoted as a fertility treatment for menopause. We aimed to review the literature on the impact of PRP on fertility in menopause.MethodsA literature search was performed using the PubMed and MEDLINE search engines. The search was limited to the English language. Articles studying PRP use in menopause were selected for the purpose of this review.ResultsLimited case reports and case series studied fertility outcomes of PRP in menopause. Randomized controlled trials are lacking. Furthermore, no studies have been conducted to evaluate the effect of different PRP concentrations, injection techniques, or side effects on reproductive outcomes in menopausal women.ConclusionThere is a dearth of data to support the routine implementation of intraovarian PRP injections for fertility restoration in menopausal women. Patients considering such therapy need to be well aware of the lack of adequate data for PRP use in menopause and should be counseled accordingly.

A decrease in adult hippocampal neurogenesis has been linked to age-related cognitive impairment. However, the mechanisms involved in this age-related reduction remain elusive. Glucocorticoid hormones (GC) are important regulators of neural stem/precursor cells (NSPC) proliferation. GC are released from the adrenal glands in ultradian secretory pulses that generate characteristic circadian oscillations. Here, we investigated the hypothesis that GC oscillations prevent NSPC activation and preserve a quiescent NSPC pool in the aging hippocampus. We found that hippocampal NSPC populations lacking expression of the glucocorticoid receptor (GR) decayed exponentially with age, while GR-positive populations decayed linearly and predominated in the hippocampus from middle age onwards. Importantly, GC oscillations controlled NSPC activation and GR knockdown reactivated NSPC proliferation in aged mice. When modeled in primary hippocampal NSPC cultures, GC oscillations control cell cycle progression and induce specific genome-wide DNA methylation profiles. GC oscillations induced lasting changes in the methylation state of a group of gene promoters associated with cell cycle regulation and the canonical Wnt signaling pathway. Finally, in a mouse model of accelerated aging, we show that disruption of GC oscillations induces lasting changes in dendritic complexity, spine numbers and morphology of newborn granule neurons. Together, these results indicate that GC oscillations preserve a population of GR-expressing NSPC during aging, preventing their activation possibly by epigenetic programming through methylation of specific gene promoters. Our observations suggest a novel mechanism mediated by GC that controls NSPC proliferation and preserves a dormant NSPC pool, possibly contributing to a neuroplasticity reserve in the aging brain.

Background Domestic violence is a real public health problem with considerable consequences, ranging from minor injuries to death. Our study aims to determine the epidemiological and forensic characteristics relating to the violent mortality of women, and more particularly spousal homicide. Methods To do this, a double survey was conducted. The first step was descriptive and retrospective, and the second survey was analytical and prospective. This latter step covered the most populous age group of murdered women in Algeria, which is eighteen-year-old and over, and subjected a number of these female victims to a medico-judicial autopsy at the level of the thanatology unit for over four years counting two years for each survey (2017–2018 and 2019–2020). Data were entered and processed using Epi-info6 software. Results During the initial period of our study, we identified 35 cases of violent deaths involving women and representing a frequency of 5.71% of the thanatological activity. During the second period, 12 spousal homicides were recorded and autopsied, representing a frequency of 1.79% of all forensic deaths in the corresponding study period. The average age of the victims was evaluated at 33 ± 12.91 years, with extremes of 19 to 56 years. The age of the perpetrators of spousal homicide was evaluated at 42 ± 10.76 years with extremes ranging from 30 to 60 years. For victims of violent death and spousal homicide, inactivity was a strongly implicated risk factor, with respective frequencies of (88.57%) and (58.33%). Two-thirds of the persecuted women were completely unknown to the healthcare environment and had never consulted a medical professional. This parameter could be one of the predictive signs of spousal homicide. The marital home was the preferred location for violent deaths and spousal homicides. These crimes occurred variably during the period of marriage and eventually after divorce. As for the modus operandi, the perpetrators use many sharp and spinous weapons, including firearms and blunt objects. Conclusion Autopsy and medico-legal investigations took a decisive interest in the identification of the causes of spousal homicide; indeed, many serious traumatic lesions incompatible with life have been highlighted. We underline the crucial role that healthcare professionals must play in the process of identifying and evaluating potentially risky situations.

Background The circulation of tick-borne pathogens is influenced by the availability of ticks, the hosts of ticks and pathogens, and the environmental conditions that affect both the ticks and their hosts. Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato and transmitted by Ixodes spp. ticks, is the most common tick-borne disease in the Northern Hemisphere. Understanding the spatio-temporal dynamics of human LB incidence regarding abundance of ticks and hosts and environmental factors is essential for effective disease risk management. Methods We analyzed long-term (1997–2018) and spatially extensive (277 municipalities covering 230,000 km 2 ) data on human LB incidence in Finland. Using dynamic species distribution models, we assessed the effects of (i) the abundance of pathogen reservoir hosts used by immature ticks (voles and squirrels), (ii) abundance of the key reproductive hosts for adult ticks (moose and deer), (iii) landscape characteristics, and (iv) climatic variables on the risk of LB. Results LB presence and incidence varied across the study area and exhibited a clear increasing trend. While host species showed temporal and regional variation in abundance, their relationships with LB risk were inconsistent. In contrast, environmental variables showed more consistent patterns: increased forest fragmentation, longer growing seasons, and higher humidity were generally associated with elevated LB risk. Conclusions Our study suggests that the factors explaining LB epidemiology cannot be generalized spatially but depend on local climate, landscape, and host community. Given the available data, environmental conditions seem to play a more predictable role in LB epidemiology than the estimated abundances of hosts at the municipality level, yet we cannot exclude host abundance effects. Hence, the key to enhancing our understanding of the complex mechanisms underlying the epidemiology of LB and other tick-borne infections is to clarify how tick distribution and abundance respond to alterations in the host community, habitat features, and local climate. Graphical Abstract

(1) Background: Adenomyosis is a poorly understood entity which makes it difficult to standardize treatment. In this paper we review and compare the currently approved medical and surgical treatments of adenomyosis and present the evidence behind them. (2) Methods: A PubMed search was conducted to identify papers related to the different treatments of adenomyosis. The search was limited to the English language. Articles were divided into medical and surgical treatments. (3) Results: Several treatment options have been studied and were found to be effective in the treatment of adenomyosis. (4) Conclusions: Further randomized controlled trials are needed to compare treatment modalities and establish a uniform treatment algorithm for adenomyosis.

PurposeEndometriomas are a common cause of infertility necessitating assisted reproductive technology (ART). It had been previously thought that surgical removal of the endometriomas prior to ART would improve reproductive outcomes, but recent data suggests that surgical cystectomy might affect the ovarian reserve, decreasing the chances of ART success. The aim of this article is to review the literature on the effects of endometrioma surgery on ART outcomes providing an overview of the current evidence and assessing the need for further studies.MethodsA literature search was performed using PubMed and MEDLINE databases to identify studies that discuss endometriomas and assisted reproductive technology before versus after surgery.ResultsIn women with an endometrioma requiring ART, growing evidence suggests that surgery might result in damage to the ovarian reserve and further decrease chances of fertility. However, pregnancy rates, implantation rates, fertilization rates, and live birth rates seemed to be consistently similar across both groups.ConclusionThe current evidence is inconclusive on whether endometriomas should be surgically removed prior to ART. Further large randomized controlled trials are needed for a definite answer, and until then, management should be individualized.

Introduction: Patients with soft tissue infection are often encountered in clinical practice. The mainstay of treatment typically includes antimicrobial therapy, followed by surgical debridement when indicated. Blood cultures are often performed prior to starting the first dose of antibiotics. However, when patients require transfer to tertiary/quaternary-level care for more advanced surgical interventions, blood cultures are often repeated despite patients being on broad-spectrum antibiotics. Our study aims to investigate the utility of blood cultures following transfer to a higher level of care. Methods: This is a retrospective study involving adult patients (≥18 years of age) who were transferred to a quaternary academic center with soft tissue infections between 15 June 2018 and 15 February 2022. Patients with incomplete medical records and/or without blood culture data after arrival were excluded. The primary outcome was the rate of positive blood cultures post-transfer. Descriptive analyses were performed, and comparisons between groups were expressed as absolute differences and 95% CI. Results: We analyzed 303 patients with a mean (+/−SD) age of 54 (14) years, and 199 (66%) were male. Necrotizing soft tissue infections (NSTIs) predominated, 198 patients (65%), with a majority of the NSTIs involving the perineum (112, 37%). The prevalence of positive blood cultures was 20 (7%) for pre-transfer and 14 (5%) for post-transfer. Among post-transfer positive blood cultures, 3 (21%) were coagulase-negative Staphylococcus aureus, with 2 (14%) cases each for the blood culture categories of polymicrobial, methicillin-sensitive Staphylococcus aureus, and Enterococcus faecalis, and 2 (14%) with Candida species. Among 112 patients with NSTIs of the perineum, 2 (14%) patients had positive blood cultures post-transfer, compared with 110 (38%) patients with negative blood cultures (difference 24%, 95% CI −0.40, −0.12, p < 0.001). Conclusions: For patients with soft tissue infection, the prevalence of positive blood culture after arrival at our quaternary care center was low at 5%. Pathogenic cases of positive blood cultures after transfer were polymicrobial, methicillin-sensitive Staphylococcus aureus and Candida species. However, the low number of post-transfer positive blood cultures limits the strength of the inference and should be interpreted cautiously. Further studies are necessary to confirm our observation. Clinicians at tertiary/quaternary care centers should consider the utility of obtaining blood cultures from patients with soft tissue infections transferred from other facilities.

Background Audit and feedback (A&F) is an implementation strategy that can facilitate implementation tailoring by identifying gaps between desired and actual clinical care. While there are several theory-based propositions on which A&F components lead to better implementation outcomes, many have not been empirically investigated, and there is limited guidance for stakeholders when applying A&F in practice. The current study aims to illustrate A&F procedures in six community mental health clinics, with an emphasis on reporting A&F components that are relevant to theories of how feedback elicits behavior change. Methods Six clinics from a larger trial using a tailored approach to implement measurement-based care (MBC) were analyzed for feedback content, delivery mechanisms, barriers to feedback, and outcomes of feedback using archival data. Pattern analysis was conducted to examine relations between A&F components and changes in MBC use. Results Several sites utilized both aggregate and individualized data summaries, and data accuracy concerns were common. Feedback cycles featuring individual-level clinician data, data relevant to MBC barriers, and information requested by data recipients were related to patterns of increased MBC use. Conclusions These findings support extant theory, such as Feedback Intervention Theory. Mental health professionals wishing to apply A&F should consider establishing reciprocal feedback mechanisms on the quality and amount of data being received and adopting specific roles communicating and addressing data quality concerns. Trial registration ClinicalTrials.gov Identifier: NCT02266134.