Healthy Woman Research Articles

Primary splenic angiosarcoma: a rare case of embolization as a bridge to splenectomy

Primary splenic angiosarcoma is the primary malignant vascular neoplasm of the spleen. This tumor is highly aggressive and extremely rare with a nonspecific clinical presentation. Prognosis is poor and almost all patients die within one year of diagnosis. We present the case of a 69-year-old healthy woman with left-sided abdominal tenderness. An ultrasound examination of the abdomen was performed to evaluate the cause of abdominal pain and showed splenomegaly with inhomogeneous echotexture and the presence of free intraperitoneal fluid. An emergency abdominal contrast-enhanced computed tomography confirmed the splenomegaly and showed hemoperitoneum and a splenic mass with heterogeneous contrast enhancement. Due to the sudden worsening of the patient’s clinical conditions (hemoglobin level of 7 g/dl) and the unavailability of the operating room, embolization of the splenic artery was performed as a bridge to subsequent splenectomy under the suspicion of splenic rupture. Histological examination demonstrated a primary splenic angiosarcoma and the patient was referred to an oncological center. Due to the rarity of this malignancy, the optimal treatment of primary splenic angiosarcoma remains under investigation. Transcatheter splenic artery embolization is not common, but it could be useful for temporarily stabilizing the patient as a bridge to the subsequent splenectomy.

Megacolon diagnosis in pregnancy: A case report and literature review

Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. Megacolon can complicate pregnancy in terms of maternal morbidity and mortality (volvulus, ileus, systemic toxicity, bowel perforation, sepsis) and obstetrical outcomes (preterm birth, premature rupture of membranes, dystocia). Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms.A case of megacolon, first detected during pregnancy in an otherwise healthy nulliparous woman, is reported. The diagnosis was suspected on observation of a pelvic mass of unknown aetiology (mean diameter > 10 cm) constricting and dislocating the gravid uterus contralaterally during a routine mid-trimester fetal ultrasound. The diagnostic work-up and management are discussed. Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy.

A novel inherited CARD9 deficiency in an otherwise healthy woman with CNS candidiasis

Patients with caspase-associated recruitment domain-9 (CARD9) deficiency are more likely to develop invasive fungal disease that affect CNS. However, the understanding of how Candida invades and persists in CNS is still limited. We here reported a 24-year-old woman who were previously immunocompetent and diagnosed with CNS candidiasis. A novel autosomal recessive homozygous CARD9 mutation (c.184 + 5G > T) from this patient was identified using whole genomic sequencing. Furthermore, we extensively characterized the impact of this CARD9 mutation on the host immune response in monocytes, neutrophils and CD4 + T cells, using single cell sequencing and in vitro experiments. Decreased pro-inflammatory cytokine productions of CD14 + monocyte, impaired Th17 cell differentiation, and defective neutrophil accumulation in CNS were found in this patient. In conclusion, this study proposed a novel mechanism of CNS candidiasis development. Patients with CNS candidiasis in absence of known immunodeficiencies should be analyzed for CARD9 gene mutation as the cause of invasive fungal infection predisposition.

Hypopituitarism with secondary adrenocortical insufficiency and arginine vasopressin deficiency due to hypophysitis after COVID-19 vaccination: a case report

BackgroundAlthough vaccination against coronavirus disease (COVID-19) has several side effects, hypopituitarism due to hypophysitis has rarely been reported.Case presentationAn 83-year-old healthy woman, who had received her fourth COVID-19 vaccine dose 2 days before admission, presented to the emergency department with difficulty moving. On examination, impaired consciousness (Glasgow Coma Scale: 14) and fever were observed. Computed tomography and magnetic resonance imaging of the head revealed swelling from the sella turcica to the suprasellar region. Her morning serum cortisol level was low (4.4 μg/dL) and adrenocorticotropic hormone level was normal (21.6 pg/mL). Central hypothyroidism was also suspected (thyroid stimulating hormone, 0.46 μIU/mL; free triiodothyronine, 1.86 pg/mL; free thyroxine, 0.48 ng/dL). Secondary adrenocortical insufficiency, growth hormone deficiency, delayed gonadotropin response, and elevated prolactin levels were also observed. After administration of prednisolone and levothyroxine, her consciousness recovered. On the 7th day of admission, the patient developed polyuria, and arginine vasopressin deficiency was diagnosed using a hypertonic saline test. On the 15th day, the posterior pituitary gland showed a loss of high signal intensity and the polyuria resolved spontaneously. On the 134th day, the corticotropin-releasing hormone loading test showed a normal response; however, the thyrotropin-releasing hormone stimulation test showed a low response. The patient’s disease course was stable with continued thyroid and adrenal corticosteroid supplementation.ConclusionsHerein, we report a rare case of anterior hypopituitarism and arginine vasopressin deficiency secondary to hypophysitis following COVID-19 vaccination.

MATERNAL BREAST MILK AND ITS COMPOSITION FROM THE PERSPECTIVE OF RATIONAL FEEDING OF THE CHILD

MATERNAL BREAST MILK AND ITS COMPOSITION FROM THE PERSPECTIVE OF RATIONAL FEEDING OF THE CHILD

Eubacterium album sp. nov., a butyrate-producing bacterium isolated from faeces of a healthy human.

An oval to rod-shaped, Gram-stain-positive, strictly anaerobic bacterium, designated LFL-14T, was isolated from the faeces of a healthy Chinese woman. Cells of the strain were non-spore-forming, grew optimally at 37 °C (growth range 30-45 °C) and pH 7.0 (growth range 6.0-9.0) under anaerobic conditions in the liquid modified Gifu anaerobic medium (mGAM). The result of 16S rRNA gene-based analysis indicated that LFL-14T shared an identity of 94.7 0% with Eubacterium ventriosum ATCC 27560T, indicating LFL-14T represented a novel taxon. The results of genome-based analysis revealed that the average nucleotide identity (ANI), the digital DNA-DNA hybridisation (dDDH) and average amino acid identity (AAI) between LFL-14T and its phylogenetically closest neighbour, Eubacterium ventriosum ATCC 27560T, were 77.0 %, 24.6 and 70.9 %, respectively, indicating that LFL-14T represents a novel species of the genus Eubacterium. The genome size of LFL-14T was 2.92 Mbp and the DNA G+C content was 33.14 mol%. We analysed the distribution of the genome of LFL-14T in cohorts of healthy individuals, type 2 diabetes patients (T2D) and patients with non-alcoholic fatty liver disease (NAFLD). We found that its abundance was higher in the T2D cohort, but it had a low average abundance of less than 0.2 % in all three cohorts. The percentages of frequency of occurrence in the T2D, healthy and NAFLD cohorts were 48.87 %, 16.72 % and 13.10 % respectively. The major cellular fatty acids of LFL-14T were C16 : 0 (34.4 %), C17 : 0 2-OH (21.4 %) and C14 : 0 (11.7 %). Additionally, the strain contained diphosphatidylglycerol (DPG) and phosphatidylethanolamine (PE), as well as unidentified phospholipids and unidentified glycolipids. The glucose fermentation products of LFL-14T were acetate and butyrate. In summary, On the basis of its chemotaxonomic, phenotypic, phylogenetic and phylogenomic properties, strain LFL-14T (= CGMCC 1.18005T = KCTC 25580T) is identified as representing a novel species of the genus Eubacterium, for which the name Eubacterium album sp. nov. is proposed.

TRANSITION FROM MATERNAL CHRONIC RENAL FAILURE TO PERITONEAL DIALYSIS TREATMENT

Chronic kidney failure (CKF) has become an increasingly important public health issue in our country and worldwide. According to data systems in our country, as of the end of 2022, there were a total of 86,665 patients with chronic kidney failure, and 4.1% of these patients undergo peritoneal dialysis treatment. Peritoneal dialysis requires active participation of the patient in the treatment, and it can lead to negative effects on body image, self-esteem, and sexual relations due to the peritoneal dialysis catheter, causing anxiety and depression in patients and negatively affecting their quality of life. Throughout human life, individuals undergo changes in identity, roles, responsibilities, abilities, and behaviors due to various reasons (illness, pregnancy, death, birth). One of the fundamental duties of nurses is to assist individuals undergoing various transitions in their lives, to support healthy transitions, and to minimize unhealthy transitions. In this study, the process of transition experienced by a healthy woman transitioning to the role of motherhood due to health problems during pregnancy, and transitioning to chronic kidney failure and peritoneal dialysis treatment, is examined based on Meleis' Transition Theory

Streptococcus hohhotensis sp. nov., isolated from the breast milk of a healthy woman.

Human breast milk contains lactic acid bacteria (LAB), which have an important influence on the composition of the intestinal microbia of infants. In this study, one strain of an α-hemolytic species of the genus Streptococcus, IMAU99199T, isolated from the breast milk of a healthy nursing mother in Hohhot city PR China, was studied to characterise its taxonomic status using phenotypic and molecular taxonomic methods. The results indicated that it represented a member of the mitis-suis clade, pneumoniae subclade of the genus Streptococcus. It is a Gram-stain-positive, catalase-negative and oxidase-negative bacterium, and the cells are globular, paired or arranged in short chains. The results of a phylogenetic analysis of its 16S rRNA gene and two housekeeping genes (gyrB and rpoB) placed it in the genus Streptococcus. A phylogenetic tree based on 135 single-copy genes sequences indicated that IMAU99199T formed a closely related branch well separated from 'Streptococcus humanilactis' IMAU99125, 'Streptococcus bouchesdurhonensis' Marseille Q6994, Streptococcus mitis NCTC 12261T, 'Streptococcus vulneris' DM3B3, Streptococcus toyakuensis TP1632T, Streptococcus pseudopneumoniae ATCC BAA-960T and Streptococcus pneumoniae NCTC 7465T. IMAU99199T and 'S. humanilactis' IMAU99125 had the highest average nucleotide identity (93.7 %) and digital DNA-DNA hybridisation (55.3 %) values, which were below the accepted thresholds for novel species. The DNA G+C content of the draft genome of IMAU99199T was 39.8 %. The main cellular fatty acids components of IMAU99199T were C16 : 0 and C16 : 1ω7. It grew at a temperature range of 25-45 °C (the optimum growth temperature was 37 °C) and a pH range of 5.0-8.0 (the optimum growth pH was 7.0). These data indicate that strain IMAU99199T represents a novel species in the genus Streptococcus, for which the name Streptococcus hohhotensis sp. nov. is proposed. The type strain is IMAU99199T (=GDMCC 1.1874T=KCTC 21155T).

Abstract PO2-08-03: Developing a polygenic risk score for precision prevention of estrogen receptor-positive (ER+)/HER2- breast cancer in Brazilian women

Abstract Polygenic risk scores (PRS) quantify the genetic risk of diseases based on risk alleles in genomic loci identified in genome-wide association studies (GWAS). As individuals of European ancestry are overrepresented in GWAS, PRS performance may vary in individuals of different ancestries. Brazil is the largest and most populated country in Latin America, with around 43% of admixed individuals, and data on breast cancer PRS performance for this population is lacking. We aimed to evaluate the performance of a breast cancer PRS with 313 SNPs generated with Europeans in Brazilian population. In this case-control study, we expect to include 1000 women age >= 18 years old with current or previous diagnosis of ER+/HER2- breast cancer. Germline DNA samples are genotyped with Illumina Infinium Global Screening Array-24 v3.0 chip. Controls are healthy woman previously genotyped with Global Screening Array-24 v1.0 chip. We selected the 313 SNPs PRS for ER+/HER2- breast cancer from PGS Catalog for evaluation. Quality control, imputation, PRS calculation and statistical analysis were performed in PLINK v2.0, Michigan server, PGS Catalog and R, respectively. We present the preliminary results for 1347 women (504 cases and 843 controls) included until March of 2023. After quality control and imputation, we calculated PRS for 1212 subjects (475 cases and 737 controls). Out of 313 SNPs, 211 were validated in our samples. For ER+/HER2- breast cancer, the odds ratio per SD of the 211-variant PRS (PRS211) was 1.363 (95% confidence interval [CI]: 1.211 to 1.537). Compared with women with average risk (40th-60th PRS percentile), women in the top 10% of PRS211 had a 1.623-fold increased risk (95% CI: 1.047 to 2.522). The area under the receiver operating characteristic curve of 0.581. Our preliminary results indicate that a PRS derived from European-ancestry population correlates with ER+/HER2- breast cancer in admixed Brazilian population, although with attenuated performance. Further work is needed to better characterize PRS risk stratification in admixed populations. Citation Format: Marina Candido Visontai Cormedi, Álison Luís Eburnêo Pereira, Fernanda Borchers Coeli-Lacchini, Sabrina Baroni, Lívia Mara Torres Bueno, Evelyn Ayumi Onga, Victor Girelli Piloto De Oliveira, Fabiana De Oliveira Buono, Aline Fares, Tatiana Strava Correa, Iasmin Alves Chirichela, Fernanda Peria, Romulado Barroso-Sousa, Rodrigo Santa Cruz Guindalini, Taisa Manuela Bonfim Machado Lopes, Rosimeire Aparecida Roela, Maria Aparecida Azevedo Koike Folgueira, Daniel Guimarães Tiezzi, Leandro Machado Colli, Liane Rapatoni. Developing a polygenic risk score for precision prevention of estrogen receptor-positive (ER+)/HER2- breast cancer in Brazilian women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-08-03.

Averaging Tidal Flow-volume Loops: A tale of two methods

Introduction: A standard practice in cardiopulmonary exercise testing (CPET) is calculating the average flow and volume data across multiple breaths. Currently, many laboratories find average flow-volume loops by taking equal increments of the tidal volume and averaging the respective increments of flow for each breath. However, it has been proposed that using equal increments of total time to find an average flow-volume loop could more accurately capture the shape of the loop, which could be critical to determining expiratory flow limitation (EFL) when placed within a maximal flow-volume loop. Purpose: To compare the use of time vs. volume bins on producing averaged flow-volume loops and evaluate whether the results could affect the interpretation of EFL. Methods: Time, volume, and flow data of consecutive breaths at rest and during exercise were obtained for four individuals: one younger healthy man, one older healthy woman, one older man with heart failure, and one child with obesity. The data were separated into individual breaths using zero flow points, then total time and tidal volume were calculated for each full breath. For the time bin method as proposed by M. Younes, equal intervals of time were calculated for both the inspiratory and expiratory phases of each breath. Linear interpolation between surrounding data points was performed to obtain volume and flow values at these intervals. Volume data were then normalized to the tidal volume of the breath by taking the value as a percentage of the total tidal volume. From here, the volume and flow data at the corresponding intervals for each breath were averaged to create the final average flow-volume loop. For the volume bin method, equal intervals of volume were determined based on the tidal volume. Linear interpolation was then used to calculate the respective flow values at these intervals. The volume and flow data at the corresponding intervals for each breath were then averaged to generate the average flow-volume loop data. Standard deviation at each averaged point was also calculated for both methods. Results: Minimal difference was visible between the time bin and volume bin methods at 20 intervals. As the number of intervals used increased, the difference became less apparent. At 250 intervals, the volume bin method depicted the average flow-volume loop as effectively as the time bin method. Addition of standard deviations gave a better view of the variability of flow at any volume. Conclusion: Despite the inherent incrementation associated with the use of time bins vs. volume bins the average flow-volume loops looked very similar. However, the addition of the standard deviations of flow and volume at each data point could yield different results for determining EFL. Also, the time bin method may yield more resolution at rapid transition points at the beginning of inspiration and expiration. Overall, the observed similarities between time bin and volume bin methods are likely due to increased computer capabilities and the ability to create more intervals (i.e., 20 vs. 250), making a constant unit of measurement less necessary. Funding: NIH R01 HL136643, NIH R01 AG070262, NIH P01 HL137630, King Charitable Foundation Trust, Susan Lay Atwell Annuity Trust for Pulmonary Research, Cain Foundation, and Texas Health Presbyterian Hospital Dallas. Dr. Daniel Wilhite was funded by an NIH Administrative Supplement to Promote Diversity in Health-Related Research (HL136643-01S1). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Enhanced Human Skeletal Muscle Cell Differentiation via the Inhibition of 15-Hydroxyprostaglandin Dehydrogenase

Musculoskeletal diseases, including sarcopenia, are increasingly affecting billions globally. Individuals afflicted with such diseases experience impaired ability to regenerate muscle following injury or volumetric loss. Regeneration is vital for maintaining healthy muscle function and muscle cell differentiation plays a significant role. Our previous studies show that Prostaglandin E2 (PGE2) increases mouse muscle cell differentiation and improves muscle function. Adequate levels of PGE2 in muscle are therefore required for proper regeneration. 15-Hydroxyprostaglandin dehydrogenase (15-PDGH) is an enzyme which degrades PGE2. Previously, studies in rat muscle cells that were treated with SW0033291 (referred hereafter as SW), an inhibitor of 15-PDGH, showed that muscle cell differentiation was enhanced. There is no published study of SW effects on human skeletal muscle myogenesis. Our hypothesis is that when human skeletal muscle cells are treated with SW, the differentiation will be enhanced. To study the effects of SW on human muscle cell differentiation, first the cytotoxicity of SW on human primary skeletal muscle cells (HPSMC) from a young healthy woman were treated with 25, 50, 100, 500 and 1000nM SW for 24h and 48h. No cytotoxicity of SW was detected in all SW-treated groups compared to control group (p>0.05). The effects of SW on myogenic differentiation were measured on day 4 using the methodology of Fusion Index (FI). To study the molecular mechanisms of SW on myogenesis, the expression of myogenic regulator genes (MyoD, MyoG and Mhc) were analyzed by RT-qPCR after the treatment of SW. At day 4 of differentiation, compared to control, no obvious difference of FI was found in 25, 50, 100, and 500nM SW-treated groups (p > 0.05), while a significant increase in FI was found in the 1000nM (p < 0.05) SW0033291-treated group (p<0.05). These results suggest that SW enhances HPMC differentiation. Compared to control, in 25, 50, 100, and 500nM SW-treated groups, the expression of all three genes was not significantly changed (p > 0.05). In the 1000nM SW-treated group, the expression of the myogenic markers MyoD, MyoG and Mhc increased significantly (p < 0.05) by 1.83±0.21-fold, 1.47±0.18-fold, and 2.09±0.37-fold, respectively. These findings confirm our original hypothesis that SW enhances HPSMC differentiation. In conclusion, these results show initial promising application for maintaining proper PGE2 levels and thus allowing for proper human muscle cell differentiation and potential clinical applications in a wide range of musculoskeletal disorders. This work was directly supported by NIH-National Institutes of Aging P01AG039355 (MB) and the George W. and Hazel M. Jay and Evanston Research Endowments (MB). Authors were supported by NIH Grants: National Institutes of Aging (NINDS) 2-R01NS105621; NIA-R01AG056504, NIA-2R01AG060341, National Institutes of Diabetes, Digestive, and Kidney Diseases Kidney (NIDDK)-1R01DK119066 to MB, and National Institutes of Neurological Disorders and Stroke (NINDS) 2-R01NS105621 to MB. Also, NIH/NIDC 1R01DE031872-01 (VV). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Postpartumzorg in de eerste lijn: samenvatting van een multidisciplinaire richtlijn (deel 1)

Postpartum care in primary care: summary of a multidisciplinary guideline The lying time at the maternity ward for a healthy woman giving birth to a healthy baby is now on average less than 3 days. Therefore, primary care providers have a greater responsibility in the follow-up of the mother and newborn during the postpartum period. This article is a summary of the first part of the multidisciplinary guideline Postpartum care in primary care developed by the national Working Group Development of Primary Care Guidelines (WOREL) according to the internationally recognised methods of guideline development. The guideline formulates recommendations for quality postpartum care in collaboration with all involved healthcare providers with the aim of recognising and addressing complications in the newborn and mother in a timely manner. It is important that healthcare providers know what is normal, which red flags they should not miss, have basic knowledge about conditions and situations, and timely refer the patient to primary or secondary care. The article describes what attitude to adopt in case of life-threatening and serious complications in the maternity woman (postpartum haemorrhage, pre-eclampsia, venous thromboembolism and endometritis) and the newborn (jaundice, neonatal sepsis, congenital heart defect, dehydration, nutritional difficulties and metabolic disorders), as well as in case of less severe complications or complaints in the maternity woman (perineal pain, headache, constipation, haemorrhoids, urinary incontinence, fatigue and back pain) and the baby (gastro-oesophageal reflux, thrush, nappy dermatitis, intestinal cramps, conjunctivitis, cord infections and fever). Finally, specific situations in both the mother (prevention of antibody formation, rubella vaccination, thyroid disorders and gestational diabetes) and the newborn (cord care, prevention of sudden death, vitamin K and vitamin D substitution, and child abuse) are highlighted.

A case of surgical site infection with severe spondylitis caused by Streptococcus gordonii in an adult healthy woman: how to apply medico-legal method to deny malpractice hypothesis in suspected healthcare-associated infection.

We describe a rare case of severe primary spondylitis caused by Streptococcus gordonii in a 45-year-old immunocompetent woman with no relevant comorbidities. The surgical site infection arose after a L4-L5 microdiscectomy and resulted in severe clinical disability. Allegations of possible negligence as the cause prompted a forensic review to clarify the original source and transmission of this uncommon pathogen, which dismissed its cause as due to malpractice during treatment.

Comprehensive Review of Kaphaja Yonivyapath: Etiology, Diagnosis and Management Strategies

A family's health is guaranteed by a healthy woman. Ayurveda and contemporary medicine have both discussed the idea of a healthy yoni at various stages of a woman's life, from adolescence to menopause. These days, vaginal infections are a major concern for people of all ages and socioeconomic backgrounds. Because women have a special role of giving birth, gynecological illnesses have gained enormous relevance in the medical field. The majority of gynecological problems are included under the word "Yonivyapad," which is used in Ayurveda to refer to women's health care. Among 20 Yoni Vyapath’s Kaphaja yonivyapath is the one which is due to vitiation of Kapha, this vitiated Kapha reaches the Yoni Pradesha causes signs and symptoms like Kandu, Picchila Srava and Alpa Vedana as well as Sthanika and Sarvadaihika Kapha Prakopa Laxana. The treatment of Kaphaja Yonivyapath explained in classic as Kapha hara Dravyas and Shodhana Chikitsa mainly Vamana is indicated. This can be correlated with vulvovaginitis which is caused due to bacterial vaginosis, moniliasis and trichomans vaginalis. In this review an attempt has been made in this work to provide a conceptual analysis that covers nearly all of the Nidana, Samprapti and Chikitsa of Kaphaja Yoni Vyapad according to both Ayurveda and modern.

Quality of life in long-term cervical cancer survivors compared with healthy women and women with benign gynecological disorders

ObjectiveThe impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls. Study DesignA case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26).To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0–6, 7–12, 13–24, 25–60, and more than 60 months.For the contrastive analysis hypothesis, we employed R statistical software. ResultsExcept for the environment domain at 0–6, 7–12, and 13–24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0–6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13–24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls. ConclusionExcept for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorśquality of life did not vary from that of controls.

Facilitating childbirth choice for positive postnatal mental health well-being among women: a Namibian case study.

Childbirth affects women in a myriad of ways including feelings of tiredness, being overwhelmed, stressed, and having baby blues, and if not attended to, this can lead to postpartum depression, which is a mental condition that can have disastrous effects. Childbirth can affect the mental and physical status of a woman and having supportive midwives who guide women by giving adequate information is an issue of critical concern for a positive birth experience. The World Health Organisation (WHO) has emphasised the need to facilitate childbirth choices for women as a means of having a safe and memorable experience as the experience in childbirth affects the psychological status of a woman. Some women may experience worry and anxiety during labour and childbirth, which may be exacerbated by bias and a lack of childbirth choice facilitation during pregnancy. A negative childbirth experience may lead to negative psychological distress and postpartum depression, which will interfere with the bond between the mother, baby, and family. Midwives, thus, need to understand the emotional aspects that are attached to childbirth and be able to facilitate and support the emotional as well as the psychosocial needs of women under their care. However, there is a dearth of empirical evidence within the Namibian context that can provide direction and context-specific solutions to the present challenge. The current study followed a qualitative research design with an exploratory approach with one-on-one interviews with 10 midwives who were purposively selected. The midwives' experiences in this study depicted their zeal towards the issue at hand; however, what stood out were some barriers in the facilitation of childbirth choices (theme 1) as they expressed the shortages of staff, the timing of information, information sharing, and cultural influences as some of their experiences in facilitating childbirth. Furthermore, midwives shared a lack of provision for childbirth choice (theme 2) as the rights of women were not observed, and a lack of women-centred care despite protocols and guidelines being there, and yet they are not adhered to. In conclusion, midwives as primary caregivers actively need to provide unbiased childbirth information to achieve positive postpartum health. Initiating childbirth choices early in pregnancy gives women the time to weigh options and clearing of any misconceptions relating to childbirth types as well as reducing anxiety and fear of birth, which could lead to postpartum depression and by extension, the mental well-being of the women. Facilitating childbirth choices is critical in positive birth experiences and the management of childbirth as well as crafting guidelines and policy formulation that ensure a mentally healthy woman and society.

Establishment of an induced pluripotent stem cell (iPSC) line (INNDSUi005-A) from a healthy female Chinese Han

We obtained skin fibroblasts from a 34-year-old healthy woman and established a human induced pluripotent stem cell (hiPSC) line (INDSUi005-A) using a non-integrated reprogramming approach. The obtained cells have typical characteristics of embryonic stem cells, can express specific pluripotency markers and have the ability to differentiate into three germ layers in vitro. This iPSC cell line can be used as an in vitro model for studying disease mechanisms and developing novel therapies.

Fulminant Celiac Disease Presenting in the Postpartum Period

ABSTRACT Celiac disease (CD) is an immune-mediated disorder of the small intestine triggered by dietary exposure to gluten in genetically susceptible individuals. Adult CD usually has an insidious onset with gastrointestinal symptoms, most often diarrhea and weight loss. The association between CD and reproductive abnormalities has been well described in the literature, but it is uncommon for CD to initially manifest during pregnancy or the postpartum period. We report a case of adult CD in a previously healthy woman with a life-threatening presentation during the postpartum period.

Disseminated nocardiosis and anti-GM-CSF antibodies.

Infections that are unusually severe or caused by opportunistic pathogens are a hallmark of primary immunodeficiency (PID). Anti-cytokine autoantibodies (ACA) are an emerging cause of acquired immunodeficiency mimicking PID. Nocardia spp. are Gram-positive bacteria generally inducing disseminated infections in immunocompromised patients, but seldom also occurring in apparently immunocompetent hosts. Anti-GM-CSF autoantibodies are associated with autoimmune pulmonary alveolar proteinosis (PAP). In those patients, an increased incidence of disseminated nocardiosis and cryptococcosis has been observed. It is unclear whether the PAP or the autoantibodies predispose to the infection. We report an apparently immunocompetent woman presenting with disseminated nocardiosis without any evidence of PAP. Clinical data and radiological images were retrospectively collected. Lymphocyte populations were analyzed by flow cytometry. Anti-GM-CSF autoantibodies were measured by ELISA. A 55-year-old otherwise healthy woman presented with cerebral and pulmonary abscesses. Personal and familial history of infections or autoimmunity were negative. After extensive examinations, a final diagnosis of disseminated nocardiosis was made. Immunologic investigations including neutrophilic function and IFN-γ/IL-12 circuitry failed to identify a PID. Whole-exome sequencing did not find pathogenic variants associated with immunodeficiency. Serum anti-GM-CSF autoantibodies were positive. There were no clinical or instrumental signs of PAP. Trimethoprim-sulfamethoxazole and imipenem were administered, with progressive improvement and recovery of the infectious complication. We identified anti-GM-CSF autoantibodies as the cause of disseminated nocardiosis in a previously healthy and apparently immunocompetent adult. This case emphasizes the importance of including ACA in the differential diagnosis of PID, especially in previously healthy adults. Importantly, anti-GM-CSF autoantibodies can present with disseminated nocardiosis without PAP.

Estimating Public Economic Gains from Early Breast Cancer and Curative Treatment: A Case Study in Human Epidermal Growth Factor Receptor (HER-2) Positive Targeted Therapies.

Cancer diagnosis influences the choices that patients make regarding current and future labor market activity. These choices have implications for governments based on resulting changes in taxes paid and benefits received. In this analysis we explore how human growth receptor 2 (HER2)-positive residual invasive breast cancer and different treatments influence government accounts excluding health costs. HER2-positive early breast cancer (eBC) health states from a published disease model were used to establish likelihood of working and wage impact at different stages of disease. The indirect productivity losses for an average woman aged 49years were translated into fiscal consequences to government by applying an established government perspective-modeling framework. The fiscal projections (discounted) include gross tax revenue by disease stage, government transfer costs related to time off work and early retirement ,and net fiscal balance (e.g., gross taxes-transfers) in three countries Canada, Portugal, and Brazil. The net fiscal balance in Canada for a healthy woman was C$109,551 compared with a HER2-positive eBC woman treated with trastuzumab emtansine (C$69,767) or trastuzumab (C$62,971). A similar pattern was observed in the three countries but reflecting the overall tax burden in each country, labor force activity, and available public benefits. Age at diagnosis was an important determinant of the likely net fiscal balance, as this influences the remaining working years. Women diagnosed with HER2-positive eBC were estimated to pay less lifetime gross taxes and receive more in sickness benefits compared with healthy women. Treatments that improve outcomes are likely to offer fiscal gains for government from improved work force participation.