Endometrial Cancer Characteristics and Risk of Recurrence

OBJECTIVES

To describe clinicopathologic characteristics and survival outcomes of endometrial adenocarcinomas stratified by mismatch repair (MMR) status.

METHODS

Single-institution, retrospective study of all women with endometrioid adenocarcinomas treated from January 2012 through December 2017. Patients were categorized into one of three groups based on MMR testing: intact MMR expression (MMR+), probable MMR mutation (MMR-), or MLH1 hypermethylation (hMLH1+). Demographics, pathologic characteristics, recurrence rates, and survival differences were analyzed.

RESULTS

In total, 316 women were included in the analysis: 235 (74.4%) patients in the MMR+ group, 10 (3.1%) in the MMR- group, and 71 (22.5%) in the hMLH1+ group. Patients with hMLH1+ were significantly older, exhibited higher-grade histology and presence of lymphovascular space invasion, and were more likely to have received adjuvant treatment. The early stage hMLH1+ patients were more likely to recur (15.3% hMLH1+ vs 2.3% MMR+ vs 12.5% MMR-, P < .001). Hypermethylation remained a significant predictor of recurrence in multivariable analysis (odds ratio, 5.09; 95% confidence interval [CI], 1.54-16.86; P = .008). Recurrence-free survival was significantly reduced in early stage hMLH1+ (hazard ratio, 7.40; 95% CI, 2.80-21.62; P < .001).

CONCLUSIONS

Women with hMLH1+ endometrial cancer have worse prognostic features and recur more frequently, even in patients traditionally considered low risk for recurrence.

Development of endometrial stromal sarcoma in a patient undergoing in vitro fertilization: A case report

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A new endometrial lesion during IVF may represent an endometrial stromal sarcoma.

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Diagnosis of ESS requires full histologic inspection of tumor-myometrial interface.

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Main treatment of ESS is total hysterectomy and bilateral salpingo-oophorectomy.

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Fertility sparing management of low-grade ESS can be considered in young patients.

Development of endometrial stromal sarcoma during in vitro fertilization (IVF) is rare. We encountered a case of endometrial stromal sarcoma (ESS) presenting as a new endometrial mass in a patient undergoing donor egg IVF, despite normal imaging and exams prior to and throughout treatment. To our knowledge, this is the only report describing the rapid growth of ESS during IVF treatment. When diagnosing an endometrial stromal sarcoma, it is important for the clinician and patient to be aware that full histologic inspection is required to distinguish it from a benign neoplasm. Given the need for a hysterectomy for definitive diagnosis, this case presents ethical challenges and potential for patient distress.

Meta-analysis reveals that pollinator functional diversity and abundance enhance crop pollination and yield

How insects promote crop pollination remains poorly understood in terms of the contribution of functional trait differences between species. We used meta-analyses to test for correlations between community abundance, species richness and functional trait metrics with oilseed rape yield, a globally important crop. While overall abundance is consistently important in predicting yield, functional divergence between species traits also showed a positive correlation. This result supports the complementarity hypothesis that pollination function is maintained by non-overlapping trait distributions. In artificially constructed communities (mesocosms), species richness is positively correlated with yield, although this effect is not seen under field conditions. As traits of the dominant species do not predict yield above that attributed to the effect of abundance alone, we find no evidence in support of the mass ratio hypothesis. Management practices increasing not just pollinator abundance, but also functional divergence, could benefit oilseed rape agriculture.

BEESCOUT: A model of bee scouting behaviour and a software tool for characterizing nectar/pollen landscapes for BEEHAVE

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BEESCOUT is a spatially explicit, individual-based model of scouting bees.

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It determines the detection probabilities of food sources.

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It can be linked to the honey bee model BEEHAVE to predict colony development.

Social bees are central place foragers collecting floral resources from the surrounding landscape, but little is known about the probability of a scouting bee finding a particular flower patch. We therefore developed a software tool, BEESCOUT, to theoretically examine how bees might explore a landscape and distribute their scouting activities over time and space. An image file can be imported, which is interpreted by the model as a “forage map” with certain colours representing certain crops or habitat types as specified by the user. BEESCOUT calculates the size and location of these potential food sources in that landscape relative to a bee colony. An individual-based model then determines the detection probabilities of the food patches by bees, based on parameter values gathered from the flight patterns of radar-tracked honeybees and bumblebees. Various “search modes” describe hypothetical search strategies for the long-range exploration of scouting bees. The resulting detection probabilities of forage patches can be used as input for the recently developed honeybee model BEEHAVE, to explore realistic scenarios of colony growth and death in response to different stressors. In example simulations, we find that detection probabilities for food sources close to the colony fit empirical data reasonably well. However, for food sources further away no empirical data are available to validate model output. The simulated detection probabilities depend largely on the bees’ search mode, and whether they exchange information about food source locations. Nevertheless, we show that landscape structure and connectivity of food sources can have a strong impact on the results. We believe that BEESCOUT is a valuable tool to better understand how landscape configurations and searching behaviour of bees affect detection probabilities of food sources. It can also guide the collection of relevant data and the design of experiments to close knowledge gaps, and provides a useful extension to the BEEHAVE honeybee model, enabling future users to explore how landscape structure and food availability affect the foraging decisions and patch visitation rates of the bees and, in consequence, to predict colony development and survival.

A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer

To determine the incidence of lower-extremity lymphedema after surgical therapy including lymphadenectomy in endometrial cancer patients using standardized leg measurements. Also, to determine additional risk factors for the development of lymphedema and to study the effect of lymphedema on one's quality of life. In this prospective cohort study, patients with the diagnosis of endometrial cancer who were to undergo definitive surgical management were evaluated pre-operatively and followed post-operatively over the course of two years. Standardized leg measurements were performed by the same individuals at six time-points. Subjects also completed a standardized quality-of-life survey at each time-point. The incidence of lymphedema in 39 women with endometrial cancer using a standardized leg measurement protocol was 12.8% with lymphedema defined as a 20% increase in post-operative leg measurements. There was no significant association between the development of lymphedema and the number of pelvic or para-aortic lymph nodes removed, medical comorbidities, or surgical approach (p > 0.05). Of the five patients who met criteria for lymphedema, only one had worsening quality-of-life concerns post-operatively on the FACT-En, version 4, survey. This is the first prospective study using standardized leg measurements to calculate the incidence of post-operative lymphedema in endometrial cancer. Medical comorbidities, surgical approach, number of lymph nodes removed, and location of lymph nodes removed did not appear to affect the development of lymphedema in this cohort. A prospective, multicenter trial is needed to confirm these findings and to further assess the impact of lymphedema on one's quality of life.

Disease associations between honeybees and bumblebees as a threat to wild pollinators

Emerging infectious diseases (EIDs) pose a risk to human welfare, both directly and indirectly, by affecting managed livestock and wildlife that provide valuable resources and ecosystem services, such as the pollination of crops. Honeybees (Apis mellifera), the prevailing managed insect crop pollinator, suffer from a range of emerging and exotic high-impact pathogens, and population maintenance requires active management by beekeepers to control them. Wild pollinators such as bumblebees (Bombus spp.) are in global decline, one cause of which may be pathogen spillover from managed pollinators like honeybees or commercial colonies of bumblebees. Here we use a combination of infection experiments and landscape-scale field data to show that honeybee EIDs are indeed widespread infectious agents within the pollinator assemblage. The prevalence of deformed wing virus (DWV) and the exotic parasite Nosema ceranae in honeybees and bumblebees is linked; as honeybees have higher DWV prevalence, and sympatric bumblebees and honeybees are infected by the same DWV strains, Apis is the likely source of at least one major EID in wild pollinators. Lessons learned from vertebrates highlight the need for increased pathogen control in managed bee species to maintain wild pollinators, as declines in native pollinators may be caused by interspecies pathogen transmission originating from managed pollinators.

Bumble bee species' responses to a targeted conservation measure depend on landscape context and habitat quality

The global decline of insect pollinators, especially bees, is cause for concern, and there is an urgent need for cost-effective conservation measures in agricultural landscapes. While landscape context and habitat quality are known to influence species richness and abundance of bees, there is a lack of evidence from manipulative field experiments on bees' responses to adaptive management across differently structured landscapes. We present the results of a large-scale study that investigated the effects of a targeted agri-environment scheme (AES) on bumble bees (Bombus spp.) over three years in the United Kingdom. Forage patches of different sizes were sown with a conservation flower mixture across eight sites covering a broad range of agricultural land use types. Species richness and worker densities (especially of the longer-tongued Bombus species for which the mixture was targeted) were significantly higher on sown forage patches than on existing non-crop control habitats throughout the three-year study, but the strength of this response depended on both the proportions of arable land and abundance of herbaceous forb species in the surrounding landscape. The size of sown patches also affected worker density, with smaller patches (0.25 ha) attracting higher densities of some species than larger patches (1.0 ha). Our models show that a targeted AES can deliver greater net benefits in more intensively farmed areas, in terms of the number and species richness of bumble bees supported, than in heterogeneous landscapes where other foraging habitats exist. These findings serve to strengthen the evidence base for extending agri-environment schemes to boost declining pollinator populations to a larger number of agricultural landscapes across the globe.

Impacts of the use of nonnative commercial bumble bees for pollinator supplementation in raspberry

Evidence for pollinator declines has led to concern that inadequate pollination services may limit crop yields. The global trade in commercial bumble bee (Bombus spp.) colonies provides pollination services for both glasshouse and open-field crops. For example, in the United Kingdom, commercial colonies of nonnative subspecies of the bumble bee Bombus terrestris L. imported from mainland Europe are widely used for the pollination of raspberries, Rubus idaeus L. The extent to which these commercial colonies supplement the services provided by wild pollinators has not been formally quantified and the impact of commercial bumble bees on native bees visiting the crop is unknown. Here, the impacts of allowing commercially available bumble bee colonies to forage on raspberry canes are assessed in terms of the yield of marketable fruit produced and the pollinator communities found foraging on raspberry flowers. No differences were found in the abundance, diversity, or composition of social bee species observed visiting raspberry flowers when commercial bumble bees were deployed compared with when they were absent. However, weight of marketable raspberries produced increased when commercial bees were present, indicating that wild pollinator services alone are inadequate for attaining maximum yields. The findings of the study suggests that proportional yield increases associated with deployment of commercial colonies may be small, but that nevertheless, investment in commercial colonies for raspberry pollination could produce very significant increases in net profit for the grower. Given potential environmental risks associated with the importation of nonnative bumble bees, the development of alternative solutions to the pollination deficit in raspberry crops in the United Kingdom may be beneficial.

Energy spectrum of cosmic-ray electrons at TeV energies

The very large collection area of ground-based gamma-ray telescopes gives them a substantial advantage over balloon or satellite based instruments in the detection of very-high-energy (>600 GeV) cosmic-ray electrons. Here we present the electron spectrum derived from data taken with the High Energy Stereoscopic System (H.E.S.S.) of imaging atmospheric Cherenkov telescopes. In this measurement, the first of this type, we are able to extend the measurement of the electron spectrum beyond the range accessible to direct measurements. We find evidence for a substantial steepening in the energy spectrum above 600 GeV compared to lower energies.

Limits on an energy dependence of the speed of light from a flare of the active galaxy PKS 2155-304

In the past few decades, several models have predicted an energy dependence of the speed of light in the context of quantum gravity. For cosmological sources such as active galaxies, this minuscule effect can add up to measurable photon-energy dependent time lags. In this Letter a search for such time lags during the High Energy Stereoscopic System observations of the exceptional very high energy flare of the active galaxy PKS 2155-304 on 28 July 2006 is presented. Since no significant time lag is found, lower limits on the energy scale of speed of light modifications are derived.

Landscape context not patch size determines bumble-bee density on flower mixtures sown for agri-environment schemes

Bumble-bee declines across Europe have been linked to loss of habitat and forage availability due to agricultural intensification. These declines may have severe ecological and commercial consequences since bumble-bees pollinate a range of wildflowers and crops. In England, attempts are being made to reintroduce forage resources through agri-environment schemes, yet there are few data on how the area of forage, or the landscape context in which it is provided, affects their success. We investigated the effects of sown forage patches on bumble-bees across sites varying in landscape characteristics. Bumble-bee densities were higher on sown patches compared with control habitats but did not vary with patch size, i.e. total forager numbers were proportional to patch area. Importantly, the relative response to sown forage patches varied widely across a landscape gradient such that their impact in terms of attracting foraging bumble-bees was greatest where the proportion of arable land was highest.

HESS observations of the galactic center region and their possible dark matter interpretation

The detection of gamma rays from the source HESS J1745-290 in the Galactic Center (GC) region with the High Energy Spectroscopic System (HESS) array of Cherenkov telescopes in 2004 is presented. After subtraction of the diffuse gamma-ray emission from the GC ridge, the source is compatible with a point source with spatial extent less than 1.2;{'}(stat) (95% C.L.). The measured energy spectrum above 160 GeV is compatible with a power law with photon index of 2.25+/-0.04(stat)+/-0.10(syst) and no significant flux variation is detected. It is finally found that the bulk of the very high energy emission must have non-dark-matter origin.

A low level of extragalactic background light as revealed by γ-rays from blazars

The diffuse extragalactic background light consists of the sum of the starlight emitted by galaxies through the history of the Universe, and it could also have an important contribution from the 'first stars', which may have formed before galaxy formation began. Direct measurements are difficult and not yet conclusive, owing to the large uncertainties caused by the bright foreground emission associated with zodiacal light. An alternative approach is to study the absorption features imprinted on the gamma-ray spectra of distant extragalactic objects by interactions of those photons with the background light photons. Here we report the discovery of gamma-ray emission from the blazars H 2356 - 309 and 1ES 1101 - 232, at redshifts z = 0.165 and z = 0.186, respectively. Their unexpectedly hard spectra provide an upper limit on the background light at optical/near-infrared wavelengths that appears to be very close to the lower limit given by the integrated light of resolved galaxies. The background flux at these wavelengths accordingly seems to be strongly dominated by the direct starlight from galaxies, thus excluding a large contribution from other sources-in particular from the first stars formed. This result also indicates that intergalactic space is more transparent to gamma-rays than previously thought.

Discovery of very-high-energy γ-rays from the Galactic Centre ridge

The source of Galactic cosmic rays (with energies up to 10(15) eV) remains unclear, although it is widely believed that they originate in the shock waves of expanding supernova remnants. At present the best way to investigate their acceleration and propagation is by observing the gamma-rays produced when cosmic rays interact with interstellar gas. Here we report observations of an extended region of very-high-energy (> 10(11) eV) gamma-ray emission correlated spatially with a complex of giant molecular clouds in the central 200 parsecs of the Milky Way. The hardness of the gamma-ray spectrum and the conditions in those molecular clouds indicate that the cosmic rays giving rise to the gamma-rays are likely to be protons and nuclei rather than electrons. The energy associated with the cosmic rays could have come from a single supernova explosion around 10(4) years ago.

Tracking butterfly flight paths across the landscape with harmonic radar

For the first time, the flight paths of five butterfly species were successfully tracked using harmonic radar within an agricultural landscape. Until now, butterfly mobility has been predominantly studied using visual observations and mark-recapture experiments. Attachment of a light-weight radar transponder to the butterfly's thorax did not significantly affect behaviour or mobility. Tracks were analysed for straightness, duration, displacement, ground speed, foraging and the influence of linear landscape features on flight direction. Two main styles of track were identified: (A) fast linear flight and (B) slower nonlinear flights involving a period of foraging and/or looped sections of flight. These loops potentially perform an orientation function, and were often associated with areas of forage. In the absence of forage, linear features did not provide a guiding effect on flight direction, and only dense treelines were perceived as barriers. The results provide tentative support for non-random dispersal and a perceptual range of 100-200 m for these species. This study has demonstrated a methodology of significant value for future investigation of butterfly mobility and dispersal.

An interspecific comparison of foraging range and nest density of four bumblebee (Bombus) species

Bumblebees are major pollinators of crops and wildflowers in northern temperate regions. Knowledge of their ecology is vital for the design of effective management and conservation strategies but key aspects remain poorly understood. Here we employed microsatellite markers to estimate and compare foraging range and nest density among four UK species: Bombus terrestris, Bombus pascuorum, Bombus lapidarius, and Bombus pratorum. Workers were sampled along a 1.5-km linear transect across arable farmland. Eight or nine polymorphic microsatellite markers were then used to identify putative sisters. In accordance with previous studies, minimum estimated maximum foraging range was greatest for B. terrestris (758 m) and least for B. pascuorum (449 m). The estimate for B. lapidarius was similar to B. pascuorum (450 m), while that of B. pratorum was intermediate (674 m). Since the area of forage available to bees increases as the square of foraging range, these differences correspond to a threefold variation in the area used by bumblebee nests of different species. Possible explanations for these differences are discussed. Estimates for nest density at the times of sampling were 29, 68, 117, and 26/km2 for B. terrestris, B. pascuorum, B. lapidarius and B. pratorum, respectively. These data suggest that even among the most common British bumblebee species, significant differences in fundamental aspects of their ecology exist, a finding that should be reflected in management and conservation strategies.

A new population of very high energy gamma-ray sources in the Milky Way

Very high energy gamma-rays probe the long-standing mystery of the origin of cosmic rays. Produced in the interactions of accelerated particles in astrophysical objects, they can be used to image cosmic particle accelerators. A first sensitive survey of the inner part of the Milky Way with the High Energy Stereoscopic System (HESS) reveals a population of eight previously unknown firmly detected sources of very high energy gamma-rays. At least two have no known radio or x-ray counterpart and may be representative of a new class of "dark" nucleonic cosmic ray sources.

EAU Guidelines on Chronic Pelvic Pain

OBJECTIVES

On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of chronic pelvic pain patients were established.

METHOD

Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts.

RESULTS

The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain.

CONCLUSION

A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.

High-energy particle acceleration in the shell of a supernova remnant

A significant fraction of the energy density of the interstellar medium is in the form of high-energy charged particles (cosmic rays). The origin of these particles remains uncertain. Although it is generally accepted that the only sources capable of supplying the energy required to accelerate the bulk of Galactic cosmic rays are supernova explosions, and even though the mechanism of particle acceleration in expanding supernova remnant (SNR) shocks is thought to be well understood theoretically, unequivocal evidence for the production of high-energy particles in supernova shells has proven remarkably hard to find. Here we report on observations of the SNR RX J1713.7 - 3946 (G347.3 - 0.5), which was discovered by ROSAT in the X-ray spectrum and later claimed as a source of high-energy gamma-rays of TeV energies (1 TeV = 10(12) eV). We present a TeV gamma-ray image of the SNR: the spatially resolved remnant has a shell morphology similar to that seen in X-rays, which demonstrates that very-high-energy particles are accelerated there. The energy spectrum indicates efficient acceleration of charged particles to energies beyond 100 TeV, consistent with current ideas of particle acceleration in young SNR shocks.

On the rationale and interpretation of the Farm Scale Evaluations of genetically modified herbicide-tolerant crops

Farmland biodiversity and food webs were compared in conventional and genetically modified herbicide-tolerant (GMHT) crops of beet (Beta vulgaris L.), maize (Zea mays L.) and both spring and winter oilseed rape (Brassica napus L.). GMHT and conventional varieties were sown in a split-field experimental design, at 60-70 sites for each crop, spread over three starting years beginning in 2000. This paper provides a background to the study and the rationale for its design and interpretation. It shows how data on environment, field management and the biota are used to assess the current state of the ecosystem, to define the typical arable field and to devise criteria for selecting, sampling and auditing experimental sites in the Farm Scale Evaluations. The main functional and taxonomic groups in the habitat are ranked according to their likely sensitivity to GMHT cropping, and the most responsive target organisms are defined. The value of the seedbank as a baseline and as an indicator of historical trends is proposed. Evidence from experiments during the twentieth century is analysed to show that large changes in field management have affected sensitive groups in the biota by ca. 50% during a year or short run of years--a figure against which to assess any positive or negative effects of GMHT cropping. The analysis leads to a summary of factors that were, and were not, examined in the first 3 years of the study and points to where modelling can be used to extrapolate the effects to the landscape and the agricultural region.

Invertebrate responses to the management of genetically modified herbicide-tolerant and conventional spring crops. II. Within-field epigeal and aerial arthropods

The effects of the management of genetically modified herbicide-tolerant (GMHT) crops on the abundances of aerial and epigeal arthropods were assessed in 66 beet, 68 maize and 67 spring oilseed rape sites as part of the Farm Scale Evaluations of GMHT crops. Most higher taxa were insensitive to differences between GMHT and conventional weed management, but significant effects were found on the abundance of at least one group within each taxon studied. Numbers of butterflies in beet and spring oilseed rape and of Heteroptera and bees in beet were smaller under the relevant GMHT crop management, whereas the abundance of Collembola was consistently greater in all GMHT crops. Generally, these effects were specific to each crop type, reflected the phenology and ecology of the arthropod taxa, were indirect and related to herbicide management. These results apply generally to agriculture across Britain, and could be used in mathematical models to predict the possible long-term effects of the widespread adoption of GMHT technology. The results for bees and butterflies relate to foraging preferences and might or might not translate into effects on population densities, depending on whether adoption leads to forage reductions over large areas. These species, and the detritivore Collembola, may be useful indicator species for future studies of GMHT management.

Invertebrates and vegetation of field margins adjacent to crops subject to contrasting herbicide regimes in the Farm Scale Evaluations of genetically modified herbicide-tolerant crops

The effects of management of genetically modified herbicide-tolerant (GMHT) crops on adjacent field margins were assessed for 59 maize, 66 beet and 67 spring oilseed rape sites. Fields were split into halves, one being sown with a GMHT crop and the other with the equivalent conventional non-GMHT crop. Margin vegetation was recorded in three components of the field margins. Most differences were in the tilled area, with fewer smaller effects mirroring them in the verge and boundary. In spring oilseed rape fields, the cover, flowering and seeding of plants were 25%, 44% and 39% lower, respectively, in the GMHT uncropped tilled margins. Similarly, for beet, flowering and seeding were 34% and 39% lower, respectively, in the GMHT margins. For maize, the effect was reversed, with plant cover and flowering 28% and 67% greater, respectively, in the GMHT half. Effects on butterflies mirrored these vegetation effects, with 24% fewer butterflies in margins of GMHT spring oilseed rape. The likely cause is the lower nectar supply in GMHT tilled margins and crop edges. Few large treatment differences were found for bees, gastropods or other invertebrates. Scorching of vegetation by herbicide-spray drift was on average 1.6% on verges beside conventional crops and 3.7% beside GMHT crops, the difference being significant for all three crops.

Responses of plants and invertebrate trophic groups to contrasting herbicide regimes in the Farm Scale Evaluations of genetically modified herbicide-tolerant crops

Effects of genetically modified herbicide-tolerant (GMHT) and conventional crop management on invertebrate trophic groups (herbivores, detritivores, pollinators, predators and parasitoids) were compared in beet, maize and spring oilseed rape sites throughout the UK. These trophic groups were influenced by season, crop species and GMHT management. Many groups increased twofold to fivefold in abundance between early and late summer, and differed up to 10-fold between crop species. GMHT management superimposed relatively small (less than twofold), but consistent, shifts in plant and insect abundance, the extent and direction of these effects being dependent on the relative efficacies of comparable conventional herbicide regimes. In general, the biomass of weeds was reduced under GMHT management in beet and spring oilseed rape and increased in maize compared with conventional treatments. This change in resource availability had knock-on effects on higher trophic levels except in spring oilseed rape where herbivore resource was greatest. Herbivores, pollinators and natural enemies changed in abundance in the same directions as their resources, and detritivores increased in abundance under GMHT management across all crops. The result of the later herbicide application in GMHT treatments was a shift in resource from the herbivore food web to the detritivore food web. The Farm Scale Evaluations have demonstrated over 3 years and throughout the UK that herbivores, detritivores and many of their predators and parasitoids in arable systems are sensitive to the changes in weed communities that result from the introduction of new herbicide regimes.

Ontogeny of orientation flight in the honeybee revealed by harmonic radar

Cognitive ethology focuses on the study of animals under natural conditions to reveal ecologically adapted modes of learning. But biologists can more easily study what an animal learns than how it learns. For example, honeybees take repeated 'orientation' flights before becoming foragers at about three weeks of age. These flights are a prerequisite for successful homing. Little is known about these flights because orienting bees rapidly fly out of the range of human observation. Using harmonic radar, we show for the first time a striking ontogeny to honeybee orientation flights. With increased experience, bees hold trip duration constant but fly faster, so later trips cover a larger area than earlier trips. In addition, each flight is typically restricted to a narrow sector around the hive. Orientation flights provide honeybees with repeated opportunities to view the hive and landscape features from different viewpoints, suggesting that bees learn the local landscape in a progressive fashion. We also show that these changes in orientation flight are related to the number of previous flights taken instead of chronological age, suggesting a learning process adapted to changes in weather conditions, flower availability and the needs of bee colonies.

Increased nerve growth factor levels in the urinary bladder of women with idiopathic sensory urgency and interstitial cystitis

OBJECTIVES

To determine whether nerve growth factor (NGF) is elevated in painful conditions of the urinary bladder (idiopathic sensory urgency, interstitial cystitis and painful chronic cystitis).

PATIENTS AND METHODS

Sixteen women patients were recruited from the Urodynamic Clinic at The Elizabeth Garrett Anderson Hospital, London. Four each had idiopathic sensory urgency (mean age 34 years, range 24-51), chronic cystitis (mean age 51 years, range 40-79) and interstitial cystitis (mean age 41 years, range 29-53). Four women who had genuine stress incontinence on cystometry but with no irritative symptoms were used as controls (mean age 45 years, range 35-54). The levels of NGF were determined in bladder biopsies from all women and biopsy sections were immunostained to detect NGF.

RESULTS

The levels of NGF were higher in samples from all three painful bladder conditions than in samples from controls. Immunostaining showed increased NGF expression in the urothelium, most marked in patients with idiopathic sensory urgency.

CONCLUSIONS

The increased level of NGF may explain several clinical and pathological features in these conditions, including sensitization of nociceptor fibres and increased numbers of mast cells. We propose that anti-NGF treatment may be a rational and effective treatment in intractable bladder pain.

Increased levels of laminin in ascitic fluid of patients with ovarian cancer

Laminin is a component of the extracellular matrix and is associated with tumor cell metastasis. Present studies show that the ovarian cancer cell lines produce significant amounts of laminin (54-140 ng/ml) in culture. Since ovarian cancer is associated with ascites production, laminin levels were then determined in ascites and serum. The results indicate that the ascites from patients with serous adenocarcinoma of the ovary had higher levels of laminin than the normal peritoneal fluid (P < 0.0001). However, the serum levels of laminin did not differ significantly between the control population and ovarian cancer patients.

Improved method for needle electromyography of the urethral sphincter in women

Needle electromyography (EMG) of the urethral sphincter using the periurethral approach is a procedure which most women find painful and their discomfort can restrict the usefulness of the test. A new technique has been devised using a transvaginal approach. The patient lies in the left lateral position and using a Sims speculum the posterior vaginal wall is retracted. The urethral sphincter can be easily seen and palpated, assisting correct electrode placement. This new technique is much less uncomfortable and highly satisfactory EMG recordings are obtained.

Asymptomatic bladder neck incompetence in nulliparous females

This study investigated 29 nulliparous women using the technique of transvaginal ultrasound to assess whether their bladder necks were open or closed at rest. The patients comprised 2 groups: 4 reported occasional episodes of stress incontinence, all of whom had closed bladder necks; the remaining 25 patients were totally asymptomatic. Overall a 21% incidence of an open bladder neck was recorded. It is likely that the true incidence of open bladder necks in young nulliparous women is higher than this, since none of these patients had troublesome stress incontinence. Since women with open bladder necks are more likely to develop stress incontinence if the integrity of the distal sphincter mechanism is compromised by neural damage, antenatal recognition of this problem should provide a contraindication to traumatic vaginal delivery and may in the future reduce the incidence of symptomatic stress incontinence in the population.

In vitro/in vivo functionality of Catapres-TTS

The in vitro and in vivo functionality of Catapres-TTS, a transdermal therapeutic system that delivers the alpha adrenergic receptor agonist clonidine, is discussed in terms of the drug transport kinetics and resultant plasma drug concentration profiles. The design of Catapres-TTS is presented as an optimization by which the best combination of system performance characteristics is obtained within the inherent limitations of the transdermal drug transport properties and the known pharmacokinetic and pharmacodynamic properties of the drug. Clonidine is a potent antihypertensive agent with a relatively low therapeutic index. For Catapres-TTS, the majority of control over the drug input rate resides within the system, rather than within the skin, which significantly reduces the variability in drug input rate and resulting plasma drug concentration both within and between patients. Moreover, the presence of a rate-control element in the system allows for patterning of the drug release rate. An initial bolus of drug is placed in the contact adhesive layer, where its transport into the skin is not inhibited by the rate control element in the system, for reduction in the time needed to achieve steady state drug input. The selection of the loading dose of drug is described as an optimization between the minimization of the lag time and the maintenance of constant plasma drug concentrations during the crossover period between system applications in chronic therapy.

Combined intracoronary streptokinase and percutaneous coronary angioplasty for reperfusion of chronic total coronary occlusion

In a 40 year old man with a 1 month total occlusion of a dominant right coronary artery, persistent angina despite medical management indicated inadequate coronary collateral supply to the posterolateral myocardium originally supplied by the totally occluded vessel. Initial attempts at reperfusion of the chronically occluded vessel with an angioplasty guide wire and balloon were unsuccessful. However, administration of intracoronary streptokinase resulted in partial reperfusion, after which successful wire-guided balloon angioplasty was accomplished. This case illustrates the potential utility of combining a thrombolytic agent with angioplasty in attempting reperfusion for management of selected cases of chronic total coronary artery occlusion.

A comparison between carbon dioxide inhalation and increased dead space ventilation in chickens

We compared the ventilatory response to elevated PICO2 with the response to elevation of dead space volume (delta VD) in anesthetized, hyperoxic chickens. In the first experimental series (I), PICO2 was varied between 0 and 26 Torr. In a second series (II), delta VD was raised between 0 and 17 ml by placing lengths of tubing between the bird and the source of inspired gas. In series I, ventilation increased and PaCO2 remained constant at levels of PICO2 below 20 Torr. In contrast, PaCO2 increased with low levels of delta VD in Series II. When changes in PaCO2 and ventilation were expressed as a function of the change in CO2 load reaching the lungs (delta L), the change in ventilation was greater, and that in PaCO2 less in Series I than in Series II at all levels of delta L below 25 ml (STPD) . min-1. The differences in ventilatory response to PICO2 and delta VD may qualitatively be explained by the distinct time patterns of CO2 concentration in the lungs which result in different discharge frequencies of CO2-sensitive intrapulmonary chemoreceptors and, possibly, by effects on ventilation resulting from differences in the timing of receptor discharge. Thus, these data provide additional evidence that avian intrapulmonary chemoreceptors may play a significant role in the chemical control of ventilation and regulation of PaCO2.

Ventilatory responses to carbon dioxide inhalation after vagotomy in chickens

Both vagus nerves in 7 anesthetized chickens were cut midcervically. Inspired PCO2 was increased from 0 to 28 torr by successive 3.5 or 7 torr increments and then increased directly to 70 torr. At each level of PICO2, steady-state measures of PaCO2, [H+]a, VT, f and VE were made. When PICO2 was raised to 7 torr, PaCO2 AND [H+]a were above their control levels (i.e. PICO2 = 0); at each successive level of PICO2, both PaCO2 and [H+]a increased. Minute volume increased at 28 torr PICO2 but changes in VT and f individually were not significant. At 70 torr PICO2, VE and VT increased but f was not changed from its control value. We have previously suggested that CO2-sensitive intrapulmonary chemoreceptors mediate the arterial isocapnic hyperpnea at low PICO2 in chickens. The observation that vagotomy abolishes regulation of PaCO2 at low PICO2 is consistent with this hypothesis, since the afferent pathway of avian intrapulmonary chemoreceptors is predominantly vagal.

Removal of intra-abdominal intrauterine contraceptive devices

Thirteen cases of misplaced intrauterine contraceptive devices removed from the abdominal cavity over a two year period at the Chelsea Hospital for Women, are reviewed. Five of the six plastic devices were removable laparoscopically but all the copper containing devices required a laparotomy for removal because of an omental or peritoneal reaction.

Intrapulmonary and systemic CO2-chemoreceptor interaction in the control of avian respiration

Experiments on anesthetized chickens were conducted to study interactions between afferent activity from the intrapulmonary and systemic CO2-sensitive chemoreceptors in the generation of respiratory amplitude (RA) and respiratory frequency (f). The thoracoabdominal cavity was opened, air sacs ruptured and each lung independently and unidirectionally ventilated. Intrapulmonary chemoreceptor activity was altered by changing the PCO2 of the ventilatory gas (PICO2) to the vascularly isolated right lung (VIL); systemic chemoreceptor activity was altered by changing the PICO2 to the denervated left gas exchange lung (GEL). Respiratory amplitude and frequency responses to changes in intrapulmonary PCO2 were determined at four levels of systemic arterial PCO2 (PaCO2). The results indicate that elevating PaCO2 shifts the pulmonary CO2-response curves for both RA and f to the left and increases the sensitivity of the RA-CO2 response curve but decreases the sensitivity of the f-CO2 response curve. We conclude that (1) interaction occurs between intrapulmonary and systemic afferent activity in the generation of RA and f, (2) the nature of the interaction is synergism with respect to RA and interference with respect to f, and (3) the interaction is greater during hypocapnia than hypercapnia.

Avian intrapulmonary chemoreceptors: respiratory response to a step decrease in PCO2

The contribution of intrapulmonary chemoreceptors (IPC) to the respiratory response, following a step decrease in PICO2 was assessed in anesthetized and unidirectionally ventilated chickens. Step changes in the PCO2 of the ventilatory gas (PICO2) to a single lung were introduced with PICO2 to the contralateral lung held constant. Respiratory amplitude and frequency were monitored. Experimental series were conducted under conditions such that (I) both systemic chemoreceptors and IPC, (II) systemic chemoreceptors alone and (III) IPC alone contribute to the ventilatory response. The results indicate (1) that a rapid component of the transient response (complete in 25 sec) is eliminated by sectioning the pulmonary nerves (Series II), and (2) within the rapid component, a localized minimum in respiratory amplitude was observed which was not seen in either Series II or Series III experiments. We conclude that the rapid component of the transient response is due to the CO2-sensitive IPC and that intrapulmonary and systemic chemoreceptors are not simply additive in the generation of respiratory amplitude and frequency, but a more complex interaction must be involved.

Regulation of arterial PCO2 during inhalation of CO2 in chickens

Since CO2-sensitive intrapulmonary chemoreceptors have been shown to exist in the avian lung, we conducted a series of experiments to determine if birds could regulate PaCO2 when confronted with an inspired CO2 load. Chickens were anesthetized with either pentobarbital (30 mg.kg-1) or phenobarbital (160 mg.kg-1). The PICO2 was either increased or decreased in successive 7 torr steps between 0 and 35 torr. At each level of PICO2, steady-state measurements of PaCO2, PaO2 and [H+]a were made. In three of ten experiments, tidal volume and respiratory frequency were determined and minute ventilation calculated. Our results indicate that as PICO2 is varied between 0 and 21 torr, minute ventilation increases and arterial homeostasis of PCO2 and [H+] is maintained; as the PICO2 is increased above 21 torr, PaCO2 increases. We conclude that the isocapnic hyperpnea associated with inhalation of CO2 in chickens is a CO2-coupled phenomenon and that it is mediated by CO2-sensitive intrapulmonary chemoreceptors.

Ventilatory responses to CO2 in the chicken: intrapulmonary and systemic chemoreceptors

The independent effects of pulmonary and arterial Pco2 on respiratory amplitude (RA) and respiratory frequency (f) were studied in unidirectionally ventilated chickens anesthetized with phenobarbital (160 mg-kg-1). Pulmonary Pco2 was set by the level of PIco2 ventilating the vascularly isolated right lung (VIL), whereas the systemic arterial Pco2 was set by the level of PIco2 ventilating the denervated left or gas exchange lung (GEL). The following results were obtained: 1) Increasing the PIco2 to the VIL from 0 to 35 torr and maintaining Paco2 constant at 2. torr increased RA from apnea to 76% of the animals' maximal hypercapnic response and decreased f: further increases in PIco2 to VIL had only minimal effects on RA and f. 2) increasing Paco2 from 19 to 61 torr and maintaining pulmonary Pco2 constant increased RA and decreased further increases in Paco2 had only slight effects on RA ulmonary chemoreflex and can dominate the control of RA during hypocapnic conditions, and (2) systemic CO2-sensitive chemoreceptors dominate the control of RA during hypercapnic conditions. It is suggested that the intrapulmonary chemoreceptors may act as a sensory system which plays a pertinent role in the regulation of parabronchial ventilation.

Dynamic responses of CO2-sensitive avian intrapulmonary chemoreceptors

Single-unit extracellular potentials from CO2-sensitive intrapulmonary chemoreceptors (IPC) were recorded with tungsten microelectrodes from the nodose ganglia of unidirectionally, artificially ventilated White Leghorn cockerels. The responses of IPC to step and sinusoidal forcing functions of fractional concentration of carbon dioxide (FCo2) indicate that 1) about two-thirds of IPC are bidirectionally rate sensitive, 2) delay to forcing varies from essentially zero to several times larger than the time of nitrogen gas passage through the lung and, on the average, is significantly shorter to step decrease than step increase in fco2, and 3) IPC with irregular discharge intervals are more rate sensitive and respond to higher frequencies than IPC with regular interspike intervals. The physical and chemical properties of the "receptor-lung" complex are probably important in determining the dynamic responses of IPC by partitioning of CO2 from other gases within the lumen of the parabronchus. IPC are located along the length of the bronchial gas exchange areas of the avian lung and transmit information to the CNS concerning the mean level, rate, and direction of change in the partial pressure of carbon dioxide (PCo2).

The use of bromocriptine in the treatment of the unstable bladder

Initial experience with the use of bromocriptine in 24 patients with troublesome micturition symptoms associated with an unstable bladder is described. 14 patients responded symptomatically to treatment with bromocriptine and these results were confirmed by a double blind trial in this group. 11 of these patients had previously failed to benefit from treatment either with drugs or vesical distension. It is concluded that bromocriptine has a part to play in the treatment of some cases of primary detrusor instability.

A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment

169 female patients with outlet obstruction have been studied urodynamically. The results of treatment of the outlet obstruction in 102 patients have been analysed and the reason for the failures discussed. Patients with stable detrusors and those with symptoms of recurrent urinary tract infection responded well to treatment, provided this relieved the obstruction adequately; symptomatic relief was less common in patients with unstable detrusors, despite adequate outflow readjustment.

A urodynamic analysis of micturition symptoms in the female

The presenting symptoms of 570 females with micturition disorders have been studied with particular reference to the urodynamic state of the detrusor in an attempt to define those symptoms and symptom complexes which are associated with the presence of absence of detrusor instability. The results show that patients who complain of recurrent urinary tract infection or stress incontinence in the absence of any other micturition symptoms usually have stable bladders and do not require cystometric confirmation of this fact. When the symptom of urge incontinence is associated with persistent frequency and nocturia, there is a high correlation with detrusor instability, although hypersensitive urethral states which may present with identical symptoms and are usually associated with stable bladders are difficult to differentiate clinically. Groups of patients in whom it was difficult to predict the detrusor state from the symptoms were studied, and the results of a prospective analysis, predicting the detrusor state from the micturition history of 230 incontinent females, have been presented.

Structure of an isoindole pigment from the interaction of phenylmagnesium bromide and trans-o-Cyano-β-bromostyrene

The action of heat on the complex from phenylmagnesium bromide and trans-o-cyano-β-bromostyrene gives some 1-phenylisoquinoline and a crystalline, unstable, blue compound, in addition to much polymeric material. Structure (IV), which bears a formal resemblance to half a phthalocyanine molecule, is proposed for the blue compound.