Treatment of leiomyoma smooth muscle cell and myometrial smooth muscle cell spheroids with the TDO2 inhibitor 680C91 but not the IDO1 inhibitor epacadostat significantly repressed cell proliferation and the expression of collagen type I (COL1A1) and type III (COL3A1) in a dose-dependent manner; these effects were more pronounced in leiomyoma smooth muscle cells compared with myometrial smooth muscle cell spheroids.

These results underscore the physiological significance of the tryptophan degradation pathway in the pathogenesis of leiomyomas and the potential utility of anti-TDO2 drugs for treatment of leiomyomas.

These results underscore the physiological significance of the tryptophan degradation pathway in the pathogenesis of leiomyomas and the potential utility of anti-TDO2 drugs for treatment of leiomyomas.

To discuss the signs and symptoms of a cesarean section (C-section) scar defect, and to describe the techniques to repair the defect using a vaginal approach.

A video review of a 32-year-old woman with abnormal bleeding and a C-section scar defect managed surgically by vaginal repair. The patient provided consent for video recording and publication. This surgical report, with no identifying patient data, was exempt from the institutional review board approval.

Tertiary care facility.

A 32-year-old gravida 2, para 2 woman was seen with prolonged menses, and an 11 × 9 × 5-mm C-section scar defect was seen on transvaginal ultrasound.

The patient opted for the repair of the C-section scar defect using a vaginal approach.

Postoperative course.

The patient had resolution of her prolonged menses, and transvaginal ultrasound showed improvement of her C-section scar defect.

The vaginal approach is an efficacious way to repair a C-section scar defect, particularly when the defect occurs low at the level of the cervix.

The vaginal approach is an efficacious way to repair a C-section scar defect, particularly when the defect occurs low at the level of the cervix.

To examine the association between ambient temperature and antral follicle count (AFC), a standard measure of ovarian reserve.

Prospective cohort study.

Fertility center at an academic hospital in the northeastern United States.

631 women attending the Massachusetts General Hospital Fertility Center (2005-2015) who participated in the Environment and Reproductive Health Study.

Daily temperature at the women’s residential address was estimated for the 90 days before their antral follicle scan using a spatially refined gridded climate data set. We evaluated the associations between temperature and AFC using Poisson regression with robust standard errors, adjusting for relative humidity, fine particulate matter exposure, age, education, smoking status, year and month of AFC, and diagnosis of diminished ovarian reserve and ovulation disorders.

Antral follicle count as measured with transvaginal ultrasonography.

A 1°C increase in average maximum temperature during the 90 days before ovarian reserve testing was associated witha -1.6% (95% confidence interval [CI], -2.8, -0.4) lower AFC. Associations remained negative, but were attenuated, for average maximum temperature exposure in the 30 days (-0.9%, 95% CI, -1.8, 0.1) and 14 days (-0.8%, 95% CI, -1.6, 0.0) before AFC. The negative association between average maximum temperature and AFC was stronger in November through June than during the summer months, suggesting that timing of heat exposure and acclimatization to heat may be important factors to consider in future research.

Exposure to higher temperatures was associated with lower ovarian reserve. These results raise concern that rising ambient temperatures worldwide may result in accelerated reproductive aging among women.

Exposure to higher temperatures was associated with lower ovarian reserve. Aminocaproic cost These results raise concern that rising ambient temperatures worldwide may result in accelerated reproductive aging among women.

Among patients successfully resuscitated after an out-of-hospital cardiac arrest (OHCA), 10%to 15%evolve toward brain death (BD), thus becoming potential organ donors.

Is it possible to establish a score for early estimation of BD risk after OHCA?

The BD after cardiac arrest (BDCA) score was developed from data available within 24 hours after OHCA from two OHCA trials Cyclosporine in Cardiac Arrest Resuscitation and Erythropoietin After OHCA. The BDCA score was then validated in another large prospective multicenter data set. The main outcome was the occurrence of BD. Independent prognostic covariates for BD were identified using a binomial two-stage adaptive least absolute shrinkage and selection operator procedure.

The development cohort included 569 patients alive 24 hours after OHCA, among whom 84 (14.8%) experienced BD. Independent predictors of BD used to build the BDCA score were being female (4 points), nonshockable rhythm (24 points), cardiac cause of OHCA (-6 points), neurological cause of OHCA (45 points), natremia at 24 hours (natremia in millimoles per liter minus 140 points), and vasoactive drug at admission (4 points) and at 24 hours (6 points). The area under the curve (AUC) of the BDCA score was 0.82 (95%CI, 0.77-0.86), and the discrimination value in the validation cohort (n= 487) was consistent (AUC, 0.81; 95%CI, 0.76-0.86). In the validation cohort, BD occurred in 4.0%, 20.4%, and 67.7%of patients with scores of< 20, 20 to 50, and > 50, respectively.

The BDCA score allows early detection of patients with a high probability of experiencing BD, which may help increase organ donation after OHCA.

ClinicalTrials.gov; No. NCT01595958, and ClinicalTrials.gov; No. NCT00999583; URL http://www.clinicaltrials.gov.

ClinicalTrials.gov; No. NCT01595958, and ClinicalTrials.gov; No. NCT00999583; URL http://www.clinicaltrials.gov.

Persons with opioid use disorder (OUD) are prone to frequent relapse following brief inpatient medically managed withdrawal. This longitudinal, naturalistic study examines associations among illicit opioid use, use of medication for opioid use disorder (MOUD), and one’s confidence in the ability to resist drug use in the face of negative emotions (i.e., negative affect-associated drug refusal self-efficacy).

Participants were 220 adults with OUD who recently completed a short-term inpatient program and the study followed for 6months. At baseline, participants reported demographics, illicit opioid use, recent engagement with MOUD, and negative affect-associated drug refusal self-efficacy. At follow-up (1week and 1-, 3-, and 6-months following discharge), participants reported illicit opioid use and MOUD.

Participants averaged 30.7years of age, 63.2% were male, and 84.1% were white. Both illicit opioid use and rates of MOUD increased during the 6-month follow-up period, although only 34.1% received MOUD. At baseline, participants reported less than 50% self-confidence to resist using opioids during negative emotional states.