No abstract

Women with HIV were less likely to conceive than at-risk uninfected women, but pregnancy outcomes were similar. Abortion became less common after the introduction of HAART.

review reminds us that simple vaginal hysterectomy is often curative in women with endometrial cancer. In this series of 128 women over age 70 with endometrial cancer, the 5-year survival rate was 89.2% for stage I disease and a very respectable 67.4% for 33 women with stage II or III disease. All patients had a bilateral salpingo-oophorectomy, but only 8.6% of these women had a pelvic lymphadenectomy through an extraperitoneal approach. Others, including Chan et al from the University of California at Irvine, have also reported excellent results with minimal morbidity in a series of 51 medically compromised women with endometrial cancer (Obstet Gynecol 2001;97: 707). Most of these women were morbidly obese and many had 3 or more risk factors. Morbidity was minimal and 5-year survival was 88%.Although radiation therapy alone has been used to treat women with endometrial adenocarcinoma, older reports have indicated a worse outcome than when hysterectomy is part of the treatment, and there are no recent studies that have examined this question. In a study of 34 women over age 75 with endometrial cancer, Citron et al found minimal morbidity when pelvic radiation was added to surgery for high-risk disease (Int J Radiat Biol Phys 2004;59:1432). The 5-year disease-free survival was actually better in the women treated with radiation for deep myometrial invasion, cervical involvement, or poorly differentiated adenocarcinoma.Laparoscopically assisted hysterectomy has also been used for older women with endometrial cancer with good results (Scribner et al. Gynecol Oncol 2001;83:563). However, operative time and surgical morbidity are usually greater than with abdominal hysterectomy and staging. Once again, the value of lymphadenectomy in the survival of women with endometrial cancer is very much in question.-HWJ)

LACTIN-V colonized well, and was safe and acceptable in women treated for BV.

Plasma cell endometritis was frequently present in women with bacterial vaginosis and without other vaginal or cervical infections. This suggests the possibility of an association between bacterial vaginosis and nonchlamydial, nongonococcal, upper genital tract infection.

To develop a comprehensive catalogue of phenotypic and functional parameters of human CD4(+) T cell differentiation stages, we have performed microarray gene expression profiling on subpopulations of human thymocytes and circulating naive CD4(+) T cells, including CD3(-)CD4(+)CD8(-) intrathymic T progenitor cells, CD3(int)CD4(+)CD8(+) 'double positive' thymocytes, CD3(high)CD4(+)CD8(-) 'single positive' thymocytes, CD3(+)CD4(+)CD8(-) CD45RA(+)CD62L(+) naive T cells from cord blood and CD3(+)CD4(+)CD8(-) CD45RA(+)CD62L(+) naive T cells from adult blood. These subpopulations were sort-purified to >98% purity and their expressed RNAs were analyzed on Affymetrix Human Genome U133 arrays. Comparison of gene expression signals between these subpopulations and with early passage fetal thymic stromal cultures identify: (i) transcripts that are preferentially expressed in human CD4(+) T cell subpopulations and not in thymic stromal cells; (ii) major shifts in gene expression as progenitor T cells mature into progeny; (iii) preferential expression of transcripts at the progenitor cell stage with plausible relevance to the regulation of expansion and differentiation of these cells; and (iv) preferential expression of potential markers of recent thymic emigrants in naive-phenotype CD4(+) T cells from cord blood. Further evaluation of these findings may lead to a better definition of human thymopoiesis as well as to improved approaches to monitor and to augment the function of this important organ of T cell production.

Objectives To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post‐surgery. Methods We recruited a 60‐woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014–June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. Results Across post‐surgical follow‐up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self‐esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self‐perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI −30.1, −12.4). Conclusions Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula‐related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

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