Current knowledge suggests that the uterus harbours its own microbiota, where the microbes could influence the uterine functions in health and disease; however, the core uterine microbial composition and the host-microbial relationships remain to be fully elucidated. Different studies are indicating, based on next-generation sequencing techniques, that microbial dysbiosis could be associated with several gynaecological disorders, such as endometriosis, chronic endometritis, dysfunctional menstrual bleeding, endometrial cancer, and infertility. Treatments using antibiotics and probiotics and/or prebiotics for endometrial microbial dysbiosis are being applied. Nevertheless there is no unified protocol for assessing the endometrial dysbiosis and no optimal treatment protocol for the established dysbiosis. With this review we outline the microbes (mostly bacteria) identified in the endometrial microbiome studies, the current treatments offered for bacterial dysbiosis in the clinical setting, and the future possibilities such as pro- and prebiotics and microbial transplants for modifying uterine microbial composition.

There has been a recent proliferation of studies exploring awareness in people with dementia and, as is the case with similar studies in other clinical areas, results are generally mixed and inconsistent. One of the reasons underlying variability in study results relates to the complexities around the concept of awareness itself. Two sources of conceptual problems are explored. First, the meaning of awareness is examined and, within the dementia literature, various conceptualizations of awareness are identified which could be traced to three broad frameworks within which awareness and related terms are conceived. Differences between meanings of awareness are thus highlighted and the importance of making such differences explicit in studies was discussed. Second, the relational aspect of awareness is raised as a crucial issue determining the phenomenon of awareness elicited in clinical practice. Thus, in dementia, awareness is related to various "objects" including the illness as a whole, memory problems, activities of daily living, affective changes and many others. In each case, however, the object of awareness will elicit a different phenomenon of awareness, again carrying implications for the generalizability of study results. Clarification of conceptual problems is essential for future work in this area in order that empirical studies can provide meaningful answers concerning the therapeutic and predictive validity of different aspects of awareness.

BackgroundQuality of life (QoL) is increasingly used to characterize the impact of disease and the efficacy of interventions.MethodsProspective cohort study in patients' and proxies' homes with137 patients with dementia (age 52 to 88; Mini-Mental Status Examination (MMSE) 3 to 28) and their proxies (age 43 to 90). MMSE, Behave-AD, Geriatric Depression Scale (GDS), and Bayer-ADL scale (B-ADL), and the Euroqol (EQ-5D; patient self-rating, proxy self-rating, and proxy-rating of patient).ResultsB-ADL impairment and Behave-AD total score increased with dementia severity (Kruskal-Wallis p < 0.001 and p = 0.023, respectively). Patients' self-rated QoL and proxies' self-rated QoL were unrelated to dementia severity (p = 0.148 and p = 0.414, respectively). The difference between patients' self- and proxies'-rating of the patient's QoL correlated with the patient's MMSE (Spearman's rho = -0.434; p < 0.001), even if analysis was constrained to patients with mild AD (rho = -0.328; p = 0.019). The proxies' rating of the patients QoL was not only correlated with cognitive and behavioral symptoms of the patient but also with mood (GDS-score; rho = 0.317; p < 0.001) and cognitive abilities (verbal fluency; rho = 0.209; p < 0.018) of the proxy.ConclusionProxies' assessment of the patients' QoL is related to the proxies' health, and the difference of patient's and proxie's QoL-rating is correlated with dementia severity even in mild dementia stages. QOL measures use ratings of the individual to assess the impact of symptoms and disorders on everyday life. In dementia patients, however, this impact is not captured since patients' and proxies' self-assessment of their own QoL do not reflect severity of disease whatsoever. Patients' and proxies' influencing variables render the score obtained with generic quality of life assessment meaningless in capturing the impact of dementia. Decisions on initiation or discontinuation of treatment or allocation of other resources for patients with dementia therefore need not depend on generic assessment of quality of life.

Many studies have demonstrated an association between the apolipoprotein E (apoE) epsilon 4 allele and Alzheimer's disease (AD). The present study is concerned with the relationship between the apoE epsilon 4 allele and the progression of symptoms in AD. We determined rates of cognitive decline and deterioration in everyday performance prospectively over 3 years in 64 patients with clinically diagnosed AD using the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), and the Dementia Scale (DS) included in the Cambridge Mental Disorders of the Elderly Examination (CAMDEX). Carriers and noncarriers of the epsilon 4 allele did not significantly differ in cognitive functioning and everyday performance at baseline measurements. The time that had elapsed since the estimated onset of symptoms was also not different between the two groups. This suggested that the clinical progression of AD was not associated with the epsilon 4 status before the patients entered the study. On prospective observation, the rate of cognitive decline assessed with the CAMCOG and the MMSE and the rate of deterioration in everyday performance rated with the DS were also not different between carriers and noncarriers of the epsilon 4 allele. We conclude that the clinical course of AD is independent of the apoE epsilon 4 allele.