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Cognitive dysfunction is common in patients with multiple sclerosis (MS), and has been associated with MRI measures of lesion burden and atrophy. Little is known about the prevalence of cognitive impairment in patients with early MS. The associations between cognitive impairment and MRI measures of disease severity early in the disease course are also unclear. This study used a brief battery of cognitive tests to determine the prevalence and pattern of cognitive impairment in patients with clinically isolated syndromes or newly diagnosed MS. The associations between cognitive impairment and MRI measures of disease severity early in the disease course were also examined. Ninety-two patients with clinically isolated syndromes or the diagnosis of MS within the last 3 years participating in the CLIMB study underwent a neurologic examination, neuropsychological evaluation and MRI at 1.5T. Forty-nine percent of patients were impaired on one or more cognitive measures. There were no significant correlations between cognitive scores and MRI measures of disease severity including total T2 lesion volume, normal appearing white matter volume, grey matter volume, and brain parenchymal fraction. These findings suggest that cognitive impairment may predate the appearance of gross structural abnormalities on MRI and serve as an early marker of disease activity in MS. [ABSTRACT FROM AUTHOR]

The Southeast Women's Cattle Handling program was designed to promote self-confidence for women by providing hands-on educational opportunities and cattle handling skills implementing Beef Quality Assurance methods and promoting farm safety. The two-day, hands-on workshop was conducted by Alabama Cooperative Extension educators, local veterinarians, and producers. Participation was limited to 20 females in order to allow time for participants to practice the techniques taught by instructors. Applicants were asked to indicate the reason they would like to attend the workshop via an electronic questionnaire. Of the 26 applicants, 20 responded and indicated that they had either found themselves involved in the family farm through marriage (15%) or as the sole operator through inheritance (20%), the death of a spouse (20%), or chose to purchase their own operation (45%). Topics included 1) keeping reproductive/vaccination records, 2) vaccination techniques, 3) truck & trailer safety/hauling, 4) BQA certification training, 5) tractor & equipment safety, 6) forage species, 7) forage analysis & interpretation, 8) forage pests & management, 9) reproduction & dystocia, and 10) supplementing the cow herd. A pre and post-test was administered to participants (n =19) in order to compare participants' knowledge before and after the workshop. Comparison of answers using paired t-test showed an increase (P < 0.01) from pre-test (63.5%) to post-test (88.5%) knowledge. A BQA certification pre and posttest was administered to participants (n = 19), which showed an increase (P < 0.01) in passing scores from pre-test (83.2%) to post-test (93.7%). Participants completed an impact evaluation at the conclusion of the workshop where they indicated the probability of implementing the following concepts learned (mean values ± standard deviation) as a result of this program (1 = no; 2 = maybe; 3 = yes; 4 = already doing): keep vaccination/reproductive records (3.6 ± 0.51), use proper vaccination techniques (3.6 ± 0.51), assess truck and trailer before hauling (3.2 ± 0.94), apply low stress handling techniques (3.4 ± 0.51), maintain BQA certification (2.8 ± 0.55), manage forage for quality & pests (3.2 ± 0.43), assess your cow herd using 7 quality checks (3.1 ± 0.24), and forage test (2.9 ± 0.58). The total number of hectares of pasture owned and total number of cattle owned was 1014.5 ha and 1128 hd, respectively. In total, 100% of the participants stated the workshop met their expectations and would recommend this workshop to others. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN., Methods: We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up., Results: Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence., Conclusion: The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

A minority of women with endometrial cancer present with disease beyond the uterine corpus. Where disease has spread to the uterine cervix, extended or radical surgery may be curative without the need for adjuvant treatment. Radical surgery has a potential major role in the management of locally advanced disease together with adjuvant radiotherapy and/or chemotherapy. Radical pelvic surgery remains the only curative option for isolated pelvic recurrence in the previously irradiated patient. A number of published studies report a survival benefit from surgical cytoreduction in women with extra-pelvic metastases and recurrent disease, although the degree of surgical effort required in order to achieve an optimal result varies. Women with a single site of metastasis or recurrence seem most likely to benefit. However, the value of radical pelvic and abdominal procedures in advanced and recurrent disease must be balanced against the associated high morbidity and the resulting quality of life for the individual woman. Many women with endometrial cancer are elderly and have limiting co-morbidities. The treatment modality and the appropriate extent of surgery must therefore be determined on an individual patient basis.

Transvaginal ultrasound is commonly used in the investigation of postmenopausal bleeding. In this article, we report the use of transrectal ultrasound in the assessment of postmenopausal bleeding and detection of an endometrial carcinoma, where other methods of assessment were unsuccessful.

Background: Premature ovarian failure (POF) may be idiopathic or may be associated with genetic or autoimmune disorders. The 47,XXX karyotype has been associated with POF and other genitourinary anomalies., Case: A 17-year-old woman with a history of immune thrombocytopenic purpura was referred to the adolescent medicine clinic for evaluation of oligomenorrhea with secondary amenorrhea. Evaluation revealed hypergonadotrophic premature ovarian failure, a positive antinuclear antibody, and the 47,XXX karyotype. She has since developed a positive anti-cardiolipin antibody but does not meet diagnostic criteria for systemic lupus erythematosis., Conclusion: The presence of known autoimmune disease in a woman with POF should not dissuade the clinician from evaluating for a potential genetic cause.

Previous studies on colorectal carcinomas indicate that consistent differences in epithelial basement membrane (EBM) integrity are present between the tumour centre and periphery. We report that within the tumour centre, EBM staining between back-to-back (BTB) neoplastic glands (i.e., adjacent glands in direct contact with no intervening connective tissue) generally follows a pattern different from that of EBM staining at the tumour:stromal interface (TSI). Such distinctions are important, since the factors responsible for EBM deficiencies may vary with intra-tumoural location, as may the prognostic significance of these deficiencies. Analysis of paraffin sections from 130 colorectal carcinoma cases showed that EBM staining between BTB glands is generally weaker and more discontinuous than at the TSI, sometimes appearing as a linear array of immunostained granules on high-resolution light microscopy. By double-labelling immunofluorescence analysis of cryostat sections from 30 cases, a decrease in type-IV collagen:laminin staining intensity ratio was found between BTB glands. Hence, the composition of EBM between BTB glands appears to be abnormal. As much recent evidence indicates that epithelial:mesenchymal interactions play an essential role in EBM formation, the demonstration of immunostained EBM fragments between BTB glands requires an explanation: We suggest that the synthesis of EBM between BTB glands involved previously intervening stromal (mesenchymal) cells, and that EBM fusion and dissolution occur between BTB glands following the displacement of these cells.