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ABSTRACT Objective Methods Results Conclusions Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine adhesions. This study aimed to determine the predictive value and intra‐ and interobserver variation of the TVS sliding bladder sign in the assessment of vesicouterine adhesions.This was a prospective observational double‐blind diagnostic accuracy study conducted at the Amsterdam University Medical Center. Patients scheduled for gynecological laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent preoperative TVS, including a dynamic sliding bladder sign examination in our outpatient clinic. Videoclips of the TVS scans were stored for offline assessment and used as an index test. The recordings of both TVS and laparoscopy were evaluated for diagnostic characteristics of vesicouterine adhesions by independent assessors, who were blinded to the clinical situation in addition to the laparoscopic findings when assessing recordings of TVS and vice versa. The presence of adhesions on laparoscopy was used as the reference standard. The positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of the sliding bladder sign were calculated. In addition, inter‐ and intraobserver variability of the sliding bladder sign on TVS were assessed.Of 116 included women, 57 had a negative sliding bladder sign on TVS, while on laparoscopy, 51 women had mild and 28 had severe vesicouterine adhesions. A negative sliding bladder sign had a PPV of 94.7% (95% CI, 88.9–100%) for the presence of any vesicouterine adhesions, and a positive sliding bladder sign had a specificity of 91.9% (95% CI, 83.1–100%). For severe adhesions, the negative sliding bladder sign had a sensitivity of 89.3% (95% CI, 77.8–100%) and a positive sliding bladder sign had a NPV of 94.9% (95% CI, 89.3–100%). When using Cohen's kappa coefficient, inter‐ and intraobserver agreement between assessors was good.Sliding bladder sign evaluation using TVS is a reliable diagnostic tool for the prediction of vesicouterine adhesions on laparoscopy. A negative sliding bladder sign indicates the presence of vesicouterine adhesions, while a positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimize preoperative planning, and can be used for future studies to evaluate the relationship between symptomatology and vesicouterine adhesions and, subsequently, the effect of adhesion‐prevention interventions. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," presents a step-by-step technique for identifying the proximal ureter using transvaginal ultrasound (TVS). The authors note that there are currently no published descriptions of how to visualize and describe the proximal ureter above the crossing of the uterine artery. The article provides a 5-step guide with accompanying images and videos to visually present the technique, including examples of normal and abnormal proximal ureters. The authors propose that this standardized approach will allow clinicians to diagnose hydroureter and ureter endometriosis more accurately. [Extracted from the article]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," discusses the use of transvaginal sonographic (TVS) sliding bladder sign as a diagnostic tool for predicting vesicouterine adhesions. The study conducted at Amsterdam UMC included patients scheduled for gynecologic laparoscopic surgery for a benign disorder. The results showed that the absence of sliding bladder on TVS had a high positive predictive value for any adhesions and a high sensitivity for severe adhesions. The presence of sliding bladder had a high negative predictive value for severe adhesions and a high specificity for any adhesions. The study concludes that the sliding bladder sign using TVS is a reliable tool for predicting vesicouterine adhesions and recommends its routine use in preoperative planning. [Extracted from the article]

Endometriosis is a prevalent gynecological disease, leading to chronic pain and inflammation, affecting 1 in 10 individuals presumed female at birth. The diagnostic journey is often arduous, marked by neglect of the right diagnosis and prolonged wait times, significantly compromising the quality of life among those affected. This review provides a nuanced exploration of endometriosis-associated pain management, encompassing medical, surgical, and holistic approaches, all guided by accurate and refined diagnostics. Our paramount goal is to empower physicians as key figures in confronting this intricate challenge with a patient-centric approach, ultimately aiming to improve treatment and quality of life. Acknowledging each patient's unique needs, we emphasize the importance of tailoring a spectrum of options informed by current literature and insights gleaned from our experience in a high-volume tertiary endometriosis center. It is imperative to recognize endometriosis as a complex and chronic disease, often occurring with co-morbid conditions and nuanced complexities, necessitating a long-term personalized multimodal approach for each case. In addition, incorporating principles such as patient autonomy, profound respect for diverse experiences, and practical education on treatment choices is pivotal in enhancing treatment outcomes and overall patient satisfaction., Competing Interests: S.F. reports advocacy work with the Endometriosis Network Canada and EndoACT, outside the submitted work. M.L. reports grants from Australian MRFF, AbbVie, CanSAGE, Hamilton Health Sciences, Hyivy, Pfizer; honoraria for lectures/writing from AIUM, GE Healthcare, Bayer, AbbVie, TerSera; consultancy work with AbbVie, Hologic, Chugai, Roche Diagnostics, AIMA, Pfizer, affiliations with Imagendo, outside the submitted work., (© The Author(s), 2024.)

Objective: To assess the effects of aging on the features of polycystic ovary syndrome (PCOS)., Design: Cohort study., Setting: Tertiary care center., Patient(s): Women with PCOS, diagnosed according to the 2003 Rotterdam criteria, who visited our outpatient clinic repeatedly., Intervention(s): Comparisons were made between the first visit and consecutive visits., Main Outcome Measure(s): Change in PCOS phenotype groups in terms of clinical and endocrine characteristics., Result(s): A total of 596 women visited the outpatient clinic repeatedly. An estimated change per 5-year age showed a decrease in the prevalence of phenotype A and an increase in the prevalence of not having PCOS. The serum levels of testosterone, androstenedione, and dehydroepiandrosterone sulfate as well as the free androgen index decreased significantly. Clinical characteristics showed an increase in terms of body mass index and waist circumference, whereas plasma glucose levels, insulin levels, and insulin resistance did not change significantly., Conclusion(s): The prevalence of PCOS phenotype groups changes over time. There is an important age effect that indicates a more regular menstrual cycle, decrease in the serum androgen levels, and improvement in polycystic ovarian morphology when aging occurs in women with PCOS., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Importance: Presence of eating abnormalities is one of the core criteria for the diagnosis of behavioral variant frontotemporal dementia (bvFTD), yet their occurrence in other subtypes of frontotemporal dementia (FTD) and effect on metabolic health is not known., Objective: To define and quantify patterns of eating behavior and energy, sugar, carbohydrate, protein, and fat intake, as well as indices of metabolic health in patients with bvFTD and semantic dementia (SD) compared with patients with Alzheimer disease (AD) and healthy control participants., Design, Setting, and Participants: Prospective case-controlled study involving patient and caregiver completion of surveys. Seventy-five participants with dementia (21 with bvFTD, 26 with SD, and 28 with AD) and 18 age- and education-matched healthy controls were recruited from FRONTIER, the FTD research clinic at Neuroscience Research Australia in Sydney., Main Outcomes and Measures: Caregivers of patients with FTD and AD completed validated questionnaires on appetite, eating behaviors, energy consumption, and dietary macronutrient composition. All participants completed surveys on hunger and satiety. Body mass index and weight measurements were prospectively collected., Results: The bvFTD group had significant abnormalities in the domains of appetite (U = 111.0, z = 2.7, P = .007), eating habits (U = 69.5, z = 3.8, P = .001), food preferences (U = 57.0, z = 4.1, P = .001), swallowing (U = 109.0, z = 3.0, P = .003), and other oral behaviors (U = 141.0, z = 2.6, P = .009) compared with the AD group. The bvFTD and SD groups tended to have increased energy consumption. Compared with controls, the bvFTD group had significantly increased carbohydrate intake (251 vs 170 g/d; P = .05) and the SD group had significantly increased sugar intake (114 vs 76 g/d; P = .049). No significant differences in total fat or protein intake between the groups were found. Despite similar energy intake, the SD group had lower hunger and satiety scores compared with the bvFTD group. In contrast, hunger and satiety scores did not differ between the bvFTD group and controls. The abnormal eating behavior was found in the 2 groups (bvFTD and SD) with the highest body mass index (F = 4.2, P = .008) and waist circumference (F = 6.4, P = .001)., Conclusions and Relevance: Abnormal eating behaviors are prominent in patients with bvFTD and those with SD and are not limited to increased appetite. The observed higher intake of sugar and carbohydrates was found in patients with the FTD subtypes and those with higher body mass index and waist circumference and was not explained simply by increased hunger or lower satiety.