Search Results (40)

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome encompasses a range of Müllerian duct anomalies characterized by congenital absence of the uterus and the upper two-thirds of the vagina in young women who otherwise exhibit normal endocrine function and a 46,XX karyotype. MRKH syndrome can occur in an isolated form (type I) or in association with other congenital anomalies (type II or MURCS association), which may include renal, vertebral, auditory, and cardiac defects. It represents one of the most frequent causes of primary amenorrhea, affecting approximately 1 in every 4000–5000 women. MRKH syndrome often remains undiagnosed until a patient presents with primary amenorrhea, despite normal development of secondary sexual characteristics. Both genetic and non-genetic factors have been proposed as contributing to abnormal embryonic development, although the exact etiopathogenesis remains unclear. Imaging plays a key role in the evaluation of genital tract anomalies, allowing non-invasive and comprehensive assessment. Alongside physical examination and pelvic ultrasound, pelvic MRI is essential for identifying the presence of rudimentary uterine tissue. MRKH syndrome can have profound and lasting psychological impacts, making it essential for patients and their families to receive counseling both before and throughout treatment. A range of therapeutic options—both surgical and non-surgical—have been proposed for managing MRKH syndrome. Vaginal dilation remains the first-line treatment, as it offers high success rates with minimal risk of complications. Vaginoplasty is considered a second-line option for patients who do not respond to dilation therapy. Additionally, uterine transplantation and gestational surrogacy provide opportunities for women with MRKH syndrome to achieve biological motherhood. This review provides an updated overview of Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, encompassing its etiological, clinical, diagnostic, psychological, therapeutic, and reproductive aspects. We also present a case involving a 19-year-old woman with MRKH syndrome who presented with primary amenorrhea, highlighting the crucial role and advantages of MRI in diagnosis, differential assessment, and treatment planning. Full article

Surrogacy involves a surrogate carrying a baby to transfer to the intended parents after birth. This study examines how surrogacy impacts attachment patterns compared to traditional pregnancies or assisted reproductive technologies. Using PRISMA guidelines, a systematic review of databases like Scopus and PubMed identified nine relevant studies from 806 initial records, involving 1317 participants (115 pregnant women and 118 children). Key variables included maternal–fetal attachment, depression, anxiety, and somatization in surrogates, alongside intended parents’ support and children’s exploration of their origins. Findings reveal the complexity of attachment dynamics in surrogacy, emphasizing the need for psychological support and preparation to foster secure attachments among surrogates, children, and intended parents. Full article

Assisted reproduction is a rapidly expanding pillar of medical tourism. Greece combines a liberal legal framework, internationally accredited clinics, and comparatively competitive costs, attracting cross-border patients seeking ART services. Following the 2022 amendment (Law 4958/2022) which amends the original law n.3305/2005, treatment is permitted up to age 54 under specific authorization, while court-approved surrogacy, anonymous gamete donation, and the adoption of decision-support technologies (e.g., AI-assisted embryo assessment, PGT-A) underpin the sector’s growth. This review synthesizes legal, medical, economic, and social dimensions, drawing on Q1 literature and official datasets (WHO, OECD, ESHRE/ICMART), and compares Greece with Spain, the USA, the Czech Republic, and Ukraine. Quantitative indicators include age-stratified success rates and indicative treatment costs. We discuss benefits and risks for patients and the health system, highlighting policy options for sustainable, ethically robust reproductive tourism in Greece. Full article

Phosphorus (P) is a problematic waterborne pollutant, and considerable efforts have been taken to monitor its presence and transport in locales struggling with eutrophication. Most historical P datasets consist of intermittent grab samples, necessitating the construction of surrogacy models to explore P at high resolutions. In Iowa, models using historical data to relate turbidity to particulate P (PartP) have successfully been created. However, it is unknown how comprehensively historical datasets reflect Iowa’s hydrologic conditions and how well these models perform during flows not well represented within the existing data. In this study, we analyzed historical P datasets from 16 major Iowa rivers to determine how well they captured the rivers’ full range of streamflow conditions. While these datasets contained sufficient samples during low and average flows, they typically under-sampled high flows—containing few values above the 85–95th percentiles. Therefore, we collected new data in each river during wet conditions, with ~300 samples taken from 2021 to 2024. These new sampling results largely aligned with the existing surrogacy models and slightly improved model performance, suggesting that utilizing turbidity to predict PartP is appropriate in nearly all streamflow conditions. These findings may prove consequential for robustly modeling PartP due to its dynamic nature and disproportionately high transport during wet weather events. Full article

The article examines the changes to Italian legislation on assisted reproductive technology (ART) resulting from rulings by Italian courts, highlighting unresolved ethical–legal issues and potential future regulatory approaches consistent with these decisions. Additionally, it addresses the amendment defining surrogacy as “universal crime”, effective as of 18 November 2024. Through an analysis of decisions by the Constitutional Court and the Court of Cassation, it emerges that Law No. 40/2004 has been deemed unconstitutional in relation to the following: heterologous fertilization, the number of embryos that can be created, cryopreservation, the implantation of only healthy embryos, and access to ART for fertile couples. Controversial aspects include the fate of surplus embryos, access to ART for single individuals, and the recognition of parenthood for same-sex couples. The “universal crime” classification of surrogacy raises the possibility of legal consequences for individuals engaging in surrogacy abroad, even where it is lawful. Courts are unlikely to legislate on the allocation of surplus embryos without parliamentary intervention or to allow single individuals access to ART, given the perceived inconsistency with the child’s best interests. However, case-by-case evaluations are essential for recognizing non-biological or non-genetic parents in same-sex relationships and for assessing the effectiveness of the universal crime approach in safeguarding rights and public health. Full article

Allogeneic hematopoietic cell transplantation (HCT) remains an important curative-intent treatment for many patients with acute myeloid leukemia (AML), but AML recurrence after allografting is common. Many factors associated with relapse after allogeneic HCT have been identified over the years. Central among these is measurable (“minimal”) residual disease (MRD) as detected by multiparameter flow cytometry, quantitative polymerase chain reaction, and/or next-generation sequencing. Demonstration of a strong, independent prognostic role of pre- and early post-HCT MRD has raised hopes MRD could also serve as a predictive biomarker to inform treatment decision-making, with emerging data indicating the potential value to guide candidacy assessment for allografting as a post-remission treatment strategy, the selection of conditioning intensity, use of small molecule inhibitors as post-HCT maintenance therapy, and preemptive infusion of donor lymphocytes. Monitoring for leukemia recurrence after HCT and surrogacy for treatment response are other considerations for the clinical use of MRD data. In this review, we will outline the current landscape of MRD as a biomarker for patients with AML undergoing HCT and discuss areas of uncertainty and ongoing research. Full article

Mo Yan’s 2009 novel Frog (Wā 蛙) traces the dramatic career of a rural obstetrician who saves lives through modern medicine, forces vasectomies and abortions through her implementation of the one-child policy, supports her nephew’s black market surrogacy scheme, and finally ends up withdrawing into a spiritual state of atonement for her previous deeds. This article examines the relationship between human and animal in the novel, suggesting that the conceptual separation of these categories is intimately related to the various problems the novel depicts throughout Chinese modernity. By focusing on the critical possibilities offered by the novel’s title, Wā 蛙, as a homophone with both “baby” (wá 娃) and the “wa” of the mythical female progenitor Nüwa (娲wā), I suggest that Mo Yan offers a new concept of life, best referred to simply as wa, in response to certain crises of modernity. As an ambiguously generative reconceptualization of life, wa denies conventional and simplistic distinctions between human and animal while incorporating elements of spirituality and unknowability into an otherwise overly rationalized and monetized idea of the human. Full article

The European eel encounters challenges in achieving sexual maturation in captivity, which has been a concern for researchers. This study explores surrogate broodstock technology as an alternative approach for eel production. The present study aimed to evaluate zebrafish and European sea bass as potential recipients for European eel spermatogonia transplantation, given the abundance of eel type A spermatogonia (SPGA). Immature European eel testes were dissected and maintained at 4 °C or cryopreserved. SPGA were obtained by dissociation of fresh or post-thawed tissue, employing an enzymatic solution, and then labelled with fluorescent membrane marker PKH26. SPGA from fresh tissue were transplanted into wild-type zebrafish larvae and triploid European sea bass larvae, while SPGA from cryopreserved testis were transplanted into vasa::egfp transgenic zebrafish larvae. One-and-a-half months post-transplantation (mpt), fluorescent donor cells were not detected in the gonads of zebrafish or European sea bass. Molecular qPCR analyses at 1.5 or 6 mpt did not reveal European eel-specific gene expression in the gonads of any transplanted fish. The findings suggest that the gonadal microenvironments of zebrafish and European sea bass are unsuitable for the development of European eel spermatogonia, highlighting distinctive spermatogonial stem cell migration mechanisms within teleost species Full article

In gout research, serum urate has been widely accepted as the primary endpoint in clinical trials of urate-lowering therapies by both the FDA and EMA for many years. However, for serum urate to be a meaningful outcome measure, it should reflect at least one important patient-centered clinical outcome, such as gout flares. The relationship between achieving a pre-specified “target” serum urate and a corresponding improvement in patient-centered outcomes has been difficult to show due to variation in reporting of both serum urate and gout flares in clinical trials; a paradoxical rise in gout flares after starting urate-lowering therapy and a delay after achieving the pre-specified target serum urate before gout flares settle coupled with the relatively short duration of the trials. However, recent evidence from individual-level patient data from two, two-year randomized controlled trials clearly shows that achieving target urate is associated with a subsequent reduction and cessation of gout flares. In this review, we examine the evidence supporting serum urate as a surrogate outcome for gout flares, the methods, and the challenges of showing the validity of surrogacy. Full article

Cervical cancer is frequently diagnosed in women during their reproductive years, and fertility preservation is an essential part of their cancer treatment. In highly selected patients with early stage, low-risk cervical cancer and a tumor size ≤ 2 cm, several treatment strategies can be offered for patients wishing to preserve fertility, including radical/simple trachelectomy or conization with pelvic lymph node assessment. Trachelectomy can be performed through a vaginal, abdominal, or minimally invasive approach and has been shown to have an equivalent oncologic outcome compared to radical hysterectomy. All surgical approaches for radical trachelectomy seem to have excellent survival with comparable oncologic outcomes. Nevertheless, patients undergoing vaginal trachelectomy have better obstetric outcomes compared to the other routes. In patients with larger tumors (2–4 cm), neoadjuvant chemotherapy followed by fertility-sparing surgery is an alternative option. Several chemotherapy regimens have been used for this indication, with a pathologic complete response rate of 17–73%. For locally advanced diseases that require radical hysterectomy or primary chemoradiation, fertility preservation can be performed using oocyte, embryo, or ovarian tissue cryopreservation, as well as ovarian transposition. For these patients, future pregnancy is possible through surrogacy. In addition to fertility preservation, ovarian transposition, where the ovaries are repositioned outside of the radiation field, is performed to maintain ovarian hormonal function and prevent premature ovarian failure. In summary, fertility-preservation treatment strategies for patients with early stage cervical cancer are continuously evolving, and less radical surgeries are becoming more acceptable. Additional and ongoing evidence is helping determine the impact of conservative procedures on oncologic and obstetric outcomes in these patients. Full article

While the history and technology of cinema are considered for the purpose of achieving decolonial ends, this paper suggests that ‘classic’ cinema may be considered a quintessentially settler colonial medium. However, the moving image is now delivered in new ways and through new devices, and streaming has transformed global patterns of cinema production and consumption. Thus, two developments are considered in relation to this transformation. On the one hand, there are signs that mainstream cinema may be genuinely addressing its implication with colonialism, and this paper focuses on a formal apology and on a big budget movie that adopted a radically innovative approach to representing Indigenous peoples: Prey (2022). On the other hand, streaming has made cinema portable and has made consumption in personally deliberated instalments possible. The ‘digital natives’ consume cinema in fragmented and noncollective patterns, and their activity is subjected to unprecedented modalities of surveillance and appropriation. This paper concludes that a form of digital colonialism supported by streaming operates in ways that are homologous with modes of settler colonial appropriation. Full article

Uterus transplantation (UTx) is now an alternative to surrogacy and adoption for women with uterine factor infertility to have children; however, there are still unresolved clinical and technical issues. One of these is that the graft failure rate after transplantation is somewhat higher than that of other life-saving organ transplants, which is a critical concern. Herein, we summarize the details of 16 graft failures after UTx with living or deceased donors using the published literature in order to learn from these negative outcomes. To date, the main causes of graft failure are vascular factors (arterial and/or venous thrombosis, atherosclerosis, and poor perfusion). Many recipients with thrombosis develop graft failure within one month of surgery. Therefore, it is necessary to devise a safe and stable surgical technique with higher success rates for further development in the UTx field. Full article

Lichens are outstanding examples of fungal symbioses that form long-lived structures, the lichen thalli, in which a multiplicity of other microorganisms are hosted. Among these, microfungi seem to establish diverse trophic relationships with their lichen hosts. The most specialised of these fungi are the parasitic lichenicolous fungi, of which the diversity has hardly been explained as a proxy for the diversity of lichen species. Here, we used an exemplar dataset of a well-studied alpine lichen community composed of 63 lichen and 41 lichenicolous fungal species and tested it to verify the strength of the co-occurrences of the two species groups with predictive co-correspondence analyses. The results showed that the distribution of lichen abundances affects the abundance and variation of lichenicolous fungi and supports our hypothesis to use lichens as surrogates for lichenicolous fungi in surrogacy analysis. Full article

Background: To assess the usefulness of tumor response and progression-free survival (PFS) as surrogates for overall survival (OS) in non-small cell lung cancer (NSCLC) trials with immune checkpoint inhibitors (ICI), which have not been confirmed. Methods: Patient- and trial-level analyses were performed. The Response Evaluation Criteria in Solid Tumors was preferred for image assessment. For trial-level analysis, surrogacy was assessed using the weighted rank correlation coefficient (r) following “reciprocal duplication.” This method duplicates all plots as if the experimental and the reference arms were switched. Monte Carlo simulations were performed for evaluating this method. Results: A total of 3312 cases were included in the patient-level analysis. Patients without response (first line (1L): hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.71–2.23; second or later line (2L-): HR 4.22, 95% CI 3.22–5.53), without disease control (1L: HR 4.34, 95% CI 3.82–4.94; 2L-: HR 3.36, 95% CI 2.96–3.81), or with progression during the first year (1L: HR 3.42, 95% CI 2.60–4.50; 2L-: HR 3.33, 95% CI 2.64–4.20), had a higher risk of death. Systematic searches identified 38 RCTs including 17,515 patients for the study-level analysis. Odds ratio in the objective response rate (N = 38 × 2, r = −0.87) and HR in PFS (N = 38 × 2, r = 0.85) showed an excellent association with HR in overall survival, while this effect was not observed in the disease control rate (N = 26 × 2, r = −0.03). Conclusions: Objective response rate and PFS are reasonable surrogates for OS in NSCLC trials with ICI. Full article

As biodiversity continues to decline across the globe, conservation of wildlife species and the ecosystems they inhabit is more important than ever. When species dwindle, ecosystems that depend on them are also impacted, often leading to a decrease in the life-giving services healthy ecosystems provide to humans, wildlife, and the global environment. Methods of wildlife conservation are complex and multi-faceted, ranging from education and advocacy to, research, restoration, and rehabilitation. Here, we review a conservation program focused on helping recover the federally listed threatened southern sea otter (Enhydra lutris nereis) population. We describe the development of unique rehabilitation methods and steps taken to advance the program’s conservation impact. Understanding this evolution can inform conservation efforts for other vulnerable species and their ecosystems. Full article