High prevalence of chronic endometritis in women with nonstructural abnormal uterine bleeding and benefits of antimicrobial treatment on blood loss pattern: A prospective, observational study

Abstract Objective The causal link between chronic endometritis (CE) and nonstructural abnormal uterine bleeding (AUB) has been poorly investigated and requires further clarification. This study aimed to evaluate the prevalence of CE in women with nonstructural AUB and to assess the effect of CE cure on the menstrual blood loss pattern. Methods This prospective study was conducted between 2022 and 2024 at the Department of Obstetrics and Gynecology, University of Bari, Italy. Women aged 20–45 undergoing hysteroscopy for AUB with confirmation of nonstructural causes were evaluated for CE and considered affected when both hysteroscopic and histologic/immunohistochemical (HIS/IHC) criteria were met. Women with CE were treated with specific culture‐guided therapy. Cure ascertainment was confirmed by triple negativity at hysteroscopy‐HIS/IHC‐culture (Group A). In cases of a positive test, a second course of therapy, up to three courses, was repeated before declaring a persistent condition (Group B). At enrollment and at end‐of‐treatment evaluation, all participants completed a questionnaire to describe the bleeding characteristics and the Pictorial Blood Assessment Chart (PBAC). Serum hemoglobin and ferritin were also assessed. Results Chronic endometritis was diagnosed in 102 of 145 (70.3%) women with nonstructural AUB enrolled in the study. Out of 102 CE patients, 81 (79.4%) patients showed CE resolution after therapy (group A), while in 21 patients (20.6%) CE was persistent (group B). The duration of heavy bleeding before treatment (baseline) was similar in both groups ( P  = ns). In contrast, at the end of treatment, days of heavy bleeding, days of spotting, and PBAC scores decreased significantly in group A compared with both same‐group baseline assessment and group B. Serum hemoglobin and ferritin levels in cured women (A) were significantly higher than in those with persistent CE (B). PBAC scores in group A at 3 and 6 months after the end of treatment showed persistence of cure benefits on AUB. Finally, among patients with CE diagnosis, both univariate and multivariate regressions showed a significant association between cure of CE and reduced bleeding. Conclusion Chronic endometritis was highly prevalent in women with nonstructural AUB in our cohort. Cure of CE by targeted antimicrobial therapy led to significant improvements in bleeding patterns.

The impact of uncertainty estimation on radiomic segmentation reproducibility and scan–rescan repeatability in kidney MRI

Abstract Background Radiomics holds great potential but is hindered by segmentation and scan–rescan variability, which affect the reproducibility and repeatability of radiomic analysis, respectively. Recently, deep learning (DL) has shown promise in improving segmentation accuracy, thereby enhancing radiomic stability. Moreover, including uncertainty quantification into DL models could provide confidence assessments for segmentations, ultimately improving the trustworthiness and robustness of radiomic outputs. Purpose This study investigated whether the reproducibility and repeatability of radiomic features, in relation to segmentation and scan–rescan variability, respectively, could be enhanced by extracting features exclusively from confidently segmented regions, rather than from regions defined without accounting for uncertainty‐related information. Additionally, this study assessed whether stable features derived from uncertainty‐informed segmentation could improve the classification of healthy versus pathological subjects. Methods A publicly available kidney MRI dataset, including subjects with chronic kidney disease (CKD) and healthy controls (HC), was used to assess the robustness of the segmentation methods across diverse clinical scenarios. A deterministic U‐Net model was first implemented to generate kidney masks without considering segmentation uncertainty. Then, Monte Carlo dropout (MCD) and test‐time augmentation (TTA) were applied to address uncertainty in DL‐based segmentation. Both methods were trained using the traditional Dice loss and a recently proposed Dice Plus loss to improve model calibration. Confidence level‐based masks were defined from the predictions with uncertainty, identifying kidney regions segmented with different levels of certainty. Radiomic features were extracted from ground truth masks, deterministic masks, and confidence level‐based masks. These features were grouped into four classes based on their intraclass correlation coefficient values in relation to both segmentation and scan–rescan variability. Finally, based on the identified stable features, a classification model was developed for each approach to distinguish between CKD and HC subjects. Results The accuracy results were comparable across all the implemented models, with Dice score coefficients consistently above or near 0.9. Most radiomic features were unstable with respect to both segmentation and scan–rescan variability when uncertainty information was not considered. However, including uncertainty increased the number of features repeatable with respect to scan–rescan variability in both CKD and HC subjects. The greatest improvement was observed with the MCD approach trained with the Dice Plus loss, whereby the number of repeatable features increased from 24 to 70 out of 105 in total, for both CKD and HC subjects. Improvements in reproducibility with respect to segmentation variability were not consistent across methods and subject groups. Regarding the classification analysis, all uncertainty‐based approaches performed comparable to the references in terms of ROC curves. Conclusions Integrating uncertainty quantification into DL‐based segmentation for radiomic features extraction represents a promising approach to enhance the robustness of radiomic analysis against segmentation and scan–rescan variability, as well as its ability in distinguishing pathological from healthy subjects. Additionally, such integration improves the reliability and interpretability of radiomic analysis, contributing to more informed clinical decision‐making.

Probing Pedogenetic Imprints and Functional Properties of Moroccan Clayey Materials Through FFC NMR Relaxometry

ABSTRACT Understanding how soil formation processes influence the microstructure and the dynamic behavior of clay‐rich materials is essential for both pedological interpretation and technological assessment. In this study, we applied fast field cycling nuclear magnetic resonance (FFC NMR) relaxometry to investigate the microstructural heterogeneity of Moroccan clays developed under diverse pedogenetic conditions. Nuclear magnetic relaxation dispersion (NMRD) profiles were processed using a model‐free inversion algorithm to retrieve the distribution of correlation times. The latter provides a phenomenological mapping of proton–surface interactions across distinct dynamic domains. Complementary indicators of micro‐scale hydrological connectivity were, then, computed from the T₁ distributions, integrating both structural (SCI) and functional (FCI) heterogeneity. While the former indicates the breadth of molecular environments experienced by water across the system, the latter captures the dynamic contrast between fast‐ and slow‐relaxing populations associated with variations in surface accessibility and magnetic heterogeneity. The results showed that the clay sample from Khemisset exhibited the greatest relaxation heterogeneity, consistent with advanced pedogenetic reorganization related to redox‐driven redistribution of paramagnetic metals. In contrast, the clay samples from Berrechid and Tiflet displayed a more ordered architecture and lower magnetic heterogeneity, reflecting earlier‐stage pedogenetic development. This study demonstrated that FFC NMR relaxometry reveals the microstructural memory encoded into water dynamics, offering a powerful tool to infer the pedogenetic pathways leading to soil formation. Beyond its relevance for pedological studies, the method also offers valuable insights into the technological behavior of clays, supporting the selection of raw materials for industrial purposes based on their microstructural properties.

Role of TMEM230 in the Aberrant Glycosylation in Human Autoimmunity and Cancer

Socioeconomic Disparities in Prostate Cancer Treatment: The Impact of Area Deprivation Index on Initial Treatment Type for Localized PCa in a North‐American Cohort

ABSTRACT Background Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of area of deprivation index (ADI) on initial treatment type for localized PCa in a North‐American cohort. Methods We performed a retrospective analysis of patients diagnosed with localized PCa, treated within Henry Ford Health (HFH), between 1995 and 2022, with available ADI‐data. ADI was assigned based on residential census block group, ranked as a national deprivation percentile. Patients were categorized into three treatment‐groups: radical prostatectomy (RP), radiation therapy (RT) and “other” treatment. Using multinomial logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, ISUP‐grade and/or PSA, we stratified by D'Amico risk‐classification and repeated the regression analysis in each subgroup. Results Among 14,204 patients, 28.4% were NHB. Median (IQR) age at diagnosis was 65 (59–71) years. Median (IQR) ADI was 58 (36–83) for overall cohort and 51 (30–74), 66 (45–91), and 62 (39–88) for RP, RT, and “other” groups, respectively ( p  < 0.0001). Multivariable analysis showed ADI as an independent predictor of treatment choice ( p  = 0.01): for each 10‐unit increase in ADI, patients were 3% more likely to receive RT and 10% less likely to receive RP. High ADI predicted a lower likelihood of receiving initial surgery across all risk‐groups ( p  < 0.001). Conclusions Patients in more advantaged areas were more likely to receive RP, while those in disadvantaged areas received more RT. Recognizing how neighborhood factors affect treatment choices is crucial for improving health equity and reducing disparities in PCa outcomes.

Association of Area of Deprivation Index With Active Surveillance (AS) Utilization and Adherence to as Guidelines: Results From a Contemporary North American Cohort

ABSTRACT Background Active Surveillance (AS) for Prostate Cancer (PCa) requires regular follow‐up, raising concerns that socioeconomic barriers may result in underutilization or decreased adherence to AS guidelines. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and AS habits in a contemporary North American cohort. Methods We included all the patients aged ≤ 75 years and diagnosed with low (ISUP GG = 1, PSA ≤ 10 ng/mL and cT1N0M0) and intermediate risk (ISUP GG = 2, PSA 10–20 ng/mL or cT2N0M0) PCa at Henry Ford Health (HFH) between 1995 and 2023. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socioeconomic disadvantage. Logistic regression analysis tested the impact of ADI on AS utilization and adherence to AS guidelines. Only patients who underwent at least 1 PSA test per year and at least 1 biopsy every 4 years were considered as “adherent to guidelines”. Results Our final cohort consisted of 4376 patients eligible for AS, 919 of whom actually underwent AS. Older patients (66 vs. 62 years, p  < 0.0001) and those diagnosed in more recent years (2017 vs. 2010, p  < 0.0001) had higher probability to undergo AS. Moreover, patients in the AS group more likely to be NHB (36% vs. 25%, p  < 0.0001), had higher ADI score (61 vs. 55, p  < 0.0001), more comorbidities according to Charlson Comorbidity Index (CCI) score, (19.5%% vs. 13.8%, p  < 0.0001) and higher probability to harbor low risk PCa (65.7% vs. 26.6%, p  < 0.0001), compared to patients who underwent active treatment. Among the 919 patients in AS, only 410 were “adherent to guidelines”. Patients following guidelines were more likely to be NHW (64.1% vs. 52.8%, p  < 0.003), and had lower ADI percentile (55.5 vs. 66, p  < 0.0003). Furthermore, AS patients managed according to the prevailing guidelines received more PSAs tests (1.8 vs. 0.8, p  < 0.0001) and prostate biopsies (0.3 vs. 0.0, p  < 0.0001) per year, thus reporting both higher upgrading rates during AS (35.6% vs. 23%, p  < 0.0001) and an increased probability to undergo active treatment (48% vs. 27%, p  < 0.0001). At MVA, patients with a higher ADI score reported higher probability to undergo AS (OR: 1.06, 95% CI: 1.02–1.10, p  = 0.004), but at the same time they were less likely to follow AS' guidelines (OR: 0.94, 95% CI: 0.89–0.99, p  = 0.02). Conclusions Patients in the most deprived areas had a higher likelihood of undergoing AS but were more prone to receive guideline‐discordant care. This should be taken into consideration by physicians when recommending AS for those men living in the least advantaged neighborhoods. Our study highlights the need for targeted community reforms to enhance proper and informed AS utilization among socioeconomically disadvantaged populations.

Assessment of Maneuvering Influence on the Fine Alignment of Autonomous Underwater Vehicle

ABSTRACT Autonomous underwater vehicles (AUVs) are specialized robots used to accomplish important field operations such as inspection of oil and gas pipelines, marine wildlife monitoring, imaging of river and sea beds, nondestructive testing of ship hulls, and so on. Before the start of an AUV mission, its navigation system, which is generally comprised of a doppler velocity log (DVL)/pressure sensor (PS)‐aided inertial navigation system (INS) needs to be initialized. After a brief coarse stage of initialization, the AUV attitude is generally refined (as well as some inertial measurement unit (IMU)/aiding sensor systematic error parameters are corrected for) in a Kalman filter (KF)‐based estimation process known as fine alignment, which is usually performed in open sea conditions. When the latter is conducted before the submerged phase of the AUV, a Global Navigation Satellite System (GNSS) receiver may provide additional aiding information to the refinement process. As the excitation of the degrees of freedom of the AUV is known to interfere with the performance of the KF fine alignment, this study exploits Baram and Kailath's concept of estimability to assess what kind of deliberate AUV maneuver is able to deliver the best estimation results. As the main contribution, we show that among the tested AUV motion profiles, the lawn mower is the maneuver that, except for the IMU/DVL misalignment around the AUV longitudinal axis, decreases the estimation uncertainties of all remaining INS/GNSS/DVL/PS fine alignment states. Results from simulated and experimental tests confirm the adequacy of the outlined verifications.

Fast and Robust Ultra‐High‐Performance Liquid Chromatography Analysis of Thermally Labile Psychoactive Phenethylamines

ABSTRACT We report the first ultra‐high‐performance liquid chromatography (UHPLC) coupled with a diode array detection method for the rapid, sensitive, and reliable quantification of new psychoactive substances, including 2,5‐dimethoxyphenethylamines, N‐(2‐hydroxybenzyl)‐2,5‐dimethoxyphenethylamines, and N‐(2‐methoxybenzyl)‐2,5‐dimethoxyphenethylamines. In these compounds, the R group represents a substitution at the 4‐position of the phenethylamine ring, such as a halogen or an ethyl group. This analytical approach overcomes the limitations caused by the thermal lability of these analytes in gas chromatography combined with mass spectrometry (MS) and in HPLC combined with tandem MS. The method was validated over the range of 200–25,000 ng/mL, with intra and inter‐assay relative standard deviation values ≤6%. The limit of detection for the compounds was 0.05 µg/mL, except for 2‐(((4‐chloro‐2,5‐dimethoxyphenethyl)amino)methyl)phenol (0.1 µg/mL). The limit of quantification was 0.2 µg/mL, with a total run time of 8 min per analysis. The method was successfully applied to 156 real‐world blotter samples, providing unmatched speed and precision for forensic laboratories.

Direct Solvent‐Free Amide Bond Formation Catalyzed by Anatase‐TiO 2 Surface: Insight from Modeling

Amide bond formation processes are of paramount relevance for a broad spectrum of applications. Conventional amidation protocols typically rely on drastic reaction conditions and the use/disposal of large amounts of chemicals. These limitations may be bypassed by heterogeneously catalyzed amidation at dry conditions. However, progress is hindered because the mechanisms of these processes are largely unexplored. By using ab initio metadynamics, a concerted one‐step mechanism is proposed for the solvent‐free condensation of methylamine and formic acid on TiO 2 (101)‐anatase, leading to methylformamide with concomitant release of molecular water. The activation barrier—14.3 kcal mol −1 —is in line with the mild conditions experimentally adopted in amide bond syntheses on TiO 2 nanoparticles. The mechanism disclosed herein reveals the key role of Ti 4+ sites located on stoichiometric (101) anatase surfaces in promoting amide‐bond formation at the TiO 2 /vapor interface. The acid strength of the adsorbed HCOOH molecules may be tuned by the HCOOH surface coverage, thus influencing the outcome of the amidation reaction. These molecular‐level insights may foster further endeavors to improve/upscale TiO 2 ‐catalyzed amide syntheses at dry conditions, while raising the interest toward amidation processes at the surface/vapor interface promoted by economically and environmentally sustainable metal oxide nanomaterials.

Direct Solvent‐Free Amide Bond Formation Catalyzed by Anatase‐TiO 2 Surface: Insight from Modeling

Amide Bond Formation TiO 2 catalyzes the direct condensation of methylamine with formic acid, yielding methylformamide and water. In article number 2400346 , Gloria Tabacchi and Ettore Fois provide atomistic‐level insight that opens the way to upscale solvent‐free amidation processes promoted by environmentally benign catalysts.