Pathogenesis of adenomyosis

Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility.

Validity and Responsiveness of the Dutch McMaster Toronto Arthritis Patient Preference Questionnaire (MACTAR) in Patients with Osteoarthritis of the Hip or Knee

Objective.To determine the content validity, the construct validity, and the responsiveness of the Dutch McMaster Toronto Arthritis Patient Preference Questionnaire (MACTAR) in patients with osteoarthritis (OA) of the hip or knee.Methods.The MACTAR comprises 2 parts: a transitional part and a status part. Content validity was investigated by comparing patient-elicited activities to items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study Short-Form 36 (SF-36). Construct validity was determined by correlating MACTAR outcomes with WOMAC/SF-36 outcomes. Responsiveness was investigated by correlating MACTAR, WOMAC, and SF-36 change scores with patient global assessment (PGA) scores and plotting a receiver-operating characteristics (ROC) curve.Results.Eleven percent of the 894 impaired activities, identified by 192 patients, were not represented in either the WOMAC or the SF-36. The correlations (rs) investigated for the MACTAR transitional part varied between 0.27 and −0.40; the status part correlated moderately with the general health scale of the SF-36 (rs = 0.44). MACTAR change scores correlated better with PGA than with WOMAC/SF-36 change scores. The area under the ROC curve amounted to 0.90.Conclusion.Our results suggest that the MACTAR exhibits moderate construct validity and good responsiveness in a population of patients with OA of the hip or knee. The MACTAR is potentially better able to detect changes over time in activities that are important to individual patients compared to other tools measuring physical function (WOMAC, SF-36). Clinicians could use the MACTAR to evaluate clinically relevant changes over time in patient-specific physical functioning.