Objective To estimate the risk of prolapse associated with levator avulsion injury among a urogynaecological clinic population.
Design Retrospective observational study.
Setting Tertiary ...urogynaecological unit.
Sample A total of 934 women seen for interview, examination using the pelvic organ prolapse quantification (POP‐Q) staging system and imaging of the levator ani muscle by four‐dimensional translabial ultrasound.
Methods Retrospective review of charts and stored imaging data.
Main outcome measures Pelvic organ prolapse stage II and higher and presence of defects of the levator ani muscle.
Results After exclusion of 137 women with a history of anti‐incontinence or prolapse surgery, and a further exclusion of 16 women in whom either examination or imaging was impossible, we compared prolapse and imaging data in 781 women. Mean age was 53 years (range 15–89 years), and median parity was 2 (range 0–12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (stage II or higher) was diagnosed in 415 (53%) women, and 181 (23%) women were found to have levator avulsion defects. Prolapse was seen in 150/181 (83%) women with avulsion and in 265/600 (44%) women without avulsion, giving a relative risk (RR) of 1.9 (95% CI 1.7–2.1). The association was strongest for cystocele (RR 2.3, 95% CI 2.0–2.7) and uterine prolapse (RR 4.0, 95% CI 2.5–6.5).
Conclusions Women with levator avulsion defects were about twice as likely to show pelvic organ prolapse of stage II or higher than those without. This effect is mainly due to an increased risk of cystocele and uterine prolapse.
Objective
To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP‐Q stage ≥2 vaginal vault prolapse ...(VVP).
Design
Multicentre randomised controlled trial (RCT) and prospective cohort study alongside.
Setting
Seven non‐university teaching hospitals and two university hospitals in the Netherlands.
Population
Patients with symptomatic post‐hysterectomy vaginal vault prolapse, requiring surgical treatment.
Methods
Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP‐Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively.
Main outcome measures
Primary outcome was disease‐specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri‐operative data, complications and sexual function.
Results
A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease‐specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129).
Conclusions
LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow‐up period of 12 months.
Background
International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development ...project.
Methods
The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants.
Results
End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed.
Conclusion
An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
Large, reproducible interindividual differences exist in resting sympathetic nerve activity among normotensive humans with
similar arterial pressures, resulting in a lack of correlation between ...muscle sympathetic nerve activity (MSNA) and arterial
pressure among individuals. Although it is known that the arterial pressure is the main short-term determinant of MSNA in
humans via the arterial baroreflex, the lack of correlation among individuals suggests that the level of arterial pressure
is not the only important input in regulation of MSNA in humans. We studied the relationship between cardiac output (CO) and
baroreflex control of sympathetic activity by measuring MSNA (peroneal microneurography), arterial pressure (arterial catheter),
CO (acetylene uptake technique) and heart rate (HR; electrocardiogram) in 17 healthy young men during 20 min of supine rest.
Across individuals, MSNA did not correlate with mean or diastolic blood pressure ( r < 0.01 for both), but displayed a significant negative correlation with CO ( r
=
â0.71, P
= 0.001). To assess whether CO is related to arterial baroreflex control of MSNA, we constructed a baroreflex threshold
diagram for each individual by plotting the percentage occurrence of a sympathetic burst against diastolic pressure. The mid-point
of the diagram ( T 50 ) at which 50% of cardiac cycles are associated with bursts, was inversely related to CO ( r
=
â0.75, P < 0.001) and stroke volume (SV) ( r
=
â0.57, P
= 0.015). We conclude that dynamic inputs from CO and SV are important in regulation of baroreflex control of MSNA in
healthy, normotensive humans. This results in a balance between CO and sympathetically mediated vasoconstriction that may
contribute importantly to normal regulation of arterial pressure in humans.
This review paper summarizes current knowledge available for aviation operations related to meteorology and provides suggestions for necessary improvements in the measurement and prediction of ...weather-related parameters, new physical methods for numerical weather predictions (NWP), and next-generation integrated systems. Severe weather can disrupt aviation operations on the ground or in-flight. The most important parameters related to aviation meteorology are wind and turbulence, fog visibility, aerosol/ash loading, ceiling, rain and snow amount and rates, icing, ice microphysical parameters, convection and precipitation intensity, microbursts, hail, and lightning. Measurements of these parameters are functions of sensor response times and measurement thresholds in extreme weather conditions. In addition to these, airport environments can also play an important role leading to intensification of extreme weather conditions or high impact weather events, e.g., anthropogenic ice fog. To observe meteorological parameters, new remote sensing platforms, namely wind LIDAR, sodars, radars, and geostationary satellites, and in situ instruments at the surface and in the atmosphere, as well as aircraft and Unmanned Aerial Vehicles mounted sensors, are becoming more common. At smaller time and space scales (e.g., < 1 km), meteorological forecasts from NWP models need to be continuously improved for accurate physical parameterizations. Aviation weather forecasts also need to be developed to provide detailed information that represents both deterministic and statistical approaches. In this review, we present available resources and issues for aviation meteorology and evaluate them for required improvements related to measurements, nowcasting, forecasting, and climate change, and emphasize future challenges.
The prevalence of chronic rhinosinusitis (CRS) measured in epidemiologic studies is 5% to 12%. This might be an overestimation because of overlap with other diseases, such as allergic rhinitis.
We ...aimed to calculate the prevalence of CRS using a combination of epidemiologically based CRS according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) together with sinonasal opacification on imaging.
Subjects who underwent a computed tomographic or magnetic resonance imaging scan of the head for any nonrhinologic indication were asked to fill in the Global Allergy and Asthma European Network survey containing EPOS symptom criteria. The scans were evaluated according to the Lund-Mackay (LM) scoring system. Epidemiologically based CRS is based on nasal symptoms according to EPOS; clinically based CRS also encompasses endoscopy and/or CT scanning.
Eight hundred thirty-four subjects were included. One hundred seven (12.8%) had epidemiologically based CRS according to EPOS. Of these subjects, 50% had an LM score of 0, 26% had an LM score of 1 to 3, and 23% had an LM score of 4 or greater. Twenty-five (3.0%) subjects had clinically based CRS (based on LM score ≥4), and 53 (6.4%) subjects had clinically based CRS (based on LM score >0). Allergic rhinitis was reported by 167 (20%) subjects. In subjects who did not report upper airway symptoms, 57% had an LM score of 0, 30% had an LM score of 1 to 3, and 12% had an LM score of 4 or greater.
We found a prevalence of 3.0% to 6.4% of clinically based CRS (depending on an LM cutoff point; ie, LM ≥ 4 or LM > 0, respectively) in a relatively randomly selected group of subjects.
Solution processing of photovoltaic semiconducting layers offers the potential for drastic cost reduction through improved materials utilization and high device throughput. One compelling ...solution-based processing strategy utilizes semiconductor layers produced by sintering nanocrystals into large-grain semiconductors at relatively low temperatures. Using n-ZnO/p-CdTe as a model system, we fabricate sintered CdTe nanocrystal solar cells processed at 350 °C with power conversion efficiencies (PCE) as high as 12.3%. J SC of over 25 mA cm–2 are achieved, which are comparable or higher than those achieved using traditional, close-space sublimated CdTe. We find that the V OC can be substantially increased by applying forward bias for short periods of time. Capacitance measurements as well as intensity- and temperature-dependent analysis indicate that the increased V OC is likely due to relaxation of an energetic barrier at the ITO/CdTe interface.
Update
This article was updated on September 4, 2020, because of a previous error. On page 1211, in the author affiliation section, “W.L. Walter, MBBS, PhD
3
” now reads “W.L. Walter, MBBS, PhD
3,4
...,” the affiliation for Dr. Van Onsem that had read “
3
Specialist Orthopedic Group, The Mater Clinic, North Sydney, New South Wales, Australia” now reads “
3
Royal North Shore Hospital, St. Leonards, New South Wales, Australia,” and the affiliation for Dr. Walter that had read “
3
Specialist Orthopedic Group, The Mater Clinic, North Sydney, New South Wales, Australia” now reads “
3
Royal North Shore Hospital, St. Leonards, New South Wales, Australia” and “
4
University of Sydney, Sydney, New South Wales, Australia.”
An erratum has been published: J Bone Joint Surg Am. 2020 Oct 7;102(19):e113
» As we resume elective surgical procedures, it is important to understand what practices and protocols should be altered or implemented in order to minimize the risk of pathogen transfer during the severe acute respiratory syndrome (SARS)-CoV-2 pandemic.
» Each hospital and health system should consider their unique situation in terms of SARS-CoV-2 prevalence, staffing capabilities, personal protection equipment supply, and so on when determining how and when to implement these recommendations.
» All patients should be screened for SARS-CoV-2 by means of a thorough history and physical examination, as well as reverse transcription-polymerase chain reaction (RT-PCR) testing whenever possible, prior to undergoing elective surgery.
» Patients who are currently infected with coronavirus disease 2019 (COVID-19) should not undergo elective surgery.
» These guidelines are based on the available scientific evidence, albeit scant. The recommendations have been reviewed and voted on by the expert delegates who produced this document.
The mechanism by which disruption of reading frame can influence pre-messenger RNA (pre-mRNA) processing is poorly understood. We assessed the role of factors essential for nonsense-mediated mRNA ...decay (NMD) in nonsense-mediated altered splicing (NAS) with the use of RNA interference (RNAi) in mammalian cells. Inhibition of rent1/hUpf1 expression abrogated both NMD and NAS of nonsense T cell receptor β transcripts. In contrast, inhibition of rent2/hUpf2 expression did not disrupt NAS despite achieving comparable stabilization of nonsense transcripts. We also demonstrate that NAS and NMD are genetically separable functions of rent1/hUpf1. Additionally, rent1/hUpf1 enters the nucleus where it may directly influence early events in mRNA biogenesis. This provides compelling evidence that NAS relies on a component of the nonsense surveillance machinery but is not an indirect consequence of NMD.
The ecological constraints hypothesis states that as group size increases, groups travel further and occupy larger home ranges in order to meet basic energetic needs for survival and reproduction. In ...this paper we used 19 years of demographic and ranging data on a study population of golden lion tamarins, Leontopithecus rosalia, to examine this hypothesis. Significant variation in rate of predation on lion tamarins during the study affected group size, membership and population density, which allowed us to test for predicted correlations between these changes and home range size. We found that predation-mediated changes in group composition and population density explained 71% of variation in home range size. Increased predation decreased lion tamarin home ranges because of the effects of decreased group size, fewer adult natal males and fewer reproductive females in the group. The effect of these factors on decreased ranging was offset somewhat by lower population density during high predation, which resulted in range expansion due to reduced pressure from neighbouring groups. We also found that groups with high future reproductive potential (i.e. with multiple breeding females) increased their range size. This effect was independent of group size. We propose a new hypothesis, that taxa with high rates of reproduction, such as lion tamarins, will increase home range size to accommodate future energy needs, rather than current needs, as would be predicted by the ecological constraints hypothesis. No or low production of infants and litters on the smallest lion tamarin ranges in our study supports this new hypothesis.
•We examine effects of ecological constraints, group composition and predation on tamarin home ranges.•Predation-mediated changes explained 71% of the variation in home range size.•There was a positive relation between group size and home range size only for large groups.•Groups with multiple adult males and breeding females had larger home ranges.•Tamarins with high reproductive rates increased home range size to ensure future energy needs.
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