The influence of the combined exposure to water and temperature on the behaviour of polylactide/sisal biocomposites coupled with maleic acid anhydride was assessed through accelerated hydrothermal ...ageing. The biocomposites were immersed in water at temperatures from 65 to 85 °C, between the glass transition and cold crystallisation of the PLA matrix. The results showed that the most influent factor for water absorption was the percentage of fibres, followed by the presence of coupling agent, whereas the effect of the temperature was not significant. Deep assessment was devoted to biocomposites subjected to hydrothermal ageing at 85 °C, since it represents the extreme degrading condition. The morphology and crystallinity of the biocomposites were evaluated by means of X-Ray diffraction (XRD) and field emission scanning electron microscopy (FE-SEM). The viscoelastic and thermal performance were assessed by means of dynamic mechanic thermal analysis (DMTA) and thermogravimetry (TGA). The presence of sisal generally diminished the thermal stability of the biocomposites, which was mitigated by the addition of the coupling agent. After composite preparation, the effectiveness of the sisal fibre was improved by the crystallisation of PLA around sisal, which increased the storage modulus and reduced the dampening factor. The presence of the coupling agent strengthened this effect. After hydrothermal ageing, crystallisation was promoted in all biocomposites therefore showing more fragile behaviour evidencing pores and cracks. However, the addition of coupling agent in the formulation of biocomposites contributed in all cases to minimise the effects of hydrothermal ageing.
Introduction
High body mass index (BMI) is a risk‐factor for stress urinary incontinence (SUI). Mid‐urethral sling (MUS) surgery is an effective treatment of SUI. The aim of this study was to ...investigate if there is an association between BMI at time of MUS‐surgery and the long‐term outcome at 10 years.
Material and Methods
Women who went through MUS surgery in Sweden between 2006 and 2010 and had been registered in the Swedish National Quality Register of Gynecological Surgery were invited to participate in the 10‐year follow‐up. A questionnaire was sent out asking if they were currently suffering from SUI or not and their rated satisfaction, as well as current BMI. SUI at 10 years was correlated to BMI at the time of surgery. SUI at 1 year was assessed by the postoperative questionnaire sent out by the registry. The primary aim of the study was to investigate if there is an association between BMI at surgery and the long‐term outcome, subjective SUI at 10 years after MUS surgery. Our secondary aims were to assess whether BMI at surgery is associated with subjective SUI at 1‐year follow‐up and satisfaction at 10‐year follow‐up.
Results
The subjective cure rate after 10 years was reported by 2108 out of 2157 women. Higher BMI at the time of surgery turned out to be a risk factor for SUI at long‐term follow‐up. Women with BMI <25 reported subjective SUI in 30%, those with BMI 25—<30 in 40%, those with BMI 30—<35 in 47% and those with BMI ≥35 in 59% (p < 0.001). Furthermore, subjective SUI at 1 year was reported higher by women with BMI ≥30, than among women with BMI <30 (33% vs. 20%, p < 0.001). Satisfaction at 10‐year follow‐up was 82% among women with BMI <30 vs 63% if BMI ≥30 (p < 0.001).
Conclusions
We found that higher BMI at the time of MUS surgery is a risk factor for short‐ and long‐term failure compared to normal BMI.
Treating stress urinary incontinence with a mid‐urethral sling seems to be more effective if you have a BMI <30 than if you are obese and have a BMI ≥30.
Introduction
The widespread misuse of prescription pain medication, including opioids, has serious public health implications. Postoperative pain is a risk factor for persistent or chronic pain ...unless treated effectively. There are only a few studies that have assessed the use of opioid‐containing drugs after gynecological surgery and most of these usually have a short follow‐up period. The aim of this study was to identify risk‐factors for long‐term use of prescription opioid drugs following hysterectomy.
Material and methods
We performed a nationwide cohort study based on prospectively collected data. Information from two population‐based registers, the Swedish National Quality Register of Gynecological Surgery and the Swedish National Drug Register, was linked. The study population consisted of women with benign disease undergoing a total hysterectomy from 1 January 2012 until 31 December 2015. To identify long‐term changes in prescription of opioids, individual data were collected from 1 year prior to to 3 years after surgery between 2011 and 2018. Data analysis was performed using multivariable logistic regression models.
Results
The population included 17 385 women having had hysterectomy for benign disease. Of these women, 4233 (24.4%) were prescribed analgesics continuously for 3 years postoperatively and 1225 (7.1%) used opioids long term. Perioperative predictors of opioid use 3 years after surgery included a diagnosis of adenomyosis (adjusted odds ratio aOR 1.8, 95% confidence interval CI 1.2‐2.7) and preoperative use of opioids (aOR 29.6, 95% CI 19.7‐44.4), psycho‐ (aOR 3.5, 95% CI 2.4‐5.0) and neuroactive drugs (aOR 1.8, 95% CI 1.0‐3.1). For women with no opioid prescription preoperatively (n = 260, 1.5%), mild (aOR 2.8, 95% CI 1.1‐7.3) and severe (3.0% vs 6.2%: aOR 6.4, 95% CI 1.4‐20.0) postoperative complications and preoperative prescription of psychoactive drugs (aOR 4.6, 95% CI 1.9‐10.7) were associated with long‐term use of drugs containing opioids.
Conclusions
Long‐term use of prescription opioids after hysterectomy is common and is, among other risk factors, strongly associated with preoperative use of opioids, as well as psychoactive drugs and adenomyosis. To avoid opioid misuse disorders among women at risk for long‐term opioid drug prescriptions after hysterectomy, further studies and strategies are needed.
In the Project for Intercomparison of Land-Surface Parameterization Schemes phase 2a experiment, meteorological data for the year 1987 from Cabauw, the Netherlands, were used as inputs to 23 ...land-surface flux schemes designed for use in climate and weather models. Schemes were evaluated by comparing their outputs with long-term measurements of surface sensible heat fluxes into the atmosphere and the ground, and of upward longwave radiation and total net radiative fluxes, and also comparing them with latent heat fluxes derived from a surface energy balance. Tuning of schemes by use of the observed flux data was not permitted. On an annual basis, the predicted surface radiative temperature exhibits a range of 2 K across schemes, consistent with the range of about 10 W m−2in predicted surface net radiation. Most modeled values of monthly net radiation differ from the observations by less than the estimated maximum monthly observational error (±10 W m−2). However, modeled radiative surface temperature appears to have a systematic positive bias in most schemes; this might be explained by an error in assumed emissivity and by models’ neglect of canopy thermal heterogeneity. Annual means of sensible and latent heat fluxes, into which net radiation is partitioned, have ranges across schemes of 30 W m−2and 25 W m−2, respectively. Annual totals of evapotranspiration and runoff, into which the precipitation is partitioned, both have ranges of 315 mm. These ranges in annual heat and water fluxes were approximately halved upon exclusion of the three schemes that have no stomatal resistance under non-water-stressed conditions. Many schemes tend to underestimate latent heat flux and overestimate sensible heat flux in summer, with a reverse tendency in winter. For six schemes, root-mean-square deviations of predictions from monthly observations are less than the estimated upper bounds on observation errors (5 W m−2for sensible heat flux and 10 W m−2for latent heat flux). Actual runoff at the site is believed to be dominated by vertical drainage to groundwater, but several schemes produced significant amounts of runoff as overland flow or interflow. There is a range across schemes of 184 mm (40% of total pore volume) in the simulated annual mean root-zone soil moisture. Unfortunately, no measurements of soil moisture were available for model evaluation. A theoretical analysis suggested that differences in boundary conditions used in various schemes are not sufficient to explain the large variance in soil moisture. However, many of the extreme values of soil moisture could be explained in terms of the particulars of experimental setup or excessive evapotranspiration.
Introduction
One in three women with pelvic organ prolapse (POP) undergoing surgery have a relapse. Currently, no optimal surgical treatment has been identified for correcting a uterine prolapse. ...This population‐based register study aims to compare the relapse rate in patients with uterine prolapse undergoing hysterectomy with suspension or uterine‐sparing surgical procedures.
Material and methods
All women with uterine prolapse undergoing prolapse surgery in Sweden from January 1, 2015 to December 31, 2018, were identified from the Gynecological Operation Register (GynOp). The primary outcome was the number of recurrent POP surgeries up to December 31, 2020.
Results
Sacrospinous hysteropexy (SSHP) without graft and sacrohysteropexy (SHP) were associated with a significantly higher rate of recurrent POP surgery (SSHP without graft: adjusted odds ratio aOR 2.6, 95% CI 2.0–3.5; SHP aOR 2.6, 95% CI 1.8–3.7) and patients describing a sense of globe (SSHP without graft, aOR 2.0, 95% CI 1.6–2.6; SHP, aOR 1.8, 95% CI 1.1–3.1) compared with cervical amputation with uterosacral ligament fixation (Manchester procedure). There was no difference in the reoperation rate or sense of a globe between SSHP with graft and Manchester procedure. Patients undergoing SSHP without graft had a higher frequency of 1‐year postoperative complications compared with Manchester procedure (aOR 2.0, 95% CI 1.6–2.6) and SHP (aOR 2.4, 95% CI 1.4–3.9). Moreover, the frequency of 1‐year postoperative complications was higher in SSHP with graft (aOR 1.6, 95% CI 1.1–2.2) than in Manchester procedure.
Conclusions
The Manchester procedure was associated with a low rate of recurrent POP surgery, symptomatic recurrence and low surgical morbidity compared with other surgical methods in women with uterine prolapse.
Introduction
The study aims to analyze differences between robot‐assisted total laparoscopic hysterectomy (RATLH) and total laparoscopic hysterectomy (TLH) in benign indications, emphasizing surgeon ...and hospital volume.
Material and methods
All women in Sweden undergoing a total hysterectomy for benign indications with or without a bilateral salpingo‐oophorectomy from January 1, 2015 to December 31, 2017 (n = 12 386) were identified from three national Swedish registers. Operative time, blood loss, conversion rate, complications, readmission, reoperation, length of hospital stays, and time to daily life activity were evaluated by univariable and multivariable regression models in RATLH and TLH. Surgeon and hospital volume were obtained from the Swedish National Quality Register of Gynecological Surgery and divided into subclasses.
Results
TLH was associated with a higher rate of intraoperative complications (adjusted odds ratios aOR 2.8, 95% CI 1.3–5.8) and postoperative bleeding complications (aOR 1.8, 95% CI 1.2–2.9) compared with RATLH. Intraoperative data showed a higher conversion rate (aOR 13.5, 95% CI 7.2–25.4), a higher blood loss (200–500 mL aOR 3.5, 95% CI 2.7–4.7; > 500 mL aOR 7.6, 95% CI 4.0–14.6) and a longer operative time (1–2 h aOR 16.7 95% CI 10.2–27.5; >2 h aOR 47.6, 95% CI 27.9–81.1) in TLH compared with RATLH. The TLH group had a lower caseload per year than the RATLH group. Higher surgical volume was associated with lower median blood loss, shorter operative time, a lower conversion rate, and a lower perioperative complication rate. Differences in conversion rate or operative time in RATLH were not affected by surgeon volume when compared with TLH. One year after surgery, patient satisfaction was higher in RATLH than in TLH (aOR 0.6, 95% CI 0.4–0.9).
Conclusions
RATLH led to better perioperative outcome and higher patient satisfaction 1 year after surgery. These outcome differences were slightly more pronounced in very low‐volume surgeons but persisted across all surgeon volume groups.
The Common Community Physics Package (CCPP) is a collection of physical atmospheric parameterizations for use in Earth system models and a framework that couples the physics to a host model's ...dynamical core. A primary goal for this effort is to facilitate research and development of physical parameterizations and experimentation with physics-dynamics coupling methods while simultaneously offering capabilities for use in numerical weather prediction (NWP) operations. The CCPP Framework supports configurations ranging from process studies to operational NWP as it enables host models to assemble the parameterizations in flexible suites. Framework capabilities include variability in scheme call order; ability to group parameterizations for calls in different parts of the host model, allowing intervening computation or coupling to additional components; options to call some parameterizations more often than others; and automatic variable transformations.
To evaluate outcomes after pelvic floor muscle therapy, as compared with perineorrhaphy and distal posterior colporrhaphy, in the treatment of women with a poorly healed second-degree obstetric ...injury diagnosed at least 6 months postpartum.
We performed a single center, open-label, randomized controlled trial. After informed consent, patients with a poorly healed second-degree perineal tear at minimum 6 months postpartum were randomized to either surgery or physical therapy. The primary outcome was treatment success, as defined by Patient Global Impression of Improvement, at 6 months. Secondary outcomes included the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the Hospital Anxiety and Depression Scale. Assuming a 60% treatment success in the surgery group and 20% in the physical therapy group, plus anticipating a 20% loss to follow-up, a total of 70 patients needed to be recruited.
From October 2015 to June 2018, 70 of 109 eligible patients were randomized, half into surgery and half into tutored pelvic floor muscle therapy. The median age of the study group was 35 years, and the median duration postpartum at enrollment in the study was 10 months. There were three dropouts in the surgery group postrandomization. In an intention-to-treat analysis, with worst case imputation of missing outcomes, subjective global improvement was reported by 25 of 35 patients (71%) in the surgery group compared with 4 of 35 patients (11%) in the physical therapy group (treatment effect in percentage points 60% 95% CI 42-78%, odds ratio 19 95% CI 5-69). The surgery group was superior to physical therapy regarding all secondary endpoints.
Surgical treatment is effective and superior to pelvic floor muscle training in relieving symptoms related to a poorly healed second-degree perineal tear in women presenting at least 6 months postpartum.
ClinicalTrials.gov, NCT02545218.
We present electrical characterization of GaSb/InAs(Sb) nanowire tunnel field-effect transistors. The broken band alignment of the GaSb/InAs(Sb) heterostructure is exploited to allow for interband ...tunneling without a barrier, leading to high on-current levels. We report a maximum drive current of 310 μA/μm at VDS = 0.5 V. Devices with scaled gate oxides display transconductances up to gm = 250 mS/mm at VDS = 300 mV, which are normalized to the nanowire circumference at the axial heterojunction.
•Nationwide register study.•Hysterectomized with endometriosis – frequent complications.•Robotic – less conversions.
To assess whether hysterectomy in patients with endometriosis is associated with ...higher proportion of complications compared with patients without, and whether route of hysterectomy affects this outcome.
This is a population-based retrospective cohort study. Data were prospectively obtained from three National Swedish Registers. Patients undergoing a benign hysterectomy between 2015 and 2017 in Sweden were included in the study and were grouped according to a histology-proven diagnosis of endometriosis. Different hysterectomy modes were compared in patients with endometriosis. Perioperative data and postoperative complications up to 1 year after surgery were collected and measured.
In all, 8,747 patients underwent a benign hysterectomy, and 1,166 patients with endometriosis was compared with 7,581 patients without. Patients with endometriosis had higher proportion of complications (adjusted Odds ratio aOR 1.2, 95% CI 1.0–1.4), were more often converted to abdominal hysterectomy (aOR 1.7, 95% CI 1.1–2.6), had higher estimated blood loss (EBL) (200–500 ml; aOR 1.8, 95% CI 1.4–2.3, >500 ml; aOR 3.1, 95% CI 2.2–4.4) and a longer operative time (1–2 h; aOR 2.1, 95% CI 1.4–3.2, >2 h; aOR 4.3, 95% CI 2.7–6.6) than endometriosis-free patients. The conversion rate was 13.8 times higher in total laparoscopic hysterectomy (TLH) compared with robotic-assisted laparoscopic hysterectomy (RATLH) (aOR 13.8, 95% CI 3.6–52.4).
Higher conversion rate, higher EBL and higher frequency of complications were seen in patients with endometriosis. RATLH was associated with lower conversion rate compared to TLH.
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