bluuebunny/crossref_metadata_2025 huggingface dataset:
Excess palmitate induces decidual stromal cell apoptosis via the TLR4/JNK/NF-kB pathways and possibly through glutamine oxidation
Authors: Ha Si-Yao , Qiu Xue-Min , Lai Zhen-Zhen , Yang Hui-Li , Wang Yan , Ruan Lu-Yu , Shi Jia-Wei , Zhu Xiao-Yong , Li Da-Jin , Li Ming-Qing
Published: January 2020

During gestation, excess palmitate (PA) is enriched in decidua. Both excess PA and decidual dysfunctions are associated with numerous adverse pregnancy outcomes such as gestational diabetes, preeclampsia and preterm birth and intrauterine growth restriction. Here, mRNA data about the effects of PA were collected from multiple databases and analyzed. Human decidual tissues were obtained from clinically normal pregnancies, terminated for non-medical reasons, during the first trimester, and decidual stromal cells (DSCs) were isolated and exposed to PA, alone or together with the inhibitors of Toll-like receptor 4 (TLR4), Jun N-terminal kinase (JNK), nuclear factor-kappa-gene binding (NF-kB) or glutamine (GLN) oxidation. Furthermore, DSCs were transfected with lentiviral particles overexpressing human TLR4. We demonstrate that excess PA interacting with its receptor TLR4 disturbs DSC hemostasis during the first trimester. Specifically, high PA signal induced DSC apoptosis and formed an inflammatory program (elevated interleukin-1 beta and decreased interleukin-10) via the activation of TLR4/JNK/NF-kB pathways. A complexed cross-talk was found between TLR4/JNK/NF-kB signals and PA deposition in DSCs. Besides, under an excess PA environment, GLN oxidation was significantly enhanced in DSCs and the suppression of GLN oxidation further augmented PA-mediated DSC apoptosis and inflammatory responses. In conclusion, excess PA induces apoptosis and inflammation in DSCs via the TLR4/JNK/NF-kB pathways, which can be augmented by the suppression of GLN oxidation.
Uterine aquaporin expression is dynamically regulated by estradiol and progesterone and ovarian stimulation disrupts embryo implantation without affecting luminal closure
Authors: de Oliveira Vanessa , Schaefer Jennifer , Abu-Rafea Basim , Vilos George A , Vilos Angelos G , Bhattacharya Moshmi , Radovick Sally , Babwah Andy V
Published: January 2020

The study investigated the effect of normal and supraphysiological (resulting from gonadotropin-dependent ovarian stimulation) levels of estradiol (E2) and progesterone (P4) on mouse uterine aquaporin gene/protein (Aqp/AQP) expression on Day 1 (D1) and D4 of pregnancy. The study also examined the effect of ovarian stimulation on uterine luminal closure and uterine receptivity on D4 of pregnancy and embryo implantation on D5 and D7 of pregnancy. These analyses revealed that the expression of Aqp3, Aqp4, Aqp5 and Aqp8 is induced by E2 while the expression of Aqp1 and Aqp11 is induced by P4. Additionally, P4 inhibits E2 induction of Aqp3 and Aqp4 expression while E2 inhibits Aqp1 and Aqp11 expression. Aqp9, however, is constitutively expressed. Ovarian stimulation disrupts Aqp3, Aqp5 and Aqp8 expression on D4 and AQP1, AQP3 and AQP5 spatial expression on both D1 and D4, strikingly so in the myometrium. Interestingly, while ovarian stimulation has no overt effect on luminal closure and uterine receptivity, it reduces implantation events, likely through a disruption in myometrial activity and embryo development. The wider implication of this study is that ovarian stimulation, which results in supraphysiological levels of E2 and P4 and changes (depending on the degree of stimulation) in the E2:P4 ratio, triggers abnormal expression of uterine AQP during pregnancy, and this is associated with implantation failure. These findings lead us to recognize that abnormal expression would also occur under any pathological state (such as endometriosis) that is associated with changes in the normal E2:P4 ratio. Thus, infertility among these patients might in part be linked to abnormal uterine AQP expression.
The evolution of the therapeutic approach to membranous nephropathy
Authors: Ponticelli Claudio , Patrizia Passerini , Del Vecchio Lucia , Locatelli Francesco
Published: January 2020

Primary membranous nephropathy (MN) is a frequent cause of nephrotic syndrome (NS) in adults. In untreated patients, the outcome is variable, with one-third of the patients entering remission while the remaining ones show persisting proteinuria or progression to end-stage renal disease. Randomized clinical trials reported the efficacy of a 6-month regimen alternating intravenous and oral glucocorticoids with an alkylating agent every other month. The potential side effects of this regimen were limited by the fact that the use of glucocorticoids and alkylating agent did not exceed 3 months each. Two randomized trials with follow-ups (FU) up to 10 years provided assurance about the long-term efficacy and safety of this cyclical therapy. Calcineurin inhibitors have also been used successfully. However, in most responders, NS relapsed after the drug was withdrawn. Conflicting results have been reported with mycophenolate salts and adrenocorticotropic hormone. Observational studies reported good results with rituximab (RTX). Two controlled trials demonstrated the superiority of RTX over antiproteinuric therapy alone and cyclosporine. However, the FUs were relatively short and no randomized trial has been published against cyclical therapy. The available results, together with the discovery that most patients with MN have circulating antibodies against the phospholipase A2 receptor 1, support the use of cytotoxic drugs or RTX in MN. It is difficult to choose between these two different treatments. RTX is easier to use, but the FUs of the available studies are short, thus doubts remain about the long-term risk of relapses and the safety of repeated administrations of RTX.
Quality of life in patients with neurofibromatosis type 1 and 2 in Canada
Authors: Hamoy-Jimenez Geohana , Kim Raymond , Suppiah Suganth , Zadeh Gelareh , Bril Vera , Barnett Carolina
Published: January 2020

Background

There is scarce data on the quality of life of people with neurofibromatosis type 1 (NF1) and type 2 (NF2) in Canada.

Methods

A cross-sectional study of adults with NF1 and NF2 attending a tertiary center. Patients completed generic measures (SF-36, EQ-5D-5L, and PROMIS pain interference) and disease-specific questionnaires (PedsQL NF1 module and the NFTI-QOL for NF2). We compared generic scores between NF1 and NF2 individuals and used regression models to assess factors associated with quality of life.

Results

Hundred and eighty-four participants were enrolled. Mean age was 33 years in NF1 and 40 years in NF2. NF1 and NF2 individuals had lower employment rates and lower scores in all domains of the SF-36 compared to the general Canadian population (P < .005). Using the EQ-5D-5L, there was a high proportion of pain (64% in NF1 and 74% in NF2) and anxiety/depression (60% in NF1 and 68% in NF2). Pain interference correlated with poor quality of life in NF1 and NF2; perceived physical appearance was the main predictor of mental well-being in NF1.

Conclusions

Individuals with NF1 and NF2 have low quality of life, and this correlates with pain, anxiety, and depression, which are prevalent in NF1 and NF2. Perceived physical appearance predicts quality of life in NF1. A multidisciplinary approach is necessary for patients with NF1 and NF2, including mental health and pain management.
Nurses’ illness perceptions during presenteeism and absenteeism
Authors: Fiorini L A , Houdmont J , Griffiths A
Published: January 2020

Background

Presenteeism has been linked with lost productivity, impaired health and absence. Whilst much research has focused on types of diseases associated with presenteeism and absenteeism, there has been little investigation into the role of individuals’ illness perceptions in these episodes.

Aims

To assess how illness perceptions vary between presenteeism and absenteeism episodes.

Methods

A cross-sectional questionnaire was distributed to ward-based nurses working with older adults. Data on illness perceptions during presenteeism and absenteeism episodes were collected. Data were analysed via the Paired-Samples t-test, Wilcoxon test and McNemar test.

Results

Two hundred and seventy cases were analysed (88% response rate). Compared with presenteeism, illnesses during absenteeism were thought to affect lives more (P < 0.001), to have more serious symptoms (P < 0.001), to be more concerning (P = 0.003), more likely to be treated (P = 0.009), more infectious (P < 0.001) and perceived as more legitimate reasons for absenteeism (P < 0.001). Treatment was considered more effective during absenteeism (P < 0.001), whilst workability was better during presenteeism (P < 0.001). Presenteeism was perceived as harmful and absenteeism beneficial for illness. Individuals attended work when presenteeism was expected to be less harmful (P < 0.001) and avoided work when absenteeism was expected to be more beneficial for illness (P < 0.001).

Conclusions

Illness perceptions varied significantly between presenteeism and absenteeism episodes and should be included in models of illness behaviour. Findings also highlight that policy may influence illness behaviour and that nurses may attend work despite concerning levels of illness.
ICU shift related effects on sleep, fatigue and alertness levels
Authors: Bihari S , Venkatapathy A , Prakash S , Everest E , McEvoy R D , Bersten A
Published: January 2020

Background

Shift work may lead to suboptimal sleep resulting in impaired alertness, and lowered performance levels, all of which can lead to medical errors.

Aims

To examine fatigue, sleepiness and behavioural alertness prospectively in a tertiary level Australian intensive care unit (ICU).

Methods

All full-time doctors providing 24-h resident cover on a 12-h day and 12-h night shift roster were invited to participate in this study. Data collected included Epworth Sleepiness Scale (ESS), sleep and awake history, Samn-Perelli Fatigue (SPF) Scale, Karolinska Sleepiness Scale (KSS) and iOS-based Psychomotor Vigilance Test (behavioural alertness). Data about medical emergency team (MET) shifts were collected separately as they were perceived to be busier shifts.

Results

Twenty-nine ICU doctors participated in this study for a consecutive 6-week period. At baseline the median (interquartile range (IQR)) ESS was 5 (3–9). Day shift leads to an increase in fatigue and sleepiness (both P < 0.01). Night shift leads to worsening in fatigue, sleepiness and psychomotor vigilance (all P < 0.01). MET shifts had a lower psychomotor vigilance than non-MET shifts. The difference in the psychomotor vigilance was mostly due to the difference in recorded lapses and response time.

Conclusions

Shift work ICU doctors experience high levels of fatigue and sleepiness. Night shifts also lead to decreased vigilance. This is even more evident in doctors working MET shifts. These factors may lead to errors. Optimal rostering may reduce these effects and improve patient safety.
Postoperative Antifungal Treatment of Pulmonary Cryptococcosis in Non-HIV-Infected and Non-Transplant-Recipient Patients: A Report of 110 Cases and Literature Review
Authors: Wei Shuo , Su Xin , Pan Yun-hu , Zheng Yuan-yuan , Dong Xiao-wen , Hu Xiao-hua , Wu Fan , Shi Yi
Published: January 2020

Background

To explore the efficacy of postoperative antifungal treatment for preventing the recurrence of pulmonary cryptococcosis (PC) and occurrence of cryptococcal meningitis (CM), a retrospective study was conducted in 112 hospitalized PC patients with or without antifungal treatment following surgery.

Methods

The treatment failure rate, PC recurrence rate, and CM incidence were compared. Additionally, the effectiveness of postoperative antifungal therapy was assessed by gathering and analyzing the published literature.

Results

The failure rate (P = .054) and recurrence rate (P = .178) were similar in the 2 groups, but the incidence of CM was lower in the group that received postoperative antifungal treatment (P = .039).

Conclusions

This study did not show any difference in the PC recurrence rate or failure rate in the different treatment duration groups. Thus, a shorter antifungal treatment course of 2 months may be an optional treatment. In addition, upon review of the literature, no case of CM occurrence was reported among the 169 cases given postoperative antifungal treatment.
Adult haemophagocytic lymphohistiocytosis: a review
Authors: Yildiz H , Van Den Neste E , P. Defour J , Danse E , Yombi J.C
Published: January 2020

Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder characterized by hyperimmune response. The mortality is high despite progress being made in the diagnosis and treatment of the disease. This review aimed to update knowledge on adult HLH pathophysiology, identify the numerous causes and help clinicians make early diagnosis and initiate treatment. Using Embase, we searched relevant articles published from 1 January 2010 to 31 October 2019, with the MESH term ‘haemophagocytic lymphohistiocytosis; macrophagic activation syndrome, adult’. The mean age at presentation is about 50 years, with a male predominance. The most frequent disease associations are haematological diseases, viral or bacterial infections and autoimmune diseases. The pathophysiologic mechanism is probably the combination of inherited genetic mutations and extrinsic triggers. The mortality rate is 26.5–74.8%. HScore is more efficient than HLH-2004 criteria to identify HLH, with diagnostic sensitivity and specificity 90% and 79%, respectively. 18-fluorodeoxyglucose positron emission tomography–computed tomography is potentially useful for detecting underlying disease and the extent of secondary HLH. Disease-specific treatment should be given as soon as possible. Treatment with corticosteroids combined or not with etoposide is the mainstay of treatment. Monoclonal antibodies and JAK pathway inhibitors show promise of being effective. In adult HLH, infectious diseases, autoimmune disease and malignancy should be suspected so that disease-specific treatment can be given promptly. Treatment with corticosteroids combined or not with etoposide is the mainstay of treatment, but new therapies show promise of being effective.
Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS
Authors: Macfarlane Gary J , Pathan Ejaz , Jones Gareth T , Dean Linda E
Published: January 2020

Objectives

While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit.

Methods

The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the ‘biologic’ sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state.

Results

335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12–17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%).

Conclusion

Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.
Associations between amygdala reactivity to social threat, perceived stress and C-reactive protein in breast cancer survivors
Authors: Leschak Carrianne J , Dutcher Janine M , Haltom Kate E Byrne , Breen Elizabeth C , Bower Julienne E , Eisenberger Naomi I
Published: January 2020

Chronic inflammation in women diagnosed with breast cancer is critically linked with tumor progression, metastasis and survival. C-reactive protein (CRP)—a circulating marker of inflammation—is an important prognostic marker for cancer-related outcomes in breast cancer survivors (e.g. recurrence, fatigue). Psychological stress, which increases circulating markers of inflammation following sympathetic nervous system (SNS) activation, may modulate tumor-relevant inflammatory processes. However, little is known about neural mechanisms that might link stress and downstream SNS-initiated proinflammatory processes, such as elevated CRP. Past work suggests that threat-related neural regions, such as the amygdala, may be key in translating psychological stress into SNS activity and subsequent peripheral inflammation. Thus, we examined amygdala reactivity to socially threatening stimuli in association with perceived stress and plasma CRP levels to further elucidate neuro-immune pathways of social threat processing within breast cancer survivors (N = 37). Significant positive correlations were found between left amygdala reactivity in response to socially threatening stimuli (e.g. angry/fearful faces vs happy faces) and perceived stress in the previous month (r = 0.32, P = 0.025) and between left amygdala reactivity and CRP (r = 0.33, P = 0.025). This work builds on prior research implicating the amygdala as a key structure in crosstalk between threat-related neural circuitries and peripheral inflammation, particularly within cancer survivors.
Is Work and Aging Research a Science of Questionnaires? Moving the Field Forward by Considering Perceived Versus Actual Behaviors
Authors: Gerpott Fabiola H , Lehmann-Willenbrock Nale , Scheibe Susanne
Published: January 2020

Research on work and aging predominantly relies on self-report data to create new insights relevant to individuals, organizations, and society. Whereas surveys and interviews based on self-reports offer a valuable inward-directed perspective on individuals and their understanding of others, they can only provide limited knowledge on the behaviors of employees at different ages and in age-diverse settings. This is because what employees actually do is often considerably different from their survey-based reports of what they or others do. In this commentary, we challenge the field to move beyond a science of questionnaires by complementing survey research with behavioral data. First, this would allow scholars to identify when and how behaviors accurately translate into surveyed perceptions of behaviors. Second, such an approach can advance our understanding of the micro-dynamics occurring in age-diverse workforces that ultimately manifest in emerging phenomena (e.g., age-inclusive climate, psychological safety perceptions, or group affective tone). Lastly, studying concrete and specific behaviors also allows scholars to develop better interventions and provide meaningful recommendations for practice that differentiate actual from perceived behaviors.
Women With Clinically Significant Fatigue After Breast Cancer Treatment Report Increased Falls and Perform Poorly on Objective Measures of Physical Fitness and Function
Authors: Wood Lisa J. , Winters-Stone Kerri M. , Kneiss Janet A. , Fox Annie B. , Walker Rachel K.
Published: January 2020

Purpose:

To determine whether there were significant differences in self-report and objective measures of physical fitness and function between women post–breast cancer (BC) treatment with and without clinically significant fatigue.

Methods:

We performed a secondary analysis of baseline data collected from 281 postmenopausal women post–BC treatment (62 ± 10 years; time since diagnosis = 5.6 ± 3.9 years) who participated in prior exercise trials. Scores on the SF-36 (36-Item Short Form Health Survey) vitality subscale (0-100) were used to identify women with clinically significant fatigue, where a score of 45 or less represents fatigue and a score of 70 or more represents no fatigue. Objectively measured function included maximal leg press strength (kg), physical function battery, timed chair stand, Unipedal Stance Test, and gait characteristics. Self-reported outcomes included physical function, pain, mental health, sensory symptoms of chemotherapy-induced peripheral neuropathy (CIPN), habitual physical activity level, and fall history.

Results:

Twenty percent of women (n = 57) reported clinically significant fatigue 6 years postdiagnosis, whereas 34% (n = 100) reported no fatigue. Except for leg strength, unipedal stance, step length, and base of support while walking, fatigued women had significantly worse objectively measured function than women without fatigue. Fatigued women also reported poorer physical function, greater bodily pain, and poorer mental health and were twice as likely as nonfatigued women to report symptoms of CIPN and having fallen.

Conclusions:

Women with a history of BC, and in particular those with CIPN, should be routinely screened for clinically significant fatigue in the survivorship period. Clinical and survivorship care plans aimed at limiting functional decline and reducing falls in survivors of BC should include fatigue-reduction strategies.
Embodying Caring Science as Islamic Philosophy of Care
Authors: Almukhaini Salma Juma , Goldberg Lisa , Watson Jean
Published: January 2020

Despite the diversity and complexity of nursing theories, including those embedded with a philosophy of caring, few if any have aligned their assumptions with an Islamic philosophy of caring. To do so would call into question the compatibility of such caring for some Muslim scholars. The purpose of this article is to understand how and why an Islamic philosophy of care can be taken up through an application of Watson's caring science. In doing so, a broader understanding of caring is provided for nurses and other health care providers who work with Muslim communities in the context of care provision.
Proposing Standards for Teaching Authentic Nursing Knowledge
Authors: Hanna Debra R.
Published: January 2020

This article's purpose is to propose ideas about developing teaching standards for each of 4 learner levels that lead to 4 types of nursing practice. The learner levels and types of practice are undergraduate/basic practice, graduate/enhanced practice, doctor of nursing practice/translational practice, and research doctorate/knowledge development practice. Each learner level requires different content and different teaching strategies. Thus, teaching at each level requires different teaching standards. This article is written in separate parts. Each section develops necessary ideas to support a set of recommended teaching standards needed to teach authentic nursing theoretical thinking at each level of nursing education.
A Quality Improvement Initiative to Increase the Frequency of Vaginal Delivery in Brazilian Hospitals
Authors: Borem Paulo , de Cássia Sanchez Rita , Torres Jacqueline , Delgado Pedro , Petenate Ademir Jose , Peres Daniel , Parry Gareth , Pilar Betrán Ana , Barker Pierre
Published: January 2020

OBJECTIVE:

To evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals.

METHODS:

Twenty-eight hospitals enrolled in a 20-month (May 2015–December 2016) Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time.

INTERVENTION:

Most hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring “appropriate delivery,” 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers.

RESULTS:

For 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27–2.07, P<.001). In the comparator analysis, vaginal delivery for all deliveries in the five São Paulo intervention hospitals increased from 16.1% to 23% (RI 1.43, P<.001) and from 11.0% to 13.0% (relative rate ratio 1.18, P<.001) in the eight nonintervention São Paulo hospitals. The relative increase in vaginal delivery between the São Paulo intervention and nonintervention groups was 1.21 (95% CI 1.05–1.41, P=.01). The rate of maternal adverse events and neonatal intensive care unit admissions for newborns who weighed at least 2,500 g did not differ significantly during the observation period.

CONCLUSIONS:

Key interventions implemented with QI methods were associated with increased vaginal delivery. This approach may help address the global cesarean delivery epidemic.
Association of the Affordable Care Act With Ovarian Cancer Care
Authors: Smith Anna Jo Bodurtha , Fader Amanda Nickles
Published: January 2020

OBJECTIVE:

To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer.

METHODS:

We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21–64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004–2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center.

RESULTS:

A total of 39,999 ovarian cancer cases prereform and 36,564 postreform were identified for women aged 21–64 years compared with 31,290 cases prereform and 29,807 postreform for women aged 65 years or older. The ACA was associated with increased early-stage diagnosis detection for women aged 21–64 years compared with women 65 and older (difference-in-differences 1.4%, 95% CI 0.4–2.4). The ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (2.3%, 95% CI 1.7–3.0). Among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (difference-in-differences 2.7%, 95% CI 1.0–4.5, difference-in-differences 2.5%, 95% CI 1.2–3.8). Improvements in time to treatment were seen across race and income groups.

CONCLUSION:

Implementation of the ACA was associated with earlier ovarian cancer stage at detection and treatment within 30 days of diagnosis.
Effect of Surgery for Stress Incontinence on Female Sexual Function
Authors: Glass Clark Stephanie M. , Huang Qi , Sima Adam P. , Siff Lauren N.
Published: January 2020

OBJECTIVE:

To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function.

METHODS:

This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS). Sexual function (assessed by the short version of the PISQ-12 [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire]) was compared between groups at baseline, 12 and 24 months. Secondarily, the effects of subjective and objective surgical cure rates and the effect of concomitant surgical procedures on 24-month sexual function was explored.

RESULTS:

Nine hundred twenty-four women were included in this study: 249 (26.9%) had an autologous fascial sling, 239 (25.9%) underwent Burch colposuspension, 216 (23.3%) had a retropubic midurethral sling placed, and 220 (23.8%) had transobturator midurethral sling placed. Baseline characteristics (including PISQ-12 scores) were similar between the four treatment arms, with notable exceptions including race–ethnicity, prolapse stage, concomitant surgery, and number of vaginal deliveries. After adjustment for differences between the groups, there was a clinically important improvement in PISQ-12 scores over the 24-month postoperative period for all treatment groups, with no significant differences attributed to the type of anti-incontinence procedure (baseline PISQ-12: 32.6, 33.1, 31.9, 31.4; 24-month PISQ-12: 37.7, 37.8, 36.9, 37.1, P<.01). There was no significant difference in mean PISQ-12 scores between 12 months and 24 months (12-month PISQ-12: 37.7, 37.8, 36.9, 37.1; 24 months as above, P=.97). Multivariable analysis showed independent associations between objective and subjective cure rates as well as concomitant procedures with a 24-month PISQ-12 score.

CONCLUSION:

Women undergoing anti-incontinence surgery show overall improvement in sexual function from baseline to 24 months postoperatively, without significant differences based on surgical procedure performed. The majority of this improvement occurs in the first 12 months and is maintained over 24 months.
Association of Acculturation With Adverse Pregnancy Outcomes
Authors: Premkumar Ashish , Debbink Michelle P. , Silver Robert M. , Haas David M. , Simhan Hyagriv N. , Wing Deborah A. , Parry Samuel , Mercer Brian M. , Iams Jay , Reddy Uma M. , Saade George , Grobman William A.
Published: January 2020

OBJECTIVE

To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups.

METHODS

This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010–September 2013. Acculturation was defined by birthplace (United States vs non–United States), language used during study visits (English or Spanish), and self-rated English proficiency. The adverse pregnancy outcomes of interest were preterm birth (less than 37 weeks of gestation, both iatrogenic and spontaneous), preeclampsia or eclampsia, gestational hypertension, gestational diabetes, stillbirth, small for gestational age, and large for gestational age. Multivariable regression modeling was performed, as was an interaction analysis focusing on the relationship between acculturation and adverse pregnancy outcomes by maternal race or ethnicity.

RESULTS

Of the 10,006 women eligible for this analysis, 8,100 (80.9%) were classified as more acculturated (eg, born in the United States with high English proficiency), and 1,906 (19.1%) were classified as having less acculturation (eg, born or not born in the United States with low proficiency in English or use of Spanish as the preferred language during study visits). In multivariable logistic regression modeling, more acculturation was significantly associated with higher frequency of preterm birth (odds ratio [OR] 1.46, adjusted odds ratio [aOR] 1.50, 95% CI 1.16–1.95); spontaneous preterm birth (OR 1.54, aOR 1.62, 95% CI 1.14–2.24); preeclampsia or eclampsia (OR 1.39, aOR 1.31, 95% CI 1.03–1.67); preeclampsia without severe features (OR 1.44, aOR 1.43, 95% CI 1.03–2.01); and gestational hypertension (OR 1.68, aOR 1.48, 95% CI 1.22–1.79). These associations did not differ by self-described race or ethnicity.

CONCLUSION

In a large cohort of nulliparous women, more acculturation, regardless of self-described race or ethnicity, was associated with increased odds of several adverse pregnancy outcomes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01322529.
Lidocaine–Prilocaine Cream Compared With Injected Lidocaine for Vulvar Biopsy
Authors: Williams Logan K. , Weber Jeremy M. , Pieper Carl , Lorenzo Amelia , Moss Haley , Havrilesky Laura J.
Published: January 2020

OBJECTIVE:

To compare pain control during vulvar biopsy after either application of 5% lidocaine–prilocaine cream or injection of 1% lidocaine.

METHODS:

In a single-site randomized trial, patients who needed vulvar biopsy on a non–hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine–prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019.

RESULTS:

From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine–prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine–prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine–prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [−45.1 to −6.3]; P<.01). Patients randomized to lidocaine–prilocaine had a significantly better experience than those receiving injected lidocaine (median experience score 2.0 mm vs 17.0 mm; P=.02).

CONCLUSION:

Lidocaine–prilocaine cream before vulvar biopsy resulted in a lower maximum pain score and a significantly better patient rating of the biopsy experience when compared with lidocaine injection. Lidocaine–prilocaine cream, alone, is a reasonable option to use for vulvar biopsy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03654417.
Best Practices for Lactation Support at Conferences and Standardized Testing Centers
Authors: Cleveland Manchanda Emily C. , Vogel Lara D. , Kass Dara , Rouhani Shada A.
Published: January 2020

Breastfeeding has demonstrable benefits for children and their mothers; however, breastfeeding can be particularly difficult for women who return to the workplace in the months after a child's birth. The challenge of continuing to provide breast milk to an infant after a mother returns to work is evident in the day-to-day lives of health professionals who choose to do so and is reflected in the literature, which shows a marked reduction in breastfeeding rates corresponding to a woman's return to work. These barriers are even more apparent when travel is required for professional obligations or advancement, such as to attend or present at national conferences or to take standardized examinations at test centers. This article provides guidelines and practical advice for event organizers and testing centers to support a lactating mother's ability to provide for her child without compromising her professional career. In particular, we describe the physical requirements of lactation spaces, considerations for milk storage, ways to create a lactation-friendly environment, and unique considerations and accommodations for test takers and test centers. Supporting lactating health professionals should be seen as part of a larger endeavor to support gender equity, advance women in medicine, and integrate wellness and family into our professional lives.
A Risk-Adjusted Model for Ovarian Cancer Care and Disparities in Access to High-Performing Hospitals
Authors: Bristow Robert E. , Chang Jenny , Villanueva Carolina , Ziogas Argyrios , Vieira Veronica M.
Published: January 2020

OBJECTIVE:

To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals.

METHODS:

This was a retrospective population-based study of stage I–IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume. A Cox proportional hazards model was used for survival analyses, and a multivariable logistic regression model was used to identify independent predictors of access to high-performing hospitals.

RESULTS:

The study population included 30,051 patients who were treated at 426 hospitals: low observed/expected ratio (n=304) 23.5% of cases; intermediate observed/expected ratio (n=92) 57.8% of cases; and high observed/expected ratio (n=30) 18.7% of cases. Hospitals with high observed/expected ratios were significantly more likely to deliver guideline-adherent care (53.3%), compared with hospitals with intermediate (37.8%) and low (27.5%) observed/expected ratios (P<.001). Median disease-specific survival time ranged from 73.0 months for hospitals with high observed/expected ratios to 48.1 months for hospitals with low observed/expected ratios (P<.001). Treatment at a hospital with a high observed/expected ratio was an independent predictor of superior survival compared with hospitals with intermediate (hazard ratio [HR] 1.06, 95% CI 1.01–1.11, P<.05) and low (HR 1.10, 95% CI 1.04–1.16, P<.001) observed/expected ratios. Being of Hispanic ethnicity (odds ratio [OR] 0.85, 95% CI 0.78–0.93, P<.001, compared with white), having Medicare insurance (OR 0.74, 95% CI 0.68–0.81 P<.001, compared with managed care), having a Charlson Comorbidity Index score of 2 or greater (OR 0.91, 95% CI 0.83–0.99, P<.05), and being of lower socioeconomic status (lowest quintile OR 0.41, 95% CI 0.36–0.46, P<.001, compared with highest quintile) were independent negative predictors of access to a hospital with a high observed/expected ratio.

CONCLUSION:

Ovarian cancer care at a hospital with a high observed/expected ratio is an independent predictor of improved survival. Barriers to high-performing hospitals disproportionately affect patients according to sociodemographic characteristics. Triage of patients with suspected ovarian cancer according to a performance-based observed/expected ratio hospital classification is a potential mechanism for expanded access to expert care.
Comparative Clinical Effectiveness and Safety of Bone Morphogenetic Protein Versus Autologous Iliac Crest Bone Graft in Lumbar Fusion
Authors: Liu Shichao , Wang Yinqing , Liang Zeyan , Zhou Maochao , Chen Chunmei
Published: January 2020

Study Design.

This is a systematic literature review and meta-analysis.

Objective.

We aimed to evaluate the efficacy and safety of recombinant human bone morphogenetic protein (RhBMP) and autologous iliac crest bone graft (ICBG) in lumbar fusion.

Summary of Background Data.

RhBMP has been emphasized in lumbar fusion due to high fusion success rate. However, ICBG remains the criterion standard graft approach for lumbar fusion. The safety and effectiveness of rhBMP are controversial.

Methods.

Prospective randomized controlled trials were searched from PubMed, EMBASE, and Cochrane Central Register of Controlled Trails by using Medical Subject Headings terms “bone morphogenetic protein," “bone transplantation," and “spinal fusion." Two independent investigators screened eligible studies, assessed the bias of original articles, extracted data including fusion success, Oswestry disability index improvement, improved short form 36 questionnaire scores, adverse events and re-operation, and a subgroup analysis. The GRADE approach was used to grade quality of evidence.

Results.

Twenty randomized controlled trials (2185 patients) met the inclusion criteria. There were higher fusion success rate (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.88–7.63, P = 0.0002), better improvement of Oswestry Disability Index (mean difference 1.54, 95% CI 0.18–2.89, P = 0.03), and lower re-operation rate (OR 0.59, 95% CI 0.43–0.80, P = 0.0007) in rhBMP group. Heterogeneity was obvious in fusion success rate (I

2
 = 58%); hence, a subgroup analysis, based on protein type (rhBMP-2 or rhBMP-7), was performed, which suggested that only rhBMP-2 was better than ICBG for lumbar fusion. There was no difference in the incidence of adverse events between rhBMP and ICBG (OR 0.91, 95% CI 0.70–1.18, P = 0.47).

Conclusion.

In lumbar fusion, rhBMP-2 exhibited a higher fusion success rate and reduced the risk of re-operation. No difference in complication rate is between rhBMP (rhBMP-2 and rhBMP-7) and ICBG. We suggest rhBMP especially rhBMP-2 as an effective substitute for ICBG for lumbar fusion.

Level of Evidence: 1
Maternal Risk Modeling in Critical Care—Development of a Multivariable Risk Prediction Model for Death and Prolonged Intensive Care*
Authors: Simpson Nicholas B. , Shankar-Hari Manu , Rowan Kathryn M. , Cecconi Maurizio , von Dadelszen Peter , Huning Emily Y-S. , Magee Laura A. , Payne Beth A. , Quinn Audrey C. , Harrison David A.
Published: January 2020

Objectives:

We aimed to develop and validate an accurate risk prediction model for both mortality and a combined outcome of mortality and morbidity for maternal admissions to critical care.

Design:

We used data from a high-quality prospectively collected national database, supported with literature review and expert opinion. We tested univariable associations between each risk factor and outcome. We then developed two separate multivariable logistic regression models for the outcomes of acute hospital mortality and death or prolonged ICU length of stay. We validated two parsimonious risk prediction models specific for a maternal population.

Setting:

The Intensive Care National Audit and Research Centre Case Mix Programme is the national clinical audit for adult critical care in England, Wales, and Northern Ireland.

Patients:

All female admissions to adult general critical care units, for the period January 1, 2007–December 31, 2016, 16–50 years old, and admitted either while pregnant or within 42 days of delivery—a cohort of 15,480 women.

Interventions:

None.

Measurements and Main Results:

We aimed to develop and validate an accurate risk prediction model for both mortality and a combined outcome of mortality and morbidity for maternal admissions to critical care. For the primary outcome of acute hospital mortality, our parsimonious risk model consisting of eight variables had an area under the receiver operating characteristic of 0.96 (95% CI, 0.91–1.00); these variables are commonly available for all maternal admissions. For the secondary composite outcome of death or ICU length of stay greater than 48 hours, the risk model consisting of 17 variables had an area under the receiver operating characteristic of 0.80 (95% CI, 0.78–0.83).

Conclusions:

We developed risk prediction models specific to the maternal critical care population. The models compare favorably against general adult ICU risk prediction models in current use within this population.
Glaucoma in pregnancy: an update
Authors: Strelow Bryan , Fleischman David
Published: January 2020

Purpose of review

Glaucoma management during pregnancy is a complex challenge, which requires balancing the clinical disease of the mother with the potential risks of therapy to the developing child. Because systematic studies are lacking in the pregnant population, this review aims to collect the array of available data from observational studies and case reports to provide the reader with guidance and context for the safety of glaucoma interventions during pregnancy.

Recent findings

Surgical glaucoma is a rapidly expanding field with many new technologies and procedures. We review the surgical options for the gravid patient with reference to traditional procedures like trabeculectomy and tube-shunts, and newer MIGS procedures. When indicated, orphan trabeculectomy, or with collagen matrix implant may be a viable solution for severe glaucoma during pregnancy. Newer MIGS procedures such as the gelatin stent may also provide minimally invasive options for pregnant patients. Two new medications, Vyzulta and Rhopressa, were recently released in 2018 and have limited data to support their safety for use during pregnancy.

The careful consideration of fetal health in the management of glaucoma during pregnancy is best done as a part of a multidisciplinary team including obstetrics and neonatology. When medication is necessary, steps to minimize systemic absorption should be employed. Surgical management should not be excluded for pregnant patients and may be considered before medical management in some cases to prevent fetal exposures and maternal harm.
Corneal Neurotization: A Review of Pathophysiology and Outcomes
Authors: Park Ji Kwan , Charlson Emily S. , Leyngold Ilya , Kossler Andrea L.
Published: January 2020

Purpose:

The objective of this study is to provide a systematic review of the clinical outcomes of corneal neurotization and present the pathophysiology of corneal wound healing, neurotrophic keratopathy, and corneal neurotization.

Methods:

A literature review of published articles and meeting abstracts between December 2008 and February 2019 in the English language with the terms “corneal neurotization,” “corneal neurotisation,” “corneal reinnervation,” and “neurotrophic keratopathy” was performed. Reported clinical data before and after corneal neurotization, and surgical techniques, were collected and analyzed.

Results:

A total of 54 eyes that underwent corneal neurotization were identified. Final Logarithm of the Minimum Angle of Resolution (logMAR) best-corrected visual acuity improved to 0.85 (standard deviation [SD] = 0.65) from 1.25 (SD = 0.71) with a mean improvement of 0.41 (SD = 0.55; p < 0.0001). Central corneal sensation measured using Cochet-Bonnet esthesiometer improved from 2.18 mm (SD = 0.4) to 40.10 mm (SD = 18.66) with a mean filament length change of 38.00 mm (SD = 18.95; p < 0.0001). The median time to the reported maximal sensation return was 8 months (interquartile range 6–10). The most common reported limitation to visual recovery was corneal scarring (31.5%). Children (ages 0–17 years) as compared with adults (ages 18–82 years) had significantly greater final central corneal sensation esthesiometry readings, central corneal sensation return, and improvement in the logMAR best-corrected visual acuity (p < 0.011).

Conclusions:

Neurotrophic keratopathy disturbs the homeostatic balance of trophic factors and trigeminal nerve reflexes needed to support ocular surface health and corneal healing. Corneal neurotization can significantly improve corneal sensation and visual acuity and should be considered for the treatment of refractory neurotrophic keratopathy, especially in pediatric populations.