bluuebunny/crossref_metadata_2025 huggingface dataset:
Premature Expression of Pseudoexfoliation Syndrome With Presenile Cataract in a 28-Year-Old Lady
Authors: Kumar Praveen S. , Rao Aparna , Senthil Sirisha
Published: February 2019

Purpose:

We report a case of premature expression of pseudoexfoliation syndrome with presenile cataract in a 28-year-old lady with primary developmental glaucoma who had undergone glaucoma filtration surgery 26 years ago.

Methods/Results:

We report a case of a 28-year-old Indian lady with progressive diminution of vision associated with photophobia in the left eye for 5 years and loss of vision in the right eye since childhood. She underwent glaucoma filtration surgery in the left eye at the age of 2 and was on 2 topical glaucoma medications when she presented to us. Refractive error was −17.00 D with −3.50 D @ 90-degree cylinder in the left eye. The right eye was phthisical. Left eye showed superior diffuse bleb, enlarged but clear cornea with superior Haab’s striae, deep and quiet anterior chamber and patent surgical iridectomy at 1 o’clock position. There was diffuse iris atrophy with pseudoexfoliation at the pupillary ruff and over the anterior lens capsule. Lens showed grade 2 nuclear cataract. Intraocular pressure in the left eye was 23 mm Hg. Fundus examination showed 0.9 cupping with an inferior notch and diffuse pallor of the optic disc. Axial length of left eye was 31.44 mm. On the basis of these findings, she was diagnosed with primary developmental glaucoma and high myopia, status after glaucoma filtration surgery with presenile cataract and pseudoexfoliation in the left eye. The topical antiglaucoma medications were augmented. After 1 month, intraocular pressure in the left eye was reduced to 14 mm Hg. She was advised to continue topical glaucoma medications and regular follow-up.

Conclusions:

The present case is the first to describe the unusual presentation of pseudoexfoliation in a young individual along with presenile cataract. Simultaneous occurrence of pseudoexfoliation with cataract could be due to previous intraocular surgery, iris trauma, possible low-grade inflammation, and high myopia in a predisposed eye. The clinician should be aware that although a rare condition, pseudoexfoliation can occur in the young and may be associated with presenile cataract.
Adverse Event Profile Associated with Prolonged Use of CentriMag Ventricular Assist Device for Refractory Cardiogenic Shock
Authors: Cevasco Marisa R. , Li Boyangzi , Han Jiho , Chiuzan Codruta , Mauro Christine M. , Kurlansky Paul , Garan A. Reshad , Takeda Koji , Naka Yoshifumi , Takayama Hiroo
Published: February 2019

Several studies have investigated early outcomes with a surgical short-term ventricular assist device (VAD), but little is known about adverse event profile during prolonged support with a surgical short-term VAD. This is a retrospective analysis of 161 patients who received a CentriMag ventricular assist system (Abbott Laboratories, Abbott Park, IL) at our institution between January 2007 and June 2014. Device-related adverse events include major bleeding, infection, and stroke incidents occurring during CentriMag support. Cumulative frequency of adverse events was estimated by Nelson’s nonparametric method. One hundred and forty-three (88.8%) patients had biventricular VAD and 18 (11.2%) had isolated left VAD. Median duration of support was 16 days (interquartile range [IQR]: 10–29). Mortality was 24.8% and 1 year overall survival is 51.8% (95% CI: 43.3–59.5%). The most common adverse event during support was major bleeding (n = 121, 75.1%). Ninety-five (59.0%) developed major infections such as pneumonia and urinary tract infection. Sixteen patients (10%) experienced stroke. Cumulative data analysis showed that stroke and reoperation caused by bleeding were rare beyond 30 days, whereas infection and nonsurgical bleeding events were directly related to support time. In conclusion, temporary VAD with CentriMag support is an effective treatment for patients in refractory cardiogenic shock. Despite its side effect, profile including a high rate of blood transfusion early in the immediate postoperative period of CentriMag support, aggressive use of the CentriMag support device has acceptable survival to discharge and 1 year survival.
An In Vitro Blood Flow Loop System for Evaluating the Thrombogenicity of Medical Devices and Biomaterials
Authors: Jamiolkowski Megan A. , Hartung Matthew C. , Malinauskas Richard A. , Lu Qijin
Published: February 2019

A reliablein vitrodynamic test method to evaluate device thrombogenicity is very important for the improvement of the design and safety of blood-contacting medical devices, while reducing the use of animal studies. In this study, a recirculating flow loop system was developed for thrombogenicity testing, using donor sheep blood anticoagulated with Anticoagulant Citrate Dextrose Solution A (ACDA) and used within 24–36 hr postdraw. Immediately before testing, the blood was recalcified and heparinized to a donor-specific target concentration. The heparinization level was based on a static pretest, in which latex tubes were incubated at room temperature for 30 min in blood with a series of heparin concentrations and evaluated for thrombus deposition. For dynamic testing, blood was recirculated at room temperature through a polyvinyl chloride (PVC) tubing loop containing a test material for 1 hr at 200 ml/min using a roller pump. Nine materials were investigated: a negative control (polytetrafluoroethylene [PTFE]), a positive control (latex), and seven commonly used biomaterials including PVC, two silicones with different formulations (Q-Sil and V-Sil), nylon, polyurethane (PU), high-density polyethylene (HDPE), and polyether block amide (PEBAX). The results showed that latex was significantly more thrombogenic than all the other materials (p< 0.05), PVC and Q-Sil exhibited intermediate thrombogenicity with significantly more thrombus surface coverage and thrombus weight than PTFE (p< 0.05), whereas PTFE and the rest of the biomaterials had little to no thrombus deposition. In summary, the test loop system was able to effectively differentiate materials with different thrombogenic potentials.
Fatality While Bear Hunting
Authors: Spagnolia Alessandra , Kemp Walter L.
Published: February 2019

When a hunter intentionally fires a weapon and the projectile strikes another human, the manner of death is most often certified as a homicide. The intent of the individual firing the weapon is unknown and the possibility that a hunting “accident” represents a concealed intentional homicide must always be considered. However, in some circumstances such as a documented ricochet, the manner of death may be certified as accident.

The death of a hunter who was being mauled by a grizzly bear and subsequently died will be presented. While the man had injuries from the mauling, these injuries were, with treatment, survivable; however, he also had a gunshot wound of the left shoulder into the trunk. His partner had shot the bear, but unfortunately, 1 projectile perforated the bear and struck the decedent.

According to the National Association of Medical Examiners' Guide for Manner of Death Classification, if a hunter intentionally fires a weapon and kills a human the manner of death may be classified as homicide; however, if a weapon is discharged and the projectile strikes an object, ricochets, and kills a human, the manner of death may be classified as accident. In the death reported, the scenario does not exactly fit either of the above 2 situations. In this current case, given that (1) the decedent's friend fired a projectile with an intent to hit the bear that was mauling his partner and (2) that the projectile perforating the bear and entering his partner was unintended, the manner of death was certified as accident.
System Support Mapping: A Novel Systems Thinking Tool Applied to Assess the Needs of Maternal and Child Health Title V Professionals and Their Partners
Authors: Calancie Larissa , Margolis Lewis , Chall Steven A. , Mullenix Amy , Chaudhry Atyya , Hassmiller Lich Kristen
Published: February 2019

Context:

The Maternal and Child Health (MCH) workforce aims to improve health outcomes for women, children, and families. The work requires coordination and partnerships that span disciplines and service systems. As such, workforce needs assessment requires an approach that is broad, flexible, and “systems-aware.”

Objective:

To illustrate the use of System Support Mapping, a novel systems thinking tool that was used to guide participants through a structured assessment of their discrete responsibilities, key needs, and specific resources required for each.

Participants:

Thirty-four Title V MCH professionals and partners from 15 states or jurisdictions.

Main Outcome Measure(s):

Description and frequency of Title V MCH professionals' coded roles, responsibilities, needs, resources, and wishes. An aggregated map illustrating interconnections between identified codes is presented.

Results:

State- and local-level MCH professionals reported a range of roles, responsibilities, needs, resources, and wishes. The most and least frequently reported roles, responsibilities, needs, resources, and wishes by state- and local-level MCH professionals are listed, as well as the most frequent connections between those responses. The most frequent responsibility reported in local maps was “link to or provide care or resources” (82%), whereas the most frequent responsibility reported in state maps was “system management” (65%). System management was indirectly connected to 3 wishes: “access to data or information,” “funding or resources,” and “collaboration, coordination, or support from community or other external organizations.”

Conclusions:

System Support Mapping can be used to support needs assessment with MCH professionals. System Support Maps show not only the most and least frequently reported roles, responsibilities, needs, resources, and wishes of participants but also how those responses are connected and potentially interdependent. System Support Maps may be useful for MCH leaders determining how best to organize their teams to take on complex public health challenges and prioritize improvements that will better support their work.
Systemic Administration of Adipose-Derived Stromal Cells Concurrent with Fat Grafting
Authors: Hong Ki Yong , Kim Il-Kug , Park Seong Oh , Jin Ung Sik , Chang Hak
Published: February 2019

Background:

Cell-assisted lipotransfer, a technique involving free fat grafting mixed with adipose-derived stromal cells, has gained popularity for enhancing fat graft retention. In terms of stem cell delivery, intravenous injection can be a novel alternative with clinical value. However, the effects of intravenously injected adipose-derived stromal cells concurrent with fat grafting have not been described. The authors investigated the histologic and microenvironmental changes in grafted fat when adipose-derived stromal cells were injected intravenously concurrent with grafting.

Methods:

Using a modified animal model of cell-assisted lipotransfer, adipose tissue from green fluorescent protein–expressing C57BL/6J (B6) mice was grafted into recipient wild-type B6 mice, followed by intravenous injection of adipose-derived stromal cells from DsRed-expressing B6 mice. The distribution of adipose-derived stromal cells was evaluated using bioluminescent imaging, and graft volume was measured using micro–computed tomographic scans. Donor fat and adipose-derived stromal cells were traced using immunofluorescent staining.

Results:

The authors identified the recruitment of adipose-derived stromal cells inside the graft after intravenous injection of adipose-derived stromal cells concurrent with grafting despite the arrest of cells in the lungs. Intravenous injection of adipose-derived stromal cells resulted in significantly higher adipogenesis gene expression, retention of graft volume, and vascular density of the graft. A tracing study performed until postoperative week 8 revealed that intravenously injected adipose-derived stromal cells mainly induced angiogenesis and adipogenesis by paracrine action rather than direct differentiation.

Conclusions:

Consistent with results of cell-assisted lipotransfer, adipose-derived stromal cell supplementation by systemic administration led to improved retention of the fat graft. The findings broaden the surgical options for fat grafting and enhance the clinical value of cell-assisted lipotransfer.
Venous Thromboembolism after Abdominal Wall Reconstruction: A Prospective Analysis and Review of the Literature
Authors: Kraft Casey T. , Janis Jeffrey E.
Published: February 2019

Background:

Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism rates after these procedures. The authors sought to evaluate their own experience with complex abdominal wall reconstruction and venous thromboembolism events.

Methods:

The authors retrospectively reviewed their prospectively collected database of all patients who have undergone complex abdominal wall reconstruction performed by a single surgeon at their institution from September of 2013 to February of 2018. Demographic data, anticoagulant use, Caprini score, operative time, and postoperative venous thromboembolism events were recorded. A literature search was also performed, identifying all published articles evaluating venous thromboembolism events after abdominal wall reconstruction.

Results:

The authors identified 175 patients for analysis. Four patients were found to have postoperative venous thromboembolism events, for a total venous thromboembolism rate of 2.3 percent. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a venous thromboembolism event, and no deaths were reported from these complications. On literature review, three articles were identified in the literature discussing venous thromboembolism after abdominal wall reconstruction, all based on the American College of Surgeons National Surgical Quality Improvement Program database.

Conclusions:

Patients undergoing complex abdominal wall reconstruction are at high risk for venous thromboembolism events. There is scant literature published on this topic, but surgeons should be aware of the risk for venous thromboembolism after complex abdominal wall reconstruction and work to minimize this risk as much as possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Lower Urinary Tract Symptoms in Women With Female Genital Mutilation
Authors: Geynisman-Tan Julia , Milewski Andrew , Dahl Carly , Collins Sarah , Mueller Margaret , Kenton Kimberly , Lewicky-Gaupp Christina
Published: February 2019

Objective

This study aimed to describe symptom prevalence and quality of life impact from lower urinary tract symptoms (LUTS) in women living with female genital mutilation (FGM) in the United States.

Methods

A convenience sample of English-speaking women with FGM were invited to complete an anonymous survey including the Female Lower Urinary Tract Symptoms questionnaire to assess symptom prevalence and bother and the Pelvic Floor Impact Questionnaire-7 to assess quality of life impact from pelvic floor disorders. Data are reported as median (interquartile range). Correlations were calculated using Spearman ρ.

Results

Thirty women with an age of 29 (24–40) years were included. Sixty-seven percent self-identified as black/African and 77% were Muslim. Women reported being circumcised between ages 1 week and 16 years (median, 6 years). Forty percent reported type I circumcision, 23% reported type II, 23% reported type III, and 13% were unsure. Fifty percent were vaginally parous. Seventy-three percent of women reported the presence of LUTS. Twenty-seven percent voided at least 9 times per day, and 60% had nocturia at least 2 times. Bothersome voiding symptoms were commonly reported: urinary hesitancy (40%), strained urine flow (30%), and intermittent urine stream (47%). Fifty-three percent reported urgency urinary incontinence and 43% reported stress urinary incontinence. Symptom prevalence and bother were correlated for all 12 items (ρ = 0.51–0.90, P < 0.001). Median Pelvic Floor Impact Questionnaire-7 score was 102 (8–144), with 63% reporting urinary symptoms having “moderate” or “quite a bit of” impact on their activities, relationships, or feelings.

Conclusion

Lower urinary tract symptoms are common and bothersome in women with FGM. Providers caring for patients with FGM should inquire about LUTS.
A Prospective Randomized Trial Comparing Restorelle Y Mesh and Flat Mesh for Laparoscopic and Robotic-Assisted Laparoscopic Sacrocolpopexy
Authors: Ferrando Cecile A. , Paraiso Marie Fidela R.
Published: February 2019

Objective

The primary objective of this study was to compare case and mesh placement times between Restorelle Y mesh and flat mesh. The secondary objective was to compare subjective and objective outcomes between the 2 mesh configurations.

Methods

This is a randomized trial of women undergoing laparoscopic (LSC) or robotic (RSC) sacrocolpopexy for posthysterectomy vaginal prolapse. Subjects were predetermined to undergo either an LSC or RSC and randomized to Y mesh or flat mesh. Case and mesh placement times were defined as incision time to time of closure and time from mesh introduced into the abdomen to placement of the last sacral stitch, respectively. All subjects underwent Pelvic Organ Prolapse Quantification System examination and completed the 20-item Pelvic Floor Disability Index preoperatively, at 6, 12, and 24 months.

Results

Sixty-two patients were enrolled, and 59 patients were implanted with mesh: 30 with Y mesh (17 LSC, 13 RSC) and 29 with flat mesh (18 LSC, 11 RSC). There were no differences in patient characteristics between mesh groups. Mean case and mesh placement times for all subjects were 204.4 ± 48 and 46.1 ± 13.5 minutes, respectively, with no differences between the groups. At 6 months, 20-item Pelvic Floor Disability Index scores improved significantly for all subjects with no differences by mesh type. Three subjects (5.5%) reported vaginal bulge symptoms, and no subjects were retreated for prolapse or were found to have recurrent prolapse on examination. There were also no mesh erosions.

Conclusions

Case and mesh placement times do not differ in patients undergoing LSC or RSC with either Restorelle Y mesh or flat mesh. At 6 months, subjective and objective successes were 94% and 100%, respectively.
Racial Differences in Pelvic Organ Prolapse Symptoms Among Women Undergoing Pelvic Reconstructive Surgery for Prolapse
Authors: Ford Alexcis T. , Eto Chidimma U. , Smith Madeline , Northington Gina M.
Published: February 2019

Objective

The aim of this study was to determine if there is a difference in Pelvic Floor Disability Index Questionnaire (PFDI-20) scores between black and white women seeking surgical management for pelvic organ prolapse (POP).

Methods

A retrospective cohort study of 232 women who underwent pelvic reconstructive surgery with apical suspension for POP was performed. Demographic and clinical data were collected. All women completed the PFDI-20 and had a Pelvic Organ Prolapse Quantification examination at the initial consultation. Appropriate statistical tests were used to compare black and white women. Multivariable regression models adjusting for demographic and clinical variables were developed to determine the independent relationship between race and POP symptoms.

Results

In our cohort, 174 (75%) were white and 58 (25%) were black. Compared with white women, black women had higher parity, body mass index, Charlson Comorbidity Index score, and anterior POP stage. White women had higher total PFDI-20 scores corresponding to higher scores on all symptom subscales. After controlling for potential confounders, white race and prior anti-incontinence surgery remained associated with higher total PFDI scores. Higher Urogenital Distress Inventory 6 scores were significantly associated with white race, prior anti-incontinence procedures, and increasing body mass index, whereas higher CRADI-8 scores were associated with prior anti-incontinence surgery and higher POP stages.

Conclusions

White women appeared to have more overall symptom bother from prolapse, as well as urinary symptoms, as compared with black women, when assessed by validated questionnaire tools in a cohort of patients who underwent prolapse surgery. Further research is required to determine if racial differences in symptoms translate to differences in outcomes.
Complex Female Pelvic Pain: A Case Series From a Multidisciplinary Clinic in Urogynecology and Physiatry
Authors: Lillemon Jennifer Nicole , Nardos Rahel , Kaul Matthew P. , Johnson Angela N. , Choate Amy , Clark Amanda L.
Published: February 2019

Objective

The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain in the hip, groin, leg, abdomen, and/or back in patients with pelvic pain suggests that external pelvic sites may act as pain generators that contribute to chronic pelvic pain (CPP). The aim of this study was to report musculoskeletal diagnoses resulting from including a physiatry evaluation as part of a Multidisciplinary Pelvic Pain Clinic for women with complex chronic pain.

Methods

This retrospective case series was conducted by chart review of all women attending the clinic from February 2016 through March 2018. Variable definitions were created for each demographic and clinical characteristic and used to guide a structured review of the chart. Descriptive statistical analysis was performed.

Results

Ninety-six percent of the 68 women (mean age, 51 years) had CPP of 6 months’ duration or longer. Levator ani tenderness was present in 81% and obturator internus tenderness in 81%. Seventy-one percent of women had failed pelvic physical therapy. Musculoskeletal diagnoses included osteoarthritis, tendinopathies, enthesopathies, osteitis pubis, ischiofemoral impingement, Paget disease, and other systemic conditions.

Conclusions

Musculoskeletal abnormalities were common in this highly selected cohort of complex CPP cases with external pelvic symptoms. The imaging findings and specific diagnoses allowed targeted therapy beyond generalized physical therapy for CPP. The expertise of urogynecologists and physical therapists who evaluate the internal pelvic muscles and viscera combined with the physiatrist’s expertise in musculoskeletal assessment and imaging provides an expanded, collaborative approach for managing these patients.
Now Anyone Can Kegel: One-Time Office Teaching of Pelvic Floor Muscle Exercises
Authors: Nguyen My-Linh T. , Armstrong Abigail A. , Wieslander Cecilia K. , Tarnay Christopher M.
Published: February 2019

Objective

In women with pelvic floor disorders, we sought to determine time-to-teach (TTT) correct pelvic floor muscle (PFM) contraction, prevalence of inappropriate muscle contractions, and the association between TTT with PFM strength (PFMS).

Methods

From August 2017 to April 2018, patients from 2 pelvic floor disorder clinics participated in a prospective study examining PFMS. Assessment of PFMS was performed to obtain TTT, inappropriate accessory muscle, and Modified Oxford Grading Scale scores for pelvic floor muscle contractions 1 to pelvic floor muscle contractions 2.

Results

Of 100 women, 77 were from low-resource setting and 23 from high-resource setting. Mean TTT overall was 64.1 seconds (±26.0; range, 9–160 seconds), and mean TTT between settings was not significant. Mean overall TTT was significantly less than 90 seconds. Seventy-one women (71%) demonstrated at least 1 inappropriate accessory muscle, and of those, up to 50% of patients contracting 2 accessory muscle groups with abdominal muscles most frequently contracted at baseline. Thirty-nine percent of patients had a PFM contraction of at least 3 at baseline compared with 82% of patients upon completion of teaching, with 60% of women with scores of 4 or 5. The mean difference overall between baseline and pelvic floor muscle contractions 3 was 1.27 (confidence interval, 1.08–1.46; P < 0.001), and this increase was significant.

Conclusions

One-time PFMS teaching can be done in a time-proficient fashion and is translatable across high-resource and low-resource settings. Most patients show improvement in PFMS immediately and can quickly acquire this learned skill for proper home practice.
Retrospective Cohort Study on the Perioperative Risk Factors for Transient Voiding Dysfunction After Apical Prolapse Repair
Authors: Eto Chidimma , Ford Alexcis T. , Smith Madeline , Advolodkina Polina , Northington Gina M.
Published: February 2019

Objectives

The primary aim was to compare the incidence of transient voiding dysfunction (TVD) between vaginal uterosacral ligament suspension, sacrospinous ligament fixation, and robotic sacrocolpopexy. Secondarily, we identified risk factors for TVD and associated postoperative complications.

Methods

This was a retrospective cohort study of women who underwent apical repair at 1 institution. Data were collected from electronic medical records and were presented as means (SD) or numbers (percent) as appropriate. Univariate and multivariate analyses were performed to identify risk factors for TVD and its associated postoperative complications.

Results

Three hundred sixty women were included in analysis. Two hundred nineteen (60.8%) passed their voiding trial and 141 (39.2%) experienced TVD. The TVD group demonstrated a higher age, age-adjusted Charlson Comorbidity Index score, and preoperative postvoid residual (all P < 0.05). Univariate analysis demonstrated higher rates of TVD in the vaginal uterosacral ligament suspension and sacrospinous ligament fixation groups compared with the robotic sacrocolpopexy group (P = 0.012). Transient voiding dysfunction occurred more frequently with a concomitant anti-incontinence procedure, anterior repair, and/or posterior repair (all P < 0.05). In multivariate analysis, only an anti-incontinence procedure and concomitant anterior repair were independently associated with a risk of TVD (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.37–3.62, and OR, 2.20; CI, 1.14–4.27, respectively). Transient voiding dysfunction was associated with a culture-proven urinary tract infection within 6 weeks (OR, 3.2; CI, 1.3–8.55).

Conclusions

There was no difference in TVD between types of apical repair. Concomitant anti-incontinence procedure and anterior repair were associated with TVD. Women with TVD have an increased risk of postoperative urinary tract infections.
A 12-Month Clinical Durability of Effectiveness and Safety Evaluation of a Vaginal Bowel Control System for the Nonsurgical Treatment of Fecal Incontinence
Authors: Richter Holly E. , Dunivan Gena , Brown Heidi W. , Andy Uduak , Dyer Keisha Y. , Rardin Charles , Muir Tristi , McNevin Shane , Paquette Ian , Gutman Robert E. , Quiroz Lieschen , Wu Jennifer
Published: February 2019

Objective

The aim of this study was to characterize clinical success, impact on quality of life, and durability up to 1 year in women with fecal incontinence (FI) responsive to an initial test period with a trial vaginal bowel control system.

Methods

This was a prospective open-label study in subjects with FI and successfully fit who underwent an initial 2-week trial period. Those achieving 50% or greater reduction in FI episodes were provided the long-term system. Primary outcome was success at 3 months defined as 50% or greater reduction in baseline FI episodes, also assessed at 6 and 12 months. Secondary outcomes included symptom impact measured with Fecal Incontinence Quality of Life scale, symptom severity by the St Mark’s (Vaizey) questionnaire, Patient Global Impression of Improvement, and satisfaction. Adverse events were collected. Primary analysis was intention to treat (ITT).

Results

Seventy-three subjects with baseline mean of 14.1 ± 12.15 FI episodes over 2 weeks entered the treatment period. Success rate at 3 months was 72.6% (53/73,P< 0.0001); per-protocol, 84.1% (53/63,P< 0.0001). Significant improvement in all Fecal Incontinence Quality of Life subscales and St Mark’s questionnaire meeting minimally important differences was noted. Satisfaction was 91.7%, 89.7%, and 94.4% at 3, 6, and 12 months, respectively; 77.4%, 77.6%, and 79.6% were very much/much better on the Patient Global Impression of Improvement at 3, 6, and 12 months, respectively. Most common adverse event was vaginal wall injury, with most adverse events (90/134, 67%) occurring during fitting period.

Conclusions

In women with successful fitting and initial treatment response, durable efficacy was seen at 3, 6, and 12 months by objective and subjective measures, with favorable safety.
Approach to Ureterovaginal Fistula: Examining 13 Years of Experience
Authors: Chen Yufan Brandon , Wolff Birte J. , Kenton Kimberly S. , Mueller Elizabeth R.
Published: February 2019

Objective

We describe the management and outcomes of ureterovaginal fistulas over a 13-year period and present a treatment algorithm.

Methods

We performed a review of ureterovaginal fistula cases between January 2005 and December 2017 at our tertiary academic center. Demographics, diagnostic approaches, and treatment outcomes were assessed.

Results

Nineteen cases of ureterovaginal fistula were identified. Fistulas developed after hysterectomy in 18 cases and cesarean delivery in 1 case. Our primary treatment was conservative management with ureteral stenting in 12 and reimplantation in 6 cases. There was 1 case of spontaneous resolution. Ureteral stenting was successful in 11 (92%) of 12 patients. Stents were left in place for an average of 66 days (27–92 days). Complications of stents included pyelonephritis in 2 cases (18%) and stricture in 1 case (9%). Ultimately, conservative management was successful in treating ureterovaginal fistulas in 10 (83%) of 12 cases. The indications for primary ureteral reimplantation were concurrent vesicovaginal fistula in 3 cases, history of ureteral injury with surgical repair during the index surgery in 2 cases, and a 1-year delay in diagnosis in 1 case. A variety of follow-up surveillance methods were used, including tampon tests, computed tomographic urograms, retrograde pyelograms, and MAG-3 Lasix renal scans.

Conclusions

In carefully selected patients, ureteral stenting results in high cure rates for posthysterectomy ureterovaginal fistulas and should be considered first-line therapy. Complicated ureterovaginal fistulas may be best managed by primary ureteral reimplantation.
Analysis of Robotic Procedural Times Using Colpassist Versus End-to-End Anastomosis Sizer for Robotic-Assisted Sacrocolpopexy: A Randomized Controlled Trial
Authors: Brueseke Taylor , Matthews Catherine , Willis-Gray Marcella , Knight Sean , Nieto Maria Luz , Geller Elizabeth
Published: February 2019

Objective

The impact of vaginal instrumentation on operative time for robotic-assisted sacrocolpopexy (RSC) is not well understood. Colpassist (Boston Scientific, Quincy, Mass) is a vaginal positioning device designed to improve exposure with a curved double-sided handle that can be adapted to patient anatomy with 2 different sized functional ends. We sought to compare operative time for RSC using a Colpassist compared with a traditional end-to-end anastomosis sizer (EEAS).

Methods

This was a single-center randomized controlled trial of consecutive women undergoing RSC for apical pelvic organ prolapse. Participants were randomized to undergo RSC using either Colpassist or EEAS. The primary outcome was total operative time for the steps of RSC requiring use of a vaginal positioning device. Secondary outcomes included injury rates and satisfaction of the participants.

Results

Fifty-two women were enrolled (25 Colpassist, 27 EEAS). For the primary outcome, there was no significant difference in total operative time between procedures performed with Colpassist versus EEAS (P = 0.15). However, 16 (64%) of the 25 Colpassist arm versus 0 of EEAS (P < 0.01) required use of an alternative vaginal positioning device intraoperatively. Comparing secondary outcomes, there were no differences in rate of intraoperative injury between groups. Surgeon and fellow satisfaction scores were lower with Colpassist (P < 0.01). Surgical vaginal assistants were equally satisfied with both vaginal positioning devices (P > 0.05).

Conclusions

Colpassist is a potential alternative to EEAS with no significant difference in operative time or complication rate. However, case completion with Colpassist was significantly lower than EEAS and was associated with lower surgeon and fellow satisfaction.
A Cross-sectional Pilot Cohort Study Comparing Standard Urine Collection to the Peezy Midstream Device for Research Studies Involving Women
Authors: Southworth Elizabeth , Hochstedler Baylie , Price Travis K. , Joyce Cara , Wolfe Alan J. , Mueller Elizabeth R.
Published: February 2019

Objectives

The expanded quantitative urine culture protocol was used to compare the microbial abundance and diversity of voided urines obtained using a standard urine collection or using the Peezy midstream device versus paired periurethral specimens.

Methods

Sixty-two female participants were assigned to 1 of 3 cohorts. One cohort used a standard clean catch midstream urine protocol that included a castile soap wipe, the second cohort used a Peezy midstream collection device with castile soap wipe and the third used the Peezy device without a castile soap wipe. Each participant watched a video that detailed the collection method. Before using the castile soap wipe, a periurethral swab was obtained to measure periurethral microbial abundance. Demographics and pelvic floor symptoms were assessed by validated questionnaires. Microbes were detected using expanded quantitative urine culture. Diversity within each sample was analyzed using alpha diversity measures.

Results

Paired periurethral and urine samples for each woman were analyzed and compared for species abundance, richness, and diversity. Bacterial profiles of Peezy-collected urines differed significantly by multiple diversity indices and had significantly reduced colony-forming units compared to paired periurethral swabs. In contrast, within the standard clean catch cohort, voided urine had higher abundance and richness than paired periurethral swabs.

Conclusions

Compared with standard clean catch method, the Peezy urine collection device with and without the castile soap wipe resulted in urine with lower bacterial abundance that was distinct from the periurethra. Voided urine collected by Peezy may reduce postbladder microbial contribution.
Adaptive suicide: is a kin-selected driver of fatal behaviours likely?
Authors: Humphreys Rosalind K. , Ruxton Graeme D.
Published: February 2019

While several manipulated host behaviours are accepted as extended phenotypes of parasites, there remains debate over whether other altered behaviours in hosts following parasitic invasion represent cases of parasite manipulation, host defence or the pathology of infection. One particularly controversial subject is ‘suicidal behaviour’ in infected hosts. The host-suicide hypothesis proposes that host death benefits hosts doomed to reduced direct fitness by protecting kin from parasitism and therefore increasing inclusive fitness. However, adaptive suicide has been difficult to demonstrate conclusively as a host adaptation in studies on social or clonal insects, for whom high relatedness should enable greater inclusive fitness benefits. Following discussion of empirical and theoretical works from a behavioural ecology perspective, this review finds that the most persuasive evidence for selection of adaptive suicide comes from bacteria. Despite a focus on parasites, driven by the existing literature, the potential for the evolution of adaptive suicidal behaviour in hosts is also considered to apply to cases of infection by pathogens, provided that the disease has a severe effect on direct fitness and that suicidal behaviour can affect pathogen transmission dynamics. Suggestions are made for future research and a broadening of the possible implications for coevolution between parasites and hosts.
Veiled preferences and cryptic female choice could underlie the origin of novel sexual traits
Authors: Moehring Amanda J. , Boughman Janette W.
Published: February 2019

Males in many species have elaborated sexual traits that females strongly prefer, and these traits often conspicuously differ among species. How novel preferences and traits originate, however, is a challenging evolutionary problem because the initial appearance of only the female preference or only the male trait should reduce the ability to find a suitable mate, which could reduce fitness for individuals possessing those novel alleles. Here, we present a hypothesis for how novel preferences, as well as the novel male traits that females prefer, can originate, be favoured and spread in polyandrous species. Novel preference mutations can arise as ‘veiled preferences’ that are not expressed when the corresponding male trait is not present in the population, allowing preferences to be hidden from selection, and thus persist. In those cases when a male trait is present, veiled preferences provide a selective advantage, and females disproportionately produce offspring from preferred males through either mate choice or cryptic female choice. This tips the fitness advantage for novel males, allowing both preference and trait to spread, and limiting selection against them in the absence of the corresponding trait or preference.
Lizards from suburban areas learn faster to stay safe
Authors: Batabyal Anuradha , Thaker Maria
Published: February 2019

Enhanced cognitive ability is beneficial in unpredictable and harsh environments, as it enables animals to respond with flexibility. For animals living in urbanized areas, local environments not only are altered but can rapidly change during their lifetime. Urban residents are therefore challenged with identifying novel dangers and safe refuges in dynamic environments. We demonstrate that the tropical agamid lizard
Psammophilus dorsalis
experiences dramatically different habitats not only across the rural to urban spatial scale but also over the short temporal scale of a few years in suburban areas. Differences in environmental stability are expected to affect rates of learning and reversal learning in resident lizards. In testing arenas, lizards from these populations were required to choose a designated ‘safe’ refuge instead of an ‘unsafe’ one after simulated predator attacks. The contingency for safety was switched during the reversal learning task. In general,
P. dorsalis
showed high rates of learning and reversal learning, but lizards from suburban areas were quicker to learn and unlearn the location of the safe refuge than those from rural areas. This demonstrates for the first time to our knowledge that suburban lizards have faster learning and reversal learning skills for a key survival-related behaviour, finding safety in unpredictable environments.
How accurately do behavioural observations predict reproductive success in free-ranging lizards?
Authors: Olsson Mats , Schwartz Tonia S. , Wapstra Erik , Shine Richard
Published: February 2019

Behavioural ecologists often use data on patterns of male–female association to infer reproductive success of free-ranging animals. For example, a male seen with several females during the mating season is predicted to father more offspring than a male not seen with any females. We explored the putative correlation between this behaviour and actual paternity (as revealed by microsatellite data) from a long-term study on sand lizards (
Lacerta agilis
), including behavioural observations of 574 adult males and 289 adult females, and paternity assignment of more than 2500 offspring during 1998–2007. The number of males that contributed paternity to a female's clutch was correlated with the number of males seen accompanying her in the field, but not with the number of copulation scars on her body. The number of females that a male accompanied in the field predicted the number of females with whom he fathered offspring, and his annual reproductive success (number of progeny). Although behavioural data explained less than one-third of total variance in reproductive success, our analysis supports the utility of behavioural-ecology studies for predicting paternity in free-ranging reptiles.
The unified rule of phyllotaxis explaining both spiral and non-spiral arrangements
Authors: Okabe Takuya , Ishida Atsushi , Yoshimura Jin
Published: February 2019

Leaf-like appendages of different plant groups are arranged in common phyllotaxis patterns categorized into two types: spiral and non-spiral arrangements. The adaptive reason for this morphological convergence is unknown. In the non-spiral arrangement, the divergence angle between successive leaves is a simple fraction of 360°, e.g. distichy, decussate and whorled phyllotaxis. In the spiral arrangement, the divergence angle of nascent leaves at the shoot apex is fixed at the golden angle 137.5°, whereas those of the developed leaves varies within a sequence of Fibonacci fractions, such as 1/3, 2/5, 3/8, 5/13, etc. The optimality of the golden angle has been shown recently by assuming that the pattern of developed leaves varies during growth in a manner depending on the divergence angle of nascent leaves. Here we propose a unified rule of phyllotaxis to explain both types of arrangement: the developed leaves form vertical rows along the stem. In the non-spiral arrangement, nascent to developed leaves always follow this rule, so that the number of leaf rows is kept constant irrespective of stem growth. In the spiral arrangement, developed leaves attain this rule by adjusting the divergence angle from the golden angle. The spiral arrangement is adaptive in that the number of leaf rows varies during growth depending on shoot thickness.
Anisotropic residual stresses in arteries
Authors: Sigaeva Taisiya , Sommer Gerhard , Holzapfel Gerhard A. , Di Martino Elena S.
Published: February 2019

The paper provides a deepened insight into the role of anisotropy in the analysis of residual stresses in arteries. Residual deformations are modelled following Holzapfel and Ogden (Holzapfel and Ogden 2010,
J. R. Soc. Interface
7
, 787–799. (
doi:10.1098/rsif.2009.0357
)), which is based on extensive experimental data on human abdominal aortas (Holzapfel
et al.
2007,
Ann. Biomed. Eng.
35
, 530–545. (
doi:10.1007/s10439-006-9252-z
)) and accounts for both circumferential and axial residual deformations of the individual layers of arteries—intima, media and adventitia. Each layer exhibits distinctive nonlinear and anisotropic mechanical behaviour originating from its unique microstructure; therefore, we use the most general form of strain-energy function (Holzapfel
et al.
2015,
J. R. Soc. Interface
12
, 20150188. (
doi:10.1098/rsif.2015.0188
)) to derive residual stresses for each layer individually. Finally, the systematic experimental data (Niestrawska
et al.
2016,
J. R. Soc. Interface
13
, 20160620. (
doi:10.1098/rsif.2016.0620
)) on both mechanical and structural properties of the different layers of the human abdominal aorta facilitate our discussion on (i) the importance of anisotropy in modelling residual stresses; (ii) the variability of residual stresses within the same class of tissue, the abdominal aorta; (iii) the limitations of conventional opening angle method to account for complex residual deformations; and (iv) the effect of residual stresses on the loaded configuration of the aorta mimicking
in vivo
conditions.
An independent derivation and verification of the voids nucleation failure mechanism: significance for materials failure
Authors: Christensen Richard , Li Zhi , Gao Huajian
Published: February 2019

Independent derivations are given for the failure criteria of the purely dilatational stress state involving voids nucleation failure as well as for the purely distortional stress state involving shear bands failure. The results are consistent with those from a recently derived failure theory and they further substantiate the failure theory. The voids nucleation mechanism is compared with the ideal theoretical strength of isotropic materials as derived by density functional theory and two other atomic-scale methods. It is found that a cross-over occurs from the voids nucleation failure mechanism to the ideal strength limitation as the tensile to compressive strengths ratio,
T
/
C
, increases toward a value of unity. All the results are consistent with the failure modes transition results from the general failure theory.
Predation selects for smaller eye size in a vertebrate: effects of environmental conditions and sex
Authors: Svanbäck Richard , Johansson Frank
Published: February 2019

Increased eye size in animals results in a larger retinal image and thus improves visual acuity. Thus, larger eyes should aid both in finding food as well as detecting predators. On the other hand, eyes are usually very conspicuous and several studies have suggested that eye size is associated with predation risk. However, experimental evidence is scant. In this study, we address how predation affects variation in eye size by performing two experiments using Eurasian perch juveniles as prey and either larger perch or pike as predators. First, we used large outdoor tanks to compare selection due to predators on relative eye size in open and artificial vegetated habitats. Second, we studied the effects of both predation risk and resource levels on phenotypic plasticity in relative eye size in indoor aquaria experiments. In the first experiment, we found that habitat altered selection due to predators, since predators selected for smaller eye size in a non-vegetated habitat, but not in a vegetated habitat. In the plasticity experiment, we found that fish predators induced smaller eye size in males, but not in females, while resource levels had no effect on eye size plasticity. Our experiments provide evidence that predation risk could be one of the driving factors behind variation in eye size within species.
Survival of retinal ganglion cells after damage to the occipital lobe in humans is activity dependent
Authors: Schneider Colleen L. , Prentiss Emily K. , Busza Ania , Matmati Kelly , Matmati Nabil , Williams Zoë R. , Sahin Bogachan , Mahon Bradford Z.
Published: February 2019

Damage to the optic radiations or primary visual cortex leads to blindness in all or part of the contralesional visual field. Such damage disconnects the retina from its downstream targets and, over time, leads to trans-synaptic retrograde degeneration of retinal ganglion cells. To date, visual ability is the only predictor of retinal ganglion cell degeneration that has been investigated after geniculostriate damage. Given prior findings that some patients have preserved visual cortex activity for stimuli presented in their blind field, we tested whether that activity explains variability in retinal ganglion cell degeneration over and above visual ability. We prospectively studied 15 patients (four females, mean age = 63.7 years) with homonymous visual field defects secondary to stroke, 10 of whom were tested within the first two months after stroke. Each patient completed automated Humphrey visual field testing, retinotopic mapping with functional magnetic resonance imaging, and spectral-domain optical coherence tomography of the macula. There was a positive relation between ganglion cell complex (GCC) thickness in the blind field and early visual cortex activity for stimuli presented in the blind field. Furthermore, residual visual cortex activity for stimuli presented in the blind field soon after the stroke predicted the degree of retinal GCC thinning six months later. These findings indicate that retinal ganglion cell survival after ischaemic damage to the geniculostriate pathway is activity dependent.