bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ObjectiveThe 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.MethodsThis 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).ResultsSeventy-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.ConclusionsIn 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.
More Reliable EEG Electrode Digitizing Methods Can Reduce Source Estimation Uncertainty, But Current Methods Already Accurately Identify Brodmann Areas
Authors: Shirazi Seyed Yahya , Huang Helen J. 
Published: February 2019

AbstractElectroencephalography (EEG) and source estimation can be used to identify brain areas activated during a task, which could offer greater insight on cortical dynamics. Source estimation requires knowledge of the locations of the EEG electrodes. This could be provided with a template or obtained by digitizing the EEG electrode locations. Operator skill and inherent uncertainties of a digitizing system likely produce a range of digitization reliabilities, which could affect source estimation and the interpretation of the estimated source locations. Here, we compared the reliability of five digitizing methods (ultrasound, structured-light 3D scan, infrared 3D scan, motion capture probe, and motion capture) and determined the relationship between digitization reliability and source estimation uncertainty, assuming other contributors to source estimation uncertainty were constant. We digitized a mannequin head using each method five times and quantified the reliability and validity of each method. We created five hundred sets of electrode locations based on our reliability results and applied a dipole fitting algorithm (DIPFIT) to perform source estimation. The motion capture method, which recorded the locations of markers placed directly on the electrodes had the best reliability with an average electrode variability of 0.001cm. Then, in order of decreasing reliability were the method using a digitizing probe in the motion capture system, an infrared 3D scanner, a structured-light 3D scanner, and an ultrasound digitization system. Unsurprisingly, uncertainty of the estimated source locations increased with greater variability of EEG electrode locations and less reliable digitizing systems. If EEG electrode location variability was ~ 1 cm, a single source could shift by as much as 2 cm. To help translate these distances into practical terms, we quantified Brodmann area accuracy for each digitizing method and found that the average Brodmann area accuracy for all digitizing methods was > 80%. Using a template of electrode locations reduced the Brodmann area accuracy to ~ 50%. Overall, more reliable digitizing methods can reduce source estimation uncertainty, but the significance of the source estimation uncertainty depends on the desired spatial resolution. For accurate Brodmann area identification, any of the digitizing methods tested can be used confidently.
A Comprehensive Assessment of Demographic, Environmental and Host Genetic Associations with Gut Microbiome Diversity in Healthy Individuals
Authors: Scepanovic Petar , Hodel Flavia , Mondot Stanislas , Partula Valentin , Byrd Allyson , Hammer Christian , Alanio Cécile , Bergstedt Jacob , Patin Etienne , Touvier Mathilde , Lantz Olivier , Albert Matthew L. , Duffy Darragh , Quintana-Murci Lluis , Fellay Jacques ,   The Milieu Intérieur Consortium
Published: February 2019

ABSTRACTBackgroundThe gut microbiome is an important determinant of human health. Its composition has been shown to be influenced by multiple environmental factors and likely by host genetic variation. In the framework of the Milieu Intérieur Consortium, a total of 1,000 healthy individuals of western European ancestry, with a 1:1 sex ratio and evenly stratified across five decades of life (age 20 – 69), were recruited. We generated 16S ribosomal RNA profiles from stool samples for 858 participants. We investigated genetic and non-genetic factors that contribute to individual differences in fecal microbiome composition.ResultsAmong 110 demographic, clinical and environmental factors, 11 were identified as significantly correlated with α-diversity, ß-diversity or abundance of specific microbial communities in multivariable models. Age and blood alanine aminotransferase levels showed the strongest associations with microbiome diversity. In total, all non-genetic factors explained 16.4% of the variance. We then searched for associations between >5 million single nucleotide polymorphisms and the same indicators of fecal microbiome diversity, including the significant non-genetic factors as covariates. No genome-wide significant associations were identified after correction for multiple testing. A small fraction of previously reported associations between human genetic variants and specific taxa could be replicated in our cohort, while no replication was observed for any of the diversity metrics.ConclusionIn a well-characterized cohort of healthy individuals, we identified several non-genetic variables associated with fecal microbiome diversity. In contrast, host genetics only had a negligible influence. Demographic and environmental factors are thus the main contributors to fecal microbiome composition in healthy individuals.
Defining region-specific masks for reliable depth-dependent analysis of fMRI data
Authors: Weldon Kimberly B. , Burton Philip C. , Grant Andrea N. , Yacoub Essa , Olman Cheryl A. 
Published: February 2019

AbstractIn high-field fMRI research, anatomical reference information (e.g., gray matter (GM) segmentation, cortical depth delineation) is often defined in volumes acquired with pulse sequences subject to different distortions than those in functional volumes. In these cases, reliable interpretation of ultra-high resolution fMRI data depends on excellent cross-modal registration of functional volumes to reference anatomical volumes. In this paper, we describe a two-step approach to automating assessments of cross-modal registration quality for the purpose of guiding depth-dependent analysis. First, each functional/anatomical registration was scored by the ratio of the number of GM voxels in the functional data overlapping anatomical GM to the number of GM voxels in the functional data overlapping anatomical white matter (WM). This GM:WM overlap ratio provided an objective metric for determining whether an alignment algorithm had converged on a solution that would pass visual inspection. Second, surface-based maps indicating the consistency of overlap between functional and anatomical GM throughout the GM depth were generated for the entire region of cortex covered by the experiment. These maps served as a mask for the purpose of excluding regions where registration between functional and anatomical data was inadequate and thus unable to support depth-dependent analyses. We found, for both real and simulated data, that functional response profiles that were less biased toward superficial responses in regions where these metrics indicated satisfactory registration.
Use of CRISPR/Cas9 Gene Targeting to Conditionally Delete Glucocorticoid Receptors in Rat Brain
Authors: Scheimann Jessie R. , Moloney Rachel D. , Mahbod Parinaz , Morano Rachel L. , Fitzgerald Maureen , Hoskins Olivia , Packard Benjamin A. , Hu Yueh-Chiang , Herman James P. 
Published: February 2019

AbstractGlucocorticoid receptors (GR) have diverse functions relevant to maintenance of homeostasis and adaptation to environmental challenges. Understanding the importance of tissue-specific GR function in physiology and behavior has been hampered by near-ubiquitous localization in brain and body. Here we use CRISPR/Cas9 gene editing to create a conditional GR knockout in Sprague Dawley rats. To test the impact of cell-and region-specific GR deletion on physiology and behavior, we targeted GR knockout to output neurons of the prelimbic cortex.Prelimbic deletion of GR in females caused deficits in acquisition and extinction of fear memory during auditory fear conditioning, whereas males exhibit enhanced active-coping behavior during forced swim. Our data support the utility of this conditional knockout rat to afford high-precision deletion of GR across a variety of contexts, ranging from neuronal depletion to circuit-wide manipulations, leveraging the behavioral tractability and enhanced brain size of the rat as a model organism.