bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal Release of Copeptin in Response to Maternal Oxytocin Administration
Authors: Wellmann Sven , Koslowski Andrea , Spanaus Katharina , Zimmermann Roland , Burkhardt Tilo 
Published: September 2016

OBJECTIVE:
To test whether an oxytocin challenge test raises neonatal levels of copeptin, the C-terminal portion of proarginine vasopressin, a sensitive stress marker elevated in neonates born by vaginal delivery as opposed to elective cesarean delivery.

METHODS:
In a randomized controlled trial in women with a singleton pregnancy undergoing elective cesarean delivery at greater than 36 weeks of gestation and no contractions or rupture of membranes, we compared arterial umbilical cord plasma concentrations of copeptin between neonates exposed to an oxytocin challenge test before elective cesarean delivery and those administered saline infusion (placebo group). Women randomized to an oxytocin challenge test received 5 international units/500 mL oxytocin Ringer lactate infused at a rate of 12 mL/h and doubled every 10 minutes until it induced three uterine contractions per 10-minute interval, at which point it was discontinued. Neonatal copeptin levels were the primary endpoint. Secondary endpoints included biochemical and physiologic parameters of fetal and maternal well-being.

RESULTS:
From January 2012 to October 2012 and from September 2013 to January 2015, 78 women underwent an oxytocin challenge test and 78 placebo infusion, of whom 12 and 11, respectively, were excluded as a result of insufficient blood sample volume for analysis. Umbilical cord plasma copeptin levels [median (range)] were higher in neonates who underwent an oxytocin challenge test than those who underwent placebo infusion: 22.2 (3.22–2,319) compared with 7.39 (2.5–344.6) pmol/L (P<.001). There were no statistically significant differences between the two groups in secondary outcomes.

CONCLUSION:
Oxytocin challenge test-induced contractions before elective cesarean delivery trigger fetal copeptin release.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, https://clinicaltrials.gov, NCT01962701.
Gynecologic Outcomes After Hysteroscopic and Laparoscopic Sterilization Procedures
Authors: Perkins Rebecca B. , Morgan Jake R. , Awosogba Temitope P. , Ramanadhan Shaalini , Paasche-Orlow Michael K. 
Published: September 2016

OBJECTIVE:
To compare rates of gynecologic morbidity after laparoscopic and hysteroscopic sterilization.

METHODS:
This retrospective cohort study used a commercial claims administrative database, 2007–2013, to compare rates of pregnancy, menstrual dysfunction, pelvic pain, hysteroscopic surgery, and intra-abdominal gynecologic surgery after laparoscopic and hysteroscopic sterilization. Women with 12 or more continuous months of data before and after their index procedure were included. Pregnancy rates after laparoscopic and hysteroscopic sterilization were compared for the entire population of women who underwent hysteroscopic sterilization and the subset who had completed postprocedure hysterosalpingograms. Cox proportional hazard models were calculated controlling for age, comorbidities, U.S. geographic region, metropolitan statistical area designation, and insurance type.

RESULTS:
A total of 42,391 women underwent laparoscopic and 27,724 underwent hysteroscopic sterilization. The pregnancy rate was higher after hysteroscopic than laparoscopic sterilization (adjusted hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.33; 2.4% compared with 2.0% risk of pregnancy at 2 years). Only 66.1% (n=18,318) of women who underwent hysteroscopic sterilization received a hysterosalpingogram. This group had similar pregnancy rates as those who underwent laparoscopic sterilization (adjusted HR 0.90, 95% CI 0.80–1.02; 1.8% compared with 2.0% at 2 years). After undergoing hysteroscopic sterilization, more women were diagnosed with menstrual dysfunction (adjusted HR 1.23, 95% CI 1.20–1.27; 26.8% compared with 22.3% at 2 years), and more women underwent hysteroscopic surgeries (adjusted HR 2.05, 95% CI 1.96–2.14; 13.8% compared with 6.4% at 2 years), but fewer women were diagnosed with pelvic pain (adjusted HR 0.83, P<.001; 21.0% compared with 25.6% at 2 years) and fewer women underwent intra-abdominal gynecologic surgeries (adjusted HR 0.95, 95% CI 0.90–0.99; 7.7% compared with 8.1% at 2 years), including hysterectomy (adjusted HR 0.65, 95% CI 0.61–0.69; 10.9% compared with 14.3% at 5 years).

CONCLUSION:
Hysteroscopic sterilization may be associated with a higher rate of pregnancy, more menstrual dysfunction, more hysteroscopic surgeries, less pelvic pain, and fewer intra-abdominal gynecologic surgeries than laparoscopic sterilization. Pregnancy rates appear to be similar for women who completed their postprocedure hysterosalpingogram, but only 66% of women did so.
Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage
Authors: Quibel Thibaud , Ghout Idir , Goffinet François , Salomon Laurent J. , Fort Julie , Javoise Sophie , Bussieres Laurence , Aegerter Philippe , Rozenberg Patrick ,   for the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: September 2016

OBJECTIVE:
To evaluate the effectiveness and safety of misoprostol administered simultaneously with oxytocin as part of the active management of the third stage of labor.

METHODS:
This multicenter, double-blind, randomized, placebo-controlled trial recruited women in the first stage of labor with expected vaginal deliveries at 36–42 weeks of gestation. Exclusion criteria were multiple pregnancies, hypersensitivity to misoprostol, and cesarean delivery. Participants received routine intravenous oxytocin and were randomly allocated to receive 400 micrograms misoprostol or placebo orally immediately after delivery of the newborn. The primary outcome was postpartum hemorrhage (500 mL or greater within 2 hours of birth). Secondary outcomes included severe postpartum hemorrhage (1,000 mL or greater) and adverse maternal events such as fever, shivering, and nausea. Two groups of 1,550 women were required to demonstrate a 33% decrease of postpartum hemorrhage according to a two-tailed α at 0.05 with 80% power. An interim analysis was planned after 50% enrollment.

RESULTS:
Participant enrollment occurred from April 2010 to September 2013. Baseline characteristics were similar in the two groups. The study was discontinued after the planned interim analysis including 1,721 patients showed that misoprostol was not effective and was associated with significantly more adverse effects. The rate of postpartum hemorrhage was 8.4% (68/806) in the misoprostol and 8.3% (66/797) in the placebo group (P=.98), and rates of severe postpartum hemorrhage were 1.8% and 2.4%, respectively (P=.57). Maternal adverse events occurred significantly more frequently in the misoprostol group (for fever 30.4% in the misoprostol group compared with 6.3% in the placebo group, P<.001; for shivering 10.8% in the misoprostol group compared with 0.6% in the placebo group, P<.001).

CONCLUSION:
Misoprostol administered with prophylactic routine oxytocin did not reduce the rate of postpartum hemorrhage risk and increased the rate of adverse events.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, https://clinicaltrials.gov, NCT01113229.
Burch Retropubic Urethropexy Compared With Midurethral Sling With Concurrent Sacrocolpopexy
Authors: Trabuco Emanuel C. , Klingele Christopher J. , Blandon Roberta E. , Occhino John A. , Weaver Amy L. , McGree Michaela E. , Lemens Maureen A. , Gebhart John B. 
Published: September 2016

OBJECTIVE:
To compare efficacy and safety of retropubic Burch urethropexy and a midurethral sling in women with stress urinary incontinence (SUI) undergoing concomitant pelvic floor repair with sacrocolpopexy.

METHODS:
Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and a blinded cough stress test.

RESULTS:
Enrollment was June 1, 2009, through August 31, 2013. At 6 months, no difference was found in overall (29 midurethral sling [51%] compared with 23 Burch [41%]; P=.30) (odds ratio [OR] 1.49, 95% confidence interval [CI] 0.71–3.13) or stress-specific continence rates (42 midurethral sling [74%] compared with 32 Burch [57%]; P=.06) (OR 2.10, 95% CI 0.95–4.64) between groups. However, the midurethral sling group reported greater satisfaction (78% compared with 57%; P=.04) and were more likely to report successful surgery for SUI (71% compared with 50%; P=.04) and to resolve pre-existing urgency incontinence (72% compared with 41%; P=.03). No difference was found in patient global impression of severity or symptom improvement, complication rates, or mesh exposures.

CONCLUSION:
There was no difference in overall or stress-specific continence rates between midurethral sling and Burch urethropexy groups at 6 months. However, the midurethral sling group reported better patient-centered secondary outcomes.
Distance From Cervicovaginal Junction to Anterior Peritoneal Reflection Measured During Vaginal Hysterectomy
Authors: Balgobin Sunil , Hamid Cherine A. , Carrick Kelley S. , Montoya T. Ignacio , Schaffer Joseph I. , Corton Marlene M. 
Published: September 2016

OBJECTIVE:
To quantify the distance of the dissection plane from the cervicovaginal junction to the anterior peritoneal reflection for vaginal hysterectomy.

METHODS:
This is a descriptive study examining the dissection plane for anterior colpotomy in 22 surgical patients undergoing vaginal hysterectomy and in nine cadaver specimens. Intraoperatively, the distance from the vaginal incision to the anterior peritoneal reflection was measured on the uterus after removal. In nine of these patients, this distance was also measured before anterior peritoneal incision. Embalmed cadavers with intact pelvic viscera were dissected and the distance of the same dissection plane was measured.

RESULTS:
Median (interquartile range) surgical patient age was 51.5 (42–63) years and the main surgical indications were abnormal uterine bleeding and pelvic organ prolapse. In these patients, the median (interquartile range) distance from cervicovaginal incision to anterior peritoneal reflection was 3.4 (2.6–3.7) cm. In cadavers, the median (interquartile range) age was 81 (72–86) years with a measured distance of 2.7 (2.4–2.9) cm.

CONCLUSION:
When performing a vaginal hysterectomy, surgeons can expect a median (range) dissection distance of 3.4 (1.8–4.6) cm from initial incision to the peritoneal reflection for anterior colpotomy.
Dynamic Article: Percutaneous Nerve Evaluation Versus Staged Sacral Nerve Stimulation for Fecal Incontinence
Authors: Rice Teresa C. , Quezada Yarini , Rafferty Janice F. , Paquette Ian M. 
Published: September 2016

BACKGROUND:
Sacral neuromodulation using a 2-staged approach is an established therapy for fecal incontinence. Office-based percutaneous nerve evaluation is a less-invasive alternative to the stage 1 procedure but is seldom used in the evaluation of patients with fecal incontinence.

OBJECTIVE:
The aim of this study was to determine the clinical success of percutaneous nerve evaluation versus a staged approach.

DESIGN:
This was a retrospective review of a prospectively maintained, single-institution database of patients treated with sacral neuromodulation for fecal incontinence.

SETTINGS:
This study was conducted at a single academic medical center.

PATIENTS:
Eighty-six consecutive patients were treated with sacral neuromodulation for fecal incontinence.

INTERVENTIONS:
Percutaneous nerve evaluation was compared with a staged approach.

MAIN OUTCOME MEASURES:
The primary outcome measured was the proportion of patients progressing to complete implantation based on >50% improvement in Wexner score during the testing phase.

RESULTS:
Percutaneous nerve evaluation was performed in 45 patients, whereas 41 underwent a staged approach. The mean baseline Wexner score did not differ between testing groups. Success was similar between the staged approach and percutaneous nerve evaluation (90.2% versus 82.2%; p = 0.36). The mean 3-month Wexner score was not significantly different between testing methods (4.4 versus 4.1; p = 0.74). However, infection was more likely to occur after the staged approach (10.5% versus 0.0%; p < 0.05).

LIMITATIONS:
This study was limited by its retrospective nature and potential for selection bias.

CONCLUSIONS:
Percutaneous nerve evaluation offers a viable alternative to a staged approach in the evaluation of patients for sacral neuromodulation in the setting of fecal incontinence. Not only are success rates similar, but percutaneous nerve evaluation also has the benefit of limiting patients to 1 operating room visit and has lower rates of infection as compared with the traditional staged approach for sacral neuromodulation.
Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome
Authors: van Iersel Jan J. , de Witte Chris J. , Verheijen Paul M. , Broeders Ivo A. M. J. , Lenters Egbert , Consten Esther C. J. , Schraffordt Koops Steven E. 
Published: September 2016

BACKGROUND:Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques.OBJECTIVE:This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor.DESIGN:This was a prospective, observational cohort study.SETTINGS:The study was conducted in a tertiary care setting.PATIENTS:All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included.INTERVENTION:Robot-assisted sacrocolporectopexy was the study intervention.MAIN OUTCOME MEASURES:Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively.RESULTS:Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p< 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3,p= 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2;p< 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9;p= 0.002) and quality of life for each compartment (p< 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected.LIMITATIONS:This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score.CONCLUSIONS:Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function.
Controlled Dietary Restriction With a Prepackaged Low-Residue Diet Before Colonoscopy Offers Better-Quality Bowel Cleansing and Allows the Use of a Smaller Volume of Purgatives: A Randomized Multicenter Trial
Authors: Chou Chu-Kuang , Chang Chi-Yang , Chang Chun-Chao , Chang Li-Chun , Hsu Wen-Feng , Chen Chi-Yi , Wang Hsiu-Po , Chiu Han-Mo 
Published: September 2016

BACKGROUND:
Bowel preparation is burdensome, and less-demanding preparation procedures are needed. Few studies have investigated the effects of low-residue diet and prepackaged low-residue diet in combination with low-volume polyethylene glycol–electrolyte lavage solution during colonoscopy preparation.

OBJECTIVE:
We compared self-prepared low-residue diets with prepackaged low-residue diets in combination with low-volume polyethylene glycol.

DESIGN:
This was a single-blinded, 3-arm, multicenter, randomized controlled trial.

SETTING:
Colonoscopies were conducted in outpatient settings at 3 centers in Taiwan.

PATIENTS:
The study included 180 patients (age range, 20–75 years) who were scheduled for colonoscopy.

INTERVENTIONS:
Three groups were compared: group A included self-prepared, 1-day, low-residue diets with a same-day 2.0-L single-dose of polyethylene glycol; group B included prepackaged low-residue diets plus 2.0 L of polyethylene glycol; and group C included prepackaged low-residue diets plus 1.5 L of polyethylene glycol.

MAIN OUTCOME MEASURES:
The outcome measures were adherence, bowel-cleansing level, and patient satisfaction.

RESULTS:
One third of the subjects in group A, but none in the prepackaged low-residue diets groups, violated the dietary restrictions. The proportion of right-segment preparation failure was 15.0%, 1.7%, and 6.7% (p = 0.025). Accordingly, treatment B was superior to A (p = 0.008). Among subjects violating the low-residue diets guideline, the right-segment preparation failure rate was 25%. According to a multivariate analysis, low-residue diet compliance (adjusted OR = 6.55 (95% CI, 1.83–23.43)) and BMI were predictors of right-sided preparation adequacy, but the volume of polyethylene glycol ingested was not a predictor. Compared with group A, a greater proportion of subjects in groups B and C reported satisfaction.

LIMITATIONS:
Patients with high BMI and severe constipation were excluded from this study. This study included only an Asian population.

CONCLUSIONS:
The prepackaged low-residue diet provides excellent adherence, better bowel cleansing, and a better experience than a self-prepared low-residue diet. With good dietary compliance, 1.5 L of polyethylene glycol provides effective preparation.
Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management
Authors: Hong Victor 
Published: September 2016

Abstract
Patients with borderline personality disorder (BPD) are high utilizers of psychiatric emergency services and present unique challenges in that setting. Frequently advised to visit an emergency department (ED) if safety is in question, their experiences once there often do not have beneficial effects. Issues specific to patients with BPD in the ED include volatile interactions with staff, repeat visits, concerns about safety (and liability), and disposition. Emergency department staff attitudes toward these patients are frequently negative when compared to patients with other diagnoses, and can detrimentally affect outcomes and perpetuate stigma regarding BPD. These attitudes are often due to lack of education and training about how to understand, approach, and treat the patient with BPD. The limited literature regarding the treatment of BPD in the ED offers few guidelines. This article presents an approach based on Good Psychiatric Management that can reduce negative reactions by ED staff and make ED visits more effective and less harmful. Relevant principles include psychoeducation, the reinforcement of the connection between symptoms and interpersonal stressors, and employment of an active, authentic therapeutic stance. Training ED staff in these principles could lead to attitudinal changes, reduced stigma, and potentially improved outcomes.
Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care
Authors: Choi-Kain Lois W. , Albert Elizabeth B. , Gunderson John G. 
Published: September 2016

Learning Objective
After participating in this activity, learners should be better able to:
• Evaluate evidence-based therapies for borderline personality disorder

Abstract
Several manualized psychotherapies for treating borderline personality disorder (BPD) have been validated in randomized, controlled trials. Most of these approaches are highly specialized, offering different formulation of BPD and different mechanisms by which recovery is made possible. Mental health clinicians are challenged by the degree of specialization and clinical resources that these approaches require in their empirically validated adherent forms. While these effective treatments have renewed optimism for the treatment of BPD, clinicians may feel limited in their ability to offer any of them or may integrate an eclectic assortment of features from the different treatments. This article will evaluate four major evidence-based treatments for BPD—dialectical behavioral therapy, mentalization-based treatment, transference-focused psychotherapy, and General Psychiatric Management—and possible modes of implementation in adherent and integrative forms. Models of implementing these diverse treatment approaches will be evaluated, and the potential advantages of combining evidence-based treatments will be discussed, along with some cautionary notes. A proposal for providing stepwise care through assessment of clinical severity will be presented as a means of achieving system-wide changes and greater access to care.
A Neurobiological Model of Borderline Personality Disorder: Systematic and Integrative Review
Authors: Ruocco Anthony C. , Carcone Dean 
Published: September 2016

Abstract
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder’s complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain’s dynamic evaluation of the relevance of emotional stimuli in the context of an individual’s goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.