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Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse., Methods: We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance., Results: The women in the SC group had significantly higher mean apical vaginal measurements (P < 0.05), and significantly fewer stage II recurrences than women in the transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05)., Conclusion: In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.

Objective: Obesity can predispose women to pelvic organ prolapse and can also affect the success of prolapse surgery. Sacral colpopexy is a common surgical approach used to treat significant prolapse, and may be performed by laparotomy or laparoscopy. The objective of this study was to determine whether surgical outcomes following abdominal sacral colpopexy (ASC) and laparoscopic sacral colpopexy (LSC) varied according to BMI., Methods: We conducted a retrospective cohort study of women who had undergone ASC (n = 90) and LSC (n = 150). Preoperative, perioperative, and postoperative information was collected from patient charts and entered into a database according to BMI category (normal weight 18.5 to 24.9 kg/m², overweight = 25 to 29.9 kg/m², obese ≥ 30 kg/m²). Within each BMI group, outcomes were compared between ASC and LSC patients using Student t, Mann-Whitney U, and Fisher exact tests, and analyses of covariance., Results: In normal weight patients, postoperative apical measurements were worse in ASC patients (P = 0.01). In overweight patients, the ASC group had worse posterior measurements (P = 0.05) and fewer mesh/suture erosions (P = 0.03) but more recurrent prolapse symptoms (P = 0.007). In obese patients, the ASC group had better anterior measurements (P = 0.008). There were no differences in any BMI category for prolapse stage, surgical satisfaction, or classification of surgical success or failure (P > 0.05)., Conclusion: Differences between ASC and LSC were identified when patients were categorized according to BMI. These findings may be useful in counselling patients and planning the appropriate surgical approach for sacral colpopexy based on BMI.

Objective: The primary objective was to estimate the incidence of de novo stress urinary incontinence after total vaginal mesh procedures in women with negative preoperative urodynamics with prolapse reduction. Secondary objective was to identify associated risk factors., Study Design: A retrospective cohort study with a nested case-control study of women who underwent total vaginal mesh procedures without midurethral sling after a negative preoperative urodynamics., Result: Sixty patients were included in the final analysis. Fifteen (25%) patients were diagnosed with de novo stress urinary incontinence. Although no significant associated risk factors were identified, there was a trend for higher gravidity and better anterior wall support among women who had stress urinary incontinence develop., Conclusion: The incidence of de novo stress urinary incontinence after total vaginal mesh procedures in this cohort was 25%. Patients should be appropriately counseled regarding the same., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to compare pre- and postoperative pelvic organ prolapse-quantification (POP-Q) and magnetic resonance imaging (MRI) measurements in patients who undergo total Prolift (Ethicon, Inc, Somerville, NJ) colpopexy., Study Design: Pre- and postoperative MRI and POP-Q examinations were performed on patients with stage 2 or greater prolapse who underwent the Prolift procedure. MRI measurements were taken at maximum descent. Correlations between changes in MRI and POP-Q measurements were determined., Results: Ten subjects were enrolled. On MRI, statistically significant changes were seen with cystocele, enterocele, and apex. Statistically significant changes were seen on POP-Q measurements for Aa, Ba, C, Ap, Bp, and GH. Positive correlations were demonstrated between POP-Q and MRI changes. Minimal tissue reaction was seen on MRI., Conclusion: The Prolift system is effective in the surgical management of pelvic organ prolapse as measured by POP-Q and MRI. Postoperative MRIs support the inert nature of polypropylene mesh., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate the effect of concomitant hysterectomy at the time of abdominal sacral colpoperineopexy on the risk of mesh erosion with the use of type 1 polypropylene mesh., Study Design: This was a retrospective case control study. All cases of vaginal mesh erosion (n = 31) were compared with matched control cases (n = 93) in a 3:1 ratio. Demographic data, concomitant procedures, and postoperative complications were compared between groups with the use of 2-sample Student t test and Pearson chi(2) test., Results: The odds ratio of a vaginal mesh erosion was no different for those who underwent a hysterectomy at the time of abdominal sacral colpoperineopexy (odds ratio, 0.95; 95% confidence interval, 0.41-2.18; P = .899) when potential confounders were similar between groups., Conclusion: Hysterectomy at the time of abdominal sacral colpoperineopexy is not a risk factor for vaginal mesh erosion with the use of type 1 polypropylene mesh.

A market basket survey for beef retail cut composition at the retail level (four stores each from two chains in each city) was conducted in 11 US cities from January to March 2006. Beef cuts (n=17,495) were measured for external fat thickness with cuts from the chuck (0.05cm), round (0.05cm), and miscellaneous (0.04cm) having less (P<0.05) fat than cuts from the loin (0.11cm) and rib (0.11cm). Beef cuts (n=1327) were separated physically into separable components with round cuts having more (P<0.05) separable lean (96.63%) than chuck cuts (86.81%) and miscellaneous cuts (86.18%), which had more (P<0.05) separable lean than loin cuts (84.53%) with rib cuts (69.34%) having the lowest (P<0.05) separable lean. Chemical fat from the separable lean differed (P<0.05) between each cut category: round cuts (3.71%), miscellaneous cuts (4.99%), loin cuts (5.60%), chuck cuts (6.90%), and rib cuts (8.61%). Ground beef samples (n=235), with declared lean/fat percentages ranging from 73/27 to 96/4, had overall chemical fat values of 13.41% and moisture values of 67.42%. This survey documents the current beef retail cut and ground beef composition, which is helpful to those who need this information for various dietary and marketing purposes.

Objective: The purpose of this study was to determine the de novo dyspareunia rate with the Prolift procedure., Study Design: All Prolift cases performed between August 2005 and August 2007 were evaluated. The rate of de novo dyspareunia was calculated by chart review. Type and degree of dyspareunia were assessed by self-administered questionnaire. Demographics, use of hormone therapy, failure rate, and willingness to have the surgery again were summarized using descriptive statistics., Results: The rate of de novo dyspareunia was 16.7%. Over 75% of patients with de novo dyspareunia described the pain as mild or moderate. Most described dyspareunia with insertion. Eighty-three percent of respondents with de novo dyspareunia would have the procedure done again., Conclusion: The Prolift is associated with a 17% de novo dyspareunia rate. Despite this, most would have the surgery done again.

Objective: The purpose of this study was to evaluate the association between smoking and vaginal mesh erosion after abdominal sacral colpoperineopexy with the use of type 1 polypropylene mesh., Study Design: All cases of mesh erosion (n = 27) that were diagnosed between October 2003 and June 2006 were identified and compared with matched control cases (n = 81). Control cases were matched for age, diabetes mellitus status, hypoestrogenic state (menopausal status, chronic steroid use, use of hormone therapy), abdominal-vaginal rectocele repair, culdoplasty, and concomitant hysterectomy. Demographic data, surgical characteristics, and postoperative complications were also compared between groups. Continuous data were compared using 2-sample Student t tests. Categoric data were compared with the use of Pearson Chi-square tests., Results: The odds of experiencing mesh erosion was significantly greater in smokers than in nonsmokers (odds ratio, 4.4; 95% CI, 1.3, 14.4; P = .010) when potential confounders were similar between groups., Conclusion: Tobacco use is a risk factor for vaginal mesh erosion after abdominal sacral colpoperineopexy with the use of type 1 polypropylene mesh.

Effects of 10% xylitol (a five-carbon sugar alcohol) on adhesion of Escherichia coli O157:H7 and Salmonella Typhimurium to meat surfaces were examined with three approaches. First, beef outside round was inoculated with rifampin-resistant E. coli O157:H7 and Salmonella Typhimurium dispersed in xylitol or peptone solution. Samples were rinsed with water or not rinsed in a 2 x 2 factorial arrangement. No interaction existed between inoculum and rinsing treatments (P > 0.84). Incubation in xylitol had minimal impact on pathogen adhesion (P > 0.76); however, rinsing reduced pathogen cell counts (P < 0.01). Second, meat samples were treated with water, xylitol, or no rinse; inoculated with pathogens dispersed in peptone solution (8.6 log CFU/ml for each pathogen); and then treated with water, xylitol, or no rinse in a 3 x 3 factorial arrangement. No interactions were observed (P > 0.50). Postinoculation rinsing reduced pathogen loads (P < 0.01) without difference between water and xylitol (P > 0.64). Third, carcass surfaces inoculated with pathogens (5.5 log CFU/cm2) were treated with 35 degrees C water wash, 2.5% L-lactic acid spray, 10% xylitol spray, lactic acid plus xylitol, or hot water plus xylitol. Lactic acid treatments reduced Salmonella Typhimurium at 0 h (P < 0.01) and 24 h (P < 0.02). Hot water treatments tended to reduce Salmonella Typhimurium at 0 h (P < 0.07). Xylitol did not reduce pathogens (P > 0.62) or increase effectiveness of other treatments. Xylitol does not influence E. coli O157:H7 and Salmonella Typhimurium adhesion to meat surfaces.

Beef from retail and foodservice establishments in 11 US cities was evaluated using Warner-Bratzler shear (WBS) and consumer evaluation panels. Postmortem aging times ranged from 3 to 83d for retail and 7 to 136d for foodservice with mean aging times of 22.6d and 30.1d, respectively. For retail, the three cuts from the round - top round, bottom round, and eye of round - had the highest (P<0.05) WBS values compared to cuts from the chuck, rib, and loin. Top loin steaks had the lowest (P<0.05) WBS value compared to ribeye and top sirloin foodservice steaks. Retail bone-in top loin, top loin, ribeye, T-bone, and porterhouse received the highest (P<0.05) ratings by consumers for overall like and like tenderness. Quality grade had little or no effect on foodservice sensory evaluations. Improvements in round tenderness are needed to increase consumer acceptability.

Bos indicus crossbred cattle (n=79) were fed vitamin D(3) (0 or 3 million IU/hd/d) for 5d. Afterwards, half of each group was slaughtered immediately, while half was fed, without supplementation, for 7d before processing. Serum calcium concentration was increased (P<0.05) in cattle after supplement removal, but not immediately following supplementation. This also was observed in the M. longissimus lumborum and M. triceps brachii, but not in the M. semitendinosus. Liver biopsy vitamin D(3) concentrations were higher (P<0.05) in supplemented cattle immediately following supplementation, but were not different from controls after supplement removal. Vitamin D(3) did not affect tenderness at supplement removal day 0, but increased the tenderness of the M. longissimus lumborum and M. semitendinosus at supplement removal day 7. Vitamin D(3) supplementation improves muscle tenderness and may be more effective when supplementation is ceased 7d before slaughter, with minimum food safety concerns.

Three groups of steers (A, B, C) were used to study the effect of temperament (Calm, Intermediate, and Excitable) on meat quality. Temperament was based on exit velocity, pen scores, and chute scores. Temperament traits were consistent across evaluations, and values decreased (P<0.05) in magnitude over time. Increasing excitability was associated with higher (P<0.05) serum cortisol concentrations. Carcasses from cattle with calm temperaments had higher (P<0.05) 0.5h postmortem pH values than those from Intermediate and Excitable cattle (0.1 and 0.2 units, respectively). Group C Excitable steers had higher (P<0.05) WBS values than the calmer Group C steers. This trend was observed in Group A steers, although the values were not statistically different. Correlations were highest between temperament values and tenderness after 21d. Temperament influences tenderness, although the mechanism is not clear.

Objective: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial., Study Design: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chi-square test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05., Results: One hundred sixty-eight patients (41%) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P<.001) or known reconstructive surgery for prolapse (P=.010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit., Conclusion: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.

Our study examined high and low voltage electrical stimulation and postmortem storage as strategies to improve tenderness and lean color in cabrito carcasses. Boer cross (n=60) kids were assigned to either high (550 V), low (20 V), or no electrical stimulation treatments. No differences in muscle temperature were observed between treatments at any time measured. Muscle pH declined fastest in high voltage treated carcasses. High voltage electrical stimulation slightly increased (P<0.05) b (∗) and a (∗) in the M. gluteus medius and tended to increase L (∗) and b (∗) (P=0.06 and 0.11, respectively) values in the M. longissimus thoracis. Electrical stimulation had no effect on myofibril fragmentation at 1-, 3-, or 14-d postmortem or sarcomere length. High voltage electrical stimulation increased (P<0.05) tenderness at 1- and 3-d postmortem, but not at 14-d postmortem. Aging for 3 d did not affect tenderness regardless of stimulation treatment, but aging time for 14 d improved (P<0.05) tenderness. These data indicate that high voltage electrical stimulation and 14 d aging were effective in improving the tenderness of meat from cabrito carcasses.

The objective of this research was to evaluate the consumer controlled factors of cooking method and degree of doneness on top loin steaks from different USDA quality grades (Low Choice, High Select or Low Select) and breed-types (English, Continental European Cross or Brahman Cross). In addition, cities within the same region were evaluated for differences in consumer controlled factors and palatability responses. The in-home product test was conducted in Dallas and San Antonio, Texas, USA. Consumers (n=173) evaluated steaks for overall like (OSAT), tenderness (TEND), juiciness (JUIC), and flavor (FLAV) using 23-point hedonic scales. Respondents in Dallas cooked their steaks to higher degrees of doneness than did those in San Antonio. Outdoor grilling was the most frequently used method of cookery for steaks in both cities. Generally, consumers in San Antonio gave higher palatability ratings to Choice steaks and Dallas consumers gave higher ratings to Select steaks. The interactions of city×cooking method, breed-type×cooking method, and degree of doneness×cooking method were significant for all palatability attributes. In addition, the interaction of cooking method×quality grade was significant for TEND, JUIC, and FLAV. Warner-Bratzler shear (WBS) force was determined on a steak from each strip loin. Steaks from Continental European Cross cattle and Low Choice carcasses had the lowest WBS values. Differences in consumer preparation of beef top loin steaks present very unique challenges for the beef industry. Consumer information programs may serve a valuable role in connecting consumer perceptions with the preparation techniques needed to consistently achieve satisfaction.

Objectives: Our purpose was (1). to report long-term objective and subjective outcome data after total colpocleisis with high levator plication and (2). to compare operative morbidity of total colpocleisis in patients with prior versus concurrent hysterectomy., Study Design: The medical records of patients who underwent total colpocleisis with high levator plication between August 1, 1988, and December 31, 2000, were retrospectively reviewed. Patient characteristics, operative data, and objective outcome measures including pelvic organ prolapse staging measurements were obtained from subject records. Subjective outcome measures were obtained by a standardized telephone survey. A t test was used to compare continuous variables between patients who underwent prior versus concurrent hysterectomy. The Fisher exact test was used to test for association between patient group and each categorical variable., Results: During the 12-year study period, 92 subjects underwent total colpocleisis with high levator plication. Of the 92 subjects, 90 (97.8%) underwent concurrent operations and 37 (40.2%) underwent simultaneous hysterectomy. With objective cure defined as absence of prolapse to the hymen, 90 subjects (97.8%) were objectively cured after a median follow-up of 12 months (range, 0-64 months). Of 62 subjects available for telephone follow-up, 56 (90.3%) reported being satisfied or very satisfied with how the surgery cured their prolapse after a median follow-up of 24 months (range, 13-161 months). Concurrent hysterectomy was associated with statistically significant increases in absolute change in hematocrit (9.5% without vs 11.9% with hysterectomy) and transfusion requirement (12.7% without vs 35.1% with hysterectomy). There was no significant difference in surgical complications between groups., Conclusion: Total colpocleisis is an effective operation for the treatment of advanced pelvic organ prolapse. Concurrent hysterectomy is associated with higher blood loss and transfusion requirements.

Urethral adenocarcinoma associated with urethral diverticulum is a rare condition that requires a high index of suspicion to ensure early diagnosis and appropriate therapy. The development of urethral stenosis in a patient with a urethral diverticulum warrants early biopsy to rule out a malignant lesion.

Objective: This was a study of the morphologic characteristics of urethral collagen in women with stress incontinence and continent control women., Study Design: Urethral needle biopsy specimens were obtained from 31 women. Fifteen women were continent, and the other 16 had undergone full urogynecologic assessment for symptoms of urinary incontinence. Biopsy specimens were assessed under electron microscopy. Mean collagen fibril diameter was measured and collagen morphologic characteristics were assessed., Results: The biopsy specimens from 30 women were included in the analysis. Collagen fibril diameter did not vary with continence status, the presence of pelvic organ prolapse, age, race or hormonal status. Alterations in collagen fibril morphologic characteristics were evident in the biopsy specimens from nine patients with incontinence. The alterations in collagen morphologic characteristics fell into three patterns, which for convenience were referred to as the obscured pattern, the dense pattern, and the degenerative pattern., Conclusion: Altered collagen morphologic characteristics are found in some patients with stress incontinence, and possible causes for those alterations are suggested by their appearances.

Objective: Our goal was to compare urethral sphincter biopsy and needle electromyography between women who had genuine stress incontinence and those who did not., Study Design: Seventeen continent women and 10 women with stress incontinence had urethral sphincter needle electromyography and urethral biopsy specimens blindly processed for light and electron microscopy., Results: The continent group had greater skeletal muscle content and percentage in each muscle fascicle and each urethral sphincter. The group with genuine stress incontinence had higher connective tissue content. All urethral skeletal muscle was type 1. The smooth muscle was "multiunit" type and was morphologically indistinguishable between the 2 groups. On electromyography, patients with genuine stress incontinence had significantly more fibrillation potentials, fewer motor unit action potentials, a higher percentage of polyphasia, and less maximum voluntary electrical activity than control subjects., Conclusions: Women with stress incontinence differ from continent women in skeletal muscle volume, amount of fibrosis, and electromyographic parameters; these differences support a neurogenic contribution to genuine stress incontinence. Urethral sphincter has only type 1 skeletal muscle and "multiunit" type smooth muscle.

Top loin (TLS), top sirloin (TSS), and eye of round (EYS) steaks, and loin end (LRR) and blade end (BRR) rib, and eye of round (EYR) roasts were used to determine the effect of USDA quality grade, Choice or Select, external fat trim level, and internal temperature endpoint on sensory, chemical and cooking characteristics. Cuts cooked with external fat required slightly greater cooking times and had higher fat content in the lean than cuts cooked without external fat (p < 0.05). Regardless of quality grade or external fat trim, increasing internal temperature endpoint resulted in tougher, drier cuts with longer cooking times and greater cooking loss (p < 0.05). Choice TLS, TSS and LRR were higher (p < 0.05) in palatability than Select, but quality grade did not affect palatability of BRR, EYS or EYR., (Copyright © 1998. Published by Elsevier Ltd.)

A commercial ostrich slaughter protocol was developed. Ostriches (n = 7 males and n = 7 females) averaged 95.54 kg live weight and yielded 55.91-kg carcasses. By-product yields were measured. The most significant by-products by weight were full viscera (8.29 kg), hide (6.71 kg), full gizzard and crop (5.80 kg), and abdominal fat (4.11 kg). Sex had no effect on slaughter yields. Post-mortem temperature declines were measured on five separate muscles and showed that chilling for 24 h was sufficient to adequately chill the deep muscle temperature to under 4 C. The effect of electrical stimulation on post-mortem pH decline also was investigated and had no effect.

The effect of calcium chloride, lactic acid or their combination on palatability, microbiological, and flavor characteristics of mature cow semimembranosus muscle was investigated. Regardless of aging time, a 10% injection of equal volumes of 0·3 m calcium chloride and 0·3 m lactic acid into hot-boned semimembranous muscle improved (P < 0·05) shear force values (approximately 35%) compared to hot- and cold-boned control cuts. Microbiological characteristics for all treatments were similar. Control cuts retained more desirable flavor (beefy and serumy/bloody) and less off-flavor (liver, sour, bitter and astringent) than calcium-chloride- or lactic-acid-injected cuts., (Copyright © 1994. Published by Elsevier Ltd.)

Areas on freshly slaughtered beef carcasses were sprayed with hot (95°C), sterilized, distilled water in order to elevate carcass surface temperature to 82°C. A significant (P < 0·05) reduction in bacterial numbers was observed between control (prespray) and hot water treated carcass surfaces. These results indicate that microbial decontamination of beef carcasses with hot water will be effective if an approprite spraying apparatus is used., (Copyright © 1993. Published by Elsevier Ltd.)

Hot (55°C), dilute (1% v/v) lactic acid was sprayed on beef carcass surfaces immediately after dehiding, after evisceration (immediately before chilling), or at both locations. Surface samples of carcasses were examined for total aerobic plate counts (APCs) and for the presence of Salmonella and Listeria . APCs of treated beef carcasses were lower (P<0.05) than those of control carcasses. APCs were determined both at slaughter day 0 (immediately after carcasses enter the chill room) and after 72 h postmortem. At day 0, reductions in log 10 APC by more than 90% occurred when carcasses were treated with lactic acid after evisceration or both after dehiding and after evisceration. The effect of lactic acid decontamination was greatest on carcasses treated with lactic acid both after dehiding and after evisceration. No further reductions in APCs of carcasses were observed on samples taken 72 h postmortem. No difference in color between control and acid-treated carcasses was observed. All samples tested for the presence of Salmonella were negative. Listeria was detected in three samples from control carcasses only. Samples obtained from strip loins of acid-treated or control carcasses did not show any consistent pattern of differences in microbiological counts. Additional data collected from carcasses sprayed with lactic acid in three different sized slaughter plants showed that irrespective of differences in size of slaughter facility, mean APCs of acid-treated carcasses were significantly (P<0.05) lower than those of control carcasses.