Search

To describe the perioperative outcomes of repeat myomectomy. Single center retrospective study. High-volume academic medical center. Patients undergoing repeat abdominal, laparoscopic, or robotic-assisted myomectomy from January 2022 to March 2024. N/A. A total of 65 of 1093 cases (6%) were identified as repeat myomectomies. Mean patient age was 41 years. Cases were performed by fellowship trained gynecologic surgeons (76.9%) and general gynecologists (23.1%). Repeat myomectomy was predominantly performed via abdominal route (81.5%), followed by laparoscopic (10.8%), and robotic assisted (7.7%) routes. Most patients undergoing repeat surgery had a history of prior abdominal myomectomy (67.8%), followed by laparoscopic (13.8%), robotic-assisted (9.2%), and 6 patients (9.2%) had two prior myomectomies. On average, repeat myomectomy was performed 8.7 years after primary myomectomy. Mean total number of fibroids removed was 25.6 (range 1-87). Overall transfusion rate was 7.7%. 2 cases (3.1%) were complicated by bowel injury. 38.5% of repeat myomectomies had significant intra-abdominal adhesions, 20% mild adhesions, and 41.5% no adhesions. A chi-square test of independence confirmed a significant association between the route of prior myomectomy and presence of adhesions (p <0.001); namely prior abdominal myomectomy was associated with current adhesive disease. Comparing abdominal and minimally invasive repeat myomectomies, there was no significant difference in mean estimated blood loss (381 mL vs. 248 mL, p= 0.21) or mean operative time (157 vs. 151 minutes, p= 0. 79). There were no bladder injuries, unplanned overnight admissions, readmissions or reoperations. Although uncommonly performed, we found that repeat myomectomy is generally safe. Most cases were complicated by adhesive disease, although transfusions and bowel injury were overall rare. Our rate of perioperative blood transfusion is consistent with published rates after myomectomy. However, our rate of bowel injury was higher than published rates for benign gynecologic surgery. Our findings can aide in pre-operative counseling of patients prior to undergoing repeat myomectomy. [ABSTRACT FROM AUTHOR]

To evaluate the association between cesarean scar nice (CSN) and pelvic pain. We performed a systematic review and meta-analysis. A comprehensive strategy was used to search MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and clinicaltrials.gov. PROSPERO registration was obtained (CRD42022346443). We included published manuscripts of randomized controlled trials, prospective and retrospective cohorts, and case series. Inclusion criteria was limited to studies including symptomatic patients with a radiologic diagnosis of a CSN, and those which evaluated pain as an outcome. Risk of bias was assessed with the Robins-I tool. The primary outcome was prevalence of pelvic pain in patients with confirmed CSN. Other outcomes included the risk of pain in patients with CSN compared those without, and changes in pain symptoms following medical or surgical management of niche. Forty-seven studies reported on pain (dysmenorrhea, dyspareunia, chronic pelvic pain (CPP), suprapubic pain (SPP)) in patients with CSN. Patients with a CSN were at increased risk of dysmenorrhea (RR 2.25, 95%CI 0.90-5.62), dyspareunia (RR 2.05 95%CI 1.42-2.99), and CPP (2.72, 95%CI 1.63-4.54) compared to those without. In symptomatic patients with a confirmed niche, the prevalence of dysmenorrhea was 35.4% (95%CI 31.0-56.5); dyspareunia 20.1% (95%CI 14.3-48.7); CPP 20.2% (95%CI 15.9-36.2) and SPP 33.5% (95%CI 14.4-58.0). Both medical and surgical treatment of CSN were associated with a significant decrease in pain (OR 0.11, 95%CI 0.06-0.22, 17 studies, 999 patients, I2=83.0%). Most studies were high risk for measurement bias due to lack of standardization for outcome measures. There is a strong association between uterine niche and various pelvic pain symptoms. Providers should have a low threshold to assess for CSN in patients with a history of otherwise unexplained pain arising after cesarean delivery, and treatment should be strongly considered. Future studies require standardization of nomenclature and reporting for pain in this context. [ABSTRACT FROM AUTHOR]

Background: Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards).Aim: To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour.Methods: The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs.Findings: In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model.Conclusion: The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units. [ABSTRACT FROM AUTHOR]

Highlights • Almost half of multi-drug resistant equine E. coli isolates were classified as ExPEC. • Serogroups O1, O19a, O40, O101 and O153 are previously reported human clinical ExPEC. • Quinolone and fluoroquinolone resistance was prevalent among equine E. coli isolates. • 65% of isolates harboured one or more TEM, SHV and CTX-M-2 group β-lactamases. • Class 1 and class 2 integrons were detected in 85% of equine E. coli isolates. Abstract Extraintestinal pathogenic E. coli (ExPEC) possess the ability to cause extraintestinal infections such as urinary tract infections, neonatal meningitis and sepsis. While information is readily available describing pathogenic E. coli populations in food-producing animals, studies in companion/sports animals such as horses are limited. In addition, many antimicrobial agents used in the treatment of equine infections are also utilised in human medicine, potentially contributing to the spread of antibiotic resistance determinants among pathogenic strains. The aim of this study was to phenotypically and genotypically characterise the multidrug resistance and virulence associated with 83 equine E. coli isolates recovered from foals with diarrhoeal disease. Serotyping was performed by both PCR and sequencing. Antibiotic resistance was assessed by disc diffusion. Phylogenetic groups, virulence genes, antibiotic resistance genes and integrons were determined by PCR. Thirty-nine (46%) of the isolates were classified as ExPEC and hence considered to be potentially pathogenic to humans and animals. Identified serogroups O1, O19a, O40, O101 and O153 are among previously reported human clinical ExPEC isolates. Over a quarter of the E. coli were assigned to pathogenic phylogroups B2 (6%) and D (23%). Class 1 and class 2 integrons were detected in 85% of E. coli , revealing their potential to transfer MDR to other pathogenic and non-pathogenic bacteria. With 65% of potentially pathogenic isolates harbouring one or more TEM, SHV and CTX-M-2 group β-lactamases, in addition to the high levels of resistance to fluoroquinolones observed, our findings signal the need for increased attention to companion/sport animal reservoirs as public health threats. [ABSTRACT FROM AUTHOR]

Despite a great deal of research into Alzheimer’s disease (AD) over the last 20 years, an effective treatment to halt or slow its progression has yet to be developed. With many aspects of the disease progression still to be elucidated, focus has shifted from reducing levels of amyloid β (Aβ) in the brains of AD patients towards tau, another pathology, which initiates much earlier in deeper brainstem networks and is thought to propagate via cell-to-cell processes prior to the onset of amyloid pathology and cognitive impairments. In-vitro, ex-vivo molecular biology/biochemistry read-outs, and various transgenic animal models have been developed, yet clinical failures have highlighted a clear disconnect and inadequate use of such animal models in translational research across species. AD pathology is now estimated to begin at least 10–20 years before clinical symptoms, and imaging and cerebrospinal fluid biomarkers are leading the way in assessing the disease progression at a stage where neuronal damage has already occurred. Here, we emphasize the relevance of assessing early disruptions in network connectivity and plasticity that occur before neuropathological damage and progressive memory dysfunction, which can have high translational value for discovery of pre-symptomatic AD biomarkers and early mechanism-based disease interception therapeutics. [ABSTRACT FROM AUTHOR]

Low carbon shipping research focuses on energy efficiency and mitigation measures related to operations and technology. However, reducing energy use and greenhouse gas emissions associated with a vessel's material production receives limited attention. Material efficiency is defined as "providing material services with less material production and processing". The current business model for ship building and breaking does not embrace fully material efficiency principles. Exploring a case study of a vessel's steel hull, this study applies a Life Cycle Assessment approach to determine the effectiveness of material efficiency to reduce CO2 emissions. When compared to Business as Usual, designing and manufacturing for 100% hull reuse provides an emissions reduction of 29% from 221,978 t CO2 to 158,285 t CO2; 50% reuse provides a 10% reduction (199,816 t CO2). From a technical and safety perspective there remain key barriers that need addressing: a vessel's hull would require to be designed for dismantling to improve reuse; the operation and maintenance schedule must ensure the value of the steel is retained and; data must flow between key stakeholders on the quality of the steel. Despite these challenges, progressing material efficiency would require different business models that reach out and integrate the whole supply chain. There is a need for public and privately funded demonstration projects at a range of scales and markets, to provide investors the confidence that there is retained value in the steel hull when it reaches its end-of-life. [ABSTRACT FROM AUTHOR]

Cohort studies have suggested that the use of statins is associated with decreased risk of glioma formation and mortality. Here, a cohort of patients with glioblastoma multiforme (GBM) was analyzed to further investigate associations between preoperative use of statins and recurrence, and progression free and overall survival. Patients who had surgery for GBM (N = 284) were followed up for a median of 18.1 months. Seventy-eight patients were taking statins preoperatively while the rest were not. Cox proportional hazards models adjusted for several covariates of interest were applied before and after propensity score matching. Compared with statin users, those not taking the lipid-lowering drugs had similar progression free survival before (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.70–1.26; p = 0.68) and after propensity score matching (HR 0.95, 95% CI 0.67–1.35; p = 0.68). Mortality was similar between both groups of patients before (HR 0.94, 95% CI 0.70–1.22; p =  0.73) and after propensity score matching (HR 1.13, 95% CI 0.78–1.64; p = 0.49). Age and dexamethasone use were independent prognostic factors of survival. Contrary to previously published evidence, this study could not find an association between preoperative statin use and longer survival in GBM patients. Due to the small number of patients and retrospective nature of the study, further work is needed to understand the role of perioperative statins in GBM patients. [ABSTRACT FROM AUTHOR]

Wollongong, Australia is an urban site at the intersection of anthropogenic, biomass burning, biogenic and marine sources of atmospheric trace gases. The location offers a valuable opportunity to study drivers of atmospheric composition in the Southern Hemisphere. Here, a record of surface carbon monoxide (CO), methane (CH 4 ) and carbon dioxide (CO 2 ) was measured with an in situ Fourier transform infrared trace gas analyser between April 2011 and August 2014. Clean air was found to arrive at Wollongong in approximately 10% of air masses. Biomass burning influence was evident in the average annual cycle of clean air CO during austral spring. A significant negative short-term trend was found in clean air CO (−1.5 nmol mol −1 a −1 ), driven by a reduction in northern Australian biomass burning. Significant short-term positive trends in clean air CH 4 (5.4 nmol mol −1 a −1 ) and CO 2 (1.9 μmol mol −1 a −1 ) were consistent with the long-term global average trends. Polluted Wollongong air was investigated using wind-direction/wind-speed clustering, which revealed major influence from local urban and industrial sources from the south. High values of CH 4 , with anthropogenic ΔCH 4 /ΔCO 2 enhancement ratio signatures, originated from the northwest, in the direction of local coal mining. A pollution climatology was developed for the region using back trajectory analysis and ΔO 3 /ΔCO enhancement ratios. Ozone production environments in austral spring and summer were associated with anticyclonic meteorology on the east coast of Australia, while ozone depletion environments in autumn and winter were associated with continental transport, or fast moving trajectories from southern latitudes. This implies the need to consider meteorological conditions when developing policies for controlling air quality. [ABSTRACT FROM AUTHOR]

To systematically review and meta-analyze randomized controlled trials (RCTs) comparing postoperative bladder retrofilling to passive filling after outpatient gynecologic surgery to evaluate effects on postoperative outcomes. Systematic review and meta-analysis. N/A. Two reviewers screened 1465 articles after searching MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and ClinicalTrials.gov from 1947 to August 2020. We included RCTs comparing postoperative bladder retrofilling to passive filling in patients who underwent outpatient gynecologic surgery by any approach. The primary outcome was time to first void. Secondary outcomes included time to discharge, postoperative urinary retention, urinary tract infection, and patient satisfaction. N/A. We included eight studies with 1173 patients. Bladder retrofilling in the operating room resulted in a significant decrease in time to first void (mean difference (MD) –33.5 minutes; 95% confidence interval (CI): –49.1 to –17.9, 4 studies, 403 patients) and time to discharge (MD –32.0 minutes; 95% CI: –51.5 to –12.6, 8 studies, 1164 patients). Bladder retrofilling did not shorten time to discharge when performed in the post-anesthetic care unit (MD –14.8 min; 95% CI: –62.6 to 32.9, 3 studies, 258 patients) or after laparoscopic hysterectomy (MD –26.0 min; 95% CI: –56.5 to 4.5, 5 studies, 657 patients). There were no differences in patient satisfaction, postoperative urinary retention, or risk of urinary tract infection between groups. Retrofilling the bladder in the operating room after outpatient gynecologic surgery reduces the time to first void and discharge with no increase in adverse events. [ABSTRACT FROM AUTHOR]

Abstract: The study assessed radiation exposure during EVAR. Two types of patient dose were estimated: effective dose (ED), which allows estimation of radiation risk to the EVAR patient population; and Peak Skin Dose (PSD), which allows us assess the potential for an individual patient to receive a radiation skin injury. An ancillary aim was to examine dose optimization in EVAR procedures. Based on 111 EVAR cases we estimated average ED as 12.4 mSv. Cumulative patient dose in our centre was lower than other studies because the follow up of EVAR patients is based on ultrasound rather than CT. PSD calculated using a published conversion formula closely matched measurements with calibrated gafchromic film. 99% of patients had an estimated PSD of < 2Gy. Results indicate that skin injuries are possible, but very unlikely in EVAR procedures at our centre. EVAR is a high dose procedure and emphasis on dose optimisation is important. We broke the EVAR procedure into 15 steps and, in a phantom study, showed how skin dose changes as procedure steps are varied. The resulting dose matrix has the potential to be used as an educational tool to promote dose optimization. [Copyright &y& Elsevier]

Abstract: We report the results of an intercomparison of vertical column amounts of HCl, HF, N2O, HNO3, CH4, O3, CO2 and N2 derived from the spectra recorded by two ground-based FTIR spectrometers operated side-by-side using the sun as a source. The procedures used to record spectra and derive vertical column amounts followed the format of previous instrument intercomparisons organised by the Network for Detection of Stratospheric Change (NDSC), but the level of agreement achieved was significantly better than for previous intercomparisons. For most gases the differences were typically 1% or less, with at least one of the five datasets showing no statistically significant difference between the results from different instruments. Principal exceptions were HNO3 and CO2 when measured on the Mercury Cadmium Telluride (MCT) detectors. For these gases differences of between 2% and 3% were more typical. We present evidence that these larger differences are due to the effects of detector non-linearity and show that by applying an established non-linearity correction method the typical level of agreement can be improved to better than 1% for these gases. We suggest that the improved level of agreement achieved during this intercomparison is indicative of the current state of the art within the NDSC infra-red working group and is a result of improved understanding of the importance of critical alignment parameters and newly developed techniques to characterise the spectrometers’ performance. [Copyright &y& Elsevier]

To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. We also evaluated for factors associated with treatment success and pregnancy outcomes following medical management. Systematic review and metanalysis. Not applicable. Thirty-two studies representing 121 premenopausal women with medically treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science and cited references. Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception (CHC), uterotonics, danazol, or combination of the above. The primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (re-admission or transfusion). The unadjusted overall success rate of medical management was 88% (106/121), while individual agent success rates were progestins (82.5%), GnRH-a (89.3%), methotrexate (90.9%), CHC (42.8%), uterotonics (100%), and danazol (66.6%). After adjusting for clustering effects, success rates for progestin (82.5%, 95% CI 70.1% to 90.4%, <0.001), GnRH-a (89.3%, 95% CI 71.4% to 96.5%, p<0.001) and methotrexate (90.0%, 95% CI 55.8% to 98.8%, p=0.028) were significantly different from the null hypothesis of 50% success. In a pairwise comparisons, progestins (OR 6.29, 95% CI 1.19 to 33.17, p=0.030) and GnRH-a (OR 11.13, 95% CI 1.63 to 76.10, p=0.014) were more efficacious compared to CHC. The agents with the lowest adjusted proportion of complications were progestins (10.0%, 95% CI 3.3% to 26.8%, p<0.001) and GnRH-a (10.7%, 95% CI 3.5% to 28.4%, p<0.001). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM. Primary medical management for symptomatic uterine AVM is a reasonable approach in a well selected patient. This data should be interpreted in the context of significant publication bias. [ABSTRACT FROM AUTHOR]