Evaluation of Outcomes Between the Top-down Versus the Bottom-up Approach for Retropubic Midurethral Sling

Introduction and hypothesis: Retropubic midurethral sling (MUS) placement is the gold standard for the treatment of stress urinary incontinence in the USA. The procedure can be approached from either a top-down or a bottom-up direction, but there is a paucity of contemporary data regarding outcomes between these approaches. The aim of this study was to provide updated clinical outcomes data. Methods: This was a retrospective cohort study of women undergoing the retropubic MUS procedure alone or at the time of pelvic organ prolapse repair between 2010 and 2020 at a single academic medical center. The electronic medical record was used to extract demographic data, operative approach, and perioperative complications. The primary outcome was a composite incidence of any perioperative complication. Results: Of the 309 patients analyzed, 140 (45.3%) underwent top-down and 169 (54.7%) underwent bottom-up retropubic MUS placement. Patients undergoing top-down MUS placement were more likely to be older (mean age 58 vs 54, p=0.02), have a history of diabetes mellitus (20% vs 8.9%, p=0.004), and have had a prior hysterectomy (27% vs 16%, p=0.02). They were less likely to have a concurrent anterior (p\u3c0.001) or posterior repair (p\u3c0.001). Patients undergoing the top-down procedure were less likely to experience sling exposure (p=0.02); complications in the two groups were otherwise similar. Conclusions: The top-down approach to retropubic MUS placement was associated with lower rates of mesh erosion in this population of patients. Neither approach is associated with an increased overall risk of complications or de novo overactive bladder symptoms

Evaluating Social Vulnerability Impact on Care & Prognosis of Head & Neck-Nervous System Cancers in the US

Introduction In the current literature, the association between social determinants of health (SDH) and head & neck-nervous system cancer (HNNsC) is limited by the narrow scope of SDH assessed and the broad classifications of HNNsC. Our study utilizes the CDC-Social Vulnerability Index (SVI) to assess both the individual and collective impact of four social determinant themes on various HNNsC in US adults. Methods This retrospective cohort study utilized the SEER database to evaluate 116,373 adult patients from 1975-2017 who presented with various types of HNNsC. Patients were assigned SVI scores based on county-of-residence at the time of diagnosis, encompassing total SVI score and 4 sub-scores of socioeconomic status, minority-language status, household composition, and housing-transportation. Using these scores, univariate linear regressions were used to assess patient care (months of follow-up) and prognosis (months of survival). Results As the total SVI score/overall social vulnerability increased, a significant decrease in months of follow-up was observed for many HNNsC tumors (p\u3c 0.001), ranging from 3.55-36.6% decreases in mean lengths of follow-up when comparing the lowest to highest vulnerability cohorts. Similarly, a decrease in months of survival was observed (p\u3c 0.001), ranging from 6.90-45.81% decreases in the mean survival period when comparing the lowest to highest vulnerability cohorts. Increases in vulnerability within SVI sub-scores/SDH themes contributed significantly to these total-SVI trends in months of follow-up and survival, with each social determinant impacting different disease classes to varying extents. Conclusions The results of this study show that with increasing social vulnerability, there is a significant decrease in both the care (follow-up) and the prognosis (survival) of US adults with HNNsC and highlight which particular SDH contributes more to disparities

The impact of digital inequities on salivary gland cancer disparities in the United States

Introduction: Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC). Methods: The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality. Results: Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01–1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01–1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91–0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods. Conclusions: Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities

Injectable PLGA Microscaffolds with Laser-Induced Enhanced Microporosity for Nucleus Pulposus Cell Delivery

Intervertebral disc (IVD) degeneration is a leading cause of lower back pain (LBP). Current treatments primarily address symptoms without halting the degenerative process. Cell transplantation offers a promising approach for early-stage IVD degeneration, but challenges such as cell viability, retention, and harsh host environments limit its efficacy. This study aimed to compare the injectability and biocompatibility of human nucleus pulposus cells (hNPC) attached to two types of microscaffolds designed for minimally invasive delivery to IVD. Microscaffolds are developed from poly(lactic-co-glycolic acid) (PLGA) using electrospinning and femtosecond laser structuration. These microscaffolds are tested for their physical properties, injectability, and biocompatibility. This study evaluates cell adhesion, proliferation, and survival in vitro and ex vivo within a hydrogel-based nucleus pulposus model. The microscaffolds demonstrate enhanced surface architecture, facilitating cell adhesion and proliferation. Laser structuration improved porosity, supporting cell attachment and extracellular matrix deposition. Injectability tests show that microscaffolds can be delivered through small-gauge needles with minimal force, maintaining high cell viability. The findings suggest that laser-structured PLGA microscaffolds are viable for minimally invasive cell delivery. These microscaffolds enhance cell viability and retention, offering potential improvements in the therapeutic efficiency of cell-based treatments for discogenic LBP

Telehealth vs Clinic Postoperative Visit After Hysterectomy: A Randomized Controlled Trial

Introduction and Hypothesis: Telehealth is becoming more common, but there is a paucity of literature investigating the role of telehealth in perioperative gynecologic care. The authors hypothesized that patients evaluated via telehealth 4 weeks after minimally invasive hysterectomy would not have lower satisfaction than patients evaluated in clinic. Methods: This was a randomized controlled noninferiority trial of patients who underwent minimally invasive hysterectomy at a single academic medical center. Participants were randomized to postoperative clinic visit or telehealth visit 4 weeks after hysterectomy. After the 4-week postoperative visit, patients were sent a satisfaction questionnaire. The primary outcome was overall patient satisfaction on a 100 mm visual analog scale. Secondary outcomes were 90-day postoperative complications and unplanned events. Results: One hundred one patients who underwent minimally invasive hysterectomy were identified for inclusion. Complete data were collected for 47 in the clinic group and 45 in the telehealth group. Overall postoperative visit satisfaction did not differ between groups (94.3 clinic vs. 92.0 telehealth, p = 0.47). The clinic group was significantly more likely to contact the clinic two or more times (p = 0.02); both groups were similarly likely to contact the clinic at least once (57.4% vs. 51.1%). Postoperative complications did not differ between groups, nor did unplanned clinic visits or emergency department (ED) visits. Conclusions: Postoperative visit satisfaction of patients evaluated via telehealth was noninferior to the satisfaction of patients seen in the clinic 4 weeks after minimally invasive hysterectomy. Unplanned clinic visits and ED visits did not differ between groups, nor did 90-day postoperative complications

Assessing social vulnerabilities of salivary gland cancer care, prognosis, and treatment in the United States

Background: Salivary gland cancers (SGC)-social determinants of health (SDoH) investigations are limited by narrow scopes of SGC-types and SDoH. This Social Vulnerability Index (SVI)-study hypothesized that socioeconomic status (SES) most contributed to SDoH-associated SGC-disparities. Methods: Retrospective cohort of 24 775 SGCs assessed SES, minority-language status (ML), household composition (HH), housing-transportation (HT), and composite-SDoH measured by the SVI via regressions with surveillance and survival length, late-staging presentation, and treatment (surgery, radio-, chemotherapy) receipt. Results: Increasing social vulnerability showed decreases in surveillance/survival; increased odds of advanced-presenting-stage (OR: 1.12, 95% CI: 1.07, 1.17), chemotherapy receipt (OR: 1.13, 95% CI: 1.03, 1.23); decreased odds of primary surgery (0.89, 0.84, 0.94), radiotherapy (0.91, 0.85, 0.97, p = 0.003) for SGCs. Trends were differentially correlated with SES, ML, HH, and HT-vulnerabilities. Conclusions: Through quantifying SDoH-derived SGC-disparities, the SVI can guide targeted initiatives against SDoH that elicit the most detrimental associations for specific sociodemographics

Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US: Epidemiology

Background: Previous social determinants of health (SDoH) studies on laryngeal cancer (LC) have assessed individual factors of socioeconomic status and race/ethnicity but seldom investigate a wider breadth of SDoH-factors for their effects in the real-world. This study aims to delineate how a wider array of SDoH-vulnerabilities interactively associates with LC-disparities. Methods: This retrospective cohort study assessed 74,495 LC-patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) database using the Social Vulnerability Index (SVI) from the CDC, total SDoH-vulnerability from 15 SDoH variables across specific vulnerabilities of socioeconomic status, minority-language status, household composition, and infrastructure/housing and transportation, which were measured across US counties. Univariate linear and logistic regressions were performed on length of care/follow-up and survival, staging, and treatment across SVI scores. Results: Survival time dropped significantly by 34.37% (from 72.83 to 47.80 months), and surveillance time decreased by 28.09% (from 80.99 to 58.24 months) with increasing overall social vulnerability, alongside advanced staging (OR 1.15; 95%CI 1.13–1.16), increased chemotherapy (OR 1.13; 95%CI 1.11–1.14), decreased surgical resection (OR 0.91; 95%CI 0.90–0.92), and decreased radiotherapy (OR 0.97; 95%CI 0.96–0.99). Discussion: In this SDoH-study of LCs, detrimental care and prognostic trends were observed with increasing overall SDoH-vulnerability. (Figure presented.

Guidance for gynecologists utilizing telemedicine during COVID‐19 pandemic based on expert consensus and rapid literature reviews

Guidance for gynecologists using telemedicine during COVID‐19 based on rapid literature review, review of society recommendations, and expert consensus in accessible format

The Impact of Digital Inequities on Oropharyngeal Cancer Disparities in the United States

Objective: To assess associations of digital inequity with oropharyngeal cancer (OPC) prognostic and care outcomes in the United States while adjusting for traditional social determinants/drivers of health (SDoH). Study Design: Retrospective cohort study. Setting: United States. Methods: In total, 70,604 patients from 2008 to 2017 were assessed for regression trends in long-term follow-up period, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the Digital Inequity Index (DII). DII is based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (ie, digital-related variables) or sociodemographic (ie, education, income, and disability status) and weighted-averaged into a composite score. Results: With increasing DII, decreases in length of follow-up (10.22%, 32.9-29.5 months; P \u3c .001) and survival (8.93%, 19-17.3 months; P \u3c .001) were observed. Affordability of internet access displayed the largest influence, followed by device access and internet-service availability. Compared to OPC patients with low digital inequity, high digital inequity was associated with increased odds of diagnosing more than one malignant tumor (odds ratio [OR] 1.01, 95% CI 1.01-1.03; P =.012) and advanced staging (OR 1.01, 95% CI 1.00-1.02; P =.034), while having decreased odds of receiving indicated chemotherapy (OR 0.98, 95% CI 0.97-0.99; P \u3c .001), radiation therapy (OR 0.98, 95% CI 0.97-0.99; P \u3c .001), or primary surgery (OR 0.98, 95% CI 0.97-0.99; P \u3c .001). Conclusion: Digital inequities contribute to detrimental trends in OPC patient care and prognosis in the United States. These findings can inform strategic discourse targeted against the most pertinent disparities in the modern-day environment

Nitric oxide production and antioxidant function during viral infection of the coccolithophore Emiliania huxleyi

Emiliania huxleyi is a globally important marine phytoplankton that is routinely infected by viruses. Understanding the controls on the growth and demise of E. huxleyi blooms is essential for predicting the biogeochemical fate of their organic carbon and nutrients. In this study, we show that the production of nitric oxide (NO), a gaseous, membrane-permeable free radical, is a hallmark of early-stage lytic infection in E. huxleyi by Coccolithoviruses, both in culture and in natural populations in the North Atlantic. Enhanced NO production was detected both intra- and extra-cellularly in laboratory cultures, and treatment of cells with an NO scavenger significantly reduced viral production. Pre-treatment of exponentially growing E. huxleyi cultures with the NO donor S-nitroso-N-acetylpenicillamine (SNAP) prior to challenge with hydrogen peroxide (H2O2) led to greater cell survival, suggesting that NO may have a cellular antioxidant function. Indeed, cell lysates generated from cultures treated with SNAP and undergoing infection displayed enhanced ability to detoxify H2O2. Lastly, we show that fluorescent indicators of cellular ROS, NO, and death, in combination with classic DNA- and lipid-based biomarkers of infection, can function as real-time diagnostic tools to identify and contextualize viral infection in natural E. huxleyi blooms