Obliterative surgery for the treatment of pelvic organ prolapse: A patient survey on reasons for surgery selection and post-operative decision regret and satisfaction

Objectives: To identify patient-reported reasons for selecting obliterative surgery for the purpose of predicting decision regret and satisfaction. Methods: We created a deidentified database of patients who underwent an obliterative procedure for prolapse from 2006 to 2013. Patients were excluded if they declined study participation, were deceased, or had dementia. Participants completed a survey regarding reasons for selecting obliterative surgery and a modified version of validated questionnaires on decision regret (Decision Regret Scale-Pelvic Floor Disorder) and satisfaction (Satisfaction with Decision Scale-Pelvic Floor Disorder). Parsimonious multivariate linear regression models were constructed to determine if any of the reasons given for choosing obliterative surgery were independent predictors of decision regret and satisfaction after controlling for significant sociodemographic, clinical, and surgical outcome data identified by bivariate analysis. Results: Seventy-seven women completed the surveys. "To follow my doctor's recommendations" and "no longer sexually active," and/or "did not plan to be" as reasons for selecting obliterative surgery made the most difference; however, these reasons were not identified as independent predictors of decision regret or satisfaction after controlling for confounders. The regret linear regression models identified preoperative sexual activity rather than the patient-reported reason "no longer sexually active and/or did not plan to be," as the only independent predictor of more decision regret after obliterative surgery (B coefficient 1.68, P < 0.01). The satisfaction linear regression models identified reoperation for any reason as an independent predictor of lower satisfaction ([beta], -0.24; P = 0.04) and the patient-reported reason for choosing obliterative surgery "not interested in pessary" as a predictor of higher satisfaction ([beta], 0.30, P = 0.01). Conclusions: This study advances our knowledge about the obliterative surgical decision making process. Behavioral and educational interventions directed at improving patient and physician communications concerning the dynamics of sexual health issues in an aging population will likely decrease regret when obliterative surgery is chosen. Minimizing reoperation after obliterative surgery through increased experience, knowledge, and improved surgical skills and patient validation when pessary is declined will likely improve satisfaction when obliterative surgery is chosen

Sp converted waves reveal the structure of the lithosphere below the Alps and their northern foreland

The structure of the lithosphere is reflecting its evolution. The Moho of the European lithosphere has already been studied intensively. This is, however, not yet the case for the lower boundary of the lithosphere, i.e., the lithosphere-asthenosphere boundary (LAB). We are using S-to-P converted seismic waves to study the structures of the Moho and the LAB beneath Europe including the greater Alpine Area with data from the AlpArray project and the European networks of permanent seismic stations. We use plain waveform stacking of converted waves without deconvolution and compare the results with stacking of deconvolved traces. We also compare Moho depths determinations using S-to-P converted waves with those obtained by other seismic methods. We present more detailed information about negative velocity gradients (NVG) below the Moho. Its lower bound may be interpreted as representing the LAB. We found that the thickness of the European mantle lithosphere is increasing from about 50°N towards the Alps along the entire east-west extension of the Alps. The NVG has also an east dipping component towards the Pannonian Basin and the Bohemian Massif. The Alps and their northern foreland north of about 50°N are surrounded in the east, west and north by a north dipping mantle lithosphere. Along 50°N, where the NVG is reversing its dip direction towards the north, is also the area along which the volcanoes of the European Cenozoic Rift System are located. Our results possibly indicate that the Alpine collision has deformed the entire lithosphere of the Alpine foreland as far north as about 50°N

Intraluminal crawling of neutrophils to emigration sites: a molecularly distinct process from adhesion in the recruitment cascade

The prevailing view is that the β2-integrins Mac-1 (αMβ2, CD11b/CD18) and LFA-1 (αLβ2, CD11a/CD18) serve similar biological functions, namely adhesion, in the leukocyte recruitment cascade. Using real-time and time-lapse intravital video-microscopy and confocal microscopy within inflamed microvessels, we systematically evaluated the function of Mac-1 and LFA-1 in the recruitment paradigm. The chemokine macrophage inflammatory protein-2 induced equivalent amounts of adhesion in wild-type and Mac-1−/− mice but very little adhesion in LFA-1−/− mice. Time-lapse video-microscopy within the postcapillary venules revealed that immediately upon adhesion, there is significant intraluminal crawling of all neutrophils to distant emigration sites in wild-type mice. In dramatic contrast, very few Mac-1−/− neutrophils crawled with a 10-fold decrease in displacement and a 95% reduction in velocity. Therefore, Mac-1−/− neutrophils initiated transmigration closer to the initial site of adhesion, which in turn led to delayed transmigration due to movement through nonoptimal emigration sites. Interestingly, the few LFA-1−/− cells that did adhere crawled similarly to wild-type neutrophils. Intercellular adhesion molecule-1 but not intercellular adhesion molecule-2 mediated the Mac-1–dependent crawling. These in vivo results clearly delineate two fundamentally different molecular mechanisms for LFA-1 and Mac-1 in vivo, i.e., LFA-1–dependent adhesion followed by Mac-1–dependent crawling, and both steps ultimately contribute to efficient emigration out of the vasculature

3D shear wave velocity imaging of the subsurface structure of granite rocks in the arid climate of Pan de Azúcar, Chile, revealed by Bayesian inversion of HVSR curves

Seismic methods are emerging as efficient tools for imaging the subsurface to investigate the weathering zone. The structure of the weathering zone can be identified by differing shear wave velocities as various weathering processes will alter the properties of rocks. Currently, 3D subsurface modelling of the weathering zone is gaining increasing importance as results allow the identification of the weathering imprint in the subsurface not only from top to bottom but also in three dimensions. We investigated the 3D weathering structure of monzogranite bedrock near the Pan de Azúcar National Park (Atacama Desert, northern Chile), where the weathering is weak due to the arid climate conditions. We set up an array measurement that records seismic ambient noise, which we used to extract the horizontal-to-vertical spectral ratio (HVSR) curves. The curves were then used to invert for 1D shear wave velocity (Vs) models, which we then used to compile a pseudo-3D model of the subsurface structure in our study area. To invert the 1D Vs model, we applied a transdimensional hierarchical Bayesian inversion scheme, allowing us to invert the HVSR curve with minimal prior information. The resulting 3D model allowed us to image the granite gradient from the surface down to ca. 50 m depth and confirmed the presence of dikes of mafic composition intruding the granite. We identified three main zones of fractured granite, altered granite, and the granite bedrock in addition to the mafic dikes with relatively higher Vs. The fractured granite layer was identified with Vs of 1.4 km s−1 at 30–40 m depth, while the granite bedrock was delineated with Vs of 2.5 km s−1 and a depth range between 10 and 50 m depth. We compared the resulting subsurface structure to other sites in the Chilean coastal cordillera located in various climatic conditions and found that the weathering depth and structure at a given location depend on a complex interaction between surface processes such as precipitation rate, tectonic uplift and fracturing, and erosion. Moreover, these local geological features such as the intrusion of mafic dikes can create significant spatial variations to the weathering structure and therefore emphasize the importance of 3D imaging of the weathering structure. The imaged structure of the subsurface in Pan de Azúcar provides the unique opportunity to image the heterogeneities of a rock preconditioned for weathering but one that has never experienced extensive weathering given the absence of precipitation.</p

If you could see what we see, would it bother you?

Objective The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam. Methods Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: “In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?” Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. Results The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as “not at all” or “somewhat” successful. Conclusion Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination

La responsabilidad social empresaria como emergente territorial, aproximaciones a partir del estudio de caso del Partido de General Pueyrredon

Este trabajo expone los resultados preliminares de un proyecto de investigación exploratorio que indaga en un conjunto de organizaciones del Partido de General Pueyrredon (PGP) que se caracterizan por su participación en iniciativas de Responsabilidad Social Empresaria (RSE). Se considera que el sector empresario en sus múltiples dimensiones -éticas, organizativas, productivas, y contables- conforma un objeto de estudio de relevancia debido a su capacidad de generar valor compartido para el conjunto de la comunidad. Nuestros hallazgos evidencian el emergente de una compleja Red de Colaboración entre organismos públicos, grupos de promoción, organizaciones sin fines de lucro y -fundamentalmente- empresas con fines de lucro que impulsan la agenda de RSE en el PGP. El análisis realizado da cuenta de los vínculos entre los componentes de dicha red, la sinergia entre sus organizaciones y agentes de influencia, la conformación de espacios de representación y decisión, y los principales dispositivos organizativos que han institucionalizado para dar viabilidad a sus iniciativas.Fil: Hammond, Fernando. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Colaianni, Florencia. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Sánhez, J. M. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Heit, M. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Moya, E. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina

In vivo imaging and quantitative analysis of leukocyte directional migration and polarization in inflamed tissue

Directional migration of transmigrated leukocytes to the site of injury is a central event in the inflammatory response. Here, we present an in vivo chemotaxis assay enabling the visualization and quantitative analysis of subtype-specific directional motility and polarization of leukocytes in their natural 3D microenvironment. Our technique comprises the combination of i) semi-automated in situ microinjection of chemoattractants or bacteria as local chemotactic stimulus, ii) in vivo near-infrared reflected-light oblique transillumination (RLOT) microscopy for the visualization of leukocyte motility and morphology, and iii) in vivo fluorescence microscopy for the visualization of different leukocyte subpopulations or fluorescence-labeled bacteria. Leukocyte motility parameters are quantified off-line in digitized video sequences using computer-assisted single cell tracking. Here, we show that perivenular microinjection of chemoattractants [macrophage inflammatory protein-1alpha (MIP-1alpha/Ccl3), platelet-activating factor (PAF)] or E. coli into the murine cremaster muscle induces target-oriented intravascular adhesion and transmigration as well as polarization and directional interstitial migration of leukocytes towards the locally administered stimuli. Moreover, we describe a crucial role of Rho kinase for the regulation of directional motility and polarization of transmigrated leukocytes in vivo. Finally, combining in vivo RLOT and fluorescence microscopy in Cx3CR1(gfp/gfp) mice (mice exhibiting green fluorescent protein-labeled monocytes), we are able to demonstrate differences in the migratory behavior of monocytes and neutrophils.Taken together, we propose a novel approach for investigating the mechanisms and spatiotemporal dynamics of subtype-specific motility and polarization of leukocytes during their directional interstitial migration in vivo

Cancer and thrombosis: Managing the risks and approaches to thromboprophylaxis

Patients with cancer are at increased risk of venous thromboembolism (VTE) compared with patients without cancer. This results from both the prothrombotic effects of the cancer itself and iatrogenic factors, such as chemotherapy, radiotherapy, indwelling central venous devices and surgery, that further increase the risk of VTE. Although cancer-associated thrombosis remains an important cause of morbidity and mortality, it is often underdiagnosed and undertreated. However, evidence is accumulating to support the use of low-molecular-weight heparins (LMWHs) in the secondary prevention of VTE in patients with cancer. Not only have LMWHs been shown to be at least as effective as coumarin derivatives in this setting, but they have a lower incidence of complications, including bleeding, and are not associated with the practical problems of warfarin therapy. Furthermore, a growing number of studies indicate that LMWHs may improve survival among patients with cancer due to a possible antitumor effect. Current evidence suggests that LMWHs should increasingly be considered for the long-term management of VTE in patients with cancer