Minimal Criteria for the Diagnosis of Avulsion of the Puborectalis Muscle by Tomographic Ultrasound

Introduction and hypothesis Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse(FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. Methods We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle. Results Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma (‘partial avulsion’) were not associated with symptoms or signs of pelvic floor dysfunction. Conclusions Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance

Emission Factors for a Taxi Fleet Operating on Liquefied Petroleum Gas (LPG) as a Function of Speed and Road Slope

Real-driving emissions of NOx, CO, and THC, as well as fuel consumption (FC) were studied from 18 liquefied petroleum gas (LPG) fueled taxis operating in a metropolitan road network. Euro 2 to Euro 5 technology vehicles were measured with the use of portable emission measurement systems (PEMS). Statistical processing was implemented to derive mean emission levels for the different technologies. The taxis were measured from 6 months to 2.5 years after their catalysts and lambda sensors were replaced. The emission levels of Euro 4 taxis after catalyst replacement appear higher compared to pre-replacement levels, while pre-Euro 4 taxis emission levels were moderately reduced by the catalyst replacement. Overall, Euro 5 LPG taxis exhibit the lowest emissions, even below the respective regulated limits. The NH3 and N2O pollutant levels of a Euro 5 LPG taxi measured in the lab were found at about half its NOx emissions. Different integration methods of PEMS data were investigated toward the development of emission factors, including both time-based and distance-based approaches at different resolutions. Distance-based integration in sections of 500 m was considered suitable, as this provides a large dataset for statistical confidence and sufficient resolution for link-based modeling. Based on this, FC and emission factors of NOx, CO, and THC as a function of speed and road slope are presented, separately for vehicles considered as normal and high emitters. Volatile organic compounds speciation of Euro 5 taxis showed that methane and butane are the most abundant hydrocarbon species in the exhaust

Association between the risk of seizure and COVID-19 vaccinations: A self-controlled case-series study

OBJECTIVE: The risk of seizure following BNT162b2 and CoronaVac vaccinations has been sparsely investigated. This study aimed to evaluate this association. METHOD: Patients who had their first seizure-related hospitalization between February 23, 2021 and January 31, 2022 were identified in Hong Kong. All seizure episodes happening on the day of vaccination (day 0) were excluded since clinicians validated that most of the cases on day 0 were syncopal episodes. Within-individual comparison using a modified self-controlled case series analysis was applied to estimate the incidence rate ratio (IRR) with 95% confidence intervals (CI) of seizure using conditional Poisson regression. RESULTS: We identified 1656 individuals who had their first seizure-related hospitalization (BNT162b2: 426; CoronaVac: 263; unvaccinated: 967) within the observation period. The incidence of seizure was 1.04 (95% CI: 0.80-1.33) and 1.11 (95% CI: 0.80-1.50) per 100,000 doses of BNT162b2 and CoronaVac administered respectively. 16 and 17 individuals received second dose after having first seizure within 28 days after first dose of BNT162b2 and CoronaVac vaccinations, respectively. None had recurrent seizures after the second dose. There was no increased risk during day 1-6 after the first (BNT162b2: IRR=1.39, 95% CI=0.75-2.58; CoronaVac: IRR=1.19, 95% CI=0.50-2.83) and second doses (BNT162b2: IRR=1.36, 95% CI 0.72-2.57; CoronaVac: IRR=0.71, 95% CI=0.22-2.30) of vaccinations. During 7-13, 14-20- and 21-27-days post-vaccination, no association was observed for both vaccines. SIGNIFICANCE: The findings demonstrated no increased risk of seizure following BNT162b2 and CoronaVac vaccinations. Future studies will be warranted to evaluate the risk of seizure following COVID-19 vaccinations in different populations with subsequent doses to ensure the generalizability

Definition of apical descent in women with and without previous hysterectomy: A retrospective analysis.

BackgroundWhile normal pelvic organ support has been defined for women with intact uterus, this is not the case for post- hysterectomy vault descent. A recent systematic review found that definitions of apical prolapse are highly variable.ObjectivesTo investigate the relationship between prolapse symptoms and apical POP-Q measurements and establish cutoffs for 'significant apical descent using receiver-operator characteristics (ROC) statistics.Study designRetrospective analysis of patients seen at a tertiary urogynecological unit. Evaluation included a standardized interview and clinical assessment using the Pelvic Organ Prolapse Quantification (POP-Q) system. ROC curves were prepared for the relationship between prolapse symptoms and POP-Q measure "C".ResultsThe records of 3010 women were available for analysis. Prolapse symptoms were reported by 52.3% (n = 1573), with a mean bother of 5.9 (SD 3.0, range 0-10). POP-Q point "C" was associated with symptoms of prolapse (p ConclusionA cut- off for 'significant central compartment descent' of 5 cm above the hymen on Valsalva seems valid regardless of previous hysterectomy

Does childbirth play a role in the etiology of rectocele?

Artículo de publicación ISIRectoceles are common among parous women and they are believed to be due to disruption or distension of the rectovaginal septum as a result of childbirth. However, the etiology of rectocele is likely to be more complex since posterior compartment prolapse does occur in nulliparous women. This study was designed to determine the role of childbearing as an etiological factor in true radiological rectocele. This was a secondary analysis of the data from 657 primiparous women recruited as part of a previously reported study and another ongoing prospective study. Women were invited for antenatal and postnatal appointments comprising an interview, clinical examination and translabial ultrasonography. The presence and depth of any rectocele were determined on maximum Valsalva maneuver, as was descent of the rectal ampulla. Potential demographic and obstetric factors as predictors of rectocele development were evaluated using either multiple regression or logistic regression analysis as appropriate. A true rectocele was identified in 4 % of women antenatally and in 16 % after childbirth (P < 0.001). Mean rectocele depth was 13.5 mm (10 - 23.2 mm). The mean antepartum position of the rectal ampulla on Valsalva maneuver was 4.39 mm above and it was 1.64 mm below the symphysis pubis postpartum (P < 0.0001). De novo appearance of true rectocele was significantly associated with a history of previous < 20 weeks pregnancy and fetal birth weight. Body mass index and length of the second stage were associated with rectocele depth increase. Childbirth seems to play a distinct role in the pathogenesis of rectocele. Both maternal and fetal factors seem to contribute.G

A comparison of two different mesh kit systems for anterior compartment prolapse repair

Background and Aim: Mesh reinforcement is considered an effective method for anterior compartment prolapse repair. Two common methods of mesh reinforcement involve either transobturator fixation (eg Perigee™) or lateral and apical anchoring (eg Anterior Elevate™). The aim of this study was to assess subjective and objective outcomes after Anterior Elevate and Perigee mesh kit surgery. Materials and Methods: This was a surgical audit of patients after anterior colporrhaphy (AC) with mesh reinforcement, undertaken at three tertiary urogynaecological centres. All patients were assessed for prolapse recurrence, which was defined as either (i) symptoms of prolapse (vaginal lump/dragging), (ii) ICS POPQ ≥ Stage 2, or (iii) bladder descent ≥10 mm below the symphysis pubis on transperineal ultrasound. Mesh co-ordinates and organ descent on Valsalva were determined relative to the inferior symphyseal margin. Results: Two hundred and twenty-nine patients with anterior compartment mesh (138 Perigee, 91 Elevate) were assessed at a median follow-up of 1.09 years (IQR 0.65–2.01). On assessment, 24% (n = 55) had symptoms of prolapse recurrence, 46% (n = 106) had a clinical recurrence, and 41% (n = 95) a recurrent cystocele sonographically. All objective results favoured the Perigee group. The superiority of the Perigee kit remained highly significant (P < 0.0001 for all clinical and ultrasound measures of prolapse recurrence) on multivariate analysis. Conclusions: This retrospective analysis suggests that apical anchoring such as Anterior Elevate mesh system does not necessarily confer an advantage over the original transobturator mesh fixation technique for anterior compartment reconstruction

Is vaginal flatus related to pelvic floor functional anatomy?

Introduction and hypothesis: Vaginal flatus is an embarrassing condition that can impair women’s quality of life. The underlying pathophysiology is unclear. We aimed to evaluate the association between vaginal flatus and pelvic floor anatomy. Methods: Retrospective observational study on women seen in a tertiary urogynaecological service. All had undergone a standardised interview, clinical examination and four-dimensional transperineal ultrasound. Offline analysis of volume data was performed blinded against clinical data. Results: Datasets of 570 women were analysed. Five hundred twelve (90%) were vaginally parous. Vaginal flatus was reported by 190 (33%). Mean bother score was 4.2 (SD 3.4, range 0–10). One hundred eighty-five reported frequency of vaginal flatus: it occurred once daily in 15 (8%). One hundred two women identified the following precipitating factors: intercourse in 72 (71%), postural change in 22 (22%) and physical activities in 9 (9%). Vaginal birth, central and posterior compartment prolapse, anal incontinence, higher levator resting tone and younger age were associated with vaginal flatus. The latter was moderately correlated with symptom bother (correlation coefficient − 0.21). Conclusions: Vaginal flatus is a prevalent and bothersome condition affecting one-third of our study population. The condition is associated with pelvic floor functional anatomy. A higher resting tone may confer a higher resistance against which trapped air is expelled during physical activities. Younger age was moderately correlated with symptom bother