Vaginal Repair of Cystocele with Anterior Wall Mesh via Transobturator Route: Efficacy and Complications with Up to 3-Year Followup

Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up

Simultaneous Labia Minora and Majora Reduction: A Case Report

ABSTRACT Labia minora enlargement may constitute a cosmetic or functional problem for a woman, potentially leading to surgery. However, more rarely, the labia majora may also be problematic for women. This case describes the rare situation of a woman presenting with enlargement of both the labia minora and majora and her subsequent simultaneous surgical treatment

Nonsurgical Transurethral Radiofrequency Collagen Denaturation: Results at Three Years after Treatment

Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL) and urogenital distress inventory (UDI-6) instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years). At 36 months, intent-to-treat analysis (n = 139) revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P = .0004), while mean UDI-6 score improved (decreased) 19 points (P = .0005). Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years

Investigation of lower hybrid physics through power modulation experiments on Alcator C-Mod

Lower hybrid current drive (LHCD) is an attractive tool for off-axis current profile control in magnetically confined tokamak plasmas and burning plasmas (ITER), because of its high current drive efficiency. The LHCD system on Alcator C-Mod operates at 4.6 GHz, with ~ 1 MW of coupled power, and can produce a wide range of launched parallel refractive index (n[subscript ∣∣]) spectra. A 32 chord, perpendicularly viewing hard x-ray camera has been used to measure the spatial and energy distribution of fast electrons generated by lower hybrid (LH) waves. Square-wave modulation of LH power on a time scale much faster than the current relaxation time does not significantly alter the poloidal magnetic field inside the plasma and thus allows for realistic modeling and consistent plasma conditions for different n[subscript ∣∣] spectra. Inverted hard x-ray profiles show clear changes in LH-driven fast electron location with differing n[subscript ∣∣]. Boxcar binning of hard x-rays during LH power modulation allows for ~ 1 ms time resolution which is sufficient to resolve the build-up, steady-state, and slowing-down phases of fast electrons. Ray-tracing/Fokker-Planck modeling in combination with a synthetic hard x-raydiagnostic shows quantitative agreement with the x-ray data for high n[subscript ∣∣] cases. The time histories of hollow x-ray profiles have been used to measure off-axis fast electron transport in the outer half of the plasma, which is found to be small on a slowing down time scale.United States. Dept. of Energy (Award DE-FC02-99ER54512)United States. Dept. of Energy (Award DE-AC02-76CH03073

The effects of main-ion dilution on turbulence in low q95 C-Mod ohmic plasmas, and comparisons with nonlinear GYRO

Recent experiments on C-mod seeding nitrogen into ohmic plasmas with [subscript q]95 = 3.4 found that the seeding greatly reduced long-wavelength (ITG-scale) turbulence. The long-wavelength turbulence that was reduced by the nitrogen seeding was localized to the region of r/a≈0.85, where the turbulence is well above marginal stability (as evidenced by Q[subscript i]/Q[subscript GB]≫1). The nonlinear gyrokinetic code GYRO was used to simulate the expected turbulence in these plasmas, and the simulated turbulent density fluctuations and turbulent energy fluxes quantitatively agreed with the experimental measurements both before and after the nitrogen seeding. Unexpectedly, the intrinsic rotation of the plasma was also found to be affected by the nitrogen seeding, in a manner apparently unrelated to a change in the electron-ion collisionality that was proposed by other experiments.United States. Dept. of Energy. Office of Fusion Energy Sciences (Award E-FG02-94-ER54235

Validation of full-wave simulations for mode conversion of waves in the ion cyclotron range of frequencies with phase contrast imaging in Alcator C-Mod

Mode conversion of fast waves in the ion cyclotron range of frequencies (ICRF) is known to result in current drive and flow drive under optimised conditions, which may be utilized to control plasma profiles and improve fusion plasma performance. To describe these processes accurately in a realistic toroidal geometry, numerical simulations are essential. Quantitative comparison of these simulations and the actual experimental measurements is important to validate their predictions and to evaluate their limitations. The phase contrast imaging (PCI) diagnostic has been used to directly detect the ICRF waves in the Alcator C-Mod tokamak. The measurements have been compared with full-wave simulations through a synthetic diagnostic technique. Recently, the frequency response of the PCI detector array on Alcator C-Mod was recalibrated, which greatly improved the comparison between the measurements and the simulations. In this study, mode converted waves for D-{superscript 3]He and D-H plasmas with various ion species compositions were re-analyzed with the new calibration. For the minority heating cases, self-consistent electric fields and a minority ion distribution function were simulated by iterating a full-wave code and a Fokker-Planck code. The simulated mode converted wave intensity was in quite reasonable agreement with the measurements close to the antenna, but discrepancies remain for comparison at larger distances.United States. Department of Energy (Grant DE-FG02- 94ER54235

The Biology of Chronic Graft-versus-Host Disease: A Task Force Report from the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease

Chronic graft-versus-host disease (GVHD) is the leading cause of late, nonrelapse mortality and disability in allogeneic hematopoietic cell transplantation recipients and a major obstacle to improving outcomes. The biology of chronic GVHD remains enigmatic, but understanding the underpinnings of the immunologic mechanisms responsible for the initiation and progression of disease is fundamental to developing effective prevention and treatment strategies. The goals of this task force review are as follows: • Summarize the current state of the science regarding pathogenic mechanisms of chronic GVHD and critical knowledge gaps. • Develop working hypotheses/overriding concepts for chronic GVHD development. • Define the usefulness of current preclinical models to test working hypotheses and ultimately discover and develop new therapeutic strategies. • Identify shortcomings of preclinical models, and define criteria for the creation of additional models to address these limitations. This document is intended as a review of our understanding of chronic GVHD biology and therapies resulting from preclinical studies, and as a platform for developing innovative clinical strategies to prevent and treat chronic GVHD

Correlation ECE diagnostic in Alcator C-Mod

Correlation ECE (CECE) is a diagnostic technique that allows measurement of small amplitude electron temperature, T[subscript e], fluctuations through standard cross-correlation analysis methods. In Alcator C-Mod, a new CECE diagnostic has been installed[Sung RSI 2012], and interesting phenomena have been observed in various plasma conditions. We find that local T[subscript e] fluctuations near the edge (ρ ~ 0:8) decrease across the linearto- saturated ohmic confinement transition, with fluctuations decreasing with increasing plasma density[Sung NF 2013], which occurs simultaneously with rotation reversals[Rice NF 2011]. T[subscript e] fluctuations are also reduced across core rotation reversals with an increase of plasma density in RF heated L-mode plasmas, which implies that the same physics related to the reduction of T[subscript e] fluctuations may be applied to both ohmic and RF heated L-mode plasmas. In I-mode plasmas, we observe the reduction of core T[subscript e] fluctuations, which indicates changes of turbulence occur not only in the pedestal region but also in the core across the L/I transition[White NF 2014]. The present CECE diagnostic system in C-Mod and these experimental results are described in this paper