30 Years of Cystocele/Rectocele Repair in the United States

Objective: A growing body of evidence suggests an increased role for apical support in the treatment of pelvic organ prolapse regardless of phenotype. The objective of this study was to determine whether changes in cystocele/rectocele diagnosis and surgical management for the last 30 years reflect this changing paradigm. Methods: Data from the National Hospital Discharge Survey were mined from 1979 to 2009 for diagnosis and procedure codes. Records were categorized according to predefined combinations of diagnosis and procedure codes and weighted according to the National Hospital Discharge Survey data set. Pearson [chi]2 test was used to evaluate the changes in population proportions during the study interval. Results: The proportion of isolated cystocele/rectocele diagnoses decreased from 1979 to 2009 (56.5%, n = 88,548, to 34.8%, n = 31,577). The proportion of isolated apical defect diagnoses increased from 1979 to 2009 (38.4%, n = 60,223, to 60.8%, n = 55,153). There was a decrease in the frequency of isolated cystocele/rectocele repair procedures performed from 1979 to 2009 (96.3%, n = 150,980, to 67.7%, n = 61,444), whereas there was an increase in isolated apical defect repair procedures (2.5%, n = 3929, to 22.5%, n = 20,450). The proportion of cystocele/rectocele plus apical defect procedures also increased (1.2%, n = 1879, to 9.7%, n = 8806). Furthermore, 87.0% of all studied diagnostic groups were managed by cystocele/rectocele repair alone. Conclusions: Surgeons have responded to the increased contribution of apical support defects to cystocele/rectocele by modifying their diagnostic coding practices. Unfortunately, their surgical choices remain largely rooted in an older paradigm

Alkaloids from single skins of the Argentinian toad Melanophryniscus rubriventris (ANURA, BUFONIDAE): An unexpected variability in alkaloid profiles and a profusion of new structures

GC-MS analysis of single-skins of ten Melanophryniscus rubriventris toads (five collections of two toads each) captured during their breeding season in NW Argentina has revealed a total of 127 alkaloids of which 56 had not been previously detected in any frog or toad. Included among these new alkaloids are 23 new diastereomers of previously reported alkaloids. What is particularly distinguishing about the alkaloid profiles of these ten collections is the occurrence of many of the alkaloids, whether known or new to us, in only one of the ten skins sampled, despite two skins being obtained from each breeding site of the five populations. Many of the alkaloids are of classes known to have structures with branched-chains (e.g. pumiliotoxins and tricyclic structures) that are considered to derive from dietary mites. A large number of previously reported and new alkaloids are also of unclassified structures. Only a very few 3,5-disubstituted-indolizidine or -pyrrolizidine alkaloids are observed that have a straight-chain carbon skeleton and are likely derived from ant prey. The possible relationship of these collections made during the toad’s brief breeding episodes to sequestration of dietary arthropods and individual alkaloid profiles is discussed.Fil: Garraffo, H. Martin. Laboratorio de Bioorganic Chemistry; Estados UnidosFil: Andriamaharavo, Nirina R.. Laboratorio de Bioorganic Chemistry; Estados UnidosFil: Vaira, Marcos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Bio y Geociencias del NOA. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Museo de Ciencias Naturales. Instituto de Bio y Geociencias del NOA; Argentina. Universidad Nacional de Jujuy. Facultad de Ingeniería; ArgentinaFil: Quiroga, Maria Fernanda. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Jujuy. Universidad Nacional de Jujuy. Centro de Investigaciones y Transferencia de Jujuy; ArgentinaFil: Heit, Cecilia Inés. Laboratorio de Análisis de Residuos y Trazas; ArgentinaFil: Spande, Thomas F.. Laboratorio de Bioorganic Chemistry; Estados Unido

Constraints on Crustal Structure in the Vicinity of the Adriatic Indenter (European Alps) From Vp and Vp/Vs Local Earthquake Tomography

In this study, 3-D models of P-wave velocity (Vp) and P-wave and S-wave ratio (Vp/Vs) of the crust and upper mantle in the Eastern and eastern Southern Alps (northern Italy and southern Austria) were calculated using local earthquake tomography (LET). The data set includes high-quality arrival times from well-constrained hypocenters observed by the dense, temporary seismic networks of the AlpArray AASN and SWATH-D. The resolution of the LET was checked by synthetic tests and analysis of the model resolution matrix. The small inter-station spacing (average of ∼15 km within the SWATH-D network) allowed us to image crustal structure at unprecedented resolution across a key part of the Alps. The derived P velocity model revealed a highly heterogeneous crustal structure in the target area. One of the main findings is that the lower crust is thickened, forming a bulge at 30–50 km depth just south of and beneath the Periadriatic Fault and the Tauern Window. This indicates that the lower crust decoupled both from its mantle substratum as well as from its upper crust. The Moho, taken to be the iso-velocity contour of Vp = 7.25 km/s, agrees with the Moho depth from previous studies in the European and Adriatic forelands. It is shallower on the Adriatic side than on the European side. This is interpreted to indicate that the European Plate is subducted beneath the Adriatic Plate in the Eastern and eastern Southern Alps

Diet selection in the Coyote Canis latrans

The Coyote (Canis latrans) is one of the most studied species in North America with at least 445 papers on its diet alone. While this research has yielded excellent reviews of what coyotes eat, it has been inadequate to draw deeper conclusions because no synthesis to date has considered prey availability. We accounted for prey availability by investigating the prey selection of coyotes across its distribution using the traditional Jacobs’ index method, as well as the new iterative preference averaging (IPA) method on scats and biomass. We found that coyotes selected for Dall’s Sheep (Ovis dalli), White-tailed Deer (Odocoileus virginianus), Eastern Cottontail Rabbit (Sylvilagus floridanus), and California Vole (Microtus californicus), which yielded a predator-to-preferred prey mass ratio of 1:2. We also found that coyotes avoided preying on other small mammals, including carnivorans and arboreal species. There was strong concordance between the traditional and IPA method on scats, but this pattern was weakened when biomass was considered. General linear models revealed that coyotes preferred to prey upon larger species that were riskier to hunt, reflecting their ability to hunt in groups, and were least likely to hunt solitary species. Coyotes increasingly selected Mule Deer (O. hemionus) and Snowshoe Hare (Lepus americanus) at higher latitudes, whereas Black-tailed Jackrabbit (L. californicus) were increasingly selected toward the tropics. Mule Deer were increasingly selected at higher coyote densities, while Black-tailed Jackrabbit were increasingly avoided at higher coyote densities. Coyote predation could constrain the realized niche of prey species at the distributional limits of the predator through their increased efficiency of predation reflected in increased prey selection values. These results are integral to improved understandings of Coyote ecology and can inform predictive analyses allowing for spatial variation, which ultimately will lead to better understandings about the ecological role of the coyote across different ecosystems

Stream-subhalo interactions in the Aquarius simulations

Aims. We perform the first self-consistent measurement of the rate of interactions between stellar tidal streams created by disrupting satellites and dark subhalos in a cosmological simulation of a Milky-Way-mass galaxy. Methods. Using a retagged version of the Aquarius A dark-matter-only simulation, we selected 18 streams of tagged star particles that appear thin at the present day and followed them from the point their progenitors accrete onto the main halo, recording in each snapshot the characteristics of all dark-matter subhalos passing within several distance thresholds of any tagged star particle in each stream. We considered distance thresholds corresponding to constant impact parameters (1, 2, and 5 kpc), as well as those proportional to the region of influence of each subhalo (one and two times its half-mass radius r1=2). We then measured the age and present-day, phase-unwrapped length of each stream in order to compute the interaction rate in different mass bins and for different thresholds, and compared these to analytic predictions from the literature. Results. We measure a median rate of 1.5^(+3.0)_(-1.1) (9.1^(+17.5)_(-7.1), 61.8^(+211)_(-40.6)) interactions within 1 (2, 5) kpc of the stream per 10 kpc of stream length per 10 Gyr. Resolution effects (both time and particle number) affect these estimated rates by lowering them

CD4+CD25+ regulatory T cells control CD8+ T-cell effector differentiation by modulating IL-2 homeostasis

Humoral immunity develops in the spleen during blood-stage Plasmodium infection. This elicits parasite-specific IgM and IgG, which control parasites and protect against malaria. Studies in mice have elucidated cells and molecules driving humoral immunity to Plasmodium, including CD4(+) T cells, B cells, interleukin (IL)-21 and ICOS. IL-6, a cytokine readily detected in Plasmodium-infected mice and humans, is recognized in other systems as a driver of humoral immunity. Here, we examined the effect of infection-induced IL-6 on humoral immunity to Plasmodium. Using P.\ua0chabaudi chabaudi AS (PcAS) infection of wild-type and IL-6(-/-) mice, we found that IL-6 helped to control parasites during primary infection. IL-6 promoted early production of parasite-specific IgM but not IgG. Notably, splenic CD138(+) plasmablast development was more dependent on IL-6 than germinal centre (GC) B-cell differentiation. IL-6 also promoted ICOS expression by CD4(+) T cells, as well as their localization close to splenic B cells, but was\ua0not required for early Tfh-cell development. Finally, IL-6 promoted parasite control, IgM and IgG production, GC B-cell development and ICOS expression by Tfh cells in a second model, Py17XNL infection. IL-6 promotes CD4(+) T-cell activation and B-cell responses during blood-stage Plasmodium infection, which encourages parasite-specific antibody production

Modeling Cell Gradient Sensing and Migration in Competing Chemoattractant Fields

Directed cell migration mediates physiological and pathological processes. In particular, immune cell trafficking in tissues is crucial for inducing immune responses and is coordinated by multiple environmental cues such as chemoattractant gradients. Although the chemotaxis mechanism has been extensively studied, how cells integrate multiple chemotactic signals for effective trafficking and positioning in tissues is not clearly defined. Results from previous neutrophil chemotaxis experiments and modeling studies suggested that ligand-induced homologous receptor desensitization may provide an important mechanism for cell migration in competing chemoattractant gradients. However, the previous mathematical model is oversimplified to cell gradient sensing in one-dimensional (1-D) environment. To better understand the receptor desensitization mechanism for chemotactic navigation, we further developed the model to test the role of homologous receptor desensitization in regulating both cell gradient sensing and migration in different configurations of chemoattractant fields in two-dimension (2-D). Our results show that cells expressing normal desensitizable receptors preferentially orient and migrate toward the distant gradient in the presence of a second local competing gradient, which are consistent with the experimentally observed preferential migration of cells toward the distant attractant source and confirm the requirement of receptor desensitization for such migratory behaviors. Furthermore, our results are in qualitative agreement with the experimentally observed cell migration patterns in different configurations of competing chemoattractant fields

Vaginal delivery and serum markers of ischemia/reperfusion injury

Objective: Vaginal deliveries have been associated with pelvic organ prolapse and incontinence. The objective was to show whether markers of ischemia/reperfusion injury are dependent upon the mode of delivery and length of labor. Method: Complete venipuncture sets were obtained on 62 subjects. All samples collected were analyzed for serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH). Lipid peroxidation was analyzed, using thiobarbituric acid reactive substances (TBARS), on a subset of 37 patients. Results: There was a significant increase in CPK from admission to 1 h postpartum and postpartum day 1 in vaginal delivery versus cesarean delivery. Longer second stages were associated with significant increases in CPK. There were no significant changes in either LDH or TBARS from admission to any other time point regardless of mode of delivery. Conclusion: Vaginal delivery and longer second stages were associated with a much greater increase in one of these injury markers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135489/1/ijgo96.pd