Can The Delivery Method Influence Lower Urinary Tract Symptoms Triggered By The First Pregnancy

Introduction and Objectives: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could infl uence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolutionin the late puerperium, correlating them with the delivery method. Materials and Methods: A longitudinal study was conducted, which included 75 primigravidae women, classifi ed according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased signifi cantly in the postpartum period, regardless of the delivery method (p = 0.0001). However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). Conclusions: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.382267276Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society (2002) Neurourol Urodyn., 21, pp. 167-178Milsom, I., Altman, D., Lapitan, M.C., Nelson, R., Sillén, U., Thom, D., Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). In: Abrams P, Cardozo L, Khoury S, Wein A (eds). Incontinence, 4th edn. (2009) Committee 1. Paris, France: Health Publication Ltd., pp. 37-111Mostwin, J., Bourcier, J., Haab, F., Koebl, S., Rao, N., Resnick, S., Pathophysiology of urinary incontinence, fecal incontinence and pelvic organ prolapse (2005) In: Abrams P, Cardozo L, Khoury, Wein A (eds). Incontinence. 3nd ed. Plymouth: Health Publication Ltd, 1, pp. 436-462Viktrup, L., Lose, G., The risk of stress incontinence 5 years after first delivery (2001) Am J Obstet Gynecol, 185, pp. 82-87Toozs-Hobson, P., Boos, K., Cardozo, L., Pregnancy, childbirth and pelvic floor damage. In: Appell RA, Bourcier AP, La Torre F, eds. Pelvic floor dysfunction: Investigations and conservative treatment (1999) Rome: Casa Editrice Scientifica Internazionale, pp. 97-106Amaro, J.L., Macharelli, C.A., Yamamoto, H., Kawano, P.R., Padovani, C.V., Agostinho, A.D., Prevalence and risk factors for urinary and fecal incontinence in Brazilian women (2009) Int Braz J Urol, 35, pp. 592-597. , discussion 598Torkestani, F., Zafarghandi, N., Davati, A., Hadavand, S.H., Garshasbi, M., Case-controlled study of the relationship between delivery method and incidence of post-partum urinary incontinence (2009) J Int Med Res, 37, pp. 214-219Martins, G., Soler, Z.A., Cordeiro, J.A., Amaro, J.L., Moore, K.N., Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women (2010) Int Urogynecol J, 21, pp. 1271-1277Brown, S.J., Donath, S., MacArthur, C., McDonald, E.A., Krastev, A.H., Urinary incontinence in nulliparous women before and during regnancy: prevalence, incidence, and associated risk factors (2010) Int Urogynecol J, 21, pp. 193-202Rortveit, G., Daltveit, A.K., Hannestad, Y.S., Hunskaar, S., Norwegian EPINCONT Study. Urinary incontinence after vaginal delivery or cesarean section (2003) N Engl J Med, 348, pp. 900-907Arrue, M., Ibañez, L., Paredes, J., Murgiondo, A., Belar, M., Sarasqueta, C., Stress urinary incontinence six months afterfirst vaginal delivery (2010) Eur J Obstet Gynecol Reprod Biol, 150, pp. 210-214Huebner, M., Antolic, A., Tunn, R., The impact of pregnancy and vaginal delivery on urinary incontinence (2010) Int J Gynaecol Obstet, 110, pp. 249-251Diez-Itza, I., Arrue, M., Ibañez, L., Murgiondo, A., Paredes, J., Sarasqueta, C., Factors involved in stress urinary incontinence 1 year after first delivery (2010) Int Urogynecol J, 21, pp. 439-445Leijonhufvud, A., Lundholm, C., Cnattingius, S., Granath, F., Andolf, E., Altman, D., Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth (2011) Am J Obstet Gynecol, 204, pp. 70.e1-77.e1Thüroff, J.W., Abrams, P., Andersson, K.E., Artibani, W., Chapple, C.R., Drake, M.J., EAU guidelines on urinary incontinence (2011) Eur Urol, 59, pp. 387-400Koebl, H., Nitti, V., Baessler, K., Salvatore, S., Sultan, A., Yamaguchi, O., Pathophysiology of urinary incontinence, fecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury, Wein A (ed.), Incontinence. 4th ed. (2009) Plymouth: Health Publication Ltd, pp. 255-330Parente, M.P., Jorge, R.M., Mascarenhas, T., Fernandes, A.A., Martins, J.A., Deformation of the pelvic floor muscles during a vagin l delivery (2008) Int Urogynecol J Pelvic Floor Dysfunct, 19, pp. 65-71Arruda, R.M., Castro, R.A., GirÃo, M.J.B.C., Impacto na qualidade de vida. In: Truzzi JC, Dambros M. Bexiga Hiperativa - AspectosPráticos (2009) SÃo Paulo, Nome da Rosa, pp. 36-39Tamanini, J.T., Dambros, M., D'Ancona, C.A., Palma, P.C., Rodrigues Netto Jr., N., ValidaçÃo para o português do International Consultation on Incontinence questionnaire - Short Form (ICIQ-UI SF) (2004) Rev Saude Publica, 38, pp. 438-444Pereira, S.B., Thiel, R.R.C., Riccetto, C., Silva, J.M., Pereria, L.C., Herrmann, V., ValidaçÃo do International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQOAB) para a língua portuguesa (2010) Rev. Bras. Ginecol. Obstet, 32, pp. 273-278Abrams, P., Andersson, K.E., Birder, L., Brubaker, L., Cardozo, L., Chapple, C., Fourth International Consultation on Incontinence (2010) Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn, 29, pp. 213-240Staskin, D., Kelleher, C., Avery, K., Bosch, R., Cotterill, N., Coyne, K., Initial assessment of urinary and faecal incontinence in adult male and female patients (2009) Plymouth UK: Health Publications, pp. 3311-3412. , Abrams P, Cardozo L, Khoury S, Wein A (ed.), Incontinence. 4th edvan Brummen, H.J., Bruinse, H.W., van der Bom, J.G., Heintz, A.P., van der Vaart, C.H., How do the prevalences of urogenital symptomschange during pregnancy? (2006) Neurourol Urodyn, 25, pp. 135-139Scarpa, K.P., Herrmann, V., Palma, P.C.R., Riccetto, C.L.Z., Morais, S., Prevalências de sintomas do trato urinário inferior no terceiro trimestre da gestaçÃo (2006) Rev Assoc Med Bras, 52, pp. 153-156van Brummen, H.J., Bruinse, H.W., van de Pol, G., Heintz, A.P., van der Vaart, C.H., The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference? (2007) Int Urogynecol J Pelvic Floor Dysfunct, 18, pp. 133-139Scarpa, K.P., Herrmann, V., Palma, P.C.R., Ricetto, C.L.Z., Morais, S., Sintomas do trato urinário inferior três anos apòs o parto: estudo prospectivo (2008) Bras Ginecol Obstet, 30, pp. 355-359Sharma, J.B., Aggarwal, S., Singhal, S., Kumar, S., Roy, K.K., Prevalence of urinary incontinence and other urological problems during pregnancy: a questionnaire based study (2009) Arch Gynecol Obstet, 279, pp. 845-851Genadry, R., A urogynecologist's view ofthe pelvic floor effects of vaginal delivery/cesarean section for the urologist (2006) Curr Urol Rep, 7, pp. 376-383Mørkved, S., Salvesen, K.A., BØ, K., Eik-Nes, S., Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women (2004) Int Urogynecol J Pelvic Floor Dysfunct, 15, pp. 384-389. , discussion 390Casey, B.M., Schaffer, J.I., Bloom, S.L., Heartwell, S.F., McIntire, D.D., Leveno, K.J., Obstetric antecedents for postpartum pelvic floor dysfunction (2005) Am J Obstet Gynecol, 192, pp. 1655-1662Scarabotto, L.B., Riesco, M.L., Fatores relacionados ao trauma perineal no parto normal em nulíparas Rev Esc Enferm USP (2006), 40, pp. 389-395Ekström, A., Altman, D., Wiklund, I., Larsson, C., Andolf, E., Planned cesarean section versus planned vaginal delivery: compar son of lower urinary tract symptoms (2008) Int Urogynecol J Pelvic Floor Dysfunct, 19, pp. 459-465Thomason, A.D., Miller, J.M., Delancey, J.O., Urinary incontinence symptoms during and after pregnancy in continent and incont nent primiparas (2007) Int Urogynecol J Pelvic Floor Dysfunct, 18, pp. 147-151Wesnes, S.L., Hunskaar, S., Bo, K., Rortveit, G., The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum (2009) A cohort study. BJOG, 116, pp. 700-707Botelho, S., Riccetto, C., Ribeiro, G., Gome, J., Brisola, M., Herrmann, V., Overactive bladder symptoms in pregnancy and puerperium: is there a relationship between the symptoms score and quality of life? (2010) Actas Urol Esp, 34, pp. 794-797Viktrup, L., Lose, G., Rolff, M., Barfoed, K., The symptom of stress incontinence caused by pregnancy or delivery in primipar s (1992) Obstet Gynecol, 79, pp. 945-949Viktrup, L., Rortveit, G., Lose, G., Does the impact of subsequent incontinence risk factors depend on continence status du ing the first pregnancy or the postpartum period 12 years before? A cohort study in 232 primiparous women (2008) Am J Obstet Gy ecol, 199, pp. 73.e1-74.e1McLennan, M.T., Melick, C.F., Alten, B., Young, J., Hoehn, M.R., Patients' knowledge of potential pelvic floor changes associated with pregnancy and delivery (2006) Int Urogynecol J Pelvic Floor Dysfunct, 17, pp. 22-26Burgio, K.L., Zyczynski, H., Locher, J.L., Richter, H.E., Redden, D.T., Wright, K.C., Urinary incontinence in the 12-month postpartum eriod (2003) Obstet Gynecol, 102, pp. 1291-1298Bruschini, H., Etiopatogenia e classificaçÃo da incontinÊncia urinária feminina. In: Amaro JL, Haddad JM, Trindade JCS,Ribeiro RM (ed.), ReabilitaçÃo do assoalho pélvico nas disfunções urinárias e anorretais. (2005) SÃo Paulo: Se mento Farma, pp. 41-46Chin, H.Y., Chen, M.C., Liu, Y.H., Wang, K.H., Postpartum urinary incontinence: a comparison of vaginal delivery, elective, and emergent cesarean section (2006) Int Urogynecol J Pelvic Floor Dysfunct, 17, pp. 631-635Dumoulin, C., Hay-Smith, J., Pelvic floor muscle training versus no treatment for urinary incontinence in women (2007) Eura Medicophys, 43, pp. 1-17Hay-Smith, J., Berghmans, B., Burgio, K., Dumoulin, C., Hagen, S., Moore, K., Adult Conservative Management In: Abrams P, Cardozo L, Khoury S, Wein A (ed.), Incontinence. 4th International Consultation on Incontinence, Paris, July 5-8, 2008. (2009) Health Publications Ltd, Portsmouth, pp. 1025-112

The concept of anorexia of aging in late life depression:A cross-sectional analysis of a cohort study.

INTRODUCTION: Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS: We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS: Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS: Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings

Improved search for invisible modes of nucleon decay in water with the SNO+ detector

This paper reports results from a search for single and multi-nucleon disappearance from the $^{16}$O nucleus in water within the \snoplus{} detector using all of the available data. These so-called "invisible" decays do not directly deposit energy within the detector but are instead detected through their subsequent nuclear de-excitation and gamma-ray emission. New limits are given for the partial lifetimes: $\tau(n\rightarrow inv) > 9.0\times10^{29}$ years, $\tau(p\rightarrow inv) > 9.6\times10^{29}$ years, $\tau(nn\rightarrow inv) > 1.5\times10^{28}$ years, $\tau(np\rightarrow inv) > 6.0\times10^{28}$ years, and $\tau(pp\rightarrow inv) > 1.1\times10^{29}$ years at 90\% Bayesian credibility level (with a prior uniform in rate). All but the ($nn\rightarrow inv$) results improve on existing limits by a factor of about 3.info:eu-repo/semantics/publishedVersio

Focus on collagen: in vitro systems to study fibrogenesis and antifibrosis _ state of the art

Fibrosis represents a major global disease burden, yet a potent antifibrotic compound is still not in sight. Part of the explanation for this situation is the difficulties that both academic laboratories and research and development departments in the pharmaceutical industry have been facing in re-enacting the fibrotic process in vitro for screening procedures prior to animal testing. Effective in vitro characterization of antifibrotic compounds has been hampered by cell culture settings that are lacking crucial cofactors or are not holistic representations of the biosynthetic and depositional pathway leading to the formation of an insoluble pericellular collagen matrix. In order to appreciate the task which in vitro screening of antifibrotics is up against, we will first review the fibrotic process by categorizing it into events that are upstream of collagen biosynthesis and the actual biosynthetic and depositional cascade of collagen I. We point out oversights such as the omission of vitamin C, a vital cofactor for the production of stable procollagen molecules, as well as the little known in vitro tardy procollagen processing by collagen C-proteinase/BMP-1, another reason for minimal collagen deposition in cell culture. We review current methods of cell culture and collagen quantitation vis-à-vis the high content options and requirements for normalization against cell number for meaningful data retrieval. Only when collagen has formed a fibrillar matrix that becomes cross-linked, invested with ligands, and can be remodelled and resorbed, the complete picture of fibrogenesis can be reflected in vitro. We show here how this can be achieved. A well thought-out in vitro fibrogenesis system represents the missing link between brute force chemical library screens and rational animal experimentation, thus providing both cost-effectiveness and streamlined procedures towards the development of better antifibrotic drugs

Observation of Antineutrinos from Distant Reactors using Pure Water at SNO+

The SNO+ collaboration reports the first observation of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis used events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods were used to distinguish reactor antineutrinos from background events in 190 days of data and yielded consistent observations of antineutrinos with a combined significance of 3.5 $\sigma$.Comment: v2: add missing author, add link to supplemental materia

Measurement of neutron-proton capture in the SNO+ water phase

The SNO+ experiment collected data as a low-threshold water Cherenkov detector from September 2017 to July 2019. Measurements of the 2.2-MeV $\gamma$ produced by neutron capture on hydrogen have been made using an Am-Be calibration source, for which a large fraction of emitted neutrons are produced simultaneously with a 4.4-MeV $\gamma$. Analysis of the delayed coincidence between the 4.4-MeV $\gamma$ and the 2.2-MeV capture $\gamma$ revealed a neutron detection efficiency that is centered around 50% and varies at the level of 1% across the inner region of the detector, which to our knowledge is the highest efficiency achieved among pure water Cherenkov detectors. In addition, the neutron capture time constant was measured and converted to a thermal neutron-proton capture cross section of $336.3^{+1.2}_{-1.5}$ mb

Isomer spectroscopy in odd–even Ti isotopes:Approaching n = 40

Our understanding of the evolution of the shell structure in nuclei far from stability is based on the study of some key nuclei. Nuclei at or next to double shell closures play a special role in this. Presently, a lot of discussion is concentrated on the neutron-rich calcium isotopes, which provide a rich testing ground for various nuclear models with several traditional and new magic numbers. Ca-60 is now almost within reach with the most advanced radioactive beam facilities. In order to investigate the evolution of the shell gap at N = 40, the configuration of states in the odd-even titanium isotopes up to N = 37 (Ti-59) have been studied. In order to experimentally access the shell gap at N = 40, it is nowadays within the reach of the most advanced facility the investigation of neutron hole configuration states in odd-even titanium isotopes up to N = 37, in the Ti-59 nucleus. Such states correspond to relatively simple configurations that constitute a challenging testing ground for effective nuclear interactions. The new data obtained in our experiment allows to place the present predictions concerning the shell closure at N = 40 in the calcium region on a more solid ground

First spectroscopy of ⁶¹ Ti and the transition to the Island of Inversion at N = 40

Isomeric states in 59,61Ti have been populated in the projectile fragmentation of a 345 AMeV 238U beam at the Radioactive Isotope Beam Factory. The decay lifetimes and delayed \u3b3-ray transitions were measured with the EURICA array. Besides the known isomeric state in 59Ti, two isomeric states in 61Ti are observed for the first time. Based on the measured lifetimes, transition multipolarities as well as tentative spins and parities are assigned. Large-scale shell model calculations based on the modified LNPS interaction show that both 59Ti and 61Ti belong to the Island of Inversion at with ground state configurations dominated by particle-hole excitations to the and orbits