Effect of weight loss on urinary incontinence in women.

BackgroundThe purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence.MethodsA literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized.ResultsEpidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%-70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4-5. The odds of incident urinary incontinence over 5-10 years increase by approximately 30%-60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence.ConclusionEpidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence

A real-time ppg peak detection method for accurate determination of heart rate during sinus rhythm and cardiac arrhythmia

Objective: We have developed a peak detection algorithm for accurate determination of heart rate, using photoplethysmographic (PPG) signals from a smartwatch, even in the presence of various cardiac rhythms, including normal sinus rhythm (NSR), premature atrial contraction (PAC), premature ventricle contraction (PVC), and atrial fibrillation (AF). Given the clinical need for accurate heart rate estimation in patients with AF, we developed a novel approach that reduces heart rate estimation errors when compared to peak detection algorithms designed for NSR. Methods: Our peak detection method is composed of a sequential series of algorithms that are combined to discriminate the various arrhythmias described above. Moreover, a novel Poincaré plot scheme is used to discriminate between basal heart rate AF and rapid ventricular response (RVR) AF, and to differentiate PAC/PVC from NSR and AF. Training of the algorithm was performed only with Samsung Simband smartwatch data, whereas independent testing data which had more samples than did the training data were obtained from Samsung’s Gear S3 and Galaxy Watch 3. Results: The new PPG peak detection algorithm provides significantly lower average heart rate and interbeat interval beat-to-beat estimation errors—30% and 66% lower—and mean heart rate and mean interbeat interval estimation errors—60% and 77% lower—when compared to the best of the seven other traditional peak detection algorithms that are known to be accurate for NSR. Our new PPG peak detection algorithm was the overall best performers for other arrhythmias. Conclusion: The proposed method for PPG peak detection automatically detects and discriminates between various arrhythmias among different waveforms of PPG data, delivers significantly lower heart rate estimation errors for participants with AF, and reduces the number of false negative peaks. Significance: By enabling accurate determination of heart rate despite the presence of AF with rapid ventricular response or PAC/PVCs, we enable clinicians to make more accurate recommendations for heart rate control from PPG data

Natural orifice surgery: initial clinical experience

Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation. However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder, and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial clinical experience. Under an Institutional Review Board (IRB)-approved protocol, patients consented to a natural orifice operation for removal of either the gallbladder or the appendix via either the vagina or the stomach using a single umbilical trocar for safety and assistance. Nine transvaginal cholecystectomies, one transgastric appendectomy, and one transvaginal appendectomy have been completed to date. All but one patient were discharged on postoperative day 1 as per protocol. No complications occurred. The limited initial evidence from this study demonstrates that NOTES is feasible and safe. The addition of an umbilical trocar is a bridge allowing safe performance of NOTES procedures until better instruments become available. The addition of a flexible long grasper through the vagina and a flexible operating platform through the stomach has enabled the performance of NOTES in a safe and easily reproducible manner. The use of a uterine manipulator has facilitated visualization of the cul de sac in women with a uterus to allow for safe transvaginal access

Chronic pancreatitis: Pediatric and adult cohorts show similarities in disease progress despite different risk factors

Objectives: To investigate the natural history of chronic pancreatitis (CP), patients in the North American Pancreatitis Study2 (NAPS2, adults) and INternational Study group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE, pediatric) were compared. Methods: Demographics, risk factors, disease duration, management and outcomes of 224 children and 1,063 adults were compared using appropriate statistical tests for categorical and continuous variables. Results: Alcohol was a risk in 53% of adults and 1% of children (p<0.0001); tobacco in 50% of adults and 7% of children (p<0.0001). Obstructive factors were more common in children (29% vs 19% in adults, p=0.001). Genetic risk factors were found more often in children. Exocrine pancreatic insufficiency was similar (children 26% vs adult 33%, p=0.107). Diabetes was more common in adults than children (36% vs 4% respectively, p<0.0001). Median emergency room visits, hospitalizations, and missed days of work/school were similar across the cohorts. As a secondary analysis, NAPS2 subjects with childhood onset (NAPS2-CO) were compared to INSPPIRE subjects. These two cohorts were more similar than the total INSPPIRE and NAPS2 cohorts, including for genetic risk factors. The only risk factor significantly more common in the NAPS2-CO cohort compared with the INSPPIRE cohort was alcohol (9% NAPS2-CO vs 1% INSPPIRE cohorts, p=0.011). Conclusions: Despite disparity in age of onset, children and adults with CP exhibit similarity in demographics, CP treatment, and pain. Differences between groups in radiographic findings and diabetes prevalence may be related to differences in risk factors associated with disease and length of time of CP

Genome-wide association study identifies multiple susceptibility loci for pancreatic cancer

We performed a multistage genome-wide association study (GWAS) including 7,683 individuals with pancreatic cancer and 14,397 controls of European descent. Four new loci reached genome-wide significance: rs6971499 at 7q32.3 (LINC-PINT; per-allele odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.74–0.84; P = 3.0×10−12), rs7190458 at 16q23.1 (BCAR1/CTRB1/CTRB2; OR = 1.46; 95% CI = 1.30–1.65; P = 1.1×10−10), rs9581943 at 13q12.2 (PDX1; OR = 1.15; 95% CI = 1.10–1.20; P = 2.4×10−9), and rs16986825 at 22q12.1 (ZNRF3; OR = 1.18; 95% CI = 1.12–1.25; P = 1.2×10−8). An independent signal was identified in exon 2 of TERT at the established region 5p15.33 (rs2736098; OR = 0.80; 95% CI = 0.76–0.85; P = 9.8×10−14). We also identified a locus at 8q24.21 (rs1561927; P = 1.3×10−7) that approached genome-wide significance located 455 kb telomeric of PVT1. Our study has identified multiple new susceptibility alleles for pancreatic cancer worthy of follow-up studies

The Role of Autism Susceptibility Candidate 2 in Models of Alcohol Use Disorder

Alcohol consumption and abuse has been an ongoing public health concern across the globe for many years. Over the past decade, it has become a critical epidemic in the United States. Excessive alcohol use costs more than $249 billion annually and affects 17 million people, 8% of the adult population, and is the fifth leading risk factor for premature death and disability. Alcohol use disorder (AUD) is inherently complex with a myriad of genetic and environmental contributors. Ultimately, this complexity makes AUD difficult to treat. Recent literature suggests that changes in the genetic sequence only partially accounts for the molecular profile of AUD. An emerging theme is that the overall expression of several genes is markedly different in the alcoholic brain. This regulation of gene expression, sometimes termed epigenetic regulation, plays a key role in AUD. However, the exact factors responsible for these changes are not well understood. Recent literature suggests that autism susceptibility candidate 2 (AUTS2) may be a possible regulator of phenotypes related to AUD. AUTS2 is part of a larger complex known as Polycomb Repressive Complex 1 (PRC1). Together, they play a major role in epigenetic regulation in the body. However, in the brain, aberrations in AUTS2 may cause changes in the expression of certain genes that result in behaviors that are commonly associated with AUD. Normally, the PRC1 complex works to inhibit the expression of certain genes. However, when this complex is associated with AUTS2, genes tend to be activated instead. In humans, there is a single nucleotide polymorphism (SNP) in the AUTS2 gene associated with less alcohol consumption among the general population, and these same individuals have increased expression of AUTS2. Despite its association with addiction-related diseases, the direct role of AUTS2 and PRC1 in gene expression in the brain and ultimately, in AUD-phenotypes is not known. We show here that AUTS2 impacts AUD phenotypes in brain-region specific knockdown mouse models. Using CRE recombinase driver lines to delete AUTS2 from the whole brain, prefrontal cortex (PFC), and cerebellum, we have elucidated a role for AUTS2 within the brain in the context of AUD. In whole brain knockdown models, loss of AUTS2 does not affect performance in the rotarod or loss of righting reflex (LORR) tasks following ethanol injection. These same mice drink more during intermittent access to ethanol. In PFC knockdown mice, loss of AUTS2 does not affect performance in rotarod, LORR, or intermittent access. In cerebellar knockdown mice, loss of AUTS2 does not affect performance in rotarod or LORR, but surprisingly these mice may drink less during intermittent access than their wildtype (WT) littermates. These results reveal that AUTS2 differentially effects AUD characteristics such as ataxia and ethanol consumption depending on where it is expressed in the brain. By better understanding AUTS2 and what components drive excessive AUD characteristics, we can identify key drivers of AUD that may represent novel predictors or targetable therapeutic strategies for individuals with AUD

Washtenaw County Green Infrastructure Development Analysis

A technical report provided to the Washtenaw County Water Resources Office as a final result of the research conducted by the Winter 2021 CLIMATE 592 course.Rain gardens and other types of green infrastructure help reduce surface water runoff from entering nearby water sources. Our goal is to locate areas that would benefit from the installation of green infrastructure, based on the three priority areas of water quality, equity, and wildlife, in the context of a changing climate. In this report, we show our analysis determining ideal locations in Washtenaw County for the development of green infrastructure based on the three priority areas. We incorporate parameters such as land-use tract areas, poverty status data, roadways, precipitation intensity, degraded creeksheds, etc. in order to calculate preference values that will show where to install green infrastructure. Final maps for each of the three priority areas are shown. We also discuss how climate change may affect the locations we have identified in the long term. Green infrastructure has numerous environmental, social, and financial benefits and therefore it may be beneficial for the Washtenaw County Water Resources Office to consider coordinating with SEMCOG and their green infrastructure efforts to increase resilience and avoid maladaptation.http://deepblue.lib.umich.edu/bitstream/2027.42/176118/1/Climate592_FinalReport_2021.pdfDescription of Climate592_FinalReport_2021.pdf : Technical ReportSEL