A novel sensorimotor movement and walking intervention to improve balance and gait in women

PurposeThis study evaluated the effectiveness of a 5-day mind-body exercise (MBE) program on measures of quality of life, balance, balance confidence, mobility and gait in community-dwelling women.MethodsThe MBE program was a 5-day retreat where multiple sessions of Feldenkrais^®-based sensorimotor movement training and walking were performed daily. Forty-six women aged 40–80 years old participated in either the MBE program or maintained normal daily activity. Two-footed eyes-closed balance, gait characteristics, mobility via the Timed Up and Go test, balance confidence and quality of life were assessed before and after the intervention.ResultsWomen in the MBE group experienced improvements in mobility (6%; p = 0.01), stride length (3%; p = 0.008), single limb support time (1.3%; 0.006), balance confidence (5.2%; p < 0.001) and quality of life (p < 0.05) while the control group did not change.ConclusionThis short-term intensive program may be beneficial to women at risk of mobility limitations.     

Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials

ObjectiveThis study aimed to evaluate the effects of motor imagery (MI) on walking function and balance in patients after stroke.MethodsRelated randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration.ResultsA total of 17 studies were included. When compared with “routine methods of treatment or training”, meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.81, random effect model, 95% CI = −0.03 to 1.65, P = 0.06). Statistically significant improvement in walking abilities was noted at short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) assessments (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = −0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration.ConclusionMI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding the effects of MI in patients after stroke remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effects of MI in post-stroke patients.     

Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis

ObjectiveTo systematically review literature about the rehabilitative effects of traditional Chinese exercises (TCEs) on limb function among patients with stroke.MethodsSystematic review and meta-analysis of randomized controlled trials (RCTs). Twelve electronic databases were searched from their inceptions to February 2017, including PudMed, The Cochrane Library, Web of Science, EMBase, Science Direct, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Chinese Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and WanFang Data. RCTs were located to examine the rehabilitative effects of TCEs on limb function among stroke patients. Two authors independently screened the literature, extracted data and assessed the risk bias of the included studies. Methodological quality evaluation and meta-analysis of included studies was performed by using Cochrane Collaboration's tool (RevMan 5.3).ResultsA total of 31 RCTs with 2349 participants were included. Results of meta-analysis showed that TCEs produced positive effects on limb motor function (random effects model, standardized mean difference [SMD] = 1.21, 95% confidence interval [CI] = 0.66 to 1.77, P < 0.01), balance function{Berg balance scale: (random effects model, SMD = 2.07, 95%CI = 1.52 to 2.62, P < 0.01), timed-up-and-go test: (fixed effects model, mean difference [MD] = −1.77, 95%CI = −2.87 to −0.67, P < 0.01)}, activities of daily living (ADL) ability {Barthel Index scale: (random effects model, MD = 15.60, 95%CI = 7.57 to 23.63, P < 0.01), Modified Barthel Index scale: (random effects model, MD = 12.30, 95%CI = 7.48 to 17.12, P < 0.01)}, and neurological impairment (fixed effects model, MD = −2.57, 95%CI = −3.14 to −2.00, P < 0.01). After subgroup analysis and sensitivity analysis, the positive effects did not be affected by different types of TCEs and different lengths of intervention time. However, TCEs were no benefit to physical function on Short Physical Performance Battery and 2-min Step Test among stroke patients.ConclusionCurrent evidence showed that TCEs produced positive effects on limb motor function, balance function, ADL ability and neurological impairment among stroke patients. More large-scale, high-quality, multiple center RCTs are required to further verify above conclusions in the future.     

Age-related changes in human conventional semen parameters and sperm chromatin structure assay-defined sperm DNA/chromatin integrity

Research questionWhat are the correlations between male age, traditional semen parameters, sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) in a sufficiently large sample size?DesignRetrospective cohort study of 18,441 semen samples, with data divided into seven age groups according to male age: ≤25, 26–30, 31–35, 36–40, 41–45, 46–50 and ≥51 years.ResultsAge was negatively correlated with semen volume, total sperm count, motility and HDS, and positively correlated with sperm concentration and DFI (P < 0.001). After 35 years of age, semen volume and total sperm count began to decline. After 30 years of age, motility and HDS decreased consistently. Sperm concentration and DFI increased from 26–30 years of age. DFI was negatively correlated with sperm concentration, total sperm count, motility and normal morphology (P < 0.001) and positively correlated with semen volume and HDS (P < 0.001). HDS was negatively correlated with all parameters (P < 0.001) except semen volume (r = –0.013, P = 0.074) and DFI (r = 0.124, P < 0.001). Patients aged ≥40 years had higher DFI than those aged <40 years in the entire cohort, in the abnormal semen parameters cohort, and in the normal semen parameters cohort (OR 2.145, 2.042, 1.948, respectively, P < 0.001). The ≥40 years age group had a lower HDS than the <40 years age group in the entire cohort and abnormal semen parameters cohort (OR 0.719, 0.677, respectively, P < 0.001).ConclusionsAgeing is a negative effector of sperm quantity and quality, and routine sperm parameters have weak but significant correlations with sperm DNA/chromatin integrity.     

Baduanjin exercise ameliorates motor function in patients with post-stroke cognitive impairment: A randomized controlled trial

Background and purposeAs a traditional Chinese mind-body exercise, Baduanjin has been documented to have a positive effect on cognitive and physical function in a wide range of populations, but it is unclear whether it helps improve motor function in patients with post-stroke cognitive impairment (PSCI). The aim of this two-arm, randomized, parallel controlled study was to explore the rehabilitation effect of Baduanjin exercise on motor function in patients with PSCI.Materials and methodsForty-eight patients with PSCI were randomly assigned to control and intervention groups. The control group received health education sessions on stroke prevention and rehabilitation. The intervention group received Baduanjin training in addition to the health education intervention. Before and after the 24-week intervention, both groups completed the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Manual Muscle Test (MMT), Modified Ashworth Scale (MAS), and Three-Dimensional Gait Analysis (3DGA).ResultsAfter the 24-week intervention, both groups showed significant improvements in the FMA, BBS, MMT and MAS test results, but the Baduanjin group exhibited significantly better FMA, BBS and MMT test results than the control group (all P < 0.05). Furthermore, the Baduanjin exercise group showed significant improvements in spatial gait parameters, including the step length, walking speed and cadence, which were significantly better than the control group (all P < 0.05). No adverse events were reported during the study period.ConclusionThe 24-week Baduanjin exercise training may improve the limb motor function, balance, muscle strength and gait function of individuals with PSCI.     

Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database

BackgroundMany patients with erectile dysfunction (ED) after radical prostatectomy (RP) improve with conservative therapy but some do not; penile prosthesis implantation rates have been sparsely reported, and have used nonrepresentative data sets.AimTo characterize rates and timing of penile prosthesis implantation after RP and to identify predictors of implantation using a more representative data set.MethodsThe Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery databases for Florida from 2006 to 2015 were used. Patients undergoing RP (2006–2012) were tracked longitudinally for penile prosthesis implantation. Patient and clinical data were analyzed using multivariable logistic regression.OutcomesThe primary outcome was risk-adjusted predictors of prosthesis implantation, and the secondary outcome was predictors of the highest quartile of time between RP and penile prosthesis.ResultsOf 29,288 men who had RP, 1,449 (4.9%) patients underwent subsequent prosthesis. The mean time from RP to prosthesis was 2.6 years (median: 2.1; interquartile range [IQR]: 1.2–3.5). Adjusted predictors of prosthesis implantation included open RP (odds ratio [OR]: 1.5, P < .01), African American race (OR: 1.7, P < .01) or Hispanic ethnicity (OR: 3.2, P < .01), and Medicare (OR: 1.4, P < .01) insurance. Oler patients (age >70 years; OR: 0.7, P < .01) and those from the highest income quartile relative to the lowest (OR: 0.8, P < .05) were less likely to be implanted. Adjusted predictors of longer RP-to-implantation time (highest quartile: median: 4.7 years; IQR: 3.9–6.0 years) included open RP (OR: 1.78, P < .01), laparoscopic RP (OR: 4.67, P < .01), Medicaid (OR: 3.03, P < .05), private insurance (OR: 2.57, P < .01), and being in the highest income quartile (OR: 2.52, P < .01).Clinical ImplicationsThese findings suggest ED treatment healthcare disparities meriting further investigation; upfront counseling on all ED treatment modalities and close monitoring for conservative treatment failure may reduce lost quality of life years.Strengths & LimitationsThis study is limited by its use of administrative data, which relies on accurate coding and lacks data on ED questionnaires/prior treatments, patient-level cost, and oncologic outcomes. Quartile-based analysis of income and time between RP and prosthesis limits the conclusions that can be drawn.ConclusionLess than 5% of post-RP patients undergo penile prosthesis implantation, with open RP, Medicare, African American race, and Hispanic ethnicity predicting post-RP implantation; living in the wealthiest residential areas predicts lower likelihood of implantation compared to the least wealthy areas. Patients with the longest time between RP and prosthesis are more likely to live in the wealthiest areas or have undergone open/laparoscopic RP relative to robotic RP.Bajic P, Patel PM, Nelson MH, et al. Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database. J Sex Med 2020;17:1175–1181.     

Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: A pilot study

This study assessed feasibility and effect of weekly, 15-min chair massages during work for 38 nurses. Mean Perceived Stress Scale-14 (PSS-14), Smith Anxiety Scale (SAS), linear analog self-assessment scale (LASA), and symptom visual analog scale (SX-VAS) scores were tracked at baseline, 5 weeks, and 10 weeks. Of 400 available massage appointments, 329 were used. At 10 weeks, mean PSS-14 score decreased from 17.85 to 14.92 (P = .002); mean SAS score, from 49.45 to 40.95 (P < .001). Mean LASA score increased from 42.39 to 44.84 (P = .006); mean SX-VAS score, from 65.03 to 74.47 (P < .001). Massages for nurses during work hours reduced stress-related symptoms.     

Maternal BMI in Twin Pregnancies and Impact on Neonatal Outcomes in the Level I Unit: A Retrospective Cohort Study

ObjectiveWith maternal obesity rates and twin pregnancies on the rise, the aim of this study was to assess the impact of pre-pregnancy or first trimester BMI on short-term neonatal morbidities in twins admitted to a level I unit.MethodsThis retrospective single-centre cohort study was conducted on twins born between January 1, 2010 and December 31, 2013 and admitted to the level I unit at Mount Sinai Hospital in Toronto, Ontario. Twin pairs were categorized according to maternal BMI: underweight (<18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥30 kg/m²). The primary outcome was combined neonatal morbidities of hypoglycemia and hyperbilirubinemia. The secondary outcome was length of hospital stay. All outcomes were compared between twins in various BMI groups, and data were analyzed using the chi-square test or ANOVA (Canadian Task Force Classification II-2).ResultsData on 700 neonates born to 350 women were analyzed. Baseline maternal and neonatal characteristics were similar between the groups, except for a statistically significantly higher incidence of maternal hypertension (P < 0.02) and a trend towards increased gestational diabetes rates (P = 0.05) in women with overweight or obesity compared with women with underweight or normal weight. No association was noted between maternal BMI and occurrence of neonatal hypoglycemia, hyperbilirubinemia, and length of stay in either twin pair (P > 0.05)ConclusionMaternal BMI had no detectable effect on neonatal morbidities and length of stay in twins admitted to the level I unit in the study centre.     

Diagnostic value of endometrial volume and flow parameters under 3D ultrasound acquisition in combination with serum CA125 in endometrial lesions

ObjectiveThis study aims to discuss the differential diagnosis value of endometrial volume and flow parameters in combination with serum carbohydrate antigen 125 (CA125) in endometrial benign and malignant lesions.Materials and methodsThe data of 250 patients with endometrial lesions were retrospectively analyzed. Carbohydrate antigen 125 (CA125) was determined before the operation. The morphology, hemodynamics, volume and flow parameters of the endometrium were measured by transvaginal three-dimensional-power Doppler angiography (3D-PDA). The endometrial volume (EV), 3D-PDA vascular index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the virtual organ computer-aided analysis software (VOCAL).ResultsAccording to the pathological results, 202 patients (80.8%) had benign endometrial lesions and 48 patients (19.2%) had endometrial cancer (EC). The endometrium of EC patients was thicker (15.64 ± 7.26 mm vs. 9.24 ± 5.06 mm, P < 0.001), the endometrial volume was larger (9.23 ± 4.08 ml vs. 2.26 ± 3.42 ml, P < 0.001), and the flow parameters VI, FI and VFI were higher, when compared to those of benign lesions (P < 0.001). The area under the receiver operating characteristic curve (AUROCC) of VI receptors was 0.86, while the AUC of endometrial thickness (ET) was only 0.66. Therefore, the best variable for distinguishing benign and malignant endometrial lesions was VI. The level of CA125 in the EC group significantly increased (40.57 ± 17.45 vs. 17.87 ± 7.64, P < 0.001), and the level of CA125 increased (P < 0.05) with the increase in clinical grade, degree of tumor differentiation, and pelvic lymph node metastasis (P < 0.05). However, the difference in myometrial invasion was not statistically significant (P > 0.05).ConclusionTransvaginal 3D-PDA can clearly show the morphological and hemodynamic characteristics of endometrial lesions, and assist in the detection of EC in combination with serum CA125. This may have important clinical application value.     

A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program

BackgroundGiven the burgeoning demand for gender affirmation surgery, there are few studies examining both surgical process variables and patient outcome variables. Knowing the learning curve for surgical teams who are beginning to perform this procedure will be important for patient safety and presurgical patient counseling as more institutions open transgender surgical programs.AimThe purpose of this study was to determine the demographics of patients pursuing penoscrotal vaginoplasty, to determine their postoperative course, and to determine a learning curve for the surgical team performing penoscrotal vaginoplasty.MethodsWe retrospectively reviewed charts of all 43 patients who underwent penoscrotal vaginoplasty from the commencement of a new male-to-female penoscrotal vaginoplasty program in March 2018 through July 2019.OutcomesPrimary outcomes included mean hemoglobin decrease from surgery and operative time. Mean time to neoclitoral sensation, length of hospital admission, complication rates, reoperation rates, length of narcotic use after surgery, and demographics were also evaluated. Associations between surgical team experience and outcomes were assessed with Spearman's rho and Cox regression, and curve-fitting procedures were applied to determine the relationship.ResultsThe mean operative time from initial incision to procedure finish was 225 minutes, and the mean decrease in hemoglobin was 3.3 g/dL. The mean time to neoclitoral sensation was 0.72 months. The time until neoclitoral sensation decreased as the surgical cases performed increased (Spearman's rho, −0.577 [P < .001]), with a power function best describing the learning curve. Operative time did not change with case number (Spearman's rho, 0.062 [P = .698]) but overall time in the operating room did (Spearman's rho, 0.631 [P < .001]). Mean length of hospital admission was 2.9 days. There were no intraoperative complications. 18 patients (42%) experienced a postoperative complication. 8 of 43 patients underwent reoperation (20%). Narcotics were used a mean of 9.5 days after surgery.Clinical ImplicationsA learning curve can be demonstrated in penoscrotal vaginoplasty for time to neoclitoral sensation and overall time in the operating room, plateauing between 30 and 40 cases.Strengths and LimitationsStrengths include assessing a learning curve for time to neoclitoral sensation, length of hospital stay, and length of postoperative narcotic use after penoscrotal vaginoplasty, which, to our knowledge, has not been reported elsewhere. Limitations include our overall low number of patients.ConclusionDespite a low number of cases, length of hospital stay was short and the postoperative complication rate was similar to that of long-standing penoscrotal vaginoplasty programs.Whynott RM, Summers K, Mickelsen R, et al. A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program. J Sex Med 2020;17:1787–1794.     

2D-ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia

Objectives

To study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome.

Study design

Prospective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE).

Main outcome measures

Basal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11–13 + 6 weeks, MS inhibin A at 15–22 weeks and birthweight centile at delivery.

Results

In the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD.

Conclusion

The basal plate surface area at 11–14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE.     

Association of serum anti-Müllerian hormone and other factors with cumulative live birth rate following IVF

Research questionWhat are the optimal values of maternal age and body mass index (BMI), paternal age and BMI, number of oocytes retrieved, and serum AMH concentrations for cumulative live birth rate (CLBR) in IVF and embryo transfer (IVF–ET)?DesignThis retrospective cohort study included 9494 women who underwent their first IVF–ET cycle between January 2017 and July 2018. The primary outcome was the CLBR within one complete cycle. Cox regression analysis was used to test the hazard ratio, with 95% confidence intervals.ResultsCLBR was significantly lower when maternal age was over 35 (adjusted P < 0.01 for age 36–38 years, adjusted P < 0.00001 for all age groups above 38 years). CBLR increased with increasing serum AMH concentrations and number of retrieved oocytes up to peak values at 5–7 ng/ml AMH and 16–20 oocytes in all women. CLBR was significantly increased when serum AMH concentrations were 3–7 ng/ml (adjusted P < 0.001) and number of oocytes retrieved was more than five (adjusted P < 0.00001). Overweight had a negative effect on CLBR compared with normal BMI in women under 35 years of age (adjusted P = 0.037). In women aged over 35 years, paternal overweight had a negative effect on CLBR compared with normal paternal BMI (adjusted P < 0.01).ConclusionsMaternal age had an impact on optimal serum AMH concentrations and number of oocytes retrieved. Maternal overweight negatively affected CLBR in women under 35 years of age, and paternal overweight negatively affected CLBR in women over 35 years.     

Are morphokinetic parameters of embryo development associated with adverse perinatal outcomes following fresh blastocyst transfer?

Research questionAre obstetric and perinatal complications associated with morphokinetic parameters of embryo development?DesignThis proof-of-concept pilot study included a retrospective analysis of embryo morphokinetic parameters of 85 live births following day 5 single blastocyst transfer. Kinetic variables included time interval (hours) from time of pronuclei fading (tPNf) to: time of 2 cells (tPNf–t2), 9 cells (tPNf–t9), morula (tPNf–tM), start of blastulation (tPNf–tSB), full blastocyst (tPNf–tB) and expanded blastocyst (tPNf–tEB). Multivariable logistic models were used to calculate the risk of perinatal complications after adjustment for confounders.ResultsThe mean interval of tPNf–tSB was significantly longer for newborns with congenital anomalies compared with healthy newborns (79.49 ± 5.78 versus 71.7 ± 6.3, respectively, P = 0.01) and for embryos of women who had gestational diabetes mellitus compared with normoglycemic women (76.56 ± 7.55 versus 71.5 ± 6.13, respectively, P = 0.015). The mean interval of tPNf–t9 was significantly longer for low-birthweight newborns compared with normal weight (49.25 ± 5.54 versus 45.47 ± 4.77, respectively, P = 0.01). Preterm delivery was associated with several longer intervals of cell divisions compared with delivery at term (tPNf–t5: 28.76 ± 3.13 versus 26.64 ± 2.40, respectively, P = 0.01; tPNf–t6: 30.10 ± 3.05 versus 27.68 ± 2.30, respectively, P < 0.001; tPNf–t7: 32.08 ± 4.11 versus 28.70 ± 2.67, respectively, P < 0.001; tPNf–t8: 34.75 ± 4.95 versus 30.70 ± 4.10, respectively, P < 0.001; tPNf–t9: 50.23 ± 5.87 versus 45.44 ± 4.67, respectively, P < 0.001). For each of the outcomes, the association remained significant after adjusting for confounders.ConclusionThis study indicates that there may be a possible association between adverse perinatal outcomes and morphokinetic parameters. Larger studies are needed to establish this association.     

Laser surgery in twin–twin transfusion syndrome with proximate cord insertions

Objective

To estimate the prevalence of proximate cord insertions in twin–twin transfusion syndrome (TTTS) and evaluate the outcome after fetoscopic laser coagulation surgery.

Methods

We included all TTTS cases treated with laser at our center between 2002 and 2013. Placentas were examined after birth and injected with colored dye. TTTS cases without complete placental injection study were excluded. We recorded the presence of proximate cord insertions (distance < 5 cm) after birth and the presence and types of residual anastomoses. We compared the clinical outcome and placental findings in cases with and without proximate cord insertions.

Results

The prevalence of proximate cord insertions in TTTS placentas was 2% (4/252). Perinatal mortality in the TTTS group with and without proximate cord insertions was 13% (1/8) and 12% (61/496), respectively (P = 1.0). Residual anastomoses were detected in all placentas with proximate cord insertions (100%, 4/4) compared to 27% (66/248)(P < .01) in TTTS placentas without proximate cord insertions.

Conclusion

Fetoscopic laser coagulation in TTTS cases with proximate cord insertions is challenging due to technical difficulties in visualizing the vascular equator and results in an increased risk of incomplete laser treatment.     

Minimally Invasive Hysterectomy Rates in Québec: Trends Over the Last Decade and Predictors of Technicity

ObjectiveTo assess trends and predictors of a high technicity index for hysterectomies performed in the province of Québec.MethodsWe conducted a retrospective study using the ADAM database to determine the annual number hysterectomies performed for a suspected benign condition and the surgical approach used across 81 hospitals in the province of Québec from 2007 to 2017. We calculated the technicity index for each hospital and analyzed trends in surgical approach using the Cochran-Armitage test. We used logistic regression to assess potential predictors of a high technicity index (>70%), including academic centre, urban area, high volume of hysterectomies performed, and greater number of gynaecologists per hospital.ResultsFifty-nine hospitals were eligible for inclusion, representing 96 431 hysterectomies during the study period. Over the decade, the technicity index increased from 43% to 66% (P < 0.001, with a 198% increase in laparoscopic hysterectomies (from 685 to 2039 per year; P < 0.001), a 50% decrease in abdominal hysterectomies (from 5528 to 2790 per year; P < 0.001), and a 8% decrease in vaginal hysterectomies (form 3551 to 3257 per year; P < 0.001). Meanwhile, the total number of hysterectomies per year declined by 17% (P < 0.001). Being an academic centre was the only significant predictor of a high technicity index >70% (68% vs. 38%; OR 7.5; P = 0.047).ConclusionTechnicity is increasing in the province of Québec and the majority of hysterectomies are now performed using a minimally invasive approach. This shift has mainly occurred through an increase in the laparoscopic approach and a decrease in the abdominal approach. Academic centres are more likely to have high technicity indexes.     

The Effect on Perioperative Bleeding of Placental Extraction From an Exteriorized Uterus During Caesarean Section

ObjectiveTo evaluate the effect on perioperative bleeding of an alternative technique for Caesarean section, in which placental extraction is performed while the uterus is exteriorized.MethodsWe performed a retrospective matched cohort study using data obtained through chart review. Group 1 included women who had CS performed using the technique of placental removal while the uterus was exteriorized, and group 2 included women who had CS performed using the conventional method of placental removal from a non-exteriorized uterus. Women in each group were matched for number of previous Caesarean sections, indications for CS, and gestational age. The primary outcome was the difference between preoperative and postoperative hemoglobin concentrations. Secondary outcomes included the incidence of blood transfusion, estimated blood loss (EBL), operative time, the incidence of postoperative endometritis, and length of hospital stay.ResultsA total of 90 charts were reviewed (45 per group). Baseline clinical characteristics were similar in both groups. The mean decrease in hemoglobin concentration was 22% less in women who had placental extraction from an exteriorized uterus than in those who had the conventional placental extraction (13.2 g/L vs. 16.9 g/L, P = 0.016). Among secondary outcomes, women in group 1 had a lower mean EBL (531.1 mL vs. 691.1 mL, P < 0.05) and a shorter mean duration of surgery (28.0 minutes vs. 40.5 minutes, P < 0.05).ConclusionExteriorizing the uterus prior to removal of the placenta during CS may decrease intraoperative and immediate postoperative bleeding compared with the conventional technique. Further studies on this technique are indicated.     

Study of Length of Umbilical Cord and Fetal Outcome: A Study of 1,000 Deliveries

Objective

To study the correlation of umbilical cord length with fetal parameters like Apgar score, sex, weight, and length, and its effect on labor outcome.

Design

Prospective study of 1,000 cases.

Setting

Government Hospital

Material and Method

Examination of umbilical cord was done for any loop around neck, trunk, etc; no. of loops of cord and positions; Knots of cord (True or false), any cord abnormalities. Fetal parameters recorded were sex, weight, and length of the newborn. Fetal outcome studied by Apgar score at 1 and 5 min.

Results

In our study, the cord length varied from 24 to 124 cm. The mean cord length was 63.86 cm (±15.69 cm). Maximum cases seen were in the group of cord length between 51 and 60 cm. Lower 5th percentile was considered as short cord and upper 5th percentile was considered as long cord. Short-cord group was associated with significantly higher (p < 0.05) incidence of LSCS cases. Cord length did not vary according to the weight, length, and sex of the baby. The incidence of all types of cord complications increases as the cord length increases (p < 0.001*). Nuchal cords had higher mean cord length than in cases without nuchal cords (p < 0.001). As the number of loops in a nuchal cord increases to more than two loops, the operative interference increases. The significance was tested by using a Chi-square test, and it was found to be statistically significant (p < 0.05). Nuchal cords were seen to be associated with more cases of fetal heart abnormalities (p < 0.001). There is higher incidence of variability in fetal heart rate with extremes of cord length (p < 0.001). The incidence of birth asphyxia was significantly more in long and short cords as compared to cords with normal cord length (p < 0.001).

Conclusion

The present study showed that the length of umbilical cord is variable; however, maximum number of cases had normal cord length. Cases which had short and long cords constituted abnormal cord length. These cases had higher incidence of cord complications, increased incidence of operative interference, intrapartum complications, increased fetal heart rate abnormalities, and more chances of birth asphyxia. But cord length did not vary according to the weight, length, and sex of the baby.     

Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes,Costs, and Predictive Factors

BackgroundThe surgical treatment of urinary incontinence and erectile dysfunction by prosthetic devices has become part of urologic practice, although sparse data exist at a national level on readmissions and hospital costs.AimTo assess causes and costs of early (≤30 days) and late (31–90 days) readmissions after implantation of penile prostheses (PPs), artificial urinary sphincters (AUSs), or PP + AUS.MethodsUsing the 2013 and 2014 US Nationwide Readmission Databases, sociodemographic characteristics, hospital costs, and causes of readmission were compared among PP, AUS and AUS + PP surgeries. Multivariable logistic regression models tested possible predictors of hospital readmission (early, late, and 90 days), increased hospital costs, and prolonged length of stay at initial hospitalization and readmission.OutcomeOutcomes were rates, causes, hospital costs, and predictive factors of early, late, and any 90-day readmissions.ResultsOf 3,620 patients, 2,626 (73%) had PP implantation, 920 (25%) had AUS implantation, and 74 (2%) underwent PP + AUS placement. In patients undergoing PP, AUS, or PP + AUS placement, 30-day (6.3% vs 7.9% vs <15.0%, P = .5) and 90-day (11.6% vs 12.8% vs <15.0%, P = .8) readmission rates were comparable. Early readmissions were more frequently caused by wound complications compared with late readmissions (10.9% vs <4%, P = .03). Multivariable models identified longer length of stay, Charlson Comorbidity Index score higher than 0, complicated diabetes, and discharge not to home as predictors of 90-day readmissions. Notably, hospital volume was not a predictor of early, late, or any 90-day readmissions. However, within the subset of high-volume hospitals, each additional procedure was associated with increased risk of late (odds ratio = 1.06, 95% CI = 1.03–1.09, P < .001) and 90-day (odds ratio = 1.03 95% CI = 1.02–1.05, P < .001) readmissions. AUS and PP + AUS surgeries had higher initial hospitalization costs (P < .001). A high hospital prosthetic volume decreased costs at initial hospitalization. Mechanical complications led to readmission of all patients receiving PP + AUS.Clinical ImplicationsHigh-volume hospitals showed a weaker association with increased initial hospitalization costs. Charlson Comorbidity Index, diabetes, and length of stay were predictors of 90-day readmission, showing that comorbidity status is important for surgical candidacy.Strengths and LimitationsThis is the first study focusing on readmissions and costs after PP, AUS, and PP + AUS surgeries using a national database, which allows ascertainment of readmissions to hospitals that did not perform the initial surgery. Limitations are related to the limited geographic coverage of the database and lack of surgery- and surgeon-specific variables.ConclusionsAnalysis of readmissions can provide better care for urologic prosthetic surgeries through better preoperative optimization, counseling, and resource allocation.Pederzoli F, Chappidi MR, Collica S, et al. Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes, Costs, and Predictive Factors. J Sex Med 2017;14:1059–1065.     

Obesity and follicular fluid oxidative stress: Relationship to ICSI outcome

ObjectiveTo study the influence of female obesity on follicular fluid oxidative stress and to correlate it to intracytoplasmic sperm injection (ICSI) outcome.Study designSeventy-four normal females below the age of 40 undergoing ICSI for reason of male factor infertility were enrolled in the study. They were divided into 2 groups according to body mass index (BMI); Group I (non-obese) (n = 24, BMI < 25 Kg/m²) and Group II (obese) (n = 50, BMI ⩾ 25 Kg/m²). Oxidative stress markers (MDA (malonaldehyde), NO₂/NO₃ (Nitrite/Nitrate) ratio, GSH (reduced glutathione) and GSH/GSSG (reduced glutathione/oxidized glutathione) ratio) were measured by high performance liquid chromatography (HPLC).ResultsObese women had significantly higher mean follicular fluid MDA (P = 0.006) as well as NO₂/NO₃ ratio (P = 0.004). BMI strongly correlated to follicular fluid MDA (P = < 0.01). MDA showed strong positive correlation to NO₂/NO₃ ratio (P = 0.02). GSH and GSH/GSSG ratio showed a non-significant difference between the two groups (P = 0.14 and 0.67, respectively). Clinical pregnancy rate was significantly higher in the non-obese group (87%) compared to the obese (43%) (P = <0.01, OR:13; 95% CI 3.54–52). With binary logistic regression, MDA was found to be a good predictor of the occurrence of pregnancy (P = <0.01). No significant differences were detected as regards parameters including estradiol on day of hCG, gonadotropin dose, number of retrieved oocytes, metaphase II(MII) and fertilized oocytes.ConclusionObesity aggravates follicular fluid oxidative stress with a negative impact on pregnancy outcome of ICSI cycles.     

Effect of exercise on the reproductive outcome and fetal development of diabetic rats

The aim of this study was to evaluate the effect of exercise on pregnancy outcome in streptozotocin-induced diabetic Wistar rats (n = 11 animals/group). These animals were randomly assigned to sedentary (G1) and exercised groups, beginning from day 0 (G2) or 7 (G3) to day 20 of pregnancy. The moderate exercise was a swimming programme. At day 21 of pregnancy, all rats were anaesthetized and killed to obtain pregnancy outcome data. All rats presented glycaemia higher than 300 mg/dl, regardless of the exercise training. The G3 group showed higher live fetus number per implantation site and lower resorption number per implantation site compared with the G1 group. The fetal and placental mean weights per litter and the total number of ossification sites were significantly lower in the exercised groups (P < 0.05). Placental index was lower in the G2 and G3 groups compared with the G1 group. The occurrence of skeletal anomalies indicated that exercise increased the number of altered fetuses. Thus, moderate exercise achieved better outcomes by increasing the number of live births and decreasing resorption. However, exercise increased skeletal anomalies and decreased fetal and placental weights.