Critical review of the efficacy and safety of cryotherapy of the prostate

Modern cryoablation of the prostate is a procedure that has evolved since the early 1990s into a safer and more successful treatment of adenocarcinoma of the prostate. The improvement of this technique has taken place secondary to advancement in engineering, procedure refinement, temperature monitoring, and a better understanding of physiologic events during the freezing process. Long-term results are available that demonstrate durable efficacy equivalent to other therapies in low-risk groups. In moderate to high risk groups, results point toward equal to superior results than other standard therapies. New ideas on potency preservation using vacuum erection devices have improved men’s return to function over the course of the postoperative year. Early morbidity issues, such as fistula formation and incontinence, have become much less problematic, with results between 0% and 1% in some series. Cryoablation of the prostate now offers significantly improved outcomes with a parallel decrease in morbidity.     

OUTLOOKS ON THE FUTURE OF NURSE-MIDWIFERY*

It is essential that people and organizations stop to think about their personal and professional expectations of the future. Inherent in this is the need to explore societal as well as professional trends before adopting a plan for professional growth. This scenario was developed to be a futuristic look at nurse-midwifery from the year 1980 to the year 2005. The 25 years that will follow the 25th Anniversary Convention will be important for nurse-midwives, and this article explores some of the societal, women's, and health care issues that may impact the profession of nurse-midwifery.     

Sexual victimization among a national probability sample of adolescent women

CONTEXT: Forced sexual intercourse is becoming more salient for adolescent women nationwide, but little is known about sexual revictimization and its mediators among adolescents in middle and high school. METHODS: Data on 7,545 adolescent women who participated in both Wave 1 (April-December 1995) and Wave 2 (1996) of the National Longitudinal Study of Adolescent Health were used in logistic regression analyses to identify predictors of completed forced sexual intercourse, estimate prevalence of sexual revictimization and determine mediators of the relationship between history of forced sex and sexual revictimization. RESULTS: At Wave 1, 7% of adolescent women reported having been forced into sexual intercourse. Of these, 8% were revictimized in the following year. In multivariate analyses, predictors of sexual victimization by Wave 1 included having been in a romantic relationship in the past 18 months (odds ratio, 2.1), having been exposed to violence in the past year (1.9), alcohol use in the last year (1.7), marijuana use in the last 30 days (1.5) and increasing levels of emotional distress (1.4). Predictors of sexual victimization between waves included having had sex by the first wave (2.3), alcohol use (2.0), recent cocaine use (4.7), rising levels of emotional distress (1.4) and genital touching within romantic relationships (2.7). CONCLUSIONS: Health care providers, teachers and school counselors can play key roles in identifying adolescent women at high risk for sexual victimization and revictimization by being attuned to adolescents' mental health symptoms, substance use and levels of sexual activity.     

Clarification of glycosylphosphatidylinositol anchorage of OTOANCORIN and human OTOA variants associated with deafness

Otoancorin (OTOA), encoded by OTOA, is required for the development of the tectorial membrane in the inner ear. Mutations in this gene cause nonsyndromic hearing loss (DFNB22). The molecular mechanisms underlying most DFNB22 remain poorly understood. Disruption of glycosylphosphatidylinositol (GPI) anchorage has been assumed to be the pathophysiology mandating experimental validation. From a Korean deaf family, we identified two trans OTOA variants (c.1320 + 5 G>C and p.Gln589ArgfsX55 [NM_144672.3]) . The pathogenic potential of c.1320 + 5 G>C was confirmed by a minigene splicing assay. To experimentally determine the GPI anchorage, wild‐type (WT) and mutant OTOA harboring p.Gln589ArgfsX55 were expressed in HEK293T cells. The mutant OTOA with p.Gln589ArgfsX55 resulted in an uncontrolled release of OTOA into the medium in contrast with phosphatidylinositol‐specific phospholipase C‐induced controlled release of WT OTOA from the cell surface. Together, the results of this reverse translational study confirmed GPI‐anchorage of OTOA and showed that downstream sequences from the 589th amino acid are critical for GPI‐anchorage.     

Predictors of successful labor induction with oral or vaginal misoprostol

Objective: To identify independent predictors of successful labor induction with oral or vaginal misoprostol.

Methods: Women enrolled in four previous randomized trials involving oral or vaginal misoprostol for cervical ripening and labor induction were included in the present cohort study, with dosing of 25–50?μg every 4 to 6?h vaginally (n?=?574) or 50?μg every 4?h orally (n?=?207). Multiple logistic regression was performed to identify factors independently associated with successful labor induction – defined as vaginal delivery within 12?h, vaginal delivery within 24?h and spontaneous vaginal delivery. Predictors of Cesarean birth and the need for only one dose of misoprostol were also identified. Variables included in the models were maternal age, weight, height, parity, gravidity, membrane status, route of misoprostol, gestational age, birth weight, and Bishop score and its individual components.

Results: Maternal age, height, weight, parity, birth weight, dilatation, effacement and cervical station were associated with vaginal delivery within 24?h of induction. Maternal age, height, weight, nulliparity, birth weight and route of misoprostol were associated with Cesarean birth, with oral misoprostol being associated with a lower rate of Cesarean birth. The need for only one dose of misoprostol was predicted by maternal height, weight, parity, gestational age, Bishop score and route of misoprostol.

Conclusion: Characteristics of the woman (height, weight, parity), the fetus (birth weight) and some of the individual components of the Bishop score, were associated with successful labor induction, with oral misoprostol being associated with a lower rate of Cesarean birth.