Effect of pessary use on genital hiatus measurements in women with pelvic organ prolapse

OBJECTIVE: To compare the size of the genital hiatus in women wearing a pessary for pelvic organ prolapse after consistent pessary use, describe characteristics of patients who continue use, and assess change in pelvic floor symptoms. METHODS: This was an observational cohort study of 90 women seeking nonsurgical management of symptomatic prolapse. Our primary outcome was change in genital hiatus (in centimeters) after 3 months of consistent pessary use. Pelvic floor symptoms were assessed with the Pelvic Floor Distress Inventory. Change in genital hiatus measurements and Pelvic Floor Distress Inventory scores were assessed using a paired Student t test. Between-group differences were evaluated using the Student t, Mann Whitney U, and Fisher exact tests, where appropriate. Logistic regression was used to assess baseline characteristics predictive of continued pessary use. RESULTS: The average (+/-standard deviation) age of participants enrolled was 62.8 +/-13.2 years. Median parity was 3, and 87.7% were postmenopausal. Forty-two (47%) continued pessary use at 3 months. After 2 weeks, there was a decrease in the size of the genital hiatus measured with strain from 4.8+/-1.6 cm to 4.1+/-1.2 cm, P<.001, which persisted at 3 months (3.9+/-1.1 cm, P<.001). The greatest change occurred with the Gellhorn pessary. Baseline Pelvic Organ Prolapse Quantification system point Aa was positively associated with continued pessary use at 3 months, and perineal body at rest was negatively associated. CONCLUSION: After 3 months of pessary use, genital hiatus size decreased significantly. Pessary use results in significant anatomic changes to the genital hiatus in patients with pelvic organ prolapse.     

Vicarious,direct, and imaginal aversion in habit control: Outcomes,heart rates,and subjective perceptions

Direct, modeled, or imaginal shocks administered by therapist or recipient were compared as aversion techniques for 60 women college students with severe nail-biting habits. All methods increased habit control (p <.001)on self-report and objective measures but with no outcome differences among treatments. Providing mental rehearsal guidance for extralaboratory use failed to alter outcome but raised client optimism to ward therapy. Vicarious aversion produced the most rapid heart rates and, typically, the greatest subjective arousal; no data suggested that direct shock was superior. In a second study with unselected student volunteers of both sexes, modeled shock consistently surpassed imaginal shock in ratings of perceived badness, subjective discomfort, and vividness of covert pain (p <.01).Treatment and ethical implications were discussed. We are indebted to Lisa Obstfeld, who performed ably as the long-suffering model, and to Albert Bandura, Mary Gabrielson, Glenn M. White, and Louis Zimmer, who assisted with other matters. Part of this research was completed while all authors were at the University of Arizona, Tucson.     

A bibliometric analysis of occupational therapy publications

Background: Bibliometrics involves the statistical analysis of the publications in a specific discipline or subject area. A bibliometric analysis of the occupational therapy refereed literature is needed.

Aim: A bibliometric analysis was completed of the occupational therapy literature from 1991-2014, indexed in the Science Citation Index-Expanded or the Social Sciences Citation Index.

Method: Publications were searched by title, abstract, keywords, and KeyWords Plus. Total number of article citations, citations per journal, and contributions per country, individual authors, and institution were calculated.

Results: 5,315 occupational therapy articles were published in 821 journals. It appears that there is a citation window of an approximate 10-year period between the time of publication and the peak number of citations an article receives. The top three most highly cited articles were published in Developmental Medicine and Child Neurology, JAMA, and Lancet. AJOT, BJOT and AOTJ published the largest number of occupational therapy articles with the United States, Australia, and Canada producing the highest number of publications. McMaster University, the University of Queensland, and the University of Toronto were the institutions that published the largest number of occupational therapy journal articles.

Conclusion: The occupational therapy literature is growing and the frequency of article citation is increasing.     

Immune-mediated neurological syndromes in SARS-CoV-2-infected patients

Journal of Neurology - Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore...     

Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy

The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.     

Acute inflammation induced by the biopsy of mouse mammary tumors promotes the development of metastasis

Development of metastasis in peripheral tissues is a major problem in the fight to cure breast cancer. Although it is becoming evident that chronic inflammation can contribute to tumor progression and metastasis, the effect of acute inflammation in primary tumor is less known. Using mouse models for breast cancer here we show that biopsy of mammary tumors increases the frequency of lung metastases. This effect is associated with the recruitment of inflammatory cells to the lung and elevated levels of certain cytokines such as IL-6 in the lung airways. Antiinflammatory treatment prior to and after the biopsy reduces the development of metastases triggered by the biopsy. In addition, while lack of IL-6 does not affect primary tumor development, it protects from increasing number of metastases upon biopsy. Thus, our studies show that in addition to chronic inflammation, acute immune response caused by invasive procedures in the primary tumor may cause an increased risk on peripheral metastases, but the risk could be decreased by anti-inflammatory treatments.