Recent Publications
June 2012
Surgical site infections and cellulitis after abdominal hysterectomy
Savage MW, Pottinger JM, Chiang HY, Yohnke KR, Bowdler NC, Herwaldt LA.
Am J Obstet Gynecol. 2013 May 24. pii: S0002-9378(13)00532-2. doi: 10.1016/j.ajog.2013.05.043. [Epub ahead of print]
Objectives
To identify risk factors for and outcomes of surgical site infections (SSIs) and cellulitis after abdominal hysterectomies.
Study Design
We used logistic regression analysis to analyze data from a case-control study of 1104 patients undergoing abdominal hysterectomies at a university hospital between 01/01/2007 and 12/30/2010.
Results
Independent risk factors for SSIs and for cellulitis were: pulmonary disease, operations done in Main Operating Room East, and seroma. Body mass index > 35, no private insurance, and fluid and electrolyte disorders were risk factors for SSIs. The mean prophylactic dose of cefazolin was significantly higher for controls than for patients with SSIs. Pre-operative showers with Hibiclens® and cefazolin prophylaxis were associated with a significantly decreased cellulitis risk. SSIs and cellulitis were significantly associated with readmissions and return visits and SSIs were associated with reoperations.
Conclusions
Pre-operative showers, antimicrobial prophylaxis, surgical techniques preventing seromas, and the operating room environment may affect the risk of surgical site infections and cellulitis after abdominal hysterectomies.
For a full text of the article, click here: http://www.sciencedirect.com/science/article/pii/S0002937813005322.
Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment
Hess R, Huang AJ, Richter HE, Ghetti CC, Sung VW, Barrett-Connor E, Gregory WT, Pinkerton JV, Bradley CS, Kraus SR, Rogers RG, Subak LL, Johnson KC, Arya LA, Schembri M, Brown JS.
Am J Obstet Gynecol. 2013 May 6. pii: S0002-9378(13)00480-8. doi: 10.1016/j.ajog.2013.05.008. [Epub ahead of print]
Objective
The objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation.
Study Design
Women completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by the measurement of postvoid residual volume and adverse event monitoring; if necessary, women underwent a specialist evaluation. The longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline.
Results
Of the 567 women completing the randomized trial, 498 (87.8%) took at least 1 dose of medication during this open-label study. Compared with the baseline visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes per day and urgency incontinence episodes per day at the end of the open-label study (adjusted mean [SE], 4.6 [0.12] to 1.2 [0.13] and 3.9 [0.11] to 0.9 [0.11], respectively, P < .0001 for both). Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months, respectively). Twenty-six women experienced 28 serious adverse events, 1 of which was considered possibly treatment related. Twenty-two women had a specialist evaluation: 5 women's incontinence was misclassified by the 3 Incontinence Questions; none experienced harm because of misclassification.
Conclusion
Using a simple validated questionnaire to diagnose and initiate treatment for UUI in community-dwelling women is safe and effective, allowing timely treatment by primary care practitioners.
For a full text of the article, click here: http://www.sciencedirect.com/science/article/pii/S0002937813004808.
Body size and endometriosis: results from 20 years of follow-up within the Nurses' Health Study II prospective cohort
Shah DK, Correia KF, Vitonis AF, Missmer SA.
Hum Reprod. 2013 May 14. [Epub ahead of print]
Study Question
Is there a relationship between body mass index (BMI), body shape and endometriosis?
Summary Answer
Endometriosis is inversely associated with early adult BMI and may correlate with a peripheral body fat distribution.
What is Known Already
The literature suggests an inverse relation between endometriosis and BMI, although few studies have specifically explored this association in depth.
Study Design/Size/Duration
Prospective cohort study using data collected from 116 430 female nurses from September 1989 to June 2011 as part of the Nurses' Health Study II cohort.
Participants/Materials, Methods and Setting
Cases were restricted to laparoscopically confirmed endometriosis. Weight at age 18 and height were reported at baseline, and current weight was updated every 2 years. Waist and hip measurements were first taken in 1993 and updated in 2005. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards models with time-varying covariates.
Main Results and the Role of Chance
A total of 5504 incident cases of endometriosis were reported during 1 299 349 woman-years (incidence rate = 385 per 100 000 woman-years). BMI at age 18 and current BMI were each significantly inversely associated with endometriosis (P-value, test for linear trend <0.0001). Both associations were stronger among infertile women. Obese infertile women with current BMIs of 35-39.9 kg/m2 and ≥40 kg/m2 had a 55% (95% CI 0.30-0.67) and a 62% (95% CI 0.23-0.62) lower risk of endometriosis, respectively, compared with the low-normal BMI referent (18.5-22.4 kg/m2). Rates of endometriosis were nearly 3-fold higher in women with waist-to-hip ratios <0.60 (RR = 2.78, 95% CI 1.38-5.60) compared with those with waist-to-hip ratios between 0.70 and 0.79, although the sample size for this category was very small.
Limitations and Reasons for Caution
Although women with undiagnosed endometriosis certainly remain in the comparison population even in this prospective cohort study, the community prevalence of endometriosis in an asymptomatic population is very low. Moreover, the characteristics of this small proportion of undiagnosed cases are diluted among the >90 000 women accurately defined as being endometriosis-free and are, therefore, unlikely to impact on effect estimation. Although geographically diverse, the NHS II cohort is overwhelmingly Caucasian, which may limit generalizability to more ethnically diverse populations.
Wider Implications of the Study
The results of this study suggest that endometriosis is inversely associated with early adult BMI and may correlate with a peripheral body fat distribution.
For a full text of the article, click here: http://humrep.oxfordjournals.org/content/early/2013/05/09/humrep.det120.long.
Is breast always best?: a personal reflection on the challenges of breastfeeding
Shah DK.
Obstet Gynecol. 2013 Apr;121(4):869-71. doi: 10.1097/AOG.0b013e3182878246.
Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors.
Borello-France D, Burgio KL, Goode PS, Ye W, Weidner AC, Lukacz ES, Jelovsek JE, Bradley CS, Schaffer J, Hsu Y, Kenton K, Spino C; for the Pelvic Floor Disorders Network.
Phys Ther. 2013 Mar 28. [Epub ahead of print]
Background
First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.
Objective
The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.
Design
This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).
Methods
Data were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.
Results
During supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly "trouble remembering to do exercises." Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only "trouble remembering" was associated with exercise adherence.
Limitations
Adherence and barrier questionnaires were not validated.
Conclusions
Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.
For a full text of the article, click here: http://ptjournal.apta.org/content/early/2013/03/26/ptj.20120072.long
Neurokinin-1 receptor signalling impacts bone marrow repopulation efficiency.
Berger A, Frelin C, Shah DK, Benveniste P, Herrington R, Gerard NP, Zúñiga-Pflücker JC, Iscove NN, Paige CJ.
PLoS One. 2013;8(3):e58787. doi: 10.1371/journal.pone.0058787. Epub 2013 Mar 14.
Abstract
Tachykinins are a large group of neuropeptides with both central and peripheral activity. Despite the increasing number of studies reporting a growth supportive effect of tachykinin peptides in various in vitro stem cell systems, it remains unclear whether these findings are applicable in vivo. To determine how neurokinin-1 receptor (NK-1R) deficient hematopoietic stem cells would behave in a normal in vivo environment, we tested their reconstitution efficiency using competitive bone marrow repopulation assays. We show here that bone marrow taken from NK-1R deficient mice (Tacr1(-/-)) showed lineage specific B and T cell engraftment deficits compared to wild-type competitor bone marrow cells, providing evidence for an involvement of NK-1R signalling in adult hematopoiesis. Tachykinin knockout mice lacking the peptides SP and/or HK-1 (Tac1 (-/-), Tac4 (-/-) and Tac1 (-/-)/Tac4 (-/-) mice) repopulated a lethally irradiated wild-type host with similar efficiency as competing wild-type bone marrow. The difference between peptide and receptor deficient mice indicates a paracrine and/or endocrine mechanism of action rather than autocrine signalling, as tachykinin peptides are supplied by the host environment.
For a full text of the article, click here:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597582/
Pre-eclampsia and eclampsia: global challenges in low resource settings complete with proposed interventions in rural Haiti
Bender RM, Ryan GL
Proceedings in Obstetrics and Gynecology, 2013;3(1):1
Abstract
Preeclampsia is a complex multi-pathway disease process diagnosed by hypertension with two readings of systolic blood pressure ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, separated by a 4-6 hour period, and proteinuria with a urine dipstick of ≥ 1+ or ≥ 300 mg per 24 hours, after 20 weeks’ gestation in a previously normotensive patient. Ninety-nine percent of pregnancy related deaths occur in middle and low-income countries (LMIC). Of these deaths, the World Health Organization (WHO) ranks pre-eclampsia and eclampsia as the second leading direct cause of maternal morbidity and mortality, behind only postpartum hemorrhage. A woman born in a developing country has a seven times greater risk of developing pre-eclampsia and a three times greater risk of progressing to eclampsia. This paper seeks to review what we know about the basics of detection and management to encourage thoughtful applications in improving the global burden of pre-eclampsia and eclampsia in low resources settings.
For a full text of the article, click here: http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1205&context=pog
Preeclampsia and MicroRNAs
Devor EJ, Santillan DA, Santillan MK.
Proceedings in Obstetrics and Gynecology, 2013;3(1):2
Abstract
Preeclampsia is a critical gestational condition that threatens the life of both mother and child. One of the most serious aspects of preeclampsia hampering both clinical management and scientific understanding is that there are, as yet, no early warning signs or risk markers. The discovery of microRNAs (miRNAs), tiny post-transcriptional regulators of gene expression, offers potentially fertile ground for developing such markers. The current state of knowledge about miRNAs in preeclampsia is presented along with information regarding miRNA detection in peripheral fluids that could lead to minimally invasive risk assessment.
For a full text of the article, click here: http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1206&context=pog
The effects of preeclampsia on signaling to hematopoietic progenitor cells
Santillan DA, Hamilton W, Christenson A, Talcott K, Gravatt L, Santillan MK, Hunter SK
Proceedings in Obstetrics and Gynecology, 2013;3(1):3
Background
The role of the microenvironment is important in cell differentiation. The effect of placental disease on the growth and differentiation and hematopoietic stem cells has not been well-studied.
Methods
Enzyme linked immunoassay was used to measure erythropoietin and osteopontin in plasma from umbilical cord blood of children born to normotensive and preeclamptic women. Additionally, CD34+ cells were isolated from umbilical cord blood and grown in complete methylcellulose media. Colony types were identified and enumerated.
Results
Differences in the concentration of erythropoietin in the cord blood between the controls and the preeclamptics approached significance (P = 0.067) using a Mann-Whitney U test. In the plasma of cord blood from children born to normotensive women, the median erythropoietin was 0.186 mIU/mL compared to 1.986 mIU/mL in children of preeclamptic women. We did not find any significant differences in the number and types of colonies; however, there was a trend toward increased BFU-E in the preeclamptic samples. Furthermore, this trend for increased BFU-E colonies was also seen from CD34+ cells isolated from umbilical cord blood of severe preeclamptics compared to mild.
Conclusion
Our preliminary studies suggest that abnormalities in the placenta, such as those found when the mother experiences preeclampsia, may affect the ability of hematopoietic stem cells to grow and differentiate.
For a full text of the article, click here: http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1207&context=pog