The effect of vaginal closure technique on early post-operative pain following vaginal prolapse surgery: a feasibility pilot study and qualitative assessment

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

INTRODUCTION AND HYPOTHESIS

Evidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.

METHODS

A questionnaire survey was conducted to describe current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).

RESULTS

The questionnaire return rate was 90% (n = 56 out of 62). Substantial variations in surgical techniques were seen at every step of the procedure. Native tissue repair: most surgeons used infiltration, 95% (n = 53 out of 56), but the volume used varied (10-80 ml). All but one surgeon performed a midline incision; this surgeon performed an elliptical incision. The depth of tissue dissection varied, being both above and below the vaginal muscularis (fascia). Fascial repair methods included midline, closure of separate fascial defects, paravaginal repair and rectal/levator plication. Graft/mesh repairs: many different products and manufacturers were used. There was variation in the method of attachment of graft/mesh inserts and their placement in relation to the fascia. For both native tissue and graft/mesh repairs, the method of fascial dissection, suturing methods and suture material varied. Most surgeons inserted a pack, 91% (n = 50 out of 55), soaked in varying substances before use.

CONCLUSIONS

There is considerable variation between UK-based surgeons in the surgical techniques used to perform both native tissue and graft/mesh-augmented POP repairs. Further research is required to determine whether these differences influence outcome.

Evolution of the Araliaceae family inferred from complete chloroplast genomes and 45S nrDNAs of 10 Panax-related species

We produced complete sequences and conducted comparative analysis of the maternally inherited chloroplast (cp) genomes and bi-parentally inherited 45S nuclear ribosomal RNA genes (nrDNA) from ten Araliaceae species to elucidate the genetic diversity and evolution in that family. The cp genomes ranged from 155,993 bp to 156,730 bp with 97.1-99.6% similarity. Complete 45S nrDNA units were about 11 kb including a 5.8-kb 45S cistron. Among 79 cp protein-coding genes, 74 showed nucleotide variations among ten species, of which infA, rpl22, rps19 and ndhE genes showed the highest Ks values and atpF, atpE, ycf2 and rps15 genes showed the highest Ka/Ks values. Four genes, petN, psaJ, psbF, and psbN, related to photosynthesis and one gene, rpl23, related to the ribosomal large subunit remain conserved in all 10 Araliaceae species. Phylogenetic analysis revealed that the ten species could be resolved into two monophyletic lineages, the Panax-Aralia and the Eleutherococcus-Dendropanax groups, which diverged approximately 8.81-10.59 million years ago (MYA). The Panax genus divided into two groups, with diploid species including P. notoginseng, P. vietnamensis, and P. japonicus surviving in Southern Asia and a tetraploid group including P. ginseng and P. quinquefolius Northern Asia and North America 2.89-3.20 MYA.

Utilization and farmers' knowledge on pigeonpea diversity in Benin, West Africa

BACKGROUND

Understanding factors driving farmers' uses of crop genetic resources is a key component not only to design appropriate conservation strategies but also to promote sustainable production. However, in Benin, limited information is available on farmers' knowledge related to pigeonpea uses and conservation. This study aimed at i) identifying and investigating the different uses of pigeonpea in relation with socio-cultural factors, namely age, gender, ethnic group and respondents' residence, ii) assessing pigeonpea varieties richness at household level and iii) evaluating the extent and distribution of pigeonpea varieties.

METHODS

Three hundred and two farmers were surveyed using structured questionnaire. Direct observation, field visit and focus group discussion were carried out. Association between number of varieties maintained at household level and socio-cultural variables was tested. Mann-Whitney test was used to assess whether the number of varieties held by households headed by men and women were different. Distribution and extent of diversity was assessed through four cells analysis.

RESULTS

Farmers in Benin mainly grow pigeonpea for its grains for home consumption. Pigeonpea's stem and leaves are used for medicinal purposes to treat malaria, dizziness, measles, and eye infection. The ethnic group and the locality of residence of farmers influenced on the use of pigeonpea for medicinal purposes (P < 0.01). There was no significant association (P > 0.05) between the number of varieties held by household and the age of the respondent, number of years of experience in pigeonpea cultivation, the size of household, number of family members engaged in agricultural activities and gender. Farmers used criteria including seed colors, seed size, plant height, maturity groups and cooking time to classify their varieties. Varieties with white seed coat color were the most grown while varieties with black, red or mottled seed coat color are being abandoned and deserve to be conserved.

CONCLUSION

Knowledge on medicinal uses of pigeonpea is vertically transmitted within community and pigeonpea varieties maintenance at household level does not depend on socio-cultural factors. This study will contribute to raise awareness on the various utilization of pigeonpea. In addition, it provides the basis for designing conservation strategies of pigeonpea genetic resources.

Impact of Matrix-Assisted Laser Desorption and Ionization Time-of-Flight and Antimicrobial Stewardship Intervention on Treatment of Bloodstream Infections in Hospitalized Children

BACKGROUND.

Early definitive identification of infectious pathogens coupled with antimicrobial stewardship interventions allow for targeted and timely administration of antimicrobials. We investigated the combined impact of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology and an antimicrobial stewardship program (ASP) in pediatric patients with blood stream infections (BSIs).

METHODS.

This is a single-center study comparing a control group of patients from October 2009 to July 2010 with BSIs to a cohort of patients postimplementation of MALDI-TOF and an ASP, from October 2013 to July 2014. Primary outcome was time to optimal therapy. Secondary outcomes included time to effective therapy, 30-day all-cause mortality, 30-day readmission rate, hospital length of stay, and intensive care admission.

RESULTS.

One hundred episodes of BSIs were identified in the preintervention period, and 121 episodes were identified in the postintervention period. Time from blood culture collection to organism identification was significantly reduced in the prospective cohort compared with historical controls (18.8 vs 43.7 hours, respectively). A total of 73 ASP interventions were made on the treatment of BSIs in the postintervention period. Combined use of MALDI-TOF and ASP significantly reduced time to optimal therapy (77.0 to 54.2 hours, P < .001). In the subgroup analysis of Gram-negative bacteremia, time to effective and optimal therapy were significantly reduced (2.0 vs 0.7 hours and 146.8 vs 48.0 hours, respectively). There were no significant differences in clinical outcomes.

CONCLUSIONS.

The combined use of MALDI-TOF and ASP allows early optimization of antimicrobial therapy in pediatric inpatients with BSIs.

Levels of DNA methylation and transcript accumulation in leaves of transgenic maize varieties

BACKGROUND

Prior to their release in the environment, transgenic crops are examined for their health and environmental safety. In addition, transgene expression needs to be consistent in order to express the introduced trait (e.g. insecticidal and/or herbicide tolerance). Moreover, data on expression levels for GM events are usually required for approval, but these are rarely disclosed or they are considered insufficient. On the other hand, biosafety regulators do not consider epigenetic regulation (e.g. DNA methylation, ncRNAs and histone modifications), which are broadly known to affect gene expression, within their risk assessment analyses. Here we report the results of a DNA methylation (bisulfite sequencing) and transgene transcript accumulation (RT-qPCR) analysis of four Bt-expressing single transgenic maize hybrids, under different genetic backgrounds, and a stacked transgenic hybrid expressing both insecticidal and herbicide tolerance traits.

RESULTS

Our results showed differences in cytosine methylation levels in the FMV promoter and cry2Ab2 transgene of the four Bt-expressing hybrid varieties. The comparison between single and stacked hybrids under the same genetic background showed differences in the 35S promoter sequence. The results of transgene transcript accumulation levels showed differences in both cry1A.105 and cry2Ab2 transgenes among the four Bt-expressing hybrid varieties. The comparison between single and stacked hybrids showed difference for the cry2Ab2 transgene only.

CONCLUSIONS

Overall, our results show differences in DNA methylation patterns in all varieties, as well as in transgene transcript accumulation levels. Although the detection of changes in DNA methylation and transgenic accumulation levels does not present a safety issue per se, it demonstrates the need for additional studies that focus on detecting possible safety implications of such changes.

Culturally Relevant Protective and Risk Factors of Youth Risk Behaviors Among Pakistani and Indian Students in Hong Kong: A Focus Group Study

PURPOSE

The risk behaviors of Hong Kong ethnic minority students are understudied. This exploratory qualitative study aimed to explore culturally nuanced factors for the development and prevention of risk behaviors among Pakistani and Indian students in Hong Kong.

METHOD

Twenty-three students participated in four focus groups. All interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

The participants reported bullying, delinquency, gambling, alcohol, cigarette, and drug uses as risk behaviors. Four themes emerged in the development and prevention of risk behaviors: (a) Parental and peer influence, (b) An unsafe community environment were perceived by the participants as essential factors for the development of risk behaviors, (c) Parental monitoring, and (d) Strong religious beliefs were believed as protective factors for the prevention of risk behaviors.

CONCLUSION

Further research and practice may investigate and focus on the factors embedded in the Hong Kong ethnic minorities' sociocultural contexts to prevent risk behaviors.

Regeneration of soapnut tree through somatic embryogenesis and assessment of genetic fidelity through ISSR and RAPD markers

Somatic embryogenic system was developed in Sapindus mukorossi Gaertn. using rachis as explants from a mature tree. Explants showed callus initiation on Murashige and Skoog medium supplemented with TDZ (1-Phenyl-3-(1, 2, 3-thiadiazol-5-yl) urea), zeatin or 6-benzylaminopurine. Induction of somatic embryogenesis was achieved on both MS basal medium and MS medium supplemented with 8.88 µM 6-benzylaminopurine. Hundred percent embryogenesis was observed on MS medium supplemented with 8.88 µM 6-benzylaminopurine with maximum intensity of embryogenesis (51.92 ± 0.40 a). Maximum maturation of somatic embryos (92.86 ± 0.34 a) was observed on induction medium supplemented with 0.0378 µM abscisic and treated for 21 days. Germination of somatic embryos was maximum (77.33 ± 0.58 a) on MS medium supplemented with 8.88 µM 6-benzylaminopurine. In vitro raised plantlets were hardened, acclimatized and transferred to the field. Survival frequency of plantlets was 80 % in field conditions. The genetic fidelity of in vitro regenerated plants was also evaluated and compared with mother plant using random amplified polymorphic DNA and inter simple sequence repeat. Both markers showed similarity in molecular profile of mother plant and in vitro regenerated plants.

Adomian decomposition sumudu transform method for solving a solid and porous fin with temperature dependent internal heat generation

In this paper, Adomian decomposition sumudu transform method is introduced and used to solve the temperature distribution in a solid and porous fin with the temperature dependent internal heat generation for a fractional order energy balance equation. In this study, we assume heat generation as a variable of fin temperature for solid and porous fin and the heat transfer through porous media is simulated by using Darcy’s model. The results are presented for the temperature distribution for the range of values of parameters appeared in the mathematical formulation and also compared with numerical solutions in order to verify the accuracy of the proposed method. It is found that the proposed method is in good agreement with direct numerical solution.

Differences in technology innovation R&D performance creation behavior between for-profit institutions and not-for-profit institutions

The present study compares the performance creation behavior between for-profit institutions and not-for-profit institutions within a national technology innovation research and development (R&D) program. Based on the stepwise performance creation chain structure of typical R&D logic models, a series of successive binary logistic regression models is newly proposed. Using the models, a sample of n = 2076 completed government-sponsored R&D projects was analyzed. For each institution type, its distinctive behavior is diagnosed, and relevant implications are suggested for improving the R&D performance.

Muscle sphingolipids during rest and exercise: a C18:0 signature for insulin resistance in humans

AIMS/HYPOTHESES

Ceramides and other sphingolipids comprise a family of lipid molecules that accumulate in skeletal muscle and promote insulin resistance. Chronic endurance exercise training decreases muscle ceramides and other sphingolipids, but less is known about the effects of a single bout of exercise.

METHODS

We measured basal relationships and the effect of acute exercise (1.5 h at 50% [Formula: see text]) and recovery on muscle sphingolipid content in obese volunteers, endurance trained athletes and individuals with type 2 diabetes.

RESULTS

Muscle C18:0 ceramide (p = 0.029), dihydroceramide (p = 0.06) and glucosylceramide (p = 0.03) species were inversely related to insulin sensitivity without differences in total ceramide, dihydroceramide, and glucosylceramide concentration. Muscle C18:0 dihydroceramide correlated with markers of muscle inflammation (p = 0.04). Transcription of genes encoding sphingolipid synthesis enzymes was higher in athletes, suggesting an increased capacity for sphingolipid synthesis. The total concentration of muscle ceramides and sphingolipids increased during exercise and then decreased after recovery, during which time ceramide levels reduced to significantly below basal levels.

CONCLUSIONS/INTERPRETATION

These data suggest ceramide and other sphingolipids containing stearate (18:0) are uniquely related to insulin resistance in skeletal muscle. Recovery from an exercise bout decreased muscle ceramide concentration; this may represent a mechanism promoting the insulin-sensitising effects of acute exercise.

Diversity and distribution of the endophytic bacterial community at different stages of Eucalyptus growth

The relationships between plants and endophytic bacteria significantly contribute to plant health and yield. However, the microbial diversity in leaves of Eucalyptus spp. is still poorly characterized. Here, we investigated the endophytic diversity in leaves of hybrid Eucalyptus grandis x E. urophylla (Eucalyptus "urograndis") by using culture-independent and culture-dependent approaches, to better understand their ecology in leaves at different stages of Eucalyptus development, including bacteria with N2 fixation potential. Firmicutes, Proteobacteria (classes alpha-, beta- and gamma-) and Actinobacteria were identified in the Eucalyptus "urograndis" endophytic bacterial community. Within this community, the species Novosphingobium barchaimii, Rhizobium grahamii, Stenotrophomonas panacihumi, Paenibacillus terrigena, P. darwinianus and Terrabacter lapilli represent the first report these bacteria as endophytes. The diversity of the total endophytic bacteria was higher in the leaves from the 'field' (the Shannon-Wiener index, 2.99), followed by the indices obtained in the 'clonal garden' (2.78), the 'recently out from under shade (2.68), 'under shade' (2.63) and 'plants for dispatch' (2.51). In contrast, for diazotrophic bacteria, the highest means of these indices were obtained from the leaves of plants in the 'under shade' (2.56), 'recently out from under shade (2.52)' and 'field' stages (2.54). The distribution of the endophytic bacterial species in Eucalyptus was distinct and specific to the development stages under study, and many of the species had the potential for nitrogen fixation, raising the question of whether these bacteria could contribute to overall nitrogen metabolism of Eucalyptus.

Practices in pelvic organ prolapse operations among surgeons: an international survey identifying needs for further research

OBJECTIVE AND HYPOTHESIS

Our aim was to identify variation in surgical technique for treating pelvic floor disorders looking specifically at differences in approach between subspeciality trained urogynaecologists and general gynaecologists. We hypothesised that speciality trained surgeons would have a more uniform operative technique. We did not make a hypothesis about which operative areas would have the most variation overall.

METHODS

We performed a single-timepoint online survey of members of the International Urogynaecological Association (IUGA). Probability of difference from mean is presented as a raw value and significance of difference of means between surgical cohorts was calculated using the t test for independent variables.

RESULTS

We received 205 responses from 118 general gynaecologists and 87 from subspecialty trained urogynaecologists (8 % response rate) to 27 questions concerning operative steps in four common urogynaecological operations. Surgeons had low levels of variation. The probability of any surgeon providing a different answer from the mode of their cohort was not significant within or between surgeons with and without subspeciality training (p = 0.47). Two areas with high levels of variation between surgeons were identified (probability of variation >0.5). These were: "In order to reduce cystocele, do you plicate the fascia covering the bladder or use vaginal tissue?" and "Would you usually plicate the rectovaginal facial septum to the vault?"

CONCLUSIONS

Most urogynaecological surgeries were of similar technique; however there were two areas of significant variation between surgeons that may affect outcomes and warrant further study.

Assessment of genetic diversity, population structure and relationships in Indian and non-Indian genotypes of finger millet (Eleusine coracana (L.) Gaertn) using genomic SSR markers

We evaluated the genetic variation and population structure in Indian and non-Indian genotypes of finger millet using 87 genomic SSR primers. The 128 finger millet genotypes were collected and genomic DNA was isolated. Eighty-seven genomic SSR primers with 60–70 % GC contents were used for PCR analysis of 128 finger millet genotypes. The PCR products were separated and visualized on a 6 % polyacrylamide gel followed by silver staining. The data were used to estimate major allele frequency using Power Marker v3.0. Dendrograms were constructed based on the Jaccard’s similarity coefficient. Statistical fitness and population structure analyses were performed to find the genetic diversity. The mean major allele frequency was 0.92; the means of polymorphic alleles were 2.13 per primer and 1.45 per genotype; the average polymorphism was 59.94 % per primer and average PIC value was 0.44 per primer. Indian genotypes produced an additional 0.21 allele than non-Indian genotypes. Gene diversity was in the range from 0.02 to 0.35. The average heterozygosity was 0.11, close to 100 % homozygosity. The highest inbreeding coefficient was observed with SSR marker UGEP67. The Jaccard’s similarity coefficient value ranged from 0.011 to 0.836. The highest similarity value was 0.836 between genotypes DPI009-04 and GPU-45. Indian genotypes were placed in Eleusine coracana major cluster (EcMC) 1 along with 6 non-Indian genotypes. AMOVA showed that molecular variance in genotypes from various geographical regions was 4 %; among populations it was 3 % and within populations it was 93 %. PCA scatter plot analysis showed that GPU-28, GPU-45 and DPI009-04 were closely dispersed in first component axis. In structural analysis, the genotypes were divided into three subpopulations (SP1, SP2 and SP3). All the three subpopulations had an admixture of alleles and no pure line was observed. These analyses confirmed that all the genotypes were genetically diverse and had been grouped based on their geographic regions.

Visual function among commercial vehicle drivers in the central region of Ghana

AIM

To determine the relationship between some visual functions: colour vision defects, abnormal stereopsis, visual acuity and the occurrence of road traffic accident (RTAs) among commercial vehicle drivers in the central region of Ghana, and to assess their knowledge of these anomalies.

METHOD

A descriptive cross-sectional study employing a multi-stage random sampling approach was conducted in the major commercial towns within the central region of Ghana. Participants were taken through a comprehensive eye examination after the administration of a structured questionnaire.

RESULTS

520 male commercial vehicle drivers were enrolled for this study with a mean age of 39.23 years ±10.96 years and mean visual acuity of 0.02±0.08 logMAR. Protans were more likely to be involved in RTAs (χ(2)=6.194, p=0.034). However, there was no statistically significant association between abnormal stereopsis (OR=0.89 95% CI: 0.44-1.80, p=0.56), poor vision due to refractive error (χ(2)=3.090, p=0.388) and the occurrence of RTAs. While 86.9% were aware of abnormal stereopsis, only 45% were aware of colour vision defects. There was a statistically significant association between stereopsis anomaly and colour vision defect (r=0.371, p<0.005).

CONCLUSION

The study found an association between protanopia and RTAs but none between stereopsis anomalies, refractive errors and the occurrence of RTAs. Drivers were less knowledgeable on colour vision defects as compared to stereopsis anomalies.

Fluid retention, muscle damage, and altered body composition at the Ultraman triathlon

PURPOSE

The primary purpose of this investigation was to determine the effects of participation in a 3-day multistage ultraendurance triathlon (stage 1 = 10 km swim, 144.8 km bike; stage 2 = 275.4 km bike; stage 3 = 84.4 km run) on body mass and composition, hydration status, hormones, muscle damage, and blood glucose.

METHODS

Eighteen triathletes (mean ± SD; age 41 ± 7.5 years; height 175 ± 9 cm; weight 73.5 ± 9.8 kg; male n = 14, female n = 4) were assessed before and after each stage of the race. Body mass and composition were measured via bioelectrical impedance, hydration status via urine specific gravity, hormones and muscle damage via venous blood draw, and blood glucose via fingerstick.

RESULTS

Following the race, significant changes included reductions in body mass (qualified effect size: trivial), fat mass (moderate), and percent body fat (small); increases in percent total body water (moderate) and urine specific gravity (large); and unchanged absolute total body water and fat-free mass. There were also extremely large increases in creatine kinase, C-reactive protein, aldosterone and cortisol combined with reductions in testosterone (small) and the testosterone:cortisol ratio (moderate). There were associations between post-race aldosterone and total body water (r = -0.504) and changes in cortisol and fat-free mass (r = -0.536). Finally, blood glucose increased in a stepwise manner prior to each stage.

CONCLUSIONS

Participation in Ultraman Florida leads to fluid retention and dramatic alterations in body composition, muscle health, hormones, and metabolism.