Investigating the Underutilization of Uterine Fibroid Embolization by Surveying OB/GYN Practice Preferences

This study aimed to survey OB/GYN practice preferences that may be contributing to the underutilization of uterine fibroid embolization (UFE) in the treatment of symptomatic uterine fibroids (SUF). A 22-question survey was created using Qualtrics XM software and distributed to an OB/GYN-specific social media group to resident or attending OB/GYNs practicing in the US. 112 responses met inclusion criteria. For patients with symptomatic UF, UFE was offered as a first choice option less than 2% of the time. For patients with symptomatic UF seeking to maintain fertility, UFE was recommended only 1% of time, behind medical therapy (54%) and myomectomy (42%). Respondents reported lower rates of confidence (selecting "strongly agree" or "agree") regarding risks and benefits of UFE (77%) in comparison to myomectomy (99%) or hysterectomy (100%). Since UFE was seldom recommended by respondents, further, more robust polling of OB/GYNs is warranted.

Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

OBJECTIVE

To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks.

STUDY DESIGN

This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant.

RESULTS

A total of 280 mother-infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis.

CONCLUSION

There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

[Event-related brain activity changes to consonant and dissonant chords in musicans and non-musicans]

The present study assessed brain activity changes related to perception of consonant and dissonant chords by musicians and non-musicians. Perception of dissonant chords in non-musicians was accompanied by increase of lower theta activity over right anterior regions, while consonant chords induced greater theta activity over left anterior regions; this pattern of asymmetrical activation was not observed in musicians. ERP analysis revealed that musicians had greater amplitude of early components (P100, N200) than non-musicians irrespective of chord type. The obtained results reflect more efficient musical harmony processing and, possibly, less emotional perception of chords in musicians.

Event-related synchronization and desynchronization during affective processing: emergence of valence-related time-dependent hemispheric asymmetries in theta and upper alpha band

Event-related desynchronization (ERD) and synchronization (ERS) in the individually defined theta, alpha-1, alpha-2, and alpha-3 frequency bands were measured in 22 healthy subjects (Ss) in response to neutral (Neut), emotionally positive (Pos), and negative (Neg) IAPS stimuli. The 62-channel EEG, facial EMG and ECG were simultaneously recorded while subjects viewed sequentially presented pictures and subjectively rated them after each presentation. The obtained findings indicate that differences induced by pictures varying in emotional valence are associated mainly with increased theta and alpha-3 synchronization activity and anterior hemispheric asymmetries. In the anterior temporal leads theta ERS revealed a significant valence by hemisphere interaction showing relatively greater right hemisphere theta ERS for Neg and left hemisphere ERS for Pos stimuli in the time window of 100-700 ms post-stimulus, whereas in the alpha-3 band Neg stimuli induced lateralized time-dependent left hemisphere ERS increased in the time window of 800-1200 ms, were not observed for Neut and Pos stimuli. The obtained results along with earlier observations on EEG correlates of affective processing challenge the notion that affective anterior hemispheric asymmetries are mainly sensitive to wide alpha frequency band. Frequency and time dependence of anterior hemispheric asymmetries in emotional valence discrimination is emphasized.