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Andy UU, Iriondo-Perez J, Carper B, Richter HE, Dyer KY, Florian-Rodriguez M, Napoe GS, Myers D, O'Shea M, Mazloomdoost D, Gantz MG. Dietary Intake and Symptom Severity in Women with Fecal Incontinence. Int Urogynecol J 2024:10.1007/s00192-024-05776-6. [PMID: 38656362 DOI: 10.1007/s00192-024-05776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of this study was to determine whether dietary fat/fiber intake was associated with fecal incontinence (FI) severity. METHODS Planned supplemental analysis of a randomized clinical trial evaluating the impact of 12-week treatment with percutaneous tibial nerve stimulation versus sham in reducing FI severity in women. All subjects completed a food screener questionnaire at baseline. FI severity was measured using the seven-item validated St. Mark's (Vaizey) FI severity scale. Participants also completed a 7-day bowel diary capturing the number of FI-free days, FI events, and bowel movements per week. Spearman's correlations were calculated between dietary, St. Mark's score, and bowel diary measures. RESULTS One hundred and eighty-six women were included in this analysis. Mean calories from fats were 32% (interquartile range [IQR] 30-35%). Mean dietary fiber intake was 13.9 ± 4.3 g. The percentage of calories from fats was at the higher end of recommended values, whereas fiber intake was lower than recommended for adult women (recommended values: calories from fat 20-35% and 22-28 g of fiber/day). There was no correlation between St. Mark's score and fat intake (r = 0.11, p = 0.14) or dietary fiber intake (r = -0.01, p = 0.90). There was a weak negative correlation between the number of FI-free days and total fat intake (r = -0.20, p = 0.008). Other correlations between dietary fat/fiber intake and bowel diary measures were negligible or nonsignificant. CONCLUSION Overall, in women with moderate to severe FI, there was no association between FI severity and dietary fat/fiber intake. Weak associations between FI frequency and fat intake may suggest a role for dietary assessment in the evaluation of women with FI.
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Affiliation(s)
- Uduak U Andy
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3737 Market Street, 12Th Floor, Philadelphia, PA, 19104, USA.
| | - Jeniffer Iriondo-Perez
- Social, Statistical & Environmental Sciences, RTI International, Research Triangle Park, Durham, NC, USA
| | - Benjamin Carper
- Social, Statistical & Environmental Sciences, RTI International, Research Triangle Park, Durham, NC, USA
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keisha Y Dyer
- Department of Obstetrics and Gynecology Kaiser Permanente, San Diego, CA, USA
| | - Maria Florian-Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - G Sarah Napoe
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Deborah Myers
- Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA
| | - Michele O'Shea
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Donna Mazloomdoost
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marie G Gantz
- Social, Statistical & Environmental Sciences, RTI International, Research Triangle Park, Durham, NC, USA
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Meyer I, Iriondo-Perez J, Dyer KY, Sung V, Ackenbom MF, Florian-Rodriguez M, Kim E, Mazloomdoost D, Carper B, Gantz MG. Correlation Between Mobile-Application Electronic Bowel Diary and Validated Questionnaires in Women with Fecal Incontinence. Int Urogynecol J 2024; 35:545-551. [PMID: 38206340 PMCID: PMC11023758 DOI: 10.1007/s00192-023-05711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Despite growing interest in a mobile-app bowel diary to assess fecal incontinence (FI) symptoms, data are limited regarding the correlation between mobile-app diary and questionnaire-based outcomes. The primary aim is to determine whether percentage reduction in FI episodes (FIEs)/week recorded on a mobile-app diary correlates with changes in scores of validated FI-symptom measures from baseline to 12 weeks in women with FI undergoing percutaneous tibial nerve stimulation (PTNS) versus sham. METHODS This is a planned secondary analysis of a multicenter randomized trial in which women with FI underwent PTNS or sham. FIEs were collected using a mobile-app diary at baseline and after 12 weekly sessions. FI-symptom-validated measures included St. Mark's, Accidental Bowel Leakage Evaluation, FI Severity Index (FISI), Colorectal Anal Distress Inventory, Colorectal Anal Impact Questionnaire, FI Quality of Life, Patient Global Impression of Improvement (PGI-I), and Patient Global Symptom Control (PGSC) rating. Spearman's correlation coefficient (ρ) was computed between %-reduction in FIEs/week and change in questionnaire scores from baseline to 12 weeks. Significance was set at 0.005 to account for multiple comparisons. RESULTS Baseline characteristics of 163 women (109 PTNS, 54 sham) include mean age 63.4±11.6, 81% white, body mass index 29.4±6.6 kg/m2, 4% previous FI surgeries, 6.6±5.5 FIEs/week, and St. Mark's score 17.4±2.6. A significant correlation was demonstrated between %-reduction in FIEs/week and all questionnaires (p<0.005). A moderate-strength correlation (|ρ|>0.4) was observed for St. Mark's (ρ=0.48), FISI (ρ=0.46), PGI-I (ρ=0.51), and PGSC (ρ=-0.43). CONCLUSIONS In women with FI randomized to PTNS versus sham, a moderate correlation was noted between FIEs measured via mobile-app diary and FI-symptom-validated questionnaire scores.
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Affiliation(s)
- Isuzu Meyer
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | | | - Vivian Sung
- Alpert Medical School of Brown University, University/Women & Infants Hospital, Providence, RI, USA
| | - Mary F Ackenbom
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Edward Kim
- Department of Obstetrics & Gynecology, Division of Urogynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Marie G Gantz
- RTI International, Research for the NICHD Pelvic Floor Disorders Network, Triangle Park, NC, USA
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White SE, Karbasion N, Snider JC, Florian-Rodriguez M, Bersi MR, Miller KS. Remodeling of murine vaginal smooth muscle function with reproductive age and elastic fiber disruption. Acta Biomater 2024; 175:186-198. [PMID: 38151068 DOI: 10.1016/j.actbio.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
Advanced maternal age during pregnancy is associated with increased risk of vaginal tearing during delivery and maladaptive postpartum healing. Although the underlying mechanisms of age-related vaginal injuries are not fully elucidated, changes in vaginal microstructure may contribute. Smooth muscle cells promote the contractile nature of the vagina and contribute to pelvic floor stability. While menopause is associated with decreased vaginal smooth muscle content, whether contractile changes occur before the onset of menopause remains unknown. Therefore, the first objective of this study was to quantify the active mechanical behavior of the murine vagina with age. Further, aging is associated with decreased vaginal elastin content. As such, the second objective was to determine if elastic fiber disruption alters vaginal contractility. Vaginal samples from mice aged 2-14 months were used in maximum contractility experiments and biaxial extension-inflation protocols. To evaluate the role of elastic fibers with age, half of the vaginal samples were randomly allocated to enzymatic elastic fiber disruption. Contractile potential decreased and vaginal material stiffness increased with age. These age-related changes in smooth muscle function may be due, in part, to changes in microstructural composition or contractile gene expression. Furthermore, elastic fiber disruption had a diminished effect on smooth muscle contractility in older mice. This suggests a decreased functional role of elastic fibers with age. Quantifying the age-dependent mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties provides a first step towards better understanding how age-related changes in vaginal structure may contribute to tissue integrity and healing. STATEMENT OF SIGNIFICANCE: Advanced maternal age at the time of pregnancy is linked to increased risks of vaginal tearing during delivery, postpartum hemorrhaging, and the development of pelvic floor disorders. While the underlying causes of increased vaginal injuries with age and associated pathologies remain unclear, changes in vaginal microstructure, such as elastic fibers and smooth muscle cells, may contribute. Menopause is associated with fragmented elastic fibers and decreased smooth muscle content; however, how reproductive aging affects changes in the vaginal composition and the mechanical properties remains unknown. Quantifying the mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties with age will advance understanding of the potential structural causes of age-related changes to tissue integrity and healing.
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Affiliation(s)
- Shelby E White
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, USA
| | - Niyousha Karbasion
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, USA
| | - J Caleb Snider
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Maria Florian-Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew R Bersi
- Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Kristin S Miller
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Mechanical Engineering, University of Texas at Dallas, Richardson, TX, USA; Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA.
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Buchanan LM, Domingo MJ, White SE, Vanoven TN, Karbasion N, Bersi MR, Pence IJ, Florian-Rodriguez M, Miller KS. Advances in vaginal bioengineering: Applications, techniques, and needs. Curr Res Physiol 2023; 6:100111. [PMID: 38107786 PMCID: PMC10724214 DOI: 10.1016/j.crphys.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Lily M. Buchanan
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Mari J.E. Domingo
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Shelby E. White
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Triniti N. Vanoven
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Niyousha Karbasion
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Matthew R. Bersi
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Isaac J. Pence
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Internal Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Maria Florian-Rodriguez
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Cecil H. and Ida Green Center for Reproductive Biology Sciences, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kristin S. Miller
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas at Dallas, Department of Mechanical Engineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
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Rosenthal E, Tappy E, Pan E, Verma D, Wang A, Brown LS, Santiago-Muñoz P, Florian-Rodriguez M. Linguistic Differences by Gender in Letters of Recommendation for Maternal-Fetal Medicine Fellowship Applicants. Am J Perinatol 2023. [PMID: 37336234 DOI: 10.1055/s-0043-1770148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE As in many realms of academia and medicine, in obstetrics and gynecology, women experience gender bias in residency evaluations and academic promotions. More specifically, women in Maternal-Fetal Medicine (MFM) are underrepresented within departmental leadership positions. As a means of identifying spaces where bias may exist, multiple investigators have previously reported on gender bias in letters of recommendation (LORs) for residency and subspecialty training programs. We aimed to determine if linguistic differences exist in LORs for self-identified male and female applicants to MFM fellowship at an academic institution. STUDY DESIGN This was a retrospective single-site cohort study from 2019 to 2021. Data collected included applicant's age, self-reported race/ethnicity and gender, geographic region of residency, step 1 and 2 scores, scholarly and volunteer activities, and number of LORs. The Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, was used to characterize LOR linguistic content. Multivariable analysis was used to compare letter characteristics to applicant demographics. RESULTS A total of 212 applications were reviewed, including 808 LORs. Women comprised 76.9% of applicants, and men 23.1%. Most applicants identified as non-Hispanic White (52.8%). Men were more likely to be international medical graduates (20 vs. 6%, p ≤ 0.01), and women reported more volunteer activities (7.1 ± 5.1 vs. 5.5 ± 4.3, p = 0.04). There were no differences in step scores, number of research projects, or number of LORs. Multivariable analysis controlling for applicant race, step 1 score, and gender of letter writer revealed that letters written for males contained significantly more references to the word category cognitive processes (7.4 ± 0.2 vs. 7.1 ± 0.1, p = 0.046), specifically in reference to the subcategories of certainty and differentiation. CONCLUSION We identified linguistic differences in LORs written for MFM applicants, suggesting potential bias in the style of writing for male and female physicians applying to this field. KEY POINTS · Gender bias exists in the evaluation and promotion of women in medicine.. · We sought to determine whether it also exists in letters of recommendation for MFM fellowship.. · Previous studies have examined gender bias in letters of recommendation for other specialties.. · Linguistic bias was detected in letters of recommendation for MFM fellowship from 2019 through 2021.. · We found evidence of linguistic differences based on gender of applicant and letter writers..
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Affiliation(s)
- Elise Rosenthal
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Erryn Tappy
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Evelyn Pan
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Angela Wang
- UT Southwestern Medical School, Dallas, Texas
| | - Larry S Brown
- Department of Biostatistics, Parkland Health & Hospital System, Dallas, Texas
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Clark-Patterson GL, Buchanan LM, Ogola BO, Florian-Rodriguez M, Lindsey SH, De Vita R, Miller KS. Smooth muscle contribution to vaginal viscoelastic response. J Mech Behav Biomed Mater 2023; 140:105702. [PMID: 36764168 DOI: 10.1016/j.jmbbm.2023.105702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Smooth muscle cells contribute to the mechanical function of various soft tissues, however, their contribution to the viscoelastic response when subjected to multiaxial loading remains unknown. The vagina is a fibromuscular viscoelastic organ that is exposed to prolonged and increased pressures with daily activities and physiologic processes such as vaginal birth. The vagina changes in geometry over time under prolonged pressure, known as creep. Vaginal smooth muscle cells may contribute to creep. This may be critical for the function of vaginal and other soft tissues that experience fluctuations in their biomechanical environment. Therefore, the objective of this study was to develop methods to evaluate the contribution of smooth muscle to vaginal creep under multiaxial loading using extension - inflation tests. The vaginas from wildtype mice (C57BL/6 × 129SvEv; 3-6 months; n = 10) were stimulated with various concentrations of potassium chloride then subjected to the measured in vivo pressure (7 mmHg) for 100 s. In a different cohort of mice (n = 5), the vagina was stimulated with a single concentration of potassium chloride then subjected to 5 and 15 mmHg. A laser micrometer measured vaginal outer diameter in real-time. Immunofluorescence evaluated the expression of alpha-smooth muscle actin and myosin heavy chain in the vaginal muscularis (n = 6). When smooth muscle contraction was activated, vaginal creep behavior increased compared to the relaxed state. However, increased pressure decreased the active creep response. This study demonstrated that extension - inflation protocols can be used to evaluate smooth muscle contribution to the viscoelastic response of tubular soft tissues.
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Affiliation(s)
| | - Lily M Buchanan
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Road, Richardson, TX, 75080, USA.
| | - Benard O Ogola
- Augusta University, Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA.
| | - Maria Florian-Rodriguez
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery and Cecil H and Ida Green Center for Reproductive Biological Sciences, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA.
| | - Sarah H Lindsey
- Tulane University School of Medicine, Department of Pharmacology, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Raffaella De Vita
- Virginia Tech,Department of Biomedical Engineering and Mechanics, 330 A Kelly Hall, 325 Stanger St, Blacksburg, VA, 24061, USA.
| | - Kristin S Miller
- Tulane University, Department of Biomedical Engineering, 6823 St Charles Ave, New Orleans, LA, 70118, USA; University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Road, Richardson, TX, 75080, USA.
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Meriwether K, Krashin J, Kim-Fine S, Ablove T, Dale L, Orejuela F, Mazloomdoost D, Beckham A, Probst K, Crisp C, Winkelman W, Florian-Rodriguez M, Grimes C, Turk J, Ollendorff A, Ros S, Chang O, Horvath S, Iglesia C. Trainee opinions regarding the effect of the dobbs v. jackson women’s health organization supreme court decision on obstetrics and gynecology training. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Jackson LA, Shi H, Acevedo J, Lee S, Annabi N, Word RA, Florian-Rodriguez M. Effect of gelatin methacryloyl hydrogel on healing of the guinea pig vaginal wall with or without mesh augmentation. Int Urogynecol J 2022; 33:2223-2232. [PMID: 34999912 DOI: 10.1007/s00192-021-05031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to evaluate the effectiveness of gelatin methacryloyl as an adjunct to anterior vaginal wall injury with or without vaginal mesh compared with traditional repair with suture. METHODS Virginal cycling Hartley strain guinea pigs (n = 60) were randomized to undergo surgical injury and repair using either polyglactin 910 suture or gelatin methacryloyl for epithelium re-approximation or anterior colporrhaphy with mesh augmentation using either polyglactin 910 suture or gelatin methacryloyl for mesh fixation and epithelium re-approximation. Noninjured controls (n = 5) were also evaluated. After 4 days, 4 weeks, or 3 months, tissues were analyzed by hematoxylin & eosin in addition to immunolabeling for macrophages, leukocytes, smooth muscle, and fibroblasts. RESULTS Surgical injury repaired with suture was associated with increased inflammation and vessel density compared with gelatin methacryloyl. Vimentin and α-smooth muscle actin expression were increased with gelatin methacryloyl at 4 days (p = 0.0026, p = 0.0272). There were no differences in changes in smooth muscle or overall histomorphology after 3 months between the two closure techniques. Mesh repair with suture was also associated with increased inflammation and vessel density relative to gelatin methacryloyl. Quantification of collagen content by picrosirius red staining revealed increased thick collagen fibers throughout the implanted mesh with gelatin methacryloyl compared with suture at 4 weeks (0.62 ± 0.01 μm2 vs 0.55 ± 0.01, p = 0.018). Even at the long-term time point of 3 months, mesh repair with suture resulted in a profibrotic encapsulation of the mesh fibers, which was minimal with gelatin methacryloyl. Smooth muscle density was suppressed after mesh implantation returning to baseline levels at 3 months regardless of fixation with suture or gelatin methacryloyl. CONCLUSIONS These results suggest that gelatin methacryloyl might be a safe alternative to suture for epithelium re-approximation and anchoring of prolapse meshes to the vagina and may improve chronic inflammation in the vaginal wall associated with mesh complications.
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Affiliation(s)
- Lindsey A Jackson
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA
| | - Haolin Shi
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jesus Acevedo
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sohyung Lee
- Department of Chemical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Nasim Annabi
- Department of Chemical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - R Ann Word
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Florian-Rodriguez
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA.
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Tappy E, Pan E, Verma D, Wang A, Brown LS, Chang S, Florian-Rodriguez M. Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants. J Surg Educ 2022; 79:928-934. [PMID: 35249843 DOI: 10.1016/j.jsurg.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Various surgical specialties have reported gender bias in letters of recommendation (LOR). We aimed to determine if linguistic differences exist in LOR for female and male physicians applying to Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). DESIGN Retrospective cohort study including application cycles 2019 and 2020. SETTING Academic university hospital. PARTICIPANTS FMIGS applicants. RESULTS Applicant demographic and baseline data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha and Gold Humanism status and number of LOR, as well as the gender and academic rank of the letter writer. The Linguistic Inquiry and Word Count software, a validated text analysis program, was used to characterize LOR linguistic content. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) applicants were female and 42 (35.6%) were male. Most female applicants were white (46% vs. 36%, p = 0.04), had Alpha Omega Alpha status (13% vs. 0%, p = 0.01), higher Step 2 scores (239.7 vs. 230.4, p < 0.01), and more service activities (7.7 vs. 4.7, p < 0.01), compared to male applicants. Male applicants were more likely to graduate from international medical schools (45% vs. 16%, p < 0.01). Female authors wrote 159 LOR, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in Linguistic Inquiry and Word Count linguistic categories existed. CONCLUSIONS Although Baseline differences were noted between female and male FMIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect the impact of female predominance and increased efforts to address gender bias within Obstetrics and Gynecology.
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Affiliation(s)
- Erryn Tappy
- UT Southwestern Medical Center, Dallas, Texas.
| | - Evelyn Pan
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Angela Wang
- UT Southwestern Medical Center, Dallas, Texas
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Tappy E, Pan E, Chang S, Wang A, Diksha V, Brown S, Florian-Rodriguez M. Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Florian-Rodriguez M, Chin K, Hamner J, Acevedo J, Keller P, Word RA. Effect of Protease Inhibitors in Healing of the Vaginal Wall. Sci Rep 2019; 9:12354. [PMID: 31451729 PMCID: PMC6710245 DOI: 10.1038/s41598-019-48527-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/07/2019] [Indexed: 12/25/2022] Open
Abstract
Impaired elastogenesis and increased degradation of elastic fibers has been implicated in the pathogenesis of pelvic organ prolapse. Loss of the elastogenic organizer, fibulin-5 (FBLN5), leads to pelvic organ prolapse in mice. The objective of this study was to investigate the regulation of FBLN5 after surgical injury of the vaginal wall using the rat as a preclinical animal model. Both endogenous and recombinant FBLN5 were degraded after surgical injury. Estrogen did not alter the dramatic loss of vaginal FBLN5 in the acute phase after injury (12–48 h), but resulted in rescue of the poor recovery of FBLN5 levels in the late phase (7 d) of healing in ovariectomized animals. In contrast with estrogen, the general MMP inhibitor, actinonin, abrogated injury-induced degradation of FBLN5 significantly. Further, actinonin rescued the negative effects of injury on biomechanics, histomorphology, and elastic fibers. Control of excessive matrix degradation by local application of actinonin at the time of surgery may lead to improved elastic fiber regeneration and wound healing, thereby potentially enhancing pelvic floor recovery after reconstructive surgery for prolapse.
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Affiliation(s)
- Maria Florian-Rodriguez
- Department of Obstetrics and Gynecology Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Kathleen Chin
- Department of Obstetrics and Gynecology Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer Hamner
- Department of Obstetrics and Gynecology Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jesus Acevedo
- Cecil H. and Ida Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patrick Keller
- Cecil H. and Ida Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Ann Word
- Cecil H. and Ida Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Maldonado P, Jackson L, Florian-Rodriguez M, Wai C. 51: Comparisons of functional support with sacrohysteropexy versus sacrocolpopexy: A cadaveric study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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