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Berger AA, Bretschneider CE, Gregory WT, Sung V. Longitudinal Reoperation Risk After Apical Prolapse Procedures in Women Aged 65 Years and Older. Obstet Gynecol 2024; 143:411-418. [PMID: 38227947 PMCID: PMC10994006 DOI: 10.1097/aog.0000000000005511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/26/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe longitudinal reoperation risk among older women undergoing surgery for apical pelvic organ prolapse (POP) and to compare risk of reoperation for prolapse and complications among different surgical approaches. METHODS This nationwide, retrospective cohort study evaluated older adult women (aged 65 years and older) within the Centers for Medicare & Medicaid Services' (CMS) 5% LDS (Limited Data Set) who underwent sacrocolpopexy, uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF), or colpocleisis, or their uterine-preserving equivalents, from January 1, 2011, to December 31, 2018, with follow-up through 2019. The primary outcome was overall reoperation, and secondary outcomes included reoperation for POP and for complications. Rates were compared using χ 2 tests for categorical variables, Wilcoxon rank-sum for continuous variables and Kaplan Meier estimates of cumulative incidence. Death and exit from CMS insurance were considered as censoring events. We used cumulative incidence to calculate reoperation risk as a function of time at 1 year or more, 3 years or more, and 7 years or more. RESULTS This cohort included 4,089 women who underwent surgery to treat apical POP from 2011 to 2018: 1,034 underwent sacrocolpopexy, 717 underwent USLS, 1,529 underwent SSLF, and 809 underwent colpocleisis. Demographics varied among patients for each POP surgery. Patients who underwent the different surgeries had differences in age ( P <.01), Charlson Comorbidity Index score ( P <.01), diabetes ( P <.01), chronic obstructive pulmonary disease ( P <.01), hypertension ( P <.01), chronic pain ( P =.01), congestive heart failure ( P <.01), and concomitant hysterectomy ( P <.01). Reoperation rates were low and increased over time. The overall reoperation risk through 7 years was 7.3% for colpocleisis, 10.4% for USLS, 12.5% for sacrocolpopexy, and 15.0% for SSLF ( P <.01). Reoperation for recurrent POP through 7 years was 2.9% for colpocleisis, 7.3% for sacrocolpopexy, 7.7% for USLS, and 9.9% for SSLF ( P <.01). Reoperation for complications through 7 years was 5.3% for colpocleisis, 8.2% for sacrocolpopexy, 6.4% for USLS, and 8.2% for SSLF ( P <.01). CONCLUSION The type of surgical repair is significantly associated with long-term risk of reoperation. Colpocleisis offers the least likelihood of reoperation for prolapse, followed by sacrocolpopexy; colpocleisis followed by USLS has the least risk of long-term reoperation for complication.
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Affiliation(s)
| | | | | | - Vivian Sung
- Women and Infants Hospital/Alpert Medical School of Brown University, Providence, RI, United States
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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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Berger AA, Bretschneider CE, Gregory WT, Sung V. Effects of Same-Day Discharge on 30-Day Readmission Rates in Women Aged 65 Years and Older Undergoing Minimally Invasive Pelvic Organ Prolapse Surgery. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00793. [PMID: 37290098 DOI: 10.1097/aog.0000000000005226] [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] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/10/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the effects of same-day discharge on 30-day readmission after minimally invasive pelvic organ prolapse (POP) surgery in older patients. METHODS This retrospective cohort study examined all minimally invasive POP surgeries performed and included in the national Centers for Medicare & Medicaid Services 5% Limited Data Set (2011-2018). Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department (ED) visits. RESULTS Of the 7,278 patients undergoing surgery, patients who had same-day discharge were older (73.5 years vs 73.1 years, P=.04) and less likely to undergo concomitant hysterectomy (9.5% vs 34.9%, P<.01) or midurethral sling (36.8% vs 40.1%, P=.02). Same-day discharge increased over the study period from 15.7% in 2011 to 25.5% in 2018 (P<.01). On propensity score-matching multiple logistic regression, the adjusted difference was statistically significant, with same-day discharge increasing the odds of 30-day readmission compared with next-day discharge (adjusted odds ratio [OR] 1.57, 95% CI 1.19-2.08). There was no difference (OR 0.81, 95% CI 0.63-1.05) for 30-day ED visits on propensity score-matching multiple logistic regression. CONCLUSION After minimally invasive POP surgery, older women have low rates of readmission and ED visits within 30 days. After propensity score matching and adjustment for perioperative factors, there may be increased odds in readmission and no difference in ED visits risk in those who had same-day discharge. When considering patient factors, same-day discharge after minimally invasive POP surgery may be effective for older patients.
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Affiliation(s)
- Alexander A Berger
- Penn Medicine, Philadelphia, Pennsylvania; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Oregon Health & Science University, Portland, Oregon; and Women and Infants Hospital/Alpert Medical School of Brown University, Providence, Rhode Island
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Robison K, Wohlrab K, Howe CJ, Richter HE, Sung V, Bevis KS, Luis C, McCourt C, Lowder J, Occhino J, Glaser G, Lokich E, Dunivan G, Brown A, Tunitsky-Bitton E, Wethington S, Chen CCG, Rahn D, Carlson M, Cram R, Raker C, Clark MA. Endometrial Cancer Surgery With or Without Concomitant Stress Urinary Incontinence Surgery. Obstet Gynecol 2023; 141:642-652. [PMID: 36897162 DOI: 10.1097/aog.0000000000005059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To compare quality of life (QOL) among patients with endometrial intraepithelial neoplasia or early-stage endometrial cancer and stress urinary incontinence (SUI) who chose to have concomitant surgery with cancer surgery alone. METHODS A multicenter, prospective cohort study was conducted across eight U.S. sites. Potentially eligible patients were screened for SUI symptoms. Those who screened positive were offered referral to urogynecology and incontinence treatment, including concomitant surgery. Participants were categorized into two groups: 1) concomitant cancer and SUI surgery or 2) cancer surgery alone. The primary outcome was cancer-related QOL as measured by the FACT-En (Functional Assessment of Cancer Therapy-Endometrial) (range 0-100; higher score indicates better QOL). The FACT-En and questionnaires assessing urinary symptom-specific severity and effects were assessed before surgery and 6 weeks, 6 months, and 12 months after surgery. Adjusted median regression accounting for clustering was used to examine the relationship between SUI treatment group and FACT-En scores. RESULTS Of 1,322 (53.1%) patients, 702 screened positive for SUI with 532 analyzed; 110 (21%) chose concomitant cancer and SUI surgery, and 422 (79%) chose cancer surgery alone. FACT-En scores increased for both the concomitant SUI surgery and cancer surgery-only groups from the preoperative to the postoperative period. After adjustment for timepoint and preoperative covariates, the median change in FACT-En score (postoperative-preoperative) was 1.2 points higher (95% CI -1.3 to 3.6) for the concomitant SUI surgery group compared with the cancer surgery-only group across the postoperative period. Median time until surgery (22 days vs 16 days; P <.001), estimated blood loss (150 mL vs 72.5 mL; P <.001), and operative time (185.5 minutes vs 152 minutes; P <.001) were all greater for the concomitant cancer and SUI surgery group compared with the cancer-only group, respectively. CONCLUSION Concomitant surgery did not result in improved QOL compared with cancer surgery alone for endometrial intraepithelial neoplasia and patients with early-stage endometrial cancer with SUI. However, FACT-En scores were improved in both groups.
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Affiliation(s)
- Katina Robison
- Women & Infants Hospital and Brown University, Providence, Rhode Island; the University of Alabama at Birmingham, Birmingham, Alabama; Washington University of St. Louis Hospital, St. Louis, Missouri; Mayo Clinic, Rochester, Minnesota; the University of New Mexico Hospital, Albuquerque, New Mexico; Hartford Hospital, Hartford, Connecticut; Johns Hopkins Hospital, Baltimore, Maryland; and the University of Texas Southwestern Medical Center, Dallas, Texas
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Rahn D, Richter H, Sung V, Pruszynski J. Impact of 4 versus 6 apical suspension sutures for uterosacral ligament suspension. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.120] [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: 03/11/2023]
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Napoe GS, Luchristt D, Sridhar A, Ellington D, Ridgeway B, Mazloomdoost D, Sung V, Ninivaggio C, Harvie H, Santiago-Lastra Y, Gantz MG, Zyczynski HM. Reoperation for prolapse recurrence after sacrospinous mesh hysteropexy: characteristics of women choosing retreatment. Int Urogynecol J 2023; 34:255-261. [PMID: 36449027 PMCID: PMC9839581 DOI: 10.1007/s00192-022-05411-2] [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: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Factors that contribute to reoperation and surgical approaches for the management of recurrent uterovaginal prolapse after vaginal mesh hysteropexy (mesh hysteropexy) are unknown. We aimed to describe surgical management of pelvic organ prolapse recurrence after vaginal mesh hysteropexy, and patient characteristics in those who chose reoperation. METHODS This is a descriptive analysis of women who experienced treatment failure within 5 years of mesh hysteropexy in a multi-site randomized trial. The composite definition of treatment failure included retreatment (pessary or reoperation), prolapse beyond the hymen, or bothersome prolapse symptoms. Characteristics of those pursuing and not pursuing repeat prolapse surgery, measures of prolapse, and symptom severity are described. RESULTS Over 5-year follow up, 31/91 (34%) of the hysteropexy group met treatment failure criteria. All seven women who pursued reoperation reported bothersome prolapse symptoms; six were anatomic failures. Most seeking reoperation were early treatment failures; six (86%) by the 12-month visit and all by the 18-month visit. Compared to those electing expectant management, those pursuing reoperation had more apical prolapse, POP-Q point C median (IQR) -5.5 (-6.0, -4.0) cm versus +1.0 (-1.0, 3.0) cm respectively. Hysterectomy was performed in 6/7 reoperations (three vaginal, three endoscopic), with apical suspension in 5/6 hysterectomies. One participant with posterior compartment prolapse underwent transvaginal enterocele plication, uterosacral ligament suspension with posterior colpoperineorrhaphy. At a mean surgical follow-up of 34.3 (15.8) months, all women remained without anatomic or symptomatic failure. CONCLUSIONS When recurrent prolapse after mesh hysteropexy occurred, most women did not choose reoperation. Those who pursued surgery experienced more significant apical prolapse and were universally symptomatic. CLINICAL TRIAL IDENTIFICATION NUMBER NCT01802281.
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Affiliation(s)
- Gnankang Sarah Napoe
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
| | - Douglas Luchristt
- RTI International, Biostatics and Epidemiology Division, Research Triangle Park, Durham, NC, USA
| | - Amaanti Sridhar
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Ellington
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beri Ridgeway
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Donna Mazloomdoost
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Vivian Sung
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Cara Ninivaggio
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heidi Harvie
- Department of Urology, University of California - San Diego Health, La Jolla, CA, USA
| | | | - Marie G Gantz
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Halina M Zyczynski
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
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de Tayrac R, Antosh DD, Baessler K, Cheon C, Deffieux X, Gutman R, Lee J, Nager C, Schizas A, Sung V, Maher C. Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse. J Clin Med 2022; 11:jcm11206106. [PMID: 36294427 PMCID: PMC9605527 DOI: 10.3390/jcm11206106] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance.
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Affiliation(s)
- Renaud de Tayrac
- Service de Gynécologie-Obstétrique, CHU de Nîmes, Université de Montpellier, 34000 Nîmes, France
- Correspondence:
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Kaven Baessler
- Pelvic Floor Centre, Franziskus and St. Joseph Hospitals, Budapester Str. 15-19, 10787 Berlin, Germany
| | - Cecilia Cheon
- Urogynaecology Section of Queen Elizabeth Hospital, Hong Kong and Shenzhen Hong Kong University Hospital, Shenzhen 518009, China
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 92140 Clamart, France
| | - Robert Gutman
- Urogynecology & Pelvic Reconstructive Surgery, MedStar Washington Hospital Center, 106 Irving St. NW 405 S, Washington, DC 20010, USA
| | - Joseph Lee
- St. Vincents Clinic, UNSW University of New South Wales, Sydney, NSW 2010, Australia
| | - Charles Nager
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego Health, San Diego, CA 92037, USA
| | - Alexis Schizas
- General Surgery Department, Guy’s and St. Thomas’ NHS Foundation Trust, Monkton Street, London SE11 4TX, UK
| | - Vivian Sung
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher Maher
- Royal Brisbane and Womens Hospital, Urogynaecology University QLD, Herston, QLD 4029, Australia
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Bretschneider CE, Scales CD, Osazuwa-Peters O, Sheyn D, Sung V. Adverse outcomes after minimally invasive surgery for pelvic organ prolapse in women 65 years and older in the United States. Int Urogynecol J 2022; 33:2409-2418. [PMID: 35662357 PMCID: PMC9724747 DOI: 10.1007/s00192-022-05238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/28/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To describe complications at the time of surgery, 90-day readmission and 1-year reoperation rates after minimally invasive pelvic organ prolapse (POP) in women > 65 years of age in the US using Medicare 5% Limited Data Set (LDS) Files. METHODS Medicare is a federally funded insurance program in the US for individuals 65 and older. Currently, 98% of individuals over the age of 65 in the US are covered by Medicare. We identified women undergoing minimally invasive POP surgery, defined as laparoscopic or vaginal surgery, in the inpatient and outpatient settings from 2011-2017. Patient and surgical characteristics as well as adverse events were abstracted. We used logistic regression for complications at index surgery and Cox proportional hazards regression models for time to readmission and time to reoperations. RESULTS A total of 11,779 women met inclusion criteria. The mean age was 72 (SD ± 8) years; the majority were White (91%). Most procedures were vaginal (76%) and did not include hysterectomy (68%). The rate of complications was 12%; vaginal hysterectomy (aOR 2.4, 95% CI 2.2-2.7) was the factor most strongly associated with increased odds of complications. The 90-day readmission rate was 7.3%. The most common reason for readmission was infection (2.0%), three quarters of which were urinary tract infections. Medicaid eligibility (aHR 1.5, 95% CI 1.3-1.8) and concurrent sling procedures (aHR 1.2, 95% CI 1.04-1.4) were associated with a higher risk of 90-day readmission. The 1-year reoperation rate was 4.5%. The most common type of reoperation was a sling procedure (1.8%). Obliterative POP surgery (aHR 0.6, 95% CI 0.4-0.9) was associated with a lower risk of reoperation than other types of surgery. CONCLUSIONS US women 65 years and older who are also eligible to receive Medicaid are at higher risk of 90-day readmission following minimally invasive surgery for POP with the most common reason for readmission being UTI.
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Affiliation(s)
- C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Charles D Scales
- Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Oyomoare Osazuwa-Peters
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Vivian Sung
- Department Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, RI, USA
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Siddique M, Stewart L, Jacobs K, Raker C, Sung V. Oral phenazopyridine versus intravesical lidocaine for office onabotulinumtoxina analgesia: a randomized controlled trial. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.153] [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: 11/16/2022]
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Shinnick J, Siddique M, Jarmale S, Raker C, Sung V, Carberry C. Whose outcomes are we measuring? review of patient-reported outcome study populations. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.169] [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: 11/29/2022]
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Napoe G, Sridhar A, Luchristt D, Ridgeway B, Ellington D, Sung V, Ninivaggio C, Harvie H, Santiago-lastra Y, Mazloomdoost D, Gantz M, Zyczynski H. Clinical and procedure characteristics of women electing surgical management for recurrent prolapse after sacrospinous hysteropexy with mesh graft. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.095] [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: 11/01/2022]
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Sripad A, Raker C, Shireman T, Sung V. Overactive bladder medication prescription trends from 2014 to 2018. Neurourol Urodyn 2022; 41:806-812. [PMID: 35132687 DOI: 10.1002/nau.24880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE A growing literature points to an association between overactive bladder (OAB) medications and dementia. Given differences in side effects for extended-release (ER) and immediate-release (IR) anticholinergic formulations and beta-3 agonists, we examined prescription utilization patterns in a national dataset of older adults from 2014 to 2018. METHODS We performed a retrospective study using the Medicare Part D Drug Spending Dashboard, a publicly available database that includes data from outpatient pharmacy claims from 2014 to 2018 in the United States. We identified total claims and total spending on common OAB medications, and further assessed trends by anticholinergic burden by medication, and immediate and ER formulations. RESULTS There were 54.1 million claims for OAB medications, accounting for $10.1 billion (2018 United States dollars) in spending from 2014 to 2018. When considering beta-agonist, mirabegron accounted for 13.1% of total claims and 29.0% of total spending. Mirabegron accounted for a greater proportion of OAB medication claims and spending during the 5 years from 5.7% to 20.1% and 11.3% to 44%, respectively. IR anticholinergics accounted for fewer total claims over this period, from 58.5% to 42.6%. ER formulations increased in proportion of all OAB medication total claims from 35.8% to 37.5% from 2014 to 2016, and decreased to 37.3% by 2018. CONCLUSION OAB medications and expenditures increased from 2014 to 2018. Mirabegron accounted for higher proportions and IR-formulations for decreased proportions of each from 2014 to 2018. The impact on clinical outcomes is a key area for future investigation considering our findings.
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Affiliation(s)
- Abhishek Sripad
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christina Raker
- Division of Research, Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Theresa Shireman
- Department of Health Services Policy & Practice, Center for Gerontology & Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Vivian Sung
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Jelovsek JE, Gantz MG, Lukacz ES, Zyczynski HM, Sridhar A, Kery C, Chew R, Harvie HS, Dunivan G, Schaffer J, Sung V, Varner RE, Mazloomdoost D, Barber MD. Subgroups of failure after surgery for pelvic organ prolapse and associations with quality of life outcomes: a longitudinal cluster analysis. Am J Obstet Gynecol 2021; 225:504.e1-504.e22. [PMID: 34157280 PMCID: PMC8578254 DOI: 10.1016/j.ajog.2021.06.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/11/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment outcomes after pelvic organ prolapse surgery are often presented as dichotomous "success or failure" based on anatomic and symptom criteria. However, clinical experience suggests that some women with outcome "failures" are asymptomatic and perceive their surgery to be successful and that other women have anatomic resolution but continue to report symptoms. Characterizing failure types could be a useful step to clarify definitions of success, understand mechanisms of failure, and identify individuals who may benefit from specific therapies. OBJECTIVE This study aimed to identify clusters of women with similar failure patterns over time and assess associations among clusters and the Pelvic Organ Prolapse Distress Inventory, Short-Form Six-Dimension health index, Patient Global Impression of Improvement, patient satisfaction item questionnaire, and quality-adjusted life-year. STUDY DESIGN Outcomes were evaluated for up to 5 years in a cohort of participants (N=709) with stage ≥2 pelvic organ prolapse who underwent surgical pelvic organ prolapse repair and had sufficient follow-up in 1 of 4 multicenter surgical trials conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Surgical success was defined as a composite measure requiring anatomic success (Pelvic Organ Prolapse Quantification system points Ba, Bp, and C of ≤0), subjective success (absence of bothersome vaginal bulge symptoms), and absence of retreatment for pelvic organ prolapse. Participants who experienced surgical failure and attended ≥4 visits from baseline to 60 months after surgery were longitudinally clustered, accounting for similar trajectories in Ba, Bp, and C and degree of vaginal bulge bother; moreover, missing data were imputed. Participants with surgical success were grouped into a separate cluster. RESULTS Surgical failure was reported in 276 of 709 women (39%) included in the analysis. Failures clustered into the following 4 mutually exclusive subgroups: (1) asymptomatic intermittent anterior wall failures, (2) symptomatic intermittent anterior wall failures, (3) asymptomatic intermittent anterior and posterior wall failures, and (4) symptomatic all-compartment failures. Each cluster had different bulge symptoms, anatomy, and retreatment associations with quality of life outcomes. Asymptomatic intermittent anterior wall failures (n=150) were similar to surgical successes with Ba values that averaged around -1 cm but fluctuated between anatomic success (Ba≤0) and failure (Ba>0) over time. Symptomatic intermittent anterior wall failures (n=82) were anatomically similar to asymptomatic intermittent anterior failures, but women in this cluster persistently reported bothersome bulge symptoms and the lowest quality of life, Short-Form Six-Dimension health index scores, and perceived success. Women with asymptomatic intermittent anterior and posterior wall failures (n=28) had the most severe preoperative pelvic organ prolapse but the lowest symptomatic failure rate and retreatment rate. Participants with symptomatic all-compartment failures (n=16) had symptomatic and anatomic failure early after surgery and the highest retreatment of any cluster. CONCLUSION In particular, the following 4 clusters of pelvic organ prolapse surgical failure were identified in participants up to 5 years after pelvic organ prolapse surgery: asymptomatic intermittent anterior wall failures, symptomatic intermittent anterior wall failures, asymptomatic intermittent anterior and posterior wall failures, and symptomatic all-compartment failures. These groups provide granularity about the nature of surgical failures after pelvic organ prolapse surgery. Future work is planned for predicting these distinct outcomes using patient characteristics that can be used for counseling women individually.
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Affiliation(s)
- J Eric Jelovsek
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
| | - Marie G Gantz
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Research Triangle Park, NC
| | - Emily S Lukacz
- Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA
| | - Halina M Zyczynski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Amaanti Sridhar
- Biostatistics and Epidemiology Division, Research Triangle Institute International, Research Triangle Park, NC
| | - Caroline Kery
- Division for Statistical and Data Sciences, Research Triangle Institute International, Research Triangle Park, NC
| | - Rob Chew
- Division for Statistical and Data Sciences, Research Triangle Institute International, Research Triangle Park, NC
| | - Heidi S Harvie
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Gena Dunivan
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - Joseph Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivian Sung
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, the Warren Alpert Medical School, Brown University, Providence, RI
| | - R Ed Varner
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Matthew D Barber
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
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Thomas E, Walker H, Middlebrooks E, Fiveash J, Nicholas A, Popple R, Sung V, Stover N, Standaert D, Guthrie B, Bredel M. Frameless MLC-Based Radiosurgical Thalamotomies on the Modern Linear Accelerator Platform ― Prospective Phase I/II Clinical Trial Results. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.232] [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: 10/20/2022]
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15
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Goh J, Romanzi L, Elneil S, Haylen B, Chen G, Ghoniem G, Ijaiya M, Kwon S, Lee J, Mourad S, Ramanah R, Regmi M, Mohsin Rivzi R, Rogers R, Sharp J, Sung V. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn 2021; 39:2040-2071. [PMID: 33068487 DOI: 10.1002/nau.24508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. METHODS This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female PFF, encompassing 416 (188 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female-specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5-10 years) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female PFF has been produced to aid clinical practice and research.
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Affiliation(s)
- Judith Goh
- Department of Gynecology, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Romanzi
- Department of Global Health and Global Medicine, Harvard Medical School, New York, New York, USA
| | - Sohier Elneil
- Department of Urogynecology, University College, London Hospitals, London, UK
| | - Bernard Haylen
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Chen
- Department of Gynecology, John Hopkins University, Baltimore, Maryland, USA
| | - Gamal Ghoniem
- Division of Female Urology, UC Irvine Health, Irvine, California, USA
| | - Munir'deen Ijaiya
- Department of Obstetrics and Gynecology, University of IIorin, IIorin, Kwara, Nigeria
| | - Soo Kwon
- Department of Gynecology, Zucker School of Medicine, New York, New York, USA
| | - Joseph Lee
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sherif Mourad
- Department of Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Mohan Regmi
- Department of Obstetrics and Gynecology, BP Koirala Institute, Dharan, Nepal
| | | | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of Texas, Austin, Texas, USA
| | - Jonothan Sharp
- Department of Women's Health, Fenwek Hospital, Bomet, Kenya
| | - Vivian Sung
- Division of Urogynecology, Woman & Infants Hospital, Providence, Rhode Island, USA
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Robison K, Bevis K, Howe C, Wohlrab K, Sung V, Richter H, Lokich E, McCourt C, Glaser G, Brown A, Wethington S, Carlson M, DiSilvestro P, Lowder J, Rahn D, Occhino J, Dunivan G, Tunitsky E, Chen G, Luis C, Raker C, Clark M. Concurrent surgical treatment of urinary incontinence at the time of endometrial cancer surgery is associated with improved quality of life 6 months after cancer surgery: Cancer of the uterus and treatment of incontinence (CUTI) study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.042] [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: 10/26/2022]
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17
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Glassman D, Wohlrab K, Bevis K, Sung V, Richter H, Howe C, Lokich E, McCourt C, Glaser G, Brown A, Wethington S, DiSilvestro P, Lowder J, Occhino J, Dunivan G, Chen G, Luis C, Raker C, Clark M, Robison K, Carlson M, Tunitsky E. Adverse outcomes among women after concurrent surgery for endometrial cancer and pelvic floor disorders: The cancer of the uterus and treatment of incontinence (CUTI) trial. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.427] [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: 11/29/2022]
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18
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Meyer I, Richter H, Whitworth R, Lukacz E, Smith A, Sung V, Ackenbom M, Visco A, Wai C, Mazloomdoost D, Gantz M. 04: Transvaginal apical approaches for advanced pelvic organ prolapse. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.014] [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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19
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Shinnick J, Raker C, Sung V. 53: Misclassification of frailty in an outpatient urogynecologic population. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.083] [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: 10/27/2022]
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20
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Dunivan GC, Sussman AL, Jelovsek JE, Sung V, Andy UU, Ballard A, Jakus-Waldman S, Amundsen CL, Chermansky CJ, Bann CM, Mazloomdoost D, Rogers RG. Gaining the patient perspective on pelvic floor disorders' surgical adverse events. Am J Obstet Gynecol 2019; 220:185.e1-185.e10. [PMID: 30612960 DOI: 10.1016/j.ajog.2018.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Institute for Healthcare Improvement defines an adverse event as an unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment, or hospitalization or that results in death. The majority of research has focused on adverse events from the provider's perspective. OBJECTIVE The objective of this qualitative study was to describe patient perceptions on adverse events following surgery for pelvic floor disorders. STUDY DESIGN Women representing the following 3 separate surgical populations participated in focus groups: (1) preoperative (women <12 weeks prior to surgery); (2) short-term postoperative (women up to 12 weeks after surgery); and (3) long-term postoperative (women 1-5 years after surgery). Deidentified transcripts of audio recordings were coded and analyzed with NVivo 10 software to identify themes, concepts, and adverse events. Women were asked to rank patient-identified and surgeon-identified adverse events in order of perceived severity. RESULTS Eighty-one women participated in 12 focus groups. Group demographics were similar between groups, and all groups shared similar perspectives regarding surgical expectations. Women commonly reported an unclear understanding of their surgery and categorized adverse events such as incontinence, constipation, nocturia, and lack of improvement in sexual function as very severe, ranking these comparably with intensive care unit admissions or other major surgical complications. Women also expressed a sense of personal failure and shame if symptoms recurred. CONCLUSION Women consider functional outcomes such as incontinence, sexual dysfunction, and recurrence of symptoms as severe adverse events and rate them as similar in severity to intensive care unit admissions and death.
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21
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Wang J, Sung V, le Clercq CMP, Burt RA, Carew P, Liu RS, Mensah FK, Gold L, Wake M. High prevalence of slight and mild hearing loss across mid-life: a cross-sectional national Australian study. Public Health 2019; 168:26-35. [PMID: 30682637 DOI: 10.1016/j.puhe.2018.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Although presbycusis typically becomes symptomatic only in older age, slight and mild hearing loss may be detectable well before this. We studied current prevalence and characteristics of hearing loss in Australian mid-life adults. STUDY DESIGN This was a population-derived national cross-sectional study nested within the Longitudinal Study of Australian Children. METHODS A total of 1485 parents/guardians (87.3% female) aged 30-59 years underwent air-conduction audiometry. Hearing loss was defined in three ways to maximize cross-study comparability: high Fletcher index (mean of 1, 2 and 4 kHz; primary outcome relevant to speech perception), lower frequency (mean of 1 and 2 kHz) and higher frequency (mean of 4 and 8 kHz). Multivariable logistic regression examined how losses vary by age, sex and neighbourhood disadvantage. RESULTS On high Fletcher index, 27.3% had bilateral and 23.8% unilateral thresholds >15 dB hearing level (HL) (slight or worse), and 4.9% had bilateral and 6.3% unilateral thresholds >25 dB HL (mild or worse). Bilateral higher frequency losses were more common than lower frequency losses for thresholds >15 dB HL (30.9% vs. 26.4%) and >25 dB HL (11.0% vs. 4.6%). Age increased the risk of bilateral speech and higher frequency losses (all P for trend < 0.05), but not lower frequency losses >25 dB HL. Although sex was not associated with speech and lower frequency losses, men were more likely to have bilateral higher frequency losses (e.g. >15 dB HL: odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.5-3.2, P < 0.001). CONCLUSIONS Both slight and mild hearing loss show high and rising prevalence across mid-life. This offers opportunities to prevent progression to reduce the profound later burden of age-related hearing loss.
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Affiliation(s)
- J Wang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - V Sung
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Department of General Medicine, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - C M P le Clercq
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Otolaryngology, Erasmus University Medical Center, Rotterdam 3015, the Netherlands
| | - R A Burt
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - P Carew
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, VIC 3052, Australia
| | - R S Liu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - F K Mensah
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - L Gold
- School of Health and Social Development, Deakin University, Geelong, VIC 3217, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - M Wake
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics & the Liggins Institute, The University of Auckland, Grafton, Auckland 1142, New Zealand.
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22
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Shaw J, Negbenebor N, Wohlrab K, Raker C, Sung V. Audiovisual stimulus during urodynamics to provoke detrusor overactivity: A randomized trial. Low Urin Tract Symptoms 2018; 11:127-132. [PMID: 30565422 DOI: 10.1111/luts.12248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/27/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study estimated the effect of adding an audiovisual (AV) intervention during urodynamic evaluation (UDE) on increasing detrusor contractions (DO) versus routine UDE testing without AV cues. METHODS A randomized trial was conducted of women with overactive bladder (OAB) undergoing UDE with and without AV intervention. The AV intervention was a 1-minute video on continuous loop showing common OAB triggers. A continuous running waterfall provided auditory stimulation. The primary outcome was the proportion of patients who had DO on UDE, interpreted by masked clinicians. Secondary outcomes included the number, amplitude, and duration of DO and urinary leakage associated with DO. A sample size of 109 per group was calculated to have 80% power to detect a 20% difference with a significance level of 0.05. RESULTS In all, 109 women each were randomized to standard UDE and to the AV intervention. There was no difference in the proportion of patients with DO on UDE between the intervention and control groups (35% vs 32%, respectively; P = 0.8). Furthermore, there were no differences between the intervention and control groups in leakage with DO on UDE (24% vs 21%, respectively), mean duration of detrusor contractions (23.9 vs 25.3 s, respectively), or mean maximum detrusor pressure during involuntary contractions (18.1 vs 20.6 cm H2 O, respectively). Clinical severity of OAB symptoms was not associated with the detection of DO or other UDE parameters. CONCLUSIONS Addition of AV intervention during UDE did not increase the finding of detrusor contractions. The relationship between OAB triggers, urge incontinence, and urodynamic findings remains unclear.
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Affiliation(s)
- Jonathan Shaw
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Negbenebor
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kyle Wohlrab
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christine Raker
- Division of Research, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Vivian Sung
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Robison K, Bevis K, Howe C, Wohlrab K, Sung V, Richter H, Lokich E, McCourt C, Glaser G, Brown A, Wethington S, Carlson M, Rahn D, Lowder J, Occhino J, Dunivan G, Tunitsky E, Chen G, Luis C, Raker C, DiSilvestro P, Clark M. Characteristics of women with endometrial cancer and stress urinary incontinence (SUI) that desire concurrent cancer and SUI surgery: Cancer of the uterus and treatment of incontinence (CUTI) study. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.372] [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: 10/28/2022]
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Shinnick J, Raker C, Sung V. 70: Long-term improvements in physical activity levels and physical functioning after midurethral sling for female stress urinary incontinence. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.089] [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: 10/18/2022]
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25
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Jacobs K, Hokenstad E, Hamner J, Park B, Mahal A, Shannon M, Zigman J, Pilkinton M, Sheyn D, Elmer C, Korbly N, Sung V. 04: Patient knowledge and preferences regarding hysterectomy route: A study from the Fellows' Pelvic Research Network. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.022] [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: 11/29/2022]
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26
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Wohlrab K, Raker C, Sung V. 4: Long-term symptoms, quality of life and goal attainment after surgery versus pessary for pelvic organ prolapse. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.034] [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: 11/16/2022]
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27
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Madsen A, Raker C, Sung V. 4: Patient-reported functioning outcomes after surgery compared to pessary for the treatment of pelvic organ prolapse using the patient reported outcomes measurement system. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.013] [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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Gleason JL, Parden AM, Jauk V, Ballard A, Sung V, Richter HE. Outcomes of midurethral sling procedures in women with mixed urinary incontinence. Int Urogynecol J 2015; 26:715-20. [PMID: 25576468 DOI: 10.1007/s00192-014-2580-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to compare midurethral sling (MUS) urinary outcomes in women with stress urinary incontinence (SUI) only versus mixed UI (MUI). METHODS This was a retrospective cohort study of women who underwent primary MUS surgery for SUI. MUI was defined as at least "moderately" bothersome urgency and stress incontinence on the Urinary Distress Inventory (UDI-6) subscale of the Pelvic Floor Distress Inventory-20 (PFDI-20). The primary outcome was SUI cure defined by a response of "no," "not at all," or "somewhat" bothersome SUI on both of the two UDI-6 stress subscale items. Symptom impact was assessed using the Urinary Impact Questionnaire (UIQ-7). Multivariable models assessed the effect of MUI on SUI outcomes. RESULTS One thousand one hundred and ninety-one primary MUS procedures were reviewed. Seven hundred and fifteen out of 1,191 (60%) questionnaires were returned and 534 out of 715 (75%) had completed baseline and follow-up questionnaires. Mean (± SD) follow-up time was 35 ± 15 months. Women with MUI had a higher (worse) baseline total score on the UDI-6 (p ≤ 0.001). A lower proportion of women with MUI had SUI success compared with the SUI only group (64 vs 84.5%, p < 0.001). On multivariable analyses, women in the MUI group were at an increased risk of SUI failure (OR 2.5, 95% CI 1.6, 4.0), but greater improvements in UDI-6 (-31.6 ± 30.6 vs -15.5 ± 25.1), and UIQ-7 scores (-21.7 ± 35.3 vs -15.1 ± 28.2) compared with women with SUI only (all p < 0.02). CONCLUSIONS Women with MUI are at an increased risk of SUI failure after MUS compared with women with SUI only, but experience greater overall improvement in the impact of urinary symptoms on the quality of life.
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Affiliation(s)
- Jonathan L Gleason
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA,
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Richter HE, Whitehead N, Arya L, Ridgeway B, Allen-Brady K, Norton P, Sung V, Shepherd JP, Komesu Y, Gaddis N, Fraser MO, Tan-Kim J, Meikle S, Page GP. Genetic contributions to urgency urinary incontinence in women. J Urol 2014; 193:2020-7. [PMID: 25524241 DOI: 10.1016/j.juro.2014.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE We identify genetic variants associated with urgency urinary incontinence in postmenopausal women. MATERIALS AND METHODS A 2-stage genome-wide association analysis was conducted to identify variants associated with urgency urinary incontinence. The WHI GARNET substudy with 4,894 genotyped post-reproductive white women was randomly split into independent discovery and replication cohorts. Genome-wide imputation was performed using IMPUTE2 with the 1000 Genomes ALL Phase I integrated variant set as a reference. Controls reported no urgency urinary incontinence at enrollment or followup. Cases reported monthly or greater urgency urinary incontinence and leaked sufficiently to wet/soak underpants/clothes. Logistic regression models were used to predict urgency urinary incontinence case vs control status based on genotype, assuming additive inheritance. Age, obesity, diabetes and depression were included in the models as covariates. RESULTS Following quality control, 975,508 single nucleotide polymorphisms in 2,241 cases (discovery 1,102; replication 1,133) and 776 controls (discovery 405, replication 371) remained. Genotype imputation resulted in 9,077,347 single nucleotide polymorphisms and insertions/deletions with minor allele frequency greater than 0.01 available for analysis. Meta-analysis of the discovery and replication samples identified 6 loci on chromosomes 5, 10, 11, 12 and 18 associated with urgency urinary incontinence at p <10(-6). Of the loci 3 were within genes, the zinc finger protein 521 (ZFP521) gene on chromosome 18q11, the ADAMTS16 gene on chromosome 5p15 and the CIT gene on chromosome 12q24. The other 3 loci were intergenic. CONCLUSIONS Although environmental factors also likely contribute, this first exploratory genome-wide association study for urgency urinary incontinence suggests that genetic variants in the ZFP521, CIT and ADAMTS16 genes might account for some of the observed heritability of the condition.
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Affiliation(s)
| | - Nedra Whitehead
- Research Triangle International, Research Triangle Park, North Carolina
| | - Lily Arya
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Vivian Sung
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Yuko Komesu
- University of New Mexico, Albuquerque, New Mexico
| | - Nathan Gaddis
- Research Triangle International, Research Triangle Park, North Carolina
| | | | | | - Susan Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Grier P Page
- Research Triangle International, Research Triangle Park, North Carolina
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Jeppson P, Rahimi S, Gattoc L, Westermann L, Cichowski S, Raker C, LeBrun EEW, Sung V. Impact of Robotic Technology on Hysterectomy Route and Associated Implications for Resident Education. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McFadden B, Constantine M, Rogers R, Dunivan G, Hammil S, Sussman A, Romero A, Abed H, Kenton K, Sung V. Surgical Consent Factors That Influence Risk Recall for Midurethral Sling Surgery. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.021] [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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Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, Aschkenazi S, Olivera C, South M, Lowenstein L, Schaffer J, Balk EM, Sung V. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 2013; 21:353-61. [PMID: 24295923 DOI: 10.1016/j.jmig.2013.11.010] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [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: 10/13/2013] [Revised: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 12/31/2022]
Abstract
The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability.
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Affiliation(s)
- Rajiv B Gala
- Department of Obstetrics and Gynecology, Ochsner Clinical School, New Orleans, Louisiana.
| | - Rebecca Margulies
- Department of Obstetrics and Gynecology, Kaiser Medical Center, Oakland, California
| | - Adam Steinberg
- Department of Obstetrics and Gynecology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Miles Murphy
- Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, Pennsylvania
| | - James Lukban
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Peter Jeppson
- Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sarit Aschkenazi
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin
| | - Cedric Olivera
- Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Mary South
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lior Lowenstein
- Urogynecology Service, Rambam Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph Schaffer
- Urogynecology Service, Rambam Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ethan M Balk
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Vivian Sung
- Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
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Good MM, Korbly N, Kassis NC, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Harvie HS, Sung V. Prolapse-related knowledge and attitudes toward the uterus in women with pelvic organ prolapse symptoms. Am J Obstet Gynecol 2013; 209:481.e1-6. [PMID: 23748108 DOI: 10.1016/j.ajog.2013.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 01/08/2013] [Revised: 04/26/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to describe the basic knowledge about prolapse and attitudes regarding the uterus in women seeking care for prolapse symptoms. STUDY DESIGN This was a cross-sectional study of English-speaking women presenting with prolapse symptoms. Patients completed a self-administered questionnaire that included 5 prolapse-related knowledge items and 6 benefit-of-uterus attitude items; higher scores indicated greater knowledge or more positive perception of the uterus. The data were analyzed using descriptive statistics and multiple linear regression. RESULTS A total of 213 women were included. The overall mean knowledge score was 2.2 ± 1.1 (range, 0-5); 44% of the items were answered correctly. Participants correctly responded that surgery (79.8%), pessary (55.4%), and pelvic muscle exercises (34.3%) were prolapse treatment options. Prior evaluation by a female pelvic medicine and reconstructive surgery specialist (beta = 0.57, P = .001) and higher education (beta = 0.3, P = .07) was associated with a higher mean knowledge score. For attitude items, the overall mean score was 15.1 (4.7; range, 6-30). A total of 47.4% disagreed with the statement that the uterus is important for sex. The majority disagreed with the statement that the uterus is important for a sense of self (60.1%); that hysterectomy would make me feel less feminine (63.9%); and that hysterectomy would make me feel less whole (66.7%). Previous consultation with a female pelvic medicine and reconstructive surgery specialist was associated with a higher mean benefit of uterus score (beta = 1.82, P = .01). CONCLUSION Prolapse-related knowledge is low in women seeking care for prolapse symptoms. The majority do not believe the uterus is important for body image or sexuality and do not believe that hysterectomy will negatively affect their sex lives.
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Affiliation(s)
- Meadow M Good
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
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Hampton BS, Magrane D, Sung V. Perceptions of operating room learning experiences during the obstetrics and gynecology clerkship. J Surg Educ 2011; 68:377-381. [PMID: 21821216 DOI: 10.1016/j.jsurg.2011.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/15/2011] [Accepted: 03/19/2011] [Indexed: 05/27/2023]
Abstract
BACKGROUND There is little published describing curriculum development for the medical student in the operating room (OR). PURPOSE Explore student and faculty perceptions of learning experiences in the OR during the Obstetrics and Gynecology (Ob/Gyn) clerkship as a prelude to defining OR-specific learning objectives and curriculum. METHODS Fourth year students and Obstetrics and Gynecology faculty participated in structured, audiotaped focus groups aimed at defining OR educational objectives and curriculum content. Review of audiotapes identified emergent themes used to categorize perceived learning experiences. RESULTS Two focus groups including 13 students and 1 focus group including 5 faculty were conducted. Four dominant categories of OR learning were identified: (1) development of a foundation of clinical knowledge; (2) surgical technique and skill acquisition; (3) personal insight into career choice; and (4) surgical culture and OR functioning. CONCLUSIONS Students and faculty were aligned regarding general categories of key OR learning experiences, building an experiential framework for developing OR-specific learning objectives and curricular components.
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Affiliation(s)
- Brittany Star Hampton
- Alpert Medical School of Brown University/Women and Infants' Hospital of Rhode Island, Providence, RI 02905, USA.
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Jones L, Sung V, Lascaratos G, Nagi H, Holder R. Intraocular pressures after ketamine and sevoflurane in children with glaucoma undergoing examination under anaesthesia. Br J Ophthalmol 2009; 94:33-5. [PMID: 19692370 DOI: 10.1136/bjo.2008.148122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM For accurate intraocular pressure (IOP) measurement in very young children examination under anaesthesia (EUA) may be necessary. Most anaesthetic agents used for EUA have some effect on IOP. We compared IOPs in children after ketamine and sevoflurane anaesthesia. METHODS Consecutive patients with definite or suspected glaucoma, uncooperative for reliable IOP measurement in clinic and requiring EUA, were included in this study. IOPs were measured after intramuscular injection (5 mg/kg) or intravenous injection (2 mg/kg) of ketamine using a Perkins applanation tonometer. Three measurements were taken from each eye. The IOPs were rechecked after sevoflurane, given for maintenance anaesthesia. Mean IOPs were used for analysis. Paired t test was used to assess the differences in IOPs for the whole group and one-way ANOVA for the three subgroups (ketamine IOP <20, 20-30, >30 mmHg). RESULTS The records of eight patients (16 eyes) were available for review. The mean age was 55.42 (SD 25, range 26-89) months. Seventy data-points from both eyes (35 EUAs) were used for the analysis. The mean IOP after sevoflurane (17 (SD 10) mmHg) was statistically lower than after ketamine (24.4 (SD 12.7) mmHg, p<0.001). The percentage difference was 28.5 (SD 20.8; 95% CI 23.5 to 33.4)). The difference between the subgroups was not statistically significant (p = 0.192). CONCLUSION Sevoflurane lowers the IOP significantly compared with the IOP measured after ketamine. This difference is independent of the IOP level. It may be important to use ketamine as the induction anaesthetic agent when accurate IOP measurement is necessary during EUA for children.
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Affiliation(s)
- L Jones
- Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH, UK
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Woodfield CA, Hampton BS, Sung V, Brody JM. Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging. Int Urogynecol J 2009; 20:695-701. [DOI: 10.1007/s00192-009-0865-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 03/10/2009] [Indexed: 10/21/2022]
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Abstract
AIMS To determine whether documented evidence of pre-existing maculopathy is present in Type 2 diabetic patients who require photocoagulation or vitrectomy for proliferative disease. This is a retrospective case notes review. METHODS The study was performed at Queen's Medical Centre, UK. All patients listed in the laser register and operating theatre register over 5 years (March 1994 to March 1999) who had undergone pan retinal photocoagulation (PRP) for diabetic retinopathy, in one consultant firm, were studied. The medical records of patients who had undergone vitrectomy as their first treatment for proliferative diabetic retinopathy in a vitreo-retinal firm over the 5 years were examined. The proportion of patients with documented maculopathy before development of proliferative retinopathy was determined. RESULTS All except 1/134 or 0.7% (95% confidence interval 0.1-4.5%) patients had documentation of macular signs in at least one eye prior to the patient's first session of PRP. Of the remaining 133, 104 (78%) had had focal or grid photocoagulation of the macula. The median time between the documentation of maculopathy before the first PRP treatment session was 16 months (interquartile range 7-36). Fourteen patients had vitrectomy and endolaser performed as the initial treatment for proliferative disease. All patients had documented maculopathy before the onset of proliferative disease. CONCLUSIONS The results of this study suggest that in Type 2 diabetes, proliferative disease occurs relatively late compared with maculopathy. In such patients, maculopathy is almost invariably present when proliferative disease is detected.
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Affiliation(s)
- L Tong
- Department of Ophthalmology, University Hospital, Queen's Medical Centre, Nottingham, UK
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Tong L, Ang A, Vernon SA, Zambarakji HJ, Bhan A, Sung V, Page S. Sensitivity and specificity of a new scoring system for diabetic macular oedema detection using a confocal laser imaging system. Br J Ophthalmol 2001; 85:34-9. [PMID: 11133709 PMCID: PMC1723671 DOI: 10.1136/bjo.85.1.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To assess the use of the Heidelberg retina tomograph (HRT) in screening for sight threatening diabetic macular oedema in a hospital diabetic clinic, using a new subjective analysis system (SCORE). METHODS 200 eyes of 100 consecutive diabetic patients attending a diabetologist's clinic were studied, all eyes had an acuity of 6/9 or better. All patients underwent clinical examination by an ophthalmologist. Using the HRT, one good scan was obtained for each eye centred on the fovea. A System for Classification and Ordering of Retinal Edema (SCORE) was developed using subjective assessment of the colour map and the reflectivity image. The interobserver agreement of using this method to detect macular oedema was assessed by two observers (ophthalmic trainees) who were familiarized with SCORE by studying standard pictures of eyes not in the study. All scans were graded from 0-6 and test positive cases were defined as having a SCORE value of 0-2. The sensitivity of SCORE was assessed by pooling the data with an additional 88 scans of 88 eyes in order to reduce the confidence interval of the index. RESULTS 12 eyes in eight out of the 100 patients had macular oedema clinically. Three scans in three patients could not be analysed because of poor scan quality. In the additional group of scans 76 out of 88 eyes had macular oedema clinically. The scoring system had a specificity of 99% (95% CI 96-100) and sensitivity of 67% (95% CI 57-76). The predictive value of a negative test was 87% (95% CI 82-99), and that of a positive test was 95% (95% CI 86-99). The mean difference of the SCORE value between two observers was -0.2 (95% CI -0.5 to +0.07). CONCLUSIONS These data suggest that SCORE is potentially useful for detecting diabetic macular oedema in hospital diabetic patients.
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Affiliation(s)
- L Tong
- Department of Ophthalmology, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, UK
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Abstract
1,25-Dihydroxyvitamin-D3 [1,25(OH)2D3], the active hormonal metabolite of vitamin D, acts through a specific nuclear receptor to inhibit proliferation and promote differentiation of several tumor cell types including the LNCaP, DU145 and PC-3 prostate cancer cell lines as well as primary prostate tumor lines. 1,25(OH)2D3 can also decrease invasion of breast and prostate cancer cell lines in vitro. We confirm this latter finding in the DU145 and PC-3 prostate cancer cell lines, and further show that 1,25(OH)2D3 inhibits overall invasion, cell adhesion and migration to the basement membrane matrix protein laminin. These changes appear to be due in part to a 1,25(OH)2D3-induced decrease in expression of alpha6 and beta4 integrins, both of which are receptors for laminin and associated with increased migration and invasion of prostate cancer cells in vitro. Blocking function of these particular integrins with antibodies inhibits both adhesion and migration of the cells. Collectively, these data demonstrate that 1,25(OH)2D3, in addition to decreasing proliferation of tumor cells, can also inhibit prostate cancer cell invasion through modulation of select cell surface adhesion molecules.
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Affiliation(s)
- V Sung
- Department of Medicine, Stanford University School of Medicine, CA 94305-5103, USA
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Sharp JA, Sung V, Slavin J, Thompson EW, Henderson MA. Tumor cells are the source of osteopontin and bone sialoprotein expression in human breast cancer. J Transl Med 1999; 79:869-77. [PMID: 10418827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Bone sialoprotein (BSP) and osteopontin (OPN) are secreted glycoproteins with a conserved Arg-Gly-Asp (RGD) integrin-binding motif and are expressed predominantly in bone. The RGD tripeptide is commonly present in extracellular attachment proteins and has been shown to mediate the attachment of osteosarcoma cells and osteoclasts. To determine the origin and incidence of BSP and OPN mRNA expression in primary tumor, a cohort of archival, primary invasive breast carcinoma specimens was analyzed. BSP transcripts were detected in 65% and OPN transcripts in 77% of breast cancers examined. In general, BSP and OPN transcripts were detected in both invasive and in situ carcinoma components. The transcripts were not detected in surrounding stromal cells or in peritumoral macrophages. Despite its abundance in carcinomas, BSP expression was not detected in a panel of 11 human breast cancer cell lines (MCF-7, T47D, SK-Br-3, MDA-MB-453, MDA-MB-231, MDA-MB-436, BT549, MCF-7ADR, Hs578T, MDA-MB-435, and LCC15-MB) and OPN expression was detected only in two of these (MDA-MB-435 and LCC15-MB). To examine the possibility that expression of these genes was down-regulated in cell culture, several cell lines were grown as nude mouse xenografts in vivo; however, these tumors also failed to express BSP. OPN expression was identified in all cell lines grown as nude mouse xenografts. Our data suggest that in human primary breast tumors, the origin of BSP and OPN mRNA is predominantly the breast cancer cells and that expression of these transcripts is influenced by the tumor environment.
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Affiliation(s)
- J A Sharp
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Thompson EW, Sung V, Lavigne M, Baumann K, Azumi N, Aaron AD, Clarke R. LCC15-MB: a vimentin-positive human breast cancer cell line from a femoral bone metastasis. Clin Exp Metastasis 1999; 17:193-204. [PMID: 10432004 DOI: 10.1023/a:1006598422203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The LCC15-MB cell line was established from a femoral bone metastasis that arose in a 29-year-old woman initially diagnosed with an infiltrating ductal mammary adenocarcinoma. The tumor had a relatively high (8%) S-phase fraction and 1/23 positive lymph nodes (LN). Both the primary tumor and LN metastasis were positive for estrogen receptor (ER) and progesterone receptor (PgR), but lacked erbB2 expression. Approximately one year later, the patient presented with a 0.8 cm comedo-type intraductal mammary adenocarcinoma in the left breast that was negative for ER and PgR, but positive for erbB2. Thirty-five months after the initial diagnosis she was treated for acute skeletal metastasis, and stabilized with a hip replacement. At this time, tumor cells were removed from surplus involved bone, inoculated into cell culture, and developed into the LCC 15-MB cell line. The bone metastasis was a poorly differentiated adenocarcinoma lacking ER, PgR, and erbB2, characteristics shared by the LCC15-MB cells, although ER can be re-expressed by treatment of the LCC15-MB cells for 5 days with 75 microM 5-aza-2'-deoxycytidine. The LCC15-MB cell line is tumorigenic when implanted subcutaneously in NCr nu/nu mice and produces long-bone metastases after intracardiac injection. Although the bone metastasis from which the LCC15-MB cell line was derived lacked vimentin (VIM) expression, the original primary tumor and lymph node metastasis were strongly VIM positive, as are LCC15-MB cells in vitro and in nude mice. The karyotype and isozyme profiles of LCC15-MB cells are consistent with its origin from a human female, with most chromosome counts in the hypertriploid range. Thirty-two marker chromosomes are present. These cells provide an in vitro/in vivo model in which to study the inter-relationships between ER, VIM, and bone metastasis in human breast cancer.
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MESH Headings
- Adult
- Animals
- Bone Neoplasms/metabolism
- Bone Neoplasms/secondary
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Cell Division
- Female
- Humans
- Immunohistochemistry
- Intermediate Filament Proteins/metabolism
- Isoenzymes/metabolism
- Karyotyping
- Mice
- Mice, Nude
- Microscopy, Fluorescence
- Neoplasm Transplantation
- Polymerase Chain Reaction
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Tumor Cells, Cultured/cytology
- Tumor Cells, Cultured/metabolism
- Vimentin/metabolism
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Affiliation(s)
- E W Thompson
- Vincent T. Lombardi Cancer Center, and Department of Cell Biology, Georgetown University Medical Center, Washington, DC 20007, USA
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Sung V, Stubbs JT, Fisher L, Aaron AD, Thompson EW. Bone sialoprotein supports breast cancer cell adhesion proliferation and migration through differential usage of the alpha(v)beta3 and alpha(v)beta5 integrins. J Cell Physiol 1998; 176:482-94. [PMID: 9699501 DOI: 10.1002/(sici)1097-4652(199809)176:3<482::aid-jcp5>3.0.co;2-k] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bone sialoprotein (BSP), a secreted glycoprotein found in bone matrix, has been implicated in the formation of mammary microcalcifications and osteotropic metastasis of human breast cancer (HBC). BSP possesses an integrin-binding RGD (Arg-Gly-Asp) domain, which may promote interactions between HBC cells and bone extracellular matrix. Purified BSP, recombinant human BSP fragments and BSP-derived RGD peptides are shown to elicit migratory, adhesive, and proliferative responses in the MDA-MB-231 HBC cell line. Recombinant BSP fragment analysis localized a significant component of these activities to the RGD domain of the protein, and synthetic RGD peptides with BSP flanking sequences (BSP-RGD) also conferred these responses. The fibronectin-derived RGD counterpart, GRGDSP (Gly-Arg-Gly-Asp-Ser-Pro), could not support these cellular responses, emphasizing specificity of the BSP configuration. Although most of the proliferative and adhesive responses could be attributed to RGD interactions, these interactions were only partly responsible for the migrational responses. Experiments with integrin-blocking antibodies demonstrated that BSP-RGD-induced migration utilizes the alpha(v)beta3 vitronectin receptor, whereas adhesion and proliferation responses were alpha(v)beta5-mediated. Using fluorescence activated cell sorting, we selected two separate subpopulations of MDA-MB-231 cells enriched for alpha(v)beta3 or alpha(v)beta5 respectively. Although some expression of the alternate alpha(v) integrin was still retained, the alpha(v)beta5-enriched MDA-MB-231 cells showed enhanced proliferative and adhesive responses, whereas the alpha(v)beta3-enriched subpopulation was suppressed for proliferation and adhesion, but showed enhanced migratory responses to BSP-RGD. In addition, similar analysis of two other HBC cell lines showed less marked, but similar RGD-dependent trends in adhesion and proliferation to the BSP fragments. Collectively, these data demonstrate BSP effects on proliferative, migratory, and adhesive functions in HBC cells and that the RGD-mediated component differentially employs alpha(v)beta3 and alpha(v)beta5 integrin receptors.
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Affiliation(s)
- V Sung
- Department of Cell Biology, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Sung V, Gilles C, Murray A, Clarke R, Aaron AD, Azumi N, Thompson EW. The LCC15-MB human breast cancer cell line expresses osteopontin and exhibits an invasive and metastatic phenotype. Exp Cell Res 1998; 241:273-84. [PMID: 9637769 DOI: 10.1006/excr.1998.4029] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have characterized the LCC15-MB cell line which was recently derived from a breast carcinoma metastasis resected from the femur of a 29-year-old woman. LCC15-MB cells are vimentin (VIM) positive, exhibit a stellate morphology in routine cell culture, and form penetrating colonies when embedded in three-dimensional gels of Matrigel or fibrillar collagen. They show high levels of activity in the Boyden chamber chemomigration and chemoinvasion assays, and like other invasive human breast cancer (HBC) cell lines, LCC15-MB cells activate matrix-metalloproteinase-2 in response to treatment with concanavalin A. In addition, these cells are tumorigenic when implanted subcutaneously in nude mice and recolonize bone after arterial injection. Interestingly, both the primary lesion and the bone metastasis from which LCC15-MB were derived, as well as the resultant cell line, abundantly express the bone matrix protein osteopontin (OPN). OPN is also expressed by the highly metastatic MDA-MB-435 cells, but not other invasive or noninvasive HBC cell lines. Expression of OPN is retained in the subcutaneous xenograft and intraosseous metastases of LCC15-MB as detected by immunohistochemistry. Both VIM and OPN expression have been associated with breast cancer invasion and metastasis, and their expression by the LCC15-MB cell line is consistent with its derivation from a highly aggressive breast cancer. These cells provide a useful model for studying molecular mechanisms important for breast cancer metastasis to bone and, in particular, the implication(s) of OPN and VIM expression in this process.
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Affiliation(s)
- V Sung
- Department of Cell Biology, Georgetown University Medical Center, 3970 Reservoir Road NW, Washington, DC, 20007, USA
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Sung V, Venkateshan CN, Williamson L, Ward R, Espey MG, Gibbs CJ, Moffett JR, Namboodiri MA. Immuno-electron microscopy reveals that the excitotoxin quinolinate is associated with the plasma membrane in human peripheral blood monocytes/macrophages. Cell Tissue Res 1997; 290:633-9. [PMID: 9369539 DOI: 10.1007/s004410050969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Quinolinate (QUIN), a tryptophan-derived excitotoxin, was localized ultrastructurally in human peripheral blood monocytes/macrophages (MO) by immuno-electron microscopy. A combined carbodiimide/glutaraldehyde/paraformaldehyde-based fixation procedure was developed for optimal retention of QUIN in the cell as well as minimal loss of ultrastructure; a silver-enhanced colloidal gold detection system was used for electron-microscopic analysis. Gold particles representing QUIN immunoreactivity were associated with the inner side of the plasma membrane in normal MO. The number of gold particles increased significantly when QUIN levels were elevated by treatment with its precursor kynurenine, but location of the gold particles remained essentially the same under this condition. Treatment with interferon-gamma increased the number of Golgi bodies, vacuoles and pseudopodia, reflecting the activated state of the cell. Significantly increased numbers of gold particles representing QUIN were detectable in approximately the same location as in the case of kynurenine treatment. Combined treatment with kynurenine and interferon-gamma maximally increased the number of gold particles at the periphery of the cell. The pseudopodia were intensely stained with gold particles, while they were not detectable in the inner part of the cytoplasm or in any other organelle even under this activated condition. The significance of the specific location of QUIN revealed in the present study and its relation to the release and subsequent actions of QUIN are discussed.
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Affiliation(s)
- V Sung
- Department of Biology, Georgetown University, Washington DC 20057, USA
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Sung V, Cattell DA, Bueno JM, Murray A, Zwiebel JA, Aaron AD, Thompson EW. Human breast cancer cell metastasis to long bone and soft organs of nude mice: a quantitative assay. Clin Exp Metastasis 1997; 15:173-83. [PMID: 9062394 DOI: 10.1023/a:1018409028662] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Bone is a common metastatic site in human breast cancer (HBC). Since bone metastasis occurs very rarely from current spontaneous or experimental metastasis models of HBC cells in nude mice, an arterial seeding model involving the direct injection of the cells into the left ventricle has been developed to better understand the mechanisms involved in this process. We present here a sensitive polymerase chain reaction (PCR) method to detect and quantitate bone and soft organ metastasis in nude mice which have been intracardially inoculated with Lac Z transduced HBC cells. Amplification of genomically incorporated Lac Z sequences in MDA-MB-231-BAG HBC cells enables us to specifically detect these cells in mouse organs and bones. We have also created a competitive template to use as an internal standard in the PCR reactions, allowing us to better quantitate levels of HBC metastasis. The results of this PCR detection method correlate well with cell culture detection from alternate long bones from the same mice, and are more sensitive than gross Lac Z staining with X-gal or routine histology. Comparable qualitative results were obtained with PCR and culture in a titration experiment in which mice were inoculated with increasing numbers of cells, but PCR is more quantifiable, less time consuming, and less expensive. This assay can be employed to study the molecular and cellular aspects of bone metastasis, and could easily be used in conjunction with RT-PCR-based analyses of gene products which may be involved with HBC metastasis.
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Affiliation(s)
- V Sung
- Lombardi Cancer Center and Department of Cell Biology, Georgetown University Medical Center, Washington, DC 20007, USA
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Wong BJF, Sung V, Berns MW, Svaasand LO, Neev J. Holmium-YAG Laser ablation characteristics in calvarial lamellar and cortical bone: The role of water and tissue micro-architecture. Lasers Med Sci 1995. [DOI: 10.1007/bf02133329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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