Pelvic Floor Dysfunction in Morbidly Obese Women: Pilot Study

Objective: The objective of this study was to evaluate the impact of obesity on pelvic floor function in women. Research Methods and Procedures: This was a prospective controlled study of 20 morbidly obese female patients planning to undergo gastric bypass surgery and 20 age‐matched female controls. Subjects completed symptom and impact questionnaires, including the Incontinence Impact Questionnaire (IIQ‐7), Urogenital Distress Inventory (UDI), the Kobashi Prolapse Symptom Inventory and Quality‐of‐Life Questionnaire (PSI‐QOL), and Index of Female Sexual Function. Data were analyzed with Wilcoxon or ratio χ² tests. Results: Mean weight was 295.7 ± 87.9 lbs in the study group and 144.79 ± 33.07 lbs in the control group. Mean BMI was 52.65 ±14.49 kg/m² in the study group and 25.11 ± 5.27 kg/m² in the control group. According to the IIQ‐7, urinary incontinence significantly affected lifestyle in the study group. The total IIQ‐7 score was also significantly affected in the study group (p = 0.03). The UDI indicated more urinary leakage with activity (p = 0.04) and more incidents of small amounts of leakage (p = 0.02) in the study group. According to the PSI‐QOL, women in the study group experienced constipation more often because of difficulty in emptying the rectum (p = 0.04). The PSI‐QOL score was higher in the study group (6.75 ± 6.84) than in the control group (2.65 ± 3.03; p = 0.04). There were no significant differences between groups regarding sexual function. Discussion: Morbid obesity is associated with a significant negative impact on urogenital health. Sexual function did not seem to be affected in women who are morbidly obese.     

Environmental life cycle assessment of linoleum

Linoleum is a floor covering consisting mainly of linseed oil, other vegetable oils, wood flour and limestone on a carrier of jute. Forbo-Krommenie B.V. commissioned the Centre of Environmental Science (CML) to carry out an Environmental Life Cycle Assessment for linoleum floors. The goal of this study was to assess the environmental performance of linoleum floors, indicating possible options for improvement, and assessing the sensitivity of the results to methodological choices. The functional unit was defined as: 2000 m² linoleum produced in 1998, used in an office or public building over a period of 20 years. The method followed in this study is based on a nearly final draft version of the LCA guide published by CML in corporation with many others, which is an update of the guide on LCA of 1992. From the contribution analysis, the main contributing processes became clear. In addition, the sensitivity analysis by scenarios showed that the type of maintenance during use and the pigments used can have a large influence on the results. Major data gaps of the study were capital goods and unknown chemicals. Sensitivity analysis also showed that these gaps can lead to an underestimation. Based on this study, some options to improve the environmental performance of linoleum were formulated and advice for further LCA studies on linoleum was given.     

Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal

We developed an intravaginal instrumented probe (covered with a 10 × 10 matrix of capacitive sensors) for assessing the three-dimensional (3D) spatiotemporal pressure profile of the vaginal canal. The pressure profile was compared to the pelvic floor (PF) digital assessment, and the reliability of the instrument and repeatability of the protocol was tested. We also tested its ability to characterize and differentiate two tasks: PF maximum contraction and Valsalva maneuver (maximum intra-abdominal effort with downward movement of the PF). Peak pressures were calculated for the total matrix, for three major sub-regions, and for 5 planes and 10 rings throughout the vaginal canal. Intraclass correlation coefficients indicated excellent inter- and intra-rater reliability and intra-trial repeatability for the total and medial areas, with moderate reliability for the cranial and caudal areas. There was a moderate correlation between peak pressure and PF digital palpation [Spearman’s coefficient r = 0.55 (p < 0.001)]. Spatiotemporal profiles were completely different between tasks (2-way ANOVAs for repeated measures) with notably higher pressures (above 30 kPa) for the maximum contraction task compared to Valsalva (below 15 kPa). At maximum contraction, higher pressures occurred in the mid-antero-posterior zone, with earlier peak pressure onsets and more variable along the vaginal depth (from rings 3 to 10-caudal). During Valsalva, the highest pressures were observed in rings 4–6, with peak pressure onsets more synchronized between rings. With this protocol and novel instrument, we obtained a high-resolution and highly reliable innovative 3D pressure distribution map of the PF capable of distinguishing vaginal sub-regions, planes, rings and tasks.     

Assessment of soil calcium status in red spruce forests in the northeastern United States

Long-term changes in concentrations of available Ca in soils of redspruce forests have been documented, but remaining questions aboutthe magnitude and regional extent of these changes have precluded anassessment of the current and future status of soil Ca. To addressthis problem, soil samples were collected in 1992—93from 12 sites in New York, Vermont, New Hampshire, and Maine toprovide additional data necessary to synthesize all availableresearch results on soil Ca in red spruce forests. Sites werechosen to encompass the range of environmental conditionsexperienced by red spruce. Concentrations of exchangeableCa ranged from 2.13 to 21.6 cmol_ckg^–1 in the Oa horizon, and from 0.11 to 0.68cmol_c kg^–1 in the upper 10 cm of theB horizon. These measurements expanded the range of exchangeable Ca reported in the literature for both horizons in northeastern redspruce forests. Exchangeable Ca was the largest Ca fraction in theforest floor at most sites (92% ofacid-extractableCa), but mineral Ca was the largest fraction at the three sites that also had the highest mineral-matter concentrations. Theprimary factor causing variability in Ca concentrations among siteswas the mineralogy of parent material, but exchangeable concentrationsin the B horizon of all sites were probably reduced by acidicdeposition. Because the majority of Ca in the forest floor isin a readily leachable form, and Ca inputs to the forest floor from the mineral soil and atmospheric deposition have beendecreasing in recent decades, the previously documented decreasesin Ca concentrations in the forest floor over previous decades mayextend into the future.     

Multiple environmental changes drive forest floor vegetation in a temperate mountain forest

Human‐induced changes of the environment and their possible impacts on temperate forest understory plant communities have been examined in many studies. However, the relative contribution of individual environmental factors to these changes in the herb layer is still unclear. In this study, we used vegetation survey data covering a time period of 21 years and collected from 143 permanent plots in the Northern Limestone Alps, Austria. Data on soil chemistry (49 plots), light condition (51 plots), soil temperature and moisture (four and six plots), disturbance (all plots), climate (one station in a clearing area), and airborne sulfur (S) and nitrogen (N) deposition (two forest stands) were available for analyses. We used these data together with plot mean Ellenberg indicator values in a path analysis to attribute their relative contributions to observed vegetation changes. Our analysis reveals a strong directional shift of the forest understory plant community. We found strong evidence for a recovery of the ground‐layer vegetation from acidification as response to decreased S deposition. We did not observe a community response to atmospheric N deposition, but we found a response to altered climatic conditions (thermophilization and drying). The path analysis revealed that changes in the light regime, which were related to small‐scale disturbances, had most influence on herb layer community shifts. Thermophilization and drying were identified as drivers of understory community changes independent of disturbance events.     

Overlapped and differential expression of cAMP‐dependent kinase‐inhibitor isoforms during avian organogenesis period

Although cAMP‐dependent kinase (PKA) has been known to regulate many biological systems, including patterning, cell differentiation and proliferation, it is not well understood how the spatial‐temporal specificity of the PKA signaling is generated. While the PKA signal activation is regulated in many ways, a direct visualization of PKA activity in situ is not possible. Thus, examinations of PKA regulators will provide indirect, but nonetheless important information to elucidate the distribution of PKA activity. In the present study, three isoforms of PKA‐inhibitor (PKI) genes were identified from avian genome, and their expression patterns were examined during the organogenesis period. PKI genes were strongly expressed in muscle, liver, and nervous system primordia, suggesting their inhibitory roles on the PKA signaling in the development of these tissues.     

Incipient forebrain boundaries traced by differential gene expression and fate mapping in the chick neural plate

We correlated available fate maps for the avian neural plate at stages HH4 and HH8 with the progress of local molecular specification, aiming to determine when the molecular specification maps of the primary longitudinal and transversal domains of the anterior forebrain agree with the fate mapped data. To this end, we examined selected gene expression patterns as they normally evolved in whole mounts and sections between HH4 and HH8 (or HH10/11 in some cases), performed novel fate-mapping experiments within the anterior forebrain at HH4 and examined the results at HH8, and correlated grafts with expression of selected gene markers. The data provided new details to the HH4 fate map, and disclosed some genes (e.g., Six3 and Ganf) whose expression domains initially are very extensive and subsequently retract rostralwards. Apart from anteroposterior dynamics, some genes soon became downregulated at the prospective forebrain floor plate, or allowed to identify an early roof plate domain (dorsoventral pattern). Peculiarities of the telencephalon (initial specification and differentiation of pallium versus subpallium) are contemplated. The basic anterior forebrain subdivisions seem to acquire correlated specification and fate mapping patterns around stage HH8.     

Mechanical Restoration of California Mixed‐Conifer Forests: Does it Matter Which Trees Are Cut?

The montane ecosystems of northern California have been subjected to repeated manipulation and active fire suppression for over a century, resulting in changes in community structure that contribute to increased wildfire hazard. Ecosystem restoration via reduction of stand density for wildfire hazard mitigation has received substantial attention in recent years; however, many ecological questions remain unanswered. This study compares belowground effects of two alternative forest thinning treatments designed to restore the large, old tree component of late‐seral structure, one of which focuses on restoring Pinus ponderosa dominance (Pine‐preference) and the other of which promotes development of large trees regardless of species (Size‐preference). We evaluated forest floor and soil chemical and microbial parameters in six experimental thinning treatment units of 40 ha each in the Klamath National Forest of northern California 5–6 years after thinning. Inorganic N availability, soil organic C content, phenol oxidase activity, and forest floor C:N ratio were greater in the Size‐preference treatment, whereas forest floor N and soil pH were greater in the Pine‐preference treatment. Our results indicate that these two thinning strategies produce differences in the soil environment that has the potential to affect growth rates of trees that remain, as well as the growth and survivorship of newly established seedlings. Thus, which species/individuals are removed during structural restoration of these mixed‐conifer forests matters both to the belowground components of the ecosystem today and the vegetation and productivity of the ecosystem in future decades.     

The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth

Vaginal childbirth is the leading cause of pelvic floor muscles injury, which contributes to pelvic floor dysfunction, being enhanced by fetal malposition. Therefore, the aim of the present study is to verify the influence of mediolateral episiotomies in the mechanics of the pelvic floor with the fetus in occiput posterior position when compared to the occiput anterior position. Numerical simulations of vaginal deliveries, with and without episiotomy, are performed based on the Finite Element Method. The biomechanical model includes the pelvic floor muscles, a surface to delimit the anterior region of the birth canal and a fetus. Fetal malposition induces greater extension of the muscle compared to the normal position, leading to increases of stretch. The faster enlargement may be responsible for a prolonged second stage of labor. Regarding the force required to achieve delivery, the difference between the analyzed cases are 35 N, which might justify the increased need of surgical interventions. Furthermore, episiotomy is essential in reducing the damage to values near the ones obtained with normal position, making the fetal position irrelevant. These biomechanical models have become extremely useful tools to provide some understanding of pelvic floor function during delivery helping in the development of preventative strategies.     

上尿路腔内手术中降低肾盂压力机制与方法的研究进展

1983年,Wickham教授首先提出微创外科(minimally invasive surgery),此后,微创泌尿外科逐渐成外具有科学意义上的微创外科学的一个重要的分支学科。上尿路的腔内手术,包括PNL(Percutaneous nephrolithotomy)、URS(Ureteroscopic)、f-URS(Flexible ureteroscope)等。与传统手术相比,上尿路的腔内手术具有创伤小、时间短、恢复快、并发症少,并且可以直视下进行手术操作,临床应用较广泛。在腔内操作时,为保证术中手术视野的清晰度,手术多采用生理盐水(NS)进行灌注,进而导致肾盂压力升高,引起各项潜在的危害。因此如何在上尿路腔内手术中降低肾盂压力成为一个研究的热点。近些年,腔内器械的改进,包括镜体灌注通道入路与出路的分开设计、回流鞘的设计、压力泵的改进,在一定程度上降低了肾盂压力。灌注液体中加入相应浓度的药物,抑制上尿路平滑肌的蠕动与收缩,也在一定程度上降低了肾盂压力。本文介绍了上尿路腔内手术中肾盂压力的影响因素,回顾了肾盂压力升高后的危害,分析了肾盂压力升高机制,总结了肾盂压力降低的各种方案以及将来的应用前景。