Hiatus and pelvic floor failure patterns in pelvic organ prolapse: A 3D MRI study of structural interactions using a Level III conceptual model.

Background: A large urogenital hiatus in Level III results in a higher risk of developing pelvic organ prolapse after birth and failure after prolapse surgery. Deepening of the pelvic floor and downward rotation of the levator plate have also been linked to prolapse. Currently we lack data that evaluates how these measures relate to one another and to prolapse occurrence and size.

Clinical characteristics associated with cervical hydrated nucleus pulposus extrusion in dogs.

Background: Clinical characteristics of cervical hydrated nucleus pulposus extrusion (HNPE) in dogs compared to other causes of cervical myelopathy are not well described.

Hypothesis/objectives: To evaluate for clinical characteristics and mechanical ventilation likelihood associated with HNPE compared to other causes of cervical myelopathy.

Animals: Three hundred seventy-seven client-owned dogs from 2010 to 2022.

Urogynecologic Care for Women Who Are Incarcerated.

In the United States, approximately 180,700 women are incarcerated across jails and prisons, comprising a demographic with an aging population and a higher growth rate compared to men. Despite this demographic trend, research into urogynecologic care for women who are incarcerated is notably lacking, with few studies addressing pelvic floor disorders such as incontinence, and even fewer focusing on access to treatment options like vaginal pessaries or surgical interventions. Women who are incarcerated may face unique challenges in obtaining urogynecologic care, including limited access to medical evaluations, invasive search procedures affecting intravaginal device use, and inadequate hygiene resources, all of which hinder effective management strategies.

Vaginal Orthosis After Native Tissue Reconstructive Surgery: Design and Phase 0.

Importance: Pelvic organ prolapse recurrence following native tissue repair occurs with composite failure rates of 9-19% within 12 months, predominantly involving apical/anterior compartments. Objective The objective of this study was to develop a novel vaginal orthosis (NVO) device prototype through an iterative design process based on investigator and user feedback.

Study Design: The NVO was designed based on pelvic floor biomechanical principles to mitigate unopposed intra-abdominal pressure of the anterior vagina by absorbing and redirecting intra-abdominal forces to the levator ani and tailored to accommodate postoperative vaginal caliber and axis.

Predictors of biochemical remission after transsphenoidal surgery in a large cohort of acromegaly patients.

Purpose: The objective of this study was to characterize the clinical characteristics and factors predictive of biochemical remission in patients with symptomatic acromegaly undergoing transsphenoidal surgery (TSS) at an academic tertiary care center, as defined by the 2022 Acromegaly Consensus Conference guidelines.

Methods: In this single institution, longitudinal, retrospective study, a large cohort of 158 patients with a preoperative diagnosis of acromegaly undergoing surgery at a large, academic, tertiary care center were examined. We excluded 38 patients as IGF-1 testing was performed less than 12 weeks postoperatively.

Perioperative Mobility Assessment of Acromegalic Patients Undergoing Endoscopic Endonasal Resection of Pituitary Adenomas Using Digital Phenotyping.

Methods to assess quality of life and recovery after endoscopic endonasal surgery (EES) for sellar lesions are limited and often biased by subjective patient-reported assessments. Objective in-situ assessments are lacking. Smartphone-based digital phenotyping has been increasingly studied across a variety of pathologies, utilizing built-in technologies to measure behavioral patterns pertaining to sleep, physical mobility, social interactions, and cognitive functioning, among others.

The delicate nature of a constructive peer review: pearls from the editorial board.

Peer review stands as a cornerstone of academic publishing, especially in the era of evidence-based neurosurgery - the scientific literature relies on proficient peer reviewers. Providing a constructive peer review is an art and learned skill that requires knowledge of study design and expertise in the neurosurgical subspeciality. Peer reviewers guard against arbitrary decision-making and are essential in ensuring that published manuscripts are of the highest quality.

Association Among Surgeon Volume, Surgical Approach, and Uterine Size for Hysterectomy for Benign Indications.

Objective: To assess the relationship between surgeon volume and surgical approach for patients undergoing hysterectomy for benign indications among uteri of varying sizes.

Methods: This was a retrospective cohort study of patients who underwent hysterectomy for benign indications from 2012 to 2021 within the Michigan Surgical Quality Collaborative registry. For each hysterectomy, the relative annual volume of the performing surgeon was assessed by calculating the proportion of hysterectomy cases contributed by the surgeon each calendar year relative to the total number of hysterectomies in the registry for that year.

A multicenter study of clinical outcomes and volumetric trends in suspected microprolactinomas.

The diagnosis of pituitary microprolactinomas is often obscured by relatively low levels of elevated prolactin compared to macroprolactinomas. This may lead to varying patterns of medical therapy versus observation. We sought to correlate prolactin levels in suspected microprolactinomas with tumor volumes and clinical outcomes.

Decreasing Utilization of Vaginal Hysterectomy in the United States: An Analysis by Candidacy for Vaginal Approach.

Introduction And Hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach.

Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion.

Hyperelastic material models for simulating deformation of silicone ring pessaries.

Pessaries are removable gynecological prosthetic devices that provide mechanical support for temporary or long-term symptom relief of pelvic floor disorders, such as pelvic organ prolapse and stress urinary incontinence. To date, limited mechanical tests have been performed on physical pessary designs to characterize their behaviour under load; however, custom pessary manufacturing is expensive and time consuming. As an alternative, finite element (FE) modeling can provide detailed numerical insight into the response of a pessary design under load but to date has seen limited application, with little data available for pessary silicone materials.

Use of In-Training Examination Scores as a Fellowship Candidate Evaluation Metric: Time for a Change.

In the field of obstetrics and gynecology (OB/GYN), the Council on Resident Education in Obstetrics and Gynecology (CREOG) administers an annual in-training examination to all OB/GYN residents as a formative educational tool for assessing medical knowledge and promoting self-improvement. Although the CREOG examination is not designed or intended for knowledge certification, many OB/GYN subspecialty fellowship programs request and use CREOG examination scores as a metric to evaluate fellowship candidates. Among the 57 gynecology-based urogynecology fellowship programs, 30 programs (53%) request CREOG examination scores to be submitted by candidates, as of March 2023.

Bacteria Invade the Brain Following Sterile Intracortical Microelectrode Implantation.

Brain-machine interface performance is largely affected by the neuroinflammatory responses resulting in large part from blood-brain barrier (BBB) damage following intracortical microelectrode implantation. Recent findings strongly suggest that certain gut bacterial constituents penetrate the BBB and are resident in various brain regions of rodents and humans, both in health and disease. Therefore, we hypothesized that damage to the BBB caused by microelectrode implantation could amplify dysregulation of the microbiome-gut-brain axis.

Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction.

Importance: Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow.

Objective: To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry.

Aims: To assess and compare 30-day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women.

Methods: This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure.

A visiting otolaryngology team in northern Ontario - demographics, clinical presentation and barriers to access.

Context: Approximately 20% of Canadians reside in rural or remote communities where access to medical specialties such as otolaryngology remains challenging due to long wait times and distance to services. The purpose of this study was to characterize patient demographics, common clinical diagnoses, and barriers to accessing otolaryngology services, in a remote Northern Ontario setting. A secondary objective was to describe a care model that provides multi-subspecialty otolaryngology services to a remote community.

Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors.

Patients with pituitary tumors may experience persistent fatigue and reduced physical activity, based on subjective measures after treatment. These symptoms may persist despite gross total resection of their tumors and biochemical normalization of pituitary function. While reduced quality of life has been commonly acknowledged in pituitary tumor patients, there is a lack of studies on what interventions may be best implemented to ameliorate these issues, particularly when hormonal levels have otherwise normalized.

A feasibility study of three-dimensional ultrasound imaging of the vagina under distension.

Background: The distension properties of the vagina are critical to its function including support of surrounding organs, childbirth, and intercourse. It could be altered by many pathophysiological processes like pregnancy, radiotherapy, and reconstruction surgery. However, there are no clinically available diagnostic tools capable of quantifying the distension properties of the vagina.

A novel class of broad-spectrum active-site-directed 3C-like protease inhibitors with nanomolar antiviral activity against highly immune-evasive SARS-CoV-2 Omicron subvariants.

Antivirals with broad coronavirus activity are important for treating high-risk individuals exposed to the constantly evolving SARS-CoV-2 variants of concern (VOCs) as well as emerging drug-resistant variants. We developed and characterized a novel class of active-site-directed 3-chymotrypsin-like protease (3CLpro) inhibitors (). Our lead direct-acting antiviral (DAA), , is a non-covalent, non-peptide with a dissociation constant of 170 nM against recombinant SARS-CoV-2 3CLpro.