Background: The aim of the study was to investigate the development of evidence-based monitoring strategies in a population with progressive or recurrent disease. A simulation study of monitoring strategies using a new biomarker (ELF) for the detection of liver cirrhosis in people with known liver fibrosis was undertaken alongside a randomised controlled trial (ELUCIDATE).
Methods: Existing data and expert opinion were used to estimate the progression of disease and the performance of repeat testing with ELF.
Background: There is interest in using treatment breaks in oncology, to reduce toxicity without compromising efficacy.
Trial Design: A Phase II/III multicentre, open-label, parallel-group, randomised controlled non-inferiority trial assessing treatment breaks in patients with renal cell carcinoma.
Methods: Patients with locally advanced or metastatic renal cell carcinoma, starting tyrosine kinase inhibitor as first-line treatment at United Kingdom National Health Service hospitals.
We present GPSat; an open-source Python programming library for performing efficient interpolation of non-stationary satellite altimetry data, using scalable Gaussian process techniques. We use GPSat to generate complete maps of daily 50 km-gridded Arctic sea ice radar freeboard, and find that, relative to a previous interpolation scheme, GPSat offers a 504 × computational speedup, with less than 4 mm difference on the derived freeboards on average. We then demonstrate the scalability of GPSat through freeboard interpolation at 5 km resolution, and Sea-Level Anomalies (SLA) at the resolution of the altimeter footprint.
View Article and Find Full Text PDFImportance: Although access to urogynecologic care is known to influence patient outcomes, less is known regarding geographic access to care and how it may vary by population characteristics.
Objective: The primary objective of this study was to estimate geographic accessibility of urogynecologic services in terms of drive time and by population demographics.
Study Design: We performed a descriptive study using practice location data by zip code for all board-certified urogynecologists who are American Urogynecologic Society members (n = 497) and pelvic floor physical therapists (n = 985).
Adjuvant bisphosphonates are often recommended in postmenopausal women with early breast cancer at intermediate-to-high risk of disease recurrence, but the magnitude and duration of their effects on bone mineral density (BMD) and bone turnover markers (BTMs) are not well described. We evaluated the impact of adjuvant zoledronate on areal BMD and BTMs in a sub-group of patients who had completed the large 5-yr randomized Adjuvant Zoledronic Acid to Reduce Recurrence (AZURE) trial. About 224 women (recurrence free) who had completed the AZURE trial within the previous 3 mo were recruited from 20 UK AZURE trial sites.
View Article and Find Full Text PDFImportance: The associated effect of duration of the second stage of labor (SSL) on pelvic floor symptoms development is not well studied.
Objective: This study aimed to examine the association between duration of SSL and pelvic floor symptoms at 6 months postpartum among primiparous women.
Study Design: A planned secondary analysis of a multicenter randomized trial evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes was conducted between 2014 and 2018.
Importance: Overactive bladder (OAB) affects millions of women in the United States, with negative effects in multiple domains that have an impact on quality of life. Third-line therapies for OAB are as effective or superior to lifestyle/behavior modification and medical management, yet few women access these treatments and often spend more than 36 months to reach these treatments after starting medication. Factors associated with time to reach third-line therapy are not well studied, and little is known about how patients progress through care pathways for OAB.
View Article and Find Full Text PDFBackground: Because complete urinary bladder eversion is rare, a medical dilemma exists on the optimal treatment approach. The most extensive cases of this disorder have required a laparotomy for definitive management. Our transvaginal approach in this case provides an additional surgical perspective, which could potentially guide clinical care for patients with this disorder.
View Article and Find Full Text PDFObjective: To determine intrapartum factors associated with perineal laceration at delivery.
Methods: This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts.
Single-cell RNA-seq data allow the quantification of cell type differences across a growing set of biological contexts. However, pinpointing a small subset of genomic features explaining this variability can be ill-defined and computationally intractable. Here we introduce MarkerMap, a generative model for selecting minimal gene sets which are maximally informative of cell type origin and enable whole transcriptome reconstruction.
View Article and Find Full Text PDFBackground: Aging beyond 65 years is associated with increased prevalence of urinary incontinence (UI), frailty, and increased complication rate with UI treatments. To investigate this relationship, we examined frailty as a predictor of procedure-based UI treatment patterns and urologic complications in Medicare-eligible women.
Methods: We identified women undergoing procedures for UI between 2011 and 2018 in the 5% limited Medicare data set.
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.
Introduction: The purpose of this study was to retrospectively examine predictors of fracture risk when adult patients experienced a denosumab treatment lapse or discontinuation in a real-world clinic setting.
Materials And Methods: Eligible patients were adults who had received ≥2 doses of denosumab at an academic health center in the United States. Demographics, treatment doses, reasons for missed doses, and fractures, were collected retrospectively from electronic health records, from an 8-year period (2010-2018).
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.
Pharmacological management has advanced considerably since the 2015 British Society for Rheumatology axial spondyloarthritis (axSpA) guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. The aim of this guideline is to provide an evidence-based update on pharmacological management of adults with axSpA (including AS and non-radiographic axSpA) using b/tsDMARDs. This guideline is aimed at health-care professionals in the UK who care directly for people with axSpA, including rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees and pharmacists; people living with axSpA; and other stakeholders, such as patient organizations and charities.
View Article and Find Full Text PDFBackground: Temporary drug treatment cessation might alleviate toxicity without substantially compromising efficacy in patients with cancer. We aimed to determine if a tyrosine kinase inhibitor drug-free interval strategy was non-inferior to a conventional continuation strategy for first-line treatment of advanced clear cell renal cell carcinoma.
Methods: This open-label, non-inferiority, randomised, controlled, phase 2/3 trial was done at 60 hospital sites in the UK.
Importance: There are limited data to determine the change in severity, efficacy, and mechanism of action of yoga-Pilates in the treatment of stress urinary incontinence (SUI).
Objectives: The primary objective was to evaluate the effect of an 8-week web-based home yoga-Pilates exercise program on SUI severity and to evaluate the potential mechanism of action through ultrasound examination of the urethral rhabdosphincter cross-sectional area.
Study Design: This was a prospective cohort study of women with SUI.
The genus contains parasitic nematodes capable of infecting a wide range of hosts including mammals, birds and reptiles. Like other helminths, secretes a complex mixture of bioactive molecules capable of modulating its immediate surroundings and creating a hospitable environment for growth, survival and ultimately transmission. The constitution of these excretory-secretory products (ESPs) changes depending on the tissue niche and the specific stage of parasite development.
View Article and Find Full Text PDFObjective: To assess whether immediate or delayed pushing in the second-stage results in higher risk of pelvic floor morbidity.
Methods: This study was a planned secondary aim of a multicenter randomized clinical trial that included nulliparous patients at 37 weeks of gestation or greater in labor with neuraxial analgesia. Participants were randomized in the second stage to initiate pushing immediately or wait 60 minutes before pushing.
Lenalidomide is an effective maintenance agent for patients with myeloma, prolonging first remission and, in transplant eligible patients, improving overall survival (OS) compared to observation. The 'Myeloma XI' trial, for newly diagnosed patients, aimed to evaluate whether the addition of the histone deacetylase inhibitor vorinostat to the lenalidomide maintenance backbone could improve outcomes further. Patients included in this analysis were randomised to maintenance therapy with lenalidomide alone (10 mg/day on days 1-21 of each 28-day cycle), or in combination with vorinostat (300 mg/day on day 1-7 and 15-21 of each 28-day cycle) with treatment continuing until unacceptable toxicity or progressive disease.
View Article and Find Full Text PDFObjective: To determine cardiorespiratory fitness and neuromuscular function of people with CFS and FMS compared to healthy individuals.
Design: Systematic review and meta-analysis.
Data Sources: PubMed, Medline, CINAHL, AMED, Cochrane Central Register of Controlled Trials (CENTRAL), and PEDro from inception to June 2022.
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