Bacterial vaginosis after menopause: factors associated and women's experiences: a cross-sectional study of Australian postmenopausal women.

Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods We conducted an online survey (July-September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women.

Prevalence of bacterial vaginosis in postmenopausal women: a systematic review and meta-analysis.

Bacterial vaginosis (BV), the most common cause of vaginal discharge in women of reproductive age, is associated with considerable reproductive and gynaecological sequelae and increases the risk of acquiring sexually transmissible infections including HIV. Although we understand the burden of BV in women of reproductive age, much less is known about the burden of BV in postmenopausal women. We undertook this systematic review and meta-analysis to estimate the prevalence of BV in postmenopausal women. The electronic databases PubMed, EMBASE, Web of Science, and The Cochrane Library were searched for English-language papers reporting on the prevalence of BV in postmenopausal women and published up until the end of July 2020. Search terms included: (prevalence OR survey OR proportion) AND 'bacterial vaginosis'. Meta-analysis was used to calculate pooled estimates of prevalence. We identified 2461 unique references and assessed 328 full-text articles for eligibility, with 13 studies included in the meta-analysis. The prevalence of BV ranged from 2.0 to 57.1%, with a summary estimate of 16.93% (95% CI: 8.5-27.4; I 2 =97.9). There was considerable heterogeneity between studies and quality varied considerably. Further research is needed to provide a better understanding of the condition in postmenopausal women and understand its effect on their lives.

Biomarker Expression in Multifocal Vulvar High-Grade Squamous Intraepithelial Lesions.

In patients with high-grade squamous intraepithelial lesion (HSIL) of the vulva, the presence of multiple lesions, called multifocal HSIL, is common. The aim of this exploratory study was to investigate biomarker expression profiles in multifocal HSIL. In total, 27 lesions from 12 patients with high-risk human papillomavirus (HPV)-positive multifocal HSIL were tested for HPV genotype, expression of p16INK4a and Ki-67, and DNA methylation of six genes. HPV16 was found most commonly in 21 (77.8%) HSILs. In two (16.4%) patients, HPV genotype differed between the lesions. All lesions demonstrated diffuse p16INK4a staining, of which three (11.1%) were combined with patchy staining. One patient (8.3%) demonstrated markedly different DNA methylation levels between lesions. Generally, heterogeneity in methylation profiles was observed between different patients, even when other biomarkers showed similar expression. In conclusion, this study is the first to demonstrate heterogeneity of individual lesions in patients with multifocal HSIL. The studied biomarkers have the potential to refine prognostic and predictive diagnostics. Future prospective, longitudinal studies are needed to further explore the potential of a biomarker profile for management of patients with multifocal HSIL.

Why psychiatry is different - challenges and difficulties in managing a nosocomial outbreak of coronavirus disease (COVID-19) in hospital care.

OBJECTIVE: Coronavirus disease (COVID-19) was officially declared a pandemic in March 2020. Many cases of COVID-19 are nosocomial, but to the best of our knowledge, no nosocomial outbreaks on psychiatric departments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in Europe. The different nature of psychiatry makes outbreak management more difficult. This study determines which psychiatry specific factors contributed to a nosocomial outbreak taking place in a psychiatric department. This will provide possible interventions in future outbreak management. METHOD: A case series describing a nosocomial outbreak in a psychiatric department of an acute care hospital in the Netherlands between March 13, 2020 and April, 14 2020. The outbreak was analyzed by combining data from standardized interviews, polymerase chain reaction (PCR) tests and whole genome sequencing (WGS). RESULTS: The nosocomial outbreak in which 43% of staff of the psychiatric department and 19% of admitted patients were involved, was caused by healthcare worker (HCW)-to-HCW transmissions, as well as patient-to-HCW-to-patient transmission. We identified four aspects associated with the mental health care system which might have made our department more susceptible to an outbreak. CONCLUSIONS: Infection control measures designed for hospitals are not directly applicable to psychiatric departments. Psychiatric patients should be considered a high-risk group for infectious diseases and customized measures should be designed and implemented. Extra attention for psychiatric departments is necessary during a pandemic as psychiatric HCWs are less familiar with outbreak management. Clear communication and governance is crucial in correctly implementing these measures.

Comparison of PD-L1 expression between paired cytologic and histologic specimens from non-small cell lung cancer patients.

Expression of programmed death ligand 1 assessed on histologic samples is a confirmed predictive biomarker for anti-PD-1 immunotherapy, but its evaluation is not approved for immunocytochemistry. We investigated if PD-L1 expression shows comparable results on paired cytologic and histologic tumor specimens and interobserver variability. Percentage of PD-L1-positive tumor cells of 247 paired samples of non-small cell lung cancer was evaluated by three independent investigators. Samples were compared on the basis of the continuous values and also categorized with the tumor proportion score (TPS). Concordance was defined if continuous values were both within a deviation of 10% and if categorized values were identically grouped. Interobserver variability was assessed by the standard deviation of the mean. Based on continuous values between paired samples, perfect concordance rate was approximately 53%. With categorization of PD-L1 expression based on TPS, category was identical in 74.1%. However, defining the continuous values of PD-L1 expression between paired samples within a deviation of 10% as concordant, concordance rate was 82%. Interobserver variability was significantly higher in evaluation of cytologic specimens. Evaluation of PD-L1 expression in paired histologic and cytologic tumor specimens shows comparable results if a deviation of 10% between the values is tolerated. Interobserver variability demonstrates a much more challenging interpretation of PD-L1 expression for cytologic samples.

Systematic review of published literature on oxaliplatin and mitomycin C as chemotherapeutic agents for hyperthermic intraperitoneal chemotherapy in patients with peritoneal metastases from colorectal cancer.

BACKGROUND: The role of hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin in addition to cytoreductive surgery (CRS) has recently been questioned in peritoneal metastases of colorectal cancer. Whether this applies to all published CRS/HIPEC regimens is unclear. METHODS: A systematic literature search identified 46 studies on CRS/HIPEC using either oxaliplatin of mitomycin C with at least one oncological outcome parameter RESULTS: Oxaliplatin and mitomycin C studies were comparable regarding extent of disease, but differed substantially regarding synchronous versus metachronous presentation, application of neo-adjuvant systemic chemotherapy, duration of HIPEC, and completeness of cytoreduction for at least one of the oncological endpoints. Severe postoperative complication rate seemed significantly higher after oxaliplatin-based CRS/HIPEC. CONCLUSION: Published cohorts on oxaliplatin-based CRS/HIPEC differed essentially from MMC-based procedures, especially considering the application of oxaliplatin-containing neo-adjuvant systemic therapy and shorter exposure time to intraperitoneal chemotherapy in oxaliplatin studies. No meaningful comparison could be made regarding DFS and OS.

Placental abruption in parents who were born small: registry-based cohort study.

OBJECTIVE: To assess whether parents who were born small for gestational age (below the 10th birthweight centile, SGA) have increased risk of severe or mild placental abruption. To assess whether a history of SGA in other family members modifies this intergenerational effect. DESIGN: Prospective population-based observational study. SETTING: The Medical Birth Registry of Norway. POPULATION: From 1967 to 2013, 785 333 mother-offspring pairs, 643 066 father-offspring pairs, 272 941 maternal tetrads (i.e. her offspring, sibling, and niece/nephew), and 265 505 paternal tetrads were identified. METHODS: Cohort study based on linked data from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES: Relative risk (RR) of severe placental abruption (preterm birth, birthweight below the 10th centile, or perinatal death) and mild placental abruption (other cases) in families with SGA. RESULTS: Mothers who were born SGA had increased risk of severe placental abruption (RR 1.5; 95% confidence interval, 95% CI 1.3-1.8), but not mild abruption. The paternal effects were weaker. The combined effect of SGA in the mother and her sibling on severe abruption was twofold (RR 2.4; 95% CI 1.7-3.3) compared with birthweight centiles ≥10 for both. Similarly, the effect of adding an SGA niece/nephew was twofold (RR 2.3; 95% CI 1.3-3.9), whereas the combined effect of SGA in the mother, her sibling and her niece/nephew was fourfold (RR 3.6; 95% CI 1.9-6.8). CONCLUSIONS: Women who were born SGA have an increased risk of severe placental abruption. The corresponding paternal effect was modest. A history of SGA in other family members increases the generational effect. TWEETABLE ABSTRACT: Women born small for gestational age have excess risk of placental abruption.

Drug survival and reasons for discontinuation of intramuscular methotrexate: a study of 212 consecutive patients switching from oral methotrexate.

OBJECTIVES: To assess the drug survival and reasons for discontinuation of intramuscular methotrexate (imMTX) in rheumatological patients who had switched to imMTX from oral methotrexate (oMTX). METHODS: Data from 212 consecutive patients who switched from oMTX to imMTX therapy at our outpatient clinic between April 1997 and January 2004 were collected retrospectively through survey of case records. Data included reason for discontinuation of oMTX, disease activity parameters, duration of imMTX therapy, and, in patients who withdrew, the reason for discontinuation of imMTX. RESULTS: The main reasons for switching from oMTX to imMTX were lack of efficacy (66%) and adverse events (28%). After 6 months, 114 patients (54%) were still receiving imMTX therapy, and their median serum C-reactive protein (CRP) and the percentage of patients who had received glucocorticoids during the previous 6 weeks had decreased (p<0.001). The median survival of imMTX therapy was 7.5 months (interquartile range 3-17). Twenty per cent of the patients received imMTX for more than 24 months. Of the 212 patients, 41% and 9% stopped imMTX therapy because of lack of efficacy and adverse events, respectively. Of the patients who had stopped oMTX because of adverse events, 22% also withdrew from imMTX because of adverse events. CONCLUSION: Half of the patients benefited from switching from oral to intramuscular methotrexate for at least 6 months, but only a minority adhered to the treatment for years. Lack of efficacy was the most frequent reason for discontinuation, while adverse events were rare.

Internal and external validation of the NOSEP prediction score for nosocomial sepsis in neonates.

OBJECTIVE: To evaluate the performance of a scoring system (NOSEP) to predict nosocomial sepsis in neonates at the hospital where the score was developed (internal validation) and in an independent data set from other centers (external validation). DESIGN: Multiple center prospective cohort study. SETTING: Six neonatal intensive care units from the Flanders in Belgium. PATIENTS: We analyzed two groups of patients: 62 episodes of presumed nosocomial sepsis in the internal validation cohort and 93 episodes of presumed nosocomial sepsis in a multiple center external validation cohort. INTERVENTIONS: Assessment of the predictive power of the NOSEP score 24 hrs preceding sepsis workup and the patients' basic demographic characteristics and co-morbidity was performed. Diagnosis of nosocomial sepsis and the microbiology results were registered. MAIN RESULTS: The NOSEP score's discriminative capability was very good in the internal validation (area under receiver operating characteristic curve = 0.73 +/- 0.08 [sem]). The NOSEP score performed satisfactory in the external validation (area under receiver operating characteristic curve = 0.66 +/- 0.06). The calibration capability in both validation sets as measured by goodness-of-fit tests (internal validation, p =.56; external validation, p =.48) was good. An improvement of the NOSEP score was obtained for the external centers by redefining the cut-off of the items of the NOSEP score (area under receiver operating characteristic curve for NOSEP-NEW-I = 0.71 +/- 0.05) or adding co-morbidity factors (area under receiver operating characteristic curve for NOSEP-NEW-II = 0.82 +/- 0.04), with good calibration performance (goodness-of-fit test, p >.50). Finally, the fit of the NOSEP score demonstrated no significant variation across subgroups of patients. CONCLUSIONS: The predictive power of the original NOSEP score is very good in neonates at the original neonatal intensive care unit. In other neonatal intensive care units, its discriminatory performance is satisfactory but could be improved after modification of the variables in the model or adding additional variables. To use such a NOSEP score in other neonatal intensive care units, its accuracy has to be validated and adjusted if necessary.

Partial left ventriculectomy: the 2nd International Registry Report 2000.

BACKGROUND: Partial left ventriculectomy (PLV) has been performed without standardized inclusion or exclusion criteria. METHODS: An international registry of PLV was expanded, updated, and refined to include 287 nonischemic cases voluntarily reported from 48 hospitals in 11 countries. RESULTS: Gender, age, ventricular dimension, etiology, ethnology, myocardial mass, operative variation, presence or absence of mitral regurgitation, and transplant indication had no effects on event-free survival, which was defined as absence of death or ventricular failure that required a ventricular assist device or listing for transplantation. Preoperative patient conditions, such as duration of symptoms (> 9 vs < 3 years; p = 0.001), New York Heart Association (NYHA) class (Class IV vs < Class IV; p = 0.002), depressed contractility (fractional shortening [FS] < 5% vs > 12%; p = 0.001), and refractory decompensation that required emergency procedure (p < 0.001) were associated with reduced event-free survival. Five or more cases in each hospital led to significantly better outcomes than the initial four cases. Rescue procedures for 14 patients nonsignificantly improved patient survival (2-year survival 52%) over event-free survival (2-year survival 48%; p = 0.49), with improved NYHA class among survivors (3.6 to 1.8; p < 0.001). Outcome was better in 1999 than in all series before 1999 (p = 0.02) most likely due to patient selection, which was refined to avoid known risk factors such as reduced proportion of patients in NYHA Class IV, FS < 5%, and hospitals with experience in 10 or less cases. A combination of these risk factors could have stratified 17 high-risk patients with 0% 1-year survival and 26 low-risk patients with 75% 2-year event-free survival. CONCLUSION: Avoidance of risk factors appears to improve survival and might help stratify high- or low-risk patients. Although less symptomatic patients with preserved contractility had better results after PLV, change of indication requires prospective randomized comparison with medical therapies or other approaches.

Partial left ventriculectomy: history, current status, and future role.

Whereas discouraging clinical results and lack of scientific evidence decreased the initial interest in partial left ventriculectomy (PLV), factors contributing to success and failure have now been identified by clinical observations, theoretical analyses, and data from an international registry, which are herein reviewed to outline the current status and future role of this procedure as a treatment of heart failure.

Partial left ventriculectomy in children and adolescents.

Theoretical aspects, pediatric indications and initial results of a new operation, partial left ventriculectomy, are presented.

Auditory attention and multiattribute decision-making during a 33 h sleep-deprivation period: mean performance and between-subject dispersions.

One purpose of this study was to compare attention in the evening (22:00 h), in the late night (04:00 h), in the morning (10:00 h) and in the afternoon (16:00 h) during a period of complete wakefulness beginning at 08:00 h with a mean daytime performance without sleep deprivation. Another purpose was to investigate sleep deprivation effects on a multi-attribute decision-making task with and without time pressure. Twelve sleep-deprived male students were compared with 12 male non-sleep-deprived students. Both groups were tested five times with an auditory attention and a symbol coding task. Significant declines (p < 0.05) in mean level of performance on the auditory attention task were found at 04:00, 10:00 and 16:00 h for subjects forced to the vigil. However, the effect of the sleep deprivation manifested itself even more in increased between-subject dispersions. There were no differences between time pressure and no time pressure on the decision-making task and no significant differences between sleep-deprived and non-sleep-deprived subjects in decision strategies. In fact, the pattern of decision strategies among the sleep-deprived subject was more similar to a pattern of decision strategies typical for non-stressful conditions than the pattern of decision strategies among the non-sleep-deprived subjects. This result may have been due to the fact that the sleep loss acted as a dearouser. Here too, however, the variances differed significantly among sleep-deprived and non-sleep-deprived subjects, indicating that the sleep-deprived subjects were more variable in their decision strategy pattern than the control group.

Determining the current roles of physical and occupational therapists in burn care.

The team approach has enjoyed great success in the care of patients with burns, and it has been shown to decrease morbidity and mortality in these cases. Although the concept of the team approach is well-defined, the delineation of roles within this approach remains unclear. This study was designed to better explain the roles of physical therapists (PTs) and occupational therapists (OTs) in burn care. With the use of a questionnaire, PT and OT responsibilities were reviewed. The results showed that OTs perform the majority of activities of daily living training, PTs perform the majority of functional mobility training, both professions are involved in scar management, and neither profession has significant responsibility for care of the burn wound itself. Role delineation occurs to help avoid role confusion and the duplication of services. The title burn therapist offers an example of unclear role definition when a physical therapy assistant uses that title to identify himself or herself. Communication is critical to define these roles within individual burn centers.

Arm pain among Swedish fighter pilots during +Gz flight and centrifuge exposures.

BACKGROUND: The purpose was to survey the occurrence of arm pain among Swedish fighter or test pilots in connection with exposures to high +Gz load when flying or performing centrifuge tests. HYPOTHESIS: +Gz induced arm pain occurs in connection with high +Gz loads in flight as well as in centrifuge tests of high performance fighter pilots. METHODS: A questionnaire was used for data collection regarding +Gz induced arm pain. Respondents were 35 Swedish Air Force Viggen and Gripen fighter pilots who had previously participated as subjects in centrifuge tests between 1990 and 1995 at Brooks Air Force Base, TX, either with the standard anti-G suit or with extended coverage anti-G suit with pressure breathing during +Gz. RESULTS: Of the respondents, 55% reported that they had experienced arm pain during flight at least once and 42% experienced it more than three times. However, arm pain was more common in the centrifuge tests (82% once; and 42% more than 3 times). CONCLUSIONS: Presence of arm pain during high performance fighter aircraft flights is a phenomenon that should be taken into consideration when designing high performance aircraft or +Gz protective equipment.

Effects of reduced oxygen partial pressure on cognitive performance in confined spaces.

The reduction of oxygen levels is a technique used both for fire fighting and fire protection in confined spaces. The purpose of this study was to find out if and how reduced oxygen levels affect cognitive performance in a small group of persons living in a confined space such as a submarine. In 3 separate experiments lasting for 11 to 14 days, a total of 22 men were exposed to normoxic and different levels of hypoxic normobaric atmospheres (15, 14, and 13 kPa O2). Each participant completed a cognitive test battery twice every 24-hr period in the first 2 experiments, but only once a day in the 3rd experiment. Performance in almost all tests improved with the number of test sessions performed, despite reductions of the oxygen partial pressure. Under the conditions tested, cognitive performance decrements could not be observed if inspiratory oxygen partial pressure was kept above 13 kPa.

Uracil phosphoribosyltransferase from the extreme thermoacidophilic archaebacterium Sulfolobus shibatae is an allosteric enzyme, activated by GTP and inhibited by CTP.

Uracil phosphoribosyltransferase, which catalyses the formation of UMP and pyrophosphate from uracil and 5-phosphoribosyl alpha-1-pyrophosphate (PRPP), was partly purified from the extreme thermophilic archaebacterium Sulfolobus shibatae. The enzyme required divalent metal ions for activity and it showed the highest activity at pH 6.4. The specific activity of the enzyme was 50-times higher at 95 degrees C than at 37 degrees C, but the functional half-life was short at 95 degrees C. The activity of uracil phosphoribosyltransferase was strongly activated by GTP, which increased Vmax of the reaction by approximately 20-fold without much effect on K(m) for the substrates. The concentration of GTP required for half-maximal activation was about 80 microM. CTP was a strong inhibitor and acted by raising the concentration of GTP needed for half-maximal activation of the enzyme. We conclude that uracil phosphoribosyltransferase from S. shibatae is an allosteric enzyme which is activated by a purine nucleotide and inhibited by a pyrimidine nucleotide as seen for several enzymes in the pyrimidine nucleotide biosynthetic pathway of Escherichia coli, but not observed before for any phosphoribosyltransferase.

Mental effects of caffeine in fatigued and non-fatigued female and male subjects.

In experiment 1 eight male and eight female subjects were randomly assigned to either a caffeine or a placebo condition. Caffeine (150 mg) was given at midnight and at 4 a.m. Oral temperature, subjective ratings of fatigue and mood, and performance in two cognitive tasks (an auditive attention task and a visual coding task) were assessed. Subjective 'drowsiness' and 'tiredness' increased significantly more in subjects given placebo than in subjects given caffeine treatment. The effects of drug treatment in performance and temperature were non-significant. However, the temperature of female subjects increased between midnight and 4 a.m. and the temperature of male subjects decreased during the same period of time. On the other hand, at 5 a.m. female subjects rated themselves as more sleepy, tired and 'disorganized' than the male subjects. In experiment 2 nine female and nine male subjects were assigned randomly to either placebo or caffeine treatment. Caffeine (200 mg) was given at 5 a.m. Oral temperature, subjective ratings of fatigue and mood, and level of performance in three cognitive tasks (the same as above plus Raven's progressive matrices) were assessed. Moreover, the subjects rated the effort of performing each task. The effects of drug treatment in level of performance were non-significant. However, the subjective effort of performing the auditive attention task increased significantly in subjects given placebo treatment, suggesting a compensatory arousal mechanism (Broadbent 1971). The effect of gender on temperature was non-significant. There was a significant interaction between gender and treatment in respect of subjective effort of performing the matrices task. In men caffeine decreased subjective effort and in women subjective effort was increased by caffeine. Experiment 3 was set up to investigate the hypothesis that negative effects of caffeine in women, observed in experiment 2, were due to over-optimal ('vigilance-related') arousal for the visual coding and matrices tasks. Ten female and eight male non-sleep deprived subjects were given 200 mg caffeine or placebos at 3 p.m. and tested at 4 p.m. Experiment 3 was not found to support the over-optimal 'vigilance-related-arousal' hypothesis. Effects of caffeine in performance and effort were non-significant in experiment 3. Combining data from experiments 2 and 3 gave a significant three-way interaction between caffeine, time for experiment and rule complexity in the visual coding task. When there was a complex rule, caffeine was found to have a positive effect in experiment 3 and a negative effect in experiment 2.

Evaluation of treatment modalities in perioral electrical burns.

A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results.