Incidence and determinants of peripartum hysterectomy in the metropolitan area of the District of Columbia.

OBJECTIVE: To review the impact of the changes that have occurred in the standard of care in obstetrics and in the trend of cesarean delivery rates in recent times and factors associated with peripartum hysterectomy procedure. STUDY DESIGN: A retrospective analysis of all cases of peripartum hysterectomies among inpatient hospitalizations at 4 major hospitals in the Washington metropolitan areas of the District of Columbia from January 1, 2000, through December 31, 2009, was conducted. RESULTS: The total number of deliveries and postpartum hysterectomies that occurred at all 4 locations was 150,847 and 128, respectively. The rate of peripartum hysterectomies per 1,000 deliveries was 0.85. Primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity have direct association with peripartum hysterectomy. Up to 80% of all cases of peripartum hysterectomy are accounted for by class III and IV hemorrhage. Peripartum hysterectomy is associated with increased prevalence of uterine atony, placenta previa, and placenta accreta. CONCLUSION: Our results suggest that primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity, uterine atony, placenta previa, and placental accreta, and class III and IV hemorrhage are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern given the increasing rate of cesarean deliveries in the District.

Application of Biomechanics in Treating the Athlete: The All Important Measurements of Relaxed Calcaneal Stance Position, Achilles Flexibility, and First Ray Range of Motion.

Biomechanics is a crucial component of treating lower extremity pathology. The relaxed calcaneal stance position, the Achilles flexibility, and the first ray motion and position tests are demonstrated and should be mastered. The relaxed calcaneal stance position is crucial in children's flat feet treatment, adult acquired flat feet, and all pronatory symptoms. The Achilles flexibility measurement demonstrates normality, tightness, or overflexibility. Tightness and overflexibility denote weakness owing to the contractile properties of the tendon. The first ray motion and position examination elucidates whether the first ray is normal or part of a pronatory problem or a supinatory problem.

Recording information on protein complexes in an information management system.

The Protein Information Management System (PiMS) is a laboratory information management system (LIMS) designed for use with the production of proteins in a research environment. The software is distributed under the CCP4 licence, and so is available free of charge to academic laboratories. Like most LIMS, the underlying PiMS data model originally had no support for protein-protein complexes. To support the SPINE2-Complexes project the developers have extended PiMS to meet these requirements. The modifications to PiMS, described here, include data model changes, additional protocols, some user interface changes and functionality to detect when an experiment may have formed a complex. Example data are shown for the production of a crystal of a protein complex. Integration with SPINE2-Complexes Target Tracker application is also described.

xtalPiMS: a PiMS-based web application for the management and monitoring of crystallization trials.

A major advance in protein structure determination has been the advent of nanolitre-scale crystallization and (in a high-throughput environment) the development of robotic systems for storing and imaging crystallization trials. Most of these trials are carried out in 96-well (or higher density) plates and managing them is a significant information management challenge. We describe xtalPiMS, a web-based application for the management and monitoring of crystallization trials. xtalPiMS has a user-interface layer based on the standards of the Protein Information Management System (PiMS) and a database layer which links the crystallization trial images to the meta-data associated with a particular crystallization trial. The user interface has been optimized for the efficient monitoring of high-throughput environments with three different automated imagers and work to support a fourth imager is in progress, but it can even be of use without robotics. The database can either be a PiMS database or a legacy database for which a suitable mapping layer has been developed.

The Protein Information Management System (PiMS): a generic tool for any structural biology research laboratory.

The techniques used in protein production and structural biology have been developing rapidly, but techniques for recording the laboratory information produced have not kept pace. One approach is the development of laboratory information-management systems (LIMS), which typically use a relational database schema to model and store results from a laboratory workflow. The underlying philosophy and implementation of the Protein Information Management System (PiMS), a LIMS development specifically targeted at the flexible and unpredictable workflows of protein-production research laboratories of all scales, is described. PiMS is a web-based Java application that uses either Postgres or Oracle as the underlying relational database-management system. PiMS is available under a free licence to all academic laboratories either for local installation or for use as a managed service.

Freehand 3D ultrasound reconstruction algorithms--a review.

Three-dimensional (3D) ultrasound (US) is increasingly being introduced in the clinic, both for diagnostics and image guidance. Although dedicated 3D US probes exist, 3D US can also be acquired with the still frequently used two-dimensional (2D) US probes. Obtaining 3D volumes with 2D US probes is a two-step process. First, a positioning sensor must be attached to the probe; second, a reconstruction of a 3D volume can be performed into a regular voxel grid. Various algorithms have been used for performing 3D reconstruction based on 2D images. Up till now, a complete overview of the algorithms, the way they work and their benefits and drawbacks due to various applications has been missing. The lack of an overview is made clear by confusions about algorithm and group names in the existing literature. This article is a review aimed at explaining and categorizing the various algorithms into groups, according to algorithm implementation. The algorithms are compared based on published data and our own laboratory results. Positive and practical uses of the various algorithms for different applications are discussed, with a focus on image guidance.

Leiomyomata uteri: hormonal and molecular determinants of growth.

OBJECTIVE: To review the available English literature that examines the biology of leiomyoma uteri in African-American women and other ethnic groups. Factors that influence the growth and development of leiomyomas are examined to understand the basis for larger myomas in African-American women. DESIGN: Literature review of 176 articles regarding the pathobiology of leiomyoma in various ethnic groups. RESULTS: The initiating factor(s) associated with the transformation of a normal myometrial cell into a leiomyoma cell remain(s) to be determined. Epidemiological studies have confirmed that different ethnic groups develop leiomyomas. However, African-American ethnicity is a risk factor for the development of leiomyomas. Studies have examined diet, genetics, hormonal, growth, enzymatic and molecular determinants of myoma biology, with critical advances in some of these areas. The best radiological tools to identify and monitor leiomyomas are ultrasonography and/or magnetic resonance imaging. Evidence supports progesterone and growth factors (e.g., transforming growth factor-B), have significant impact on the development of leiomyomas. CONCLUSIONS: Early monitoring and intervention should become standard for African-American women who are at greater risk for developing leiomyomas. There are plausible biological mechanisms that explain the predisposition for developing larger leiomyomas in African-American women as compared with other ethnic groups.