'What research was carried out on this vaginal mesh?' Health-related concerns in women following mesh-augmented prolapse surgery: a thematic analysis.

OBJECTIVE: To understand health-related issues in women following mesh-augmented prolapse surgery. DESIGN: Inductive thematic analysis of free-text comments from participants in a cross-sectional study of laparoscopic mesh sacrohysteropexy. SETTING: Tertiary urogynaecology centres, United Kingdom. POPULATION: Women who underwent laparoscopic mesh sacrohysteropexy by surgeons based at two tertiary urogynaecology centres between 2010 and 2018. METHODS: A total of 1766 potential participants were contacted by post and invited to complete paper, online or telephone questionnaires containing a free-text comments section. Of 1121 participants (response proportion 63.5%), 752 (67.1%) provided such comments. These were analysed with a six-stage inductive thematic analysis, using NVivo 11® software. MAIN OUTCOME MEASURES: Themes developed from free-text comments. RESULTS: Following familiarisation, 29 codes and 189 sub-codes were identified. These defined six themes: pelvic floor symptoms, health status, treatment success, mesh, pain and care received. The majority of comments centred on the first of these six themes. There were concerns about mesh use and a desire for more information. A range of pain symptoms were mentioned, often associated with pelvic floor symptoms, prolapse surgery or mesh. CONCLUSIONS: Despite the mesh controversy, pelvic floor symptoms and their impact on quality of life remain the principle concern of women following mesh-augmented prolapse surgery. There is a need for quality, accessible and evidence-based information sources for those women with concerns, and for those considering such surgery in the future, particularly regarding mesh safety and postoperative recovery. The relationships between pain, prolapse, mesh and pelvic floor surgery require further study. TWEETABLE ABSTRACT: Following mesh-augmented prolapse surgery, pelvic floor symptoms remain women's main focus; pain deserves further research.

Changes in nerve growth factor level and symptom severity following antibiotic treatment for refractory overactive bladder.

INTRODUCTION AND HYPOTHESIS: Overactive bladder (OAB) has a multifactorial aetiology, and for some women symptoms may be associated with chronic urothelial inflammation secondary to bacterial colonisation. One marker of such inflammation may be urinary nerve growth factor (NGF). We hypothesised that for women with OAB and urothelial inflammation, urinary NGF would be reduced following antibiotic therapy. METHODS: Women with overactive bladder and urodynamic diagnosis of detrusor overactivity who were refractory to anticholinergics, and had histological evidence of urothelial inflammation were treated with a 6-week course of rotating antibiotics. Urinary NGF was measured by ELISA before and after treatment. Three-day bladder diaries, the Patients' Perception of Intensity of Urgency Scale, the King's Health Questionnaire and the Patients' Perception of Bladder Condition questionnaire were used to assess subjective and objective outcomes of therapy. RESULTS: Thirty-nine women with refractory DO were recruited. The NGF levels decreased significantly after antibiotic therapy (Wilcoxon signed rank test; p = 0.015). There were significant improvements in daytime frequency, nocturia and urgency (p < 0.05), and 74 % of women reported improvement in perception of their bladder condition. CONCLUSIONS: Urinary NGF is responsive to antibiotic therapy. Women with refractory overactive bladder and elevated NGF may benefit from antibiotic treatment.

Endogenous CO2 ice mixture on the surface of Europa and no detection of plume activity.

Jupiter's moon Europa has a subsurface ocean beneath an icy crust. Conditions within the ocean are unknown, and it is unclear whether it is connected to the surface. We observed Europa with the James Webb Space Telescope (JWST) to search for active release of material by probing its surface and atmosphere. A search for plumes yielded no detection of water, carbon monoxide, methanol, ethane, or methane fluorescence emissions. Four spectral features of carbon dioxide (CO2) ice were detected; their spectral shapes and distribution across Europa's surface indicate that the CO2 is mixed with other compounds and concentrated in Tara Regio. The 13CO2 absorption is consistent with an isotopic ratio of 12C/13C = 83 ± 19. We interpret these observations as indicating that carbon is sourced from within Europa.

Vacuum-assisted deliveries and the risk of obstetric anal sphincter injuries-a retrospective register-based study in Finland.

OBJECTIVES: To identify and quantify the risks of obstetric anal sphincter injury (OASIS) separately in nulliparae, including women admitted for a first vaginal delivery after a previous caesarean section for their first birth, and multiparae delivered by vacuum extraction in Finland where the type of episiotomy is exclusively lateral. DESIGN: A retrospective population-based register study. METHODS: Nulliparous and multiparous women with OASIS were compared separately with women without OASIS using stepwise logistic regression analysis. MAIN OUTCOME MEASURES: Risk of OASIS. RESULTS: Among a sample of 16,802 women whose infants were delivered by vacuum extraction between 2004 and 2007, the incidence of OASIS was significantly higher among nulliparous women (475 of 13,981, 3.4%) than multiparous women (40 of 2821, 1.4%), with adjusted odds ratio 2.44 (95% CI 1.77-3.39). Lateral episiotomy was associated with 46% decreased incidence of OASIS (adjusted odds ratio 0.54, 95% CI 0.42-0.70) in nulliparae delivered by vacuum extraction. There was no statistically significant association for multiparous women. An increase of 1000 g in birthweight increased the OASIS incidence 2.10-fold for nulliparae and 2.83-fold for multiparae. CONCLUSIONS: Nulliparous women with infants delivered by vacuum extraction had an increased risk of OASIS compared with multiparous women. Lateral episiotomy was associated with a decreased incidence of OASIS, especially in women with large babies and long second stage. These results support liberal use of lateral episiotomy at vacuum extraction for nulliparous women at high risk of OASIS, but the role of episiotomy should be re-investigated in interventional randomised trials.

Identification of the rice blast resistance gene Pib in the National Small Grains Collection.

The Pib gene in rice confers resistance to a wide range of races of the rice blast pathogen, Magnaporthe oryzae, including race IE1k that overcomes Pita, another broad-spectrum resistance gene. In this study, the presence of Pib was determined in 164 rice germplasm accessions from a core subset of the National Small Grains Collection utilizing DNA markers and pathogenicity assays. The presence of Pib was evaluated with two simple sequence repeat (SSR) markers and a dominant marker (Pib-dom) derived from the Pib gene sequence. Pathogenicity assays using two avirulent races (IE1k and IB1) and a virulent race (IB54) were performed to verify the resistance responses of accessions. Of the 164 accessions evaluated, 109 contained the Pib gene as determined using both SSR markers and pathogenicity assays, albeit different haplotypes were detected. The remaining 52 germplasm accessions were different in their responses to the blast races IB54, IE1k, and IB1, thus indicating the presence of R gene(s) other than Pib. The accessions characterized in this study could be used for marker-assisted breeding to improve blast resistance in indica and japonica cultivars worldwide.

Protocol of trans-Tasman feasibility randomised controlled trial of the Younger Women's Wellness After Breast Cancer (YWWACP) lifestyle intervention.

BACKGROUND: Younger women (defined as those < 50 years who are likely pre-menopausal at time of diagnosis) with breast cancer often experience persistent treatment-related side effects that adversely affect their physical and psychological wellbeing. The Women's Wellness After Cancer Program (WWACP) was adapted and piloted in Australia to address these outcomes in younger women. The aims of this feasibility study are to determine (1) the potential to translate the Younger WWACP (YWWACP) intervention to a broader population base in Aotearoa/New Zealand and Australia, and (2) the potential for success of a larger, international, phase ΙΙΙ, randomised controlled trial. METHODS: This bi-national, randomised, single-blinded controlled trial involves two main study sites in Aotearoa/New Zealand (Kowhai study) and Australia (EMERALD study). Young women aged 18 to 50 years who completed intensive treatment (surgery, chemotherapy, and/or radiotherapy) for breast cancer in the previous 24 months are eligible. The potential to translate the YWWACP to women in these two populations will be assessed according to several feasibility outcomes. These include examining intervention accessibility, acceptability and uptake; intervention sustainability and adherence; the prevalence components of the intervention in the control group; intervention efficacy; participants' perception of measurement burden; the effectiveness of planned recruitment strategies; and trial methods and procedures. The studies collectively aim to enrol 60 participants in the intervention group and 60 participants in the control group (total = 120 participants). DISCUSSION: Ethical approval has been received from the Southern Health and Disability Ethics Committee (Kowhai ref: 19/STH/215), and UnitingCare Human Research Ethics Committee (EMERALD ref: 202103). This study will provide important data on the feasibility of the refined YWWACP in the trans-Tasman context. This study will account for and harmonise cross-country differences to ensure the success of a proposed international grant application for a phase ΙΙΙ randomised controlled trial of this program to improve outcomes in younger women living with breast cancer. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): Kowhai ACTRN12620000260921 , registered on 27 February 2020. EMERALD ACTRN12621000447853 , registered on 19 April 2021.

Two-year results from an open-label, multicentre, phase III study evaluating the safety and efficacy of canakinumab in patients with cryopyrin-associated periodic syndrome across different severity phenotypes.

OBJECTIVE: Longer-term effects of prolonged selective interleukin-1ß blockade with canakinumab were evaluated in the largest cohort of cryopyrin-associated periodic syndrome (CAPS) patients studied to date. METHODS: Adult and paediatric CAPS patients (n=166, including canakinumab-naive and pretreated patients from previous studies) received canakinumab subcutaneously 150 mg or 2 mg/kg (≤40 kg) every 8 weeks for up to 2 years. Response and relapse was assessed using scores for disease activity, skin rash and C-reactive protein (CRP) and/or serum amyloid A (SAA) levels. RESULTS: Complete response was achieved in 85 of 109 canakinumab-naive patients (78%; 79/85 patients within 8 days, and five patients between days 10 and 21). Of 141 patients with an available relapse assessment, 90% did not relapse, their CRP/SAA levels normalised (<10 mg/l) by day 8, and remained in the normal range thereafter. Median treatment duration was 414 days (29-687 days). Upward adjustments of dose or frequency were needed in 24.1% patients; mostly children and those with severe CAPS. Predominant adverse events (AE) were infections (65.7%) of mostly mild-to-moderate severity. Serious AE reported in 18 patients (10.8%) were mainly infections and were responsive to standard treatment. The majority of patients (92%) reported having no injection-site reactions and only 8% patients reported mild-to-moderate reactions. Patients receiving vaccination (15%) showed normal immune response. CONCLUSIONS: Subcutaneous canakinumab 150 mg every 8 weeks was well tolerated and provided substantial disease control in children and adults across all CAPS phenotypes. Higher canakinumab doses in younger patients and more severe CAPS disease were efficacious in achieving complete responses without evidence of increased AE. TRIAL REGISTRATION NUMBER: NCT00685373 (clinicaltrials.gov).

Inter- and intra-rater reliability of fluoroscopic cough stress testing.

The aim of this study was to assess inter- and intra-rater reliability in the interpretation of severity and type of stress urinary incontinence (SUI) during fluoroscopic cough stress testing. A total of 32 videourodynamic clips were selected from women presenting with stress, urge or mixed urinary incontinence. On two separate occasions, six urogynaecology healthcare professionals independently assessed the clips and classified the severity and type of SUI. Fleiss' and Cohen's kappa coefficients were calculated to assess strength of inter- and intra-rater reliability, respectively. Absolute inter-rater agreement for severity of SUI was observed in 24 of the 32 (75%) and 26 of the 32 (81%) cases for the first and second occasion, respectively. Absolute inter-rater agreement for type of SUI was seen in 16/32 cases (50%). Corresponding Fleiss' kappa coefficients supported reliability. Both the severity and, to a lesser degree, type of SUI assessed using fluoroscopic cough stress testing can be reliably interpreted.

Prevalence of incontinence and incontinence-specific quality of life impairment in women with cystic fibrosis.

AIMS: Cystic fibrosis (CF) is the commonest autosomal recessive disorder in Caucasians. With advancing medical technology, the life expectancy has more than double in the last twenty years. This has led to new unforeseen health problems like urinary incontinence. The aim was to establish the prevalence, symptomatic typology, and quality of life impact of incontinence in a population of women with CF. METHODS: Women were recruited from two London tertiary referral centres for CF. They were asked to fill in a self- completed anonymous King's Health Questionnaire (KHQ) for assessment of symptoms and quality of life Impairment. Their age was also noted. Descriptive statistics are reported. Correlation was assessed using Pearson's Product Moment Correlation Coefficient (r). RESULTS: One hundred and forty six women were approached for enrolment. 98(67%) consented to take part in study. Their mean age was 28. Seventy three (74%) reported symptoms of urinary incontinence, which in all cases was perceived as stress urinary incontinence. Of these 44(60%) reported mild stress incontinence, 16(22%) moderate stress incontinence and 13(18%) severe stress incontinence. Continent and incontinent women perceived their general health to be similarly poor (mean score 40 vs 44 points). Strong positive correiations were found between age and stress urinary incontinence severity (r=0.742; P <0.001) and between age and total King's Health Questionnaire score (r=0.828; P <0.001). CONCLUSIONS: Women with CF have a higher prevalence of stress urinary incontinence than the general population, with both the prevalence and associated quality of life impairment increasing with age.

First Report of Fruit Rot of Pumpkin Caused by Fusarium solani f. sp. cucurbitae in Arkansas.

During 2008, fruit rot of pumpkin (Cucurbita pepo L.) occurred on several cultivars in commercial fields in northeast and northwest Arkansas. Disease incidence ranged from 50 to 75% of the fruit, which were unmarketable. Symptoms included large (>10 cm), brown, corky lesions where the fruit was in contact with the soil. Initially, the lesions were water soaked. A cross section of the symptomatic fruit rind revealed a dry, brown, spongy rot with a light brown halo. Lesions finally became soft and wet, causing infected fruit to collapse. Masses of white mycelia surrounded advanced lesions. No rot symptoms were observed on the vines. Fusarium spp. were isolated from symptomatic fruit. Macroconidia obtained from field-infected fruit and pure potato dextrose agar (PDA) cultures of the predominant Fusarium sp. were morphologically similar. The straight, cylindrical, and robust macroconidia contained between five and seven septa. The apical cell was rounded and blunt and the basal cell was rounded. All three morphological types were tested for pathogenicity on mature fruit of cv. Sorcerer. Fruit were surface disinfected in 70% ethanol. Wounds were made (4 mm deep) in the fruit surface with a cork borer. Three wounds per isolate per fruit were inoculated with a PDA plug colonized with mycelium from a 3-day-old culture. Three replicated wounds were inoculated per isolate and four replicate fruit were used. After inoculation, the wounds were covered with saran wrap. The fruit were incubated at approximately 24°C and evaluated after 7 days. An uncolonized PDA plug was used as a negative control. After 7 days, only the predominant Fusarium sp. produced typical lesions, which were brown, water soaked, and approximately 3 cm in diameter. Fusarium spp. were recovered from the inoculated lesions. The colonies on PDA and macroconidia of the pathogenic Fusarium sp. were morphologically similar to the isolate inoculated and the ones recovered from field lesions. DNA was extracted from the same three isolates used in the pathogenicity test. A portion of the translation elongation factor 1α (TEF) gene was sequenced to verify the identity of the pathogenic isolates. On the basis of a comparison of the Fusarium-ID database at Pennsylvania State University (3), the pathogenic isolates had a 100% match with Fusarium solani f. sp. cucurbitae race 1, teleomorph Nectria haematococca mating population I, isolate NRRL 22098. F. solani f. sp cucurbitae was previously identified as the causal agent of crown and foot rot and a fruit rot of cucurbits and responsible for outbreaks on pumpkin fruit in Connecticut, Missouri, New York, and Ohio from 2001 to 2003 and again in Ohio in 2005 (2). In 2008, a higher average total of monthly precipitation was recorded late in the growing season in Arkansas, (13.7 cm in August and 23.7 cm in September). Although F. equiseti has previously been reported as a fruit rot pathogen of pumpkin in Arkansas (1), to our knowledge, this is the first report of F. solani f. sp cucurbitae as causal agent of pumpkin fruit rot in the state. Reference: (1) J. C. Correll et al. Plant Dis. 75:751, 1991. (2) W. H. Elmer et al. Plant Dis. 91:1142, 2007. (3) D. M. Geiser et al. Eur. J. Plant Pathol. 110:473, 2004.

Burkholderia glumae and B. gladioli Cause Bacterial Panicle Blight in Rice in the Southern United States.

Bacterial panicle blight (BPB) is among the three most limiting rice diseases in Louisiana and the southern United States. The identity and characterization of pathogens associated with this disease was unclear. This research details studies carried out on the pathogens causing BPB on rice in Louisiana and other rice producing southern states. Bacterial strains were isolated from BPB-infected sheath, panicle, or grain samples collected from rice fields in Louisiana, Arkansas, Texas, and Mississippi. In greenhouse inoculation tests, 292 of 364 strains were pathogenic on rice seedlings or panicles. Identification of strains in the pathogen complex by growth on S-PG medium, carbon source utilization profile (Biolog), cellular fatty acid analysis, and polymerase chain reaction (PCR) methods revealed that 76 and 5% of the strains were Burkholderia glumae and B. gladioli, respectively. The other strains have not been conclusively identified. Although strains of both species produced similar symptoms on rice, B. glumae strains were generally more aggressive and caused more severe symptoms on rice than B. gladioli. Virulent strains of both species produced toxoflavin in culture. The two species had similar growth responses to temperature, and optima ranged from 38 to 40°C for B. glumae and 35 to 37°C for B. gladioli. PCR was the most sensitive and accurate method tested for identifying the bacterial pathogens to the species level. The 16S rDNA gene and 16S-23S rDNA internal transcribed spacer (ITS) region sequences of the B. glumae and B. gladioli strains from rice showed more than 99% sequence homology with published sequences. A real-time PCR system was developed to detect and quantify this pathogen from infected seed lots. Our results clearly indicate that B. glumae and B. gladioli were the major pathogens causing BPB in the southern United States.

Fluctuating reproductive rates in Hawaii's humpback whales, Megaptera novaeangliae, reflect recent climate anomalies in the North Pacific.

Alongside changing ocean temperatures and ocean chemistry, anthropogenic climate change is now impacting the fundamental processes that support marine systems. However, where natural climate aberrations mask or amplify the impacts of anthropogenic climate change, identifying key detrimental changes is challenging. In these situations, long-term, systematic field studies allow the consequences of anthropogenically driven climate change to be distinguished from the expected fluctuations in natural resources. In this study, we describe fluctuations in encounter rates for humpback whales, Megaptera novaeangliae, between 2008 and 2018. Encounter rates were assessed during transect surveys of the Au'Au Channel, Maui, Hawaii. Initially, rates increased, tracking projected growth rates for this population segment. Rates reached a peak in 2013, then declined through 2018. Specifically, between 2013 and 2018, mother-calf encounter rates dropped by 76.5%, suggesting a rapid reduction in the reproductive rate of the newly designated Hawaii Distinct Population Segment of humpback whales during this time. As this decline coincided with changes in the Pacific decadal oscillation, the development of the NE Pacific marine heat wave and the evolution of the 2016 El Niño, this may be another example of the impact of this potent trifecta of climatic events within the North Pacific.