Differences in motor learning of pelvic floor muscle contraction between women with and without stress urinary incontinence: Evaluation by transabdominal ultrasonography.

AIMS: To evaluate differences in motor learning of pelvic floor muscle (PFM) contraction between women with and without stress urinary incontinence (SUI) under transabdominal ultrasonography (TAUS)-guided PFM training. METHODS: Postpartum women received an intensive 3-month PFM training program from 3 to 6 months postpartum. The program consisted of home exercises and weekly group sessions with individual TAUS-guided training. Motor learning progress of PFM contraction was evaluated with TAUS at each weekly session. We regarded a woman who contracted her PFM correctly more than 9 times out of the 10 repetitions as having achieved the associative stage of motor learning. Women were evaluated before and after a 12-week intervention for PFM and SUI by using transperineal ultrasonography and questionnaire, respectively. RESULTS: Seventy-three women were included: 44 primiparous women (60.3%) and 64 vaginal deliveries (87.7%). Of 73 women, 22 (30.1%) were classified as the SUI group. By the fifth session, the proportion of women who could correctly contract their PFM > 9 out of the 10 repetitions had increased significantly more in the non-SUI group than in the SUI group (90.0% vs. 58.8%, P = 0.011). The proportion of women achieving the associative stage of correct PFM contraction was not different between the two groups after the sixth session. PF morphology and SUI were improved after intervention (P < 0.05). CONCLUSIONS: The proportion of women achieving the associative stage in women with SUI was less than that in women without SUI in the early phase of the combination of group and home PFM training with TAUS-guided training. Neurourol. Urodynam. 36:98-103, 2017. © 2015 Wiley Periodicals, Inc.

Availability of two self-administered diet history questionnaires for pregnant Japanese women: A validation study using 24-hour urinary markers.

BACKGROUND: Accurate and easy dietary assessment methods that can be used during pregnancy are required in both epidemiological studies and clinical settings. To verify the utility of dietary assessment questionnaires in pregnancy, we examined the validity and reliability of a self-administered diet history questionnaire (DHQ) and a brief-type self-administered diet history questionnaire (BDHQ) to measure energy, protein, sodium, and potassium intake among pregnant Japanese women. METHODS: The research was conducted at a university hospital in Tokyo, Japan, between 2010 and 2011. The urinary urea nitrogen, sodium, and potassium levels were used as reference values in the validation study. For the reliability assessment, participants completed the questionnaires twice within a 4-week interval. RESULTS: For the DHQ (n = 115), the correlation coefficients between survey-assessed energy-adjusted intake and urinary protein, sodium, and potassium levels were 0.359, 0.341, and 0.368, respectively; for the BDHQ (n = 112), corresponding values were 0.302, 0.314, and 0.401, respectively. The DHQ-measured unadjusted protein and potassium intake levels were significantly correlated with the corresponding urinary levels (rs = 0.307 and rs = 0.342, respectively). The intra-class correlation coefficients for energy, protein, sodium, and potassium between the time 1 and time 2 DHQ (n = 58) and between the time 1 and time 2 BDHQ (n = 54) ranged from 0.505 to 0.796. CONCLUSIONS: Both the DHQ and the BDHQ were valid and reliable questionnaires for assessing the energy-adjusted intake of protein, sodium, and potassium during pregnancy. In addition, given the observed validity of unadjusted protein and potassium intake measures, the DHQ can be a useful tool to estimate energy intake of pregnant Japanese women.

Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan.

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.

Associations of dietary intake and plasma concentrations of eicosapentaenoic and docosahexaenoic acid with prenatal depressive symptoms in Japan.

The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.

Validity of a self-administered diet history questionnaire for estimating vitamin D intakes of Japanese pregnant women.

Maternal vitamin D status is important for fetal development and the prevention of pregnancy complications. Mothers require both sufficient intakes and skin production of this vitamin. We investigated the validity and test-retest reliability of a self-administered diet history questionnaire (DHQ) to establish a method of assessing vitamin D intakes of Japanese pregnant women, using a serum marker. A total of 245 healthy pregnant women in the second trimester, who were not taking vitamin D supplements, were recruited at a university hospital in Tokyo between June 2010 and July 2011. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured as an indicator of vitamin D status. To assess the test-retest reliability of the DHQ, 58 pregnant women completed it twice within a 4-5-week interval. Significant positive correlations between intakes and serum concentrations of vitamin D were found (r = 0.266 for daily intakes and r = 0.249 for energy-adjusted intakes). In the winter investigation in which the serum 25(OH)D concentrations were less likely to be affected by sunlight exposure, the correlation coefficients were 0.304 for both daily and energy-adjusted intakes. After excluding participants with pregnancy-associated nausea, the coefficients increased. The intraclass correlation coefficient between vitamin D intakes estimated from the two-time DHQ was 0.638. The DHQ provides an acceptable validity and reliability of the vitamin D intake of Japanese pregnant women. However, the data of women with nausea should be interpreted with caution. We believe that the DHQ is a useful questionnaire to grasp and improve vitamin D intakes during pregnancy.

Relationship between plasma total homocysteine level and dietary caffeine and vitamin B6 intakes in pregnant women.

A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6 , after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.

Reliability and validity of the Japanese version of the pelvic floor distress inventory-short form 20.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) into Japanese and test its reliability and validity among Japanese women. METHODS: Fifty-nine women with and without pelvic floor disorders (age 55.8 ± 16.8 years, mean ± SD) completed the Japanese PFDI-20 (J-PFDI-20) questionnaire at baseline and 2 weeks later. Intraclass correlation coefficients (ICC) and the Bland and Altman method for test-retest reliability and Cronbach's alpha for internal consistency of the J-PFDI-20 were used. Scores of total and subscales were compared between women with and without pelvic floor disorders for known-groups validity. Spearman's correlation coefficients between the J-PFDI-20 and the severity of pelvic floor disorders and Urinary Incontinence Quality of Life Scale (I-QOL) were used for construct validity. RESULTS: The PFDI-20 was successfully translated from English into Japanese with face validity through rigorous cross-cultural validation. Test-retest reliability of the J-PFDI-20 and three subscales was good to excellent (ICC=0.77-0.90). The Bland and Altman analysis showed that differences between the first and second scores of total J-PFDI-20 and its subscales were not significantly different from 0 and largely fell within the range of 0 ± 1.96 SD. Cronbach's alpha values were 0.52-0.83. Analysis of known-groups validity showed differences in scores of the J-PFDI-20 between women with and without pelvic floor disorders. Acceptable construct validity was found in J-PFDI-20 total and subscale scores with positive correlations to severity of pelvic floor disorders (ρ>0.35) and negative correlations to I-QOL (ρ<-0.39). CONCLUSIONS: The results suggest that the J-PFDI-20 is a reliable and valid condition-specific quality of life instrument for women with pelvic floor disorders.

Validity of a diet history questionnaire estimating ß-carotene, vitamin C and α-tocopherol intakes in Japanese pregnant women.

We investigated the validity and reproducibility of a self-administered diet history questionnaire (DHQ) that estimates the intakes of ß-carotene, vitamin C and α-tocopherol. Ninety-five healthy women with singleton pregnancies in the second trimester were examined at a university hospital in Tokyo. The intakes of ß-carotene, vitamin C and α-tocopherol assessed by the DHQ were compared to the corresponding serum concentrations. To assess the reproducibility, 58 pregnant women completed it in two sessions within a 4-5 week interval. We found significantly positive correlations between the energy-adjusted intakes and serum concentrations of ß-carotene and vitamin C (r = 0.254 and r = 0.323, respectively). However, α-tocopherol intake was not associated with the corresponding serum concentration. The intraclass correlation coefficients of the two-time DHQ were 0.743 (ß-carotene), 0.665 (vitamin C) and 0.718 (α-tocopherol). DHQ has acceptable validity and reproducibility for ß-carotene and vitamin C intakes in Japanese pregnant women.

Translation and validation of the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire version A.

Severe antenatal fear of childbirth causes adverse effects on emotional well-being during the postpartum period. The Wijma Delivery Expectancy/Experience Questionnaire is widely used to measure fear of childbirth among women before (version A) and after (version B) delivery. In this study, the original Swedish version was translated into Japanese, and its validity and reliability were examined among healthy, pregnant Japanese women. The Japanese-translated version presented a multidimensional structure with four factors: fear, lack of positive anticipation, isolation, and riskiness. Exhibiting concurrent/convergent validity, the Japanese version correlated with other psychological measures at expected levels. The Cronbach's α (0.90) and the intraclass correlation coefficient (0.86, P < 0.001) were high. In conclusion, the results provide support for the Japanese version to be considered a valid and reliable measure of prenatal fear of childbirth among pregnant Japanese women.

Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

PURPOSE: To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. METHODS: Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. RESULTS: Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p < 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p < 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02). CONCLUSION: The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.

Creation of the Forearm 3D-Model with Veins from Transversal Ultrasonography Image Sequence.

This study developed an automatic detection algorithm of vessel and skin regions in a transversal ultrasonography image on the arm. We also developed an algorithm to generate a 3D model from detected areas to assist vein puncture. In the algorithm, the vessel's candidate regions in the ultrasonography image were detected using U-Net or Mask R-CNN, which are a kind of deep learning method for segmentation. Then vessel regions were selected among the candidates based on continuous properties in an image sequence. The skin regions were also detected. The 3D polygon data was created from paired pixels in sequential images. The experiments demonstrated that Mask R-CNN could correctly estimate the branch of vessel which were difficult to identify accurate region separately using U-Net, and achieved an overall IoU of 80%. The confirmation experiment of 3D model demonstrated that generated model have enough feasibility for assessment of appropriate veins and locations for puncture.Clinical relevance-The developed 3D model generation from ultrasonography images will be useful for support to identify the appropriate veins for puncture.

Effectiveness of ultrasonography for peripheral catheter insertion and catheter failure prevention in visible and palpable veins.

BACKGROUND: The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. METHODS: Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein's visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. RESULTS: Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. CONCLUSIONS: Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

Predictive Factors for Infusion Site Induration After Outpatient Chemotherapy in Japan: A Secondary Analysis.

PURPOSE: Even in the absence of extravasation, some patients develop induration at the peripheral intravenous catheterization site prior to the next day's treatment. Infusion site induration commonly affects patients who undergo repeated chemotherapy administrations. Vessel health is crucial for the continuation of chemotherapy. However, there is no effective method to prevent induration. Hence, this study aimed to investigate the factors that could cause induration for preventing its occurrence. METHODS: This study was a secondary analysis of a prospective observational study. All participants were undergoing outpatient chemotherapy. Participant characteristics and related catheterization data were collected on the treatment day as baseline, and induration incidence was recorded on the subsequent treatment day. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of cutoff points of the vein and catheter diameter ratios for distinguishing between developed induration and not developed induration. Additionally, cox regression analysis with multiple imputation was used to investigate the factors that predicted induration. RESULTS: Seventy-one patients participated in the study. The cutoff point of the vein/catheter diameter ratio calculated using ROC analysis was ≥3.7. The ratio of larger-diameter veins to catheter diameter of ≥3.7 times was negatively associated with induration in both complete case analysis (HR: 0.11; p = 0.034) and multiple imputation analysis (HR: 0.12; p = .049). CONCLUSIONS: Selecting the vein with 3.7 times higher diameter than the catheter diameter for the catheterization site may help prevent induration on the next treatment day.

Verification study on the catheterization of an upper arm vein using the new long peripheral intravenous catheter to reduce catheter failure incidence: A randomized controlled trial.

Intravenous infusion using a peripheral intravenous catheter (PIVC) is often complicated by catheter failure (CF). We hypothesized that catheterization of an upper arm vein instead of a forearm vein may help prevent CF. This study was designed to compare the incidence of CF in patients receiving hyper-stimulant drugs when catheters are placed in the forearm using short PIVCs (SPCs) with that when catheters are placed in the upper arm using the new long PIVCs. Patients admitted to a university hospital in Tokyo, Japan were enrolled in this study and were assigned to the SPC or the new long PIVC group. The primary outcome was the incidence of CF until 7 days. The secondary outcomes were the number of CFs per 1,000 days, the duration of the indwelling catheter, and the presence of thrombi and subcutaneous edema. Forty-seven patients were analyzed (median age, 67.0 years). The incidence of CF was 0% in the new long PIVCs and 32.0% (8 catheters) in the SPCs (p = 0.007), and the number of CF per 1,000 days was 0/1,000 and 81.7/1,000 days, respectively (p = 0.001). A significant difference in the duration of the indwelling catheter until CF occurrence was observed between the two groups (p = 0.004). Thrombi and subcutaneous edema were observed more frequently in the SPC group (p < 0.001). Catheterization of an upper arm vein using the new long PIVC to administer a hyper-stimulant drug might reduce CF compared with catheterization of a forearm vein using SPC.

Effects of ultrasound with an automatic vessel detection system using artificial intelligence on the selection of puncture points among ultrasound beginner clinical nurses.

BACKGROUND: Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system. METHODS: In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points. RESULTS: Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants. CONCLUSION: Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.

Validity and reproducibility of folate and vitamin B(12) intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women.

BACKGROUND: No validated dietary questionnaire for assessing folate and vitamin B(12) intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B(12) estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women. METHODS: A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B(12) were assessed using the DHQ. The serum concentrations of folate and vitamin B(12) were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval. RESULTS: Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B(12) (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B(12) increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B(12), approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B(12). CONCLUSION: The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B(12) intakes in Japanese pregnant women.

Diagnosis of anal sphincter defects by three-dimensional transperineal ultrasound in women with anal incontinence.

PURPOSE: To assess the utility of transperineal three-dimensional (3D) ultrasound for diagnosing anal sphincter defects and evaluating the function of the anal canal in women with anal incontinence. METHODS: The study subjects were 13 women with anal incontinence. Symptoms of fecal incontinence were assessed by Wexner score. The anal canal of each woman was examined ultrasonically with both a convex transperineal 3D scanner and a radial transanal scanner to compare the accuracy of the two approaches for diagnosis of anal sphincter defects. The anorectal angle and the length of the anal canal were also measured by utilizing the functionality of the transperineal 3D ultrasound. RESULTS: The mean age was 58.9 ± 14.9 years (±SD), and the mean Wexner score was 8.4 ± 5.6. In terms of ultrasound diagnosis of anal sphincter defects, the two methods showed consistent results in each woman. The length of the portion where both the internal and external anal sphincters were intact was significantly correlated with the Wexner score, whereas the total length of the anal canal was not. CONCLUSIONS: Less invasive transperineal 3D ultrasound provides accurate evaluation of the internal and external anal sphincters in women with anal incontinence, and the method is potentially useful for detection of anal sphincter abnormalities.

Incidence, causes, and timing of peripheral intravenous catheter failure related to insertion timing in the treatment cycle in patients with hematological malignancies: A prospective descriptive study.

AIM: We aimed to reveal detailed descriptive data on peripheral intravenous catheter (PIVC) failure related to insertion timing during the treatment cycle, in patients with lymphoma, leukemia, and myeloma. METHODS: We conducted a prospective descriptive study to investigate the incidence of PIVC failure, defined as PIVC removal prior to completing infusion therapy. This was judged by ward nurses for adult patients requiring PIVC insertion for chemotherapy. A research nurse confirmed the timing and determined the causes of PIVC failure using ultrasonographic imaging. Descriptive data were collected in the hematology and oncology ward of a tertiary hospital in Japan. RESULTS: We recruited 85 patients (with 303 PIVCs), and analyzed 67 patients (with 280 PIVCs). Of these, 118 PIVCs (42%) were inserted during the chemotherapeutic dosing period of the treatment cycle, and 106 (38%), during the rest period. The incidence of cumulative PIVC failure was 43.2% of all analyzed PIVCs (89.97 per 1,000 PIVC days). Of the PIVCs in patients with lymphoma, those inserted during the dosing period were less likely to show PIVC failure (32% vs. 57%, p < .001). Conversely, those inserted after the treatment cycle were more likely to show PIVC failure (22% vs. 7%, p = .002). CONCLUSION: This study demonstrated that the incidence of PIVC failure in patients with hematological malignancies was unacceptably high. Conceivably, the incidence of PIVC failure varies by the onset time of side effects in the treatment cycle. This should be considered when using PIVCs and selecting optimal vascular access devices for patients with hematological malignancies.

Automatic vein measurement by ultrasonography to prevent peripheral intravenous catheter failure for clinical practice using artificial intelligence: development and evaluation study of an automatic detection method based on deep learning.

OBJECTIVES: Complications due to peripheral intravenous catheters (PIVC) can be assessed using ultrasound imaging; however, it is not routinely conducted due to the need for training in image reading techniques. This study aimed to develop and validate a system that automatically measures blood vessel diameters on ultrasound images using artificial intelligence (AI) and provide recommendations for selecting an implantation site. DESIGN: Pilot study. SETTING: The University of Tokyo Hospital, Japan. PRIMARY AND SECONDARY OUTCOME MEASURES: First, based on previous studies, the vessel diameter was calculated as the mean value of the maximum long diameter plus the maximum short diameter orthogonal to it. Second, the size of the PIVC to be recommended was evaluated based on previous studies. For the development and validation of an automatic detection tool, we used a fully convoluted network for automatic estimation of vein location and diameter. The agreement between manually generated correct data and automatically estimated data was assessed using Pearson's product correlation coefficient, systematic error was identified using the Bland-Altman plot, and agreement between catheter sizes recommended by the research nurse and those recommended by the system was evaluated. RESULTS: Through supervised machine learning, automated determination was performed using 998 ultrasound images, of which 739 and 259 were used as the training and test data set, respectively. There were 24 false-negatives indicating no arteries detected and 178 true-positives indicating correct detection. Correlation of the results between the system and the nurse was calculated from the 178 images detected (r=0.843); no systematic error was identified. The agreement between the sizes of the PIVC recommended by the research nurse and the system was 70.2%; 7% were underestimated and 21.9% were overestimated. CONCLUSIONS: Our automated AI-based image processing system may aid nurses in assessing peripheral veins using ultrasound images for catheterisation; however, further studies are still warranted.t.

Relationship between low back pain and stress urinary incontinence at 3 months postpartum.

Previous studies have proposed that pelvic misalignment may be associated with stress urinary incontinence through a decrease in the contractile function of the pelvic floor muscles; however, this relationship remains unclear. This study aimed to clarify the relationship between low back pain, an indication of pelvic misalignment, and stress urinary incontinence at 3 months postpartum. We conducted a cross-sectional study of women who gave birth to full-term babies between July 2008 and July 2009. Stress urinary incontinence was defined as urinary leakage when coughing, sneezing, or exercising. Low back pain was defined as pain between the ribs and gluteal sulcus in the preceding 2 months. Of the 228 subjects included in the study, the prevalence of stress urinary incontinence was 22.8% (n = 52). The prevalence of low back pain in the stress urinary incontinence group was significantly higher than that in the non-stress urinary incontinence group (78.8% [n = 41] vs. 57.4% [n = 101]; p = 0.005). Stress urinary incontinence was associated with older age, primiparity, vaginal delivery, and low back pain at 3 months. In conclusion, low back pain was associated with stress urinary incontinence after adjusting for pregnancy and delivery factors, suggesting pelvic misalignment contributes to the development of stress urinary incontinence. We propose that including care for pelvic misalignment in pelvic floor muscle training, the treatment of choice for stress urinary incontinence, could be beneficial.