Effect of intra-operative glove changing during cesarean section on post-operative complications: a randomized controlled trial.

PURPOSE: To compare the rates of wound-related complications among women undergoing a cesarean section when the surgical team used intra-operative glove changing versus usual care. METHODS: All women undergoing a cesarean section at a single, county hospital were randomized to usual care or intra-operative glove changing prior to abdominal closure. Participants were randomized at the time of decision for cesarean section; surgeons were not blinded to the randomization arm. The primary outcome was any wound-related complication, including wound hematoma, seroma, skin separation of at least 1 cm, wound infection, or other incisional abnormality requiring treatment within 8 weeks of surgery. To detect a reduction in the primary outcome from 17% in the control group to 9% in the intervention group with 80% power, a total of 554 women (277 per group) were required. Secondary outcomes included other infectious complications including endometritis and other superficial or deep soft tissue infections. RESULTS: From August 2015 to November 2016, 277 women were randomized to usual care and 276 women were randomized to intra-operative glove changing. The two groups were well balanced in terms of demographic data, comorbid conditions and surgical characteristics. Intra-operative glove changing led to a significant decrease in composite wound complications from 13.6% in the control group to 6.4% in the intervention group (p = 0.008). CONCLUSION: Intra-operative glove changing prior to abdominal closure during cesarean section significantly reduced the incidence of post-operative wound complications.

"Man Cannot Exist Alone": The Challenge of Health Care to Honor the Role of Women in Society.

Women's roles in society are changing. While most of those changes recognize and enhance the contributions of feminine ingenuity to human development, some threaten to isolate women physically, socially, and emotionally. Developments in reproductive health care, and the writings of Pope Saint John Paul II, offer lenses by which to evaluate the shifting landscape of women's role in society. On the one hand, practices such as contraception, abortion, surrogacy, and assisted reproductive technologies over time will weaken the physical, social, and emotional bonds that procreation has held between man and woman, parents and children, and families and society. On the other hand, the expansion of different modes of natural family planning and pregnancy support centers offers to preserve those bonds. SUMMARY: Women's role in families, and therefore society, is invaluable. Several approaches to reproductive health offered by medicine may isolate women over time, and some evidences suggest we are already seeing that effect. Other approaches to women's health may be able to preserve the physical, emotional, and social bonds that integrate women to the family, and therefore society.

"Mirror of Patients": A Reflection on the Honor of Serving as a Male Obstetrician-gynecologist.

Physicians' work challenges them to learn and grow from their experiences with patients. Male obstetrician-gynecologists are uniquely blessed and challenged by their experiences in women's health care. The following is a reflection by one male obstetrician-gynecologist who considers the role of Saint Joseph in the holy family in contemplating his own role in providing women's health care. Summary: One hundred twenty-five men who underwent therapy trying to change sexual orientation from homosexual to heterosexual were asked about negative and positive experiences. About two-thirds recorded changes of varying extent. There was also much decrease in suicidality, depression, and substance abuse, and increases in social functioning and self-esteem. Almost all harmful effects were none to slight and comparable to therapies for other unwelcome conditions.

Human RAP1 inhibits non-homologous end joining at telomeres.

Telomeres, the nucleoprotein structures at the ends of linear chromosomes, promote genome stability by distinguishing chromosome termini from DNA double-strand breaks (DSBs). Cells possess two principal pathways for DSB repair: homologous recombination and non-homologous end joining (NHEJ). Several studies have implicated TRF2 in the protection of telomeres from NHEJ, but the underlying mechanism remains poorly understood. Here, we show that TRF2 inhibits NHEJ, in part, by recruiting human RAP1 to telomeres. Heterologous targeting of hRAP1 to telomeric DNA was sufficient to bypass the need for TRF2 in protecting telomeric DNA from NHEJ in vitro. On expanding these studies in cells, we find that recruitment of hRAP1 to telomeres prevents chromosome fusions caused by the loss of TRF2/hRAP1 from chromosome ends despite activation of a DNA damage response. These results provide the first evidence that hRAP1 inhibits NHEJ at mammalian telomeres and identify hRAP1 as a mediator of genome stability.