Mindfulness-Based Group Cognitive Behavior Therapy for Provoked Localized Vulvodynia: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the effectiveness of mindfulness-based group cognitive behavior therapy (M-gCBT) versus education support group therapy for the pain and distress associated with provoked localized vulvodynia. MATERIALS AND METHODS: Participants were randomized to M-gCBT or education support group therapy. Mindfulness-based group cognitive behavior participants attended 8 weekly sessions. Education support group participants received 8 weeks of online education with 3 in-person group visits. Vaginal insertion pain (tampon test) was the primary outcome. Secondary outcomes (Generalized Anxiety Disorder 7, Beck's Depression Index, Female Sexual Distress Scale, Female Sexual Function Index, and Pain Catastrophizing) were administered before intervention and at the completion of the study period, 3 months, and 6 months. Sample size was based on the ideal number for group dynamics of 6 to 12 participants per group. RESULTS: Participants were enrolled from August 1, 2016, to January 30, 2017. Thirty-two participants were enrolled and 31 were randomized: 14 to M-gCBT and 17 to education support. Baseline characteristics did not differ significantly. Vaginal insertion pain decreased in both groups but was not statistically different between groups (difference of 1.23; 95% CI = -0.52 to 2.98). At 6 months, participants in the M-gCBT group showed statistically significant improvement in the Female Sexual Function Index, Generalized Anxiety Disorder 7, and Beck's Depression Index compared with the education support group. CONCLUSIONS: Mindfulness-based group cognitive behavior and education support group therapy are effective in reducing pain and distress. However, women in the M-gCBT program showed greater improvement in certain secondary outcomes, indicating that M-gCBT may offer some advantages in reducing distress associated with provoked localized vulvodynia.

Does small for gestational age worsen outcomes in gestational diabetics?

OBJECTIVE: Our goal was to determine whether pregnancy outcomes are worse in gestational diabetics with small for gestational age (SGA) than those without. METHODS: This was a retrospective cohort study of 114 199 pregnancies with gestational diabetes mellitus (GDM) in California, 6446 of which were complicated by SGA. SGA was defined as birth weight < 10th percentile. Predictors included the presence or absence of SGA. Outcomes included respiratory distress syndrome (RDS), neonatal demise (NND), intrauterine fetal demise (IUFD), hypoglycemia and jaundice. The data were also stratified by gestational age looking at 32 + 0-36 + 6 weeks and 37 + 0-41 + 6 weeks. Univariate and multivariate analyses were performed. RESULTS: In the term 37 + 0 to 41 + 6 week GDM cohort the risk of RDS increased from 0.4% to 1.3%, the risk of neonatal demise from 0.02% to 0.09%, the risk of IUFD from 0.1% to 0.4%, the risk of hypoglycemia from 0.4% to 1.0% and the risk of jaundice from 18.0% to 23.3% (p < 0.001 for all). Similar relationships were seen in the 32 + 0 to 36 + 6 week group. The findings remained significant in multivariate analyses. CONCLUSIONS: The presence of SGA in a patient with gestational diabetes is associated with significantly increased risks of adverse outcomes compared to gestational diabetics without SGA including increased risks of RDS, neonatal demise, IUFD, hypoglycemia and jaundice.

Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks' gestation are associated with adverse perinatal outcomes.

OBJECTIVE: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone. METHODS: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD). RESULTS: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p < 0.001), higher CD rate (66.5% versus 55.0%, p < 0.001), and higher likelihood of a CD for FHR abnormalities (21.7% versus 10.0%, p < 0.001). SGA infants were more likely to experience adverse neonatal outcomes including RDS (10.1% versus 4.9%, p < 0.001), jaundice (59.8% versus 39.2%, p < 0.001), hypoglycemia (8.9% versus 3.9%, p < 0.001), asphyxia (0.6% versus 0.2%, p = 0.015), and IUFD (1.5% versus 0.3%, p < 0.001). CONCLUSIONS: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates.

Outcomes following microfracture of full-thickness articular cartilage lesions of the knee in adolescent patients.

The purpose of this study was to document outcomes following microfracture for full-thickness cartilage defects of the knee in adolescents. Our hypothesis was that patients aged 18 years or less would have excellent outcomes and function following microfracture of full-thickness knee articular cartilage defects. This study was approved by the Institutional Review Board. Patients < 19 years old with full-thickness knee articular cartilage defects treated with microfracture between January 1992 and June 2008 were identified. Surgical, demographic data, Lysholm score, Tegner activity scale, and patient satisfaction were collected prospectively. A total of 26 patients (14 females, 12 males) met inclusion criteria. Average age was 16.6 years (range: 12-18.9 years). Ninety-six percent of lesions were patellar (37%) or femoral condyle defects (medial 26%, lateral 33%). Minimum 2-year follow-up was obtained in 22/26 patients (85%) with average follow-up of 5.8 years (range: 2.0-13.3 years). Average postoperative Lysholm score was 90 (range: 50-100). Median Tegner scale was 6 (range: 2-10). Median patient satisfaction with outcome was 10 (range: 1-10). Lysholm correlated with Tegner scale (rho = 0.586; p = 0.011) and patient satisfaction (rho = 0.70; p = 0.001). Average postoperative Lysholm score in males was 93 and 86 in females (p = 0.22). One patient underwent revision microfracture. This study showed that adolescent patients who underwent microfracture for treatment of full-thickness knee chondral defects demonstrated increased activity levels and excellent function following surgery.

High-dose ibuprofen is not associated with increased biomarkers of kidney injury in patients with cystic fibrosis.

High-dose ibuprofen (IBU) may slow the decline of lung function in patients with cystic fibrosis (CF), but its use has been limited due to concerns over renal and gastrointestinal toxicity. In this pilot study, we examined the association of IBU with markers of acute kidney injury (AKI) in patients with CF. The effect of aminoglycoside (AG) exposure on AKI biomarkers was also examined. The AKI markers, kidney injury molecule-1 (KIM), N-acetyl-ß-glucosaminidase (NAG) and urine protein, normalized for creatinine, were chosen as they are more sensitive indicators of kidney injury than changes in serum creatinine. Urine samples from 52 patients, 26 from patients who were treated with IBU, were analyzed. There was no significant association between IBU treatment and KIM-1, NAG or protein levels, compared to patients never treated with IBU. While there was an association between AG courses and KIM-1 levels, there were no differences in biomarker levels between IBU and non-IBU groups with respect to AG courses. These preliminary results suggest that IBU treatment in patients with CF may be safe with respect to renal toxicity.

Outcomes after knee microfracture of chondral defects in alpine ski racers.

Articular cartilage defects of the knee have been shown to cause pain, swelling, decreased function, and suboptimal athletic performance. Treatment of elite-level athletes presenting with full-thickness chondral defects of the knee continues to be a challenge for orthopedic surgeons. The purpose of this study was to document outcomes in elite professional alpine ski racers after microfracture surgery. This study was approved by an institutional review board. All patients who competed in professional ski races recognized by International Ski Federation and had a full-thickness knee articular cartilage defect, treated with microfracture, by a single surgeon, were included in the study. All data were collected prospectively. At minimum 2 years following microfracture, all patients completed a questionnaire, including Lysholm score, Tegner activity scale, and patient satisfaction with outcome. Minimum 2-year follow-up was available for 18 of 20 skiers (90%) at an average follow-up of 77 months (range, 24-255 months). Size of knee articular cartilage defect was larger in males (195 mm(2)) compared with females (155 mm(2)); however, this difference was not statistically significant (p > 0.05). Median postoperative Tegner activity scale was 10 (range, 4-10). Mean postoperative Lysholm score was 86 (range, 41-100). Median postoperative patient satisfaction score was 10 (range, 9-10). Out of the 20 skiers, 19 (95%) returned to competitive skiing. The age of the skier who did not return was 28 years. The average time from surgery to return to competition was 13.4 months (range, 0.5-25.3 months). Average end-of-season overall World Cup ranking was calculated for the nine skiers before and after surgery. Of these nine skiers, six had an improved average overall World Cup ranking after microfracture. In this study, patient satisfaction with outcome and function were high following microfracture of full-thickness chondral lesions of the knee. Nearly all skiers returned to full competition. Microfracture is an acceptable treatment option for elite skiers who have full thickness articular cartilage lesions of the knee.