Postpartum urinary retention after the institution of a universal voiding protocol.

OBJECTIVE: Postpartum urinary retention is a frequently occurring condition for which screening is not typically a standardized part of postpartum care. The aim of this study was to determine the incidence of and risk factors for postpartum urinary retention after the introduction of a universal postpartum voiding protocol. METHODS: This was a single-center retrospective case-control study of women delivering in a 12-month period. Women with a documented diagnosis of postpartum urinary retention per the institution's voiding protocol were classified as cases, and a matched sample of those without urinary retention were controls. Demographic and obstetric characteristics were compared between both groups using univariate and multivariate analyses as a means to identify risk factors for postpartum urinary retention. RESULTS: 8992 women were studied during the time period examined; 195 (2.2%) were identified to have postpartum urinary retention. On multivariate logistic regression analysis, operative vaginal delivery (aOR 2.98 95% CI 1.32-6.70) and second-degree or greater perineal laceration (aOR 2.83 CI 1.59-5.04) were significantly associated with postpartum urinary retention. CONCLUSIONS: The incidence of postpartum urinary retention with a postpartum voiding protocol in place was low. Risk factors identified for urinary retention included operative vaginal delivery and second degree or greater perineal laceration. Awareness of these risk factors and implementation of standardized voiding protocols may aid with the early identification and prevention of postpartum urinary retention.

Disposition preferences in oocyte preservation patients.

PURPOSE: To characterize the frozen oocyte disposition preferences of patients undergoing medical and planned fertility preservation. METHODS: All oocyte cryopreservation (OC) patients were identified between 2015 and 2018. Demographic information and fertility preservation (FP) indication (medical or planned) were identified for each patient. Oocyte disposition options included disposal, donation to research, or donation to a specified third party, which was decided at the time of initial consent and made available in the electronic medical record. The primary outcome was the disposition selection. Secondary outcomes included differences in demographic variables and disposition selections between medical and planned FP patients using chi-squared analysis. RESULTS: A total of 336 OC patients with a documented oocyte disposition preference were identified in the study timeframe. Patients were on average 34.5 years old (SD = 5.1) and were predominantly White (70.2%), nulliparous (83.0%), with a BMI of 24.7 (SD = 5.4). A total of 101 patients underwent OC for medical FP and 235 for planned FP. In both groups, the most commonly selected disposition option was donation to research (50% planned, 52% medical), followed by donation to a specified third party (30% planned, 30% medical), and finally disposal of oocytes (20% planned, 18% medical). There were no significant differences in disposition selection between each group. When comparing patient variables between groups, medical FP patients were more likely to be under the age of 35 and were less likely to be nulliparous (p < .001). CONCLUSION: This study shows that oocyte disposition choices are similar in patients undergoing OC for medical and planned indications. As donation to research was the most commonly selected option in both groups, it is time to start thinking of streamlining ways to utilize this potential research material in the future.

Allergic inflammation is initiated by IL-33-dependent crosstalk between mast cells and basophils.

IgE-primed mast cells in peripheral tissues, including the skin, lung, and intestine, are key initiators of allergen-triggered edema and inflammation. Particularly in severe forms of allergy, this inflammation becomes strongly neutrophil dominated, and yet how mast cells coordinate this type of response is unknown. We and others have reported that activated mast cells--a hematopoietic cell type--can produce IL-33, a cytokine known to participate in allergic responses but generally considered as being of epithelial origin and driving Type 2 immune responses (e.g., ILC2 and eosinophil activation). Using models of skin anaphylaxis, our data reveal that mast cell-derived IL-33 also initiates neutrophilic inflammation. We demonstrate a cellular crosstalk mechanism whereby activated mast cells crosstalk to IL-33 receptor-bearing basophils, driving these basophils to adopt a unique response signature rich in neutrophil-associated molecules. We further establish that basophil expression of CXCL1 is necessary for IgE-driven neutrophilic inflammation. Our findings thus unearth a new mechanism by which mast cells initiate local inflammation after antigen triggering and might explain the complex inflammatory phenotypes observed in severe allergic diseases. Moreover, our findings (i) establish a functional link from IL-33 to neutrophilic inflammation that extends IL-33-mediated biology well beyond that of Type 2 immunity, and (ii) demonstrate the functional importance of hematopoietic cell-derived IL-33 in allergic pathogenesis.

Transplant-acquired food allergy: current perspectives.

Mechanisms that regulate the tolerance to dietary proteins or the loss of this and subsequent development of disease are poorly understood. In food allergy, there is growing awareness of the urgency in understanding these events to aid in the development of next-generation therapies and interventions. This review focuses on the accumulating evidence related to food allergy that develops after transplantation. This intriguing immunological phenomenon has been described in several different types of transplant settings and to variety of different foods. We outline these studies and the evidence from them that support transplant-acquired food allergy being a process regulated by both the donor allergic status and the recipient genetics and treatments. A number of key risk factors seem prevalent throughout transplant-acquired food allergy and include type of transplant, age and general health of the recipient, modality of immunosuppression and potentially the genetics of both donor and recipient. Importantly, these studies provide a window into better general understanding of food allergy, and facilitate clearer understanding of the critical immunological and epidemiological factors needed to allow the adoptive transfer of a food-specific allergic disease from one individual to another.