Streamlined Analysis of Maternal Plasma Indicates Small Extracellular Vesicles are Significantly Elevated in Early-Onset Preeclampsia.

Preeclampsia (PE) is a leading cause of maternal and fetal mortality and morbidity. While placental dysfunction is a core underlying issue, the pathogenesis of this disorder is thought to differ between early-onset (EOPE) and late-onset (LOPE) subtypes. As recent reports suggest that small extracellular vesicles (sEVs) contribute to the development of PE, we have compared systemic sEV concentrations between normotensive, EOPE, and LOPE pregnancies. To circumvent lengthy isolation techniques and intermediate filtration steps, a streamlined approach was developed to evaluate circulating plasma sEVs from maternal plasma. Polymer-based precipitation and purification were used to isolate total systemic circulating maternal sEVs, free from bias toward specific surface marker expression or extensive subpurification. Immediate Nanoparticle Tracking Analysis (NTA) of freshly isolated sEV samples afforded a comprehensive analysis that can be completed within hours, avoiding confounding freeze-thaw effects of particle aggregation and degradation.Rather than exosomal subpopulations, our findings indicate a significant elevation in the total number of circulating maternal sEVs in patients with EOPE. This streamlined approach also preserves sEV-bound protein and microRNA (miRNA) that can be used for potential biomarker analysis. This study is one of the first to demonstrate that maternal plasma sEVs harbor full-length hypoxia inducible factor 1 alpha (HIF-1α) protein, with EOPE sEVs carrying higher levels of HIF-1α compared to control sEVs. The detection of HIF-1α and its direct signaling partner microRNA-210 (miR-210) within systemic maternal sEVs lays the groundwork for identifying how sEV signaling contributes to the development of preeclampsia. When taken together, our quantitative and qualitative results provide compelling evidence to support the translational potential of streamlined sEV analysis for future use in the clinical management of patients with EOPE.

Vaginal Calculus Formation on Exposed Midurethral Sling Mesh.

The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment.

Racial differences in hypertensive disorders in pregnancy during the COVID-19 pandemic.

OBJECTIVE: To compare rates of pregnancy induced hypertensive disorders during the period of the COVID-19 pandemic to prior, baseline years. METHODS: We conducted a retrospective study of 17,742 patients on rates for pregnancy induced hypertensive disorders delivering at 2 local hospitals before (Cohort 1; January 2018 to December 2019; n = 8245) and after (Cohort 2; February 2020 to February 2022; n = 9497) the onset of the COVID-19 pandemic. The primary outcomes were rates of gestational hypertension, pre-eclampsia, and chronic hypertension in patients.Wecompared by year (2018-2022), by patient COVID infection status, and by racial demographics. RESULTS: During the pandemic (Cohort 2), there were lower rates of chronic hypertension (7.4 % vs 6.5 %, p =.02), higher rates of gestational hypertension (26.3 % vs 27.8 %, p =.03), and higher rates of preeclampsia (11.3 % vs 13.1 %, p <.001) compared to years prior to the pandemic (Cohort 1). When evaluating by year, rates of chronic hypertension did not statistically change while rates for preeclampsia increased in the first year of the pandemic and remained high, and rates for gestational hypertension did not increase until the second year of the pandemic. When evaluating by COVID infection status, rates for gestational hypertension were significantly higher for individuals with a positive COVID infection status (COVID negative = 27.4 % vs. COVID positive = 32.8 %; p <.004). Rates of preeclampsia did not differ according to COVID infection status (p = 0.15). CONCLUSION: In this study, rates of pregnancy induced hypertensive disorders increased during the COVID pandemic regardless of COVID infection status.

Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study.

BACKGROUND: Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS. AIM: To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy. METHODS: Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600 IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6 months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D. OUTCOMES: The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone. RESULTS: A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use. CLINICAL IMPLICATIONS: Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary. STRENGTHS AND LIMITATIONS: This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability. CONCLUSION: Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.

Learning Pelvic Anatomy and Pathology Through Drawing: An Interactive Session in the Obstetrics and Gynecology Clerkship.

Introduction: Within undergraduate medical education, there is a gap between students' understanding of anatomy and application of that knowledge within surgical specialties. The integration of drawing, in conjunction with traditional learning, has been shown to increase retention and understanding of information. Currently, no educational curriculum integrates drawing to aid in medical students' understanding of surgical pelvic anatomy. We anticipated that the utilization of drawing anatomy in an OB/GYN clerkship would enhance students' ability to explain surgical pelvic anatomy and pelvic pathology. Methods: At the beginning of the OB/GYN clerkship, third-year medical students participated in an interactive, 1.5-hour session requiring them to draw pelvic anatomy, present their work, and explain topics related to pelvic surgery and pathology to the other clerkship students. At the end of their clinical rotation, the students were invited to complete a five-item survey to assess long-term retention and understanding of concepts presented in the session. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Results: Thirty-seven of 44 respondents (84%) reported that the anatomy interactive session prepared them for the surgical portion of the OB/GYN clinical rotation. Thirty-five respondents (80%) reported that drawing the pelvic structures helped their understanding of pelvic pathology; 33 respondents (75%) reported they had a thorough understanding of pelvic anatomy after taking the OB/GYN anatomy interactive educational session (p < .001). Discussion: Our session shows that integrating drawing and anatomy increases students' ability to discuss pelvic pathology and surgical anatomy.

Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network.

OBJECTIVES: Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or cholecystectomies, can be classified as high-volume/low-morbidity procedures. The performance of a standard set of perioperative tasks has been suggested as one way to optimize quality of care in elective high-volume/low-morbidity procedures. Our primary objective was to evaluate the performance of 5 perioperative tasks-(1) offering nonsurgical treatment, (2) performance of a standard preoperative prolapse examination, (3) cough stress test, (4) postvoid residual test, and (5) intraoperative cystoscopy for women undergoing surgery for stress urinary incontinence-compared among surgeons with and without board certification in female pelvic medicine and reconstructive surgery (FPMRS). STUDY DESIGN: This study was a retrospective chart review of anti-incontinence surgical procedures performed between 2011 and 2013 at 9 health systems. Cases were reviewed for surgical volume, adverse outcomes, and the performance of 5 perioperative tasks and compared between surgeons with and without FPMRS certification. RESULTS: Non-FPMRS surgeons performed fewer anti-incontinence procedures than FPMRS-certified surgeons. Female pelvic medicine and reconstructive surgery surgeons were more likely to perform all 5 perioperative tasks compared with non-FPMRS surgeons. After propensity matching, FPMRS surgeons had fewer patients readmitted within 30 days of surgery compared with non-FPMRS surgeons. CONCLUSIONS: Female pelvic medicine and reconstructive surgery surgeons performed higher volumes of anti-incontinence procedures, were more likely to document the performance of the 5 perioperative tasks, and were less likely to have their patients readmitted within 30 days.

Perceived quality of sleep across the menopausal transition: A retrospective cohort study.

Background and Aims: To compare sleep quality among naturally and surgically post-menopausal women, and to identify lifestyle factors that predict sleep quality in pre, peri, and postmenopausal women. Methods: This is a retrospective cohort study of data collected from 429 women who participated in Fels Longitudinal Study data. Sleep quality, based on the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, demographics, medical history, depression, quality of life, and physical activity levels were included in the analysis. Results: The four study groups did not differ on overall sleep quality with either scale (p = 0.61). Both Post-M groups were more likely to have a major sleep problem than the Peri-M and Pre-M groups (p < 0.001), and to have a history of restless leg syndrome (p = 0.016), but the two Post-M groups did not differ on these problems. Predictors of sleep quality included depression, bodily pain, vitality, and surgical menopause (p<0.001). Conclusion: Menopause is associated with sleep disrupting conditions. This study did not find any significant differences in sleep quality among the three reproductive stages or for natural versus surgical menopause. Women may benefit from addressing other lifestyle factors associated with poor sleep quality including mental health factors.

A Review of OB/GYN, Internal Medicine, Family Medicine, and Pediatrics Residency Program Websites for Diversity, Equity, and Inclusion Elements.

Background: Residency program websites have become a central source of information for applicants due to a shift toward virtual interviewing. Applicants, particularly those from diverse backgrounds, place strong value on programs that present commitments to diversity, equity, and inclusion (DEI). The DEI content of residency program websites for primary care specialties has been largely unexplored. Objective: The objective of this study is to review, in an exploratory manner, family medicine, internal medicine, obstetrics and gynecology, and pediatrics residency program websites for number of DEI elements present. By identifying lacking DEI content, we hope to give residency programs that are seeking to increase diversity among applicants some direction for improving their websites. Methods: We reviewed all available residency program websites (1814) in the Fellowship and Residency Electronic Interactive Database (FREIDA) from August to December 2021. Each website was evaluated for the presence of 10 DEI elements chosen from previously published website reviews and informal applicant surveys. Some elements included the presence of resident and faculty photos/biographies, patient population descriptions, and dedicated DEI curricula. Program demographic information was collected, and summative statistics were performed. Results: The average number of DEI elements displayed per program ranged from 3.5 (internal medicine) to 4.9 (pediatrics). The most common elements were resident and faculty photographs/biographies. Internal medicine programs displayed significantly fewer elements than the other 3 specialties. This difference remained significant after controlling for program size, location, and type. Conclusions: This study highlights a lack of DEI elements available for residency program website visitors to review.

Long-Acting Bupivacaine for Pain Control After Cesarean Birth.

OBJECTIVE: To evaluate women's postcesarean pain levels and total opioid use for standard opioid pain management compared with local anesthetic with patient-requested opioids. DESIGN: Retrospective cohort study. SETTING/LOCAL PROBLEM: Rural southeast Ohio. Ohio had a higher rate of opioid use disorder (1.4%) than both the regional average (0.8%) and the national average (0.7%). PARTICIPANTS: We performed a retrospective study of 402 medical records of women who gave birth by cesarean. INTERVENTION: Women were provided one of three types of perioperative anesthesia: routine spinal (standard of care group), wound infiltration with liposomal bupivacaine (LB INF), and transversus abdominis plane (TAP) block with liposomal bupivacaine (LB TAP). Data were collected on the amount of opioids taken postoperatively (measured as morphine milligram equivalents [MME]), pain scores, and history of opioid use. RESULTS: The LB INF and LB TAP groups had significantly lower total and average MME per day than the standard of care group (p < .001). Pain scores for the LB INF group were lower on postoperative day (POD) 0 and POD1, whereas LB TAP pain scores were lower than standard of care pain scores on POD1 (p < .004). Women with a prior history of substance use disorders reported higher pain scores, took more total opioids. and stayed in the hospital longer regardless of type of anesthesia received (p < .001). CONCLUSION: LB INF and LB TAP were associated with lower amounts of opioids used and with lower postcesarean pain scores compared with the standard of care.

Addition of Transversus Abdominis Plane Block to Conventional Pain Regimens in Robotic Sacrocolpopexy Procedures-A Pilot Randomized Controlled Trial (SACROTAP).

IMPORTANCE: There have been no randomized trials assessing the benefits of integration of transversus abdominis plane (TAP) blocks in sacrocolpopexy procedure postoperative pain management. OBJECTIVE: The aim of this study was to assess the variation in pain perception upon adding TAP blocks to conventional oral pain medications in patients undergoing sacrocolpopexy. The primary outcome was the reduction in pain reported using the numeric rating scale (NRS) among patient groups. The secondary outcome was the change in narcotic analgesic use postoperatively. STUDY DESIGN: This was a prospective double-blind, pilot randomized controlled trial of women undergoing robotic sacrocolpopexy, with and without supracervical hysterectomy, with 20 patients enrolled in each arm. Randomization included receiving a TAP block in addition to the conventional analgesic regimen. RESULTS: A total of 48 women were approached to participate in the study; 40 women provided consent (20 per study arm) and completed the 7-day follow-up. Patients receiving a TAP block had lower NRS pain scores at 4 hours postoperatively (4.95 ± 0.76 vs 5.50 ± 0.61, P = 0.02), 7 days postoperatively (2.20 ± 1.11 vs 3.15 ± 1.04, P = 0.008), and lower cumulative NRS pain scores at 48 hours postoperatively (14.90 ± 2.2 vs 16.60 ± 2.04, P = 0.02) and 7 days postoperatively (17.10 ± 2.63 vs 19.75 ± 2.65, P = 0.003) than patients not receiving a block. Patients in the intervention group also had lower cumulative morphine milliequivalents at 7 days postoperatively (17.25 ± 10.7 vs 29.25 ± 14.53, P = 0.005). CONCLUSION: Use of TAP blocks in robotic sacrocolpopexy cases, with or without concurrent hysterectomy, may reduce postoperative pain and narcotic medication needs.

Do medical student mental stress and burnout vary with virtual versus in-person residency interviews.

AIM: This study aimed to identify medical student stressors and mitigation methodologies based on interview modality. MATERIALS & METHODS: A survey was administered to obstetrics and gynecology applicants in in-person (IP) and virtual (VR) National Resident Matching Program cycles. This included demographics, the Mayo Clinic Medical Students Well-Being Index and stressor questions. RESULTS: A total of 137 of 151 surveys were completed (91% response rate). Subjective stress was significant in 76% of IP and 57% of VR applicants (p = 0.07). The objective Mayo Clinic Medical Students Well-Being Index values were higher in the IP (2.47 ± 1.75) compared with the VR group (2.00 ± 1.55; p = 0.10), suggesting lower stress with VR interviews. More IP (53%) compared with VR applicants (44%) were deemed 'at risk' (p < 0.01). CONCLUSION: VR interviews may mitigate select stressors during interviews.

Community Healthy Workers Fill in the Gaps for Participants Who Became Lost to Follow-up in a Healthy Start Program.

The purpose of this mixed methods study was to solicit information from Community Health Workers (CHWs) in order to further understand reasons for Healthy Start participants becoming lost to follow-up after delivery. Four CHWs from a local Healthy Start Program completed questionnaires for participants in their caseloads who had become lost to follow-up from the program (n = 146) between Sep 2018 and Jan 2020. The questionnaire included open ended items about ease of contact before and after delivery, changes in contact information, compliance with prenatal care visits, other life challenges (such as housing, legal, transportation, and family support), family size, living arrangements, working/student status, and substance use. Participants were categorized by ease of contact throughout participation into Easy (28.8%), Easy then Difficult (11%) and Difficult (60.3%). Responses to questions were reviewed and coded to identify common themes. Groups differed on: having a change in contact information, having challenges with transportation, having lots of help, having other children between 6 and 10 years old, compliance with prenatal care, and race being non-Black. Areas where groups differed may indicate possible reasons for participants becoming lost to follow up after delivery. The descriptive results from this study can help CHWs address these issues with participants during prenatal care, when they are easier to contact, to develop contingency plans for remaining in contact after delivery.

Quality improvement: patient education for management of hypertension in pregnancy.

Objective: To assess the effectiveness of interactive education tools for hypertension in pregnancy.Two interactive education tools were introduced.Methods: Pregnant women with hypertension completed questionnaires before (Pre-I) and after)Post-I) the intervention.Providers rated satisfaction and effectiveness of the education methods.Results: The Post-I group (N=45) showed slight improvement on both Perceived (4.5±0.7) and Actual knowledge (2.2 ± 1.0) compared to the Pre-I group (N=45; Perceived: 4.2±1.0; Actual: 1.7±1.3; p<.05) .Providers reported higher satisfaction after the intervention (2.6±1.1 vs 4.1±0.7; p <.001).iscussion: The intervention increased patients' knowledge and providers rating of patient knowledge, and decreased the time needed for patient education.

Neonatal Outcomes After Delivery in Water.

OBJECTIVE: To assess neonatal intensive care unit (NICU) admissions and neonatal outcomes after water birth or land birth in an alternative birthing center. METHODS: We conducted a prospective observational study of preselected low-risk parturients separated into three groups depending on their location for labor and delivery: land-land, water-land, and water-water. Delivery outcomes, labor length, maternal pain assessment, need for newborn resuscitation, and NICU admission and diagnoses were collected. The primary outcome was admission to the NICU. RESULTS: There were 2,077 total deliveries from April 2015 to December 2019, consisting of 458 land-land deliveries, 730 water-land deliveries, and 889 water-water deliveries. The rate of NICU admission was 2.8% (95% CI 1.5-4.8%) for land-land deliveries, 4.1% (2.8-5.8%) for water-land deliveries, and 2.0% (1.2-3.2%) for water-water deliveries. A post hoc power analysis revealed a 70% power to detect a 2.1% difference in NICU admissions between the water-land and water-water groups. CONCLUSION: In this cohort of low-risk pregnant women, births in water and on land were associated with similar rates of admission to the NICU.

Comparison of obstetrician-gynecologists and family physicians regarding weight-related attitudes, communication, and bias.

OBJECTIVES: To assess physician perceptions regarding weight-related communication, quality of care, and bias in obstetrics-gynecology (OBGYN) and family physician (FP) practices. METHODS: A cross-sectional survey study based on a convenient sampling of OBGYN and FP was conducted. Physicians completed a 40-question survey assessing perceived obesity management and weight bias in caring for female patients with body mass index ≥25kg/m2. RESULTS: Reponses from 51 physicians (25 OBGYN and 26 FP) were received. There was no difference between specialties in satisfaction with care or level of confidence in treating patients with obesity. However, OBGYNs reported more negative perceptions of patients with obesity (mean score 19.2±3.3 vs. 15.0±4.0, p<0.001) and greater weight bias (11.8±2.0 vs. 9.7±2.5, p<0.01) compared to FPs. OBGYNs were also more likely to expect less favorable treatment outcomes (13.3±2.5 vs. 15.5±2.8. p<0.01). Physicians between 31-50 years old displayed a significantly higher perception of weight bias in their profession when compared to the reference 21-30year olds, and for each unit increase in self-reported BMI there was a 0.18 average increase in the composite score for perceived weight bias. CONCLUSIONS: OBGYN physicians reported significantly higher levels of weight bias than FP physicians, indicating a need for improved education in OBGYN training. CLINICAL TRIAL REGISTRATION: N/A.

A Risk-Stratified Peri-Operative Protocol for Reducing Surgical Site Infection after Cesarean Delivery.

Background: Surgical site infections (SSI) are multifaceted. Pre-operative, intra-operative, and post-operative factors influence the risk of developing an infection. Our objective was to evaluate the effectiveness of an infection risk-stratification checklist, utilizing known SSI risk factors, and a tailored surgical protocol for SSI prevention in women undergoing cesarean delivery. Patients and Methods: A prospective project to reduce SSI was conducted for women undergoing cesarean delivery on the resident staff service at a midwestern, urban tertiary care hospital. Patients were categorized according to an SSI risk-stratification checklist as high risk or low risk. The low-risk group received the local standard of care (single prophylactic dose of pre-operative intravenous antibiotics and a standard pressure dressing). In the high-risk group, prophylactic antibiotic agents were given pre-operatively and continued for the first 24 hours post-operatively. Additionally, patients at high risk received an absorbent dressing (Mepilex Ag®; Mölnlycke Health Care AB, Gothenburg, Sweden) that was applied in the operating room and worn for one week. Results: The overall rate of SSIs decreased from 6.1% (pre-study rate) to 1.4% after initiation of the protocol, a 77% reduction (p < 0.001). The low- and high-risk groups did not differ in infection rate (0% and 1.4%, respectively; p < 0.59). Both deep incisional and organ/space SSIs decreased after initiation of the protocol (91% and 62% decrease, respectively). Conclusion: Stratifying patients into high- and low-risk groups with tailored peri-operative management strategies reduced overall SSIs. The protocol incorporates known risk factors for SSI in a surgical procedure with high rates of SSI. This approach offers a structured method that can be adopted by other hospital systems for SSI prevention in patients undergoing cesarean delivery.

Optimizing interactions between soluble silk fibroin and capryl glucoside for design of a natural and high-performance co-surfactant system.

OBJECTIVES: Because of the strong consumer driver towards more natural or higher sustainability cosmetic products, silk fibroin was evaluated to help develop a formulation with natural and effective ingredients for personal care. In order to exploit the physical properties of silk fibroin, it was evaluated to maximize the surfactant properties of other commercial ingredients to lower surface tension and build up viscosity. A synergistic effect was seen between silk fibroin and capryl glucoside, a sugar surfactant which exhibited a natural and effective co-surfactant system. This system demonstrated better surface tension properties than sodium laureth sulphate (SLES), cocamidopropyl betaine (CAPB), rhamnolipids and sophorolipids, which led to greater foamability and cleansing properties. This system proved to also be compatible with polysaccharide viscosity modifiers to enhance the viscosity of the system. The present study comprises a systematic exploration of natural formulation development of silk proteins and other natural ingredients, which result in high performance such as enhanced foam quality, foam stability and enhanced sebum removal. All of these properties are desirable and may utilized when formulating cleaners and shampoos. METHODS: A force tensiometer, Attension Sigma 701, was used to measure the surface tension of the silk protein and its various combinations with biosurfactants and biopolymers. To measure bulk rheology, a traditional mechanical rheometer TA DHR-3 was utilized. Foaming tests and sebum removal assays were also carried out to evaluate the performance of the samples. RESULTS: Silk fibroin was evaluated to maximize the surfactant properties of other commercial systems to develop a formulation containing natural and effective ingredients for personal care. The surface activity of silk proteins was seen to be synergistically enhanced in the presence of sugar surfactants such as capryl glucoside, resulting in a surface tension at the air-water interface which is lower than either that of pure silk fibroin or pure capryl glucoside. This surface tension value is additionally lower than that obtained from currently utilized synthetic surfactants like sodium laureth sulphate (SLES) and cocamidopropyl betaine (CAPB). This reduction in surface tension demonstrated greater foamability and cleansing properties than that of the commercial systems. The very low surface tension values obtained through combinations of silk proteins and glucoside resulted in a natural and effective co-surfactant system by forming high-quality stable foams and enhancing sebum removal. The rheological performance of the silk proteins was impacted through microstructure modifications as a result of interactions with biopolymers like carrageenan. This shows that this system is compatible with polysaccharide viscosity modifiers. It was observed that both the flow curve and the absolute viscosity values were significantly impacted in the presence of carrageenan, with higher viscosity generation and significant non-Newtonian/shear thinning behaviour evolution. These results indicate that the silk fibroin can be utilized to build a high-performance natural product and significantly enhance the performance of other natural/sustainable cosmetic formulations through building synergistic interactions with other natural ingredients such as sugar surfactants and biopolymers. These properties exhibited by this system are all desirable for cleansers and shampoos within the cosmetic industry. CONCLUSION: Silk fibroin in combination with capryl glucoside outperforms other commercial surfactants that are commonly used in the industry because of its surface-active behaviour and synergy. This system is then enhanced further with polysaccharide rheological modifiers, carrageen and xanthan gum to help build up viscosity. The complex mixture of silk fibroin, sugar surfactant and biopolymer results in a formulation that is all natural, while still having high performance by achieving great foamability and enhanced sebum removal. The mixture can further be used to formulate a fully natural product such as a cleanser or shampoo while still having the same or greater effectiveness as synthetic surfactants and ingredients typically used in cosmetic formulations.

OBJECTIFS: En raison de la forte incitation des consommateurs vers des produits cosmétiques plus naturels ou plus durables, la fibroïne de soie a été évaluée pour aider à développer une formulation avec des ingrédients naturels et efficaces pour les soins personnels. Afin d'exploiter les propriétés physiques de la fibroïne de soie, il a été évalué pour maximiser les propriétés tensioactives d'autres ingrédients commerciaux pour abaisser la tension superficielle et augmenter la viscosité. Un effet synergique a été observé entre la fibroïne de soie et le capryl glucoside, un tensioactif de sucre qui présentait un système de co-tensioactif naturel et efficace. Ce système a démontré de meilleures propriétés de tension superficielle que le laureth sulfate de sodium (SLES), la cocamidopropyl bétaïne (CAPB), les rhamnolipides et les sophorolipides, ce qui a conduit à une plus grande moussabilité et des propriétés de nettoyage. Ce système s'est avéré également compatible avec les modificateurs de viscosité polysaccharidiques pour améliorer la viscosité du système. La présente étude comprend une exploration systématique du développement de formulation naturelle de protéines de soie et d'autres ingrédients naturels, qui se traduisent par des performances élevées telles qu'une qualité de mousse améliorée, une stabilité de la mousse et une élimination améliorée du sébum. Toutes ces propriétés sont souhaitables et peuvent être utilisées lors de la formulation de nettoyants et de shampooings. MÉTHODES: Un tensiomètre de force, Attension Sigma 701, a été utilisé pour mesurer la tension superficielle de la protéine de soie et ses diverses combinaisons avec des biosurfactants et des biopolymères. Pour mesurer la rhéologie de masse, un rhéomètre mécanique traditionnel TA DHR-3 a été utilisé. Tests de moussage et dosages d'élimination du sébum ont également été réalisés pour évaluer les performances des échantillons. RÉSULTATS: La fibroïne de soie a été évaluée pour maximiser les propriétés tensioactives d'autres systèmes commerciaux afin de développer une formulation contenant des ingrédients naturels et efficaces pour les soins personnels. L'activité de surface des protéines de soie s'est avérée être renforcée de manière synergique en présence d'agents tensioactifs de sucre tels que le capryl glucoside, entraînant une tension de surface à l'interface air-eau qui est inférieure à celle de la fibroïne de soie pure ou du capryl glucoside pur. Cette valeur de tension superficielle est en outre inférieure à celle obtenue à partir d'agents tensioactifs synthétiques actuellement utilisés comme le laureth sulfate de sodium (SLES) et la cocamidopropyl bétaïne (CAPB). Cette réduction de la tension superficielle a démontré une moussabilité et des propriétés de nettoyage supérieures à celles des systèmes commerciaux. Les très faibles valeurs de tension superficielle obtenues grâce à des combinaisons de protéines de soie et de glucoside ont abouti à un système de co-tensioactif naturel et efficace en formant des mousses stables de haute qualité et en améliorant l'élimination du sébum. Les performances rhéologiques des protéines de soie ont été affectées par des modifications de microstructure à la suite d'interactions avec des biopolymères comme le carraghénane. Cela montre que ce système est compatible avec les modificateurs de viscosité polysaccharidiques. Il a été observé que la courbe d'écoulement et les valeurs de viscosité absolue étaient significativement affectées en présence de carraghénane, avec une génération de viscosité plus élevée et une évolution significative du comportement d'amincissement non newtonien / cisaillement. Ces résultats indiquent que la fibroïne de soie peut être utilisée pour construire un produit naturel haute performance et améliorer considérablement les performances d'autres formulations cosmétiques naturelles / durables en créant des interactions synergiques avec d'autres ingrédients naturels tels que les tensioactifs de sucre et les biopolymères. Ces propriétés présentées par ce système sont toutes souhaitables pour les nettoyants et les shampooings dans l'industrie cosmétique. CONCLUSION: La fibroïne de soie en combinaison avec le capryl glucoside surpasse les autres tensioactifs du commerce couramment utilisés dans l'industrie en raison de son comportement tensioactif et de sa synergie. Ce système est ensuite amélioré avec des modificateurs rhéologiques polysaccharidiques, de la carraghénine et de la gomme xanthane pour aider à augmenter la viscosité. Le mélange complexe de fibroïne de soie, de tensioactif de sucre et de biopolymère donne une formulation entièrement naturelle, tout en conservant des performances élevées en obtenant une grande capacité de moussage et une élimination améliorée du sébum. Le mélange peut en outre être utilisé pour formuler un produit entièrement naturel tel qu'un nettoyant ou un shampooing tout en ayant toujours la même efficacité ou une plus grande efficacité que les tensioactifs synthétiques et les ingrédients généralement utilisés dans les formulations cosmétiques.

Saline-Air Hysterosalpingo-Contrast Sonography Is Equivalent to the Modified Hysterosalpingogram Following Hysteroscopic Sterilization.

PURPOSE: To estimate the diagnostic efficacy of saline-air hysterosalpingo-contrast sonography (SA-HyCoSy) compared with the modified hysterosalpingogram (mHSG) for confirmation of both coil location and tubal occlusion following hysteroscopic sterilization. METHODS: This study included 19 women who underwent both SA-HyCoSy and mHSG where 1 test was followed by the other. Sensitivity, specificity, and positive and negative predictive values for tubal occlusion against the mHSG were calculated for each fallopian tube by 2 independent interpreters. Interrater reliability was assessed using Cohen κ statistic. Procedure time and pain level by 11-point numeric rating scale of SA-HyCoSy and mHSG were also compared. RESULTS: Thirty-eight fallopian tubes were evaluated. Tubal occlusion was noted in 97.3% of tubes for both interpreters with the mHSG compared with 92.1% and 94.7% with SA-HyCoSy. The positive and negative predictive values for tubal occlusion were 100%/100% and 50%/33%, respectively, with an overall agreement of 97.4% and 95.7%, κ = 0.48, P < 0.01. Saline-air HyCoSy changed interpretation of coil insert location in 50% and 44.7% for each interpreter, being downgraded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13), respectively. There were no statistically significant differences in procedural time (7.5 vs 9.4 minutes, P > 0.05) or maximum pain scores (2.3 vs 3.1, P > 0.05) for the mHSG compared with SA-HyCoSy. CONCLUSIONS: Our findings revealed a high degree of diagnostic accuracy with SA-HyCoSy for tubal occlusion, although coil location changed in nearly half of cases. Avoidance of radiation and patient convenience/compliance with SA-HyCoSy may outweigh the drawbacks.

Enterocele Presenting as Anterior Rectal Prolapse: Resolution with Vaginal Repair.

An enterocele is a pelvic hernia formed from the separation of endopelvic fascia, associated with the posterior or anterior vaginal fornix, and most commonly located in the posterior superior vaginal segment. Rectal prolapse is a debilitating condition in which the mucosa of the rectum protrudes circumferentially from the anus. Surgical repair is the recommended treatment for rectal prolapse, and though there are many different surgical options, there is no consensus on which approach is best. We present a case of anterior rectal prolapse due to enterocele which was treated by correction of enterocele with a vaginal approach and propose some clinical features and diagnostic techniques that may distinguish this entity from traditional rectal prolapse.