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Allen Rossen posted an update 6 months, 1 week ago
The objective of our study was to provide a contemporary description of hysterectomy practice and temporal trends in Canada.
A national whole-population retrospective analysis of data from the Canadian Institute for Health Information.
Canada.
All women who underwent hysterectomy for benign indication from April 1, 2007, to March 31, 2017, in Canada.
Hysterectomy.
A total of 369 520 hysterectomies were performed in Canada during the 10-year period, during which the hysterectomy rate decreased from 313 to 243 per 100 000 women. The proportion of abdominal hysterectomies decreased (59.5% to 36.9%), laparoscopic hysterectomies increased (10.8% to 38.6%), and vaginal hysterectomies decreased (29.7% to 24.5%), whereas the national technicity index increased from 40.5% to 63.1% (p <.001, all trends). The median length of stay decreased from 3 (interquartile range 2-4) days to 2 (interquartile range 1-3), and the proportion of patients discharged within 24 hours increased from 2.1% to 7.2%. In year 20uebec, and Alberta were not significantly different.
The proportion of minimally invasive hysterectomies for benign indication has increased significantly in Canada. The declining use of vaginal approaches and the variation among provinces are of concern and necessitate further study.
The proportion of minimally invasive hysterectomies for benign indication has increased significantly in Canada. The declining use of vaginal approaches and the variation among provinces are of concern and necessitate further study.
To evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE).
Single-center retrospective cohort study.
University hospital.
A total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan.
Surgical resection of the DIE nodule from the dorsal compartment.
After surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Iberdomide purchase Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3-18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001).
Postoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.
3 cm, a higher risk of postoperative voiding dysfunction is to be expected.The destabilization/reconsolidation process can be triggered by memory recall, allowing consolidated memories to be modified. We have previously reported that stress prior to fear conditioning induces memories that exhibit resistance to the engagement of some molecular events associated with the destabilization/reconsolidation process. Here, we evaluated whether stress could affect the expression of Lys-48 polyubiquitinated proteins within the basolateral amygdala complex, a phenomenon crucially linked to memory destabilization. As expected, a post-recall increase of Lys-48 polyubiquitinated proteins in control animals was observed; however, this phenomenon was prevented by stress exposure before fear conditioning. On the other hand, pre-recall administration of D-cycloserine -a positive modulator of NMDA sites capable of reverting memory resistance to pharmacological interference-, facilitated the increase of Lys-48 polyubiquitinated proteins in stressed animals. In conclusion, the protein polyubiquitination-dependent destabilization is impaired after the recall of stress-induced resistant memories, with D-cycloserine restoring such molecular event. Hence, the present report contributes to further characterize the neurobiological events associated with stress-induced memory resistance as well as to corroborate the connection between glutamatergic signaling, protein degradation and memory destabilization in stress-induced resistant memories.A rich body of studies in the human and non-human literature has examined the question how novelty influences memory. For a variety of different stimuli, ranging from simple objects and words to vastly complex scenarios, the literature reports that novelty improves memory in some cases, but impairs memory in other cases. In recent attempts to reconcile these conflicting findings, novelty has been divided into different subtypes, such as relative versus absolute novelty, or stimulus versus contextual novelty. Nevertheless, a single overarching theory of novelty and memory has been difficult to attain, probably due to the complexities in the interactions among stimuli, environmental factors (e.g., spatial and temporal context) and level of prior knowledge (but see Duszkiewicz et al., 2019; Kafkas & Montaldi, 2018b; Schomaker & Meeter, 2015). Here we describe how a predictive coding framework might be able to shed new light on different types of novelty and how they affect declarative memory in humans. More precisely, we consider how prior expectations modulate the influence of novelty on encoding episodes into memory, e.g., in terms of surprise, and how novelty/surprise affect memory for surrounding information. By reviewing a range of behavioural findings and their possible underlying neurobiological mechanisms, we highlight where a predictive coding framework succeeds and where it appears to struggle.
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