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Aim: An estimated 5%-25% of women with endometriosis have colorectal involvement. Colorectal resection is the most suitable surgical management for cases with large bowel infiltration. However, this method is also associated with the highest rate of postoperative complications. Data focusing on surgeon speciality and surgical outcomes are currently limited. The aim of this work was to evaluate the surgical characteristics and short-term postoperative outcomes following colorectal resection for endometriosis according to surgeon speciality., Method: Using the National Surgical Quality Improvement Program (NSQIP) database, we included women who underwent colorectal resection for endometriosis between 2012 and 2020. Surgeries by general/colorectal surgeons were compared with those by gynaecological surgeons. The primary outcome was major complications according to the Clavien-Dindo classification., Results: Among 745 colorectal resections, 82.3% were performed by general/colorectal surgeons and 17.7% by gynaecologists. Racial and ethnic characteristics differed between groups, but other baseline characteristics were comparable. General/colorectal surgeons performed fewer minimally invasive surgeries (29.9% vs. 58.3%, p < 0.001). General/colorectal surgery cases had lower rates of any postoperative complications and minor complications (14.8% vs. 29.5%, p < 0.001; 10.1% vs. 23.5%, p < 0.001), while major complication rates were similar. Multivariable regression showed no association between major complications and surgical speciality. In a propensity score-matched analysis, no significant differences were found between the two cohorts., Conclusion: Most colorectal resections are performed by general/colorectal surgeons while a minimally invasive approach is more common among gynaecologists. There were no significant differences in outcomes between the two groups after adjusting for confounding variables. This suggests considering a multidisciplinary or dual surgery team approach to deep infiltrative endometriosis requiring bowel resection., (© 2025 Association of Coloproctology of Great Britain and Ireland.)

Background: The Laparoscopic Approach to Cervical Cancer study results revolutionized our understanding of the best surgical management for this disease. After its publication, the guidelines state that the standard and recommended approach for radical hysterectomy is an open abdominal approach. Nevertheless, the effect of the Laparoscopic Approach to Cervical Cancer trial on real-world changes in the surgical approach to radical hysterectomy remains elusive., Objective: This study aimed to investigate the trends and routes of radical hysterectomy and to evaluate postoperative complication rates before and after the Laparoscopic Approach to Cervical Cancer trial (2018)., Study Design: The National Surgical Quality Improvement Program registry was used to examine radical hysterectomy for cervical cancer performed between 2012 and 2022. This study excluded vaginal radical hysterectomies and simple hysterectomies. The primary outcome measures were the trends in the route of surgery (minimally invasive surgery vs laparotomy) and surgical complication rates, stratified by periods before and after the publication of the Laparoscopic Approach to Cervical Cancer trial in 2018 (2012-2017 vs 2019-2022). The secondary outcome measure was major complications associated specifically with the different routes of surgery., Results: Of the 3611 patients included, 2080 (57.6%) underwent laparotomy, and 1531 (42.4%) underwent minimally invasive radical hysterectomy. There was a significant increase in the minimally invasive surgery approach from 2012 to 2017 (45.6% in minimally invasive surgery in 2012 to 75.3% in minimally invasive surgery in 2017; P<.01) and a significant decrease in minimally invasive surgery from 2018 to 2022 (50.4% in minimally invasive surgery in 2018 to 11.4% in minimally invasive surgery in 2022; P<.001). The rate of minor complications was lower in the period before the Laparoscopic Approach to Cervical Cancer trial than after the trial (317 [16.9%] vs 288 [21.3%], respectively; P=.002). The major complication rates were similar before and after the Laparoscopic Approach to Cervical Cancer trial (139 [7.4%] vs 78 [5.8%], respectively; P=.26). The rates of blood transfusions and superficial surgical site infections were lower in the period before the Laparoscopic Approach to Cervical Cancer trial than in the period after the trial (137 [7.3%] vs 133 [9.8%] [P=.012] and 20 [1.1%] vs 53 [3.9%] [P<.001], respectively). In a comparison of minimally invasive surgery vs laparotomy radical hysterectomy during the entire study period, patients in the minimally invasive surgery group had lower rates of minor complications than in those in the laparotomy group (190 [12.4%] vs 472 [22.7%], respectively; P<.001), and the rates of major complications were similar in both groups (100 [6.5%] in the minimally invasive surgery group vs 139 [6.7%] in the laparotomy group; P=.89). In a specific complications analysis, the rates of blood transfusion and superficial surgical site infections were lower in the minimally invasive surgery group than in the laparotomy group (2.4% vs 12.7% and 0.6% vs 3.4%, respectively; P<.001; for both comparisons), and the rate of deep incisional surgical site infections was lower in the minimally invasive surgery group than in the laparotomy group (0.2% vs 0.7%, respectively; P=.048). In the multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with the occurrence of major complications (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65)., Conclusion: Although the proportion of minimally invasive radical hysterectomies decreased abruptly after the Laparoscopic Approach to Cervical Cancer trial, there was no change in the rate of major postoperative complications. In addition, the hysterectomy route was not associated with major postoperative complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs)., Design: Retrospective cohort study., Setting: Quaternary care academic hospital., Patients: Patients undergoing MIH for benign indications from March 2015 to March 2020 were included., Interventions: MIH., Measurements and Main Results: The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons' group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36-3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70-4.12). Major intra- or postoperative complications were associated with surgeons' groups (OR, 7.02; 95% CI, 2.67-18.47, and OR, 6.84; 95% CI, 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52-20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07-4.22; OR, 2.48; 95% CI, 1.49-4.12, respectively)., Conclusion: Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Research Question: We aimed to assess the impact of Body Mass Index (BMI) on 30-day postoperative complications in patients undergoing minimally invasive hysterectomy (MIH) for fibroids., Design: Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2012-2020), we analyzed major and minor 30-day postoperative complications, stratified by BMI, in patients with uterine fibroids who underwent MIH. Complications were stratified according to the Clavien-Dindo classification., Results: Among 61,192 patients, overall complication rates ranged from 6.3 % to 8.1 %, with the highest rates in obesity class 3. Significant differences were observed in minor complication rates across BMI groups, though major complication rates did not significantly vary. Higher BMI classes correlated with longer operative times, with mean durations ranging from 127.1 min in the lowest BMI group to 158.1 min in the highest BMI group (p < 0.001). In multivariable regression, higher BMI was associated with increased odds of minor complications [2 , aOR 95 % CI = 1.10 (1.01-1.21)]. There was no significant association between lower and higher BMI (2 ) and major complications. Additionally, overweight, obesity class 2 and 3 were independently associated with lower odds of major complications [aOR 95 % CI 0.82 (0.71-0.94), 0.77 (0.64-0.92) and 0.82 (0.67-1.00), respectively], compared to the normal BMI group. BMI categories were not independently associated with any or minor complications compared to normal the normal BMI category., Conclusion: After adjusting for confounding factors, overweight, obesity class 2 and 3 are associated with a decreased risk of major complications compared to normal BMI. In contrast, BMI categories were not associated with any- or minor complications. Higher BMI classes were associated with longer operative times., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: RS- Claria Medical- consultant; MS- Applied Medical- consultant, Claria Medical- consultant; KW- Aqua Therapeutics- consultant, Hologic- consultant, Ethicon- consultant, Karl Storz- consultant; RM- Claria Medical- consultant; All other authors report no conflicts of interest, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To study characteristics and identify factors associated with full manuscript publication of oral abstracts presented at gynecologic surgery societies' annual meetings., Study Design: We reviewed all oral abstracts presented at four major gynecologic surgery meetings in 2018. Oral abstracts subsequently published as peer-reviewed manuscripts were compared to those that were not published. Descriptive statistical analysis and multivariable regression analyses were conducted to identify factors associated with peer-reviewed manuscript publication., Results: A total of 396 oral presentation abstracts from the four nationally recognized gynecologic societies were identified. The overall journal publication rate was 47.4% (188/396). The rate of publication of oral abstracts was 35.1% (72/205) for those presented at AAGL, 73.8% (62/84) for AUGS, 53.2% (42/79) for SGO and 42.9% (12/28) for SGS. In multivariable regression analysis, last author's H-index [aOR 95% CI 1.02 (1.00-1.03)], academic center affiliation [aOR 95% CI 2.29 (1.20-4.37)], and randomized controlled trials [aOR 95% CI 2.47 (1.12-5.47)] were associated with journal publication. Of the published articles, the median time to publication was 3.0 years [1.0-5.0], the median journal impact factor was 3.9 [1.8-4.8], the median relative citation ratio was 1.0 [0.4-1.9], and the median number of citations per year was 2.0 [1.0-4.1]., Conclusions: In the field of gynecologic surgery, several factors, including the last researcher's H-index, academic affiliation, randomized controlled trial design and type of societal meeting are associated with increased odds of an oral abstract ultimately reaching full manuscript peer-reviewed publication. These findings can serve researchers in the fields of gynecologic surgical subspecialties., Competing Interests: Declarations. Conflict of interest: None relevant to this study; included for complete transparency. Rebecca Schneyer: Consultant for Ethicon and Intuitive Surgical. Kelly N. Wright: Consultant for Aqua Therapeutics, Hologic, Karl Storz. Matthew T. Siedhoff: Consultant for Applied Medical. Raanan Meyer: Consultant for Intuitive Surgical, Claria Medical. The remaining authors report no conflict of interest. Ethical approval: As the study used deidentified, publicly available data, it was deemed exempt by the Institutional Review Board of the Cedars Sinai Medical Center (#00003363)., (© 2024. The Author(s).)

Study Objective: To compare surgical outcomes among patients undergoing minimally invasive myomectomy (MIM) or abdominal myomectomy (AM) with MIGS subspecialists versus general obstetrician/gynecologists (OB/GYNs), and to characterize the complexity of myomectomies by surgeon type., Design: Retrospective cohort study., Setting: Quaternary care institution., Participants: Patients who underwent MIM (laparoscopic or robotic) or AM with a fellowship-trained MIGS subspecialist or general OB/GYN from March 15, 2015 to March 14, 2020., Interventions: Myomectomy., Results: Of 609 myomectomies, 460 (75.5%) were MIM, 404 (87.8%) of which were performed by MIGS subspecialists. The remaining 149 (24.5%) cases were AM, 36 (24.1%) of which were performed by MIGS subspecialists. Compared to general OB/GYNs, MIGS subspecialists excised a greater number of fibroids for both MIM (median 3.0 [range 1.0-30.0] vs 2.0 [1.0-9.0], p <.001) and AM (21.0 [10.0-60.0] vs 6.0 [1.0-42.0], p <.001), and had a greater proportion of uteri >20 weeks size for AM (22.2% vs 3.5%, p = .003). Composite perioperative complication rates were significantly higher for general OB/GYNs than for MIGS subspecialists (29.0% vs 11.8%, adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 1.48-4.92). In a subgroup analysis of MIM only, general OB/GYNs had higher rates of composite perioperative complications (28.6% vs 9.9%, aOR 4.51, 95% CI 2.27-8.97), excessive blood loss and/or transfusion (10.7% vs 3.0%, unadjusted odds ratio [OR] 3.92, 95% CI 1.41-10.91), surgery time ≥ 90th percentile (25.0% vs 8.9%, aOR 5.05, 95% CI 2.39-10.64), and conversions to laparotomy (10.7% vs 0.2%, unadjusted OR 48.36, 95% CI 5.71-409.93). For AM only, there were no significant differences in perioperative complication rates between groups., Conclusion: Fellowship-trained MIGS subspecialists had improved surgical outcomes for MIM compared to general OB/GYNs, with fewer conversions to laparotomy, reduced surgery time, and less blood loss, while outcomes for AM were similar by surgeon type. MIGS subspecialists excised a greater number of fibroids regardless of surgical approach, highlighting a level of comfort in complex benign gynecology beyond endoscopic surgery at our institution., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objectives: Due to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy., Method: We used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012-2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration., Results: Overall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01-1.05)], diabetes [aOR 1.82 95 % CI (1.13-3.22)], low serum albumin [aOR 0.73 95 % CI (0.54-0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05-2.77)]., Conclusions: Major postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Study Objective: To evaluate the impact of virtual versus in-person preoperative evaluation on perioperative complication rates in a minimally invasive gynecologic surgery (MIGS) practice., Design: Retrospective cohort study., Setting: Quaternary care academic hospital in the United States., Participants: Patients who underwent surgery with a MIGS surgeon between January 2016 and May 2023., Interventions: Patients underwent either in-person or virtual preoperative visits (defined as the initial consultation and any subsequent follow-up or preoperative counseling visits). Those who had both an in-person and virtual preoperative visit were excluded. Complication rates among the virtual and in-person cohorts were compared, and logistic regression was performed to adjust for potential confounders., Results: The analysis included 2,947 patients, 1196 (40.6%) with exclusively virtual preoperative visits and 1751 (59.4%) with exclusively in-person visits. Following the implementation of telemedicine in 3/2020, 80.6% of patients had all their preoperative visits conducted virtually via videoconference. Surgical approach included conventional laparoscopy (78.8%), robotic-assisted laparoscopy (3.8%), laparotomy (2.1%), and other gynecologic procedures without abdominal entry (15.3%). The most common procedures were endometriosis excision (43.1%), myomectomy (34.0%), and hysterectomy (24.8%). Composite perioperative complication rates were similar between cohorts (5.9% virtual vs 6.3% in-person, adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.58-1.17). There were no significant differences for major complications (2.3% virtual vs 1.2% in-person, aOR 1.52, 95% CI 0.85-2.74) or minor complications (5.7% virtual vs 6.1% in-person, aOR 0.83, 95% CI 0.59-1.19). Conversion to laparotomy was rare in both groups (0.1% virtual vs 0.2% in-person)., Conclusion: Implementation of virtual preoperative visits within a MIGS practice did not impact composite surgical complication rates. For subspecialized gynecologic surgeons, a virtual preoperative evaluation may offer a safe alternative to the traditional in-person visit., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Uterine leiomyomas are common benign neoplasms, often causing symptoms like abnormal uterine bleeding, pelvic pain, and subfertility, with treatment options ranging from medical management to surgical interventions such as myomectomy. While myomectomy is effective in symptom relief, the impact of body mass index (BMI) on postoperative complications remains underexplored, warranting further investigation., Objective: This study aimed to assess the relationship between BMI and short-term postoperative complications after myomectomy., Study Design: An analysis of major and minor 30-day postoperative complications stratified by BMI among patients who underwent abdominal or laparoscopic (conventional or robotic-assisted) myomectomy was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Vaginal myomectomy cases were excluded from this study. Complications were stratified according to the Clavien-Dindo classification., Results: A total of 27,387 cases were included. Postoperative complications occurred in 11.4% of cases (n=3131), ranging from 9.4% among patients who were underweight (n=26) to 16.1% among patients with obesity class 3 (n=350) (P<.001). In multiple regression analysis, patients with obesity class 1 experienced fewer major postoperative complications (adjusted odds ratio, 0.71; 95% confidence interval, 0.53-0.96) than those with normal BMI. Conversely, patients with obesity class 2 demonstrated more complications (adjusted odds ratio, 1.18; 95% confidence interval, 1.03-1.35), including minor complications (adjusted odds ratio, 1.17; 95% confidence interval, 1.02-1.34), than those with normal BMI. In addition, patients with obesity class 3 demonstrated more complications (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.47), including minor (adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42) and major (adjusted odds ratio, 1.41; 95% confidence interval, 1.01-21.99) complications, than those with normal BMI. Similar outcomes were observed when analyzing abdominal myomectomy exclusively, with disparities being much less pronounced when the analysis was confined to laparoscopic myomectomy., Conclusion: Patients with class 2 or 3 obesity are at increased odds of experiencing complications after myomectomy, whereas those with a slightly elevated body mass index may experience a protective effect. Complications related to BMI predominantly manifest after abdominal myomectomy procedures rather than after laparoscopic approaches., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To study the rate and odds of 30 day postoperative complications among patients undergoing minimally invasive total (TLH) compared to supracervical (LSCH) hysterectomy for endometriosis., Study Design: A cohort study of patients with a diagnosis of endometriosis undergoing hysterectomy. We used prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. We compared short-term (30 day) complications, following minimally invasive TLH and LSCH for endometriosis. The primary outcome was the risk of any postoperative complications according to the surgical approach., Results: A total of 5,278 patients were included, 4,952 (93.8%) underwent TLH and 326 (6.2%) underwent LSCH. The incidence of any complication was significantly lower in the LSCH group compared to the TLH group (3.7% vs. 8.5%, p = .001). Both major complications (1.5% vs. 3.7%, p = 0.043) and minor complications (2.8% vs. 5.4%, p = .039) were less frequent in the LSCH group compared to the TLH group. In multivariable regression analysis, patients undergoing LSCH had significantly lower odds of any complication [aOR 95%CI 0.40 (0.22-0.72)], and of minor complications [aOR 95%CI 0.47 (0.24-0.92)] compared to TLH., Conclusions: LSCH is associated with a lower odd of short-term postoperative complications compared to TLH for patients with endometriosis., (© 2024. The Author(s).)

Background: Uterine fibroids are the most common indication for benign hysterectomy in the United States, but data regarding the association between hysterectomy type and outcomes for this indication are lacking., Objective: This study aimed to describe the rate and odds of short-term (30 days) postoperative complications between patients who underwent minimally invasive total laparoscopic hysterectomy and those who underwent laparoscopic supracervical hysterectomy for uterine fibroids., Study Design: This was a cohort study of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. The characteristics of women who underwent total laparoscopic hysterectomy and those who underwent laparoscopic supracervical hysterectomy for uterine fibroids were identified. In addition, the risk factors associated with the occurrence of 30-day postoperative complications, defined according to the Clavien-Dindo classification, were identified. Multivariate regression analysis, including age, body mass index, race, comorbidities, American Society of Anesthesiologists classification, uterine weight, and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The co-primary outcomes were (1) the risk of a composite of any postoperative complications and (2) the risk of major postoperative complications according to surgical type., Results: Overall, 44,413 patients underwent minimally invasive total laparoscopic hysterectomy, and 6383 patients underwent laparoscopic supracervical hysterectomy. The operative time was shorter in the total laparoscopic hysterectomy group than in the laparoscopic supracervical hysterectomy group (143.0 vs 150.6 minutes, respectively; P < .001). In addition, the proportion of uterine weight of >250 g was lower in the total laparoscopic hysterectomy group than in the laparoscopic supracervical hysterectomy group (39.4% vs 45.1%, respectively; P < .001). The rates of any and major complications were higher in the total laparoscopic hysterectomy group than in the laparoscopic supracervical hysterectomy group (any complications: 6.6% vs 5.3%, respectively; P < .001; major complications: 2.7% vs 1.6%, respectively; P < .001), whereas the rates of minor complications were comparable in both groups (4.4% vs 4.1%, respectively; P = .309). In multivariate regression analysis, laparoscopic supracervical hysterectomy was independently associated with a lower risk of any (adjusted odds ratio, 0.79; 95% confidence interval, 0.70-0.88) and major (adjusted odds ratio, 0.55; 95% confidence interval, 0.44-0.69) complications than total laparoscopic hysterectomy., Conclusion: Laparoscopic supracervical hysterectomy was associated with a lower risk of short-term postoperative complications in patients with uterine fibroids than total laparoscopic hysterectomy. Our findings can aid in shared decision-making before minimally invasive hysterectomy for uterine fibroids., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates., Design: A retrospective cross-sectional study., Setting: AAMC databases were queried for demographic information between 2011 and 2023., Patients/subjects: AAGL FMIGS fellows and graduates., Interventions: N/A MEASUREMENTS AND MAIN RESULTS: Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population. 477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)]., Conclusion: White and Hispanic fellows' representation was lower than expected, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows' representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the rate and surgical outcomes of sentinel lymph node (SLN) biopsy in patients with endometrial intraepithelial neoplasia (EIN)., Methods: We conducted a cohort study that used the prospective American College of Surgeons National Surgical Quality Improvement Program database. Women with EIN on postoperative pathology who underwent minimally invasive hysterectomy from 2012 to 2020 were included. The cohort was dichotomized based on the performance of SLN biopsy. Patients' characteristics, perioperative morbidity, and mortality were compared between patients who underwent SLN biopsy and those who did not. Postoperative complications were defined using the Clavien-Dindo classification system., Results: Overall, 4,447 patients were included; of those, 586 (13.2%) underwent SLN biopsy. The proportion of SLN biopsy has increased steadily from 0.6% in 2012 to 26.1% in 2020 ( P <.001), with a rate of 16% increase per year. In a multivariable regression that included age, body mass index (BMI), and year of surgery, a more recent year of surgery was independently associated with an increased adjusted odds ratio of undergoing SLN biopsy (1.51, 95% CI, 1.43-1.59). The mean total operative time was longer in the SLN biopsy group (139.50±50.34 minutes vs 131.64±55.95 minutes, P =.001). The rate of any complication was 5.9% compared with 6.7%, the rate of major complications was 2.3% compared with 2.4%, and the rate of minor complications was 4.1% compared with 4.9% for no SLN biopsy and SLN biopsy, respectively. In a single complications analysis, the rate of venous thromboembolism was higher in the SLN biopsy group (four [0.7%] vs four [0.1%], P =.013). In a multivariable regression analysis adjusted for age, BMI, American Society of Anesthesiologists classification, uterus weight, and preoperative hematocrit, the performance of SLN biopsy was not associated with any complications, major complications, or minor complications., Conclusion: The performance of SLN biopsy in EIN is increasing. Sentinel lymph node biopsy for EIN is associated with an increased risk of venous thromboembolism and a negligible increased surgical time., Competing Interests: Financial Disclosure Jason D. Wright's institution received payments from Merck. He received payments from UpToDate. The other authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis., Recent Findings: The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design., Summary: The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Uterine fibroids are the most common benign tumors that affect females. A laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of a myomectomy is excessive bleeding. However, risk factors for hemorrhage during a laparoscopic myomectomy are not well studied and no risk stratification tool specific for identifying the need for a blood transfusion during a laparoscopic myomectomy currently exists in the literature., Objective: This study aimed to identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool to determine the risk for requiring a blood transfusion., Study Design: This was a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Women who underwent a laparoscopic (conventional or robotic) myomectomy were included. Women who received 1 or more blood transfusions within 72 hours after the start time of a laparoscopic myomectomy were compared with those who did not require a blood transfusion. A multivariable analysis was performed to identify risk factors independently associated with the risk for transfusion. Two risk stratification tools to determine the need for a blood transfusion were developed based on the multivariable results, namely (1) based on preoperative factors and (2) based on preoperative and intraoperative factors., Results: During the study period, 11,498 women underwent a laparoscopic myomectomy. Of these, 331(2.9%) required a transfusion. In a multivariable regression analysis of the preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, American Society of Anesthesiologists class III or IV classification, and a preoperative hematocrit value ≤35.0% were independently associated with the risk for transfusion. Identified intraoperative factors included specimen weight >250 g or ≥5 intramural myomas and an operation time of ≥197 minutes. A risk stratification tool was developed in which points are assigned based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of the points., Conclusion: We identified preoperative and intraoperative independent risk factors for a blood transfusion among women who underwent a laparoscopic myomectomy. A risk stratification tool to determine the risk for requiring a blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To study racial and ethnic disparities among women undergoing hysterectomy performed for adenomyosis across the United States., Design: A cohort study., Setting: Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2012-2020., Patients: Patients with an adenomyosis diagnosis., Intervention: Hysterectomy for adenomyosis., Main Outcome Measures: Patients were identified using the International Classification of Diseases 9th and 10th editions codes 617.0 and N80.0 (endometriosis of the uterus). Hysterectomies were classified on the basis of the Current Procedural Terminology codes. We compared baseline and surgical characteristics and 30-day postoperative complications across the different racial and ethnic groups. Postoperative complications were classified into minor and major complications according to the Clavien-Dindo classification system., Results: A total of 12,599 women underwent hysterectomy for adenomyosis during the study period: 8,822 (70.0%) non-Hispanic White, 1,597 (12.7%) Hispanic, 1,378 (10.9%) non-Hispanic Black or African American, 614 (4.9%) Asian, 97 (0.8%) Native Hawaiian or Pacific Islander, and 91 (0.7%) American Indian or Alaska Native. Postoperative complications occurred in 8.8% of cases (n = 1,104), including major complications in 3.1% (n = 385). After adjusting for confounders, non-Hispanic Black race and ethnicity were independently associated with an increased risk of major complications (adjusted odds ratio 1.54, 95% confidence interval [CI] {1.16-2.04}). Laparotomy was performed in 13.7% (n = 1,725) of cases. Compared with non-Hispanic White race and ethnicity, the adjusted odd ratios for undergoing laparoscopy were 0.58 (95% CI 0.50-0.67) for Hispanic, 0.56 (95% CI 0.48-0.65) for non-Hispanic Black or African American, 0.33 (95% CI 0.27-0.40) for Asian, and 0.26 (95% CI 0.17-0.41) for Native Hawaiian or Pacific Islander race and ethnicity., Conclusion: Among women undergoing hysterectomy for postoperatively diagnosed adenomyosis, non-Hispanic Black or African American race and ethnicity were associated with an increased risk of major postoperative complications. Compared with non-Hispanic White race and ethnicity, Hispanic ethnicity, non-Hispanic Black or African American, Asian, Native Hawaiian, or Pacific Islander race and ethnicity were less likely to undergo minimally invasive surgery., Competing Interests: Declaration of Interests R.M. has nothing to disclose. C.M. has nothing to disclose. K.H. has nothing to disclose. Y.N. has nothing to disclose. M.B. has nothing to disclose. G.L. has nothing to disclose. M.D.T. has reported serving as a consultant for Ethicon, Medtronic, Heracure Medical, and Cooper Surgical; K.N.W. has reported serving as a consultant for Aqua Therapeutics, Hologic, Ethicon, and Karl Storz. M.T.S. has reported serving as a consultant for Applied Medical and Intuitive Surgical., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: We aimed to describe the incidence and identify risk factors for the occurrence of short-term major posto-perative complications following colorectal resection for endometriosis., Methods: A cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. We included patients with a primary diagnosis of endometriosis who underwent colon or rectal resections for endometriosis., Results: Of 755 women who underwent colorectal resection, 495 (65.6%) had laparoscopic surgery and 260 (34.4%) had open surgery. The major complication rate was 13.5% (n = 102). Women who underwent open surgery had a higher proportion of major complications (n = 53, 20.4% vs. n = 49, 9.9%, p < 0.001). In a multivariable regression analysis, Black race (aOR 95%CI 2.81 (1.60-4.92), p < 0.001), Hispanic ethnicity (aOR 95%CI 3.02 (1.42-6.43), p = 0.004), hypertension (aOR 95%CI 1.89 (1.08-3.30), p = 0.025), laparotomy (aOR 95%CI 1.64 (1.03-3.30), p = 0.025), concomitant enterotomy (aOR 95%CI 3.02 (1.26-7.21), p = 0.013), and hysterectomy (aOR 95%CI 2.59 (1.62-4.15), p < 0.001) were independently associated with major post-operative complications. In a subanalysis of laparoscopies only, Hispanic ethnicity, chronic hypertension, lysis of bowel adhesions, and hysterectomy were independently associated with major complications. In a subanalysis of laparotomies only, Black race and hysterectomy were independently positively associated with the occurrence of major complications., Conclusion: This study provides a current population-based estimate of short-term complications after surgery for colorectal endometriosis in the USA. The identified risk factors for complications can assist during preoperative shared decision-making and informed consent process., (© 2023. The Author(s).)

Study Objective: The purpose of this study is to review the trends in racial and gender representation among the various national obstetrics and gynecology societies' presidents over the past 15 years., Design: A retrospective cross-sectional study., Setting: Data obtained from publicly available information on official websites of the professional societies studied., Patients: Presidents of national societies in obstetrics and gynecology., Interventions: The study was performed by obtaining publicly available data for past presidents from the official websites of the professional societies studied. Gender and race were inferred based on name and image. Racial classification was selected using the United States Census classification system. Educational background, residency training, and practice type were also collected. Assessment of 15-year trends was completed using linear regression analysis and differences in representation was assessed using analysis of variance and post hoc analysis., Measurements and Main Results: Over 15 years, there were 134 presidents elected for the 10 obstetrics and gynecology societies. Of those leaders, 85.2% were white, 8.2% Asian, and 5.2% black; 59% were men and 41% were women. During the study period, there was a significantly increasing slope for representation of women (+2.3% per year; 95% confidence interval, 0.4-4.2; p = .016). The representation of nonwhite presidents (+1.5% per year; 95% confidence interval, 0.2-2.8; p = .028) increased significantly during the same time period., Conclusion: Over the last 15 years, less than 50% of obstetrics and gynecology national societies' presidents were women and most were of white race. However, there has been an increasing trend in the ratio of women to men and nonwhite to white representation among presidents of obstetrics and gynecology national societies., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: Surgery is an integral element of treatment for infertility caused by endometriosis. This review summarizes the purported mechanisms of infertility in endometriosis, as well as the impacts of surgery for endometriosis on fertility, including pregnancy achieved spontaneously and with assisted reproductive technology (ART)., Recent Findings: Endometriosis' effect on fertility is multifactorial. The sequela of increased inflammation resulting from endometriosis causes alterations in ovarian, tubal, and uterine function. Removing or destroying these lesions reduces inflammation. Surgical treatment of both early-stage endometriosis and deeply infiltrating endometriosis improves spontaneous pregnancy rates and ART pregnancy rates. Conventional or robotic laparoscopy is the preferred surgical approach., Summary: Endometriosis has detrimental effects on fertility, including negative impacts on oocyte, tubal, and endometrial function. Laparoscopic surgery for endometriosis elevates both spontaneous and ART pregnancy rates above those achieved with expectant management alone. The resection or destruction of endometriosis implants reduces inflammation, which likely improves the multifactorial infertility related to endometriosis. This topic is complex and controversial; more research in the form of high-quality randomized control trials is needed., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Anthelmintic resistance (AR) is an ever increasing problem for the sheep industry. Several studies worldwide have investigated reversing the trend of increasing AR and documented evidence for reversion toward susceptibility has been found. The hypothesis that resistance mutations compromise parasite fitness was drawn from this evidence. The aim of this study was to assess whether there were measurable differences in the fitness of Teladorsagia circumcincta isolates depending on their AR status. Four isolates were selected for the trial based on their known resistance status; D and M were multi-drug resistant, and T and W were susceptible to the benzimidazole, levamisole, and macrocyclic lactone anthelmintic classes. A secondary aim was to develop a series of in vitro bioassays for assessing fitness characteristics of parasites. The in vitro assays included; the cold stress test measured the number of third stage larvae (L3) developing from eggs stored at 4 °C for different lengths of time. Larval aging measured the locomotory activity of L3 after storage at 30 °C for different lengths of time. The exsheathment assay measured the exsheathment percentage of L3. Larval Length used length as a proxy for fecundity. The egg hatch assay evaluated egg hatch rate in water at room temperature. All isolates exhibited a decrease in the number of L3 recovered after storage of eggs at 4 °C (p < 0.001). Storage of L3 at 30 °C significantly influenced the ability of L3 to migrate through a 20 µm sieve (p < 0.001), however, there were no differences between isolates (p > 0.05). Exsheathment rate was higher for isolate D in comparison to isolates M and W, and for isolate T compared to isolate W. Isolate W was significantly longer than all other isolates (p < 0.05), whilst isolate M was significantly longer than isolate D (p < 0.05). No significant differences were found between isolates in egg hatch (p > 0.05). Overall, the results do not support differences in fitness associated with anthelmintic resistance status, even though differences were seen between the isolates for some assays. This suggests there is considerable variation in fitness parameters between isolates, making it difficult to determine whether resistance genotypes come with lower fitness., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The mainstay of treatment for cerebellar pilocytic astrocytomas in the pediatric population is surgery. The use of intraoperative magnetic resonance imaging (iMRI) as a surgical adjunct may lower the likelihood of reoperation. Studies have examined iMRI in heterogenous tumor populations, but few have looked at single pathologies., Objective: To compare iMRI vs non-iMRI for hemispheric cerebellar pilocystic astrocytomas, specifically looking at revision surgeries and residual disease in follow-up., Methods: Retrospective review of medical records for 60 sequential patients with cerebellar hemispheric pilocytic astrocytoma at a single institution was conducted. Thirty-two patients with cerebellar pilocytic astrocytoma underwent surgery without iMRI, whereas 28 patients underwent surgical resection with iMRI. All patients had at least 3-year follow-up., Results: There were no significant differences between the patient populations in age, tumor size, or need for cerebrospinal fluid diversion between groups. Operative time was shorter without iMRI (without iMRI 4.4 ± 1.3 hours, iMRI 6.1 ± 1.5, P = .0001). There was no significant difference in the patients who had repeat surgery within 30 days (9% without iMRI, 0% iMRI, P = .25), residual disease at 3 months (19% without iMRI, 14% iMRI, P = .78), or underwent a second resection beyond 30 days (9% without iMRI, 4% iMRI, P = .61). There were more total reoperations in the group without iMRI, although this did not reach significance (19% vs 4%, P = .11)., Conclusion: For hemispheric cerebellar pilocytic astrocytomas, iMRI tended to leave less residual and fewer reoperations; however, neither of these outcomes achieved statistical significance leaving utilization to be determined by the surgeon., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Objective: To examine the impact of nonmedical use of prescription drugs (NMUPD) during sexual activity on the frequency of condom use among a sample of college students. Participants: Students attending a large Midwestern University ( N  = 4284) during April 2015. Methods: Retrospective cross-sectional analysis of survey data using logistic regression. Results: Respondents and/or their sexual partners who engaged in NMUPD during sexual activity were significantly less likely to use condoms during 75% or more of past 12-month sexual encounters compared to respondents who had not engaged in lifetime and past 12-month NMUPD. Although not statistically significant, trends suggest that respondents who engaged in NMUPD during sexual activity may be less likely to use condoms than those who engaged in lifetime or past 12-month NMUPD but not during sexual activity. Conclusions: Findings suggest a need for specific strategies for reducing risk behaviors related to prescription drugs and sexual activity.

We introduce a theoretical framework of lesbian disclosure of sexual orientation in workplace contexts. Existing empirical research suggests (1) that disclosing one's sexual orientation results in positive, negative, and neutral workplace outcomes; and (2) that scholarship focused specifically on lesbian disclosure in workplace contexts is relatively limited. We extend this literature by introducing new theory that suggests that reactions to disclosure of lesbian identities will vary as a function of self-presentation. Specifically, we suggest that the extent of stereotypical gender expression (embodying stereotypically masculine vs. feminine traits or behaviors) will impact both the decision to disclose and the outcomes of disclosure in workplace contexts. We describe a conceptual model that includes intrapersonal, interpersonal, organizational, and societal considerations related to lesbian disclosure and present eight specific research propositions to advance this literature.

The description of diversity is a key imperative in current biological studies and has been revolutionised by the molecular era that allows easy access to microbial diversity not visible to the naked eye. Broadly targeted SSU rRNA gene amplicon studies of diverse environmental habitats continue to reveal new microbial eukaryotic diversity. However, some eukaryotic lineages, particularly parasites, have divergent SSU sequences, and are therefore undersampled or excluded by the methodologies used for SSU studies. One such group is the Microsporidia, which have particularly divergent SSU sequences and are rarely detected in even large-scale amplicon studies. This is a serious omission as microsporidia are diverse and important parasites of humans and other animals of socio-economic importance. Whilst estimates of other microbial diversity are expanding, our knowledge of true microsporidian diversity has remained largely static. In this work, we have combined high throughput sequencing, broad environmental sampling and microsporidian-specific primers to broaden our understanding of the evolutionary diversity of the Microsporidia. Mapping our new sequences onto a tree of known microsporidian diversity we uncover new diversity across all areas of the microsporidian tree and uncover clades dominated by novel sequences, with no close described relatives., (© 2018 The Authors. Environmental Microbiology published by Society for Applied Microbiology and JohnWiley & Sons Ltd.)

Background: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem., Objectives: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving., Methods: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in data analyses; significance was set at p < 0.05., Results: Seven hundred fifty-six high school teenage drivers completed surveys. Males (52%) and females (48%) were equally distributed; 32% of males reported that they were extremely safe drivers, whereas only 18% of females reported that they were extremely safe drivers (p < 0.001). Significantly more females (91%) compared to males (77%) reported always wearing their seatbelts (p < 0.001). Female drivers were more likely than male drivers to self-report that they always make their passengers wear a seat belt (76% vs. 63%, p < 0.001). A higher proportion of males reported using their cell phones while driving, compared to females (68% vs. 56%, p = 0.004), and 42% of males reported texting while driving, compared to 34% of females (p = 0.037)., Conclusion: Teenage male drivers perceive themselves to be safe drivers, but report engaging in more distracted driving and risky behaviors compared to females. These results suggest that there is an opportunity for gender-specific educational and injury prevention programs for teen drivers., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose/objectives: This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology., Primary Practice Setting: Inpatient acute care hospital., Findings/conclusions: A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for, Case Management: The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..

Context: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly., Objective: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR., Design: Quasi-experimental study with enrollment between January and December 2008., Setting: Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania., Participants: Mothers at least 18 years old who had given birth within the previous 24 hours., Intervention: The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD and practiced on a manikin. The control group included mothers with prior conventional CPR training., Main Outcome Measures: In both groups, knowledge and proficiency were assessed with written and practical examinations developed by certified CPR instructors. Participant surveys were conducted at 3 times: immediately before dissemination of course materials, within 24 hours after the mother agreed to participate in the study, and 6 months after initial evaluation., Results: A total of 126 mothers were enrolled in the study: 79 in the experimental group, 25 in the control group, and 22 who withdrew from the study. Written and practical examinations were used to determine proficiency, and composite scores were generated, with a maximum composite score of 12. The composite scores were statistically significantly higher in the experimental group than in the control group, with median scores of 10 and 7, respectively (P<.001). Twenty-two mothers (21%) had been previously offered CPR training. In the experimental group, 76 mothers (96%) felt more confident as caregivers after learning CPR. Before training in both groups, 84 mothers (81%) stated that learning CPR was extremely important, compared with 100 mothers (96%) after training (P=.001)., Conclusion: Use of an instructional kit is an effective method of teaching CPR to new mothers. Mothers reported that learning CPR is extremely important and that it increases their confidence as caregivers.

This study reports on an emerging fungal disease of the edible crab, Cancer pagurus. Juvenile (prerecruit) crabs were found to be subject to this disease condition during the months of May to September at two intertidal sites in South Wales, United Kingdom. Histopathology revealed that the fungi overwhelm the host response in the tissues, leading to progressive septicemia. The causative agent of this infection was isolated and grown in pure culture and was identified as a member of the Ophiocordyceps clade by sequencing of the small subunit of the fungal ribosomal DNA (rDNA). Of the crabs naturally infected with the fungus, 94% had a coinfection with the parasitic dinoflagellate Hematodinium species. To determine if there was any interaction between the two disease-causing agents, apparently fungus-free crabs, both with and without natural Hematodinium infections, were challenged with the fungal isolate. The presence of Hematodinium caused a significant reduction in fungal multiplication in the hemocoel of the crabs in comparison to that in Hematodinium-free individuals. Histopathology of coinfected crabs showed a systemic multiplication of Hematodinium within host tissues, leading to a rapid death, while Hematodinium-free crabs experimentally infected with the fungal isolate died due to fungal sepsis (septicemia) with the same characteristic pathology as seen in natural infections.

Marine reserves (or No-Take Zones) are implemented to protect species and habitats, with the aim of restoring a balanced ecosystem. Although the benefits of marine reserves are commonly monitored, there is a lack of insight into the potential detriments of such highly protected waters. High population densities attained within reserves may induce negative impacts such as unfavourable trophic cascades and disease outbreaks. Hence, we investigated the health of lobster populations in the UK's Marine Conservation Zone (MCZ) at Lundy Island. Comparisons were made between the fished, Refuge Zone (RZ) and the un-fished, No-Take Zone (NTZ; marine reserve). We show ostensibly positive effects such as increased lobster abundance and size within the NTZ; however, we also demonstrate apparent negative effects such as increased injury and shell disease. Our findings suggest that robust cost-benefit analyses of marine reserves could improve marine reserve efficacy and subsequent management strategies.

Encephaloceles are acquired or congenital defects in which intracranial contents protrude through a defect in the calvaria. The embryogenesis of these lesions is incompletely understood. The vast majority of lesions occur at or near the anatomical midline. The authors present an extremely rare case of a laterally oriented, pathologically proven encephalocele associated with a posterior fossa cyst and cerebellar migrational defect in an infant. The authors review past and current theories of encephalocele formation as it relates to this case.

Crustaceans worldwide are infected with alveolate parasites of the genus Hematodinium, causing substantial losses to langoustine and crab fisheries. The distinct seasonality in Hematodinium occurrence in their decapod hosts, as well as unsuccessful attempts at transmission, suggest the existence of life stages outside their benthic crustacean hosts. We used a nested polymerase chain reaction method to detect Hematodinium rDNA in the environment and in potential alternative hosts. Environmental samples from the Clyde Sea, Scotland, were screened during the April release of dinospores and during June and August, when infection prevalence is rare in benthic crustaceans. Hematodinium rDNA was amplified in 15% (14/94) of isolated langoustine larvae, and in 12% (13/111) of crab larvae. In addition, Hematodinium rDNA was present in mixed plankton samples devoid of decapod larvae, but including the 2 μm-10 mm fraction of particulate organic matter in the water column, containing phytoplankton and other zooplankton. These results indicate that Hematodinium occurs in the water column and is harboured by planktonic organisms, including larval stages of the crustacean hosts, when infections are at their lowest in adult hosts., (© 2011 The Author(s). Journal of Eukaryotic Microbiology © 2011 International Society of Protistologists.)

This is the first study comparing physiological responses of three decapod species to infection by parasites of the genus Hematodinium, which belongs to the dinoflagellate-like Syndinea. Responses varied profoundly between the crabs Carcinus maenas and Cancer pagurus (Brachyura), but also differed to those of hermit crabs, Pagurus bernhardus (Anomura). Osmoregulatory capacity was reduced significantly in Hematodinium-infected C. maenas, haemolymph pH increased in parasitised C. pagurus and P. bernhardus, and L-lactate concentration decreased in infected P. bernhardus. Changes to tissues and exoskeletons were observed in C. pagurus, but not in C. maenas and P. bernhardus., (Copyright 2010 Elsevier Inc. All rights reserved.)

In the absence of distinct morphological characteristics, knowledge of genetic relationships within and between protist parasite species is important for determining reservoir hosts and understanding the biology of the causative agents of emerging diseases. The genus Hematodinium is a member of Syndinea, an ubiquitous alveolate group found in all oceanic environments. Hematodinium parasites cause epizootics in crustaceans, yet their life cycle, genotypic variety and their phylogeny is poorly understood. By combining phylogenetic methods with analyses of secondary structures of variable ribosomal RNA genes we show that Hematodinium from the east and west North-Atlantic is comprised of distinct ribotypes or clades. These did not correspond to a specific area, but varied in host specificity. For example, a Hematodinium 'Langoustine' clade was only found in Nephrops norvegicus langoustines, whereas other clades were specific to crabs or seem to be generalist parasites., (Copyright (c) 2009 Elsevier GmbH. All rights reserved.)

Twelve patients, 32 to 60 years of age, received a polycrystalline ceramic form of pure dense hydroxylapatite as an alloplastic bone implant material in intrabony defects following reflection of full mucoperiosteal flaps, root planing and defect-curettement. The defects were measured from an acrylic stent, using an endodontic silver point which was placed to the base of the defect. Similarly, debrided and curetted defects in the same patients were not implanted and served as controls. Recalls for documentation and plaque control were at 1, 2, and 4 weeks, and at 3, 6 and 9 months. Measurements relating to changes in defect-depth were made upon reentry at 9 months. The twelve defects, serving as controls, showed very little difference between the pretherapy and 9-month measurements. The initial mean measurement from the base of the defect to the highest alveolar crest was 4.27 mm and the 9-month mean measurement after curettage only was 3.36 mm. In terms of resolution of the original defect this amounted to 19.49% reduction, but a 0.46-mm mean loss in height of the alveolar crest provided an actual percentage fill of the original defect of 9.91%. Of sixteen experimental defects, the same initial mean measurement from the base of the defect to the highest alveolar crest was 5.18 mm and the 9-month mean measurement after grafting was 2.43 mm. In terms of resolution of the original defect, this amounted to a 53.57% reduction, but in contradistinction to the curettage sites, a mean increase in height of the highest alveolar crest of 0.61 mm gave a true percentage fill of the original defect of 66.89%. At the 9-month reentry, the implanted mass seemed to be partially "calcified" and was resistant to penetration with a probe or removal with a curette. The data and clinical impression strongly suggest that hydroxylapatite has a potential as an alloplastic implant with clinically apparent acceptance by the soft and hard tissues.

The psychometric properties of four ataxia tests and their sensitivities to disorientation were examined to assess their potential for measuring balance disturbances frequently reported with simulator sickness. The study was conducted in two parts. In the first, subjects practiced for 10 sessions to examine learning effects and to stabilize performance. In the second, the sensitivities of the four tests were examined by comparing performance before and after exposure to sensory conflict produced using a disorientation training flight simulator. Subjective measures of disorientation, including reports of postural disequilibrium, were also collected. The results indicated initial learning on all four ataxia measures. Two of the tests, the Stand on One Leg Eyes Closed and the Sharpened Romberg, exhibited acceptable levels of reliability. However, only the latter showed sufficient sensitivity to corroborate subjective reports of postural disequilibrium.

A Sternberg-type varied set procedure was used in which the set of stimuli associated with the "different" response was, in some cases, large and unspecified. A 3-factor design was used with repeated measures on list length (1, 2, or 4 faces), decision ("same" or "different"), and number of critical features varied between memory and target faces (0, 2, 4, or 7). Reaction times of college students for recognition of faces were analyzed to determine the nature of the retrieval processes employed. Reaction times were faster as the number of feature changes increased, and both parallel and serial processes were indicated for both "same" and "different" responses.