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Current Opinion in Obstetrics &... Dec 2020In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years... (Review)
Review
PURPOSE OF REVIEW
In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies.
RECENT FINDINGS
Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods.
SUMMARY
There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.
Topics: Contraception; Contraceptive Agents; Contraceptive Devices, Female; Female; Humans; Research; Sexually Transmitted Diseases
PubMed: 32969852
DOI: 10.1097/GCO.0000000000000666 -
Seminars in Perinatology Aug 2020In the context of medically complicated pregnancies, a "high risk patient" is an individual who is at increased risk for having a complicated pregnancy. These patients... (Review)
Review
In the context of medically complicated pregnancies, a "high risk patient" is an individual who is at increased risk for having a complicated pregnancy. These patients often experience limited contraceptive counseling and access, despite the fact that most effective contraceptive methods are associated with less risk than that of pregnancy. Free evidence-based resources are available to assist healthcare providers in discerning fact from myth about the risks of contraception. This review covers all available contraceptive methods, with particular focus on the benefits, risks, and attributes most relevant to high risk patients as well as the benefits and risks of initiating contraception post-pregnancy.
Topics: Condoms; Contraception; Contraceptive Agents; Contraceptive Devices, Female; Contraceptive Effectiveness; Contraceptives, Oral; Contraindications, Drug; Delayed-Action Preparations; Drug Implants; Female; Humans; Injections, Intramuscular; Injections, Subcutaneous; Intrauterine Devices; Long-Acting Reversible Contraception; Postpartum Period; Pregnancy; Pregnancy, High-Risk; Risk; Risk Assessment; Sterilization, Reproductive; Transdermal Patch
PubMed: 32624199
DOI: 10.1016/j.semperi.2020.151268 -
The Annals of Thoracic Surgery Sep 2022In appropriately selected patients diaphragm plication improves quality of life by alleviating dyspnea and allowing patients to return to their routine activities. Many...
In appropriately selected patients diaphragm plication improves quality of life by alleviating dyspnea and allowing patients to return to their routine activities. Many plication techniques exist, but the optimal surgical approach remains unclear. We report our experience with a minimally invasive radial diaphragm plication technique. It offers 2 distinct advantages: (1) suture placement avoids the phrenic nerve fibers, allowing for potential nerve recovery, and (2) the interrupted radial sutures improve the distribution of tension along the flaccid muscle and may achieve a more durable repair.
Topics: Diaphragm; Humans; Phrenic Nerve; Quality of Life; Respiratory Paralysis; Sutures
PubMed: 34951968
DOI: 10.1016/j.athoracsur.2021.11.037 -
Thoracic Surgery Clinics May 2024The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining...
The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining gastrointestinal function. A careful consideration of anatomy should be taken during surgical procedures to minimize injury to this crucial organ.
Topics: Humans; Diaphragm
PubMed: 38705658
DOI: 10.1016/j.thorsurg.2024.01.002 -
Obstetrics and Gynecology Dec 2022To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors. (Clinical Trial)
Clinical Trial
OBJECTIVE
To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors.
METHODS
The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) study was a U.S. cohort study using electronic health records from three integrated health care systems (Kaiser Permanente Northern California, Southern California, and Washington) and a health care information exchange (Regenstrief Institute). These analyses included individuals aged 50 years or younger with IUD insertions from 2001 to 2018. Intrauterine device expulsion cumulative incidence and incidence rates were estimated. Using Cox regression models, hazard ratios with 95% CIs were estimated before and after adjustment for risk factors of interest (age, race and ethnicity, parity, body mass index [BMI], heavy menstrual bleeding, and dysmenorrhea) and potential confounders.
RESULTS
In total, 228,834 individuals with IUD insertion and no delivery in the previous 52 weeks were identified (184,733 [80.7%] with levonorgestrel-releasing intrauterine system). Diagnosis of heavy menstrual bleeding-particularly a diagnosis in both recent and past periods-was the strongest risk factor for IUD expulsion. Categories with the highest risk of IUD expulsion within each risk factor included individuals diagnosed with overweight, obesity, and morbid obesity; those in younger age groups, especially among those aged 24 years or younger; and in those with parity of four or more. Non-Hispanic White individuals had the lowest incidence and risk, and after adjustment, Asian or Pacific Islander individuals had the highest risk. Dysmenorrhea was not independently associated with expulsion risk when adjusting for heavy menstrual bleeding.
CONCLUSION
Most risk factors for expulsion identified in this study appear consistent with known physiologic factors that affect uterine anatomy and physiology (age, BMI, heavy menstrual bleeding, parity). The increased risk of IUD expulsion among individuals of color warrants further investigation. Intrauterine devices are an effective long-term contraceptive; expulsion is uncommon, but patients should be counseled accordingly.
FUNDING SOURCE
Bayer AG.
CLINICAL TRIAL REGISTRATION
EU PAS register, EUPAS33461.
Topics: Female; Humans; Pregnancy; Cohort Studies; Demography; Dysmenorrhea; Intrauterine Device Expulsion; Intrauterine Devices; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Levonorgestrel; Menorrhagia; Risk Factors
PubMed: 36357958
DOI: 10.1097/AOG.0000000000005000 -
Journal of Thoracic Imaging Jul 2019The diaphragm is an inconspicuous fibromuscular septum, and disorders may result in respiratory impairment and morbidity and mortality when untreated. Radiologists need... (Review)
Review
The diaphragm is an inconspicuous fibromuscular septum, and disorders may result in respiratory impairment and morbidity and mortality when untreated. Radiologists need to accurately diagnose diaphragmatic disorders, understand the surgical approaches to diaphragmatic incisions/repairs, and recognize postoperative changes and complications. Diaphragmatic defects violate the boundary between the chest and abdomen, with the risk of herniation and strangulation of abdominal contents. In our surgical practice, patients with diaphragmatic hernias present acutely with incarceration and/or strangulation. Bochdalek hernias are commonly diagnosed in asymptomatic older adults on computed tomography; however, when viscera or a large amount of fat herniates into the chest, surgical intervention is strongly advocated. Morgagni hernias are rare in adults and typically manifest acutely with bowel obstruction. Patients with traumatic diaphragm injury may have an acute, latent, or delayed presentation, and radiologists should be vigilant in inspecting the diaphragm on the initial and all subsequent thoracoabdominal imaging studies. Almost all traumatic diaphragm injury are surgically repaired. Finally, with porous diaphragm syndrome, fluid, air, and tissue from the abdomen may communicate with the pleural space through diaphragmatic fenestrations and result in a catamenial pneumothorax or large pleural effusion. When the underlying disorder cannot be effectively treated, the goal of surgical intervention is to establish the diagnosis, incite pleural adhesions, and close diaphragmatic defects. Diaphragmatic plication may be helpful in patients with eventration or acquired injuries of the phrenic nerve, as it can stabilize the affected diaphragm. Phrenic nerve pacing may improve respiratory function in select patients with high cervical cord injury or central hypoventilation syndrome.
Topics: Diaphragm; Hernia, Diaphragmatic; Humans; Tomography, X-Ray Computed
PubMed: 31206456
DOI: 10.1097/RTI.0000000000000416 -
Respiratory Physiology & Neurobiology Apr 2023We hypothesized that activation of phrenic afferents induces diaphragm motor plasticity. In anesthetized and spontaneously breathing rats we delivered 40 Hz, low...
We hypothesized that activation of phrenic afferents induces diaphragm motor plasticity. In anesthetized and spontaneously breathing rats we delivered 40 Hz, low threshold (twitch and 1.5X twitch threshold), inspiratory-triggered stimulation to the left hemidiaphragm for 30 min to activate ipsilateral phrenic afferents. Diaphragm amplitude ipsilateral and contralateral to stimulation were increased for 60 min following both currents compared to time controls not receiving stimulation. Diaphragm stimulation was repeated in laminectomy controls or following a unilateral C3-C6 dorsal rhizotomy to eliminate phrenic afferent volleys. Laminectomy controls expressed neuromuscular plasticity post-stimulation. In contrast, ipsilateral and contralateral diaphragm amplitude following dorsal rhizotomy was lower than laminectomy controls and no different than time controls, suggesting diaphragm motor plasticity was not induced post-rhizotomy. Our results indicate that diaphragm stimulation induces a novel form of plasticity in the phrenic motor system which requires phrenic afferent activation. Respiratory motor plasticity elicited by diaphragm stimulation may have value as a therapeutic strategy to improve diaphragm output in neuromuscular conditions.
Topics: Rats; Animals; Diaphragm; Thorax; Respiration; Phrenic Nerve; Electric Stimulation
PubMed: 36642318
DOI: 10.1016/j.resp.2023.104014 -
Medicina (Kaunas, Lithuania) May 2023: Common problems in people with COVID-19 include decreased respiratory strength and function. We investigated the effects of (TMRT) and lower limb ergometer (LE)... (Randomized Controlled Trial)
Randomized Controlled Trial
: Common problems in people with COVID-19 include decreased respiratory strength and function. We investigated the effects of (TMRT) and lower limb ergometer (LE) training on diaphragm thickness and respiratory function in patients with a history of COVID-19. : In total, 30 patients were randomly divided into a TMRT training group and an LE training group. The TMRT group performed thoracic mobilization and respiratory muscle endurance training for 30 min three times a week for 8 weeks. The LE group performed lower limb ergometer training for 30 min three times a week for 8 weeks. The participants' diaphragm thickness was measured via rehabilitative ultrasound image (RUSI) and a respiratory function test was conducted using a MicroQuark spirometer. These parameters were measured before the intervention and 8 weeks after the intervention. : There was a significant difference ( < 0.05) between the results obtained before and after training in both groups. Right diaphragm thickness at rest, diaphragm thickness during contraction, and respiratory function were significantly more improved in the TMRT group than in the LE group ( < 0.05). : In this study, we confirmed the effects of TMRT training on diaphragm thickness and respiratory function in patients with a history of COVID-19.
Topics: Humans; Diaphragm; Respiratory Muscles; Endurance Training; COVID-19; Respiration; Muscle Strength
PubMed: 37241138
DOI: 10.3390/medicina59050906 -
Biomechanics and Modeling in... Apr 2022The lung vital function of providing oxygen to the body heavily relies on its mechanical behavior and the interaction with its complex environment. In particular, the...
The lung vital function of providing oxygen to the body heavily relies on its mechanical behavior and the interaction with its complex environment. In particular, the large compliance and the porosity of the pulmonary tissue are critical for lung inflation and air inhalation, and the diaphragm, the pleura, the rib cage and intercostal muscles all play a role in delivering and controlling the breathing driving forces. In this paper, we introduce a novel poromechanical model of the lungs. The constitutive law is derived within a general poromechanics theory via the formulation of lung-specific assumptions, leading to a hyperelastic potential reproducing the volume response of the pulmonary mixture to a change of pressure. Moreover, physiological boundary conditions are formulated to account for the interaction of the lungs with their surroundings, including a following pressure and bilateral frictionless contact. A strategy is established to estimate the unloaded configuration from a given loaded state, with a particular focus on ensuring a positive porosity. Finally, we illustrate through several realistic examples the relevance of our model and its potential clinical applications.
Topics: Diaphragm; Lung; Respiration
PubMed: 35072891
DOI: 10.1007/s10237-021-01547-0 -
Journal of Cardiothoracic and Vascular... Sep 2019Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and... (Review)
Review
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning. Although still in its infancy, modern ultrasound (US) provides a fascinating way to study the diaphragm, permitting the assessment of its excursion, thickness, and thickening. Furthermore, US enables the course of diaphragmatic function to be followed on a day-to-day basis, from intensive care admission to discharge, and it can help us understand the different causes of underlying disease: trauma, infection (eg, sepsis-induced diaphragm dysfunction), cancer, weaning problems (eg, ventilation-induced diaphragm dysfunction), etc. Today, the assessment of diaphragm dysfunction with US provides an important first step toward improving the detection of diaphragm dysfunction and as a protective and supportive strategy for its management. The purposes of this review are as follows: (1) to explore which US method is best for evaluating diaphragm function in the intensive care unit and how and when it should be used, and (2) to discuss which diseases may involve the diaphragm, and what therapies should be used.
Topics: Critical Care; Diaphragm; Humans; Ultrasonography, Interventional
PubMed: 30686657
DOI: 10.1053/j.jvca.2019.01.003