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Fellow Journeyers Walt Whitman and Jesse Talbot: Painting, Poetry, and Puffery in 1850s New York
Get PDFHow about Some Muscle?: C. H. McCloy and Strength Training Research at the University of Iowa, 1940-1959
Get PDFAge of Fear: Othering and American Identity during World War I
Get PDFReview of: Age of Fear: Othering and American Identity during World WarI, by Zachary Smith
Remembrance of Things Present: The Invention of the Time Capsule
Get PDFReview of: Remembrance of Things Present: The Invention of the Time Capsule, by Nick Yablon
Civil War Monuments and the Militarization of America
No full textReview of: Civil War Monuments and the Militarization of America, by Thomas J. Brown
Efficacy and safety of misoprostol for intrauterine device insertion in women with no previous vaginal delivery: a systematic review and meta-analysis of randomized controlled trials
Get PDFIntroduction: The efficacy of misoprostol use for cervical priming before intrauterine device insertion (IUD) is controversial. This review aims to evaluate the evidence from published randomized controlled trials about the efficacy and safety of misoprostol before IUD insertion for pain relief in women with no previous vaginal delivery.
Materials and methods: We searched the following electronic databases: Web of Science, Cochrane CENTRAL, SCOPUS, and PubMed for relevant studies using the following Mesh terms: (misoprostol) AND (intrauterine device OR IUD). The primary outcome was the mean pain score during insertion. Secondary outcomes included the ease of insertion score, the rate of successful IUD insertion, the rate of IUD insertion failure, and the adverse effects.
Results: Ten randomized controlled trials (RCTs) (misoprostol: n=698 and placebo: n=689) were pooled in the analysis. The overall Standardized Mean Difference (SMD) of pain score did not favor either of the two groups (SMD= -0.09, 95%CI [-0.50, 0.33], p=0.007). Pooled results were highly heterogeneous (I2=93%, P\u3c0.001). The total MD of the ease of insertion score favored the misoprostol group (MD= -1.36, 95% CI [-2.20, -0.52], p =0.002). The overall risk ratio (RR) of the number of failed insertions showed that misoprostol is associated with less IUD insertion failures compared to placebo (RR=0.55, 95% CI [0.38, 0.81], p=0.002). Finally, the overall risk showed that misoprostol is associated with more shivering, diarrhea and pelvic pain.
Conclusions: Misoprostol facilitates IUD insertion in women with no previous vaginal delivery, and is associated with 50% less chance for IUD insertion failure despite inducing mild adverse effect
Programmed Death Ligand-1 (PD-L1) expression is up-regulated and related to the pattern of invasion in FIGO Stage I vulvar squamous cell carcinomas
Get PDFThe immune checkpoint protein programmed death ligand-1 (PD-L1) is expressed in different types of cancer and is a potential prognostic factor as well as therapeutic target.
This study evaluated PD-L1 expression in the neoplastic progression of vulvar epithelia with respect to the pattern of infiltration in FIGO stages I keratinizing squamous cell carcinomas (SCC). Normal squamous vulvar epithelia (n=20), usual type vulvar intraepithelial neoplasia (uVIN, n=23), differentiated VIN (dVIN, n=21) and FIGO stage I SCC (n=35) were immunostained for PD-L1. In SCC a cohesive growth with well-delineated borders was considered as pushing, dissociative growth in small groups or single cells was defined as diffuse pattern of infiltration. Immunostaining was done with a monoclonal anti PD-L1 antibody (clone SP263, Ventana) and scored to determine up-regulation and overexpression (score 0/1+, 0-5% immunoreactive cells; score 2+, \u3e5 to 50% immunoreactive cells; score 3+, \u3e50% immunoreactive cells). PD-L1 immunoexpression was comparable in normal epithelia and VINs (score 0/1+, n=59; score 2+, n=5, in VINs only; score 3+, n=0), was significantly increased (P\u3c0.0001) in SCC (score 0/1+, n=13; score 2+, n=16; score 3+, n=6), and was related to a diffuse pattern of infiltration (P\u3c0.0001). Staining was accentuated at the invasive margins of SCC frequently. PD-L1 expression is up-regulated in the neoplastic cells of vulvar low stage SCC, related to the development of an invasive phenotype reflecting the initiation of cancer immunoediting, and to an aggressive diffuse type of stromal invasion
Planned use of long acting reversible postpartum contraception in low-risk women in CenteringPregnancy® group versus individual physician prenatal care
Get PDFIntroduction: Education on effective contraceptive methods is necessary during the prenatal period to help women achieve optimal birth spacing. This study identified rates of long-acting reversible contraception (LARC) uptake in women who attended CenteringPregnancy® (CP) group prenatal care versus individual physician care (IP).
Methods: Charts for low-risk women who participated in group CP or IP prenatal care between March 2012 and May 2016 were reviewed. Charts of IP subjects were randomly selected in each year to achieve a CP:IP ratio of at least 1:3. The primary outcome was rate of LARC use at discharge and within 8 weeks postpartum. Pearson chi-squared test and Wilcoxon rank-sum tests were performed, and a p-value \u3c0.05 was considered significant.
Results: 129 women participated in CP care and 412 in IP care. CP women were more likely nulliparous (91, or 70.5% vs 212, or 51.5%, p=0.0001) and more likely to attend at least 15 prenatal visits (54, or 41.9% vs 62, or 15.1%, p\u3c0.0001). LARC use rates at discharge and at the postpartum visit were similar (36, or 27.9% vs 89, or 21.6%, p=0.142; 39, or 32.2% vs 110, or 29.4%, p=0.557). Rates of women using effective contraception (LARC and other hormonal options, including oral contraceptives and Depo Provera) at discharge and at the postpartum visit were similar (59, or 45.7% vs 206, or 50.0%, p=0.177; 72, or 59.5% vs 229, or 61.2%, p=0.157). IUD use was greater than subdermal implant use in both groups (31, or 24.0% vs 5, or 3.9%; 72, or 17.5% vs 17, or 4.1%; p=0.081). Rates of routine postpartum visit attendance at 6-8 weeks postpartum were similar and high in both groups (121, or 93.8% vs 374, or 90.8%; adjusted p-value=0.164).
Conclusion: Although CP subjects had more prenatal visits and spent more time with providers, there was no difference on uptake of LARC or effective contraception at discharge or at the postpartum visit when compared to IP subjects
