although transcatheter aortic valvuloplasty is effective for relief of congenital AS, there are steady long-term hazards for surgical aortic valve reintervention and replacement that are independent of age at initial intervention or AS severity.

Stress urinary incontinence (SUI) is a common medical problem affecting 25% to 50% of women in the United States. This article reviews the literature on the current systems- and population-based costs of management of SUI in women. A PubMed search was conducted to seek studies examining the cost of various management options. Both nonsurgical and surgical management can effectively improve symptoms of SUI at a wide spectrum of costs. Over $12 billion are spent annually, an amount that continues to grow. Patients pay out-of-pocket for 70% of conservative management, amounting to a significant individual financial burden. Systems-based cost of SUI management continues to rise with the aging population. Costs to both individuals and systems may be mitigated if more patients are treated with intent to cure and as surgical management transitions from inpatient to outpatient procedures.

Background-Access to beneficial novel healthcare technology has been inequitable in the United States. Fetal echocardiography, used with increasing frequency for prenatal diagnosis (PD) of congenital heart disease, allows for optimal neonatal management and possible improved outcomes. We sought to evaluate whether PD of critical congenital heart disease is related to socioeconomic (SE) position, medical insurance, and race.

SUD is extremely rare after BAVP for congenital AS. No beneficial effect of the recommendation for exercise restriction was observed in this longitudinal cohort with 6,000 patient-years of follow-up.

Background-Transcatheter balloon aortic valvuloplasty for critical aortic stenosis in neonates is routinely performed without recognized complication. Aortic wall injury has rarely been observed after balloon aortic valvuloplasty, although the incidence of this complication is unstudied. We reviewed single-center data to determine the incidence of aortic injury during balloon aortic valvuloplasty and to identify risk factors. Methods and Results-This retrospective study included all patients Ͻ2 months of age who underwent balloon aortic valvuloplasty at our institution from 1985 to 2007. We defined aortic wall injury as an intimal flap, dissection, or vessel rupture as diagnosed by angiography, echocardiography, or direct surgical or postmortem inspection. Primary imaging data were reviewed, as were all procedural and pathology reports, to identify cases of aortic wall injury. Patient and procedural variables were analyzed. Of 187 procedures performed, 28 procedures resulted in aortic wall injury (15%). Injury was recognized at the time of the procedure in only 16 cases (57%). Intimal flaps occurred most commonly in the distal ascending aorta (nϭ13), most often involving the greater curvature. In multivariate analysis, severe ventricular dysfunction at the time of the procedure (odds ratio, 2.8; Pϭ0.02), greater number of balloon dilation attempts per procedure (odds ratio, 1.5; Pϭ0.005), and novice interventional staff (odds ratio, 2.5; Pϭ0.05) were associated with aortic injury. Incidence of injury was not different in the recent era compared with earlier experience. Conclusions-Aortic

Objectives To compare short-term outcomes between prolapse repairs with and without mesh using a national dataset. Mesh use in surgical treatment of pelvic organ prolapse (POP) has gained wide popularity. However, mesh complications have increased concomitantly with its use. Methods Public Use File data were obtained for a 5% random national sample of female Medicare beneficiaries age 65 and over. Women who underwent prolapse surgery were identified by CPT-4 codes. Since the code for mesh placement was effected in 2005, we separated patients into three cohorts: those who underwent prolapse repairs from 1999–2000 (presumably without mesh), those who underwent repairs in 2007–2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) in 2007–2008. One-year outcomes were identified using ICD-9 diagnosis and procedure codes and CPT-4 procedure codes. Results 9,180 prolapse repairs without mesh were performed in 1999–2000, 7,729 without mesh in 2007–2008, and 1,804 prolapse repairs with mesh were performed in 2007–2008. Prolapse re-operation within one year of surgery was higher in non-mesh vs. mesh cohorts (6–7% vs. 4%, p < 0.02). Mesh removal rates were higher in mesh vs. non-mesh group (4% vs. 0–1%, p < 0.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling. Conclusions Mesh to treat POP and stress urinary incontinence (SUI) was associated with a small decrease in early re-operation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.

Wildlife detection dog (WDD) programs are increasingly being developed to combat illegal wildlife trafficking. However, there is little scientific research available on how sniffer dogs perform when wildlife parts are hidden during the smuggling process, which hampers the effectiveness of WDD programs. Here, we investigate the ability of WDDs to detect wildlife parts that are hidden in legally traded goods. We employed a smell test using the two most smuggled wildlife parts worldwide: elephant ivory and pangolin scales, in combination with two obfuscation items of plant and animal origin commonly employed by smugglers. We then established the sensitivity of the dogs to the target substances. Our results showed that there was a large variation between the two dogs in their sensitivity to ivory and pangolin scales. However, both dogs were generally less sensitive to ivory compared to pangolin scales, and stronger‐smelling obfuscation items could potentially lower the sensitivity of the dogs to the wildlife parts. Our study highlights the potential of dogs to detect hidden wildlife parts, but their effectiveness may depend on other aspects such as training, personality, the health of the dog, the type of wildlife substance, and the obfuscation item used. Given the variability of our findings, WDD programs need to invest in research to optimize the number and type of dogs with the right balance of traits to successfully detect wildlife parts that could potentially be obfuscated during smuggling.

No abstract