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Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR’s potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.

Nonpuerperal uterine inversions are rare. Typically occurring in older women, they are most commonly due to transcervical mass expulsion. Diagnosis is often difficult because of vague symptomatology, presentation, and unknown course of the pathology. Surgical correction is often necessary in the presence of active bleeding or prolapse severity causing urinary retention. This case of nonpuerperal inversion presented to the emergency department with vaginal bleeding and mass protrusion. The examination was consistent with POPQ stage IV prolapse and uterine inversion secondary to cervical expulsion of multiple uterine fibroids. Because of full cervical dilation and concerns of ureteral injury with an extirpative procedure, vaginal myomectomy was performed with concomitant robotic uterosacral ligament hysteropexy. The operative procedure and postoperative course were uncomplicated, and discharge occurred on post-op day 1. She remained asymptomatic at the 6-month follow-up encounter. Though uterine preservation has been performed in cases of uterine inversion to maintain fertility, there are no reported cases of concomitant hysteropexy being completed for correction of POPQ stage IV prolapse simultaneously encountered. Additionally, the novel robotic approach has not been documented. This case illustrates the short-term success of robotic uterosacral hysteropexy as an additional option of care with potentially less morbidity when compared to hysterectomy for advanced stage uterine prolapse with nonpuerperal uterine inversion.

Background Women in mid-life experience unique stressors, including transitions within their family roles, informal caregiving, job stress, and perceived discrimination. The impact of these stressors on cardiovascular health in women during mid-life is of growing interest in both the popular and scientific literature. The objective of this review is to summarize the recent literature on stress and cardiovascular health in mid-life women. We focus on stressors that are relevant to mid-life women, including social stress and discrimination, and long-term risk of CVD events and subclinical CVD measures. Methods We systematically reviewed the literature published between January 2012 and April 2018 for studies examining stress in mid-life and either CVD endpoints or subclinical CVD outcomes. Eligible studies included at least one psychosocial stress exposure, a CVD or subclinical CVD outcome, and either included only female participants, reported sex-stratified analyses or tested for a sex*stress interaction. Results We identified 37 studies published since 2012 that met our criteria and included women between the ages of 40 and 65, including 3 case-control studies, 15 cross-sectional studies, and 19 prospective cohort studies. Because clinical CVD events typically occur after age 65 in women, only 22 studies were available that evaluated stress and hard CVD events in samples with mid-life women. Results from these studies suggested an increased and significant risk of CVD due to stress. Of the 15 studies that included subclinical CVD outcomes, the majority showed that mid-life women experiencing greater levels of stress had more subclinical CVD, as indicated by carotid intima-media thickness, flow-mediated dilation and arterial stiffness; however, several studies reported null associations. Conclusions General life stress, including perceived stress and life events, in mid-life was significantly related to later-life CVD risk and mid-life subclinical CVD in the majority of studies published in the past six years. Job stress was inconsistently related to CVD risk in women, and fewer studies examined characteristics of other social roles, such as marriage, motherhood or caregiving. Perceived discrimination also was associated with CVD events and subclinical CVD in some samples of mid-life women. Further investigation into specific stressors relevant to women in mid-life, including caregiving and marital stress, are needed to understand the full extent to which life stress impacts CVD risk in mid-life women.

The notoriously blunt businessman shares the ups and downs of his career and the lessons he's learned in business--with just a little profanity--in a new book, \"Am I Being Too Subtle?\" Worth an estimated $5 billion, Mr. Zell has also been involved in such industries as health care, energy and media. At age 12, he bought Playboy magazines for 50 cents at a newsstand in the city and sold them to friends in the suburbs at a steep markup. Mr. Zell lost his $315 million investment and is no longer involved in the company.) Tribune employees criticized him for cutting jobs while rewarding executives with bonuses, for saddling the company with debt and for blurring the line between advertising and editorial.