bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraarticular hip preservation procedures in healed Perthes disease: a systemic review and meta-analysis
Authors: Elnewishy Ahmed Awad , Mahran Mahmoud A. , El Abd Mostafa A. , Baraka Mostafa M.
Published: June 2022

Background:

There is limited data about surgical options in treatment of healed Perthes disease. The authors conducted this systematic review and meta-analysis to compare two newly described surgical techniques: femoral head reduction osteotomy (FHRO) and relative femoral neck lengthening (RFNL) in the management of healed Perthes disease in terms of efficacy and complications.

Methods:

This systematic review and meta-analysis examined controlled and noncontrolled studies that compared FHRO and RFNL. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between January 2000 and February 2021.

Results:

Fourteen studies that assessed RFLN and five studies that assessed FHRO were examined. The FHRO group demonstrated better improvement in the Harris Hip Score (HHS) than RFLN. The RFNL group showed better improvement than the FHRO group regarding flexion and internal rotation degree. The incidence of postoperative pain and postoperative stiffness was higher in the FHRO group than in the RFNL group. In the FHRO group, 28 patients with postoperative complications were reported (59.5%) versus 72 patients in the RFNL (16.4%).

Conclusion:

FHRO and RNFL are effective and safe modalities for post-Perthes sequelae. However, the postoperative clinical outcomes were observed to be in favor of RFNL, with less incidence of postoperative complication, compared to the FHRO. Moreover, the FHRO group needed more secondary acetabular procedures than the RFNL group. On the other hand, FHRO showed observed greater improvements in radiographic coverage indices.

Level of Evidence:

Level III.
Psychological interventions targeting patients with metastatic cancer and prolonged survival expectancies: advances and challenges
Authors: Righes Sadio , Lewis Florence , Waroquier Pauline , Delevallez France , Merckaert Isabelle
Published: June 2022

Purpose of review

The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies.

Recent findings

Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients’ adaptation by increasing their knowledge, developing patients’ stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer.

On the basis of this review, we proposed suggestions according to patients’ levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
Complications With Noninvasive Fat and Cellulite Reduction Devices: A Cross-sectional Analysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience Database
Authors: Wulkan Adam J. , Vazirnia Aria , Avram Mathew M.
Published: June 2022

BACKGROUND AND OBJECTIVE

The US FDA mandates that manufacturers and device operators disclose medical device reports (MDRs) to monitor suspected injuries and device malfunctions by submitting information to the Manufacturer and User Facility Device Experience (MAUDE) database. Given the rapid growth in the noninvasive fat and cellulite reduction market, it is essential that physicians be aware of associated adverse events.

STUDY DESIGN/MATERIALS AND METHODS

Using the MAUDE electronic database on the FDA website, the authors performed a comprehensive search of reported complications of noninvasive fat reduction and cellulite reduction devices from January 1, 2014 to January 1, 2020 at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm. Medical device reports that likely represented medical adverse events from device use were included.

RESULTS

The search yielded 165 MDRs, a majority submitted by patients. There were 68 MDRs reported on cryolipolysis (41.2%), 34 MDRs reported on 1,060-nm laser lipolysis (20.6%), 19 MDRs reported on high-intensity focused ultrasound (11.5%), 17 MDRs reported on vacuum-assisted subcision (10.3%), 10 MDRs reported on 1,440-nm laser-assisted subcision (6.1%), 8 MDRs reported on monopolar radiofrequency (4.8%), 6 MDRs reported on focused ultrasound (3.6%), and 4 MDRs reported for a combination infrared light, bipolar radiofrequency energy, massage, and gentle suction treatment (2.4%).

CONCLUSION

It can be safely presumed that most physicians do not regularly report adverse events to the FDA; however, the MAUDE database remains the largest global repository of adverse events reported for noninvasive body contouring devices, an area that has grown tremendously over the last few years. Some MDRs may be unrelated and/or unsubstantiated, and MDRs for any given device must be correlated to the total number of procedures performed. Nevertheless, the MAUDE database allows a glimpse into potential adverse events that can occur. The authors hope that physician awareness of this database and the adverse events it reports will help improve patient safety.
Recurrent Gingival Lesions in a Pediatric Patient
Authors: Yu Jenny L. , Kapur Raj P. , Susarla Srinivas M.
Published: June 2022

We present the case of a 13-year-old girl who developed numerous gingival masses that recurred after two prior resections. Following the initial resection as a child, she reported that there was a period of resolution for several years before recurrence as a teenager. After the second resection, the masses recurred after 4 months. The lesions obscured the majority of her dentition and interfered with speech, eating, and oral hygiene. The patient underwent staged resection of the masses, and the wounds were allowed to heal by secondary intention. The histopathologic findings of the specimens were consistent with a diagnosis of peripheral ossifying fibroma, which is unusual as these are generally solitary lesions. We believe that this case brings attention to an underrecognized and atypical presentation of peripheral ossifying fibroma, and it should be considered in the differential diagnosis of multicentric gingival masses.
Free Your Mind, Not Your Flap
Authors: Neusner Alexander D. , Pribaz Julian J. , Guo Lifei
Published: June 2022

The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.
When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia
Authors: Cain Abigail , Carter Kimberly , Salazar Christina , Young Amy
Published: June 2022

Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women’s health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.
11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial
Authors: Puar Troy H. , Khoo Chin Meng , Tan Colin Jingxian , Tong Aaron Kian Ti , Tan Michael Chien Sheng , Teo Ada Ee Der , Ng Keng Sin , Wong Kang Min , Reilhac Anthonin , O’Doherty Jim , Gomez-Sanchez Celso E. , Kek Peng Chin , Yee Szemen , Tan Alvin W.K. , Chuah Matthew Bingfeng , Lee Daphne Hui Min , Wang Kuo Weng , Zheng Charles Qishi , Shi Luming , Robins Edward George , Foo Roger Sik Yin
Published: June 2022

Objective:

Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.

Methods:

Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.

Results:

All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3–94.3] and AVS was 75% (95% CI: 50.9–91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7–94.8) and 100% (95% CI: 15.8–100), and AVS was 68.2% (95% CI: 45.1–86.1) and 100% (95% CI: 15.8–100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.

Conclusion:

In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.

Video Abstract:

http://links.lww.com/HJH/B918.
Blood pressure variability and structural brain changes: a systematic review
Authors: Gutteridge Daria S. , Tully Phillip J. , Ghezzi Erica S. , Jamadar Sharna , Smith Ashleigh E. , Commerford Toby , Keage Hannah A.D.
Published: June 2022

Background:

Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures.

Methods and results:

The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume.

Conclusion:

Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.
Associations of maternal periconceptional alcohol consumption with offspring prehypertension/hypertension at age 6 years: the Growing Up in Singapore Towards healthy Outcomes prospective mother-offspring cohort study
Authors: Sadananthan Suresh Anand , Michael Navin , Tint Mya Thway , Thirumurugan Kashthuri , Yuan Wen Lun , Ong Yi Ying , Law Evelyn , Choo Jonathan , Ling Lieng Hsi , Shek Lynette , Fabian Yap , Tan Kok Hian , Vickers Mark , Godfrey Keith M. , Gluckman Peter D. , Chong Yap Seng , Fortier Marielle , Lee Yung Seng , Eriksson Johan G. , Chan Shiao-Yng , Moritz Karen , Velan S. Sendhil , Wlodek Mary E.
Published: June 2022

Objective:

To evaluate the relationship of the levels of maternal alcohol consumption during the 1 year before pregnancy recognition with childhood cardiorenal, metabolic, and neurocognitive health.

Methods:

In 1106 women and their children from the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort, quantity of maternal alcohol consumption in the 12 months prior to pregnancy recognition was categorized as high (≥75th percentile: 1.9 g/day), low (<1.9 g/day), and none, and frequency of alcohol consumption was categorized as high (≥2–3 times/week), low (<2–3 times/week), and none. Offspring MRI-based abdominal fat depot, kidney, and brain volumes, blood pressure, metabolic syndrome score, and cognitive intelligence scores were assessed. Child prehypertension/hypertension at age 6 years was defined using a simplified pediatric threshold of 110/70 mmHg.

Results:

The average maternal alcohol consumption in the year prior to pregnancy recognition was 2.5 g/day, which is lower than the daily maximal limit of one standard drink (10 g) recommended for women by Singapore's Ministry of Health. After adjusting for participant characteristics, alcohol consumption at least 1.9 g/day was associated with over two-fold higher risk (risk ratio = 2.18, P = 0.013) of child prehypertension and 15% greater kidney growth between early infancy and age 6 years (P = 0.040) compared with abstinence. Alcohol consumption was not associated with metabolic and neurocognitive health at age 6–7 years. The associations with high frequency of alcohol consumption were concordant with those obtained for quantity of alcohol consumption.

Conclusion:

Maternal self-reported alcohol consumption at least 1.9 g/day prior to pregnancy recognition was associated with increased risk of child prehypertension and rapid kidney growth. Our findings highlight the potential detrimental effects of low periconceptional alcohol consumption, below national guidelines on offspring cardiorenal health.
New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking
Authors: Ekblad Mikael O. , Gissler Mika , Korhonen Päivi E.
Published: June 2022

Objective:

The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia.

Study design:

The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004–2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association.

Results:

In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67–0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P 
= 0.02).

Conclusion:

Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.
MACULAR HOLE HYDRODISSECTION TECHNIQUE WITH HUMAN AMNIOTIC MEMBRANE FOR REPAIR OF LARGE MACULAR HOLES
Authors: Felfeli Tina , Corrin Michael , Papanikolaou John , Mandelcorn Efrem D.
Published: June 2022

Purpose:

To describe a combined surgical technique using the macular hole hydrodissection (MHH) with human amniotic membrane for repair of large macular holes.

Methods:

A step-by-step procedure and a surgical video using the combined MHH and human amniotic membrane technique are presented.

Description and technique:

As the first step, the MHH separates the adhesions of the macular hole to the underlying retinal pigment epithelium with a soft-tipped cannula through proportional reflux followed by gentle passive aspiration. The human amniotic membrane graft is marked to identify the nonsticky epithelial side and ensure that the stromal layer (sticky and nonshinny) is facing downward toward the retinal pigment epithelium. The graft is then tucked into the space created with MHH between the macular hole edges and the retinal pigment epithelium with closed forceps to decrease the likelihood of the graft from dislocating postoperatively.

Conclusion:

The MHH in combination with the human amniotic membrane is a practical and effective technique for addressing challenging large macular holes.
Association Between CYP2D6 Metabolizer Status and Vortioxetine Exposure and Treatment Switching
Authors: Frederiksen Trine , Smith Robert L. , Jukic Marin M. , Molden Espen
Published: June 2022

Purpose

The antidepressant vortioxetine is mainly metabolized by the polymorphic enzyme CYP2D6. The aim of this study was to investigate the absolute serum concentrations of vortioxetine and frequency of switching to an alternative antidepressant in relation to CYP2D6 genotype in a naturalistic patient population.

Methods

The analyses included data from 640 CYP2D6-genotyped patients treated with vortioxetine from a Norwegian therapeutic drug monitoring database. Serum concentration of vortioxetine was determined using ultrahigh-performance liquid chromatography—high-resolution mass spectrometry, whereas longitudinal reviews of therapeutic drug monitoring profiles were performed to identify cases of patients switching from vortioxetine to an alternative antidepressant.

Results

Compared with CYP2D6 normal metabolizers (n = 342), the median vortioxetine serum concentration (ng/mL) was 2.1-fold (P < 0.001) increased in poor metabolizers (PMs) (n = 48), 1.5-fold (P < 0.001) increased in intermediate metabolizers (n = 238), and not significantly changed in ultrarapid metabolizers (n = 12). Compared with CYP2D6 normal metabolizers, treatment switch from vortioxetine to alternative antidepressants was 5.1-fold (95% confidence interval, 1.6–15.4, P = 0.003) more frequent among PMs. The prescribed doses did not differ significantly between the subgroups (P = 0.26). A possible explanation for the increased frequency of treatment switch among PMs is that concentration-dependent adverse events were more frequent in this group because of increased drug exposure.

Conclusions

This naturalistic study provides novel data on the association between CYP2D6 genotype and treatment switch of vortioxetine, which likely reflects the significant effect of CYP2D6 genotype on vortioxetine exposure.
Therapeutic Drug Monitoring of Paliperidone in Patients With Schizophrenia in Taiwan
Authors: Chiu Chih-Chiang , Lin Chun , Chen Wen-Yin , Chen Chia-Ru , Lin Shih-Ku
Published: June 2022

Background

The blood level of antipsychotics affects clinical responses to the drug; it can be influenced by race and several individual factors. This study analyzed the therapeutic plasma concentrations (Cps) of paliperidone for both oral and long-acting injectable (LAI) formulations in clinical samples from Taiwanese patients.

Methods

Patients diagnosed with schizophrenia and treated with either oral paliperidone for at least 4 weeks or LAI paliperidone for at least 6 months were enrolled. Blood samples were taken before the morning dose of oral paliperidone or the injection of LAI paliperidone to obtain the trough Cps.

Results

Among the patients in this study, 51 were taking oral paliperidone, and 26 were receiving LAI paliperidone. In the oral group, the mean Cps were 40.2 ± 19.8 ng/mL in patients taking 9 mg/d and 44.2 ± 15.9 ng/mL in those taking 12 mg/d. In the LAI group, the mean Cps were 32.9 ± 12.7 ng/mL in patients receiving 100 mg per 28 days and 49.9 ± 25.9 ng/mL in those receiving 150 mg per 28 days. The mean Cps per daily dose (Cps/DD) were 4.11 ± 1.99 ng/mL/mg in the oral group and 9.24 ± 3.78 ng/mL/mg in the LAI group.

Conclusions

Under the suggested DD for oral and LAI paliperidone treatment, most Taiwanese patients with schizophrenia can reach the suggested therapeutic Cps range. Wide interindividual differences were observed in the Cps/DD for both the oral (7-fold) and LAI paliperidone (4-fold) groups. Compared with Western reports, no difference was observed in the body weight–adjusted Cps/DD.
Crusted Keratotic Exophytic Nodule on the Lower Lip
Authors: Park Ariel , Serabyn Cynthia Lee
Published: June 2022

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of a slowly growing crusted keratotic exophytic nodule on the lower lip.
Contrasting Comprehension of HIV Research by Adolescents, Young Adults, and Caregivers in Western Kenya: A Cross-sectional Analysis
Authors: Dyer Jessica , Shah Seema K. , Agot Kawango , Wilson Kate , Bosire Risper , Badia Jacinta , Inwani Irene , Beima-Sofie Kristin , Richardson Barbra A. , John-Stewart Grace , Kohler Pamela
Published: June 2022

Adolescent participation in research is critical to inform interventions that improve outcomes for this group. Adolescents and young adults living with HIV often present to care without caregivers, yet caregiver permission is typically required for those younger than 18 years. We evaluated whether understanding of key consent information differed between adolescents (n = 1,393) and caregiver adults (n = 169). Compared with caregivers, adolescents aged 10–14 years showed significantly lower understanding, whereas understanding for older adults living with HIV did not differ significantly from caregivers. Risks were the least understood consent information for all age groups. Our findings suggest that for low-risk research, waiving caregiver permission requirements will not compromise the ethical need to ensure understanding of research before enrollment and may allow adolescents greater access to potential research benefits.
Lessons from effect of etelcalcetide on left ventricular hypertrophy in patients with end-stage kidney disease
Authors: Dörr Katharina , Kainz Alexander , Oberbauer Rainer
Published: June 2022

Purpose of review

Patients with end-stage kidney disease (ESKD) frequently develop left ventricular hypertrophy (LVH), which is associated with an exceptionally high risk of cardiovascular events and mortality. This review focuses on interventional studies that modify levels of fibroblast growth factor 23 (FGF23) and examine effects on myocardial hypertrophy, cardiovascular events and mortality.

Recent findings

Quantitative evaluations of trials of calcimimetics found no effects on cardiovascular events and cardiovascular and all-cause mortality when compared with placebo. However, a recent randomized, controlled trial of etelcalcetide versus alfacalcidol showed that etelcalcetide effectively inhibited the progression of LVH in comparison to vitamin D in patients on haemodialysis after 1 year of treatment. Prior to that, oral calcimimetic treatment has already been shown to reduce left ventricular mass in patients on haemodialysis, whereas treatment with active vitamin D or mineralocorticoids was ineffective in patients with ESKD.

Data from a recent trial of etelcalcetide on LVH suggest that FGF23 may be a possible therapeutic target for cardiac risk reduction in patients on haemodialysis. If these findings are confirmed by further research, it might be speculated that a treatment shift from active vitamin D towards FGF23-lowering therapy may occur in patients on haemodialysis.
Money Matters in Psychiatric Assessment, Case Formulation, Treatment Planning, and Ongoing Psychotherapy
Authors: Yager Joel , Kay Jerald
Published: June 2022

Trainees often receive little guidance concerning money matters in patients' lives and treatment, that is, clinical psycho-economics. Accordingly, this article considers: a) practical approaches to inquiring about intrapsychic and interpersonal influences of money matters pertinent to psychiatric assessment; b) how money matters should impact case formulation; c) how money matters realistically impact treatment planning; and d) money matters in ongoing psychotherapy affecting transference, countertransference, and clinical supervision. To supplement their clinical experiences, the authors conducted a limited narrative review via PubMed, followed by snowballing for articles of interest. Evidence suggests that money matters influencing intrapsychic and interpersonal lives commonly cause emotional distress, generating a range of dysfunctional behaviors. These reactions manifest as explicit conflicts, implicit issues, and unequivocal money-related pathologies. Clinical vignettes illustrate specific issues. By explicitly addressing money matters in patient's intrapsychic and interpersonal lives, trainees can enrich their assessments, case formulations, treatment planning, and ongoing psychotherapy.
Data Set for the Reporting of Carcinomas of the Vagina: Recommendations From the International Collaboration on Cancer Reporting (ICCR)
Authors: Wong Richard Wing-Cheuk , Webster Fleur , Bosse Tjalling , Focchi Gustavo , Gilks C. Blake , Hoang Lynn , Howitt Brooke E. , McAlpine Jessica , Ordi Jaume , Singh Naveena , Lax Sigurd F. , McCluggage W. Glenn
Published: June 2022

Primary carcinomas of the vagina are uncommon and currently detailed recommendations for the reporting of resection specimens of these neoplasms are not widely available. The International Collaboration on Cancer Reporting (ICCR) is developing standardized, evidence-based reporting data sets for multiple cancer sites. We describe the development of a cancer data set by the ICCR expert panel for the reporting of primary vaginal carcinomas and present the core and noncore data elements with explanatory commentaries. This data set has incorporated the updates in the 2020 World Health Organization Classification of Female Genital Tumours, 5th edition. The data set addresses controversial issues such as tumor grading, margin assessment, and the role of ancillary studies. The adoption of this data set into clinical practice will help ensure standardized data collection across different countries, facilitate future research on vaginal carcinomas, and ultimately lead to improvements in patient care.
A Novel Intervention: Stand Up Paddle Boarding Aquatic Therapy (SUPAT) for Pediatric Patients With Cerebral Palsy: 2 Case Studies
Authors: Walz Alyssa D. , Doran Stephen , Potter Priscilla , Chen Yuping
Published: June 2022

Background and Purpose:

Cerebral palsy (CP) is a nonprogressive neurological condition that typically causes motor dysfunction. Children with CP often have decreased endurance, balance, and strength. This leads to decreased physical activity and difficulty performing sports with their age-related peers. The purpose of these case studies was to determine whether stand up paddle boarding aquatic therapy (SUPAT) improves gross motor function and decreases the number of falls experienced by 2 children with spastic CP.

Case Description:

Participants included 2 adolescent girls diagnosed with spastic CP categorized as Gross Motor Function Classification System (GMFCS) level II.

Intervention:

Over 10 weeks, the patients attended seven 1-hour SUPAT sessions. The sessions included a 10-minute warm-up and a variety of paddle boarding skills. Both participants completed Gross Motor Function Measure-88 (GMFM-88) and reported the average number of falls before and after the SUPAT intervention. During each session, a trial run (the total duration a child could maintain balance on the paddle board) was also measured.

Outcomes:

Participant 1 increased GMFM-88 scores from 92.5% to 95.5% and trial run duration from 1 minute 24 seconds to 6 minutes 14 seconds. Participant 2 increased GMFM-88 scores from 91.6% to 92.9% and trial run duration from 1 minute 12 seconds to 3 minutes 7 seconds. Both participants reported a reduction in the number of falls.

Discussion:

These case studies indicated the SUPAT program was beneficial for pediatric patients with CP. Following the SUPAT intervention, both participants improved scores on the GMFM-88 and increased their ability to maintain balance on the board (trial run). These findings support the notion that the SUPAT program is beneficial for increasing gross motor function, improving balance, and decreasing the number of falls. SUPAT could be a viable alternative therapeutic intervention to traditional aquatic therapy and an opportunity to participate in an outdoor sport.
Addressing Racism's Role in the US HIV Epidemic: Qualitative Findings From Three Ending the HIV Epidemic Prevention Projects
Authors: Harrison Sayward E. , Muessig Kathryn , Poteat Tonia , Koester Kimberly , Vecchio Alyssa , Paton Mariajosé , Miller Sarah J. , Pereira Nastacia , Harris Orlando , Myers Janet , Campbell Chadwick , Hightow-Weidman Lisa
Published: June 2022

Background:

Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions.

Methods:

Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals—including Black individuals—about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects.

Results:

Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given—yet these primarily focused on the individual level (eg, enhanced training, outreach).

Conclusions:

EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia
Authors: Wood Sarah M. , Meanley Steven , Bonett Stephen , Torres Mary E. , Watson Dovie L. , Williams Javontae L. , Brady Kathleen A. , Bauermeister José A.
Published: June 2022

Background:

Strengthening HIV prevention services is a key priority of the Ending the HIV Epidemic plan. Informed by the Consolidated Framework for Implementation Research, we examined HIV testers' perceived barriers and facilitators to implementing HIV prevention services, including testers' strengths and weaknesses; enabling factors within the inner and outer settings; and willingness to adopt potential implementation strategies.

Methods:

In 2019, the Penn Center for AIDS Research (CFAR) partnered with the Philadelphia Department of Public Health (PDPH) to examine system-level challenges and opportunities experienced by PDPH-funded HIV testers (individuals conducting HIV testing) in Philadelphia. We recruited HIV testers to complete 2 web surveys (n ≈ 40 each) and in-depth interviews (n = 11).

Results:

Testers self-reported high HIV testing self-efficacy and competence, despite identifying gaps in their knowledge of STI testing, reporting moderate willingness to recommend pre-exposure prophylaxis, and having insufficient cultural competency when working with priority populations. Testers indicated that educational materials and policies within their agencies might require realignment to affirm sexual and gender minority clients. In qualitative interviews, testers noted challenges to implementing PDPH priorities because limited funding fueled competition between local agencies, deterred interagency partnerships, and limited their ability to serve key populations locally.

Discussion:

HIV testers are critical partners in addressing agency-level barriers to HIV prevention service provision through multilevel implementation strategies. In partnership with PDPH, we will create and implement a train-the-trainers program consisting of skill-building activities, technical assistance, and capacity-building for all agency personnel to address missed opportunities in HIV prevention. These activities will reinforce scalability and sustainability of PDPH-supported HIV prevention programs.
Using Implementation Mapping to Ensure the Success of PrEP Optimization Through Enhanced Continuum Tracking (PrOTECT) AL-A Structural Intervention to Track the Statewide PrEP Care Continuum in Alabama
Authors: Creger Thomas , Burgan Kaylee , Turner Wesli H. , Tarrant Ashley , Parmar Jitesh , Rana Aadia , Mugavero Michael , Elopre Latesha
Published: June 2022

Introduction:

Ending the HIV Epidemic initiatives provide a unique opportunity to use implementation scientific methods to guide implementation of evidence-based practices and evaluate their effectiveness in real-word settings to improve HIV inequities. This report demonstrates our use of Implementation Mapping (IM) to engage participating county health departments, AIDS services organizations, and community-based organizations in the development of a data dashboard to track the PrEP care continuum for the state of Alabama, an Ending the HIV Epidemic hotspot.

Methods:

Our project is guided by an overarching Implementation Research Logic Model and by the tenets of IM, a 5-step approach to support researchers and community partners in the systematic selection, development, and/or tailoring of implementation strategies to increase program adoption, implementation, and sustainability.

Results:

Step 1, the needs assessment, established baseline data elements for a PrEP care continuum for participating community-based organizations, AIDS services organizations, and the state health department as well as investigated their desire for data visualization and willingness to share data to inform initiatives to improve PrEP access. Step 2 identified adaptability, relative advantage, and complexity as determinants of intervention adoption. Based on findings from steps 1 and 2, the investigators and community partners determined to move forward with development of a data dashboard. Step 3 identified the following implementation strategies to support a dashboard, including development of educational materials, synchronous and asynchronous training, technical assistance, and improved record systems.

Discussion:

Using IM supports community-engaged researchers in designing strategies to end the epidemic that are context-specific and more impactful in real-word settings.
Stakeholder Perspectives on MAPS
Authors: Sanchez Amanda L. , Hoskins Katelin , Pettit Amy R. , Momplaisir Florence , Gross Robert , Brady Kathleen A. , Hoffacker Carlin , Zentgraf Kelly , Beidas Rinad S.
Published: June 2022

Background:

Managed problem solving (MAPS) is an evidence-based intervention that can boost HIV medication adherence and increase viral suppression, but it is not widely used in community clinics. Deploying community health workers to deliver MAPS could facilitate broader implementation, in support of the Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections in the US by 90% by 2030.

Setting:

Ryan White-funded clinics in Philadelphia, 1 of 48 US counties prioritized in the EHE.

Methods:

Semistructured stakeholder interviews were conducted with 13 clinics and 4 stakeholder groups: prescribing clinicians, nonprescribing clinical team members (eg, medical case managers), clinic administrators, and policymakers. Interviews were based on the Consolidated Framework for Implementation Research and investigated perceived barriers to and facilitators of MAPS delivery by community health workers. Rapid qualitative analytic techniques were used to synthesize interview data and identify key categories along an implementation pathway. Core determinants (ie, barriers and facilitators) of MAPS implementation were grouped within each category.

Results:

Stakeholders were receptive to CHW-delivered MAPS and offered critical information on potential implementation determinants including preferences for identification and referral of patients, and the importance of integration and communication within the care team.

Conclusions:

This study elucidates insights regarding barriers and facilitators to delivering an evidence-based behavioral intervention in clinics serving people with HIV (PWH) and extends a rapid qualitative approach to HIV care that rigorously incorporates stakeholder data into the development of implementation strategies. It also offers insights for national implementation efforts associated with EHE.
Exergames to Improve Rehabilitation for Shoulder Injury: Systematic Review and GRADE Evidence Synthesis
Authors: Fernandes Carla Sílvia , Magalhães Bruno , Gomes José Augusto , Santos Célia
Published: June 2022

Introduction

The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care.

Methods

We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included.

Results

The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders’ range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury.

Conclusions

The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants’ degree of satisfaction, motivation, and adherence.
Three-Dimensional Z-Epicanthoplasty Retains the Depth of the Medial Canthus With Scars That Are Less Visible
Authors: Su Zhiguo , Liu Liqiang , Fan Jincai , Tian Jia , Gan Cheng , Jiao Hu , Yang Zengjie , Zhang Tiran , Chen Yihua
Published: June 2022

Background

Traditional coronal Z-epicanthoplasty usually generates visible scars, and V-Y advancement or skin redraping can damage the normal shape of the lower eyelid. In addition, these methods usually lead to loss of the medial canthus depth, which is important for the natural appearance of East Asians. This report aims to describe a 3-dimensional Z-epicanthoplasty that can maintain the depth of the medial canthus with fewer visible scars.

Methods

Patients who underwent 3-dimensional Z-epicanthoplasty from January 2016 to December 2019 were included. In our method, excess skin in the horizontal direction was first rotated to the vertical position and then turned inward from a coronal to a sagittal orientation to supplement the skin deficiency of the medial canthus in the sagittal orientation. The skin flap turned in the sagittal orientation and maintained the depth of the medial canthus and the natural appearance of the eye.

Results

In total, 138 patients were included, and the follow-up interval ranged from 6 to 36 months. After the surgery, the epicanthi were removed, and the shapes of the patients' eyes were significantly improved and appeared natural. The surgical scars were hidden in the sagittal orientation rather than in the coronal orientation, which cannot be seen easily. The depth of the medial canthus was well preserved without any lower eyelid destruction. Patients were satisfied with the natural appearance of the medial canthus.

Conclusions

This method could not only correct the epicanthal fold effectively with scars that are less visible but also maintain the depth of the medial canthus and make the appearance of the eye look more natural.
Effects of Preconditioning With Transcutaneous Electrical Nerve Stimulation Monitored by Infrared Thermography on the Survival of Pedicled Perforator Flaps in a Rat Model
Authors: Zheng Yinhua , Chang Kun , Gong Xu
Published: June 2022

Objective

Pedicled perforator partial or complete necrosis with a rate of 13.7%. This study was undertaken to test whether preconditioning with transcutaneous electrical nerve stimulation (TENS) monitored by infrared thermography protect against partial necrosis by converting the choke anastomoses to the true anastomoses via inducing heme oxygenase-1 (HO-1) in a rat pedicled perforator flap model.

Methods

Seventy-two Sprague-Dawley rats were randomly assigned to the control, the TENS, the TENS + SnPP (tin protoporphyrin; HO-1 activity inhibitor; 50 μmol/kg) and the TENS +0.9% saline groups. On the unilateral dorsum of the rats, a rectangular flap donor site of 11 × 3 cm was marked out, which contained three perforator angiosomes and two choke zones. On days 1, 3 and 4, 1 hour of TENS (biphasic pulses, 25 mA, 80 Hz, 200 μs) was applied to the flap donor sites, respectively. On day 5, after the flap donor sites were assessed by infrared thermography, the flaps were harvested based on the deep circumflex iliac artery perforator.

Results

Infrared thermography showed that the choke zones in the flap donor sites presented white in the TENS and the TENS +0.9% saline groups, whereas they presented red in the control and the TENS + SnPP groups. Postmortem arteriography showed that the number of arterioles across each choke zone significantly increased in the TENS and the TENS +0.9% saline groups compared with the control and the TENS + SnPP groups. Immunohistochemistry and western blot showed a significant increase in HO-1 in the choke zones after TENS preconditioning. The necrotic area percentage of the flaps was significantly decreased in the TENS (4.3% ± 2.6%) and the TENS +0.9% saline groups (4.5% ± 2.3%) compared with the control (24.8% ± 5.0%) (P < 0.001); there was no significant difference between the TENS and the TENS + SnPP (24.4% ± 7.3%) groups.

Conclusions

These data show that TENS preconditioning monitored by infrared thermography might be a promising strategy to prevent pedicled perforator flaps from partial necrosis.